Kk Pattern Recognition Ii

Front 1

50M dilated cardiomyopathy after travel to South America

Back 1

Chagas

Hint 1

CM--> SOB, swelling + weight gain, trypanosome cruzii, reflux + megacolon

Front 2

25M midsystolic murmur, louder with Valsalva

Back 2

HOCM

Front 3

65M drug for NYHA class 2 systolic dysfunction

Back 3

ACE

Front 4

55F AA restrictive cardiomyopathy, arrhythmia, wheezing

Back 4

Sarcoidosis

Front 5

25M CP on recumbency, diffuse 2 mm ST elevations on EKG

Back 5

Pericarditis

Hint 5

Most commonly viral

Front 6

58M hyperlipidemia, diffuse weakness

Back 6

Statin induced myopathy

Hint 6

increased CPK, LDH, aldolase, maybe AST and ALT

Front 7

70 M orthopnea, PND, BP 160/90, HR 110, crackles, sinus tach, LVH, normal EF, what drugs to give?

Back 7

diuretic, B blocker, Ca blocker

Hint 7

stiff LV with normal EF is diastolic dysfunction, from long standing HTN

Front 8

72F CHF, EF 25%, blurry yellow vision

Back 8

dig toxicity

Front 9

45M a fib, hospitalized, sudden SOB, afebrile, HR 110, RR 28, BP 95/60, new R axis deviation and RBBB

Back 9

PE

Hint 9

Most common EKG with PE is sinus tach, classic is R axis deviation, S1 Q3 T3

Front 10

25M hepatitis C, develops CHF, what hx?

Back 10

IV drug use, HIV

Front 11

30W 34 weeks pregnant, tearing sensation in chest radiates to back

Back 11

aortic dissection

Hint 11

secondary to HTN

Front 12

58M hx of v tach, on meds, develops SOB, fatigue, and cold intolerance

Back 12

amiodorone

Hint 12

check PFTs, TFTs, and LFTs for patients on amiodorone

Front 13

25M intermittent palpitations, baseline ECG his wide QRS and short PR

Back 13

WPW

Hint 13

delta wave, early contraction of ventricle

Front 14

45F palpitations, HR 190, narrow QRS, no P waves

Back 14

SVT

Front 15

80M chest pain, 3/6 harsh murmur at RUSB, diagnosis and other sx?

Back 15

Aortic stenosis

Hint 15

assoc with angina (35-50%), syncope, and HF, delayed carotid upstroke, soft S2, S4, may reflect to mitral area- Gallavardin's phenom

Front 16

36 IV drugs LLSB systolic murmur, louder with inspiration, what wave most prominent in JVP

Back 16

v wave

Hint 16

tricuspid regurgitation

Front 17

58F decrescendo diastolic murmur LSB, uvula pulsations, wide pulse pressure

Back 17

aortic insufficiency

Front 18

70M ST elevation in 2,3,avf, what additional ECG analysis?

Back 18

R sided EKG for RV infarcts

Front 19

35F Raynaud's, GERD, increasing DOE

Back 19

pulm HTN 2ndary to CREST

Front 20

55F diabetes, arthritis, cirrhosis, arrhythmia, runs in family

Back 20

hemochromatosis

Front 22

30 fatigue, weight gain, cold intolerance

Back 22

hypothyroid

Front 23

40F obesity, HTN, new hyperglycemia

Back 23

metabolic syndrome

Front 24

60F hypercalcemia, hyperphosphatemia, health food junkie

Back 24

vitamin D toxicity

Front 25

50 HTN, tachycardia, flushing

Back 25

pheochromocytoma

Hint 25

HTN may be intermittent

Front 26

65M diarrhea, weight loss, a fib

Back 26

hyperthyroid

Front 27

60M fasting blood sugar 130 on 2 different ocassions

Back 27

diabetes

Hint 27

fbs>126 two times

Front 28

60M galactorrhea

Back 28

prolactinoma

Front 29

50M thyroid ca and neurofibromas

Back 29

MEN 2b

Hint 29

also includes pheo, MEN2a= thyroid, parathyroid, pheo, MEN1= parathyroid, pancreatic, pituitary

Front 30

75 hypercalcemia, long tobacco hx

Back 30

squamous cell lung ca

Front 31

18F hypoglycemia, mom has DM2

Back 31

factitious

Front 32

40F proptosis and palpitations

Back 32

Graves

Front 33

30F has 8 month old, increased fatigue

Back 33

postpartum thyroiditis

Front 34

50F hypokalemia, HTN

Back 34

Conns

Hint 34

aka primary hyperaldo

Front 35

25F hirsutism, amenorrhea

Back 35

polycystic ovarian dz

Front 36

55M bilat visual field loss, headache

Back 36

pituitary tumor

Front 37

60M meningococcemia, severe hypotension and hyperkalemia

Back 37

Waterhouse Friderichsen

Hint 37

due to meningococcemia, hemorrhage into adrenal glands

Front 39

35M wheezing while working on assembly line

Back 39

occupational asthma

Front 40

65M heavy tobacco, sputum each morning for 3 months each year

Back 40

chronic bronchitis

Front 41

55M, thin smokes 1ppd, pursed lip breathing

Back 41

emphysema

Front 42

45M large bullae at bases on CXR, fam hx of lung dz

Back 42

alpha 1 antitrypsin deficiency

Front 43

30F tender nodules on shins, intermittent wheezing, arthralgias

Back 43

sarcoidosis

Hint 43

see cardio 4

Front 44

66M sinus tenderness, 2+ blood on UA, caviation on CXR

Back 44

Wegeners

Hint 44

positive c-ANCA

Front 45

50 severe wheezing, peripheral eosinophilia

Back 45

Churg-Strauss

Hint 45

aka allergic asthma or angiitis

Front 46

30M nonsmoker, hemoptysis, hematuria

Back 46

Goodpastures

Front 47

45F ulnar deviation, MCP stiffness, SOB, pleural effusion and lung nodules

Back 47

rheumatoid lung dz

Front 48

35 IVDA cannonball lesions peripherally on cxr

Back 48

septic pulmonary emboli

Front 49

65 nephritic syndrome, acute SOB, tachypnea, tachycardia, normal cxr

Back 49

PE

Hint 49

nephritic syndrome --> decreased protein c and s

Front 50

35F comm acquired pneumonia, bilateral infiltrates, Na 130, transaminases slightly high, diarrhea

Back 50

Legionella

Front 51

30F photosensitivity, alopecia, pleuritic chest pain

Back 51

SLE

Front 52

50M obese bilateral 2+ pitting edema, wife claims he is "lazy"

Back 52

cor pulmonale due to OSA

Hint 52

other serious OSA complications- arrhythmias, pulmonary HTN

Front 53

25F progressive chest pain and SOB over months

Back 53

primary pulmonary HTN

Front 54

65M diffuse basilar crackles despite diuresis, interstitial infiltrates on baseline cxr

Back 54

interstitial pulmonary fibrosis

Front 55

60M methotrexate therapy for psoriasis, progressive sob

Back 55

pulmonary fibrosis

Front 56

35M homeless, pleural effusion

Back 56

TB

Front 57

55M recent CABG, L sided pleural effusion on cxr one month post-op

Back 57

Dressler's Syndrome

Hint 57

aka post MI syndrome, 1-12 weeks after infarction, autoimmune, pericarditis and possible effusion

Front 58

25M HIV, chest pain, pneumothorax

Back 58

PCP

Front 60

23F photosensitivity, arthralgias, pleuritic chest pain

Back 60

SLE

Front 61

50M dry mouth, arthralgias, peripheral neuropathy

Back 61

Sjogrens

Front 62

60F one hour of morning stiffness in bilateral wrists, effusion on CXR

Back 62

rheumatoid arthritis

Front 63

70M alcohol abuse, tender warm left ankle, no fevers

Back 63

gout

Front 64

20 student R knee swelling and warmth

Back 64

gonorrhea

Front 65

50M new heart murmur, red warm L elbow

Back 65

septic emboli

Front 66

73F swollen DIP joints for months

Back 66

OA

Front 67

45M sausage digits, scaly skin plaques

Back 67

psoriasis

Front 68

25 eye irritation, ankle swelling, dysuria

Back 68

Reiters

Hint 68

conjunctivitis, arthritis, urethritis

Front 69

50 oral and genital ulcers, arthralgias

Back 69

Behcets

Hint 69

a type of vasculitic syndrome

Front 70

35F purpuric lesions on shins, renal insufficiency

Back 70

HSP or cryoglobulinemia

Hint 70

cryo- many pts have HCV in the immune complexes

Front 71

40F reflux, digits get painful in cold, sob

Back 71

scleroderma/ CREST

Front 72

50F difficulty brushing hair, rash around eyes

Back 72

dermatomyositis

Front 73

50F dermatomyositis, what further eval?

Back 73

malignancy

Front 74

60F lupus, pain out of proportion to abdominal exam

Back 74

mesenteric ischemia

Hint 74

due to vasculitis

Front 75

25F 3 pregnancies with 3 miscarriages

Back 75

antiphospholipid ab syndrome

Hint 75

coagulation abnormalities

Front 76

30F depression, multiple tender areas

Back 76

fibromyalgia

Front 77

35F angioedema, hx in father

Back 77

C1 esterase deficiency

Front 78

50M low back pain, sacroiliitis on pxr

Back 78

ankylosing spondylitis

Front 79

70M h/o iron overload, joint pains in wrists

Back 79

pseudogout

Front 81

65F painless jaundice

Back 81

pancreatic head tumor

Front 82

45F pruritis, xanthelasmas, AP 8x normal

Back 82

primary billiary cirrhosis

Front 83

50M ulcerative colitis, newly elevated AP

Back 83

primary sclerosing cholangitis

Front 84

40M IVDA purpuric lesions on shins, jaundice, arthralgias

Back 84

cryoglobulinemia

Hint 84

assoc with Hep C

Front 85

60M tan, arrhythmia, mild elevation of liver enzymes, blood glucose 200, arthralgias

Back 85

hemochromatosis

Front 86

25F new liver dz, no alcohol, fam hx

Back 86

autoimmune hepatitis

Front 87

25M homosexual, new jaundice, dark urine, mild RUQ discomfort, vaccinated for Hep B with proven Ab

Back 87

Hep A

Front 88

18M elevated liver enzymes, new gait dysfunction

Back 88

Wilsons

Front 89

35M homosexual, severe odynophagia, white plaques in oral cavity

Back 89

esophageal candidiasis, thrush

Front 90

70M LLQ cramping pain, similar episodes in past, heme positive

Back 90

diverticulitis

Front 91

70 pencil thin stools

Back 91

rectal mass around anus

Front 92

45F Roux-en-Y for weight loss, greasy malodorous stools

Back 92

malabsorption

Hint 92

aka dumping

Front 93

50M copious diarrhea, skin flushing

Back 93

carcinoid

Front 94

65F 30# weight loss in past year, iron deficiency anemia, heme pos stools, no abd pain

Back 94

colorectal cancer

Front 95

68M CAD, PVOD, post prandial pain 30 minutes after eating

Back 95

mesenteric ischemia

Front 96

55M rheumatoid arthritis, gnawing pain radiating to back, improves with eating

Back 96

PUD

Hint 96

duodenal ulcers usually feel better with food

Front 97

35 alcoholic severe epigastric pain after recent binge episode

Back 97

acute pancreatitis

Front 98

18 3 days of abd pain, shifted from umbilicus to RLQ

Back 98

appendicitis

Front 99

18F LLQ pain, vaginal discharge, sexually active

Back 99

PID

Front 101

80M h/o nocturia, suprapubic tenderness, rising creatinine, hydronephrosis

Back 101

obstruction

Hint 101

eg. BPH, prostate ca

Front 102

30F fevers to 102, renal failure, thrombocytopenia, schistocytes

Back 102

DIC

Hint 102

may see mental status changes

Front 103

65M CAD, PVOD, started on lisinopril, Cr from 1 to 4.5

Back 103

renal artery stenosis

Front 104

65F unstable angina, rising Cr, microscopic hematuria, 2 blue toes

Back 104

atheroemboli

Hint 104

see decreased complement levels

Front 105

70M LE edema to waist, lost weight over 18 months, intermittent BRBPR

Back 105

membranous glomerulopathy

Hint 105

assoc with carcinoma, also with infection, autoimmune dz or drugs, most common primary nephrotic syndrome in adults

Front 106

16F recent URI, Cr 3.0 three weeks later, red cells on UA

Back 106

poststrep GN

Front 107

67M CAD, 4 drugs to get bp control, what will renal US show?

Back 107

renal artery stenosis

Front 108

55M DM, retinopathy, nephropathy, neuropathy, Cr 1.7, what antihypertensive should he get?

Back 108

ACE I

Front 109

60M unasyn for pneumonia, 10 days later pyuria and peripheral eosinophilia, Cr from 1.1 to 2.5

Back 109

Allergic Interstitial Nephritis

Front 110

60M s/p MVA, hypernatremia, UA specific gravity 1.002

Back 110

diabetes insipidus

Front 111

55 diabetic, non-anion gap hyperchloremic metabolic acidosis and hyperK

Back 111

Type 4 renal tubular acidosis

Hint 111

hyporeninemic hypoaldo

Front 112

25F fever to 102, R flank pain, pyuria

Back 112

pyelonephritis

Front 113

55M primary hyperparathyroidism, left flank pain, hematuria

Back 113

nephrolithiasis

Front 114

17M abdominal pain, arthralgias, hematuria, elevated serum IgA

Back 114

HSP

Front 115

65M pancytopenia, back pain, rising Cr, elevated protein/albumin ratio

Back 115

multiple myeloma

Front 116

55F neuropathy, arthralgias, renal failure, pANCA positive

Back 116

PAN

Front 117

25 microscopic hematuria becomes macroscopic after flu like illness

Back 117

IgA nephropathy

Hint 117

aka Bergers

Front 118

35F 3rd trimester, hyperreflexia, edema, proteinuria

Back 118

pre-eclampsia

Front 119

70M 3 days IV piperacillin and gent for pneumonia, oral cipro, Cr at discharge was 1.2, Now Cr 2.5 one wk later, BUN unchanged

Back 119

Aminoglycoside toxicity

Front 120

15 diarrhea, renal failure, after eating at Jack in the Box

Back 120

HUS

Hint 120

0:157 H:7 E Coli

Front 122

35 resident of UP, epigastric discomfort and copious diarrhea, neg fecal leukocytes

Back 122

Giardia

Hint 122

treat with flagyl, stool ova and parasites, from well water, kids in day care

Front 123

50 alcoholic fatigue, gradual increase sob, fevers, pleural fluid that doesn't layer on decubitus films

Back 123

aspiration pneumonia

Hint 123

think anaerobes, treat by drainage, empyema doesn't layer

Front 124

18 new hematuria and rising Cr 2 weeks after severe URI

Back 124

post strep GN

Hint 124

low complement

Front 125

21 LUQ discomfort, sore throat, fatigue, post cervical LAN

Back 125

mono

Front 126

parasitic cause of vit B12 deficiency

Back 126

fish tapeworm

Hint 126

Diphyllobothrium

Front 127

2 infections by Ixodes tick vector

Back 127

Lyme dz, Babesiosis

Hint 127

treat Lyme with doxy, treat Babesiosis with clinda

Front 128

40M severe R flank pain, 100+RBC/HPF, ph9.0, what org?

Back 128

Proteus

Hint 128

struvite stone, treat with quinolone

Front 129

35M HIV fever, chills, rigors, LLL infiltrate on CXR

Back 129

strep pneumo

Front 130

55F HIV CD4 count 100, sudden onset sob, pneumothorax

Back 130

PCP

Hint 130

treat with IV bactrim and steroids

Front 131

65M colon ca, fevers and chills, GPC in chains

Back 131

strep bovis

Hint 131

gut gram positive bug

Front 132

20M interstitial infiltrates, fever, nonproductive cough

Back 132

mycoplasma

Hint 132

treat with azithromycin

Front 133

40M exposure to prostitutes, maculopapular skin rash, sore on penis 2 months earlier

Back 133

syphillis

Front 134

parasitic cause of portal hypertension and bladder ca

Back 134

schistosomiasis

Front 135

35M sepsis, widespread purpura, DIC, adrenal insufficiency

Back 135

meningococcemia

Hint 135

Waterhouse Friedrickson

Front 136

40M immunocompromised, respiratory complaints and skin lesions, broad based budding yeast in sputum

Back 136

blasto

Front 137

65F s/p BMT, new hemoptysis, cavitary lesion with fungus ball on cxr

Back 137

aspergillus

Front 138

60M 2 wks on Abx, watery diarrhea

Back 138

C diff

Front 139

45M duodenal ulcer bx

Back 139

H pylori

Front 140

55M homeless, weight loss, fatigue, sterile pyuria on UA persists despite Bactrim and Augmentin

Back 140

tb

Front 141

35M rash, arthralgias, Cape Cod

Back 141

Lyme dz