Disease and conditions 

Erben’s reflex is a slowing of the pulse observed when the head and trunk are forcibly bent forward, indicating increased vagal excitability.

Hoarseness is a rough or raspy voice caused by laryngeal inflammation, vocal cord lesions, nerve injury, systemic disorders, or external irritants. It can be acute or chronic, and persistent cases require evaluation for infections, reflux, malignancy, or airway obstruction.

Beau’s lines are transverse depressions across the fingernails that may appear after severe illness, systemic stress, malnutrition, nail trauma, or cardiac events such as coronary artery occlusion.

Dugas’ sign is an inability to touch the opposite shoulder and bring the elbow to the chest with the affected arm, indicating shoulder dislocation.

Paresthesia is an abnormal sensation—such as numbness, tingling, or prickling—along peripheral nerve pathways, which may be transient or permanent. It can arise from neurologic, vascular, metabolic, infectious, traumatic, or drug-related causes, so thorough history-taking and neurologic examination are essential for diagnosis.

Ptosis is the abnormal drooping of one or both upper eyelids, which can be congenital or acquired and may signal neuromuscular, ocular, or life-threatening conditions. Evaluation involves history, ocular examination, and addressing underlying causes, with treatment ranging from medical management to surgery.

Conversion is an altered physical function or activity mimicking an organic disorder but without an identifiable physical cause, typically arising unconsciously from psychological conflict, as seen in conversion disorder.

Earache (otalgia) is pain in the external, middle, or inner ear caused by infection, obstruction, trauma, or referred pain, often accompanied by hearing loss, discharge, or vertigo. Its onset, character, and associated symptoms help differentiate underlying causes such as otitis externa, otitis media, cerumen impaction, or barotrauma.

Dyslipidemia is defined as having blood lipid levels that are too high or low. Lowering blood cholesterol levels using statins is recommended to reduce the impact of cardiovascular morbidity and mortality

Shallow respirations are rapid, low-volume breaths that can signal respiratory distress or neuromuscular weakness, leading to inadequate oxygenation and possible cyanosis, confusion, or respiratory failure. Management includes assessing airway and breathing, providing oxygen, treating underlying causes, and monitoring for deterioration with interventions such as mechanical ventilation if needed.

Blocking is a sudden interruption of speech or thought, typically occurring mid-sentence, where the patient cannot explain the pause; commonly observed in schizophrenia but may occasionally occur in normal individuals.

Waddling gait is a ducklike walk caused by weakness of the pelvic girdle muscles, leading to trunk lean toward the stance leg, exaggerated lumbar lordosis, and abdominal protrusion. It is commonly seen in muscular dystrophies, spinal muscle atrophies, and congenital hip disorders.

Pruritus is an unpleasant itching sensation affecting the skin or mucous membranes, often caused by dermatologic, systemic, or drug-related conditions. Evaluation focuses on identifying underlying causes, avoiding triggers, managing symptoms with topical or systemic therapy, and educating the patient to minimize scratching.

Anesthesia is an absence of cutaneous sensation, including touch, temperature, and pain, which may be partial, total, unilateral, or bilateral; detected by assessing patient response to touch with eyes closed.

Muscle spasticity is excessive, involuntary muscle contraction caused by upper motor neuron lesions, often leading to stiffness, contractures, and functional limitations. Early recognition, targeted therapy, and supportive care are essential to preserve mobility and prevent complications.

Diaphoresis is excessive sweating triggered by physical, emotional, or pathological stress, often indicating underlying conditions like hypoglycemia, infection, or myocardial infarction. It may be localized or generalized and requires urgent evaluation when accompanied by systemic symptoms.

Idea of reference is a delusion in which a person believes that others’ statements, actions, or events hold a special personal significance. It commonly occurs in schizophrenia and paranoid disorders.

Babinski’s reflex is an abnormal upward movement of the big toe with fanning of the other toes upon sole stimulation, indicating corticospinal tract dysfunction. It is normal in infants up to 24 months but signifies neurological pathology in older children and adults.

Narrow QRS tachycardias (QRS 0.1 seconds or less) include atrial fibrillation, atrial flutter and atrial tachycardia. Manage atrial fibrillation with anticoagulation (warfarin INR 2–3 or rivaroxaban), rate control (beta-blocker, diltiazem, verapamil or digoxin) and DC cardioversion when unstable; atrial flutter responds best to DC cardioversion.

AV junctional re-entry tachycardias are paroxysmal narrow QRS tachycardias, often in young people with normal hearts, caused by AV nodal re-entry or WPW syndrome. Treat with vagal manoeuvres, then adenosine 6 mg then 12 mg IV, and DC shock if hypotensive; refer for radiofrequency ablation.

Wide QRS tachycardias (QRS over 0.12 seconds) are ventricular tachycardia until proved otherwise. Emergency DC cardioversion is first-line even when stable, with amiodarone or lidocaine for recurrence; irregular wide QRS tachycardia above 170/minute suggests WPW with atrial fibrillation.

Cognitive Dysfunction is an impairment in perceiving, organizing, interpreting stimuli, and solving problems, often linked to CNS disorders, systemic illness, or unknown causes like chronic fatigue syndrome.

This article provides clinical guidelines on managing productive cough, emphasizing airway clearance, fluid intake, humidification, and appropriate use of medications. It also includes special considerations for pediatric and geriatric patients, highlighting risks and tailored care approaches.

Mostly from clinical history characterized by chest pain due to myocardial ischaemia usually inducible by exercise, emotion or other stress and reproducible, relieved by rest but may occur spontaneously and stable in nature.

Adipsia is the abnormal absence of thirst despite fluid deficit or hyperosmolar states, often caused by hypothalamic injury, tumor, or systemic disorders. Early recognition is critical to prevent severe dehydration and hypernatremia, and management involves guided hydration and treatment of the underlying cause.

Clicks are extra, brief, high-frequency heart sounds heard in systole or diastole. Ejection clicks occur soon after S1, often due to sudden distention of the aorta or pulmonary artery, or forceful valve opening, while systolic clicks, best heard at the apex, are characteristic of mitral valve prolapse.

Hypoactive deep tendon reflexes indicate reduced or absent reflex activity due to dysfunction in the reflex arc. They are associated with neuromuscular, metabolic, toxic, and structural disorders and require careful clinical evaluation to determine the underlying cause.

Pulmonary oedema or pulmonary congestion is a broad descriptive term and is usually defined as an abnormal accumulation of fluid in the extravascular compartments of the lung

A sunken anterior fontanel is a hallmark sign of dehydration in infants, reflecting reduced intracranial and extracellular fluid volume. Prompt assessment, fluid replacement, and electrolyte monitoring are critical to prevent shock and complications.

Steppage gait is a compensatory walking pattern caused by footdrop, usually from lower motor neuron lesions, characterized by exaggerated hip and knee flexion to prevent the toes from dragging. It can be unilateral or bilateral, permanent or transient, depending on the underlying neural damage.

Nonreproductive cough is a dry cough not related to reproductive system causes, often resulting from respiratory, gastrointestinal, cardiovascular, or environmental conditions. Common examples include asthma, pneumonia, GERD, and inhalation injuries.

Linder’s sign is pain in the lower back or leg triggered by passive neck flexion, indicating sciatica. It is elicited with the patient supine or sitting and legs extended, stretching the irritated sciatic nerve.

Visual blurring, characterized by indistinct visual details and reduced acuity, may result from ocular, neurologic, systemic disorders, trauma, or drug effects. Assessment includes history, visual acuity testing, eye inspection, identification of emergencies like acute glaucoma or retinal detachment, and management to prevent permanent vision loss.

Muscle flaccidity involves profound hypotonia and weakness, usually due to neurologic or traumatic causes, and can affect isolated or generalized muscle groups. Prompt assessment, supportive care, and rehabilitation are crucial to preserve mobility, prevent complications, and ensure patient safety.

Nipple discharge is fluid release from one or both nipples that may be benign (e.g., galactorrhea, duct ectasia) or serious (e.g., intraductal papilloma, carcinoma). Careful history, breast exam, and targeted investigations (cytology, imaging, prolactin/thyroid tests, or biopsy) guide diagnosis and management.

Murmurs are auscultatory heart sounds classified by timing, location, loudness, and quality. Accurate history, auscultation, and identification of underlying cardiac conditions are essential for diagnosis and management.

Lhermitte’s sign is a sudden, transient, electric-like shock sensation radiating down the spine and limbs, triggered by neck flexion. It is associated with multiple sclerosis, spinal cord degeneration, and cervical spinal injuries.

Galeazzi’s sign is unequal knee heights when an infant’s hips and knees are flexed to 90° while supine. A lower knee on one side indicates femoral shortening, commonly due to congenital hip dislocation.

Hamman’s sign is a loud, crunching sound over the precordium synchronous with the heartbeat, indicating mediastinal emphysema from conditions like pneumothorax or tracheobronchial rupture. Detected by auscultation with the patient in a left lateral recumbent position.

Compulsion is a repetitive, stereotyped behaviors performed despite awareness of their irrationality, such as constant hand washing. It is characteristic of obsessive-compulsive disorder and can occasionally occur in schizophrenia.