USMLE Step 1 HY Images to Know
"bird's beak" sign = *Achalasia* - ANS-esoph on barium swallow
\"sack of blood" adrenals (ie b/l adrenal hmrg) = *waterhouse-friderichsen
syndrome*; d/t N. gon infxn - ANS-b/l adrenals; cause
\(arrow points to intranuc inclusion so u know its virus): CMV - ANS-interstitial PNA
in transplant Pt.
\*Anitschkow cells*: histiocyte w/ caterpillar nuc; look on prev one you will see them
in the Aschoff body - ANS-cells found in aschoff bodies
\*aortic stenosis* again (notice how small lumen is) but this is d/t *wear & tear* (no
valve commissure fusion) - ANS-aortic valve2
\*apoptotic body* (pink Eos cytoplasm (bc it's getting concentrated as cell shrinks) &
nuc is smaller) - ANS-what's the cell
\*asteroid body* (config of giant cells in *sarcoid's non-caseating granuloma*) -
ANS-^same histo
\*atherosclerotic emboli bc of chol clefts* - ANS-vessel: what is this & how do you
know
\*Auer rods in AML*
rmr Auer rods are crystal aggregates of MPO, which are only prod by MYELOblasts
-also notice it's large w/ punched out nucleolus = blast - ANS-for 2nd time; notice thin
rod
\*b9*: small, well demarcated (looks 'punched out'), clear borders - ANS-ulcer in
stomach: b9 or mal?
\*bite cells* in *G6PD def* - ANS-wtf rbc4? cause?
\*boot shaped heart in ToF*
boot = ToE/ToF - ANS-whats good with this heart on CXR
\*Carcinoid tumor* - ANS-polyps in submucosa
\*caseating* necrotic granuloma in *Tb*
-necrosis in center
-epith histiocyte on edge - ANS-lung histo: Dx?
\*charcot-leyden crystals* (derived from Eos) in asthma Pt. - ANS-asthma Pt. lung
biopsy
\*chipmunk facies* d/t *B-thal major* - ANS-and this?
\*clear cell type of RCC* - ANS-^histo of Renal
\*curschmann's spirals* (mucus plugs from shed epith) in asthma Pt. - ANS-again
asthma Pt. lung biopsy
\*endometrial polyp* d/t A/E of *tamoxifen* (anti-E on breast but actually promotes E
in endometrium so ya) - ANS-endometrium histo; common cause?
\*erythroblast* (immature RBC, lacking cytoplasm, w/ "punched out" nucleolus
circled)
-can't tell if myeloidblast or lymphoidblast - ANS-and vut dis?
,\*FAP* d/t APC gene mut; 100% -> colorectal cancer - ANS-what's going on in colon
here; cause; sequelae?
\*fat emboli* (circular spaces = fat cells) - ANS-and this
\*ferruginous body* (each bead = iron deposit) aka *asbestos body* - ANS-histo of
pneumoconiosis Pt.
\*fibrinous pericarditis* (notice fibrin, inflm debris, on surface of heart)
comp only of transmural infarct, not subendocardial - ANS-gross <3; comp of?
\*fibroma* (just look how fibrous it is bro) - ANS-gross ovary
\*ghon complex*: fibrosed & calcified nodule w/ hilar LN involvement - ANS-gross
lung again what's circled
\*granuloma* (notice rim of lymphocytes around epithelioid histiocytes); it's
*non-caseating* bc each of the histiocytes (small circles) has their nuc present so it's
not yet necrotic like caseating - ANS-what is this? how can u tell?
\*HbC crystal* d/t glutamic acid to *LYSINE* (C for LyCn) mut - ANS-wtf rbc3?
cause?
\*hemangioma*; looks like a bleed into skin (ex purpura); diff by pushing on it. if it
blanches, it's hemangioma. - ANS-tumor on skin; confused for? how to diff?
\*HS* (smaller than avg *RBC w/ no central pallor*)
-range of size d/t fact that oldest cells lose more membrane (smaller RBC than
newer ones) - ANS-what's wrong w/ cells here
\*intestinal metaplasia*: normal cells @ top (foveolar cells) are being replaced by
cells @ bottom (goblet cells w/ big circles of mucus) - ANS-stomach histo
\*Intima*: endothelial cells sitting on BM
*Media*: sm. mm.
*Adventitia*: outer CT - ANS-blood vessel layers
\*intra-parenchymal hmrg* d/t systemic HTN -> *Charcot-Bouchard microaneurysm*
of lenticulostriate aa. off MCA in BG - ANS-intra-cranial hmrg: type, cause, loc
\*Iron Def Anemia*:
-lymphocyte nuc & RBC size should be same so as reference you can tell RBC size
small
-also notice spectrum of RBC exists (bc this first has normocytic anemia b4
microcytic)
-also increased central pallor = hypochromic - ANS-what is this and how can you tell
\*keloid*
-earlobes of blacks
-T3 collagen - ANS-wtf are we looking at here; clin pres; made of
\*keratomalacia* (notice thickened/white cells @ bottom) d/t vit A def -> metaplasia
in conjunctiva - ANS-ocular path; cause
\*koilocyte* (raisin-like cell on bottom compared to normal one on top) = *condyloma
acuminata d/t HPV 6,11* - ANS-hi power of ^
\*lacunar infarct* d/t hyaline arteriolosclerosis - ANS-deep structures of brain show;
d/t?
, \*liver cirrhosis* (bc misfolded A1AT, purple circles, accum in ER of hepatocytes,
hence def) - ANS-hepatocytes of panacinar emphysema Pt.
\*LN*
-Cortex = B-cells (hyerplasia in RA, early HIV)
-Paracortex = T-cells (all viral)
-Medulla, site of sinus histiocytosis (reactive hyperplasia to cancer) - ANS-what
lymphoid tissue is this
\*mal*: larger, irreg borders, mucosa piles up at edge of the ulcer so ulcer likely d/t
*gastric ADCA* - ANS-ulcer in stomach2: b9 or mal?
\*malarial* org present w/in RBC's (*Plasmodium*) - ANS-wtf rbc5? cause?
\*Meckel's diverticulum*; persistence of vitelline duct - ANS-GI defect; cause
\*MS*
-areas of oligodendrocyte loss + reactive gliosis - ANS-paraventricular plaques
\*MVP* (mitral valve flopping backwards) - ANS-perspective is from LA during
systole
\*notching of ribs* via engorgement of intercostal aa. in *adult coarctation of aorta* -
ANS-whats funny abt these here ribs
\*ovarian CA* spread to abdominal *omentum* via *body seeding*
-aka *omental caking* - ANS-wtf is this
\*plexiform lesions* (group of capillaries joined together) - ANS-pulm HTN histo
\*prussian blue stain* (stains for Fe) shows iron accum in Mt rings around nuc =
*sideroblastic anemia*
this is a BM biopsy of erythroblast cells - ANS-blue ring indicates what; stain?
\*prussian blue stain* turns iron blue; differentiates iron deposition in cells from
lipofuscin ('grey hair of cell') - ANS-hemochromatosis Pt. - stain name? diff what
\*psammoma body* (calcified papillary)
*P*apillary thyroid cancer
*S*erous (papillary) cyst-ADCA of ovary
*M*esothelioma
*M*eningioma - ANS-part of papillary thyroid CA; also found in?
\*red (hmrg-ic) infarct* of testicle
-d/t re-perfusion & fact tissue is loosely org (allows tissue to hold re-entered blood)
-cause: spermatic cord houses thick walled a. and thin v. when cord twists, a. is ok
d/t thick wall but v. ruptures easily and the blood from their (that was supposed to
exits) instead spills into scrotum - ANS-ID again; d/t what 2 things; cause
\*red neurons* during (first 12-24 hrs) - ANS-brain injury histo - early; when would u
see this
\*retinoblastoma* (Rb TSG needs double hit) - ANS-looking at eye. what's circled?
\*RICKETS* d/t vit D def
-notice femurs bowed out (genu varum) - ANS-x-ray of legs of toddler
"bird's beak" sign = *Achalasia* - ANS-esoph on barium swallow
\"sack of blood" adrenals (ie b/l adrenal hmrg) = *waterhouse-friderichsen
syndrome*; d/t N. gon infxn - ANS-b/l adrenals; cause
\(arrow points to intranuc inclusion so u know its virus): CMV - ANS-interstitial PNA
in transplant Pt.
\*Anitschkow cells*: histiocyte w/ caterpillar nuc; look on prev one you will see them
in the Aschoff body - ANS-cells found in aschoff bodies
\*aortic stenosis* again (notice how small lumen is) but this is d/t *wear & tear* (no
valve commissure fusion) - ANS-aortic valve2
\*apoptotic body* (pink Eos cytoplasm (bc it's getting concentrated as cell shrinks) &
nuc is smaller) - ANS-what's the cell
\*asteroid body* (config of giant cells in *sarcoid's non-caseating granuloma*) -
ANS-^same histo
\*atherosclerotic emboli bc of chol clefts* - ANS-vessel: what is this & how do you
know
\*Auer rods in AML*
rmr Auer rods are crystal aggregates of MPO, which are only prod by MYELOblasts
-also notice it's large w/ punched out nucleolus = blast - ANS-for 2nd time; notice thin
rod
\*b9*: small, well demarcated (looks 'punched out'), clear borders - ANS-ulcer in
stomach: b9 or mal?
\*bite cells* in *G6PD def* - ANS-wtf rbc4? cause?
\*boot shaped heart in ToF*
boot = ToE/ToF - ANS-whats good with this heart on CXR
\*Carcinoid tumor* - ANS-polyps in submucosa
\*caseating* necrotic granuloma in *Tb*
-necrosis in center
-epith histiocyte on edge - ANS-lung histo: Dx?
\*charcot-leyden crystals* (derived from Eos) in asthma Pt. - ANS-asthma Pt. lung
biopsy
\*chipmunk facies* d/t *B-thal major* - ANS-and this?
\*clear cell type of RCC* - ANS-^histo of Renal
\*curschmann's spirals* (mucus plugs from shed epith) in asthma Pt. - ANS-again
asthma Pt. lung biopsy
\*endometrial polyp* d/t A/E of *tamoxifen* (anti-E on breast but actually promotes E
in endometrium so ya) - ANS-endometrium histo; common cause?
\*erythroblast* (immature RBC, lacking cytoplasm, w/ "punched out" nucleolus
circled)
-can't tell if myeloidblast or lymphoidblast - ANS-and vut dis?
,\*FAP* d/t APC gene mut; 100% -> colorectal cancer - ANS-what's going on in colon
here; cause; sequelae?
\*fat emboli* (circular spaces = fat cells) - ANS-and this
\*ferruginous body* (each bead = iron deposit) aka *asbestos body* - ANS-histo of
pneumoconiosis Pt.
\*fibrinous pericarditis* (notice fibrin, inflm debris, on surface of heart)
comp only of transmural infarct, not subendocardial - ANS-gross <3; comp of?
\*fibroma* (just look how fibrous it is bro) - ANS-gross ovary
\*ghon complex*: fibrosed & calcified nodule w/ hilar LN involvement - ANS-gross
lung again what's circled
\*granuloma* (notice rim of lymphocytes around epithelioid histiocytes); it's
*non-caseating* bc each of the histiocytes (small circles) has their nuc present so it's
not yet necrotic like caseating - ANS-what is this? how can u tell?
\*HbC crystal* d/t glutamic acid to *LYSINE* (C for LyCn) mut - ANS-wtf rbc3?
cause?
\*hemangioma*; looks like a bleed into skin (ex purpura); diff by pushing on it. if it
blanches, it's hemangioma. - ANS-tumor on skin; confused for? how to diff?
\*HS* (smaller than avg *RBC w/ no central pallor*)
-range of size d/t fact that oldest cells lose more membrane (smaller RBC than
newer ones) - ANS-what's wrong w/ cells here
\*intestinal metaplasia*: normal cells @ top (foveolar cells) are being replaced by
cells @ bottom (goblet cells w/ big circles of mucus) - ANS-stomach histo
\*Intima*: endothelial cells sitting on BM
*Media*: sm. mm.
*Adventitia*: outer CT - ANS-blood vessel layers
\*intra-parenchymal hmrg* d/t systemic HTN -> *Charcot-Bouchard microaneurysm*
of lenticulostriate aa. off MCA in BG - ANS-intra-cranial hmrg: type, cause, loc
\*Iron Def Anemia*:
-lymphocyte nuc & RBC size should be same so as reference you can tell RBC size
small
-also notice spectrum of RBC exists (bc this first has normocytic anemia b4
microcytic)
-also increased central pallor = hypochromic - ANS-what is this and how can you tell
\*keloid*
-earlobes of blacks
-T3 collagen - ANS-wtf are we looking at here; clin pres; made of
\*keratomalacia* (notice thickened/white cells @ bottom) d/t vit A def -> metaplasia
in conjunctiva - ANS-ocular path; cause
\*koilocyte* (raisin-like cell on bottom compared to normal one on top) = *condyloma
acuminata d/t HPV 6,11* - ANS-hi power of ^
\*lacunar infarct* d/t hyaline arteriolosclerosis - ANS-deep structures of brain show;
d/t?
, \*liver cirrhosis* (bc misfolded A1AT, purple circles, accum in ER of hepatocytes,
hence def) - ANS-hepatocytes of panacinar emphysema Pt.
\*LN*
-Cortex = B-cells (hyerplasia in RA, early HIV)
-Paracortex = T-cells (all viral)
-Medulla, site of sinus histiocytosis (reactive hyperplasia to cancer) - ANS-what
lymphoid tissue is this
\*mal*: larger, irreg borders, mucosa piles up at edge of the ulcer so ulcer likely d/t
*gastric ADCA* - ANS-ulcer in stomach2: b9 or mal?
\*malarial* org present w/in RBC's (*Plasmodium*) - ANS-wtf rbc5? cause?
\*Meckel's diverticulum*; persistence of vitelline duct - ANS-GI defect; cause
\*MS*
-areas of oligodendrocyte loss + reactive gliosis - ANS-paraventricular plaques
\*MVP* (mitral valve flopping backwards) - ANS-perspective is from LA during
systole
\*notching of ribs* via engorgement of intercostal aa. in *adult coarctation of aorta* -
ANS-whats funny abt these here ribs
\*ovarian CA* spread to abdominal *omentum* via *body seeding*
-aka *omental caking* - ANS-wtf is this
\*plexiform lesions* (group of capillaries joined together) - ANS-pulm HTN histo
\*prussian blue stain* (stains for Fe) shows iron accum in Mt rings around nuc =
*sideroblastic anemia*
this is a BM biopsy of erythroblast cells - ANS-blue ring indicates what; stain?
\*prussian blue stain* turns iron blue; differentiates iron deposition in cells from
lipofuscin ('grey hair of cell') - ANS-hemochromatosis Pt. - stain name? diff what
\*psammoma body* (calcified papillary)
*P*apillary thyroid cancer
*S*erous (papillary) cyst-ADCA of ovary
*M*esothelioma
*M*eningioma - ANS-part of papillary thyroid CA; also found in?
\*red (hmrg-ic) infarct* of testicle
-d/t re-perfusion & fact tissue is loosely org (allows tissue to hold re-entered blood)
-cause: spermatic cord houses thick walled a. and thin v. when cord twists, a. is ok
d/t thick wall but v. ruptures easily and the blood from their (that was supposed to
exits) instead spills into scrotum - ANS-ID again; d/t what 2 things; cause
\*red neurons* during (first 12-24 hrs) - ANS-brain injury histo - early; when would u
see this
\*retinoblastoma* (Rb TSG needs double hit) - ANS-looking at eye. what's circled?
\*RICKETS* d/t vit D def
-notice femurs bowed out (genu varum) - ANS-x-ray of legs of toddler
