USMLE Step 1 Exam 2022/2023 with complete solutions

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Anticentromere antibodies - ANSWER Scleroderma (CREST) Antidesmoglein (epithelial) antibodies - ANSWER Pemphigus vulgaris (blistering) Anti-glomerular basement membrane antibodies - ANSWER Goodp... asture's syndrome (glomerulonehpritis and hemoptysis) Antihistone antibodies - ANSWER Drug-induced SLE (hydralazine, isoniazid, phenytoin, procainamide) Anti-IgG antibodies - ANSWER Rheumatoid arthritis (systemic inflammation, joint pannus, boutonniere deformity) Antimitochondrial antibodies (AMAs) - ANSWER Primary biliary cirrhosis (female, cholestasis, portal hypertension) Antineutrophil cytoplasmic antibodies (ANCAs) - ANSWER Vasculitis (c-ANCA: Wegener's; p-ANCA: microscopic polyangiitis, Churg-Strauss syndrome) Antinuclear antibodies (ANAs: anti-Smith and anti-dsDNA) - ANSWER SLE (type III hypersensitivity) Antiplatelet antibodies - ANSWER Idiopathic thrombocytopenic purpura (ITP) Anti-topoisomerase antibodies - ANSWER Diffuse systemic scleroderma Anti-transglutamniase/anti-gliadin/anti-endomysial antibodies - ANSWER Celiac disease (diarrhea, distension, weight loss) "Apple core" lesion on abdominal x-ray - ANSWER Colorectal cancer (usually left-sided) Azurophilic granular needles in leukemic blasts - ANSWER Auer rods (acute myelogenous leukemia, especially the promyelocytic [M3] type) Bacitracin response - ANSWER Sensitive: Streptocococcus pyogenes (group A) Resistant: Streptococcus agalactiae (group B) "Bamboo spine" on x-ray - ANSWER Ankylosing spondylitis (chronic inflammatory arthritis: HLA-B27) Basophilic nuclear remnants in RBCs - ANSWER Howell-Jolly bodies (due to splenectomy or nonfunctional spleen) Basophilic stippling of RBCs - ANSWER Lead poisoning or sideroblastic anemia Bloddy tap on LP - ANSWER Subarachnoid hemorrhage "Boot-shaped" heart on x-ray - ANSWER Tetralogy of Fallot, RVH Branching gram-positive rods with sulfur granules - ANSWER Actinomyces israelii Bronchogenic apical lung tumor - ANSWER Pancoast tumor (can compress sympathetic ganglion and cause Horner's syndrome) "Brown" tumor of bone - ANSWER Hemorrhage (hemosiderin) causes brown color of osteolytic cysts. Due to: 1. Hyperparathyroidism 2. Osteitis fibrosa cystica Cardiomegaly with apical atrophy - ANSWER Chagas' disease (Trypanosoma cruzi) Cellular crescents in Bowman's capsule - ANSWER Rapidly progressive crescentic glomerulonephritis "Chocolate cyst" of ovary - ANSWER Endometriosis (frequently involves both ovaries) Circular grouping of dark tumor cells surrounding pale neurofibrils - ANSWER Homer Wright rosettes (neuroblastoma, medulloblastoma, retinoblastoma) Colonies of mucoid Pseudomonas in lungs - ANSWER Cystic fibrosis (AR mutation to CFTR resulting in fat-soluble vitamin deficiency and mucous plugs) Decreased alpha-fetoprotein in amniotic fluid/maternal serum - ANSWER Down syndrome or other chromosomal abnormality Degeneration of dorsal column nerves - ANSWER Tabes dorsalis (tertiary syphilis) Depigmentation of neurons in substantia nigra - ANSWER Parkinson's disease (basal ganglia disorder: rigidity, resting, tremor, bradykinesia) Desquamated epithelium casts in sputum - ANSWER Curschmann's spirals (bronchial asthma; can result in whorled mucous plugs) Disarrayed granulosa cells in eosinophilic fluid - ANSWER Call-Exner bodies (granulosa-theca cell tumor of the ovary) Dysplastic squamous cervical cells with nuclear enlargment and hyperchromasia - ANSWER Koilocytes (HPV: predisposes to cervical cancer) Enlarged cells with intranuclear inclusion bodies - ANSWER "Owl's eye" appearance of CMV Enlarged thyroid cells with ground-glass nuclei - ANSWER "Orphan Annie" eye nuclei (papillary carcinoma of the thyroid) Eosinophilic cytoplasmic inclusion in liver cell - ANSWER Mallory bodies (alcoholic liver disease) Eosinophilic cytoplasmic inclusion in nerve cell - ANSWER Lewy body (Parkinson's disease) Eosinophilic inclusion bodies in cytoplasm of hippocampal nerve cells - ANSWER Rabies virus (Lyssavirus) Extracellular amyloid deposition in gray matter of brain - ANSWER Senile plaques (Alzhemier's disease) Giant B cells with bilobed nuclei with prominent inclusions ("owl's eye") - ANSWER Reed-Sternberg cells (Hodgkin's lymphoma) Glomerulus-like structure surrounding vessel in germ cells - ANSWER Schiller-Duval bodies (yolk sac tumor) "Hair-on-end" (crew cut) appearance on x-ray - ANSWER Beta-thalassemia, sickle cell anemia (marrow expansion) hCG elevated - ANSWER Choriocarcinoma, hydatidiform mole (occurs with and without embryo) Heart nodules (granulomatous) - ANSWER Aschoff bodies (rheumatic fever) Heterophile antibodies - ANSWER Infectious mononucleosis (EBV) Hexagonal, double-pointed, needle-like crystals in bronchial secretions - ANSWER Bronchial asthma (Charcot-Leyden crystals: eosinophilic granules) High level of D-dimers - ANSWER DVT, pulmonary embolism, DIC Hilar lymphadenopathy, peripheral granulomatous lesion in middle or lower lung lobes (can calcify) - ANSWER Ghon complex (primary TB: Mycobacterium bacilli) "Honeycomb lung" on x-ray - ANSWER Interstitial fibrosis Hypersegmented neutrophils - ANSWER Megaloblastic anemia (B12 deficiency: neurologic symptoms; folate deficiency: no neurologic symptoms) Hypochromic microcytic anemia - ANSWER Iron deficiency anemia, lead poisoning, thalassemia (HbF sometimes present) Increased alpha-fetoprotein in amniotic fluid/maternal serum - ANSWER Dating error, anencephaly, spina bifida (neural tube defects) Increased uric acid levels - ANSWER Gout, Lesch-Nyhan syndrome, tumor lysis syndrome, loop and thiazide diuretics Intranuclear eosinophilic droplet-like bodies - ANSWER Cowdry type A bodies (HSV or CMV) Iron-containing nodules in alveolar septum - ANSWER Ferruginous bodies (asbestosis: increased chance of mesothelioma) Large lysosomal vesicles in phagocytes, immunodeficiency - ANSWER Chediak-Higashi disease (congenital failure of phagolysosome formation) "Lead pipe" appearance of colon on x-ray - ANSWER Ulcerative colitis (loss of haustra) Linear appearance of glomeruli on immunofluorescence - ANSWER Goodpasture's syndrome Low serum ceruloplasmin - ANSWER Wilson's disease (hepatolenticular degeneration) "Lumpy-bumpy" appearance of glomeruli on immunofluorescence - ANSWER Poststerptococcal glomerulonephritis (immune complex deposition of IgG and C3b) Lytic ("hole-punched") bone lesions on x-ray - ANSWER Multiple myeloma Mammary gland ("blue-domed") cyst - ANSWER Fibrocystic change of the breast Monoclonal antibody spike - ANSWER 1. Multiple myeloma (called the M protein; usually IgG or IgA) 2. Monoclonal gammopathy of undetermined significance (MGUS); normal consequence of aging) 3. Waldenstrom's (M protein = IgM) macroglobulinemia 4. Primary amyloidosis Monoclonal globulin protein in blood/urine - ANSWER Bence Jones proteins (multiple myeloma [kappa or lambda Ig light chains in urine]), Waldenstrom's macroglobinemia (IgM) Mucin-filled cell with peripheral nucleus - ANSWER Signet ring (gastric carcinoma) Narrowing of bowel lumen on barium radiograph - ANSWER "String sign" (Crohn's disease) Needle-shaped, negatively birefringent crysytals - ANSWER Gout (monosodium urate crystals) Nodular hyaline depostis in glomeruli - ANSWER Kimmelstiel-Wilson nodules (diabetic nephropathy) Novobiocin response - ANSWER Sensitive: Staphylococcus epidermidis Resistant: Staphylococcus saprophyticus "Nutmeg" appearance of liver - ANSWER Chronic passive congestion of liver due to right heart failure "Onion-skin" periosteal reaction - ANSWER Ewing's sarcoma (malignant round-cell tumor) Optochin response - ANSWER Sensitive: Streptococcus pneumoniae Resistant: Viridans streptococcus Periosteum raised from bone, creating triangular area - ANSWER Codman's triangle on x-ray (osteosarcoma, Ewing's sarcoma, pyogenic osteomyelitis) Podocyte fusion of EM - ANSWER Minimal change disease (child with nephrotic syndrome) Polished, "ivory-like" appearance of bone at cartilage erosion - ANSWER Eburnation(osteoarthritis resulting in bony sclerosis) Protein aggregates in neurons from hyperphosphorylation of protein tau - ANSWER Neurofibrillary tangles (Alzheimer's disease and Creuzfeldt Jakob disease) Pseudopalisading tumor cells on brain biopsy - ANSWER Glioblastoma multiforme RBC casts in urine - ANSWER Acute glomerulonephritis Rectangular, crystal-like, cytoplasmic inclusions in Leydig cells - ANSWER Reinke crystals (Leydig cell tumor) Renal epithelial casts in urine - ANSWER Acute toxic/viral nephrosis Rhomboid crystals, positively birefringent - ANSWER Pseudogout (calcium pyrophosphate dihydrate) Rib notching - ANSWER Coarctation of the aorta Ring-enhancing brain lesions in AIDS - ANSWER Toxoplasma gondii Sheets of medium-sized lymphoid cells ("starry sky" appearance on histology) - ANSWER Burkitt's lymphoma (t[8:14] c-myc activation, associated with EBV; "black sky" made up of malignant cells) Silver-staining spherical aggregation of tau proteins in neurons - ANSWER Pick bodies (Pick's disease: progressive dementia, changes in personality) "Soap bubble" in femur or tibia on x-ray - ANSWER Giant cell tumor of bone (generally benign) "Spikes" on basement membrane, "dome-like" subepithelial deposits - ANSWER Membranous glomerulonephritis (may progress to nephrotic syndrome) Stacks of red blood cells - ANSWER Rouleaux formation (high ESR, multiple myeloma) Stippled vaginal epithelial cells - ANSWER "Clue cells" (Gardnerella vaginalis) "Tennis-racket"-shaped cytoplasmic organelles (EM) in Langerhans cells - ANSWER Birbeck granules (histiocytosis X: eosinophilic granuloma) [Show More]

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