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248 Cards in this Set

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


Child presenting with palpable flank mass and hematuria

Wilm's tumor (most common childhood renal malignancy)