High yield hallmark findings for USMLE Step 1

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

S No Findings Conditions
1 Pink Puffer Emphysema
2 Blue bloater Bronchitis
3 Centroacinar-smoking, Panacinar - α1-antitrypsin deficiency Emphysema
4 45 Degree Branch Points Aspergillosis
5 Acanthocytes RBSc w/ spiny projections. Seen in Abetalipoproteinemia.
6 Albumino-Cytologic Dissociation Guillain-Barre (markedly increased protein in CSF with only modest increase in cell count)
7 Antiplatelet Antibodies Idiopathic thrombocytopenic purpura
8 Arachnodactyly Marfan's
9 Aschoff Bodies Rheumatic fever
10 Auer Rods Acute promyelocytic leukemia (AML type M3)
11 Autosplenectomy Sickle cell anemia
Low O2 ↑ sickling
Aplastic crisis w/ B19 (Parvovirus ssDNA) infection
Salmonella osteomyelitis
Vaso-occlusive painful crisises
Hydroxyurea as Txt (↑ HbF) & Bone marrow transplant
12 Babinski sign UMN lesion
13 Basophilic Stippling of RBCs Lead poisoning
14 Bence Jones Protein Multiple myeloma free light chains (either kappa or lambda)
Waldenstrom's macroglobinemia
15 Birbeck Granules Histiocytosis X (eosinophilic granuloma)
16 Blue Bloater Chronic Bronchitis (at least 3 months for at least 2 years of ecessive mucus secretion & chronic
17 Boot-Shaped Heart Tetralogy of Fallot
18 Both Sensory & Motor Lesion Brown Sequard; Anterior Spinal artery Occlusion
19 Both UMN & LMN Lesion ALS = Lou Gherig's Disease
20 Bouchards Nodes Osteoarthritis (Proximal IP joint of the fingers)
21 Boutonnieres Deformity Rheumatoid arthritis flex proximal & extend distal IP joints
22 Brown Tumor Hyperparathyroidism
23 Brushfield Spots Down's
24 Call-Exner Bodies Granulosa cell tumor: associated w/ endometrial hyperplasia & carcinoma
Granuloma-Theca cell tumor
25 Cardiomegaly with Apical Atrophy Chagas Disease
26 Chancre 1° Syphilis
27 Chancroid Haemophilus ducreyi
28 Charcot Triad Multiple sclerosis = nystagmus, intention tremor, scanning speech
29 Charcot-Leyden Crystals Bronchial asthma
30 Cheyne-Stokes Breathing Cerebral lesion
31 Chocolate Cysts Endometriosis
32 Chvosteks Sign Hypocalcemia facial spasm in tetany
33 Clue Cells Gardnerella vaginitis
34 Codmans Triangle Osteosarcoma
35 Cold Agglutinins Mycoplasma pneumoniae
Infectious mononucleosis
36 Condyloma Lata 2° Syphilis
37 Congo Red Shows amyloid deposition in plaques & vascular walls
38 Cotton Wool Spots HTN; Aka, cytoid bodies seen w/ SLE (yellowish cotton wool fundal lesions)
39 Councilman Bodies Dying hepatocytes – HepB
40 Cowdry A Inclusions Seen w/ Herpes Simplex Encephalitis – in oligodendroglia
41 Crescents Goodpastures syndrome (pneumonia w/ hemoptysis & rapidly progressive glomerulonephritis)
42 Crescents In Bowmans Capsule Rapidly progressive (crescentic glomerulonephritis)
43 Cuneocerebellar tr. Unconscious proprioception & fine motor movements of upper extremities
44 Currant-Jelly Sputum Klebsiella
45 Curschmanns Spirals Bronchial asthma
46 Depigmentation Of Substantia Nigra Parkinson's
47 Devics Syndrome “Neuromyelitis Optica”;
A variant of multiple sclerosis: rapid demyelination of the optic nerve & spinal cord w/ paraplegia
48 Donovan Bodies Granuloma inguinale (STD)
49 Dorsal Column Conscious proprioception of the body
50 Dorsal Spinocerebellar tr. Unconscious prorpioception & fine motor movements
51 Eburnation Osteoarthritis (polished, ivory-like appearance of bone)
52 Ectopia Lentis Marfan's
53 Erythema Chronicum Migrans Lyme Disease
54 Fatty Liver Alcoholism
55 Ferruginous Bodies Asbestosis - & Iron laden
56 Foster-Kennedy Syndrome A tumor causing blindness & loss of smell w/ papilloedema
57 Ghon Focus / Complex Tuberculosis (1° & 2°, respectively)
58 Glitter Cells Acute Pyelonephritis
59 Gowers Maneuver Duchenne's MD use of arms to stand
60 Ground Glass Appearance (Hyaline) Seen w/ Progressive Multifocal Leukoencephalopathy oligodendrocytes;
Nuclei seen in Papillary CA of the thyroid (malignant)
61 Heberdens Nodes Osteoarthritis (Distal IP joint of the fingers)
62 Heinz Bodies G6PDH Deficiency
63 Heterophil Antibodies Infectious mononucleosis (EBV)
64 Hirano Bodies Alzheimer's
65 Hoffmans Sign Flicking of the middle finger's nail
66 Honey Combing of the lung Seen w/ Asbestosis (a restrictive lung disease)
67 Hypersegmented PMNs Megaloblastic anemia
68 Hypochromic Microcytic RBCs Iron-deficiency anemia or β Thalassemia
69 Jarisch-Herxheimer Reaction Syphilis over-aggressive treatment of an asymptomatic pt. that causes symptoms 2° to rapid lysis
70 Joint Mice Osteoarthritis (fractured osteophytes)
71 Kaussmaul Breathing Acidosis / Diabetic Ketoacidosis
72 Keratin Pearls Squamous Cell CA of skin Actinic Keratosis is a precursor
73 Keyser-Fleischer Ring Wilson's
74 Kimmelstiel-Wilson Nodules Diabetic nephropathy: Nodular Glomerulosclerosis nodules of mesangial matrix
75 Koilocytes HPV 6 & 11 (condyloma acuminatum - benign) and HPV 16 & 18 (malignant association)
76 Koplik Spots Measles
77 LMN Lesion Werndig Hoffman (progressive infantile muscular atrophy); Poliomyelitis
78 Lateral Spinothalamic tr. Pain & Temperature sensation
79 Lewy Bodies Parkinson's (eosinophilic inclusions in damaged substantia nigra cells)
80 Linear Ig Deposits Goodpastures syndrome
81 Lines of Zahn Arterial thrombus
82 Lisch Nodules Neurofibromatosis (von Recklinhausen's disease) = pigmented iris hamartomas
83 Lumpy-Bumpy IF Glomeruli Poststreptococcal glomerulonephritis – prototype of nephritic syndrome
84 Mallory Bodies Alcoholic hepatitis
85 Mamillary Body Can have hemorrhages as seen in Wernicke's Encephalopathy
86 McBurneys Sign Appendicitis (McBurney's Point is 2/3 of the way from the umbilicus to anterior superior iliac spine)
87 Meningiomas & Progesterone Some meningiomas have Progesterone receptors = rapid growth in pregnancy can occur
88 Michealis-Gutmann Bodies Malakoplakia lesion on bladder due to macros & calcospherites (M-G Bodies): usually due to E. Coli
89 Monoclonal Antibody Spike Multiple myeloma this is called the M protein (usually IgG or IgA); MGUS
90 Myxedema Hypothyroidism
91 Negri Bodies Rabies
92 Neuritic Plaques Alzheimer's
93 Neurofibrillary Tangles Alzheimer's
94 Non-pitting Edema  Myxedema; Anthrax Toxin
95 Notching of Ribs Coarctation of Aorta
96 Nutmeg Liver CHF = causing congested liver
97 Owls Eye Cells CMV; Reed Sternburg Cells (Hodkins Lymphoma); Aschoff cells seen w/ Rheumatic Fever
98 PAS(+) Dutcher Bodies Waldenstrom's Macroglobulinemia = ↑IgM = Hyperviscosity
99 Painless Jaundice Pancreatic CA (head)
100 Pannus Rheumatoid arthritis, also see morning stiffnes that ↓ w/ joint use, HLA-DR4
101 Pautriers Microabscesses Mycosis fungoides (cutaneous T-cell lymphoma), Sezary
102 Philadelphia Chromosome CML
103 Pick Bodies Pick's Disease
104 Podagra Gout (MP joint of hallux)
105 Port-Wine Stain Hemangioma
106 Posterior Anterior Drawer Sign Tearing of the ACL
107 Psammoma Bodies Papillary adenocarcinoma of the thyroid
Serous papillary cystadenocarcinoma of the ovary
108 Pseudohypertrophy Seen w/ Duchenne muscular dystrophy @ the claf muscles, due to ↑ fat
109 Punched-Out Bone Lesions Multiple myeloma
110 Rash on Palms & Soles 2° Syphilis; RMSF; Coxsackie virus infection: Hand-Foot-Mouth Disease
111 Red Morning Urine Paroxysmal nocturnal hemoglobinuria. You would use Ham's test to confirm.
112 Red Nucleus Destruction Intention tremors of the arm
113 Reed-Sternberg Cells Hodgkin's Disease
114 Reid Index Increased Chronic bronchitis = ↑d ratio of bronchial gland to bronchial wall thickness
115 Reinke Crystals Leydig cell tumor
116 Rouleaux Formation Multiple myeloma RBC's stacked as poker chips
117 S3 Heart Sound L→R Shunt (VSD, PDA, ASD); Mitral Regurg; LV Failure
118 S4 Heart Sound Pulmonary Stenosis; Pulmonary HTN
119 Schwartzman Reaction Neisseria meningitidis impressive rash with bugs
120 Sensory Pathway Lesion Subacute Combined Degeneration = Friedrich's Ataxia = B12 deficiency; Tabes Dorsalis (Neurosyphilis
121 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
122 Soap Bubble on X-Ray Giant cell tumor of bone
123 Spike & Dome Glomeruli Membranous glomerulonephritis = Nephrotic syndrome
Spike = basement membrane material & Dome = immune complex deposits (IgG orC3)
124 String Sign on X-ray Crohn's bowel wall thickening
125 Suprachiasmatic Nucleus Controls circadian rhythm
126 Target Cells Thalassemia in α Thalassemia w/ no α gene: Hydrops Fetalis & Intrauterine death associations = HbBarts
127 Tendinous Xanthomas Familial Hypercholesterolemia
128 Thyroidization of Kidney Chronic pyelonephritis
129 Tophi Gout
130 Tram-Track Glomeruli Membranoproliferative GN
Nephritic syndrome – basement membrane is duplicated into 2 layers
131 Trousseaus 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.
132 Tuberous Sclerosis Triad Seizures; Mental retardation;
Leukoderma (congenital facial white spots or macules): angiofibromas
133 Ventral Spinocerebellar tr. Unconscious proprioception of lower extremities
134 Ventral Spinothalamic tr. Light touch perception
135 Virchows Node Supraclavicular node enlargement by metastatic carcinoma of the stomach
136 WBC Casts Pyelonephritis
137 Warthin-Finkeldey Giant Cells Measles
138 Whipples Triad CNS disfunction – Hypoglycemic episodes – glu injection reverses CNS Sympt's
139 Wire Loop Glomeruli Lupus nephropathy, type IV (diffuse proliferative form)
140 c-erb B2 Breast Cancer association
141 “Ground Glass” in Abdomen(Hyaline) Seen in the hepatocytes of healthy carriers of HBsAg in liver biopsies
142 “Ground Glass” on chest x-ray

Due to Pneumocystis carinii; Seen w/ Atelectasia
143 “Signet Ring” Cells Cells that replace the ovaries, due to Krukenberg's tumor that has metastasized from the stomach
144 ↑ AFP in amniotic fluid or mothers Spina Bifida; Anencephaly
145 ↑ Uric Acid Gout, Lesch Nyhan, Myeloproliferative Disorders, Diuretics (Loop & Thiazides)


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