First Aid USMLE 1 - Rapid Review Common Presentations Flashcards
1
Q
Abdominal pain, ascites, hepatomegaly
A
Budd-Chiari syndrome (posthepatic venous thrombosis)
2
Q
Achilles tendon xanthoma
A
Familial hypercholesterolemia ( LDL receptor signaling)
3
Q
Adrenal hemorrhage, hypotension, DIC
A
Waterhouse-Friderichsen syndrome (meningococcemia)
4
Q
Arachnodactyly, lens dislocation, aortic dissection,
hyperflexible joints
A
Marfan syndrome (fibrillin defect)
5
Q
Athlete with polycythemia
A
2° to erythropoietin injection
6
Q
Back pain, fever, night sweats, weight loss
A
Pott disease (vertebral TB)
7
Q
Bilateral hilar adenopathy, uveitis
A
Sarcoidosis (noncaseating granulomas)
8
Q
Blue sclera
A
Osteogenesis imperfecta (type I collagen defect)
9
Q
Bluish line on gingiva
A
Burton line (lead poisoning)
10
Q
Bone pain, bone enlargement, arthritis
A
Paget disease of bone ( osteoblastic and osteoclastic activity)
11
Q
Bounding pulses, diastolic heart murmur, head bobbing
A
Aortic regurgitation
12
Q
“Butterfly” facial rash and Raynaud phenomenon in a young female
A
Systemic lupus erythematosus
13
Q
Café-au-lait spots, Lisch nodules (iris hamartoma)
A
Neurofibromatosis type I (+ pheochromocytoma, optic
gliomas)
14
Q
Café-au-lait spots, polyostotic fibrous dysplasia, precocious
puberty, multiple endocrine abnormalities
A
McCune-Albright syndrome (mosaic G-protein signaling
mutation)
15
Q
Calf pseudohypertrophy
A
Muscular dystrophy (most commonly Duchenne): X-linked recessive deletion of dystrophin gene
16
Q
“Cherry-red spots” on macula
A
Tay-Sachs (ganglioside accumulation) or Niemann-Pick
(sphingomyelin accumulation), central retinal artery occlusion
17
Q
Chest pain on exertion
A
Angina (stable: with moderate exertion; unstable: with
minimal exertion)
18
Q
Chest pain, pericardial effusion/friction rub, persistent fever
following MI
A
Dressler syndrome (autoimmune-mediated post-MI fibrinous pericarditis, 1–12 weeks after acute episode)
19
Q
Child uses arms to stand up from squat
A
Gowers sign (Duchenne muscular dystrophy)
20
Q
Child with fever later develops red rash on face that spreads to body
A
“Slapped cheeks” (erythema infectiosum/fifth disease:
parvovirus B19)
21
Q
Chorea, dementia, caudate degeneration
A
Huntington disease (autosomal dominant CAG repeat expansion)
22
Q
Chronic exercise intolerance with myalgia, fatigue, painful
cramps, myoglobinuria
A
McArdle disease (muscle glycogen phosphorylase deficiency)
23
Q
Cold intolerance
A
Hypothyroidism
24
Q
Conjugate lateral gaze palsy, horizontal diplopia
A
Internuclear ophthalmoplegia (damage to MLF; bilateral [multiple sclerosis], unilateral [stroke])
25
Continuous “machine-like” heart murmur
PDA (close with indomethacin; open or maintain with
| misoprostol)
26
Dark purple skin/mouth nodules in a patient with AIDS
Kaposi sarcoma, associated with HHV-8
27
Deep, labored breathing/hyperventilation
Kussmaul respirations (diabetic ketoacidosis)
28
Dermatitis, dementia, diarrhea
Pellagra (niacin [vitamin B3] deficiency)
29
Dilated cardiomyopathy, edema, alcoholism or malnutrition
Wet beriberi (thiamine [vitamin B1] deficiency)
30
Dog or cat bite resulting in infection
Pasteurella multocida (cellulitis at inoculation site)
31
Dry eyes, dry mouth, arthritis
Sjögren syndrome (autoimmune destruction of exocrine
| glands)
32
Dysphagia (esophageal webs), glossitis, iron deficiency
| anemia
Plummer-Vinson syndrome (may progress to esophageal
| squamous cell carcinoma)
33
Elastic skin, hypermobility of joints
Ehlers-Danlos syndrome (type III collagen defect)
34
Enlarged, hard left supraclavicular node
Virchow node (abdominal metastasis)
35
Erythroderma, lymphadenopathy, hepatosplenomegaly,
| atypical T cells
```
Mycosis fungoides (cutaneous T-cell lymphoma) or Sézary
syndrome (mycosis fungoides + malignant T cells in blood)
```
36
Facial muscle spasm upon tapping
Chvostek sign (hypocalcemia)
37
Fat, female, forty, and fertile
Cholelithiasis (gallstones)
38
Fever, chills, headache, myalgia following antibiotic
| treatment for syphilis
Jarisch-Herxheimer reaction (rapid lysis of spirochetes results in toxin release)
39
Cutaneous/dermal edema due to connective tissue deposition
Myxedema (caused by hypothyroidism, Graves disease
| [pretibial])
40
Fever, cough, conjunctivitis, coryza, diffuse rash
Measles
41
Fever, night sweats, weight loss
B symptoms (staging) of lymphoma
42
Fibrous plaques in soft tissue of penis
Peyronie disease (connective tissue disorder)
43
Gout, intellectual disability, self-mutilating behavior in a boy
Lesch-Nyhan syndrome (HGPRT deficiency, X-linked
| recessive)
44
Green-yellow rings around peripheral cornea
Kayser-Fleischer rings (copper accumulation from Wilson
| disease)
45
Hamartomatous GI polyps, hyperpigmentation of
| mouth/feet/hands
Peutz-Jeghers syndrome (inherited, benign polyposis can
| cause bowel obstruction; cancer risk, mainly GI)
46
Hepatosplenomegaly, osteoporosis, neurologic
| symptoms
Gaucher disease (glucocerebrosidase deficiency)
47
Indurated, ulcerated genital lesion
Nonpainful: chancre (1° syphilis, Treponema pallidum)
| Painful, with exudate: chancroid (Haemophilus ducreyi)
48
Hereditary nephritis, sensorineural hearing loss,
| cataracts
Alport syndrome (mutation in collagen IV)
49
Hyperphagia, hypersexuality, hyperorality,
| hyperdocility
Klüver-Bucy syndrome (bilateral amygdala lesion)
50
Hyperreflexia, hypertonia, Babinski sign present
UMN damage
51
Hyporeflexia, hypotonia, atrophy, fasciculations
LMN damage
52
Hypoxemia, polycythemia, hypercapnia
“Blue bloater” (chronic bronchitis: hyperplasia of mucous
| cells)
53
Infant with cleft lip/palate, microcephaly or
| holoprosencephaly, polydactyly, cutis aplasia
Patau syndrome (trisomy 13)
54
Infant with failure to thrive, hepatosplenomegaly, and
| neurodegeneration
Niemann-Pick disease (genetic sphingomyelinase deficiency)
55
Infant with hypoglycemia, failure to thrive, and hepatomegaly
Cori disease (debranching enzyme deficiency) or Von Gierke disease (glucose-6-phosphatase deficiency, more severe)
56
Infant with microcephaly, rocker-bottom feet, clenched
| hands, and structural heart defect
Edwards syndrome (trisomy 18)
57
Jaundice, palpable distended non-tender gallbladder
Courvoisier sign (distal obstruction of biliary tree)
58
Large rash with bull’s-eye appearance
Erythema chronicum migrans from Ixodes tick bite (Lyme
| disease: Borrelia)
59
Lucid interval after traumatic brain injury
```
Epidural hematoma (middle meningeal artery
rupture)
```
60
Male child, recurrent infections, no mature B cells
Bruton disease (X-linked agammaglobulinemia)
61
Mucosal bleeding and prolonged bleeding time
```
Glanzmann thrombasthenia (defect in platelet aggregation
due to lack of GpIIb/IIIa)
```
62
Muffled heart sounds, distended neck veins, hypotension
Beck triad of cardiac tamponade
63
Multiple colon polyps, osteomas/soft tissue tumors, impacted/ supernumerary teeth
Gardner syndrome (subtype of FAP)
64
Myopathy (infantile hypertrophic cardiomyopathy), exercise
| intolerance
Pompe disease (lysosomal α-1,4-glucosidase deficiency)
65
Neonate with arm paralysis following difficult birth
Erb-Duchenne palsy (superior trunk [C5–C6] brachial plexus
| injury: “waiter’s tip”)
66
No lactation postpartum, absent menstruation, cold
| intolerance
Sheehan syndrome (pituitary infarction)
67
Nystagmus, intention tremor, scanning speech, bilateral
| internuclear ophthalmoplegia
Multiple sclerosis
68
Oscillating slow/fast breathing
Cheyne-Stokes respirations (central apnea in CHF or
| intracranial pressure)
69
Painful blue fingers/toes, hemolytic anemia
Cold agglutinin disease (autoimmune hemolytic
anemia caused by Mycoplasma pneumoniae, infectious
mononucleosis)
70
Painful, pale, cold fingers/toes
Raynaud phenomenon (vasospasm in extremities)
71
Painful, raised red lesions on pad of fingers/toes
```
Osler nodes (infective endocarditis, immune complex
deposition)
```
72
Painless erythematous lesions on palms and soles
```
Janeway lesions (infective endocarditis, septic emboli/
microabscesses)
```
73
Painless jaundice
Cancer of the pancreatic head obstructing bile duct
74
Palpable purpura on buttocks/legs, joint pain, abdominal pain (child), hematuria
Henoch-Schönlein purpura (IgA vasculitis affecting skin and
| kidneys)
75
Pancreatic, pituitary, parathyroid tumors
MEN 1 (autosomal dominant)
76
Periorbital and/or peripheral edema, proteinuria,
| hypoalbuminemia, hypercholesterolemia
Nephrotic syndrome
77
Pink complexion, dyspnea, hyperventilation
“Pink puffer” (emphysema: centriacinar [smoking], panacinar
| [α1-antitrypsin deficiency])
78
Polyuria, renal tubular acidosis type II, growth failure,
| electrolyte imbalances, hypophosphatemic rickets
Fanconi syndrome (proximal tubular reabsorption defect)
79
Pruritic, purple, polygonal planar papules and plaques (6 P’s)
Lichen planus
80
Ptosis, miosis, anhidrosis
Horner syndrome (sympathetic chain lesion)
81
Pupil accommodates but doesn’t react
Argyll Robertson pupil (neurosyphilis)
82
Rapidly progressive leg weakness that ascends following GI/upper respiratory infection
Guillain-Barré syndrome (acute autoimmune inflammatory
| demyelinating polyneuropathy)
83
Single palmar crease
Down syndrome
84
Short stature, incidence of tumors/leukemia, aplastic
| anemia
Fanconi anemia (genetic loss of DNA crosslink repair; often progresses to AML)
85
Severe RLQ pain with rebound tenderness
McBurney sign (acute appendicitis)
86
Severe RLQ pain with palpation of LLQ
Rovsing sign (acute appendicitis)
87
Severe jaundice in neonate
Crigler-Najjar syndrome (congenital unconjugated
| hyperbilirubinemia)
88
Retinal hemorrhages with pale centers
Roth spots (bacterial endocarditis)
89
Rash on palms and soles
Coxsackie A, 2° syphilis, Rocky Mountain spotted fever
90
Resting tremor, rigidity, akinesia, postural instability
Parkinson disease (nigrostriatal dopamine depletion)
91
Renal cell carcinoma (bilateral), hemangioblastomas,
| angiomatosis, pheochromocytoma
von Hippel-Lindau disease (dominant tumor suppressor gene mutation)
92
Red “currant jelly” sputum in alcoholic or diabetic patients
Klebsiella pneumoniae
93
Red “currant jelly” stools
Acute mesenteric ischemia (adults), intussusception (infants)
94
Red urine in the morning, fragile RBCs
Paroxysmal nocturnal hemoglobinuria
95
Red, itchy, swollen rash of nipple/areola
Paget disease of the breast (sign of underlying neoplasm)
96
Recurrent colds, unusual eczema, high serum
IgE Hyper-IgE syndrome (Job syndrome: neutrophil chemotaxis abnormality)
97
Situs inversus, chronic sinusitis, bronchiectasis, infertility
Kartagener syndrome (dynein arm defect affecting cilia)
98
“Worst headache of my life”
Subarachnoid hemorrhage
99
Weight loss, diarrhea, arthritis, fever, adenopathy
Whipple disease (Tropheryma whipplei)
100
Vomiting blood following gastroesophageal lacerations
Mallory-Weiss syndrome (alcoholic and bulimic patients)
101
Vascular birthmark (port-wine stain)
Hemangioma (benign, but associated with Sturge-Weber syndrome)
102
Urethritis, conjunctivitis, arthritis in a male
Reactive arthritis associated with HLA-B27 (Reiter's syndrome)
103
Unilateral facial drooping involving forehead
Facial nerve (LMN CN VII palsy)
104
Toe extension/fanning upon plantar scrape
Babinski sign (UMN lesion)
105
Thyroid tumors, pheochromocytoma, ganglioneuromatosis
MEN 2B (autosomal dominant ret mutation)
106
Thyroid and parathyroid tumors, pheochromocytoma
MEN 2A (autosomal dominant ret mutation)
107
Skin hyperpigmentation, hypotension, fatigue
```
Addison disease (1° adrenocortical insufficiency causes
ACTH and α-MSH production)
```
108
Systolic ejection murmur (crescendo-decrescendo)
Aortic valve stenosis
109
Swollen, hard, painful finger joints
Osteoarthritis (osteophytes on PIP [Bouchard nodes], DIP
| [Heberden nodes])
110
Swollen gums, mucosal bleeding, poor wound healing,
| petechiae
Scurvy (vitamin C deficiency: can’t hydroxylate proline/lysine for collagen synthesis)
111
Sudden swollen/painful big toe joint, tophi
Gout/podagra (hyperuricemia)
112
Streak ovaries, congenital heart disease, horseshoe kidney, cystic hygroma at birth, short stature, webbed neck, lymphedema
Turner syndrome (45,XO)
113
“Strawberry tongue”
Scarlet fever, Kawasaki disease, toxic shock syndrome
114
Splinter hemorrhages in fingernails
Bacterial endocarditis
115
Smooth, flat, moist, painless white lesions on genitals
Condylomata lata (2° syphilis)
116
Slow, progressive muscle weakness in boys
Becker muscular dystrophy (X-linked missense mutation in
| dystrophin; less severe than Duchenne)
117
Small, irregular red spots on buccal/lingual mucosa with
| blue-white centers
Koplik spots (measles; rubeola virus)
118
Anticentromere antibodies
Scleroderma (CREST)
119
Antidesmoglein (epithelial) antibodies
Pemphigus vulgaris (blistering)
120
Basophilic nuclear remnants in RBCs
Howell-Jolly bodies (due to splenectomy or nonfunctional
| spleen)
121
“Bamboo spine” on x-ray
```
Ankylosing spondylitis (chronic inflammatory arthritis:
HLA-B27)
```
122
Bacitracin response
```
Sensitive: Streptococcus pyogenes (group A); resistant:
Streptococcus agalactiae (group B)
```
123
Anti–glomerular basement membrane antibodies
Goodpasture syndrome (glomerulonephritis and hemoptysis)
124
Azurophilic peroxidase granular inclusions in granulocytes and myeloblasts
Auer rods (AML, especially the promyelocytic [M3] type)
125
“Apple core” lesion on abdominal x-ray
Colorectal cancer (usually left-sided)
126
Anti-IgG antibodies
```
Rheumatoid arthritis (systemic inflammation, joint pannus,
boutonnière deformity)
```
127
Antihistone antibodies
Drug-induced SLE (hydralazine, INH, phenytoin,
| procainamide)
128
Antimitochondrial antibodies (AMAs)
1° biliary cirrhosis (female, cholestasis, portal hypertension)
129
Antineutrophil cytoplasmic antibodies (ANCAs)
Microscopic polyangiitis and Churg-Strauss syndrome
(MPO-ANCA/p-ANCA); granulomatosis with polyangiitis
(Wegener; PR3-ANCA/c-ANCA)
130
Antinuclear antibodies (ANAs: anti-Smith and anti-dsDNA)
SLE (type III hypersensitivity)
131
Anti-transglutaminase/anti-gliadin/anti-endomysial
| antibodies
Celiac disease (diarrhea, distention, weight loss)
132
Antiplatelet antibodies
Idiopathic thrombocytopenic purpura
133
Anti-topoisomerase antibodies
Diffuse systemic scleroderma
134
Basophilic stippling of RBCs
Lead poisoning or sideroblastic anemia
135
Bloody tap on LP
Subarachnoid hemorrhage
136
“Boot-shaped” heart on x-ray
Tetralogy of Fallot, RVH
137
Branching gram-positive rods with sulfur granules
Actinomyces israelii
138
Disarrayed granulosa cells in eosinophilic fluid
Call-Exner bodies (granulosa-theca cell tumor of the ovary)
139
Desquamated epithelium casts in sputum
Curschmann spirals (bronchial asthma; can result in whorled mucous plugs)
140
Bronchogenic apical lung tumor on imaging
```
Pancoast tumor (can compress sympathetic ganglion and
cause Horner syndrome)
```
141
Depigmentation of neurons in substantia nigra
```
Parkinson disease (basal ganglia disorder: rigidity, resting
tremor, bradykinesia)
```
142
“Chocolate cyst” of ovary
Endometriosis (frequently involves both ovaries)
143
“Brown” tumor of bone
Hyperparathyroidism or osteitis fibrosa cystica (deposited
| hemosiderin from hemorrhage gives brown color)
144
Cardiomegaly with apical atrophy
Chagas disease (Trypanosoma cruzi)
145
Cellular crescents in Bowman capsule
Rapidly progressive crescentic glomerulonephritis
146
Circular grouping of dark tumor cells surrounding pale
| neurofibrils
Homer-Wright rosettes (neuroblastoma, medulloblastoma,
| retinoblastoma)
147
Colonies of mucoid Pseudomonas in lungs
```
Cystic fibrosis (autosomal recessive mutation in CFTR gene
fat-soluble vitamin deficiency and mucous plugs)
```
148
AFP in amniotic fluid/maternal serum
Down syndrome or other chromosomal abnormality
149
Degeneration of dorsal column nerves
```
Tabes dorsalis (3° syphilis), subacute combined degeneration
(dorsal columns and lateral corticospinal tracts affected)
```
