Rapid review: first aid

1. Rapid review:first aid

2. Often precedes squamous cell carcinoma Actinic keratosis • Primary adrenocortical deficiency Addison’s disease • Polyostotic fibrous dysplasia, precocious puberty, café au lait spots, short stature, young girls Albrights syndrome • Guillain barre (increase protein in CSF with only modest increase in cell count) Albuminocytologic dissociation • Hereditary nepritis with nerve deafness Alport’s syndrome • Anti-basement membrane Goodpastures syndrome • Anti- centromere antibodies Scleroderma - CREST

3. Anti- double stranded DNA antibodies (ANA- antibodies) SLE (type III hypersensitivity) • Anti-epithelial cell Pemphigus vulgaris • Antigliadan antibodies Celiac disease • Anti-histone antibodies Drug induced SLE • Anti – IgG antibodies Rheumatoid arthritis • Anti-mitochondrial antibodies Primary biliary cirrhosis • Anti-neutrophil antibodies vasculitis • Anti-platelet antibodies Idiopathic thrombocytopenic purpura (ITP)

4. Arachnodactyly Marfan’s syndrome • Argyll Robertson pupil Neurosyphilis • Cerebellar tonsillar herniation Arnold Chiari malformation • Aschoff bodies Rheumatic fever • Atrophy of the mammillary bodies Wernicke’s encephalopathy • Auer rods AML- esp promyelocytic type • Autosplenectomy Sickle cell • Babinski sign UMN lesion • Baker’s cyst in popliteal fossa Rheumatoid arthritis

5. Bamboo spine on x-ray Ankylosing spondylitis • Hyperreninemia Bartter’s syndrome • Basophilic stippling on RBCs Lead posioning • Defective dystophin Becker’s muscular dystophy- less sever than Duchenne’s • LMN CN VIII palsy Bells palsy • Bence jones proteins Multiple myeloma- Kappa or lambda Ig chains in urine, Waldenstroms macroglobulinemia (IgM) • IgA nephropathy Berger’s disease

6. Bernard-Soulier disease Defect in platelet adhesion • Bilateral hilar adenopathy, uveitis sarcoidosis • Berbeck granules on EM Histiocytosis X • Bloody tap on LP Subarachnoid hemorrage • “blue bloater” Chronic bronchitis • Blue domed cyst Fibrocystic change of the breast • Blue sclera Osteogenesis imperfecta • Boot shaped heart on x ray Tetralogy of Fallot, RVH

7. Bouchard’s nodes Osteoarthritis (PIP swelling secondary to osteophytes) • Boutonniere deformity Rheumatoid arthritis • Branching rods in oral infection Actinomyces israelli • Brown tumor of bone Hemorrhage cause brown color of osteolytic cysts • Hyperparathyroidism • Osteitis fibrosa cystica (von Recklinghasen’s disease) • Brushfields spots Down syndrome • Brutons disease X-linked agammaglobulinemia • Budd- Chiari syndrome Post hepatic venous throbosis • Buerger’s disease Small/medium artery vasculitis

8. 8:14 translocation, associated with EBV Burkitt’s lymphoma • Burton’s lines Lead posioning • C-ANCA, P-ANCA Wegeners granulomatosis, polyarteritis nodosa • Café au lait spots on skin neurofibromatosis • Caisson disease Gas emboli • Calf pseudohypertrophy Duchenne’s muscular dystrophy • Call- Exner bodies Granulosa theca cell tumor of the ovary • Cardiomegaly with apical atrophy Chagas disease

9. Cerebriform nuclei Mycosis fungoides (cutaneous T cell lymphoma) • Trypanosome infection Chaga’s disease • Chancre Primary syphilis – non painful • Chancroid Haemophilus ducreyi - painful • Charcot’s triad Multiple sclerosis (nystagmus, intention tremor, scanning speech), cholangitis (jaundice, RUQ pain, fever) • Charcot-leyden crystals Bronchial asthma (eosinophil membranes) • Phagocyte deficiency Chediak Higashi disease

10. Cherry red spot on macula Tay-Sachs, Niemann Pick disease, central retinal artery occlusion • Cheyne-stokes respirations Central apnea in CHF and increased intracranial pressure • Chocolate cysts Endometriosis (frequently involves both ovaries) • Predisposition to gastric carcinoma Chronic atrophic gastritis • Chvostek’s sign Hypocalcemia (facial mm spasm upon tapping) • DES exposure in utero Clear cell adenocarcinoma of the vagina • Clue cells Gardnerella vaginitis • Codman’s triangle on x ray osteosarcoma

11. Cold agglutinins Mycoplasma pneumoniae, infectious mono • Cold intolerance hypothyroidism • Condylomata lata Secondary syphilis • Continuous machinery murmur Patent ductus arteriosus • Cori’s disease Debranching enzyme deficiency • Cotton wool spots Chronic hypertension • Cough, conjuncitivitis, coryza + fever measles • Councilman bodies Toxic or viral hepatitis

12. Cowdry type A bodies Herpes virus • Crescents in bowman’s capsule Rapidly progessive crescentric glomerulonephritis • Crigler-Najjar syndrome Congential unconjugated hyperbilirubinemia • Curling’s ulcer Acute gastric ulcer associated with severe burns • Currant jelly sputum Klebsiella • Curshmann’s spirals Bronchial asthma (whorled mucous plugs) • Cushing’s ulcer Acute gastric ulcer associated with CNS injury • D dimers DIC • Depigmentation of neurons in substantia nigra Parkinson’s disease (basal ganglia disorder- rigidity, resting tremor, bradykinesia)

13. Pellagra (niacin, vitamin B3 deficiency) Dermatitis, dementia, diarrhea • Hand-Schuller Christian disease Diabetes insipidus + exophthalmos + lesions of skull • Dog or cat bite Pasteurella multocida • Donovan bodies Granuloma inguinale • Dressler’s syndrome Post MI fibrinous pericarditis • Dubin Johnson syndrome Congenital conjugated hyperbilirbuinemia (black liver) • Eburnation Osteoarthritis (polished, ivory like appearance of bone) • Edward’s syndrome Trisomy 18 associated with rocker bottom feet, low set ears, heart disease

14. Eisenmenger’s complex Late cyanosis shunt (uncorrected LR shunt becomes RL shunt) • Elastic skin Ehlers-Danlos • Erb-Duchenne palsy Superior trunk branchial plexus injury (Waiters tip) • Erythema chronicum migrans Lyme disease • Fanconi syndrome Proximal tubular reabsorption defect • Fat Female Forty and Fertile Acute cholecystitis • Fatty liver alcholism • Ferruginous bodies asbestosis

15. Colon polyps with osteomas and soft tissue tumors Gardner’s syndrome • Glucocerebrosidase deficiency Gaucher’s disease • Ghon complex Primary TB • Benign congenital unconjugated hyperbilirubinemia Gilbert’s disease • Glanzmann’s thrombobastenia Defect in platelet aggregation • Autoantibodies to alveolar and glomerular basement membrane proteins Goodpasture syndrome • Use of patients arms to help legs pick self off the floor Gower’s maneuver • Idiopathic polyneurtitis Guillain Barre syndrome

16. “hair on end” appearance on x-ray Beta thalassemia, sickle cell (extramedullary hematopoiesis) • Hamptons hump on x ray Pulmonary embolism • Chronic progressive histiocytosis Hand- Schuller-Christian disease • Sickle cell anemia HbS • Elevated hCG Choriocarcinoma, hyadatidiform mole (occurs with and without embryo) • Heberden’s nodes Osteoarthritis (DIP swelling secondary to osteophytes) • Heinz bodies G6PD deficiency • HSP – Henoch-Schonlein purpura Hypersensitivity vasculitis associated with hemorrhagic urticaria and URIs

17. Heterophil antibodies Infectious mononucleosis (EBV) • HbF Thalassemia major • High output cardiac failure Dilated cardiomyopathy, wet beriberi (thiamine, vit B1 deficiency) • HLA B27 Reiter’s syndrome, ankylosing spondylitis • HLA DR3, DR4 Diabetes mellitus type 1 (caused by autoimmune destruction of B cells) • Homer Wright rosettes Neuroblastoma • Honey comb lung on x ray Interstitial fibrosis • Ptosis, miosis, andhidrosis Horner’s syndrome

18. Howell Jolley bodies Splenectomy (or non functional spleen) • Huntington’s disease Caudate degeneration (AD) • Hyperphagia + hypersexuality + hyperorality + hyperdocility Kluver Bucy syndrome (amygdala) • Hyperpigmentation of skin Primary adrenal insuffiency (Addison’s disease) • Hypersegmented neutrophils Macrocytic anemia • HTN + hypocalemia Conn’s syndrome • Hypochromic microcytosis Iron deficiency anemia, lead poisioning

19. Increased alpha fetoprotein in amniotic fluid/maternal serum Anencephaly, spina bifida (NTDs) • Increased uric acid levels Gout, Lesch-Nyhan syndrome, myeloproliferative disorders, loop and thaizide diuretics • Intussusception Adenovirus (causes hyperplasia of Peyer’s patches) • Janeway lesions Endocarditis • jarisch Herxheimer reaction Syphilis- overaggressive treatment of an asymptomatic patient that causes symptoms due to rapid lysis • Job’s syndrome Neutrophil chemotaxis abnormality • Kaposi’s sarcoma AIDS in men who have sex with men • Kartagener’s syndrome Dynein defect

20. Kayser-Fleischer rings Wilson’s disease • Keratin pearls Squamous cell carcinoma • Kimmelstiel Wilson nodules Diabetic nephropathy • Kluver Bucy nodules Bilateral amygdala lesions • Koilocytes HPV • Koplick spots Measles • Krukenberg tumor Gastric adenocarcinomas with ovarian metastases • Kussmaul hyperpnea Diabetic ketoacidosis

21. Lens dislocation + aortic dissection + joint hyperflexibility Marfan’s syndrome • Lesch-Nyhan syndrome HGPRT deficiency • Letterer Siwe disease Langerhans cell histiocytosis • Lewy bodies Parkinson’s disease • Libman Sacks disease Endocarditis associated with SLE

22. Lines of zahn Arterial thrombus • Lisch nodules Neurofibromatosis (von Recklinghausen’s disease) • Low serum ceruloplasmin Wilson’s disease • Lucid interval Epidural hematoma • Lumpy bumpy appearance of glomeruli on immunofluorscence Poststreptococcal glaomerulonephritis • Lytic bone lesions on x ray Multiple myeloma • Mallory bodies Alcoholic liver disease • Mallory Weiss syndrome Esophagogastric lacerations

23. McArdle’s disease Muscle phosphorylase deficiency • McBurney’s sign appendicitis • MLF syndrome (INO) Multiple sclerosis • Monoclonal antibody spike Multiple myeloma (called the M protein; usually IgG or IgA), MGUS (monoclonal gammopathy of undetermined significance), Waldenstrom’s (M protein= IgM) macroglobulinemia. • Myxedema hypothyroidism • Necrotizing vasculitis (lungs) and necrotizing glomerulonephritis Wegener’s and goodpasture’s (hemoptysis and glomerular disease) • Needle shaped, negatively bifringent crystals Gout • Negri bodies rabies

24. Nephritis + cataracts + hearing loss Alport’s syndrome • Neurofibrillary tangles Alzheimer’s disease • Niemann Pick disease Spingomyelinase deficiency • No lactation postpartum Sheehan syndrome (pituitary infarction) • Nutmeg liver CHF • Occupational exposure to asbestos Malignant mesothelioma • Orphan Annie nuclei Papillary carcinoma of the thyroid • Osler’s nodes endocarditis

25. Owl’s eye CMV • Painless jaundice Pancreatic cancer of the head • Palpable purpura on legs and butt HSP- Henoch Schonein purpura • Pancoast tumor Bronchogenic apical tumor associated with Horner’s syndrome • Pannus Rheumatoid Arthritis • Nigrostriatal dopamine depletion Parkinson’s disease • Periosteal elevation on x ray Pyogenic osteomyelitis • Peutz Jeghers syndrome Benign polyposis

26. Penile fibrosis Peyronie’s disease • Philadephia chromosome (bcr-abl) CML (may sometimes be associated with AML) • Pick bodies Pick’s disease • Pick’s disease Progressive dementia, similar to Alzheimer’s • “pink puffer” Emphysema (centroacinar [smoking], panacinar [alpha 1 antitrypsin deficiency]) • Esophaeal webs with iron deficiency anemia Plummer Vision syndrome • Podagra Gout (MP joint of hallux) • Podocyte fusion Minimal change disease • Polyneuropathy, cardiac pathology, and edema Dry beri beri (thiamine, vitamin B1 deficiency) • Pompe’s disease Lysosomal glucosidase deficiency associated with cardiomegaly

27. Polyneuropathy preceded by GI or respiratory infection Guillain Barre syndrome • Port wine stain hemangioma • Positive anterior “drawer sign” Anterior cruciate ligament injury • Pott’s disease Vertebral tuberculosis • Pseudopalisade tumor cell arrangement Glioblastoma multiforme • Pseudorosettes Ewing’s sarcoma • Ptosis, miosis, anhidrosis Horner’s syndrome (pancoast tumor) • Rash on palms and soles Secondary syphilis, Rocky mountain spotted fever • Raynaud’s syndrome Recurrent vasospasm in extremities • RBC casts in urine Acute glomerulonephritis

28. Recurrent pulmonary pseudomonas and S. aureus infections Cystic fibrosis • Red urine in the morning Paroxysmal nocturnal hemoglobinuria • Reed sternburg cells Hodgkin’s lymphoma • Reid index (increased) Chronic bronchitis • Reinke crystals Leydig cell tumor • Reiters syndrome Urethritis, conjunctivitis, arthritis • Renal cell carcinoma + cavernous hemangiomas + adenomas Von Hippel- Lindau disease

29. Renal epithelial casts in urine Acute toxic/viral nephrosis • Rhomboid crystals, postively bifringent pseudogout • Rib notching Coarctation of aorta • Roth’s spots in the retina endocarditis • Rotor’s syndrome Congenital conjugated hyperbilirubinemia • Rouleaux formation (RBCs) Multiple myeloma • Russell bodies Multiple myeloma • S3 Left to right shunt (VSD, PDA, ASD), mitral regurgitation, LV failure (CHF) • S4 Aortic stenosis, hypertrophic subaortic stenosis • Schiller-Duval bodies Yolk sac tumor

30. Senile plaques Alzheimer’s disease • Sezary syndrome Cutaneous T cell lymphoma • Sheehan’s syndrome Postpartum pituitary necrosis • Shwartzman reaction Neisseria meningitidis • Signet ring cells Gastric carcinoma • Simian creases Down syndrome • Sipple’s syndrome MEN IIa • Sjogren’s syndrome Dry eyes, dry mouth, arthritis • Skip lesions Crohn’s disease • Slapped cheeks Erythema infectiosum (fifth disease)

31. Smith antigen SLE • Smudge cells CLL • Soap bubble on x ray Giant cell tumor of bone • Spike and dome on EM Membranous glomerulonephritis • Spitz nevus Benign juvenile melanoma • Splinter hemorrhages in fingernails endocarditis • Starry sky pattern Burkitts lymphoma • Strawberry tongue Scarlet fever • Streaky ovaries Turner’s syndrome

32. String sign on x ray Crohn’s disease • Subepithelial humps on EM Post streptococcal glomerulonephritis • Suboccipital lymphadenopathy Rubella • Sulfur granules Actinomyces israelli • Swollen gums, bruising, poor wound healing, anemia Scurvy (ascorbic acid, vitamin C deficiency)- vitamin C is necessary for hydroxylation of proline and lysine in collagen synthesis • Systolic ejection murmur (crescendo-decrescendo) Aortic valve stenosis • t(8,14) Burkitt’s lymphoma (c-myc activation)

33. t(9,22) Philadephia chromosome, CML (bcr-abl) • t(14,18) Folilcular lymphomas (bcl-2 activation) • Tabes dorsalis Tertiary syphilis • Tendon xanthomas (classically achilles) Familial hypercholesterolemia • Thumb sign on lateral x ray Epiglottitis (H. influenza) • Thyroidization of kidney Chronic bacterial pyelonephritis • Tophi Gout • “tram track” appearance on LM Membranoproliferative glomerulonephritis • Trousseau’s sign Visceral cancer, pancreatic adenocarcinoma (migratory thrombophelibits), hypocalcemia (carpal spasm) • Virchow’s triad Left supraclavicular node enlargement from metastatic carcinoma of the stomach

34. Von Recklinghausen’s disease Neurofibromatosis with café au lait spots • Von Recklinghausen’s disease of bone Osteitis fibrosa cystica (brown tumor) • Wallenberg’s syndrome PICA thrombosis • Waterhouse Fridrichensen syndrome Adrenal hemorrhage associated with meningococcemia • Waxy cast Chronic end stage renal disease • WBC casts in urine Acute pyelonephritis • Wermer’s syndrome MEN 1 • Whipple’s syndrome Malabsorption syndrome caused by Tropheryma whippelii

35. Wilson’s disease Hepatolenticular degeneration • Wire loop appearance on LM Lupus nephropathy • Worst Headache of my life Berry aneurysm- associated with adult polycystic kidney disease • Xanthochromia (CSF) Subarachnoid hemorrhage • Xerostomia + arthritis + keratoconjunctivitis sicca Sjogren’s syndrome • Zenker’s diverticulum Upper GI diverticulum • Zollinger-ellison syndrome Gastrin secreting tumor associated with ulcers

36. Most common associations

37. Bacteremia/pneumonia (IVDA) S aureus • Bacteria associated with cancer H pylori • Bacteria found in the GI tract Bacteroides (second most common is E coli) • Brain tumor in adults Mets>astrocytoma (including glioblastoma multiforme)> meningioma > schwannoma • Brain tumor in kids Medulloblastoma in cerebellum • Breast cancer craniopharyngioma • Breast mass Fibrocystic change (in postmenopausal women, carcinoma is the most common) • Breast tumor benign fibroadenoma

38. Bug in debilitated, hospitalized pneumonia patient Klebsiella • Cardiac primary tumor (adults) Myxoma (4:1 left to right atrium; “ball and valve”) • Cardiac primary tumor (kids) Rhabdomyoma • Cardiac tumor (adults) mets • Cardiomyopathy Dilated cardiomyopathy • Chromosomal disorder Down syndrome (associated with ALL, Alzheimer’s dementia, and endocardial cushion defects) • Chronic arrhythmia Atrial fibrilliation (associated with risk of emboli) • Congenital cardiac anomaly VSD

39. Constrictive pericarditis TB • Coronary artery involved in thrombosis LAD > RCA > LCA • Cyanosis (early, less common) Tetralogy of Fallot, transposition of great vessels, truncus arteriosus • Cyanosis (late, more common) VSD, ASD, PDA (close with indomethacin; open with misoprostol) • Demyelinating disease Multiple sclerosis • Dietary deficit Iron • Epiglottitis Haemophilus influenza type B • Esophageal cancer Squamous cell carcinoma

40. Gene involved in cancer P53 tumor suppressor gene • Group affected by cystic fibrosis Caucasians (fat soluble vitamin deficiencies, mucus plugs/lung infections) • Gynocologic malignancy Endometrial carcinoma • Heart murmur Mitral valve prolapse • Heart valve in bacterial endocarditis Mitral • Heart valve in bacterial endocarditis in IVDA Tricuspid • Heart valve in Rheumatic fever Mitral valve (aortic is second) • Helminth infection in US Enterobius vermicularis ( Ascaris lumbricoides is 2nd)

41. Hereditary bleeding disorder Von Willebrand’s • Kidney stones Calcium = radioopaque (2nd most common is ammonium = radioopaque, formed by urease + organisms: Proteus or Staphylococcus) • Liver disease Alcoholic liver disease • Location of brain tumors in adults supratentorial • Location of brain tumors in kids infratentorial • Lysosomal storage disease Gaucher’s disease • Male cancer Prostatic carcinoma • Malignancy associated with non infectious fever Hodgkin’s disease • Malignant skin tumor Basal cell carcinoma (rarely metastasizes)

42. Mets to bone Breast, lung, thyroid, testes, prostate, kidney • Mets to brain Lung, breast, skin (melanoma), kidney (renal cell carcinoma), GI • Mets to liver Colon, gastric, pancreatic, breast, and lung carcinomas • Motor neuron disease ALS • Neoplasm in kids ALL (2nd most common is cerebellar medulloblastoma) • Nephrotic syndrome Membranous glomerulonephritis • Obstruction of male urinary tract BPH • Opportunitstic infection in AIDS Pneumoncystis carinii pneumonia • Organ receiving mets Adrenal glands due to rich blood supply • Organ sending mets Lung > breast, stomach

43. Ovarian tumor (benign) Serous cystadenoma • Ovarian tumor (malignant) Serous cystadenocarcinoma • Pancreatic tumor Adenocarinoma (head of pancreas) • Patient with ALL/CLL/AML/CML ALL- child, CLL- adult > 60, AML- adult>60, CML –adult 35-50 • Patient with Hodgkin’s Young male (expect nodular sclerosis type- female) • Patient with minimal change disease Young child • Patient with Reiter’s male • Pituitary tumor Prolactinoma (2nd- somatotrophic “acidiophilic” adenoma) • Preventable cancer Lung cancer

44. Primary bone tumor (adults) Multiple myeloma • Primary hyperparathyroidism Adenomas (followed by hyperplasia, then carcinoma) • Primary liver tumor hepatoma • Renal tumor Renal cell carcinoma- associate with von Hipple Lindau and acquired polycystic kidney disease; paraneoplastic syndrome ( EPO, renin, PTH, ACTH) • Secondary hyperparathyroidism Hypocalcemia due to chronic renal failure • Sexually transmitted disease chlamydia • Site of diverticula Sigmoid colon • Site of metastasis Regional lymph nodes • Site of metastasis (2nd most common) liver

45. Sites of atherosclerosis Abdominal aorta > coronary > popliteal > carotid • Skin cancer Basal cell carcinoma • Stomach cancer adenocarcinoma • testicular tumor seminoma • Thyroid cancer Papillary carcinoma • Tracheoesphageal fistula Lower esophagus joins trachea/ upper esophagus – blind pouch • Tumor in men Prostate carcinoma • Tumor in women Leiomyoma (estrogen dependent) • Tumor in infancy hemangioma • Tumor of adrenal medulla in adults Pheochoromocytoma benign • Tumor of adrenal medulla in kids Neuroblastoma (malignant)

46. Type of Hodgkin’s disease Nodular sclerosis ( vs mixed cellularity, lymphocytic predominant, lymphocytic depeletion) • Type of non Hodgkin’s disease Follicular, small cleaved • Type of pituitary adenoma prolactinoma • Vasculitis Temporal arteritis (risk of ipsilateral blindness due to thrombosis of opthalmic artery) • Viral encephalitis HSV • Vitamin deficiency in US Folic acid (pregnant women are at high risk, body stores only 3-4 month supply)

47. Most frequent cause of ….

48. Addison’s disease Autoimmune (infection is the 2nd most common cause) • Aneurysm, dissecting HTN • Aortic aneurysm, abdominal and descending aorta atherosclerosis • Aortic aneurysm, ascending Tertiary syphilis • Bacterial meningitis (adults) Neisseria meningitidis • Bacterial meningitis (elderly) Streptococcus pneumoniae • Bacterial meningitis (kids) Haemophilus influenzae type B • Bacterial meningitis (newborns) E. coli • Cancer associated with AIDS Kaposi sarcoma • Congential adrenal hyperplasia 21 hydroxylase deficiency

49. Cretinism Iodine deficient/ hypothyroidism • Cushing’s syndrome Corticosteroid therapy (2nd most common cause is excess ACTH secretion by pituitary) • Death in CML Blast crisis • Death in SLE Lupus nephropathy • Dementia Alzheimer’s (2nd most common is multiinfarct) • DIC Gram negative sepsis, obstetric complications, cancer, burn trauma • Ejection click Aortic/pulmonic stenosis • Food poisoning S. aureus • Glomerulonephritis (adults) IgA nephropathy (Berger’s disease)

50. Hematoma- epidural Rupture of middle meningeal artery (arterial bleeding is first) • Hematoma – subdural Rupture of bridging veins (trauma, venous bleeding is slow) • Hemochromatosis Multiple blood transfusions (can result in CHF and increase risk of hepatocellualr carcinoma) • Hepatic cirrhosis EtOH • Hepatocellular carcinoma Cirrhotic liver (often associated with hepatitis B and C) • Holosystolic murmur VSD, tricuspid regurgitation, mitral regurgitation • Hypertension, secondary Renal disease • Hypoparathyroidism thyroidectomy • Hypopituitarism adenoma • Infection in blood transfusion Hepatitis C