First Aid 2012 Rapid Review: Classic disease presentations Flashcards
Abdominal pain, ascites, hepatomegaly
Budd-Chiari syndrome (posthepatic venous thrombosis)
Achilles tendon xanthoma
Familial hypercholesterolemia (decreased LDL receptor signaling)
Adrenal hemorrhage, hypotension, DIC
Waterhouse-Friderichsen syndrome (meningococcemia)
Arachnodactyly, lens dislocation, aortic dissection, hyperflexible joints
Marfan’s syndrome (fibrillin defect)
Athlete with polycythemia
EPO injections
Back pain, fever, night sweats, weight loss
Pott’s disease (vertebral TB)
Bilateral hilar adenopathy, uveitis
Sarcoidosis (non-caseating granulomas)
Blue sclera
Osteogenesis imperfecta (collagen defect)
Bluish line on gingiva
Burton’s line (lead poisoning)
Bone pain, bone enlargement, arthritis
Paget’s disease of bone (increased osteoblastic and osteoclastic activity)
Bounding pulses, diastolic murmur, head bobbing
Aortic regurgitation
“Butterfly” facial rash, Raynaud’s phenomenon in young female
SLE
Cafe-au-lait spots, Lisch nodules (iris hamartomas)
NF Type1 (+pheochromocytoma and optic gliomas) NF Type 2 (+bilateral acoustic neuromas)
Cafe-au-lait spots, polyostoic fibrous dysplasia, precocious puberty
McCune-Albright syndrome (mosaic G-protein signaling mutation)
Calf pseudohypertrophy
Muscular dystrophy (most commonly Duchenne’s): X-linked recessive deletion of dystrophin gene
“Cherry-red” spot on macula
Tay-Sachs (ganglioside accumulation) or Niemann-Pick (sphingomyelin accumulation), central retinal artery occlusion
Chest pain, pericardial effusion/friction rub, persistent fever after MI
Dressler syndrome (autoimmune post MI fibrinous pericarditis, 1-12 weeks after acute episode)
Child uses arm to stand up from squat
Gower’s sign (DMD)
Child with fever develops red rash on face that spreads to body
“Slapped cheeks” (erythema infectiosum/5th disease/parvovirus B19)
Chorea, dementia, caudate degeneration
Huntington’s disease (AD CAG repeat expansion)
Chronic exercise intolerance with myalgia, fatigue, painful cramps, myoglobinuria)
McArdle’s disease (muscle glycogen phosphorylase deficiency)
Cold intolerance
Hypothyroidism
Conjugate lateral gase palsy, horizontal diplopia
Internuclear opthalmoplegia (damage to MLF; B/L –> MS, U/L –> stroke)
Continuos “machinery”-like murmur
PDA (close with indomethacin, open with misoprostol)
Cutaneous/dermal edema due to connective tissue deposition
Myxedema (caused by hypothyroidism, Graves disease [periorbital])
Dark purple skin/mouth nodules
Kaposi’s sarcoma (associated with HHV-8 and HIV)
Deep, labored breathing/hyperventilation
Kussmaul breathing (DKA)
Dermatitis, dementia, diarrhea
Pellagra - Niacin (B3) deficiency
Dilated cardiomyopathy, edema, polyneuropathy
Wet beriberi - Thiamin (B1) deficiency
Dog or cat bite resulting in infection
Pasteurella multocida (cellulitis at inoculation site)
Dry eyes, dry mouth, arthritis
Sjogren’s syndrome (autoimmune destruction of exocrine glands)
Dysphagia (esophageal webs), glossitis, iron deficiency anemia
Plummer-Vinson syndrome (may progress to esophageal squamous cell carcinoma)
Elastic skin, joint hypermobility
Ehlers-Danlos syndrome (type III collagen defect)
Enlarged, hard left supraclavicular node
Virchow’s node (abdominal metastasis)
Erythroderma, lymphadenopathy, hepatosplenomegaly, atypical T cells
Sezary syndrome (cutaneous T cell lymphoma) or mycosis fungoides
Facial muscle spasm upon tapping
Chvostek’s sign (hypocalcemia)
Fat, female, forty and fertile
Acute cholelithiasis (bile duct blockade)
Fever, chills, headache, myalgia following antibiotic treatment for syphilis
Jarisch-Herxheimer reaction (rapid lysis of spirochetes results in toxin release)
Fever, cough, conjunctivitis, coryza, diffuse rash
Measles (Morbillivirus)
Fever, night sweats, weight loss
B symptoms (lymphoma)
Fibrous plaques in soft tissue of penis
Peyronie’s disease (connective tissue disorder)
Gout, mental retardation, self-mutilation behavior in a boy
Lesch-Nyhan syndrome (HGPRT deficiency, X-linked recessive)
Green-yellow rings around peripheral cornea
Kayser-Fleischer rings (copper accumulation from Wilson’s disease)
Hamartomatous GI polyps, hyperpigmentatin of mouth, feet/hands
Peutz-Jeghers syndrome (genetic benign polyposis can cause bowel obstruction; increased cancer risk)
Hepatosplenomegaly, osteoporosis, neurologic symptoms
Gaucher’s disease (glucoerebrosidase deficiency)
Hereditary nephritis, sensory neural hearing loss, cataracts
Alport syndrome (mutation in alpha chain of collage IV)
Hypercoagulability (leading to migrating DVTs and vasculitis)
Trousseau’s sign (adenocarcinoma of pancreas or lung)
Hyperphagia, hypersexuality, hyperorality, hyperdocility
Kluver-Bucy syndrome (B/L amygdala lesion)
Hyperreflexia, hypertonia, positive Babinski sign
UMN damage
Hypertension, hypokalemia, metabolic alkalosis
Conn’s syndrome
Hyporeflexia, hypotonia, atrophy
LMN damage
Hypoxemia, polycythemia, hypercapnia
“Blue bloater” (chronic bronchitis: hyperplasia of mucus cells)
Indurated, ulcerated genital lesion
Non-painful –> chancre (primary syphilis, Treponema pallidum)
Painful, with exudate –> chancroid (Haemophilus ducreyi)
Infant with failure to thrive, hepatosplenomegaly, neurodegeneration
Niemann-Pick disease (genetic sphingomyelinase deficiency)
Infant with hypoglycemia, failure to thrive, and hepatomegaly
Cori’s disease (debranching enzyme deficiency)
Infant with microcephaly, rocker-bottom feet, clenched hands, and structural heart defect
Edward’s syndrome (trisomy 18)
Keratin pearls on skin biopsy
Squamous cell carcinoma
Large rash with Bull’s-eye appearance
Erythema chronicum migrans from Ixodes tick bite (Lyme disease: Borrelia)
Lucid interval after traumatic brain injury
Epidural hematoma (middle meningeal artery rupture)
Male child, recurrent infections, no mature B cells
Bruton’s disease (X-linked agammaglobulinemia)
Mucosal bleeding and prolonged bleeding time
Glanzmann’s thrombasthemia (defect in platelet aggregation due to lack of GpIIb/IIIa)
Multiple colon polyps, osteomas/soft tissue tumors, impacted/supernumerary teeth)
Gardner’s syndrome (subtype of FAP)
Myopathy (infantile hypertrophic cardiomyopathy), exercise intolerance
Pompe’s disease (lysosomal alpha-1,4-glucosidase deficiency)
Necrotizing vasculitis (lungs) and necrotizing glomerulonephritis
Wegener’s (c-ANCA positive) and Goodpasture’s syndromes (anti-BM antibodies)
Neonate with arm paralysis following difficult birth
Erb-Duchenne palsy (superior trunk [C5-C6] brachial plexus injury: “waiter’s tip”)
No lactation postpartum, absent menstruation, cold intolerance
Sheehan’s syndrome (pituitary infarction)
Nystagmus, intention tremor, scanning speech, B/L internuclear opthalmoplegia
Multiple Sclerosis
Oscillating slow/fast breathing
Cheyne-Stokes respirations (central apnea in CHF or increased ICP)
Painful blue fingers/toes, hemolytic anemia
Cold agglutinin disease (AIHA caused by Mycoplasma pneumoniae, infectious mononucleosis)
Painful, pale, cold fingers/toes
Raynaud’s syndrome (vasospasm in extremities)
Painful, raised red lesions on palms and soles
Osler’s nodes (infective endocarditis)
Painless erythematous lesions on palms and soles
Janeway lesions (infective endocarditis)
Painless jaundice
Cancer of pancreatic head obstructing bile duct
Palpable purpura on buttocks/legs, joint pain, abdominal pain, child
Henoch-Schonlein purpura (IgA vasculitis affecting skin and kidneys)
Pancreatic, pituitary, parathyroid tumors
MEN 1 (autosomal dominant)
Pink complexion, dyspnea, hyperventilation
“Pink puffer” (emphysema: centroacinar –> smoking, panacinar –> alpha-1 antitrypsin deficiency)
Polyuria, acidosis, growth failure, electrolyte imbalances
Fanconi’s syndrome (PCT reabsorption defect)
Positive anterior “drawer sign”
Anterior cruciate ligament (ACL) injury
Ptosis, miosis, anhidrosis
Horner’s syndrome (sympathetic chain lesion)
Pupil accommodates but does not react
Argyll Robertson pupil (neurosyphilis)
Rapidly progressive leg weakness that ascends (following GI/upper respiratory infection)
Guillain-Barre syndrome (autoimmune acute inflammatory demyelinating polyneuropathy)
Rash on palms and soles
Coxsackie A, secondary syphilis, Rocky Mountain spotted fever
Recurrent colds, unusual eczema, high serum IgE
Hyper IgE syndrome (Job’s syndrome: neutrophil chemotaxis abnormality)
Red “current jelly” sputum in alcoholic od diabetic patient
Klebsiella pneumoniae
Red, itchy, swollen rash of nipple/areola
Paget’s disease of the breast (represents underlying neoplasm)
Red urine in the morning, fragile RBCs
Paroxysmal nocturnal hemoglobinuria
Renal cell carcinoma (B/L), hemangioblastomas, angiomatosis, pheochromocytoma
von Hippel-Lindau disease (dominant tumor suppressor gene mutation)
Resting tremor, rigidity, akinesia, postural instability
Parkinson’s disease (nigrostriatal dopamine depletion)
Retinal hemorrhages with pale centers
Roth’s spots (bacterial endocarditis)
Sever jaundice in neonate
Crigler-Najjar syndrome (congenital unconjugated hyperbilirubinemia)
Sever RLQ pain with rebound tenderness
McBurney’s sign (appendicitis)
Short stature, increased incidence of tumors/leukemias, aplastic anemia
Fanconi’s anemia (genetic loss of DNA crosslink repair, often progresses to AML)
Single palm crease
Simian crease (Down syndrome)
Situs inversus, chronic sinusitis, bronchiectasis, infertility
Kartagener’s syndrome (dynein arm defect affecting celia)
Skin hyperpigmentation
Addison’s disease (primary adrenocortical insufficiency causes increase in ACTH and alpha-MSH production)
Slow, progressive muscle weakness in boys
Becker’s muscular dystrophy (X-linked missense mutation in dystrophin; less sever than Duchenne’s)
Small, irregular red spots on buccal/lingual mucosa with blue-white centers
Koplik spots (measles; rubeola virus)
Smooth, flat, moist white lesions on genitalia
Condylomata lata (secondary syphilis)
Splinter hemorrhages in fingernails
Bacterial endocarditis
“Strawberry tongue”
Scarlet fever, Kawasaki disease, toxic shock syndrome
Streak ovaries, congenital heart disease, horseshoe kidney, cystic hygroma at birth
Turner Syndrome (45 XO, short stature, webbed neck, lymphedema)
Sudden swollen/painful big toe joint, tophi
Gout/podagra (hyperuricemia)
Swollen gums, mucus bleeding, poor wound healing, spots on skin
Scurvy (Vitamin C deficiency –> can’t hydroxylate proline/lysine for collagen syntesis)
Swollen hard painful finger joints
Osteoarthritis (osteophytes on PIP [Bouchard’s nodes], DIP [Heberden’s nodes])
Systolic ejection murmur (crescendo-decrescendo)
Aortic valve stenosis
Thyroid and parathyroid tumors, pheochromocytoma
MEN 2A (autosomal dominant ret mutation)
Thyroid tumors, pheochromocytoma, ganglioneuromatosis
MEN 2B (autosomal dominant ret mutation)
Toe extension/fanning upon plantar scrape
Babinski sign (UMN lesion)
U/L facial drooping involving forehead
Bell’s palsy (LMN CN VII palsy)
Urethritis, conjunctivitis, arthritis in a male
Reactive arthritis associated with HLA-B27
Vascular birth mark (port wine stain)
Hemangioma (benign, but associated with Sturge-Webber syndrome)
Vomiting blood following esophageal lacerations
Mallory-Weiss syndrome (alcoholic and bulimic patients)
“Waxy” casts with very low urine flow
Chronic end-stage renal disease
WBC casts in urine
Acute pyelonephritis
Weight loss, diarrhea, arthritis, fever, adenopathy
Whipple’s disease (Tropheryma whippellii)
“Worst headache of my life”
Subarachnoid hemorrhage