Table Of Content

Robbins and Cotran Review of Pathology Robbins and Cotran Review of Pathology F O U R T H E D I T I O N Edward C. Klatt, MD Professor of Pathology Department of Biomedical Sciences Director, Biomedical Education Program Mercer University School of Medicine Savannah, Georgia Vinay Kumar, MBBS, MD, FRCPath Donald N. Pritzker Professor Chair, Department of Pathology Biologic Sciences Division and Pritzker School of Medicine The University of Chicago Chicago, Illinois 1600 John F. Kennedy Blvd. Ste. 1800 Philadelphia, PA 19103-2899 ROBBINS AND COTRAN REVIEW OF PATHOLOGY, FOURTH EDITION ISBN: 978-1-4557-5155-6 Copyright © 2015, 2010, 2005, 2000 by Saunders, an imprint of Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. 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Library of Congress Cataloging-in-Publication Data Klatt, Edward C., 1951- , author. Robbins and Cotran review of pathology / Edward C. Klatt, Vinay Kumar. -- Fourth edition. p. ; cm. Review of pathology Complemented by: Robbins basic pathology / [edited by] Vinay Kumar, Abul K. Abbas, Jon C. Aster. 9th ed. c2013; and Robbins and Cotran pathologic basis of disease / [edited by] Vinay Kumar, Abul K. Abbas, Jon C. Aster. Ninth edition. United VRG [2015] ISBN 978-1-4557-5155-6 I. Kumar, Vinay, 1944- , author. II. Robbins basic pathology. Complemented by (work): III. Rob- bins and Cotran pathologic basis of disease. Complemented by (work): IV. Title. V. Title: Review of pathology. [DNLM: 1. Pathology--Examination Questions. QZ 18.2] RB119 616.07076--dc23 2014031270 Executive Content Strategist: William R. Schmitt Content Development Specialist: Laura Schmidt Publishing Services Manager: Anne Altepeter Project Manager: Louise King Designer: Louis Forgione Printed in Canada Last digit is the print number: 9 8 7 6 5 4 3 2 1 To our students, for their constant challenge and stimulation Preface This book is designed to provide a comprehensive review of complete reading of topics targeted for further review. Pathol- both general and organ-specific pathology through multiple ogy is a visually oriented discipline; hence full-color images choice questions with explanations of the answers. The source accompany many of the questions. The illustrations are taken materials are the ninth editions of Robbins and Cotran Patho- mainly from the Robbins textbooks, so students can reinforce logic Basis of Disease (PBD9) and Robbins Basic Pathology (BP9), their study of the figures in the texts with questions that utilize and in several chapters, Robbins and Cotran Atlas of Pathology the same or similar images. (AP3). The questions in this review book follow the chapters The revisions in this fourth edition reflect new topics and and topics in these source materials to facilitate ongoing self- new understanding of disease processes reflected in the most assessment as students work their way through a curriculum recent editions of the Robbins textbooks. The questions are to gain and then apply their understanding of key concepts. intentionally written to be fairly difficult, with the purpose This book is intended to be a useful resource for students in a of “pushing the envelope” of students’ understanding of pa- variety of health science training programs. thology. We are pushing it even further with a comprehensive In keeping with recommended question writing style for final examination section that includes questions drawn from licensing examinations, we have included single best-answer challenging topics covered in the entire book. questions, most with a clinical vignette, followed by a series Mastery of this book will better prepare the student for fur- of homogenous choices. This approach emphasizes an under- ther challenges. Many of the questions require the student to en- standing of pathophysiologic mechanisms and manifestations gage in a “multi-step” process: first, to interpret the information of disease in a clinical context. We have incorporated relevant presented to arrive at a diagnosis, and then to solve a problem laboratory, radiologic, and physical diagnostic findings in based on that diagnosis. This reinforces the clinical reasoning the questions to emphasize clinicopathologic correlations. skills needed in delivery of health care. We must hasten to add Although this adds to the extent of individual questions, the that no review book is a substitute for textbooks and other course thoroughness reinforces learning, as a review should. Each an- materials provided by individual instructors within the context swer includes a succinct explanation of why a particular choice of a curriculum. This book should be used in conjunction with is “correct” and the other choices are “incorrect.” Each answer thorough study of Robbins and Cotran Pathologic Basis of Disease is referenced by page numbers to both Robbins and Cotran and/or Robbins Basic Pathology and curricular materials. Finally, Pathologic Basis of Disease and Robbins Basic Pathology (both the we hope that both students and their faculty will find this review current ninth edition and the previous eighth edition of each), book to be a useful adjunct to the learning of pathology. and in several cases, to figures in the third edition of Robbins Edward C. Klatt, MD and Cotran Atlas of Pathology, to facilitate and encourage a more Vinay Kumar, MBBS, MD, FRCPath vii To Our Students Although medical knowledge has increased exponentially learning to occur, there are a finite number of synaptic modifi- over the past 100 years, the desire to learn and apply this cations that can be established per unit time, above which total knowledge to the service of others has not changed. The study comprehension is reduced. Increasing the rate or length of in- and practice of the healing arts requires persistence more than formation delivery diminishes the efficiency of learning. Lack brilliance. By continuing as a lifelong student, it is possible to of break periods or engaging in “all nighters” presage onset of become a better health practitioner with the passage of time. diminished performance, particularly when least desirable— Use this book to find where you are on the pathway to ex- during an examination. There is also decay of learning over cellence and be inspired to continue down that path. We pro- time, with inevitable random loss of data elements. The key vide a guide to light the way toward knowledge in pathology branch points in learning, where review with reinforcement within the welcoming environment of this book. can reduce data loss, occur at 20 to 40 minutes (transfer to in- Common mistakes made by students in answering ques- termediate memory) and at 24 to 48 hours (transfer to long- tions result from failure to read and analyze information care- term memory) following initial learning. fully by: (1) relying on a single finding as an exclusionary Develop methods for filtering information from quality criterion, and (2) ignoring important diagnostic information. sources. We live in an age of information overload. Stay on task Medicine is mostly analogue, not digital, and the information and avoid distractions. Identify the important data and under- you obtain is applicable across a continuum of probability. In lying concepts. Develop a specific, personalized plan for ap- selecting the best answer, remember these four key elements: proaching, reviewing, and preparing for assessments of your (1) read the question thoroughly, (2) define the terms (use knowledge. Seek quality feedback, both positive to provide your vocabulary), (3) rank possible answers from common to motivation for your commitment to further learning, as well as uncommon, and (4) recognize key diagnostic information that negative to focus on your rate of progress toward competency. differentiates the answers. We hope, therefore, that this review will be useful not only There are no magic formulas for academic achievement. in preparing for examinations but also for courses you take The most important thing you can do is to spend some time throughout your career. It is our sincere hope that this review each day in a learning process. Learning requires modification book will make you a better health practitioner in your chosen of synaptic interfaces at the dendritic level in the brain, and for career. ix