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DO NOT EVER MISS BUZZWORDS

Subauricular bruit, submandibular bruit - Carotid artery stenosis → FMD
Abdominal bruit - RAS
Prevertebral calcification - extensive atherosclerosis
Geography
Wisconsin - Blastomycosis
New Jersey, Connecticut, Maine - Lyme disease
North Carolina, Texas, Oklahoma, Arkansas, Tennessee, and Missouri
- RMSF
High-pitched sound in early diastole → pericardial knock → constrictive
pericarditis
High voltage QRS complex + ST segment depression + lateral T wave
inversion → LVH
Large-amplitude S waves in R-sided precordial leads and increased R-
wave amplitude in V6 → HOCM
Bilateral choroid plexus cyst → Trisomy 18
Enteral feeding in a preterm neonate → NEC
Only murmur that is quieter with increased preload (eg inspiration) and
increased afterload (handgrip) → HOCM
Only murmur that is louder with Valsalva → HOCM
LV blood volume: Valsalva strain, abrupt standing, nitroglycerin (all
preload)
LV blood volume: sustained hand grip, squatting, passive leg raise
Tricuspid regurgitation: prominent V wave, absent X descent, tricuspid
annular dilation
Atrial tachycardia with AV block (Mobitz 1): digoxin toxicity
ST segment elevation in V4R: RV infarct
Kartagener syndrome: low nasal NO levels
Scleroderma: Limited cutaneous - Pulmonary arterial HTN; Diffuse
cutaneous - ILD
Lung involvement
Upper - smoker, bronchiectasis due to CF
 Lower - AAT deficiency
RVH: enlarged central pulmonary arteries and loss of retrosternal air
space
Pneumothorax: supraclavicular fossa distension with inspiration
Homan sign (DVT): calf pain on dorsiflexion of foot
Curtain falling over eye: amaurosis fugax (resolves within min) or retinal
detachment (does not resolve immediately)
VIPoma (WDHA)- can have coexisting hyperparathyroidism as part of
MEN
PSC - dilated intrahepatic & extrahepatic bile ducts; PBC - dilated
intrahepatic bile ducts
Intrahepatic: no biliary tract dilation, Extrahepatic: biliary tract dilation
Fecal calprotectin: IBD
Low fecal elastase, low trypsinogen: chronic pancreatitis, exocrine
insufficiency
Acid steatocrit: fat malabsorption
Difficulty swallowing solids but not liquids: mechanical obstruction
Hiatal hernia: gastric folds protruding above diaphragm
Oropharyngeal dysphagia→ videofluoroscopic barium swallow
Esophageal dysphagia → barium swallow ff by manometry with
endoscopy
EC PU → Erythema nodosum in Crohn, Pyoderma gangrenosum in
Ulcerative colitis
Sphincter of Oddi dysfunction → cholecystitis-like picture but pain
after opioids and dilated bile ducts without stones
Budd-Chiari syndromes: OCP users, Polycythemia vera, PNH
TPN (>2 weeks): Cholestatic jaundice
Carbohydrate breath test in SIBO: <1.5 hrs
Neuropathic abdominal pain (no tenderness on palpation) → acute
intermittent porphyria
HSM is rare in hairy cell leukemia, AML, AA, MDS
Other names
Quantitative immunoglobulin assay aka flow cytometry
Hepatoma aka HCC
 Primary myelofibrosis aka Agnogenic Myeloid Metaplasia
Nasogastric decompression = nasogastric intubation
Autism spectrum disorder aka pervasive developmental disorder
Ependymoma aka 4th ventricle tumor
VZV aka HHV-3
Capillary malformations (naevus flammeus, port-wine stain,
firemark)
Sturge Weber aka Encephalotrigeminal angiomatosis
Atopic dermatitis aka eczema
Gastric emptying study aka Technetium 99m radiolabeled scan
Periorbital aka preseptal cellulitis
Oculovestibular testing aka Dix-Hallpike
Bronchopulmonary dysplasia or neonatal chronic lung disease
Complex regional pain syndrome aka reflex sympathetic dystrophy
Rituximab uses: NHL, RA, CLL, ITP
Bortezomib: MM
Inability to lift the skin on the dorsum of the second toe (positive
Stemmer sign): lymphedema
Leukostasis (end-organ damage, look for pulmo or neuro complications):
ALL & AML
Soft tissue sarcoma: gradually enlarging painless mass within an
extremity, do CTAP (evaluate for distant spread)
Dimorphic RBC population (hypochromic & normochromic): sideroblastic
anemia
Patient needing large doses of heparin to record any changes in PTT →
ATIII deficiency
Headaches worse when leaning forward → SVC syndrome
Myelodysplastic syndrome: oval macrocytes and hypOsegmented/
hypOgranulated neutrophils, hypercellular marrow
High LAP: primary myelofibrosis, leukemoid reaction, PV, or ET
Low LAP: CML, PNH
Anti-topoisomerase type I (anti-Scl-70): diffuse scleroderma
Anti U1 RNP: mixed connective tissue disease
Drop arm sign (inability to control shoulder abduction), Neer test
(shoulder internally rotated and forearm pronated, thumb pointed to the
floor): rotator cuff tear/tendinopathy
Supracondylar fracture: median nerve injury (weak OK sign) & brachial
artery
Tarsal tunnel syndrome: posterior medial malleolar area, distal plantar
surface of the foot/toes
Stenosing tenosynovitis: locking of a finger in flexed position which
releases suddenly with a snap/pop on extension + nodule at base of
MCP
Patellar tendon rupture: unable to maintain knee extension, patella rides
high
Quadriceps tendon rupture: patella rides low
Anti-Mi-2 (against helicase) and anti-Jo-1 (antisynthetase): DM/PM
Lateral epicondylitis: pain elicited by resisted wrist extension & passive
wrist flexion
Scheuermann kyphosis: rigid curving that does not correct in the prone
or supine positions
Patchy demineralization/osteopenia ff local trauma or surgery + allodynia
+ severe burning or tingling → complex regional pain syndrome
Osteoblastic lesions: focal, sclerotic (Prostate CA)
Yersinia: tender lymph nodes but no genital ulcers
Afebrile + initially watery then bloody stools → STEC
Shigella: also initially watery then bloody but antibiotics do not increase
risk of HUS
Pneumonia + skin abscess + organ abscess + travel history → Melioidosis
Positive 14-3-3 protein titers, positive RT-QuIC: CJD
Viral esophagitis: odynophagia (pain with swallowing), Can𝗗i𝗗a
esophagitis: 𝗗ysphagia (difficulty swallowing)
Vesicular rash at same stages: Smallpox (bioterrorism)
No response to vaccination: CVID
CGD: organism filled neutrophils, CGD-IBD: pigment laden histiocytes
Normal VS: opioid withdrawal, isolated BZD overdose
Recreational synthetic amphetamines and analogues (eg, MDMA, bath
salts): negative urine tox screen
Brown recluse spider bite: deep necrotic ulcer
Pulse ox 85%, large difference between pulse ox O2 sat and ABG:
methemoglobinemia
Awake seizure: strychnine poisoning
Scorpion sting: awake while jerking of ext and complaining of pain at
sting site
Episodic vomiting + relief with hot-water bathing → cannabis
hyperemesis syndrome
Methamphetamine: tactile hallucinations + poor dentition (aka meth,
crystal ice, tina)
MDMA (ecstasy): myoclonus + hyponatremia
Ciguatera (fish): temperature dysesthesia, painful sensation that teeth
are loose, painful urination
Meningitis with normal imaging: cryptococcus
Pronator drift (downward): UMN or pyramidal/corticospinal tract disease
I/L upward arm drift: cerebellar lesion
Renal angiomyolipomas: tuberous sclerosis
DAI: punctate hemorrhages in white matter
Lacunar stroke: pure motor hemiparesis
Femoral neck fracture/intertrochanteric fracture: shortened externally
rotated leg
Headaches worsen during recumbent positioning or straining:
papilledema
ALS: widespread fibrillations and positive sharp waves
Crossed SLR: exacerbation of pain with passive lifting of unaffected leg
→ vertebral disc herniation
Stroke: hypertension is the strongest modifiable risk factor, age is the
strongest nonmodifiable risk factor
Statins and aspirin for secondary prevention of future CVAs
Seizures + oral and manual automatisms + autonomic disturbance
(epigastric rising sensation) → temporal lobe seizure
Hippocampus - AD, Caudate - PD, HD, Nucleus accumbens - addiction,
Amygdala - herpes encephalitis
Tourette comorbid disorders: ADHD & OCD
MS comorbid psych disorder: depression
ADHD - substance use disorder
PTSD in children: violent themes in play (rams a toy truck into a stuffed
animal, hitting other kids and breaking toys), recurrent nightmare
Head-banging or handbiting: ASD (less common: Lesch-Nyhan)
GAD in children: need for perfectionism and order, coping difficulties
MDD and sleep: REM latency, slow-wave sleep
SGA causing QTc prolongation → Ziprasidone
Clues to breech presentation: 1) subcostal pain, 2) hard mass on uterine
fundus, 3) lack of fetal presenting part on IE
Frank or complete breech may be okay for vaginal delivery
Contraindications to vaginal delivery: 1) classical CS 2)extensive uterine
myomectomy 3) previa
Ideal fetal head: occiput anterior (OA)
Cervical insufficiency: vaginal discharge, light vaginal bleeding,
bulging membranes, cervical dilation w/o contractions, history of
pregnancy loss/preterm birth
Lambda sign (thick intertwin membrane meeting the placenta): Di-Di
T sign: Mo-Di → Twin-twin transfusion
MSAFP: multiple gestation, inaccurate pregnancy dating (MC),
abdominal wall defects, open NTDs
Shoulder dystocia: turtle sign (retraction of head into perineum after it
delivers)
Postpartum + protruding vaginal mass with minimal vaginal bleeding →
uterine artery injury
Myasthenia gravis pregnant patient → never use MgSO4
Bulging amniotic sac or high fetal station → indeterminate fetal
presentation → do transabdominal UTZ
Postpartum patient unresponsive to antibiotics → septic pelvic
thrombophlebitis → anticoagulation + BSA
Shortened vagina: cervix flush with vaginal wall
Endometriosis: lateral cervical displacement and cervical motion
tenderness
Boggy tender uterus: adenomyosis or uterine atony
Adenomyosis: loss of endomyometrial border, subendometrial cysts
Perianal skin thickening in figure eight pattern + loss of labia minora +
clitoral hood retraction + labial adherence + white atrophic papules →
vulvar lichen sclerosus
Increased clear vaginal discharge + oligohydramnios → may be
spontaneous ROM (if term) happening over days
POI common in: Fragile X, TS, Galactosemia
Voice deepening → frank virilization
ASCUS or LSIL → HPV Co-testing, HSIL → colposcopy
Only cyanotic CHD with LAD: TVA (tall peaked P waves, hypoplastic RV)
Brightness on transillumination → pneumothorax
MCAD: hypoketotic hypoglycemia
Pedia with UTI & hematuria →do test of cure
Sandifer syndrome: intermittent opisthotonic posturing; pathologic
feature of GERD
Idiopathic intussusception: ileocolic (enema), Intussusception in HSP:
ileoileal (surgical)
Retrocardiac opacity: sliding hiatal hernia
Celiac disease may NOT present with diarrhea
UGIB after necrotizing pancreatitis + varices → splenic vein thrombosis
Hepatic vein thrombosis (Budd Chiari): hepatomegaly, portal HTN,
jaundice, abdominal pain/distension
Mother who has fractures as a child may have child abuse, becomes a
risk factor for child abuse for her own child
Congenital clubfoot: Plantar-flexed foot with an adducted and internally
rotated forefoot
Middle third clavicular fracture: nonoperative, distal third: operative
(ORIF)
Osteochondroma: painless mass near a joint, such as knee or ankle joint
Epitrochlear LAD characteristic of secondary syphilis
Retropharyngeal abscess: widening of prevertebral space, acute
mediastinitis (do CXR)
Lymphadenitis with purplish discoloration: Mycobacterium spp (MAC)
Bacterial tracheitis: tracheal air column with irregular borders
Gout: 1st MTP, Pseudogout: knee
Lung cancer classically metastasizes to the adrenal gland (lung mass +
adrenal mass)
Tenderness to palpation of spine: osteomyelitis, vertebral compression
fracture, or cancer metastatic to bone
Effort-induced upper extremity DVT: Paget–Schroetter disease
Family history of colon CA and breast CA → think Lynch or Peutz Jegher
Acanthosis nigricans: insulin resistance → T2DM
HARD symptoms (Hyperarousal, Avoidant behavior, Reliving experience,
Disturbed mood/thinking): PTSD or ASD
Riedel thyroiditis: Rock-hard thyroid gland
Posterior dislocation: after seizure or electrocution → lateral xray
History of numerous respiratory infections: immunodeficiency, CF
Distractibility, Irresponsibility, Grandiosity, Flight of ideas, Activity
increase, Sleep deficit, and Talkativeness
Laminated calcifications: Psamomma bodies
Eculizumab use: PNH, at risk for Neisseria meningitidis
MMA: Vit B12 deficiency
Drug-induced PML: Natalizumab (used in MS, alpha-4 integrin INH)
Tunnel vision: bitemporal hemianopsia
Vertical diplopia with the jaw tilted towards the side of the lesion +
difficulty going down stairs→ CN4 (trochlear) lesion
Pure motor lesion: internal capsule — lenticulostriate arteries
Abnormal eye tracking: schizophrenia
Increased sensitivity to lactate infusions: panic disorder
Intoxication + periodontal disease: amphetamine intoxication
Acalculia + L-R disorientation: Gerstmann syndrome (dominant parietal
lobe)
FMR1 - Friedrich Ataxia, MECP2 - Rett, DMPK - Myotonic dystrophy
Drug intoxication
Nystagmus - PCP
Bad oral hygiene - Methamphetamine
 Hyponatremia + affectionate behavior + serotonin syndrome +
danced for hours on end- Ecstasy/MDMA
Conjunctival injection + slowed time - Marijuana
Nasal septum perforation, tactile hallucinations - Cocaine
Flashbacks, hallucinations - LSD
Tachycardia, nystagmus, slurred speech, ataxia - Inhalants
Defective integrins - LAD; neutrophil recruitment - HyperIgE; class-
switching - HyperIgM; negative selection of T cells - CMCC
No air in colon: complete bowel obstruction
Pearly gray retracted TM: OME
Diarrhea in a child with pet turtle/reptile/chicken → Salmonella enteritidis
Schizophrenia: increased size of lateral ventricles
Chronic postprandial pain → mesenteric ischemia → CTA
Symptomatic + stenosis of >70% → carotid endarterectomy
Plop sound on chest auscultation → cardiac myxoma
Burst fracture → anterior cord syndrome
Trauma + restricted upward gaze (inferior rectus entrapment) → orbital
floor fracture/blowout fracture
Restricted downward gaze (cannot look on the floor) + head tilt →
trochlear nerve palsy
D
Weber Effect = if you are tracking adverse events, the incidence of that
adverse event will go down (for the first year)
Loud P2: Pulmonary HTN
Crohn disease: rectal sparing, Ulcerative colitis: ileal sparing
Crohn disease assoc with CaOx stones
Tracheal narrowing with ulceration: GPA
Ibrutinib: CLL, Imatinib, Dasatinib: CML
Tsat <20% : IDA
Signet ring cells in ovary → Kruckenberg tumor (GI mets to ovaries)
Blood type A, CEA → gastric CA
Supernumerary teeth → Gardner syndrome or Job (HyperIgE) syndrome
Acomm aneurysm → bitemporal hemianopsia
Neutrophilic dermal infiltrate → pyoderma gangrenosum, sweet syndrome
Leptomeningeal angioma + episcleral hemangioma + tram track
appearance → Sturge Weber
Soft occipital bone (craniotabes) → Rickets
High-voltage delta waves → hypsarrhythmias → West syndrome → TSC
Bone polyps, EXT1 mutation → osteochondroma, hereditary multiple
exostoses
Paradoxical septal motion→ constrictive pericarditis or after cardiac
surgery
Basilar consolidations with increased interstitial markings → pneumonia
or an infectious process
Mature leukocytosis with a left shift (especially with metamyelocytes and
myelocytes)
Limping is NON-weight bearing
Depression & Narcolepsy: REM latency (shortened) + REM
density
Nausea/emesis/epigastric pain in female, diabetics or severe PAD
patients → atypical angina
Downwardly displaced TV + huge RA → Ebstein anomaly
Tram tracks/signet ring sign on CT → bronchiectasis
Syncope + Angina + Dyspnea (SAD) + murmur → aortic stenosis
Opsoclonus: irregular jerking eye movements
Loss of haustrations: dilated colon
Uncal herniation: dilated, nonreactive ipsilateral pupil, contralateral
extensor posturing, coma, and respiratory compromise
Good days and bad days: fluctuating cognition
Metaphysis: osteosarcoma, diaphysis (or axial skeleton): Ewing (DE MO)
Ear pain with manipulation of pinna: otitis externa
Harsh vibratory sound forced expiration: expiratory stridor
Expiratory stridor + FVC > slow VC + scooped out flow volume loop →
tracheal collapse
Chest pain that worsens with breathing, coughing, sneezing → pleuritic
chest pain → pneumothorax, pleurisy, pericarditis, pulmonary embolism
Osseous fragmentation, new bone formation, subluxation/dislocation,
 arch collapse → chronic charcot arthropathy
Cyanotic NB + single S2 → truncus arteriosus
TGA: immediate cyanosis within 24 hrs of life, single S2

Anti-Saccharomyces cerevisiae antibody → Crohn’s disease

Pet lizard → Risk factor for non-typhi Salmonella
Multiple flaccid bullae on an erythematous base over the buttocks →
immersion burn
PS: widened splitting of S2, AS: paradoxical splitting
Prominent parasternal impulse: RVH
Irregular respirations: watch out for Cushing triad (HTN, bradycardia)
Shuffling or festinating strides: Parkinsonism
Difficulty initiating movement (appear stuck to the ground/magnetic): gait
ataxia (eg, NPH)
Waddling gait, PMW, abnormal pelvic tilt: myopathies
SUPRAglottic narrowing → thumbprint sign → epiglottitis
SUBglottic narrowing of trachea → steeple sign → croup
Pseudofracture = linear lucency = looser zone → Osteomalacia
Punched-out erosion with hemorrhagic crust → herpes related
Calymmatobacterium granulomatis: granuloma inguinale or donovanosis
Psoas sign: abdominal pain with hip extension, seen in psoas abscess,
appendicitis
Standing from a sitting position is a form of stress incontinence
Rapidly enlarging head circumference crossing multiple growth
percentiles (25th, 50th) + developmental delay → Hydrocephalus
Distal radius (Colles) fracture → Median nerve injury
Vocal tics: grunting, snorting, throat clearing, barking, yelling, coprolalia
(obscenities), squeaking
Rheuma
Plantar fasciits: worse when first standing from rest/after long periods
of standing, (+) pain on anteromedial heel
Morton neuroma: pain on 3rd-4th metatarsal
Stress fracture: pain on Sides of heel
 Tarsal tunnel syndrome: pain on posterior medial malleolar area/
posterior tibial nerve
Achilles tendinopathy: pain 2-6cm above posterior calcaneus
AC joint sprain: cross-body adduction pain
Suprascapular nerve entrapment: pain on abduction and external
rotation
Rotator cuff tendinopathy: similar to above, Neer test
Adhesive capsulitis: pain ff by stiffness, reduced active AND passive
ROM
Osgood-Schlatter: growth spurt, pain on tibial tubercle, squatting,
extending knee w/ resistance
SCFE: obese adolescent, leg is external rotated, Trendelenburg gait
or limp
Iliotibial band syndrome: lateral knee pain
Pes anserinus: medial knee/tibia
Patellofemoral pain: anterior knee pain/worse with running/climbing
stairs/prolonged sitting, quadriceps atrophy/pain provocation during
tonic contraction of quadriceps with knee flexed
Greater trochanteric pain syndrome: lateral hip pain, worse with hip
flexion, lying on affected side, tenderness on greater trochanter
Intrahepatic bile duct proliferation, portal tract inflammation & edema,
fibrosis - biliary atresia
Air dissecting from the alveoli into the interstitial space - pulmonary
interstitial emphysema
Perivenular leukocytoclastic (neutrophils & monocytes) vasculitis: HSP
(IgA vasculitis)
Joint space narrowing, subchondral sclerosis, periarticular osteophytes:
osteoarthritis
Prominent capillary pulsations on fingertips or nail beds - AR
Paradoxical splitting of S2 - AS, HTN, LBBB
Systolic murmur that increases when patient stands up - HCM
Diastolic collapse (failure of ventricular filling) due to elevated right
ventricular filling pressure - cardiac tamponade
Free fluid in the cul-de-sac: may be accumulation of A (eg, ruptured EP)
Diffuse leukoaraiosis with periventricular white matter: hyperintense
signal on MRI, chronic vascular pathology (HTN, DM, vascular dementia)
Short, shuffling gait: postural instability, seen in parkinsonism
Daytime somnolence but restorative sleep: narcolepsy
Acneiform lesions without comedones: angiofibroma
Aquaporin-4 autoantibodies: neuromyelitis optica
Long series of single coughs ending with a loud, high-pitched inhalation:
whooping cough (pertussis)
Opaque conjunctival plaques: Bitot spots
Distal humerus/supracondylar fracture: median nerve - brachial a. injury
Midshaft fracture: radial nerve
Medial epicondyle, hook of hamate, Guyon: ulnar