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276 Cards in this Set
- Front
- Back
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DKA Pres
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Type 1 DM
Glucose 450 Depression (not taking insulin) - polyuria polydipsia nausea vomiting abd pain (Sx mimic surgical abdomen) Metabolic acidosis w/ AG |
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Cerebellar Dysfxn (2/2 ETOH) Pres
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HO ETOH
Frequent falls Broad based gait Ataxia Dysmetria Nystagmus Intention tremor RAM difficulty Pendular knee reflex (2/2 muscle hypotonia) |
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Actinic Keratosis Pres
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Excessive skin exposure
Age > 40yo Sandpaper texture Erythematous papules w/ central scale (hyperkeratosis) Location – face, ears, scalp, arms/hands LM – acanthosis, parakeratosis, dyskeratosis, hyperkeratosis, atypia of keratinocytes |
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TTP-HUS Pres
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Headaches
Confusion Hb 8.4 Plt 80K Cr 2.2 PBS – fragmented RBC |
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Chemotherapy induced N/V Pres
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HO Chemo
Vomiting Malaise No real lab abnlty – minor anemia, thrombocytopenia |
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Presbyopia Pres
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Age 40-60
Decreased near-vision No HO eye problems |
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Arteriovenous fistula Pres
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Congenital or HO trauma
Widened Pulse pressure Brisk carotid upstroke (strong arterial pulse) Tachycardia Flushing of extremities LVH/displaced PMI EKG – LVH (holosystolic murmur that does not vary w/ valsalva?) |
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Brain Death Pres
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No Cortical Fxn
No Brain Stem Fxn +/- Spinal Cord Fxn |
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Vertebral Compression Fx Pres
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Intense vertebral pain
No neurologic Sx |
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Bronchiectasis Pres
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CT – dilated central bronchi (larger than pulm A.), thickening of bronchial walls
Chronic productive cough Tx w/ several courses Abx Hemoptysis |
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Whipple Dz Pres
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Chronic malabsorptive diarrhea (steatorrhea, flatulence, abd distension)
Protein-losing enteropathy Weight loss Migratory non-deforming arthritis LAD Low-grade fever CNS, eye, myocardial damage |
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Giardiasis Pres
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Poor Sanitary Conditions/Developing country
Malabsorbtion +/- weight loss Foul-smelling stools Fatty stools Bloating Flatulence Nausea Malaise Abd cramps |
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Crystal-induced nephropathy Pres
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Periodic flank pain
Red urine Cr 2.2 UA – hematuria, needle-shaped crystals On HARRT for HIV |
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Parkinsonism Pres
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Limb muscle Rigidity
Gait problems Resting Tremor Bradykinesia Masked facies Stooped posture Shuffling gait |
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Neuropathic pain Pres
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Present at rest
Worse at night |
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Radioactive Iodine Adverse Rxn Pres
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New-onset Afib
Hand tremor |
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Afib Pres
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EKG – no P wave, irregularly irregular, narrow QRS
Often s/p CABG |
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Trachoma Pres
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(caused by chlamydia)
Follicular conjunctivitis Corneal neovascularization (pannus) Nasal discharge |
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Urinary Retention Pres
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Lower abd pain
Nausea 2d constipation HO amytriptyline Fullness/tenderness at midline below umbilicus |
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Wegeners Granulomatosis Pres
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URI, LRI, kidney dz…
Bloody/purulent nasal discharge Oral ulcers Sinusitis Dyspnea Cough Hemoptysis Fever, weight loss Cr – elevated UA – RBC casts CXR – nodular densities, alveolar/pleural opacities |
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Wegeners Granulomatosis Pres
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SOB
Fever Malaise 2 yrs recurrent sinusitis CXR – multiple bilateral nodular densities Cr – 2.7 UA – RBC casts |
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Pellagra Pres
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Corn-based diet (India/Africa/China, ETOH, carcinoid syndrome, Hartnup)
Diarrhea Dermatitis – rash in sun exposed areas Dementia Early Sx – weakness, irritability, abd pain, loss of appetite |
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Spinal Cord Compression/Cauda Equina Pres
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Absent rectal tone
Urinary incontinence Motor/sensory loss HO Prostate Cancer |
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Lateral Epicondylitis Pres
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Activities w/ wrist extension/supination (tennis)
Point tenderness distal to lateral epicondyle Pain during active wrist extension |
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Partial Congential Adrenal Hyperplasia Pres
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Puberty/adulthood
Virilization in female – dark hair growth Irregular periods Elevated 17-a-hydroxyprogesterone Usually no salt wasting |
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Hereditary Spherocytosis Pres
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Retic count
Increased bili Negative coombs PBS – spherocytes +/- jaundice, splenomegaly high MCHC (>36%) |
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Baker Cyst Pres
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HO RA – deformed hands, systemic Sx
Soft tender mass in popliteal fossa |
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Squamous Cell Carcinoma of Lung Pres
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Hypercalcemia Sx – anorexia, constipation, increased thirst, easy fatiguability
Cough Bloody sputum HO smoking CXR – hilar mass |
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Retinal Detachment Pres
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Sudden burst of flashing lights
Blurred vision Small spots Curtain HO cataract surgery/trauma Grayish retina |
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Primary Hyperaldosteronism Pres
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HTN
Polyuria Polydipsia Fatigue Low K+ High Aldo Adrenal mass Mild hypernatremia Low rennin Metabolic alkalosis NO EDEMA |
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Porphyria cutanea tarda Pres
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Painless blisters
Increased skin fragility on dorsum of hands Facial hypertrichosis, hyperpigmentation A/w HCV A/w ETOH, estrogens |
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Intrahepatic cholestasis of Pregnancy Pres
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2nd/3rd trimester
generalized pruritis skin excoriations 10-20% jaundice elevated total Bili elevated AST/ALT |
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Benign intracranialHTN/pseudotumor cerebri
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A/w – steroids, OCPs, trauma, obesity
HA – pulsatile, awakens from sleep ICP – N/V, neck pain, double vision, vision loss, tinnitus CN VI palsy Often empty sella |
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SIADH 2/2 cancer Pres
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Cancer Sx – cough, hemoptysis, parahilar nodule
Na – very low (124) |
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Heparin Inudced Thrombocytopenia Pres
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Tx w/ unfractionated heparin (> LMWH)
Plt count drops Onset -HIT I – 2 days -HIT II – 4-10 days (autoimmune) |
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Molluscum Contagiosum Pres
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Non-pruritic Rash – dome-shaped, flesh-colored papules, central umbilication
Location – trung, lumbs, anogenital, lower abd wall A/w immunodeficiency/HIV, steroids, ChTx |
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Renal Cyst Pres
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Incidental finding on CT
-thin walls -no solid component -no enhancement |
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Torticollis Pres
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Periodic involuntary head turning
Unilateral head fixation SCM hypertrophy |
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Dystonia Pres
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Sustained muscle contraction
Twisting repetitive mvmts Repetitive postures |
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Septic Arthritis Pres
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HO RA
Knee pain resistant to Tx (monoarthritis) -red swollen joint -passive and active motion limited by pain Fever |
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Aortic Regurgitation Pres
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Dyspnea
Murmur – diastolic decrescendo LUSB, intensified by handgrip Cardiomegaly Wide PP |
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C. difficile Colitis Pres
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BSABx post-op
POD 6 N/V/D/abd pain Profuse watery diarrhea Sigmoid TTP Fever |
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Blood Transfusion Anaphylaxis Pres
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Wheezing min after blood transfusion
Respiratory distress LOC (2/2 HoTN?) - rapid bronchospasm and HoTN w/out fever |
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ABO mismatching Pres
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Fever
Flank pain Dark urine DIC S/Sx |
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Toxic Shock syndrome Pres
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Sudden-onset flu
High fever HoTN Erythematous rash Systemic Failure S/Sx Skin peeling 1-2 wks later Use of tampons or other vaginal articles |
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Dresslers Syndrome Pres
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CP 2 weeks after MI s/p PCI/stent
Pericarditis CP – worse w/ deep inspiration, improved w/ leaning forward Pericarditis EKG – diffuse ST elevation, depression in aVR Malaise Fever Elevated ESR |
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OSA Pres
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Obese
Daytime somnolence Early AM HA Snoring Mild HTN |
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Herpes Simplex Keratitis Pres
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Eye pain
Photophobia Blurred vision Tearing Redness Corneal vesicles and dendritic ulcers |
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RA Pres
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Morning stiffness in hands
Elevated ESR |
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Epiglottitis Pres
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Rapid progression of sore throat dysphagia, muffled voice, drooling
Fever Cervical LAD Larynx TTP Stridor (harsh shrill) |
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Cocaine Abuse/Vasospasm Pres
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Severe substernal CP
Dilated pupils Blood in external nares EKG – ST elevation V1-V4 |
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Osteosarcoma Pres
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XR – codman triangle (lifted periosteum), “sunburst”
15yo pain swelling limited motion |
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Laryngeal Edema Pres
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Food rxn…sudden onset SOB
Flow-volume loop – limitation of both inspiratory/expiratory volume (equal as well) |
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Allergic Conjunctivitis Pres
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Itching and watering of both eyes
No BV Conjunctival edema, hyperemia, swollen eyelids, watery discharge HO asthma, rhinitis, atopic dermatitis |
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Hemochromatosis Pres
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Newly Dx DM
Hepatomegaly Arthropathy Hyperpigmentation Restrictive heart failure Hypogonadism Cirrhosis |
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Primary Biliary Cirrhosis Pres
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Middle aged women
Insidious onset Pruritis (esp at night) Fatigue HSM Xanthomatous lesions of eyelids/skin/tendons Later – jaundice, steatorrhea, portal HTN, osteopenia Alp Cholesterol Serum IgM |
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Postoperative Cholestasis Pres
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S/p major surgery
HoTN Blood into tissues massive blood replacement Jaundice POD 2-3 ALP > LFTs |
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Acute Tubular Necrosis 2/2 hypovolemic shock Pres
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HoTN s/p MVA
BUN 34 Cr 2.2 (ratio < 20) |
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PE Pres
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S/p major surgery
Severe SOB POD 5 DVT + |
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Invasive Aspergillosis Pres
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Immunocompromised Pt (neutropenia, cytotoxic drugs, high dose steroids)
Fever Cough Dyspnea Hemoptysis CXR – rapid dense consolidation CT – pulm nodules w/ halo sign, air crescent |
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Acute Pancreatitis Pres
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Acute epigastric pain R back
Fever Vomiting Agitation WBC amylase, lipase |
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Cardiogenic Pulm Edema Pres
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HO long-standing HTN
Dyspnea CP/SOB that awakens – PND |
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Aortic Dissection Pres
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Tearing CP Rback
Shock Sx – pale, anxious, diaphoretic, HoTN BP different btw arms JVD Echo – some pericardial fluid |
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Urinary Obstruction (Hydronephrosis 2/2 BPH) Pres
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Urinary Sx – urgency, hesitancy, nocturia, weak stream
DRE – smooth, enlarged prostate Cr – elevated |
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Chronic Pancreatitis Pres
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Epigastric pain (after eating)
Steatorrhea – pale, voluminous, foul-smelling Glucose intollerance |
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Infectious Mononucleosis Pres
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Fatigue, malaise
Sore throat, fever Generalized maculopapular rash Cervical LAD Palatal petichiae Splenomegaly |
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2nd AV block – Mobitz I Pres
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Asx or hypoperfusion/syncope
EKG – irregular rhythm, P wave before every QRS, PR interval grows leading to dropped beats |
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2nd AV block – Mobitz II Pres
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EKG – same as I but PR interval constant before dropped beats
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Macular Degeneration Pres
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Grid Test - Distortion of straight lines wavy
RF – age Ophtho exam – drusen deposits in macula |
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Folate Deficiency Pres
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Megaloblastic anemia
+/- anti-epileptic Rx usage +/- Bactrim usage |
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UTI Pres
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Post-op, elderly, DM
Fever AMS Incontinent UA – WBC > 5, bacteria, nitrites, leukocyte esterase |
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CN III DM neuropathy Pres
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Ptosis
Down-out gaze NOT fixed, dilated pupil w/out accomodation |
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PE Pres
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Syncopal epidose = acute
Right Heart Cath -RA > 10 -Pulm A > 40 -PCWP – nl can shock |
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Primary Open Angle Glaucoma Pres
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Asx when early
RF – black, FHx glaucoma, DM IOP Cupping of optic disk Loss of peripheral vision |
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INH hepatitis Pres
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Txd for active TB
LFTs but < 100 Sx in first few wks of Tx |
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DKA Pres
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Type I DM
Abd pain, nausea, vomiting AG, Bicarb, glucose |
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Neurogenic/Charcot Joint Pres
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Neuropathy/DM
XR – loss of cartilage, osteophyte, loose bodies/extraarticular bone fragments Mild pain Deformed joint |
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Cellulitis Pres
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RF – obesity, tinea pedis
Red erythematous skin, warm to touch +/- Fever LAD (i.e. groin mass) |
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Goodpasteures Syndrome Pres
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Renal and Pulmonary Findings
Renal – mild proteinuria, Cr, dysmorphic RBC Pulm – SOB, cough, hemoptysis Uncommon Systemic – fever, weight loss, arthralgias |
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3rd Degree Heart block Pres
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no consistent PR interval, no connection between P and QRS
p wave at 90-100bpm QRS at 30bpm Wide QRS +/- CP (MI cause) dizziness, hypotension (2/2 bradycardia) |
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Lumbar Spinal Stenosis Pres
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Middle age/elderly, HO DJD
Worse w/ standing, downhill walking (extension) Improved w/ sitting and uphill walking (flexion) Sx – weaknes, sensory loss, numbness/tingling, discomfort Nl Neuro exam |
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Pseudomonas Osteomyelitis Pres
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Osteomyelitis – fever, pain/swelling of bone
Nail Puncture |
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Hawthorne Effect Pres
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Study affected b/c people are aware of being studied
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Muscle injury 2/2 statin Pres
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Generalized aches and pains
Rx = statin CPK BUN, Cr, AST, ALT |
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Migratory Thrombophlebitis Pres
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Pain/itching/red streaks in arm
Same episode in chest Cord-like veins in same arm Weight loss Mild epigastric tenderness |
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IBS Pres
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GI and extra-GI Sx
Abd pain Relief w/ BMs Mucuous w/ stools Extra GI – depression, sexual dysfxn, urinary Sx exacerbated by stress |
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Jervell-Lange-Neilson Pres
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AR inheritance/FHx
Congenital deafness QT prolongation Torsades de Pointes (VT) Syncope w/out confusion |
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TCA OD Pres
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Seizures
Hyperthermia/Fever Antichol – dilated pupils, flushed/dry skin, ileus CNS depression QRS prolongation |
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Subconjunctival Hemorrhage Pres
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Woke up w/ Red eye
Asx |
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Hepatic Encephalopathy Pres
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HO cirrhosis
Decerebrate DTR ammonia |
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Osteoarthritis Pres
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Brief morning stiffness
Exertional joint pain No systemic Sx XR – narrowed joint space, osteophytes, subdural sclerosis/cysts |
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HZV Pres
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Older/immunosuppressed pt
Rash – vesicular eruption, unilateral, dermatomal Pain before eruption |
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Fulminant Hepatic Failure Pres
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Hepatic Encephalopathy w/in 8 wks of onset of liver failure
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Leprosy Pres
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Hypopigmented plaque w/out sensation
Muscle atrophy ?previous flu-like Sx |
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Postoperative Endophthalmitis Pres
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W/in 6 wks of surgery
Eye pain Decreased visual acuity Swollen eyelids/conjunctiva Hypopyon Corneal edema/infxn |
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Chlamydial Urethritis Pres
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Mucopurulent urethral discharge
HO multiple sexual partners Dysuria, frequency UA – no bacteria Ucx - < 100 colonies |
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Rx-induced edema Pres
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Symmetrical edema
Nl HxPE Nl labs Takes DHP CCB – amlodipine |
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Carpal-Tunnel Syndrome Pres
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Numbness/pain in hand
Thenar atrophy |
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Psychosocial CP Pres
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Low risk factors
Unrelated to activity Lasts for hours |
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Atrial Myxoma Pres
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mid-diastolic rumble
systemic sx – fever, weight loss neuro Sx (embolism) Echo – mass on LA |
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Lipoid Pnuemonitis 2/2 amiodarone Pres
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HO VT medication
DOE 3 mo later CXR – bilateral lung fibrosis Bx – lipoid pneumonitis |
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Bradyarrhythmia Pres
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HO syncopal episodes
Prolonged PR and/or QRS |
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Papillary Muscle dysfxn (MR) 2/2 MI Pres
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Sx 3-7 days after MI – HoTN, severe SOB
MR/valve Sx – soft S1, pansystolic murmur (apical Raxilla) LV Failure pulm edema – SOB, bibasilar crackles Echo – akinetic region of anterior wall |
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Latex Allergy Pres
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HoTN and rash w/ protected sex and surgery
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Acute Aortic Dissection Pres
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Tearing CP R back
Decrescendo murmur at SB CXR – wide mediastinum |
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Stable/Exertional angina Pres
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Periodic substernal pressure w/ exertion
EKG stress test – ST depression (non-diffuse) |
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Costochondritis Pres
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CP several hours
Sharp, central, nonradiating Worsens w/ inspiration/mvmt TTP |
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Aortic Dissection Pres
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Severe pain in chest
Later difficulty walking CXR – R. pleural effusion EKG – sinus tachy HTN |
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IC antiarrhythmic EKG effect of use-dependance
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Prolonged QRS w/ stress test (HR)
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Acute Aortic Dissection Pres
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Severe retrosternal pain
EKG – LVH/nl HTN CT – descending w/ true and false lumen |
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PCKD Pres
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FHx something
Morning headaches Bilateral NT upper abd masses |
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Chagas Dz Pres
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Brazil
Exertional dyspnea HO megacolon Edema JVD S3 |
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Aflutter Pres
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Palpitations
EKG -sawtooth -variable amt Pwaves, but > #QRSs) |
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Constrictive Pericarditis Pres
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CO – fatigue, DOE, muscle wasting
venous overload – JVP, ascites, Kussmaul sign, edema JVP tracing – sharp x, y descents Pericardial knock |
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GERD Pres
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CP after eating, burning
Cough Hoarseness |
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CHF Pres
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Recent onset dyspnea, cough
BNP |
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Hypertrophic Cardiomyopathy Pres
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FHx SCD
Dual Carotid upstroke Strong apical impulse Murmur – systolic ejection murmur LSB -increase w/ VR – valsalva, standing -decrease w/ VR – squatting -decrease w/ afterload – handgrip |
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PE Pres
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HoTN, Tachy
SOB HO DVT |
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Aspirin Sensitivity Syndrome Pres
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Aspirin ingestion
Persistent nasal blockage Episodes of bronchoconstriction |
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Acute Bronchitis Pres
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Hemoptysis/yellow sputum
Recent HO dry cough, malaise, throat pain Minimal Phys findings – wheezes No fever |
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Obesity Hypoventilation syndrome Pres
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OSA + inability to resume nl ventilation when awake
Chronic respiratory failure ABG - CO2, O2 |
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Emphysema Pres
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SOB/COPD
Thin man CXR – hyperinflation, diaphragm flattened, small heart |
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GERD-induced asthma Pres
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New HO wheezing, chest tightness
Worse after meals, exercise, laying down Obesity Hoarseness Erythematous larynx/pharynx |
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Chronic Bronchitis Pres
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Chronic smoker
Productive cough DOE Decreased FEV1/FVC Prominent bronchovascular markings Nl DLCO |
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Asbestosis/Bronchogenic cancer Pres
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SHx mining, shipbuilding, insulation, pipe work
Dyspnea WOUT cough, sputum Bibasilar end-inspiratory crackles Clubbing Lower lung abnlty/fibrosis Cancer – weight loss, peripheral mass |
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PCP Pres
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CD4 count < 150
Lung Sx Diffuse pulm infiltrates |
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Legionella Pres
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Atypical Pneumonia Sx – fever, non-productive cough, SOB
Refractory to amoxicillin HoTN GI – abd pain, loose stools Labs – hyponatremia, LFTs |
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Aspiration pneumonia Pres
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Pneumonia Sx – fever, productive cough, SOB
Foul-smelling sputum CT – no mass/obstruction RF – alcohol/altered consciousness, dysphagia, CNS Dz, sedation |
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ACEI-induced cough Pres
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Non-productive cough several weeks
Recently on ACEI/ has HTN Pretty nl exam |
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Klebsiella pneumonia Pres
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Pneumonia Sx – fever, productive cough, pleuritic CP, RUL infiltrate
Alcoholic Capsulated GNR Mucoid colonies Currant-jelly sputum |
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COPD exacerbation Pres
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SOB/respiratory distress after 1wk dry cough, mild fever (preceding URI)
Smoker ABG – acidosis, hypoxia, hypercapnia Accessory muscle use |
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Rhabdomyolysis Pres
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Immobilization
Cocaine abuse CPK K+ UA - +blood w/ no RBCs (myoglobin) |
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OSA Pres
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Daytime sleepiness
Morning HA Snoring BMI > 30 Nl ABG |
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Aspergilloma Pres
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Generalized malaise, cough, fever
Intermittent hemoptysis CXR – ball, lesion changes w/ mvmt |
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Secondary Lung Cancer Pres
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HO ChTx/Radiation > 20yrs ago
Lung Sx Lesion on CXR |
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Anaerobic Pneumonia Pres
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Pneumonia Sx – fever, productive cough
Refractory to azithromycin Foul-smelling sputum HO EGD |
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Pulm HTN Pres
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DOE/weakness/fatigue
CP, hemoptysis, syncope, hoarseness RHF S/Sx CXR – prominent pulm Aa, enlarged R heart border EKG – RAD |
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Angiodysplasia Pres
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Episodic bleeding (nl MCV) or chronic occult bleeding (low MCV)
A/w Aortic Stenosis/SEM at RUSB Age > 65yo Colonoscopy – often nl |
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ZE syndrome Pres
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Epigastric pain
Diarrhea Chronic PUD EGD – prominent gastric folds, multiple ulcers, ulcer beyond duodenum |
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Chrons Flare Pres
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Young pt
Abd pain, diarrhea, weight loss -- Ulcers in mouth RLQ pain w/out rebound XR – gas in small and large bowel |
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Toxic Megacolon 2/2 CUC Pres
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?young
abd pain, bloody diarrhea, weight loss fever diffuse tenderness, distension XR – dilated transverse colon |
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Folic Acid Deficiency Pres
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Fatigue
Tea and toast diet Pallor of nail bed/skin/conjunctiva |
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Gastric Cancer Pres
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Asian
Old Weakness, vague postprandial epigastric pain FOB+ EGD – antral ulcer |
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HZV Pres
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Right sided abd pain – const burning
No N/V/D Immunocompromised – receiving ChTx Light touch intense pain |
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Pancreatic Adenocarcinoma Pres
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Painless jaundice
Conjugated hyperbili w/ ALP -- Fatigue Jaundice Weight loss ALP, LFTs, bilis no pain |
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Zenkers Diverticulum Pres
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Dysphagia
R. neck mass increases w/ drinking |
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Chronic Mesenteric Ischemia Pres
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Postprandial pain w/ bloating, N/D
Weight loss, food aversion CXR/CT – nl Atherosclerotic Dz S/Sx, RF |
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Diverticulitis Pres
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LLQ pain
F/C CVA negative, UA – few WBC +/- AKI |
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Primary HIV infxn Pres
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3 mo diarrhea, distension, flatulence
weight loss night sweats arthralgias LAD +/- mucocutaneous ulcerations, rash, HA, dry cough |
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PUD Pres
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Melena, FOBT+
Abd pain, nausea Pain relieved with eating |
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ZE syndrome Pres
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Periodic abd pain refractor to PPI/H2 blocker
EGD – multiple ulcers, jejunal ulcer + stool fat/steatorrhea |
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Carcinoid Syndrome Pres
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Lower abd pain
Watery diarrhea Flushing Expiratory wheezes No fever JVD |
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Inflammatory diarrhea Pres
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IBD picture
Chronic diarrhea Weight loss, anemia, ESR, plt +FOB, +WBC in stool |
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Hepatorenal Syndrome Pres
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Severe liver dz
Cr, urine sodium (<10) UA – no protein, blood |
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Retroperitoneal hematoma Pres
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Weakness, dizziness, anemia, tachycardia
HO anticoagulation Back pain CT – white patch behind kidney near vertebra |
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Celiac Dz Pres
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Chronic diarrhea
Weight loss Fecal fat > 10g/d D-xylose - <2 g before and after Abx |
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Graves Dz Pres
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Palpitations
Weight loss Increased appetite Diarrhea Exophthalamos |
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Thyroid Cancer Pres
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Thyroid nodule
No Sx 4-5 cm, fixed, hard, non-tender FNA – malignant cells |
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DM2 Pres
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Polyuria, polydipsia
glc |
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MEN IIa Pres
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Malaise, HA, episodic palpitations, BP, HR
Ca (12) ? FHx (early death/BP) |
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SIADH 2/2 lung cancer Pres
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Transient LOC, lethargic confused
Hemoptysis, weight loss, CXR – hilar mass Na, Urine Na, high urine osm, low serum osm |
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Central/Secondary Hypogonadism (Males) Pres
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Impotence/decreased libido
Decreased testicular size Low testosterone, low/nl LH/FSH Increased Prl level |
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Primary Hypogonadism (males) Pres
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Impotence/decreased libido
Decreased testicular size Low testosterone, high LH/FSH Increased Estradiol |
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Addisons Dz Pres
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Weakness, fatigue, weight loss, anorexia, depression
Increased pigmentation HoTN |
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Generalized resistance to thyroid hormones Pres
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Hypothyroid S/Sx
Increased T3/4, nl TSH |
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|
Virilizing neoplasm Pres
|
mid-age
rapid hirsutism enlarged clitoris |
|
|
Osteomalacia Pres
|
Generalized bone pain
XR – pseudofractures, blurring of spine - bowel surgery |
|
|
Primary Adrenal Insufficiency 2/2 TB Pres
|
Weight loss, fever, sputum
Nausea, abd pain, postural dizziness Abnl cosyntropin stimulation test CT – bilateral adrenal calcifaction |
|
|
TSH secreting pituitary adenoma Pres
|
HA, visual problems, bitemporal hemianopsia
Hyperthyroid Sx, symmetrically enlarged thyroid gland Elevated T3, T4, TSH, alpha-subunit |
|
|
Androgen-producing adrenal tumor Pres
|
mid-age
rapid virilization – hair, irregular periods, clitoromegaly Left adrenal mass DHEAS |
|
|
Insulinoma Pres
|
Hypoglycemia (38) w/ S/Sx – palpitations, tremor, nervousness, HA
insulin, pro-insulin, C-peptide |
|
|
Exogenous insulin Pres
|
Hypoglycemia S/Sx
insulin low C-peptide nl proinsulin |
|
|
DM gastroparesis Pres
|
Anorexia, N/V, bloating, early satiety
Post-meal hypoglycemia (2/2 insulin use) |
|
|
Acromegaly Pres
|
HA
Joint pain Carpal Tunnel Cant get wedding ring off HTN Skin tags |
|
|
PTU-induced agranulocytosis Pres
|
PTU for hyperthryoidism
Sore throat Fever - WBC < 1000 (if > 1500 not the cause?) Soft palate/pharynx/tonsils red, swollen |
|
|
Cord Compression Pres
|
Sensory
Proprioception Numbness/tingling Motor Sx +Babinski |
|
|
Lewy-Body Dementia Pres
|
Fluctuating confusion
Well-formed visual hallucinations Parkinsonian motor features/EPS -- Confusion Motor loss Increased tone Visual hallucinations Stiffness aggravated by Anti-psychotics |
|
|
Exertional heat stroke Pres
|
Healthy individual
Hot outside Temp > 105 AMS, dizziness, dry skin, HoTN, tachys Rhabdomyolysis, ARF, DIC |
|
|
ALS Pres
|
Upper and lower MN signs
Upper – hyperreflexia, abnl reflexes, increased tone, bulbar Lower – atrophy, fasciculations |
|
|
Wernickes encephalopathy Pres
|
AMS
Gait instability Nystagmus, conjugate gaze palsy HO alcoholism |
|
|
Korsakoff syndrome Pres
|
?HO wernicke
irreversible amnesia confabulation apathy |
|
|
Glaucoma Pres
|
Sudden-onset photophobia, eye pain, HA, nausea
Eye may feel hard Non-reactive mid-dilated pupil |
|
|
Epidural Abscess Pres
|
S/Sx cord compression
-Symmetric lower extremity Sx -sensation -UMN HO IVDU (regardless of fever) |
|
|
Complex Partial Seizure Pres
|
Brief
Impaired consciousness, Failure to respond to stimuli, Staring spell, Automatisms – lip smaking, swallowing, pick mvmt of hand Post-ictal confusion EEG – nl or brief dishcarge |
|
|
MS Pres
|
Patchy Neuro problems
-RUE/LLE -ON – painful loss of vision, central scotoma MRI – bilateral, multifocal asymmetric contrast enhancement |
|
|
Essential Tremor Pres
|
Tremor w/out addl neurological S/Sx
More noticeable w/ task/mvmt Difficulty holding paper, writing, drinking coffee |
|
|
Internal Capsule stroke
|
Sudden onset weakness
Motor Sx only – diffuse on one side, face, arm, leg No other Neuro Sx – HA, VF abnormalities, higher cortical difficulty |
|
|
Acute Angle closure glaucoma Pres
|
Severe unilateral HA
Pain around eye worse w/ bright light Seeing halos Non-reactive dilated pupil Erythematous eye ESR |
|
|
GBS Pres
|
Ascending motor/sensory loss in lower extremities
Recent URI or vaccination |
|
|
Delirium Pres
|
Acute confusion, disorientation, hallucinations
|
|
|
Medial Medullary stroke Pres
|
Contralateral spastic hemiplegia
Contralateral DC loss Tongue deviation to injured side |
|
|
Lateral Medulla stroke Pres
|
Ispilateral Horners
STT loss of face, contra body CN IX, X weakness Cerebellar ataxia |
|
|
Normal Pressure Hydrocephalus Pres
|
Abnl gait – slow, broad-based, shuffling
Incontinence Dementia – memory loss w/out focal neuro changes CT/MRI – enlarged ventricles |
|
|
Myasthenia Gravis Pres
|
18-25yo
intermittent bulbar Sx – dysarthria, diplopia, dysphagia, ptosis generalized weakness/fatigue – worse w/ day, exercise resolves w/ rest |
|
|
Opiate Intoxication Pres
|
Pinpoint pupils
Respiratory depression |
|
|
BZD overdose Pres
|
HoTN
Drowsiness |
|
|
Hereditary Spherocytosis Pres
|
Severe abd pain, N/V
Brother had similar problem surgery Fever RUQ TTP, exacerbated by deep inspiration Palpable spleen -- acute cholecystitis from gallstones 2/2 hemolysis |
|
|
Waldenstroms macroglobulinemia Pres
|
HSM
LAD Tiredness/anemia Bleeding/bruising Night sweats HA Dizziness Visual problems Pain/numbness – demyelination Serum Electrophoresis – IgM spike |
|
|
Febrile Transfusion Rxn Pres
|
F/C that respond to NSAIDs/acetaminophen
HDS No renal dysfxn |
|
|
Juvenile Angiofibroma Pres
|
Adolescent boy
Nasal obstruction, visible nasal mass, frequent nosebleeds Found in back of nose, can be eroding |
|
|
Turcots syndrome Pres
|
Colonic polyps – FAP, HNPCC
Brain tumor – medulloblastoma, glioma |
|
|
CML Pres
|
B-Sx – fatigue, decreased appetitie, early satiety
WBC, Hb, plt abnl chr 22 |
|
|
B12 deficiency Pres
|
Anemia S/Sx
Improvement w/ folate Tingling |
|
|
AIHA Pres
|
Anemia Sx – dyspnea, fatigue, pallor
Hemolysis Sx – jaundice, indirect bili, LDH, retic PBS – spherocytes +osmotic fragility +direct coombs NO FHx |
|
|
Mediastinal Teratoma Pres
|
Progressive SOB, wheezes at night
CT – mediastinal mass AFP, b-HCG |
|
|
PNH Pres
|
Abd pain, RUQ TTP
Hb, Total bili, LDH, Haptoglobin (intravascular) MRI – hepatic v. thrombosis |
|
|
CML Pres
|
WBC, Hb, immature WBCs
>50yo B-Sx, bone pain Bone Marrow – hypercellularity, granulocytic hyperplasia leukocyte alkaline phosphatase |
|
|
MAHA Pres
|
Fatigue/anemia
HO prosthetic valve PBS – schistocytes |
|
|
Pagets Dz of breast Pres
|
Nipple rash – ulcerating eczematous appearance
Skin Bx – large cells surrounded by halos |
|
|
Pernicious Anemia pres
|
HO autoimmune dz – vitiligo, autoimmune thyroiditis
Macrocytic anemia |
|
|
Lyme Dz Pres
|
Rash, fever, malaise
Tick bite in NE USA |
|
|
Nocardia Pneumonia Pres
|
HO HIV
Anorexia, malaise, night sweats, fever, weight loss Productive cough, yellow sputum RUL cavitation Partial acid fast, branching filaments |
|
|
PCP Pres
|
HO HIV
Fever, exertional dyspnea, non-productive cough O2 increases w/ mask CXR – diffuse bilateral infiltrate LDH 400 |
|
|
Post-influenza Staph Pneumonia Pres
|
Flu syndrome Txd w/ meds
New pneumonia less than 2wks later |
|
|
EBV Mono Pres
|
Fever, sore throat, severe fatigue
Exudative tonsillitis LAD, splenomegaly |
|
|
Hereditary Hemochromatosis Pres
|
Fatigue, malaise
Disabling joint pain – morning stiffness FHx liver cancer Grayish skin pigmentation glc LFTs iron studies |
|
|
Kaposi Sarcoma Pres
|
HO HIV
Skin lesion pinkviolet – Asx, elliptical, linear arrangment Low CD4 count (30) |
|
|
S. aureus pulm infxn 2/2 septic emboli Pres
|
HO IVDU
F/C, SOB CT – multiple nodular lesions w/ small cavities |
|
|
Erysipelas Pres
|
Fever
Painful swelling – erythematous rash, well-demarcated border |
|
|
Pseudomonas Pneumonia Pres
|
HO CF
F/C, CP, dullness, tactile fremitus CXR – lower lobe infiltrate Green-colored sputum |
|
|
CMV mono Pres
|
Mono – fatigue, fever, muscle aches, splenomegaly
Lymphocytosis PBS – large basophilic lymphocytes w/ vacuolated appearance (atypical lympohocytes) Negative Heterophile NO pharygitis/sore throat or LAD |
|
|
Malignant otitis Externa Pres
|
Intense ear pain R TMJ
Ear discharge Granulation tissue in external canal Worse despite topical Abx RF – DM, immunosuppression |
|
|
Lyme Dz Pres
|
Erythema migrans? – many rashes?, no pain, itching, burning
Facial nerve palsy – inability to close right eye HO camping |
|
|
Primary Syphilis Pres
|
Painless ulcer on penis
Recent dangerous sex practice Darkfield – spirochetes |
|
|
CMV Pneumonitis Pres
|
HO Bone marrow transplant
Lung and intestinal infxn - fever, dyspnea abd pain, diarrhea HO bone marrow transplant 2-4 mo ago Thrush CXR – multifocal diffuse patchy infiltrates |
|
|
Proteus UTI Pres
|
Indwelling foley
BUN pH (8.5) UA – leukocyte esterase, WBC, few bacteria |
|
|
SLE Pres
|
AAF 20-40yo
Fatigue Painless oral ulcers Non-deforming arthritis!! – MCP, PIP Hematologic abnlty – deficiency of any cell line Low-fever, rash, weight loss, serositis, proteinuria |
|
|
Septic Arthritis Pres
|
Prosthetic joint
Acute onset painful swollen limited motion Fever Synovial fluid – high WBC (50-150K) |
|
|
Vertebral Osteomyelitis Pres
|
Back pain
Low-grade fever – inconsistent ESR local TTP on vertebrae, paravertebral muscular spasm - increases w/ motion IVDU plt (inflammation) |
|
|
Pagets of bone Pres
|
Asx ALP in elderly
- mosaic pattern of lamellar bone femoral bowing ALP deformities, joint pain, Fx, nerve entrapment ( hearing loss), osteosarcoma |
|
|
Lumbosacral strain Pres
|
Acute back pain after physical exertion
No radiation (to thighs) PARAvertebral TTP Negative straight leg, nl neuro exam |
|
|
CUC Pres
|
Young age
Acute-onset bloody diarrhea, lower abd pain, tenesmus Erythema nodosumm – painful erythematous nodules over face Pyoderma gangrenosum Episcleritis Arthritis/Ankylosing spondylitis – low back pain/stiffness, worse in AM Cholangitis +P-ANCA |
|
|
Lung Restriction 2/2 Ankylosing spondylitis Pres
|
FEV, nl FEV1/FVC ratio
FRC chronic low back pain ESR |
|
|
Fibromyalgia Pres
|
Diffuse MSK pain – back, arms, shoulders, SCM, traps
NO joint swelling, nl lab abnlties (ESR 12) Female 20-55 Excessive TTP Pain worse w/ exercise ?Tx Poor sleep/fatigue/depression |
|
|
Enthesitis Pres
|
Pain/inflammation at sites of tendon attachment – heels, iliac crests, tibial tuberosity
A/w Ankylosing spondylitis, Psoriatic Arhtritis |
|
|
Polymyositis/Dermatomyositis Pres
|
Woman 40-50yo
Gradual prox muscle weakness – shoulders, hips ESR, CK (inflammation) |
|
|
Osteoarthritis Pres
|
Older
Hands, weight-bearing joints – hip, knee Mild morning stiffness < 30 min Worse w/ exercise, relief w/ rest +/- effusions, NOT hot bony crepitus, enlargement painful/decreased range of motion Synovial fluid – WBC 200-2000 XR – narrowed joint space, osteophyte, subchondral sclerosis/cysts |
|
|
Ankylosing spondylitis Pres
|
20-30yo man
progressive back pain, morning stiffness > 3 mo reduced range of motion sacroiliac TTP anterior uveitis – monocular pain, blurring, photophobia HLA-B27+ |
|
|
Vertebral Mets Pres
|
HO cancer (non-small cell lung cancer)
Back pain – constant, worse at night/rest |
|
|
Amyloidosis (AA) Pres
|
Dz setting – see FC…chronic inflammation
Systemic Sx -kidney – nephritic syndrome -GI – hepatomegaly -Heart – cardiomegaly -MSK – pseudohypertrophy -PNS – neuropathy |
|
|
Vertebral Compression Fx Pres
|
Older/osteoporosis (steroids)
Acute onset back pain – setting of trauma (lifting turkey) Spinal tenderness (NOT paravertebral TTP) Nl neuro exam |
|
|
Gonococcemia Pres
|
Polyarthralgia – wrist, elbow, ankle pain
Tenosynovitis – pain along tendon sheaths Painless vesiculo-pustular skin lesions – red circles (reverse bullet holes) HO unprotected sex |
|
|
Giant Cell Arteritis Pres
|
HA
Jaw claudication Muscle fatigue Visual disturbance Palpable temporal cord ESR > 50 |
|
|
Pseudogout 2/2 HyperPTH Pres
|
Acute arthritis of knee
Ca, Phos constipation, fatigue, excess urination Ca changes – abd pain, urinary stones, AMS, osteoporosis Synovial fluid – rhomboid, positive birefringence |
|
|
Systemic Sclerosis/Scleroderma Pres
|
Skin – thickening, raynaud, mask-like face (thickening)
Pulm – exertional dyspna, Pulm HTN/RHF = edema, JVD Esophagus/GI – GERD Renal – HTN |
|
|
Hydatid Cyst Pres
|
Intimate contact w/ dogs
Asx or Sx 2/2 compression, i.e. RUQ TTP CT – eggshell calcification (hepatic) |
|
|
Fxnl pain Pres
|
RUQ pain s/p chole
Nl LFTs No CBD dilation |
|
|
Amebic Liver abscess Pres
|
Mexico Travel HO bloody diarrhea
RUQ pain Single cyst in RUL liver “anchovy paste” on aspiration (acellular proteinaceous) |
|
|
Pancreatic Cancer Pres
|
Painless jaundice +/- steatorrhea
Fatigue, weight loss CT – mass at pancreas +/- recent onset DM, migratory thrombophlebitis, previous pancreatitis |
|
|
Acute Cholecystitis Pres
|
Large/fatty meal
Acute epi/RUQ pain +/- R R. scapula Murphy sign – arrest of inspiration w/ gb palpation Fever, vomiting, WBC Mild elevation of bili, LFTs, ALP |
|
|
NASH Pres
|
Alcoholic hepatitis Sx
-RUQ fullness -LFTs -hepatomegaly DM Sx -acanthosis -obesity |
|
|
Acute Ascending Cholangitis Pres
|
Fever, severe jaundice, RUQ pain
Confusion, HoTN Appears very ill ALP, nl LFTs, WBC US – dilated CBD |
|
|
Vanishing Bile Duct syndrome Pres
|
Fever
Severe diarrhea Pruritis, jaundice Liver Bx – decreased quantity of bile ducts |
|
|
Pancreatic Pseudocyst Pres
|
Palpable mass 4 wks s/p acute/chronic pancreatitis
Epi pain R back amylase |
|
|
Acute Pancreatitis Pres
|
Epi pain R back
N/V, low grade fever amylase, lipase |
|
|
HCC Pres
|
HO HBV
Abd discomfort, early satiety, distension, weight loss +/- new-onset ascites |
|
|
Dubin-Johnson Pres
|
Icterus w/ nl phys exam
Nonspecific Sx – abd pain, weakness, fatigue Nl labs w/ - bili (conjugated = mostly direct) +/- Jewish urine coproporphyrin I (not III) black liver/dark pigment in hepatocytes |
|
|
Primary Sclerosing Cholangitis Pres
|
Asx or
Fatigue/pruritis Fever, chills, night sweats, RUQ pain ALP, bili, LFTs (<300) HO IBD/CUC cholangiography – multifocal structuring and dilation/beading of ducts Bx – fibrous obliteration of small ducts, “onion skin” +/- Igs, atypical p-ANCA …eventual liver failure S/Sx |
|
|
Hepatic Adenoma Pres
|
Woman w/ lengthy OCP use
Dull RUQ pain, palpable mass +/- hepatomegaly, jaudnice ALP, GGT Bx – atypical enlarged cells w/ glycogen/lipid |
|
|
Acute Hemolytic transfusion rxn/ABO mismatch Pres
|
W/in 1 hr of transfusion
Fever, chills, flank pain, Hb in urine Complications – DIC, renal failure, shock |
|
|
BPH Pres
|
Urinary Sx – frequency, nocturia, hesitancy, weak stream
Rectal – smooth, firm, enlargment |
|
|
Membranous GN Pres
|
GN Sx – fatigue, edema, dark urine
UA – nephritic proteinuria, (micro)hematuria Bx – C3+ at GBM |
|
|
Hypertensive Nephrosclerosis Pres
|
Fatigue, BUN, Cr
Small kidneys Bx – intimal thickening, arteriole narrowing, evidence of sclerosis |
|
|
Post-op Urinary retention Pres
|
POD ?4 s/p abd/pelvic surgery in males
New onset pain Oliguria BUN, Cr |
|
|
DM Denervated bladder Pres
|
HO DM w/ neuropathy, and other complications
Day and night incontinence Distended bladder post-void residual |
|
|
Urinary retention 2/2 pain Pres
|
CC- inability to urinate
Acute pain/trauma HO BPH/mild obstruction Inability/pain w/ valsalva Intact anal tone |
|
|
Dehydration Pres
|
AMS
Dry MM electrolytes BUN/Cr > 20 More likely if elderly |
|
|
Nephrotic syndrome Pres
|
Protienuria > 3g
alb edema HLD, fatty casts |
|
|
Acute Pyelonephritis Pres
|
Flank pain
Dysuria High F/C CVA tenderness |
|
|
Cystinuria Pres
|
HO recurrent kidney stones
FHx recurrent kidney stones UA – hexagonal crystals |
|
|
Mixed cryoglobulinemia Pres
|
Palpable purpura
Proteinuria w/ hematuria Nonspecific – arthralgia, HSM, complement HO HCV Circulating cryoglobulins |
|
|
Membranous GN Pres
|
Child w/ +active HBV (esp HbeAg)
4+ proteinuria alb Sx – facial puffiness, fatigue, decreased appetite |
|
|
FSGS/HIV nephropathy Pres
|
HIV+ (even w/ nl CD4), often black
alb Sx – fatigue, edema BUN, Cr 3+ proteinuria nl size kidney |
|
|
Contrast-induced nephropathy Pres
|
Spike in Cr w/in 24 hrs
Resolves w/in 5-7 days RF – Cr > 1.5, DM |
|
|
Acyclovir-Nephrotoxicity Pres
|
Receive IV acyclovir – esp high dose
Big Cr on day ?3 |
|
|
Aminoglycoside Nephrotoxicity Pres
|
Tx for GNR (resistant pyelo)
UA – no WBC (r/o AIN) FENa – r/o pre-renal |
