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8204_Brown_fm_c.qxd 11/14/01 3:27 PM Page i

PRE
TEST ®

Pathology
PreTest® Self-Assessment and Review
8204_Brown_fm_c.qxd 11/14/01 3:27 PM Page ii

Notice

Medicine is an ever-changing science. As new research and clinical experience

broaden our knowledge, changes in treatment and drug therapy are required. The
authors and the publisher of this work have checked with sources believed to be
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the possibility of human error or changes in medical sciences, neither the authors
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8204_Brown_fm_c.qxd 11/14/01 3:27 PM Page iii

PRE
TEST ®

Pathology
PreTest® Self-Assessment and Review
Tenth Edition

Earl J. Brown, M.D.

Associate Professor
Department of Pathology
Quillen College of Medicine
Johnson City, Tennessee

Student Reviewers
Sara M. Nesler
University of Iowa College of Medicine
Iowa City, Iowa
Class of 2002
Misha F. Haque
Baylor College of Medicine
Houston, Texas
Class of 2001
Joseph Cummings
University of Iowa College of Medicine
Iowa City, Iowa
Class of 2002
Harvey Castro
University of Texas—Galveston School of Medicine
Galveston, Texas
Class of 2002

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DOI: 10.1036/007138975X
8204_Brown_fm_c.qxd 11/14/01 3:27 PM Page ix

Introduction
Each PreTest® Self-Assessment and Review allows medical students to com-
prehensively and conveniently assess and review their knowledge of a par-
ticular basic science, in this instance pathology. The 500 questions parallel
the format and degree of difficulty of the questions found in the United
States Medical Licensing Examination (USMLE) Step 1. Practicing physi-
cians who want to hone their skills before USMLE Step 3 or recertification
may find this to be a good beginning in their review process.
Each question is accompanied by an answer, a paragraph explanation,
and a specific page reference to an appropriate textbook or journal article.
A bibliography listing sources can be found following the last chapter of
this text.
An effective way to use this PreTest® is to allow yourself one minute to
answer each question in a given chapter. As you proceed, indicate your
answer beside each question. By following this suggestion, you approxi-
mate the time limits imposed by the Step 1 exam.
After you finish going through the questions in the section, spend as
much time as you need verifying your answers and carefully reading
the explanations provided. Pay special attention to the explanations for
the questions you answered incorrectly—but read every explanation. The
author of this material has designed the explanations to reinforce and sup-
plement the information tested by the questions. If you feel you need fur-
ther information about the material covered, consult and study the
references indicated.
The High-Yield Facts added for this edition are provided to facilitate
rapid review of pathology topics. It is anticipated that the reader will use
the High-Yield Facts as a “memory jog” before proceeding through the
questions.

ix

Copyright 2002 The McGraw-Hill Companies. Click Here for Terms of Use.
8204_Brown_fm_c.qxd 11/14/01 3:27 PM Page v

Contents
Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Laboratory Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi

High-Yield Facts
High Yield Facts in Pathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

General Pathology
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80

Cardiovascular System
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187

Hematology
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232

Respiratory System
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277

Head and Neck

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295

Gastrointestinal System
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 324

Urinary System
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 357
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 368

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8204_Brown_fm_c.qxd 11/14/01 3:27 PM Page vi

vi Contents

Reproductive Systems
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399

Endocrine System
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 423
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 436

Skin
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 464

Musculoskeletal System
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 473
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 482

Nervous System
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 503

Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 519
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 521
8204_Brown_fm_c.qxd 11/14/01 3:27 PM Page vii

Preface
The study of pathology, a science so basic to clinical medicine, has been
abbreviated sadly in many medical schools in recent years, and at a time
when explosive growth is occurring in the science. Recent advances in
immunopathology, diagnosis of bacterial and viral diseases including AIDS,
and detection of infectious agents such as papillomavirus in cervical dys-
plasia are proceeding at a tremendous rate. The tenth edition of Pathology:
PreTest® Self-Assessment and Review includes such new subject areas as pre-
dictive values in the interpretation of laboratory data, the importance of
cytokines, the molecular basis of genetic and other disease processes, and
molecular biology techniques as these apply to lymphoproliferative disor-
ders and other tumors.
The medical student must feel submerged at times in the flood of in-
formation—occasionally instructors may have similar feelings. This edition
is not intended to cover all new knowledge in addition to including older
anatomic and clinical pathology. It is, rather, a serious attempt to present
important facts about many disease processes in hopes that the student will
read much further in major textbooks and journals and will receive some
assistance in passing medical school, licensure, or board examinations.

vii

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8204_Brown_fm_c.qxd 11/14/01 3:27 PM Page xi

Laboratory Values
Substance Source Normal

Albumin Serum 3.2–4.5 g/dL

Alkaline phosphatase Serum 20–130 IU/L
Bicarbonate Plasma 21–28 mM
Bilirubin, direct (conjugated) Serum <0.3 mg/dL
Bilirubin, indirect (unconjugated) Serum 0.1–1.0 mg/dL
Bilirubin, total Serum 0.1–1.2 mg/dL
BUN Serum 8–23 mg/dL
Calcium Serum 9.2–11.0 mg/dL
(4.6–5.5 meq/L)
Chloride Serum 95–103 meq/L
Cholesterol Serum 150–250 mg/dL
Creatinine Serum 0.6–1.2 mg/dL
GGT (γ-glutamyltransferase) Serum 5–40 IU/L
Glucose (fasting) Serum 70–110 mg/dL
Insulin Plasma 4–24 µIU/mL
Iron Serum 60–150 µg/dL
Iron saturation Serum 20–55%
Osmolality Serum 280–295 mosm/L
Phosphorus Serum 2.3–4.7 mg/dL
Potassium Plasma 3.8–5.0 meq/L
Protein Serum 6.0–7.8 g/dL
Sodium Plasma 136–142 meq/L
T3 resin uptake Serum 25–38 relative % uptake
Thyrotropin (TSH) Serum 0.5–5 µIU/mL
Thyroxine, free (FT4) Serum 0.9–2.3 ng/dL
Thyroxine, total (T4) Serum 5.5–12.5 µg/dL
Triiodothyronine (T3) Serum 80–200 mg/dL

Hematology
Platelet count 150,000–450,000/µL
White cell count 4,440–11,000/µL
Lymphocyte count 1,000–4,800/µL
(about 34%)
Mean corpuscular volume 80–96 µm3
(MCV)
Mean corpuscular hemoglobin 27.5–33.2 pg
(MCH)
Mean corpuscular hemoglobin 33.4–35.5%
concentration (MCHC)
Hemoglobin Whole blood Female 12–16 g/dL
Male 13.5–18 g/dL

Copyright 2002 The McGraw-Hill Companies. Click Here for Terms of Use.
8204_Brown_fm_c.qxd 11/14/01 3:27 PM Page xiii

PRE
TEST ®

Pathology
PreTest® Self-Assessment and Review
This page intentionally left blank.
8204_Brown_hy_c.qxd 11/14/01 3:30 PM Page 1

High-Yield Facts
in Pathology
1. CELL INJURY
Reversible Cell Injury
• swelling of cell organelles and entire cell
• dissociation of ribosomes from endoplasmic reticulum
• decreased energy production by mitochondria
• increased glycolysis → decreased pH → nuclear chromatin clumping

Irreversible Cell Injury

• dense bodies within mitochondria (flocculent densities in heart)
• release of cellular enzymes (e.g., SGOT, LDH, and CPK after MI)
• nuclear degeneration (pyknosis, karyolysis, karyorrhexis)
• cell death
2. FATTY CHANGE OF THE LIVER
Mechanisms
1. Increased delivery of free fatty acids to liver
• starvation
• corticosteroids
• diabetes mellitus
2. Increased formation of triglycerides
• alcohol (note: NADH > NAD)
3. Decreased formation of apoproteins
• carbon tetrachloride
• protein malnutrition (kwashiorkor)
3. CELL DEATH
Apoptosis
• “programmed” cell death
• single cells (not large groups of cells)
• cells shrink → form apoptotic bodies
• gene activation → forms endonucleases
• peripheral condensation of chromatin with DNA ladder
• no inflammatory response

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8204_Brown_hy_c.qxd 11/14/01 3:30 PM Page 2

2 Pathology

Examples of apoptosis:
1. Physiologic
• involution of thymus
• cell death within germinal centers of lymph nodes
• fragmentation of endometrium during menses
• lactating breast during weaning
2. Pathologic
• viral hepatitis
• cytotoxic T cell–mediated immune destruction (type IV hypersensi-
tivity)

Necrosis
• cause → hypoxia or toxins (irreversible injury)
• many cells or clusters of cells
• cells swell
• inflammation present
Examples of necrosis:
• coagulative necrosis → ischemia (except the brain)
• liquefactive necrosis → bacterial infection (and brain infarction)
• fat necrosis → pancreatitis and trauma to the breast
• caseous necrosis → tuberculosis
• fibrinoid necrosis → autoimmune disease (type III hypersensitivity reac-
tion)
• gangrene → ischemia to extremities → dry (mainly coagulative necrosis)
or wet (mainly liquefactive necrosis due to bacterial infection)

4. TERMS
Adaptation
• hypertrophy → increase in the size of cells
• hyperplasia → increase in the number of cells
• atrophy → decrease in the size of an organ
• aplasia → failure of cell production
• hypoplasia → decrease in the number of cells
• metaplasia → replacement of one cell type by another
• dysplasia → abnormal cell growth

Abnormal Organ Development

• anlage → primitive mass of cells
• aplasia → complete failure of an organ to develop (anlage present)
8204_Brown_hy_c.qxd 11/14/01 3:30 PM Page 3

High-Yield Facts 3

• agenesis → complete failure of an organ to develop (no anlage present)

• hypoplasia → reduction in the size of an organ due to a decrease in the
number of cells
• atrophy → decrease in the size of an organ due to a decrease in the num-
ber of preexisting cells
5. CARDINAL SIGNS OF INFLAMMATION
• rubor → red
• calor → hot
• tumor → swollen
• dolor → pain
6. COMPLEMENT CASCADE
Products
• C3b → opsonin
• C5a → chemotaxis and leukocyte activation
• C3a, C4a, C5a → anaphylatoxins
• C5–9 → membrane attack complex

Deficiencies
• deficiency of C3 and C5 → recurrent pyogenic bacterial infections
• deficiency of C6, C7, and C8 → recurrent infections with Neisseria species
• deficiency of C1 esterase inhibitor → hereditary angioedema
• deficiency of decay-accelerating factor → paroxysmal nocturnal hemo-
globinuria
7. THROMBOXANE VS. PROSTACYCLIN
Thromboxane
• produced by platelets
• causes vasoconstriction
• stimulates platelet aggregation

Prostacyclin
• produced by endothelial cells
• causes vasodilation
• inhibits platelet aggregation
8. GRANULOMATOUS INFLAMMATION
Caseating Granulomas
• aggregates of activated macrophages (epitheloid cells)
• tuberculosis
8204_Brown_hy_c.qxd 11/14/01 3:30 PM Page 4

4 Pathology

Noncaseating Granulomas
• sarcoidosis
• fungal infections
• foreign-body reaction

9. COLLAGEN TYPES
Fibrillar Collagens
• type I → skin, bones, tendons, mature scars
• type II → cartilage
• type III → embryonic tissue, blood vessels, pliable organs, immature
scars

Amorphous Collagens
• type IV → basement membranes
• type VI → connective tissue

10. EDEMA
Exudates
1. Composition
• increased protein
• increased cells
• specific gravity greater than 1.020
2. Cause
• inflammation
• increased blood vessel permeability

Transudates
1. Composition
• no increased protein
• no increased cells
• specific gravity less than 1.012
2. Cause → abnormality of Starling forces
a. increased hydrostatic (venous) pressure
• congestive heart failure
• portal hypertension
b. decreased oncotic pressure → due to decreased albumin
• liver disease
• renal disease (nephrotic syndrome)
8204_Brown_hy_c.qxd 11/14/01 3:30 PM Page 5

High-Yield Facts 5

c. lymphatic obstruction
• tumors or surgery
• filaria

11. CARCINOMAS
Squamous Cell Carcinoma
• skin cancer
• lung cancer
• esophageal cancer
• cervical cancer
Adenocarcinoma
• lung cancer
• colon cancer
• stomach cancer
• prostate cancer
• endometrial cancer
Transitional Cell Carcinoma
• urinary bladder cancer
• renal cancer (renal pelvis)
Clear Cell Carcinoma
• renal cortex
• vaginal cancer (associated with DES)

12. NEOPLASMS
Benign
• grow slowly
• remain localized
• may have well-developed fibrous capsule
• do not metastasize
• well differentiated histologically
Malignant
• grow rapidly
• locally invasive
• irregular growth; no capsule
• capable of metastasis
• variable degrees of differentiation (well differentiated, moderately differ-
entiated, poorly differentiated)
8204_Brown_hy_c.qxd 11/14/01 3:30 PM Page 6

6 Pathology

13. ONCOGENE EXPRESSION

Growth Factors
1. c-sis
• β chain of platelet-derived growth factor
• astrocytomas and osteogenic sarcomas
Growth Factor Receptors
1. c-erb B1
• receptor for epidermal growth factor
• breast cancer and squamous cell carcinoma of the lung
2. c-neu
• receptor for epidermal growth factor
• breast cancer
3. c-fms
• receptor for colony-stimulating factor (CSF)
• leukemia
Abnormal Membrane Protein Kinase
1. c-abl
• membrane tyrosine kinase
• chronic myelocytic leukemia (CML)
GTP-Binding Proteins
1. c-ras
• product is p21 (protein)
• adenocarcinomas
Nuclear Regulatory Proteins
1. c-myc → Burkitt’s lymphoma
2. N-myc → neuroblastoma
3. L-myc → small cell carcinoma of the lung
4. c-jun
5. c-fos
14. CHROMOSOMES AND CANCER
Point Mutations
• c-ras → adenocarcinomas
8204_Brown_hy_c.qxd 11/14/01 3:30 PM Page 7

High-Yield Facts 7

Translocations
• c-abl on chromosome 9 → CML
• c-myc on chromosome 8 → Burkitt’s lymphoma
• bcl-2 on chromosome 18 → nodular lymphoma

Gene Amplification
• N-myc → neuroblastoma
• c-neu → breast cancer
• c-erb B2 → breast cancer

15. ANTIONCOGENES
Tumor Suppressor Genes
• Rb → retinoblastoma and osteogenic sarcoma
• p53 → many tumors and the Li-Fraumeni syndrome
• WT1 → Wilms’ tumor and aniridia
• NF1 → neurofibromatosis type 1

16. CHEMICAL CARCINOGENS

Initiators
• tobacco smoke → many tumors
• benzene → leukemias
• vinyl chloride → angiosarcomas of the liver
• β-naphthylamine → cancer of the urinary bladder
• azo dyes → tumors of the liver
• aflatoxin → hepatoma
• asbestos → mesotheliomas and lung tumors
• arsenic → skin cancer

Promoters
• saccharin → bladder cancer in rats
• hormones (estrogen)

17. VIRUSES AND CANCER

RNA Viruses
• acute-transforming viruses
• slow-transforming viruses
• HTLV-1 → adult T cell leukemia/lymphoma
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