Signs, triads, etc. Flashcards
What are the ABC’s of melanoma?
Asymmetric
Border irregularities
Color variation
Diameter >0.6 cm and Dark color
What is the Allen’s test?
Test for patency of ulnar artery prior to placing a radial arterial line or perform- ing 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
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
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
Barrett’s Esophagus
Columnar metaplasia of the distal esophagus (GERD related)
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
Bergman’s Triad
Seen with fat emboli syndrome:
- Mental status changes
- Petechiae (often in the axilla/thorax)
- Dyspnea
Blumer’s Shelf
Metastatic disease to the rectouterine (pouch of Douglas) or rectovesical pouch creating a “shelf” that is palpable on rectal examination
Boas’ Sign
Right subscapular pain resulting from cholelithiasis
Borchardt’s Triad
Seen with gastric volvulus:
- Emesis followed by retching
- Epigastric distention
- Failure to pass an NGT
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
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
Barrett’s esophagus
Columnar metaplasia of the distal esophagus (GERD related)
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
Bergman’s triad
Seen with fat emboli syndrome:
- Mental status changes
- Petechiae (often in the axilla/thorax)
- Dyspnea
Blumer’s shelf
Metastatic disease to the rectouterine (pouch of Douglas) or rectovesical pouch creating a “shelf” that is palpable on rectal examination
Boas’ sign
Right subscapular pain resulting from cholelithiasis
Borchardt’s triad
Seen with gastric volvulus:
- Emesis followed by retching
- Epigastric distention
- Failure to pass an NGT
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
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
Dance’s sign
Empty right lower quadrant in children with ileocecal intussusception
Fothergill’s sign
Used to differentiate an intra-abdominal mass from one in the abdominal wall; if mass is felt while there is tension on the musculature, then it is in the wall (i.e., sitting halfway upright)
Fox’s sign
Ecchymosis of inguinal ligament seen with retroperitoneal bleeding
Goodsall’s rule
Anal fistulae course in a straight path anteriorly and a curved path posteriorly from midline (Think of a dog with a straight anterior nose and a curved posterior tail)
Grey Turner’s sign
Ecchymosis or discoloration of the flank in patients with retroperitoneal hemorrhage as a result of dissecting blood from the retroperitoneum (Think: TURNer’s = TURN side-to-side = flank)
Hamman’s sign/crunch
Crunching sound on auscultation of the heart resulting from emphysematous mediastinum; seen with Boerhaave’s syndrome, pneumomediastinum, etc.
Homan’s sign
Calf pain on forced dorsiflexion of the foot in patients with DVT
Howship-Romberg sign
Pain along the inner aspect of the thigh; seen with an obturator hernia as the result of nerve compression
Kehr’s sign
Severe left shoulder pain in patients with splenic rupture (as a result of referred pain from diaphragmatic irritation)
Kelly’s sign
Visible peristalsis of the ureter in response to squeezing or retraction; used to identify the ureter during surgery
Krukenberg tumor
Metastatic tumor to the ovary (classically from gastric cancer)
Laplace’s law
Wall tension = pressure x radius (thus, the colon perforates preferentially at the cecum because of the increased radius and resultant increased wall tension)
McBurney’s point
One third the distance from the anterior iliac spine to the umbilicus on a line connecting the two
McBurney’s sign
Tenderness at McBurney’s point in patients with appendicitis
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
Mittelschmerz
Lower quadrant pain due to ovulation
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
Pheochromocytoma rule of 10s
10% bilateral, 10% malignant, 10% in children, 10% extra-adrenal, 10% have multiple tumors
Psoas sign
Pain elicited by extending the hip with the knee in full extension, seen with appendicitis and psoas inflammation
Racoon eyes
Bilateral black eyes as a result of basilar skull fracture
Reynold’s 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
Saint’s triad
- Cholelithiasis
- Hiatal hernia
- Diverticular disease
Silk glove sign
Indirect hernia sac in the pediatric patient; the sac feels like a finger of a silk glove when rolled under the examining finger
Sister Mary Joseph’s sign
Metastatic tumor to umbilical lymph node(s)
Virchow’s node
Metastatic tumor to left supraclavicular node (classically due to gastric cancer)
Virchow’s triad
Risk factors for thrombosis:
- Stasis
- Abnormal endothelium
- Hypercoagulability
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
Westermark’s sign
Decreased pulmonary vascular markings on CXR in a patient with pulmonary embolus
Whipple’s triad
Evidence for insulinoma: 1. Hypoglycemia (50) 2. CNS and vasomotor symptoms (e.g., syncope, diaphoresis) 3. Relief of symptoms with administration of glucose
