First Aid Rapid Review - 1. Classic Presentations (JR) Part#8

hysteresis's version from 2016-01-12 05:01


Clinical PresentationDiagnosis/Disease
Target cells on blood smearHALT (HbC, Asplenia, Lead poisoning, Thalassemia)
TdT+ (DNA polymerase), > 20% lymphoblasts, children, can spread to CNS or testes, t(12;21) = better prognosisALL (Acute Lymphoblastic Leukemia)
Tear drop red blood cells, bone marrow fibrosis, JAK2 kinase mutationMyelofibrosis (bone marrow is crying b/c it's fibrosed) (aplastic anemia = fatty change in bone marrow)
Tearing chest pain that radiates to back + wide mediastinum

Aortic Dissection (HTN or Marfans) --> Ascending Aorta
Tendon rupture from an antibioticFluroquinolone (-floxacin). Blocks DNA topoisomerase II (DNA gyrase) (fluroquinolones hurt attachment to your bones)
Thalamus1. VPL = PT,PTV from body
2. VPM = PT,PTV from face (face sensation and taste)
3. LGB = Vision (CN II --> Calcarine sulcus))
4. MGB = Music (Inferior Colliculus --> Auditory cortex)
5. VL = motor (Basal Ganglia --> Motor Cortex)
Thick bones, more fractures. Pancytopenia. Bone-in-bone appearanceOsteopetrosis aka Marble Bone Disease (↓ Osteoclast b/c of Carbonic Anhydrase II mutation)
Thyroid & parathyroid tumors, pheochromocytomaMEN 2A (auto dom RET mutation)
Thyroid tumors, pheochromocytoma, mucosal neuromas (oral/intestinal)MEN 2B (auto dom RET mutation)
Toe extension/fanning upon plantar scrapeBabinski sign (UMN lesion)
Torsades de pointes (↑ QT interval), defect in heart sodium or potassium channels, sensorineural deafnessJervell and Lange-Nielsen Syndrome (autosomal recessive)
vs Romano-Ward syndrome —autosomal dominant, pure cardiac phenotype (no deafness).
TRAP positive, ↑ Mature B-cells, Tx = CLADIRIBINE (adenosine deaminase inhibitor)Hairy Cell Leukemia (as you mature, you get hairy = easier for things to get trapped)
Tremor, chorea (dancing-like, sudden, jerky, purposeless movements) or athetosis (writhing, snake-like movements of fingers)Basal Ganglia Lesion (Parkinsons = resting tremor vs. Huntington's = chorea, athetosis)
Tremor w/ movement = slow, zig/zag motion when pointing/extending toward a targetIntention Tremor (Cerebellar dysfunction)
Truncal/Axial ataxia, dysarthriaCerebellar Vermis Lesion (medial = central)
Twisting of bowel (cecum or sigmoid the two ends of the colon) around mesentryVolvulus
UMN & LMN lesion (ONLY MOTOR LOSS), no sensory loss, no oculomotor deficits.Amyotrophic Lateral Sclerosis aka Lou Gehrig's Disease (Stephen Hawking) (defect in Zinc-Copper Superoxide Dismutase (SOD))
Unilateral facial drooping involving foreheadBell's palsy (LMN CN VII palsy)
Urethritis, conjunctivitis, arthritis in a maleReiter's/reactive arthritis associated with HLA-B27, cross reactivity rxn to infection
Urine smells like maple syrupMaple syrup urine disease (↓ alpha-ketoacid dehydrogenase), ↑ ketoacids in blood. I Love Vermont (Isoleucine, Leucine, Valine). Tx = protein restriction.
Urine w/ clear prism or plate crystals
Uric acid crystals (GOUT) Tx = Acetazolamide or Allopurinol
Urine w/ coffin lid shaped crystals
Triple Phosphate
Urine w/ colorless squares or squares w/ cross crystals
Calcium Oxalate. Tx = HCTZ
Urine w/ hexagonal crystals
Cystinuria (defect in COLA (cysteine, ornithine, lysine, arginine) transporter in PCT of Kidney). Tx = Acetazolamide
Vascular birthmark (port-wine stain)Hemangioma (benign, but associated with Sturge-Weber syndrome)
Vasculitis, older adults >50 yo, carotid artery + branches, unilateral headache, jaw claudication, irreversible blindness, granulomaTemporal Giant Cell Arteritis (Tx = Corticosteroids) (Diagnose by biopsy)
Vasculitis, <50 yo asian female, aortic arch, pulseless disease (weak upper extremity pulses), granulomaTakayasu's Arteritis (all of the a's = asian, aortic arc) (Tx = corticosteroids)
Vasculitis, small arteries, multiple organs/viscera (but NO LUNGS), Hepatitis B +, fibrinoid necrosis, "string of pearl" aneurysmsPolyarteritis Nodosa (tx = Cyclophosphamide)
Vasculitis, coronary arteries, asian children > 4 yo, rash on palm + soles of feet, strawberry tongue, ↑ risk of MIKawasaki Disease (Tx = aspirin + IV IgG) (kawasaki motorcycle = palm + sole, rush = heart)
Vasculitis, male, smokers, digits (toes, fingers, feet) --> gangrene, auto-amputation, Raynaud phenomenonBuerger''s Disease (Tx = stop smoking), eat Burgers w/ fingers and smoke w/ fingers
Vasculitis of nose + lungs + kidneys, c-ANCA+, Triad= necrotizing vasculitis, granulomas, glomerulonephritisWegner's Granulomatosis (Granulomatosis w/ Polyangiitis) (Tx = cyclophosphamide) C's of Wegner's
Vasculitis of lungs + kidneys, p-ANCA+, NO granulomasMicroscopic Polyangiitis (Tx = Cyclophosphamide + Corticosteroids) ((Like Wegner's, but NO granuloma, No nose, No c-ANCA)
Vasculitis of lungs + Eosinophils + granuloma, p-ANCA+, Asthma, ↑IgEChurg-Strauss Syndrome
Vasculitis after UPPER RESPIRATORY TRACT INFECTION, IgA complex deposit, Triad = Palpable purpura on buttocks/legs, Arthralgia, GI pains/melana. IgA nephropathyHenoch-Shonlein purpura
Vertigo + tinnitus + hearing lossMénière's disease (Endolymphatic Hydrops)
Vomiting blood, tear in gastro-esophageael junction b/c of forceful vomiting against a tight lower esophageal sphincter = loss of H+ in vomit = metabolic alkalosisMallory-Weiss syndrome (alcoholic/bulimic pxn)
"Waxy" casts w/ very low urine flowchronic end-stage renal disease
WBC casts in urineacute pyelonephritis
Weight loss, diarrhea, arthritis, fever, adenopathy, INTENSE PINK ON SLIDE (Glycoprotein) (Cardio + Arthritis + Neuro)Whipple's disease (Tropheryma whippelii, GI malabsorption) (FOAMY WHIPPed cream in a CAN)
White (curdy) discharge from vagina, pseudohypaeCandida albicans
Winged scapula, ipsilateral lymphademaLong Thoracic Nerve (from C5,C6,C7 roots) (Serratus Anterior), injured during masectomy
"Worst headache of my life"
Subarachnoid hemorrhage (Cerebral Arteries - Circle of Willis)

*Berry Aneurysm --> Anterior Communicating Artery --> Rupture = Subarachnoid hemorrhage

*Seen in Adult PKF, Marfan's and Ehler-Danlos Syndrome
Yellow-Green, foamy, foul smelling discharge from vaginaTrichomonas (Trichomonas vaginalis) (Tx = metronidazole)
Well differentiated papillary structure with calcifications and large, ground glass, grooved nucleiPapillary thyroid carcinoma (PSaMMoma)
Nests of polygonal cells with Congo red-positive depositsMedullary thyroid carcinoma (Men2aMen2b)
Pleomorphic giant cell nests with occasional multinucleated cellsAnaplastic Thyroid Carcinoma
Chromaffin Cells -> Activated by Acetylcholine -> release NE 20% & Epi 80%Adrenal Medulla Inner most area
Round eosinphilic, intraplasmic inclusions contain neurofilaments of alpha-synucleinLewy Bodies Parkinson
Round Eosinophilic inclusions in the cytoplasm of pyramidal hippocampal neurons and cerebellar Purkinje cellsNegri Bodies Rabies
Eosinophilic intracytoplasmic inclusions found in cortical NeuronsPick Bodies (Picks disease or Frontotemporal dementia)
Lamina calicfications PSaMMomaPapillary Thyroid carcinomas, Serous, Meingomas
Abdomen pain, DISTAL duodenum ulcer, diaarheaZolinger Elison Syndrome(Nongastric Neoplasm)
Chronic gastritis with Antral sparingAutoimmune Gastritis
Chronic Antral dominant gastritisH.Pylori
Vision LossOptic Nerve
Vertical and horizontal diplopia/ Ptosis/ non reactive pupilOcculomotor Nerve
Abduction of eye/ inward deviationAbducens
Double vision"Vertical diplopia"Trochelear nerve
Atrophic precentral gyrus and thin anterior roots of spinal cord. Loss of neurons in anterior horn of spinal cord. Demyelinization of corticospinal tractsAmyotrophic lateral Sclerosis
Enteroviral infection, Damages motor neurons of anterior horns-> Pure lower motor diseasePoliomyelitis(Flaccid paralysis, atrophy areflexia)
Atrophy of caudate nucleus and putamen leading to dementia, behavorial changesHuntington
5-15yrs difficulty walking, HCM, KYPHOSCOLIOSIS, foot abnormalities, diabetesFriedrich Ataxia
Fertility evaluation(Estrogen), irregular menustral(Progestrone), mild hypertension, Obese, Facial acne and excessive hair growth(Spirnolactone)Polycystic ovarian disease "Enlarged ovaries"
Intracranial tumor, Uptake bromodeoxyuridine a thymidine analogHighgrade means tumor differentiation
Hurthle cells, Lymphocytic infiltrate with germinal centers, Antimicrosomal and anthithyroglobulin antibodiesHashimotos thyroiditis
Potbellied, pale, puffy faced child with protruding umbilicus and protuberant tongueCretinism
Increased ESR, Jaw Pain, Inflammation and very tender thyroidSubacute thyroiditis
Fixed , Hard (Fibrosed rock like and painless goiterRiedels thyroidits
During Stress, TSH antibodies, proptosis, PRETIBIAL myxedema, diffuse goiterGraves Disease
Stress induced catecholmine surge, May see increase Alkaline phosphataseThyroid storm
Focal patches of follicle working independant of TSH due to mutation of receptors "Multinodular goiter" -> Thyrotoxicosis due to iodine repletionToxic Multinodular goiter.
Childhood radiation History, Ground glass nuclei(Orphan Annie), Psammoma bodies, Nuclear groovesPapillary Thyroid carcinoma(Excellent)
Uniform FolliclesFollicular Thyroid Carcinoma(Good)
Female with amenorrhea, GaLaCtoRrhea, low libido,Hairy and manly, infertility, bitemporal hemianopiaPituitary Adenoma
Islet Leukocyte infiltrationDiabetes Type1 (Younger)
Islet Amyloid DepositionDiabetes Type2 (Older)
Small,round blue cell tumors, Children, NEURITIC PROCESS(neuropil). NSE,chromogranin,synatophysin and s100, HVA, VMANeuroblastoma(n-myc)
Chest pain, cough, medistanial widening, decresendo diastolic murmur, FTA-ABSAortic Regurg(Tertiary syphilis) Vasavasorum obliteration
Olderfemale, weight loss, abdominal discomfort, jaundice, epigastric massPancreatic cancer
Long history of pruritius, High alkaline phosphatase, antimitochondiral antibodies, fatigue, pale stool, and xanthelsema, granuloma destruction of interlobular bile ductsPrimary Biliary Cirrhosis(Similiar to graft vs host disesase HISTOLOGY)
Nueroendocrine cell basal layer of epidermis for perception of touchMerckel
Head size increased percentile for age, significant dilation of lateral ventricles, irritability, poor feeding, muscle hypertonicity, hyperreflexia due to upper motor neuron damage by stretching of periventricular pyrimadsHydrocephalus
Sudden onset of Difficulity swallowing, blurred vision. Normal nerve conduction but abnormal compound muscle action potentialBotulism(Diplopia,Dysphagia,Dysphonia)
Red , flushed, cheeks with circumoral pallorSlapped cheek syndrome (replicates in bone marrow and loves erythroid precursor cells)
Child, gait instability, frequent falls, kyphoscoliosis, pes cavus(Higharch), lower extremity ataxia, position and joint sensation impairedFriedreich Ataxia leads to Hypertrophic cardiomyopathy
Cola colored urine, history of streptococcal infection, facial edemaPoststreptococcal glomerulonephritis(Age the best prognosis factor)
Watery Diarrhea, abdomnal cramps, nausea, vomiting, after trip to underdeveloped country & resolved on its ownETEC(Cholera like toxin - LT or ST toxin)
Young pt, Mid systolic click followed by short systolic murmur, myxomatous degeneration, marfan syndrome Mitral Regurgation
Cut blood for <30Reversible Heart injury
Cut blood for >30Irreversible Heart Injury
Cut Blood for >1 MinuteDecrease Contractility
Hyperesterinism(Gyncomastia), Alcoholic, testicular atrophy, light hairSpider Angiomata (Liver unable to catabolize estrogen(Androestidone)
Pregnant Women Hyper esterinismSpider Angiomata
>70 yr, dyspenia, fatigue, Harsh ejection murmor radiating to neckSenile Aortic Stenosis (Calcium deposition)