Signs And Symptoms Usmle

Front 1

Child

irritable, poor attention, lethargic, anorexia, abdominal pain (vague), constipation, pale, reduced reflexes in extremities

Back 1

Lead poisoning

Inh ALA & Ferrochelatase
Tx with EDTA or chelation therapy

Front 2

Bloody diarrhea, hx of travel and liver infection

Back 2

Probably Entamoeba Histolytica

look for "cartwheel" distribution of chromatin in nucleus and injested RBCs on liver biopsy

Front 3

Rapidly increased serum creatinine, nausea, vomitting, malaise

Back 3

Acute Renal Failure

(most common cause is pre-renal; i.e. renal hypoperfusion)

Front 4

Young adult male, Hep B or C positive, multi-organ affliction (espec. GI or Renal), thrombus symptoms, fibrinoid necrosis of vessels with fibrotic thickening in healing vessels

Back 4

polyarteritis nodosa

Front 5

50's male, rapidly progressive memory loss, ataxic gait, startle myoclonus, recurrent bursts of high voltage slow waves on EEG

Back 5

Creutzfeldt-Jakob Disease

Hallmark: Spongiform change in gray matter

Front 6

Japanese male, sexually active, 25 years later gets lymphadenopathy, hepatosplenomegaly, skin rash, hypercalcemia, elevated WBC

Back 6

ATLL after HTLV infection

Front 7

16 y/o with HTN, hypokalemia, increased blood volume, decreased renin, acne, hirsutism

Back 7

Partial glucocorticoid resistance

Inc. ACTH causes acne/hirsutism, Inc. steroid precursors cause other symptoms

Front 8

Child is clumsy, frequent falls, knee/ankle injuries, foot drop, pes planus (flat feet), muscle wasting gives legs stork-like appearance

Back 8

Charcot-Marie-Tooth Disease

Sensory-motor neuropathy type one results in atrophy in ant. compartment of leg (deep peroneal nn)

Front 9

Tremor, tachycardia, HTN, malaise, nausea, hallucinations, delirium tremens (autonomic instability, fever, tachycardia, delirium, death)

Back 9

Alcohol withdrawal

tx with benzos or replace the ETOH

Front 10

Fatigue, malaise, DIC and AML diagnosis...What sub-type

Back 10

M3 AML subtype (promyelocytic Leukemia), assc with lots of Auer rods

Front 11

Kid, bright red rash starts on cheeks and spreads to shoulders/upper thorax. Then gets reticulated, lacy appearance.

Back 11

Parvo B19 (if spread to a preg woman in 1st trimester, baby could get aplastic anemia and develop "Non-immune hydrops"

Front 12

Flacid bullae with cleavage plan above the basal layer of epidermis

Back 12

pemphigus vulgaris (aasc with Desmoglein 1 or 3)

Front 13

Several hours of increasing chest pain thats not relieved by nitroglycerin (no MI findings)

Back 13

Unstable angina (probably due to thrombosis with or without underlying atherosclerosis)

Front 14

Slightly curved, motile, gram negative aerobic rods

Back 14

Pseudomonas aeruginosa (pneumionia and Otitis EXTERNA)

Front 15

Several hours of increasing chest pain thats not relieved by nitroglycerin (no MI findings)

Back 15

Unstable angina (probably due to thrombosis with or without underlying atherosclerosis)

Front 16

Slightly curved, motile, gram negative aerobic rods

Back 16

Pseudomonas aeruginosa (pneumionia and Otitis EXTERNA)

Front 17

Infant with hypotonia, progressive dyspnea, fatigue, hepatomegaly, bilateral rales, cardiomegaly

Back 17

Glycogen storage disease (most likely Pompe's--lysosomal alpha glucosidase deficiency--which includes cardio/hepatomegaly)

Front 18

Infant with hypotonia, cirrhosis, and early death

Back 18

Andersen disease (branching enzyme deficiency)

Front 19

Infant with severe hypoglycemia, lactic acidosis, hepatomegaly, renomegaly, hyperlipidemia, and hyperuricemia

Back 19

Von Gierke's Disease (Glucose 6 Phosphatase disease)

Front 20

Infants with muscle cramps and weakness on exercise

Back 20

McArdle's Disease (myophosphorylase deficiency)

Front 21

Infants with hepatosplenomegaly, microcephaly, severe mental retardation, zebra body inclusions (characteristic foamy macrophages), early death

Back 21

Niemann-Pick Disease (Sphingomyelinase deficiency)

Front 22

Infant born with jaundice and icterus that don't respond to photo therapy (although no kernicterus forms). After phototherapy total bilirubin is sky high, but direct bilirubin is ok

Back 22

Crigler-Najjar Syndrome (decreased UDP-glucuronyl transferase activity prevents conjugation of bilirubin)

Front 23

Carotid bruits

Back 23

Severe atherosclerosis (stroke risk)

Front 24

66 y/o man with chronic fatigue, lymphadenopathy, hepatosplenomegaly, isolated lymphocytosis, mature lymphocytes

Back 24

CLL (tx with nitrogen mustard...ie chlorambucil)

Front 25

65 y/o male with HTN and stroke hx. only shaves right face. Can feel touch on right and left face, but if both are touched simultaneously, he only feels it on the right side

Back 25

Sensory neglect syndrome (rt parietal lobe defect)

Front 26

Normal infant at birth can't pass muconium, distended abdomen, vomitting, poor feeding, narrowed rectum. Passes some stool with digital rectal exam.

Back 26

Hirschsprung disease--neural crest migration defect resulting in congenital constipation from lack of ganglion cells in meissner (submucosal) and auerbach (myenteric) plexi in rectum (always involved). Can extend more proximal as well.

Front 27

70 y/o female in nursing home with flu-like sx's later develops high fever, dyspnea, and productive cough. Also mental status changes. CXR shows cavitary lesion in left lung

Back 27

Pulmonary abcess (most likely staph aureus)

Front 28

Wasting of thenar eminence and lack of sensation on nailbed of middle finger

Back 28

median nn lesion

Front 29

80 y/o man in car accident with severe thoracic and abdominal trauma goes to ICU and gets rapid myocardial dysfunction, hypotensin, DIC, and coma

Back 29

Septic shock (big giveaway is DIC) probably from gram - bacteria spilling out of his bowels

Front 30

60 y/o man with headaches, big hands, sweating, weakness, big feet, coarse facial features and skin tags

Back 30

Acromegaly (unregulated GH secretion)

Front 31

20 y/o with 3-day fever, chills, chest pain, cough w/ reddish brown sputum, rt. lower lobe consolodation with alpha hemolytic gram positive diplococci

Back 31

Streptococcus pneumoniae (has a capsule, so immunity involves Abs to the capsule)

Front 32

30 y/o female with weakness, headaches, depression, irritability, scleral icterus, small firm liver, tremor that resembles bird flapping its wings

Back 32

Wilson's disease (inadequate copper excretion due to ATP7B mutation on chromosome 13). Copper spills into eye, liver and brain (parkinsonian sxs). Dx with high urinary copper, low ceruloplasmin level or slit lam eye exam (Kayser-fleischer rings in cornea)

Front 33

35 y/o female with esophageal dysfunction and thickening skin.

Back 33

Scleroderma (progressive autoimmune systemic sclerosis)

Front 34

50 y/o female with weight loss, femoral neck fracture, lytic bone lesions, M protein spikes, Bence jones proteinuria, renal failure, anemia

Back 34

Multiple myeloma

Front 35

70 y/o female with muscle cramps, parathesias, carpopedal spasms when measuring blood pressure, involuntary facial twitch when ear is tapped.

Back 35

Hypocalcemia (may be transient if, for example, a goiter is removed and parathyrois tissue is taken out with it)

Carpopedal spasms = Trosseau's sign
Involuntary facial twitch when facial nn is tapped = Chvostek's sign

Front 36

30 y/o male smoker/drinker with gangrenous finger tips

Back 36

Buerger disease (vasculitis causes segmental thrombosis in youg males with hx of early smoking)

Front 37

30 y/o male smoker/drinker with gangrenous finger tips

Back 37

Buerger disease (vasculitis causes segmental thrombosis in youg males with hx of early smoking)

Front 38

Ovarian mass is a lymphoma with small lymphocytes, interspersed with macrophages and surrounded by clear spaces?

Back 38

Classic "starry sky" appearance of Burkitt's Lymphoma (c-myc associated)

Front 39

Man presents with decreased sperm motility, respiratory/earinfections

Back 39

Kartagener Syndrome--dynein protein is defective, so cilia and flagella don't move correctly

Front 40

15 y/o with headaches, paralyzed upwards gaze, bilateral papilledema, pupils that accomidate but don't react

Back 40

Parinaud Syndrome: pineal tumor compresses pretectal area of dorsal midbrain (where vertical gaze center is) and also pinches the cerebral aquaduct

Front 41

35 y/o female with 3rd degree burns and secondary infection gets hypoxia, hyaline membrane within alveolar walls, alveolar septal thickening, and neutrophilic infiltrate

Back 41

ARDS!!! Key feature is hyaline membrane within alveolar walls

Front 42

tingling in 1st, 2nd, 3rd digits on rt hand and loss of coordination/strength in rt thumb

Back 42

Carpal tunnel affecting the median nn on right hand

Front 43

25 y/o male with multiple small nodules on his lips, tall think build with long fingers, hyperextensible joints

Back 43

MEN IIb has neuromas of mucosal surfaces and marfanoid habitus. Its assc with medullary carcinoma of the thyroid

Front 44

Double vision reading or going down stairs gets better when head tilted to the right. Also strabismus with left eye elevated and extorted

Back 44

Super oblique mm damaged (for example if CN V is damaged by trauma to the forehead)

Front 45

5 y/o boy with yellow, soft, slightly raised bumps on his eyelids with no other sx's

Back 45

Probably Familial hypercholesterolemia from a defect in LDL receptor gene. AutoDom, homozygotes get way worse disease

Front 46

Young kid, good appetite but still underweight, bulky, greasy stools, persistent cough, wheezes, skin tastes salty

Back 46

Cystic fibrosis (recessive epithelial Cl- channel defect), confirm dx with sweat test

Front 47

Flushing, diarrhea, swelling of face/neck, wheezing, heart failure symptoms (esp. SOB)

Back 47

Carcinoid syndrome from tumor secreting 5HT(look for excess 5-HIAA in the urine--a breakdown product of tryptophan/seratonin)

Front 48

Problems digesting pizza, bread, cereal, pasta, etc....flatulence, weight loss and diarrhea result

Back 48

Celiac disease (gluten intolerance due to IgA destruction of intestinal ECM..look for crypt cell hyperplasia, flattened villi, and lack of microvilli)

Front 49

1.5 year old boy with recurrent infections, easy bruising, hepatosplenomegaly, and eczema

Back 49

Wiskott-Aldrich Syndrome (X-link recessive defect in cytoskeletal protein, elevated IgA & IgE, low IgM & platelets...tx with bone marrow transplant from HLA-identical sibling or death by age 6)

Front 50

17 /o boy with 1 year hx of multiple bacterial pneumonias, severe bronchiectasis, normal B&T cell counts, and "+" skin hypersensativity test to Candida

Back 50

Common Variable Immunodeficiency (low level of all Igs, but normal Bcell level)

Front 51

50 y/o transplant recipient ges headaches, nausea, vomitting and a CT shows "ring enhanced lesions" in his head (lungs clear, no rashes, no skin lesions)

Back 51

Toxoplasmosis gondii (70% are seropositive and it became active when he was immunosuppressed...usually kept in check by cell-mediated immunity)

Front 52

Frequent bacterial infections but no pus forms; 3 family members have it

Back 52

Leukocyte Adhesion Deficiency (LAD); AutoRec, absence of CD18 (integrin), without integrin leukocytes can't migrate to inflammation sites

Front 53

10 y/o from Haiti w/ SOB, wheezing, exertional dyspnea, urticaria, Ova/parasites in feces w/ nematode/eosinophilic infiltrates

Back 53

Ascaris lumbricoides (possess potent allergens and migrates to lungs)

Front 54

Kid, fever >10 days, dequamative rash on fingers/toes, cervical lymphadenopathy, bilateral conjunctavitis, polymorphous rash, oral lesions, pharyngeal erythema, strawberry tongue

Back 54

Kawasaki Syndrome (mucocutaneous lymphnode syndrome)...assc with coronary artery aneurysms

Front 55

16 y/o male with low levels of all Igs, normal B cell count, frequent bacterial infections

Back 55

Common variable immuno deficiency

Front 56

Turkish immigrant suffers from sensory loss/acid-fast granulomas on his extremities and cold areas (ie. ears)

Back 56

Leprosy

Front 57

nuclear homogenization (aka "ground glass nuclei"), Cowdry type A bodies, multinucleated cells

Back 57

HIV encephalitis (patient will be immunocompromised...probably AIDS)

Front 58

Young kid with chicken pox develops pernicious vomitting, lethargy, hepatomegaly, and coma 5 days later

Back 58

Reyes Syndrome (post viral phenomenon, often assc with aspirin)

Front 59

Child brain tumor with Rosenthal fibers that stains with GFAP

Back 59

Pilocytic astrocytoma

Front 60

34 y/o female with painful uirnation an knee pain, plus puss coming out of her eye)

aka: Urethritis, cervicitis, arthritis, and mucocutaneous lesions

Back 60

Reiter's syndrome (assc with chlamydia)

Front 61

72 y/o man with progressive memory loss, gait instability, and urinary incontinence (no tangles, plaques and a normal cerebral cortex)

Back 61

intermittently raised pressure hydrocephalus (aka normal pressure hydrocephalus)...tx with ventricular shunt

Front 62

65 y/o man has a colon polyp with saw-tooth glandular epithelium, goblet cell proliferation an columnar epithelieum

Back 62

Hyperplastic polyp (90% of all colon polyps, benign)

Front 63

1 year old gets fever/rash; 6 years later she's got seizures, behavior change, ataxia, focal neuralgias. She is soon quadraparetic and then dead.

Back 63

Subacute Sclerosing Panencephalitis (SSPE); rare complication of measles (rubeola)

Front 64

Patient from Bolivia has a blood film positive for Schuffner dots

Back 64

Plasmodium vivax (P. ovale also has Schuffner dots--aka hypnozoites--but only vivax occurs in the western hemisphere)

Front 65

Light shined in patient's right eye results in dilation of right eye and left eye

Back 65

Marcus-Gunn Pupil seen in Multiple Sclerosis or right retinal detachment (right eye is getting so little light that it dilates to receive more and then sends the same dilation signal to the left eye)

Front 66

25 y/o female with tremors, heat intolerance, weight loss, low TSH, no neck mass or opthalmopathy, and unilateral ovarian cystic mass

Back 66

Monodermal teratoma (aka struma ovarii) making thyroid hormone

(note: mature teratomas cannot produce hormones)

Front 67

17 y/o man with paroxysmal tachycardia, shortened PR interval, delta wave, and wide QRS complex on EKG

Back 67

Wolff-Parkinson-White Syndrome (ventricular pre-excitation aasociated with an atrioventricular bypass track)