Medical Signs Game


Game is simple enough... just write a sign you know from medicine or surgery with brief description if possible..

Lets start:

Abadie’s Sign
Abadie’s sign is the absence or diminution of pain sensation when exerting deep pressure on the Achilles tendon by squeezing. This is a frequent finding in the tabes dorsalis variant of neurosyphilis (i.e., with dorsal column disease).

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"It's psychosomatic. You need a lobotomy. I'll get a saw." - Calvin in Calvin and Hobbes

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Busy with preparation of prelims. Will be back in Jan '09. PM your queries to asrafee or a4assasins

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If we go in detail the signs are
Medical signs may be classified by the type of inference that may be made from their presence,[6] for example:

Prognostic signs (from progignokein, προγιγνωσκειν, "to know beforehand"): signs that indicate the outcome of the current bodily state of the patient (i.e., rather than indicating the name of the disease). Prognostic signs always point to the future.[7]
Anamnestic signs (from anamnestikós, αναμνηστικός, "able to recall to mind"): signs that (taking into account the current state of a patient's body), indicate the past existence of a certain disease or condition. Anamnestic signs always point to the past.[8]
Diagnostic signs (from diagnostikós, διαγνωστικός, "able to distinguish"): signs that lead to the recognition and identification of a disease (i.e., they indicate the name of the disease).
Pathognomonic signs (from pathognomonikós, παθογνωμονικός, "skilled in diagnosis", derived from páthos, πάθος, "suffering", and gnōmon, γνώμον, "judge"): the particular signs whose presence means, beyond any doubt, that a particular disease is present. They represent a marked intensification of a diagnostic sign.[9] Singular pathognonomic signs are relatively uncommon.
[Thus] a symptom is a phenomenon, caused by an illness and observable directly in experience. We may speak of it as a manifestation of illness. When the observer reflects on that phenomenon and uses it as a base for further inferences, then that symptom is transformed into a sign. As a sign it points beyond itself — perhaps to the present illness, or to the past or to the future. That to which a sign points is part of its meaning, which may be rich and complex, or scanty, or any gradation in between.
In medicine, then, a sign is thus a phenomenon from which we may get a message, a message that tells us something about the patient or the disease. A phenomenon or observation that does not convey a message is not a sign. The distinction between signs and symptom rests on the meaning, and this is not perceived but inferred. (King, 1982, p.81)

Aaron's sign is a referred pain felt in the epigastrium upon continuous firm pressure over McBurney's point. It is indicative of chronic appendicitis.

Aaron's sign is named for Charles Dettie Aaron, an American gastroenterologist





although word chronic appendicitis is misnomer
love and bailley

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Abadie's symptom may be elicited during clinical examination. Pinching of, or the application of firm pressure to, the Achilles tendon does not result in pain in tabes dorsalis. This is because the sense of deep pain has been abolished.

It is named for Joseph Louis Irenée Jean Abadie, a French neurologist.

since the name concide i hav posted it

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Adie syndrome, also Adie's syndrome, Adie's Tonic Pupil or Holmes-Adie's syndrome, is caused by damage to the postganglionic fibers of the parasympathetic innervation of the eye and characterized by a tonically dilated pupil. It most commonly affects younger women and is unilateral in 80% of cases. The pupil is characteristically poorly reactive to light but slowly reactive to accommodation. This clinical picture is often accompanied by signs of aberrant regeneration of these nerves and asymmetrically reduced deep tendon reflexes.

Signs and symptoms may/can include blurry vision due to accommodative paresis, photophobia and difficulty reading.

Clinical exam may reveal sectoral paresis of the iris sphincter and/or vermiform iris movements. The tonic pupil may become smaller (miotic) over time which is referred to as "little old Adie's".

Testing with low dose (1/8%) pilocarpine may constrict the tonic pupil due to cholinergic denervation supersensitivity. A normal pupil will not constrict with the dilute dose of pilocarpine.

No specific treatment is required unless glare is overly symptomatic

It is named for William John Adie

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Adson's sign is seen during abduction and external rotation at the shoulder, where there is loss of the radial pulse in the arm. It can be a sign of thoracic outlet syndrome. Thoracic outlet obstruction may be caused by a number of abnormalities, including degenerative or bony disorders, trauma to the cervical spine, fibromuscular bands, vascular abnormalities, and spasm of the anterior scalene muscle. Symptoms are due to compression of the brachial plexus and subclavian vasculature, and consist of complaints ranging from diffuse arm pain to a sensation of arm fatigue, frequently aggravated by carrying anything in the ipsilateral hand or doing overhead work such as window cleaning.

As cited in the literature the Adson's sign is loss of radial pulse while turning the head to the contralateral side, slightly elevating the chin and breathing in.

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In medicine, Allen's test, also Allen test, is used to test blood supply to the hand. It is performed prior to radial arterial blood sampling or cannulation.


The Allen Test
1) The hand is elevated and the patient/person is asked to make a fist for about 30 secs.

2) Pressure is applied over the ulnar and the radial arteries so as to occlude both of them.

3) Still elevated, the hand is then opened. It should appear blanched (pallor can be observed at the finger nails).

4) Ulnar pressure is released and the color should return in 5 secs.

Inference: Ulnar artery supply to the hand is sufficient and it is safe to cannulate/prick the radial

If color does not return or returns after 7 seconds, then the ulnar artery supply to the hand is not sufficient and the radial artery therefore cannot be safely pricked/cannulat
Anatomical basis
The hand is normally supplied by blood from the ulnar and radial arteries. The arteries undergo anastomosis in the hand. Thus, if the blood supply from one of the arteries is cut off, the other artery can supply adequate blood to the hand. A minority of people lack this dual blood supply.


Significance
An uncommon complication of radial arterial blood sampling/cannulation is disruption of the artery (obstruction by clot), placing the hand at risk of ischemia. Those people who lack the dual supply are at much greater risk of ischemia. The risk can be reduced by performing Allen's test beforehand. People who have a single blood supply in one hand often have a dual supply in the other, allowing the practitioner to take blood from the side with dual supply.

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Argyll Robertson pupils (“AR pupils”) are bilateral small pupils that constrict when the patient focuses on a near object (they “accommodate” with near vision), but do not constrict when exposed to bright light (they do not “react” to light). They were formerly known as "prostitute's pupils" because of their association with syphilis and because, like a prostitute, they “accommodate but do not react.”[1]). They are a highly specific sign of neurosyphilis. Pupils that “accommodate but do not react” are said to show light-near dissociation. A video of AR pupils and light-near dissociation is available at

AR pupils are extremely uncommon in the developed world. There is continued interest in the underlying pathophysiology, but the scarcity of cases makes ongoing research difficult.



History
The AR pupil was named after Douglas Moray Cooper Lamb Argyll Robertson, a Scottish ophthalmologist who noted the association with syphilis in 1869.When serological tests for syphilis became available, patients with AR pupils usually tested positive for syphilis. The AR pupil became known as a reliable clinical sign of syphilis.

In the early 20th century, Adie described a second type of pupil that could “accommodate but not react.” Adie’s tonic pupil is usually associated with a benign peripheral neuropathy (Adie syndrome), not with syphilis.

When penicillin became widely available in the 1940s, the prevalence of AR pupils (which develop only after decades of untreated infection) decreased dramatically. AR pupils are now quite rare. A patient whose pupil “accommodates but does not react” almost always has a tonic pupil, not an AR pupil.

In the 1950s, Loewenfeld distinguished between the two types of pupils by carefully observing the exact way in which the pupils constrict with near vision. The near response in AR pupils is brisk and immediate. The near response in tonic pupils is slow and prolonged.


Pathophysiology
The two different types of near response are caused by different underlying disease processes. Adie pupil is caused by damage to peripheral pathways to the pupil (parasympathetic neurons in the ciliary ganglion that cause pupillary constriction to bright light and with near vision). The AR pupil is thought to be caused by damage to central pathways for pupillary constriction. Specifically, the AR pupil is thought to be caused by selective damage to pathways from the retina to the Edinger-Westphal nucleus. These light-sensitive pathways allow the pupil to constrict to bright light. The accommodation pathways – pathways to the Edinger-Westphal nucleus that cause the pupils to constrict with near vision – are thought to be spared because of their more ventral course in the brainstem.

The exact relationship between syphilis and the two types of pupils (AR pupils and tonic pupils) is not known at the present time. The older literature on AR pupils did not report the details of pupillary constriction (brisk vs. tonic) that are necessary to distinguish AR pupils from tonic pupils. Tonic pupils can occur in neurosyphilis.It is not known whether neurosyphilis itself (infection by Treponema pallidum) can cause tonic pupils, or whether tonic pupils in syphilis simply reflect a coexisting peripheral neuropathy.

Thompson and Kardon (2006) summarize the present view:

The evidence supports a midbrain cause of the AR pupil, provided one follows Loewenfeld’s definition of the AR pupil as small pupils that react very poorly to light and yet seem to retain a normal pupillary near response that is definitely not tonic.
To settle the question of whether the AR pupil is of central or peripheral origin, it will be necessary to perform iris transillumination (or a magnified slit-lamp examination) in a substantial number of patients who have a pupillary light-near dissociation (with and without tonicity of the near reaction), perhaps in many parts of the world.

Parinaud syndrome
A third cause of light-near dissociation is Parinaud syndrome, also called dorsal midbrain syndrome. This uncommon syndrome involves vertical gaze palsy associated with pupils that “accommodate but do not react.” The causes of Parinaud syndrome include brain tumors (pinealomas), multiple sclerosis and brainstem infarction.

Due to the lack of detail in the older literature and the scarcity of AR pupils at the present time, it is not known whether syphillis can cause Parinaud syndrome. It is not known whether AR pupils are any different from the pupils seen in other dorsal midbrain lesions.

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Auspitz's sign is the appearance of punctate bleeding spots when psoriasis scales are scraped off. It is named after Heinrich Auspitz. The sign was first described by Daniel Turner, of the College of Physicians London in 1711

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In cardiology, an Austin Flint murmur is a mid-diastolic, low-pitched rumbling murmur which is best heard at the cardiac apex. It is associated with severe aortic regurgitation.



Mechanism
Echocardiography, conventional and colour flow doppler ultrasound, and cine nuclear magnetic resonance (cine NMR) imaging suggest the murmur is the result of (aortic regurgitant) flow impingement on the inner surface of the heart, i.e. the endocardium.


Classical description
Classically, it is described as being the result of mitral valve leaftlet displacement and turbulent mixing of antegrade mitral flow and retrograde aortic flow

Displacement: The blood jets from the aortic regurgitation strike the anterior leaflet of the mitral valve, which often results in premature closure of the mitral leaflets.

Turbulance of the two columns of blood: Blood from left atrium to left ventricle and blood from aorta to left ventricle.


Treatment
Aortic valve replacement may be necessary to correct the abnormality if symptomatic.


Eponym
It is named after the 19th century American physician Austin Flint (1812–1886).

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