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Published byErin Sharp Modified over 9 years ago
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Signs Daniel Podd RPA-C
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Beau's lines Strawberry tongue Peripheral papular or punctate rash Sandpaper rash Pastia's lines
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Scarlet Fever
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Nikolsky's sign
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Pemphigus vulgaris Toxic Epidermal Necrolysis Staphylococcal scalded skin syndrome
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Osler's nodes
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Splinter Hemorrhages
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Janeway lesions
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Roth Spots
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Subacute Bacterial Endocarditis
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Heberden's node
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Osteoarthritis
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Bouchard's nodes
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Osteoarthritis
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Boutonnieres deformity Swan neck deformity
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Subcutaneous nodules Pannus formation
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Rheumatoid arthritis
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Skin contractures, “mask-like face”; (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, telangiectasias)
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Systemic Sclerosis (limited)
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Fever, malar rash, splenomegaly, uveitis Vasculitis Oral ulcers Pancytopenia (Thrombocytopenia)
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SLE
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Needle- shaped, Negatively birefringent monosodium urate crystals
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Gouty Arthritis
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Rhomboid- shaped, calcium pyrophosphate dihydrate crystals, positively birefringent
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Pseudogout
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Negative Nikolsky's sign
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Bullous Pemphigoid
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“Stuck on” Papules or Plaques
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Seborrheic Keratosis
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“Target lesions”
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Erythema Multiforme
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“A rash that itches”
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Atopic Dermatitis/Eczema
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Sharply demarcated bright pink plaques with overlying loose “silvery scale”; positive Auspitz sign & Koebner phenomenon
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Psoriasis
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“Honey-colored crusts”
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Impetigo
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“Polygonal, Purple, Pruritic, Papular”
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Lichen Planus
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Erythema, scaly, oily skin
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Seborrheic Dermatitis
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Erythema (rubor), swelling (tumor), local tenderness (dolor), warm to touch (calor); flat and without sharp demarcation
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Cellulitis
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Shiny, bright red erythema; Indurated, elevated, tender, hot, edematous; irregular border sharply demarcated
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Erysipelas
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Flushing, telangiectasis, papules/ pustules,rhinophyma
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Acne Rosacea
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Herald patch progressing to Christmas- tree papular/plaques
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Pityriasis Rosea
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“Dewdrop on a rose petal”
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Varicella
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“Pruritic, ring-shaped, erythematous, scaling plaques”
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Tinea Corporis
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“Pearly, fine telangiectasias, rodent ulcer”
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Basal Cell Carcinoma
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Asymmetic, Borders Irregular, Mottled Color, Diameter > 6mm, Elevated
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Melanoma
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Kayser-Fleischer ring
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Wilson’s Disease
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Red eye: “Fixed, mid-dilated pupils, steamy/cloudy cornea”
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Acute angle closure glaucoma
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Copious watery, purulent discharge; conjunctival injection/beefy red conjunctiva
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Bacterial conjunctivitis
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Red eye: “ciliary flush”, small/constricted, and poorly reactive pupils
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Anterior Uveitis
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External, erythematous, swollen, tender mass on lid margin
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Hordeolum
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Small, nontender “English pea” nodule internally on lid
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Chalazion
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Pain and limitation of EOMs, proptosis, chemosis, decreased visual acuity
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Orbital Cellulitis
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Hyperemic, exudative tonsils, posterior cervical LAD, fever, palatal petechiae, hepatosplenomegaly
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Mononucleosis
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Levine’s sign, tachycardia, S4 gallop hyper/hypotension, diaphoresis, tachypnea, pallor, cool/clammy skin, low-grade fever
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Acute Coronary Syndrome/AMI
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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
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EKG LBBB LVH Q-waves Left Axis Deviation
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CHF: LV Failure Which can progress to…
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CXR “Bat-winged” or “Butterfly pattern”
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Pulmonary Edema
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Peripheral edema, jugular venous distention, tachycardia, hepatosplenomegaly, ascites, hemorrhoids Caput medusa
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EKG: Right Ventricular Hypertrophy “Poor R-wave progression” and deep S waves in V leads R axis deviation
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CHF: RV Failure
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Fever, left lower sternal border friction rub, tachycardia Patient’s position of relief “Diffuse ST-segment elevations”
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Pericarditis
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Kussmaul’s sign, Pulsus Paradoxus,cool clammy skin, tachycardia, distant heart sounds, friction rub, hypotension, pulsus alternans, and JVD…
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EKG: Tachycardia, low voltage QRS, and electrical alternans “Water bottle” heart
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Cardiac Tamponade
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Murmurs
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Low-pitched apical diastolic murmur “Opening Snap” Accentuated in left lateral decubitus & after exercise
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Mitral Stenosis
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High-pitched, blowing diastolic murmur, 2 nd - 4 th left interspaces Radiation to apex, RSB Accentuated: Patient sitting/leaning forward, exhalation
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Aortic Regurgitation
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Blowing, holosystolic murmur at apex Radiation to left axilla, LSB Medium-high pitch
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Mitral Regurgitation
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Harsh crescendo-decrescendo, medium pitched systolic murmur at right 2 nd interspace Radiation to neck Accentuated: patient sitting/leaning forward
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Aortic Stenosis
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“Midsystolic click”; murmur prolonged with Valsalva and decreased with squatting
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Mitral Valve Prolapse
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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)…
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+ Family history of sudden death…
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Hypertrophic Cardiomyopathy
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LVH
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acute anterior lateral myocardial infarction
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Primary AV block
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“Bird’s Beak”
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Achalasia
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Cullen’s Sign
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Grey-Turner’s sign
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Sentinel loop sign
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Colon cut-off sign
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Acute Pancreatitis
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“Discontinuous (skip lesions), transmural inflammation, cobblestoning”
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Crohn’s Disease
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“Continuous, Colonic (rectal), Coating (mucosa/submucosa)”
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Ulcerative Colitis
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Obturator sign Psoas sign RLQ pain/McBurney’s Point tenderness + rebound tenderness Also: Rovsing’s sign, fever, cutaneous hyperesthesias, abdominal guarding
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Appendicitis
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Dental erosions, oropharyngeal inflammation; hx of burning retrosternal chest pain provoked by supine position and regurgitation of digested food Upper Endoscopy
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GERD (with progression to Barrett’s esophagus)
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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
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Duodenal Ulcer (H. pylori induced)
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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
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Peptic Ulcer Disease (gastric irritant/NSAID induced)…
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…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”
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Perforated Ulcer/Viscus
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Fever/chills, RUQ, jaundice; tachycardia, hypoactive bowel sounds, toxic appearance, + Murphy’s sign RUQ sonogram
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Acute Cholecystitis Charcot’s triad + shock/hypotension and altered mental status = Reynolds' pentad…Dx?
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Acute cholangitis
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Erythema Migrans
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Hepatitis B Serology The first clinically detectable serological agent in acute hepatitis B is…
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HBsAg
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Appears after successful clearance of HBsAg or after HepB vaccination…
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Anti-HBs
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Implies highly infectious state, found in acute or chronic HepB…
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HBeAg... While low infectivity/replication is inferred by…
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Anti-HBe
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Found in window period, signifies acute infection…
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IgM anti-HBc (and HBeAg)
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Signifies Chronic Hepatitis B, without recovery…
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IgG anti-HBc and HBsAg
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Signifies Chronic Hepatitis B, WITH recovery/immunity…
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IgG anti-HBc and Anti-HBs (HBsAg and HBeAg negative)
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The only positive serological marker in HepB vaccination…
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Anti-HBs
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Primary Lyme Disease
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Fever; initial macular rash on periphery…
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…Later: Central Papules and Petechiae
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Rocky Mountain Spotted Fever
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Productive rust-colored cough, fever, tachypnea, rigors, ill appearance Pulmonary Exam: Decreased breath sounds, increased fremitus, rales, + bronchophony, egophony, whispered pectoriloquy
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Pneumococcal Pneumonia
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…In the chronically ill
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Staphylococcal Pneumonia
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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
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Mycoplasma (walking) pneumonia
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Unilateral absent breath sounds, ipsilateral atelectasis Hyperresonant to percussion, decreased fremitus
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Pneumothorax
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Wheezing, nocturnal cough, pulsus paradoxus; history of atopic dermatitis & allergic rhinitis Increased bronchial wall markings Flattening of diaphragm Hyperinflation
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Asthma
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Tachypnea/cardia, rales, fever, unilateral lower extremity edema, venous cords…
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EKG: sinus tachycardia, “S1 Q3 T3”, RBBB…
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CXR: Elevated hemidiaphragm, Hampton's hump, Westmark sign…
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V-Q Mismatching
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Pulmonary Embolism
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Hyperinflated (barrel chest), wheezing, crackles, diffusely decreased breath sounds, hyperresonance on percussion, prolonged expiration, cyanosis, accessory muscle of respiration use…
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PFT: Reduced FEV1 CXR: Lung hyperinflation Diaphragm flattening Distal pulmonary vessel tapering Increased basilar markings
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COPD
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Bulging TM, increased vascularity, erythema, distortion of normal landmarks, immobile to insufflation
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AOM
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Tenderness on pinna palpation/auricle traction; edema, purulent discharge
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Otitis externa
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Waters view: opacification, air-fluid levels, thickened mucosa
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Maxillary Sinusitis
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Soft white plaques, erythematous, bleeding base
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Oral Candidiasis
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Thick, white patch, adherent
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Leukoplakia
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Irregular, raised white-pink cauliflower lesion
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Condyloma acuminata
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Tender! vesicles ulcerations, grouped lesions common and may coalesce; regional LAD, fever
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Herpes Simplex Virus (II)
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Painless Solitary Chancre
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Primary Syphilis
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Condyloma Lata
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Secondary Syphilis
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Granulomatous Gummas
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Tertiary Syphilis
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“Bronze Diabetes” + Cirrhosis Iron Deposits
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Hemochromatosis
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CD4+ < 200, fever, nonproductive cough, rales/rhonchi, bibasilar crackles, respiratory distress Bilateral Interstitial Infiltrates
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Pneumocystis carinii pneumonia (PCP)
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Good Luck!!!
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