Chapter 1: Introduction- Surgical Signs, Triads Flashcards
What is the Allen’s test?
Test for patency of ulnar artery prior to placing a radial arterial line or performing an ABG: Examiner occludes both ulnar and radial arteries with fingers as patient makes fist; patient opens fist while examiner releases ulnar artery occlusion to assess blood flow to hand (28% of pop. have complete radial artery dominance!)
Ballance’s sign
Constant dullness to percussion in the left flank/LUQ and resonance to percussion in the right flank seen with splenic rupture/hematoma
Battle’s sign
Ecchymosis over the mastoid process in patients with basilar skull fractures
Beck’s triad
Seen in patients with cardiac tamponade:
- JVD
- Decreased or muffled heart sounds
- Decreased blood pressure
Blumer’s shelf
Metastatic disease to the rectouterine (pouch of Douglas) or rectovesical pouch creating a “shelf” that is palpable on rectal examination
Carcinoid triad
Seen with carcinoid syndrome (Think: “FDR”):
- Flushing
- Diarrhea
- Right-sided heart failure
Charcot’s triad
Seen with cholangitis:
- Fever (chills)
- Jaundice
- Right upper quadrant pain
Chvostek’s sign
Twitching of facial muscles upon tapping the facial nerve in patients with hypocalcemia
(Think: CHvostek’s = CHeek)
Courvoisier’s law
Enlarged nontender gallbladder seen with obstruction of the common bile duct, most commonly with pancreatic cancer
Note: Not seen with gallstone obstruction because the gallbladder is scarred secondary to chronic cholelithiasis
Cullen’s sign
Bluish discoloration of the periumbilical area due to retroperitoneal hemorrhage tracking around to the anterior abdominal wall through fascial planes (e.g., acute hemorrhagic pancreatitis)
Cushing’s triad
Signs of increased intracranial pressure:
- Hypertension
- Bradycardia
- Irregular respirations
Hamman’s sign/crunch
Crunching sound on auscultation of the heart resulting from emphysematous mediastinum; seen with Boerhaave’s syndrome, pneumomediastinum, etc.
Howship–Romberg sign
Pain along the inner aspect of the thigh; seen with an obturator hernia as the result of nerve compression
McBurney’s point
One third the distance from the anterior iliac spine to the umbilicus on a line connecting the two
Meckel’s diverticulum rule of 2s
2% of the population have a Meckel’s diverticulum, 2% of those are symptomatic, and they occur within ≈2 feet of the ileocecal valve
Murphy’s sign
Cessation of inspiration while palpating under the right costal margin; the patient cannot continue to inspire deeply because it brings an inflamed gallbladder under pressure (seen in acute cholecystitis)
Obturator sign
Pain upon internal rotation of the leg with the hip and knee flexed; seen in patients with appendicitis/pelvic abscess
Pheochromocytoma SYMPTOMS triad
Think of the first three letters in the word pheochromocytoma—“P-H-E”:
- Palpitations
- Headache
- Episodic diaphoresis
Psoas sign
Pain elicited by extending the hip with the knee in full extension, seen with appendicitis and psoas inflammation
Raccoon eyes
Bilateral black eyes as a result of basilar skull fracture
Reynolds’ pentad
- Fever
- Jaundice
- Right upper quadrant pain
- Mental status changes
- Shock/sepsis
Thus, Charcot’s triad plus #4 and #5; seen in patients with suppurative cholangitis
Rovsing’s sign
Palpation of the left lower quadrant resulting in pain in the right lower quadrant; seen in appendicitis
Virchow’s node
Metastatic tumor to left supraclavicular node (classically due to gastric cancer)
Virchow’s triad
Trousseau’s sign
Carpal spasm after occlusion of blood to the forearm with a BP cuff in patients with hypocalcemia
Valentino’s sign
Right lower quadrant pain from a perforated peptic ulcer due to succus/pus draining into the RLQ
Whipple’s triad
Evidence for insulinoma:
- Hypoglycemia (<50)
- CNS and vasomotor symptoms (e.g., syncope, diaphoresis)
- Relief of symptoms with administration of glucose
