1. Signs Daniel Podd RPA-C

2. Beau's lines Strawberry tongue Peripheral papular or punctate rash Sandpaper rash Pastia's lines

3. Scarlet Fever

4. Nikolsky's sign

5. Pemphigus vulgaris Toxic Epidermal Necrolysis Staphylococcal scalded skin syndrome

6. Osler's nodes

7. Splinter Hemorrhages

8. Janeway lesions

9. Roth Spots

10. Subacute Bacterial Endocarditis

11. Heberden's node

12. Osteoarthritis

13. Bouchard's nodes

14. Osteoarthritis

15. Boutonnieres deformity Swan neck deformity

16. Subcutaneous nodules Pannus formation

17. Rheumatoid arthritis

18. Skin contractures, “mask-like face”; (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, telangiectasias)

19. Systemic Sclerosis (limited)

20. Fever, malar rash, splenomegaly, uveitis Vasculitis Oral ulcers Pancytopenia (Thrombocytopenia)

21. SLE

22. Needle- shaped, Negatively birefringent monosodium urate crystals

23. Gouty Arthritis

24. Rhomboid- shaped, calcium pyrophosphate dihydrate crystals, positively birefringent

25. Pseudogout

26. Negative Nikolsky's sign

27. Bullous Pemphigoid

28. “Stuck on” Papules or Plaques

29. Seborrheic Keratosis

30. “Target lesions”

31. Erythema Multiforme

32. “A rash that itches”

33. Atopic Dermatitis/Eczema

34. Sharply demarcated bright pink plaques with overlying loose “silvery scale”; positive Auspitz sign & Koebner phenomenon

35. Psoriasis

36. “Honey-colored crusts”

37. Impetigo

38. “Polygonal, Purple, Pruritic, Papular”

39. Lichen Planus

40. Erythema, scaly, oily skin

41. Seborrheic Dermatitis

42. Erythema (rubor), swelling (tumor), local tenderness (dolor), warm to touch (calor); flat and without sharp demarcation

43. Cellulitis

44. Shiny, bright red erythema; Indurated, elevated, tender, hot, edematous; irregular border sharply demarcated

45. Erysipelas

46. Flushing, telangiectasis, papules/ pustules,rhinophyma

47. Acne Rosacea

48. Herald patch progressing to Christmas- tree papular/plaques

49. Pityriasis Rosea

50. “Dewdrop on a rose petal”

51. Varicella

52. “Pruritic, ring-shaped, erythematous, scaling plaques”

53. Tinea Corporis

54. “Pearly, fine telangiectasias, rodent ulcer”

55. Basal Cell Carcinoma

56. Asymmetic, Borders Irregular, Mottled Color, Diameter > 6mm, Elevated

57. Melanoma

58. Kayser-Fleischer ring

59. Wilson’s Disease

60. Red eye: “Fixed, mid-dilated pupils, steamy/cloudy cornea”

61. Acute angle closure glaucoma

62. Copious watery, purulent discharge; conjunctival injection/beefy red conjunctiva

63. Bacterial conjunctivitis

64. Red eye: “ciliary flush”, small/constricted, and poorly reactive pupils

65. Anterior Uveitis

66. External, erythematous, swollen, tender mass on lid margin

67. Hordeolum

68. Small, nontender “English pea” nodule internally on lid

69. Chalazion

70. Pain and limitation of EOMs, proptosis, chemosis, decreased visual acuity

71. Orbital Cellulitis

72. Hyperemic, exudative tonsils, posterior cervical LAD, fever, palatal petechiae, hepatosplenomegaly

73. Mononucleosis

74. Levine’s sign, tachycardia, S4 gallop hyper/hypotension, diaphoresis, tachypnea, pallor, cool/clammy skin, low-grade fever

75. Acute Coronary Syndrome/AMI

76. S3 gallop, laterally displaced PMI, rales, altered mental status, cool extremities, delayed capillary refill, tachypnea, hypertension, Pulsus alternans… Pulmonary venous congestion Kerley B lines CXR

77. EKG LBBB LVH Q-waves Left Axis Deviation

78. CHF: LV Failure Which can progress to…

79. CXR “Bat-winged” or “Butterfly pattern”

80. Pulmonary Edema

81. Peripheral edema, jugular venous distention, tachycardia, hepatosplenomegaly, ascites, hemorrhoids Caput medusa

82. EKG: Right Ventricular Hypertrophy “Poor R-wave progression” and deep S waves in V leads R axis deviation

83. CHF: RV Failure

84. Fever, left lower sternal border friction rub, tachycardia Patient’s position of relief “Diffuse ST-segment elevations”

85. Pericarditis

86. Kussmaul’s sign, Pulsus Paradoxus,cool clammy skin, tachycardia, distant heart sounds, friction rub, hypotension, pulsus alternans, and JVD…

87. EKG: Tachycardia, low voltage QRS, and electrical alternans “Water bottle” heart

88. Cardiac Tamponade

89. Murmurs

90. Low-pitched apical diastolic murmur “Opening Snap” Accentuated in left lateral decubitus & after exercise

91. Mitral Stenosis

92. High-pitched, blowing diastolic murmur, 2 nd - 4 th left interspaces Radiation to apex, RSB Accentuated: Patient sitting/leaning forward, exhalation

93. Aortic Regurgitation

94. Blowing, holosystolic murmur at apex Radiation to left axilla, LSB Medium-high pitch

95. Mitral Regurgitation

96. Harsh crescendo-decrescendo, medium pitched systolic murmur at right 2 nd interspace Radiation to neck Accentuated: patient sitting/leaning forward

97. Aortic Stenosis

98. “Midsystolic click”; murmur prolonged with Valsalva and decreased with squatting

99. Mitral Valve Prolapse

100. Double apical impulse, paradoxically split S2, prominent jugular ‘a’ waves, systolic ejection murmur @ apex or left sternal border that ↑ with standing and Valsalva (reduced preload) and ↓ with squatting (increased preload)…

101. + Family history of sudden death…

102. Hypertrophic Cardiomyopathy

104. LVH

106. acute anterior lateral myocardial infarction

108. Primary AV block

109. “Bird’s Beak”

110. Achalasia

111. Cullen’s Sign

112. Grey-Turner’s sign

113. Sentinel loop sign

114. Colon cut-off sign

115. Acute Pancreatitis

116. “Discontinuous (skip lesions), transmural inflammation, cobblestoning”

117. Crohn’s Disease

118. “Continuous, Colonic (rectal), Coating (mucosa/submucosa)”

119. Ulcerative Colitis

120. Obturator sign Psoas sign RLQ pain/McBurney’s Point tenderness + rebound tenderness Also: Rovsing’s sign, fever, cutaneous hyperesthesias, abdominal guarding

121. Appendicitis

122. Dental erosions, oropharyngeal inflammation; hx of burning retrosternal chest pain provoked by supine position and regurgitation of digested food Upper Endoscopy

123. GERD (with progression to Barrett’s esophagus)

124. Mid-epigastric pain, deep recurring ache that is relieved with food or antacids; positive hemoccult blood; hx of nocturnal pain (1-2 am) Upper Endoscopy + Urea breath test + ELISA for IgG to Helicobacter pylori

125. Duodenal Ulcer (H. pylori induced)

126. Mid-epigastric pain that is relieved by antacids but aggravated by food; hx of severe osteoarthritis, CAD, EtOH abuse, and cigarette smoking Upper Endoscopy Negative H. pylori diagnostics

127. Peptic Ulcer Disease (gastric irritant/NSAID induced)…

128. …a history of either ulcer disease process, with presentation of: sudden, “exact-timing” upper quadrant to generalized abdominal pain signs/symptoms of shock peritoneal signs “Free air under the diaphragm”

129. Perforated Ulcer/Viscus

130. Fever/chills, RUQ, jaundice; tachycardia, hypoactive bowel sounds, toxic appearance, + Murphy’s sign RUQ sonogram

131. Acute Cholecystitis Charcot’s triad + shock/hypotension and altered mental status = Reynolds' pentad…Dx?

132. Acute cholangitis

133. Erythema Migrans

134. Hepatitis B Serology The first clinically detectable serological agent in acute hepatitis B is…

135. HBsAg

136. Appears after successful clearance of HBsAg or after HepB vaccination…

137. Anti-HBs

138. Implies highly infectious state, found in acute or chronic HepB…

139. HBeAg... While low infectivity/replication is inferred by…

140. Anti-HBe

141. Found in window period, signifies acute infection…

142. IgM anti-HBc (and HBeAg)

143. Signifies Chronic Hepatitis B, without recovery…

144. IgG anti-HBc and HBsAg

145. Signifies Chronic Hepatitis B, WITH recovery/immunity…

146. IgG anti-HBc and Anti-HBs (HBsAg and HBeAg negative)

147. The only positive serological marker in HepB vaccination…

148. Anti-HBs

149. Primary Lyme Disease

150. Fever; initial macular rash on periphery…

151. …Later: Central Papules and Petechiae

152. Rocky Mountain Spotted Fever

153. Productive rust-colored cough, fever, tachypnea, rigors, ill appearance Pulmonary Exam: Decreased breath sounds, increased fremitus, rales, + bronchophony, egophony, whispered pectoriloquy

154. Pneumococcal Pneumonia

155. …In the chronically ill

156. Staphylococcal Pneumonia

157. Slowly progressive fatigue, malaise, arthralgias, fever; dry/nonproductive cough; URI symptoms (otalgia & pharyngitis) Pulmonary exam: Wheezing, scattered rhonchi, basilar rales Serous Otitis Media bilateral diffuse hazy infiltrates

158. Mycoplasma (walking) pneumonia

159. Unilateral absent breath sounds, ipsilateral atelectasis Hyperresonant to percussion, decreased fremitus

160. Pneumothorax

161. Wheezing, nocturnal cough, pulsus paradoxus; history of atopic dermatitis & allergic rhinitis Increased bronchial wall markings Flattening of diaphragm Hyperinflation

162. Asthma

163. Tachypnea/cardia, rales, fever, unilateral lower extremity edema, venous cords…

164. EKG: sinus tachycardia, “S1 Q3 T3”, RBBB…

165. CXR: Elevated hemidiaphragm, Hampton's hump, Westmark sign…

166. V-Q Mismatching

167. Pulmonary Embolism

168. Hyperinflated (barrel chest), wheezing, crackles, diffusely decreased breath sounds, hyperresonance on percussion, prolonged expiration, cyanosis, accessory muscle of respiration use…

169. PFT: Reduced FEV1 CXR: Lung hyperinflation Diaphragm flattening Distal pulmonary vessel tapering Increased basilar markings

170. COPD

171. Bulging TM, increased vascularity, erythema, distortion of normal landmarks, immobile to insufflation

172. AOM

173. Tenderness on pinna palpation/auricle traction; edema, purulent discharge

174. Otitis externa

175. Waters view: opacification, air-fluid levels, thickened mucosa

176. Maxillary Sinusitis

177. Soft white plaques, erythematous, bleeding base

178. Oral Candidiasis

179. Thick, white patch, adherent

180. Leukoplakia

181. Irregular, raised white-pink cauliflower lesion

182. Condyloma acuminata

183. Tender! vesicles  ulcerations, grouped lesions common and may coalesce; regional LAD, fever

184. Herpes Simplex Virus (II)

185. Painless Solitary Chancre

186. Primary Syphilis

187. Condyloma Lata

188. Secondary Syphilis

189. Granulomatous Gummas

190. Tertiary Syphilis

191. “Bronze Diabetes” + Cirrhosis Iron Deposits

192. Hemochromatosis

193. CD4+ < 200, fever, nonproductive cough, rales/rhonchi, bibasilar crackles, respiratory distress Bilateral Interstitial Infiltrates

194. Pneumocystis carinii pneumonia (PCP)

195. Good Luck!!!