4

Question 1

Pruritic, purple, polygonal planar papules and plaques (6 Ps)

Answer 1

Lichen planus

Question 2

Ptosis, miosis, anhidrosis

Answer 2

Horner syndrome (sympathetic chain lesion)

Question 3

Pupil accommodates but doesnt react

Answer 3

Argyll Robertson pupil (neurosyphilis)

Question 4

Rapidly progressive leg weakness that ascends following GI/upper respiratory infection

Answer 4

Guillain Barre syndrome (acute autoimmune inflammatory demyelinating polyneuropathy)

Question 5

Rash on palms and soles

Answer 5

Coxsackie A, secondary syphilis, Rocky Mountain spotted fever

Question 6

Recurrent colds, unusual eczema, high serum IgE

Answer 6

Hyper-IgE syndrome (Job syndrome: neutrophil chemotaxis abnormality)

Question 7

Red currant jelly sputum in alcoholic or diabetic patients

Answer 7

Klebsiella pneumoniae

Question 8

Red currant jelly stools

Answer 8

Acute mesenteric ischemia (adults), intussusception (infants)

Question 9

Red, itchy, swollen rash of nipple/areola

Answer 9

Paget disease of the breast (sign of underlying neoplasm)

Question 10

Red urine in the morning, fragile RBCs

Answer 10

Paroxysmal nocturnal hemoglobinuria

Question 11

Renal cell carcinoma (bilateral), hemangioblastomas, angiomatosis, pheochromocytoma

Answer 11

von Hippel Lindau disease (dominant tumor suppressor gene mutation)

Question 12

Resting tremor, rigidity, akinesia, postural instability

Answer 12

Parkinson disease (nigrostriatal dopamine depletion)

Question 13

Retinal hemorrhages with pale centers

Answer 13

Roth spots (bacterial endocarditis)

Question 14

Severe jaundice in neonate

Answer 14

Crigler-Najjar syndrome (congenital unconjugated hyperbilirubinemia)

Question 15

Severe RLQ pain with palpation of LLQ

Answer 15

Rovsing sign (acute appendicitis)

Question 16

Severe RLQ pain with rebound tenderness

Answer 16

McBurney sign (acute appendicitis)

Question 17

Short stature, increase incidence of tumors/leukemia, aplastic anemia

Answer 17

Fanconi anemia (genetic loss of DNA crosslink repair, often progresses to AML)

Question 18

Single palmar crease

Answer 18

Down syndrome

Question 19

Situs inversus, chronic sinusitis, bronchiectasis, infertility

Answer 19

Kartagener syndrome (dynein arm defect affecting cilia)

Question 20

Skin hyperpigmentation, hypotension, fatigue

Answer 20

Addison disease (primary adrenocortical insufficiency causes increase ACTH and increase MSH production)

Question 21

Slow, progressive muscle weakness in boys

Answer 21

Becker muscular dystrophy (X linked missense mutation in dystrophin, less severe than Duchenne)

Question 22

Small, irregular red spots on buccal or lingual mucosa with blue-white centers

Answer 22

Koplik spots (measles, rubeola virus)

Question 23

Smooth, flat, moist, painless white lesions on genitals

Answer 23

Condylomata lata (secondary syphilis)

Question 24

Splinter hemorrhages in fingernails

Answer 24

Bacterial endocarditis

Question 25

Strawberry tongue

Answer 25

Scarlet fever, Kawasaki disease, toxic shock syndrome

Question 26

Streak ovaries, congenital heart disease, horseshoe kidney, cystic hygroma at birth, short stature, webbed neck, lymphedema

Answer 26

Turner syndrome (45 XO)

Question 27

Sudden swollen/painful big toe joint, tophi

Answer 27

Gout/podagra (hyperuricemia)

Question 28

Swollen gums, mucosal bleeding, poor wound healing, petechiae

Answer 28

Scurvy (vitamin C deficiency: cant hydroxylate proline/lysine cant hydroxylate proline/lysine petechiae

Question 29

Swollen, hard, painful finger joints

Answer 29

Osteoarthritis (osteophytes on PIP [Bouchard nodes], DIP [Heberden nodes])

Question 30

Systolic ejection murmur (crescendo decrescendo)

Answer 30

Aortic valve stenosis

Question 31

Thyroid and parathyroid tumors, pheochromocytoma

Answer 31

MEN 2A (autosomal dominant ret mutation)

Question 32

Thyroid tumors, pheochromocytoma, ganglioneuromatosis

Answer 32

MEN 2B (autosomal dominant ret mutation)

Question 33

Toe extension/fanning upon plantar scrape

Answer 33

Babinski sign (UMN lesion)

Question 34

Unilateral facial drooping involving forehead

Answer 34

Facial nerve (LMN CN VII palsy)

Question 35

Urethritis, conjunctivitis, arthritis in a male

Answer 35

Reactive arthritis associated with HLA-B27

Question 36

Vascular birthmark (port-wine stain)

Answer 36

Hemangioma (benign, but associated with Sturge-Weber syndrome)

Question 37

Vomiting blood following gastroesophageal lacerations

Answer 37

Mallory-Weiss syndrome (alcoholic and bulimic patients)

Question 38

Weight loss, diarrhea, arthritis, fever, adenopathy

Answer 38

Whipple disease (Tropheryma whipplei)

Question 39

Worst headache of my life

Answer 39

Subarachnoid hemorrhage