First Aid Rapid Review - 1. Classic Presentations (JR) Part#5

zoyogasa's version from 2016-04-14 01:17

Clinical presentations

Clinical PresentationDiagnosis/Disease
Nasal polyp in child
Abnormal transprotein degraded before reaching the cell surface
Cystic Fibrosis
Sweat that contains High concentration of sodium & Chloride
Nasal polyps in adultAspirin-Intolerant Asthma (Asthma + Aspirin + Polyps)
Necrotizing vasculitis (Intranasal ulcer) and necrotizing glomerulonephritis(Oligouria & Highserum creatinine)Wegener's (+ c-ANCA) (nasal + lungs + kidney); Goodpasture's syndromes (anti-GBM [typeIVcollagen] IgG)
Neonate w/ arm paralysis following difficult birthErb-Duchenne palsy (superior trunk [C5,6] brachial plexus injury: "waiter's tip")
Neural tube defect, megaloblastic anemia, no neuro symptomsFolic acid (Vitamin B9) deficiency, jejunum, supplement 0.4 mg THF in pregnant women, ↑ homocysteine, normal levels of Methylmalonic Acid
Neuronal atrophy (Alzheimer's, HIV, Pick's disease) --> gives the appearance of ↑ ICP (but is normal) = Diffuse CORTICAL ATROPHY
No triad of Wet, Wobbly, Wacky aka NO urinary incontinence, NO ataxia, NO dementia
Hydrocephalus ex vacuo
Neurotransmitter sourcesSubstantia Nigra & Ventral Tegmentum (Midbrain) = DA
Locus Cerules (Pons) = NE
Raphe Nucleus (Pons) = Serotonin (5-HT)
Nucleus of Meynert = ACh
Nucleus Accumbens = GABA
No lactation postpartum, absent menstruation, cold intoleranceSheehan's syndrome (pituitary infarction)
Non-ceaseating granuloma in lung, aerospace worker, ↑ risk of lung cancerBerylloisis
Non-ceaseating granulomas in lungs (+ other organs), bilateral hilar lymphadenopathy, asteroid bodies, uveitis, erythema nodosum, salivary and lacrimal gland (can't eat a cracker, dry eyes), ↑ ACE, ↑ 1-α-hydroxylase (↑ 1,25(OH) Vit D) = ↑ calcium absorption from gut = hypercalcemiaSarcoidosis
- a type of restrictive lung disease.
Non-smoker, lung cancer at the periphery, glands & mucin producing, EGFR mutation (tyrosine kinase-like)Adenocarcinoma
Northeast US (NY, Massachusetts) + fever + hemolytic anemia + Iodes tick + Maltese cross on blood smearBabesia
Notching of ribs,hypertension in upper extremities, ocassional head aches, pulsatile vessels palpable by the ribs weak pulses in lower extremitiesCoarctation of Aorta (Adult type - distal to ligamentum arteriosum) (coarctation = narrowing, after the main branches - brachiocephalic, left common carotid, left subclavian a)
Nystagmus, Intention tremor, scanning speech (brain-stem), bilateral internuclear ophthalmoplegia (MLF), lower extremity loss of sensation (spinal cord), bladder/bowel/sexual dysfunction (autonomic nervous system). Gray plaques in white matter (demyelination), Oligodendrocyte Depletion.
↑ lymphocytes, ↑ oligoclonal IgG bands~
Multiple sclerosis (degeneration of WHITE MATTER any where in CNS or PNS), HLA-DR2
*Autoimmune destruction
*Tx = steroids & INF-beta
Oscillating slow/fast breathing
Cheyne-Stokes respirations (central apnea in CHF or ↑ ICP) - breath normally and then stop breathing, until pCO2 rises and when have too much pCO2 --> start breathing again
Osteomyelitis in sickle cell patients (children) hydRoxyuRea - Ribonucletide reductase &increase Hb FSalmonella (have flagella, also cause bloody diarrhea)
Pain in a dermatone distribution and then followed by rashHerpes Zoster (HSV-3 = Varicella Zoster Virus --> causes chicken pox --> virus is dormant in nervous system (Trigeminal Ganglion & DRG) --> REACTIVATION in immunosuppressed ptx --> SHINGLES)
Pain relieved by sitting forward, sharp-pleuritic pain, friction rub, ST-ELEVATION in ALL leads, Kussmaul's Sign ( ↑ in JVP on inspiration (normal = ↓ in JVP b/c blood fills the RV))Pericarditis
Pain worsen by deep breathing and/or motionPleuritic Pain
Painful blue fingers/toes, hemolytic anemiaCold agglutinin disease (IgM) (autoimmune hemolytic anemia caused by Mycoplasma pneumoniae, infectious mononucleosis)
Painful clusters of clusters of ulcers on labia/penis HSV-2
Painful, large/ragged/necrotic base/undermined edge lesion on vagina/penis + Painful inguinal LAD

Chancroid = Haemophilus ducreyi (G- coccobacilli)
Painful lymphadenopathy (acute vs. chronic) acute infection
Painful, pale, cold fingers/toes
Raynaud's syndrome (vasospasm of arterioles in extremities) (seen in SLE & CREST Scleroderma, Buerger)
Painful, raised red lesions on palms and solesOsler's node (infective endocarditis, immune complex deposition) (Osler = Ouch Ouch) = get these from breaking off of the septic vegetations form the mitral valve leaflet and traveling in the systemic circulation to different sites
Painless chancre, VDRL, FTA-ABS
Syphilis (traponema pallidum)
Painless erythematous lesions on palms and solesJaneway lesions (infective endocarditis, septic emboli/microabscesses) = get these from breaking off of the septic vegetations form the mitral valve leaflet and traveling in the systemic circulation to different sites
Painless jaundiceCancer of the pancreatic head obstructing bile duct
Painless lymphadenopathy (acute vs. chronic)chronic inflammation (chronic lymphadenitis, metastatic carcinoma or lymphoma)
Painless lymphadenopathy, B-cell tumor, multiple lymph nodes involved, associated w/ HIV & immunosuppression, 20-40 yoNon-Hodgkin's Lymphoma
Painless lymphadenopathy, B-cell (CD20), hyperplasia of follicles in the lymph node (found everywhere), no macrophages, monoconal Ig, t(14;18), ↑↑ bcl-2, no apoptosisFollicular Lymphoma (Non-Hodgkin's Lymphoma) Tx = Rituximab, anti-CD20 ab
Painless lymphadenopathy, t(11;14), Cyclin D1 (bcl-1) --> ↑ G1 to SMantle Cell Lymphoma (Non-Hodgkin's Lymphoma)
Palpable purpura on buttocks/legs, joint pain/arthritis, abdominal pain, blood stools, blood in urine (child, often following pharyngitis)
Henoch-Schonlein purpura (IgA complex [typeIII] vasculitis affecting skin and kidneys)
Painful abdomen, Port wine-colored urine, Polyneuropathy, Psychological disturbances, Precipitated by drugs abdominal pain + paresthesiaAcute intermittent porphyria
Pancreatic, pituitary, parathyroid tumorsMEN I (auto dom, chromosome 11)
Paralysis (ascending)
Endoneural Infllammatory infiltration
Guillain–Barré (autoimmune destruction of myelin in peripheral nerves, Campylobacter jejuni)
Paralysis (descending)
- Reduced Motor End-Plate potential
Myasthenia Gravis (antibodies against acetylcholine receptors, muscles become progressively weaker during periods of activity and improve after periods of rest, eye and eyelid movement, facial expressions, chewing muscles affected first)
Paralysis (descending)Botulism (Clostridium botulinum, blocks ACh release)
Paroxysms of increased sympathetic tone = anxiety, palpitations, diaphoresis, Headache, Episodic HypertensionPheochromocytoma (episodic NE/Epi release)
Pautrier microabscesses (cancerous Mature T-cells in skin --> rash) + Sezary syndrome (lymphocytes w/ crebriform nucleus --> look like cerebrum)Mycosis Fungiodes
Perianal pruritus
Scotch Tape test.
Bendazoles = at the end of the bus
Persistent Lymphedema (post-radical mastectomy) can cause thisLymphangiosarcoma
Permanent dilation of bronchioles (straw vs. pipe), b/c of necrotizing inflammation (cystic fibrosis, kartagener, foreign body, tumor, aspergillosis)Bronchiectasis
Pharyngitis (sore throat) + Hepatitis + B-cells + Atypical Lymphocytes + Heterophile Ab positive (IgM)EBV (Infectious Mononucleosis)
Pink complexion, dyspnea, hyperventilation"Pink puffer" (COPD emphysema: centroacinar [smoking], panacinar [α1-antitrypsin deficiency])
"Pipestem arteries", calcification in the media of the arteries (ULNAR & RADIAL), no intima involvedMonckeberg Arteriosclerosis (M = media)
Polyps (thousands of polyps), ↑ risk of colorectal cancer, APC gene mutationFamilial Adenomatous Polyposis
Polyps (thousands of polyps) = FAP + bone/soft tissue tumors + eye (hypertrophy of retinal pigment epithelium) "Impacted supernumerous teeth >32 = Flower of garden"Gardner's Syndrome
Polyps (thousands of polyps) = FAP + CNS tumorsTurcot (turcot = turban)
Polyuria, renal tubular acidosis type II, growth failure, electrolyte imbalances, hypophosphatemic rickets (Vtiamin D resistant)Fanconi's syndrome (proximal tubular reabsorption defect) = PCT defect (wasting of a lot of proteins & electrolytes)
Pork tape worm, seizures and brain calcificationsTaenia solium
solar = up, toward the brain
Port-Wine stain on face + Ipsilateral Leptomeningeal Angiomatosis (small meningial artery tumor) + seizures + glaucomaSturge-Weber Disease (congenital vascular disorder of capillaries) (Sturge Weber= Seizures + Wine (port-wine stain on face))
Positive anterior "drawer sign"ACL injury
Positive whiff test, Clue cells, no WBC, fishy odorBacterial Vaginosis (↑ Gardnerella vaginalis, ↑ pH)
Pruritic, purple, polygonal planar papules and plaques (6 P's)Lichen planus
Pseudotumor cerebri (↑ ICP), alopecia (loosing hair), arthralgias, headache, fatigueVit A toxicity (Irotretinoin)
Pseudoappendicitis, day-care outbreak of bloody diarrhea, transmitted from pet feces (puppies)Yersinia enterocolitica
Pseudomembraneous colitis, secondary to antibiotic use, 2 toxins. Toxin A = enterotoxin (binds to brush border of gut), Toxin B = cytotoxin (destroys cytoskeleton structure of enterocytes)Clostridium difficile (Tx = metronidazole or oral vancomycin)
Ptosis, miosis, anhidrosis
Horner's syndrome (sympathetic chain lesion)
Pulmonary stenosis, RVH, overiding aorta, VSDTetralogy of Fallot
- Caused by anterosuperior displacement of the infundibular (aorticpulmonary) septum
Pulsating mass in the abdomen, common in males > 50 & smokersAAA (Abdominal Aortic Aneurysm) (if >5cm = surgery)
Pupil accommodates but doesn't react (accommodation = object near/far, react = light on/off), does not react to lightArgyll-Robertson pupil (neurosyphilis) aka prostitute’s pupil (do their work at night = no light reflex)
Purulent (pus) yellow discharge from vaginaN. gonorrhea or C. trachomatis (PID)
Psammoma bodies (laminated, concentric, calcific spherules - rings on a tree) seen in PSaMMoma (Papillary thyroid cancer, Serous ovary adenocarcinoma, Meningioma, Mesothelioma)