PANCE/PANRE Word Associations Study Sheet

PANCE/PANRE Word Associations
1

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. Its 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, pagets 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

2

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
(Becks triad)
Pericarditis post open heart surgery Dresslers 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

3

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, Quinckes pulse, Corrigans
pulse, Austin flint murmur,
deMussets sign, water
Aortic Regurgitation/Insufficiency:
Quinckes 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


4

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
Marfans 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
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)

5

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 Miners 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 (Virchows 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

6

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)

7

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
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 (Charcots
triad)

8

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 Gilberts 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
Turners 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.

9

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 Meckels diverticulum
Alcoholic with massive hemoptysis Esophageal varicies (Tx w/ octreotide)

Female with recurrent abdominal pain,
alternating diarrhea, constipation.
Pain relieved with defecation.
IBS. TCAs (nortriptyline) good if
diarrhea predominant symptom

Bloody Diarrhea Ulcerative colitis

Supraclavicular LAD (L > R) Virchows 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
(Gardners 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)


10

Travelers 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 (4Ds 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

11

ENDOCRINE
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 Wernickes encephalopathy

Decreased radioactive iodine uptake,
decreased free T4, increased TSH
Hashimotos 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
Pheochromocytoma Tx pre-op w/
alpha blocker


12

metanephrines
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 Addisons disease, crisis

Hyperpigmentation, hypoglycemia,
orthostatic hypotension, hypotension
not responsive to fluids, hypotension
following an illness, trauma, or surgery

Addisons 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
Addisons disease, crisis (Low
aldosterone; get Random or AM
cortisol, ACTH stimulation test)

Hyponatremia, hyperkalemia Acute adrenal insufficiency
(Addisons crisis)

Polyuria, polydipsia. Dilute urine,
Hypernatremia
Diabetes insipidus
Concentrated urine. Hyponatremia SIADH


13

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
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 Peyronies disease
Cant retract foreskin Phimosis
Inflammation of glans Balanitis

14

< 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
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

15

Meningitis > 2yo, adults Strep, N. meningititis
Viral Meningitis Mumps

Unilateral facial weakness w/ inability
to close eye
Bells 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); Lhermittes
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

16

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

Reyes 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
< 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

17

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


18

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
Menieres 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

19

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
Philadelphia chromosome CML
Auer rods AML

Reed-sternberg cells Hodgkins lymphoma
Painless LAD (us. Neck or axilla),
LAD in orderly fashion; B signs +
pruritis; splenomegaly; LN pain after
drinking alcohol
Hodgkins 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-Hodgkins 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


20

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
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
Woods 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

21

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, Bells 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


22

MSK/RHEUMATOLOGY
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
Colles 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.
deQuervains tenosynovitis
Hand injury after a punch Boxers 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

23

Pain on plantar foot @ 2 3
rd

metatarsal. Associated w/ tight
shoes, relieved by removing shoes.
Palpable painful mass
Mortons neuroma; Tx w/ NSAIDs,
wide shoes, then steroid injections

Pain after tx of fracture w/ cast Compartment syndrome

HLA-B27 Ankylosing spondylitis, Reiters
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
Reiters syndrome

Erythema nodosum Systemic autoimmune diseases (RA,
IBD), OCP
Female with Arthralgias, malar rash,
+ANA, + anti-double stranded DNA
antibodies, +anti-phospholipid
antibodies
SLE


24

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
Raynauds 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
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


25

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
Parkinsons

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


26

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
TCA overdose

REPRO
Frothy, clear white or yellow-green to
gray adherent vaginal discharge,
dysuria, vaginal pruritis. Vulvar and
cervical erythema. Flagellated
protozoa
Trichomonas
Fishy odor, Thin grayish vaginal
discharge, Clue cells
Bacterial vaginitis; Gardnerella
vaginalis
Thick white vaginal discharge, hyphae
& buds on KOH prep
Candida
Postmenopausal, dyspareunia, thin
vaginal discharge, atrophic vulvar
changes, vaginal petechiae
Atrophic vaginitis; Tx = topical
estrogen

Secondary amenorrhea Pregnancy
Female with acute abdominal pain. No
characteristic acute abdomen pattern
Ectopic pregnancy

20yo female w/ rubbery, firm, well-
circumscribed, non-tender breast
lesion, doesnt change w/ cycle
Fibroadenoma

30 50yo female, painful, multiple,
bilateral breast masses that increase in
pain and size before menses

Fibrocystic breast disease


27

Spontaneous bloody, serous, or cloudy
nipple discharge

Intraductal papilloma

Breast mass, nipple retraction, bloody
nipple discharge
Breast cancer (mass is most common
presenting clinical manifestation)

Overweight, irregular menstrual cycles
(poss. Amenorrhea), elevated blood
sugar, hirsutism
PCOS (stein-leventhal syndrome)
Adolescent female with midcycle pain
alternating from left to right side.
Relieved w/ NSAIDs
Mittelschmerz
Dysmenorrhea, dyspareunia, dyschezia.
Uterus is fixed, retroflexed. Cyclic
pelvic pain. May have palpable pelvic
mass
Endometriosis. Palpable pelvic mass
chocolate cyst
Firm irregular shaped, NONTENDER
enlarged uterus
Leiomyoma
Softened, tender, diffusely globular
uterine enlargement
Adenomyosis

6cm unilateral, mobile, tender adnexal
mass
Tubo-ovarian abscess

Pregnant Nagels rule: LMP + 7 3 mo
Pregnant + rash, post-auricular or
occipital LAD
Rubella. Give vaccine AFTER delivery
Pregnant, HA, visual disturbance Pre-eclampsia
Pregnant, seizures Eclampsia

Pregnant < 20 wks gestation w/ vaginal
bleeding, abd & pelvic pain. Blood
from closed cervical os.
Threatened abortion
Pregnant < 20 wks gestation w/ vaginal
bleeding, abd & pelvic pain. Tissue at
or said to be passed from open
cervical os.
Incomplete abortion (complete
abortion will have empty uterus,
complete passage of fetal tissue, pain
resolves after passage of tissue)

28

Pregnant who drinks during pregnancy
and inadequate peri-natal care
Fetal alcohol syndrome low birth
weight

Postpartum hemorrhage Uterine Atony. Tx = uterine massage

Postmenopausal vaginal bleeding Endometrial Ca do endometrial
biopsy
Postmenopausal adnexal mass Ovarian Ca

DERM
Procainamide, hydralazine & rash Lupus-type eruptions
Photosensitive rash TCN, Sulfa drugs

Woods light Coral red = Erythrasma
KOH Fungus, Candida; Hyphae & buds,
spaghetti & meatballs
Gram stain Bacterial infections

Beefy red, sharp bordered rash in
groin (infants), under breast folds with
satellite lesions
Candida: Tx: Nystatin/Lotrimin
cream QID x14d; if fails Ketoconazole
Warm, erythematous, tender skin with
possible induration or fluctuance
Cellulitis
Red, less distinct borders. Coral red
fluorescence under Woods lamp
Erythrasma
Distinct, sharp raised demarcated
border with fever, chills. Group A
Strep
Erysipelas
Grouped vesicles on erythematous
base
Herpes virus
Infant or pediatric w/ grouped vesicles
on thumb or tapioca vesicles on
thumb
Herpetic whitlow

29

Pain preceding vesicular rash in
dermatomal pattern
Herpes Zoster (if involved eye =
herpes keratitis. NO steroids. Get
immediate ophthalmology referral)
Hx URI the palpable purpuric rash to
buttocks, posterior thighs
HSP (Hx post Strep A infection)
Honey colored crusts on erythematous
base around nose & mouth
Impetigo. Tx = Mupirocin
Small white papules on diffusely red
base on buccal mucosa
Koplick spots Rubeola (Measles).
Spots occur before rash
Cough, coryza, conjunctivitis Rubeola (Measles)

Pastias lines, positive ASO titer Scarlet fever (Grp A Strep)
Strawberry tongue Scarlet fever (Grp A Strep)
Pruritic raised erythematous plaques Urticaria
Dewdrops on rose petal, pustules &
vesicles at different stages of healing
Varicella (Chicken Pox)

Flesh-colored, pink or yellow-brown
lesion with rough, sandpaper feel, at
sun-exposed areas
Actinic Keratosis
Non-pruritic, raised, warty brown-
black plaques, stuck onto skin feel
greasy
Seborrheic keratosis

Flat brown spots with sharp borders
on dorsum of hand
Lentigines
Erythematous, dome-shaped nodule
with central plug
Keratoacanthoma

Raised pearly-borders, telangiectasia,
central ulcer
Basal cell Ca
Pearly papule with umbilicated center Molluscum contagiosum

Sexually active person w/ rash on
palms & soles, general LAD

Secondary syphilis (Money spots);
VDRL will confirm


30

Scabies & Pediatrics NO LINDANE (KWELL). Permethrin
(Elimite) is drug of choice

Christmas tree pattern, erythematous
papules w/ oval plaues w/ scaly itchy
border. Rash preceded by lagre oval
plaque w/ central clearing & scaly
border
Pityriasis rosea; Herald patch
Hypopigmented lesions, white, scaly.
Gets worse w/ tanning or sun exposure
Pityriasis Alba
Erythematic ring with scaly border &
central clearing

Tinea (fungal infection); KOH prep =
hyphae

spaghetti & meatballs Tinea (fungal infection
Thick, yellow, brittle nails Onychomycosis. Tx = PO Terbinafine

Infant w/ erythematous, scaly crusty
lesions at vertex of scalp

Cradle cap seborrheic dermatitis (Tx
in infants w/ baby shampoo, warm olive
oil compress, mild Hydrocortisone
cream; Adults selenium sulfide
shampoo)

Children < 10yo w/ vesicles on pharynx,
mouth, hands, feet w/ NO ulceration
Hand-Foot-Mouth disease.
Coxksackie Virus
Healthy looking < 5yo with lace-like
rash on both cheeks red papules
Erythema infectiosum Slapped
cheek, 5
th
Dz.
Pediatric with high fever then after
fever macular rash over trunk and
neck. (rash after defervesence)
Roseola infantum (Herpesvirus);
Motrin, symptomatic treatment
Truncal Rash in pediatric after fever Roseola infantum (Herpesvirus);
Motrin, symptomatic treatment
Fever, pharyngitis, sandpaper rash
over face, neck, trunk, extremities
Scarlet Fever
High fever (up to 105
o
F) x 5 days then
rash. May have conjunctivitis,
cracking, lip fissures
Kawasakis Disease; look for cardiac
complications (myocarditis,
pericarditis, arteritis, aneurysms)

31

Erythema marginatum Rheumatic Fever

Silvery scaling plaques on extensor
sensors. Ausptiz sign, Koebners
phenomena
Psoriasis
Rat bite erosions on XR Psoriatic arthritis

Dark skinned person with whitening
or lightening of skin. Hx pernicious
anemia or other autoimmune disease
Vitilligo. Skin biopsy to diagnose

PEDIATRICS
Introduce solid foods (cereal, fruits) 4 6 mo; after 6 mo add meat, eggs,
starchy foods
1
st
tooth (central incisor) 6 8 mo
Walks alone 15 mo
3 words, fees self w/ spoon, builds
tower
24 mo

< 2mo fever Septic w/u - blood Cx, LP
< 5yo fever, seizures Febrile seizure

Premature birth, fetal maturity Give corticosteroids
Meconium-stained amniotic fluids Fetal distress

Positive osmotic fragility test G6PD deficiency (hemolytic anemia w/
oxidative drugs sulfa, nitrofurantoin,
quinidine)
Mousy urine PKU

Vit D Rickets X-linked dominant
Hemophilia A, Duchennes MD X-linked Recessive
Neurofibromatosis Autosomal dominant
Sickle cell, CF, PKU Autosomal Recessive

PANCE/PANRE Word Associations Study Sheet

Hochgeladen von

Dokumentinformationen

Originaltitel

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

PANCE/PANRE Word Associations Study Sheet

Hochgeladen von

Copyright:

Verfügbare Formate

PANCE/PANRE Word Associations

Das könnte Ihnen auch gefallen