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Clx presentation Flashcards

1
Q

Neuroblastoma (adrenal medulla)

A

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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2
Q

VSD (acyanotic lesion)

A

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

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3
Q

Fungal Sinusitis

A

Maxillary sinus cyanosis
Black eschars on the palate
Turbinate destruction
Epistaxis

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4
Q

Scombroid- Food poisoning from spoiled fish

A

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

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5
Q

Syphilis

A

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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6
Q

Hyper IgE

A

Recurrent SKIN infections with STAPH.

*consider prophy with diclox. or cephlex

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7
Q

Interventricular Hemorrhage (associated with prematurity)

A

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

*germinal matrix hemorrhage

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8
Q

HUS Triad

A

Uremia
Hemolytic Anemia
Thrombocytopenia

*sometimes with/after bloody diarrhea

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9
Q

Preterm Labor

A

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

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10
Q

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

A

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

  • Increased risk of E. coli sepsis
  • Cannot breastfeed
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11
Q

Toxic Megacolon

A

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

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12
Q

Meniere’s Disease

A

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

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13
Q

Disseminated Gonoccocal Infxn

A

Polyarthralgias
Tenosynovitis
Vesiculopustular Rash

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14
Q

Glucagonoma

A 
Mild DM
Diarrhea, constipation, abdominal pain
weight loss
Necrolytic migratory erythema
Venous thromboses predisposition
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15
Q

Neurosyphilis

A

Forgetful, personality changes, dysarthria, intention tremor

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16
Q

Hepatorenal Syndrome

A

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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17
Q

Hereditary Hemachromatosis

A 
Hepatomegaly
Diabetes
Bronze Skin
MCP arthropathy from chondrocalcinosis (pseudogout)
Heart failure
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18
Q

Endometriosis

A

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

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19
Q

Spider Bite

  • brown recluse
  • black widow
A

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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20
Q

Toxic Shock Syndrome

A

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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21
Q

Hyponatremia

A

Lethargy, seizures, AMS, cramps, anorexia, coma

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22
Q

Hyponatremia in a pregnant patient about to deliver?

A

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

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23
Q

Hypokalemia

A 
Muscle weakness (paralysis/ventilatory failure if severe), ileus. 
EKG: T-wave flattening, U waves, PVCs, vtach, atach
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24
Q

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

A

Interstitial Cystitis

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25
Q

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

A 
Pyoderma Gangrenosum (seen in Crohn's disease) 
-most commonly associated with trauma
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26
Q

Vertigo without hearing loss after viral illness

Balance problems: patient falls to the side of the lesion

A

Vestibular Neuritis

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27
Q 
Elevated Conjungated bilirubin
Markedly elev alk phos
Jaundice
Pruritis
Clay-colored stools 
Dark urine
A

Biliary tract obstruction

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28
Q

Jaundice + palpably enlarged GB

A

Courvoisier Sign : pancreatic cancer

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29
Q

Middle-aged woman
jaundice
pruritis
Anti-Mtch. abs

A

PBC

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30
Q

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

A

Midgut volvulus

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31
Q

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

A

Strangulated hernia

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32
Q

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

A

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

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33
Q

Acalculous Cholecystitis

A

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

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34
Q

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

A

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

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35
Q

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

A

Malignant Otitis Externa

*mcc - pseudomonas aeruginosa

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36
Q

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

A

Rosacea

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37
Q

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

A

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

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38
Q

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

A

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

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39
Q

After transplant-

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

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

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40
Q

Nystagmus
Ataxia
Oculomotor dysfunction

+irreversible amnesia, apathy, confabulations

A

Thiamine Deficiency (Wernicke’s Encephalopathy)

Korsakoff Syndrome

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41
Q

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

A

Friedrich’s Ataxia (demyelinated spinocerebellar tracts)

42
Q

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

A

Histoplasmosis

43
Q

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

A

Vitamin A deficiency

44
Q 
Sore throat, hyperemic oral mucosa,
Cheilitis, stomatitis, glossitis
noromocytic anemia
Seborrheic dermatitis
Photophobia
A

Riboflavin (B2) deficiency

45
Q

Coiled hair, depression, neuropathy, bleeding, bruising

A

Vitamin C deficiency

46
Q

Umbilicated vesicles over an area of healing eczema

A

Eczema herpeticum - Give acyclovir asap.

47
Q

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

A

Acute decompensated Heart Failure

48
Q

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

A

CT/lateral neck XRAY… retropharyngeal abscess

more gradual progression than epiglottitis

49
Q

Nephrotic syndrome patient who acutely develops flank pain

A

Renal vein thrombosis (MOST common in membranous nephropathy)

50
Q

Acute flank pain within 1 hr of blood transfusion

Coombs+

A

Acute hemolytic reaction (ABO mismatch)

51
Q

Acute respiratory distress within 6 hrs of blood transfusion

A

TRALI (donor antibodies attack)

52
Q

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

53
Q

Red eye, eye pain, miosis, photophobia

A

Anterior Uveitis

54
Q

Hemoptysis, renal failure, dyspnea

A

Goodpasture’s Syndrome

55
Q

Tm with vesicles, bulging membrane

A

Bullous myringitis 2/2 mycoplasma, strep, viruses

56
Q 
Ipsilateral hemiparesis
Fixed dilated pupil
Down, out gaze
ptosis
Contralateral homonymous hemianopsia
AMS
A

Uncal (transtentorial) herniation

57
Q

Forefoot pain in a runner

Palpable click between 3-4th metatarsals

A

Morton’s Neuroma

58
Q

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

A

Tarsal Tunnel Syndrome

59
Q

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

60
Q

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

A

Panic attack

61
Q

Dyspnea + dullness to percussion at bilateral bases

A

Pleural effusion

62
Q

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

A

Methemoglobinemia

63
Q

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

A

CO poisoning

64
Q

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

A

Renal Cell Carcinoma- Get an abdominal CT

65
Q 
Proximal muscle weakness in adults
Improves with movement
Ptosis that improves with upward gaze
Autonomic Dysfunction (dry mouth, erectile dysfxn)
ABSENT/DIMINISHED DTRs
A

Lambert-Eaton myasthenic Syndrome

66
Q

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

A

Giant Cell Tumor

67
Q

Shoulder pain, ptosis, facial edema, constricted pupil

A

Superior sulcus Tumor

68
Q

Rumbling diastolic murmur with opening snap

History of rheumatic fever

A

Mitral stenosis

69
Q

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

A

Esophageal spasms

70
Q

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

A

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

71
Q

Old lady fall on outstretched hand

Distal radius dispaced

A

Colle’s Fracture (dinner fork)

72
Q

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

A

Scaphoid fracture- immobilize!

73
Q

Punched a wall, hand hurts

A

Boxer’s fracture (4th-5th metacarpal)

74
Q

Salmon colored fluid leaking from the wound, post-op

A

Wound Dehiscence (back to the OR)

75
Q

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

A

Epidermal inclusion cyst

76
Q

Unhealing ulcer –> predisposition to SCC

A

Marjolin’s Ulcer (always Biopsy)

77
Q

Gastric Varices

A

Splenic Vein Thromboses

78
Q

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

A 
Polyarteritis Nodosa (NON-specific findings)
(tx with prednisone and cyclophosphamide)
79
Q

Mobile cavitary mass with intermittent hemoptysis

A

Aspergilloma

80
Q

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

A

Paroxysmal Nocturnal hemoglobinuria

81
Q

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

A

Paroxysmal Nocturnal hemoglobinuria

82
Q

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

A

Acute pancreatitis

look for gallstones/alcohol/trauma in history

83
Q

Chest pain improved by leaning forward, friction rub

A

Pericarditis

84
Q

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

A

Necrotizing wound infection (IV abx + surgically debride)

85
Q

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

A

Complex partial seizure

86
Q

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

A

Absence seizure (Typical)

87
Q

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

A

Zenker Diverticulum

88
Q

Fever, uvula deviation, muffled voice

A

Peritonsilar abscess

89
Q

Pruritis, Hyperviscosity, splenomegaly

A

Polycythemia Vera

90
Q

Malabsorption + IDA in otherwise healthy person

A 
Consider Celiacs
(even if negative antibodies- if IgA deficient, could be falsely negative)
91
Q

Immunocompromised, respiratory + GI (diarrhea) sxs

Multifocal patchy infiltrates on CXR

92
Q

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

A

Perinephric Abscess (Drain fluid, cx, abx)

93
Q

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

A

Mycoplasma pneumoniae

94
Q

Otorrhea, rhinorrhea, racoon eyes, mastoid bruising

A

Basal skull fracture (CT scan)

95
Q

Neck hyperextension - burning pain and paralysis

A

Central cord syndrome

96
Q

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

A

Pulmonary contusion (leaky): give PEEP, no crystalloids

97
Q

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

A

Tinea Versicolor

98
Q

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

A

Pulmonary fibrosis

ALWAYS GET CXR FIRST

99
Q

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

A

Congenital Varicella

100
Q

Holoprosencephaly, Cleft lip/palate

A

Patau Syndrome

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