This document provides definitions and descriptions of various physical examination signs. It discusses signs related to conditions involving the abdomen, musculoskeletal system, cardiovascular system, neurological system and others. Signs include Murphy's sign, McBurney's sign, Homan's sign, Chvostek's sign, Cushing's triad and others. The document also provides details on how to elicit some of the signs and what medical conditions they may indicate.

1. Dan fordh sign
B/l shoulderpain+ ectopicrupture
Chvostek Sign
taping on the facial n causing CNVII spasm
clinical sign of existing nerve hyperexcitability (tetany) seen in HYPOCALCEMIA.
It refers to an abnormal reaction to the stimulation of the facial nerve.
Trousseau sign
sign observed in patients w/ HYPOCALCEMIA
This sign may be positive before other manifestations of hypocalcemia such as
hyperreflexia and tetany
BP cuff pumped up causes pt to have flexor carpi muscle spasms--makes hand form a
SWAN HEAD
Triad of MS
SIN
Scanning speech
intention tremor
Nystagmus
COMBANK EX:
A 32-year-old female presents to her primary care physician with complaints of involuntary
pauses and slurs in her speech, twitching eye movements, and a hand tremor that
worsens with movement. Last month she developed severe eye pain and numbness in her
left arm that resolved spontaneously. MRI shows periventricular lesions.

2. Charcots Triad
1. Fever
2. RUQ pain
3. jaundice
(Abnormal) varus stress test
LATERAL COLLATERAL LIGAMENTS
(Abnormal) valgus stress test
MEDIAL COLLATERAL LIGAMENTS
Obturator Sign
eliciting RLQ Pain with IR and ER of the FLEXED R hip
pain elicted dt ACUTE APPENDICITIS
pain occurs dt the inflamed appendix in the RIGHT hemipelvis
Psoas Sign
indicates irritation to iliopsoas group of hip flexors in the abdomen--therefore, indicates
that inflamed appendix is retrocaecal in orientation
HOW TO DO:
passively extending the thigh of pt lying on his side with knees extended

3. OR
asking pt to actively flex his thigh at the hip.
If abdominal pain results-->
"(+)psoas sign". can indicate:
1. APPENDICITIS
2. PELVIC ABSESS
The pain results because the psoas borders the peritoneal cavity, so stretching (by
hyperextension at hip) or contraction (by flexion of hip) of the muscles causes FRICTION
AGAINST nearby inflamed tissues. In particular, the right iliopsoas muscle lies UNDER
THE APPENDIX when the patient is supine...(+) PSOAS ON RIGHT-->may suggest
appendicitis.
Rovsing's Sign
palpation of the LLQ of abdomen increases the pain felt in RIGHT lower quadrant --> (+)
Rovsing's sign and may have APPENDICITIS.
In acute appendicitis, palpation in the left iliac fossa may produce pain in the right iliac
fossa.
ROVSING= ROAMING SIGN
Abdominal Pain is DISPROPORTIONATE to any physical exam findings
ACUTE MESENTERIC ISCHEMIC [AMI]
McBurney's point/Sign
point over RIGHT side of abdomen --one-third distance fromASIS to the umbilicus.
This point roughly corresponds to MC location of base of the appendix where it is attached
to the cecum
THEREFORE --> McBurney's sign, is a sign of acute appendicitis
SX of Neonatal RDS
1. nasal flaring
2. expiratory grunting
3. cyanosis of lips/mucosal membranes

4. 4. increased RR
5. intercostal retractions
Romana's Sign
unilateral painless periorbital swelling associated with the acute stage of CHAGAS
DISEASE.
occurs 1-2 weeks after infection with TRYPANOSOMA CRUZI -- transmitted by the
KISSING BUG defecating on face and causing PERIORIBTAL EDEMA.
SIGN is DT: conjunctival swelling after contamination with the vector's feces, which
contains the parasitic Trypanosoma cruzi.
After review of a radiograph, patient was diagnosed with a distal spiral humeral shaft
defect consistent with a Holstein-Lewis fracture. Which of the following is this patient
most likely at risk for?
Holstein-Lewis fracture is a fracture of the distal third of the humerus resulting in
entrapment of the radial nerve.
**RADIAL N traverses through the spiral shaft of the posterior humerus-innervates all
POSTERIOR muscles of UE as well as LAteral Brachioradialis
What nerve is implicated in supracondylar humeral fractures?
MEDIAN N
posteriolateral distal fracture fragment puts the median n and anterior interosseous branch
at greatest risk of injury
Moodley's Sign
SIGN TO CHECK JVP waveforms- This sign is used to determine which waveform you
are viewing.
Feel the radial pulse while simultaneously watching the JVP. The waveform that is seen
immediately after the arterial pulsation is felt is the 'v wave' of the JVP.

5. Blanching after fingertip P to upper thorax
(+) Superior vena cava syndrome
Facial Plethora
bodily condition characterized by an excess of blood and marked by turgescence and a
reddish complexion
Pemberton maneuver
PE method that elicits manifestations of latent increased pressure in the THORACIC
INLET by altering arm position to further narrow the aperture.
maneuver is achieved by having patient elevate both arms until they touch the sides of the
face.
(+) Pemberton's sign -marked by the presence of facial congestion and cyanosis, as well
as respiratory distress after approximately one minute
(+) Pemberton's sign is indicative of superior vena cava syndrome (SVC), commonly the
result of a mass in the mediastinum.
MC seen in goiter pts

6. Cannon "a" wave- [JVP]
an "explosive" a-wave on JVP wave
An abnormal JVP curve with an accentuated 'a' wave of sufficient intensity to cause the
earlobes to 'flap'
MOA: dt ↓ right ventricular compliance, tricuspid stenosis or an arrhythmia in which the
atrium contracts against a closed or stenosed tricuspid valve
Kussmaul's sign
[not Kussmaul's respirations]
Parodoxical JVP
paradoxical rise in jugular venous pressure (JVP) on inspiration--> (Kussmaul's sign: JVP
rises w/ inspiration, drops with expiration)
MOA: could be dt:
1. Pericardial effusion
2. Constrictive pericarditis
3. Pericardial tamponade
Ordinarily the JVP falls with inspiration due to reduced pressure in the expanding thoracic
cavity and the increased volume afforded to right ventricular expansion during diastole.
Kussmaul sign suggests impaired filling of the right ventricle due to either fluid in the
pericardial space or a poorly compliant myocardium or pericardium. This impaired filling
causes the increased blood flow to back up into the venous system, causing the jugular
vein distension (JVD) and is seen clinically in the external jugular veins becoming more
readily visible
Kussmaul breathing
deep and labored breathing pattern

7. often associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA)
but also kidney failure.
It is a form of hyperventilation, which is any breathing pattern that reduces carbon dioxide
in the blood due to increased rate or depth of respiration.
In metabolic acidosis, breathing is first rapid and shallow but as acidosis worsens,
breathing gradually becomes deep, labored and gasping. It is this latter type of breathing
pattern that is referred to as Kussmaul breathing.
What acid base disorder promotes "rapid shallow breathing" in its early stages?
METABOLIC ACIDOSIS:
metabolic acidosis soon produces hyperventilation, but at first it will tend to be rapid and
relatively shallow.
want to increase RR in order to BLOW OFF more CO2 to reduce acidosis
Kussmaul breathing develops as the acidosis grows more severe. Indeed, Kussmaul
originally identified this type of breathing as a sign of coma and imminent death in diabetic
patients.
Café-au-lait (CAL) spot
Café-au-lait (CAL) spot.
Round or oval patches of light brown pigmentation
common in children
usually are up to a few centimeters in diameter, in contrast to this larger CAL spot of the
face.
Although a rare disorder, segmental distribution of CAL spot should alert one to consider
the possibility of McCune-Albright syndrome.
A 58-year-old male with a history of alcohol abuse presents to the office complaining of
peripheral edema and diffuse swelling of his abdomen. Physical examination reveals
jaundice, ascites, 3+ pitting edema, and a coarse hand tremor.
What PE sign is the indicative feature of the suspected DX?
[Which of the following serum calcium values would most likely be present in this
patient?]
LIVER FLAP!!!
*build up of toxic metabolites [increased NH3] lt ASTERIXIS--hand tremor*

8. This pt w/ HX alcholism ml suuffering from CIRROHSIS:
SIGNS/SX:
1. decreased protein prod [albumin; carrier proteins] --> ASCITES; EDEMA
2. incr pressure in portal system [PORTAL VENOUS ANASTOMOSIS-- esophageal
varices; rectal hemmorrhoids; caput medusa [gastric v];
3. build up of TOXIC metabolites [no metabolism in liver --> lt accumulation of AMMONIA -
-> LIVER FLAP]
TOTAL AMT OF CALCIUM IS DEPENDANT ON [ALBUMIN]:
**MANIFESTION RESULTING FROM CIRRHOSIS: DECREASED TOTAL CA+2:
MOD: HYPOcalcemia
1. albumin is mainly responsible for carrying Ca+2 in it's inactive form; w/o liver producing
albumin, Ca+2 is in ACTIVE form w/in the serum
2. PTH secreted in response to UNBOUND FREE IONIZED Ca+2--ionized levels would
still be normal because PTH works independantly of albumin
3. TOTAL Ca+2 would be affected, dt unionized form unable to bind albumin.
THUS: HYPOALBUMINEMIA: causes HYPOcalcemia with a Decreased TOTAL Ca+2,
normal IONIZED Ca+. There will NOT be SX a/w abnormally low Ca+2 levels [tetany,
paresthesias, abdominal cramping] dt the still present ionized Ca+2 levels.
Syndrome a/w Cluster H/A
Cluster H/A characterized by:
1. watery eyes
2. nasal congestion
3. periorbital pain
4. Horner's Syndrome
SX: brief and recurrent
MEN> Females
HORNER'S SYNDROME:
1. P: Ptosis [eyelid drooping]
2. A: Anhydrosis [ aka: hypohidrosis, sudomotor dysfunction or sweating dysfunction, is an
abnormal lack of sweat in response to heat ]
3. M: Miosis [pupillary constriction]
ALCOHOL is common trigger
TX:
1. Sumatriptan
2. removal of triggers

9. Gower's Sign
(+) Gowers' sign: indicates weakness of the proximal muscles, namely those of the lower
limb. The sign describes a patient that has to use their hands and arms to "walk" up their
own body from a squatting position due to lack of hip and thigh muscle strength.
reflects more severe impairment of lower extremities muscles.
EX: The child helps himself to get up with upper extremities: first by rising to stand on his
arms and knees, and then "walking" his hands up his legs to stand upright.
Whipple Triad
Whipple's triad =collection of 3 criteria suggest a patient's Sxs result from HYPOglycemia
which may indicate INSULINOMA of pancreas.
The triad= essential conditions are:
1. Sx HYPOglycemia [lethargy, syncope, diplopia]: SXs known or likely to be caused by
hypoglycemia [especially after fasting or heavy exercise]
2. LOW plasma glucose [measured at time of SXs]
3. Relief of SXs when glucose is raised to normal

10. Froment's sign
patient is asked to hold a piece of paper between their thumb and index finger
ADDUCTOR POLLICIS M test -- acts in adduction and opposition of the thumb
*special test of wrist; tests for palsy of the ulnar nerve, specifically, the action of adductor
pollicis
Bottom of Form
ABCDs of melanoma
Asymmetric, Border irregularities, color variation, diamtere >0.6 cm,
Evolution (growing or changing)
Allen's Test
Test for patency of ulnar artery prior to ABG or arterial line - hold
both radial and ulnar artery and pt makes a fist --> release ulnar
artery and fist = see how the hand responds

11. Ballance's sign
Constant dullness to percussion in the left flank/LUQ and
resonance to percussion in right flank seen with splenic
rupture/hematoma
Barrett's esophagus
Columnar metaplasia of the distal esophagus (GERD related)
Battle's sign
Ecchymosis over the mastoid process in pts with basilar skull
fractures
Beck's Triad
Cardiac tamponade = JVD, Decreased or muffled heart sounds,
decreased blood pressure
Bergman's triad
Fat emboli syndrome = Mental status changes, petchiae
(axillae/thorax) and dyspnea
Blumer's shelf
Metastatic disease to rectouterine pouch (douglas) or rectovesical
pouch - creating a "shelf" that is palpable on rectal exam
Boas sign

12. Right subscapular pain resulting from cholethiasis
Borchardt's triad
Gastric volvulus = emesis followed by retching, epigastric
distention, failure to pass an NGT
Carcinoid triad
FDR = Flushing, Diarrhea, Right-sided heart failure
Charcot's triad
Cholangitis = Fever (chills), jaundice, RUQ pain
Chvostek's sign
Twitching of facial muscles upon tapping the facial nerve in pts with
hypocalcemia (Chvostek and Cheek)
Courvoisier's law
Enlarged nontender GB seen with obstruction of CBD - most
commonly pancreatic CA (not from gallstone in CBD as you will see
GB scarring)
Cullen's sign
Bluish discoloration of the periumbilical are due to retroperitoneal
hemorrhage tracking around to the anterior abdomen wall through
fascial planes ( eg acute hemorrhagic pancreatitis)

13. Cushing's Triad
Elevated ICP = Hypertension, Bradycardia, Irregular respirations
Dance's sign
Empty RLQ in kids with ileocecal intussusception
Fothergill's sign
Used to differentiate an intra-ab mass from one in the ab wall - if
the mass is felt when there is tension on the musculature = in the
wall
Fox's sign
Ecchymosis of inguinal ligament seen with retroperitoneal bleeding
Goodsall's rule
Anal fistulae course is straight anteriorly and curved posteriorly
(from midline) Dog with curved tail*
Grey Turner's sign
Ecchymosis or discoloration of the flank in pts with retroperitoneal
hemorrhage - as result of dissecting blood from the retroperitoneum
Hamman's sign/crunch

14. Crunching sound on auscultation of the heart resulting from
emphysematous mediastinum; seen with boerhaave's syndrome,
pneumomediastinum etc
Homan's sign
Calf pain on forced dorsiflexion of the foot in pts with DVT
Howship-Romberg sign
Pain along the inner aspect of the thigh seen with an obturator
hernia as result of nerve compression
Kehr's sign
Severe left shoulder pain in pts with splenic rupture (as result of
referred pain from diaphragmatic irritation)
Kelly's sign
Visible perstalsis of the ureter in response to squeezing or
retraction = used to identify ureter during surgery
Krukenberg tumor
Mets to ovary (from gastric CA)
Laplace's law
Wall tension = pressure X radius -- thus colon perforates at the
cecum due to its increased radius

15. McBurney's Point
One third the distance from the anterior iliac spine to the umbilicus
on a line connecting the two
McBurney's sign
Tenderness at McBurney's point in pts with appendicitis
Meckel's diverticulum rule of 2s
2% of population, 2% are symptomatic, approx 2 feet from
illeocecal valve
Mittelschmerz
Lower quadrant pain with ovulation
Obturator sign
Pain upon internal rotation of the leg with the hip and knee flexed;
seen in patients with appendicitis/ pelvic abscess
Murphy's sign
Cessation of inspiration while palpating under the right costal
margin - pt can't continue to inspire deeply because it brings an
inflammed GB under pressure = acute cholecystitis
Pheochromocytoma symptoms triad
PHE = Palpitations, Headache, Episodic diaphoresis

16. Pheochromocytoma rule of 10s
10% bilateral, 10% malignant, 10% in kids, 10% extra adrenal, 10%
have multiple tumors
Psoas sign
Pain elicited by extending the hip with the knee in full extension =
appendicitis and psoas inflammation
Raccoon eyes
Bilateral black eyes as a result of basilar skull fracture
Reynold's pentad
Fever, jaundice, RUQ pain, Mental status changes,
shock/sepsis/hypotension - ascending cholangitis (suppurative)
Rovsing's sign
Palpation of the LLQ resulting in pain in the RLQ = appendicitis
Saint's Triad
Cholelithiasis, HIatal hernia, Diverticular disease (opposite of
ocam's razor)
Silk Glove Sign

17. Indirect hernia sac in the pediatric pt - feels like a finger of a silk
glove when rolled under the examining finger
Sister Mary Joseph sign
Metastatic tumor to umbilical lymph node(s) - aka sister mary
joseph node
Virchow's triad
RF for thrombosis = Stasis, abnormal endothelium ,
hypercoagulability
Trousseaus Sign
Carpal spasm after occlusion of blood to the forearm with a bp cuff
in pts with hypocalcemia
Valentino's sign
RLQ pain from a perforated peptic ulcer due to succus/pus draining
into the RLQ
Westermark's sign
Decreased pulmonary vascular markings on CXR in a pt with
pulmonary embolus
Whipple's triad
Evidence for insulinoma = hypoglycemia <50, CNS and vasomotor
symptoms (syncope, diaphoresis), Relief of symptoms with
administration of glucose

18. Allen's test
Check patency of ulnar artery prior to placing radial artery line or
ABG
Ballance's sign
Dullness to percussion in the left flank/LLQ and resonance to
percussion in the right flank
Seen with splenic rupture/hematoma
Battle's sign
Ecchymosis over the mastoid process in patients w/ basilar skull
fractures
Beck's triad
Seen w/ cardiac tamponade:
1) JVD
2) Muffled heart sounds
3) Hypotension
Bergman's triad
See w/ fat emboli syndrome:
1) Mental status changes
2) Petechiae
3) Dyspnea

19. Blumer's shelf
Metastatic disease to the rectouterine pouch of Douglas or
retrovesical pouch - creatining a 'shelf' that is palpable on rectal
exam
Boas' sign
R subscapular pain resulting from cholelithiasis (11th
and 12th
rib )
Borchardt's triad
Seen w/ gastric volvulus:
1) Emesis followed by no emesis
2) Epigastric distention
3) Inability to pass NG tube
Carcinoid triad
1) Flushing
2) Diarrhea
3) Right-sided heart failure
Charcot's triad
Seen w/ cholangitis:
1) Fever and chills
2) Jaundice
3) RUQ pain
Chvostek's sign

20. Twitching of facial muscles upon tapping the facial nerve in pts with
hypocalcemia
Courvoisier's law
An enlarged nontender gallbladder seen with obstruction of the
common bile duct, most commonly with w/ pancreatic cancer
Note: not seen w/ acute cholecystitis b/c gallbladder is scarred 2/2
chronic cholelithiasis
Cullen's sign
Bluish discoloration of the periumbilical area 2/2 retroperitoneal
hemorrhage tracking around the anterior abdominal wall through
fascial planes - ie: acute hemorrhagic pancreatitis
Cushing's triad
Signs of increased intracranial pressure:
1) Hypertension
2) Bradycardia
3) Irregular respirations
Dance's sign
Empty RLQ in children w/ ileocecal intussusception
Fothergill's sign
Used to differentiate an intra-abdominal mass from one in the
abdominal wall
If mass is felt while flexing abdominal musculature, the mass is in
the wall

21. Fox's sign
Ecchymosis of inguinal ligament seen with retroperitoneal bleeding
Goodsall's rule
Anal fistula course in a straight path anteriorly and in curved path
posteriorly
Grey Turner's sign
Ecchymosis or discoloration of the flank in pts w/ retroperitoneal
hemorrhage
Hamman's crunch
Crunching sound on auscultation resulting from emphysematous
mediastinum
Seen with Bowerhaave's syndrome, pneumomediastinum,
pericarditis...
Homan's sign
Calf pain on forced dorsiflexion of the foot in pts with DVT
Howship-Romberg sign
Pain on the inner aspect of thigh; seen with obturator hernia 2/2
nerve compression
Kehr's sign

22. Severe left shoulder pain in pts with splenic rupture - 2/2 referred
pain from diaphragmatic irritation
Krunkenberg tumor
Metastatis tumor to the ovary, classically from gastric cancer
Kelly's sign
Visible peristalsis of the ureter in response to squeezing or
retraction
Used to ID ureters during surgery
Laplace's law
Wall tension = pressure x radius
Thus, the colon perforates preferentially at the cecum b/c of
increased radius and hence wall tension
McBurney's point
1/3 the distance from the ASIS to the umbilicus on a line connecting
the two
McBurney's sign
Tenderness location in pts w/ appendicitis
Meckel's diverticulum Rule of 2's
2% of population, 2% symptomatic, w/in 2 ft of ileocecal valve

23. Mittelschmerz
Lower quadrant pain due to ovulation
Murphy's sign
Cessation of inspiration while palpating under the right costal
margin
Pt cannot inspire deeply b/c it brings an inflamed gallbladder under
pressure (acute cholecystitis)
Obturator sign
Pain upon internal rotation with the hip and knee flexed
Seen in pts with appendicitis or pelvic abscess
Psoas sign
Pain elicited by extending the hip with the knee in full extension
Seen in pts with appendicitis or psoas inflammation
Pheo symptoms triad
PHE - Palpitations, Headache, Episodic diaphoresis
Pheo rule of 10s
10% bilateral, 10% malignant, 10% pediatric, 10% extra-adrenal,
10% multiple tumors
Raccoon eyes

24. Bilateral black eyes due to basilar skull fracture
Reynold's pentad
1) Fever and chills
2) Jaundice
3) RUQ pain
[Charcot's triad] +
4) Mental status changes
5) Shock or sepsis
Seen in pts with supperative cholangitis
Rovsing's sign
Palpation of the LLQ resulting in pain in the RLQ; seen in pts with
appendicitis
Saint's triad
1) Cholelithiasis
2) Hiatal hernia
3) Diverticular disease
Silk glove sign
Indirect hernia sac in the pediatric patient
Sister Mary Joseph's Node
Metastatic tumor to umbilical lymph nodes
Vichow's node

25. Metastatic tumor to the left supraclavicular node, classically due to
gastric cancer
Virchow's triad
Risk factors for thrombosis:
1) Stasis
2) Endothelial injury
3) Hypercoagulability
Trousseau's sign
Carpal spasm after occlusion of blood to the forearm (BP cuff) in
pts with hypocalcemia
Valentino's sign
RLQ pain from a perforated peptic ulcer due to succus/pus draining
into the RLQ
Westermark's sign
Decreased pulmonary vasculature markings on CXR in a pt with PE
Whipple's triad
Evidence for insulinoma:
1) Hypoglycemia <50
2) CNS and vasomotor symptoms (syncope, diaphoresis)
3) Relief of symptoms w/ administration of glucose

26. RIGGLERS TRIAD
GALL STONE ILLIUS
1. MULTIPLE AIR FLUID LEVEL
2. RADIOOPAQUESHADOW
3. AIRIN GALL BLADDER
BAURET SYNDROME
GASTRICOUTLET SYNDROME –STONE IN DEUODENUM
MIRRZI SYNDROME
GB STONECOMPRESSINGCBD OBSTRUCTION
BLOOMBERG SIGN
REBOUND TENDERNESS—(PERITONITIS)

27. DUNPHY SIGN
PAIN ON COUGH ------(PERITONITIS)
RIGGLER SIGN
AIRINSIDE ANDOUTSIDE BOWEL …………..PERFORATION
CUPOLAS SIGN
AIRUNDER CEMTRAL TENDON OF DIAPHRAM…………..PERFORATION
FOOT BALL SIGN
LARGE PNEUMOPERITONEUM…………..PERFORATION

28. DOGE CAPE SIGN
AIRIN MORRISONSPOUCH …………..PERFORATION
CHILAIDITY SYNDROME
PSEUDOPNEUMOPERITONIUM…………LOOP OF BOWEL BTN LIVER ANDDIAPHRAM
Valentino's sign
RLQ pain from a perforated peptic ulcer due to succus / pus
draining into the RLQ
RENAL WEIL SIGN
AIRAROUND RIGHT KIDNEY ----PERFORATION
CARNEY TRIAD
GIST
PARAGANGLIONOMA
PULM CHONDROMA