1.

"Soap bubble" in femur or Giant cell tumor of bone (generally benign)

tibia on x-ray

2. "Spikes" on basement Membranous nephropathy (nephrotic syndrome)

membrane, "dome-like"
subepithelial deposits
3. Stacks of RBCs Rouleaux formation (high ESR, multiple myeloma)

4. "Steeple" sign on frontal Croup (parainfluenza virus)

CXR
5. Stippled vaginal epithelial "Clue cells" (Gardnerella vaginalis)
cells

6. Streptococcus bovis Colon cancer

bacteremia
7. "Tennis racket"-shaped Birbeck granules (Langerhans cell histiocytosis)
cytoplasmic organelles (EM)
in Langerhans cells

8. Thousands of polyps on Familial adenomatous polyposis (autosomal dominant,

colonoscopy mutation of APC gene)
9. Thrombi made of white/red Lines of Zahn (arterial thrombus, layers of platelets/RBCs)
layers

10. "Thumb sign" on lateral neck Epiglottitis (Haemophilus influenza)

x-ray
11. Thyroid-like appearance of Chronic pyelonephritis (usually due to recurrent infections)
kidney

12. "Tram-track" appearance of Membranoproliferative glomerulonephritis

capillary loops of glomerular
basement membranes on
light microscopy

13. Triglyceride accumulation in Fatty liver disease (alcoholic or metabolic syndrome)

liver cell vacuoles

14. increased uric acid levels Gout, Lesch-Nyhan syndrome, tumor lysis syndrome, loop
and thiazide diuretics
15. "Waxy" casts with very low Chronic end-stage renal disease
urine flow

16. WBC casts in urine Acute pyelonephritis

17. WBCs that look "smudged" CLL (almost always B cell)

18. "Wire loop" glomerular Diffuse proliferative glomerulonephritis (usually seen with
capillary appearance on light lupus)
microscopy
19. Yellowish CSF Xanthochromia (eg, due to subarachnoid hemorrhage)s

20. Low serum ceruloplasmin Wilson disease (hepatolenticular degeneration)

21. "Lumpy bumpy" appearance Poststreptococcal glomerulonephritis (due to deposition of
of glomeruli on IgG, IgM, and C3)
immunofluorescence

22. Lytic ("punched-out") bone Multiple myeloma

lesions on x-ray
23. Mammary gland ("blue Fibrocystic change of the breast
domed") cyst
24. Monoclonal antibody spike Multiple myeloma (usually IgG or IgA), Monoclonal
gammopathy of undetermined significance (MGUS
consequence of aging), Waldenström (M protein = IgM)
macroglobulinemia, Primary amyloidosis

25. Mucin- filled cell with "Signet ring" (gastric carcinoma)

peripheral nucleus
26. Narrowing of bowel lumen "String sign" (Crohn disease)
on barium x-ray

27. Necrotizing vasculitis (lungs) Granulomatosis with polyangiitis (Wegener; PR3-ANCA/ c-

and necrotizing ANCA) and Goodpasture syndrome (anti-basement
glomerulonephritis membrane antibodies)

28. Needle-shaped, ⊝ Gout (monosodium urate crystals)

birefringent crystals
29. Nodular hyaline deposits in Kimmelstiel-Wilson nodules (diabetic nephropathy)
glomeruli

30. Novobiocin response Sensitive: S epidermidis; resistant: S saprophyticus

31. "Nutmeg" appearance of Chronic passive congestion of liver due to right heart failure
liver or Budd-Chiari syndrome
32. "Onion skin" periosteal Ewing sarcoma (malignant small blue cell tumor)
reaction

33. Optochin response Sensitive: S pneumoniae; resistant: viridans streptococci (S

mutans, S sanguis)

34. Podocyte fusion or Minimal change disease (child with nephrotic syndrome)
"effacement" on electron
microscopy
35. Polished, "ivory-like" Eburnation (osteoarthritis resulting in bony sclerosis)
appearance of bone at
cartilage erosion

36. Protein aggregates in Neurofibrillary tangles (Alzheimer disease) and Pick bodies
neurons from (Pick disease)
hyperphosphorylation of tau
protein
37. Psammoma bodies Meningiomas, papillary thyroid carcinoma, mesothelioma,
papillary serous carcinoma of the endometrium and ovary

38. Pseudopalisading tumor Glioblastoma multiforme

cells on brain biopsy
39. Raised periosteum (creating Aggressive bone lesion (eg, osteosarcoma, Ewing
a "Codman triangle") sarcoma, osteomyelitis)
40. RBC casts in urine Glomerulonephritis

41. Rectangular, crystal-like, Reinke crystals (Leydig cell tumor)

cytoplasmic inclusions in
Leydig cells

42. Recurrent infections, Wiskott-Aldrich syndrome

eczema, thrombocytopenia

43. Renal epithelial casts in Intrinsic renal failure (eg, ischemia or toxic injury)
urine
44. Rhomboid crystals, ⊕ Pseudogout (calcium pyrophosphate dihydrate crystals)
birefringent
45. Rib notching (inferior Coarctation of the aorta (Turner's syndrome)
surface, on x-ray)
46. Ring-enhancing brain lesion Toxoplasma gondii, CNS lymphoma
on CT/MRI in AIDS
47. Sheets of medium-sized Burkitt lymphoma (t[8:14] c-myc activation, associated with
lymphoid cells with scattered EBV; "starry sky" made up of malignant cells)
pale, tingible body-laden
macrophages ("starry sky"
histology)

48. Silver-staining spherical Pick bodies (Pick disease: progressive dementia, changes
aggregation of tau proteins in personality)
in neurons
49. Disarrayed granulosa cells Call-Exner bodies (granulosa cell tumor of the ovary)
arranged around collections
of eosinophilic fluid

50. Dysplastic squamous Koilocytes (HPV: predisposes to cervical cancer)

cervical cells with "raisinoid"
nuclei and hyperchromasia
51. Electrical alternans Pericardial tamponade
(alternating amplitude on
EKG)

52. Enlarged cells with "Owl eye" appearance of CMV

intranuclear inclusion bodies
53. Enlarged thyroid cells with "Orphan Annie" eyes nuclei (papillary carcinoma of the
ground-glass nuclei with thyroid)
central clearing

54. Eosinophilic cytoplasmic Mallory body (alcoholic liver disease)

inclusion in liver cell
55. Eosinophilic cytoplasmic Lewy body (Parkinson disease and Lewy body dementia)
inclusion in neuron

56. Eosinophilic globule in liver Councilman body (viral hepatitis, yellow fever), represents
hepatocyte undergoing apoptosis
57. Eosinophilic inclusion bodies Negri bodies of rabies
in cytoplasm of hippocampal
and cerebellar neurons

58. Extracellular amyloid Senile plaques (Alzheimer disease)

deposition in gray matter of
brain
59. Giant B cells with bilobed Reed-Sternberg cells (Hodgkin lymphoma) ("owl's eye")
nuclei with prominent
inclusions

60. Glomerulus-like structure Schiller-Duval bodies (yolk sac tumor)

surrounding vessel in germ
cells
61. "Hair on end" ("Crew-cut") β-thalassemia, sickle cell disease (marrow expansion)
appearance on x-ray

62. hCG elevated Choriocarcinoma, hydatidiform mole (occurs with and

without embryo, and multiple pregnancy)

63. Heart nodules Aschoff bodies (rheumatic fever)

(granulomatous)
64. Heterophile antibodies Infectious mononucleosis (EBV)

65. Hexagonal, double-pointed, Bronchial asthma (Charcot-Leyden crystals: eosinophilic

needle-like crystals in granules)
bronchial secretions

66. High level of d-dimers DVT, PE, DIC

67. Hilar lymphadenopathy, Ghon complex (1° TB: Mycobacterium bacilli)
peripheral granulomatous
lesion in middle or lower
lung lobes (can calcify)

68. "Honeycomb lung" on x-ray Interstitial pulmonary brosis

or CT
69. Hypercoagulability (leading Trousseau syndrome (adenocarcinoma of pancreas or
to migrating DVTs and lung)
vasculitis)

70. Hypersegmented Megaloblastic anemia (B12 deficiency: neurologic

neutrophils symptoms; folate deficiency: no neurologic symptoms)
71. Hypertension, hypokalemia, 1° hyperaldosteronism (Conn syndrome)
metabolic alkalosis

72. Hypochromic, microcytic Iron deficiency anemia, lead poisoning, thalassemia (fetal
anemia hemoglobin sometimes present)
73. Intranuclear eosinophilic Cowdry type A bodies (HSV or VZV)
droplet-like bodies

74. Iron-containing nodules in Ferruginous bodies (asbestosis: chance of mesothelioma)

alveolar septum
75. Keratin pearls on a skin Squamous cell carcinoma
biopsy

76. Large granules in Chédiak-Higashi disease (congenital failure of

phagocytes, phagolysosome formation)
immunodeficiency
77. "Lead pipe" appearance of Ulcerative colitis (loss of haustra)
colon on abdominal imaging
78. Linear appearance of IgG Goodpasture syndrome
deposition on glomerular
and alveolar basement
membranes

79. Antineutrophil cytoplasmic Microscopic polyangiitis and eosinophilic granulomatosis

antibodies (ANCAs) with polyangiitis (Churg-Strauss syndrome) (MPO-ANCA/p-
ANCA); granulomatosis with polyangiitis (Wegener; PR3-
ANCA/c-ANCA)

80. Antinuclear antibodies SLE (type III hypersensitivity)

(ANAs: anti-Smith and anti-
dsDNA)
81. Antiplatelet antibodies Idiopathic thrombocytopenic purpura

82. Anti-topoisomerase Diffuse systemic scleroderma

antibodies

83. Anti-transglutaminase/anti- Celiac disease (diarrhea, weight loss)

gliadin/anti-endomysial
antibodies
84. "Apple core" lesion on Colorectal cancer (usually left-sided)
barium enema x-ray

85. Atypical lymphocytes EBV

86. Azurophilic peroxidase ⊕ Auer rods (AML, especially the promyelocytic [M3] type)
granular inclusions in and myeloblasts
granulocytes

87. Bacitracin response Sensitive: S pyogenes (group A); resistant: S agalactiae

(group B)

88. "Bamboo spine" on x-ray Ankylosing spondylitis (chronic in ammatory arthritis: HLA-
B27)
89. Basophilic nuclear remnants Howell-Jolly bodies (due to splenectomy or nonfunctional
in RBCs spleen)

90. Basophilic stippling of RBCs Lead poisoning or sideroblastic anemia

91. Bloody or yellow tap on Subarachnoid hemorrhage
lumbar puncture

92. "Boot-shaped" heart on x- Tetralogy of Fallot (due to RVH)

ray
93. Branching gram ⊕ rods with Actinomyces israelii
sulfur granules

94. Bronchogenic apical lung Pancoast tumor (can compress cervical sympathetic chain
tumor on imaging and cause Horner syndrome)

95. "Brown" tumor of bone Hyperparathyroidism or osteitis fibrosa cystica (deposited

hemosiderin from hemorrhage gives brown color)
96. Cardiomegaly with apical Chagas disease (Trypanosoma cruzi)
atrophy
97. Cellular crescents in Rapidly progressive crescentic glomerulonephritis
Bowman capsule

98. "Chocolate cyst" of ovary Endometriosis (frequently involves both ovaries)

99. Circular grouping of dark Homer-Wright rosettes (neuroblastoma, medulloblastoma)
tumor cells surrounding pale
neurofibrils

100. Colonies of mucoid Cystic fibrosis (autosomal recessive mutation in CFTR

Pseudomonas in lungs gene --> fat-soluble vitamin deficiency and mucous plugs)

101. Decreased AFP in amniotic Down syndrome or other chromosomal abnormalities

fluid/maternal serum

102. Degeneration of dorsal Tabes dorsalis (3° syphilis), subacute combined

column fibers degeneration (dorsal columns, lateral corticospinal,
spinocerebellar tracts affected)
103. "Delta wave" on EKG, short Wolff-Parkinson-White syndrome (Bundle of Kent bypasses
PR interval, supraventricular AV node)
tachycardia

104. Depigmentation of neurons Parkinson disease (basal ganglia disorder: rigidity, resting
in substantia nigra tremor, bradykinesia)
105. Desquamated epithelium Curschmann spirals (bronchial asthma; can result in
casts in sputum whorled mucous plugs)

106. Increased AFP in amniotic Dating error, anencephaly, spina bifida (neural tube defects)
fluid/maternal serum

107. Anticentromere antibodies Scleroderma (CREST)

108. Anti-desmoglein (anti- Pemphigus vulgaris (blistering)
desmosome) antibodies

109. Anti-glomerular basement Goodpasture syndrome (glomerulonephritis and

membrane antibodies hemoptysis)

110. Antihistone antibodies Drug-induced SLE (eg, hydralazine, isoniazid, phenytoin,

procainamide)
111. Anti-IgG antibodies Rheumatoid arthritis (systemic inflammation, joint pannus,
boutonnière deformity)

112. Antimitochondrial antibodies 1° biliary cirrhosis (female, cholestasis, portal hypertension)

(AMAs)

113. Leser-Trélat sign (Sudden GI adenocarcinomas and other visceral malignancies

onset of multiple seborrheic
keratoses)
114. Sister Mary Joseph nodule subcutaneous periumbilical metastasis from gastric
carcinoma (usually intestinal type)

115. Virchow nodule involvement of left supraclavicular node by metastasis from

stomach
116. Palpable olive mass Pyloric stenosis
117. Bird's beak (on barium Achalasia
swallow)

118. Hour glass appearance Hiatal hernia

119. Stellate granulomas on Bartonella henselae (cat scratch disease)
lymph node biopsy

120. Target cells HbC Disease, Asplenia, Liver Disease, Thalassemia

121. Spherocyte Hereditary spherocytosis, drug- and infection- induced
hemolytic anemia
122. Sickle cell Sickle cell anemia (sickling occurs with dehydration,
deoxygenation, and at high altitude)

123. Schistocyte DIC, TTP/HUS, HELLP syndrome, mechanical hemolysis

124. Ringed sideroblast Sideroblastic anemia (excess iron in mitochondria)

125. Macro-ovalocyte Megaloblastic anemia (also see hyperhsegmented PMNs),

marrow failure
126. Elliptocyte Hereditary elliptocytosis (usually asymptomatic; caused by
mutation in genes encoding RBC membrane proteins, e.g.
spectrin)

127. Echinocyte (burr cell) End stage renal disease, liver disease, pyruvate kinase
deficiency
128. Dacrocyte (teardrop cell) Bone marrow infiltration (e.g. myelofibrosis)

129. Degmacyte (bite cell) G6PD deficiency

130. Basophilic stippling Lead poisoning, sideroblastic anemia, myelodysplastic
syndromes

131. Acanthocyte (spur cell) Liver disease, abetalipoproteinemia (states of cholesterol

dysregulation)
132. Heinz bodies G6PD deficiency (oxidation of Hb -SH groups to -S--S-
leads to Hb precipitation. Subsequent phagocytic damage
to RBCs membrane leads to bite cells)

133. Howell-Jolly bodies Patients with functional hyposplenia or asplenia (they are
basophilic nuclear remnants found in RBCs that are
normally removed from RBCs by splenic macrophages)
134. Serum Ca2+, phosphorus, Paget disease of the bone
and PTH levels normal.
Increased ALP

135. Normal bone mineralization Osteoporosis

and lab values but T-score
</= -2.5

136. Decreased vitamin D, Osteomalacia

decreased serum Ca2+,
Increased PTH, decreased
PO43-, Increased ALP

137. Anti-cyclic citrullinated Rheumatoid Arthritis

peptide antibody

138. CD55/59 negative Paroxysmal Nocturnal Hemoglobinuria

139. "Soap bubble" in femur or Giant cell tumor of bone (generally benign)
tibia on x-ray

140. "Spikes" on basement Membranous nephropathy (nephrotic syndrome)

membrane, "dome-like"
subepithelial deposits
141. Stacks of RBCs Rouleaux formation (high ESR, multiple myeloma)

142. "Steeple" sign on frontal Croup (parainfluenza virus)

CXR
143. Stippled vaginal epithelial "Clue cells" (Gardnerella vaginalis)
cells

144. Streptococcus bovis Colon cancer

bacteremia
145. "Tennis racket"-shaped Birbeck granules (Langerhans cell histiocytosis)
cytoplasmic organelles (EM)
in Langerhans cells

146. Thousands of polyps on Familial adenomatous polyposis (autosomal dominant,

colonoscopy mutation of APC gene)
147. Thrombi made of white/red Lines of Zahn (arterial thrombus, layers of platelets/RBCs)
layers

148. "Thumb sign" on lateral neck Epiglottitis (Haemophilus influenza)

x-ray
149. Thyroid-like appearance of Chronic pyelonephritis (usually due to recurrent infections)
kidney

150. "Tram-track" appearance of Membranoproliferative glomerulonephritis

capillary loops of glomerular
basement membranes on
light microscopy

151. Triglyceride accumulation in Fatty liver disease (alcoholic or metabolic syndrome)

liver cell vacuoles

152. increased uric acid levels Gout, Lesch-Nyhan syndrome, tumor lysis syndrome, loop
and thiazide diuretics
153. "Waxy" casts with very low Chronic end-stage renal disease
urine flow

154. WBC casts in urine Acute pyelonephritis

155. WBCs that look "smudged" CLL (almost always B cell)

156. "Wire loop" glomerular Diffuse proliferative glomerulonephritis (usually seen with
capillary appearance on light lupus)
microscopy
157. Yellowish CSF Xanthochromia (eg, due to subarachnoid hemorrhage)s

158. Low serum ceruloplasmin Wilson disease (hepatolenticular degeneration)

159. "Lumpy bumpy" appearance Poststreptococcal glomerulonephritis (due to deposition of
of glomeruli on IgG, IgM, and C3)
immunofluorescence

160. Lytic ("punched-out") bone Multiple myeloma

lesions on x-ray
161. Mammary gland ("blue Fibrocystic change of the breast
domed") cyst
162. Monoclonal antibody spike Multiple myeloma (usually IgG or IgA), Monoclonal
gammopathy of undetermined significance (MGUS
consequence of aging), Waldenström (M protein = IgM)
macroglobulinemia, Primary amyloidosis

163. Mucin- filled cell with "Signet ring" (gastric carcinoma)

peripheral nucleus
164. Narrowing of bowel lumen "String sign" (Crohn disease)
on barium x-ray

165. Necrotizing vasculitis (lungs) Granulomatosis with polyangiitis (Wegener; PR3-ANCA/ c-

and necrotizing ANCA) and Goodpasture syndrome (anti-basement
glomerulonephritis membrane antibodies)

166. Needle-shaped, ⊝ Gout (monosodium urate crystals)

birefringent crystals
167. Nodular hyaline deposits in Kimmelstiel-Wilson nodules (diabetic nephropathy)
glomeruli

168. Novobiocin response Sensitive: S epidermidis; resistant: S saprophyticus

169. "Nutmeg" appearance of Chronic passive congestion of liver due to right heart failure
liver or Budd-Chiari syndrome
170. "Onion skin" periosteal Ewing sarcoma (malignant small blue cell tumor)
reaction

171. Optochin response Sensitive: S pneumoniae; resistant: viridans streptococci (S

mutans, S sanguis)

172. Podocyte fusion or Minimal change disease (child with nephrotic syndrome)
"effacement" on electron
microscopy
173. Polished, "ivory-like" Eburnation (osteoarthritis resulting in bony sclerosis)
appearance of bone at
cartilage erosion

174. Protein aggregates in Neurofibrillary tangles (Alzheimer disease) and Pick bodies
neurons from (Pick disease)
hyperphosphorylation of tau
protein
175. Psammoma bodies Meningiomas, papillary thyroid carcinoma, mesothelioma,
papillary serous carcinoma of the endometrium and ovary

176. Pseudopalisading tumor Glioblastoma multiforme

cells on brain biopsy
177. Raised periosteum (creating Aggressive bone lesion (eg, osteosarcoma, Ewing
a "Codman triangle") sarcoma, osteomyelitis)
178. RBC casts in urine Glomerulonephritis

179. Rectangular, crystal-like, Reinke crystals (Leydig cell tumor)

cytoplasmic inclusions in
Leydig cells

180. Recurrent infections, Wiskott-Aldrich syndrome

eczema, thrombocytopenia

181. Renal epithelial casts in Intrinsic renal failure (eg, ischemia or toxic injury)
urine
182. Rhomboid crystals, ⊕ Pseudogout (calcium pyrophosphate dihydrate crystals)
birefringent
183. Rib notching (inferior Coarctation of the aorta (Turner's syndrome)
surface, on x-ray)
184. Ring-enhancing brain lesion Toxoplasma gondii, CNS lymphoma
on CT/MRI in AIDS
185. Sheets of medium-sized Burkitt lymphoma (t[8:14] c-myc activation, associated with
lymphoid cells with scattered EBV; "starry sky" made up of malignant cells)
pale, tingible body-laden
macrophages ("starry sky"
histology)

186. Silver-staining spherical Pick bodies (Pick disease: progressive dementia, changes
aggregation of tau proteins in personality)
in neurons
187. Disarrayed granulosa cells Call-Exner bodies (granulosa cell tumor of the ovary)
arranged around collections
of eosinophilic fluid

188. Dysplastic squamous Koilocytes (HPV: predisposes to cervical cancer)

cervical cells with "raisinoid"
nuclei and hyperchromasia
189. Electrical alternans Pericardial tamponade
(alternating amplitude on
EKG)

190. Enlarged cells with "Owl eye" appearance of CMV

intranuclear inclusion bodies
191. Enlarged thyroid cells with "Orphan Annie" eyes nuclei (papillary carcinoma of the
ground-glass nuclei with thyroid)
central clearing

192. Eosinophilic cytoplasmic Mallory body (alcoholic liver disease)

inclusion in liver cell
193. Eosinophilic cytoplasmic Lewy body (Parkinson disease and Lewy body dementia)
inclusion in neuron

194. Eosinophilic globule in liver Councilman body (viral hepatitis, yellow fever), represents
hepatocyte undergoing apoptosis
195. Eosinophilic inclusion bodies Negri bodies of rabies
in cytoplasm of hippocampal
and cerebellar neurons

196. Extracellular amyloid Senile plaques (Alzheimer disease)

deposition in gray matter of
brain
197. Giant B cells with bilobed Reed-Sternberg cells (Hodgkin lymphoma) ("owl's eye")
nuclei with prominent
inclusions

198. Glomerulus-like structure Schiller-Duval bodies (yolk sac tumor)

surrounding vessel in germ
cells
199. "Hair on end" ("Crew-cut") β-thalassemia, sickle cell disease (marrow expansion)
appearance on x-ray

200. hCG elevated Choriocarcinoma, hydatidiform mole (occurs with and

without embryo, and multiple pregnancy)

201. Heart nodules Aschoff bodies (rheumatic fever)

(granulomatous)
202. Heterophile antibodies Infectious mononucleosis (EBV)

203. Hexagonal, double-pointed, Bronchial asthma (Charcot-Leyden crystals: eosinophilic

needle-like crystals in granules)
bronchial secretions

204. High level of d-dimers DVT, PE, DIC

205. Hilar lymphadenopathy, Ghon complex (1° TB: Mycobacterium bacilli)
peripheral granulomatous
lesion in middle or lower
lung lobes (can calcify)

206. "Honeycomb lung" on x-ray Interstitial pulmonary brosis

or CT
207. Hypercoagulability (leading Trousseau syndrome (adenocarcinoma of pancreas or
to migrating DVTs and lung)
vasculitis)

208. Hypersegmented Megaloblastic anemia (B12 deficiency: neurologic

neutrophils symptoms; folate deficiency: no neurologic symptoms)
209. Hypertension, hypokalemia, 1° hyperaldosteronism (Conn syndrome)
metabolic alkalosis

210. Hypochromic, microcytic Iron deficiency anemia, lead poisoning, thalassemia (fetal
anemia hemoglobin sometimes present)
211. Intranuclear eosinophilic Cowdry type A bodies (HSV or VZV)
droplet-like bodies

212. Iron-containing nodules in Ferruginous bodies (asbestosis: chance of mesothelioma)

alveolar septum
213. Keratin pearls on a skin Squamous cell carcinoma
biopsy

214. Large granules in Chédiak-Higashi disease (congenital failure of

phagocytes, phagolysosome formation)
immunodeficiency
215. "Lead pipe" appearance of Ulcerative colitis (loss of haustra)
colon on abdominal imaging
216. Linear appearance of IgG Goodpasture syndrome
deposition on glomerular
and alveolar basement
membranes

217. Antineutrophil cytoplasmic Microscopic polyangiitis and eosinophilic granulomatosis

antibodies (ANCAs) with polyangiitis (Churg-Strauss syndrome) (MPO-ANCA/p-
ANCA); granulomatosis with polyangiitis (Wegener; PR3-
ANCA/c-ANCA)

218. Antinuclear antibodies SLE (type III hypersensitivity)

(ANAs: anti-Smith and anti-
dsDNA)
219. Antiplatelet antibodies Idiopathic thrombocytopenic purpura

220. Anti-topoisomerase Diffuse systemic scleroderma

antibodies

221. Anti-transglutaminase/anti- Celiac disease (diarrhea, weight loss)

gliadin/anti-endomysial
antibodies
222. "Apple core" lesion on Colorectal cancer (usually left-sided)
barium enema x-ray

223. Atypical lymphocytes EBV

224. Azurophilic peroxidase ⊕ Auer rods (AML, especially the promyelocytic [M3] type)
granular inclusions in and myeloblasts
granulocytes

225. Bacitracin response Sensitive: S pyogenes (group A); resistant: S agalactiae

(group B)

226. "Bamboo spine" on x-ray Ankylosing spondylitis (chronic in ammatory arthritis: HLA-
B27)
227. Basophilic nuclear remnants Howell-Jolly bodies (due to splenectomy or nonfunctional
in RBCs spleen)

228. Basophilic stippling of RBCs Lead poisoning or sideroblastic anemia

229. Bloody or yellow tap on Subarachnoid hemorrhage
lumbar puncture

230. "Boot-shaped" heart on x- Tetralogy of Fallot (due to RVH)

ray
231. Branching gram ⊕ rods with Actinomyces israelii
sulfur granules

232. Bronchogenic apical lung Pancoast tumor (can compress cervical sympathetic chain
tumor on imaging and cause Horner syndrome)

233. "Brown" tumor of bone Hyperparathyroidism or osteitis fibrosa cystica (deposited

hemosiderin from hemorrhage gives brown color)
234. Cardiomegaly with apical Chagas disease (Trypanosoma cruzi)
atrophy
235. Cellular crescents in Rapidly progressive crescentic glomerulonephritis
Bowman capsule

236. "Chocolate cyst" of ovary Endometriosis (frequently involves both ovaries)

237. Circular grouping of dark Homer-Wright rosettes (neuroblastoma, medulloblastoma)
tumor cells surrounding pale
neurofibrils

238. Colonies of mucoid Cystic fibrosis (autosomal recessive mutation in CFTR

Pseudomonas in lungs gene --> fat-soluble vitamin deficiency and mucous plugs)

239. Decreased AFP in amniotic Down syndrome or other chromosomal abnormalities

fluid/maternal serum

240. Degeneration of dorsal Tabes dorsalis (3° syphilis), subacute combined

column fibers degeneration (dorsal columns, lateral corticospinal,
spinocerebellar tracts affected)
241. "Delta wave" on EKG, short Wolff-Parkinson-White syndrome (Bundle of Kent bypasses
PR interval, supraventricular AV node)
tachycardia

242. Depigmentation of neurons Parkinson disease (basal ganglia disorder: rigidity, resting
in substantia nigra tremor, bradykinesia)
243. Desquamated epithelium Curschmann spirals (bronchial asthma; can result in
casts in sputum whorled mucous plugs)

244. Increased AFP in amniotic Dating error, anencephaly, spina bifida (neural tube defects)
fluid/maternal serum

245. Anticentromere antibodies Scleroderma (CREST)

246. Anti-desmoglein (anti- Pemphigus vulgaris (blistering)
desmosome) antibodies

247. Anti-glomerular basement Goodpasture syndrome (glomerulonephritis and

membrane antibodies hemoptysis)

248. Antihistone antibodies Drug-induced SLE (eg, hydralazine, isoniazid, phenytoin,

procainamide)
249. Anti-IgG antibodies Rheumatoid arthritis (systemic inflammation, joint pannus,
boutonnière deformity)

250. Antimitochondrial antibodies 1° biliary cirrhosis (female, cholestasis, portal hypertension)

(AMAs)

251. Leser-Trélat sign (Sudden GI adenocarcinomas and other visceral malignancies

onset of multiple seborrheic
keratoses)
252. Sister Mary Joseph nodule subcutaneous periumbilical metastasis from gastric
carcinoma (usually intestinal type)

253. Virchow nodule involvement of left supraclavicular node by metastasis from

stomach
254. Palpable olive mass Pyloric stenosis
255. Bird's beak (on barium Achalasia
swallow)

256. Hour glass appearance Hiatal hernia

257. Stellate granulomas on Bartonella henselae (cat scratch disease)
lymph node biopsy

258. Target cells HbC Disease, Asplenia, Liver Disease, Thalassemia

259. Spherocyte Hereditary spherocytosis, drug- and infection- induced
hemolytic anemia
260. Sickle cell Sickle cell anemia (sickling occurs with dehydration,
deoxygenation, and at high altitude)

261. Schistocyte DIC, TTP/HUS, HELLP syndrome, mechanical hemolysis

262. Ringed sideroblast Sideroblastic anemia (excess iron in mitochondria)

263. Macro-ovalocyte Megaloblastic anemia (also see hyperhsegmented PMNs),

marrow failure
264. Elliptocyte Hereditary elliptocytosis (usually asymptomatic; caused by
mutation in genes encoding RBC membrane proteins, e.g.
spectrin)

265. Echinocyte (burr cell) End stage renal disease, liver disease, pyruvate kinase
deficiency
266. Dacrocyte (teardrop cell) Bone marrow infiltration (e.g. myelofibrosis)

267. Degmacyte (bite cell) G6PD deficiency

268. Basophilic stippling Lead poisoning, sideroblastic anemia, myelodysplastic
syndromes

269. Acanthocyte (spur cell) Liver disease, abetalipoproteinemia (states of cholesterol

dysregulation)
270. Heinz bodies G6PD deficiency (oxidation of Hb -SH groups to -S--S-
leads to Hb precipitation. Subsequent phagocytic damage
to RBCs membrane leads to bite cells)

271. Howell-Jolly bodies Patients with functional hyposplenia or asplenia (they are
basophilic nuclear remnants found in RBCs that are
normally removed from RBCs by splenic macrophages)
272. Serum Ca2+, phosphorus, Paget disease of the bone
and PTH levels normal.
Increased ALP

273. Normal bone mineralization Osteoporosis

and lab values but T-score
</= -2.5

274. Decreased vitamin D, Osteomalacia

decreased serum Ca2+,
Increased PTH, decreased
PO43-, Increased ALP

275. Anti-cyclic citrullinated Rheumatoid Arthritis

peptide antibody

276. CD55/59 negative Paroxysmal Nocturnal Hemoglobinuria

277. Sickle cell disease Hydroxyurea (fetal hemoglobin)

278. Sporothrix schenckii Itraconazole, oral potassium iodide

279. Stable angina Sublingual nitroglycerin

280. Staphylococcus aureus MSSA: nafcillin, oxacillin, dicloxacillin (antistaphylococcal
penicillins); MRSA: vancomycin, daptomycin, linezolid,
ceftaroline

281. Streptococcus bovis Penicillin prophylaxis; evaluation for colon cancer if linked
to endocarditis

282. Streptococcus pneumoniae Penicillin/cephalosporin (systemic infection, pneumonia),

vancomycin (meningitis)
283. Streptococcus pyogenes Penicillin prophylaxis

284. Temporal arteritis High-dose steroids

285. Tonic-clonic seizures Levetiracetam, phenytoin, valproate, carbamazepine

286. Toxoplasma gondii Sulfadiazine + pyrimethamine

287. Treponema pallidum Penicillin

288. Trichomonas vaginalis Metronidazole (patient and partner)

289. Trigeminal neuralgia (tic Carbamazepine

douloureux)
290. Ulcerative colitis 5-ASA preparations (eg, mesalamine), 6-mercaptopurine, in
iximab, colectomy

291. UTI prophylaxis TMP-SMX

292. Warfarin reversal Fresh frozen plasma (acute), vitamin K (non-acute)

293. Hypercholesterolemia Statin (first-line)

294. Hypertriglyceridemia Fibrate

295. Immediate anticoagulation Heparin

296. Infertility Leuprolide, GnRH (pulsatile), clomiphene

297. Influenza Oseltamivir, zanamivir

298. Kawasaki disease IVIG, high-dose aspirin

299. Legionella pneumophila Macrolides (eg, azithromycin)

300. Long-term anticoagulation Warfarin, dabigatran, rivaroxaban and apixaban

301. Malaria Chloroquine, mefloquine, atovaquone/proguanil (for blood
schizont), primaquine (for liver hypnozoite)

302. Malignant hyperthermia Dantrolene

303. Medical abortion Mifepristone

304. Migraine Abortive therapies (eg, sumatriptan, NSAIDs); prophylaxis
(eg, propranolol, topiramate, CCBs, amitriptyline)

305. Multiple sclerosis Disease-modifying therapies (eg, β-interferon,

natalizumab); for acute flares, use IV steroids
306. Mycobacterium tuberculosis RIPE (rifampin, isoniazid, pyrazinamide, ethambutol)

307. Neisseria gonorrhoeae Ceftriaxone (add doxycycline to cover likely concurrent C

trachomatis)
308. Neisseria meningitidis Penicillin/ceftriaxone, rifampin (prophylaxis)

309. Neural tube defect prevention Prenatal folic acid

310. Osteomalacia/rickets Vitamin D supplementation

311. Osteoporosis Calcium/vitamin D supplementation (prophylaxis);
bisphosphonates, PTH analogs, SERMs, calcitonin,
denosumab (treatment)

312. Patent ductus arteriosus Close with indomethacin; keep open with PGE analogs
313. Pheochromocytoma α-antagonists (eg, phenoxybenzamine)

314. Pneumocystis jirovecii TMP-SMX (prophylaxis and treatment in

immunosuppressed patients)
315. Prolactinoma Cabergoline/bromocriptine (dopamine agonists)

316. Prostate Leuprolide, GnRH (continuous)

adenocarcinoma/uterine
fibroids

317. Prostate adenocarcinoma Flutamide

318. Pseudomonas aeruginosa Antipseudomonal penicillins, aminoglycosides,
carbapenems

319. Pulmonary arterial Sildenafil, bosentan, epoprostenol

hypertension (idiopathic)
320. Rickettsia rickettsii Doxycycline, chloramphenicol

321. Schizophrenia (negative Atypical antipsychotics

symptoms)

322. Schizophrenia (positive Typical and atypical antipsychotics

symptoms)

323. SIADH Fluid restriction, IV hypertonic saline, conivaptan/tolvaptan,

demeclocycline

324. Breast cancer in Aromatase inhibitor (anastrozole)

postmenopausal woman
325. Buerger disease Smoking cessation

326. Bulimia nervosa SSRIs

327. Candida albicans Topical azoles (vaginitis); nystatin, uconazole, caspofungin

(oral/esophageal); uconazole, caspofungin, amphotericin B
(systemic)

328. Carcinoid syndrome Octreotide

329. Chlamydia trachomatis Doxycycline (+ ceftriaxone for gonorrhea coinfection),
erythromycin eye drops (prophylaxis in infants)

330. Chronic gout Xanthine oxidase inhibitors (eg, allopurinol, febuxostat);

pegloticase; probenecid

331. Chronic hepatitis B or C IFN-α (HBV and HCV); ribavirin, simeprevir, sofosbuvir
(HCV)
332. Chronic myelogenous Imatinib
leukemia

333. Clostridium botulinum Antitoxin

334. Clostridium dificile Oral metronidazole; if refractory, oral vancomycin

335. Clostridium tetani Antitoxin

336. CMV Ganciclovir, foscarnet, cidofovir

337. Crohn disease Corticosteroids, in iximab, azathioprine

338. Cryptococcus neoformans Fluconazole (in AIDS patients)

339. Cyclophosphamide-induced Mesna
hemorrhagic cystitis

340. Depression SSRIs (first-line)

341. Diabetes insipidus Desmopressin (central); hydrochlorothiazide, indomethacin,

amiloride (nephrogenic)

342. Diabetes mellitus type 1 Dietary intervention (low carbohydrate) + insulin

replacement

343. Diabetes mellitus type 2 Dietary intervention, oral hypoglycemics, and insulin (if
refractory)

344. Diabetic ketoacidosis Fluids, insulin, K+

345. Drug of choice for Heparin

anticoagulation during
pregnancy

346. Enterococci Vancomycin, aminopenicillins/cephalosporins

347. Erectile dysfunction Sildenafil, tadalafil, vardenafil

348. ER ⊕ breast cancer Tamoxifen

349. Ethylene glycol/methanol Fomepizole (alcohol dehydrogenase inhibitor)
intoxication

350. Haemophilus influenzae (B) Rifampin (prophylaxis)

351. Generalized anxiety disorder SSRIs, SNRIs ( rst line); buspirone (second line)
352. Granulomatosis with Cyclophosphamide, corticosteroids
polyangiitis (Wegener)

353. Heparin reversal Protamine sulfate

354. HER2/neu ⊕ breast cancer Trastuzumab

355. Hyperaldosteronism Spironolactone

356. Absence seizures Ethosuximide

357. Acute gout attack NSAIDs, colchicine, glucocorticoids

358. Acute promyelocytic All-trans retinoic acid
leukemia (M3)

359. ADHD Methylphenidate, CBT, atomoxetine, guanfacine, clonidine

360. Alcoholism Disulfiram, acamprosate, naltrexone, supportive care

361. Alcohol withdrawal Long-acting benzodiazepines

362. Anorexia Nutrition, psychotherapy, mirtazapine

363. Arrhythmia in damaged Class IB antiarrhythmic (lidocaine, mexiletine)

cardiac tissue
364. Benign prostatic hyperplasia α1-antagonists, 5α-reductase inhibitors, PDE-5 inhibitors

365. Bipolar disorder Mood stabilizers (eg, lithium, valproic acid,

carbamazepine), atypical antipsychotics

366. Type of non-Hodgkin Diffuse large B-cell lymphoma

lymphoma

367. UTI E coli, Staphylococcus saprophyticus (young women)

368. Vertebral compression Osteoporosis (type I: postmenopausal woman; type II:

fracture elderly man or woman)

369. Viral encephalitis affecting HSV-1

temporal lobe
370. Vitamin deficiency (US) Folate (pregnant women are at high risk; body stores only
3- to 4-month supply; prevents neural tube defects)

371. 1° amenorrhea Turner syndrome (45,XO or 45,XO/46,XX mosaic)

372. 1° bone tumor (adults) Multiple myeloma

373. 1° hyperaldosteronism Adenoma of adrenal cortex

374. 1° hyperparathyroidism Adenomas, hyperplasia, carcinoma

375. 1° liver cancer Hepatocellular carcinoma (chronic hepatitis, cirrhosis,

hemochromatosis, α1-antitrypsin deficiency, Wilson
disease)
376. Pulmonary hypertension Idiopathic, heritable, left heart disease (eg, HF), lung
disease (eg, COPD), hypoxemic vasoconstriction (eg,
OSA), thromboembolic (eg, PE)

377. Recurrent Buerger disease (strongly associated with tobacco)

inflammation/thrombosis of
small/medium vessels in
extremities
378. Refractory peptic ulcers and Zollinger-Ellison syndrome (gastrinoma of duodenum or
high gastrin levels pancreas), associated with MEN1

379. Renal tumor Renal cell carcinoma: associated with von Hippel-Lindau
and cigarette smoking; paraneoplastic syndromes (EPO,
renin, PTHrP, ACTH)

380. Right heart failure due to a Cor pulmonale

pulmonary cause
381. S3 heart sound ventricular filling pressure (eg, mitral regurgitation, HF),
common in dilated ventricles

382. S4 heart sound Stiff/hypertrophic ventricle (aortic stenosis, restrictive

cardiomyopathy)

383. 2° hyperparathyroidism Hypocalcemia of chronic kidney disease

384. Sexually transmitted disease C trachomatis (usually coinfected with N gonorrhoeae)

385. SIADH Small cell carcinoma of the lung

386. Site of diverticula Sigmoid colon

387. Sites of atherosclerosis Abdominal aorta > coronary artery > popliteal artery >
carotid artery

388. t(14;18) Follicular lymphomas (BCL-2 activation, anti-apoptotic

oncogene)
389. t(8;14) Burkitt lymphoma (c-myc fusion, transcription factor
oncogene)

390. t(9;22) Philadelphia chromosome, CML (BCR-ABL activation,

tyrosine kinase oncogene)
391. Temporal arteritis Risk of ipsilateral blindness due to occlusion of ophthalmic
artery; polymyalgia rheumatica

392. Testicular tumor Seminoma (malignant, radiosensitive), placental ALP

393. Thyroid cancer Papillary carcinoma (childhood irradiation)

394. Tumor in women Leiomyoma (estrogen dependent, not precancerous)

395. Tumor of infancy Strawberry hemangioma (grows rapidly and regresses
spontaneously by childhood)

396. Tumor of the adrenal Pheochromocytoma (usually benign)

medulla (adults)
397. Tumor of the adrenal Neuroblastoma (malignant)
medulla (kids)

398. Type of Hodgkin lymphoma Nodular sclerosing (vs mixed cellularity, lymphocytic
predominance, lymphocytic depletion)

399. Intellectual disability Down syndrome, fragile X syndrome

400. Kidney stones Calcium = radiopaque, Struvite (ammonium) = radiopaque
(formed by urease), ⊕ organisms such as Klebsiella,
Proteus species, and S saprophytic), Uric acid =
radiolucent, Cystine = radiolucent

401. Late cyanotic shunt Eisenmenger syndrome (caused by ASD, VSD, PDA;
(uncorrected left to right results in pulmonary hypertension/polycythemia)
becomes right to left)

402. Liver disease Alcoholic cirrhosis

403. Lysosomal storage disease Gaucher disease

404. Male cancer Prostatic carcinoma

405. Malignancy associated with Hodgkin lymphoma

noninfectious fever
406. Malignancy (kids) ALL, medulloblastoma (cerebellum)

407. Metastases to bone Prostate, breast > lung > thyroid

408. Metastases to brain Lung > breast > genitourinary > melanoma > GI

409. Metastases to liver Colon >> stomach, pancreas

410. Microcytic anemia Iron deficiency

411. Mitochondrial inheritance Disease occurs in both males and females, inherited
through females only

412. Mitral valve stenosis Rheumatic heart disease

413. Mixed (UMN and LMN) Amyotrophic lateral sclerosis
motor neuron disease

414. Myocarditis Coxsackie B

415. Nephrotic syndrome (adults) Focal segmental glomerulosclerosis

416. Nephrotic syndrome (kids) Minimal change disease

417. Neuron migration failure Kallmann syndrome (hypogonadotropic hypogonadism and

anosmia)

418. Nosocomial pneumonia S aureus, Pseudomonas, other enteric gram ⊝ rods

419. Obstruction of male urinary BPH

tract

420. Opening snap Mitral stenosis

421. Opportunistic infection in Pneumocystis jirovecii pneumonia

AIDS
422. Osteomyelitis S aureus (most common overall)

423. Osteomyelitis in sickle cell Salmonella

disease
424. Osteomyelitis with IV drug Pseudomonas, Candida, S aureus
use
425. Ovarian tumor (benign, Serous cystadenoma
bilateral)

426. Ovarian tumor (malignant) Serous cystadenocarcinoma

427. Pancreatitis (acute) Gallstones, alcohol

428. Pancreatitis (chronic) Alcohol (adults), cystic fibrosis (kids)

429. Pelvic inflammatory disease C trachomatis, N gonorrhoeae

430. Philadelphia chromosome CML (may sometimes be associated with ALL/AML)

t(9;22) (BCR-ABL)

431. Pituitary tumor Prolactinoma, somatotropic adenoma

432. Dementia Alzheimer disease, multiple infarcts (vascular dementia)

433. Demyelinating disease in Multiple sclerosis
young women
434. DIC Severe sepsis, obstetric complications, cancer, burns,
trauma, major surgery, acute pancreatitis, APL

435. Diverticulum in pharynx Zenker diverticulum (diagnosed by barium swallow)

436. Ejection click Aortic stenosis

437. Esophageal cancer Squamous cell carcinoma (worldwide); adenocarcinoma

(US)
438. Food poisoning (exotoxin S aureus, B cereus
mediated)

439. Gastric cancer Adenocarcinoma

440. Glomerulonephritis (adults) Berger disease (IgA nephropathy)

441. Gynecologic malignancy Endometrial carcinoma (most common in US); cervical

carcinoma (most common worldwide)

442. Heart murmur, congenital Mitral valve prolapse

443. Heart valve in bacterial Mitral > aortic (rheumatic fever), tricuspid (IV drug abuse)
endocarditis

444. Helminth infection (US) Enterobius vermicularis, Ascaris lumbricoides

445. Hematoma—epidural Rupture of middle meningeal artery (trauma; lentiform
shaped)

446. Hematoma—subdural Rupture of bridging veins (crescent shaped)

447. Hemochromatosis Multiple blood transfusions or hereditary HFE mutation (can
result in heart failure, "bronze diabetes," and risk of
hepatocellular carcinoma)

448. Hepatocellular carcinoma Cirrhotic liver (associated with hepatitis B and C and with
alcoholism)
449. Hereditary bleeding disorder von Willebrand disease

450. Hereditary harmless Gilbert syndrome (benign congenital unconjugated

jaundice hyperbilirubinemia)

451. HLA-B27 Psoriatic arthritis, ankylosing spondylitis, IBD-associated

arthritis, reactive arthritis (formerly Reiter syndrome)
452. HLA-DR3 Diabetes mellitus type 1, SLE, Graves disease, Hashimoto
thyroiditis, Addison disease

453. HLA-DR4 Diabetes mellitus type 1, rheumatoid arthritis, Addison

disease

454. Holosystolic murmur VSD, tricuspid regurgitation, mitral regurgitation

455. Hypercoagulability, Virchow triad ( risk of thrombosis)

endothelial damage, blood
stasis

456. Hypertension, 2° Renal artery stenosis, chronic kidney disease (eg,

polycystic kidney disease, diabetic nephropathy),
hyperaldosteronism

457. Hypoparathyroidism Accidental excision during thyroidectomy

458. Hypopituitarism Pituitary adenoma (usually benign tumor)

459. Infection 2° to blood Hepatitis C

transfusion

460. Infections in chronic S aureus, E coli, Aspergillus (catalase ⊕)

granulomatous disease
461. Autosplenectomy (fibrosis Sickle cell disease (hemoglobin S)
and shrinkage)

462. Bacteria associated with H pylori

gastritis, peptic ulcer
disease, and gastric
malignancies (eg,
adenocarcinoma, MALToma)

463. Bacterial meningitis (adults S pneumoniae

and elderly)

464. Bacterial meningitis Group B streptococcus/E coli (newborns), S pneumoniae/N

(newborns and kids) meningitidis (kids/teens)

465. Bilateral ovarian metastases Krukenberg tumor (mucin-secreting signet ring cells)
from gastric carcinoma
466. Bleeding disorder with GpIb Bernard-Soulier syndrome (defect in platelet adhesion to
deficiency von Willebrand factor)

467. Brain tumor (adults) Supratentorial: metastasis, astrocytoma (including

glioblastoma multiforme), meningioma, schwannoma

468. Brain tumor (kids) Infratentorial: medulloblastoma (cerebellum) or

supratentorial: craniopharyngioma

469. Breast cancer Invasive ductal carcinoma

470. Breast mass Fibrocystic change, carcinoma (in postmenopausal women)

471. Breast tumor (benign, young Fibroadenoma

woman)

472. Cardiac 1° tumor (kids) Rhabdomyoma, often seen in tuberous sclerosis

473. Cardiac manifestation of Marantic/thrombotic endocarditis (nonbacterial)
lupus

474. Cardiac tumor (adults) Metastasis, myxoma (90% in left atrium; "ball and valve")

475. Cerebellar tonsillar Chiari II malformation

herniation

476. Chronic arrhythmia Atrial fibrillation (associated with high risk of emboli)

477. Chronic atrophic gastritis Predisposition to gastric carcinoma (can also cause
(autoimmune) pernicious anemia)

478. Clear cell adenocarcinoma DES exposure in utero

of the vagina
479. Congenital adrenal 21-hydroxylase deficiency
hyperplasia, hypotension

480. Congenital cardiac anomaly VSD

481. Congenital conjugated Dubin-Johnson syndrome (inability of hepatocytes to

hyperbilirubinemia (black secrete conjugated bilirubin into bile)
liver)

482. Constrictive pericarditis TB (developing world); idiopathic, viral illness (developed

world)

483. Coronary artery involved in LAD > RCA > circucflex

thrombosis

484. Cretinism Iodine deficit/congenital hypothyroidism

485. Cushing syndrome Iatrogenic (from corticosteroid therapy), Adrenocortical
adenoma (secretes excess cortisol), ACTH-secreting
pituitary adenoma (Cushing disease), Paraneoplastic (due
to ACTH secretion by tumors)

486. Cyanosis (early; less Tetralogy of Fallot, transposition of great vessels, truncus
common) arteriosus

487. Death in CML Blast crisis

488. Death in SLE Lupus nephropathy

489. Actinic (solar) keratosis Precursor to squamous cell carcinoma

490. Acute gastric ulcer Cushing ulcer ( intracranial pressure stimulates vagal
associated with CNS injury gastric H+ secretion)

491. Acute gastric ulcer Curling ulcer (greatly reduced plasma volume results in
associated with severe sloughing of gastric mucosa)
burns

492. Age ranges for patient with ALL: child, CLL: adult > 60, AML: adult ∼ 65, CML: adult 45-
ALL/CLL/AML/CML 85

493. Alternating areas of Skip lesions (Crohn disease)

transmural inflammation and
normal colon
494. Aortic aneurysm, abdominal Atherosclerosis
495. Aortic aneurysm, ascending 3° syphilis (syphilitic aortitis), vasa vasorum destruction
or arch
496. Aortic aneurysm, thoracic Marfan syndrome (idiopathic cystic medial degeneration)

497. Aortic dissection Hypertension

498. Atrophy of the mammillary Wernicke encephalopathy (thiamine de ciency causing

bodies ataxia, ophthalmoplegia, and confusion)
499. t(11;14) Mantle cell lymphoma (cyclin D1 activation)

500. t(15;17) APL (M3 type of AML. Responds to all-trans retinoic acid.
See Auer rods)

501. t(8;21) M2-AML (AML with maturation)

502. t(12;21) B cell acute lymphocytic leukemia (ALL)

503. Small, irregular red spots on Koplik spots (measles [rubeola] virus)
buccal/lingual mucosa with
blue-white centers

504. Smooth, moist, painless, Condylomata lata (2° syphilis)

wart-like white lesions on
genitals
505. Splinter hemorrhages in Bacterial endocarditis
fingernails

506. "Strawberry tongue" Scarlet fever, Kawasaki disease

507. Streak ovaries, congenital Turner syndrome (45,XO)
heart disease, horseshoe
kidney, cystic hygroma at
birth, short stature, webbed
neck, lymphedema

508. Sudden swollen/painful big Gout/podagra (hyperuricemia)

toe joint, tophi
509. Swollen gums, mucosal Scurvy (vitamin C deficiency: can't hydroxylate
bleeding, poor wound proline/lysine for collagen synthesis)
healing, petechiae

510. Swollen, hard, painful finger Osteoarthritis (osteophytes on PIP [Bouchard nodes], DIP
joints [Heberden nodes])
511. Systolic ejection murmur Aortic stenosis
(crescendo-decrescendo)

512. Telangiectasias, recurrent Osler-Weber-Rendu syndrome

epistaxis, skin discoloration,
arteriovenous
malformations, GI bleeding,
hematuria
513. Thyroid and parathyroid MEN 2A (autosomal dominant RET mutation)
tumors, pheochromocytoma

514. Thyroid tumors, MEN 2B (autosomal dominant RET mutation)

pheochromocytoma,
ganglioneuromatosis
515. Toe extension/fanning upon Babinski sign (UMN lesion)
plantar scrape

516. Unilateral facial drooping LMN facial nerve (CN VII) palsy; UMN lesions spare the
involving forehead forehead
517. Urethritis, conjunctivitis, Reactive arthritis associated with HLA-B27
arthritis in a male
518. Vascular birthmark (port- Nevus flammeus (benign, but associated with Sturge-
wine stain) of the face Weber syndrome - Congenital, non-inherited (somatic),
developmental anomaly of neural crest derivatives due to
activating mutation of GNAQ gene)

519. Vomiting blood following Mallory-Weiss syndrome (alcoholic and bulimic patients)
gastroesophageal
lacerations
520. Weight loss, diarrhea, Whipple disease (Tropheryma whipplei)
arthritis, fever, adenopathy

521. "Worst headache of my life" Subarachnoid hemorrhage

522. Painless erythematous Janeway lesions (infective endocarditis, septic emboli/
lesions on palms and soles microabscesses)

523. Painless jaundice Cancer of the pancreatic head obstructing bile duct
524. Palpable purpura on Henoch-Schönlein purpura (IgA vasculitis affecting skin and
buttocks/legs, joint pain, kidneys)
abdominal pain (child),
hematuria

525. Pancreatic, pituitary, MEN 1 (autosomal dominant)

parathyroid tumors
526. Periorbital and/or peripheral Nephrotic syndrome
edema, proteinuria (>
3.5g/day),
hypoalbuminemia,
hypercholesterolemia

527. Pink complexion, dyspnea, Emphysema ("pink puffer," centriacinar [smoking] or

hyperventilation panacinar [α1-antitrypsin deficiency)
528. Polyuria, renal tubular Fanconi syndrome (multiple combined dysfunction of the
acidosis type II, growth proximal convoluted tubule)
failure, electrolyte
imbalances,
hypophosphatemic rickets

529. Pruritic, purple, polygonal Lichen planus

planar papules and plaques
(6 P's)

530. Ptosis, miosis, anhidrosis Horner syndrome (sympathetic chain lesion)

531. Pupil accommodates but Neurosyphilis (Argyll Robertson pupil - also called
doesn't react prostitute's pupil: it accommodates but doesn't react)
532. Rapidly progressive limb Guillain-Barré syndrome (acute inflammatory demyelinating
weakness that ascends polyradiculopathy subtype)
following GI/upper
respiratory infection
533. Rash on palms and soles Coxsackie A, 2° syphilis, Rocky Mountain spotted fever
534. Recurrent cold Hyper-IgE syndrome (Job syndrome: neutrophil chemotaxis
(noninflamed) abscesses, abnormality)
unusual eczema, high
serum IgE

535. Red "currant jelly" sputum in Klebsiella pneumoniae pneumonia

alcoholic or diabetic patients
536. Red "currant jelly" stools Acute mesenteric ischemia (adults), intussusception
(children)

537. Red, itchy, swollen rash of Paget disease of the breast (sign of underlying neoplasm)
nipple/areola
538. Red urine in the morning, Paroxysmal nocturnal hemoglobinuria
fragile RBCs

539. Renal cell carcinoma von Hippel-Lindau disease (dominant tumor suppressor
(bilateral), gene mutation)
hemangioblastomas,
angiomatosis,
pheochromocytoma
540. Resting tremor, rigidity, Parkinson disease (loss of dopaminergic neurons in
akinesia, postural instability, substantia nigra pars compacta)
shuffling gait

541. Retinal hemorrhages with Roth spots (bacterial endocarditis)

pale centers
542. Severe jaundice in neonate Crigler-Najjar syndrome (congenital unconjugated
hyperbilirubinemia)

543. Severe RLQ pain with Rovsing sign (acute appendicitis)

palpation of LLQ
544. Severe RLQ pain with deep McBurney sign (acute appendicitis)
tenderness

545. Short stature, café au lait Fanconi anemia (genetic loss of DNA crosslink repair; often
spots, thumb/radial defects, progresses to AML)
increased incidence of
tumors/leukemia, aplastic
anemia
546. Single palmar crease Down syndrome

547. Situs inversus, chronic Kartagener syndrome (dynein arm defect affecting cilia)
sinusitis, bronchiectasis,
infertility
548. Skin hyperpigmentation, 1° adrenocortical insufficiency (eg, Addison disease)
hypotension, fatigue causes increased ACTH and increased α-MSH production)
549. Slow, progressive muscle Becker muscular dystrophy (X-linked missense mutation in
weakness in boys dystrophin; less severe than Duchenne)

550. Hereditary nephritis, Alport syndrome (mutation in collagen IV)

sensorineural hearing loss,
cataracts
551. Hyperphagia, Klüver-Bucy syndrome (bilateral amygdala lesion)
hypersexuality, hyperorality,
hyperdocility

552. Hyperreflexia, hypertonia, UMN damage

Babinski sign present
553. Hyporeflexia, hypotonia, LMN damage
atrophy, fasciculations

554. Hypoxemia, polycythemia, Chronic bronchitis (hyperplasia of mucous cells, "blue

hypercapnia bloater")
555. Indurated, ulcerated genital Nonpainful: chancre (1° syphilis, Treponema pallidum)
lesion Painful, with exudate: chancroid (Haemophilus ducreyi)

556. Infant with cleft lip/palate, Patau syndrome (trisomy 13)

microcephaly or
holoprosencephaly,
polydactyly, cutis aplasia
557. Infant with hypoglycemia, Cori disease (debranching enzyme deficiency) or Von
hepatomegaly Gierke disease (glucose-6-phosphatase deficiency, more
severe)
558. Infant with microcephaly, Edwards syndrome (trisomy 18)
rocker-bottom feet, clenched
hands, and structural heart
defect

559. Jaundice, palpable Courvoisier sign

distended non-tender
gallbladder
560. Large rash with bull's-eye Erythema chronicum migrans from Ixodes tick bite (Lyme
appearance disease: Borrelia)

561. Lucid interval after traumatic Epidural hematoma (middle meningeal artery rupture)
brain injury
562. Male child, recurrent Bruton disease (X-linked agammaglobulinemia)
infections, no mature B cells

563. Mucosal bleeding and Glanzmann thrombasthenia (defect in platelet aggregation

prolonged bleeding time due to lack of GpIIb/IIIa)
564. Muffled heart sounds, Beck triad of cardiac tamponade
distended neck veins,
hypotension

565. Multiple colon polyps, Gardner syndrome (subtype of FAP)

osteomas/soft tissue tumors,
impacted/ supernumerary
teeth
566. Myopathy (infantile Pompe disease (lysosomal α-1,4-glucosidase deficiency)
hypertrophic
cardiomyopathy), exercise
intolerance

567. Neonate with arm paralysis Erb-Duchenne palsy (superior trunk [C5-C6] brachial plexus
following difficult birth injury: "waiter's tip")
568. No lactation postpartum, Sheehan syndrome (pituitary infarction)
absent menstruation, cold
intolerance

569. Nystagmus, intention tremor, Multiple sclerosis

scanning speech, bilateral
internuclear
ophthalmoplegia

570. Painful blue fingers/toes, Cold agglutinin disease (autoimmune hemolytic anemia
hemolytic anemia caused by Mycoplasma pneumoniae, infectious
mononucleosis, CLL)
571. Painful fingers/toes Raynaud phenomenon (vasospasm in extremities)
changing color from blue to
white to red with cold or
stress

572. Painful, raised red lesions Osler nodes (infective endocarditis, immune complex
on pads of fingers/toes deposition)
573. Chronic exercise intolerance McArdle disease (skeletal muscle glycogen phosphorylase
with myalgia, fatigue, painful deficiency)
cramps, myoglobinuria

574. Cold intolerance Hypothyroidism

575. Conjugate horizontal gaze Internuclear ophthalmoplegia (damage to MLF; may be

palsy, horizontal diplopia unilateral or bilateral)

576. Continuous "machine-like" PDA (close with indomethacin; keep open with PGE
heart murmur analogs)
577. Cutaneous/dermal edema Myxedema (caused by hypothyroidism, Graves disease
due to connective tissue [pretibial])
deposition
578. Cutaneous flushing, Carcinoid syndrome (right-sided cardiac valvular lesions, 5-
diarrhea, bronchospasm HIAA)
579. Dark purple skin/mouth Kaposi sarcoma, associated with HHV-8
nodules in a patient with
AIDS

580. Deep, labored Diabetic ketoacidosis (Kussmaul respirations)

breathing/hyperventilation
581. Dermatitis, dementia, Pellagra (niacin [vitamin B3] deficiency)
diarrhea
582. Dilated cardiomyopathy, Wet beriberi (thiamine [vitamin B1] deficiency)
edema, alcoholism or
malnutrition

583. Dog or cat bite resulting in Pasteurella multocida (cellulitis at inoculation site)
infection
584. Dry eyes, dry mouth, Sjögren syndrome (autoimmune destruction of exocrine
arthritis glands)

585. Dysphagia (esophageal Plummer-Vinson syndrome (may progress to esophageal

webs), glossitis, iron squamous cell carcinoma)
deficiency anemia
586. Elastic skin, hypermobility of Ehlers-Danlos syndrome (type V collagen defect, type III
joints, increased bleeding collagen defect seen in vascular subtype of ED)
tendency

587. Enlarged, hard left Virchow node (abdominal metastasis)

supraclavicular node
588. Episodic vertigo, tinnitus, Meniere disease
hearing loss
589. Erythroderma, Mycosis fungoides (cutaneous T-cell lymphoma) or Sézarys
lymphadenopathy, syndrome (mycosis fungoides + malignant T cells in blood)
hepatosplenomegaly,
atypical T cells

590. Facial muscle spasm upon Chvostek sign (hypocalcemia)

tapping
591. Fat, female, forty, and fertile Cholelithiasis (gallstones)

592. Fever, chills, headache, Jarisch-Herxheimer reaction (rapid lysis of spirochetes

myalgia following antibiotic results in endotoxin release)
treatment for syphilis
593. Fever, cough, conjunctivitis, Measles
coryza, diffuse rash

594. Fever, night sweats, weight B symptoms (staging) of lymphoma

loss
595. Fibrous plaques in soft Peyronie disease (connective tissue disorder)
tissue of penis with
abnormal curvature

596. Golden brown rings around Wilson disease (Kayser-Fleischer rings due to copper
peripheral cornea accumulation)
597. Gout, intellectual disability, Lesch-Nyhan syndrome (HGPRT de ciency, X-linked
self-mutilating behavior in a recessive)
boy

598. Hamartomatous GI polyps, Peutz-Jeghers syndrome (inherited, benign polyposis can

hyperpigmentation of cause bowel obstruction; cancer risk, mainly GI)
mouth/feet/hands/genitalia
599. Hepatosplenomegaly, Gaucher disease (glucocerebrosidase deficiency)
pancytopenia, osteoporosis,
aseptic necrosis of femoral
head, bone crises

600. Abdominal pain, ascites, Budd-Chiari syndrome (posthepatic venous thrombosis)

hepatomegaly
601. Abdominal pain, diarrhea, Clostridium difficile infection
leukocytosis, recent
antibiotic use

602. Achilles tendon xanthoma Familial hypercholesterolemia (decreased LDL receptor

signaling)
603. Adrenal hemorrhage, Waterhouse-Friderichsen syndrome (meningococcemia)
hypotension, DIC

604. Anaphylaxis following blood IgA deficiency

transfusion

605. Anterior "drawer sign" ⊕ Anterior cruciate ligament injury

606. Arachnodactyly, lens Marfan syndrome (fibrillin defect)
dislocation (upward), aortic
dissection, hyperflexible
joints

607. Athlete with polycythemia 2° to erythropoietin injection

608. Back pain, fever, night Pott disease (vertebral TB)

sweats

609. Bilateral acoustic Neurofibromatosis type 2

schwannomas
610. Bilateral hilar adenopathy, Sarcoidosis (noncaseating granulomas)
uveitis

611. Black eschar on face of Mucor or Rhizopus fungal infection

patient with diabetic
ketoacidosis

612. Blue sclera Osteogenesis imperfecta (type I collagen defect)

613. Bluish line on gingiva Burton line (lead poisoning)

614. Bone pain, bone Paget disease of bone (increased osteoblastic and
enlargement, arthritis osteoclastic activity)
615. Bounding pulses, wide pulse Aortic regurgitation
pressure, diastolic heart
murmur, head bobbing

616. "Butterfly" facial rash and Systemic lupus erythematosus

Raynaud phenomenon in a
young female
617. Café-au-lait spots, Lisch Neurofibromatosis type I
nodules (iris hamartoma),
cutaneous neurofibromas,
pheochromocytomas, optic
gliomas

618. Café-au-lait spots McCune-Albright syndrome (mosaic G-protein signaling

(unilateral), polyostotic mutation)
fibrous dysplasia,
precocious puberty, multiple
endocrine abnormalities
619. Calf pseudohypertrophy Muscular dystrophy (most commonly Duchenne, due to X-
linked recessive frameshift mutation of dystrophin gene)
620. Cervical lymphadenopathy, Kawasaki disease (treat with IVIG and aspirin)
desquamating rash,
coronary aneurysms, red
conjunctivae and tongue,
hand-foot changes
621. "Cherry-red spots" on Tay-Sachs (ganglioside accumulation) or Niemann-Pick
macula (sphingomyelin accumulation), central retinal artery
occlusion

622. Chest pain on exertion Angina (stable: with moderate exertion; unstable: with
minimal exertion or at rest)
623. Chest pain, pericardial Dressler syndrome (autoimmune-mediated post-MI
effusion/friction rub, fibrinous pericarditis, 2 weeks to several months after acute
persistent fever following MI episode)

624. Chest pain with ST Unstable angina (⊝ troponins) or NSTEMI (⊕ troponins)

depressions on EKG

625. Child uses arms to stand up Duchenne muscular dystrophy (Gowers sign)
from squat

626. Child with fever later Erythema infectiosum/fifth disease ("slapped cheeks"
develops red rash on face appearance, caused by parvovirus B19)
that spreads to body
627. Chorea, dementia, caudate Huntington disease (autosomal dominant CAG repeat
degeneration expansion)

628. Chorioretinitis, Congenital toxoplasmosis

hydrocephalus, intracranial
calcifications
629. Painful hematemesis Mallory-weiss syndrome (longitudinal laceration of mucosa
at GE junction)

630. Painless hematemesis Esophageal varices

631. Papule and pustule Bartonella henselae (Cat Scratch Disease)

formation + regional
lymphadenopathy

632. Hat size increased, hearing Paget disease of the bone

loss, chalk stick fractures

633. Hemolytic anemia, Paroxysmal nocturnal hemoglobinuria

pancytopenia, venous
thrombosis
634. HLA- A3 Hemochromatosis

635. HLA- B8 Addison disease, myasthenia gravis

636. HLA- B27 Psoriatic arthritis, Anklyosing spondylitis, IBD-associated

arthritis, Reactive arthritis/Reiter's syndrome ("PAIR" or
seronegative arthropathies)

637. HLA-DQ2/DQ8 Celiac dx ("I 8 2 much DQ)

638. HLA- DR2 Multiple sclerosis (MS), hay fever, SLE, Goodpastures

639. HLA- DR3 Type 1 DM, SLE, Graves dx, Hashimoto thyroiditis, Addison
dx

640. HLA- DR4 Rheumatoid arthritis, Type 1 DM, Addison dx

641. HLA- DR5 Pernicious anemia, vit B12 deficiency, Hashimoto's

thyroiditis

642. HLA-B *5701 mutation C/I for giving abacavir (NRTI)

643. IL-1 "osteoclast activating factor"; endothelial expression of

adhesion molecules, recruit WBCs, + FEVER, acute
inflamma

644. IL-6 Fever, acute phase proteins

645. IL-8 Chemotaxis for neutrophils, clear infxn

646. IL- 12 Diff of T cells --> Th1, activate NK cells

647. TNFa Mediate septic shock, activate endothelium, WBC

recruitment, vascular leak; causes cachexia in malignancy;
lead to granuloma formation

648. IL-2 Stimulate growth of helper/cytoxic/regulatory T cells and NK

cells

649. IL-3 Growth/diff of bone marrow stem cells

650. INFg Secreted by NK cells/T cells in response to IL-12 from
macrophages; stimulates macrophages to kill
phagocytosed pathogens; inhibited diff of Th2; increases
MHC expression, antigen presentation by all cells

651. IL-4 T cell diff --> Th2, B cell growth, class IgE and IgG class
switching

652. IL-5 Growth/diff of B cells, IgA class switching, eosinophilia

653. IL-10 Mediates and attenuates inflamma; decrease MHC Class II

expression and Th1 cytokines; inhibits activated
macrophages, dendritic cells; secreted by Treg cells

654. TGFb Attenuates the immune response, from Treg cells; leads to
angiogenesis, fibrosis, cell cycle arrest

655. Interferons (INFa/b) innate host defense against DNA/RNA viruses; are
glycoproteins that prime uninfected cells to degrate viral
NAs and proteins

656. Metalloproteinase (MMPs) tissue remodeling

657. PGDF from activated platelets/macrophages; induces vascular

remodeling, smooth muscle cell migration; stimulate
fibroblast growth for collagen synthesis

658. FGF stimulate angiogenesis

659. EGF stimulate cell growth via tyrosine kinases (EGFR, ErbB1)

660. VEGF stimulates angiogenesis

661. Anti- ACh receptor Myasthenia gravis

662. Anti- basement membrane Goodpasture syndrome

(BM)

663. anticardiolipin, lupus SLE, antiphospholipid syndrome

anticoagulant

664. Anti- centromere Limited scleroderma (CREST syndrome)

665. Anti- desmoglein Pemphigus vulgaris
(desmosome)

666. Anti- dsDNA, anti-Smith SLE

667. Anti- glutamic acid Type 1 DM

decarboxylase (GAD65)

668. Anti- hemidesmosome Bullous pemphigoid

669. Anti- histone Drug-induced lupus

670. Anti- Jo1, anti- SRP, anti- Polymyositis, dermatomyositis

Mi2

671. Anti- microsomal, Anti- Hashimoto thyroiditis

thyroglobulin

672. Anti- mitochondrial Primary biliary cirrhosis (PBC)

673. Anti-nuclear (ANA) SLE, nonspecific marker

674. Anti- parietal cell Pernicious anemia

675. Anti- phospholipase A2 Primary membranous nephropathy

receptor

676. Anti- Scl70, (antiDNA Diffuse scleroderma

topoisomerase I)

677. Anti- smooth muscle Autoimmune hepatitis Type 1

678. Anti- SSA, SSB (anti Ro, Sjogren syndrome

Anti La)

679. Anti- TSH receptor Graves disease

680. Anti- U1 RNP Mixed connective tissue disease

(ribonucleoprotein)

681. Voltage-gated Ca Channel Lambert-Eaton syndrome

Abs
682. IgA anti-endomysial, IgA Celiac disease
anti-tissue transglutaminase

683. MPO-ANCA, p-ANCA Microscopic polyangiitis, eosinophilic granulomatosis with

polyangiitis (Churg-Strauss syndrome)

684. PR3-ANCA, c-ANCA Granulomatosis w/polyangiitis (Wegener)

685. Rheumatoid factor (RF), Rheumatoid arthritis

anti-CCP

686. Glycoprotein 2b/3a idiopathic thrombocytopenic purpura