Bare Minimum Keyword Associations

USMLE & COMLEX Review

Northwestern Medical Review [email protected]

Northwestern Medical Review PO Box 22174 Lansing, Michigan 48909 www.northwesternmedicalreview.com

Copyright © 2015 Northwestern Medical Review eBookit.com and Northwestern Medical Review Second Edition ISBN 978-0-9960-9340-1

All rights reserved. Written, published, and printed in the United States of America. No part of this book may be used, reproduced, or transmitted in any form or by any means, electronic or mechanical without written permission from its author or Northwestern Medical Review.

All photos adapted from fotolia.com

Northwestern Medical Review claims no rights to USMLE or COMLEX USMLE ® National Board of Medical Examiners COMLEX ® National Board of Osteopathic Medical Examiners

This book is adapted from the first chapter of Primary Care for the USMLE and COMLEX by Northwestern Medical Review. The full book version is primarily intended to accompany online or live review courses from Northwestern Medical Review.

How to use this book

This book is adapted from the first chapter of Northwestern Medical Review’s Primary Care for the USMLE and COMLEX book. It contains exceptionally high-yield material found on board exams. The mini-chapters are divided into sections containing commonly tested concepts with keywords that should immediately come to mind while you’re taking your exam.

In the back of the book are two additional sections: a Test Your Knowledge section containing questions and answers with explanations from our follow-along lecture workbooks and NMR Question Bank, and a Sample Mnemonics section containing examples of memorable mnemonics from our course material.

A note from the author

This book is yours. It is your companion for the boards. Until your exam is over, you would be smart to have it handy – in your backpack, in your jacket, or in your pocket. You can read it anywhere – on a bus, on a train, on a plane, or even in the rain.

This book has no beginning and no end. Each part is both dependent on and independent of the other parts. Much like the human body. You can start it anywhere – at the beginning, in the middle, or at the end. You can open it anytime – early morning, midday, or at night. You may write on it, draw on it, and add to it – and you may do so as your heart desires.

It will tell you how much you have learned and what you have yet to learn. The more you read it, wear it, and tear it, the more you will earn from it.

And when it’s all over, you will remember that you had one companion the whole way – the one that was there for you every day.

Dr. Jahan Eftekar

Table of Contents

1. Cardiology 1 2. Vasculitides 6 3. Hematology 10 4. Hematopoietic and Lymphatic System 13 5. Pulmonology 16 6. Gastroenterology 21 7. Liver and Pancreas 26 8. Nephrology 31 9. Male Reproductive 35 10. Female Reproductive 37 11. Integumentary System 41 12. Endocrinology 44 13. Musculoskeletal System 50 14. Central Nervous System 53 15. Autoimmune Diseases 58 16. Immune Deficiencies 62 17. Oncology 64 18. Genetics 68 19. Infectious Diseases 73 20. Cellular Pathology 76 21. Behavioral Sciences 79 22. Nutritional Deficiencies 80 Test Your Knowledge 82 Answers 87 Sample Mnemonics 91 Contact Us! 93

Northwestern Medical Review

1 Bare Minimum Keyword Associations

1 CARDIOLOGY

Rheumatic Fever ⋅ Group A β-hemolytic Streptococcus ⋅ Pancarditis ⋅ Aschoff bodies ⋅ Valve verrucae ⋅ Chorda tendineae thickening and fusion ⋅ Sydenham’s chorea ⋅ MacCallam’s plaque (Left Atrium) ⋅ Migratory Polyarthritis ⋅ Erythema marginatum ⋅ Elevated ASO ⋅ Fish Mouth (buttonhole deformity)

Coarctation Of Aorta ⋅ Around or on ductus arteriosus site ⋅ Turner’s Syndrome ⋅ Dilatation of intercostal arteries ⋅ Hypertension—upper extremities ⋅ Left ventricular hypertrophy ⋅ Distal Aortic Arch ⋅ Elevated renin / angiotensin

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Tricuspid Valve Endocarditis ⋅ IV Drug Use ⋅ Young men without predisposing cardiac lesion

Non-Bacterial Endocarditis (Marantic) ⋅ Systemic malignancy ⋅ Valve Surfaces

Non-septic peripheral emboli ⋅ Libman-Sachs Endocarditis ⋅ Systemic Lupus Erythematosus ⋅ Mitral and tricuspid valves ⋅ Fibrinoid necrosis

Cor Pulmonale ⋅ Right ventricular dilatation ⋅ Severe Lung disease with pulmonary hypertension ⋅ Elevated CK-MB ⋅ LDH flipped fraction I > 2 ⋅ Abdominal aortic aneurysm ⋅ Hypertrophy of muscular pulmonary arteries

Atrial Myxoma ⋅ Left atrium ⋅ Mitral ⋅ Ball-valve obstruction

Mitral Prolapse ⋅ Young exercising thin women ⋅ Systolic prolapse of mitral into the left atrium

3 Bare Minimum Keyword Associations

⋅ Most frequent valvular lesion ⋅ Marfan’s disease (rare association) ⋅ Parachute deformity ⋅ Arrhythmias ⋅ Mid-systolic click, late systolic murmur, and mitral regurgitation

Carcinoid Syndrome ⋅ Cutaneous flushing ⋅ Asthmatic wheezing ⋅ Endocardial Plaque often on the right side ⋅ High level of serotonin (5 HT) ⋅ Recurrent diarrhea

Myocardial Infarction ⋅ ST elevation ⋅ Crushing chest pain at rest ⋅ Troponin I and CPK Early AST later; and LDH latest ⋅ LDH 1 > LDH 2 ⋅ More in men than women ⋅ Most common cause of cardiac death less than 1 hour after MI is ventricular tachycardia.

Heart Failure ⋅ Left-sided; Pulmonary edema ⋅ Right-sided; Hepatomegaly, Nutmeg liver

Rubella ⋅ Patent Ductus Arteriosus ⋅ IgM antibody (anti-rubella) indicates recent primary infection

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⋅ Congenital associated with deafness, cataracts, glaucoma, and mental retardation ⋅ Prenatal worse than postnatal

Cardiomyopathies ⋅ Hypertrophic: autosomal dominance, obstructive. A.K.A. Idiopathic hypertrophic sub-aortic stenosis ⋅ Dilated: Congestive. Associated with ethanol, doxorubicin (adriamycin), mercury and lead poisoning, thyrotoxicosis, hypophosphatemia, hypocalcemia, thiamine deficiency. Left and right congestive failure. ⋅ Restrictive: Impaired diastolic filling. Sarcoidosis, amyloidosis, and carcinoid syndrome

ECG Readings and Associated Conditions Hypercalcemia ⇔ Short QT Hypocalcemia ⇔ Long QT Hypokalemia ⇔ Flat T and U waves Hyperkalemia ⇔ Tall T, wide QRS Digitalis ⇔ Long PR, Short QT First Degree AV Block ⇔ Long PR > 0.2 Second Degree AV ⇔ Gradual PR increase Block (Mobitz I) until missing a QRS Second Degree AV ⇔ Constant PR Block (Mobitz II) Third Degree AV Block ⇔ Independent P and QRS (Complete) Premature Ventricular ⇔ Wide, tall, odd QRS Contraction Atrial Flutter ⇔ Saw-toothed pattern

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ECG Readings and Associated Conditions Atrial Fibrillation ⇔ Irregularly spaced QRS, no detectable P wave Ventricular Tachycardia ⇔ Rapid, odd QRS Left Atrial Hypertrophy ⇔ M-Shaped P wave Right Atrial ⇔ Tall and wide P Hypertrophy Left Ventricular ⇔ Tall and wide QRS Hypertrophy

6 Northwestern Medical Review 2 VASCULITIDES

Atherosclerosis ⋅ Mural thrombus ⋅ Men more than women ⋅ Hypercholesterolemia ⋅ Abdominal aorta, coronary artery and carotid artery ⋅ Inverse relation to HDL cholesterol

Pulmonary Embolism ⋅ Wasted ventilation in the affected, and over- perfusion of the remaining lung tissue ⋅ Wedge-shaped infarcts ⋅ Immobilized post-op patients ⋅ Deep venous thrombosis ⋅ Lower extremity

Syphilitic Aortic Aneurysm ⋅ Ascending aorta ⋅ Tree bark appearance ⋅ Tertiary syphilis ⋅ Aortic valve insufficiency

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Aortic Dissecting Aneurysm ⋅ Cystic medial necrosis ⋅ Longitudinal intraluminal tear ⋅ Ascending aorta ⋅ Marfan’s Syndrome ⋅ Hypertension and Hemopericardium

Idiopathic Hypertrophic Subaortic Stenosis ⋅ Haphazard Myocardial Arrangement ⋅ Ca++ channel blockers

Wegener’s Granulomatosis ⋅ Paranasal sinuses ⋅ Otitis media ⋅ Necrotizing arteritis and glomerulonephritis ⋅ Granuloma formation ⋅ C-ANCA ⋅ TRT: Methotrexate

Malignant Hypertension ⋅ Young male African Americans ⋅ Accelerated, early death ⋅ Flea-bitten Kidney

Berry Aneurysm ⋅ Circle of Willis ⋅ Bifurcation of cerebral arteries ⋅ Subarachnoidal hemorrhage

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Secondary Hypertension ⋅ Renal ischemia, stenosis ⋅ Coarctation of aorta ⋅ Pheochromocytoma ⋅ Hyperthyroidism ⋅ Cushing’s syndrome ⋅ Primary aldosteronism

Thromboangiitis Obliterans ⋅ Buerger’s disease ⋅ Young Jewish men ⋅ Heavy smoking ⋅ Ischemia of extremities

Polyarteritis Nodosa ⋅ P-ANCA ⋅ Small-medium sized arteries ⋅ Increased ESR

Budd-Chiari Syndrome ⋅ Occlusion of inferior vena cava ⋅ Central lobular hepatic necrosis ⋅ Congestive liver disease ⋅ Polycythemia vera

9 Bare Minimum Keyword Associations

Vasoactive Agents Vasoconstriction Thromboxane A2 (TXA2) Leukotrienes: LTC4, LTD4, and LTE4 Platelet activating factor (RAF) Vasodilation Endothelial Prostacyclin PGI2 PGD2, PGE2, PGF2? Bradykinin RAF EDRF (endothelial derived relaxing factor) = NO (nitric oxide) Increasing Vascular Permeability Serotonin Histamine Bradykinin PGD2, PGE2, PGF2? LTC4, LTE4, LTD4 Vasoconstriction

10 Northwestern Medical Review 3 HEMATOLOGY

Hereditary Spherocytosis ⋅ Spectrin defect ⋅ Increased RBC Brittleness ⋅ Increased mean corpuscular hemoglobin concentration

G6PD Deficiency ⋅ Antimalarial induced hemolysis ⋅ X-linked ⋅ Episodic and acute ⋅ Mediterranean heritage + African American ⋅ Sulfa drugs induced hemolysis ⋅ Fava beans ⋅ Intravascular hemolysis

Pyruvate Kinase Deficiency ⋅ Autosomal recessive ⋅ Chronic anemia, non-episodic ⋅ Non-spherocytic hemolytic anemia

Sickle Cell Anemia ⋅ Substitution of VAL for glutamic acid ⋅ African Americans

11 Bare Minimum Keyword Associations

⋅ Resistance to malaria ⋅ Small spleen in adults ⋅ Pigment gallstones ⋅ Chronic leg ulcers ⋅ Painful occlusion of vessels

β-Thalassemia ⋅ Fetal hemoglobin (HbF) increases ⋅ Hemosiderosis ⋅ Mediterranean anemia ⋅ Microcytosis, hypochromia ⋅ Splenomegaly

α-Thalassemia

⋅ HbA2 ⋅ Hb Bart in fetal life ⋅ Southeast Asia

Megaloblastic Anemia ⋅ B12 or Folate deficiency ⋅ Pancytopenia ⋅ Oval Macrocytosis ⋅ Increased MCV ⋅ Increased MCH

Pernicious Anemia ⋅ B12 deficiency (megaloblastic) ⋅ Anti-intrinsic factor ⋅ Gastric fundus ⋅ Gastric carcinoma ⋅ Abnormal Schilling Test ⋅ Lemon/yellow skin coloration

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Folate Deficiency ⋅ (Megaloblastic) ⋅ Chronic Alcoholism ⋅ Pregnancy ⋅ Giardia lamblia ⋅ Cancer chemotherapy ⋅ Spina bifida of fetus

Hemolytic Anemia ⋅ Increased Serum Bilirubin ⋅ Pigmented gallstones ⋅ Reticulocytosis ⋅ Decreased Haptoglobin

Warm Antibody Autoimmune ⋅ Hemolytic Anemia ⋅ IgG auto-antibodies ⋅ Positive Coombs test ⋅ Spherocytosis ⋅ Secondary to Hodgkin’s

Cold Agglutinin Anemia ⋅ Anti-I-antibody ⋅ Lymphoid neoplasms ⋅ Cold weather ⋅ Jaundice

13 Bare Minimum Keyword Associations 4 HEMATOPOIETIC AND LYMPHATIC SYSTEM

Hodgkin’s Lymphoma ⋅ Bilateral hilar Adenopathy ⋅ Young adult men ⋅ Reed-Sternberg Cells (Eosinophilic Giant Cells) ⋅ Stage I-IV ⋅ Elevated erythrocytic sedimentation rate ⋅ Lymphopenia

Non-Hodgkin’s Lymphoma ⋅ B-cells ⋅ Malignancy ⋅ Lymph node adenopathy ⋅ Elevated LDH ⋅ “Starry sky” ⋅ Splenomegaly

Lymphoblastic Lymphoma ⋅ Male children ⋅ Mediastinal mass ⋅ T-cell type

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Burkitt’s Lymphoma ⋅ Non-nucleated cells ⋅ High grade B-cell lymphoma ⋅ Starry-Sky histology ⋅ EBV infection ⋅ Translocation Chromosomes 8 and 14 ⋅ American form = Abdominal organs, ovary, girls ⋅ African form = jaws, boys

Acute Lymphocytic Leukemia ⋅ Children ⋅ CNS infiltrate ⋅ Ecchymoses ⋅ Lymphoblast

Chronic Lymphocytic Leukemia (CLL) ⋅ B-Cells ⋅ Aged men ⋅ Early hypogammaglobinemia ⋅ Granulocytopenia and thrombocytopenia ⋅ Low IgG

Acute Myeloblastic Leukemia (AML) ⋅ Auer rods in myeloblasts ⋅ Adults ⋅ DIC ⋅ Increased PT, PTT ⋅ Splenomegaly ⋅ Translocation 15 and 17

15 Bare Minimum Keyword Associations

Chronic Myeloid Leukemia (CML) ⋅ Blastic crisis ⋅ Marked leukocytosis ⋅ Middle aged (35-50) ⋅ Myeloid stem cells ⋅ Translocation of 9 and 22 (Philadelphia chromosome) ⋅ No lymphadenopathy ⋅ Splenomegaly ⋅ Ethanol Abuse

Multiple Myeloma ⋅ 60+ years ⋅ Normocytic normochromic anemia ⋅ M-protein spike, IgG or IgM ⋅ Urine Bence Jones protein ⋅ Lytic-punched out bony lesions ⋅ Rouleaux formation by RBCs ⋅ Hypercalcemia ⋅ Russell’s bodies

Infectious Mononucleosis ⋅ Rupture of spleen ⋅ Hepatosplenomegaly ⋅ EBV ⋅ Cytotoxic T cells

16 Northwestern Medical Review 5 PULMONOLOGY

Bronchiectasis ⋅ More in bases than apices, except in TB ⋅ Paroxysmal cough ⋅ Cystic fibrosis (mucoviscidosis) ⋅ Kartagener’s Syndrome ⋅ Permanent abnormal bronchial dilatation ⋅ Obstruction by tumor ⋅ Chronic sinusitis

Lobar Pneumonia ⋅ Pneumococcus ⋅ Klebsiella ⋅ Interalveolar exudate ⋅ Pneumocystis Carnii Pneumonia ⋅ Fluffy foamy intra-alveolar exudate ⋅ Helmet shaped cells with silver stain ⋅ AIDS ⋅ Upper lobes

Cytomegalovirus ⋅ Pneumonia associated with bone transplant and Immune suppressed states ⋅ Leukopenia ⋅ Owl’s eye intranuclear inclusion

17 Bare Minimum Keyword Associations

Mycoplasma ⋅ Hyaline membrane ⋅ Cold agglutinin ⋅ Negative gram stain ⋅ Atypical pneumonia ⋅ Children, young adults

Tuberculosis ⋅ Caseous necrosis ⋅ Caseating Granulomas ⋅ Acid-fast positivity ⋅ Ziehl Neilson positive ⋅ Langham’s giant cells ⋅ Ghon complex

Histoplasmosis ⋅ Ohio-Mississippi Valley ⋅ Leukopenia ⋅ Increased LDH ⋅ Intracellular yeasts ⋅ Pulmonary lesions, late calcification

Coccidiodomycosis ⋅ California ⋅ Desert

Cryptococcus ⋅ Capsule ⋅ India Ink ⋅ Meningitis-AIDS

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Asthma ⋅ Expiratory Wheezing ⋅ IgE mediated ⋅ Thickened basement membrane ⋅ Eosinophils ⋅ Charcot Leyden crystals ⋅ Curschmann’s spirals

Pulmonary Emboli ⋅ V/Q scan mismatch ⋅ Immobilized post op ⋅ Wedge-shaped infarct ⋅ Deep vain thrombosis

Squamous Cell Carcinoma ⋅ Hypercalcemia ⋅ Ectopic PTH ⋅ Nose and larynx, malignant ⋅ Men 40+

Adenocarcinoma ⋅ A.K.A Non-small cell, large cell ⋅ 75% of all bronchiogenic carcinomas ⋅ Scar carcinoma

Oat Cell Carcinoma ⋅ Cigarette ⋅ Ectopic ACTH and ADH ⋅ Poor prognosis ⋅ Chemotherapy only ⋅ Horner’s syndrome ⋅ Nail clubbing

19 Bare Minimum Keyword Associations

ARDS ⋅ Diffuse alveolar lesions ⋅ Hyaline membranes ⋅ Atelectasis and hemorrhage ⋅ Hypoxia ⋅ Leukocytosis and neutrophilia ⋅ Increased BUN, AST and ALT ⋅ “Bat Wing Alveoli” ⋅ Gram negative sepsis, DIC, and trauma

Emphysema ⋅ Smoking ⋅ Barrel chest ⋅ Alpha 1 antitrypsin deficiency

Bronchitis ⋅ Hypertrophy of submucosal glands ⋅ Smoking ⋅ Blue bloaters ⋅ Cor pulmonale

Sarcoidosis ⋅ Boeck’s sarcoid ⋅ Elevated ACE ⋅ Hyper calcemia ⋅ Non-caseating Granulomas ⋅ Arthritis

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Malignant Mesothelioma ⋅ Poor prognosis ⋅ Polycythemia ⋅ Restrictive pattern ⋅ Asbestos materials (Asbestos = Ferruginous body)

21 Bare Minimum Keyword Associations 6 GASTROENTEROLOGY

Reflux Esophagitis ⋅ Squamous epithelium ⋅ Columnar metaplasia ⋅ Barrett’s esophagus = Adeno-carcinoma ⋅ Rat-tailed lower esophagus

Achalasia ⋅ Lower esophageal sphincter ⋅ Difficult swallowing ⋅ Lack of ganglions in Myenteric plexus

Esophageal Varices ⋅ Nodular hepatomegaly ⋅ Increased alkaline phosphatase ⋅ Increased ALT and AST ⋅ Upper GI hemorrhage ⋅ Cirrhosis ⋅ Portal hypertension

Mallory-Weiss Tears ⋅ Upper GI hemorrhage ⋅ Alcoholism ⋅ Prolonged vomiting

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Menetrier’s Disease ⋅ Giant gastritis ⋅ Gastric rugal hypertrophy ⋅ Protein wasting

Gastric Adenocarcinoma ⋅ Japanese population ⋅ Men 50+, blood group A ⋅ Linitis plastica

Krukenberg’s Tumor ⋅ Bilateral ovarian metastasis ⋅ Gastric carcinoma ⋅ Signet-ring cells

Yersinia ⋅ Bubonic plague ⋅ Gastroenteritis ⋅ Mesenteric adenitis

Vibrio Cholera ⋅ Rice water stool ⋅ Increased GI Pumping of Cl- and water

Giardia Lamblia ⋅ Duodenum ⋅ Intestinal malabsorption

Cryptosporidiosis ⋅ AIDS ⋅ Colitis, gastroenteritis

23 Bare Minimum Keyword Associations

⋅ Intestinal malabsorption ⋅ Celiac Disease ⋅ Cereals ⋅ Blunting of small intestinal villi ⋅ B-cell lymphoma ⋅ Growth retardation ⋅ Gluten sensitivity

Amebiasis ⋅ Large bowel, cecum ⋅ Flask-shaped ulcers ⋅ Brain-liver abscesses

Pseudomembraneous Colitis ⋅ Due to antimicrobials ⋅ Clostridium difficile

Ulcerative Colitis ⋅ Young adults ⋅ Large bowel ⋅ Crypts abscess ⋅ Pseudopolyps ⋅ Mucosal/submucosal inflammation

Crohn’s Disease ⋅ Jewish young adults (aged 20-30) ⋅ Granulomas ⋅ Transmural inflammation ⋅ Cobblestones ⋅ String sign ⋅ Fistulas

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Villous Adenoma ⋅ Cauliflower shape ⋅ Rectum ⋅ Protein losing enteropathy ⋅ Tubular Adenoma ⋅ Colonal lesions ⋅ Most common ⋅ Small and pedunculated ⋅ Risk of carcinoma if larger than 2cm

Adenocarcinoma ⋅ Iron deficiency anemia ⋅ Apple-core lesions ⋅ CEA elevation in serum

Meckel’s Diverticulum ⋅ Vitelline duct remnant ⋅ Intussusception and volvulus ⋅ Distal small intestine ⋅ Small bowel obstruction

Colonal Carcinoma ⋅ Men aged 60-70 ⋅ Adenocarcinoma ⋅ CEA antigen

Hirschsprung’s Disease ⋅ Congenital megacolon ⋅ Lack of ganglion cells (Meissner and Auerbach) ⋅ No meconium

25 Bare Minimum Keyword Associations

⋅ Colonic dilatation proximal to aganglionic segment ⋅ Male to female ratio: 4:1

Familial Polyposis ⋅ 100% risk of malignant transformation ⋅ Autosomal dominance ⋅ APC gene defect ⋅ Association with Turcot’s syndrome ( with osteomas) Gardner’s syndromes (with CNS tumors)

26 Northwestern Medical Review 7 LIVER AND PANCREAS

Hepatitis B ⋅ Parenteral, sexual and vertical transmission ⋅ Acidophil (Councilman) body ⋅ Ground glass hepatocytes ⋅ Apoptosis ⋅ Hepatocellular carcinoma ⋅ ALT > AST

Hepatitis A ⋅ Fecal-oral transmission ⋅ Direct hyperbilirubinemia ⋅ Incubation: 14 - 21 days ⋅ ALT > AST

Hepatitis C ⋅ Blood transfusion ⋅ Proliferative glomerulonephritis

Reye’s Syndrome ⋅ Young children ⋅ Encephalopathy and coma

27 Bare Minimum Keyword Associations

⋅ Flu-like illness ⋅ Chicken pox and Influenza ⋅ Aspirin ingestion ⋅ Fatty Liver

Primary Billiary Cirrhosis ⋅ Autoimmune ⋅ Middle-aged women ⋅ Antimitochondrial antibody ⋅ Severe obstructive jaundice

Chronic Passive Congestion ⋅ Right heart failure ⋅ Nutmeg liver

Hepatic Adenoma ⋅ Subcapsular and intraperitoneal hemorrhage ⋅ Oral contraceptives

Hepatocellular Carcinoma ⋅ Most common primary malignancy ⋅ Hepatitis B, cirrhosis ⋅ Aflatoxin B ⋅ Alpha-fetoprotein marker ⋅ Alcoholism ⋅ Low serum albumin ⋅ Increased PT, Ascites ⋅ Wilson disease

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Angiosarcoma ⋅ Vinyl chloride ⋅ Thorotrast ⋅ Arsenic

Alcoholic Cirrhosis ⋅ Mallory’s hyaline—cytokeratin filament ⋅ Fatty liver changes ⋅ Focal necrosis

Wilson’s Disease ⋅ Autosomal recessive ⋅ Kayser-Fleischer rings, cornea ⋅ Hepatolenticular degeneration ⋅ Copper accumulation, liver ⋅ Low ceruloplasmin ⋅ Chromosome 13, band q14.3

Hemochromatosis ⋅ Iron absorption defect ⋅ Cirrhosis ⋅ Bronze diabetes ⋅ Steatorrhea ⋅ Skin pigmentation

α -1 Antitrypsin Deficiency ⋅ Barrel-shaped chest ⋅ RT ventricular hypertrophy ⋅ Obstructive pattern ⋅ Panacinar emphysema-lower lobe ⋅ Cirrhosis

29 Bare Minimum Keyword Associations

Chronic Pancreatitis ⋅ 40+ year old men ⋅ Alcoholism ⋅ Steatorrhea ⋅ Epigastric pain ⋅ High serum amylase and lipase ⋅ Cystic fibrosis

Acute Pancreatitis ⋅ Males ⋅ Alcoholism ⋅ Mid epigastric pain ⋅ Increased Amylase, SGOT, LDH ⋅ Hypocalcemia ⋅ Gallstones

Cholangiocarcinoma ⋅ Intrahepatic biliary epithelium ⋅ Clonorchis sinensis

Diabetes Mellitus ⋅ Type I: IDDM; Juvenile, weight loss, no insulin synthesis ⋅ Type II: NIDDM, Adult, weight gain, insulin resistance ⋅ Glycosylation of hemoglobin protein ⋅ Kimmelstiel-Wilson nodule in kidney glomerulus

Pancreatic Adenocarcinoma ⋅ Trousseau’s sign ⋅ Painless jaundice ⋅ Palpable gallbladder

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⋅ Hyper-coagulopathy ⋅ Pruritus ⋅ Increased bilirubin, dark urine ⋅ Increased alkaline phosphatase ⋅ Diabetes, and chronic pancreatitis ⋅ Ki-ras oncogen

Gastrinoma ⋅ Hypergastrinemia ⋅ Zollinger-Ellison Syndrome

31 Bare Minimum Keyword Associations 8 NEPHROLOGY

Adult Polycystic Kidney ⋅ Autosomal dominance ⋅ 15-30 years old ⋅ Berry Aneurysm ⋅ Hematuria ⋅ Polycystic liver disease ⋅ Hypertension ⋅ Chromosome 16 ⋅ Mitral prolapse

Infantile Polycystic Kidney ⋅ Autosomal recessive ⋅ Hepatic fibrosis ⋅ Closed cysts

Post-Streptococcal Glomerulonephritis ⋅ Elevated ASO ⋅ Intense inflammation ⋅ Lumpy-bumpy immunofluorescence

Goodpasture’s Syndrome ⋅ Men mid-20’s ⋅ Glomerulonephritis

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⋅ Linear IgG at basal membrane ⋅ Pulmonary hemorrhage ⋅ Hematuria

Lipoid Nephrosis ⋅ Very young children ⋅ Fusion of foot processes ⋅ Normal glomerulus (light microscopy) ⋅ Lipid-laden renal cortices

Nephrotic Syndrome ⋅ Edema ⋅ Hypoalbuminemia ⋅ Hypercholesterolemia ⋅ Hyperlipidemia ⋅ Hypoproteinemia ⋅ Severe proteinuria

Nephritic Syndrome ⋅ Oliguria ⋅ Hypertension ⋅ Azotemia ⋅ Smoky-brown urine ⋅ Urinary Blood Cell Casts (Hematuria)

Membranoproliferative Glomerulonephritis ⋅ Immune complex nephritis: Type I ⋅ Dense deposit disease: Type II ⋅ Tram-track-like membrane

Diabetic Glomerulonephritis ⋅ IDDM

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⋅ Edema, hypertension ⋅ Kimmelstiel-Wilson nodule in kidney glomeruli ⋅ Increased BUN, cholesterol ⋅ Low albumin ⋅ Papillary necrosis ⋅ Retinopathy

Benign Nephrosclerosis ⋅ 60+ years old ⋅ Hyaline arteriosclerosis ⋅ Diabetes and hypertension

Malignant (Hypertension) Nephrosclerosis ⋅ Onion-skinning ⋅ Flea bitten kidney ⋅ Necrotizing lesions

Renal Cell Carcinoma ⋅ Most common renal malignancy ⋅ Men aged 50-70 ⋅ Polygonal Clear Cells ⋅ Hematogenous spread ⋅ Smoking ⋅ Renal vein pathology ⋅ Hypercalcemia

Papillary Necrosis ⋅ Diabetes ⋅ Sickle Cell disease

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Transitional Cell Carcinoma ⋅ Most common tumor of collecting ducts ⋅ Hematuria ⋅ Benzidine, smoking, cyclophosphamide, and aniline ⋅ Local dissemination ⋅ Schistosoma

Squamous Cell Carcinoma of Bladder ⋅ Sequel of inflammation ⋅ Schistosomiasis ⋅ Renal calculi

Other Keywords Myoglobinuria ⇔ Trauma Potter’s syndrome ⇔ Bilateral renal agenesis Milk-Alkali syndrome ⇔ Nephrocalcinosis Wilm’s Tumor ⇔ Childhood, Nephroblastoma, flank mass Pre-renal Azotemia ⇔ Decreased renal flow, Oliguria, High BUN/Creatinine ratio Fanconi Syndrome ⇔ Glycosuria, Systemic acidosis, proximal tubule, hypophosphatemia Hartnup’s Disease ⇔ Tryptophan mal- absorption Alport Disease ⇔ Male, red urine, visual disturbance, proteinuria

35 Bare Minimum Keyword Associations 9 MALE REPRODUCTIVE

Seminoma ⋅ Most common ⋅ Mid 30’s ⋅ Radio-sensitivity ⋅ Germ Cell tumor

Yolk Sac Tumor ⋅ Infants ⋅ Mostly testis ⋅ Endodermal sinus ⋅ Alpha-fetoprotein

Choriocarcinoma ⋅ 20-30 years of age ⋅ HCG increase ⋅ Gynecomastia

Leydig Tumor ⋅ Interstitial cells (non-germ) ⋅ Benign

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⋅ Intra-cytoplasmic Reinke crystals ⋅ Adult gynecomastia

Prostatic Carcinoma ⋅ Inner group of glands ⋅ Posterior lobe ⋅ PSA in serum ⋅ PAP (Prostatic acid phosphate)

Other Keywords Inflammation Balanitis ⇔ Poor hygiene Syphilis ⇔ Chancre Gonorrhea ⇔ Neisseria Chlamydia ⇔ Nongonococcal urethritis Testicular Diseases Torsion of Spermatic ⇔ Testicular gangrene cord Cryptorchidism ⇔ Atrophy Hydrocele ⇔ Distended tunica vaginalis Other Tumors Teratoma ⇔ Germ cell tumor Androblastoma ⇔ Sertoli cell

37 Bare Minimum Keyword Associations 10 FEMALE REPRODUCTIVE

Ductal Papilloma ⋅ Bloody Nipple Discharge ⋅ Unilateral

Lobular Carcinoma ⋅ Pre-menopausal female ⋅ Mostly bilateral ⋅ Multifocal

Ductal Carcinoma ⋅ Unilateral ⋅ Most common malignant

Fibrocystic Disease (Disorder) ⋅ Ages 25-50 ⋅ Most common breast disorder ⋅ Bilateral pain ⋅ Apocrine metaplasia ⋅ Fibrosis and sclerosing adenosis ⋅ Cysts

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⋅ Often benign ⋅ Regression with pregnancy

Fibroadenoma ⋅ 20-30 years age ⋅ Intracanalicular and pericanalicular Fibroadenoma ⋅ Increased sensitivity to estrogen ⋅ Benign focal tumor

Cervical Carcinoma ⋅ Related to HPV types 16 and 18 ⋅ Dysplasia ⋅ Squamous cell carcinoma ⋅ Squamo-columnar junction ⋅ Post-coital bleeding

Ovarian Tumors Granulosa tumor ⇔ Estrogen Arrhenoblastoma ⇔ Sertoli Cystadenoma ⇔ Pseudomyxoma Dysgerminoma ⇔ Seminoma, radiosensitive Krukenberg’s ⇔ Etastatic ovarian; Signet-ring Fibroma ⇔ Meig’s syndrome Choriocarcinoma ⇔ HCG Dermoid Cysts ⇔ Mature teratoma

Other Breast Conditions Acute Mastitis ⇔ S. aureus

39 Bare Minimum Keyword Associations

Other Breast Conditions Medullary ⇔ Fleshy texture carcinoma Mucinous ⇔ Gelatinous texture carcinoma Paget’s ⇔ Poor prognosis, ductal carcinoma, older women, nipples

Diseases Vaginal Clear Cell ⇔ DES in utero Mucinous ⇔ Pseudomyxoma cystadenocarcinoma peritonei Serous Cystadenoma ⇔ Psammoma bodies Hydatidiform ⇔ HCG Choriocarcinoma ⇔ Lung metastasis

Infectious Diseases Trichomoniasis ⇔ Malodorous vaginitis, “strawberry cervix” Candidiasis ⇔ Pruritic white thick discharge, mostly coitus related, HIV positive Gardnerella vaginalis ⇔ Clue cells Chlamydia ⇔ Asymptomatic PID Lymphogranuloma ⇔ Rectal stricture venereum Toxic shock syndrome ⇔ S. aureus tampons Gonorrhea ⇔ N. gonorrhea PID Herpes (HSV) ⇔ Multinucleated giant cells

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Infectious Diseases Granuloma inguinale ⇔ Donovan bodies (Calymmatobacterium granulomatis) Syphilis ⇔ Condyloma lata, VDRL, FTA-abs, tabes dorsalis Chancroids ⇔ Haemophilus ducreyi

41 Bare Minimum Keyword Associations 11 INTEGUMENTARY SYSTEM

Psoriasis ⋅ More common in men ⋅ Auspitz ⋅ Spongiform pustule of Kogoj ⋅ Munro’s micro-abscess ⋅ 7% of patients with arthritis ⋅ Autosomal dominance

Erythema Multiforme ⋅ Target lesion ⋅ A.K.A. Steven Johnson syndrome ⋅ Recurrence ⋅ “Iris lesion”

Pemphigus Vulgaris ⋅ 40-60 years of age ⋅ Jewish population ⋅ Intra-epidermal bullae ⋅ Keratinocytes with IgG ⋅ Ethanol Abuse

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Bullous Pemphigoid ⋅ 60+ age ⋅ Linear IgG in basement membrane

Basal Cell Carcinoma ⋅ Most common skin neoplasm ⋅ Mostly face and scalp ⋅ Pearly border ⋅ Palisading ⋅ Sunlight

Kaposi’s Sarcoma ⋅ More in men ⋅ Children ⋅ Lower extremities with or without visceral involvement ⋅ AIDS ⋅ Purple Plaques ⋅ Spindle cells ⋅ Hemosiderin

Malignant Melanoma ⋅ Horizontal and vertical growth ⋅ Epidermal-dermal junction ⋅ Clark’s level ⋅ Sun exposure ⋅ Most malignant skin neoplasm ⋅ Nodular melanoma ⋅ Metastasis

Acanthosis Nigricans ⋅ Chronic external irritation

43 Bare Minimum Keyword Associations

⋅ Visceral/internal malignancies ⋅ Hyper-pigmentation

Vitiligo ⋅ Albino-like manifestations ⋅ Antimelanocyte antibodies

Squamous Cell Carcinoma ⋅ Men more than women ⋅ Sun-damaged skin ⋅ Metastatic potency ⋅ Keratin pearls

Herpes Zoster ⋅ Chicken pox ⋅ Dorsal root ganglia ⋅ Dermatome eruption ⋅ Albinism ⋅ Tyrosine ⋅ Ocular: X-linked

Contact Dermatitis ⋅ T-cells ⋅ Delayed type hypersensitivity

44 Northwestern Medical Review 12 ENDOCRINOLOGY

Grave’s Disease ⋅ Toxic goiter ⋅ Exophthalmia ⋅ HLA-DR3, HLA-B8 ⋅ Thyroid Stimulating Immunoglobulin (TSI) ⋅ Thyroid Growth Immunoglobulin (TGI)

Papillary Thyroid Carcinoma ⋅ Ground-glass nuclei ⋅ Psammoma bodies

Follicular Thyroid Carcinoma ⋅ Capsule invasion ⋅ Vessel invasion ⋅ Vascular metastasis (poor prognosis)

Medullary Thyroid Carcinoma ⋅ Calcitonin ⋅ Associated with MEN IIa and IIb ⋅ Amyloid stroma

45 Bare Minimum Keyword Associations

Primary Hyperparathyroidism ⋅ Increased alkaline phosphatase ⋅ Osteitis fibrosa ⋅ Cystic-brown bone tumor ⋅ Hypercalcemia ⋅ Hypophosphatemia ⋅ Increased PTH

Secondary Hyperparathyroidism ⋅ Chronic Renal Disease ⋅ Hypocalcemia ⋅ Osteoclastic bone disease ⋅ Increased PTH ⋅ Hyperphosphatemia

Pseudohypoparathyroidism ⋅ Autosomal recessive ⋅ Short finger and stature ⋅ Unresponsiveness to PTH

Hypoparathyroidism ⋅ Surgical accident (Thyroidectomy) ⋅ DiGeorge’s Syndrome ⋅ Tetany and hypocalcemia, seizures ⋅ Chvostek and Trousseau signs ⋅ Low calcium, high phosphate ⋅ Low PTH

Cushing’s Syndrome ⋅ Hypercortism (Adrenal) ⋅ High ACTH activity ⋅ Adrenal cortical adenoma

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⋅ Adrenal carcinoma ⋅ Zona fasciculata ⋅ Hypokalemia, glucosuria

Primary Adrenocortical Deficiency ⋅ Addison’s ⋅ Autoimmune atrophy ⋅ TB, infections ⋅ Hypotension ⋅ Pigmentation ⋅ Decreased serum Na+ ⋅ High serum K+

Pheochromocytoma ⋅ Adrenal Medullary tumor ⋅ Chromaffin cells ⋅ Episodic Hypertension ⋅ Increased urinary catecholamines

Neuroblastoma ⋅ Homer Wright rosettes ⋅ Spontaneous differentiation to ganglioneuroma ⋅ Childhood ⋅ N-myc oncogene

Diabetes Mellitus ⋅ TYPE I: Ketoacidosis, young, HLA DR3 and DR4 ⋅ TYPE II: Less ketoacidosis, older, obese, neuropathy ⋅ See also pancreas/liver

47 Bare Minimum Keyword Associations

Insulinoma ⋅ β-Cell tumor ⋅ Whipple’s Triad ⋅ Increased circulatory pre-insulin

Gastrinoma ⋅ Zollinger-Ellison Syndrome ⋅ Hypergastrinemia

Glucagonoma ⋅ Secondary diabetes mellitus ⋅ Necrolytic migratory erythema

VIPoma ⋅ A.K.A. Werner-Morrison Syndrome ⋅ Pancreatic tumor ⋅ Elevated vasoactive intestinal peptide (VIP) ⋅ Watery diarrhea ⋅ Hypokalemia ⋅ Achlorhydria ⋅ Dehydration

MEN Syndromes Type I ⇔ Wermer’s Syndrome; Zollinger-Ellison, adrenal cortex, pituitary, parathyroid, pancreas Type IIa ⇔ Sipple’s Syndrome; hyperparathyroidism, Pheochromocytoma

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MEN Syndromes Type IIb (MEN III) ⇔ Pheochromocytoma, adrenal medulla, thyroid medulla

Other Thyroid Hypothyroidism ⇔ Cretinism and myxedema Hashimoto’s thyroiditis ⇔ Autoimmune, Lymphocytic infiltration, anti-thyroglobulin antibodies; Hypothyroid Plummer’s Syndrome ⇔ Colloid accumulation, Hyperthyroidism with no exophthalmia Thyroglossal Duct Cyst ⇔ Common Congenital

Pituitary Hyperfunctions Prolactinoma ⇔ Chromophobic cells; Amenorrhea, galactorrhea Somatotropic adenoma ⇔ Acidophilic adenoma; gigantism; acromegaly Corticotropic adenoma ⇔ Basophilic, ACTH, Cushing’s Antidiuretic ⇔ Ectopic lung carcinoma Hyperfunction Hypofunctions Simmond’s Disease ⇔ Panhypopituitarism; wasting Sheehan’s ⇔ Postpartum ischemic necrosis

49 Bare Minimum Keyword Associations

Pituitary Growth hormone ⇔ Dwarfism TSH ⇔ Secondary hypothyroidism ADH ⇔ Diabetes insipidus

50 Northwestern Medical Review 13 MUSCULOSKELETAL SYSTEM

Myasthenia Gravis ⋅ 20-30 year-old females ⋅ Thymic hyperplasia ⋅ Eaton-Lambert myasthenia ⋅ Motor end-plate acetylcholine receptor antibody ⋅ Fatigue on exertion ⋅ Swallowing and ocular muscles problems ⋅ Symptoms worse at night ⋅ Improves with edrophonium

Duchenne Muscular Dystrophy ⋅ Dystrophin deficiency ⋅ X-linked ⋅ Calves pseudohypertrophy ⋅ Creatine-phosphokinase

Becker Muscular Dystrophy ⋅ X-linked ⋅ Better prognosis than Duchenne ⋅ Walking through mid 20’s

51 Bare Minimum Keyword Associations

Rheumatoid Arthritis ⋅ Rheumatoid factor ⋅ Pannus ⋅ Proximal interphalangeal joints ⋅ Symmetric arthritis ⋅ HLA antigen ⋅ Felty’s syndrome

Gout ⋅ Hyperuricemia ⋅ Tophi ⋅ Monosodium urate crystals in joints ⋅ Uric acid stones ⋅ Metatarsophalangeal joint

Osteosarcoma ⋅ Malignant ⋅ Adolescence ⋅ Codman’s triangle ⋅ Metaphysis ⋅ Retinoblastoma ⋅ Chromosome 13, deletion 14

Chondrosarcoma ⋅ Pelvis ⋅ Mostly older adult males ⋅ Malignant

Ewing’s Sarcoma ⋅ Diaphysis ⋅ Skull metastasis ⋅ Soft tissue penetration

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⋅ Pelvis and long bones ⋅ Young male Caucasians (< 15 years old) ⋅ Resembles osteomyelitis ⋅ “Onion skin”

Paget’s Bone Disease ⋅ Increased osteoblastic and osteoclastic activities ⋅ Tibial bowing ⋅ Mosaic bone ⋅ Increased serum phosphatase ⋅ High output cardiac failure ⋅ Increased risk of osteosarcoma

Ankylosing Spondylitis ⋅ Spine sacroiliac joint ⋅ HLA-B27 ⋅ Young males ⋅ Aortic insufficiency ⋅ Iritis

53 Bare Minimum Keyword Associations 14 CENTRAL NERVOUS SYSTEM

Pyogenic Meningitis ⋅ E. Coli, infants ⋅ H. Influenzae, children ⋅ N. Meningitidis, adolescence

Multiple Sclerosis ⋅ Increased CSF immunoglobulin ⋅ HLA haplotypes ⋅ Paraventricular plaques ⋅ Helper CD4+ and cytotoxic CD8+ T lymphocytic infiltration ⋅ IgM antibody = recent primary infection

Alzheimer’s ⋅ Progressive dementia ⋅ Choline acetyltransferase deficiency ⋅ Alteration of nucleus basalis of Meynert

Parkinson’s ⋅ Substantia nigra ⋅ Lewy bodies ⋅ L-dopa

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⋅ Resting tremor ⋅ Rigidity ⋅ Bradykinesia ⋅ Mask-like facies

Huntington’s Disease ⋅ Atrophy of caudate nucleus ⋅ Atrophy of Putnam ⋅ Chromosome 4 ⋅ Delay of clinical abnormalities until 30-40 years of age

Medulloblastomas ⋅ Young children ⋅ Cerebellum ⋅ Rosette or perivascular pseudo-rosette pattern

Keyword Associations Syphilis ⇔ Tabes dorsalis Rabies ⇔ Negri body Epidural hematoma ⇔ Middle meningeal Subdural hematoma ⇔ Bridging veins tear Berry aneurysm ⇔ Subarachnoidal hemorrhage Cerebral infarct ⇔ Middle cerebral artery Anencephaly ⇔ α-fetoprotein Pituitary tumor ⇔ Bitemporal hemianopsia Toxoplasmosis ⇔ Placental infection Lacunar infarct ⇔ Thalamus Creutzfeldt-Jacob ⇔ Rapidly progressive dementia

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Keyword Associations Progressive multifocal ⇔ Measles, AIDS leukoencephalopathy Meningioma ⇔ Psammoma bodies, Palisading Alzheimer’s ⇔ Eurofibrillary tangles, β2 Amyloid, most common Pick’s disease ⇔ Pick’s bodies Guillain-Barré ⇔ Acute peripheral neuritis syndrome Multiple Sclerosis ⇔ HLA haplotypes Parkinson’s ⇔ Substantia nigra, Lewy bodies, L-dopa, Resting tremor Toxoplasmosis ⇔ Transplacental Viral ⇔ Perivascular cuffing, glial meningoencephalitis inclusion bodies Poliomyelitis ⇔ Necrosis of anterior horn of spinal cord Idiopathic Parkinson’s ⇔ Paralysis agitans, Lewy bodies, L-dopa Von Economo’s ⇔ Post-encephalitis encephalitis Parkinsonism Shy-Dragger Syndrome ⇔ Parkinsonism plus autonomic disorder Cytomegalovirus ⇔ Giant cells with eosinophilic bodies Kuru ⇔ Cannibalism, spongiosis Subacute sclerosing ⇔ Measles panencephalitis Progressive Multifocal ⇔ Papovavirus leukoencephaly

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CNS Lesions CNS Organ ⇔ Attributes / Diseases Temporal lobe ⇔ Epilepsy Frontal lobe ⇔ Personality change, and judgment deficit Right parietal lobe ⇔ Contralateral agnosia Occipital lobe ⇔ Visual defect Broca’s ⇔ Motor aphasia Wernicke’s ⇔ Sensory aphasia Amygdala (bilateral) ⇔ Kluver-Bucy syndrome Mamillary bodies ⇔ Wernicke-Korsakoff’s (alcoholism) psychosis Hippocampus ⇔ Memory deficit Basal Meynert nuclei ⇔ Alzheimer’s (Ach) Substantia Nigra ⇔ Parkinson’s (dopamine) Caudate nucleus ⇔ Huntington chorea (GABA) Subthalamic nucleus ⇔ Hemiballism (Glu) Cerebellum ⇔ Asynergia, ataxia, (spino/cerebro) dysmetria, intention tremor Cerebellum (vestibule) ⇔ Equilibrium Nucleus of VI ⇔ Lateral gaze paralysis Nerve VI ⇔ Medial strabismus, lateral rectus palsy Nerve III ⇔ Mydriasis, ptosis, lateral strabismus Nerves VI and VII, ⇔ Millard-Gubler Syndrom Pyramidal tract Brainstem above ⇔ Decerebrate rigidity superior colliculus

57 Bare Minimum Keyword Associations

CNS Lesions Reticular formation ⇔ Syncope Anterior spinal artery ⇔ Inferior alternating (proximal) hemiplegia Posterior inferior ⇔ Wallenberg syndrome cerebellar artery (lateral medullary syndrome) Anterior inferior ⇔ Lower lateral pontine cerebellar artery syndrome Superior cerebellar ⇔ Rostral lateral pontine artery syndrome Hemisection of spinal ⇔ Brown-Sequard cord syndrome Conus medullaris ⇔ Areflexive bladder Above T6 Autonomic dysreflexia Upper Motor Neuron Positive Babinski, Spastic Signs Paralysis, Hyperreflexia, Loss of Cutaneous Reflexes Lower Motor Neuron Flaccid Paralysis, Signs Hypotonia, Areflexia, Hyporeflexia, Muscle atrophy, Muscle Fasciculation Alternating Hemiplegia Superior III, Trigeminal V, Middle VI, and Inferior VII

58 Northwestern Medical Review 15 AUTOIMMUNE DISEASES

SLE ⋅ 10 times more common in females ⋅ More common in African Americans ⋅ 20-30 years of age ⋅ Photosensitivity ⋅ Butterfly facial rash ⋅ Triggered by Procainamide ⋅ ANA ⋅ Anti-ds DNA ⋅ Sm antigen ⋅ Libman-Sachs endocarditis ⋅ Diffuse Glomerulonephritis

Sjogren’s Syndrome ⋅ Middle age women ⋅ HLA-DR3 ⋅ Parotid enlargement ⋅ Xerostomia ⋅ Rheumatoid arteritis ⋅ Keratoconjunctivitis

59 Bare Minimum Keyword Associations

Scleroderma ⋅ A.K.A. Systemic sclerosis ⋅ Raynaud’s phenomena ⋅ Esophageal fibrosis ⋅ ANA (antinuclear antibody) ⋅ Hyper-gammaglobinemia ⋅ Anticentromere angiopathy ⋅ Xerostomia

Amyloid ⋅ Congo red stain ⋅ Multiple myeloma ⋅ Alzheimer ⋅ Dilated: Congestive

Graves Disease ⋅ Middle-aged female ⋅ Exophthalmia ⋅ Heat intolerance

Hashimato Thyroiditis ⋅ Auto microsomal antibody ⋅ Enlarged thyroid ⋅ Lymphocytic infiltration ⋅ Cold intolerance ⋅ Associated with: SLE, Sjogren’s, chronic hepatitis, HLA-DR5 and DR3

Myasthenia Gravis ⋅ See musculoskeletal

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Lambert- Eaton Syndrome ⋅ Similar to myasthenia ⋅ Auto-antibody to Ca++ channels ⋅ Decreased presynaptic Ach release ⋅ Proximal weakness

Good Pasture’s ⋅ Males ⋅ Autoantibody against basement membrane ⋅ Kidneys and lungs

Dermatomyositis ⋅ Eye and knuckle’s rash ⋅ Bilateral proximal muscle weakness ⋅ Polymyositis ⋅ Increased CPK, SGOT, LDH, and CK ⋅ Subcutaneous calcification

Rheumatoid Arthritis ⋅ Antibody against Fc of IgG ⋅ Females, aged 40-50 ⋅ Pannus ⋅ Synovitis and morning stiffness ⋅ Joint deformity

Conditions Associated with Eosinophillia Addison’s Leukemia Lymphoma Polyarteritis nodosa Pemphigus vulgaris

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Conditions Associated with Eosinophillia Hepatocellular carcinoma Chronic eosinophilic pneumonia Loeffler’s Syndrome Ascaris Strongyloides Wuchereria Aspergillosis Allergic rhinitis and Asthma Eczema Urticaria

62 Northwestern Medical Review 16 IMMUNE DEFICIENCIES

DiGeorge’s Syndrome ⋅ 3rd and 4th pouches developmental defect ⋅ Thymus and parathyroid defect ⋅ Hypocalcemia ⋅ Neonatal tetany ⋅ Loss of cell mediated immunity ⋅ Abnormal facies

Wiskott-Aldrich Syndrome ⋅ X-linked recessive ⋅ Eczema ⋅ Thrombocytopenia ⋅ Recurrent infections

SCID (Severe Combined Immunodeficiency) ⋅ B and T cell deficiency ⋅ Sex-linked or autosomal recessive

Acquired Immunodeficiency (AIDS) ⋅ HIV ⋅ ELISA and Western Blot

63 Bare Minimum Keyword Associations

Inflammation Acute ⇔ Neutrophils Chronic ⇔ Macrophage, lymphocyte, fibrosis Bacteria ⇔ Neutrophils Virus and Fungi ⇔ Macrophages, Lymphocytes C5A ⇔ Chemotaxis C5-9 ⇔ Membrane attack complex Opsonins ⇔ IgG, C3b Chediak-Higashi ⇔ Chemotaxic defect Bradykinin ⇔ Pain Leukotriene B4 ⇔ Chemotaxis Leukotriene C4, D4, E4 ⇔ Vasodilation

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ONCOLOGY

Pre-Cancerous States and Associated Cancers Actinic keratosis ⇔ Squamous cell carcinoma Alcoholic Cirrhosis ⇔ Hepatocellular carcinoma AIDS ⇔ Kaposi’s sarcoma, and aggressive B-cell lymphomas Autoimmune diseases ⇔ Malignant and benign (Hashimoto’s, thymomas myasthenia gravis) Barrett’s esophagus ⇔ Esophageal Adenocarcinoma Café au lait of skin ⇔ Neurofibromatosis Chronic atrophic ⇔ Gastric Adenocarcinoma gastritis Hepatitis B ⇔ Hepatocellular carcinoma Paget’s ⇔ Oste and fibrosarcomas Pernicious anemia ⇔ Gastric Adenocarcinoma Plummer-Vinson ⇔ Esophageal squamous Syndrome cell carcinoma Actinic keratosis ⇔ Cardiac rhabdomyoma

65 Bare Minimum Keyword Associations

Pre-Cancerous States and Associated Cancers Alcoholic Cirrhosis ⇔ Colonic Adenocarcinoma AIDS ⇔ Basal and squamous cell carcinoma of skin

Tumor Suppressor Genes Gene, Chromosome ⇔ Related Tumor NF-2, 22q ⇔ Acoustic neuroma; Neurofibromatosis II NF-1, 17q ⇔ Neurofibromatosis Type I BRCA-1, 17q ⇔ Ovarian and breast cancer BRCA-2, 13q ⇔ Breast APC, 5q ⇔ Familial polyposis DCC, 18q ⇔ Coloanal and gastric Rb, 13q ⇔ Osteosarcoma, Retinoblastoma WT-1, 11p ⇔ Wilm’s

Tumor Markers βHCG ⇔ Hydatidiform mole, Choriocarcinoma, dysgerminoma α-1 Anti-Trypsin ⇔ Liver, yolk sac S-100 ⇔ Neural neoplasms and melanoma Bombesin ⇔ Neuroblastoma, pancreatic and gastric carcinomas CA-125 ⇔ Ovarian tumors

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Tumor Markers α-Fetoprotein ⇔ Hepatocellular carcinoma, yolk sac, malignant teratoma CEA ⇔ Breast, colorectal, and pancreatic CA PSA ⇔ Prostate adenocarcinoma Acid Phosphatase ⇔ Prostate

Oncogenic Agents Viral Oncogens HPV ⇔ Cervical carcinoma, 16 and 18 Kaposi sarcoma ⇔ Kaposi’s sarcoma associated herpes (KSHV) EBV ⇔ Burkitt’s Lymphoma, nasopharyngeal carcinoma HBV ⇔ Hepatocellular carcinoma HTLV-1 ⇔ Adult T-cell leukemia and lymphoma Energy Related Oncogens UV ⇔ Basal and squamous cell carcinoma + skin melanoma Radiation Therapy ⇔ Leukemias, thyroid carcinoma, skin melanoma Chemical Oncogens Vinyl Chloride ⇔ Hepatic angiosarcoma

67 Bare Minimum Keyword Associations

Oncogenic Agents Thorotrast ⇔ Hepatic angiosarcoma Aflatoxin B ⇔ Hepatocellular carcinoma Alkylating agents ⇔ Leukemia/Lymphoma Nitrosamines ⇔ Gastric carcinoma Arsenic ⇔ Squamous cell carcinoma Chromium and Nickel ⇔ Pulmonary carcinoma Benzene ⇔ Acute leukemia Other Oncogens Asbestos ⇔ Mesothelioma Cigarettes ⇔ Pulmonary, oral, and bladder carcinoma Low fiber ⇔ Colon adenocarcinoma High fat ⇔ Breast carcinoma

DES ⇔ Vaginal clear cell Adenocarcinoma, vaginal adenosis Alcohol ⇔ Esophageal squamous carcinoma N-myc ⇔ Neuroblastoma L-myc ⇔ Small cell carcinoma of lung Bcl-2 ⇔ Follicular lymphomas Erb-b2 ⇔ Breast and ovarian carcinomas Myc ⇔ Burkitt’s lymphoma

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GENETICS

Autosomal Dominant Conditions Condition ⇔ Attributes Adult-polycystic kidney ⇔ Renal cyst, Liver, Berry disease aneurysm, Mitral Familial ⇔ Myocardial infarction, hypercholesterolemia LDL receptors Huntington’s ⇔ Progressive dementia, Chromosome 4, low GABA Hereditary ⇔ Skin telangiectasia, Hemorrhagic convoluted venules telangiectasia (Osler- Weber-Rendu Syndrome) Familial Polyposis coli ⇔ APC gene, chromosome 5, Colonal cancer Von Hippel-Lindau ⇔ Hemangioblastoma, chromosome 3, Renal tumors Von Recklinghausen’s ⇔ Café au lait spots, neural (Neurofibromatosis) tumors, chromosome 17 Marfan’s ⇔ Fibrillin, floppy mitral, lens subluxation, tall stature

69 Bare Minimum Keyword Associations

Autosomal Dominant Conditions Hereditary ⇔ Hemolytic anemia Spherocytosis Thorotrast ⇔ Hepatic angiosarcoma Retinoblastoma ⇔ Risk of osteosarcoma and breast carcinoma Ehlers Danlos ⇔ Collagen and elastin Syndrome defect, elastic skin, easy bleeding Von Willebrand ⇔ Bleeding

Autosomal Recessive Conditions Condition ⇔ Attributes Alkaptonuria ⇔ Homogentisic oxidase Cori’s Disease ⇔ Amylo 1, 6-glucosidase (Glycogen Storage III) Pompe’s (Glycogenesis ⇔ α1,4 glucosidase II) Von Gierke’s ⇔ Glucose-6-phosphatase (Glycogenesis I) McArdle’s ⇔ Muscle phosphorylase (Glycogenesis V) Galactosemia ⇔ Galactose-1-phosphate uridyl transferase Tay-Sachs ⇔ Hexosaminidase A Hurler’s ⇔ α-L-Iduronidase Gaucher’s ⇔ Glucocerebrosidase Niemann-Pic ⇔ Sphingomyelinase Phenylketonuria ⇔ Phenylalanine hydroxylase Wilson’s disease ⇔ Decreased serum (Hepatolenticular ceruloplasmin (a copper degeneration) binder)

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Autosomal Recessive Conditions Cystic fibrosis ⇔ Exocrine malfunction, thick mucus, sweat test (high Cl-), chromosome 7 Sickle Cell anemia ⇔ African Americans, Chromosome 11, hypoxia α-Thalassemia ⇔ Insufficient α-globin, chromosome 16, Bart’s anemia β-Thalassemia ⇔ β-globin deficiency, Cooley’s anemia ADA deficiency ⇔ Impaired Adenine and (Adenosine deaminase) Thymine

Sex-linked Conditions Condition ⇔ Attributes Duchenne muscular ⇔ Dystrophin defect, dystrophy pseudohypertrophy of calf Becker muscular ⇔ dystrophin deficiency dystrophy Wiskott-Aldrich ⇔ B and T defect, Syndrome thrombocytopenia, see Immune deficiency Lesch-Nyhan ⇔ Hypoxanthine-guanine phosphoribosyl transferase deficiency, self-mutilation, mental retardation Hunter’s ⇔ L-Iduronosulfate sulfatase

71 Bare Minimum Keyword Associations

Sex-linked Conditions Glucose-6-phosphate ⇔ Hemolytic anemia, dehydrogenase oxidative injury, deficiency antimalarial, sulfonamide Hemophilia A (Classic) ⇔ Factor VIII Fabry’s ⇔ α -galactosidase A Fragile X ⇔ Dominant, Folate deficiency, CGG trinucleotide repeat, mental retardation Bruton’s ⇔ B cell defect agammaglobulinemia

Tumor Suppressor Genes Down’s Syndrome ⇔ Trisomy 21, non- disjunction, mental retardation, Simian crease Edwards’s ⇔ Trisomy 18, PDA, Clenched fist Patau’s ⇔ Trisomy 13, syndactyly, mental retardation Cri du chat ⇔ Chromosome 5, mental retardation, microencephaly Klinefelter’s ⇔ XXY, male hypogonadism, low IQ, Barr bodies (buccal smear) XYY Syndrome ⇔ Violent behavior, severe acne XXX Syndrome ⇔ Mental retardatio

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Tumor Suppressor Genes Turner’s syndrome ⇔ XO, female hypogonadism, no Barr bodies Fragile X ⇔ Frequency of mental retardation is second after Down’s, long arm of chromosome X defect

73 Bare Minimum Keyword Associations 19 INFECTIOUS DISEASES

Keyword Associations Adult bacterial ⇔ Neisseria meningitidis, meningitis Strep pneumoniae Elderly bacterial ⇔ Strep pneumoniae, meningitis Gram-negative bacilli Neonate bacterial ⇔ Strep agalactiae, Staph meningitis aureus, Klebsiella, and E. coli Granulomatous ⇔ Mycobacterium (chronic) meningitis tuberculosis, Cryptococcus neoformans Viral meningitis and ⇔ Enterovirus, Arbo virus, encephalitis Herpes simplex, HIV and Arbovirus Bronchitis ⇔ H. influenza, and Streptococcus pneumoniae Pneumonia, neonatal ⇔ E coli, Strep agalactiae Pneumonia, infants ⇔ Chlamydia trachomatis Pneumonia, children ⇔ Parainfluenza, RSV, Mycoplasma, and influenza A

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Keyword Associations Tonsillitis ⇔ Beta-hemolytic Streptococcus Pharyngitis and ⇔ Mainly Viral Laryngitis (Adenovirus, Herpes, EBV, Coxsackie’s) Stomach ulcers ⇔ Helicobacter pylori Sinusitis ⇔ Staph aureus and Strep pneumoniae Burn sepsis ⇔ Pseudomonas aeruginosa Carbuncle ⇔ Staph aureus Catheter sepsis ⇔ Staph aureus, and Candida Common Cold ⇔ Rhino virus Cystitis/pyelonephritis ⇔ E. coli PID ⇔ Neisseria gonorrhea, and Chlamydia trachomatis Endocarditis ⇔ Strep viridans, Staph aureus and epidermidis Osteomyelitis ⇔ Staph aureus Arthritis ⇔ Staph aureus, and Neisseria gonorrhea Genital ulcer ⇔ Syphilis and herpes Otitis media ⇔ Strep pneumoniae and H. influenza Otitis externa ⇔ Pseudomonas aeruginosa Urethritis ⇔ Chlamydia Food poisoning ⇔ Bacillus cereus, Staph aureus, Clostridium perfringens, and Clostridium botulism

75 Bare Minimum Keyword Associations

Zoonotic Diseases Human Disease ⇔ Common Animal Host (Vector) Pasteurellosis ⇔ Dogs, cats Leptospirosis ⇔ Dogs, cats, rats Toxoplasmosis ⇔ Cats Anthrax ⇔ Cow and Swine Brucellosis ⇔ Goat, Swine, Cow Rocky mountain spotted ⇔ Dogs and rodents fever Endemic typhus ⇔ Rodents (flea) Psittacosis ⇔ Birds Tularemia ⇔ Rabbit and deer (tick bite) Lyme ⇔ Mice, and deer (tick) Plaque ⇔ Squirrel, prairie dog and rat (Flea bite) Chagas ⇔ (Kissing bug) Kala-azar ⇔ (Sand fly) Rabies ⇔ Squirrels, bats, raccoons, and dogs West Nile ⇔ Crows

76 Northwestern Medical Review 20 CELLULAR PATHOLOGY

Diseases and Inclusion Bodies Condition/Disease ⇔ Inclusions Rabies ⇔ Negri body DIC ⇔ D-dimers Multiple myeloma ⇔ Russell bodies in plasma cells Alcoholic Hepatitis ⇔ Mallory bodies Parkinson’s ⇔ Lewy Hodgkin’s ⇔ Reed Sternberg bodies SLE ⇔ Kidney wire-loops AML ⇔ Auer rods in myeloblasts Wilson’s Disease ⇔ Mallory, liver Rheumatic fever ⇔ Aschoff Cytomegalovirus ⇔ Intra-nuclear bodies Heinz ⇔ G6PD Howell-Jolly ⇔ Splenectomy Basophilic Stippling ⇔ Lead poisoning Siderocytes ⇔ Iron overload

77 Bare Minimum Keyword Associations

Enzyme Markers Lipase ⇔ Acute pancreatitis Aminotransferase ⇔ Myocardial infarction, (AST and ALT) viral and alcoholic hepatitis Gamma-glutamyl ⇔ Liver diseases transpeptidase Amylase ⇔ Acute pancreatitis, Mumps, Wilson’s CPK ⇔ Myocardial infarction and muscle disorder

Keyword Associations Aplasia ⇔ Agenesis Anaplasia ⇔ Lack of consistent differentiation Hypoplasia ⇔ Slow genesis Metaplasia ⇔ Replacement of tissues Hypertrophy ⇔ Size Hyperplasia ⇔ Number Irreversible damage ⇔ AST, CPK, LDH indicators Autolysis ⇔ Degradation by internal enzymes Heterolysis ⇔ Degradation by extrinsic enzymes Pyknosis ⇔ Nuclear shrinkage Karyorrhexis ⇔ Chromatin fragmentation Karyolysis ⇔ Dissolution of pyknotic nucleus Apoptosis ⇔ Councilman body of viral hepatitis

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Keyword Associations Coagulation necrosis ⇔ Nuclear changes Liquefaction necrosis ⇔ Liquefied necrotic tissues (Brain) Caseous necrosis ⇔ Soft, cheesy (TB) Gangrenous necrosis ⇔ Wet/dry Fibrinoid necrosis ⇔ Arterial fibrin-like deposition Traumatic Fat ⇔ Breast necrosis Enzymatic Fat ⇔ Pancreas necrosis Lipofuscin ⇔ Wear/Tear aging Hemosiderin ⇔ Red cell destruction Increased melanin ⇔ Sun tanning Decreased melanin ⇔ Vitiligo Free radical ⇔ Lipid peroxidation Carbon ⇔ Anthracosis Lead poisoning ⇔ RBC Basophilic (Plumbism) stippling Methanol poisoning ⇔ CNS edema, blindness Carbon monoxide ⇔ Cherry red skin ⋅

79 Bare Minimum Keyword Associations 21 BEHAVIORAL SCIENCES

Keyword Associations Condition ⇔ Attributes Dysthymic disorder ⇔ Chronic Manic Depression ⇔ Grandiosity, flight of (Bipolar disorder) ideas, pressured speech, insomnia Cyclothymia ⇔ Cyclothymia ? Hypomania altering with depression Somatization disorder ⇔ Young females, somatic complaints Schizophrenia ⇔ Hallucinations, delusions, withdrawal, catatonic, apathy, loosening of association, impaired abstraction Schizoid Disorder ⇔ Leave-me alone-type! Antidepressants ⇔ Decreased REM

80 Northwestern Medical Review 22 NUTRITIONAL DEFICIENCIES

Keyword Associations Vitamin / Element ⇔ Attributes/Diseases Vitamin A ⇔ Vision, Xerophthalmia Vitamin B1 ⇔ Beri Beri, Wernicke- Korsakoff Vitamin B2 ⇔ Angular stomatitis Vitamin B5 ⇔ Dermatitis Vitamin B6 ⇔ Convulsions, hyperirritability Vitamin B12 ⇔ Macrocytic and Megaloblastic Anemia Vitamin B3 ⇔ Pellagra, Hartnup’s, 3 D’s (dementia, dermatitis, and diarrhea) Biotin ⇔ Dermatitis Folic Acid ⇔ Anemia (Macrocytic and megaloblastic); PABA is folic acid analog in bacteria; Sulfa drugs are PABA analogs Vitamin C ⇔ Scurvy

81 Bare Minimum Keyword Associations

Keyword Associations Vitamin D2 and D3 ⇔ Deficiency: Rickets, and osteomalacia; Excess: Hypercalcemia, Stupor Vitamin E ⇔ Fragile RBC Vitamin K ⇔ Attributes/Diseases ++ Ca and PO3 ⇔ Vision, Xerophthalmia Na+ and K+ ⇔ Beri Beri, Wernicke- Korsakoff Cl- ⇔ Neonatal hemorrhage; Clotting factors II, VII, IX, and X affected Mg++ ⇔ Rickets and osteomalacia Fe++ ⇔ Paralysis and weakness Fiber ⇔ Diarrhea and renal disease Essential fatty acids ⇔ Diarrhea

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Test your knowledge

10 items 12 minutes

1. Seven adults are admitted to the emergency room. All of them are nauseating and presented with common symptoms that include vomiting, flushing, abdominal cramps and diarrhea. They all claim that they have been to the same buffet-type restaurant and their symptoms began while they have been still dinning at the restaurant. History shows that all of them have consumed a few hot fish dishes that included anchovy, herring, and mahi-mahi. Assuming that the patients are resented with enterotoxicity, which of the following is the most probable cause of these findings?

A. Staphylococcus aureus B. Bacillus cereus C. Scombroid D. Vibrio parahaemolyticus E. Enterotoxigenic E. coli

2. You are evaluating a 20-year-old female patient with a 4-year history of renal disease for complaint of visual problems. History shows that her disease has begun with an abrupt incidence of hematuria that has gradually progressed to proteinuria of more than 3.5 grams per day. A recent renal biopsy of the patient has been significant for presence of dense homogenous deposition along the glomerular basement membrane and in the mesangium. Which of the following mechanisms will better explain the etiology of this patient’s renal findings?

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A. Activation of classic complement pathway B. Activation of alternate complement pathway C. Activation of lectin complement pathway D. Circulating antistreptolysin O antibodies E. Circulating HLA-B27 antibodies

3. A 5-year-old boy is seen for evaluation of lack of appetite and painful ulcers in his mouth. On examination the ulcers are about 2 to 3 millimeters wide. Her mother states that several of the children at her son’s kindergarten have had the same findings. She further states that the sores started as small red spots before turning into fluid-filled sacs and then popping and turning to these painful sores. What is the most likely cause of these findings?

A. Herpes virus B. Herpes virus C. ECHOvirus D. Adenovirus E. Papilloma Virus

4. A 32 year-old man has had a worsening productive cough and episodes of protracted bleeding. The patient is afebrile and has a mild splenomegaly and several palpable non-tender axillary lymph nodes. Laboratory studies show low hemoglobin, platelets and hematocrit levels but a very high WBC count. Peripheral blood smear indicates the presence of blastic cells with cytoplasmic clumps of azurophilic granular material that appear as elongated needles. Which of the following is the most likely diagnosis for this patient?

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A. Chronic lymphocytic leukemia B. Chronic myelocytic leukemia C. Acute lymphoblastic leukemia D. Acute myelogenous leukemia E. Waldenstrom's macroglobulinemia

5. A 42-year-old male Caucasian is seen for the complaint of progressively worsening productive cough and shortness of breath, epistaxis and two recent episodes of hemoptysis. He has a 2-year history of sinusitis and has been treated with different antibiotics as an outpatient without any improvement. Chest X-ray shows bilateral pulmonary nodules. Biopsy of the nodules is significant for vasculitis, aggregation of mononuclear inflammatory cells and multinucleated giant cells that are surrounded by lymphocytes in additions to presence of large areas of necrosis. What is the most likely cause of these findings?

A. Wegener’s Granulomatosis B. Goodpasture’s Syndrome C. Henoch-Schonlein Purpura D. Systemic Lupus Erythematosus E. Scleroderma

6. A 60-year-old woman is seen for the complaint of weight loss, polyuria, polydipsia, and skin rash. Physical examination is significant for mild anemia and ulcerating rash, primarily on the shins, groin, and face. She claims that her rash has been worsening within the past 2 years despite specialized wound care. Lab results are significant for low serum hemoglobin, hyperglycemia and a mild increase in ACTH levels. High serum titer of which the

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following hormones is most likely associated with these findings?

A. Insulin B. Glucagon C. Cortisol D. Thyroxine E. Progesterone

7. X-ray of the hip of an 8-year-old boy with history of recurrent bone pain is significant for avascular necrosis of the head of femur. If the child has been diagnosed with osteomyelitis on several occasions in the past, which of the following conditions would be the underlining cause of his avascular necrosis?

A. Sickle cell disease B. Cystic fibrosis C. Vascular thrombosis D. Scalded Skin Syndrome E. Legg-Calvé-Perthes syndrome

8. Sensitivity to a very high dose of dexamethasone suppression is indicative of which of the following conditions?

A. Adrenal carcinoma-induced hypercortisolism B. Oat-cell carcinoma-induced hypercortisolism C. Pituitary adenoma-induced hypercortisolism D. Drug-induced (iatrogenic) hypercortisolism E. Adrenal adenoma-induced hypercortisolism

9. A 30 year-old woman complains of gradual weight gain. She has normal menstrual periods. Examination shows that she has a blood pressure of 180/110 mm Hg. Her serum creatinine, sodium, potassium, and chloride are within normal ranges.

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Further lab findings indicate hypocapnia and hyperglycemia. Which of the following radiological findings would you expect in this patient?

A. Thyroid mass B. Ovarian cysts C. Nodules within one of her lungs D. Mass in one of her adrenals E. Pituitary tumors

10. In humans, surgical procedures that involve total hypophysectomy are less fatal than total adrenalectomy without hormone replacement therapy. A reasonable explanation for this striking fatal effect would be which of the following?

A. Hypophysectomy does not affect aldosterone release from the adrenal cortex B. After hypophysectomy, the adrenal cortex undergoes total atrophy due to lack of ACTH C. Levels of estrogen and testosterone do not drop after hypophysectomy D. Hypophysectomy does not affect the cortical zones of the adrenals E. The pituitary gland plays only a small role in maintaining the adrenal's integrity

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Answers

1. (C) Scombroid poisoning has rapid onset, anywhere from 10 minutes to an hour and typically occurs in people who eat certain fish that have been inadequately preserved. A histamine-like toxin produced by certain bacteria that grow on fish, Scombroid is resistant to cooking. Fish that are susceptible to the growth of the bacteria mainly include anchovy, Australian salmon, bluefish, herring, mackerel, mahi-mahi, sardine, and tuna.

Note that Bacillus cereus (mostly acquired from re- heated rice) and Staphylococcus aureus have incubation of 3-8 hours and they are also acquired from pre-formed and heat resistant toxins. Also note that Vibrio parahaemolyticus toxicity is acquired from eating raw fish. It is responsible for about 50% of food-poisoning incidents in Japan. This poisoning is similar to mild forms of cholera.

2. (B) The patient has type II MPGN. The etiology of the disease is most likely due to uncontrolled activation of the alternate complete system.

3. (B) The child most likely has herpangina (mouth blisters) due to coxsackievirus A.

Note that coxsackievirus B and echovirus may also cause this condition. Most cases of herpangina occur in the summer, and mostly affect young children. Other symptoms of the disease are high fever and sore throat. The lesions originally appear as macules, mostly on the soft palate and tonsillar pillars, but later they turn into vesicles, and finally into ulcers.

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The condition is very contagious and child-to-child spread is very common.

Note that hand-foot-and-mouth disease that is also caused by coxsackievirus A, produces similar spots and ulcers in the mouth as herpangina.

4. (D) The age of the patient, high WBC count with blastic cells, and Auer rods are characteristic of acute myelogenous leukemia. Note that azurophilic granular materials that appear as elongated needles is here, the description of Auer rods.

5. (A) Wegener's granulomatosis is characterized by: (1) acute necrotizing granulomas of the upper and lower respiratory tract; (2) focal necrotizing vasculitis affecting small to medium vessels; and (3) renal disease in the form of focal or diffuse necrotizing glomerulitis.

Note that the most common early symptom of the Wegener's granulomatosis is chronic sinusitis. Other early symptoms include a fever that has no clear cause, night sweats, and fatigue.

Also note that determination of Anti-neutrophil cytoplasmic antibodies (ANCAs) can aid in the diagnosis of the condition, but positivity is not conclusive and negative ANCAs are not sufficient to reject the diagnosis.

6. (B) The patient most likely has glucagonoma that is more common in pre- and post-menopausal women. It results from adenoma of pancreatic alpha cells that leads to marked increase in serum glucagon level. Patients present with symptoms of mild diabetes mellitus as a result of gluconeogenic

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effects of glucagon. A characteristic skin finding in these patients is necrolytic migratory erythema (NME).

Note that a blood serum glucagon concentration of 1000 pg/mL or greater is indicative of Glucagonoma (the normal range is 50–200 pg/mL).

7. (A) Sickle cell disease, cystic fibrosis, vascular thrombosis and Legg-Calvé-Perthes syndrome are causes of AVN. Etiology of avascular necrosis of bone are often aseptic. But frequent infections (osteomyelitis) and resultant chronic inflammation would also predispose to avascular necrosis. More commonly, however, avascular necrosis of the bone is a complication of corticosteroid use, trauma, systemic lupus erythematosus, pancreatitis, alcoholism, gout, and sickle cell disease. The two organisms that commonly cause osteomyelitis are Salmonella and Staph aureus. Children with sickle cell disease are more prone to recurrent osteomyelitis due to Salmonella because of splenectomy.

Note that a common cause of AVN in children at the femoral head is Legg-Calvé-Perthes syndrome (A.K.A. Perthes disease) which is an idiopathic degenerative and ischemic disease related to reduction of blood flow to the femur head and hip joint most likely as a result of low flow through the ligamentum teres femoris artery.

8. (C) The dexamethasone suppression test is for diagnosis of Cushing's disease. In practice, the test helps to differentiate the two causes of hypercortisolism that are both associated with high titers of ACTH and cortisol. These two causes are

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ectopic hypercortisolism (e.g. oat-cell carcinoma of the lung) and pituitary adenoma. A very high dose of ACTH cannot suppress the ACTH of ectopic adenomas, but it will suppress the ACTH output of pituitary adenoma (i.e. Cushing's disease).

9. (D) Given her sex, hypertension, and hyperglycemia, one would expect unilateral adenoma of the adrenal cortex or adrenal Cushing's as the most probable cause of this patient's ailment. Note that adrenal adenomas are often unilateral.

10. (A) Aldosterone, a product of the zona glomerulosa, is not controlled by ACTH. After hypophysectomy, all zones of the adrenals will undergo hypotrophy except the zona glomerulosa. Aldosterone and mineralocorticoids are vital hormones for maintaining osmotic pressure of the blood within the normal range.

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Sample mnemonics from our courses

Our goal is to provide you material in a variety of ways for maximum retention. We use steadfast study methods along side mnemonics and animations to make your exam preparation fun and memorable while working to maximize your score.

Vancomycin has a ton of side effects! The one ton van!

T = thromboPhlebitis O = Ototoxicity N = Nephrotoxicity

Loop Diuretics causes ototoxicity!

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Herpes relaxes in the ganglion of the trigeminal nerve

8urki14’s!

The aberrant myc gene (Mickey Mouse) is a result of translocation between chromosome 8 and 14. This causes Burkitt’s Lymphoma!

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