First Aid Rapid Review - 1. Classic Presentations (JR) Part#2

nelotebi's version from 2015-06-24 19:16

Clinical presentations

Clinical PresentationDiagnosis/Disease
Can't repeat (poor repetition) but can speak and can understand. Lesion?Conduction Aphasia (Damage to Arcuate Fasciculus = connection b/w Broca's and Wernicke's areas)
Can't speak (motor deficit), expressive aphasiaBroca's Aphasia (Inferior Frontal Gyrus of Frontal Lobe) (Brodmann 44,45)
Can't speak and Can't understandGLOBAL Aphasia (BOTH Broca's + Wernickie's)
Can't understand language/speech, receptive aphasia
Lesion location?
Wernickie's Aphasia (Superior Temporal Gyrus of Temporal Lobe) (Brodmann 22)
Can't write (agraphia), can't do math (acalculia), can't distinguish fingers (finger aphasia), L/R disorientationGerstman Syndrome --> Dominant (Left) Parietal Lobe lesion. (Right Handed --> Dominant aka Left = verbal/language vs. Non-dominant aka Right = visual-spatial)

Circle of Willis Angiogram
Ipsilateral cerebellum lesion
Vermis = Medial
Paravermal Zone = lateral to vermis
Lateral Hemispheres = most lateral
Lateral to Medial = Dentate --> Emboliform --> Globus --> Fastigial
*VESTIBULOCEREBELLUM = Flocculonodular lobe + vermis (Fastigial)
*SPINOCEREBELLUM = Vermis & Paravermal (Fastgial & Interposed)
*CEREBEROCEREBELLUM = Lateral hemisphere (Dentate)
Incoming connections = Climbing or Mossy fibers
Outgoing connections = Purkinje Fibers

**Superior Cerebellar Peduncle = Cerebellum to Cortex
**Middle Cerebellar Peduncle = Cortex to Cerebellum
**Inferior Cerebellar Peduncle = Spine to Cerebellum
*Chronic otitis media + cystic lesion lined w/ keratinizing squamous epithelium + negative pressure in eustachian tube + filled w/ amorphous debrisCholesteatoma
CoA donorVitamin B5 (Pantothenate)
Cold intoleranceHypothyroidism
Collagen type of fibrosis/scar tissueCOLLAGEN TYPE I
Coma (↓ wakefulness and ↓ arousal)Reticular Activating System (Midbrain)
Confusion + vision loss + ataxia + confabulation (can't recall past and make up events), memory lossWernicke-Korsakoff (damage to medial dorsal Thalamus & mammillary bodies) --> seen in Vitamin B1 (Thiamine) Deficiency
Congenital megacolon, lack of ganglionic cells (auerbach's & meissner's), failure of neural crest cell migration, can't pass meconiumHirschsprung's Disease (inc risk w/ Down's Syndrome = ALL, Hirschsprung, Duodenal Atresia, Annular pancreas, celiac dz)
Test - Submucosa of the narrow part
Conjugate lateral gaze palsy (can't move both eyes in the same direction), horizontal diplopia
Left Lateral gaze = left eye (CN VI) works to abduct and then sends the signal to CN III via MLF to abduct the right eye. Demyelation of MLF. CN III does not work = no adduction of the Right Eye. Left eye = ↑ abduction = nystagmus.
Left eye nystagmus + Right eye impaired adduction --> Right MLF damaged
Internuclear ophthalmoplegia (damage to MLF = connects CN VI & CN III; bilateral [multiple sclerosis], unilateral [stroke])

Internuclear = b/w the nucleus of CN VI & CN III
Ophthalmoplegia = paralysis of eyes
Continuous "machinery" heart murmurPDA (close w/ indomethacin; open w/ misoprostol (Prostaglandin) Cyanosis of lower extremity but not upper. VS Coarctation of Aorta - Upper and lower extremities have two different pulses.
Convulsions (↓ GABA) , easily irritable, peripheral neuropathy, sideroblastic anemiaVitamin B6 Deficiency (Pyridoxine), used for Transamination (Liver - ALT, AST). Isoniazid --> dec B6
Construction worker/plumber, dumbell shaped fibers in lung, assocaited w/ iron in lower lobe, ↑ risk of lung carcinoma Asbestos
Contralateral hemiballismus (wild swinging of one arm ONLY)Subthalamic Nucleus lesion (contralateral side) (STN = inhibitory, if lesion --> no inhibition)
Cough and Angioedema w/ ACE-inhibitors (Lisinopril)↑ Bradykinin (vasodilator, ↑ vascular permeability) (bradykinin = histamine-like) ((normally, ACE degrades bradykinin, but if ACE-I = ↑ bradykinin)
Crab meat worm, causes lung inflammationParagonimus westermani (West aka US people are crazy (MANIac) about eating CRAB!)
Cranial nerve lesionsCN V = mastication (JAW deviates towards the side of lesion) (opposite of Corticobulbar tract = tract connecting cortex to Brainstem (CN nucleus), crosses before reaching the CN nucleus)
CN X = Uvula deviates away from side of lesion (vagus lifts the palate, if lesion = on the side of lesion, the palate is not lifted = uvula points away)
CN XI = SCM muscle + trapezius (shoulder drop on same side as lesion, can't turn head away from side of lesion)
CN XII = tongue (tongue deviates towards the side of lesion) lick your wounds
Cutaneous/dermal edema due to connective tissue depositionMyxedema (caused by hypothyroidism, Graves'disease [periorbital, pretibial])


Clinical PresentationDiagnosis/Disease
*Daily headache in a fat female, with papilledema, risk of vision loss, ↑ ICP (CSF pressure > 200 mmHg), due to excess Vitamin A, tetracycline or corticosteroid withdrawalPseudotumor Cerebri (Benign Intracranial Hypertension) Tx = Acetazolamide
Dark purple skin/mouth nodulesKaposi's sarcoma (usually AIDS pxn [gay men]: associated w/ HHV-8)
D-Dimer ↑ , ↓ fibrinogen, ↓ coagualtion factors V & VIIIDIC (STOP Making New Thrombi = Sepsis (G-), Trauma, OB complications, Pancreatitis, Malignancy, Nephrotic syndrome, Transfusion)
Deficiency in ADAMTS13, schistocytes, ↑ LDH , Pentad Thrombocytopenia, Uremia, Neuro deficit, Hemolysis, Fever, ↓ platelets, ↑ bleeding timeTTP (Thrombotic Thrombocytopenia Purpura) = ↓ degradation of vWF (↓ Factor 8)
Deep, labored breathing/hyperventilationKussmaul breathing (Diabetic Ketoacidosis)
Decrease in CSF absorption by arachnoid granulations = ↑ICP, papilledema, herniation. Seen after scarring post-meningitisCommunicating Hydrocephalus (↑ CSF)
Decreased iron + anemia in >50 yo, weight loss, "apple core" lesion on barium enema, CEA tumor marker
Colon Cancer (APC, K-RAS, p53) (Familial adenomatous polyposis = APC, chromosome 5 (COLON), Gardner's, Turcot, Hereditary non-polyposis colorectal cancer (DNA mismatch repair genes)) right side bleeds - anaemia, fatigue; left side obstructs - chronic constipation and sting like faeces)
Decreased iron, decreased ferritin, increased TBIC, dec % saturationIron deficiency (pica, microcytic anemia, hypochromia; tx = ferrous sulfate)
Deficiency caused by eating too many egg whitesVitamin B7 (Biotin) - needed for CARBOXYLATION rxns (adding Carbon)
Degeneration of cortex (dementia), slow-onset memory loss, loss of learned skills, changes in behavior and personality, mute and bed-ridden. Disease of elderly. E4 allele of Apoliporotein (APOE) = ↑ risk, Presenilin 1 = ↑risk. Cerebral atrophy = narrow gyrus, wide sulcus, dilated ventricles, Aβ-amyloid plaques + entagled neuritic processes, Neurofibrillary tangles of HYPER-PHOSPHORYLATED tau-protein, ↓ACh. Alzheimer's Disease
Delta wave on EKG (early ventricular depolarization), accessory conduction pathway from atria to ventricle that bypass AV node, bundle of KENT
Wolf-Parkinson-White Syndrome (Tx = Procainamide or Amiodarone)
Dermatitis, dementia, diarrheaPellagra (niacin [B3] def), 3D's, NAD (red-ox), derived from Tryptophan. Use Niacin to ↓ LDL (b/c ↓ lipolysis). Excess Niacin = vasodilation --> flushing
Destruction of alveolar air sacs, airway collapses during expiration, loss of elastic recoil, ↑ compliance (V/P), barrel chest, weight loss, pursed pink puffers

*smoking = centroacinar, upper lobes

*α1-antitrypsin deficiency (PiZZ gene) = panacinar, lower lobes)
Diaphoresis, severe retrosternal chest pain, pain in left arm and/or jaw, shortness of breath, fatigueMI
1 day = coagulative necrosis, arrhythmias
(red) neutrophils --> macrophages
1 week = (yellow) granulation tissue + macrophages, free wall rupture
1 month = (white) fibrosis, scar, Dressler's Syndrome
Labs = Troponin I (4 hrs to 7 days), CK-MB (48 hrs - check for re-infarction)
EKG = ST-elevation (transmural, infarction) (ST-depression = subendocardial, ischemia), Q-waves (>0.04, >1 small box, previous MI)
Diarrhea (bloody), lead pipe appearance, colon inflamed, + rectum inflammation, mucosa &  submucosa involved only, ↑ risk of colorectal cancer Uclerative Colitis (Tx = ASA, 6-mercaptopurine, infliximab, colectomy)
Diarrhea (may or not be bloody), string sign on barium x-ray, cobblestone mucosa, non-caseating granuloma, polyarthritis, ankylosing spondilitis, uveitis, kidney stones, skip transmural lesions, no rectum involved, ass-to-mouth Crohn's Disease (tx = corticosteroids, methotrexate, infliximab, no colectomy --> b/c recurrence)
Diarrhea (diarrhea), liver abscess, RUQ pain, dysenteryEntamoeba histolytica
Diarrhea (bloating, flatulence, bad-smelling, fatty diarrhea) in campers and hikersGiardia
Diarrhea (severe) in HIV ptxCryptosporidium

Clinical presentations

Clinical PresentationDiagnosis/Disease
Dilated cardiomyopathy (high output cardiac failure), edema, polyneuropathyWet beriberi (thiamine [B1] def) (need Thiamine for PDH & alpha-ketoglutarate D & Transketolase = dec ATP = brain (dry) & heart (wet) affected)
Dilated cardiomyopathy + Megacolon + Megaesophagus (big heart + colon + esophagus), South America, Reduviid bug "kissing bug"Chagas disease (Trypanosoma cruzi) (Big heart, esophagus, colon)
Dilated R. atrium, congenital, hypoplastic R. ventricle, tricuspid leaflets displaced into R. ventricle, b/c of lithium use by mother Ebstein's Anomaly
Disinhibition and can't concentrate, poor judgement, acting like an animal/impulsiveFrontal Lobe lesion
Dog or cat bite resulting in infection'Pasteurella multocida' (cellulitis at inoculation site); 'Bartonella henselae' (cat scratch fever) toxocara (cutaneous larva migrans)
Dry eyes, dry mouth, arthritisSjogren's syndrome (autoimmune destruction of exocrine glands)
Dysphagia (esophageal webs), glossitis, iron deficiency anemia (microcytic, hypochromic anemia)Plummer-Vinson syndrome (may progress to esophageal SCC)
Elastic skin, hypermobility of jointsEhlers-Danlos syndrome (type III collagen defect)

Classical type (joint and skin symptoms): caused by a mutation in type V collagen.
Vascular type (vascular and organ rupture): deficient type III collagen ThreE D
Elephantiasis (blocked lymph vessels)Wuchereria bancrofti
Elevated AST, ALT, GGT & ANA(+), Anti-mitochondrial Ab(-), Anti-smooth muscle Ab (+),  but NO hepatitis serology markersAutoimmune Hepatitis
Endocarditis w/ negative blood culturesHACEK organisms = H. flu, Actinobacillus, Cardiobacerium, Eikenella, Kingella
Endocarditis w/ non-bacterial originSterile vegetations b/c of Hyper-coagulation State or Adenocarcinoma
Enlarged, hard left supraclavicular nodeVirchow's node (abdominal metastasis from Gastric Adenocarcinoma)
Eosinophils pile up in the lungLoffler's Syndrome
Epyndemal Cells of Choroid Plexus --> Lateral Ventricle --> Interventricular foramina of Monroe --> 3rd V --> Cerebral Aqueduct --> 4th V --> Foramina of Luschka/Magendie --> Subarachnoid Space --> Arachnoid Granules --> Superior Saggital Sinus --> Confluence of Sinuses --> Transverse Sinus --> Sigmoid Sinus --> Internal Jugular VeinVentricular System
Erythema marginatum + J♥NES criteria
Rheumatic Fever (Strep. pyogenes, M protein, ASO)
Erythema chronicum migrans + flu
Lyme disease (Borrelia burgdorferi, Ixodes, north east US). 1st stage = bull’s eye red rash w/ central clearing + flu. 2nd stage = neuro (bell’s palsy) + heart (AV nodal block). 3rd stage = arthritis, neuro, skin rash. Tx = doxycycline (I, II) or Ceftriaxone (II)
Erythroderma, lymphadenopathy, hepatosplenomegaly, atypical mature CD4+ T cellscutaneous T cell lymphoma (NHL), mycosis fungoides, Sézary syndrome
Esophageal varices, ascites, internal hemorrhoidsPortal hypertension (low albumin in fluid in ascites)
Exophthalmos (bulging eyes) in a child, Diabetes Insipidus, Lytic lesions in skull + rash, malignantHand-Schuller-Christian Disease (type of Langerhans Cell Histiocytosis)
when you look at Han Sol, your eyes pop out and you pee
Eyes look away from side of lesionParamedian Pontine Reticular Formation (PPRF) ( responsible REM sleep)
Eyes look toward the side of lesionFrontal Eye Field