Husain A. Sattar - Fundamentals of Pathology: Medical Course and Step 1 Review: 2015 Edition

Assistant Professor of Pathology
Associate Director of Clinical Pathophysiology and Therapeutics The University of Chicago
Pritzker School of Medicine
Chicago, Illinois

Chicag o 201 1PATHOMA.COMFundamentals of Pathology: Medical Course and Step I Review, First EditionISBN 978-0-9832246-0-0Printed in the United Slates of America.Copyright 2011 by Pathoma LLC.

All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form, or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without prior permission in writing from the publisher (email: info@pathoma.com).

Disclaimer
Fundamentals of Pathology aims at providing general principles at pathology and its associated disciplines and is not intended as a working guide to patient care, drug administration or treatment. Medicine is a constantly evolving field and changes in practice regularly occur. It is the responsibility of the treating practitioner, relying on independent expertise and knowledge of the patient, to determine the best treatment and method of application for the patient. Neither the publisher nor the author assume any liability for any injury and/o r damage to persons or property arising fro m or related to the material within this publication.

Furthermore, although care has been taken to ensure the accuracy of information present in this publication, the author and publisher make no representations or warranties whatsoever, express or implied, with respect to the completeness, accuracy or currency of the contents of this publication. '1 his publication is not meant to be a substitute for the advice of a physician or other licensed and qualified medical professional. Information presented in this publication may refer to drugs, devices or techniques which are subject to government regulation, and it is the responsibility of the treating practitioner to comply with all applicable laws.

'f his book is printed on acid-free paper.

Published by Pathoma LLC, http://www.pathoma.com info@pathoma.com

Cover and page design by Olaf Nelson, Chinook Design, Inc. h t tp://w w w. chiiiooktype.co m Chapter 1.Growth Adaptations, Cellular Injury, and Cell Death 1
Chapter 2. Inflammation, Inflammatory Disorders, and Wound Healing ... 11
Chapter 3, Principles of Neoplasia 23
Chapter 4. Hemostasis and Related Disorders 31
Chapters, Red Blood Cell Disorders 41
chapters. White Blood Cell Disorders 53
Chapter 7. Vascular Pathology 65
Chapters. Cardiac Pathology 73
Chapter9. Respiratory Tract Pathology 85
Chapter 10. Gastrointestinal Pathology 99
Chapter 11. Exocrine Pancreas, Gallbladder, and Liver Pathology 115
Chapter 12, Kidney and Urinary Tract Pathology 125
Chapter 13. Female Genital System and Gestational Pathology 137
Chapter 14. Male Genital System Pathology 151
Chapter 15. Endocrine Pathology 159
Chapter 16. Breast Pathology 171
Chapterl7. Central Nervous System Pathology 177
Chapter IS. Musculoskeletal Pathology 191
Chapter 19. Skin Pathology 201
Index 209
USING THIS BOOK

This work is intended as a review for students during their preclinical years and while preparing for examinations, such as the USMLEi". To this effect, the organization of (his book follows thai of most primary texts in the field and parallels the syllabus used in pathophysiology courses in medical schools throughout the United States. Ample space is provided for students to make notes during course study and while viewing the online videos that cover each section of the text (www.pa.thoma.com).

We recommend that students use Fundamentals of Pathology during their medical courses, taking notes in the margin as pertinent topics are covered. When exam time comes around, these notes will likely be invaluable.

for examination preparation, we suggest students read the material first, then listen to the online lecture, and then reread the material to develop a solid grasp of each topic. One should not become disheartened if they are not able to retain all the information contained herein. This deceptively slim volume covers a tremendous amount of materia!, and repetition will be a key aid as you progress in your studies.

An effort has been made to emphasize concepts and principles over random facts, the forest rather than the trees. Attention to the same by the student will provide a deeper, more meaningful understanding of human disease. We must always remind ourselves that ultimately our goal is to learn, to share, and to serve. Fundamentals of Pathology was developed with this goal in mind.

Husai n A, Sattar, M D Chicago, IllinoisACKNOWLEDGMENT S

This work would not have been possible without the support and encouragement of those around me. To begin with, I would like to acknowledge Shaykh Zulftqar Ahmad, whose clear vision has guided me to horizons I would never have known. My family is to be acknowledged tor their limitless sacrifice, in particular the constant encouragement and support of my wife Amina, who has proved through the years to be the wind under my wings, Thomas Krausz, MDan d Aliya Husain, MD (both Professors of Pathology at the University of Chicago) deserve particular mention for their valuable advice and guiding vision, both in the development of this book as well as my career. Special thanks to the multiple reviewers at medical centers throughout the country for their critical comments, in particular Mir Basharath Alikhan, MD (Pathology resident, University of Chicago) and Joshua T.B. Williams (Class of 2013, Pritzker School of Medicine, University of Chicago) for their extensive review. Olaf Nelson (Chinook Design, Inc.) is to be commended for his excellent layout and design. Finally, 1 would be remiss without acknowledging my students, who give meaning to what I do.

TO MY PARENTS AND EACH OF MYTEACHERSYOU R SACRIFIC E FORMSTH E FOUNDATIO N UPON WHIC H OUR WOR K IS BUILTGROWT H ADAPTATION S

I. BASIC PRINCIPLE S
A. An organ is in homeostasis with the physiologic stress placed oil it. B. An increase, decrease, or change in stress on an organ can result in growt h

adaptations.II, HYPERPLASI A AN D HYPERTROPH YA. An increase in stress leads to an increase in organ size.1. Occur s via an increase in the size (hypertrophy) and/o r the numbe r (hyperplasia) ot cells

B. Hypertrophy involves gene activation, protein synthesis, and production of organelles.
C. Hyperplasia involves the production of new cells fro m stem cells.
D. Hyperplasia and hypertrophy generally occur together (e.g., uterus durin g pregnancy).
1. Permanen t tissues (e.g., cardiac muscle, skeletal muscle, and nerve), however, cannot mak e new cells and underg o hypertrophy only.
2. For example, cardiac myocytes underg o hypertrophy, not hyperplasia, in response to systemic hypertension (Kg, 1,1).
E. Pathologic hyperplasia (e.g., endometrial hyperplasia) can progress to dysplasia and, eventually, cancer.
1, A notable exception is benign prostatic hyperplasia (BPH), which does not increase the risk for prostate cancer,

III. ATROPH Y
A. A decrease in stress (e.g., decreased hormona l stimulation, disuse, or decreased nutrients/blood supply) leads to a decrease in organ size (atrophy). 1. Occurs via a decrease in the size and numbe r of cells