classic presentations 1

Question 1

Abdominal pain, ascites, hepatomegaly

Answer 1

Budd-Chiari syndrome (posthepatic venous thrombosis)

Question 2

Abdominal pain, diarrhea, leukocytosis, recent antibiotic use

Answer 2

Clostridium difficile infection

Question 3

Achilles tendon xanthoma

Answer 3

Familial hypercholesterolemia (LDL receptor signaling)

Question 4

Adrenal hemorrhage, hypotension, DIC

Answer 4

Waterhouse-Friderichsen syndrome (meningococcemia)

Question 5

Anaphylaxis following blood transfusion

Answer 5

IgA deficiency

Question 6

Anterior “drawer sign” ⊕

Answer 6

Anterior cruciate ligament injury

Question 7

Arachnodactyly, lens dislocation (upward), aortic dissection, hyperflexible joints

Answer 7

Marfan syndrome (fibrillin defect)

Question 8

Athlete with polycythemia

Answer 8

2° to erythropoietin injection

Question 9

Back pain, fever, night sweats

Answer 9

Pott disease (vertebral TB)

Question 10

Bilateral acoustic schwannomas

Answer 10

Neurofibromatosis type 2

Question 11

Bilateral hilar adenopathy, uveitis

Answer 11

Sarcoidosis (noncaseating granulomas)

Question 12

Black eschar on face of patient with diabetic ketoacidosis

Answer 12

Mucor or Rhizopus fungal infection

Question 13

Blue sclera

Answer 13

Osteogenesis imperfecta (type I collagen defect)

Question 14

Bluish line on gingiva

Answer 14

Burton line (lead poisoning)

Question 15

Bone pain, bone enlargement, arthritis

Answer 15

Paget disease of bone (^osteoblastic and osteoclastic activity)

Question 16

Bounding pulses, wide pulse pressure, diastolic heart murmur, head bobbing

Answer 16

Aortic regurgitation

Question 17

“Butterfly” facial rash and Raynaud phenomenon in a young female

Answer 17

Systemic lupus erythematosus

Question 18

Café-au-lait spots, Lisch nodules (iris hamartoma), cutaneous neurofibromas, pheochromocytomas, optic gliomas

Answer 18

Neurofibromatosis type I

Question 19

Café-au-lait spots (unilateral), polyostotic fibrous dysplasia, precocious puberty, multiple endocrine abnormalities

Answer 19

McCune-Albright syndrome (mosaic G-protein signaling mutation)

Question 20

Calf pseudohypertrophy

Answer 20

Muscular dystrophy (most commonly Duchenne, due to X-linked recessive frameshift mutation of dystrophin gene)

Question 21

Cervical lymphadenopathy, desquamating rash, coronary aneurysms, red conjunctivae and tongue, hand-foot changes

Answer 21

Kawasaki disease (treat with IVIG and aspirin)

Question 22

“Cherry-red spots” on macula

Answer 22

Tay-Sachs (ganglioside accumulation) or Niemann-Pick (sphingomyelin accumulation), central retinal artery occlusion

Question 23

Chest pain on exertion

Answer 23

Angina (stable: with moderate exertion; unstable: with minimal exertion or at rest)

Question 24

Chest pain, pericardial effusion/friction rub, persistent fever following MI

Answer 24

Dressler syndrome (autoimmune-mediated post-MI fibrinous pericarditis, 2 weeks to several months after acute episode)

Question 25

Chest pain with ST depressions on EKG

Answer 25

Unstable angina (⊝ troponins) or NSTEMI (⊕ troponins)

Question 26

Child uses arms to stand up from squat

Answer 26

Duchenne muscular dystrophy (Gowers sign)

Question 27

Child with fever later develops red rash on face that spreads to body

Answer 27

Erythema infectiosum/fifth disease (“slapped cheeks” appearance, caused by parvovirus B19)

Question 28

Chorea, dementia, caudate degeneration

Answer 28

Huntington disease (autosomal dominant CAG repeat expansion)

Question 29

Chorioretinitis, hydrocephalus, intracranial calcifications

Answer 29

Congenital toxoplasmosis

Question 30

Chronic exercise intolerance with myalgia, fatigue, painful cramps, myoglobinuria

Answer 30

McArdle disease (skeletal muscle glycogen phosphorylase deficiency)

Question 31

Cold intolerance

Answer 31

Hypothyroidism

Question 32

Conjugate horizontal gaze palsy, horizontal diplopia

Answer 32

Internuclear ophthalmoplegia (damage to MLF; may be unilateral or bilateral)

Question 33

Continuous “machine-like” heart murmur

Answer 33

PDA (close with indomethacin; keep open with PGE analogs)

Question 34

Cutaneous/dermal edema due to connective tissue deposition

Answer 34

Myxedema (caused by hypothyroidism, Graves disease [pretibial])

Question 35

Cutaneous flushing, diarrhea, bronchospasm

Answer 35

Carcinoid syndrome (right-sided cardiac valvular lesions, ^5-HIAA)

Question 36

Dark purple skin/mouth nodules in a patient with AIDS

Answer 36

Kaposi sarcoma, associated with HHV-8

Question 37

Deep, labored breathing/hyperventilation

Answer 37

Diabetic ketoacidosis (Kussmaul respirations)

Question 38

Dermatitis, dementia, diarrhea

Answer 38

Pellagra (niacin [vitamin B3] deficiency)

Question 39

Dilated cardiomyopathy, edema, alcoholism or malnutrition

Answer 39

Wet beriberi (thiamine [vitamin B1] deficiency)

Question 40

Dog or cat bite resulting in infection

Answer 40

Pasteurella multocida (cellulitis at inoculation site)