Actinic keratosis: squamous cell carcinoma of the skin. Tx: 5-fluorouracil (won’t cause scarring), cryotherapy and surgery (scarring) (presentation: sunbathing area, rough, adherent, yellow-brown scale)
2. Acanthosis nigricans: <40yo, type II DM, >40 yo, visceral malignancy
3. ADHD: Genetic factors may predispose an individual to ADHD. These include fragile X syndrome, G6PD deficiency, and PKU.
4. AIDS: agreesive malignant lymphomas (non-Hodgkin’s) and Kapsosi’s sarcoma.
5. Aniridia: absence of iris is associated with Wilms tumor so do USG to detect the mass.
6. Aneurysm of circle of Willis: polycystic kidney, Ehlers-Danlos syndrome, some other connective tissue disease. (SAH-subarachnoid hemorrhage)
7. Angiomyolipoma: most often associated with tuberous sclerosis. ( a benign neoplasm of adipose tissue (lipoma) in which muscle cells and vascular structures are fairly conspicuous; most commonly a renal tumor containing smooth muscle)
8. Ankylosing Spondylitis: anterior uveitis+ aortic insufficiency+ third-degree heart block.
9. ADPKD (autosomal dominant polycystic kidney disease): hepatic cysts, MVP, aortic returgitation, colonic diverticula, abdominal wall and inguinal hernia. Aneurysm of circle of Willis.
10. Aldosterone deficiency: leads to a mild non-anionic gap adrenal failure (Addison’shyperkalemic, hyponatremic metabolic acidosis. (TB ↓ aldosteronedisease)
11. ARDS: associated with acute pancreatitis, sepsis (MCC), heroin overdose, near drowning, aspiration of gastric contents, severe trauma, severe burns, massive transfusion of blood, bone marrow and lung transplantation
12. Ataxia-telangiectasia: absence of IgA and IgE, choreoathetoid movements, slurred speech, ophthalmoplegia, progressive mental retardation. Predisposition for leukemias, brain cancer, GI cancer.
13. Autoimmune diseases : (eg. Hashimoto’s thyroiditis, myasthenia gravis)—benign and malignant thymomas.
14. Babesia microti: visit to woods on eastern seaboard beach, 1 week incubation time, blood smear demonstrate protozoa in RBCs.
15. Bacterial overgrowth (causing malabsorption syndrome): associated with a history of abdominal surgery.
16. Barrett’s esophagus (chronic GI reflux): esophageal adenocarcinoma
17. Basophilic stippling: thalassemias, lead or heavy metal poisoning. ~ are ribosomal precipitates which appears as blue granules of various sizes dispersed throughout the cytoplasm of the RBCs.
18. Behcet’s disease: autoimmune etiology and manifests with recurrent ulceration in the mouth (lips, palate, tongue) and genital area associated with uveitis.
19. Blueberry muffin sign:
• Café-au-lait spots
• Pulmonary embolism
• Adynamic ileus simulating bowel obstruction
• Polyhydrmnios
• Congenital rubella infection
• CMV infection
20. Budd-Chiari syndrome: pregnancy, polycythemia rubra vera, hepatocellular carcinoma.
21. Calcium oxalate crystals: (rectangular, envelope shaped crystals in urine) are seen in patients with ethylene glycol high anion gap metabolic acidosis.(anti-freeze) poinsoning.
22. Carcinoid: Niacin deficiency, pellagra.
23. Celiac sprue: dermatitis herpetiformis. A biopsy of the skin lesion reveals IgA deposits.
24. Charcot joint: (neuropathic joint) DM, syphilis and vit B12 deficiency. (severely deformed secondary to loss of innervation with proprioception or pain nerve fibers. This cuase the joint to be overused)
25. Chronic atrophic gastritis: Gastric adenocarcinoma, pernicious anemia
26. Chrug Strauss syndrome (CSS): leukotriene antagonists (i.e., zafirlukast) are known to cause CSS.
27. Cirrhosis (alhoholic, hep B or C): hepatocellular carcinoma
cuaneous28. CMV (cytomegalovirus) infection: in a newborn lesions, deaf, periventricular calcification (blueberry muffin baby)
29. Coccidioides infection: If the broads mention California or Arizona, it is significant and most likely indicates ~, which causes pulmonary infection as well as erythema nodosum in about 10% cases.
30. Cryoglobulinemia: purpura, GN, arhtralgias, hepatosplenomegaly, peripheral neuropathy, hypocomplementemia, hepatitis C.
31. Dermatitis herpetiformis: 24% of celiac disease associated with it.
32. Dermatomyositis: Heliotrope rash (periorbital edema with a purplish suffusion), Gottron’s sign (scaly patches over the dorsum of proximal interphalangeal and metacarpophalangeal joints-fairly unique to dermatomyositis), proximal muscle weakness
33. Duodenal atresia: double bubble sign on abdominal radiography, bilious vomiting. 30-40% associated with Down syndrome.
34. Diabetes mellitus: renal papillary necrosis
35. Down’s syndrome: ALL, AML, Alzheimer’s
36. Dysplastic nevus: malignant melanoma.
37. Eczema herpeticum: a form of primary HSV-1 infection associated with atopic dermatitis (eczema)
38. Emphema: secondary polycythmia. (least likely to have anemia)
39. Erythema chronicum migrans: Lyme disease. (rash started out as a small, red bump, and got larger over the next few days until it was roughly the diameter of a grapefruit, but the center clear up while the outside red part kept getting bigger.
40. Erythema multiforme: allergic (drug sensitivity), HSV infection, sometimes fatal (eg. Multiforme major or Stevens-Johnson syndrome.)
41. Erythema nodosum: coccidioides infection, sarcoidosis (inflammatory granulomas, EN often is the first presenting sings. DOC: steroid, mostly in U.S. and Europe), ulcerative colitis (P-ANCA +), TB (in parts of the world other than U.S. and Europe), recent streptococcal infection. (how the disase present: bilateral red, tender nodules on the extensor surfaces of the shins)
42. Felty’s syndrome: in adult with RA or SLE: polyarticular RA + splenomegaly + leg ulcers + leukopenia.
43. Friedreich Ataxia: associated with necrosis and degeneration of cardiac muscle fibers leading to myocarditis, myocardial fibrosis and cardiomyopathy. Cardiac arrhythmia and CHF contribute to a significant number of deaths. (T-wave inversion)
44. Germinoma: Parinaud’s syndrome and Collier’s sign, indicating a lesion in the rostral midbrain. (Parinaud’s: paralysis of vertical gaze—upward or downward gaze) Collier’s: papillary disturbances and eyelid retraction.
45. Hairy leukoplakia: manifestation of EBV infection in HIV/AIDS patients. Associated with oral SCC.
46. Harshimoto’s thyroiditis: at risk for developing thyroid lymphoma.
47. Hartnup syndrome: niacin deficiency (pellagra)
48. HCV: associated with 80% cases of mixed essential cryoglobulinemia. (crops of palpable purpura, biopsy of the purpura reveals leukocytoclastic vasculitis and IgM and C3 deposits around the small blood vessels.)
49. HELLP syndrome: thrombocytopenia + microangiopathic hemolytic anemia + increased liver enzymes in a patient with preeclampsia.
50. Helmet cells: are fragmented RBCs. Their presence is suggestive of traumatic hemolytic conditions: DIC, HUS and TTP.
51. Hemochromatosis: suspect it with new-onset DM, arhtropathy, and hepatomegaly.
52. Hepatic adenoma: a benign hepatocellular neoplasm associated with used of oral contraceptives and anabolic androgens.
53. Hepatocellular carcinoma: hepatitis B and C, Wilson’s disease, hemochromatosis, α1-antitrypsin deficiency, alcoholic cirrhosis, carcinogens (aflatoxin b1)
54. Hepatitis C: cryoglobulinemia
55. Homocystinuria: Marfan’s features + mental retardation + thromboembolic event + downward dislocation fo the lens. (AR caused by cystathionine synthase deficiency, Tx: high dose of Vit B6)
56. Hydatiform mole: classic snow storm appearance on ultrasound.
57. Hypercalcemia: as a paraneoplastic syndrome of head & neck SCC as well as SCC of the lung. (PTHrP)
58. IBD (ulcerative colitis or Crohn disease): pyoderma gangrenosum (a chronic, noninfective eruption of spreading, undermined ulcers showing central healing, with diffuse dermal neutrophil infiltration; often associated with ulcerative colitis and erythema nodosum.
59. Ig A nephropathy: celiac sprue, Henoch-Shonlein purpura. (systemic childhood disorder, onset follows URI, Ig A nephropathy, abdominal pain, GI bleeding, arthralgia, palpable purpura on legs/buttocks.)
60. Immunodeficiency states: malignant lymphomas
61. Infectious mononucleosis: associated with a characteristic polymorphous rash after taking ampicillin (amoxicillin) for an apparent upper respiratory tract infection.
62. Kawasaki syndrome: associated with MI in children younger than 10 yo. (coronary artery aneurysm and arteritis)
63. Lesch-Nyhan syndrome: gout, arthritis, nephrolithiasis, progressive renal failure, self-mutilative biting of the lips and fingers, choreoathetosis, and spasticity. (X-linked recessive), deficiency of HPRT (hypoxanthine phosphoribosyltransferase)
64. Legionella infection: pneumonia, hyponatremia, diarrhea plus CNS symptoms (headache, confusion etc) Tx: erythromycin.
65. Lichen planus: suspect hepatitis C infection.
66. MAOIs: no tyramine (wine or cheese etc), no meperidine, no sympathomimetic drugs (such as amphetamine), no SSRIs to avoid HTN crisis.
67. McCune-Albright syndrome: (precocious puberty, pigmentation and polyostotic fibrous dysplasia), associated with other endocrine disorders: hyperthyroidism, prolactin or GH- secreting pituitary adenomas, adrenal hypercortisolism (Cushing’s syndrome).
68. MEN I: pituitary adenoma+ parathyroid+ pancreatic tumor (Z-E syndrome)
69. MEN II: pheochromacytoma + medullary carcinoma of the thyroid (MTC), + hyperparathyroidism. The serum calcitonin level is elevated in patients with medullary thyroid cancer. Virtually 100% of patients with MENII have c-cell hyperplasia or MTC, 50% have pheo, and 20-30% have hyperparathyroidism.
70. MEN II: pheochromacytoma + medullary carcinoma of the thyroid + mucosal neuromas (oral and intestinal ganglioneuromatosis)
71. Metabolic acidosis in Diabetic ketoacidosis: associated with hyperkalemia.
72. Metabolic alkalosis: occurs in hemodialysis patients who receive citrate.
73. Molluscum contagiosum: the poxvirus causing mollcuscum contatiosum of humans. “multiple pearly papules on the skin”
74. Myasthenic syndrome(Eaton-Lambert syndrome): small-cell carcinoma, sometimes developing before the tumor is diagnosed.
75. Myotonic muscular dystrophy: endocrine manifestations include DM, testicular atrophy, frontal baldness and hypothyroidism. (chromosome 19)
76. risk of meningiomaNeurofibromatosis type I: & pheochromocytoma
77. Nephropathy associations:
• Hantanvirus—Mesangial GN
• HUS (hemolytic uremic syndrome)—narrowing of the capillary wall by fibrin deposition.
• Hepatitis B—Membranous, membranoproliferative, or mesangial proliferative GN
• Hepatitis C—Focal segmental glomerulosclerosis (classis lesion in IV drug abuser), membranous GN (also seen)
• HIV-focal segmental glomerulosclerosis (classic lesion), membranoproliferative GN or minimal change disease (less common)
• Hydatid—Mesangiocapillary GN, membranous GN
• Leishmaniasis—Mesangial or focal proliferative GN
• MCC of nephritic syndrome in Blacks--- FSGS
• Lupus nephritis—Anti-DsDNA antibodies are primarily involved in the pathogenesis of lupus nephritis.
• Shistosomiasis—Mesangial proliferative GN, focal segmental glomerulosclerosis, membranoproliferative GN, or membranous GN
• Syphilis—Membranous or difuse proliferative GN
• Skin pop drug abuser—amyloid nephropathy.
• Toxoplasmosis—Mesangioproliferative GN
78. Neurofibromatosis: harmartomas (nodular swelling in the irises), type 1 is associated with optic glioma.
79. Nummular dermatitis: “coin-shaped” or “discoid” skin lesion, a chronic inflammation of the skin. Tx: corticosteroids or antibiotics.
80. Paget’s disease of the bone: secondary oestosarcoma and fibrosarcoma (sarcomatous changes)
81. Pancreatic adenocarcinoma: Migratory thrombophlebitis (Trousseau’s syndrome)
82. Pancreatic calcification: chronic pancreatitis.
83. Panic attack: associated with agoraphobia (fear of leaving the house) in roughly incidence of depression, agoraphobia,half of the cases. Associated with generalized anxiety and substance abuse (extremely important) Tx: clonazepam
84. Parkinson’s disease: seborrheic dermatitis (characterized by dry scales with underlying erythema on the scalp, central face, presternal region, interscapular areas, umbilicus and body folds). Shy-Dragger syndrome.
85. Peutz-Jeghers syndrome: GI tract polyposis, mucocutaneous pigmentation, may also involve the development of an estrogen-secreting tumor--leading to precocious puberty. Not premalignant for colonic carcinoma, but is premalignant for lung, pancrease, breast, ovary and uterus etc.
86. Pickwickian syndrome: severe obesity + somnolence + general debility resulting from hypoventilation induced by the obesity. (hypercapnia, pulmonary HTN, or cor pulmonale can result)
87. Pigmented gallstones in youngs: most likely associated with hemolysis, such as sickle cell anemia.
88. Pinealoma: Parinaud’s syndrome and Collier’s sign, indicating a lesion in the rostral midbrain. (Parinaud’s: paralysis of vertical gaze—upward or downward gaze) Collier’s: papillary disturbances and eyelid retraction.
89. Plummer-Vinson syndrome(atrophic glossitis+esophageal webs+iron deficiency anemia): all due to iron deficiency, associated with esophageal SCC (squamous cell carcinoma)
90. Primary biliary cirrhosis: systemic sclerosis (scleroderma)
91. Porcelain gall bladder: predisposes individuals to gall bladder carcinoma and requires resection.
92. Postsurgical gastric remnant: pernicious anemia, gastric adenocarcinoma
93. Post-tramatic stress disorder (PTSD): is strongly associated with substance abuse, the prescribing of addictive medications like benzodiazepines should be avoided when possible.
94. Pseudogout: hyperparathyroidism, hemochromatosis, hypopohsphatasia, hypomagnesemia. (when present in patients <50 yo, should suspect these 4 Hs)
95. Pyloric stenosis: olive-shaped mass in the epigastric area. Projectile vomiting in the first 2-3 weeks of life. Male>female
96. Pyoderma gangrenosum: a chronic, noninfective eruption of spreading, undermined ulcers showing central healing, with diffuse dermal neutrophil infiltration; often associated with ulcerative colitis.
97. Reiter’s syndrome: (reactive arthritis+conjunctivitis+nongonococcal urethritis), Chlamydia, ureaplasma infection.
98. Renal cell carcinoma: polycythemia as paraneoplastic syndrome.
99. Renal papillary necrosis: DM, acute pyelonephritis, chronic phenacetin (an analgesic) use, sickle cell anemia. Obstruction.
100. Respiratory syncytial virus infection: ↑ risk of asthma later in life.
101. Sarcoidosis: erythema nodosum on the shins (multiple red nodules in the pretibial area bilaterally that are tender to palpation.)
102. Scarlet fever: sand paper rash.
103. Seborrheic dermatitis: suspect HIV infection in a young patient. Also associated with Parkinson’s disease.
104. Shy-Dragger syndrome: associated with Parkinsonism, orthostatic hypotension, impotence, incontinence, or other autonomic symptoms.
105. Sickle cell anemia: Howell-Jolly bodies (nuclear remnant of the RBCs which are generally removed by a functional spleen), therefore their presence in a peripheral smear suggests functional asplenia in sicle cell patients.
106. Signs :
• Ashman phenomenon: aberrant ventricular conduction of a beat ending a short cycle that is preceded by a longer cycle most commonly during atrial fibrillation.
• Beck’s triad: cardiac tamponade (JVD + muffled heart sound + hypotension)
• Brudzinskin’s sign: pain on neck flexion with meningeal irritation (meningitis)
• Charcot’s triad: fever or chills, jaundice, and RUQ pain with cholangitis.
• Chvostek’s sign: tappy on the facial nerve elicits tetany in hypocalcemia
• Coruvoisier’s sign: A painless, palpable gallbladder plus jaundice equals pancreatic cancer.
• Cullen’s sign: Bluish discoloration of periumbilical area from retroperitoneal hemorrhage (pancreatitis)
• Cushing’s reflex: HTN, bradycardia, and irregular respirations with high intracranial pressure.
• Duroziez Sign: systolic and or diastolic thrill or murmur heard over the femoral arteries (in aortic regurgitation).
• Finkelstein sign: pain reproduced by ulnar deviation to stretch the affected tendons in De Quervain’s tenosynovitis.
• Gottron sign: the patches on the dorsal aspect of inerphalangeal and emtacarpophalangeal joints as in dermatomyositis.
• Gower sign: use of limb muscles to assume an upright sitting position, with the patient using the hands to “walk” up the legs; seen in conditions of weak pelvic girdle and proximal leg muscles, i.e., Duchenne muscular dystrophy.
• Grey Turner’s sign: Bluish discoloration of flank from retroperitoneal hemorrhage (think pancreatitis)
• Homan’s sign: Calf pain on forced dorsiflexion of the foot with deep verous thrombosis.
• Kehr’s sign: pain in the left shoulder with a ruptured spleen.
• Kernig’s sign: when a subject is supine and the thigh is flexed to a right angle with the axis of the trunk, complete extension of the leg on the thigh is impossible; present in various forms of meningitis.
• Kussmaul sgin: in constrictive pericarditis, a paradoxical increase in venous distention and pressure or failure to collapse during inspiration; seen occasionally in effusive-constrictive pericarditis when tamponading pericardial fluid overlies a constricting epicarditis.
• Leriche’s syndrome: Claudication and atrophy of the buttocks with impotence (aortoiliac occlusive disease).
• McBurney’s sign: Tenderness at McBurney’s point with appendicitis
• Murphy’s sign: Arrest of inspiration when palpating under the rib cage on the right with cholecystitis.
• Ortolani’s sign/test: palpable or audible click in congenital hip dysplasia caused by abducting infant’s flexed hips.
• Prehn’s sign: Elevation of a painful testicle that relieves pain in epididymitis (versus testicular torsion)
• Rovsing’s sign: Pain at McBurney’s point in appendicitis that is caused by pushing on left lower quadrant.
• Tinel’s sign: Paresthesias in carpal tunnel syndrome elicited by tapping on the volar surface of the wrist.
• Trousseau’s sign: Carpopedal spasm (tetany) in hypocalcemia caused by pumping up a blood pressure cuff.
• Virchow’s sign: Stasis, endothelial damage, and hypercoagulability (deep venous thrombosis risk factors)
107. Small cell carcinoma of the lung: SIADH, Eaton-Lambert syndrome, Cushing’s syndrome (as paraneoplastic syndrome).
108. Streptococcus bovis endocarditis: associated with colorectal cancer, so colonoscopy is advisable in such patients.
109. Sturge-Weber diseae: mental retardation, seizures, visual impairment and a characteristic port-wine stain over the territory of the trigeminal nerve. Tx. of port-wine stains: pulsed dye laser.
110. Surreptitious vomiting: associated with hypokalemic alkalosis in a normotensive patient.
111. Tangier disease: orange-yellow tonsillar hyperplasia.
112. Temporal arteritis (giant cell arteristis): polymyalgia rheumatica.
113. Thyoma: myasthenia gravis
114. Tuberous sclerosis (facial angiofibroma, seizures, mental retardation): (ash leaf spots—hypopigmented lesions) Astrocytoma, cardiac rhabdomyoma, pulmonary harmartoma, angiomyolipomas. Retinal hamartoma Best Tx: ACTH (IM)
115. Tularemia: rabbit hunting and skinning. Tx of choice: streptomycin (inflamed papule on one finger, rapidly enlarges and then bursts, releasing pus and forming ulcer cavity, productive of thin, colorless exudates.
116. Ulcerative colitis: colonic adenocarcinoma, primary sclerosing cholangitis (beading on ERCP), erythema nodusum (+P-ANCA)-but this is more common in Crohn’s. UC associated with pyoderma gangrenosum.
117. Urinary retention: should make you think of cauda equine compression
118. Vitiligo: pernicious anemia, autoimmune thyroid disease, type I DM, primary adrenal insufficiency, hypopituitarism and alopecia areata.
119. Vit B1 (thiamine) deficiency: beriberi, Wernicke-Korsakoff syndrome. 120. Vit B2 (riboflavin) deficiency: edematous oropharyngeal mucous membranes, chelilitis, stomatitis, glossitis, normocytic-normochromic, seborrheic dermatitis, and photophobia.
121. von Hippel-Lindau syndrome: hemangioblastoma + angiomatous lesion of the retina (ataxia, cystic mass in the cerebellar hemisphere, a vascular tumor in the retina) autosomal recessive.
122. Wiskott-Aldrich syndrome: triad of thrombocytopenia, eczema and recurrent respiratory infection (B and T cell defect, X-linked recessive). Years later will show an increased risk of getting lymphoma (NHL, will occur in 12% of WAS patients), and ALL. Tx include: splenectomy, continous antibiotic therapy, IV immunoglobulin and BM tansplantation.
123. Xeroderma pigmentosum: melanoma and basal, squamous cell carcinoma of the skin
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