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1158 Cards in this Set

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“Ash leaf” hypopigmentation of trunk & Ext, shagreen patch, sebaceous adenomas, seizures, mental retardation; Ass. w/ PCK, renal hemartomas
Tuberous sclerosis
< 2 days post-op with fever
Atelectasis
< 2mo fever
Septic w/u - blood Cx, LP
< 40 yo male with Fever, perineal pain, dysuria.
Acute prostatitis caused by Chlamydia & N. gonorrhea. Treat accordingly (Bactrim #2 choice). > 40yo think e. coli is cause (Tx w/ FQ)
< 5yo fever, seizures
Febrile seizure
< 70 yo blindness
DM retinopathy (MCC)
<35 yo, college students. Fever, cough, +/- sputum, chills, muscle aches
Mycoplasma pneumonia
> 70 yo blindness
Macular degeneration
>35yo with PNA. Rusty colored or yellow-green sputum. Acute onset F/C
Strep. Pneumonia
>50 yo female w/ HA. Temporal artery tenderness or blindness
Temporal arteritis (Giant cell arteritis). Elevated ESR, get temporal artery biopsy
>50 yo obstructive voiding sx, nocturia. Firm smooth enlarged prostate. Nl PSA
BPH. (Cancer would have firm, irregular, nodular non-tender prostate, elevated PSA)
>60yo F, LLQ pain
Diverticulitis. IV Abx, fluids, NPO.
12 – 15yo overweight male knee pain, limp, hip pain (knee XR normal)
SCFE
1st tooth (central incisor)
6 – 8 mo
20yo female w/ rubbery, firm, well-circumscribed, non-tender breast lesion, doesn’t change w/ cycle
Fibroadenoma
3 mHz spikes on EEG
Absence (petit-mal) seizures.
3 words, fees self w/ spoon, builds tower
24 mo
30 – 50yo female, painful, multiple, bilateral breast masses that increase in pain and size before menses
Fibrocystic breast disease
45,X – low hairline, low set ears, webbed neck, short stature; shield chest, wide set nipples, infertility, lack of Secondary sex characteristics
Turners (gonadal dysgenesis
6cm unilateral, mobile, tender adnexal mass
Tubo-ovarian abscess
8 – 10yo male with limp, knee pain
Legg-Calve-Perthes Disease
Abdominal distension, bloating, intermittent, colicky pain, high-pitched rushes & tinkles
SBO
Abdominal pain, diarrhea after picnic/party. Eaten ham, cream, custards, mayonnaise
Staphylococcus aureus infectious diarrhea
Acetowhitening
Condyloa acuminata
Acute bacterial diarrhea w/ prodrome of HA, F, then crampy abd pain & diarrhea
Campylobacter jejuni – most common cause of acute bacterial diarrhea
Acute joint pain. Swollen, warm, erythema.
Septic arthritis (synovial fluid = leukocytosis, low glucose)
Acute Painful red eye, halos (or colored rings around lights), hazy, steamy cornea. Pupil is fixed and (mid) dilated. Onset after being in dark room
Acute angle-closure glaucoma
Acute steroid withdrawal
Addison’s disease, crisis
Acute swollen big toe
Gout
Adolescent female w/ HA. +FHx. Severe HA, N/V, photphobia. +/- auras
Migraine HA
Adolescent female with midcycle pain alternating from left to right side. Relieved w/ NSAIDs
Mittelschmerz
Adolescent male with knee pain, tenderness over tibial tuberosity
Osgood-schlatter disease
Afebrile, watery or loose stool. No blood or mucus
Viral Gastroenteritis
Afferent papillary defect, marcus-gunn pupils
Optic nerve lesion. Tertiary syphilis (marcus-gunn)
AFP
Hepatocellular carcinoma, testicular seminoma (germ cell tumor)
Air fluid levels on upright abd plain film
SBO
Air under diaphragm, rigid board-like abdomen
Perforated viscus, perforated ulcer
Airway edema with eosinophils, neutrophils, lymphocytes
Asthma
Alcoholic with DOE, heart failure
Primary dilated CM
Alcoholic with massive hemoptysis
Esophageal varicies (Tx w/ octreotide)
Alcoholic with palpitations, arrhythmia
Atrial fibrillation (Holiday heart)
Anemia after colectomy, partial gastrectomy. Glossitis, decreased vibratory sensation
B12 or Pernicious anemia
Antidepressant use w/ anticholinergic side effects, dry mouth, dysrhythmias, sedation, orthostatic hypotension
TCA overdose
Anti-endomysial antibodies
Celiac Sprue
Antipsychotic meds (phenotiazines), facial tics, lip smacking, tongue disorders, blinking, ataxia
Tardive dyskinesia
Apical infiltrates, F, C, dry cough
TB
Apple core lesion
Colon Cancer
Ascending paralysis
GBS
Atrial fibrillation or prosthetic valve
Warfarin (2 – 3 for Afib; 2.5 – 3.5 for valve); Tx Warfarin OD is vitamin K
Attacks of severe HA, HTN, glucosuria
Pheochromocytoma – Tx pre-op w/ alpha blocker
Auer rods
AML
Beefy red, sharp bordered rash in groin (infants), under breast folds with satellite lesions
Candida: Tx: Nystatin/Lotrimin cream QID x14d; if fails Ketoconazole
Beriberi
Thiamine; Alcoholics, Neuro Sx
Bilateral DILATED pupils
Anticholinergics, TCA, anti-parkinsonian drugs, profound hypoxemia
Bilateral hemianopia
Optic chiasm lesion
Bilateral pinpoint pupils
Pontine hemorrhage
Binge eating, laxative use, starvation
Bulimia nervosa (Tx w/ SSRI – Fluoxetine)
Bite w/ fever, lacrimation, rhinorrhea, bradycardia, HTN, tachyarrhythmias
Black widow (neurotoxin)
Bite with local edema, erythema, central necrosis
Brown recluse
Bloody Diarrhea
Ulcerative colitis
Blue extremities worse w/ cold exposure, improves w/ warming
Acrocyanosis
Breast mass, nipple retraction, bloody nipple discharge
Breast cancer (mass is most common presenting clinical manifestation)
Bulimia with electrolyte disorders
Hypokalemia, metabolic alkalosis
Bullous myringitis
Mycoplasma pneumonia
CA 19-9
Pancreatic Ca
CA-125
Ovarian Carcinoma
Can’t retract foreskin
Phimosis
Cavitations on CXR
Infections – lung abscess, TB (Gohn focus)
CEA
Colon Carcinoma
Central obesity, abdominal stria, hyperglycemia, moon facies, buffalo hump, easy bruising
Cushing syndrome
Chemotherapy induced N&V
Treat with Ondansetron (Zofran) (5-HT3 blockers)
Children < 10yo w/ vesicles on pharynx, mouth, hands, feet w/ NO ulceration
Hand-Foot-Mouth disease. Coxksackie Virus
Choking, cyanosis, respiratory distress, increased secretions in 1st hours of life
Tracheoesophageal fistula
Christmas tree pattern, erythematous papules w/ oval plaues w/ scaly itchy border. Rash preceded by lagre oval plaque w/ central clearing & scaly border
Pityriasis rosea; Herald patch
Chronic cough, bitter taste in mouth or throat, dyspepsia
GERD
Claudication with rest pain, (ABI < 0.4)
Tx is arterial bypass
Clear vulvar vesicles, inguinal LAD
Herpes virus (Genital)
Cold induced pain at extremities with color change as they warm up
Raynaud’s phenomenon
College student with sore throat. Enlarged tonsils, anterior cervical LAD. Splenomegaly. CBC – elevated atypical lymphoctyes
EBV - mononucleosis
Concave
Subdural Hematoma
Concentrated urine. Hyponatremia
SIADH
Conjunctivitis, iritis, arthritis, cervicitis, urethritis
Reiter’s syndrome
Constant, sharp CP worse lying down, better sitting up and leaning forward
Pericarditis
Continuous bleeding post-op or trauma. Given multiple blood transfusions. Low platelets, increased PT, INR, + fibrin split products (increased d-dimer)
DIC
Continuous harsh, machine-like murmur
PDA
Cough, coryza, conjunctivitis
Rubeola (Measles)
Crush injury, alcoholic on ground, elevated CPK, ARF
Rhabdomyolysis
Crushing CP, dyspnea, palpitations, radiation to neck or left arm
Angina (if lasts minutes), AMI if lasts > 30 minutes. Acute Ischemia – ST elevation; Injury – T wave depression; Infarct – Q wave
Curtain or veil over my eyes, new onset floaters
Retinal detachment
Cyanotic infant with systolic thrill @ LSB, systolic ejection murmur +/- click
Tetralogy of falot
Cystic fibrosis w/ PNA
Pseudomonas aueroginosa causative agent
Dark skinned person with “whitening or lightening” of skin. Hx pernicious anemia or other autoimmune disease
Vitiligo. Skin biopsy to diagnose
Decreased radioactive iodine uptake, decreased free T4, increased TSH
Hashimoto’s thyroiditis
Deep breathing alternating w/ apnea
Cheyne-Stokes breathing – heart failure, brain damage
Deterioration of cognitive function, memory
Dementia
Dewdrops on rose petal, pustules & vesicles at different stages of healing
Varicella (Chicken Pox)
Dexamethasone suppression test
Cushing syndrome
Diabetic w/ anorexia, anemia, wt loss, pallor
CRF
Diabetic, ear pain
MOE, Pseudomonas, IV abx (FQ), CT head
Diamond shaped, blowing systolic murmur. May have angina, syncope, CHF
Aortic stenosis
Diastolic murmur best heart at apex without radiation
Mitral stenosis (ARMS are BAD)
Diplopia, dysarthria, dysphagia
Vertibrobasilar insufficiency
Distinct, sharp raised demarcated border with fever, chills. Group A Strep
Erysipelas
Dix-hallpike maneuver
BPPV
DM & HTN Tx
ACEI is best choice
DOE, PND, edema. Echo w/ LVH or RVH, hypokinesis
CHF
Drooling, sniffing position, tripod, toxic
Epiglottitis
dusky red, well localized single or multiple papules or plaques usually of face
Discoid lupus
Dysmenorrhea, dyspareunia, dyschezia. Uterus is fixed, retroflexed. Cyclic pelvic pain. May have palpable pelvic mass
Endometriosis. Palpable pelvic mass – “chocolate cyst”
Dyspnea after surgery, travel (airplane), LE Fx. May have c/o calf pain also.
DVT/PE
Eggshell pattern on CXR
Silicosis (Sandblasters)
EKG changes, N, V, yellow-green visual disturbances
Digoxin toxicity (Hypokalemia will make worse)
Elderly w/ systolic murmur
Aortic stenosis (due to calcifications – age related (or bicuspid valve - congenital)
Elderly with positive hemmocult.
Colon Cancer – get colonoscopy
Elderly, Hx atherosclerosis. Dull crampy periumbilical pain post-prandial
Mesenteric ischemia
Electrical alternans, narrow pulse pressure, pulsus paradoxus
Pericardial effusion/tamponade
Elevated Alkaline phosphatase, urinary bilirubin
Cholecystitis
Elevated AST, ALT, indirect bilirubin
Hepatitis
Elevated Hgb, Hct, splenomegaly, post showering pruritis, plethora, engorged retinal veins
Polycythemia vera; Tx = Phlebotomy
Elevated indirect bilirubin w/ defective glucuronyl transferase
Crigler-Najjar Dz
Enlarged PID, DIP
Osteoarthritis (herberden – PIP; bouchard – DIP)
Erythema marginatum
Rheumatic Fever
Erythema nodosum
Systemic autoimmune diseases (RA, IBD), OCP
Erythematic ring with scaly border & central clearing
Tinea (fungal infection); KOH prep = hyphae
Erythematous, dome-shaped nodule with central plug
Keratoacanthoma
Exogenous corticosteroid use
Cushing syndrome
Exopthalmos, palpitations, wt. loss. Elevated radioactive idodine uptake
Hyperthyroid, Graves Dx – Tx w/ Radioactive iodine
Extrapyradimidal signs, BP changes, altered consciousness, hyperpyrexia, muscle rigidity, dysarthria, CV instability, fever, pulmonary congestion, diaphoresis. Pt on antipsychotic meds
Neuroleptic malignant syndrome. Tx supportive care & antipyretics
Eye trauma, diplopia. Exophthalmos, fixed upward gaze, hyphema
Orbital blow-out fracture; Immediate ophthalmology referral
F, RUQ pain, Jaundice, gallstones & dilated common duct on US
Ascending cholangitis (Charcot’s triad)
Family history of young age colon cancer, multiple polyps found on colonoscopy
Familial adenomatous polyposis (Gardner’s syndrome)
Fat, forty, female, fertile w/ RUQ pain
Cholelithiasis or Cholecystitis
Fatigue, PM sweats, weight loss, painless LAD or neck mass
Lymphoma – do Lymph node biopsy. Bone marrow Bx and CT scan used for staging
Fatigue, weakness, low fever, purpura, pallor, gingival bleeding. No HSM
Aplastic anemia
Feelings of worthlessness, hopelessness, apathy, weight loss, insomnia, daytime sleepiness. Thoughts of suicide
Depression (SSRI = drug of choice)
Female exam, asymmetric posterior chest wall or uneven scapula height with forward bending
Scoliosis (> 25 degree Cobb angle = surgery)
Female morning joint pain & stiffness esp. hand/wrists. MCP joint swelling, ulnar deviation
Rheumatoid arthritis. Methotrexate (DMARDs) #1.
Female or Post MI, systolic murmur best @ apex preceded by click without radiation
Mitral valve prolapse
Female with acute abdominal pain. No characteristic acute abdomen pattern
Ectopic pregnancy
Female with Arthralgias, malar rash, +ANA, + anti-double stranded DNA antibodies, +anti-phospholipid antibodies
SLE
Female with recurrent abdominal pain, alternating diarrhea, constipation. Pain relieved with defecation.
IBS. TCA’s (nortriptyline) good if diarrhea predominant symptom
Female, fatigue, general aching, pain at neck, upper shoulders, sleeping problems, tender points
Fibromyalgia (exercise program good management)
Female, weight loss, palpitations, atrial fibrillation
Hyperthyroid (work it up with TSH, T4)
Fever, cough, sputum. Crackles, decreased breath sounds, dullness to percussion, +egophony, pectoriloquy. CXR – infiltrates or consolidation
Pneumonia
Fever, pharyngitis, “sandpaper” rash over face, neck, trunk, extremities
Scarlet Fever
Fever, RUQ pain, radiation to back
Cholecystitis
Fibrous band on lateral penis
Peyronie’s disease
Firm irregular shaped, NONTENDER enlarged uterus
Leiomyoma
Fishy odor, Thin grayish vaginal discharge, Clue cells
Bacterial vaginitis; Gardnerella vaginalis
Flank pain, hypotension, pulsatile abdominal mass
AAA
Flat brown spots with sharp borders on dorsum of hand
Lentigines
Flesh-colored, pink or yellow-brown lesion with rough, sandpaper feel, at sun-exposed areas
Actinic Keratosis
FOOSH, Radial fracture w/ dorsal displacement, dinner-fork deformity
Colle’s Fx; Tx = volar splint
Football player with burning pain, numbness, tingling from shoulder to hand which resolves
Brachial plexus neurapraxia, “stinger”. Caused by stretching of brachial plexus
Frothy, clear – white or yellow-green to gray adherent vaginal discharge, dysuria, vaginal pruritis. Vulvar and cervical erythema. Flagellated protozoa
Trichomonas
FTA-ABS, MTA-TP
Syphilis diagnosis
G6PD + Quinidine, Nitrofurantoin, Sulfa
Hemolytic anemia
Gangrene
Clostridium infection – an anaerobic bacteria. Tx w/ hyperbaric oxygen, Penicillins, surgical excision
Gastroparesis, impotence, recurrent infections, stocking-glove paresthesia
Diabetic neuropathy (Treat w/ TCA (amitriptyline)
Giant Multinucleated cells
Herpes virus (Genital)
Gram negative intracellular diplococcic
Gonorrhea
Gram stain
Bacterial infections
Granulomas and inflammation of alveoli, small bronchi and small blood vessels
Sarcoidosis
Gray pharyngeal pseudomembrane, rash, splenomegaly, supraclavicular LAD
Diphtheria
Greasy, foul smelling, floating stools. Pear-shaped flagellated protozoan w/ 2 “eyes”. Water, travel, camping history
Giardia
Grossly elevated blood pressure esp. w/ signs of EOD
Malignant or Urgent HTN
Ground glass appearance on CXR
Asbestosis (shipbuilders, building demolition)
Grouped vesicles on erythematous base
Herpes virus
H.pylori gastritis
2antibiotics & PPI
HA worse in AM w/ focal neuro deficits
Brain Tumor (MC is glioma)
HA, sinus pressure, yellow – green nasal discharge
Sinusitis – CT is gold standard
Hand injury after a punch
Boxer’s fracture. Ulnar gutter w/ intrinsic plus positioning. ORIF if angulation > 40 degress
Hard periumbilical nodule
Sister mary Joseph nodule = indicates metastatic gastric and pancreatic cancers
Head trauma, disoriented – lucent – coma
Epidural Hematoma
Healthy looking < 5yo with lace-like rash on both cheeks – red papules
Erythema infectiosum “Slapped cheek”, “5th Dz”.
Hearing loss or tinnitus w/ metabolic acidosis
Aspirin OD
Heart failure after URI
Myocarditis
Heart failure, LVH
ACEI (improves survival, prevents development of heart failure Sx)
Hematuria, purpuric rash following streptococcal infection
Glomerulonephritis, HSP
Hematuria, RBC casts, proteinuria
Glomerulonephritis
Hemophilia A, Duchennes MD
X-linked Recessive
High fever (up to 105oF) x 5 days then rash. May have conjunctivitis, cracking, lip fissures
Kawasaki’s Disease; look for cardiac complications (myocarditis, pericarditis, arteritis, aneurysms)
High output heart failure
Pregnancy, thyrotoxicosis, anemia, beriberi, paget’s disease
Hilar mass on CXR
Lung Ca
HLA-B27
Ankylosing spondylitis, Reiter’s syndrome
Holosystolic murmur @ LSB, may have ventricular hypertrophy
VSD
Honey colored crusts on erythematous base around nose & mouth
Impetigo. Tx = Mupirocin
Horizontal Nystagmus, acute onset vertigo
Peripheral lesion
HTN not responsive to basic meds
Think secondary HTN most likely Renal artery stenosis (infrarenal artery).
HTN not responsive to meds
Renal artery stenosis (Infrarenal artery)
HTN Tx w/ meds, cough or angioedema
ACEI is cause
HTN w/ hypernatremia, hypokalemia
Primary Aldosteronism
Hx angina but no acute sx. EKG no acute changes.
Do Exercise stress test
Hx CHF on diuretic & digoxin
Suspect dig toxicity (hypokalemia from diuretic = dig toxicity)
Hx HTN, nephrotic syndrome, CRF or Renal insufficiency. Know CBC.
Anemia
Hx IBD, progressive RUQ pain, wt loss, F, jaundice & pruritis. Elevated bilrubin & alkaline phosphate. ERCP with bile duct stenosis, dilatation
Primary sclerosing cholangitis (diffuse intra- and extrahepatic duct sclerosing and dilatation)
Hx URI the palpable purpuric rash to buttocks, posterior thighs
HSP (Hx post Strep A infection)
Hyaline Casts
Normal (may be present after febrile illness, strenuous exercise)
Hyperinflation on CXR, tear drop heart
Emphysema
Hyperpigmentation, hypoglycemia, orthostatic hypotension, hypotension not responsive to fluids, hypotension following an illness, trauma, or surgery
Addison’s disease, crisis (Low aldosterone; get Random or AM cortisol, ACTH stimulation test)
Hypoglycemia despite glucose administration. Increased C-peptide
Insulinoma
Hypoglycemia in alcoholic
Give Thiamine before glucose to prevent Wernicke’s encephalopathy
Hyponatremia w/ bizarre behavior.
Lithium toxicity
Hyponatremia, hyperkalemia
Acute adrenal insufficiency (Addison’s crisis)
Hypopigmented lesions, white, scaly. Gets worse w/ tanning or sun exposure
Pityriasis Alba
Incontinence with straining
Stress
Increased BUN/Cr, low FeNa
Prerenal Failure (Azotemia)
Indirect immunofluorescent Ab, Weil-Felix rxn, complement
RMSF (Rickettsia rickettsia)
Infant or pediatric w/ grouped vesicles on thumb or “tapioca” vesicles on thumb
Herpetic whitlow
Infant w/ dyspnea, difficulty feeding. Holosystolic murmur @ LSB, 3rd ICS. LVH & RVH
VSD
Infant w/ erythematous, scaly crusty lesions at vertex of scalp
Cradle cap – seborrheic dermatitis (Tx in infants w/ baby shampoo, warm olive oil compress, mild Hydrocortisone cream; Adults – selenium sulfide shampoo)
Infant w/ round face, large protruding tongue, dry skin, umbilical hernia, constipation, enlarged abdomen, poor feeding, delayed developmental milestones
Congenital Hypothyroidism
Inflammation of glans
Balanitis
Infrequent blinking, tremor, rigidity, bradykinesia, shuffling gait, masked facies
Parkinson’s
Inspiratory stridor
FB, viral croup (laryngotracheobronchitis)
Intense pruritis esp. PM. Burrow like lesions at wrists, elbows, hands, webs of fingers
Scabies
Introduce solid foods (cereal, fruits)
4 – 6 mo; after 6 mo add meat, eggs, starchy foods
Irregular irregular
Atrial fibrillation; (if > 48 or chronic – anticoagulate)
Irritative voiding symptoms, Fever, chills, CVA tenderness
Pyelonephritis
Isolated elevated indirect bilirubin
Gilbert’s syndrome
IVDA w/ new murmur
Bacterial endocarditis (strep. Viridians)
JVD, Hypotension, muffled heart sounds
Pericardial effusion/tamponade (Beck’s triad)
Kidney & lung bleeding (hematuria, hemoptysis)
Goodpasteures
Knee injury during football game
ACL (look for description of lachman or drawer test)
KOH
Fungus, Candida; Hyphae & buds, spaghetti & meatballs
Large joint pain. Knees w/ medial joint space narrowing, osteophytes. No erythema or warmth.
Osteoarthritis. Acetaminophen #1 choice
Lateral displaced PMI, Canon “a” waves, Quincke’s pulse, Corrigan’s pulse, Austin flint murmur, deMusset’s sign, water
Aortic Regurgitation/Insufficiency: Quincke’s pulse (subungual capillar pulsation), Corrigan (rapid rise and fall), Austin filnt (low pitch middiastolic murmur at apex)
LE pain after long periods of standing. Dilated, tortuous, veins
Varicose veins. Tx w/ compression stockings
LE rubor, no hair, brittle nails, pallor on elevation, calf or LE pain esp. with walking short distances relieved with rest or at PM
Arterial insufficiency/PAD, Intermittent claudication (ABI best choice, ateriogram gold standard)
Lens shaped hemorrhage
Epidural Hematoma
Loss of central vision
Ipsilateral optic nerve lesion
Low output heart failure
Ischemic heart disease, HTN, dilated CM, valve disease, arrhythmia
LP w/ decreased glucose, increased protein
Bacterial meningitis
LP w/ decreased protein, very few neutrophils
syphilitic meningitis
Lung scan with perfusion defects
PE
Lytic lesions in the back or skull
Multiple myeloma
Magenta tongue
Riboflavin deficiency (B2)
Malaria prophylaxis
Chloroquine
Male w/ gynecomastia, diminished or delayed secondary sex characteristics, small firm testicles, long arms & legs (eunechoid body habitus)
Klinefelter Syndrome XXY. Low serum testosterone & infertility.
Male w/ low back pain, stiffness. Pain worse wakening, improve during day. Decreased ROM at spine. Plain films show sacroiliac abnormality. HLA-B27 positive
Ankylosing spondylitis; Tx = NSAIDs (Indomethacin)
Male, recurrent relapsing HA. Worsened w/ EtOH, Lacrimation, salivation, rhinorrhea
Cluster HA
Mechanical valve or prosthesis & Dental, GU, GI, or ortho procedure prophylaxis
Bacterial endocarditis (strep. Viridians) prevention
Meconium-stained amniotic fluids
Fetal distress
Meningitis & <2mo
Grp B Strep, E. coli (Tx < 1yo = Vanco + Rocephin)
Meningitis < 4yo
H. flu, Grp B strep, N. meningititis
Meningitis > 2yo, adults
Strep, N. meningititis
Meningitis and rash
Meningiococcal
Mousy urine
PKU
MRSA
“spider bite” appearing lesion that turns into abscess. Tx w/ Vanco +/- rifampin, gentamicin, linezolid
Mucosal or gingival bleeding, epistaxix, menorrhagia
Von Willebrand disease
Multiple or constant GI ulcer pain despite medications
Zollinger-Ellison Syndrome
Murmur & Hx rheumatic heart disease
Mitral stenosis #1, Tricuspid Stenosis #2
myelin fragments, ↑ IgG, oligoclonal bands (Pathognomonic); Lhermitte’s sign = electrical sensation down body w/ neck flexion
MS
N/V, epigastric abdominal pain, worse supine, caused by alcohol ingestion, or following fatty meals
Acute pancreatitis
Neonate w/ projectile vomiting. Olive sized mass.
Pyloric stenosis
Neurofibromatosis
Autosomal dominant
New murmur after MI (esp. if apical systolic)
Mitral regurgitation (caused by papillary muscle rupture)
Night blindness
Vit A deficiency
Non-pruritic, raised, warty brown-black plaques, stuck onto skin feel greasy
Seborrheic keratosis
Oliguria, hematuria, proteinuria following streptococcal infection
Acute glomeruloneprhitis
Osteomyelitis after stepping on nail wearing sandals or tennis shoes
Pseudomonas aeruginosa (foam padding in shoes)
Otitis media
Strep. Pneumonia, H. influenza, strep. Pyogenes, moraxella catarhallis
Overweight, irregular menstrual cycles (poss. Amenorrhea), elevated blood sugar, hirsutism
PCOS (stein-leventhal syndrome)
Pain after tx of fracture w/ cast
Compartment syndrome
Pain at base of thumb, distal radial styloid. Pain reproduced with ulnar deviation of clenched fist.
deQuervain’s tenosynovitis
Pain on plantar foot @ 2 – 3rd metatarsal. Associated w/ tight shoes, relieved by removing shoes. Palpable painful mass
Morton’s neuroma; Tx w/ NSAIDs, wide shoes, then steroid injections
Pain preceding vesicular rash in dermatomal pattern
Herpes Zoster (if involved eye = herpes keratitis. NO steroids. Get immediate ophthalmology referral)
Painful swelling of upper or lower eyelid
Hordeolum
Painless bony mass. Plain films = stalky or broad-based projection from bone surface
Osteochondroma
Painless hematuria, flank pain or mass
Renal cell Carcinoma
Painless LAD (us. Neck or axilla), LAD in orderly fashion; “B” signs + pruritis; splenomegaly; LN pain after drinking alcohol
Hodgkin’s lymphoma
Painless LAD us. Scattered. “B” signs
Non-Hodgkin’s lymphoma
Painless rectal bleeding in pediatrics
Meckel’s diverticulum
Painless rectal bleeding. Bulging perianal mass w/ straining
Internal hemorrhoids
Painless vision loss. History of HTN
CRVO (blood & Thunder, retinal hemorrhages)
Painless vision loss. History of TIA, palpitations, arrhythmia, carotid disease, embolic source
CRAO (pale retina, cherry red macula)
Painless, nontender nodule on upper or lower eyelid
Chalazion
Painless, yellow triangular nodule on conjunctivia
Pinguecula (more common on nasal side)
Pale, edematous, boggy turbinates
Allergic rhinitis
Paplitations, tremors, hyperventilation or respiratory alkalosis, numb or tingling mouth or extremities
Anxiety
Paralysis after Campylobacter enteritis
GBS
Pastia’s lines, positive ASO titer
Scarlet fever (Grp A Strep)
Patchy fibrosis on CXR
Farmers lung
Peaked T-waves
HyperKalemia
Pearly papule with umbilicated center
Molluscum contagiosum
Pediatric wheezing
lower respiratory FB, asthma
Pediatric with barking cough, stridor
viral croup (laryngotracheobronchitis); Tx w/ racemic epi and glucocorticosteroids if stridor at rest.
Pediatric with episodes of blank stares
Absence (petit-mal) seizures.
Pediatric with fever or Hx URI with encephalopathy, emesis, hyperactive reflexes, hepatomegaly, elevated liver enzymes
Reye’s syndrome from URI/post-flu or aspirin use
Pediatric with high fever then after fever macular rash over trunk and neck. (rash after defervesence)
Roseola infantum (Herpesvirus); Motrin, symptomatic treatment
Pediatric with Hx recurrent lung infections, pancreatitis, reproductive problems, FTT
Cystic fibrosis (Staph & Pseudomonal infections usually cause of death)
Pediatric with perianal pruritis esp. at PM. Positive cellophane tape test
Pruritis ani – Pinworms (enterobiasis). Tx is Mebendazole
Peds w/ leg pain after physical activity, abnormal heart sounds, unequal UE & LE pulses, rib notching
Coarctation of aorta
Pellagra
Niacin (4D’s dermatitis, diarrhea, dementia, death), bright red tongue
Pericarditis post open heart surgery
Dressler’s syndrome. Tx w/ ASA #1. Indomethacin or other NSAID OK.
Periods of excessive drinking, buying, spending
Manic phase of bipolar disorder
Peri-umbilical or flank ecchymosis
Acute pancreatitis (Cullen & Grey Turner’s Sign)
Philadelphia chromosome
CML
Photosensitive rash
TCN, Sulfa drugs
Photosensitivity, abd pain w/ neurologic dysfunction, erythema or skin fragility
Porphyria
PICA, Pregnant & fatigue, Menstruation. Cheilosis
Fe Deficiency Anemia
Pleural thickening on CXR
Mesothelioma
PNA & decreased mental status, poor dental hygiene, dentures, foul smelling sputum, bronchiectasis. Patchy infiltrates in dependant lung zones
Aspiration PNA
PNA & HIV+, AIDS, Immunocompromised. Sx out of proportion to exam. Diffuse interstitial & alveolar infiltrates
Pneumocystis jerovecii; TMP-SMX = Drug of choice
PNA from Nursing homes, chronic care facility. Purulent sputum
Staphylococcus aureus
PNA w/ DM, immunocompromised, EtOH. Currant color sputum.
Klebsiella
PNA w/ Smokers, COPD
H. influenza
PNA w/ Water, late summer, construction site. Diarrhea. Toxic looking
Legionella
Polyuria, polydipsia. Dilute urine, Hypernatremia
Diabetes insipidus
Poor sleeping, obese, daytime fatigue & drowsy, snoring, HTN, PM wakening
Obstructive sleep apnea
Positive osmotic fragility test
G6PD deficiency (hemolytic anemia w/ oxidative drugs – sulfa, nitrofurantoin, quinidine)
Post MI
Beta-blockers
Post thyroidectomy – electrolyte watch
Hypocalcemia
Post thyroidectomy – most likely injury
Recurrent laryngeal nerve = hoarseness
Postmenopausal adnexal mass
Ovarian Ca
Postmenopausal vaginal bleeding
Endometrial Ca – do endometrial biopsy
Postmenopausal, dyspareunia, thin vaginal discharge, atrophic vulvar changes, vaginal petechiae
Atrophic vaginitis; Tx = topical estrogen
Postpartum hemorrhage
Uterine Atony. Tx = uterine massage
Preemie CXR w/ hypoexpansion (ATX), air bronchograms
Hyaline Mb Disease
Pregnant
Nagel’s rule: LMP + 7 – 3 mo
Pregnant + rash, post-auricular or occipital LAD
Rubella. Give vaccine AFTER delivery
Pregnant < 20 wks gestation w/ vaginal bleeding, abd & pelvic pain. Blood from closed cervical os.
Threatened abortion
Pregnant < 20 wks gestation w/ vaginal bleeding, abd & pelvic pain. Tissue at or said to be passed from open cervical os.
Incomplete abortion (complete abortion will have empty uterus, complete passage of fetal tissue, pain resolves after passage of tissue)
Pregnant who drinks during pregnancy and inadequate peri-natal care
Fetal alcohol syndrome – low birth weight
Pregnant, HA, visual disturbance
Pre-eclampsia
Pregnant, seizures
Eclampsia
Premature birth, fetal maturity
Give corticosteroids
Premature infant with respiratory distress
Hyaline Mb Disease
Procainamide, hydralazine & rash
Lupus-type eruptions
Proximal symmetric muscle pain & stiffness esp. shoulder, neck, pelvic girdle
Polymyalgia rheumatica
Pruritic raised erythematous plaques
Urticaria
Pt on antipsychotic meds develops altered consciousness, lead-pipe rigidity, diaphoresis, catatonia. Hyperthermia, tachypnea, blood pressure changes.
Neuroleptic malignant syndrome. Tx supportive care & antipyretics
PUD, Pernicious anemia (Type A Gastritis), H. pylori
Gastric Ca
pulsus paradoxus
Pericardial effusion/tamponade, pericarditis, asthma attack, tension PTX, SVC obstruction
QT prolongation
Hypocalemia
Raccoons, bats, skunks
Rabies; give Ig, Rabies vaccine if animal is not caught and tested
Raised pearly-borders, telangiectasia, central ulcer
Basal cell Ca
Rapid onset of cognitive symptoms, mental status fluctuations, anxiety, irritability
Delerium
Rapid, deep labored breathing
Kussmaul breathing – DKA, Metabolic acidosis
Rat bite erosions on XR
Psoriatic arthritis
Raw red hands, chafed.
Obsessive compulsive disorder
RBC casts
Glomerulonephritis
Recurrent episodes of vision change, diplopia that resolve
MS
Recurrent episodes of vision change, diplopia, weakness & tingling in extremities that resolve
MS
Recurrent HA, HTN not responding to meds, sweating
Pheochromocytoma – Tx pre-op w/ alpha blocker
Recurrent kidney stones, elevated Calcium, decreased phosphorus
Hyperparathyroidism
Red cervix w/ mucopurulent discharge in sexually active female
Chlamydia
Red eye, copious purulent discharge
Gonococcal conjunctivitis
Red eye, hyperemia, chemosis, nodular conjunctivia
Allergic conjunctivitis
Red eye, watery discharge, preauricular LAD
Viral conjunctivitis
Red, less distinct borders. Coral red fluorescence under Wood’s lamp
Erythrasma
Reed-sternberg cells
Hodgkin’s lymphoma
Reticular to nodular pattern on CXR
Coal Miner’s lung
Retropatellar knee pain esp. in females
Patellorfemoral pain syndrome – increased Q angle, strengthen quadriceps
Rickets
Vit D (Osteomalacia)
s/p Fall w/ bilateral LE weakness, urinary and rectal incontinence, decreased rectal tone
Cauda equine syndrome = neurosurgical consult
s/p gastric bypass surgery or gastric surgery. N, abd cramping, dizziness after eating. No masses, bleeding
Dumping syndrome
s/p thoracic trauma. Multiple rib fractures. Chest wall moves in with inspiration, out with expiration.
Flail chest (pain control, incentive spirometry, pulmonary toilet, intubation)
S3
CHF, dilagted cardiomyopathy
Scabies & Pediatrics
NO LINDANE (KWELL). Permethrin (Elimite) is drug of choice
Scurvy
Vit C (easy bleeding, bruising, hair & tooth loss, joint pain & swelling)
Secondary amenorrhea
Pregnancy
Sensorineural loss > 50yo
Presbyacussis (Hi freq sounds 1st to go)
Sexually active person w/ rash on palms & soles, general LAD
Secondary syphilis (Money spots); VDRL will confirm
Sexually active, multiple or new partner, urethral discharge, Gram negative intracellular diplococci
Gonorrhea
Short lived, intense relationships. Difficulty controlling anger esp. when feeling abandoned. Hx sexual promiscuity and substance abuse.
Borderline personality disorder
Short PR, wide QRS, Delta wave
Wolf-parkinson-white; avoid Digoxin,
Shoulder pain after repetitive activity, point tenderness at anterior humerus or AC joint. + drop arm test or apprehension test
Rotator cuff injury (SITS muscles)
Sickle cell
Autosomal Recessive, pain in extremities after exercise, priaprism
Sickle cell, CF, PKU
Autosomal Recessive
Silvery scaling plaques on extensor sensors. Ausptiz sign, Koebner’s phenomena
Psoriasis
Small white papules on diffusely red base on buccal mucosa
Koplick spots – Rubeola (Measles). Spots occur before rash
Smoker, chronic productive cough. NO hemoptysis, wt. loss.
Brochitis (COPD)
Smoker, DOE, cough
COPD
Smoker, white mouth lesion cannot be rubbed off
Leukoplakia, rule out oral cancer
Sneezing, clear rhinorrhea, post-nasal drip, nasal congestion seasonal occurance
Allergic rhinitis. Nedocromil effective Tx.
Softened, tender, diffusely globular uterine enlargement
Adenomyosis
spaghetti & meatballs
Tinea (fungal infection
Splenectomy
Pneumococcal vaccine
Spontaneous bloody, serous, or cloudy nipple discharge
Intraductal papilloma
Spontaneous Hemarthrosis
Hemophilia A
Stab wound to chest. Hypotension, tracheal shift
Tension PTX
Stab wound, hyperresonance to percussion, decreased breath sounds, tympany
Pneumothorax
Steeple sign
FB, viral croup (laryngotracheobronchitis)
Stqb wound, dullness to percussion, decreased breath sounds.
Hemothorax
Strawberry tongue
Scarlet fever (Grp A Strep)
Sudden dizzy, N, V. NO tinnitus, hearing loss. Recent URI
Vestibular neuronitis, labrynthitis
Sudden dizzy, vertigo, hearing loss, tinnitus
Meniere’s disease; Treat w/ diuretics & low-sodium diet
Sudden onset ripping, tearing chest pain, diminished pulses
Aortic dissection
Sudden onset thunderclap HA, “worse HA of my life”
Subarachnoid hemorrhage
Sudden vertigo with changes in head position
BPPV
Superior contralateral quadrantopia
Temporal optic radiation
Supraclavicular LAD (L > R)
Virchow’s node – metastatic abdominal cancer
Sweat chloride test
Cystic fibrosis
Swimmer with ear pain, discharge
Otitis externa
Systolic ejection murmur heard best at base with radiation to left clavicle
Pulmonary stenosis
Systolic murmur heard best at apex with radiation to left axilla (apical systolic)
Mitral regurgitation
Tall, skinny, male, band student, acute onset one-sided chest pain, dyspnea
Spontaneous PTX
Target lesion, arthralgia, Bell’s Palsy
Lyme Dz (Borrelia Burgdorfi)
Teenage female with long bone pain without trauma or injury. XR w/ lytic mass, multi-laminated periosteal reaction
Ewing sarcoma – periosteal “onion skin” reaction
Temporal field loss
Ipsilateral optic tract lesion
Tetany, hypocalcemia, cataracts
Hypoparathyroidism
Thick white vaginal discharge, hyphae & buds on KOH prep
Candida
Thick, yellow, brittle nails
Onychomycosis. Tx = PO Terbinafine
Thumbprint sign
Epiglottitis
Tibial pain after running (military recruits), athletic activity (running sports)
Shin splints, stress fracture. Get bone scan if negative x-ray
Tinnitus and metabolic acidosis
Salicylate Ingestion
Transient monocular vision loss
Amaurosis fugax – TIA, emboli
Traveler’s Diarrhea
E. coli is cause. Hydration & Cipro to treat
Trendelenberg test of extremities
Tests for veinous insufficiency.
Truncal Rash in pediatric after fever
Roseola infantum (Herpesvirus); Motrin, symptomatic treatment
Tx of HTN w/ alpha-blocker
SE is postural Hypotension
Typing, secretary wrist pain and numb/tingling from wrist to hand. New mothers, pregnant may worsen
Carpal Tunnel syndrome
Tzank Smear
Herpes virus (Genital)
U waves
HypoKalemia
Unilateral facial weakness w/ inability to close eye
Bell’s palsy (self-limiting)
Unilateral foul smelling or purulent nasal discharge in a pediatric patient
Nasal Foreign body
Unilateral nerve deafness in middle age Pt
Acoustic neuroma (order MRI)
Urinary catecholamines, urinary metanephrines
Pheochromocytoma – Tx pre-op w/ alpha blocker
Venous stasis, vessel wall injury, hypercoagulability
DVT/PE (Virchow’s triad)
Vertical Nystagmus, insidious onset vertigo
Central lesion (tumor)
Viral Meningitis
Mumps
Vision loss over hours to days, painful EOM
Optic Neuritis (assoc. w/ MS)
Vit D – Rickets
X-linked dominant
Walks alone
15 mo
Warm, erythematous, tender skin with possible induration or fluctuance
Cellulitis
Weakness and fatigue in upper limbs, blurry vision, diplopia, respiratory distress
Myasthenia gravis
Weight loss, recurrent greasy stools (steatorrhea) mixed with diarrhea after certain foods
Celiac Sprue
Wheezing, prolonged expiration
Asthma
Wood’s light
Coral red = Erythrasma
Wood’s light fluoroscopy
Dermatophytes infections, Erythrasma (coral red)
Woods, forest, hikers. Macular rash at wrist, ankles then moves up extremities then trunk. After 5 days rash at palms & soles
RMSF (Rickettsia rickettsia)
Worsening fatigue, wt loss, weakness, recurrent abdominal pain, hair loss, hyperpigmentation. Hyponatremia, hyperkalemia
Addison’s disease, crisis (Low aldosterone; get Random or AM cortisol, ACTH stimulation test)
Wt. gain, edema, coarse dry skin, hair, menorrhagia, cold intolerance, hx transphenoidal surgery & radiation
Hypothyroidism
XXY ♂ - short stature, ↓ intelligence; small firm testes, gynecomastia, abn arm-body length
Klinefelters (hypogonadism)
Young athlete with syncope during athletic event or practice. No physical exam abnormalities
Hypertrophic CM or fatal arrhythmia. Get EKG or Echo
Young female (<30yo), palpitations, long arms & fingers, pectus excavatum, ectopic lentis, flexible joints
Marfan’s Syndrome – MVP, Aortic regurgitation, Aortic dissection, Aortic root dilatation, ectopic lentis
Young kid with difficulty standing from seated position. Calf muscle wasting
Muscular dystrophy (weakness begins at pelvic girdle)
Monoclonal spike on serum electrophoresis (M-protein)
Multiple myeloma
Smudge cells on peripheral smear
CLL
Palpable olive
Pyloric Stenosis
String sign (long narrow pyloric lumen)
Pyloric Stenosis
Bag of worms in scrotum
Varicocele
Boggy uterus
Adenomyosis
Steeple sx on x-ray
croup
Thumb sx on x-ray
epiglottitis
Cherry red spot (red fovea) on Fundoscopy
CRAO
Blood and Thunder retina
CR Vein occlusion
Rust-colored sputum
Strep. Pneumo PNA
Currant Jelly sputum
Klebsiella pneumo. PNA
Unilateral ptosis, anhidrosis, miosis
Horner's Syndrome
Parenchymal bullae or subpleural blebs
Emphysema (patho.)
ECG = S1Q3 inverted T3
cor pulmonale from PE
CXR honeycombing
pulmonary fibrosis or bronchiectasis
Lung bx = nonencaseating granulomas
Sarcoidosis
Hot potato voice
peritonsillar abscess
CXR visceral pleural line or "deep sulcus sign" on supine
PTX
Pharyngeal gray pseudomembrane
Diphtheria
Electrical alternans on ECG
cardiac effusion (patho.)
Osler nodes (pnful finger, toe, feet lesions), Janeway lesions (pnless palm and sole lesions), Roth spots (exudative retinal lesions/hemhorrages)
Infective Endocarditis
Bite cells (loss of Heinz body) on peripheral smear
G6PD deficiency
Heinz bodies on peripheral smear
G6PD def. or thalassemia
Beefy red tongue
pronounced anemia
Pica
Fe deficiency
Macro-ovalocytes and hypersegmented PMNs
Folate def. anemia (patho.)
Pancytopenia with circulating blasts
acute leukemia
Auer rods on peripheral smear (needle-like inclusions in eosinophiles)
AML (can also be ALL, but less likely)
Blast-crisis
CML
Reed-Sternberg Cells on LN bx
Hodgkin's Lymphoma
Rouleau Formation on peripheral smear
Multiple Myeloma
Bence Jones Proteins in urine
Muliple Myeloma
Parrot-beaked esophagus (dilated esophagus taper to the distal obstruction) on barium swallow
Achalasia
Cobblestone-pattern filling defects with segmental areas of involvement (skip lesions) on Barium enema or CT
Chron's Dz.
Currant Jelly stools
Intussusception
Sausage-like mass on abdominal exam
Intussusception
Chvostek's Sign (twitch facial nerve on tap)
Hypocalcemia
Trousseau's Sign (carpal tunnel spasm with BP cuff for 3 min.)
Hypocalcemia
Herberden's nodes (DIP nodes)
OA
Bouchard's nodes (PIP nodes)
OA
Swan neck deformity (flexed DIP, extended PIP, flexed MCP)
RA
Boutinniere deformity (extended DIP, flexed PIP)
RA
Subcutaneous nodules on extensor surfaces
RA (patho.)
Koebner's phenomenon (maculopapular rash elicited by scratching that appears in the evening)
Juvenile RA
Cup and Saucer appearance of proximal phalanx on x-ray
Psoriatic arthritis
Tinel's sign (percussion of volar wrist causes tingling)
Carpal Tunnel
Phalen's sign (wrist flexion for 1 min causes pain)
Carpal Tunnel
Fx of 5th MC neck
Boxer's fx
Distal radial fx with dorsal angulation
Colle's fx
Distal radial fx with volar angulation
Smith's fx
Sprain of ulnar collateral ligament of thumb
Gamekeeper's thumb
Anterior fat pad sign
hemarthrosis in radial head fx
Anatomical snuffbox pain
Scaphoid fx
Bamboo appearance on x-ray of spine
Ankylosing Spondylitis
Cresent sign of hip on x-ray
Avascular necrosis of hip
Posterior Fat pad sign
Radial Head fx
Amyloid plaques and neurofibrillary tangles
Alzheimer's
Battle sx
Basilar skull fx
WBC casts
pyelo. (or nephritis)
Hyaline casts
ARF (or normal in athletes)
Renal Tubular Epitheleal cell casts ("muddy brown casts")
ATN
RBC casts
glomerulonephritis
Positive Finkelstein (pain with fist ulnar deviation)
DeQuervain's
Pedunculated bone mass capped in cartilage
Osteochondroma
Gottron's sx (scaly, papule rash on dorsal hands)
Dermatomyositis
Heliotrope rash (eyelid erythema)
Dermatomyositis (or SLE)
Low morning cortisol with elevated ACTH
Addison's disease
More than 125 mg/dL urine cortisol in 24 hours
Cushings
Milkman lines or Looser zones (pseudofractures)
Osteomalacia
Eruptive and tendious xanthomas
Hyperlipidemia (patho.)
Petechial rash with meningeal sxs
Neisseria Meningitidis
KOH hyphae and spores ("spaghetti and meatballs")
Tinea versicolor
S-shaped burrows on skin
Scabies
Snowstorm on TVU with elevated BHcg
Hydatidiform mole
Rope-like on CBE
Fibrocystic breasts
Herald patch then "Christamas tree" appearing rash
Pityrasis Rosea
Oncholysis with oil spots
Psoriasis (patho.)
Hot tub folliculitis
Pseudomonas aureginosa
Terry's nails (white nail bed)
Liver disease/cirrhosis
Azure (blue) lunulae on nails
Wilson's disease
Absent or decreased femoral pulses with a murmur
Coarctation of the aorta (patho.)
Kayser-Fleischer rings (brown rings btw iris and cornea)
Wilson's Disease
Boot-shaped heart
RVH from Tet. Of Fallot
Egg on a string (narrow mediastinum)
Transposition of Great Vessels
Lower BP in arms vs legs
Coarct. Aorta
Barking cough like a seal
Croup
Figure 3 sign on CXR
Coarct. Aorta
Machine-like murmur
Patent Ductus Arteriosis
Absence of "Scottie-Dog" sign on spinal film
Spondyloysis
Inability to pass NGT in an infant
Choanal Atresia
Palpable, non-tender gallbladder (Courvoisier's sign)
Pancreatic CA
Charcot's triad (fever, chills, RUQ pain, jaundice)
Ascending Cholangitis
Bird beak deformity on x-ray
Achalasia or Sigmoid Volvulus
Apple-core lesion on Barium Enema
Colon CA
Lead pipe deformity (loss of normal haustral markings) on Barium Enema
UC
Clue cells on wet-prep and positive Whiff test (amine odor)
BV (Gardnerella vaginalis)
Strawberry Cervix
Trichomonas
Hyphae and buds on KOH Prep
Vaginal Candidiasis
String sign/ Sign of Kantor (Stricture or Stenosis) on Barium Enema
Chron's disease
Chandelier Sign on pelvic/speculum exam (cervical motion tenderness)
PID
Koplik spots-grains of sand on an erythematous base (Blue-White buccal lesions)
Measles/Rubeola (patho.)
Sandpaper rash (like sunburn with goosebumps)
Scarlet Fever
Strawberry tongue
Scarlet Fever
Honey golden crusts on face
Impetigo (Streptococcus Pyoderma)
Gram-positive, encapsulated, box-shaped rods in chains
Cutaneous Anthrax
Rice-water diarrhea (gray, turbid, and without odor, blood, or pus)
Cholera
Pea-soup Diarrhea
Enteric/Typhoid fever
Hyperplastic prickle cells with excess keratin
HPV skin warts
Koilocytotic squamous cells or vacuolated Squamous epithelial cells in clumps on Pap
HPV cervical warts
Multinucleated giant cells on Tzanck Smear
Herpes Simplex Virus
Intracytoplasmic inclusions ("owl's eyes") on tissue biopsy
CMV
Pizza pie (neovascularization with profliferation) on Fund
CMV
Satellite lesions on buttocks
Diaper dermatitis with candida
Bull's eye skin lesion
Erythema Migrans from Lyme Dz.
String of Pearls on ovarian US
PCOS
Sack of grapes or "grape-like vesicles" on TVU
Complete Hydatidiform Mole
5 Ps (purple, planar, polygonal, pruritic papule)
Lichen Planus
Lesions that have white lines (Wickham's striae)
Lichen Planus
Slapped cheek syndrome
Parvovirus B19/ Fifth's Dz/ Erythema Infecticosum
11:22
transloc seen in ewing sarcoma
11-hydroxylase deficiency
virilism, no cortisol, salt retention, HTN
14:18
follicular lymphoma IG heavy chain on 14, bcl-2 oncogene on 18
15:17
acute promyelocytic leukemia PML gene on 15 and RARa on 17
8:14
Burkitts c::myc is on 8, IG heavy chain is on 14
9:22
Philadelphia chromosome, CML bcr abl fusion c-abl on 9, bcr on 22
Actinic keratosis
Often precedes SCC
Addison’s disease
1° adrenocortical deficiency
Addisonian Anemia
pernicious anemia (antibodies to intrinsic factor or parietal cells ? ?IF ? ?Vit B12 ? megaloblastic anemia)
Adhesive arachnoiditis
Caused by bacterial meningitis, leads to obstructive hydrocephalus
AFP decrease
Down’s
AFP in amniotic fluid or mother’s serum
Spina Bifida; Anencephaly
AFP increase
Neural tube defects, hepatocellular carcinoma, yolk sac and embryonal carcinoma
Albers SCHonberg dx
aka osteopetrosis, marble bone dx, dense skeleton, failure of osteoclastic activity
Albright’s syndrome
Polyostotic fibrous dysplasia, precocious puberty, café-au-lait spots, short stature, young girls
Albuminocytologic dissociation
Guillain-Barré (↑ protein in CSF with only modest ↑ in cell count)
Alport’s Syndrome
hereditary nephritis with nerve deafness, Type 4 collagen defect (basement membranes)
Alzheimer’s
progressive dementia; tau proteins, neurofibrillary tangles, apolipoprotein E4 allele, narrow gyri and wide sulci (atrophy), occipital sparing, hydrocephalus ex vacuo, plaques in hippocampus and cortex, ? Acetylcholine, Hiramo bodies (inrtacellular inclusion bodies in hippocampal cells)
Amnion nodosum
Renal agenesis
Amyloid in thyroid
Thyroid medullary carcinoma (calcitonin)
Analgesic abuse
Papillary necrosis, esp. in diabetics
ANAs in SLE
dsDNA antibodies and Sm Smith antigen
Anasarca
Minimal change disease
Aneurysmal nodules
Polyarteritis nodosa
Angelman syndrome
materal transmission del(15)(q11q13), aka happy puppet syndrome, mental retardation, ataxia, seizures, inappropriate laughter
Angiomyolipoma
Tuberous sclerosis
Anosmia
Kallman’s syndrome
Anterior vermian atrophy
alcoholism
Anti–basement membrane antibodies
Goodpasture’s syndrome
Anti-centromere antibody
Limited scleroderma (CREST)
Anti-DNA topoisomerase antibody
Diffuse scleroderma
Anti-double-stranded DNA antibodies (ANA antibodies)
SLE (type III hypersensitivity)
Anti-endomysial antibody
Celiac sprue
Anti–epithelial cell antibodies
Pemphigus vulgaris
Antigliadin antibodies
Celiac disease
Antihistone antibodies
Drug-induced SLE
Anti-IgG antibodies
Rheumatoid arthritis
Anti-jo antibody
polymyositis
Anti-mitochondrial antibody
1° biliary cirrhosis
Antineutrophil antibodies
Vasculitis
Antiplatelet antibodies
Idiopathic thrombocytopenic purpura
Anti-sacharommyces cervisiae antibody
Crohn’s
Anti-Smith antibodies
Specific for SLE, anti-ribonulceoprotein
Anti-smooth muscle antibody
Autoimmune hepatitis type I
APC
tumor suppressor common in familial polyposis coli and adenoCA of colon as well as other tumors
Arachnodactyly
Marfan’s syndrome
Argyll-Robertson Pupil
loss of light reflex constriction (contralateral or bilateral), “Prostitute’s Eye” -accommodates but does not react, Pathognomonic for 3° Syphilis
Arnold Chiari formation
downward displacement of cerebellar tonsils and medulla through foramen magnum
Arthus reaction
seen in hyperacute rejection,
Aschoff body
Rheumatic fever; area of focal interstitial myocardial inflammation characterized by fragmented collagen and fibrinoid material, by large cells (Anitschkow myocytes) and occasional multinucleated giant cells (Aschoff cells)
Ashleaf spots (skin)
Tuberous sclerosis
Atrophy of the mammillary bodies
Wernicke’s encephalopathy
Atypical lymphocytes
EBV
Auer rods
Acute myelogenous leukemia (especially the promyelocytic type; (AML type M3))
Autosplenectomy
Sickle cell anemia
Babinski’s sign
UMN lesion
Bacterial conjunctivitis
S. aureus, strep. pneumo, Hemophilus aegyptius
Baker’s cyst in popliteal fossa
Rheumatoid arthritis
Bamboo spine” on x-ray
Ankylosing spondylitis
Barrett’s
columnar metaplasia of lower esophagus (* risk of adenocarcinoma)
Bartter’s Syndrome
hyperreninemia
Basophilic stippling of RBCs
Lead poisoning
Bax
gene product facilitates apoptosis
Bcl2
gene product inhibits apoptosis
Becker’s muscular dystrophy
Defective dystrophin; less severe than Duchenne’s
Beckwith Weidemann syndrome
hemihypertrophy, macroglossia, organomegaly, neonatal hypoglycemia, various embryonal tumors, deleted WT 2 gene
Bell’s Palsy
CNVII palsy (entire face; recall that UMN lesion only affects lower face)
Bence Jones proteins
Multiple myeloma (kappa or lambda Ig light chains in urine), Waldenström’s macroglobulinemia (IgM)
Berger dx
aka IgA nephropathy, deposition of IgA in mesangium, benign recurrent hematuria in kids following infection
Beriberi
this comes in a wet variety and a dry one, they are both Vit B1 thiamine deficiency
Bernard-Soulier Disease
defect in platelet adhesion (abnormally large platelets & lack of platelet-surface glycoprotein ["GPIb IX V"]) autosomal recessive
Berry Aneurysm
circle of Willis (subarachnoid bleed), often associated with ADPKD
Bilateral breast cancer
Lobular carcinoma
Bilateral hilar adenopathy, uveitis
Sarcoidosis
Bilateral renal cell carcinoma
Von Hippel-Lindau
Binswanger dx
aka subcortical leukoencephalopathy, assoc with HTN, multiple lacunar infarcts and progressive demyelination in subcortical area
Birbeck granules on EM
Histiocytosis X (eosinophilic granuloma); tennis racket shaped cytoplasmic inclusion seen in langerhans cells (so also seen in langerhan cell histiocytosis)
Bladder trabeculation
BPH
Bloody nipple discharge
Intraductal papilloma
Bloody tap on LP
Subarachnoid hemorrhage
Blue bloater”
Chronic bronchitis
Blue sclera
Osteogenesis imperfecta
Blueberry muffin baby
Rubella
Blue-domed cysts
Fibrocystic change of the breast
Boot-shaped heart on x-ray
Tetralogy of Fallot; RVH
Bouchard’s nodes
Osteoarthritis (PIP swelling 2° to osteophytes)
Boutonnière deformity
Rheumatoid arthritis
Bowen’s Disease
carcinoma in situ on shaft of penis (* risk of visceral ca)
Bowenoid papulosis
appears as multiple wart-like lesions resembling condyloma accuminatum
Branching rods in oral infection
Actinomyces israelii
BRCA1
tumor suppressor mutated in breast and ovary CA
BRCA2
associated with breast alone (isn't one of these associated with prostate? Check)
Brenner tumor
ovarian tumor resembling bladder transitional epith
Briquet’s Syndrome
somatization disorder
Broca’s Aphasia
Motor Aphasia intact comprehension
Bronchiolitis
RSV
Bronze Diabetes
Hemochromatosis
Brown tumor” of bone
Hemorrhage causes brown color of osteolytic cysts
Brown-Sequard
hemisection of cord (contralateral loss of pain & temp / ipsilateral loss of fine touch, UMN)
Brudzinski sign
meningitis
Brushfield spots
seen in Down synd, small white spots on periphery of iris
Brutons Agammaglobulinemia
x linked, absence of plasma cells and serum immunoglobulins, cell mediated immunity still ok, no germinal centers, recurrent bacterial infections, resistances to fungal and viral still, btk gene defect
Btk gene
defective in x-linked brutons agammaglobulinemia, B-cell tyrosine kinase
Budd Chiari
Posthepatic venous thrombosis; thrombotic occlusion of major hepatic veins, abnormal pain, jaundice, hepatomegaly, acites, liver failure, assoc with polycythemia vera, hepatocellular CA, and other common neoplasms, may occur as a complication of pregnancy
Buerger’s Disease
aka thromboangiitis obliterans, young jewish men, worse with smoking, acute inflammation of small, medium arteries * painful ischemia * gangrene
Burkitt’s Lymphoma
aggressive B-cell lymphoma, starry sky appearance, small noncleaved cell lymphoma EBV, 8
Burton’s lines
Lead poisoning
Café-au-lait spots on skin
Neurofibromatosis
Caisson disease
Gas emboli
Calf pseudohypertrophy
Duchenne’s muscular dystrophy
Call-Exner bodies
Granulosa-theca cell tumor of the ovary, small follicles filled with eosinophilic secretion, diagnostic feature of granulose cell tumor
C-ANCA, P-ANCA
Wegener’s granulomatosis, polyarteritis nodosa
Carbon monoxide poisoning
hyperemia, edema and necrosis of globus
Cardiomegaly with apical atrophy
Chagas’ disease
Carpal Tunnel Syndrome
Median nerve entrapment
Central Nuclei in Muscle
Muscular dystrophies
Cerebriform nuclei
Mycosis fungoides (cutaneous T-cell lymphoma)
Chagas’ Disease
Trypansoma infection sleeping disease, cardiomegaly with apical atrophy, megaesophagus, megacolon
Chancre
ulcer, 1° syphilis (not painful)
Chancroid
Haemophilus ducreyi, painful soft ulcers
Charcot Bouchard aneurysm
aneurysm at small artery bifurcations
Charcot’s triad
Multiple sclerosis (nystagmus, intention tremor, scanning speech), cholangitis (jaundice, RUQ pain, fever)
Charcot-Leyden crystals
Bronchial asthma (eosinophil membranes)
Chediak-Higashi Disease
Phagocyte Deficiency
Cherry-red spot on macula
Tay-Sachs, 50% of Niemann-Pick disease, central retinal artery occlusion
Cheyne-Stokes respirations
Central apnea in CHF and ↑ intracranial pressure
Chocolate cysts”
Endometriosis (frequently involves both ovaries)
Cholesterol clefts
atherosclerosis
Chordae tendinae short and fused
Rheumatic heart disease
Chromosome 10
paracentric inversion or translocation with 17 associated with papillary thyroid CA
Chronic atrophic gastritis
Predisposition to gastric carcinoma
Chronic staph infections
Chronic granulomatous disease, a deficiency of NADPH oxidase, can’t kill catalase positive bugs
Churg Strauss syndrome
aka allergic granulomatous angiitis, necrotizing vasculitis, variant of polyarteritis nodosa, involves pulmonary vasculature, peripheral eosinophilia, and asthma
Chvostek’s sign
Hypocalcemia (facial muscle spasm/tetany upon tapping)
Clear cell adenocarcinoma of
DES exposure in utero
Clear nuclei
Thyroid papillary carcinoma (Orphan Annie’s eyes)
Clue cell
Bacterial Vaginitis w/ Gardnerella vaginosis, vaginal epithelial cell with stippled appearance due to adherent coccobacilli
Codman’s triangle on x-ray
Osteosarcoma, periostium in bone tumors
Coin Lesions in Lung
Pulmonary Hamartoma
Cold agglutinins
Mycoplasma pneumoniae, infectious mononucleosis
Cold intolerance
Hypothyroidism
Cold thyroid nodules
Colloid cyst or thyroid adenoma
Concentric laminar intimal fibrosis of small arteries of lung
1° pulmonary HTN
Condylomata lata
2° syphilis
Congenital adrenal hyperplasia
21-hydroxylase deficiency
Congenital Hepatic Fibrosis
Polycystic Kidney Disease, juvenile autosomal recessive form
Conn’s Syndrome
1° aldosteronism
Continuous machinery murmur
Patent ductus arteriosus
Contraction Band Necrosis
MI
Cori’s Disease
glycogen storage disease (debranching enzyme deficiency), stunted growth, hepatomegaly, hypoglycemia
Cotton-wool spots
Chronic HTN
Cough, conjunctivitis, coryza
Measles
Councilman bodies
Toxic or viral hepatitis (dying hepatocytes); small round eosinophilic masses found in dying hepatocytes often containing chromatin remnants
Cowdry type A bodies
Herpesvirus
Crescents In Bowman’s Capsule
rapidly progressive (crescentic glomerulonephritis)
Creutzfeldt-Jakob
prion infection * cerebellar & cerebral degeneration
Cri du chat syndrome
5p chromosome deletion, severe mental retardation, microcephaly, catlike cry, low birth weight, round face, hypertelorism (wide eyes)
Crigler-Najjar Syndrome
congenital hyperbilirubinemia (unconjugated); due to deficient glucuronyl transferase
Crohn’s
IBD; ileocecum, transmural, skip lesions, lymphocytic infiltrate, granulomas, (contrast to UC
Croup
Parainfluenza
Crushed ping pong balls
Pneumocystis carinii
Crypt abscesses
Ulcerative colitis
Curling’s ulcer
Acute gastric ulcer associated with severe burns
Currant-jelly sputum
Klebsiella
Curschmann’s spirals
Bronchial asthma (whorled mucous plugs)
Cushing’s
Disease
Cushing’s ulcer
Acute gastric ulcer associated with CNS injury
Cystathioine synthase deficieny
homocystinuria
D-dimers
DIC
de Quervain’s Thyroiditis
self-limiting focal destruction (subacute thyroiditis)
Denys Drash syndrome
abnormal WT 1 gene, intersexual disorders, nephropathy, wilms tumor
Depigmentation of neurons in substantia nigra
Parkinson’s disease (basal ganglia disorder––rigidity, resting tremor, bradykinesia)
Dermatitis, dementia, diarrhea
Pellagra (niacin, vitamin B3 deficiency)
Dew drop on rose petal
Chicken pox
Diabetes insipidus + exophthalmos + ?
Hand-Schüller-Christian disease
Diaphragmatic pleural plaques
Asbestosis
DiGeorge’s Syndrome
thymic hypoplasia, T-cell deficiency; aka velocardiofacial syndrome and CATCH 22 syndrome, micro deletion of 22q11, Cardiac abnormalities, Abnormal facies, Cleft palate, Hypocalcemia due to hypoparathyroidism, from poor development of 3rd and 4th cranial arches
Dog or cat bite
Pasteurella multocida
Donovan bodies
seen in granuloma inguinale (STD), multiple organisms filling large histiocytes
dopamine receptors
Parkinson’s & schizophrenia
Double bubble sign on ultrasound
Down’s syndrome – duodenal atresia
Down’s Syndrome
trisomy 21 or translocation
Dressler’s Syndrome
Post-MI Fibrinous Pericarditis autoimmune
Dry beriberi
peripheral neuropathy, atrophy of muscles, wet - high output cardiac failure, DCM, AV shunting, hypervolemia
Dubin-Johnson Syndrome
congenital hyperbilirubinemia (conjugated), striking brown-to-black discoloration of the liver; autosomal recessive, defect in bili transport
Duchenne Muscular Dystrophy
deficiency of dystrophin protein * MD X-linked recessive
Duret Hemorrhages
Uncal herniation
E4 allele of apoprotein E
chromosome 19, allele common in alzheimers
Eburnation
Osteoarthritis (polished, ivory-like appearance of bone)
Eccentric intimal fibrosis with medial hypertrophy
Chronic transplant rejection
Ectopia Lentis
Marfan’s
Edwards’ Syndrome
trisomy 18, rocker-bottom feet, low ears, heart disease, mental retardation, prominent occiput, micrognathia (small jaw), finger deformities
Ehler’s-Danlos
defective collagen
Eisenmenger’s Complex
late cyanotic shunt (R→L) pulmonary HTN & RVH 2° to long-standing VSD, ASD, or PDA
Elastic skin
Ehlers-Danlos syndrome
Embolizing endocarditis
Infectious, marantic (fibrin deposits in hypercoagulable states)
Erb-Duchenne palsy
Superior trunk brachial plexus injury (“waiter’s tip”)
Erythema chronicum migrans
Lyme disease
Ewing Sarcoma
undifferentiated round cell tumor of long bone; kids, "onion skin" type periosteal reaction, 11:22 transloc
Excavation of Optic Cup
Glaucoma
Exopthalmos
hyperthyroid
Eyrthroplasia of Queyrat
carcinoma in situ on glans penis
Fabry dx
aka angiokeratoma corporis diffusum universal, deficient a::galactosidase A, accumulate ceramide trihexoside, skin lesions angiokeratomas, fever, burning pain in extremities, cardiovascular and cerebrovascular involvement, death as adult by renal failure p59
False positive VDRL
SLE, Treponema pertenue (non-STD tropical infection)
Fanconi’s Syndrome
impaired proximal tubular reabsorption 2* to lead poisoning or Tetracycline (glycosuria, hyperphosphaturia, aminoaciduria, systemic acidosis)
FAT RN
TTP (fever, anemia, thrombocytopenia, renal failure, neuro problems)
Fat, female, forty, and fertile”
Acute cholecystitis
Fatty liver
Alcoholism
Fecalith
Acute appendicitis
Felty’s Syndrome
rheumatoid arthritis, neutropenia, splenomegaly
Ferruginous body
asbestosis, yellow-brown, rod shaped body with clubbed ends, stain with Prussian blue
FEV1/FVC ↓
COPD (< 70%)
FGFR3
gene mutated in achondroplasia (most common form of dwarfism),
Fish-mouthed mitral valve
Rheumatic heart disease
Flea-bitten Kidney
Malignant HTN
Foamy histiocyte
sphingomyelin containing phagocytes seen in Niemman::Pick dx in liver, spleen, lymph nodes and skin
Frontal bossing
Sickle cell anemia
Fungus ball in lung
Apergillus
galactosemia
Galactose-1-phosphate uridyl transferase deficiency or galactokinase deficiency
Gardner’s Syndrome
adenomatous polyps of colon plus osteomas & soft tissue tumors; autosomal dominant
Garlic odor on breath
Arsenic (or lasagna)
Gaucher’s Disease
Lysosomal Storage Disease glucocerebrosidase deficiency, hepatosplenomegaly, femoral head & long bone erosion, anemia
Gerstmann Straussler
Scheinker syndrome :
Ghon focus/complex
1° TB
Gilbert’s Syndrome
benign congenital hyperbilirubinemia (unconjugated); modest elevated serum unconj bilirubin, due to decreased uptake by liver cells and reduced activity of glucuronyl transferase
GIST
Tumor arising in cells of Cajal (pacemakers of gut)
Glanzmann’s thrombasthenia
Defect (glycoprotein) in platelet aggregation
glucose, protein in CSF
Bacterial meningitis
GNAS1
mutation here causes pseudohypoparathyroidism
Gold Pneumonia
Lipid pneumonia, exogenous (aspiration) or endogenous (obstruction
Goodpasture’s
autoimmune
Gowers’ maneuver
Duchenne’s (use of patient’s arms to help legs pick self off the floor)
Graves Dz
autoimmune thyroiditis, hyperthyroid, exophthalmos, increased in HLA DR3 and HLA B8 pos people
Gray discoloration of skin
Argyria (silver poisoning)
Guillain-Barre
idiopathic polyneuritis; acute inflammatory demyelinating Dz primarily involving peripheral nerves (ascending muscle weakness & paralysis; usually self-limiting)
H shaped vertebrae
Sickle cell anemia
Hair-on-end” appearance on x-ray
β-thalassemia, sickle cell anemia (extramedullary hematopoiesis)
Hamman-Rich Syndrome
idiopathic pulmonary fibrosis
Hand Schuller Christian Dz
aka chronic progressive histiocytosis, not as bad as Letterer Siwe
Hartnup dx
impaired tubular reabsorption of tryptophan, pellagra::like manifestations
Hashimoto’s Thyroiditis
autoimmune hypothyroidism (antimicrosomal or antithyroglobulin); Hurthle cells, thyroid germinal centers,
Hashitoxicosis
initial hyperthyroidism in Hashimoto’s Thyroiditis that precedes hypothyroidism
Hat size increase
Paget’s disease of bone
HbF
Thalassemia major
HbS
Sickle cell anemia
hCG elevated
Choriocarcinoma, hydatidiform mole (occurs with and without embryo)
Heart failure cells
intra::alveolar hemosiderin-laden macrophages caused by RBCs from capillary rupture 2* to pulmonary HTN
Heberden’s nodes
Osteoarthritis (DIP swelling 2° to osteophytes)
Heinz bodies
G6PD deficiency
Hemarthrosis
Coagulation factor deficiency
Hemorrhagic Temporal Lobe Lesion
HSV
Hemorrhagic Urticaria
Henoch-Schonlein
Henoch-Schönlein purpura
Hypersensitivity vasculitis; hemorrhagic urticaria of extensor surfaces of arms, legs, and buttocks, with fever, arthralgias, and GI renal involvement similar to IgA nephropathy, associated with URIs
HER
2/neu :
Hereditary Spherocytosis