Unlocking Your Success: A Comprehensive Guide to
Mastering Step 1 with USMLE-RX
A Comprehensive Exam Study Guide 100% Certified by
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Latest Updated Guide 2025/2026.
Granulocyte: time to mature in bone marrow? - ans6-10 days
Granulocyte: time spent in circulation? - ans6-10 hours
Granulocyte: time spent in peripheral tissues? - ans1-4 days
Erythrocyte (RBC): time spent in circulation?L-12 - ans110-120 days
Platelet (thrombocyte): time spent in circulation? - ans8-10 days
Platelet (thrombocyte): derived from - ansMegakaryocytes
Monocyte: time spent in circulation? - ans1-3 days
Chronic Granulomatous Disease (CGD): defect? - ansDefect of NADPH Oxidase
Thus are unable to produce a robust respiratory burst in neutrophils
Ferritin: function? - ansbinds free iron and stores it intracellularly
TIBC & Ferritin: how do they correlate? - ansTIBC & Ferritin will be opposite
If Ferritin is LOW then TIBC will be HIGH (Ferritin is low if Iron is low because Ferritin
can't bind iron if it is low)
Iron deficiency Anemia: lab values? - ansLow MCV
Low Iron
Low Ferritin
High TIBC
Hypochromasia (central pallor)
Pregnancy: anemia often associated with? - ansIron Deficiency Anemia
Iron Deficiency Anemia: symptoms? - ans-fatigue
-conjunctival pallor
-Pica
-spoon nails (koilonychia)
koilonychia aka?
2. Diagnosis - ansspoon nails
2. Iron Deficiency Anemia
Iron Deficiency Anemia
Esophageal Webs
Dysphagia - ansPlummer-Vinson Syndrome
Breast mass biopsy: proliferation of intralobular stroma distorting the associated epithelium?
1. Diagnosis? - ans1. Fibroadenoma
(proliferation of intralobular stroma)
BENIGN BREAST TUMOR
Fibroadenoma: characteristics? - ans-small
-mobile
-sharp edges
-DOES NOT METASTASIZE TO LYMPH NODES
Multiple Myeloma: calcium level? - ansHYPERCALCEMIA
,Unlocking Your Success: A Comprehensive Guide to
Mastering Step 1 with USMLE-RX
A Comprehensive Exam Study Guide 100% Certified by
Expert.
Latest Updated Guide 2025/2026.
MM is a tumor arising from, it causes BONE LESIONS, WHICH CAUSE
HYPERCALCEMIA.
Single-file stacking of RBCs - ansMultiple Myeloma
Stacked RBCs (Rouleaux formation)
Multiple Myeloma: what is seen on blood smear? - ansStacked RBCs (Rouleaux formation)
72 yo man with chronic cough comes into clinic with sharp pain in his ribs that started after
he had an episode of severe coughing. He has also been feeling very fatigued lately and has
lost 10 lbs in the past 3 months. Physician orders a chest x-ray which reveals a rib fracture.
Suspicious, the physician then orders a bone marrow biopsy. Results are shown (see image)
1. Diagnosis
2. Calcium Levels
3. characteristic cell?
4. What would be seen on a blood smear? - ans1. Multiple Myeloma
2. Hypercalcemia
3. Plasma Cell
4. Stacked RBCs (Rouleaux formation)
MM must be on the differential in an ELDERLY PATIENT WITH PATHOLOGIC
FRACTURES.
MM is a bone marrow neoplasm, specifically the plasma cell. Recognized by their off-center
nuclei and clock-face chromatin distribution.
MM is a tumor arising from, it causes BONE LESIONS, WHICH CAUSE
HYPERCALCEMIA.
Karyotyping of suspicious cells reveals a t(9;22) translocation?
1. Diagnosis?
2. Treatment
3. Treatment: MOA? - ansChronic Myelogenous Leukemia (CML)
2. Imatinib
3. Imatinib targets this Tyrosine Kinase to treat the disease and achieves a high remission
rate.
t(9;22) translocation: name for this?
2. gene that results?
3. what does this gene encode?
,Unlocking Your Success: A Comprehensive Guide to
Mastering Step 1 with USMLE-RX
A Comprehensive Exam Study Guide 100% Certified by
Expert.
Latest Updated Guide 2025/2026.
4. Treatment & MOA?
5. Diagnosis? - ansPhiladelphia Chromosome
2. bcr-abl -> Fusion protein
3. Tyrosine Kinase (Bcr-Abl protein) that is constitutively active)
4. Imatinib targets this Tyrosine Kinase to treat the disease and achieves a high remission
rate.
5. Chronic Myelogenous Leukemia (CML)
Acute Myelogenous Leukemia: treatment? - ansDaunorubicin
&
Cytarabine
Chronic Lymphocytic leukemia: treatment? - ansFludarabine
&
Rituximab
Smudge Cells: Diagnosis? - ansChronic Lymphocytic Leukemia (CLL)
THESE ARE FRAGILE B-LYMPHOCYTES THAT FALL APART ON SLIDE
PREPARATION.
One way to distinguish from Chronic Myelogenous Leukemia (CML)
Chronic Myelogenous Leukemia (CML) VS Chronic Lymphocytic Leukemia (CLL): KEY
DIFFERENCES! - ansCLL & CML present with symptoms that mimic each other; insidious
onset (weakness, anorexia, lethargy, & fever). Both patients typically have ANEMIA,
LEUKOCYTOSIS, THROMBOCYTOPENIA.
CML
-Philadelphila Chromosome t[9;22]
-granulocytosis
CLL
-smudge cells (fragile B-LYPHOCYTES)
-Lymphocytosis
Li-Fraumeni Syndrome (Cancer Syndrome): cancers associated with? -
ansOSTEOSARCOMAS
Soft tissue sarcomas
BREAST CANCERS (early-onset)
ADRENOCORTICAL Tumors
Leukemias
Li-Fraumeni Syndrome (Cancer Syndrome): mutation - ansp53 tumor suppressor gene
Li-Fraumeni Syndrome (Cancer Syndrome): inheritance? - ansAutosomal Dominant
scenario will show multiple family members (brother, sister)
, Unlocking Your Success: A Comprehensive Guide to
Mastering Step 1 with USMLE-RX
A Comprehensive Exam Study Guide 100% Certified by
Expert.
Latest Updated Guide 2025/2026.
Gardner Syndrome (Cancer Syndrome): cancers associated with? - ansColorectal Cancer
Osseos Tumors
Soft tissue tumors
Gardner Syndrome (Cancer Syndrome): mutation? - ansAPC gene on Chromosome 5
Family with Osteosarcoma, Breast Cancer, and Adrenocortical Caner?
1. Syndrome?
2. Mutation? - ans1. Li-Fraumeni Syndrome
2. p53 (TP53)
Auer Rod
1. Diagnosis?
2. Treatment?
3. treatment: moa? - ansAcute Promyelocytic Leukemia (APL)
2. All-trans retinoic acid (Vitamin A)
3. rapidly induces tumor cell differentiation
Auer Rod
1. Diagnosis?
2. Treatment?
3. treatment: moa? - ansLess distinct Auer Rod (may be subtle and single)
1. Acute Promyelocytic Leukemia (APL)
2. All-trans retinoic acid (Vitamin A)
3. rapidly induces differentiation of promyelocytes
A 60 yo hispanic woman complains of vaginal bleeding. There also is bleeding from the
gums, and bruises are found over her legs. inspection of a peripheral blood smear reveals
very few platelets and large WBCs with azurophilic granular needles in the cytoplasm.
1. Diagnosis
2. Common presentation that is occurring in this case? - ans1. Acute Promyelocytic
Leukemia (APL)
2. Acute Disseminated Intravascular Coagulation (DIC) is a common presentation.
azurophilic granular needles in the cytoplasm?
Mastering Step 1 with USMLE-RX
A Comprehensive Exam Study Guide 100% Certified by
Expert.
Latest Updated Guide 2025/2026.
Granulocyte: time to mature in bone marrow? - ans6-10 days
Granulocyte: time spent in circulation? - ans6-10 hours
Granulocyte: time spent in peripheral tissues? - ans1-4 days
Erythrocyte (RBC): time spent in circulation?L-12 - ans110-120 days
Platelet (thrombocyte): time spent in circulation? - ans8-10 days
Platelet (thrombocyte): derived from - ansMegakaryocytes
Monocyte: time spent in circulation? - ans1-3 days
Chronic Granulomatous Disease (CGD): defect? - ansDefect of NADPH Oxidase
Thus are unable to produce a robust respiratory burst in neutrophils
Ferritin: function? - ansbinds free iron and stores it intracellularly
TIBC & Ferritin: how do they correlate? - ansTIBC & Ferritin will be opposite
If Ferritin is LOW then TIBC will be HIGH (Ferritin is low if Iron is low because Ferritin
can't bind iron if it is low)
Iron deficiency Anemia: lab values? - ansLow MCV
Low Iron
Low Ferritin
High TIBC
Hypochromasia (central pallor)
Pregnancy: anemia often associated with? - ansIron Deficiency Anemia
Iron Deficiency Anemia: symptoms? - ans-fatigue
-conjunctival pallor
-Pica
-spoon nails (koilonychia)
koilonychia aka?
2. Diagnosis - ansspoon nails
2. Iron Deficiency Anemia
Iron Deficiency Anemia
Esophageal Webs
Dysphagia - ansPlummer-Vinson Syndrome
Breast mass biopsy: proliferation of intralobular stroma distorting the associated epithelium?
1. Diagnosis? - ans1. Fibroadenoma
(proliferation of intralobular stroma)
BENIGN BREAST TUMOR
Fibroadenoma: characteristics? - ans-small
-mobile
-sharp edges
-DOES NOT METASTASIZE TO LYMPH NODES
Multiple Myeloma: calcium level? - ansHYPERCALCEMIA
,Unlocking Your Success: A Comprehensive Guide to
Mastering Step 1 with USMLE-RX
A Comprehensive Exam Study Guide 100% Certified by
Expert.
Latest Updated Guide 2025/2026.
MM is a tumor arising from, it causes BONE LESIONS, WHICH CAUSE
HYPERCALCEMIA.
Single-file stacking of RBCs - ansMultiple Myeloma
Stacked RBCs (Rouleaux formation)
Multiple Myeloma: what is seen on blood smear? - ansStacked RBCs (Rouleaux formation)
72 yo man with chronic cough comes into clinic with sharp pain in his ribs that started after
he had an episode of severe coughing. He has also been feeling very fatigued lately and has
lost 10 lbs in the past 3 months. Physician orders a chest x-ray which reveals a rib fracture.
Suspicious, the physician then orders a bone marrow biopsy. Results are shown (see image)
1. Diagnosis
2. Calcium Levels
3. characteristic cell?
4. What would be seen on a blood smear? - ans1. Multiple Myeloma
2. Hypercalcemia
3. Plasma Cell
4. Stacked RBCs (Rouleaux formation)
MM must be on the differential in an ELDERLY PATIENT WITH PATHOLOGIC
FRACTURES.
MM is a bone marrow neoplasm, specifically the plasma cell. Recognized by their off-center
nuclei and clock-face chromatin distribution.
MM is a tumor arising from, it causes BONE LESIONS, WHICH CAUSE
HYPERCALCEMIA.
Karyotyping of suspicious cells reveals a t(9;22) translocation?
1. Diagnosis?
2. Treatment
3. Treatment: MOA? - ansChronic Myelogenous Leukemia (CML)
2. Imatinib
3. Imatinib targets this Tyrosine Kinase to treat the disease and achieves a high remission
rate.
t(9;22) translocation: name for this?
2. gene that results?
3. what does this gene encode?
,Unlocking Your Success: A Comprehensive Guide to
Mastering Step 1 with USMLE-RX
A Comprehensive Exam Study Guide 100% Certified by
Expert.
Latest Updated Guide 2025/2026.
4. Treatment & MOA?
5. Diagnosis? - ansPhiladelphia Chromosome
2. bcr-abl -> Fusion protein
3. Tyrosine Kinase (Bcr-Abl protein) that is constitutively active)
4. Imatinib targets this Tyrosine Kinase to treat the disease and achieves a high remission
rate.
5. Chronic Myelogenous Leukemia (CML)
Acute Myelogenous Leukemia: treatment? - ansDaunorubicin
&
Cytarabine
Chronic Lymphocytic leukemia: treatment? - ansFludarabine
&
Rituximab
Smudge Cells: Diagnosis? - ansChronic Lymphocytic Leukemia (CLL)
THESE ARE FRAGILE B-LYMPHOCYTES THAT FALL APART ON SLIDE
PREPARATION.
One way to distinguish from Chronic Myelogenous Leukemia (CML)
Chronic Myelogenous Leukemia (CML) VS Chronic Lymphocytic Leukemia (CLL): KEY
DIFFERENCES! - ansCLL & CML present with symptoms that mimic each other; insidious
onset (weakness, anorexia, lethargy, & fever). Both patients typically have ANEMIA,
LEUKOCYTOSIS, THROMBOCYTOPENIA.
CML
-Philadelphila Chromosome t[9;22]
-granulocytosis
CLL
-smudge cells (fragile B-LYPHOCYTES)
-Lymphocytosis
Li-Fraumeni Syndrome (Cancer Syndrome): cancers associated with? -
ansOSTEOSARCOMAS
Soft tissue sarcomas
BREAST CANCERS (early-onset)
ADRENOCORTICAL Tumors
Leukemias
Li-Fraumeni Syndrome (Cancer Syndrome): mutation - ansp53 tumor suppressor gene
Li-Fraumeni Syndrome (Cancer Syndrome): inheritance? - ansAutosomal Dominant
scenario will show multiple family members (brother, sister)
, Unlocking Your Success: A Comprehensive Guide to
Mastering Step 1 with USMLE-RX
A Comprehensive Exam Study Guide 100% Certified by
Expert.
Latest Updated Guide 2025/2026.
Gardner Syndrome (Cancer Syndrome): cancers associated with? - ansColorectal Cancer
Osseos Tumors
Soft tissue tumors
Gardner Syndrome (Cancer Syndrome): mutation? - ansAPC gene on Chromosome 5
Family with Osteosarcoma, Breast Cancer, and Adrenocortical Caner?
1. Syndrome?
2. Mutation? - ans1. Li-Fraumeni Syndrome
2. p53 (TP53)
Auer Rod
1. Diagnosis?
2. Treatment?
3. treatment: moa? - ansAcute Promyelocytic Leukemia (APL)
2. All-trans retinoic acid (Vitamin A)
3. rapidly induces tumor cell differentiation
Auer Rod
1. Diagnosis?
2. Treatment?
3. treatment: moa? - ansLess distinct Auer Rod (may be subtle and single)
1. Acute Promyelocytic Leukemia (APL)
2. All-trans retinoic acid (Vitamin A)
3. rapidly induces differentiation of promyelocytes
A 60 yo hispanic woman complains of vaginal bleeding. There also is bleeding from the
gums, and bruises are found over her legs. inspection of a peripheral blood smear reveals
very few platelets and large WBCs with azurophilic granular needles in the cytoplasm.
1. Diagnosis
2. Common presentation that is occurring in this case? - ans1. Acute Promyelocytic
Leukemia (APL)
2. Acute Disseminated Intravascular Coagulation (DIC) is a common presentation.
azurophilic granular needles in the cytoplasm?
