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Recently, I got to teach what Throckmorton sign was to someone.
It made me wonder- what other humorous signs/symptoms/diagnoses exist? Bonus points for increasing amounts of esotericism, and if they're actually clinically useful.
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A chronic smoker suddenly stops smoking cause they don't feel like it anymore.
A hallmark for lung cancer.
Should call this Camel Sign
If I had any fake awards I would give them to you
It also leads to all my patients saying that they're scared to quit because they knew someone who quit and was diagnosed with lung cancer within a year.
Or long term drinkers who suddenly stop drinking… pancreatic cancer.
Has been studied: https://www.jto.org/article/S1556-0864(15)32206-1/fulltext
Also works for chronic alcohol intake and developing alcoholic hepatitis
This one is absolutely real.
Also this had been studied: https://www.jto.org/article/S1556-0864(15)32206-1/fulltext
One of our old attendings (RIP) developed and validated the sandwich sign. If a person is pretending to be too intoxicated/asleep to wake up (likely because they don't want to be discharged), you place a sandwich on their chest and go see another patient. If the sandwich disappears, you can discharge the patient.
This sounds a lot like the hand-drop test to determine if a seizure is epileptiform in nature - raising a patient's hand above the face, and evaluating for skeletal muscle action when dropped
I've seen that one fail a number of times. It takes a lot more cognition and motor ability to unwrap a sandwich, eat it, then pull the blanket back over your head.
If you're drunk enough to not react when you basically backhand yourself, you're pretty damn drunk and I would let them stay just for having either the balls to do it or the level of intoxicated they are bc that had to hurt.
Patients can definitely be faking and fail the hand drop test. It just takes practice at home.
Well most people don't even know its a test, so they aren't trying to fake it.
If you are talking about the expierienced 'FND' patients i agree
Positive Samsonite Sign. Patient shows up to the ER with luggage, usually via EMS.
SAMSONITE! I was way off.
Incredible finding a dumb and dumber reference this thread.
Gotta do it
I'm all about moving from the STEMI paradigm to the OMI one championed by Dr Smith et al.
As part of this, I want to introduce a new sign which is even more specific for detecting OMI than ST segment abnormalities, and arguably more definitive than high sensitivity trops: the Spousal Attribution of Nociception Index.
A patient who reports "my wife says I have chest pain" has a positive SAONI, and will almost certainly have a major infarct.
If they report this after having driven themselves to hospital, they are periarrest.
Right up there with "I have heartburn" in a 65yo who hasn't seen a doctor in multiple decades.
I had to look up omi. From a naming perspective I agree calling it "occlusive myocardial infarct" better shows off what the problem is and how to fix it rather than what a test shows will help to "future proof" it for when we have other modalities to quickly and accurately determine it.
That said - I'm definitely going to go down a rabbit hole about what tools we have available in addition to the ekg tracing. I'm assuming echo/pocus would be a good place to start; but let me know if there's another interesting tool to look up there
Well, to be honest I think ECG reigns supreme. Part of Smith's whole issue is that we've got very... guideliney about interpretation, which had lead to good, even disgnostic ECG evidence being disregarded. People thinking "NSTEMI" means "no ECG changes" when actually there are often plenty of changes - just not ones that neatly fit the expectation of Xmm of elevation in contiguous leads with Ymm reciprocally.
I'm forever being frustrated by patients who are clearly having OMI being (initially) rejected for PPCI, because my local centre don't care for Sgarbossa criteria, hyperacute Ts, and so on. Even obvious posterior MIs aren't accepted until they've obtained their own, redundant posterior view in resus, wasting a good hour or so.
But anyway, I forgot the jocularity. Oops.
Not quite a humorous sign, but I made up Possum Sign. We're trained to think of opioid withdrawal as hyperarousal, puking everywhere, causing a ruckus, etc. I noticed that some young women will instead "play possum" - they'll lie very still on their bed and barely open their eyes to talk to you. They're so miserable they can barely move. If you ask if they're in withdrawal they'll say yes, and once you start treating the withdrawal they'll start moving and talking. When I was a resident I sometimes had to argue with attendings about Possum Sign but I was usually right.
They're like sick kids until you treat for withdrawal. I've seen it too. More often than the ruckus causers.
Bringing a stuffed animal to the epilepsy monitoring unit.
Patients 18 and older with stuffed animals had a 3.21 (95% confidence interval = 1.58, 8.90) times greater odds of being diagnosed to have PNES or both PNES and epilepsy than to have epilepsy alone after adjusting for other patient characteristics (p = 0.022).
The statistics have me dead
PNES = Plushie Needed for Emotional Support
Ref:
Cervenka MC, Lesser R, Tran TT, Fortuné T, Muthugovindan D, Miglioretti DL. Does the teddy bear sign predict psychogenic nonepileptic seizures? Epilepsy Behav. 2013 Aug;28(2):217-20. doi: 10.1016/j.yebeh.2013.05.016. Epub 2013 Jun 14. PMID: 23770681.
Does that population have high co-morbidity with DSM-5 diagnoses? I wonder if collaboration with psych could lead to the creation of a diagnostic questionnaire, like the phq-9 but for pnes
Speaking from personal experience, so take this with a grain of salt... I have encountered a subset of patients who are not networked with a mental health team, and are very reluctant to do so, but their symptoms are... not neurologic in origin. They probably would meet diagnostic criteria for a DSM-5 diagnosis, but they have to make the first step in accepting that they have a mental health disorder in the first place. Oftentimes they never network with psychiatry.
A non-trivial number of these people had psychiatry and psychotherapy used against them by abusive parents when they were kids, and don't trust any of it.
Absolutely
~ ✨ Cluster B ✨ ~
I looked this up and the abstract says “We conclude that patient possession of toy stuffed animals in the EMU is not a reliable sign of PNES.”?
It is associated but the difference is relatively small, not enough to be a useful marker clinically.
Length of patient’s allergy list is also predictive of PNES.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4747833/
And predictive of preoperative pain and disability in spine surgery: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7359683/
And both preoperative distress and decreased satisfaction after spine surgery:
https://pubmed.ncbi.nlm.nih.gov/29864076/
If you thought a long allergy list was a red flag... you were probably right
Absolutely, when I see more than 3 or 4 med allergies listed, I feel that is a sign!
Also the number of allergies correlating with PNES
I personally LOVE an obscure eponymous sign, lol. I think it must come from the same deeply disturbed part of me that likes percussing and looking at people's nails.
My most commonly used fake sign is "the stretcher sign," which is: When a patient is brought to their oncology appointment on a stretcher, it means they're not getting chemotherapy.
I was taught that the stretcher sign means if the patient’s girlfriend or boyfriend is in the stretcher with them, then they are probably not that sick
This is a sad one, but Stuffed Animal Sign - if your adult patient brings a stuffed animal with them when they are coming to L&D to deliver a baby, there is nearly a 100% guarantee of hx childhood abuse.
Well that's depressing.
Yeah. Every time someone comes in with a stuffie I check the chart and so far I haven't had any outliers. I know it's just anecdata but.... It does help as an easy tell for what patients are going to need a little extra TLC and help with coping.
If they bring a stuffed animal with them to the ED and aren’t pregnant, they most likely still have that hx. Attachment issues etc
And if they bring in a 10 page birth plan and 2 suitcase of things to put around the room? I’m an oncology nurse but I think that would be the “fuck!” Sign.
Guaranteed 2am C section
And years and years of Facebook posts about their "birth trauma"
OMG these are so good. But just remember that they will want the sheets changed q4. It will be their own $500 sheets so make sure you know how to wash them properly.
Wait- as a comfort item for themselves, you mean? I know it isn't recommended, but bringing a bear for baby is very different from bringing one for the laboring person.
Yes, for themselves. You can tell these are usually very well-loved items.
I took a brand new stuffed animal with me when I delivered my first, but it was supposed to be my focal item. Never got to use it, though. She came too fast.
I brought a stuffed bat with me to my colonoscopy. I am a mid-40s woman with a history of SA.
The doctor brought propofol. That and the bat were a good team, and I had a nice nap.
I brought my "lucky socks". Worked for final exams so why not labor?
I don't have 'lucky socks' but I do have 'lucky undies'... which I think would probably be counterproductive :D
During Covid: mask sign. If a patient wears the mask below the nose, they are not vaccinated against covid. Had a specificity of 100% while working in the ER.
I have one I invented myself. The “Dr. Durden’s Dr. Pepper sign”.
If patient has Dr. Pepper bedside, pathgnomonic for an A1c above 10. I have yet to be proven wrong. n ~ 100.
Toe dentist…I chortled
I also consider myself a practitioner of mind dentistry
Hey. Our profession is gaining respect amongst real doctors, but I think too many DPMs take themselves too serious.
I love you guys and gals and nonbinary physicians and surgeons of the foot and ankle. Saved my ass from having to cut toe nails on the psych ward many a time
Debrided!
When the patient comes to their obesity management follow-up with a Mountain Dew I pre-load the "failure to improve" template.
It’s correlate the mt dew at the retina doc for diabetic retinopathy has an 80% positive predictive value for pdr.
Is it specific to Dr Pepper? What’s the prognosis of other sodas? How about Mr Pibb or Dr Skipper?
Generic brand usually correlates with formulary selection. So if your only options are sulfonylureas, or Walmart insulin, assuredly worse. But further studies are needed to fill this gap in literature.
Teeth to tatt ratio has never failed me.
Ok, this is a really good one.
Wait- is this an inverse relationship?
What does it predict? Endocarditis? GSW while 'minding my own business'?
Meth habit, I'd guess.
And so much more
ER doc. I have several. 1) If patient has multiple complaints and those complaints are above and below the umbilicus then they’re crazy and nothing is wrong. 2) Asian from the motherland and in my ER? You’re going to the ICU no matter your complaint. Example: complaining of a hangnail? Must be necrotizing fasc. Straight to ICU. Feel a little dizzy? Why that’s your catastrophic brain bleed showing. Straight to ICU. Asian population at my shop is notorious for minimizing complaints while having catastrophic pathology. I have yet to be proved wrong.
I agree with you about east Asian immigrants. Once had the sweetest little grandma who didn't speak a lick of English. She had both emphysematous cholecystitis AND a septic kidney stone. Either one could have killed her and she was politely smiling and nodding while in overt septic shock.
Halloween sign for a normal epiglottis is one of my favorites.
Spooky but reassuring.
Oh cool!
LLS score (Looks Like Shit). It can only be 0 or 1. I originally encountered this when I was learning emergency medicine ultrasound and the conditions when a RUSH exam is indicated, I.e. check the heart, lungs, IVC, belly for blood, and aorta, for general badness - generally this is done when the patient is unstable, unexplained hypotension, or generally has an LLS score or 1.
The LLS score is so fucking effective. I remember my first was a CP patient admitted to neuro, chronic trach etc. She just looked like shit my whole shift. I couldn't put my finger on it, and the docs couldn't figure out any specific issue either. Told the incoming (much more experienced) nurse at the end of the shift that I wouldn't be surprised if she coded, and the nurse all but laughed me off the unit for the night. I came back the next day, and sure enough the patient had coded. I can't recall the underlying cause of the event but damn do I absolutely preach the LLS gospel.
I call it sick/ not sick. You can be ill but not sick and you can have the outward appearance of not ill but look sick. It is a good indicator
I imagine the sensitivity and specificity of this varies by provider though. I know as a med student on clinicals I am still very much calibrating my sick/not sick-ometer.
The End-of-the-bed-o-gram produces the LLS score
Ah, I have something similar in my clinic-we call it a SAS sign-“sick as shit” and is either positive or negative
We call it "OMG score", patient can be OMG positive or negative. Omg stands for the same things you would use it for generally, being: "oh my god"
The LLS score in trauma is a good barometer of whether they need blood product resuscitation or not, as well.
This is one of mine, haven't named it yet.
Patient over age 50, laying diagonally in bed (Head in top L, feet in bottom R for example) = delirium, or at the very least some other variant encephalopathy, until proven otherwise.
An alternate presentation is patient in bed but legs handing off the side/over the side rail
Hypotenuse sign? C-square sign?
Nah, those are boring. Call it: "Modern Major General Sign".
I saw something similar working on Med-Surg/Onc--if the patient cannot be convinced that they're not falling out of bed (bed is stable, not one of the fancy fluid mattresses), they will not be there for your next shift.
Sometimes they go for a full 180 with their head at the foot of the bed.
We had a guy recently kept rotating himself sideways in the bed and talking about the clock going clockwise and it took all night to realize he was the clock trying to go clockwise around in the bed
Or they're tall. I'm not NBA tall, but that's how I sleep in almost every bed just to straighten my legs
AKA the ballsack sign. If you can see the boys from the hallway, delirium.
"Mr. Jones I used to think you were just crazy. But now I can see your nuts."
Or:
I don't know where I am, I don't know why I'm here or even what day it is. What I do know is I need to get the fuck out of here and I need to be nekkid right god-damn-now.