Classical Presentations

Question 1

+ anterior drawer sign

Answer 1

ACL injury (anterior cruciate ligament)

Question 2

Back pain, fever, night sweats

Answer 2

Potts disease (TB to the vertebrae)

Question 3

Bilateral acoustic schwannomas

Answer 3

NF2 (usually CN VII)

Question 4

bilateral hilar adenopathy, uveitis

Answer 4

Sarcoidosis (non caseating granulomas)

Question 5

Blue sclera

Answer 5

osteogenesis imperfecta (COL1A1 alpha and COL1A2mutations ) type 1 collagen

Question 6

butterfly rash, raynaud phenomenon in young female

Answer 6

SLE

Question 7

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

Answer 7

fifth disease, slapped cheeks, parvovirus B19

Question 8

Chorea, dementia, caudate degeneration

Answer 8

Huntington disease (autsomal dominant, CAG repeats, anticipation)

Question 9

cold intolerance

Answer 9

hypothyroidism

Question 10

conjugate horizontal gaze palsy, horizontal diplopia

Answer 10

MLF syndrome, INO

Question 11

dilated cardiomyopathy, edema, alcoholism, or malnutrition

Answer 11

Vitamin B1 deficiency (thiamine)

wet beriberi

Question 12

dry eyes, dry mouth, arthritis

Answer 12

sjogren’s syndrome with sicca syndrome, exocrine glands destruction, autoimmune)

Question 13

elastic skin, hypermobility of joints, increased bleeding

Answer 13

Ehler’s danlos syndrome, type V collagen defect, type III collagen defect seen in vascular subtype of ED

Question 14

fever, night sweats, weight loss

Answer 14

B symptoms (staging) of lymphoma

Question 15

gout, intellectual disability, self mutilating behavior in a boy

Answer 15

Lesch-Nyhan syndrome (HGPRT deficiency, X-linked recessive)

Question 16

Hyperreflexia, hypertonia, Babinski sign present

Answer 16

UMN damage

Question 17

Hyporeflexia, hypotonia, atrophy, fasciculations

Answer 17

LMN damage

Question 18

Indurated, ulcerated genital lesion

Answer 18

Nonpainful: chancre (1° syphilis, Treponema pallidum)

Painful, with exudate: chancroid (Haemophilus ducreyi)

Question 19

hypoxemia, polycythemia, hypercapnia

Answer 19

blue bloater - chronic bronchitis, hyperplasia of mucous cells

Question 20

Large rash with bull’s eye appearance

Answer 20

Erythema chronicum migrans from Ixodes tick bite (Lyme disease: Borrelia)

Question 21

Lucid interval after TBI

Answer 21

epidural hematoma (Middle meningeal artery)

Question 22

Neonate with arm paralysis following difficult birth

Answer 22

Erb-Duchenne palsy (superior trunk [C5–C6] brachial plexus injury: “waiter’s tip”)

Question 23

Nystagmus, intention tremor, scanning speech, bilateral INO (SI(i)N)

Answer 23

Multiple sclerosis

Question 24

Painful fingers/toes changing color from blue to white to red with cold or stress

Answer 24

Raynaud phenomenon (vasospasm in extremities)

Question 25

Palpable purpura on buttocks/legs, joint pain, abdominal pain (child), hematuria

Answer 25

Henoch-Schönlein purpura (IgA vasculitis affecting skin and kidneys

Question 26

Pink complexion, dyspnea, hyperventilation

Answer 26

Pink puffer” (emphysema: centriacinar [smoking], panacinar [α1-antitrypsin deficiency])

Question 27

Ptosis, miosis, anhidrosis

Answer 27

Horner syndrome

Question 28

Pruritic, purple, polygonal planar papules and plaques (6 P’s)

Answer 28

lichen planus

Question 29

Rapidly progressive limb weakness that ascends following GI/URI

Answer 29

Guillain-Barré syndrome (acute inflammatory demyelinating polyradiculopathy subtype)

Question 30

Red urine in the morning, fragile RBCs

Answer 30

Paroxysmal nocturnal hemoglobinuria

Question 31

Resting tremor, rigidity, akinesia, postural instability, shuffling gait

Answer 31

Parkinson disease (loss of dopaminergic neurons in substantia nigra pars compacta)

Question 32

Severe RLQ pain with palpation of LLQ

Answer 32

Rovsing sign (acute appendicitis)

Question 33

Severe RLQ pain with rebound tenderness

Answer 33

McBurney sign (acute appendicitis)

Question 34

Situs inversus, chronic sinusitis, bronchiectasis, infertility

Answer 34

Kartagener syndrome (dynein arm defect affecting cilia)

Question 35

“Strawberry tongue”

Answer 35

Scarlet fever, Kawasaki disease

Question 36

Sudden swollen/painful big toe joint, tophi

Answer 36

Gout/podagra (hyperuricemia)

Question 37

Toe extension/fanning upon plantar scrape

Answer 37

Babinski sign (UMN lesion)

Question 38

Swollen gums, mucosal bleeding, poor wound healing, petechiae

Answer 38

Scurvy (vitamin C deficiency: can’t hydroxylate proline/lysine for collagen synthesis)

Question 39

Unilateral facial drooping involving forehead

Answer 39

LMN facial nerve (CN VII) palsy; Bell's palsy, UMN lesions spare the forehead

Question 40

Urethritis, conjunctivitis, arthritis in a male (can't pee, can't see, can't climb a tree"

Answer 40

Reactive arthritis associated with HLA-B27

Question 41

“Worst headache of my life”

Answer 41

Subarachnoid hemorrhage

Question 42

Vascular birthmark (port-wine stain) of the face

Answer 42

Nevus flammeus (benign, but associated with Sturge-Weber syndrome)

Question 43

Daily, productive cough for at least 3 months a year for 2 consecutive years

Answer 43

Chronic Bronchitis: daily cough with sputum for at least 3 months per year for 2 consecutive years - mucous gland hyperplasia, mucus over secretion - found in smokers mostly - inflammation and mucous can clog airways - increase resistance - obstructive disease

Question 44

Rare, fatal side effects of antipsychotics?

Answer 44

``` Neuroleptic Malignant Syndrome: FEVER symptoms Fever Encephalopathy Vitals unstable Elevated enzymes (CPR, WBC) Rigidity of muscles Gradual onset ```

Question 45

Patient taking Prozac and is added on another medication for panic disorders. She develops muscle stiffness, altered mental status, ANS instability, and hyperthemia. What med was she given?

Answer 45

SSRI -Prozac (fluoxetine) + MAOIs (e.g. phenelzine, selegine) and develops serotonin syndrome. Medical emergency

Question 46

Patient taking medications for atypical depression when she goes for a BBQ party with red wine, cheeses, and meats. She suddenly develops chest pain, headaches, and confusion. What happened?

Answer 46

Patient is taking MAOIs which inhibit degradation of tyramine found in wines, cheese, and smoked meats. Tyramine accumulates in GI and leads to release of NE, E from nervous tissue --> hypertensive crisis

Question 47

Intermittent wheezing, facial flushing, and diarrhea

Answer 47

- carcinoid syndrome -- secretion of vasoactive amines, serotonin -- metabolized into 5-hydroxyindoleacetic acid in the urine. - neuroendocrine tumors-- arise in the GI system -- substances escape escaped hepatic degradation -- metastasis