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What's the Sign?

by Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC

In all lines of work, jargon abounds. Health care is no different. We have a plethora of signs and findings that often bear the name of a person who first described the sign and noted its association with a given disease state. Check your skill at recognizing common and no-so-common disease-associated signs by taking the quiz below. Click here for answers.

 _____ 1. A cluster of pinpoint white macules on the buccal mucosa, usually found adjacent to the 1st and 2nd molars. Usually precede the rash stage in rubeola by 1 day.

_____ 2. In contrast to the normal decrease in jugular venous pressure (JVP) during inspiration, there is a paradoxic JVP increase. It is noted in constrictive pericarditis and severe right-sided heart failure.

 _____ 3. Painful arrest of inspiration triggered by palpating edge of inflamed gallbladder. Found in cholecystitis.

 ____ 4. Elicited by gentle but deep palpation of an area of abdominal tenderness followed by rapid release of the pressure. Pain is typically worse with release, usually indicating abdominal wall or peritoneal inflammation.

 _____ 5. To elicit this sign, ask the patient to stand on tiptoes then let his or her body weight fall quickly onto the heels. The sign is positive if abdominal pain increases and localizes with the maneuver and suggestive of peritoneal inflammation.

 ____ 6.  Elicited by inflating a blood pressure cuff to the point of obliterating the radial pulse and then feeling the artery. Consider positive if radial artery remains palpable in the absence of a pulse. In the presence of this sign, the vessels are likely severely arteriosclerotic and blood pressure (systolic and diastolic) may be overestimated. 

____ 7. Systolic blood pressure in thigh is >20 mm Hg greater than in the arm (normal limits = 10 mm Hg to 15 mm Hg). Indicative of high cardiac stroke volume and found in a number of hyperkinetic states including aortic regurgitation. 

______ 8. Caused by poor adherence of the epidermal cells to the dermis, this sign is elicited when the skin shears in response to the pressure of a sliding finger. Found in blistering epidermal diseases such as pemphigus vulgaris.

 _____ 9. Dorsiflexion of the great toe in response to stroking the lateral foot. A normal finding in early childhood, the presence of this sign can indicate an upper motor neuron lesion of the pyramidal (corticospinal) tract.

 ____ 10. An ecchymotic area over or behind mastoid process or visible blood behind the tympanic membrane. Noted in about 12% of patients with basilar skull fracture, this sign may take 3 to 12 days to develop and can be found in the ipsilateral or contralateral side of the injury.

 _____ 11. Ecchymotic areas noted in the periumbilical area, caused by retroperitoneal or intraperitoneal blood leaks. A rare but significant finding in acute pancreatitis or ruptured ectopic pregnancy.

 ____ 12. The head bobs in synchrony with each heartbeat. Occurs with severe aortic regurgitation and hyperkinetic heart states with large stroke volumes. Named for a 19th century French poet who likely had tertiary syphilis, a condition often associated with aortic regurgitation.

 _____13. A retraction of the upper lid that causes a wide palpebral fissure. Most commonly seen in Graves disease.

 ____ 14.  Noted in the first trimester of pregnancy, a softening of the uterus at the junction between the cervix and uterine body.

 ____ 15. Found in carpal tunnel syndrome, symptoms are reproduced by a tap over the median nerve at the wrist. 

Answer Choices

A. DeMusset’s sign

B. Cullen’s sign

C. Murphy’s sign

D. Kussmaul’s sign

E. Koplik’s spots

F. Markle’s sign

G. Osler’s sign

H. Nikolsky’s sign

I. Hill’s sign

J. Babinski’s sign

K. Battle’s sign

L. Dalrymple’s sign

M. Blumberg’s sign

N. Hegar’s sign

O. Tinel’s sign

Reference: Mangione, S. (2007) Physical Diagnosis Secrets, 2nd Ed. Elsevier

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This article originally appeared in my quarterly certification column in Advance for Nurse Practitioners and is made available here by the courtesy of Advance. For other articles of interest to Nurse Practitioners, be sure to subscribe to this outstanding journal.