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A site for medical students - Practical,Theory,Osce Notes

What are the Signs and Symptoms of Cushing’s Syndrome

Cushing syndrome produce changes in body fat,skin,bone,muscle,resproductive system,cardiovasular and blood.
Changes in the body fat
  •          Body fat Weight gain
  •        Central obesity
  •          Rounded face
  •          Fat pad on back of neck (“buffalo hump”)
Changes in the Skin
  •  Facial plethora
  •          Thin and brittle skin
  •          Easy bruising,
  •          Broad and purple stretch marks,
  •          Acne
  • ·        Hirsutism
Changes in Bone
  •         Osteopenia
  •          Osteoporosis (vertebral fractures),
  •         Decreased linear growth in children
Changes in muscle
  •          Muscle Weakness
  •          Proximal myopathy (prominent
  • ·        Atrophy of gluteal and upper leg muscles
Changes Metabolism
  • Glucose intolerance/diabetes
  • Dyslipidemia
  • Changes in the Cardiovascular system
  • Hypertension
  • Hypokalemia,
  • Edema
  • Atherosclerosis 
Reproductive system changes
  • Decreased libido,  amenorrhea in women
Blood and immune system changes
  • Increased susceptibility to infections
  • Increased white blood cell count
  • Eosinopenia,
  • Hypercoagulation with increased risk of deep vein thrombosis and pulmonary embolism
Central nervous system changes
  • Irritability
  • Emotional lability
  • Depression,
  • Cognitive defect and paranoid psychosis

How to examine for Collapsing Pulse an OSCE guide

The term collapsing pulse is used to describe a pulse with a rapid upstroke and descent, and is characteristically described in aortic regurgitation.
Other  names of the collapsing pulse
  • Watson's water hammer pulse
  • Cannonball pulse 
  • Pulsus celer.
How to elicit collapsing pulse?
To elicit the collapsing pulse you have to palpate the carotids or the radial pulse.
For the radial pulse:
  • Ask the patient to fully pronate his forearm.
  • Place your right hand on the radial pulse.
  • Grasp the patient's forearm with left hand (with your palm on the flexor aspect of patient's forearm).
  • Raise the hand above the level of the patient's head
  • Repeat the manoeuvre to note the accentuation of the collapse in the elevated position.

How to examine for radiofemoral delay.an OSCE guide

Radiofemoral delay is an important clinical sign that help to detect the coarctation of aorta
How to elicit radiofemoral delay?
To detect the radiofemoral delay you have to palpate the radial and femoral artery simultaneously.Normally the time taken for the pulse wave to reach the radial artery after the cardiac systole is 80 milliseconds and for the femoral artery it is 75milleseconds.If the femoral pulse is delayed compared to radial pulse it is called as radiofemoral delay.
Causes of radiofemoral delay
Coarctation ol aorta
Atherosclerosis of aorta.
Thrombosis or embolism of aorta
 Aortoarteritis.



How to examine for Femoral pulse:an OSCE guide

The femoral pulse is palpated over the ventral thigh between the pubic symphysis and anterior superior iliac spine with the middle and index fingers.
How to examine for femoral pulse?
  • Ask the patient to lie supine,
  • Make the leg partially flexed: abduct and externally rotate the hip,
  • Feel the pulse below the midinguinal point.
Comment on the following
  • Rate, rhythm, character, volume.
  • Character of the vessel wall.
  • Palpability of all vessels.
  • Radio-femoral delay.
Clinical significance
Examination of peripheral pulse is imporatant for detection of radiofemoral delay

This is very important for students preparing for USMLE and MRCP

How to examine for carotid artery an OSCE guide

The common carotid artery is palpated on the neck below the jaw and lateral to the larynx/trachea (that is mid-point between your earlobe and chin) using the middle and index fingers.
It can be felt between the anterior border of the sternocleidomastoid muscle, above the hyoid bone and lateral to the thyroid cartilage
Precaution on palpating the carotid artery
  • The carotid artery should be palpated gently 
  • The patient should be in  sitting or lying down posture. 
  • Stimulating its baroreceptors with low palpitation can result in  severe bradycardia or even stop the heart in some sensitive persons. 
  • Two carotid arteries of a person should not be palpated at the same time. as it may limit the flow of blood to the head, possibly leading to fainting or brain ischemia.
How to examine for carotid pulse?
  • Ask the patient to look straight ahead
  • Use your thumb and press it backwards
  • The pulse is felt at the level of the medial border of the sternomastoid muscle and lateral to the thyroid cartilage.
Comment on the following
Rate, rhythm, character, volume.
Character of the vessel wall.
Palpability of all vessels,


This is very important for students preparing for USMLE and MRCP

How to examine for Brachial pulse:an OSCE guide

Brachial artery pulse is located on the inside of the upper arm near the elbow
The brachial artery is palpated on the anterior aspect of the elbow by gently pressing the artery against the underlying bone with the middle and index fingers. 
Clinical significance 
This pulse is commonly used to measure blood pressure with a stethoscope and sphygmomanometer
How to examine for brachial artery pulse?
  • Partially flex the elbow,
  • Feel the pulse over the elbow with thumb or fingers
Comment on the following
Rate, rhythm, character, volume.
Character of the vessel wall.
Palpability of all vessels,

How to examine for Radial pulse:an OSCE guide

Radial artery pulse is located on the lateral of the wrist , it can also be found in the anatomical snuff box
The radial pulse is palpated immediately above the wrist joint near the base of the thumb (i.e., common site), or in the anatomical snuff box (i.e., alternative site), by gently pressing the radial artery against the underlying bone with the middle and index fingers.
Clinical significance
The examination of radial pulse is very useful in the following condition
Radioradial delay-seen in thoracic inlet syndrome and takayasu disease
Radiofemoaral delay in Coarctation of aorta
How examine for radial pulse
  • Semipronate the forearm,
  • Flex the wrist
  • Feel the pulse near the wrist,
Comment on the following
Rate, rhythm, character, volume.
Character of the vessel wall.
Palpability of all vessels,
Radio-femoral delay.


This is very important for students preparing for USMLE and MRCP