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PANCE Word Assoc.
| Question | Answer |
|---|---|
| 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 |
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