HI G.

H YIELD NOTES PATHOLOGY c

USMLE pic(Ures: sec handout describing high yield pictures in Robbin's Six.OJ
ed'•non
.
USMLE hematology pictures no t •n
- °
• R bb',ns� • supravital stain showin
·
g rcncu· locytc RNA
filaments, • c �arsc b�soph·1· sn . pp 1ng
1r tn po
.1s .
on1 �g, • x-ray with density in
. ph scs- b
1 1c . Pb
ac
polsontng, • nnged s1deroblast,. • u progranuloeyticte leukemia- lots of A � Y P
. and Hx of
�, s 1·yu,p -h om.a enctrcli�g trachea and arch ves
ucr rvu:.
DIC, • � ss of non-H_..1 vug,..:-•
_ sels without i
them. • rrncro of B cell follicular lymphoma, • multipl� mycloma marrow with plasma cclt�g s- BJ m
unn _,.a �Stc:m b
' e, • R= erg cc II , • app I c � en b.u-c n&c ncc of amyloid, • back of hand Of C e.
ld ly
fri
• o c Id erl . ·
patient W1.th. seni'l e purpu ra, arms patle nt with multiple bruises- nrobabl b
d

f
. 'j a USC1 •
y
r•
midbrain with yellow d.rseo1oration of k .
em1ctcrus, • fetus with hydrops fetalis
USMLE canf.iovascular pictures not in Rf)bbios: • xanthelasrna, • Achilles tendon xanth
pathognomonic of famili �� hypcrcholestcrol�a, • turbid supranatc (chylomicrons) and�=
(VLDL). • stasis damat:1t:ts of lower leg- SJgn of deep venous thrombosis,• Osler-Wcbc:r-Reodu
_
diease telangiecr.asia on fingers and mucous membranes, • spider telangicctasia, • lyx,tpllcdema
post mastectomy, • Kaposi's sarcoma. • micro of small vessel vasculitis with fibrinoid necrosis •
thramboangiitis obliterans_, • patient with Henoch-Schonlein purpura, • gross of renovascul�
hypertension d �e to athe�osc�eros�s, • capill� he�gioma on the face of a newborn, • Sturgc
Weber- port wme nevus 1n tngenunal nerve d1stribution,• gross and micro of pulmonary edema..
coronary .artery• • identify platelet l'.hrombus, • fibrofatty plaque, • dystrophic calcification, •
athc:roscle:rosis (ei1ipty slits). • section through ascending aorta- "vhat pan dilated with postductal
coarctation? proximal aorta, • ruptl,lre of posteromedial papillae)• muscle in -an Ai\fi, • rupcure of
,anterior wall of LV in an AMI, • r uptured intcrvc:ntricular septum in patient with -an acute
myocardial infarction- rupture occurs in site of coagul.ati0n necros-is and leads to right heart failure,
• mural thrombus in an AMI, • fibrinous pericarditis, • old AMI with scar tissue on anterior wall­
do not confuse with a pale infarct, • valve vegetations- • MV "·eret'.tions in rheumatic fever: along
the lines of closure of the valve, • infective endocarditis: see destruction of valv� • marantic
vegetations on MV: • sinular in appearance lQ rheumatic fever. • Ih of colon cancer or ulcerative
colitis, IF Libman S3cks endocarditis:. occur on MV in patients with SLE, • gross of mitral valve
prolapse, • micro of myocardium with .ly1uphocytic infiltrate- coxsaclcie myocarditis
USMLE respiratory pictures not in Robbins: • x-ray with spontarleous pneurnothorax (tracheal
shift to side of the pneumothorax) o r tension pncumothorax (tracheal shift to cona-alateral side)1 •
gram sta-in of Streptococcus pneumoniae, • x-ray o r gross of lobar pneumonia, • gram stain of
of
filammtous gram positive bacteria- Actinomyces or Nocardia (partially acid fast), • micro
acid-fast
macrophage with Histoplasma yeasts, • gross of cavitary apical lesion of TB- possible
stain of organisms. • micro of a macrophage: with acid�fast bacteria- TB, • .micro of broad
based
-ang led non• septa te hyph ae of ?v{uc or, • gross of lung abscess,
bud o( Blastomyces, • micro of wide
a gros s of Ham man -Ric h hone ycom b lung,• x-
• micr o of non ..cas eati ng gran ulom in sarc oido sis. •
ray of classic COPD. • gtoss of m.ain•stcm primary lung cancer
exudauve
USMJ.E gastrointestinal pictures not io Robbins: • patient with l-Ierpes simplex. •
tonsillitis, • hairy lcukoplakia. • thrush with or witho ut gram stain of pseud ohyph a e and �east$, "
gross of two tongues with lcukoplakia- one tongue is squamous dysp1asia and the other
is 1nv_asive
squa mou s canc er,• Peu tt-Je gher s hps, •
cancer (look for asymmetry of tongue) • tower lip with
• gross Qf
patient with mixed tumor of parotid, ••gross or barium study of Zenke-r's divcmculurn,
or ade:n oca rcin oma distal eso pha gus..• x­
esophageal cancer- think squamous ii mid-esophagus if
ls and step- ladd er effec t. •
ray of classic small bowei obstruction with air-fluid leve
gross of

inrus.�itsceptioo in a child� • micro of absent ganglion cells in rectal biopsy in Hirs chsp runS-S, ,.

I
 . l is co py righ t ed. Al l ricbts reserved. Edward Golj ua, M.D. 2002
Nott: Tills macen •
,-

o f an gi od � las i a in cecum. • gros s of carcinoid tumor (yello w col or) of

. r 0
mic ti p of apPcndix,
o ding mass from anus in adult •
pro)apsed ,· ntemal hemorrh i d- protru . . .
ancreas pictures not Robbins : • eye s with j aundi
USJ\1L E bep atob ili.a ry/p
1 0
· ce � • gross or nucro \
o f amebic l iver abscess or fl as k sh aped u. 1 ccrs 1n cecum.- look for trophozo1· tcs Wlt . h RBC
o f 1 iv
· cr cc h . noc occ os1 s. • gro ss r truer
phagoc ytosis, • gross_ � � � o � obstructi ve jaundice- liver is r
on 11 uct. • Kayscr-Fl c 1schcr nn m Wilson's dis
gieen, look for sto ne m c omm � � d _ � ease- r emember \
total copper is low, ccrul � plasmm_ 1s l �w . � d frcc copper 1 � high, • patient With Du '
1 c1 fi th puytrcn s
U A rure ' • x-ra
Con �c y sho wi ng ca 1cat1on s m c pancreas 1n chroni c paneIea...;..;
u uS� • gross of r
pancreatic can cc:t" of hea d of pan cr ea s
'
USMLE genito urin ary pictu res not in Robbi n s : • casts in urine- hyal inc ( fuxey and round
borders) vs waxy (sharp border s ). RBC cas� renal tubu l ar cast, fatty cast with Maltese cro
cells in urine- WB Cs, RBCs, • crystals in � nc- uric ac id. calci um oxalate, cystine
horseshoe kidney , • gross or x-ray of duplicated ureter, • gro ss of bilateral polycystic kidn
cry:�:: • •

diseas,... in a child. • gross of adult polycystic_ disease with or without brain with e ither;
subarachnoi d bleed (ruptured bet 1y anemysm) or mtracercbral bl eed (hypertensive bleed), • linear
immunofl uoresccnce- think Goodpasture's S)Tldromc, • l wnpy bua1py IF- think type m
immW1ocomplcx g lomerulonephritis, • EM pictures- fus i on of podocytes in l ipo id ncphrosis
subcpithelia l depo sits (post-stteptococcal . membranous)� subendothe lial (type IV SLE,
membranoproliferative), • micro of nodular glomerulosclcrosis in DM- look for hyalin;
anerio )osclerosis of afferent/efferent and pink balls in mcsangi� " Christmas ball" disease , •
micro of ischemic A'IN- look for coagulation necrosis of tubular cells, • pictw-c of kidney and
show where Hg- or Pb damages- proximal tubule:, • gross of staghom calculus, • gross or micro or
renal infarction - look for pale, sunken areas on the cortex and coagulation necrosis, • gross of
benign nephrosclerosis- granular appearing cortical surface� • gross of malignant hypertension­
look for petechial lesions on surface of the kidney, • micro of foreign body giant cell reaction in
tubules - BJ protein reaction in multiple mycloma, • gross of prostate hyperplasia- bulging nodular
surfa� \\11th occlusion of the urethra, • patient with Kl inefelte.r's- look for si gns of feminization, •
patient with testicular feminization- looks l ike a ,voman but they wi l l give history of blind vaginal
pouch, • gross of renal adenocarcinoma- yell ow mass wi th hemorrhage . yellow mass ex.tending up
the inferior vena cava
USMLE gynecology pictures not i n Robbins: • Herpes geni talis \Vlth or without a Tzanck prep
showing multinucleated squamous cells with intranuclear inclusions. • condyloma acuminata­
looks like a fem, HPV 6/ 1 1 , • Chlamydia- ceil with vacuole in the cytoplasm containing an
elementary body, • cervix or penis with thick exudate of GC with or v.rithout gram stain showing
gram -negative diplococci in polys, • clue cell of Gardnerel/a vagina/is- squamous cell covered by
bacteria, • primary syphilitic chancre on penis or labia- • pain less . • if painful look for Hemophilus
ducreyi, • picture of Iymphogranuloma venerewn- C. trachomatis subtype, papulcs with draining
sinus from nodes, lymphcdema. • Candida- cottage cheese discharge with or without gram stain of
pscudohyphac and yeasts, • squamous cell carcinoma of vulva- large ulcer on labi� • gross of
cervical cancer. • micro ·of squamous dysplasia, • woman with hirsutism- • increased testosterone
indica tes ovarian origin, • increased DHEA-sulfatc: indicates adrenal cortex origin, • ovary Mth
blood in cyst- cndomctriosis, • gross of ruptured tube (small embryo) from ectopic pregnancy, •
gross of follict1�iar - cyst, • gross or mi cro of serous cystadcnocarcinoma of ovary- look for
psam.moma bodies . • micro o f si gnet ring cells with muc in in ovaries- Kruk.enberg tumor from
stomach metastasis, • gross of abruptio placenta� • micro of choriocarcinoma- look for
multinuc1cated cells representing syncytiotrophoblast and c1ear cells representing cytotrophoblast. •
gros� of fibrocystic change, • patient with Pagct•s disease of nipple, • patient with inflammatory
carcinoma of the breast with peau du orange appearance