Borchers Andrea Ann (ed.) Handbook of Signs & Symptoms 2015

recti abdominis muscles associated with lesions at T10.

Bell’s sign Reflexive upward and outward deviation of the eyes that occurs when the patient attempts to close the eyelid. It occurs on the affected side in Bell’s palsy and indicates that the defect is supranuclear. Also known as Bell’s phenomenon.

Bárány’s sign With warm water irrigation of the ear, rotary nystagmus toward the irrigated side; with cold water irrigation, rotary nystagmus away from the irrigated side. Absence of this symptom indicates labyrinthine dysfunction. This is also called the

caloric test.

Bezold’s sign Swelling and tenderness of the mastoid area. Resulting from formation of an abscess beneath the sternocleidomastoid muscle, Bezold’s sign indicates mastoiditis.

BEZOLD’S SIGN

Bitot’s spots Triangular white or foamy gray spots, varying from a few bubbles to a frothy white coating. Appearing on the conjunctiva at the lateral margin of the cornea, they’re associated with vitamin A deficiency.

blepharoclonus Excessive blinking of the eyes. This extrapyramidal sign occurs with disorders of the basal ganglia and cerebellum.

blocking A cognitive disturbance resulting in interruption of a stream of speech or thought. It usually occurs in midsentence or before completion of a thought. Generally, the patient is unable to explain the interruption. Blocking may occur in normal individuals but most commonly occurs in schizophrenics.

Bonnet’s sign Pain on adduction of the thigh, seen in sciatica.

Bozzolo’s sign Pulsation of arteries in the nasal mucous membrane, seen occasionally with thoracic aortic aneurysms. To detect this sign, examine both nostrils using a speculum and light.

bradykinesia Slowness of all voluntary movement and speech, believed to be due to a reduced level of dopamine to the neurons in the brain stem region. Normal function within the central

nervous system is inhibited. Bradykinesia is most frequently associated with parkinsonism or extrapyramidal or cerebellar disorders. It can also result from certain drugs. Patients displaying bradykinesia are usually older than age 50, but it may also occur in children who have suffered hypoxic accidents. Associated findings include tremor and muscle rigidity.

Braunwald’s sign Occurrence of a weak pulse rather than a strong pulse immediately after a premature ventricular contraction (PVC). To detect this sign, watch for a PVC during cardiac monitoring, and check the quality of the pulse after it. Braunwald’s sign may indicate idiopathic hypertrophic subaortic stenosis.

breath sounds, absent or decreased Absent or diminished loudness of breath sounds detected by auscultation. This may reflect reduced airflow to a lung segment caused by a tumor, foreign body, mucus plug, or mucosal edema. It may also reflect hyperinflation of the lungs in emphysema or an asthma attack. Or, it may indicate air or fluid in the pleural cavity from a pneumothorax, hemothorax, pleural effusion, atelectasis, or empyema. In an obese or extremely muscular patient, breath sounds may be diminished or inaudible because of increased thickness of the chest wall.

Broadbent’s inverted sign Pulsations in the left posterolateral chest wall during ventricular systole. To detect this sign, palpate the patient’s chest with your fingers and palm over areas of visible pulsation while auscultating for ventricular systole. When you feel pulsations, note their rate, rhythm, and intensity. This sign may indicate gross dilation of the left atrium.

Broadbent’s sign Visible retraction of the left posterior chest wall (back) near the 11th and 12th ribs, occurring during systole. To detect this sign, inspect the chest wall while standing at the patient’s right side. Position a strong light so that it casts rays tangential to the skin. While auscultating the heart, watch for retraction of the skin and muscles and determine its timing in the cardiac cycle. Broadbent’s sign may occur in extensive adhesive pericarditis.

C

catatonia Marked inhibition or excitation in motor behavior, occurring in psychotic disorders. Catatonic stupor refers to extreme inhibition of spontaneous activity or movement. Catatonic excitement refers to extreme psychomotor agitation.

Chaddock’s sign Chaddock’s toe sign: extension (dorsiflexion) of the great toe and fanning of the other toes. To elicit this sign, firmly stroke the side of the patient’s foot just distal to the lateral malleolus. A positive sign indicates pyramidal tract disorders. Chaddock’s wrist sign: flexion of the wrist and extension of the fingers. To elicit this sign, stroke the ulnar surface of the patient’s forearm near the wrist. A positive sign occurs on the affected side in hemiplegia. Although Chaddock’s sign signals pathology in children and adults, it’s a normal finding in infants up to age 7 months.

CHADDOCK’S TOE SIGN

cherry-red spot The choroid appearing as a red circular area surrounded by an abnormal graywhite retina. It’s viewed through the fovea centralis of the eye with an ophthalmoscope. A cherryred spot appears in infantile cerebral sphingolipidosis; for example, this spot is detected in more than 90% of patients with Tay-Sachs disease.

circumstantiality Speech in which the main point is obscured by minute detail. Although the speaker may recognize his or her main point and return to it after many digressions, the listener may fail to recognize it. Circumstantiality commonly occurs in compulsive disorders, organic brain disorders, and schizophrenia.

Claude’s hyperkinesis sign Increased reflex activity of paretic muscles, elicited by painful stimuli.

clavicular sign Swelling, puffiness, or edema at the medial third of the right clavicle, most often seen in congenital syphilis.

Cleeman’s sign Slight linear depression or wrinkling of the skin superior to the patella. It usually indicates a femoral fracture with overriding bone fragments.

clenched fist sign The patient’s placement of a clenched fist against the chest. This gesture may be performed by patients with angina pectoris when they’re asked to indicate the location of their pain. The patient’s gesture conveys the constricting, oppressive quality of substernal pain.

clicks Extra, brief, high-frequency heart sounds auscultated during systole or diastole. Ejection clicks occur soon after the first heart sound. Presumably, they result from sudden distention of a dilated pulmonary artery or the aorta or from forceful opening of the pulmonic or aortic valves. Associated with increased pulmonary resistance and hypertension, they occur usually with septal defects or patent ductus arteriosus. To detect ejection clicks best, have the patient sit upright or lie down, and then auscultate the heart with the diaphragm of the stethoscope.Systolic clicks occur most often in mid-to-late systole. They’re characteristic of mitral valve prolapse. A click is heard most distinctly at or medial to the heart’s apex, but it may also be heard at the lower left sternal border. Clicks are heard best using the diaphragm of the stethoscope.

clonus Abnormal response of a muscle to stretching. It is a sign of damage to nerve fibers that

carry impulses to a particular muscle from the motor cortex. Usually, a muscle that is stretched responds by contracting once and then relaxing. In clonus, stretching sets off a series of contractions of the muscle or muscles in rapid succession. Clonus-like, or clonic, muscle contractions are also a feature of seizures in grand mal epilepsy.

Codman’s sign Pain resulting from rupture of the supraspinatus tendon. To elicit this sign, have the patient relax the arm on the affected side while you abduct it. If the patient reports no pain until you remove your support and the deltoid muscle contracts, you’ve detected Codman’s sign.

cognitive dysfunction Inability to perceive, organize, and interpret sensory stimuli and to think and solve problems. It may arise from various causes, including central nervous system disturbances, extrapyramidal conditions, systemic illness, endocrine diseases, deficiency states, or from unknown etiology, as in chronic fatigue syndrome.

Comolli’s sign Triangular swelling over the scapula that matches its shape. This sign indicates scapular fracture.

complementary opposition sign Increased effort in lifting a paretic leg, demonstrated in the opposite leg. To elicit this sign, help the patient into a supine position, and place your hand under the heel of the unaffected leg. Then ask the patient to lift the paretic leg. If his or her effort produces marked downward pressure on your hand, you’ve detected this sign. Also known as

Grasset-Gaussel-Hoover sign.

compulsion Stereotyped, repetitive behavior in which the individual recognizes the irrationality of his or her actions but is unable to stop them. An example is constant hand washing. Compulsion occurs in obsessive-compulsive disorders and occasionally in schizophrenia.

confabulation Fabrication to cover gaps in memory. The recounts are generally plausible and detailed. Confabulation is most often seen in alcoholism and Korsakoff’s syndrome and in those with dementia, lead poisoning, or head injuries.

conjunctival paleness Lack of color in the tissues inside the eyelid. Although the conjunctiva is a transparent mucous membrane, the portion lining the eyelids normally appears pink or red because it overlies the vasculature of the inner lid. Pale conjunctiva indicates anemia. To detect this sign, separate the eyelids widely by applying gentle pressure against the orbit of the eye. Ask the patient to look up, down, and to each side.

conversion An alteration in physical activity or function that resembles an organic disorder but lacks an organic cause. Occurring without voluntary control, conversion is generally considered symbolic of psychological conflict and usually occurs in conversion disorders.

Coopernail’s sign Ecchymoses on the perineum, scrotum, or labia. This sign indicates pelvic fracture.

Corrigan’s pulse A jerky pulse in which a strong surge precedes an abrupt collapse. To detect this sign, hold the patient’s hand above the head, and palpate the carotid artery. Corrigan’s pulse

occurs in aortic insufficiency. It may also occur in severe anemia, patent ductus arteriosus, coarctation of the aorta, and systemic arteriosclerosis.

Cowen’s sign A jerky consensual pupillary light reflex. To detect this sign, observe for constriction and dilation of one pupil while the other is stimulated by increased and decreased light. This sign occurs in Graves’ disease.

crossed extensor reflex Extension of one leg in response to stimulation of the opposite leg; a normal reflex in neonates. It’s mediated at the spinal cord level and should disappear after age 6 months. To elicit this sign, place the neonate in a supine position with the legs extended. Tap the medial aspect of the thigh just above the patella. The neonate should respond by extending and adducting the opposite leg and fanning the toes of that foot. Persistence of this reflex beyond 6 months of age indicates anoxic brain damage. Its appearance in a child signals a central nervous system lesion or injury.

crowing respirations Slow, deep inspirations accompanied by a high-pitched crowing sound — the characteristic whoop of the paroxysmal stage of pertussis.

Cruveilhier’s sign Swelling in the groin associated with inguinal hernia. To detect this sign, ask the patient to flex one knee slightly while you insert your index finger in the inguinal canal on the same side. When your finger is inserted as deeply as possible, ask the patient to cough. If a hernia is present, you’ll feel a mass of tissue that meets your finger and then withdraws.

Cullen’s sign Irregular, bluish hemorrhagic patches on the skin around the umbilicus and occasionally around abdominal scars. Cullen’s sign indicates massive hemorrhage after trauma or rupture in such disorders as duodenal ulcer, ectopic pregnancy, abdominal aneurysm, gallbladder or common bile duct obstruction, or acute hemorrhagic pancreatitis. Usually, Cullen’s sign appears gradually; blood travels from a retroperitoneal organ or structure to the periumbilical area, where it diffuses through subcutaneous tissues. It may be difficult to detect in a dark-skinned patient. The extent of discoloration depends on the extent of bleeding. In time, the bluish discoloration fades to greenish yellow and then yellow before disappearing.

D

Dalrymple’s sign Abnormally wide palpebral fissures associated with retraction of the upper eyelids. To detect this sign of thyrotoxicosis, observe the eyes while the patient focuses on a fixed point, or ask him or her to close the eyes. There may be infrequent blinking and noticeable restriction of lid movement. The patient may not be able to close the eyes completely.

Darier’s sign Whealing and itching of the skin upon rubbing the macular lesions of urticaria pigmentosa (mastocytosis). To elicit this sign, vigorously rub the pigmented macules with the blunt end of a pen or a similar blunt object. The appearance of pruritic, red, palpable wheals around the macules — a positive Darier’s sign — follows the release of histamine when mast cells are irritated.

Dawbarn’s sign Pain on palpation of the acromial process in acute subacromial bursitis. To elicit

this sign, palpate the patient’s shoulder while the arm hangs at the side and as the patient abducts it. If palpation causes pain that disappears on abduction, you’ve detected Dawbarn’s sign.

Delbet’s sign Adequate collateral circulation to the distal portion of a limb associated with aneurysmal occlusion of the main artery. To detect this sign, check pulses, color, and temperature in the affected limb. If you find absent pulses but normal color and temperature, you’ve detected Delbet’s sign.

delirium Acute confusion characterized by restlessness, agitation, incoherence and, often, hallucinations. Typically, delirium develops suddenly and lasts for a short period. It’s a common effect of drug and alcohol abuse, metabolic disorders, and high fever. Delirium may also follow head trauma or seizure.

delusion A persistent false belief held despite invalidating evidence. A delusion of grandeur, which may occur in schizophrenia and bipolar disorders, refers to an exaggerated belief in one’s importance, wealth, or talent. The patient may take a powerful figure, such as Napoleon, as his persona. In a paranoid delusion, which may occur in schizophrenia and paranoid disorders, the patient believes that he or someone close to him is the victim of an attack, harassment, or conspiracy. In a somatic delusion, which may occur in psychotic disorders, the patient believes that his or her body is diseased or distorted.

Demianoff’s sign Lumbar pain caused by stretching the sacrolumbalis muscle. To elicit this sign, help the patient into a supine position on the examining table and raise the extended leg. Lumbar pain that prevents lifting the leg high enough to form a 10-degree angle to the table — a positive Demianoff’s sign — occurs in lumbago.

denial An unconscious defense mechanism used to ward off distressing feelings, thoughts, wishes, or needs. Denial occurs in normal and pathologic mental states. In terminal illness, it represents the first stage of the response to dying.

depersonalization Perception of the self as strange or unreal. For example, a person may report feeling as if he’s observing himself from a distance. This symptom occurs in patients with schizophrenia and depersonalization disorders and in normal individuals during periods of great stress, fatigue, or anxiety.

Desault’s sign Alteration of the arc made by the greater trochanter upon rotation of the femur; seen in fracture of the intracapsular region of the femur. In this fracture, the greater trochanter rotates only on the axis of the femur, making a much smaller arc than it does upon normal rotation of the femur in the capsule of the hip joint, which normally describes the arc of a circle.

disorientation Inaccurate perception of time, place, or identity. Disorientation may occur in organic brain disorders, cerebral anoxia, and drug and alcohol intoxication. It occurs occasionally after prolonged, severe stress.

Dorendorf’s sign Fullness at the supraclavicular groove. This sign may occur in an aneurysm of the aortic arch.

DORENDORF’S SIGN

Duchenne’s sign Inward movement of the epigastrium during inspiration. This may indicate diaphragmatic paralysis or accumulation of fluid in the pericardium.

Dugas’ sign An indicator of a dislocated shoulder. To detect this sign, ask the patient to place the hand of the affected side on the opposite shoulder and to move the elbow toward the chest. The inability to perform this maneuver — a positive Dugas’ sign — indicates dislocation.

Duroziez’s sign A double murmur heard over a large peripheral artery. To detect this sign, auscultate over the femoral artery, alternately compressing the vessel proximally and then distally. If you hear a systolic murmur with proximal compression and a diastolic murmur with distal compression, you’ve detected Duroziez’s sign — an indicator of aortic insufficiency. It’s also known as

Duroziez’s murmur.

dysdiadochokinesia Difficulty in stopping one movement and starting another and performing rapidly alternating movements. This extrapyramidal sign occurs with disorders of the basal ganglia and cerebellum.

dysphonia Hoarseness or difficulty in producing voice sounds. This sign may reflect disorders of the larynx or laryngeal nerves, overuse or spasm of the vocal cords, or central nervous system disorders, such as Parkinson’s disease. Pubertal changes are termed

dysphonia puberum.

E

echolalia In an adult: repetition of another’s words or phrases with no comprehension of their meaning. This sign occurs in schizophrenia and frontal lobe disorders.In a child: an imitation of sounds or words produced by others.

echopraxia Repetition of another’s movements with no comprehension of their meaning. This sign may occur in catatonic schizophrenia and certain neurologic disorders.

ectropion Eversion of the eyelid. It may affect the lower eyelid or both lids, exposing the

palpebral conjunctiva. If the lacrimal puncta are everted, the eye cannot drain properly and tearing occurs. Ectropion may occur gradually as part of aging but may also occur with injury or paralysis of the facial nerve.

entropion Inversion of the eyelid. It typically affects the lower lid but may also affect the upper lid. The eyelashes may touch and irritate the cornea. Usually associated with aging, entropion may also stem from chemical burns, mechanical injuries, spasm of the orbicularis muscle, pemphigoid, Stevens-Johnson syndrome, and trachoma.

ECTROPION

ENTROPION

epicanthal folds Vertical skin folds that partially or fully obscure the inner canthus of the eye. These folds may make the eyes appear crossed because the pupil lies closer to the inner canthus than to the outer canthus. Epicanthal folds are a normal characteristic in many young children and Asians. They also occur as a familial trait in other ethnic groups and as an acquired trait in aging. However, the presence of epicanthal folds along with oblique palpebral fissures in non-Asian children indicates Down syndrome.

Erben’s reflex Slowing of the pulse when the head and trunk are forcibly bent forward. It may indicate vagal excitability.

Erb’s sign In tetany, increased irritability of motor nerves, detected by electromyography. Erb’s sign also refers to dullness on percussion over the sternum’s manubrium in acromegaly.

Escherich’s sign Contraction of the lips, tongue, and masseters, occurring in tetany. To elicit Escherich’s sign, percuss the inner surface of the lips or the tongue.

euphoria A feeling of great happiness or well-being. When euphoria doesn’t accompany enlightening experiences or superb achievements, it may reflect bipolar disorder, organic brain disease, or use of such drugs as heroin, cocaine, and amphetamines.

Ewart’s sign Bronchial breathing heard on auscultation of the lungs and dullness heard on percussion below the angle of the left scapula. These compression signs commonly occur in pericardial effusion. They also occur beneath the prominence of the sternal end of the first rib in some cases of pericardial effusion.

extensor thrust reflex Extension of the leg upon stimulation of the sole of the foot; a normal reflex in neonates. This reflex is mediated at the spinal cord level and should disappear after 6 months of age.To elicit the extensor thrust reflex, place the neonate in a supine position with the leg flexed.Then stimulate the sole of the foot. If the extensor thrust reflex is present, the leg will slowly extend. In premature neonates, this reflex may be weak. Its persistence beyond age 6 months indicates anoxic brain damage. Its recurrence in a child signals a central nervous system lesion or injury.

extinction In neurology: inability to perceive one of two stimuli presented simultaneously. To detect this sign, simultaneously stimulate two corresponding areas on opposite sides of the body. Extinction is present if the patient fails to perceive one sensation.In neurophysiology: loss of excitability of a nerve, synapse, or nervous tissue in response to stimuli that were previously adequate.In psychology: disappearance of a conditioned reflex resulting from lack of reinforcement.

extrapyramidal signs and symptoms Movement and posture disturbances characteristically resulting from disorders of the basal ganglia and cerebellum. These disturbances include asynergy, ataxia, athetosis, blepharoclonus, chorea, dysarthria, dysdiadochokinesia, dystonia, muscle rigidity and spasticity, myoclonus, spasmodic torticollis, and tremors.

F

Fabere sign Pain produced by maneuvers used in Patrick’s test. It indicates an arthritic hip. The name is an acronym for maneuvers used to elicit the sign: flexion, abduction, external rotation, and extension. Begin by helping the patient into a supine position and asking him or her to flex the thigh and knee of the leg being examined. Then have the patient externally rotate the leg and place the lateral malleolus on the patella of the opposite leg. Depress the knee. If he or she experiences pain, you’ve detected the Fabere sign.

Fajersztajn’s crossed sciatic sign In sciatica, pain on the affected side caused by lifting the extended opposite leg. To elicit this sign, place the patient supine and have him or her flex the unaffected hip, keeping the knee extended. Flexion at the hip will produce pain on the affected side caused by stretching of the irritated sciatic nerve.

fan sign A component of Babinski’s reflex. This sign refers to the spreading apart of the patient’s toes after the foot is firmly stroked.

flexor withdrawal reflex Flexion of the knee upon stimulation of the sole of the foot; a normal reflex in neonates. This reflex is mediated at the spinal cord level and should disappear after age 6 months.To elicit this reflex, place the neonate in a supine position, extend the legs, and pinch the sole of the foot. Normally, an infant younger than 6 months of age will respond with slow, uncontrolled flexion of the knee. This reflex may be weak in premature neonates. Its persistence beyond age 6 months may indicate anoxic brain damage. Its recurrence signals a central nervous system lesion or injury.

flight of ideas Continuous, often seemingly pressured speech with abrupt changes of topic. In contrast with loose association, a listener can discern the connection between topics based on word similarities or sounds. This sign characteristically occurs in the manic phase of a bipolar disorder.

foot malposition, congenital Anomalous positioning of the foot, present at birth in roughly 0.4% of neonates. It may reflect the fetal position of comfort, neuromuscular disease, or malformation of a joint or connective tissue. To assess this sign, observe the resting neonate’s foot to determine the position of comfort. Then observe the foot during spontaneous activity. Using gentle passive maneuvers, determine the full range of motion of the foot and ankle.

Fränkel’s sign In tabes dorsalis, the excessive range of passive motion at the hip joint. This excessive motion stems from decreased tone in the surrounding muscles.

G

Galant’s reflex Movement of the pelvis toward the stimulated side when the back is stroked laterally to the spinal column. Normally present at birth, this reflex disappears by age 2 months. To elicit this reflex, place the neonate in a prone position on the examining table or on your hand. Then, using a pin or your finger, stroke the back laterally to the midline. Normally, the neonate responds by moving the pelvis toward the stimulated side, indicating integrity of the spinal cord from T1 to S1. The absence, irregularity, or asymmetry of this reflex may indicate a spinal cord lesion.

GALANT’S REFLEX