USMLE Step 1 Pathology review PART 1
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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 second part.
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USMLE Step 1 Pathology review PART 1
- 1. Part 1
- 15. CNS Psychosis, Stroke Malar rash Arthritis PleuritisPericarditis, Myocarditis, Libman-Saks endocarditis Diffuse proliferative glomerulonephritis Fever, weight loss, anemia, leukopenia thrombocytop enia, Systemic Lupus Erythematosus Dx: ANA or Anti-dsDNA Deep venous thrombosis Hepatic vein thrombosis (Budd Chiari) Placental thrombosis (pregnancy loss)
- 17. Associated with Rheumatoid Arthritis and B-cell Lymphoma (unilateral enlargement of parotid gland) DX: anti-SS-A and anti- SS-B (targets anti- ribonucleoprotein) Sjögren Syndrome
- 18. Scleroderma Dx: ANA and Scl-70 (anti- DNA topoisomerase I), anti- centromere antibodies. Dental caries (cannot brush) Sjogren Syndrome: Tears, saliva production. Raynaud’s and arthritis Shortness of breath, cough due to scarring Heart muscle hypertrophy and scarring Early signs: Hypertension and proteinuriaNausea, poor absorption of nutrients Dysphagia
- 21. 1 2 3Fibroblast – deposit type III collagen Capillaries – provide nutrients Myofibroblasts – contract wound 1 Final granulation tissue, scar. Myofibroblasts have the ability to decrease the wound size 2 3 Zinc required to switch from Collagen type III to type I in order to make a scar.
- 22. Type I – Bundles of fibers High tensile strength Bone, skin, tendon Diseases: Osteogenesis Imperfecta, Ehlers-Danlos, hypertrophic scars Type II – Thin fibrils, Structural. Cartilage, vitreous humor Diseases: NONE Type III – Thin fibrils, pliable Blood vessels, granulation tissue. Diseases: Ehlers Danlos type IV Keloid formation Type IV – Amorphous Basement membranes Diseases: Goodpasture sx Alport disease, epidermolysis Bullosa.
- 23. CHEMICAL Type of Cancer Derivative Aflatoxins Hepatocellular carcinoma Aspergillus, which contaminates stored grains Alkylating agents Leukemia/Lymphoma Side effect of chemotherapy Alcohol Squamous cell carcinoma of oropharynx and upper esophagus, pancreatic carcinoma and hepatocellular carcinoma Arsenic Squamous cell carcinoma of skin, lung cancer and angiosarcoma of the liver Arsenic is present in cigarette smoke Asbestos Lung carcinoma and mesothelioma Exposure to asbestos is more likely to lead to lung cancer than mesothelioma Cigarette smoke Carcinoma of the oropharynx, esophagus, lung, kidney and bladder Most common carcinogen worldwide; polycyclic aromatic hydrocarbons are particularly carcinogenic Nitrosamines Stomach carcinoma Found in smoked foods; high rate of stomach carcinoma in Japan Naphthylamine Urothelial carcinoma of the bladder Derived from cigarette smoke Vinyl chloride Angiosarcoma of the liver Occupational exposure; used to make PVC Nickel, chromium, beryllium or silica Lung carcinoma Occupational exposure Thorotrast Angiosarcoma of the liver Contrast for X-ray Radon Lung carcinoma Generated from radioactive decay of uranium
- 24. Basement Membrane Lymphatics – Lymph nodes spread Carcinomas Blood vessel – other organ spread Sarcoma Cadherins Cadherins CARCINOMA SPREAD 1. Downregulation of E-Cadherins 2. Attachment to laminin 3. Destroy BM using collagenase type IV 4. Attach to fibronectin 5. Enter vascular/lymphatic space Except 1. Follicular Thyroid 2. Renal cell Carcinoma 3. Hepatocellular Carcinoma 4. Choriocarcinoma
- 31. RC: Reticulocyte Count RC: Hematocrit 45 Normocytic anemia Reticulocyte count might be falsely elevated. Correction is needed. RC > 3% Good bone marrow response.
- 34. α α α α α α α α α α α α α α α α α α α α α α α α Normal Carrier: Asymptomatic No abnormalities α-thalassemia minor: Asymptomatic or mild anemia Hb H disease: Symptomatic Hemolytic and microcytic anemia Splenomegaly Incompatible with life Hydrops fetalis Hemoglobin Barts α-Thalassemia decreased production of alpha globin due to a gene deletion. Trans: Africa Cis: Asia
- 35. β β β β Normal β thalassemia minor: Asymptomatic Increased RBC and microcytic anemia Target cells, increased HbA2 β thalassemia intermediate β thalassemia major: Severe anemia a few months after birth, no HbA β-Thalassemia decreased production of beta globin due to a gene mutation. β+ β β β β β β β β β+β+ β0 β β β0β0
- 36. β-Thalassemia Severe anemia a few months after birth (because of fetal hemoglobin) Ineffective erythropoiesis – expansion of hematopoiesis into skull and facial bones. (chipmunk and X-ray appearance) Aplastic crisis in parvovirus. Chronic transfusions can lead to hemochromatosis.
- 37. Small bowel Storage is depleted within YEARS Pancreatic insufficiency Ileum damage due to Crohn
- 38. RBC, White cells and Platelets have molecules to protect them from Complement. CD55 (DAF)– Decay of C3 convertase MIRL - Membrane inhibitor of reactive lysis Connected by anchoring proteins (GPI) In PNH, GPI is absent due to a myeloid stem cell defect (risk for developing AML). During the night, due to shallow breathing we retain CO2 and complement activates due to respiratory acidosis. Paroxysmal Nocturnal Hemoglobinuria
- 39. INTERMEDIATE FILAMENTS Keratin Epithelium (Carcinoma) Vimentin Mesenchyme (Sarcoma) Desmin Muscle GFAP Neuroglia Neurofilament Neurons OTHERS PSA Prostatic epithelium Estrogen Receptor Breast epithelium Thyroglobulin Thyroid follicular cells Chromogranin Neuroendocrine cells (Small Cell Ca lung and carcinoid tumors) S-100 Melanoma
- 40. 1 2 PRIMARY Hemostasis 1. Injury occurs – Transient vasoconstriction (mediated by neural reflex and endothelin) 2. Platelets adhesion 1. Von Willebrand factor binds to subendothelial collagen 2. Platelets bind vWF using GP1b receptor 3. Platelets degranulate 1. ADP – induces GP2b/3a (platelet aggregation) 2. Thromboxane A2 – derivative of COX 4. Platelet aggregation using fibrinogen, which is converted into Fibrin (I) by Thrombin (II). vWF gp 1b ADP TA2 3 4 Fibrinogen Mucosal bleeding (epistaxis), Intracranial bleeding, skin bleeding (petechiae) Deep tissue bleeding into muscles, joints. Rebleeding after surgery. PTPTT XII XI IX VIII VII X I II VIntrinsic Extrinsic SEC + TT + Better for Heparin Better for Coumadin, Warfarin, Cirrhosis Hemophilia A Hemophilia B Von Willebrand Disease K K K K DIC – Pathologic activation of coagulation cascade Dx: D-dimer increase Inhibited by Aspirin Protein C/S -K 4
- 51. Rheumatoid Arthritis and early HIV LN draining tissue w/Cancer Viral Infection
- 59. Intima Media Adventitia Intima – Endothelial cells on a basement membrane Media – Smooth muscle Adventitia – Connective tissue 3. Atherosclerosis 4. Arteriolosclerosis 5. Monckeberg medial sclerosis 6. Aortic Dissection 7. Aneurysm Large Vessel vasculitis: Aorta and its branches. 1. Temporal (Giant cell) arteritis 2. Takayasu Arteritis Medium Vessel Vasculitis: Muscular arteries. • Polyarteritis Nodosa • Kawasaki Disease • Buerger Disease Small Vessel Vasculitis • Wegener Granulomatosis • Microscopic Polyangiitis • Churg-Strauss Syndrome 1 2 3 4 5 6 7