Disease and conditions 

Bruits are abnormal vascular sounds caused by turbulent blood flow from conditions like arterial stenosis, aneurysms, or arteriovenous fistulas. They often signal underlying diseases such as atherosclerosis, anemia, or thyrotoxicosis, accompanied by specific clinical symptoms depending on the affected vessel.

An absent or weak pulse may indicate shock, arrhythmia, or acute arterial occlusion, but can also result from benign factors such as palpation pressure or normally faint distal pulses. Rapid assessment of rate, amplitude, and symmetry, plus evaluation of associated symptoms, guides emergency management and identification of underlying causes.

Hallucination is a perception without an external stimulus, occurring while awake. It can affect any sense auditory, visual, olfactory, tactile, or gustatory—and is seen in psychiatric, neurologic, or toxic conditions.

Abdominal pain, originating from various abdominal and pelvic structures, can indicate benign or life-threatening conditions requiring thorough history, physical examination, and timely interventions. Prompt assessment and appropriate diagnostics are essential to guide management and improve patient outcomes.

Polyphagia is excessive or voracious eating often caused by endocrine disorders, psychological conditions, or certain drugs, and may result in weight gain or metabolic complications. Evaluation involves assessing dietary habits, associated symptoms, underlying medical causes, and providing emotional, nutritional, and psychological support tailored to the patient’s needs.

Vertigo is a sensation of spinning or movement, often accompanied by nausea, vomiting, nystagmus, and hearing changes, and may result from neurologic, vestibular, or systemic causes, including inner ear disorders, brainstem pathology, trauma, or drug effects. Evaluation involves detailed history, physical and neurologic examination, diagnostic testing, and patient counseling on safety and symptom management.

Abdominal distention is a clinical sign resulting from increased intra-abdominal pressure due to gas, fluid, masses, or organ dysfunction, potentially indicating life-threatening conditions such as bowel obstruction or peritonitis. Timely assessment, including physical examination, imaging, and laboratory testing, is critical for diagnosis and management in clinical practice.

Bladder distention is the abnormal enlargement of the bladder due to urine retention, often caused by obstruction, neurologic disorders, or medications. It presents with suprapubic pain, difficulty urinating, and may require emergency catheterization to prevent complications.

Opisthotonos is a severe, involuntary muscle spasm causing arching of the back, hyperextension of the neck, and flexion of the limbs, typically indicating meningeal irritation. It is most commonly caused by meningitis, tetanus, subarachnoid hemorrhage, or Arnold-Chiari syndrome and requires urgent neurologic assessment and supportive care.

Dizziness results from disrupted integration of vestibular, visual, and proprioceptive inputs or reduced cerebral perfusion, causing imbalance or faintness. Vertigo specifically arises from vestibular system dysfunction, producing a false sensation of spinning or motion.

Myoclonus consists of sudden, involuntary muscle jerks caused by hyperexcitability of cortical, subcortical, or spinal neurons and may signal neurologic disease or impending seizures. Early evaluation, seizure precautions, and management of underlying causes are essential for patient safety and optimal outcomes.

Spastic (hemiplegic) gait is a stiff, foot-dragging walk caused by unilateral corticospinal tract damage, often following flaccidity, with compensatory pelvic tilt and circumduction of the affected leg. Its presence signals underlying neurologic disorders such as stroke, brain tumor, multiple sclerosis, or cerebral palsy, and requires careful assessment and targeted rehabilitation.

Joffroy’s sign is immobility of the facial muscles when the eyes rotate upward, seen in Graves’ disease with exophthalmos. It may also indicate early organic brain disorder when associated with inability to perform simple mathematics.

Battle’s sign, bruising behind the ear, is a key clinical indicator of a basilar skull fracture and may be the only visible sign. Prompt recognition, neurologic assessment, and imaging are critical to prevent complications.

Goldthwait’s sign: Pain elicited during leg raising or pressure maneuvers to distinguish sacroiliac joint irritation from lumbosacral pathology. Pain during leg raising suggests sacroiliac joint involvement; pain only with lumbar pressure suggests lumbosacral origin.

Constipation can arise from various medical conditions including anorectal, metabolic, neurological, and gastrointestinal disorders, each with unique clinical features. It may also result from medications, diagnostic tests, surgery, or radiation, requiring thorough evaluation for effective management.

Visible peristaltic waves are rippling movements across the abdomen that occur when the gut contracts forcefully, often in response to an obstruction in the stomach or intestines. They may also be seen in thin or malnourished patients, but when linked with pain, vomiting, or distention, they suggest pyloric or bowel obstruction and require prompt assessment and treatment.

Dysphagia is a symptom of impaired swallowing caused by structural, neuromuscular, infectious, malignant, or systemic conditions, often classified by the swallowing phase affected.
Recognizing distinguishing features of each cause is essential for timely diagnosis, prevention of aspiration, and appropriate management.

Malingering is the intentional exaggeration or feigning of symptoms to avoid responsibilities or gain attention or other benefits.

Fecal breath odor, typically seen in conditions like intestinal obstruction or gastrojejunocolic fistula, signals a potentially life-threatening GI disorder. Immediate evaluation and emergency interventions, including possible surgery, are crucial for managing this condition.

Codman’s sign is a shoulder pain appearing when support is withdrawn during passive abduction, indicating supraspinatus tendon rupture. The sign is positive if pain arises only as the deltoid contracts.

Kussmaul’s respirations are deep, rapid, and sighing breaths, typically associated with diabetic ketoacidosis.

Illusion is a misperception of real external stimuli, often visual or auditory. It occurs in normal individuals as well as in schizophrenia and toxic states.

Delirium is an acute onset of confusion with restlessness, agitation, incoherence, and sometimes hallucinations; commonly triggered by drugs, metabolic disturbances, infections, or neurologic injury.

Polyphagia is excessive or voracious eating often caused by endocrine disorders (e.g., diabetes mellitus), psychological conditions (e.g., anxiety, bulimia), hormonal changes (e.g., PMS), or certain drugs, and may lead to weight changes. Evaluation involves dietary history, physical examination (including weight and thyroid assessment), identification of underlying medical or emotional causes, and appropriate counseling or referral for nutritional and psychological support.

Splenomegaly, an enlarged spleen, is a nonspecific finding that may indicate infection, hematologic, hepatic, autoimmune, or neoplastic disorders, and requires careful palpation and imaging for accurate assessment. Evaluating associated symptoms—fatigue, infections, bruising, abdominal fullness—and monitoring for complications like splenic rupture are essential for diagnosis and management.

Nipple retraction is an inward pulling of the nipple below the surrounding breast surface, most often due to scarring from cancer, duct ectasia, abscess, or mastitis. Diagnosis relies on careful history, inspection in several arm positions, palpation for subareolar masses, and appropriate imaging or biopsy to rule out malignancy.

Absent or decreased breath sounds are a critical bedside finding that often signal serious pulmonary or pleural disease. Systematic auscultation, coupled with percussion and imaging, is essential to detect and treat underlying causes promptly, improving outcomes in both acute and chronic respiratory conditions.

An abdominal mass is a localized swelling that may indicate serious underlying pathology, including neoplasms, organomegaly, or vascular anomalies like an aortic aneurysm. Prompt evaluation through thorough clinical examination and appropriate imaging is essential for accurate diagnosis and management.

Muscle spasms are sudden, painful contractions often caused by fatigue, electrolyte imbalances, or neuromuscular disorders. Early recognition, supportive care, and stretching exercises are key to symptom relief and prevention of complications.

Headache is the most common neurological symptom; about 90% of headaches are benign (migraine, tension-type, cluster), but some signal life-threatening disease such as intracranial hemorrhage, meningitis or acute angle-closure glaucoma. Assessment focuses on red flags, a careful history and a neurological examination to decide who needs urgent investigation and referral.

Cardiovascular disease (CVD) prevention is a coordinated set of actions, at the population level or targeted at an individual at risk of developing cardiovascular disease, that are aimed at eliminating or minimizing the impact of CVDs and their related disabilities.

Kleist’s sign is the flexion or “hooking” of the fingers when passively raised, indicating frontal lobe or thalamic lesions. It is elicited by turning the patient’s palms down and gently raising the fingers.

Bozzolo’s sign is a visible pulsation of arteries in the nasal mucosa, occasionally indicating a thoracic aortic aneurysm. Detection is done by examining the nostrils with a speculum and light.

Lichtheim’s sign is the inability to speak seen in subcortical aphasia. Patients can, however, indicate the number of syllables in a word using their fingers.

Photopsias (light flashes) are warning signs of possible retinal detachment or other ocular/neurologic disorders. Any new or sudden flashes warrant urgent eye examination to prevent permanent vision loss.

Laugier’s sign is an abnormal alignment of the radial and ulnar styloid processes due to a distal radius fracture. The radial styloid may migrate proximally, becoming level with the ulnar styloid, unlike the normal distal position.

Eye discharge is a common sign of ocular or systemic disease, ranging from serous to purulent secretions, and may indicate infections, inflammation, or systemic conditions. Early identification of the cause and prompt management are critical to prevent vision-threatening complications.

Abdominal rigidity is a critical clinical sign indicating possible life-threatening intra-abdominal conditions like peritonitis or ruptured aneurysm. Prompt recognition, differentiation from voluntary guarding, and emergency intervention are essential for patient survival.

Extrapyramidal signs and symptoms are movement and posture disturbances caused by basal ganglia or cerebellar disorders, including asynergy, ataxia, athetosis, blepharoclonus, chorea, dysarthria, dysdiadochokinesia, dystonia, muscle rigidity, spasticity, myoclonus, spasmodic torticollis, and tremors. These signs reflect dysfunction in motor control pathways outside the pyramidal tracts.