Disease and conditions 

Otorrhea is ear drainage that may be purulent, bloody, serous, or serosanguineous, often caused by infections, trauma, neoplasms, or external/middle ear disorders. Careful history, physical examination, and hearing assessment guide diagnosis and management, with pediatric considerations for anatomy and safety.

Epistaxis is bleeding from the nose, usually anterior but occasionally posterior, and can range from mild to life-threatening. Causes include trauma, coagulation disorders, hypertension, infections, tumors, systemic diseases, drugs, and chemical irritants.

Mannkopf’s sign is an increase in pulse rate when pressure is applied to a painful area. It helps differentiate genuine pain from simulated pain, as the sign is absent in the latter.

A papular rash is a cluster of small, solid, raised lesions (<1 cm) that may be red, purple, or flesh-colored, arising from allergic, infectious, autoimmune, drug-related, or neoplastic conditions. Diagnosis relies on history, physical exam, and identifying underlying causes; treatment targets the etiology and may include antipruritic, antihistamine, or antibiotic therapy.

Scrotal swelling is an enlargement of the scrotum from various causes, ranging from painless cysts to painful emergencies like testicular torsion. Evaluation includes history, physical exam, and diagnostics, with management based on the underlying cause.

A bulging fontanel in infants is a key indicator of increased intracranial pressure, often secondary to infection, hydrocephalus, or trauma. Prompt recognition, emergency stabilization, and investigation of underlying causes are essential to prevent neurological deterioration.

Priapism is a persistent, painful penile erection unrelated to sexual activity, often caused by blood disorders, spinal cord injury, drugs, or penile cancer, and constitutes a urologic emergency. Management focuses on prompt pain relief, decompression of the corpora cavernosa, addressing underlying causes, and patient education to prevent complications.

Nonreactive (fixed) pupils fail to constrict or dilate in response to light, indicating possible life-threatening emergencies such as brain herniation, oculomotor nerve palsy, or severe ocular disease. Prompt assessment of cranial nerve function, intracranial pressure, and ocular status is critical for timely intervention.

Hypernasality is a speech abnormality caused by excessive airflow through the nose, often linked to neuromuscular disorders, cleft palate, or velar paralysis. It may accompany dysarthria or swallowing difficulties.

Low-set ears are defined by the superior helix lying below the level of the eyes. They are a common feature in genetic syndromes such as Down, Turner, Noonan, Apert’s, and Potter’s, as well as other congenital anomalies.

Bradypnea is abnormally slow breathing (less than 10 breaths per minute), often signaling life-threatening conditions like drug overdose, increased intracranial pressure, or metabolic failure. Immediate assessment and airway support are critical to prevent respiratory arrest.

Crackles are abnormal breath sounds signaling underlying pulmonary or cardiovascular pathology. Accurate interpretation through clinical assessment, differential diagnosis, and targeted management is crucial for guiding appropriate interventions and improving patient outcomes.

Flank pain, ranging from dull ache to severe colicky pain, commonly signals renal or upper urinary tract disease, obstruction, or trauma. Early recognition, thorough assessment, and prompt intervention are crucial to prevent complications and address underlying causes.

Grasset’s phenomenon is an inability to raise both legs simultaneously, though each leg can be raised individually. In adults, it indicates complete organic hemiplegia due to an upper motor neuron lesion; in infants, it is a normal finding until 5–7 months of age.

Jaundice is yellow discoloration of skin, sclera, or mucous membranes due to elevated bilirubin from prehepatic, hepatic, or posthepatic causes. Diagnosis relies on history, physical examination, laboratory tests, and imaging, while management addresses the underlying cause, pruritus, and complications.

Anxiety is a common psychiatric symptom characterized by feelings of uneasiness or dread, ranging from mild discomfort to severe, life-threatening conditions. It can result from physical illness, psychological disorders, or external factors, and requires careful evaluation to identify underlying causes and provide appropriate management.

Absence seizures are brief, benign generalized seizures causing sudden staring and inattention, often in children aged 4–12. Diagnosis involves observation, EEG, and imaging, with management focusing on anticonvulsants, safety, and patient education.

Peau d’orange is the thickened, pitted appearance of breast skin resembling an orange peel, typically indicating advanced breast cancer. It can also occur with breast or axillary infections, and careful history, breast examination, and evaluation of axillary lymph nodes are essential for diagnosis and management.

Extensor thrust reflex is a primitive reflex in neonates where leg extension follows sole stimulation, mediated at the spinal cord level. Normally disappears by 6 months; persistence beyond this age suggests anoxic brain damage, and its reappearance in older children indicates central nervous system injury.

Homans’ sign is elicited when abrupt dorsiflexion of the ankle causes deep calf pain, suggesting possible deep vein thrombosis or calf inflammation. However, it is an unreliable indicator and must be interpreted alongside clinical history, physical findings, and diagnostic tests.

Orthopnea is difficulty breathing while lying flat, often relieved by sitting upright or using pillows, commonly indicating cardiopulmonary disorders such as left-sided heart failure or COPD. Its severity and associated signs guide evaluation, treatment, and monitoring, including oxygen therapy, diuretics, and positional adjustments.

Vaginal discharge varies physiologically with age, menstrual cycle, and estrogen status, but changes in color, odor, consistency, or quantity may indicate infection, sexually transmitted disease, reproductive tract pathology, or malignancy. Assessment includes detailed history, physical and pelvic examination, laboratory testing, and patient counseling on hygiene, medication adherence, and safe sexual practices.

Visual floaters are moving particles in the vitreous that appear as spots or dots in the visual field. Sudden onset may indicate retinal detachment, vitreous hemorrhage, or posterior uveitis, requiring urgent ophthalmologic evaluation and careful patient management to prevent vision loss.

Agnosia is the inability to recognize or interpret sensory stimuli despite intact primary sensation, caused by lesions in sensory association areas of the parietal cortex. Subtypes include visual, auditory, tactile (astereognosis), gustatory, olfactory (anosmia), autotopagnosia, and anosognosia, commonly following stroke.

Flexor withdrawal reflex is a neonatal reflex in which the knee flexes upon stimulation of the sole of the foot; normal up to 6 months of age, mediated at the spinal cord level. Persistence beyond 6 months may indicate CNS injury or anoxic brain damage.

Hyperpnea is sustained deep or rapid breathing caused by metabolic, neurologic, or respiratory disorders and may be compensatory, as in Kussmaul’s respirations. Prompt evaluation is essential to identify underlying causes such as acidosis, hypoxemia, or brain injury and to prevent life-threatening complications.

Intermittent claudication is exercise-induced limb pain relieved by short rest, commonly caused by arterial occlusive disease or neurogenic compression. Diagnosis relies on history, physical examination, pulse assessment, and imaging, with management focusing on risk factor modification, exercise, and, in severe cases, revascularization.

It is a non–suppurative sequela of a group A ß haemolytic streptococcal (GABHS) pharyngeal infection.

Chaddock’s sign is a reflex indicating pyramidal tract dysfunction; dorsiflexion of the great toe with fanning of other toes when the lateral foot is stroked, or wrist flexion with finger extension when the ulnar forearm is stroked. Normal in infants under 7 months.

Paralysis is the complete loss of voluntary motor function, caused by central or peripheral nervous system injury, degenerative disease, trauma, infection, or toxins, and may be acute, chronic, localized, or generalized. Management involves emergency stabilization for acute cases, thorough neurologic assessment, prevention of complications from immobility, supportive care, and addressing the underlying cause through medical, surgical, or rehabilitative interventions.

Cloudy or turbid urine usually signals urinary tract infection but may also result from mucus, cells, crystals, or specimen deterioration. Diagnosis relies on urinalysis and culture, with treatment focused on the underlying cause, adequate hydration, and patient education on hygiene and therapy adherence.

Absent bowel sounds signal serious intestinal dysfunction from obstruction, ischemia, or paralysis, requiring urgent evaluation. Prompt intervention is vital to prevent life-threatening complications like perforation and sepsis.

Conjunctival paleness is a pale appearance of the inner eyelid’s mucous membrane, indicative of anemia. Detected by gently everting the eyelid and inspecting the conjunctiva for reduced redness.

A bounding pulse is a strong, forceful pulsation that can occur normally with exercise, pregnancy, or anxiety but may also signal fever, thyrotoxicosis, aortic insufficiency, or acute alcoholism. Assessment focuses on vital signs, cardiac rhythm, and identifying underlying metabolic or cardiovascular causes.

Beevor’s sign is an upward movement of the umbilicus when the patient contracts the abdominal muscles, indicating paralysis of the lower rectus abdominis muscles, typically associated with lesions around T10.

Ammonia-scented breath, common in end-stage chronic kidney disease, is caused by metabolic disturbances and the breakdown of urea into ammonia. Regular oral care and dietary adjustments are important in managing this symptom.

Flight of ideas refers to a continuous, pressured speech with rapid topic changes, where connections are based on word sounds or similarities. It is characteristic of the manic phase of bipolar disorder.

A marked elevated systolic blood pressure SBP ≥ 180mmHg and/or a diastolic DBP ≥130mmHg associated with life threatening situations.

Hypertensive urgency is severe hypertension (SBP above 180 mmHg and/or DBP above 110 mmHg) without target organ damage such as pulmonary oedema, cardiac ischaemia, neurological deficit or acute renal failure. Treat in hospital and lower the DBP slowly to about 100 mmHg over 48–72 hours with two or more oral agents.

Hypertension that remains >140/90mmHg despite the use of 3 antihypertensive drugs in a rational combination at full doses and including a diuretic i.e. thiazide.