Classic Presentations part 4

Question 1

Jaundice, palpable distended non-tender gallbladder

Answer 1

Courvoisier sign (distal malignant obstruction of biliary tree)

Question 2

Vomiting blood following gastroesophageal lacerations

Answer 2

Mallory-Weiss syndrome (alcohol use disorder, bulimia nervosa)

Question 3

Dysphagia (esophageal webs), glossitis, iron deficiency anemia

Answer 3

Plummer-Vinson syndrome (may progress to esophageal

squamous cell carcinoma)

Question 4

Enlarged, hard left supraclavicular node

Answer 4

Virchow node (abdominal metastasis)

Question 5

Hematemesis, melena

Answer 5

Upper GI bleeding (eg, peptic ulcer disease)

Question 6

Hematochezia

Answer 6

Lower GI bleeding (eg, colonic diverticulosis)

Question 7

Arthralgias, adenopathy, cardiac and neurological

symptoms, diarrhea

Answer 7

Whipple disease (Tropheryma whipplei)

Question 8

Severe RLQ pain with palpation of LLQ

Answer 8

Rovsing sign (acute appendicitis)

Question 9

Severe RLQ pain with deep tenderness

Answer 9

McBurney sign (acute appendicitis)

Question 10

Hamartomatous GI polyps, hyperpigmented macules on mouth, feet, hands, genitalia

Answer 10

Peutz-Jeghers syndrome (inherited, benign polyposis can cause bowel obstruction; cancer risk, mainly GI)

Question 11

Multiple colon polyps, osteomas/soft tissue tumors, impacted/supernumerary teeth

Answer 11

Gardner syndrome (subtype of FAP)

Question 12

Severe jaundice in neonate

Answer 12

Crigler-Najjar syndrome (congenital unconjugated hyperbilirubinemia)

Question 13

Golden brown rings around peripheral cornea

Answer 13

Wilson disease (Kayser-Fleischer rings due to copper accumulation)

Question 14

Female, fat, fertile, forty

Answer 14

Cholelithiasis (gallstones)

Question 15

Painless jaundice with enlarged gallbladder

Answer 15

Cancer of the pancreatic head obstructing bile duct

Question 16

Bluish line on gingiva

Answer 16

Burton line (lead poisoning)

Question 17

Short stature, café-au-lait spots, thumb/radial defects, increased incidence of tumors/leukemia, aplastic anemia

Answer 17

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

Question 18

Red/pink urine, fragile RBCs

Answer 18

Paroxysmal nocturnal hemoglobinuria

Question 19

Painful blue fingers/toes, hemolytic anemia

Answer 19

Cold agglutinin disease (autoimmune hemolytic anemia caused by Mycoplasma pneumoniae, infectious mononucleosis, CLL)

Question 20

Petechiae, mucosal bleeding, prolonged bleeding time

Answer 20

Platelet disorders (eg, Glanzmann thrombasthenia, Bernard Soulier, HUS, TTP, ITP)

Question 21

Fever, night sweats, weight loss

Answer 21

B symptoms of malignancy

Question 22

Skin patches/plaques, Pautrier microabscesses, atypical T cells

Answer 22

Mycosis fungoides (cutaneous T-cell lymphoma) or Sézary syndrome (mycosis fungoides + malignant T cells in blood)