First Aid Rapid Review 2015--Classic Presentations Flashcards
Classic Presentations, Classic Labs/Findings, Classic/Relevant Treatments, & Key Associations from First Aid 2014 (Equation Review omitted). dec = decreased, inc = increased; + = positive; 1° = primary; 2° = secondary (129 cards)
0
Q
Abdominal pain, diarrhea, leukocytosis, recent antibiotic use.
A
Clostridium difficile infection
1
Q
Abdominal pain, ascites, hepatomegaly.
A
Budd-Chiari syndrome (posthepatic venous thrombosis)
2
Q
Achilles tendon xanthoma.
A
Familial hypercholesterolemia (↓LDL receptor signaling)
3
Q
Adrenal hemorrhage, hypotension, DIC.
A
Waterhouse-Friderichsen syndrome (meningococcemia)
4
Q
Anaphalaxis following drug transfusion.
A
IgA Deficiency
5
Q
Anterior “drawer sign” (+).
A
Anterior Cruciate Ligament (ACL) injury
6
Q
Arachnodactyly, lens dislocation, aortic dissection, hyperflexible joints.
A
Marfan syndrome (fibrillin defect)
7
Q
Athlete with polycythemia.
A
Exogenous erythropoietin (EPO) injection
8
Q
Back pain, fever, night sweats, weight loss.
A
Pott disease (vertebral TB)
9
Q
Bilateral acoustic schwannomas.
A
Neurofibromatosis Type 2 (NF2)
10
Q
Bilateral hilar adenopathy, uveitis.
A
Sarcoidosis (noncaseating granulomas)
11
Q
Black eschar on face of patient with DKA.
A
Mucor or Rhizopus fungal infection
12
Q
Blue sclera.
A
Osteogenesis imperfecta (type I collagen defect)
13
Q
Bluish line on gingiva.
A
Burton line (lead poisoning)
14
Q
Bone pain, bone enlargement, arthritis.
A
Paget disease of bone (↑osteoblastic and osteoclastic activity)
15
Q
Bounding pulses, diastolic heart murmur, head bobbing.
A
Aortic regurgitation
16
Q
“Butterfly” facial rash and Raynaud phenomenon in a young female.
A
Systemic Lupus Erythematosus (SLE)
17
Q
Café-au-lait spots, Lisch nodules (iris hamartoma), Cutaneous tumors, Pheochromocytomas, Optic glioma, Freckling in the axillary (Crowe sign) or inguinal regions.
A
Neurofibromatosis type I (NF1)
18
Q
Café-au-lait spots (unilateral), polyostotic fibrous dysplasia, precocious puberty, multiple endocrine abnormalities.
A
McCune-Albright syndrome (mosaic G-protein signaling mutation)
19
Q
Calf pseudohypertrophy.
A
Muscular dystrophy (most commonly Duchenne): X-linked recessive deletion of dystrophin gene
20
Q
Cervical lymphadenopathy, desquamating rash, coronary aneurysm, red conjunctivae and red tongue.
A
Kawasaki Disease (Tx: IVIG and Aspirin)
21
Q
“Cherry-red spots” on macula.
A
Tay-Sachs (ganglioside accumulation)
Niemann-Pick (sphingomyelin accumulation, paired with hepatosplenomegaly and neurodegeneration), central retinal artery occlusion
22
Q
Chest pain on exertion.
A
Angina
- stable: with moderate exertion
- unstable: with minimal exertion
23
Q
Chest pain, pericardial effusion/friction rub, persistent fever following MI.
A
Dressler syndrome (autoimmune-mediated post-MI fibrinous pericarditis, 2-12 weeks after acute episode)
24
Chest pain w/ ST depressions on EKG.
```
Unstable angina if (-)troponin
NSTEMI if (+)troponin
```
25
Child uses arms to stand up from squat.
Gowers sign (Duchenne muscular dystrophy)
26
Child with fever later develops red rash on face that spreads to body.
"Slapped cheeks" (erythema infectiosum/fifth disease: parvovirus B19)
27
Chorea, dementia, caudate degeneration.
Huntington disease (autosomal dominant CAG repeat expansion)
28
Chorioretinitis (posterior uveitis), hydrocephalus, intracranial calcifications. [Infant]
Congenital toxoplasmosis
29
Chronic exercise intolerance with myalgia, fatigue, painful cramps, myoglobinuria.
McArdle disease (muscle glycogen phosphorylase deficiency)
30
Cold intolerance.
Hypothyroidism
31
Conjugate lateral gaze palsy (ipsi eye can't look contra), horizontal diplopia. [Bilateral or unilateral]
Internuclear ophthalmoplegia
(damage to MLF)
-bilateral [multiple sclerosis],
-unilateral [stroke]
32
Continuous "machine-like" heart murmur.
Patent ductus arteriosus (PDA) [close with indomethacin; open or maintain with misoprostol or other PGE analogs]
33
Cutaneous/dermal edema due to connective tissue deposition.
Myxedema
(caused by hypothyroidism or
Graves disease [pretibial])
34
Cutaneous flushing, diarrhea, bronchospasm, right sided heart lesions.
Carcinoid syndrome
| [↑5-HIAA, metabolite of serotonin --> think enterochromaffin (Kultschitzsky) cells of the small intestine]
35
Dark purple skin/mouth nodules in a patient with AIDS.
Kaposi sarcoma, associated with HHV-8
36
Deep, labored breathing/hyperventilation.
Kussmaul respirations (diabetic ketoacidosis)
37
Dermatitis, dementia, diarrhea.
Pellagra (niacin [vitamin B3] deficiency)
38
Dilated cardiomyopathy, edema, alcoholism or malnutrition.
Wet beriberi (thiamine [vitamin B1] deficiency)
39
Dog or cat bite resulting in infection.
Pasteurella multocida
| cellulitis at inoculation site
40
Dry eyes, dry mouth, arthritis.
Sjögren syndrome (autoimmune destruction of exocrine glands)
41
Dysphagia (esophageal webs), glossitis (beefy red tongue), iron deficiency anemia.
Plummer-Vinson syndrome (may progress to esophageal squamous cell carcinoma)
42
Elastic skin, hypermobility of joints, ↑bleeding tendency
Ehlers-Danlos syndrome
- type V collagen defect, or
- type III collagen defect seen in vascular subtype
43
Enlarged, hard left supraclavicular node.
Virchow node [Troisier's sign] -->
| metastatic abdominal/GI cancer
44
Episodic Vertigo, tinnitus, hearing loss.
Meniere Disease
45
Erythroderma, lymphadenopathy, hepatosplenomegaly, atypical T cells.
- Mycosis fungoides (a cutaneous T-cell lymphoma = a type of non-Hodgkin's lymphoma not a fungal disease)
- Sézary syndrome (mycosis fungoides + malignant T cells in blood)
46
Facial muscle spasm upon tapping.
Chvostek sign (hypocalcemia)
47
Fat, female, forty, and fertile.
Cholelithiasis (gallstones)
48
Fever, chills, headache, myalgia following antibiotic treatment for syphilis.
Jarisch-Herxheimer reaction (rapid lysis of spirochetes results in endotoxin release)
49
Fever, cough, conjunctivitis, coryza (stuffy nose), diffuse rash.
Measles (rubeola)
50
Fever, night sweats, weight loss.
```
B symptoms (systemic) of lymphoma
-A = absence of systemic symptoms,
-B = presence of symptoms
(Ann Arbor staging of lymphoma)
```
51
Fibrous plaques in soft tissue of the penis.
Peyronie disease (connective tissue disorder)
52
Golden brown rings around peripheral cornea
Kayser Fleischer rings (copper accumulation from Wilson disease)
53
Gout, intellectual disability, self-mutilating behavior in a boy.
Lesch-Nyhan syndrome (HGPRT deficiency, X-linked recessive)
54
Hamartomatous GI polyps, hyperpigmentation of mouth/feet/hands.
Peutz-Jeghers syndrome (inherited, benign polyposis can cause bowel obstruction; ↑cancer risk, mainly GI)
55
Hepatosplenomegaly, pancytopenia, osteoporosis, aseptic necrosis of femur, bone crises
Gaucher disease
(glucocerebrosidase deficiency)
[a lysosomal storage disease]
56
Hereditary nephritis, sensorineural hearing loss, cataracts.
Alport syndrome (mutation in collagen IV)
57
Hyperphagia, hypersexuality, hyperorality, hyperdocility.
Klüver-Bucy syndrome (bilateral amygdala lesion)
58
Hyperreflexia, hypertonia, Babinski sign present.
UMN damage
59
Hyporeflexia, hypotonia, atrophy, fasciculations.
LMN damage
60
Hypoxemia, polycythemia, hypercapnia.
"Blue bloater" (chronic bronchitis: hyperplasia of mucous cells)
61
Indurated, ulcerated genital lesion.
-Nonpainful: chancre (1° syphilis, Treponema pallidum) -Painful, with exudate: chancroid (Haemophilus ducreyi)
62
Infant with cherry red spot on macula, hepatosplenomegaly, and neurodegeneration
Niemann-Pick disease (genetic sphingomyelinase deficiency)
63
Infant with cleft lip/palate, microcephaly or holoprosencephaly, polydactyly, cutis aplasia.
Patau syndrome (trisomy 13)
64
Infant with hypoglycemia and hepatomegaly.
- Cori disease (debranching enzyme deficiency) or
| - Von Gierke disease (glucose-6-phosphatase deficiency, more severe)
65
Infant with microcephaly, rocker-bottom feet, clenched hands, and structural heart defect.
Edwards syndrome (trisomy 18)
66
Jaundice, palpable distended non-tender gallbladder.
Courvoisier sign (distal obstruction of biliary tree)
67
Large rash with bull's-eye appearance.
Erythema chronicum migrans from Ixodes tick bite (Lyme disease: Borrelia)
68
Lucid interval after traumatic brain injury.
Epidural hematoma (middle meningeal artery rupture)
69
Male child, recurrent infections, no mature B cells.
Bruton disease (X-linked agammaglobulinemia)
70
Mucosal bleeding and prolonged bleeding time.
Glanzmann thrombasthenia (defect in platelet aggregation due to lack of GpIIb/IIIa)
71
Muffled heart sounds, distended neck veins, hypotension.
Beck triad of cardiac tamponade
72
Multiple colon polyps, osteomas/soft tissue tumors, impacted/ supernumerary teeth.
Gardner syndrome (subtype of FAP)
73
Myopathy (infantile hypertrophic cardiomyopathy), exercise intolerance.
Pompe disease (lysosomal α-1,4-glucosidase deficiency)
74
Neonate with arm paralysis following difficult birth.
Erb-Duchenne palsy (superior trunk [C5-C6] brachial plexus injury: "waiter's tip")
75
No lactation postpartum, absent menstruation, cold intolerance.
Sheehan syndrome (pituitary infarction)
76
Nystagmus, intention tremor, scanning speech, bilateral internuclear ophthalmoplegia.
Multiple sclerosis
77
Oscillating slow/fast breathing. Disease/Dx?
Cheyne-Stokes respirations (central apnea in CHF or inc intracranial pressure)
78
Painful blue fingers/toes, hemolytic anemia.
Cold agglutinin disease (autoimmune hemolytic anemia caused by Mycoplasma pneumoniae, infectious mononucleosis, CLL)
79
Painful fingers/toes changing color from blue to white to red with cold or stress.
Raynaud phenomenon (vasospasm in extremities)
80
Painful, raised red lesions on pad of fingers/toes.
Osler nodes (infective endocarditis, immune complex deposition)
81
Painless erythematous lesions on palms and soles.
Janeway lesions (infective endocarditis, septic emboli/ microabscesses)
82
Painless jaundice.
Cancer of the pancreatic head obstructing bile duct
83
Palpable purpura on buttocks/legs, joint pain, abdominal pain (child), hematuria.
Henoch-Schönlein purpura (IgA vasculitis affecting skin and kidneys)
84
Pancreatic, pituitary, parathyroid tumors.
MEN 1 (autosomal dominant)
85
Periorbital and/or peripheral edema, proteinuria, hypoalbuminemia, hypercholesterolemia. Disease/Dx?
Nephrotic syndrome
86
Pink complexion, dyspnea, hyperventilation.
"Pink puffer" (emphysema: centriacinar [smoking], panacinar [α1-antitrypsin deficiency])
87
Polyuria, renal tubular acidosis type II, growth failure, electrolyte imbalances, hypophosphatemic rickets.
Fanconi syndrome (proximal tubular reabsorption defect)
88
Pruritic, purple, polygonal planar papules and plaques (6 P's).
Lichen planus
89
Ptosis, miosis, anhidrosis.
Horner syndrome (sympathetic chain lesion)
90
Pupil accommodates but doesn't react.
Argyll Robertson pupil (neurosyphilis)
91
Rapidly progressive limb weakness that ascends following GI/upper respiratory infection.
Guillain-Barré syndrome (acute inflammatory demyelinating polyneuropathy subtype)
92
Rash on palms and soles.
Coxsackie A, 2° syphilis, Rocky Mountain spotted fever
93
Recurrent cold (noninflamer) abcesses, unusual eczema, high serum IgE.
Hyper-IgE syndrome (Job syndrome: neutrophil chemotaxis abnormality)
94
Red "currant jelly" sputum in alcoholic or diabetic patients.
Klebsiella pneumoniae
95
Red "currant jelly" stools.
Acute mesenteric ischemia (adults), intussusception (children)
96
Red, itchy, swollen rash of nipple/areola.
Paget disease of the breast (sign of underlying neoplasm)
97
Red urine in the morning, fragile RBCs.
Paroxysmal nocturnal hemoglobinuria
98
Renal cell carcinoma (bilateral), hemangioblastomas, angiomatosis, pheochromocytoma. Disease/Dx?
von Hippel-Lindau disease (dominant tumor suppressor gene mutation)
99
Resting tremor, rigidity, akinesia, postural instability.
Parkinson disease (loss of dopaminergic neurons in the substantia nigra pars compacta)
100
Retinal hemorrhages with pale centers.
Roth spots (bacterial endocarditis)
101
Severe jaundice in neonate.
Crigler-Najjar syndrome (congenital unconjugated hyperbilirubinemia)
102
Severe RLQ pain with palpation of LLQ.
Rovsing sign (acute appendicitis)
103
Severe RLQ pain with rebound tenderness.
McBurney sign (acute appendicitis)
104
Short stature, cafe-au-lait spots, thumb/radial defects, ↑incidence of tumors/leukemia, aplastic anemia.
Fanconi anemia (genetic loss of DNA crosslink repair; often progresses to AML)
105
Single palmar crease.
Down syndrome (trisomy 21)
106
Situs inversus, chronic sinusitis, bronchiectasis, infertility.
Kartagener syndrome (dynein arm defect affecting cilia)
107
Skin hyperpigmentation, hypotension, fatigue.
Addison disease (1° adrenocortical insufficiency causes ↑ACTH and ↑α-MSH production)
108
Slow, progressive muscle weakness in boys.
Becker muscular dystrophy (X-linked missense mutation in dystrophin; less severe than Duchenne)
109
Small, irregular red spots on buccal/lingual mucosa with blue-white centers
Koplik spots (measles; rubeola virus)
110
Smooth, flat, moist, painless wart-like white lesions on genitals.
Condylomata lata (2° syphilis)
111
Splinter hemorrhages in fingernails.
Bacterial endocarditis
112
"Strawberry tongue".
Scarlet fever, Kawasaki disease
113
Streak ovaries, congenital heart disease, horseshoe kidney, cystic hygroma at birth, short stature, webbed neck, lymphedema.
Turner syndrome (45,XO)
114
Sudden swollen/painful big toe joint, tophi.
Gout/podagra (hyperuricemia)
115
Swollen gums, mucosal bleeding, poor wound healing, petechiae.
Scurvy (vitamin C deficiency: can't hydroxylate proline/lysine for collagen synthesis)
116
Swollen, hard, painful finger joints.
Osteoarthritis (osteophytes on PIP [Bouchard nodes], DIP [Heberden nodes])
117
Systolic ejection murmur (crescendo-decrescendo).
Aortic valve stenosis
118
Telangiectasias, recurrent epistaxis, skin discoloration, arteriovenous malformations, GI bleeds, hematuria
Osler-Weber-Rendu Syndrome (inherited disorder of blood vessels aka Hereditary Hemorrhagic Telangiectasia)
119
Thyroid and parathyroid tumors, pheochromocytoma.
MEN 2A (autosomal dominant RET mutation)
120
Thyroid tumors, pheochromocytoma, ganglioneuromatosis.
MEN 2B (autosomal dominant RET mutation)
121
Toe extension/fanning upon plantar scrape.
Babinski sign (UMN lesion)
122
Unilateral facial drooping involving forehead.
Facial nerve (LMN CN VII palsy). Bell's palsy
123
Unilateral facial drooping not involving the forehead
Central CN VII lesion; stroke
124
Urethritis, conjunctivitis, arthritis in a male.
Reactive arthritis associated with HLA-B27
125
Vascular birthmark (port-wine stain) on the face.
Nevus flammeus (benign, but associated with Sturge-Weber syndrome)
126
Vomiting blood following gastroesophageal lacerations.
Mallory-Weiss syndrome (alcoholic and bulimic patients)
127
Weight loss, diarrhea, arthritis, fever, adenopathy.
Whipple disease (Tropheryma whipplei)
128
"Worst Headache of my life."
Subarachnoid hemorrhage
