PANCE/PANRE Word Associations

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 DOE, PND, edema. Echo w/ LVH or RVH, hypokinesis S3 High output heart failure Low output heart failure Heart failure after URI Young athlete with syncope during athletic event or practice. No physical exam abnormalities Alcoholic with DOE, heart failure Alcoholic with palpitations, arrhythmia Irregular irregular Atrial fibrillation or prosthetic valve Hx angina but no acute sx. EKG no acute changes. Crushing CP, dyspnea, palpitations, radiation to neck or left arm CHF CHF, dilagted cardiomyopathy Pregnancy, thyrotoxicosis, anemia, beriberi, pagets disease Ischemic heart disease, HTN, dilated CM, valve disease, arrhythmia Myocarditis Hypertrophic CM or fatal arrhythmia. Get EKG or Echo Primary dilated CM Atrial fibrillation (Holiday heart) Atrial fibrillation; (if > 48 or chronic anticoagulate) Warfarin (2 3 for Afib; 2.5 3.5 for valve); Tx Warfarin OD is vitamin K Do Exercise stress test Angina (if lasts minutes), AMI if lasts > 30 minutes. Acute Ischemia ST elevation; Injury T wave depression; Infarct Q wave Pericarditis Pericardial effusion/tamponade, pericarditis, asthma attack, tension PTX, SVC obstruction Pericardial effusion/tamponade Pericardial effusion/tamponade (Becks triad)
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Diagnosis Associated

Constant, sharp CP worse lying down, better sitting up and leaning forward pulsus paradoxus Electrical alternans, narrow pulse pressure, pulsus paradoxus JVD, Hypotension, muffled heart sounds

PANCE/PANRE Word Associations

Pericarditis post open heart surgery Sudden onset ripping, tearing chest pain, diminished pulses Flank pain, hypotension, pulsatile abdominal mass EKG changes, N, V, yellow-green visual disturbances Hx CHF on diuretic & digoxin Grossly elevated blood pressure esp. w/ signs of EOD HTN Tx w/ meds, cough or angioedema DM & HTN Heart failure, LVH Post MI Tx of HTN w/ alpha-blocker HTN not responsive to basic meds

Dresslers syndrome. Tx w/ ASA #1. Indomethacin or other NSAID OK. Aortic dissection AAA Digoxin toxicity (Hypokalemia will make worse) Suspect dig toxicity (hypokalemia from diuretic = dig toxicity) Malignant or Urgent HTN ACEI is cause ACEI is best choice ACEI (improves survival, prevents development of heart failure Sx) Beta-blockers SE is postural Hypotension Think secondary HTN most likely Renal artery stenosis (infrarenal artery). Bacterial endocarditis (strep. Viridians) prevention Bacterial endocarditis (strep. Viridians) Aortic stenosis (due to calcifications age related (or bicuspid valve congenital) Aortic stenosis Aortic Regurgitation/Insufficiency: Quinckes pulse (subungual capillar pulsation), Corrigan (rapid rise and fall), Austin filnt (low pitch middiastolic murmur at apex) Mitral stenosis (ARMS are BAD)
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Mechanical valve or prosthesis & Dental, GU, GI, or ortho procedure prophylaxis IVDA w/ new murmur Elderly w/ systolic murmur Diamond shaped, blowing systolic murmur. May have angina, syncope, CHF Lateral displaced PMI, Canon a waves, Quinckes pulse, Corrigans pulse, Austin flint murmur, deMussets sign, water Diastolic murmur best heart at apex without radiation

PANCE/PANRE Word Associations

Systolic ejection murmur heard best at base with radiation to left clavicle Female or Post MI, systolic murmur best @ apex preceded by click without radiation Systolic murmur heard best at apex with radiation to left axilla (apical systolic) New murmur after MI (esp. if apical systolic) Murmur & Hx rheumatic heart disease Continuous harsh, machine-like murmur Cyanotic infant with systolic thrill @ LSB, systolic ejection murmur +/click Holosystolic murmur @ LSB, may have ventricular hypertrophy Infant w/ dyspnea, difficulty feeding. Holosystolic murmur @ LSB, 3rd ICS. LVH & RVH Peds w/ leg pain after physical activity, abnormal heart sounds, unequal UE & LE pulses, rib notching

Pulmonary stenosis Mitral valve prolapsed Mitral regurgitation Mitral regurgitation (caused by papillary muscle rupture) Mitral stenosis #1, Tricuspid Stenosis #2 PDA Tetralogy of falot

VSD VSD

Coarctation of aorta

Short PR, wide QRS, Delta wave Young female (<30yo), palpitations, long arms & fingers, pectus excavatum, ectopic lentis, flexible joints 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)
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Wolf-parkinson-white; avoid Digoxin, Marfans Syndrome MVP, Aortic regurgitation, Aortic dissection, Aortic root dilatation, ectopic lentis

Arterial insufficiency/PAD, Intermittent claudication (ABI best choice, ateriogram gold standard) Tx is arterial bypass

PANCE/PANRE Word Associations

LE pain after long periods of standing. Dilated, tortuous, veins Trendelenberg test of extremities Blue extremities worse w/ cold exposure, improves w/ warming PULMONARY Description Rapid, deep labored breathing Deep breathing alternating w/ apnea Cavitations on CXR Apical infiltrates, F, C, dry cough Pleural thickening on CXR Hilar mass on CXR Eggshell pattern on CXR Ground glass appearance on CXR Reticular to nodular pattern on CXR Patchy fibrosis on CXR Granulomas and inflammation of alveoli, small bronchi and small blood vessels Dyspnea after surgery, travel (airplane), LE Fx. May have c/o calf pain also. Lung scan with perfusion defects Venous stasis, vessel wall injury, hypercoagulability Pediatric with barking cough, stridor

Varicose veins. Tx w/ compression stockings Tests for veinous insufficiency. Acrocyanosis

Diagnosis Associated Kussmaul breathing DKA, Metabolic acidosis Cheyne-Stokes breathing heart failure, brain damage Infections lung abscess, TB (Gohn focus) TB Mesothelioma Lung Ca Silicosis (Sandblasters) Asbestosis (shipbuilders, building demolition) Coal Miners lung Farmers lung Sarcoidosis

DVT/PE PE DVT/PE (Virchows triad) viral croup (laryngotracheobronchitis); Tx w/ racemic epi and glucocorticosteroids if stridor at rest. lower respiratory FB, asthma
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Pediatric wheezing

PANCE/PANRE Word Associations

Drooling, sniffing position, tripod, toxic Thumbprint sign Steeple sign Inspiratory stridor Premature infant with respiratory distress Preemie CXR w/ hypoexpansion (ATX), air bronchograms Smoker, chronic productive cough. NO hemoptysis, wt. loss. Smoker, DOE, cough Hyperinflation on CXR, tear drop heart Wheezing, prolonged expiration Airway edema with eosinophils, neutrophils, lymphocytes Fever, cough, sputum. Crackles, decreased breath sounds, dullness to percussion, +egophony, pectoriloquy. CXR infiltrates or consolidation >35yo with PNA. Rusty colored or yellow-green sputum. Acute onset F/C <35 yo, college students. Fever, cough, +/- sputum, chills, muscle aches Bullous myringitis PNA w/ Smokers, COPD PNA w/ DM, immunocompromised, EtOH. Currant color sputum. PNA w/ Water, late summer, construction site. Diarrhea. Toxic looking PNA from Nursing homes, chronic care facility. Purulent sputum PNA & HIV+, AIDS, Immunocompromised. Sx out of proportion to exam. Diffuse
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Epiglottitis Epiglottitis FB, viral croup (laryngotracheobronchitis) FB, viral croup (laryngotracheobronchitis) Hyaline Mb Disease Hyaline Mb Disease Brochitis (COPD) COPD Emphysema Asthma Asthma Pneumonia

Strep. Pneumonia Mycoplasma pneumonia Mycoplasma pneumonia H. influenza Klebsiella Legionella Staphylococcus aureus Pneumocystis jerovecii; TMP-SMX = Drug of choice

PANCE/PANRE Word Associations

interstitial & alveolar infiltrates PNA & decreased mental status, poor dental hygiene, dentures, foul smelling sputum, bronchiectasis. Patchy infiltrates in dependant lung zones Pediatric with Hx recurrent lung infections, pancreatitis, reproductive problems, FTT Sweat chloride test Cystic fibrosis w/ PNA < 2 days post-op with fever Stab wound, hyperresonance to percussion, decreased breath sounds, tympany Stqb wound, dullness to percussion, decreased breath sounds. Tall, skinny, male, band student, acute onset one-sided chest pain, dyspnea Stab wound to chest. Hypotension, tracheal shift

Aspiration PNA

Cystic fibrosis (Staph & Pseudomonal infections usually cause of death) Cystic fibrosis Pseudomonas aueroginosa causative agent Atelectasis Pneumothorax Hemothorax Spontaneous PTX

Tension PTX

Poor sleeping, obese, daytime fatigue Obstructive sleep apnea & drowsy, snoring, HTN, PM wakening 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 Fat, forty, female, fertile w/ RUQ pain Fever, RUQ pain, radiation to back Elevated Alkaline phosphatase,
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Diagnosis Associated Cholelithiasis or Cholecystitis Cholecystitis Cholecystitis

PANCE/PANRE Word Associations

urinary bilirubin F, RUQ pain, Jaundice, gallstones & dilated common duct on US Hx IBD, progressive RUQ pain, wt loss, F, jaundice & pruritis. Elevated bilrubin & alkaline phosphate. ERCP with bile duct stenosis, dilatation Elevated AST, ALT, indirect bilirubin Isolated elevated indirect bilirubin Elevated indirect bilirubin w/ defective glucuronyl transferase Photosensitivity, abd pain w/ neurologic dysfunction, erythema or skin fragility H.pylori gastritis Chronic cough, bitter taste in mouth or throat, dyspepsia Multiple or constant GI ulcer pain despite medications Ascending cholangitis (Charcots triad) Primary sclerosing cholangitis (diffuse intra- and extrahepatic duct sclerosing and dilatation) Hepatitis Gilberts syndrome Crigler-Najjar Dz Porphyria

2antibiotics & PPI GERD Zollinger-Ellison Syndrome

N/V, epigastric abdominal pain, worse Acute pancreatitis supine, caused by alcohol ingestion, or following fatty meals Peri-umbilical or flank ecchymosis Abdominal distension, bloating, intermittent, colicky pain, highpitched rushes & tinkles Air fluid levels on upright abd plain film Air under diaphragm, rigid board-like abdomen >60yo F, LLQ pain Elderly, Hx atherosclerosis. Dull crampy periumbilical pain postprandial
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Acute pancreatitis (Cullen & Grey Turners Sign) SBO SBO Perforated viscus, perforated ulcer Diverticulitis. IV Abx, fluids, NPO. Mesenteric ischemia

PANCE/PANRE Word Associations

Neonate w/ projectile vomiting. Olive sized mass. Choking, cyanosis, respiratory distress, increased secretions in 1st hours of life Painless rectal bleeding in pediatrics Alcoholic with massive hemoptysis Female with recurrent abdominal pain, alternating diarrhea, constipation. Pain relieved with defecation. Bloody Diarrhea Supraclavicular LAD (L > R) Hard periumbilical nodule PUD, Pernicious anemia (Type A Gastritis), H. pylori Apple core lesion Elderly with positive hemmocult. CEA Family history of young age colon cancer, multiple polyps found on colonoscopy AFP CA 19-9 CA-125 Chemotherapy induced N&V Travelers Diarrhea Greasy, foul smelling, floating stools. Pear-shaped flagellated protozoan w/ 2 eyes. Water, travel, camping history Afebrile, watery or loose stool. No
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Pyloric stenosis Tracheoesophageal fistula Meckels diverticulum Esophageal varicies (Tx w/ octreotide) IBS. TCAs (nortriptyline) good if diarrhea predominant symptom

Ulcerative colitis Virchows node metastatic abdominal cancer Sister mary Joseph nodule = indicates metastatic gastric and pancreatic cancers Gastric Ca Colon Cancer Colon Cancer get colonoscopy Colon Carcinoma Familial adenomatous polyposis (Gardners syndrome) Hepatocellular carcinoma, testicular seminoma (germ cell tumor) Pancreatic Ca Ovarian Carcinoma Treat with Ondansetron (Zofran) (5HT3 blockers) E. coli is cause. Hydration & Cipro to treat Giardia

Viral Gastroenteritis

PANCE/PANRE Word Associations

blood or mucus Abdominal pain, diarrhea after picnic/party. Eaten ham, cream, custards, mayonnaise Acute bacterial diarrhea w/ prodrome of HA, F, then crampy abd pain & diarrhea Painless rectal bleeding. Bulging perianal mass w/ straining Pediatric with perianal pruritis esp. at PM. Positive cellophane tape test Weight loss, recurrent greasy stools (steatorrhea) mixed with diarrhea after certain foods Anti-endomysial antibodies Beriberi Pellagra Scurvy Rickets Night blindness Magenta tongue s/p gastric bypass surgery or gastric surgery. N, abd cramping, dizziness after eating. No masses, bleeding ENDOCRINE Description Diabetic w/ anorexia, anemia, wt loss, pallor Gastroparesis, impotence, recurrent infections, stocking-glove paresthesia Hypoglycemia despite glucose administration. Increased C-peptide Hypoglycemia in alcoholic Decreased radioactive iodine uptake,
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Staphylococcus aureus infectious diarrhea Campylobacter jejuni most common cause of acute bacterial diarrhea Internal hemorrhoids Pruritis ani Pinworms (enterobiasis). Tx is Mebendazole Celiac Sprue Celiac Sprue Thiamine; Alcoholics, Neuro Sx Niacin (4Ds dermatitis, diarrhea, dementia, death), bright red tongue Vit C (easy bleeding, bruising, hair & tooth loss, joint pain & swelling) Vit D (Osteomalacia) Vit A deficiency Riboflavin deficiency (B2) Dumping syndrome

Diagnosis Associated CRF Diabetic neuropathy (Treat w/ TCA (amitriptyline) Insulinoma Give Thiamine before glucose to prevent Wernickes encephalopathy Hashimotos thyroiditis

PANCE/PANRE Word Associations

decreased free T4, increased TSH Female, weight loss, palpitations, atrial fibrillation Exophthalmos, palpitations, wt. loss. Elevated radioactive idodine uptake Post thyroidectomy most likely injury Post thyroidectomy electrolyte watch Infant w/ round face, large protruding tongue, dry skin, umbilical hernia, constipation, enlarged abdomen, poor feeding, delayed developmental milestones

Hyperthyroid (work it up with TSH, T4) Hyperthyroid, Graves Dx Tx w/ Radioactive iodine Recurrent laryngeal nerve = hoarseness Hypocalcemia Congenital Hypothyroidism

Recurrent HA, HTN not responding to Pheochromocytoma Tx pre-op w/ meds, sweating alpha blocker Attacks of severe HA, HTN, glucosuria Urinary catecholamines, urinary 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 Tetany, hypocalcemia, cataracts Exogenous corticosteroid use Dexamethasone suppression test Central obesity, abdominal stria, hyperglycemia, moon facies, buffalo hump, easy bruising Acute steroid withdrawal Hypothyroidism

Hypoparathyroidism Cushing syndrome Cushing syndrome Cushing syndrome

Addisons disease, crisis

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PANCE/PANRE Word Associations

Hyperpigmentation, hypoglycemia, orthostatic hypotension, hypotension not responsive to fluids, hypotension following an illness, trauma, or surgery Worsening fatigue, wt loss, weakness, recurrent abdominal pain, hair loss, hyperpigmentation. Hyponatremia, hyperkalemia Hyponatremia, hyperkalemia Polyuria, polydipsia. Dilute urine, Hypernatremia Concentrated urine. Hyponatremia 45,X low hairline, low set ears, webbed neck, short stature; shield chest, wide set nipples, infertility, lack of Secondary sex characteristics XXY - short stature, intelligence; small firm testes, gynecomastia, abn arm-body length

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

Addisons disease, crisis (Low aldosterone; get Random or AM cortisol, ACTH stimulation test) Acute adrenal insufficiency (Addisons crisis) Diabetes insipidus SIADH Turners (gonadal dysgenesis

Klinefelters (hypogonadism)

GU/ELECTROLTES Description Hyaline Casts Increased BUN/Cr, low FeNa Irritative voiding symptoms, Fever, chills, CVA tenderness Crush injury, alcoholic on ground, elevated CPK, ARF Painless hematuria, flank pain or mass

Diagnosis Associated Normal (may be present after febrile illness, strenuous exercise) Prerenal Failure (Azotemia) Pyelonephritis Rhabdomyolysis Renal cell Carcinoma

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PANCE/PANRE Word Associations

Oliguria, hematuria, proteinuria following streptococcal infection Hematuria, purpuric rash following streptococcal infection Hematuria, RBC casts, proteinuria RBC casts Kidney & lung bleeding (hematuria, hemoptysis) Fibrous band on lateral penis Cant retract foreskin Inflammation of glans < 40 yo male with Fever, perineal pain, dysuria. >50 yo obstructive voiding sx, nocturia. Firm smooth enlarged prostate. Nl PSA Incontinence with straining Peaked T-waves U waves QT prolongation Recurrent kidney stones, elevated Calcium, decreased phosphorus Hearing loss or tinnitus w/ metabolic acidosis NEURO Description Head trauma, disoriented lucent coma Lens shaped hemorrhage Concave LP w/ decreased glucose, increased protein LP w/ decreased protein, very few neutrophils Meningitis and rash

Acute Glomerulonephritis Glomerulonephritis, HSP Glomerulonephritis Goodpasteures Peyronies disease Phimosis Balanitis Acute prostatitis caused by Chlamydia & N. gonorrhea. Treat accordingly (Bactrim #2 choice). > 40yo think e. coli is cause (Tx w/ FQ) BPH. (Cancer would have firm, irregular, nodular non-tender prostate, elevated PSA) Stress HyperKalemia HypoKalemia Hypocalemia Hyperparathyroidism Aspirin OD

Diagnosis Associated Epidural Hematoma Epidural Hematoma Subdural Hematoma Bacterial meningitis syphilitic meningitis Meningiococcal
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PANCE/PANRE Word Associations

Meningitis & <2mo Meningitis < 4yo Meningitis > 2yo, adults Viral Meningitis Unilateral facial weakness w/ inability to close eye Adolescent female w/ HA. +FHx. Severe HA, N/V, photphobia. +/auras Male, recurrent relapsing HA. Worsened w/ EtOH, Lacrimation, salivation, rhinorrhea Sudden onset thunderclap HA, worse HA of my life >50 yo female w/ HA. Temporal artery tenderness or blindness

Grp B Strep, E. coli (Tx < 1yo = Vanco + Rocephin) H. inlu, Grp B strep, N. meningititis Strep, N. meningititis Mumps Bells palsy (self-limiting)

Migraine HA Cluster HA Subarachnoid hemorrhage Temporal arteritis (Giant cell arteritis). Elevated ESR, get temporal artery biopsy MS MS

Recurrent episodes of vision change, diplopia, weakness & tingling in extremities that resolve myelin fragments, IgG, oligoclonal bands (Pathognomonic); Lhermittes sign = electrical sensation down body w/ neck flexion HA worse in AM w/ focal neuro deficits s/p Fall w/ bilateral LE weakness, urinary and rectal incontinence, decreased rectal tone Ascending paralysis Paralysis after Campylobacter enteritis Weakness and fatigue in upper limbs, blurry vision, diplopia, respiratory

Brain Tumor (MC is glioma) Cauda equine syndrome = neurosurgical consult GBS GBS Myasthenia gravis
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PANCE/PANRE Word Associations

distress Young kid with difficulty standing from seated position. Calf muscle wasting Pediatric with fever or Hx URI with encephalopathy, emesis, hyperactive reflexes, hepatomegaly, elevated liver enzymes Pediatric with episodes of blank stares 3 mHz spikes on EEG Muscular dystrophy (weakness begins at pelvic girdle) Reyes syndrome from URI/post-flu or aspirin use

Absence (petit-mal) seizures. Absence (petit-mal) seizures.

Ash leaf hypopigmentation of trunk Tuberous sclerosis & Ext, shagreen patch, sebaceous adenomas, seizures, mental retardation; Ass. w/ PCK, renal hemartomas

HEENT Description < 70 yo blindness > 70 yo blindness Afferent papillary defect, marcusgunn pupils Bilateral pinpoint pupils Bilateral DILATED pu;ils Diagnosis Associated DM retinopathy (MCC) Macular degeneration Optic nerve lesion. Tertiary syphilis (marcus-gunn) Pontine hemorrhage Anticholinergics, TCA, antiparkinsonian drugs, profound hypoxemia Optic chiasm lesion Ipsilateral optic nerve lesion Temporal optic radiation Ipsilateral optic tract lesion Orbital blow-out fracture; Immediate ophthalmology referral Chalazion
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Bilateral hemianopia Loss of central vision Superior contralateral quadrantopia Temporal field loss Eye trauma, diplopia. Exophthalmos, fixed upward gaze, hyphema Painless, nontender nodule on upper

PANCE/PANRE Word Associations

or lower eyelid Painful swelling of upper or lower eyelid Painless, yellow triangular nodule on conjunctivia Curtain or veil over my eyes, new onset floaters Transient monocular vision loss Painless vision loss. History of TIA, palpitations, arrhythmia, carotid disease, embolic source Painless vision loss. History of HTN

Hordeolum Pinguecula (more common on nasal side) Retinal detachment Amaurosis fugax TIA, emboli CRAO (pale retina, cherry red macula)

CRVO (blood & Thunder, retinal hemorrhages) Vision loss over hours to days, painful Optic Neuritis (assoc. w/ MS) EOM Recurrent episodes of vision change, MS diplopia that resolve Red eye, watery discharge, preauricular LAD Red eye, copious purulent discharge Red eye, hyperemia, chemosis, nodular conjunctivia 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 Diplopia, dysarthria, dysphagia Unilateral foul smelling or purulent nasal discharge in a pediatric patient HA, sinus pressure, yellow green nasal discharge Sneezing, clear rhinorrhea, postnasal drip, nasal congestion seasonal occurance Pale, edematous, boggy turbinates Bullous myringitis Otitis media Viral conjunctivitis Gonococcal conjunctivitis Allergic conjunctivitis Acute angle-closure glaucoma

Vertibrobasilar insufficiency Nasal Foreign body Sinusitis CT is gold standard Allergic rhinitis. Nedocromil effective Tx. Allergic rhinitis Mycoplasma pneumonia Strep. Pneumonia, H. influenza, strep. Pyogenes, moraxella catarhallis
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PANCE/PANRE Word Associations

Swimmer with ear pain, discharge Diabetic, ear pain Tinnitus and metabolic acidosis Sudden dizzy, vertigo, hearing loss, tinnitus Dix-hallpike maneuver Sudden vertigo with changes in head position Sudden dizzy, N, V. NO tinnitus, hearing loss. Recent URI Unilateral nerve deafness in middle age Pt Sensorineural loss > 50yo Vertical Nystagmus, insidious onset vertigo Horizontal Nystagmus, acute onset vertigo Smoker, white mouth lesion cannot be rubbed off Gray pharyngeal pseudomembrane, rash, splenomegaly, supraclavicular LAD College student with sore throat. Enlarged tonsils, anterior cervical LAD. Splenomegaly. CBC elevated atypical lymphoctyes

Otitis externa MOE, Pseudomonas, IV abx (FQ), CT head Salicylate Ingestion Menieres disease; Treat w/ diuretics & low-sodium diet BPPV BPPV Vestibular neuronitis, labrynthitis Acoustic neuroma (order MRI) Presbyacussis (Hi freq sounds 1st to go) Central lesion (tumor) Peripheral lesion Leukoplakia, rule out oral cancer Diphtheria

EBV - mononucleosis

HEMATOLOGY/ONCOLOGY Description Philadelphia chromosome Auer rods Reed-sternberg cells Painless LAD (us. Neck or axilla), LAD in orderly fashion; B signs + pruritis; splenomegaly; LN pain after drinking alcohol

Diagnosis Associated CML AML Hodgkins lymphoma Hodgkins lymphoma

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PANCE/PANRE Word Associations

Fatigue, PM sweats, weight loss, painless LAD or neck mass Painless LAD us. Scattered. B signs Hx HTN, nephrotic syndrome, CRF or Renal insufficiency. Know CBC. PICA, Pregnant & fatigue, Menstruation. Cheilosis Anemia after colectomy, partial gastrectomy. Glossitis, decreased vibratory sensation G6PD + Quinidine, Nitrofurantoin, Sulfa Fatigue, weakness, low fever, purpura, pallor, gingival bleeding. No HSM Elevated Hgb, Hct, splenomegaly, post showering pruritis, plethora, engorged retinal veins Splenectomy Sickle cell Spontaneous Hemarthrosis Mucosal or gingival bleeding, epistaxix, menorrhagia Continuous bleeding post-op or trauma. Given multiple blood transfusions. Low platelets, increased PT, INR, + fibrin split products (increased d-dimer)

Lymphoma do Lymph node biopsy. Bone marrow Bx and CT scan used for staging Non-Hodgkins lymphoma Anemia Fe Deficiency Anemia B12 or Pernicious anemia Hemolytic anemia Aplastic anemia

Polycythemia vera; Tx = Phlebotomy

Pneumococcal vaccine Autosomal Recessive, pain in extremities after exercise, priaprism Hemophilia A Von Willebrand disease DIC

INFECTIOUS DISEASE Description MRSA

Diagnosis Associated spider bite appearing lesion that turns into abscess. Tx w/ Vanco +/rifampin, gentamicin, linezolid
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PANCE/PANRE Word Associations

Clear vulvar vesicles, inguinal LAD Giant Multinucleated cells Tzank Smear Acetowhitening Woods light fluoroscopy Bite w/ fever, lacrimation, rhinorrhea, bradycardia, HTN, tachyarrhythmias Bite with local edema, erythema, central necrosis Woods, forest, hikers. Macular rash at wrist, ankles then moves up extremities then trunk. After 5 days rash at palms & soles Indirect immunofluorescent Ab, WeilFelix rxn, complement Target lesion, arthralgia, Bells Palsy Intense pruritis esp. PM. Burrow like lesions at wrists, elbows, hands, webs of fingers Raccoons, bats, skunks Gangrene

Herpes virus (Genital) Herpes virus (Genital) Herpes virus (Genital) Condyloa acuminata Dermatophytes infections, Erythrasma (coral red) Black widow (neurotoxin) Brown recluse RMSF (Rickettsia rickettsia)

RMSF (Rickettsia rickettsia) Lyme Dz (Borrelia Burgdorfi) Scabies

Rabies; give Ig, Rabies vaccine if animal is not caught and tested Clostridium infection an anaerobic bacteria. Tx w/ hyperbaric oxygen, Penicillins, surgical excision Gonorrhea Gonorrhea

Gram negative intracellular diplococcic Sexually active, multiple or new partner, urethral discharge, Gram negative intracellular diplococci Red cervix w/ mucopurulent discharge in sexually active female FTA-ABS, MTA-TP Malaria prophylaxis

Chlamydia Syphilis diagnosis Chloroquine

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PANCE/PANRE Word Associations

MSK/RHEUMATOLOGY Description Shoulder pain after repetitive activity, point tenderness at anterior humerus or AC joint. + drop arm test or apprehension test Football player with burning pain, numbness, tingling from shoulder to hand which resolves FOOSH, Radial fracture w/ dorsal displacement, dinner-fork deformity Typing, secretary wrist pain and numb/tingling from wrist to hand. New mothers, pregnant may worsen Pain at base of thumb, distal radial styloid. Pain reproduced with ulnar deviation of clenched fist. Hand injury after a punch

Diagnosis Associated Rotator cuff injury (SITS muscles)

Brachial plexus neurapraxia, stinger. Caused by stretching of brachial plexus Colles Fx; Tx = volar splint Carpal Tunnel syndrome deQuervains tenosynovitis Boxers fracture. Ulnar gutter w/ intrinsic plus positioning. ORIF if angulation > 40 degress Scoliosis (> 25 degree Cobb angle = surgery) Shin splints, stress fracture. Get bone scan if negative x-ray ACL (look for description of lachman or drawer test) Legg-Calve-Perthes Disease SCFE Osgood-schlatter disease Patellorfemoral pain syndrome increased Q angle, strengthen quadriceps Mortons neuroma; Tx w/ NSAIDs, wide shoes, then steroid injections

Female exam, asymmetric posterior chest wall or uneven scapula height with forward bending Tibial pain after running (military recruits), athletic activity (running sports) Knee injury during football game 8 10yo male with limp, knee pain 12 15yo overweight male knee pain, limp, hip pain (knee XR normal) Adolescent male with knee pain, tenderness over tibial tuberosity Retropatellar knee pain esp. in females Pain on plantar foot @ 2 3rd metatarsal. Associated w/ tight

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PANCE/PANRE Word Associations

shoes, relieved by removing shoes. Palpable painful mass Pain after tx of fracture w/ cast HLA-B27 Acute joint pain. Swollen, warm, erythema. Large joint pain. Knees w/ medial joint space narrowing, osteophytes. No erythema or warmth. Enlarged PID, DIP Female morning joint pain & stiffness esp. hand/wrists. MCP joint swelling, ulnar deviation Acute swollen big toe Proximal symmetric muscle pain & stiffness esp. shoulder, neck, pelvic girdle Male w/ low back pain, stiffness. Pain worse wakening, improve during day. Decreased ROM at spine. Plain films show sacroiliac abnormality. HLAB27 positive Conjunctivitis, iritis, arthritis, cervicitis, urethritis Erythema nodosum Female with Arthralgias, malar rash, +ANA, + anti-double stranded DNA antibodies, +anti-phospholipid antibodies dusky red, well localized single or multiple papules or plaques usually of face Female, fatigue, general aching, pain at neck, upper shoulders, sleeping problems, tender points Cold induced pain at extremities with Compartment syndrome Ankylosing spondylitis, Reiters syndrome Septic arthritis (synovial fluid = leukocytosis, low glucose) Osteoarthritis. Acetaminophen #1 choice Osteoarthritis (herberden PIP; bouchard DIP) Rheumatoid arthritis. Methotrexate (DMARDs) #1. Gout Polymyalgia rheumatica Ankylosing spondylitis; Tx = NSAIDs (Indomethacin)

Reiters syndrome Systemic autoimmune diseases (RA, IBD), OCP SLE

Discoid lupus Fibromyalgia (exercise program good management)

Raynauds phenomenon
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PANCE/PANRE Word Associations

color change as they warm up Osteomyelitis after stepping on nail wearing sandals or tennis shoes Teenage female with long bone pain without trauma or injury. XR w/ lytic mass, multi-laminated periosteal reaction Painless bony mass. Plain films = stalky or broad-based projection from bone surface Lytic lesions in the back or skull Pseudomonas aeruginosa (foam padding in shoes) Ewing sarcoma periosteal onion skin reaction Osteochondroma Multiple myeloma

PSYCHE Description Deterioration of cognitive function, memory Rapid onset of cognitive symptoms, mental status fluctuations, anxiety, irritability Paplitations, tremors, hyperventilation or respiratory alkalosis, numb or tingling mouth or extremities Feelings of worthlessness, hopelessness, apathy, weight loss, insomnia, daytime sleepiness. Thoughts of suicide Raw red hands, chafed. Binge eating, laxative use, starvation Bulimia with electrolyte disorders Antipsychotic meds (phenotiazines), facial tics, lip smacking, tongue disorders, blinking, ataxia Pt on antipsychotic meds develops altered consciousness, lead-pipe Diagnosis Associated Dementia Delerium

Anxiety

Depression (SSRI = drug of choice)

Obsessive compulsive disorder Bulimia nervosa (Tx w/ SSRI Fluoxetine) Hypokalemia, metabolic alkalosis Tardive dyskinesia Neuroleptic malignant syndrome. Tx supportive care & antipyretics
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PANCE/PANRE Word Associations

rigidity, diaphoresis, catatonia. Hyperthermia, tachypnea, blood pressure changes. Extrapyradimidal signs, BP changes, altered consciousness, hyperpyrexia, muscle rigidity, dysarthria, CV instability, fever, pulmonary congestion, diaphoresis. Pt on antipsychotic meds Infrequent blinking, tremor, rigidity, bradykinesia, shuffling gait, masked facies Short lived, intense relationships. Difficulty controlling anger esp. when feeling abandoned. Hx sexual promiscuity and substance abuse. Periods of excessive drinking, buying, spending Male w/ gynecomastia, diminished or delayed secondary sex characteristics, small firm testicles, long arms & legs (eunechoid body habitus) Hyponatremia w/ bizarre behavior. Antidepressant use w/ anticholinergic side effects, dry mouth, dysrhythmias, sedation, orthostatic hypotension REPRO Description Frothy, clear white or yellow-green to gray adherent vaginal discharge, dysuria, vaginal pruritis. Vulvar and cervical erythema. Flagellated protozoa Fishy odor, Thin grayish vaginal

Neuroleptic malignant syndrome. Tx supportive care & antipyretics

Parkinsons

Borderline personality disorder

Manic phase of bipolar disorder

Klinefelter Syndrome XXY. Low serum testosterone & infertility.

Lithium toxicity TCA overdose

Diagnosis Associated Trichomonas

Bacterial vaginitis; Gardnerella

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PANCE/PANRE Word Associations

discharge, Clue cells Thick white vaginal discharge, hyphae & buds on KOH prep Postmenopausal, dyspareunia, thin vaginal discharge, atrophic vulvar changes, vaginal petechiae Secondary amenorrhea Female with acute abdominal pain. No characteristic acute abdomen pattern 20yo female w/ rubbery, firm, wellcircumscribed, non-tender breast lesion, doesnt change w/ cycle 30 50yo female, painful, multiple, bilateral breast masses that increase in pain and size before menses Spontaneous bloody, serous, or cloudy nipple discharge Breast mass, nipple retraction, bloody nipple discharge Overweight, irregular menstrual cycles (poss. Amenorrhea), elevated blood sugar, hirsutism Adolescent female with midcycle pain alternating from left to right side. Relieved w/ NSAIDs Dysmenorrhea, dyspareunia, dyschezia. Uterus is fixed, retroflexed. Cyclic pelvic pain. May have palpable pelvic mass Firm irregular shaped, NONTENDER enlarged uterus Softened, tender, diffusely globular uterine enlargement 6cm unilateral, mobile, tender adnexal mass Pregnant Pregnant + rash, post-auricular or

vaginalis Candida Atrophic vaginitis; Tx = topical estrogen Pregnancy Ectopic pregnancy

Fibroadenoma Fibrocystic breast disease

Intraductal papilloma Breast cancer (mass is most common presenting clinical manifestation) PCOS (stein-leventhal syndrome) Mittelschmerz Endometriosis. Palpable pelvic mass chocolate cyst Leiomyoma Adenomyosis Tubo-ovarian abscess Nagels rule: LMP + 7 3 mo Rubella. Give vaccine AFTER delivery
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PANCE/PANRE Word Associations

occipital LAD Pregnant, HA, visual disturbance Pregnant, seizures Pregnant < 20 wks gestation w/ vaginal bleeding, abd & pelvic pain. Blood from closed cervical os. Pregnant < 20 wks gestation w/ vaginal bleeding, abd & pelvic pain. Tissue at or said to be passed from open cervical os. Pregnant who drinks during pregnancy and inadequate peri-natal care Postpartum hemorrhage Postmenopausal vaginal bleeding Postmenopausal adnexal mass

Pre-eclampsia Eclampsia Threatened abortion Incomplete abortion (complete abortion will have empty uterus, complete passage of fetal tissue, pain resolves after passage of tissue) Fetal alcohol syndrome low birth weight Uterine Atony. Tx = uterine massage Endometrial Ca do endometrial biopsy Ovarian Ca

DERM Description Procainamide, hydralazine & rash Photosensitive rash Woods light KOH Gram stain Beefy red, sharp bordered rash in groin (infants), under breast folds with satellite lesions Warm, erythematous, tender skin with possible induration or fluctuance Red, less distinct borders. Coral red fluorescence under Woods lamp Distinct, sharp raised demarcated border with fever, chills. Group A Strep Grouped vesicles on erythematous Diagnosis Associated Lupus-type eruptions TCN, Sulfa drugs Coral red = Erythrasma Fungus, Candida; Hyphae & buds, spaghetti & meatballs Bacterial infections Candida: Tx: Nystatin/Lotrimin cream QID x14d; if fails Ketoconazole Cellulitis Erythrasma Erysipelas Herpes virus
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PANCE/PANRE Word Associations

base Infant or pediatric w/ grouped vesicles on thumb or tapioca vesicles on thumb Pain preceding vesicular rash in dermatomal pattern Hx URI the palpable purpuric rash to buttocks, posterior thighs Honey colored crusts on erythematous base around nose & mouth Small white papules on diffusely red base on buccal mucosa Cough, coryza, conjunctivitis Pastias lines, positive ASO titer Strawberry tongue Pruritic raised erythematous plaques Dewdrops on rose petal, pustules & vesicles at different stages of healing Flesh-colored, pink or yellow-brown lesion with rough, sandpaper feel, at sun-exposed areas Non-pruritic, raised, warty brownblack plaques, stuck onto skin feel greasy Flat brown spots with sharp borders on dorsum of hand Erythematous, dome-shaped nodule with central plug

Herpetic whitlow Herpes Zoster (if involved eye = herpes keratitis. NO steroids. Get immediate ophthalmology referral) HSP (Hx post Strep A infection) Impetigo. Tx = Mupirocin Koplick spots Rubeola (Measles). Spots occur before rash Rubeola (Measles) Scarlet fever (Grp A Strep) Scarlet fever (Grp A Strep) Urticaria Varicella (Chicken Pox)

Actinic Keratosis Seborrheic keratosis Lentigines Keratoacanthoma

Raised pearly-borders, telangiectasia, Basal cell Ca central ulcer Pearly papule with umbilicated center Molluscum contagiosum Sexually active person w/ rash on palms & soles, general LAD Scabies & Pediatrics Secondary syphilis (Money spots); VDRL will confirm NO LINDANE (KWELL). Permethrin (Elimite) is drug of choice
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PANCE/PANRE Word Associations

Christmas tree pattern, erythematous papules w/ oval plaues w/ scaly itchy border. Rash preceded by lagre oval plaque w/ central clearing & scaly border Hypopigmented lesions, white, scaly. Gets worse w/ tanning or sun exposure Erythematic ring with scaly border & central clearing spaghetti & meatballs Thick, yellow, brittle nails Infant w/ erythematous, scaly crusty lesions at vertex of scalp

Pityriasis rosea; Herald patch

Pityriasis Alba Tinea (fungal infection); KOH prep = hyphae Tinea (fungal infection Onychomycosis. Tx = PO Terbinafine Cradle cap seborrheic dermatitis (Tx in infants w/ baby shampoo, warm olive oil compress, mild Hydrocortisone cream; Adults selenium sulfide shampoo) Hand-Foot-Mouth disease. Coxksackie Virus Erythema infectiosum Slapped cheek, 5th Dz. Roseola infantum (Herpesvirus); Motrin, symptomatic treatment Roseola infantum (Herpesvirus); Motrin, symptomatic treatment Scarlet Fever Kawasakis Disease; look for cardiac complications (myocarditis, pericarditis, arteritis, aneurysms) Rheumatic Fever Psoriasis Psoriatic arthritis

Children < 10yo w/ vesicles on pharynx, mouth, hands, feet w/ NO ulceration Healthy looking < 5yo with lace-like rash on both cheeks red papules Pediatric with high fever then after fever macular rash over trunk and neck. (rash after defervesence) Truncal Rash in pediatric after fever Fever, pharyngitis, sandpaper rash over face, neck, trunk, extremities High fever (up to 105oF) x 5 days then rash. May have conjunctivitis, cracking, lip fissures Erythema marginatum Silvery scaling plaques on extensor sensors. Ausptiz sign, Koebners phenomena Rat bite erosions on XR

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PANCE/PANRE Word Associations

Dark skinned person with whitening or lightening of skin. Hx pernicious anemia or other autoimmune disease PEDIATRICS Description Introduce solid foods (cereal, fruits) 1st tooth (central incisor) Walks alone 3 words, fees self w/ spoon, builds tower < 2mo fever < 5yo fever, seizures Premature birth, fetal maturity Meconium-stained amniotic fluids Positive osmotic fragility test Mousy urine Vit D Rickets Hemophilia A, Duchennes MD Neurofibromatosis Sickle cell, CF, PKU

Vitilligo. Skin biopsy to diagnose

Diagnosis Associated 4 6 mo; after 6 mo add meat, eggs, starchy foods 6 8 mo 15 mo 24 mo Septic w/u - blood Cx, LP Febrile seizure Give corticosteroids Fetal distress G6PD deficiency (hemolytic anemia w/ oxidative drugs sulfa, nitrofurantoin, quinidine) PKU X-linked dominant X-linked Recessive Autosomal dominant Autosomal Recessive

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