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