associations Flashcards
heart failure after URI
myocarditis
high output heart failure
pregnancy, thyrotoxicosis, anemia, beriberi, paget’s disease
low output heart failure
arrhythmia, ischemic heart disease, HTN, dilated CM, valve disease
alcoholic with palpitations, arrhythmia
atrial fibrillation (holiday heart)
pulsus paradoxus
pericardial effusion/tamponade, pericarditis, ashtma attack, tension pneumo, SVC obstruction
EKG changes, N & V, yellow-green visual disturbances
digoxin toxicity
flank pain, hypotension, pulsatile abdominal mass
AAA
short PR, wide QRS, delta wave
WPW – avoid digoxin
LE rubor, no hair, brittle nail, pallor, calf pain with walking, claudication, ABI less .4
arterial insufficiency/PAD
trendelenberg test of extremitiess
tests for veinous insufficiency
rapid, deep labored breathing
Kussmaul brething–DKA, metabolic acidosis
cavitations on CXR
lung abscess, TB
deep breathing alternating with apnea
Cheyne-stokes breathing – heart failure, brain damage
pleural thickening on CXR
mesothelioma
hilar mass on CXR
lung cancer
eggshell pattern on CXR
silicosis or coal miners lung
ground glass appearance on CXR
asbestosis
reticular to nodular patter on CXR
coal miner’s lung
granulomas and inflammation of alveoli, small bronchi and small blood vessels
sarcoidosis
thumbprint sign
epiglottitis
inspiratory stridor
FB, viral croup
steeple sign
FB, viral croup
premature infant with respiratory distress, CXR has hypoexpansion and air bronchograms
hyaline membrane disease
elevated alk phos and urinary bilirubin
cholecystitis
fever, RUQ pain, gallstones, dilated common duct on US
ascending cholangitis (Charcot’s triad)
isolated elevated indirect bilirubin
Gilbert’s syndrome
elevated indirect bilirubin with defective glucuronyl transferase
Crigler-Najjar disease
multiple or constant GI ulcer pain despite meds
zollinger-ellison syndrome
CA-125
ovarian cancer
CA 19-9
pancreatic cancer
traveler’s diarrhea
Ecoli. tx with hydration and cipro
greasy, foul smelling, floating stool. water, travel, camping hx
giardia
zofran pharm category
5-HT3 blocker
afebrile, watery or loose stool with no blood or mucus
viral gastroenteritis
acute bacterial diarrhea with prodrome of HA, F, then crampy abd pain and diarrhea
campylobacter jejuni. most common cause of bacterial diarrhea
anti-endomysial antibodies
celiac sprue
beriberi
thiamine deficiency, alcoholic, neuro symptoms
pellagra
niacin deficiency ( 4D’s – dermatitis, diarrhea, dementia, death), bright red tongue
scurvy
Vit C deficiency (easy bleeding, bruising, hair and tooth loss, joint pain and swelling)
rickets
Vit D deficiency– osteomalacia
night blindness
vit A deficiency
magenta tongue
riboflavin deficiency (B2)
hypoglycemia in alcoholic
give thiamine before flucose to prevent Wernicke’s encephalopathy
hyponatremia and concentrated urine
SIADH
hyaline casts
normal…may be present after febrile illness or strenuous exercise
increased BUN/Cr and low FeNa
prerenal failure
kidney and lung bleeding
goodpasteures
vibrous band on lateral penis
peyronie’s disease
can’t retract foreskin
phimosis
lens shaped hemorrhage
epidural hematoma
concave
subdural hematoma
LP with decreased glucose, increased protein
bacterial meningitis
LP with decreased protein, few neutrophils
syphilitc meningitis
viral meningitis
mumps
meningitis and rash
meningiococcal
ascending paralysis
GBS
paralysis after campylobacter enteritis
GBS
weakness and fatigue in upper limbs, visual symptoms
myasthenia gravis
young kid with difficulty standing from seated position, calf muscle wasting
muscular dystrophy (weakness begins in pelvic girdle)
peds with fever or hx or URI with encephalopathy, emesis, hyperactive reflexes, hepatomegaly, elevated liver enzymes
Reye’s syndrome from URI/post flu or aspirin use
pediatric patient with episodes of blank stares
absence (petit-mall) seizures
3 mHz spikes on EEG
absence (petit-mall) seizures
ash leaf hypopigmentation of trunk and ext, shagreen patch, sebaceous adenomas, seizures, mental retardation, associated with PCK, renal hemartomas
tuberous sclerosis
bilateral pinpoint pupils
pontine hemorrhage
bilateral dilated pupils
anticholinergics, TCA, anti-parkinsonian drugs, profound hypoxemia
bilateral hemianopia
optic chiasm lesion
temporal field loss
ipsilateral optic tract lesion
eye trauma, exopthalmos, fixed upward gaze, hyphema, diplopia
orbital blow-out fx, immediate referral
painless, yellow triangular nodule on conjunctivia
pinguecula
transient monocular vision loss
amaurosis fugax – TIA, emboli
painless vision loss, hx of TIA, palpitations, arrhythmia, carotid disease, embolic source
CRAO (pale retina, cherry red macula)
painless vision loss, hx of HTN
CRVO (blood and thunder, retinal hemorrhages)
diplopia, dysarthria, dysphagia
vertibrobasilar insufficiency
unilateral foul smelling or purulent nasal discharge in peds patient
nasal foreign body
bullous myringitis
mycoplasma pneumonia
tinnitus and metabolic acidosis
salicylate ingestion
sudden dizziness, N&V, NO tinnitus, hearing loss, recent URI
vestibular neuronitis, labrynthitis
sudden dizziness, vertigo, hearling loss, tinnitus
meniere’s disease. tx with diuretics and low sodium diet
unilateral nerve deafness in middle age patient
acoustic neuroma–order MRI
horizontal nystagmus, acute onset vertigo
peripheral lesion
vertical nystagmus, insidious onset vertigo
central lesion (tumor)
smoker, white mouth lesion that cannot be rubbed off
leukoplakia, rule out oral cancer
gray pharyngeal pseudomembrane, rash, splenomegaly, supraclavicular LA
diptheria
philidelphia chromosome
CML
Auer rods
AML
reed-sternberg cells
hodgkin’s lymphoma
anemia after colectomy, partial gastrectomy, glossitis, decreased vibratory sensation
B12 or pernicious anemia
G6PD plus quinidine, nitrofuantoin, sulfa
hemolytic anemia
elevated Hgb, splenomegaly, post showering pruritis, plethora, engorged retinal veins
polycythemia vera. Tx = phlebotomy
mucosal or gingival bleeding, epistaxis, menorrhagia
von willebrand disease
Tzank smear
herpes virus
acetowhitening
condyloma acuminata
wood’s light fluoroscopy
dermatophytes infections, erythrasma (coral red)
bite with local edema, erythema, central necrosis
brown recluse
bite with fever, lacrimation, rhinorrhea, bradycardia, HTN, tachyarrhythmias
black widow (neurotoxin)
woods, forest, hikers, macular rash at wrist, ankles, then moves up to extremities then trunk. after 5 days, rash at palms and soles
RMSF (rickettsia rickettsia)
indirect immunofluorescent ab, weil-felix rxn, compliment
RMSF rickettsia
target lsion, arthralgia, bell’s palsy
lyme disease (borrelia burgdorfi)
intense pruritis, burrow like lesions at wrists, elbows, hands, web spaces
scabies
raccoons, bats, skunks
rabies.
gangrene
clostridium infection–anaerobic bacteria. tx with hyperbaric oxygen, penicillins, surgical excision
gram negative intracellular diplococci
gonorrhea
FTA-ABS, MTA-TP
syphilis diagnosis
malaria prophylaxis
chloroquine
pain at base of thumb, distal radial stylid, pain reproduced with ulnar deviation of clenched fist
deQuervain’s tenosynovitis
FOOSH, radial fx with dorsal displacement, dinner fork deformity
colles 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
scoliosis angle
> 25 degree cobb angle
8-10 yo male with limp, knee pain
legg-calve-perthes disease
HLA-B27
ankylosing spondylitis, reiter’s syndrome
positive ANA, anti-double stranded DNA antibodies, + anti-phospholipid antibodies
SLE
dusky red, well localized single or multiple papules or plaques usually of face
discoid lupus
osteomyelitis after stepping on nail
pseudomonas aeruginosa
teenage female with long bone pain w/o trauma or injury. XR w/ lytic mass, multi luminated periosteal reaction
Ewing sarcoma
periosteal onion skin reaction
Ewing sarcoma
painless bony mass…plain films show stalky or broad based projection from bone surface
osteochondroma
lytic lesions in back or skull
multiple myeloma
patient on antipsychotic meds develops altered consciousness, lead pipe rigidity, catatonia, hyperthermia, tachypnea, blood pressure changes, diaphoresis
neuroleptic malignant syndrome. tx is supportive care and antipyretics
infrequent blinking, tremor, rigidity, bradykinesia, shuffling gait, masked facies
parkinson’s
short lived, intense relationships. difficulty controlling anger, hx sexual promiscuity and substance abuse
borderline personality disorder
extrapyradimindal signs, BP changes, latered consciousness, hyperpyrexia, muscle rigidity, dysarthria, CV instability, fever, pulmonary congestion, diaphoresis, pt on antipsychotic meds
neuroleptic malignant syndrome
hyponatremia with bizarre behavior
lithium toxicity
antidepressant use with anticholinergic side effects, dry mouth, dysrhythmias, sedation, orthostatic hypotension
TCA overdose
male with gynecomastia, diminished or delayed secondary sex characteristics, small and firm testicles, long arms and legs
Klinefelter syndrome XXY. low serum testosterone and infertility
spontaneous bloody, serous, or cloudy nipple discharge
intraductal papilloma
adolescent female with midcycle pain alternating from left to right side, relieved with NSAIDS
Mittelschmerz
chocolate cyst
endometriosis
dysmenorrhea, dyspareunia, dyschezia, uterus fixed and retroflexed, cyclic pelvic pain
endometriosis
firm irregular shaped, nontender, enlarged uterus
leiomyoma
softened, tender, diffusel globular uterine enlargement
adenomyosis
unlilateral mobile tender adenexal mass…6cm ish
tubo-ovarian abscess
nagels rule
LMP +7 -3 mo
pregnant + rash, post-auricular or occipital LAD
rubella. give vaccine after delivery
pregnant, less 20 wks gestation with vaginal bleeding, abd and pelvic pain, blood from closed cervical os
threatened abortion
pregnant less 20 wks gestation with vaginal bleeding, abd and pelvic pain, tissue at or said to be passed from open cervical os
incomplete abortion (complete will have empty uterus, complete passage of fetal tissue and pain resolves after passage)
postpartum hemorrhage
uterine atony tx with massage
postmenopausal vaginal bleeding
endometrial cancer. do endometrial biopsy
postmenopausal adnexal mass
ovarian cancer
procainamide, hydralazine, rash
lupus-type eruptions
photosensitive rash
TCN, sulfa drugs
coral red on wood’s light
erythrasma
KOH
fungus, candida. hyphae, buds, spagetti and meatballs
gram stain
bacterial infection
beefy red, sharp bordered rash in groin and under breast folds with satellite lesions
candida. tx = nystatin/lotrimin cream if fails ketoconazole
red, less distinct borders. coral red on woods
erythrasma
distinct, sharp raised demarcated border with fever, chills. group A strep
erysipelas
grouped vesicles on erythematous base
herpes virus
infant or peds patient with grouped vesicles on thumb or tapicoa vesicles on thumb
herpetic whitlow
pain preceding vesicular rash in dermatomal pattern
herpes zoster
cough coryza conjunctivitis
rubeola (measles)
small white papules on diffusely red base on buccal mucosa
Koplick spots (rubeola) aka measles
pastia’s lines, positive ASO titer
scarlet fever (group A strep)
strawberry tongue
scarlet fever (group A strep)
pruritic raised erythematous plaques
urticaria
dewdrops on rose petal, pustules and vesicles at different stages of healing
varicella (chicken pox)
flesh colored, pink or yellow-brown lesion with rough, sandpaper feel, at sun-exposed areas
actinic keratosis
non-pruritic, raised, warty brown black plaques stuck onto skin feel greasy
seborrheic keratosis
flat brown spots with sharp borders on dorsum of hand
lentigines
erythematous, dome-shaped nodule with central plug
keratocanthoma
pearly papules with umbilicated center
molluscum contagiosum
sexually active person with rash on palms and soles, general LAD
secondary syphilis (money spots) VDRL will confirm
hypopigmented lesions, white, scaly, gets worse with tanning or sun exposure
pityriasis alba
erythematic ring with scaly border and central clearing
tina (fungal infection) KOH prep = hyphae
thick, yellow, brittle nails
onychomycosis tx = terbinafine
infant with erythematous, scaly, crusty lesions at vertex of scalp
cradle cap (seborrheic dermatitis)
tx with baby shampo, olive oil, hydrocortisone cream
adults treat with selenium slufide shampoo
children <10yo with vesicles on pharynx, mouth, hands, feet, with no ulceration
hand-foot-mouth disease. coxksackie virus
healthy looking less than 5yo with lace-like rash on both cheeks and red papules
erythema infectiosum (slapped cheeck) disease…fifths disease
truncal rash in pediatric after fever
roseola infantum (herpesvirus) motrin, symptommatic tx
fever, pharygitis, sandpaper rash over face, neck, trunk, extremities
scarlet fever
high fever x 5days, then rash. may have conjunctivitis, cracking, lip fissures
Kawasakis disease. look for cardiac complications
erythema marginatum
rheumatic fever
auspitz sign, koebner’s phenomena
psoriasis
rate bite erosions on XR
psoriatic arthritis
ddark skinned person with whitening or lightening of skin. hx of pernicious anemia or other autoimmune diseases
vitilligo. skin biopsy to dx
introduce solid foods
4-6 months.
first tooth
6-8mo
3 words, feeds self with spoon, build tower
2 yrs
walks alone
15 mo
positive osmotic fragility test
G6/PD deficiency (hemolytic anemia with oxidative drugs - sulfa, nitrofurantoin, quinidine)
