USMLE Step 1 Rapid Review

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1. Abdominal pain, ascites, Budd-Chiari 20. Chronic exercise intolerance McArdle's (muscle
hepatomegaly, (also high D dimer, syndrome with myalgia, fatigue, painful phosphorylase deficiency)
CHF without JVD) cramps
2. Achilles tendon xanthoma Familial 21. Cold intolerance Hypothyroidism
hypercholesterolemia
22. Conjugate lateral gaze palsy, Internuclear
3. Adrenal hemorrhage, hypotension, Waterhouse- horizontal diplopia ophthalmoplegia (MS or
DIC Friderichsen stroke)
syndrome
23. Continuous machinery heart PDA
(meningococcemia)
murmur
4. Arachnodactyly, lens dislocation, Marfan's (fibrillin
24. Cutaneous/dermal edema due Myxedema
aortic dissection, hyperflexible defect)
to CT expansion
joints
25. Dark purple skin / mouth Kaposi's sarcoma
5. Athlete with polycythemia Erythropoietin
nodules
injection
26. Deep, labored breathing / Kussmaul breathing, DKA
6. Back pain, fever, night sweats, Pott's (TB to the
hyperventilation
weight loss vertebrae)
27. Dermatitis, dementia, diarrhea Pellagra (B3 / niacin
7. Bilateral hilar adenopathy, uveitis Sarcoid
deficiency)
8. Blue sclera Osteogenesis
28. Dilated cardiomyopathy, Wet beriberi (B1 / thiamine
imperfecta
edema, polyneuropathy deficiency)
9. Bluish line on gingiva Burton's line - lead
29. Dog or cat bite resulting in Pasteurella multocida
poisoning
infection (local cellulitis)
10. Bone pain, bone enlargement, Paget's
30. Dry eyes, dry mouth, arthritis Sjogren's syndrome
arthritis, (also increased hat size,
fracture, increased alk phos) 31. Dysphagia (esophageal webs), Plummer-Vinson syndrome
glossitis (smooth tongue), iron
11. Bounding pulses, diastolic hear Aortic regurg
deficiency anemia
murmur, head bobbing
32. Elastic skin, hypermobility of Ehler-Danlos (type III
12. Caf-au-lait spots, Lisch nodules NF (1 = optic glimoas
joints collagen)
and pheo, 2 =
acoustic 33. Enlarged. hard left VIrchow's node (abdominal
Schwannomas) supraclavicular node met)

13. Caf-au-lait spots, polyostotic McCune-Albright 34. Erythroderma, Sezary syndrome

fibrous dysplasia, precocious syndome (G protein
puberty problem)
14. Calf pseudohypertrophy Duchenne's muscular
dystrophy 35.
15. Cherry-red spot on macula Tay-Sachs, Niemann-
Pick, central retinal 36.
artery occlusion 37.
16. Chest pain, pericardial Dressler's
effusion/friction rub, persistent (autoimmune post-MI)
fever following MI
lymphadenopathy, (cutaneous T cell
hepatosplenomegaly, atypical lymphoma)
T cells
Facial muscle spasm upon Chvostek's sign
tapping (hypocalcemia)
Fat, female, fertile, forty Gallstones
Fever, chills, headache, Jarisch-Herxheimer
myalgia following antibiotic reaction (lysis of
treatment for syphillis spirochetes results in toxin
release)

17. Child uses arms to stand up from Gower's sign 38. Fever, cough, conjunctivitis, Measles
squat (Duchenne's) coryza, diffuse rash, Koplick
spots
18. Child with fever develops red rash Slapped cheek - B19
on face that spreads to body 39. Fever, night sweats, weight loss B symptoms or TB

19. Chorea, dementia, caudate Huntington's 40. Fibrous plaques in soft tissue Peyronie's disease
degeneration of penis
41. Gout, MR, self-mutilating
behavior in a boy
42. Green-yellow rings around
peripheral iris
43. Hamartomatous GI polyps,
hyperpigmentation of mouth,
feet and hands
44. Hepatosplenomegaly,
osteoporosis, neurologic
symptoms, crinkled cytoplasm
45. Hereditary nephritis,
sensorineural hearing loss,
cataracts
46. Hypercoagulability leading to
thrombophlebitis
47. Hyperphagia, hypersexuality,
hyperorality, hyperdocility
48. HTN, hypoK, metabolic
alkalosis
49. Hypoxemia, polycythemia,
hypercapnia
50. Indurated, ulcerated genital
lesion
51. Infant with failure to thrive,
hepatosplenomegaly,
neurodegeneration
52. Infant with hypoglycemia,
failure to thrive, and
hepatomegaly
53. Infant with microcephaly,
rocker-bottom feet, clenched
hands, and structural heart
defect
54. Jaundice, RUQ pain, fever
55. Keratin pearls
56. Large rash with bull's eye
appearance
57. Lucid interval after TBI
58. Male child, recurrent
infections, no mature B cells
Lesch-Nyhan syndrome
(HGPRT deficiency, X-
linked recessive)
Kayser-Fleischer rings
(copper accumulation from
Wilson's disease)
Peutz-Jeghers syndrome
Gaucher's disease
(glucocerebrosidase
deficiency)
Alport's syndrome (type IV
collagen)
Trousseau's sign
(adenocarcinoma of
pancreas or lung)
Kluver-Bucy syndrome
(bilateral amygdala)
Conn's (1*
hyperaldosterone)
Blue bloater (chronic
bronchitis)
Nonpainful = syphillis.
Painful with exudate =
chancroid
Niemann-Pick disease
(genetic sphingomyelinase
deficiency)
Cori's disease (debranching
enzyme deficiency, no
glycogenolysis) or Von
Gierke's
Edward's syndrome
(Trisomy 18)
Charcot's triad (ascending
cholangitis)
Squamous cell carcinoma
Erythema chronicum
migrans from Ixodes tick
bite (Lyme)
Epidural hematoma (middle
meningeal artery)
Bruton's disease (X-linked
agammaglobulinemia)
59. Mucosal bleeding and
prolonged bleeding time
60. Multiple colon polyps,
osteomas / soft tissue tumors,
impacted / supernumary teeth
61. Necrotizing vasculitis (lungs)
and necrotizing GN
62. Neonate with arm paralysis
following difficult birth.
Possible clavicle fx, probably
large for gestational age
63. No lactation postpartum,
absent menstruation, cold
intolerance
64. Nystagmus, intention tremor,
scanning speech, also
bilateral internuclear
ophthalmoplegia
65. Oscillating slow / fast
breathing
66. Painful blue fingers / toes,
hemolytic anemia
67. Painful, pale, cold fingers /
toes
68. Painful, raised red lesions on
palms and soles
69. Painless erythematous lesions
on palms and soles
70. Painless jaundice
71. Palpable purpura, joint pain,
abdominal pain in a child
72. Pancreatic, pituitary,
parathyroid tumors
73. Pink complexion, dypnea,
hyperventilation
74. Polyuria, acidosis, growth
failure, electrolyte imbalances
75. Ptosis, miosis, anhidrosis
76. Pupil accommodates but
doesn't react
Glanzmann's
thrombasthenia (defect in
platelet aggregation due to
lack of GpIIb/IIIa)
Gardner's syndrome
Wegner's (c-ANCA) and
Goodpasture's (anti-GBM).
Wegner's can also have
upper airway involvement
Erb-Duchenne palsy
Sheehan's syndrome
MS (Charcot's)
Cheyne-Stokes (central
apnea from CHF or
increased ICP)
Cold agglutinin disease
(autoimmune from Mp or
mono, from IgM)
Raynaud's syndrome
(vasospasm)
Osler's node (infective
endocarditis)
Janeway lesions (infective
endocarditis)
Cancer at head of pancreas
obstructing bile duct
Henoch-Schonlein purpura
(IgA vasculitis)
MEN 1 (Wermer's)
Pink puffer (emphysema)
Fanconi's syndrome
(proximal tubular
reabsorption defect)
Horner's syndrome (usually
with Pancoast tumor in apex
of lung)
Argyll Robertson pupil
(neurosyphilis)
77. Rapidly progressive leg
weakness that ascend,
following GI infection
78. Rash on palms and soles
79. Recurrent colds, unusual
eczema, high serum IgE
80. Red "current jelly" sputum in
alcoholic or diabetic patients
81. Red, itchy, swollen rash of
nipple/areola
82. Red urine in the morning,
fragile RBCs
83. Renal cell carcinoma,
hemangioblastomas,
angiomatosis,
pheochromocytoma
84. Resting tremor, rigidity,
akinesia, postural instability
85. Restrictive cardiomyopathy
(juvenile = cardiomegaly),
exercise intolerance
86. Retinal hemorrhages with
pale centers
87. Severe jaundice in neonate
88. Severe RLQ pain with
rebound tenderness
89. Short stature, increased
incidence of tumors /
leukemia, aplastic anemia
90. Single palm crease
91. Situs inversus, chronic
sinusitis, bronchiectasis,
infertility
92. Skin hyperpigmentation
93. Slow progressive muscle
weakness in boys
94. Small, irregular red spots on
buccal mucosa with blue-
white centers
95. Smooth, flat, moist white
lesions on genitals
96. Splinter hemorrhages in
fingernails
Guillain-Barre syndrome
2* syphilis, Rocky Mountain
spotted fever, coxsackie A
Job's syndrome
Klebsiella pneumoniae
Paget's disease of the breast
Paroxysmal nocturnal
hemoglobinuria (C' mediated
damage, lack of CD55/59)
von Hippel-Lindau diease
Parkinson's
Pompe's disease (lysosomal
glucosidase deficiency)
Roth's spots (bacterial
endocarditis)
Crigler-Najjar syndrome
(congenital unconj hyper
bilirubinemia)
McBurney's sign
Fanconi's anemia (esp AML)
Simian crease (Down's)
Kartagener's syndrome
(dynein)
Addison's
Becker's muscular dystrophy
Koplick spots (measles)
Condylomata lata (2*
syphilis)
Bacterial endocarditis
97. Strawberry tongue Scarlet fever, Kawasaki disease,
TSS
98. Rusty sputum Strep pneumo
99. Current jelly stool Intussesseption
100. Streak ovaries, Turner syndrome (X0, short
congenital heart stature, webbed neck,
disease, horseshoe lymphedema)
kidney
101. Sudden swollen/painful Gout/podagra (hyperuricemia)
big toe joint, tophi
102. Swollen gums, mucous Scurvy (vit C deficiency: can't
bleeding, poor wound hydroxylate proline/lysine for
healing, spots on skin collagen synthesis)
103. Swollen, hard, painful OA (osteophytes on PIP
finger joints (Bouchard) and DIP (Heberden)
104. Systolic ejection Aortic valve stenosis
murmur (crescendo-
decrescendo)
105. Thyroid (medullary) and MEN 2A (Sipple)
parathyroid tumors,
pheochromocytoma
106. Toe extension / fanning Babinski (UMN lesion)
upon plantar scrape
107. Unilateral facial Bell's palsy (LMN CN VII)
drooping involving
forehead
108. Urethritis, conjunctivitis, Reiter's syndrome (reactive
arthritis in a male arthritis associated with HLA B27)
109. Vascular birthmark Hemangioma (benign, associated
(port-wine stain) with Sturge-Weber syndrome, in
which case it's V1 distribution)
110. Vasculitis from exposure Shwartzman reaction (follows
to endotoxin casuing second exposure to endotoxin)
glomerular thrombosis
111. Vomiting blood Mallory-Weiss syndrome
following (alcoholic and bulimic patients)
esophagogastric
lacerations
112. Waxy casts with very Chronic ESRD
low urine flow
113. WBC casts in urine Acute pyelo
114. Weight loss, diarrhea, Whipple's disease (Tropheryma
arthritis, fever, whippelii)
adenopathy
115. Worst headache of my USMLE Step 1 (or subarachnoid
life hemorrhage)
116. Anticentromere Scleroderma (CREST)
antibodies
117. Antidesmoglein (epithelial) Pemphigus vulgaris 134. Bronchogenic apical Pancoast tumor (can cause
antibodies (blistering) lung tumor Horner's)
118. AntiGBM antibodies Goodpasture's 135. Brown tumor of bone Hemorrhage (hemosiderin) causes
syndome brown color of osteolytic cysts.
(glomerulonephritis and Due to hyperparathyroidism or
hemoptysis) osteitis fibrosa cystica
119. Antihistone antibodies Drug-induced SLE 136. Cardiomegaly with Chagas disease (Trypanosoma
(hydralazine, isoniazid, apical atrophy cruzi)
phenytoin,
137. Cellular crescents in Rapidly progressive crescentic
procainamide)
Bowman's capsule glomerulonephritis
120. Anti-IgG antibodies RA (systemic
138. Chocolate cyst of ovary Endometriosis (usually bilateral)
inflammation, joint
pannus, boutonniere 139. Circular grouping of Homer Wright rosettes (adrenal
deformity) - IgM anti dark tumor cells neuroblastoma, medulloblastoma,
IgG surrounding pale Ewing's sarcoma)
neurofibrils
121. Antimitochondrial antibodies 1* biliary cirrhosis
(female, cholestasis, 140. Colonies of mucoid CF
portal HTN) Pseudomonas in lungs

122. Antineutrophil cytoplasmic Vasculitis (c-ANCA = 141. Degeneration of dorsal Tabes dorsalis - lose
antibodies (ANCA) Wegener's, p-ANCA = column nerves proprioception (3* syphilis)
microscopic polyangiitis 142. Depigmentation of Parkinson's
or Churg-Strauss neurons in substantia
syndrome) nigra
123. Antinuclear antibodies SLE (type III 143. Desquamated Curschmann's spirals (bronchial
hypersensitivity) epithelium casts in asthma, can result in whorled
124. Antiplatelet antibodies Idiopathic sputum mucous plugs)
thrombocytopenic 144. Disarrayed granulosa Call-Exner bodies (granulosa-
purpura (ITP - bleeding cells in eosinophilic theca cell tumor of the ovary)
diathesis) fluid
125. Anti-topoisomerase antibodies Diffuse systemic 145. Dysplastic squamous Koilocytes (HPV) "perrinuclear
scleroderma cervical cells with cytoplasmic clearing"
126. Anti- Celiac (diarrhea, nuclear enlargement
transglutaminase/antigliadin/anti- distention, weight loss) and hyperchromasia
endomysial antibodies 146. Enlarged cells with Owl's eye appearance of CMV -
127. Azurophilic granular needles in Auer rods (AML, esp intranuclear inclusion Cowdry A bodies
leukemic blasts promyelocytic type) bodies

128. Bamboo spine on X-ray Ankylosing spondylitis 147. Enlarged thyroid cells Orphan Annie nuclei, or
(chronic inflammatory with ground-glass "disbursed chromatin" (papillary
arthritis, HLA B27) nuclei carcinoma of the thyroid)

129. Basophilic nuclear remnants in Howell-Jolly bodies 148. Eosinophilic Mallory bodies (alcoholic liver
RBCs (due to splenectomy or cytoplasmic inclusion in disease)
nonfunctional spleen) liver cell

130. Basophilic stipplling of RBCs Lead poisoning or 149. Eosinophilic Lewy body (Parkinson's)
sideroblastic anemia cytoplasmic inclusion in
nerve cell
131. Bloody tap on LP Subarachnoid
hemorrhage 150. Eosinophilic globule in Councilman body (toxic or viral
liver hepatitis, often yellow fever)
132. Boot-shaped heart on X-ray Tetralogy of Fallot, RVH
151. Eosinophilic inclusion Rabies virus - negri bodies
133. Branching gram + rods with sulfur Actinomyces israelii
bodies in cytoplasm of (Lyssavirus)
granules
hippocampal nerve
cells
152. Extracellular amyloid Senile plaques (Alzheimer's) 169. Large lysosomal Chediak-Higashi disease
deposition in gray matter vesicles in (congenital failure of
of brain phagocytes, phagolysosome formation)
immunodeficiency
153. Giant B cells with bilobed Reed-Sternberg cells
nuclei with prominent (Hodgkin's lymphoma) 170. Low serum Wilson's disease (hepatolenticular
inclusions (Owl's eye) ceruloplasmin degeneration)
154. Glomerulus-like structure Schiller-Duval bodies (yolk 171. Lumpy-bumpy Poststrep glomerulonephritis (IgG
surrounding vessel in germ sac tumor) appearance of and C3b deposition)
cells glomeruli on
immunofluorescence
155. Hair-on-end (crewcut) "b-thalassemia, sickle cell
appearance on X-ray anemia (extramedullary 172. Lytic (punched-out) Multiple myeloma
hematopoiesis). ""Hair on bone lesions on X-ray
end"" means marrow
173. Mammary gland Fibrocystic change of the breast
expansion (skull)
(blue-domed) cyst
156. hCG elevated Choriocarcinoma,
174. Monoclonal antibody 1. Multiple myeloma (M protein, IgG
hydatidiform mole
spike or IgA) 2. Monoclonal gammopathy
157. Heart nodules Aschoff bodies = focal of undetermined significance
(inflammatory) myocardial inflammation with (aging) 3. Waldenstrom's
giant cells (rheumatic fever) macroglobulinemia (IgM) 4. Primary
amyloidosis
158. Heterophile antibodies Infectious mono (HBV). IgM
that agglutinates sheep RBCs 175. Monoclonal globulin 1. Bence Jones proteins (multiple
protein in blood/urine myeloma, kappa or lambda light
159. Hexagonal, double- Bronchial asthma (Charcot-
chains in urine) 2. Waldenstrom's
pointed, needle-like Leyden crystals: eosinophilic
macroglobulinemia (IgM)
crystals in bronchial granules)
secretions 176. Mucin-filled cell with Signet ring (gastric carcinoma)
peripheral nucleus
160. High level of D dimers DVT, PE, DIC, Budd-Chiari (D
dimer is fibrin breakdown 177. Narrowing of bowel String sign (Crohn's)
products) lumen on barium
radiograph
161. Hilar lymphadenopathy, Ghon complex (1* TB)
peripheral granulomatous 178. Needle-shaped, Gout
lesion in middle or lower negatively
lung lobes (can calcify) birefringent crystals
162. Honeycomb lung on X-ray Interstitial fibrosis 179. Nodular hyaline Kimmelstiel-Wilson nodules
deposits in glomeruli (diabetic)
163. Hypersegmented Megaloblastic anemia (B12,
neutrophils folate deficiency) 180. Nutmeg liver Chronic passive congestion of the
liver due to right heart failure
164. Hypochromic, microcytic Iron deficiency anemia, lead
anemia poisoning, thalassemia (HbF 181. Onion-skin periosteal Ewing's sarcoma (malignant round
sometimes present) reaction cell tumor)
165. Increased a-fetoprotein in Anencephaly, spina bifida 182. Periosteum raised Codman's triangle on X-ray
amniotic fluid / maternal (neural tube defects), from bone, creating (osteosarcoma, Ewing's, pyogenic
serum gastrocesis, omphalmocele triangular area osteomyelitis)
166. Increased uric acid levels Gout, Lesch-Nyhan syndrome, 183. Podocyte fusion on Minimal change disease (child,
tumor lysis syndrome, loop EM nephrotic)
and thiazide diuretics
184. Polished, ivory-like Eburnation (OA resulting in bony
167. Intranuclear eosinophilic Cowdry type A bodies (HSV appearance of bone sclerosis)
droplet-like bodies or CMV) at cartilage erosion
168. Iron-containing nodules in Ferruginous bodies 185. Protein aggregates in Neurofibrillary tangles (Alzheimer's
alveolar septum (asbestosis: risk of neurons from and CJD)
mesothelioma) hyperphosphorylation
of tau protein
186. Pseudopalisading tumor cells GBM (cells may be called 208. liver cysts (parasite) Echinococcus
on brain biopsy "serpentine") granulosus
187. RBC casts in urine Acute glomerulonephritis 209. B12 deficiency (parasite) Diphyllobothrium latum
188. Rectangular, crystal-like, Reinke crystals (Leydig 210. biliary tract disease, Clonorchis sinensis
cytoplasmic inclusions in cell tumor) cholangiocarcinoma (parasite)
Leydig cells
211. hemoptysis (parasite) Paragonimus
189. Renal epithelial casts in urine Acute toxic/viral westermani
nephrosis
212. portal hypertension (parasite) Schistosoma mansoni
190. Rhomboid crystals, positively Pseudogout
213. hematuria, bladder cancer Schistosoma
birefringent
(parasite) haematobium
191. Rib notching Coarctation of the aorta
214. microcytic anemia (parasite) Ancylostoma, Necator
192. Sheets of medium-sized Burkitt's lymphoma (t(8:14) (hook worms)
lymphoid cells (starry sky) c-myc, EBV)
215. perianal pruritis (parasite) Enterobius
193. Silver-staining spherical Pick bodies
aggregation of tau proteins in
neurons
194. Soap bubble in femur or tibia Giant cell tumor of bone
on X-ray (generally benign)
195. Spikes on basement Membranous
membrane, dome-like glomerulonephritis (may
endothelial deposits progress to nephrotic)
196. Stacks of RBCs Rouleax formation (high
ESR, multiple myeloma)
197. Stippled vaginal epithelial Clue cells (Gardenella
cells vaginalis)
198. Tennis racket shaped Bibeck granules
cytoplasmic organelles (EM) in (histiocytosis X:
Langerhans cells eosinophilic granuloma)
199. Thrombi made of white/red Lines of Zahn (arterial
layers thrombus, layers of
platelets/RBCs)
200. Thumb sign on lateral X-ray Epiglossitis (H flu)
201. Thyroid-like appearance of Chronic bacterial pyelo
kidney
202. Tram-track on LM Membranoproliferative
glomerulonephritis
203. Triglyceride accumulation in Fatty liver disease
liver cell vacuoles (alcoholic or metabolic
syndrome)
204. WBCs that look smudged CLL (almost always B cell,
affects the elderly)
205. Wire loop glomerular SLE nephropathy
appearance on LM
206. Yellow CSF Xanthochromia
(subarachnoid
hemorrhage)
207. brain cysts, seizures (parasite) Taenia solium
(cysticercosis)