First Aid 2015 High Yield Flashcards
1
Q
Abdominal pain, ascites, heptatomegaly
A
Budd-Chiari syndrome (posthepatic venous thrombosis)
2
Q
Abdominal pain, diarrhea, leukocytosis, recent antibiotic use
A
Clostridium difficile infection
3
Q
Achilles tendon xanthoma
A
Familial hypercholesterolemia ( LDL receptor signaling)
4
Q
Adrenal hemorrhage, hypotension, DIC
A
Waterhouse-Friderichsen syndrome (meningococcemia
5
Q
Anaphylaxis following blood transfusion
A
IgA deficiency
6
Q
Anterior “drawer sign” ⊕
A
Anterior cruciate ligament injury
7
Q
Arachnodactyly, lens dislocation, aortic dissection,
hyperflexible joints
A
Marfan syndrome (fibrillin defect)
8
Q
Athlete with polycythemia
A
2° to erythropoietin injection
9
Q
Back pain, fever, night sweats
A
Pott disease (vertebral TB)
10
Q
Bilateral acoustic schwannomas
A
Neurofibromatosis type 2
11
Q
Bilateral hilar adenopathy, uveitis
A
Sarcoidosis (noncaseating granulomas
12
Q
Black eschar on face of patient with diabetic ketoacidosis
A
Mucor or Rhizopus fungal infection
13
Q
Blue sclera
A
Osteogenesis imperfecta (type I collagen defect)
14
Q
Bluish line on gingiva
A
Burton line (lead poisoning)
15
Q
Bone pain, bone enlargement, arthritis
A
Paget disease of bone ( osteoblastic and osteoclastic activity)
16
Q
Bounding pulses, diastolic heart murmur, head bobbing
A
Aortic regurgitation
17
Q
“Butterfly” facial rash and Raynaud phenomenon in a young female
A
Systemic lupus erythematosus
18
Q
Café-au-lait spots, Lisch nodules (iris hamartoma), cutaneous
neurofibromas, pheochromocytomas, optic gliomas
A
Neurofibromatosis type I, pheochromocytoma, optic gliomas
19
Q
Café-au-lait spots (unilateral), polyostotic fibrous dysplasia,
precocious puberty, multiple endocrine abnormalities
A
McCune-Albright syndrome (mosaic G-protein signaling
mutation)
20
Q
Calf pseudohypertrophy
A
Muscular dystrophy (most commonly Duchenne, due to X-linked recessive frameshift mutation of dystrophin gene)
21
Q
Cervical lymphadenopathy, desquamating rash, coronary
aneurysms, red conjunctivae and tongue
A
Kawasaki disease (treat with IVIG and aspirin)
22
Q
“Cherry-red spots” on macula
A
Tay-Sachs (ganglioside accumulation) or Niemann-Pick
(sphingomyelin accumulation), central retinal artery occlusion
23
Q
Chest pain on exertion
A
Chest pain on exertion
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)
25
Chest pain with ST depressions on EKG
Unstable angina (troponins −) or NSTEMI (troponins +)
26
Child uses arms to stand up from squat
Gowers sign (Duchenne muscular dystrophy)
27
Child with fever later develops red rash on face that spreads to
body
“Slapped cheeks” (erythema infectiosum/fifth disease:
| parvovirus B19)
28
Chorea, dementia, caudate degeneration
```
Huntington disease (autosomal dominant CAG repeat
expansion)
```
29
Chorioretinitis, hydrocephalus, intracranial calcifications
Congenital toxoplasmosis
30
Chronic exercise intolerance with myalgia, fatigue, painful
| cramps, myoglobinuria
```
McArdle disease (skeletal muscle glycogen phosphorylase
deficiency)
```
31
Cold intolerance
Hypothyroidism
32
Conjugate horizontal gaze palsy, horizontal diplopia
```
Internuclear ophthalmoplegia (damage to MLF; may be
unilateral or bilateral)
```
33
Continuous “machine-like” heart murmur
PDA (close with indomethacin; open or maintain with PGE
| analogs)
34
Cutaneous/dermal edema due to connective tissue deposition
Myxedema (caused by hypothyroidism, Graves disease
| [pretibial])
35
Cutaneous flushing, diarrhea, bronchospasm
```
Carcinoid syndrome (right-sided cardiac valvular lesions,
5-HIAA)
```
36
Dark purple skin/mouth nodules in a patient with AIDS
Kaposi sarcoma, associated with HHV-8
37
Deep, labored breathing/hyperventilation
Kussmaul respirations (diabetic ketoacidosis)
38
Dermatitis, dementia, diarrhea
Pellagra (niacin [vitamin B3] deficiency)
39
Dilated cardiomyopathy, edema, alcoholism or malnutrition
Wet beriberi (thiamine [vitamin B1] deficiency)
40
Dog or cat bite resulting in infection
Pasteurella multocida (cellulitis at inoculation site)
41
Dry eyes, dry mouth, arthritis
Sjögren syndrome (autoimmune destruction of exocrine
| glands)
42
Dysphagia (esophageal webs), glossitis, iron deficiency anemia
Plummer-Vinson syndrome (may progress to esophageal
| squamous cell carcinoma)
43
Elastic skin, hypermobility of joints, bleeding tendency
Ehlers-Danlos syndrome (type V collagen defect, type III
| collagen defect seen in vascular subtype of ED)
44
Enlarged, hard left supraclavicular node
Virchow node (abdominal metastasis
45
Episodic vertigo, tinnitus, hearing loss
Meniere disease
46
Erythroderma, lymphadenopathy, hepatosplenomegaly,
| atypical T cells
```
Mycosis fungoides (cutaneous T-cell lymphoma) or Sézary
syndrome (mycosis fungoides + malignant T cells in blood)
```
47
Facial muscle spasm upon tapping
Chvostek sign (hypocalcemia)
48
Fat, female, forty, and fertile
Cholelithiasis (gallstones)
49
Fever, chills, headache, myalgia following antibiotic
| treatment for syphilis
Jarisch-Herxheimer reaction (rapid lysis of spirochetes results
in endotoxin release)
50
Fever, cough, conjunctivitis, coryza, diffuse rash
Measles
51
Fever, night sweats, weight loss
B symptoms (staging) of lymphoma
52
Fibrous plaques in soft tissue of penis with abnormal
| curvature
Peyronie disease (connective tissue disorder
53
Golden brown rings around peripheral cornea
Kayser-Fleischer rings (copper accumulation from Wilson
| disease)
54
Gout, intellectual disability, self-mutilating behavior in a boy
Lesch-Nyhan syndrome (HGPRT deficiency, X-linked
| recessive)
55
Hamartomatous GI polyps, hyperpigmentation of
| mouth/feet/hands/genitalia
Peutz-Jeghers syndrome (inherited, benign polyposis can
| cause bowel obstruction; cancer risk, mainly GI)
56
Hepatosplenomegaly, pancytopenia, osteoporosis, aseptic
| necrosis of femur, bone crises
Gaucher disease (glucocerebrosidase /betaglucosidase deficiency)
57
Hereditary nephritis, sensorineural hearing loss,
| cataracts
Alport syndrome (mutation in collagen IV)
58
Hyperphagia, hypersexuality, hyperorality,
| hyperdocility
Klüver-Bucy syndrome (bilateral amygdala lesion)
59
Hyperreflexia, hypertonia, Babinski sign present
UMN damage
60
Hyporeflexia, hypotonia, atrophy, fasciculations
LMN damage
61
Hypoxemia, polycythemia, hypercapnia
“Blue bloater” (chronic bronchitis: hyperplasia of mucous
| cells)
62
Indurated, ulcerated genital lesion
Nonpainful: chancre (1° syphilis, Treponema pallidum)
| Painful, with exudate: chancroid (Haemophilus ducreyi)
63
Infant with “cherry-red” spot on macula, hepatosplenomegaly,
| and neurodegeneration
Niemann-Pick disease (genetic sphingomyelinase deficiency)
64
Infant with cleft lip/palate, microcephaly or
| holoprosencephaly, polydactyly, cutis aplasia
Patau syndrome (trisomy 13)
65
Infant with hypoglycemia, hepatomegaly
```
Cori disease (debranching enzyme deficiency) or Von Gierke
disease (glucose-6-phosphatase deficiency, more severe)
```
66
Infant with microcephaly, rocker-bottom feet, clenched
| hands, and structural heart defect
Edwards syndrome (trisomy 18)
67
Jaundice, palpable distended non-tender gallbladder
Courvoisier sign (distal obstruction of biliary tree)
68
Large rash with bull’s-eye appearance
Erythema chronicum migrans from Ixodes tick bite (Lyme
| disease: Borrelia)
69
Lucid interval after traumatic brain injury
```
Epidural hematoma (middle meningeal artery
rupture)
```
70
Male child, recurrent infections, no mature B cells
Bruton disease (X-linked agammaglobulinemia)
71
Mucosal bleeding and prolonged bleeding time
```
Glanzmann thrombasthenia (defect in platelet aggregation
due to lack of GpIIb/IIIa)
```
72
Muffled heart sounds, distended neck veins, hypotension
Beck triad of cardiac tamponade
73
Multiple colon polyps, osteomas/soft tissue tumors, impacted/
supernumerary teeth
Gardner syndrome (subtype of FAP)
74
Myopathy (infantile hypertrophic cardiomyopathy), exercise
| intolerance
Pompe disease (lysosomal α-1,4-glucosidase deficiency)
75
Neonate with arm paralysis following difficult birth
Erb-Duchenne palsy (superior trunk [C5–C6] brachial plexus
| injury: “waiter’s tip”)
76
No lactation postpartum, absent menstruation, cold
| intolerance
Sheehan syndrome (pituitary infarction
77
Nystagmus, intention tremor, scanning speech, bilateral
| internuclear ophthalmoplegia
Multiple sclerosis
78
Painful blue fingers/toes, hemolytic anemia
Cold agglutinin disease (autoimmune hemolytic
anemia caused by Mycoplasma pneumoniae, infectious
mononucleosis, CLL)
79
Painful fingers/toes changing color from blue to white to red
with cold or stress
Raynaud phenomenon (vasospasm in extremities)
80
Painful, raised red lesions on pads of fingers/toes
```
Osler nodes (infective endocarditis, immune complex
deposition)
```
81
Painless erythematous lesions on palms and soles
```
Janeway lesions (infective endocarditis, septic emboli/
microabscesses)
```
82
Painless jaundice
Cancer of the pancreatic head obstructing bile duct
83
Palpable purpura on buttocks/legs, joint pain, abdominal pain
(child), hematuria
Henoch-Schönlein purpura (IgA vasculitis affecting skin and
| kidneys)
84
Pancreatic, pituitary, parathyroid tumors
MEN 1 (autosomal dominant)
85
Periorbital and/or peripheral edema, proteinuria,
| hypoalbuminemia, hypercholesterolemia
Nephrotic syndrome
86
Pink complexion, dyspnea, hyperventilation
“Pink puffer” (emphysema: centriacinar [smoking], panacinar
| [α1-antitrypsin deficiency])
87
Polyuria, renal tubular acidosis type II, growth failure,
| electrolyte imbalances, hypophosphatemic rickets
```
Fanconi syndrome (multiple combined dysfunction of the
proximal convoluted tubule)
```
88
Pruritic, purple, polygonal planar papules and plaques (6 P’s)
Lichen planus
89
Ptosis, miosis, anhidrosis
Horner syndrome (sympathetic chain lesion)
90
Pupil accommodates but doesn’t react
Argyll Robertson pupil (neurosyphilis)
91
Rapidly progressive limb weakness that ascends following GI/
| upper respiratory infection
Guillain-Barré syndrome (acute inflammatory demyelinating
| polyradiculopathy subtype)
92
Rash on palms and soles
Coxsackie A, 2° syphilis, Rocky Mountain spotted fever
93
```
Recurrent cold (noninflamed) abscesses, unusual eczema,
high serum IgE
```
Hyper-IgE syndrome (Job syndrome: neutrophil chemotaxis
| abnormality)
94
Red “currant jelly” sputum in alcoholic or diabetic patients
Klebsiella pneumoniae pneumonia
95
Red “currant jelly” stools
Acute mesenteric ischemia (adults), intussusception (children)
96
Red, itchy, swollen rash of nipple/areola
Paget disease of the breast (sign of underlying neoplasm)
97
Red urine in the morning, fragile RBCs
Paroxysmal nocturnal hemoglobinuria
98
Renal cell carcinoma (bilateral), hemangioblastomas,
| angiomatosis, pheochromocytoma
von Hippel-Lindau disease (dominant tumor suppressor gene
| mutation)
99
Resting tremor, rigidity, akinesia, postural instability,
| shuffling gait
```
Parkinson disease (loss of dopaminergic neurons in substantia
nigra pars compacta)
```
100
Retinal hemorrhages with pale centers
Roth spots (bacterial endocarditis)
101
Severe jaundice in neonate
Crigler-Najjar syndrome (congenital unconjugated
| hyperbilirubinemia)
102
Severe RLQ pain with palpation of LLQ
Rovsing sign (acute appendicitis)
103
Severe RLQ pain with rebound tenderness
McBurney sign (acute appendicitis)
104
Short stature, café au lait spots, thumb/radial defects,
| incidence of tumors/leukemia, aplastic anemia
```
Fanconi anemia (genetic loss of DNA crosslink repair; often
progresses to AML)
```
105
Single palmar crease
Down syndrome
106
Situs inversus, chronic sinusitis, bronchiectasis, infertility
Kartagener syndrome (dynein arm defect affecting cilia
107
Skin hyperpigmentation, hypotension, fatigue
1° adrenocortical insufficiency (e.g., Addison disease) causes
ACTH and α-MSH production
108
Slow, progressive muscle weakness in boys
Becker muscular dystrophy (X-linked missense mutation in
| dystrophin; less severe than Duchenne)
109
Small, irregular red spots on buccal/lingual mucosa with
| blue-white centers
Koplik spots (measles; rubeola virus)
110
Smooth, moist, painless, wart-like white lesions on genitals
Condylomata lata (2° syphilis)
111
Splinter hemorrhages in fingernails
Bacterial endocarditis
112
“Strawberry tongue”
Scarlet fever, Kawasaki disease
113
Streak ovaries, congenital heart disease, horseshoe kidney, cystic
hygroma at birth, short stature, webbed neck, lymphedema
Turner syndrome (45,XO)
114
Sudden swollen/painful big toe joint, tophi
Gout/podagra (hyperuricemia
115
Swollen gums, mucosal bleeding, poor wound healing,
| petechiae, coiled hairs
Scurvy (vitamin C deficiency: can’t hydroxylate proline/lysine
for collagen synthesis)
116
Swollen, hard, painful finger joints
Osteoarthritis (osteophytes on PIP [Bouchard nodes], DIP
| [Heberden nodes])
117
Systolic ejection murmur (crescendo-decrescendo)
Aortic stenosis
118
Telangiectasias, recurrent epistaxis, skin discoloration,
| arteriovenous malformations, GI bleeding, hematuria
Osler-Weber-Rendu syndrome
119
Thyroid and parathyroid tumors, pheochromocytoma
MEN 2A (autosomal dominant RET mutation)
120
Thyroid tumors, pheochromocytoma, ganglioneuromatosis
MEN 2B (autosomal dominant RET mutation)
121
Toe extension/fanning upon plantar scrape
Babinski sign (UMN lesion)
122
Unilateral facial drooping involving forehead
LMN facial nerve (CN VII) palsy; UMN lesions spare the
| forehead
123
Urethritis, conjunctivitis, arthritis in a male
Reactive arthritis associated with HLA-B27
124
Vascular birthmark (port-wine stain) of the face
```
Nevus flammeus (benign, but associated with Sturge-Weber
syndrome)
```
125
Vomiting blood following gastroesophageal lacerations
Mallory-Weiss syndrome (alcoholic and bulimic patients)
126
Weight loss, diarrhea, arthritis, fever, adenopathy
Whipple disease (Tropheryma whipplei
127
“Worst headache of my life”
Subarachnoid hemorrhage
128
Anticentromere antibodies
```
Scleroderma (CREST) - limited form
Calcinosis
Raynaud
Esophageal dysmotility
Sclerodactyly
Telangiectasia
```
129
Anti-desmoglein (epithelial) antibodies
Pemphigus vulgaris (blistering)
130
Anti–glomerular basement membrane antibodies
Goodpasture syndrome (glomerulonephritis and hemoptysis)
131
Antihistone antibodies
Drug-induced SLE (e.g., hydralazine, isoniazid, phenytoin,
| procainamide)
132
Anti-IgG antibodies
```
Rheumatoid arthritis (systemic inflammation, joint pannus,
boutonnière deformity)
```
133
Antimitochondrial antibodies (AMAs)
1° biliary cirrhosis (female, cholestasis, portal hypertension)
134
Antineutrophil cytoplasmic antibodies (ANCAs)
Microscopic polyangiitis and eosinophilic granulomatosis
with polyangiitis (Churg-Strauss syndrome) (MPO-ANCA/
p-ANCA);
granulomatosis with polyangiitis (Wegener; PR3-
ANCA/c-ANCA)
135
Antinuclear antibodies (ANAs: anti-Smith and anti-dsDNA)
SLE (type III hypersensitivity)
136
Antiplatelet antibodies
Idiopathic thrombocytopenic purpura
137
Anti-topoisomerase (scl-70) antibodies
Diffuse systemic scleroderma
138
Anti-transglutaminase/anti-gliadin/anti-endomysial antibodies
Celiac disease (diarrhea, weight loss)
139
“Apple core” lesion on barium enema x-ray
Colorectal cancer (usually left-sided)
140
Atypical lymphocytes
EBV
141
Azurophilic peroxidase ⊕ granular inclusions in granulocytes
| and myeloblasts
Auer rods (AML, especially the promyelocytic [M3] type)
142
Bacitracin response
Sensitive: S. pyogenes (group A); resistant: S. agalactiae
| group B
143
“Bamboo spine” on x-ray
```
Ankylosing spondylitis (chronic inflammatory arthritis:
HLA-B27)
```
144
Basophilic nuclear remnants in RBCs
Howell-Jolly bodies (due to splenectomy or nonfunctional
| spleen)
145
Basophilic stippling of RBCs
Lead poisoning or sideroblastic anemia
146
Bloody or yellow tap on lumbar puncture
Subarachnoid hemorrhage
147
“Boot-shaped” heart on x-ray
Tetralogy of Fallot (due to RVH)
148
Branching gram-positive rods with sulfur granules
Actinomyces israelii
149
Bronchogenic apical lung tumor on imaging
Pancoast tumor (can compress cervical sympathetic chain and cause Horner syndrome)
150
“Brown” tumor of bone
Hyperparathyroidism or osteitis fibrosa cystica (deposited
| hemosiderin from hemorrhage gives brown color)
151
Cardiomegaly with apical atrophy
Chagas disease (Trypanosoma cruzi)
152
Cellular crescents in Bowman capsule
Rapidly progressive crescentic glomerulonephritis
153
“Chocolate cyst” of ovary
Endometriosis (frequently involves both ovaries)
154
Circular grouping of dark tumor cells surrounding pale
| neurofibrils
Homer-Wright rosettes (neuroblastoma, medulloblastoma)
155
Colonies of mucoid Pseudomonas in lungs
Cystic fibrosis (autosomal recessive mutation in CFTR gene fat-soluble vitamin deficiency and mucous plugs)
156
decreased AFP in amniotic fluid/maternal serum
Down syndrome or other chromosomal abnormalities
157
Degeneration of dorsal column fibers
Tabes dorsalis (3° syphilis), subacute combined degeneration (dorsal columns, lateral corticospinal, spinocerebellar tracts affected)
158
“Delta wave” on EKG, short PR interval, supraventricular
| tachycardia
Wolf-Parkinson-White syndrome (Bundle of Kent bypasses AV node)
159
Depigmentation of neurons in substantia nigra
```
Parkinson disease (basal ganglia disorder: rigidity, resting
tremor, bradykinesia)
```
160
Desquamated epithelium casts in sputum
```
Curschmann spirals (bronchial asthma; can result in whorled
mucous plugs)
```
161
Disarrayed granulosa cells arranged around collections of
| eosinophilic fluid
Call-Exner bodies (granulosa cell tumor of the ovary)
162
Dysplastic squamous cervical cells with “raisinoid” nuclei and
hyperchromasia
Koilocytes (HPV: predisposes to cervical cancer)
163
Electrical alternans (alternating amplitude on EKG)
Pericardial tamponade
164
Enlarged cells with intranuclear inclusion bodies
“Owl eye” appearance of CMV
165
Enlarged thyroid cells with ground-glass nuclei with central
| clearing
“Orphan Annie” eyes nuclei (papillary carcinoma of the
| thyroid)
166
Eosinophilic cytoplasmic inclusion in liver cell
Mallory body (alcoholic liver disease)
167
Eosinophilic cytoplasmic inclusion in nerve cell
Lewy body (Parkinson disease)
168
Eosinophilic globule in liver
```
Councilman body (viral hepatitis, yellow fever), represents
hepatocyte undergoing apoptosis
```
169
Eosinophilic inclusion bodies in cytoplasm of hippocampal
| and cerebellar neurons
Negri bodies of rabies
170
Extracellular amyloid deposition in gray matter of brain
Senile plaques (Alzheimer disease)
171
Giant B cells with bilobed nuclei with prominent inclusions
| “owl’s eye”
Reed-Sternberg cells (Hodgkin lymphoma
172
Glomerulus-like structure surrounding vessel in germ cells
Schiller-Duval bodies (yolk sac tumor)
173
“Hair on end” (“Crew-cut”) of the skull appearance on x-ray
β-thalassemia, sickle cell disease (marrow expansion)
174
hCG elevated
Choriocarcinoma, hydatidiform mole (occurs with and
| without embryo, and multiple pregnancy)
175
Heart nodules (granulomatous)
Aschoff bodies (rheumatic fever)
176
Heterophile antibodies
Infectious mononucleosis (EBV)
177
Hexagonal, double-pointed, needle-like crystals in bronchial
| secretions
```
Bronchial asthma (Charcot-Leyden crystals: eosinophilic
granules)
```
178
High level of d-dimers
DVT, PE, DIC
179
Hilar lymphadenopathy, peripheral granulomatous lesion in
| middle or lower lung lobes (can calcify)
Ghon complex (1° TB: Mycobacterium bacilli)
180
“Honeycomb lung” on x-ray or CT
Interstitial pulmonary fibrosis
181
Hypercoagulability (leading to migrating DVTs and vasculitis)
Trousseau syndrome (adenocarcinoma of pancreas or lung)
182
Hypersegmented neutrophils
```
Megaloblastic anemia (B12 deficiency: neurologic symptoms;
folate deficiency: no neurologic symptoms)
```
183
Hypertension, hypokalemia, metabolic alkalosis
Conn syndrome (primary hyperaldosteronism
184
Hypochromic, microcytic anemia
Iron deficiency anemia, lead poisoning, thalassemia (fetal
| hemoglobin sometimes present)
185
Increased AFP in amniotic fluid/maternal serum
Dating error, anencephaly, spina bifida (neural tube defects)
186
Increased uric acid levels
Gout, Lesch-Nyhan syndrome, tumor lysis syndrome, loop
| and thiazide diuretics
187
Intranuclear eosinophilic droplet-like bodies
Cowdry type A bodies (HSV or VZV)
188
Iron-containing nodules in alveolar septum
Ferruginous bodies (asbestosis: chance of mesothelioma)
189
Keratin pearls on a skin biopsy
Squamous cell carcinoma
190
Large granules in phagocytes, immunodeficiency
Chédiak-Higashi disease (congenital failure of phagolysosome
| formation)
191
“Lead pipe” appearance of colon on abdominal imaging
Ulcerative colitis (loss of haustra)
192
Linear appearance of IgG deposition on glomerular and
| alveolar basement membranes
Goodpasture syndrome
193
Low serum ceruloplasmin
Wilson disease (hepatolenticular degeneration)
194
“Lumpy bumpy” appearance of glomeruli on
| immunofluorescence
```
Poststreptococcal glomerulonephritis (due to deposition of
IgG, IgM, and C3)
```
195
Lytic (“punched-out”) bone lesions on x-ray
Multiple myeloma
196
Mammary gland (“blue domed”) cyst
Fibrocystic change of the breast
197
Monoclonal antibody spike
Multiple myeloma (usually IgG or IgA)
Monoclonal gammopathy of undetermined significance
(MGUS consequence of aging)
Waldenström (M protein = IgM) macroglobulinemia
Primary amyloidosis
198
Mucin-filled cell with peripheral nucleus
“Signet ring” (gastric carcinoma)
199
Narrowing of bowel lumen on barium x-ray
“String sign” (Crohn disease)
200
```
Necrotizing vasculitis (lungs) and necrotizing
glomerulonephritis
```
Granulomatosis with polyangiitis (Wegener; PR3-ANCA/
c-ANCA) and Goodpasture syndrome (anti–basement
membrane antibodies)
201
Needle-shaped, negatively birefringent crystals
Gout (monosodium urate crystals)
202
Nodular hyaline deposits in glomeruli
Kimmelstiel-Wilson nodules (diabetic nephropathy)
203
Novobiocin response
Sensitive: S. epidermidis; resistant: S. saprophyticus
204
“Nutmeg” appearance of liver
Chronic passive congestion of liver due to right heart failure
or Budd-Chiari syndrome
205
“Onion skin” periosteal reaction
Ewing sarcoma (malignant small blue cell tumor)
206
Optochin response
Sensitive: S. pneumoniae; resistant: viridans streptococci
| S. mutans, S. sanguis
207
Periosteum raised from bone, creating triangular area
Codman triangle on x-ray, Ewing sarcoma, pyogenic
| osteomyelitis)
208
Podocyte fusion or “effacement” on electron microscopy
Minimal change disease (child with nephrotic syndrome
209
Polished, “ivory-like” appearance of bone at cartilage erosion
Eburnation (osteoarthritis resulting in bony sclerosis)
210
Protein aggregates in neurons from hyperphosphorylation of
| tau protein
Neurofibrillary tangles (Alzheimer disease) and spherical Pick bodies (Pick disease)
211
Psammoma bodies
Meningiomas, papillary thyroid carcinoma, mesothelioma,
| papillary serous carcinoma of the endometrium and ovary
212
Pseudopalisading tumor cells on brain biopsy
Glioblastoma multiforme
213
RBC casts in urine
Glomerulonephritis
214
Rectangular, crystal-like, cytoplasmic inclusions in Leydig cells
Reinke crystals (Leydig cell tumor)
215
Recurrent infections, eczema, thrombocytopenia
Wiskott-Aldrich syndrome
216
Renal epithelial casts in urine
Intrinsic renal failure (e.g., ischemia or toxic injury)
217
Rhomboid crystals, positively birefringent
Pseudogout (calcium pyrophosphate dihydrate crystals)
218
Rib notching
Coarctation of the aorta
219
Ring-enhancing brain lesion in AIDS
Toxoplasma gondii, CNS lymphoma
220
Sheets of medium-sized lymphoid cells with scattered pale,
| tingible body–laden macrophages (“starry sky” histology)
```
Burkitt lymphoma (t[8:14] c-myc activation, associated with
EBV; “starry sky” made up of malignant cells)
```
221
Silver-staining spherical aggregation of tau proteins in
| neurons
```
Pick bodies (Pick disease: progressive dementia, changes in
personality)
```
222
“Soap bubble” in femur or tibia on x-ray
Giant cell tumor of bone (generally benign)
223
“Spikes” on basement membrane, “dome-like” subepithelial
| deposits
Membranous nephropathy (nephrotic syndrome)
224
Stacks of RBCs
Rouleaux formation (high ESR, multiple myeloma)
225
“Steeple” sign on CXR
Croup (parainfluenza virus)
226
Stippled vaginal epithelial cells
“Clue cells” (Gardnerella vaginalis
227
Streptococcus bovis bacteremia
Colon cancer
228
“Tennis racket”-shaped cytoplasmic organelles (EM) in
| Langerhans cells
Birbeck granules (Langerhans cell histiocytosis)
229
Thousands of polyps on colonoscopy
Familial adenomatous polyposis (autosomal dominant,
| mutation of APC gene)
230
Thrombi made of white/red layers
Lines of Zahn (arterial thrombus, layers of platelets/RBCs)
231
“Thumb sign” on lateral neck x-ray
Epiglottitis (Haemophilus influenzae)
232
Thyroid-like appearance of kidney
Chronic pyelonephritis (usually due to recurrent infections)
233
“Tram-track” appearance of capillary loops of glomerular
| basement membranes on light microscopy
Membranoproliferative glomerulonephritis
234
Triglyceride accumulation in liver cell vacuoles
Fatty liver disease (alcoholic or metabolic syndrome)
235
“Waxy” casts with very low urine flow
Chronic end-stage renal disease
236
WBC casts in urine
Acute pyelonephritis
237
WBCs that look “smudged”
CLL (almost always B cell)
238
“Wire loop” glomerular capillary appearance on light
| microscopy
Diffuse proliferative glomerulonephritis (usually seen with
| lupus)
239
Yellowish CSF
Xanthochromia (e.g., due to subarachnoid hemorrhage)
240
Tx:Absence seizures
Ethosuximide
241
Tx:Acute gout attack
NSAIDs, colchicine, glucocorticoids
242
Tx:Acute promyelocytic leukemia (M3)
All-trans retinoic acid
243
Tx:ADHD
Methylphenidate, CBT, atomoxetine
244
Tx:Alcoholism
Disulfiram, acamprosate, naltrexone, supportive care
245
Tx:Alcohol withdrawal
Long-acting benzodiazepines
246
Tx:Anorexia
Nutrition, psychotherapy, mirtazapine
247
Tx:Anticoagulation during pregnancy
Heparin
248
Tx:Arrhythmia in damaged cardiac tissue
Class IB antiarrhythmic (lidocaine, mexiletine)
249
Tx:B12 deficiency
Vitamin B12 supplementation (work up cause with Schilling test)
250
Tx:Benign prostatic hyperplasia
α1-antagonists, 5α-reductase inhibitors, PDE-5 inhibitors
251
Tx:Bipolar disorder
```
Mood stabilizers (e.g., lithium, valproic acid, carbamazepine),
atypical antipsychotics
```
252
Tx:Breast cancer in postmenopausal woman
Aromatase inhibitor (anastrozole)
253
Tx:Buerger disease
Smoking cessation
254
Tx:Bulimia nervosa
SSRIs
255
Tx:Candida albicans
Topical azoles (vaginitis); nystatin, fluconazole, caspofungin
(oral/esophageal); fluconazole, caspofungin, amphotericin B
(systemic)
256
Tx:Carcinoid syndrome
Octreotide
257
Tx:Chlamydia trachomatis
Doxycycline/Azithromycin (+ ceftriaxone for gonorrhea coinfection), erythromycin eye drops (prophylaxis in infants)
258
Tx:Chronic gout
Xanthine oxidase inhibitors (e.g., allopurinol, febuxostat
259
Tx:Chronic hepatitis B or C
IFN-α (HBV and HCV); ribavirin, simeprevir, sofosbuvir
| HCV
260
Tx:Chronic myelogenous leukemia
Imatinib
261
Tx:Clostridium botulinum
Antitoxin
262
Tx:Clostridium difficile
Oral metronidazole; if refractory, oral vancomycin
263
Tx:Clostridium tetani
Antitoxin
264
Tx:CMV
Ganciclovir, foscarnet, cidofovir
265
Tx:Crohn disease
Corticosteroids, infliximab, azathioprine
266
Tx:Cryptococcus neoformans
Fluconazole (in AIDS patients)
267
Tx:Cyclophosphamide-induced hemorrhagic cystitis
Mesna
268
Tx:Depression
SSRIs (first-line)
269
Tx:Diabetes insipidus
Desmopressin (central); hydrochlorothiazide, indomethacin,
| amiloride (nephrogenic)
270
Tx:Diabetes mellitus type 1
Dietary intervention (low carbohydrate) + insulin replacement
271
Tx:Diabetes mellitus type 2
Dietary intervention, oral hypoglycemics, and insulin (if
| refractory)
272
Tx:Diabetic ketoacidosis
Fluids, insulin, K+
273
Tx:Enterococci
Vancomycin, aminopenicillins/cephalosporins
274
Tx:Erectile dysfunction
Sildenafil, tadalafil, vardenafil
275
Tx:ER ⊕ breast cancer
Tamoxifen
276
Tx:Ethylene glycol/methanol intoxication
Fomepizole (alcohol dehydrogenase inhibitor)
277
Tx:Haemophilus influenzae (B)
Rifampin (prophylaxis)
278
Tx:Generalized anxiety disorder
SSRIs, SNRIs (first line); buspirone (second line)
279
Tx:Granulomatosis with polyangiitis (Wegener
Cyclophosphamide, corticosteroids
280
Tx:Heparin reversal
Protamine sulfate
281
Tx:HER2/neu ⊕ breast cancer
Trastuzumab
282
Tx:Hyperaldosteronism
Spironolactone
283
Tx:Hypercholesterolemia
Statin (first-line)
284
Tx:Hypertriglyceridemia
Fibrate
285
Tx:Immediate anticoagulation
Heparin
286
Tx:Infertility
Leuprolide, GnRH (pulsatile), clomiphene
287
Tx:Influenza
Oseltamivir, zanamivir
288
Tx:Kawasaki disease
IVIG, high-dose aspirin
289
Tx:Legionella pneumophila
Macrolides (e.g., azithromycin)
290
Tx:Long-term anticoagulation
Warfarin, dabigatran, rivaroxaban and apixaban
291
Tx:Malaria
Chloroquine, mefloquine, atovaquone/proguanil (for blood
| schizont), primaquine (for liver hypnozoite)
292
Tx:Malignant hyperthermia
Dantrolene
293
Tx:Medical abortion
Mifepristone
294
Tx:Migraine
```
Abortive therapies (e.g., sumatriptan, NSAIDs); prophylaxis
(e.g., propranolol, topiramate, CCBs, amitriptyline)
```
295
Tx:Multiple sclerosis
Disease-modifying therapies (e.g., β-interferon, natalizumab);
for acute flares, use IV steroids
296
Tx:Mycobacterium tuberculosis
RIPE (rifampin, isoniazid, pyrazinamide, ethambutol)
297
Tx:Neisseria gonorrhoeae
Ceftriaxone (add doxycycline/azizthromycin to cover likely concurrent C. trachomatis)
298
Tx:Neisseria meningitidis
Penicillin/ceftriaxone, rifampin (prophylaxis)
299
Tx:Neural tube defect prevention
Prenatal folic acid
300
Tx:Osteomalacia/rickets
Vitamin D supplementation
301
Tx:Osteoporosis
Calcium/vitamin D supplementation (prophylaxis);
bisphosphonates, PTH analogs, SERMs, calcitonin,
denosumab (treatment)
302
Tx:Patent ductus arteriosus
Close with indomethacin; open or maintain with PGE
| analogs
303
Tx:Pheochromocytoma
α-antagonists (e.g., phenoxybenzamine)
304
Tx:Pneumocystis jirovecii
TMP-SMX (prophylaxis in AIDS patient)
305
Tx:Prolactinoma
Cabergoline/bromocriptine (dopamine agonists)
306
Tx:Prostate adenocarcinoma/uterine fibroids
Leuprolide, GnRH (continuous)
307
Tx:Prostate adenocarcinoma
Flutamide
308
Tx:Pseudomonas aeruginosa
Antipseudomonal penicillins, aminoglycosides, carbapenems
309
Tx:Pulmonary arterial hypertension (idiopathic)
Sildenafil, bosentan, epoprostenol
310
Tx:Rickettsia rickettsii
Doxycycline, chloramphenicol
311
Tx:Schizophrenia (negative symptoms)
Atypical antipsychotics
312
Tx:Schizophrenia (positive symptoms)
Typical and atypical antipsychotics
313
Tx:SIADH
Fluid restriction, IV hypertonic saline, conivaptan/tolvaptan,
demeclocycline
314
Tx:Sickle cell disease
Hydroxyurea ( fetal hemoglobin)
315
Tx:Sporothrix schenckii
Itraconazole, oral potassium iodide
316
Tx:Stable angina
Sublingual nitroglycerin
317
Tx:Staphylococcus aureus
MSSA: nafcillin, oxacillin, dicloxacillin (antistaphylococcal
penicillins); MRSA: vancomycin, daptomycin, linezolid,
ceftaroline
318
Tx:Streptococcus bovis
Penicillin prophylaxis; evaluation for colon cancer if linked to
endocarditis
319
Tx:Streptococcus pneumoniae
Penicillin/cephalosporin (systemic infection, pneumonia),
| vancomycin (meningitis)
320
Tx:Streptococcus pyogenes
Penicillin prophylaxis
321
Tx:Temporal arteritis
High-dose steroids
322
Tx:Tonic-clonic seizures
Levetiracetam, phenytoin, valproate, carbamazepine
323
Tx:Toxoplasma gondii
Sulfadiazine + pyrimethamine
324
Tx:Treponema pallidum
Penicillin
325
Tx:Trichomonas vaginalis
Metronidazole (patient and partner)
326
Tx:Trigeminal neuralgia (tic douloureux)
Carbamazepine
327
Tx:Ulcerative colitis
5-ASA preparations (e.g., mesalamine), 6-mercaptopurine,
| infliximab, colectomy
328
Tx:UTI prophylaxis
TMP-SMX
329
Tx:Warfarin reversal
Fresh frozen plasma (acute), vitamin K (chronic)
330
Actinic (solar) keratosis
Precursor to squamous cell carcinoma
331
Acute gastric ulcer associated with CNS injury
```
Cushing ulcer ( intracranial pressure stimulates vagal gastric
H+ secretion)
```
332
Acute gastric ulcer associated with severe burns
```
Curling ulcer (greatly reduced plasma volume results in
sloughing of gastric mucosa)
```
333
Alternating areas of transmural inflammation and normal
| colon
Skip lesions (Crohn disease)
334
Aortic aneurysm, abdominal
Atherosclerosis
335
Aortic aneurysm, ascending or arch
3° syphilis (syphilitic aortitis), vasa vasorum destruction
336
Aortic aneurysm, thoracic
Marfan syndrome (idiopathic cystic medial degeneration)
337
Aortic dissection
Hypertension
338
Atrophy of the mammillary bodies
```
Wernicke encephalopathy (thiamine deficiency causing
ataxia, ophthalmoplegia, and confusion)
```
339
Autosplenectomy (fibrosis and shrinkage)
Sickle cell disease (hemoglobin S)
340
Bacteria associated with gastritis, peptic ulcer disease, and
stomach cancer
H. pylori
341
Bacterial meningitis (adults and elderly)
S. pneumoniae
342
Bacterial meningitis (newborns and kids)
Group B streptococcus/E.coli/Listeria (newborns),
| S. pneumoniae/N. meningitidis (kids/teens)
343
Bilateral ovarian metastases from gastric carcinoma
Krukenberg tumor (mucin-secreting signet ring cells)
344
Bleeding disorder with GpIb deficiency
Bernard-Soulier syndrome (defect in platelet adhesion to von
| Willebrand factor)
345
Brain tumor (adults)
Supratentorial: metastasis, astrocytoma (including
| glioblastoma multiforme), meningioma, schwannoma
346
Brain tumor (kids)
Infratentorial: medulloblastoma (cerebellum) or
supratentorial: craniopharyngioma
347
Breast tumor (benign)
Fibroadenoma
348
Cardiac 1° tumor (kids)
Rhabdomyoma, often seen in tuberous sclerosis
349
Cardiac manifestation of lupus
Marantic/thrombotic endocarditis (nonbacterial) - Libmann Sachs
350
Cardiac tumor (adults)
Metastasis, myxoma (90% in left atrium; “ball and valve”)
351
Cerebellar tonsillar herniation
Chiari II malformation
352
Chronic arrhythmia
Atrial fibrillation (associated with high risk of emboli)
353
Chronic atrophic gastritis (autoimmune)
Predisposition to gastric carcinoma (can also cause pernicious
anemia)
354
Clear cell adenocarcinoma of the vagina
DES exposure in utero
355
Congenital adrenal hyperplasia, hypotension
21-hydroxylase deficiency
356
Congenital conjugated hyperbilirubinemia (black liver)
Dubin-Johnson syndrome (inability of hepatocytes to secrete
| conjugated bilirubin into bile)
357
Constrictive pericarditis
TB (developing world); idiopathic, viral illness (developed
| world)
358
Coronary artery involved in thrombosis
LAD > RCA > circumflex
359
Cretinism
Iodine deficit/congenital hypothyroidism
360
Cushing syndrome
Iatrogenic (from corticosteroid therapy)
Adrenocortical adenoma (secretes excess cortisol)
ACTH-secreting pituitary adenoma (Cushing disease)
Paraneoplastic (due to ACTH secretion by tumors)
361
Cyanosis (early; less common)
Tetralogy of Fallot, transposition of great vessels, truncus
| arteriosus
362
Cyanosis (late; more common)
VSD, ASD, PDA
363
Death in CML
Blast crisis
364
Death in SLE
Lupus nephropathy
365
Demyelinating disease in young women
Multiple sclerosis
366
DIC
Severe sepsis, obstetric complications, cancer, burns, trauma,
major surgery
367
Diverticulum in pharynx
Zenker diverticulum (diagnosed by barium swallow)
368
Ejection click
Aortic stenosis
369
Esophageal cancer
Squamous cell carcinoma (worldwide); adenocarcinoma
| U.S.
370
Food poisoning (exotoxin mediated)
S. aureus, B. cereus
| fast, within a few hours
371
Glomerulonephritis (adults)
Berger disease (IgA nephropathy)
372
Gynecologic malignancy
```
Endometrial carcinoma (most common in U.S.); cervical
carcinoma (most common worldwide)
```
373
Heart valve in bacterial endocarditis
Mitral > aortic (rheumatic fever), tricuspid (IV drug
| abuse)
374
Helminth infection (U.S.)
Enterobius vermicularis, Ascaris lumbricoides
375
Hematoma—epidural
Rupture of middle meningeal artery (trauma; lentiform
| shaped)
376
Hematoma—subdural
Rupture of bridging veins (crescent shaped)
377
Hemochromatosis
Multiple blood transfusions or hereditary HFE mutation
(can result in heart failure, “bronze diabetes,” and risk of
hepatocellular carcinoma)
378
Hepatocellular carcinoma
```
Cirrhotic liver (associated with hepatitis B and C and with
alcoholism)
```
379
Hereditary bleeding disorder most common
von Willebrand disease
380
Hereditary harmless jaundice
```
Gilbert syndrome (benign congenital unconjugated
hyperbilirubinemia)
```
381
Hypercoagulability, endothelial damage, blood stasis
Virchow triad ( risk of thrombosis)
382
Hypertension, 2°
Renal disease
383
Infection 2° to blood transfusion
Hepatitis C
384
Infections in chronic granulomatous disease
S. aureus, E. coli, Aspergillus (catalase ⊕)
385
Intellectual disability
Down syndrome, fragile X syndrome
386
Kidney stones
Calcium = radiopaque
Struvite (ammonium) = radiopaque (formed by urease
⊕ organisms such as Klebsiella, Proteus species, and
S. saprophyticus)
Uric acid = radiolucent
387
Malignancy associated with noninfectious fever
Hodgkin lymphoma
388
Malignancy (kids)
ALL, medulloblastoma (cerebellum)
389
Metastases to bone
Prostate, breast > lung > thyroid
390
Metastases to brain
Lung > breast > genitourinary > melanoma > GI
391
Metastases to liver
Colon >> stomach, pancreas
392
Mitochondrial inheritance
Disease occurs in both males and females, inherited through
| females only
393
Mitral valve stenosis
Rheumatic heart disease
394
Mixed (UMN and LMN) motor neuron disease
Amyotrophic lateral sclerosis
395
Myocarditis
Coxsackie B
396
Nephrotic syndrome (adults)
Focal segmental glomerulosclerosis
397
Nephrotic syndrome (kids)
Minimal change disease
398
Neuron migration failure
```
Kallmann syndrome (hypogonadotropic hypogonadism and
anosmia)
```
399
Nosocomial pneumonia
S. aureus, Pseudomonas, other enteric gram-negative rods
400
Obstruction of male urinary tract
BPH
401
Opening snap
Mitral stenosis
402
Osteomyelitis
S. aureus (most common overall)
| Salmonella (sickle cell)
403
Osteomyelitis with IV drug use
Pseudomonas, Candida, S. aureus
404
Ovarian tumor (benign, bilateral)
Serous cystadenoma
405
Ovarian tumor (malignant
Serous cystadenocarcinoma
406
Recurrent inflammation/thrombosis of small/medium vessels
| in extremities
Buerger disease (strongly associated with tobacco)
407
SIADH
Small cell carcinoma of the lung
408
Site of diverticula
Sigmoid colon
409
Sites of atherosclerosis
Abdominal aorta > coronary artery > popliteal artery
| > carotid artery
410
Stomach cancer
Adenocarcinoma
411
t(14;18)
```
Follicular lymphomas (BCL-2 activation, anti-apoptotic
oncogene)
```
412
t(8;14)
```
Burkitt lymphoma (c-myc fusion, transcription factor
oncogene
```
413
t(9;22)
Philadelphia chromosome, CML (BCR-ABL activation,
| tyrosine kinase oncogene)
414
Temporal arteritis
Risk of ipsilateral blindness due to occlusion of ophthalmic
| artery; polymyalgia rheumatica
415
Testicular tumor
Seminoma (malignant, radiosensitive
416
Thyroid cancer
Papillary carcinoma
417
Tumor of the adrenal medulla (adults)
Pheochromocytoma (usually benign)
418
Tumor of the adrenal medulla (kids)
Neuroblastoma (malignant)
419
Type of Hodgkin lymphoma
```
Nodular sclerosing (vs. mixed cellularity, lymphocytic
predominance, lymphocytic depletion)
```
420
UTI
E. coli, Staphylococcus saprophyticus (young women)
421
Vertebral compression fracture
Osteoporosis (type I: postmenopausal woman; type II: elderly
| man or woman)
422
Viral encephalitis affecting temporal lobe
HSV-1
423
Vitamin deficiency (U.S.)
Folate (pregnant women are at high risk; body stores only 3- to
4-month supply; prevents neural tube defects)
