Disease and conditions 

Aortic root dilatation is suspected when the aortic diameter is above 40 mm in men or 36 mm in women, from hypertension, Marfan syndrome or syphilis. CT aortogram confirms it; refer to a specialised hospital for elective repair of large abdominal aneurysms (5.5 cm or more in men, above 5 cm in women) and emergency repair of ruptures.

Aortic dissection is a life-threatening tear in the inner layer of the aorta, linked to hypertension, Marfan syndrome and trauma, causing tearing chest pain, fainting and pulse or BP differences between the arms. CT aortogram confirms it; Stanford type A needs urgent surgery and type B may be managed medically, so consult a specialist and refer.

Chronic peripheral arterial disease from atherosclerosis may be silent or cause intermittent claudication or critical limb ischaemia; an ankle-brachial index below 0.9 suggests PAD. Manage with smoking cessation, exercise and risk-factor control, aspirin or clopidogrel with or without cilostazol, and revascularisation for severe disease.

Varicose veins are dilated, tortuous superficial leg veins caused by venous insufficiency, ranging from cosmetic to ulceration and limb loss. Assess with Doppler ultrasound; treat with compression stockings first and use sclerotherapy, thermal ablation or surgery when skin changes or symptoms progress.

Lymphoedema is protein-rich fluid collecting in the tissues because lymphatic drainage is blocked, usually in a leg, with recurrent cellulitis and loss of function. Lymphoscintigraphy is the reference test; management is skin care, complex physical therapy with compression, limb elevation and weight loss, with surgery only for refractory cases.

Hemoptysis is the expectoration of blood from the lower respiratory tract, commonly caused by infections, chronic bronchitis, bronchiectasis, lung cancer, or pulmonary vascular disorders. Massive hemoptysis is life-threatening and requires urgent airway management, hemodynamic stabilization, and localization of the bleeding source.

Cowen’s sign is a jerky, consensual pupillary light reflex in which one pupil shows abrupt constriction or dilation when the other is exposed to light. This sign is associated with Graves’ disease.

Cheyne-Stokes respirations are a cyclic breathing pattern of gradually increasing then decreasing breaths followed by apnea, often caused by heart failure or neurologic impairment. Management focuses on treating the underlying condition and supportive respiratory care.

Miosis is pupillary constriction caused by physiologic responses, drugs, ocular, or neurologic disorders. Proper evaluation of history, ocular examination, and underlying systemic conditions is essential for diagnosis and management.

Syncope is a transient loss of consciousness due to decreased cerebral perfusion or hypoxia, often preceded by light-headedness, pallor, and hypotension. Evaluation includes assessing underlying cardiac, neurologic, or vascular causes, monitoring vital signs, ensuring patient safety, and providing emergency interventions such as supine positioning, leg elevation, oxygen, cardiac monitoring, and treatment of arrhythmias if present.

Griffith’s sign is a lagging of the lower eyelids during upward gaze, commonly seen in thyrotoxicosis. To detect it, have the patient follow a steadily rising object; if the lower eyelid fails to move smoothly with the eye, the sign is present.

Throat pain (sore throat) refers to discomfort in the nasopharynx, oropharynx, or hypopharynx, caused by infections, trauma, allergies, cancer, systemic disorders, or nonpathologic factors such as dry mucosa or vocal strain. Management involves thorough history-taking, physical and laryngoscopic examination, analgesia, culture if indicated, and treatment of the underlying cause.

Agraphia is the inability to express thoughts in writing, with subtypes including aphasic (spelling/grammar errors), constructional (misordering of words), and apraxic (inability to form letters despite intact motor function). It most commonly results from lesions due to stroke.

Crowing respirations are slow, deep inspirations producing a high-pitched “crowing” sound, typically seen during the paroxysmal stage of pertussis.

Escherich’s sign is a contraction of the lips, tongue, and masseters elicited by percussion of the inner surface of the lips or tongue; commonly observed in tetany.

A sluggish pupillary reaction is an abnormally slow response to light, often indicating cranial nerve (II or III) dysfunction, degenerative CNS disease, or ocular disorders. While not always life-threatening, it requires assessment of visual function, pupillary reflexes, and underlying systemic or ocular causes.

Excessive weight loss occurs when caloric intake is insufficient, absorption is impaired, or metabolic demands are elevated, and may result from endocrine, neoplastic, gastrointestinal, psychiatric, infectious, or neurologic disorders. Evaluation involves detailed history, physical examination, laboratory and radiologic tests, and assessment of nutritional, psychological, and lifestyle factors.

Diplopia is the perception of double vision caused by dysfunction of extraocular muscles or cranial nerves controlling them. It may be monocular or binocular and can result from neurologic, muscular, orbital, or systemic disorders.

Arm edema is the accumulation of excess interstitial fluid in one or both arms, often due to trauma, vascular disorders, toxins, or treatment-related complications. Early assessment, elevation, and careful monitoring are essential to prevent complications such as neurovascular compromise and lymphedema.

Abadie’s sign is spasm of the levator palpebrae superioris muscle of the upper eyelid, often seen in exophthalmic goiter associated with Graves’ disease. It is supportive but not definitive for diagnosis and should be interpreted alongside other ocular and systemic features of hyperthyroidism.

Violent behavior is the sudden loss of self-control resulting in harm to others, oneself, or objects, often caused by psychiatric or organic disorders, substance use, or learned behavior within the family. Management involves assessing the cause, ensuring safety, environmental control, de-escalation, and, when necessary, pharmacologic or physical intervention.

Neck pain originates from multiple musculoskeletal, neurologic, or systemic causes, ranging from trauma to tumors. Early assessment, appropriate immobilization, and diagnostic evaluation are essential to prevent complications and guide effective treatment.

Peau d’orange is a pitted, thickened breast skin resembling an orange peel, most often indicating advanced breast cancer but also seen in abscess or lymphatic obstruction. Evaluation includes thorough breast and axillary examination, diagnostic imaging or biopsy, and providing clear information and emotional support.

Jugular vein distention reflects elevated central venous pressure, often due to heart failure, cardiac tamponade, or fluid overload. Accurate assessment, monitoring, and prompt intervention are essential for preventing complications.

Large for gestational age (LGA) refers to a neonatal weight above the 90th percentile for gestational age. Affected infants face increased risks of birth trauma, respiratory distress, metabolic disturbances, and polycythemia.

Ectropion is an outward turning (eversion) of the eyelid, often affecting the lower lid, which can cause exposure of the conjunctiva, impaired tear drainage, and excessive tearing. It may result from aging, facial nerve paralysis, or trauma.

Fasciculations are involuntary, visible muscle twitches caused by spontaneous motor nerve discharge, which can be benign or indicate serious neuromuscular disorders. Prompt evaluation is essential to identify underlying causes such as motor neuron disease, spinal cord lesions, or toxin exposure.

Hoffmann’s sign is flexion of the thumb and fingers when the nail of the index, middle, or ring finger is flicked. A positive response suggests a pyramidal tract disorder, such as spastic hemiparesis. It may also refer to increased sensitivity of sensory nerves to electrical stimulation, as in tetany.

Apneustic respirations are prolonged, gasping inspirations caused by severe pontine damage disrupting normal breathing regulation. Immediate airway management and neurological assessment are critical for patient survival.

Leg edema is the accumulation of excess interstitial fluid in one or both legs, caused by venous, cardiac, renal, infectious, or traumatic conditions. Clinical assessment, including history, examination, and diagnostic studies, guides management and prevention of complications.

Echopraxia is an involuntary repetition of another person’s movements without understanding, commonly observed in catatonic schizophrenia and some neurologic disorders.

Biot’s respirations are irregular, unpredictable breathing patterns indicating severe brain stem dysfunction, often due to increased intracranial pressure. They are a medical emergency requiring urgent airway management and neuroimaging to identify and relieve the underlying cause.

Elevated blood pressure (hypertension) is a common but often unnoticed condition caused by various factors like kidney or hormonal disorders, requiring careful diagnosis to prevent life-threatening complications. Management includes identifying underlying causes, monitoring, and emergency interventions for hypertensive crises.

A scotoma is a partial or complete blind spot within the visual field, caused by retinal, choroidal, or optic nerve disorders such as macular degeneration, optic neuritis, or retinal pigmentary degeneration. Detection involves visual field testing, ophthalmoscopy, and assessment of visual acuity, with patient counseling focused on monitoring progression, using assistive devices, and regular eye exams.

Anorexia refers to a lack or loss of appetite, often resulting from various physical or psychological conditions. It can lead to serious health issues like malnutrition, weakness, and delayed healing if not properly addressed.

Urinary incontinence is the involuntary leakage of urine, classified as stress, overflow, urge, or total incontinence, caused by bladder dysfunction, neurologic disorders, pelvic muscle weakness, infection, prostate disease, or surgery. Diagnosis includes history, physical exam, urinalysis, and neurologic assessment, while management involves bladder retraining, Kegel exercises, catheterization if needed, treatment of underlying causes, and environmental adaptations.

Ambivalence is simultaneous presence of opposing feelings, such as love and hate, toward a person, object, or idea, causing indecision or internal conflict. Severe ambivalence is often observed in schizophrenia and can impair social and decision-making abilities.

Clubbing is a painless, bilateral enlargement of the soft tissue around the nail beds, commonly indicating chronic pulmonary or cyanotic cardiovascular diseases. It reflects underlying tissue hypoxia and vascular changes and warrants investigation for serious systemic conditions.

Tics are sudden, involuntary, repetitive movements or sounds, often involving the face, neck, or upper body, usually triggered or worsened by stress and anxiety. Management includes careful history and observation, addressing underlying causes (e.g., Tourette’s syndrome), stress reduction, psychotherapy, and, if needed, medications such as antipsychotics to control severe tics.

A pericardial friction rub is a scratching or grating heart sound caused by inflamed pericardial layers rubbing together, most often signaling acute pericarditis. It is typically best heard at the lower left sternal border, may be triphasic, and requires careful evaluation for underlying causes and monitoring for complications such as cardiac tamponade.