question

Abdominal pain, ascites, hepatomegaly

answer

Budd-Chiari syndrome (posthepatic venous thrombosis)

question

Abdominal pain, diarrhea, leukocytosis, recent antibiotic use

answer

Clostridium difficile infection

question

Achilles tendon xanthoma

answer

Familial hypercholesterolemia (decreased LDL receptor signaling)

question

Adrenal hemorrhage, hypotension, DIC

answer

Waterhouse-Friderichsen syndrome (meningococcemia)

question

Anaphylaxis following blood transfusion

answer

IgA deficiency

question

Anterior "drawer sign" ⊕

answer

Anterior cruciate ligament injury

question

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

answer

Marfan syndrome (fibrillin defect)

question

Athlete with polycythemia

answer

2° to erythropoietin injection

question

Back pain, fever, night sweats

answer

Pott disease (vertebral TB)

question

Bilateral acoustic schwannomas

answer

Neurofibromatosis type 2

question

Bilateral hilar adenopathy, uveitis

answer

Sarcoidosis (noncaseating granulomas)

question

Black eschar on face of patient with diabetic ketoacidosis

answer

Mucor or Rhizopus fungal infection

question

Blue sclera

answer

Osteogenesis imperfecta (type I collagen defect)

question

Bluish line on gingiva

answer

Burton line (lead poisoning)

question

Bone pain, bone enlargement, arthritis

answer

Paget disease of bone (increased osteoblastic and osteoclastic activity)

question

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

answer

Aortic regurgitation

question

"Butterfly" facial rash and Raynaud phenomenon in a young female

answer

Systemic lupus erythematosus

question

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

answer

Neurofibromatosis type I

question

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

answer

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

question

Calf pseudohypertrophy

answer

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

question

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

answer

Kawasaki disease (treat with IVIG and aspirin)

question

"Cherry-red spots" on macula

answer

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

question

Chest pain on exertion

answer

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

question

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

answer

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

question

Chest pain with ST depressions on EKG

answer

Unstable angina (troponins − ) or NSTEMI (troponins +)

question

Child uses arms to stand up from squat

answer

Duchenne muscular dystrophy (Gowers sign)

question

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

answer

Erythema infectiosum/fifth disease ("slapped cheeks" appearance, caused by parvovirus B19)

question

Chorea, dementia, caudate degeneration

answer

Huntington disease (autosomal dominant CAG repeat expansion)

question

Chorioretinitis, hydrocephalus, intracranial calcifications

answer

Congenital toxoplasmosis

question

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

answer

McArdle disease (skeletal muscle glycogen phosphorylase deficiency)

question

Cold intolerance

answer

Hypothyroidism

question

Conjugate horizontal gaze palsy, horizontal diplopia

answer

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

question

Continuous "machine-like" heart murmur

answer

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

question

Cutaneous/dermal edema due to connective tissue deposition

answer

Myxedema (caused by hypothyroidism, Graves disease [pretibial])

question

Cutaneous flushing, diarrhea, bronchospasm

answer

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

question

Dark purple skin/mouth nodules in a patient with AIDS

answer

Kaposi sarcoma, associated with HHV-8

question

Deep, labored breathing/hyperventilation

answer

Diabetic ketoacidosis (Kussmaul respirations)

question

Dermatitis, dementia, diarrhea

answer

Pellagra (niacin [vitamin B3] deficiency)

question

Dilated cardiomyopathy, edema, alcoholism or malnutrition

answer

Wet beriberi (thiamine [vitamin B1] deficiency)

question

Dog or cat bite resulting in infection

answer

Pasteurella multocida (cellulitis at inoculation site)

question

Dry eyes, dry mouth, arthritis

answer

Sjögren syndrome (autoimmune destruction of exocrine glands)

question

Dysphagia (esophageal webs), glossitis, iron deficiency anemia

answer

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

question

Elastic skin, hypermobility of joints, increased bleeding tendency

answer

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

question

Enlarged, hard left supraclavicular node

answer

Virchow node (abdominal metastasis)

question

Episodic vertigo, tinnitus, hearing loss

answer

Meniere disease

question

Erythroderma, lymphadenopathy, hepatosplenomegaly, atypical T cells

answer

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

question

Facial muscle spasm upon tapping

answer

Chvostek sign (hypocalcemia)

question

Fat, female, forty, and fertile

answer

Cholelithiasis (gallstones)

question

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

answer

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

question

Fever, cough, conjunctivitis, coryza, diffuse rash

answer

Measles

question

Fever, night sweats, weight loss

answer

B symptoms (staging) of lymphoma

question

Fibrous plaques in soft tissue of penis with abnormal curvature

answer

Peyronie disease (connective tissue disorder)

question

Golden brown rings around peripheral cornea

answer

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

question

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

answer

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

question

Hamartomatous GI polyps, hyperpigmentation of mouth/feet/hands/genitalia

answer

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

question

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

answer

Gaucher disease (glucocerebrosidase deficiency)

question

Hereditary nephritis, sensorineural hearing loss, cataracts

answer

Alport syndrome (mutation in collagen IV)

question

Hyperphagia, hypersexuality, hyperorality, hyperdocility

answer

Klüver-Bucy syndrome (bilateral amygdala lesion)

question

Hyperreflexia, hypertonia, Babinski sign present

answer

UMN damage

question

Hyporeflexia, hypotonia, atrophy, fasciculations

answer

LMN damage

question

Hypoxemia, polycythemia, hypercapnia

answer

Chronic bronchitis (hyperplasia of mucous cells, "blue bloater")

question

Indurated, ulcerated genital lesion

answer

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

question

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

answer

Patau syndrome (trisomy 13)

question

Infant with hypoglycemia, hepatomegaly

answer

Cori disease (debranching enzyme deficiency) or Von Gierke disease (glucose-6-phosphatase deficiency, more severe)

question

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

answer

Edwards syndrome (trisomy 18)

question

Jaundice, palpable distended non-tender gallbladder

answer

Courvoisier sign (distal malignant obstruction of biliary tree)

question

Large rash with bull's-eye appearance

answer

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

question

Lucid interval after traumatic brain injury

answer

Epidural hematoma (middle meningeal artery rupture)

question

Male child, recurrent infections, no mature B cells

answer

Bruton disease (X-linked agammaglobulinemia)

question

Mucosal bleeding and prolonged bleeding time

answer

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

question

Muffled heart sounds, distended neck veins, hypotension

answer

Beck triad of cardiac tamponade

question

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

answer

Gardner syndrome (subtype of FAP)

question

Myopathy (infantile hypertrophic cardiomyopathy), exercise intolerance

answer

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

question

Neonate with arm paralysis following difficult birth

answer

Erb-Duchenne palsy (superior trunk [C5-C6] brachial plexus injury: "waiter's tip")

question

No lactation postpartum, absent menstruation, cold intolerance

answer

Sheehan syndrome (pituitary infarction)

question

Nystagmus, intention tremor, scanning speech, bilateral internuclear ophthalmoplegia

answer

Multiple sclerosis

question

Painful blue fingers/toes, hemolytic anemia

answer

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

question

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

answer

Raynaud phenomenon (vasospasm in extremities)

question

Painful, raised red lesions on pads of fingers/toes

answer

Osler nodes (infective endocarditis, immune complex deposition)

question

Painless erythematous lesions on palms and soles

answer

Janeway lesions (infective endocarditis, septic emboli/microabscesses)

question

Painless jaundice

answer

Cancer of the pancreatic head obstructing bile duct

question

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

answer

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

question

Pancreatic, pituitary, parathyroid tumors

answer

MEN 1 (autosomal dominant)

question

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

answer

Nephrotic syndrome

question

Pink complexion, dyspnea, hyperventilation

answer

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

question

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

answer

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

question

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

answer

Lichen planus

question

Ptosis, miosis, anhidrosis

answer

Horner syndrome (sympathetic chain lesion)

question

Pupil accommodates but doesn't react

answer

Neurosyphilis (Argyll Robertson pupil)

question

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

answer

Guillain-Barré syndrome (acute inflammatory demyelinating polyradiculopathy subtype)

question

Rash on palms and soles

answer

Coxsackie A, 2° syphilis, Rocky Mountain spotted fever

question

Recurrent cold (noninflamed) abscesses, unusual eczema, high serum IgE

answer

Hyper-IgE syndrome (Job syndrome: neutrophil chemotaxis abnormality)

question

Red "currant jelly" sputum in alcoholic or diabetic patients

answer

Klebsiella pneumoniae pneumonia

question

Red "currant jelly" stools

answer

Acute mesenteric ischemia (adults), intussusception (children)

question

Red, itchy, swollen rash of nipple/areola

answer

Paget disease of the breast (sign of underlying neoplasm)

question

Red urine in the morning, fragile RBCs

answer

Paroxysmal nocturnal hemoglobinuria

question

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

answer

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

question

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

answer

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

question

Retinal hemorrhages with pale centers

answer

Roth spots (bacterial endocarditis)

question

Severe jaundice in neonate

answer

Crigler-Najjar syndrome (congenital unconjugated hyperbilirubinemia)

question

Severe RLQ pain with palpation of LLQ

answer

Rovsing sign (acute appendicitis)

question

Severe RLQ pain with deep tenderness

answer

McBurney sign (acute appendicitis)

question

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

answer

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

question

Single palmar crease

answer

Down syndrome

question

Situs inversus, chronic sinusitis, bronchiectasis, infertility

answer

Kartagener syndrome (dynein arm defect affecting cilia)

question

Skin hyperpigmentation, hypotension, fatigue

answer

1° adrenocortical insufficiency (e.g., Addison disease) causes increased ACTH and increased α-MSH production

question

Slow, progressive muscle weakness in boys

answer

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

question

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

answer

Koplik spots (measles [rubeola] virus)

question

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

answer

Condylomata lata (2° syphilis)

question

Splinter hemorrhages in fingernails

answer

Bacterial endocarditis

question

"Strawberry tongue"

answer

Scarlet fever, Kawasaki disease

question

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

answer

Turner syndrome (45,XO)

question

Sudden swollen/painful big toe joint, tophi

answer

Gout/podagra (hyperuricemia)

question

Swollen gums, mucosal bleeding, poor wound healing, petechiae

answer

Scurvy (vitamin C deficiency: can't hydroxylate proline/lysine for collagen synthesis)

question

Swollen, hard, painful finger joints

answer

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

question

Systolic ejection murmur (crescendo-decrescendo)

answer

Aortic stenosis

question

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

answer

Osler-Weber-Rendu syndrome

question

Thyroid and parathyroid tumors, pheochromocytoma

answer

MEN 2A (autosomal dominant RET mutation)

question

Thyroid tumors, pheochromocytoma, ganglioneuromatosis

answer

MEN 2B (autosomal dominant RET mutation)

question

Toe extension/fanning upon plantar scrape

answer

Babinski sign (UMN lesion)

question

Unilateral facial drooping involving forehead

answer

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

question

Urethritis, conjunctivitis, arthritis in a male

answer

Reactive arthritis associated with HLA-B27

question

Vascular birthmark (port-wine stain) of the face

answer

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

question

Vomiting blood following gastroesophageal lacerations

answer

Mallory-Weiss syndrome (alcoholic and bulimic patients)

question

Weight loss, diarrhea, arthritis, fever, adenopathy

answer

Whipple disease (Tropheryma whipplei)

question

"Worst headache of my life"

answer

Subarachnoid hemorrhage

question

Actinic (solar) keratosis

answer

Precursor to squamous cell carcinoma

question

Acute gastric ulcer associated with CNS injury

answer

Cushing ulcer (increased intracranial pressure stimulates vagal gastric H+ secretion)

question

Acute gastric ulcer associated with severe burns

answer

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

question

Age ranges for patient with ALL/CLL/AML/CML

answer

ALL: child, CLL: adult > 60, AML: adult ~ 65, CML: adult 45-85

question

Alternating areas of transmural inflammation and normal colon

answer

Skip lesions (Crohn disease)

question

Aortic aneurysm, abdominal

answer

Atherosclerosis

question

Aortic aneurysm, ascending or arch

answer

3° syphilis (syphilitic aortitis), vasa vasorum destruction

question

Aortic aneurysm, thoracic

answer

Marfan syndrome (idiopathic cystic medial degeneration)

question

Aortic dissection

answer

Hypertension

question

Atrophy of the mammillary bodies

answer

Wernicke encephalopathy (thiamine deficiency causing ataxia, ophthalmoplegia, and confusion)

question

Autosplenectomy (fibrosis and shrinkage)

answer

Sickle cell disease (hemoglobin S)

question

Bacteria associated with gastritis, peptic ulcer disease, and gastric malignancies (e.g. adenocarcinoma, MALToma)

answer

H. pylori

question

Bacterial meningitis (adults and elderly)

answer

S. pneumoniae

question

Bacterial meningitis (newborns and kids)

answer

Group B streptococcus/E.coli (newborns), S. pneumoniae/N. meningitidis (kids/teens)

question

Bilateral ovarian metastases from gastric carcinoma

answer

Krukenberg tumor (mucin-secreting signet ring cells)

question

Bleeding disorder with GpIb deficiency

answer

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

question

Brain tumor (adults)

answer

Supratentorial: metastasis, astrocytoma (including glioblastoma multiforme), meningioma, schwannoma

question

Brain tumor (kids)

answer

Infratentorial: medulloblastoma (cerebellum) or supratentorial: craniopharyngioma

question

Breast cancer

answer

Invasive ductal carcinoma

question

Breast mass

answer

Fibrocystic change, carcinoma (in postmenopausal women)

question

Breast tumor (benign, young woman)

answer

Fibroadenoma

question

Cardiac 1° tumor (kids)

answer

Rhabdomyoma, often seen in tuberous sclerosis

question

Cardiac manifestation of lupus

answer

Marantic/thrombotic endocarditis (nonbacterial)

question

Cardiac tumor (adults)

answer

Metastasis, myxoma (90% in left atrium; "ball and valve")

question

Cerebellar tonsillar herniation

answer

Chiari II malformation

question

Chronic arrhythmia

answer

Atrial fibrillation (associated with high risk of emboli)

question

Chronic atrophic gastritis (autoimmune)

answer

Predisposition to gastric carcinoma (can also cause pernicious anemia)

question

Clear cell adenocarcinoma of the vagina

answer

DES exposure in utero

question

Congenital adrenal hyperplasia, hypotension

answer

21-hydroxylase deficiency

question

Congenital cardiac anomaly

answer

VSD

question

Congenital conjugated hyperbilirubinemia (black liver)

answer

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

question

Constrictive pericarditis

answer

TB (developing world); idiopathic, viral illness (developed world)

question

Coronary artery involved in thrombosis

answer

LAD > RCA > circumflex

question

Cretinism

answer

Iodine deficit/congenital hypothyroidism

question

Cushing syndrome

answer

- Iatrogenic (from corticosteroid therapy) - Adrenocortical adenoma (secretes excess cortisol) - ACTH-secreting pituitary adenoma (Cushing disease) - Paraneoplastic (due to ACTH secretion by tumors)

question

Cyanosis (early; less common)

answer

Tetralogy of Fallot, transposition of great vessels, truncus arteriosus

question

Death in CML

answer

Blast crisis

question

Death in SLE

answer

Lupus nephropathy

question

Dementia

answer

Alzheimer disease, multiple infarcts (vascular dementia)

question

Demyelinating disease in young women

answer

Multiple sclerosis

question

DIC

answer

Severe sepsis, obstetric complications, cancer, burns, trauma, major surgery, acute pancreatitis, APL

question

Diverticulum in pharynx

answer

Zenker diverticulum (diagnosed by barium swallow)

question

Ejection click

answer

Aortic stenosis

question

Esophageal cancer

answer

Squamous cell carcinoma (worldwide); adenocarcinoma (U.S.)

question

Food poisoning (exotoxin mediated)

answer

S. aureus, B. cereus

question

Gastric cancer

answer

Adenocarcinoma

question

Glomerulonephritis (adults)

answer

Berger disease (IgA nephropathy)

question

Gynecologic malignancy

answer

Endometrial carcinoma (most common in U.S.); cervical carcinoma (most common worldwide)

question

Heart murmur, congenital

answer

Mitral valve prolapse

question

Heart valve in bacterial endocarditis

answer

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

question

Helminth infection (U.S.)

answer

Enterobius vermicularis, Ascaris lumbricoides

question

Hematoma—epidural

answer

Rupture of middle meningeal artery (trauma; lentiform shaped)

question

Hematoma—subdural

answer

Rupture of bridging veins (crescent shaped)

question

Hemochromatosis

answer

Multiple blood transfusions or hereditary HFE mutation (can result in heart failure, "bronze diabetes," and increased risk of hepatocellular carcinoma)

question

Hepatocellular carcinoma

answer

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

question

Hereditary bleeding disorder

answer

von Willebrand disease

question

Hereditary harmless jaundice

answer

Gilbert syndrome (benign congenital unconjugated hyperbilirubinemia)

question

HLA-B27

answer

Psoriatic arthritis, ankylosing spondylitis, IBD-associated arthritis, reactive arthritis (formerly Reiter syndrome)

question

HLA-DR3

answer

Diabetes mellitus type 1, SLE, Graves disease, Hashimoto thyroiditis, Addison disease

question

HLA-DR4

answer

Diabetes mellitus type 1, rheumatoid arthritis, Addison disease

question

Holosystolic murmur

answer

VSD, tricuspid regurgitation, mitral regurgitation

question

Hypercoagulability, endothelial damage, blood stasis

answer

Virchow triad (increased risk of thrombosis)

question

Hypertension, 2°

answer

Renal artery stenosis, chronic kidney disease (e.g. polycystic kidney disease, diabetic nephropathy), hyperaldosteronism

question

Hypoparathyroidism

answer

Accidental excision during thyroidectomy

question

Hypopituitarism

answer

Pituitary adenoma (usually benign tumor)

question

Infection 2° to blood transfusion

answer

Hepatitis C

question

Infections in chronic granulomatous disease

answer

S. aureus, E. coli, Aspergillus (catalase ⊕ )

question

Intellectual disability

answer

Down syndrome, fragile X syndrome

question

Kidney stones

answer

- Calcium = radiopaque - Struvite (ammonium) = radiopaque (formed by urease ⊕ organisms such as Klebsiella, Proteus species, and S. saprophyticus ) - Uric acid = radiolucent - Cystine = radiolucent

question

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

answer

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

question

Liver disease

answer

Alcoholic cirrhosis

question

Lysosomal storage disease

answer

Gaucher disease

question

Male cancer

answer

Prostatic carcinoma

question

Malignancy associated with noninfectious fever

answer

Hodgkin lymphoma

question

Malignancy (kids)

answer

ALL, medulloblastoma (cerebellum)

question

Metastases to bone

answer

Prostate, breast > lung > thyroid

question

Metastases to brain

answer

Lung > breast > genitourinary > melanoma > GI

question

Metastases to liver

answer

Colon >> stomach, pancreas

question

Microcytic anemia

answer

Iron deficiency

question

Mitochondrial inheritance

answer

Disease occurs in both males and females, inherited through females only

question

Mitral valve stenosis

answer

Rheumatic heart disease

question

Mixed (UMN and LMN) motor neuron disease

answer

Amyotrophic lateral sclerosis

question

Myocarditis

answer

Coxsackie B

question

Nephrotic syndrome (adults)

answer

Focal segmental glomerulosclerosis

question

Nephrotic syndrome (kids)

answer

Minimal change disease

question

Neuron migration failure

answer

Kallmann syndrome (hypogonadotropic hypogonadism and anosmia)

question

Nosocomial pneumonia

answer

S. aureus, Pseudomonas, other enteric gram-negative rods

question

Obstruction of male urinary tract

answer

BPH

question

Opening snap

answer

Mitral stenosis

question

Opportunistic infection in AIDS

answer

Pneumocystis jirovecii pneumonia

question

Osteomyelitis

answer

S. aureus (most common overall)

question

Osteomyelitis in sickle cell disease

answer

Salmonella

question

Osteomyelitis with IV drug use

answer

Pseudomonas, Candida, S. aureus

question

Ovarian tumor (benign, bilateral)

answer

Serous cystadenoma

question

Ovarian tumor (malignant)

answer

Serous cystadenocarcinoma

question

Pancreatitis (acute)

answer

Gallstones, alcohol

question

Pancreatitis (chronic)

answer

Alcohol (adults), cystic fibrosis (kids)

question

Pelvic inflammatory disease

answer

C. trachomatis, N. gonorrhoeae

question

Philadelphia chromosome t(9;22) (BCR-ABL)

answer

CML (may sometimes be associated with ALL/AML)

question

Pituitary tumor

answer

Prolactinoma, somatotropic adenoma

question

1° amenorrhea

answer

Turner syndrome (45,XO or 45,XO/46XX mosaic)

question

1° bone tumor (adults)

answer

Multiple myeloma

question

1° hyperaldosteronism

answer

Adenoma of adrenal cortex

question

1° hyperparathyroidism

answer

Adenomas, hyperplasia, carcinoma

question

1° liver cancer

answer

Hepatocellular carcinoma (chronic hepatitis, cirrhosis, hemochromatosis, α1-antitrypsin deficiency, Wilson disease)

question

Pulmonary hypertension

answer

Idiopathic, heritable, left heart disease (e.g. HF), lung disease (e.g. COPD), hypoxemic vasoconstriction (e.g. OSA), thromboembolic (e.g. PE)

question

Recurrent inflammation/thrombosis of small/medium vessels in extremities

answer

Buerger disease (strongly associated with tobacco)

question

Renal tumor

answer

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

question

Right heart failure due to a pulmonary cause

answer

Cor pulmonale

question

S3 heart sound

answer

Increased ventricular filling pressure (e.g., mitral regurgitation, HF), common in dilated ventricles

question

S4 heart sound

answer

Stiff/hypertrophic ventricle (aortic stenosis, restrictive cardiomyopathy)

question

2° hyperparathyroidism

answer

Hypocalcemia of chronic kidney disease

question

Sexually transmitted disease

answer

C. trachomatis (usually coinfected with N. gonorrhoeae)

question

SIADH

answer

Small cell carcinoma of the lung

question

Site of diverticula

answer

Sigmoid colon

question

Sites of atherosclerosis

answer

Abdominal aorta > coronary artery > popliteal artery > carotid artery

question

t(14;18)

answer

Follicular lymphomas (BCL-2 activation, anti-apoptotic oncogene)

question

t(8;14)

answer

Burkitt lymphoma (c-myc fusion, transcription factor oncogene)

question

t(9;22)

answer

Philadelphia chromosome, CML (BCR-ABL activation, tyrosine kinase oncogene)

question

Temporal arteritis

answer

Risk of ipsilateral blindness due to occlusion of ophthalmic artery; polymyalgia rheumatica

question

Testicular tumor

answer

Seminoma (malignant, radiosensitive), increased placental ALP

question

Thyroid cancer

answer

Papillary carcinoma (childhood irradiation)

question

Tumor in women

answer

Leiomyoma (estrogen dependent, not precancerous)

question

Tumor of infancy

answer

Strawberry hemangioma (grows rapidly and regresses spontaneously by childhood)

question

Tumor of the adrenal medulla (adults)

answer

Pheochromocytoma (usually benign)

question

Tumor of the adrenal medulla (kids)

answer

Neuroblastoma (malignant)

question

Type of Hodgkin lymphoma

answer

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

question

Type of non-Hodgkin lymphoma

answer

Diffuse large B-cell lymphoma

question

UTI

answer

E. coli, Staphylococcus saprophyticus (young women)

question

Vertebral compression fracture

answer

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

question

Viral encephalitis affecting temporal lobe

answer

HSV-1

question

Vitamin deficiency (U.S.)

answer

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

question

Absence seizures

answer

Ethosuximide

question

Acute gout attack

answer

NSAIDs, colchicine, glucocorticoids

question

Acute promyelocytic leukemia (M3)

answer

All-trans retinoic acid

question

ADHD

answer

Methylphenidate, CBT, atomoxetine, guanfacine, clonidine

question

Alcoholism

answer

Disulfiram, acamprosate, naltrexone, supportive care

question

Alcohol withdrawal

answer

Long-acting benzodiazepines

question

Anorexia

answer

Nutrition, psychotherapy, mirtazapine

question

Arrhythmia in damaged cardiac tissue

answer

Class IB antiarrhythmic (lidocaine, mexiletine)

question

Benign prostatic hyperplasia

answer

α1-antagonists, 5α-reductase inhibitors, PDE-5 inhibitors

question

Bipolar disorder

answer

Mood stabilizers (e.g., lithium, valproic acid, carbamazepine), atypical antipsychotics

question

Breast cancer in postmenopausal woman

answer

Aromatase inhibitor (anastrozole)

question

Buerger disease

answer

Smoking cessation

question

Bulimia nervosa

answer

SSRIs

question

Candida albicans

answer

Topical azoles (vaginitis); nystatin, fluconazole, caspofungin (oral/esophageal); fluconazole, caspofungin, amphotericin B (systemic)

question

Carcinoid syndrome

answer

Octreotide

question

Chlamydia trachomatis

answer

Doxycycline (+ ceftriaxone for gonorrhea coinfection), erythromycin eye drops (prophylaxis in infants)

question

Chronic gout

answer

Xanthine oxidase inhibitors (e.g., allopurinol, febuxostat); pegloticase; probenecid

question

Chronic hepatitis B or C

answer

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

question

Chronic myelogenous leukemia

answer

Imatinib

question

Clostridium botulinum

answer

Antitoxin

question

Clostridium difficile

answer

Oral metronidazole; if refractory, oral vancomycin

question

Clostridium tetani

answer

Antitoxin

question

CMV

answer

Ganciclovir, foscarnet, cidofovir

question

Crohn disease

answer

Corticosteroids, infliximab, azathioprine

question

Cryptococcus neoformans

answer

Fluconazole (in AIDS patients)

question

Cyclophosphamide-induced hemorrhagic cystitis

answer

Mesna

question

Depression

answer

SSRIs (first-line)

question

Diabetes insipidus

answer

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

question

Diabetes mellitus type 1

answer

Dietary intervention (low carbohydrate) + insulin replacement

question

Diabetes mellitus type 2

answer

Dietary intervention, oral hypoglycemics, and insulin (if refractory)

question

Diabetic ketoacidosis

answer

Fluids, insulin, K+

question

Drug of choice for anticoagulation during pregnancy

answer

Heparin

question

Enterococci

answer

Vancomycin, aminopenicillins/cephalosporins

question

Erectile dysfunction

answer

Sildenafil, tadalafil, vardenafil

question

ER ⊕ breast cancer

answer

Tamoxifen

question

Ethylene glycol/methanol intoxication

answer

Fomepizole (alcohol dehydrogenase inhibitor)

question

Haemophilus influenzae (B)

answer

Rifampin (prophylaxis)

question

Generalized anxiety disorder

answer

SSRIs, SNRIs (first line); buspirone (second line)

question

Granulomatosis with polyangiitis (Wegener)

answer

Cyclophosphamide, corticosteroids

question

Heparin reversal

answer

Protamine sulfate

question

HER2/neu ⊕ breast cancer

answer

Trastuzumab

question

Hyperaldosteronism

answer

Spironolactone

question

Hypercholesterolemia

answer

Statin (first-line)

question

Hypertriglyceridemia

answer

Fibrate

question

Immediate anticoagulation

answer

Heparin

question

Infertility

answer

Leuprolide, GnRH (pulsatile), clomiphene

question

Influenza

answer

Oseltamivir, zanamivir

question

Kawasaki disease

answer

IVIG, high-dose aspirin

question

Legionella pneumophila

answer

Macrolides (e.g., azithromycin)

question

Long-term anticoagulation

answer

Warfarin, dabigatran, rivaroxaban and apixaban

question

Malaria

answer

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

question

Malignant hyperthermia

answer

Dantrolene

question

Medical abortion

answer

Mifepristone

question

Migraine

answer

Abortive therapies (e.g., sumatriptan, NSAIDs); prophylaxis (e.g., propranolol, topiramate, CCBs, amitriptyline)

question

Multiple sclerosis

answer

Disease-modifying therapies (e.g., β -interferon, natalizumab); for acute flares, use IV steroids

question

Mycobacterium tuberculosis

answer

RIPE (rifampin, isoniazid, pyrazinamide, ethambutol)

question

Neisseria gonorrhoeae

answer

Ceftriaxone (add doxycycline to cover likely concurrent C. trachomatis )

question

Neisseria meningitidis

answer

Penicillin/ceftriaxone, rifampin (prophylaxis)

question

Neural tube defect prevention

answer

Prenatal folic acid

question

Osteomalacia/rickets

answer

Vitamin D supplementation

question

Osteoporosis

answer

Calcium/vitamin D supplementation (prophylaxis); bisphosphonates, PTH analogs, SERMs, calcitonin, denosumab (treatment)

question

Patent ductus arteriosus

answer

Close with indomethacin; keep open with PGE analogs

question

Pheochromocytoma

answer

α-antagonists (e.g., phenoxybenzamine)

question

Pneumocystis jirovecii

answer

TMP-SMX (prophylaxis and treatment in immunosuppressed patient)

question

Prolactinoma

answer

Cabergoline/bromocriptine (dopamine agonists)

question

Prostate adenocarcinoma/uterine fibroids

answer

Leuprolide, GnRH (continuous)

question

Prostate adenocarcinoma

answer

Flutamide

question

Pseudomonas aeruginosa

answer

Antipseudomonal penicillins, aminoglycosides, carbapenems

question

Pulmonary arterial hypertension (idiopathic)

answer

Sildenafil, bosentan, epoprostenol

question

Rickettsia rickettsii

answer

Doxycycline, chloramphenicol

question

Schizophrenia (negative symptoms)

answer

Atypical antipsychotics

question

Schizophrenia (positive symptoms)

answer

Typical and atypical antipsychotics

question

SIADH

answer

Fluid restriction, IV hypertonic saline, conivaptan/tolvaptan, demeclocycline

question

Sickle cell disease

answer

Hydroxyurea (increased fetal hemoglobin)

question

Sporothrix schenckii

answer

Itraconazole, oral potassium iodide

question

Stable angina

answer

Sublingual nitroglycerin

question

Staphylococcus aureus

answer

MSSA: nafcillin, oxacillin, dicloxacillin (antistaphylococcal penicillins); MRSA: vancomycin, daptomycin, linezolid, ceftaroline

question

Streptococcus bovis

answer

Penicillin prophylaxis; evaluation for colon cancer if linked to endocarditis

question

Streptococcus pneumoniae

answer

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

question

Streptococcus pyogenes

answer

Penicillin prophylaxis

question

Temporal arteritis

answer

High-dose steroids

question

Tonic-clonic seizures

answer

Levetiracetam, phenytoin, valproate, carbamazepine

question

Toxoplasma gondii

answer

Sulfadiazine + pyrimethamine

question

Treponema pallidum

answer

Penicillin

question

Trichomonas vaginalis

answer

Metronidazole (patient and partner)

question

Trigeminal neuralgia (tic douloureux)

answer

Carbamazepine

question

Ulcerative colitis

answer

5-ASA preparations (e.g., mesalamine), 6-mercaptopurine, infliximab, colectomy

question

UTI prophylaxis

answer

TMP-SMX

question

Warfarin reversal

answer

Fresh frozen plasma (acute), vitamin K (non-acute)

question

Increased AFP in amniotic fluid/maternal serum

answer

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

question

Anticentromere antibodies

answer

Scleroderma (CREST)

question

Anti-desmoglein (anti-desmosome) antibodies

answer

Pemphigus vulgaris (blistering)

question

Anti-glomerular basement membrane antibodies

answer

Goodpasture syndrome (glomerulonephritis and hemoptysis)

question

Antihistone antibodies

answer

Drug-induced SLE (e.g., hydralazine, isoniazid, phenytoin, procainamide)

question

Anti-IgG antibodies

answer

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

question

Antimitochondrial antibodies (AMAs)

answer

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

question

Antineutrophil cytoplasmic antibodies (ANCAs)

answer

Microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) (MPO-ANCA/p-ANCA); granulomatosis with polyangiitis (Wegener; PR3-ANCA/c-ANCA)

question

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

answer

SLE (type III hypersensitivity)

question

Antiplatelet antibodies

answer

Idiopathic thrombocytopenic purpura

question

Anti-topoisomerase antibodies

answer

Diffuse systemic scleroderma

question

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

answer

Celiac disease (diarrhea, weight loss)

question

"Apple core" lesion on barium enema x-ray

answer

Colorectal cancer (usually left-sided)

question

Atypical lymphocytes

answer

EBV

question

Azurophilic peroxidase ⊕ granular inclusions in granulocytes and myeloblasts

answer

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

question

Bacitracin response

answer

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

question

"Bamboo spine" on x-ray

answer

Ankylosing spondylitis (chronic inflammatory arthritis: HLA-B27)

question

Basophilic nuclear remnants in RBCs

answer

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

question

Basophilic stippling of RBCs

answer

Lead poisoning or sideroblastic anemia

question

Bloody or yellow tap on lumbar puncture

answer

Subarachnoid hemorrhage

question

"Boot-shaped" heart on x-ray

answer

Tetralogy of Fallot (due to RVH)

question

Branching gram-positive rods with sulfur granules

answer

Actinomyces israelii

question

Bronchogenic apical lung tumor on imaging

answer

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

question

"Brown" tumor of bone

answer

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

question

Cardiomegaly with apical atrophy

answer

Chagas disease (Trypanosoma cruzi)

question

Cellular crescents in Bowman capsule

answer

Rapidly progressive crescentic glomerulonephritis

question

"Chocolate cyst" of ovary

answer

Endometriosis (frequently involves both ovaries)

question

Circular grouping of dark tumor cells surrounding pale neurofibrils

answer

Homer-Wright rosettes (neuroblastoma, medulloblastoma)

question

Colonies of mucoid Pseudomonas in lungs

answer

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

question

Decreased AFP in amniotic fluid/maternal serum

answer

Down syndrome or other chromosomal abnormalities

question

Degeneration of dorsal column fibers

answer

Tabes dorsalis (3° syphilis), subacute combined degeneration (dorsal columns, lateral corticospinal, spinocerebellar tracts affected)

question

"Delta wave" on EKG, short PR interval, supraventricular tachycardia

answer

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

question

Depigmentation of neurons in substantia nigra

answer

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

question

Desquamated epithelium casts in sputum

answer

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

question

Disarrayed granulosa cells arranged around collections of eosinophilic fluid

answer

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

question

Dysplastic squamous cervical cells with "raisinoid" nuclei and hyperchromasia

answer

Koilocytes (HPV: predisposes to cervical cancer)

question

Electrical alternans (alternating amplitude on EKG)

answer

Pericardial tamponade

question

Enlarged cells with intranuclear inclusion bodies

answer

"Owl eye" appearance of CMV

question

Enlarged thyroid cells with ground-glass nuclei with central clearing

answer

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

question

Eosinophilic cytoplasmic inclusion in liver cell

answer

Mallory body (alcoholic liver disease)

question

Eosinophilic cytoplasmic inclusion in neuron

answer

Lewy body (Parkinson disease and Lewy body dementia)

question

Eosinophilic globule in liver

answer

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

question

Eosinophilic inclusion bodies in cytoplasm of hippocampal and cerebellar neurons

answer

Negri bodies of rabies

question

Extracellular amyloid deposition in gray matter of brain

answer

Senile plaques (Alzheimer disease)

question

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

answer

Reed-Sternberg cells (Hodgkin lymphoma)

question

Glomerulus-like structure surrounding vessel in germ cells

answer

Schiller-Duval bodies (yolk sac tumor)

question

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

answer

β -thalassemia, sickle cell disease (marrow expansion)

question

hCG elevated

answer

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

question

Heart nodules (granulomatous)

answer

Aschoff bodies (rheumatic fever)

question

Heterophile antibodies

answer

Infectious mononucleosis (EBV)

question

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

answer

Bronchial asthma (Charcot-Leyden crystals: eosinophilic granules)

question

High level of D-dimers

answer

DVT, PE, DIC

question

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

answer

Ghon complex (1° TB: Mycobacterium bacilli)

question

"Honeycomb lung" on x-ray or CT

answer

Interstitial pulmonary fibrosis

question

Hypercoagulability (leading to migrating DVTs and vasculitis)

answer

Trousseau syndrome (adenocarcinoma of pancreas or lung)

question

Hypersegmented neutrophils

answer

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

question

Hypertension, hypokalemia, metabolic alkalosis

answer

Primary hyperaldosteronism (Conn syndrome)

question

Hypochromic, microcytic anemia

answer

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

question

Intranuclear eosinophilic droplet-like bodies

answer

Cowdry type A bodies (HSV or VZV)

question

Iron-containing nodules in alveolar septum

answer

Ferruginous bodies (asbestosis: increased chance of mesothelioma)

question

Keratin pearls on a skin biopsy

answer

Squamous cell carcinoma

question

Large granules in phagocytes, immunodeficiency

answer

Chédiak-Higashi disease (congenital failure of phagolysosome formation)

question

"Lead pipe" appearance of colon on abdominal imaging

answer

Ulcerative colitis (loss of haustra)

question

Linear appearance of IgG deposition on glomerular and alveolar basement membranes

answer

Goodpasture syndrome

question

Low serum ceruloplasmin

answer

Wilson disease (hepatolenticular degeneration)

question

"Lumpy bumpy" appearance of glomeruli on immunofluorescence

answer

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

question

Lytic ("punched-out") bone lesions on x-ray

answer

Multiple myeloma

question

Mammary gland ("blue domed") cyst

answer

Fibrocystic change of the breast

question

Monoclonal antibody spike

answer

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

question

Mucin-filled cell with peripheral nucleus

answer

"Signet ring" (gastric carcinoma)

question

Narrowing of bowel lumen on barium x-ray

answer

"String sign" (Crohn disease)

question

Necrotizing vasculitis (lungs) and necrotizing glomerulonephritis

answer

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

question

Needle-shaped, negatively birefringent crystals

answer

Gout (monosodium urate crystals)

question

Nodular hyaline deposits in glomeruli

answer

Kimmelstiel-Wilson nodules (diabetic nephropathy)

question

Novobiocin response

answer

Sensitive: S. epidermidis ; resistant: S. saprophyticus

question

"Nutmeg" appearance of liver

answer

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

question

"Onion skin" periosteal reaction

answer

Ewing sarcoma (malignant small blue cell tumor)

question

Optochin response

answer

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

question

Podocyte fusion or "effacement" on electron microscopy

answer

Minimal change disease (child with nephrotic syndrome)

question

Polished, "ivory-like" appearance of bone at cartilage erosion

answer

Eburnation (osteoarthritis resulting in bony sclerosis)

question

Protein aggregates in neurons from hyperphosphorylation of tau protein

answer

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

question

Psammoma bodies

answer

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

question

Pseudopalisading tumor cells on brain biopsy

answer

Glioblastoma multiforme

question

Raised periosteum (creating a "Codman triangle")

answer

Aggressive bone lesions (e.g., osteosarcoma, Ewing sarcoma, osteomyelitis)

question

RBC casts in urine

answer

Glomerulonephritis

question

Rectangular, crystal-like, cytoplasmic inclusions in Leydig cells

answer

Reinke crystals (Leydig cell tumor)

question

Recurrent infections, eczema, thrombocytopenia

answer

Wiskott-Aldrich syndrome

question

Renal epithelial casts in urine

answer

Intrinsic renal failure (e.g., ischemia or toxic injury)

question

Rhomboid crystals, positively birefringent

answer

Pseudogout (calcium pyrophosphate dihydrate crystals)

question

Rib notching (inferior surface, on x-ray)

answer

Coarctation of the aorta

question

Ring-enhancing brain lesion on CT/MRI in AIDS

answer

Toxoplasma gondii, CNS lymphoma

question

Sheets of medium-sized lymphoid cells with scattered pale, tingible body-laden macrophages ("starry sky" histology)

answer

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

question

Silver-staining spherical aggregation of tau proteins in neurons

answer

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

question

"Soap bubble" in femur or tibia on x-ray

answer

Giant cell tumor of bone (generally benign)

question

"Spikes" on basement membrane, "dome-like" subepithelial deposits

answer

Membranous nephropathy (nephrotic syndrome)

question

Stacks of RBCs

answer

Rouleaux formation (high ESR, multiple myeloma)

question

"Steeple" sign on CXR

answer

Croup (parainfluenza virus)

question

Stippled vaginal epithelial cells

answer

"Clue cells" (Gardnerella vaginalis)

question

Streptococcus bovis bacteremia

answer

Colon cancer

question

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

answer

Birbeck granules (Langerhans cell histiocytosis)

question

Thousands of polyps on colonoscopy

answer

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

question

Thrombi made of white/red layers

answer

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

question

"Thumb sign" on lateral neck x-ray

answer

Epiglottitis (Haemophilus influenzae )

question

Thyroid-like appearance of kidney

answer

Chronic pyelonephritis (usually due to recurrent infections)

question

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

answer

Membranoproliferative glomerulonephritis

question

Triglyceride accumulation in liver cell vacuoles

answer

Fatty liver disease (alcoholic or metabolic syndrome)

question

Increased uric acid levels

answer

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

question

"Waxy" casts with very low urine flow

answer

Chronic end-stage renal disease

question

WBC casts in urine

answer

Acute pyelonephritis

question

WBCs that look "smudged"

answer

CLL (almost always B cell)

question

"Wire loop" glomerular capillary appearance on light microscopy

answer

Diffuse proliferative glomerulonephritis (usually seen with lupus)

question

Yellowish CSF

answer

Xanthochromia (e.g., due to subarachnoid hemorrhage)

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