Pathology USMLE step 1 LATEST
EXAM QUESTIONS WITH CORRECT
ANSWERS
Hypochromic microcytic anemia - ANSWER ✔ Iron deficiency
anemia, lead poisoning, thalassemia (HbF sometimes present)
Increased alpha-fetoprotein in amniotic fluid/maternal serum -
ANSWER ✔ Dating error, anencephaly, spina bifida (neural tube
defects)
Increased uric acid levels - ANSWER ✔ Gout, Lesch-Nyhan
syndrome, tumor lysis syndrome, loop and thiazide diuretics
Intranuclear eosinophilic droplet-like bodies - ANSWER ✔
Cowdry type A bodies (HSV or CMV)
Iron-containing nodules in alveolar septum - ANSWER ✔
Ferruginous bodies (asbestosis: increased chance of
mesothelioma)
Large lysosomal vesicles in phagocytes, immunodeficiency -
ANSWER ✔ Chediak-Higashi disease (congenital failure of
phagolysosome formation)
"Lead pipe" appearance of colon on x-ray - ANSWER ✔
Ulcerative colitis (loss of haustra)
,Linear appearance of glomeruli on immunofluorescence -
ANSWER ✔ Goodpasture's syndrome
Low serum ceruloplasmin - ANSWER ✔ Wilson's disease
(hepatolenticular degeneration)
"Lumpy-bumpy" appearance of glomeruli on immunofluorescence
- ANSWER ✔ Poststerptococcal glomerulonephritis (immune
complex deposition of IgG and C3b)
Lytic ("hole-punched") bone lesions on x-ray - ANSWER ✔
Multiple myeloma
Mammary gland ("blue-domed") cyst - ANSWER ✔ Fibrocystic
change of the breast
Monoclonal antibody spike - ANSWER ✔ 1. Multiple myeloma
(called the M protein; usually IgG or IgA)
2. Monoclonal gammopathy of undetermined significance
(MGUS); normal consequence of aging)
3. Waldenstrom's (M protein = IgM) macroglobulinemia
4. Primary amyloidosis
Monoclonal globulin protein in blood/urine - ANSWER ✔ Bence
Jones proteins (multiple myeloma [kappa or lambda Ig light
chains in urine]), Waldenstrom's macroglobinemia (IgM)
Mucin-filled cell with peripheral nucleus - ANSWER ✔ Signet ring
(gastric carcinoma)
Narrowing of bowel lumen on barium radiograph - ANSWER ✔
"String sign" (Crohn's disease)
,Needle-shaped, negatively birefringent crysytals - ANSWER ✔
Gout (monosodium urate crystals)
Nodular hyaline depostis in glomeruli - ANSWER ✔ Kimmelstiel-
Wilson nodules (diabetic nephropathy)
Novobiocin response - ANSWER ✔ Sensitive: Staphylococcus
epidermidis
Resistant: Staphylococcus saprophyticus
"Nutmeg" appearance of liver - ANSWER ✔ Chronic passive
congestion of liver due to right heart failure
"Onion-skin" periosteal reaction - ANSWER ✔ Ewing's sarcoma
(malignant round-cell tumor)
Optochin response - ANSWER ✔ Sensitive: Streptococcus
pneumoniae
Resistant: Viridans streptococcus
Periosteum raised from bone, creating triangular area - ANSWER
✔ Codman's triangle on x-ray (osteosarcoma, Ewing's sarcoma,
pyogenic osteomyelitis)
Podocyte fusion of EM - ANSWER ✔ Minimal change disease
(child with nephrotic syndrome)
Polished, "ivory-like" appearance of bone at cartilage erosion -
ANSWER ✔ Eburnation(osteoarthritis resulting in bony sclerosis)
Protein aggregates in neurons from hyperphosphorylation of
protein tau - ANSWER ✔ Neurofibrillary tangles (Alzheimer's
disease and Creuzfeldt Jakob disease)
, Pseudopalisading tumor cells on brain biopsy - ANSWER ✔
Glioblastoma multiforme
RBC casts in urine - ANSWER ✔ Acute glomerulonephritis
Rectangular, crystal-like, cytoplasmic inclusions in Leydig cells -
ANSWER ✔ Reinke crystals (Leydig cell tumor)
Renal epithelial casts in urine - ANSWER ✔ Acute toxic/viral
nephrosis
Rhomboid crystals, positively birefringent - ANSWER ✔
Pseudogout (calcium pyrophosphate dihydrate)
Rib notching - ANSWER ✔ Coarctation of the aorta
Ring-enhancing brain lesions in AIDS - ANSWER ✔ Toxoplasma
gondii
Sheets of medium-sized lymphoid cells ("starry sky" appearance
on histology) - ANSWER ✔ Burkitt's lymphoma (t[8:14] c-myc
activation, associated with EBV; "black sky" made up of malignant
cells)
Silver-staining spherical aggregation of tau proteins in neurons -
ANSWER ✔ Pick bodies (Pick's disease: progressive dementia,
changes in personality)
"Soap bubble" in femur or tibia on x-ray - ANSWER ✔ Giant cell
tumor of bone (generally benign)
EXAM QUESTIONS WITH CORRECT
ANSWERS
Hypochromic microcytic anemia - ANSWER ✔ Iron deficiency
anemia, lead poisoning, thalassemia (HbF sometimes present)
Increased alpha-fetoprotein in amniotic fluid/maternal serum -
ANSWER ✔ Dating error, anencephaly, spina bifida (neural tube
defects)
Increased uric acid levels - ANSWER ✔ Gout, Lesch-Nyhan
syndrome, tumor lysis syndrome, loop and thiazide diuretics
Intranuclear eosinophilic droplet-like bodies - ANSWER ✔
Cowdry type A bodies (HSV or CMV)
Iron-containing nodules in alveolar septum - ANSWER ✔
Ferruginous bodies (asbestosis: increased chance of
mesothelioma)
Large lysosomal vesicles in phagocytes, immunodeficiency -
ANSWER ✔ Chediak-Higashi disease (congenital failure of
phagolysosome formation)
"Lead pipe" appearance of colon on x-ray - ANSWER ✔
Ulcerative colitis (loss of haustra)
,Linear appearance of glomeruli on immunofluorescence -
ANSWER ✔ Goodpasture's syndrome
Low serum ceruloplasmin - ANSWER ✔ Wilson's disease
(hepatolenticular degeneration)
"Lumpy-bumpy" appearance of glomeruli on immunofluorescence
- ANSWER ✔ Poststerptococcal glomerulonephritis (immune
complex deposition of IgG and C3b)
Lytic ("hole-punched") bone lesions on x-ray - ANSWER ✔
Multiple myeloma
Mammary gland ("blue-domed") cyst - ANSWER ✔ Fibrocystic
change of the breast
Monoclonal antibody spike - ANSWER ✔ 1. Multiple myeloma
(called the M protein; usually IgG or IgA)
2. Monoclonal gammopathy of undetermined significance
(MGUS); normal consequence of aging)
3. Waldenstrom's (M protein = IgM) macroglobulinemia
4. Primary amyloidosis
Monoclonal globulin protein in blood/urine - ANSWER ✔ Bence
Jones proteins (multiple myeloma [kappa or lambda Ig light
chains in urine]), Waldenstrom's macroglobinemia (IgM)
Mucin-filled cell with peripheral nucleus - ANSWER ✔ Signet ring
(gastric carcinoma)
Narrowing of bowel lumen on barium radiograph - ANSWER ✔
"String sign" (Crohn's disease)
,Needle-shaped, negatively birefringent crysytals - ANSWER ✔
Gout (monosodium urate crystals)
Nodular hyaline depostis in glomeruli - ANSWER ✔ Kimmelstiel-
Wilson nodules (diabetic nephropathy)
Novobiocin response - ANSWER ✔ Sensitive: Staphylococcus
epidermidis
Resistant: Staphylococcus saprophyticus
"Nutmeg" appearance of liver - ANSWER ✔ Chronic passive
congestion of liver due to right heart failure
"Onion-skin" periosteal reaction - ANSWER ✔ Ewing's sarcoma
(malignant round-cell tumor)
Optochin response - ANSWER ✔ Sensitive: Streptococcus
pneumoniae
Resistant: Viridans streptococcus
Periosteum raised from bone, creating triangular area - ANSWER
✔ Codman's triangle on x-ray (osteosarcoma, Ewing's sarcoma,
pyogenic osteomyelitis)
Podocyte fusion of EM - ANSWER ✔ Minimal change disease
(child with nephrotic syndrome)
Polished, "ivory-like" appearance of bone at cartilage erosion -
ANSWER ✔ Eburnation(osteoarthritis resulting in bony sclerosis)
Protein aggregates in neurons from hyperphosphorylation of
protein tau - ANSWER ✔ Neurofibrillary tangles (Alzheimer's
disease and Creuzfeldt Jakob disease)
, Pseudopalisading tumor cells on brain biopsy - ANSWER ✔
Glioblastoma multiforme
RBC casts in urine - ANSWER ✔ Acute glomerulonephritis
Rectangular, crystal-like, cytoplasmic inclusions in Leydig cells -
ANSWER ✔ Reinke crystals (Leydig cell tumor)
Renal epithelial casts in urine - ANSWER ✔ Acute toxic/viral
nephrosis
Rhomboid crystals, positively birefringent - ANSWER ✔
Pseudogout (calcium pyrophosphate dihydrate)
Rib notching - ANSWER ✔ Coarctation of the aorta
Ring-enhancing brain lesions in AIDS - ANSWER ✔ Toxoplasma
gondii
Sheets of medium-sized lymphoid cells ("starry sky" appearance
on histology) - ANSWER ✔ Burkitt's lymphoma (t[8:14] c-myc
activation, associated with EBV; "black sky" made up of malignant
cells)
Silver-staining spherical aggregation of tau proteins in neurons -
ANSWER ✔ Pick bodies (Pick's disease: progressive dementia,
changes in personality)
"Soap bubble" in femur or tibia on x-ray - ANSWER ✔ Giant cell
tumor of bone (generally benign)
