Disease and conditions 

Breast nodules are lumps in the breast that may be benign or malignant and require thorough evaluation. Most are caused by benign conditions like fibrocystic changes, but cancer must always be ruled out.

Retractions are visible chest wall indentations in infants and children indicating respiratory distress, often signaling increased work of breathing with accessory muscle use. Their location and severity help identify the underlying cause and guide urgent interventions.

Confabulation is unintentionally fabricated or distorted memories used to fill gaps in memory, usually plausible and detailed. Commonly observed in Korsakoff’s syndrome, alcoholism, dementia, lead poisoning, and head injuries.

Muscle atrophy arises from denervation, disuse, systemic disease, or aging, leading to visible wasting and functional weakness. Early recognition, proper examination, and targeted rehabilitation can prevent contractures and maintain mobility.

Epicanthal folds are vertical skin folds that partially or completely cover the inner corner (canthus) of the eye, giving the eyes a “crossed” appearance. They are normal in many young children and Asian populations but may indicate Down syndrome when combined with oblique palpebral fissures in non-Asian children.

Barré’s pyramidal sign: A clinical sign indicating pyramidal tract or prefrontal brain dysfunction, detected when a patient in the prone position with knees flexed 90° is unable to hold the lower legs still.

Ewart’s sign is a clinical finding in pericardial effusion, characterized by bronchial breathing on auscultation and dullness to percussion below the angle of the left scapula. These are compression signs caused by the enlarged pericardial sac pressing on adjacent lung tissue. The sign may also be noted beneath the prominence of the sternal end of the first rib in some effusion cases.

Fatigue is a subjective sensation of persistent tiredness, lack of energy, or exhaustion, often worsened by activity and relieved by rest. It may result from normal physical exertion, psychological stress, or underlying medical conditions such as infection, endocrine disorders, cardiovascular disease, or metabolic imbalances.

Fabere sign is a pain elicited during Patrick’s test (Flexion, ABduction, External Rotation, and Extension) indicates hip arthritis. The maneuver involves placing the patient supine, flexing the thigh and knee, externally rotating the leg, and depressing the knee; pain confirms a positive sign.

In scissors gait, careful history taking and physical examination identify the underlying neurologic lesion, differentiate between congenital, hereditary, or acquired causes, and guide targeted interventions like physical therapy, spasticity management, or orthopedic correction.

Urinary hesitancy is difficulty initiating a urine stream, often accompanied by reduced force or intermittent flow, commonly caused by benign prostatic hyperplasia, prostatic cancer, urethral stricture, urinary tract infection, spinal cord lesions, or medications with anticholinergic effects. Diagnosis involves patient history, physical and genital/rectal or gynecologic examination, urinalysis, and imaging, with management directed at the underlying cause and supportive measures such as bladder monitoring, heat application, and intermittent catheterization if needed.

Postmenopausal vaginal bleeding, occurring ≥6 months after menopause, may indicate benign causes like atrophic vaginitis or polyps but also signals potential gynecologic malignancy. Evaluation involves detailed history, pelvic examination, imaging, and biopsy, with management directed at the underlying cause and patient counseling on risks and follow-up.

Heat intolerance is the inability to tolerate elevated temperatures, often causing persistent overheating and profuse sweating. It commonly results from thyroid dysfunction, menopause, hypothalamic disorders, or certain medications.

Hyperacusis is abnormally acute hearing due to increased irritability of the auditory neural pathway, resulting in an unusually low hearing threshold.

Coopernail’s sign is a presence of ecchymoses on the perineum, scrotum, or labia, indicative of an underlying pelvic fracture.

An atrial (S4) gallop is a presystolic heart sound caused by atrial contraction against a stiff ventricle, often indicating diastolic dysfunction. It is associated with hypertension, ischemic heart disease, valvular disorders, and cardiomyopathies and can be a key diagnostic clue in angina or heart failure.

Wheezing is a high-pitched, musical breath sound caused by air flowing through narrowed airways, often heard during expiration, and may indicate airway obstruction from bronchospasm, edema, secretions, foreign bodies, or extrinsic compression. Evaluation includes history, physical examination, auscultation, vital signs, and relevant diagnostics, with management focusing on airway support, bronchodilators, oxygen therapy, and treatment of underlying causes.

Facial edema is swelling of the face that may be localized or generalized, developing gradually or abruptly, and can result from trauma, allergy, systemic disorders, or drug reactions. Severe cases may compromise the airway, requiring urgent intervention, while mild cases often precede peripheral or generalized edema.

Hypoactive bowel sounds indicate decreased intestinal motility often caused by obstruction, surgery, medications, or ischemia. While not always urgent, they require close monitoring to prevent progression to life-threatening conditions like paralytic ileus or bowel obstruction.

Decerebrate posture is a severe abnormal motor response indicating brain stem damage. It signals a grave neurological insult and requires urgent airway support, diagnostic evaluation, and neurocritical care.

Oliguria is defined as urine output less than 400 mL per 24 hours and is a key indicator of renal or urinary tract dysfunction, which may result from prerenal, intrarenal, or postrenal causes. It often signals potentially life-threatening conditions and requires careful evaluation of history, physical examination, laboratory tests, and close monitoring of fluid status and vital signs.

Koplik’s spots, or Koplik’s sign, are small red spots with bluish-white centers on the lingual and buccal mucosa, characteristic of measles. They typically appear 1–2 days before the measles rash erupts.

Gifford’s sign is a resistance to eversion of the upper eyelid, often observed in thyrotoxicosis. To detect, attempt to lift and evert the eyelid over a blunt instrument; resistance indicates a positive sign.

Amnesia is a condition characterized by partial or complete memory loss, which may be temporary or permanent. It can result from various medical, neurological, or psychological causes, affecting either past memories (retrograde) or the ability to form new ones (anterograde).

Dawbarn’s sign is a pain on palpation of the acromial process that disappears on abduction, indicative of acute subacromial bursitis.

Fever (pyrexia) is a temporary rise in body temperature caused by infection, immune disorders, or other systemic conditions. While mild fevers are common, very high or persistent fevers may signal serious illness and require urgent medical attention.

Thyroid enlargement (goiter) may result from inflammation, iodine deficiency, tumors, drugs, or physiologic changes, and can be associated with hyperthyroidism or hypothyroidism depending on hormone activity. Management involves detailed history and neck examination, laboratory and imaging tests, treatment of underlying causes, hormone therapy if needed, and monitoring for complications such as airway obstruction or thyroid storm.

Chvostek’s sign, an abnormal facial muscle twitch upon tapping the facial nerve, is an early clinical sign of hypocalcemia. It helps assess calcium imbalance, particularly in patients with parathyroid issues or undergoing neck surgery.

Back pain is a common clinical complaint with diverse causes ranging from musculoskeletal strain to serious underlying conditions requiring prompt identification of red flags. Proper history, physical examination, and timely intervention are critical to effective management and prevention of complications.

Clammy skin is cool, moist, and pale skin caused by sympathetic activation from stress or serious illness such as shock, hypoglycemia, arrhythmias, or heat exhaustion. Management requires rapid assessment, treating the underlying cause, monitoring vitals, and supporting the patient’s comfort and safety.

Drooling refers to the unintentional loss of saliva from the mouth, commonly associated with neurological disorders, oral structural abnormalities, or medication side effects. It requires assessment of underlying causes to guide appropriate management.

Vision loss, ranging from mild impairment to total blindness, may occur suddenly or gradually due to ocular, neurologic, systemic disorders, trauma, or drug effects. Evaluation includes history, visual acuity testing, ocular examination, identification of emergencies like central retinal artery occlusion or acute angle-closure glaucoma, and appropriate management to preserve vision.

Male genital lesions may present as warts, ulcers, vesicles, or scaly patches and arise from infections, neoplasms, parasites, allergies, or drugs. Proper diagnosis, including STD screening, patient counseling, and early intervention, is critical to prevent complications and ensure sexual health.

Urinary frequency is an increased urge to void without an increase in total urine volume, commonly caused by urinary tract infections, prostate enlargement, bladder irritation, neurologic disorders, or pressure on the bladder from tumors or pregnancy. Diagnosis involves patient history, physical examination, urinalysis, and imaging, with treatment directed at the underlying cause and supportive measures such as fluid management and Kegel exercises.

Agitation can result from various medical conditions, including withdrawal syndromes, neurological disorders, hypoxemia, and hypersensitivity reactions. Severity ranges from mild restlessness to life-threatening states with systemic symptoms.

Photophobia is an abnormal sensitivity to light, which can result from ocular conditions, systemic disorders, trauma, or certain drugs. It may indicate mild issues, such as contact lens irritation, or serious conditions like corneal ulcers, uveitis, or meningitis, and requires careful history-taking, eye examination, and appropriate diagnostic evaluation.

Nystagmus is involuntary, rhythmic oscillation of the eyes, which may be horizontal, vertical, rotary, or mixed, and classified as pendular or jerk. It indicates pathology in the brainstem, cerebellum, vestibular system, or visual pathways, and evaluation involves history, ocular motor testing, neurologic exam, and imaging, with management targeting the underlying cause and safety precautions.

Delusion is a persistent false belief held despite clear evidence to the contrary; types include grandiose, paranoid, and somatic delusions, commonly seen in schizophrenia and bipolar disorders.

Insomnia is the inability to initiate or maintain sleep or achieve restful sleep, which may be acute or chronic, caused by physiologic, pathophysiologic, psychiatric, or drug-related factors. Comprehensive evaluation—including history, examination, and sleep studies—is essential for diagnosis and targeted management through behavioral, pharmacologic, and supportive interventions.

Kussmaul’s sign is paradoxical jugular vein distention during inspiration, indicating impaired right ventricular filling. It is classically seen in constrictive pericarditis and other causes of right heart dysfunction.