PM – Signs, Triads, Syndromes, Radiology

Enlarged thymus in children; the “sail sign” suggests an enlarged thymus on a chest X-ray. Pleural effusion presents with blunting of the costophrenic angle. Pneumothorax shows a clear space with no lung markings. Pneumonia typically presents with an area of consolidation.

Cholangitis; Charcot‘s triad includes right upper quadrant pain, jaundice, and fever. Appendicitis symptoms are lower abdominal pain, nausea, and fever but do not form Charcot‘s triad. Diverticulitis often presents with left lower quadrant pain. Pancreatitis often presents with epigastric pain and elevated pancreatic enzymes.

Pathognomonic sign of Wegener’s granulomatosis is a red-purplish, granular gingivitis called strawberry
gums.

Acute cholecystitis; Murphy‘s sign is the cessation of breath during right subcostal palpation. Hepatitis involves liver inflammation but not Murphy‘s sign. Peptic ulcer disease involves the stomach or duodenum. Pancreatitis pain can radiate to the back but doesn‘t cause Murphy‘s sign.

Dyskeratosis congenita is an inherited bone-marrow-failure syndrome in childhood & presents
with the triad of reticular hyperpigmentation, nail dystrophy and mucous membrane leukoplasia

Diabetic ketoacidosis (DKA); Kussmaul breathing is deep, rapid breathing associated with the acidotic state of DKA. Asthma involves wheezing and difficulty exhaling. COPD often presents with a barrel chest and pursed-lip breathing. Pulmonary edema presents with pink frothy sputum and dyspnea.

Hypocalcemia; Trousseau‘s sign is carpal spasm induced by inflating a blood pressure cuff, indicating hypocalcemia. Hyperkalemia affects heart rhythm. Hypokalemia can cause muscle weakness. Hyponatremia affects fluid balance, not directly causing tetany.

The classic triad of myeloma is marrow plasmacytosis (>10%), lytic bone lesions, and a serum
and/or urine M component.

Wernicke‘s encephalopathy triad includes confusion, ophthalmoplegia, and ataxia, typically due to thiamine deficiency. Korsakoff‘s syndrome involves memory loss and confabulation. Parkinson‘s disease triad involves tremor, rigidity, and bradykinesia. Multiple sclerosis can present with varied neurological symptoms over time.

Prolongation of QRS duration does not necessarily indicate a conduction delay but may be due
toA form of ventricular preexcitation via a bypass tract, Wolff-Parkinson-White (WPW) syndrome
is diagnosed by a triad consisting of a wide QRS complex associated with a relatively short PR
interval and slurring of the initial part of the QRS (delta wave), with the latter effect being due to
aberrant activation of ventricular myocardium.

Infective endocarditis; Janeway lesions are non-tender, erythematous lesions on palms and soles associated with infective endocarditis. Rheumatoid arthritis involves joint inflammation. Psoriasis can cause skin plaques. SLE (Systemic Lupus Erythematosus) can present with a malar rash.

Three main features of cardiac tamponade (Beck’s triad) are hypotension, soft or absent heart
sounds, and jugular venous distention with a prominent “x” descent but an absent “y” descent

Neurosyphilis; Argyll Robertson pupil constricts with accommodation but does not react to light, associated with neurosyphilis. Glaucoma involves increased intraocular pressure. Cataracts lead to lens clouding. Retinitis pigmentosa affects night vision and peripheral vision.

Headaches, palpitations, and diaphoresis form the triad for pheochromocytoma, a tumor of the adrenal medulla. Polyuria, polydipsia, and polyphagia are symptoms of diabetes mellitus. Fever, neck stiffness, and altered mental status indicate meningitis. Jaundice, ascites, and spider angiomas suggest liver cirrhosis.

Hypertensive retinopathy; “steel wool” appearance in the fundus is indicative of hypertensive retinopathy. Diabetic retinopathy involves microaneurysms and hemorrhages. Retinal detachment presents with a “curtain” over the visual field. Age-related macular degeneration affects central vision.

Functional asplenia or post-splenectomy; Howell-Jolly bodies are remnants of nuclear material in red blood cells, seen when the spleen is not filtering blood properly. Iron deficiency anemia involves microcytic anemia. Megaloblastic anemia is characterized by large red blood cells due to B12 or folate deficiency. Hemolytic anemia involves the destruction of red blood cells.

Clinical features of thromboangiitis obliterans include a triad of claudication of the affected
extremity, Raynaud’s phenomenon, and migratory superficial vein thrombophlebitis.

Liver cirrhosis; Terry‘s nails are characterized by a white nail bed, commonly seen in liver cirrhosis. Chronic renal failure may cause half-and-half nails. Iron deficiency anemia may lead to spoon nails. Psoriasis can cause nail pitting and onycholysis but not Terry‘s nails.

Ptosis, miosis, and anhidrosis; Horner‘s syndrome results from disruption of the sympathetic nerves. Dysphagia, dysarthria, and diplopia suggest brainstem pathology. Hypertension, hypokalemia, and metabolic alkalosis indicate Conn‘s syndrome. Rigidity, bradykinesia, and tremor describe Parkinson‘s disease.

Tay-Sachs disease; a “cherry-red spot” is characteristic of Tay-Sachs disease, a lysosomal storage disorder. Niemann-Pick disease also presents with a cherry-red spot but has additional systemic features. Lead poisoning affects multiple systems but not with a cherry-red spot. Vitamin A deficiency causes night blindness and xerophthalmia.

Measles (Rubeola); Koplik‘s spots are small, white lesions on the buccal mucosa, indicative of measles. Herpangina is caused by Coxsackievirus with lesions in the throat. Oral candidiasis presents with white, curd-like plaques. Hand, foot, and mouth disease causes oral ulcers and rash on hands/feet.

Infective endocarditis; Roth‘s spots are retinal hemorrhages with pale centers, seen in infective endocarditis. Hypertensive retinopathy may show cotton wool spots. Diabetic retinopathy features microaneurysms and hemorrhages. Retinal vein occlusion presents with widespread retinal hemorrhages.

Mediastinal emphysema; Hamman‘s sign is a crunching, rasping sound, synchronous with the heartbeat, heard over the precordium, indicating air in the mediastinum. Pericarditis presents with a friction rub. Aortic dissection can present with a tearing chest pain. Pneumothorax involves absent breath sounds and hyperresonance.

Peritonitis; Blumberg‘s sign, or rebound tenderness, indicates peritoneal irritation or peritonitis. Appendicitis may present with Blumberg‘s sign but it‘s more specific for peritoneal irritation. Cholecystitis involves right upper quadrant pain, not specifically Blumberg‘s sign. Pancreatitis typically presents with epigastric pain.

Chronic bronchitis; “Blue bloater” describes the appearance of a patient with chronic bronchitis part of COPD, characterized by cyanosis and fluid retention. Emphysema presents as a “pink puffer” with dyspnea and minimal cyanosis. Asthma involves reversible airway obstruction. Pulmonary fibrosis leads to restrictive lung disease.

Bulimia nervosa; Russell‘s sign is calluses on the knuckles from induced vomiting, associated with bulimia nervosa. Anorexia nervosa involves extreme weight loss. Cushing‘s syndrome features weight gain and moon face. Hyperthyroidism can cause weight loss and increased appetite.

Meniscus sign; the meniscus sign indicates fluid accumulation in the pleural space. Boot-shaped heart is indicative of Tetralogy of Fallot. Eggshell calcification is seen in silicosis. Honeycombing is characteristic of interstitial lung diseases.

Joint space narrowing and osteophyte formation are typical radiographic findings in osteoarthritis. Bamboo spine is seen in ankylosing spondylitis. Rat bite erosions are seen in rheumatoid arthritis. Periosteal reaction can be seen in infections or malignancies.

Yellow nail syndrome is due to hypoplastic lymphatics. The triad of lymphedema, pleural effusion
and yellow discoloration of nails is accompanied by bronchiectasis in ~40% of patients.

Coffee bean sign; the coffee bean sign indicates a twisted sigmoid colon. String sign is seen in Crohn‘s disease. Apple core lesion is characteristic of colorectal carcinoma. Thumbprinting is seen in ischemic colitis.

Batwing pattern; batwing or butterfly pattern suggests pulmonary edema, with fluid accumulation in the perihilar areas. Cavitation is seen in tuberculosis. Coin lesion suggests a solitary pulmonary nodule. Kerley B lines are also seen in pulmonary edema, indicating interstitial fluid.

Patients with long-standing cirrhosis and portal hypertension are prone to develop the hepatopulmonary
syndrome, defined by the triad of liver disease, hypoxemia, and pulmonary arteriovenous shunting.
The defect in oxygenation is due to a ventilation.perfusion mismatch.

Breast carcinoma; a spiculated mass is often malignant, indicating breast carcinoma. Benign cysts are usually round or oval with distinct margins. Fibroadenomas are well-circumscribed, benign tumors. Fat necrosis can mimic cancer but often has a history of trauma.

West syndrome is a triad of infantile spasms, mental retardation & hypsarrhythmic EEG pattern

Colorectal carcinoma; an apple-core lesion is characteristic of a constricting type of colorectal carcinoma. Diverticulosis presents as outpouchings. Ulcerative colitis shows loss of haustration and mucosal ulceration. Crohn‘s disease can show “string sign” due to narrowing.

Duodenal atresia; the “double bubble” sign indicates a blockage in the duodenum, seen in duodenal atresia. Intussusception involves telescoping of the intestine. Hirschsprung disease involves a lack of ganglion cells in the colon. Necrotizing enterocolitis is a serious condition affecting the intestines of premature infants.

Dawson‘s fingers; periventricular white matter lesions resembling fingers, indicative of Multiple Sclerosis. Lacunar infarcts are small, deep cerebral infarcts. Ring-enhancing lesions suggest abscesses or tumors. Leukoaraiosis indicates white matter changes associated with small vessel disease.

Osteosarcoma; a sunburst pattern suggests aggressive periosteal reaction seen in osteosarcoma. Ewing‘s sarcoma might show an “onion skin” periosteal reaction. Osteochondroma is characterized by a bony outgrowth capped with cartilage. Paget‘s disease of bone shows thickened and disorganized bone.

In chest radiographs, presence of “tram tracks” indicate dilated airways and is consistent with
bronchiectasis. Chest CT findings include airway dilation that is detected as parallel “tram tracks” or
as “signet-ring sign” i.e. a cross-sectional area of the airway with a diameter at least 1.5 times that
of the adjacent vessel, lack of bronchial tapering (including the presence of tubular structures within
1 cm from the pleural surface), bronchial wall thickening in dilated airways, inspissated secretions
(e.g., the “tree-in-bud” pattern), or cysts emanating from the bronchial wall (especially pronounced
in cystic bronchiectasis.

Radiological sign of cardiovascular syphilis is appearance of linear calcification of ascending aorta

In rheumatoid arthritis, the earliest radiological sign is juxta-articular osteopenia due to increased blood flow (hyperemia) and inflammation of the synovium, which leads to localized bone demineralization near the joint.
Other findings like loss of articular cartilage and bone erosions appear later in the disease course. Soft tissue swelling can be seen earlier clinically but is not the earliest specific radiological sign.

CT and MRI are not generally recommended for hepatocellular carcinoma surveillance. Their sensitivity,
specificity, and positive and negative predictive values for this purpose are unknown, and their use
is associated with high cost as well as possible harm.

Recurrent head trauma in professional boxers may lead to dementia, called the “punch drunk”
syndrome or dementia pugilistica.

A paraneoplastic syndrome of dementia associated with occult carcinoma (small cell lung cancer)
is termed limbic encephalitis in which confusion, agitation, seizures, poor memory, emotional
changes, and frank dementia may occur.

Besides increasing risk of venous thrombosis, Protein S deficiency and homocysteinemia may
cause arterial thromboses as well.

Thalassemia syndromes arise from mutations that impair production or translation of globin
mRNA, leading to deficient globin chain biosynthesis

Sickle cell dactylitis or hand-foot syndrome caused by painful infarcts of digits & dactylitis is seen
in sickle cell disease & sickle cell thalassemia below the age 4 or 5 years & not in adults.

Excessive serotonergic activity; Serotonin Syndrome is caused by drugs that increase serotonin levels, leading to symptoms like agitation, sweating, and muscle rigidity. Neuroleptic Malignant Syndrome involves dopamine blockade. Malignant Hyperthermia is a reaction to anesthesia. Tardive Dyskinesia is a side effect of long-term antipsychotic use.

Down syndrome, Fanconi anemia, Bloom syndrome, Ataxia telangiectasia, Kostmann syndrome,
myeloproliferative syndromes, germ-line mutations of CCAAT/enhancer-binding protein (CEBPA),
runt-related transcription factor 1 (RUNX1), and tumor protein p53 (TP53) are associated with
an increased incidence of AML

Hypertensive Emergency; Severe hypertension can lead to end-organ damage, characterized as a hypertensive emergency. Metabolic Syndrome involves hypertension but also includes other cardiovascular risk factors. Pheochromocytoma can cause episodic hypertension. Renal Artery Stenosis may lead to secondary hypertension.