Most Likely Diagnosis
Sarcoidosis
African-Americans. Dry cough, hilar lymphadenopathy, erythema nodosum, anterior uveitis. (NON-caseating granulomas)
Cardiogenic Shock
Hypotension and CHF at the same time.
Ventricular Septal Defect
MC congenital heart disease in childhood; high-pitched harsh systolic murmur best heard at LLSB; +/- palpable thrill
Peripheral Artery Disease
Claudication brought on by exercise & relieved with rest. Muscle atrophy, thin/shiny skin, hair loss, thick nails, cool limbs, usually no edema, decreased capillary refill, decreased/absent pulses
Compression fracture secondary to osteoporosis
Sudden or gradual onset of back pain and loss of height in the affected vertebral body
Atrial Septal Defect
Systolic crescendo-decrescendo; widely fixed-split S2 that does NOT vary with respiration
Diaphragmatic Hernia
This is in a baby. Congenital defect - hole in the diaphragm allowing abdominal contents into the thorax. Babies have bowel sounds in the thorax, tachypnea, tachycardia, cyanosis, diminished breath sounds
Cor Pulmonale
This is right sided CHF and it's the most common cardiac finding associated with chronic bronchitis. JVD/HJR/ascites/leg edema
Bezoar
"Lack of appetite. Feeling full after eating a small food portion. N/V and abdominal pain. Bloating. Trichophagia"
Cancer, bone, secondary
sudden, severe pain in the upper arm followed by weakness in arm movement and a visible bulge in the upper arm muscle
Aortic Insufficiency
Diastolic blowing decrescendo murmur best heard in LUSB that increases when pt sits and leans forward, squats, or lays supine and raises leg; decreases with valsalva maneuvers and standing; wide pulse pressure; bounding pulses; definitive diagnosis made on cardiac catheterization
Arrhythmia, Paroxysmal Supraventricular Tachycardia (PSVT)
Heart rate > 100 bpm; rhythm usually regular with narrow QRS complexes; P waves hard to discern due to the rapid rate
Tricuspid Regurgitation
Holosystolic blowing high-pitched murmur @ LLSB. No radiation. Increase murmur intensity with inspiration (Carvallo's sign.) Usually from IV drug use
Chondromalacia patellae
Knee pain and tenderness, particularly when going up and down stairs or sitting for long periods, often accompanied by a grinding or creaking sensation in the knee.
Indirect Inguinal Hernia
Lateral to the inferior epigastric artery. Follows testicle tract into scrotum. Often congenital due to patent process vaginalis. Most common type in both men and woman. Right sided more common
Bacterial Tracheitis
Like a super sick croup. Inspiratory strider - increasing deep or barking croup cough post URI. Started as a low grade, viral illness then had a spike in fever as a bacterial infection set in. "Scratchy" feeling in throat; hoarseness; chest pain, fever, headache, dizziness. dyspnea
Endocarditis, bacterial
Look at hands for splinter hemmorhages, Osler's Nodes and Janesway Lesions. In the eye it's Roth spots. Explore IV drug use or anyone who already has an artificial valve
Vitamin B12 Deficiency
Look for neuro symptoms and glossitis. Neuro sxs: paresthesias, gait abnormalities, memory loss. GI: glossitis, anorexia, diarrhea, macrocytic anemia with hypersegmented neutrophils
Superior Vena Cava Syndrome
Lung cancer pushing on the SVC. +JVD. Characteristic features are edema of the face (facial plethora) and arms worse in the monring
Interstitial Lung Disease
M > 40yo smoker w/ reticular opacities/honeycombing and ground glass appearance on CT. There is a reduced lung volumes and increased FEV1/FVC
Arrhythmia, premature atrial contractions
PAC is a premature atrial beat. There will be an early beat with a P wave
Sprain, shoulder, rotator cuff
Pain. Weakness. Stiffness. Swelling. Difficulty with activities: Patients may have difficulty with activities that place stress on the shoulder, such as lifting objects or playing sports
Cancer, Pancreas
Painless jaundice. Cancer weight loss. History of ETOH abuse
Arrhythmia, Ventricular Fibrillation
Patient is in cardiac arrest. Dead. Only treatment is CPR and defibrillation
Pneumoperitoneum
Something perforated (usually appendix, diverticulum, or peptic ulcer); Most sensitive test is free air under diaphragm omn upright CXR. Demands an operation.
Boerhaave Syndrome, Rupture of Esophagus
Anyone who was scoped yesterday and is sick today is a perforation until proven otherwise. This is full thickness rupture of the distal esophagus. Often associated with repeated, forceful vomiting (ex. bulimia) or iatrogenic perforation of the esophagus during endoscopy procedure. Retrosternal chest pain, hematemesis, crepitus due to pneumomediastinum
Esophagus Perforation
Anyone who was scoped yesterday and is sick today is a perforation until proven otherwise. This is full thickness rupture of the distal esophagus. Often associated with repeated, forceful vomiting (ex. bulimia) or iatrogenic perforation of the esophagus during endoscopy procedure. Retrosternal chest pain, hematemesis, crepitus due to pneumomediastinum
Bunion
enlargement of bone or tissue around the joint at the base of the big toe
Regurgitation, mitral
high-pitched, "blowing" holosystolic murmur best heard at the apex
Vitamin Deficiency, Riboflavin
"""Oral-Ocular-Genital"" Syndrome: Oral: magenta colored tongue, angular cheilitis, pharyngitis. Ocular: photophobia, corneal lesions. Genital: scrotal dermatitis "
Cardiac Tamponade
"Beck's Triad (JVD-""distended neck veins"", muffled heart sounds, low BP)
Cystic Fibrosis
"Classic: young pt with bronchiectasis (foul smelling sputum/chronic cough and lung infections.) Chronic sinusitis, pancreatic insufficiency (steatorrhea), growth delays & infertility Meconium ileus @ birth "
Pulmonary valve stenosis
"Click" separated from the first heart sound. Part of Tetralogy of Fallot
Budd-Chiari Syndrome
"Condition caused by blockage (thrombus) of the portal vein. Presents with hepatomegaly, ascites, RUQ pain, rapid development of acute liver disease - jaundice & hepatosplenomegaly. Most common in women ~ 25 years old. 20's-30's. "
Coronary Artery Vasospasm: Variant (Prinzmetal) Angina
"Coronary spasm leading to transient ST elevations; the chest pain is usually non-exertional, often occurring @ rest (early morning or wakes pt up at night.) Angiography:vasospasm with IV Ergonovine Cocaine-induced MI: coronary artery vasospasm we treat with CCB & Nitrates; avoid BB"
Atrial Fibrillation
"EKG: irregularly irregular rhythm, no P waves, usually narrow complex QRS Presents as either an arrhythmia or an embolic event (CVA, limb ischemia, mesentery ischemia, renal artery stenosis)"
Arrhythmia, Atrial Fibrillation
"EKG: irregularly irregular rhythm, no P waves, usually narrow complex QRS Presents as either an arrhythmia or an embolic event (CVA, limb ischemia, mesentery ischemia, renal infarct)"
Joint injury, knee (meniscus)
"Injury presents as pain, swelling, and stiffness in the knee joint, with difficulty moving the knee and a popping or clicking sensation while walking or moving the joint.
Kawasaki Disease
"Most common in children less than 5 YO, boys, Asians ""Warm + CREAM"" - Conjunctivitis, Rash, Extremity changes, Adenopathy, Mucous membrane (lip swelling/fissures, strawberry tongue)"
Pulmonary Hypertension
"Most common symptoms include the following: dyspnea and fatigue. The most common initial symptoms is exertional dyspnea, lethargy, and fatigue. Accentuated increased S2 Signs of R-sided CHF JVD/HJR/ascites/edema"
Acute MI, Anterior
"ST elevations in V1-V4 on 12-lead EKG with resiprocal changes "
Silicosis
"Sand-blasting/quarry work/pottery. Small round opacities throughout lungs- ""eggshell calcifications"" of hilar and mediastinal lymph nodes; usually affects upper lobes "
Essential Hypertension
"Stage 1: SBP 130-139 mmHg or DBP 80-89 mmHg Stage 2: SBP > 140 mmHg or DBP > 90 mmHg "
Hiatal Hernia
"Type I ""sliding"" and is most common. "slides" into mediastinum increasing reflux Type II = Paraesophageal/"rolling" = fundus of stomach protrudes through diaphragm with gastroesophageal junction remaining in anatomical location"
Abdominal Aortic Aneurysm
"White men > 65 YO with a smoking history Asx until expanding/ruptures; rupture = sudden, severe, constant back/flank/abdominal/groin pain and/or in shock Palpable pulsatile abdominal mass on PE "
Arrhythmia, Bradycardia
HR < 60bpm. If responsive to atropoine, usually benign. If not responding to atrpoine, probably needs a pacemaker
Arrhythmia, PSVT
HR usually about 150. Narrow QRS complex with a T wave in-between
Pertussis
1. Catarrhal phase - excessive discharge or buildup of mucus in the nose or throat (for 1-2 weeks; most contagious) 2. Paroxysmal phase - a fit, attack, or sudden increase or recurrence of symptoms (cough fits, inspiratory whoop, +/- post-tussive emesis for 2-4 weeks) 3. Convalescent phase - they get better. Treat house hold contacts with macrolides
Pulsus Paradoxus:
> 10 mm Hg decrease in SBP w/ inspiration "
Empyema
A type of pleural effusion that is filled with pus - or an intro lung abscess. Consider with a post op day 4 fever.
Heart murmur, venous hum
AKA "innocent heart murmur." Causes: fever, anemia, hyperthyroidism, pregnancy
G6PD Deficiency
African-American males genetic blood problem. Asymptomatic until times of crisis (something attacks the RBS: infections, fava beans, sulfa drugs and others.) Episodic acute hemolytic anemia (elevated retics/bilirubin/Coomb's.) Back or abdominal pain, jaundice, dark urine, splenomegaly
Papillary muscle rupture
Acute CHF with hypotension (AKA cardiogenic shock or flash pulmonary edema)
Papillary Muscle Rupture
Acute onset of MR ~ 2-7 days s/p STEMI/NSTEMI; sudden onset of hypotension and pulmonary edema; definitive dx with echocardiogram
Embolism, pulmonary
Big "saddle" PE = Sudden onset of SOB. Abnormal vital signs and very sick. Tachypnea leading to respiratory alkalosis + hypoxemia. Small ones have purely pleuritic chest pain, cough/hemoptysis.
Mitral Regurgitation
Blowing holosystolic murmur. Radiates to the axilla
Effusion, pleural
Blunting of costophrenic angles on CXR. Fluid levels on lateral decubitus CXR: physical exam has dullness to percussion, decreased fremitus, decreased breath sounds. Can be transudate or exudate.
Cholangitis
Charcot's Triad:RUQ pain/jaundice/fever. Murphey's & Boas sign
Myocardial infarction
Chest pain > 30 min not relieved by rest or NTG. ST-elevation in 2 contiguous leads + reciprocal changes. Jaw pain, "GERD" like abdominal pain, dyspnea/SOB. Diaphoresis. N/V. Precipitated by exertion
Flail chest
Chest trauma. Multiple rib fractures resulting in a segment of the chest wall moving paradoxically in opposite directions during respiration.
Prosthetic perivalvular leak
Complication of an artificial heart valve surgery. May initially present as a heart murmur or severe anemia, CHF (SOB/edema)
Patent Ductus Arteriosus
Continuous machine-like murmur. Left to Right shunting of blood (noncyanotic)
Tuberculosis
Cough lasting at least 3 weeks. CP. Hemoptysis, night sweats, fever, chills, wt. loss; cavitations on CXR (caseating granulomas.) Latent TB will not present with symptoms and cannot spread to others
Lung Cancer
Cough, chest pain, SOB, unexplained wt. loss, sometimes hemoptysis (in small & squamous cell.) Exact same persentation as TB
Supraventricular Tachycardia
EKG: Narrow complex and tachycardic with T wave between. "Skinny - bump - skinny bump"
Cardiomyopathy, Alcoholic
ETOH causes dilated cardiomyopathy = systolic HF --> S3 gallop + decreased EF + h/o ETOH; thin ventricular walls on echocardiogram
Biliary Dysfunction
Early symptoms: itchy skin that can progress into dry eyes/mouth, RUQ pain, edema, xanthomas, jaundice, steatorrhea (pooping out lipids)
Mallory Weiss Tear
Excessive vomiting with wrenching and small amount of hemodynamically stable blood. Benign upper GI bleeding
Pneumococcal Pneumonia
Gram-positive gram stain; blood-tinged sputum with rapid onset of fever and chills. Bronchial breath sounds with dullness to percussion, increased tactile fremitus and egophony
Acute Bronchitis
Inflammation of bronchi often follows URI. MCC = viral (adenovirus.) Hallmark = cough with or without production. May lasts 1-3 weeks. CXR = normal. Low grade fever. If the patient is a chronic smoker and has a chronic cough with sputum production, that's not acute bronchitis. That's an acute exacerbations of chronic bronchitis
Atrial Fibrillation
Irregularly irregular rhythm with fibrillatory waves on EKG; atrial rate > 250bpm
Chondrocalcinosis
Joint pain, stiffness, and swelling, often accompanied by a crunching sound or sensation when moving the affected joint
Bronchogenic Carcinoma
Most commin cause is smoking and it's the most commmon cause of cancer-related deaths in US. Adenocarcinoma is most common and is a peripheral lesion. Squamous has "CCCP" (Ccentral, Cavitary, hyperCalcemia, panCoast syndrome.) Small cell is most aggressive - central lesions, and associated with paraneoplastic syndromes (SIADH and Lambert Eaton Syndrome.) WARNING - same exact presentation as TB
Atelectasis
Most common cause of cause of Post-Op fever day 1. Atelectasis is a collaspe of all or part of a lung from numerous causes. There will be loss of volume - raised diaphragn or shifting of medistinal structures towards affected lung.
Meckel Diverticulum
Most common congenital anomaly of the gastrointestinal tract. It results from incomplete obliteration of the vitelline duct leading to the formation of a true diverticulum of the small intestine. Look for painless rectal bleeding/ulceration
Gastroparesis
Ofen seen in diabetics. Lack of appetite. Feeling full after eating a small food portion. N/V and abdominal pain. Bloating
Fatty Liver
Often without symptoms. Often associated with metabolic syndrome and found with elevated AST/ALT or when hepatic steatosis was detected incidentally on abdominal imaging
Acute Respiratory Distress Syndrome (ARDS)
Only seen in critically ill pts. Severe hypoxemia not responsive to highflow oxygen. Bilateral pulmonary infiltrates on CXR. Usually seen in sepsis, burns and pancreatitis
Septal defect, ventricular
Poor growth and weight gain. CHF (SOB/edema) often diagnosed in infants
Paralytic Ileus
Post-op ileus. Post op we always ask about flatus/BM. These patients have no bowel sounds/BM or flatus
Coarctation of the Aorta
Refractory HTN. Bilateral lower extremity claudication. BP in upper extremities > lower extremities. Delayed or weak femoral pulses
Heart failure
SOB - they always has dyspnea on exertion. Look for leg swelling, JVD,HJR and ascites
Pleurisy
Sharp, stabbing, burning or dull pain in either side of the chest during breathing - especially when one inhales & exhales/laughs /coghs or sneezes
Effusion, pericardial
Shortness of breath. CP usually when supine
Restrictive lung disease
The patient has a difficult time breating in for a number of reasons. Decreased total lung capacity (TLC), residual volume (RV), functional residual capacity (FRC), forced vital capacity (FVC), and FEV1; normal FEV1/FVC (which are altered in obstructive disease.)
Reiter's syndrome
They will have complaints for an eye problem and a joint problem at the same time. Look foor STD (chlamydia) or dirrhea (Yersinia, salmonella, camplobacter, shigella)
Hypertension, secondary
Things to look for: Hypercalcemia for hyperparathyroidism. Excessive fat with cushing's. Abdominal bruit and refractory to ACEI with renal artery stenosis. Low K+ with hyperaldosterone.
Mesothelioma
Unilateral pleural thickening on CXR with history of exposure to asbestos. This is a lung cancer - so there will be weight loss, night sweats, pleuritic chest pain, and hemoptysis
Rhabdomyolysis
Usally from a crush injury or prolonged laying in one position. Can be from meds (statins)
Pseudomembranous Colitis
Usually after recent abx use (clinda most common antibiotic cause. )Copious watery stools, mucus or blood, lower abdominal pain/cramps, low-grade fever, nausea, anorexia
Giant Cell Arteritis
Usually elderly female. Unilateral temporal HA with visual disturbance. scalp tenderness. Jaw claudication
Humerus fracture
Usually elderly females post fall
Right atrial hypertrophy
Usually from a problem with the tricuspid valve. Heart palpitations, CHF: SOB/edema
Fracture, vertebra
Usually in elderly with osteoporosis. Sudden onset of back pain, difficulty moving, limited range of motion, and potentially nerve symptoms such as weakness, numbness, or tingling.
Pericarditis, acute
Usually post viral infection. Chest pain worse when supine and relieved sitting forward. Possibly a friction rub
Wolff-Parkinson-White
Wide complex QRS (>0.12 sec) 2. Short PR interval (<0.12 sec) 3.Delta wave
De Quervain tenosynovitis
presents as pain and swelling at the base of the thumb, with difficulty moving the thumb and wrist