1

Preface
The aim of this atlas is to help the medical students in the detection and interpretation of the physical signs of various medical diseases. I have no authority for any of these slides but I had collected them from different websites and added my notes. (cont.)

Preface

The title of the slide has been hidden for self assessment. To reveal the title click on the slide.

Assist. prof. Safaa Ali FICMS (med.) College of Medicine / Kufa University 2009

drsafaa65@gmail.com

Lid retraction [Thyrotoxicosis]

Lid lag [Thyrotoxicosis]

Exophthalmos [Graves disease]

Puffy apathetic face with coarse hair

[Hypothyroidism, before and after treatment]

Moon face with hirsutism [Cushing syndrome]

Coarse features of the face and bulky hands [Acromegaly]

10

Proganthism (protrusion of lower jaw) [Acromegaly]

11

Puffy eyes [nephrotic syndrome, hypothyroidism]

12

Xanthelasma [hypercholesterolemia]

13

Heliotrope rash (purple discoloration on the upper eyelids) [dermatomyositis]

14

Pallor of conjunctiva [anemia]

15

Yellowish discoloration of the sclera and skin [jaundice]

16

Kayser fleischer ring [Wilsons disease]

17

Kayser fleischer ring [Wilsons disease]

18

Red painful eye(anterior uveitis)

[Behcet disease, Reiter's syndrome, IBD]

19

Infiltration of lower eye lid [Lymphoma]

20

Discoid lupus lesion [SLE]

21

Saddle nose [Wegner granulomatosis]

22

Ulcer with rolled borders [basal cell carcinoma]

23

Hyperpigmented elevated lesion [malignant melanoma]

24

Papules, pustules and comedones [Acne vulgaris] (adolescence, steroid therapy)

25

Whitehead and blackhead comedones [Acne vulgaris] (adolescence, steroid therapy)

26

Melasma (symmetric brown patches on the face) [pregnancy, oral contraceptive]

27

erythematous plaque over the nose (butterfly rash) [SLE]

28

Papules, pustules and telangiectasia on erythematous plaque [acne rosacea]

29

Multiple angiofibroma [tuberous sclerosis]

30

Maculopapular rash [measles, drug eruption]

31

Maculopapular rash behind the ear [measles]

32

Erythema and edema of the face [Erysipelas / streptococcal infection ]

33

Periorbital edema [angioedema, hereditary or IgE dependent]

34

Unilateral ptosis [Congenital, Myasthenia gravis]

35

Bilateral ptosis
{before and after edrophonium (tensilon) test}

[Myasthenia gravis]

36

Ptosis, divergent squint and dilated pupil [Oculomotor nerve palsy]

37

Enophthalmos, ptosis and meiosis [Horners syndrome]

38

Inability to elevate the left eyebrow and incomplete closure of left eye with Bells phenomena. Right side deviation of the mouth

[left LMN facial nerve palsy (Bells palsy)]

39

Flat nasolabial fold and inability to show teeth in the right side [right UMN facial nerve palsy]

40

Chvostek's sign [hypoparathyroidism]

41

Scattered hemorrhage, yellow exudates and new vessels formation near optic disc [proliferative diabetic retinopathy]

42

Scattered hemorrhage and cotton wool spots (retinal infarcts) [hypertensive retinopathy]

43

Massive retinal hemorrhage [central retinal vein occlusion]

44

Papilloedema [raised intracranial pressure]

45

Optic atrophy [optic neuropathies]

46

Pallor of the lips [anemia]

47

Bluish discoloration of the lips [central cyanosis]

48

Confluent vesicles on the lips [Herpes simplex infection]

49

Dark brown spots on the lips [Peutz- Jeghers disease]

50

Aphthous ulcer
[idiopathic, Behcet disease, IBD, HIV infection]

51

Swelling of the lip [angioedema, hereditary or IgE dependent]

52

Gum hyperpigmentation [Addisons disease]

53

Gum hypertrophy [calcium channel blockers, Phenytoin therapy and AML M5]

54

Buccal hyperpigmentation [Addisons disease]

55

Multiple aphthous ulcers

[idiopathic, Behcet disease, IBD, HIV infection]

56

White patches of oral mucosa [Candida albicans infection]

57

Tonsillar enlargement [Tonsillar abscess]

58

Dry tongue [dehydration]

59

Swelling of the tongue [angioedema, hereditary or IgE dependent]

60

Atrophic glossitis [B12 and iron deficiency]

61

Herpes glossitis [Herpes simplex infection]

62

White patches on the tongue [Candida albicans infection]

63

White plaques on the tongue [Leukoplakia /Epstein Barr virus infection]

64

High arched palate [Marfan syndrome]

65

Unequal lower teeth [fracture mandible]

66

Left parotid enlargement [Sjogrens syndrome]

67

Right parotid enlargement [mumps]

68

Cervical lymph node enlargement [lymphoma]

69

Supraclavicular lymph node enlargement (Virchow's node) [gastric cancer]

70

Multinodular goiter [simple multinodular goiter]

71

Multinodular goiter [simple multinodular goiter]

72

Clubbing and cyanosis [cyanotic congenital heart diseases]

73

Clubbing [bronchogenic cancer]

74

Koilonychia (spooning of nail) [iron deficiency anemia]

75

Beaus lines [chemotherapy, transient medical illness]

76

Central nail canal [peripheral vascular disease]

77

Nail beading [DM, endocrine disorders]

78

Nail pitting [psoriasis]

79

Leukonychia (white nail) [liver cirrhosis, CRF]

80

Yellow nail [yellow nail syndrome] (pleural effusion and bronchiectasis)

81

Splinter hemorrhage [trauma, vasculitis, bacterial endocarditis]

82

Paronychia [bacterial or fungal infection]

83

Swelling of the right hand [angioedema, hereditary or IgE dependent]

84

Fingers cyanosis [Raynauds phenomena]

85

Digital infarction [DIC, vasculitis, sever Raynauds disease]

86

Palmar erythema
[liver disease, thyrotoxicosis, pregnancy and fever]

87

Depigmentation of skin
[vitiligo with possible associated autoimmune
diseases]

88

Palmar xanthoma [familial hypercholesterolemia]

89

Tendon xanthoma of thumb [familial hypercholesterolemia]

90

Tuberous xanthoma [familial hypercholesterolemia]

91

Carpal spasm [hypocalcemia]

92

Trousseau's signs [hypocalcemia]

93

Thick tight skin [scleroderma]

94

Flexion contractures [scleroderma]

95

Limited extension of fingers [scleroderma, DM]

96

Dupuytren's contracture [alcoholic liver disease, DM, idiopathic fibrosis]

97

Hypermobility of the joints [Ehlers - Danlos syndrome]

98

Long fingers (arachnodactyly) [Marfan syndrome]

99

Long arm span [Marfan syndrome]

100

Heberden's nodes [osteoarthritis]

101

Swan neck deformity [rheumatoid arthritis]

102

Boutonniere deformity [rheumatoid arthritis]

103

Z-deformity of the thumb [rheumatoid arthritis]

104

Rheumatoid nodule [rheumatoid arthritis]

105

Warts [Papillomavirus infection]

106

Extradactyly and syndactyly [Laurence Moon- Biedl syndrome]

107

Short fourth metacarpal bone [Pseudohypoparathyroidism]

108

Erythematous plaques with adherent silvery scale. [psoriasis]

109

Pathergy test [Behcets disease]

110

Lipodystrophy [insulin therapy]

111

Eruptive xanthoma [hypertriglyceridemia]

112

Hyperpigmented lesions [diabetic dermopathy]

113

Purpura [thrombocytopenia, Henoch-Schnlein purpura]

114

Erythema nodosum
[ TB, streptococcal infection, IBD, sarcoidosis, OC]

115

Erythema ab igne [local heat effect]

116

Necrobiosis lipoidica diabeticorum [DM]

117

Pyoderma gangrenosum
[idiopathic, IBD, chronic active hepatitis, RA, CML]

118

Swelling and redness of the right leg [acute DVT]

119

Swelling and redness of the left leg [extensive DVT]

120

Hoffmans sign [acute DVT]

121

Swelling and redness of the leg [cellulitis]

122

Bilateral leg edema

[heart failure, nephrotic syndrome, liver cirrhosis]

123

Unilateral leg edema [lymphatic obstruction]

124

Swelling behind the right knee [Baker cyst /RA]

125

Varicose veins
[primary or secondary to deep venous insufficiency ]

126

Swelling and redness of the varicose vein [superficial thrombophlebitis]

127

Stasis dermatitis with ulcer [chronic venous insufficiency]

128

Foot ulcer and amputation of toes [DM]

129

Blisters and ulcer of the foot [DM]

130

Dry gangrene [DM]

131

Bony abnormality and nail infection [DM]

132

Interdigital infection [DM]

133

Swelling and redness of 1st MP joint [acute gouty arthritis]

134

Skin hyperpigmentation [Addison's disease]

135

Achilles tendon xanthoma [familial hypercholesterolemia]

136

Hammer toe [DM]

137

Pes cavus (high arched foot) [Friedreich's Ataxia, Charcot-Marie-Tooth

neuropathy, muscular dystrophy]

138

Spider nevi [chronic liver disease]

139

Purplish striae [Cushing syndrome, recent weight gain]

140

Velvety hyperpigmentation of axilla (Acanthosis nigricans) [obesity, acromegaly, insulin resistance, GI malignancy]

141

Gynecomastia
[puberty, liver disease, drugs like cimetidine,

digoxin and spironolactone]

142

Loss of male hair distribution [hypogonadism: hypothalamic-pituitary disorders, testicular disease, liver cirrhosis]

143

Dilated superficial veins [superior vena cava obstruction]

144

Pectus carinatum [congenital, Marfan syndrome]

145

Pectus carinatum [congenital, Marfan syndrome]

146

Barrel chest [chronic obstructive lung diseases]

147

Scoliosis [congenital, Marfan syndrome]

148

Ascites
[liver cirrhosis, nephrotic syndrome, heart failure, TB peritonitis, malignancy]

149

Caput medusa(dilated peri-umbilical veins) [liver cirrhosis with portal hypertension]

150

Dilated superficial veins with upwards flow [inferior vena cava obstruction]

151

Purplish abdominal striae [Cushing syndrome]

152

Maculopapular rash [viral infections like measles, drug allergy]

153

vesicular eruption of variable stages [Varicella (chicken pox)]

154

Unilateral vesicular eruption [Herpes zoster(shingles)]

155

Urticaria [drug allergy, physical urticaria, hereditary urticaria and vasculitis ]

156

Blisters over the abdomen [Bullous pemphigoid ]

157

Erythema multiformi
[drug allergy, herpes and Mycoplasma infection ]

158

Scaly lesion with central healing and peripheral inflammation [Tinea (ring worm) /fungal infection]

159

Erythematous papules in the trunk [cherry hemangioma]

160

Neurofibromas and caf au lait spots [neurofibromatosis type 1] (Von Recklinghausen's disease)

161

Lipoatrophy [local complication of insulin injection]

162

Wasting of face and neck muscles/frontal baldness [myotonic dystrophy]

163

Gowers sign [Duchenne muscular dystrophy]

164

Muscle wasting and contracture [Duchenne muscular dystrophy]

165

Short stature and obesity [Cushing syndrome in children]

166

Dwarfism [achondroplasia]

167

Gigantism [GH excess before puberty]

168