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Pathology-First-Aid-For-The-Usmle-Step-1
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First Aid for the USMLE Step 1 2020, Thirtieth
FA 2019.pdf
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26 pages (293.11 MB)
24 pages (109.99 MB)
1/5/20, 12:57:57 PM
1/5/20, 12:52:18 PM
BY u/verified-idiot
To the only girl i've ever loved, to soufia.
BLUE new in FA 2020
YELLOW text of FA 2019 was edited; the note box next to the yellow highlight will show the difference between
them the old text and the new text of FA 2020
Some pages might look scary! because of note boxes and highlighting , but it is not, my recommendation for
you is to study your book and after than look for the new stuff and edits.. I DONT recommend comparing while
you are studying since it will consume your time.
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,HIGH-YIELD PRINCIPLES IN
Pathology
“Digressions, objections, delight in mockery, carefree mistrust are signs of ` Cellular Injury 206
health; everything unconditional belongs in pathology.”
—Friedrich Nietzsche ` Inflammation 213
“You cannot separate passion from pathology any more than you can ` Neoplasia 219
separate a person’s spirit from his body.”
—Richard Selzer
The fundamental principles of pathology are key to understanding
diseases in all organ systems. Major topics such as inflammation and
neoplasia appear frequently in questions across different organ systems,
and such topics are definitely high yield. For example, the concepts of
cell injury and inflammation are key to understanding the inflammatory
response that follows myocardial infarction, a very common subject of
board questions. Similarly, a familiarity with the early cellular changes
that culminate in the development of neoplasias—for example,
esophageal or colon cancer—is critical. Finally, make sure you
recognize the major tumor-associated genes and are comfortable with
key cancer concepts such as tumor staging and metastasis.
205
, 206 SEC TION II PATHOLOGY `P̀ATHOLOGY—CELLULAR INJURY
``
PATHOLOGY—CELLULAR INJURY
Cellular adaptations Reversible changes that can be physiologic (eg, uterine enlargement during pregnancy) or pathologic
(eg, myocardial hypertrophy 2° to systemic HTN). If stress is excessive or persistent, adaptations
can progress to cell injury (eg, significant LV hypertrophy injury to myofibrils HF).
Hypertrophy structural proteins and organelles in size of cells. Example: cardiac hypertrophy.
Hyperplasia Controlled proliferation of stem cells and differentiated cells in number of cells. Excessive
stimulation pathologic hyperplasia (eg, endometrial hyperplasia), which may progress to
dysplasia and cancer. Example: benign prostatic hyperplasia.
Atrophy in tissue mass due to in size ( cytoskeleton degradation via ubiquitin-proteasome pathway
and autophagy; protein synthesis) and/or number of cells (apoptosis). Causes include disuse,
denervation, loss of blood supply, loss of hormonal stimulation, poor nutrition.
Metaplasia Reprogramming of stem cells replacement of one cell type by another that can adapt to a
new stress. Usually due to exposure to an irritant, such as gastric acid ( Barrett esophagus) or
cigarette smoke ( respiratory ciliated columnar epithelium replaced by stratified squamous
epithelium). May progress to dysplasia malignant transformation with persistent insult (eg,
Barrett esophagus esophageal adenocarcinoma). Metaplasia of connective tissue can also occur
(eg, myositis ossificans, the formation of bone within muscle after trauma).
Dysplasia Disordered, precancerous epithelial cell growth; not considered a true adaptive response.
Characterized by loss of uniformity of cell size and shape (pleomorphism); loss of tissue
orientation; nuclear changes (eg, nuclear:cytoplasmic ratio and clumped chromatin). Mild and
moderate dysplasias (ie, do not involve entire thickness of epithelium) may regress with alleviation
of inciting cause. Severe dysplasia often becomes irreversible and progresses to carcinoma in situ.
Usually preceded by persistent metaplasia or pathologic hyperplasia.
Hyperplasia Change in cell Change in cell
size and/or type and
number structure
Reversible Generally
Normal cells irreversible Neoplasia
Hypertrophy
Atrophy Severe stress Reversible
or injury
Inability Change in Change in
to adapt cell structure cell type
Irreversible
injury ! necrosis
or apoptosis Dysplasia Metaplasia
If chronic irritant
persists
Irreversible
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