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In medicine, a sign is a feature of disease as detected by the doctor during physical examination of a patient. It is therefore "objective", as opposed to the patient's experience (symptom), which is (relatively) subjective.
The phrase "clinical sign" is sometimes used to emphasize that the observation occurs in a clinical context.
Examples of signs are elevated blood pressure, or abnormal appearance of the retina, or clubbing of the fingernails. These would generally be meaningless to the patient, but can prompt the doctor to look for certain categories of diseases to explain the patient's symptoms.
Types of signs
Medical signs may be classified by the type of inference that may be made from their presence,:80–81 for example:
- Prognostic signs (from progignṓskein, προγιγνώσκειν, "to know beforehand"): signs that indicate the outcome of the current bodily state of the patient (i.e., rather than indicating the name of the disease). Prognostic signs always point to the future. Perhaps the most famous prognostic sign is the facies Hippocratica:
"[If the patient's facial] appearance may be described thus: the nose sharp, the eyes sunken, the temples fallen in, the ears cold and drawn in and their lobes distorted, the skin of the face hard, stretched and dry, and the colour of the face pale or dusky.… and if there is no improvement within [a prescribed period of time], it must be realized that this sign portends death."
- Anamnestic signs (from anamnēstikós, ἀναμνηστικός, "able to recall to mind"): signs that (taking into account the current state of a patient's body), indicate the past existence of a certain disease or condition. Anamnestic signs always point to the past. (Whenever we see a man walking with a particular gait, with one arm paralysed in a particular way, we say "This man has had a stroke"; and, if we see a woman in her late 50s with one arm distorted in a particular way, we say "She had polio as a child".)[dubious — see talk page]
- Diagnostic signs (from diagnōstikós, διαγνωστικός, "able to distinguish"): signs that lead to the recognition and identification of a disease (i.e., they indicate the name of the disease).
- Pathognomonic signs (from pathognomonikós, παθογνωμονικός, "skilled in diagnosis", derived from páthos, πάθος, "suffering, disease", and gnṓmon, γνώμον, "judge, indicator"): the particular signs whose presence means, beyond any doubt, that a particular disease is present. They represent a marked intensification of a diagnostic sign. (An example would be the palmar xanthomata seen on the hands of people suffering from hyperlipoproteinaemia.) Singular pathognomonic signs are relatively uncommon.
"[Thus] a symptom is a phenomenon, caused by an illness and observable directly in experience. We may speak of it as a manifestation of illness. When the observer reflects on that phenomenon and uses it as a base for further inferences, then that symptom is transformed into a sign. As a sign it points beyond itself — perhaps to the present illness, or to the past or to the future. That to which a sign points is part of its meaning, which may be rich and complex, or scanty, or any gradation in between. In medicine, then, a sign is thus a phenomenon from which we may get a message, a message that tells us something about the patient or the disease. A phenomenon or observation that does not convey a message is not a sign. The distinction between signs and symptom rests on the meaning, and this is not perceived but inferred.":81
Signs as tests
In some senses, the process of diagnosis is always a matter of assessing the likelihood that a given condition is present in the patient. In a patient who presents with haemoptysis (coughing up blood), the haemoptysis is very much more likely to be caused by respiratory disease than by the patient having broken their toe. Each question in the history taking allows the medical practitioner to narrow down their view of the cause of the symptom, testing and building up their hypotheses as they go along.
Examination, which is essentially looking for clinical signs, allows the medical practitioner to see if there is evidence in the patient's body to support their hypotheses about the disease that might be present. A patient who has given a good story to support a diagnosis of tuberculosis might be found, on examination, to show signs that lead the practitioner away from that diagnosis and more towards sarcoidosis, for example. Examination for signs tests the practioner's hypotheses, and each time a sign is found that supports a given diagnosis, that diagnosis becomes more likely.
Special tests (blood tests, radiology, scans, a biopsy, etc.) also allow a hypothesis to be tested. These special tests are also said to show signs in a clinical sense. Again, a test can be considered pathognonomic for a given disease, but in that case the test is generally said to be "diagnostic" of that disease rather than pathognonomic. An example would be an history of a fall from a height, followed by a lot of pain in the leg. The signs (a swollen, tender, distorted lower leg) are only very strongly suggestive of a fracture; it might not actually be broken, and even if it is, the particular kind of fracture and its degree of dislocation need to be known, so the practitioner orders an x-ray. The x-ray film shows a fractured tibia, so the film is said to be diagnostic of the fracture.
List of signs of psychological/psychiatric importance
- Blunted affect
- Depression (mood)
- Formal thought disorder
- Ideas of reference
- Mood congruence
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- Chadwick, J. & Mann, W.N.(trans.) (1978). Hippocratic writings, 170–171, Harmondsworth, UK: Penguin.