More than 100 facts connected with birds for medical students

Mediwood
By Dr Naveen Koval
Be the light…..
limelight
Not because you want the ….
But to dispell the darkness of ignorance ...
Let’s share the light of knowledge.

- Dr Naveen Koval

Mediwood
By Dr Naveen Koval
Let’s make medical education fun…….
 Anterior vertebral body beaking
INFERIOR BEAKING
CENTRAL BEAKING (LOWER 3RD PORTION OF VERTEBRAL BODY)
(MIDDLE 3RD PORTION OF VERTEBRAL BODY)

Note that
MORQUIO syndrome has
beaking at the MIDDLE
&
DOWN syndrome has
beaking at the
DOWNMOST part(lower)

HURLER SYNDROME
DOWN SYNDROME(DOWN =LOWER)
MORQUIO SYNDROME
BEAKING of the 12th thoracic
or 1st or 2nd lumbar vertebra is common
in CONGENITAL HYPOTHYROIDISM
 Bird beak sign
The bird's beak sign of the
oesophagus is used to refer to the
tapering of the inferior oesophagus
in achalasia. The same
appearance (although it is difficult
to see the similarity) is also referred
to as the rat-tail sign.
 Beak Sign
Seen in Hypertrophic Pyloric Stenosis.

Other signs in HPS

"beak" sign is peak of
barium entering the
narrowed pyloric channel
 Claw sign in INTUSSUSCEPTION
Barium enema showed filling defect with Claw Sign(also known as Crab Claw Sign) at the mid transverse colon

Some more signs related to CLAW are:

Bird Flu
Avian H5N1 commonly referred as bird flu
is a highly pathogenic strain of influenza virus
that infects and kills humans in close contact
with diseased birds but has not acquired
pandemic potential due to limited human-to-
human transmissibility.
Bird–like Facies
Pierre Robin syndrome

PIERRE ROBIN SYNDROME :

Micrognathia (mandibular hypoplasia), cleft palate,
CHDs, respiratory obstruction, foreshortened
floor of mouth, normal size tongue.
 Bird-like Facies
Hallermann-Streiff syndrome
A rare genetic syndrome characterized mainly by head & facial abnormalities
such as bird-like facies (with beak-shaped nose and retrognathia)

Precocious dentition is seen in

Ellis Van Creveld and
Hallermann Steriff syndrome
Bird-like facies:
Small face, thin beaked nose, and recessed chin giving a bird-like facies

is seen in patients of Progeria

HUTCHINSON GILFORD SYNDROME-
progeria ,accelerated ageing disease due to new point
mutation in LMNA gene----->defective lamin A protein
--->defective nuclear envelope
(the whole condition is like a 10 year old trapped inside
a 70 year old body)......
Bird-headed Dwarfism
Seckel Syndrome
Seckel syndrome is a
genetic disorder characterized by
growth retardation, very small head
( microcephaly )with intellectual
disability , and unique facial features
such as large eyes, beak-like nose,
narrow face, and receding lower jaw.
About less than 25% of the patients
also have blood abnormalities
Bird sign
The presence of a zone of dullness on percussion with
absence of respiratory signs in hydatid cyst of the lung.
Bird Of Prey Sign
Sigmoid
volvulus
Infantile Tremor Syndrome :
Infantile tremor syndrome was described in
exclusively breastfed Indian infants, presenting at 8-
18 months of age with listlessness, developmental
delay and regression ,pallor, depigmented sparse
hair and hyperpigmented knuckles. Subsequent
symptoms include progressive limb tremors,
bleating goat like cry,
and arms positioned like a
'bird about to take flight’.
The condition is linked to cobalamin deficiency and
responds to therapy with cobalamin & propranolol.
 Winging Of Scapula
Winging of the left scapula
Flapping tremor:
Also known as
Asterixis(LIVER FLAPS) is a tremor of the hand when
the wrist is extended, sometimes said to resemble a
bird flapping its wings
Flapping tremor is classically seen in:
1. Hepatic precoma (‘liver flap’)
2. Severe cardiac failure,
3. Renal failure
4. Hypnotic poisoning, and
5. Respiratory failure (carbon dioxide narcosis)
6. Toxic encephalopathies.
* Flapping tremor is absent in hepatic coma.
Humming Bird Sign
Seen in
progressive supranuclear palsy
midsagittal T1-weighted MRI ....
atrophy of the midbrain tegmentum,
with a relatively preserved pons;
this gives an appearance resembling the
head and body, respectively, of a
hummingbird .
Ardeid Birds:
The Japanese encephalitis
infection is zoonotic, with
pigs and Ardeid birds as
the chief hosts that harbor,
amplify and transmit the
infection without developing
illness, despite significant
viremia.
‘Bird Nest’ Appearance’
Pott's spine:
An X-ray of the spine reveals a
fusiform radiodense shadow in
the region of the thoracic spine,
typically described as
‘bird nest’ appearance’
Pterygium colli
Also known as
Webbing of neck
& seen in Turner
and
Noonan syndrome
Pterygium of eye
Also known as

Surfer's eye:
benign growth in conjunctiva & affects nasal side.

Also know that

Fuchs' Patches :
minute gray blemishes that disperse near the pterygium head
PTERYGIUM of nail
Seen in
LICHEN PLANUS
 “Absence Of The Swallow Tail” Sign :
It is a sensitive marker for presynaptic dopaminergic deficiency
(both PD and Parkinson‐plus syndromes)

In the healthy state, susceptibility‐weighted

MRI (SWI) demonstrating signal
hyperintensity in the caudal and mediolateral
SN can be used to infer a normal
concentration of dopaminergic neurons in
nigrosome.
This normal appearance of the SN is
described as having a “swallow tail
appearance” on SWI, and denotes healthy
nigrosome 1 dopaminergic neurons

Absence of swallow‐tail sign: Parkinsons Disease

(tails of swallow denoted by red arrows)
 Stork Leg
INVERTED CHAMPAGNE BOTTLE LEG

(or stork leg)

is seen in

Charcot Marie Tooth disease

(due to peroneal muscle atrophy),

Lipodermatosclerosis of leg
(as a complication of chronic venous insufficiency)
Swan-Ganz catheter
pulmonary artery catheter
measures pulmonary arterial pressure
Swan Neck Deformity Of Fingers
Hyperextension of the proximal
interphalangeal joint with
flexion of the distal
interphalangeal joint of the finger.
seen in rheumatoid
arthritis
Kite’s Angle:
Talocalcaneal angle
in AP view radiograph.
Its <20 degree in clubfoot.
Kite’s Rotation Test
a maneuver used to distinguish b/w congenital
and acquired medial leg torsion......

Kites Clubfoot Cast

The manipulation and corrective cast application
for club foot done by Kite's method
EAGLE'S syndrome
Styalgia
-Occurs due to the
elongated styloid
process or calcification
of stylohyoid ligament
Goose Skin:
Also known as

cutis anserina
The reflex of producing goose skin is known as piloerection or
the pilomotor reflex.
Piloerection is also a classic symptom of some diseases, such
as temporal lobe epilepsy, some brain tumors, and autonomic
hyperreflexia. Goose bumps can also be caused by withdrawal
from opiates such as heroin. A skin condition that mimics goose
bumps in appearance is keratosis pilaris.
Goose foot appearance:
Also known as

Pes anserinus
It is the term used for the branch point of the facial
nerve (extratemporal) after it leaves the stylomastoid
foramen. It is also known as the "parotid plexus".
This division takes place within the parotid gland.
From the anterior border of the gland, five branches
emerge; temporal, zygomatic, buccal, mandibular
(marginal) and cervical. ..
Goose Neck Deformity
endocardial cushion defect(left ventriculogram)
also seen in rheumatoid arthritis & colle’s fracture due to rupture of extensor pollicis longus tendon..

Frontal view of a left ventriculogram

of a patient with partial endocardial
cushion defect showing a
goose-neck deformity.
The left ventricular outflow tract is
elongated and narrowed. The arrows
point to the mitral cleft.
AO=aorta: LV= left ventricle.
Owl Eye Sign
Papillary Carcinoma Thyroid
( cold area within a benign autonomous thyroid nodule)

There is a large photopenic area with a central focal area

of increased uptake in the left lobe of thyroid, which gives
the appearance of an “owl 's eye.
Owl Eye Inclusion Body
in Cyto Megalo Virus(CMV)
Owl Eye cells
Reed Sternberg Cells
(Hodgkin’s Lymphoma)

In REED STERNBERG CELLS eyes are RED(eosinophilic nucleoli) in color

Owl eye appearance:

Histopathology of verruca plana showing the typical

cytopathic effect on keratinocytes called as koilocytes having a
perinuclear halo referred to as "owl-eye appearance"
Owl eye appearance:

Accentuated, erythematous, scaly periorbital lesions in

neonatal lupus erythematosus

(also known as Raccoon eyes)
 Winking Owl Sign
Seen in
Pedicle
Metastasis
A reliable sign of osteolytic spinal metastases on AP radiographs is loss of the normal pedicle contour. The appearance of
unilateral pedicle absence has been likened to that of a winking owl with the missing pedicle being the closed eye, the
contralateral pedicle being the open eye and the spinous process being the beak)
HAWKinsinuria & Swimming pool urine odour

HAWK at
SWIMMING POOL
Duck like gait:
Also known as The body is first tilted backwards, with an increase of lumbar lordosis.
The feet are placed wide apart and the body sways from side to side
WADDLING GAIT as soon as the patient starts stepping. The hip tilts down when the leg
is being lifted. The heel and toes are brought down simultaneously.
It is due to weakness of the proximal pelvic muscles and is specially
seen in myopathy.

Causes ofwaddling gait are :

1. Duchenne muscular dystrophy.
2. Pregnancy (advanced).
3. Congenital dislocation of hip (bilateral).
4. Sometimes in huge ascites or morbid obesity.
 Ugly Duckling Stage
Also known as
BROADBENT’S PHENOMENON

A stage of dental development, usually between the ages of 8 and

11 years, preceding the eruption of the permanent canines when the
upper central and lateral incisors are tipped laterally due to the
crowding created by the unerupted canines, to produce a midline
space (median diastema). The midline space is normally transitory
and the incisors usually assume normal alignment when the upper
canines erupt into position.
 Ugly Duckling rule:
It states that the “spot”/nevus that is unlike the others is often the most suspect for malignancy & should be
considered for biopsy

In 1998, Grob and Bonerandi

introduced the "ugly duckling" concept
to demonstrate that nevi in the same
individual tend to resemble one another
and that atypical mole often deviates
from the individual's nevus pattern.
In other words, nevus that does not
resemble other nevi(like an ugly
duckling) is more likely to be suspicious
of melanoma.
 Age independent anthropometric factors:
Remember as Baby & Mama DUCKS in Water
BMI
MAC(between 1-5 years)
DUGDALE INDEX (sounds like DUCKdale)
CC/HC
KANAWATI INDEX
SINGH & RAO INDEX
Note that the DUCKS are very
cute so QUETELET INDEX SKINFOLD THICKNESS
POND=PONDERAL INDEX Water represents weight for height because its assessed
QUAC STICK using WATERLOW classification
(because DUCK says QUAC QUAC) WATER also represents JELLIFFE’S ratio(hc/cc)
(JAL in hindi=WATER)
Sitting Duck Appearance:
Persistent Truncus Arteriosus
The Duck is between two Geese
The location of THORACIC DUCT can be remembered as :
“The Duck is between two Geese”

Duck = Thoracic Duct

2 Geese = Azygous &
Esophagus
Goose & Duck:
Posterior Mediastinum Structures
can be memorized as:

The esophaGOOSE (esophagus)

The vaGOOSE nerve
The azyGOOSE vein
The thoracic DUCK (duct)
 Pigeon Chest
PIGEON CHEST is
PECTUS CARINATUM
Pectus carinatum is a protrusion deformity of the anterior chest wall.
The term is derived from the Latin phrase for "chest with keel.“
There are two main types of pectus carinatum deformity:
1. Chondrogladiolar prominence
2. Chondromanubrial prominence — also known as Pouter pigeon breast
Pectus carinatum may be associated with Marfan syndrome, Noonan syndrome, Poland syndrome, osteogenesis imperfecta,
Coffin-Lowry syndrome, and Morquio disease
Pigeon Breeders Disease:
Hypersensitivity pneumonitis or extrinsic allergic alveolitis
due to inhalation of organic agents from pigeons
Pigeon Toe
Pigeon toe, also known as in-toeing, is a condition which
causes the toes to point inward when walking. It is most
common in infants and children under two years of age.

The cause of in-toeing (Pigeon Toe)are:

•Curved foot (metatarsus adductus)
•Twisted shin (tibial torsion)
•Twisted thighbone (femoral anteversion)
Dove Coo Murmur
Aortic Regurgitation
(musical high pitched diastolic murmur)
Among all sounds emanating from the human heart, the
"dove-coo" or "sea-gull" murmur is unique. None so closely
approximates a pure musical tone, and none is so clearly
perceived by the ear. Its flowing note, characteristically
decrescendo and sliding downward in pitch as it is prolonged
throughout most of diastole, bears a startling resemblance to
the coo of a dove. Variously described as the "sea-gull cry," the
"humming top" or "whistling" murmur, it is referred to in most
cardiology textbooks simply as the musical murmur of aortic
regurgitation.
Sea Gull Sign

When acetabular fractures

involve the acetabular roof, X-ray films
show two typical double arc shadows on
the acetabular roof, which are similar to
sea gull wings in flight and therefore
vividly described as the “sea gull sign”.
Sea Gull Sign

The “seagull sign” in abdominal ultrasound identifies

the celiac trunk and its division into hepatic and
splenic arteries creates the wings of the seagull.
Wherever an artery divides into two smaller arteries or
two veins unite to form a larger vein, they can give an
appearance of a seagull.
Sea Gull sign:
The centre of Gallstone may contain radiolucent gas in a
triradiate or biradiate fissure, this gives rise to characteristic dark
shapes on radiograph.
Also known as Mercedes –Benz sign.
Gull wing appearance

EROSIVE
OSTEOARTHRITIS
Parrot Beaking
Grade 3 Clubbing
Parrot Like Nose
Psittichorhina
Seen in Crouzon syndrome
(craniofacial dysostosis)
Parrot Fever
Psittacosis
 Parrots Paralysis
Painful osteochondritis and/or periostitis may cause
pseudoparalysis (Parrot paralysis) in
congenital syphilis
PERIOSTITIS & OSTEOCHONDRITIS IN X RAY

The word PARROT is not

about the bird here….
Parrot pseudoparalysis, named after

Joseph Jules Parrot.

Pseudoparalysis is the result of a separation
epyphysis in infants with congenital
syphilis.
Parrot studied syphilis extensively in the
1800s at the Hospice de Enfants-assistes.
 Jules Parrot
Here are some clinical findings of congenital syphilis apart from pseudoparalysis that are named after him.

PARROT FURROWS OR PARROT LINES:

Rhagades heal with radial scars known as Parrot lines

FRONTAL BOSSING OF PARROT:

PARROT NODES:
Localized osteoperiostitis of the skull bones causes
the formation of rounded, bony swelling

Please note that the term ‘achondroplasia’ was first used by Jules Parrot in
1878, and in 1900, Pierre Marie described the main features in children and adults.
Parrot Sign
In Meningitis
(dilatation of pupil on pinching the skin at the back of the neck)
 Ostrich Sign
(A) Axial fat-saturated T1-
weighted magnetic resonance
angiography (MRA) of bilateral
vertebral artery
dissection (VAD) resembles
the face of an ostrich (B).

(a) The oropharynx corresponds to the plume; (b) subintimal hematoma of dissection corresponds to the ostrich’s
sclera; (c) residual arterial lumen corresponds to the ostrich’s pupil; (b and c) VAD corresponds to the ostrich’s
eyes; (d) the fourth cervical vertebral body corresponds to the upper beak (maxillary rhamphotheca); (e) the
superior articular facet and lamina correspond to the lateral interramal space; (f) the cervical spinal cord and
canal correspond to the lower beak (mandibular rhamphotheca); and (g) the spinous process corresponds to the
ostrich’s throat and neck
 Crow Fukase Syndrome
Also known as POEMS syndrome
a condition characterized
by polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy,
and skin changes
Imagine the
CROW
reading
POEMS
Crow's Feet Appearance
Angiographic appearance
of cerebellopontine angle
hemorrhage

ageing lines emanating from

the lateral canthi of eyes
seen in round atelectasis.
On CT, this is seen as linear bands
radiating from a mass into
adjacent lung tissue resembling The terminal branches of the left
the feet of a crow. (anterior) vagus nerve, which are
preserved in highly selective vagotomy
for surgical therapy of peptic ulcer
disease is termed crow’s foot
Crowe Sign
axillary freckling
in
neurofibromatosis
Crowe –Beck test:
Pressure on I.J.V. on normal side

engorgement of retinal veins

+ papilloedema seen in fundoscopy

due to lateral sinus thrombosis

on opposite side.
Albatross Reaction
A variant of Münchausen's syndrome
characterised by the sick person's persistent pursuit of the surgeon, like
the albatros follows “his” ship.
Flamingo’s Flush Sign
seen in active phase of otosclerosis(otospongiosis).
In clinical examination of the tympanic membrane,
increased vascularity of the promontory may be seen
through the tympanic membrane. This sign is known as
Flemingo's flush sign or Schwartz's sign.
Peacock Tail sign
CT/MRI finding in
Small Bowel Volvulus
Axial CT scan shows distension of the
small bowel, whirl sign of the rotated
mesentery signifying volvulus, and

“peacock tail” sign (arrow)

due to the torsion of the bowel around
the mesenteric axis
Chicken Pox
Varicella zoster(Type 3 Herpes Virus with IP=14-16 Days)

DEW DROP ON A ROSE PETAL APPEARANCE OF RASH

Embryonated
Chicken Egg
used as substrate for
vaccines
(Measles,Mumps,
Influenza A&B,
Yellow Fever)
 Chick Martin Test

For testing in vitro efficiency of a bactericidal agent,

using a standard culture of Salmonella typhi.
 Chicken Fat Clot
clot formed in vitro or postmortem
from leucocytes & plasma of sedimented blood
Plucked Chicken Appearance
Pseudoxanthoma Elasticum
 Egg Shell Calcification
Sarcoidosis,Silicosis....
Eggshell calcification
is most commonly seen in:
occupational diseases, like silicosis and coal-worker’s
pneumoconiosis as well as sarcoidosis but rarely in
postirradiated Hodgkin's disease, blastomycosis,
scleroderma, amyloid and histoplasmosis

Plain X-ray posteroanterior view

showing bilateral hilar adenopathy
with eggshell calcification in a case
of Silicosis
 "Egg Shell Crackling"
Seen in Craniotabes in rickets

Craniotabes with "egg shell crackling" feeling (soft skull bones).

The skull has small round unossified areas in the membranous part.
(also known as “ping-pong ball skull”)
 Crumpled Egg Shell
Plain radiograph may demonstrate a

crumpled egg-shell-
like calcification in the
splenic area suggestive of
Splenic hydatidosis.
Egg On String
Transposition Of Great Vessels
The heart appears globular due to an
abnormal convexity of the right atrial
border and left atrial enlargement
and therefore appears like an egg.
The superior mediastinum appears
narrow due to stress-induced thymic
atrophy and hyperinflated lungs
which give the picture of an egg
suspended by a string on a chest
radiograph, hence the name
egg-on-a-string or
egg on its side
Egg In Cup Appearance
Constrictive Pericarditis

The ball-on-tee sign, golf ball-on-tee

sign, or egg in cup appearance, refers to a
IVP finding in
renal papillary necrosis.
The sign occurs when contrast material fills central
excavations in the papilla of the interpolar region
giving a egg in cup appearance.
Egg Yolk Lesion In Macula
Best Disease(vitelliform Dystrophy)
Best disease
primarily affects the
macular and paramacular
areas. The classical lesion
resembles an
egg yolk centered on
the fovea.
Scrambled Egg Appearance
Carcinoma Pancreas
ERCP finding
Here are some findings in carcinoma pancreas
Fried Egg Appearance

Malignant plasma cells in Oligodendrocytes in HAIRY CELL LEUKEMIA on

MULTIPLE MYELOMA OLIGODENDROGLIOMA bone marrow biopsy

DYSGERMINOMA in ovary G Cells in the antrum of MYCOPLASMA PNEUMONIAE

(also seen in SEMINOMA testis) stomach & duodenum Colonies on EATON agar
 Schistosoma Eggs

S haematobium S mansoni S japonicum

Remember as : Remember as : Remember as:
S.haemaTTTTobium S.mansoniLLLLL S.japoniKKKKum
has has has
TTTTerminal spine LLLLateral spine lateral KKKKnob
Non-Bile Stained Eggs
are seen in ????
Imagine A HEN
with
NON-BILE STAINED EGGS

Ancylostoma duodenale
Hymenolepis nana
Enterobius vermicularis
Necator americanus
Rotten egg odour
Seen in

Hydrogen sulphide ,Mercaptans &

Disulfiram toxins
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