Lessons 1 Flashcards
(250 cards)
1
Q
Gout, intellectual disability, self-mutilating behavior in a boy
A
Lesch-Nyhan syndrome (HGPRT deficiency, X-linked recessive)
2
Q
Situs inversus, chronic sinusitis, bronchiectasis, infertility
A
Kartagener syndrome (dynein arm defect affecting cilia)
3
Q
Blue sclera
A
Osteogenesis imperfecta (type I collagen defect)
4
Q
Elastic skin, hypermobility of joints,bleeding tendency
A
Ehlers-Danlos syndrome (type V collagen defect, type III collagen defect seen in vascular subtype of ED)
5
Q
Arachnodactyly, lens dislocation (upward and temporal), aortic dissection, hyperflexible joints
A
Marfan syndrome (fibrillin defect)
6
Q
Café-au-lait spots (unilateral), polyostotic fibrous dysplasia, precocious puberty, multiple endocrine abnormalities
A
McCune-Albright syndrome (Gs-protein activating mutation)
7
Q
Calf pseudohypertrophy
A
Muscular dystrophy (most commonly Duchenne, due to X-linked recessive frameshift mutation of dystrophin gene)
8
Q
Child uses arms to stand up from squat
A
Duchenne muscular dystrophy (Gowers sign)
9
Q
Slow, progressive muscle weakness in boys
A
Becker muscular dystrophy (X-linked non-frameshift deletions in dystrophin; less severe than Duchenne)
10
Q
Infant with cleft lip/palate, microcephaly or holoprosencephaly, polydactyly, cutis aplasia
A
Patau syndrome (trisomy 13)
11
Q
Infant with microcephaly, rocker-bottom feet, clenched hands, and structural heart defect
A
Edwards syndrome (trisomy 18)
12
Q
Single palmar crease
A
Down syndrome
13
Q
Dilated cardiomyopathy, edema, alcoholism or malnutrition
A
Wet beriberi (thiamine [vitamin B1] deficiency)
14
Q
Dermatitis, dementia, diarrhea
A
Pellagra (niacin [vitamin B3] deficiency)
15
Q
Swollen gums, mucosal bleeding, poor wound healing, petechiae
A
Scurvy (vitamin C deficiency: can’t hydroxylate proline/ lysine for collagen synthesis)
16
Q
Chronic exercise intolerance with myalgia, fatigue, painful cramps, myoglobinuria
A
McArdle disease (skeletal muscle glycogen phosphorylase deficiency)
17
Q
Infant with hypoglycemia, hepatomegaly
A
Cori disease (debranching enzyme deficiency) or Von Gierke disease (glucose-6-phosphatase deficiency, more severe)
18
Q
Myopathy (infantile hypertrophic cardiomyopathy), exercise intolerance
A
Pompe disease (lysosomal α-1,4-glucosidase deficiency)
19
Q
Cherry-red spots” on macula
A
Tay-Sachs (ganglioside accumulation) or Niemann-Pick (sphingomyelin accumulation), central retinal artery occlusion
20
Q
Hepatosplenomegaly, pancytopenia, osteoporosis, avascular necrosis of femoral head, bone crises
A
Gaucher disease (glucocerebrosidase [β-glucosidase] deficiency)
21
Q
Achilles tendon xanthoma
A
Familial hypercholesterolemia (LDL receptor signaling
22
Q
Anaphylaxis following blood transfusion
A
IgA deficiency
23
Q
Male child, recurrent infections, no mature B cells
A
Bruton disease (X-linked agammaglobulinemia)
24
Q
Recurrent cold (noninflamed) abscesses, eczema, high
A
Hyper-IgE syndrome (Job syndrome: neutrophil serum IgE,eosinophils chemotaxis abnormality)
25
Strawberry tongue”
Scarlet fever Kawasaki disease
26
Abdominal pain, diarrhea, leukocytosis, recent antibiotic
Clostridium difficile infection
27
Back pain, fever, night sweats
Pott disease (vertebral TB)
28
Adrenal hemorrhage, hypotension, DIC
Waterhouse-Friderichsen syndrome (meningococcemia)
29
Red “currant jelly” sputum in alcoholic or diabetic
Klebsiella pneumoniae pneumonia
30
Large rash with bull’s-eye appearance
Erythema migrans from Ixodes tick bite (Lyme disease: Borrelia)
31
Ulcerated genital lesion
Nonpainful, indurated: chancre (1° syphilis, Treponema , pallidum)
Painful, with exudate: chancroid (Haemophilus ducreyi)
32
Pupil accommodates but doesn’t react
Neurosyphilis (Argyll Robertson pupil)
33
Smooth, moist, painless, wart-like white lesions on
Condylomata lata (2° syphilis) genitals
34
Fever, chills, headache, myalgia following antibiotic
Jarisch-Herxheimer reaction (rapid lysis of spirochetes treatment for syphilis results in endotoxin-like release)
35
Dog or cat bite resulting in infection
Pasteurella multocida (cellulitis at inoculation site)
36
Rash on palms and soles
Coxsackie A, 2° syphilis, Rocky Mountain spotted fever
37
Black eschar on face of patient with diabetic ketoacidosis
Mucor or Rhizopus fungal infection
38
Chorioretinitis, hydrocephalus, intracranial calcifications
Congenital toxoplasmosis
39
Child with fever later develops red rash on face that
Erythema infectiosum/fifth disease (“slapped cheeks” spreads to body appearance, caused by parvovirus B19)
40
Fever, cough, conjunctivitis, coryza, diffuse rash
Measles
41
Small, irregular red spots on buccal/lingual mucosa with
Koplik spots (measles [rubeola] virus) blue-white centers
42
Bounding pulses, wide pulse pressure, diastolic heart murmur, head bobbing
Aortic regurgitation
43
Systolic ejection murmur (crescendo-decrescendo)
Aortic stenosis
44
Continuous “machine-like” heart murmur
PDA (close with indomethacin; keep open with PGE analogs)
45
Chest pain on exertion
Angina (stable: with moderate exertion; unstable: with minimal exertion or at rest)
46
Chest pain with ST depressions on ECG
Angina (⊝ troponins) or NSTEMI (⊕ troponins)
47
Chest pain, pericardial effusion/friction rub, persistent fever following MI
Dressler syndrome (autoimmune-mediated post-MI fibrinous pericarditis, 2 weeks to several months after
acute episode)
48
Painful, raised red lesions on pads of fingers/toes
Osler nodes (infective endocarditis, immune complex deposition)
49
Painless erythematous lesions on palms and soles
Janeway lesions (infective endocarditis, septic emboli/ microabscesses)
50
Splinter hemorrhages in fingernails
Bacterial endocarditis
51
Retinal hemorrhages with pale centers
Roth spots (bacterial endocarditis)
52
Distant heart sounds, distended neck veins, hypotension
Beck triad of cardiac tamponade
53
Cervical lymphadenopathy, desquamating rash, coronary aneurysms, red conjunctivae and tongue, hand-foot
changes
Kawasaki disease (mucocutaneous lymph node syndrome, treat with IVIG and aspirin)
54
Palpable purpura on buttocks/legs, joint pain, abdominal
Immunoglobulin A vasculitis (Henoch-Schönlein pain (child), hematuria purpura, affects skin and kidneys)
55
Telangiectasias, recurrent epistaxis, skin discoloration, Weber- arteriovenous malformations, GI bleeding, hematuria
Hereditary hemorrhagic telangiectasia (Osler-Rendu syndrome)
56
Skin hyperpigmentation, hypotension, fatigue 1°
adrenocortical insufficiencyACTH,α-MSH (eg, Addison disease
57
Cutaneous flushing, diarrhea, bronchospasm
Carcinoid syndrome (right-sided cardiac valvular lesions, 5-HIAA)
58
Cold intolerance, weight gain, brittle hair
Hypothyroidism
59
Cutaneous/dermal edema due to deposition of mucopolysaccharides in connective tissue [pretibial])
Myxedema (caused by hypothyroidism, Graves disease
60
Facial muscle spasm upon tapping
Chvostek sign (hypocalcemia)
61
No lactation postpartum, absent menstruation, cold intolerance
Sheehan syndrome (postpartum hemorrhage leading to pituitary infarction)
62
Deep, labored breathing/hyperventilation
Diabetic ketoacidosis (Kussmaul respirations)
63
Pancreatic, pituitary, parathyroid tumors
MEN 1 (autosomal dominant)
64
Thyroid tumors, pheochromocytoma, ganglioneuromatosis, Marfanoid habitus
MEN 2B (autosomal dominant RET mutation)
65
Thyroid and parathyroid tumors, pheochromocytoma
MEN 2A (autosomal dominant RET mutation)
66
Jaundice, palpable distended non-tender gallbladder
Courvoisier sign (distal malignant obstruction of biliary tree)
67
Vomiting blood following gastroesophageal lacerations
Mallory-Weiss syndrome (alcoholic and bulimic patients)
68
Dysphagia (esophageal webs), glossitis, iron deficiency anemia
Plummer-Vinson syndrome (may progress to esophageal squamous cell carcinoma)
69
Enlarged, hard left supraclavicular node
Virchow node (abdominal metastasis)
70
Arthralgias, adenopathy, cardiac and neurological symptoms, diarrhea
Whipple disease (Tropheryma whipplei)
71
Severe RLQ pain with palpation of LLQ
Rovsing sign (acute appendicitis)
72
Severe RLQ pain with deep tenderness
McBurney sign (acute appendicitis)
73
Hamartomatous GI polyps, hyperpigmented macules on(inherited, benign polyposis mouth, feet, hands, genitalia
Peutz-Jeghers syndrome can cause bowel obstruction;cancer risk, mainly GI)
74
Multiple colon polyps, osteomas/soft tissue tumors, impacted/supernumerary teeth
Gardner syndrome (subtype of FAP)
75
Abdominal pain, ascites, hepatomegaly
Budd-Chiari syndrome (posthepatic venous thrombosis)
76
Severe jaundice in neonate
Crigler-Najjar syndrome (congenital unconjugated hyperbilirubinemia)
77
Golden brown rings around peripheral cornea
Wilson disease (Kayser-Fleischer rings due to copper accumulation)
78
Fat, female, forty, fertile
Cholelithiasis (gallstones)
79
Painless jaundice
Cancer of the pancreatic head obstructing bile duct
80
Bluish line on gingiva
Burton line (lead poisoning)
81
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)
82
Red/pink urine, fragile RBCs
Paroxysmal nocturnal hemoglobinuria
83
Painful blue fingers/toes, hemolytic anemia
Cold agglutinin disease (autoimmune hemolytic anemia caused by Mycoplasma pneumoniae, infectious
mononucleosis, CLL)
84
Petechiae, mucosal bleeding, prolonged bleeding time
Platelet disorders (eg, Glanzmann thrombasthenia, Bernard Soulier, HUS, TTP, ITP)
85
Fever, night sweats, weight loss
B symptoms of malignancy
86
Skin patches/plaques, Pautrier microabscesses, atypical T cells
Mycosis fungoides (cutaneous T-cell lymphoma) or Sézary syndrome (mycosis fungoides + malignant
T cells in blood)
87
WBCs that look “smudged”
CLL
88
Neonate with arm paralysis following difficult birth, arm in “waiter’s tip” position
Erb-Duchenne palsy (superior trunk [C5–C6] brachial plexus injury)
89
Anterior drawer sign ⊕
Anterior cruciate ligament injury
90
Bone pain, bone enlargement, arthritis
Osteitis deformans (Paget disease of bone,osteoblastic and osteoclastic activity)
91
Swollen, hard, painful finger joints in an elderly individual, pain worse with activity
Osteoarthritis (osteophytes on PIP [Bouchard nodes], DIP Heberden nodes])
92
Sudden swollen/painful big toe joint
Gout/podagra (hyperuricemia)
93
Dry eyes, dry mouth, arthritis
Sjögren syndrome (autoimmune destruction of exocrine glands)
94
Urethritis, conjunctivitis, arthritis in a male
Reactive arthritis associated with HLA-B27
95
Butterfly” facial rash and Raynaud phenomenon in a young female
Systemic lupus erythematosus
96
Painful fingers/toes changing color from white to blue to) red with cold or stress
Raynaud phenomenon (vasospasm in extremities
97
Anticentromere antibodies
Scleroderma (CREST)
98
Dark purple skin/mouth nodules in a patient with AIDS
Kaposi sarcoma, associated with HHV-8
99
Anti-desmoglein (anti-desmosome) antibodies
Pemphigus vulgaris (blistering)
100
Pruritic, purple, polygonal planar papules and plaques (6 P’s)
Lichen planus
101
elevated AFP in amniotic fluid/maternal serum
Dating error, anencephaly, spina bifida (open neural tube defects)
102
Ataxia, nystagmus, vertigo, dysarthria
Cerebellar lesion
103
Toe extension/fanning upon plantar scrape
Babinski sign (UMN lesion)
104
Hyperphagia, hypersexuality, hyperorality
Klüver-Bucy syndrome (bilateral amygdala lesion)
105
Resting tremor, athetosis, chorea
Basal ganglia lesion
106
Lucid interval after traumatic brain injury
Epidural hematoma (middle meningeal artery rupture)
107
Worst headache of my life”
Subarachnoid hemorrhage
108
Resting tremor, rigidity, akinesia, postural instability,(shuffling gait
Parkinson disease loss of dopaminergic neurons in substantia nigra pars compacta)
109
Chorea, dementia, caudate degeneration
Huntington disease (autosomal dominant CAG repeat expansion)
110
Nystagmus, intention tremor, scanning speech, bilateral internuclear ophthalmoplegia
Multiple sclerosis
111
Rapidly progressive limb weakness that ascends following GI/upper respiratory infection
Guillain-Barré syndrome (acute inflammatory demyelinating polyradiculopathy subtype)
112
Café-au-lait spots, Lisch nodules (iris hamartoma), cutaneous neurofibromas, pheochromocytomas, optic
gliomas
Neurofibromatosis type I
113
Vascular birthmark (port-wine stain) of the face
Nevus flammeus (benign, but associated with Sturge- Weber syndrome)
114
Renal cell carcinoma (bilateral), hemangioblastomas, angiomatosis, pheochromocytoma
von Hippel-Lindau disease (dominant tumor suppressor gene mutation)
115
Bilateral vestibular schwannomas
Neurofibromatosis type 2
116
Hyperreflexia, hypertonia, Babinski sign present
UMN damage
117
Hyporeflexia, hypotonia, atrophy, fasciculations
LMN damage
118
Spastic weakness, sensory loss, bowel/bladder dysfunction
Spinal cord lesion
119
Unilateral facial drooping involving forehead
LMN facial nerve (CN VII) palsy; UMN lesions spare the forehead
120
Episodic vertigo, tinnitus, hearing loss
Ménière disease
121
Ptosis, miosis, anhidrosis
Horner syndrome (sympathetic chain lesion)
122
Conjugate horizontal gaze palsy, horizontal diplopia
Internuclear ophthalmoplegia (damage to MLF; may be unilateral or bilateral)
123
Polyuria, renal tubular acidosis type II, growth failure, electrolyte imbalances, hypophosphatemic rickets
Fanconi syndrome (multiple combined dysfunction of the proximal convoluted tubule)l
124
Athlete with polycythemia
2° to erythropoietin injection
125
Periorbital and/or peripheral edema, proteinuria (> 3.5g/ day), hypoalbuminemia, hypercholesterolemia
Nephrotic syndrome
126
Hereditary nephritis, sensorineural hearing loss, retinopathy, lens dislocation
Alport syndrome (mutation in collagen IV)
127
Streak ovaries, congenital heart disease, horseshoe kidney, cystic hygroma at birth, short stature, webbed neck,
lymphedema
Turner syndrome (45,XO)
128
Red, itchy, swollen rash of nipple/areola sign of underlying neoplasm)
Paget disease of the breast
129
Fibrous plaques in tunica albuginea of penis with abnormal curvature
Peyronie disease (connective tissue disorder)
130
Hypoxemia, polycythemia, hypercapnia
Chronic bronchitis (hyperplasia of mucous cells, “blue bloater”)
131
Pink complexion, dyspnea, hyperventilation
Emphysema (“pink puffer,” centriacinar [smoking] or panacinar [α1-antitrypsin deficiency])
132
Bilateral hilar adenopathy, uveitis
Sarcoidosis (noncaseating granulomas)
133
Low AFP in amniotic fluid/maternal serum
Down syndrome, Edwards syndrome
134
Large granules in phagocytes, immunodeficiency
Chédiak-Higashi disease (congenital failure of phagolysosome formation)
135
Recurrent infections, eczema, thrombocytopenia
Wiskott-Aldrich syndrome
136
Optochin sensitivity
Sensitive: S pneumoniae; resistant: viridans streptococci (S mutans, S sanguis)
137
Novobiocin response
Sensitive: S epidermidis; resistant: S saprophyticus
138
Bacitracin response
Sensitive: S pyogenes (group A); resistant: S agalactiae (group B)
139
Streptococcus bovis bacteremia
Colon cancer
140
Branching gram ⊕ rods with sulfur granules
Actinomyces israelii
141
Hilar lymphadenopathy, peripheral granulomatous lesion in middle or lower lung lobes (can calcify)
Ghon complex (1° TB: Mycobacterium bacilli)
142
Thumb sign” on lateral neck x-ray
Epiglottitis (Haemophilus influenzae)
143
Bacteria-covered vaginal epithelial cells
“
Clue cells” (Gardnerella vaginalis)
144
Cardiomegaly with apical atrophy
Chagas disease (Trypanosoma cruzi)
145
Atypical lymphocytes
EBV
146
Enlarged cells with intranuclear inclusion bodies
“Owl eye” appearance of CMV
147
Heterophile antibodies
Infectious mononucleosis (EBV
148
Intranuclear eosinophilic droplet-like bodies
Cowdry type A bodies (HSV or VZV)
149
Eosinophilic globule in liver
Councilman body (viral hepatitis, yellow fever), represents hepatocyte undergoing apoptosis
150
Steeple” sign on frontal CXR
Croup (parainfluenza virus)
151
Eosinophilic inclusion bodies in cytoplasm of hippocampal and cerebellar neurons
Negri bodies of rabies
152
Ring-enhancing brain lesion on CT/MRI in AIDS
Toxoplasma gondii, CNS lymphoma
153
Psammoma bodies
Meningiomas, papillary thyroid carcinoma, mesothelioma, papillary serous carcinoma of the endometrium and ovary
154
Delta wave” on ECG, short PR interval, supraventricular tachycardia
Wolff-Parkinson-White syndrome (Bundle of Kent bypasses AV node)
155
Boot-shaped” heart on x-ray
Tetralogy of Fallot (due to RVH)
156
Rib notching (inferior surface, on x-ray)
Coarctation of the aorta
157
Heart nodules (granulomatous)
Aschoff bodies (rheumatic fever)
158
Electrical alternans (alternating amplitude on ECG)
Cardiac tamponade
159
Antineutrophil cytoplasmic antibodies (ANCAs)
Microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis (MPO-ANCA/p-ANCA);
granulomatosis with polyangiitis (Wegener; PR3- ANCA/c-ANCA); primary sclerosing cholangitis (MPO- ANCA/p-ANCA)
160
Hypertension, hypokalemia, metabolic alkalosis
1° hyperaldosteronism (Conn syndrome)
161
Enlarged thyroid cells with ground-glass nuclei with “central clearing
Orphan Annie” eyes nuclei (papillary carcinoma of the thyroid)
162
Mucin-filled cell with peripheral nucleus “
Signet ring” (gastric carcinoma)
163
Anti-transglutaminase/anti-gliadin/anti-endomysial antibodies
Celiac disease (diarrhea, weight loss) 381
164
Narrowing of bowel lumen on barium x-ray “
String sign” (Crohn disease)
165
Lead pipe” appearance of colon on abdominal imaging
Ulcerative colitis (loss of haustra)
166
Thousands of polyps on colonoscopy
Familial adenomatous polyposis (autosomal dominant, mutation of APC gene)
167
Apple core” lesion on barium enema x-ray
Colorectal cancer (usually left-sided)
168
Eosinophilic cytoplasmic inclusion in liver cell
Mallory body (alcoholic liver disease)
169
Triglyceride accumulation in liver cell vacuoles
Fatty liver disease (alcoholic or metabolic syndrome)
170
Nutmeg” appearance of liver
Chronic passive congestion of liver due to right heart failure or Budd-Chiari syndrome
171
Antimitochondrial antibodies (AMAs)
1° biliary cholangitis (female, cholestasis, portal hypertension)
172
Low serum ceruloplasmin
Wilson disease (hepatolenticular degeneration; Kayser- Fleischer rings due to copper accumulation)
173
Migratory thrombophlebitis (leading to migrating DVTs and vasculitis)
Trousseau syndrome (adenocarcinoma of pancreas or lung)
174
Basophilic nuclear remnants in RBCs
Howell-Jolly bodies (due to splenectomy or nonfunctional spleen)
175
Basophilic stippling of RBCs
Lead poisoning or sideroblastic anemia
176
Hypochromic, microcytic anemia
Iron deficiency anemia, lead poisoning, thalassemia (fetal ,hemoglobin sometimes present)
177
Hair on end” (“Crew-cut”) appearance on x-ray
β-thalassemia, sickle cell disease (marrow expansion)
178
Hypersegmented neutrophils
Megaloblastic anemia (B12 deficiency: neurologic symptoms; folate deficiency: no neurologic symptoms)
179
Antiplatelet antibodies
Idiopathic thrombocytopenic purpura
180
High level of d-dimers
DVT, PE, DIC 428
181
Giant B cells with bilobed nuclei with prominent) inclusions (“owl’s eye”)
Reed-Sternberg cells (Hodgkin lymphoma
182
Sheets of medium-sized lymphoid cells with scattered tingible body–laden macrophages histology)
Burkitt lymphoma (t[8:14] c-myc activation, associated pale,(“starry sky” with EBV; “starry sky” made up of malignant cells)
183
Lytic (“punched-out”) bone lesions on x-ray
Multiple myeloma
184
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
185
Stacks of RBCs
Rouleaux formation (high ESR, multiple myeloma)
186
Azurophilic peroxidase ⊕ granular inclusions in (granulocytes and myeloblasts
Auer rods AML, especially the promyelocytic [M3] type)
187
WBCs that look “smudged”
CLL (almost always B cell)
188
Tennis racket”-shaped cytoplasmic organelles (EM) in Langerhans cells
Birbeck granules (Langerhans cell histiocytosis)
189
Brown” tumor of bone
Hyperparathyroidism or osteitis fibrosa cystica (deposited hemosiderin from hemorrhage gives brown color)
190
Soap bubble” in femur or tibia on x-ray
Giant cell tumor of bone (generally benign)
191
Raised periosteum (creating a “Codman triangle”)
Aggressive bone lesion (eg, osteosarcoma, Ewing sarcoma, osteomyelitis)
192
Onion skin” periosteal reaction
Ewing sarcoma (malignant small blue cell tumor)
193
Anti-IgG antibodies
Rheumatoid arthritis (systemic inflammation, joint pannus, boutonniere and swan neck deformities)
194
Rhomboid crystals, ⊕ birefringent
Pseudogout (calcium pyrophosphate dihydrate crystals)
195
Needle-shaped, ⊝ birefringent crystals
Gout (monosodium urate crystals)
196
High uric acid levels
Gout, Lesch-Nyhan syndrome, tumor lysis syndrome, loop and thiazide diuretic
197
Bamboo spine” on x-ray
Ankylosing spondylitis (chronic inflammatory arthritis: HLA-B27)
198
Antinuclear antibodies (ANAs: anti-Smith and anti-) dsDNA)
SLE (type III hypersensitivity
199
Anti-histone antibodies
Drug-induced SLE (eg, hydralazine, isoniazid, phenytoin, procainamide)
200
Anti-topoisomerase antibodies
Diffuse scleroderma
201
Keratin pearls on a skin biopsy
Squamous cell carcinoma
202
Bloody or yellow tap on lumbar puncture)
Xanthochromia (due to subarachnoid hemorrhage
203
Eosinophilic cytoplasmic inclusion in neuron
Lewy body (Parkinson disease and Lewy body dementia)
204
Extracellular amyloid deposition in gray matter of brain
Senile plaques (Alzheimer disease)
205
Depigmentation of neurons in substantia nigra
Parkinson disease (basal ganglia disorder: rigidity, resting tremor, bradykinesia)
206
Protein aggregates in neurons from hyperphosphorylation tau protein
Neurofibrillary tangles (Alzheimer disease) and Pick of bodies (Pick disease)
207
Silver-staining spherical aggregation of tau proteins in neurons bodies
Pick bodies Pick disease: progressive dementia, changes in personality)
208
Pseudopalisading tumor cells on brain biopsy
Glioblastoma multiforme
209
Circular grouping of dark tumor cells surrounding pale neurofibrils
Homer-Wright rosettes (neuroblastoma, medulloblastoma)
210
Waxy” casts with very low urine flow
Chronic end-stage renal disease
211
Nodular hyaline deposits in glomeruli
Kimmelstiel-Wilson nodules (diabetic nephropathy)
212
Podocyte fusion or “effacement” on electron microscopy
Minimal change disease (child with nephrotic syndrome)
213
Spikes” on basement membrane, “dome-like” subepithelial deposits
Membranous nephropathy (nephrotic syndrome)
214
RBC casts in urine
Glomerulonephritis
215
Tram-track” appearance of capillary loops of glomerular basement membranes on light microscopy
Membranoproliferative glomerulonephritis
216
Anti–glomerular basement membrane antibodies
Goodpasture syndrome (glomerulonephritis and hemoptysis)
217
Cellular crescents in Bowman capsule
Rapidly progressive (crescentic) glomerulonephritis
218
Wire loop” glomerular capillary appearance on light microscopy
Diffuse proliferative glomerulonephritis usually seen with lupus
219
Linear appearance of IgG deposition on glomerular and alveolar basement membranes
Goodpasture syndrome
220
Lumpy bumpy” appearance of glomeruli on immunofluorescence
Poststreptococcal glomerulonephritis (due to deposition of IgG, IgM, and C3)
221
Necrotizing vasculitis (lungs) and necrotizing glomerulonephritis
Granulomatosis with polyangiitis (Wegener; PR3-ANCA/ c-ANCA) and Goodpasture syndrome (anti–basement
membrane antibodies)l
222
Thyroid-like appearance of kidney
Chronic pyelonephritis (usually due to recurrent infections)
223
WBC casts in urine
Acute pyelonephritis
224
Renal epithelial casts in urine
Intrinsic renal failure (eg, ischemia or toxic injury)
225
hCG elevated
Choriocarcinoma, hydatidiform mole (occurs with and without embryo, and multiple pregnancy)
226
Dysplastic squamous cervical cells with “raisinoid” nuclei and hyperchromasia
Koilocytes (HPV: predisposes to cervical cancer)
227
Disarrayed granulosa cells arranged around collections of eosinophilic fluid
Call-Exner bodies (granulosa cell tumor of the ovary)
228
Chocolate cyst” of ovary
Endometriosis (frequently involves both ovaries)
229
Mammary gland (“blue domed”) cyst
Fibrocystic change of the breast
230
Glomerulus-like structure surrounding vessel in germ cells
Schiller-Duval bodies (yolk sac tumor)
231
Rectangular, crystal-like, cytoplasmic inclusions in) cells
Leydig Reinke crystals (Leydig cell tumor
232
Thrombi made of white/red layers
Lines of Zahn (arterial thrombus, layers of platelets/ RBCs)
233
Hexagonal, double-pointed, needle-like crystals in bronchial secretions
Bronchial asthma (Charcot-Leyden crystals: eosinophilic granules)
234
Desquamated epithelium casts in sputum
Curschmann spirals (bronchial asthma; can result in whorled mucous plugs)
235
“Honeycomb lung” on x-ray or CT
Idiopathic pulmonary fibrosis
236
Colonies of mucoid Pseudomonas in lungs
Cystic fibrosis (autosomal recessive mutation in CFTR genefat-soluble vitamin deficiency and mucous plugs)
237
Iron-containing nodules in alveolar septum
Ferruginous bodies (asbestosis:chance of lung cancer increased)
238
Bronchogenic apical lung tumor on imaging
Pancoast tumor (can compress cervical sympathetic chain and cause Horner syndrome)
239
Ethylene glycol/methanol intoxication
Fomepizole (alcohol dehydrogenase inhibitor)
240
Chronic hepatitis B or C
IFN-α (HBV and HCV); ribavirin, simeprevir, sofosbuvir (HCV)
241
Streptococcus bovis
Penicillin prophylaxis; evaluation for colon cancer if linked to endocarditis
242
Clostridium botulinum
Antitoxin
243
Clostridium tetani
Antitoxin
244
Haemophilus influenzae (B)
Amoxicillin ± clavulanate (mucosal infections), ceftriaxone (meningitis), rifampin (prophylaxis)
245
Neisseria gonorrhoeae
Ceftriaxone (add doxycycline to cover likely concurrent C trachomatis)
246
Neisseria meningitidis
Penicillin/ceftriaxone, rifampin (prophylaxis)
247
Legionella pneumophila
Macrolides (eg, azithromycin)
248
Pseudomonas aeruginosa
Piperacillin/tazobactam, aminoglycosides, carbapenems
249
Treponema pallidum
Penicillin G
250
Chlamydia trachomatis
Doxycycline (+ ceftriaxone for gonorrhea coinfection), oral erythromycin to treat chlamydial conjunctivitis in infants
