PATHOLOGY USMLE STEP 1 COMPLETE
HIGH-YIELD REVIEW GUIDE WITH DISEASE
MECHANISMS AND NOTES
| GRADED A+ | GUARANTEED SUCCESS
Updated 2026 Questions and Answers
100% Verified Exam Prep and Comprehensive
Rationales Included
,Anti-transglutamniase/anti-gliadin/anti-endomysial Celiac disease (diarrhea, distension, weight loss)
antibodies
"Apple core" lesion on abdominal x-ray Colorectal cancer (usually left-sided)
Azurophilic granular needles in leukemic blasts Auer rods (acute myelogenous leukemia, especially the promyelocytic [M3] type)
Bacitracin response Sensitive: Streptocococcus pyogenes (group A)
Resistant: Streptococcus agalactiae (group B)
"Bamboo spine" on x-ray Ankylosing spondylitis (chronic inflammatory arthritis: HLA-B27)
Basophilic nuclear remnants in RBCs Howell-Jolly bodies (due to splenectomy or nonfunctional spleen)
Basophilic stippling of RBCs Lead poisoning or sideroblastic anemia
Bloddy tap on LP Subarachnoid hemorrhage
"Boot-shaped" heart on x-ray Tetralogy of Fallot, RVH
Branching gram-positive rods with sulfur granules Actinomyces israelii
Bronchogenic apical lung tumor Pancoast tumor (can compress sympathetic ganglion and cause Horner's
syndrome)
"Brown" tumor of bone Hemorrhage (hemosiderin) causes brown color of osteolytic cysts. Due to:
1. Hyperparathyroidism
2. Osteitis fibrosa cystica
Cardiomegaly with apical atrophy Chagas' disease (Trypanosoma cruzi)
Cellular crescents in Bowman's capsule Rapidly progressive crescentic glomerulonephritis
"Chocolate cyst" of ovary Endometriosis (frequently involves both ovaries)
Circular grouping of dark tumor cells surrounding pale Homer Wright rosettes (neuroblastoma, medulloblastoma, retinoblastoma)
neurofibrils
Colonies of mucoid Pseudomonas in lungs Cystic fibrosis (AR mutation to CFTR resulting in fat-soluble vitamin deficiency and
mucous plugs)
Decreased alpha-fetoprotein in amniotic fluid/maternal Down syndrome or other chromosomal abnormality
serum
,Degeneration of dorsal column nerves Tabes dorsalis (tertiary syphilis)
Depigmentation of neurons in substantia nigra Parkinson's disease (basal ganglia disorder: rigidity, resting, tremor, bradykinesia)
Desquamated epithelium casts in sputum Curschmann's spirals (bronchial asthma; can result in whorled mucous plugs)
Disarrayed granulosa cells in eosinophilic fluid Call-Exner bodies (granulosa-theca cell tumor of the ovary)
Dysplastic squamous cervical cells with nuclear Koilocytes (HPV: predisposes to cervical cancer)
enlargment and hyperchromasia
Enlarged cells with intranuclear inclusion bodies "Owl's eye" appearance of CMV
Enlarged thyroid cells with ground-glass nuclei "Orphan Annie" eye nuclei (papillary carcinoma of the thyroid)
Eosinophilic cytoplasmic inclusion in liver cell Mallory bodies (alcoholic liver disease)
Eosinophilic cytoplasmic inclusion in nerve cell Lewy body (Parkinson's disease)
Eosinophilic inclusion bodies in cytoplasm of Rabies virus (Lyssavirus)
hippocampal nerve cells
Extracellular amyloid deposition in gray matter of brain Senile plaques (Alzhemier's disease)
Giant B cells with bilobed nuclei with prominent Reed-Sternberg cells (Hodgkin's lymphoma)
inclusions ("owl's eye")
Glomerulus-like structure surrounding vessel in germ Schiller-Duval bodies (yolk sac tumor)
cells
"Hair-on-end" (crew cut) appearance on x-ray Beta-thalassemia, sickle cell anemia (marrow expansion)
hCG elevated Choriocarcinoma, hydatidiform mole (occurs with and without embryo)
Heart nodules (granulomatous) Aschoff bodies (rheumatic fever)
Heterophile antibodies Infectious mononucleosis (EBV)
Hexagonal, double-pointed, needle-like crystals in Bronchial asthma (Charcot-Leyden crystals: eosinophilic granules)
bronchial secretions
High level of D-dimers DVT, pulmonary embolism, DIC
, Hilar lymphadenopathy, peripheral granulomatous lesion Ghon complex (primary TB: Mycobacterium bacilli)
in middle or lower lung lobes (can calcify)
"Honeycomb lung" on x-ray Interstitial fibrosis
Hypersegmented neutrophils Megaloblastic anemia (B12 deficiency: neurologic symptoms; folate deficiency: no
neurologic symptoms)
Hypochromic microcytic anemia Iron deficiency anemia, lead poisoning, thalassemia (HbF sometimes present)
Increased alpha-fetoprotein in amniotic fluid/maternal Dating error, anencephaly, spina bifida (neural tube defects)
serum
Increased uric acid levels Gout, Lesch-Nyhan syndrome, tumor lysis syndrome, loop and thiazide diuretics
Intranuclear eosinophilic droplet-like bodies Cowdry type A bodies (HSV or CMV)
Iron-containing nodules in alveolar septum Ferruginous bodies (asbestosis: increased chance of mesothelioma)
Large lysosomal vesicles in phagocytes, Chediak-Higashi disease (congenital failure of phagolysosome formation)
immunodeficiency
"Lead pipe" appearance of colon on x-ray Ulcerative colitis (loss of haustra)
Linear appearance of glomeruli on immunofluorescence Goodpasture's syndrome
Low serum ceruloplasmin Wilson's disease (hepatolenticular degeneration)
"Lumpy-bumpy" appearance of glomeruli on Poststerptococcal glomerulonephritis (immune complex deposition of IgG and
immunofluorescence C3b)
Lytic ("hole-punched") bone lesions on x-ray Multiple myeloma
Mammary gland ("blue-domed") cyst Fibrocystic change of the breast
Monoclonal antibody spike 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 Bence Jones proteins (multiple myeloma [kappa or lambda Ig light chains in
urine]), Waldenstrom's macroglobinemia (IgM)
Mucin-filled cell with peripheral nucleus Signet ring (gastric carcinoma)
Narrowing of bowel lumen on barium radiograph "String sign" (Crohn's disease)
Needle-shaped, negatively birefringent crysytals Gout (monosodium urate crystals)
HIGH-YIELD REVIEW GUIDE WITH DISEASE
MECHANISMS AND NOTES
| GRADED A+ | GUARANTEED SUCCESS
Updated 2026 Questions and Answers
100% Verified Exam Prep and Comprehensive
Rationales Included
,Anti-transglutamniase/anti-gliadin/anti-endomysial Celiac disease (diarrhea, distension, weight loss)
antibodies
"Apple core" lesion on abdominal x-ray Colorectal cancer (usually left-sided)
Azurophilic granular needles in leukemic blasts Auer rods (acute myelogenous leukemia, especially the promyelocytic [M3] type)
Bacitracin response Sensitive: Streptocococcus pyogenes (group A)
Resistant: Streptococcus agalactiae (group B)
"Bamboo spine" on x-ray Ankylosing spondylitis (chronic inflammatory arthritis: HLA-B27)
Basophilic nuclear remnants in RBCs Howell-Jolly bodies (due to splenectomy or nonfunctional spleen)
Basophilic stippling of RBCs Lead poisoning or sideroblastic anemia
Bloddy tap on LP Subarachnoid hemorrhage
"Boot-shaped" heart on x-ray Tetralogy of Fallot, RVH
Branching gram-positive rods with sulfur granules Actinomyces israelii
Bronchogenic apical lung tumor Pancoast tumor (can compress sympathetic ganglion and cause Horner's
syndrome)
"Brown" tumor of bone Hemorrhage (hemosiderin) causes brown color of osteolytic cysts. Due to:
1. Hyperparathyroidism
2. Osteitis fibrosa cystica
Cardiomegaly with apical atrophy Chagas' disease (Trypanosoma cruzi)
Cellular crescents in Bowman's capsule Rapidly progressive crescentic glomerulonephritis
"Chocolate cyst" of ovary Endometriosis (frequently involves both ovaries)
Circular grouping of dark tumor cells surrounding pale Homer Wright rosettes (neuroblastoma, medulloblastoma, retinoblastoma)
neurofibrils
Colonies of mucoid Pseudomonas in lungs Cystic fibrosis (AR mutation to CFTR resulting in fat-soluble vitamin deficiency and
mucous plugs)
Decreased alpha-fetoprotein in amniotic fluid/maternal Down syndrome or other chromosomal abnormality
serum
,Degeneration of dorsal column nerves Tabes dorsalis (tertiary syphilis)
Depigmentation of neurons in substantia nigra Parkinson's disease (basal ganglia disorder: rigidity, resting, tremor, bradykinesia)
Desquamated epithelium casts in sputum Curschmann's spirals (bronchial asthma; can result in whorled mucous plugs)
Disarrayed granulosa cells in eosinophilic fluid Call-Exner bodies (granulosa-theca cell tumor of the ovary)
Dysplastic squamous cervical cells with nuclear Koilocytes (HPV: predisposes to cervical cancer)
enlargment and hyperchromasia
Enlarged cells with intranuclear inclusion bodies "Owl's eye" appearance of CMV
Enlarged thyroid cells with ground-glass nuclei "Orphan Annie" eye nuclei (papillary carcinoma of the thyroid)
Eosinophilic cytoplasmic inclusion in liver cell Mallory bodies (alcoholic liver disease)
Eosinophilic cytoplasmic inclusion in nerve cell Lewy body (Parkinson's disease)
Eosinophilic inclusion bodies in cytoplasm of Rabies virus (Lyssavirus)
hippocampal nerve cells
Extracellular amyloid deposition in gray matter of brain Senile plaques (Alzhemier's disease)
Giant B cells with bilobed nuclei with prominent Reed-Sternberg cells (Hodgkin's lymphoma)
inclusions ("owl's eye")
Glomerulus-like structure surrounding vessel in germ Schiller-Duval bodies (yolk sac tumor)
cells
"Hair-on-end" (crew cut) appearance on x-ray Beta-thalassemia, sickle cell anemia (marrow expansion)
hCG elevated Choriocarcinoma, hydatidiform mole (occurs with and without embryo)
Heart nodules (granulomatous) Aschoff bodies (rheumatic fever)
Heterophile antibodies Infectious mononucleosis (EBV)
Hexagonal, double-pointed, needle-like crystals in Bronchial asthma (Charcot-Leyden crystals: eosinophilic granules)
bronchial secretions
High level of D-dimers DVT, pulmonary embolism, DIC
, Hilar lymphadenopathy, peripheral granulomatous lesion Ghon complex (primary TB: Mycobacterium bacilli)
in middle or lower lung lobes (can calcify)
"Honeycomb lung" on x-ray Interstitial fibrosis
Hypersegmented neutrophils Megaloblastic anemia (B12 deficiency: neurologic symptoms; folate deficiency: no
neurologic symptoms)
Hypochromic microcytic anemia Iron deficiency anemia, lead poisoning, thalassemia (HbF sometimes present)
Increased alpha-fetoprotein in amniotic fluid/maternal Dating error, anencephaly, spina bifida (neural tube defects)
serum
Increased uric acid levels Gout, Lesch-Nyhan syndrome, tumor lysis syndrome, loop and thiazide diuretics
Intranuclear eosinophilic droplet-like bodies Cowdry type A bodies (HSV or CMV)
Iron-containing nodules in alveolar septum Ferruginous bodies (asbestosis: increased chance of mesothelioma)
Large lysosomal vesicles in phagocytes, Chediak-Higashi disease (congenital failure of phagolysosome formation)
immunodeficiency
"Lead pipe" appearance of colon on x-ray Ulcerative colitis (loss of haustra)
Linear appearance of glomeruli on immunofluorescence Goodpasture's syndrome
Low serum ceruloplasmin Wilson's disease (hepatolenticular degeneration)
"Lumpy-bumpy" appearance of glomeruli on Poststerptococcal glomerulonephritis (immune complex deposition of IgG and
immunofluorescence C3b)
Lytic ("hole-punched") bone lesions on x-ray Multiple myeloma
Mammary gland ("blue-domed") cyst Fibrocystic change of the breast
Monoclonal antibody spike 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 Bence Jones proteins (multiple myeloma [kappa or lambda Ig light chains in
urine]), Waldenstrom's macroglobinemia (IgM)
Mucin-filled cell with peripheral nucleus Signet ring (gastric carcinoma)
Narrowing of bowel lumen on barium radiograph "String sign" (Crohn's disease)
Needle-shaped, negatively birefringent crysytals Gout (monosodium urate crystals)
