1200

Questions

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 Lippincott’s
Illustrated Review of

Rubin's Pathology
SECOND EDITION

Bruce A. Fenderson, PhD

Professor of Pathology
Department of Pathology, Anatomy and Cell Biology
Jefferson Medical College
Thomas Jefferson University
Philadelphia, Pennsylvania

David S. Strayer, MD, PhD

Professor of Pathology
Department of Pathology, Anatomy and Cell Biology
Jefferson Medical College
Thomas Jefferson University
Philadelphia, Pennsylvania

Raphael Rubin, MD
Professor of Pathology
Department of Pathology, Anatomy and Cell Biology
Jefferson Medical College
Thomas Jefferson University
Philadelphia, Pennsylvania

Emanuel Rubin, MD
Founder and Consulting Editor, Rubin’s Pathology
Recipient of the Tom Kent Award for Excellence
in Pathology Education
Gonzalo E. Aponte Distinguished Professor
Department of Pathology, Anatomy and Cell Biology
Jefferson Medical College
Thomas Jefferson University
Philadelphia, Pennsylvania

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Library of Congress Cataloging-in-Publication Data

Lippincott’s illustrated Q & A review of Rubin’s pathology / Bruce A. Fenderson ... [et al.]. — 2nd ed.
p. ; cm.
Other title: Illustrated Q & A review of Rubin’s pathology
Other title: Lipppincott’s illustrated Q and A review of Rubin’s pathology
Rev. ed. of: Lippincott’s review of pathology / Bruce A. Fenderson, Raphael Rubin, Emanuel Rubin. c2007.
A learning companion to 5th and 6th ed. of Rubin’s pathology.
Includes index.
Summary: “Lippincott’s Illustrated Review of Rubin’s Pathology, Second Edition offers up-to-date, clinically relevant board-style
questions-perfect for course review and board prep! Approximately 1,000 multiple-choice questions with detailed answer explanations
cover frequently tested topics in general and systemic pathology. The book is heavily illustrated with photos in the question or answer
explanation. Online access to the questions and answers provides flexible study options”—Provided by publisher.
ISBN 978-1-60831-640-3 (pbk.)
1. Pathology—Examinations, questions, etc. I. Fenderson, Bruce A. II. Fenderson, Bruce A. Lippincott’s review of pathology.
III. Rubin’s pathology. IV. Title: Illustrated Q & A review of Rubin’s pathology. V. Title: Lipppincott’s illustrated Q and A review of
Rubin’s pathology.
[DNLM: 1. Pathology—Examination Questions. QZ 18.2 L765 2011]
RB31.F46 2011
616.07076—dc22
2010025179

DISCLAIMER
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editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book
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 Dedication

We dedicate this book to our many teachers and colleagues for generously sharing
their time and knowledge, and to all students of medicine for their intellectual stimulation
and passion for learning.

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 Preface
Lippincott’s Illustrated Q&A Review of Rubin’s Pathology presents the key concepts of modern pathology in the form of
clinical vignette-style questions. Using the format of the National Board of Medical Examiners (NBME), the questions
address the major topics in general and systemic pathology presented in Rubin’s Pathology: Clinicopathologic Founda-
tions of Medicine. In addition to being a learning companion to this textbook, these questions will serve as a stand-
alone resource for self-assessment and board review.
The questions are prepared at a level appropriate for second-year medical students. They provide a roadmap for
students completing their courses in pathology and preparing for the United States Medical Licensing Examination
(USMLE). Students in the allied health sciences (e.g., nursing and physical therapy) will also find considerable
didactic value in clinical vignette-style questions.
Clinical vignette-style questions strengthen problem-solving skills. Students must integrate clinical and laboratory
data, thereby simulating the practice of pathology and medicine in general. Case-based questions probe a level of
competency that is expected for success on national licensing examinations. Given below are key features of this
text:
• Multiple choice questions follow the USMLE template. Case-based questions include (1) patients’ demographics,
(2) clinical history, (3) physical examination findings, and (4) results of diagnostic tests and procedures. Each
clinical vignette is followed by a question stem that addresses a key concept in pathology.
• Questions frequently involve “two-step” logic—a strategy that probes the student’s ability to integrate basic knowl-
edge into a clinical setting. The answer choices appear homogeneous and are listed alphabetically to avoid unin-
tended cueing.
• Over 200 full-color images link clinical and pathologic findings.
• Answers are linked to the clinical vignettes and address key concepts. Incorrect answers are explained in context.
• Normal laboratory reference values are included for key laboratory tests.
• As an additional test-taking practice tool, the questions are also presented in an electronic format on our connection
Web site (http://thePoint.lww.com/LIQARpathology2). Questions can be presented in both “quiz” and “test” modes.
In quiz mode, students receive instant feedback regarding the correctness of their answer choice, along with a ratio-
nale. The test mode helps familiarize the user with the computer-generated USMLE experience.
We hope that this review of pathology will encourage students to think critically and formulate their own ques-
tions concerning mechanisms of disease. We are mindful of the words of e. e. Cummings, who wrote “always the
beautiful answer who asks a more beautiful question.” We wish our students success in their learning adventure.
Most importantly, have fun with pathology.
Bruce A. Fenderson
Raphael Rubin
David S. Strayer
Emanuel Rubin

iv

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 Acknowledgments
The contributions of the editors and authors of Rubin’s Pathology: Clinicopathologic Foundations of Medicine, 5th and
6th editions were invaluable in the preparation of this text. We are particularly indebted to Dr. Ivan Damjanov and
Dr. Hector Lopez for their contributions. Finally, we gratefully acknowledge the staff at Lippincott Williams &
Wilkins for their expert help with manuscript preparation.

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 Contents
Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .iv

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v

Chapter 1 Cell Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 01

Chapter 2 Inflammation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Chapter 3 Repair, Regeneration, and Fibrosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25

Chapter 4 Immunopathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Chapter 5 Neoplasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Chapter 6 Developmental and Genetic Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

Chapter 7 Hemodynamic Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

Chapter 8 Environmental and Nutritional Pathology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

Chapter 9 Infectious and Parasitic Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

Chapter 10 Blood Vessels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98

Chapter 11 The Heart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111

Chapter 12 The Respiratory System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125

Chapter 13 The Gastrointestinal Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142

Chapter 14 The Liver and Biliary System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160

Chapter 15 The Pancreas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175

Chapter 16 The Kidney. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180

Chapter 17 The Lower Urinary Tract and Male Reproductive System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198

Chapter 18 The Female Reproductive System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210

Chapter 19 The Breast. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225

Chapter 20 Hematopathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234

Chapter 21 The Endocrine System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253

Chapter 22 Obesity, Diabetes Mellitus, Metabolic Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267

Chapter 23 The Amyloidoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271

Chapter 24 The Skin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 276

vi

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 Contents vii
Chapter 25 The Head and Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283

Chapter 26 Bones, Joints, and Soft Tissues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291

Chapter 27 Skeletal Muscle. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301

Chapter 28 The Nervous System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306

Chapter 29 The Eye . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328

Chapter 30 Cytopathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335

Appendix A: Normal Reference Range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 340

Appendix B: Common Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 342

Appendix C: Figure Credits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343

Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 351

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