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USMLE Rapid Review

Budd-Chiari syndrome Abdominal pain, ascites, hepatomegaly
Familial hypercholesterolemia Achilles tendon xanthoma
Waterhouse-Friderichsen syndrome Adrenal hemorrhage, hypotension, DIC
ACL injury Anterior “drawer sign”
Marfan syndrome Arachnodactyly, lens dislocation, aortic dissection, hyperflexible joints
2° to erythropoietin injection Athlete with polycythemia
Pott disease Back pain, fever, night sweats, weight loss
Sarcoidosis Bilateral hilar adenopathy, uveitis
Osteogenesis imperfecta Blue sclera
Burton line Bluish line on gingiva
Paget disease of bone Bone pain, bone enlargement, arthritis
Aortic regurgitation Bounding pulses, diastolic heart murmur, head bobbing
Systemic lupus erythematosus “Butterfly” facial rash and Raynaud phenomenon in a young female
Neurofibromatosis type I Café-au-lait spots, Lisch nodules (iris hamartoma)
McCune-Albright syndrome Café-au-lait spots, polyostotic fibrous dysplasia, precocious puberty, multiple endocrine abnormalities
Duchenne muscular dystrophy Calf pseudohypertrophy
Tay-Sachs “Cherry-red spots” on macula
Angina Chest pain on exertion
Dressler syndrome Chest pain, pericardial effusion/friction rub, persistent fever following MI
Gowers sign Child uses arms to stand up from squat
“Slapped cheeks” Child with fever later develops red rash on face that spreads to body
Huntington disease Chorea, dementia, caudate degeneration
McArdle disease Chronic exercise intolerance with myalgia, fatigue, painful cramps, myoglobinuria
Hypothyroidism Cold intolerance
Internuclear ophthalmoplegia Conjugate lateral gaze palsy, horizontal diplopia
PDA Continuous “machine-like” heart murmur
Myxedema Cutaneous/dermal edema due to connective tissue deposition
Kaposi sarcoma Dark purple skin/mouth nodules in a patient with AIDS
Kussmaul respirations Deep, labored breathing/hyperventilation
Pellagra Dermatitis, dementia, diarrhea
Wet beriberi Dilated cardiomyopathy, edema, alcoholism or malnutrition
Pasteurella multocida Dog or cat bite resulting in infection
Sjögren syndrome Dry eyes, dry mouth, arthritis
Plummer-Vinson syndrome Dysphagia (esophageal webs), glossitis, iron deficiency anemia
Ehlers-Danlos syndrome Elastic skin, hypermobility of joints
Virchow node Enlarged, hard left supraclavicular node
Mycosis fungoides or Sézary syndrome Erythroderma, lymphadenopathy, hepatosplenomegaly, atypical T cells
Chvostek sign Facial muscle spasm upon tapping
Cholelithiasis Fat, female, forty, and fertile
Jarisch-Herxheimer reaction Fever, chills, headache, myalgia following antibiotic treatment for syphilis
Measles Fever, cough, conjunctivitis, coryza, diffuse rash
B symptoms of lymphoma Fever, night sweats, weight loss
Peyronie disease Fibrous plaques in soft tissue of penis
Lesch-Nyhan syndrome Gout, intellectual disability, self-mutilating behavior in a boy
Kayser-Fleischer rings Green-yellow rings around peripheral cornea
Peutz-Jeghers syndrome Hamartomatous GI polyps, hyperpigmentation of mouth/feet/hands
Gaucher disease Hepatosplenomegaly, osteoporosis, neurologic symptoms
Alport syndrome Hereditary nephritis, sensorineural hearing loss, cataracts
Klüver-Bucy syndrome Hyperphagia, hypersexuality, hyperorality, hyperdocility
UMN damage Hyperreflexia, hypertonia, Babinski sign present
LMN damage Hyporeflexia, hypotonia, atrophy, fasciculations
“Blue bloater” (chronic bronchitis) Hypoxemia, polycythemia, hypercapnia
Patau syndrome (trisomy 13) Infant with cleft lip/palate, microcephaly or holoprosencephaly, polydactyly, cutis aplasia
Niemann-Pick disease Infant with failure to thrive, hepatosplenomegaly, and neurodegeneration
Cori disease or Von Gierke disease Infant with hypoglycemia, failure to thrive, and hepatomegaly
Edwards syndrome (trisomy 18) Infant with microcephaly, rocker-bottom feet, clenched hands, and structural heart defect
Courvoisier sign Jaundice, palpable distended non-tender gallbladder
Lyme disease: Borrelia Large rash with bull’s-eye appearance
Epidural hematoma Lucid interval after traumatic brain injury
Bruton disease Male child, recurrent infections, no mature B cells
Glanzmann thrombasthenia Mucosal bleeding and prolonged bleeding time
Beck triad of cardiac tamponade Muffled heart sounds, distended neck veins, hypotension
Gardner syndrome Multiple colon polyps, osteomas/soft tissue tumors, impacted/supernumerary teeth
Pompe disease Myopathy (infantile hypertrophic cardiomyopathy), exercise intolerance
Erb-Duchenne palsy Neonate with arm paralysis following difficult birth
Sheehan syndrome No lactation postpartum, absent menstruation, cold intolerance
Multiple sclerosis Nystagmus, intention tremor, scanning speech, bilateral internuclear ophthalmoplegia
Cheyne-Stokes respirations Oscillating slow/fast breathing
Cold agglutinin disease Painful blue fingers/toes, hemolytic anemia
Raynaud phenomenon Painful, pale, cold fingers/toes
Osler nodes Painful, raised red lesions on pad of fingers/toes
Janeway lesions Painless erythematous lesions on palms and soles
Cancer of the pancreatic head obstructing bile duct Painless jaundice
Henoch-Schönlein purpura Palpable purpura on buttocks/legs, joint pain, abdominal pain (child), hematuria
MEN 1 Pancreatic, pituitary, parathyroid tumors
Nephrotic syndrome Periorbital and/or peripheral edema, proteinuria, hypoalbuminemia, hypercholesterolemia
“Pink puffer” (emphysema) Pink complexion, dyspnea, hyperventilation
Fanconi syndrome Polyuria, renal tubular acidosis type II, growth failure, electrolyte imbalances, hypophosphatemic rickets
Lichen planus Pruritic, purple, polygonal planar papules and plaques (6 P’s)
Horner syndrome Ptosis, miosis, anhidrosis
Argyll Robertson pupil Pupil accommodates but doesn’t react
Guillain-Barré syndrome Rapidly progressive leg weakness that ascends following GI/upper respiratory infection
Coxsackie A, 2° syphilis, Rocky Mountain spotted fever Rash on palms and soles
Hyper-IgE syndrome Recurrent colds, unusual eczema, high serum IgE
Klebsiella pneumoniae Red “currant jelly” sputum in alcoholic or diabetic patients
Acute mesenteric ischemia (adults), intussusception (infants) Red “currant jelly” stools
Paget disease of the breast Red, itchy, swollen rash of nipple/areola
Paroxysmal nocturnal hemoglobinuria Red urine in the morning, fragile RBCs
von Hippel-Lindau disease Renal cell carcinoma (bilateral), hemangioblastomas, angiomatosis, pheochromocytoma
Parkinson disease Resting tremor, rigidity, akinesia, postural instability
Roth spots Retinal hemorrhages with pale centers
Crigler-Najjar syndrome Severe jaundice in neonate
Rovsing sign Severe RLQ pain with palpation of LLQ
McBurney sign Severe RLQ pain with rebound tenderness
Fanconi anemia Short stature, incidence of tumors/leukemia, aplastic anemia
Down syndrome Single palmar crease
Kartagener syndrome Situs inversus, chronic sinusitis, bronchiectasis, infertility
Addison disease Skin hyperpigmentation, hypotension, fatigue
Becker muscular dystrophy Slow, progressive muscle weakness in boys
Koplik spots Small, irregular red spots on buccal/lingual mucosa with blue-white centers
Condylomata lata (2° syphilis) Smooth, flat, moist, painless white lesions on genitals
Bacterial endocarditis Splinter hemorrhages in fingernails
Scarlet fever, Kawasaki disease, toxic shock syndrome “Strawberry tongue”
Turner syndrome Streak ovaries, congenital heart disease, horseshoe kidney, cystic hygroma at birth, short stature, webbed neck, lymphedema
Gout/podagra Sudden swollen/painful big toe joint, tophi
Scurvy Swollen gums, mucosal bleeding, poor wound healing, petechiae
Osteoarthritis Swollen, hard, painful finger joints
Aortic valve stenosis Systolic ejection murmur (crescendo-decrescendo)
MEN 2A Thyroid and parathyroid tumors, pheochromocytoma
MEN 2B Thyroid tumors, pheochromocytoma, ganglioneuromatosis
Babinski sign Toe extension/fanning upon plantar scrape
Facial nerve (LMN CN VII palsy/Bell's palsy) Unilateral facial drooping involving forehead
Reactive arthritis associated with HLA-B27 Urethritis, conjunctivitis, arthritis in a male
Hemangioma Vascular birthmark (port-wine stain)
Mallory-Weiss syndrome Vomiting blood following gastroesophageal lacerations
Whipple disease Weight loss, diarrhea, arthritis, fever, adenopathy
Subarachnoid hemorrhage “Worst headache of my life”
Scleroderma (CREST) Anticentromere antibodies
Pemphigus vulgaris Antidesmoglein (epithelial) antibodies
Goodpasture syndrome Anti–glomerular basement membrane antibodies
Drug-induced SLE Antihistone antibodies
Rheumatoid arthritis Anti-IgG antibodies
1° biliary cirrhosis Antimitochondrial antibodies (AMAs)
Microscopic polyangiitis and Churg-Strauss syndrome Antineutrophil cytoplasmic antibodies (ANCAs)
SLE (type III hypersensitivity) Antinuclear antibodies (ANAs: anti-Smith and anti-dsDNA)
Idiopathic thrombocytopenic purpura Antiplatelet antibodies
Diffuse systemic scleroderma Anti-topoisomerase antibodies
Celiac disease Anti-transglutaminase/anti-gliadin/anti-endomysial antibodies
Colorectal cancer “Apple core” lesion on abdominal x-ray
Auer rods Azurophilic peroxidase granular inclusions in granulocytesand myeloblasts
Sensitive: Streptococcus pyogenes (group A); resistant: Streptococcus agalactiae (group B) Bacitracin response
Ankylosing spondylitis “Bamboo spine” on x-ray
Howell-Jolly bodies Basophilic nuclear remnants in RBCs
Lead poisoning or sideroblastic anemia Basophilic stippling of RBCs
Subarachnoid hemorrhage Bloody tap on LP
Tetralogy of Fallot, RVH “Boot-shaped” heart on x-ray
Actinomyces israelii Branching gram-positive rods with sulfur granules
Pancoast tumor Bronchogenic apical lung tumor on imaging
Hyperparathyroidism or osteitis fibrosa cystica “Brown” tumor of bone
Chagas disease Cardiomegaly with apical atrophy
Rapidly progressive crescentic glomerulonephritis Cellular crescents in Bowman capsule
Endometriosis “Chocolate cyst” of ovary
Homer-Wright rosettes Circular grouping of dark tumor cells surrounding pale neurofibrils
Cystic fibrosis Colonies of mucoid Pseudomonas in lungs
Down syndrome or other chromosomal abnormality Decrease in AFP in amniotic fluid/maternal serum
Tabes dorsalis Degeneration of dorsal column nerves
Parkinson disease Depigmentation of neurons in substantia nigra
Curschmann spirals Desquamated epithelium casts in sputum
Call-Exner bodies Disarrayed granulosa cells in eosinophilic fluid
Koilocytes Dysplastic squamous cervical cells with nuclear enlargement and hyperchromasia
“Owl eye” appearance of CMV Enlarged cells with intranuclear inclusion bodies
“Orphan Annie” eyes nuclei Enlarged thyroid cells with ground-glass nuclei
Mallory body (alcoholic liver disease) Eosinophilic cytoplasmic inclusion in liver cell
Lewy body (Parkinson disease) Eosinophilic cytoplasmic inclusion in nerve cell
Councilman body Eosinophilic globule in liver
Negri bodies of rabies Eosinophilic inclusion bodies in cytoplasm of hippocampal and cerebellar nerve cells
Senile plaques (Alzheimer disease) Extracellular amyloid deposition in gray matter of brain
Reed-Sternberg cells (Hodgkin lymphoma) Giant B cells with bilobed nuclei with prominent inclusions (“owl’s eye”)
Schiller-Duval bodies (yolk sac tumor) Glomerulus-like structure surrounding vessel in germ cells
β-thalassemia, sickle cell anemia “Hair on end” (crew-cut) appearance on x-ray
Choriocarcinoma, hCG elevated
Aschoff bodies (rheumatic fever) Heart nodules (granulomatous)
Infectious mononucleosis (EBV) Heterophile antibodies
Bronchial asthma Hexagonal, double-pointed, needle-like crystals in bronchial secretions
DVT, PE, DIC High level of d-dimers
Ghon complex Hilar lymphadenopathy, peripheral granulomatous lesion in middle or lower lung lobes (can calcify)
Interstitial pulmonary fibrosis “Honeycomb lung” on x-ray or CT
Trousseau syndrome Hypercoagulability (leading to migrating DVTs and vasculitis)
Megaloblastic anemia Hypersegmented neutrophils
Conn syndrome Hypertension, hypokalemia, metabolic alkalosis
Iron deficiency anemia, lead poisoning, thalassemia Hypochromic, microcytic anemia
Dating error, anencephaly, spina bifida (neural tube defects) Increased AFP in amniotic fluid/maternal serum
Gout, Lesch-Nyhan syndrome, tumor lysis syndrome, loop and thiazide diuretics Increased uric acid levels
Cowdry type A bodies (HSV or CMV) Intranuclear eosinophilic droplet-like bodies
Ferruginous bodies Iron-containing nodules in alveolar septum
Squamous cell carcinoma Keratin pearls on a skin biopsy
Chédiak-Higashi disease Large lysosomal vesicles in phagocytes, immunodeficiency
Ulcerative colitis “Lead pipe” appearance of colon on barium enema x-ray
Goodpasture syndrome Linear appearance of IgG deposition on glomerular basement membrane
Wilson disease Low serum ceruloplasmin
Poststreptococcal glomerulonephritis “Lumpy bumpy” appearance of glomeruli on immunofluorescence
Multiple myeloma Lytic (“hole punched”) bone lesions on x-ray
Fibrocystic change of the breast Mammary gland (“blue domed”) cyst
Multiple myeloma (usually IgG or IgA) - Monoclonal gammopathy of undetermined significance - (MGUS consequence of aging) - Waldenström (M protein = IgM) macroglobulinemia - Primary amyloidosis Monoclonal antibody spike
“Signet ring” (gastric carcinoma) Mucin-filled cell with peripheral nucleus
“String sign” (Crohn disease) Narrowing of bowel lumen on barium x-ray
Wegener; PR3-ANCA/c-ANCA and Goodpasture syndrome Necrotizing vasculitis (lungs) and necrotizing glomerulonephritis
Gout Needle-shaped, negatively birefringent crystals
Kimmelstiel-Wilson nodules Nodular hyaline deposits in glomeruli
Sensitive: Staphylococcus epidermidis; resistant: Staphylococcus saprophyticus (No SRES) Novobiocin response
Chronic passive congestion of liver due to right heart failure “Nutmeg” appearance of liver
Ewing sarcoma “Onion skin” periosteal reaction
Sensitive: Streptococcus pneumoniae; resistant: viridans streptococci ( OVRPS) Optochin response
Codman triangle on x-ray (osteosarcoma, Ewing sarcoma, pyogenic osteomyelitis) Periosteum raised from bone, creating triangular area
Minimal change disease (child with nephrotic syndrome) Podocyte fusion or “effacement” on electron microscopy
Eburnation Polished, “ivory-like” appearance of bone at cartilage erosion
Neurofibrillary tangles (Alzheimer disease) and Pick bodies (Pick disease) Protein aggregates in neurons from hyperphosphorylation of tau protein
Meningiomas, papillary thyroid carcinoma, mesothelioma, papillary serous carcinoma of the endometrium and ovary Psammoma bodies
Glioblastoma multiforme Pseudopalisading tumor cells on brain biopsy
Acute glomerulonephritis RBC casts in urine
Reinke crystals (Leydig cell tumor) Rectangular, crystal-like, cytoplasmic inclusions in Leydig cells
Acute toxic/viral renal injury Renal epithelial casts in urine
Pseudogout Rhomboid crystals, positively birefringent
Coarctation of the aorta Rib notching
Toxoplasma gondii, CNS lymphoma Ring-enhancing brain lesion in AIDS
Burkitt lymphoma Sheets of medium-sized lymphoid cells with scattered pale, tingible body–laden macrophages (“starry sky” histology)
Pick bodies: Pick disease: Silver-staining spherical aggregation of tau proteins in neurons
Giant cell tumor of bone “Soap bubble” in femur or tibia on x-ray
Membranous glomerulonephritis “Spikes” on basement membrane, “dome-like” subepithelial deposits
Rouleaux formation Stacks of RBCs
“Clue cells” (Gardnerella vaginalis) Stippled vaginal epithelial cells
Birbeck granules (Langerhans cell histiocytosis or histiocytosis X: eosinophilic granuloma) “Tennis racket”-shaped cytoplasmic organelles (EM) in Langerhans cells
Lines of Zahn Thrombi made of white/red layers
Epiglottitis (Haemophilus influenzae) “Thumb sign” on lateral x-ray
Chronic bacterial pyelonephritis Thyroid-like appearance of kidney
Membranoproliferative glomerulonephritis “Tram-track” appearance of capillary loops of glomerular basement membranes on light microscopy
Fatty liver disease (alcoholic or metabolic syndrome) Triglyceride accumulation in liver cell vacuoles
Chronic end-stage renal disease “Waxy” casts with very low urine flow
Acute pyelonephritis WBC casts in urine
CLL (almost always B cell) WBCs that look “smudged”
Lupus nephropathy “Wire loop” glomerular capillary appearance on light microscopy
Xanthochromia Yellowish CSF
Created by: hadarbah



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