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