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PATHOLOGY SECRETS, THIRD EDITION

PATHOLOGY SECRETS, THIRD EDITION

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Pathology–Examinations, questions, etc, Pathology–Examination Questions. QZ 18.2 D161pa 2009]

Ivan Damjanov

Acquisitions Editor: Jim Merritt
Developmental Editor: Barbara Cicalese
Project Manager: Mary Stermel
Marketing Manager: Allan McKeown


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Book Details
 Price
 4.00
 Pages
 522 p
 File Size 
 3,686 KB
 File Type
 PDF format
 ISBN
 978-0-323-05594-9    
 Copyright©   
 2009 by Mosby, Inc.,
 an affiliate of Elsevier Inc.

CONTRIBUTORS
Ivan Damjanov, MD, PhD
Professor of Pathology, Department of Pathology and Laboratory Medicine, University of Kansas School of Medicine, Kansas City, Kansas
Snjezˇana Dotlic´, MD
Staff Pathologist, Clinical Hospital Center Zagreb, Zagreb, Croatia
Bruce A. Fenderson, PhD
Professor of Pathology, Department of Pathology, Anatomy, and Cell Biology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
Zoran Gatalica, MD, DSc
Professor of Pathology, Department of Pathology, Creighton University School of Medicine, Omaha, Nebraska
Pe´ter P. Molna´r, MD, DSc
Professor of Pathology, Department of Pathology, University of Debrecen School of Medicine, Medical and Health Sciences Center, Debrecen, Hungary
Anamarija Morovic´, MD
Clinical Instructor, Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
Marin Nola, MD, PhD
Associate Professor of Pathology, Department of Pathology, University of Zagreb School of Medicine, Zagreb, Croatia

PREFACE
This book was prepared for medical students in the hope that they will use it as a study guide
and a source of succinct information complementing other sources that have been made
available to them by their professors. I also hope that the book will help them prepare for
seminars and discussion groups, both in the standard medical school setting and in the new
problem-based curriculum. Finally, I hope that some students will use it while reviewing the
pathology material for the board examinations.
During the past 30 years, I have taught pathology in several medical schools and have
thus had the privilege of interacting with many medical students. Many of them, assuming
that I have gathered some experience in teaching, used to ask me how to study pathology.
My usual answer was this: Try to develop your own style, find out what is the most efficient
way of studying (i.e., discover whatever works best for you), and then apply this approach
systematically by using all means that you have at hand.
Over the years, I learned that some medical students profit most from lectures, others from
books, whereas still others need both the books and the lectures. Some students like to use
atlases, whereas others like to study the pictures from the computers. Some students love to
study microscopy slides and autopsy material, whereas others think that such exercises are a
waste of time. In other words, there are no secret ways to learn pathology or, for that matter,
anything else.
If there are no secrets to be offered on how to study pathology, what would then be a good
reason to read a book titled Pathology Secrets? My answer to the astute student asking this
question is simple: This book might help you see more clearly the ‘‘secret’’ pearls of wisdom
contained in the ‘‘big books’’ (i.e., the prescribed textbooks of pathology), help you tackle the
material presented during the course in various other formats, and help you concentrate on
the ‘‘important’’ topics. It could also help you understand better the basic topics of pathology
by presenting them from a different angle than you have seen than in the standard textbooks.
In addition, because many questions in this book are answered in a concise, bulleted form, I
thought that Pathology Secrets could help you acquire the essential concepts of pathology more
easily and in a more systematic way than if you had to compile such an outline on your own.
As an added bonus, I have also included a few mnemonics here and there and a few other
tricks to help you memorize for the long term the important facts, information you could use
later in the clinics.
This book contains close to 2000 questions dealing with the most important topics of
pathology. Almost all these questions were classroom tested; that is, most of these questions
were used in discussions with medical students. The answers provided to these questions
are short and in a format that I would expect from my students attending seminars and
discussion groups or in written essay–type examinations. I hope that my presentation of
these answers conveys a clear message: Always cover the main topics; ignore the trivia and
unnecessary details. Be systematic! Be concise! And remember: You do not have to know
everything; nobody knows everything.
At the end of this Preface, I would like to acknowledge the input of all those medical
students who have, in one form or another, helped me develop the Socratic course of
pathology outlined here, formulate the questions, and summarize the answers. I must also
acknowledge the contributions of my colleagues, or former students and collaborators from
other universities in the United States and Europe, who helped me put this book together.
—Ivan Damjanov, MD, PhD


TOP 100 SECRETS
These secrets are 100 of the top board alerts. They summarize the concepts,
principles, and most salient details of pathology.

1. The cell volume depends on the proper function of the cell membrane, which remains
semipermeable only if properly energized with adenosine triphosphate (ATP).

2. Cell injury is accompanied by an increased concentration of free calcium ions in the hyaloplasm.

3. Cell death causes distinctive nuclear changes, including pyknosis, karyolysis, and karyorrhexis.

4. Necrosis is death of cells or tissues caused most often by ischemia or the action of toxic
substances and infectious pathogens.

5. Although apoptosis is also called programmed cell death, it can be also induced by exogenous
factors, such as viruses or drugs.

6. Hyperplasia is an increase in the size of a tissue or organ resulting from an increased number of
constituent cells, whereas hypertrophy entails enlargement of individual cells.

7. Inflammation involves a vascular, a cellular, and a humoral response.

8. Mediators of inflammation are produced by many cells, including endothelial cells and
inflammatory cells, and the liver, which is the main source of plasma proteins.

9. Hageman factor (clotting factor XII) plays a pivotal role in activating the kinin, complement,
clotting, and fibrinolytic systems.

10. Cytokines are multifunctional polypeptides that modulate the function of other cells.

11. Polymorphonuclear leukocytes are the principal cells of acute inflammation, whereas
lymphocytes, macrophages, and plasma cells participate in chronic inflammation.

12. Edema is accumulation of fluid in the interstitial spaces and the body cavities.

13. Thrombosis is a pathologic form of coagulation of circulating blood inside intact vascular
spaces.

14. The Virchow triad includes three factors that promote thrombosis: changes in the vessel wall,
changes in blood flow, and changes in the composition of blood.

15. Thromboembolism is the most common form of embolism.

16. Disseminated intravascular coagulation is a form of thrombosis in small blood vessels
associated with uncontrollable bleeding because of consumption of coagulation factors in
blood.

17. Infarct is an area of ischemic necrosis that is usually caused by occlusion of vessels or
hypoperfusion of tissues with blood.

18. Shock, a condition caused by hypoperfusion of tissues with blood, can be classified as
cardiogenic, hypovolemic, and distributive (related to vasodilatation).

19. Hypersensitivity reactions involve cell and tissue injury caused by antibodies or products of
activated T lymphocytes.

20. Autoimmune diseases are based on the immune reaction against self-antigens.

21. Acquired immunodeficiency syndrome (AIDS), an infectious disease caused by the human
immunodeficiency virus (HIV), is characterized by profound suppression of the immune system
and susceptibility to infections, neurologic disorders, and malignancies.

22. Cancer is a synonym for malignant tumors.

23. The main groups of malignant tumors are carcinomas, sarcomas, lymphomas, and gliomas.

24. Carcinogens are cancer-inducing factors that include physical forces, chemicals, viruses, and
endogenous oncogenes.

25. Reactions of the host to the tumor can be classified as local or systemic and include various
inflammatory, immune, hormonal, circulatory, and neural processes.

26. Teratogens are chemical, physical, or biological agents capable of inducing developmental
abnormalities in a fetus.

27. Down syndrome, the most common autosomal chromosomal abnormality, is characterized by
mental deficiency and characteristic facial and somatic features.

28. According to the laws of Mendelian genetics, single gene defects are inherited as autosomal
dominant, autosomal recessive, or sex-linked dominant or recessive traits.

29. Atherosclerosis is a multifactorial disease that predominantly affects older people, but it can be
accelerated by hypertension, hyperlipidemia, and smoking.

30. Arterial hypertension is a multifactorial disease of unknown etiology, but it can also be
secondary to renal, endocrine, vascular, and neurologic diseases.

31. Vasculitis, an inflammation of vessels, is most often immunologically mediated.

32. Aneurysms are localized dilatations of the arteries most often caused by atherosclerosis and
hypertension.

33. Cardiac failure may be caused by inherent heart disease or extracardiac causes, such as
pressure overload in hypertension or volume overload in renal water retention.

34. Coronary heart disease is the most common cause of cardiac failure and the most common
cause of death in the United States.

35. Myocardial infarction represents an area of myocardial cell necrosis caused by ischemia.

36. Arrhythmia is the most common complication of myocardial infarction.

37. Endocarditis is most often caused by bacteria.

38. Cardiomyopathy occurs in three forms known as dilatated, hypertrophic, and restrictive
cardiomyopathy.

39. Ventricular septal defect, the most common noncyanotic congenital heart disease, is
characterized by a left-to-right shunt.

40. Tetralogy of Fallot, the most common cyanotic congenital heart disease, includes four
pathologic findings: ventricular septal defect, overriding dextraposed aorta, pulmonary artery
stenosis, and right ventricular hypertrophy.

41. Hypochromic microcytic anemia is most often caused by iron deficiency and chronic blood loss.

42. Sickle cell anemia is a hereditary hemoglobinopathy caused by a mutation of the a-globin gene.

43. Lymphomas—malignant tumors of lymphoid cells—are most often of B-cell origin.

44. Leukemia is a malignancy of hematopoietic and lymphoid cells characterized by the appearance
of malignant cells in the circulation.

45. Multiple myeloma, a malignancy of plasma cells, is associated with lytic bone lesions and
monoclonal gammopathy.

46. Hodgkin disease, a form of lymph node malignancy characterized by the presence of Reed–
Sternberg cells, occurs in several histologic forms.

47. Atelectasis is incomplete expansion of the lungs or the collapse of previously inflated lung
parenchyma.

48. Adult respiratory distress syndrome (ARDS) is caused by diffuse alveolar damage resulting
from injury of endothelial cells or pneumocytes forming the alveolar–capillary units.

49. Chronic obstructive pulmonary disease includes several diseases, the most important of which
are emphysema and chronic bronchitis.

50. Bronchial asthma is a chronic relapsing inflammatory obstructive lung disease presenting with
hyperreactivity of airways and periodic bronchospasm.

51. Acute pneumonia is an inflammation of lungs usually caused by viruses or bacteria.

52. Pneumoconioses are interstitial lung diseases caused by inhaled particles such as coal, silica, or
asbestos.

53. Most lung cancers originate from the epithelium of the bronchi and are related to smoking.

54. Esophagitis is most often caused by gastroesophageal reflux disease (GERD).

55. Atrophic gastritis, the most common form of gastritis, is most often caused by Helicobacter
pylori.

56. Peptic ulcers are prone to bleeding.

57. Carcinomas of the esophagus and stomach have poor prognosis.

58. Diarrhea can be classified as osmotic, secretory, exudative, malabsorptive, and mixed.

59. Malabsorption syndrome is characterized by steatorrhea and deficiency of fat-soluble vitamins.

60. Inflammatory bowel disease includes Crohn disease and ulcerative colitis, which share some
features but also differ in many aspects.

61. Carcinoma of the large intestine is the third most common form of cancer and the third most
common cancer-related cause of death in the United States. It occurs most often in the
rectosigmoid area.

62. Jaundice can be classified as prehepatic (hemolytic), hepatic, and posthepatic (obstructive).

63. Cirrhosis is equivalent to end-stage liver disease characterized by loss of normal hepatic
architecture, fibrosis, and the formation of regenerating nodules.

64. Hepatitis is most often caused by viruses, drugs, or immune mechanisms.

65. Chronic alcoholism may cause three pathologic changes in the liver: fatty liver, alcoholic
hepatitis, and cirrhosis.

66. Alcohol and biliary disease account for 80% of all causes of acute pancreatitis.

67. Diabetes mellitus, a disease characterized by hyperglycemia, is caused by insulin deficiency or
tissue resistance to insulin, and it occurs in two main forms called type 1 and type 2.

68. Uremia is a set of clinical and laboratory findings found in patients with end-stage kidney
disease.

69. Glomerulonephritis is immunologically mediated in most instances.

70. Pyelonephritis is a bacterial kidney infection.

71. The most important tumors of the kidneys and the urinary tract are renal cell carcinoma,
transitional cell carcinoma, and Wilms tumor.

72. Testicular tumors are derived from germ cells in 90% of cases and belong to two groups:
seminomas and nonseminomatous germ cell tumors (NSGCTs).

73. Prostate carcinoma is the most common malignant tumor in males.

74. Carcinomas of the vulva, vagina, and cervix are linked to human papilloma virus (HPV) infection.

75. Endometrial adenocarcinoma is linked to hyperestrinism.

76. Leiomyomas are the most common benign tumors of the uterus.

77. Breast carcinoma is the most common malignant tumor in females.

78. Hyperthyroidism may be caused by autoimmune mechanisms (e.g., in Graves disease), tumors
(e.g., follicular adenomas), or hyperfunctioning goiters.

79. Hyperparathyroidism, most often caused by parathyroid adenoma, is characterized by
hypercalcemia.

80. Hypofunction of adrenal glands is the cause of Addison disease, whereas hyperfunction causes
Cushing syndrome.

81. The three most important skin diseases caused by bacteria are impetigo, folliculitis, and acne.
82. Warts are caused by HPV infection.

83. Psoriasis is a common chronic skin disease of unknown etiology affecting 1% to 2% of the
population.

84. Skin cancer is related to sun exposure.

85. Basal cell carcinoma of the skin, the most common malignant tumor, is only locally invasive and rarely metastasizes.

86. Pigmented skin lesions may be benign (such as freckles, lentigo, and nevus) or malignant (such
as malignant melanoma).

87. Osteoporosis is a form of osteopenia characterized by a loss of both calcium salts and organic
matrix of the bones (osteoid).

88. The two most important diseases of the joints are rheumatoid arthritis and osteoarthritis.

89. Osteosarcoma occurs most often in children and young people, whereas chondrosarcoma has
its peak incidence in adults.

90. Duchenne muscular dystrophy is the most common genetic muscle disease.

91. The most important immunologic diseases of the muscle are polymyositis and myasthenia
gravis.

92. Rhabdomyosarcoma is a malignant tumor of striated muscle.

93. The most important forms of intracranial bleeding are intracerebral hemorrhage in
hypertension, subdural hematoma, subarachnoid hematoma, and epidural hematoma.

94. Infection of the brain and the meninges can occur through four main routes: vascular spread,
direct extension, ascending neural route, and penetrating wounds.

95. Tabes dorsalis is a spinal cord lesion caused by syphilis.

96. Multiple sclerosis is a demyelinating autoimmune disease characterized by a chronic relapsing
and remitting course.

97. Alzheimer’s disease, an old-age neurodegenerative disease of unknown etiology, is the most
common cause of dementia.

98. Most brain tumors are malignant.

99. Gliomas are malignant tumors of the central nervous system originating from astrocytes,
oligodendroglia cells, and ependymal cells.

100. Diabetic neuropathy is the most common peripheral nerve disease encountered in general
practice.

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