First Aid for the USMLE STEP 1 (2023): Key Associations

Actinic (solar) keratosis - ANSWER-Precursor to squamous cell carcinoma Acute gastric ulcer associated with CNS injury - ANSWER-Cushing ulcer (intracranial pressure stimulates vagal gastric H+ secretion) Acute gastric ulcer associated with severe burns - ANSWER-Curling ulcer (greatly reduced plasma volume results in sloughing of gastric mucosa) Alternating areas of transmural inflammation and normal colon - ANSWER-Skip lesions (Crohn disease) Aortic aneurysm, abdominal - ANSWER-Atherosclerosis Aortic aneurysm, ascending or arch - ANSWER-3° syphilis (syphilitic aortitis), vasa vasorum destruction Aortic aneurysm, thoracic - ANSWER-Aortic aneurysm, thoracic Aortic dissection - ANSWER-Hypertension Atrophy of mammillary bodies - ANSWER-Wernicke encephalopathy (thiamine deficiency causing ataxia, ophthalmoplegia, and confusion) Autosplenectomy (fibrosis and shrinkage) - ANSWER-Sickle cell disease (hemoglobin S) Bacteria associated with gastritis, peptic ulcer disease, and stomach cancer - ANSWER-H. pylori Bacterial meningitis (adults and elderly) - ANSWER-S. pneumoniae Bacterial meningitis (newborns and kids) - ANSWER-Group B streptococcus/E.coli (newborns), S. pneumoniae/N. meningitidis (kids/teens) Bilateral ovarian metastases from gastric carcinoma - ANSWER-Krukenberg tumor (mucin-secreting signet ring cells) Bleeding disorder with GpIb deficiency - ANSWER-Bernard-Soulier syndrome (defect in platelet adhesion to von Willebrand factor) Brain tumor (adults) - ANSWER-Supratentorial: metastasis, astrocytoma (including glioblastoma multiforme), meningioma, schwannoma Brain tumor (kids) - ANSWER-Infratentorial: medulloblastoma (cerebellum) or supratentorial: craniopharyngioma Breast cancer - ANSWER-Invasive ductal carcinoma Breast mass - ANSWER-Fibrocystic change, carcinoma (in postmenopausal women) Breast tumor (benign) - ANSWER-Fibroadenoma Cardiac 1° tumor (kids) - ANSWER-Rhabdomyoma, often seen in tuberous sclerosis Cardiac manifestation of lupus - ANSWER-Marantic/thrombotic endocarditis (nonbacterial) Cardiac tumor (adults) - ANSWER-Metastasis, myxoma (90% in left atrium; "ball and valve") Cerebellar tonsillar herniation - ANSWER-Chiari II malformation Chronic arrhythmia - ANSWER-Atrial fibrillation (associated with high risk of emboli) Chronic atrophic gastritis (autoimmune) - ANSWER-Predisposition to gastric carcinoma (can also cause pernicious anemia) Clear cell adenocarcinoma of the vagina - ANSWER-DES exposure in utero Congenital adrenal hyperplasia, hypotension - ANSWER-21-hydroxylase deficiency Congenital conjugated hyperbilirubinemia (black liver) - ANSWER-Dubin-Johnson syndrome (inability of hepatocytes to secrete conjugated bilirubin into bile) Constrictive pericarditis - ANSWER-TB (developing world); idiopathic, viral illness (developed world) Coronary artery involved in thrombosis - ANSWER-LAD > RCA > circumflex Cushing syndrome - ANSWER--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) - ANSWER-Tetralogy of Fallot, transposition of great vessels, truncus arteriosus Cyanosis (late; more common) - ANSWER-VSD, ASD, PDA Death in CML - ANSWER-Blast crisis Death in SLE - ANSWER-Lupus nephropathy Dementia - ANSWER-Alzheimer disease, multiple infarcts (vascular dementia) Demyelinating disease in young women - ANSWER-Multiple sclerosis DIC - ANSWER-Severe sepsis, obstetric complications, cancer, burns, trauma, major surgery Dietary deficit - ANSWER-Iron Diverticulum in pharynx - ANSWER-Zenker diverticulum (diagnosed by barium swallow) Ejection click - ANSWER-Aortic stenosis Esophageal cancer - ANSWER-Squamous cell carcinoma (worldwide); adenocarcinoma (U.S.) Food poisoning (exotoxin mediated) - ANSWER-S. aureus, B. cereus Glomerulonephritis (adults) - ANSWER-Berger disease (IgA nephropathy) Gynecologic malignancy - ANSWER-Endometrial carcinoma (most common in U.S.); cervical carcinoma (most common worldwide) Heart murmur, congenital - ANSWER-Mitral valve prolapse Heart valve in bacterial endocarditis - ANSWER-Mitral > aortic (rheumatic fever), tricuspid (IV drug abuse) Helminth infection (U.S.) - ANSWER-Enterobius vermicularis, Ascaris lumbricoides Hematoma—epidural - ANSWER-Rupture of middle meningeal artery (trauma; lentiform shaped) Hematoma—subdural - ANSWER-Rupture of bridging veins (crescent shaped) Hemochromatosis - ANSWER-Multiple blood transfusions or hereditary HFE mutation (can result in heart failure, "bronze diabetes," andrisk of hepatocellular carcinoma) Hepatocellular carcinoma - ANSWER-Cirrhotic liver (associated with hepatitis B and C and with alcoholism) Hereditary bleeding disorder - ANSWER-von Willebrand disease Hereditary harmless jaundice - ANSWER-Gilbert syndrome (benign congenital unconjugated hyperbilirubinemia) HLA-B27 - ANSWER-Ankylosing spondylitis, reactive arthritis, ulcerative colitis, psoriatic arthritis HLA-DR3 - ANSWER-Diabetes mellitus type 1, SLE, Graves disease, Hashimoto thyroiditis HLA-DR4 - ANSWER-Diabetes mellitus type 1, rheumatoid arthritis Holosystolic murmur - ANSWER-VSD, tricuspid regurgitation, mitral regurgitation Hypercoagulability, endothelial damage, blood stasis - ANSWER-Virchow triad (risk of thrombosis) Hypertension, 2° - ANSWER-Renal disease Hypoparathyroidism - ANSWER-Accidental excision during thyroidectomy Hypopituitarism - ANSWER-Pituitary adenoma (usually benign tumor) Infection 2° to blood transfusion - ANSWER-Hepatitis C Infections in chronic granulomatous disease - ANSWER-S. aureus, E. coli, Aspergillus (catalase ⊕) Intellectual disability - ANSWER-Down syndrome, fragile X syndrome Kidney stones - ANSWER--Calcium = radiopaque -Struvite (ammonium) = radiopaque (formed by urease ⊕ organisms such as Klebsiella, Proteus species, and S. saprophyticus) -Uric acid = radiolucent Late cyanotic shunt (uncorrected left to right becomes right to left) - ANSWER-Eisenmenger syndrome (caused by ASD, VSD, PDA; results in pulmonary hypertension/polycythemia) Liver disease - ANSWER-Alcoholic cirrhosis Lysosomal storage disease - ANSWER-Gaucher disease