PANCE Word Assoc.
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| DOE, PND, edema. Echo w/ LVH or RVH, hypokinesis | CHF
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| S3 | CHF, dilagted cardiomyopathy
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| High output heart failure | Pregnancy, thyrotoxicosis, anemia, beriberi, paget’s disease
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| Low output heart failure | Ischemic heart disease, HTN, dilated CM, valve disease, arrhythmia
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| Heart failure after URI | Myocarditis
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| Young athlete with syncope during athletic event or practice. No physical exam abnormalities | Hypertrophic CM or fatal arrhythmia. Get EKG or Echo
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| Alcoholic with DOE, heart failure | Primary dilated CM
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| Alcoholic with palpitations, arrhythmia | Atrial fibrillation (Holiday heart)
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| Irregular irregular | Atrial fibrillation; (if > 48 or chronic – anticoagulate)
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| Atrial fibrillation or prosthetic valve | Warfarin (2 – 3 for Afib; 2.5 – 3.5 for valve); Tx Warfarin OD is vitamin K
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| Hx angina but no acute sx. EKG no acute changes. | Do Exercise stress test
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| 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
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| Constant, sharp CP worse lying down, better sitting up and leaning forward | Pericarditis
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| pulsus paradoxus | Pericardial effusion/tamponade, pericarditis, asthma attack, tension PTX, SVC obstruction
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| Electrical alternans, narrow pulse pressure, pulsus paradoxus | Pericardial effusion/tamponade
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| JVD, Hypotension, muffled heart sounds | Pericardial effusion/tamponade (Beck’s triad)
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| Pericarditis post open heart surgery | Dressler’s syndrome. Tx w/ ASA #1. Indomethacin or other NSAID OK.
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| Sudden onset ripping, tearing chest pain, diminished pulses | Aortic dissection
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| Flank pain, hypotension, pulsatile abdominal mass | AAA
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| EKG changes, N, V, yellow-green visual disturbances | Digoxin toxicity (Hypokalemia will make worse)
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| Hx CHF on diuretic & digoxin | Suspect dig toxicity (hypokalemia from diuretic = dig toxicity)
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| Grossly elevated blood pressure esp. w/ signs of EOD | Malignant or Urgent HTN
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| HTN Tx w/ meds, cough or angioedema | ACEI is cause
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| DM & HTN | ACEI is best choice
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| Heart failure, LVH | ACEI (improves survival, prevents development of heart failure Sx)
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| Post MI | Beta-blockers
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| Tx of HTN w/ alpha-blocker | SE is postural Hypotension
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| HTN not responsive to basic meds | Think secondary HTN most likely Renal artery stenosis (infrarenal artery).
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| Mechanical valve or prosthesis & Dental, GU, GI, or ortho procedure prophylaxis | Bacterial endocarditis (strep. Viridians) prevention
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| IVDA w/ new murmur | Bacterial endocarditis (strep. Viridians)
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| Elderly w/ systolic murmur | Aortic stenosis (due to calcifications – age related (or bicuspid valve - congenital)
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| Diamond shaped, blowing systolic murmur. May have angina, syncope, CHF | Aortic stenosis
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| 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)
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| Diastolic murmur best heart at apex without radiation | Mitral stenosis (ARMS are BAD)
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| Systolic ejection murmur heard best at base with radiation to left clavicle | Pulmonary stenosis
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| Female or Post MI, systolic murmur best | apex preceded by click without radiation
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| Systolic murmur heard best at apex with radiation to left axilla (apical systolic) | Mitral regurgitation
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| New murmur after MI (esp. if apical systolic) | Mitral regurgitation (caused by papillary muscle rupture)
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| Murmur & Hx rheumatic heart disease | Mitral stenosis #1, Tricuspid Stenosis #2
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| Continuous harsh, machine-like murmur | PDA
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| Cyanotic infant with systolic thrill | LSB, systolic ejection murmur +/- click
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| Holosystolic murmur | LSB, may have ventricular hypertrophy
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| Infant w/ dyspnea, difficulty feeding. Holosystolic murmur | LSB, 3rd ICS. LVH & RVH
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| Peds w/ leg pain after physical activity, abnormal heart sounds, unequal UE & LE pulses, rib notching | Coarctation of aorta
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| Short PR, wide QRS, Delta wave | Wolf-parkinson-white; avoid Digoxin,
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| 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
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| 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)
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| Claudication with rest pain, (ABI < 0.4) | Tx is arterial bypass
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| LE pain after long periods of standing. Dilated, tortuous, veins | Varicose veins. Tx w/ compression stockings
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| Trendelenberg test of extremities | Tests for veinous insufficiency.
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| Blue extremities worse w/ cold exposure, improves w/ warming | Acrocyanosis
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| Description | Diagnosis Associated
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| Rapid, deep labored breathing | Kussmaul breathing – DKA, Metabolic acidosis
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| Deep breathing alternating w/ apnea | Cheyne-Stokes breathing – heart failure, brain damage
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| Cavitations on CXR | Infections – lung abscess, TB (Gohn focus)
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| Apical infiltrates, F, C, dry cough | TB
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| Pleural thickening on CXR | Mesothelioma
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| Hilar mass on CXR | Lung Ca
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| Eggshell pattern on CXR | Silicosis (Sandblasters)
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| Ground glass appearance on CXR | Asbestosis (shipbuilders, building demolition)
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| Reticular to nodular pattern on CXR | Coal Miner’s lung
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| Patchy fibrosis on CXR | Farmers lung
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| Granulomas and inflammation of alveoli, small bronchi and small blood vessels | Sarcoidosis
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| Dyspnea after surgery, travel (airplane), LE Fx. May have c/o calf pain also. | DVT/PE
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| Lung scan with perfusion defects | PE
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| Venous stasis, vessel wall injury, hypercoagulability | DVT/PE (Virchow’s triad)
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| Pediatric with barking cough, stridor | viral croup (laryngotracheobronchitis); Tx w/ racemic epi and glucocorticosteroids if stridor at rest.
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| Pediatric wheezing | lower respiratory FB, asthma
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| Drooling, sniffing position, tripod, toxic | Epiglottitis
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| Thumbprint sign | Epiglottitis
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| Steeple sign | FB, viral croup (laryngotracheobronchitis)
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| Inspiratory stridor | FB, viral croup (laryngotracheobronchitis)
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| Premature infant with respiratory distress | Hyaline Mb Disease
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| Preemie CXR w/ hypoexpansion (ATX), air bronchograms | Hyaline Mb Disease
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| Smoker, chronic productive cough. NO hemoptysis, wt. loss. | Brochitis (COPD)
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| Smoker, DOE, cough | COPD
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| Hyperinflation on CXR, tear drop heart | Emphysema
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| Wheezing, prolonged expiration | Asthma
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| Airway edema with eosinophils, neutrophils, lymphocytes | Asthma
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| Fever, cough, sputum. Crackles, decreased breath sounds, dullness to percussion, +egophony, pectoriloquy. CXR – infiltrates or consolidation | Pneumonia
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| >35yo with PNA. Rusty colored or yellow-green sputum. Acute onset F/C | Strep. Pneumonia
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| <35 yo, college students. Fever, cough, +/- sputum, chills, muscle aches | Mycoplasma pneumonia
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| Bullous myringitis | Mycoplasma pneumonia
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| PNA w/ Smokers, COPD | H. influenza
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| PNA w/ DM, immunocompromised, EtOH. Currant color sputum. | Klebsiella
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| PNA w/ Water, late summer, construction site. Diarrhea. Toxic looking | Legionella
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| PNA from Nursing homes, chronic care facility. Purulent sputum | Staphylococcus aureus
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| PNA & HIV+, AIDS, Immunocompromised. Sx out of proportion to exam. Diffuse interstitial & alveolar infiltrates | Pneumocystis jerovecii; TMP-SMX = Drug of choice
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| PNA & decreased mental status, poor dental hygiene, dentures, foul smelling sputum, bronchiectasis. Patchy infiltrates in dependant lung zones | Aspiration PNA
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| Pediatric with Hx recurrent lung infections, pancreatitis, reproductive problems, FTT | Cystic fibrosis (Staph & Pseudomonal infections usually cause of death)
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| Sweat chloride test | Cystic fibrosis
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| Cystic fibrosis w/ PNA | Pseudomonas aueroginosa causative agent
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| < 2 days post-op with fever | Atelectasis
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| Stab wound, hyperresonance to percussion, decreased breath sounds, tympany | Pneumothorax
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| Stqb wound, dullness to percussion, decreased breath sounds. | Hemothorax
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| Tall, skinny, male, band student, acute onset one-sided chest pain, dyspnea | Spontaneous PTX
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| Stab wound to chest. Hypotension, tracheal shift | Tension PTX
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| Poor sleeping, obese, daytime fatigue & drowsy, snoring, HTN, PM wakening | Obstructive sleep apnea
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| 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)
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| Fat, forty, female, fertile w/ RUQ pain | Cholelithiasis or Cholecystitis
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| Fever, RUQ pain, radiation to back | Cholecystitis
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| Elevated Alkaline phosphatase, urinary bilirubin | Cholecystitis
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| F, RUQ pain, Jaundice, gallstones & dilated common duct on US | Ascending cholangitis (Charcot’s triad)
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| 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)
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| Elevated AST, ALT, indirect bilirubin | Hepatitis
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| Isolated elevated indirect bilirubin | Gilbert’s syndrome
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| Elevated indirect bilirubin w/ defective glucuronyl transferase | Crigler-Najjar Dz
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| Photosensitivity, abd pain w/ neurologic dysfunction, erythema or skin fragility | Porphyria
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| H.pylori gastritis | 2antibiotics & PPI
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| Chronic cough, bitter taste in mouth or throat, dyspepsia | GERD
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| Multiple or constant GI ulcer pain despite medications | Zollinger-Ellison Syndrome
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| N/V, epigastric abdominal pain, worse supine, caused by alcohol ingestion, or following fatty meals | Acute pancreatitis
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| Peri-umbilical or flank ecchymosis | Acute pancreatitis (Cullen & Grey Turner’s Sign)
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| Abdominal distension, bloating, intermittent, colicky pain, high-pitched rushes & tinkles | SBO
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| Air fluid levels on upright abd plain film | SBO
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| Air under diaphragm, rigid board-like abdomen | Perforated viscus, perforated ulcer
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| >60yo F, LLQ pain | Diverticulitis. IV Abx, fluids, NPO.
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| Elderly, Hx atherosclerosis. Dull crampy periumbilical pain post-prandial | Mesenteric ischemia
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| Neonate w/ projectile vomiting. Olive sized mass. | Pyloric stenosis
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| Choking, cyanosis, respiratory distress, increased secretions in 1st hours of life | Tracheoesophageal fistula
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| Painless rectal bleeding in pediatrics | Meckel’s diverticulum
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| Alcoholic with massive hemoptysis | Esophageal varicies (Tx w/ octreotide)
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| Female with recurrent abdominal pain, alternating diarrhea, constipation. Pain relieved with defecation. | IBS. TCA’s (nortriptyline) good if diarrhea predominant symptom
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| Bloody Diarrhea | Ulcerative colitis
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| Supraclavicular LAD (L > R) | Virchow’s node – metastatic abdominal cancer
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| Hard periumbilical nodule | Sister mary Joseph nodule = indicates metastatic gastric and pancreatic cancers
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| PUD, Pernicious anemia (Type A Gastritis), H. pylori | Gastric Ca
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| Apple core lesion | Colon Cancer
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| Elderly with positive hemmocult. | Colon Cancer – get colonoscopy
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| CEA | Colon Carcinoma
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| Family history of young age colon cancer, multiple polyps found on colonoscopy | Familial adenomatous polyposis (Gardner’s syndrome)
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| AFP | Hepatocellular carcinoma, testicular seminoma (germ cell tumor)
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| CA 19-9 | Pancreatic Ca
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| CA-125 | Ovarian Carcinoma
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| Chemotherapy induced N | Treat with Ondansetron (Zofran) (5-HT3 blockers)
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| Traveler’s Diarrhea | E. coli is cause. Hydration & Cipro to treat
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| Greasy, foul smelling, floating stools. Pear-shaped flagellated protozoan w/ 2 “eyes”. Water, travel, camping history | Giardia
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| Afebrile, watery or loose stool. No blood or mucus | Viral Gastroenteritis
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| Abdominal pain, diarrhea after picnic/party. Eaten ham, cream, custards, mayonnaise | Staphylococcus aureus infectious diarrhea
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| Acute bacterial diarrhea w/ prodrome of HA, F, then crampy abd pain & diarrhea | Campylobacter jejuni – most common cause of acute bacterial diarrhea
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| Painless rectal bleeding. Bulging perianal mass w/ straining | Internal hemorrhoids
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| Pediatric with perianal pruritis esp. at PM. Positive cellophane tape test | Pruritis ani – Pinworms (enterobiasis). Tx is Mebendazole
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| Weight loss, recurrent greasy stools (steatorrhea) mixed with diarrhea after certain foods | Celiac Sprue
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| Anti-endomysial antibodies | Celiac Sprue
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| Beriberi | Thiamine; Alcoholics, Neuro Sx
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| Pellagra | Niacin (4D’s dermatitis, diarrhea, dementia, death), bright red tongue
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| Scurvy | Vit C (easy bleeding, bruising, hair & tooth loss, joint pain & swelling)
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| Rickets | Vit D (Osteomalacia)
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| Night blindness | Vit A deficiency
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| Magenta tongue | Riboflavin deficiency (B2)
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| s/p gastric bypass surgery or gastric surgery. N, abd cramping, dizziness after eating. No masses, bleeding | Dumping syndrome
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| Diabetic w/ anorexia, anemia, wt loss, pallor | CRF
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| Gastroparesis, impotence, recurrent infections, stocking-glove paresthesia | Diabetic neuropathy (Treat w/ TCA (amitriptyline)
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| Hypoglycemia despite glucose administration. Increased C-peptide | Insulinoma
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| Hypoglycemia in alcoholic | Give Thiamine before glucose to prevent Wernicke’s encephalopathy
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| Decreased radioactive iodine uptake, decreased free T4, increased TSH | Hashimoto’s thyroiditis
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| Female, weight loss, palpitations, atrial fibrillation | Hyperthyroid (work it up with TSH, T4)
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| Exopthalmos, palpitations, wt. loss. Elevated radioactive idodine uptake | Hyperthyroid, Graves Dx – Tx w/ Radioactive iodine
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| Post thyroidectomy – most likely injury | Recurrent laryngeal nerve = hoarseness
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| Post thyroidectomy – electrolyte watch | Hypocalcemia
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| Infant w/ round face, large protruding tongue, dry skin, umbilical hernia, constipation, enlarged abdomen, poor feeding, delayed developmental milestones | Congenital Hypothyroidism
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| 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
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| HTN not responsive to meds | Renal artery stenosis (Infrarenal artery)
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| HTN w/ hypernatremia, hypokalemia | Primary Aldosteronism
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| Wt. gain, edema, coarse dry skin, hair, menorrhagia, cold intolerance, hx transphenoidal surgery & radiation | Hypothyroidism
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| Tetany, hypocalcemia, cataracts | Hypoparathyroidism
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| Exogenous corticosteroid use | Cushing syndrome
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| Dexamethasone suppression test | Cushing syndrome
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| Central obesity, abdominal stria, hyperglycemia, moon facies, buffalo hump, easy bruising | Cushing syndrome
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| Acute steroid withdrawal | Addison’s disease, crisis
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| 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)
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| 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)
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| Hyponatremia, hyperkalemia | Acute adrenal insufficiency (Addison’s crisis)
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| Polyuria, polydipsia. Dilute urine, Hypernatremia | Diabetes insipidus
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| Concentrated urine. Hyponatremia | SIADH
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| 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
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| XXY ♂ - short stature, ↓ intelligence; small firm testes, gynecomastia, abn arm-body length | Klinefelters (hypogonadism)
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| Description | Diagnosis Associated
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| Hyaline Casts | Normal (may be present after febrile illness, strenuous exercise)
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| Increased BUN/Cr, low FeNa | Prerenal Failure (Azotemia)
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| Irritative voiding symptoms, Fever, chills, CVA tenderness | Pyelonephritis
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| Crush injury, alcoholic on ground, elevated CPK, ARF | Rhabdomyolysis
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| Painless hematuria, flank pain or mass | Renal cell Carcinoma
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| Oliguria, hematuria, proteinuria following streptococcal infection | Acute glomeruloneprhitis
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| Hematuria, purpuric rash following streptococcal infection | Glomerulonephritis, HSP
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| Hematuria, RBC casts, proteinuria | Glomerulonephritis
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| Kidney & lung bleeding (hematuria, hemoptysis) | Goodpasteures
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| Fibrous band on lateral penis | Peyronie’s disease
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| Can’t retract foreskin | Phimosis
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| Inflammation of glans | Balanitis
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| < 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)
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| >50 yo obstructive voiding sx, nocturia. Firm smooth enlarged prostate. Nl PSA | BPH. (Cancer would have firm, irregular, nodular non-tender prostate, elevated PSA)
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| Incontinence with straining | Stress
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| Peaked T-waves | HyperKalemia
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| U waves | HypoKalemia
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| QT prolongation | Hypocalemia
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| Recurrent kidney stones, elevated Calcium, decreased phosphorus | Hyperparathyroidism
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| Hearing loss or tinnitus w/ metabolic acidosis | Aspirin OD
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| Head trauma, disoriented – lucent – coma | Epidural Hematoma
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| Lens shaped hemorrhage | Epidural Hematoma
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| Concave | Subdural Hematoma
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| LP w/ decreased glucose, increased protein | Bacterial meningitis
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| LP w/ decreased protein, very few neutrophils | syphilitic meningitis
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| Meningitis and rash | Meningiococcal
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| Meningitis & <2mo | Grp B Strep, E. coli (Tx < 1yo = Vanco + Rocephin)
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| Meningitis < 4yo | H. inlu, Grp B strep, N. meningititis
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| Meningitis > 2yo, adults | Strep, N. meningititis
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| Viral Meningitis | Mumps
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| Unilateral facial weakness w/ inability to close eye | Bell’s palsy (self-limiting)
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| Adolescent female w/ HA. +FHx. Severe HA, N/V, photphobia. +/- auras | Migraine HA
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| Male, recurrent relapsing HA. Worsened w/ EtOH, Lacrimation, salivation, rhinorrhea | Cluster HA
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| Sudden onset thunderclap HA, “worse HA of my life” | Subarachnoid hemorrhage
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| >50 yo female w/ HA. Temporal artery tenderness or blindness | Temporal arteritis (Giant cell arteritis). Elevated ESR, get temporal artery biopsy
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| Recurrent episodes of vision change, diplopia, weakness & tingling in extremities that resolve | MS
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| myelin fragments, ↑ IgG, oligoclonal bands (Pathognomonic); Lhermitte’s sign = electrical sensation down body w/ neck flexion | MS
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| HA worse in AM w/ focal neuro deficits | Brain Tumor (MC is glioma)
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| s/p Fall w/ bilateral LE weakness, urinary and rectal incontinence, decreased rectal tone | Cauda equine syndrome = neurosurgical consult
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| Ascending paralysis | GBS
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| Paralysis after Campylobacter enteritis | GBS
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||||
| 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
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| < 5yo fever, seizures | Febrile seizure
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| Premature birth, fetal maturity | Give corticosteroids
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| Meconium-stained amniotic fluids | Fetal distress
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| Positive osmotic fragility test | G6PD deficiency (hemolytic anemia w/ oxidative drugs – sulfa, nitrofurantoin, quinidine)
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| Mousy urine | PKU
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| Vit D – Rickets | X-linked dominant
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| Hemophilia A, Duchennes MD | X-linked Recessive
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| Neurofibromatosis | Autosomal dominant
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|
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| Sickle cell, CF, PKU | Autosomal Recessive
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|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
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Created by:
ges13
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