Risk Factors USMLE Step 2

Lung CA

cigarette smoke (polycyclic aromatic hydrocarbons, arsenic); radon (uranium miners); asbestos

Oral SCC

tobacco; alcohol (precursor lesions = leukoplakia; erythroplakia)

GERD

alcohol; tobacco; obesity; fat-rich diet; caffeine; hiatal hernia

Esophageal Adenocarcinoma

GERD; Barrett Esophagus

Esophageal SCC

alcohol; tobacco; very hot tea; achalasia; esophageal webs (e.g. Plummer-Vinson); esophageal injury

Acute Gastritis

severe burn (Curling Ulcer), NSAIDs, heavy EtOH consumption, chemo, ↑ ICP (Cushing Ulcer), stress/shock

Intestinal-type Gastric CA

H. pylori, nitrosamines (smoked foods), tobacco, smoking, achlorhydria, chronic gastritis; (NOTE: gastric ulcers have risk of transformation to carcinoma, whereas duodenal ulcers are generally benign)

Intussusception

Meckel's Diverticulum (MC), adenovirus (→ peyer's patch hypertrophy → lead point), rotavirus vaccine

Colorectal Carcinoma

adenomatous & serrated polyps, familial CA syndromes, IBD, tobacco use, processed meats, low-fiber diet

Acute Pancreatitis

PANCREATITIS mnemonic → Posterior duodenal ulcer, Alcohol, Neoplasm, Cholelithiasis & ↑ Ca++, Renal disease, ERCP, Anorexia, Trauma (MC = seatbelts), Infection (Mumps), Toxins/Drugs (Thiazides, AZT, protease inhibitors), Incineration, Scorpion stings

Pancreatic Adenocarcinoma

smoking; chronic pancreatitis, DM, age >50 y/o, Jewish & African-American males

Acalculous Cholecystitis

critically ill patients (sepsis, burns, trauma, immunosuppression)

Cholelithiasis (Gallstones)

Cholesterol Stones — age (40s), estrogen (female, obesity, multiple pregnancies, OCPs), clofibrate, Native American ethnicity, Crohn's Disease, cirrhosis Bilirubin Stones — extravascular hemolysis, biliary tract infection (E. coli, Ascaris lumbricoides, Clonorchis sinensis)

Gallbladder Adenocarcinoma

cholelithiasis, chronic cholecystitis (esp. if complicated by porcelain gallbladder) associated with chronic Salmonella typhi infection

Cholangiocarcinoma

PSC (MCC), thorotrast, choledochal cyst, Clonorchis sinensis

Hepatocellular Carcinoma

chronic HBV/HCV; cirrhosis (alcohol, NAFLD, Hemochromatosis, Wilson's, A1ATD); aflatoxins from Aspergillus (→ P53 mutations)

Hepatic Adenoma

oral contraceptive use, anabolic steroid use

Angiosarcoma

exposure to arsenic, vinyl chloride

Nephrotoxic Acute Tubular Necrosis

aminoglycosides (MCC), heavy metals (lead), myoglobinuria (from crush injuries), ethylene glycol, radiocontrast dye, urate (tumor lysis syndrome secondary to chemotherapy induction)

Renal Cellular Carcinoma

loss of VHL (3p) tumor suppressor gene; cigarette smoking

Transitional Cell Carcinoma

smoking; naphthylamine, azo dyes, long-term cyclophosphamide or phenacetin use

Squamous Cell Carcinoma of the Bladder

chronic cystitis, Schistosoma haematobium, chronic nephrolithiasis

Adenocarcinoma of the Bladder

urachal remnant (dome of bladder), cystitis glandularis, exstrophy (congenital failure to form the caudal portion of the anterior abdominal wall & bladder walls)

Vulvar Carcinoma

VIN d/t high-risk HPV 16/18 (↑ # of partners & early intercourse); lichen sclerosus (NOT assoc. w/ VIN)

Vaginal Carcinoma

high-risk HPV (VAIN = precursor lesion)

Adenosis

associated with diethylstilbestrol (DES) exposure in utero

Clear Cell Adenocarcinoma of the Vagina

complication of DES-associated vaginal adenosis

Cervical Carcinoma

key = high-risk HPV; secondary = smoking & immunodeficiency

Endometrial Carcinoma

endometriosis, endometrial hyperplasia (major predictor = presence of cellular atypia) hyperplasia pathway ‒ age = 60 y/o; related to estrogen exposure (early menarche, late menopause, nulliparity, infertility w/ anovulatory cycles, obesity) sporadic pathway ‒ age = 70 y/o; no evident precursor lesion; arises in an atrophic endometrium

Spontaneous Abortion

chromosomal defects, hypercoagulability, congenital infection, teratogens (esp. Isotretinoin)

Ectopic Pregnancy

endometriosis of the fallopian tubes, PID, mechanical obstruction by

Postpartum Endometritis

C-section, chorioamnionitis, GBS, intrauterine instrumentation, preterm delivery, prolonged labor, prolonged ROM, retained POC

Sudden-Infant Death Syndrome (SIDS)

sleeping on stomach, exposure to cigarette smoke, prematurity

Choriocarcinoma

spontaneous abortion, normal pregnancy, complete mole

Cerebral Palsy

prematurity, low birth weight, heavy maternal alcohol use

Penile SCC

HPV, lack of circumcision, precursor lesions (Bowen Disease, Erythroplasia of Queyrat, Bowenoid Papulosis)

Testicular Germ Cell Tumor

Cryptorchidism, Klinefelter Syndrome

Prostate Adenocarcinoma

age, race (AA > caucasians > asians), diet high in saturated fats

Multiple Sclerosis

female gender, HLA-DR2, ↑ distance from equator

Vitamin D Deficiency

↓ sun exposure (northern latitudes), poor diet, malabsorption, liver failure, renal failure

Osteoarthritis

major risk factor = age (common after >60 y/o); additional = obesity, trauma

Rheumatoid Arthritis

HLA-DR4

Basal Cell Carcinoma of the Epithelium

UVB-induced DNA damage (sunlight, albinism, Xeroderma Pigmentosum)

Squamous Cell Carcinoma of the Epithelium

UVB-induced DNA damage (sunlight, albinism, Xeroderma Pigmentosum), immunosuppressive therapy, arsenic exposure, chronic inflammation (scar from burn or draining sinus tracts)

Melanoma

UVB-induced DNA damage (sunlight, albinism, Xeroderma Pigmentosum), Dysplastic Nevus Syndrome

Pseudotumor Cerebri

female gender, obesity, vitamin A excess, tetracycline, danazol