PANCE Quick Hitters
Dermatology
- Bullous impetigo – Staph A
- Psoriasis associated with pitting of the nails in yellow brown discoloration is underneath the nail bed
Auspitz sign
- Alopecia areata = Broken hairs at the border of well demarcated lesion, pitting of nails likely present
- Tinea capitis – erythema and scaling associated with hair loss
- Guttate psoriasis associated with group a strep infections – tear dop sign
Cardiology
- Restrictive cardiomyopathy Echo findings – diastolic dysfunction with marked dilation of both
- Graham Steell murmur = pulmonary regurgitation
- 25 to 50% chance of sudden death in one to two years of symptomatic aortic stenosis is not treated
surgically
- Heparin contraindicated in Dresslers
-
HENT
- Sensorineural hearing loss – MC type of hearing loss in elderly
- Fluid filled blisters on tympanic membrane is associated with mycoplasma pneumonia
- Centor criteria = age 3–14, absence of cough, exudates, anterior cervical lymphadenopathy, fever
- Retinal detachment = floaters and flashing lights with positive Shafer sign (pigment cells in vitreous
humor) fluid that shifts with position changes
- Hearing loss = labyrinthitis
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Pulmonology
- ARDS – Bilateral findings on Xray and exam
- Empyema – pus in the pleural space, bacteria or other microorganisms needs to be present for this, gram
stain showing microorganism is needed
- Emphysema = decreased DLCO, if the sea, FEV1, increase RV
- Residual volume is also increased in chronic bronchitis
- FVC/FEV1 <0.7 in COPD
- FVC/FEV1 >0.7 in IPF with decrease in RV and TLC
- Any patient hospitalized or in a skilled nursing or rehab facility within the past the 90 days = HAP
Pneumonia diagnosed 48 + hours = HAP
- Pneumothorax less than 15% = symptomatic care without intervention
- Bronchoscopy for central lesions
- Percutaneous for peripheral lesions
- Legionella Pneumonia = Hyponatremia Tx: Macrolide
- Silicosis = Eggshell calcification of hilar nodes
GI
- H. pylori – Lymphoid tissue lymphoma
- Trypsinogen – contributes to patho of pancreatitis
- Chronic omeprazole – B12 deficiency
- Secretin test is associated with ZES
- Magnesium and potassium go together = low magnesium/low potassium and vice versa
- Dawn phenomenon = idiopathic surge in glucagon, cortisol, growth hormone
- Somogyi effect = iatrogenic caused by nocturnal hypoglycemia followed by rebound hyperglycemia Both
of these are hyper glycemic issues
- Anti-mitochondrial = Primary BILIARY cirrhosis
- Primary SCLEROSING cholangitis = Crohn’s/UC
- Wernicke Encephalopathy THEN Korsakoff’s Syndrome
- H. Pylori eradication = urea, fecal, or scope regardless of symptoms after completion of therapy. Stop PPI
1-2 weeks before checking
GU
- Spermatocele is a fluid filled mass that transilluminate and it sits on top of the epididymis Hydrocele is a
fluid filled mass that transilluminate and may worsen with Valsalva and can be more anterior and lateral
- Orchiopexy is needed in contralateral testicle to stitch it to the inner wall
- 40% of infertile males have varicocele, leading them to make unhealthy sperm
Renal
- PCKD is associated with abdominal pain, flank mass as well as cyst in the liver mitral valve prolapse or
regurgitation and Berry aneurysms that can lead to SAH
- Nephrotic in kids = Minimal change (tx: steroids)
- Nephrotic in adults = Focal segmental glomerulosclerosis (tx: ACEi)
Endo
- DDAVP can be used in Cushings
- Assess T3&T4 when a nodule is found before going to immediate bx
- Pretibial edema MC caused by Graves’ (not Hashimoto)
- Vasopressin Challenge test = polyuria gets better with CDI, not affected with NDI
Hematology
- Waldenstrom macroglobulinemia is the most common cause of hyperviscosity syndrome
- TTP – women and those over 40
- Ferritin – most accurate for dx iron deficiency
- DDAVP – mild hemophilia A, but in acute setting of active bleeding use VIII
- Hemoglobin electrophoresis = thalassemia & sickle cell
- Philly chromosome = 22nd chromosome, BCR/ABL gene
- Lovenox Anticoagulant of choice for pregnancy
- Hepatomegaly/Splenomegaly = CLL
- C-ANCA = Granulomatosis with polyangiitis (AKA Wegener’s)
- P-ANCA = Eosinophilic granulomatosis
ID
- Erythema nodulosum – MC cause is infection (strep)
- EBV is associated with Hodgkin’s lymphoma oral hairy leukoplakia and others (this needs to be
investigated further)
- Atovaquone – proguanil is recommended anti-malarial for international travel
- CMV is associated with visual impairment and is the most common cause of congenital viral infection in
the United States
- Coxiella can cause thrombocytopenia in vet workers
- Seizures are associated with Shiga toxin
- Mycoplasma pneumonia can cause CNS problems and hemolysis
- Reactive arthritis = Chlamydia (+HLA-B27)
- Dark field = syphilis
Reproductive
- Late decelerations – uteroplacental insuff
- Variable – Cord compression
- HPV becomes whitened with acetic acid
- Women greater than 25 with HPV positive ASC US = colpo
- Pre-or peri-partum eclampsia = IV magnesium first then delivery
- Copper IUD (ParaGard) = 10 year duration
- Marina IUD = 5 year duration
- Fibrocystic breast disease = responsive to menstrual cycles and tender, Straw-colored fluid on
aspiration
- Fibroadenoma = do not change with menstrual cycles
- Breast development typically begins about two years before the onset of menarche No
type of development or menarche by 13-14 = primary amenorrhea
- Breast development with no menarche by 16 = primary amenorrhea
- DES is associated with clear cell adenocarcinoma
- Even if vaccinated pregnant women receive tamiflu
Peds
- Mature pincer grasp and walking = 12 months
- VIRMMR = live
- 1st Hep B = at birth
- Osteomyelitis in kids = Femur
2 mo: 2B DR HIP: 2 Hep B, DTaP, RV, HiB, IPV, PCV
nd
4 mo: DR HIP: DTap, RV, HiB, IPV, PCV
6 mo: DR HIP Flu: DTaP, RV, HiB, IPV, PCV, Influenza
12 mo: V MAD HIP: MMRV, Hep A, DTaP, HiB, IPV, PCV
- 4-6 years: Very DIM: Varicella, Dtap, IPV, MMR
- 11 year: HPV, meningococcal (2 16-18yo), Tdap
nd
Pharm
- Bupropion has been shown to cause less G.I. and sexual dysfunction compared to SSRI
- Tetracyclines cut off for age is eight years old
- Thiazolidinediones are associated with MI and increased edema, increased cholesterol
- Tramadol = increased risk for serotonin syndrome
- Beta-blockers = Risk for hypoglycemia
- Fibrates increase the risk of myositis when used with statins
Drug-induced lupus mnemonic: SHIPP
- Sulfonamides
- Hydralazine
- Isoniazid
- Procainamide
- Phenytoin
Psych
- Akathisia is a subjective feeling of restlessness, which often manifests with a compelling need to move
constantly – associated with starting SSRI or psych med
- Cooking – First thing to go in dementia
- Bupropion = least sexual side effects
Neuro
- ALS is associated with positive Babinski sign, increase the deep tendon reflexes, atrophic tongue with
fasciculations
- C7 – triceps
- L5 root – big toe extension
- S1 – Lateral border area
- Anterior cerebral artery = Legs > Arms
- Trigeminal Neuralgia Tx: Carbamazepine
- Add ampilcillin to elder meningitis
- 1st line for pituitary prolactinoma with no concerning sx = dopamine agonist
MSK
- Calcaneal apophysitis – MC posterior heel pain. Bilateral. 5-11 y/o. Bones grow faster than tendons and
repeating activities cause the pain.
- Cefotaxime – Osteomyelitis covers staph and salmonella
- Diaphysis Metaphysis Epiphyseal plate Epiphysis
- Olecranon bursitis = MC
- RA and other rheumatologic disease = Immune complex reactions (type III)
Juvenile Idiopathic Arthritis (formerly Juvenile Rheumatoid Arthritis)
- Patient presents with persistent, unexplained arthritis in one or more joints for more than 6 weeks in
children < 16 years
- Diagnosis is made after exclusion of infection, other inflammatory diseases, and trauma
- Unknown etiology, often with no preceding illness
- The clinical manifestations vary widely and can be very severe
- Polyarticular (RF positive and negative), pauciarticular (type 1 or 2), and systemic (Still disease)
- Treatment is NSAIDs, methotrexate, steroids, specialist referrals
- Hip abduction – DDH MC sign
- ACL tears associated with a segond fracture (lateral tibial condyle avulsion fracture)
- Osteosarcoma = sunburst appearance and hair on end appearance (most common)
Ewings sarcoma = layered periosteal (onion peel)
- Chondrosarcoma = punctuate or ring and arc
- Osteoid osteoma = relieved with aspirin
- For scoliosis, 10 to 25° should be monitored, 25 to 40° should be braced, above 40 or 45 should be
referred for evaluation
- After school to maturity has been breached no treatment is necessary for curves less than 40°
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Genetics
- Fragile X syndrome is associated with macroorchidism
- Klinefelter’s = Microorchidism, XXY
- Down = ALL Fall down = ALL(and AML) AFP is decreased, duodenal atresia, celiac, and Hirschsprung
(GI stuff)
- Trisomy 13&18 and neural tube defects = Increased AFP
- Lisch nodules = NF1
- Turner = Coarctation of aorta
