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USMLE Step 1 Rapid Review
Abdominal pain, ascites, hepatomegaly, (also high D dimer, CHF without JVD) Budd-Chiari syndrome Achilles tendon xanthoma Familial hypercholesterolemia Adrenal hemorrhage, hypotension, DIC Waterhouse-Friderichsen syndrome (meningococcemia) Arachnodactyly, lens dislocation, aortic dissection, hyperflexible joints Marfan's (fibrillin defect) Athlete with polycythemia Erythropoietin injection Back pain, fever, night sweats, weight loss Pott's (TB to the vertebrae) Bilateral hilar adenopathy, uveitis Sarcoid Blue sclera Osteogenesis imperfecta Bluish line on gingiva Burton's line - lead poisoning Bone pain, bone enlargement, arthritis, (also increased hat size, fracture, increased alk phos) Paget's Bounding pulses, diastolic hear murmur, head bobbing Aortic regurg Café-au-lait spots, Lisch nodules NF (1 = optic glimoas and pheo, 2 = acoustic Schwannomas) Café-au-lait spots, polyostotic fibrous dysplasia, precocious puberty McCune-Albright syndome (G protein problem)
Calf pseudohypertrophy Duchenne's muscular dystrophy Cherry-red spot on macula Tay-Sachs, Niemann-Pick, central retinal artery occlusion Chest pain, pericardial effusion/friction rub, persistent fever following MI Dressler's (autoimmune post-MI) Child uses arms to stand up from squat Gower's sign (Duchenne's) Child with fever develops red rash on face that spreads to body Slapped cheek - B Chorea, dementia, caudate degeneration Huntington's Chronic exercise intolerance with myalgia, fatigue, painful cramps McArdle's (muscle phosphorylase deficiency) Cold intolerance Hypothyroidism Conjugate lateral gaze palsy, horizontal diplopia Internuclear ophthalmoplegia (MS or stroke) Continuous machinery heart murmur PDA Cutaneous/dermal edema due to CT expansion Myxedema Dark purple skin / mouth nodules Kaposi's sarcoma Deep, labored breathing / hyperventilation Kussmaul breathing, DKA Dermatitis, dementia, diarrhea Pellagra (B3 / niacin deficiency)
Green-yellow rings around peripheral iris Kayser-Fleischer rings (copper accumulation from Wilson's disease) Hamartomatous GI polyps, hyperpigmentation of mouth, feet and hands Peutz-Jeghers syndrome Hepatosplenomegaly, osteoporosis, neurologic symptoms, crinkled cytoplasm Gaucher's disease (glucocerebrosidase deficiency) Hereditary nephritis, sensorineural hearing loss, cataracts Alport's syndrome (type IV collagen) Hypercoagulability leading to thrombophlebitis Trousseau's sign (adenocarcinoma of pancreas or lung) Hyperphagia, hypersexuality, hyperorality, hyperdocility Kluver-Bucy syndrome (bilateral amygdala) HTN, hypoK, metabolic alkalosis Conn's (1* hyperaldosterone) Hypoxemia, polycythemia, hypercapnia Blue bloater (chronic bronchitis) Indurated, ulcerated genital lesion Nonpainful = syphillis. Painful with exudate = chancroid Infant with failure to thrive, hepatosplenomegaly, neurodegeneration Niemann-Pick disease (genetic sphingomyelinase deficiency) Infant with hypoglycemia, failure to thrive, and hepatomegaly Cori's disease (debranching enzyme deficiency, no glycogenolysis) or Von Gierke's Infant with microcephaly, rocker-bottom feet, clenched hands, and structural heart defect Edward's syndrome (Trisomy 18) Jaundice, RUQ pain, fever Charcot's triad (ascending cholangitis) Keratin pearls Squamous cell carcinoma
Large rash with bull's eye appearance Erythema chronicum migrans from Ixodes tick bite (Lyme) Lucid interval after TBI Epidural hematoma (middle meningeal artery) Male child, recurrent infections, no mature B cells Bruton's disease (X-linked agammaglobulinemia) Mucosal bleeding and prolonged bleeding time Glanzmann's thrombasthenia (defect in platelet aggregation due to lack of GpIIb/IIIa) Multiple colon polyps, osteomas / soft tissue tumors, impacted / supernumary teeth Gardner's syndrome Necrotizing vasculitis (lungs) and necrotizing GN Wegner's (c-ANCA) and Goodpasture's (anti-GBM). Wegner's can also have upper airway involvement Neonate with arm paralysis following difficult birth. Possible clavicle fx, probably large for gestational age Erb-Duchenne palsy No lactation postpartum, absent menstruation, cold intolerance Sheehan's syndrome Nystagmus, intention tremor, scanning speech, also bilateral internuclear ophthalmoplegia MS (Charcot's) Oscillating slow / fast breathing Cheyne-Stokes (central apnea from CHF or increased ICP) Painful blue fingers / toes, hemolytic anemia Cold agglutinin disease (autoimmune from Mp or mono, from IgM) Painful, pale, cold fingers / toes Raynaud's syndrome (vasospasm) Painful, raised red lesions on palms and soles Osler's node (infective endocarditis) Painless erythematous lesions on palms and soles
von Hippel-Lindau diease Resting tremor, rigidity, akinesia, postural instability Parkinson's Restrictive cardiomyopathy (juvenile = cardiomegaly), exercise intolerance Pompe's disease (lysosomal glucosidase deficiency) Retinal hemorrhages with pale centers Roth's spots (bacterial endocarditis) Severe jaundice in neonate Crigler-Najjar syndrome (congenital unconj hyper bilirubinemia) Severe RLQ pain with rebound tenderness McBurney's sign Short stature, increased incidence of tumors / leukemia, aplastic anemia Fanconi's anemia (esp AML) Single palm crease Simian crease (Down's) Situs inversus, chronic sinusitis, bronchiectasis, infertility Kartagener's syndrome (dynein) Skin hyperpigmentation Addison's Slow progressive muscle weakness in boys Becker's muscular dystrophy Small, irregular red spots on buccal mucosa with blue-white centers Koplick spots (measles) Smooth, flat, moist white lesions on genitals Condylomata lata (2* syphilis) Splinter hemorrhages in fingernails Bacterial endocarditis Strawberry tongue
Scarlet fever, Kawasaki disease, TSS Rusty sputum Strep pneumo Current jelly stool Intussesseption Streak ovaries, congenital heart disease, horseshoe kidney Turner syndrome (X0, short stature, webbed neck, lymphedema) Sudden swollen/painful big toe joint, tophi Gout/podagra (hyperuricemia) Swollen gums, mucous bleeding, poor wound healing, spots on skin Scurvy (vit C deficiency: can't hydroxylate proline/lysine for collagen synthesis) Swollen, hard, painful finger joints OA (osteophytes on PIP (Bouchard) and DIP (Heberden) Systolic ejection murmur (crescendo-decrescendo) Aortic valve stenosis Thyroid (medullary) and parathyroid tumors, pheochromocytoma MEN 2A (Sipple) Toe extension / fanning upon plantar scrape Babinski (UMN lesion) Unilateral facial drooping involving forehead Bell's palsy (LMN CN VII) Urethritis, conjunctivitis, arthritis in a male Reiter's syndrome (reactive arthritis associated with HLA B27) Vascular birthmark (port-wine stain) Hemangioma (benign, associated with Sturge-Weber syndrome, in which case it's V distribution) Vasculitis from exposure to endotoxin casuing glomerular thrombosis Shwartzman reaction (follows second exposure to endotoxin)
Idiopathic thrombocytopenic purpura (ITP - bleeding diathesis) Anti-topoisomerase antibodies Diffuse systemic scleroderma Anti-transglutaminase/antigliadin/anti-endomysial antibodies Celiac (diarrhea, distention, weight loss) Azurophilic granular needles in leukemic blasts Auer rods (AML, esp promyelocytic type) Bamboo spine on X-ray Ankylosing spondylitis (chronic inflammatory arthritis, HLA B27) Basophilic nuclear remnants in RBCs Howell-Jolly bodies (due to splenectomy or nonfunctional spleen) Basophilic stipplling of RBCs Lead poisoning or sideroblastic anemia Bloody tap on LP Subarachnoid hemorrhage Boot-shaped heart on X-ray Tetralogy of Fallot, RVH Branching gram + rods with sulfur granules Actinomyces israelii Bronchogenic apical lung tumor Pancoast tumor (can cause Horner's) Brown tumor of bone Hemorrhage (hemosiderin) causes brown color of osteolytic cysts. Due to hyperparathyroidism or osteitis fibrosa cystica Cardiomegaly with apical atrophy Chagas disease (Trypanosoma cruzi) Cellular crescents in Bowman's capsule Rapidly progressive crescentic glomerulonephritis
Chocolate cyst of ovary Endometriosis (usually bilateral) Circular grouping of dark tumor cells surrounding pale neurofibrils Homer Wright rosettes (adrenal neuroblastoma, medulloblastoma, Ewing's sarcoma) Colonies of mucoid Pseudomonas in lungs CF Degeneration of dorsal column nerves Tabes dorsalis - lose proprioception (3* syphilis) Depigmentation of neurons in substantia nigra Parkinson's Desquamated epithelium casts in sputum Curschmann's spirals (bronchial asthma, can result in whorled mucous plugs) Disarrayed granulosa cells in eosinophilic fluid Call-Exner bodies (granulosa-theca cell tumor of the ovary) Dysplastic squamous cervical cells with nuclear enlargement and hyperchromasia Koilocytes (HPV) "perrinuclear cytoplasmic clearing" Enlarged cells with intranuclear inclusion bodies Owl's eye appearance of CMV - Cowdry A bodies Enlarged thyroid cells with ground-glass nuclei Orphan Annie nuclei, or "disbursed chromatin" (papillary carcinoma of the thyroid) Eosinophilic cytoplasmic inclusion in liver cell Mallory bodies (alcoholic liver disease) Eosinophilic cytoplasmic inclusion in nerve cell Lewy body (Parkinson's) Eosinophilic globule in liver Councilman body (toxic or viral hepatitis, often yellow fever) Eosinophilic inclusion bodies in cytoplasm of hippocampal nerve cells Rabies virus - negri bodies (Lyssavirus)
Anencephaly, spina bifida (neural tube defects), gastrocesis, omphalmocele Increased uric acid levels Gout, Lesch-Nyhan syndrome, tumor lysis syndrome, loop and thiazide diuretics Intranuclear eosinophilic droplet-like bodies Cowdry type A bodies (HSV or CMV) Iron-containing nodules in alveolar septum Ferruginous bodies (asbestosis: risk of mesothelioma) Large lysosomal vesicles in phagocytes, immunodeficiency Chediak-Higashi disease (congenital failure of phagolysosome formation) Low serum ceruloplasmin Wilson's disease (hepatolenticular degeneration) Lumpy-bumpy appearance of glomeruli on immunofluorescence Poststrep glomerulonephritis (IgG and C3b deposition) Lytic (punched-out) bone lesions on X-ray Multiple myeloma Mammary gland (blue-domed) cyst Fibrocystic change of the breast Monoclonal antibody spike
- Multiple myeloma (M protein, IgG or IgA) 2. Monoclonal gammopathy of undetermined significance (aging) 3. Waldenstrom's macroglobulinemia (IgM) 4. Primary amyloidosis Monoclonal globulin protein in blood/urine
- Bence Jones proteins (multiple myeloma, kappa or lambda light chains in urine) 2. Waldenstrom's macroglobulinemia (IgM) Mucin-filled cell with peripheral nucleus Signet ring (gastric carcinoma) Narrowing of bowel lumen on barium radiograph String sign (Crohn's) Needle-shaped, negatively birefringent crystals Gout
Nodular hyaline deposits in glomeruli Kimmelstiel-Wilson nodules (diabetic) Nutmeg liver Chronic passive congestion of the liver due to right heart failure Onion-skin periosteal reaction Ewing's sarcoma (malignant round cell tumor) Periosteum raised from bone, creating triangular area Codman's triangle on X-ray (osteosarcoma, Ewing's, pyogenic osteomyelitis) Podocyte fusion on EM Minimal change disease (child, nephrotic) Polished, ivory-like appearance of bone at cartilage erosion Eburnation (OA resulting in bony sclerosis) Protein aggregates in neurons from hyperphosphorylation of tau protein Neurofibrillary tangles (Alzheimer's and CJD) Pseudopalisading tumor cells on brain biopsy GBM (cells may be called "serpentine") RBC casts in urine Acute glomerulonephritis Rectangular, crystal-like, cytoplasmic inclusions in Leydig cells Reinke crystals (Leydig cell tumor) Renal epithelial casts in urine Acute toxic/viral nephrosis Rhomboid crystals, positively birefringent Pseudogout Rib notching Coarctation of the aorta Sheets of medium-sized lymphoid cells (starry sky) Burkitt's lymphoma (t(8:14) c-myc, EBV)
brain cysts, seizures (parasite) Taenia solium (cysticercosis) liver cysts (parasite) Echinococcus granulosus B12 deficiency (parasite) Diphyllobothrium latum biliary tract disease, cholangiocarcinoma (parasite) Clonorchis sinensis hemoptysis (parasite) Paragonimus westermani portal hypertension (parasite) Schistosoma mansoni hematuria, bladder cancer (parasite) Schistosoma haematobium microcytic anemia (parasite) Ancylostoma, Necator (hook worms) perianal pruritis (parasite) Enterobius
