USMLE Gold Pearls

Guillain-Barre (markedly increased protein in CSF w/ only modest increase in cell count)

Idiopathic thrombocytopenic purpura

Marfan's

Rheumatic fever

Acute promyelocytic leukemia (AML type M₃)

• Sickle cell anemia: switch a glu --> val in beta chain
• Low O₂ increased sickling
• Aplastic crisis w/ B19 (Parvovirus ssDNA) infection
• Salmonella osteomyelitis
• Vaso-occlusive painful crises
• Hydroxyurea as Txt (increased Hb^F) and bone marrow transplant

UMN lesion

Lead poisoning

• Multiple myeloma - free light chains (either kappa or lambda)
• Waldenstrom's macroglobinemia

Histiocytosis X (eosinophilic granuloma)

Chronic Bronchitis (at least 3 months for at least 2 years of excessive mucus secretion & chronic recurrent productive cough)

Tetralogy of Fallot

Osteoarthritis (proximal IP joint of fingers)

RA Flexed proximal and extended distal IP joint

Hyperparapthyroidism

Down's

• Granulosa cell tumor: associated w/ endometrial hyperplasia & carcinoma
• Granuloma - Theca cell tumor

Chagas' Disease

Primary Syphilis

Haemophilus ducreyi

MS - nystagmus, intention tremor, scanning speech

Bronchial asthma

Cerebral lesion

Endometriosis

Hypocalcemia - facial spasm in tetany

Gardnerella vaginitis

Osteosarcoma

• Mycoplasma pneumoniae
• Infectious mononucleosis

Secondary Syphilis

• HTN
• aka - cytoid bodies seen w/ SLE (yellowish cotton wool fundal lesions)

Dying hepatocytes - Hep B

Rapidly progressive (crescentic) glomerulonephritis

Klebsiella

Bronchial asthma

Parkinson's

Granuloma inguinale (STD)

Osteoarthritis (polished, ivory-like appearance of bone)

Marfan's

Lyme Disease

Alcoholism

Asbestosis - and iron laden

Tuberculosis (primary and secondary respectively)

Acute Pyelonephritis

Duchenne's MD - use of arms to stand

Osteoarthritis - distal IP joint of finger

G6PDH deficiency

Infectious mononucleosis (EBV)

Alzheimer's

Megaloblastic anemia

Iron deficiency anemia or beta-Thalassemia

Syphilis - over aggressive tx of an asymptomatic pt that causes symptoms secondary to rapid lysis

Osteoarthritis (fractured osteophytes)

Acidosis / Diabetic Ketoacidosis

Squamous Cell CA of Skin - actinic keratosis is a precursor

Wilson's

Diabetic nephropathy - Nodular Glomerulosclerosis nodules of mesangial matrix

HPV 6 & 11 (condyloma acuminatum - benign) and HPV 16 &18 (malignant association)

Measles

Parkinson's (eosinophilic inclusions in damaged substantia nigra cells)

Arterial thrombosis

Neurofibromatosis (von Recklinhausen's disease) = pigmented iris hamartomas

Poststreptococcal glomerulonephritis = prototype of nephritic syndrome

Alcoholic hepatitis

Appendicitis (McBurney's Point is 2/3 of the way from the umbilicus to ASIS)

Malakoplakia - lesion on bladder due to macros & calcospherites (M-G Bodies): usually due to E. coli

• Multiple myeloma - this is called the M protein (usually IgG or IgA)
• MUGS

Hypothyroidism

Rabies

Alzheimer's

Alzheimer's

• Myxedema
• Anthrax toxin

Coarctation of Aorta

CHF - causing congested liver

• CMV
• Reed Sternburg Cells (Hodgkin Lymphoma)
• Aschoff cells seek w/ Rheumatic Fever

Pancreatic CA (head)

• RA, also see morning stiffness that decreases w/ joint use
• HLA-DR4

Mycosis fungoides (cutaneous T-cell lymphoma), Sezary

CML

Pick's Disease

• Pink Puffer - Type A: Emphysema (Centroacinar - smoking, Panacinar - alpha 1 antitrypsin deficiency)
• Blue Bloater - Type B: Bronchitis

Gout (MP joint of hallux)

Hemangioma

Tearing of ACL

• Papillary adenocarcinoma of the thyroid
• Serous papillary cyst adenocarcinoma of the ovary
• Meningioma
• Mesothelioma

Seen w/ Duchenne MD at the calf muscle due to increased fat

Multiple myeloma

• Secondary Syphilis
• RMSF
• Coxsackie virus infection: Hand-Foot-Mouth Disease

Paroxysmal nocturnal hemoglobinuria. You will use Ham's Test to confirm

Hodgkin's Disease

Chronic bronchitis = increased ratio of bronchial gland to bronchial wall thickness

Leydig cell tumor

Multiple myeloma - RBCs stacked as poker chips

• L--> R Shunt (VSD, PDA, ASD)
• Mitral Regurg
• LV Failure

• Pulmonary Stenosis
• Pulmonary HTN

Neisseria menigitidis - impressive rash with bugs

• SLE (also anti-dsDNA)
• Malor Rash, Wire look kidney lesions, Joint pain, False (+) syphilis test (VDRL)
• 90% 14-45 yo females
• Also seen w/ use of INH; Procainamide, Hydralazine = SLE-like syndrome

Giant cell tumor of bone

• Membranous glomerulonephritis = Nephrotic syndrome
• Spike = BM material
• Dome = immune complex deposits (IgG or C3)

Crohn's - bowel wall thickening

Thalassemia - in alpha-Thalassemia w/ no alpha gene: Hydrops Fetalis & Intrauterine death associations = HbBarts

Familial Hypercholesterolemia

Chronic pyelonephritis

Gout

Membranoproliferative GN: Nephritic Syndrome - BM is duplicated into 2 layers

• Visceral CA, classically pancreatic (migratory thrombophlebitis)
• Hypocalcemia (carpal spasm)
• These are two entirely different disease processes and different signs w/ the same name

Supraclavicular node enlargement by metastatic carcinoma of the stomach

Measles

Pyelonephritis

CNS disfunction - Hypoglycemic episodes - glu injections reverse CNS symptoms

Lupus nephropathy, type IV (diffuse proliferative form)

• Spina Bifida
• Anencephaly

• Gout
• Lesch Nyjan
• Myeloproliferative Disorders
• Diuretics (Loop and Thiazides)

COPD

• Due to Pneumocystis carinii
• Seen w/ Atelectasia

Seen w/ asbestosis (reactive lung disease)

Goodpasture syndrome (pneumonia w/ hemoptysis & rapidly progressive glomerulonephritis)

Goodpasture's Syndrome

Aspergillosis

Waldenstrom's Macroglobulinemia = increased IgM = Hyperviscosity

Seen in hepatocytes of healthy carriers of HBsAg in liver biopsies

Cells that replace the ovaries, due to Krukenberg's tumor that has metastasized from the stomach

• Seen w/ progressive multifocal leukoencephalopathy oligodendrocytes
• Nuclei seen in Papillary CA of the thyroid (malignant)

Shows amyloid deposition in plaques and vascular wall

Some meningiomas have progesterone receptors = rapid growth in pregnancy can occur

• Seizures
• Mental Retardation
• Leukoderma (congenital facial white spots or macules): angiofibromas

Seen w/ herpes simples encephalitis - in oligodendroglia

• Neuromyelitis Optica
• A variant of MS: rapid demyelination of the optic nerve & spinal cord w/ paraplegia

Breast Cancer association

A tumor causing blindness and loss of smell w/ papilloedema

Flicking of the middle finger's nail

Intention Tremors of arm

Unconscious proprioception of lower extremities

Unconscious proprioception and fine motor movements

Unconscious proprioception and fine motor movement of UE

Conscious proprioception of the body

Pain and Temp sensation

Light touch preception

Taste and Smell

Muscles of the eye and tongue

Vision; Hearing; Equilibrium

• Sensation of tongue; soft palate
• Carotid Body and Sinus innervation

• Edinger Westphal = parasympathetic eye innervation
• Gland innervation = secretion
• Viscera

• Pain and temp of face
• Sensation of external ear

Innervation of muscles of mastication, facial expressions, larynx and pharynx

• Werndig Hoffman (progressive infantile muscular atrophy)
• Polimyelitis

• Subacute Combined Degeneration = Friedrich's Ataxia = B12 deficiency
• Tabes Dorsalis (Neurosyphilis)

ALS - Lou Gherig's Disease

• Brown Sequard
• Anterior Spinal artery Occlusion

Controls circadian rhythm

Satiety center, Savage behavior and obesity with lesion

Induces eating, Starvation with lesion

Release of PIF (dopa-ergic neurons)

Can have hemorrhage as seen in Wernicke's Encephalopathy

RBC's w/ spiny projections. Seen in Abetalopoproteinemia