100 BUZZ WORDS FOR STEP 2 CK

BUZZ WORDS These secrets are 100 of the top board alerts. They summarize the concepts, principles, and most salient details that you should review before you take the Step 2 exam. Understanding of these Top Secrets will serve you well in your final review- 1. Smoking is the number-one cause of preventable morbidity and mortality in the U.S.(e.g., atherosclerosis, cancer, chronic obstructive pulmonary disease). 2. Alcohol is number-two cause of preventable morbidity and mortality in the U.S. More than half of accidental and intentional (e.g., murder) deaths involve alcohol. Alcohol is the number-one cause of preventable mental retardation (fetal alcohol syndrome); it also causes cancer and cirrhosis and is potentially fatal in withdrawal. 3. In alcoholic hepatitis the classic ratio of aspartate aminotransferase (AST) to alanine aminotransferase (ALT) is > 2:1, although both may be elevated. 4. Vitamins: Give folate to reproductive-age women to prevent neural tube defects. Watch for pernicious anemia, and treat with vitamin B 12 to prevent permanent neuro-logic deficits. Isoniazid causes pyridoxine (vitamin B6) deficiency. Watch for Wernicke enecephalopathy in alcoholics, and treat with thiamine to prevent Korsakoff dementia. 5. Minerals: Iron-deficiency anemia is most common cause of anemia. Think of men- strual loss in reproductive-age women and of cancer in men and older women if no other cause is obvious. 6. Vitamin A is a known teratogen. Counsel and treat reproductive-age women appro- priately (e.g., take care in treating acne with the vitamin A analog isotretinoin). 7. Complications of atherosclerosis (e.g., myocardial infarction, heart failure, stroke, gangrene) are involved in roughly one-half of deaths in the U.S. The primary risk fac- tors for atherosclerosis are age/sex, family history, cigarette smoking, hypertension, diabetes mellitus, high LDL cholesterol, and low HDL cholesterol. 8. Diabetes leads to atherosclerosis and its complications, retinopathy (a leading cause of blindness), nephropathy (a leading cause of end-stage renal failure), peripheral vascu-lar disease (a leading cause of limb amputation), peripheral neuropathy (sensory and autonomic), and an increased incidence of infections. 9. Although hypertension is most often mild or moderate and clinically silent, severe hyper-tension can lead to acute problems (known as a hypertensive emergency): headaches, dizziness, blurry vision, papilledema, cerebral edema, altered mental status, seizures, intracerebral hemorrhage (classically in the basal ganglia), renal failure/azotemia, angina, myocardial infarction, and/or heart failure. 10. In milder cases, lifestyle modifications (e.g., diet, exercise, weight loss, cessation of alcohol/tobacco use, elevation of head of bed) may be able to "cure" the following disorders without the use of medications: hypertension, hyperlipidemia, diabetes, gastroesophageal reflux disease (GERD), insomnia, obesity, and sleep apnea. 11. Arterial blood gas analysis: In general, pH tells you the primary event (acidosis vs. alka- losis), whereas carbon dioxide and bicarbonate values give you the cause (same direction as pH) and suggest any compensation present (opposite of pH). 12. Exogenous causes of hyponatremia to keep in mind: oxytocin, surgery, narcotics, inap- propriate IV fluid administration, diuretics, and antiepileptic medications. 13. EKG findings in electrolyte disturbances: tall, tented T waves in hyperkalemia; loss of T waves/T-wave flattening and U waves in hypokalemia; QT prolongation in hypocal- cemia; QT shortening in hypercalcemia. 14. Shock: First give the patient oxygen, start an IV line, and set up monitoring (pulse oxime- try, EKG, frequent vital signs). Then give a fluid bolus (1 L normal saline or Ringer's lac- tate) if no signs of congestive heart failure (e.g., bibasilar rales) are present while you try to figure out the cause if it is not known. 15. Virchow's triad of deep venous thrombosis: endothelial damage (e.g., surgery, trauma), venous stasis (e.g., immobilization, surgery, severe heart failure), and hypercoagulable state (e.g., malignancy, birth control pills, pregnancy, lupus anticoagulant, inherited deficiencies). 16. Therapy for congestive heart failure: diuretics (e.g., furosemide and ACE inhibitors) and beta blockers (for stable patients) are the mainstays of pharmacologic treatment. Be sure to screen for and address underlying atherosclerosis risk factors (e.g., smoking, hyperlipidemia). 17. Cor pulmonale: right-sided heart enlargement, hypertrophy, or failure due to primary lung disease (usually chronic obstructive pulmonary disease). The most common cause of right heart failure, however, is left heart failure (not cor pulmonale). 18. In patients with atrial fibrillation, the main issues are ventricular rate (if needed, slow the rate with medications) and atrial clot formation/embolic disease (consider anticoagulation). 19. Ventricular fibrillation requires immediate defibrillation; ventricular tachycardia is treated with amiodarone or lidocaine unless the patient is unstable (then defibrillate). 20. Obstructive vs. restrictive lung disease: the FEV,/FEV ratio is the most important parameter on pulmonary function testing to distinguish the two (FEV, may be the same). 21. The most common cause of esophageal cancer: reflux disease -* Barrett metaplasia -*• adenocarcinoma. Smoking and alcohol abuse are the second most common causes (squamous cell carcinoma). 22. All gastric ulcers must be biopsied or followed to resolution to exclude malignancy. 23. Testing a nasogastric tube aspirate for blood is the best initial test to distinguish an upper from a lower GI bleed, although bright red blood via mouth or anus is a fairly reliable sign of a nearby bleeding source. 24. Irritable bowel syndrome is one of the most common causes of GI complaints. Phys- ical exam and basic tests are by definition negative; this is a diagnosis of exclusion. The classic patient is a young female adult with a chronic history of alternating con- stipation and diarrhea. 25. Crohn disease vs. ulcerative colitis CROHN'S DISEASE ULCERATIVE COLITIS Place of origin Distal ileum, proximal colon Rectum Thickness of pathology Transmural Mucosa/submucosa only Progression Irregular (skip-lesions) Proximal, continuous from rectum; no skipped areas Location From mouth to anus Involves only colon, rarely extends to ileum Bowel habit changes Obstruction, abdominal pain Bloody diarrhea Classic lesions Fistulas/abscesses, cobblestoning,Pseudopolyps, lead-pipe colon on string sign on barium x-ray barium x-ray, toxic megacolon Colon cancer risk Slightly increased Markedly increased Surgery No (may make worse) Yes (proctocolectomy with ileoanal anastomosis) 26. All forms of viral hepatitis can present similarly in the acute stage; serology testing and history are needed to distinguish them. Hepatitis B, C, and D are transmitted par- enterally and can lead to chronic infection, cirrhosis, and hepatocellular carcinoma. 27. Hereditary hemochromatosis is currently the most common known genetic disease in white people. The initial symptoms (fatigue, impotence) are nonspecific, but patients often have hepatomegaly. Screen with transferrin saturation test (serum iron/total iron binding capacity) and ferritin level. Treat with phlebotomy after confirming the diagnosis with genetic testing and liver biopsy. 28. Sequelae of liver failure: coagulopathy (that cannot be fixed with vitamin K), jaundice/ hyperbilirubinemia, hypoalbuminemia, ascites, portal hypertension, hyperammone- mia/encephalopathy, hypoglycemia, and disseminated intravascular coagulation. 29. Pancreatitis is usually due to alcohol or gallstones. Patients present with abdominal pain, nausea/vomiting, and elevated amylase and lipase. Treat supportively, and avoid mor- phine (which causes sphincter of Oddi spasm) for pain control. Complications include pseudocyst formation, infection/abscess, and adult respiratory distress syndrome. 30. Jaundice/hyperbilirubinemia in neonates is usually physiologic (only monitoring and follow-up lab tests are needed), but jaundice present at birth is always pathologic. 31. Primary vs. secondary endocrine disturbances. In primary disorders (e.g., Graves, Hashimoto, or Addison disease), the gland malfunctions, but the pituitary or another gland and the central nervous system respond appropriately (e.g., TSH, TRH, or ACTH elevate or depress as expected in the setting of a malfunctioning gland). In secondary disorders (e.g., ACTH-secreting lung carcinoma, heart failure-induced hyperreninemia, renal fail- ure-induced hyperparathyroidism), the gland itself is doing what it is told to do by other controlling forces (e.g., pituitary gland, hypothalamus, tumor, disease); they are the prob- lem, not the gland itself. 32. Corticosteroid side effects: weight gain, easy bruising, acne, hirsutism, emotional lability, depression, psychosis, menstrual changes, sexual dysfunction, insomnia, memory loss, buffalo hump, truncal and central obesity with wasting of extremities, round plethoric facies, purplish skin striae, weakness (especially of the proximal mus- cles), hypertension, peripheral edema, poor wound healing, glucose intolerance or dia- betes, osteoporosis, and hypokalemic metabolic alkalosis (due to mineralocorticoid effects of certain corticosteroids). Growth can also be stunted in children. 33. Osteoarthritis is by far the most common cause of arthritis (> 15% of cases) and usu- ally does not have hot, swollen joints or significant findings if arthrocentesis is per- formed. 34. Cancer incidence and mortality in the U.S. OVERALL HIGHEST INCIDENCE OVERALL HIGHEST MORTALITY RATE Male Female Male Female 1. Prostate 1. Breast 1. Lung 1. Lung 2. Lung 2. Lung 2. Prostate 2. Breast 3. Colon 3. Colon 3. Colon 3. Colon 35. Sequelae of lung cancer: hemoptysis, Horner syndrome, superior vena cava syn- drome, phrenic nerve involvement/diaphragmatic paralysis, haorseness from recurrent laryngeal nerve involvement, and paraneoplastic syndromes (Gushing, SIADH, hyper- calcemia, Eaton-Lambert syndrome). 36. Bitemporal hemianopsia (loss of peripheral vision in both eyes) is due to a space- occupying lesion pushing on the opic chaism (classically a pituitary tumor) until proven otherwise. Order a CT or MRI of the brain. 37. Potential risks and side effects of estrogen therapy (e.g., contraception, post- menopausal hormone replacement): endometrial (and possibly breast) cancer, hepatic adenomas, glucose intolerance/diabetes, deep venous thrombosis, cholelithi- asis, hypertension, endometrial bleeding, depression, weight gain, nausea/vomiting, headache, weight gain, drug-drug interactions, teratogenesis, and aggravation of pre- existing uterine leiomyomas (fibroids), breast fibroadenomas, migraines, and epilepsy. 38. ABCD characteristics of a mole that should make you suspicious of malignant trans- formation: asymmetry, borders (irregular), color (change in color or multiple colors), and diameter (the bigger the lesion, the more likely that it is malignant). Do an exci- sional biopsy of such moles and/or if a mole starts to itch or bleED 59. Always perform ultrasound before pelvic exam in the setting of third-trimester bleed- ing (in case placenta previa is present). 60. Uterine atony is the most common cause of postpartum bleeding and is typically due to uterine overdistension (e.g., twins, polyhydramnios), prolonged labor, and/or oxy- tocin usage. 61. Acute abdomen pathology localization by physical exam AREA ORGAN (CONDITIONS) Right upper quadrant Gallbladder/biliary (cholecystitis, cholangitis) or liver (abscess) Left upper quadrant Spleen (rupture with blunt trauma) Right lower quadrant Appendix (appendicitis), pelvic inflammatory disease (PID) Left lower quadrant Sigmoid colon (diverticulitis), pelvic inflammatory disease (PID) Epigastric area Stomach (peptic ulcer) or pancreas (pancreatitis) 62. The "6 Ws" of postoperative fever: water, wind, walk, wound, "wawa," and weird drugs. Water stands for urinary tract infection, wind for atelectasis or pneumonia, walk for deep venous thrombosis, wound for surgical wound infection, "wawa" for breast (usually relevant only in the postpartum state), and weird drugs for drug fever. In patients with daily fever spikes that do not respond to antibiotics, think about a post- surgical abscess. Order a CT scan to locate, then drain the abscess if one is present. 63. ABCDEs of trauma (follow in order if you are asked to choose): airway, breathing, circulation, disability, and exposure. 64. Six rapidly fatal thoracic injuries that must be recognized and treated immediately: 1. Airway obstruction (establish airway) 2. Open pneumothorax (intubate and close defect on three sides) 3. Tension pneumothorax (perform needle thoracentesis followed by chest tube) 4. Cardiac tamponade (perform pericardiocentesis) 5. Massive hemothorax (place chest tube to drain; thoracotomy if bleeding doesn't stop) 6. Flail chest (consider intubation and positive pressure ventilation if oxygenation inadequate) 65. Neonatal conjunctivitis may be caused by chemical reaction (in first 12-24 hours of giving drops for prophylaxis), gonorrhea (2-5 days after birth; usually prevented by prophylactic drops), and chlamydial infection (5-14 days after birth; often not pre- vented by prophylactic drops). 66. Glaucoma is usually (90%) due to the open-angle form, which is painless (no "attacks") and asymptomatic until irreversible vision loss (that starts in the periphery) occurs. Screening is thus important. Open-angle glaucoma is the most common cause of blindness in African Americans. 67. Uveitis is often a marker for systemic conditions: juvenile rheumatoid arthritis, sar- coidosis, inflammatory bowel disease, ankylosing spondylitis, Reiter syndrome, multi- ple sclerosis, psoriasis, or lupus. Photophobia, blurry vision, and eye pain are common complaints. 68. Bilateral (though often asymmetric) painless gradual loss of vision in older adults is usually due to cataracts, macular degeneration, or glaucoma, which can be distin- guished on physical exam. Presbyopia is a normal part of aging and affects only near vision (i.e. accomodation). 69. Compartment syndrome, usually in the lower extremity after trauma or surgery, causes the "6 Ps": 1. Pain (present on passive movement and often out of proportion to injury) 2. Paresthesias (numbness, tingling, decreased sensation) 3. Pallor (or cyanosis) 4. Pressure (firm feeling muscle compartment, elevated pressure reading) 5. Paralysis (late, ominous sign) 6. Pulselessness (very late, ominous sign) Treat with fasciotomy to relieve compartment pressure and prevent permanent neurologic damage. 70. Peripheral nerve evaluation NERVE MOTOR FUNCTION SENSORY FUNCTION CLINICAL SCENARIO Radial Wrist extension Back of forearm, back of hand Humeral fracture (watch for wrist drop) (first 3 digits) Ulnar Finger abduction Front and back of last 2 digitsElbow dislocation (watch for "claw hand") Median Pronation, thumb Palmar surface of hand (first Carpal tunnel syndrome, opposition 3 digits) humeral fracture Axillary Abduction, lateral Lateral shoulder Upper humeral dis- rotation location or fracture Peroneal Dorsiflexion, eversion Dorsal foot and lateral leg Knee dislocation (watch for foot drop) 71. Pediatric hip disorders NAME AGE EPIDEMIOLOGY SYMPTOMS/SIGNS TREATMENT CHD At birth Female, first-borns, breech Barlow's and Ortolani's Harness delivery signs LCPD 4-10yr Short male with delayed Knee, thigh, groin pain, Orthoses bone age limp SCFE 9-13 yr Overweight male adolescent Knee, thigh, groin pain, Surgical pinning limp CHD = congenital hip dysplasia, LCPD = Legg-Calve-Perthes disease, SCFE = slipped capital femoral epi- physis. Note: All of these conditions may present in an adult as arthritis of the hip. 72. Avoid lumbar puncture in a patient with head trauma or signs of increased intracra- nial pressure. Perform CT scan without contrast instead. 73. In children, 75% of neck masses are benign (e.g., lymphadenitis, thyroglossal duct cyst), but 75% of neck masses in adults are malignant (e.g., squamous cell carcinoma and/or metastases, lymphoma). 74. Manage carotid artery stenosis > 70% with carotid endarterectomy, <> 100 beats/min Respiratory effort None Slow, weak cry Good, strong cry Muscle tone Limp Some flexion of extremitiesActive motion Reflex irritability* None Grimace Grimace and strong cry, cough, and sneeze Color Pale, blue Body pink, extremities blueCompletely pink * Reflex irritability usually is measured by the infant's response to stimulation of the sole of the foot or acatheter put into the nose. 83. Diuretics are a common cause of metabolic derangement. Thiazide diuretics cause cal- cium retention, hyperglycemia, hyperuricemia, hyperlipidemia, hyponatremia, hypokalemic metabolic alkalosis, and hypovolemia; because they are sulfa drugs, watch out for sulfa allergy. Loop diuretics cause hypokalemic metabolic alkalosis, hypovolemia (more potent than thiazides), ototoxicity, and calcium excretion; with the exception of ethacrynic acid, they also are sulfa drugs. Carbonic anhydrase inhibitors cause metabolic acidosis, and potassium-sparing diuretics (e.g.. spironolactone) may cause hyperkalemia. 84. Overdoses and antidotes POISON OR MEDICATION ANTIDOTE Acetaminophen Acetylcysteine Cholinesterase inhibitors Atropine, pralidoxime Quinidine or tricyclic anti- Sodium bicarbonate (cardioprotective) depressants Iron Deferoxamine Digoxin Normalize potassium and other electrolytes; digoxin antibodies Methanol/ethylene glycol Ethanol Benzodiazepines Flumazenil Beta blockers Glucagon Lead Edetate (EDTA); use succimer in children Copper or gold Penicillamine Opioids Naloxone Carbon monoxide Oxygen (hyperbaric in cases of severe poisoning) Muscarinic blockers Physostigmine 85. Aspirin/NSAID side effects: GI bleeding, gastric ulcers, renal damage (e.g., interstitial nephritis, papillary necrosis), allergic reactions, platelet dysfunction (life of platelet for aspirin, reversible dysfucntion with NSAIDs), and Reye syndrome (aspirin given to child with viral infection). Aspirin overdose can be fatal and classically leads to both metabolic acidosis and respiratory alkalosis. 86. Central pontine myelinolysis (brainstem damage and possibly death) may result from overly rapid correction of hyponatremia. 87. Due to cellular shifts, alkalosis and acidosis can cause symptoms of potassium and/or calcium derangement (e.g., alkalosis can lead to symptoms of hypokalemia or hypocalcemia). In this setting, pH correction is needed (rather than direct treat- ment of the calcium or potassium levels). Magnesium depletion can also make hypocalcemia and hypokalemia unresponsive to replacement therapy (until magne- sium is corrected). 88. Adult patients of sound mind are allowed to refuse any form of treatment. Watch for depression as a cause of "incompetence." Treat depression before wishes for death are respected. 89. If a patient is incompetent (including younger minors who lack adequate decision- making capacity) and an emergency treatment is needed, seek family member or court-appointed guardian to make health care decisions. If no one available, treat as you see fit in an emergency, or contact the courts in a nonemergency setting. 90. Respect patient wishes and living wills (assuming that they are appropriate) even in the face of dissenting family members, but take time to listen to family members' concerns. 91. Always be a patient advocate and treat patients with respect and dignity, even if they refuse your proposed treatment or are noncompliant. If patients' actions puzzle you, do not be afraid to ask them why they are doing or saying what they are. 92. Break doctor-patient confidentiality only in the following situations: • The patient asks you to do so. • Child abuse is supected. • The courts mandate you to do so. • You must fulfill the duty to warn or protect (if a patient says that he is going to kill someone or himself, you have to tell the someone, the authorities, or both). • The patient has a reportable disease. • The patient is a danger to others (e.g., if a patient is blind or has seizures, let the proper authorities know so that they can revoke the patient's license to drive; if the patient is an airplane pilot and a paranoid, hallucinating schizophrenic, authorities need to know). 93. Causes of "false" lab disturbances: hemolysis (hyperkalemia), pregnancy (elevated sedimentation rate and alkaline phosphatase), hypoalbuminemia (hypocalcemia), and hyperglycemia (hyponatremia). 94. EKG findings of myocardial infarction: flipped or flattened T waves, ST-segment elevation (depression means ischemia; elevation means injury), and/or Q waves in a segmental distribution (e.g., leads II, III, and AVF for an inferior infarct). ST depres- sion may also be seen in "reciprocal'Vopposite leads. 95. Drugs that may be useful in the setting of acute coronary syndrome: aspirin, mor- phine, nitroglycerine, beta blocker, ACE inhibitor, HMG-CoA reductase inhibitor, gly- coprotein Ilb/IIIa receptor inhibitors, heparin, and tissue-plasminogen activator (t-PA; strict criteria for use). 96. Cholesterol management guidelines (numbers in the chart represent mg/dl) TWO OR MORE NO CHD RISK FACTORS TWO OR MORE CHD RISK FACTORS INTERVENTION Total cholesterol <> 239 Total cholesterol > 200 Do fasting lipoprotein analysis (gives LDL) LDL <> 189 LDL > 159 Medications CHD = coronary heart disease, LDL = low-density lipoproteins. *Unless HDL <35> 30 yr Associated body habitus Thin Obese Development of ketoacidosis Yes No Development of hyperosmolar stateNo Yes Level of endogenous insulin Low to none Normal to high (insulin resistance) Twin concurrence <50%>50% HLA association Yes No Response to oral hypoglycemics No Yes Antibodies to insulin Yes (at diagnosis) No Risk for diabetic complications Yes Yes Islet-cell pathology Insulitis (loss of most B cells)Normal number, but with amyloid deposits Remember, however, that these findings may overlap. 98. Hypertension classification SYSTOLIC BP* DIASTOLIC BP* (mm Hg) (mmHg) CLASSIFICATION <120> 100 Stage II hypertension *Classification is based onthe worst number (e.g., 168/6m0m Hg considered stage II hypertension even though diastolic pressure inormal)s. 99. Word associations (not 100%, but help when you have to guess): BUZZ PHRASE OR SCENARIO CONDITION Friction rub Pericarditis Kussmaul breathing (deep, rapid breathing) Diabetic ketoacidosis Kayser-Fleischer ring in the eye Wilson's disease Bitot's spots Vitamin A deficiency Dendritic corneal ulcers on fluorescein stainHerpes keratitis of the eye Cherry-red spot on the macula without Tay-Sachs disease hepatosplenomegaly Cherry-red spot on the macula with Niemann-Pick disease hepatosplenomegaly Bronze skin plus diabetes Hemochromatosis Malar rash on the face Systemic lupus erythematosus Heliotrope rash (purplish rash on the eyelids)Dermatomyositis Clue cells Gardnerella vaginalis infection Meconium ileus Cystic fibrosis Rectal prolapse Cystic fibrosis Salty-tasting infant Cystic fibrosis Cafe-au-lait spots with normal IQ Neurofibromatosis Cafe-au-lait spots with mental retardation McCune-Albright syndrome or tuberous sclerosis Worst headache of the patient's life Subarachnoid hemorrhage Abdominal striae Cushing's syndrome or pregnancy Honey ingestion Infant botulism Left lower quadrant tenderness/rebound Diverticulitis Children who torture animals Conduct disorder Currant jelly stools in children Intussusception Ambiguous genitalia and hypotension 21-Hydroxylase deficiency in girls Cat-like cry in an infant Cri-du-chat syndrome Infant weighing more than 10 pounds Maternal diabetes Anaphylaxis from immunoglobulin therapy IgA deficiency Postpartum fever unresponsive to broad- Septic pelvic thrombophlebitis spectrum antibiotics Increased hemoglobin A2 and anemia Thalassemia Heavy young woman with papilledema and Pseudotumor cerebri negative CT/MR scan of head Low-grade fever in the first 24 hours after surgerAtelectasiys Vietnam veteran Posttraumatic stress disorder Bilateral hilar adenopathy in a black patient Sarcoidosis Sudden death in a young athlete Hypertrophic obstructive cardiomyopathy Fractures or bruises in different stages Child abuse of healing in a child Absent breath sounds in a trauma patient Pneumothorax Shopping sprees Mania Constant clearing of throat in a child or teenagerTourette's syndrome Intermittent bursts of swearing Tourette's syndrome Koilocytosis Human papillomavirus or cytomegalovirus Rash develops after administration of ampicillinEpstein-Barr virus infection or amoxicillin for sore throat Daytime sleepiness and occasional falling downNarcolepsy (cataplexy) Facial port wine stain and seizures Sturge-Weber syndrome 100. Signs and syndromes SIGN/SYNDROME EXPLANATION Babinski's sign Stroking the bottom of the foot yields extension of the big toe and fanning of other toes (upper motor neuron lesion) Beck's triad Jugular venous distention, muffled heart sounds, and hypotension (cardiac tamponade) Brudzinski's sign Pain on neck flexion with meningeal irritation (meningitis) Charcot's triad Fever/chills, jaundice, and right upper quadrant pain (cholangitis) Courvoisier's sign Painless, palpable gallbladder plus jaundice (pancreatic cancer) Chvostek's sign Tapping on the facial nerve elicits tetany (hypocalcemia) Cullen's sign Bluish discoloration of periumbilical area (pancreatitis with retroperitoneal hemorrhage) Cushing's reflex Hypertension, bradycardia, and irregular respirations (high intracranial pressure) Grey-Turner's sign Bluish discoloration of flank (pancreatitis with retroperitoneal hemorrhage) Homan's sign Calf pain on forced dorsiflexion of the foot (deep venous thrombosis) Kehr's sign Pain in the left shoulder (ruptured spleen) Leriche's syndrome Claudication and atrophy of the buttocks with impotence (aortoiliac occlusive disease) McBumey's sign Tenderness at McBumey's point (appendicitis) Murphy's sign Arrest of inspiration during palpation under the rib cage on the right (cholecystitis) Ortolani's sign/test Abducting an infant's flexed hips causes a palpable/audible click (congenital hip dysplasia) Prehn's sign Elevation of a painful testicle relieves pain (epididymitis vs. testicular torsion) Rovsing's sign Pushing on left lower quadrant then releasing your hand produces pain at McBurney's point (appendicitis) Tinel's sign Tapping on the volar surface of the wrist elicits paresthesias (carpal tunnel syndrome) Trousseau's sign Pumping up a blood pressure cuff causes carpopedal spasm (tetany from hypocalcemia) Virchow's triad Stasis, endothelial damage, and hypercoagulability (risk factors for deepvenous thrombosis)