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HEENT
Brain Disorders
| traumatic head injury, conscious in ER followed by unconsciousness | Epidural hematoma (“lucid interval”) |
| “Worst headache of my life” | Subarachnoid hemorrhage |
| Pituitary tumor, pancreatic tumor, and parathyroid tumor | MEN- I |
| rapid correction of hyponatremia | Central pontine myelinosis |
Altered Mental Status
| Confusion, ataxia, and ophthalmoplegia | Wernicke’s encephalopathy |
Vertigo
| Hearing loss, tinnitus, and vertigo | Ménière’s disease |
Eye Disorders
traumatic blinding in one eye followed by blindness
in the contralateral eye 2 weeks later | Sympathetic ophthalmia |
| Mitotic pupil, ptosis, and anhydrosis | Horner’s syndrome |
Ear Disorders
| Otorrhea (clear) and Battle’s sign | Basilar skull fracture |
Nose Disorders
| Adolescent boy with nasal obstruction and recurrent epistaxis | Juvenile nasopharyngeal angiofibroma |
Mouth Disorders
| Buccal mucosa with pigmentation | Peutz-Jeghers syndrome |
| Marfanoid body habitus and mucosal neuromas | MEN II-b |
| Necrotizing migratory erythema | Glucagonoma |
| Bleeding gums and wound dehiscence | Vitamin C deficiency |
Neck Disorders
| Child with MIDLINE neck mass | Thyroglossal duct cyst |
| Child with LAtERAL neck mass | Branchial cleft cyst |
Epiglottis Disorders
Child <5 years of age sitting upright and drooling, with “hot-potato”
voice | Epiglottitis |
Thyroid Disorders
| Psammoma bodies | Papillary thyroid cancer |
| Thyroid tumor with AMYLOID tissue | Thyroid medullary cancer |
| Medullary thyroid cancer, pheochromocytoma, and hyperparathyroidism | MEN-IIa |
Parathyroid Disorders
| PALPABLE neck tumor and hypercalcemia | Parathyroid cancer |
Upper Extremity Disorders
| Arm pain and syncope with arm movement | Subclavian steal syndrome |
| Supracondylar fracture and contracture of forearm flexors | Volkmann’s contracture |
Chest Disorders
| Esophagus | Emesis, chest pain radiating to back, and mediastinal air | Boerhaave’s |
| Vomiting, retching, and epigastric pain | Mallory-Weiss tear |
| Newborn with inability to “pass an NG “ | Esophageal atresia |
| | |
| Aorta | Chest pain radiating to back and described as a “tearing” pain | Aortic dissection |
Palpitations
| Hypertension, diaphoresis (episodic), and palpitations | Pheochromocytoma |
Cardiac Disorders
| Angina, syncope, and CHF | Aortic stenosis |
| Hypotension, decreased, heart sounds, and JVD | Pericardial tamponade |
Ribs
| Four ribs broken in two places and pulmonary contusion | Flail chest |
Shortness of Breath
| Femur fracture, respiratory failure, petechiae, and mental status changes | Fat embolism |
| tracheal deviation, decreased breath sounds, and hyperresonance | Tension pneumothorax |
Pleuritic Chest Pain
| tobacco use, asbestos exposure, and pleuritic chest pain | Mesothelioma |
Hardware
| Fever, central line, and HYPERglycemia | Central line infection |
Breast
| 18-year-old woman with bloody nipple discharge | Ductal papilloma |
Abdominal Disorders
RUQ
| Liver | RUQ pain, travel, and exposure to sheep | Hydatid cyst |
| Liver abscess with “anchovy paste” | Amebic abscess |
| Female taking birth control pills with liver mass | Hepatic adenoma |
| Liver tumor with “central scar” | Focal nodular hyperplasia |
| RUQ bruit and CHF in young adult | Liver hemangioma |
| A 25-year-old man with liver mass with fibrous septae and NO history of cirrhosis or hepatitis | Fibrolamellar hepatocellular carcinoma |
| GallBladder | A 45-year-old woman with RUQ pain or 12 hours, fever, and leukocytosis | Acute cholecystitis |
| RUQ pain, jaundice, and fever | Cholangitis |
| Pylorus | Infant with projectile
vomiting | Pyloric stenosis |
| Duodenal | Ulcer and decreased pain with food | Duodenal ulcer |
| Misc. | Upper GI bleed, jaundice, and RUQ pain | Hemobilia |
Epigastric
| Pancreas | Epigastric pain radiating to back, with nausea and vomiting | Pancreatitis |
| Epigastric pain radiating to back and any ecchymosis | Hemorrhagic pancreatitis |
| Gallstones, epigastric pain radiating to back, and nausea | Gallstone pancreatitis |
| Pancreatitis and palpable epigastric mass | Pancreatic pseudocyst |
| Elderly man with large non-tender palpable gallbladder | Pancreatic cancer (Courvoisier’s sign) |
| Pancreatic mass, gallstones, diabetes, and diarrhea | Somatostatinoma |
| Irritability, diaphoresis, weakness, tremulousness, and palpitations | Insulinoma |
LUQ
RLQ
| “Currant jelly” stools and abdominal colic | Intussusception |
| Appendectomy followed by ever and abdominal pain on postoperative day #7 | Peritoneal abscess |
LLQ
| LLQ pain, ever, and change in bowel habits | Diverticulitis |
| Institutionalized, abdominal pain, vomiting, and distention, with proximal colonic dilation | Sigmoid volvulus |
| Pneumaturia and LLQ pain | Colovesicular fistula |
| Newborn with failure to pass meconium in first 24 hours | Hirschsprung’s |
Lower Abdominal Disorders
| Jejunal ulcers | Zollinger-Ellison syndrome |
| Abdominal pain, fever, hypotension, HYPERkalemia, and HYPOnatremia | Adrenal insufficiency (Addisonian crisis) |
| Newborn with pneumatosis | Necrotizing enterocolitis (NEC) |
| Child with abdominal mass that crosses midline | Neuroblastoma |
Child <4 years of age with abdominal tumor
that does NOt cross midline | Wilms’ tumor |
| Elderly woman, SBO, and air in biliary tract | Gallstone ileus |
| Lower GI bleed, technetium pertechnetate scan | Meckel’s diverticulum |
| Flushing, diarrhea, and right-sided heart failure | Carcinoid |
| Elevated urine 5-HIAA | Carcinoid |
| Desmoid tumor, oste oma, and colon cancer | Gardner’s syndrome |
| Abdominal pain, hypotension, and abdominal pulsatile mass | Ruptured abdominal aortic aneurysm (AAA) |
| Abdominal pain “out of proportion” to abdominal exam | Mesenteric ischemia |
| Caput medusa | Portal hypertension |
| Increasing creatinine on ACE inhibitor | Renal artery stenosis |
| Abdominal pain, diarrhea, and anal fistulae | Crohn’s disease |
| Increased peak airway pressure, low urine output, and urinary bladder 25 mmHg | Abdominal compartment syndrome |
| Infant with bilious vomiting | Malrotation |
| Newborn with an abdominal defect and umbilical cord on sac | Omphalocele |
Diarrhea
| IV antibiotics, fever, diarrhea | Clostridium difficile pseudomembranous colitis |
Anal Disorders
| Excruciating pain with bowel movement | Anal fissure |
| Hematochezia and tenesmus | Rectal cancer |
Pelvic Disorders
| Pelvis | Elderly woman with pain down inner aspect of thigh | Obturator hernia (Howship-Romberg sign) |
| Crush injury and dark urine | Myoglobinuria |
| Bladder | A 60-year-old white man with painless hematuria | Bladder cancer |
Back Disorders
Flank Pain
| Hematuria, flank pain, and abdominal mass (palpable) | Renal cell carcinoma |
Urinary Disorders
| Massive urine output and HYPERnatremia | Diabetes insipidus |
| Increased urine osmolality, HYPOnatremia, and low serum osmolality | SIADH |
Lower Extremity Disorders
| Advancing crepitus, fever, and blood blisters | Necrotizing fasciitis |
Thigh Disorders
tibia fracture, “pain out of proportion,” pain on
passive foot movement, and palpable pulses | Compartment syndrome |
Infectious Disorders
| Fever on postoperative day #1, with “bronze” weeping, tender wound | Clostridial wound infection |
Metabolic Disorders
| EKG with “peaked” waves | Hyperkalemia |
| EKG with flattening of T waves and U waves | Hypokalemia |
| Polydipsia, polyuria, and constipation | Hypercalcemia |
| Hypokalemia refractory to IV potassium supplementation | Hypomagnesemia |
Bleeding Disorders
| Factor VIII deficiency | Hemophilia A |
Substance Abuse
A 40-year-old man with tachycardia/hypertension
and cofusion on postoperative day #2 | Alcohol withdrawal |
Operative Disorders
| High INtRAoperative fever | Malignant hyperthermia |
Post-Op Disorders
| Day 1 | atelectasis |
| Day 2 | pneumonai |
| Day 3 | UTI |
| Day 5 | DVT |
| Day 7 | wound infection |
| Day 10 | deep abscess (CT scan) |
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