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



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



Aschoff Bodies

Rheumatic fever

Auer Rods

Acute promyelocytic leukemia (AML type M3)


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


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


Brushfield Spots


Call-Exner Bodies

Granulosa cell tumor: associated w/ endometrial hyperplasia & carcinoma

Granuloma-Theca cell tumor

Cardiomegaly with Apical Atrophy

Chagas Disease


1° Syphilis


Haemophilus ducreyi

Charcot Triad

Multiple sclerosis = nystagmus, intention tremor, scanning speech

Charcot-Leyden Crystals

Bronchial asthma

Cheyne-Stokes Breathing

Cerebral lesion

Chocolate Cysts


Chvostek's Sign

Hypocalcemia facial spasm in tetany

Clue Cells

Gardnerella vaginitis

Codman's Triangle


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


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


Curschmann's Spirals

Bronchial asthma

Depigmentation Of Substantia Nigra


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


Osteoarthritis (polished, ivory-like appearance of bone)

Ectopia Lentis


Erythema Chronicum Migrans

Lyme Disease

Fatty Liver


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


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


Kimmelstiel-Wilson Nodules

Diabetic nephropathy: Nodular Glomerulosclerosis nodules of mesangial matrix


HPV 6 & 11 (condyloma acuminatum - benign) and HPV 16 & 18 (malignant association)

Koplik Spots


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



Negri Bodies


Neuritic Plaques


Neurofibrillary Tangles


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)


Rheumatoid arthritis, also see morning stiffnes that ↓ w/ joint use, HLA-DR4

Pautrier's Microabscesses

Mycosis fungoides (cutaneous T-cell lymphoma), Sezary

Philadelphia Chromosome


Pick Bodies

Pick's Disease


Gout (MP joint of hallux)

Port-Wine Stain


Posterior Anterior Drawer Sign

Tearing of the ACL

Psammoma Bodies

Papillary adenocarcinoma of the thyroid

Serous papillary cystadenocarcinoma of the ovary




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



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


Tuberous Sclerosis Triad

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


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


Warthin-Finkeldey Giant Cells


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


Due to Pneumocystis carinii; Seen w/ Atelectasia

Signet Ring

Cells that replace the ovaries, due to Krukenberg's tumor that has metastasized from the




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