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USMLE Flashcards > Classic Presentations > Flashcards

Classic Presentations Flashcards

1
Q

Abdominal pain, diarrhea, leukocytosis, recent antibiotic use

A

Clostridium difficile infection

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2
Q

Achilles tendon xanthoma

A

Familial hypercholesterolemia

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3
Q

Adrenal hemorrhage, hypotension, DIC

A

Waterhouse-Friderichsen syndrome (meningococcemia)

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4
Q

Abdominal pain, ascites, hepatomegaly

A

Budd-Chiari syndrome (posthepatic venous thrombosis)

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5
Q

Anaphylaxis following blood transfusion

A

IgA deficiency

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6
Q

Anterior “drawer sign” ⊕

A

Anterior cruciate ligament injury

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7
Q

Arachnodactyly, lens dislocation, aortic dissection, hyperflexible joints

A

Marfan syndrome (fibrillin defect)

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8
Q

Athlete with polycythemia

A

2° to erythropoietin injection

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9
Q

Back pain, fever, night sweats

A

Pott disease (vertebral TB)

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10
Q

Bilateral acoustic schwannomas

A

Neurofibromatosis type 2

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11
Q

Bilateral hilar adenopathy, uveitis

A

Sarcoidosis (noncaseating granulomas)

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12
Q

Black eschar on face of patient with diabetic ketoacidosis

A

Mucor or Rhizopus fungal infection

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13
Q

Blue sclera

A

Osteogenesis imperfecta (type I collagen defect)

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14
Q

Bluish line on gingiva

A

Burton line (lead poisoning)

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15
Q

Bone pain, bone enlargement, arthritis

A

Paget disease of bone (􏰁osteoblastic and osteoclastic activity)

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16
Q

Bounding pulses, diastolic heart murmur, head bobbing

A

Aortic regurgitation

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17
Q

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

A

Systemic lupus erythematosus

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18
Q

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

A

Neurofibromatosis type I, pheochromocytoma, optic gliomas

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19
Q

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

A

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

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20
Q

Calf pseudohypertrophy

A

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

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21
Q

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

A

Kawasaki disease (treat with IVIG and aspirin)

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22
Q

“Cherry-red spots” on macula

A

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

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23
Q

Chest pain on exertion

A

Angina (stable: with moderate exertion; unstable: with minimal exertion or at rest)

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24
Q

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

A

Dressler syndrome (autoimmune-mediated post-MI fibrinous pericarditis, 2-12 weeks after acute episode)

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25
Q

Chest pain with ST depressions on EKG

A

Unstable angina (troponins −) or NSTEMI (troponins +)

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26
Q

Child uses arms to stand up from squat

A

Gowers sign (Duchenne muscular dystrophy)

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27
Q

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

A

“Slapped cheeks” (erythema infectiosum/fifth disease: parvovirus B19)

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28
Q

Chorea, dementia, caudate degeneration

A

Huntington disease (autosomal dominant CAG repeat expansion)

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29
Q

Chorioretinitis, hydrocephalus, intracranial calcifications

A

Congenital toxoplasmosis

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30
Q

Chronic exercise intolerance with myalgia, fatigue, painful cramps, myoglobinuria

A

McArdle disease (skeletal muscle glycogen phosphorylase deficiency)

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31
Q

Cold intolerance

A

Hypothyroidism

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32
Q

Conjugate horizontal gaze palsy, horizontal diplopia

A

Internuclear ophthalmoplegia (damage to MLF; may be unilateral or bilateral)

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33
Q

Continuous “machine-like” heart murmur

A

PDA (close with indomethacin; open or maintain with PGE analogs)

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34
Q

Cutaneous/dermal edema due to connective tissue deposition

A

Myxedema (caused by hypothyroidism, Graves disease [pretibial])

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35
Q

Cutaneous flushing, diarrhea, bronchospasm

A

Carcinoid syndrome (right-sided cardiac valvular lesions, 􏰁5-HIAA)

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36
Q

Dark purple skin/mouth nodules in a patient with AIDS

A

Kaposi sarcoma, associated with HHV-8

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37
Q

Deep, labored breathing/hyperventilation

A

Kussmaul respirations (diabetic ketoacidosis)

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38
Q

Dermatitis, dementia, diarrhea

A

Pellagra (niacin [vitamin B3] deficiency)

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39
Q

Dilated cardiomyopathy, edema, alcoholism or malnutrition

A

Wet beriberi (thiamine [vitamin B1] deficiency)

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40
Q

Dog or cat bite resulting in infection

A

Pasteurella multocida (cellulitis at inoculation site)

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41
Q

Dry eyes, dry mouth, arthritis

A

Sjögren syndrome (autoimmune destruction of exocrine glands)

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42
Q

Dysphagia (esophageal webs), glossitis, iron deficiency anemia

A

Plummer-Vinson syndrome (may progress to esophageal squamous cell carcinoma)

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43
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)

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44
Q

Enlarged, hard left supraclavicular node

A

Virchow node (abdominal metastasis)

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45
Q

Episodic vertigo, tinnitus, hearing loss

A

Meniere disease

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46
Q

Erythroderma, lymphadenopathy, hepatosplenomegaly, atypical T cells

A

Mycosis fungoides (cutaneous T-cell lymphoma) or Sézary syndrome (mycosis fungicides + malignant T cells in blood)

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47
Q

Facial muscle spasm upon tapping

A

Chvostek sign (hypocalcemia)

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48
Q

Fat, female, forty, and fertile

A

Cholelithiasis (gallstones)

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49
Q

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

A

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

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50
Q

Fever, cough, conjunctivitis, coryza, diffuse rash

A

Measles

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51
Q

Fever, night sweats, weight loss

A

B symptoms (staging) of lymphoma

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52
Q

Fibrous plaques in soft tissue of penis with abnormal curvature

A

Peyronie disease (connective tissue disorder)

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53
Q

Golden brown rings around peripheral cornea

A

Kayser-Fleischer rings (copper accumulation from Wilson disease)

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54
Q

Gout, intellectual disability, self-mutilating behavior in a boy

A

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

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55
Q

Hamartomatous GI polyps, hyper pigmentation of mouth/feet/hands/genitalia

A

Peutz-Jeghers syndrome (inherited, benign polyposis can cause bowel obstruction;􏰁cancer risk, mainly GI)

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56
Q

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

A

Gaucher disease (glucocerebrosidase deficiency)

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57
Q

Hereditary nephritis, sensorineural hearing loss, cataracts

A

Alport syndrome (mutation in collagen IV)

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58
Q

Hyperphagia, hypersexuality, hyperorality, hyperdocility

A

Klüver-Bucy syndrome (bilateral amygdala lesion)

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59
Q

Hyperreflexia, hypertonia, Babinski sign present

A

UMN damage

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60
Q

Hyporeflexia, hypotonia, atrophy, fasciculations

A

LMN damage

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61
Q

Hypoxemia, polycythemia, hypercapnia

A

“Blue bloater” (chronic bronchitis: hyperplasia of mucous cells)

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62
Q

Indurated, ulcerated genital lesion

A

Nonpainful: chancre (1° syphilis, Treponema pallidum) Painful, with exudate: chancroid (Haemophilus ducreyi)

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63
Q

Infant with “cherry-red” spot on macula, hepatosplenomegaly, and neurodegeneration

A

Niemann-Pick disease (genetic sphingomyelinase deficiency)

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64
Q

Infant with cleft lip/palate, microcephaly or holoprosencephaly, polydactyly, cutis aplasia

A

Patau syndrome (trisomy 13)

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65
Q

Infant with hypoglycemia, hepatomegaly

A

Cori disease (debranching enzyme deficiency) or Von Gierke disease (glucose-6-phosphatase deficiency, more severe)

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66
Q

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

A

Edwards syndrome (trisomy 18)

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67
Q

Jaundice, palpable distended non-tender gallbladder

A

Courvoisier sign (distal obstruction of biliary tree)

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68
Q

Large rash with bull’s-eye appearance

A

Erythema chronicum migrans from Ixodes tick bite (Lyme disease: Borrelia)

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69
Q

Lucid interval after traumatic brain injury

A

Epidural hematoma (middle meningeal artery rupture)

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70
Q

Male child, recurrent infections, no mature B cells

A

Bruton disease (X-linked agammaglobulinemia)

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71
Q

Mucosal bleeding and prolonged bleeding time

A

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

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72
Q

Muffled heart sounds, distended neck veins, hypotension

A

Beck triad of cardiac tamponade

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73
Q

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

A

Gardner syndrome (subtype of FAP)

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74
Q

Myopathy (infantile hypertrophic cardiomyopathy), exercise intolerance

A

Pompe disease (lysosomal α-1,4-glucosidase deficiency)

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75
Q

Neonate with arm paralysis following difficult birth

A

Erb-Duchenne palsy (superior trunk [C5–C6] brachial plexus injury: “waiter’s tip”)

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76
Q

No lactation postpartum, absent menstruation, cold intolerance

A

Sheehan syndrome (pituitary infarction)

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77
Q

Nystagmus, intention tremor, scanning speech, bilateral internuclear ophthalmoplegia

A

Multiple sclerosis

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78
Q

Painful blue fingers/toes, hemolytic anemia

A

Cold agglutinin disease (autoimmune hemolytic anemia caused by Mycoplasma pneumoniae, infectious mononucleosis, CLL)

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79
Q

Painful fingers/toes changing color from blue to white to red with cold or stress

A

Raynaud phenomenon (vasospasm in extremities)

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80
Q

Painful, raised red lesions on pads of fingers/toes

A

Osler nodes (infective endocarditis, immune complex deposition)

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81
Q

Painless erythematous lesions on palms and soles

A

Janeway lesions (infective endocarditis, septic emboli/ microabscesses)

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82
Q

Painless jaundice

A

Cancer of the pancreatic head obstructing bile duct

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83
Q

Palpable purpura on buttocks/legs, joint pain, abdominal pain (child), hematuria

A

Henoch-Schönlein purpura (IgA vasculitis affecting skin and kidneys)

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84
Q

Pancreatic, pituitary, parathyroid tumors

A

MEN 1 (autosomal dominant)

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85
Q

Periorbital and/or peripheral edema, proteinuria, hypoalbuminemia, hypercholesterolemia

A

Nephrotic syndrome

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86
Q

Pink complexion, dyspnea, hyperventilation

A

“Pink puffer” (emphysema: centriacinar [smoking], panacinar [α1-antitrypsin deficiency])

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87
Q

Polyuria, renal tubular acidosis type II, growth failure, electrolyte imbalances, hypophosphatemic rickets

A

Fanconi syndrome (multiple combined dysfunction of the proximal convoluted tubule)

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88
Q

Pruritic, purple, polygonal planar papules and plaques (6 P’s)

A

Lichen planus

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89
Q

Ptosis, miosis, anhidrosis

A

Horner syndrome (sympathetic chain lesion)

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90
Q

Pupil accommodates but doesn’t react

A

Argyll Robertson pupil (neurosyphilis)

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91
Q

Rapidly progressive limb weakness that ascends following GI/upper respiratory infection

A

Guillain-Barré syndrome (acute inflammatory demyelinating polyradiculopathy subtype)

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92
Q

Rash on palms and soles

A

Coxsackie A, 2° syphilis, Rocky Mountain spotted fever

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93
Q

Recurrent cold (noninflamed) abscesses, unusual eczema, high serum IgE

A

Hyper-IgE syndrome (Job syndrome: neutrophil chemotaxis abnormality)

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94
Q

Red “currant jelly” sputum in alcoholic or diabetic patients

A

Klebsiella pneumoniae pneumonia

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95
Q

Red “currant jelly” stools

A

Acute mesenteric ischemia (adults), intussusception (children)

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96
Q

Red, itchy, swollen rash of nipple/areola

A

Paget disease of the breast (sign of underlying neoplasm)

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97
Q

Red urine in the morning, fragile RBCs

A

Paroxysmal nocturnal hemoglobinuria

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98
Q

Renal cell carcinoma (bilateral), hemangioblastomas, angiomatosis, pheochromocytoma

A

von Hippel-Lindau disease (dominant tumor suppressor gene mutation)

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99
Q

Resting tremor, rigidity, akinesia, postural instability, shuffling gait

A

Parkinson disease (loss of dopaminergic neurons in substantia nigra pars compacta)

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100
Q

Retinal hemorrhages with pale centers

A

Roth spots (bacterial endocarditis)

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101
Q

Severe jaundice in neonate

A

Crigler-Najjar syndrome (congenital unconjugated hyperbilirubinemia)

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102
Q

Severe RLQ pain with palpation of LLQ

A

Rovsing sign (acute appendicitis)

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103
Q

Severe RLQ pain with rebound tenderness

A

McBurney sign (acute appendicitis)

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104
Q

Short stature, café au lait spots, thumb/radial defects, increased incidence of tumors/leukemia, aplastic anemia

A

Fanconi anemia (genetic loss of DNA crosslink repair; often progress to AML)

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105
Q

Single palmar crease

A

Down syndrome

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106
Q

Situs inversus, chronic sinusitis, bronchiectasis, infertility

A

Kartagener syndrome (dynein arm defect affecting cilia)

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107
Q

Skin hyperpigmentation, hypotension, fatigue

A

1° adrenocortical insufficiency (e.g., Addison disease) causes increased 􏰁ACTH and increased 􏰁α-MSH production)

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108
Q

Slow, progressive muscle weakness in boys

A

Becker muscular dystrophy (X-linked missense mutation in dystrophin; less severe than Duchenne)

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109
Q

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

A

Koplik spots (measles; rubeola virus)

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110
Q

Smooth, moist, painless, wart-like white lesions on genitals

A

Condylomata lata (2° syphilis)

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111
Q

Splinter hemorrhages in fingernails

A

Bacterial endocarditis

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112
Q

“Strawberry tongue”

A

Scarlet fever, Kawasaki disease

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113
Q

Streak ovaries, congenital heart disease, horseshoe kidney, cystic hygroma at birth, short stature, webbed neck, lymphedema

A

Turner syndrome (45,XO)

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114
Q

Sudden swollen/painful big toe joint, tophi

A

Gout/podagra (hyperuricemia)

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115
Q

Swollen gums, mucosal bleeding, poor wound healing, petechiae

A

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

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116
Q

Swollen, hard, painful finger joints

A

Osteoarthritis (osteophytes on PIP [Bouchard nodes], DIP [Heberden nodes])

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117
Q

Systolic ejection murmur (crescendo-decrescendo)

A

Aortic stenosis

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118
Q

Telangiectasias, recurrent epistaxis, skin discoloration, arteriovenous malformations, GI bleeding, hematuria

A

Osler-Weber-Rendu syndrome

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119
Q

Thyroid and parathyroid tumors, pheochromocytoma

A

MEN 2A (autosomal dominant RET mutation)

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120
Q

Thyroid tumors, pheochromocytoma, ganglioneuromatosis

A

MEN 2B (autosomal dominant RET mutation)

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121
Q

Toe extension/fanning upon plantar scrape

A

Babinski sign (UMN lesion)

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122
Q

Unilateral facial drooping involving forehead

A

LMN facial nerve (CN VII) palsy; UMN lesions spare the forehead

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123
Q

Urethritis, conjunctivitis, arthritis in a male

A

Reactive arthritis associated with HLA-B27

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124
Q

Vascular birthmark (port-wine stain) of the face

A

Nevus flammeus (benign, but associated with Sturge-Weber syndrome)

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125
Q

Vomiting blood following gastroesophageal lacerations

A

Mallory-Weiss syndrome (alcoholic and bulimic patients)

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126
Q

Weight loss, diarrhea, arthritis, fever, adenopathy

A

Whipple disease (Tropheryma whipplei)

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127
Q

“Worst headache of my life”

A

Subarachnoid hemorrhage

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128
Q

Anticentromere antibodies

A

Scleroderma (CREST)

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129
Q

Anti-desmoglein (epithelial) antibodies

A

Pemphigus vulgaris (blistering)

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130
Q

Anti-glomerular basement membrane antibodies

A

Goodpasture syndrome (glomerulonephritis and hemoptysis)

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131
Q

Antihistone antibodies

A

Drug-induced SLE (e.g., hydralazine, isoniazid, phenytoin, procainamide)

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132
Q

Anti-IgG antibodies

A

Rheumatoid arthritis (systemic inflammation, joint pannus, boutonnière deformity)

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133
Q

Antimitochondrial antibodies (AMAs)

A

1° biliary cirrhosis (female, cholestasis, portal hypertension)

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134
Q

p-ANCA (MPO-ANCA)

A

Microscopic polyangiitis

Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)

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135
Q

c-ANCA (PR3-ANCA)

A

Granulomatosis with polyangiitis (Wegener)

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136
Q

Antinuclear antibodies (ANAs: anti-Smith and anti-dsDNA)

A

SLE (type III hypersensitivity)

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137
Q

Antiplatelet antibodies

A

Idiopathic thrombocytopenic purpura

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138
Q

Anti-topoisomerase antibodies

A

Diffuse systemic scleroderma

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139
Q

Anti-transglutaminase/anti-gliadin/anti-endomysial antibodies

A

Celiac disease (diarrhea, weight loss)

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140
Q

“Apple core” lesion on barium enema x-ray

A

Colorectal cancer (usually left-sided)

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141
Q

Atypical lymphocytes

A

EBV

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142
Q

Azurophilic peroxidase ⊕ granular inclusions in granulocytes and myeloblasts

A

Auer rods (AML, especially the promyelocytic [M3] type)

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143
Q

Bacitracin response

A

Sensitive: S. pyogenes (group A); resistant: S. agalactiae (group B)

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144
Q

“Bamboo spine” on x-ray

A

Ankylosing spondylitis (chronic inflammatory arthritis: HLA-B27)

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145
Q

Basophilic nuclear remnants in RBCs

A

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

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146
Q

Basophilic stippling of RBCs

A

Lead poisoning or sideroblastic anemia

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147
Q

Bloody or yellow tap on lumbar puncture

A

Subarachnoid hemorrhage

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148
Q

“Boot-shaped” heart on x-ray

A

Tetralogy of Fallot (due to RVH)

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149
Q

Branching gram-positive rods with sulfur granules

A

Actinomyces israelii

150
Q

Bronchogenic apical lung tumor on imaging

A

Pancoast tumor (can compress cervical sympathetic chain and cause Horner syndrome)

151
Q

“Brown” tumor of bone

A

Hyperparathyroidism or osteitis fibrosa cystica (deposited hemosiderin from hemorrhage gives brown color)

152
Q

Cardiomegaly with apical atrophy

A

Chagas disease (Trypanosoma cruzi)

153
Q

Cellular crescents in Bowman capsule

A

Rapidly progressive crescentic glomerulonephritis

154
Q

“Chocolate cyst” of ovary

A

Endometriosis (frequently involves both ovaries)

155
Q

Circular grouping of dark tumor cells surrounding pale neurofibrils

A

Homer-Wright rosettes (neuroblastoma, medulloblastoma)

156
Q

Colonies of mucoid Pseudomonas in lungs

A

Cystic fibrosis (autosomal recessive mutation in CFTR gene causing 􏰀fat-soluble vitamin deficiency and mucous plugs)

157
Q

􏰂Low AFP in amniotic fluid/maternal serum

A

Down syndrome or other chromosomal abnormalities

158
Q

Degeneration of dorsal column fibers

A 
Tabes dorsalis (3° syphilis), subacute combined degeneration (dorsal columns, lateral corticospinal, spinocerebellar tracts
affected)
159
Q

“Delta wave” on EKG, short PR interval, supraventricular tachycardia

A

Wolf-Parkinson-White syndrome (Bundle of Kent bypasses AV node)

160
Q

Depigmentation of neurons in substantia nigra

A

Parkinson disease (basal ganglia disorder: rigidity, resting tremor, bradykinesia)

161
Q

Desquamated epithelium casts in sputum

A

Curschmann spirals (bronchial asthma; can result in whorled mucous plugs)

162
Q

Disarrayed granulosa cells arranged around collections of eosinophilic fluid

A

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

163
Q

Dysplastic squamous cervical cells with “raisinoid” nuclei and hyperchromasia

A

Koilocytes (HPV: predisposes to cervical cancer)

164
Q

Electrical alternans (alternating amplitude on EKG)

A

Pericardial tamponade

165
Q

Enlarged cells with intranuclear inclusion bodies

A

“Owl eye” appearance of CMV

166
Q

Enlarged thyroid cells with ground-glass nuclei with central clearing

A

“Orphan Annie” eyes nuclei (papillary carcinoma of the thyroid)

167
Q

Eosinophilic cytoplasmic inclusion in liver cell

A

Mallory body (alcoholic liver disease)

168
Q

Eosinophilic cytoplasmic inclusion in nerve cell

A

Lewy body (Parkinson disease)

169
Q

Eosinophilic globule in liver

A

Councilman body (viral hepatitis, yellow fever), represents hepatocyte undergoing apoptosis

170
Q

Eosinophilic inclusion bodies in cytoplasm of hippocampal and cerebellar neurons

A

Negri bodies of rabies

171
Q

Extracellular amyloid deposition in gray matter of brain

A

Senile plaques (Alzheimer disease)

172
Q

Giant B cells with bilobed nuclei with prominent inclusions (“owl’s eye”)

A

Reed-Sternberg cells (Hodgkin lymphoma)

173
Q

Glomerulus-like structure surrounding vessel in germ cells

A

Schiller-Duval bodies (yolk sac tumor)

174
Q

“Hair on end” (“Crew-cut”) appearance on x-ray

A

β-thalassemia, sickle cell disease (marrow expansion)

175
Q

hCG elevated

A

Choriocarcinoma, hydatidiform mole (occurs with and without embryo, and multiple pregnancy)

176
Q

Heart nodules (granulomatous)

A

Aschoff bodies (rheumatic fever)

177
Q

Heterophile antibodies

A

Infectious mononucleosis (EBV)

178
Q

Hexagonal, double-pointed, needle-like crystals in bronchial secretions

A

Bronchial asthma (Charcot-Leyden crystals: eosinophilic granules)

179
Q

High level of d-dimers

A

DVT, PE, DIC

180
Q

Hilar lymphadenopathy, peripheral granulomatous lesion in middle or lower lung lobes (can calcify)

A

Ghon complex (1° TB: Mycobacterium bacilli)

181
Q

“Honeycomb lung” on x-ray or CT

A

Interstitial pulmonary fibrosis

182
Q

Hypersegmented neutrophils

A

Megaloblastic anemia (B12 deficiency: neurologic symptoms; folate deficiency: no neurologic symptoms)

183
Q

Hypertension, hypokalemia, metabolic alkalosis

A

Conn syndrome (primary hyperaldosteronism)

184
Q

Hypochromic, microcytic anemia

A

Iron deficiency anemia, lead poisoning, thalassemia (fetal hemoglobin sometimes present)

185
Q

Increased AFP in amniotic fluid/maternal serum

A

Dating error, anencephaly, spina bifida (neural tube defects)

186
Q

Increased uric acid levels

A

Gout, Lesch-Nyhan syndrome, tumor lysis syndrome, loop and thiazide diuretics

187
Q

Intranuclear eosinophilic droplet-like bodies

A

Cowdry type A bodies (HSV or VZV)

188
Q

Iron-containing nodules in alveolar septum

A

Ferruginous bodies (asbestosis:􏰁chance of mesothelioma)

189
Q

Keratin pearls on a skin biopsy

A

Squamous cell carcinoma

190
Q

Large granules in phagocytes, immunodeficiency

A

Chédiak-Higashi disease (congenital failure of phagolysosome formation)

191
Q

“Lead pipe” appearance of colon on abdominal imaging

A

Ulcerative colitis (loss of haustra)

192
Q

Linear appearance of IgG deposition on glomerular and alveolar basement membranes

A

Goodpasture syndrome

193
Q

Low serum ceruloplasmin

A

Wilson disease (hepatolenticular degeneration)

194
Q

“Lumpy bumpy” appearance of glomeruli on immunofluorescence

A

Poststreptococcal glomerulonephritis (due to deposition of IgG, IgM, and C3)

195
Q

Lytic (“punched-out”) bone lesions on x-ray

A

Multiple myeloma

196
Q

Mammary gland (“blue domed”) cyst

A

Fibrocystic change of the breast

197
Q

Monoclonal antibody spike

A

ƒ Multiple myeloma (usually IgG or IgA)

ƒ Monoclonal gammopathy of undetermined significance
(MGUS consequence of aging)

ƒ Waldenström (M protein = IgM) macroglobulinemia ƒ

Primary amyloidosis

198
Q

Mucin-filled cell with peripheral nucleus

A

“Signet ring” (gastric carcinoma)

199
Q

Narrowing of bowel lumen on barium x-ray

A

“String sign” (Crohn disease)

200
Q

Necrotizing vasculitis (lungs) and necrotizing glomerulonephritis

A

Granulomatosis with polyangiitis (Wegener; PR3-ANCA/c-ANCA) and Goodpasture syndrome (anti–basement membrane antibodies)

201
Q

Needle-shaped, negatively birefringent crystals

A

Gout (monosodium urate crystals)

202
Q

Nodular hyaline deposits in glomeruli

A

Kimmelstiel-Wilson nodules (diabetic nephropathy)

203
Q

Novobiocin response

A

Sensitive: S. epidermidis; resistant: S. saprophyticus

204
Q

“Nutmeg” appearance of liver

A

Chronic passive congestion of liver due to right heart failure or Budd-Chiari syndrome

205
Q

“Onion skin” periosteal reaction

A

Ewing sarcoma (malignant small blue cell tumor)

206
Q

Optochin response

A

Sensitive: S. pneumoniae; resistant: viridans streptococci (S. mutans, S. sanguis)

207
Q

Periosteum raised from bone, creating triangular area

A

Codman triangle on x-ray, Ewing sarcoma, pyogenic osteomyelitis)

208
Q

Podocyte fusion or “effacement” on electron microscopy

A

Minimal change disease (child with nephrotic syndrome)

209
Q

Polished, “ivory-like” appearance of bone at cartilage erosion

A

Eburnation (osteoarthritis resulting in bony sclerosis)

210
Q

Protein aggregates in neurons from hyperphosphorylation of tau protein

A

Neurofibrillary tangles (Alzheimer disease) and Pick bodies (Pick disease)

211
Q

Psammoma bodies

A

Meningiomas, papillary thyroid carcinoma, mesothelioma, papillary serous carcinoma of the endometrium and ovary

212
Q

Pseudopalisading tumor cells on brain biopsy

A

Glioblastoma multiforme

213
Q

RBC casts in urine

A

Glomerulonephritis

214
Q

Rectangular, crystal-like, cytoplasmic inclusions in Leydig cells

A

Reinke crystals (Leydig cell tumor)

215
Q

Recurrent infections, eczema, thrombocytopenia

A

Wiskott-Aldrich syndrome

216
Q

Renal epithelial casts in urine

A

Intrinsic renal failure (e.g., ischemia or toxic injury)

217
Q

Rhomboid crystals, positively birefringent

A

Pseudogout (calcium pyrophosphate dihydrate crystals)

218
Q

Rib notching

A

Coarctation of the aorta

219
Q

Ring-enhancing brain lesion in AIDS

A

Toxoplasma gondii, CNS lymphoma

220
Q

Sheets of medium-sized lymphoid cells with scattered pale, tangible body-laden macrophages (“starry sky” histology)

A

Burkitt lymphoma (t[8:14] c-myc activation, associated with EBV; “starry sky” made up of malignant cells)

221
Q

Silver-staining spherical aggregation of tau proteins in neurons

A

Pick bodies (Pick disease: progressive dementia, changes in personality)

222
Q

“Soap bubble” in femur or tibia on x-ray

A

Giant cell tumor of bone (generally benign)

223
Q

“Spikes” on basement membrane, “dome-like” subepithelial deposits

A

Membranous nephropathy (nephrotic syndrome)

224
Q

Stacks of RBCs

A

Rouleaux formation (high ESR, multiple myeloma)

225
Q

“Steeple” sign on CXR

A

Croup (parainfluenza virus)

226
Q

Stippled vaginal epithelial cells

A

“Clue cells” (Gardnerella vaginalis)

227
Q

Streptococcus bovis bacteremia

A

Colon cancer

228
Q

“Tennis racket”-shaped cytoplasmic organelles (EM) in Langerhans cells

A

Birbeck granules (Langerhans cell histiocytosis)

229
Q

Thousands of polyps on colonoscopy

A

Familial adenomatous polyposis (autosomal dominant, mutation of APC gene)

230
Q

Thrombi made of white/red layers

A

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

231
Q

“Thumb sign” on lateral neck x-ray

A

Epiglottitis (Haemophilus influenzae)

232
Q

Thyroid-like appearance of kidney

A

Chronic pyelonephritis (usually due to recurrent infections)

233
Q

“Tram-track” appearance of capillary loops of glomerular basement membranes on light microscopy

A

Membranoproliferative glomerulonephritis

234
Q

Triglyceride accumulation in liver cell vacuoles

A

Fatty liver disease (alcoholic or metabolic syndrome)

235
Q

“Waxy” casts with very low urine flow

A

Chronic end-stage renal disease

236
Q

WBC casts in urine

A

Acute pyelonephritis

237
Q

WBCs that look “smudged”

A

CLL (almost always B cell)

238
Q

“Wire loop” glomerular capillary appearance on light microscopy

A

Diffuse proliferative glomerulonephritis (usually seen with lupus)

239
Q

Yellowish CSF

A

Xanthochromia (e.g., due to subarachnoid hemorrhage)

240
Q

Key associations: Actinic (solar) keratosis)

A

Precursor to squamous cell carcinoma

241
Q

Key associations: Acute gastric ulcer associated with CNS injury

A

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

242
Q

Key associations: Acute gastric ulcer associated with severe burns

A

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

243
Q

Key associations: Alternating areas of transmural inflammation and normal colon

A

Skip lesions (Crohn disease)

244
Q

Key associations: Aortic aneurysm, abdominal

A

Atherosclerosis

245
Q

Key associations: aortic aneurysm, ascending or arch

A

3° syphilis (syphilitic aortitis), vasa vasorum destruction

246
Q

Key associations: Aortic aneurysm, thoracic

A

Marfan syndrome (idiopathic cystic medial degeneration)

247
Q

Key associations: Aortic dissection

A

Hypertension

248
Q

Key associations: Atrophy of the mammillary bodies

A

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

249
Q

Key associations: Autosplenectomy (fibrosis and shrinkage)

A

Sickle cell disease (hemoglobin S)

250
Q

Key associations: Bacteria associated with gastritis, peptic ulcer disease, and stomach cancer

251
Q

Key associations: bacterial meningitis (adults and elderly)

A

S. pneumoniae

252
Q

Key associations: Bacterial meningitis (newborns and kids)

A

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

253
Q

Key associations: Bilateral ovarian metastases from gastric carcinoma

A

Krukenberg tumor (mucin-secreting signet ring cells)

254
Q

Key associations: Bleeding disorder with GpIb deficiency

A

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

255
Q

Key associations: Brain tumor (adults)

A

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

256
Q

Key associations: Brain tumor (kids)

A

Infratentorial: medulloblastoma (cerebellum) or supratentorial: craniopharyngioma

257
Q

Key associations: Breast cancer

A

Invasive ductal carcinoma

258
Q

Key associations: Breast mass

A

Fibrocystic change, carcinoma (in postmenopausal women)

259
Q

Key associations: Breast tumor (benign)

A

Fibroadenoma

260
Q

Key associations: Cardiac 1° tumor (kids)

A

Rhabdomyoma, often seen in tuberous sclerosis

261
Q

Key associations: Cardiac manifestation of lupus

A

Marantic/thrombotic endocarditis (nonbacterial)

262
Q

Key associations: Cardiac tumor (adults)

A

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

263
Q

Key associations: Cerebellar tonsillar herniation

A

Chiari II malformation

264
Q

Key associations: Chronic arrhythmia

A

Atrial fibrillation (associated with high risk of emboli)

265
Q

Key associations: Chronic atrophic gastritis (autoimmune)

A

Predisposition to gastric carcinoma (can also cause pernicious anemia)

266
Q

Key associations: Clear cell adenocarcinoma of the vagina

A

DES exposure in utero

267
Q

Key associations: Congenital adrenal hyperplasia, hypotension

A

21-hydroxylase deficiency

268
Q

Key associations: Congenital cardiac anomaly

269
Q

Key associations: Congenital conjugated hyperbilirubinemia (black liver)

A

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

270
Q

Key associations: Constrictive pericarditis

A

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

271
Q

Key associations: Coronary artery involved in thrombosis

A

LAD > RCA > circumflex

272
Q

Key associations: Cretinism

A

Iodine deficit/congenital hypothyroidism

273
Q

Key associations: Cushing syndrome

A

ƒ Iatrogenic (from corticosteroid therapy)

ƒ Adrenocortical adenoma (secretes excess cortisol)

ƒ ACTH-secreting pituitary adenoma (Cushing disease)

ƒ Paraneoplastic (due to ACTH secretion by tumors)

274
Q

Key associations: Cyanosis (early; less common)

A

Tetralogy of Fallot, transposition of great vessels, truncus arteriosus

275
Q

Key associations: Cyanosis (late; more common)

A

VSD, ASD, PDA

276
Q

Key associations: Death in CML

A

Blast crisis

277
Q

Key associations: Death in SLE

A

Lupus nephropathy

278
Q

Key associations: Dementia

A

Alzheimer disease, multiple infarcts (vascular dementia)

279
Q

Key associations: Demyelinating disease in young women

A

Multiple sclerosis

280
Q

Key associations: DIC

A

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

281
Q

Key associations: Diverticulum in pharynx

A

Zenker diverticulum (diagnosed by barium swallow)

282
Q

Key associations: Ejection click

A

Aortic stenosis

283
Q

Key associations: Esophageal cancer

A

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

284
Q

Key associations: Food poisoning (exotoxin mediated)

A

S. aureus, B. cereus

285
Q

Key associations: glomerulonephritis (adults)

A

Berger disease (IgA nephropathy)

286
Q

Key associations: Gynecologic malignancy

A

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

287
Q

Key associations: Heart murmur, congenital

A

Mitral valve prolapse

288
Q

Key associations: Heart valve in bacterial endocarditis

A

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

289
Q

Key associations: Helminth infection (U.S.)

A

Enterobius vermicularis, Ascaris lumbricoides

290
Q

Key associations: Hematoma—epidural

A

Rupture of middle meningeal artery (trauma; lentiform shaped)

291
Q

Key associations: Hematoma—subdural

A

Rupture of bridging veins (crescent shaped)

292
Q

Key associations: Hemochromatosis

A

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

293
Q

Key associations: Hepatocellular carcinoma

A

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

294
Q

Key associations: Hereditary bleeding disorder

A

von Willebrand disease

295
Q

Key associations: Hereditary harmless jaundice

A

Gilbert syndrome (benign congenital unconjugated hyperbilirubinemia)

296
Q

Key associations: HLA-B27

A

Ankylosing spondylitis, reactive arthritis, ulcerative colitis, psoriatic arthritis

297
Q

Key associations: HLA-DR3

A

Diabetes mellitus type 1, SLE, Graves disease, Hashimoto thyroiditis

298
Q

Key associations: HLA-DR4

A

Diabetes mellitus type 1, rheumatoid arthritis

299
Q

Key associations: Holosystolic murmur

A

VSD, tricuspid regurgitation, mitral regurgitation

300
Q

Key associations: Hypercoagulability, endothelial damage, blood stasis

A

Virchow triad (􏰁increased risk of thrombosis)

301
Q

Key associations: Hypertension, 2°

A

Renal disease

302
Q

Key associations: Hypoparathyroidism

A

Accidental excision during thyroidectomy

303
Q

Key associations: Hypopituitarism

A

Pituitary adenoma (usually benign tumor)

304
Q

Key associations: Infection 2° to blood transfusion

A

Hepatitis C

305
Q

Key associations: Infections in chronic granulomatous disease

A

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

306
Q

Key associations: Intellectual disability

A

Down syndrome, fragile X syndrome

307
Q

Key associations: Kidney stones

A

ƒCalcium = radiopaque
ƒ
Struvite (ammonium) = radiopaque (formed by urease ⊕ organisms such as Klebsiella, Proteus species, and S. saprophyticus)

Uric acid = radiolucent

308
Q

Key associations: Late cyanotic shunt (uncorrected left to right becomes right to left)

A

Eisenmenger syndrome (caused by ASD, VSD, PDA; results in pulmonary hypertension/polycythemia)

309
Q

Key associations: Liver disease

A

Alcoholic cirrhosis

310
Q

Key associations: Lysosomal storage disease

A

Gaucher disease

311
Q

Key associations: Male cancer

A

Prostatic carcinoma

312
Q

Key associations: Malignancy associated with noninfectious fever

A

Hodgkin lymphoma

313
Q

Key associations: Malignancy (kids)

A

ALL, medulloblastoma (cerebellum)

314
Q

Key associations: Metastases to bone

A

Prostate, breast > lung > thyroid

315
Q

Key associations: Metastases to brain

A

Lung > breast > genitourinary > melanoma > GI

316
Q

Key associations: Metastases to liver

A

Colon&raquo_space; stomach, pancreas

317
Q

Key associations: Mitochondrial inheritance

A

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

318
Q

Key associations: Mitral valve stenosis

A

Rheumatic heart disease

319
Q

Key associations: Mixed (UMN and LMN) motor neuron disease

A

Amyotrophic lateral sclerosis

320
Q

Key associations: Myocarditis

A

Coxsackie B

321
Q

Key associations: Nephrotic syndrome (adults)

A

Focal segmental glomerulosclerosis

322
Q

Key associations: Nephrotic syndrome (kids)

A

Minimal change disease

323
Q

Key associations: Neuron migration failure

A

Kallmann syndrome (hypogonadotropic hypogonadism and anosmia)

324
Q

Key associations: Nosocomial pneumonia

A

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

325
Q

Key associations: Obstruction of male urinary tract

326
Q

Key associations: Opening snap

A

Mitral stenosis

327
Q

Key associations: Opportunistic infection in AIDS

A

Pneumocystis jirovecii pneumonia

328
Q

Key associations: Osteomyelitis

A

S. aureus (most common overall)

329
Q

Key associations: Osteomyelitis in sickle cell disease

A

Salmonella

330
Q

Key associations: Osteomyelitis with IV drug use

A

Pseudomonas, Candida, S. aureus

331
Q

Key associations: Ovarian tumor (benign, bilateral)

A

Serous cystadenoma

332
Q

Key associations: Ovarian tumor (malignant)

A

Serous cystadenocarcinoma

333
Q

Key associations: Pancreatitis (acute)

A

Gallstones, alcohol

334
Q

Key associations: Pancreatitis (chronic)

A

Alcohol (adults), cystic fibrosis (kids)

335
Q

Key associations: Patient with ALL /CLL /AML /CML

A

ALL: child, CLL: adult > 60, AML: adult ∼ 65, CML: adult 45–85

336
Q

Key associations: Pelvic inflammatory disease

A

C. trachomatis, N. gonorrhoeae

337
Q

Key associations: Philadelphia chromosome t(9;22) (BCR-ABL)

A

CML (may sometimes be associated with ALL/AML)

338
Q

Key associations: Pituitary tumor

A

Prolactinoma, somatotropic adenoma

339
Q

Key associations: 1° amenorrhea

A

Turner syndrome (45,XO)

340
Q

Key associations: 1° bone tumor (adults)

A

Multiple myeloma

341
Q

Key associations: 1° hyperaldosteronism

A

Adenoma of adrenal cortex

342
Q

Key associations: 1° hyperparathyroidism

A

Adenomas, hyperplasia, carcinoma

343
Q

Key associations: 1° liver cancer

A

Hepatocellular carcinoma (chronic hepatitis, cirrhosis, hemochromatosis, α1-antitrypsin deficiency, Wilson disease)

344
Q

Key associations: Pulmonary hypertension

345
Q

Key associations: Recurrent inflammation/thrombosis of small/medium vessels in extremities

A

Buerger disease (strongly associated with tobacco)

346
Q

Key associations: Renal tumor

A

Renal cell carcinoma: associated with von Hippel-Lindau and cigarette smoking; paraneoplastic syndromes (EPO, renin,
PTHrP, ACTH)

347
Q

Key associations: Right heart failure due to a pulmonary cause

A

Cor pulmonale

348
Q

Key associations: S3 heart sound

A

􏰁Increased ventricular filling pressure (e.g., mitral regurgitation, HF), common in dilated ventricles

349
Q

Key associations: S4 heart sound

A

Stiff/hypertrophic ventricle (aortic stenosis, restrictive cardiomyopathy)

350
Q

Key associations: 2° hyperparathyroidism

A

Hypocalcemia of chronic kidney disease

351
Q

Key associations: Sexually transmitted disease

A

C. trachomatis (usually coinfected with N. gonorrhoeae)

352
Q

Key associations: SIADH

A

Small cell carcinoma of the lung

353
Q

Key associations: Site of diverticula

A

Sigmoid colon

354
Q

Key associations: Sites of atherosclerosis

A

Abdominal aorta > coronary artery > popliteal artery > carotid artery

355
Q

Key associations: Stomach cancer

A

Stomach cancer

356
Q

Key associations: Stomach ulcerations and high gastrin levels

A

Zollinger-Ellison syndrome (gastrinoma of duodenum or pancreas)

357
Q

Key associations: t(14;18)

A

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

358
Q

Key associations: t(8:14)

A

Burkitt lymphoma (c-myc fusion, transcription factor oncogene)

359
Q

Key associations: t(9;22)

A

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

360
Q

Key associations: temporal arteritis

A

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

361
Q

Key associations: Testicular tumor

A

Seminoma (malignant, radiosensitive)

362
Q

Key associations: Thyroid cancer

A

Papillary carcinoma

363
Q

Key associations: tumor in women

A

Leiomyoma (estrogen dependent, not precancerous)

364
Q

Key associations: Tumor of infancy

A

Strawberry hemangioma (usually regresses spontaneously by childhood)

365
Q

Key associations: Tumor of the adrenal medulla (adults)

A

Pheochromocytoma (usually benign)

366
Q

Key associations: Tumor of the adrenal medulla (kids)

A

Neuroblastoma (malignant)

367
Q

Key associations: Type of Hodgkin lymphoma

A

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

368
Q

Key associations: Type of non-Hodgkin lymphoma

A

Diffuse large B-cell lymphoma

369
Q

Key associations: UTI

A

E. coli, Staphylococcus saprophyticus (young women)

370
Q

Key associations: Vertebral compression fracture

A

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

371
Q

Key associations: Viral encephalitis affecting temporal lobe

372
Q

Key associations: Vitamin deficiency (U.S.)

A

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

USMLE Flashcards (2 decks)

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