USMLE Step 1 General review - Appendix
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This document lists various medical terms and conditions. It includes: 1. Names of medical conditions, anatomical structures, cell types, stains, and imaging findings. 2. Systems covered include dermatology, infectious diseases, hematology, cardiology, pulmonary, gastrointestinal, renal, neurology, and oncology. 3. Related information provided for some terms includes associated symptoms, cell or tissue affected, and relevant clinical information.
USMLE Step 1 General review - Appendix
- 2. Syndactyly Mucormycosis Leptospira Bacillary Angiomatosis Diphtheria (bull’s neck) Stormy fermentation Ataxia- Telangiectasia Follicular Dendritic Cell
- 3. Korsakoff Syndrome Tardive Dyskinesia DiGeorge Syndrome Bartonella (Cat Scratch) Owl Eye (CMV) Clue Cells (Vaginosis) Norwalk Virus Negri Bodies (Rabies)
- 4. Spina Bifida Occulta Keloid scar Solar Elastosis Nutmeg Liver (Right CHF and Budd-Chiari) Brushfield Spots Simian Crease Rocker Bottom Feet Cystic Hygroma
- 5. Zebra bodies (Niemann Pick) Gaucher cells Kyphoscoliosis (EDS9) Lisch Nodules (NF1) Fragile X Syndrome Angelman Sx Patau Sx Edwards Sx
- 6. Raynaud’s Phenomenon Sclerodactyly CREST syndrome Hairy Leukoplakia Malar Rash Kaposi Sarcoma Mees Lines (Arsenic Poisoning) Basophilic Stippling
- 8. Erythema Multiforme Pityriasis Rosea Granuloma Annulare Erythema Nodosum Bowen’s Disease Actinic Keratosis Keratoacanthoma Basal Cell Carcinoma
- 9. Birbeck Granules (Langherhans Histiocytosis) Dacriocytes (Myelofibrosis) Target Cells Acanthocytes Echinocytes Schistocytes Sickle Cell Heinz Bodies
- 10. Howell-Jolly Bodies Pappenheimer Bodies Ring Sideroblasts Prussian Blue Stain (copper) Crew cut Skull RX Chipmunk Face (Thalassemia) Onion Skin (Arteriolosclerosis) Flea Bitten Kidney (Malignant HTN)
- 11. Tree-Bark of Aorta Boxcar Nuclei (Left CHF) Roth Spots (Endocarditis) Osler’s Nodes Janeway Lesions Splinter Hemorrhages Notching of the Ribs. (P-D C) Spider Cells (rhabdomyoma)
- 12. Skin Flushing (Carcinoid HD) Ghon Focus (Primary TB) Simon Focus (Reactive TB) Ziehl-Neelsen Miliary Tuberculosis Cavitary Tuberculosis Pott’s Disease (Spinal TB) Bilateral Hilar Lymphadenopathy
- 13. Blue Bloater (Bronchitis) Pink Puffer (Emphysema) Barrel Chest (Emphysema) Curschmann Spirals (Asthma) Charcot-Leyden Crystals Bronchiectasis “White out” (ARDS) Tension Pneumothorax
- 14. Pneumothorax Glomerular Crescent Formation Mallory Bodies (Alcoholic Hepatitis) Councilman Bodies (Viral Hepatitis) Cowdry Body (HVS encephalitis) Lewy Bodies (Parkinson’s) Rosenthal Fibers (Astrocytoma 1) Pseudorosettes (Ependymoma)
- 15. Psammoma Bodies (Meningioma) Downey Cell (Mononucleosis) Smudge/Parachute cells (CLL) Hairy Cell Leukemia Burkitt’s Lymphoma (African) Starry Sky (Burkitt’s Lymphoma) 4 leaf clover (ATLL) Sezary Syndrome (Mycosis Fungoides)
- 16. Reed-Sternberg (Hodgkin Lymphoma) “Popcorn Cell” Lymphocyte-Rich Hodgkin “Auer Rods” (Acute Myelogenous Leukemia) Pelger-Huet cell (Myelodisplastic Syndrome) Sulfur Granules (Actino and more) Call-Exner bodies (Granulosa tumor) “Signet-ring” cells (Krukenberg tumor) Paget cells
- 17. Classic Seminoma Schiller-Duval (Yolk-sac tumor) Pretibial Myxedema Exophthalmos (Graves disease) Periorbital Edema Hurthle Cells (H. Tyroiditis) Orphan Annie eye (Papillary C.) Blue Sclera (Osteogenesis I.)
- 18. Erlenmeyer Flask (Osteopetrosis) Pott’s Disease (TB osteomielitis) Avascular Necrosis Knobby Knees (Osgood-Schlatter) Sheperd’s Crook (Fibrous dysplasia) Osteoid Osteoma Osteochondroma Soap-Bubble (Osteoclastoma)
- 19. Paget’s Disease Osteosarcoma Homer-Wright Rosettes Onion Skin (Ewing sarcoma) Bone Spur (Osteoarthritis) Heberden / Bouchard Nodes Rheumatoid Arthritis Baker’s Cyst (RA)
- 20. Boutonniere deformity (RA) Rheumatoid Nodules Uric Acid Crystals Calcium Pyrophosphate Lipoblast (Liposarcoma) Dermatofibroma “Herringbone pattern” (Fibrosarcoma) “Storiform” (Malignant Histiocytoma)
- 21. Cell Nucleus Rough Endoplasmic Reticulum Smooth Endoplasmic Reticulum Golgi Apparatus Peroxisome and Lysosome Mitochondria Tight Junction Desmosome
- 23. Stratified cuboidal Mixed serous and mucus Loose connective tissue Macrophages Collagen fibers Basal lamina Hyaline Cartilage Elastic Cartilage
- 24. Osteoblasts Mature bone Osteoclasts Intramembranous Bone Endochondral Bone (left to right) Skeletal muscle (I band-light, A band- dark) Cardiac muscle (junctional complexes and single nucleus) Smooth muscle (gap junctions and fusiform fibers)
- 25. Nissl Stain (Neurons) Axon Hillock (Light staining area) Peripheral Nerve Node of Ranvier Nucleolus White blood cells Plasma cell (clockface pattern) Hassall’s Corpuscle (thymus)
- 26. Hyaline cartilage ring (Trachea) Bronchus w/Hyaline cartilage Clara cells (Bronchioles) Alveolar Pneumocytes Dust cell & Pore of Kohn GI tract Esophagus- Stomach transition Brunner’s glands (Duodenum)
- 27. Seminiferous tubule Interstitium between tubules Uterine wall Stomach Tongue Papillae
- 29. Pharyngeal/Aort ic Arch Associated Cranial Nerve Key Aortic Arch Derivatives 1 Trigeminal (V) Maxillary artery 2 Facial (VII) Stapedial artery 3 Glossopharyngeal (IX) Common carotid artery Prox. Internal carotid artery 4 Superior laryngeal branch of Vagus (X) True aortic arch Subclavian arteries 5 Obliterated Obliterated 6 Recurrent laryngeal branch of Vagus (X) Pulmonary arteries Ductus arteriosus
- 30. Manouvers Increase Preload Right side Deep breath. (Inspiration) Laying supine Left side Expiration Increase Afterload Aortic/Systemic Hand grip Sustained squatting Pulmonary NOT IMPORTANT Valsalva Increases thoracic pressure Reduces right sided murmurs Decreases Heart rate and BP (Parasympathetic)
- 31. . A P . 2-3rd 5-6th . Aortic Pulmonary Tricuspid Mitral Close at beginning of S Open at beginning of D Close at beginning of D Open at beginning of S Sounds are generated at the time of closure. S1 beginning of systole S2 beginning of diastole Stenosis – Anterograde Insufficiency – Retrograde MT A: Systolic – Aortic stenosis P: Systolic – Mitral insufficiency T: Systolic – Tricuspid insufficiency T: Diastolic – Tricuspid stenosis M: Diastolic – Mitral stenosis and aortic insufficiency T P
- 33. Murmur Systolic Bicuspid aortic valve Early systolic High-frequency click Right 2nd interspace Hypertrophic Cardiomyopathy Crescendo- decrescendo murmur Between apex and left sternal Radiates to the suprasternal notch Louder standing up Aortic Stenosis Early Systolic Click Pulse late and weak Old age / Rheumatic F. Congenital Bicuspid valve Angina, syncope, CHF Pulmonary Stenosis Tetralogy of Fallot Harsh ejection murmur Systolic thrill Mitral Regurgitation Holosystolic Radiates to axilla Increases After load Tricuspid Regurgitation Holosystolic Increase right heart Flow Taking a Deep breath IV drug users w/ endocarditis Septal Defects Ventricular Harsh Holosystolic Atrial Fixed Splitting of S2 Diastolic Atrial Regurgitation Blowing murmur Widened pulse pressure Pulmonary Regurgitation Mitral Stenosis Opening snap Rheumatic Fever Tricuspid Stenosis
- 34. 100 50 0 Time Aortic valve closes Aortic valve opens Mitral valve opens Mitral valve closes Normal Pressure tracing Left atrium Left Ventricle Aorta
- 35. a c x v y A: Right atrial contraction B: Bulging of tricuspid valve during right ventricular contraction X: Right atrial relaxation V: Continued inflow of venous blood Y: Passive emptying of right atrium after tricuspid valve opening Jugular Venous Tracing
- 36. Hemodynamic measurements in shock Parameter Hypovolemic shock Cardiogenic Shock Obstructive Shock Septic Shock Central venous pressure (right-sided preload) Pulmonary capillary wedge pressure (left-sided preload) Cardiac index (LV output) Systemic vascular resistance (afterload) Mixed venous oxygen saturation
- 40. Pterygopalatine Fossa Laterally – Infratemporal fossa Medially – Nasal Cavity (Sphenopalatine foramen) Inferiorly – Oral Cavity (Greater and lesser palatine canals) Anteriorly – Orbit (Inferior orbital fissure) Posteriorly – Pharynx Cerebral Nuclei Locus Caeruleus – Neuromelanin cells (Norepinephrine) Basal nucleus of Meynert – Cholinergic neurons (Alzheimer) Caudate nucleus – GABA and Cholinergic acetylcholine (Huntington and Parkinson) Raphe nuclei – Serotonergic bodies Substantia nigra – Dopamine and GABA (Parkinson) Ventral tegmental area – mesolimbic Dopamine (Schizophrenia)
- 41. Elevated AFP • Gastroschisis • Omphalocele • Anencephaly • Spina Bifida Decreased AFP • Down Syndrome Elevated Ache • Anencephaly • Spina Bifida
- 42. Normal Brain Chiari Malformation Type 2 Dandy-Walker Malformation
- 43. Neural Tube Prosencephalon Telencephalon Cerebral hemispheres (Cerebral cortex, basal ganglia, deep white matter) Diencephalon Thalamus Motor and sensory relay nuclei Hypothalamus Control of endocrine and autonomic function Epithalamus Pineal gland Subthalamus Component of basal Ganglia Posterior lobe of the pituitary Neural Retina Mesencephalon Rhombencephalon Metencephalon Cerebellum Pons CN V, VI, VII, VIII Myelencephalon Medulla oblongata CN VIII-XIII
- 44. Reflex Cord Segment Involved Muscle Tested Knee (Patellar) L2-L4 (femoral n.) Quadriceps Ankle S1 (tibial n.) Gastrocnemius Elbow C5-C6 (musculocutaneous n.) Biceps Elbow C7-C8 (radial n.) Triceps Forearm C5-C6 (radial n.) Brachioradialis
- 45. Korsakoff syndrome Amnesia, confabulation and preserved long-term memory Lesions in the anterior and medial thalami Wernicke Encephalopathy Encephalopathy, ocular dysfunction and ataxia Atrophy of Mamillary bodies Cerebellar Degeneration Tremor, unsteady gait Loss of Purkinje cells in the cerebellar vermis
- 46. Upper Motor Neuron Lesion • Spastic Paresis • Hyperreflexia • Babinski sign • Increased muscle tone • Clasp knife reflex • Disuse atrophy of muscles • Decreased speed of voluntary movements • Large area of the body involved Lower Motor Neuron Lesion • Flaccid paralysis • Areflexia • No Babinski • Fasciculations • Decreased muscle tone or atonia • Atrophy of muscle(s) • Loss of voluntary movements • Small area of the body affected
- 47. Foramen Rotundum- CN V2 (Maxillary Nerve) CN V3 (Mandibular Nerve)Foramen Ovale- Superior Orbital Fissure CN II (Optic Nerve) Ophthalmic Artery CN III (Oculomotor Nerve) CN IV (Trochlear Nerve) CN V1 (Ophthalmic Nerve) CN VI (Abduncens Nerve) Ophthalmic Veins Optic Canal Cribiform Plate- CN I (Olfactory Nerve) Foramen Spinosum Foramen Lacerum- Middle Meningeal A. Meningeal N. (V3) Internal Carotid Artery
- 48. Skull Foramen Traversing Structures Anterior Cranial Fossa Cribiform plate CN I olfactory bundles Middle Cranial Fossa Optic canal CN II, ophthalmic artery, central retinal vein Superior Orbital fissure CN III, IV, V1, VI, ophthalmic vein, sympathetic fibers Foramen rotundum CN V2 (maxillary) Foramen ovale CN V3 (mandibular) Foramen spinosum Middle meningeal artery and vein Posterior Cranial Fossa Internal acoustic meatus CN VII, VIII Jugular foramen CN IX, X, XI, jugular vein Hypoglossal canal CN XII Foramen magnum Spinal roots of CN XI, brain stem, vertebral arteries
- 49. Spinal Cord Hemisection (Brown-Sequard Sx) Ipsilateral • Spastic Weakness • Altered vibratory sense Contralateral • Loss of pain and temperature NO Cranial Nerve signs
- 50. Brain-Stem Lesions Ipsilateral • Cranial Nerve signs to lesion • Horner’s Syndrome Contralateral • All deficits (Wallenberg syndrome IX,X)
- 51. Cortex or Capsular Lesions Ipsilateral • None Contralateral • Anesthesia • Lower face weakness • Sensory deficits
- 52. Cerebellar Lesion (Hemisphere) Ipsilateral • Intention tremor • Dysmetria • Dyadochokinesia • Scanning dysarthria • Nystagmus • Hypotonia (Insult to deep nuclei) Vermal Lesion • Gait Ataxia (alcoholism) • Truncal Ataxia (medulloblastoma)
- 53. Cerebellar Lesion (Vermal Lesion) • Gait Ataxia (alcoholism) • Truncal Ataxia (medulloblastoma)
- 54. Parkinson Disease Bradykinesia, cogwheel rigidity, resting tremor, shuffling gait, Stooped posture, masked face, depression and dementia Pathognomonic: Lewy bodies Loss of dopaminergic neurons from substantia nigra Huntington Disease Chorea (rapid movements), athetosis (slow movements), personality changes, dementia Type of disease: Autosomal Dominant (Chromosome 4) Degeneration of GABA neurons, causing atrophy of head of caudate nucleus Wilson Disease Tremor, asterixis, parkinsonian symptoms, chorea, fatty change, Neuropsychiatric symptoms, hepatitis or cirrhosis, tremor may be “wing beating”. Pathognomonic: Kayser-Fleischer ring
- 55. Hemiballism CONTRALATERAL Wild, flinging movements of limbs Pathognomonic: Hypertensive Patients Hemorrhagic destruction of subthalamic nucleus Tourette Syndrome Motor and vocal tics, commonly associated with OCD and ADHD Treatment: Antipsychotic agents Excess of striatal dopamine
- 56. POLIO Flaccid Paralysis, Muscle atrophy, Fasciculations, Areflexia TABES DORSALIS Paresthesias, Pain, Polyuria/Urine retention, Associated w/neurosyphilis, +Romberg sign, suppressed reflexes, pupillary reflex defects. ALS Spastic paralysis in lower limbs, flaccid paralysis in upper limbs, increased tone and reflexes. ANTERIOR SPINAL ARTERY OCCLUSION Pain, temperature and spastic weakness bilateral signs, spastic bladder Vibratory and pressure senses spared
- 57. SUBACUTE COMBINED DEGENERATION Paresthesias, bilateral spastic weakness, Babinski sign, antibodies to the intrinsic factor (Vitamin B12 pernicious anemia) SYRINGOMYELIA Bilateral loss of pain and temperature upper limbs. “Cape-like” It eventually gets to flaccid paralysis and atrophy of the upper limb May be associated with hydrocephalus and Arnold Chiari II. BROWN-SÉQUARD SYNDROME (HEMISECTION) Ipsilateral Horner’s sx, paresis, loss of position and vibratory senses. Contralateral loss of pain and temperature.
- 58. Hypothalamus Anterior Region Paraventricular and Supraoptic Nuclei Synthesize ADH and Oxytocin Suprachiasmatic Nucleus Circadian Rhythms Tuberal Region Arcuate Nucleus Release hormones in the anterior pituitary Ventromedial Nucleus Satiety center Posterior Region Mamillary Bodies Wernicke-Korsakoff Hypotalamic Zone Anterior Senses elevation of temperature Posterior Senses decrease of temperature Lateral Feeding center Preoptic Area . Sensitive to androgens and estrogens
- 59. Expressive Aphasia- Agraphia, decreased ability to repeat words or answer questions. Single-syllable words (pt frustrated) Left MCA infarct Lower face weakness if associated w/Primary motor cortex Receptive Aphasia-Oral aphasia (they don’t understand) if restricted to area 22. They use “word salad” to speak, paraphasic speech. Aware and not concerned, fluent speech but incoherent. May have hearing loss. Gerstmann Syndrome- Alexia with agraphia, often seen with acalculia, finger agnosia (particularly right hand).
- 60. Conductive Aphasia- Speech and comprehension may be normal, but patient paraphrases and needs word-finding pauses. Pt cannot repeat words or execute verbal commands. Aware and frustrated. Cannot speak or write Area 7, 39 ,40 Asomatognosia/Neglect- Unawareness or neglect of contralateral Half of the body. Pt ignores left side of his body or things. Visual Agnosia- Inability to recognize visual patterns or objects. If lesions 20 and 21 involved pt develops prosopagnosia which is the inability to recognize faces.
- 61. Transcortical Apraxia- From an occlusion of the ACA Inability to move the left arm to respond to verbal commands NO motor weakness. Alexia without Agraphia- From an occlusion of the left PCA Right homonymous hemianopsia w/macular sparing. Visual information cannot reach the language area. Color anomia, pt unable to read, able to write. Kluver-Bucy Syndrome- Hypersexuality, hyperphagia and visual agnosia.
- 62. Global Aphasia- Both Broca and Wernicke are damaged. Includes labored telegraphic speech and poor comprehension. NO motor weakness. Naming severely impaired Transcortical Aphasia- Capacity to repeat statements unimpaired Patient cannot speak spontaneously. NO motor weakness.
- 63. 1. Parinaud’s Syndrome 2. Korsakoff’s psychosis 3. Contralateral leg weakness 4. Superior quadrantanopia w/macular sparing 5. Alexia without agraphia 6. Hoarseness 7. Difficulty chewing 8. Temperature regulation 9. Rathke’s pouch 10. Truncal ataxia D E A C B M F G H I L K 1. M- Pineal gland Tumor 2. L- Mamillary body degeneration 3. D- Motor homunculus (precentral gyrus) 4. B- Lingual Gyrus (Meyer’s Loop) 5. A- Splenium of Corpus Callosum lesion 6. H- Vagus nerve rostral medulla 7. G- Trigeminal nerve rostral pons 8. I- Hypothalamus 9. K-Anterior Pituitary gland 10. J- Posterior part of the cerebellar vermis J
- 64. Autosomal Recessive Autosomal Dominant Onset Early uniform onset (Infancy or childhood) Variable onset (may be delayed into adulthood) Penetrance Complete Penetrance Incomplete penetrance with variable expression Mutation Usually an enzyme protein Usually a structural protein or receptor Requires Mutation of both alleles Mutation of one allele