Pathology PDF
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Oklahoma Notes Basic-Sciences Review for Medical Licensure Developed at The University of Oklahoma, College of Medicine Suitable Reviews for: National Board of Medical Examiners (NBME), Part I Medical Sciences Knowledge Profile (MSKP) Foreign Medical Graduate Examination in the Medical Sciences (FMGEMS) Oklahoma Notes Pathology Second Edition John H. Holliman Daniel L Feeback NancyKHall Springer-Verlag New York Berlin Heidelberg London Paris Tokyo John H. Holliman, M.D. Department of Pathology College of Medicine Health Sciences Center The University of Oklahoma Oklahoma City, OK 73190 USA Daniel L. Feeback, Ph.D. Department of Anatomical Sciences College of Medicine Health Sciences Center The University of Oklahoma Oklahoma City, OK 73190 USA Nancy K. Hall, Ph.D. Department of Pathology College of Medicine Health Sciences Center The University of Oklahoma Oklahoma City, OK 73190 USA Library of Congress Cataloging-in-Publication Data Holliman, John H. Pathology. (Oklahoma notes) Rev. ed. of: Pathology I Nancy K Hall, Daniel L. Feeback, © 1987. 1. Pathology-Outlines, syllabi, etc. 2. Pathology Examinations, questions, etc. I. Feeback, Daniel L. II. Hall, Nancy K III. Title. IV. Series. [DNIM: 1. Pathology-examination questions. 2. Pathology outlines. QZ 18 H739pj RB32.H65 1987 616.07'076 88-2038 © 1987, 1988 by Springer-Ver/a~ New York Inc. All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer-Ver/ag, 175 Fifth Avenue, New York, New York 10010, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use of general descriptive names, trade names, trademarks, etc. in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Camera-ready text prepared by the authors. 987 6 543 2 1 ISBN-13: 978-0-387-96718-9 e-1SBN-13: 978-1-4684-0322-0 001: 10.1007/978-1-4684-0322-0 Preface to the Oklahoma Notes In 1973, the University of Oklahoma College of Medicine instituted a requirement for passage of the Part I National Boards for promotion to the third year. To assist students in preparation for this examination, a two week review of the basic sciences was added to the curriculum in 1975. Ten review texts were written by the faculty: four in anatomical sciences and one each in the other six basic sciences. Self-instructional quizzes were also developed by each diSCipline and administered during the review period. The first year the course was instituted the Total Score performance on National Boards Part I increased 60 points, with the relative standing of the school changing from 56th to 9th in the nation. The performance of the class has remained near the national candidate mean (500) since then, with a mean over the 12 years of 502 and a range of 467 to 537. This improvement in our own students' performance has been documented (Hyde et al: Performance on NBME Part I examination in relation to policies regarding use of test. J. Med. Educ. 60:439-443, 1985). A questionnaire was administered to one of the classes after they had completed the boards; 82% rated the review books as the most beneficial part of the course. These texts have been recently updated and rewritten and are now available for use by all students of medicine who are preparing for comprehensive examinations in the Basic Medical Sciences. RICHARD M. HYDE, Ph.D. Executive Editor This text is dedicated to students of medicine past, present, and future. May your hearts always be filled with humanity, your minds with wisdom, your spirits with humility, and your hands with skill. PREFACE These notes were developed to assist in the review of the basic science of pathology for those students preparing to sit for various national proficiency examinations which include, as part of their content, material dealing with general and systemic pathology. As such, the notes are not intended to replace the many fine textbooks of pathology whose scope, detail, and mission are more suited to the in depth study of pathology. Rather, these notes are intended to serve as "memory joggers" to rekindle and refresh the mind of some of the salient features of various disease processes and to point out to the student possible areas of weakness which they may need to address in more detail by referring to one of the standard textbooks of pathology. In this regard, these notes are presented in an organized and sensible (we hope!) outline format which is intended to allow systematic review of the material in a reasonable amount of time. In an effort to contain cost and avoid undue repetition with other volumes of the Oklahoma Notes series, some topics that are generally covered in most standard pathology courses as well as illustrative material have been omitted from the present edition. The authors would like to extend our sincere gratitude to the faculty and staff of the Department of Pathology for their ideas, support, and assistance during the preparation of these notes. In particular, we would like to thank Drs. K. Michael Parker, Kenneth E. Blick, Richard B. Passey, and Ronald L. Gillum for their help in preparing information on clinical laboratory testing. Finally, plaudits are once again due to Mel Beery whose organizational skills and attention to detail are greatly responsible for the completion of this work. J.H.H. D.L.F. N.K.H. TABLE OF CONTENTS Title Cell Injury, Degeneration, and Necrosis 1 Inflammation and Repair 7 Fluid, Hemodynamic, and Coagulation Disorders 12 Growth Disturbances 25 Neoplasia 28 Neuromuscular Central Nervous System 34 Peripheral. Nervous System 52 Skeletal Muscle 56 Cardiovascular Developmental Abnormalities 60 Arteriosclerosis 63 Ischemic Heart Disease/Coronary Heart Disease 66 Rheumatic Fever and Rheumatic Heart Disease 70 Valvular Disease 71 Myocardial Disease 73 Pericardial Disease 76 Neoplasms 76 Heart Failure 77 Vascular Disease 78 Pulmonary 82 Urinary Tract Kidney 97 Urinary Bladder 110 Gastrointestinal Structural/Functional Disorders 112 Vascular Disease 115 Non-Infectious Inflammatory Diseases 116 Malabsorptive Diseases 121 Gastrointestinal Polyps 123 Neoplasia 124 Title Pancreas and Hepatobiliary Liver 128 Gallbladder and Bile Ducts 137 Exocrine Pancreas 140 Endocrine Pituitary 142 Thyroid 147 Parathyroid 154 Adrenal Cortex 156 Diffuse Endocrine System 161 Diabetes Mellitus 165 Breast 169 Female Genital Vulva 176 Vagina 177 Cervix 178 Endometrium 181 Myometrium 183 Fallopian Tube 184 Ovary 185 Gestational Trophoblastic Neoplasms 189 Male Genital 190 Bone and Joint Bone 195 Joint and Related Structures 199 Skin Infectious Diseases 203 Non-Infectious Vesicular and Bullous Diseases 208 Connective Tissue Diseases 212 Erythematous and Papulosquamous Diseases 215 Epidermal and Tumor-like Conditions 217 Dermal Tumors 220 Tumors of Melanocytic Origin 221 Sample Questions 222 xii CELL INJURY, DEGENERATION, AND NECROSIS I. The Science of Pathology A. Classification of pathology can be divided into general pathology (the study of the general reactions of cells and tissues to insults and injuries that are basic to all disease processes) and systemic pathology (the study of specific disease processes or reactions as they affect particular organs or organ systems). B. Application of these classes can be further refined into: 1. Anatomic pathology including necropsy (the study of cadavers in the interest of elucidating the cause or causes of death and contributing to the education of primary care practitioners in their endeavor to provide concise diagnostic protocols and improved treatment modalities), surgical pathology (examination or study of tissues excised from living patients in an effort to establish a specific diagnosis or to exclude specific disease processes) and cytopathology (the study of individual cells primarily as a method to detect malignant (cancer) cells scraped from surface tissues or suspended in body fluids). 2. Clinical pathology or the analysis of various specimens (whole blood, serum, plasma, urine, feces, spinal fluid, sputum, etc.) from patients to facilitate diagnosis, direct therapeutic approach and monitor therapy. 3. Experimental pathology which is the study or investigation of the causes and mechanisms of disease. 4. Forensic pathology - medicolegal investigation of death. C. Pathology includes consideration of all aspects of a disease: etiology (cause), pathogenesis (mechanisms of its development), morphologic alterations (structural changes induced in cells and organs of the body) and clinical significance (functional consequences of the morphologic alterations). II. Cellular Basis of Disease A. Rudolf Virchow (1865) showed that cellular alterations correlate with clinical aspects of disease. Health depends on the ability of the body's cells to adjust to their constantly changing microenvironment. The narrow range of stability is referred to as homeostasis. A disease process reflects adverse conditions in which body cells fail to maintain homeostasis. These deviations from the norm may be reflected by structural, physiologic, biochemical or molecular changes in the cell. B. There are few, if any, new biochemical pathways or structures which occur in diseased cells - rather there is accentuation, alteration or loss of existing pathways or structures. III. The Steady State Concept A. The normal steady state involves a preservation of homeostasis and consists of a fairly narrow range of cellular responses to normal, day to day noninjurious stimuli. 1 B. An altered steady state occurs in response to stimuli that are greater than those that the cell normally experiences. Injurious stimuli range in intensity from the extremely subtle to the extremely severe. Depending on the intensity and duration of the injurious stimulus the cell ££ the tissue composed of these cells may adapt, be reversibly injured, or be irreversibly injured and die. IV. The Injured Cell or Tissue A. Overtaxation or sublethal injury may result in adaptation which involves an altered steady state but which is potentially reversible to the normal steady state. Adaptive changes include the following: 1. Hypertrophy - increase in the size of an organ or tissue due to an increase in size of its component cells as a response to increased functional demand. 2. Hyperplasia - increase in the number of cells compr1s1ng a tissue or organ in response to increased functional demands. 3. Metaplasia - change of one cell or tissue type to another which is better suited to the stimulus which induced the change. 4. Atrophy - a decrease in the size of a tissue or organ that had previously been of normal size. May be an adaptive response or a normal physiologic process. When pathologic, it results from a number of influences that may restrict nourishment, stimulation, or function of a tissue or organ. 5. Dysplasia (atypical hyperplasia) - atypical growth pattern of cells within a tissue usually induced by chronic (prolonged) irritation or stimulation. Not truly an adaptation. Reversible injury may be manifested by both functional or structural derangements and the line between reversibly and irreversibly injured cells may at times be quite indistinct. B. Overwhelming, persistent or unusual injuries result in: 1. Degeneration - this is a somewhat ill-defined term which is used to describe a variety of'retrograde changes in cells. It is usually manifested by abnormal intracellular accumulation of some type of material whose nature depends upon a number of factors including the quality of the injury and the intrinsic state of the cell. 2. Cell Death - at some point the injury to a cell may be of sufficient quality to result in death. If sufficient numbers of cells are injured to bring about the death of the organism, the cells and tissues will normally undergo autolysis. If the organism survives, the dead cells will undergo necrosis. V. Etiology of Reversible and Irreversible Injury A. Physical agents that induce 1nJury are widely varied and induce significant changes in cell structure and function. 1. Temperature - Cell injury and/or cell death result if tissue is maintained at a level greater than SaC (hyperthermia) above or 1S0C below (hypothermia) normal body temperature. The severity of injury is related to the duration of the exposure. 2
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