Pattern Recognition

Front 1

50M

dilated cardiomyopathy after travel to South America

Back 1

Chagas

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

Most commonly viral

Front 6

58M

hyperlipidemia, diffuse weakness

Back 6

Statin induced myopathy

increased CPK, LDH, aldolase, maybe AST and ALT

Front 7

70M

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

Back 7

diuretic, B blocker, Ca blocker

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

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

30F

34 weeks pregnant, tearing sensation in chest radiates to back

Back 11

aortic dissection

secondary to HTN

Front 12

58M

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

Back 12

amiodorone

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

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

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

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 21

30

fatigue, weight gain, cold intolerance

Back 21

hypothyroid

Front 22

40F

obesity, HTN, new hyperglycemia

Back 22

metabolic syndrome

Front 23

60F

hypercalcemia, hyperphosphatemia, health food junkie

Back 23

vitamin D toxicity

Front 24

50

HTN, tachycardia, flushing

Back 24

pheochromocytoma

HTN may be intermittent

Front 25

65M

diarrhea, weight loss, a fib

Back 25

hyperthyroid

Front 26

60M

fasting blood sugar 130 on 2 different ocassions

Back 26

diabetes fbs>126 two times

Front 27

60M

galactorrhea

Back 27

prolactinoma

Front 28

50M

thyroid ca and neurofibromas

Back 28

MEN 2b

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

Front 29

75

hypercalcemia, long tobacco hx

Back 29

squamous cell lung ca

Front 30

18F

hypoglycemia, mom has DM2

Back 30

factitious

Front 31

40F

proptosis and palpitations

Back 31

Graves

Front 32

30F

has 8 month old, increased fatigue

Back 32

postpartum thyroiditis

Front 33

50F

hypokalemia, HTN

Back 33

Conns

aka primary hyperaldo

Front 34

25F

hirsutism, amenorrhea

Back 34

polycystic ovarian dz

Front 35

55M

bilat visual field loss, headache

Back 35

pituitary tumor

Front 36

60M

meningococcemia, severe hypotension and hyperkalemia

Back 36

Waterhouse Friderichsen

due to meningococcemia, hemorrhage into adrenal glands

Front 37

35M

wheezing while working on assembly line

Back 37

occupational asthma

Front 38

65M

heavy tobacco, sputum each morning for 3 months each year

Back 38

chronic bronchitis

Front 39

55M, thin

smokes 1ppd, pursed lip breathing

Back 39

emphysema

Front 40

45M

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

Back 40

alpha 1 antitrypsin deficiency

Front 41

30F

tender nodules on shins, intermittent wheezing, arthralgias

Back 41

sarcoidosis

see cardio 4

Front 42

66M

sinus tenderness, 2+ blood on UA, cavitation on CXR

Back 42

Wegeners

positive c-ANCA

Front 43

50

severe wheezing, peripheral eosinophilia

Back 43

Churg-Strauss

aka allergic asthma or angiitis

Front 44

30M

nonsmoker, hemoptysis, hematuria

Back 44

Goodpastures

Front 45

45F

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

Back 45

rheumatoid lung dz

Front 46

35 IVDA

cannonball lesions peripherally on cxr

Back 46

septic pulmonary emboli

Front 47

65

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

Back 47

PE

nephritic syndrome --> decreased protein c and s

Front 48

35F

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

Back 48

Legionella

Front 49

30F

photosensitivity, alopecia, pleuritic chest pain

Back 49

SLE

Front 50

50M obese

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

Back 50

cor pulmonale due to OSA

other serious OSA complications- arrhythmias, pulmonary HTN

Front 51

25F

progressive chest pain and SOB over months

Back 51

primary pulmonary HTN

Front 52

65M

diffuse basilar crackles despite diuresis, interstitial infiltrates on baseline cxr

Back 52

interstitial pulmonary fibrosis

Front 53

60M

methotrexate therapy for psoriasis, progressive sob

Back 53

pulmonary fibrosis

Front 54

35M

homeless, pleural effusion

Back 54

TB

Front 55

55M

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

Back 55

Dressler's Syndrome

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

Front 56

25M

HIV, chest pain, pneumothorax

Back 56

PCP

Front 57

23F

photosensitivity, arthralgias, pleuritic chest pain

Back 57

SLE

Front 58

50M

dry mouth, arthralgias, peripheral neuropathy

Back 58

Sjogrens

Front 59

60F

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

Back 59

rheumatoid arthritis

Front 60

70M

alcohol abuse, tender warm left ankle, no fevers

Back 60

gout

Front 61

20 student

R knee swelling and warmth

Back 61

gonorrhea

Front 62

50M

new heart murmur, red warm L elbow

Back 62

septic emboli

Front 63

73F

swollen DIP joints for months

Back 63

OA

Front 64

45M

sausage digits, scaly skin plaques

Back 64

psoriasis

Front 65

25

eye irritation, ankle swelling, dysuria

Back 65

Reiters

conjunctivitis, arthritis, urethritis

Front 66

50

oral and genital ulcers, arthralgias

Back 66

Behcets

a type of vasculitic syndrome

Front 67

35F

purpuric lesions on shins, renal insufficiency

Back 67

HSP or cryoglobulinemia

cryo- many pts have HCV in the immune complexes

Front 68

40F

reflux, digits get painful in cold, sob

Back 68

scleroderma/ CREST

Front 69

50F

difficulty brushing hair, rash around eyes

Back 69

dermatomyositis

Front 70

50F

dermatomyositis, what further eval?

Back 70

malignancy

Front 71

60F

lupus, pain out of proportion to abdominal exam

Back 71

mesenteric ischemia

due to vasculitis

Front 72

25F

3 pregnancies with 3 miscarriages

Back 72

antiphospholipid ab syndrome

coagulation abnormalities

Front 73

30F

depression, multiple tender areas

Back 73

fibromyalgia

Front 74

35F

angioedema, hx in father

Back 74

C1 esterase deficiency

Front 75

50M

low back pain, sacroiliitis on pxr

Back 75

ankylosing spondylitis

Front 76

70M

h/o iron overload, joint pains in wrists

Back 76

pseudogout

Front 77

65F

painless jaundice

Back 77

pancreatic head tumor

Front 78

45F

pruritis, xanthelasmas, AP 8x normal

Back 78

primary billiary cirrhosis

Front 79

50M

ulcerative colitis, newly elevated AP

Back 79

primary sclerosing cholangitis

Front 80

40M IVDA

purpuric lesions on shins, jaundice, arthralgias

Back 80

cryoglobulinemia

assoc with Hep C

Front 81

60M

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

Back 81

hemochromatosis

Front 82

25F

new liver dz, no alcohol, fam hx

Back 82

autoimmune hepatitis

Front 83

25M

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

Back 83

Hep A

Front 84

18M

elevated liver enzymes, new gait dysfunction

Back 84

Wilsons

Front 85

35M

homosexual, severe odynophagia, white plaques in oral cavity

Back 85

esophageal candidiasis, thrush

Front 86

70M

LLQ cramping pain, similar episodes in past, heme positive

Back 86

diverticulitis

Front 87

70

pencil thin stools

Back 87

rectal mass around anus

Front 88

45F

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

Back 88

malabsorption

aka dumping

Front 89

50M

copious diarrhea, skin flushing

Back 89

carcinoid

Front 90

65F

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

Back 90

colorectal cancer

Front 91

68M

CAD, PVOD, post prandial pain 30 minutes after eating

Back 91

mesenteric ischemia

Front 92

55M

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

Back 92

PUD duodenal ulcers usually feel better with food

Front 93

35 alcoholic

severe epigastric pain after recent binge episode

Back 93

acute pancreatitis

Front 94

18

3 days of abd pain, shifted from umbilicus to RLQ

Back 94

appendicitis

Front 95

18F

LLQ pain, vaginal discharge, sexually active

Back 95

PID

Front 96

80M

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

Back 96

obstruction

eg. BPH, prostate ca

Front 97

30F

fevers to 102, renal failure, thrombocytopenia, schistocytes

Back 97

DIC

may see mental status changes

Front 98

65M

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

Back 98

renal artery stenosis

Front 99

65F

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

Back 99

atheroemboli see decreased complement levels

Front 100

70M

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

Back 100

membranous glomerulopathy

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

Front 101

16F

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

Back 101

poststrep GN

Front 102

67M

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

Back 102

renal artery stenosis

Front 103

55M

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

Back 103

ACE I

Front 104

60M

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

Back 104

Allergic Interstitial Nephritis

Front 105

60M

s/p MVA, hypernatremia, UA specific gravity 1.002

Back 105

diabetes insipidus

Front 106

55

diabetic, non-anion gap hyperchloremic metabolic acidosis and hyperK

Back 106

Type 4 renal tubular acidosis

hyporeninemic hypoaldo

Front 107

25F

fever to 102, R flank pain, pyuria

Back 107

pyelonephritis

Front 108

55M

primary hyperparathyroidism, left flank pain, hematuria

Back 108

nephrolithiasis

Front 109

17M

abdominal pain, arthralgias, hematuria, elevated serum IgA

Back 109

HSP

Front 110

65M

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

Back 110

multiple myeloma

Front 111

55F

neuropathy, arthralgias, renal failure, pANCA positive

Back 111

PAN

Front 112

25

microscopic hematuria becomes macroscopic after flu like illness

Back 112

IgA nephropathy

aka Bergers

Front 113

35F

3rd trimester, hyperreflexia, edema, proteinuria

Back 113

pre-eclampsia

Front 114

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 114

Aminoglycoside toxicity

Front 115

15

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

Back 115

HUS 0:157 H:7 E Coli

Front 116

35

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

Back 116

Giardia

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

Front 117

50 alcoholic

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

Back 117

aspiration pneumonia

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

Front 118

18

new hematuria and rising Cr 2 weeks after severe URI

Back 118

post strep GN low complement

Front 119

21

LUQ discomfort, sore throat, fatigue, post cervical LAN

Back 119

mono

Front 120

parasitic cause of vit B12 deficiency

Back 120

fish tapeworm

Diphyllobothrium

Front 121

2 infections by Ixodes tick vector

Back 121

Lyme dz, Babesiosis

treat Lyme with doxy, treat Babesiosis with clinda

Front 122

40M

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

Back 122

Proteus

struvite stone, treat with quinolone

Front 123

35M HIV

fever, chills, rigors, LLL infiltrate on CXR

Back 123

strep pneumo

Front 124

55F HIV

CD4 count 100, sudden onset sob, pneumothorax

Back 124

PCP

treat with IV bactrim and steroids

Front 125

65M

colon ca, fevers and chills, GPC in chains

Back 125

strep bovis

gut gram positive bug

Front 126

20M

interstitial infiltrates, fever, nonproductive cough

Back 126

mycoplasma

treat with azithromycin

Front 127

40M

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

Back 127

syphillis

Front 128

parasitic cause of portal hypertension and bladder ca

Back 128

schistosomiasis

Front 129

35M

sepsis, widespread purpura, DIC, adrenal insufficiency

Back 129

meningococcemia

Waterhouse Friedrickson

Front 130

40M

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

Back 130

blasto

Front 131

65F

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

Back 131

aspergillus

Front 132

60M

2 wks on Abx, watery diarrhea

Back 132

C diff

Front 133

45M

duodenal ulcer bx

Back 133

H pylori

Front 134

55M

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

Back 134

tb

Front 135

35M

rash, arthralgias, Cape Cod

Back 135

Lyme dz