Busy. Please wait.

Forgot Password?

Don't have an account?  Sign up 

show password


Make sure to remember your password. If you forget it there is no way for StudyStack to send you a reset link. You would need to create a new account.

By signing up, I agree to StudyStack's Terms of Service and Privacy Policy.

Already a StudyStack user? Log In

Reset Password
Enter the email address associated with your account, and we'll email you a link to reset your password.

Remove ads
Don't know (0)
Know (0)
remaining cards (0)
To flip the current card, click it or press the Spacebar key.  To move the current card to one of the three colored boxes, click on the box.  You may also press the UP ARROW key to move the card to the "Know" box, the DOWN ARROW key to move the card to the "Don't know" box, or the RIGHT ARROW key to move the card to the Remaining box.  You may also click on the card displayed in any of the three boxes to bring that card back to the center.

Pass complete!

"Know" box contains:
Time elapsed:
restart all cards

Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.

  Normal Size     Small Size show me how

PANCE Word Assoc.

DOE, PND, edema. Echo w/ LVH or RVH, hypokinesis CHF
S3 CHF, dilagted cardiomyopathy
High output heart failure Pregnancy, thyrotoxicosis, anemia, beriberi, paget’s disease
Low output heart failure Ischemic heart disease, HTN, dilated CM, valve disease, arrhythmia
Heart failure after URI Myocarditis
Young athlete with syncope during athletic event or practice. No physical exam abnormalities Hypertrophic CM or fatal arrhythmia. Get EKG or Echo
Alcoholic with DOE, heart failure Primary dilated CM
Alcoholic with palpitations, arrhythmia Atrial fibrillation (Holiday heart)
Irregular irregular Atrial fibrillation; (if > 48 or chronic – anticoagulate)
Atrial fibrillation or prosthetic valve Warfarin (2 – 3 for Afib; 2.5 – 3.5 for valve); Tx Warfarin OD is vitamin K
Hx angina but no acute sx. EKG no acute changes. Do Exercise stress test
Crushing CP, dyspnea, palpitations, radiation to neck or left arm Angina (if lasts minutes), AMI if lasts > 30 minutes. Acute Ischemia – ST elevation; Injury – T wave depression; Infarct – Q wave
Constant, sharp CP worse lying down, better sitting up and leaning forward Pericarditis
pulsus paradoxus Pericardial effusion/tamponade, pericarditis, asthma attack, tension PTX, SVC obstruction
Electrical alternans, narrow pulse pressure, pulsus paradoxus Pericardial effusion/tamponade
JVD, Hypotension, muffled heart sounds Pericardial effusion/tamponade (Beck’s triad)
Pericarditis post open heart surgery Dressler’s syndrome. Tx w/ ASA #1. Indomethacin or other NSAID OK.
Sudden onset ripping, tearing chest pain, diminished pulses Aortic dissection
Flank pain, hypotension, pulsatile abdominal mass AAA
EKG changes, N, V, yellow-green visual disturbances Digoxin toxicity (Hypokalemia will make worse)
Hx CHF on diuretic & digoxin Suspect dig toxicity (hypokalemia from diuretic = dig toxicity)
Grossly elevated blood pressure esp. w/ signs of EOD Malignant or Urgent HTN
HTN Tx w/ meds, cough or angioedema ACEI is cause
DM & HTN ACEI is best choice
Heart failure, LVH ACEI (improves survival, prevents development of heart failure Sx)
Post MI Beta-blockers
Tx of HTN w/ alpha-blocker SE is postural Hypotension
HTN not responsive to basic meds Think secondary HTN most likely Renal artery stenosis (infrarenal artery).
Mechanical valve or prosthesis & Dental, GU, GI, or ortho procedure prophylaxis Bacterial endocarditis (strep. Viridians) prevention
IVDA w/ new murmur Bacterial endocarditis (strep. Viridians)
Elderly w/ systolic murmur Aortic stenosis (due to calcifications – age related (or bicuspid valve - congenital)
Diamond shaped, blowing systolic murmur. May have angina, syncope, CHF Aortic stenosis
Lateral displaced PMI, Canon “a” waves, Quincke’s pulse, Corrigan’s pulse, Austin flint murmur, deMusset’s sign, water Aortic Regurgitation/Insufficiency: Quincke’s pulse (subungual capillar pulsation), Corrigan (rapid rise and fall), Austin filnt (low pitch middiastolic murmur at apex)
Diastolic murmur best heart at apex without radiation Mitral stenosis (ARMS are BAD)
Systolic ejection murmur heard best at base with radiation to left clavicle Pulmonary stenosis
Female or Post MI, systolic murmur best apex preceded by click without radiation
Systolic murmur heard best at apex with radiation to left axilla (apical systolic) Mitral regurgitation
New murmur after MI (esp. if apical systolic) Mitral regurgitation (caused by papillary muscle rupture)
Murmur & Hx rheumatic heart disease Mitral stenosis #1, Tricuspid Stenosis #2
Continuous harsh, machine-like murmur PDA
Cyanotic infant with systolic thrill LSB, systolic ejection murmur +/- click
Holosystolic murmur LSB, may have ventricular hypertrophy
Infant w/ dyspnea, difficulty feeding. Holosystolic murmur LSB, 3rd ICS. LVH & RVH
Peds w/ leg pain after physical activity, abnormal heart sounds, unequal UE & LE pulses, rib notching Coarctation of aorta
Short PR, wide QRS, Delta wave Wolf-parkinson-white; avoid Digoxin,
Young female (<30yo), palpitations, long arms & fingers, pectus excavatum, ectopic lentis, flexible joints Marfan’s Syndrome – MVP, Aortic regurgitation, Aortic dissection, Aortic root dilatation, ectopic lentis
LE rubor, no hair, brittle nails, pallor on elevation, calf or LE pain esp. with walking short distances relieved with rest or at PM Arterial insufficiency/PAD, Intermittent claudication (ABI best choice, ateriogram gold standard)
Claudication with rest pain, (ABI < 0.4) Tx is arterial bypass
LE pain after long periods of standing. Dilated, tortuous, veins Varicose veins. Tx w/ compression stockings
Trendelenberg test of extremities Tests for veinous insufficiency.
Blue extremities worse w/ cold exposure, improves w/ warming Acrocyanosis
Description Diagnosis Associated
Rapid, deep labored breathing Kussmaul breathing – DKA, Metabolic acidosis
Deep breathing alternating w/ apnea Cheyne-Stokes breathing – heart failure, brain damage
Cavitations on CXR Infections – lung abscess, TB (Gohn focus)
Apical infiltrates, F, C, dry cough TB
Pleural thickening on CXR Mesothelioma
Hilar mass on CXR Lung Ca
Eggshell pattern on CXR Silicosis (Sandblasters)
Ground glass appearance on CXR Asbestosis (shipbuilders, building demolition)
Reticular to nodular pattern on CXR Coal Miner’s lung
Patchy fibrosis on CXR Farmers lung
Granulomas and inflammation of alveoli, small bronchi and small blood vessels Sarcoidosis
Dyspnea after surgery, travel (airplane), LE Fx. May have c/o calf pain also. DVT/PE
Lung scan with perfusion defects PE
Venous stasis, vessel wall injury, hypercoagulability DVT/PE (Virchow’s triad)
Pediatric with barking cough, stridor viral croup (laryngotracheobronchitis); Tx w/ racemic epi and glucocorticosteroids if stridor at rest.
Pediatric wheezing lower respiratory FB, asthma
Drooling, sniffing position, tripod, toxic Epiglottitis
Thumbprint sign Epiglottitis
Steeple sign FB, viral croup (laryngotracheobronchitis)
Inspiratory stridor FB, viral croup (laryngotracheobronchitis)
Premature infant with respiratory distress Hyaline Mb Disease
Preemie CXR w/ hypoexpansion (ATX), air bronchograms Hyaline Mb Disease
Smoker, chronic productive cough. NO hemoptysis, wt. loss. Brochitis (COPD)
Smoker, DOE, cough COPD
Hyperinflation on CXR, tear drop heart Emphysema
Wheezing, prolonged expiration Asthma
Airway edema with eosinophils, neutrophils, lymphocytes Asthma
Fever, cough, sputum. Crackles, decreased breath sounds, dullness to percussion, +egophony, pectoriloquy. CXR – infiltrates or consolidation Pneumonia
>35yo with PNA. Rusty colored or yellow-green sputum. Acute onset F/C Strep. Pneumonia
<35 yo, college students. Fever, cough, +/- sputum, chills, muscle aches Mycoplasma pneumonia
Bullous myringitis Mycoplasma pneumonia
PNA w/ Smokers, COPD H. influenza
PNA w/ DM, immunocompromised, EtOH. Currant color sputum. Klebsiella
PNA w/ Water, late summer, construction site. Diarrhea. Toxic looking Legionella
PNA from Nursing homes, chronic care facility. Purulent sputum Staphylococcus aureus
PNA & HIV+, AIDS, Immunocompromised. Sx out of proportion to exam. Diffuse interstitial & alveolar infiltrates Pneumocystis jerovecii; TMP-SMX = Drug of choice
PNA & decreased mental status, poor dental hygiene, dentures, foul smelling sputum, bronchiectasis. Patchy infiltrates in dependant lung zones Aspiration PNA
Pediatric with Hx recurrent lung infections, pancreatitis, reproductive problems, FTT Cystic fibrosis (Staph & Pseudomonal infections usually cause of death)
Sweat chloride test Cystic fibrosis
Cystic fibrosis w/ PNA Pseudomonas aueroginosa causative agent
< 2 days post-op with fever Atelectasis
Stab wound, hyperresonance to percussion, decreased breath sounds, tympany Pneumothorax
Stqb wound, dullness to percussion, decreased breath sounds. Hemothorax
Tall, skinny, male, band student, acute onset one-sided chest pain, dyspnea Spontaneous PTX
Stab wound to chest. Hypotension, tracheal shift Tension PTX
Poor sleeping, obese, daytime fatigue & drowsy, snoring, HTN, PM wakening Obstructive sleep apnea
s/p thoracic trauma. Multiple rib fractures. Chest wall moves in with inspiration, out with expiration. Flail chest (pain control, incentive spirometry, pulmonary toilet, intubation)
Fat, forty, female, fertile w/ RUQ pain Cholelithiasis or Cholecystitis
Fever, RUQ pain, radiation to back Cholecystitis
Elevated Alkaline phosphatase, urinary bilirubin Cholecystitis
F, RUQ pain, Jaundice, gallstones & dilated common duct on US Ascending cholangitis (Charcot’s triad)
Hx IBD, progressive RUQ pain, wt loss, F, jaundice & pruritis. Elevated bilrubin & alkaline phosphate. ERCP with bile duct stenosis, dilatation Primary sclerosing cholangitis (diffuse intra- and extrahepatic duct sclerosing and dilatation)
Elevated AST, ALT, indirect bilirubin Hepatitis
Isolated elevated indirect bilirubin Gilbert’s syndrome
Elevated indirect bilirubin w/ defective glucuronyl transferase Crigler-Najjar Dz
Photosensitivity, abd pain w/ neurologic dysfunction, erythema or skin fragility Porphyria
H.pylori gastritis 2antibiotics & PPI
Chronic cough, bitter taste in mouth or throat, dyspepsia GERD
Multiple or constant GI ulcer pain despite medications Zollinger-Ellison Syndrome
N/V, epigastric abdominal pain, worse supine, caused by alcohol ingestion, or following fatty meals Acute pancreatitis
Peri-umbilical or flank ecchymosis Acute pancreatitis (Cullen & Grey Turner’s Sign)
Abdominal distension, bloating, intermittent, colicky pain, high-pitched rushes & tinkles SBO
Air fluid levels on upright abd plain film SBO
Air under diaphragm, rigid board-like abdomen Perforated viscus, perforated ulcer
>60yo F, LLQ pain Diverticulitis. IV Abx, fluids, NPO.
Elderly, Hx atherosclerosis. Dull crampy periumbilical pain post-prandial Mesenteric ischemia
Neonate w/ projectile vomiting. Olive sized mass. Pyloric stenosis
Choking, cyanosis, respiratory distress, increased secretions in 1st hours of life Tracheoesophageal fistula
Painless rectal bleeding in pediatrics Meckel’s diverticulum
Alcoholic with massive hemoptysis Esophageal varicies (Tx w/ octreotide)
Female with recurrent abdominal pain, alternating diarrhea, constipation. Pain relieved with defecation. IBS. TCA’s (nortriptyline) good if diarrhea predominant symptom
Bloody Diarrhea Ulcerative colitis
Supraclavicular LAD (L > R) Virchow’s node – metastatic abdominal cancer
Hard periumbilical nodule Sister mary Joseph nodule = indicates metastatic gastric and pancreatic cancers
PUD, Pernicious anemia (Type A Gastritis), H. pylori Gastric Ca
Apple core lesion Colon Cancer
Elderly with positive hemmocult. Colon Cancer – get colonoscopy
CEA Colon Carcinoma
Family history of young age colon cancer, multiple polyps found on colonoscopy Familial adenomatous polyposis (Gardner’s syndrome)
AFP Hepatocellular carcinoma, testicular seminoma (germ cell tumor)
CA 19-9 Pancreatic Ca
CA-125 Ovarian Carcinoma
Chemotherapy induced N Treat with Ondansetron (Zofran) (5-HT3 blockers)
Traveler’s Diarrhea E. coli is cause. Hydration & Cipro to treat
Greasy, foul smelling, floating stools. Pear-shaped flagellated protozoan w/ 2 “eyes”. Water, travel, camping history Giardia
Afebrile, watery or loose stool. No blood or mucus Viral Gastroenteritis
Abdominal pain, diarrhea after picnic/party. Eaten ham, cream, custards, mayonnaise Staphylococcus aureus infectious diarrhea
Acute bacterial diarrhea w/ prodrome of HA, F, then crampy abd pain & diarrhea Campylobacter jejuni – most common cause of acute bacterial diarrhea
Painless rectal bleeding. Bulging perianal mass w/ straining Internal hemorrhoids
Pediatric with perianal pruritis esp. at PM. Positive cellophane tape test Pruritis ani – Pinworms (enterobiasis). Tx is Mebendazole
Weight loss, recurrent greasy stools (steatorrhea) mixed with diarrhea after certain foods Celiac Sprue
Anti-endomysial antibodies Celiac Sprue
Beriberi Thiamine; Alcoholics, Neuro Sx
Pellagra Niacin (4D’s dermatitis, diarrhea, dementia, death), bright red tongue
Scurvy Vit C (easy bleeding, bruising, hair & tooth loss, joint pain & swelling)
Rickets Vit D (Osteomalacia)
Night blindness Vit A deficiency
Magenta tongue Riboflavin deficiency (B2)
s/p gastric bypass surgery or gastric surgery. N, abd cramping, dizziness after eating. No masses, bleeding Dumping syndrome
Diabetic w/ anorexia, anemia, wt loss, pallor CRF
Gastroparesis, impotence, recurrent infections, stocking-glove paresthesia Diabetic neuropathy (Treat w/ TCA (amitriptyline)
Hypoglycemia despite glucose administration. Increased C-peptide Insulinoma
Hypoglycemia in alcoholic Give Thiamine before glucose to prevent Wernicke’s encephalopathy
Decreased radioactive iodine uptake, decreased free T4, increased TSH Hashimoto’s thyroiditis
Female, weight loss, palpitations, atrial fibrillation Hyperthyroid (work it up with TSH, T4)
Exopthalmos, palpitations, wt. loss. Elevated radioactive idodine uptake Hyperthyroid, Graves Dx – Tx w/ Radioactive iodine
Post thyroidectomy – most likely injury Recurrent laryngeal nerve = hoarseness
Post thyroidectomy – electrolyte watch Hypocalcemia
Infant w/ round face, large protruding tongue, dry skin, umbilical hernia, constipation, enlarged abdomen, poor feeding, delayed developmental milestones Congenital Hypothyroidism
Recurrent HA, HTN not responding to meds, sweating, Attacks of severe HA, HTN, glucosuria, Urinary catecholamines, urinary metanephrines Pheochromocytoma – Tx pre-op w/ alpha blocker
HTN not responsive to meds Renal artery stenosis (Infrarenal artery)
HTN w/ hypernatremia, hypokalemia Primary Aldosteronism
Wt. gain, edema, coarse dry skin, hair, menorrhagia, cold intolerance, hx transphenoidal surgery & radiation Hypothyroidism
Tetany, hypocalcemia, cataracts Hypoparathyroidism
Exogenous corticosteroid use Cushing syndrome
Dexamethasone suppression test Cushing syndrome
Central obesity, abdominal stria, hyperglycemia, moon facies, buffalo hump, easy bruising Cushing syndrome
Acute steroid withdrawal Addison’s disease, crisis
Hyperpigmentation, hypoglycemia, orthostatic hypotension, hypotension not responsive to fluids, hypotension following an illness, trauma, or surgery Addison’s disease, crisis (Low aldosterone; get Random or AM cortisol, ACTH stimulation test)
Worsening fatigue, wt loss, weakness, recurrent abdominal pain, hair loss, hyperpigmentation. Hyponatremia, hyperkalemia Addison’s disease, crisis (Low aldosterone; get Random or AM cortisol, ACTH stimulation test)
Hyponatremia, hyperkalemia Acute adrenal insufficiency (Addison’s crisis)
Polyuria, polydipsia. Dilute urine, Hypernatremia Diabetes insipidus
Concentrated urine. Hyponatremia SIADH
45,X – low hairline, low set ears, webbed neck, short stature; shield chest, wide set nipples, infertility, lack of Secondary sex characteristics Turners (gonadal dysgenesis
XXY ♂ - short stature, ↓ intelligence; small firm testes, gynecomastia, abn arm-body length Klinefelters (hypogonadism)
Description Diagnosis Associated
Hyaline Casts Normal (may be present after febrile illness, strenuous exercise)
Increased BUN/Cr, low FeNa Prerenal Failure (Azotemia)
Irritative voiding symptoms, Fever, chills, CVA tenderness Pyelonephritis
Crush injury, alcoholic on ground, elevated CPK, ARF Rhabdomyolysis
Painless hematuria, flank pain or mass Renal cell Carcinoma
Oliguria, hematuria, proteinuria following streptococcal infection Acute glomeruloneprhitis
Hematuria, purpuric rash following streptococcal infection Glomerulonephritis, HSP
Hematuria, RBC casts, proteinuria Glomerulonephritis
Kidney & lung bleeding (hematuria, hemoptysis) Goodpasteures
Fibrous band on lateral penis Peyronie’s disease
Can’t retract foreskin Phimosis
Inflammation of glans Balanitis
< 40 yo male with Fever, perineal pain, dysuria. Acute prostatitis caused by Chlamydia & N. gonorrhea. Treat accordingly (Bactrim #2 choice). > 40yo think e. coli is cause (Tx w/ FQ)
>50 yo obstructive voiding sx, nocturia. Firm smooth enlarged prostate. Nl PSA BPH. (Cancer would have firm, irregular, nodular non-tender prostate, elevated PSA)
Incontinence with straining Stress
Peaked T-waves HyperKalemia
U waves HypoKalemia
QT prolongation Hypocalemia
Recurrent kidney stones, elevated Calcium, decreased phosphorus Hyperparathyroidism
Hearing loss or tinnitus w/ metabolic acidosis Aspirin OD
Head trauma, disoriented – lucent – coma Epidural Hematoma
Lens shaped hemorrhage Epidural Hematoma
Concave Subdural Hematoma
LP w/ decreased glucose, increased protein Bacterial meningitis
LP w/ decreased protein, very few neutrophils syphilitic meningitis
Meningitis and rash Meningiococcal
Meningitis & <2mo Grp B Strep, E. coli (Tx < 1yo = Vanco + Rocephin)
Meningitis < 4yo H. inlu, Grp B strep, N. meningititis
Meningitis > 2yo, adults Strep, N. meningititis
Viral Meningitis Mumps
Unilateral facial weakness w/ inability to close eye Bell’s palsy (self-limiting)
Adolescent female w/ HA. +FHx. Severe HA, N/V, photphobia. +/- auras Migraine HA
Male, recurrent relapsing HA. Worsened w/ EtOH, Lacrimation, salivation, rhinorrhea Cluster HA
Sudden onset thunderclap HA, “worse HA of my life” Subarachnoid hemorrhage
>50 yo female w/ HA. Temporal artery tenderness or blindness Temporal arteritis (Giant cell arteritis). Elevated ESR, get temporal artery biopsy
Recurrent episodes of vision change, diplopia, weakness & tingling in extremities that resolve MS
myelin fragments, ↑ IgG, oligoclonal bands (Pathognomonic); Lhermitte’s sign = electrical sensation down body w/ neck flexion MS
HA worse in AM w/ focal neuro deficits Brain Tumor (MC is glioma)
s/p Fall w/ bilateral LE weakness, urinary and rectal incontinence, decreased rectal tone Cauda equine syndrome = neurosurgical consult
Ascending paralysis GBS
Paralysis after Campylobacter enteritis GBS
Weakness and fatigue in upper limbs, blurry vision, diplopia, respiratory distress Myasthenia gravis
Young kid with difficulty standing from seated position. Calf muscle wasting Muscular dystrophy (weakness begins at pelvic girdle)
Pediatric with fever or Hx URI with encephalopathy, emesis, hyperactive reflexes, hepatomegaly, elevated liver enzymes Reye’s syndrome from URI/post-flu or aspirin use
Pediatric with episodes of blank stares Absence (petit-mal) seizures.
3 mHz spikes on EEG Absence (petit-mal) seizures.
“Ash leaf” hypopigmentation of trunk & Ext, shagreen patch, sebaceous adenomas, seizures, mental retardation; Ass. w/ PCK, renal hemartomas Tuberous sclerosis
< 70 yo blindness DM retinopathy (MCC)
> 70 yo blindness Macular degeneration
Afferent papillary defect, marcus-gunn pupils Optic nerve lesion. Tertiary syphilis (marcus-gunn)
Bilateral pinpoint pupils Pontine hemorrhage
Bilateral DILATED pu;ils Anticholinergics, TCA, anti-parkinsonian drugs, profound hypoxemia
Bilateral hemianopia Optic chiasm lesion
Loss of central vision Ipsilateral optic nerve lesion
Superior contralateral quadrantopia Temporal optic radiation
Temporal field loss Ipsilateral optic tract lesion
Eye trauma, diplopia. Exophthalmos, fixed upward gaze, hyphema Orbital blow-out fracture; Immediate ophthalmology referral
Painless, nontender nodule on upper or lower eyelid Chalazion
Painful swelling of upper or lower eyelid Hordeolum
Painless, yellow triangular nodule on conjunctivia Pinguecula (more common on nasal side)
Curtain or veil over my eyes, new onset floaters Retinal detachment
Transient monocular vision loss Amaurosis fugax – TIA, emboli
Painless vision loss. History of TIA, palpitations, arrhythmia, carotid disease, embolic source CRAO (pale retina, cherry red macula)
Painless vision loss. History of HTN CRVO (blood & Thunder, retinal hemorrhages)
Vision loss over hours to days, painful EOM Optic Neuritis (assoc. w/ MS)
Recurrent episodes of vision change, diplopia that resolve MS
Red eye, watery discharge, preauricular LAD Viral conjunctivitis
Red eye, copious purulent discharge Gonococcal conjunctivitis
Red eye, hyperemia, chemosis, nodular conjunctivia Allergic conjunctivitis
Acute Painful red eye, halos (or colored rings around lights), hazy, steamy cornea. Pupil is fixed and (mid) dilated. Onset after being in dark room Acute angle-closure glaucoma
Diplopia, dysarthria, dysphagia Vertibrobasilar insufficiency
Unilateral foul smelling or purulent nasal discharge in a pediatric patient Nasal Foreign body
HA, sinus pressure, yellow – green nasal discharge Sinusitis – CT is gold standard
Sneezing, clear rhinorrhea, post-nasal drip, nasal congestion seasonal occurance Allergic rhinitis. Nedocromil effective Tx.
Pale, edematous, boggy turbinates Allergic rhinitis
Bullous myringitis Mycoplasma pneumonia
Otitis media Strep. Pneumonia, H. influenza, strep. Pyogenes, moraxella catarhallis
Swimmer with ear pain, discharge Otitis externa
Diabetic, ear pain MOE, Pseudomonas, IV abx (FQ), CT head
Tinnitus and metabolic acidosis Salicylate Ingestion
Sudden dizzy, vertigo, hearing loss, tinnitus Meniere’s disease; Treat w/ diuretics & low-sodium diet
Dix-hallpike maneuver BPPV
Sudden vertigo with changes in head position BPPV
Sudden dizzy, N, V. NO tinnitus, hearing loss. Recent URI Vestibular neuronitis, labrynthitis
Unilateral nerve deafness in middle age Pt Acoustic neuroma (order MRI)
Sensorineural loss > 50yo Presbyacussis (Hi freq sounds 1st to go)
Vertical Nystagmus, insidious onset vertigo Central lesion (tumor)
Horizontal Nystagmus, acute onset vertigo Peripheral lesion
Smoker, white mouth lesion cannot be rubbed off Leukoplakia, rule out oral cancer
Gray pharyngeal pseudomembrane, rash, splenomegaly, supraclavicular LAD Diphtheria
College student with sore throat. Enlarged tonsils, anterior cervical LAD. Splenomegaly. CBC – elevated atypical lymphoctyes EBV - mononucleosis
Philadelphia chromosome CML
Auer rods AML
Reed-sternberg cells Hodgkin’s lymphoma
Painless LAD (us. Neck or axilla), LAD in orderly fashion; “B” signs + pruritis; splenomegaly; LN pain after drinking alcohol Hodgkin’s lymphoma
Fatigue, PM sweats, weight loss, painless LAD or neck mass Lymphoma – do Lymph node biopsy. Bone marrow Bx and CT scan used for staging
Painless LAD us. Scattered. “B” signs Non-Hodgkin’s lymphoma
Hx HTN, nephrotic syndrome, CRF or Renal insufficiency. Know CBC. Anemia
PICA, Pregnant & fatigue, Menstruation. Cheilosis Fe Deficiency Anemia
Anemia after colectomy, partial gastrectomy. Glossitis, decreased vibratory sensation B12 or Pernicious anemia
G6PD + Quinidine, Nitrofurantoin, Sulfa Hemolytic anemia
Fatigue, weakness, low fever, purpura, pallor, gingival bleeding. No HSM Aplastic anemia
Elevated Hgb, Hct, splenomegaly, post showering pruritis, plethora, engorged retinal veins Polycythemia vera; Tx = Phlebotomy
Splenectomy Pneumococcal vaccine
Sickle cell Autosomal Recessive, pain in extremities after exercise, priaprism
Spontaneous Hemarthrosis Hemophilia A
Mucosal or gingival bleeding, epistaxix, menorrhagia Von Willebrand disease
Continuous bleeding post-op or trauma. Given multiple blood transfusions. Low platelets, increased PT, INR, + fibrin split products (increased d-dimer) DIC
MRSA “spider bite” appearing lesion that turns into abscess. Tx w/ Vanco +/- rifampin, gentamicin, linezolid
Clear vulvar vesicles, inguinal LAD Herpes virus (Genital)
Giant Multinucleated cells Herpes virus (Genital)
Tzank Smear Herpes virus (Genital)
Acetowhitening Condyloa acuminata
Wood’s light fluoroscopy Dermatophytes infections, Erythrasma (coral red)
Bite w/ fever, lacrimation, rhinorrhea, bradycardia, HTN, tachyarrhythmias Black widow (neurotoxin)
Bite with local edema, erythema, central necrosis Brown recluse
Woods, forest, hikers. Macular rash at wrist, ankles then moves up extremities then trunk. After 5 days rash at palms & soles RMSF (Rickettsia rickettsia)
Indirect immunofluorescent Ab, Weil-Felix rxn, complement RMSF (Rickettsia rickettsia)
Target lesion, arthralgia, Bell’s Palsy Lyme Dz (Borrelia Burgdorfi)
Intense pruritis esp. PM. Burrow like lesions at wrists, elbows, hands, webs of fingers Scabies
Raccoons, bats, skunks Rabies; give Ig, Rabies vaccine if animal is not caught and tested
Gangrene Clostridium infection – an anaerobic bacteria. Tx w/ hyperbaric oxygen, Penicillins, surgical excision
Gram negative intracellular diplococcic Gonorrhea
Sexually active, multiple or new partner, urethral discharge, Gram negative intracellular diplococci Gonorrhea
Red cervix w/ mucopurulent discharge in sexually active female Chlamydia
FTA-ABS, MTA-TP Syphilis diagnosis
Malaria prophylaxis Chloroquine
Shoulder pain after repetitive activity, point tenderness at anterior humerus or AC joint. + drop arm test or apprehension test Rotator cuff injury (SITS muscles)
Football player with burning pain, numbness, tingling from shoulder to hand which resolves Brachial plexus neurapraxia, “stinger”. Caused by stretching of brachial plexus
FOOSH, Radial fracture w/ dorsal displacement, dinner-fork deformity Colle’s Fx; Tx = volar splint
Typing, secretary wrist pain and numb/tingling from wrist to hand. New mothers, pregnant may worsen Carpal Tunnel syndrome
Pain at base of thumb, distal radial styloid. Pain reproduced with ulnar deviation of clenched fist. deQuervain’s tenosynovitis
Hand injury after a punch Boxer’s fracture. Ulnar gutter w/ intrinsic plus positioning. ORIF if angulation > 40 degress
Female exam, asymmetric posterior chest wall or uneven scapula height with forward bending Scoliosis (> 25 degree Cobb angle = surgery)
Tibial pain after running (military recruits), athletic activity (running sports) Shin splints, stress fracture. Get bone scan if negative x-ray
Knee injury during football game ACL (look for description of lachman or drawer test)
8 – 10yo male with limp, knee pain Legg-Calve-Perthes Disease
12 – 15yo overweight male knee pain, limp, hip pain (knee XR normal) SCFE
Adolescent male with knee pain, tenderness over tibial tuberosity Osgood-schlatter disease
Retropatellar knee pain esp. in females Patellorfemoral pain syndrome – increased Q angle, strengthen quadriceps
Pain on plantar foot 2 – 3rd metatarsal. Associated w/ tight shoes, relieved by removing shoes. Palpable painful mass
Pain after tx of fracture w/ cast Compartment syndrome
HLA-B27 Ankylosing spondylitis, Reiter’s syndrome
Acute joint pain. Swollen, warm, erythema. Septic arthritis (synovial fluid = leukocytosis, low glucose)
Large joint pain. Knees w/ medial joint space narrowing, osteophytes. No erythema or warmth. Osteoarthritis. Acetaminophen #1 choice
Enlarged PID, DIP Osteoarthritis (herberden – PIP; bouchard – DIP)
Female morning joint pain & stiffness esp. hand/wrists. MCP joint swelling, ulnar deviation Rheumatoid arthritis. Methotrexate (DMARDs) #1.
Acute swollen big toe Gout
Proximal symmetric muscle pain & stiffness esp. shoulder, neck, pelvic girdle Polymyalgia rheumatica
Male w/ low back pain, stiffness. Pain worse wakening, improve during day. Decreased ROM at spine. Plain films show sacroiliac abnormality. HLA-B27 positive Ankylosing spondylitis; Tx = NSAIDs (Indomethacin)
Conjunctivitis, iritis, arthritis, cervicitis, urethritis Reiter’s syndrome
Erythema nodosum Systemic autoimmune diseases (RA, IBD), OCP
Female with Arthralgias, malar rash, +ANA, + anti-double stranded DNA antibodies, +anti-phospholipid antibodies SLE
dusky red, well localized single or multiple papules or plaques usually of face Discoid lupus
Female, fatigue, general aching, pain at neck, upper shoulders, sleeping problems, tender points Fibromyalgia (exercise program good management)
Cold induced pain at extremities with color change as they warm up Raynaud’s phenomenon
Osteomyelitis after stepping on nail wearing sandals or tennis shoes Pseudomonas aeruginosa (foam padding in shoes)
Teenage female with long bone pain without trauma or injury. XR w/ lytic mass, multi-laminated periosteal reaction Ewing sarcoma – periosteal “onion skin” reaction
Painless bony mass. Plain films = stalky or broad-based projection from bone surface Osteochondroma
Lytic lesions in the back or skull Multiple myeloma
Description Diagnosis Associated
Deterioration of cognitive function, memory Dementia
Rapid onset of cognitive symptoms, mental status fluctuations, anxiety, irritability Delerium
Paplitations, tremors, hyperventilation or respiratory alkalosis, numb or tingling mouth or extremities Anxiety
Feelings of worthlessness, hopelessness, apathy, weight loss, insomnia, daytime sleepiness. Thoughts of suicide Depression (SSRI = drug of choice)
Raw red hands, chafed. Obsessive compulsive disorder
Binge eating, laxative use, starvation Bulimia nervosa (Tx w/ SSRI – Fluoxetine)
Bulimia with electrolyte disorders Hypokalemia, metabolic alkalosis
Antipsychotic meds (phenotiazines), facial tics, lip smacking, tongue disorders, blinking, ataxia Tardive dyskinesia
Pt on antipsychotic meds develops altered consciousness, lead-pipe rigidity, diaphoresis, catatonia. Hyperthermia, tachypnea, blood pressure changes. Neuroleptic malignant syndrome. Tx supportive care & antipyretics
Extrapyradimidal signs, BP changes, altered consciousness, hyperpyrexia, muscle rigidity, dysarthria, CV instability, fever, pulmonary congestion, diaphoresis. Pt on antipsychotic meds Neuroleptic malignant syndrome. Tx supportive care & antipyretics
Infrequent blinking, tremor, rigidity, bradykinesia, shuffling gait, masked facies Parkinson’s
Short lived, intense relationships. Difficulty controlling anger esp. when feeling abandoned. Hx sexual promiscuity and substance abuse. Borderline personality disorder
Periods of excessive drinking, buying, spending Manic phase of bipolar disorder
Male w/ gynecomastia, diminished or delayed secondary sex characteristics, small firm testicles, long arms & legs (eunechoid body habitus) Klinefelter Syndrome XXY. Low serum testosterone & infertility.
Hyponatremia w/ bizarre behavior. Lithium toxicity
Antidepressant use w/ anticholinergic side effects, dry mouth, dysrhythmias, sedation, orthostatic hypotension TCA overdose
Frothy, clear – white or yellow-green to gray adherent vaginal discharge, dysuria, vaginal pruritis. Vulvar and cervical erythema. Flagellated protozoa Trichomonas
Fishy odor, Thin grayish vaginal discharge, Clue cells Bacterial vaginitis; Gardnerella vaginalis
Thick white vaginal discharge, hyphae & buds on KOH prep Candida
Postmenopausal, dyspareunia, thin vaginal discharge, atrophic vulvar changes, vaginal petechiae Atrophic vaginitis; Tx = topical estrogen
Secondary amenorrhea Pregnancy
Female with acute abdominal pain. No characteristic acute abdomen pattern Ectopic pregnancy
20yo female w/ rubbery, firm, well-circumscribed, non-tender breast lesion, doesn’t change w/ cycle Fibroadenoma
30 – 50yo female, painful, multiple, bilateral breast masses that increase in pain and size before menses Fibrocystic breast disease
Spontaneous bloody, serous, or cloudy nipple discharge Intraductal papilloma
Breast mass, nipple retraction, bloody nipple discharge Breast cancer (mass is most common presenting clinical manifestation)
Overweight, irregular menstrual cycles (poss. Amenorrhea), elevated blood sugar, hirsutism PCOS (stein-leventhal syndrome)
Adolescent female with midcycle pain alternating from left to right side. Relieved w/ NSAIDs Mittelschmerz
Dysmenorrhea, dyspareunia, dyschezia. Uterus is fixed, retroflexed. Cyclic pelvic pain. May have palpable pelvic mass Endometriosis. Palpable pelvic mass – “chocolate cyst”
Firm irregular shaped, NONTENDER enlarged uterus Leiomyoma
Softened, tender, diffusely globular uterine enlargement Adenomyosis
6cm unilateral, mobile, tender adnexal mass Tubo-ovarian abscess
Pregnant Nagel’s rule: LMP + 7 – 3 mo
Pregnant + rash, post-auricular or occipital LAD Rubella. Give vaccine AFTER delivery
Pregnant, HA, visual disturbance Pre-eclampsia
Pregnant, seizures Eclampsia
Pregnant < 20 wks gestation w/ vaginal bleeding, abd & pelvic pain. Blood from closed cervical os. Threatened abortion
Pregnant < 20 wks gestation w/ vaginal bleeding, abd & pelvic pain. Tissue at or said to be passed from open cervical os. Incomplete abortion (complete abortion will have empty uterus, complete passage of fetal tissue, pain resolves after passage of tissue)
Pregnant who drinks during pregnancy and inadequate peri-natal care Fetal alcohol syndrome – low birth weight
Postpartum hemorrhage Uterine Atony. Tx = uterine massage
Postmenopausal vaginal bleeding Endometrial Ca – do endometrial biopsy
Postmenopausal adnexal mass Ovarian Ca
Procainamide, hydralazine & rash Lupus-type eruptions
Photosensitive rash TCN, Sulfa drugs
Wood’s light Coral red = Erythrasma
KOH Fungus, Candida; Hyphae & buds, spaghetti & meatballs
Gram stain Bacterial infections
Beefy red, sharp bordered rash in groin (infants), under breast folds with satellite lesions Candida: Tx: Nystatin/Lotrimin cream QID x14d; if fails Ketoconazole
Warm, erythematous, tender skin with possible induration or fluctuance Cellulitis
Red, less distinct borders. Coral red fluorescence under Wood’s lamp Erythrasma
Distinct, sharp raised demarcated border with fever, chills. Group A Strep Erysipelas
Grouped vesicles on erythematous base Herpes virus
Infant or pediatric w/ grouped vesicles on thumb or “tapioca” vesicles on thumb Herpetic whitlow
Pain preceding vesicular rash in dermatomal pattern Herpes Zoster (if involved eye = herpes keratitis. NO steroids. Get immediate ophthalmology referral)
Hx URI the palpable purpuric rash to buttocks, posterior thighs HSP (Hx post Strep A infection)
Honey colored crusts on erythematous base around nose & mouth Impetigo. Tx = Mupirocin
Small white papules on diffusely red base on buccal mucosa Koplick spots – Rubeola (Measles). Spots occur before rash
Cough, coryza, conjunctivitis Rubeola (Measles)
Pastia’s lines, positive ASO titer Scarlet fever (Grp A Strep)
Strawberry tongue Scarlet fever (Grp A Strep)
Pruritic raised erythematous plaques Urticaria
Dewdrops on rose petal, pustules & vesicles at different stages of healing Varicella (Chicken Pox)
Flesh-colored, pink or yellow-brown lesion with rough, sandpaper feel, at sun-exposed areas Actinic Keratosis
Non-pruritic, raised, warty brown-black plaques, stuck onto skin feel greasy Seborrheic keratosis
Flat brown spots with sharp borders on dorsum of hand Lentigines
Erythematous, dome-shaped nodule with central plug Keratoacanthoma
Raised pearly-borders, telangiectasia, central ulcer Basal cell Ca
Pearly papule with umbilicated center Molluscum contagiosum
Sexually active person w/ rash on palms & soles, general LAD Secondary syphilis (Money spots); VDRL will confirm
Scabies & Pediatrics NO LINDANE (KWELL). Permethrin (Elimite) is drug of choice
Christmas tree pattern, erythematous papules w/ oval plaues w/ scaly itchy border. Rash preceded by lagre oval plaque w/ central clearing & scaly border Pityriasis rosea; Herald patch
Hypopigmented lesions, white, scaly. Gets worse w/ tanning or sun exposure Pityriasis Alba
Erythematic ring with scaly border & central clearing Tinea (fungal infection); KOH prep = hyphae
spaghetti & meatballs Tinea (fungal infection
Thick, yellow, brittle nails Onychomycosis. Tx = PO Terbinafine
Infant w/ erythematous, scaly crusty lesions at vertex of scalp Cradle cap – seborrheic dermatitis (Tx in infants w/ baby shampoo, warm olive oil compress, mild Hydrocortisone cream; Adults – selenium sulfide shampoo)
Children < 10yo w/ vesicles on pharynx, mouth, hands, feet w/ NO ulceration Hand-Foot-Mouth disease. Coxksackie Virus
Healthy looking < 5yo with lace-like rash on both cheeks – red papules Erythema infectiosum “Slapped cheek”, “5th Dz”.
Pediatric with high fever then after fever macular rash over trunk and neck. (rash after defervesence) Roseola infantum (Herpesvirus); Motrin, symptomatic treatment
Truncal Rash in pediatric after fever Roseola infantum (Herpesvirus); Motrin, symptomatic treatment
Fever, pharyngitis, “sandpaper” rash over face, neck, trunk, extremities Scarlet Fever
High fever (up to 105oF) x 5 days then rash. May have conjunctivitis, cracking, lip fissures Kawasaki’s Disease; look for cardiac complications (myocarditis, pericarditis, arteritis, aneurysms)
Erythema marginatum Rheumatic Fever
Silvery scaling plaques on extensor sensors. Ausptiz sign, Koebner’s phenomena Psoriasis
Rat bite erosions on XR Psoriatic arthritis
Dark skinned person with “whitening or lightening” of skin. Hx pernicious anemia or other autoimmune disease Vitilligo. Skin biopsy to diagnose
Introduce solid foods (cereal, fruits) 4 – 6 mo; after 6 mo add meat, eggs, starchy foods
1st tooth (central incisor) 6 – 8 mo
Walks alone 15 mo
3 words, fees self w/ spoon, builds tower 24 mo
< 2mo fever Septic w/u - blood Cx, LP
< 5yo fever, seizures Febrile seizure
Premature birth, fetal maturity Give corticosteroids
Meconium-stained amniotic fluids Fetal distress
Positive osmotic fragility test G6PD deficiency (hemolytic anemia w/ oxidative drugs – sulfa, nitrofurantoin, quinidine)
Mousy urine PKU
Vit D – Rickets X-linked dominant
Hemophilia A, Duchennes MD X-linked Recessive
Neurofibromatosis Autosomal dominant
Sickle cell, CF, PKU Autosomal Recessive
Created by: ges13