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248 Cards in this Set
- Front
- Back
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Q: Most common cause of abdominal aortic aneurysm
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A: Atherosclerosis (often associated with mutation in LDL receptor in familial hyperchloesterolemia)
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Q: Sudden onset of excruciating substernal pain, often confused with myocardial infarction
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A: Dissecting aortic aneurysm (caused by cystic medial necrosis, more common in Marfan syndrome)
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Q: Vasculitis of the elderly, presenting as headache, facial pain, and/or impaired vision
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A: Giant cell (temporal) arteritis (most common vasculitis, affecting branches of the carotid artery)
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Q: Vast majority of cases are idiopathic, although they may be secondary to renal disease
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A: Hypertension (other secondary causes include primary hyperaldosteronism, Cushing syndrome, and pheochromocytoma)
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Q: Rapidly precipitating hypertension in an African American male with papilledema and retinal hemorrhages
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A: Malignant hypertension (histologically characterized by hyperplastic arteriolosclerosis or "onion-skin" thickening of arterial walls)
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Q: Pallor or cyanosis of fingers and toes caused by recurrent vasospasm of arterioles, often in young, healthy women
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A: Raynaud disease (reaction to cold or emotion)
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Q: Vasculitis primarily affecting the tibial and radial arteries
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A: Thromboangiitis obliterans (Buerger disease) - associated with cigarette smoking
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Q: Concentric hypertrophy of the left ventricle
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A: Aortic stenosis or Hypertensive heart disease (occurs in response to left ventricular pressure overload)
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Q: Congenital abnormality predisposing to calcify aortic stenosis
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A: Bicuspid aortic valve
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Q: Right heart failure due to intrinsic lung disease or primary disease of pulmonary vasculature
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A: Chronic cor pulmonale
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Q: Upper extremity hypertension with lower extremity hypotension
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A: Coarctation of the aorta (postductal) - can radiologically detect notching of the ribs caused by enlargement of intercostal and internal mammary arteries
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Q: Associated with cocaine abuse, alcohol abuse, and pregnancy; can also be idiopathic
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A: Dilated cardiomyopathy (heart may be 3 times heavier than normal with dilation of all four chambers)
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Q: Haphazard disarray of cardiac myofibrils
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A: Hypertrophic cardiomyopathy (autosomal dominant mutation in the myosin heavy chain gene)
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Q: Bulky, friable, nonsterile vegetations with the potential to embolize
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A: Infective (bacterial) endocarditis (often caused by Strep viridans infection of mitral valve, or Staph aureus infection of tricuspid valve in IV drug users)
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Q: Dyspnea, orthopnea, and paroxysmal nocturnal dyspnea caused by congestion of the lungs
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A: Left heart failure
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Q: Midsystolic click followed by a late systolic murmur
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A: Mitral valve prolapse (most common valvular heart disease in the U.S., especially in young women; also associated with Marfan syndrome)
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Q: Crushing or squeezing, substernal pain radiating down the left arm
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A: Myocardial infarction (serum findings include elevated cardiac Troponins, CK-MB, and LDH)
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Q: Causes include Coxsackie viruses A and B and Trypanosoma cruzi
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A: Myocarditis
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Q: Ball valve obstruction by left atrial mass
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A: Myxoma (most common primary tumor of the heart in adults)
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Q: Friable, sterile emboli caused by hypercoagulable states
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A: Nonbacterial thrombotic (marantic) endocarditis (associated with disseminated intravascular coagulation and adenocarcinoma of the pancreas)
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Q: Harsh waxing and waning murmur (machinery murmur)
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A: Patent ductus arteriosus (closed with indomethacin administration, which decreases prostaglandin E levels)
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Q: Friction rub
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A: Pericarditis (causes include infections, rheumatic fever, myocardial infarction and uremia)
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Q: Associated with cardiac amyloidosis, radiation injury, and sarcoidosis
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A: Restrictive cardiomyopathy (manifests as decreased ventricular filling owing to reducing ventricular compliance)
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Q: Migratory polyarthritis, erythema marginatum, subcutaneous nodules, Sydenham chorea, and pancarditis
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A: Rheumatic Fever (Aschoff bodies in the myocardium are pathognomonic)
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Q: Sequela of acute rheumatic fever
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A: Rheumatic heart disease (fish mouth deformity from fusion of commissures; most common is mitral stenosis and then finally next most common is mitral and aortic stenosis)
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Q: Peripheral edema, splenomegaly, and nutmeg liver
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A: Right heart failure
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Q: Precordial pain on exertion or increased cardiac workload, but relieved by rest
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A: Stable angina (caused by decreased coronary artery flow from atherosclerotic narrowing)
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Q: Right to left shunts
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A: Tetralogy of Fallot (most common), transposition of the great vessels, and persistent truncus arteriosus (early cyanosis)
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Q: Prolonged or recurrent chest pain with increasing frequency, often at rest
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A: Unstable (Crescendo, Preinfarction) angina - (a developing myocardial infarction)
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Q: Most common congenital heart defect
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A: Ventricular septal defect (may require surgical correction at birth, or if small, may close spontaneously)
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Q: Leukemia most common in younger patients
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A: ALL (acute lymphoblastic leukemia) - (peripheral blood smear shows predominance of lymphoblasts that stain positive for terminal deoxytransferase (TdT))
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Q: Predominance of myeloblasts (sometimes with Auer rods) or early promyelocytes in the peripheral blood
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A: AML (acute myeloid leukemia; auer rods = abnormal azurophilic granules in the cytoplasm, most abundant in M3 variant)
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Q: t(15;17), resulting in PML-RAR alpha fusion protein
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A: AML (acute myeloid leukemia); M3 variant (fusion gene encodes an abnormal retinoic acid receptor, blocking myeloid differentiation; treated with all-trans retinoic acid which induces cells to differentiate)
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Q: Markedly hypocellular marrow
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A: Aplastic anemia (often associated with chloramphenicol use)
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Q: t(8;14)
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A: Burkitt lymphoma (c-myc expression under the control of the Ig heavy chain gene)
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Q: Marrow fibrosis with extensive extramedullary hematopoiesis and teardrop cells in peripheral blood
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A: Chronic idiopathic myelofibrosis with myeloid metaplasia (agnogenic myeloid metaplasia)
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Q: Smudge cells
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A: CLL (chronic lymphocytic leukemia) - fragile lymphocytes destroyed or "smudged" during preparation of peripheral smear
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Q: t(9;22)
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A: CML (chronic myelogenous leukemia) - Philadelphia chromosome; creates bcr-abl fusion protein with increased tyrosine kinase activity
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Q: Concomitant widespread microvascular thrombosis and hemorrhage due to consumption coagulopathy
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A: DIC (disseminated intravascular coagulation) - Increase in fibrin split products and depletion of platelets and labile clotting factors II, VIII and fibrinogen
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Q: Most common heritable cause of coagulability
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A: Factor V Leiden (Hereditary resistance to activated Protein C)
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Q: X-linked bleeding disorders
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A: Factor VIII deficiency (classic hemophilia) and Factor IX deficiency (Christmas disease) - Prolonged partial thromboplastin time but normal bleeding time, platelet count, and prothrombin time in both diseases.
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Q: t(14;18)
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A: Follicular lymphoma (Most common form of non-Hodgkin lymphoma; expression of bcl-2 under the Ig heavy chain promoter)
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Q: Drug sensitivity hemolytic anemia (i.e., primaquine, chloroquine, sulfonamides, nitrofurantoins)
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A: Glucose-6-phosphate dehydrogenase (G6PD) deficiency (X-linked; common, especially in African and Mediterranean populations)
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Q: Tumor cells with tartrate-resistant acid phosphatase (TRAP) and fine hair-like cytoplasmic projections
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A: Hairy cell leukemia
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Q: Synthesis of structurally abnormal globin chains
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A: Hemoglobinopathies (i.e., Sickle cell anemia and hemoglobin C disease)
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Q: Reticulocytosis and polychromatophilia with disappearance of serum haptoglobin
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A: Hemolytic anemia (Haptoglobin is a hemoglobin-binding protein)
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Q: Most common inherited hemolytic anemia in persons of northern European lineage
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A: Hereditary spherocytosis (Usually autosomal dominant inheritance; most commonly ankyrin mutation leading to spectrin deficiency)
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Q: Reed-Sternberg cells
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A: Hodgkin disease (Binucleated giant cells with inclusion-like nucleoli)
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Q: Target cells, splenomegaly, and a mild hemolytic anemia in African Americans
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A: Homozygous hemoglobin C disease (Target cells may also be found in thalassemias)
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Q: Hypochromic microcytic anemias
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A: Iron deficiency anemia, thalassemia minor, and anemia of chronic disease
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Q: Hypersegmented polys and hypercellular marrow
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A: Megaloblastic anemia (Folate or vitamin B12 deficiency leads to defects in DNA synthesis, with accumulation of megaloblasts due to nuclear maturation problems)
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Q: Punched out lytic bone lesions of the spine, cranium and ribs
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A: Multiple myeloma (Peripheral blood smear may show rouleaux formation of RBC caused by hyperglobulinemia)
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Q: Propensity for lower cervical, supraclavicular, and medistinal lymph nodes
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A: Nodular sclerosis Hodgkin lymphoma (Only Hodgkin variant more common in females)
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Q: Anti-parietal cell and anti-intrinsic factor antibodies with achlorhydria
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A: Pernicious anemia (Parietal cells produce HCl and intrinsic factor; IF is required for vitamin B12 absorption in the terminal ileum)
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Q: Leg ulcers and recurrent painful crises
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A: Sickle cell anemia (homozygous HbSS disease) - patients also undergo autosplenectomy
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Q: Reduced synthesis of structurally normal globin chains
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A: Thalassemias (thalassemias are most common in Mediterranean populations)
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Q: Vitamin deficiencies that result in bleeding disorders
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A: Vitamin C deficiency, Vitamin K deficiency (Vitamin C is required for collagen synthesis and vessel integrity; Vitamin K is required for function of clotting factors II, VII, IX, and X)
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Q: Most common hereditary bleeding disorder
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A: von Willebrand disease (Prolonged partial thromboplastin time and bleeding time, but normal platelet count and prothrombin time)
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Q: Positive direct Coombs test
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A: Warm antibody hemolytic anemia (Differentiates warm antibody hemolytic anemia from hereditary spherocytosis)
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Q: Most common bronchogenic carcinoma type in women and nonsmokers
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A: Adenocarcinoma (Localize peripherally)
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Q: Rapid onset of respiratory insufficiency refractory to oxygen therapy associated with sepsis, infections, aspiration, or trauma
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A: Adult respiratory distress syndrome (diffuse alveolar damage) - Histologically characterized by intra-alveolar hyaline membranes
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Q: Restrictive pulmonary diseases
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A: Adult respiratory distress syndrome (diffuse alveolar damage), penumoconiosis, silicosis, sarcoidosis (Reduced total lung capacity because of decreased expansion of lung parenchyma)
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Q: Harmless black pigment in the lungs
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A: Anthracosis (Common in coal miners, urban dwellers, or smokers)
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Q: Severe dyspnea, wheezing, hyperreactive airways, and bronchospasm triggered by various stimuli
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A: Bronchial asthma (most commonly IgE mediated, Type I hypersensitivity reaction in the lung)
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Q: Copious purulent sputum, hemoptysis, and recurrent lung infections which may lead to abscess
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A: Bronchiectasis (bronchi and bronchioles can be dilated up to 4 times normal size)
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Q: Neoplastic columnar and cuboidal epithelial cells that line the alveolar septa
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A: Bronchioloalveolar carcinoma (tumor cells are also found loose in alveolar spaces)
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Q: Persistant productive cough for at least 3 consecutive months in at least 2 consecutive years
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A: Chronic bronchitis (Increased Reid index, which is a ratio of the thickness of mucous gland to the thickness of bronchiolar wall)
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Q: Blue bloater
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A: Chronic bronchitis (Cyanosis resulting from severe hypoxia)
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Q: Heart failure cells
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A: Chronic passive congestion of lung (Hemosiderin-laden macrophages)
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Q: Pink puffer
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A: Emphysema (Patient who overventilates and remains well-oxygenated)
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Q: Dilation of air spaces with destruction of alveolar walls
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A: Emphysema (Results from accelerated protease and elastase destruction of the lung)
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Q: Chronic obstructive pulmonary disease (COPD)
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A: Emphysema, chronic bronchitis, bronchiectasis, and bronchial asthma (Caused by airway narrowing or loss of elastic recoil of the lung, resulting in decreased forced expiratory volume at 1 second)
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Q: Central region of caseating necrosis encircled by lymphocytes, plasma cells, and epithelioid cells
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A: Granulomatous inflammation (Found in tuberculosis, fungal infections, and foreign body)
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Q: Associated with asbestos exposure
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A: Malignant mesothelioma (Neoplasm of visceral or parietal pleura or peritoneal neoplasm)
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Q: Alpha-1-antitrypsin deficiency
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A: Panacinar (panlobar) emphysema (Alpha-1-antitrypsin inhibits proteases, particularly elastase)
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Q: Chills, fever, malaise, pleuritic pain, and rusty sputum
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A: Pneumonia (More than 90% of lobar pneumonia is caused by Streptococcus pneumoniae; bronchopneumonia shows patchy consolidation)
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Q: Cause of sudden death often in immobilized postoperative patients
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A: Pulmonary embolism (Thrombi are most often from the deep veins of the lower extremities)
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Q: Embolism obstructing the bifurcation of the pulmonary artery
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A: Saddle embolus
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Q: Noncaseating granulomas in the lungs often in a young, adult, African American female
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A: Sarcoidosis (May be detected incidentally as bilateral hilar adenopathy)
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Q: Most prevalent chronic occupational disease in the world
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A: Silicosis
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Q: Lung tumors with strongest correlation to smoking
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A: Small cell carcinoma and Squamous cell carcinoma of the lung (Both types localize centrally near the hilus)
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Q: Associated with SIADH and Cushing syndrome as paraneoplastic syndromes
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A: Small cell carcinoma (Small cell carcinoma has the worst prognosis of bronchogenic carcinoma subtypes)
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Q: Rupture of apical subpleural blebs in young patients
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A: Spontaneous idiopathic pneumothorax
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Q: Tumor associated with hypercalcemia due to elaboration of parathyroid hormone-related peptide (PTHrp)
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A: Squamous cell carcinoma of the lung
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Q: Fever, night sweats, weight loss, and hemoptysis
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A: Tuberculosis (TB) - Ghon complex in primary TB (single lesion w/ hilar lymph involvement); multiple cavitary lesions in lung apices in secondary TB
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Q: Difficulty swallowing due to increased tone of the lower esophageal sphincter
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A: Achalasia (can be caused by destruction of the myenteric plexus in Chagas disease)
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Q: Right lower quadrant pain, nausea, fever, and an elevated WBC
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A: Acute appendicitis
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Q: Serotonin elaboration causing flushing, diarrhea, bronchospasm, and right heart damage
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A: Carcinoid syndrome (Carcinoid tumors of the appendix and rectum rarely metastasize)
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Q: Increased CEA (carcinoembryonic antigen)
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A: Carcinoma of the colon (Risk factor includes low fiber diet)
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Q: Presents early as obstruction and crampy discomfort
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A: Carcinoma of the rectosigmoid colon (Left-sided carcinoma)
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Q: Fatigue, weakness, and iron deficiency anemia in older males
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A: Carcinomas of the right colon (secondary to blood loss)
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Q: Malabsorption that resolves upon withdrawal of wheat gliadins from the diet
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A: Celiac sprue (Histologically characterized as flattening of the mucosal villi with inflammatory infiltrate)
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Q: Persistent projectile vomiting usually appearing in the 2nd-3rd week of life
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A: Congenital hypertrophic pyloric stenosis
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Q: Skip lesions
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A: Crohn disease (Discontinuous involvement of the intestinal mucosa visualized as a "string sign" on X-ray)
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Q: Cobblestone appearance of the bowel mucosa
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A: Crohn disease (Caused by inflammation and thickening of all three layers of the GI wall)
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Q: Small sac-like outpouchings of the colon through the muscular wall, common in the elderly
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A: Diverticulosis (Most commonly asymptomatic)
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Q: Barrett esophagus is the only recognized precursor
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A: Esophageal adenocarcinoma (Barrett esophagus = squamous to columnar metaplasia (specialized, intestinal type epithelium) in the distal esophagus)
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Q: Can rupture producing massive hemorrhage into the esophageal lumen
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A: Esophageal varices (often associated with portal hypertension, as in cirrhosis)
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Q: 100% chance of colon cancer by midlife
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A: Familial polyposis syndromes (Caused by autosomal dominant mutations in the APC gene with hundreds of adenomatous polyps carpeting the intestines)
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Q: Signet ring cells
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A: Gastric carcinoma, diffuse variant (Extensive infiltration of malignant cells can lead to linitis plastica or "leather bottle stomach"; metastasis bilaterally to the ovaries results in Krukenberg tumors)
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Q: Weakness in the peritoneal wall allowing protrusions of bowel segments
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A: Hernia
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Q: Congenital absence of ganglion cells in the muscular or submucosal layers of the GI wall
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A: Hirschsprung disease (congenital megacolon) - absence of ganglion cells is in the nondilated region of the colon
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Q: Telescoping of one intestinal segment into another, usually in children
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A: Intussusception
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Q: Most common and innocuous congenital abnormality in the GI
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A: Meckel diverticulum (failure of involution of the vitelline duct)
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Q: Sharply punched out lesions in the stomach or duodenum
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A: Peptic ulcer (Associated with NSAID use and Helicobacter pylori)
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Q: Autosomal dominant disorder with multiple benign hamartomatous polyps and melanin pigmentation of the oral mucosa, hands, and genitals
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A: Peutz-Jegher syndrome
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Q: Recurs often and is difficult to completely resect because of proximity to the facial nerve
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A: Pleomorphic adenoma (mixed tumor of the salivary gland) - most common salivary tumor
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Q: Pseudomembranes consisting of fibrin, mucin, and inflammatory debris covering the colonic mucosa
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A: Pseudomembranous colitis (caused by elaboration of exotoxins by Clostridium difficile)
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Q: Toxic megacolon is a complication
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A: Ulcerative colitis (destruction of neural plexus leading to massive dilation, gangrene, and imminent rupture of colon)
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Q: Pseudopolyps
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A: Ulcerative colitis (regenerating mucosal areas in the ulcerated mucosa and submucosa)
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Q: Sudden right upper quadrant or epigastric pain with nausea, vomiting, and leukocytosis
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A: Acute calculous cholecystitis (one of the most common indications for abdominal surgery)
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Q: Micronodules on liver surface in early stages
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A: Alcoholic cirrhosis
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Q: Mallory bodies, neutrophilic infiltrate, and hepatocyte swelling and necrosis
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A: Alcoholic hepatitis (mallory bodies = accumulation of cytokeratin intermediate filaments in hepatocytes)
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Q: Most common liver disease in the U.S.
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A: Alcoholic liver disease
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Q: Fatal thrombotic occlusion of the hepatic veins associated with polycythemia vera and other hypercoagulable states
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A: Budd-Chiari syndrome
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Q: Obstructive jaundice with palpably enlarged gallbladder
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A: Carcinoma of the head of the pancreas or carcinoma of the extrahepatic biliary ducts and ampulla of Vater (Courvoisier Law = obstructive jaundice with palpable gallbadder indicates probable tumor; jaundice with nonpalpable gallbladder indicates probable gallstones)
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Q: Obese multiparous woman with fat intolerance
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A: Cholelithiasis (gallstones)
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Q: Grossly distended abdomen, esophageal varices, caput medusae, and hemorrhoids
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A: Cirrhosis (caused by portal hypertension and active portocaval anastomoses
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Q: Palmar erythema, spider angiomatas, and gynecomastia
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A: Cirrhosis (all caused by hyperestrinism)
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Q: Soft, yellow, greasy liver
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A: Fatty liver (hepatic steatosis)
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Q: Asterixis
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A: Hepatic (portosystemic) encephalopathy (flapping tremor and neurologic sign, caused by nitrogenous metabolites which cannot be detoxified by the damaged liver)
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Q: Most common primary malignancy of the liver
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A: Hepatocellular carcinoma (often associated with Hepatitis B infection)
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Q: Increase in AFP (Alpha-fetoprotein)
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A: Hepatocellular carcinoma (also present in yolk sac tumors)
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Q: Triad of cirrhosis, skin pigmentation, and diabetes mellitus ("bronze diabetes")
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A: Idiopathic hemochromatosis (primary defect in iron absorption leading to a net accumulation)
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Q: Macronodular pattern on liver surface
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A: Posthepatitic (postnecrotic, macronodular) cirrhosis
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Q: Middle-aged female with pruritus, jaundice, xanthomas, and antimitochondrial antibodies
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A: Primary biliary cirrhosis (histologically characterized by granulomatous destruction of intrahepatic bile ducts)
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Q: Biliary tract disease, commonly seen in association with ulcerative colitis
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A: Primary sclerosing cholangitis (histologically characterized by onion-skin fibrosis of bile ducts)
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Q: Councilman bodies
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A: Viral hepatitis (apoptotic hepatocytes)
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Q: Hepatolenticular degeneration causing extrapyramidal motor signs
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A: Wilson disease (copper deposits in the liver, cornea of the eye (Kayser-Fleischer rings), and putamen and lenticular nuclei of the basal ganglia)
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Q: Osteoblastic metastases with increase in serum alkaline phosphatase in an older male
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A: Carcinoma of the prostate (most common carcinoma in males; often arises in the peripheral zone of the prostate)
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Q: Maternal exposure to DES (diethylstilbestrol)
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A: Clear cell carcinoma of the vagina in daughters
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Q: Predisposes to male germ cell tumors even if surgically corrected
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A: Cryptochidism (undescended testes)
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Q: Toxemia with CNS involvement, including convulsions and coma in a pregnant woman
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A: Eclampsia
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Q: Most common cause of hematosalpinx
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A: Ectopic pregnancy (chronic pelvic inflammatory disease may predispose to ectopic pregnancy)
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Q: Leukorrhea and irregular bleeding in a postmenopausal woman
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A: Endometrial carcinoma (risk factors include obesity, diabetes, hypertension, infertility, and endometrial hyperplasia)
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Q: Leading cause of infertility, with menstrual irregularities, severe dysmenorrhea, and intrapelvic bleeding in a young woman
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A: Endometriosis ("Chocolate cysts" or blood- and debris-filled cysts in ovaries may develop)
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Q: Discrete, rubbery, movable mass in the inner lower quadrant of the breast of a young female
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A: Fibroadenoma (most common benign tumor of the female breast)
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Q: Blue-domed cysts and dense fibrosis that produce palpable lumps and mammographic densities
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A: Fibrocystic change of the breast (epithelial cell lining around cysts shows apocrine metaplasia)
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Q: Bleeding with passage of grape-like structures, increased hCG, and rapid increase in uterine size
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A: Hydatidiform mole (similar presentation without uterine enlargement = choriocarcinoma)
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Q: Most common cause of scrotal enlargement
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A: Hydrocele (clear, serous fluid can be seen upon transillumination of scrotal sac)
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Q: Tumor with tendency to affect both breasts
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A: Infiltrating lobular carcinoma
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Q: Nodule of rock hard consistency in the upper outer quadrant of the breast of a postmenopausal woman
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A: Invasive (infiltrating) carcinoma of the breast (histologically characterized by nests of tumor cells in a scirrhous, or scar-like, dense, hard stroma)
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Q: Most common benign tumor in females
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A: Leiomyoma (benign tumor of the smooth muscle of the uterus)
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Q: Germ cell tumor that may contain hair, teeth, cartilage, and/or glands
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A: Mature cystic teratoma (dermoid cyst) - tumor is derived from all three germ cell layers
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Q: Presents as urinary urgency, frequency, and nocturia in an older male
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A: Nodular hyperplasia of the prostate (benign prostatic hyperplasia) - commonly arises in the periurethral and transition zones of the prostate causing compression of the urethra
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Q: Eczematoid lesion of the nipple, often with underlying ductal carcinoma
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A: Paget disease of the breast
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Q: Psammoma bodies
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A: Papillary serous cystadenocarcinoma of the ovary (also in papillary carcinoma of the thyroid and meningioma)
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Q: Young female with amenorrhea, infertility, obesity, and hirsutism
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A: Polycystic ovary (Stein-Leventhal) syndrome - may be caused by excess secretion of luteinizing hormone
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Q: Insidious onset of hypertension, edema, proteinuria, and headache after the 32nd week of pregnancy
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A: Preeclampsia
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Q: Salt-losing hyponatremia leading to hypotension and virilization of female infants
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A: 21-hydroxylase deficiency (most common enymatic defect in congenital adrenal hyperplasis)
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Q: Prognathism, enlargement of the face, viscera, feet and hands (sausage-like fingers)
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A: Acromegaly (growth hormone hypersecretion caused by somatotroph cell adenoma)
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Q: Epigastric pain radiating to the back with an increase in serum amylase and lipase
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A: Acute pancreatitis (major association with alcoholism and gallstones)
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Q: Migratory thrombophlebitis (Trousseau syndrome)
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A: Carcinoma of the pancreas
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Q: Severe retardation, short stature, coarse facies, protruding tongue, and umbilical hernia
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A: Cretinism (hypothyroidism in children)
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Q: Moon facies, hypertension, and accumulation of truncal fat
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A: Cushing syndrome (caused by the action of cortisol)
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Q: Most commonly caused by iatrogenic corticosteroid therapy
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A: Cushing syndrome
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Q: Marked increase in free water clearance
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A: Diabetes insipidus (caused by lack of ADH)
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Q: Increased Hemoglobin A1c (HbA1c)
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A: Diabetes mellitus (HbA1c = serum marker for nonenzymatic glycosylation of proteins)
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Q: Loss of pain sensation in extremities
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A: Diabetic neuropathy
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Q: Retinal microaneurysms and cotton-wool spots
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A: Diabetic retinopathy
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Q: Female with staring gaze and exophthalmos
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A: Graves' disease (characterized by anti-TSH receptor antibodies in serum)
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Q: Most common cause of hypothyroidism in iodine sufficient areas
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A: Hashimoto thyroiditis (histologically characterized by dense lymphocytic infiltrate and germinal centers in the thyroid)
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Q: Hypoglycemia and CNS impairment, which are reversed upon glucose administration, and increased serum C-peptide
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A: Insulinoma (patients surreptitiously administering insulin do not have increased C-peptide levels in serum)
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Q: General apathy, cold intolerance, obesity, and constipation
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A: Myxedema (hypothyroidism)
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Q: Most common thyroid carcinoma associated with exposure to ionizing radiation
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A: Papillary carcinoma of the thyroid (histologically characterized by papillae lined "Orphan Annie" nuclei or empty looking nuclei)
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Q: Paroxysmal hypertension, tachycardia, sweating, tremor and hyperglycemia
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A: Pheochromocytoma
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Q: Causes compression of the optic chiasm resulting in bitemporal hemianopsia
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A: Pituitary adenoma (often visualized as radiographic enlargment of sella turcica)
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Q: Hypotension, hyperpigmentation, and decreased heart rate
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A: Primary adrenal cortical insufficiency (Addison disease)
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Q: Salt-retaining hypertension, hypernatremia, hypokalemic alkalosis, and decreased plasma renin
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A: Primary hyperaldosteronism (as opposed to increased plasma renin in secondary hyperaldosteronism)
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Q: Osteitis fibrosis cystica
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A: Primary hyperparathyroidism (cysts, fibrinous accumulation, and focal hemorrhage in bone; also called brown tumor of bone)
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Q: Premenopausal woman with amenorrhea, galactorrhea, loss of libido, and infertility
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A: Prolactinoma (most common hyperfunctioning pituitary adenoma)
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Q: Most common cause of secondary hyperparathyroidism
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A: Renal failure
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Q: Peripartal hypotension resulting in necrosis and destruction of the anterior pituitary
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A: Sheehan syndrome
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Q: Excessive resorption of free water with hyponatremia and cerebral edema, but no peripheral edema
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A: SIADH (syndrome of inappropriate antidiuretic hormone secretion)
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|
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Q: Tremor, tachycardia, heat intolerance, and increase in appetite with decrease in weight
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A: Thyrotoxicosis (hyperthyroidism) - most commonly caused by Graves' disease
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Q: Hypergastrinemia, hyperchlorhydria, and recurrent peptic ulcer disease
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A: Zollinger-Ellison syndrome
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Q: Marker of visceral malignancy
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A: Acanthosis nigricans (thickened and hyperpigmented areas commonly found in flexural areas)
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|
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Q: Pearly papules with superficial telangiectases
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A: Basal cell carcinoma (almost never metastasizes)
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|
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Q: Type IV hypersensitivity reaction in the skin
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A: Contact dermatitis (primarily T cell and macrophage mediated immunity)
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|
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Q: Extremely pruritic vesicular lesions associated with celiac disease
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A: Dermatitis herpetiformis (may respond to a gluten-free diet)
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|
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Q: Abnormal proliferation of connective tissue of skin scars that results in a large raised tumor-like lesions
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A: Keloid (more common in African Americans)
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|
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Q: Black-blue papule with irregular borders
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A: Malignant melanoma (depth of invasion correlates with prognosis)
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|
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Q: Tumor arising from actinic keratosis
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A: Squamous cell carcinoma
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|
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Q: Antimelanocyte antibodies associated with cell loss in discrete areas of skin
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A: Vitiligo (often associated with other autoimmune diseases like pernicious anemia)
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|
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Q: Yellowish tumor-like nodules composed of focal dermal collections of lipid-laden macrophages
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A: Xanthoma
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|
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Q: Major genetic cause of dwarfism
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A: Achondroplasia (most cases are due to new mutations, although may also be autosomal dominant)
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|
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Q: HLA-B27
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A: Ankylosing spondylitis (fusion of vertebrae as articular cartilage is destroyed)
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Q: Young boy presents with clumsiness and difficulty walking with pseudohypertrophy of calf muscles
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A: Duchenne muscular dystrophy (X-linked; due to dystrophin deficiency; increased serum creatine kinase)
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Q: Small, round, blue, cell tumor of bone in children
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A: Ewing sarcoma (reactive periosteal bone layers form an "onion-skin" appearance)
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Q: Arthritis associated with monosodium urate crystals in metatarsophalangeal (MTP) joints (podagra)
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A: Gout (crystal deposits form tophi)
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|
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Q: Tumor-like formations in bone with cafe au lait spots and precocious puberty
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A: McCune-Albright syndrome (polyostotic fibrous dysplasia with endocrine dysfunction)
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|
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Q: Dramatically improves with anticholinesterase drugs
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A: Myasthenia gravis (disease caused by antiacetylcholine receptor antibodies)
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|
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Q: Wear-and-tear arthritis
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A: Osteoarthritis (eburnation ("polished ivory" appearance) is caused by erosion of cartilage and articular bone surfaces
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|
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Q: Blue sclerae and multiple childhood fractures
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A: Osteogenesis imperfecta (Blue sclerae caused by a decrease in collagen content making them translucent)
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|
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Q: Kyphosis and lordosis in a postmenopausal female
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A: Osteoporosis (Age-related changes and estrogen deficiency increase bone loss)
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|
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Q: Most common primary malignancy of bone, frequently occurring in the knee of a male under 20 years old
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A: Osteosarcoma (may see Codman triangle on X-ray as tumor lifts the periosteum; often associated with familial retinoblastoma)
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|
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Q: Headache, enlargement of the head, visual disturbances, and deafness
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A: Paget disease of bone (osteitis deformans) - histologically characterized as a mosaic pattern of bone with irregular cement lines
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|
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Q: Ulnar deviation of the fingers
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A: Rheumatoid arthritis (may also find swan-neck deformity)
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|
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Q: Patients present with morning stiffness with symmetric involvement of the proximal interphalangeal joints
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A: Rheumatoid arthritis (majority have rheumatoid factor, an autoantibody directed against the Fc region of IgG, in their serum)
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|
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Q: Meningitis, with increased mononuclear cells, normal or increased protein, and normal glucose in CSF
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A: Acute aseptic (viral) meningitis
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|
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Q: Neurofibrillary tangles and senile Beta-amyloid plaques in elderly patients
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A: Alzheimer disease (associated with mutations on chromosomes 21, 19, 14, and 1)
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|
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Q: Common neurodegenerative diseases with dementia
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A: Alzheimer disease, Huntington disease, and Pick disease
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|
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Q: Degeneration of the upper and lower motor neurons of the lateral and ventral corticospinal tracts
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A: Amyotrophic lateral sclerosis (ALS) - may be associated with mutations of superoxide dismutase
|
|
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Q: Most common cause of cerebral embolic infarcts
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A: Cerebral atherosclerosis (most common location is the middle cerebral artery)
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|
|
Q: Changes in memory and behavior followed by rapid dementia and startle myoclonus
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A: Creutzfeld-Jakob disease (histologically characterized by spongiform change; transmission via prion protein)
|
|
|
Q: Rupture of middle meningeal artery because of skull fracture
|
A: Epidural hematoma (can be rapidly fatal)
|
|
|
Q: Most common primary intracranial neoplasm
|
A: Glioblastoma multiforme (as opposed to the most common intracranial neoplasm overall which is metastases to the brain)
|
|
|
Q: Pseudopalisading arrangement of malignant nuclei
|
A: Glioblastoma multiforme
|
|
|
Q: Patients present with involuntary jerky movements or writhing of the extremities
|
A: Huntington disease (autosomal dominant disease associated with trinucleotide repeat expansions)
|
|
|
Q: Atrophy of the caudate, putamen, and globus pallidus
|
A: Huntington disease (caudate atrophy leads to "bat wing" lateral ventricles)
|
|
|
Q: Most common cause of primary brain parenchymal hemorrhage
|
A: Hypertension
|
|
|
Q: One of the most common intracranial tumors in children
|
A: Medulloblastoma
|
|
|
Q: Tumor pushes on (rather than infiltrates) adjacent parenchyma
|
A: Meningioma (slow growing and often surgically resectable)
|
|
|
Q: Charcot triad: nystagmus, intention tumor, and scanning speech
|
A: Multiple sclerosis (in a gross specimen, glassy, dirty tan periventricular plaques indicate demyelination in white matter)
|
|
|
Q: Associated with folate deficiency during the initial weeks of gestation
|
A: Neural tube defects (Alpha-fetoprotein level is elevated in maternal serum)
|
|
|
Q: Multiple neurofibromas on the skin, cafe au lait spots, and Lisch nodules (pigmented hamartomas on the iris)
|
A: Neurofibromatosis Type-1 (von Recklinghausen disease) - autosomal dominant mutation in the NF-1 gene
|
|
|
Q: Rigid expressionless face and a pill-rolling tremor
|
A: Parkinson disease
|
|
|
Q: Atrophy and gross depigmentation of the dopamine-producing cells of the substantia nigra and locus coeruleus
|
A: Parkinson disease (histologically characterized by Lewy bodies which are intracytoplasmic, eosinophilic inclusions within neurons)
|
|
|
Q: Spinal tap with numerous leukocytes, decreased glucose and increased protein
|
A: Pyogenic (bacterial) meningitis
|
|
|
Q: Most common cause of subarachnoid hemorrhage
|
A: Rupture of a berry aneurysm (most common location of berry aneurysms is the Circle of Willis)
|
|
|
Q: Intracranial tumor presenting with tinnitus and hearing loss
|
A: Schwannoma (acoustic neuroma) - involves CN VII and VIII at the cerebellopontine angle
|
|
|
Q: "Worst headache of my life", vomiting, loss of consciousness, and blood in the CSF
|
A: Subarachnoid hemorrhage
|
|
|
Q: Intracranial hemorrhage due to disruption of the bridging veins
|
A: Subdural hematoma
|
|
|
Q: Loss of pain and temperature sensation in the upper extremities
|
A: Syringomyelia
|
|
|
Q: Weakness, paresthesia, and "pins-and-needles" feeling
|
A: Vitamin B12 deficiency (affects the lateral and posterior columns)
|
|
|
Q: Hemorrhage into the mammillary bodies and dorsal medial gray matter around the cerebral aqueducts
|
A: Wernicke-Korsakoff syndrome
|
|
|
Q: Confusion, paralysis of the lateral rectus, and ataxia with memory loss and confabulation
|
A: Wernicke-Korsakoff syndrome (caused by thiamine deficiency, typically in alcoholics)
|
|
|
Costovertebral angle tenderness, fever, and burning urination |
Acute pyelonephritis (Most commonly caused by ascending infection by ecoli) |
|
|
Acute renal failure presenting as severe oliguria, causing death if untreated |
Acute tubular necrosis (tubules are capable of regeneration if basement membrane is intact) |
|
|
Associated with berry aneurysms and subsequent subarachnoid hemorrhage |
Adult polycystic kidney disease (most common cystic disease of the kidney) |
|
|
Extended use of phenacetin, aspirin, acetaminophen, caffeine, and codeine |
Analgesic abuse nephropthy (renal papillary necrosis leading to tubulointerstitial nephritits) |
|
|
Corticomedullary scarring over blunted calyces, with thyroidization of tubules |
Chronic pyelonephritis (histologically characterized as colloid cast filled tubules) |
|
|
Kimmelstiel-wilson nodules |
Diabetic nephropathy (PAS + nodules resulting from increased mesangial matrix deposition) |
|
|
Basement membrane thickening resulting from nonenzymatic glycosylation |
Diabetic nephropathy |
|
|
Sclerosis of some glomeruli with only parts of capillary tufts affected |
Focal segmental glomerulosclerosis
|
|
|
Hemorrhagic pneumonitis with glomerulonephritis |
Goodpasture syndrome (seen as linear immunofluorescence of glomeruli) |
|
|
Immune complex deposits in mesangium associated with Henoch-Schonlein purpura |
IgA nephropathy (berger disease) (most common glomerulonephropathy worldwide) |
|
|
Spike and dome appearance |
Membranous glomeruloneprhitis (spile= basemenet membrane proliferating around domes; dome= immune complex deposits) |
|
|
Glomeruli appear normal in conventional light microscopy, but fusion of epithelial foot processes in electron microscope |
Minimal change disease (lipoid nephrosis) (most common cause of nephrotic syndrome in children) |
|
|
Tram-track appearance due to apparent reduplication of the glomerular basement membrnae |
MPGN (membranoproliferative glomerulonephritis) (Type II MPGN is also known as dense-deposit disease) |
|
|
Hematuria, oliguria, azotema, and hypertension |
Nephritic syndrome (prototype is poststreptococcal glomerulonephritis) |
|
|
Proteinuria, generalized edema, hyperlipidemia, and lipiduria |
Nephrotic syndrome |
|
|
Coarse, irregular, and granular immunofluorescence (visualized as lumpy-dumpy) |
Poststreptococcal glomerulonephritis (also in membranous glomerulonephritis, lupus nephropathy) present in immune complex deposit diseases |
|
|
Triad of hematuria, flank pain, and palpable abdominal mass |
Renal cell carcinoma (histologically characterized by clear cells containing glycogen and lipids) |
|
|
Crescent like formation in majority of glomeruli |
RPGN (rapidly progressive crescentic glomerulonephritis) (rapid renal failure associated with either antiglomerular basement membrane antibodies (goodpasture syndrome) or immune comlex deposits (poststreptococcal glomerulonephritis) |
|
|
Related to exposure to B-naphthylamine or cyclophosphamide |
Transitional cell carcinoma of the bladder (squamous cell carcinoma of the bladder is associated with infection by schistosoma hematobium, rare in the US) |
|
|
Bread-and-butter (fibrinous) pericarditis |
Uremia |
|
|
Child presenting with palpable flank mass and hematuria |
Wilm's tumor (most common childhood renal malignancy) |
