Surgery signs, triads, etc.

Question 1

what is ballance’s sign?

Answer 1

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

Question 2

what is barrett’s esophagus?

Answer 2

columnar metaplasia of the distal esophagus (GERD related)

Question 3

what is battle’s sign? where do we see it?

Answer 3

ecchymosis over the mastoid process in patients with basilar skull fractures

Question 4

what is beck’s triad? where do we see it?

Answer 4

1) JVD
2) decreased or muffled heard sounds
3) decreased BP

seen with cardiac tamponade

Question 5

what is bergman’s triad? what do we see it with?

Answer 5

1) mental status change
2) petechiae (often in axilla/thorax)
3) dyspnea

seen with fat emboli syndrome

Question 6

what is boas’ sign seen with?

Answer 6

right subscapular pain resulting from cholelithiasis

Question 7

what is borchardt’s triad? where do we see it?

Answer 7

1) emesis followed by retching
2) epigastric distension
3) failure to pass NG tube

seen with gastric volvulus

Question 8

what is the triad seen with carcinoid syndrome?

Answer 8

carcinoid triad

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

Question 9

what are the components of charcot’s triad? where do we see it?

Answer 9

seen with cholangitis

1) fever
2) jaundice
3) RUQ pain

Question 10

what is chvostek’s sign? when do we see it?

Answer 10

twitching of the facial muscles when tapping the facial nerve in patients with hyPOcalcemia

Question 11

what is courvoisier’s law? when do we see it?

Answer 11

enlarged, non-tender gallbladder seen with obstruction of the common bile duct

most commonly with pancreatic cancer (NOT seen with gallstone obstruction)

Question 12

cullen’s sign?

Answer 12

periumbilical bruising due to retroperitoneal hemorrhage

often seen with hemorrhagic pancreatitis

Question 13

what is cushing’s triad? when do we see it?

Answer 13

1) hypertension
2) bradycardia
3) irregular respirations

signs of increased intracranial pressure

Question 14

what is dance’s sign?

Answer 14

empty RLQ in children with ileocecal intusussception

Question 15

what is fox’s sign?

Answer 15

ecchymosis of inguinal ligament seen with retroperitoneal bleeding

Question 16

what is goodsall’s rule?

Answer 16

anal fistulae course in a straight path anteriorly and a curved path posteriorly from midline

(think of dog with straight anterior nose and a curved posterior tail)

Question 17

grey turner’s sign?

Answer 17

flank ecchymosis from retroperitoneal hemorrhage

Question 18

what is hamman’s sign/crunch?

Answer 18

crunching sounds on auscultation of the heart resulting from emphysematous mediastinum

Question 19

when might we hear hamman’s sign/crunch?

Answer 19

boerhaave’s syndrome, pneumomediastinum, etc.

Question 20

what is homan’s sign? when do we see it?

Answer 20

calf pain on forced dorsiflexion of the foot in patients with DVT

Question 21

howship-romberg sign?

Answer 21

pain along inner aspect of the thigh

seen with an obturator hernia as the result of nerve compression

Question 22

kehr’s sign?

Answer 22

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

Question 23

kelly’s sign?

Answer 23

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

Question 24

what is the term for a metastatic tumor to the ovary? clasically, where does it metastasize from?

Answer 24

krunkenberg tumor

clasically from gastric cancer

Question 25

what is laplace’s law?

Answer 25

wall tension = pressure x radius

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

Question 26

where is mcburney’s point?

Answer 26

one third the distance from the anterior iliac spine to the umbilicus

Question 27

what is meckel’s diverticulum rule of 2s?

Answer 27

2 percent of the population have a meckel’s diverticulum, 2 percent are symptomatic, and they occur within 2 feet of the ileocecal valve

Question 28

what is mittelschmerz?

Answer 28

lower quadrant pain due to ovulation

Question 29

murphy’s sign?

Answer 29

cessation of inspiration when palpating under the right costal margin; patient cannot continue to inspire deeply because it brings an inflamed gallbladder under pressure

seen in acute cholecystitis