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Rapid Review > Clinical Presentations > Flashcards

Clinical Presentations Flashcards

1
Q

Abdominal pain, ascites, hepatomegaly, (also high D dimer, CHF without JVD)

A

Budd-Chiari syndrome

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2
Q

Achilles tendon xanthoma

A

Familial hypercholesterolemia

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3
Q

Adrenal hemorrhage, hypotension, DIC

A

Waterhouse-Friderichsen syndrome (meningococcemia)

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4
Q

Arachnodactyly, lens dislocation, aortic dissection, hyperflexible joints

A

Marfan’s (fibrillin defect)

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5
Q

Athlete with polycythemia

A

Erythropoietin injection

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6
Q

Back pain, fever, night sweats, weight loss

A

Pott’s (TB to the vertebrae)

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7
Q

Bilateral hilar adenopathy, uveitis

A

Sarcoid

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8
Q

Blue sclera

A

Osteogenesis imperfecta

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9
Q

Bluish line on gingiva

A

Burton’s line - lead poisoning

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10
Q

Bone pain, bone enlargement, arthritis, (also increased hat size, fracture, increased alk phos)

A

Paget’s

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11
Q

Bounding pulses, diastolic hear murmur, head bobbing

A

Aortic regurg

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12
Q

Café-au-lait spots, Lisch nodules

A

NF (1 = optic glimoas and pheo, 2 = acoustic Schwannomas)

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13
Q

Café-au-lait spots, polyostotic fibrous dysplasia, precocious puberty

A

McCune-Albright syndome (G protein problem)

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14
Q

Calf pseudohypertrophy

A

Duchenne’s muscular dystrophy

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15
Q

Cherry-red spot on macula

A

Tay-Sachs, Niemann-Pick, central retinal artery occlusion

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16
Q

Chest pain, pericardial effusion/friction rub, persistent fever following MI

A

Dressler’s (autoimmune post-MI)

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17
Q

Child uses arms to stand up from squat

A

Gower’s sign (Duchenne’s)

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18
Q

Child with fever develops red rash on face that spreads to body

A

Slapped cheek - B19

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19
Q

Chorea, dementia, caudate degeneration

A

Huntington’s

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20
Q

Chronic exercise intolerance with myalgia, fatigue, painful cramps

A

McArdle’s (muscle phosphorylase deficiency)

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21
Q

Cold intolerance

A

Hypothyroidism

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22
Q

Conjugate lateral gaze palsy, horizontal diplopia

A

Internuclear ophthalmoplegia (MS or stroke)

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23
Q

Continuous machinery heart murmur

A

PDA

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24
Q

Cutaneous/dermal edema due to CT expansion

A

Myxedema

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25
Q

Dark purple skin / mouth nodules

A

Kaposi’s sarcoma

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26
Q

Deep, labored breathing / hyperventilation

A

Kussmaul breathing, DKA

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27
Q

Dermatitis, dementia, diarrhea

A

Pellagra (B3 / niacin deficiency)

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28
Q

Dilated cardiomyopathy, edema, polyneuropathy

A

Wet beriberi (B1 / thiamine deficiency)

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29
Q

Dog or cat bite resulting in infection

A

Pasteurella multocida (local cellulitis)

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30
Q

Dry eyes, dry mouth, arthritis

A

Sjogren’s syndrome

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31
Q

Dysphagia (esophageal webs), glossitis (smooth tongue), iron deficiency anemia

A

Plummer-Vinson syndrome

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32
Q

Elastic skin, hypermobility of joints

A

Ehler-Danlos (type III collagen)

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33
Q

Enlarged. hard left supraclavicular node

A

VIrchow’s node (abdominal met)

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34
Q

Erythroderma, lymphadenopathy, hepatosplenomegaly, atypical T cells

A

Sezary syndrome (cutaneous T cell lymphoma)

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35
Q

Facial muscle spasm upon tapping

A

Chvostek’s sign (hypocalcemia)

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36
Q

Fat, female, fertile, forty

A

Gallstones

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37
Q

Fever, chills, headache, myalgia following antibiotic treatment for syphillis

A

Jarisch-Herxheimer reaction (lysis of spirochetes results in toxin release)

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38
Q

Fever, cough, conjunctivitis, coryza, diffuse rash, Koplick spots

A

Measles

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39
Q

Fever, night sweats, weight loss

A

B symptoms or TB

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40
Q

Fibrous plaques in soft tissue of penis

A

Peyronie’s disease

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41
Q

Gout, MR, self-mutilating behavior in a boy

A

Lesch-Nyhan syndrome (HGPRT deficiency, X-linked recessive)

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42
Q

Green-yellow rings around peripheral iris

A

Kayser-Fleischer rings (copper accumulation from Wilson’s disease)

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43
Q

Hamartomatous GI polyps, hyperpigmentation of mouth, feet and hands

A

Peutz-Jeghers syndrome

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44
Q

Hepatosplenomegaly, osteoporosis, neurologic symptoms, crinkled cytoplasm

A

Gaucher’s disease (glucocerebrosidase deficiency)

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45
Q

Hereditary nephritis, sensorineural hearing loss, cataracts

A

Alport’s syndrome (type IV collagen)

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46
Q

Hypercoagulability leading to thrombophlebitis

A

Trousseau’s sign (adenocarcinoma of pancreas or lung)

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47
Q

Hyperphagia, hypersexuality, hyperorality, hyperdocility

A

Kluver-Bucy syndrome (bilateral amygdala)

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48
Q

HTN, hypoK, metabolic alkalosis

A

Conn’s (1* hyperaldosterone)

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49
Q

Hypoxemia, polycythemia, hypercapnia

A

Blue bloater (chronic bronchitis)

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50
Q

Indurated, ulcerated genital lesion

A

Nonpainful = syphillis. Painful with exudate = chancroid

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51
Q

Infant with failure to thrive, hepatosplenomegaly, neurodegeneration

A

Niemann-Pick disease (genetic sphingomyelinase deficiency)

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52
Q

Infant with hypoglycemia, failure to thrive, and hepatomegaly

A

Cori’s disease (debranching enzyme deficiency, no glycogenolysis) or Von Gierke’s

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53
Q

Infant with microcephaly, rocker-bottom feet, clenched hands, and structural heart defect

A

Edward’s syndrome (Trisomy 18)

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54
Q

Jaundice, RUQ pain, fever

A

Charcot’s triad (ascending cholangitis)

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55
Q

Keratin pearls

A

Squamous cell carcinoma

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56
Q

Large rash with bull’s eye appearance

A

Erythema chronicum migrans from Ixodes tick bite (Lyme)

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57
Q

Lucid interval after TBI

A

Epidural hematoma (middle meningeal artery)

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58
Q

Male child, recurrent infections, no mature B cells

A

Bruton’s disease (X-linked agammaglobulinemia)

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59
Q

Mucosal bleeding and prolonged bleeding time

A

Glanzmann’s thrombasthenia (defect in platelet aggregation due to lack of GpIIb/IIIa)

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60
Q

Multiple colon polyps, osteomas / soft tissue tumors, impacted / supernumary teeth

A

Gardner’s syndrome

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61
Q

Necrotizing vasculitis (lungs) and necrotizing GN

A

Wegner’s (c-ANCA) and Goodpasture’s (anti-GBM). Wegner’s can also have upper airway involvement

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62
Q

Neonate with arm paralysis following difficult birth. Possible clavicle fx, probably large for gestational age

A

Erb-Duchenne palsy

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63
Q

No lactation postpartum, absent menstruation, cold intolerance

A

Sheehan’s syndrome

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64
Q

Nystagmus, intention tremor, scanning speech, also bilateral internuclear ophthalmoplegia

A

MS (Charcot’s)

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65
Q

Oscillating slow / fast breathing

A

Cheyne-Stokes (central apnea from CHF or increased ICP)

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66
Q

Painful blue fingers / toes, hemolytic anemia

A

Cold agglutinin disease (autoimmune from Mp or mono, from IgM)

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67
Q

Painful, pale, cold fingers / toes

A

Raynaud’s syndrome (vasospasm)

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68
Q

Painful, raised red lesions on palms and soles

A

Osler’s node (infective endocarditis)

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69
Q

Painless erythematous lesions on palms and soles

A

Janeway lesions (infective endocarditis)

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70
Q

Painless jaundice

A

Cancer at head of pancreas obstructing bile duct

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71
Q

Palpable purpura, joint pain, abdominal pain in a child

A

Henoch-Schonlein purpura (IgA vasculitis)

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72
Q

Pancreatic, pituitary, parathyroid tumors

A

MEN 1 (Wermer’s)

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73
Q

Pink complexion, dypnea, hyperventilation

A

Pink puffer (emphysema)

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74
Q

Polyuria, acidosis, growth failure, electrolyte imbalances

A

Fanconi’s syndrome (proximal tubular reabsorption defect)

75
Q

Ptosis, miosis, anhidrosis

A

Horner’s syndrome (usually with Pancoast tumor in apex of lung)

76
Q

Pupil accommodates but doesn’t react

A

Argyll Robertson pupil (neurosyphilis)

77
Q

Rapidly progressive leg weakness that ascend, following GI infection

A

Guillain-Barre syndrome

78
Q

Rash on palms and soles

A

2* syphilis, Rocky Mountain spotted fever, coxsackie A

79
Q

Recurrent colds, unusual eczema, high serum IgE

A

Job’s syndrome

80
Q

Red “current jelly” sputum in alcoholic or diabetic patients

A

Klebsiella pneumoniae

81
Q

Red, itchy, swollen rash of nipple/areola

A

Paget’s disease of the breast

82
Q

Red urine in the morning, fragile RBCs

A

Paroxysmal nocturnal hemoglobinuria (C’ mediated damage, lack of CD55/59)

83
Q

Renal cell carcinoma, hemangioblastomas, angiomatosis, pheochromocytoma

A

von Hippel-Lindau diease

84
Q

Resting tremor, rigidity, akinesia, postural instability

A

Parkinson’s

85
Q

Restrictive cardiomyopathy (juvenile = cardiomegaly), exercise intolerance

A

Pompe’s disease (lysosomal glucosidase deficiency)

86
Q

Retinal hemorrhages with pale centers

A

Roth’s spots (bacterial endocarditis)

87
Q

Severe jaundice in neonate

A

Crigler-Najjar syndrome (congenital unconj hyper bilirubinemia)

88
Q

Severe RLQ pain with rebound tenderness

A

McBurney’s sign

89
Q

Short stature, increased incidence of tumors / leukemia, aplastic anemia

A

Fanconi’s anemia (esp AML)

90
Q

Single palm crease

A

Simian crease (Down’s)

91
Q

Situs inversus, chronic sinusitis, bronchiectasis, infertility

A

Kartagener’s syndrome (dynein)

92
Q

Skin hyperpigmentation

A

Addison’s

93
Q

Slow progressive muscle weakness in boys

A

Becker’s muscular dystrophy

94
Q

Small, irregular red spots on buccal mucosa with blue-white centers

A

Koplick spots (measles)

95
Q

Smooth, flat, moist white lesions on genitals

A

Condylomata lata (2* syphilis)

96
Q

Splinter hemorrhages in fingernails

A

Bacterial endocarditis

97
Q

Strawberry tongue

A

Scarlet fever, Kawasaki disease, TSS

98
Q

Rusty sputum

A

Strep pneumo

99
Q

Current jelly stool

A

Intussesseption

100
Q

Streak ovaries, congenital heart disease, horseshoe kidney

A

Turner syndrome (X0, short stature, webbed neck, lymphedema)

101
Q

Sudden swollen/painful big toe joint, tophi

A

Gout/podagra (hyperuricemia)

102
Q

Swollen gums, mucous bleeding, poor wound healing, spots on skin

A

Scurvy (vit C deficiency: can’t hydroxylate proline/lysine for collagen synthesis)

103
Q

Swollen, hard, painful finger joints

A

OA (osteophytes on PIP (Bouchard) and DIP (Heberden)

104
Q

Systolic ejection murmur (crescendo-decrescendo)

A

Aortic valve stenosis

105
Q

Thyroid (medullary) and parathyroid tumors, pheochromocytoma

A

MEN 2A (Sipple)

106
Q

Toe extension / fanning upon plantar scrape

A

Babinski (UMN lesion)

107
Q

Unilateral facial drooping involving forehead

A

Bell’s palsy (LMN CN VII)

108
Q

Urethritis, conjunctivitis, arthritis in a male

A

Reiter’s syndrome (reactive arthritis associated with HLA B27)

109
Q

Vascular birthmark (port-wine stain)

A

Hemangioma (benign, associated with Sturge-Weber syndrome, in which case it’s V1 distribution)

110
Q

Vasculitis from exposure to endotoxin casuing glomerular thrombosis

A

Shwartzman reaction (follows second exposure to endotoxin)

111
Q

Vomiting blood following esophagogastric lacerations

A

Mallory-Weiss syndrome (alcoholic and bulimic patients)

112
Q

Waxy casts with very low urine flow

A

Chronic ESRD

113
Q

WBC casts in urine

A

Acute pyelo

114
Q

Weight loss, diarrhea, arthritis, fever, adenopathy

A

Whipple’s disease (Tropheryma whippelii)

115
Q

Worst headache of my life

A

USMLE Step 1 (or subarachnoid hemorrhage)

116
Q

Anticentromere antibodies

A

Scleroderma (CREST)

117
Q

Antidesmoglein (epithelial) antibodies

A

Pemphigus vulgaris (blistering)

118
Q

AntiGBM antibodies

A

Goodpasture’s syndome (glomerulonephritis and hemoptysis)

119
Q

Antihistone antibodies

A

Drug-induced SLE (hydralazine, isoniazid, phenytoin, procainamide)

120
Q

Anti-IgG antibodies

A

RA (systemic inflammation, joint pannus, boutonniere deformity) - IgM anti IgG

121
Q

Antimitochondrial antibodies

A

1* biliary cirrhosis (female, cholestasis, portal HTN)

122
Q

Antineutrophil cytoplasmic antibodies (ANCA)

A

Vasculitis (c-ANCA = Wegener’s, p-ANCA = microscopic polyangiitis or Churg-Strauss syndrome)

123
Q

Antinuclear antibodies

A

SLE (type III hypersensitivity)

124
Q

Antiplatelet antibodies

A

Idiopathic thrombocytopenic purpura (ITP - bleeding diathesis)

125
Q

Anti-topoisomerase antibodies

A

Diffuse systemic scleroderma

126
Q

Anti-transglutaminase/antigliadin/anti-endomysial antibodies

A

Celiac (diarrhea, distention, weight loss)

127
Q

Azurophilic granular needles in leukemic blasts

A

Auer rods (AML, esp promyelocytic type)

128
Q

Bamboo spine on X-ray

A

Ankylosing spondylitis (chronic inflammatory arthritis, HLA B27)

129
Q

Basophilic nuclear remnants in RBCs

A

Howell-Jolly bodies (due to splenectomy or nonfunctional spleen)

130
Q

Basophilic stipplling of RBCs

A

Lead poisoning or sideroblastic anemia

131
Q

Bloody tap on LP

A

Subarachnoid hemorrhage

132
Q

Boot-shaped heart on X-ray

A

Tetralogy of Fallot, RVH

133
Q

Branching gram + rods with sulfur granules

A

Actinomyces israelii

134
Q

Bronchogenic apical lung tumor

A

Pancoast tumor (can cause Horner’s)

135
Q

Brown tumor of bone

A

Hemorrhage (hemosiderin) causes brown color of osteolytic cysts. Due to hyperparathyroidism or osteitis fibrosa cystica

136
Q

Cardiomegaly with apical atrophy

A

Chagas disease (Trypanosoma cruzi)

137
Q

Cellular crescents in Bowman’s capsule

A

Rapidly progressive crescentic glomerulonephritis

138
Q

Chocolate cyst of ovary

A

Endometriosis (usually bilateral)

139
Q

Circular grouping of dark tumor cells surrounding pale neurofibrils

A

Homer Wright rosettes (adrenal neuroblastoma, medulloblastoma, Ewing’s sarcoma)

140
Q

Colonies of mucoid Pseudomonas in lungs

A

CF

141
Q

Degeneration of dorsal column nerves

A

Tabes dorsalis - lose proprioception (3* syphilis)

142
Q

Depigmentation of neurons in substantia nigra

A

Parkinson’s

143
Q

Desquamated epithelium casts in sputum

A

Curschmann’s spirals (bronchial asthma, can result in whorled mucous plugs)

144
Q

Disarrayed granulosa cells in eosinophilic fluid

A

Call-Exner bodies (granulosa-theca cell tumor of the ovary)

145
Q

Dysplastic squamous cervical cells with nuclear enlargement and hyperchromasia

A

Koilocytes (HPV) “perrinuclear cytoplasmic clearing”

146
Q

Enlarged cells with intranuclear inclusion bodies

A

Owl’s eye appearance of CMV - Cowdry A bodies

147
Q

Enlarged thyroid cells with ground-glass nuclei

A

Orphan Annie nuclei, or “disbursed chromatin” (papillary carcinoma of the thyroid)

148
Q

Eosinophilic cytoplasmic inclusion in liver cell

A

Mallory bodies (alcoholic liver disease)

149
Q

Eosinophilic cytoplasmic inclusion in nerve cell

A

Lewy body (Parkinson’s)

150
Q

Eosinophilic globule in liver

A

Councilman body (toxic or viral hepatitis, often yellow fever)

151
Q

Eosinophilic inclusion bodies in cytoplasm of hippocampal nerve cells

A

Rabies virus - negri bodies (Lyssavirus)

152
Q

Extracellular amyloid deposition in gray matter of brain

A

Senile plaques (Alzheimer’s)

153
Q

Giant B cells with bilobed nuclei with prominent inclusions (Owl’s eye)

A

Reed-Sternberg cells (Hodgkin’s lymphoma)

154
Q

Glomerulus-like structure surrounding vessel in germ cells

A

Schiller-Duval bodies (yolk sac tumor)

155
Q

Hair-on-end (crewcut) appearance on X-ray

A

b-thalassemia, sickle cell anemia (extramedullary hematopoiesis). “Hair on end” means marrow expansion (skull)
hCG elevated Choriocarcinoma, hydatidiform mole
Heart nodules (inflammatory) Aschoff bodies = focal myocardial inflammation with giant cells (rheumatic fever)
Heterophile antibodies Infectious mono (HBV). IgM that agglutinates sheep RBCs
Hexagonal, double-pointed, needle-like crystals in bronchial secretions Bronchial asthma (Charcot-Leyden crystals: eosinophilic granules)
High level of D dimers DVT, PE, DIC, Budd-Chiari (D dimer is fibrin breakdown products)
Hilar lymphadenopathy, peripheral granulomatous lesion in middle or lower lung lobes (can calcify) Ghon complex (1* TB)
Honeycomb lung on X-ray Interstitial fibrosis
Hypersegmented neutrophils Megaloblastic anemia (B12, folate deficiency)
Hypochromic, microcytic anemia Iron deficiency anemia, lead poisoning, thalassemia (HbF sometimes present)
Increased a-fetoprotein in amniotic fluid / maternal serum Anencephaly, spina bifida (neural tube defects), gastrocesis, omphalmocele
Increased uric acid levels Gout, Lesch-Nyhan syndrome, tumor lysis syndrome, loop and thiazide diuretics
Intranuclear eosinophilic droplet-like bodies Cowdry type A bodies (HSV or CMV)
Iron-containing nodules in alveolar septum Ferruginous bodies (asbestosis: risk of mesothelioma)
Large lysosomal vesicles in phagocytes, immunodeficiency Chediak-Higashi disease (congenital failure of phagolysosome formation)
Low serum ceruloplasmin Wilson’s disease (hepatolenticular degeneration)
Lumpy-bumpy appearance of glomeruli on immunofluorescence Poststrep glomerulonephritis (IgG and C3b deposition)
Lytic (punched-out) bone lesions on X-ray Multiple myeloma
Mammary gland (blue-domed) cyst Fibrocystic change of the breast
Monoclonal antibody spike 1. Multiple myeloma (M protein, IgG or IgA) 2. Monoclonal gammopathy of undetermined significance (aging) 3. Waldenstrom’s macroglobulinemia (IgM) 4. Primary amyloidosis
Monoclonal globulin protein in blood/urine 1. Bence Jones proteins (multiple myeloma, kappa or lambda light chains in urine) 2. Waldenstrom’s macroglobulinemia (IgM)
Mucin-filled cell with peripheral nucleus Signet ring (gastric carcinoma)
Narrowing of bowel lumen on barium radiograph String sign (Crohn’s)
Needle-shaped, negatively birefringent crystals Gout
Nodular hyaline deposits in glomeruli Kimmelstiel-Wilson nodules (diabetic)
Nutmeg liver Chronic passive congestion of the liver due to right heart failure
Onion-skin periosteal reaction Ewing’s sarcoma (malignant round cell tumor)
Periosteum raised from bone, creating triangular area Codman’s triangle on X-ray (osteosarcoma, Ewing’s, pyogenic osteomyelitis)
Podocyte fusion on EM Minimal change disease (child, nephrotic)
Polished, ivory-like appearance of bone at cartilage erosion Eburnation (OA resulting in bony sclerosis)
Protein aggregates in neurons from hyperphosphorylation of tau protein Neurofibrillary tangles (Alzheimer’s and CJD)
Pseudopalisading tumor cells on brain biopsy GBM (cells may be called serpentine”)

156
Q

RBC casts in urine

A

Acute glomerulonephritis

157
Q

Rectangular, crystal-like, cytoplasmic inclusions in Leydig cells

A

Reinke crystals (Leydig cell tumor)

158
Q

Renal epithelial casts in urine

A

Acute toxic/viral nephrosis

159
Q

Rhomboid crystals, positively birefringent

A

Pseudogout

160
Q

Rib notching

A

Coarctation of the aorta

161
Q

Sheets of medium-sized lymphoid cells (starry sky)

A

Burkitt’s lymphoma (t(8:14) c-myc, EBV)

162
Q

Silver-staining spherical aggregation of tau proteins in neurons

A

Pick bodies

163
Q

Soap bubble in femur or tibia on X-ray

A

Giant cell tumor of bone (generally benign)

164
Q

Spikes on basement membrane, dome-like endothelial deposits

A

Membranous glomerulonephritis (may progress to nephrotic)

165
Q

Stacks of RBCs

A

Rouleax formation (high ESR, multiple myeloma)

166
Q

Stippled vaginal epithelial cells

A

Clue cells (Gardenella vaginalis)

167
Q

Tennis racket shaped cytoplasmic organelles (EM) in Langerhans cells

A

Bibeck granules (histiocytosis X: eosinophilic granuloma)

168
Q

Thrombi made of white/red layers

A

Lines of Zahn (arterial thrombus, layers of platelets/RBCs)

169
Q

Thumb sign on lateral X-ray

A

Epiglossitis (H flu)

170
Q

Thyroid-like appearance of kidney

A

Chronic bacterial pyelo

171
Q

Tram-track on LM

A

Membranoproliferative glomerulonephritis

172
Q

Triglyceride accumulation in liver cell vacuoles

A

Fatty liver disease (alcoholic or metabolic syndrome)

173
Q

WBCs that look smudged

A

CLL (almost always B cell, affects the elderly)

174
Q

Wire loop glomerular appearance on LM

A

SLE nephropathy

175
Q

Yellow CSF

A

Xanthochromia (subarachnoid hemorrhage)

176
Q

brain cysts, seizures (parasite)

A

Taenia solium (cysticercosis)

177
Q

liver cysts (parasite)

A

Echinococcus granulosus

178
Q

B12 deficiency (parasite)

A

Diphyllobothrium latum

179
Q

biliary tract disease, cholangiocarcinoma (parasite)

A

Clonorchis sinensis

180
Q

hemoptysis (parasite)

A

Paragonimus westermani

181
Q

portal hypertension (parasite)

A

Schistosoma mansoni

182
Q

hematuria, bladder cancer (parasite)

A

Schistosoma haematobium

183
Q

microcytic anemia (parasite)

A

Ancylostoma, Necator (hook worms)

184
Q

perianal pruritis (parasite)

A

Enterobius

Rapid Review (4 decks)

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