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USMLE > RR > Flashcards

RR Flashcards

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USMLE® Step 1 flashcards
1
Q

Abdominal pain, ascites, hepatomegaly

A

Budd-Chiari Syndrome (posthepatic venous thrombosis)

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2
Q

Achilles tendon xanthoma

A

Familial hypercholesterolemia (decreased LDL receptor signaling)

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3
Q

Adrenal hemorrhage, hypotension, DIC

A

Waterhouse-Friderichsen syndrome (meningococcemia)

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4
Q

Arachnodactyly, lens dislocation, aortic dissection, hyperflexible joints

A

Marfan’s syndrome (fibrillin defect)

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5
Q

Athlete with polycythemia

A

Secondary to erythropoietin injection

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6
Q

Back pain, fever, night sweats, weight loss

A

Pott’s disease (vertebral tuberculosis)

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7
Q

Bilateral hilar adenopathy, uveitis

A

Sarcoidosis (noncaseating granulomas)

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8
Q

Blue sclera

A

Osteogenesis imperfecta (Type I collagen defect)

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9
Q

Bluish line on gingiva

A

Burton’s line (lead poisoning)

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10
Q

Bone pain, bone enlargement, arthritis

A

Paget’s disease of bone (increased osteoblastic and osteoclastic activity)

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11
Q

Bounding pulses, diastolic heart murmur, head bobbing

A

Aortic regurgitation

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12
Q

Butterfly facial rash and Raynaud’s phenomenon in a young female

A

Systemic lupus erthematosus

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13
Q

Cafe-au-lait spots, Lisch nodules (iris hamortoma)

A

Neurofibromatosis type I (+ pheochromocytoma, optic gliomas)

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14
Q

Cafe-au-lait spots, polyostotic fibrous dysplasia, precocious puberty, multiple endocrine abnormalities

A

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

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15
Q

Calf pseudohypertrophy

A

Muscular dystrophy (most commonly Duchenne’s); X-linked recessive deletion of dystophin gene

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16
Q

Cherry-red spot on macula

A

Tay-Sachs (ganglioside accumulation) Niemman-Pick (sphingomyelin accumulation), central artery occlusion

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17
Q

Chest pain on exertion

A

Angina (stable: with moderate exertion; unstable; with minimal exertion)

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18
Q

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

A

Dressler’s syndrome (autoimmune-mediated post-MI fibrinous pericarditis, 1-12 weeks after acute episode)

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19
Q

Child uses arms to stand up from squat

A

Gower’s sign (Duchenne muscular dystrophy)

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20
Q

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

A

Slapped cheeks (erthema infectiosum/fifth disease: Parovirus B19)

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21
Q

Chorea, dementia, caudate degeneration

A

Huntington’s disease (autosomal-dominant CAG repeat on expansion)

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22
Q

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

A

McArdle’s disease (muscle glycogen phosphorylase deficiency)

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23
Q

Cold intolerance

A

Hypothyroidism

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24
Q

Conjugate lateral gaze palsy, horizontal diplopia

A

Internuclear ophthalmoplegia (damage to MLF; bilateral= MS, unilateral=stroke)

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25
Q

Continuous “machinery” heart murmur

A

PDA (close eith indomethacin; open with misoprostol)

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26
Q

Cutaneous/dermal edema due to connective tissue deposition

A

Myxedema (caused by hypothyroidism, Grave’s disease)

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27
Q

Dark purple skin/mouth nodules

A

Kaposi’s sarcoma (usually AIDS pts; associated w/ HHV-8)

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28
Q

Deep, labored breathing/hyperventilation

A

Kussmaul breathing (diabetic ketoacidosis)

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29
Q

Dermatitis, dementia, diarrhea

A

Pellagra (niacin/B3 deficiency)

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30
Q

Dilated cardiomyopathy, edema, alcoholism or malnutrition

A

Wet beriberi (thiamine/B1 deficiency)

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31
Q

Dog or cat bite resulting in infection

A

Pasteurella multocida (cellulitis at inoculation site)

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32
Q

Dry eyes, dry mouth, arthritis

A

Sjogren’s syndrome (autoimmune destruction of exocrine glands)

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33
Q

Dysphagia (esophageal webs), glossitis, iron deficiency anemia

A

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

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34
Q

Elastic skin, hypermobility of joints

A

Ehler-Danlos syndrome (type III collagen defect )

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35
Q

Enlarged, hard left supraclavicular node

A

Virchow’s node (abdominal metastasis)

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36
Q

Erthroderma, lymphadenopathy, hepatosplenomegaly, atypical T cells

A

Sezary syndrome (cutaneous T-cell lymphoma) or mycosis fungoides

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37
Q

Facial muscle spasm upon tapping

A

Chvostek’s sign (hypocalcemia)

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38
Q

Fat, female, forty and fertile

A

Cholelithiasis (gallstones)

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39
Q

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

A

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

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40
Q

Fever, cough, conjuctivitis, coryza, diffuse rash

A

Measles (morbillivirus)

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41
Q

Fever, nightsweats, weight loss

A

B symptoms (staging) of lymphoma

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42
Q

Fibrous plaques in soft tissue of penis

A

Peyronie’s disease (connective tissue disorder)

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43
Q

Gout, mental retardation, self-mutilation behavior in boy

A

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

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44
Q

Green-yellow rings around peripheral cornea

A

Kayser-Fleischer rings (copper accumulation from Wilson’s disease)

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45
Q

Hamartomatous GI polyps, hyperpigmentation of mouth/feet/hands

A

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

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46
Q

Hepatosplenomegaly, osteoporosis, neurologic symptoms

A

Gaucher’s disease (Glucocerebrosidase deficiency)

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47
Q

Hereditary nephritis, sensorineural hearing loss, cataracts

A

Alport syndrome (mutation in alpha chain of collagen IV)

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48
Q

Hyperphagia, hypersexuality, hyperorality, hyperdocility

A

Kluver-Bucy syndrome (bilateral amygdala lesion)

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49
Q

Hyperreflexia, hypertonia, Babinski sign present

A

UMN damage

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50
Q

Hyporeflexia, hypotonia, atrophy, fasiculations

A

LMN damage

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51
Q

Hypoximia, polycythemia, hypercapnia

A

Blue bloater (chronic bronchitis, hyperplasia of mucus cells)

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52
Q

Indurated, ulcerated genital lesion

A

Nonpainful:Chancre of primary syphilis (Treponema pallidum)

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53
Q

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

A

Patau’s syndrome (Trisomy 13)

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54
Q

Infant with failure to thrive, hepatosplenomegaly and neurodegeneration

A

Niemann-Pick disease (genetic sphingomyelinase deficiency)

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55
Q

Infant with hypoglycemia, failure to thrive and hepatomegaly

A

Cori’s disease (debranching enzyme deficiency)

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56
Q

Infant with microcephaly, rocker-bottom feet, clentched hangs and structural heart defect

A

Edward’s syndrom (trisomy 18)

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57
Q

Jaundice, palpable distended non-tender gallbladder

A

Courvoisier’s sign (distal obstruction of biliary tree)

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58
Q

Large rash with bull’s eye appearance

A

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

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59
Q

Lucid interval after traumatic brain injury

A

Epidural hematoma (middle meningeal artery rupture)

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60
Q

Male child, recurrent infections, no mature B cells

A

Bruton’s disease (X-linked agammaglobulinemia)

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61
Q

Mucosal bleeding and prolonged bleeding time

A

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

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62
Q

Muffled heart sounds, distended neck veins, hypotension

A

Beck’s triad of cardiac tamponade

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63
Q

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

A

Gardner’s syndrome (subtype FAP)

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64
Q

Myopathy (infantile hypertrophic cardiomyopathy), exercise intolerance

A

Pompe’s disease (lysosomal alpha-1,4-glucosidase deficiency)

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65
Q

Neonate with arm paralysis following difficult birth

A

Erb-Duchenne palsy (superior trunk (C5-C6) brachial plexus injury; waiter’s tip)

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66
Q

No lactation postpartum, absent menstruation, cold intolerace

A

Sheehan’s syndrome (pituitary infarction)

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67
Q

Nystagmus, intention tremor, scanning speech, bilateral internuclear ophthalmoplegia (HLA-DR2)

A

Multiple sclerosis

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68
Q

Oscillating slow/fast breathing

A

Cheyne-Stokes respirations (central apnea in CHF or increased intracranial pressure)

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69
Q

Painful blue fingers/toes, hemolytic anemia

A

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

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70
Q

Painful, pale, cold fingers/toes

A

Raynaud’s phenomenon (vasospasm in extremities)

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71
Q

Painful, raised red lesions on pad of fingers/toes

A

Osler’s node (infective endocarditis, spetic emboli, microabscesses)

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72
Q

Painless jaundice

A

Cancer of the pancreatic head obstructing the bile duct

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73
Q

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

A

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

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74
Q

Pancreatic, pituitary, parathyroid tumors

A

MEN 1 (autosomal dominant)

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75
Q

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

A

Nephrotic syndrome

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76
Q

Pink complexion, dyspnea, hyperventilation

A

Pink puffer (emphysema:centriacinar=smoking, panacinar=alpha1-antitrypsin deficiency)

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77
Q

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

A

Fanconi’s syndrome (proximal tubular HCO3- reabsorption defect)

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78
Q

Positive anterior “drawer sign”

A

Anterior cruciate ligament injury

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79
Q

Pruritic, purple, polygonal planar papules and plaques

A

Lichen planus (associated with Hep C)

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80
Q

Ptosis, miosis, anhidrosis

A

Horner’s syndrome (sympathetic chain lesion, associated with loss of PICA)

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81
Q

Pupil that accomodates but doesn’t react

A

Argyll Robertson pupil (neurosyphilis)

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82
Q

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

A

Guillain-Barre syndrome (acute autoimmune inflammatory demyelinating polyneuropathy)

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83
Q

Rash on palms and soles

A

Coxsackie A, secondary syphilis, Rocky Mountain spotted fever

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84
Q

Recurrent colds, unusual ezema, high serum IgE

A

Hyper-IgE syndrome (Job’s syndrome; neutrophil chemotaxis abnormality)

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85
Q

Red “currant jelly” stools

A

Acute mesenteric ischemia (adults) intussusception (infants)

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86
Q

Red “current jelly” sputum in alcoholic or diabetic patients

A

Klebsiella pneumoniae

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87
Q

Red, itchy, swollen rash of nipple/areola

A

Paget’s disease of breast (represents underlying neoplasm)

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88
Q

Red urine in the morning, fragile RBCS

A

Paroxysmal nocturnal hemoglobinuria

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89
Q

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

A

Von Hippel-Lindau disease (dominant tumor suppressor gene mutation, VHL on chromosome 3)

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90
Q

Resting tremor, rigidity, akinesia, postural instability

A

Parkinson’s disease (nigrostriatal dopamine depletion)

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91
Q

Retinal hemorrhages with pale centers

A

Roth’s spots (bacterial endocarditis)

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92
Q

Severe jaundice in neonate

A

Crigler-Najjar syndrome (congenital unconjugated hyperbilirubinemia secondary to loss of UDP-glucuronyl transferase)

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93
Q

Severe RLQ pain w/ palpation of LLQ

A

Rovsing’s sign (acute appendicitis)

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94
Q

Severe RLQ pain with rebound tenderness

A

McBurney’s sign (appendicitis)

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95
Q

Short stature, increased incidence of tumors’/leukemia, aplastic anemia

A

Falconi’s anemia (genetic loss of DNA crosslink repair; often progresses to AML)

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96
Q

Single palmar crease

A

Simian crease (Down syndrome)

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97
Q

Situs inversus, chronic sinusitis, bronchiectasis, infertility

A

Kartagener’s syndrome (dynein arm defect affecting cells)

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98
Q

Skin hyperpigmentation, hypotension, fatigue

A

Addison’s disease (primary adrenocortical insufficiency causes increased ACTH and increased alpha-MSH production)

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99
Q

Slow, progressive muscle weakness in boys

A

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

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100
Q

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

A

Koplik spots (measles; rubeola virus)

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101
Q

Smooth, flat, moist painless lesions on genitals

A

Condylomata lata (secondary syphilis)

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102
Q

Splinter hemorrhages in fingernails

A

Bacterial endocarditis

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103
Q

Strawberry tongue

A

Scarlet fever, Kawasaki disease, toxic shock syndrome

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104
Q

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

A

Turner syndrome (45, XO)

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105
Q

Sudden swollen/painful big toe joint, tophi

A

Gout/Podagra (hyperuricemia)

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106
Q

Swollen gums, mucosal bleeding, poor wound healing, spots on skin

A

Scurvy (Vitamin C deficiency; failure to hydroxylate proline/lysine for collagen synthesis)

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107
Q

Swollen, hard, painful finger joints

A

Osteoarthritis (osteophytes on PIP=Bouchard’s nodes, DIP=Heberdin’s nodes)

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108
Q

Systolic ejection murmur (crescendo-decrescendo)

A

Aortic valve stenosis

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109
Q

Thyroid and parathyroid tumors, pheochromocytoma

A

MEN 2A (Autosomal dominant ret mutation)

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110
Q

Thyroid tumors, pheochromocytoma, ganglioneuromatosis

A

MEN 2B (autosomal dominant ret mutation)

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111
Q

Toe extension/fanning upon plantar scrape

A

Babinski’s sign (UMN lesion)

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112
Q

Unilaterial facial drooping involving forehead

A

Facial nerve (LMN CN VII) palsy

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113
Q

Urethritis, conjuctivitis, arthritis in male

A

Reactive arthritis associated with HLA-B27

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114
Q

Vascular birthmark (port-wine stain)

A

Hemangioma (benign, but associated with Struge-Weber syndrome)

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115
Q

Vomitting blood following gastroesophageal lacerations

A

Mallory-Weiss syndrome (alcoholic and bulimic patients)

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116
Q

Weight loss, diarrhea, arthritis, fever, adenopathy

A

Whipple disease (Tropheryma whipplei)

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117
Q

Worst headache of my life

A

Subarachnoid hemorrhage

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118
Q

Anticentromere antibodies

A

Scleroderma (CREST)

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119
Q

Antidesmoglein (epithelial) antibodies

A

Pemphigus vulgaris (blistering)

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120
Q

Anti-glomerular basement membrane antibodies

A

Goodpasture’s syndrome (glomerulonephritis and hemoptysis)

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121
Q

Antihistone antibodies

A

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

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122
Q

Anti-IgG antibodies

A

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

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123
Q

Antimitochondiral antibodies

A

Vasculitis (c-ANCA=granulomatosis w/ polyangiitis (Wegner’s) p-ANCA=microscopic polyangiitis, (Churg-Strauss syndrome)

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124
Q

Antiplatelet antibodies

A

Idiopathic thrombocytopenic purpura

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125
Q

Anti-topoisomerase antibodies

A

Diffuse systemic scleroderma

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126
Q

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

A

Celiac disease (diarrhea, distention, weight loss)

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127
Q

Apple core lesion on abdominal xray

A

Colorectal cancer (usually left-sided)

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128
Q

Azurophilic peroxidase positive granular inclusions in granulocytes and myeloblasts

A

Auer rods (acute myelogenous leukemia, especially promyelocytic M3 type)

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129
Q

Bacitracin response

A

Sensitive: Streptocococcus pyogenes (group A) resistant: Streptococcus agalactiae (group B)

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130
Q

Bamboo spine on x-ray

A

Ankylosing spondylitis (chronic inflammatory arthritis: HLA-B27)

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131
Q

Basophilic nuclear remnants in RBCs

A

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

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132
Q

Basophilic stippling of RBCs

A

Lead poisoning or sideroblastic anemia

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133
Q

Bloody tap on LP

A

Subarachnoid hemorrhage

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134
Q

Boot-shaped heart on xray

A

Tetralogy of Fallot, RVH

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135
Q

Branching gram-positive rods with sulfur granules

A

Actinomyces isralii

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136
Q

Brochogenic apical lung tumor on imaging

A

Pancoast tumor (can compress sympathetic ganglion and cause Horner’s syndrome)

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137
Q

Brown tumor of bone

A

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

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138
Q

Cardiomegaly with apical atrophy

A

Chagas’ disease (Trypanosoma cruzi, tx: Nifurtimox)

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139
Q

Cellular crescents in Bowman’s capsule

A

Rapidly progressive crescentic glomerulonephritis

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140
Q

Chocolate cyst of ovary

A

Endometriosis (frequently involves both ovaries)

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141
Q

Circular grouping of dark tumor cells surrounding pale neurofibrils

A

Homer-Wright rosettes (neuroblastoma, medulloblastoma, retinoblastoma)

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142
Q

Colonies of mucoid Pseudomonas in lungs

A

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

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143
Q

Decreased alpha-fetoprotein in amniotic fluid/maternal serum

A

Down syndrome or other chromosomal abnormality

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144
Q

Degeneration of dorsal column nerves

A

Tabes dorsalis (tertiary syphilis), subacute combined degeneration (dorsal columns and lateral corticospinal tracts are affected)

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145
Q

Depigmentation of neurons in substantia nigra

A

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

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146
Q

Desquamated epithelium casts in sputum

A

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

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147
Q

Disarrayed granulosa cells in eosinophilic fluid

A

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

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148
Q

Dysplastic squamous cervical cells with nuclear enlargement and hyperchromasia

A

Koilocytes (HPV:Predisposes to cervical cancer)

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149
Q

Enlarged cells with intranuclear inclusion bodies

A

Owl’s eyeappearance of CMV

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150
Q

Enlarged thyroid cells with ground-glass nuclei

A

Orphan Annie’s eyes Nuclei (papillary carcinoma of the thyroid)

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151
Q

Eosinophilic cytoplasmic inclusion in liver cell

A

Mallory bodies (alcoholic liver disease)

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152
Q

Eosinohphilic cytoplasmic inclusion in nerve cell

A

Lewy body (Parkinson’s disease)

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153
Q

Eosinophilic globule in liver

A

Councilman body (toxic or viral hepatitis, often yellow fever)

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154
Q

Eosinophilic inclusion bodies in cytoplasm of hippocampal nerve cells

A

Negri bodies of rabies (Lyssavirus)

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155
Q

Extracellular amyloid deposition in gray matter of brain

A

Senile plaques (Alzheimer’s disease)

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156
Q

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

A

Reed-Sternburg cells (Hodgkin’s lymphoma)

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157
Q

Glomerulus-like structure surrounding vessel in germ cells

A

Schiller-Duval bodies (yolk sack tumor)

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158
Q

Hair on end crew cut appearance on xray

A

Beta-thalasemia, sickle cell anemia (marrow expansion)

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159
Q

hCG elevated

A

Choriocarcinoma, hydratidform mole (occurs w/ and w/o embryo)

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160
Q

Heart nodules (granulomatous)

A

Aschoff bodies (rheumatic fever)

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161
Q

Heterophile antibodies

A

Infectious mononucleosis (EBV)

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162
Q

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

A

Bronchial asthma (Charcot-Leyden crystals, eosinophilic granules)

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163
Q

High level of d-dimers

A

DVT, pulmonary embolism, DIC

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164
Q

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

A

Ghon complex (Primary TB: Mycobacterium bacilli)

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165
Q

Honeycomb lung on xray

A

Interstitial pulmonary fibrosis

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166
Q

Hypercoagulability (leading to migrating DVT’s and vasculitis)

A

Trousseau’s syndrome (adenocarcinoma of the pancreas or lung)

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167
Q

Hypersegmented neutrophils

A

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

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168
Q

Hypertension, hypokalemia, metabolic acidosis

A

Conn’s syndrome

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169
Q

Hypochromic, microcytic anemia

A

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

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170
Q

Increased alpha-fetoprotein in amniotic fluid/maternal serum

A

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

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171
Q

Increased uric acid levels

A

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

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172
Q

Intranuclear eosinohilic droplet-like bodies

A

Cowdry type A bodies (HSV or CMV)

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173
Q

Iron-containing nodules in alveolar septum

A

Ferruginous bodies (asbestosis: increased risk of mesothelioma)

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174
Q

Keratin pearls on a skin biopsy

A

Squamous cell carcinoma

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175
Q

Large lysosomal vesicles in phagocytes, immunodeficiency

A

Chediak-Higashi disease (congenital failure of phagolysosome formation)

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176
Q

Lead pipe appearance of colon on barium enema x-ray

A

Ulcerative colitis (loss of haustra)

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177
Q

Linear appearance of IgG deposition on glomerular basement membrane

A

Goodpasture’s syndrome

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178
Q

Low serum ceruloplasmin

A

Wilson’s disease (hepatoenticular degeneration)

179
Q

Lumpy bumpy appearance of glomeruli on immunofluorescence

A

Poststreptococcal glomerulonephritis (immune complex deposition of IgG and C3b)

180
Q

Lytic (“hole punched”) bone lesions on xray

A

Multiple Myeloma

181
Q

Mammary gland (“blue domed”) cyst

A

Fibrocystic change of the breast

182
Q

Monoclonal antibody spike

A
  1. Multiple myeloma (IgG or IgA) 2. Monoclonal gammopathy of undetermined significance (MGUS; normal consequence of aging) 3. Waldenstrom’s (M protein=IgM) macroglobulinemia 4. Primary amyloidosis
183
Q

Mucin-filled cell with peripheral nucleus

A

Signet ring (gastric carcinoma)

184
Q

Narrowing of bowel lumen on barium on xray

A

String sign (Crohn’s disease)

185
Q

Necrotizing vasculitis (lungs) and necrotizing glomerulonephritis

A

Granulomatosis w/ polyangiitis (Wegener’s; c-ANCA positve) Goodpasture’s syndrome (anti-basement membrane antibodies)

186
Q

Needle-shaped, negatively birefringent crystals

A

Gout (monosodium urate crystals)

187
Q

Nodular hyaline deposits in glomeruli

A

Kimmelstiel-Wilson nodules (diabetic nephropathy)

188
Q

Novobicin response

A

Sensitive: Staphylococcus epidermidis Resistant: Staphylococcus saprophyticus

189
Q

Nutmeg appearance of liver

A

Chronic passive congestion of liver due to heart failure

190
Q

Onion skin periosteal reaction

A

Ewing’s sarcoma (malignant round cell tumor)

191
Q

Optochin response

A

Sensitive: Streptococcus pneumoniae Resistant: Viridans streptococcus

192
Q

Periosteum raised from bone, creating triangular area

A

Codman’s triangle on xray (osteosarcoma, Ewing’s sarcoma, pyogenic osteomyelitis)

193
Q

Podocyte fusion or “effacement” on electron microscopy

A

Minimal change disease (child with nephrotic syndrome)

194
Q

Polished “ivory like” appearance of bone at cartilage erosion

A

Eburnation (osteoarthritis resulting in bony sclerosis)

195
Q

Protein aggregates in neurons from hyperphosphorylation of protein tau

A

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

196
Q

Psammoma bodies

A

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

197
Q

Pseudopalisading tumor cells on biopsy

A

Glioblastoma multiforme (associated with HHV-6 and CMV)

198
Q

RBC casts in urine

A

Acute glomerulonephritis

199
Q

Rectangular, crystal-like, cytoplasmic inclusions in Leydig cells

A

Reinke crystals (Leydig cell tumor)

200
Q

Renal epithelial casts in urine

A

Acute toxic/viral nephrosis

201
Q

Rhomboid crystals, positively birefringent

A

Pseudogout (calcium pyrophosphate dihydrate crystals)

202
Q

Rib notching

A

Coarctation of the aorta

203
Q

Ring-enhancing brain lesion in AIDS

A

Toxoplasma gondii, CNS lymphoma

204
Q

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

A

Burkitt’s lymphoma (t8:14) c-myc activation associated with EBV; “black sky” made up of malignant cells

205
Q

Silver-staining spherical aggregation of tau proteins in neurons

A

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

206
Q

Soap bubbles on femur or tibia on xray

A

Giant cell tumor of bone (generally benign)

207
Q

Spikes on basement membrane “dome like” subepithelial deposits

A

Membranous glomenulonephritis (may progress nephrotic syndrome)

208
Q

Stacks of RBCs

A

Rouleaux formation (high ESR, multiple myeloma)

209
Q

Stippled vaginal epithelial cells

A

Clue cells (Gardnerella vaginalis)

210
Q

Tennis racket shaped cytoplasmic organelles (EM) in Langerhans cells

A

Birbeck granules (Langerhans cells histiocytosis or histocytosis X: eosinophilic granuloma)

211
Q

Thrombi make of red/white layers

A

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

212
Q

Thumb sign on lateral xray

A

Epiglottitis (haemophilus influenzae)

213
Q

Thyroid-like appearance of kidney

A

Chronic bacterial pyelonephritis

214
Q

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

A

Membranoproliferative glomerulonephritis

215
Q

Triglyceride accumulation in liver cell vacuoles

A

Fatty liver disease (alcoholic or metabolic syndrome)

216
Q

Waxy casts with very low urine

A

Chronic end-stage renal disease

217
Q

WBC casts in urine

A

Acute pyelonephritis

218
Q

WBCs that look “smudged”

A

CLL (almost always B cell)

219
Q

Wire loop glomerular capillary appearance on light microscopy

A

Lupus nephropathy

220
Q

Yellowish CSF

A

Xanthochromia (due to subarachnoid hemorrhage)

221
Q

Absence seizures

A

Ethosuximide

222
Q

Acute gout attack

A

NSAIDS, colchicine

223
Q

Acute promyelocytic leukemia (M3)

A

All-trans retinoic acid

224
Q

ADHD

A

Methylphenidate, amphetamines

225
Q

Alcohol abuse

A

AA + disulfram for patient and Al-Anon for family

226
Q

Alcohol withdrawl

A

Benzodiazepines

227
Q

Anorexia

A

SSRIs

228
Q

Anticoagulation during pregancy

A

Heparin

229
Q

Arrhthymia in damaged cardiac tissue

A

Class IB antiarrhythmic (lidocaine, mexiletine, tocainide)

230
Q

B12 deficiency

A

Vitamin B12 supplementation (work up cause with Schilling test)

231
Q

Benign prostatic hyperplasia

A

Tamsulosin, finasteride

232
Q

Bipolar disorder

A

Lithium, valproate, carbamazepine, lamotrigine (mood stabilizers)

233
Q

Breast cancer in postmenopausal woman

A

Aromatase inhibitor (anastrozole)

234
Q

Buerger’s disease

A

Smoking cessation

235
Q

Bulemia

A

SSRIs

236
Q

Candida albicans

A

Amphotericin B (systemic), nystatin (oral thrush, esophagitis)

237
Q

Carcinoid syndrome

A

Octreotide

238
Q

Chlamydia trachomatis

A

Doxycycline (+ cefriaxone for gonohrrhea coinfections), erythromycin eye drops (prophylaxis in infants)

239
Q

Chronic gout

A

Probenecid (underexcretor) and allopurinal (overproducer)

240
Q

Chronic hepatitis

A

IFN-alpha

241
Q

Chronic myelogenous leukemia

A

Imatinib

242
Q

Clostridium botulinum

A

Antitoxin

243
Q

Clostridium difficile

A

Oral metronidazole; if refractory, oral vancomycin

244
Q

Clostridium tetani

A

Antitoxin + vaccine booster + Diazepam

245
Q

Crohn’s disease

A

Corticosteroids, infliximab

246
Q

Cryptococcus neoformans

A

Fluconazole (prophylaxis in AIDS patients)

247
Q

Cyclophosphamide-induced hemorrhagic cystitis

A

Mesna

248
Q

Cystic fibrosis

A

N-acetylcysteine + antipseudomonal prophylaxis (tobramycin/azithromycin)

249
Q

Cytomegalovirus

A

Ganciclovir

250
Q

Depression

A

SSRIs

251
Q

Diabetes insipidus

A

Desmopressin (central); hydrochlorothiazide indomethacin, amiloride (nephrogenic)

252
Q

Diabetes mellitus type 1

A

Dietary intervention and insulin replacement

253
Q

Diabetes melitus type 2

A

Dietary intervention, oral hypoglycemia and possibly insulin

254
Q

Diabetic ketoacidosis

A

Fluids, insulin, K+

255
Q

Enterococci

A

Vancomycin/ampicillin + aminoglycoside

256
Q

Erectile dysfuction

A

Sildenafil, vardenafil

257
Q

ER-positive breast cancer

A

Tamoxifen

258
Q

Ethylene glycol/methanol intoxication

A

Fomepizole

259
Q

Haemophilus influenzae B

A

Rifampin (prophylaxis)

260
Q

Generalized anxiety disorder

A

Buspirone

261
Q

Heparin toxicity

A

Protamine sulfate

262
Q

HER2/neu-postive breast cancer

A

Trastuzumbab

263
Q

Hyperaldosteronism

A

Spironolactone

264
Q

Hypercholesterolemia

A

Statin

265
Q

Hypertriglyceridemia

A

Fibrate

266
Q

Immediate anticoagulation

A

Heparin

267
Q

Infertility

A

Leuprolide, GnRH (pulsatile)

268
Q

Influenza

A

Rimantadine, oseltamivir

269
Q

Legionella pneumophilia

A

Erythromycin

270
Q

Long-term anticoagulation

A

Warfarin

271
Q

Malaria

A

Chloroquine/mefloquine (for blood schizont), primaquine (for liver hypnozoite)

272
Q

Malignant hyperthermia

A

Dantrolene

273
Q

Medical abortion

A

Mifepristone

274
Q

Migraine

A

Sumatriptan

275
Q

MRSA

A

Vancomycin

276
Q

Multiple sclerosis

A

Beta-interferon, immunosuppression, natazlizumab

277
Q

Mycobacterium tuberculosis

A

RIPE (Rifampin, INH, pyrazinambide, ethambutol)

278
Q

Neisseria gonorrhoeae

A

Ceftriaxone (add doxycycline to cover likely Chlamydia co-infection)

279
Q

Nesseria meningitidis

A

Penicillin/ceftriaxone, rifampin (prophylaxis)

280
Q

Neural tube defect prevention

A

Prenatal folic acid supplementation

281
Q

Osteomalacia/rickets

A

Vitamin D supplementation

282
Q

Osteoporosis

A

Bisphosphonates; calcium and vitamin D supplementation

283
Q

Patent ductus arteriosis

A

Indomethacin

284
Q

Pheochromocytoma

A

alpha-antagonist (phenoxybenzamine)

285
Q

Pneumocystis jirovecii

A

TMP-SMX (prophylaxis in AIDS pt)

286
Q

Prolactinoma

A

Bromocriptine (dopamine agonists)

287
Q

Prostate cancer/uterine fibroids

A

Leuprolide, GnRH (continuous)

288
Q

Prostate carcinoma

A

Flutamide

289
Q

Pseudomonas aeruginosa

A

Antipseudomonal penicillin + aminoglycoside

290
Q

Pulmonary arterial hypertension

A

Sildenafil, bosentan, epoprostenol

291
Q

Rickettsia rickettsii

A

Doxycycline, chloramphenicol (especially in context of aplastic anemia)

292
Q

Ringworm infection

A

Terbinafine, griseofulvin, imidazole

293
Q

Schizophrenia (Negative)

A

5-HT2A antagonists (second generation antipsychotics)

294
Q

Schizophrenia (Positive)

A

D2 receptor antagonists (first and second generation antipsychotics)

295
Q

SIADH

A

Demeclocycline, lithium, vasopressin receptor antagonists

296
Q

Sickle cell anemia

A

Hydroxyurea (increased fetal hemoglobin)

297
Q

Sporothrix schenckii

A

Oral potassium iodide

298
Q

Stable angina

A

Sublingual nitroglycerin

299
Q

Staphylococcus aureus

A

MSSA: nafcillin, oxacillin, dicloxacillin (antinstaphylococcal penicillins); MRSA: vancomycin

300
Q

Streptococcus bovis

A

Penicillin prophylaxis, evaluation for colon cancer if linked to endocarditis

301
Q

Streptococcus pneumoniae

A

Penicillin/cephalosporin (systemic infection, pneumonia) vancomycin (meningitis)

302
Q

Streptococcus pyogenes

A

Penicillin prophylaxis

303
Q

Temporal arteritis

A

High-dose steroids

304
Q

Tonic-clonic seizures

A

Phenytoin, valproate, carbamazepine

305
Q

Toxoplasma gondii

A

Sulfadiazine + pyrimethamine

306
Q

Treponema pallidum

A

Penicillin

307
Q

Trichomonas vaginalis

A

Metronidazole (patient and partner)

308
Q

Ulcerative colitis

A

5-ASA, infliximab

309
Q

UTI prophylaxis

A

TMP-SMX

310
Q

Warfarin toxicity

A

Fresh frozen plasma (acute) Vitamin K (chronic)

311
Q

Wegener’s granulomatosis w/ polyangiitis

A

Cyclophosphamide, corticosteroids

312
Q

Actinic (solar) keratosis

A

Precursor to squamous cell carcinoma

313
Q

Acute gastric ulcer associated with CNS injury

A

Cushing’s ulcer (increase ICP stimulates vagal gastric secretion)

314
Q

Acute gastric ulcer associated with severe burns

A

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

315
Q

Alternating areas of transmural inflammation and normal colon

A

Skip lesions (Crohn’s disease)

316
Q

Aneurysm, dissecting

A

Hypertension

317
Q

Aortic aneurysm, abdominal and descending aorta

A

Atherosclerosis

318
Q

Aortic aneurysm, arch

A

Tertiary syphilis (syphilis), vasa vasorum destruction

319
Q

Aortic aneurysm, ascending

A

Marfan’s syndrome (idiopathic cystic medial degeneration)

320
Q

Atropy of the mammillary bodies

A

Wenicke’s encephalopathy (thiamine deficiency causing ataxia, ophthalmoglegia, and confusion)

321
Q

Autosplenectomy (fibrosis and shrinkage)

A

Sickle cell anemia (hemoglobin S)

322
Q

Bacteria associated with gastritis, peptic ulcer disease, and stomach cancer

A

H. pylori

323
Q

Bacterial meningitis (adults and elderly)

A

Streptococcus pneumoniae

324
Q

Bacterial meningitis (newborns and kids)

A

Group B streptococcus (newborns), S. pneumoniae/Neisseria meningitidis (kids)

325
Q

Benign melanocytic nevus

A

Spitz nevus (most common and first two decades)

326
Q

Bleeding disorder with GpIB deficiency

A

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

327
Q

Brain tumor (adults)

A

Supratentorial: metastasis>astrocytoma (including glioblastoma multiform)>meningioma> schwannoma

328
Q

Brain tumor (kids)

A

Infratentorial: medulloblastom (cerebellum) or supratentorial: craniopharyngioma (cerebrum)

329
Q

Breast cancer

A

Infiltrating ductal carcinoma (in US 1 in 9 women will develop breast cancer)

330
Q

Breast tumor (benign)

A

Fibrocystic change, carcinoma (in postmenopausal women)

331
Q

Cardiac primary tumor (kids)

A

Rhabdomyoma, often seen in tuberous sclerosis

332
Q

Cardiac manifestation of lupus

A

Libman-Sacks exdocarditis (nonbacterial, affecting both sides of mitral valve)

333
Q

Cardiac tumor (adults)

A

Metastasis, primary myxoma (4:1 left to right atrium; “ball and valve”)

334
Q

Cerebellar tonsillar herniation

A

Chiari malformation (often presents with progressive hydrocephalus or syringomyelia)

335
Q

Chronic arrhythmia

A

Atrial fibrillation (associated with high risk of emboli)

336
Q

Chronic atrophic gastritis (autoimmune)

A

Predisposition to gastic carcinoma (can also cause pernicious anemia)

337
Q

Clear cell adenocarcinoma of the vagina

A

DES exposure in utero

338
Q

Compression fracture

A

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

339
Q

Congenital adrenal hyperplasia, hypotension

A

21-hydroxylase deficiency

340
Q

Congenital cardiac anomaly

A

VSD

341
Q

Congenital conjugated hyperbilirubinemia (black liver)

A

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

342
Q

Constrictive pericarditis

A

Tuberculosis (developing world); systemic lupus erythematosus (developed world)

343
Q

Coronary artery involved in thrombosis

A

LAD>RCA>LCA

344
Q

Cretinism

A

Iodine deficit/hypothyroidism

345
Q

Cushing’s syndrome

A
  1. Iatrogenic Cushing’s 2. Adrenocortical adenoma (excess cortisol) 3. ACTH-secreting pituitary adema 4. Paraneoplastic Cushing’s (due to ACTH secretion by tumors)
346
Q

Cyanosis (early; less common)

A

Tetralogy of Fallot, transposition of great vessels, truncus arteriosus

347
Q

Cyanosis (late; more common)

A

VSD, ASD, PDA

348
Q

Death in CML

A

Blast crisis

349
Q

Death in SLE

A

Lupus nephropathy

350
Q

Dementia

A

Alzheimer’s disease, multiple infarcts

351
Q

Demyelinating disease in young women

A

Multiple sclerosis

352
Q

DIC

A

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

353
Q

Dietary deficit

A

Iron

354
Q

Diverticulum in pharynx

A

Zenker’s diverticulum (diagnosed by barium swallow)

355
Q

Ejection click

A

Aortic/pulmonic stenosis

356
Q

Esophageal cancer

A

Squamous cell carcinoma (worldwide); adenocarcinoma (US)

357
Q

Food poisoning (exotoxin mediated)

A

S. aureus, B. cereus

358
Q

Glomerulonephritis (adults)

A

Berger’s disease (IgA nephropathy)

359
Q

Gynecologic malignancy

A

Endometrial carcinoma (most common in US); cervical carcinoma (most common worldwide)

360
Q

Heart murmur, congenital

A

Mitral valve prolapse

361
Q

Heart valve in bacterial endocarditis

A

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

362
Q

Helminth infection (US)

A

Enterbius vernicularis, Ascaris lumbricoides

363
Q

Hematoma- epidural

A

Rupture of middle meningeal artery (trauma; lentiform shaped)

364
Q

Hematoma-subdural

A

Rupture of bridging veins (Crescent shaped)

365
Q

Hemochromatosis

A

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

366
Q

Hepatocellular carcinoma

A

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

367
Q

Hereditary bleeding disorder

A

von Wilebrand’s disease

368
Q

Hereditary harmless jaundice

A

Gilbert’s syndrome (benign congenital unconjugated hyperbilirubinemia)

369
Q

HLA-B27

A

Ankyosing spondylitis, Reiter’s syndrome, ulcerative colitis, psoriasis

370
Q

HLA-DR3 or DR4

A

Diabetes mellitus type 1, rheumatoid arthritis, SLE

371
Q

Holosystolic murmur

A

VSD, tricuspid regurgitation, mitral reurgitation

372
Q

Hypercoagulability, endothelial damage, blood stasis

A

Virchow’s triad (results in venous thrombosis)

373
Q

Secondary hypertension

A

Renal disease

374
Q

Hypoparathyroidism

A

Accidental excision during thyroidectomy

375
Q

Hypopituitarism

A

Pituitary adenoma (usually benign tumor)

376
Q

Infection secondary to blood transfusion

A

Hepatitis C

377
Q

Infections in chronic granulomatous disease

A

Staphylococcus aureus, E. coli, Asperigillus (catalase positive)

378
Q

Kidney stones

A
  1. Calcium=radiopaque 2. Struvite (ammonium)=radiopaque (formed by urease positive organisms such as Proteus vulgaris or Staphylococcus) 3. Uric acid=radiolucent
379
Q

Late cyanotic shunt (uncorrected left to right becomes right to left)

A

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

380
Q

Liver disease

A

Alcoholic cirrhosis

381
Q

Lysosomal storage disease

A

Gaucher’s disease

382
Q

Male cancer

A

Prostatic carcinoma

383
Q

Malignancy associated with noninfectious fever

A

Hodgkin’s lymphoma

384
Q

Malignancy (kids)

A

ALL, medulloblastoma (cerebellum)

385
Q

Mental retardation

A

Down syndrome, fragile X syndrome

386
Q

Metastases to bone

A

Prostate,breast>lung>thyroid, testes

387
Q

Metastases to brain

A

Lung>breast>genitourinary>osteosarcoma>melanoma>GI

388
Q

Metastases to liver

A

Colon»stomach, pancreas

389
Q

Mitochondrial inheritance

A

Disease occurs in males and females, inherited through females only

390
Q

Mitral valve stenosis

A

Rheumatic heart disease

391
Q

Mixed (UMN and LMN) motor neuron disease

A

ALS

392
Q

Myocarditis

A

Coxxsackie B

393
Q

Nephrotic syndrome (adults)

A

Focal segmental glomerulosclerosis

394
Q

Nephrotic syndrome (kids)

A

Minimal change disease

395
Q

Neuron migration failure

A

Kallmann syndrome (hypogonadotropic hypogonadism and anosmia)

396
Q

Nosocomial pneumonia

A

Klebsiella, E. coli, Pseugomonas aeruginosa

397
Q

Obstruction of male urinary tract

A

BPH

398
Q

Opening snap

A

Mitral stenosis

399
Q

Opportunistic infection in AIDS

A

Pneumocytis jirovecii pneumonia

400
Q

Osteomyelitis

A

S. aureus

401
Q

Osteomyelitis in sickle cell disease

A

Salmonella

402
Q

Osteomyelitis with IV drug use

A

Pseudomonas, S. aureus

403
Q

Ovarian metastasis from gastic carcinoma or breast cancer

A

Krukenberg tumor (mucin-secreting signet-ring cells)

404
Q

Ovarian tumor (benign, bilateral)

A

Serous cystadenoma

405
Q

Ovarian tumor (malignant)

A

Serous cystadenocarcinoma

406
Q

Pancreatitis (acute)

A

Gallstones, alcohol

407
Q

Pancreatitis (chronic)

A

Alcohol (adults) cystic fibrosis (kids)

408
Q

Patient with ALL/CLL/AML/CML

A

ALL: Child, CLL:adult>60, AML:adult~65, CML:adult 30-60

409
Q

Pelvic inflammatory disease

A

Chlamydia trachomatis, Neisseria gonorrhoae

410
Q

Philadelphia chromosome t(9;22)(bcr-abl)

A

CML (may sometimes be associated with ALL/AML)

411
Q

Pituitary tumor

A

Prolactinoma, somatotropic “acidophilic” adenoma

412
Q

Primary amenorrhea

A

Turner syndrome

413
Q

Primary bone tumor (adults)

A

Multiple myeloma

414
Q

Primary hyperaldosteronism

A

Adenoma of adrenal cortex

415
Q

Primary hyperparathyroidism

A

Adenomas, hyperplasia, carcinoma

416
Q

Primary liver cancer

A

Hepatocellular carcinoma (chronic hepatitis, cirrhosis, hemochromatosis, alpha1 antritrypsin deficiency)

417
Q

Pulmonary hypertension

A

COPD

418
Q

Recurrent inflammation/thrombosis of small/medium vessels in extremities

A

Buerger’s disease (strongly associated with tobacco)

419
Q

Renal tumor

A

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

420
Q

Right failure due to pulmonary cause

A

Cor pulmonale

421
Q

S3 (protodiastolic gallop)

A

Increased ventricular filling (left to right shunt, mitral regurgitation, LV failure, CHF)

422
Q

S4 (protodiastolic gallop)

A

Stiff/hypertrophic ventricle (aortic stenosis, restrictive cardiomyopathy)

423
Q

Secondary hyperparathyroidism

A

Hypocalcemia of chronic kidney disease

424
Q

Sexually transmitted disease

A

Chlamydia (usually with gonorrhea)

425
Q

SIADH

A

Small cell cacinoma of the lung

426
Q

Site of diverticula

A

Sigmoid colon

427
Q

Sites of atherosclerosis

A

Abdominal aorta>coronary artery>popliteal artery>carotid artery

428
Q

Stomach cancer

A

Adenocarcinoma

429
Q

Stomach ulcerations and high gastrin levels

A

Zollinger-Ellison syndrome (gastrinoma of duodenum or pancreas)

430
Q

t(14:18)

A

Follicular lymphoma (bcl-2 activation)

431
Q

t(8:14)

A

Burkitt’s lymphomas (c-myc activation)

432
Q

t(9:22)

A

Philadelphia chromosome, CML (bcr-abl fusion)

433
Q

Temporal arteritis

A

Risk of ipsilateral blindness due to thrombosis of opthalmic artery; polymyalgia rheumatica

434
Q

Testicular tumor

A

Seminoma

435
Q

Thyroid cancer

A

Papillary carcinoma

436
Q

Tumor in women

A

Leiomyoma (estrogen dependent, not precancerous)

437
Q

Tumor of infancy

A

Hemangioma (usually regresses spontaneously by childhood)

438
Q

Tumor of the adrenal medulla (kids)

A

Neuroblastoma (malignant)

439
Q

Type of Hodgkins

A

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

440
Q

Type of non-Hodgkins

A

Diffuse large cell

441
Q

UTI

A

E. coli, Staphylocuccus saprophyticus (young women)

442
Q

Viral encephalitis affecting temporal lobe

A

HSV-1

443
Q

Vitamin deficiency (US)

A

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

USMLE (2 decks)

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