HYR- Cone Pathology Review for USMLE & COMP

Pathology CBSE Review

1. COMP PATHOLOGY REVIEW
Cecil W. Cone II, M.D.
Professor and Emeritus Chair of Pathology
Asst. Dean of Diversity, Equity, and Inclusion
AUC School of Medicine

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2. CELL ADAPTATION AND INJURY
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3. Cellular Response to Stress and Injury

4. Types of Cellular Adaptation
•Hyperplasia
•Hypertrophy
•Atrophy
•Metaplasia

5. Hypertrophy
UAB Dept. of Pathology

6. Metaplasia

7. SITES OF DAMAGE IN CELL INJURY

8. HYPOXIC INJURY

9. INCREASED CALCIUM IN CELL INJURY

10. IRREVERSIBLE INJURY

11. Hydropic change

12. Hydropic and fatty change

13. COAGULATIVE NECROSIS
UAB Dept. Pathology

14. MECHANISMS OF APOPTOSIS

15. COUNCILMAN/ACIDOPHILIC BODY

16. Apoptosis
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17. NECROSIS VS APOPTOSIS

18. MALLORY-DENK BODY

19. LIPOFUSCIN PIGMENT

20. HEMOSIDERIN AND PRUSSIAN BLUE STAIN

21. DYSTROPHIC CALCIFICATION

22. CAUSES OF HYPERCALCEMIA
(CHIMPS)
•C – Cancer
•H – Hyperparathyroidism
•I – Intoxication of vit D
•M – Multiple myeloma/Milk alkali syndrome
•P – Paget disease of the bone
•S - Sarcoidosis

23. ACUTE INFLAMMATION
Cecil W. Cone II, M.D.
Professor and Emeritus Chair of Pathology
Asst. Dean of Diversity, Equity, and Inclusion
AUC School of Medicine

24. Neutrophils

25. Precursor Neutrophil (Band Cell)
UAB Dept. of Pathology

26. Adhesion and Migration

27. Oxygen-Dependent Killing

28. Acute Phase Response

29. Fibrinous Inflammation

30. Purulent Inflammation
UAB Dept. of Pathology

31. Purulent Inflammation (Abscess)

32. Acute Inflammation Outcome

33. CHRONIC INFLAMMATION
Cecil W. Cone II, M.D.
Professor and Emeritus Chair of Pathology
Asst. Dean of Diversity, Equity, and Inclusion
AUC School of Medicine

34. Monocyte

35. Eosinophil

36. Basophil

38. Lymphocytes
UAB Dept. of Pathology

39. Plasma Cells

40. Granuloma Formation

41. Caseating Granuloma

42. Non-caseating Granuloma
UAB Dept. of Pathology

43. Non-caseating Granuloma
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44. Interstitial Inflammation
UAB Dept. of Pathology

45. TISSUE REPAIR
Cecil W. Cone II, M.D.
Professor and Emeritus Chair of Pathology
Asst. Dean of Diversity, Equity, and Inclusion
AUC School of Medicine

46. Regeneration and Healing

48. Granulation Tissue
UAB Dept. of Pathology

49. Granulation Tissue
UAB Dept. of Pathology

51. Healed MI
UAB Dept. of Pathology

52. Healed MI
UAB Dept. of Pathology

53. Trichrome stain

54. Keloid

55. FLUID AND HEMODYNAMIC
DISORDERS
Cecil W. Cone II, M.D.
Professor and Chair Emeritus
Department of Pathology
Third Semester Lead
AUC School of Medicine

56. PULMONARY EDEMA

57. HEART “FAILURE” CELLS

58. DEEP VENOUS THROMBOSIS

59. PETECHIAL HEMORRHAGE

60. COLONIC AND INTRACEREBRAL HEMORRHAGE

61. HEMOPERICARDIUM

62. VIRCHOW TRIAD IN THROMBOSIS
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63. LAMINATED MURAL THROMBUS

64. FATE OF THROMBUS

65. PULMONARY (SADDLE) THROMBOEMBOLUS

66. PULMONARY THROMBOEMBOLUS

67. FAT EMBOLISM

68. FAT EMBOLISM

69. AMNIONIC FLUID EMBOLISM
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70. TYPES OF EMBOLI

71. WEDGE-SHAPED RED INFARCT

72. RED INFARCT

73. RED AND WHITE INFARCTS

74. OLD CYSTIC CEREBRAL INFARCT

75. TYPES OF SHOCK
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76. SEPTIC SHOCK

77. MICROTHROMBI

78. SHOCK
1.H – hypotension
2.A – acidosis
3.T – tachycardia
4.C – cold and clammy skin
5.O – oliguria
6.A – apprehension
7.T - tachypnea

79. NEOPLASIA
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80. Key Definitions
•Tumor (mass lesion)
–A growth or enlargement (may be neoplastic or non-neoplastic)
•Hamartoma
–A localized mass-like lesion of haphazard growth of tissues
normally found at a given site
•Choristoma (heterotopia, ectopia)
–A mass-like growth consisting of tissue that is not normal to the
site of origin
•Neoplasia
–New, uncontrolled growth

81. Key Definitions
•Benign neoplasia
–Non-infiltrative growth with a low fatality potential
•Malignant neoplasia
–An infiltrative growth with high fatality potential
•Cancer
–Implies a malignant neoplasm
•Metastasis
–A distant spread of a malignant lesion

82. BENIGN NEOPLASMS
•Clinical Features
▪Usually solitary
▪May cause problem through mass effect or secretion of
substances (hormones, etc.)
•Nomenclature
▪Word usually ends with –oma (adenoma); exceptions: lymphoma,
glioma, melanoma, seminoma

83. Malignant Neoplasms
•Cytologic features
–Increased nuclear size (increased nuclear, cytoplasmic ratio)
–Variation in nuclear size and shape (pleomorphism)
–Lack of differentiation (anaplasia)
–Increased nuclear DNA content
–Prominent nucleoli with the nuclei
–Increased mitosis (irregular or bizarre mitosis)

84. HISTIOGENESIS OF CARCINOMA
•Epithelial surfaces
▪Squamous, columnar, transitional cells
•Organs with epithelia-lined ducts
▪Breast, pancreas
•Endocrine glands
▪Thyroid

85. HISTIOGENESIS OF SARCOMAS
•Arise from soft tissue (connective tissue)
▪Nerve, muscle, fat, bone, cartilage, fibroblasts, blood
vessels
•Generally big and fleshy
•Composed of cells that are:
▪Very pleomorphic
▪Spindle-shaped

86. BENIGN VS MALIGNANT NEOPLASMS

87. Age-related tumors
AGE GROUPS TUMORS
Children Leukemia, Brain tumors, blastomas
Young Adults Gonadal tumor, lymphomas
Elderly Carcinoma, prostate and endometrium

88. Commonly associated oncogenes

89. Oncogenes

90. Tumor suppressor genes

91. RB gene

92. P53

93. Reserved for captions

94. Chemical carcinogenesis

95. Radiation-associated tumors

96. Etiology of neoplasia
CLASS EXAMPLE RELATED TUMOR
Chemicals
man-made
drugs
natural occurring
compounds

Aniline dyes
Cigarette smoke

Aflatoxins

Urinary bladder
Lung

Liver
Oncogenic viruses
Human papilloma virus (HPV)
Epstein-Barr virus (EBV)
Hepatitis B virus (HBV)

Cervix
Burkitt lymphoma
Liver
Radiation
Ultraviolet
Ionizing

Skin
Leukemia
Thyroid
Lung
Colon
Breast

98. Immunohistochemical stains

99. Tumor Markers
TUMOR MARKER RELATED NEOPLASM
Carcinoembryonic antigen (CEA)

CA 19-9
Carcinoma of colon

Carcinoma of pancreas
Human chorionic gonadotropin (HCG)

CA-125
Choriocarcinoma

Carcinoma of ovary
Placental alkaline phosphatase (PLAP)

Alpha-fetoprotein (AFP)
Seminoma

Yolk sac tumor, Hepatocellular carcinoma

100. Cancer cell adhesion

102. PD-1 therapy
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103. CARDIO
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104. •Ventricular septal defect (VSD)
•Atrial septal defect (ASD)
•Patent ductus arteriosus (PDA)
Left-to-Right Shunts

105. Left to right

106. Right to left

107. VSD

108. VSD

109. ASD

110. ASD and VSD

111. •Tetralogy of Fallot
•Transposition of the great vessels
•Truncus arteriosus
•Tricuspid atresia
•Total anomalous pulmonary venous return
Right-to-Left Shunts (5 Ts)

112. Tetralogy of Fallot

113. Transposition

114. (PREDUCTAL VS POSTDUCTAL)

115. Causes of High Output Cardiac Failure
•Beri beri (wet)
•Grave disease (high metabolic rate)
•Paget disease of the bone (a/v shunts)
•Pregnancy (twin, triplet, etc.)
•Severe anemia

116. Atherosclerotic Plaque Rupture

117. Thrombosis and Atherosclerotic Plaque with Rupture

118. •Left anterior descending branch
▪Anterior wall of the left ventricle
▪Anterior 2/3 of the interventricular septum
•Left circumflex branch
▪Lateral border of the left heart
•Right coronary artery
-Inferior/posterior wall of the left ventricle
▪Posterior 1/3 of the interventricular septum
▪Inferior/posterior right ventricular free wall
Distribution of Coronary Blood Flow

119. •MAJOR CAUSES OF DEATH
▪Cardiac arrhythmia
▪Cardiogenic shock
▪Congestive heart failure
▪Thromboembolization

Myocardial Infarction Complications

120. •Myocardial rupture
•Papillary muscle rupture
•Mural thrombosis
•Ventricular aneurysm
•Fibrinous pericarditis
Myocardial Infarction Complications

121. Vegetative Endocarditis

122. Aschoff body

123. Acute and healed MIs

124. Acute MI

125. •Fibrinous (“RUMS”)
▪Rheumatic fever
▪Uremia
▪Myocardial infarction
▪Systemic lupus erythematosus
Acute Pericarditis

126. Myxoma

127. RESPIRATORY
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128. Interstitial lung disease
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129. Interstitial lung markings on x-ray DDx
•ARDS (acute)
•Pulmonary edema (acute)
•Restrictive lung disease (chronic)
•Interstitial pneumonia (chronic)

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130. LUNG ABSCESS

131. PRIMARY TUBERCULOSIS
(GHON COMPLEX)

132. SECONDARY TUBERCULOSIS

133. Apical lung lesion DDx
•Reactive/secondary Tb
•Fungus ball
•Pancoast tumor
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134. SITUS INVERSUS

135. SARCOIDOSIS

136. ASTEROID BODIES

137. TENSION PNEUMOTHORAX

138. SPONTANEOUS PNEUMOTHORAX

139. Left-sided Atelectasis

140. Lung cancer
•Central (hilar) location
▪Squamous cell carcinoma
•Male smoker, Tp53, hypercalcemia, cytokeratin +
▪Small cell carcinoma
•Male smoker, L-myc, SIADH, Cushing syndrome, Eaton-Lambert
syndrome, synaptophysin +, chromogranin +

•Peripheral location
▪Adenocarcinoma
•Female nonsmoker, KRAS, EGFR, TTF-1, cytokeratin +
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141. Mesothelioma
•Differentiate between mesothelioma and
adenocarcinoma
•Mesothelioma stains positive for keratin proteins,
calretinin, Wilms tumor 1 (WT-1)
•Microvilli on EM:
•Mesothelioma-long, slender
•Adenocarcinoma-short, blunted

142. RENAL

143. Membranous GN

144. Membranoproliferative GN

145. Focal Segmental Sclerosis

146. Urinary casts
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147. Urinary casts
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148. ATN

149. Pale cortical infarct

150. Papillary Necrosis

151. RCC vs Wilm’s Tumor

152. HEMATOPOIETIC
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153. Anemia Classification
•Normocytic anemia with reticulocytosis (reticulocyte
count >2%)
▪Hemolytic Anemia
▪Acute Blood Loss Anemia

154. Anemia Classification
•Normocytic Anemia without reticulocytosis
▪Aplastic Anemia
▪Marrow Failure
▪Leukemia/Metastasis
▪Renal Failure
▪Anemia of Chronic Disease
▪Myelofibrosis

155. Iron Panel for Microcytic Anemias

156. β-Thalassemia Major

157. Microangiopathic Hemolytic Anemia
•CONDITIONS:
▪DIC
▪Thrombotic thrombocytopenic purpura
▪Hemolytic uremic syndrome

158. Microangiopathic Hemolytic Anemia

159. Myelophthisic Anemia

160. ORIGIN OF LYMPHOID NEOPLASMS

161. FOLLICULAR HYPERPLASIA

162. FOLLICULAR LYMPHOMA

163. LACUNAR VARIANT RS CELL

164. L & H VARIANT (POPCORN) RS CELL

165. AML vs ALL

166. CLL

167. Causes of Bleeding Disorders
•Thrombocytopenia (quantitative)
•Defective platelet function (qualitative)
•Abnormalities of clotting factors
•Vessel wall abnormalities
•Disseminated intravascular coagulation (DIC)

168. Coagulation Cascade

169. Differential for DIC causes
•Malignancy
•Obstetrical complications
•Sepsis
•Trauma

•Positive D-dimer (also seen with PE)
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170. GI
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171. Dysphagia DDx
•Stenosis/strictures (radiation Tx, caustic agents, etc.)
•Achalasia
•Plummer-Vinson syndrome
•Schatzki’s ring
•Esophageal cancer
•Scleroderma
•Sjögren syndrome
•GERD
•Myxoma

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172. Epigastric pain DDx
•Cholecystitis
•Cholangitis
•Pancreatitis
•GERD
•MI
•PUD
•Gastritis

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173. LUQ pain DDx
•Splenic infarct
•Watershed infarct
•Splenic rupture (Infectious mononucleosis, trauma, etc.)

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174. RLQ pain DDx
•Appendicitis
•Colon cancer


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175. Disorders which mimic acute appendicitis
•Mesenteric lymphadenitis (often secondary to unrecognized
Yersinia infection or viral enterocolitis)
•Acute salpingitis
•Ectopic pregnancy
•Ovarian cyst or torsion
•Mittelschmerz pain (caused by minor pelvic bleeding at the time of
ovulation)
•Meckel diverticulitis
•Crohn disease

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176. RUQ pain DDx
•Cholecystitis
•Hepatitis (viral, alcoholic, autoimmune, etc.)
•Hepatic adenoma
•HCC
•Gallbladder adenocarcinoma

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177. LLQ pain DDx
•Diverticulitis
•GYN complications
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178. GYN causes of GI and urinary symptoms
•Leiomyoma
•Endometriosis
•Cervical cancer
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179. Leiomyoma

180. Endometriosis

181. Upper GI bleeding DDx
•PUD
•Acute hemorrhagic gastritis
•Esophageal varices
•Mallory-Weiss syndrome

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182. Peptic Ulcer Disease: Etiology and Complications
•Acid and pepsin are
thought to be crucial to
ulcer development, but
the great majority of
peptic ulcers are directly
commonly related to
infection with
Helicobacter pylori or
NSAID use.
•Vomiting of bright red blood
or coffee-ground material
and/or passage of dark tarry
stool (melena) or
hematochezia may indicate
bleeding from a peptic ulcer.

Melena
Coffee-groun
d emesis

183. Lower GI bleeding DDx
•Right sided (occult bleeding)
▪Adenocarcinoma (pain, mass, anemia)
▪Angiodysplasia

•Left sided (bright red/frank bleeding)
▪Hemorrhoids
▪Villous adenoma
▪Adenocarcinoma (napkin ring/apple core)
▪Diverticulosis
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184. Angiodysplasia

185. Crohn disease

186. Chromosomal instability pathway
Modified from: Lynch JP et al. Hematol Oncol Clin North Am 2002;16:775.
Main point: It’s the accumulation of multiple genetic mutations (oncogene
activation with loss of tumor suppressor genes) which results in cancer.
Robbins & Cotran Pathologic Basis of Disease, 9
th
ed.

187. Germline MSI pathway
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188. MISCELLANEOUS DIFFERENTIALS
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189. CNS
•Ring/rim enhancing lesion
▪Toxoplasmosis
▪GBM
▪Abscess
•Lesion at gray/white junction
▪Abscess
▪Metastasis (multiple)

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190. Rim/ring enhancing lesion

191. Young male with fever, night sweats, weight loss
•Reactive Tb
•HIV
•Hodgkin lymphoma
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192. Tumors that invade nerves
•Pancreas carcinoma
•Prostate carcinoma
•Adenoid cystic carcinoma (head and neck)
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193. Disorders associated with visceral cancer
•Dermatomyositis
•Acanthosis nigricans
•Bowen’s disease
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194. Differential for syncope
•Hypoglycemia
▪Insulinoma
▪Von Gierke
▪DM
•Hypotension
▪Addison’s
•Aortic stenosis
•HOCM
•Arrhythmias


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195. Diseases caused by sulfa drugs (Bactrim)
•G6PD deficiency
•Erythema multiforme
•Acute intermittent porphyria

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196. Test taking strats
•RTFQ!
▪Understand what the question is asking you
•Read the last line again
•Skip it!
•Slice it up!
▪Cut the test block time and number of questions in half
•Read back!
▪Read the line before the last line
•The biopsy or autopsy is the answer!
•Click and move!
▪Study long, study wrong!
▪Be confident!
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197. Let’s go!
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