USMLE Pathognomics

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Pathognomics USMLE – Step 1

Actinic keratosis Preceeds squamous cell carcinoma

Albuminocytologic dissociation Guillan-Barre (incr. Protein in CSF w/ modest incr. In cell count)

Atrophy of mammillary bodies Wernicke's encephalopathy

Anti-basement membrane ab Goodpasture's

Anticentromere ab Scleroderma (CREST)

Anti-double-stranded DNA ab (ANA) SLE (Type III hypersensitivity)

Antiepithelial cell Pemphigus vulgaris

Antigliadin ab Celiac disease (sprue)

Antihistone ab Drug-induced SLE

Anti-IgG ab Rheumatoid arthritis

Antimitochondrial ab Primary biliary cirrhosis

Antineutrophil ab Vasculitis

Antiplatelet ab Idiopathic thrombocytopenic purpura

Arachnodactyly Marfan's syndrome

Argyll-robertson pupil Neurosyphilis

Aschoff bodies Rheumatic fever

Auer rods AML

Autosplenectomy Sickle cell

Babinski sign Upper motor neuron lesion

Baker's cyst in popliteal fossa Rheumatoid arthritis <escaped synovial fluid>

"Bamboo spine" on x-ray Ankylosing spondylitis

Basophilic stippling of rbcs Lead poisoning

Bence-jones proteins Multiple myeloma (kappa or lambda Ig light chains in urine), Waldenstroem's macroglobulinemia (IgM)

Bilateral hilar adenopathy, uveitis Sarcoidosis

Birbeck granules on em Histiocytosis X (eosinophilic granuloma) <tennis rackets>

Bloody tap on lp Subarachnoid hemorrhage

Blue bloater Chronic bronchitis

Blue-domed cysts Fibrocystic change of the breast

Blue sclera Osteogenesis imperfecta

Boot-shaped heart on x-ray Tetralogy of Fallot; RV hypertrophy

Bouchard's nodes Osteoarthritis

Boutonniere deformity Rheumatoid arthritis

Branching rods in oral infection Actinomyces israelii

Brown tumor of bone Hyperparathyroidism; osteitis fibrosa cystica (von Recklinghausen's disease of bone)

Brushfield spots Down's syndrome

Bruton's lines Lead poisoning

c-ANCA Wegener's granulomatosis

p-ANCA Polyarteritis nodosa

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Calf pseudohypertrophy Duchenne's MD

Call-exner bodies Granulosa/thecal cell tumor of

ovary<extracellular multilaminated bodies among granulosa cells>

Cardiomegaly w/ apical atrophy Chagas' disease

Cerebriform nuclei > mycosis fungoides (cutaneous T-cell lymphoma)

Chancre Primary syphillis (NOT painful)

Chancroid Haemophilus ducreyi (PAINFULL)

Charcot's triad MS (nystagmus, intention tremor, scanning speech),

or…cholangitis (jaundice, RUQ pain, fever)

Charcot-leyden crystals Bronchial asthma (eosinophil membranes)

Cherry-red spot on macula [3] Tay-Sachs, Niemann Pick, central retinal artery occlusion

Cheyne-stokes respiration Central apnea in CHF and increased ICP <Apnea, followed by gradually increasing hyperpnea>

Chocolate cysts Endometriosis (freq. Involve both ovaries)

Chronic atrophic gastritis Predisposition to gastric carcinoma

Chvostek's sign Hypocalcemia

Clue cells Gardnerella vaginitis

Codman's triangle on x-ray Osteosarcoma

Cold agglutinins Mycoplasma pneumoniae; infectious mononucleosis

Cold intolerance Myxedema

Condylomata 2' syphilis

Continuous machinery murmur Patent ductus arteriosus

Cotton-wool spots Chronic hypertension

Cough, conjunctivitis, coryza, fever Measles

Councilman bodies Toxic or viral hepatitis

<dead, shrunken hepatocytes>

Cowdry type a bodies Herpesvirus

Crescents in bowman's capsule Rapidly progressive crescentic glomerulonephritis

Currant-jelly sputum Klebsiella

Curschmann's spirals Bronchial asthma (whorled mucous plugs)

D-dimers DIC

Depigmentation of neurons in substantia nigra

Parkinson's disease (basal ggl. Disorder--rigidity, resting tremor, bradykinesia

Dermatitis + dementia + diarrhea Pellagra (niacin--vit B3 deficiency)

Diabetes insipidus + exophtlamos + lesions of skull

Hand-Schueller-Christian disease < a form of histiocytosis >

Dog or cat bite Pasteurella multocida

Donovan bodies Granuloma inguinale

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Erythema chronicum migrans Lyme disease

Fat+female+fertile+forty Acute cholecystitis

Fatty liver Alcoholism

Ferruginous bodies Asbestosis

Ghon focus Primary tuberculosis

Gower's maneuver Duchenne's MD

Hair-on-end appearance on x-ray Beta thalassemia

Hampton's hump on x-ray Pulmonary embolism<convex opacity next to chest wall or diaphragm>

Hbs Sickle cell anemia

Hcg elevated Choriocarcinoma (testicular cancer), multiple pregnancy, hyatidiform mole

Heberden's nodes Osteoarthritis < DIP swelling secondary to osteophytes>

Heinz bodies G6PD deficiency < refractile granules in rbcs>

Heterophil antibodies Infectious mononucleosis (EBV)

Hgb f Thalassemia major

High-output cardiac failure (dilated cardiomyopathy)

Wet beri-beri (thiamine--vit B1 deficiency)

Hla-b27 [2] Reiter's syndrome, ankylosing spondylitis

Hla-dr3 or -dr4 T1dm

Homer wright rosettes Neuroblastoma

Honeycomb lung on x-ray Interstitial fibrosis

Howell-jolly bodies Splenectomy or nonfunctional spleen <small round nuclear remnants in rbcs>

Hyperphagia + hypersexuality +

hyperorality + hyperdocility Kluever-Bucy syndrome (amygdala) Hyperpigmentation of skin Primary adrenal insufficiency (Addison's

disease

Hypersegmented pmns Macrocytic anemia

Hypertension + hypokalemia Cushing's & Conn's syndromes

Hypochromatic microcytosis Iron-deficiency anemia

Alpha fetoprotein in amniotic fluid/maternal serum increased

Anencephaly, spina bifida

Increased uric acid levels [4] Gout, Lesch-Nyhan syndromes, myeloproliferative disorders, loop and thiazine diuretics

Intussuception Adenovirus (cause hyperplasia of Peyer's patches)

Janeway lesions Endocarditis

Jarisch-herxheimer reaction Syphilis: overaggressive treatment of an asymptomatic pt. Causing symptoms due to rapid lysis

Kaposi's sarcoma Homosexual AIDS pts. (not assoc'd w/ IVDA-acquired HIV/AIDS)

Kayser-fleischer rings Wilson's disease

Keratin pearls Squamous cell carcinoma

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Koilocytes Human papilloma virus

Koplik spots Measles<minute blueish-white lesions surrounded by a bright ring on mucous membrane of cheeks>

Kussmaul hyperpnea Diabetic ketoacidosis

Lens dislocation + aortic dissection + joint hyperflexibility

Marfan's syndrome (fibrillin deficit)

Lewy bodies Parkinson's disease (basal ggl. Disorder--rigidity, resting tremor, bradykinesia

Lines of zahn Arterial thrombus

Lisch nodules Neurofibromatosis (von Recklinhausen's) <minute pigmented mass in the iris>

Low serum ceruloplasmin Wilson's disease

Lucid interval Epidural hematoma

Lumpy-bumpy appearance of glomeruli on if

Poststreptococcal glomerulonephritis

Lytic bone lesions on x-ray Multiple myeloma

Mallory bodies Alcoholic liver disease

Mcburney's sign Appendicitis

Mlf syndrome (ino) Ms

Monoclonal ab spike [3] Multiple myeloma (M protein, usu. Igg or IgA), MGUS, Waldenstroem's

macroglobulinemia (IgM)

Myxedema Hypothyroidism

Necrotizing vasculitis (lungs) & necrotizing glomerulitis

Wegener's and Goodpasture's (hemoptysis & glomerular disease)

Needle-shaped, negatively birefringent crystals

Gout

Negri bodies Rabies

Nephritis + cataracts + hearing loss Alport's syndrome

Neurofibrillary tangles Alzheimer's disease

No lactation postpartum Sheehan's syndrome

Nutmeg liver CHF

Occupational exposure to asbestos Malignant mesothelioma

Orphan annie nuclei Papillary carcinoma of the thyroid

Osler's nodes Subacute endocarditis

<small, tender, discolored node on pads of fingers & toes>

Owl's eye Cytomegalo virus

Painless jaundice Pancreatic cancer (head)

Palpable purpura on legs & buttocks Henoch-Schoenlein purpura

<purpura: spont. Bleeding in subcut. Tissues>

Pannus Rheumatoid arthritis

Periosteal elevation on x-ray Pyogenic osteomyelitis

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Pick bodies Pick's disease

Pink puffer Emphysema (centroacinar [smoking],

panacinar [alpha-1 antitrypsin def.])

Podagra Gout (MP joint of hallux)

Podocyte fusion Minimal change disease

Polyneuropathy preceeded by gi or resp. Infex

Guillan-barre

Polyneuropathy, cardiac pathology,

edema Dry beri-beri (thiamine, B1 def.)

Port wine stain Hemangioma

Positive anterior drawer sign ACL injury

Pseudopalisade tumor cell arrangement Glioblastoma multiforme

Pseudorosettes Ewing's sarcoma

Ptosis, miosis, anhidrosis Horner's syndrome (Pancoast's tumor)

Rash on palms and soles Secondary syphillis, Rocky Mountain spotted fever

Rbc casts in urine Acute glomerulonephritis

Recurrent pulmonary pseudomonas & s.

Aureus infex Cystic fibrosis

Red urine in morning Paroxysmal nocturnal hemoglobinuria

Reed-Sternberg cells Hodgkin's lymphoma

Reid index (increased) Chronic bronchitis

Reinke crystals Leydig cell tumor

Renal cell carcinoma + cavernous

hemangioma + adenomas Von Hippel-Lindau disease Renal epithelial casts in urine Acute toxic/viral nephrosis

Rhomboid crystals, positively birefringent

Pseudogout

Rib notching Coarctation of aorta

Roth spots in retina Endocarditis

Roleaux formation Multiple myeloma

Russell bodies Multiple myeloma

S3 Left-to-right shunt (VSD, PDA, ASD),

mitral regurg., LV failure (CHF)

S4 Aortic stenosis, hypertrophic subaortic

stenosis

Schwartzman reaction N. Meningitidis

Schiller-duval bodies Yolk sac tumor

Senile plaques Alzheimer's disease

Signet ring cells Gastric carcinoma

Simian crease Down's syndrome

Skip lesions Crohn's

Slapped cheeks Erythema infectiosum (fifth disease)

Smith antigen SLE

Smudge cell Cll

Soap bubble on x-ray Giant cell tumor of bone

Spike & dome on em of kidney tissue Membranous glomerulonephritis

Spitz nevus Benign juvenile melanoma

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Starry-sky pattern Burkitt's lymphoma

"Strawberry tongue" Scarlet fever

Streaky ovaries Turner's syndrome

String sign on x-ray Crohn's disease

Subepithelial humps on em of kidney tissue

Poststreptococcal glomerulonephritis

Suboccipital lymphadenopathy Rubella

Sulfur granules Actinomyces israelii

Swollen gums, bruising, poor wound healing, anemia

Scurvy (ascorbic acid, vitamin C deficiency) - vit. 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)

t(9:22) Philadelphia chromosome, CML (bcr-abl

hybrid)

t(14:18) Follicular lymphomas (bcl-2 activation)

Tabes dorsalis Tertiary symphilis

Tendon xanthomas (classically achilles) Familial hypercholesterolemia

Thumb sign on lateral x-ray Epiglotitis (Haemophilus influenzae)

Thyroidization of kidney Chronic bacterial pyelonephritis

Tophi Gout

"Tram-track" appearance on lm Membranoproliferative glomerulonephritis

Trousseau's sign Visceral cancer, pancreatic adenocarcinoma (migratory

thrombophlebitis), hypocalcemia (carpal spasm)

Virchow's node Left supraclavicular node enlargement from metastatic carcinoma of the stomach

Virchow's node Pulmonary embolism (triad = blood stasis, endothelial damage, hypercoagulation)

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-friderichsen syndrome Adrenal hemorrhage associated with meningococcemia

Waxy casts Chronic end-stage renal disease

Wbc casts in urine Acute pyelonephritis

Wbcs in urine Acute cystitis

Wermer's syndrome MEN type I

Whipple's disease Malabsorption syndrome caused by Tropheryma whippelii

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

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Zollinger-ellison syndrome Gastrin-secreting tumor associated with ulcers

Deletion on chromosome 13 Retinoblastoma

Thrombocytopenia & eczema &

recurrent infex Wiskott-Aldrich syndrome

Tree-bark calcification of aorta Syphilitic aortitis (3')

Psammoma bodies 1- papillary carcinoma of thyroid or ovary 2- meningioma

3- malignant mesothelioma

5-hydroxyindoleacetic acid increase Carcinoid syndrome

Bronze diabetes Hemochromatosis

Benzene Aplastic anemia

Dry tap Myelofibrosis

Cut potato lymph nodes Non-Hodgkins lymphoma

Most common cause of death in cystic fibrosis

Pseudomonas infex

Klinefelter's karyo- & phenotype XXY, male eunuch

Ca-125 elevated Ovarian cancer

+S100 antigen, -mucin Vulvar malignant melanoma

Pancoast tumor Apical lung tumor compressing cervical sympathetic plexus, causing Horner's syndrome

Hfe gene defect, chromosome 6 Hereditary hemochromatosis

Deficient activity of NADPH oxidase Chronic granulomatous disease of childhood

Hla-dr5 & hla-b5 Hashimoto thyroiditis

5p Cri du chat

Anti-scl-70 Scleroderma

Anti-ss-b Sjogren's

Anti-nrnp Mixed connective tissue disease

Elevated alpha-fetoprotein Hepatocellular carcinoma

Loss of GTPase Ras mutation

T(14;18) Follicular lymphoma (bcl-2)

T(15;17 Acute promyleocytic leukemia

N-myc amplification Neuroblastoma

Familial p-53 mutation Li fraumeni syndrome

Ret mutation MEN IIa

Aflatoxin b1 causes Hepatocellular carcinoma

B-napthylamine causes Bladder cancer

Mc cause of viral pharyngitis Adenovirus

Down's syndrome heart disease Cushion defects

Turner's syndrome heart disease Coarcted aorta

Order of mi enzymes Ck-mb & trop-i AST

ldh

Sydenham chorea Rheumatic fever

Death from acute respiratory failure Myocarditis

Cyanosis in congenital heart disease Right to left shunt

Abnormal schilling test Pernicious anemia

Increased a2 hemoglobin B thalassemia minor

Low serum Fe with low TIBC Anemia of chronic disease

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secretion, predisposing to panacinar emphysema

Lemon-yellow skin Pernicious anemia

Absence of serum haptoglobins Hemolytic anemia

Increased hemoglobin f B thalassemia major

Positive ham test Paroxysmal nocturnal hemoglobinuria

Schistocytes TTP

Spherocytes w/ negative coomb's test Hereditary spherocytosis

Spherocytes w/ positive coomb's test Waha

Postive t.r.a.p. Test Hairy cell leukemia

Erythrocytosis w/ low erythropoeitin Polycytemia vera

Tear-drop erythrocytes Chronic idiopathic myelofibrosis

T(11;14) Mantle cell lymphoma

Anergy to skin test ag Sarcoidosis

Q fever Rickettsial pneumonia from unpasteurized

milk

Low glucuronyl transferase Crigler-Najar, Gilbert syndromes (liver enzyme conjugating billirubin)

Anti-smooth muscle ab Autoimmune hepatitis

Fatty food intolerance Cholelithiasis

Saber shin Skeletal syphillis

Spindle-shaped cells w/ herringbone pattern

Fibrosarcoma

T(11;22)(q24;12) translocation Ewing sarcoma

(malignant round cell tumor of bone)

Spike & dome Membranous glomerulonephritis (a nephrotic synd)

Smoky brown urine Nephritis syndrome

Bun:creatinine > 15 Prerenal azotemia

Precocious male puberty Leydig cell tumor

Precocious female puberty Granulosa cell tumor

Mc urinary tract tumor Transitional cell

Increased total psa, decreased % free

psa Prostatic carcinoma

Increased total psa, no change in % free psa

Bph

Complete hydatidiform mole karyotype 46XX, but all paternal

Hla-dr3 & hla-b8 Increased risk of Grave's disease

Plummer disease Grave's, without the exophthalmos

Increased pth, hypercalcemia Parathyroid adenoma

Increased pth, hypocalcemia Renal disease

Short 4th or 5th metacarpals & metatarsals

Pseudohypoparathyroidism (AR)

Buffalo hump Hypercortisolism (Cushing's)

21-hydroxylase deficiency Virilism w/ salt loss and hypotension

11-hydroxylase deficiency Virilism w/ salt retention and HTN

"Target" lesion Erythema multiforme

Accanthosis nigricans Visceral malignancy

Small blue cell bone tumor Ewing sarcoma

Blue sclera Osteogenesis imperfecta

Mc site of cerebrovascular thrombosis/embolism

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Maternal folic acid deficiency Fetal neural tube defects

Mc cause of intracerebral hemorrhage Htn