Physical examination

Chest percussion.
1.Grocco triangle: an area of dullness on normal side,formed by spine and diaphragm,either by opposite pleural effusion or consolidation or elevated ipsilateral diaphragm and ipsilateral pericardial effusion.It represents acoustic muffling produced by diseased side.
2.Ewart sign: area of dull note always on left side(unless dextrocardia) cos pericardial effusion compresses the posterior lung
3.Traube space:Area of tympanic note cos of air in stomach,on left side bordered by liver and on right by spleen and superiorly by heart
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Inspection of chest
Inspiratory retraction
1.Generalized exaggeration
-pan lung diseases

2.Localized exaggeration
-local obstruction
-flail chest
3.Generalized loss
-pan lung diseases
4.Localized loss
-local consolidation/air/fluid accumulation
Expiratory bulging

1.Generalized exaggeration
as above

2.Localized exaggeration
-pneumothorax
-flail chest
3.Generalizes loss
as above
4.Localized loss
as localized causes above
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Broadbent sign
Exaggerated retraction of intercoastal spaces over precordium during systole-seen in constrictive perdicarditis
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Tracheal deviation could be marker of retrosternal goiter.
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Diaphragm normally pulls rib cage(attached to last 6 ribs) horizontally during expiration so that it can move up and the indentations there by produced on pliable ribs in rickets-Harrison groove/Hoover groove
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Hutchinson's sign:Subungual melanoma extending into paranychial tissues especially around cuticle.
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Muehrcke(pronunced: Me-rku) lines:transient transverse white lines of nail bed due to hypoalbuminemia
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Onycholysis is most prominent in 4th finger cos its lesser prone to trauma (lesser usage except for marriage ring!In other sense,uselss thing for useless one!!)
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White transverse lines of nail
Mees-arsenic poisoning
Reil- inter current illness
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Finger nail grows at rate of 0.5 mm /day
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Stiffening of ear lobe- a feature of addison's disease(Might be due to dehydration status with subsequent elevated serum calcium)
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Brown limbal ring of eye:Addison disease(ACTH induced melanosomes).Seen more clearly superior & inferior.
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Brushfield spots on iris-Down syndrome-white in color
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Lisch nodules-Brown spots-Neurofibromatosis type 1;
Try to see with plus 20 D of direct ophthalmoscope if slit lamp is not immediately available
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3D of Anti cardiolipin anitbody syndrome
1.Dead babies(recurrent abortions)
2.Dementia and
3.Discoloration of skin(livedo reticularis)
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