Word Associations

This study sheet is used to help you recognize key words and patterns associated with certain diagnosis. It is NOT intended to steer you to remember answers to test, but instead to help you recognize the intent or most likely diagnosis. The information of that specific diagnosis is up to your level of knowledge. It’s to help narrow that differential so you can focus on the specifics of the most likely diagnosis.

CARDIO

Description	Diagnosis Associated
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	Mitral valve prolapse
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	Tetralogy of falot
Holosystolic murmur @ LSB, may have ventricular hypertrophy	VSD
Infant w/ dyspnea, difficulty feeding. Holosystolic murmur @ LSB, 3^rd ICS. LVH & RVH	VSD
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 Claudication with rest pain, (ABI < 0.4)	Arterial insufficiency/PAD, Intermittent claudication (ABI best choice, ateriogram gold standard) 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

PULMONARY

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)

GI/NUTRITION

Description	Diagnosis Associated
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 1^st 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&V	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

ENDOCRINE

Description	Diagnosis Associated
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)

GU/ELECTROLTES

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
RBC casts
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

NEURO

Description	Diagnosis Associated
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

HEENT

Description	Diagnosis Associated
< 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 1^st 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

HEMATOLOGY/ONCOLOGY

Description	Diagnosis Associated
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

INFECTIOUS DISEASE

Description	Diagnosis Associated
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

MSK/RHEUMATOLOGY

Description	Diagnosis Associated
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 – 3^rd metatarsal. Associated w/ tight shoes, relieved by removing shoes. Palpable painful mass	Morton’s neuroma; Tx w/ NSAIDs, wide shoes, then steroid injections
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

PSYCHE

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