• Test for patency of ulnar artery prior to placing a radial arterial line or performing an ABG.
• Examiner occludes both ulnar and radial aa withi fingers as patient makes fist.
• Patient opens fist while examiner releases ulnar artery occlusion to assess blood flow to hand

• constant dullness to percussion in left flank/LUQ & resonance/shifting dullness to percussion in right flank
• seen with splenic rupture/hematoma
• dullness on left side d/t coagulated blood and shifting dullness on right side d/t fluid blood

Seen in patients with cardiac tamponade.

1. JVD
2. Decreased/muffled heart sounds
3. Decreased bp

• seen in patients with fat emboli syndrome
• mental status changes
• petechiae (often in axilla/thorax)
• dyspnea

• Metastatic dz to the rectouterine pouch (of Douglas) or rectovesical pouch creating a "shelf" that is palpable on rectal exam.

• Seen with gastric volvulus
• emesis followed by retching
• epigastric distension
• failure to pass NGT

Seen in carcinoid syndrome (FDR).

1. flushing
2. diarrhea
3. right-sided heart failure

Seen in cholangitis

1. fever/chills
2. jaundice
3. RUQ pain

• enlarged nontender gallbladder seen with obstruction of the common bile duct
• most commonly associated with pancreatic cancer
• not seen with gallstone obstruction b/c gallbladder is scarred secondary to chronic cholelithiasis

• bluish discoloration of periumbilical area
• caused by retroperitoneal hemorrhage tracking around to anterior abdominal wall through fascial planes
• ex. acute hemorrhagic pancreatitis

Signs of increased ICP

1. HTN
2. bradycardia
3. irregular respirations

• used to differentiate intra-abdominal mass from abdominal wall mass
• if mass is felt while there is tension on the musculature (i.e. when sitting halfway upright), then it is in the wall

• anal fistulae courses in a straight path anteriorly and a curved path posteriorly (dog: straight nose, upwardly curved tail)

• Cullen's sign (periumbilical discoloration)
• Fox's sign (inguinal ligament discoloration)
• Grey Turner's sign (flank discoloration)

• crunching sound on auscultation of the heart resulting from emphysematous mediastinum
• seen in Boerhaave's syndrome, pneumomediastinum, etc.

• calf pain on forced dorsiflexion of the foot seen in patients with DVT

• pain along the inner aspect of the thigh, seen in obturator hernia as the result of of nerve compression

• severe left shoulder pain in patients with splenic rupture 
• cause is referred pain from diaphragmatic irritation

• visible peristalsis of the ureter in response to squeezing or retraction 
• used to identify the ureter during surgery

• Wall tension = pressure x radius
• thus, the colon perforates preferentially at the cecum b/c of the increased radius → increased wall tension

• present in 2% of the population
• 2% are symptomatic
• occur within 2 feet of the ileocecal valve

• cessation of inspiration while palpating under the right costal margin
• patient cannot continue to inspire deeply b/c it brings the inflammed gallbladder under pressure
• seen in acute cholecystitis

• pain upon internal rotation of the leg with hip and knee flexed
• seen in patients with appendicitis/pelvic abscess

• Pain elicited by extending the hip (patient lying on his side, pull leg posteriorly) with the knee in full extension
• seen with appendicitis and psoas inflammation

• bilateral black eyes d/t basilar skull fx
• other sign seen in basilar skull fx = Battle's sign = bruise over mastoid process

• seen in patients with suppurative cholangitis (Charcot's triad + 4&5)

1. fever
2. jaundice
3. RUQ pain
4. mental status changes
5. shock/sepsis

• palpation of LLQ results in pain in RLQ
• seen in appendicitis

1. cholelithiasis
2. hiatal hernia
3. diverticular disease

• carpal spasm after occlusion of blood to forearm with a BP cuff in patients with hypocalcemia
• (similar: Chvostek's sign)

• RLQ pain from perforated peptic ulcer d/t succus/pus draining into RLQ

Evidence of insulinoma

1. hypoglycemia (<50)
2. CNS and vasomotor sx: syncope, diaphoresis
3. relief of sx with administration of glucose

• esophageal perforation
• may note Hamman's sign/crunch (air in mediastinum)

• delivery of large amount of hyperosmolar chyme into the small bowel
• usually occurs after vagotomy and a gastric drainage procedure (pyloroplasty or gastrojejunostomy)
• results in autonomic instability, abdominal pain, diarrhea

A gardner plants SOD:

• Sebaceous cysts
• Osteomas
• Desmoid tumors
• polyps have high malignancy potential

• "CIA"
• Claudication of buttocks and thighs
• Impotence
• Atrophy of legs 
• seen with iliac occlusive dz