1
USMLE
Pathology USMLE step 1 Exam
Questions with Correct Verified
Answers Latest Update
(2024/2025) Guaranteed Pass
1. Hypochromic microcytic anemia - ANS ✓Iron deficiency anemia,
lead poisoning, thalassemia (HbF sometimes present)
2. Increased alpha-fetoprotein in amniotic fluid/maternal serum -
ANS ✓Dating error, anencephaly, spina bifida (neural tube defects)
3. Increased uric acid levels - ANS ✓Gout, Lesch-Nyhan syndrome,
tumor lysis syndrome, loop and thiazide diuretics
4. Intranuclear eosinophilic droplet-like bodies - ANS ✓Cowdry
type A bodies (HSV or CMV)
5. Iron-containing nodules in alveolar septum - ANS ✓Ferruginous
bodies (asbestosis: increased chance of mesothelioma)
6. Large lysosomal vesicles in phagocytes, immunodeficiency - ANS
✓Chediak-Higashi disease (congenital failure of phagolysosome
formation)
Pathology USMLE step 1
, 2
USMLE
7. "Lead pipe" appearance of colon on x-ray - ANS ✓Ulcerative colitis
(loss of haustra)
8. Linear appearance of glomeruli on immunofluorescence - ANS
✓Goodpasture's syndrome
9. Low serum ceruloplasmin - ANS ✓Wilson's disease
(hepatolenticular degeneration)
10. "Lumpy-bumpy" appearance of glomeruli on
immunofluorescence - ANS ✓Poststreptococcal glomerulonephritis
(immune complex deposition of IgG and C3b)
11. Lytic ("hole-punched") bone lesions on x-ray - ANS
✓Multiple myeloma
12. Mammary gland ("blue-domed") cyst - ANS ✓Fibrocystic
change of the breast
13. Monoclonal antibody spike - ANS ✓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
14. Monoclonal globulin protein in blood/urine - ANS ✓Bence
Jones proteins (multiple myeloma [kappa or lambda Ig light chains in
urine]), Waldenstrom's macroglobinemia (IgM)
Pathology USMLE step 1
, 3
USMLE
15. Mucin-filled cell with peripheral nucleus - ANS ✓Signet ring
(gastric carcinoma)
16. Narrowing of bowel lumen on barium radiograph - ANS
✓"String sign" (Crohn's disease)
17. Needle-shaped, negatively birefringent crystals - ANS
✓Gout (monosodium urate crystals)
18. Nodular hyaline deposits in glomeruli - ANS ✓Kimmelstiel-
Wilson nodules (diabetic nephropathy)
19. Novobiocin response - ANS ✓Sensitive: Staphylococcus
epidermidis
Resistant: Staphylococcus saprophyticus
20. "Nutmeg" appearance of liver - ANS ✓Chronic passive
congestion of liver due to right heart failure
21. "Onion-skin" periosteal reaction - ANS ✓Ewing's sarcoma
(malignant round-cell tumor)
22. Optochin response - ANS ✓Sensitive: Streptococcus
pneumoniae
Resistant: Viridians streptococcus
Pathology USMLE step 1
, 4
USMLE
23. Periosteum raised from bone, creating triangular area -
ANS ✓Codman's triangle on x-ray (osteosarcoma, Ewing's sarcoma,
pyogenic osteomyelitis)
24. Podocyte fusion of EM - ANS ✓Minimal change disease (child
with nephrotic syndrome)
25. Polished, "ivory-like" appearance of bone at cartilage
erosion - ANS ✓Eburnation(osteoarthritis resulting in bony
sclerosis)
26. Protein aggregates in neurons from hyperphosphorylation
of protein tau - ANS ✓Neurofibrillary tangles (Alzheimer's disease
and Creutzfeldt Jakob disease)
27. Pseudo palisading tumor cells on brain biopsy - ANS
✓Glioblastoma multiforme
28. RBC casts in urine - ANS ✓Acute glomerulonephritis
29. Rectangular, crystal-like, cytoplasmic inclusions in Leydig
cells - ANS ✓Reinke crystals (Leydig cell tumor)
30. Renal epithelial casts in urine - ANS ✓Acute toxic/viral
nephrosis
31. Rhomboid crystals, positively birefringent - ANS
✓Pseudogout (calcium pyrophosphate dihydrate)
Pathology USMLE step 1
USMLE
Pathology USMLE step 1 Exam
Questions with Correct Verified
Answers Latest Update
(2024/2025) Guaranteed Pass
1. Hypochromic microcytic anemia - ANS ✓Iron deficiency anemia,
lead poisoning, thalassemia (HbF sometimes present)
2. Increased alpha-fetoprotein in amniotic fluid/maternal serum -
ANS ✓Dating error, anencephaly, spina bifida (neural tube defects)
3. Increased uric acid levels - ANS ✓Gout, Lesch-Nyhan syndrome,
tumor lysis syndrome, loop and thiazide diuretics
4. Intranuclear eosinophilic droplet-like bodies - ANS ✓Cowdry
type A bodies (HSV or CMV)
5. Iron-containing nodules in alveolar septum - ANS ✓Ferruginous
bodies (asbestosis: increased chance of mesothelioma)
6. Large lysosomal vesicles in phagocytes, immunodeficiency - ANS
✓Chediak-Higashi disease (congenital failure of phagolysosome
formation)
Pathology USMLE step 1
, 2
USMLE
7. "Lead pipe" appearance of colon on x-ray - ANS ✓Ulcerative colitis
(loss of haustra)
8. Linear appearance of glomeruli on immunofluorescence - ANS
✓Goodpasture's syndrome
9. Low serum ceruloplasmin - ANS ✓Wilson's disease
(hepatolenticular degeneration)
10. "Lumpy-bumpy" appearance of glomeruli on
immunofluorescence - ANS ✓Poststreptococcal glomerulonephritis
(immune complex deposition of IgG and C3b)
11. Lytic ("hole-punched") bone lesions on x-ray - ANS
✓Multiple myeloma
12. Mammary gland ("blue-domed") cyst - ANS ✓Fibrocystic
change of the breast
13. Monoclonal antibody spike - ANS ✓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
14. Monoclonal globulin protein in blood/urine - ANS ✓Bence
Jones proteins (multiple myeloma [kappa or lambda Ig light chains in
urine]), Waldenstrom's macroglobinemia (IgM)
Pathology USMLE step 1
, 3
USMLE
15. Mucin-filled cell with peripheral nucleus - ANS ✓Signet ring
(gastric carcinoma)
16. Narrowing of bowel lumen on barium radiograph - ANS
✓"String sign" (Crohn's disease)
17. Needle-shaped, negatively birefringent crystals - ANS
✓Gout (monosodium urate crystals)
18. Nodular hyaline deposits in glomeruli - ANS ✓Kimmelstiel-
Wilson nodules (diabetic nephropathy)
19. Novobiocin response - ANS ✓Sensitive: Staphylococcus
epidermidis
Resistant: Staphylococcus saprophyticus
20. "Nutmeg" appearance of liver - ANS ✓Chronic passive
congestion of liver due to right heart failure
21. "Onion-skin" periosteal reaction - ANS ✓Ewing's sarcoma
(malignant round-cell tumor)
22. Optochin response - ANS ✓Sensitive: Streptococcus
pneumoniae
Resistant: Viridians streptococcus
Pathology USMLE step 1
, 4
USMLE
23. Periosteum raised from bone, creating triangular area -
ANS ✓Codman's triangle on x-ray (osteosarcoma, Ewing's sarcoma,
pyogenic osteomyelitis)
24. Podocyte fusion of EM - ANS ✓Minimal change disease (child
with nephrotic syndrome)
25. Polished, "ivory-like" appearance of bone at cartilage
erosion - ANS ✓Eburnation(osteoarthritis resulting in bony
sclerosis)
26. Protein aggregates in neurons from hyperphosphorylation
of protein tau - ANS ✓Neurofibrillary tangles (Alzheimer's disease
and Creutzfeldt Jakob disease)
27. Pseudo palisading tumor cells on brain biopsy - ANS
✓Glioblastoma multiforme
28. RBC casts in urine - ANS ✓Acute glomerulonephritis
29. Rectangular, crystal-like, cytoplasmic inclusions in Leydig
cells - ANS ✓Reinke crystals (Leydig cell tumor)
30. Renal epithelial casts in urine - ANS ✓Acute toxic/viral
nephrosis
31. Rhomboid crystals, positively birefringent - ANS
✓Pseudogout (calcium pyrophosphate dihydrate)
Pathology USMLE step 1
