Clx presentation Flashcards
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
VSD (acyanotic lesion)
Holosystolic mumur + FTT (will not eat) in an infant
Fungal Sinusitis
Maxillary sinus cyanosis
Black eschars on the palate
Turbinate destruction
Epistaxis
Scombroid- Food poisoning from spoiled fish
Looks like an allergy : wheezing, flushing, rash
Most rapid onset- diarrhea
Treat with antihistamines.. like an allergy
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
Hyper IgE
Recurrent SKIN infections with STAPH.
*consider prophy with diclox. or cephlex
Interventricular Hemorrhage (associated with prematurity)
Bulging fontanelle, seizure, hypotension, focal neurologic signs, pallor, cyanosis, apnea, bradycardia
*germinal matrix hemorrhage
HUS Triad
Uremia
Hemolytic Anemia
Thrombocytopenia
*sometimes with/after bloody diarrhea
Preterm Labor
20-37 weeks GA
Contractions (abdominal, back, pelvic pain)
Dilated cervix
Galactosemia (Galactose-1-phospho-uridyl transferase deficiency)
Poor feeding, jaundice, convulsions, HSM, hypoglycemia, bilateral cateracts, FTT
- Increased risk of E. coli sepsis
- Cannot breastfeed
Toxic Megacolon
Common in IBD
Nonobstructive bowel dilation
Severe bloody diarrhea
Systemic Sxs (fever, tachy)
Meniere’s Disease
Accumulation of endolymph in the middle ear
Presents with dizziness, vertigo, nausea and EAR FULLNESS
+/- tinnitis, hearing loss
Disseminated Gonoccocal Infxn
Polyarthralgias
Tenosynovitis
Vesiculopustular Rash
Glucagonoma
Mild DM Diarrhea, constipation, abdominal pain weight loss Necrolytic migratory erythema Venous thromboses predisposition
Neurosyphilis
Forgetful, personality changes, dysarthria, intention tremor
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
Hereditary Hemachromatosis
Hepatomegaly Diabetes Bronze Skin MCP arthropathy from chondrocalcinosis (pseudogout) Heart failure
Endometriosis
Dyschezia, dysmenorrhea, dyspareunia
Pelvic pain 1-2wks before menstruation
Nodular uterus/recto-sacral nodules +/- adnexal mass
Decreased uterine mobility
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
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.
Hyponatremia
Lethargy, seizures, AMS, cramps, anorexia, coma
Hyponatremia in a pregnant patient about to deliver?
From OXYTOCIN - which acts like ADH, (both posterior pituitary released)
Hypokalemia
Muscle weakness (paralysis/ventilatory failure if severe), ileus. EKG: T-wave flattening, U waves, PVCs, vtach, atach
Chronic suprapubic tenderness, pain with filling, relief with voiding; +/- dyspareunia
Interstitial Cystitis
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-
- ) Jaundice- from biliary infiltration
- ) bloody diarrhea
- ) 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
PE
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