Classical Clues

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Posted by Care from IP 65.38.211.18 on May 03, 2010 at 12:48:38:

Straight forward USMLE 1 , 2 , 3 clues.

Hypogonadism + Anosmia = Kallman syndrome

Eczema + Petichiae + Immunodeficieny = Wiskott-Aldrich syndrome

Vaginal discharge + RUQ pain = Fitz Hugh Curtis Syndrome

Hypercalcemia + Hilar lymphadenopathy + Elevated ACE levels = Sarcoidosis

Hypotonia + Jaundice + Seizures + Mental retardation = Zellweger syndrome

Child + Headaches + Ataxia + Brain Cystic with Mural Nodule = Pilocytic Astrocytoma

Painless Testicular mass + Gynecomastia + rod shaped crystals in the tumor cells = Leydig cell tumor

Delayed Umbilical Sloughing = Leukocyte Adhesion Deficiency

Teen with Liver Problem + Personality Changes = Wilson's Disease

55 Yr Old Smoker + living in air condition environment = Legionnaire's Disease

Alzheimer disease sudden death = Cerebral Amyloid Angiopathy

Unexpected Hypertension + young woman + increased Renin = Renal Artery Stenosis secondary to Fibromuscular dysplasia

Dementia + Gait Apraxia + Incontinence = Normal Pressure Hydrocephalus

Exaggerated bowel sounds + distension = jejunal or ileal obstruction

Old man with lower back pain + osteoblastic lesions in the lumbar spine = metastatic prostatic carcinoma

Hypertension + increased adrenal androgen production = 11 Beta Hydorxylase deficiency

Hypertension + decreased adrenal androgen production = 17 Alfa Hydroxylase deficiency

Female with breast lump + < Age 35 = Fibroadenoma

Female with breast lump + > Age 35 = CA or Fibrocystic disease

Psychotic patient with polydipsia = Phenothiazine

Adolescent with fatigue + Fever = Mononucleosis

Leukemia + Spherocytes = CLL associated with Autoimmune hemolityc anemia

Great improvement of his anemia after splenectomy = Spherocytosis

Jaundice and Cataract after birth + Small infant + Hepatomegaly = Galactosemia

Dexamethasone Suppression Test

- Positive DST to high dose then do brain CT [because it's most likely cushing disease ie pituitary adenoma]

- Negative DST to high dose then do lungs or abdomen CT or U/S because it's most likely ectopic ACTH source such as lung CA or Adrenal adenoma

Breath Smells

Acetone ---------- Diabetic Ketoacidosis
Garlic ------------ Arsenic poisoning
Bitter Almond --- Cyanide poisoning
Foul smell ------- Halitosis

Hypoxemia + Confusion + Petechiae = pulmonary fat embolism

Hypertension + Adrenal Mass
1. Pheochromocytoma
2. Primary hyperaldosteronism
The differentiation is relatively easy:
In Pheochromocytoma you have elevated catecholamines with it consequent increased urinary VMA and cortisol and the crises of tachycardia, sweating, irritability ...etc Tx: surgical treatment / alpha and beta blockers
In Conn's syndrome you have the effects of high aldosterone such as hypokalemia and alkalosis. Tx: surgical treatment / aldosterone antagonists such as sprinolactone or amiloride.

Fever + Parotitis + Uveitis + Bell's Palsy = Heerfordt-Waldenstrom syndrome which is one of the presentations of Sarcoidois

Intoxicated + Elevated Anion Gap + Envelop Shaped crystals stuff in Urine = Oxalicaciduria causing acute renal failure

Cognitive loss + Joint aches + Nystagmus + Diarrhea = Whipple Disease

Rheumatoid Arthritis + Splenomegaly + Neutropenia = Felty Syndrome

Rheumatoid Arthritis + pneumoconiosis = Caplan Syndrome

Acne + Pain in swollowing = Tetracylines or doxycyclin cause Pill Esophagitis.

Leg swelling + Dyspnea + Abortions = Antiphospholipid syndrome

Claudication + Impotance + Leg atrophy = Leriche syndrome also called Aortoiliac Occlusive Disease.

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