Surgery-

Surgical Signs, Tests, Laws, Syndromes and Eponyms

Allen’s Test

Allen’s test is used to assess the circulation of the hand and the patency of the radial and ulnar arteries. The patient is asked to drain the hand of blood by forming a fist while the examiner compresses both the radial and ulnar arteries. The patient then opens the hand, which should appear blanched. One artery is released and the examiner observes for palmar flushing, indicating arterial patency. The procedure is then repeated for the other artery.

Argyll Robertson Pupil

Argyll Robertson pupil is a condition in which the pupil constricts or dilates appropriately during accommodation but does not respond to light. In other words, the accommodation reflex is preserved while the pupillary light reflex is absent. A useful mnemonic is ARP, PRA, which translates to Accommodation Reflex Present, Pupillary Response Absent.

Barton’s Fracture

Barton’s fracture is a fracture-dislocation of the distal radius and may sometimes be mistaken for a Colles’ fracture. The fracture line extends across the volar lip of the radius and into the wrist joint. The hand and the associated fragment of distal radius undergo proximal and volar displacement.

Battle’s Sign

Battle’s sign is ecchymosis over the mastoid or post-auricular region and is associated with a basal skull fracture. It is an important clinical sign indicating possible fracture of the base of the skull.

Beck’s Triad

Beck’s triad is classically seen in cardiac tamponade. It consists of jugular venous distension, muffled heart sounds, and decreased blood pressure or hypotension. These findings result from impaired cardiac filling due to pressure from fluid within the pericardial sac.

Bell’s Palsy

Bell’s palsy is an acute lower motor neurone facial nerve palsy of unknown aetiology. It produces weakness or paralysis of the muscles on one side of the face and is generally regarded as a diagnosis of exclusion.

Chvostek’s Sign

Chvostek’s sign is seen in hypocalcaemia. It is elicited by tapping over the facial nerve, which causes twitching or contraction of the facial muscles due to increased neuromuscular excitability.

Colles’ Fracture

A Colles’ fracture is a fracture of the distal approximately 2 cm of the radius with dorsal displacement of the distal fragment. This produces the characteristic dinner-fork deformity of the wrist.

Compartment Syndrome

Compartment syndrome is a condition in which pressure increases within a confined anatomical compartment. The rising pressure adversely affects circulation and threatens the function and viability of the muscles, nerves, and other tissues within that compartment.

Cushing’s Triad

Cushing’s triad is seen in raised intracranial pressure. It consists of increased blood pressure, bradycardia, and irregular respirations. These findings may indicate severe intracranial hypertension.

De Quervain’s Tenosynovitis

De Quervain’s tenosynovitis is inflammation of the extensor pollicis brevis (EPB) and abductor pollicis longus (AbPL) tendons, usually secondary to overuse. It causes pain around the radial side of the wrist and may be demonstrated clinically using Finkelstein’s test.

Finkelstein’s Test

Finkelstein’s test is used to assess for De Quervain’s tenosynovitis. The thumb is clenched within the fist and the wrist is moved in a way that stretches the extensor pollicis brevis and abductor pollicis longus tendons. Reproduction of pain over the radial aspect of the wrist supports the diagnosis.

Frey’s Syndrome

Frey’s syndrome is characterized by warmth, flushing, and sweating in the malar or parotid region of the face during eating, or even when thinking or talking about food. It is also known as gustatory sweating. It may follow damage in the parotid region caused by trauma, mumps, purulent infection, or parotidectomy. After the initial damage, autonomic fibres that previously supplied the salivary glands may regenerate incorrectly and connect with sweat glands. As a result, a stimulus that normally causes salivation instead causes sweating and flushing. Flushing has been described as more prevalent in females and sweating as more prevalent in males. Gustatory tears, also known as crocodile tears, may sometimes occur.

Galeazzi Fracture

A Galeazzi fracture is a fracture of the radial shaft associated with dislocation of the distal radioulnar joint. This disrupts the normal forearm axis. It is sometimes referred to as a reverse Monteggia fracture.

Gradenigo’s Syndrome

Gradenigo’s syndrome is seen as a complication of suppurative otitis media. It consists of signs of acute suppurative otitis media, ipsilateral abducens nerve palsy, and pain in the distribution of the ipsilateral trigeminal nerve.

Hitselberger’s Sign

Hitselberger’s sign is an abnormal sensory change involving the posterior external auditory canal, classically associated with acoustic neuroma. It may occur together with ipsilateral hearing loss.

Horner’s Syndrome

Horner’s syndrome results from disruption of the ipsilateral sympathetic nerve supply to the eye and face. It is characterized by ipsilateral ptosis, miosis, anhidrosis, and apparent enophthalmos. A classic cause is a Pancoast tumour, which is a tumour arising from the upper part or apex of the lung.

Monteggia Fracture

A Monteggia fracture consists of dislocation of the radial head associated with a fracture of the proximal third of the ulna.

Osler–Rendu–Weber Syndrome

Osler–Rendu–Weber syndrome, also known as hereditary haemorrhagic telangiectasia, is a familial disorder characterized by telangiectasia affecting mucosal surfaces. These vascular lesions may be present in several areas, but a common presentation is recurrent epistaxis.

Pendred’s Syndrome

Pendred’s syndrome is an autosomal recessive disorder characterized by congenital sensorineural hearing loss and thyroid enlargement or goitre.

Pierre Robin Sequence

Pierre Robin sequence is characterized by a hypoplastic or small mandible, cleft palate, and glossoptosis. Glossoptosis refers to posterior or downward displacement of the tongue and may contribute to upper airway obstruction or obstructive sleep apnoea. External, middle, and inner ear problems may also occur.

Raccoon Eyes

Raccoon eyes are seen in basal skull fractures and consist of bilateral periorbital ecchymosis. The appearance is also known as panda eyes.

Refsum’s Disease

Refsum’s disease is characterized by retinitis pigmentosa, cerebellar ataxia, peripheral neuropathy, and sensorineural hearing loss. It is an inherited metabolic disorder with prominent neurological, ophthalmological, and auditory manifestations.

Ramsay Hunt Syndrome

Ramsay Hunt syndrome is a facial nerve palsy caused by herpes zoster infection involving the facial nerve. It presents with a lower motor neurone facial nerve palsy together with painful vesicular or haemorrhagic blistering involving the ipsilateral ear or tympanic membrane. It is also known as herpes zoster oticus.

Smith’s Fracture

A Smith’s fracture is a fracture of the distal radius that usually occurs when a patient lands on a flexed wrist. The distal radial fragment is displaced anteriorly or volarly. It is often referred to as a reverse Colles’ fracture.

Superior Vena Cava Syndrome

Superior vena cava syndrome is caused by obstruction of the superior vena cava, for example by a tumour or thrombosis. It produces venous congestion and engorgement of the face, neck, and upper chest veins in the distribution of the superior vena cava.

Thoracic Outlet Syndrome

Thoracic outlet syndrome occurs when structures passing through the thoracic outlet are compressed. Possible causes include a cervical rib. Depending on the structures affected, the patient may develop neurological or vascular symptoms involving the upper limb.

Thornwaldt’s Cyst

A Thornwaldt’s cyst is a benign cystic swelling of the nasopharynx and is uncommon, particularly in adults. It arises from the pharyngeal bursa and is located in the superoposterior nasopharynx. A sufficiently large cyst may contribute to obstruction in this region.

Treacher Collins Syndrome

Treacher Collins syndrome is an autosomal dominant craniofacial disorder characterized by hypoplasia of the maxilla and mandible. Patients may also have microtia, meaning small or underdeveloped ears, together with abnormalities of the external, middle, or inner ear and associated hearing problems.

Trousseau’s Sign

Trousseau’s sign is seen in hypocalcaemia. It is demonstrated by producing temporary blood-flow occlusion with a blood pressure cuff, which causes carpopedal spasm due to increased neuromuscular excitability.

Waardenburg Syndrome

Waardenburg syndrome is an inherited disorder characterized by abnormalities of pigmentation and hearing. Features include telecanthus, pigment abnormalities such as a white forelock and heterochromia iridis, and sensorineural hearing loss. Telecanthus refers to an increased distance between the inner corners of the eyes.