ML & DOWN SYNDROME

ML & DOWN SYNDROME
1. Down Syndrome kids have 150 fold RISK of AML by 5 years
2. MC AML subtype in Down syndrome is AML M7.
3. AML M7 is the MC leukemia in Kids < 3 years with Down syndrome
4. Children with Down syndrome and AML comprise 10% of all pediatric AML cases.
5 . ALL INFANTS WITH DOWN SYNDROME ARE CONSIDERED HIGH RISK FOR AML.
6. HIGHEST RISK of AML in Down syndrome is between 1-3 years age.. Those kids >4years and getting AML have a SIGNIFICANTLY LESSER SURVIVAL RATE compared to those <4years of age
7. Mutation in GATA-1 gene is present in all Down syndrome kids with Transient Myeloproliferative Disorder (TMD) and AML M7.
8. IN GENERAL Down syndrome kids with AML have better prognosis than NON-Down syndrome KIDS with AML!!

some high yield points for insects :

some high yield points for insects :

life span of mosquito -2 weeks
life span of hosuefly-----15 days in summer and 20 days in winter
life span of lice----30 to 50 days
life span of tsetse---100 days
life span of tick---1 year
starved flea jupms 6 inch
fed flea jumps 3 inch
flying span of hosuefly 14 mm
distance flown by anopheles---5km
 by culex----11km
 by aedes---1oom
by black fly----100 miles

Sequestra

Different types of sequestra:-

Ring- amputation stump
Ivory- syphilis
Feathery- TB rib
Kissing- peridiscal TB vertebra
Sandy- central body TB vertebra
Button hole- after radiation
Coke- cancellous bone
Bombay/black- due to h2s(pollution)

Forensic

 Gustafson s method
:: (25-60years),APSRTC
Attrition
Paradentosis
Secondary dentine
Root resorption
Transparency of root
Cementum apposition

 The study of incremental lines in the enamel of tooth to assess the age of a person is known as Boyde’s Method

 Stakes method:: Upto age of 12years, by measuring dimension of teeth and weight of teeth one can make out the age

Taurodontism is a peculiar tooth form in which the body of the tooth and the pulp chamber are enlarged at the expense of the root. Seen in Mongols

Declaration of geneva--> Declaration of a physician's dedication to the humanitarian goals of medicine
Declaration of Oslo--> Therapeutic abortion.
Declaration of Helsinki-->Human experimentation and clinical trials
 Declaration of Tokyo--> Torture in medicine*

 Kennedy phenomenon deals with Evaluation of exit and entry wound

One Liners

Q.Binswanger disease ---->>
It is a sub cortical leukoencephalopathy, form of small vessel vascular dementia caused by damage to the white brain Matter

Q.Dot nd blot hemorrhage are seen in---->>inner nuclear layer
Dot and Blot Hemorrhages
Hemorrhages lie deeper in the retina.
Usually blood. accumulates in the outer plexiform or inner nuclear layers, or more easily seen at peripheral retina where the nerve fiber layer is thin.
Commonly seen in association with diabetic or hypertensive retinopathy, peripapillary hemorrhage in patients with normal tension glaucoma that is also called splinter hemorrhage and retinal vein occlusion.

Q.cozen sign seen in---->>Tennis elbow
Q.Umami taste by------>>glutamate
Q.capacitance of sperm in------>>uterus

Q.Crumpled tissue paper in ----->>gaucher's disease??
Q.Loeffler syndrome----->>Ascariasis??
Q.most common. Cause of neonatal mortality in india----->>>low birth weight/ prematurity
Q.Muddy irisis seen in association with----->>>iritis
Q.laryngoscope blade was discovered by ------>>>> macintosh
Q.tailing of wound is a characteristic feature of ----->>>>incised wound
Q.bundle of kent is seen in association with------>>>
Wpw syndrome
Q.gaiesbock. Syndrome-------->>spurious polycythemia
Q.Espundia------>> an infection caused by leishmania brazilensis
Q.poroscopy was given by------>>> locard
Q.succinyl co- A is formed by------>>> valine,isoleucine,methionine
Q.180 nd 230 bp antibodies ------>> bullous pemphigoid

Q.IOC for a trauma patient
Stable----->CT Scan
Unstable------>>FAST

Q.Finkelstein test----->>dequeveiran tenosynovitis
Q.Hofmann degradation is for ------->>>>atracurium
Leads to accumulation of a byproduct laudanosine
Q.Naegler' s reaction shown by----->>> clostridium perfringens
Q.Gradenigo syndrome----->>> diplopia+ otorrhea+retro orbital pain
Q.money bag heart is seen in---->>> pericardial effusion
Q.hyoid bone is at the level of ----->>> c3
Q.Apex of the lung lies at the level of------>>>>T1
Posterior superior iliac spine is at the level of ----->>>S2
Michelis' s guttman bodies are seen in----->>>> malakoplakia
Q.Translocation involved in AML- M3---->>t(15;17)
Q.Marker for angiosarcoma------>>>> CD-31
Q.Marker for melanoma---->> hmb-45
Q.SADE Classification used for----->>> Retraction of pars tensa
Q.Nyhus classification is used for the grading of---->>> inguinal hernias
Q.oil drop sign is seen in------>>> keratoconus
Q.Red currant jelly stools are seen in----->>> intussusception
Q.passavant's ridge is formed by------>> palatopharyngeus
Q.HLA Associated with Rheumatoid arthritis----->> HLA- dr4
Q.HLA associated with psoriasis----->>>HLA-CW6
Q..koebner's phenomena is characterostically seen in------>>psoriasis
Q.telefona----->>consists of hitting both the ears simultaneously with the palms of the hands
Q.falanga------>>> consists of tying both the legs and soles of feet are beaten with the help of an object
Q.Harakiri------>>> ritual practice of suicide in which the person does self disembowelment on a sword practised in primitive japanese society
Q.Target sign seen in ------->>>erythema multiforme
Q.hanging curtain sign seen in----->>pityriasis rosea
Q.Frankfurt plane------>>>it is from inferior margin of orbit to upper margin of external auditory meatus
Q.zavanelli pocedure is used for----->>shoulder dystocia in vertex presentation
Q.spider leg appearance is seen in---->> Adult polycystic kidney disease
Q.dukoral is ----->> oral cholera vaccine
Q.Ascoli's thermoprecipitin test is done for---->> bacillus anthracis
Q.artery used in tram flap----->> deep inferior epigastric artery
Q.cause of unilateral bloody discharge from breast----->>>duct papilloma
Q.mouse nibbled appearance of vocal cords is seen in------>> TB Larynx
Q.substance responsible for the symptoms of carcinoid syndrome----->>> serotonin
Q.Fox fordycee disease is due to----->> obliteration and obstruction of apocrine glands
Q.sunflower cataract is associated with----->>> chalcosis
Section 509 IPC deals with------>>> to insult the modesty of a woman
Q.most common cause of laryngotracheobronchitis------>> parainfluenzae
Q.Cause of corneal transparency------->>>
Endothelium&
Cornea transparency also due to arrangement of collagen in basement membrane site
Q.snowstorm cataract is seen in----->>> D.M.
Q.Capgras syndrome----->> delusion of doubles
Q.nerve supply of deltoid------>> axillary nerve
Q.nerve supply of trpezius------ >> spinal accessory nerve
Q.stain used for tongue in oral carcinoma------->>> 2% toulidine blue??
Q.methotrexate toxicity treated by----->> citrovorum factor
Q.structure derived from both ectoderm and mesoderm----->> suprarenal gland
Q.elek' s gel precipitation test is ------>>>>double dimension double diffusion test
Q.inventor of microscope------>> anton von leuwenhoek
Q.skirrow's media is used for----->>> campylobacter jejuni
Q.carcinomas developing after radiation exposure------>>> breast carcinoma and papillary carcinoma of thyroid
Q.bicalutamide is an ------>>> androgen receptor blocker
Q.Naegler's reaction is shown by------->>clostridium welchii
Q.pyoderma gangrenosum is caused by------>> pseudomonas
Q.mode of infection of entrrovirus-----,>>> faecooral route
Q.germ theory of disease was given by------>> louis pasteur
Q.heller's myotomy is the procedure done for----->> achlasia cardia
Q.widmark's formula is used for---->> estmation of alcohol level of blood
Q.calorie requirement of a moderately working pregnant lady----->>> 2580 calories
Q.test done to assess foetal blood------>> kleinhauer 's test
Q.discovery year of x rays----->> 1894
Q.bacillary angiomatosis is caused by----->> batonella henslae
Q.CVP monitoring is done through----->> subclavian vein??
Q.maximum mineralocorticoid activity----->>  aldosterone
Q.most cardiotoxic local anaesthetic----->> bupivacaine
Q.RDA Of niacin------>>6.0 mg.per 1000 k.cal.
Q.Etiology of decubitus ulcer------>> due to venous congestion
Q.bird beak appearance seen in----->> achlasia cardia
Q.dose of clonidine required for the diagnosis of pheochromocytima----->>>300 micrograms???
Q.wickham's striae seen in ---->>lichen planus
Q.mikulickz cells found in---->> rhinoscleroma

Criteria

• Halls criteria : Downs syndrome
• Dukes criteria: Endocarditis/Heart failure
• Butchers criteria :mesothelioma
• Ann Arbours classifiacation :Hodgki.s lymphoma
• Bismuth classification: tumors of hepatic ductal system
• Nazers Index: Wilsons disz
• Pagets Index : Abruptio placentae
• Quetlet index: BMI -wt in kg/ht in meter square
• Ponderial Index: ht in cm/cube root of body wt in kgs
• rocas index : Ht in cms-100
• Corpulence index : Actual wt/ desired wt
• Milans crjteria: for liver transplant in HCC
• ayers n cottons grading system: Subglottic stenosis
• studifort criteria: abdominal pregnancy
• GCS/Ransons criteria/APACHE score: Pancreatitis
• Ennekings staging : Bone tumors
• Mc Donald's criteria: Multiple Sclerosis
• Epworths criteria : Sleep apnea
• Framminghams criteria/Boston's criteria: CHF
• Durie salmon system of staging: Multiple myeloma
• Lights criteria: pleural effusion
• GOLD's criteria :COPD
• OKUDA staging : HCC
• Child's Turcott pug score/MELD/ PELD- Cirrhosis of liver
• Mantrles criteria/Alvarado score: Appendicitis
• Evan's stagng: Neuroblastoma
• FAB: Leukemias
• Glisson's staging: Prostrate
• Robson's staging : RCC
• NADA's criteria: ASD assesment of child fo parameters checked in Nazer index
• Rye classification: Hodgkins lymphoma
• Chang staging: Medulloblastoma
• Jackson's ataging :Penile Carcinoma
• Seddons classification: Nerve injury n regeneration
• Larren's classification:Gastric Ca
• Neer's classification: supracondylar# femur
• Gartland's classification: Supracondylar # Humerus
• Amsel's criteria: bacterial vaginosis
• Mallampati scoring: for intubation
• Forrest classification: peptic ulcer bleed
• Hess & Hunt Scale: subarachnoid hemorrhage
• Duke staging : colon cancer
• Rotterdam's criteria : PCOS
• LEEFORDT's classification : facial #
• ells criteria: pulmonary embolism
• Rule of wallace/Rule of 9: Burns
• Mansons classification: Radial head #
• Stanford classifi ation: Aortic dissection
• Rockall scoring: adverse out come after GI bleed
• Glasgow Blatchford score : UGI bleed for medical

Opthal Numbers

vol of orbit- 30ml.

volume of globe/eyeball- 6ml.

dark adaptation time - 20min.

depth of ant chmbr- 3mm.

incision fr icce-10-12mm,

ecce-8mm,

sics-6mm,

phaco- 3mm..

duration of action of tropicamide- 6hrs. complete dilation of pupil- 9 to 10mm

Optimum cold ischaemia time

Optimum cold ischaemia time

Kidney <24 hours

Kidney/pancreas <21

Liver <12

Lungs 4-6

Heart 4

ARSENIC POISONING

ARSENIC POISONING
golden hair-- arsenic poisoning
tests for arsenic poisoning are marsch,,reinsch and gutzeit test
polyneurits,paraathesias nd encephalopathy seen in arsenic poisoning
hyperkeratosis of palms and soles seen
in chronic poisoning,hair,nail,skin samples are preserved
Other features are rain drop pigmentation and red velvety mucosa of stomach( rapidly absorbed and max amount seen in liver)
measles like fading
it mimics cholera
antidote--freshly precipitated fe2o3
commonly and most popular homicidal poison

MC tumour

MC tumour of the appendix : Carcinoid
MC tumour of the oesophagus : Leiomyomas
MC tumour of the minor salivary glands : Adenoid Cystic Carcinoma
MC type of abdominal wall hernia : Inguinal hernia
MC type of ASD : Ostium secundum
MC type of brain herniation : anterior / uncal transtentorial
MC tarsal bone to get fractured : Calcaneus
MC tarsal coalition : Talocalcaneal
MC testicular tumour in a young male : Yolk sac tumor
MC tibial plateau fractures : Lateral tibial plateau (Schatzker classification type I–III)
MC trigonal intraventricular mass in adulthood : Meningioma
MC tumor of adenohypophysis : Pituitary Adenoma

Sucide

Suicide ->

* 85% peoples hav psychiatric  problem

* mc cause of suicide - depression
* 2nd mc cause - schizophrenia

* mc method india  -
Poison ingestion> hanging> burn

*Risk factors-
√male
√ single or divorced
√ age more than 40 yrs

* mc type of depression in suicide-
involutional depression or endogenous depression whichever in option

Points

1. Heart size is Normal in : TOF and TAPVC ( infracardiac form )

2. Visual reflex formation or Macula mature by 5-6 months life

3. Gardasil -- 16 , 18 , 6 , 11
    Cervarix -- 16 , 18

4. Renal tubular acidosis -- Normal Anion gap Hyperchloremic Metabolic Acidosis
    Point to remember -- its NORMAL in Serum but POSITIVE anion gap in Urine

5. Ectopic ACTH Syndrome -- Hypokalemic Alkalosis

6. Anatomical Closure of Ductus arteriosus -- 1-3 months after birth. 1-3 months after birth. (ref: Langman's embryology & Guyton)

7. Corneal donor -- till 6 hour after death

8. Nerve fibers -- A and B are Myelinated ; A to C - Diameter and Velocity decrease

9. For Congenital hypothyroidism -- TSH , best done >48 hrs - 6 days life

10. Child of HIV positive Mother -- Cant use IgG for 1st 18 months to diagnose as that comes from
      mother. So p24 assay , PCR , Viral Culture are used.

11. Neomycin is present in Polio Vaccine

12. TORCH infectivity -- All at time of birth BUT Rubella has 2 peaks i.e 10 -11 wks and delivery.

13. Unchanged during child birth -- Diameter between Sacral promontary and Pubic Symphisis.

14. RAIU -- I 123 ;
      RIA ---- I 125

15. CO poisoning -- PO2 Normal but O2 saturation is less.

16. Fetal distress -- S/D ratio-- increases in Umblical Artery , decreases in MCA.

17. All Myopathies are Proximal except Myotonic Dystrophy (type 1)

18. All Neuropathies are Distal except GBS and SMA.

19. Glysine is the smallest and simplest Amino Acid.

20. Adder Head on IVP -- Ureterocele

21. Flower vase / shaking hand sign -- Horseshoe kidney

22. Ligament of Struthers.-- remnant of 3rd head of coracobrachialis , runs from supracondylar spur on anteromedial humerus to medial epicondyle, median n and brachial a may run beneath it.

23. Shortest Colon - Ascending
      Longest Colon - Transverse

24. Trigeminal Neuralgia rarely involves Ophthalmic division
      If in a young / if it is Bilateral -- then Multiple Sclerosis is a key consideration

25. After overnight fasting , levels of glucose transporters are reduced in Muscle.

26. Pacini Corpuscles -- detects gross pressure changes and vibration

27. Epiphyseal dysgenesis -- in Hypothyroidism

28. In Hypothyroidism --- Increased CSF protein

29. Most characteristic cutaneous manifestation of FMF (Familial Medit. fever) -- Erysipelas like erythema.

30. Two halves of Mandible join together by 2yrs of Life

31. Syphilitic Aortitis -- Proximal Ascending Aorta

32. Superficial spreading melanoma -- Buckshot appearance (Pagetoid cells)

33. Seborrheic Keratoses -- Stuck on lesion

34. Finger prints can be taken in cases of advanced decomposition and drowning
      But NOT in case of corrosion

35. Generally all bones ossify earlier in females
      Skull sutures obliterate earlier in Males.

36. Anterior neuropore closes by 25th day, and posterior one closes by 27th day of IUL.

37. Gittre cells are modified CNS macrophages.

38. Hirano Bodies in Hyppocampus -- Alzheimer's

39. Acrocentric Chromosomes -- 13 , 14 , 15 , 21 , 22 , Y

40. LAP increased in -- Leukamoid reaction , Polycythemia Vera
              decreased in -- CML , PNH

41. Schistiocyte -- MicroAngiopathic Hemolytic anaemia

42. Tear Drop cell -- Myelofibrosis

43. Target cell -- Thallesemia , HbC disease , Liver disease.

44. Good ALL -- Female , 2-10 years , Hyperdiploidy , B-ALL (NOT preB-ALL)

45. Pregnancy tumor of gums = Granuloma pyogenicum

46. RCC = Hypernephroma = Grawitz Tumor

47. Holly leaf mesangial deposits -- FSGN

48. Spike & Dome , String of Popcorn -- Membranous GN

49. Wire loop -- Class IV Lupus Nephritis

50. Post Mortem staining is well developed in 4 hrs and becomes fixed in 6-12 hrs

Vertebra Levels

Adult larynx - c3 to c6
Level of body of hyoid - c3
C3-c4 junction - bifurcation of cca and upper border of thyroid cartilage
C4-c5 level of thyroid cartilage
C6- cricoid cartilage
Begining of trachea
Begining of oesophagus
Apex of lung

Tongue Muscles

Q.muscle which helps in protrusion and upper movement of tongue
A.palatoglossus
B.hyoglossus
C.genioglossus
D.styloglossus
------>>>Genioglossus – helps to protrude the tongue, depress the central part of tongue making it concave, and move the tongue to the opposite side

Hyoglossus – helps to depress the tongue

Styloglossus – helps to pull the tongue upwards and backwards
to aid swallowing

Palatoglossus – pulls the soft palate onto the tongue while swallowing

Intrinsic muscles – help in widening, flattening, thickening, lengthening and rolling of the tongue.

HEMATOLOGY STAINS:

1) ROMANOWSKY STAIN:routine stain for peripheral smearexaminationit’s a family of stain consisting of
1) Giemsa ( best and most commonlyused)
2) leishman
3) wright
4) jennerit can stain( apart from normal cells):a) reticulocytes ( but non specific)
           b) howell jolly bodies
           c) basophilic stippling
           d) cabot rings
BUT NOT FOR ---heinz bodies
2) HEINZ- BODIES By supravital staining---methyl violet and crystal violet
3) RETICULOCYTES: Specific stains are SUPRAVITALSTAINSBEST –brilliant CRESYL BLUE ALSO used are---NEW METHYLENE BLUE

AWESOME THREE'S

AWESOME THREE'S:
Triple negative tumor - Medullary carcinoma of breast,
Triple endoscopy- bronchi,laryngo and oesophagoscopy,
Triple assessment - breast examination,
Triple anastomosis - pancreaticojejunostomy,choledochojejunostomsy and gastrojejunostomy,
Triple test screening - 2nd trimester pregnancy test(AFP, beta HCG & estriol ),
Third day fever - surgical fever,
Third day disease - rubella

ROBSON’s classification ( USED FOR RENAL CELL CARCINOMA)

ROBSON’s classification ( USED FOR RENAL CELL CARCINOMA)
Stage I- Rcc confined to kidney
II- extend through renal capsule but confined to Gerota’s fascia
III- Renal vein / IVC involved
IV- Tumor spread to local , adjacent organs or distant sites

most common site of EXTRA GONADAL GERM CELL TUMOR------MEDIASTINUM

metabolism in tumor cell is by -------aerobic glycolysis ( WARBURG EFFECT)

Rett syndrome originally termed as cerebroatrophic
hyperammonemia is a neurodevelopmental disorder of
the grey matter of the brain.......microcephaly present. ...seizures

gertsmann syndrome ............ brain lesions in the
dominant (usually left) hemisphere including the angular
and supramarginal gyri near the temporal and parietal lobe
junction
lung cancer
Low-dose, noncontrast, thin-slice helical or spiral chest CT has emerged as a possible new tool for lung cancer screening.
Based on extant data, it appears that nodules <0.5 mm are unlikely to be cancerous and those 5–10 mm in diameter (25–40% of noncalcified nodules detected) are of uncertain significance.

A major challenge confronting advocates of CT screening is the high false-positive rate.

Mutations in MODY

Mutations in MODY

Type 1: HNF 4 alpha
Type 2: glucokinase
Type 3: HNF 1 alpha
Type 4: IPF1 (insulin promoter factor 1)
Type 5: HNF 1 beta

Pannincitis

Subcutaneous fat has Lobular and septal parts. Inflammation of fat is panniculitis
LOBULAR PANNICULITIS:
a) with vasculitis:
- Erythema nodosum leprosum
- Erythema induratum of bazins (it is a type of tuberculid)
b) without vasculitis
- Subcutaneous fat necrosis of newborn
- Alpha-1 anti trypsin deficiency
- Pancreatic panniculitis
- Sclerema neonatorum
- Post steroid panniculitis
- lipodermatosclerosis
- Lupus panniculitis

SEPTAL PANNICULITIS
a) without vasculitis
- Erythema nodosum
- Necrobiosis lipoidica
- Rheumatoid nodule
b) with vasculitis
- Cutaneous polyarteritis nodosa

Medicine Signs

SIGNS IN MEDICINE
(A)
- Aaron’s sign seen in appendicitis. On firm pressure over the McBurney’s point the patient with appendicitis will feel distress in the epigastrium or precordial region.
- Abadie’sign -– This is the test of Muscle sense .Compress or squeeze big muscle bellies (calf,` triceps or biceps)and note whether the patient complains of pain (Abadie’sign ).This is the test of pressure sense too.
- Adler’s sign- Is seen in Ectopic pregnancy .The abdominal tenderness is fixed ,even when the patient is turned from side to side.
- Albright sign-Metacarpels are shortened in pseudohypoparathyroidism , nevoid basal cell carcinoma ,turner and Larsen .In the presence of short fourth metacarpal ,there will be a dimple at the metacarpophalangeal joint.
- Alfred Demusset sign - Bobbing of the head with each heart beat. The rapid blood flow in the carotids will push the head with each beat, thus leading to movement of head up and down with each heart beat.
- Allis sign- is seen in developmental dysplasia.
- Arm drop sign- sign suggestive of complete tear of the rotator cuff.
- Antenna sign- seen in Keratosis pilaris
- Anterior drawer sign-(Bon bruise sign) for anterior cruciate ligament tear. It is used to diagnose rupture of the cruciate ligaments .The knee should be flexed at a right angle an  the upper part of the tibia is pulled forward and pushed backward. Increased anterior and posterior movements will indicate the rupture of cruciate ligaments.
- Asboe Hansen sign- (Bulla spread sign) – seen in Pemphigus
- Auenbrugger’s sign-In pericardial effusion ,an epigastric prominence is seen.
- Auspitz’s sign-When the scales of Psoriasis are removed ,pin point bleeding spots will be seen .
- Babinski’s sign- By stroking the lateral aspect of the dorsum of the foot. There is contraction of tibialis anterior, hamstrings, and tensor fascia lata.
- Baccelli’s sign- Good conduction of whisper in non purulent pleural effusion.
- Ball’s sign- is seen in fetal death .There will be hyperflexion of the spine.
- Ballance sign -The dullness can be elicited on both sides in rupture of spleen .On the right side there will be shift of the dullness ,but it is constant on the left side.
- Ballentyne-Runge sign - Decrease in the abdominal circumference late in pregnancy due to placental
insufficiency
- Banana sign –the frontal lobes will be concave .This is due to neural tube defects
- Barber’s chair sign in multiple sclerosis. An electric shock like sensation which radiates in to the arms., down the back to the legs, when the patient flexes the head..
- . Barlow’s sign- Von Rosen’s sign In congenital instability of the hip joint the hips are held flexed and abducted , A click can be heard when the femoral head leaves the acetabulum
- Bastedo’s sign seen in chronic appendicitis. On inflation of the colon with air ,pain and tenderness
will be present in the right iliac fossa.
- Battle’s sign- blood pigment stain behind the ear over the mastoid due to basal skull fracture (Sphenoid bone )
- Beak sign - in patients with Hypertrophic pyloric stenosis. ,abrupt cut of the barium column in the pylorus.
- Beak sign in renal arteriogram-Renal cyst.
- Becker's sign - Pulsations seen in the retinal artery.
- Beevor’s sign-in patients with paralysis of lower part of rectus abdominis the umbilicus will move upwards when the rising test is performed. The umbilicus will move downwards in paralysis of upper part of rectus abdominis
- Beheaded scottish terrior sign- Spondylolisthesis. (In oblique view)
- Belly dancer’s sign- It is seen in unilateral diaphragmatic paralysis .During inspiration the umbilicus shifts upward and toward the side of the paralysed diaphragm
- Benda’s sign- This is of importance in tuberculous meningitis. Here the child has spasm of the trapezius muscle with the result that the shoulder on affected side is raised up and at times also brought forward. The sign is elicited by turning the head and chin to one side and if there is upward and forward lifting of the  shoulder the sign is positive. It may be positive on one or both sides.
- Bergara –Warten Berg sign-Loss of vibration on elevation of the closed upper eyelid. It is the earliest sign of facial nerve paralysis.
- Bergman sign (Chalice sign)- is a finding in renal imaging studies where there is dilatation of ureter distal to a neoplasm. Such dilatation will be absent in calculus or thrombus.
- Bing sign – Pricking the dorsum of foot by a pin produces extensor response.
- Blue berry muffin sign- is seen in dermal metastases of Neuroblastoma .There will be raised
purple skin lesions.
- Blue dot sign-is seen in torsion of appendix testis .The appendix that has undergone torsion may be visible through the scrotal skin. 

- Blumberg’s sign – Rebound tenderness. It is seen in acute appendicitis.
- Boas sign- is helpful in differentiating acute cholecystitis from other conditions. In acute cholecystitis there is a referred pain to the right scapula. There is an area of hyperaesthesia between the ninth and the eleventh ribs posteriorly on the right side..
- Bow’s sign- Seen in septicemia in infants. The right side of the mediastinal shadow resembles a bow.
- Bow string sign- is used in lumbar disc herniation. It is a variation of straight leg raising test. When the leg is raised pain will occur. At the point of pain, the knee will be flexed which will reduce the pain.
- Branham’s sign- (see Nicoladoni’s sign) i s seen in aretrio venous fistula .The swelling due to arteriovenous fistula disappears on applying pressure on the artery proximal to the fistula, thrill and bruit will decrease and the pulse rate fall .the pulse pressure will return to normal.
- Brim sign- is seen in Paget’s disease.
- Braxton –Hick’s sign-Intermittent uterine contractions can be detected by palpation after 16 weeks of gestation in pregnancy.
- Brudzinski’s sign is seen in meningitis Flexion of one lower limb causes flexion of opposite limb immediately. It is the leg sign. Flexion of neck produces flexion of hips and knees. This is the neck sign.
(Brudzinski’s neck Sign-Both the lower limbs should be in extended position, with full flexion of the
neck, the child flexes both his lower limbs, at the hips as well as knees. This is a common sign of meningitis in infancy. There may be minimum flexion of the lower limbs when the child has paraplegia or quadriplegia; there is unilateral flexion of the unaffected limb. This not only helps in the diagnosis of meningitis but also in the diagnosis of hemi paresis. Brudzinski’s leg sign- Here one of the lower limbs is flexed to 45º at the hip and 90-120º at knee.
While trying to extend the lower limbs there is flexion of the opposite limb at the hip and knee.
This is a positive Brudzinski’s leg sign. In children who are constantly moving the lower limbs, particularly in the first 2-3 years of life, the test should be carried out 3 to 4 times before it is concluded as positive. If a child has weakness or paralysis of the opposite limb there may be minimum flexion at the hip and knee.)
- Brun’s sign- Excruciating headache , vertiginous episodes , coma and death due to sudden movement of the head ,if the cysts are present in the fourth ventricle .
- Bryant’s sign -in shoulder dislocation .Abnormal position of axillary folds.
- Bulge sign- Small effusion in the knee joint. Apply gentle pressure first on the medial side of
the joint when the patient is lying with the quadriceps relaxed. Watch for the bulge on the lateral side.
- Button hole sign- is seen in Neurofibromatosis (C)
- Capener’s sign- is seen in slipped epiphysis .Normally, the posterior acetabular margin will cut across the medial corner of the metaphysis. In this condition the entire metaphysis will remain lateral to the posterior acetabular margin.
- Cardarelli’s sign- transverse pulsation in the laryngotracheal tube in aneurysms and dilatation of the aortic arch.
- Carman’s Meniscus sign - A radiological finding seen in malignant gastric ulcer. Meniscus shaped gastric ulcer with the concavity pointed towards the gastric lumen
- Carpet tack’s sign- is seen in Discoid Lupus Erythematosis (DLE)
- Carvallo’s sign- In cases with ASD, the tricuspid murmur is maximal at the lower sternal edge and increases in intensity during inspiration
- Cerebriform tongue sign-is seen in Pemphigus vegetans
- Chaddock’s sign –seen in pyramidal tract lesion.
Extensor response is seen after striking the skin around the lateral malleolus in a circular fashion.
- Champagne flute sign- due to portal air in NNEC.
- Chandelier’s sign-is seen in Gonorrhoea in women
- Circumflex`sign -the metaphysis have some flaring and may appear V-shaped in achondroplasia.
- Chvostek’s sign -The facial nerve is tapped at its exit from the stylomastoid foramen. This leads to brief twitching of the facial muscles, ala of the nose and the blinking of the eyelids. .Elevation of the corner of mouth may b e seen.
- Coffee bean sign- Strangulation of incompletely obstructed loop of small bowel.
- Coin test -is found in tense Pneumothorax. Place a metallic coin on the upper part of the affected chest, and percuss over the coin with another coin. Listen at the same time from the back with the diaphragm of a stethoscope. A high pitched tympanitic bell-like metallic sound can be heard in the presence of Pneumothorax.
- Coleman’s sign- Hematoma over the floor of the mouth in fracture of body of mandible.
- Comby’s sign- is seen in measles. In early stages thin whitish patches are seen on the gums and buccal mucous membranes.
- Commando’s sign- in spastic cerebral palsy the child drags the feet like a rudder.
- Cooper’s sign- In acute appendicitis, the tenderness is elicited in the left lateral position.
- Corner’s sign- seen in scurvy. A groove will be present just above the zone of provisional calcification.
- Corrigan's sign - Dancing carotids in aortic regurgitation..
- Counting sign-in diaphragmatic paralysis ,the patient cannot count more than 10 in one breath.
- Coup’d’ongue sign- Tinea versicolor.
- Courvoisier sign- Gall bladder will be palpable in patients with carcinoma head of the pancreas.
- Crack –pot sign- see Macewen sign
- Crescent sign -In hydronephrosis, crescents of contrast medium seen with in the enlarged renal parenchyma. This is due to the contrast medium circulating in the collecting ducts compressed by the dilated calyces.
- Crowe’s sign –In neurofibromatosis , axillary freckling and speckled hyperpigmentation over the
upper chest ,groin and perineal region will be present .
- Cruveilhier s sign- is seen in portal hypertension . Caput medusa due to portocaval anastomosis.
- Cullen sign- A bluish discoloration seen around the umbilicus in patients with acute hemorrhagic
pancreatitis.
- Curtsy sign is seen in Sham or Urge syndrome
- Czerny’s sign-The abdomen normally bulges at the beginning of inspiration. But in patients with
chorea, there is paradoxical retraction..
- Dagger sign- is due to ossification of supraspinous and interspinous ligaments in Ankylosing spondylitis . On frontal radiograph a single radio dense line will be seen.
- Dance sign- in intussusception. The right lower quadrant may feel empty to palpation in
intussusception.
- Darier sign- Urticaria pigmentosa. The lesions tend to become red, itchy and urticarial if they are
rubbed.
- Dalrymple sign -(Lid retraction) Staring appearance due to abnormal widening of palpebral
fissures in hyperthyroidism
- Dawbarn’s sign- seen in subacromial bursitis .The pain in this condition will disappear on abduction of
the arm.
- Dawson’s sign- Palmar erythema in cirrhosis of liver
- De Dance sign-The Signe de Dance – A feeling of emptiness in the right iliac fossa in acute intussusception.
- D Espine’s sign- A large mediastinal node or a mass in Bronchogenic carcinoma may transmit the tracheal sound .This can result in bronchial breath sound, whispering pectoriloquy and rarely egophony in the inter scapular region.(Below D 4 )
- Delbet’s sign-in aneurysm of limb’s main artery .
- Demusset sign- See Alfred Demusset sign
- Deuel’s halo sign- This is x-ray finding in intrauterine death. The usual zone of reduced density visible around the head of relatively mature fetus before delivery appears to be separated from the cranium .The density of this zone will be similar to that of the soft tissues. This can be demonstrated radiologically within 3 days after the death of fetus.
- Dimple sign - Cart-Wheel pattern of fibroblast seen in Dermatofibrosarcoma protuberans.
- Dimple sign(Fitzpatrick sign) in Dermatofibrosarcoma protuberans.
- Dock’s sign- Rib notching in corctation of aorta.
- Dog’s ear sign-in ascites .Radiodensity superior and lateral to the bladder
- Double bubble sign- is seen in the following conditions
Duodenal atresia,
Annular pancreas,
Duodenal stenosis
- Double duct sign in ERCP- Carcinoma pancreas
- Drawer sign- see Anterior drawer sign-(Bon bruise sign)
- Dressler’s sign- Dull note in the lower part of sternum in pericardial effusion.
- Drooping lily sign- is seen in renal pelvis with duplicated collecting system.
- Dubois sign- Short little finger in congenital syphilis.
- Duga’s sign-is seen in fresh shoulder dislocation . The patient will not be able to put the hand to the opposite shoulder with the elbow close to the body .
- Duroziez’s sign- diastolic murmur heard on the femoral artery on distal compression. (E)
- Emptying sign in straw berry angioma
- Erb’s sign- seen in latent tetany. Muscular contractions can be produced by application of subthreshold electrical stimulation.
- Eye-of-the –tiger appearance- is a MRI finding in Hallevorden-Spatz disease
- Ewart’s sign- (Pin’s sign) Is seen in compression collapse of the basal segments due to large pericardial effusion.. There will be dullness on percussion, increased vocal resonance, tubular breath sounds., increased vocal resonance. and bronchial breathing are seen in cardiac tamponade due to pericardial effusion.
- Ewing sign - pericardial sign (F)
- Faget’s sign- is seen in yellow fever. Relative bradycardia is present from the second day of the illness.
- Falling fragment sign- Solitary bone cyst.
- Fat pad sign-is seen in pericardial effusion .In normal persons the parietal pericardium is separated from the epicardial fat by about 1-2 mm. This is increased in pericardial effusion.
- Felson ‘s silhouette sign- any intrathoracic mass touching the heart ,aorta or diaphragm will obliterate that border on the chest X ray.
- Fistula sign- Pressure changes can be transmitted to the membranous labyrinth if there is a fistula in the bony labyrinth. Pressing the tragus will induce jerk nystagmus.
- Fitzpatrick sign-in dermatofibroma .There will be dimpling when the mass is squeezed on both sides.
- Flag sign- Flag sign may be seen in Kwashiorkor. The hair will be alternately normal and depigmented.
The hair in cases of severe malnutrition will be hypopigmented. As the nutrition improves the pigmentation of the hair will be normal. Hence the hair will be alternately normally pigmented and hypopigmented, giving the appearance of a flag
- Flank stripe sign- or McCort sign-in ascites. Increased distance (>2 cm) between the properitoneal fat stripe and the right colon.
- Floating membrane sign- Hydatid cyst
- Floating teeth sign- in eosinophilic Granuloma.
- Flying’ W’ sign- the posterior mitral leaflet movement resembles the letter W. In partial systolic closure of the pulmonary valves there will be flying W sign .
- Football sign- In NNEC, the free air over the liver with outlining of the falciform ligament indicates
perforation and needs surgical treatment. (Pneumoperitoneum)
- Forscheimer sign- Enanthem in rubella.
- Forester’s sign- In hypotonic or Atonic cerebral palsy, when the child is lifted by holding at the
axilla ,there will be flexion at the hips.
- Frederick’s sign- Increased jugular venous pulse with sharp diastolic collapse. rapid ‘Y’descent in
pericardial effusion.
- Froment’s sign-in ulnar nerve paresis , Ask the patient to grasp a book firmly between the thumb
and the other fingers .In normal persons the thumb will be straight while holding the book . In patients with ulnar nerve palsy the terminal phalanx of the thumb will be flexed.
- Frostberg’s inverted 3 sign-Carcinoma head of pancreas. (G )
- Galeazzi sign- is a check for apparent thigh length on both sides. There will be lowering of the knee on the affected side when the child lies prone with hip flexed and knee flexed..
- Gerhardt's sign - Pulsations over the spleen in aortic regurgitation.
- Goodell’s sign –Softening of cervix and vagina is a sign of pregnancy.
- Gonda sign – Extensor response is elicited after forceful stretching or snapping of distal phalanx
of either of the 2nd or 4th toe.
- Gower’s sign- is seen in Duchenne muscular dystrophy ,.It will be evident by 3 years of age and will be fully expressed by 5-6 years of age. Climbing upon his own body while getting up from sitting posture.
- Grasset’s sign in hemiplegia .When a patient with hemiplegia walk on heels, there will be abnormal
movements of the hands on the same side of hemiparesis. The arms will come slightly in front, with elbow bent and not taking part in co movements. There will be inability to keep the fingers stretched and together.
- Grey Turner’s sign- A bluish discoloration seen in the flanks in patients with acute hemorrhagic
pancreatitis.
- Griesinger’s sign- is seen in lateral sinus thrombosis. The thrombus may extend and result in indurated tender area over the upper part of the internal jugular vein and mastoid region.
- Groove sign- Lymphogranuloma venereum (LGV) The enlarged lymph nodes are seen both above and
below the inguinal ligament. (H)
-“ Halo sign”.- Severe erythroblastosis with hydrops fetalis is demonstrable by extensive edema, which elevates fat layers beneath the skin to produce a “halo sign”. The so-called “Buddha position” is also indicative of hydrops fetalis
- Halo sign in breast tumour - a narrow radiolucent ring surrounding a benign breat lesion.
- Hamman’s crunch sign -crackling ,bubbling, crunching and churning sounds heard over the precordium in pneumomediastinum..It is better heard during the systole in left lateral position in expiration.
- Head drop sign - The patient is asked to lie down. The shoulders are raised off the bed. Usually the head also will raise but in this case the head lag will occur. Children with poliomyelitis are unable to lift the head or bring it along the trunk, and this is known as head lag.
- Head light sign- perinasal and periorbital pallor in atopic dermatitis
- Heel pad sign- Acromegaly
- Hellmen sign- in ascites. Radiolucent shadow between the lateral walls; of liver and the abdominal
wall.
- Hegar ‘s sign-Softening of the isthmus or the lower segment of the uterus This can be seen at 6
-12 weeks of gestation.
- Hertoghe’s sign- Loss of lateral third of eyebrow in atopic dermatitis
- Hick’s sign-is seen in pregnancy. There is light, painless irregular uterine contractions which increase in frequency and intensity as the pregnancy advances.
- Higoumenaki’s sign-Enlargement of the medial end of the clavicle which is a late feature of syphilis. 

- Hill's sign -is seen in Aortic Regurgitation .The systolic pressure in the lower limb is more than that of the upper limb .Normally this pressure difference will be less than 20 mm of Hg. The severity of the aortic regurgitation can be assessed by measuring this difference.
- Mild Aortic Regurgitation - 20-40 mm of Hg. 

- Moderate Aortic Regurgitation - 40 -60 mm of Hg.
- Severe Aortic Regurgitation - >60 mm of Hg.
- Hip sign - The lower limbs of a preterm baby can be abducted for more than 160 degrees
- Hoffman’s sign –is significant of pyramidal lesion. The terminal phalanx of middle finger to be grasped by the examiner. The hand to be pronated. Sharp flickering movement of terminal phalanx will produce  adduction and flexion of the thumb and flexion of the other fingers.
- Homan’s sign-is positive in venous thrombosis. Tenderness can be elicited indirectly by forcible dorsiflexion of the foot with the knee extended.
- Hook sign-In acute fulminating tenosynovitis there will be flexion of finger with pain on extension.
- Hoover’s sign – is seen in pleural effusion .There will be decreased chest movements on the affected
side in pleural effusion.
- Hoover’s sign(for unilateral weakness or paralysis of one leg ) - is done to differentiate between paralysis and Pseudoparalysis of one leg .The examiner’s hand is placed under the heel of the paralysed leg .Now ask the patient to raise the normal leg against resistance .In normal individuals the examiner can feel the pressure by the normal leg ..This will be absent if the leg is weak or paralysed.
- Hutchinson’s sign- In Herpes Zoster ophthalmicus, when the tip of the nose is involved ,the eye also will, be involved. This is because both the area are supplied  by nasociliary nerve.
- Hyppocratic sign- Succussion splash present in pyopneumothorax. ( I )
- Inverted mustache sign- seen in x -ray chest in congestive cardiac failure. (J)
- Jacquemier’s sign-(Chadwick’s sign) bluish discoloration of the vagina will be seen by about 4-8 weeks of pregnancy.
- Jellinek sign- Hyperpigmented lid in hyperthyroidism
- Joffroy’s sign- Absence of wrinkling on the forehead on looking upwards in thyrotoxocisis. (K)
- Kanavel’s sign- In infection of ulnar bursa ,there will be tenderness over the part of the ulnar bursa
lying in between the transverse palmar creases. 

- Kehr’s sign- pain referred to the left shoulder in rupture of spleen .The pain is due to the contact of blood in the under surface of diaphragm .The pain is mediated through the afferent fibres of the Phrenic nerve.
- Kernig’s sign-The patient lies supine .The hip is flexed and the knee is extended passively. In patients with meningitis there will be pain and spasm of hamstrings. It is positive in meningeal irritation and sub
arachnoid haemorrhage. It is relatively less important in infancy and early childhood as it may be negative in spite of meningeal involvement. However, it is a very useful sign in older children.
- Kestenbaum’s sign- is seen in optic atrophy. The number of capillaries that cross the disc margin is reduced from a normal of 10 to 7 or less. 

- Kiloh-Nevin sign- Ask the patient to form a ‘O’ with the tip of the finger and the index finger In patients with anterior interosseous syndrome, fine pinch posture is abnormal.
- Kiss –the-knee sign- Ask the child to sit and kiss the knee. In the presence of Nuchal rigidity, the child cannot kiss the knee without bending the knee.
- Kocher’s sign-Frightened, staring look in Thyrotoxicosis.
- Knuckle sign- is seen in vessel occlusion due to thrombosis .there is an abrupt tapering of the vessel distal to the occlusion.
- Kritchley’s sign (Cortical thumb) in pyramidal tract lesion.
- Kussmaul’s sign- Inspiratory prominence of jugular veins in pericardial effusion, constrictive pericarditis, restrictive cardiomyopathy.
- Ladin’s sign-is seen in pregnancy. There is softening of the medial anterior surface of the body of uterus just above the body and cervix.
- Lambda sign- Small ascending aorta seen in hypoplastic left heart syndrome
- Laminar dot sign- -seen in advanced glaucoma.
- Landolfi's sign - constriction and dilatation of pupils with the heart beats and not related to light reflex.
- Lassigue sign- A positive leg rising test .It is present in sciatica, prolapsed intervertebral disc. With the patient lying supine, ask him to elevate the extended leg .A normal person can extend up to 90 degrees. The test is positive if the movement is restricted.
- Lemon sign- See banana sign –the frontal lobes will be concave .This is due to neural tube defects.
- Leri’s sign- is seen in hemiplegia. There will be absence of normal flexion of the elbow on passive
flexion of the hand at wrist on the affected side. 

- Leser-Trelat sign- is seen in internal malignancy. There will be sudden appearance of large number of
keratosis. 

- Lhermitte’s sign- electric shock like sensation radiates down the trunk ,when the trunk is flexed .it indicates cervical cord lesion ,cervical spondylotic myelopathy, sub acute combined degeneration of the cord,  radiation myelopathy
- Light house sign - alternate flushing, and blanching of the forehead in Aortic Regurgitation
- Light house sign in acute Suppurative otitis media.. a pulsating discharge will reflect the light intermittently.
- Litten’s sign- in diaphragmatic palsy .There is absence of indrawing of subcostal margin during inspiration.
- Ludloff’s sign – is seen in avulsion fracture of the lesser trochanter. There will be inability to flex
the stretched leg, when the patient is seated. (M)
- Macewen’s sign (Crack – pot resonance) - a ‘cracked-pot’ sound on percussion of the skull, may be present with hydrocephalus, increased intracranial pressure and sutural separation. It is due to separation of sutures in a child having increased intracranial tension. It is also simulated in many normal infants. To elicit this sign the child’s head should be lifted up from the bed and supported by putting the examiner’s hand under
the neck In children who can sit up this can be done in the sitting position. A sharp tap with the middle
finger is given on the parietal region on each side.
- Macewen’s sign (in pericardial effusion )
- Macewen’s sign (alcohol poisoning ) pupillary sign.
- Marcus Gunn pupil sign- is seen in the patients with asymmetric, prechiasmatic, afferent conduction defect.
- Marion’s sign -seen in benign prostatic enlargement.
- Mathe’s sign- In patients with perinephric abscess, the kidney does not descend down in erect posture .In normal persons the kidney will descend in erect posture .
- Maxwell-Lyons sign-is seen in vernal conjunctivitis. A fibrinous pseudomembrane may be seen.
- Mc Burney’s sign- In acute appendicitis; pain can be elicited at the Mcburney’s point by pressing with a finger
- McEwan sign- In coma the pupil is constricted and dilates on painful stimuli.
- McMurray’s sign -In meniscus injury a painful click can be demonstrated if the flexed tibia is rotated upon the femur.
- Melting sign- In pulmonary embolism with infarction .The consolidation regresses from periphery to the centre.
- Mercedes Benz sign (Seagull sign ) When gas is present in the gall stones, a characteristic dark shape will be seen in the X ray
- Milian’s ear sign- Erysipelas can spread in to the pinna (cellulitis cannot spread as there is no
areolar tissue )
- Milk maid sign-Ask the patient to hold the examiner's hand,(index and middle fingers can be placed together).Feel for the uniformity in the force of contraction by the patient. Ask the patient to hold the fingers of opposite hand and compare with the other side. In the affected side there will be alternating forces (contractions and relaxations),as like milking of a cow. 

- Meniscus sign- seen in X-ray , when a mobile mass is present in the pulmonary cavity due to
aspergillus fungal ball
- Moebius sign –Lack of convergence of the eye ball in thyrotoxocisis.
- Moniz sign – Extensor response is seen after forceful passive plantar flexion of ankle
- Moses sign-In venous thrombosis, pain can be elicited by squeezing the calf muscles.
- Moulage sign- is seen in Malabsorption syndrome .It is due to flocculation and segmentation of barium and mucosal thickening.
- Moyniham’s sign - is acute cholecystitis.
- Muller's sign - Pulsations seen in the uvula, in aortic regurgitation.
- Munson’s sign- is seen in keratoconus. There will be bulging of the lower eye lid when the patient
looks down.
- Murphy’s Sign: Ask the patient to breathe in deeply and palpate for gall bladder. At the height of
inspiration the breath is arrested with a gasp as the mass is felt. This is the sign of acute cholecystitis. (N)
- Naffziger’s sign-Stand behind the patient and look vertically downwards in the plane of super ciliary ridges .The eye balls can be seen protruding out of this plane if proptosis is present. 

- Napkin ring sign- Annular carcinoma of colon.
- Nashe’s sign- Increased pulmonary blood flow in moderate and severe VSD.
- Naunyn’s sign- See Murphy’s sign
- Nicoladonis sign- see -Branham’s sign
- Nicolsky’s sign- Separation of the epidermis on giving pressure over the skin. Pemphigus vulgaris, TEN –Toxic Epidermal necrolysis, porphyria, Stevenson Johnson’s syndrome, Staphylococcal scalded syndrome. (O)
- Oil drop sign- In psoriasis .there is discolouration of nail bed.
- Ollendorf sign- is seen in secondary syphilis. The papule is tender .
- Olliver’s sign- Upward and down ward movement of the trachea can be seen in patients with COPD.
The chin should be raised and upward pressure should be applied over the trachea. A downward traction can be felt on the trachea. This is known as tracheal tug. 

- Oppenheim’s sign – Heavy pressure is applied by the thumb and index finger from above downwards
over the anterior surface of tibia (to its medial side). The extensor response usually occurs towards the end of the stimulation.
- Ortolani’s sign- Ortalani’s sign of jerk is the earliest sign of congenital dislocation of hip. By holding the limbs with the hip and knees flexed ,abduct the hip joint.Placea finger over the greater trochanter.A click can be felt as the femoral head slips in to the acetabulum.
- Osiander’s sign will be seen in pregnancy due to increased vaginal pulsations
- Osler’s sign- Alkaptonuria (P )
- Panda’ sign- bilateral periorbital haematoma in a patient with a fracture of the anterior cranial fossa.
- Pardee’s sign- It is an electrocardiogram finding in myocardial infarction. A few hours after the infarction there will be a Q wave and S-T segment is elevated.
- Pastia’s sign-is seen in scarlet fever .Residual petechial lesions in the antecubital fossa.
- Peroneal sign-Seen in latent tetany. Tapping the peroneal nerve at the neck of the fibula will produce dorsiflexion and abduction of the foot. (eversion of foot )
- Patellar apprehension sign- apply lateral pressure to the patella with the knee extended to 30 degrees .and the quadriceps relaxed .The patient fears that the patella may be dislocated and extends the knee thereby relocating the patella to the normal position. 

- Patellar tap sign- is seen in knee joint effusion. The effusion delays the patellar tapping against the femur. ,when it is pressed firmly and quickly.  

- Pedestal sign- is seen in cementless total hip arthroplasty, when there is prosthetic loosening of the femoral stem
- Pelken’s sign- is seen in scurvy . Thickened zone of provisional calcification protruding beyond the border of the shaft.
- Pen Britton sign-In retrosternal thyroid, on lifting the upper limbs ,the face is suffused, due to the pressure by the thyroid on the SVC
- Penetrating sign-A radiological finding in benign gastric ulcer. The ulcer crater should project from
the contrast filled lumen and erode in to the stomach wall rather than in to the mass in the stomach wall.
- Phalen’s sign -In carpel tunnel syndrome ,the signs and symptoms will increase on flexion of the wrist .On straightening these will improve. This is also known as Wrist flexion test.. 

- Phelp’s sign is seen in Glomus jugulare.
- Pipe stem sign- is seen in Ulcerative colitis.
- Pillow sign- hairs on the pillow on getting up in netherton’s syndrome.
- Platysma sign of Babinski- Loss of contraction on eversion of lower eyelid or retraction of angles of
mouth..
- Prayer sign- Is seen in diabetes. It is due to limited joint mobility (Cheiroarthropathy) There is inability to extend, the interphalangeal joint to 180 degree or limited joint mobility of interphalangeal joints of at least one finger bilaterally.
- Prehn’s sign- is seen in epididymo -orchitis .On elevation of the testis the pain increases in torsion and in epididymo-orchitis the pain decreases.
- Pronator sign-Ask the child to hold the hands above the head with the palm facing each other for some time. The patient will not be able to hold it in same position. The hand on the affected side will be pronated and the palm will face outwards
- Pseudo-babinski's sign The plantar extensor response may be seen in the absence of pyramidal tract lesions in the following conditions
1) Voluntary withdrawal
2) In plantar hyperaesthesia
3) Strong or painful stimulus,
4) In extrapyramidal lesions
- Pseudo Darrier sign- Congenital smooth muscle hamartoma
- Puddle’s sign -To diagnose minimal ascites. The patient is put in knee chest position .Percuss the abdomen towards the umbilicus to elicit the dullness.
- Quinke's sign – (In aortic regurgitation) There will be alternate flushing and blanching in the nail bed.

- Raccoon eye sign- is seen in fracture of the base of the skull. Bilateral ecchymosis and swelling of
the upper eye lids will be present.. 

- Red dot sign -Abdominal wall is discolored with focal or diffuse erythema reflects underlying peritonitis. This sign is seen in neonatal necrotizing enterocolitis.
- Reisser’s sign -iliac apophysis fuses with the iliac bone at maturity .This indicates a completion of growth. There will be no worsening of Scoliosis.
- Reversed 3 sign in barium x ray- Coarctation of aorta.
- Rib notching sign is seen in coarctation of aorta.
- Rigler sign- The bowel wall will be outlined by air inside and outside, in Pneumoperitoneum.
- Rim sign-In severe hydronephrosis some times only a thin rim of the contrast will be seen outlining the kidney. This is due to the contrast medium circulating in the capillaries compressed by the dilated calyces.
- Robert’s sign- appearance of gas shadow in the heart and great vessels by 12 hours of fetal death
- Romana’s sign- in Chaga’s disease ,.there will be unilateral painless oedema of the periorbital tissues .it is due to infection through the conjunctiva.
- Romberg’s sign- It is a test to find out the loss of position sense. It is special test to find out the Co-ordination of the lower limbs. The patient is asked to stand with his feet close together with both his eyes opened and closed. If Romberg’s sign is present as soon as the patient closes his eye, he begins to sway or may even fall, It signifies sensory ataxia.
- Rope sign- due to constriction of hypopharynx in poliomyelitis. There is acute angulation between the
chin and larynx due to weakness of the Hyoid muscles.
- Rosenbach’s sign - Pulsations of the liver in aortic regurgitation.
- Rossolimo’s Sign- Plantar surface of the Great toe is tapped with a hammer or flick the distal phalanges of the toes into extension and then allow them to fall back to their normal position. In pyramidal tract lesions, there will be plantar flexion of all the other toes including the Great toe. (This is equivalent of Hoffman’s sign of the upper limbs)
- Rotch’s sign- Flat note in the cardio hepatic angle on the right side in pericardial effusion .
- Rovsing’s sign -In appendicitis, when the abdomen is pressed on the left iliac region ,there will be
pain in the right side. This is due to the stretching of the inflamed peritoneum on the right side.
- Sail sign- The sail shaped shadow of the thymus in the upper mediastinal shadow.
- Sandwich sign- Mesenteric adenopathy. 

- Schamroth’s sign .This is seen in clubbing .Normally when the thumbs are placed in close approximation to each other so that the nails are facing each other a quadrangular space can be seen in between the thumbs. In clubbing (Grade II or more) of the fingers this space will be obliterated. This is called Shamroth sign.
- Scarf sign - The elbow crosses the midline when the arm is crossed across the chest .Keep the head
in the midline pull the hand across the chest .The elbow will cross the midline in preterm babies..
- Schwartz sign- is seen in Otosclerosis. A pink tinge may be seen due to otospongiotic mass
(Flamingo’s tint)
- Scimitar sign- Crescentic shadow (Curved Turkish sword shaped shadow) of vascular density along the right border of the cardiac silhouette. This is due to anomalous pulmonary vein draining in to the
inferior vena cava.
- Scottish dog sign- is seen in spondylolysis. The defect is in the pars interarticularis.. It appears
like a scottish dog wearing a collar .
- Sea gull sign- See Mercedes Benz sign
- Sectoral sign- is seen in Avascular necrosis of femoral head. The internal rotation of the hip will be full with hip extended ,but will be grossly restricted with the hip flexed.
- Seidel’s sign- Sickle shaped extension of the blind spot above or below ,or both ,with the concavity
of the sickle directed towards the fixation point. This sign is seen in field defects ,in simple glaucoma 

- Setting sun eye sign - Usually seen in hydrocephalus . - Normally the sclera above the upper limbus will not be visible. In hydrocephalus , eyes deviate downward because of the impingement of the dilated suprarenal recess on the tectum. .In normal new born babies this may be visible transiently. In kernicterus and  hydrocephalus it will be persistent
- Shawl sign- In dermatomyosistis .there will be erythema over the upper back and shoulders.
- Shoulder sign- The hypertrophied pyloric muscle will cause an indentation of the barium filled
antrum in patients with Hypertrophic pyloric stenosis.
- Shrug sign is seen in patello-femoral osteoarthritis.There will be pain ,when the patella is compressed manually against the femur during quadriceps contraction.
- Sore thumb sign-Acute Epiglottitis .
- Signet –ring sign- seen in the x-ray of a patient with scurvy.
- Silk sign- on physical examination , thickening of the spermatic cord in children with inguinal hernia. .It is elicited by palpating the spermatic cord at the pubic tubercle.
- Soft neurological signs – is a particular form of deviant performance on a motor or sensory test in a neurological examination that is abnormal for a particular age. These are present in normal children
at some stage of their development like .repetitive and successive finger movements, foot taps, hopping, tandem walking.
- Spalding’s sign- This is a radiological feature of intrauterine death overlapping of the skull bones at
the sutural lines and shrinkage of the skull contents in fetal death.
- Spatula sign- In tetanus, spasm of the child will be aggravated, when the child’s mouth is pressed
with a spatula.
- Spooning sign – is seen in chorea. Ask the patient to stretch the arms forward and hold them parallel to the floor with the palms facing each other. The affected arm will be flexed at the wrist and extended at the metacarpophalangeal joints. This resembles a dinner fork.( Dinner fork deformity)
- Steeple sign – in croup.
- Steinberg sign- ( Thumb sign) -In Marfan’s syndrome ,Protrusion of the thumb beyond the ulnar border of the hand ,when flexed across the palm..
- Step sign seen in
- Spondylolisthesis,
- Acromio clavicular dislocation.
- String of beads sign- in dilated small bowel filled with fluid, small bubbles of gas may be trapped
between the valvular conniventes
- Square root sign- on right ventricular pressure tracing in constrictive pericarditis. 

- Stellwag sign- (Staring look ) Infrequent blinking in Thyrotoxicosis.
- String sign-is seen in Hypertrophic pyloric stenosis. In barium meal study the elongated pyloric canal will be seen as a single line of barium. Some times it will be seen as a double line.
- String sign of Kantor- in barium meal study.-
Crohn’s disease is due to the marked narrowing of
the affected bowel.
- Sulcus sign – a radiological sign in inferior dislocation of shoulder ,where the head of the
humerus lies below the glenoid.
- Sun setting sign-See setting sun eye sign.
- Suzman's sign-In Coarctation of aorta collaterals are formed in the back and will cause pulsations
over the back. . The pulsations are prominent over the scapula and is best visualized with the patient
bending forwards. (T )
- Target sign – Thick pylorus in the ultrasonogram in pyloric stenosis
- Tear drop sign- in orbits- Blow out fracture
- Tear drop sign- in ankle- Ankle effusion
- Tent sign- In ovarian cyst ,the vaginal fornix on that side will be deep like a tent.
- Terry Thomas sign- Scapholunate dislocation
- Thinker’s sign- due to the abnormal posture of the patient in COPD.
- Thumb sign- See Steinberg sign. It is seen in Marfan’s syndrome.
- Thurston-Holland sign -Intra articular
fracture ,the line going through the plate and
through the part of the metaphysis.
- Tinel’s sign- When a regenerating nerve is tapped
at the level of regeneration there will be a tingling
sensation
- Trager’s sign
This is a sign of fetal death in utero. The fetal attitude in a X-ray will be with marked curvature or
collapse of spine. Loss of fetal attitude or posture is a result of decreased muscle tone .
- Trail sign- Undue prominence of clavicular head of sternomastoid muscle on one side is indicative of
tracheal displacement to that side .
- Tram track sign-Double track of barium will be seen outlining the Hypertrophic mucosa in the elongated pyloric canal in Hypertrophic pyloric stenosis.
- Tram track sign-is also seen in Sturge Weber syndrome.
- Tram track sign -is also seen in membranous glomerulonephritis.
- Traube's sign - Pistol shot sound in the femoral
artery in aortic regurgitation
- Trendelenburg sign -in congenital dislocation of hip. Ask the patient to stand on one leg and note the position of the pelvis. If the test is negative the pelvis will be raised on the unsupported side .If the test is positive the pelvis will drop on the unsupported side. 

- Trethowan’s sign- is positive in slipped femoral epiphysis. Normally the line drawn along the
superior surface of the neck passes bisecting the head of femur. In this condition this line` passes superior to the head.
- Triple bubble sign- Jejunal atresia.
- Tripod sign is seen in poliomyelitis. The child sits with the knees flexed and both the hands placed behind him supporting on the back as if in the tripod position. On stretching the legs the meninges are stretched which aggravates the pain. By assuming the tripod position the stretching of the meninges is avoided thereby the pain is reduced.
- Troisier’s sign enlarged left supraclavicular node (Virchow’s node)due the gastric malignancy.
- Trolley track sign -Signs in Ankylosing spondylitis Three vertical linerar lines with increased density will be seen.
- Trousseau’s sign- Phlebo thrombosis of superficial veins.
- Trousseau's sign- Ischemia of the upper limb is caused by inflating a sphygmomanometer cuff above the arterial pressure for not more than 2-3 minutes .. This will precipitate the carpopedal spasm.
- Trumbling bullet sign –is seen in post-traumatic bone cyst.
- Trumpet sign- is seen in intervertebral disc herniation. Enlargement of the nerve root seconday
to edema.
- Throgmorton’s sign- Extension of the suspensory ligament of the penis prior to micturition in newborn infants.
( V )
- Vacuum cleft sign- is seen in vertebra plana.
- Vallecular sign- Retention of barium in hypopharynx in patients with carcinoma of larynx.
- Vascular sign of Narath- is seen in anterior dislocation of the hip joint. The femorals are easily
felt in Scarpa’s triangle.
- Verumonten sign- is seen in complete rupture of urethra. The prostate will be floating in per rectal
examination.
- Von Graefe’s sign- in Thyrotoxicosis. Lag of the upper lid on downward gaze.
- Von Rosen’s sign (Barlow’s sign ) In congenital instability of the hip joint the hips are held flexed
and abducted , A click can be heard when the femoral head leaves the acetabulum .
- Victor Horsley’s sign- The temperature will be 1-2 degree more on the paralysed side.
( W )
- Water Lily sign- Hydatid cyst.
- Watenberg 's sign .-The fingers of the hand to be examined should be flexed and interlocked to the examiners flexed fingers. A pull in the opposite direction should be applied , so that the fingers of each other pull against other's resistance. Normally the thumb extends. In the presence of cortical lesions the thumb adducts and flexes.
- Wimberger’s sign—X-ray knee bilateral erosion in upper medial end of tibia. It will be seen in
congenital syphilis ,scurvy .
- Winter bottom sign- is seen in Trypanosoma brucei infection African trypanosomiasis (Sleeping
sickness).The regional nodes enlarge in the posterior cervical triangle..
- Wreden’s sign- is seen in a stillborn baby. Gelatinous material more or less completely fills the
external auditory meatus.
- Wrist sign -It is seen in Marfan’s syndrome. Ask the patient to grasp the wrist with the thumb and
the little finger. There will be overlapping of the fingers.
- ‘W’ sitting- is seen in persistent anteversion of the femoral neck .Children sit between their feet
with the hips fully internally rotated.