Rapid Review: Classic Presentations Flashcards
Abdominal pain, ascites, hepatomegaly
Budd-Chiari syndrome
Achilles tendon xanthoma

Familial hypercholesterolemia
- LDLR mutation = decr LDL receptor signaling
- LDL R binds ApoB on LDL
- Rx (Heterozygotes)
- Statins
- BAS: cholestyramine, colesevelam
- Rx (Homozygotes)
- LDL apheresis
- Liver transplant
Adrenal hemorrhage, hypotension, DIC
Waterhous-Friderichsen syndrome (mengiococcemia)
Gram neg diplococci with capsule and pilus
How is it different from N. gonorrhea?
Arachnodactyly, lens dislocation, aortic dissection, hyperflexible joints
Marfan’s syndrome
- Fibrillin defect
Athlete with polycythemia
EPO injection
Back pack, fever, night sweats, weight loss
Pott’s disease (vertebral TB)
Bilateral hilar adenopathy, uveitis
Sarcoidosis
- Noncaseating granulomas

Blue sclera
Osteogenesis imperfecta
- Collagen defect, exposes veins
Bluish line on gingiva
Burton’s line (lead poisoning)
Bone pain, bone enlargement, arthritis
Paget’s disease of bone
- Incr osteoblast AND osteoclast activity
Bounding pulses, diastolic heart murmur, head bobbing
Aortic regurgitation
- Acute: e.g. endocarditis
- Florid CHF 2/2 LV overload
- Chronic:
- LV eccentric adaptation and hypertrophy
- Inital compensation and then later decompensation
- Physical exam
- Waterhammer pulse
- Rapid upstroke and collapse of carotid artery pulse (Corrigan’s pulse)
- Low diastolic and incr pulse pressure
- Head nodding in time with heartbeat
Other diastolic heart murmurs: PR, MS (opening snap with mid-diastolic rumbling), TS
“Butterfly” facial rash, Raynaud’s phenomenon in young female
Systemic lupus erythematosus
Cafe-au-lait spots, pigmented hamartomas on iris,
plus:
a) pheochromocytoma, optic glioma
b) bilateral acoustic neuromas

a) NF1
b) NF2
Pigmented hamartomas on iris = Lisch nodules
Cafe-au-lait spots, polyostotic fibrous dysplasia, precocious puberty
McCune-Albright syndrome
- Post-zygotic mutation in GNAS1 (guanine
- Mosiac G-protein signaling mutation, prevents downregulation of cAMP
Calf pseudohypertrophy
Muscular dystrophy
- Most commonly Duchenne’s
- X-linked recessive deletion of dystrophin gene
“Cherry-red spot” on macula
- Niemann-Pick
- Sphingomyelinase deficiency
- Sphingomyelin accumulation
- Tay-Sachs
- Hexosaminidase A
- Ganglioside (GM2) accumulation
- Central retinal artery occlusion
Chest pain on exertion
Angina
- Stable: moderate exertion
- Unstable: minimal exertion
Chest pain, pericardial effusion/friction rub, persistent fever following MI
Dressler’s syndrome
- Autoimmune-mediated post-MI fibrinous pericarditis
- 1-12 weeks after acute episode
Child uses arms to stand up from squat
Gowers’ sign
- Duchenne muscular dystrophy
Child with fever develops red rash on face that spreads to body
“Slapped cheeks”
- Erythema infectiosum/fifth 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 gazepalsy, horizontal diplopia
Internuclear ophthalmoplegia
- Damage to MLF
- Types
- Bilateral: multiple sclerosis
- Unilateral: stroke
Continuous “marchinery” heart murmur
PDA
- Close with indomethacin
- Open with misoprostol
Cutaneous/dermal edema due to connective tissue deposition
Myxedema
- Etiologies
- Hypothyroidism
- Graves’ disease (hyperthyroid): pretibial
- infiltrative thyroid dermopathy

Dark purple skin/mouth nodules
Kaposi’s sarcoma
- AIDS patients
- HHV-8 associated
Deep, labored breathing/hyperventilation
Kussmaul breathing
- Diabetic ketoacidosis
Dermatitis, dementia, diarrhea
Pellagra
- Niacin (Vit B3) deficiency
Dilated cardiomyopathy, edema, polyneuropathy
Wet beriberi
- Thiamine (B1) deficiency
Dog or car bite resulting in infection
- Pasteurella multicida*
- Cellulitis at inoculation site
Dry eyes, dry mouth, arthritis
Sjogren’s syndrome
- Autoimmune destruction of exocrine glands
Dysphagia (esopheal webs), glossitis, iren deficiency anemia
Plummer-Vinson syndrome
- May progress to esophageal squamous cell carcinoma
Elastic skin, hypermobility of joints
Ehlers-Danlos syndrome
- Type III collagen defect
Enlarged, hard left supraclavicular node
Virchow’s node (adominal metastasis)
Erythroderma, lymphadenopathy, hepatosplenomegaly, atypical T cells
- Sézary sydrome: cutaneous T cell lymphoma (a type of nHL)
- Mycosis fungoides
Facial muscle spasm upon tapping
Chvostek’s sign
- Hypocalcemia
Fat, female, forty, and fertile
Acute cholelithiasis
- Bile duct blockage
Fever, chills, headache, myalgia following antibiotic treatment for syphillis
Jarisch-Herxheimer reaction
- Rapid lysis of spirochetes results in toxin release
Fever, cough, conjunctivitis, coryza, diffuse rash
Measles
- Morbillibivirus, a type of Paramyxovirus
Fever, night sweats, weight loss
B symptoms
- Lymphoma
Fibrous plaques in soft tissue of penis
Peyronie’s disease

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
- Cu accumulation from Wilson’s disease
Hamartomatous GI polyps, hyperpigmentation of mouth/feet/hands
Peutz-Jeghers syndrome
- Genetic benign polyposis can cause bowel obstruction
- Incr cancer risk
HSM, osteoporosis, neurologic symptoms
Guacher’s disease
- Glucocerebrosidase deficiency
Hereditary nephritis, sensorineural hearing loss, cataracts
Alport syndrome
- Mutation in alpha chain of collagen IV
Hypercoagulabilty (leading to migrating DVTs and vasculitis)
Trousseau’s syndrome
- Migratory thrombophlebitis associated with malignancies–successive crops of tender nodules in affected veins
- Adenomacarcinoma of pancreas or lung
Hyperphagia, hypersexualit, hyperorality, hyperdocility
Kluver-Bucy syndrome
- Bilateral amygdala lesion
Hyperreflexia, hypertonia, positive Babinksi sign
UMN damage
Hypertension, hypokalemia, metabolic alkaloosis
Conn’s syndrome
Hyporeflexia, hypotonia, atrophy
LMN damage
Hypoxemia, polycythemia, hypercapnia
“Blue bloater”
- Chronic bronchitis: hyperplasia of mucus membranes
Indurated, ulcerated genital lesion
- Non-painful
- Painful, with exudate
- Chancre
- Primary syphillis
- Treponema pallidum
- Chancroid
- Haemophilus ducreyi
Infant with failure to thrive, HSM, neurodegeneration
Niemann-Pick disease
- Genetic sphingomyelinase deficiency (AR)
- Spingomyelin accumulation
- Foamy macrophages
- Death by 2-3 yrs
Infant with microcephaly, rocker-bottom feet, clenched hands, and structural heart disease
Edwards’ syndrome (Trisomy 18)
Keratin pearls on skin biopsy
Squamous cell carcinoma
Large rash with bull’s eye appearance
Erythema chronicum migrans
- Iodes 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
- BTK defect
- Tyrosine kinase gene: blocks pro-B cells from forming pre-B cells
- B-cell disease
- Normal pro-B, decr maturation, decr number of B cells, ALL Ig’s decreased
Mucosal bleeding and prolonged bleeding time
Glanzmann’s thombasthenia
- Defect in platelet aggregation due to lack of GpIIb/IIIa
- Bleeding time is a measure of platelet function! Early bleeding.
Multiple colon polyps, osteomas/soft tissue tumors, exercise intolerance
Gardner’s syndrome (FAP subtype)
Myopathy (infantile hypertrophic cardiomyopathy), exercise intolerance
Pompe’s disease (GSD)
- Lysosomal alpha-1,4 glucosidase deficiency (acid maltase)
- Glycogen accumulation
- Cardiomegaly and systemic findings leading to early death
- “Pompe’s trashes the Pump” (heart, liver, muscle)
Necrotizing vasculitis (lungs) and necrotizing glomerulonephritis
- Wegener’s
- c-ANCA
- Goodpasture’s
- Anti-GBM
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, scanning speach, bilateral intranuclear opthalmoplegia
Multiple sclerosis
- Bilateral INO (esp young pt) = MLF lesion
- Disorder of conjugate gaze
- MLF connects:
- PPRF-abducens nucleus
- Contralateraloculomotor nucleus
- Ex) RIGHT INO = lesion to RIGHT MLF = inability to adduct RIGHT eye on L gaze
Oscillating slow/fast breathing
Cheyne-Stokes respirations
- Central apnea in CHF, OR
- Increased ICP
Painful blue fingers/toes, hemolytic anemia
Cold agglutinin diease
- Autoimmune hemolytic anemia
- anti-RBC antibody, usually IGM
- Binds RBCs, activates complement, MAC destroys cells
- Primary
- Idiopathic
- Secondary
- Adults: CLL, lymphoma, infection
- Kids: Mycoplasma pneumonia, infectious mononucleosis
Painful, raised red lesions on palms and soles
Osler’s node (infective endocarditis)
Painless, erythematous lesions on palms and soles
Janeway lesions (infective endocarditis)
Painless jaundice
Cancer of the pancreatic head obstructing bile duct
Palpable purpura on buttocks/legs, joint pain, abdominal pain (child)
Henoch-Schönlein 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: alpha1-antitrypsin deficiency
Polyuria, acidosis, growth failure, electrolyte imbalances
Fanconi’s syndrome
- Proximal tubular reabsorption defect
Positive anterior “drawer sign”
ACL injury
Ptosis, miosis, anhidrosis
Horner’s syndrome
- Sympathetic chain lesion
Pupil accomodates but doesn’t react
Argyll Robertson pupil (neurosyphillis)
Rapidly progressing leg weakness that ascends following GI/URI
Guillain-Barré syndrome
- Autoimmune actue inflammatory demyelinating polyneuropathy
Rash on palms and soles
- Coxsackie A
- Picornaviridae (PERCH)
- Hand-foot-mouth disease
- Secondary syphillis
- RMSF
- Rickettsia rickettsi
Recurrent colds, unusual eczema, high serum IgE
Hyper-IgE syndrome (Job’s syndrome)
- Th cells fail to produce IFN-gamma = neutrophils unable to respond to chemotactic stimuli
- FATED:
- coarse Facies
- cold/non-inflammed staph Abcesses
- retained primary Teeth
- incr IgE
- Derm probs (eczema)
Red “currant jelly” sputum in alcoholic or diabetic patients
Klebsiella pneumoniae
- GNR
- Fast lactose fermenter (like E. coli, Enterobacter)
- Pink colonies on MacConkey’s agar
- Abundant polysaccaride capsule
- Mucoid colonies
- Lobar pneumonia
Red, itchy, swollen rash of nipple/areola

Paget’s disease of the breast (represents underlying neoplasm)
Red urin in the morning, fragile RBCs
Paroxysmal nocturnal hemoglobinuria
Renal cell carcinoma (bilateral), hemangioblastomas, angiomatosis, pheochromocytoma
von Hippel-Lindau disease
- Dominant tumor suppressor gene mutation
Resting tremor, rigidity, akinesia, postural instability
Parkinson’s disease
- Nigrostriatal DA depletion
Retinal hemorrhages with pale centers
Roth’s spots
- Bacterial endocarditis
Severe jaundice in neonate
Crigler-Najjar syndrome
- Congenital unconjugated hyperbilirubinemia
Severe RLQ pain with rebound tenderness
McBurney’s point
- Appendicitis
Short stature, increased incidence of tumors/leukemia, aplastic anemia
Fanconi’s anemia
- Genetic loss of DNA crosslink repair; often progresses to AML
Single palm crease
Simian crease
- Down’s syndrome
Situs inversus, chronic sinusitis, bronchiectasis, infertility
Kartagener’s syndrome
- Dynein arm defect affecting cilia
Skin hyperpigmentation
Addison’s disease
- Primary adrenocortical insufficiency causes incr ACTH and alpha-MSH production
Slow progressive muscle weakness in boys
Becker’s muscular dystrophy
- X-linked misssense mutation in dystrophin; less severe than Duchenne’s
Small, irregular red spots on buccal/lingual mucosa with blue-white centers
Koplik spots
- Measles (Rubeola virus)
- Paramyxovirus
- -ssRNA
- Paramyxovirus
Smooth, flat, moist white lesions on genitals
Condylomata lata
- Secondary syphillis
Splinter hemorrhages in fingernails
Bacterial endocarditis
Strawberry tongue
- Scarlet fever
- GBS
- Kawasaki disease
- Toxic shock syndrome
Streak ovaries, congenital heart disaese, horseshoe kidney, cystic hygroma at birth
Turner syndrome
- 45,XO
- Short stature, webbed neck, lymphedeoma
Sudden swollen/painful big joint, tophi
Gout/podagra
- Hyperuricemia
Swollen gums, mucous bleeding, poor wound healing, spots on skin
Scurvy
- Vitamin C deficiency
- Can’t hydroxylate proine/lysine for collagen synthesis
Swollen, hard, painful finger joints
Osteoarthritis
- Osteophytes on PIP (Bouchard’s nodes) and DIP (Heberden’s nodes)
SEM, crescendo-decrescendo
Aortic valve stenosis
Thyroid and parathyroid tumors, pheochromocytoma
MEN 2A
- AD ret mutation (proto-oncogene)
Thyroid tumors, pheochromocytoma, ganglioneuromatosis/mucosal neuromas
MEN 2B
- AD ret mutation (proto-oncogene)
Toe extension/fanning upon plantar scrape
Babinski sign (UMN lesion)
Unilateral facial drooping involving forehead
Bell’s palsy
- LMN CN VII palsy
Urethritis, conjunctivitis, arthritis in a male
Reactive arthritis associated with HLA-B27
Vascular birthmark (port-wine stain)
Hemangioma
- Benign, but associated with Sturge-Weber syndrome
- port-wine stains of the face, glaucoma, seizures, mental retardation, and ipsilateral leptomeningeal angioma.
- Characterized by abnormal blood vessels on the brain surface
Vomiting blood following esophagogastric 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 whippelii
- Primarily malabsorption, but may affect any part of the body including the heart, lungs, brain, joints, skin, and the eyes
- Malabsorption (insufficient absorption of nutrients from the diet) leads to wasting and the enlargement of lymph nodes in the abdomen.
- Poor absorption of fat means that many develop steatorrhea (fatty, offensive stool). Depletion of albumin, a blood protein, causes peripheral oedema.
- Neuro: dementia, memory loss, confusion, and decreased level of consciousness
“Worst headache of life”
Subarachnoid hemorrhage