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Rubor
Steatorrhea
Stenosis
Sterile field
Succus
Tenesmus
Thoracotomy
Transect
Trendelenburg
Urgency
Wet-to-dry dressing
Redness; a classic sign of inflammation
Fatty stools as a result of decreased fat
absorption
Abnormal narrowing of a passage oropening
Area covered by sterile drapes or preppedin sterile fashion using antiseptics (e.g.,Betadine®)
Fluid (e.g., succus entericus is fluid fromthe bowel lumen)
Urge to defecate with ineffectualstraining
Surgical opening of the chest cavity
To divide transversely (to cut in half)
Patient posture with pelvis higher thanthe head, inclined about 45 (a.k.a.“headdownenburg”)
Sudden strong urge to urinate; often seen with a UTI
Damp gauze dressing placed on a wound and removed after the dressingdries to the wound, providingmicrodébridement
Chapter 1 / Introduction 25
What are the ABCDs of melanoma?
Signs of melanoma: A symmetricBorder irregularitiesColor variationDiameter 0.6 cm and Dark color
SURGERY SIGNS,TRIADS, ETC. YOU SHOULD KNOW
Surgery Signs, Triads and
Sydromes
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26 Section I / Overview and Background Surgical Information
Ulnarartery
Radialartery
Define the following terms:Ballance’s sign
Barrett’s esophagus
Battle’s sign
Constant dullness to percussion in theleft flank/LUQ and resonance topercussion in the right flank seen withsplenic rupture/hematoma
Columnar metaplasia of the distal
esophagus (GERD related)
Ecchymosis over the mastoid process inpatients with basilar skull fractures
Battle’ssign
What is the Allen’s test? Test for patency of ulnar artery prior toplacing a radial arterial line or perform-ing an ABG: Examiner occludes both
ulnar and radial arteries with fingersas patient makes fist; patient opensfist while examiner releases ulnarartery occlusion to assess blood flow to hand
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Chapter 1 / Introduction 27
Beck’s triad
Bergman’s triad
Blumer’s shelf
Boas’ sign
Borchardt’s triad
Carcinoid triad
Charcot’s triad
Chvostek’s sign
Courvoisier’s law
Seen in patients with cardiac tamponade:1. JVD2. Decreased or muffled heart sounds
3. Decreased blood pressure
Seen with fat emboli syndrome:1. Mental status changes2. Petechiae (often in the axilla/thorax)3. Dyspnea
Metastatic disease to the rectouterine(pouch of Douglas) or rectovesical pouchcreating a “shelf” that is palpable onrectal examination
Right subscapular pain resulting fromcholelithiasis
Seen with gastric volvulus:1. Emesis followed by retching
2. Epigastric distention3. Failure to pass an NGT
Seen with carcinoid syndrome (Think:“FDR”):
1. Flushing2. Diarrhea3. Right-sided heart failure
Seen with cholangitis:1. Fever (chills)2. Jaundice3. Right upper quadrant pain
(Pronounced “char-cohs”)
Twitching of facial muscles upon tapping the
facial nerve in patients with hypocalcemia(Think: CH vostek’s CHeek)
Enlarged nontender gallbladder seen withobstruction of the common bile duct,most commonly with pancreatic cancer Note: not seen with gallstone obstructionbecause the gallbladder is scarred
secondary to chronic cholelithiasis(Pronounced “koor-vwah-ze-ay”)
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Cullen’s sign
28 Section I / Overview and Background Surgical Information
Bluish discoloration of the periumbilicalarea due to retroperitoneal hemorrhagetracking around to the anterior abdominal
wall through fascial planes (e.g., acutehemorrhagic pancreatitis)
Umbilicus
Cushing’s triad
Dance’s sign
Fothergill’s sign
Fox’s sign
Goodsall’s rule
Signs of increased intracranial pressure:1. Hypertension2. Bradycardia3. Irregular respirations
Empty right lower quadrant in children with ileocecal intussusception
Used to differentiate an intra-abdominalmass from one in the abdominal wall; if mass is felt while there is tension on themusculature, then it is in the wall (i.e.,sitting halfway upright)
Ecchymosis of inguinal ligament seen
with retroperitoneal bleeding
Anal fistulae course in a straight pathanteriorly and a curved path posteriorly from midline (Think of a dog with astraight anterior nose and a curvedposterior tail)
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Grey Turner’s sign
Hamman’s sign/crunch
Homans’ sign
Howship-Romberg sign
Kehr’s sign
Kelly’s sign
Krukenberg tumor
Laplace’s law
Ecchymosis or discoloration of the flankin patients with retroperitonealhemorrhage as a result of dissectingblood from the retroperitoneum (Think:TURNer’s TURN side-to-side flank)
Crunching sound on auscultation of theheart resulting from emphysematousmediastinum; seen with Boerhaave’s
syndrome, pneumomediastinum, etc.
Calf pain on forced dorsiflexion of thefoot in patients with DVT
Pain along the inner aspect of the thigh;seen with an obturator hernia as theresult of nerve compression
Severe left shoulder pain in patients with splenic rupture (as a result of referred pain from diaphragmaticirritation)
Visible peristalsis of the ureter inresponse to squeezing or retraction;
used to identify the ureter duringsurgery
Metastatic tumor to the ovary (classically from gastric cancer)
Wall tension pressure radius (thus,the colon perforates preferentially at the
cecum because of the increased radiusand resultant increased wall tension)
Chapter 1 / Introduction 29
Anterior
Goodsall
Posterior
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McBurney’s point
McBurney’s sign
Meckel’s diverticulumrule of 2s
Mittelschmerz
Murphy’s sign
Obturator sign
30 Section I / Overview and Background Surgical Information
One third the distance from the anterioriliac spine to the umbilicus on a lineconnecting the two
Tenderness at McBurney’s point inpatients with appendicitis
2% of the population have a Meckel’sdiverticulum, 2% of those are symptomatic,and they occur within 2 feet of theileocecal valve
Lower quadrant pain due to ovulation
Cessation of inspiration while palpatingunder the right costal margin; thepatient cannot continue to inspiredeeply because it brings an inflamedgallbladder under pressure (seen inacute cholecystitis)
Pain upon internal rotation of the leg with the hip and knee flexed; seen inpatients with appendicitis/pelvic abscess
PheochromocytomaSYMPTOMS triad
Pheochromocytoma ruleof 10s
Think of the first three letters in the word pheochromocytoma—“P-H-E”:
PalpitationsHeadacheEpisodic diaphoresis
10% bilateral, 10% malignant, 10% inchildren, 10% extra-adrenal, 10% have
multiple tumors
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Raccoon eyes Bilateral black eyes as a result of basilarskull fracture
Reynold’s pentad
Rovsing’s sign
Saint’s triad
Silk glove sign
1. Fever2. Jaundice3. Right upper quadrant pain
4. Mental status changes5. Shock/sepsisThus, Charcot’s triad plus #4 and #5; seen
in patients with suppurative cholangitis
Palpation of the left lower quadrantresulting in pain in the right lowerquadrant; seen in appendicitis
1. Cholelithiasis2. Hiatal hernia3. Diverticular disease
Indirect hernia sac in the pediatricpatient; the sac feels like a finger of a silkglove when rolled under the examining
finger
Chapter 1 / Introduction 31
Psoas sign Pain elicited by extending the hip withthe knee in full extension, seen withappendicitis and psoas inflammation
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Sister Mary Joseph’s sign(a.k.a. Sister Mary Joseph’s node)
Virchow’s node
Virchow’s triad
Trousseau’s sign
Valentino’s sign
Westermark’s sign
Whipple’s triad
32 Section I / Overview and Background Surgical Information
Metastatic tumor to umbilical lymphnode(s)
Metastatic tumor to left supraclavicularnode (classically due to gastric cancer)
Risk factors for thrombosis:1. Stasis2. Abnormal endothelium3. Hypercoagulability
Carpal spasm after occlusion of blood tothe forearm with a BP cuff in patients with hypocalcemia
Right lower quadrant pain from aperforated peptic ulcer due to succus/ pus draining into the RLQ
Decreased pulmonary vascular markings onCXR in a patient with pulmonary embolus
Evidence for insulinoma:1. Hypoglycemia (50)2. CNS and vasomotor symptoms
(e.g., syncope, diaphoresis)3. Relief of symptoms with
administration of glucose
What is afferent loopsyndrome?
What does ARDS stand for?
Surgical
Syndromes
Chapter 2
Obstruction of the afferent loop of aBillroth II gastrojejunostomy
A cute Respiratory Distress S yndrome(poor oxygenation caused by leakycapillaries)
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What is blind loop syndrome?
What is Boerhaave’ssyndrome?
What is Budd-Chiarisyndrome?
What is carcinoid syndrome?
What is compartmentsyndrome?
What is Cushing’s syndrome?
What is dumping syndrome?
What is Fitz-Hugh-Curtissyndrome?
What is Gardner’ssyndrome?
What is HITT syndrome?
Bacterial overgrowth of intestine causedby stasis
Esophageal perforation
Thrombosis of hepatic veins
Syndrome of “B FDR”:Bronchospasm
FlushingDiarrheaRight-sided heart failure (caused by
factors released by carcinoidtumor)
Compartmental hypertension caused by edema, resulting in muscle necrosis of
the lower extremity, often seen in thecalf; patient may have a distal pulse
Excessive cortisol production
Delivery of a large amount of hyperosmolar chyme into the smallbowel, usually after vagotomy and a
gastric drainage procedure (pyloroplasty/ gastrojejunostomy); results in autonomicinstability, abdominal pain, and diarrhea
Perihepatic gonorrhea infection
GI polyps and associated findings of Sebaceous cysts, Osteomas, and Desmoidtumors (SOD); polyps have high malig-nancy potential (Think: A Gardner plants SOD)
Heparin-Induced ThrombocytopenicThrombosis syndrome: Heparin-inducedplatelet antibodies cause platelets tothrombose vessels, often resulting in loss
of limb or life
Chapter 2 / Surgical Syndromes 33
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What is Leriche’s syndrome?
What is Mallory-Weisssyndrome?
What is Mendelson’ssyndrome?
What is Mirizzi’s syndrome?
What is Munchausensyndrome?
What is Ogilvie’s syndrome?
What is Peutz-Jegherssyndrome?
What is Plummer-Vinsonsyndrome?
What is RED reactionsyndrome?
What is refeeding
syndrome?
What is Rendu-Osler-Weber (ROW) syndrome?
What is short-gut syndrome?
34 Section I / Overview and Background Surgical Information
Claudication of buttocks and thighs,Impotence, A trophy of legs (seen withiliac occlusive disease) (Think: CIA )
Post-emesis/-retching tears in the gastricmucosa (near gastroesophageal junction)
Chemical pneumonitis after aspiration of gastric contents
Extrinsic obstruction of the commonhepatic bile duct from a gallstone in thegallbladder or cystic duct
Self-induced illness
Massive nonobstructive colonicdilatation
Benign GI polyps and buccal pigmenta-tion (Think: Peutz Pigmentation)
Syndrome of:1. Esophageal web2. Iron-deficiency anemia3. Dysphagia4. Spoon-shaped nails
5. Atrophic oral and tongue mucosaTypically occurs in elderly women; 10%
develop squamous cell carcinoma
Syndrome of rapid vancomycin infusion,resulting in skin erythema
Hypokalemia, hypomagnesemia, and
hypophosphatemia after refeeding astarved patient
Syndrome of GI tract telangiectasia/A-V malformations
Malnutrition resulting from 200 cm of viable small bowel
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What is SIADH?
What is another name for Sipple’s syndrome?
What is superior vena cava(SVC) syndrome?
What is thoracic outletsyndrome?
What is Tietze’s syndrome?
What is toxic shocksyndrome?
What is Trousseau’ssyndrome?
What is another name for Wermer’s syndrome?
What is Zollinger-Ellison
syndrome?
Chapter 3 / Surgical Most Commons 35
S yndrome of Inappropriate A ntiDiureticHormone (Think: Inappropriately Increased ADH)
MEN II
Obstruction of the SVC (e.g., by tumor,thrombosis)
Compression of the structures exitingfrom the thoracic outlet
Costochondritis of rib cartilage; aseptic(treat with NSAIDs)
Staphylococcus aureus toxin-inducedsyndrome marked by fever, hypotension,organ failure, and rash (desquamation—especially palms and soles)
Syndrome of deep venous thrombosis(DVT) associated with carcinoma
MEN I
Gastrinoma and PUD
What is the most common:Indication for surgery with Crohn’s disease?
Type of melanoma?
Type of breast cancer?
Surgical MostCommons
Chapter 3
Small bowel obstruction (SBO)
Superficial spreading
Infiltrating ductal
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