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