Chapter 1: Introduction- Surgical Signs, Triads

Question 1

What is the Allen’s test?

Answer 1

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!)

Question 2

Ballance’s sign

Answer 2

Constant dullness to percussion in the left flank/LUQ and resonance to percussion in the right flank seen with splenic rupture/hematoma

Question 3

Battle’s sign

Answer 3

Ecchymosis over the mastoid process in patients with basilar skull fractures

Question 4

Beck’s triad

Answer 4

Seen in patients with cardiac tamponade:

1. JVD
2. Decreased or muffled heart sounds
3. Decreased blood pressure

Question 5

Blumer’s shelf

Answer 5

Metastatic disease to the rectouterine (pouch of Douglas) or rectovesical pouch creating a “shelf” that is palpable on rectal examination

Question 6

Carcinoid triad

Answer 6

Seen with carcinoid syndrome (Think: “FDR”):

1. Flushing
2. Diarrhea
3. Right-sided heart failure

Question 7

Charcot’s triad

Answer 7

Seen with cholangitis:

1. Fever (chills)
2. Jaundice
3. Right upper quadrant pain

Question 8

Chvostek’s sign

Answer 8

Twitching of facial muscles upon tapping the facial nerve in patients with hypocalcemia

(Think: CHvostek’s = CHeek)

Question 9

Courvoisier’s law

Answer 9

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

Question 10

Cullen’s sign

Answer 10

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)

Question 11

Cushing’s triad

Answer 11

Signs of increased intracranial pressure:

1. Hypertension
2. Bradycardia
3. Irregular respirations

Question 12

Hamman’s sign/crunch

Answer 12

Crunching sound on auscultation of the heart resulting from emphysematous mediastinum; seen with Boerhaave’s syndrome, pneumomediastinum, etc.

Question 13

Howship–Romberg sign

Answer 13

Pain along the inner aspect of the thigh; seen with an obturator hernia as the result of nerve compression

Question 14

McBurney’s point

Answer 14

One third the distance from the anterior iliac spine to the umbilicus on a line connecting the two

Question 15

Meckel’s diverticulum rule of 2s

Answer 15

2% of the population have a Meckel’s diverticulum, 2% of those are symptomatic, and they occur within ≈2 feet of the ileocecal valve

Question 16

Murphy’s sign

Answer 16

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)

Question 17

Obturator sign

Answer 17

Pain upon internal rotation of the leg with the hip and knee flexed; seen in patients with appendicitis/pelvic abscess

Question 18

Pheochromocytoma SYMPTOMS triad

Answer 18

Think of the first three letters in the word pheochromocytoma—“P-H-E”:

1. Palpitations
2. Headache
3. Episodic diaphoresis

Question 19

Psoas sign

Answer 19

Pain elicited by extending the hip with the knee in full extension, seen with appendicitis and psoas inflammation

Question 20

Raccoon eyes

Answer 20

Bilateral black eyes as a result of basilar skull fracture

Question 21

Reynolds’ pentad

Answer 21

1. Fever
2. Jaundice
3. Right upper quadrant pain
4. Mental status changes
5. Shock/sepsis

Thus, Charcot’s triad plus #4 and #5; seen in patients with suppurative cholangitis

Question 22

Rovsing’s sign

Answer 22

Palpation of the left lower quadrant resulting in pain in the right lower quadrant; seen in appendicitis

Question 23

Virchow’s node

Answer 23

Metastatic tumor to left supraclavicular node (classically due to gastric cancer)

Question 24

Virchow’s triad

Answer 24

Question 25

Trousseau’s sign

Answer 25

Carpal spasm after occlusion of blood to the forearm with a BP cuff in patients with hypocalcemia

Question 26

Valentino’s sign

Answer 26

Right lower quadrant pain from a perforated peptic ulcer due to succus/pus draining into the RLQ

Question 27

Whipple’s triad

Answer 27

Evidence for insulinoma:

1. Hypoglycemia (<50)
2. CNS and vasomotor symptoms (e.g., syncope, diaphoresis)
3. Relief of symptoms with administration of glucose