Disease and conditions 

Anhidrosis is the absence or reduction of sweating, which can be localized or generalized and may result from neurologic, skin disorders, or certain drugs. Severe cases, like heatstroke, require urgent cooling and supportive care to prevent life-threatening complications.

Cherry-red spot is a red circular area at the fovea centralis surrounded by a pale or grayish retina, visible on ophthalmoscopic examination; commonly associated with Tay-Sachs disease and other sphingolipidoses.

The setting sun sign is a late indicator of increased intracranial pressure in infants, marked by downward eye deviation with visible scleral rim above the irises. Management includes urgent evaluation of ICP causes, supportive care, and preparing for interventions such as diuretics, shunting, or surgery.

A breast ulcer, often a late sign of cancer, can result from trauma, infection, or radiation. It requires careful evaluation of patient history, physical examination, and appropriate diagnostic tests to determine the underlying cause and guide treatment.

Visible peristaltic waves are early signs of intestinal obstruction, appearing as rolling movements across the abdomen due to increased intestinal contractions. Detection involves careful inspection and auscultation, with prompt evaluation and treatment to prevent complications like dehydration and bowel compromise.

Increased capillary refill time indicates impaired peripheral perfusion and can result from conditions such as arterial occlusion, aortic aneurysm, cardiac tamponade, or Raynaud’s disease. It may also arise from external factors like vasoconstrictive drugs, trauma, or improper medical devices.

Depression is a mood disorder marked by persistent sadness, loss of interest, and impaired daily functioning. It requires timely diagnosis, risk assessment for suicide, and combined medical and psychological treatment for recovery.

Urinary urgency is a sudden, compelling need to void, most often linked to urinary tract infections but also to neurologic, structural, or inflammatory conditions. Diagnosis requires targeted history, urinalysis, and neurologic assessment, with treatment directed at the underlying cause and patient education on hygiene and bladder control.

These are chronic acquired sequelae of Acute Rheumatic Fever or Acute Sequelae of Infective Endocarditis or Ischaemic Heart Disease, consisting of valvular damage, usually left heart valves, with varied progression of severity and complications.

Metrorrhagia is irregular uterine bleeding occurring between menstrual periods and may signal underlying gynecologic disorders. Careful history, physical examination, and investigation are essential to determine cause and guide management.

Dysphonia is a hoarseness or difficulty producing voice sounds, which may result from laryngeal disorders, vocal cord overuse or spasm, laryngeal nerve injury, or central nervous system conditions such as Parkinson’s disease. Pubertal voice changes are specifically termed dysphonia puberum.

Urethral discharge is an excretion from the male urinary meatus that may be purulent, mucoid, thin, or clear, often arising from prostatitis, urethritis, or sexually transmitted infections. Diagnosis relies on patient history, physical examination, urine tests, and urethral discharge culture, with treatment targeting the underlying cause.

Barré’s sign is a delayed pupillary (iris) contraction observed in patients with mental deterioration, reflecting possible central nervous system involvement.

Braunwald’s sign is a weak pulse occurring immediately after a premature ventricular contraction, suggesting idiopathic hypertrophic subaortic stenosis.

Duroziez’s sign is a double murmur heard over a large peripheral artery, typically the femoral artery. On auscultation, proximal compression produces a systolic murmur, while distal compression produces a diastolic murmur. This finding is an indicator of aortic insufficiency and is also called Duroziez’s murmur.

Patients who have had HF as defined above for some time are often said to have ‘Chronic Heart Failure’. A treated patient with symptoms and signs that have remained generally unchanged for at least 1 month is said to be ‘Stable chronic heart failure’

Nuchal rigidity is neck stiffness that prevents flexion, often signaling meningeal irritation from meningitis or subarachnoid hemorrhage, though it can also result from cervical arthritis, encephalitis, or listeriosis.
Evaluation includes history, careful neck examination, assessment of meningeal signs, neurologic status, and imaging, while management focuses on urgent diagnosis, monitoring for increased intracranial pressure, and treating the underlying cause.

A widened pulse pressure (>50 mm Hg) may result from physiologic states like fever or exercise, or pathologic conditions such as aortic insufficiency, arteriosclerosis, or increased intracranial pressure, and can indicate serious cardiovascular or neurologic compromise. Prompt recognition, monitoring, and treatment of underlying causes are crucial to prevent complications.

A pustular rash consists of pus-filled lesions that can be localized or widespread, often arising from infections, inflammatory skin disorders, or drug reactions. It may be associated with conditions like acne, folliculitis, impetigo, pustular psoriasis, or viral infections, and requires evaluation of underlying causes, infection control, and symptomatic management.

Loss of the gag reflex signals disruption of cranial nerves IX/X or brainstem function, placing patients at high risk of aspiration. Rapid airway protection, swallowing assessment, and neurologic evaluation are essential.

Loose association is a thought disorder where speech lacks logical connections between ideas. It is commonly seen in schizophrenia, bipolar disorder, and other psychotic conditions.

Hearing loss affects millions worldwide and may be temporary or permanent, partial or complete, involving low-, middle-, or high-frequency tones. Early identification is critical for optimal patient outcomes, especially in children and older adults.

Arthralgia is a pain in one or more joints, which may be benign or associated with disorders such as arthritis, autoimmune disease, or systemic lupus erythematosus.

Priapism is a persistent, painful penile erection unrelated to sexual stimulation, often caused by sickle cell anemia, penile cancer, spinal cord injury, stroke, or certain drugs. It is a urologic emergency requiring prompt interventions to prevent ischemia and preserve erectile function.

Ortolani’s sign is a palpable or audible click when a neonate’s hip is flexed and abducted, indicating developmental dysplasia of the hip (DDH). Early detection within the first 4–6 weeks allows effective treatment with abduction devices or casting to ensure normal hip development.

Generalized edema is the widespread accumulation of interstitial fluid throughout the body, often resulting from cardiac, renal, hepatic, endocrine, or nutritional disorders. Its severity ranges from mild, barely noticeable swelling to massive anasarca, frequently accompanied by weight gain, dyspnea, and skin changes.

Dyspepsia is a condition characterized by upper abdominal discomfort, including bloating, early satiety, and epigastric pain, often related to meals. It may result from functional disorders, peptic ulcers, GERD, or medication effects, and requires evaluation to rule out serious pathology.

Circumstantiality is a speech in which the main point is obscured by excessive, unnecessary detail; the speaker eventually returns to the point, commonly seen in schizophrenia, compulsive disorders, and organic brain disorders.

Bell’s sign (Bell’s phenomenon) is a reflexive upward and outward deviation of the eyes when attempting to close the eyelid, observed on the affected side in Bell’s palsy, indicating a supranuclear defect.

Dysdiadochokinesia is a difficulty in performing rapidly alternating movements, such as pronation and supination of the hands or tapping the foot. It reflects an impaired ability to stop one movement and initiate another. This sign commonly occurs in cerebellar disorders and may also be seen in basal ganglia dysfunction.

Euphoria is an intense feeling of happiness or well-being. When it occurs without appropriate cause, such as meaningful achievements or profound experiences, it may be pathological. Euphoria can be seen in bipolar disorder, organic brain disease, or as a result of substance use (e.g., heroin, cocaine, amphetamines).

Aphonia is a complete loss of the ability to produce speech sounds, commonly caused by laryngeal disorders, vocal cord overuse, nerve injury, muscle spasm, or functional (psychogenic) disturbances.

Dysarthria is a motor speech disorder resulting from neurological injury affecting speech muscles, with diverse etiologies including degenerative diseases, stroke, toxins, and infections. Diagnosis requires detailed neurologic and speech assessment, and management involves treating underlying causes and supportive rehabilitation.

Bradycardia is defined as a heart rate under 60 beats/min; it may be physiological or pathologic, often requiring evaluation for cardiac, metabolic, or drug-related causes. When symptomatic—manifesting as syncope, chest pain, or dyspnea—it necessitates urgent assessment and potentially life-saving interventions.

Aphasia is a language disorder caused by damage to the brain's language centers, affecting speech comprehension and expression, with various types including Broca’s, Wernicke’s, anomic, and global aphasia. It often results from conditions like stroke, head trauma, brain tumors, or infections, and requires careful clinical assessment and supportive communication strategies.

Hyperesthesia is an abnormal increase in sensitivity to touch, temperature, or pain. It may indicate nerve or central nervous system disorders.

Absent doll’s eye sign is a vital neurological bedside test indicating brainstem integrity. It assists in localizing lesions, assessing coma severity, and guiding further diagnostic and therapeutic interventions.

Costovertebral angle (CVA) tenderness is a key clinical sign indicating renal capsular distention, often from infection, obstruction, or vascular compromise. Accurate elicitation and interpretation help in early diagnosis of serious renal conditions such as pyelonephritis or renal calculi.

Unstable angina is a medical emergency and if untreated can progress to Non-ST Elevation Myocardial Infarction (NSTEMI) 11, 12, 13.

Galant’s reflex: Lateral stroking of a neonate’s back elicits pelvis movement toward the stimulated side; normally present at birth and disappears by 2 months. Absence or asymmetry may indicate a spinal cord lesion (T1–S1).