Sign/Symptom | Pathology |
Cough of recent origin | Common cold, rhinitis, acute bronchitis, exacerbation of chronic bronchitis or pneumonia (especially if associated with fever) |
Chronic cough | Asthma (+/- wheezing), COPD, bronchiectasis, cardiac failure, dry in oesophageal reflux and ACE inhibitors. |
Cough with postnasal drip or headaches | Upper airway cough syndrome |
Chronic cough with large amounts of purulent sputum | Bronchiectasis |
Cough that is worse in the morning | COPD |
Cough that is worse at night | Asthma |
Small amounts of blood with sputum | Bronchitis |
Frank blood, history of smoking, hoarseness | Bronchial carcinoma |
Dyspnoea with wheeze | Aiway obstruction (COPD or asthma). |
Dyspnoea of sudden onset | Pneumothorax |
Asterixis | Respiratory:
Severe COPD (CO2 retention)
GIT:
Early stage of chronic liver failure |
Central cyanosis | COPD, pulmonary embolism, pneumonia |
Stridor | Anaphylaxis, acute epiglottitis, inhaled foreign body, tumour |
Clubbing | Respiratory Tract:
Lung carcinoma, bronchiectasis, cystic fibrosis, asbestosis.
GIT:
Cirrhosis, inflammatory bowel disease, coeliac disease |
Wasting of interosseous muscles and weakness of abduction | Compression of T1 nerve root (apical lung carcinoma) |
Pulsus paradoxus and tachycardia | Severe asthma |
Hypertrophic osteoarthropathy | Associated with clubbing - Lung carcinomas and pleural fibromas |
Nasal polyps | Asthma |
Engorged turbinates | Allergic conditions |
Poor dentition | respiratory:
Lung abscess, pneumonia
GI:
Fetor, ulcers |
Plethora or cyanosis | SVC obstruction |
Displacement of trachea towards affected side | Upper lobe fibrosis, atelectasis, pneumothorax |
Displacement of trachea away from affected side | Massive pleural effusion, tension pneumothorax |
Barrel chest | Severe asthma or emphysema (gas trapping) |
Pigeon chest | Manifestation of chronic childhood respiratory illness (RSV) |
Funnel chest | Developmental defect |
Harrison's sulcus | Severe childhood asthma or rickets (vitamin D deficiency) |
Kyphocoliosis | Poliomyelitis, Marfan's syndrome |
Subcutaneous emphysema | Pneumothorax, rupture of oesophagus |
Reduced chest wall expansion on one side | Lung fibrosis, consolidation, collpase, pleural effusion, pneumothorax |
Bilateral reduction of chest wall expansion | COPD, diffuse interstitial lung disease |
Paradoxical movement of chest | Diaphragmatic paralysis |
Hoover's sign | COPD |
Increased vocal resonance, fremitus and whispering pectoriloquy | Consolidation |
Stony dull percussion | Pleural effusion |
Hyper-resonant percussion | Bowel, pneumothorax, tension pneumothorax |
Dull percussion | Consolidation, collapsed lung, liver (upper level of dullness at the 5th rib) |
Bronchial breath sounds | Consolidation |
Reduction of breath sounds | COPD (especially emphysema), pleural effusion, pneumothorax, pneumonia, large neoplasm and pulmonary collapse |
High pitched wheezes | Asthma |
Low-pitched wheezes | COPD |
Localised, monophonic wheeze | Fixed bronchial obstruction (carcinoma of the lung) |
Early-inspiratory crackles | COPD |
Late-inspiratory crackles | Disease confined to alveoli eg. asbestosis |
Coarse crackles | Bronchiectasis |
Pleural friction rub | Pleurisy, pneumonia |
Liver ptosis | Emphysema |
Facial plethora, cyanosis,inspiratory stridor, elevated JVP | Positive Pemberton's sign - SVC obstruction |
Peripheral oedema or cyanosis | Cor pulmonale |
Reduced FEV1 and FVC with FEV1 being disproporitonately low. Reduced FEV1/FVC ratio | Obstructive ventilatory defect |
Reduced FEV1 and FVC but increased or normal FEV1/FVC ratio | Restrictive ventilatory defect |
Dull, burning pain in epigastrium that is relieved by foods or antacids. May wake the patient from sleep | Peptic ulcer disease |
Steady epigastric pain that radiates to the back. Relieved by sitting forwards | Pancreatic pain |
Severe, constant pain in the epigastrium that shift the right subcostal region. | Cholecystitis |
Colicky pain in the renal angle that radiates to the groin. | Renal colic |
Colicky pain with vomiting, constipation and abdominal distension | Bowel obstruction |
Anorexia and weight loss | Malignancy, depression. |
Weight loss and increased appetite | Thyrotoxicosis |
Disturbance of taste | Liver disease |
Early satiation | Peptic ulcer disease |
Acute nausea | GIT infections, small bowel obstruction |
Chronic nausea | Pregnancy, opiates, chemotherapy, alcoholism, gastric outlet obstruction, acute hepatobiliary disease |
Heartburn and acid regurgitation | GORD, sliding hiatus herniation |
Dysphagia for solids only | Mechanical obstruction - carcinoma, foreign body, mediastinal tumours |
Dysphagia for solids and liquids | Neuromuscular - achalasia (progressive), diffuse oesophageal spasms |
Odynophagia | Infective oesophagitis, peptic ulceration of oesophagus or oesophageal perforation |
Constipation | Old age, bowel obstruction, codeine, hypothyroidism, pregnancy |
Passage of mucus | Solitary rectal uler, fistula, IBS, villous adenoma |
Haematemesis | Gastric ulcers, oesophageal varices, Mallory-Weiss tear (huge due to coughing or vomiting) |
Maelena | Bleeding from oesophagus, duodenum or stomach, chronic peptic ulceration, right sided colonic bleeding. |
Haemaochezia | Haemorrhoids, anal fissures |
Pruritis | Cholestatic liver disease |
Jaundice, painlessly distended gall bladder | Carcinoma of the head of the pancreas - Courvoiser's Sign |
Freckle like spots around the mouth and in the oral mucosa | Peutz-Jeghers Syndrome - associated with hamartomatous polyps in colon |
Generalised skin pigmentation | Haemochromatosis |
Brown-black velvety elevtaions of the epidermis of the axilla. | Acanthosis nigricans - associated with GI carcinoma |
Impaired mental state | Hepatic encephalopathy |
Leuconychia | Hypoalbuminaemia - chronic liver or renal failure. |
Palmar erythema | Chronic liver disease, pregnancy, thyrotoxicosis, rheumatoid arthritis |
Pallor or palmar creases and/or conjunctiva | Anaemia - GI blood bloss, malabsorption (folate or B12) or haemolysis (hypersplenism) |
Ecchymoses | Clotting abnormalities, obstructive jaundice |
Petechiae | Chronic excessive alcohol consumption, splenomegaly caused by portal hypertension |
Spider naevi | Cirrhosis, viral hepatitis, pregnancy |
Yellow sclera | Hyperbilirubinaemia |
Kayse-Fleisher rings | Wilson's disease |
Xanthelasma | Hypercholesterolaemia |
Bilateral parotid enlargement | Alcoholism |
Unilateral parotid enlargement | Parotid carcinoma, mumps |
Fetor hepaticus | Severe hepatocellular disease, precomatose condition |
Leucoplakia | Poor dental hygiene, smoking, alcohol, sepsis, syphilis |
Glossitis | Deficiences of folate, B12, alcoholism |
Apthous ulceration | Crohn's disease, Coeliac disease |
Angular stomatis (cracks at the corners of the mouth) | Deficiences of vitamin B6, B12, folate or iron |
Candidiasis | Broad spectrum antibiotics, faulty oral hygeinei, iron deficiency, diabetes mellitus |
Enlarged left supraclavicular node (Virchow's node) | Gastric cancer |
Gynaecomastia and hair loss | Chronic liver failure, cirrhosis, alcoholism |
Bulging region of abdomen when patient coughs | Herniation |
Abdominal distension | Food, faeces, foetus, flatus, tumour or phantom pregnancy |
Prominent veins - Caput Medusae | Portal hypertension or IVC obstruction |
Visible peristalsis | Pyloric obstruction |
Bluish tinge to umbilicus | Cullen's sign - acute haemorrhagic pancreatitis or severe haemaperitoneum |
Striae | Cushing's syndrome, pregnancy, ascites |
Guarding, rigidity, rebound tenderness, cross tenderness, pain on coughing, pain on straight leg raising | Peritonitis |
Murphy's sign | Cholecystitis |
Hepatomegaly | Metastases, alcoholic liver disease, right heart falure, hepatocellular cancer, haemochromatosis, bilairy obstruction, hepatitis |
Epigastric pain | Myocardial infarction, peptic ulcer, pancreatitis, biliary colic |
Left upper quadrant pain | Spleen, renal colic, diverticulitis |
Periumbilical pain | Irritable bowel disease, ischaemic bowel disease, ruptured AAA, appendicits, gastroenteritis |
Left lower quadrant pain | Ovarian, ruptured ectopic pregnancy |
Right lower quadrant pain | Ovarian, appendicitis, ruptured ectopic pregnancy |
Right upper quadrant pain | Biliary colic, hepatitis, renal colic, diverticulitis |
Hepatosplenomegaly | Portal hypertension with chronic liver disease, acute viral hepatitis, sarcoidosis, leukaemia |
Enlarged kidneys | Renal cell carcinoma, polycystic kidney disease, infiltrative disease |
Palpable, distended bladder | Urinary retention |
Arterial pulsations > 5cm apart | AAA |
Dullness on inspiration of spleen | Splenomegaly |
Suprapubic dullness | Enlarged bladder or pelvic mass |
Dull percussion of flanks which becomes resonant when patient rolled onto one side | Acites -shifting dullness |
Loss of liver dullness | Massive hepatic necrosis, perforated bowel |
High pitched 'tinkling' bowel sounds | Bowel obstruction |
Absent bowel sounds over 4 minutes | Paralytic ileus |
Borboryogmi | Diarrhoea |
Hepatic friction rub | Tumour within the liver, liver abscess, recent liver biopsy, liver infarct |
Splenic friction rub | Splenic infarct |
Venous hum | Intrahepatic portal hypertension |
Renal artery bruits | Renal artery stenosis |
Steatorrhoea | Malabsorption of fat, severe pancreatic disease |
Colorectal cancer (rectum) | Fresh blood with faeces |
Colorectal cancer (left colon) | Tenesmus, faecal urgency, constipation, rectal bleeding |
Colorectal cancer (right colon) | Usually asymptomatic until systemic features (weight loss, anaemia, fatgiue) |
Abdominal fullness, vomiting, problems with absorption and digestion in diabetic patients | Gastroparesis due to neuropathy |
Intermittent dysphagia, regurgitation, a sense of food being stuck in the oesophagus and chest pain | Achalasia (aperistalsis) |