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USMLE Step 1 Cards Editable Flashcards

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USMLE® Step 1 flashcards
1
Q

Abdominal pain, ascites, and hepatomegaly

A

Budd-Chiari syndrome (posthepatic venous thrombosis)

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2
Q

Achilles tendon xanthoma

A

Familial hypercholesterolemia (dec LDL receptor signaling), AutoDom

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3
Q

Adrenal hemorrhage, hypotension, DIC

A

Waterhouse-Friderichsen Syndrome (meningococcemia)

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4
Q

Anterior Drawer Sign (positive)

A

Anterior cruciate ligament injury

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5
Q

Arachnodactyly, lens dislocation, aortic dissection, hyperflexible joints

A

Marfan syndrome (fibrillin defect)

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6
Q

Athlete with polycythemia

A

Secondary to erythropoietin injection

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7
Q

Back pain, fever, night sweats, weight loss

A

Pott disease (vertebral TB)

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8
Q

Bilateral hilar adenopathy, uveitis

A

Sarcoidosis (noncaseating granulomas)

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9
Q

Blue sclera

A

Osteogenesis imperfecta (type I collagen defect)

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10
Q

Bluish line on gingiva

A

Burton line (lead poisoning)

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11
Q

Bone pain, bone enlargement, arthritis

A

Paget disease of bone (increased osteoclastic and osteoblastic activity)

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12
Q

Bounding pulses, diastolic heart murmur, head bobbing

A

Aortic regurgitation

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13
Q

“Butterfly” facial rash and Raynaud phenomenon in young female

A

Systemic lupus erythematosus

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14
Q

Cafe-au-lait spots, Lisch nodules (iris hamartoma)

A

Neurofibromatosis Type I (+ pheochromocytoma, optic gliomas), Chromo 17.

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15
Q

Cafe-au-lait spots, polyostotic fibrous dysplasia, precocious puberty, multiple endocrine abnormalities

A

McCune-Albright Syndrome (mosaic G-protein signaling mutation)

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16
Q

Calf pseudohypertrophy

A

Muscular dystrophy (most commonly Duchenne): X linked recessive DELETION of dystrophin gene. Presents early. Becker’s presents in teens, DECREASED production.

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17
Q

“Cherry-red spots” on macula

A

Niemann-Pick (sphingomyelin accumulation, HEPATOSPLENOMEGALY) or Tay-Sachs (ganglioside accumulation, NO HSM) or, central retinal artery occlusion.

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18
Q

Chest pain on exertion

A

Angina (stable: with moderate exertion; unstable: with minimal exertion)

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19
Q

Chest pain, pericardial effusion/friction rub, persistent fever following MI

A

Dressler syndrome (autoimmune-mediated post-MI fibrinous pericarditis, 1-12 weeks after acute episode)

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20
Q

Child uses arms to stand up from squat

A

Gowers Sign (Duchenne muscular dystrophy)

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21
Q

Child with fever later develops red rash on face that spreads to body

A

“Slapped cheeks” (erythemia infectiosum/fifth disease: parvovarius B19. Aplastic Anemia in sickle cell/hereditary spherocytosis)

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22
Q

Chorea, dementia, caudate degeneration

A

Huntington disease (autosomal dominant CAG repeat expansion). Disease shows “anticipation”.

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23
Q

Chronic exercise intolerance with myalgia, fatigue, painful cramps, and myoglobulinuria

A

McArdle Disease (muscle glycogen phosphorylase deficiency)

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24
Q

Cold interolerance

A

Hypothyroid

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25
Q

Conjugate lateral gaze palsy, horizontal diplopia

A

Internuclear ophthalmoplegia (damage to MLF [medial longitudinal fasciculus]; bilateral [multiple sclerosis] or unilateral [stroked])

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26
Q

Continuous machine-like heart murmur

A

PDA (close with indomethacin; open or maintain with misoprostol)

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27
Q

Cutaneous/dermal edema due to connective tissue deposition

A

Myxedema (caused by hypothyroidism, Graves disease [pretibial])

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28
Q

Dark purple skin/mouth nodules in a patient with AIDS

A

Kaposi sarcoma, associated with HHV-8

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29
Q

Deep, labored breathing/hyperventilation

A

Kussmaul respirations (diabete ketoacidosis)

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30
Q

Dermatitis, dementia, diarrhea

A

Pellagra (niacin [Vitamin B3] deficiency)

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31
Q

Dog or cat bite resulting in infection

A

Pasteurella multocida (cellulitis at inoculation site)

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32
Q

Dilated cardiomyopathy, edema, alcoholism or malnutrition

A

Wet beriberi (thiamine [Vitamin B1] deficiency)

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33
Q

Dry eyes, dry mouth, arthritis

A

Sjogren syndrome (autoimmune destruction of exocrine glands)

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34
Q

Dysphagia (esophageal webs), glossitis, iron deficiency anemia

A

Plummer-Vinson syndrome (may progress to esophageal squamous cell carcinoma)

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35
Q

Elastic skin, hypermobility of joints

A

Ehlers-Danlos syndrome (Type III collagen defect)

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36
Q

Enlarged, hard left supraclavicular nodes

A

Virchow’s Node (abdominal metastasis)

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37
Q

Erythroderma, lymphadenopathy, hepatosplenomegaly, atypical T cells

A

Mycosis fungoides (cutaneous T-cell lymphoma) or Sezary Syndrome (mycosis fungoides + malignant T cells in blood)

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38
Q

Facial muscle spasm during tapping

A

Chvostek sign (hypocalcemia)

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39
Q

Fat, female, forty, and fertile

A

Cholelithiasis (gallstones)

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40
Q

Fever, chills, headache, myalgia following antibiotic treatment for Syphilis

A

Jarisch-Herxheimer reaction (rapid lysis of spirochetes results in toxin release)

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41
Q

Fever, cough, conjunctivitis, coryza, diffuse rash

A

Measles

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42
Q

Fever, night sweats, weight loss

A

B symptoms (staging) of lymphoma

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43
Q

Gout, intellectual disability, self-mutilating behavior in boy

A

Lesch-Nyhan Syndrome (HGPRT deficiency, X-linked recessive)

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44
Q

Fibrous plaques in soft tissue of penis

A

Peyronie disease (connective tissue disorder)

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45
Q

Green-yellow rings around peripheral cornea

A

Kayser-Fleischer rings (copper accumulation from Wilson disease); Low Ceruplasmin, low serum, high urinary copper. Treat w/ Penicilliamine

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46
Q

Hamartomatous GI polyps, hyperpigmentation of mouth/feet/hands

A

Peutz-Jeghers syndrome (inherited, benign polyposis can cause bowel obstruction; inc cancer risk, mainly GI)

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47
Q

Hepatosplenomegaly, osteoporosis, neurologic symptoms

A

Gaucher disease (glucocerebrosidase deficiency)

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48
Q

Hereditary nephritis, sensorineural hearing loss, cataracts

A

Alport syndrome (mutation in collagen IV)

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49
Q

Hyperphagia, hypersexuality, hyperorality, hyperdocility

A

Kluver-Bucy syndrome (bilateral amygdala lesion)

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50
Q

Hyperreflexia, hypertonia, Babinski sign present

A

UMN damage

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51
Q

Hyporeflexia, hypotonia, atrophy, fasciculations

A

LMN damage

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52
Q

Hypoxemia, polycythemia, hypercapnia

A

Blue Bloater (chronic bronchitis: hyperplasia of mucous cells)

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53
Q

Indurated, ulcerated genital lesion

A

Nonpainful: chancre (1˚ syphilis, Trepnenma palldium)Painful, with exudate: chancroid (Haemophilus ducreyi)

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54
Q

Infant with cleft lip/palate, micocephaly or holoprosencephaly, polydactyly, cutis aplasia

A

Patau syndrome (Trisomy 13)

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55
Q

Infant with failure to thrive, hepatosplenomegaly, and neurodegeneration

A

Niemann-Pick disease (genetic phingomyelinase deficiency)

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56
Q

Infant with hypoglycemia, failure to thrive, and hepatomegaly

A

Cori disease (debranching enzyme deficiency, alpha- 1,6 glucosidase) or Von Gierke disease (glucose-6-phosphatase deficiency, more severe, lactate)

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57
Q

Infant with microcephaly, rocker-bottom feet, clenched hands, and structural heart defect

A

Edwards syndrome (trisomy 18)

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58
Q

Jaundice, palpable distended non-tender gallbladder

A

Courvoisier sign (distal obstruction of biliary tree)

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59
Q

Large rash with bull’s-eye appearance

A

Erythemia chronicum migrans form Ixodes tick bite (Lyme disease: Borrelia)

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60
Q

Lucid interval after traumatic brain injury

A

Epidural hematoma (middle meningeal artery rupture)

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61
Q

Male child, recurrent infections, no mature B cells

A

Bruton disease (X-linked agammaglobulinemia due to bad bruton’s tyrosine kinase)

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62
Q

Mucosal bleeding and prolonged bleeding time

A

Glanzmann thrombasthenia (defect in platelet aggregation due to lack of GpIIb/IIIa)

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63
Q

Muffled heart sounds, distended neck veins, hypotension

A

Beck triad of cardiac tamponade (pressure on the heart that occurs when blood or fluid builds up in the space between the heart muscle [myocardium] and the outer covering sac of the heart [pericardium])

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64
Q

Myopathy (infantile hypertrophic cardiomyopathy), exercise intolerance

A

Pompe Disease (lysosomal alpha-1,4-glucosidase deficiency)

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65
Q

Neonate with arm paralysis following difficult birth

A

Erb-Duchenne palsy (superior trunk [C5-C6] brachial plexus injury: waiter’s tip)

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66
Q

No lactation postpartum, absent menstruation, cold intolerance

A

Sheehan syndrome (pituitary infarction)

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67
Q

Nystagmus, intention tremor, scanning speech, bilateral internuclear ophthalmoplegia

A

Multiple Sclerosis

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68
Q

Oscillating slow/fast breathing

A

Cheyne-Stokes respirations (central apnea in CHF or increased intracranial pressure)

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69
Q

Painful blue fingers/toes, hemolytic anemia

A

Cold agglutinin disease (autoimmune hemolytic anemia caused by Mycoplasma penumoniae, infectious mononucleosis)

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70
Q

Painful, pale, cold fingers/toes

A

Raynaud phenomenon (vasospasm in extremities)

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71
Q

Painful, raised red lesions on pad of fingers/toes

A

Osler nodes (infective endocarditis, immune complex deposition)

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72
Q

Painless erythematous lesions on palms and soles

A

Janeway lesions (infective endocarditis, septic emboli/microabscesses)

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73
Q

Painless jaundice

A

Cancer of the pancreatic head obstructing bile duct

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74
Q

Palpable purpura on buttocks/legs, joint pain (child), hematuria

A

Henoch-Schonlein purpura (IgA vasculitis affecting skin and kidneys)

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75
Q

Pancreatic, pituitary, parathyroid tumors

A

MEN I (autosomal dominant)

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76
Q

Pink complexion, dyspnea, hyperventilation

A

Pink Puffer: emphysema: centriacinar [smoking], panacinar [alpha1-antitrypsin deficiency], PAS + staining)

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77
Q

Polyuria, renal tubular acidosis Type II, growth failure, electrolyte imbalances, hypophosphatemic rickets

A

Fanconi syndrome (proximal tubular reabsorption defect)

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78
Q

Pruritic, purple, polygonal planar papules and plaques

A

Lichen planus

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79
Q

Ptosis, miosis, anhidrosis

A

Horner Syndrome (sympathetic chain lesion)

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80
Q

Pupil accommodates but doesn’t react

A

Argyll Robertson pupil (neurosyphilis)

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81
Q

Rapidly progressive leg weakness that ascends following GI/upper respiratory infection

A

Guillian-Barre syndrome (acute autoimmune inflammatory demyelinating polyneuropathy); camplobacter jejuni

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82
Q

Rash on palms and soles

A

Coxsackie A, 2˚ syphilis, Rocky Mountain Spotted fever

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83
Q

Recurrent colds, unusual eczema, high serum IgE

A

Hyper-IgE syndrome (Job syndrome: neutrophil chemotaxis abnormality)

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84
Q

Red current jelly sputum in alcoholic or diabetic patient

A

Klebsiella penumoniae

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85
Q

Red current jelly stools

A

Acute mesenteric ischemia (adults), intussusception (infants)

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86
Q

Red, itchy, swollen rash of nipple/aerolea

A

Paget disease of the breast (sign of underlying neoplasm)

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87
Q

Red urine in the morning, fragile RBCs

A

Paroxysmal nocturnal hemoglobinuria (no PIG therefore cannot attach DAF (CD55) and MIRL (CD59)

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88
Q

Renal cell carcinoma (bilateral), hemagioblastomas, angiomatosis, pheechromocytoma

A

von Hippel-Lindau disease (dominant tumor suppressor gene mutation)

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89
Q

Resting tremor, rigidity, akinesia, postural instability

A

Parkinson disease (nigrostriatal dopamine depletion)

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90
Q

Retinal hemorrhages with pale centers

A

Roth spots (bacterial endocarditis)

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91
Q

Severe jaundice in neonate

A

Crigler-Najjar syndrome (congenital unconjugated hyperbilirubinemia)

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92
Q

Severe RLQ pain with palpation of LLQ

A

Rovsing sign (acute appendicitis)

93
Q

Severe RLQ pain with rebound tenderness

A

McBurney sign (acute appendicitis)

94
Q

Short stature, inc incidence of tumors/leukemia, aplastic anemia

A

Fanconi anemia (genetic loss of DNA crosslink repair; often progresses to AML)

95
Q

Single palmar crease

A

Down Syndrome

96
Q

Situs inversus, chronic sinusitis, bronchiectasis, infertility

A

Kartagener syndrome (dyenien arm defect affecting cilia)

97
Q

Skin hyperpigmentation, hypotension, fatigue

A

Addison disease (1˚ adrenocortical insufficiency causes inc ACTH and inc alpha-MSH production)

98
Q

Slow, progressive muscle weakness in boys

A

Becker muscular dystrophy (X linked missense mutation in dystrophin; less severe than Duchenne)

99
Q

Small, irregular red spots on buccal/lingual mucosa with blue-white centers

A

Koplik spots (measles; rubeola virus: “measles gets all the “PRESSN”: Paramyoxviridae, RNA, Env, Single Stranded, Negative)

100
Q

Smooth, flat, moist, painless white lesions on genitals

A

Condylomata lata (2˚ syphilis)

101
Q

Splinter hemorrhages in fingernails

A

Bacterial endocarditis

102
Q

Strawberry tongue

A

Scarlet fever, Kawasaki disease, toxic shock syndrome

103
Q

Streak ovaries, congenital heart disease, horseshoe kidney, cystic hygroma at birth, short stature, webbed neck, lymphedema

A

Turner syndrome (45, XO)

104
Q

Sudden swollen/painful big toe joint, tophi

A

Gout/podagra (hyperuricemia)

105
Q

Swollen gums, mucosal bleeding, poor wound healing, petechiae

A

Scurvy (Vitamin C deficiency: can’t hydroxylate proline/lysine for collagen synthesis)

106
Q

Swollen, hard, painful finger joints

A

Osteoarthritis (osteophytes on PIP [Bouchard nodes], DIP [Heberden nodes])

107
Q

Systolic ejection murmur (cresendo-decrescendo)

A

Aortic valve stenosis

108
Q

Thyroid and parathyroid tumors, pheochromocytoma

A

MEN 2A (autosomal dominant ret mutation)

109
Q

Thyroid tumors, pheochromocytoma, ganglioneuromatosis, Marfinoid body habitus

A

MEN 2B (autosomal dominant ret mutation)

110
Q

Toe extension/fanning upon plantar scrape

A

Babinski sign (UMN lesion)

111
Q

Unilateral facial dropping involving forehead

A

Facial nerve (LMN CN VII palsy)

112
Q

Urethritis, conjunctivitis, arthritis in a male

A

Reactive (Reiters) arthritis associated with HLA-B27 (can’t pee, can’t see, can’t climb a tree); associated with recent GI infection or Chlamydia infection

113
Q

Vascular birthmark (port-wine stain)

A

Hemangioma (benign, but associated with Sturge-Weber syndrome)

114
Q

Vomiting blood following gastroesophageal lacerations

A

Mallory-Weiss syndrome (alcoholic and bulimic patients)

115
Q

Weight loss, diarrhea, arthritis, fever, adenopathy

A

Whipple disease (Tropheryma whipplei: foamy macrophages (PAS+) in the lamina propria)

116
Q

Worst headache of life

A

Subarachnoid hemorrhage

117
Q

Anticentromere antibodies

A

Scleroderma (CREST)

118
Q

Antidesmoglein (epithelial) antibodies

A

Pemphigus vulgaris (blistering), Positive Nikolsky Sign

119
Q

Anti-glomerular basement membrane antibodies

A

Goodpasture syndrome (glomerulonephritis & hemoptysis), against Type 4 collagen

120
Q

Antihistone antibodies

A

Drug-induced SLE (SHIPP: Sulfonamides, hydralazine, INH, phenytoin, procainamide):

121
Q

Anti-IgG antibodies

A

Rheumatoid arthritis (systemic inflammation, joint pannus, boutonniere deformity)

122
Q

Antimitochondrial antibodies (AMAs)

A

1˚ biliary cirrhosis (female, cholestasis, portal HTN)

123
Q

MPO-ANCA/p-ANCA

A

Microscopic polyangiitis & Churg-Strauss syndrome

124
Q

PR3-ANCA/c-ANCA

A

Granulomatosis w/polyangiitis (Wegener)

125
Q

Antinuclear antibodies (anti-Smith & anti-dsDNA)

A

SLE (type III hypersensitivity)

126
Q

Antiplatelet antibodies

A

Idiopathic thrombocytopenic purpura

127
Q

Anti-topoisomerase antibodies

A

Diffuse systemic scleroderma

128
Q

Anti-transglutaminase/anti-gliadin/anti-endomysial antibodies

A

Celiac disease (diarrhea, distention, weight loss)

129
Q

Apple core lesion on abdominal x-ray

A

Colorectal cancer (usually left-sided)

130
Q

Azurophilic peroxidase (+) granular inclusions in granulocytes & myeloblasts

A

Auer rods (AML, especially the promyelocytic [M3] type)

131
Q

Bacitracin response

A

Sensitive: Steptococcus pyogenes (Group A); resistant: streptococcus agalactiae (Group B)

132
Q

Bamboo spine on x-ray

A

Ankylosing spondylitis (chronic inflammatory arthritis; HLA-B27)

133
Q

Basophilic nuclear remnants in RBCs

A

Howell-Jolly bodies (d/t splenectomy or nonfunctional spleen)

134
Q

Basophilic stippling of RBCs

A

Lead poisoning or Sideroblastic anemia

135
Q

Bloody tap on LP

A

Subarachnoid hemorrhage

136
Q

Boot-shaped heart on x-ray

A

Tetralogy of Fallot, RVH

137
Q

Branching gram-positive rods w/sulfur granules

A

Actinomyces israelii

138
Q

Bronchogenic apical lung tumor on imaging

A

Pancoast tumor (can compress sympathetic ganglion & cause Horner syndrome)

139
Q

Brown tumor of bone

A

Hyperparathyroidism or osteitis fibrosa cystica (deposited hemosiderin from hemorrhage gives brown color)

140
Q

Cardiomegaly with apical atrophy

A

Chagas disease (Trypanosoma cruzi)

141
Q

Cellular crescents in Bowman capsule

A

Rapidly progressive crescentic glomerulonephritis

142
Q

Chocolate cyst of ovary

A

Endometriosis (frequently involves both ovaries)

143
Q

Circular grouping of dark tumor cells surrounding pale neurofibrils

A

Homer-Wright rosettes (neuroblastoma, medulloblastoma, retinoblastoma)

144
Q

Colonies of mucoid Pseudomonas in lungs

A

Cystic fibrosis (autosomal recessive mutation in CFTR gene –> fat-soluble vitamin deficiency and mucous plugs)

145
Q

Dec AFP in amniotic fluid/maternal serum

A

Down syndrome or other chromosomal abnormality

146
Q

Degeneration of dorsal column nerves

A

Tabes dorsalis (3˚ syphilis), subacute combined degeneration (dorsal columns & lateral corticospinal tracts affected)

147
Q

Depigmentation of neurons in substantia nigra

A

Parkinson disease (basal ganglia disorder; rigidity, resting tremor, bradykinesia)

148
Q

Desquamated epithelium casts in sputum

A

Curschmann spirals (bronchial asthma; can result in whorled mucous plugs)

149
Q

Disarrayed granulosa cells in eosinophilic fluid

A

Call-Exner bodies (granulosa-theca cell tumor of ovary)

150
Q

Dysplastic squamous cervical cells w/nuclear enlargement & hyperchromasia

A

Koilocytes (HPV; predisposes to cervical cancer)

151
Q

Enlarged cells with intranuclear inclusion bodies

A

Owl eye appearance of CMV

152
Q

Enlarged thyroid cells with ground glass nuclei

A

Orphan Annie eyes nuclei (papillary carcinoma of thyroid)

153
Q

Eosinophilic cytoplasmic inclusion in liver cell

A

Mallory body (alcoholic liver disease)

154
Q

Eosinophilic cytoplasmic inclusion in nerve cell

A

Lewy body (Parkinson disease)

155
Q

Eosinophilic globule in liver

A

Councilman body (toxic or viral hepatitis, often yellow fever)

156
Q

Eosinophilic inclusion bodies in cytoplasm of hippocampal & cerebellar nerve cells

A

Negri bodies of rabies

157
Q

Extracellular amyloid deposition in gray matter of brain

A

Senile plaques (Alzheimer disease)

158
Q

Giant B cells w/bilobed nuclei with prominent inclusions (“owl’s eye”)

A

Reed-Sternberg cells (Hodgkin lymphoma)

159
Q

Glomerulus-like structure surrounding vessel in germ cells

A

Schiller-Duval bodies (yolk sac tumor)

160
Q

Hair on end (crew-cut) appearance on x-ray

A

beta-Thalassemia, sickle cell anemia (marrow expansion)

161
Q

hCG elevated

A

Choriocarcinoma, hydatidiform mole (occurs w/& w/o embryo, and multiple pregnancy)

162
Q

Heart nodules (granulomatous)

A

Aschoff bodies (rheumatic fever)

163
Q

Heterophile antibodies

A

Infectious mononucleosis (EBV)

164
Q

Hexagonal, double-pointed, needle-like crystals in bronchial secretions

A

Bronchial asthma (Charcot-Leyden crystals; eosinophilic granules)

165
Q

High level of D-dimers

A

DVT, PE, DIC

166
Q

Hilar lymphadenopathy, peripheral granulomatous lesion in middle or lower lung lobes (can calcify)

A

Ghon complex (1˚ TB; Mycobacterium bacilli)

167
Q

Honeycomb lung on x-ray or CT

A

Interstitial pulmonary fibrosis

168
Q

Hypercoagulability (leading to migrating DVTs and vasculitis)

A

Trousseau syndrome (adenocarcinoma of pancreas or lung)

169
Q

Hypersegmented neutrophils

A

Megaloblastic anemia (B12 deficiency - neurologic symptoms; folate deficiency - no neurologic symptoms)

170
Q

Hypertension, hypokalemia, metabolic alkalosis

A

Conn syndrome

171
Q

Hypochromic, microcytic anemia

A

Iron deficiency anemia, lead poisoning, thalassemia (fetal Hg sometimes present)

172
Q

Increased AFP in amniotic fluid/maternal serum

A

Dating error, anencephaly, spina bifida (neural tube defects)

173
Q

Increased uric acid levels

A

Gout, Lesch-Nyhan syndrome, tumor lysis syndrome, loop and thiazide diuretics

174
Q

Intranuclear eosinophilic droplet-like bodies

A

Cowdry type A bodies (HSV or CMV)

175
Q

Iron-containing nodules in alveolar septum

A

Ferruginous bodies (asbestosis inc chance of mesothelioma)

176
Q

Keratin pearls on a skin biopsy

A

Squamous cell carcinoma

177
Q

Large lysosomal vesicles in phagocytes, immunodeficiency

A

Chediak-Higashi disease (congenital failure of phagolysososome formation)

  • partial albinism
  • neuropathy
178
Q

Lead pipe appearance of colon on barium enema x-ray

A

Ulcerative colitis (loss of haustra)

179
Q

Linear appearance of IgG depostion on glomerular basement membrane

A

Goodpasture syndrome

180
Q

Low serum ceruloplasmin

A

Wilson disease (hepatolenticular degeneration)

181
Q

Lumpy bumpy appearance of glomeruli on immunofluorescence

A

Poststreptococcal glomerulonephritis (immune complex deposition on IgG and C3b)

182
Q

Lytic (“hole punches”) bone lesions on x-ray

A

Multiple myeloma

183
Q

Mammary gland (“blue domed”) cyst

A

Fibrocystic change of the breast

184
Q

Monoclonal antibody spike (IgG or IgA)

A

Multiple myeloma (usually IgG or IgA)

185
Q

Monoclonal antibody spike

A

Monoclonal gammopathy of undetermined significance (MGUS consequence of aging); Primary amyloidosis

186
Q

Monoclonal antibody spike (IgM)

A

Waldestrom (M protein = IgM) macroglobulinemia

187
Q

Mucin-filled cell with peripheral nucleus

A

Signet ring (gastric carcinoma)

188
Q

Narrowing of bowel lumen on barium x-ray

A

String sign (Crohn disease)

189
Q

Necrotizing vasculitis (lungs) and necrotizing glomerulonephritis

A

Granulomatosis with polyangiitis (Wegener; PR3-ANCA/c-ANCA) and Goodpasture syndrome (anti-basement membrane antibodies)

190
Q

Needle-shaped, negatively birefringent crystals

A

Gout (monosodium urate crystals)

191
Q

Nodular hyaline deposits in glomeruli

A

Kimmelstiel-Wilson nodules (diabetic nephropathy)

192
Q

Novobiocin response

A

Sensitive: Staphylococcus epidermiditis; resistant: staphylococcus saprophyticus

193
Q

Nutmeg appearance of liver

A

Chronic passive congestion of liver due to right heart failure

194
Q

Onion skin periosteal reaction

A

Ewing sarcoma (malignant round-cell tumor)

195
Q

Optochin response

A

Sensitive: Streptococcus pneumoniae; resistant: viridans streptococci

196
Q

Periosteum raised from bone, creating triangular area

A

Codman triangle on x-ray (osteosarcoma, Ewing sarcoma, pyogenic osteomyelitis)

197
Q

Podocyte fusion or “effacement” on electron microscopy

A

Minimal change disease (child with nephrotic syndrome)

198
Q

Polished, “ivory-like” appearance of bone at cartilage erosion

A

Eburnation (osteoarthritis resulting in bony sclerosis)

199
Q

Protein aggregates in neurons from hyperphosphorylation of tau protein

A

Neurofibrillary tangles (Alzheimer disease) and Pick bodies (Pick disease)

200
Q

Psammoma bodies

A

Meningiomas, papillary thyroid carcinoma, mesothelioma, papillary serous carcinoma of the endometrium and ovary

201
Q

Pseudopalisading tumor cells on brain biopsy

A

Gioblastoma multiforme

202
Q

RBC casts in urine

A

Acute glomerulonephritis

203
Q

Rectangular, crystal-like, cytoplasmic inclusions in Leydig cells

A

Reinke crystals (Leydig cell tumor)

204
Q

Renal epithelial casts in urine

A

Acute toxic/viral renal injury

205
Q

Rhomboid crystals, positively birefringent

A

Pseudogout (calcium pyrophosphate dihydrate crystals)

206
Q

Rib notching

A

Coarctation of the aorta

207
Q

Ring-enhancing brain lesions in AIDS

A

Toxoplasma gondii, CNS lymphoma

208
Q

Sheets of medium-sized lymphoid cells with scattered pale, tangible body-laden macrophages (“starry sky” histology)

A

Burkitt lymphoma (t[8:14] c-myc activation, associated with EBV; “black sky” made up of malignant cells)

209
Q

Silver-staining spherical aggregation of tau proteins in neurons

A

Pick bodies (Pick disease; progressive dementia, changes in personality)

210
Q

Soap bubble in femur or tibia on x-ray

A

Giant cell tumor of bone (generally benign)

211
Q

Spikes on basement membrane, “dome-like” subepithelial deposits

A

Membranous glomerulonephritis (may progress to nephrotic syndrome)

212
Q

Stacks of RBCs

A

Rouleaux formation (high ESR, multiple myeloma)

213
Q

Stippled vaginal epithelial cells

A

Clue cells (Gardnerella vaginalis)

214
Q

Tennis racket-shaped cytoplasmic organelles (EM) in Langerhans cells

A

Birbeck granules (Langerhans cell histiocytosis or histiocytosis X; eosinophilic granuloma)

215
Q

Thrombi made of white/red layers

A

Lines of Zahn (arterial thrombus, layers of platelets/RBCs)

216
Q

Thumb sign on lateral x-ray

A

Epiglottitis (Haemophilus influenzae)

217
Q

Thyroid-like appearance of kidney

A

Chronic bacterial pyelonephritis

218
Q

Tram-tack appearance of capillary loops of glomerular basement membranes on light microscopy

A

Membranoproliferative glomerulonephritis

219
Q

Triglyceride accumulation in liver cell vacuoles

A

Fatty liver disease (alcoholic or metabolic syndrome)

220
Q

Waxy casts with very low urine flow

A

Chronic end-stage renal disease

221
Q

WBC casts in urine

A

Acute pyelonephritis

222
Q

WBCs that look “smudged”

A

CLL (almost always B cell)

223
Q

Wire loop glomerular capillary appearance on light microscopy

A

Lupus nephropathy

224
Q

Yellowish CSF

A

Xanthochromia (e.g. subarachnoid hemorrhage due to Bilirubin breakdown products)

225
Q

Short Stature, Short 4th and 5th digits, Hypocalcemia

A

Psuedohypoparathryoidism. Inactivating mutation of Gsalpha which cannot stimulate Adenylate Cyclase leading to decreased cAMP, leaving body unable to respond to PTH.

226
Q

Headache in a firefighter

A

CO exposure. Early sign of CO poisoning is headache

227
Q

Symptoms of HyperPTH

A

“Bones, stones, moans (psychiatric), and groans (GI)”

228
Q

Myotonia, Muscle Wasting, Frontal Balding, Cataracts, Testicular atrophy, Arrhythmia

A

Myotonic Dystrophy

229
Q

Pharyngoconjunctival Fever

A

Adenovirus

Group effort USMLE Step 1 (3 decks)

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