Signs, Triads, etc to know

Question 1

What are the ABCDs of

melanoma?

Answer 1

Signs of melanoma:
Asymmetric
Border irregularities
Color variation
Diameter 0.6 cm and Dark color

Question 2

What is the Allen’s test?

Answer 2

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

Question 3

Ballance’s sign

Answer 3

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

Question 4

Barrett’s esophagus

Answer 4

Columnar metaplasia of the distal

esophagus (GERD related)

Question 5

Battle’s sign

Answer 5

Ecchymosis over the mastoid process in

patients with basilar skull fractures

Question 6

Beck’s triad

Answer 6

Seen in patients with cardiac tamponade:

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

Question 7

Bergman’s triad

Answer 7

Seen with fat emboli syndrome:

1. Mental status changes
2. Petechiae (often in the axilla/thorax)
3. Dyspnea

Question 8

Blumer’s shelf

Answer 8

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

Question 9

Boas’ sign

Answer 9

Right subscapular pain resulting from

cholelithiasis

Question 10

Borchardt’s triad

Answer 10

Seen with gastric volvulus:

1. Emesis followed by retching
2. Epigastric distention
3. Failure to pass an NGT

Question 11

Carcinoid triad

Answer 11

Seen with carcinoid syndrome (Think:
“FDR”):
1. Flushing
2. Diarrhea
3. Right-sided heart failure

Question 12

Charcot’s triad

Answer 12

Seen with cholangitis:
1. Fever (chills)
2. Jaundice
3. Right upper quadrant pain
(Pronounced “char-cohs”)

Question 13

Chvostek’s sign

Answer 13

Twitching of facial muscles upon tapping the
facial nerve in patients with hypocalcemia
(Think: CHvostek’s CHeek

Question 14

Courvoisier’s law

Answer 14

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”)

Question 15

Cullen’s sign

Answer 15

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 16

Cushing’s triad

Answer 16

Signs of increased intracranial pressure:

1. Hypertension
2. Bradycardia
3. Irregular respirations

Question 17

Dance’s sign

Answer 17

Empty right lower quadrant in children

with ileocecal intussusception

Question 18

Fothergill’s sign

Answer 18

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)

Question 19

Fox’s sign

Answer 19

Ecchymosis of inguinal ligament seen

with retroperitoneal bleeding

Question 20

Goodsall’s rule

Answer 20

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)

Question 21

Grey Turner’s sign

Answer 21

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)

Question 22

Hamman’s sign/crunch

Answer 22

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

Question 23

Homans’ sign

Answer 23

Calf pain on forced dorsiflexion of the

foot in patients with DVT

Question 24

Howship-Romberg sign

Answer 24

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

Question 25

Kehr’s sign

Answer 25

Severe left shoulder pain in patients
with splenic rupture (as a result of
referred pain from diaphragmatic
irritation)

Question 26

Kelly’s sign

Answer 26

Visible peristalsis of the ureter in
response to squeezing or retraction;
used to identify the ureter during
surgery

Question 27

Krukenberg tumor

Answer 27

Metastatic tumor to the ovary (classically

from gastric cancer)

Question 28

Laplace’s law

Answer 28

Wall tension pressure radius (thus,
the colon perforates preferentially at the
cecum because of the increased radius
and resultant increased wall tension

Question 29

McBurney’s point

Answer 29

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

Question 30

McBurney’s sign

Answer 30

Tenderness at McBurney’s point in

patients with appendicitis

Question 31

Meckel’s diverticulum

rule of 2s

Answer 31

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 32

Mittelschmerz

Answer 32

Lower quadrant pain due to ovulation

Question 33

Murphy’s sign

Answer 33

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 34

Obturator sign

Answer 34

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

Question 35

Pheochromocytoma

SYMPTOMS triad

Answer 35

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

Question 36

Pheochromocytoma rule

of 10s

Answer 36

10% bilateral, 10% malignant, 10% in
children, 10% extra-adrenal, 10% have
multiple tumors

Question 37

Psoas sign

Answer 37

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

Question 38

Raccoon eyes

Answer 38

Bilateral black eyes as a result of basilar

skull fracture

Question 39

Reynold’s pentad

Answer 39

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 40

Rovsing’s sign

Answer 40

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

Question 41

Saint’s triad

Answer 41

1. Cholelithiasis
2. Hiatal hernia
3. Diverticular disease

Question 42

Silk glove sign

Answer 42

Indirect hernia sac in the pediatric
patient; the sac feels like a finger of a silk
glove when rolled under the examining
finger

Question 43

Sister Mary Joseph’s sign
(a.k.a. Sister Mary
Joseph’s node

Answer 43

Metastatic tumor to umbilical lymph

node(s)

Question 44

Virchow’s node

Answer 44

Metastatic tumor to left supraclavicular

node (classically due to gastric cancer)

Question 45

Virchow’s triad

Answer 45

Risk factors for thrombosis:

1. Stasis
2. Abnormal endothelium
3. Hypercoagulability

Question 46

Trousseau’s sign

Answer 46

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

Question 47

Valentino’s sign

Answer 47

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

Question 48

Westermark’s sign

Answer 48

Decreased pulmonary vascular markings on

CXR in a patient with pulmonary embolus

Question 49

Whipple’s triad

Answer 49

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