Sarcoidosis bilateral hilar lymphadenopathy, non-caseating granulomas
tinea corporis ringworm
Intestine with Gram positive Cocci
Liver with gram negative rods
Scabies (common location in ventral wrist) Sarcoptes scabei. Rx: PICK permethrin. LEAVE Lindane (neurotox)
B12 anemia (pernicious), megaloblastic anemia, hypersegs
Sideroblastic (microcytic) anemia
AML - Auer Rods, DIC
AML with Auer Rods
CLL (more cytoplasmic space) think frequent infections
CLL Smudge cell
Hairy Cell Leukemia (Staining: Tartrate resistant acid Phosphatase; Rx: Cladribine with 80% Remission rate)
Multiple Myeloma (IgG>IgA)
Reed-Sternberg Hodgkin's Lymphoma
Acanthocytes (abetalipoproteinemia)
Dohle Body (Toxic Lymphocytes, EBV)
Heinz Bodies, Bite Cells (i.e. Degmacytes) G6PD Deficiency (remember that Sulfa drugs and Quinidine may precipitate G6PD...)
Howel Jolly Bodies (Asplenia)
Malaria (organisms in cells)
Reticulocytes.
Schistocytes (DIC, TTP, MAHA)
Helmet Cells (evidence of hemolysis)
Sickle Cell Disease
Spherocytosis (autosomal dominant, incr GB disease)
Target Cells (Thallassemia or Severe Liver Disfunction)
Teardrop cells (i.e. dacrocytes) Myelofibrosis (assoc with CML)
Bacterial Conjunctivitis. If this were gonorrheal in an infant (days 2-5), then topical erythro + IV/IM ceftriaxone.
Cataracts (This could be congenital: Galactosemia or TORCH)
Central Retinal Artery Occlusion (embolus; painless, unilateral vision loss)
Central Retinal Vein Occlusion: HTN, DM, Leukemia (unilateral painless vision loss)
Glaucoma (closed: acute, painful. Use pilocarpine, glycerine, acetazolamide) (open: painless, insidious. Rx: B-block, latanoprost, acetazolamide, pilocarpine)
Orbital Cellulitis (strep pneumo, H flu B, staph/strep) Medical emergency. Inpt IV Abx.
pre- and post-septal Orbital Cellulitis
Leukocoria (Retinoblastoma)
Diabetic Fundus with hemorrhages (dot-blot hemorrhages, microaneurisms, neovascularization)
Normal Fundus. If the corresponding pupil consistently DILATES to light. Think optic neuritis ++/- pain (and consider cause being ethambutol, MS, Lyme, Syphilis, Tumor)
Papilledema
Roth Spot (white-centered hemorrhage - endocarditis)
Acne vulgaris. Propionibacterium acnes. Rx: topical Benzoyl peroxide; topical clinda; oral tetra; oral erythro; oral isotretinoin (with knowledge of teratogenic effect)
Actinic keratosis
Contact Dermatitis (Hpersensitivity IV) linear Posion Ivy
Cavernous Hemangioma
Condyloma Accumulata (HPV)
Erythema Infectiosum (Fifth's Disease, Parvo B19)
Erythema Multiforme (HSV, drug rxn, target lesion) Severe = Stevens-Johnson Syndrome
Heliotrope rash (Dermatomyositis) Prox muscle weakness
Henoch-Schonlein Purpura
Impetigo
Keyloids
Melanoma
Molluscum Contagiosum (Rx: Curettage, Cryotherapy, etc)
Pityriasis rosea. Reassurance
Psoriasis (uv light, steroids, keratolytics)
Psoriasis nail pitting
Squamous cell skin cancer
temporal arteritis
tinea capitus (Trichophyton. scalp boggy granuloma = kerion; if + Woods Lamp, then it's Microsporon spp.)
tinea cruris
vitiligo (pernicious anemia, DM, Addison's, Hypothyroid)
abdominal straiae (vertical)
acanthosis nigricans
adenoma sebaceum: This could be a sign of Tuberous Sclerosis. Think seizures, gliomas, MR, Kidney tumors, heart muscle tumor.
arterial insufficiency
cafe au lait (NFT1 or NFT2)
cafe au lait (with MR, it's McCune Albright)
chelitis (low riboflavin)
clubbing
cullen's sign (That's an umbilicus. Severe pancreatitis)
Diabetic foot ulcer
erythema marginatum (Rheumatic fever) Strep Pyogenes. Aspirin. Risk of carditis. Treat THAT with steroids.
Erythema nodosum (IBD, Coccidoides Immitus, TB, Sarcoid)
herpes simplex
hirsuitism (PCOS, Cushing's Syndrome, Phenytoin, Leydig Cell Tumor)
Osler's Lesions (Endocarditis)
Erythema Chronicum Migrans (Lyme Disease)
Malar Rash (SLE) antiphospholipid Ab, might have a false + VDRL.
Neisseriea Septicemia
Neurofibromatosis
Oral Hairy Leucoplakia (EBV, HIV). Oral Leukoplakia without EBV is cancer.
pretibial myxedema (Grave's Disease) TSH receptor Ab that act as agonists.
pyoderma Gangrenosum (IBD)
Raynaud's Phenomenon (ANA is screen. Dx: Scleroderma - antitopisomerase antibody; CREST - antimitochondrial Ab)
Sturge Weber (port wine stain with hemangioma)
Chancre, Syphillis, painless
condyoma lata (syphilis secondary)
varicella zoster
shingles
caseating granuloma (TB)
clue cells (Gardnerella Vaginalis) Rx: Goin' Down Low with the Metro (Metronidazole)
Goodpasture Disease
Gout (Needles, no birefringence, monosodium urate) Rx: Acute - Colchicine. Chronic - Allopurinol
HPV Koilocytosis
Non-caseating granuloma (Sarcoid)
Positive India Ink stain (Cryptococcus neoformans) Rx: Ampho B, flucytosine, check liver fx. Serial Spinal taps
Trichomonas Rx: Metronidazole. (Goin' down low with the Metro)
Abdominal Aortic Aneurism
Congestive Heart Failure
Carotid Stenosis on Angio
Colon Cancer on Barium Enema (Apple core)
Sigmoid colon cancer with barium (apple core)
Congenital Diaphragmatic hernia (male, left)
duodenal atresia (double bubble), Down Syndrome
Liver Tumor on CT
Small Bowel Obstruction
Staghorn Calculus (Proteus, Staphyloccucus)
Toxic Megacolon (Hirschsprung's, U.C.) Rx: NPO, NG, IV with Amp and cefazolin, steroids if U.C. Surgery.
Stroke on CT (R MCA Distribution)
Epidural Hematoma
Tuberculosis
Tuberculosis cavitation
Pulmonary Hypertension
Pancoast Tumor: Watch for Horner's Syndrome: Ptosis, anhydrosis, meiosis
Osteoarthritis
Osteoarthritis again
osteosarcoma with sunray pattern
shoulder dislocation
slipped capital femoral epiphysis
Bell's Palsy (LMN, possible hyperacusis) HSV 1
ptosis (Horner's on the Pt's right)
Peutz-Jegher's freckles (multiple non-cancerous GI polyps. incr in stomach, breast, ovaries CA.) Autosom Dom.
Scleroderma (Antitopoisomerase Ab) Steroids might help
achondroplasia
acute tonsillitis (strep, EBV)
Cushing's Syndrome
Dactylitis (Sickle Cell Disease, probable Salmonella)
Simian Crease (Down)
Erb's Palsy (Brachial Plexus stretch injury at birth)
gyencomastia (EtOH, Spironolatone...)
Rheumatoid Arthritis. Rx: Methotrexate, etanercept, infliximab.
Spina Bifida
Strawberry Tongue [Kawasaki's or (Scarlet Fever - Strep pyogenes)] Get an ECHO in the Kawasaki's
Turner's Syndrome, XO, risk of coarctation of aorta, horseshoe kidneys, etc.)
varicose veins
candidal infection (Thrush, HIV)
dilated cardiomyopathy
gonorrhea Ceftriaxone, Ciprofloxacin
klinefelter's
osteomyelitis
Polycystic Kidney Disease
atrial fibrillation
Rib notching (red), coarctation (blue), pos-stenotic dilation of aorta (green): Turner's XO
Calcium Oxalate crystals (Bipyramidal, rhubarb, ethylene Glycol)
Triple Phosphate crystals (Coffin lids)
Urate Crystals (dissolve in alkaline)
Renal Tubule Epithelium (rounded, exccentric nuclei, chronic glomerulonephritis)
Squamous Epithelium in urine
Atrial Flutter
Atrial Flutter with 2:1 conduction
Basal Cell skin cancer
Decubitus ulcer
Pseudogout (Calcium pyrophosphate crystals)
Esophageal atresia
Giardia species (cysts in stool). Rx: Down low with Metro.
Hutchinson's teeth (congential syphilis)
Iron deficiency anemia
Koilocytosis (HPV, CMV)
Lytic Bone Lesion
Multiple Myeloma punch out lesions
Pneumothorax
Saddle nose (congenital syphilis)
Secondary Syphilis rash
Sigmoid volvulus with barium (and arrows)
Turner's Syndrome Karyotype. Risk of aortic coarctation, horseshoe kidneys.
Xanthelasma
Heart hypertrophy
Pleural Effusions
Sigmoid volvulus with barium
Cystine crystals (hexagonal, clear, acidic urine, take two) <2% of kidney stones. Familial pattern...
Birbeck Granules (tennis racket shaped, Histiocytosis, CD1+)
Paget's Disease of the Nipple
Cervical Cancer at Transformational Zone HPV 16, 18
Codman's Triangle (Osteosarcoma, Distal Femur, Proximal Tibia; Possible sequelae to Retinoblastoma)
Sarcoma Botryoides (“bunch of grapes” coming out the vagina)
Basophilic Stippling (Pb poisoning, burns, granules are ribosomal and mitochondrial detritus)
Echinocytes (Burr cells, many blunted spicules; think Uremia)
Acanthocytes (Spur cells. Fewer of them, and less evenly distributed than in Burr cells, which would be associated with...Uremia. These SPUR cells are associated with...abetalipoproteinemia or chronic liver disease.)
Chronic Lymphocytic Lekemia (bcl-2) Alpha interferon improves survival. Hydroxyurea or Busulfan relieves Sx.
Dermatitis Herpetiformis (assoc with Celiac Disease)
Rouleaux Formation (Multiple Myelom, increased serum proteins make rbcs sticky.)
Koplik's spots [Measles (Rubeola): Prodrome: Koplik's, cough, coryza, conjunctivitis] Cepahlocaudal spread of rash after.
Roseola Infantum: high fever, then return to normal fast. HHV-6. Cephalocaudal spread.
RMSF: East Coast tick bite, centripetal spread with palms and soles involved, Doxycycline or Chloramphenicol.
Thumb Sign, Epiglottitis: #1 H. flu, #2 Staph au. Rx: Airway and 3rd Gen ceph.
Steeple Sign: Croup (layrgotracheal inflammation). #1 paraflu, #2 Influenza. Rx: Mist and racemic Epi.
Rubella: congenital. Cephalocaudal spread. Rx: Supportive.
Uveitis (presenting Sx for juvenile RA) Rx: Corticosteroids.
Bamboo spine Ankylosing spondylitis, ossification fo annulus fibrosis. HLA-B27. Rx: exercise, NSAIDS, Methotrexate, etanercept, infliximab
Keratoderma blennorrhagica (Reiter's: Can't see, pee, or climb a tree. Chlamydia) Rx: Azithro, Doxy, NSAIDS, sulfasalazine
Floppy Baby: Werdnig-Hoffman, LMN, palliation
Primary Biliary Cirrhosis: anti-mitochondrial Ab. Rx for Sx: Cholestyramine.
Hashimoto's Thyroiditis: Antimicrosomal Ab.
Huntington's Disease: Caudate Nucleus atrophy (less bulge, inferiorly, into the ventricles) >70 CAG repeats on Ch4.
Ragged Red muscle fibers: Mitochondrial myopathy (e.g. Lever's Hereditary optic atrophy)
Duchenne's Muscular Dystrophy: Dystrophin, fatty, fibrous muscle biopsy
BItot's spots (Vit A Deficiency):
Multiple sclerosis
Snow storm ultrasound (hydatidiform mole). 46XX = complete, all male, no fetal tissue. 69XXY = incomplete, M/F, + fetal tissue.
Left nasal polyp. Aspirin could precipitate asthma exacerbation.
thyroglossal duct cyst
Chemical Conjunctivits. Ag Nitrate. first day or two postnatally. Day 2-5, think syphilis. After that, think Chlamydia. Rx is topical first, but for chlamydia, you need to prevent pneumonia, so go PO.
N. gonorrhea (gn diplococci) in conjunctivitis...day 2-5. Rx: erythro ointment + IV/IM 2 or 3GC
Chlamydial conjunctivitis (Day 5-14)Rx: erythromycin PO
0.5 to 0.9 cup-to-disk ratio. increase seen with open angle glaucoma. Rx: B-block, prostaglandin (latanoprost), acetazolamide, pilocarpine.
macular drusen. Dry (90%) Rx: A, C, E, Zn. Wet (10%) pegaptanib (antiangiogenic), laser +/- verteporfin.
Kerpes Simplex Keratitis stained with fluorescein. Rx: famciclovir, valcyclovi, acyclovir,
Chalazion (away from lid margin) [Hordeolon would be in the lid margin] Warm compress, I&D
Cherry Red Spot. Baby: Tay-Sachs. Adult: Central retinal artery occlusion (sudden painless unilateral vision loss) HTN, DM, Leukemia. Consider temporal artery biopsy. Corticosteroids immediately.
