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easy notes BIOCHEMISTRY (BIOCHEM) First Aid for the USMLE Step 1 2021, Thirty First Edition, ISBN: 9798706918194
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,ContentsPreface ..............................................................................................................................................................................viii
.
Acknowledgments ........................................................................................................................................................... ix
.
How to Use This Series .....................................................................................................................................................x
.
About the Authors .......................................................................................................................................................... xii
.
1 Cell Injury, Adaptations, and Death ..............................................................................................................................1
.
2 Inflammation and Repair ................................................................................................................................................9
.
3 Hemodynamics ............................................................................................................................................................... 17
.
4 Diseases of the Immune System ................................................................................................................................. 29
.
5 Neoplasia ........................................................................................................................................................................... 45
.
6 Genetic and Pediatric Diseases ................................................................................................................................... 51
.
7 Environmental and Nutritional Diseases ................................................................................................................. 67
.
8 Diseases of the Cardiovascular System ..................................................................................................................... 77
.
9 Diseases of the Hematopoietic and Lymphoid Systems .....................................................................................103
.
10 Diseases of the Respiratory System .........................................................................................................................125
.
11 Diseases of the Kidney and Urinary Tract ..............................................................................................................143
.
12 Diseases of the Mouth and Gastrointestinal Tract ...............................................................................................155
.
13 Diseases of the Liver, Gallbladder, and Biliary Tract............................................................................................177
.
14 Diseases of the Pancreas .............................................................................................................................................197
.
15 Diseases of the Male and Female Genital Tract ....................................................................................................201
.
16 Diseases of the Breast ..................................................................................................................................................213
.
17 Diseases of the Endocrine System ............................................................................................................................217
.
18 Diseases of the Musculoskeletal System.................................................................................................................235
19 Diseases of the Peripheral and Central Nervous Systems..................................................................................241
.
20 Diseases of the Skin......................................................................................................................................................263
.
21 Mixed Items ....................................................................................................................................................................271
.
22 Images ..............................................................................................................................................................................291
.
Index ................................................................................................................................................................................. 405
.
vii
, How to Use This Series
Question Difficulty Key
Chapter Green box = Easy question
Head Yellow box = Medium question
Red box = Hard question
1 Cell Injury, Adaptations, and Death
Section 1.1 Cellular Adaptations— 4. A pathologist is examining the biopsy of an indi-
vidual’s left ventricular myocardium and notices that
Header Questions the cardiac myocytes are enlarged. Of the following
Easy Medium Hard conditions, which would best explain this finding?
A. Pulmonary hypertension
1. A 50-year-old male dies during a car accident. B. Systemic hypertension
At autopsy, he is noted to have a moderately stenotic C. Lambl’s excresences on the aortic valve
aortic valve. The heart weighs 500 grams. The cause D. A probe patent fossa ovalis
Question of death from the motor vehicle accident is entirely
blunt force injuries of the head and neck, including an
E. Acute pericardial hemorrhage
Stem atlanto-occipital dislocation. No internal injuries below Cardiovascular
the neck are identified. There is no history of heart fail-
ure. A section of the myocardium from the left ventricle 5. A 2-year-old female aspirates a small coin, unbe-
would reveal which of the following processes? knownst to her caregivers. Over the next few days,
she develops a cough and becomes less responsive
A. Hypertrophy
and sleeps longer periods. Her parents also notice
B. Hyperplasia that she feels warm to the touch, but do not take her
C. Atrophy temperature. Six days following the coin being swal-
D. Metaplasia lowed, her parents find her unresponsive in her bed-
E. Reversible cell injury room. They call 9-1-1 and she is pronounced dead at
the hospital. Autopsy reveals a widespread broncho-
F. Irreversible cell injury
pneumonia in the right lung and a coin lodged in the
Cardiovascular right mainstem bronchus, nearly completely block-
ing it. A microscopic section of the bronchus from
2. A 25-year-old male, who is an offensive lineman where the coin was lodged reveals stratified squa-
for the local college football team, dies during a car acci- mous epithelium, which appears essentially normal,
dent. At autopsy, the injuries, being multiple rib frac- similar to that seen in the inner lining of the esopha-
tures and lacerations of the lungs and heart, with 1500 gus. Which of the following processes has occurred
mL of blood found in the left pleural cavity, are confined in the bronchus?
to the chest. At autopsy, a biopsy of his left biceps femo-
A. Hypertrophy
ris muscle would reveal which of the following?
B. Hyperplasia
A. Physiologic hyperplasia
C. Metaplasia
B. Pathologic hyperplasia
D. Atrophy
C. Physiologic hypertrophy
Answer D. Pathologic hypertrophy
E. Irreversible cellular injury
Options E. Physiologic atrophy
Respiratory
F. Pathologic atrophy
6. After developing hematuria and flank pain, a
Musculoskeletal 55-year-old male is diagnosed with a renal cell car-
cinoma in his right kidney. To treat the tumor, the
3. A 27-year-old male is in a car accident and sus- patient’s right kidney is resected. Five years later, he
tains a fracture of the 2nd thoracic vertebra, with dies in a car accident. At autopsy, there is an absence
resultant damage to the spinal cord at the same level, of the right kidney, and the left kidney weighs 300
leading to paraplegia, requiring him to be wheelchair grams (normal weight is 150-200 grams for an adult
bound. Five years following the accident, he develops male). Of the following processes, which is most
Organ System Tag a neoplasm of the right lower extremity, requiring a
wide local excision, which includes a small superficial
likely occurring in the left kidney?
A. Physiologic hypertrophy
Organ-specific questions will segment of underlying skeletal muscle. When view-
B. Pathologic hypertrophy
ing the microscopic slides, which of the following
be tagged as such (in this would the pathologist identify in the skeletal muscle? C. Physiologic hyperplasia, hormonal type
case: Musculoskeletal) and A. Physiologic hyperplasia
D. Physiologic hyperplasia, compensatory type
can be used for review of an B. Pathologic hyperplasia
E. Pathologic hyperplasia
isolated system. C. Physiologic hypertrophy Genitourinary
D. Pathologic hypertrophy
E. Physiologic atrophy
F. Pathologic atrophy
2 Musculoskeletal
Difficulty Level Icon
In general, an easy question requires only a diagnosis
based upon the question stem.
A medium question requires not just the diagnosis of the
condition based upon the question stem, but knowledge
about that diagnosis so as to answer a question about it.
Hard questions are a combination of medium questions
with less commonly known material about the diagnosis.
x
, Chapter Question Difficulty Key
Head Green box = Easy question Indicates
Yellow box = Medium question
Question
Red box = Hard question
Difficulty
1 Cell Injury, Adaptations, and Death
4. Correct: Systemic hypertension (B). 7. Correct: Ubiquitin-proteasome (E).
The pathologist is viewing hypertrophy of the car- The patient has disuse atrophy of the upper and
diac myocytes. While identification of enlarged lower extremities. The two primary processes occur-
cells themselves is a difficulty, enlarged rectangular ring in atrophy are decreased protein synthesis and
nuclei (i.e., boxcar nuclei) serve as a marker of car- increased protein degradation. Protein degradation
diac myocyte hypertrophy. Increased blood pressure is accomplished by binding of ubiquitin to the sub-
in the systemic vessels would put strain on the left stances to be degraded followed by its subsequent
ventricle and lead to hypertrophy (B). Pulmonary destruction by proteasomes (E). Cyclooxygenase and
hypertension would cause similar changes in the thromboxane A2 and 12-lipooxygenase-lipoxin A4
right ventricular myocardium (A). Lambl’s excres- function in inflammation (A, B), and plasmin-C3a
cences are incidental small nodules on the valve in the complement cascade (C), both of which could
leaflets that are of no physiologic consequence (C). be active in the muscle to some degree but are not
A probe patent fossa ovalis is usually of no physio- the main source of protein degradation, and p53-Bax
logic significance (D). However, if a left to right shunt functions in apoptosis (D), which might be occurring
developed, this condition could potentially lead to to some small degree but is not the main cause of the
volume overload in the right atrium and ventricle, protein degradation.
with resultant hypertrophy and dilation, but the left
ventricle would not be affected. An acute pericar-
dial hemorrhage would not explain hypertrophy, as
cardiac myocyte hypertrophy does not develop over 1.5 Cellular Injury— Correct
such a short period of time, but instead requires a Answers and Explanations Answer
longer exposure to the stimulus (E).
Easy Medium Hard
5. Correct: Metaplasia (C).
The bronchus is usually lined by respiratory epi- 8. Correct: Karyorrhexis of nuclei (E).
thelium (pseudostratified columnar epithelium); After 1 hour of ischemia, some of the affected myo-
however, when the nature of the stimulus to the cytes would have irreversible damage, in this case,
epithelium changes, which, in this case is trauma represented by the subendocardial myocardial Correct
caused by the pressure from the coin, the epithelium infarct. Of the choices, only karyorrhexis of the
can change to a different form to better handle the nuclei is characteristic of irreversible injury, i.e., Answer
abnormal stimulus. The transition from one epithe-
lium type to another is termed metaplasia (C). In
necrosis (E), whereas the other choices are seen
with reversible injury (A-D). Other microscopic fea-
Explanation
the lung, squamous metaplasia most commonly is tures of irreversible ischemic injury (i.e., necrosis)
a result of cigarette smoking, and, in this situation, include increased eosinophilia of the cytoplasm, and
metaplasia can lead to dysplasia and finally to carci- other nuclei changes including karyolysis (i.e., fad-
noma, accounting for the presence of squamous cell ing of the chromatin) and pyknosis (i.e., shrinkage
carcinomas in the lung. If the coin is removed, the of the nucleus). Karyorrhexis is fragmentation of the
epithelium could transition back to respiratory epi- nucleus. As the thrombus was lysed relatively early,
thelium; therefore, the change is reversible, and not myocytes closer to the epicardium may have had
irreversible cellular injury. (A-B, D-E) are incorrect signs of reversible injury, but not irreversible injury.
based on the previously discussed information.
9. Correct: Thrombus of distal branch of left Incorrect
6. Correct: Physiologic hyperplasia, renal artery (E).
compensatory type (D). The gross description is that of an infarct, which has
Answer
Because of the absence of the right kidney, the left
kidney has a higher workload, and in response, the
coagulative necrosis. In coagulative necrosis, the nor- Explanation
mal organ architecture is preserved in the beginning
left kidney increases the number of cells in its struc- phases of the development of the infarct. A thrombus
ture to handle this increased workload and thus, of a branch of the renal artery can produce an infarct
the organ weight has increased. The cells in the kid- of the cortex of the kidney (E). Infarcts are typically
ney are capable of division, and thus hyperplasia wedge-shaped, essentially exhibiting the down-
can occur (unlike in the cardiac or skeletal muscle). stream effects of a blockage of the arterial system,
The hyperplasia is physiologic in nature because with the amount of organ affected increasing mov-
it is stimulated by an increased workload, and it is ing distal from a single point, the tip of the wedge.
to compensate for the loss of the other kidney (D). Preservation of architecture does not occur with liq-
(A-C, E) are incorrect based on previously discussed uefactive necrosis (as could be seen with a bacterial
information. pyelonephritis) or caseous necrosis (as could be seen
with a tuberculosis infection), and by their nature,
tumors do not have preservation of architecture
6 within their boundaries (A-D).
xi
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