Disease and conditions 

Fruity breath odor is a key sign of ketoacidosis, caused by excess acetone from fat breakdown due to lack of usable glucose. It signals a medical emergency requiring prompt insulin, fluid, and electrolyte treatment to prevent coma or death.

Ataxia is a neurological condition characterized by uncoordinated voluntary movements due to cerebellar or sensory pathway dysfunction. It may present acutely or chronically, requiring prompt evaluation to identify reversible or life-threatening causes.

Non-ST Elevation Myocardial Infarction is medical emergency characterized with chest pain that is increasing in frequency and/or severity or occurring at rest.

Eye discharge, eye pain, and exophthalmos are critical ophthalmic signs that may indicate infections, trauma, inflammation, systemic disease, or vision-threatening emergencies. Accurate evaluation, timely intervention, and patient education are essential to preserve vision and ocular health.

Tremors are involuntary, rhythmic oscillations of muscles caused by alternating contractions of opposing muscle groups. They may be classified as resting, postural, or intention tremors and result from neurologic, metabolic, drug-induced, or systemic disorders, with clinical evaluation guiding diagnosis and management.

Ludloff’s sign is the inability to raise the thigh while sitting, accompanied by edema and ecchymosis at the base of Scarpa’s triangle. In children, it indicates traumatic separation of the epiphyseal growth plate of the greater trochanter.

Most cases occur in patients over 60 years and is idiopathic, with an excellent long-term prognosis, provided a permanent pacemaker is implanted.

Scaly skin arises from abnormal keratinization, leading to flaking that can range from fine and dry to thick and greasy, often indicating underlying dermatologic, infectious, or systemic conditions. Careful history, examination, and targeted investigations help distinguish benign causes from serious disorders like psoriasis, lymphoma, or drug-induced scaling.

Clonus are repetitive, rhythmic muscle contractions triggered by sudden stretching, indicating upper motor neuron lesions or motor cortex pathway damage. Clonus may also appear during generalized tonic-clonic seizures.

Palpitations are the conscious awareness of one’s heartbeat — felt as pounding, fluttering, racing, or skipped beats — and may stem from anxiety, stimulants, cardiac arrhythmias, valvular disease, or metabolic disorders such as thyrotoxicosis. Assessment involves history, physical exam, and ECG monitoring; urgent signs (dizziness, hypotension, irregular pulse) require oxygen, cardiac monitoring, and antiarrhythmic therapy as indicated.

Paresthesia is an abnormal tingling, numbness, or prickling along nerve pathways, often due to neurologic, vascular, metabolic, or traumatic causes. Assessment and management focus on identifying the underlying cause and protecting areas with reduced sensation from injury.

Gynecomastia is the benign enlargement of male breast tissue caused by hormonal imbalances, drugs, systemic diseases, or tumors, often presenting with tenderness or, rarely, nipple discharge. Evaluation involves a thorough history, physical exam, hormonal assessment, and imaging, with management ranging from observation and pharmacologic therapy to surgery in severe or persistent cases.

Orthostatic Hypotension (Postural Hypotension) is a drop in blood pressure upon standing, often causing dizziness, syncope, or blurred vision, and may result from autonomic dysfunction, hypovolemia, drugs, or systemic disorders. Management includes gradual positional changes, fluid and electrolyte monitoring, medication review, and addressing underlying causes to prevent falls and complications.

Corrigan’s pulse is a jerky, bounding pulse with a rapid upstroke followed by abrupt collapse, typically detected by palpating the carotid artery with the patient’s hand elevated. It is classically associated with aortic insufficiency but may also occur in severe anemia, patent ductus arteriosus, coarctation of the aorta, and systemic arteriosclerosis.

Complementary Opposition Sign (Grasset-Gaussel-Hoover Sign) is an increased effort in lifting a paretic leg, observed as marked downward pressure of the opposite (unaffected) leg when the patient attempts to lift the affected leg.

A bizarre gait is a non-organic, theatrical walking disturbance seen in conversion disorder, malingering, or somatization, often inconsistent with neurological patterns.
It requires careful differentiation from true gait disorders, emphasizing supportive care and psychiatric referral when appropriate.

Leichtenstern’s sign is pain elicited by gentle tapping of an extremity’s bones. It is seen in cerebrospinal meningitis, often causing the patient to wince, withdraw, or cry out.

Pulsus bisferiens is a double-peaked systolic pulse, often caused by aortic insufficiency, hypertrophic obstructive cardiomyopathy, or high-output states. Detection requires careful palpation, usually of the carotid artery, and its presence indicates the need for further cardiac evaluation.

Aaron’s sign is precordial or epigastric pain elicited by gentle, steadily increasing pressure over McBurney’s point, and a positive sign suggests acute appendicitis. It is used as part of the physical examination to support the diagnosis of appendiceal inflammation.

Dyspnea is the subjective sensation of difficult or uncomfortable breathing, ranging from mild to severe. It can result from respiratory, cardiac, neuromuscular, or systemic conditions, with onset and pattern helping to distinguish underlying causes.

STEMI/AMI is a medical emergency caused by the complete or partial occlusion of a coronary artery and requires prompt hospitalization and intensive care intervention management.

Paroxysmal nocturnal dyspnea is a sudden, frightening attack of breathlessness that awakens a patient from sleep, often accompanied by coughing, wheezing, sweating, or chest discomfort. It most commonly signals left-sided heart failure, caused by increased pulmonary venous pressure when lying down, and requires prompt evaluation of cardiac and respiratory function.

Propulsive (festinating) gait is a stooped, rigid, forward-leaning gait with short, rapid, shuffling steps, commonly seen in advanced Parkinson’s disease due to basal ganglia degeneration. It can also result from drug-induced extrapyramidal effects, carbon monoxide or manganese toxicity, and rare pediatric neurodegenerative disorders.

Hematuria is the presence of blood in urine, ranging from microscopic to gross, and may indicate renal, urinary tract, or systemic disorders. Evaluation involves history, physical examination, urine testing, and imaging to identify underlying causes and guide management.

Menorrhagia is abnormally heavy or prolonged menstrual bleeding that can signal hormonal, hematologic, or uterine pathology. Early assessment, hemodynamic monitoring, and investigation of underlying causes are essential to prevent complications.

Allis’ sign detects hip pathology: in adults, deep sinking of the fascia lata between the iliac crest and greater trochanter suggests a femoral neck fracture; in infants, unequal knee heights when hips and knees are flexed indicate possible hip dislocation.

A vesicular rash consists of small, fluid-filled lesions (<0.5 cm) that may appear singly or in groups, resulting from infections, inflammation, allergic reactions, burns, or drug reactions, and may be accompanied by systemic symptoms. Management involves identifying the underlying cause, preventing secondary infection, maintaining fluid and electrolyte balance, and symptomatic relief.

Comolli’s Sign is a triangular swelling over the scapula that mirrors its shape, typically indicative of a scapular fracture.

Chronic pulmonary emboli are mainly a consequence of incomplete resolution of acute pulmonary thromboembolism. Clinically symptoms and signs may be preceded by Acute PE for more than two weeks

Hematochezia, the passage of blood per rectum, often indicates lower GI bleeding but may arise from rapid upper GI hemorrhage. Prompt evaluation and stabilization are crucial, with causes ranging from anal fissures and colitis to malignancy and vascular lesions.

Breast pain is usually due to benign conditions like fibrocystic changes, infections, or hormonal shifts, rather than cancer. It can be cyclic or constant, affecting one or both breasts, and may radiate to the arms, back, or neck.

Impotence is the inability to achieve or maintain an erection sufficient for sexual intercourse and may have psychological, neurologic, hormonal, or vascular causes. Diagnosis involves a detailed psychosocial and medical history, physical examination, and targeted investigations to guide individualized therapy.

Dystonia is characterized by slow, involuntary, twisting movements of large muscle groups, often aggravated by stress and relieved by sleep. It may be hereditary, idiopathic, or secondary to neurological disorders or certain drugs.

Grasp reflex: Reflexive flexion of the fingers when the palm is touched and of the toes when the sole is touched. Normally present in infants from 26–28 weeks’ gestation; absence, weakness, or asymmetry may indicate CNS injury or depression. In adults, it is abnormal and suggests premotor cortex dysfunction.

Langoria’s sign is relaxation of the thigh and hip extensor muscles due to an intracapsular femoral fracture. It is elicited by palpating the gluteus maximus and hamstrings in the prone position, with greater softness noted on the affected side.

Complex partial seizures are focal seizures, usually originating in the temporal lobe, causing altered consciousness, automatisms, and postictal confusion. Management involves ensuring patient safety, diagnosing with EEG or imaging, anticonvulsant therapy, and educating patients and families on seizure precautions.

Has a twisting pattern to the QRS complexes and a prolonged QT interval in sinus rhythm It is usually due to a QT–prolonging drug, ± hypokalaemia

Confusion is a state of disorganized thinking or inappropriate behavior that may be sudden or gradual, reversible or permanent. It can result from medical, neurological, metabolic, infectious, or drug-related causes and requires thorough evaluation and patient safety measures.

Bonnet’s sign is a pain produced on adduction of the thigh, suggesting sciatic nerve irritation. It is commonly used in the clinical assessment of sciatica.

In neurology, extinction is the inability to perceive one of two simultaneously presented stimuli, detected by stimulating corresponding areas on both sides of the body; failure to perceive one indicates extinction. In neurophysiology, it refers to loss of excitability of a nerve or synapse, and in psychology, the disappearance of a conditioned reflex due to lack of reinforcement.