Rapid Review: Key Associations Flashcards
Acute gastric ulcer associated with CNS injury
Cushing’s ulcer (aka Rokitansky-Cushing syndrome)
- incr ICP stimulates vagal gastric secretion
- Vagus releases Ach, which stimulates the M3 receptor on the parietal cell and activates the second messenger to stimulate IP3/Ca2+ to stimulate the H+/K+ ATPase pump which will increase gastric acid production.
Actinic (solar) keratosis
Precursor to SCC
Acute gastric ulcer associated with severe burns
Curling’s ulcer (greatly reduced plasma volume results in sloughing of gastric mucosa)
Alternating areas of transmural inflammation and normal colon
Skip lesions (Crohn’s disease)
Aneurysm, dissecting
Hypertension
Aortic aneurysm, ascending
Marfan’s syndrome (idiopathic cystic medial degeneration)
- degenerative breakdown of collagen, elastin, and smooth muscle caused by aging contributes to weakening of the wall of the artery
Aortic aneurysm, abdominal and descending aorta
Atherosclerosis
Atrophy of the mammillary bodies
Wernicke’s encephalopathy (thiamine deficiency)
- ataxia, ophthalmoplegia, confusion
Autosplenectomy (fibrosis and shrinkage)
Sickle cell anemia (HbS)
Bacteria associated with gastritis, PUD, stomach cancer
H. pylori
Bacterial meningitis (adults and elderly)
S. pneumo
Bacterial meningitis (kids)
S. pneumo
N, meningitidis
Bacterial meningitis (newborns)
Group B strep
Bleeding disorder with GpIb deficiency
Bernard-Soulier disease (defect in platelet adhesion to von Willebrand’s factor)
Benign melanocytic nevus
Spitz nevus (most common in first 2 decades)
Brain tumor (adults)
Supratentorial: mets > astrocytoma (including GBM) > meningioma > schawnnoma
Astrocytoma: GFAP
Meningioma: arachnoid cells, psammoma bodies
Schwannoma: S-100 (like melanoma bc they both come from neural crest!)
Brain tumor (kids)
Intratentorial: medulloblastoma (cerebellum)
- PNET, Homer-Wright rosettes
Supratentorial: craniopharyngioma (cerebrum)
- remnant of Rathke’s pouch
Breast mass
- Fibrocystic changes
2. Carcinoma (in postmenopausal women)
Breast cancer
Infiltrating ductal carcinoma
Breast tumor (benign)
Fibroadenoma
Cardiac primary tumor (kids)
Rhabdomyoma (benign tumor of striated muscle), often seen in tuberous sclerosis
Cardiac tumor (adults)
- Metastasis
- Primary atrial myxoma (4:1 L to R shunt, “ball and valve” obstruction, “tumor plop” on auscultation, risk of afib, embolism)
Cardiac manifestation of lupus
- Pericarditis
- Libman-Sacks endocarditis
- nonbacterial, affecting both sides (atria and ventricle) of MV
- small vegetations made of strands of fibrin, neutrophils, lymphocytes, and histiocytes
Cerebellar tonsillar herniation
Chiari malformation (often presents with progressive hydrocephalus or syringomyelia)
Chronic arrhythmia
Atrial fibrillation (associated with high risk of emboli)
Clear cell adenocarcinoma of the vagina
DES exposure in utero
- synthetic nonsteriodal estrogen
- used off-label to prevent adverse pregnancy outcomes in women with a history of miscarriage
Chronic atrophic gastritis (autoimmune)
Predisposition to gastric carcinoma (can also cause pernicious anemia)
Compression fracture
Osteoporosis: normal bone mineralization and lab values, but loss of trabecular meshwork
- Type I: postmenopausal (incr bone resorp due to decr estrogen)
- Type II: elderly man or woman, >~70 (decr ability of osteoblasts to divide and produce osteoid)
Congenital adrenal hyperplasia, hypotension
21-hydroxylase deficiency
- Newborn with HTN, hypokalemia, low sex hormone levels (pseudohermaprodite male or normal internal sex organ female)
vs. - HTN and masculinization
- CAH, 17alpha-OH deficiency
2. CAH, 11beta-OH deficiency
Congenital cardiac anomaly
VSD (most common)
Congenital conjugated hyperbilirubinemia
Dubin-Johnson (black liver); Rotor’s (not black)
- inability to hepatocytes to secrete conj BR into bile
Constrictive pericarditis (developing vs. developed world)
TB (developing world)
SLE (developed world)
Coronary artery involved in thrombosis
LAD > RCA > LCA
Cretinism
Iodine deficit/hypothyroidism (in newborn)
- Dull look
- Puffy face
- Thick tongue that sticks out
- Decreased muscle tone
- Failure to grow
- Hoarse-sounding cry or voice
- Short arms and legs
- Very large soft spots on the skull (fontanelles)
- Wide hands with short fingers
- Widely separated skull bones
Cushing’s syndrome
- CS therapy
- Excess ACTH secretion by pituitary
- SCLC
Cyanosis (early; less common)
Tetralogy of Fallot, TGA, Truncus arteriosus
Cyanosis (late; more common)
VSD, ASD, PDA
Death in CML
Blast crisis
Death in SLE
Lupus nephropathy
Dementia
- Alzheimer’s
2. Multiple infarcts
Demyelinating disease in young women
MS
DIC
- Gram-neg sepsis
- Obstetric complications
- Cancer
- Burn trauma
Dietary deficit
Iron
Diverticulum in pharynx
Zenker’s diverticulum (diagnosed by barium swallow)
Ejection click
Aortic/pulmonic stenosis
Esophageal cancer
Squamous cell carcinoma (worldwide);
Adenocarcinoma (US)
Food poisoning (exotoxin mediated)
S. aureus (enterotoxin)
B. cereus (enterotxin; heat labile and stable)
Glomerulonephritis (adults)
Berger’s disease (IgA nephropathy)
Gyn malignancy
Endometrial carcinoma (MC in US); Cervical carcinoma (MC worldwide)
Heart murmur, congenital
MVP
Heart valve in bacterial endocarditis
Mitral (rheumatic fever);
Tricuspid (IVDU);
Aoritc (2nd in RF)
Helminth infection (US)
- Enterobius vermicularis (pinworm, Scotch tape test, egg ingestion)
- Ascaris lumbricoides (egg ingestion, fecal fertilizer/contaminated food)
Treat with -bendazoles or pyrantel pamoate
Hematoma - epidural
Rupture of middle meningeal artery (trauma, lentiform/lens shaped)
Hematoma - subdural
Rupture of bridging veins (crescent shaped)
Hemochromatosis
Multiple blood transfustions or hereditary HFE (Human hemochromatosis protein) mutation.
- Can result in CHF, “bronze diabetes,” and incr risk of HCC
Hepatocellular carcinoma
Cirrhotic liver (assoc w/ HBV, HCV)
Hereditary bleeding disorder
von Willebrand’s disease
Hereditary harmless jaundice
Gilbert’s syndrome (benign congenital unconjugated hyperbilirubinemia)
HLA-B27
Ankylosing spondylitis, Reiter’s syndrome, IBD (ulcerative colitis), psoriasis
HLA-DR3 or DR4
T1DM, RA, SLE
Holosystolic murmur
VSD, TR, MR
Hypercoagulability, endothelial damage, blood stasis
Virchow’s triad (results in venous thrombosis)
Hypertension, secondary
Renal disease
Hypopituitarism
Pituitary adenoma (usually benign tumor)
Infection secondary to blood transfusion
Hepatitis C
Infections in CGD
Catalase (+)! Organisms can degrade the limited H2O2.
S. aureus, E. coli, Aspergillus
- Deficient in NADPH oxidase; lack of ROS/respiratory burst; neg nitroblue tetrazolium test
Also: Serratia, Pseudomonas, Candida, Listeria (SSPACEL)
Kidney stones
- Calcium = radiopaque
- Struvite (ammonium) = radiopaque (formed by urease-positive organisms e.g. Proteus vulgaris or Staph)
- Uric acid = radiolucent
Late cyanotic shunt (uncorrected L–>R becomes R–>L)
Eisenmenger’s syndrome (caused by ASD, VSD, PDA, results in PAH/polycythemia)
Liver disease
Alcoholic cirrhosis
Lysosomal storage disease
Gaucher’s (AR - vs. Fabry’s is XR)
- Glucocerbrosidase deficiency, accumulated glucocerebroside
Male cancer
Prostatic carcinoma
Malignancy associated with noninfectious fever
Hodgkin’s lymphoma
Malignant skin tumor
Basal cell carcinoma (rarely metastasizes)
Mental retardation
- Down syndrome
2. Fragile X syndrome
Metastases to bone
Breast, lung, thyroid, testes, prostate, kidney
Metastases to brain
Lung, breast, skin (melanoma), kidney (RCC), GI
Metastases to liver
Colon, gastric, pancreatic, breast, lung
Mitochondrial inheritance
Disease occurs in both males and females, inherited through females only
- Heteroplasmy: mixture of more than one type of an organellar genome (mtDNA or plastid DNA) within a cell or individual–mutation affects some mt and not others. Factor for disease severity.
Mitral valve stenosis
Rheumatic heart disease
Mixed (UMN and LMN) motor neuron disorder
ALS
- UMN: spasticity, hyperreflexia, Babinksi
- LMN: fasiculations, weakness, atrophy
Myocarditis
Coxsackie B
- Picornavirus: +ssRNA, iscosahedral, PERCH
Neoplasm (kids)
- ALL
2. Cerebellar medulloblastoma
Nephrotic syndrome (adults)
FSGS
Nephrotic syndrome (kids)
Minimal change disease (associated with infections, vaccinations, treat with corticosteroids!)
Neuron migration failure
Kallmann syndrome (anosmia and hypogonadism–GnRH deficiency)
Nosocomial pneumonia
Klebsiella, E. coli, Pseudomonas
Obstruction of the male urinary tract
BPH
Opening snap
Mitral stenosis
Opportunistic infection in AIDS
- Pneumocystic jirveci (PCP) pneumonia: TMP/SMX at CD4 <50
Osteomyelitis
S. aureus
Osteomylitis in SCD
Salmonella
Osteomyelitis in IVDU
Pseudomonas, S. aureus
Ovarian metastasis from gastric carcinoma or breast cancer
Krukenberg tumor (mucin-secreting signet-ring cells)
Ovarian tumor (benign, bilateral)
Serous cystadenoma
Ovarian tumor (malignant)
Serious cystadenocarcnioma
Pancreatitis (acute)
Gallstones, alcohol
Pancreatitis (chronic)
Alcohol (adults), CF (kids)
Patient with ALL/CLL/AML/CML
ALL = child CLL = adult > 60 AML = adult ~60 CML = adult 30-60
PID
Neisseria gonorrhoeae (monoarticular arthritis)
Philadelphia chromosome t(9;22)
bcr-abl: tyrosine kinase, oncogene
CML (sometimes ALL/AML)
Pituitary tumor
- Prolactinoma
2. Somatotrophic “acidophillic” adenoma (acidophiles: prolactin or GH producing cells, stain red)
Primary amenorrhea
Turner syndrome (XO)
Primary bone tumor (adults)
Multiple myeloma
Primary hyperaldosteronism
Adenoma of adrenal cortex
Primary hyperparathyroidism
- Adenomas
- Hyperplasia
- Carcinoma
Primary liver cancer
Hepatocellular carcinoma (chronic helpatitis, cirrhosis, hemochromatosis, alpha-1 antitrypsin)
Pulmonary hypertension
COPD
Recurrent inflammation/thrombosis of small/medium vessels in extremeties
Buerger’s disease (Thromboangiitis obliterans, strongly associated with tobacco, corkscrew appearance of vessels)
vs. Raynaud’s which is decr BF upon exposure to cold
Renal tumor
RCC: associated with vHL and adult polycystic kidney disease (AR/AD); paraneoplastic syndromes–EPO, renin, PTH, ACTH
RHF due to pulmonary cause
Cor pulmonale Acute: 1. Massive pulmonary embolization 2. Exacerbation of chronic cor pulmonale Chronic: 1. COPD 3. Primary Pulmonary Hypertension 3. Asthma 4. Recurrent Pulmonary Embolism 5. Loss of lung tissue following trauma or surgery 6. Pierre Robin sequence 7. End stage Pneumoconiosis 8. Sarcoidosis 9. T1-4 Vertebral subluxation 10. Obstructive sleep apnea 11. Altitude sickness 12. Sickle cell anemia 13. Bronchopulmonary dysplasia (in infants)
S3 (protodiastolic gallop)
Incr ventricular filling (L–>R shunt, MR, LVF/CHF)
S4 (presystolic gallop)
Stiff/hypertrophic ventricle (AS, restrictive cardiomyopathy)
Secondary hyperparathyroidism
Hypocalcemia of chronic kidney disease
Sexually transmitted disease
Chlamydia (usually co-infected with GC)
SIADH
Small cell lung cancer
Site of diverticula
Sigmoid colon
Sites of atherosclerosis
Abdominal aorta > coronary > popliteal > carotid
Stomach cancer
Adenocarcinoma
Stomach ulcerations and high gastrin levels
Zollinger-Ellison syndrome (gastrinoma of duodenum or pancreas)
t(14;18)
Follicular lymphoma (bcl-2 activation, oncogene, anti-apoptotic molecule/incr cell survival)
t(8;14)
Burkitt’s lymphoma (c-myc activation, oncogene, TF)
t(9;22)
Philadelphia chromosome, CML (bcr-abl fusion, abl is an oncogene, tyr kinase)
Temporal arteritis
Risk of ipsilateral blindness due to thrombosis of ophthalmic artery, polymyalgia rheumatica
Testicular tumor
Seminoma
Thyroid cancer
Papillary carcinoma
- Orphan Annie nuceli
- Lymphatic spread
- Previous radiation to the head and neck
Tumor in women
Leiomyoma (estrogen dependent, not precancerous)
Tumor of infancy
Hemangioma (usually regresses spontaneously by childhood)
Tumor of the adrenal medulla (adults)
Pheochromocytoma (usually benign)
Tumor of the adrenal medulla (kids)
Neuroblastoma (malignant)
Type of Hodgkin’s
Nodular sclerosis (vs. mixed cellularity, lymphocytic predominancy, lymphocytic depletion)
UTI
E. coli
Staph sap (young women)
- No StRES
Viral encephalitis, temporal lobe
HSV-1
Vitamin deficiency (U.S.)
Folic acid (pregnant women are at high risk; body stores only 3-4 month supply; prevents NTDs)