Classic presentations Flashcards by Brian Boyarsky

Abdominal pain, ascites, hepatomegaly

Budd-Chiari syndrome (post-hepatic venous thrombosis)

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Achilles tendon xanthoma

Familial hypercholesterolemia (decreased LDL receptor signaling)

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Adrenal hemorrhage, hypotension, DIC

Waterhouse-Friderichsen syndrome (meningococcemia)

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Arachnodactyly, lens dislocation, aortic dissection, hyperflexible joints

Marfan’s syndrome (fibrllin)

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Athlete with polycythemia

2/2 EPO injection

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Back pain, fever, night sweats, weight loss

Pott’s disease 2/2 vertebral TB

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Bilateral hilar LAD & uveitis

Sarcoidosis (non-caseating granuloma)

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Blue sclera

OI (type 1 collagen defect)

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Bluish line on gingiva

Burton’s line (lead poisoning)

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Bone pain, bone enlargement, arthritis

Paget’s disease (increased blastic and clastic activity)

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Bounding pulses, diastolic murmur, head bobbing

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Butterfly facial rash and Raynaud’s phenomenon in a young female

SLE

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Cafe-au-lait spots, Lisch nodules (iris hamartoma)

NF-1 (plus pheochromocytoma, optic glioma)

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Cafe-au-lait spots, polyostotic fibrous dysplasia, precocious puberty, multiple endocrine abnormalities

McCune-Albright syndrome (mosaic G-protein signaling mutation)

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Calf pseudohypertropy

Muscular dystrophy (Duchenne)

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Cherry-red spot macula

Tay Sachs (ganglioside)
Niemann-Pick (sphingomyelin)
Central retinal artery occlusion

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Chest pain on exertion

Angina (stable: moderate; unstable: mild)

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Chest pain, pericardial effusion/friction rub, persistent fever following MI

Dressler’s syndrome (AI-mediated post MI fibrinous pericarditis): 1-12 weeks following AMI

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Child uses arms to stand up from squat

Gower’s sign: DMD

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Child with fever later develops rash on face that spreads to body

Parvovirus B19/Erythema infeciosum/Fifth disease “slapped cheek”

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Chorea, dementia, caudate degeneration

Huntington’s disease (AD CAG-repeat)

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Chronic exercise intolerance with myalgia, fatigue, painful cramps, myoglobinuria

McArdle’s disease (muscle glycogen phosphorylase deficiency)

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Cold intolerance/sensitivity

Hypothyroidism

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Conjugate lateral gaze palsy; horizontal diplopia

Internuclear opthalmoplegia (damage to MLF)
Bilateral: MS
Unilateral: stroke

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Continuous machinery heart murmur

PDA (close with indomethacin; open with misoprostol)

Cutaneous edema 2/2 CT deposition

Myxedema (hypothyroidism, Grave's -- pre-tibial)

Dark purple skin/mouth nodules

Kaposi's sarcoma (HHV-8)

Deep, labored breathing/hyperventilation

Kussmaul breathing (DKA)

Dermatitis, dementia, diarrhea

Pellagra (B3 deficiency)

Dilated CM, edema, alcoholism/malnutrition

Wet beriberi (B1 deficiency)

Dog/cat bite resulting in infection

Pasturella multocida (cellulitis at site of innoculation)

Dry eyes, mouth, arthritis

Sjogren's (AI exocrine glands)

Dysphagia, glossitis, Fe-deficiency anemia

Plummer-Vinson syndrome (may progress to esophageal SCC)

Elastic skin, hypermobility of joints

EDS (type 3 collagen)

Enlarged, hard left supraclavicular LN

Vircow's node (abdominal mets)

Erythroderma, LAD, HSM, atypical T cells

Sezary syndrome (cutaneous T-cell lymphoma) or mycosis fungoides

Facial muscle spasm upon tapping

Chovstek's sign (hypocalcemia)

Fat, female, forty, fertile

Cholelithiasis (gall stones)

Fever, chills, headache, myalgia 2/2 ABX treatment for syphillis

Jarisch-Herxheimer reaction: rapid lysis of spirochetes; toxin release

Fever, cough, conjunctivitis, coryza, diffuse rash

Measles

Fever, night sweats, weight loss

B symptoms (lymphoma)

Fibrous plaques in soft tissue of penis

Peyronie's disease (CT disorder)

Gout, mental retardation, self-mutaliting behavior in boy

Lesch.Nyan syndrome (HGPRT XLR)

Green-yellow rings around peripheral cornea

KF rings (Wilson's disease - Cu)

Hamartomatous GI polyps, hyperpigmentation of mouth, hands, feet

Peutz-Jegher's syndrome (inherited, benign polyposis can cause bowel obstruction; higher cancer risk, mainly GI)

HSM, osteoporosis, neurological symptoms

Gaucher's disease (glucocerebrosidase deficiency)

Hereditary nephritis, sensorineural hearing loss, cataracts

Alport syndrome (can't see, can't pee, can't climb a tree: alpha-chain of collagen 4)

Hyperphagia, hypersexuality, hyperorality loss, cataracts

Kluver-Bucy sydrome (bilataral amygdala lesion)

Hyperreflexia, hypertonia, Babinski sign

UMN lesion

Hyporeflexia, hypotonia, atrophy, fasiculations

LMN lesion

Hypoxemia, polycythemia, hypercapnia

Blue bloater: chronic bronchitis

Indurated, ulcerated genital lesion

Painful: H. ducreyi (chancroid) Painless: Syphillis (T. pallidum)

Infant with cleft lip/palate; microcephaly/holoprosencephaly, polydactyly, cutis aplasia

Patau's syndrome (Trisomy 13)

Carcinogen: Aflatoxin (Aspergillus)

Liver: HCC

Carcinogen: Alkylating agents

Blood: Leukemia/Lymphoma

Carcinogen: Aromatic amines (benzidine, 2-naphthylamine)

Bladder: TCC

Carcinogen: Arsenic

Liver: Angiosarcoma Lung: Ca Skin: SCC

Carcinogen: Asbestos

Lung: bronchogenic > mesothelioma

Carcinogen: Carbon tetrachloride

Liver: centrilobular necrosis, fatty change

Carcinogen: Cigarette smoke

Bladder (TCC)/Esophagus (SCC) /Kidney (RCC)/Larynx, Lung (SCC) /Pancreas (AC)

Carcinogen: Ethanol

Liver: HCC

Carcinogen: Ionizing radiation

Thyroid: Papillary thyroid cancer

Carcinogen: Nitrosamines (smoked foods)

Stomach cancer

Carcinogen: Radon

Lung cancer (second leading cause to lung cancer)

Carcinogen: Vinyl chloride

Liver: Angiosarcoma

Carcinogens associated with hepatic angiosarcoma

1. Vinyl chloride | 2. Arsenic

Infant with FTT, HSM and neurodegeneration

Niemann-Pick disease (genetic sphingomyelinase deficiency)

Infant with hypoglycemia, FTT and HSM

Cori's disease (debranching enzyme)

Infant with microcephaly, rocker-bottom feet, clenched hands, and structural heart defect

Edward's syndrome (trisomy 18)

Jaundice, palpable distended non-tender gall bladder

Courvoisier's sign (distal obstruction of biliary tree)

Large rash with bull's eye appearance

Erythema migrans (Ixodes tick/Lyme disease)

Lucid interval after traumatic brain injury

Epidural hematoma

Male child, recurrent infections, no mature B cells

Bruton's X-linked agammaglobulinemia

Mucosal bleeding and prolonged bleeding time

Glanzmann's thrombasthenia (Gp2b/3a platelet aggregation)

Muffled heart sounds, distended neck veins, hypotension

Beck's triad of cardiac tamponade

Multiple colon polyps, osteomas/soft tissue tumors, impacted/supernumerary teeth

Gardner's syndrome (subtype of FAP)

Infantile hypertrophic cardiomyopathy; exercise intolerance

Pmpe's disease (lysosomal alpha-1,4, glucosidase deficiency)

Neonate w/ arm paralysis following difficult birth

Erb-Duchenne palsy (superior trunk, C5-6 brachial plexus injury -- waiter's tip)

No lactation post-partum, absent menstruation, cold intolerance

Sheehan's pituitary infarction

Nystagmus, intention tremor, scanning speech, bilateral internuclear opthalmoplegia

Oscillating slow/fast breathing

Cheyne-Stokes (central apnea in CHF or raiced ICP)

Painful blue fingers/toes, hemolytic anemia

Cold agglutinin disease (AIHA 2/2 M. pna or Mono)

Painful, pale, cold fingers/toes

Raynaud's phenomenon (vasospasm in extremities)

Painful, raised red lesions on pads of fingers, toes

Osler's node (immune complex)

Painless erythematous rash on palms and soles

Janeway lesions (infective endocarditis, septic emboli, microabscess)

Painless jaundice

Pancreatic ca obstructing bile duct

Palpable purpura on buttocks, joint pain, abdominal pain, hematuria

HSP (IgA vasculitis)

Pink puffer with dyspnea and hyperventilation

Emphysema: centriacinar (smoking) | Panacinar (A1AT)

Polyuria, RTA type 2, growth failure, electrolyte imbalances, hypophosphatemic rickets

Fanconi's syndrome (proximal tubular reabsorption defect)

Positive anterior drawer sign

ACL injury

Pruritic, purple, polygonal planar papules and plaques

Lichen planus

Ptosis, miosis, anhydrosis

Horner's syndrome

Pupil accomodates, but does not react

Argyll Robertson pupil

Rapidly progressive leg weakness that ascends following GI/URT infection

GBS

Rash on palms and soles

Coxsackie A, RMSF, Syphillis

Recurrent colds, unusual eczema, high IgE

Hyper IgE syndrome (Job syndrome: neutrophil chemotaxis abnormality)

Red currant jely sputum in ETOH/DM patients

Klebsiella

Red currrant jelly stools (adults vs. infants)

Acute mesenteric ischemia (adults); intussusception (infants)

Red, itchy, swollen rash of nipple/areola

Paget's disease of the breast (underlying neoplasm)

Red urine in the morning, fragile RBC's

PNH

RCC (B/L), hemangioblastoma, angiomatosis, pheo

VHL (AD TS gene mutation)

Resting tremor, rigidity, akinesia, postural instability

Parkinson's disease

Retinal hemorrhage with pale centers

Roth spots (bacterial endocarditis)

Severe jaundice in a neonate

Crigler-Najjar

Severe RLQ pain with palpation of LLQ

Rovsing sign

Severe RLQ pain with RB tenderness

McBurney's sign

Short stature, high incidence of tumors/leukemia, aplastic anemia

Fanconi's anemia (genetic loss of DNA cross link repair) often progresses to AML

Single palmar crease

Down's syndrome

Situs inversus, chronic sinusitis, bronchiectasis, infertility

Kartagener's syndrome (dyein arm)

Skin hyperpigmentation, hypotension, fatigue

Addison's disease

Slow, progressive muscle weakness in boys

Becker's MD (X-linked missense)

Small, irregulat spots on buccal/lingual mucosa with blue-white centers

Koplik's spots

Splinter hemorrhages in fingernails

Endocarditis

Strawberry tongue (3 associations)

Scarlet fever, Kawasaki disease, TSS

Streak ovaries, congenital heart disease, horseshoe kidney, cystic hygroma, short stature, webbed neck, lymphedema

Turner syndrome (45, XO)

Sudden swollen/painful big toe joint, tophi

Gout

Swollen gums, mucosal bleeding, poor wound healing, spots on skin

Scurvy (vitamin C; cannot hydroxylate proline/lysine for collagen synthesis)

Swollen, hard, painful finger joints

OA (osteophytes on PIP = Bouchard; DIP = Heverden's)

Systolic ejection murmur

Toe extension, fanning upond plantar scrape

Babinski sign (UMN)

Urethritis, conjunctivitis, arthritis in a male

Reactive arthritis (HLA-B27)

Vascular birthmark (port wine stain)

Hemangioma (benign, but associated with Sturge-Weber syndrome)

Vomiting blood following GE lacerations

MW syndrome (ETOH anb bulimic)

Weight loss, diarrhea, fever, arthritis, adenopathy

Whipple's disease

Worst headache of my life

SA hemorrhage

Anticentromere Ab

Scleroderma (CREST)

Anti-desmoglein Ab

Pemphigus vulgaris

Anti-GBM

Goodpasture's syndrome

Anti-histone Ab

Drug induced SLE: hydralazine, INH, phenytoin, procainamide

Anti-IgG Ab

Anti-mitochondrial Ab

Primary biliary cirrhosis (female, choestasis, portal hypertension)

C-ANCA

Wegener's granulomatosis

P-ANCA

Churg-Strauss, Microscopic polyangiitis

ANA

SLE

Anti-platelet Ab

Idiopathic thrombocytopenic prpura

Anti-topoisomerase Ab

Diffuse systemic scleroderma

Anti-transglutaminase Ab

Celiac

Anti-gliadin Ab

Celiac

Anti-Endomysial Ab

Celiac

Apple core lesion on AXR

Left-sided colorectal cancer

Azurophilic peroxidase positive granular inclusions in granuloycytes and myeloblastis

Auer rods: AML (especially APML)

Bamboo spine on X-ray

Ankylosing spondylitis (HLA-B27)

Basophilic nuclear remnants in RBC

Howell-Jolly bodies (2/2 auto or actual splenectomy)

Basophilic stippling of RBC

Lead poisoning or sideroblastic anemia

Bloody tap on LP

SA hemorrhage

Boot shaped heart on X-ray

TOF, RVH

Branching gram-positive rods with sulfur granules

Actinomyces israelii

Bronchogenic apical lung tumor on imaging

Pancoast tumor

Brown tumor of bone

Hyperparathyroidism or osteitis fibrosis cystica (deposited hemosiderin from hemorrhage gives brown color)

Cardiomegaly with apical atrophy

Chagas disease (T. cruzi)

Chocolate cyst of ovary

Endometriosis

Circular grouping of dark tumor cells surrounding pale neurofibrils

Homer-Writght rosettes (neuroblastoma, medulloblastoma, Rb)

Colonies of mucoid Pseudomonas in lungs

Decreased AFP in AF or maternal serum

Down Syndrome

Degeneration of dorsal columns

Tabes dorsalis

Depigmentation of neurons in SN

Parkinson's diease

Desquamated epithelial casts in sputum

Curschmann's spirals (asthma)

Disarrayed granulosa cells in eosinophilic fluid

Call-Exner bodies (GT cells of ovarian tumor)

Dysplastic squamous cervical cells with nuclear enlargement and hyperchromasia

Koilocytes

Enlarged cells with intranuclear inclusions

CMV Owl's eye

Enlarged thyroid cells with ground glass nuclei

Orphan Annie Eyes (papillary thyroid cancer)

Eosinophilic intracytoplasmic inclusion of liver cell

Mallory body (ETOH)

Eosinophilic intracytoplasmic inclusion of nerve cell

Lewy body (Parkinson's)

Eosinophilic globule in liver

Councilman body (hepatitis or yellow fever)

Eosinophilic intracytoplasmic inclusion of hippocampal nerve cells

Negri bodies of rabies; Lyssavirus

Extracellular amyloid deposition in gray matter of brain

Alzheimer's senile plaques

Giant B cells with owl's eye prominent inclusions

RS cells: HL

Glomerulus like structure surrounding vessel in germ cell

Schiller-Duval bodies: yolk sac tumor

Hair on end (crew cut appearance) on skull xray

Beta-thal or SCA (marrow expansion)

HCG elevated

Choriocarcinoma, hydatidiform mole

Heart nodules (granulomatous)

Aschoff bodies (Rheumatic Fever)

Heterophile Ab

Mono; EBV

Hexagonal, double-pointed, needle-like crystals in bronchial secretions

Bronchial asthma (Charcot-Leyden crystals -- eosiniphilic granules)

High levels of d-dimers

DVT, PE, DIC

Hilar LAD, peripheral granulomatous lesion in middle or lower lung lobes

Primary TB

Honeycombing on lung on CT or X-ray

Interstitial pulmonary fibrosis

Hypercoagulability (leading to migrating DVTS and vascultitis)

Trousseau's syndrome (AC lung or pancreas)

Hypersegmented neutrophils

Megaloblastic anemia (B12 or folate)

Hypochromic, microcytic anemia

Fe, Lead, thalassemia

Increased AFP in maternal serum

Dating error, anencephaly, NTD

HTN, hpokalenia, metabolic alkalosis

Conn's syndrome

Increased uric acid levels

Gout, Lesch-Nyhan, tumor lysis syndrome, loop and thiazide diuretics

Intranuclear eosinophilic droplet-like bodies

Cowdry A inclusions (HSV or CMV)

Iron-containing nodules in alveolar septum

Ferruginou bodies (asbestosis)

Keratin pearls on skin biopsy

SCC

Large lysosomal vesicles in phagocytes; immunodeficiency

Chediak-Higashi (phagolysosome)

Lead pip appearance of colon on barium enema X-ray

Linear IgG on GBM

Goodpasture's syndrome

Low serum ceuloplasmin

Wilson's disease

Lumpy bumpy appearance of glomeruli on IF

PSGN (IgG, C3)

Lytic "punched out" lesions on X-ray

Multiple myeloma

Mammary gland "blue domed" cyst

FCC breast

Monoclonal Ab spike

MM (IgG or IgA) MGUS IgM Waldenstrom's Primary amyloidosis

Mucin-filled cell with peripheral nucleus

Signet cell

Narrowing of bowel lumen on barium X-ray (String sign)

Crohn's disease

Necrotizing vasculitis and necrotizing GN

Wegener's (c-ANCA); Goodpasture's

Needle-shaped, negative birefringent crystals

Gout

Nodular hyaline deposits in glomeruli

KW nodules: DM nephropathy

Nutmeg liver

Chronic passive congestion 2/2 RHF

Onion skin periosteal reaction

Ewing's sarcoma (malignant round cell tumor)

Periosteum raised from bone, creating triangular area

Codman's triangle (OS, Ewings, pyogenic OM)

Podocyte effacement on EM

MCD

Polished, ivory-like appearance of bone at cartilage erosion

Eburnation (OA resulting in bony sclerosis)

Protein aggregates in neurons from hyperphosphorylated tau proteins

NF tangles & Pick bodies

Psammoma bodies

Meningioma, Papillary thyroid cancer, mesothelima, papillary serous ca ovary/endometrium

Pseudopalisading tumor cells on brain bx

GBM

RBC casts in urine

Nephritic syndrome

Rectangular, crystal-like cytoplasma inclusions in Leydig cells

Reinke crystals (Leydig cell tumor)

Renal epithelial casts in urine

Acute toxic/viral nephrosis

Rhomboid crystals, positively birefringent

Pseudogout; Ca pyropp hihydrate

Rib notching

Coarctation of aorta

Ring-enhancing brain lesion in AIDS

Toxoplasma, CNS lymphoma

Sheets of medium-sized lymphoid cells with scater pale, tingibile body-laden macrophages

Burkitt's lymphoma

Silver staining spherical aggregation of tau proteins in neurons

Pick bodies

Soap bubble in femur or tibia on X-ray

Giant cell tumor of bone

Spike & dome on GBM

Membranous nephropathy

Stacks of RBC's

Rouleaux formation: MM

Stippled vaginal epithelial cells

Clue cells (Gardenella)

Tennis racket shaped cytoplasmic organelles in Langerhans cells

Birbeck granules: Langerhans cell histiocytosis

Thrombi made of white/red layers

Lines of Zahn (arterial thrombus)

Thumb sign on lateral X-ray

Epiglottitis

Thyroid-like appearance of the kidney

Chronic bacterial pyelonephritis

Tram-track capillary loops of GBM

MPGN

Triglyceride accumulation in liver cell vacuoles

Fatty liver disease

Waxy casts with very low urine flow

ESRD

WBC casts in urine

Acute pyelonephritis

WBC's that look smudged

CLL

Wire loop glomerular capillary on LM

Lupus nephropathy

Yellowish CSF

Xanthochromia (2/2 SAH)

Classic presentations Flashcards

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