Traid in Medicine

TRAIDS IN MEDICINES :

Triad of Alports Syndrome
Sensorineural deafness
Progressive renal failure
Ocular anomalies
Triad of Behcet's Syndrome
Recurrent oral ulcers
Genital ulcers
Iridocyclitis
[mnemonic: can’t see, can’t pee, can’t
eat spicy curry]
Beck’s Triad
Muffled heart sound
Distended neck veins
Hypotension
Charcot’s Triad
Pain + fever + jaundice
Gradenigos Triad
Sixth cranial n. Palsy
Persistent ear discharge
Deep seated retro orbital pain
Triad of Hypernephroma
Pain + hematuria + renal mass
Hutchinson’s Triad
Hutchison's teeth
Interstitial keratitis
Nerve deafness
Triad of Kwashiorkar
Growth retardation
Mental changes
Edema
Saint's Triad
Gall stones
Diverticulosis
Hiatus hernia
Trotter's Triad
Conductive deafness
Immobility of homolateral soft palate
Trigeminal neuralgia
Virchow’s Triad
Stasis
Hypercoagulabilty
Vessel injury
Whipple’s Triad
Hypoglycaemia during attacks
S.glucose 10%
Hypergammaglobulinemia
Lytic bone lesions
Hemolytic Uremic Syndrome Triad
Anaemia
Thrombocytopenia
Renal failure
Fanconi Syndrome Triad
Aminoaciduria
Proteinuria
Phosphaturia
Tetany in Children - Triad
Stridor
Carpopedal spasm
Convulsions
Alkaptonuria Triad
Ochronotic arthritis
Ochronotic pigmentation
Urine darkens on standing
Anderson Triad
Bronchiectasis
Cystic fibrosis
Vitamin A deficiency
Triad of Albinism
Black locks
Occulo-cutaneous Albinism
Deafness of sensorineural type
[mnemonic: BADS]
Pentad of TTP
Microangiopathic haemolytic anaemia
Fever
Disturbed neurological function
Renal failure
Thrombocytopenia
Triad of Causes of Biotin Deficiency
Glossitis,
Alopecia,
Dermatitis
Reynolds Pentad
Abdominal pain,
Fever,
Jaundice,
Shock, and
Depression of central nervous system
function (usually indicative of acute
suppurative cholangitis)
Pentalogy of Fallot
Fallot's tetralogy with, in addition, a
patent foramen ovale or
Atrial septal defect.
Triple Test
Estimation of hcg,
Estriol,
and AFP
(for diagnosis of downs syndrome)
O’ Donoghue Triad
Twisting force in a weight bearing
knee joint causes injury to
1. Medial collateral ligament
2. Anterior cruciate ligament
3. Medial meniscus
Congestive Heart Failure Triad
Tachycardia
Tachypnea
Tender hepatomegaly
Cushing Triad of
Increased Intracranial Pressure
Bradycardia
Bradypnea
Hypertension
Hemobilia - Triad (Triad of Sandblom)
Malena
Obstructive jaundice
Biliary colic
[mnemonic: MOB]
Kartagener’s Syndrome Triad
Triad of bronchiectasis
Recurrent sinusitis, and
Situs inversus

Radiological findings

Heart

Flask-shaped / Pear-shaped / Leathe- bottle / Money-bag shaped heart - Pericardial effusion
Boot-shaped heart / Coer-en-sabot - Fallot's tetralogy
Box shaped appearance - Tricuspid atresia
Jug Handle appearance - Primary pulmonary artery hypertension
"3" like appearance - Coarctation of Aorta
 
Egg on side appearance - Transposition of great vessels
Egg in cup appearance - Constrictive pericarditis
 
Snow-man heart - TAPVC (total anomalous pulmonary venous connection)
Figure of '8' - TAPVC (total anomalous pulmonary venous connection)
Cottage Leaf appearance - TAPVC
 
Pericardial calcification - Constrictive pericarditis
Calcification in heart wall - is seen in - Carcinoid syndrome
Calfication of ascending aorta - Atherosclerosis, Syphilis
 
Hilar dance on fluoroscopy - Atrial  Septal Defect
Xray finding in Ebstein's anomaly - Pulmonary oligemia
 
Posterior displacement of trachea - seen in - aneurysm of aorta
Obliteration of left border of heart (PA view of chest) is - suggestive of - Lingular pathology (left lung)
Bat's wings appearance - Pulmonary oedema
Pruned tree appearance (of pulmonary circulation) - Pulmonary artery hypertension

Lungs

Ground glass appearance - Hyaline membrane disease
Solitary pulmonary mass lesion > 4cms - is most commonly due to - Bronchial adenoma
Honey Comb appearance -
SarcoidosisQ
Histiocytosis XQ
Interstitial lung diseaseQ
TuberculosisQ
Collagen disordersQ
PneumoconiosisQ
Drugs - bleomycin, busulphan, melphalan, cyclophosphamide

 
Meniscus sign / Crescent sign (mobile mass in pulmonary cavity) is most commonly seen in - Aspergilloma (fungal ball lesion)
Egg-Shell calcification - SilicosisQ , SarcoidosisQ , Coal miner's pneumoconiosisQ, Lymphoma following radiotherapyQ
Pop-corn calcification / Craggy pop-corn calcification - Pulmonary Hamartoma
 
Pleural calcification - commonest cause is - Tuberculosis (Asbestosis)
Diaphragmatic Pleura calcification - is due to - Asbestosis
Calcification in a pulmonary metastasis - is most commomly due to - Osteosarcoma
Coin shadow in the lung (single), with calcification in the centre - Epidermoid carcinoma
 
For radiologically evident pleural effusion - the minimal amount of pleural fluid that should be present is - 250 ml
 
Plethoric lung fields - seen in - L-R shunts ( VSD, PDA, ASD)
Oligemic lung fields - Pulmonary atreisa, Stenosis; Ebstein's anomaly
Perihilar fluffy opacities - seen in - Pulmonary venous hypertension

Ribs

Superior surface notch of ribs - seen in - Hyperparathyroidsm, Neurofibromatosis, Connective tissue disorders
Inferior surface notch of ribs -   seen in  - Coarctation of Aorta, SVC obstruction, Chest wall AV fistula, Aortic Thrombosis,
Unilateral notching of ribs - Coarctation of Left subclavian artery, Subclavian artery block, Blalock-Taussig Operation

Others

Displacement of tracheal shadow - most common cause is - Thyroid swelling
Water Lily sign - Ruptured hydatid cyst

Factors affecting appetite

INCREASE	DECREASE
Neuropeptide –Y MCH (melanin concentrating hormome) AGRP (Agouti related peptide ) Orexin Endocannabinoid CCK Ghrelin Gut peptides PYY Vagal stimulation	Alpha-MSH ( melanin stimulating hormone ) CART (cocaine and amphetamine related transcript ) GLP-1 (Glucagon related peptide ) Serotonin Glucose Ketones Leptin Insulin Cortisol

Related articles

• New brain target for appetite control identified


• Appetite Controlling Brain Receptor May Be Target For Anti-Obesity Medications

The Hypothalamic Nuclei

Region	Area	Nucleus	Function
Anterior	Medial	Preoptic nucleus	Thermoregulation/Heat loss centre
		Supraoptic nucleus (SO)	vasopressin (ADH) release
		Paraventricular nucleus (PV)	CRHreleaseOxytocinand to a lesser extentantidiuretic hormone
		Anterior hypothalamic nucleus(AH)	Thermoregulation/Heat loss centre (set point comparison) Heat loss if core temp > set point
		Suprachiasmatic nucleus	Circadian rhythms
		Part of supraoptic nucleus (SO)	vasopressin release release
Tuberal	Medial	Dorsomedial hypothalamic nucleus (DM)	Blood Pressure Heart Rate GIstimulation
		Ventromedial nucleus (VM)	satiety centre (controls eating)lesion causes voracious appetite
		Arcuate nucleus (AR)/ Infundibular nucleus/ Periventricular nucleus	Endocrine function (releasing hormones) - controls Adenohypophysis
	Lateral	Lateral hypothalamic area	Feeding centre (thirst and hunger)- lesion causes anorexia
Posterior	Medial	Mammillary nuclei (part of mammillary bodies) (MB)	memory feeding reflex
		Posterior nucleus (PN)	Increase blood pressure Pupillary dilation Thermoregulation (generates shivering, if core temp <set point)

Autoantibody and diseases

Indian Reference Man and Woman (New criteria)

Cytokines

Name	Major Cellular Source	Selected Biologic Effects
IFN-α, β	Macrophages (IFNα) fibroblasts (IFNβ)	Antiviral
IFN-γ	CD4+ T cells, NK cells	Activates macrophages, TH1 differentiation
TNF-α	Macrophages, T cells	Cell activation, Fever, cachexia, antitumor
TNF-α, LT (lymphotoxin)	T cells	Activates PMNs
IL-1	Macrophages	Cell activation, Fever (Pro inflammatory)
IL-2	T cells	T cell growth and activation
IL-3	T cells	Hematopoiesis
IL-4	T cells, mast cells	B cell proliferation and switching to IgE, TH2 differentiation
IL-5	T cells	Differentiation of eosinophil, activates B cells
IL-7	Bone marrow stroma cells	T cell progenitor differentiation
IL-8	Macrophages, T cells	Chemotactic for neutrophils
IL-10	Macrophages, T cells	Inhibits activated macrophages and dendritic cells, Anti-inflammatory
IL-12	Macrophages	Differentiation of T cells, activation of NK cells
GM-CSF	T cells, macrophages, monocytes	Differentiation of myeloid progenitor cells
M-CSF	Macrophages, monocytes, fibroblasts	Differentiation of monocytes and macrophages
G-CSF	Fibroblasts, monocytes, macrophages	Stimulates neutrophil production in bone marrow

Adult Derivatives and Vestigial Remains of Embryonic Urogenital Structures

Embryonic Structure	Male	Female
Gonadal Ridge	Testis	Ovary
Cortex	Seminiferous tubules	Ovarian follicles
Medulla	Rete testis	Medulla Rete ovarii
Gubernaculum	Gubernaculum testis	Ovarian ligament Round ligament of uterus
Mesonephric tubules	Ductus efferentes Paradidymis	Epoophoron Paroophoron
Mesonephric duct	Appendix of epididymis Ductus epididymidis Ductus deferens Ureter, pelvis, calices, and collecting tubules Ejaculatory duct and seminal vesicle	Appendix vesiculosa Duct of epoophoron Duct of Gartner Ureter, pelvis, calices, and collecting tubules
Paramesonephric duct (Mullerian duct)	Appendix of testis	Hydatid (of Morgagni) Uterine tube Uterus Upper Vagina
Urogenital sinus	Urinary bladder Urethra (except glandular portion) Prostatic utricle Prostate gland Bulbourethral glands	Urinary bladder Urethra Lower Vagina (from sinovaginal bulb) Urethral and paraurethral glands Greater vestibular glands Vestibule of vagina
Müllerian tubercle	Seminal colliculus	Hymen
Genital tubercle	Penis Glans penis Corpora cavernosa penis Corpus spongiosum	Clitoris Glans clitoridis Corpora cavernosa clitoridis Bulb of the vestibule
Urogenital folds	Ventral aspect of penis	Labia minora
Labioscrotal swellings	Scrotum	Labia majora

Glycogen Storage Disease

Number	Enzyme deficiency	Eponym	Hepato megaly	Muscle symptoms	Develop- ment/ prognosis	Other symptoms
GSD type I	glucose-6- phosphatase	von Gierke's disease	Yes	None	Growth failure	Lactic acidosis, hyperuri- cemia
GSD type II	acid maltase	Pompe's disease	Yes	Muscle weakness	Death by 2 years (infantile variant)	heart failure
GSD type III	glycogen debrancher	Cori's disease or Forbes' disease	Yes	Myopathy
GSD type IV	glycogen branching enzyme	Andersen disease	Yes, also cirrhosis	None	Failure to thrive, death at ~5 years
GSD type V	muscle glycogen phospho-rylase	McArdle disease	No	Exercise induced cramps Rhabdo-myolysis		Renal failure by myoglobin- uria
GSD type VI	Liver -glycogen phospho-rylase	Hers' disease	Yes	None
GSD type VII	muscle phospho- fructokinase	Tarui's disease	No	Exercise- induced muscle cramps and weakness	growth retardation	Haemo-lytic anaemia
GSD type IX	Phospho-rylase kinase, PHKA 2	–	No	None	Delayed motor develop-ment, Growth retarda- tion
GSD type XI	glucose transporter, GLUT 2	Fanconi- Bickel syndrome	Yes	None

 

• Hyperlipidemia is seen in GSD Type I,III and IX.
  
• Hypoglycemia is seen in GSD Type I,III,VI,XI.

Most Common

• MCC of intracranial metastasis-Ca lung


• MCC of hepatic metastasis - Bronchogenic carcinoma


• MCC of hepatic mets from GIT – Colonic ca


• MCC of Intrauterine Growth retardation-C/c pyelonephritis?


• MCC of HTN in children-A/c Glomerulonephritis


• MC complication of CSOM-Temporal lobe abscess


• MC ovarian tumour in pregnancy-Teratoma/Dermoid cyst


• MC joint involved in Osteo Arthritis-Knee joint


• MCC of interstitial/atypical pneumonia- Mycoplasma


• MC Glycogen storage disease-Gaucher's disease


• MC porphyria-Porphyria cutanea tarda.


• MC cause of childhood nephrotic syndrom-Minimal change disease


• MC cause of adult nephrotic syndrome- Membranous glomerulonephritis.


• MC cancer-Lung cancer


• MC cancer in females-Breast cancer


• MC cause of maternal deaths-Obstetric hemorrhage(PPH)


• MC cause of Blindness in India-Cataract


• MC site of Gastrinoma- Duodenum.


• MC Paraneoplastic Syndrome-Hypercalcemia


• MC paraneoplastic endocrinopathy-Cushings syndrome


• Mc presentation of meckel's diverticulum—–bleeding


• Mc s/e of radiation on heart —— pericardial effusion


• M.c. Cause of cushing's disease- pituitary microadenoma


• Mcc of primary hyperaldosteronism- b/l cortical hyperplasia


• Mc aldosterone producing adrenal tumour- u/l adrenal adenoma


• Mcc of post trauma vegetative state- diffuse axonal injury


• Mc asso anomaly with coarctation of aorta- bicuspid aortic valve


• Mcc of vasculitis in child- henoch-schonlein purpura


• Mc feature of aortitis on x-ray- calcified ascending aorta


• MC intra-abdominal malignancy in children – Neuroblastoma
  2nd MC intra-abdominal malignancy in children – Wilm's tumor


• MC hepatic malignancy in children – Hepatoblastoma


• MC soft tissue sarcoma – Rhabdomyosarcoma


• MC site for rhabdomyosarcoma – Head and neck


• MC Pediatric tumor – ALL
  2nd MC Pediatric tumor – Brain tumor


• MC brain tumor in children – Astrocytoma


• MC brain tumor in infancy – Supratentoria


• MC brain tumor between 1-10 yrs of age – Infratentorial


• MC brain tumor after 10 yrs of age – Supratentorial


• MC embryonal brain tumor – Medulloblastoma


• MC renal mass in neonates – Multicystic renal dysplasia


• MC malignant tumor of kidney – Wilm's tumor

• 
  
  MC TUMOURS IN PARTS OF MEDIASTINUM


• anterior- thymomas


• mid- cyst


• posterior- neurogenic tu


• Mc tumour of mediastinum- neurogenic tumour


• most malignant masses of mediastinum- lymphomas

• MC cause of renal artery stenosis

1. Old age- atherosclerosis


2. Young(india)- Takayasu arteritis


3. 
   
   Young( western world)- fibro muscular dysplasia

• 
  
  MC of eye in AIDS 
  
  


• 1.Lesion- microvasculopathy of conjunctiva and retina


• 2. Infection- chorioretinitis


• 3. Neoplasm- kaposi sarcoma


• 4. Cause of chorioretinitis- CMV


• 5. Finding in HIV retinopathy- cotton wool spots


• 6. Rx of CMV retinitis- ganciclovir,foscarnet

• 
  
  MOST COMMON site in GIT


• Small bowel carcinoid-ILEUM


• Ulcerative colitis,hirsprung disease-RECTUM


• Polyps in peutz jegher syndrome,pneumatosis cystoid intestinale–JEJUNUM


• Amoebic colitis,volvulus-SIGMOID COLON


• Bleeding from angiodysplasia-RIGHT COLON


• Brenner's gland-1ST PART OF DUODENUM


• MC cause of maternal death- obst haemorrhage


• MC of isoniazid resistance- kat G gene mutation


• MC primary lymphoma of spleen- NHL


• MC cause of seizure in newborn-HIE


• MC type of seizure in newborn-subtle


• MC extranodal site of lymphoma


• MC tumours in newborn-sacrococcygeal teratoma


• Mc site of colonic volvulus- sigmoid

• Top of Form 


• 
  
  Most common testicular tumour


• prepuberty–yolk sac tumour


• overall–seminoma


• in age above 50– lymphoma

• MCC of hereditary thrombophilia-factor V leiden mutation


• MC hereditary cause of venous thrombosis-factor V leiden mutation


• MC hereditary blood coagulation disorder-factor V leiden mutation


• Mc pancreatic tumour in men1- gastrinoma


• MC complication of IUCD- Bleeding

• 
  
  Mc sites of primary for bone metastasis- 
  
  


• male-prostate>lung


• Female-breast>lung


• children- neuroblastoma


• mc osteolytic mets- male-lung ca


• female-breast ca


• mc osteoblastic mets- male-prostate


• female-breast ca

• Mc glomerulopathy worldwide-iga nephropathy


• Mc cardiac tumours are secondaries


• Mc primary neplasm of the heart -myxoma


• Mc in infants and children-rhabdomyomas


• MC site of sub ependymal astrocytoma-foramen of munroe


• MC corneal dystrophy-keratoconus


• MC anterior corneal dystrophy-Anterior basement membrane dystrophy (ABMD)


• MC of stromal dystrophies-Lattice dystrophy is usually an autosomal dominant condition


• MC endothelial corneal dystrophy-Fuchs


• Macular dystrophy of the cornea is the least common, but most severe


• MC phakomatosis-neurofibromatosis(NF1)


• MC involved in vestibular schwannoma- SUP. VES. > INF. VEST. > COCHLEAR DIV.


• MC site of TB lung-Apices


• Mc injury encounter in spine injuries-flexion of spine


• MCC of viral meningitis-enterovirus


• MCC of sporadic viral encephalitis-HSV1


• MCC of epidemic viral encephalitis-Arbovirus


• MC site for thrombin formation in DIC-Brain

Important Signs

Trousseau's Sign


Trousseau's Sign of latent tetany-To elicit the sign, a blood pressure cuff is placed around the arm and inflated to a pressure greater than the systolic blood pressure and held in place for 3 minutes. This will occlude the brachial artery. In the absence of blood flow, the patient's hypocalcemia and subsequent neuromuscular irritability will induce spasm of the muscles of the hand and forearm. The wrist and metacarpophalangeal joints flex, the DIP and PIP joints extend, and the fingers adduct. The sign is also known as main d'accoucheur (French for "hand of the obstetrician") because it supposedly resembles the position of an obstetrician's hand in delivering a baby.

Trousseau's sign of malignancy- Migratory thromboplebitis, due to hypercoagulable states.Seen in adenocarcinomas of the pancreas and lung

The Chvostek sign-


(also Weiss sign) is one of the signs of tetany seen in hypocalcemia. It refers to an abnormal reaction to the stimulation of the facial nerve. When the facial nerve is tapped at the angle of the jaw (i.e. masseter muscle), the facial muscles on the same side of the face will contract momentarily (typically a twitch of the nose or lips) because of hypocalcaemia (ie from hypoparathyroidism, pseudohypoparathyroidism, hypovitaminosis D) with resultant hyperexcitability of nerves. Though classically described in hypocalcaemia, this sign may also be encountered in respiratory alkalosis, such as that seen in hyperventilation, which actually causes decreased serum Ca²⁺ with a normal calcium level due to a shift of Ca²⁺ from the blood to albumin which has become more negative in the alkalotic state.

Chvostek's sign may also be present in hypomagnesemia, frequently seen in alcoholics, persons with diarrhea, patients taking aminoglycosides or diuretics, because hypomagnesemia can cause hypocalcemia. Magnesium is a cofactor for Adenylate Cyclase. The reaction that Adenylate Cyclase catalyzes is the conversion of ATP to 3′,5′-cyclic AMP. The 3′,5′-cyclic AMP (cAMP) is required for Parathyroid hormone activation.

Target sign/Bulls eye sign


Seen in Congenital/infantile Hypertrophic Pyloric stenosis

Double bubble sign


Radiological appearance of Duodenal atresia,annular pancreas

Triple bubble sign


Jejunal atresia

Duodenal cutoff sign


Barium meal finding in superior mesenteric syndrome and in duodenal ileus

Colon Cutoff sign


Acute pancreatitis

Central dot sign


Caroli's disease

Pneumatic tyre sign


Sigmoid volvulus

Omega sign


Sigmoid volvulus

Boas sign


Acute Cholecystitis

Signs in appendicitis


1.Pointing sign

2.Rovsing sign

3.Copes sign

4.Bastede's sign

5.Alder's sign-Shifting tenderness

Tear drop Sign


In trapdoor fracture of inferior wall of orbit, coronal section of orbit  shows that the eyeball has migrated into the maxillary sinus appearing as a drop.

Bear track sign- Congenital hypertrophy of retinal pigment epithelium


Homan Sign- Calf tenderness on dorsiflexion of ankle

Robert sign -appearance of gas in great vessels,the surest sign of IUD

maxwell lyon sign – vernal conjunctivitis

Litten's sign -is diaphragmatic movement seen on one side but not the other side in unilateral phrenic nerve palsy

Markle sign is jar tenderness in abdomen from heel drop as a localizing sign of peritoneal irritation

Pratt's sign is in deep vein thrombosis – presence of three dilated veins or sentinel veins over the tibia; dilatation persists when legs are elevated to 45 degrees

1-Stallworthy sign is to diffrentiate proptosis of thyrotoxicosis and of retroorbital tumours. In thyrotoxicosis you can evert upper eye lid but in case of retro orbital tumors one cant evert eyelid-rxpg se liya

2-Slowing / irregular fetal heart rate on pressing the head down I to the pelvis and prompt recovery on release of pressure is termed Stallworthy's sign in case of posterior placenta praevia, particularly with low insertion of cord, due to compression of placental vessels from fetal head

Adson's sign is in thoracic outlet syndrome – decrease in ipsilateral radial pulse and/or presence of subclavian bruit while patient extending neck maximally – rotating head towards side being tested – and holding breath

Dalrymple sign is retraction of the upper eyelid in Graves's disease – causing abnormal wideness of the palpebral fissure

Winterbottom's sign is in West African trypanosomiasis (sleeping sickness – caused by Trypanosoma brucei gambiense – humans primary reservoir) – classic finding of posterior cervical triangle lymphadenopathy

Kanavel's sign is four signs of tenosynovitis: 1. affected finger held in slight flexion; 2. pain over volar aspect of affected finger tendon upon palpation; 3. swelling of affected finger; 4. pain on passive extension of affected finger

D'Espine's sign is breath sounds louder over C7 than adjacent lung – suggests lesion in posterior mediastinum – e.g. lymphoma – tuberculosis – etc.

Signs of Pregnancy


Placental sign- Bleeding at the time of next menstruation

Hartman sign- Implantation bleeding

Jacquemier's sign(Chadwick's sign) -Blue hue of vagina

Osiander's sign - Increased pulsation felt through lateral fornix by 8 weeks.

Goodell's sign – Softening of cervix

Piskacek's sign – One half more firm than other half(site of implantation)

Hegar's sign – Upper part of body of uterus enlarged,lower part empty(6-10wks)

Palmer's sign – Rhythmic uterine contraction during bimanual examination

Markers of Hepatitis B

VIRUS MARKER	SIGNIFICANCE
Hbsag	Acute Or Chrnoic HBV Infection
IgM Anti-Hbc -High Titre	Acute Hbv Infection
IgM Anti-Hbc -Low Titre/ Absent	Chronic Hbv Infection
IgG Anti Hbc	Past Exposure To Hbv
Anti Hbs	Immunity Against Hbv
Hbe ag	Continued Infectious State, Acute Or Chronic Hbv Infection
Anti Hbe	Convalesecence
HBV DNA	Continued Infectious State

Urine Casts and crystals

• URINARY CRYSTALS
  

Crystals	Shape
Uric acid crystals	Envelope shaped
Uric acid dehydrate	Tear drop shaped  crystals in urine
Cystine crystals	Hexagonal plate shaped
Struvite crystals	Rectangular prisms
Hippurate crystals	Needle shaped crystals

• URINE CASTS
  

Casts	Disease
Hyaline casts	Normally present in urine
RBC casts	Glomerular injury
White cell casts	Interstitial nephritis / pyelonephritis
Broad granular casts	Chronic renal failure
Pigment muddy brown granular casts	Tubular necrosis

Dislocation of shoulder

Imp. Points about shoulder dislocation :

• MC joint in body to dislocate
  
• MC joint to undergon recurrent dislocation
  
• MC type of dislocation is anterior
  
• MC type of anterior is subcoracoid
  
• MC method of reduction : Kocher's manoeuver
  
• MC c/c : axillary nerve injury (loss of sensation and absence of deltoids contraction)
  
• MC late c/c : recurrent dislocation (causes of recurrence : a) shallow glenoid labrum b) injury to humeral head)
  
• MC nerve injured : axillary nerve
  

Luxatio erecta :

• Head in subglenoid position
  
• Inferior dislocation of shoulder
  

Mechanism of ant. dislocation :

• Fall on out stretched hand with the shoulder abducted and externally rotated.
  

Lesions :

• Bankert's lesion : stipping of anterior surface of glenoid labrum
  
• Hill-sach'sn lesion : depression on the humerus head in its posterolateral quadrant.
  
• X-ray : associated fractureof greater tuberosity of humerous
  
• Roundning off of the anterior glenoid rim
  
• Hatchat head apearance
  
• Recurrent shoulder dislocation
  

On examination :

• Shoulder abducted
  
• Shoulder joit : flattend (normal  contour lost)
  
• Fullness below the clavicle
  

Complications :

• Early : axillary nerve injury
  
• Late : recurrent dislocation [ causes : marfan's syndrome,inadequate treatment,epileptic patients etc.)
  

Tests :

1. Dugas test
   
2. Callway's test
   
3. Hmilton ruler test
   

Techniques of reduction :

• Kocher's maneuver [ TEA-I : Traction/External rotation/Adduction/Internal rotation ]
  
• Hippocrates maneuver
  

Operations :

• Putti-platt operation
  
• Bankart's operation
  
• Bristow's operation
  
• Arthoscopic bankart's repair
  

 

Disease and associated HLA

• Multiple sclerosis- HLA DR2


• Narcolepsy- HLA DR2


• Goodpasture’s syndrome- HLA DR2


• Sjogrens- HLA DR3


• Dermatitis herpetiformis- HLA DR3


• Celiac disease- HLA DR3


• Rheumatoid arthritis- HLA DR4


• Behcets disease – HLA B5


• Congenital adrenal hyperplasia - HLA B47


• SLE- HLA DR2,DR3


• Type 1 Diabetes – HLA DR2,DR3,DR4


• Hyperthyroidism – HLA B8,DR3


• Myasthenia gravis- HLA B8,DR3


• Tuberculoid leprosy- HLA B8,DR3


• VKH syndrome- HLA DW 15,DR4

• HLAB27 :

1. Ankylosing spondylitis,


2. Psoriaticarthritis,


3. Reiter's syndrome,


4. Reactive arthritis(Yersinia,salmonella,gonococci),


5. JRA (pauci articular)

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Test in orthopedics

• Barlow’s test -CDH


• Ortolani’s test -CDH


• Galleazi test -CDH


• Allis test -CDH


• Harts test – CDH


• Thomas test -Fixed flexion deformity


• Allens test – Palmar arch integrity


• Gaenslens test – Sciatica


• Mc Murrays test – Menisci


• Anterior drawer test – Anterior cruciate ligament


• Lachmans test – Anterior cruciate ligament


• Pivot shift test – Anterior cruciate ligament


• Posterior drawer test – Posterior cruciate ligament


• Apprehension test – Anterior shoulder dislocation


• Phalens test – Carpal tunnel syndrome


• Finkelsteins test – De Quervains disease


• Adsons test – Thoracic outlet syndrome


• Wringing test – Lateral epicondylitis


• Cozens test -Lateral epicondylitis


• Lift off test – Subscapularis


• Dial test - Postrolateral coner injury

Systematic effects of Inhalational Agents:

• Maximum depression of respiration: ENFLURANE.
• Maximum bronchodilation in non-asthmatics: SEVOFLURANE.
• Non inhibitor of ciliary activity (reduced coughing out of secretions): ETHER.
• Maximum nephrotoxicity: METHOXYFLURANE.
• Agent causing maximum muscle relaxation: DESFLURANE.
• Agent causing maximum analgesia: TRIELENE.
• Agent causing maximum hyperglycemia: CHLOROFORM.
• Maximum inhibition to ventilator response: HALOTHANE.
• Maximum bronchodilation in asthmatics: HALOTHANE. (agent of choice in asthmatics)
• Inhibition of myocardial contractily: HALOTHANE.
• Maximum hepatocellular damage: HALOTHANE.
• Maximum sensitization of heart to adrenaline: HALOTHANE.
• Best maintenance of cardiac output: ISOFLURANE (agent of choice in cardiac patients)
• Maximum hypotension: ISOFLURANE.
• Agent causing megaloblastic and aplastic anemia: NITROUS OXIDE.
• Agent causing Sub-acute combined degeneration of spinal cord: NITROUS OXIDE.

POSITIONS IN HIP DISEASES N FRACTURES

# NECK FEMUR .................FADERS(Flexion/ADduction/External Rotation/Shortning)

# INTERTROCHANTRIC......FARDERS

ANT. DISLOCATION HIP.....FABERS(Flexion/ABduction/External Rotation/Shortning)

POST.DISLOCATION HIP...FADIRS(Flexion/ADduction/Internal Rotation/Shortning)

TB HIP.......

1.Stage of synovitis..........FABER...AL (Flexion/ABduction/External Rotation/Apparent lengthning)

2.Stage of arthritis...........FADIR...AS(Flexion/ADduction/Internal Rotation / Apparent Shortning)

3.Stage of erosion..........FADIR...TS(Flexion/ADduction/Internal Rotation / TRUE Shortning)

Selection of Antiepileptic Drugs

# Generalized-onset Tonic-Clonic

1.Valproic acid
2.Lamotrigine
3.Topiramate

# Focal

1.Lamotrigine
2.Carbamazepine
3.Oxcarbazepine
4.Phenytoin
5.Levetiracetam

# Typical Absence

1.Valproic acid
2.Ethosuximide

# Atypical Absence, Myoclonic,
Atonic

1.Valproic acid
2.Lamotrigine
3.Topiramate

SIGNS IN RADIOLOGY

• Accordion sign : Appearance of bowel that may be seen with pseudomembranous colitis.


• Air crescent sign : Appearance of cavitation that may be seen with invasive apergillosis (see also Monod sign).


• Anteater’s nose sign : Sign of calcaneonavicular tarsal coalition.


• Apple Core lesion : Circumferential narrowing of the lumen secondary to colon cancer.


• Ball on tee sign : Sign of papillary necrosis on IVU.


• Banana sign : Seen on antenatal US and refers to a banana-shaped configuration of the cerebellum. Associated with neural tube defects.


• Bat wing appearance (chest) : Classic chest radiography finding for pulmonary edema.


• Bat wing appearance (neuro) : Appearance of 4th ventricle that may be seen with Joubert syndrome.


• Bergman’s coiled catheter sign : Sign of ureteral transitional cell carcinoma when a catheter coils in region of neoplasm (see also Goblet sign).


• Bird’s beak : Narrowing of the esophagus in achalasia.


• Bird’s beak sign or bird of prey sign : Narrowing of the colon in cecal volvulus.


• Blade of grass : Paget disease.


• Bone in bone sign : Appearance of spine that may be seen osteopetrosis.


• Boot-shaped Heart : Appearance of heart that may be seen with tetralogy of Fallot.


• Boxcar ventricles : Appearance of frontal horns that may be seen in Huntington’s disease.


• Bracket Calcification  : Corpus Callosum Lipoma


• Breast in a breast : Term used to describe Fibroadenolipomas.


• Bulging fissure sign : Bulging of a pulmonary fissure. Most commonly associated with Klebsiella pneumonia.


• Bullet carpal bones : Appearance of carpal bones that may be seen with mucopolysaccharidoses.


• Butterfly vertebrae : Results from failure of fusion of the lateral halves of the vertebral body because of persistent notochondal tissue between them.


• C sign : Sign of talocalcaneal tarsal coalition.


• Cake kidney : All renal tissue is fused into one pelvic mass and gives rise to two separate ureters which enter the bladder in normal relationship.


• Canoe paddle ribs : Appearance of ribs that may be seen with mucopolysaccharidoses.


• Celery stalking : Irregular appearance of metaphyses in patients with rubella. Also used to describe metaphyses in patients with osteopathia striata.


• Central dot sign : Sign of Caroli’s disease.


• Champagne sign : Specific but not commonly seen ultrasound finding for emphysematous cholecystitis.


• Cloverleaf skull : Appreance of the skull that may be seen with thanatophoric dysplasia.


• Cluster of grapes : Appearance that may be seen with pneumatosis cystoides coli.


• Cobra head sign : Dilatation of the distal ureter which may be seen in patients with ureteroceles.


• Coffee bean sign : Sigmoid volvulus.


• Collar sign : Sign of diaphragmatic rupture.


• Comet sign : Sign to differential a phlebolith from a ureteral stone. Calcified phlebolith represents the comet nucleus and the adjacent, tapering, noncalcified portion of the vein is the comet tail (also see soft-tissue rim sign).


• Comet tail sign : Produced by the distortion of vessels and bronchi that lead to an adjacent area of round atelectasis.


• Cord sign : Sign of intracranial dural sinus thrombosis.


• Corkscrew collaterals : Appearance of collaterals that may be seen in patients with Buerger disease.


• Corkscrew sign : Upper GI series sign of midgut volvulus.


• Corduroy appearance : Appearance of thickening trabeculations seen in intraosseous hemangiomas of the spine. See also polka-dot pattern.


• Crazy-paving sign : Nonspecific appearance consisting of linear network or reticular pattern with areas of ground-glass opacification. Classically associated with pulmonary alveolar proteinosis.


• Crossover sign : Anterior acetabular rim is projected laterally relative to the same point of the posterior rim in the superolateral aspect of the acetabulum. See with pincer type femoroacetabular impingement.


• Cyclops lesion : May occur status post anterior cruciate ligament reconstruction.


• David Letterman sign : :Sign of scapholunate ligament disruption (also see Terry Thomas sign).


• Dense vessel sign : Sign of cerebrovascular accident that represent thrombus in the middle cerebral artery.


• Dependent viscera sign : Sign of diaphragmatic rupture (viscera falls to a dependent position).


• Dot and dash pattern : Sacral insufficiency fracture.


• Double bleb sign : Appearance of amnion and yolk sac at 5-6 weeks. Embryo lies between amnion and yolk sac


• Double bubble sign : Sign of duodenal atresia and other forms of duodenal obstruction.


• Double decidua sign : Sign of early normal intrauterine gestation.


• Double density sign (cardiac) : Sign of left atrial enlargement when right side of the left atrium pushes into the adjacent lung.


• Double density sign (Nucs) : Pattern of uptake that may be seen on bone scans in patients with osteoid osteomas.


• Double duct sign : Simultaneous dilatation of the common bile and pancreatic ducts that is generally caused by a tumor in the pancreatic head.


• Double PCL sign : MRI sign of a bucket-handle meniscal tear.


• Double track sign : :Appearance of hypertrophic pyloric stenosis that may be seen on upper GI series.


• Draped aorta sign : Sign of contained rupture of an abdominal aoric aneurysm.


• Drooping lily sign : Inferolateral displacement of the opacified lower pole moiety in a duplex kidney from an obstructed (unopacified) upper pole moeity.


• Egg on a string : Appearance of the heart that may be seen with transposition of great arteries.


• Empty delta sign : Sign of intracranial dural sinus thrombosis.


• Epicardial fat pad sign : Sign of a pericardial effusion.


• Eye of the tiger sign : low signal intensity circumscribing the globus pallidus in patients with Hallervorden-Spatz syndrome.


• Faceless kidney : Appearance of kidney secondary to any process that obliterates renal sinus (i.e. lymphoma, transitional cell carcinoma).


• Fallen fragment sign : Sign of a pathologic fracture seen with unicameral bone cysts.


• Feeding vessel sign : Sign of pulmonary septic emboli.


• Flame shaped (Breast) : Gynecomastia.


• Flame shaped (MSK) : Paget disease.


• Fat halo sign : Seen in various diseases of the bowel in which fatty infiltration of the submucosa is present.


• Fat ring sign : Preservation of the perivascular fat around the mesenteric vessels that may be seen with mesenteric panniculitis.


• Flat tire sign : Sign of a ruptured globe.


• Flat waist sign : Appearance of left heart border that may be seen with left lower lobe atelectasis.


• Figure 3 sign : Appearance of the aorta that may be seen in patients with coarctation of the aorta.


• Figure of eight : Appearance of the brain in pachygyria.


• Finger in glove sign : Sign of mucous plugging seen with allergic bronchopulmonary aspergillosis.


• Fish vertebrae : Description of shape of vertebral bodies that may be seen in patients with sickle cell disease. See also: H-shaped vertebral bodies.


• Football sign : Sign of pneumoperitoneum seen on supine radiographs.


• Gastrointestinal string sign : Sign of Crohn disease.


• Goblet sign : Sign of ureteral transitional cell carcinoma that may be seen on retrograde or intravenous urography (see also Bergman’s coiled catheter sign).


• Gull wing appearance : Appearance of erosions that may occur in patients with erosive osteoarthritis.


• H-shaped vertebral bodies : Shape of vertebral bodies that may be seen in patients with sickle cell disease. See also: Fish vertebrae.


• Halo sign : Ground-glass attenuation surrounding a pulmonary nodule or mass on CT images. Represents hemorrhage and is highly suggestive of Aspergillus.


• Hampton’s hump : Triangular opacity secondary to infarction in the periphery of the lung distal to a pulmonary embolism.


• Head cheese sign : Sign of subacute hypersensitivity pneumonitis.


• Hidebound sign : On small bowel series, crowding of folds in dilated loops of small bowel may be seen in patients with scleroderma.


• High-attenuating crescent sign : Sign of impending abdominal aoric aneurysm rupture.


• Hole within a hole : Appearance that may be seen when eosinophilic granuloma involves the skull.


• Holly leaf appearance : Chest radiograph finding that may be seen with asbestos pleural plaques.


• Honda sign : Sacral insufficiency fracture.


• Hot cross bun sign : May be seen on axial T2 weighted images of the pons in multiple system atrophy.


• Hot nose sign : Sign that may be observed on brain flow scans in patients with brain death.


• Hourglass appearance : MRI appearance that may be seen with concentric cystic adventitial disease.


• Interstitial line sign : Sign that may be seen with an interstitial ectopic pregnancy.


• Inverted Napoleon’s hat sign : Sign of severe spondylolisthesis at the lumbosacral junction.


• Ivory vertebra sign : Increase in opacity of a vertebral body that retains its size and contours, with no change in the opacity and size of adjacent intervertebral disks.


• Juxtaphrenic peak sign : Tenting of the diaphragm that may be seen with right upper lobe atelectasis.


• Keyhole sign : US appearance that may be seen with posterior urethral valves.


• Lace like : Pattern that may be seen with sarcoid arthropathy.


• Lace-like pattern : Ultrasound appearance of hemorrhagic ovarian cysts.


• Lacunar skull : Appearance of skull that may be seen in infants with Chiari II malformation.


• Lambda sign : On a Gallium-67 citrate scan, uptake in the hilar and paratracheal lymph nodes gives the appearance of a lambda. This is seen in sarcoidosis.


• Lead pipe : Narrowing of colon with loss of haustra that may be seen in patients with ulcerative colitis.


• Linguine sign : MRI sign that may be seen in patients with intracapsular breast implant rupture.


• Lobster claw sign : Sign of papillary necrosis on IVU.


• Lollipop : Appearance of diverticula that may been seen on HSG in patients with adenomyosis.


• Luftsichel sign : “Air cresent”. Sign that may be seen with left upper lobe atelectasis.


• Mark Morton sign : Throckmorton’s sign with a small penis.


• Mercedes Benz sign : Appearance of gas within gallstones.


• Moulage sign : Effaced loop of bowel that may be seen on a small bowel series in sprue.


• Molar tooth sign (GU) : Perivesicular extravasation of contrast on CT cystogram in a patient with extraperitoneal bladder rupture.


• Molar tooth sign (Neuro) : Enlarged and horizontally directed tubular structure on each side of the midline emerging from the midbrain in patients with Joubert syndrome.


• Monod sign : Air surrounding an aspergilloma (Also see air crescent sign).


• Mount Fuji sign : CT sign of tension pneumocephalus.


• Naclerio’s V sign : V shaped lucency that may be seen over the left lower mediastinium in pneumomediastinum.


• Nipple sign : Appearance of hypertrophic pyloric stenosis that may be seen on ultrasound.


• Nubbin sign : Reflux nephropathy involving the lower pole of a duplicated collecting system.


• Nutmeg liver : Pattern of liver enhancement seen with passive congestion.


• Onion ring appearance : US appearance that may be seen with a testicular epidermoid cyst.


• Paintbrush appearance : Linear striations of contrast material opacifing collecting tubules that may be seen with medullary sponge kidney.


• Panda sign : On a Gallium-67 citrate scan, uptake in the lacrimal and salivary glands gives the appearance of a panda. This is suggestive of sarcoidosis.


• Parallel track sign : Pattern of uptake that may be seen on bone scan in patients with hypertrophic osteoarthropathy.


• Pear-shaped bladder : Bladder assumes the shape of a pear when it undergoes extrinsic compression due to excess tissue in the pelvis.


• Pearl necklace sign : MRI sign that may be seen with adenomyomatosis.


• Pencil in cup deformity : Erosion pattern of digits that may be seen in patients with psoriatic arthritis.


• Picture frame vertebral body : Thicken cortex of vertebral bodies that may be seen in patients with Paget disease.


• Picket fence : Appearance of bowel that may be seen on small bowel series with Whipple disease or gastrointestinal amyloidosis.


• Pistol grip deformity : Appearance of the proximal femur that may be seen with cam type femoroacetabular impingement.


• Playboy bunny sign : US sign of the appearance of the confluence of the hepatic veins with the IVC.


• Polka-dot pattern : Appearance of thickening trabeculations seen in intraosseous hemangiomas of the spine. See also Corduroy appearance.


• Porcelain gallbladder : Calcification of the gallbladder wall.


• Putty kidney : Appearance that may be seen with end-stage renal tuberculosis.


• Reversal sign : CT sign of anoxic brain injury where gray matter is lower in attenuation that white matter (the opposite is normal).


• Reversed halo sign : Relatively specific sign of pulmonary nodules in cryptogenic organizing pneumonia.


• Ribbon bowel : Appearance of bowel that may be seen on barium studies in graft versus host disease.


• Ribbon ribs : Appearance of ribs that may be seen with neurofibromatosis 1.


• Rice kernel : CT appearance that may be seen with dacryolithiasis.


• Rigler’s sign : Sign of pneumoperitoneum where both sides of a loop of bowel are outlined by air.


• Rim sign : On cholescintigraphy, increased uptake is seen in the region of the gallbladder fossa. Sign is specific for acute cholecystitis.


• Ring of fire sign : US finding. Hypervascular ring in the adnexa that may be seen with either ectopic pregnancy or corpus luteum.


• Ring sign : CT sign of epiploic appendagitis.


• Rosary sign : CT sign that may be seen with adenomyomatosis.


• Rugger jersey spine sign : Appearance of spine that may be seen with secondary hyperparathyroidism or chronic renal failure


• S sign of Golden : Right upper lobe atelectasis created by a central mass. Should raise the suspicion of a central neoplasm.


• Saber-sheath trachea : Appearance of trachea that may be seen with COPD.


• Saber shin : Appearance of tibia that may be seen with syphilis.


• Sandstorm appearance : Appearance of lungs that may be seen in pulmonary alveolar microlithiasis.


• Salt and pepper pattern : Flow voids seen in glomus tumors.


• Salt and pepper skull : Appearance of skull that may be seen in patients with hyperparathyroidism.


• Sandwich sign : Bulky lymphoma encasing mesenteric vessels.


• Sandwich vertebra : Sclerotic endplates that may be seen with osteopetrosis.


• Sausage digit : Soft tissue swelling of digits in patients with psoriatic arthritis.


• Scimitar sign : MRI appearance that may be seen with eccentric cystic adventitial disease.


• Scottie dog : On oblique radiographs, the posterior elements form the appearance of a Scottie dog. Spondylolysis can have the appearance of a collar around the neck.


• Shepard’s crook deformity : Appearance of proximal femur that may be seen with fibrous dyplasia.


• Shoulder sign : Appearance of hypertrophic pyloric stenosis that may be seen on upper GI series.


• Signet ring sign (Chest) : Sign of bronchiectasis.


• Signet ring sign (GU) : Sign of papillary necrosis on IVU.


• Small heart sign : Sign of tension pneumopericardium.


• Snowman : Appearance of heart that may be seen with supracardiac total anomalous pulmonary venous return.


• Snowstorm pattern (breast) : US pattern for breast implant rupture.


• Snowstorm pattern (Ob/gyn) : US pattern for a molar pregnancy.


• Soft-tissue rim sign : Appearance of a ureteral edema surrounding a calculus. Helps differentiates a calculus from a phlebolith (also see comet sign).


• Spade shape : Shape of tufts that may be seen with acromegaly.


• Spalding sign : Overlapping cranial sutures. Sign of fatal demise on prenatal ultrasound.


• Spider web : Appearnace of collateral vessels that may be seen on hepatic venography in Budd-Chiari syndrome.


• Spinnaker sail sign : Elevation of the thymus by air that may be seen with pneumomediastinum.


• Split pleura sign : CT sign of thoracic empyema.


• Spoke wheel enhancement pattern (GU) : May be seen with oncocytomas


• Spoke wheel enhancement pattern (GI) : May be seen with focal nodular hyperplasia.


• Spokewheel sign (GI) : Pattern of mesentery that may be seen with small bowel volvulus.


• Starry sky : US appearance that may be seen with hepatitis.


• Steeple sign : Appearance of narrowing of the subglottic tracheal lumen that may be seen with croup.


• Stepladder sign : US sign that may be seen in patients with intracapsular breast implant rupture.


• Straight line sign : PET sign of peritoneal carcinomatosis.


• Strawberry skull : Appearance of skull that may be seen on fetal US with Trisomy 18.


• String of beads : Appearnace of multiple stenosis that may be seen in patients with fibromuscular dysplasia.


• String sign : Appearance of hypertrophic pyloric stenosis that may be seen on upper GI series.


• Stripe sign : On a V/Q scan, subpleural activity in a region of decreased pulmonary perfusion. Sign is used to rule out pulmonary embolism.


• Subependymal Calcification : Tuberous Sclerosis


• Superior triangle sign : Sign that may be seen with right lower lobe atelectasis.


• Talar beak : Sign of talocalcaneal tarsal coalition.


• Tau sign : MRI sign of a persistent trigeminal artery.


• Telephone receiver shaped femora : Appearance of femora that can be seen with thanatophoric dysplasia.


• Terry Thomas sign : Sign of scapholunate ligament disruption (also see David Letterman sign).


• Throckmorton’s sign : The penis points to the pathology.


• Thumb sign : Classic lateral radiographic finding for epiglotitis.


• Thumbprinting : Sign of bowel wall thickening seen with entities such as ischemic bowel, diverticulitis, Crohn’s disease, and ulcerative colitis.


• Tip of the iceberg sign : Ultrasound sign that may be seen with mature cystic teratomas.


• Tit sign : Appearance of hypertrophic pyloric stenosis that may be seen on upper GI series.


• Tram-track sign (chest) : Sign of bronchiectasis.


• Tram line calcification (neuro) : Sign of optic nerve meningioma in tuberous sclerosis.


• Tram-track calcification (neuro) : Appearance of cortical calcifications that may be seen with Sturge Weber syndrome.


• Tram-track sign (nucs) : Bone scan finding that may be seen with hypertrophic osteoarthropathy.


• Tree in bud : Nonspecific pulmonary pattern seen on thin-section computed tomography,most commonaly with tuberculosis.


• Trident hand : Appearance of hands that may be seen with achondroplasia.


• Trough line sign : In posterior shoulder dislocation, frontal radiographs reveal two nearly parallel lines in the superomedial aspect of the humeral head.


• Umbrella sign : Sign of a ruptured globe.


• Wall-echo-shadow sign : Sign of cholelithiasis on US when the gallbladder is filled with calculi.


• Waterlily sign : Sign of hydatid cyst.


• Water can perineum : Sign of fistula formation secondary to periurethral abscess,associated with gonnorhea infection.


• Wave sign : Sign produced by lateral indentation of thymus by adjacent anterior ribs. This sign in seen in the pediatric population and represents a normal thymus.


• Whirlpool Sign : US sign of midgut volvulus in a neonate.


• Wimberger’s ring sign : A circular, opaque radiologic shadow surroundsing epiphyseal centers of ossification in patients with scurvy.


• Wimberger’s sign : Symmetrical lesions seen in the proximal tibial medial metaphysis in patient’s with syphilis.


• Westermark’s sign : Regional pulmonary oligemia secondary to pulmonary embolism.


• Yin-yang sign : Swirling blood flow pattern within a pseudoaneurysm.


• Yo-yo on a string sign : MRI appearance of a Stener lesion (see Gamekeeper thumb)