Spider Bite - brown recluse - black widow

Sudden and sharp pain (like piece of glass/stepping on nail) Brown: Local skin necrosis, bullae, blebs Black: Abdominal/muscle pain, hypocalcemia

Clx presentation Flashcards by Lindsey Shantzer

Neuroblastoma (adrenal medulla)

MC cancer in infancy
Most common extracranial solid malignancy
Presents with Hypsarrythmia (dancing eyes) and opsoclonus (dancing feet)* -Hallmarks
Increased urine VMA/Metanephrines

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VSD (acyanotic lesion)

Holosystolic mumur + FTT (will not eat) in an infant

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Fungal Sinusitis

Maxillary sinus cyanosis
Black eschars on the palate
Turbinate destruction
Epistaxis

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Scombroid- Food poisoning from spoiled fish

Looks like an allergy : wheezing, flushing, rash
Most rapid onset- diarrhea
Treat with antihistamines.. like an allergy

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Syphilis

Primary: Painless chancre (heaped up/indurated edges) + painless adenopathy

Secondary: Rash (palms/soles), Alopecia areata, Mucous patches, condyloma lata

Tertiary: Stroke from vasculitis, tabes dorsalis, general paresis (memory/personality), argyll robertson pupil

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Hyper IgE

Recurrent SKIN infections with STAPH.

*consider prophy with diclox. or cephlex

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Interventricular Hemorrhage (associated with prematurity)

Bulging fontanelle, seizure, hypotension, focal neurologic signs, pallor, cyanosis, apnea, bradycardia

*germinal matrix hemorrhage

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HUS Triad

Uremia
Hemolytic Anemia
Thrombocytopenia

*sometimes with/after bloody diarrhea

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Preterm Labor

20-37 weeks GA
Contractions (abdominal, back, pelvic pain)
Dilated cervix

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Galactosemia (Galactose-1-phospho-uridyl transferase deficiency)

Poor feeding, jaundice, convulsions, HSM, hypoglycemia, bilateral cateracts, FTT

Increased risk of E. coli sepsis
Cannot breastfeed

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Toxic Megacolon

Common in IBD
Nonobstructive bowel dilation
Severe bloody diarrhea
Systemic Sxs (fever, tachy)

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Meniere’s Disease

Accumulation of endolymph in the middle ear
Presents with dizziness, vertigo, nausea and EAR FULLNESS
+/- tinnitis, hearing loss

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Disseminated Gonoccocal Infxn

Polyarthralgias
Tenosynovitis
Vesiculopustular Rash

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Glucagonoma

Mild DM
Diarrhea, constipation, abdominal pain
weight loss
Necrolytic migratory erythema
Venous thromboses predisposition

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Neurosyphilis

Forgetful, personality changes, dysarthria, intention tremor

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Hepatorenal Syndrome

History of cirrhosis, end-stage liver disease
(ascites, jaundice, stigmata of liver disease)
Decreased GFR/elevated Cr without any identifiable source, no proteinuria, no shock
VERY LOW URINE SODIUM

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Hereditary Hemachromatosis

Hepatomegaly
Diabetes
Bronze Skin
MCP arthropathy from chondrocalcinosis (pseudogout)
Heart failure

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Endometriosis

Dyschezia, dysmenorrhea, dyspareunia
Pelvic pain 1-2wks before menstruation
Nodular uterus/recto-sacral nodules +/- adnexal mass
Decreased uterine mobility

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Spider Bite

brown recluse
black widow

Sudden and sharp pain (like piece of glass/stepping on nail)

Brown: Local skin necrosis, bullae, blebs
Black: Abdominal/muscle pain, hypocalcemia

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Toxic Shock Syndrome

Doesn’t have to be from menstruation/tampon use
Pt presents with fever, myalgias, hypotension, and eryhtroderma. Can progress to multiorgan involvement with transaminitis, thrombocytopenia, leukocytosis, etc.

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Hyponatremia

Lethargy, seizures, AMS, cramps, anorexia, coma

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Hyponatremia in a pregnant patient about to deliver?

From OXYTOCIN - which acts like ADH, (both posterior pituitary released)

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Hypokalemia

Muscle weakness (paralysis/ventilatory failure if severe), ileus. 
EKG: T-wave flattening, U waves, PVCs, vtach, atach

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Chronic suprapubic tenderness, pain with filling, relief with voiding; +/- dyspareunia

Interstitial Cystitis

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Papule, pustule, nodule, or vesicle which expands to form an ulcer (neutrophilic ulcerative disease)

``` Pyoderma Gangrenosum (seen in Crohn's disease) -most commonly associated with trauma ```

Vertigo without hearing loss after viral illness | Balance problems: patient falls to the side of the lesion

Vestibular Neuritis

``` Elevated Conjungated bilirubin Markedly elev alk phos Jaundice Pruritis Clay-colored stools Dark urine ```

Biliary tract obstruction

Jaundice + palpably enlarged GB

Courvoisier Sign : pancreatic cancer

Middle-aged woman jaundice pruritis Anti-Mtch. abs

PBC

0-2 year old with sudden onset pain, abdominal distention, rectal bleeding, peritonitis, bird's beak on xray

Midgut volvulus

Bilious vomiting in a kid with bowel loops in the inguinal canal

Strangulated hernia

Newborn with significant respiratory difficulty- opacification of left hemithorax, scaphoid abdomen

Congenital diaphragmatic hernia (3-4 days, then surg)

Acalculous Cholecystitis

Super sick ICU patients (trauma/burn/TPN) U/S shows no stones with fluid surrounding gallbladder 2/2 infection, infarction, stasis

Young person with asymptomatic HTN, recurrent epistaxis, headaches, if severe- aortic dissection

Late Presenting Coarct: CXR: rib notching Murmur: collaterals Upper/Lower Extremity discrepancy

Older person w DM + med-resistant ear infxn + Ear drainage and granulation tissue +/- Facial droop 2/2 damage to facial nerve

Malignant Otitis Externa | *mcc - pseudomonas aeruginosa

Rosy cheeks, nose, chin with overlying telangiectasias in a 30-60yr old person. Conditioned worsened by hot drinks, sun exposure, or intense emotions

Rosacea

JVD, edema, ascites, Kussmaul breathing exaggerated x and y descent Pericardial knock (sound after s2) Calcifications surrounding heart

Constrictive Pericarditis Non-US: Think TB US: Think post-viral myocarditis or idiopathic

Shoulder pain with arms overhead Limited active motion, but passive ROM intact Improved with lidocaine

Rotator Cuff Impingement- This improvement with lidocaine injection differentiates from cuff tears

After transplant- 1. ) Jaundice- from biliary infiltration 2. ) bloody diarrhea 3. ) maculopapular rash

Graft-versus-host-disease (T-cells from donor attack host)

Nystagmus Ataxia Oculomotor dysfunction +irreversible amnesia, apathy, confabulations

Thiamine Deficiency (Wernicke's Encephalopathy) Korsakoff Syndrome

Young person with progressive ataxia, frequent falls and dysarthria. Commonly see scoliosis and hammar toes. Cardiomyopathy + Respiratory issues MCCOD.

Friedrich's Ataxia (demyelinated spinocerebellar tracts)

Asymptomatic young person from ohio/mississippi with pulmonary nodule *this presents with patchy interstitial infiltrates + hilar LAD when pts are symptomatic

Histoplasmosis

Night blindness, photophobia dry skin, dry eyes, silver-gray plaques on bulbar conj Follicular hyperkeratosis

Vitamin A deficiency

``` Sore throat, hyperemic oral mucosa, Cheilitis, stomatitis, glossitis noromocytic anemia Seborrheic dermatitis Photophobia ```

Riboflavin (B2) deficiency

Coiled hair, depression, neuropathy, bleeding, bruising

Vitamin C deficiency

Umbilicated vesicles over an area of healing eczema

Eczema herpeticum - Give acyclovir asap.

Acute dyspnea, orthopnea, PND HTN, accessory muscle use, tachy Crackles +wheezes Possible S3, JVD, edema

Acute decompensated Heart Failure

Neck pain, fever, limited neck mobility from pain Trismus (inability to open mouth normally) Typically 2/2 trauma

CT/lateral neck XRAY... retropharyngeal abscess | more gradual progression than epiglottitis

Nephrotic syndrome patient who acutely develops flank pain

Renal vein thrombosis (MOST common in membranous nephropathy)

Acute flank pain within 1 hr of blood transfusion | Coombs+

Acute hemolytic reaction (ABO mismatch)

Acute respiratory distress within 6 hrs of blood transfusion

TRALI (donor antibodies attack)

Infant/Child with FTT, pale skin, intellectual disability, +/- family history, musty body odor, seizure

PKU

Red eye, eye pain, miosis, photophobia

Anterior Uveitis

Hemoptysis, renal failure, dyspnea

Goodpasture's Syndrome

Tm with vesicles, bulging membrane

Bullous myringitis 2/2 mycoplasma, strep, viruses

``` Ipsilateral hemiparesis Fixed dilated pupil Down, out gaze ptosis Contralateral homonymous hemianopsia AMS ```

Uncal (transtentorial) herniation

Forefoot pain in a runner | Palpable click between 3-4th metatarsals

Morton's Neuroma

Burning/numbness of distal plantar foot/toes 2/2 compression at the ankle

Tarsal Tunnel Syndrome

Sudden onset dyspnea, clear lungs, recent immobility, hx hypercoagulability, malignancy, recent sx

Sudden onset SOB, circumoral numbness, caffeine use, hx of anxiety

Panic attack

Dyspnea + dullness to percussion at bilateral bases

Pleural effusion

Recent anesthetic use, BROWN BLOOD, not improved with oxygen, clear lungs on auscultation, cyanosis

Methemoglobinemia

Burning building/car, wood-burning stove in WINTER, suicide attempt, works in car-garage

CO poisoning

Varicocele that fails to empty when recumbent History of smoking Gross Hematuria

Renal Cell Carcinoma- Get an abdominal CT

``` Proximal muscle weakness in adults Improves with movement Ptosis that improves with upward gaze Autonomic Dysfunction (dry mouth, erectile dysfxn) ABSENT/DIMINISHED DTRs ```

Lambert-Eaton myasthenic Syndrome

Knee pain and swelling in a young person Lytic lesion at the epiphysis of the femur Soap bubble appearance on Xray

Giant Cell Tumor

Shoulder pain, ptosis, facial edema, constricted pupil

Superior sulcus Tumor

Rumbling diastolic murmur with opening snap | History of rheumatic fever

Mitral stenosis

Chest pain like MI, dysphagia worse with hot and cold liquids

Esophageal spasms

Bilious vomiting, post-prandial pain, s/p losing a ton of weight

SMA syndrome (duodenal compression between aorta and SMA) Tx: restoring nutrition

Old lady fall on outstretched hand | Distal radius dispaced

Colle's Fracture (dinner fork)

Young person fall on outstretched hand Anatomic snuff box pain Negative xray initially

Scaphoid fracture- immobilize!

Punched a wall, hand hurts

Boxer's fracture (4th-5th metacarpal)

Salmon colored fluid leaking from the wound, post-op

Wound Dehiscence (back to the OR)

Dome-shaped, freely mobile skin cyst with central umbilication. Can spontaneously resolve and recur. +/- white, cheesy, malodorous discharge

Epidermal inclusion cyst

Unhealing ulcer --> predisposition to SCC

Marjolin's Ulcer (always Biopsy)

Gastric Varices

Splenic Vein Thromboses

Fever, malaise, weight loss, arthralgia over weeks-mos Peripheral neuropathy Abdominal pain (often worse with eating) Stroke in a young person Purpura, petechiae, digital gangrene, livedo reticularis

``` Polyarteritis Nodosa (NON-specific findings) (tx with prednisone and cyclophosphamide) ```

Mobile cavitary mass with intermittent hemoptysis

Aspergilloma

Hemolysis--> Fatigue, Dark Urine RUQ pain Cytopenias Venous thromboses

Paroxysmal Nocturnal hemoglobinuria

Hemolysis--> Fatigue, Dark Urine RUQ pain Cytopenias Venous thromboses

Paroxysmal Nocturnal hemoglobinuria

Abdominal pain that gets better sitting up and leaning foward, vomiting

Acute pancreatitis | look for gallstones/alcohol/trauma in history

Chest pain improved by leaning forward, friction rub

Pericarditis

Tachy, HoTN, fever Wound with purulent, cloudy-grey drainage Anesthesia/paresthesia at wound edges Crepitus/subQ emphysema

Necrotizing wound infection (IV abx + surgically debride)

Staring spells, non-responsive to verbal stimulus, automatisms (picking, lip-smacking), post-ictal confusion

Complex partial seizure

Staring spells with impaired consciousness, +/- automatisms, WITHOUT post-ictal confusion +3hz/wave discharges on EEG with hyperventilation

Absence seizure (Typical)

Dysphagia, food "sticking in throat," halitosis, regurgitation/choking with eating

Zenker Diverticulum

Fever, uvula deviation, muffled voice

Peritonsilar abscess

Pruritis, Hyperviscosity, splenomegaly

Polycythemia Vera

Malabsorption + IDA in otherwise healthy person

``` Consider Celiacs (even if negative antibodies- if IgA deficient, could be falsely negative) ```

Immunocompromised, respiratory + GI (diarrhea) sxs | Multifocal patchy infiltrates on CXR

CXR

Pyelonephritis that doesn't resolve with abx 5-7 days--get US or CT

Perinephric Abscess (Drain fluid, cx, abx)

PNA of young adults, longer prodrome of low-grade fevers, sore throat, myalgias, fatigue, dry cough, +/- hemolytic anemia from cold agluttinin

Mycoplasma pneumoniae

Otorrhea, rhinorrhea, racoon eyes, mastoid bruising

Basal skull fracture (CT scan)

Neck hyperextension - burning pain and paralysis

Central cord syndrome

Within 48 hrs of blunt chest trauma, initially normal CXR, acute dyspnea and pulmonary edema- worsened by fluids

Pulmonary contusion (leaky): give PEEP, no crystalloids

hypopigmented rash, KOH prep shoes hyphae and spores (meatballs on a string)

Tinea Versicolor

Dyspnea, worsening with exertion Fine rales or crackles Loud P2 Clubbing of the fingers

Pulmonary fibrosis | ALWAYS GET CXR FIRST

Newborn with limb hypoplasia, chorioretinitis, cutaneous scars, cortical atrophy

Congenital Varicella

Holoprosencephaly, Cleft lip/palate

Patau Syndrome