First Aid 2015 High Yield Flashcards Preview

Step Nuggets > First Aid 2015 High Yield > Flashcards

Flashcards in First Aid 2015 High Yield Deck (423):
1

Abdominal pain, ascites, heptatomegaly

Budd-Chiari syndrome (posthepatic venous thrombosis)

2

Abdominal pain, diarrhea, leukocytosis, recent antibiotic use

Clostridium difficile infection

3

Achilles tendon xanthoma

Familial hypercholesterolemia ( LDL receptor signaling)

4

Adrenal hemorrhage, hypotension, DIC

Waterhouse-Friderichsen syndrome (meningococcemia

5

Anaphylaxis following blood transfusion

IgA deficiency

6

Anterior “drawer sign” ⊕

Anterior cruciate ligament injury

7

Arachnodactyly, lens dislocation, aortic dissection,
hyperflexible joints

Marfan syndrome (fibrillin defect)

8

Athlete with polycythemia

2° to erythropoietin injection

9

Back pain, fever, night sweats

Pott disease (vertebral TB)

10

Bilateral acoustic schwannomas

Neurofibromatosis type 2

11

Bilateral hilar adenopathy, uveitis

Sarcoidosis (noncaseating granulomas

12

Black eschar on face of patient with diabetic ketoacidosis

Mucor or Rhizopus fungal infection

13

Blue sclera

Osteogenesis imperfecta (type I collagen defect)

14

Bluish line on gingiva

Burton line (lead poisoning)

15

Bone pain, bone enlargement, arthritis

Paget disease of bone ( osteoblastic and osteoclastic activity)

16

Bounding pulses, diastolic heart murmur, head bobbing

Aortic regurgitation

17

“Butterfly” facial rash and Raynaud phenomenon in a young female

Systemic lupus erythematosus

18

Café-au-lait spots, Lisch nodules (iris hamartoma), cutaneous
neurofibromas, pheochromocytomas, optic gliomas

Neurofibromatosis type I, pheochromocytoma, optic gliomas

19

Café-au-lait spots (unilateral), polyostotic fibrous dysplasia,
precocious puberty, multiple endocrine abnormalities

McCune-Albright syndrome (mosaic G-protein signaling
mutation)

20

Calf pseudohypertrophy

Muscular dystrophy (most commonly Duchenne, due to
X-linked recessive frameshift mutation of dystrophin gene)

21

Cervical lymphadenopathy, desquamating rash, coronary
aneurysms, red conjunctivae and tongue

Kawasaki disease (treat with IVIG and aspirin)

22

“Cherry-red spots” on macula

Tay-Sachs (ganglioside accumulation) or Niemann-Pick
(sphingomyelin accumulation), central retinal artery occlusion

23

Chest pain on exertion

Chest pain on exertion

24

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

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,
 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,  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;  cancer risk, mainly GI)

56

Hepatosplenomegaly, pancytopenia, osteoporosis, aseptic
necrosis of femur, bone crises

Gaucher disease (glucocerebrosidase /betaglucosidase 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,
 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
 ACTH and  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, coiled hairs

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) - limited form
Calcinosis
Raynaud
Esophageal dysmotility
Sclerodactyly
Telangiectasia

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 (scl-70) 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”) of the skull 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:  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)
ƒƒMonoclonal gammopathy of undetermined significance
(MGUS consequence of aging)
ƒƒWaldenström (M protein = IgM) macroglobulinemia
ƒƒ 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 spherical 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

Tx:Absence seizures

Ethosuximide

241

Tx:Acute gout attack

NSAIDs, colchicine, glucocorticoids

242

Tx:Acute promyelocytic leukemia (M3)

All-trans retinoic acid

243

Tx:ADHD

Methylphenidate, CBT, atomoxetine

244

Tx:Alcoholism

Disulfiram, acamprosate, naltrexone, supportive care

245

Tx:Alcohol withdrawal

Long-acting benzodiazepines

246

Tx:Anorexia

Nutrition, psychotherapy, mirtazapine

247

Tx:Anticoagulation during pregnancy

Heparin

248

Tx:Arrhythmia in damaged cardiac tissue

Class IB antiarrhythmic (lidocaine, mexiletine)

249

Tx:B12 deficiency

Vitamin B12 supplementation (work up cause with Schilling test)

250

Tx:Benign prostatic hyperplasia

α1-antagonists, 5α-reductase inhibitors, PDE-5 inhibitors

251

Tx:Bipolar disorder

Mood stabilizers (e.g., lithium, valproic acid, carbamazepine),
atypical antipsychotics

252

Tx:Breast cancer in postmenopausal woman

Aromatase inhibitor (anastrozole)

253

Tx:Buerger disease

Smoking cessation

254

Tx:Bulimia nervosa

SSRIs

255

Tx:Candida albicans

Topical azoles (vaginitis); nystatin, fluconazole, caspofungin
(oral/esophageal); fluconazole, caspofungin, amphotericin B
(systemic)

256

Tx:Carcinoid syndrome

Octreotide

257

Tx:Chlamydia trachomatis

Doxycycline/Azithromycin (+ ceftriaxone for gonorrhea coinfection), erythromycin eye drops (prophylaxis in infants)

258

Tx:Chronic gout

Xanthine oxidase inhibitors (e.g., allopurinol, febuxostat

259

Tx:Chronic hepatitis B or C

IFN-α (HBV and HCV); ribavirin, simeprevir, sofosbuvir
(HCV)

260

Tx:Chronic myelogenous leukemia

Imatinib

261

Tx:Clostridium botulinum

Antitoxin

262

Tx:Clostridium difficile

Oral metronidazole; if refractory, oral vancomycin

263

Tx:Clostridium tetani

Antitoxin

264

Tx:CMV

Ganciclovir, foscarnet, cidofovir

265

Tx:Crohn disease

Corticosteroids, infliximab, azathioprine

266

Tx:Cryptococcus neoformans

Fluconazole (in AIDS patients)

267

Tx:Cyclophosphamide-induced hemorrhagic cystitis

Mesna

268

Tx:Depression

SSRIs (first-line)

269

Tx:Diabetes insipidus

Desmopressin (central); hydrochlorothiazide, indomethacin,
amiloride (nephrogenic)

270

Tx:Diabetes mellitus type 1

Dietary intervention (low carbohydrate) + insulin replacement

271

Tx:Diabetes mellitus type 2

Dietary intervention, oral hypoglycemics, and insulin (if
refractory)

272

Tx:Diabetic ketoacidosis

Fluids, insulin, K+

273

Tx:Enterococci

Vancomycin, aminopenicillins/cephalosporins

274

Tx:Erectile dysfunction

Sildenafil, tadalafil, vardenafil

275

Tx:ER ⊕ breast cancer

Tamoxifen

276

Tx:Ethylene glycol/methanol intoxication

Fomepizole (alcohol dehydrogenase inhibitor)

277

Tx:Haemophilus influenzae (B)

Rifampin (prophylaxis)

278

Tx:Generalized anxiety disorder

SSRIs, SNRIs (first line); buspirone (second line)

279

Tx:Granulomatosis with polyangiitis (Wegener

Cyclophosphamide, corticosteroids

280

Tx:Heparin reversal

Protamine sulfate

281

Tx:HER2/neu ⊕ breast cancer

Trastuzumab

282

Tx:Hyperaldosteronism

Spironolactone

283

Tx:Hypercholesterolemia

Statin (first-line)

284

Tx:Hypertriglyceridemia

Fibrate

285

Tx:Immediate anticoagulation

Heparin

286

Tx:Infertility

Leuprolide, GnRH (pulsatile), clomiphene

287

Tx:Influenza

Oseltamivir, zanamivir

288

Tx:Kawasaki disease

IVIG, high-dose aspirin

289

Tx:Legionella pneumophila

Macrolides (e.g., azithromycin)

290

Tx:Long-term anticoagulation

Warfarin, dabigatran, rivaroxaban and apixaban

291

Tx:Malaria

Chloroquine, mefloquine, atovaquone/proguanil (for blood
schizont), primaquine (for liver hypnozoite)

292

Tx:Malignant hyperthermia

Dantrolene

293

Tx:Medical abortion

Mifepristone

294

Tx:Migraine

Abortive therapies (e.g., sumatriptan, NSAIDs); prophylaxis
(e.g., propranolol, topiramate, CCBs, amitriptyline)

295

Tx:Multiple sclerosis

Disease-modifying therapies (e.g., β-interferon, natalizumab);
for acute flares, use IV steroids

296

Tx:Mycobacterium tuberculosis

RIPE (rifampin, isoniazid, pyrazinamide, ethambutol)

297

Tx:Neisseria gonorrhoeae

Ceftriaxone (add doxycycline/azizthromycin to cover likely concurrent C. trachomatis)

298

Tx:Neisseria meningitidis

Penicillin/ceftriaxone, rifampin (prophylaxis)

299

Tx:Neural tube defect prevention

Prenatal folic acid

300

Tx:Osteomalacia/rickets

Vitamin D supplementation

301

Tx:Osteoporosis

Calcium/vitamin D supplementation (prophylaxis);
bisphosphonates, PTH analogs, SERMs, calcitonin,
denosumab (treatment)

302

Tx:Patent ductus arteriosus

Close with indomethacin; open or maintain with PGE
analogs

303

Tx:Pheochromocytoma

α-antagonists (e.g., phenoxybenzamine)

304

Tx:Pneumocystis jirovecii

TMP-SMX (prophylaxis in AIDS patient)

305

Tx:Prolactinoma

Cabergoline/bromocriptine (dopamine agonists)

306

Tx:Prostate adenocarcinoma/uterine fibroids

Leuprolide, GnRH (continuous)

307

Tx:Prostate adenocarcinoma

Flutamide

308

Tx:Pseudomonas aeruginosa

Antipseudomonal penicillins, aminoglycosides, carbapenems

309

Tx:Pulmonary arterial hypertension (idiopathic)

Sildenafil, bosentan, epoprostenol

310

Tx:Rickettsia rickettsii

Doxycycline, chloramphenicol

311

Tx:Schizophrenia (negative symptoms)

Atypical antipsychotics

312

Tx:Schizophrenia (positive symptoms)

Typical and atypical antipsychotics

313

Tx:SIADH

Fluid restriction, IV hypertonic saline, conivaptan/tolvaptan,
demeclocycline

314

Tx:Sickle cell disease

Hydroxyurea ( fetal hemoglobin)

315

Tx:Sporothrix schenckii

Itraconazole, oral potassium iodide

316

Tx:Stable angina

Sublingual nitroglycerin

317

Tx:Staphylococcus aureus

MSSA: nafcillin, oxacillin, dicloxacillin (antistaphylococcal
penicillins); MRSA: vancomycin, daptomycin, linezolid,
ceftaroline

318

Tx:Streptococcus bovis

Penicillin prophylaxis; evaluation for colon cancer if linked to
endocarditis

319

Tx:Streptococcus pneumoniae

Penicillin/cephalosporin (systemic infection, pneumonia),
vancomycin (meningitis)

320

Tx:Streptococcus pyogenes

Penicillin prophylaxis

321

Tx:Temporal arteritis

High-dose steroids

322

Tx:Tonic-clonic seizures

Levetiracetam, phenytoin, valproate, carbamazepine

323

Tx:Toxoplasma gondii

Sulfadiazine + pyrimethamine

324

Tx:Treponema pallidum

Penicillin

325

Tx:Trichomonas vaginalis

Metronidazole (patient and partner)

326

Tx:Trigeminal neuralgia (tic douloureux)

Carbamazepine

327

Tx:Ulcerative colitis

5-ASA preparations (e.g., mesalamine), 6-mercaptopurine,
infliximab, colectomy

328

Tx:UTI prophylaxis

TMP-SMX

329

Tx:Warfarin reversal

Fresh frozen plasma (acute), vitamin K (chronic)

330

Actinic (solar) keratosis

Precursor to squamous cell carcinoma

331

Acute gastric ulcer associated with CNS injury

Cushing ulcer ( intracranial pressure stimulates vagal gastric
H+ secretion)

332

Acute gastric ulcer associated with severe burns

Curling ulcer (greatly reduced plasma volume results in
sloughing of gastric mucosa)

333

Alternating areas of transmural inflammation and normal
colon

Skip lesions (Crohn disease)

334

Aortic aneurysm, abdominal

Atherosclerosis

335

Aortic aneurysm, ascending or arch

3° syphilis (syphilitic aortitis), vasa vasorum destruction

336

Aortic aneurysm, thoracic

Marfan syndrome (idiopathic cystic medial degeneration)

337

Aortic dissection

Hypertension

338

Atrophy of the mammillary bodies

Wernicke encephalopathy (thiamine deficiency causing
ataxia, ophthalmoplegia, and confusion)

339

Autosplenectomy (fibrosis and shrinkage)

Sickle cell disease (hemoglobin S)

340

Bacteria associated with gastritis, peptic ulcer disease, and
stomach cancer

H. pylori

341

Bacterial meningitis (adults and elderly)

S. pneumoniae

342

Bacterial meningitis (newborns and kids)

Group B streptococcus/E.coli/Listeria (newborns),
S. pneumoniae/N. meningitidis (kids/teens)

343

Bilateral ovarian metastases from gastric carcinoma

Krukenberg tumor (mucin-secreting signet ring cells)

344

Bleeding disorder with GpIb deficiency

Bernard-Soulier syndrome (defect in platelet adhesion to von
Willebrand factor)

345

Brain tumor (adults)

Supratentorial: metastasis, astrocytoma (including
glioblastoma multiforme), meningioma, schwannoma

346

Brain tumor (kids)

Infratentorial: medulloblastoma (cerebellum) or
supratentorial: craniopharyngioma

347

Breast tumor (benign)

Fibroadenoma

348

Cardiac 1° tumor (kids)

Rhabdomyoma, often seen in tuberous sclerosis

349

Cardiac manifestation of lupus

Marantic/thrombotic endocarditis (nonbacterial) - Libmann Sachs

350

Cardiac tumor (adults)

Metastasis, myxoma (90% in left atrium; “ball and valve”)

351

Cerebellar tonsillar herniation

Chiari II malformation

352

Chronic arrhythmia

Atrial fibrillation (associated with high risk of emboli)

353

Chronic atrophic gastritis (autoimmune)

Predisposition to gastric carcinoma (can also cause pernicious
anemia)

354

Clear cell adenocarcinoma of the vagina

DES exposure in utero

355

Congenital adrenal hyperplasia, hypotension

21-hydroxylase deficiency

356

Congenital conjugated hyperbilirubinemia (black liver)

Dubin-Johnson syndrome (inability of hepatocytes to secrete
conjugated bilirubin into bile)

357

Constrictive pericarditis

TB (developing world); idiopathic, viral illness (developed
world)

358

Coronary artery involved in thrombosis

LAD > RCA > circumflex

359

Cretinism

Iodine deficit/congenital hypothyroidism

360

Cushing syndrome

ƒƒ Iatrogenic (from corticosteroid therapy)
ƒƒ Adrenocortical adenoma (secretes excess cortisol)
ƒƒ ACTH-secreting pituitary adenoma (Cushing disease)
ƒƒ Paraneoplastic (due to ACTH secretion by tumors)

361

Cyanosis (early; less common)

Tetralogy of Fallot, transposition of great vessels, truncus
arteriosus

362

Cyanosis (late; more common)

VSD, ASD, PDA

363

Death in CML

Blast crisis

364

Death in SLE

Lupus nephropathy

365

Demyelinating disease in young women

Multiple sclerosis

366

DIC

Severe sepsis, obstetric complications, cancer, burns, trauma,
major surgery

367

Diverticulum in pharynx

Zenker diverticulum (diagnosed by barium swallow)

368

Ejection click

Aortic stenosis

369

Esophageal cancer

Squamous cell carcinoma (worldwide); adenocarcinoma
(U.S.)

370

Food poisoning (exotoxin mediated)

S. aureus, B. cereus
fast, within a few hours

371

Glomerulonephritis (adults)

Berger disease (IgA nephropathy)

372

Gynecologic malignancy

Endometrial carcinoma (most common in U.S.); cervical
carcinoma (most common worldwide)

373

Heart valve in bacterial endocarditis

Mitral > aortic (rheumatic fever), tricuspid (IV drug
abuse)

374

Helminth infection (U.S.)

Enterobius vermicularis, Ascaris lumbricoides

375

Hematoma—epidural

Rupture of middle meningeal artery (trauma; lentiform
shaped)

376

Hematoma—subdural

Rupture of bridging veins (crescent shaped)

377

Hemochromatosis

Multiple blood transfusions or hereditary HFE mutation
(can result in heart failure, “bronze diabetes,” and  risk of
hepatocellular carcinoma)

378

Hepatocellular carcinoma

Cirrhotic liver (associated with hepatitis B and C and with
alcoholism)

379

Hereditary bleeding disorder most common

von Willebrand disease

380

Hereditary harmless jaundice

Gilbert syndrome (benign congenital unconjugated
hyperbilirubinemia)

381

Hypercoagulability, endothelial damage, blood stasis

Virchow triad ( risk of thrombosis)

382

Hypertension, 2°

Renal disease

383

Infection 2° to blood transfusion

Hepatitis C

384

Infections in chronic granulomatous disease

S. aureus, E. coli, Aspergillus (catalase ⊕)

385

Intellectual disability

Down syndrome, fragile X syndrome

386

Kidney stones

ƒƒ Calcium = radiopaque
ƒƒ Struvite (ammonium) = radiopaque (formed by urease
⊕ organisms such as Klebsiella, Proteus species, and
S. saprophyticus)
ƒƒ Uric acid = radiolucent

387

Malignancy associated with noninfectious fever

Hodgkin lymphoma

388

Malignancy (kids)

ALL, medulloblastoma (cerebellum)

389

Metastases to bone

Prostate, breast > lung > thyroid

390

Metastases to brain

Lung > breast > genitourinary > melanoma > GI

391

Metastases to liver

Colon >> stomach, pancreas

392

Mitochondrial inheritance

Disease occurs in both males and females, inherited through
females only

393

Mitral valve stenosis

Rheumatic heart disease

394

Mixed (UMN and LMN) motor neuron disease

Amyotrophic lateral sclerosis

395

Myocarditis

Coxsackie B

396

Nephrotic syndrome (adults)

Focal segmental glomerulosclerosis

397

Nephrotic syndrome (kids)

Minimal change disease

398

Neuron migration failure

Kallmann syndrome (hypogonadotropic hypogonadism and
anosmia)

399

Nosocomial pneumonia

S. aureus, Pseudomonas, other enteric gram-negative rods

400

Obstruction of male urinary tract

BPH

401

Opening snap

Mitral stenosis

402

Osteomyelitis

S. aureus (most common overall)
Salmonella (sickle cell)

403

Osteomyelitis with IV drug use

Pseudomonas, Candida, S. aureus

404

Ovarian tumor (benign, bilateral)

Serous cystadenoma

405

Ovarian tumor (malignant

Serous cystadenocarcinoma

406

Recurrent inflammation/thrombosis of small/medium vessels
in extremities

Buerger disease (strongly associated with tobacco)

407

SIADH

Small cell carcinoma of the lung

408

Site of diverticula

Sigmoid colon

409

Sites of atherosclerosis

Abdominal aorta > coronary artery > popliteal artery
> carotid artery

410

Stomach cancer

Adenocarcinoma

411

t(14;18)

Follicular lymphomas (BCL-2 activation, anti-apoptotic
oncogene)

412

t(8;14)

Burkitt lymphoma (c-myc fusion, transcription factor
oncogene

413

t(9;22)

Philadelphia chromosome, CML (BCR-ABL activation,
tyrosine kinase oncogene)

414

Temporal arteritis

Risk of ipsilateral blindness due to occlusion of ophthalmic
artery; polymyalgia rheumatica

415

Testicular tumor

Seminoma (malignant, radiosensitive

416

Thyroid cancer

Papillary carcinoma

417

Tumor of the adrenal medulla (adults)

Pheochromocytoma (usually benign)

418

Tumor of the adrenal medulla (kids)

Neuroblastoma (malignant)

419

Type of Hodgkin lymphoma

Nodular sclerosing (vs. mixed cellularity, lymphocytic
predominance, lymphocytic depletion)

420

UTI

E. coli, Staphylococcus saprophyticus (young women)

421

Vertebral compression fracture

Osteoporosis (type I: postmenopausal woman; type II: elderly
man or woman)

422

Viral encephalitis affecting temporal lobe

HSV-1

423

Vitamin deficiency (U.S.)

Folate (pregnant women are at high risk; body stores only 3- to
4-month supply; prevents neural tube defects)