2015 Flashcards
(466 cards)
1
Q
Abdominal pain, ascites, hepatomegaly
A
Budd-Chiari syndrome (posthepatic venous thrombosis)
2
Q
Abdominal pain, diarrhea, leukocytosis, recent antibiotic use
A
Clostridium difficile infection
3
Q
Achilles tendon xanthoma
A
Familial hypercholesterolemia (Decrease LDL receptor signaling)
4
Q
Adrenal hemorrhage, hypotension, DIC
A
Waterhouse-Friderichsen syndrome (meningococcemia)
5
Q
Anaphylaxis following blood transfusion
A
IgA deficiency
6
Q
Anterior “drawer sign” ⊕
A
Anterior cruciate ligament injury
7
Q
Arachnodactyly, lens dislocation, aortic dissection,
hyperflexible joints
A
Marfan syndrome (fibrillin defect)
8
Q
Athlete with polycythemia
A
2° to erythropoietin injection
9
Q
Back pain, fever, night sweats
A
Pott disease (vertebral TB)
10
Q
Bilateral acoustic schwannomas
A
Neurofibromatosis type 2
11
Q
Bilateral hilar adenopathy, uveitis
A
Sarcoidosis (noncaseating granulomas)
12
Q
Black eschar on face of patient with diabetic ketoacidosis
A
Mucor or Rhizopus fungal infection
13
Q
Blue sclera
A
Osteogenesis imperfecta (type I collagen defect)
14
Q
Bluish line on gingiva
A
Burton line (lead poisoning)
15
Q
Bone pain, bone enlargement, arthritis
A
Paget disease of bone ( Increased osteoblastic and osteoclastic activity)
16
Q
Bounding pulses, diastolic heart murmur, head bobbing
A
Aortic regurgitation
17
Q
“Butterfly” facial rash and Raynaud phenomenon in a young female
A
Systemic lupus erythematosus
18
Q
Café-au-lait spots, Lisch nodules (iris hamartoma), cutaneous neurofibromas, pheochromocytomas, optic gliomas
A
Neurofibromatosis type I, pheochromocytoma, optic gliomas
19
Q
Café-au-lait spots (unilateral), polyostotic fibrous dysplasia, precocious puberty, multiple endocrine abnormalities
A
McCune-Albright syndrome (mosaic G-protein signaling
mutation)
20
Q
Calf pseudohypertrophy
A
Muscular dystrophy (most commonly Duchenne, due to X-linked recessive frameshift mutation of dystrophin gene)
21
Q
Cervical lymphadenopathy, desquamating rash, coronary
aneurysms, red conjunctivae and tongue
A
Kawasaki disease (treat with IVIG and aspirin)
22
Q
“Cherry-red spots” on macula
A
Tay-Sachs (ganglioside accumulation) or Niemann-Pick
(sphingomyelin accumulation), central retinal artery occlusion
23
Q
Chest pain on exertion
A
Angina (stable: with moderate exertion; unstable: with
minimal exertion or at rest)
24
Q
Chest pain, pericardial effusion/friction rub, persistent fever following MI
A
Dressler syndrome (autoimmune-mediated post-MI fibrinous pericarditis, 2–12 weeks after acute episode)
25
Chest pain with ST depressions on EKG
Unstable angina (troponins −) or NSTEMI (troponins +)
26
Child uses arms to stand up from squat
Gowers sign (Duchenne muscular dystrophy)
27
Child with fever later develops red rash on face that spreads to body
“Slapped cheeks” (erythema infectiosum/fifth disease:
| parvovirus B19)
28
Chorea, dementia, caudate degeneration
```
Huntington disease (autosomal dominant CAG repeat
expansion)
```
29
Chorioretinitis, hydrocephalus, intracranial calcifications
Congenital toxoplasmosis
30
Chronic exercise intolerance with myalgia, fatigue, painful cramps, myoglobinuria
McArdle disease (skeletal muscle glycogen phosphorylase deficiency)
31
Cold intolerance
Hypothyroidism
32
Conjugate horizontal gaze palsy, horizontal diplopia
```
Internuclear ophthalmoplegia (damage to MLF; may be
unilateral or bilateral)
```
33
Continuous “machine-like” heart murmur
PDA (close with indomethacin; open or maintain with PGE analogs)
34
Cutaneous/dermal edema due to connective tissue deposition
Myxedema (caused by hypothyroidism, Graves disease
| [pretibial])
35
Cutaneous flushing, diarrhea, bronchospasm
Carcinoid syndrome (right-sided cardiac valvular lesions, Increased 5-HIAA)
36
Dark purple skin/mouth nodules in a patient with AIDS
Kaposi sarcoma, associated with HHV-8
37
Deep, labored breathing/hyperventilation
Kussmaul respirations (diabetic ketoacidosis)
38
Dermatitis, dementia, diarrhea
Pellagra (niacin [vitamin B3] deficiency)
39
Dilated cardiomyopathy, edema, alcoholism or malnutrition
Wet beriberi (thiamine [vitamin B1] deficiency)
40
Dog or cat bite resulting in infection
Pasteurella multocida (cellulitis at inoculation site)
41
Dry eyes, dry mouth, arthritis
Sjögren syndrome (autoimmune destruction of exocrine
| glands)
42
Dysphagia (esophageal webs), glossitis, iron deficiency anemia
Plummer-Vinson syndrome (may progress to esophageal squamous cell carcinoma)
43
Elastic skin, hypermobility of joints, Increased bleeding tendency
Ehlers-Danlos syndrome (type V collagen defect, type III
| collagen defect seen in vascular subtype of ED)
44
Enlarged, hard left supraclavicular node
Virchow node (abdominal metastasis)
45
Episodic vertigo, tinnitus, hearing loss
Meniere disease
46
Erythroderma, lymphadenopathy, hepatosplenomegaly,
| atypical T cells
Mycosis fungoides (cutaneous T-cell lymphoma) or Sézary syndrome (mycosis fungoides + malignant T cells in blood)
47
Facial muscle spasm upon tapping
Chvostek sign (hypocalcemia)
48
Fat, female, forty, and fertile
Cholelithiasis (gallstones)
49
Fever, chills, headache, myalgia following antibiotic
| treatment for syphilis
Jarisch-Herxheimer reaction (rapid lysis of spirochetes results in endotoxin release)
50
Fever, cough, conjunctivitis, coryza, diffuse rash
Measles
51
Fever, night sweats, weight loss
B symptoms (staging) of lymphoma
52
Fibrous plaques in soft tissue of penis with abnormal
| curvature
Peyronie disease (connective tissue disorder)
53
Golden brown rings around peripheral cornea
Kayser-Fleischer rings (copper accumulation from Wilson disease)
54
Gout, intellectual disability, self-mutilating behavior in a boy
Lesch-Nyhan syndrome (HGPRT deficiency, X-linked
| recessive)
55
Hamartomatous GI polyps, hyperpigmentation of
| mouth/feet/hands/genitalia
Peutz-Jeghers syndrome (inherited, benign polyposis can cause bowel obstruction; Increased cancer risk, mainly GI)
56
Hepatosplenomegaly, pancytopenia, osteoporosis, aseptic necrosis of femur, bone crises
Gaucher disease (glucocerebrosidase deficiency)
57
Hereditary nephritis, sensorineural hearing loss,
| cataracts
Alport syndrome (mutation in collagen IV)
58
Hyperphagia, hypersexuality, hyperorality,
| hyperdocility
Klüver-Bucy syndrome (bilateral amygdala lesion)
59
Hyperreflexia, hypertonia, Babinski sign present
UMN damage
60
Hyporeflexia, hypotonia, atrophy, fasciculations
LMN damage
61
Hypoxemia, polycythemia, hypercapnia
“Blue bloater” (chronic bronchitis: hyperplasia of mucous cells)
62
Indurated, ulcerated genital lesion
Nonpainful: chancre (1° syphilis, Treponema pallidum)
| Painful, with exudate: chancroid (Haemophilus ducreyi)
63
Infant with “cherry-red” spot on macula, hepatosplenomegaly, and neurodegeneration
Niemann-Pick disease (genetic sphingomyelinase deficiency)
64
Infant with cleft lip/palate, microcephaly or
| holoprosencephaly, polydactyly, cutis aplasia
Patau syndrome (trisomy 13)
65
Infant with hypoglycemia, hepatomegaly
Cori disease (debranching enzyme deficiency) or Von Gierke disease (glucose-6-phosphatase deficiency, more severe)
66
Infant with microcephaly, rocker-bottom feet, clenched
| hands, and structural heart defect
Edwards syndrome (trisomy 18)
67
Jaundice, palpable distended non-tender gallbladder
Courvoisier sign (distal obstruction of biliary tree)
68
Large rash with bull’s-eye appearance
Erythema chronicum migrans from Ixodes tick bite (Lyme
| disease: Borrelia)
69
Lucid interval after traumatic brain injury
```
Epidural hematoma (middle meningeal artery
rupture)
```
70
Male child, recurrent infections, no mature B cells
Bruton disease (X-linked agammaglobulinemia)
71
Mucosal bleeding and prolonged bleeding time
Glanzmann thrombasthenia (defect in platelet aggregation due to lack of GpIIb/IIIa)
72
Muffled heart sounds, distended neck veins, hypotension
Beck triad of cardiac tamponade
73
Multiple colon polyps, osteomas/soft tissue tumors, impacted/supernumerary teeth
Gardner syndrome (subtype of FAP)
74
Myopathy (infantile hypertrophic cardiomyopathy), exercise intolerance
Pompe disease (lysosomal α-1,4-glucosidase deficiency)
75
Neonate with arm paralysis following difficult birth
Erb-Duchenne palsy (superior trunk [C5–C6] brachial plexus injury: “waiter’s tip”)
76
No lactation postpartum, absent menstruation, cold
| intolerance
Sheehan syndrome (pituitary infarction)
77
Nystagmus, intention tremor, scanning speech, bilateral
| internuclear ophthalmoplegia
Multiple sclerosis
78
Painful blue fingers/toes, hemolytic anemia
Cold agglutinin disease (autoimmune hemolytic
anemia caused by Mycoplasma pneumoniae, infectious
mononucleosis, CLL
79
Painful fingers/toes changing color from blue to white to red with cold or stress
Raynaud phenomenon (vasospasm in extremities)
80
Painful, raised red lesions on pads of fingers/toes
```
Osler nodes (infective endocarditis, immune complex
deposition)
```
81
Painless erythematous lesions on palms and soles
```
Janeway lesions (infective endocarditis, septic emboli/
microabscesses)
```
82
Painless jaundice
Cancer of the pancreatic head obstructing bile duct
83
Palpable purpura on buttocks/legs, joint pain, abdominal pain (child), hematuria
Henoch-Schönlein purpura (IgA vasculitis affecting skin and kidneys)
84
Pancreatic, pituitary, parathyroid tumors
MEN 1 (autosomal dominant)
85
Periorbital and/or peripheral edema, proteinuria,
| hypoalbuminemia, hypercholesterolemia
Nephrotic syndrome
86
Pink complexion, dyspnea, hyperventilation
“Pink puffer” (emphysema: centriacinar [smoking], panacinar [α1-antitrypsin deficiency])
87
Polyuria, renal tubular acidosis type II, growth failure,
| electrolyte imbalances, hypophosphatemic rickets
Fanconi syndrome (multiple combined dysfunction of the proximal convoluted tubule)
88
Pruritic, purple, polygonal planar papules and plaques (6 P’s)
Lichen planus
89
Ptosis, miosis, anhidrosis
Horner syndrome (sympathetic chain lesion)
90
Pupil accommodates but doesn’t react
Argyll Robertson pupil (neurosyphilis)
91
Rapidly progressive limb weakness that ascends following GI/ upper respiratory infection
Guillain-Barré syndrome (acute inflammatory demyelinating polyradiculopathy subtype)
92
Rash on palms and soles
Coxsackie A, 2° syphilis, Rocky Mountain spotted fever
93
Recurrent cold (noninflamed) abscesses, unusual eczema, high serum IgE
Hyper-IgE syndrome (Job syndrome: neutrophil chemotaxis abnormality)
94
Red “currant jelly” sputum in alcoholic or diabetic patients
Klebsiella pneumoniae pneumonia
95
Red “currant jelly” stools
Acute mesenteric ischemia (adults), intussusception (children)
96
Red, itchy, swollen rash of nipple/areola
Paget disease of the breast (sign of underlying neoplasm)
97
Red urine in the morning, fragile RBCs
Paroxysmal nocturnal hemoglobinuria
98
Renal cell carcinoma (bilateral), hemangioblastomas,
| angiomatosis, pheochromocytoma
von Hippel-Lindau disease (dominant tumor suppressor gene mutation)
99
Resting tremor, rigidity, akinesia, postural instability,
| shuffling gait
Parkinson disease (loss of dopaminergic neurons in substantia nigra pars compacta
100
Retinal hemorrhages with pale centers
Roth spots (bacterial endocarditis)
101
Severe jaundice in neonate
Crigler-Najjar syndrome (congenital unconjugated
| hyperbilirubinemia)
102
Severe RLQ pain with palpation of LLQ
Rovsing sign (acute appendicitis)
103
Severe RLQ pain with rebound tenderness
McBurney sign (acute appendicitis)
104
Short stature, café au lait spots, thumb/radial defects, Increase incidence of tumors/leukemia, aplastic anemia
Fanconi anemia (genetic loss of DNA crosslink repair; often progresses to AML)
105
Single palmar crease
Down syndrome
106
Situs inversus, chronic sinusitis, bronchiectasis, infertility
Kartagener syndrome (dynein arm defect affecting cilia)
107
Skin hyperpigmentation, hypotension, fatigue
1° adrenocortical insufficiency (e.g., Addison disease) causes Increased ACTH and Imcreased α-MSH production)
108
Slow, progressive muscle weakness in boys
Becker muscular dystrophy (X-linked missense mutation in dystrophin; less severe than Duchenne)
109
Small, irregular red spots on buccal/lingual mucosa with
| blue-white centers
Koplik spots (measles; rubeola virus)
110
Smooth, moist, painless, wart-like white lesions on genitals
Condylomata lata (2° syphilis)
111
Splinter hemorrhages in fingernails
Bacterial endocarditis
112
“Strawberry tongue”
Scarlet fever, Kawasaki disease
113
Streak ovaries, congenital heart disease, horseshoe kidney, cystic hygroma at birth, short stature, webbed neck, lymphedema
Turner syndrome (45,XO)
114
Sudden swollen/painful big toe joint, tophi
Gout/podagra (hyperuricemia)
115
Swollen gums, mucosal bleeding, poor wound healing,
| petechiae
Scurvy (vitamin C deficiency: can’t hydroxylate proline/lysine for collagen synthesis)
116
Swollen, hard, painful finger joints
Osteoarthritis (osteophytes on PIP [Bouchard nodes], DIP [Heberden nodes])
117
Systolic ejection murmur (crescendo-decrescendo)
Aortic stenosis
118
Telangiectasias, recurrent epistaxis, skin discoloration,
| arteriovenous malformations, GI bleeding, hematuria
Osler-Weber-Rendu syndrome
119
Thyroid and parathyroid tumors, pheochromocytoma
MEN 2A (autosomal dominant RET mutation)
120
Thyroid tumors, pheochromocytoma, ganglioneuromatosis
MEN 2B (autosomal dominant RET mutation)
121
Toe extension/fanning upon plantar scrape
Babinski sign (UMN lesion)
122
Unilateral facial drooping involving forehead
LMN facial nerve (CN VII) palsy; UMN lesions spare the
| forehead
123
Urethritis, conjunctivitis, arthritis in a male
Reactive arthritis associated with HLA-B27
124
Vascular birthmark (port-wine stain) of the face
Nevus flammeus (benign, but associated with Sturge-Weber syndrome)
125
Vomiting blood following gastroesophageal lacerations
Mallory-Weiss syndrome (alcoholic and bulimic patients)
126
Weight loss, diarrhea, arthritis, fever, adenopathy
Whipple disease (Tropheryma whipplei)
127
“Worst headache of my life”
Subarachnoid hemorrhage
128
Anticentromere antibodies
Scleroderma (CREST)
129
Anti-desmoglein (epithelial) antibodies
Pemphigus vulgaris (blistering)
130
Anti–glomerular basement membrane antibodies
Goodpasture syndrome (glomerulonephritis and hemoptysis)
131
Antihistone antibodies
Drug-induced SLE (e.g., hydralazine, isoniazid, phenytoin, procainamide)
132
Anti-IgG antibodies
Rheumatoid arthritis (systemic inflammation, joint pannus, boutonnière deformity)
133
Antimitochondrial antibodies (AMAs)
1° biliary cirrhosis (female, cholestasis, portal hypertension)
134
Antineutrophil cytoplasmic antibodies (ANCAs)
Microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) (MPO-ANCA/p-ANCA); granulomatosis with polyangiitis (Wegener; PR3-ANCA/c-ANCA)
135
Antinuclear antibodies (ANAs: anti-Smith and anti-dsDNA)
SLE (type III hypersensitivity)
136
Antiplatelet antibodies
Idiopathic thrombocytopenic purpura
137
Anti-topoisomerase antibodies
Diffuse systemic scleroderma
138
Anti-transglutaminase/anti-gliadin/anti-endomysial antibodies
Celiac disease (diarrhea, weight loss)
139
“Apple core” lesion on barium enema x-ray
Colorectal cancer (usually left-sided)
140
Atypical lymphocytes
EBV
141
Azurophilic peroxidase ⊕ granular inclusions in granulocytes and myeloblasts
Auer rods (AML, especially the promyelocytic [M3] type)
142
Bacitracin response
Sensitive: S. pyogenes (group A); resistant: S. agalactiae
| group B
143
“Bamboo spine” on x-ray
```
Ankylosing spondylitis (chronic inflammatory arthritis:
HLA-B27)
```
144
Basophilic nuclear remnants in RBCs
Howell-Jolly bodies (due to splenectomy or nonfunctional spleen)
145
Basophilic stippling of RBCs
Lead poisoning or sideroblastic anemia
146
Bloody or yellow tap on lumbar puncture
Subarachnoid hemorrhage
147
“Boot-shaped” heart on x-ray
Tetralogy of Fallot (due to RVH)
148
Branching gram-positive rods with sulfur granules
Actinomyces israelii
149
Bronchogenic apical lung tumor on imaging
Pancoast tumor (can compress cervical sympathetic chain and cause Horner syndrome)
150
“Brown” tumor of bone
Hyperparathyroidism or osteitis fibrosa cystica (deposited hemosiderin from hemorrhage gives brown color)
151
Cardiomegaly with apical atrophy
Chagas disease (Trypanosoma cruzi)
152
Cellular crescents in Bowman capsule
Rapidly progressive crescentic glomerulonephritis
153
“Chocolate cyst” of ovary
Endometriosis (frequently involves both ovaries)
154
Circular grouping of dark tumor cells surrounding pale
| neurofibrils
Homer-Wright rosettes (neuroblastoma, medulloblastoma)
155
Colonies of mucoid Pseudomonas in lungs
```
Cystic fibrosis (autosomal recessive mutation in CFTR gene
-> fat-soluble vitamin deficiency and mucous plugs)
```
156
Decreased AFP in amniotic fluid/maternal serum
Down syndrome or other chromosomal abnormalities
157
Degeneration of dorsal column fibers
Tabes dorsalis (3° syphilis), subacute combined degeneration (dorsal columns, lateral corticospinal, spinocerebellar tracts affected)
158
“Delta wave” on EKG, short PR interval, supraventricular
| tachycardia
Wolf-Parkinson-White syndrome (Bundle of Kent bypasses AV node)
159
Depigmentation of neurons in substantia nigra
Parkinson disease (basal ganglia disorder: rigidity, resting tremor, bradykinesia)
160
Desquamated epithelium casts in sputum
Curschmann spirals (bronchial asthma; can result in whorled mucous plugs)
161
Disarrayed granulosa cells arranged around collections of eosinophilic fluid
Call-Exner bodies (granulosa cell tumor of the ovary)
162
Dysplastic squamous cervical cells with “raisinoid” nuclei and hyperchromasia
Koilocytes (HPV: predisposes to cervical cancer)
163
Electrical alternans (alternating amplitude on EKG)
Pericardial tamponade
164
Enlarged cells with intranuclear inclusion bodies
“Owl eye” appearance of CMV
165
Enlarged thyroid cells with ground-glass nuclei with central clearing
“Orphan Annie” eyes nuclei (papillary carcinoma of the
| thyroid)
166
Eosinophilic cytoplasmic inclusion in liver cell
Mallory body (alcoholic liver disease)
167
Eosinophilic cytoplasmic inclusion in nerve cell
Lewy body (Parkinson disease)
168
Eosinophilic globule in liver
Councilman body (viral hepatitis, yellow fever), represents hepatocyte undergoing apoptosis
169
Eosinophilic inclusion bodies in cytoplasm of hippocampal and cerebellar neurons
Negri bodies of rabies
170
Extracellular amyloid deposition in gray matter of brain
Senile plaques (Alzheimer disease)
171
Giant B cells with bilobed nuclei with prominent inclusions (“owl’s eye”)
Reed-Sternberg cells (Hodgkin lymphoma)
172
Glomerulus-like structure surrounding vessel in germ cells
Schiller-Duval bodies (yolk sac tumor)
173
“Hair on end” (“Crew-cut”) appearance on x-ray
β-thalassemia, sickle cell disease (marrow expansion)
174
hCG elevated
Choriocarcinoma, hydatidiform mole (occurs with and
| without embryo, and multiple pregnancy)
175
Heart nodules (granulomatous)
Aschoff bodies (rheumatic fever)
176
Heterophile antibodies
Infectious mononucleosis (EBV)
177
Hexagonal, double-pointed, needle-like crystals in bronchial secretions
```
Bronchial asthma (Charcot-Leyden crystals: eosinophilic
granules)
```
178
High level of d-dimers
DVT, PE, DIC
179
Hilar lymphadenopathy, peripheral granulomatous lesion in middle or lower lung lobes (can calcify)
Ghon complex (1° TB: Mycobacterium bacilli)
180
“Honeycomb lung” on x-ray or CT
Interstitial pulmonary fibrosis
181
Hypercoagulability (leading to migrating DVTs and vasculitis)
Trousseau syndrome (adenocarcinoma of pancreas or lung)
182
Hypersegmented neutrophils
Megaloblastic anemia (B12 deficiency: neurologic symptoms; folate deficiency: no neurologic symptoms)
183
Hypertension, hypokalemia, metabolic alkalosis
Conn syndrome (primary hyperaldosteronism)
184
Hypochromic, microcytic anemia
Iron deficiency anemia, lead poisoning, thalassemia (fetal hemoglobin sometimes present)
185
Increased AFP in amniotic fluid/maternal serum
Dating error, anencephaly, spina bifida (neural tube defects)
186
Increased uric acid levels
Gout, Lesch-Nyhan syndrome, tumor lysis syndrome, loop and thiazide diuretics
187
Intranuclear eosinophilic droplet-like bodies
Cowdry type A bodies (HSV or VZV)
188
Iron-containing nodules in alveolar septum
Ferruginous bodies (asbestosis: Increased chance of mesothelioma)
189
Keratin pearls on a skin biopsy
Squamous cell carcinoma
190
Large granules in phagocytes, immunodeficiency
Chédiak-Higashi disease (congenital failure of phagolysosome formation)
191
“Lead pipe” appearance of colon on abdominal imaging
Ulcerative colitis (loss of haustra)
192
Linear appearance of IgG deposition on glomerular and
| alveolar basement membranes
Goodpasture syndrome
193
Low serum ceruloplasmin
Wilson disease (hepatolenticular degeneration)
194
“Lumpy bumpy” appearance of glomeruli on
| immunofluorescence
Poststreptococcal glomerulonephritis (due to deposition of IgG, IgM, and C3)
195
Lytic (“punched-out”) bone lesions on x-ray
Multiple myeloma
196
Mammary gland (“blue domed”) cyst
Fibrocystic change of the breast
197
Monoclonal antibody spike
-Multiple myeloma (usually IgG or IgA)
-Monoclonal gammopathy of undetermined significance
(MGUS consequence of aging)
-Waldenström (M protein = IgM) macroglobulinemia
-Primary amyloidosis
198
Mucin-filled cell with peripheral nucleus
“Signet ring” (gastric carcinoma)
199
Narrowing of bowel lumen on barium x-ray
“String sign” (Crohn disease)
200
```
Necrotizing vasculitis (lungs) and necrotizing
glomerulonephritis
```
Granulomatosis with polyangiitis (Wegener; PR3-ANCA/
c-ANCA) and Goodpasture syndrome (anti–basement
membrane antibodies)
201
Needle-shaped, negatively birefringent crystals
Gout (monosodium urate crystals)
202
Nodular hyaline deposits in glomeruli
Kimmelstiel-Wilson nodules (diabetic nephropathy)
203
Novobiocin response
Sensitive: S. epidermidis; resistant: S. saprophyticus
204
“Nutmeg” appearance of liver
Chronic passive congestion of liver due to right heart failure or Budd-Chiari syndrome
205
“Onion skin” periosteal reaction
Ewing sarcoma (malignant small blue cell tumor)
206
Optochin response
Sensitive: S. pneumoniae; resistant: viridans streptococci
| S. mutans, S. sanguis
207
Periosteum raised from bone, creating triangular area
Codman triangle on x-ray, Ewing sarcoma, pyogenic
| osteomyelitis)
208
Podocyte fusion or “effacement” on electron microscopy
Minimal change disease (child with nephrotic syndrome)
209
Polished, “ivory-like” appearance of bone at cartilage erosion
Eburnation (osteoarthritis resulting in bony sclerosis)
210
Protein aggregates in neurons from hyperphosphorylation of tau protein
Neurofibrillary tangles (Alzheimer disease) and Pick bodies (Pick disease)
211
Psammoma bodies
- Meningiomas
- Papillary thyroid carcinoma
- Mesothelioma
- Papillary serous carcinoma of the endometrium and ovary
212
Pseudopalisading tumor cells on brain biopsy
Glioblastoma multiforme
213
RBC casts in urine
Glomerulonephritis
214
Rectangular, crystal-like, cytoplasmic inclusions in Leydig cells
Reinke crystals (Leydig cell tumor)
215
Recurrent infections, eczema, thrombocytopenia
Wiskott-Aldrich syndrome
216
Renal epithelial casts in urine
Intrinsic renal failure (e.g., ischemia or toxic injury)
217
Rhomboid crystals, positively birefringent
Pseudogout (calcium pyrophosphate dihydrate crystals)
218
Rib notching
Coarctation of the aorta
219
Ring-enhancing brain lesion in AIDS
Toxoplasma gondii, CNS lymphoma
220
Sheets of medium-sized lymphoid cells with scattered pale, tingible body–laden macrophages (“starry sky” histology)
```
Burkitt lymphoma (t[8:14] c-myc activation, associated with
EBV; “starry sky” made up of malignant cells)
```
221
Silver-staining spherical aggregation of tau proteins in
| neurons
Pick bodies (Pick disease: progressive dementia, changes in personality)
222
“Soap bubble” in femur or tibia on x-ray
Giant cell tumor of bone (generally benign)
223
“Spikes” on basement membrane, “dome-like” subepithelial deposits
Membranous nephropathy (nephrotic syndrome)
224
Stacks of RBCs
Rouleaux formation (high ESR, multiple myeloma)
225
“Steeple” sign on CXR
Croup (parainfluenza virus)
226
Stippled vaginal epithelial cells
“Clue cells” (Gardnerella vaginalis)
227
Streptococcus bovis bacteremia
Colon cancer
228
“Tennis racket”-shaped cytoplasmic organelles (EM) in
| Langerhans cells
Birbeck granules (Langerhans cell histiocytosis)
229
Thousands of polyps on colonoscopy
Familial adenomatous polyposis (autosomal dominant,
| mutation of APC gene)
230
Thrombi made of white/red layers
Lines of Zahn (arterial thrombus, layers of platelets/RBCs)
231
“Thumb sign” on lateral neck x-ray
Epiglottitis (Haemophilus influenzae)
232
Thyroid-like appearance of kidney
Chronic pyelonephritis (usually due to recurrent infections)
233
“Tram-track” appearance of capillary loops of glomerular basement membranes on light microscopy
Membranoproliferative glomerulonephritis
234
Triglyceride accumulation in liver cell vacuoles
Fatty liver disease (alcoholic or metabolic syndrome)
235
“Waxy” casts with very low urine flow
Chronic end-stage renal disease
236
WBC casts in urine
Acute pyelonephritis
237
WBCs that look “smudged”
CLL (almost always B cell)
238
“Wire loop” glomerular capillary appearance on light
| microscopy
Diffuse proliferative glomerulonephritis (usually seen with
| lupus)
239
Yellowish CSF
Xanthochromia (e.g., due to subarachnoid hemorrhage)
240
Absence seizures
Ethosuximide
241
Acute gout attack
NSAIDs, colchicine, glucocorticoids
242
Acute promyelocytic leukemia (M3)
All-trans retinoic acid
243
ADHD
Methylphenidate, CBT, atomoxetine
244
Alcoholism
Disulfiram, acamprosate, naltrexone, supportive care
245
Alcohol withdrawal
Long-acting benzodiazepines
246
Anorexia
Nutrition, psychotherapy, mirtazapine
247
Anticoagulation during pregnancy
Heparin
248
Arrhythmia in damaged cardiac tissue
Class IB antiarrhythmic (lidocaine, mexiletine)
249
B12 deficiency
Vitamin B12 supplementation (work up cause with Schilling test)
250
Benign prostatic hyperplasia
α1-antagonists, 5α-reductase inhibitors, PDE-5 inhibitors
251
Bipolar disorder
```
Mood stabilizers (e.g., lithium, valproic acid, carbamazepine),
atypical antipsychotics
```
252
Breast cancer in postmenopausal woman
Aromatase inhibitor (anastrozole)
253
Buerger disease
Smoking cessation
254
Bulimia nervosa
SSRIs
255
Candida albicans
Topical azoles (vaginitis); nystatin, fluconazole, caspofungin (oral/esophageal); fluconazole, caspofungin, amphotericin B (systemic)
256
Carcinoid syndrome
Octreotide
257
Chlamydia trachomatis
Doxycycline (+ ceftriaxone for gonorrhea coinfection),
| erythromycin eye drops (prophylaxis in infants)
258
Chronic gout
Xanthine oxidase inhibitors (e.g., allopurinol, febuxostat)
259
Chronic hepatitis B or C
IFN-α (HBV and HCV); ribavirin, simeprevir, sofosbuvir
| HCV
260
Chronic myelogenous leukema
Imatinib
261
Clostridium botulinum
Antitoxin
262
Clostridium botulinum
Oral metronidazole; if refractory, oral vancomycin
263
Clostridium tetani
Antitoxin
264
CMV
Ganciclovir, foscarnet, cidofovir
265
Crohn disease
Corticosteroids, infliximab, azathioprine
266
Cryptococcus neoformans
Fluconazole (in AIDS patients)
267
Cyclophosphamide-induced hemorrhagic cystitis
Mesna
268
Depression
SSRIs (first-line)
269
Diabetes insipidus
Desmopressin (central); hydrochlorothiazide, indomethacin, amiloride (nephrogenic)
270
Diabetes mellitus type 1
Dietary intervention (low carbohydrate) + insulin replacement
271
Diabetes mellitus type 2
Dietary intervention, oral hypoglycemics, and insulin (if
| refractory)
272
Diabetic ketoacidosis
Fluids, insulin, K+
273
Enterococci
Vancomycin, aminopenicillins/cephalosporins
274
Erectile dysfunction
Sildenafil, tadalafil, vardenafil
275
ER ⊕ breast cancer
Tamoxifen
276
Ethylene glycol/methanol intoxication
Fomepizole (alcohol dehydrogenase inhibitor)
277
Haemophilus influenzae (B)
Rifampin (prophylaxis)
278
Generalized anxiety disorder
SSRIs, SNRIs (first line); buspirone (second line)
279
SSRIs, SNRIs (first line); buspirone (second line)
Cyclophosphamide, corticosteroids
280
Heparin reversal
Protamine sulfate
281
HER2/neu ⊕ breast cancer
Trastuzumab
282
Hyperaldosteronism
Spironolactone
283
Hypercholesterolemia
Statin (first-line)
284
Hypertriglyceridemia
Fibrate
285
Immediate anticoagulation
Heparin
286
Infertility
Leuprolide, GnRH (pulsatile), clomiphene
287
Influenza
Oseltamivir, zanamivir
288
Kawasaki disease
IVIG, high-dose aspirin
289
Legionella pneumophila
Macrolides (e.g., azithromycin)
290
Long-term anticoagulation
Warfarin, dabigatran, rivaroxaban and apixaban
291
Malaria
Chloroquine, mefloquine, atovaquone/proguanil (for blood schizont), primaquine (for liver hypnozoite)
292
Malignant hyperthermia
Dantrolene
293
Medical abortion
Mifepristone
294
Migraine
Abortive therapies (e.g., sumatriptan, NSAIDs); prophylaxis (e.g., propranolol, topiramate, CCBs, amitriptyline)
295
Multiple sclerosis
Disease-modifying therapies (e.g., β-interferon, natalizumab); for acute flares, use IV steroids
296
Mycobacterium tuberculosis
RIPE (rifampin, isoniazid, pyrazinamide, ethambutol)
297
Neisseria gonorrhoeae
Ceftriaxone (add doxycycline to cover likely concurrent
| C. trachomatis)
298
Neisseria meningitidis
Penicillin/ceftriaxone, rifampin (prophylaxis)
299
Neural tube defect prevention
Prenatal folic acid
300
Osteomalacia/rickets
Vitamin D supplementation
301
Osteoporosis
Calcium/vitamin D supplementation (prophylaxis);
bisphosphonates, PTH analogs, SERMs, calcitonin,
denosumab (treatment)
302
Patent ductus arteriosus
Close with indomethacin; open or maintain with PGE
| analogs
303
Pheochromocytoma
α-antagonists (e.g., phenoxybenzamine)
304
Pneumocystis jirovecii
TMP-SMX (prophylaxis in AIDS patient)
305
Prolactinoma
Cabergoline/bromocriptine (dopamine agonists)
306
Prostate adenocarcinoma/uterine fibroids
Leuprolide, GnRH (continuous)
307
Prostate adenocarcinoma
Flutamide
308
Pseudomonas aeruginosa
Antipseudomonal penicillins, aminoglycosides, carbapenems
309
Pulmonary arterial hypertension (idiopathic)
Sildenafil, bosentan, epoprostenol
310
Rickettsia rickettsii
Doxycycline, chloramphenicol
311
Schizophrenia (negative symptoms)
Atypical antipsychotics
312
Schizophrenia (positive symptoms)
Typical and atypical antipsychotics
313
SIADH
Fluid restriction, IV hypertonic saline, conivaptan/tolvaptan, demeclocycline
314
Sickle cell disease
Hydroxyurea (Increases fetal hemoglobin)
315
Sporothrix schenckii
Itraconazole, oral potassium iodide
316
Stable angina
Sublingual nitroglycerin
317
Staphylococcus aureus
MSSA: nafcillin, oxacillin, dicloxacillin (antistaphylococcal
penicillins); MRSA: vancomycin, daptomycin, linezolid,
ceftaroline
318
Streptococcus bovis
Penicillin prophylaxis; evaluation for colon cancer if linked to endocarditis
319
Streptococcus pyogenes
Penicillin prophylaxis
320
Temporal arteritis
High-dose steroids
321
Tonic-clonic seizures
Levetiracetam, phenytoin, valproate, carbamazepine
322
Toxoplasma gondii
Sulfadiazine + pyrimethamine
323
Treponema pallidum
Penicillin
324
Trichomonas vaginalis
Metronidazole (patient and partner)
325
Trigeminal neuralgia (tic douloureux)
Carbamazepine
326
Ulcerative colitis
5-ASA preparations (e.g., mesalamine), 6-mercaptopurine, infliximab, colectomy
327
UTI prophylaxis
TMP-SMX
328
Warfarin reversal
Fresh frozen plasma (acute), vitamin K (chronic)
329
Actinic (solar) keratosis
Precursor to squamous cell carcinoma
330
Acute gastric ulcer associated with CNS injury
Cushing ulcer (Increased intracranial pressure stimulates vagal gastric H+ secretion)
331
Acute gastric ulcer associated with severe burns
```
Curling ulcer (greatly reduced plasma volume results in
sloughing of gastric mucosa)
```
332
Alternating areas of transmural inflammation and normal
| colon
Skip lesions (Crohn disease)
333
Aortic aneurysm, abdominal
Atherosclerosis
334
Aortic aneurysm, ascending or arch
3° syphilis (syphilitic aortitis), vasa vasorum destruction
335
Aortic aneurysm, thoracic
Marfan syndrome (idiopathic cystic medial degeneration)
336
Aortic dissection
Hypertension
337
Atrophy of the mammillary bodies
```
Wernicke encephalopathy (thiamine deficiency causing
ataxia, ophthalmoplegia, and confusion)
```
338
Autosplenectomy (fibrosis and shrinkage)
Sickle cell disease (hemoglobin S)
339
Bacteria associated with gastritis, peptic ulcer disease, and stomach cancer
H. pylori
340
Bacterial meningitis (adults and elderly)
S. pneumoniae
341
Bacterial meningitis (newborns and kids)
Group B streptococcus/E.coli (newborns),
| S. pneumoniae/N. meningitidis (kids/teens)
342
Bilateral ovarian metastases from gastric carcinoma
Krukenberg tumor (mucin-secreting signet ring cells)
343
Bleeding disorder with GpIb deficiency
Bernard-Soulier syndrome (defect in platelet adhesion to von Willebrand factor)
344
Brain tumor (adults)
Supratentorial: metastasis, astrocytoma (including
| glioblastoma multiforme), meningioma, schwannoma
345
Brain tumor (kids)
Infratentorial: medulloblastoma (cerebellum) or
supratentorial: craniopharyngioma
346
Breast cancer
Invasive ductal carcinoma
347
Breast mass
Fibrocystic change, carcinoma (in postmenopausal
| women)
348
Breast tumor (benign)
Fibroadenoma
349
Cardiac 1° tumor (kids)
Rhabdomyoma, often seen in tuberous sclerosis
350
Cardiac manifestation of lupus
Marantic/thrombotic endocarditis (nonbacterial)
351
Cardiac tumor (adults)
Metastasis, myxoma (90% in left atrium; “ball and valve”)
352
Cerebellar tonsillar herniation
Chiari II malformation
353
Chronic arrhythmia
Atrial fibrillation (associated with high risk of emboli)
354
Chronic atrophic gastritis (autoimmune)
Predisposition to gastric carcinoma (can also cause pernicious anemia)
355
Clear cell adenocarcinoma of the vagina
DES exposure in utero
356
Congenital adrenal hyperplasia, hypotension
21-hydroxylase deficiency
357
Congenital cardiac anomaly
VSD
358
Congenital conjugated hyperbilirubinemia (black liver)
Dubin-Johnson syndrome (inability of hepatocytes to secrete conjugated bilirubin into bile)
359
Constrictive pericarditis
TB (developing world); idiopathic, viral illness (developed world)
360
Coronary artery involved in thrombosis
LAD > RCA > circumflex
361
Cretinism
Iodine deficit/congenital hypothyroidism
362
Cushing syndrome
- Iatrogenic (from corticosteroid therapy)
- Adrenocortical adenoma (secretes excess cortisol)
- ACTH-secreting pituitary adenoma (Cushing disease)
- Paraneoplastic (due to ACTH secretion by tumors)
363
Cyanosis (early; less common)
Tetralogy of Fallot, transposition of great vessels, truncus arteriosus
364
Cyanosis (late; more common)
VSD, ASD, PDA
365
Death in CML
Blast crisis
366
Death in SLE
Lupus nephropathy
367
Dementia
Alzheimer disease, multiple infarcts (vascular dementia)
368
Demyelinating disease in young women
Multiple sclerosis
369
DIC
Severe sepsis, obstetric complications, cancer, burns, trauma, major surgery
370
Dietary deficit
Iron
371
Diverticulum in pharynx
Zenker diverticulum (diagnosed by barium swallow)
372
Ejection click
Aortic stenosis
373
Esophageal cancer
Esophageal cancer Squamous cell carcinoma (worldwide); adenocarcinoma
374
Food Poisoning (Exotoxin mediated)
S. aureus, B. cereus
375
Glomerulonephritis (adults)
Berger disease (IgA nephropathy)
376
Gynecologic malignancy
```
Endometrial carcinoma (most common in U.S.); cervical
carcinoma (most common worldwide)
```
377
Heart murmur, congenital
Mitral valve prolapse
378
Heart valve in bacterial endocarditis
Mitral > aortic (rheumatic fever), tricuspid (IV drug
| abuse)
379
Helminth infection (U.S.)
Enterobius vermicularis, Ascaris lumbricoides
380
Hematoma—epidural
Rupture of middle meningeal artery (trauma; lentiform
| shaped)
381
Hematoma—subdural
Rupture of bridging veins (crescent shaped)
382
Hemochromatosis
Multiple blood transfusions or hereditary HFE mutation
| can result in heart failure, “bronze diabetes,” and increased risk of hepatocellular carcinoma
383
Hepatocellular carcinoma
Cirrhotic liver (associated with hepatitis B and C and with alcoholism)
384
Hereditary bleeding disorder
von Willebrand disease
385
Hereditary harmless jaundice
```
Gilbert syndrome (benign congenital unconjugated
hyperbilirubinemia)
```
386
HLA-B27
Ankylosing spondylitis, reactive arthritis, ulcerative colitis, psoriatic arthritis
387
HLA-DR3
Diabetes mellitus type 1, SLE, Graves disease, Hashimoto thyroiditis
388
HLA-DR4
Diabetes mellitus type 1, rheumatoid arthritis
389
Holosystolic murmur
VSD, tricuspid regurgitation, mitral regurgitation
390
Hypercoagulability, endothelial damage, blood stasis
Virchow triad (Increased risk of thrombosis)
391
Hypertension, 2°
Renal disease
392
Hypoparathyroidism
Accidental excision during thyroidectomy
393
Hypopituitarism
Pituitary adenoma (usually benign tumor)
394
Infection 2° to blood transfusion
Hepatitis C
395
Infections in chronic granulomatous disease
S. aureus, E. coli, Aspergillus (catalase ⊕)
396
Intellectual disability
Down syndrome, fragile X syndrome
397
Kidney stones
- Calcium = radiopaque
- Struvite (ammonium) = radiopaque (formed by urease
⊕ organisms such as Klebsiella, Proteus species, and
S. saprophyticus)
- Uric acid = radiolucent
398
Late cyanotic shunt (uncorrected left to right becomes right to left)
Eisenmenger syndrome (caused by ASD, VSD, PDA; results in pulmonary hypertension/polycythemia)
399
Liver disease
Alcoholic cirrhosis
400
Lysosomal storage disease
Gaucher disease
401
Male cancer
Prostatic carcinoma
402
Malignancy associated with noninfectious fever
Hodgkin lymphoma
403
Malignancy (kids)
ALL, medulloblastoma (cerebellum)
404
Metastases to bone
Prostate, breast > lung > thyroid
405
Metastases to brain
Lung > breast > genitourinary > melanoma > GI
406
Metastases to liver
Colon >> stomach, pancreas
407
Mitochondrial inheritance
Disease occurs in both males and females, inherited through females only
408
Mitral valve stenosis
Rheumatic heart disease
409
Mixed (UMN and LMN) motor neuron disease
Amyotrophic lateral sclerosis
410
Myocarditis
Coxsackie B
411
Nephrotic syndrome (adults)
Focal segmental glomerulosclerosis
412
Nephrotic syndrome (kids)
Minimal change disease
413
Neuron migration failure
Kallmann syndrome (hypogonadotropic hypogonadism and anosmia)
414
Nosocomial pneumonia
S. aureus, Pseudomonas, other enteric gram-negative rods
415
Obstruction of male urinary tract
BPH
416
Opening snap
Mitral stenosis
417
Opportunistic infection in AIDS
Pneumocystis jirovecii pneumonia
418
Osteomyelitis
S. aureus (most common overall)
419
Osteomyelitis in sickle cell disease
Salmonella
420
Osteomyelitis with IV drug use
Pseudomonas, Candida, S. aureus
421
Ovarian tumor (benign, bilateral)
Serous cystadenoma
422
Ovarian tumor (malignant)
Serous cystadenocarcinoma
423
Pancreatitis (acute)
Gallstones, alcohol
424
Pancreatitis (chronic)
Alcohol (adults), cystic fibrosis (kids)
425
Patient with ALL /CLL /AML /CML
ALL: child, CLL: adult > 60, AML: adult ∼ 65, CML: adult
| 45–85
426
Pelvic inflammatory disease
C. trachomatis, N. gonorrhoeae
427
Philadelphia chromosome t(9;22) (BCR-ABL)
CML (may sometimes be associated with ALL/AML)
428
Pituitary tumor
Prolactinoma, somatotropic adenoma
429
1° amenorrhea
Turner syndrome (45,XO)
430
1° bone tumor (adults)
Multiple myeloma
431
1° hyperaldosteronism
Adenoma of adrenal cortex
432
1° hyperparathyroidism
Adenomas, hyperplasia, carcinoma
433
1° liver cancer
```
Hepatocellular carcinoma (chronic hepatitis, cirrhosis,
hemochromatosis, α1-antitrypsin deficiency, Wilson disease)
```
434
Pulmonary hypertension
COPD
435
Recurrent inflammation/thrombosis of small/medium vessels in extremities
Buerger disease (strongly associated with tobacco)
436
Renal tumor
Renal cell carcinoma: associated with von Hippel-Lindau and cigarette smoking; paraneoplastic syndromes (EPO, renin, PTHrP, ACTH)
437
Right heart failure due to a pulmonary cause
Cor pulmonale
438
S3 heart sound
Increased ventricular filling pressure (e.g., mitral regurgitation, HF), common in dilated ventricles
439
S4 heart sound
Stiff/hypertrophic ventricle (aortic stenosis, restrictive
| cardiomyopathy)
440
2° hyperparathyroidism
Hypocalcemia of chronic kidney disease
441
Sexually transmitted disease
C. trachomatis (usually coinfected with N. gonorrhoeae)
442
SIADH
Small cell carcinoma of the lung
443
Site of diverticula
Sigmoid colon
444
Sites of atherosclerosis
Abdominal aorta > coronary artery > popliteal artery
| > carotid artery
445
Stomach cancer
Adenocarcinoma
446
Stomach ulcerations and high gastrin levels
Zollinger-Ellison syndrome (gastrinoma of duodenum or
| pancreas)
447
t(14;18)
```
Follicular lymphomas (BCL-2 activation, anti-apoptotic
oncogene)
```
448
t(8;14)
```
Burkitt lymphoma (c-myc fusion, transcription factor
oncogene)
```
449
t(9;22)
Philadelphia chromosome, CML (BCR-ABL activation,
| tyrosine kinase oncogene)
450
Temporal arteritis
Risk of ipsilateral blindness due to occlusion of ophthalmic artery; polymyalgia rheumatica
451
Testicular tumor
Seminoma (malignant, radiosensitive)
452
Thyroid cancer
Papillary carcinoma
453
Tumor in women
Leiomyoma (estrogen dependent, not precancerous)
454
Tumor of infancy
Strawberry hemangioma (usually regresses spontaneously by childhood)
455
Tumor of the adrenal medulla (adults)
Pheochromocytoma (usually benign)
456
Tumor of the adrenal medulla (kids)
Neuroblastoma (malignant)
457
Type of Hodgkin lymphoma
```
Nodular sclerosing (vs. mixed cellularity, lymphocytic
predominance, lymphocytic depletion)
```
458
Type of non-Hodgkin lymphoma
Diffuse large B-cell lymphoma
459
UTI
E. coli, Staphylococcus saprophyticus (young women)
460
Vertebral compression fracture
Osteoporosis (type I: postmenopausal woman; type II: elderly man or woman)
461
Viral encephalitis affecting temporal lobe
HSV-1
462
Vitamin deficiency (U.S.)
Folate (pregnant women are at high risk; body stores only 3- to 4-month supply; prevents neural tube defects)
463
Sensitivity
TP / (TP + FN)
464
Specificity
TN / (TN + FP)
465
Positive predictive value
TP / (TP + FP)
466
Negative predictive value
TN / (FN + TN)
