症状与体征

症状与体征 PHYSICAL SYMPTOMS AND EPONYMS Allen’s Test: (See Chapter 13, page 246.) Apley’s Test: Determination of meniscal tear in the knee by grinding the joint manually Argyll–Robertson Pupil: Bilaterally small, irregular, unequal pupils that react to accommodation but not to light. Seen with tertiary syphilis Austin Flint Murmur: Late diastolic mitral murmur; associated with aor1ic insufficiency with a normal mitral valve Babinski’s Sign: Extension of the large toe with stimulation of the plantar surface of the foot instead of the normal flexion; indicative of upper motor neuron disease (normal in neonates) Bainbridge’s Reflex: Increased heart rate due to increased right atrial pressure Battle’s Sign: Ecchymosis behind the ear associated with basilar skull fractures. Beau’s Lines: Transverse depressions in nails due to previous systemic disease Beck’s Triad: JVD, diminished or muffled heart sounds, and decreased blood pressure associated with cardiac tamponade Bell’s Palsy: Lower motor neuron lesion of the facial nerve affecting muscles of upper and lower face. Easily distinguished from upper motor lesions, which affect predominately muscles of lower face since upper motor neurons from each side innervate muscles on both sides of the upper face Bergman’s Triad: Altered mental status, petechiae, and dyspnea associated with fat embolus syndrome Biot’s Breathing: Seen with brain injury; abruptly alternating apnea and equally deep breaths Bisferious Pulse: A double-peaked pulse seen in severe chronic aortic insufficiency Bitot’s Spots: Small scleral white patches suggesting vitamin A deficiency Blumberg’ Sign: Pain felt in the abdomen when steady constant pressure is quickly released. Seen with peritonitis Blumer’s Shelf: Hardness palpable on rectal examination due to metastatic cancer of the rectouterine (pouch of Douglas) or rectovesical pouch Bouchard’s Nodes: Hard, nontender, painless nodules in the dorsolateral aspects of the proximal interphalangeal joints associated with osteoarthritis. Results from hypertrophy of the bone Branham’s Sign: With large AV fistulas, abrupt slowing of the heart rate with compression of the feeding artery Brudzinski’s Sign: Flexion of the neck causing flexion of the hips in meningitis Chadwick’s Sign: Bluish color of cervix and vagina, seen with pregnancy Chandelier’s Sign: Extreme pain elicited with movement of the cervix during bimanual pelvic examination. Indicates PID Charcot’s Triad: Right upper quadrant pain, fever (chills), and jaundice associated with cholangitis Cheyne–Stokes Respiration: Repeating cycle of a gradual increase in depth of breathing followed by a gradual decrease to apnea; seen with CNS disorders, uremia, some normal sleep patterns Chvostek’s Sign: Tapping over the facial nerve causes facial spasm in hypocalcemia (tetany). May be normal finding in some patients Corrigan’s Pulse: A palpable hard pulse immediately followed by sudden collapse, seen in aortic regurgitation Cullen’s Sign: Ecchymosis around the umbilicus associated with severe intraperitoneal bleeding. Seen with ruptured ectopic pregnancy and hemorrhagic pancreatitis Cushing’s Triad: Hypertension, bradycardia, and irregular respiration associated with increased intracranial pressure Darier’s Sign: Stroking of the skin causes erythema and edema in mastocytosis Doll’s Eyes: Conjugated movement of eyes in one direction as head is briskly turned in the other direction in comatose patients. Tests oculocephalic reflex indicating intact brain stem Drawer Sign: Forward (or backward) movement of the tibia with pressure, indicating laxity or a tear in the anterior (or posterior) cruciate ligament Dupuytren’s Contracture: Proliferation of fibrosis tissue of the palmar fascia resulting in contracture of the fourth and/or fifth digits, which is often bilateral. May be hereditary or seen in patients with chronic alcoholic liver disease or seizures Duroziez’s Sign: Found in aortic regurgitation a “to and fro” murmur when stethoscope is pressed over the femoral artery Electrical Alternans: Beat to beat variation in the electrical axis, seen in large pericardial effusions, suggests impending hemodynamic compromise Ewart’s Sign: Dullness to percussion, increased fremitus and bronchial breathing beneath the angle of the left scapula found with pericardial effusion Fong Lesion/Syndrome: Autosomal-dominant anomalies of the nails and patella associated with renal abnormalities Frank’s Sign: Fissure of the ear lobe; may be associated with CAD, diabetes, and hypertension Gibbus: Angular convexity of the spine due to vertebral collapse; associated with osteoporosis or metastasis Gregg’s Triad: Cataracts, heart defects, and deafness with congenital rubella Grey Turner’s Sign: Ecchymosis in the flank associated with retroperitoneal hemorrhage Grocco’s Sign: Triangular area of paravertebral dullness, opposite side of a pleural effusion Heberden’s Nodes: Hard, nontender, painless nodules on the dorsolateral aspects of the distal interphalangeal joints associated with osteoarthritis. Results from hypertrophy of the bone Hegar’s Sign: Softening of the distal uterus. Reliable early sign of pregnancy Hellenhorst’s Plaque: A cholesterol plaque on retina seen on funduscopic examination associated with amaurosis fugax Hill’s Sign: Femoral artery pressure 20 mm Hg greater than brachial pressure seen in severe aortic regurgitation Hoffmann’s Sign/Reflex: Flicking of the volar surface of the distal phalanx causing fingers to flex; associated with pyramidal tract disease Homans’ Sign: Calf pain with forcible dorsiflexion of the foot, associated with venous thrombosis Horner’s Syndrome: Unilateral miosis, ptosis, and anhidrosis (absence of sweating). From destruction of ipsilateral superior cervical ganglion often from lung carcinoma, especially squamous cell carcinoma Janeway’s Lesion: Erythematous or hemorrhagic lesion seen on the palm or sole with subacute bacterial endocarditis Joffroy’s Reflex: Inability to wrinkle the forehead when patient asked to bend head and look up, seen in hyperthyroidism Kayser–Fleischer Ring: Brown pigment lesion due to copper deposition seen in Wilson’s disease Kehr’s Sign: Left shoulder and left upper quadrant pain associated with splenic rupture Kernig’s Sign: When the thigh is flexed at a right angle, complete extension of the leg is not possible because of inflammation of the meninges; seen with meningitis Koplik’s Spots: White papules on buccal mucosa opposite molars seen in measles Korotkoff’s Sounds: Low-pitched sounds resulting from vibration of the artery, detected when obtaining a blood pressure using the bell of the stethoscope. The last Korotkoff sound may be a more accurate estimate of the true diastolic blood pressure than the diastolic blood pressure obtained using the diaphragm. Kussmaul’s Respiration: Deep, rapid respiratory pattern seen in coma or DKA Kussmaul’s Sign: Paradoxical rise in the jugular venous pressure on inspiration in constrictive pericarditis or COPD 1 History and Physical Examination 25 Kyphosis: Excessive rounding of the thoracic spinal convexity, associated with aging, especially in women Lasegue’s Sign/Straight-Leg-Raising Sign: The patient is extended in the supine position and raises the leg gently. Pain in the distribution of nerve root suggests sciatica. Levine’s Sign: Clenched fist over the chest while describing chest pain; associated with angina and AMI Lhermitte’s Sign: In MS, neck flexion results in a “shock sensation.” List: Lateral tilt of the spine, frequently associated with herniated disk and muscle spasm Lordosis: Accentuated normal concavity of the lumbar spine, normal in pregnancy Louvel’s Sign: Coughing or sneezing causes pain in the leg with DVT Marcus–Gunn Pupil: Dilation of pupils with swinging flashlight test. Results from unilateral optic nerve disease. Normal pupillary response is elicited when light is directed from the normal eye and a subnormal response when light is quickly directed from the normal eye into the abnormal eye. When light is directed into the abnormal eye, both pupils dilate rather than maintain the previous degree of miosis. McBurney’s Point/Sign: Point located one-third of the distance from the anterior superior iliac spine to the umbilicus on the right; tenderness at the site is associated with acute appendicitis. McMurray’s Test: External rotation of the foot produces a palpable or audible click on the joint line, suggesting medial meniscal injuries Mobius’ Sign:Weakness of convergence seen in thyrotoxicosis Moro’s Reflex (Startle Reflex): Abduction of hips and arms with extension of arms when infant’s head and upper body is suddenly dropped several inches while being held. Normal reflex in early infancy Murphy’s Sign: Severe pain and inspiratory arrest with palpation of the right upper quadrant during deep inspiration; associated with cholecystitis Musset’s or de Musset’s Sign: Rhythmic nodding or movement of the head with each heart beat caused by blood flow back into the heart in aortic insufficiency Obturator Sign: Flexion and internal rotation of the thigh elicits hypogastric pain in cases of inflammation of the obturator internus; positive with pelvic abscess and appendicitis Ortolani’s Test/Sign: Sign is hip click that suggests congenital hip dislocation. With the infant supine, point the legs toward you and flex the legs to 90 degrees at the hips and knees. Osler’s Node: Tender, red, raised lesions on the hands or feet seen with SBE. Pancoast’s Syndrome: Carcinoma involving apex of lung, resulting in arm and or shoulder pain from involvement of brachial plexus and Horner’s syndrome from involvement of the superior cervical ganglion Pastia’s Lines: Linear striations of confluent petechiae in axillary folds are antecubital fossa seen in scarlet fever Phalen’s Test: Prolonged maximum flexion of wrists while opposing dorsum of each hand against each other. A positive test results in pain and tingling in the distribution of the median nerve, indicating carpal tunnel syndrome Psoas Sign (Iliopsoas Test): Flexion against resistance or extension of the right hip, producing pain; seen with inflammation of the psoas muscle; positive with appendicitis. Pulsus Alternans: Fluctuation of pulse pressure with every other beat. Seen in aortic stenosis and CHF Queckenstedt’s Test: Tests patency of the subarachnoid space; compression of the internal jugular vein during lumbar puncture; should normally immediately raise CSF pressure 26 Clinician’s Pocket Reference, 9th Edition Quincke’s Sign: Alternating blushing and blanching of the fingernail bed following light compression; seen in chronic aortic regurgitation Radovici’s Sign: A frontal release sign, scratching palm causes chin contractions Raynaud’s Phenomenon/Disease: Pain and tingling in fingers after exposure to cold with characteristic color changes of white to blue and then often red. May be seen with scleroderma, and SLE Romberg’s Test: Used to test position sense or cerebellar function. The patient stands with heels and toes together. Arms may be outstretched with palms facing upward or down or arms can be at the patient’s side. The patient may be lightly tapped by the examiner with the eyes open and then closed. A positive test is a loss of balance. A loss of balance with the eyes open indicates cerebellar dysfunction. Normal balance with eyes open and loss of balance with eyes closed indicates loss of position sense. Roth’s Spots: Oval retinal hemorrhages with a pale central area occurring in patients with bacterial endocarditis Rovsing’s Sign: Pain in the right lower quadrant with deep palpation of the left lower quadrant. Seen in acute appendicitis Schmorl’s Node: Degeneration of the intervertebral disk resulting in herniation into the adjacent vertebral body Scoliosis: Lateral curvature of the spine Sentinel Loop: A single dilated loop of small or large bowel, usually occurs localized inflammation such as pancreatitis Sister Mary Joseph’s Sign/Node: Metastatic cancer to umbilical lymph node Stellwag’s Sign: Infrequent ocular blinking Tinel’s Sign: Radiation of an electric shock sensation in the distal distribution of the median nerve elicited by percussion of the flexor surface of the wrist when fully extended. Seen in carpal tunnel syndrome Traube’s Sign: Booming or pistol shot sounds heard over the femoral arteries in chronic aortic insufficiency Trendelenburg’s Test: Observe patient from behind while patient shifts weight from one leg to the other; a pelvis tilt to opposite side suggests hip disease and weakness of the gluteus medius muscle. If normal, pelvis will not tilt. Trousseau’s Sign: Carpal spasm produced by inflating a blood pressure cuff above the systolic pressure for 2–3 min, indicates hypocalcemia; also migratory thrombophlebitis associated with cancer Turner’s Sign: See Grey Turner’s sign Virchow’s Node (Signal or Sentinel Node): A palpable, left supraclavicular lymph node; often first sign of a GI neoplasm, such as pancreatic or gastric carcinoma von Graefe’s Sign: Lid lag associated with thyrotoxicosis Weber–Rinne Test: For the Weber test a 512- or 1024-Hz tuning fork is placed on the middle of the skull to determine if the sound lateralizes. For the Rinne test, the tuning fork is held against the mastoid process (BC) with the opposite ear covered. The patient indicates when the sound is gone. The tuning fork is then held next to the ear and the patient indicates whether the sound is present and when the sound (AC) disappears. Normally AC is better than BC. With sensorineural hearing loss, the Weber test lateralizes to the less affected ear and AC > BC; with conduction hearing loss, the Weber test lateralizes to the more affected ear and BC > AC. Whipple’s Triad: Hypoglycemia, CNS, and vasomotor symptoms (ie, diaphoresis, syncope); relief of symptoms with glucose; associated with insulinoma 1 History and Physical Examination 27