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By Franklin B. Saksena
Chapter 1 normal Observations (pages 1–8):
Chapter 2 Face (pages 9–39):
Chapter three Ear (pages 40–41):
Chapter four Mouth and nostril (pages 42–47):
Chapter five Neck (pages 48–49):
Chapter 6 Hand (pages 50–68):
Chapter 7 top Extremity (pages 69–72):
Chapter eight Thorax again (pages 73–82):
Chapter nine stomach (pages 83–87):
Chapter 10 reduce Extremity (pages 88–97):
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Extra info for Color Atlas of Local and Systemic Signs of Cardiovascular Disease
She had a substernal thyroid. 36 CHAPTER 2 Figure 74 Pemberton’s sign: a nuclear scan showing that the patient in Figure 73 had a substernal thyroid. A CT of the chest conﬁrmed that the thyroid extended inferiorly to the great vessels of neck. Figure 75 Angioedema of face: the patient had marked swelling of the face of sudden onset. There was brawny edema of the scalp (conﬁrmed by CT of the head). On the right, the patient has improved dramatically in 2 days with steroids. He may have been hypersensitive to enalapril and/or bees.
This distal/interphalangeal ratio may also be visually assessed at the bedside with a “shadowgram” . Subcuticular edema (Figure 110) and ballotability of the nail itself are often present but the latter may be a late sign of clubbing . Clubbing needs to be distinguished from nail beaking and acro-osteolysis. In nail beaking, the nail is curved, the hyponychial angle is preserved, and there is loss of pulp tissue (Figure 111) [163, 164]. Nail beaking is not associated with cardiac disease.
Subcuticular edema (Figure 110) and ballotability of the nail itself are often present but the latter may be a late sign of clubbing . Clubbing needs to be distinguished from nail beaking and acro-osteolysis. In nail beaking, the nail is curved, the hyponychial angle is preserved, and there is loss of pulp tissue (Figure 111) [163, 164]. Nail beaking is not associated with cardiac disease. Patients with acroosteolysis exhibit a somewhat ﬂattened and bulbous shape of the distal digits due to soft tissue collapse as a result of necrosis of the distal phalanges.