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USMLE Step 1 Prep 2

Subjects : health-sciences, usmle-step-1

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. GBM (cells may be called 'serpentine')
Azurophilic granular needles in leukemic blasts
Brown tumor of bone
Pseudopalisading tumor cells on brain biopsy
Bounding pulses - diastolic hear murmur - head bobbing

2. Koilocytes (HPV) 'perrinuclear cytoplasmic clearing'
Soap bubble in femur or tibia on X- ray
Mucosal bleeding and prolonged bleeding time
Branching gram + rods with sulfur granules
Dysplastic squamous cervical cells with nuclear enlargement and hyperchromasia

3. Ewing's sarcoma (malignant round cell tumor)
liver cysts (parasite)
Chronic exercise intolerance with myalgia - fatigue - painful cramps
hemoptysis (parasite)
Onion - skin periosteal reaction

4. 'b - thalassemia - sickle cell anemia (extramedullary hematopoiesis). ''Hair on end'' means marrow expansion (skull)
No lactation postpartum - absent menstruation - cold intolerance
Swollen - hard - painful finger joints
Abdominal pain - ascites - hepatomegaly - (also high D dimer - CHF without JVD)
Hair - on - end (crewcut) appearance on X- ray

5. 1. Multiple myeloma (M protein - IgG or IgA) 2. Monoclonal gammopathy of undetermined significance (aging) 3. Waldenstrom's macroglobulinemia (IgM) 4. Primary amyloidosis
Monoclonal antibody spike
Continuous machinery heart murmur
Needle - shaped - negatively birefringent crystals
Branching gram + rods with sulfur granules

6. Eburnation (OA resulting in bony sclerosis)
Polished - ivory- like appearance of bone at cartilage erosion
Hereditary nephritis - sensorineural hearing loss - cataracts
Nodular hyaline deposits in glomeruli
Arachnodactyly - lens dislocation - aortic dissection - hyperflexible joints

7. 1* biliary cirrhosis (female - cholestasis - portal HTN)
Antimitochondrial antibodies
Rapidly progressive leg weakness that ascend - following GI infection
Circular grouping of dark tumor cells surrounding pale neurofibrils
Restrictive cardiomyopathy (juvenile = cardiomegaly) - exercise intolerance

8. Choriocarcinoma - hydatidiform mole
No lactation postpartum - absent menstruation - cold intolerance
hCG elevated
Weight loss - diarrhea - arthritis - fever - adenopathy
Fever - cough - conjunctivitis - coryza - diffuse rash - Koplick spots

9. USMLE Step 1 (or subarachnoid hemorrhage)
Heart nodules (inflammatory)
Worst headache of my life
Disarrayed granulosa cells in eosinophilic fluid
Infant with failure to thrive - hepatosplenomegaly - neurodegeneration

10. Job's syndrome
Recurrent colds - unusual eczema - high serum IgE
Extracellular amyloid deposition in gray matter of brain
Anticentromere antibodies
Periosteum raised from bone - creating triangular area

11. Osteogenesis imperfecta
Blue sclera
Athlete with polycythemia
Hamartomatous GI polyps - hyperpigmentation of mouth - feet and hands
Intranuclear eosinophilic droplet - like bodies

12. Signet ring (gastric carcinoma)
Waxy casts with very low urine flow
Lumpy- bumpy appearance of glomeruli on immunofluorescence
Mucin - filled cell with peripheral nucleus
Chronic exercise intolerance with myalgia - fatigue - painful cramps

13. MEN 2A (Sipple)
Thyroid (medullary) and parathyroid tumors - pheochromocytoma
Small - irregular red spots on buccal mucosa with blue - white centers
Large lysosomal vesicles in phagocytes - immunodeficiency
Caf

14. Giant cell tumor of bone (generally benign)
Mucosal bleeding and prolonged bleeding time
Soap bubble in femur or tibia on X- ray
Skin hyperpigmentation
Glomerulus - like structure surrounding vessel in germ cells

15. Wilson's disease (hepatolenticular degeneration)
Mucin - filled cell with peripheral nucleus
Enlarged cells with intranuclear inclusion bodies
Low serum ceruloplasmin
Chest pain - pericardial effusion/friction rub - persistent fever following MI

16. Curschmann's spirals (bronchial asthma - can result in whorled mucous plugs)
Desquamated epithelium casts in sputum
Eosinophilic globule in liver
Skin hyperpigmentation
Adrenal hemorrhage - hypotension - DIC

17. CF
Polyuria - acidosis - growth failure - electrolyte imbalances
Bounding pulses - diastolic hear murmur - head bobbing
Colonies of mucoid Pseudomonas in lungs
Increased uric acid levels

18. Chronic ESRD
hematuria - bladder cancer (parasite)
Waxy casts with very low urine flow
portal hypertension (parasite)
Polyuria - acidosis - growth failure - electrolyte imbalances

19. Waterhouse - Friderichsen syndrome (meningococcemia)
portal hypertension (parasite)
Needle - shaped - negatively birefringent crystals
Single palm crease
Adrenal hemorrhage - hypotension - DIC

20. Glanzmann's thrombasthenia (defect in platelet aggregation due to lack of GpIIb/IIIa)
Rash on palms and soles
Single palm crease
Dermatitis - dementia - diarrhea
Mucosal bleeding and prolonged bleeding time

21. Rouleax formation (high ESR - multiple myeloma)
Dilated cardiomyopathy - edema - polyneuropathy
Caf
Athlete with polycythemia
Stacks of RBCs

22. Clue cells (Gardenella vaginalis)
Rash on palms and soles
Child with fever develops red rash on face that spreads to body
Stippled vaginal epithelial cells
Bronchogenic apical lung tumor

23. Bell's palsy (LMN CN VII)
Unilateral facial drooping involving forehead
Hexagonal - double - pointed - needle - like crystals in bronchial secretions
Vascular birthmark (port - wine stain)
Branching gram + rods with sulfur granules

24. Drug - induced SLE (hydralazine - isoniazid - phenytoin - procainamide)
Hereditary nephritis - sensorineural hearing loss - cataracts
Tennis racket shaped cytoplasmic organelles (EM) in Langerhans cells
Antihistone antibodies
Giant B cells with bilobed nuclei with prominent inclusions (Owl's eye)

25. Squamous cell carcinoma
Keratin pearls
Low serum ceruloplasmin
Jaundice - RUQ pain - fever
Antidesmoglein (epithelial) antibodies

26. Paget's disease of the breast
Red - itchy - swollen rash of nipple/areola
Periosteum raised from bone - creating triangular area
Iron - containing nodules in alveolar septum
Thumb sign on lateral X- ray

27. MEN 1 (Wermer's)
Protein aggregates in neurons from hyperphosphorylation of tau protein
Nystagmus - intention tremor - scanning speech - also bilateral internuclear ophthalmoplegia
Dry eyes - dry mouth - arthritis
Pancreatic - pituitary - parathyroid tumors

28. Minimal change disease (child - nephrotic)
Renal cell carcinoma - hemangioblastomas - angiomatosis - pheochromocytoma
Podocyte fusion on EM
Intranuclear eosinophilic droplet - like bodies
Bounding pulses - diastolic hear murmur - head bobbing

29. Jarisch - Herxheimer reaction (lysis of spirochetes results in toxin release)
Green -yellow rings around peripheral iris
Depigmentation of neurons in substantia nigra
Fever - chills - headache - myalgia following antibiotic treatment for syphillis
Antihistone antibodies

30. Roth's spots (bacterial endocarditis)
Child with fever develops red rash on face that spreads to body
Dermatitis - dementia - diarrhea
Small - irregular red spots on buccal mucosa with blue - white centers
Retinal hemorrhages with pale centers

31. Charcot's triad (ascending cholangitis)
Child uses arms to stand up from squat
Anticentromere antibodies
Jaundice - RUQ pain - fever
Extracellular amyloid deposition in gray matter of brain

32. Gardner's syndrome
Swollen - hard - painful finger joints
Hypoxemia - polycythemia - hypercapnia
Multiple colon polyps - osteomas / soft tissue tumors - impacted / supernumary teeth
Rusty sputum

33. Schistosoma haematobium
hematuria - bladder cancer (parasite)
Heterophile antibodies
Antihistone antibodies
Rhomboid crystals - positively birefringent

34. Aortic valve stenosis
Systolic ejection murmur (crescendo - decrescendo)
Antihistone antibodies
Deep - labored breathing / hyperventilation
Severe jaundice in neonate

35. Whipple's disease (Tropheryma whippelii)
Calf pseudohypertrophy
perianal pruritis (parasite)
Weight loss - diarrhea - arthritis - fever - adenopathy
Rash on palms and soles

36. Aschoff bodies = focal myocardial inflammation with giant cells (rheumatic fever)
Worst headache of my life
Heart nodules (inflammatory)
Hypersegmented neutrophils
Retinal hemorrhages with pale centers

37. Shwartzman reaction (follows second exposure to endotoxin)
biliary tract disease - cholangiocarcinoma (parasite)
Lucid interval after TBI
Podocyte fusion on EM
Vasculitis from exposure to endotoxin casuing glomerular thrombosis

38. Erythema chronicum migrans from Ixodes tick bite (Lyme)

39. Chediak - Higashi disease (congenital failure of phagolysosome formation)
Branching gram + rods with sulfur granules
Large lysosomal vesicles in phagocytes - immunodeficiency
Anti - topoisomerase antibodies
Dysphagia (esophageal webs) - glossitis (smooth tongue) - iron deficiency anemia

40. DVT - PE - DIC - Budd - Chiari (D dimer is fibrin breakdown products)
Streak ovaries - congenital heart disease - horseshoe kidney
Resting tremor - rigidity - akinesia - postural instability
hemoptysis (parasite)
High level of D dimers

41. Homer Wright rosettes (adrenal neuroblastoma - medulloblastoma - Ewing's sarcoma)
Swollen gums - mucous bleeding - poor wound healing - spots on skin
Circular grouping of dark tumor cells surrounding pale neurofibrils
Indurated - ulcerated genital lesion
Mucin - filled cell with peripheral nucleus

42. Pink puffer (emphysema)
Painful blue fingers / toes - hemolytic anemia
Hexagonal - double - pointed - needle - like crystals in bronchial secretions
Pink complexion - dypnea - hyperventilation
Dark purple skin / mouth nodules

43. McCune - Albright syndome (G protein problem)
Rapidly progressive leg weakness that ascend - following GI infection
Caf
Extracellular amyloid deposition in gray matter of brain
Dog or cat bite resulting in infection

44. Megaloblastic anemia (B12 - folate deficiency)
Rectangular - crystal - like - cytoplasmic inclusions in Leydig cells
WBCs that look smudged
Hypersegmented neutrophils
Fibrous plaques in soft tissue of penis

45. Peutz - Jeghers syndrome
Hamartomatous GI polyps - hyperpigmentation of mouth - feet and hands
Skin hyperpigmentation
Antidesmoglein (epithelial) antibodies
Single palm crease

46. Idiopathic thrombocytopenic purpura (ITP - bleeding diathesis)
Antiplatelet antibodies
Palpable purpura - joint pain - abdominal pain in a child
Narrowing of bowel lumen on barium radiograph
hCG elevated

47. Vasculitis (c - ANCA = Wegener's - p - ANCA = microscopic polyangiitis or Churg - Strauss syndrome)
Fibrous plaques in soft tissue of penis
Slow progressive muscle weakness in boys
Antineutrophil cytoplasmic antibodies (ANCA)
Adrenal hemorrhage - hypotension - DIC

48. Koplick spots (measles)
Small - irregular red spots on buccal mucosa with blue - white centers
Infant with microcephaly - rocker - bottom feet - clenched hands - and structural heart defect
Painless erythematous lesions on palms and soles
Child with fever develops red rash on face that spreads to body

49. 2* syphilis - Rocky Mountain spotted fever - coxsackie A
Rash on palms and soles
Polished - ivory- like appearance of bone at cartilage erosion
Deep - labored breathing / hyperventilation
Dilated cardiomyopathy - edema - polyneuropathy

50. Bibeck granules (histiocytosis X: eosinophilic granuloma)
Child uses arms to stand up from squat
Tennis racket shaped cytoplasmic organelles (EM) in Langerhans cells
Pancreatic - pituitary - parathyroid tumors
Painful - raised red lesions on palms and soles