Review of Pathology and Genetics G Seventh Edition R V d e t Gobind Rai Gargi MBBS MD n (Gold Medalist) Ex-Assistant ProfeUssor (Pharmacology) MAMC, Delhi, India Director Ayush Institute of Medical Sciences - Delhi, India 9 Sparsh Gupta MBBS MD 9 (Gold Medalist) Assistant Professor (Pharmacology) rVMMC and Safdarjung Hospital, Delhi, India i h a t The Health Sciences Publisher New Delhi | London | Panama | Philadelphia https://kat.cr/user/Blink99/ Jaypee Brothers Medical Publishers (P) Ltd Headquarters Jaypee Brothers Medical Publishers (P) Ltd 4838/24, Ansari Road, Daryaganj New Delhi 110 002, India Phone: +91-11-43574357 Fax: +91-11-43574314 Email: [email protected] Overseas Offices J.P. 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Jaypee Brothers Medical Publishers (P) Ltd The Bourse 17/1-B, Babar Road, Block-B, Shaymali 111, South Independence Mall East Mohammadpur, Dhaka-1207 Suite 835, Philadelphia, PA 19106, USA Bangladesh Phone: +1 267-519-9789 Mobile: +08801912003485 Email: [email protected] Email: [email protected] Jaypee Brothers Medical Publishers (P) Ltd Bhotahity, Kathmandu, Nepal Phone: +977-9741283608 Email: [email protected] Website: www.jaypeebrothers.com Website: www.jaypeedigital.com © 2015, Gobind Rai Garg, Sparsh Gupta The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book. All rights reserved. No part of this publication maybe reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers. 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This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought. Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity. Inquiries for bulk sales may be solicited at: [email protected] Assistant Editors: Mrs Praveen Kumari, Mrs Krishna Gupta Review of Pathology and Genetics First Edition: 2009 Second Edition: 2010 Third Edition: 2011 Fourth Edition: 2012 Fifth Edition: 2013 Sixth Edition 2014 Seventh Edition 2015 ISBN: 978-93-5152-867-8 Printed at https://kat.cr/user/Blink99/ G R V d e t i Dedicatned to U My parents, wife Praveen, son Ayush and other family members - —Gobind Rai Garg 9 My family members and 9 my teachers (Shri SK Suri and Mrs V Gopalan) r i h —Sparsh Gupta a t https://kat.cr/user/Blink99/ Preface to the Seventh Edition G We acknowledge the support shown by each of our esteemed readers (present and past) for placing the book at the numero uno position amongst the pathology books for PGMEE. To meet the expectations of students, we have tried to further improve this seventh edition. R The book has been fully colored to increase its appeal to the esteemed readers. We have intentionally chosen the topic of ‘Immunology’ because apart from being very important, it is considered as one of the mVost difficult chapters of Pathology. Dear friends, the apprehension regarding the National Eligibility Cum Entrance Test (NEET) has now been taken care of as the examination pattern has not been modified drastically. Cracking the NEETd exam and other important PG examinations require a thorough knowledge and understanding of the subject. Readers of this book have got an edge over others because of the strong theory and conceptual questions. This along with the key pointes given under the heading of various boxes in the chapters has helped many of you to get extremely good ranks in NEET 2013, 14 and 2015. It is a humble request from our side that all the chapters (and not tonly general pathology) of this book has to be read by the student so as to maximise the benefit. This is because many additiional concepts and questions asked frequently in the exam n have been explained in systemic pathology chapters. This is one important point which came as a gist differentiating the people getting a good rank in NEET versus those who did not. U In our constant endeavour to improvise the book, there has been incorporation of important additions in almost all chapters along with the new section of Most recent questions. The question bank of the every chapter has been subdivided into smaller portions. It will help students to solve MCQs after reading the theory of a particular topic of a chapter. - For getting a grasp on the NEET questions in a better way, a new section in the end comprising of Image Based Questions has also been added. 9 In this seventh edition, we have added a lot of diagrams and flow charts to make learning interesting and easier. Another salient feature of this edition is the updating9 of appropriate authentic references from standard textbooks particularly in regard to the controversial questions so that reader gets all the relevant information under one roof. Other salient features of the current edition are: r i • All references have been uphdated from Robbins 9th edition • The question bank has been expanded and includes the most recent questions • More color plates for imaage based questions have been added • A summary of important information added in Robbins 9th edition has been mentioned separately at the end of each chapter. t We have fully revised the book and corrected the typographical and some other errors present in the previous editions. We have also added plenty of vital information under the heading of ‘Concept’, ‘Info’ and ‘Subject Links’ at multiple places in almost all the chapters in the book. Further, we have also expanded some of the old topics. Questions from latest entrance examinations of AIIMS have been added. Several other questions have been incorporated from PGI, DNB and other state PG entrance examinations. In some topics, there are contradictions between different books. In such a situation, we have quoted the text from Harrison’s Principles of Internal Medicine, 18th edition. To help the students to understand the subject better, Dr Gobind has started Ayush Institute of Medical Sciences. Any query regarding the admission in the same maybe addressed to Dr Gobind at the under mentioned e-mail ID. We must admit hereby that despite keeping an eagle’s eye for any inaccuracy regarding factual information or typographical errors, some mistakes must have crept in inadvertently. You are requested to communicate these errors and send your valuable suggestions for the improvement of this book. Your suggestions, appreciation and criticism are most welcome. April 2015 Gobind Rai Garg Sparsh Gupta E-mail: [email protected] [email protected] https://kat.cr/user/Blink99/ Preface to the First Edition Pathology is one of the most difficult and at the same time most important subject in various postgraduate entrance examinations. As we experienced it ourselves, most of the students preparing for postgraduate entrance examinations are in a dilemma, whether to study antegrade or retrograde. Antegrade study takes a lot of time and due to bulky textbooks, some important questions are likely to be missed. In a retrograde study, the students are likely to answer the frequently asked MCQs but new questions are not covered. We have tried to overcome the shortcomings of both of the methods while keeping the advantages intact. In this book, we have given a concise and enriched text in each chapter followed by MCQs from various postgraduate entrance examinations and other important questions likely to come. The text provides the advantage of antegrade study in a short span of time. After going through the book, it will be easier for the student to solve the questions of most recent examinations, which are given at the end of the book. Eighth edition of Robbins is just to strike the Indian market. We have arranged this edition directly from US and added the references from its text. Further, important differences between 7th and 8th edition of Robbins have been mentioned with the relevant questions. It is very difficult and at times very confusing to remember large number of pathological features. To make learning easy, several easy to grasp MNEMONICS have been given throughout the text. Despite our best efforts, some mistakes might have crept in, which we request all our readers to kindly bring to our notice. Your suggestions, appreciation and criticism are most welcome. Gobind Rai Garg Sparsh Gupta E-mail: [email protected] [email protected] https://kat.cr/user/Blink99/ Acknowledgments G When emotions are profound, words sometimes are not sufficient to express our thanks and gratitude. With these few words, we would like to thank our teachers at University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, for the foundation they helped to lay in shaping our careers. R We are especially thankful to Dr KK Sharma, Ex-Professor and Head, Department of Pharmacology, UCMS, Delhi who has been a father-figure to whole of the department. Prof CD Tripathi, (Director-ProfesVsor and Head, VMMC and Safdarjung Hospital). We would also like to acknowledge the encouragement and guidance of Prodf CD Tripathi, (Director Professor and Head, Pharmacology, VMMC and Safdarjung Hospital), Dr SK Bhattacharya (Professor and Head, Hindu Rao Hospital), Dr Uma Tekur (Director Professor, MAMC), Col (Dr) AG Mathur (Professor, ACMS),e Dr Vandana Roy (MAMC) and Dr Shalini Chawla (MAMC), all professors in the department of Pharmacology, in the completion of this book. t We feel immense pleasure in conveying our sincere thanks to all the residents of department of Pharmacology at VMMC, i MAMC and ACMS for their indispensable help and support. n No words can describe the immense contribution of our parents, Ms Praveen Garg, Ms Ruhee, Mr Nitin Misra, Ms Dhwani Gupta, Mr Rohit Singla and Mrs Komal Singla, wUithout whose support this book could not have seen the light of the day. We want to extend our special thanks to Dr Sonal A ggarwal (ESI Hospital, Delhi) and Dr Raina SG (AIIMS, Delhi) for their unconditional support in the making of this edition. - We would also like to extend our special thank s to Dr Sonal Pruthi (UCMS, Delhi), Dr Smiley M Gupta (Kerala), Dr Saurabh Jain (TSMA, Tver, Russia), Dr Amrita Talwar 9(ACMS, Delhi), Dr Avinash A, Dr Nikita Mary Baby, Dr Mamta Nikhurpa, Dr Rihas Mohammed, Dr Anuradha Tiwari (ACMS, Delhi) and Dr Sandeep Goel (MD Radiodiagnosis, AIIMS). Although it is impossible to acknowled9ge the contribution of all individually, we extend our heartfelt thanks to: • Dr Bhupinder Singh Kalra, Assistant Professor (Pharmacology), MAMC, Delhi r • Lt Col (Dr) Dick BS Brashier, Associate Professor (Pharmacology), AFMC, Pune i • Lt Col (Dr) Sushil Sharma, Associate Professor (Pharmacology), AFMC, Pune h • Lt Col (Dr) Dahiya, Associate Professor (Pharmacology), AFMC, Pune • Dr Nitin Jain, DCHa, DNB (Pediatrics, Std), Delhi • Dr Sushant Verma, MS (General Surgery), MAMC, Delhi • Dr Kapil Dev tMehta, MD (Pharmacology), UCMS, Delhi • Dr Saurabh Arya, MD (Pharmacology), UCMS, Delhi • Dr Deepak Marwah, MD (Pediatrics), MAMC, Delhi • Dr Shubh Vatsya, MD (Medicine), MAMC, Delhi • Mr Rajesh Sharma, MBA • Dr Puneet Dwivedi DA (Std), Hindu Rao Hospital, Delhi • Dr Sandeep Agnihotri, DVD, Safdarjung Hospital, Delhi • Dr Harsh Vardhan Gupta MD, Pediatrics (Std), Patiala • Mr Tarsem Garg, LLB, DM, SBOP • Dr Pardeep Bansal, MD (Radiodiagnosis), UCMS, Delhi • Dr Pankaj Bansal, MS (Orthopedics), RML Hospital, Delhi • Dr Pradeep Goyal, MD (Radiodiagnosis), LHMC, Delhi • Dr Rakesh Mittal, MS (Surgery), Safdarjung Hospital, Delhi • Dr Amit Miglani, DM (Gastroenterology), PGI, Chandigarh • Dr Sachin Gupta DA, DMC (Ludhiana) • Dr Reenu Gupta DGO BMC (Bangalore) • Dr Shiv Narayan Goel, MCh (Urology), KEM, Mumbai https://kat.cr/user/Blink99/ Review of Pathology • Dr Kamal Jindal, Assistant Professor (Physiology), LHMC, Delhi • Dr Gaurav Jindal, MD, Radiodiagnosis Resident, Boston, USA • Dr Saket Kant, MD (Medicine UCMS), DM (Endocrinology, BHU) • Dr Mukesh Kr Joon, DM (Cardiology), Udaipur, Rajasthan • Dr Amit Garg, Assistant Professor (Psychiatry), IHBAS, Delhi • Dr Garima Mahajan, MD (Pathology), UCMS, Delhi • Dr Ravi Gupta, MD (Psychiatry), Jolly Grants Medical College, Dehradun, Uttarakhand • Dr Shashank Mohanty, MD (Medicine), Udaipur, Rajasthan • Dr Amit Shersia, MS (Orthopedics), MAMC, Delhi • Dr Mohit Gupta, DCP, DNB (Pathology), Delhi • Dr Mayank Dhamija, DCH, DNB (Pediatrics), DNB (Hemato-oncology), Delhi Last but not the least, we would like to thank Shri Jitendar P Vij (Group Chairman), M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, publishers of this book and the entire PGMEE team, for their keen interest, innovative suggestions and hardwork in bringing out this edition. April 2015 Gobind Rai Garg Sparsh Gupta From the Publisher’s Desk We request all the readers to provide us their valuable suggestions/errors (if any) at: [email protected] so as to help us in further improvement of this book in the subsequent edition viii https://kat.cr/user/Blink99/ References G • Robbin’s Pathological Basis of Diseases, 9th edition • Harsh Mohan’s Textbook of Pathology, 7th edition R • Harrison’s Principles of Internal Medicine, 18th edition • Current Medical Diagnosis and Treatment 2015 V • Wintrobe’s Clinical Hematology, 12th edition • Ackerman’s Surgical Pathology, 10th edition d • Sternberg’s Diagnostic Surgical Pathology, 5th edition e SYMBOLS USED IN BOXES ON ‘HIGH YIELD POINTS’ t i • Key points n • Definition U • Mnemonic - • Concept Concept 9 9 • Questions asked in most recent exam r i h a t https://kat.cr/user/Blink99/ Contents Important Notes of New Chapter Added in Robbins 9th Edition xiii-xvi 1. Cell Injury 1 Chapter Review 1 Multiple Choice Questions 10 Explanations 18 2. Inflammation 31 Chapter Review 31 Multiple Choice Questions 46 Explanations 55 3. Hemodynamics 71 Chapter Review 71 Multiple Choice Questions 78 Explanations 82 4. Genetics 89 Chapter Review 89 Multiple Choice Questions 106 Explanations 114 5. Neoplasia 133 Chapter Review 133 Multiple Choice Questions 151 Explanations 161 6. Immunity 183 Chapter Review 183 Multiple Choice Questions 206 Explanations 217 7. Anemia and Red Blood Cells 239 Chapter Review 239 Multiple Choice Questions 259 Explanations 272 8. White Blood Cells and Platelets 297 Chapter Review 297 Multiple Choice Questions 319 Explanations 332 9. Cardiovascular System 361 Chapter Review 361 Multiple Choice Questions 379 Explanations 388 https://kat.cr/user/Blink99/