Classic Presentations part 3

Question 1

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

Answer 1

Aortic regurgitation

Question 2

Systolic ejection murmur (crescendo-decrescendo)

Answer 2

Aortic stenosis

Question 3

Continuous “machine-like” heart murmur

Answer 3

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

Question 4

Chest pain on exertion

Answer 4

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

Question 5

Chest pain with ST depressions on ECG

Answer 5

Angina (- troponins) or NSTEMI (+ troponins)

Question 6

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

Answer 6

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

Question 7

Painful, red lesions on pads of fingers/toes

Answer 7

Osler nodes (infective endocarditis, immune complex deposition)

Question 8

Painless erythematous lesions on palms and soles

Answer 8

Janeway lesions (infective endocarditis, septic emboli/microabscesses)

Question 9

Splinter hemorrhages in fingernails

Answer 9

Bacterial endocarditis

Question 10

Retinal hemorrhages with pale centers

Answer 10

Roth spots (bacterial endocarditis)

Question 11

Telangiectasias, recurrent epistaxis, skin discoloration,

arteriovenous malformations, GI bleeding, hematuria

Answer 11

Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)

Question 12

Polyuria (water diuresis), polydipsia

Answer 12

Primary polydipsia, diabetes insipidus (central, nephrogenic)

Question 13

No lactation postpartum, absent menstruation, cold

intolerance

Answer 13

Sheehan syndrome (postpartum hemorrhage leading to pituitary infarction)

Question 14

Heat intolerance, weight loss, palpitations

Answer 14

Hyperthyroidism

Question 15

Cold intolerance, weight gain, brittle hair

Answer 15

Hypothyroidism

Question 16

Cutaneous/dermal edema due to deposition of

mucopolysaccharides in connective tissue

Answer 16

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

Question 17

Facial muscle spasm upon tapping

Answer 17

Chvostek sign (hypocalcemia)

Question 18

Carpal spasm upon inflation of BP cuff

Answer 18

Trousseau sign (hypocalcemia)

Question 19

Deep, labored breathing/hyperventilation

Answer 19

Diabetic ketoacidosis (Kussmaul respirations)

Question 20

Skin hyperpigmentation, orthostatic hypotension, fatigue, weakness, muscle aches, weight loss, GI disturbances

Answer 20

Chronic 1° adrenal insufficiency (Addison disease) –> increased ACTH, increased α-MSH

Question 21

Shock, altered mental status, vomiting, abdominal pain,

weakness, fatigue

Answer 21

Acute adrenal insufficiency (adrenal crisis)

Question 22

Pancreatic, pituitary, parathyroid tumors

Answer 22

MEN 1 (autosomal dominant MEN1 mutation)

Question 23

Thyroid tumors, pheochromocytoma,

ganglioneuromatosis, Marfanoid habitus

Answer 23

MEN 2B (autosomal dominant RET mutation)

Question 24

Thyroid and parathyroid tumors, pheochromocytoma

Answer 24

MEN 2A (autosomal dominant RET mutation)

Question 25

Cutaneous flushing, diarrhea, bronchospasm, heart

murmur

Answer 25

Carcinoid syndrome (increased 5-HIAA)