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USMLE Step 1 Bits & Pieces High yield short focused points, monographs, charts, illustrations, tables, and other stuff related to the USMLE Step 1 Exam.


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  #1  
Old 01-26-2013
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X Ray Step 1 X-Rays, CTs, MRIs & Histo slides

I noticed that a lot of us are having difficulties interpreting X-rays/CTs, MRIs and histology slides so I figured a thread dedicated to high yield images might be helpful.
Feel free to attach images and get everyone to participate in learning!
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I guess I'll go first!
#1: Barium findings of a pt complaining of solid and liquid dysphagia. What's the likely diagnosis?
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Quote:
Originally Posted by SarahM View Post
I guess I'll go first!
#1: Barium findings of a pt complaining of solid and liquid dysphagia. What's the likely diagnosis?
Achalasia
Birds beak
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#2: This is an x-ray of a 72 y/o pt complaining of "pain after eating", what's the dx?
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Quote:
Originally Posted by SarahM View Post
#2: This is an x-ray of a 72 y/o pt complaining of "pain after eating", what's the dx?
Intestinal angina and fibrosis with constriction of lumen i guess
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#3: This baby's mom has diabetes, what does s/he have?
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Intestinal angina and fibrosis with constriction of lumen i guess
Due to what?
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#4: This a histo slide of an esophagus, what's wrong with this pt?
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Man has arrived from brazil with cough weight loss and night sweats
Step 1 X-Rays, CTs, MRIs & Histo slides-imageuploadedbytapatalk1359255952.792877.jpg
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Quote:
Originally Posted by SarahM View Post
Due to what?
Repeated scarring
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Quote:
Originally Posted by SarahM View Post
#4: This a histo slide of an esophagus, what's wrong with this pt?
Barrett's esophagus
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Quote:
Originally Posted by SarahM View Post
#3: This baby's mom has diabetes, what does s/he have?
Double buble sign
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Man has arrived from brazil with cough weight loss and night sweats
Attachment 3016
TB acid fast?
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Originally Posted by MedicalExaminer View Post
Repeated scarring
It's a pretty good guess but I'm looking for a specific answer, your answer might be a complication of this problem.
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Quote:
Originally Posted by SarahM View Post
TB acid fast?
No thats not TB
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Quote:
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It's a pretty good guess but I'm looking for a specific answer, your answer might be a complication of this problem.
Mesenteric artery atherosclerosis
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Mesenteric artery atherosclerosis
Compromising supply to Watershed area
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No thats not TB
Hmm what am i looking at? Is that a lung section?
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Compromising supply to Watershed area
Good job! its Ischemic colitis at the splenic flexture
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Originally Posted by SarahM View Post
#2: This is an x-ray of a 72 y/o pt complaining of "pain after eating", what's the dx?
Answer: "Thumb-printing" sign, associated with Ischemic Colitis (Splenic flexture)
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Hmm what am i looking at? Is that a lung section?
Yes thats it
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Yes thats it
Histoplasmosis
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Histoplasmosis
No not histo
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No not histo
Hmm it looks like it should be something obvious but its just not ringing a bell right now...can u give me a hint?
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This one is kinda tricky but it emphasizes an important "buzz word" for a specific GI disease associated with achlorhydria
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Hmm it looks like it should be something obvious but its just not ringing a bell right now...can u give me a hint?
Actually the hint is trip from brazil
The physical i gave here was clueless so almost 90% of this case is based on image recognition
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#2: This is an x-ray of a 72 y/o pt complaining of "pain after eating", what's the dx?
apple core ?? carcinoma?
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This one is kinda tricky but it emphasizes an important "buzz word" for a specific GI disease associated with achlorhydria
Can u add some more hints ?
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This one is kinda tricky but it emphasizes an important "buzz word" for a specific GI disease associated with achlorhydria
This patient is at a high risk for adenocarcinoma of the stomach.
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apple core ?? carcinoma?
dr maps, no its not a carcinoma
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Man has arrived from brazil with cough weight loss and night sweats
Attachment 3016
captain's wheel??
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This patient is at a high risk for adenocarcinoma of the stomach.
Menetriers disease
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captain's wheel??
ohhhh paracoccidioidomycosis!
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ohhhh paracoccidioidomycosis!
Yeap
Paracoccidio
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This one is kinda tricky but it emphasizes an important "buzz word" for a specific GI disease associated with achlorhydria
Answer: Ménétrier disease, the buzz word was "Hypertrophic gastropathy/ Giant rugal folds"
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captain's wheel??
Yeap
Captain's wheel appearance
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This one is kinda tricky but it emphasizes an important "buzz word" for a specific GI disease associated with achlorhydria
gastritis??
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gastritis??
yes ménétrier gastritis (chronic type A)
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#6: what gastrointestinal pathology is this?
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GI disease looks like stomach cancer, appearance Linitis plastica/ leather bottle appearance ????
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#6: what gastrointestinal pathology is this?
any clue??
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GI disease looks like stomach cancer, appearance Linitis plastica/ leather bottle appearance ????
if you're referring to number 6, you're gonna have to take another guess
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any clue??
it is stomach related...
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GI disease looks like stomach cancer, appearance Linitis plastica/ leather bottle appearance ????
ya thought of it but it does not seem like signet ring
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#7: This image shows normal epithelium on the left and abnormal epithelium on the right. Hint: this pt also has vesicles on their extremities
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#6: what gastrointestinal pathology is this?
peptic ulcer??
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#8: This pt has AIDS and recently visited his doctor complaining of abdominal pain and diarrhea
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peptic ulcer??
Good job! It's an H.pylori infection which obviously leads to PUD...noticed the rods in the image
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#6: what gastrointestinal pathology is this?
Answer: Active H. pylori infection
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#8: This pt has AIDS and recently visited his doctor complaining of abdominal pain and diarrhea
cryptosporidium
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#7: This image shows normal epithelium on the left and abnormal epithelium on the right. Hint: this pt also has vesicles on their extremities
is that a histo section of jejunum??
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#7: This image shows normal epithelium on the left and abnormal epithelium on the right. Hint: this pt also has vesicles on their extremities
Celiac sprue
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#7: This image shows normal epithelium on the left and abnormal epithelium on the right. Hint: this pt also has vesicles on their extremities
absolutely celiac sprue.
and i suppose vesicles in extremities is dermatitis herpetiformis
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This one is kinda tricky but it emphasizes an important "buzz word" for a specific GI disease associated with achlorhydria
MENETRIERS DISEASE- rugae of stomach are so hypertrophied that they look like brain gyri
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47y/o male with urinary incontinence and colostomy dies from chronic debilitating disease
autopsy reveals Step 1 X-Rays, CTs, MRIs & Histo slides-imageuploadedbytapatalk1359300635.685180.jpg
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47y/o male with urinary incontinence and colostomy dies from chronic debilitating disease
autopsy reveals Attachment 3021
hmm is this a tumor?
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Can u first identify the location of lesion ?
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Can u first identify the location of lesion ?
yeah well at first i thought it was normal pressure hydorcephalus but the pt is too young and the ventricles don't look too enlarged...It does look like there's a mass obstruction possibly a choroid plexus tumor?
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#7: This image shows normal epithelium on the left and abnormal epithelium on the right. Hint: this pt also has vesicles on their extremities
Answer: Celiac Disease, notice the blunting of small intestinal villi.
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#8: This pt has AIDS and recently visited his doctor complaining of abdominal pain and diarrhea
Answer: Cryptosporidiosis
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#9: This is a section of a pt's colon. What is a possible complication of this disease?
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yeah well at first i thought it was normal pressure hydorcephalus but the pt is too young and the ventricles don't look too enlarged...It does look like there's a mass obstruction possibly a choroid plexus tumor?
No
Choroid is tiny structure and its tumor cant be visualized on gross specimen
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#9: This is a section of a pt's colon. What is a possible complication of this disease?
Ulcerative colitis
Colon cancer
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#9: This is a section of a pt's colon. What is a possible complication of this disease?
colon cancer..??
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47y/o male with urinary incontinence and colostomy dies from chronic debilitating disease
autopsy reveals Attachment 3021
is it multiple sclerosis?? if not plz give some clues..
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is it multiple sclerosis?? if not plz give some clues..
Why u suspect MS ?
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Why u suspect MS ?
demylinating sisease+ young age+ bladder/bowel incontinence
i am not able to locate lesion in d brain autopsy
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Yes correct

On the image periventricular area on the left side is demyelinated (right periventricular area for patient)
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[QUOTE=MedicalExaminer;172871]Yes correct

On the image periventricular area on the left side is demyelinated (right periventricular area for patient)[

g8.. in d image Lt periventricularal area seems to be dialated, does that mean its demylinated.. having diffuculty recognizing image.. plz help
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This is wet section probably (not formalin fixed) and the tissue is flexible so original ventricular dimensions are distorted
Can u see a brown area on left side (periventricular demyelinating focus) now compare it to the right side which is what should it look normally (white glistening appearance)
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Quote:
Originally Posted by MedicalExaminer View Post
This is wet section probably (not formalin fixed) and the tissue is flexible so original ventricular dimensions are distorted
Can u see a brown area on left side (periventricular demyelinating focus) now compare it to the right side which is what should it look normally (white glistening appearance)
thanks a tonn.. i understood it now.. yes i saw d brown patch..
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U are welcome
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great jub. it was very helpfull
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Default explanation needed plz

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#2: This is an x-ray of a 72 y/o pt complaining of "pain after eating", what's the dx?
plz explain that..
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Default celiac

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Originally Posted by SarahM View Post
#7: This image shows normal epithelium on the left and abnormal epithelium on the right. Hint: this pt also has vesicles on their extremities
celiac disease
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Actually the hint is trip from brazil
The physical i gave here was clueless so almost 90% of this case is based on image recognition
its paracocccidiomycosis
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Quote:
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#2: This is an x-ray of a 72 y/o pt complaining of "pain after eating", what's the dx?
Thumb printing sign.. intestinal angina or Ischemic colitis
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I agree

Cork screw oesophagus
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I agree

"Apple core" deformity --> Ca Colon
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I agree

Barett's esophagus
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Man has arrived from brazil with cough weight loss and night sweats
Attachment 3016
tuberculosis
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actually this is of great help
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Actually the hint is trip from brazil
The physical i gave here was clueless so almost 90% of this case is based on image recognition
Captain's wheel apearance, paracoccidioidomycosis
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Thanks all! This is truly very helpful
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Default Double bubble sign

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#3: This baby's mom has diabetes, what does s/he have?
Duodenal atresia
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Arrow ?

1.What is the Dx??
2.What is the Etiology?
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Sub-dural hematoma

Bridging veins rupture due to trauma
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Sub-dural hematoma

Bridging veins rupture due to trauma
GREAT JOB!!!
you know i got it wrong, it thought it was EPIDURAL, i kinda see a lentiform shape, or the lens shape has to be more sharp?? how can you be sure is subdural, thanks in advance
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GREAT JOB!!!
you know i got it wrong, it thought it was EPIDURAL, i kinda see a lentiform shape, or the lens shape has to be more sharp?? how can you be sure is subdural, thanks in advance
midline shifting in subdural
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Thanks all. This was truly helpful!
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Quote:
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Man has arrived from brazil with cough weight loss and night sweats
Attachment 3016
its paracoccidioidomycosis
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Default according to google it is bezor

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This one is kinda tricky but it emphasizes an important "buzz word" for a specific GI disease associated with achlorhydria
According to google it is Bezor? disorder of eating hair in mentally challenge children

Last edited by drpepo; 07-09-2015 at 12:13 AM.
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watershed area ischemias of peritoneum ?
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Due to what?
Wots this can any1 explain?
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Man has arrived from brazil with cough weight loss and night sweats
Attachment 3016
this is paracoccidio
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GREAT JOB!!!
you know i got it wrong, it thought it was EPIDURAL, i kinda see a lentiform shape, or the lens shape has to be more sharp?? how can you be sure is subdural, thanks in advance

It is Epidual. The SDH is never lens shaped. SDH is cresenteric as there is no lomitation from dural attachment to sutures. Midline shift is secondary to amount of blood and not specific to edh/sdh.
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Originally Posted by SarahM View Post
#2: This is an x-ray of a 72 y/o pt complaining of "pain after eating", what's the dx?
what about intestinal atresia, apple peel lesion?
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Originally Posted by MedicalExaminer View Post
Man has arrived from brazil with cough weight loss and night sweats
Attachment 3016
paracoccidiidomycosis?
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CT-Images, Figures-, Micrographs-, MRI-Images, Pathology-, Radiographs-, Step-1-Preparation

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