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U01.17.003 Clinical Finding & associated Diagnosis Review
| DISEASE/FINDING | MOST COMMON/IMPORTANT ASSOCIATIONS |
|---|---|
| A | |
| Actinic (solar) keratosis | The precursor to squamous cell carcinoma |
| Acute gastric ulcer associated with CNS injury | Cushing ulcer (? intracranial pressure stimulates vagal gastric H+ secretion) |
| Acute gastric ulcer associated with severe burns | Curling ulcer (greatly reduced plasma volume results in sloughing of gastric mucosa) |
| Age ranges for a patient with ALL/CLL/AML/CML | ALL: child, CLL: adult > 60, AML: adult ∼ 65, CML: adult 45–85 |
| Alternating areas of transmural inflammation and normal colon | Skip lesions (Crohn disease) |
| Aortic aneurysm, abdominal | Atherosclerosis |
| Aortic aneurysm, ascending or arch | 3° syphilis (syphilitic aortitis), vasa vasorum destruction |
| Aortic aneurysm, thoracic | Marfan syndrome (idiopathic cystic medial degeneration) |
| Aortic dissection | Hypertension |
| Atrophy of the mammillary bodies | Wernicke encephalopathy (thiamine deficiency causing ataxia, ophthalmoplegia, and confusion) |
| Autosplenectomy (fibrosis and shrinkage) | Sickle cell disease (hemoglobin S) |
| B | |
| Bacteria associated with gastritis, peptic ulcer disease, and gastric malignancies (eg, adenocarcinoma, MALToma) | H pylori |
| Bacterial meningitis (adults and elderly) | S pneumoniae |
| Bacterial meningitis (newborns and kids) | Group B streptococcus/E coli/Listeria monocytogenes (newborns), S pneumoniae/N meningitidis (kids/teens) |
| Bilateral ovarian metastases from gastric carcinoma | Krukenberg tumor (mucin-secreting signet ring cells) |
| Bleeding disorder with GpIb deficiency | Bernard-Soulier syndrome (defect in platelet adhesion to von Willebrand factor) |
| Brain tumor (adults) | Supratentorial: metastasis, astrocytoma (including glioblastoma multiforme), meningioma, schwannoma |
| Brain tumor (kids) | Infratentorial: medulloblastoma (cerebellum) or supratentorial: craniopharyngioma |
| Breast cancer | Invasive ductal carcinoma |
| C | |
| Cardiac 1° tumor (kids) | Rhabdomyoma, often seen in tuberous sclerosis |
| Cardiac manifestation of lupus | Marantic/thrombotic endocarditis (nonbacterial) |
| A cardiac tumor (adults) | Metastasis, myxoma (90% in the left atrium; “ball valve”) 301 |
| Cerebellar tonsillar herniation | Chiari I malformation |
| Chronic arrhythmia | Atrial fibrillation (associated with a high risk of emboli) 284 |
| Chronic atrophic gastritis (autoimmune) | Predisposition to gastric carcinoma (can also cause pernicious anemia) |
| Clear cell adenocarcinoma of the vagina | DES exposure in utero |
| Congenital adrenal hyperplasia, hypotension | 21-hydroxylase deficiency |
| Congenital cardiac anomaly | VSD |
| Congenital conjugated hyperbilirubinemia (black liver) | Dubin-Johnson syndrome (inability of hepatocytes to secrete conjugated bilirubin into bile) |
| Constrictive pericarditis | TB (developing world); idiopathic, viral illness (developed world) |
| Cretinism | Iodine deficit/congenital hypothyroidism |
| Cushing syndrome | ? Iatrogenic (from corticosteroid therapy) ? Adrenocortical adenoma (secretes excess cortisol) ? ACTH-secreting pituitary adenoma (Cushing disease) ? Paraneoplastic (due to ACTH secretion by tumors) |
| Cyanosis (early; less common) | Tetralogy of Fallot, transposition of great vessels, truncus arteriosus |
| D | |
| Death in CML | Blast crisis |
| Death in SLE | Lupus nephropathy |
| Dementia | Alzheimer disease, multiple infarcts (vascular dementia) |
| Demyelinating disease in young women | Multiple sclerosis |
| DIC | Severe sepsis, obstetric complications, cancer, burns, trauma, major surgery, acute pancreatitis, APL |
| Diverticulum in pharynx | Zenker diverticulum (diagnosed by barium swallow) |
| E | |
| Ejection click | Aortic stenosis |
| Esophageal cancer | Squamous cell carcinoma (worldwide); adenocarcinoma (US) |
| F | |
| Food poisoning (exotoxin mediated) | S aureus, B cereus |
| G | |
| Gastric cancer | Adenocarcinoma |
| Glomerulonephritis (adults) | Berger disease (IgA nephropathy) |
| Gynecologic malignancy | Endometrial carcinoma (most common in the US); cervical carcinoma (most common worldwide) |
| H | |
| Heart murmur, congenital | Mitral valve prolapse |
| Heart valve in bacterial endocarditis | Mitral > aortic (rheumatic fever), tricuspid (IV drug abuse) |
| Helminth infection (US) | Ascaris lumbricoides |
| Hematoma—epidural | Rupture of the middle meningeal artery (trauma; lentiform shaped) |
| Hematoma—subdural | Rupture of bridging veins (crescent-shaped) |
| Hemochromatosis | Multiple blood transfusions or hereditary HFE mutation (can result in heart failure, “bronze diabetes,” and? risk of hepatocellular carcinoma) |
| Hepatocellular carcinoma | Cirrhotic liver (associated with hepatitis B and C and with alcoholism) |
| Hereditary bleeding disorder | von Willebrand disease |
| Hereditary harmless jaundice | Gilbert syndrome (benign congenital unconjugated hyperbilirubinemia) |
| HLA-B27 | Psoriatic arthritis, ankylosing spondylitis, IBD-associated arthritis, reactive arthritis (formerly Reiter syndrome) |
| HLA-DR3 | Diabetes mellitus type 1, SLE, Graves disease, Hashimoto thyroiditis (also associated with HLA-DR5), Addison disease |
| HLA-DR4 | Diabetes mellitus type 1, rheumatoid arthritis, Addison disease |
| Holosystolic murmur | VSD, tricuspid regurgitation, mitral regurgitation |
| Hypercoagulability, endothelial damage, blood stasis | Virchow triad (? risk of thrombosis) |
| Hypertension, 2° | Renal artery stenosis, chronic kidney disease (eg, polycystic kidney disease, diabetic nephropathy), hyperaldosteronism |
| Hypoparathyroidism | Accidental excision during thyroidectomy |
| Hypopituitarism | Pituitary adenoma (usually benign tumor) |
| I | |
| Infection 2° to blood transfusion | Hepatitis C |
| Infections in chronic granulomatous disease | S aureus, E coli, Aspergillus (catalase ⊕) |
| Intellectual disability | Down syndrome, fragile X syndrome |
| K | |
| Kidney stones | ? Calcium = radiopaque ? Struvite (ammonium) = radiopaque (formed by urease ⊕ organisms such as Klebsiella, Proteus species, and S saprophyticus) ? Uric acid = radiolucent ? Cystine = radiolucent |
| L | |
| Late cyanotic shunt (uncorrected left to the right becomes right to left) | Eisenmenger syndrome (caused by ASD, VSD, PDA; results in pulmonary hypertension/polycythemia) |
| Liver disease | Alcoholic cirrhosis |
| Lysosomal storage disease | Gaucher disease |
| M | |
| Malignancy associated with noninfectious fever | Hodgkin lymphoma |
| Malignancy (kids) | Leukemia, brain tumors |
| Metastases to bone | Prostate, breast > lung, thyroid, kidney |
| Metastases to brain | Lung > breast > prostate > melanoma > GI |
| Metastases to liver | Colon >> stomach > pancreas |
| Microcytic anemia | Iron deficiency |
| Mitochondrial inheritance | The disease occurs in both males and females, inherited through females only |
| Mitral valve stenosis | Rheumatic heart disease |
| Mixed (UMN and LMN) motor neuron disease | Amyotrophic lateral sclerosis |
| Myocarditis | Coxsackie B |
| N | |
| Nephrotic syndrome (adults) | Membranous nephropathy |
| Nephrotic syndrome (kids) | Minimal change disease |
| Neuron migration failure | Kallmann syndrome (hypogonadotropic hypogonadism and anosmia) |
| Nosocomial pneumonia | S aureus, Pseudomonas, other enteric gram ⊝ rods |
| O | |
| Obstruction of male urinary tract | BPH |
| Opening snap | Mitral stenosis |
| Opportunistic infection in AIDS | Pneumocystis jirovecii pneumonia |
| Osteomyelitis | S aureus (most common overall) |
| Osteomyelitis in sickle cell disease | Salmonella |
| Osteomyelitis with IV drug use | Pseudomonas, Candida, S aureus |
| An ovarian tumor (benign, bilateral) | Serous cystadenoma |
| An ovarian tumor (malignant) | Serous cystadenocarcinoma |
| P | |
| Pancreatitis (acute) | Gallstones, alcohol |
| Pancreatitis (chronic) | Alcohol (adults), cystic fibrosis (kids) |
| Pelvic inflammatory disease | C trachomatis, N gonorrhoeae |
| Philadelphia chromosome t(9;22) (BCR-ABL) | CML (may sometimes be associated with ALL/AML) 410 |
| Pituitary tumor | Prolactinoma, somatotropic adenoma |
| Primary amenorrhea | Turner syndrome (45, XO or 45, XO/46, XX mosaic) |
| A primary bone tumor (adults) | Multiple myeloma |
| Primary hyperaldosteronism | Adrenal hyperplasia or adenoma |
| Primary hyperparathyroidism | Adenomas, hyperplasia, carcinoma |
| Primary liver cancer | Hepatocellular carcinoma (chronic hepatitis, cirrhosis, hemochromatosis, α1-antitrypsin deficiency, Wilson disease) |
| Pulmonary hypertension | Idiopathic, heritable, left heart disease (eg, HF), lung disease (eg, COPD), hypoxemic vasoconstriction (eg, OSA), thromboembolic (eg, PE) |
| R | |
| Recurrent inflammation/thrombosis of small/medium vessels in extremities | Buerger disease (strongly associated with tobacco) |
| Refractory peptic ulcers and high gastrin levels | Zollinger-Ellison syndrome (gastrinoma of duodenum or pancreas), associated with MEN1 |
| Renal tumor | Renal cell carcinoma: associated with von Hippel-Lindau and cigarette smoking; paraneoplastic syndromes (EPO, renin, PTHrP, ACTH) |
| Right heart failure due to a pulmonary cause | Cor pulmonale |
| S | |
| S3 heart sound | ? ventricular filling pressure (eg, mitral regurgitation, HF), common in dilated ventricles |
| S4 heart sound | Stiff/hypertrophic ventricle (aortic stenosis, restrictive cardiomyopathy) |
| Secondary hyperparathyroidism | Hypocalcemia of chronic kidney disease |
| Sexually transmitted disease | C trachomatis (usually coinfected with N gonorrhoeae) |
| SIADH | Small cell carcinoma of the lung |
| Site of diverticula | Sigmoid colon |
| Sites of atherosclerosis | Abdominal aorta > coronary artery > popliteal artery > carotid artery |
| T | |
| t(14;18) | Follicular lymphomas (BCL-2 activation, anti-apoptotic oncogene |
| t(8;14) | Burkitt lymphoma (c-myc fusion, transcription factor oncogene) |
| t(9;22) | Philadelphia chromosome, CML (BCR-ABL activation, tyrosine kinase oncogene) |
| Temporal arteritis | Risk of ipsilateral blindness due to occlusion of ophthalmic artery; polymyalgia rheumatica |
| Testicular tumor | Seminoma (malignant, radiosensitive), ? placental ALP |
| Thyroid cancer | Papillary carcinoma (childhood irradiation) |
| Tumor in women | Leiomyoma (estrogen-dependent, not precancerous) |
| Tumor of infancy | Strawberry hemangioma (grows rapidly and regresses spontaneously by childhood) |
| Tumor of the adrenal medulla (adults) | Pheochromocytoma (usually benign) |
| Tumor of the adrenal medulla (kids) | Neuroblastoma (malignant |
| Type of Hodgkin lymphoma | Nodular sclerosing (vs mixed cellularity, lymphocytic predominance, lymphocytic depletion) |
| Type of non-Hodgkin lymphoma | Diffuse large B-cell lymphoma |
| U | |
| UTI | E coli, Staphylococcus saprophyticus (young women) |
| V | |
| Vertebral compression fracture | Osteoporosis (type I: postmenopausal woman; type II: elderly man or woman) |
| Viral encephalitis affecting temporal lobe | HSV-1 |
| Vitamin deficiency (USA) | Folate (pregnant women are at high risk; body stores only 3- to 4-month supply; prevents neural tube defects) |