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SIGN DISEASE/CONDITION
ABCDs Malignant Melanoma
Acute Pancreatitis signs
Mayo-Robson's sign
Aortic regurgitation signs
Appendicitis signs
Fever of acute
appendicitis does not
exceed 38.33˚C/101˚F
Fever of perforation
exceeds 38.33˚C/101˚F
Other things to REMEMBER
Asymmetric
Border irregularities
Color variation
Diameter is >.06cm; Dark black in color
Dysplastic nevus: precursor of
Malignant Melanoma
Fox‟s sign Ecchymoses of the inguinal ligament
due to retroperitoneal hemorrhage
Cullen‟s sign hemorrhagic discoloration of the
umbilicus
Grey-Turner‟s sign Ecchymosis or discoloration of the flank
Appearance of ecchymoses around the
Grünwald sign umbilicus due to local toxic lesion of the
vessels
Körte's sign pain or resistance in the zone where the
head of pancreas is located (in the
epigastrium, 6-7cm above the
umbilicus)
Kamenchik's sign pain with pressure under the xiphoid
process
pain while pressing at the top of the
angle lateral to the Erector spinae
muscles and below the left 12th rib
(left costovertebral angle)
De Musset‟s sign Antero-posterior bobbing of the head
Duroziez‟s sign An intermittent to-and-fro femoral artery
murmur (occurring is systole and
diastole respectively) on palpation or
femoral artery compression
Hill‟s sign Increase in manually measured blood
pressure of the lower extremity
compared with the upper extremity
Quincke‟s sign Exaggerated capillary pulsations of the
nail beds (or upper lips)
Traube‟s sign leaking of the aortic valve of
the heart that causes blood to flow in
the reverse direction during
ventricular diastole, from the aorta into
the left ventricle
 (+)s3 gallop
Aaron‟s sign a referred pain felt in
the epigastrium upon continuous firm
pressure over McBurney's point
Dunphy‟s sign Pain on right lower quadrant upon
coughing
Obturator sign irritation of Obturator internus muscle
(a.k.a. Cope‟s sign) Pain on internal rotation of the right hip
with knee flexed
Markle‟s sign pain in the right lower quadrant (local
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(jar tenderness) peritoneal irritation) of the abdomen is

elicited by dropping from standing on
the toes to the heels with a jarring
landing

Psoas‟ sign Irritation of the right iliopsoas group of

hip flexors
Pain elicited by extending the hip with
full extension of the knee
Also seen in Psoas abscess

Rosenstein‟s sign tenderness in the RLQ increases when

the patient moves from the supine
position to a recumbent posture on the
left side

Rovsing‟s sign Palpation of the LLQ will elicit

pain at the RLQ
Peritoneal irritation

Bagasse sign Mottling of the lungs in sugarcane workers

(interstitial lung disease) (exposure to moldy molasses)

Battle‟s sign Fracture of the middle  Bruising over the mastoid

(Mastoid ecchymoses) cranial fossa of the skull process
 Extravasation of blood along
the path of the posterior
auricular artery

Black beard sign Paget‟s disease of the “blade of grass” appearance

bone
(a.k.a. Osteitis D.O.C.: Bisphosphonates
deformans)

Blumberg sign Peritonitis Rebound tenderness

Boa‟s sign Cholelithiasis Right subscapular pain

Brudzinski‟s sign Meningitis Severe neck stiffness causes a patient's

hips and knees to flex when the neck is
flexed.

Castell‟s sign Splenomegaly placing the patient in the supine position

With the patient in full inspiration and

then full expiration, percuss the area of
the lowest intercostal space (eighth or
ninth) in the left anterior axillary line. If
the note changes from resonant on full
expiration to dull on full inspiration,
due to enlarged spleen, the sign is
regarded as positive.

Chandelier sign PID internal pelvic examination (movement

of the cervix) evokes pain of such
intensity (extreme cervical motion
tenderness) that the patient seemingly
leaps out of the examination stirrups,
reaching „for the chandelier‟

Cholecystitis signs Lepine‟s sign light percussion with crooked third

finger at the point of the gallbladder
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projection to anterior abdominal wall

(Kerr's point) elicits pain

Murphy‟s sign Inspiratory arrest upon deep palpation

of the right subcostal area due to pain,
because it brings an inflamed
gallbladder under pressure

Dance‟s sign Ileocecal Empty right lower quadrant

intussusceptions e.g. retraction of the right iliac fossa

Eye of the Tiger sign Hallevorden Spatz  Pantothenate kinase-

syndrome associated
neurodegeneration (PKAN)
 neurodegeneration with brain
iron accumulation type 1 (NBIA-
1)
 Cysteine dioxygenase
 progressive extrapyramidal
dysfunction and dementia
 dystonia, parkinsonism
 toe walking
 retinitis pigmentosa

Gastric Cancer signs Blumber‟s shelf sign Metastasis to the rectouterine Pouch of
Douglas

Krukenberg Metastasis to the ovary

Sister Mary Joseph sign Metastasis of a malignant cancer in the

pelvis or abdomen

Troisier‟s sign Virchow’s palpable nodule bulging into

node (signal node) the umbilicus

“the seat of the devil”

ominous association with malignant
disease
a lymph node in the left supraclavicular
fossa (the
area above the left clavicle)

takes its supply from lymph vessels in

the abdominal cavity

Gower‟s sign Duchenne Muscular patient that has to use his hands and
Dystrophy arms to "walk" up his own body from a
squatting position due to lack of hip and
thigh muscle strength

Grey-Turner‟s sign Hemorrhagic pancreatitis Ecchymosis or discoloration of the flank

Dissecting abdominal Occurs in 24-48 hours when

aortic aneurysm methemalbumin from digested blood
tracks subcutaneously around the
Ruptured ectopic abdomen from the inflamed pancreas
pregnancy

Hamman‟s sign Spontaneous mediastinal a crunching, rasping sound,

emphysema synchronous with the heartbeat, heard
Pneumomediastinum over the precordium, produced by the
Pneumopericardium heart beating against air-filled tissues
Tracheobronchial injury
Boerhaave syndrome
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Hamburger‟s sign Signifies a “girl” fetus on ultrasound

Homan‟s sign Deep vein thrombosis A positive sign is present when there is
resistance (not pain) in the calf or
popliteal region with examiner's
abrupt dorsiflexion of the patient's foot
at the ankle while the knee is fully
extended

Hutchinson‟s sign Diagnostic of Subungual Pigmentation of the proximal or lateral

Melanoma nail fold

(NOTE: Hutchinson’s teeth is in

congenital syphilis)

Hypocalcemic signs Chvostek‟s sign Twisting of the facial muscles upon

tapping of the facial nerve

Trousseau‟s sign Carpal spasm after occlusion of blood

(of hypocalcemia) to the forearm using a BP cuff

Kelly‟s sign Visible peristalsis of the ureter in

response to squeezing or retraction
Used to identify ureter during surgery

Kernig‟s sign Meningitis Severe stiffness of the hamstrings

causes an inability to straighten the leg
when the hip is flexed to 90 degrees.

Kussmaul‟s sign Constrictive pericarditis Jugular venous pressure rises with

inspiration
(normally, JVP falls with inspiration)

Leser Trelat sign Paraneoplastic syndrome  explosive onset of multiple

seborrheic keratoses (many
pigmented skin lesions), often
with an inflammatory base
 an ominous sign of internal
malignancy

Levine sign M.I. Patient‟s “clenched fist” placed on the

chest

Watch out!
For subset of patients who do not
present with chest pain in M.I.:
 Elderly
 Diabetics
 Post-stroke px

Lhermitte‟s sign Cervical spinal cord Momentary electric shock-like sensation

disease evoked by neck flexion

Macewen sign Hydrocephalus “cracked pot sign” due to the presence

of fluid in the head

Matted groove sign Lymphogranuloma biovar (L-serotype) of Chlamydia

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venereum: Secondary trachomatis (serovars L1, L2, L3)

infection Chronic disease resulting from damage
to the lymphatic system draining the site
of infection
Primary: small, painless papule/ulcer
Teritary: blockage of lymphatic
channels edema
Tx: Doxycycline: 100mg PO BID x 21d
Erythromycin 500mg q6h x 21 days

Mittelschmerz sign Ovulation Lower quadrant or hypogastric pain

Monday chest tightness Byssinosis In workers of cotton or abaca factory

sign

Obturator hernia signs Hannigton-Kiff sign there is an absent adductor reflex in the
thigh in the presence of a positive
patellar reflex
due to compression of obturator nerve

Howship-Romberg sign inner thigh pain on external rotation of

the hip as a result of nerve compression
may be caused by a granuloma

Pancreatitis signs Cullen‟s sign Superficial edema and bruising (faint

blue discoloration) in the umbilicus
that appears in 24-48 hours; in Acute
Pancreatitis

Grey-Turner‟s sign Bruising (ecchymosis / discoloration) of

the flanks;
sign of retroperitoneal hemorrhage
in severe acute pancreatitis

Pemberton‟s sign Superior Vena Cava  Facial flushing

syndrome  Distended neck and head
(maybe due to goiter or superficial veins
mediastinal mass)  Inspiratory stridor
 Elevated jugular venous
pressure

Pregnancy-related signs Chadwick‟s sign Blue-red (violaceous) hyperemia of the

cervix after the 7thweek of pregnancy

Hegar‟s sign Softening of the uterus @ the junction

between cervix and fundus; usually
th
appears on the 8 week AOG

Goodell‟s sign Softening of the cervix associated with

Th
pregnancy; also on the 8 week AOG

McDonald‟s sign

Rectus abdominus sheath Carnett‟s sign (+): lift the patient‟s head and shoulders
hematoma from the table to tense the abdominal
wall increased abdominal pain

Inferior epigastric vein: the (-): lift the patient‟s head only, and the
MC injured vessel abdominal pain decreases points to
an intra-abdominal cause of pain (e.g.
Appendicitis)

Fothergill‟s sign  Mass that does not cross the

midline and remains palpable
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when the rectus muscle is tense

 Used to differentiate intra-
abdominal mass from that of
abdominal wall mass

Rigler‟s sign Pneumoperitoneum  also known as the double wall

sign
ruptured PUD  seen on an x-ray of
the abdomen when air is
present on both sides of
the intestine (inside the lumen)
and the outside (peritoneal
side)

Shawl sign Dermatomyositis Poikilodermatous macules on the

shoulders and upper back (like a shawl)

Silk-glove sign Indirect hernia  Sac feels like a finger of a silk

glove when rolled under the
examining finger
 In pediatric patients

Splenic rupture signs Ballance‟s sign Dullness to percussion on the LUQ (due
to coagulated blood) and shifting
dullness to percussion in the right flank
(due to liquid blood)

Kehr‟s sign Severe referred left shoulder pain as a

result of diaphragmatic irritation

Trousseau‟s sign Adenocarcinoma of the  Migratory thrombophlebitis 

(of malignancy) pancreas and lungs redness and tenderness on
palpation of extremities
 Hypercoagulability state
 Venous thrombosis

Valentino‟s sign Perforated Peptic Ulcer Right lower quadrant pain, due to
succus/pus draining into the RLQ

Westermark‟s sign Pulmonary embolism Decreased pulmonary vascular

markings on CXRay

SIGN OF THE CROSS