Step I Image Based Questions

[chickensoupdr]

I've come across some questions that ask you to recognize what's in the given picture. Usually, the question is very simple asks what it is, but these questions are always the hardest for me. Any advice?

 

[Phloston]

I've come across some questions that ask you to recognize what's in the given picture. Usually, the question is very simple asks what it is, but these questions are always the hardest for me. Any advice?

Histologically, know:

leydig cells vs sertoli cells (leydig are aka interstitial cells, so they're the ones outside the blood-testes barrier)

the menstrual phases (i.e., follicular is straight glands; luteal is coiled, but early luteal is without secretions and late is with)

alveolar cells (e.g., type I vs II pneumocytes, etc.). USMLE really really likes this!!!

know blue cell infiltration is typically neutrophils (e.g., old guy who's afebrile and has dribbling, diagnosis is not BPH but actually chronic prostatitis if image has craploads of small, blue cells [most old guys have BPH so most have hesitancy, dribbling, etc.]). If it's a cancer and there's small blue cells, it's some kind of neuroendocrine/carcinoid/small cell/S-100+ one.

absolutely know the layers of the adrenal gland (cortex and medulla) on histology; ultra-thin capsule looks like a layer but don't confuse it with the zona glomerulosa (that is, the cortex can look like it has 'four' layers on histology, so be careful)

know SCC vs BCC on histology

know what Celiac vs lactase-deficiency look like (i.e., loss of villi vs normal); know abetalipoproteinemia has fat goblets in the enterocytes.

Grossly, be able to identify the ACL vs PCL of the knee on MRI (sounds hyper-specific but it shows up).

Be able to identify a schwannoma at the cerebelopontine junction on MRI; pilocytic astrocytoma in kids has solid AND cystic components on MRI

Lesser sac on abdo x-ray

Annoying, but know the sarcomere on EM. This is really really HY!!!

If they show you a cilium in 2D cross-section showing you the 9x2 microtubule pattern, the answer is primary ciliary dyskinesia aka Kartagener

There are others, but those are HY ones off the top of my head.

 

[chickensoupdr]

Histologically, know:

leydig cells vs sertoli cells (leydig are aka interstitial cells, so they're the ones outside the blood-testes barrier)

the menstrual phases (i.e., follicular is straight glands; luteal is coiled, but early luteal is without secretions and late is with)

alveolar cells (e.g., type I vs II pneumocytes, etc.). USMLE really really likes this!!!

know blue cell infiltration is typically neutrophils (e.g., old guy who's afebrile and has dribbling, diagnosis is not BPH but actually chronic prostatitis if image has craploads of small, blue cells [most old guys have BPH so most have hesitancy, dribbling, etc.]). If it's a cancer and there's small blue cells, it's some kind of neuroendocrine/carcinoid/small cell/S-100+ one.

absolutely know the layers of the adrenal gland (cortex and medulla) on histology; ultra-thin capsule looks like a layer but don't confuse it with the zona glomerulosa (that is, the cortex can look like it has 'four' layers on histology, so be careful)

know SCC vs BCC on histology

know what Celiac vs lactase-deficiency look like (i.e., loss of villi vs normal); know abetalipoproteinemia has fat goblets in the enterocytes.

Grossly, be able to identify the ACL vs PCL of the knee on MRI (sounds hyper-specific but it shows up).

Be able to identify a schwannoma at the cerebelopontine junction on MRI; pilocytic astrocytoma in kids has solid AND cystic components on MRI

Lesser sac on abdo x-ray

Annoying, but know the sarcomere on EM. This is really really HY!!!

If they show you a cilium in 2D cross-section showing you the 9x2 microtubule pattern, the answer is primary ciliary dyskinesia aka Kartagener

There are others, but those are HY ones off the top of my head.

Thanks so much for going through all that! Will definitely review everything mentioned here. Thanks again

 

[Phloston]

Thanks so much for going through all that! Will definitely review everything mentioned here. Thanks again

Also, central pontine myelinolysis and diffuse axonal injury on MRI

 

[Transposony]

Go through the pictures from old/retired NBMEs.

 

[MrWonderful]

As Phloston said, the Sarcomere is probably the highest yield by far. Also basic CT and Neuro-imaging are appearing at a ~75% rate per 10,000 polled students.
Be familiar with the Sarcomere though:

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