USMLE Step 1 Pat hoi gy Volume 1: Basic Pathology Chapters 1-9 Volume 2: Systemic Pathology Chapters 10- 28 Kartik "Carlo" Rangaraj, MD National Instructor •aOJfiiiGNAl EDUCATI& ... v 1.1 Kartik "Carlo" Rangaraj, MD National Instructor, Pathology Steven R. Daugherty, PhD Director, Faculty and Curriculum at Becker Professional Education Chicago, IL The United States Medical Licensing Examination~ (USMLE'l>) is a joint program of the Federation of State Medical Boards (FSMB) and National Board of Medical Examiners® (NBME'l>). United States Medical Licensing Examination, USMLE, National Board of Medical Examiners, and NBME are registered trademarks of the National Board of Medical Examiners. The National Board of Medical Examiners does not sponsor, endorse, or support Becker Professional Education in any manner. © 2013 by DeVry/Becker Educational Development Corp. All rights reserved. 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Request for permission or further information should be addressed to the Permissions Department, DeVry/Becker Educational Development Corp. 1 23 4 56 78 9 18 17 16 15 14 13 @ Dt:Vr'y/Bcckcr Educational Development Corp, AJI rights reserved. ii Pathology Volume 1: Basic Pathology Unit 1 General Principles of Pathology Chapter 1 Cellular Pathophysiology .. . .... . .... . ... .. ... . .... . .... . ... . 1-1 1 Overview of Cellular Pathophysiology .............................. 1-1 2 Tissue Hypoxia ............................................. 1-2 3 Free Radical Cell Injury ....................................... 1-20 4 Cellular Accumulations and Reversible Changes ...................... 1-23 5 Cellular Responses to Stress ........... ..... ................ ... 1-26 6 Cell Death (Necrosis) ............. ..... ................ ...... 1-30 7 Apoptosis .. ..... ................. ..... ................ ... 1-34 Chapter 2 The Inflammatory Reaction . . .... . ... .. ... . .... . .... . ... . .... . 2-1 1 Overview of Inflammation ......... ..... ................ ...... .. 2-1 2 The Process of Acute Inflammation ...... ..... ................ .... 2-4 3 Chronic Inflammation ........................................ 2-14 Chapter 3 Tissue Repair and Wound Healing . .... . ... . .... . ........ .. ... . . 3-1 1 Overview of Regeneration and Repair .............................. 3-1 2 Repair by Regeneration ........................................ 3-1 3 Types of Wound Healing ....................................... 3-4 4 Extracellular Matrix ............. ..... ................. ..... .. 3-6 Chapter 4 Hemodynamics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1 1 Normal Vascular Hemostasis ......... ..... ................ ...... 4-1 2 Hemodynamic Dysfunction ........... ..... ................. .... 4-3 3 Diseases of Hypercoagulability .... ..... ................. ..... .. 4-10 4 Thrombosis ... ................ ...... ................ ..... . 4-12 5 Embolism ................................................ 4-13 6 Infarction ................................................ 4-14 7 Hyperemia, Congestion, and Edema .............................. 4-15 8 Shock ................................................... 4-17 Chapter 5 Neoplasia ... .. ... . .... . ... .. ... . .... . .... . ... . .... . .... . .. 5-1 1 Types of Neoplasms . . . . . . . . . . . ............................... 5-1 2 Mechanisms of Carcinogenesis ......... ..... ................ ..... 5-4 3 Cancer Epidemiology ............... ..... ................ .... 5-15 © DcVry/Bcckcr Educational Development Corp. All rights reserved. iii Pathology 4 Diagnosis of Cancer ......... ..... ................. ..... ..... 5-16 5 Paraneoplastic Syndromes .. ...... ................ ..... ....... 5-17 6 Cancer Prevention .......................................... 5-18 Unit 2 Hematology Chapter 6 Red Blood Cell Pathology .. . .... . .... . ... . .... . .... . .... . ... . . 6-1 1 Red Blood Cells . . . . . . . . . . . . . . ............................... 6-1 2 Anemia ................................................... 6-4 3 Microcytic Anemias ......... ..... ................ ...... ....... 6-6 4 Macrocytic Anemias ....... ...... ................ ..... ....... 6-15 5 Normocytic Anemia ......................................... 6-19 6 Myelofibrosis .............................................. 6-30 7 Polycythemia .............. ..... ................. ..... ..... 6-31 Chapter 7 White Blood Cell Pathology . .... . ... .. ... . .... . ... .. ... . .... . . 7-1 1 Blood Cell Differentiation ...................................... 7-1 2 Review of Morphology. ........ ..... ................ ...... ..... 7-2 3 Quantitative Disorders ...... ..... ................ ...... ....... 7-3 4 Leukemias ................................................ 7-6 Chapter 8 Lymphoid Pathology .. ... . .... . .... . ... . .... . .... . ... . .... . . 8-1 1 Lymphoid Pathology Overview ... ................ ...... .......... 8-1 2 Lymph Nodes .............................................. 8-1 3 Spleen ................................................... 8-9 4 Thymus ............. ..... ................. ..... ......... 8-10 5 Plasma Cell Neoplasms ....................................... 8-11 Chapter 9 Immunohematology . . . .... . .... . ... . .... . .... . ... .. ... . .... . 9-1 1 ABO Blood Group Antigens .... ..... ................ ...... ...... 9-1 2 Determining the ABO Group .................................... 9-2 3 Rh Antigen and Non-Rh Antigen Systems ........................... 9-3 4 Patient Crossmatch ...... ..... ................ ...... ......... 9-5 5 Transfusion Reactions ......... ..... ................ ...... ..... 9-6 6 Hemolytic Disease of the Newborn (HDN) ........................... 9-7 @ Dt:Vr'y/Bcckcr Educational Development Corp, AJI rights reserved. iv Pathology Volume 2: Systemic Pathology Unit 3 Cardiovascular Pathology Chapter 10 Cardiovascular Disorders . .. . .... . .... . ... .. ... . .... . .... . .. . 10-1 1 Heart Failure ... ................ ...... ................ ..... 10-1 2 Ischemic Heart Disease ............. ..... ................. ... 10-8 3 Cardiomyopathy ........... . 10-15 4 Valvular Heart Disease ....... . 10-17 5 Endocarditis .... .......... . 10-21 6 Congenital Heart Disease ......... ...... ................ ..... 10-25 7 Myocardial and Pericardia! Disease .............................. 10-33 Chapter 11 Cardiovascular Pathology .. .. ... . .... . ... . .... . .... . .... . ... 11-1 1 Hypertension ... ................ ...... ................ ..... 11-1 2 Arteriosclerosis . . . . . . . . . . . . . . .... ...... ................ .... 11-3 3 Hyperlipoproteinemia ........................................ 11-6 4 Aneurysms ............................................... 11-9 5 Benign Vascular Tumors ...... . 11-11 6 Malignant Vascular Tumors .... . 11-13 7 Vasculitis ................ . 11-14 Unit 4 Respiratory Pathology Chapter 12 Pulmonary Pathology . . . .... . .... . ... . .... . .... . ... .. ... . .. . 12-1 1 Basics of the Pulmonary System ...... ..... ................ ..... 12-1 2 Pulmonary Function Tests ..................................... 12-2 3 Atelectasis ............................................... 12-3 4 Chronic Obstructive Lung Disease (COPD) ... ...... ................ . 12-5 5 Restrictive Lung Disease ......... ..... ................ ...... .. 12-9 6 Pulmonary Vascular Disease ... . 12-13 7 Lung Cancer .............. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-19 © DcVry/Bcckcr Educational Development Corp. All rights reserved. v Pathology Unit 5 Renal Pathology Chapter 13 Renal Pathology . .... . ... . .... . .... . ... .. ... . .... . ... .. ... . 13-1 1 Overview of the Renal System ... ................ ...... ......... 13-1 2 Renal Functional Anatomy ... ...... ................ ..... ....... 13-3 3 Renal Pathology ........................................... 13-11 4 Glomerular Disease ........................................ 13-14 5 Diseases Affecting Tubules and Interstitium ............... ..... ... 13-25 6 Infection .............. ..... ................. ..... ....... 13-28 7 Vascular Disease .......................................... 13-29 8 Urinary Tract Obstruction .................................... 13-31 9 Renal Failure .............. ..... ................. ..... .... 13-33 10 Tumors of the Kidney ......... ..... ................ ...... ... 13-34 11 Lower Urinary Tract Pathology ................................. 13-35 Unit 6 Gastrointestinal Pathology Chapter 14 Gastrointestinal (GI) Pathology. . .... . ... .. ... . .... . .... . ... . . 14-1 1 Gastrointestinal (GI) Pathology Overview .............. ...... ...... 14-1 2 Oral Cavity ......... ...... ................ ..... ........... 14-1 3 Esophagus ............................................... 14-2 4 Gastric Diseases ........................................... 14-6 5 Acute Erosive (Hemorrhagic) Gastritis ................ ...... ...... 14-8 6 Diarrhea .............. ..... ................. ..... ....... 14-16 7 Malabsorption Syndromes .................................... 14-22 8 Appendicitis ............................................. 14-23 9 Inflammatory Bowel Disease ... ...... ................ ..... .... 14-24 10 Hemorrhoids- Two Types .. ...... ................ ..... ....... 14-25 11 Small and Large Bowel Polyps ................................. 14-26 12 Intestinal Neoplasia ........................................ 14-27 Unit 7 Hepatobiliary Pathology/Pancreas Chapter 15 Hepatobiliary Pathology. . . .... . ........ . .... . .... . ... . .... . . 15-1 1 Hepatic and Biliary Pathology .................................. 15-1 2 Cirrhosis ................................................. 15-5 3 Cholestatic Diseases ......... ..... ................ ...... ..... 15-9 @ Dt:Vr'y/Bcckcr Educational Development Corp, AJI rights reserved. vi Pathology 4 Hepatic Inflammatory Diseases .. 15-12 5 Metabolic Liver Diseases ...... . 15-16 6 Hepatic Vascular Diseases ..... . 15-18 7 Hepatic Neoplastic Diseases ... . 15-19 Chapter 16 Pancreatic Pathology . . . .... . .... . ... . .... . .... . ... .. ... . .. . 16-1 1 Congenital Disorders ............... ..... ................ .... 16-1 2 Inflammation .............................................. 16-2 3 Neoplastic Disorders ......................................... 16-5 Unit 8 Reproductive Pathology Chapter 17 Male Reproductive Pathology ... . .... . ............. . .... . ... . 17-1 1 Congenital Abnormalities ..................................... 17-1 2 Penile Pathology ............... ..... ................ ...... . 17-2 3 Abnormalities of the Testes, Epididymis, and Scrotal Sac ............... 17-4 4 Testicular Tumors-Major Categories ............................. 17-6 5 Prostate ................................................. 17-8 6 Common Male Chromosomal Abnormalities ... ................ ..... 17-11 Chapter 18 Female Reproductive Pathology .. . ... . .... . .... . ... .. ... . ... . 18-1 1 Vulva Disorders ............................................ 18-1 2 Vaginal Disorders ........................................... 18-2 3 Cervical Disorders ............. ..... ................ ...... .. 18-3 4 Reproductive Physiology ......... ..... ................ ...... .. 18-5 5 Effects of Pregnancy ......... . 18-11 6 Menopause ............... . 18-11 7 Hirsutism and Virilization ..... . 18-12 8 Menstrual Dysfunction ....... . 18-14 9 Uterine Disorders ........... . 18-17 10 Fallopian Tube Disorders ...... . 18-20 11 Ovarian Disorders ........... ..... ................. ..... ... 18-21 12 Gestational Disorders .............. ..... ................. ... 18-23 13 Sexually Transmitted Diseases and Genital Infections ................. 18-27 14 Breast Anatomy ........................................... 18-31 15 Nipple Discharge ............... ..... ................ ...... 18-32 © DcVry/Bcckcr Educational Development Corp. All rights reserved. vii Pathology 16 Fibrocystic Change ......... . . 18-33 17 Benign Breast Tumors ....... . 18-34 18 Types of Breast Cancer ....... . 18-35 Unit 9 Endocrine Pathology Chapter 19 Endocrine Pathology . . .... . ... . .... . .... . ... . .... . .... . ... . 19-1 1 Overview of Pathology ....................................... 19-1 2 The Hypothalamus and Pituitary ................................ 19-3 3 The Hypothalamus and Pituitary: Anterior Pituitary ........... ..... ... 19-5 4 The Hypothalamus and Pituitary: Thyroid Hormone ........... ..... .. 19-10 5 The Hypothalamus and Pituitary: Adrenals ........................ 19-21 6 Endocrine Pancreas ........................................ 19-33 7 Calcium Metabolism and Bone ... ................ ...... ........ 19-47 Unit 10 Nervous Pathology Chapter 20 Central Nervous System Pathology .. . .... . ... . .... . .... . ... .. . 20-1 1 Basic Neuroanatomy ...... ..... ................ ...... ....... 20-1 2 Central Nervous System Developmental Diseases ....... ...... ....... 20-3 3 Cerebral Herniation ......................................... 20-9 4 Cranial Pressure Abnormalities ................................ 20-10 5 Head Trauma .............. . 20-12 6 Spinal Cord Lesions ......... . 20-15 7 Cerebrovascular Disease ...... . 20-21 8 Infectious Diseases ......... . 20-31 9 Degenerative Diseases ... .... . 20-39 10 Central Nervous Tumors ..... . . 20-43 Chapter 21 Peripheral Nervous System Pathology . .... . ... . .... . .... . ... .. . 21-1 1 Inflammatory Neuropathy ..................................... 21-1 2 Hereditary Neuropathy ... ...... ................ ..... ......... 21-2 @ Dt:Vr'y/Bcckcr Educational Development Corp, AJI rights reserved. viii Pathology Chapter 22 Optic Pathology .. .. ... . .... . ... .. ... . .... . ... .. ... . .... . .. 22-1 1 Anatomy of the Eye ............. ..... ................ ...... . 22-1 2 Congenital Abnormalities ..................................... 22-2 3 Eyelid Disorders ............................................ 22-3 4 Conjunctival Disorders ............... ..... ................ ... 22-4 5 Disorders of the Uvea .............. ..... ................. .... 22-6 6 Retinal Disorders ........................................... 22-7 7 Macular Degeneration ....................................... 22-10 8 Ocular Melanoma .............. ..... ................. ..... . 22-11 9 Glaucoma ... ................ ...... ................ ..... . 22-12 Unit 11 Musculoskeleton and Connective Tissue Disorders Chapter 23 Connective Tissue Disorders . ... . .... . .... . ... .. ... . .... . ... . 23-1 1 Types of Connective Tissue Disorders ... ...... ................ .... 23-1 Chapter 24 Joint Pathology . . ......... . ... . .... . ........ .. ... . .... . ... 24-1 1 Classification of Joint Pathologies ................................ 24-1 2 Noninflammatory Arthritis ..................................... 24-2 3 Inflammatory Arthritis ............... ..... ................ ... 24-5 4 Arthritis of Metabolic Origin ......... ..... ................ ..... 24-12 5 Septic Arthritis ........................................... 24-15 6 Joint Tumors ............................................. 24-16 Chapter 25 Bone Pathology .. . ... . .... . .... . ... .. ... . .... . ... .. ... . ... 25-1 1 The Skeleton ... ................ ...... ................ ..... 25-1 2 Congenital Bone Disease ......... ..... ................ ...... .. 25-4 3 Metabolic and Acquired Bone Disease ............................. 25-6 4 Trauma ................................................. 25-13 5 Infection ... ................ ...... ................ ..... .. 25-16 6 Bone-Forming Tumors ............... ..... ................ .. 25-18 7 Cartilage-Forming Tumors .................................... 25-20 8 Fibrous and Other Tumors .................................... 25-21 9 Metastatic Diseases ............. ..... ................ ...... 25-22 © DcVry/Bcckcr Educational Development Corp. 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