Campbell’s sign
= tracheal descent with inspiration; due to chronic airflow obstruction
-seen with COPD but not specific to it
Oliver’s sign
for trachea
= systolic tug seen with aortic aneurysm; synchronous with each heart beat
Tietze’s syndrome
=costochondritis = inflammation of costal cartilages
Clubbing
-loss of Lovibond’s angle
-Schamroth’s sign (put fingers together, see if diamond disappears)
-floating nails, ballotability of nail bed
-abnormal phalangeal depth ratio
Causes:
-underlying respiratory disorder (SHUNT)
-GI conditions (cirrhosis, IBD, cancer)
-heart conditions
-hormone imbalance: cirrhosis, pregnancy
*not a feature of emphysema
Hypertrophic osteoarthropathy
- assoc. with clubbing
- systemic disorder of bones, joints, and soft tissues, most commonly assoc. with intrathoracic neoplasm
- **painful and tender periosteal new bone proliferation, often but not always assoc. w/clubbing
- periostosis is prominent in diaphysis of long bones
- dx with bone radiography or scintigraphy
Dahl’s sign
elbows and knees are discolored/chafed from leaning over in tripod position
-COPD sign
Hoover’s sign
= flattened diaphragm so both costal margins are drawn towards midline, more acute subcostal angle
sign of COPD
Causes of generalized lymphadenopathy
- disseminated malignancy
- collagen vascular disease (sarcoidosis)
- infectious process (mono, syphilis, CMV, toxo, RF, AIDS, TB, plague)
- rxn to drugs
Delphian nodes
prelaryngeal, small, midline nodes on thyrohyoid membrane, indicate thyroid disease
Left supraclavicular node
= intraabdominal or intrapelvic tumors
-called a sentinel node or Trosier’s node, signaling deep-sited carcinoma
OR
-Virchow’s node, signaling mets from a gastric carcinoma
Sister Mary Joseph’s nodule
periumbilical nodule or hard mass, reflects ovary or stomach malignancy
Raynaud’s Phenomenon
Precedes: -CT diseases -blood disorders -disorders characterized by arterial compression (thoracic outlet, carpal tunnel) -vasculitis and atherosclerosis -drugs and toxins -misc white blue red
Allen’s test
to assess the patency of the radial and ulnar arteries and the patency of the deep palmar arch
-if refill time >15 sec, do NOT cannulate the artery
Buerger’s Test
-use to assess arterial perfusion to legs/PVD
Stage 1:
-pt lies supine, elevate both legs at 90 deg and hold them up for 2 minutes
-observe color of feet
Stage 2:
-pt sits up with legs over edge of table at 90 deg angle for 2 minutes
-gravity aids blood flow - leg turns blue as blood is deoxygenated while passing through ischemic tissue, then dusky red flush with reactiver hyperemia from post-hypoxic vasodilation
-test is + for PVD when it elicits excessive pallor with elevation and intense rubor with dependency
Diabetic Foot
Dx:
- nerve conduction studies are gold standard but too involved
- cotton swab test is inaccurate
- foot drop/neuropathic manifestations are late signs
- Semmes-Weinstein monofilament test = screening test of choice for protective sensation in foot
- test is + if pt can’t feel filament at 4/10 sites or more
Charcot’s foot
=neuropathic osteoarthropathy caused by both a sensory loss and motor loss
- results in covex foot with rocker-bottom appearance
- most common in diabetics but also seen in syphilis or Charcot-Marie-Tooth
foot ulcer classification:
- *Neuropathic - usually painless, surrounded by callus and exhibits little to no gangrene
- arterial insufficiency
- venous insufficiency
Trendelenburg test
= test functionality of leg veins’ valves
- raise leg of supine pt to drain veins of blood, apply tourniquet to mid thigh, compress greater saphenous vein - ask pt to stand, observe leg veins, nL if greater saphenous slowly refills from below, should take backfilling from incompetent valves - pts with arterial insufficiency may have false negative test
Cullen’s sign
periumbilical ecchymosis associated with acute hemorrhagic pancreatitis
-poor sensitivity and specficity
Grey Turner’s sign
= bilateral frank reddish/purple discoloration assoc. w/acute hemorrhagic pancreatitis
Respiratory alternans
= alternate use of diaphragm or intercostal resp. mm; rock in one direction then switch to other direction
-predicts resp. failure
Venous patterns on abdomen
- Obstructed SVC: vv. are engorged on upper abd wall, when milked they go downward
- Obstructed IVC: vv. are engorged on lateral abd wall, when you milk them you get upward flow
- Obstructed portal system: network of periumbilical vv., rostral drain upward (toward internal mammary), and lower drain down (toward inferior mammary v.)
- Caput medusae: seen in cirrhotics and portal HTN when umbilical v. has reopened
Cruveilhier-Baumgarten murmur/sign
= continuous venous hum/murmur
- recanalization of umbilical v. because of portal HTN - reverse blood flow from cirrhotic liver into abd wall vv. - decompression of blood into shunts on abd wall - louder during expiration in valsalva
Techniques for percussion of spleen
Nixon’s technique = percuss whole spleen while pt in R lateral decubitus (best specificity)
Castell’s = percuss lowest intercostal space while pt breathes in and out (best sensitivity)
Percussion of Traube’s semilunar space = triangular space bordered by left 6th rib superiorly, left midaxillary line, and left costal margin inferiorly –> dullness may indicate splenomegaly
Murphy’s sign
=painful reflex arrest of inspiration, triggered by palpation of the edge of an inflamed gallbladder
- specificity is higher than sensitivity
- -> cholecystitis
