USMLE questions can be notoriously “picky”. The United States Medical Licensing Examination is designed to emphasize knowledge of clinical scenarios and clinical pearls, even on Step I. Listed below are some commonly encountered disease findings and characteristics that are often included in USMLE questions .
| Feature | Disease |
| 45, X chromosome | Turner’s syndrome |
| 5-HIAA increased in urine | Carcinoid syndrome |
| Aganglionic rectum | Hirschsrpung’s disease |
| Apple-core sign on barium enema | Colon cancer |
| Arched back (opisthotonos) | Tetanus |
| Argyll-Robertson pupil | Syphilis |
| Ash leaf on forehead | Tuberous sclerosis |
| Auer rods | Acute myelogenous leukemia |
| Austin Flint murmur | Aortic regurgitation |
| Backwash ileitis | Ulcerative colitis |
| Baker’s cyst | Rheumatoid arthritis |
| Bamboo spine | Ankylosing spondylitis |
| Bartonella henselae | Cat scratch fever |
| Basophilis stippling of RBCs | Lead poisoning |
| Bilateral lens subluxation | Marfan’s disease |
| Bird’s beak on barium swallow | Achalasia |
| Black-colored urine | Acute intermittent porphyria |
| Black eschars in nose | Mucormycosis |
| Bone spicules in retina | Retinitis pigmentosa |
| Boot-shaped heart on chest radiograph | Tetralogy of Fallot |
| Borrelia burgdorferi | Lyme disease |
| Bouchard’s, Heberden’s nodes | Osteoarthritis |
| Boutonniere deformity of fingers | Rheumatoid arthritis |
| Boxcars under microscope | Anthrax |
| Breslow’s classification | Melanoma |
| Brushfield’s spots | Down’s syndrome |
| Bull-neck edema | Diphtheria |
| Bunch-of-grapes tissue mass | Hydatidiform mole |
| Burkolderia cepacia | Cystic fibrosis |
| Burr’s cells (acanthocytosis) | Abetalipoproteinemia |
| Butterfly rash on face | Lupus |
| Butterfly shape of brain mass on MRI | Astrocytoma (glioblastoma) |
| Button-hole sign | Neurofibromatosis |
| C3 nephritic factor | Membranoproliferative glomerulonephritis |
| Café-au-lait spots | Neurofibromatosis |
| Calf muscle pseudohypertrophy | Duchenne’s muscular dystrophy |
| c-ANCA positive | Wegener’s granulomatosis |
| Candle-drippings tumor | Tuberous sclerosis |
| Caput medusae | Portal hypertension |
| Chagoma, Romana’s sign | Chagas disease |
| Chain-o-lakes duct | Chronic pancreatitis |
| Charcot-Leyden crystals | Asthma |
| Cherry red spot on macula | Tay-Sachs, Niemann-Pick disease |
| Chinese letter-shaped microbe | Diphtheria |
| Chipmunk facies | Beta-thalassemia |
| Chlamydia trachomatis | Lymphogranuloma venereum |
| Chloride sweat test positive | Cystic fibrosis |
| Chocolate cysts, powder burn tissue | Endometriosis |
| Choreoathetoid movements | Huntington’s chorea |
| Chromosome 5 partial deletion | Cri-du-chat |
| Chvostek’s sign | Hypocalcemia |
| Codman’s triangle | Osteosarcoma |
| Cogwheel rigidity | Parkinson’s disease |
| Complement (CH50) decreased | Lupus |
| Condylomata lata, gummas | Syphilis |
| Congenital bicuspid aortic valve | Aortic stenosis |
| Continuous machinery murmur | Patent ductus arteriosus |
| Cooing-seagull murmur | Mitral regurgitation |
| Coronary artery aneurysms | Kawasaki’s disease |
| Cotton-candy lungs | COPD |
| Courvoisier’s sign | Pancreatic cancer |
| Cowdry type A bodies | Herpes |
| Coxiella burnetii | Q fever |
| Crypt abscesses in bowel mucosa | Ulcerative colitis |
| Curschmann’s spirals | asthma |
| Cystic medial necrosis of aorta | Marfan’s disease |
| Cystic space in spinal cord | syringomyelia |
| Dark lung field | pneumothorax |
| Delta wave on ECG | Wolff-Parkinson-White |
| Doughnut ring in liver on CT | Q fever |
| Drusen | Macular degeneration |
| Dry eyes and mouth | Sjogren’s syndrome |
| Dural tail streak of contrast on CT | Menigioma |
| Dynein arm in cilia missing | Kartagener’s syndrome |
| E antigen | Hepatitis B |
| Eaton-Lambert | Small cell lung cancer |
| Erdrophonium (Tensilon) test positive | Myasthenia gravis |
| Eggshell calcifications in hilar nodes | sarcoidosis |
| Elliptical RBCs | Elliptocytosis |
| Ghon’s complex | Tuberculosis |
| Gleason score | Pancreatic cancer |
| Gluten-caused | Celiac sprue |
| Gowers’ sign | Duchenne’s muscular dystrophy |
| Guarnieri’s bodies | Smallpox |
| Halo, crescent signs on chest radiograph | aspergillosis |
| Ham’s test positive | Paroxysmal nocturnal hemoglobinuria |
| Hand-foot syndrome | Sickle cell disease |
| Hemoglobin S | Sickle cell disease |
| HLA-B27 | Ankylosing spondylitis, Reiter’s |
| HLA-B35 | De Quervain’s thyroiditis |
| Homan’s sign | Deep vein thrombosis (DVT) |
| Hutchinson’s teeth | syphilis |
| Hypertrophy of gastric folds | Menetrier’s disease |
| Hypopyon uveitis (pus in anterior eye) | Behcet’s disease |
| IgA in mesangium | Berger’s disease |
| IgG in glomerular basement membrane | Goodpasture’s disease |
| “infant Hercules†| Congenital hypothyroidism, cretinism |
| Irregularly irregular pulse | Atrial fibrillation |
| Itchy, scaly skin on nipple | Paget’s disease of breast |
| Janeway spots | Bacterial endocarditis |
| Jarisch-herxheimer reaction | Lyme disease, syphilis |
| Kernig’s, brudzinski’s signs | Bacterial meningitis |
| Koplik’s spots | Measles |
| Kussmaul’s respiration | Diabetic ketoacidosis |
| lanugo | Anorexia nervosa |
| Large motor neuron loss | ALS |
| Lenticonus (anterior conical lens displacement) | Alport’s syndrome |
| Leonine facies | leprosy |
| Leukocoria (white pupil) | retinoblastoma |
| Lewy body | Parkinson’s disease |
| Libman-sacks lesions | Lupus |
| Lip biopsy | Sjogren’s syndrome |
| Lucio’s phenomenon | Leprosy |
| Lytic bone lesions in skull | Multiple myeloma |
| Mcburney’s point tenderness | appendicitis |
| Mid to late systolic click | Mitral valve prolapse |
| Monoclonal spike-protein electrophoresis | Multiple myeloma |
| Moon facies, buffalo hump, striae | Cushing’s syndrome |
| Mousy odor | phenylketonuria |
| Multiple aneurysms in arteries | Polyarteritis nodosa |
| Multiple bone fractures in infants | Osteogenesis imperfecta |
| Murphy’s sign | Acute cholecystitis |
| Negri body | Rabies |
| Neurofibrillary tangles, senile plaques | Alzheimer’s disease |
| Nontender pustular papule with black eschar | anthrax |
| Notched ribs, 3 sign on chest radiograph | Coarctation of aorta |
| Nutmeg liver | Congestive heart failure (CHF) |
| Obturator sign | Appendicitis |
| Omphalomesenteric duct | Meckel’s diverticula |
| Onion-peel tumor on radiograph | Ewing’s sarcoma |
| Osler’s nodes | Bacterial endocarditis |
| Osmotic fragility abnormal | spherocytosis |
| Panacinar emphysema | Alpha-1-antitrypsin deficiency |
| p-ANCA positive | Churg-Strauss disease |
| Pancoast’s tumor | Squamous cell lung cancer |
| Paul-Bunnell heterophile antibodies | Mononucleosis |
| Peaked T waves on ECG | Hyperkalemai, MI |
| Pebbling of skin | Hunter’s syndrome |
| Pericardial friction rub | Acute pericarditis |
| Philadelphia chromosome (t9/22) | Chronic myelogenous leukemia (CML) |
| Pipestem fibrosis of liver | Schistosomiasis |
| Plasmodium | Malaria |
| Plucked-chicken skin | Pseudoxanthoma elasticum |
| Podagra, tophi | gout |
| Popcorn cells | Hodgkin’s disease |
| Pretibial myxedema | Hypothyroidism, Hashimoto’s disease |
| Psammoma bodies | Papillary thyroid carcinoma |
| Psoas sign | Appendicitis |
| Q wave on ECG | Myocardial infarction |
| Rachitic rosary chest | Rickets |
| Ranke’s complex | Tuberculosis |
| Ranson’s criteria | Acute pancreatitis |
| Red, swollen Stensen’s duct | Mumps |
| Reed-sternberg cell | Hodgkin’s disease |
| RET gene mutations | MEN |
| Rhodopsin defect | Retinitis pigmentosa |
| Rice-water stools | Cholera |
| Rickettsia rickettsii | Rocky mountain spotted fever |
| Ring hemorrhages in brain | Wernicke’s syndrome |
| Ristocetin cofactor | Von Willebrand’s disease |
| Rose spot rash on trunk | Typhoid fever |
| Roth’s spots | Bacterial endocarditis |
| Rotten egg smell on belching | Giardiasis |
| S1-Q3-T3 on ECG | Pulmonary embolus |
| “safety pin†under microscopy | plague |
| Salty tasting skin | Cystic fibrosis |
| Sawtooth waves on ECG | Atrial flutter |
| Scalloped pupils | Familial amyloid polyneuropathy |
| Sentinel loop on abdominal radiograph | Acute pancreatitis |
| Serotonin secretion increased | Carcinoid syndrome |
| Sezary’s syndrome | Mycosis fungoides |
| Skin crepitus | Gas gangrene |
| Skip areas in bowel | Crohn’s disease |
| Small platelet size | Wiskott-Aldrich syndrome |
| Smudge cell | Chronic lymphocytic leukemia (CLL) |
| Snowstorm on ultrasound | Hydatidiform mole |
| Spectrin defects | Elliptocytosis |
| Starry sky pattern in lymph nodes | Burkitt’s/non-Hodgkin’s lymphoma |
| Strawberry tongue | Toxic shock syndrome, typhoid |
| String sign on barium enema | Crohn’s disease |
| Subclavian arteritis | Takayasu’s arteritis |
| Sunburst tumor | osteosarcoma |
| Swimmer’s itch | schistosomiasis |
| Target/bullseye rash | Lyme disease |
| Tender, pustular papule with black eschar | Tularemia |
| Tennis racket-shaped organism | Tetanus |
| Tennis racket shaped structure inside cell | Hand-schuller-christian disease |
| Tight skin on face, mouth , and eyes | scleroderma |
| Tinel’s, Phalen’s signs | Carpal tunnel |
| Translocation of 11 and 22 chromosomes | Ewings sarcoma |
| Treponema pallidum | Syphilis |
| Trisomy 21 | Down’s syndrome |
| Trypanosome cruzi | Chagas’ disease |
| Two paternal 15 chromosomes | Prader-Willi syndrome |
| Urease breath test | Peptic ulcer disease |
| Vanillylmandelic acid (VMA) increased in urine | Neuroblastoma, pheochromocytoma |
| Warthin-Finkeldey giant cells | Measles |
| Water bottle-shaped heart | Acute pericarditis |
| Water-hammer pulse | Aortic regurgitation |
| Wire-loop complexes in mesangium | Lupus |
| “worst headache of my life†| CVA |
| XXY chromosomes | Klinefelter’s syndrome |
| Yersinia pestis | Plague |
| Z deformity of hand | Rheumatoid arthritis |
The key to do answering USMLE questions during the examination is early and intensive preparation. Unfortunately,a poor score may not reflect on what type of physician an examinee might develop into but a high number of correctly answered USMLE questions will make obtaining a competitive residency easier.
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