Initial observations.


Malar (butterfly) rash – systemic lupus erythematosus, systemic autoimmune disease.
Rounded face – Hypothyroidism, cushings disease (high levels of cortisol in the blood)
Lack of symmetry – stroke, bells palsy (unilateral peripheral CNVII dysfunction).
Hirsuitism – hormone dysfunction.
Rhinophyma (bulbar nose) – alcoholism or rosacea.


Enopthalmus – Hypothyroidism (Hashimoto’s thyroiditis look for preorbital myxoedema)
Exopthalmus – Hyperthyroidism (grave’s)
Ptosis – unilateral nerve palsy, horner’s syndrome (damage to cervical sympathetic nerves), myasthenia gravis (autoimmune disorder of episodic muscle weakness), inflammation, infection, malignancy.
Xanthelasma – cholesterol deposits
Blue sclera – osteogenesis imperfecta (congenital ‘brittle bone’ disorder)
Yellow sclera – Jaundice.


Oral thrush – White coating on tongue and angular stomatitis (redness at the corners of the mouth)
Bucal membrane colour – pale can indicate anaemia.
Sores and blisters on the gums – scurvy/herpes.
‘Glossy beefcake’ tongue – vitamin b deficiency.


Dental caries – poor oral hygiene, gum disease.
Discolouration – smoking, coffee, poor diet.
Bleeding gums – gingivitis, haemophilia, leukaemia, oral cancer, thrombocytopenic purpura, vitamin k deficiency, vitamin c deficiency (scurvy).

Fecal odour – bowel obstruction.
Pear drop/fruity odour – diabetic ketoacidosis.
Ammonia/urine/fishy odour – renal failure.


Goitre – hyperthyroidism, iodine deficiency, graves/hashimoto’s disease.
Tracheal deviation – pneumothorax, pleural fibrosis, hydrothorax (pleural effusion), retrosternal goitre, tumour.
Pulsations – heart failure, cardiovascular disease.


Cold – peripheral vascular disease, peripheral neuropathy, Reynauds phenomenon, diabetes mellitus, hypothyroidism.
Hot – Erythromelalgia, hypothyroidism.
Sweaty – Hyperhidrosis, stress, anxiety.
Palmar erythema – Chronic liver disease, pregnancy, rheumatoid arthritis, SLE, sarcoidosis, polyarthritis, leukemia, hyperthyroidism, polycythemia.
Dupuytrens contracture – ulnar nerve damage.
Tremor – Multiple sclerosis, hyperthyroidism, stroke/cerebrovascular accident, parkinsons disease, brain disorder/SLO, hypoglycaemia, alcoholism.


Clubbed – Infective endocarditis, empyema, liver diseases, ulcerative colitis/crohns, congenital cyanotic heart disease, hyperthyroidism, lung cancer.
Koilonychia (spoonshaped) – chronic iron deficiency, haemochromatosis, diabetes, systemic lupus erythematosus (SLE).
Onycholysis (lifting from bed) – Psoriasis, anaemia, diabetes mellitus, hyperthyroidism, hypothyroidism, sarcoidosis.
Leukonychia (whitening) – chronic liver disease, renal failure, fungal infection, malnutrition, poisoning, heart problems.


Pyramidal gait (hemiplegic) – Upper motor neurone lesion (UMNL). View here.
Extrapyramidal gait (parkinsonian) – Parkinson’s. View here.
Foot drop – Lower motor neurone lesion (LMNL). View here.
Myopathic gait – muscle weakness causing a rolling/waddling gait. View here.
Ataxic gait – broad based ‘drunken’: cerebellar dysfunction. General imbalance and wobble in walk: LMNL. View here.


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