Surgery Signs/Triads

Question 1

Ballance’s sign

Answer 1

constant fullness to percussion in the left flank?LUQ and resonance to percussion in the right flank seen w/ splenic rupture/hematoma

Question 2

Battle’s sign

Answer 2

ecchymosis over mastoid process in pts w/ basilar skull fractures

Question 3

Beck’s triad

Answer 3

seen in pts w/ cardiac tamponade

1. JVD
2. Decreased/muffled heart sounds
3. decreased BP

Question 4

Blumer’s shelf

Answer 4

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

Question 5

Carcinoid triad

Answer 5

seen in carcinoid syndrome (think FDR)

1. flushing
2. diarrhea
3. right sided heart failure

Question 6

Charcot’s triad

Answer 6

seen in pt’s w/

1. fever (chills)
2. jaundice
3. RUQ pain

Question 7

Chvostek’s sign

Answer 7

twitching of facial muscles upon tapping the facial nerve in pts w/ hypocalcemia

Question 8

Courvoisier’s law

Answer 8

enlarged nontender gallbladder seen w/ obstruction of the common bile duct
most commonly w/ pancreatic cancer

Question 9

Cullen’s sign

Answer 9

bluish discoloration of the periumbilical area due to retroperitoneal hemorrhage tracking around the anterior abdominal wall through fascial planes (acute hemorrhagic pancreatitis)

Question 10

Cushing’s triad

Answer 10

signs of increased ICP

1. HTN
2. bradycardia
3. irregular respirations

Question 11

Goodsall’s rule

Answer 11

Anal fistulae course in a straight path anteriorly and a curved path posteriorly from midline (think of a dog w/ a straight anterior nose and curved posterior tail)

Question 12

Hamman’s sign/crunch

Answer 12

crunching sound on auscultation of the heart resulting from emphysematous mediastinum
seen w/ Boerhaave’s syndrome, pneumomediastinum, etc.

Question 13

Howship-Romberg sign

Answer 13

pain along the inner aspect of the thigh, seen w/ obturator hernia as the result of nerve compression

Question 14

McBurney’s point

Answer 14

1/3 the distance from the anterior iliac spine to the umbilicus on a line connecting the 2

Question 15

Meckel’s diverticulum rule of 2’s

Answer 15

2% of the population have a Meckel’s diverticulum, 2% of those are symptomatic, and they occur within ~2 ft of the ileocecal valve

Question 16

Murphy’s sign

Answer 16

cessation of inspiration while palpating under the right costal margin
the pt cannot continue to inspire deeply b/c it brings an inflamed gallbladder under pressure (seen in acute cholecystitis)

Question 17

Obturator sign

Answer 17

pain upon internal rotation of the leg w/ the hip and knee flexed
seen in pts w/ appendicitis/pelvic abscess

Question 18

Pheochromocytoma symptoms triad

Answer 18

Think of the first 3 letters in the word pheochromocytoma “P.H.E.”

1. Palpitations
2. Headache
3. Episodic diaphoresis

Question 19

Psoas sign

Answer 19

pain elicited by extending the hip w/ the knee in full extension
seen w/ appendicitis and psoas inflammation

Question 20

Raccoon eyes

Answer 20

bilateral black eyes as a result of a basilar skull fracture

Question 21

Reynold’s pentad

Answer 21

seen in pt’s w/ suppurative cholangitis

1. fever
2. jaundice
3. RUQ pain
4. mental status change
5. shock/sepsis

Question 22

Rovsing’s sign

Answer 22

palpation of the LLQ resulting in pain in the RLQ

seen in appendicitis

Question 23

Virchow’s node

Answer 23

metastatic tumor to left supraclavicular node (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 w/ a BP cuff in pts w/ hypocalcemia

Question 26

Valentino's sign

Answer 26

RLQ pain from 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 (syncope, diaphoresis) 3. Relief of symptoms w/ administration of glucose