All First Aid 2016 Rapid Review

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Abdominal pain, ascites, hepatomegaly
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Budd-Chiari syndrome (posthepatic venous thrombosis)
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Abdominal pain, diarrhea, leukocytosis, recent antibiotic use
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Clostridium difficile infection
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Achilles tendon xanthoma
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Familial hypercholesterolemia (decreased LDL receptor signaling)
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Adrenal hemorrhage, hypotension, DIC
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Waterhouse-Friderichsen syndrome (meningococcemia)
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Anaphylaxis following blood transfusion
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IgA deficiency
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Anterior “drawer sign” ⊕
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Anterior cruciate ligament injury
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Arachnodactyly, lens dislocation (upward), aortic dissection, hyperflexible joints
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Marfan syndrome (fibrillin defect)
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Athlete with polycythemia
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2° to erythropoietin injection
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Back pain, fever, night sweats
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Pott disease (vertebral TB)
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Bilateral acoustic schwannomas
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Neurofibromatosis type 2
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Bilateral hilar adenopathy, uveitis
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Sarcoidosis (noncaseating granulomas)
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Black eschar on face of patient with diabetic ketoacidosis
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Mucor or Rhizopus fungal infection
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Blue sclera
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Osteogenesis imperfecta (type I collagen defect)
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Bluish line on gingiva
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Burton line (lead poisoning)
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Bone pain, bone enlargement, arthritis
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Paget disease of bone (increased osteoblastic and osteoclastic activity)
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Bounding pulses, wide pulse pressure, diastolic heart murmur, head bobbing
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Aortic regurgitation
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“Butterfly” facial rash and Raynaud phenomenon in a young female
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Systemic lupus erythematosus
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Café-au-lait spots, Lisch nodules (iris hamartoma), cutaneous neurofibromas, pheochromocytomas, optic gliomas
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Neurofibromatosis type I
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Café-au-lait spots (unilateral), polyostotic fibrous dysplasia, precocious puberty, multiple endocrine abnormalities
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McCune-Albright syndrome (mosaic G-protein signaling mutation)
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Calf pseudohypertrophy
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Muscular dystrophy (most commonly Duchenne, due to X-linked recessive frameshift mutation of dystrophin gene)
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Cervical lymphadenopathy, desquamating rash, coronary aneurysms, red conjunctivae and tongue, hand-foot changes
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Kawasaki disease (treat with IVIG and aspirin)
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“Cherry-red spots” on macula
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Tay-Sachs (ganglioside accumulation) or Niemann-Pick (sphingomyelin accumulation), central retinal artery occlusion
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Chest pain on exertion
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Angina (stable: with moderate exertion; unstable: with minimal exertion or at rest)
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Chest pain, pericardial effusion/friction rub, persistent fever following MI
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Dressler syndrome (autoimmune-mediated post-MI fibrinous pericarditis, 2 weeks to several months after acute episode)
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Chest pain with ST depressions on EKG
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Unstable angina (troponins − ) or NSTEMI (troponins +)
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Child uses arms to stand up from squat
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Duchenne muscular dystrophy (Gowers sign)
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Child with fever later develops red rash on face that spreads to body
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Erythema infectiosum/fifth disease (“slapped cheeks” appearance, caused by parvovirus B19)
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Chorea, dementia, caudate degeneration
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Huntington disease (autosomal dominant CAG repeat expansion)
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Chorioretinitis, hydrocephalus, intracranial calcifications
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Congenital toxoplasmosis
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Chronic exercise intolerance with myalgia, fatigue, painful cramps, myoglobinuria
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McArdle disease (skeletal muscle glycogen phosphorylase deficiency)
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Cold intolerance
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Hypothyroidism
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Conjugate horizontal gaze palsy, horizontal diplopia
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Internuclear ophthalmoplegia (damage to MLF; may be unilateral or bilateral)
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Continuous “machine-like” heart murmur
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PDA (close with indomethacin; keep open with PGE analogs)
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Cutaneous/dermal edema due to connective tissue deposition
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Myxedema (caused by hypothyroidism, Graves disease [pretibial])
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Cutaneous flushing, diarrhea, bronchospasm
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Carcinoid syndrome (right-sided cardiac valvular lesions, increased 5-HIAA)
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Dark purple skin/mouth nodules in a patient with AIDS
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Kaposi sarcoma, associated with HHV-8
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Deep, labored breathing/hyperventilation
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Diabetic ketoacidosis (Kussmaul respirations)
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Dermatitis, dementia, diarrhea
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Pellagra (niacin [vitamin B3] deficiency)
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Dilated cardiomyopathy, edema, alcoholism or malnutrition
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Wet beriberi (thiamine [vitamin B1] deficiency)
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Dog or cat bite resulting in infection
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Pasteurella multocida (cellulitis at inoculation site)
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Dry eyes, dry mouth, arthritis
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Sjögren syndrome (autoimmune destruction of exocrine glands)
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Dysphagia (esophageal webs), glossitis, iron deficiency anemia
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Plummer-Vinson syndrome (may progress to esophageal squamous cell carcinoma)
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Elastic skin, hypermobility of joints, increased bleeding tendency
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Ehlers-Danlos syndrome (type V collagen defect, type III collagen defect seen in vascular subtype of ED)
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Enlarged, hard left supraclavicular node
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Virchow node (abdominal metastasis)
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Episodic vertigo, tinnitus, hearing loss
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Meniere disease
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Erythroderma, lymphadenopathy, hepatosplenomegaly, atypical T cells
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Mycosis fungoides (cutaneous T-cell lymphoma) or Sézary syndrome (mycosis fungoides + malignant T cells in blood)
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Facial muscle spasm upon tapping
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Chvostek sign (hypocalcemia)
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Fat, female, forty, and fertile
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Cholelithiasis (gallstones)
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Fever, chills, headache, myalgia following antibiotic treatment for syphilis
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Jarisch-Herxheimer reaction (rapid lysis of spirochetes results in endotoxin release)
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Fever, cough, conjunctivitis, coryza, diffuse rash
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Measles
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Fever, night sweats, weight loss
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B symptoms (staging) of lymphoma
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Fibrous plaques in soft tissue of penis with abnormal curvature
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Peyronie disease (connective tissue disorder)
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Golden brown rings around peripheral cornea
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Wilson disease (Kayser-Fleischer rings due to copper accumulation)
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Gout, intellectual disability, self-mutilating behavior in a boy
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Lesch-Nyhan syndrome (HGPRT deficiency, X-linked recessive)
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Hamartomatous GI polyps, hyperpigmentation of mouth/feet/hands/genitalia
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Peutz-Jeghers syndrome (inherited, benign polyposis can cause bowel obstruction; increased cancer risk, mainly GI)
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Hepatosplenomegaly, pancytopenia, osteoporosis, aseptic necrosis of femoral head, bone crises
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Gaucher disease (glucocerebrosidase deficiency)
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Hereditary nephritis, sensorineural hearing loss, cataracts
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Alport syndrome (mutation in collagen IV)
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Hyperphagia, hypersexuality, hyperorality, hyperdocility
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Klüver-Bucy syndrome (bilateral amygdala lesion)
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Hyperreflexia, hypertonia, Babinski sign present
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UMN damage
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Hyporeflexia, hypotonia, atrophy, fasciculations
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LMN damage
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Hypoxemia, polycythemia, hypercapnia
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Chronic bronchitis (hyperplasia of mucous cells, “blue bloater”)
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Indurated, ulcerated genital lesion
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Nonpainful: chancre (1° syphilis, Treponema pallidum) Painful, with exudate: chancroid (Haemophilus ducreyi)
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Infant with cleft lip/palate, microcephaly or holoprosencephaly, polydactyly, cutis aplasia
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Patau syndrome (trisomy 13)
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Infant with hypoglycemia, hepatomegaly
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Cori disease (debranching enzyme deficiency) or Von Gierke disease (glucose-6-phosphatase deficiency, more severe)
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Infant with microcephaly, rocker-bottom feet, clenched hands, and structural heart defect
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Edwards syndrome (trisomy 18)
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Jaundice, palpable distended non-tender gallbladder
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Courvoisier sign (distal malignant obstruction of biliary tree)
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Large rash with bull’s-eye appearance
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Erythema chronicum migrans from Ixodes tick bite (Lyme disease: Borrelia )
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Lucid interval after traumatic brain injury
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Epidural hematoma (middle meningeal artery rupture)
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Male child, recurrent infections, no mature B cells
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Bruton disease (X-linked agammaglobulinemia)
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Mucosal bleeding and prolonged bleeding time
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Glanzmann thrombasthenia (defect in platelet aggregation due to lack of GpIIb/IIIa)
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Muffled heart sounds, distended neck veins, hypotension
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Beck triad of cardiac tamponade
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Multiple colon polyps, osteomas/soft tissue tumors, impacted/supernumerary teeth
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Gardner syndrome (subtype of FAP)
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Myopathy (infantile hypertrophic cardiomyopathy), exercise intolerance
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Pompe disease (lysosomal α-1,4-glucosidase deficiency)
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Neonate with arm paralysis following difficult birth
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Erb-Duchenne palsy (superior trunk [C5-C6] brachial plexus injury: “waiter’s tip”)
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No lactation postpartum, absent menstruation, cold intolerance
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Sheehan syndrome (pituitary infarction)
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Nystagmus, intention tremor, scanning speech, bilateral internuclear ophthalmoplegia
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Multiple sclerosis
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Painful blue fingers/toes, hemolytic anemia
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Cold agglutinin disease (autoimmune hemolytic anemia caused by Mycoplasma pneumoniae, infectious mononucleosis, CLL)
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Painful fingers/toes changing color from blue to white to red with cold or stress
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Raynaud phenomenon (vasospasm in extremities)
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Painful, raised red lesions on pads of fingers/toes
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Osler nodes (infective endocarditis, immune complex deposition)
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Painless erythematous lesions on palms and soles
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Janeway lesions (infective endocarditis, septic emboli/microabscesses)
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Painless jaundice
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Cancer of the pancreatic head obstructing bile duct
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Palpable purpura on buttocks/legs, joint pain, abdominal pain (child), hematuria
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Henoch-Schönlein purpura (IgA vasculitis affecting skin and kidneys)
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Pancreatic, pituitary, parathyroid tumors
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MEN 1 (autosomal dominant)
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Periorbital and/or peripheral edema, proteinuria (> 3.5g/day), hypoalbuminemia, hypercholesterolemia
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Nephrotic syndrome
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Pink complexion, dyspnea, hyperventilation
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Emphysema (“pink puffer,” centriacinar [smoking] or panacinar [α1-antitrypsin deficiency])
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Polyuria, renal tubular acidosis type II, growth failure, electrolyte imbalances, hypophosphatemic rickets
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Fanconi syndrome (multiple combined dysfunction of the proximal convoluted tubule)
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Pruritic, purple, polygonal planar papules and plaques (6 P’s)
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Lichen planus
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Ptosis, miosis, anhidrosis
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Horner syndrome (sympathetic chain lesion)
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Pupil accommodates but doesn’t react
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Neurosyphilis (Argyll Robertson pupil)
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Rapidly progressive limb weakness that ascends following GI/upper respiratory infection
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Guillain-Barré syndrome (acute inflammatory demyelinating polyradiculopathy subtype)
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Rash on palms and soles
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Coxsackie A, 2° syphilis, Rocky Mountain spotted fever
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Recurrent cold (noninflamed) abscesses, unusual eczema, high serum IgE
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Hyper-IgE syndrome (Job syndrome: neutrophil chemotaxis abnormality)
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Red “currant jelly” sputum in alcoholic or diabetic patients
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Klebsiella pneumoniae pneumonia
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Red “currant jelly” stools
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Acute mesenteric ischemia (adults), intussusception (children)
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Red, itchy, swollen rash of nipple/areola
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Paget disease of the breast (sign of underlying neoplasm)
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Red urine in the morning, fragile RBCs
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Paroxysmal nocturnal hemoglobinuria
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Renal cell carcinoma (bilateral), hemangioblastomas, angiomatosis, pheochromocytoma
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von Hippel-Lindau disease (dominant tumor suppressor gene mutation)
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Resting tremor, rigidity, akinesia, postural instability, shuffling gait
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Parkinson disease (loss of dopaminergic neurons in substantia nigra pars compacta)
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Retinal hemorrhages with pale centers
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Roth spots (bacterial endocarditis)
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Severe jaundice in neonate
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Crigler-Najjar syndrome (congenital unconjugated hyperbilirubinemia)
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Severe RLQ pain with palpation of LLQ
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Rovsing sign (acute appendicitis)
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Severe RLQ pain with deep tenderness
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McBurney sign (acute appendicitis)
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Short stature, café au lait spots, thumb/radial defects, increased incidence of tumors/leukemia, aplastic anemia
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Fanconi anemia (genetic loss of DNA crosslink repair; often progresses to AML)
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Single palmar crease
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Down syndrome
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Situs inversus, chronic sinusitis, bronchiectasis, infertility
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Kartagener syndrome (dynein arm defect affecting cilia)
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Skin hyperpigmentation, hypotension, fatigue
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1° adrenocortical insufficiency (e.g., Addison disease) causes increased ACTH and increased α-MSH production
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Slow, progressive muscle weakness in boys
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Becker muscular dystrophy (X-linked missense mutation in dystrophin; less severe than Duchenne)
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Small, irregular red spots on buccal/lingual mucosa with blue-white centers
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Koplik spots (measles [rubeola] virus)
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Smooth, moist, painless, wart-like white lesions on genitals
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Condylomata lata (2° syphilis)
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Splinter hemorrhages in fingernails
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Bacterial endocarditis
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“Strawberry tongue”
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Scarlet fever, Kawasaki disease
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Streak ovaries, congenital heart disease, horseshoe kidney, cystic hygroma at birth, short stature, webbed neck, lymphedema
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Turner syndrome (45,XO)
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Sudden swollen/painful big toe joint, tophi
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Gout/podagra (hyperuricemia)
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Swollen gums, mucosal bleeding, poor wound healing, petechiae
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Scurvy (vitamin C deficiency: can’t hydroxylate proline/lysine for collagen synthesis)
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Swollen, hard, painful finger joints
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Osteoarthritis (osteophytes on PIP [Bouchard nodes], DIP [Heberden nodes])
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Systolic ejection murmur (crescendo-decrescendo)
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Aortic stenosis
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Telangiectasias, recurrent epistaxis, skin discoloration, arteriovenous malformations, GI bleeding, hematuria
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Osler-Weber-Rendu syndrome
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Thyroid and parathyroid tumors, pheochromocytoma
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MEN 2A (autosomal dominant RET mutation)
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Thyroid tumors, pheochromocytoma, ganglioneuromatosis
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MEN 2B (autosomal dominant RET mutation)
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Toe extension/fanning upon plantar scrape
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Babinski sign (UMN lesion)
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Unilateral facial drooping involving forehead
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LMN facial nerve (CN VII) palsy; UMN lesions spare the forehead
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Urethritis, conjunctivitis, arthritis in a male
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Reactive arthritis associated with HLA-B27
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Vascular birthmark (port-wine stain) of the face
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Nevus flammeus (benign, but associated with Sturge-Weber syndrome)
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Vomiting blood following gastroesophageal lacerations
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Mallory-Weiss syndrome (alcoholic and bulimic patients)
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Weight loss, diarrhea, arthritis, fever, adenopathy
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Whipple disease (Tropheryma whipplei)
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“Worst headache of my life”
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Subarachnoid hemorrhage
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Actinic (solar) keratosis
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Precursor to squamous cell carcinoma
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Acute gastric ulcer associated with CNS injury
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Cushing ulcer (increased intracranial pressure stimulates vagal gastric H+ secretion)
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Acute gastric ulcer associated with severe burns
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Curling ulcer (greatly reduced plasma volume results in sloughing of gastric mucosa)
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Age ranges for patient with ALL/CLL/AML/CML
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ALL: child, CLL: adult > 60, AML: adult ~ 65, CML: adult 45-85
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Alternating areas of transmural inflammation and normal colon
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Skip lesions (Crohn disease)
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Aortic aneurysm, abdominal
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Atherosclerosis
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Aortic aneurysm, ascending or arch
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3° syphilis (syphilitic aortitis), vasa vasorum destruction
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Aortic aneurysm, thoracic
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Marfan syndrome (idiopathic cystic medial degeneration)
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Aortic dissection
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Hypertension
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Atrophy of the mammillary bodies
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Wernicke encephalopathy (thiamine deficiency causing ataxia, ophthalmoplegia, and confusion)
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Autosplenectomy (fibrosis and shrinkage)
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Sickle cell disease (hemoglobin S)
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Bacteria associated with gastritis, peptic ulcer disease, and gastric malignancies (e.g. adenocarcinoma, MALToma)
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H. pylori
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Bacterial meningitis (adults and elderly)
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S. pneumoniae
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Bacterial meningitis (newborns and kids)
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Group B streptococcus/E.coli (newborns), S. pneumoniae/N. meningitidis (kids/teens)
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Bilateral ovarian metastases from gastric carcinoma
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Krukenberg tumor (mucin-secreting signet ring cells)
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Bleeding disorder with GpIb deficiency
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Bernard-Soulier syndrome (defect in platelet adhesion to von Willebrand factor)
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Brain tumor (adults)
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Supratentorial: metastasis, astrocytoma (including glioblastoma multiforme), meningioma, schwannoma
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Brain tumor (kids)
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Infratentorial: medulloblastoma (cerebellum) or supratentorial: craniopharyngioma
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Breast cancer
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Invasive ductal carcinoma
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Breast mass
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Fibrocystic change, carcinoma (in postmenopausal women)
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Breast tumor (benign, young woman)
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Fibroadenoma
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Cardiac 1° tumor (kids)
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Rhabdomyoma, often seen in tuberous sclerosis
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Cardiac manifestation of lupus
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Marantic/thrombotic endocarditis (nonbacterial)
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Cardiac tumor (adults)
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Metastasis, myxoma (90% in left atrium; “ball and valve”)
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Cerebellar tonsillar herniation
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Chiari II malformation
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Chronic arrhythmia
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Atrial fibrillation (associated with high risk of emboli)
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Chronic atrophic gastritis (autoimmune)
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Predisposition to gastric carcinoma (can also cause pernicious anemia)
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Clear cell adenocarcinoma of the vagina
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DES exposure in utero
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Congenital adrenal hyperplasia, hypotension
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21-hydroxylase deficiency
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Congenital cardiac anomaly
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VSD
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Congenital conjugated hyperbilirubinemia (black liver)
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Dubin-Johnson syndrome (inability of hepatocytes to secrete conjugated bilirubin into bile)
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Constrictive pericarditis
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TB (developing world); idiopathic, viral illness (developed world)
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Coronary artery involved in thrombosis
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LAD > RCA > circumflex
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Cretinism
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Iodine deficit/congenital hypothyroidism
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Cushing syndrome
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– Iatrogenic (from corticosteroid therapy) – Adrenocortical adenoma (secretes excess cortisol) – ACTH-secreting pituitary adenoma (Cushing disease) – Paraneoplastic (due to ACTH secretion by tumors)
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Cyanosis (early; less common)
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Tetralogy of Fallot, transposition of great vessels, truncus arteriosus
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Death in CML
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Blast crisis
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Death in SLE
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Lupus nephropathy
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Dementia
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Alzheimer disease, multiple infarcts (vascular dementia)
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Demyelinating disease in young women
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Multiple sclerosis
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DIC
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Severe sepsis, obstetric complications, cancer, burns, trauma, major surgery, acute pancreatitis, APL
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Diverticulum in pharynx
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Zenker diverticulum (diagnosed by barium swallow)
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Ejection click
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Aortic stenosis
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Esophageal cancer
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Squamous cell carcinoma (worldwide); adenocarcinoma (U.S.)
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Food poisoning (exotoxin mediated)
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S. aureus, B. cereus
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Gastric cancer
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Adenocarcinoma
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Glomerulonephritis (adults)
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Berger disease (IgA nephropathy)
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Gynecologic malignancy
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Endometrial carcinoma (most common in U.S.); cervical carcinoma (most common worldwide)
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Heart murmur, congenital
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Mitral valve prolapse
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Heart valve in bacterial endocarditis
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Mitral > aortic (rheumatic fever), tricuspid (IV drug abuse)
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Helminth infection (U.S.)
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Enterobius vermicularis, Ascaris lumbricoides
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Hematoma—epidural
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Rupture of middle meningeal artery (trauma; lentiform shaped)
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Hematoma—subdural
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Rupture of bridging veins (crescent shaped)
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Hemochromatosis
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Multiple blood transfusions or hereditary HFE mutation (can result in heart failure, “bronze diabetes,” and increased risk of hepatocellular carcinoma)
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Hepatocellular carcinoma
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Cirrhotic liver (associated with hepatitis B and C and with alcoholism)
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Hereditary bleeding disorder
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von Willebrand disease
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Hereditary harmless jaundice
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Gilbert syndrome (benign congenital unconjugated hyperbilirubinemia)
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HLA-B27
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Psoriatic arthritis, ankylosing spondylitis, IBD-associated arthritis, reactive arthritis (formerly Reiter syndrome)
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HLA-DR3
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Diabetes mellitus type 1, SLE, Graves disease, Hashimoto thyroiditis, Addison disease
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HLA-DR4
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Diabetes mellitus type 1, rheumatoid arthritis, Addison disease
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Holosystolic murmur
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VSD, tricuspid regurgitation, mitral regurgitation
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Hypercoagulability, endothelial damage, blood stasis
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Virchow triad (increased risk of thrombosis)
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Hypertension, 2°
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Renal artery stenosis, chronic kidney disease (e.g. polycystic kidney disease, diabetic nephropathy), hyperaldosteronism
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Hypoparathyroidism
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Accidental excision during thyroidectomy
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Hypopituitarism
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Pituitary adenoma (usually benign tumor)
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Infection 2° to blood transfusion
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Hepatitis C
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Infections in chronic granulomatous disease
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S. aureus, E. coli, Aspergillus (catalase ⊕ )
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Intellectual disability
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Down syndrome, fragile X syndrome
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Kidney stones
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– Calcium = radiopaque – Struvite (ammonium) = radiopaque (formed by urease ⊕ organisms such as Klebsiella, Proteus species, and S. saprophyticus ) – Uric acid = radiolucent – Cystine = radiolucent
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Late cyanotic shunt (uncorrected left to right becomes right to left)
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Eisenmenger syndrome (caused by ASD, VSD, PDA; results in pulmonary hypertension/polycythemia)
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Liver disease
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Alcoholic cirrhosis
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Lysosomal storage disease
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Gaucher disease
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Male cancer
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Prostatic carcinoma
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Malignancy associated with noninfectious fever
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Hodgkin lymphoma
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Malignancy (kids)
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ALL, medulloblastoma (cerebellum)
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Metastases to bone
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Prostate, breast > lung > thyroid
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Metastases to brain
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Lung > breast > genitourinary > melanoma > GI
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Metastases to liver
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Colon >> stomach, pancreas
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Microcytic anemia
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Iron deficiency
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Mitochondrial inheritance
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Disease occurs in both males and females, inherited through females only
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Mitral valve stenosis
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Rheumatic heart disease
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Mixed (UMN and LMN) motor neuron disease
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Amyotrophic lateral sclerosis
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Myocarditis
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Coxsackie B
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Nephrotic syndrome (adults)
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Focal segmental glomerulosclerosis
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Nephrotic syndrome (kids)
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Minimal change disease
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Neuron migration failure
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Kallmann syndrome (hypogonadotropic hypogonadism and anosmia)
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Nosocomial pneumonia
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S. aureus, Pseudomonas, other enteric gram-negative rods
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Obstruction of male urinary tract
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BPH
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Opening snap
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Mitral stenosis
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Opportunistic infection in AIDS
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Pneumocystis jirovecii pneumonia
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Osteomyelitis
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S. aureus (most common overall)
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Osteomyelitis in sickle cell disease
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Salmonella
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Osteomyelitis with IV drug use
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Pseudomonas, Candida, S. aureus
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Ovarian tumor (benign, bilateral)
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Serous cystadenoma
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Ovarian tumor (malignant)
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Serous cystadenocarcinoma
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Pancreatitis (acute)
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Gallstones, alcohol
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Pancreatitis (chronic)
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Alcohol (adults), cystic fibrosis (kids)
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Pelvic inflammatory disease
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C. trachomatis, N. gonorrhoeae
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Philadelphia chromosome t(9;22) (BCR-ABL)
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CML (may sometimes be associated with ALL/AML)
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Pituitary tumor
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Prolactinoma, somatotropic adenoma
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1° amenorrhea
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Turner syndrome (45,XO or 45,XO/46XX mosaic)
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1° bone tumor (adults)
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Multiple myeloma
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1° hyperaldosteronism
answer

Adenoma of adrenal cortex
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1° hyperparathyroidism
answer

Adenomas, hyperplasia, carcinoma
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1° liver cancer
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Hepatocellular carcinoma (chronic hepatitis, cirrhosis, hemochromatosis, α1-antitrypsin deficiency, Wilson disease)
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Pulmonary hypertension
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Idiopathic, heritable, left heart disease (e.g. HF), lung disease (e.g. COPD), hypoxemic vasoconstriction (e.g. OSA), thromboembolic (e.g. PE)
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Recurrent inflammation/thrombosis of small/medium vessels in extremities
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Buerger disease (strongly associated with tobacco)
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Renal tumor
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Renal cell carcinoma: associated with von Hippel-Lindau and cigarette smoking; paraneoplastic syndromes (EPO, renin, PTHrP, ACTH)
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Right heart failure due to a pulmonary cause
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Cor pulmonale
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S3 heart sound
answer

Increased ventricular filling pressure (e.g., mitral regurgitation, HF), common in dilated ventricles
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S4 heart sound
answer

Stiff/hypertrophic ventricle (aortic stenosis, restrictive cardiomyopathy)
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2° hyperparathyroidism
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Hypocalcemia of chronic kidney disease
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Sexually transmitted disease
answer

C. trachomatis (usually coinfected with N. gonorrhoeae)
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SIADH
answer

Small cell carcinoma of the lung
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Site of diverticula
answer

Sigmoid colon
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Sites of atherosclerosis
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Abdominal aorta > coronary artery > popliteal artery > carotid artery
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t(14;18)
answer

Follicular lymphomas (BCL-2 activation, anti-apoptotic oncogene)
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t(8;14)
answer

Burkitt lymphoma (c-myc fusion, transcription factor oncogene)
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t(9;22)
answer

Philadelphia chromosome, CML (BCR-ABL activation, tyrosine kinase oncogene)
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Temporal arteritis
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Risk of ipsilateral blindness due to occlusion of ophthalmic artery; polymyalgia rheumatica
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Testicular tumor
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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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