Aravind Palraj Profile picture
Oct 26 12 tweets 4 min read Read on X
🧵“100 Named Clinical Signs — Hutchison’s Clinical Methods (25th Edition)”

AI detects patterns.
Hutchison detected patients.

Here are 100 named clinical signs that still shape bedside diagnosis —
signs that live in the wards, not in the algorithms.

The lost language of observation begins below 👇
@DrAkhilX @IhabFathiSulima @drkeithsiau @ArunInamadar @nirmalregency #MedTwitterImage
General and Systemic Signs

1️⃣ The body speaks before the lab does.

From Murphy’s to Nikolsky’s — every sign here was discovered by listening to the patient, not the monitor.

The skin, breath, and reflex still tell the truth first. Image
Cardiovascular Signs

2️⃣ The pulse has poetry.

Corrigan, Quincke, de Musset — names that still echo with each beat.

You don’t need an echo when your fingers already know. Image
Respiratory Signs

3️⃣ The chest is a percussion instrument — and you’re the musician.

Hoover, Hamman, Aegophony, Whispering Pectoriloquy — each note carries a clue.

Hutchison still whispers through the stethoscope. Image
Gastrointestinal Signs

4️⃣ The abdomen hides nothing from patient hands that know where to press.

Murphy, Rovsing, Psoas, Boas — every test a silent conversation with peritoneum and pain. Image
Hepatic and Haematologic Signs

5️⃣ The liver has no secrets from a watchful eye.

From Kayser–Fleischer rings to Sister Mary Joseph’s nodule —
each sign a quiet message from deep disease. Image
Neurological Signs

6️⃣ The nervous system doesn’t lie — it just hides in reflexes.

Babinski, Brudzinski, Froment — ancient signals of anatomy in action.

Clinical neurology is the original detective work. Image
Musculoskeletal Signs

7️⃣ Movement is memory.

Trendelenburg, Thomas, Lachman, McMurray —
each test a choreography between pain, power, and precision.

The body never improvises; it remembers. Image
Eye Signs

8️⃣ The eyes are still the quickest exam in medicine.

Argyll Robertson, Hutchinson’s, Kayser–Fleischer —
the iris and cornea reveal what the rest of the body conceals. Image
Infectious and Rheumatologic Signs

9️⃣ Infections and autoimmunity leave their signatures on the skin.

Osler, Janeway, Gottron, Heliotrope —
eponyms that remind us inflammation always speaks in color and contour. Image
Classic Triads and Rare Pearls

10️⃣ Some signs survive centuries because they save seconds.

Charcot, Cushing, Beck, Virchow —
the giants who turned patterns into diagnosis.

Their language is still medicine’s heartbeat. Image
Closing Line:

100 signs.
100 stories.
1 timeless lesson.

Technology can assist.
But only observation can understand.

— Dr. Aravind Palraj | RheumRounds

#MedTwitter #Hutchison #ClinicalSigns #BedsideMedicine #RheumRounds

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More from @Rheumat_Aravind

Oct 25
🧵 “100 MSK Examination Gems — Hutchison’s Clinical Methods (25th Edition)”

AI can detect shadows on a scan.
But it can’t see how a patient moves, hesitates, or hides pain.

Before MRI. Before algorithms. There was Hutchison — and the art of touch.

Here are 100 timeless MSK pearls every real clinician should know 👇
@12VRavindran @Amansharmapgi @DurgaPrasannaM1 @IndianRheum @IJRheum @ACRheum @DrAkhilX @IhabFathiSulima @Janetbirdope @RheumNow #MedTwitter #RheumatXImage
💬 Tweet 1 – General Principles

1️⃣ The musculoskeletal exam begins before touch.

Watch how they move, sit, breathe, hesitate.

“Look, feel, move” — Hutchison’s eternal rhythm of bedside medicine.

Observation > Investigation. Image
💬 Tweet 2 – Gait & Posture

2️⃣ Every step tells a story.

Antalgic → pain.
Trendelenburg → weakness.
Waddling → myopathy.

The body never lies — it just walks differently. Image
Read 12 tweets
Oct 23
🧵The best clinicians diagnose before the investigations arrive.

Here are 100 timeless history-taking gems from Hutchison’s Clinical Methods (25th Edition) — distilled into pure bedside wisdom.

🩺 This thread reminds us why the story still matters more than the scan 👇

(Bookmark this — it’ll shape your next patient encounter.)
@DrAkhilX @IhabFathiSulima @drkeithsiau @RheumNow @Janetbirdope #MedTwitter #MedEd #FOAMed #Medicine #internalmedicineImage
The Art of Beginning

1️⃣ The history starts before you speak.

Observe posture, mood, breathing, gait — the body always speaks first.

Then say softly:
“Tell me about your problem.”

Silence in the first 30 seconds is golden. Image
Chief Complaint

2️⃣ Always in the patient’s own words.

“I feel tired for 2 weeks” > “Fatigue × 2 weeks.”

Ask: “What troubles you most?”
The answer guides the whole consultation. Image
Read 12 tweets
Oct 21
🧵100 timeless bedside gems every doctor should know.
Straight from Hutchison’s Clinical Methods — distilled into 10 clean infographics.

If you love real clinical medicine, this thread will remind you why you chose it.

🩺 Let’s bring back the art of examination 👇

(Save this thread — it’ll outlive most AI tools.) #MedTwitter #MedEd #FOAMed @DrAkhilX @IhabFathiSulima @drkeithsiau @DurgaPrasannaM1 @JasmineNephroImage
General Principles

1️⃣ The patient will tell you the diagnosis — if you learn to listen.

History first. Examination next. Investigations last.

🩺 The foundation Hutchison built 125 years ago still holds true. Image
General Inspection

2️⃣ The first 10 seconds matter.

How they walk, talk, sit, breathe — that’s your first set of vitals.

The best clinicians diagnose before touching the patient. Image
Read 12 tweets
Sep 28
🧵 DADA2 & Vasculitis — The Hidden Culprit

1/
What if one mutation causes vasculitis, strokes, immune deficiency & cytopenias — all in one patient?
That’s DADA2 (Deficiency of Adenosine Deaminase 2).
@DrAkhilX @IhabFathiSulima #MedTwitter #RheumTwitter Image
2/
🔍 What is DADA2?
•Rare, autosomal recessive disease
•Mutations in ADA2 gene → enzyme deficiency
•Impacts vessels, immune system, bone marrow Image
3/
⚡ Vasculitis hallmark
•Inflammation, stenosis, occlusion of small/medium vessels
•Often mimics Polyarteritis Nodosa (PAN) Image
Read 10 tweets
Sep 24
🧵 Management of Scleroderma (Systemic Sclerosis) – 2025 Update

1/
Scleroderma (Systemic Sclerosis, SSc) is a chronic autoimmune connective tissue disease with fibrosis, vasculopathy, and autoimmunity at its core.
Management is organ-specific and evolving with new evidence. Let’s break it down. 👇
@DrAkhilX @IhabFathiSulima #MedTwitterImage
2/
🔹 General Principles
•No single “cure” exists.
•Approach is multidisciplinary: rheumatology, pulmonology, cardiology, nephrology, dermatology.
•Early recognition of organ involvement = better outcomes. Image
3/
🌿 Lifestyle & Supportive Care
•Smoking cessation
•Physical therapy & hand exercises
•Skin care (moisturizers, avoid cold exposure)
•Vaccinations (flu, pneumococcal, COVID)
•Patient education + psychosocial support
Read 12 tweets
Sep 24
🧵: Proteinuria – When to Think Beyond the Kidneys

Tweet 1:
Proteinuria isn’t always just nephrology.
Sometimes, it’s the first clue to systemic disease.
Here’s how to approach proteinuria with an internal medicine + rheumatology lens 👇 @DrAkhilX @IhabFathiSulima #MedTwitter #RheumTwitter #NephroTwitterImage
Tweet 2:
🔍 Step 1: Confirm proteinuria
•Dipstick vs. spot UPr/Cr ratio vs. 24h collection
•Rule out false positives (alkaline urine, hematuria, concentrated sample) Image
Tweet 3:
📊 Step 2: Quantify
•<500 mg/day → often tubular or overflow causes
•0.5–3.5 g/day → non-nephrotic, think secondary causes
•3.5 g/day → nephrotic, raises red flags for glomerular pathology Image
Read 7 tweets

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