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.

1. Part 2

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

7. CAUSES:
Ischemia
Hypertension (LV Hypertrophy)
Dilated cardiomyopathy
Myocardial infarction
Restrictive cardiomyopathy
Heart Failure Cells – Macrophages consume
free blood. Hemosiderin latent macrophages.
TX: ACE inhibitor

8. CAUSES:
Left side Heart failure (most
common)
Left to right shunt
Chronic lung disease (cor pulmonale)
May lead to
cirrhosis

9. PAN

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

12. OBSTRUCTIVE RESTRICTIVE
FVC
FEV1
FEV1/FVC (<80%)
TLC
FVC
FEV1
FEV1/FVC (>80%)
TLC
Can’t bring air INTO the lung
-Amiodarone and Bleomycin
Can’t take air OUT of the lung

14. Lobar PneumoniaBronchopneumonia Interstitial Pneumonia
Bacterial
S. Pneumoniae (95%)
Klebsiella Pneumoniae –Alcoholics,
Elderly people
Staph Aureus (Most common)
H. Influenzae
Pseudomonas Aeruginosa – CF patients
Mycoplasma Pneumonia (Most common)
Chlamydia Pneumoniae
RSV (Most common in infants)
Atypical

15. Respiratory Epithelium
Basement Membrane
Lamina Propria
Hypertrophied Mucinous Glands
Cartilage
CHRONIC BRONCHITIS

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

17. Pneumoconiosis
“Black Lung”
Anthracosis
Mild exposure to carbon

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

20. Lung Malignancies and associated Paraneoplastic
Syndromes
Small Cell
• SIADH (ectopic ADH)
• Cushing syndrome (ectopic ADH)
• Lambert-Eaton myasthenic syndrome
• Cerebellar ataxia
Squamous Cell • Hypercalcemia
Adenocarcinoma
• Hypertrophic osteoarthropathy
• Dermatomyositis or Polymyositis
• Migratory thrombophlebitis (Trosseau Syndrome)

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

24. Lung Hypoplasia

25. Normal Esophageal Epithelium
-Non-keratinized Stratified Squamous
Barrett’s Esophagus
Non-ciliated Columnar w/Goblet Cells

26. Increased Intracranial Pressure1
Increased Vagal stimulation2
Acetylcholine
PCR*
Acid Production
ACh
3
*Parietal Cell Receptor
CUSHING ULCER

27. Autoimmune
Gastritis
(Parietal cells)
Parietal
Parietal
G
cell
H. Pylori
Gastritis
(Gastrin cells)
IFAcid
Duodena
l Ulcer
Peptic Ulcer
(Intestinal
Cancer)

28. Superior Mesenteric Vein
Inferior Mesenteric Vein
Atrial Fibrillation
Polyarteritis Nodosa
Polycythemia Vera
Lupus Anticoagulant
Small Bowel
Infarction

29. Celiac Disease
Tropical Sprue
Folic
Acid
Vit
B12

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

34. Globin Aminoacids
Protein
Heme
Iron
Protoporphyrin
Unconjugated
Bilirubin
Albumin
Conjugated
Bilirubin
Bile duct
CTP*
*Canalicular Transport Protein
1
1. Gilbert sx, Crigler Najjar sx
2. Dubin Johnson sx (black liver),
Rotor sx
3. Obstructive Jaundice (gallstones,
pancreatic carcinoma,
cholangiocarcinoma, parasites,
liver fluke.
2
UDP-GT
3
UCB CB
(Water
soluble)
&

36. Mental Status changes,
asterixis, coma.
Hypoalbuminemia

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

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.

44. E6: Increases Destruction of p53
E7: Increases Destruction of Rb

45. 66% 33%Chance to reverse <10% 0%

46. Psammomma
Bodies
1. Papillary Carcinoma of the
Thyroid
2. Papillary Serous Carcinoma
(Endometrium or Ovary)
3. Meningioma
4. Mesothelioma

47. Luteinizing Hormone –
Induces production of
Androgen
Polycystic Ovarian Disease
Sex Core Stromal Tumors
Follicle Stimulating Hormone –
Converts Androgen into Estradiol
Sex Core Stromal Tumors
Estradiol helps oocyte mature,
starts proliferative phase in the
endometrium
Germ Cell Tumors
(2ND most common)
Theca Cells
Granulosa
Cells
Zona Pellucida
Surface epithelium – Ovary is
lined by epithelium
Surface Epithelial Tumors
(most common) CA-125
BRCA1 – serous carcinoma

48. Endodermal Sinus
(Yolk Sac) Tumor Choriocarcinoma
DysgerminomaCystic Teratoma &
Embryonal Carcinoma
AFP
β-hCG

49. Teratogen Effect
Alcohol Most common cause of mental retardation.
Facial abnormalities and microcephaly
Cocaine Intrauterine growth retardation and placental
abruption
Thalidomide Limb defects
Cigarette smoke Intrauterine growth retardation
Isotretinoin Spontaneous abortion, hearing and visual
impairment
Tetracycline Discolored teeth
Warfarin Fetal bleeding
Phenytoin Digit hypoplasia and cleft lip/palate

50. 1. Antidiuretic
Hormone
(ADH)
2. Oxytocin
1. Prolactin
2. Growth
Hormone
3. ACTH
4. TSH
5. LH
6. FSH

51. Mineralocorticoids
(Aldosterone)
Glucocorticoids
(Cortisol)
Sex Hormones
(Testosterone)
Cushing Sx
Hyperaldosteronism
21-Hydroxylase deficiency

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

53. Cholesterol
Pregnenolone
Mineralocorticoids Cortisol Sex Steroids
Mineralocorticoids
21-h 21-h11-h
11-h
21-hydroxylase deficiency
VS
11-hydroxylase deficiency
SALT-WASTING sx with
Hyperkalemia and Hypovolemia
17-h

55. Epinephrine Norepinephrine
Metanephrine Normetanephrine
Vanillylmandelic Acid (VMA)
MAO
Pheochromocytoma can be
diagnosed by Increased
metanephrine and/or VMA

56. 1
1. Acute Mastitis
• Purulent Nipple Discharge
2. Periductal Mastitis
• Seen in Smokers, nipple retraction
3. Mammary Duct Ectasia
• Green-brown Discharge
4. Fat Necrosis
• Related to trauma
5. Fibrocystic Change
• Lumpy breast in upper outer quadrant
6. Intraductal Papilloma
• Bloody nipple discharge with
myoepithelial cells
7. Fibroadenoma
• Estrogen Sensitive
8. Phyllodes Tumor
• Leaf-like projections
9. Ductal Carcinoma In Situ
• 9* Paget’s Disease
10. Invasive Ductal Carcinoma
11.Lobular Carcinoma In Situ
• Lacks e-cadherin, multifocal, bilateral
12.Invasive Lobular Carcinoma
2 3
4
5
Lobes
6
7 8
9
9*
10
11 12
ER, PR (Nucleus) =
Tamoxifen
Her2/neu (Cytoplasm) =
Trastuzumab

57. Berry Aneurysms
1. Lack media layer
2. Subarachnoid Hemorrhage
3. Marfan and Adult PKD

58. Ruptures in Epidural Hematomas

60. Grey matter
-Dementia
White matter
Lateral Ventricles
Deeper Neurons
Basal ganglia
-Movement
problems
Straitum
1. Caudate Nucleus
2. Putamen
-Huntington’s

62. Giant Cell Tumor
Osteomyelitis (Children)
Osteomyelitis (Adults)
Osteosarcoma
Ewing Sarcoma
Chondroma / Chondrosarcoma

63. DNA
RNA
AMP GMP
Hypoxanthine Guanine
Xanthine
Uric Acid
Xanthine Oxidase
GOUT
HGPRT
Lesch-
Nyhan

64. Polymyositis CD8 T cells
Dermatomyositis CD4 T cells –
Anti-Jo-1 antibody
Muscular Dystrophy – Dystrophin
mutation or deletion

65. Hemidesmosome Basement membrane
Pemphigus Vulgaris
Bullous Pemphigoid
Staphylococcal Scalded Syndrome
Toxic Epidermal Necrolysis