Signs, Triads, etc to know Flashcards
What are the ABCDs of
melanoma?
Signs 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 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
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”): 1. Flushing 2. Diarrhea 3. Right-sided heart failure
Charcot’s triad
Seen with cholangitis: 1. Fever (chills) 2. Jaundice 3. Right upper quadrant pain (Pronounced “char-cohs”)
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 (Pronounced “koor-vwah-ze-ay”)
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.
Homans’ 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 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
Raccoon 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
(a.k.a. Sister Mary
Joseph’s node
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
