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
<PIP swelling secondary to osteophytes>
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
<Pale spots of peripheral iris>
Bruton's lines Lead poisoning
c-ANCA Wegener's granulomatosis
p-ANCA Polyarteritis nodosa
Caf-au-lait spots Neurofibromatosis
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),
orcholangitis (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
<facial mm spasm on tapping>
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
<coagulated exudates fr. Retinal
capillaries, white & fluffy>
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 Parkinson's disease (basal ggl. Disorder--
nigra rigidity, resting tremor, bradykinesia
Dermatitis + dementia + diarrhea Pellagra (niacin--vit B3 deficiency)
Diabetes insipidus + exophtlamos + Hand-Schueller-Christian disease
lesions of skull < a form of histiocytosis >
Dog or cat bite Pasteurella multocida
Donovan bodies Granuloma inguinale
<large mononuclear cells containing
Donovania granulomatis. Stain blue w/
pink capsules>
Elastic skin Ehlers-Danlos syndrome
Erythema chronicum migrans
Fat+female+fertile+forty
Fatty liver
Ferruginous bodies
Ghon focus
Gower's maneuver
Hair-on-end appearance on x-ray
Hampton's hump on x-ray
Hbs
Hcg elevated
Heberden's nodes
Heinz bodies
Heterophil antibodies
Hgb f
High-output cardiac failure (dilated
cardiomyopathy)
Hla-b27 [2]
Hla-dr3 or -dr4
Homer wright rosettes
Honeycomb lung on x-ray
Howell-jolly bodies
Hyperphagia + hypersexuality +
hyperorality + hyperdocility
Hyperpigmentation of skin
Hypersegmented pmns
Hypertension + hypokalemia
Hypochromatic microcytosis
Alpha fetoprotein in amniotic
fluid/maternal serum increased
Increased uric acid levels [4]
Intussuception
Janeway lesions
Jarisch-herxheimer reaction
Kaposi's sarcoma
Kayser-fleischer rings
Keratin pearls
Kimmelstiel-wilson nodules
Lyme disease
Acute cholecystitis
Alcoholism
Asbestosis
Primary tuberculosis
Duchenne's MD
Beta thalassemia
Pulmonary embolism<convex opacity next
to chest wall or diaphragm>
Sickle cell anemia
Choriocarcinoma (testicular cancer),
multiple pregnancy, hyatidiform mole
Osteoarthritis < DIP swelling secondary to
osteophytes>
G6PD deficiency < refractile granules in
rbcs>
Infectious mononucleosis (EBV)
Thalassemia major
Wet beri-beri (thiamine--vit B1 deficiency)
Reiter's syndrome, ankylosing spondylitis
T1dm
Neuroblastoma
Interstitial fibrosis
Splenectomy or nonfunctional spleen
<small round nuclear remnants in rbcs>
Kluever-Bucy syndrome (amygdala)
Primary adrenal insufficiency (Addison's
disease
Macrocytic anemia
Cushing's & Conn's syndromes
Iron-deficiency anemia
Anencephaly, spina bifida
Gout, Lesch-Nyhan syndromes,
myeloproliferative disorders, loop and
thiazine diuretics
Adenovirus (cause hyperplasia of Peyer's
patches)
Endocarditis
<small hemorrhagic lesions in palms or
soles>
Syphilis: overaggressive treatment of an
asymptomatic pt. Causing symptoms due to
rapid lysis
Homosexual AIDS pts. (not assoc'd w/
IVDA-acquired HIV/AIDS)
Wilson's disease
Squamous cell carcinoma
Diabetic nephropathy
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 + Marfan's syndrome (fibrillin deficit)
joint hyperflexibility
Lewy bodies Parkinson's disease (basal ggl. Disorder--
rigidity, resting tremor, bradykinesia
Lines of zahn Arterial thrombus
<striations on surface of blood clot, due to
layers of platelets>
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 Poststreptococcal glomerulonephritis
on if
Lytic bone lesions on x-ray Multiple myeloma
Mallory bodies Alcoholic liver disease
<large accum. Of eosinophilic material in
damaged liver cells>
Mcburney's sign Appendicitis
Mlf syndrome (ino) Ms

Monoclonal ab spike [3] Multiple myeloma (M protein, usu. Igg or

Myxedema
Necrotizing vasculitis (lungs) &
necrotizing glomerulitis
Needle-shaped, negatively birefringent
crystals
Negri bodies
Nephritis + cataracts + hearing loss
Neurofibrillary tangles
No lactation postpartum
Nutmeg liver
Occupational exposure to asbestos
Orphan annie nuclei
Osler's nodes
Owl's eye
Painless jaundice
Palpable purpura on legs & buttocks
Pannus
Periosteal elevation on x-ray
Philadelphia chromosome (bcr:abl)
IgA), MGUS, Waldenstroem's
macroglobulinemia (IgM)
Hypothyroidism
Wegener's and Goodpasture's (hemoptysis
& glomerular disease)
Gout
Rabies
<abnormal bodies w/in nerve cells>
Alport's syndrome
Alzheimer's disease
Sheehan's syndrome
CHF
Malignant mesothelioma
Papillary carcinoma of the thyroid
Subacute endocarditis
<small, tender, discolored node on pads of
fingers & toes>
Cytomegalo virus
Pancreatic cancer (head)
Henoch-Schoenlein purpura
<purpura: spont. Bleeding in subcut.
Tissues>
Rheumatoid arthritis
<infiltration of cornea w/ blood vessels>
Pyogenic osteomyelitis
CML (occasionally AML, as well)
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. Guillan-barre
Infex
Polyneuropathy, cardiac pathology, Dry beri-beri (thiamine, B1 def.)
edema
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. Cystic fibrosis
Aureus infex
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 Von Hippel-Lindau disease
hemangioma + adenomas
Renal epithelial casts in urine Acute toxic/viral nephrosis
Rhomboid crystals, positively Pseudogout
birefringent
Rib notching Coarctation of aorta
Roth spots in retina Endocarditis
Roleaux formation Multiple myeloma
Russell bodies Multiple myeloma
<globular intracytoplasmic deposits of
acidophilic material w/in plasma cells>
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
<cutaneous malformation w/ large
epithelial-like cells>
Splinter hemorrhages in fingernails Endocarditis
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 Poststreptococcal glomerulonephritis
tissue
Suboccipital lymphadenopathy Rubella
Sulfur granules Actinomyces israelii
Swollen gums, bruising, poor wound Scurvy (ascorbic acid, vitamin C
healing, anemia deficiency) - vit. C is necessary for
hydroxylation of proline and lysine in
collagen synthesis
Systolic ejection murmur (crescendo- Aortic valve stenosis
decrescendo)
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 caf-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 + Sjogren's syndrome

keratoconjunctivitis Sicca
Zenker's diverticulum > Upper GI diverticulum
Zollinger-ellison syndrome Gastrin-secreting tumor associated with
ulcers
Deletion on chromosome 13 Retinoblastoma
Thrombocytopenia & eczema & Wiskott-Aldrich syndrome
recurrent infex
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 Pseudomonas infex
fibrosis
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
Pizz allele Homozygous defect in a1-antitrypsin
 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 Fibrosarcoma
pattern
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 Prostatic carcinoma
psa
Increased total psa, no change in % free Bph
psa
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 & Pseudohypoparathyroidism (AR)
metatarsals
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 Middle cerebral a.
thrombosis/embolism
Maternal folic acid deficiency Fetal neural tube defects
Mc cause of intracerebral hemorrhage Htn
Mc site of intracerebral hemorrhage Basal ggl & thalamus