One of the things you have to learn in order to sound smart while presenting a case (in other words, telling a patient’s story) is how to make generous use of signs. In general, signs are objective manifestations of illness, as opposed to symptoms, which are subjective: for example, in strep throat, severe pain is a symptom while white patches on the tonsils are a sign. Obviously, it is very important to make note of these.
Lots of them are eponyms: for example, Lhermitte’s sign is a sensation of electricity shooting down the spine while bending the neck forward; it’s considered classic for multiple sclerosis. (It’s also technically a symptom, not a sign, if we’re going to be pedantic about it, which of course we are.) Kernig’s sign and Brudzinski’s sign are pain when the leg is raised by an examiner, and pain causing involuntary hip flexion when the neck is flexed by an examiner, respectively; both are classic for meningitis, and I can never keep them straight. Grey Turner’s sign, bruising in the flank area, indicates internal bleeding and is frequently checked for in cases of pancreatitis. (Most of these signs have not been exhaustively investigated and it’s unclear how useful they actually are, but we love them anyway.)
When reporting these, we generally say something like “The patient has a positive Brudzinski sign.” This formulation is apparently so catchy that it has spawned a whole slew of other signs, most not particularly respectful.
Some are flippant terms for actual helpful diagnostic findings. For example, patients with pelvic inflammatory disease usually exhibit exquisite cervical motion tenderness. This is sometimes referred to as a “positive chandelier sign,” as in, the patient is jumping up to the chandelier during the pelvic exam. Of course, no one would write this in a medical record, but it’s not uncommonly heard in emergency rooms.
Then there are some terms that grow up in particular institutions. One that I’ve heard several times is the “10 allergies” sign. Patients who list more than a small handful of allergies are much more likely than others to have multiple vague complaints that are beyond the powers of modern medicine to solve, and I’ve heard more than one resident grumble “positive 10-allergy sign” before going in to see a patient.
I think the best (and also worst, in some sense) of the irreverent terms is the “fish sign.” You see, our hospital has a big fish tank stocked with many beautiful tropical fish. There’s a camera which broadcasts a view of the fish on the hospital’s closed-circuit TV system. Patients who are comatose, severely demented, or otherwise unable to express their viewing preferences often have their TVs set to the fish channel. That’s a positive fish sign. It’s considered a poor prognostic indicator.