High yield hallmark findings for USMLE Step 1

Collection of 100+ important findings that are high yield for a medical student. This is important for USMLE Step 1 or other equivalent exams.

2 types of COPD Pink Puffer  è Type A: Emphysema

Blue Bloater è Type B: Bronchitis

Emphysema- Centroacinar-smoking; Panacinar – α1-antitrypsin deficiency

45 Degree Branch Points Aspergillosis
Acanthocytes RBSc w/ spiny projections. Seen in Abetalipoproteinemia.
Albumino-Cytologic Dissociation Guillain-Barre (markedly increased protein in CSF with only modest increase in cell count)
Antiplatelet Antibodies Idiopathic thrombocytopenic purpura
Arachnodactyly Marfan’s
Aschoff Bodies Rheumatic fever
Auer Rods Acute promyelocytic leukemia (AML type M3)
Autosplenectomy Sickle cell anemia: switch a glu ! val in β chain

Low O2 ↑ sickling

Aplastic crisis w/ B19 (Parvovirus ssDNA) infection

Salmonella osteomyelitis

Vaso-occlusive painful crisises

Hydroxyurea as Txt (↑ HbF) & Bone marrow transplant

Babinski UMN lesion
Basophilic Stippling of RBCs Lead poisoning
Bence Jones Protein Multiple myeloma free light chains (either kappa or lambda)

Waldenstrom’s macroglobinemia

Birbeck Granules Histiocytosis X (eosinophilic granuloma)
Blue Bloater Chronic Bronchitis (at least 3 months for at least 2 years of ecessive mucus secretion & chronic
Boot-Shaped Heart Tetralogy of Fallot
Both Sensory & Motor Lesion Brown Sequard; Anterior Spinal artery Occlusion
Both UMN & LMN Lesion ALS = Lou Gherig’s Disease
Bouchard’s Nodes Osteoarthritis (Proximal IP joint of the fingers)
Boutonniere’s Deformity Rheumatoid arthritis flex proximal & extend distal IP joints
Brown Tumor Hyperparathyroidism
Brushfield Spots Down’s
Call-Exner Bodies Granulosa cell tumor: associated w/ endometrial hyperplasia & carcinoma

Granuloma-Theca cell tumor

Cardiomegaly with Apical Atrophy Chagas Disease
Chancre 1° Syphilis
Chancroid Haemophilus ducreyi
Charcot Triad Multiple sclerosis = nystagmus, intention tremor, scanning speech
Charcot-Leyden Crystals Bronchial asthma
Cheyne-Stokes Breathing Cerebral lesion
Chocolate Cysts Endometriosis
Chvostek’s Sign Hypocalcemia facial spasm in tetany
Clue Cells Gardnerella vaginitis
Codman’s Triangle Osteosarcoma
Cold Agglutinins Mycoplasma pneumoniae

Infectious mononucleosis

Condyloma Lata 2° Syphilis
Congo Red Shows amyloid deposition in plaques & vascular walls
Cotton Wool Spots HTN; Aka, cytoid bodies seen w/ SLE (yellowish cotton wool fundal lesions)
Councilman Bodies Dying hepatocytes – HepB
Cowdry A Inclusions Seen w/ Herpes Simplex Encephalitis – in oligodendroglia
Crescents Goodpastures syndrome (pneumonia w/ hemoptysis & rapidly progressive glomerulonephritis)
Crescents In Bowman’s Capsule Rapidly progressive (crescentic glomerulonephritis)
Cuneocerebellar tr. Unconscious proprioception & fine motor movements of upper extremities
Currant-Jelly Sputum Klebsiella
Curschmann’s Spirals Bronchial asthma
Depigmentation Of Substantia Nigra Parkinson’s
Devic’s Syndrome “Neuromyelitis Optica”; A variant of multiple sclerosis: rapid demyelination of the optic nerve & spinal cord w/ paraplegia
Donovan Bodies Granuloma inguinale (STD)
Dorsal Column Conscious proprioception of the body
Dorsal Spinocerebellar tr. Unconscious prorpioception & fine motor movements
Eburnation Osteoarthritis (polished, ivory-like appearance of bone)
Ectopia Lentis Marfan’s
Erythema Chronicum Migrans Lyme Disease
Fatty Liver Alcoholism
Ferruginous Bodies Asbestosis – & Iron laden
Foster-Kennedy Syndrome A tumor causing blindness & loss of smell w/ papilloedema
Ghon Focus / Complex Tuberculosis (1° & 2°, respectively)
Glitter Cells Acute Pyelonephritis
Gower’s Maneuver Duchenne’s MD use of arms to stand
Ground Glass Appearance (Hyaline) Seen w/ Progressive Multifocal Leukoencephalopathy oligodendrocytes; Nuclei seen in Papillary CA of the thyroid (malignant)
Heberden’s Nodes Osteoarthritis (Distal IP joint of the fingers)
Heinz Bodies G6PDH Deficiency
Heterophil Antibodies Infectious mononucleosis (EBV)
Hirano Bodies Alzheimer’s
Hoffman’s Sign Flicking of the middle finger’s nail
Honey Combing of the lung Seen w/ Asbestosis (a restrictive lung disease)
Hypersegmented PMNs Megaloblastic anemia
Hypochromic Microcytic RBCs Iron-deficiency anemia or β Thalassemia
Jarisch-Herxheimer Reaction Syphilis over-aggressive treatment of an asymptomatic pt. that causes symptoms 2° to rapid lysis
Joint Mice Osteoarthritis (fractured osteophytes)
Kaussmaul Breathing Acidosis / Diabetic Ketoacidosis
Keratin Pearls Squamous Cell CA of skin Actinic Keratosis is a precursor
Keyser-Fleischer Ring Wilson’s
Kimmelstiel-Wilson Nodules Diabetic nephropathy: Nodular Glomerulosclerosis nodules of mesangial matrix
Koilocytes HPV 6 & 11 (condyloma acuminatum – benign) and HPV 16 & 18 (malignant association)
Koplik Spots Measles
LMN Lesion Werndig Hoffman (progressive infantile muscular atrophy); Poliomyelitis
Lateral Spinothalamic tr. Pain & Temperature sensation
Lewy Bodies Parkinson’s (eosinophilic inclusions in damaged substantia nigra cells)
Linear Ig Deposits Goodpastures syndrome
Lines of Zahn Arterial thrombus
Lisch Nodules Neurofibromatosis (von Recklinhausen’s disease) = pigmented iris hamartomas
Lumpy-Bumpy IF Glomeruli Poststreptococcal glomerulonephritis – prototype of nephritic syndrome
Mallory Bodies Alcoholic hepatitis
Mamillary Body Can have hemorrhages as seen in Wernicke’s Encephalopathy
McBurney’s Sign Appendicitis (McBurney’s Point is 2/3 of the way from the umbilicus to anterior superior iliac spine)
Meningiomas & Progesterone Some meningiomas have Progesterone receptors = rapid growth in pregnancy can occur
Michealis-Gutmann Bodies Malakoplakia lesion on bladder due to macros & calcospherites (M-G Bodies): usually due to E. Coli
Monoclonal Antibody Spike Multiple myeloma this is called the M protein (usually IgG or IgA); MGUS
Myxedema Hypothyroidism
Negri Bodies Rabies
Neuritic Plaques Alzheimer’s
Neurofibrillary Tangles Alzheimer’s
Non-pitting Edema Myxedema; Anthrax Toxin
Notching of Ribs Coarctation of Aorta
Nutmeg Liver CHF = causing congested liver
Owls Eye Cells CMV; Reed Sternburg Cells (Hodkins Lymphoma); Aschoff cells seen w/ Rheumatic Fever
PAS(+) Dutcher Bodies Waldenstrom’s Macroglobulinemia = ↑IgM = Hyperviscosity
Painless Jaundice Pancreatic CA (head)
Pannus Rheumatoid arthritis, also see morning stiffnes that ↓ w/ joint use, HLA-DR4
Pautrier’s Microabscesses Mycosis fungoides (cutaneous T-cell lymphoma), Sezary
Philadelphia Chromosome CML
Pick Bodies Pick’s Disease
Podagra Gout (MP joint of hallux)
Port-Wine Stain Hemangioma
Posterior Anterior Drawer Sign Tearing of the ACL
Psammoma Bodies Papillary adenocarcinoma of the thyroid

Serous papillary cystadenocarcinoma of the ovary

Meningioma

Mesothelioma

Pseudohypertrophy Seen w/ Duchenne muscular dystrophy @ the claf muscles, due to ↑ fat
Punched-Out Bone Lesions Multiple myeloma
Rash on Palms & Soles 2° Syphilis; RMSF; Coxsackie virus infection: Hand-Foot-Mouth Disease
Red Morning Urine Paroxysmal nocturnal hemoglobinuria. You would use Ham’s test to confirm.
Red Nucleus Destruction Intention tremors of the arm
Reed-Sternberg Cells Hodgkin’s Disease
Reid Index Increased Chronic bronchitis = ↑d ratio of bronchial gland to bronchial wall thickness
Reinke Crystals Leydig cell tumor
Rouleaux Formation Multiple myeloma RBC’s stacked as poker chips
S3 Heart Sound L→R Shunt (VSD, PDA, ASD); Mitral Regurg; LV Failure
S4 Heart Sound Pulmonary Stenosis; Pulmonary HTN
Schwartzman Reaction Neisseria meningitidis impressive rash with bugs
Sensory Pathway Lesion Subacute Combined Degeneration = Friedrich’s Ataxia = B12 deficiency; Tabes Dorsalis (Neurosyphilis
Smith Antigen SLE (also anti-dsDNA); Malar Rash, Wire loop kidney lesions, Joint pain, False (+) syphilis test (VDRL); 90% 14-45 yo females; also seen w/ use of INH; Procainamide; Hydralazine = SLE-like syndrome
Soap Bubble on X-Ray Giant cell tumor of bone
Spike & Dome Glomeruli Membranous glomerulonephritis = Nephrotic syndrome

Spike = basement membrane material & Dome = immune complex deposits (IgG orC3)

String Sign on X-ray Crohn’s bowel wall thickening
Suprachiasmatic Nucleus Controls circadian rhythm
Target Cells Thalassemia in α Thalassemia w/ no α gene: Hydrops Fetalis & Intrauterine death associations = HbBarts
Tendinous Xanthomas Familial Hypercholesterolemia
Thyroidization of Kidney Chronic pyelonephritis
Tophi Gout
Tram-Track Glomeruli Membranoproliferative GN: Nephritic syndrome – basement membrane is duplicated into 2 layers
Trousseau’s Sign Visceral ca, classically pancreatic (migratory thrombophlebitis);  Hypocalcemia (carpal spasm); These are two entirely different disease processes and different signs, but they unfortunately have the same

name.

Tuberous Sclerosis Triad Seizures; Mental retardation; Leukoderma (congenital facial white spots or macules):

angiofibromas

Ventral Spinocerebellar tr. Unconscious proprioception of lower extremities
Ventral Spinothalamic tr. Light touch perception
Virchow’s Node Supraclavicular node enlargement by metastatic carcinoma of the stomach
WBC Casts Pyelonephritis
Warthin-Finkeldey Giant Cells Measles
Whipple’s Triad CNS disfunction  Hypoglycemic episodes

 glu injection reverses CNS Sympt’s

Wire Loop Glomeruli Lupus nephropathy, type IV (diffuse proliferative form)
c-erb B2 Breast Cancer association
Ground Glass in Abdomen(Hyaline) Seen in the hepatocytes of healthy carriers of HBsAg in liver biopsies
Ground Glass on chest x-ray

(Hyaline)

Due to Pneumocystis carinii; Seen w/ Atelectasia
Signet Ring Cells that replace the ovaries, due to Krukenberg’s tumor that has metastasized from the

stomach

 


Keywords: 

hallmark findings, high yield findings, pathology, pathoma, must know for medical students, usmle review, usmle preparations, usmle high yield topics


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High yield hallmark findings for USMLE Step 1
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