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USMLE 1 physical findings


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mid-abdominal pulsatile mass, lower back pain, abdominal bruit
Abdominal Aortic Aneurysm
deficiency causing erythematous pustules and scales resembling psoriasis around mouth genitalia anus feet elbows knees
zinc deficiency
fever, n/v, diffuse periumbilical pain that moves to R lower quadrant
Acute appendicitis
R lower quadrant pain
Acute Appendicitis; Ectopic pregnancy; PID; ovarian cyst; mittelschmerz; Meckel's; Intussusception.
acute onset constant dull aching RUQ pain, 30 min after eating, pain radiates to R shoulder
Acute Cholecystitis
dysuria, frequency, urgency, discomfort over the bladder
Acute cystitis
high fever, drooling, inspiratory stridor, severe dyspnea in a child. Thumbprint sign on x-ray of head/neck.
Acute epiglottitis; H. influenza type B
fever, steady boring midepigastric pain that penetrates straight thru to the back, hemorrhage in the flank's (Gray Turner's sign)
Acute Pancreatitis
knife-like midepigastric pain radiating through to the back
Acute pancreatitis
sudden onset spiking fever, flank pain, chills, n/v, dysuria, frequency
Acute Pylenoephritis
fever, HA, facial pain, postnasal d/c, chronic cough
Acute sinusitis
hyperpigmentation, weakness/fatigability, weight loss, hypotension, decreased Na; increased K
Addison's disease; adrenal insuff.
Virus causing:
pharyngitis, pneumonia, conjuctivitis, gastroenteritis, hemorrhagic cystitis
colicky abdominal pain, abdominal distention, obstipation, radiograph (distended loops of bowel w step-ladder appearance)
Adhesions; GI obstruction
high fever, dehydration, n/v, hypotension
adrenal crisis
HTN, hematuria, berry aneurysm, mitral valve prolapse, bliateral abdominal masses
Adult Polycystic Kidney Disease
café au lait spots, polyostotic fibrous dysplasia, precocious puberty, short stature, young girls
Albright syndrome
pale boggy nasal mucosa
Allergic rhinitis
hereditary nephritis with nerve deafness
Alport’s Syndrome
progressive dementia
substernal chest pain radiating to L arm or jaw, pain lasts longer than 30 min, pain relieved by nitroglycerin, sweating
awkwardness of finger movements, weakness of hands arm, spasticity of legs, hyperreflexia, no loss of sensory function
Amyotrophic lateral sclerosis
bent over posture, decreased ant flexion of lumbar spine, limited chest expantion
Ankylosing spondilitis
increase in fine hair of the body (hypertrichosis)
high pitched blowing diastolic murmur
Aortic insufficiency
crescendo-decrescendo systolic at second R intercostal space
Aortic stenosis

dyspnea on exertion, syncope, angina pectoralis
Aortic stenosis
pupil reacts to accomodation, but not to direct light
Argyll Robertson pupil; neurosyphilis
abdominal pain, fever, chills, jaundice
Ascending cholangitis
bulging of flanks, shifting dullness to percussion in the abdomen
Ascites; portal HTN, hypoalbuminemia
Murmur; fixed spliting of S2
fever, HA, n/v, confusion, nuchal rigidity
Aseptic Meningitis
inspiratory / expiratory wheezing, dyspnea, cough worse at night
feet are widely spaced, foot lifted too high, walks w slapping feet
Ataxic gait
sudden onset fever, dyspnea, cyanosis, inspiratory lag, increased A-a
Diastolic murmur; high pitched blowing murmur directly following S2;
wide pulse pressure
Aortic Insufficiency
Murmur; Systolic; crescendo decrescendo murmur
AV/PV stenosis
dorsiflexion of big toe, and fanning of other toes on plantar reflect
Babinski's sign; UMN lesion
petechiae on palms [Janeway's], painful erythematous nodules on fingers [Osler's], subconjunctival hemorrhage, splinter hemorrhage
Bacterial endocarditis
fever, HA, nuchal rigidity; CSF - increased PMN, decreased glucose, increased protein
Bacterial meningitis
fever, HA, nuchal rigidity; CSF - increased PMN, decreased glucose, increased protein

What bug is most common in newborn?
- Group B strep
- E. coli
fever, HA, nuchal rigidity; CSF - increased PMN, decreased glucose, increased protein. What bug is most common in a child?
H. influenza
fever, HA, nuchal rigidity; CSF - increased PMN, decreased glucose, increased protein. What bug is most common in a young adult?
N. menigitis
fever, HA, nuchal rigidity; CSF - increased PMN, decreased glucose, increased protein. What bug is most common in an older adult?
S. pneumonia
slow growing waxy nevi w vascular pattern
Basal cell carcinoma
Upper lip tumor
Basal cell carcinoma
resting tremor
Basal ganglia lesion
where is lesion:
slow, writhing movements
Basal ganglia lesion
Where is lesion:
sudden jerky, purposeless movements; choreaform
Basal ganglia lesion
unilateral dropping of mouth & facial m, inability to close eye
Bells' aplsy
coffe ground emesis
Bleeding peptic ulcer
paralysis of striated mm, dry mouth, dry eyes
Adenopathy - axillary
- Breast CA
- Cat scratch disease
subdural hematoma
Bridging veins; sup cerebral v.
pt understands written & spoken, but can't articulate
Broca's aphasia
broken speech; motor expressive aphasia
Broca's area lesion
fever, cough w foul smelling sputum that layers on standing, hemopytsis, recurrent respiratory infections
hemisection of cord (contralateral loss of pain & temp / ipsilateral loss of fine touch, UMN)
raised bright red lobulated vascular tumor
Capillary hemangioma
cutaneous flushing, diarrhea, valvular disease
numbness tingling and pain along thumb long and ring fingers, worse at night, atrophy of thumb
Carpal tunnel syndrome, Median n. injury
Intention tremor
cerebellar lesion
sleeping disease, cardiomegaly with apical atrophy, achlasia, megacolon
Chagas’ Disease
large painful genetial ulcers
Chancroid; Hemophilus ducreyi
rhythmic alternating pattern of apnea and hyperpnea
Cheyne-Stokes breathing; hypoxia of medulla oblongata
dyspnea, JVD, pitting edema
notching of ribs, weak femoral pulse, well developed upper body underdeveloped lower body, claudication
Coarctation of aorta
Virus causing:
fever, HA, myalgia, retro-orbital pain
Colorado tick fever virus
fever, HA, coughing, sneezing, sore throat

What is number 1 cause?
Common cold

patent ductus, deafness, retardation, cataracts
Congenital Rubella Syndrome
palpable upper right quadrant mass, projectile vomiting
Congential pyloric stenosis
HTN, suppresed renin, increased Na+, decreased K+ , muscle weakness.
Conn's syndrome
fever, sore throat, vessicles in oropharynx
Coxsackie virus
calcinosis of fingertips, Raynaud's phenomenon, esophageal motility problems, sclerodactly, telangiectasia
CREST syndrome
dwarfism, mental retardation, puffy face, protruding tongue
Cretinism, Hypothyroid
IBD; ileocecum, transmural, skip lesions, lymphocytic infiltrate, granulomas
(contrast to UC: limited to colon, mucosa & submucosa, crypt abscesses, pseudopolyps, ­ colon cancer risk)
moon facies, buffalo hump, truncal obesity, abdominal striae, diastolic HTN, hyperglycemia, thin hair, protein depletion, depression
progressive muscle weakness, hyperkeratotic cuticles, periungual telangiectasaia, flat topped violacious papulesover the knuckles
acute onset severe retrosternal chest pain, tearing pain w radiation to back
Dissecting Aneurysm
maroon colored stool
Diverticular hemorrhage
fever, rebound tenderness, constant pain, L lower quadrant
epicanthal folds, broad nose, square ears, protruding tongue, endocardial cushion defects, duodenal atresia, megacolon
Downs' syndrome
post gastrectomy: post-prandial; dizziness, tachycardia, palpitations
Dumping syndrome
fever, pain in calf on compression or dorsiflexion, ankle edema
hypogastric pain, abnormal uterine bleeding, adnexal mass, missed menstrual period, hypovolemic shock
Ectopic Pregnancy
micrognathia, prominent occipet, low-set ears, cleft palate, flexion deformities of fingers
Edward's syndrome
increased elasticity of skin and of connective tissue (contortionist)
fever, HA, nuchal rigidity, n/v --> seizures --> coma --> death
vaginal bleeding, pain, ascites, weight loss, palpable pelvic mass, post menopausal female
Endometrial Adenocarcinoma
female w/ chronic pelvic pain, painful intercourse, painful defecation, lower back pain
purple lesion w central clearing, arthritis, endocarditis, meat/fish handler
tendon xanthoma
Familial Hypercholesterolemia
acute respiratory distress following skeletal trauma
Fat embolism syndrome
peg-leg gait; knee fully extended throughout
Femoral n. damage
absent patellar reflex
Femoral n. damage [L2-L4]
common cause of newborn ASD
Fetal alcohol syndrome
Auscultation; scratchy sounds over pericardium
Fibrinous pericarditis
sore, beefy red tongue w papillary necrosis
- Folate deficiency;
- iron deficiency;
- scurvy;
- pellagra
personality change, deficits in concentration, judgement
Frontal [lobe] release signs
right upper quadrant pain, abdominal distention 30 min post prandial
Gall stones
colonic polyposis, soft tissue tumors, bone tumor
Gardner's syndrome
hyperpigmentation of the axilla
Gastric CA
n/v, diarrhea,
Gastroenteritis; Rotavirus
fever, malaise, posterior auricular lymphadenopathy
German measels; Rubella
Adenopathy - left supraclavicular
enlarged supraclavicular lymph node
GI malignancy
fever, unilateral HA, temporal swelling tenderness, jaw claudication, ÝESR
Giant cell (temporal) arteritis
urethritis w creamy purulent penile discharge; cervicitis, Bartholin gland cyst
male presenting first w hemoptysis, then acute glomerulonephritis
Goodpasture's; anti-basement membrane antibodies
creeping raised genital sores that heal by scaring
Granuloma inguinale
exophthalmos, proptosis, periorbital edema, thyroid bruit, tachycardia, afib, systolic HTN, nervousness, heat intolerance, weight loss
Graves disease
large hands, prominent brow & jaw,
Growth hormone
idiopathic polyneuritis (ascending muscle weakness & paralysis; usually self-limiting)
dyspnea, cough, swelling of the feet, wheezing
Heart failure
sudden wild flailing of one arm
cool clammy skin, delayed capillary refill, later ⬦ pallor, tachycardia
Hemorrhagic shock
nails are white at proximal and middle portions, nails are pink distally
Hepatic cirrhosis
jaundice, fever, anorexia, n/v
Hepatitis A
jaundice, fever, n/v, anorexia
Hepatitis B virus
fever, abdominal pain, weight loss, abdominal mass, hypoglycemia,
Hepatocellular CA
weakness of quadriceps, decreased knee jerk
Herniated disk at L3-L4
weakness of dorsiflexion, decreased ankle jerk
Herniated disk at L5-S1
encephailitis in the temporal lobes
Herpes simplex I
Herpes simplex I
painful vessicles that ulcerate in the genital area
Herpes simplex II
dilation & hypertrophy of colon w fecal retention
Hirschsprung's disease; Megalcolon
fever, lethargy, sore throat, lymphadenopathy, splenomegaly, rash, leukopenia
HIV initial presentation
constricted pupil, dropping eyelid, loss of sweating
Horner's syndrome
AV nicking, retinal hemorrhage / exudates, S4
morning HA, dizziness, blurry vision, sweating, chest pain, dyspnea
choreiform movement, hypotonia, progressive dementia
progressive dementia, urinary incontinence, ataxic gait
Hydrocephalus; normal-pressure
hirsutism, truncal obesity, poor wound healing
gray band of corneal opacity
increased Ca, decreased phosphate, osteitis fibrosa, polyuria, kidney stones, increased alk phos
stones, bones, abdominal groans, psychic moans
heat intolerence, tachycardia, fine oily hair, tremor weight loss
cold intolerence, bradycardia, lethargy, inc cholesterol, dry brittle hair
decreased insulin, decreased C-peptide, increased glucose, ketoacidosis
IDDM; type I diabetes
sudden death in young athletes
Idiopathic Hypertrophic Subaortic Stenosis; outflow obstruction
rash on face w discrete vessilcles that rupture and form yellow/honey colored crust
painful Adenopathy - Ant cervical
Infection, ie pharyngitis
Roth spots, splinter hemprrhages, Osler's nodes (painful nodules), Janeway's lesions (painless nodules), glomerulonephritis
Infective endocarditis
weakness in climbing stairs; pt throws torso back during heel strike while walking
Inferior gluteal n. [L5-S2]
-> gluteus maximus
virus causing:
fever, HA, cough, myalgia
Influenza virus
increased insulin, increased C-peptide, decreased glucose
dyspnea on exertion, nonproductive cough, hemoptysis, and chest pain
Interstitial (restrictive) lung disease
post prandial pain, anorexia, weight loss
Intestinal ischemia
abdominal pain, distention, vomiting, constipation
Intestinal obstruction
alternating diarrhea / constipation, cramping abdominal pain, pain relieved by bowel movement
Irritable bowel syndrome
sudden onset severe abdominal pain, n/v, abdominal distention, bloody diarrhea, hypotension, absent bowel sounds
Ischemic bowel - infarct
post-prandial pain of splenic flexure, 30 min
Ischemic bowel - warning sign
yellow skin, yellow sclera, dark yellow urine, light colored stool
AIDS pts; progressive multifocal leukoencephalopathy
JC virus
multiple red-purple lesions that progress macule -> papule -> nodule
Kaposi's sarcoma
situs inversus, recurrent pulmonary infections, sterility infection
Kartagener’s Syndrome; immotile cilia secondary to defective dynein arms.
band of golden-brown pigment on the posterior corneal surface
Kayser-Fleischer ring; Wilson's diseas
intense abdominal pain radiating to left shoulder
Kehr's sign; ruptured spleen
hematuria, proteinuria, oligouria
Kidney problem
male genetalia, female fat distribution
tall stature, eunuchoid appearance, gynecomastia, testicular atrophy
hyperoral, hypersexual, disinhibition, visual agnosia
Kluver-Bucy; Amygdala lesion
slow deep respirations with increased tidal volume
Kussmaul's breathing; ketoacidosis
non-tender Adenopathy - cervical
- Laryngeal CA
- Thyroid CA
low grade fever, mild inspiratory stridor, Steeple sign on lateral x-rays of neck.
"Seal-bark" cough
(parainfluenza virus)
black pigmentation of bowel
Laxative abuse
gout, HTN, renal insufficiency
Lead poisoning
gout, retardation, self-mutilation
Lesch-Nyhan; HGPRT deficiency
white patch on the buccal mucosa which does not wipe off
pruritic flat-topped violet papules of forearm neck thigh buccal mucosa and glans penis
Lichen planis
Winged scapula
Long thoracic n. damage; paralysis of serratus ant m.
dysuria, frequency, hematuria
Lower urinary tract infection
clubbing of nails
Lung CA if acute
Chronic lung infection if chronic
Bone growth w/ cap of cartilage in men < 25
Cough, weight loss, chest pain, hemoptysis, hoarseness
Lung CA; bronchogenic
non-tender Adenopathy - right supraclavicular
- Lung CA
- Esophageal CA.
Adenopathy - abdominal, retroperitoneal
- Malignant Lymphoma
- Testicular CA
- Prostate CA
arachnodactyly (spider fingers), dolichocephaly (long skull), dislocated lens, dissecting aortic aneurysm, mitral valve prolapse, thumb sign (thumb protrudes across clenched fist)
Marfan syndrome
Marphan's problem
fibrillin defect
Adenopathy - postauricular
fever, HA, malaise, myalgia, photophobia, burning eye pain, white spots on buccal mucosa [Koplic's
fever, malaise, Koplik's spots
Measles; Rubeola virus
diverticulum 2 inches long, 2 feet from the ileocecal valve
Meckel's diverticulum
newborn that is unable to pass meconium, absence of stool in ampulla of rectum
Megacolon; Hirschsprung's, Down's, Chaga's
ovarian fibroma, ascites, R pleural effusion
Meigs' syndrome
amenorrhea, hot flashes, night sweats, female 52 yo
chest pain, diaphoresis, dyspnea, n/v
epidural bleed
Middle Meningeal a.
holosystolic murmur at apex
Mitral regurgitation
diastolic rumbling low-pitch murmur at apex following opening snap
Mitral stenosis
fever, lethargy, atypical lymphs, neg heterophil Ab
Mononucleosis; Cytomegalovirus
fever, lethargy, sore throat, lymphadenopathy, splenomegaly, atypical lymphs, Monospot test
Mononucleosis; Epstein-Barr virus
lytic lesions of the skull
multiple myeloma
nystagmus, intention tremor, scanning speech
multiple sclerosis
fever, malaise, swelling of parotids
Mumps virus
child with difficulty walking, tendency to fall
Muscular dystrophy
Murmur; Systolic; holosystolic murmur
MV/TV regurgitation
Murmur; Diastolic; early, mid-diastolic rumble following opening snap
MV/TV stenosis
bilateral ptosis
Myasthenia gravis
difficulty talking, diplopia, muscular weakness upon exertion
Myasthenia gravis
puffiness of hands, face, feet, tired, weak; yellow skin
Myxedema; Hypothyroid
abrupt onset oligouria, HTN, periorbital edema, hematuria
Nephritic syndrome
abrupt onset severe, colicky, flank pain radiating into the groin
periorbital edema
Nephrotic syndrome
increased insulin, increased C-peptide, increased glucose, osmotic coma
NIDDM, type II diabetes
nml biceps DTR
nml C5
nml triceps DTR
nml C7
nml pupil light reflex
nml gag reflex
nml corneal reflex
CN V-1 -> CN VII
nml jaw jerk
nml CN V-3
nerve for nml cough
CN-X -> recurrent laryngeal n.; phrenic n.; spinal motor n.
nml hip adduction
nml L1-L2
nml knee extension
nml L3-L4
nml patellar DTR
nml L4
nml great toe extension
nml L5
nml knee flexion
nml L5-S1
nml achilles DTR
nml S1
nml great toe flexion
nml S1
diarrhea, n/v for 1 day
Norwalk virus
pain of weight bearing joints, worsens by end of day, DIP, Heberden's nodes
multiple bone fractures, blue sclera, deafness
Osteogenesis imperfecta
hip pain that worsens at night and is dramatically relieved by aspirin
Osteoid osteoma
Migratory thromboplebitis
Pancreatic CA
condyloma accuminata
Papillomavirus - types 6, 11
absent bowel sounds
Paralytic Ileus
stooped posture, resting tremor, festinating (shuffling) gait, cogwheel rigidity, pill-rolling tremor
machine like murmur, widened pulse pressure, bounding pulses
Murmur; machinery murmur, differential cyanosis (upper body pink, lower body blue)
sudden pleuritic chest pain, tachypnea, dyspnea, tachycardia
dermatitis, diarrhea, dementia
Pellagra; niacin deficiency
air under the diaphragm
Perforated Ulcer
rebound pain, abdominal guarding
- Perforated ulcer
- pancreatitis
- appendicitis
friction rub
abdominal guarding, rebound tenderness, pts sits perfectly still
pigmentation around mouth, colonic hamartomatous polyps
Peutz-Jeghers syndrome
HTN, HA, perspiration, palpitation, feelings of dread, abdominal pain, hyperglycemia
fever, lower abdominal pain, adnexal tenderness to cervical motion
PID; chlamydia, gonorrhea
bitemporal hemianopsia
Pituitary adenoma
bitemporal hemianopsia, diabetes insipidus, cranial nerva palsy
Pituitary adenoma
acute solitary oval annular lesion of 2-6 cm on the trunk, followed weeks later by eruption of small of christmas tree pattern w wrinkled center and scaly border w hyperpigmentation
Pityriasis rosea
dysphagia for solids, glossitis, leukoplakia, achlorhydria, iron deficiency
Plummer-Vinson syndrome
upper lobe centrilobular emphysema, cor pulmonale, lungs are black w/ nodular masses & antracotic pigment
(Coal miner's)
insidious onset low grade fever, pleuritic chest pain, chills, myalgia, non productive cough
Pneumonia, Atypical; Mycoplasma, Tb, Legionella, Chlamydia⬦
sudden onset spiking fever, pleuritic chest pain, chills, cough w rusty sputum
Bacterial Pneumonia, Typical
(Strep pneumo)

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