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130 Cards in this Set

  • Front
  • Back
Actinic (solar) keratosis
Precursor to squamous cell carcinoma

Actually only 1/1000 progress to SqCC. Actinic keratosis is easier felt than seen - rough, like sandpaper.
Treat topically - 5-fluorouracil will initially give it a beefy red color
Acute gastric ulcer associated with CNS injury
Cushing's ulcer

Inc. intracranial pressure stimulates vagal gastric acid secretion.

Cushing's triad: Inc. ICP
Inc. HR
Dec. respiration
Acute gastric ulcer associated with severe burns
Curling's ulcer
Greatly reduced plasma volume causes sloughing of gastric mucosa

Think: "curling iron" to remember "burn"
Alternating areas of transmural inflammation and normal colon
Skip lesions
Seen in Crohn's disease

One of the major differences between Crohn's and ulcerative colitis
Can be seen on radiograph
Aneurysm, dissecting
Usu due to hypertension
Aortic aneurysm, abdominal and descending aorta
Usu due to atherosclerosis

Most common area for atherosclerosis is abdominal aorta
Aortic aneurysm, ascending
Tertiary syphilis
Marfan's syndrome
Possibly from hypertension

With tertiary syphilis: aortic regurgitation or stenosis, tree-barking of aorta, "prostate's pupil," tabes dorsalis
Atrophy of the mammillary bodies
Wernicke's encephalopathy
(thiamine deficiency causing ataxia, ophthalmoplegia, and confusion)

Seen most often in chronic alcoholics
Other B1 deficiency diseases: Wet beriberi (cardiac manifestations); Dry beriberi (neurological manifestations)
Autosplenectomy (fibrosis and shrinkage)
Most commonly from sickle cell anemia (HbS)
Malformed RBCs cause autoinfarction in spleen -> sclerosed, shrunken tissue

In asplenia, beware encapsulated organisms: S. pneumoniae, Klebsiella, H. influenzae, N. meningiditis, Salmonella, Strep B
Bacteria associated with stomach cancer
H. pylori

Pretty much anytime they ask about bacterial pathology in the stomach, think H. pylori.
Bacterial meningitis in adults & elderly
S. pneumoniae considered #1 cause
#2 - Neisseria meningitidis
Bacterial meningitis in kids & newborns
Newborns - Group B strep or E. coli
Kids - S. pneumoniae or N. meningitidis
Benign melanocytic nevus
Spitz nevus
Most common in first two decades of life
Bleeding disorder with GpIb deficiency
Bernard-Soulier disease
Defect in platelet adhesion to vWF (von Willebrand's factor)

Causes inc. bleeding time, but not inc. PT or PTT
Brain tumor (adults)
Most common: metastases
Then: Glioblastoma multiforme (or astrocytomas)
Then: meningioma
Then: schwannoma

Mnemonic: MGM Studios
Brain tumor (kids)
>70% are infratentorial: astrocytoma > medulloblastoma > ependymoma

Supratentorial: most often craniopharyngioma
(origin in Rathke's pouch, like adenohypophysis)
Breast cancer
Most common: infiltrating ductal carcinoma
Same as invasive ductal carcinoma

Approx. 1 in 8 American women will develop breast cancer
Breast mass
Most likely: Fibrocystic change
Second: Carcinoma (in postmenopausal women)
Breast tumor (benign)
Usu fibroadenoma
Primary cardiac tumor (kids)
Rhabdomyoma

May be assoc w/tubular sclerosis (in which case, may also have ash leaf spots & seizures)
Cardiac manifestation of lupus
Libman-Sacks endocarditis
Nonbacterial, affects mitral valve
Cardiac tumor (adults)
#1 - Metastasis

#2 - Primary myxoma (4x as ofen in left atrium than right)
"Ball and valve" action -> syncope
Cerebellar tonsillar herniation
Chiari malformation
May be asymptomatic
OR - may present with progressive hydrocephalus or syringomyelia
Chronic arrhythmia
Atrial fibrillation most common

Assoc w/high risk of emboli
(Stasis of blood inc. risk. Must treat with warfarin before attempting to correct arrhythmia)
Chronic atrophic gastritis (autoimmune)
Predisposition to gastric carcinoma

Can cause pernicious anemia
Attack on parietal cells -> loss of Intrinsic Factor -> inability to absorb B12 in ileum
Clear cell adenocarcinoma of the vagina
DES exposure in utero

Exposure occurs in the womb when the mother takes DES. The female fetus, later in her life, develops this.
Congenital adrenal hyperplasia, hypotension
21-hydroxylase deficiency

Unable to synthesize mineralocorticoids or glucocorticoids. Precursors are shunted towards androgen production.
Dec. mineralocorticoids -- hypotension, hyperkalemia, salt wasting. Inc. renin activity.
Dec. cortisol -- inc. ACTH (hyperpigmentation)
Inc. androgens -- masculinization (of female infant)
Congenital cardiac anomaly
VSD (Ventricular Septal Defect)

Of course, not the only congenital cardiac anomaly, but it is the most common.
Congenital conjugated hyperbilirubinemia (black liver)
Dubin-Johnson syndrome
Inability of hepatocytes to secrete conjugated bilirubin into bile
Constrictive pericarditis in developing world
Tuberculosis

1/3 of the world is infected with TB (whether active of latent)
Coronary artery involved in thrombosis
LAD > RCA > LCA
Cretinism
Iodine deficit/hypothyroidism

Occurs early in life (begins in utero). CNS is not able to mature. Easily treated if recognized early.
Also presents with macroglossia, umbilical hernia, mental retardation, and short stature.
Cushing's syndrome
#1 - Corticosteroid therapy. Also know as exogenous Cushing's.

#2 - Cushing's disease: excess ACTH secretion by the pituitary
Diagnosis: ACTH is not suppressed by low-dose dexamethasone, but CAN be suppressed by high doses.
Cyanosis (early - in neonates. Less common)
Tetralogy of Fallot
Transposition of great vessels
Truncus arteriosus

In all cases, pulmonary circulation is bypassed; systemic organs cannot receive oxygenated blood
Cyanosis (late - in children. More common)
VSD, ASD, PDA

Eisenmenger's Syndrome - defect begins as a L->R shunt, so blood is properly oxygenated. After years of smooth muscle hypertrophy and fibrosis, pulmonary vasculature develops hypertension. With increased pressure, the shunt becomes R->L.
To compensate, kids squat to increase afterload.
Death in CML
Blast crisis
Death in SLE
Lupus nephropathy
anti-dsDNA strongly associated with lupus-related renal disease
Dementia
#1 - Alzheimer's disease

#2 - Multiple infarcts, often from carotid artery stenosis
Demyelinating disease in young women
Multiple sclerosis
DIC
Gram-negative sepsis, obstetric complications, cancer, burn trauma

Mnemonic: STOP Making New Thrombi
Sepsis
Trauma
OB complications
Pancreatitis
Malignancy
Nephrotic syndrome
Transfusion
Dietary deficit
Most commonly iron.

HOWEVER - most common VITAMIN deficiency is folic acid
Diverticulum in pharynx
Zenker's diverticulum
Diagnose with barium swallow
Ejection click
Aortic or pulmonic stenosis
Esophageal cancer
Worldwide - squamous cell carcinoma

In US - adenocarcinoma
This is due to high rates of GERD causing Barrett's esophagus, a precursor to esophageal adenocarcinoma.
Food poisoning (exotoxin mediated)
S. aureus, B. cereus

Toxin is preformed in food; induces vomiting within a few hours, fairly quick recovery.
Glomerulonephritis (adults)
Berger's disease (IgA nephropathy)

DO NOT confuse this with Buerger's disease - a vasculitis often seen in smokers
Gynecologic malignancy
Worldwide - cervical

US - endometrial carcinoma (#4 cancer in females)
After that, ovarian.
Heart murmur, congenital
Mitral valve prolapse
Helminth infection (US)
#1 - Enterobius vermicularis
Diagnose with "Scotch tape test"

#2 - Ascaris lumbricoides

Treat both with a -bendazole drug
Heart valve in bacterial endocarditis
If rheumatic fever - mitral
2nd - aortic

If IV drug abuse - tricuspid
Hematoma - epidural
Rupture of middle meningeal artery
Biconvex shape on imaging; risk of uncal herniation

Usu from trauma to the head. Unconsciousness -> lucid period -> confusion/delirium from increasing intracranial pressure
Hematoma - subdural
Rupture of bridging veins
Crescent shaped on imaging

Usu from trauma - deceleration injury, mild injury in elderly (due to slight atrophy of cerebral & vascular tissues)
Slow bleed - symptoms may not present for a few days
Hemochromatosis
Multiple blood transfusions - seen in pts with sickle cell anemia or thalassemia

Hereditary HFE mutation

Excess Fe deposits in tissues. Can result in CHF, "bronze diabetes," or inc. HCC risk
Triad: cirrhosis + diabetes mellitus + skin pigmentation
Hepatocellular carcinoma
Cirrhotic liver
Often associated with HBV/HCV
Hereditary bleeding disorder
#1 - von Willebrand's disease (autosomal)
#2 - hemophilia A - deficiency of factor VIII (X-linked)
Hereditary harmless jaundice
Gilbert's syndrome - benign congenital unconjugated hyperbilirubinemia

From dec. amt UDP-glucuronyl transferase or dec. bilirubin uptake by hepatocyte
Usu diagnosed incidentally, only presents in times of stress or illness
HLA-B27
"PAIR" - Seronegative Spondyloarthropaties

Psoriasis (doesn't always cause arthritic Sx)
Anklosing spondylitis
IBD (Crohn's dz, ulcerative colitis)
Reiter's syndrome (can't see/pee/climb a tree
HLA-DR3 or HLA-DR4
Diabetes mellitus type I
Rheumatoid arthritis
SLE
Holosystolic murmur
VSD
Tricuspid regurgitation
Mitral regurgitation

These are heard throughout ventricular contraction.
Aortic or pulmonary stenosis will only be heard during the second portion of systole (There is no turbulent blood flow during ISOVOLUMETRIC contraction)
Hypercoagulability, endothelial damage, blood stasis
Virchow's triad
(results in venous thrombosis)
Secondary hypertension
Usu renal disease - renal artery stenosis, chronic renal failure, etc.

If female with new onset, investigate OCP use
Hypoparathyroidism
Thyroidectomy - parathyroids are accidentally damaged or removed

Will show signs of hypoCa (tetany)
Hypopituitarism
Pituitary adenoma (usu benign)

Most common pituitary adenoma - prolactinoma
Infection secondary to blood transfusion
HCV

Although - other sources claim CMV. I can't make promises on this one.
Kidney stones
#1 - Calcium. Will be radiopaque.

#2 - Struvite (NH4 + Mg + PO4). Also radiopaque. Formed by urease-positive bugs - Proteus, Staph, etc.

#3 - Uric acid. Radiolucent (if imaged with dye, they look like empty spots). From hyperuricemia, leukemia treatment (tumor lysis syndrome), Leisch-Nyhan, inc. cellular breakdown
Late cyanotic shunt
Eisenmenger's syndrome - from an initial L->R shunt (ASD, VSD, PDA)

Shunt is present at birth, but is L to R and largely asymptomatic. Over time, pulmonary HTN inc. R pressure, and shunt reverses (R to L).

To continue perfusing tissues, RBC production increases (polycythemia). Child squats - inc. mean arterial pressure -> inc. afterload -> inc. L heart pressure.
Liver disease
Usu alcoholic cirrhosis
Lysosomal storage disease
Gaucher's disease

Histologic hallmark: "crinkled tissue paper" cytoplasm. First Aid p 111
Male cancer
Greatest incidence - prostatic carcinoma

Greatest fatality - lung. (Prostate is #2)
Malignancy assoc w/noninfectious fever
Hodgkin's lymphoma
Malignant skin tumor
Basal cell carcinoma
(Malignant, but rarely metastasizes)
Mental retardation
#1 - Fetal Alcohol Syndrome

#2 - Down Syndrome (Trisomy 21)

#3 - Fragile X Syndrome
Metastases to bone

(mnemonic)
P.T. Barnum Loves Kids

Prostate
Thyroid, Testes
Breast
Lung
Kidneys

Breast & Lung metastasize just about everywhere. Most other bone mets are GU-related.
Metastases to brain

(mnemonic)
Lots of Bad Stuff Kills Glia
(This is in order of occurence!)

#1 - Lung
#2 - Breast
#3 - Skin (melanoma)
#4 - Kidney (RCC)
#5 - GI tumors
Metastases to liver

(mnemonic)
Cancer Sometimes Penetrates Benign Liver

Colon
Stomach (gastric)
Pancreatic
Breast
Lung

Breast & Lung metastasize just about everywhere. The rest are mostly areas that could easily spread through the portal vein.
Mitral valve stenosis
Rheumatic heart disease
(More in older population)
Mixed (UMN & LMN) motor neuron disease
ALS
Damages anterior horns (LMN) & lateral corticospinal tracts (UMN)
Myocarditis
Coxsackie B
Neoplasm in kids
#1 - ALL

#2 - Cerebellar astrocytoma
Histo: perivascular pseudo-rosettes
Nephrotic syndrome (adults)
MGN - Membranous glomerulonephritis
"Spike & dome" appearance on EM
SubEPIthelial deposits
Capillary & GBM thickening
Granular on IF
Nephrotic syndrome (kids)
MCD - Minimal Change Disease
assoc w/infections & vaccinations
Appear normal on LM; podocyte foot process effacement/fusion on EM
Albumin lost in urine, but not Igs
Tx with corticosteroids
Nosocomial pneumonia (4)
Klebsiella
E. coli
Pseudomonas aeruginosa
S. aureus
Obstruction of male urinary tract
BPH - Benign Prostatic Hyperplasia
(NOT HYPERTROPHY)

Tx: alpha1-antagonists relax smooth muscle. Immediate symptomatic relief.
Finasteride blocks 5alpha-reductase, dec. DHT. Slower fx.
Opening snap (OS)
Mitral stenosis
Diastolic murmur beginning after OS (not heard during isovolumetric relaxation)

OS due to tensing of chordae tendineae. The thicker & more fibrotic they are, the earlier the OS occurs - so the time between the A2 sound and the OS can indicate the severity of the stenosis. (Shorter time = more severe)
Opportunistic infection in AIDS
Pneumonia - Pneumocystis jiroveci
Tx:prophylactic TMP-SMX (or dapsone) when CD4 < 200

Meningitis - Cryptococcus
Can start fluconazole at CD4 < 50

Diarrhea - Cryptosporidium.
MAC becomes common when CD4 < 100 (Prophylaxis with azithromycin)

Skin disorder - Kaposi's sarcoma (HHV-8)
Osteomyelitis

In sickle cell patient?

In IV drug user?
S. aureus

In SCA - Salmonella

In IVDU - Pseudomonas, S. aureus
Ovarian metastasis from gastric carcinoma or breast cancer
Krukenberg tumor - cells secrete mucus, have "signet ring" form (mucus pushes nuclear material to one side)
Ovarian tumor (benign)
Serous cystadenoma
Ovarian tumor (malignant)

Bonus point: Tumor marker
Serous cystadenocarcinoma
Show psamomma bodies!

Tumor marker - CA-125 (for all ovarian cancers)
Pancreatitis (acute)
Gallstones, alcohol (most prevalent two causes)

Mnemonic: GET SMASHED
Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune disease, Scorpion sting, HyperCa, HyperTGs, ERCP, Drugs
Pancreatitis (chronic)
Adults - alcohol

Kids - cystic fibrosis
Patient groups most likely to have ALL/CLL/AML/CML
ALL - child

CLL & AML - adult > 60

CML - adult 35-50

**ON STEP 1 - most scenarios will feature the classic case. These age groups are VERY important!
Pelvic inflammatory disease
N. gonorrhoeae
Also most common cause of monoarticular purulent arthritis in a young sexually active adult

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

95% - assoc w/CML

possible association w/ AML or ALL
Pituitary tumor
#1 - prolactinoma
Amenorrhea, bitemporal hemianopsia, gynecomastia (men)

#2 - Somatotropic "acidophilic" adenoma
Primary amenorrhea
Turner syndrome (XO)
Appearance - short stature, broad chest, webbed neck
Streak ovaries
Lymphedema
Congenital coarctation of the aorta (adult type)

Most common cause of secondary amenorrhea - pregnancy
Primary bone tumor (adults)
Multiple myeloma
Tumor of plasma cells - monoclonal antibody spike
Primary hyperaldosteronism
Adenoma of adrenal cortex

Inc. aldosterone & inc. cortisol --> Cushing's Syndrome
Primary hyperparathyroidism
#1 - Adenomas
#2 - Hyperplasia
#3 - Carcinoma (PTH-related peptide in paraneoplastic effect)
Primary liver cancer
HCC - hepatocellular carcinoma
Causes: chronic hepatitis, cirrhosis, HBV/HCV infection, hemochromatosis, alpha-1 antitrypsin deficiency
Marker: alpha-fetoprotein
Pulmonary hypertension
COPD
Recurrent inflammation/thrombosis of small/medium vessels in extremities
Buerger's disease

Often in young male smokers
Assoc w/Raynaud's
Renal tumor
RCC - renal cell carcinoma
Assoc w/von Hippel-Lindau and ADPKD (autosomal dominant polycystic kidney disease)
Paraneoplastic syndrome - can secrete EPO, renin, PTH, or ACTH
Right heart failure due to a pulmonary cause
Cor pulmonale
Most common cause of right-sided heart failure
Left-sided heart failure
S3 (protodiastolic gallop)
Inc. ventricular filling, assoc w/dilated ventricles. Causes:
L to R shunt (VSD, ASD, PDA)
Mitral regurgitation
LV failure (CHF)
S4 (presystolic gallop)
"atrial kick"
Stiff or hypertrophic ventricle: Causes:
Aortic stenosis
Restrictive cardiomyopathy
Hypertrophic cardiomyopathy
Chronic HTN
Post-myocardial infarction
Secondary hyperparathyroidism
Hypocalcemia of chronic kidney disease

Inability to make 1,25-OH Vitamin D --> dec. Ca absorption in the gut --> inc. PTH
Sexually transmitted disease
Chlamydia

Often coinfected with gonorrhea
SIADH (Syndrome of Inappropriate ADH Secretion)
Small cell carcinoma of the lung
Causes diuresis --> hypoNa

Also seen with various brain pathologies
Site of diverticula
Sigmoid colon
Sites of atherosclerosis
#1 - Abdominal aorta
#2 - Coronary arteries
#3 - Popliteal artery
#4 - Carotid arteries
Stomach cancer
Adenocarcinoma
Stomach ulcerations with high gastrin levels
Zollinger-Ellison syndrome
Gastrinoma (gastrin-secreting tumor) of duodenum or pancreas
t(14;18)
Follicular lymphoma

bcl-2 activation
t(8;14)
Burkitt's lymphoma

c-myc activation
t(9;22)
Philadelphia chromosome - CML

bcr-abl hybrid
t(11;22)
Ewing sarcoma
(bone tumor in children)
Temporal arteritis
(a.k.a. Giant Cell Arteritis)
Risk of ipsilateral blindness due to thrombosis of ophthalmic artery
Polymyalgia rheumatica
Often shows inc. ESR
Testicular tumor
Seminoma
(Male equivalent of the dysgerminoma)
Thyroid cancer
Papillary carcinoma
Histo: Orphan Annie nuclei, psamomma bodies.
Tumor in women
Leiomyoma
Estrogen dependent growth of myometrium. NOT a precursor to carcinoma
Tumor of infancy
Hemangioma
Benign; usually regresses spontaneously in childhood
Tumor of the adrenal medulla (adults)
Pheochromocytoma
Usually benign, but secreted catecholamines can be damaging.
Tumor of adrenal medulla (kids)
Neuroblastoma
Malignant
Histo: Homer-Wright rosettes
Type of Hodgkin's
Nodular sclerosis (65-75%)
The only type more prevalent in women. Good prognosis (few Reed-Sternberg cells).

Other forms: Mixed cellularity (25%, iffy prognosis)
Lymphocytic predominance (6%, good prognosis)
Lymphocytic depletion (rare, bad prognosis. In older men)
Type of non-Hodgkin's
Diffuse large cell
Mostly in adults; 20% in children
UTI
80% are E. coli
Staph saprophyticus (sexually active women)
Proteus
Viral encephalitis of temporal lobe
HSV-1
Vitamin deficiency (in US)
Folic acid
High risk in pregnant women - needed to prevent neural tube defects, but body only stores 3-4 month supply

B12 deficiency much rarer; liver contains LARGE stored