USMLE Step 1 Rapid Review (New 2026/
2027 Update) Questions & Answers {Grade
A} 100% Correct (Verified Solutions)
Hexagonal, double-pointed, needle-like crystals in bronchial secretions - correct
answer Bronchial asthma (Charcot-Leyden crystals: eosinophilic granules)
High level of D dimers - correct answer DVT, PE, DIC, Budd-Chiari (D dimer is fibrin
breakdown products)
Hilar lymphadenopathy, peripheral granulomatous lesion in middle or lower lung lobes
(can calcify) - correct answer Ghon complex (1* TB)
Honeycomb lung on X-ray - correct answer Interstitial fibrosis
Hypersegmented neutrophils - correct answer Megaloblastic anemia (B12, folate
deficiency)
,Hypochromic, microcytic anemia - correct answer Iron deficiency anemia, lead
poisoning, thalassemia (HbF sometimes present)
Increased a-fetoprotein in amniotic fluid / maternal serum - correct answer
Anencephaly, spina bifida (neural tube defects), gastrocesis, omphalmocele
Increased uric acid levels - correct answer Gout, Lesch-Nyhan syndrome, tumor lysis
syndrome, loop and thiazide diuretics
Intranuclear eosinophilic droplet-like bodies - correct answer Cowdry type A bodies
(HSV or CMV)
Iron-containing nodules in alveolar septum - correct answer Ferruginous bodies
(asbestosis: risk of mesothelioma)
Large lysosomal vesicles in phagocytes, immunodeficiency - correct answer Chediak-
Higashi disease (congenital failure of phagolysosome formation)
,Low serum ceruloplasmin - correct answer Wilson's disease (hepatolenticular
degeneration)
Lumpy-bumpy appearance of glomeruli on immunofluorescence - correct answer
Poststrep glomerulonephritis (IgG and C3b deposition)
Lytic (punched-out) bone lesions on X-ray - correct answer Multiple myeloma
Mammary gland (blue-domed) cyst - correct answer Fibrocystic change of the breast
Monoclonal antibody spike - correct answer 1. Multiple myeloma (M protein, IgG or IgA)
2. Monoclonal gammopathy of undetermined significance (aging) 3. Waldenstrom's
macroglobulinemia (IgM) 4. Primary amyloidosis
Monoclonal globulin protein in blood/urine - correct answer 1. Bence Jones proteins
(multiple myeloma, kappa or lambda light chains in urine) 2. Waldenstrom's
macroglobulinemia (IgM)
, Mucin-filled cell with peripheral nucleus - correct answer Signet ring (gastric
carcinoma)
Narrowing of bowel lumen on barium radiograph - correct answer String sign
(Crohn's)
Needle-shaped, negatively birefringent crystals - correct answer Gout
Nodular hyaline deposits in glomeruli - correct answer Kimmelstiel-Wilson nodules
(diabetic)
Nutmeg liver - correct answer Chronic passive congestion of the liver due to right
heart failure
Onion-skin periosteal reaction - correct answer Ewing's sarcoma (malignant round
cell tumor)
2027 Update) Questions & Answers {Grade
A} 100% Correct (Verified Solutions)
Hexagonal, double-pointed, needle-like crystals in bronchial secretions - correct
answer Bronchial asthma (Charcot-Leyden crystals: eosinophilic granules)
High level of D dimers - correct answer DVT, PE, DIC, Budd-Chiari (D dimer is fibrin
breakdown products)
Hilar lymphadenopathy, peripheral granulomatous lesion in middle or lower lung lobes
(can calcify) - correct answer Ghon complex (1* TB)
Honeycomb lung on X-ray - correct answer Interstitial fibrosis
Hypersegmented neutrophils - correct answer Megaloblastic anemia (B12, folate
deficiency)
,Hypochromic, microcytic anemia - correct answer Iron deficiency anemia, lead
poisoning, thalassemia (HbF sometimes present)
Increased a-fetoprotein in amniotic fluid / maternal serum - correct answer
Anencephaly, spina bifida (neural tube defects), gastrocesis, omphalmocele
Increased uric acid levels - correct answer Gout, Lesch-Nyhan syndrome, tumor lysis
syndrome, loop and thiazide diuretics
Intranuclear eosinophilic droplet-like bodies - correct answer Cowdry type A bodies
(HSV or CMV)
Iron-containing nodules in alveolar septum - correct answer Ferruginous bodies
(asbestosis: risk of mesothelioma)
Large lysosomal vesicles in phagocytes, immunodeficiency - correct answer Chediak-
Higashi disease (congenital failure of phagolysosome formation)
,Low serum ceruloplasmin - correct answer Wilson's disease (hepatolenticular
degeneration)
Lumpy-bumpy appearance of glomeruli on immunofluorescence - correct answer
Poststrep glomerulonephritis (IgG and C3b deposition)
Lytic (punched-out) bone lesions on X-ray - correct answer Multiple myeloma
Mammary gland (blue-domed) cyst - correct answer Fibrocystic change of the breast
Monoclonal antibody spike - correct answer 1. Multiple myeloma (M protein, IgG or IgA)
2. Monoclonal gammopathy of undetermined significance (aging) 3. Waldenstrom's
macroglobulinemia (IgM) 4. Primary amyloidosis
Monoclonal globulin protein in blood/urine - correct answer 1. Bence Jones proteins
(multiple myeloma, kappa or lambda light chains in urine) 2. Waldenstrom's
macroglobulinemia (IgM)
, Mucin-filled cell with peripheral nucleus - correct answer Signet ring (gastric
carcinoma)
Narrowing of bowel lumen on barium radiograph - correct answer String sign
(Crohn's)
Needle-shaped, negatively birefringent crystals - correct answer Gout
Nodular hyaline deposits in glomeruli - correct answer Kimmelstiel-Wilson nodules
(diabetic)
Nutmeg liver - correct answer Chronic passive congestion of the liver due to right
heart failure
Onion-skin periosteal reaction - correct answer Ewing's sarcoma (malignant round
cell tumor)
