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Usmle Step 1 First Aid > Lessons 1 > Flashcards

Lessons 1 Flashcards

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USMLE® Step 1 flashcards
1
Q

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

A

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

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2
Q

Situs inversus, chronic sinusitis, bronchiectasis, infertility

A

Kartagener syndrome (dynein arm defect affecting cilia)

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3
Q

Blue sclera

A

Osteogenesis imperfecta (type I collagen defect)

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4
Q

Elastic skin, hypermobility of joints,bleeding tendency

A

Ehlers-Danlos syndrome (type V collagen defect, type III collagen defect seen in vascular subtype of ED)

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5
Q

Arachnodactyly, lens dislocation (upward and temporal), aortic dissection, hyperflexible joints

A

Marfan syndrome (fibrillin defect)

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6
Q

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

A

McCune-Albright syndrome (Gs-protein activating mutation)

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7
Q

Calf pseudohypertrophy

A

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

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8
Q

Child uses arms to stand up from squat

A

Duchenne muscular dystrophy (Gowers sign)

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9
Q

Slow, progressive muscle weakness in boys

A

Becker muscular dystrophy (X-linked non-frameshift deletions in dystrophin; less severe than Duchenne)

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10
Q

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

A

Patau syndrome (trisomy 13)

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11
Q

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

A

Edwards syndrome (trisomy 18)

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12
Q

Single palmar crease

A

Down syndrome

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13
Q

Dilated cardiomyopathy, edema, alcoholism or malnutrition

A

Wet beriberi (thiamine [vitamin B1] deficiency)

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14
Q

Dermatitis, dementia, diarrhea

A

Pellagra (niacin [vitamin B3] deficiency)

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15
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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16
Q

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

A

McArdle disease (skeletal muscle glycogen phosphorylase deficiency)

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17
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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18
Q

Myopathy (infantile hypertrophic cardiomyopathy), exercise intolerance

A

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

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19
Q

Cherry-red spots” on macula

A

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

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20
Q

Hepatosplenomegaly, pancytopenia, osteoporosis, avascular necrosis of femoral head, bone crises

A

Gaucher disease (glucocerebrosidase [β-glucosidase] deficiency)

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21
Q

Achilles tendon xanthoma

A

Familial hypercholesterolemia (LDL receptor signaling

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22
Q

Anaphylaxis following blood transfusion

A

IgA deficiency

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23
Q

Male child, recurrent infections, no mature B cells

A

Bruton disease (X-linked agammaglobulinemia)

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24
Q

Recurrent cold (noninflamed) abscesses, eczema, high

A

Hyper-IgE syndrome (Job syndrome: neutrophil serum IgE,eosinophils chemotaxis abnormality)

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25
Q

Strawberry tongue”

A

Scarlet fever Kawasaki disease

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26
Q

Abdominal pain, diarrhea, leukocytosis, recent antibiotic

A

Clostridium difficile infection

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27
Q

Back pain, fever, night sweats

A

Pott disease (vertebral TB)

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28
Q

Adrenal hemorrhage, hypotension, DIC

A

Waterhouse-Friderichsen syndrome (meningococcemia)

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29
Q

Red “currant jelly” sputum in alcoholic or diabetic

A

Klebsiella pneumoniae pneumonia

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30
Q

Large rash with bull’s-eye appearance

A

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

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31
Q

Ulcerated genital lesion

A

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

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32
Q

Pupil accommodates but doesn’t react

A

Neurosyphilis (Argyll Robertson pupil)

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33
Q

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

A

Condylomata lata (2° syphilis) genitals

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34
Q

Fever, chills, headache, myalgia following antibiotic

A

Jarisch-Herxheimer reaction (rapid lysis of spirochetes treatment for syphilis results in endotoxin-like release)

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35
Q

Dog or cat bite resulting in infection

A

Pasteurella multocida (cellulitis at inoculation site)

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36
Q

Rash on palms and soles

A

Coxsackie A, 2° syphilis, Rocky Mountain spotted fever

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37
Q

Black eschar on face of patient with diabetic ketoacidosis

A

Mucor or Rhizopus fungal infection

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38
Q

Chorioretinitis, hydrocephalus, intracranial calcifications

A

Congenital toxoplasmosis

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39
Q

Child with fever later develops red rash on face that

A

Erythema infectiosum/fifth disease (“slapped cheeks” spreads to body appearance, caused by parvovirus B19)

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40
Q

Fever, cough, conjunctivitis, coryza, diffuse rash

A

Measles

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41
Q

Small, irregular red spots on buccal/lingual mucosa with

A

Koplik spots (measles [rubeola] virus) blue-white centers

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42
Q

Bounding pulses, wide pulse pressure, diastolic heart murmur, head bobbing

A

Aortic regurgitation

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43
Q

Systolic ejection murmur (crescendo-decrescendo)

A

Aortic stenosis

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44
Q

Continuous “machine-like” heart murmur

A

PDA (close with indomethacin; keep open with PGE analogs)

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45
Q

Chest pain on exertion

A

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

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46
Q

Chest pain with ST depressions on ECG

A

Angina (⊝ troponins) or NSTEMI (⊕ troponins)

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47
Q

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

A

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

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48
Q

Painful, raised red lesions on pads of fingers/toes

A

Osler nodes (infective endocarditis, immune complex deposition)

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49
Q

Painless erythematous lesions on palms and soles

A

Janeway lesions (infective endocarditis, septic emboli/ microabscesses)

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50
Q

Splinter hemorrhages in fingernails

A

Bacterial endocarditis

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51
Q

Retinal hemorrhages with pale centers

A

Roth spots (bacterial endocarditis)

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52
Q

Distant heart sounds, distended neck veins, hypotension

A

Beck triad of cardiac tamponade

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53
Q

Cervical lymphadenopathy, desquamating rash, coronary aneurysms, red conjunctivae and tongue, hand-foot
changes

A

Kawasaki disease (mucocutaneous lymph node syndrome, treat with IVIG and aspirin)

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54
Q

Palpable purpura on buttocks/legs, joint pain, abdominal

A

Immunoglobulin A vasculitis (Henoch-Schönlein pain (child), hematuria purpura, affects skin and kidneys)

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55
Q

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

A

Hereditary hemorrhagic telangiectasia (Osler-Rendu syndrome)

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56
Q

Skin hyperpigmentation, hypotension, fatigue 1°

A

adrenocortical insufficiencyACTH,α-MSH (eg, Addison disease

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57
Q

Cutaneous flushing, diarrhea, bronchospasm

A

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

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58
Q

Cold intolerance, weight gain, brittle hair

A

Hypothyroidism

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59
Q

Cutaneous/dermal edema due to deposition of mucopolysaccharides in connective tissue [pretibial])

A

Myxedema (caused by hypothyroidism, Graves disease

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60
Q

Facial muscle spasm upon tapping

A

Chvostek sign (hypocalcemia)

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61
Q

No lactation postpartum, absent menstruation, cold intolerance

A

Sheehan syndrome (postpartum hemorrhage leading to pituitary infarction)

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62
Q

Deep, labored breathing/hyperventilation

A

Diabetic ketoacidosis (Kussmaul respirations)

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63
Q

Pancreatic, pituitary, parathyroid tumors

A

MEN 1 (autosomal dominant)

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64
Q

Thyroid tumors, pheochromocytoma, ganglioneuromatosis, Marfanoid habitus

A

MEN 2B (autosomal dominant RET mutation)

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65
Q

Thyroid and parathyroid tumors, pheochromocytoma

A

MEN 2A (autosomal dominant RET mutation)

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66
Q

Jaundice, palpable distended non-tender gallbladder

A

Courvoisier sign (distal malignant obstruction of biliary tree)

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67
Q

Vomiting blood following gastroesophageal lacerations

A

Mallory-Weiss syndrome (alcoholic and bulimic patients)

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68
Q

Dysphagia (esophageal webs), glossitis, iron deficiency anemia

A

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

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69
Q

Enlarged, hard left supraclavicular node

A

Virchow node (abdominal metastasis)

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70
Q

Arthralgias, adenopathy, cardiac and neurological symptoms, diarrhea

A

Whipple disease (Tropheryma whipplei)

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71
Q

Severe RLQ pain with palpation of LLQ

A

Rovsing sign (acute appendicitis)

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72
Q

Severe RLQ pain with deep tenderness

A

McBurney sign (acute appendicitis)

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73
Q

Hamartomatous GI polyps, hyperpigmented macules on(inherited, benign polyposis mouth, feet, hands, genitalia

A

Peutz-Jeghers syndrome can cause bowel obstruction;cancer risk, mainly GI)

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74
Q

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

A

Gardner syndrome (subtype of FAP)

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75
Q

Abdominal pain, ascites, hepatomegaly

A

Budd-Chiari syndrome (posthepatic venous thrombosis)

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76
Q

Severe jaundice in neonate

A

Crigler-Najjar syndrome (congenital unconjugated hyperbilirubinemia)

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77
Q

Golden brown rings around peripheral cornea

A

Wilson disease (Kayser-Fleischer rings due to copper accumulation)

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78
Q

Fat, female, forty, fertile

A

Cholelithiasis (gallstones)

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79
Q

Painless jaundice

A

Cancer of the pancreatic head obstructing bile duct

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80
Q

Bluish line on gingiva

A

Burton line (lead poisoning)

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81
Q

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

A

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

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82
Q

Red/pink urine, fragile RBCs

A

Paroxysmal nocturnal hemoglobinuria

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83
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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84
Q

Petechiae, mucosal bleeding, prolonged bleeding time

A

Platelet disorders (eg, Glanzmann thrombasthenia, Bernard Soulier, HUS, TTP, ITP)

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85
Q

Fever, night sweats, weight loss

A

B symptoms of malignancy

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86
Q

Skin patches/plaques, Pautrier microabscesses, atypical T cells

A

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

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87
Q

WBCs that look “smudged”

A

CLL

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88
Q

Neonate with arm paralysis following difficult birth, arm in “waiter’s tip” position

A

Erb-Duchenne palsy (superior trunk [C5–C6] brachial plexus injury)

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89
Q

Anterior drawer sign ⊕

A

Anterior cruciate ligament injury

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90
Q

Bone pain, bone enlargement, arthritis

A

Osteitis deformans (Paget disease of bone,osteoblastic and osteoclastic activity)

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91
Q

Swollen, hard, painful finger joints in an elderly individual, pain worse with activity

A

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

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92
Q

Sudden swollen/painful big toe joint

A

Gout/podagra (hyperuricemia)

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93
Q

Dry eyes, dry mouth, arthritis

A

Sjögren syndrome (autoimmune destruction of exocrine glands)

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94
Q

Urethritis, conjunctivitis, arthritis in a male

A

Reactive arthritis associated with HLA-B27

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95
Q

Butterfly” facial rash and Raynaud phenomenon in a young female

A

Systemic lupus erythematosus

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96
Q

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

A

Raynaud phenomenon (vasospasm in extremities

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97
Q

Anticentromere antibodies

A

Scleroderma (CREST)

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98
Q

Dark purple skin/mouth nodules in a patient with AIDS

A

Kaposi sarcoma, associated with HHV-8

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99
Q

Anti-desmoglein (anti-desmosome) antibodies

A

Pemphigus vulgaris (blistering)

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100
Q

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

A

Lichen planus

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101
Q

 elevated AFP in amniotic fluid/maternal serum

A

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

102
Q

Ataxia, nystagmus, vertigo, dysarthria

A

Cerebellar lesion

103
Q

Toe extension/fanning upon plantar scrape

A

Babinski sign (UMN lesion)

104
Q

Hyperphagia, hypersexuality, hyperorality

A

Klüver-Bucy syndrome (bilateral amygdala lesion)

105
Q

Resting tremor, athetosis, chorea

A

Basal ganglia lesion

106
Q

Lucid interval after traumatic brain injury

A

Epidural hematoma (middle meningeal artery rupture)

107
Q

Worst headache of my life”

A

Subarachnoid hemorrhage

108
Q

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

A

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

109
Q

Chorea, dementia, caudate degeneration

A

Huntington disease (autosomal dominant CAG repeat expansion)

110
Q

Nystagmus, intention tremor, scanning speech, bilateral internuclear ophthalmoplegia

A

Multiple sclerosis

111
Q

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

A

Guillain-Barré syndrome (acute inflammatory demyelinating polyradiculopathy subtype)

112
Q

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

A

Neurofibromatosis type I

113
Q

Vascular birthmark (port-wine stain) of the face

A

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

114
Q

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

A

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

115
Q

Bilateral vestibular schwannomas

A

Neurofibromatosis type 2

116
Q

Hyperreflexia, hypertonia, Babinski sign present

A

UMN damage

117
Q

Hyporeflexia, hypotonia, atrophy, fasciculations

A

LMN damage

118
Q

Spastic weakness, sensory loss, bowel/bladder dysfunction

A

Spinal cord lesion

119
Q

Unilateral facial drooping involving forehead

A

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

120
Q

Episodic vertigo, tinnitus, hearing loss

A

Ménière disease

121
Q

Ptosis, miosis, anhidrosis

A

Horner syndrome (sympathetic chain lesion)

122
Q

Conjugate horizontal gaze palsy, horizontal diplopia

A

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

123
Q

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

A

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

124
Q

Athlete with polycythemia

A

2° to erythropoietin injection

125
Q

Periorbital and/or peripheral edema, proteinuria (> 3.5g/ day), hypoalbuminemia, hypercholesterolemia

A

Nephrotic syndrome

126
Q

Hereditary nephritis, sensorineural hearing loss, retinopathy, lens dislocation

A

Alport syndrome (mutation in collagen IV)

127
Q

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

A

Turner syndrome (45,XO)

128
Q

Red, itchy, swollen rash of nipple/areola sign of underlying neoplasm)

A

Paget disease of the breast

129
Q

Fibrous plaques in tunica albuginea of penis with abnormal curvature

A

Peyronie disease (connective tissue disorder)

130
Q

Hypoxemia, polycythemia, hypercapnia

A

Chronic bronchitis (hyperplasia of mucous cells, “blue bloater”)

131
Q

Pink complexion, dyspnea, hyperventilation

A

Emphysema (“pink puffer,” centriacinar [smoking] or panacinar [α1-antitrypsin deficiency])

132
Q

Bilateral hilar adenopathy, uveitis

A

Sarcoidosis (noncaseating granulomas)

133
Q

Low AFP in amniotic fluid/maternal serum

A

Down syndrome, Edwards syndrome

134
Q

Large granules in phagocytes, immunodeficiency

A

Chédiak-Higashi disease (congenital failure of phagolysosome formation)

135
Q

Recurrent infections, eczema, thrombocytopenia

A

Wiskott-Aldrich syndrome

136
Q

Optochin sensitivity

A

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

137
Q

Novobiocin response

A

Sensitive: S epidermidis; resistant: S saprophyticus

138
Q

Bacitracin response

A

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

139
Q

Streptococcus bovis bacteremia

A

Colon cancer

140
Q

Branching gram ⊕ rods with sulfur granules

A

Actinomyces israelii

141
Q

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

A

Ghon complex (1° TB: Mycobacterium bacilli)

142
Q

Thumb sign” on lateral neck x-ray

A

Epiglottitis (Haemophilus influenzae)

143
Q

Bacteria-covered vaginal epithelial cells
“

A

Clue cells” (Gardnerella vaginalis)

144
Q

Cardiomegaly with apical atrophy

A

Chagas disease (Trypanosoma cruzi)

145
Q

Atypical lymphocytes

A

EBV

146
Q

Enlarged cells with intranuclear inclusion bodies

A

“Owl eye” appearance of CMV

147
Q

Heterophile antibodies

A

Infectious mononucleosis (EBV

148
Q

Intranuclear eosinophilic droplet-like bodies

A

Cowdry type A bodies (HSV or VZV)

149
Q

Eosinophilic globule in liver

A

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

150
Q

Steeple” sign on frontal CXR

A

Croup (parainfluenza virus)

151
Q

Eosinophilic inclusion bodies in cytoplasm of hippocampal and cerebellar neurons

A

Negri bodies of rabies

152
Q

Ring-enhancing brain lesion on CT/MRI in AIDS

A

Toxoplasma gondii, CNS lymphoma

153
Q

Psammoma bodies

A

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

154
Q

Delta wave” on ECG, short PR interval, supraventricular tachycardia

A

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

155
Q

Boot-shaped” heart on x-ray

A

Tetralogy of Fallot (due to RVH)

156
Q

Rib notching (inferior surface, on x-ray)

A

Coarctation of the aorta

157
Q

Heart nodules (granulomatous)

A

Aschoff bodies (rheumatic fever)

158
Q

Electrical alternans (alternating amplitude on ECG)

A

Cardiac tamponade

159
Q

Antineutrophil cytoplasmic antibodies (ANCAs)

A

Microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis (MPO-ANCA/p-ANCA);
granulomatosis with polyangiitis (Wegener; PR3- ANCA/c-ANCA); primary sclerosing cholangitis (MPO- ANCA/p-ANCA)

160
Q

Hypertension, hypokalemia, metabolic alkalosis

A

1° hyperaldosteronism (Conn syndrome)

161
Q

Enlarged thyroid cells with ground-glass nuclei with “central clearing

A

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

162
Q

Mucin-filled cell with peripheral nucleus “

A

Signet ring” (gastric carcinoma)

163
Q

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

A

Celiac disease (diarrhea, weight loss) 381

164
Q

Narrowing of bowel lumen on barium x-ray “

A

String sign” (Crohn disease)

165
Q

Lead pipe” appearance of colon on abdominal imaging

A

Ulcerative colitis (loss of haustra)

166
Q

Thousands of polyps on colonoscopy

A

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

167
Q

Apple core” lesion on barium enema x-ray

A

Colorectal cancer (usually left-sided)

168
Q

Eosinophilic cytoplasmic inclusion in liver cell

A

Mallory body (alcoholic liver disease)

169
Q

Triglyceride accumulation in liver cell vacuoles

A

Fatty liver disease (alcoholic or metabolic syndrome)

170
Q

Nutmeg” appearance of liver

A

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

171
Q

Antimitochondrial antibodies (AMAs)

A

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

172
Q

Low serum ceruloplasmin

A

Wilson disease (hepatolenticular degeneration; Kayser- Fleischer rings due to copper accumulation)

173
Q

Migratory thrombophlebitis (leading to migrating DVTs and vasculitis)

A

Trousseau syndrome (adenocarcinoma of pancreas or lung)

174
Q

Basophilic nuclear remnants in RBCs

A

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

175
Q

Basophilic stippling of RBCs

A

Lead poisoning or sideroblastic anemia

176
Q

Hypochromic, microcytic anemia

A

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

177
Q

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

A

β-thalassemia, sickle cell disease (marrow expansion)

178
Q

Hypersegmented neutrophils

A

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

179
Q

Antiplatelet antibodies

A

Idiopathic thrombocytopenic purpura

180
Q

High level of d-dimers

A

DVT, PE, DIC 428

181
Q

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

A

Reed-Sternberg cells (Hodgkin lymphoma

182
Q

Sheets of medium-sized lymphoid cells with scattered tingible body–laden macrophages histology)

A

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

183
Q

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

A

Multiple myeloma

184
Q

Monoclonal antibody spike ƒ

A

Multiple myeloma (usually IgG or IgA) Monoclonal gammopathy of undetermined
significance (MGUS consequence of aging)
ƒ Waldenström (M protein = IgM) macroglobulinemia ƒ Primary amyloidosis

185
Q

Stacks of RBCs

A

Rouleaux formation (high ESR, multiple myeloma)

186
Q

Azurophilic peroxidase ⊕ granular inclusions in (granulocytes and myeloblasts

A

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

187
Q

WBCs that look “smudged”

A

CLL (almost always B cell)

188
Q

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

A

Birbeck granules (Langerhans cell histiocytosis)

189
Q

Brown” tumor of bone

A

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

190
Q

Soap bubble” in femur or tibia on x-ray

A

Giant cell tumor of bone (generally benign)

191
Q

Raised periosteum (creating a “Codman triangle”)

A

Aggressive bone lesion (eg, osteosarcoma, Ewing sarcoma, osteomyelitis)

192
Q

Onion skin” periosteal reaction

A

Ewing sarcoma (malignant small blue cell tumor)

193
Q

Anti-IgG antibodies

A

Rheumatoid arthritis (systemic inflammation, joint pannus, boutonniere and swan neck deformities)

194
Q

Rhomboid crystals, ⊕ birefringent

A

Pseudogout (calcium pyrophosphate dihydrate crystals)

195
Q

Needle-shaped, ⊝ birefringent crystals

A

Gout (monosodium urate crystals)

196
Q

High uric acid levels

A

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

197
Q

Bamboo spine” on x-ray

A

Ankylosing spondylitis (chronic inflammatory arthritis: HLA-B27)

198
Q

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

A

SLE (type III hypersensitivity

199
Q

Anti-histone antibodies

A

Drug-induced SLE (eg, hydralazine, isoniazid, phenytoin, procainamide)

200
Q

Anti-topoisomerase antibodies

A

Diffuse scleroderma

201
Q

Keratin pearls on a skin biopsy

A

Squamous cell carcinoma

202
Q

Bloody or yellow tap on lumbar puncture)

A

Xanthochromia (due to subarachnoid hemorrhage

203
Q

Eosinophilic cytoplasmic inclusion in neuron

A

Lewy body (Parkinson disease and Lewy body dementia)

204
Q

Extracellular amyloid deposition in gray matter of brain

A

Senile plaques (Alzheimer disease)

205
Q

Depigmentation of neurons in substantia nigra

A

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

206
Q

Protein aggregates in neurons from hyperphosphorylation tau protein

A

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

207
Q

Silver-staining spherical aggregation of tau proteins in neurons bodies

A

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

208
Q

Pseudopalisading tumor cells on brain biopsy

A

Glioblastoma multiforme

209
Q

Circular grouping of dark tumor cells surrounding pale neurofibrils

A

Homer-Wright rosettes (neuroblastoma, medulloblastoma)

210
Q

Waxy” casts with very low urine flow

A

Chronic end-stage renal disease

211
Q

Nodular hyaline deposits in glomeruli

A

Kimmelstiel-Wilson nodules (diabetic nephropathy)

212
Q

Podocyte fusion or “effacement” on electron microscopy

A

Minimal change disease (child with nephrotic syndrome)

213
Q

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

A

Membranous nephropathy (nephrotic syndrome)

214
Q

RBC casts in urine

A

Glomerulonephritis

215
Q

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

A

Membranoproliferative glomerulonephritis

216
Q

Anti–glomerular basement membrane antibodies

A

Goodpasture syndrome (glomerulonephritis and hemoptysis)

217
Q

Cellular crescents in Bowman capsule

A

Rapidly progressive (crescentic) glomerulonephritis

218
Q

Wire loop” glomerular capillary appearance on light microscopy

A

Diffuse proliferative glomerulonephritis usually seen with lupus

219
Q

Linear appearance of IgG deposition on glomerular and alveolar basement membranes

A

Goodpasture syndrome

220
Q

Lumpy bumpy” appearance of glomeruli on immunofluorescence

A

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

221
Q

Necrotizing vasculitis (lungs) and necrotizing glomerulonephritis

A

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

222
Q

Thyroid-like appearance of kidney

A

Chronic pyelonephritis (usually due to recurrent infections)

223
Q

WBC casts in urine

A

Acute pyelonephritis

224
Q

Renal epithelial casts in urine

A

Intrinsic renal failure (eg, ischemia or toxic injury)

225
Q

hCG elevated

A

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

226
Q

Dysplastic squamous cervical cells with “raisinoid” nuclei and hyperchromasia

A

Koilocytes (HPV: predisposes to cervical cancer)

227
Q

Disarrayed granulosa cells arranged around collections of eosinophilic fluid

A

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

228
Q

Chocolate cyst” of ovary

A

Endometriosis (frequently involves both ovaries)

229
Q

Mammary gland (“blue domed”) cyst

A

Fibrocystic change of the breast

230
Q

Glomerulus-like structure surrounding vessel in germ cells

A

Schiller-Duval bodies (yolk sac tumor)

231
Q

Rectangular, crystal-like, cytoplasmic inclusions in) cells

A

Leydig Reinke crystals (Leydig cell tumor

232
Q

Thrombi made of white/red layers

A

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

233
Q

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

A

Bronchial asthma (Charcot-Leyden crystals: eosinophilic granules)

234
Q

Desquamated epithelium casts in sputum

A

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

235
Q

“Honeycomb lung” on x-ray or CT

A

Idiopathic pulmonary fibrosis

236
Q

Colonies of mucoid Pseudomonas in lungs

A

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

237
Q

Iron-containing nodules in alveolar septum

A

Ferruginous bodies (asbestosis:chance of lung cancer increased)

238
Q

Bronchogenic apical lung tumor on imaging

A

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

239
Q

Ethylene glycol/methanol intoxication

A

Fomepizole (alcohol dehydrogenase inhibitor)

240
Q

Chronic hepatitis B or C

A

IFN-α (HBV and HCV); ribavirin, simeprevir, sofosbuvir (HCV)

241
Q

Streptococcus bovis

A

Penicillin prophylaxis; evaluation for colon cancer if linked to endocarditis

242
Q

Clostridium botulinum

A

Antitoxin

243
Q

Clostridium tetani

A

Antitoxin

244
Q

Haemophilus influenzae (B)

A

Amoxicillin ± clavulanate (mucosal infections), ceftriaxone (meningitis), rifampin (prophylaxis)

245
Q

Neisseria gonorrhoeae

A

Ceftriaxone (add doxycycline to cover likely concurrent C trachomatis)

246
Q

Neisseria meningitidis

A

Penicillin/ceftriaxone, rifampin (prophylaxis)

247
Q

Legionella pneumophila

A

Macrolides (eg, azithromycin)

248
Q

Pseudomonas aeruginosa

A

Piperacillin/tazobactam, aminoglycosides, carbapenems

249
Q

Treponema pallidum

A

Penicillin G

250
Q

Chlamydia trachomatis

A

Doxycycline (+ ceftriaxone for gonorrhea coinfection), oral erythromycin to treat chlamydial conjunctivitis in infants

Usmle Step 1 First Aid (3 decks)

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