Rapid Review1

7/30/2019 Rapid Review1

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Rapid Review1

First Aid for USMLE Step 1 Rapid Review

Question Answer

Abdominal pain, ascites, hepatomegalyBudd-Chiari Syndrome (posthepatic venous

thrombosis)

Achilles tendon xanthoma Familial hypercholesterolemia

Adrenal hemorrhage, hypotension, DICWaterhouse-Friderichsen Syndrome

(meningococcemia)

Arachnodactyly, lens dislocation, aorticdissection, hyperflexible joints

Marfan's syndrome (fibrillin defect)

Athlete with polycythemia Erythropoietin injection

Back pain, fever, night sweats, weight loss Pott's disease (vertebral tuberculosis)

Bilateral hilar adenopathy, uveitis Sarcoidosis (noncaseating granulomas)

Blue sclera Osteogenesis imperfecta (collagen defect)

Bluish line on gingiva Burton's line (lead poisoning)

Bone pain, bone enlargement, arthritisPaget's disease of bone (increased osteoblastic

and osteoclastic activity)

Bounding pulses, diastolic heart murmur,

head bobbingAortic regurgitation

Caf-au-lait spots, Lisch nodules (irishamartoma)

Neurofibromatosis type I (+ pheochromocytoma,

optic gliomas) Neurofibromatosis type II (+

bilateral acoustic neuromas)

Caf-au-lait spots, polyostotic fibrous

dysplasia, precocious puberty

McCune-Albright syndrome (mosaic G-protein

signaling mutation)

Calf pseudohypertrophy Muscular dystrophy (MCly Duchenne's)

"Cherry-red spot" on macula

Tay-Sachs (ganglioside accumulation) or

Niemann-Pick (sphingomyelin accumulation),

central retinal artery occlusion

Chest pain, pericardial effusion/friction rub,

persistent fever following MI

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

episode)

Child uses arms to stand up from squatGowers' sign (Duchenne muscular dystrophy: XR

deleted dystrophin gene)

Child with fever develops red rash on face "Slapped cheeks" (erythema infectiosum/fifth


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that spreads to body disease: parvovirus B19)

Chorea, dementia, caudate degeneration Huntington's disease (AD CAG repeat expansion)

Chronic exercise intolerance with myalgia,

fatigue, painful cramps

McArdle's disease (muscle phosphorylase

deficiency)

Cold intolerance Hypothyroidism

Conjugate lateral gaze palsy, horizontal

diplopia

Internuclear ophthalmoplegia (damage to MLF;

bilateral [multiple sclerosis], unilateral [stroke])

Continuous "machinery" heart murmurPDA (close with indomethacin; open with

misoprostol)

Cutaneous/dermal edema due to connective

tissue depositionMyxedema (hypothyroidism, Graves' disease)

Dark purple skin/mouth nodulesKaposi's sarcoma (usually AIDS patients [gay

men]: associated with HHV-8)

Deep, labored breathing/hyperventilation Kussmaul breathing (DKA)

Dermatitis, dementia, diarrhea Pellagra (niacin [vitamin B3] deficiency)

Dilated cardiomyopathy, edema,

polyneuropathyWet beriberi (thiamine [vitamin B1] deficiency)

Dog or cat bite resulting in infectionPasteurella multocida (cellulitis at inoculation

site)

Dry eyes, dry mouth, arthritisSjgren's syndrome (autoimmune destruction of

exocrine glands)

Dysphagia (esophageal webs), glossitis, irondeficiency anemia

Plummer-Vinson syndrome (may progress toesophageal squamous cell carcinoma)

Elastic skin, hypermobility of jointsEhlers-Danlos syndrome (collagen defect, usually

type III)

Enlarged, hard left supraclavicular node Virchow's node (abdominal metastasis)

Erythroderma, lymphadenopathy,

hepatosplenomegaly, atypical T cells

Szary syndrome (cutaneous T-cell lymphoma)

or mycosis fungoides

Facial muscle spasm upon tapping Chvostek's sign (hypocalcemia)

Fat, female, forty, and fertile Acute cholecystitis (bile duct blockage)

Fever, chills, headache, myalgia followingantibiotic treatment for syphilis

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

Fever, cough, conjunctivitis, coryza, diffuserash

Measles (Morbillivirus)

Fever, night sweats, weight loss B symptoms (lymphoma)


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Fibrous plaques in soft tissue of penis Peyronie's disease (connective tissue disorder)

Gout, mental retardation, self-mutilating

behavior in a boy

Lesch-Nyhan syndrome (HGPRT deficiency,

XR)

Green-yellow rings around peripheral corneaKayser-Fleischer rings (copper accumulation

from Wilson's disease)

hamartomatous GI polyps,

hyperpigmentation of mouth/feet/hands

Peutz-Jeghers syndrome (genetic benignpolyposis can cause bowel obstruction; increase

cancer risk)

Hepatosplenomegaly, osteoporosis,

neurologic symptoms

Gaucher's disease (glucocerebrosidase

deficiency)

Hereditary nephritis, sensorineural hearing

loss, cataractsAlport's syndrome (type IV collagen mutation)

Hypercoagulability (leading to migrating

DVTs and vasculitis)

Trousseau's sign (adenocarcinoma of pancreas or

lung)Hyperphagia, hypersexuality, hyperorality,

hyperdocility

Klver-Bucy syndrome (bilateral amygdala

lesion)

Hypertension, hypokalemia, metabolic

alkalosis (the high pH of the blood makesCa2+ less available to the tissues and causes

symptoms of hypocalcemia)

Conn's syndrome (primary hyperaldosteronism)

Hypoxemia, polycythemia, hypercapnia"Blue bloater" (chronic bronchitis: hyperplasia ofmucous cells)

Indurated, ulcerated genital lesion Nonpainful: chancre (primary syphilis,Treponema pallidum) Painful, with exudate:

chancroid (Haemophilus ducreyi)

Infant with failure to thrive,

hepatosplenomegaly, neurodegeneration

Niemann-Pick disease (genetic sphingomyelinase

deficiency)

Infant with hypoglycemia, failure to thrive,

and hepatomegalyCori's disease (debranching enzyme deficiency)

Infant with microcephaly, rocker-bottom feet,

clenched hands, and structural heart defectEdwards' syndrome (trisomy 18)

Jaundice, RUQ pain, fever Charcot's triad 2 (ascending cholangitis)Keratin pearls on skin biopsy Squamous cell carcinoma

Large rash with bull's-eye appearanceErythema chronicum migrans from Ixodes tick

bite (Lyme disease: Borrelia)

Lucid interval after traumatic brain injuryEpidural hematoma (middle meningeal artery

rupture)


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Male child, recurrent infections, no mature Bcells

Bruton's disease (X-linked agammaglobulinemia)

Mucosal bleeding and prolonged bleedingtime

Glanzmann's thrombasthenia (defect in plateletaggregation due to lack of GpIIb/IIIa)

Multiple colon polyps, osteomas/soft tissuetumors, impacted/supernumerary teeth

Gardner's syndrome (subtype of FAP)

Necrotizing vasculitis (lungs) and necrotizing

glomerulonephritis

Wegener's (c-ANCA positive) and Goodpasture's

syndromes (anti-basement membrane antibodies)

Neonate with arm paralysis following

difficult birth

Erb-Duchenne palsy (superior trunk [C5-C6]

brachial plexus injury: "waiter's tip")

No lactation postpartum, absent

menstruation, cold intoleranceSheehan's syndrome (pituitary infarction)

Nystagmus, intention tremor, scanning

speech, bilateral internuclearophthalmoplegia

Multiple sclerosis

Oscillating slow/fast breathingCheyne-Stokes respirations(central apnea in CHF

or increased intracranial pressure)

Painful blue fingers/toes, hemolytic anemiaCold agglutinin disease (autoimmune hemolyticanemia caused by Mycoplasma pneumoniae,

infectious mononucleosis)

Painful, pale, cold fingers/toes Rayneud's syndrome (vasospasm in extremities)

Painful, raised red lesions on palms and soles Osler's nodes (infective endocarditis)

Painless erythematous lesions on palms andsoles

Janeway lesions (infective endocarditis)

Painless jaundiceCancer of the pancreatic duct obstructing bileduct

Palpable purpura, joint pain, abdominal pain(child)

Henoch-Schnlein purpura (IgA vasculitisaffecting skin and kidneys)

Pancreatic, pituitary, parathyroid tumors Wermer's syndrome (MEN I)

Pink complexion, dyspnea, hyperventilation"Pink puffer" (emphysema: centroacinar

[smoking], panacinar [1-antitrypsin deficiency])

Polyuria, acidosis, growth failure, electrollyte

imbalances

Fanconi's syndrome (proximal tubular

reabsorpiton defect)

Positive anterior "drawer sign" Anterior cruciate ligament (ACL) injury

Ptosis, miosis, anhidrosis Horner's syndrome (sympathetic chain lesion)

Pupil accommodates but doesn't react Argyll Robertson pupil (neurosyphilis)


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Rapidly progressive leg weakness thatascends (following GI/upper respiratory

infection)

Guillain-Barr syndrome (autoimmune acute

inflammatory demyelinating polyneuropathy)

Rash on palms and solesSecondary syphilis, Rocky Mountain spotted

fever, Coxsackie A virus

Recurrent colds, unusual eczema, high serum

IgE

Job's syndrome (hyper-IgE syndrome: neutrophil

chemotaxis abnormality)

Red "currant jelly" sputum in alcoholic or

diabetic patientsKlebsiella pneumoniae

Red, itchy, swollen rash of nipple/areolaPaget's disease of the breast (represents

underlying neoplasm)

Renal cell carcinoma, hemangioblastomas,

angiomatosis, pheochromocytoma

von Hippel-Lindau disease (dominant tumor

suppressor gene mutation)

Resting tremor, rigidity, akinesia, posturalinstability

Parkinson's disease (nigrostriatal dopaminedepletion)

Restrictive cardiomyopathy (juvenile form:

cardiomegaly), exercise intolerance

Pompe's disease (lysosomal glucosidase

deficiency)

Retinal hemorrhages with pale centers Roth spots (bacterial endocarditis)

Severe jaundice in neonateCrigler-Najjar syndrome (congential

unconjugated hyperbilirubinemia)

Severe RLQ pain with rebound tenderness McBurney's sign (appendicitis)

Short stature, increased incidence of

tumors/leukemia, aplastic anemia

Fanconi's anemia (genetically inherited; often

progresses to AML)

Single palm crease Simian crease (Down syndrome)

Situs inversus, chronic sinusitis,

bronchiectasis, infertility

Kartagener's syndrome (dynein defect affecting

cilia)

Skin hyperpigmentation

Addison's disease (primary adrenocortical

insufficiency of autoimmune or infectious

etiology)

Slow, progressive weakness in boysBecker's muscular dystrophy (X-linked, defective

dystrophin; less severe than Duchenne's)

Small, irregular red spots on buccal/lingual

mucosa with blue-white centersKoplik spots (measles)

Smooth, flat, moist white lesions on genitals Condylomata lata (secondary syphilis)

Splinter hemorrhages in fingernails Bacterial endocarditis

"Strawberry tongue"Scarlet fever, Kawasaki disease, toxic shock

syndrome


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Streak ovaries, congential heart disease,horseshoe kidney

Turner syndrome (XO, short stature, webbedneck, lymphedema)

Sudden swollen/painful big toe joint, tophi Gout/podagra (hyperuricemia)

Swollen gums, mucous bleeding, poor wound

healing, spots on skin

Scurvy (vitamin C deficiency: can't hydroxylate

proline/lysine for collagen synthesis)

Swollen, hard, painful finger jointsOsteoarthritis (osteophytes on PIP [Bouchard'snodes], DIP [Heberden's nodes])

Systolic ejection murmur (crescendo-decrescendo)

Aortic valve stenosis

Thyroid and parathyroid tumors,pheochromocytoma

Sipple's syndrome (MEN 2A)

Toe extension/fanning upon plantar scrape Babinski's sign (UMN lesion)

Unilateral facial drooping involving forehead Bell's palsy (LMN CN VII palsy)

Urethritis, conjunctivitis, arthritis in a maleReiter's syndrome (reactive arthritis associated

with HLA-B27)

Vascular birthmark (port-wine stain)Hemangioma (benign, but associated with Sturge-

Weber syndrome)

Vasculitis from exposure to endotoxin causeglomerular thrombosis

Shwartzman reaction (following second exposureto endotoxin)

Vomiting blood following esophagogastriclacerations

Mallory-Weiss syndrome (alcoholic and bulimicpatients)

"Waxy" casts with very low urine flow Chronic end-stage renal diseaseWBC casts in urine Acute pyelonephritis

Weight loss, diarrhea, arthritis, fever,

adenopathyWhipple's disease (Tropheryma whippelii)

"Worst headache of my life" Subarachnoid hemorrhage

Anticentromere antibodies Scleroderma (CREST)

Andidesmoglein (epithelial) antibodies Phemphigus vulgaris (blistering)

Anti-glomerular basement membraneantibodies

Goodpasture's syndrome (glomerulonephritis andhemoptysis)

Antihistone antibodiesDrug-induced SLE (hydralazine, isoniazid,phenytoin, procainamide, quinidine)

Anti-IgG antibodiesRheumatoid arthritis (systemic inflammation,joint pannus, boutonnire deformity)

Antimitochondrial antibodies (AMAs)Primary biliary cirrhosis (female, cholestasis,

portal hypertension)


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Antineutrophil cytoplasmic antibodies

(ANCAs)

Vasculitis (c-ANCA: Wegener's; p-ANCA:microscopic polyangiitis, Churg-Strauss

syndrome)

Antinuclear antibodies (ANAs: anti-Smith

and anti-dsDNA)

SLE (type III hypersensitivity); anti-dsDNA

correlates with disease activity, anti-Smith does

not

Antiplatelet antibodiesIdiopathic thrombocytopenic purpura (ITP)

(bleeding diathesis)

Anti-topoisomerase antibodies Diffuse systemic scleroderma

Anti-transglutaminase/antigliadin/anti-

endomysial antibodiesCeliac disease (diarrhea, distension, weight loss)

Azurophilic granular needles in leukemic

blasts

Auer rods (Acute myelogenous leukemia:

especially the promyelocytic type)

"Bamboo spine" on x-ray Ankylosing spondylitis (chronic inflammatoryarthritis: HLA-B27)

Basophilic nuclear remnants in RBCsHowell-Jolly bodies (due to splenectomy or

nonfunctional spleen)

Basophilic stippling of RBCs Lead poisoning or sideroblastic anemia

Bloody tap on LP Subarachnoid hemorrhage

"Boot-shaped" heart on x-ray Tetralogy of Fallot, RVH

Branching gram-positive rods with sulfur

granulesActinomyces israelii

Bronchogenic apical lung tumorPancoast's tumor (can compress sympathetic

ganglion and cause Horner's syndrome)

"Brown" tumor of bone

Hemorrhage (hemosiderin) causes brown color of

osteolytic cysts. Due to: 1. Hyperparathyroidism

2. Osteitis fibrosa cystica

Cardiomegaly with apical atrophy Chagas' disease (Trypanosoma cruzi)

Cellular crescents in Bowman's capsuleRapidly progressive crescentic

glomerulonephritis

"Chocolate cyst" on ovary Endometriosis (frequently involves both ovaries)

Circular grouping of dark tumor cells

surrounding pale neurofibrils

Homer Wright rosettes (neuroblastoma,

medulloblastoma, retinoblastoma)

Colonies of mucoid Pseudomonas bugs

Cystic fibrosis (CFTR mutation in Caucasians

resulting in fat-soluble vitamin deficiency and

mucous plugs)

Degeneration of dorsal column nerves Tabes dorsalis (tertiary syphilis)


8/17

Depigmentation of neurons in substantianigra

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

Desquamated epithelium casts in sputumCurschmann's spirals (bronchial asthma; canresult in whorled mucous plugs)

Disarrayed granulosa cells in eosinophilicfluid

Call-Exner bodies (granulosa-theca cell tumor ofthe ovary)

Dysplastic squamous cervical cells with

nuclear enlargement and hyperchromasiaKoilocytes (HPV: predisposes to cervical cancer)

Enlarged cells with intranuclear incluusion

bodies"Owl's-eye" appearance of CMV

Enlarged thyroid cells with ground-glass

nuclei

"Orphan Annie" eye nuclei (papillary carcinoma

of the thyroid)

Eosinophilic cytoplasmic inclusion in liver

cell

Mallory bodies (alcoholic liver disease)

Eosinophilic cytoplasmic inclusion in nerve

cellLewy body (Parkinson's disease)

Eosinophilic globule in liverCouncilman body (toxic or viral hepatitis, often

yellow fever)

Eosinophilic inclusion bodies in cytoplasm of

hippocampal nerve cellsRabies virus (Lyssavirus); Negri bodies

Extracellular amyloid deposition in gray

matter of brainSenile plaques (Alzheimer's disease)

Giant B cells with bilobed nuclei withprominent inclusions ("owl's eye")

Reed-Sternberg cells (Hodgkin's lymphoma)

Glomerulus-like structure surrounding vesselin germ cells

Schiller-Duval bodies (yolk sac tumor)

"Hair-on-end" (crew-cut) appearance on x-ray

-thalassemia, sickle cell anemia (marrowexpansion)

hCG elevatedChoriocarcinoma, hydatidiform mole (occurswith and without embryo)

Heart nodules (inflammatory) Aschoff bodies (rheumatic fever)

Heterophile antibodies Infectious mononucleosis (EBV)

Hexagonal, double-pointed, needle-like

crystals in bronchial secretions

Bronchial asthma (Charcot-Leyden crystals:

eosinophilic granules)

High level of D-dimers DVT, pulmonary embolism, DIC

Hilar lymphadenopathy, peripheral

granulomatous lesion in middle or lower lung

Ghon complex (Primary TB: Mycobacterium

bacilli)


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lobes (can calcify)

"Honeycomb lung" on x-ray Interstitial fibrosis

Hypersegmented neutrophils Megaloblastic anemia (B12, folate deficiency)

Hypochromic, microcytic anemiaIron deficiency anemia, lead poisoning,

thalassemia (HbF sometimes present)

Increased -fetoprotein in amniotic

fluid/maternal serum

Anencephaly, spina bifida (neural tube defects),

multiple gestation, abdominal wall defects

Decreased -fetoprotein Down syndrome

Increased uric acid levelsGout, Lesch-Nyhan syndrome, tumor lysis

syndrome, loop and thiazide diuretics

Intranuclear eosinophilic droplet-like bodies Cowdry type A bodies (HSV or yellow fever)

Iron-containing nodules in alveolar septumFerruginous bodies (asbestosis: increased chance

of mesothelioma)Large lysosomal vesicles in phagocytes,immunodeficiency

Chdiak-Higashi disease (congential failure ofphagolysosome formation)

Low serum ceruloplasmin Wilson's disease (hepatolenticular degeneration)

"Lumpy-bumpy" appearance of glomeruli onimmunofluorescence

Poststreptococcal glomerulonephritis (immunecomplex deposition of IgG and C3b)

Lytic ("hole-punched") bone lesions on x-ray Multiple myeloma

Mammary gland ("blue-domed") cyst Fibrocystic change of the breast

Monoclonal antibody spike (4 things)

1. Multiple myeloma (called the M protein,usually IgG or IgA) 2. Monoclonal gammopathyof undetermined significance (MGUS; normal

consequence of aging) 3. Waldenstrm's

macroglobulinemia (M protein = IgM) 4. Primaryamyloidosis

Monoclonal globulin protein in blood/urineBence Jones proteins (multiple myeloma [kappaor lambda Ig light chains in urine]),

Waldenstrm's macroglobulinemia (IgM)

Mucin-filled cell with peripheral nucleus Signet ring (gastric carcinoma)

Narrowing of bowel lumen on bariumradiograph

"String sign" (Crohn's disease)

Needle-shaped, negatively birefringentcrystals

Gout (hyperuricemia)

Nodular hyaline deposits in glomeruliKimmelstiel-Wilson nodules (diabetic

nephropathy)


10/17

"Nutmeg" appearance of liver Chronic passive congestion of liver due to RHF

"Onion-skin" periosteal reaction Ewing's sarcoma (malignant round-cell tumor)

Periosteum raised from bone, creating a

triangular area

Codman's triangle on x-ray (osteosarcoma,

Ewing's sarcoma, pyogenic osteomyelitis)

Podocyte fusion on EMMinimal change disease (child with nephrotic

syndrome)

Polished, "ivory-like" appearance of bone at

cartilage erosion

Eburnation (osteoarthritis resulting in bondy

sclerosis)

Protein aggregates in neurons from

hyperphosphorylation of protein tau

Neurofibrillary tangles (Alzheimer's disease and

CJD)

Pseudopalisading tumor cells on brain biopsy Glioblastoma multiforme

RBC casts in urine Acute glomerulonephritis

Rectangular, crystal-like, cytoplasmicinclusions in Leydig cells

Reinke crystals (Leydig cell tumor)

Renal epithelial casts in urine Acute toxic/viral nephrosis

Rhomboid crystals, positively birefringent Pseudogout (calcium pyrophosphate dihydrate)

Rib notching Coarctation of the aorta

Sheets of medium-sized lymphoid cells("starry sky" appearance on histology)

Burkitt's lymphoma (t[8;14] c-myc activation,associated with EBV)

Silver-staining spherical aggregation of tau

proteins in neurons

Pick bodies (Pick's disease: progressive dementia,

similar to Alzheimer's)

"Soap bubble" in femur or tibia on x-ray Giant cell tumor of bone (generally benign)

"Spikes" on basement membrane, "dome-

like" endothelial deposits

Membranous glomerulonephritis (may progress

to nephrotic syndrome)

Stacks of RBCsRouleaux formation (high ESR, multiplemyeloma)

Stippled vaginal epithelial cells "Clue cells" (Gardnerella vaginalis)

"Tennis-racket"-shaped cytoplasmic

organelles (EM) in Langerhans cells

Birbeck granules (histiocytosis X: eosinophilic

granuloma)

Thrombi made of white/red layers Lines of Zahn (arterial thrombus, layers ofplatelets/RBCs)

"Thumb sign" on lateral x-ray Epiglottitis (Haemophilis influenzae)

Thyroid-like appearance of kidney Chronic bacterial pyelonephritis

"Tram-track" appearance on LM Membranoproliferative glomerulonephritis

Triglyceride accumulation in liver cell Fatty liver disease (alcoholic or metabolic


11/17

vacuoles syndrome)

WBCs that look "smudged" CLL (almost always B cell; affects the elderly)

"Wire loop" glomerular appearance on LM Lupus nephropathy

Yellow CSF Xanthochromia (subarachnoid hemorrhage)

Actinic (solar keratosis) Precursor to squamous cell carcinoma

Acute gastric ulcer associated with CNSinjury

Cushing's ulcer (increased ICP stimulates vagalgastric secretion)

Acute gastric ulcer associated with severeburns

Curling's ulcer (greatly reduced plasma volumeresults in sloughing of gastric mucosa)

Alternating areas of transmural inflammationand normal colon

Skip lesions (Crohn's disease)

Aneurysm, dissecting Hypertension

Aortic aneurysm, abdominal and descendingaorta

Atherosclerosis

Aortic aneurysm, ascending Tertiary syphilis, Marfan's syndrome

Atrophy of the mammillary bodiesWernicke's encephalopathy (thiamine deficiency

causing ataxia, ophthalmoplegia, and confusion)

Autosplenectomy (fibrosis and shrinkage) Sickle cell anemia (HbS)

Bacteria associated with stomach cancer H. pylori

Bacterial meningitis (adults and elderly) Neisseria meningitidis

Bacterial meningitis (newborns and kids) Group B streptococcus (newborn), S.pneumoniae/Neisseria meningitidis (kids)

Benign melanocytic nevus Spitz nevus (most common in first two decades)

Bleeding disorder with GpIb deficiencyBernard-Soulier disease (defect in plateletadhesion to von Willebrand's factor)

Brain tumor (adults) - general type and mostcommon

Suptatentorial: mets > astrocytoma (includingglioblastoma multiforme) > meningioma >

schwannoma

Brain tumor (kids) - most common &

location

Infratentorial: medulloblastoma (cerebellum) or

supratentorial: craniopharyngioma (cerebrum)

Breast cancerInfiltrating ductal carcinoma (in the US, 1 in 9

women will develop breast cancer)

Breast mass1. Fibrocystic change 2. Carcinoma (in

postmenopausal women)

Breast tumor (benign) Fibroadenoma


12/17

Cardiac primary tumor (kids) Rhabdomyoma

Cardiac manifestation of lupusLibman-Sacks endocarditis (nonbacterial,

affecting mitral)

Cardiac tumor (adults)1. Metastasis 2. Primary myxoma (4:1 LA to RA;

"ball and valve")

Cerebellar tonsillar herniationChiari malformation (often presents withprogressive hydrocephalus or syringomyelia)

Chronic arrhythmiaAtrial fibrillation (associated with high risk ofemboli)

Chronic atrophic gastritis (autoimmune)Predisposition to gastric carcinoma (can alsocause pernicious anemia)

Clear cell adenocarcinoma of the vagina DES exposure in utero

Congenital adrenal hyperplasia, hypotension 21-hydroxylase deficiency

Congential cardiac anomaly (most common) VSD

Constrictive pericarditis in developing world Tuberculosis

Coronary artery involved in thrombosis LAD>RCA>LCA

Cretinism Iodine deficit/hypothyroidism

Cushing's syndrome1. Corticosteroid therapy 2. Excess ACTHsecretion by pituitary

Cyanosis (early; less common)

Tetralogy of Fallot, transposition of great vessels,

truncus arteriosus, tricuspid atresia, total

anomalous pulmonary venous return (5 T's)

Cyanosis (late; more common) VSD, ASD, PDA

Death in CML Blast crisis

Death in SLE Lupus nephropathy

Dementia 1. Alzheimer's disease 2. Multiple infarcts

Demyelinating disease in young women Multiple sclerosis

DICGram-negative sepsis, obstetric complications,

cancer, burn trauma

Dietary deficit Iron

Diverticulum in pharynxZenker's diverticulum (diagnosed by bariumswallow)

Ejection click Aortic/pulmonic stenosis

Esophageal cancerSquamous cell carcinoma (worldwide);adenocarcinoma (US)


13/17

Food poisoning (exotoxin mediated) S. aureus, B. cereus

Glomerulonephritis (adults) Berger's disease (IgA nephropathy)

Gynecologic malignancy (most common) Endometrial carcinoma

Heart murmur, congential Mitral valve prolapse

Heart valve in bacterial endocarditisMitral (rheumatic fever), tricuspid (IV drugabuse), aortic (2nd affected in rheumatic fever)

Helminth infection (US)1. Enterobius vermicularis (pinworm--Scotch

tape test) 2. Ascaris lumbricoides

Hematoma-epiduralRupture of middle meningeal artery (crescent

shaped)

Hematoma-subduralRupture of bridging veins (trauma; lentiform

[biconvex] shaped)

HemochromatosisMultiple blood transfusions or hereditary HFEmutation (can result in CHF, "bronze diabetes,"

and increased risk of hepatocellular carcinoma)

Hepatocellular carcinomaCirrhotic liver (often associated with hepatitis B

and C)

Hereditary bleeding disorder von Willebrand's disease

Hereditary harmless jaundiceGilbert's syndrome (benign congential

unconjugated hyperbilirubinemia)

HLA-B27

Ankylosing spondylitis, Reiter's

syndrome/reactive arthritis, ulcerative colitis,psoriasis

HLA-DR3 or -DR4Diabetes mellitus type 1, rheumatoid arthritis,SLE

Holosystolic murmur VSD, tricuspid regurgitation, mitral regurgitation

Hypercoagulability, endothelial damage,blood stasis

Virchow's triad (results in venous thrombosis)

Hypertension, secondary Renal disease

Hypoparathyroidism Thyroidectomy

Hypopituitarism Pituitary adenoma (usually benign tumor)

Infection secondary to blood transfusion Hepatitis C

Kidney stones

1. Calcium = radiopaque 2. Struvite (ammonium)= radiopaque (formed by urease-positive

organisms such as Proteus vulgaris or

Staphylococcus) 3. Uric acid = radiolucent


14/17

Late cyanotic shunt (uncorrected L-->R

becomes R-->L)

Eisenmenger's syndrome (caused by ASD, VSD,PDA; results in pulmonary

hypertension/polycythemia)

Liver disease Alcoholic cirrhosis

Lysosomal storage disease Gaucher's disease

Male cancer Prostatic carcinoma

Malignancy associated with noninfectious

feverHodgkin's lymphoma

Malignant skin tumor Basal cell carcinoma (rarely metastasizes)

Mental retardation 1. Down syndrome 2. Fragile X syndrome

Metastases to bone Breast, lung, thyroid, testes, prostate, kidney

Metastases to brainLung, breast, skin (melanoma), kidney (renal cell

carcinoma), GI

Metastases to liverColon, gastric, pancreatic, breast, and lungcarcinomas

Mitral valve stenosis Rheumatic disease

Mixed (UMN and LMN) motor neurondisease

ALS

Myocarditis (virus that causes) Coxsackie B

Neoplasm (kids) 1. ALL 2. Cerebellar medulloblastoma

Nephrotic syndrome (adults) Membranous glomerulonephritis

Nephrotic syndrome (kids)Minimal change disease (associated with

infections/vaccinations; treat with corticosteroids)

Nosocomial pneumonia Klebsiella, E. coli, Pseudomonas aeruginosa

Obstruction of male urinary tract BPH

Opening snap Mitral stenosis

Opportunistic infection in AIDSPneumocystis jiroveci (formerly carinii)pneumonia

Osteomyelitis S. aureus

Osteomyelitis in sickle cell disease patients Salmonella

Osteomyelitis with IV drug abuse Pseudomonas, S. aureus

Ovarian metastasis from gastric carcinoma or

breast cancer

Krukenbery tumor (mucin-secreting signet-ring

cells)

Ovarian tumor (benign) Serous cystadenoma


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Ovarian tumor (malignant) Serous cystadenocarcinoma

Pancreatitis (acute) Gallstones, alcohol

Pancreatitis (chronic) Alcohol (adults), cystic fibrosis (kids)

Patient with ALL/CLL/AML/CMLALL: child, CLL: adult>60, AML: adult>60,

CML: adult 35-50

Pelvic inflammatory disease Neisseria gonorrhoeae (monoarticular arthritis)

Philadelphia chromosome t(9;22) (bcr-abl)CML (may sometimes be associated with

AML/ALL)

Pituitary tumor1. Prolactinoma 2. Somatotrophic "acidophilic"

adenoma

Primary amenorrhea Turner syndrome (XO)

Primary bone tumor (adults) Multiple myeloma

Primary hyperaldosteronism Adenoma of adrenal contex

Primary hyperparathyroidism 1. Adenomas 2. Hyperplasia 3. Carcinoma

Primary liver cancerHepatocellular carcinoma (chronic hepatitis,

cirrhosis, hemochromatosis, -1 antitrypsin)

Pulmonary hypertension COPD

Recurrent inflammation/thrombosis of

small/medium vessels in extremities

Buerger's disease (strongly associated with

tobacco)

Renal tumor

Renal cell carcinoma: associated with von

Hippel-lindau and adult polycystic kidneydisease; paraneoplastic syndromes(erythropoietin, renin, PTH, ACTH)

Right heart failure due to a pulmonary cause Cor pulmonale

S3 (protodiastolic gallop)Increased ventricular filling (L-->R shunt, mitralregurgitation, LV failure [CHF])

S4 (presystolic gallop)Stiff/hypertrophic ventricle (aortic stenosis,restrictive cardiomyopathy)

Secondary hyperparathyroidism Hypocalcemia of chronic kidney disease

Sexually transmitted disease Chlamydia (usually coinfected with gonorrhea)

SIADH Small cell carcinoma of the lung

Site of diverticula Sigmoid colon

Sites of atherosclerosis Abdominal aorta > coronary > popliteal > carotid

Stomach cancer Adenocarcinoma


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Stomach ulcerations and high gastrin levelsZollinger-Ellison syndrome (gastrinoma ofduodenum or pancreas)

t(14;18) Follicular lymphomas (bcl-2 activation)

t(8;14) Burkitt's lymphoma (c-myc lymphoma)

t(9;22) Philadelphiachromosome, CML (bcr-abl hybrid)

Temporal arteritisRisk of ipsilateral blindness due to thrombosis of

ophthalmic artery; polymyalgia rheumatica

Testicular tumor Seminoma

Thyroid cancer Papillary carcinoma

Tumor in women Leiomyoma (estrogen dependent)

Tumor of infancyHemangioma (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 predominance, lymphocytic

depletion)

Type of non-Hodgkin's Diffuse large cell

UTIE. coli, Staphylococcus saprophyticus (young,

sexually-active women)

Viral encephalitis affecting temporal lobe HSV

Vitamin deficiency (US)

Folic acid (pregnant women are at high risk; body

stores only 3- to 4-month supply; prevents neural

tube defects)

Sensitivity TP/(TP+FN)

Specificity TN/(TN+FP)

Positive predictive value TP/(TP+FP)

Negative predictive value TN/(TN+FN)

Relative risk (a/[a+b])/(c/[c+d])

Attributable risk (a/[a+b]) - (c/[c+d])

Number needed to treat 1/absolute risk reduction

Number needed to harm 1/attributable risk

Hardy-Weinberg equilibrium p^2+2pq+q^2 = 1 p+q = 1

Henderson-Hasselbalch equation pH = pKa + log([HCO3-]/0.03PCO2)


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Volume of distributionAmount of drug in the body/plasma drugconcentration

ClearanceRate of elimination of drug/plasma drugconcentration

Half-life t1/2 = (0.7xVd)/CL Vd = volume of distributionCL = clearance

Loading dose Cp x(Vd/F)

Maintenance dose Cp x CL/F

Cardiac outputRate of O2 consumption/(arterial O2 content-

venous O2 content) Stroke volume x heart rate

Mean arterial pressureCardiac output x total peripheral resistance 2/3

diastolic pressure + 1/3 systolic pressure

Stroke volume end diastolic volume - end systolic volume

Ejection fraction (Stroke volume/end diastolic volume) x 100

Resistance Driving pressure/flow (8viscosity x length)/r^4

Net filtration pressure [(Pc-Pi)-(c-i)]

Glomerular filtration rateU of inulin x (V/P of inulin) GFR = C of inulinKf[(Pgc-Pbs)-(gc-bs)]

Effective renal plasma flow U of PAH x (V/P of PAH) ERPF = C of PAH

Renal blood flow RPF/(1-Hct)

Filtration fraction GFR/RPFPhysiologic dead space Vt x ([PaCO2 - PeCO2]/PaCO2)

Documents

Rapid Review1