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Rapid-Fire Facts Most common cause of neural tube defects Folate Deficiency Most common cause of congenital malformations in the US Alcohol Abuse Most common cause of mental retardation in the US Fetal alcohol syndrome Hyperflexible joints, arachnodactyly, aortic dissection, lens dislocation Marfan’s Syndrome Hereditary nephritis, cataracts, sensorineural hearing loss Alport Syndrome Unilateral facial drooping involving the forehead Bell’s Palsy Ptosis, miosis and anhidrosis Horner’s Syndrome “Worst headache of my life” Subarachnoid hemorrhage Lucid interval following head trauma Epidural Hematoma Bloody CSF on LP Subarachnoid Hemorrhage Most common cause of subdural hematoma Rupture of bridging veins due to fall Most common cause of epidural hematoma Middle meningial artery tear due to skull fracture (usually temporal bone) Toe extension upon stimulating the sole of the foot with a blunt instrument Babinski Reflex Hyperreflexia, increased muscle tone, and positive Babinski sign Upper Motor Neuron Lesion Hyporeflexia, decreased muscle tone, and muscle atrophy Lower Motor Neuron Lesion Depigmentation of the substantia nigra Parkinson’s Disease Chorea, dementia, and atrophy of the caudate and putamen Huntington’s Disease Eosinophilic inclusions in the cytoplasm of neurons Lewy Bodies Conjugate lateral gaze palsy, with nystagmus and diplopia during lateral gaze Internuclear Ophthalmoplegia due to MLF lesions Degeneration of dorsal columns Tabes Dorsalis due to tertiary syphilis Demyelinating disease in a young woman Multiple Sclerosis Mixed upper and lower motor neuron disease Amyotrophic lateral sclerosis (ALS) Newborn with arm paralysis following a difficult labor Erb-Duchenne Palsy Pupil that accommodates but doesn’t react to light Argyll-Robertson Pupil Most common cause of dementia Alzheimer’s Dementia Second most common cause of dementia Multiple Infarct Dementia Extracellular amyloid deposits in the grey matter Senile plaques (beta amyloid deposits) Intracellular deposits of hyperphosphorylated tau protein Neurofibrillary Tangles Intracellular spherical aggregates of tau protein, seen on silver stain Pick Bodies Treatment for absence seizures Ethosuximide Treatment for tonic-clonic seizures Carbamazepine, Valproic Acid or Phenytoin Amyloid deposits in grey matter of the brain Senile plaques seen in Alzheimer’s Dementia Drooling Farmer Organophosphate Poisoning Inability to breastfeed, amenorrhea, cold intolerance Sheehan Syndrome Infertility, galactorrhea and bitemporal hemianopsia Prolactinoma Most common causes of Cushing’s Syndrome Iatrogenic, Cushing Disease, Ectopic ACTH secretion, and Adrenal Adenoma Most common tumor of the adrenal glands Adrenal Adenoma Most common tumor of the adrenal medulla in adults Pheochromocytoma Most common tumor of the adrenal medulla in children Neuroblastoma Most common cause of primary hyperaldosteronism Adrenal Adenoma Medical treatment for hyperaldosteronism Spironolactone Medical treatment for pheochromocytoma Phenoxybenzamine or Phentolamine Pheochromocytoma + medullary thyroid cancer + hyperparathyroidism MEN 2A Pheochromocytoma + medullary thyroid cancer + mucosal neuromas MEN 2B Adrenal disease associated with skin hyperpigmentation Addison’s Disease Hypertension, hypokalemia, and metabolic alkalosis Conn Syndrome Most common thyroid cancer Papillary Carcinoma Cold Intolerance, weight gain Hypothyroidism Enlarged thyroid cells with ground-glass nuclei Papillary carcinoma Standard treatment for DKA IV fluids, insulin and K+ replacement Standard treatment for Type 1 DM Insulin and low sugar diet Standard treatment for Type 2 DM Metformin + weight loss Most common cause of hypercalcemia Primary Hyperparathyroidism Most common cause of primary hyperparathyroidism Parathyroid adenoma Most common cause of secondary hyperparathyroidism Chronic renal failure Most common cause of hypoparathyroidism Parathyroidectomy (accidental) Facial muscle spasm when tapping on cheek Chvostek’s sign Parathyroid tumor + Pancreatic tumor + Pituitary tumor MEN 1 Dysphagia, glossitis and iron deficiency anemia Plummer-Vinson Syndrome Hematemesis with retching Mallory-Weis Tear Mucin-filled cell with a peripheral nucleus Signet ring cell in gastric adenocarcinoma Most common type of stomach cancer Gastric Adenocarcinoma Ovarian metastasis from gastric cancer Krukenburg Tumor Gastric ulcerations seen with high gastrin levels Zollinger-Ellison Syndrome Acute gastric ulcer associated with elevated ICP or head trauma Cushing Ulcer Acute gastric ulcer associated with severe burns Curling Ulcer Painless Jaundice Pancreatic Cancer Most common cause of acute pancreatitis Gallstones and alcohol abuse Most common cause of chronic pancreatitis Alcohol Abuse Weight loss, diarrhea, arthritis, fever, adenopathy and hyperpigmentation Whipple Disease Anti-transglutaminase/anti-gliadin/antiendomysial antibodies Celiac sprue Vitamin given to women to prevent neural tube defects Folate Triglyceride accumulation in hepatocytes Fatty Liver Disease Eosinophilic inclusions in the cytoplasm of hepatocytes Mallory Bodies Cancer closely linked to cirrhosis Hepatocellular Carcinoma Severe Hyperbilirubinemia in a neonate Crigler-Najjar Type 1 Mild, benign hyperbilirubinemia Gilbert Syndrome Hepatomegaly, abdominal pain and ascites Budd-Chiari Syndrome Green/yellow corneal deposits Wilson’s Diease Low serum ceruloplasmin Wilson’s Disease Cirrhosis, diabetes and hyperpigmentation Hemochromatosis Treatment for chronic hepatitis Interferon alpha Most common cancer of the appendix Carcinoid Tumor Most common surgical emergency Appendicitis GI hamartomas, hyperpigmentation of the mouth and hands Peutz-Jegher Syndrome Mutliple colon polyps, osteomas, soft tissue tumors Gardner Syndrome Severe RLQ pain w/rebound tenderness Appendicitis “Apple core” lesion on barium enema Colon cancer Most common site of colonic diverticuli Sigmoid colon “String sign” on contrast xray of abdomen Crohn’s Disease “Lead pipe” appearance of colon on contrast xray Ulcerative Colitis Most common infections seen in chronic granulomatous disease Catalase + organisms Eczema, recurrent URI, high serum IgE Hyperimmunoglobulin E Syndrome (Job syndrome) Large lysosomal vesicles in phagocytes Chediak-Higashi Syndrome A boy with self-mutilating behavior, mental retardation and gout Lesch-Nyhan Syndrome Elevated uric acid levels Orotic aciduria, Gout, Lesch-Nyhan and pt on loop/thiazide diuretics Bluish-colored lines on gingivae Lead Poisoning Treatment of choice for rickets or osteomalacia Vitamin D3 Swollen gums, poor wound healing, bleeding mucous membranes and spots on the skin Scurvy Most common vitamin deficiency in the US Folate deficiency Hypersegmented neutrophils Megaloblastic anemia Dilated cardiomyopathy, edema and polyneuropathy Vitamin B1 Deficiency (Thiamine) Dark purple nodules on the skin in an HIV patient Kaposi Sarcoma Large cells with owl’s eye inclusions CMV Treatment for CMV Gancyclovir Most common opportunistic infection in HIV Patients Pneumocystis jirovecii Drug used to prevent Pneucystis pneumonia TMP-SMX Food poisoning due to exotoxin S. aureus or B. cereus Osteomyelitis in Sickle Cell Disease Salmonella typhi Ring enhancing brain lesion seen in HIV patient Toxoplasma gondii Treatment for Trichomonas vaginalis Metronidazole Most common protozoal diarrhea Giardia lamblia Most common helminth infections in the US Enterobius vermicularis (Pinworms) Second most common helminth infection in the US Ascaris lumbricoides Most common bacteria implicated in exotoxin-mediated food poisoning S. aureus Branching gram positive rods with sulfur granules Actinomyces israelii Calcified granuloma in the lower lung plus hilar lymphadenopathy Primary TB Back pain, fever, night sweats and weight loss Multiple Myeloma or Pott’s Disease (TB) Standard treatment regimen for TB RIPE Rifampin, Isoniazid, Pyrazinamide, Ethambutol Standard treatment for T. pallidum Penicillin G Cellulitis from dog/cat bite Pasteurella multocida A non-painful indurated, ulcerated genital lesion Chancre (primary syphilis) Large bull’s-eye rash Borrelia burgdorferi (Lyme Dz) Most common opportunistic infection in HIV patients Pneumocystis pneumonia (PCP) Prophylaxis for Cryptococcus in AIDS pts Fluconazole Prophylaxis for PCP in AIDS pt TMP-SMX (CD4 <200) Treatment for Sporothrix schenckii Potassium iodide or Itraconazole Treatment for oral candidiasis Nystatin Treatment for systemic candidiasis Amphotericin B Most common medication used for UTI prophylaxis TMP-SMX Most common bacteria in a pt with struvite kidney stones Proteus mirabilis Dark purple nodules on the skin of an HIV pt Kaposi Sarcoma Temporal lobe encephalitis HSV-1 Owl’s eye inclusions in monocytes CMV Intranuclear eosinophilic droplets Type A Cowdry bodies in HSV and CMV infections Aplastic anemia in sickle cell patient Parvovirus B19 Child with a fever and ‘slapped cheek’ rash on face that spreads to body Parvovirus B19 Fever, coryza, cough, conjunctivitis, and diffuse rash Measles Small irregular blue-gray spots on the buccal mucosa, surrounded by base of red Koplik’s spots (measles) Most common etiology of nosocomial pneumonia Klebsiella Most common etiology of bacterial meningitis in neonates Group B Strep Most common etiology of bacterial meningitis in children S. pneumoniae Most common etiology of bacterial meningitis in adults S. pneumoniae Osteomyelitis in IV drug user Pseudomonas aeruginosa Osteomyelitis in sickle cell pt Salmonella typhi Most common reportable STD Chlamydia Non-painful indurated, ulcerated genital lesion Chancre in primary syphilis Painful indurated, ulcerated genital lesion, with exudate Chancroid due to H. ducreyi Stippled vaginal epithelial cells on wet prep of vaginal discharage Clue cells of bacterial vaginosis Common treatment for syphilis Penicillin G Common treatment for Trichomonas Metronidazole Common treatment for Chlamydia Doxycycline or Azithromycin Common treatment for gonorrhea Ceftriaxone Most common cause of hypochromic, microcytic anemia Iron deficiency Hypersegmented neutrophils Megaloblastic anemia Skull xray shows ‘hair-on-end’ appearance Beta thalassemia or Sickle Cell Dz Basophilic stippling of RBCs Lead Poisoning Painful cyanosis of the fingers and toes, with hemolytic anemia Cold Agglutinin Autoimmune Hemolytic Anemia Red urine in the morning with fragile RBCs Paroxysmal Nocturnal Hemoglobinuria (PNH) Basophilic nuclear remnants in RBCs Howell-Jolly Bodies Autosplenectomy Sickle Cell Disease Drug used to treat sickle cell disease Hydroxyurea Antiplatelet Antibodies Immune (Idiopathic) Thrombocytopenic Purpura Bleeding disorder with Gp1b deficiency Bernard-Soulier Syndrome Most common inherited bleeding disorder von Willebrand Factor Disease Cancer most commonly associated with a noninfectious fever Hodgkin’s Lymphoma “Smudge cells” on peripheral smear Chronic Lymphocytic Leukemia (CLL) “Punched out” lytic bone lesions Multiple Myeloma Sheets of lymphoid cells with a ‘starry sky’ appearance Burkitt Lymphoma RBCs clumped together like a stack of coins Rouleaux formation seen in MM Monoclonal antibody spike Multiple Myeloma Reddish-Pink rods in the cytoplasm of leukemic blasts Auer rods seen in Acute Myeloblastic Leukemia (AML) type M3 Large B cells with bilobed nuclei and prominent ‘owl’s eye inclusions’ Hodgkin Lymphoma Chronic sinusitis, infertility and situs inversus Kartagener Syndrome Elevated D-Dimer Pulmonary Embolism Hypercoagulability, endothelial damage, stasis of blood Virchow’s Triad Blue Bloater Chronic Bronchitis Pink Puffer Emphysema Curschmann’s spirals in sputum Asthma Most common cause of pulmonary HTN COPD Bilateral hilar adenopathy, uveitis Sarcoidosis Vasculitis and glomerulonephritis Goodpasture syndrome OR Wegener’s Granulomatosis Anti-glomerular basement membrane antibodies Goodpasture Disease Honeycomb lung on xray Interstitial fibrosis ‘Tennis racket” shaped cytoplasmic organelles Birbeck granules seen in Langerhans cell histiocytosis Most common cause of nosocomial pneumonia Klebsiella pneumoniae Lung cancer associated with SIADH Small Cell Lung cancer Iron-containing nodules in the alveolar septum Ferruginous bodies seen w/asbestosis Continuous machinery-like heart murmur Persistent Ductus Arteriosus (PDA) ‘Boot-shaped heart’ on xray Tetralogy of Fallot Rib notching Coarctation of the Aorta Most common congenital cardiac anomaly Ventricular septal defect (VSD) Most common congenital cause of early cyanosis Tetralogy of Fallot Cor pulmonale Right sided Heart Failure Nutmeg liver Right sided heart failure AND Budd-Chiari Syndrome Bounding pulses, head bobbing, diastolic murmur Aortic Regurgitation Most common congenital heart murmur Mitral Valve Prolapse Splinter hemorrhages under the fingernails Bacterial endocarditis Retinal hemorrhages with pale centers Roth’s Spots seen with bacterial endocarditis Heart valve most commonly involved in bacterial endocarditis Mitral Valve Heart valve most commonly involved in an IV drug user w/bacterial endocarditis Tricuspid Valve Granulomatous nodules in the heart Aschoff bodies in Rheumatic Heart Dz Most common cardiac tumor in adults Metastatic cancer Most common primary cardiac tumor in children Rhabdomyoma Most common cause of constrictive pericarditis Lupus Cold, painful digist Reynaud’s Phenomenon Cytoplasmic Antineutrophil Cytoplasmic Antibody (c-ANCA) Wegner’s Granulomatosis Perinuclear Anti-Neutrophil Cytoplasmic Antibodies (p-ANCA) Churg-Strauss Syndrome, Microscopic Polyangiitis, Pauci-Immune Crescentic Glomerulonephritis Treatment for Buerger Disease Smoking cessation Treatment for temporal arteritis High Dose Corticosteroids Bone enlargement, bone pain and arthritis Paget’s Disease Vertebral compression fractures Osteoporosis Positive Anterior Drawer Sign ACL injury Swollen, red, acutely painful great toe Gout Swollen, hard, painful finger joints Osteoarthritis Swollen, boggy, painful finger joints Rheumatoid Arthritis Arthritis, dry mouth, and dry eyes Sjogren’s Syndrome Positively birefringent rhomboidshaped crystals Pseudogout Negatively birefringent needle-shaped crystals Gout Cartilage erosion with polished bone beneath Osteoarthritis Bamboo spine on xray Ankylosing Spondylitis HLA-B27 Spondyloarthropathies Anti-Smith and anti-dsDNA antibodies Systemic Lupus Erythematosus Anti-histone antibodies Drug-induced SLE Anti-centromere antibodies CREST syndrome Anti-topoisomerase antibodies Diffuse scleroderma Facial rash and Raynaud phenomenon in a young woman SLE Most common cause of death in SLE Lupus nephritis Most common cardiac manifestation of SLE Libman-Sacks Endocarditis Keratin pearls on skin biopsy Squamous cell carcinoma Most common malignant skin tumor Basal cell carcinoma Most common medication for ADHD Methylphenidate or Dextroamphetamine Most common medication for bulimia nervosa SSRIs Medical treatment for alcohol withdrawal Benzodiazepines or Beer Most effective treatment for alcohol abuse Alcoholics Anonymous Atrophy of the mammillary bodies Wernicke-Korsakoff Syndrome Treatment for Central DI Desmopressin Treatment for nephrogenic DI HCTZ and indomethacin Treatment for lithium-induced nephrogenic DI Amiloride Nodular hyaline deposits in the glomeruli Kimmelstiel-Wilson nodules seen in Diabetic nephropathy Glomerulonephritis plus pulmonary vasculitis Goodpasture Disease or Wegeners Granulomatosis Red cell casts in urine Glomerulonephritis Waxy casts in urine Stasis of urine Thyroid-like appearance of kidney Chronic Pyelonephritis Most common renal tumor Renal cell carcinoma Most common type of renal stone Calcium oxalate Type of renal stone associated with Proteus mirabilis Struvite (Magnesium ammonium phosphate) Most common cancer in men Prostate cancer Most common cause of urinary obstruction in men Benign Prostatic Hypertrophy Most common treatment for erectile dysfunction Sildenafil, vildenafil Dysplastic cervical cells with enlarged dark nuclei Koilocytes d/t HPV DES exposure in utero Vaginal clear cell adenocarcinoma Most common tumor in women Leiomyoma Most common gynecologic malignancy in the US Endometrial Cancer Most common gynecologic malignancy worldwide Cervical cancer Chocolate cyst of the ovary Endometriosis Most common benign ovarian tumor Serous Cystadenoma Most common malignant ovarian tumor Serous cystadenocarcinoma Disarrayed granulosa cells in eosinophilic fluid Call-Exner Bodies Increased AFP on amniocentesis Neural tube defect or Incorrect dating of pregnancy Most common genetic cause of mental retardation Down’s Syndrome Second most common genetic cause of mental retardation Fragile X syndrome Horseshoe kidney, congenital heart defects, streak ovaries, and cystic hygroma Turner Syndrome Rocker-bottom feet, clenched hands, microcephaly with prominent occiput, small jaw Edward Syndrome Most common cancer in women in the US Breast cancer Most common benign breast tumor Fibroadenoma Most common malignant breast tumor Invasive ductal carcinoma Blue dome cyst in the breast Fibrocystic Breast Disease Treatment for estrogen receptor + breast cancer Tamoxifen Red, itchy, swollen rash on the areola and nipple Paget’s Disease
