Keywordassociations2015 PDF

Bare Minimum
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Associations
USMLE & COMLEX Review
Northwestern Medical Review

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Copyright © 2015 Northwestern Medical Review
eBookit.com and Northwestern Medical Review

Second Edition
ISBN 978-0-9960-9340-1
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United States of America. No part of this book may be
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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
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
2
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
⋅ 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
4
⋅ 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
5
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
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
7
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
8
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
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
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
⋅ 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
12
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
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
14
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
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
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
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
18
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
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
20
Malignant Mesothelioma
⋅ Poor prognosis
⋅ Polycythemia
⋅ Restrictive pattern
⋅ Asbestos materials (Asbestos = Ferruginous body)
21
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
22
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
⋅ 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
24
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
⋅ 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
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
⋅ 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
28
Angiosarcoma
⋅ Vinyl chloride
⋅ Thorotrast
⋅ Arsenic
Alcoholic Cirrhosis
⋅ Mallory’s hyaline—cytokeratin filament
⋅ Fatty liver changes
⋅ Focal necrosis
Wilson’s Disease
⋅ 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
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
30
⋅ Hyper-coagulopathy
⋅ Pruritus
⋅ Increased bilirubin, dark urine
⋅ Diabetes, and chronic pancreatitis
⋅ Ki-ras oncogen
Gastrinoma
⋅ Hypergastrinemia
⋅ Zollinger-Ellison Syndrome
31
8
NEPHROLOGY
Adult Polycystic Kidney
⋅ 15-30 years old
⋅ Berry Aneurysm
⋅ Hematuria
⋅ Polycystic liver disease
⋅ Hypertension
⋅ Chromosome 16
⋅ Mitral prolapse
Infantile Polycystic Kidney

⋅ Hepatic fibrosis
⋅ Closed cysts
Post-Streptococcal Glomerulonephritis
⋅ Elevated ASO
⋅ Intense inflammation
⋅ Lumpy-bumpy immunofluorescence
Goodpasture’s Syndrome
⋅ Men mid-20’s
⋅ Glomerulonephritis
32
⋅ 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
33
⋅ 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
34
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
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
36
⋅ 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
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
38
⋅ 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
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
40
Infectious Diseases
Granuloma inguinale ⇔ Donovan bodies
(Calymmatobacterium
granulomatis)
Syphilis ⇔ Condyloma lata, VDRL,
FTA-abs, tabes dorsalis
Chancroids ⇔ Haemophilus ducreyi
41
11
INTEGUMENTARY
SYSTEM
Psoriasis
⋅ More common in men
⋅ Auspitz
⋅ Spongiform pustule of Kogoj
⋅ Munro’s micro-abscess
⋅ 7% of patients with arthritis
Erythema Multiforme
⋅ Target lesion
⋅ A.K.A. Steven Johnson syndrome
⋅ Recurrence
⋅ “Iris lesion”
Pemphigus Vulgaris
⋅ Jewish population
⋅ Intra-epidermal bullae
⋅ Keratinocytes with IgG
⋅ Ethanol Abuse
42
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
⋅ 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
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
Primary Hyperparathyroidism
⋅ Osteitis fibrosa
⋅ Cystic-brown bone tumor
⋅ Hypercalcemia
⋅ Hypophosphatemia
⋅ Increased PTH
Secondary Hyperparathyroidism
⋅ Chronic Renal Disease
⋅ Hypocalcemia
⋅ Osteoclastic bone disease
⋅ Increased PTH
⋅ Hyperphosphatemia
Pseudohypoparathyroidism
⋅ 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
46
⋅ 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
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
48
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
Pituitary
Growth hormone ⇔ Dwarfism
TSH ⇔ Secondary
hypothyroidism
ADH ⇔ Diabetes insipidus
50
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
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
52
⋅ 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
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
54
⋅ 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
55
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
56
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
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
15
AUTOIMMUNE
DISEASES
SLE
⋅ 10 times more common in females
⋅ More common in African Americans
⋅ 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
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
60
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
61
Conditions Associated with Eosinophillia

Hepatocellular carcinoma
Chronic eosinophilic pneumonia
Loeffler’s Syndrome
Ascaris
Strongyloides
Wuchereria
Aspergillosis
Allergic rhinitis and Asthma
Eczema
Urticaria
62
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
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
64
17
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
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
66
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
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
68
18
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
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

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)
70
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
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
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

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
72

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
19
INFECTIOUS
DISEASES
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
74
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
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
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
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
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
78
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
21
BEHAVIORAL
SCIENCES
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
22
NUTRITIONAL
DEFICIENCIES
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
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
82
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?
83
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?
84
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
85
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.
86
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
87
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.
88
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
89
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
90
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.
91
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!
92
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!
93
If you like what you see in this excerpt and

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you would like more information on our
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Northwestern Medical Review

Copyright © 2015 Northwestern Medical Review

eBookit.com and Northwestern Medical Review

All rights reserved. Written, published, and printed in the

All photos adapted from fotolia.com

Northwestern Medical Review claims no rights to

This book is adapted from the first chapter of Primary

In the back of the book are two additional sections:

This book has no beginning and no end. Each part

It will tell you how much you have learned and

Dr. Jahan Eftekar

Tricuspid Valve Endocarditis

Non-Bacterial Endocarditis (Marantic)

Non-septic peripheral emboli

⋅ Most frequent valvular lesion

⋅ Congenital associated with deafness, cataracts,

ECG Readings and Associated Conditions

ECG Readings and Associated Conditions

Syphilitic Aortic Aneurysm

Aortic Dissecting Aneurysm

Idiopathic Hypertrophic Subaortic

Pyruvate Kinase Deficiency

Sickle Cell Anemia

Warm Antibody Autoimmune

Cold Agglutinin Anemia

Acute Lymphocytic Leukemia

Chronic Lymphocytic Leukemia (CLL)

Acute Myeloblastic Leukemia (AML)

Chronic Myeloid Leukemia (CML)

Squamous Cell Carcinoma

Oat Cell Carcinoma

⋅ Colonic dilatation proximal to aganglionic

Primary Billiary Cirrhosis

Chronic Passive Congestion

Infantile Polycystic Kidney

⋅ Linear IgG at basal membrane

Malignant (Hypertension) Nephrosclerosis

Renal Cell Carcinoma

Transitional Cell Carcinoma

Squamous Cell Carcinoma of Bladder

Yolk Sac Tumor

⋅ Intra-cytoplasmic Reinke crystals

Fibrocystic Disease (Disorder)

Other Breast Conditions

Other Breast Conditions

Basal Cell Carcinoma

Squamous Cell Carcinoma

Papillary Thyroid Carcinoma

Follicular Thyroid Carcinoma

Medullary Thyroid Carcinoma

Primary Adrenocortical Deficiency

Duchenne Muscular Dystrophy

Becker Muscular Dystrophy

⋅ Pelvis and long bones

Paget’s Bone Disease

Lambert- Eaton Syndrome

Conditions Associated with Eosinophillia

Conditions Associated with Eosinophillia