Classic Presentations 2

Question 1

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

Answer 1

McArdle’s dz (muscle glycogen phosphorylase deficiency)

Question 2

Cold intolerance?

Answer 2

Hypothyroidism

Question 3

Conjugate lateral gaze palsy, horizontal diplopia?

Answer 3

Internuclear ophthalmoplegia (damage to MLF; bilateral–MS, unilateral–stroke

Question 4

Continuous “machinery” heart murmur?

Answer 4

PDA (close with indomethacin; open or maintain with misoprostol)

Question 5

Cutaneous/dermal edema due to CT deposition?

Answer 5

Myxedema (caused by hypothyroidism, Grave’s dz [pretibial])

Question 6

Dark purple skin/mouth nodules?

Answer 6

Kaposi’s sarcoma (usually AIDS pts [MSM]: due to HHV-8)

Question 7

Deep, labored breathing/hyperventilation?

Answer 7

Kussmaul breathing (diabetic ketoacidosis)

Question 8

Dermatitis, dementia, diarrhea?

Answer 8

Pellagra (niacin [vitamin B3] deficiency)

Question 9

Dilated cardiomyopathy, edema, alcoholism or malnutrition?

Answer 9

Wet beriberi (thiamine [vitamin B1] deficiency)

Question 10

Dog or cat bite resulting in infection?

Answer 10

Pasteurella multocida (cellulitis at bite site)

Question 11

Dry eyes, dry mouth, arthritis?

Answer 11

Sjogren’s (autoimmune destruction of exocrine glands)

Question 12

Dysphagia (esophageal webs), glossitis, Fe deficiency anemia?

Answer 12

Plummer-Vinson (may progress to esophageal SCC)

Question 13

Elastic skin, hypermobility of joints?

Answer 13

Ehlers-Danlos (type III collagen defect)

Question 14

Enlarged, hard left supraclavicular node?

Answer 14

Virchow’s node (abdominal mets)

Question 15

Erythroderma, LAD, HSM, atypical T-cells?

Answer 15

Sezary syndrome (cutaneous T-cell lymphoma) or mycosis fungoides

Question 16

Facial muscle spasm upon tapping?

Answer 16

Chvostek’s sign (hypocalcemia)

Question 17

Fat, female, forty, and fertile?

Answer 17

Cholelithiasis (gallstones)

Question 18

Fever, chills, HA, myalgia following antibiotic tx for syphilis?

Answer 18

Jarisch-Herxheimer reaction (rapid lysis of spirochetes results in toxin release)

Question 19

Fever, cough, conjunctivitis, coryza, diffuse rash?

Answer 19

Measles (Paramyxovirus)

Question 20

Fever, night sweats, weight loss?

Answer 20

B sxs (staging) of lymphoma