Surgery signs, triads, ETC. you should know

Question 1

ABCDEs of melanoma

Answer 1

Signs of melanoma:

Asymmetric
Border irregularities
Color variation
Diameter 0.6 cm and Dark color
Evolution (i.e., change in lesion)

Question 2

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

Answer 2

Ballance’s sign

Question 3

Columnar metaplasia of the distal

esophagus (GERD related)

Answer 3

Barrett’s esophagus

Question 4

Ecchymosis over the mastoid process in patients with basilar skull fractures

Answer 4

Battle’s sign

Question 5

1. JVD
2. Decreased or mu ed heart sounds
3. Decreased blood pressure

Answer 5

Beck’s triad

Seen in patients with cardiac tamponade

Question 6

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

Answer 6

Bergman’s triad

Seen with fat emboli syndrome

Question 7

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

Answer 7

Blumer’s shelf

Question 8

Right subscapular pain resulting from cholelithiasis

Answer 8

Boas’ sign

Question 9

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

Answer 9

Borchardt’s triad

Seen with gastric volvulus

Question 10

1. Flushing
2. Diarrhea
3. Right-sided heart failure

Answer 10

Carcinoid triad

Seen with carcinoid syndrome - Think “FDR”

Question 11

1. Fever (chills)
2. Jaundice
3. Right upper quadrant pain

Answer 11

Charcot’s triad

Seen with cholangitis

Question 12

Twitching of facial muscles upon
tapping the facial nerve in patients with
hypocalcemia

Answer 12

Chvostek’s sign

Question 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

Answer 13

Courvoisier’s law

Question 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)

Answer 14

Cullen’s sign

Question 15

In the context of possible increased ICP:

1. Hypertension
2. Bradycardia
3. Irregular respirations

Answer 15

Cushing’s triad

Question 16

Empty right lower quadrant in children

with ileocecal intussusception

Answer 16

Dance’s sign

Question 17

Used to di erentiate 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)

Answer 17

Fothergill’s sign

Question 18

Ecchymosis of inguinal ligament seen with

retroperitoneal bleeding

Answer 18

Fox’s sign

Question 19

Anal stulae course in a straight path
anteriorly and a curved path posteriorly
from midline

Answer 19

Goodsall’s rule
(Think of a dog with a
straight anterior nose and a curved
posterior tail)

Question 20

Ecchymosis or discoloration of the flank in
patients with retroperitoneal hemorrhage
as a result of dissecting blood from the
retroperitoneum

Answer 20

Grey Turner’s sign
(Think: TURNer’s =
TURN side-to-side = flank)

Question 21

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

Answer 21

Hamman’s sign/crunch

Question 22

Calf pain on forced dorsiflexion of the foot in patient with DVT

Answer 22

Homan’s sign

Question 23

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

Answer 23

Howship-Romberg sign

Question 24

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

Answer 24

Kehr’s sign

Question 25

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

Answer 25

Kelly's sign

Question 26

Metastatic tumor to the ovary (classically | from gastric cancer)

Answer 26

Krukenberg tumor

Question 27

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

Answer 27

Laplace's law

Question 28

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

Answer 28

McBurney's point

Question 29

Tenderness at McBurney's point in patients with appendicitis

Answer 29

McBurney's sign

Question 30

Meckel's diverticulum rule of 2s

Answer 30

``` »2% of the population have a Meckel’s diverticulum »2% of those are symptomatic »Occur within ~2 feet of the ileocecal valve ```

Question 31

Lower quadrant pain due to ovulation

Answer 31

Mittelschmerz

Question 32

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

Answer 32

Murphy's sign | Seen in acute cholecystitis

Question 33

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

Answer 33

Obturator sign

Question 34

Palpitations Headache Episodic diaphoresis

Answer 34

Pheochromocytoma SYMPTOMS triad (Think of the first three letters in the word pheochromocytoma—“P-H-E")

Question 35

Pheochromocytoma rule of | 10s

Answer 35

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

Question 36

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

Answer 36

Psoas sign

Question 37

Bilateral black eyes as a result of basilar | skull fracture

Answer 37

Raccoon eyes

Question 38

1. Fever 2. Jaundice 3. Right upper quadrant pain 4. Mental status changes 5. Shock/sepsis

Answer 38

Reynold's pentad (Thus, Charcot’s triad plus #4 and #5; seen in patients with suppurative cholangitis)

Question 39

Palpation of the left lower quadrant resulting in pain in the right lower quadrant

Answer 39

Rovsing's sign | Seen in appendicitis

Question 40

1. Cholelithiasis 2. Hiatal hernia 3. Diverticular disease

Answer 40

Saint's triad

Question 41

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

Answer 41

Silk glove sign

Question 42

Metastatic tumor to umbilical lymph | node(s)

Answer 42

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

Question 43

Metastatic tumor to left supraclavicular | node (classically due to gastric cancer)

Answer 43

Virchow’s node

Question 44

1. Stasis 2. Abnormal endothelium 3. Hypercoagulability

Answer 44

Virchow's triad | Risk factors for thrombosis

Question 45

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

Answer 45

Trousseau’s sign

Question 46

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

Answer 46

Valentino’s sign

Question 47

Decreased pulmonary vascular markings on | CXR in a patient with pulmonary embolus

Answer 47

Westermark's sign

Question 48

1. Hypoglycemia (

Answer 48

Whipple’s triad | Evidence for insulinoma