This is a review for the USMLE Step 1 of Pathology. It contains anything you need to know for your exam in pictures, diagrams and tables. THIS IS A TWO PART SERIES, look for the first part.
3. For it to be an aortic
dissection you need 2
things:
1. Pre-existing weakness
of the media
(Hypertension or
inherited defects)
2. Occurs in the
proximal 10 cms of
the aorta
Complications:
Pericardial tamponade,
rupture or vessel
obstruction.
4. Aortic Insufficiency or Embolism
-Pulsatile mass that
grows with time
Major complication is
rupture when >5cms in
diameter.
When rupture:
-Hypotension
-Pulsatile abdominal
mass
-Flank pain
5. STABLE ANGINA
Chest pain (<20 mins)
Pain relieved with rest or Nitroglycerin
EKG: ST segment depression
(subendocardial ischemia)
UNSTABLE ANGINA
Chest pain occurs at rest
Rupture of atherosclerotic plaque –
incomplete occlusion of coronary artery.
EKG: ST segment depression
Pain relieved with Nitroglycerin
PRINZMETAL ANGINA
Coronary artery vasospasm
EKG: ST segment elevation (transmural)
MYOCARDIAL INFARCTION
Necrosis of cardiac myocytes.
Rupture of atherosclerotic plaque –
complete occlusion of coronary artery.
Occlusion for >20 mins (vasospasm or
vasculitis - Kawasaki).
Symptoms not relieved by Nitroglycerin
Most common involved:
Left Anterior Descending (1st) Anterior
LV
Right Coronary (2nd) Posterior LV
Left circumflex (3rd) Lateral LV
EPI
MYO
ENDO 1st ST segment depression
2nd ST segment elevation
10. ENDOCARDITIS
Inflammation of the endocardium that
lines the surface of the valves.
Most commonly due to bacterial
infection
S. Viridans - Infects previously damaged
valves.
S. Aureus – IV drug abuse, infects normal
valves. (Tricuspid)
S. Epidermidis – Endocarditis of
prosthetic valves.
S. Bovis – Patient with underlying
colorectal carcinoma
HACEK organisms – Negative blood
cultures
11. DILATED CARDIOMYOPATHY
• All four chambers dilated
• MOST COMMON FORM
• Systolic dysfunction
• Biventricular CHF
• Idiopathic
TX: Transplant
HYPERTROPHIC CARDIOMYOPATHY
• LV massive hypertrophy
• Mutations in the sarcomere
proteins (Autosomal D)
• Diastolic dysfunction
• Decreased cardiac output
• Sudden death
RESTRICTIVE CARDIOMYOPATHY
• Decreased compliance of
ventricular endocardium
• Restricts filling during
diastole
Causes: Amyloidosis, sarcoidosis,
Hemocromatosis, fibroelastosis,
Loeffler syndrome
16. EMPHYSEMA
Smokers
1. Most common cause
2. Pollutants cause excessive protease damage
3. Centriacinar emphysema
4. Severe in the upper lobes
Alpha-1 Antitrypsin Deficiency
1. Rare cause
2. Lack of antiprotease causes vulnerability
3. Panacinar emphysema
4. Sever in lower lobes
5. Liver cirrhosis may be present
18. L/S Ratio Lecithin Sphingomyelin
3
2
1
MATURE
TRANSITIONAL
IMMATURE
20 25 30 35 40Gestational Age
(Weeks)
19. Lung Carcinoma
Metastasis
Cannon-ball nodules
More common than
primary tumors
Small Cell
Carcinoma
Poorly
differentiated
From Kulchitsky
cells
Chromogranin
positive
Non-Small Cell
Carcinoma (85%)
Adenocarcinoma
(40%)
Glands and mucus
production
Most common in
non-smokers
Squamous Cell
Carcinoma (30%)
Keratin pearls,
intercellular bridges
Most common in
males
Large Cell
Carcinoma (10%)
All negative
Poor prognosis
Carcinoid tumor
(5%)
Chromogranin
Positive
Polyp-like mass
Bronchioloalveolar
Carcinoma
Arises from Clara
cells
Pneumonia-like
Consolidation
22. L M SM MP S
Lumen
Mucosa
Submucosa
Muscularis propria
Serosa
Inter-circular Layer
Outer-longitudinal Layer
Myenteric Plexus
Meissner Plexus
IC OL
MyP
GI EPITHELIUM
Achalasia
Esophageal Web
Mallory-Weiss
Esophageal Varices
MeP
Ulcerative Colitis
Crohn Disease
Hirschsprung Disease
23. 2% population
2 years old
2 inches long
Within 2 feet of ileocecal valve
Colonic Diverticula
30. Skin Flushing
Cyanosis
Carcinoid Heart Disease
Right-side valvular fibrosis
Diarrhea
Cramps
Nausea
Vomiting
Bronchospasm
Cough
Wheezing
Starts with Metastasis
Hepatomegaly
Small Bowel
MOST COMMON
location
CARCINOID SYNDROME
31. RISK FOR PROGRESSION
1. > 2 cm
2. Sessile growth
3. Villous Histology
P53 Mutation
Elevated COX
(Aspirin is protective)
32. Dorsal Bud:
Lower part of the
head and
uncinated
process
Ventral Bud:
Upper part of
the head, neck,
body and tail
33. Pale feces due to
blockage of bile
Bile leaks out into the
vessel and gives
jaundice.
Palpable gallbladder
PANCREATIC
CARCINOMA
Marker:
CA 19-9
Whipple procedure
37. Liver infarction secondary
to hepatic vein obstruction
Painful hepatomegaly and
ascites
1. Thrombi
2. Hepatocellular
carcinoma
38. Conjoined kidneys
usually connected at
lower pole
Most common
congenital anomaly.
Horseshoe Kidney Renal Agenesis Dysplastic Kidney Polycystic Kidney
DiseaseInferior
Mesenteric A
Kidney absence, may be
unilateral or bilateral.
Unilateral: Kidney
undergoes hypertrophy,
may lead to renal failure
Bilateral: Potter sequence
Non-inherited
malformation of renal
parenchyma with cysts
and abnormal tissue
(cartilage)
May be bilateral
Inherited defect, bilateral
enlarged kidneys with
cysts in renal cortex and
medulla, associated with
Portal HTN.
May have Potter sequence
AR vs AD(ult)
39. Pre-Renal Azotemia
Blood flow blockage
BUN:Creatinine >20
Decreased GFR
FENa <1%
Post-Renal Azotemia
Outflow blockage
BUN:Creatinine >15
Decreased GFR
FENa <1%
Intra-Renal Azotemia
1. Causes: Acute Tubular Necrosis (most
common cause of ARF) Muddy brown casts in
urine
2. Acute Interstitial Nephritis
3. Renal Papillary Necrosis
BUN:Creatinine <15
FENa >2%, Decreased GFR
Urine osmolarity <500
Long standing obstruction
BUN:Creatinine <15
FENa >2%
Urine osmolarity <500
40. NEPHROTIC SYNDROME NEPHRITIC SYNDROME
Proteinuria (>3.5 g/day)
Hypoalbuminemia Edema.
Hypogammaglobulinemia risk of infections
Hypercoagulable state lose Antithrombin III
Hyperlipidemia and Hypercholesterolemia
1. Minimal Change Disease (associated with
Hodgkin Lymphoma)
2. Focal Segmental Glomerulosclerosis
(associated with HIV, Heroin or sickle cell)
3. Membranous Nephropathy (associated with
Hepatitis, solid tumors, SLE or drugs)
Subepithelial deposits, Dome and Spike
4. Membranoproliferative
Glomerulonephritis Type I subendothelial,
associated with HBV/HCV. Tram-track
appearance
Type II intramembranous, C3 nephritic factor
5. Diabetes Mellitus (sclerosis of the mesangium)
6. Systemic Amyloidosis (amyloid deposits)
Limited Proteinuria <3.5 g/day
Oliguria and azotemia
Salt Retention periorbital edema and HTN
RBC casts and dysmorphic RBC in urine
C5a Deposits causes swelling
1. Post-streptococcal Glomerulonephritis
(associated with M protein factor)
2. Rapidly Progressive Glomerulonephritis
(crescents comprised of fibrin and macrophages)
1. Linear Goodpasture syndrome
2. Granular PSGN (most common), Diffuse
proliferative GN (SLE most common)
3. Negative IF Wegener granulomatosis (c-
ANCA) Churg-Strauss (p-ANCA)
3. IgA nephropathy (Berger disease) deposits
in the mesangium of glomeruli with infections
4. Alport Syndrome defect in type IV collagen,
splitting of glomerular BM
41. Renal Cell
Carcinoma
• Classic Triad: Hematuria, Flank
pain and palpable mass
Paraneoplastic syndromes:
1. EPO: Reactive Polycythemia
2. Renin: Hypertension
3. PTHrP: Hypercalcemia
4. ACTH: Cushing Syndrome
May present LEFT-sided varicocele.
Most common is CLEAR CELL type
Loss of VHL, increased HIF factor
42.
43. ADENOSIS
Persistent Mullerian columnar
epithelium in the anterior wall
and upper 1/3 of vagina.
After DES (diethylstilbestrol)
exposure – used for prevention
of pregnancy complications.
May lead to Clear Cell
adenocarcinoma.
52. Exogenous Corticosteroids
(Most common)
Cortisol goes to anterior pituitary and
shuts down ACTH
Both glands are atrophic
Primary adenoma, hyperplasia or
Adrenal Carcinoma.
One gland produces excess cortisol,
will shut down ACTH and affect the
other gland.
ACTH-secreting Pituitary Adenoma
Excess ACTH will hit both adrenals
making them BIG and produce
excess Cortisol
High-dose Dexamethasone will
SUPRESS ACTH production.
Paraneoplastic ACTH secretion
A tumor secreting ACTH (small cell
carcinoma) will hit both adrenals,
making them BIG and produce
cortisol