Surgery Recall Signs and Triads you should 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

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

Barrett’s esophagus

Answer 3

Columnar metaplasia of the distal

esophagus (GERD related)

Question 4

Battle’s sign

Answer 4

Ecchymosis over the mastoid process in

patients with basilar skull fractures

Question 5

Beck’s triad

Answer 5

Seen in patients with cardiac tamponade:

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

Question 6

Bergman’s triad

Answer 6

Seen with fat emboli syndrome:

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

Question 7

Boas’ sign

Answer 7

Right subscapular pain resulting from

cholelithiasis

Question 8

Borchardt’s triad

Answer 8

Seen with gastric volvulus:

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

Question 9

Carcinoid triad

Answer 9

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

Question 10

Cushing’s triad

Answer 10

Signs of increased intracranial pressure:

1. Hypertension
2. Bradycardia
3. Irregular respirations

Question 11

Charcot’s triad

Answer 11

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

Question 12

Chvostek’s sign

Answer 12

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

Question 13

Courvoisier’s law

Answer 13

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 14

Cullen’s sign

Answer 14

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 15

Grey Turner’s sign

Answer 15

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 16

Hamman’s sign/crunch

Answer 16

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

Question 17

Homans’ sign

Answer 17

Calf pain on forced dorsiflexion of the

foot in patients with DVT

Question 18

Kehr’s sign

Answer 18

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

Question 19

McBurney’s point

Answer 19

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

Question 20

Meckel’s diverticulum

rule of 2s

Answer 20

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 21

Murphy’s sign

Answer 21

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 22

Obturator sign

Answer 22

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

Question 23

Pheochromocytoma SYMPTOMS triad

Answer 23

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

Question 24

Pheochromocytoma rule

of 10s

Answer 24

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

Question 25

Psoas sign

Answer 25

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

Question 26

Raccoon eyes

Answer 26

Bilateral black eyes as a result of basilar

skull fracture

Question 27

Reynold’s pentad

Answer 27

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 28

Rovsing’s sign

Answer 28

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

Question 29

Silk glove sign

Answer 29

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

Question 30

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

Answer 30

Metastatic tumor to umbilical lymph

node(s)

Question 31

Virchow’s node

Answer 31

Metastatic tumor to left supraclavicular

node (classically due to gastric cancer)

Question 32

Virchow’s triad

Answer 32

Risk factors for thrombosis:

1. Stasis
2. Abnormal endothelium
3. Hypercoagulability

Question 33

Trousseau’s sign

Answer 33

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

Question 34

Westermark’s sign

Answer 34

Decreased pulmonary vascular markings on

CXR in a patient with pulmonary embolus

Question 35

Whipple’s triad

Answer 35

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