207
SECTI ON I I
Pathology
“The begining of health is to know the disease.” ––Spanish Proverb
High-Yield ClinicalVignettesHigh-Yield GlossyMaterialHigh-Yield TopicsCongenitalNeoplasticHematologicGastrointestinalRespiratoryNeurologicRheumatic/ AutoimmuneEndocrine/ ReproductiveVascular/ CardiacRenalFindingsPhotomicrographs
Questions dealing with this discipline are difficult to prepare for be-cause of sheer volume of material. Review the basic principles andhallmark characteristics of each key disease. Given the increasinglyclinical orientation of Step 1, it is no longer enough to know the“trigger words” or key associations of certain diseases (e.g., café-au-lait macules and neurofibromatosis); you must also know the clinicaldescriptions of these findings.With the increasingly clinical slant of the USMLE Step 1, it isalso important to review the classic presenting signs and symptomsof diseases as well as their associated laboratory findings. Delve intothe signs, symptoms, and pathophysiology of the major diseases hav-ing a high prevalence in the US (e.g., alcoholism, diabetes, hyper-tension, heart failure, ischemic heart disease, infectious disease). Beprepared to think one step beyond the simple diagnosis to treatmentor complication.The examination includes a number of color photomicrographsand photographs of gross specimens, which are presented in the set-ting of a brief clinical history. However, read the question and thechoices carefully before looking at the illustration, because the his-tory will help you identify the pathologic process. Flip through yourillustrated pathology textbook, color atlases, and appropriate websites in order to look at the pictures in the days before the exam. Payattention to potential clues such as age, sex, ethnicity, occupation,specialized lab tests, and activity.
 
PATHOLOGY—HIGH-YIELD CLINICAL VIGNETTES
These abstracted case vignettes are designed to demonstrate the thought processes necessary toanswer multistep clinical reasoning questions.
s
Patient has multiple fractures, anemia, cranial nerve deficits
→
in which of the following celltypes is there a defect?
→
osteoclasts (e.g., osteopetrosis).
s
35-year-oldman has high blood pressure in arms and low pressure in legs
→
what is the diagnosis?
→
coarctation of the aorta.
s
Woman presents with diffuse goiter and hyperthyroidism
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what are the expected values of TSH and thyroid hormones?
→
low TSH and high thyroid hormones.
s
Patient exhibits an extended expiratory phase
→
what is the disease process?
→
obstructivelung disease.
s
Woman presents with headache, visual disturbance, galactorrhea, and amenorrhea
→
what isthe diagnosis?
→
prolactinoma.
Path1.37 
s
Baby has foul-smelling stool and recurrent pulmonary infections
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what is the diagnosis, andwhat test is used?
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cystic fibrosis, chloride sweat test.
s
Obese woman presents with hirsutism and increased levels of serum testosterone
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what is thediagnosis?
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polycystic ovarian syndrome.
s
Man presents with extensive destruction of knees, subcutaneous nodules, and exquisite pain inthe metatarsophalangeal joint
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biopsy shows needle-like crystals
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what is the diagnosis?
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gouty arthritis.
s
48-year-old female with progressive lethargy and cold intolerance
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what is the diagnosis?
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hypothyroidism.
Path1.33
s
Patient with elevated serum cortisol levels undergoes dexamethasone suppression test. Onemilligram of dexamethasone does not decrease cortisol levels; 8 mg does
→
what is the diagno-sis?
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pituitary tumor.
s
During a game, a young basketball player collapses and dies immediately
→
what type of cardiacdisease?
→
hypertrophic cardiomyopathy.
Path1.10
s
Child has been anemic since birth. Splenectomy would result in increased hematocrit in what dis-ease?
→
spherocytosis.
s
43-year-old man experiences dizziness and tinnitus. CT shows enlarged internal acoustic mea-tus
→
what is the diagnosis?
→
schwannoma.
s
Child exhibits weakness and enlarged calves
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what is the disease, and how is it inherited?
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Duchenne’s muscular dystrophy, X-linked recessive.
s
25-year-old female presents with sudden uniocular vision loss and slightly slurred speech. Shehas a history of weakness and paresthesias that have resolved
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what is the diagnosis?
→
MS.
s
Teenager presents with nephritic syndrome and hearing loss
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what is his disease?
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Alport’ssyndrome.
s
Tall, thin male teenager has abrupt-onset dyspnea and left-sided chest pain. There is hyper-resonant percussion on the affected side, and breath sounds are diminished.
→
what is thediagnosis?
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pneumothorax.
s
Young man is concerned about his wife’s inability to conceive and her recurrent URIs. She hasdextrocardia
→
which of her proteins is defective?
→
dynein (Kartagener’s).
208
UC
 
V
 
s
55-year-old man who is a smoker and a heavy drinker presents with a new cough and flu-likesymptoms
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Gram stain shows no organisms; silver stain of sputum shows gram-negative rods
→
what is the diagnosis?
→
Legionella.
s
Patient has a stroke after incurring multiple long bone fractures in MVA trauma
→
whatcaused the infarct?
→
fat emboli.
s
25-year-old woman presents with a low-grade fever and a rash across her nose that gets worsewhen she is out in the sun
→
you are concerned about what disease?
→
SLE.
s
50-year-old man complains of diarrhea; on physical exam his face seems plethoric and a heartmurmur is detected
→
what is the diagnosis?
→
carcinoid syndrome.
s
Elderly woman presents with a headache and jaw pain
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labs show elevated ESR
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what isthe diagnosis?
→
temporal arteritis.
s
Pregnant woman at 16 weeks of gestation presents with an atypically large abdomen
→
whatabnormality might be seen on blood test, and what is the disorder?
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high hCG; hydatidiformmole.
s
80-year-old man presents with a systolic crescendo-decrescendo murmur
→
what is the mostlikely cause?
→
aortic stenosis.
s
Woman of short stature presents with shortened 4th and 5th metacarpals
→
what endocrinedisorder comes to mind?
→
Albright’s hereditary osteodystrophy, or pseudohypoparathyroidism.
s
After a stressful life event, 30-year-old man has diarrhea and blood per rectum; intestinalbiopsy shows transmural inflammation
→
what is the diagnosis?
→
Crohn’s.
s
Young man presents with mental deterioration and tremors. He has brown pigmentation in aring around the periphery of his cornea and altered LFTs
→
what treatment should he receive?
→
penicillamine for Wilson’s disease.
s
Patient presents with signs of vitamin B
12
deficiency
→
why not give folate?
→
masks signs of neural damage.
s
10-year-old child “spaces out” in class (e.g., stops talking midsentence and then continues as if nothing had happened). During spells, there is slight quivering of lips
→
what is the diagnosis?
→
absence seizure.
PATHOLOGY—HIGH-YIELD GLOSSY MATERIAL
s
Gross photograph of abdominal aorta with aneurysm
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what is the most likely process?
→
ath-erosclerosis.
s
Gross photograph of hydatidiform mole (“bunch of grapes”)
→
high levels of what substanceare present?
→
hCG.
s
Gross photograph of focally hemorrhagic small intestine of weight lifter
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what is the processresponsible for this?
→
strangulation of a hernia.
s
Chest x-ray shows collapse of middle lobe of right lung; recurrent pneumonia and growth inbronchus
→
what is the diagnosis?
→
bronchogenic carcinoma.
s
Middle-aged woman with intermittent syncope has a mass removed from the right atrium
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H&E shows wispy, mucus-like tissue
→
what is the diagnosis?
→
myxoma.
s
Chest x-ray shows pneumothorax
→
what are the clinical findings?
→
pleuritic chest pain.
s
1-year-old baby presents with big red splotch on face
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what is the likely course of this lesion?
→
regression vs. Sturge–Weber.
209

Pathology

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viswanatleft a comment

good job
11 / 18 / 2008
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ashy20left a comment

i lik it...contents r gud. i research on anemias during my bsc 2yr
07 / 20 / 2008
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j_vechinileft a comment

cant download it
07 / 08 / 2008
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