Surgery Signs and Triads

Question 1

What is Allen’s test?
How is Allen’s test performed?

Answer 1

Test for patency of ulnar artery prior to placing a radial arterial line or performing an ABG
1. Examiner occludes both ulnar and radial arteries with fingers as patient makes fist
2. patient opens fist while examiner releases ulnar
artery occlusion to assess blood flow to hand
Note: 28% of pop. have complete radial
artery dominance

Question 2

Balance’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. Increased 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
1. Flushing
2. Diarrhea
3. Right-sided heart failure
Think: “FDR”

Question 7

Charcot’s triad?

Answer 7

Seen with cholangitis:
1. Fever (chills)
2. Jaundice
3. Right upper quadrant pain

Question 8

Cullen’s sign?

Answer 8

Bluish discoloration of the periumbilical area due to retroperitoneal hemorrhage tracking around to the anterior abdominal wall through fascial
planes
Condition seen in: acute hemorrhagic pancreatitis

Question 9

Cushing’s triad?

Answer 9

Signs of increased intracranial pressure:
1. Hypertension
2. Bradycardia
3. Irregular respirations

Question 10

Goodsall’s rule?

Answer 10

Anal fistulae course in a straight path anteriorly and a curved path posteriorly from midline
Note: Think of a dog with a straight anterior nose and a curved posterior tail

Question 11

Hamman’s sign/crunch?

Answer 11

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

Question 12

Howship-Romberg sign?

Answer 12

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

Question 13

McBurney’s point?

Answer 13

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

Question 14

Meckel’s diverticulum rule of 2s?

Answer 14

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

Question 15

Murphy’s sign?

Answer 15

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
Condition seen in: acute cholecystitis

Question 16

Chvostek’s sign?

Answer 16

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

Question 16

Courvoisier’s law?

Answer 16

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 17

Obturator sign?

Answer 17

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

Question 18

Pheochromocytoma SYMPTOMS triad?

Answer 18

1. Palpitations
2. Headache
3. Episodic diaphoresis (excessive sweating)
   Think of the first three letters in the word pheochromocytoma—“P-H-E”

Question 19

Psoas sign?

Answer 19

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

Question 20

Racoon 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
   Conditions 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
Condition seen in: appendicitis

Question 23

Virchow’s node?

Answer 23

Metastatic tumor to left supraclavicular node Condition classically due to: gastric cancer

Question 24

Virchow’s triad?

Answer 24

Risk factors for thrombosis:
1. Stasis
2. Abnormal endothelium
3. Hypercoagulability

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