goljan errata sheet

7/26/2019 Goljan Errata sheet

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NEW ERRATA/ADDITIONS RAPID REVIEW

PATHOLOGY 3RD

EDITION REVISED REPRINT

(3-8-2013)

Some of the additional material is from Rapid Review 4th

ed, which will not be out as a

book until late next year.

Page 15B. 2. a. (3) Smooth muscle hypertrophy (also hyperplasia)in the urinary bladder.C.2.a.(3) Benign prostatic hyperplasia due to an increase in sensitivity to dihydrotestosterone

Page 23: Copy and insert as a page into book3. Rolling of neutrophils in the venules due to expression of selectin adhesion molecules on

neutrophils and endothelial cells

a. Selectins are carbohydrate-binding adhesion molecules.

b. L-Selectin is located on leukocytes (e.g., neutrophils), while E-selectin and P-selectin are

located on the surface of endothelial cells.

(1) P-selectin is produced in the Weibel-Palade bodies in endothelial cells.

(2) Weibel-Palade bodies are the glue factory of the endothelial cells, because they

synthesize P-selectin, an adhesion molecule for leukocytes) and von Willebrands

factor, the adhesion molecule of the platelet (refer to Chapter 15).

c. Interleukin-1 (IL-1) and tumor necrosis factor (TNF) stimulate the expression of selectin

ligands on the surface of neutrophils (L-selectin) and the expression of selectin molecules

on the surface of endothelial cells (E-selectin,P-selectin).

d. Binding of circulating neutrophils to E-selectin and P-selectin molecules on endothelial

cells is weak and transient causing them to roll(bind detach, bind detach) along the

endothelial surface of the venules.

Page 30

3.b.(4)(b) In the event that there is excessive DNA damage, the TP53suppressor gene produces proteinproducts that inhibit the translation of theBCl2anti-apoptosis genes, which leads to apoptosis

of the cell.

Page 41Figure 3-1 legend second sentence and the mother is haplotype A2B2C2D2


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Page 49

D. Acquired immunodeficiency syndrome (AIDS)

1. Epidemiologyc. Virus characteristics

(2) HIV-1 most common cause of AIDS in United States; HIV-2 more restricted (mostprevalent in Western Africa).

MN: HIV-2: more restricted than HIV-1; most prevalent in Western Africa

Page 52Fig. 3-5:Change 4b2b to 4b2a;change C4b2b3b toC4b2aC3b; change C3bBb3b to C3bBbC3b

Page 114First Margin note top of page, add arrow before VLDLas shown:

Kwashiorkor: fatty liver apoB synthesis; VLDL synthesisSecond Margin note from top of page

Marasmus: total calorie deprivation; protein and CHO

Page 119H.3.Excess intake.renal calculi composed of calcium oxalate.

Page 127

Fig. 8-2: D. Radiograph showing osteolytic lesions. Note the radiolucent areasin the midshaft of

the fibula(arrow).

Page 1304.a. Treatment of H. pylori infections

Decreases risk for developing malignant lymphoma of the stomach (not adenocarcinoma)

Margin Note: 3rd

from bottom: Rx H. pylori infection: risk for developing malignant lymphoma

Page 139

Box: 140/190 mm Hg

Page 140Blue box: Non-pharmacologictreatment

Page 150Fig. 9-9 legend

D. Sturge Weber syndrome.Nevus flammeus (birthmark) on the face in the distribution of theophthalmic and/or maxillary branch of cranial nerve V (trigeminal).

Page 161

Systolic dysfunction is characterized by(EF


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a. Lungs are heavy, congested, and exude a frothy pink transudate (edema) on the cut surface orin the airways.

b. Alveoli are filled with a pink staining fluid and alveolar macrophages containing hemosiderin(heart failure cells).(1) Latter finding implies that the pulmonary capillaries have ruptured under pressure and

RBCs entered the alveoli and were phagocytosed by alveolar macrophages.

(2) Excess iron in the macrophage binds to ferritin, which degrades into hemosiderin (rustycolored granules with H:E stain or blue with Prussian blue stain) producing a rustycolored sputum.

Page 182K.4.c. Microembolization findings (occurs in > 50% of cases)

(3) Oslers nodes arepainfulhemorrhagic nodules on the pads of the fingers or toes (10% to23% of cases).

(a) Although most references state that Oslers nodes are an example of animmunocomplex vasculitis, more recent studies have contradicted that belief.

(b) Early biopsies frequently demonstrate bacteria within microabscesses without anyevidence of a vasculitis, which favors microembolization as the initialprocess.

(c) However, as time progresses, the microabscess become sterile and an immune-mediated vasculitis develops.

Page 184Top Margin note: Viruses: most common knowncause myocarditis and pericarditis

VII.A.1.b. (1) (a) Viruses most common cause Adenovirus, coxsackievirus, HIV, parvovirus B19, human herpesvirus-6

B.1.b. Virusesare the most common overall known cause

Last Margin note: Pericarditis delete margin note

188

D.1.b.(4) Genes involved are mapped to chromosomes 11 (most common) and 14q.Page 199e. Ascorbic acidDELETE e. ENTIRELY

Page 2013. Laboratory findings

a. Normal to decreased MCV(1) ACD, in some cases, presents as a normocytic anemia.(2) It is most likely to be a microcytic anemia in the setting of rheumatoid arthritis and

Crohn disease.

Page 204c.1. Abdominal colic with constipation

Page 213

B.1. c. Membrane protein defect results in a loss of RBC membrane ( surface/volume ratio)and spherocyte formation.

(1) Mutation in spectrin followed by ankyrinis the most common defect.

d. Increased permeability of spherocytes topotassiumand water3. c. Increased RBC osmotic fragility


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(1) Decreased surface/volume ratio in spherocytes is the most critical factor for

increased RBC osmotic fragility.

D.1.a. Acquired stem cell disease with a somatic mutation after birth in the PIG (phosphatidylinositol glycan) group A gene in a myeloid stem cell clone

Page 226D.3.d.(1)(b) Atypical lymphocytes are antigenically stimulated B cells(Fig. 12-3).

Page 233

7.b. Clinical findings(3) Vessel thrombosis may also occur.

Page 259D.4.a. Mild cases respond to desmopressin acetate

VWF release from Weibel-Palade bodies; stabilizes circulating VIII:c

Page 260E.5.a. Desmopressin.

VWF release from Weibel-Palade bodies; stabilizes circulating VIII:c

Page 282

V.B.4.c. Respiratory acidosisor normal Paco2

Page 288Table 16-4

Pneumocystis jiroveciDiffuse intra-alveolaror Giemsa stains. Serum lactate dehydrogenase (LDH) elevatedin 90% of cases (predictive of increased morbidity/mortality).

Page 2907.a.(2) Produces a protein (cord factor)that prevents.

Page 2933.b. Pulmonary infarction

(7) Elevation of ipsilateral hemidiaphragm (most common finding)

Page 320N.1.c.(1) Smoking (DELETE THE REST)

(4) HPV most common risk factor

Page 329

Margin Note 4th

from top of page: Rx H. pylori risk for developing gastric lymphoma notadenocarcinoma

E.2.e.(4) Serologic tests have been discontinued.


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G.1.a. Majority (> 60%) are malignant and are located in the duodenum followed by the islet

cells in the pancreas

d. Ulcers are single and in the usual locations or there may be multiple ulcers.

Page 330

Table 17-2 Copy and insert as a page into bookEpidemiology Male/female ratio 1:1

Smoking may delay healing.

Risk for developing gastric cancer

(increased risk with blood group A

individuals)

Risk factors:H.pylori (most

common), chronic intake NSAIDS

(synergism withH.pylori),

moderate alcohol consumption

Male/female ratio 1:1

Risk increased with MEN I

Smoking may delay healing.

Chronic intake NSAIDS

Risk factors:H.pylori (most common),

chronic intake of NSAIDS, type O

blood group (lack blood group antigens

that are protective to the mucosal

surface)

Helicobacter pylori

association

Duodenal ulcer > gastric ulcer Duodenal ulcer > gastric ulcer

Complications Bleeding (most commonly ulceration

of left gastric artery; Fig. 18-14E).

Bleeding spontaneously ceases in

80% of cases.

Perforation (air under diaphragm,

pain radiates to left or right

shoulder; Fig. 18-14D)

Bleeding (anterior ulcer;most commonly

ulceration of gastroduodenal artery).

Fig. 18-14E). Bleeding spontaneously

ceases in 80% of cases.

Perforation (anterior ulcer;air under

diaphragm, pain radiates to left or right

shoulder)

Gastric outlet obstruction, pancreatitis

(posterior ulcer)

Page 338

8. Tests for bile salt/acid deficiency

Total bile acids

9. Tests for bacterial overgrowth a., b., and c. discussions are all okay and no changes need to

be made

Page 342

G.3.a.(1) Atrial fibrillation.

Add underneath: SMA has the greatest velocity of blood flow and the most acute angle off the aorta of all the

arteries originating from the abdominal aorta.


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Page 348Table 17-7Clinical findings Okay as is Recurrent right lower quadrant colicky

pain (obstruction) with diarrhea and

weight loss

The rest is okay


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Page 367Margin note 4th from the top of the page

Reyes syndrome: transaminases, ..

Margin note on bottom: Fulminant hepatic failure: transaminasesG.1.a. Viral hepatitis (most common infectiouscause)

b. Acetaminophen most common overall cause fulminant liver failureMargin Note: Fulminant hepatic failure: viral hepatitis most common infectiouscause

Fulminant hepatic failure: acetaminophen most common overall cause

Page 402

Table 19-7

Post-streptococcal glomerulonephritis

Usually resolves; CRF uncommon in children but common in adults

Page 403

Table 19-10Diffuse membranous glomerulopathy

Subepithelial.

Highest incidence renal vein and deep vein thrombosis (loss of antithrombin III in urine)

Treatment.

Page 414

B.2.g.Urine pH alterations(1) Alkaline urine pH favors crystallization of calcium- and phosphate-containing stones.(2) Acidic urine pH favors crystallization of uric acid, cystine, stones

Page 420

Blue box; line 12:

Reads mechanisms for outflowincontinence are outflow obstruction..

Should read overflowincontinence are outflow obstructions(e.g., BPH)

Page 429

C.2.a. DHT is the prime mediator. Causes hyperplasia of glandular and stromal cells due to increased sensitivity to DHT(see Fig.

1-14)

Page 4304.d.(1) (e) Bladder smooth muscle hypertrophy and hyperplasia

Page 434

A.1.a.(2)(c) Decreased sperm count Loss of seminiferous tubules (delete: and decreased testosterone)


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Page 437

Table 21-1

HPV (see Fig. 21-1E) Secondmost common STD (a few books say it is the most common)

Page 438Table 21-1

Trichomonas Vaginalis Most common STD;

As an aside: the stats are Trichomonas incidence 7.4 million, HPV incidence 6 million

Page 465-466 (excerpted from new RRPath 4th

ed.; copy and fold paper into book

E. Gestational trophoblastic neoplasms

1. Hydatidiform moles

a. Benign tumors of the chorionic villus

Complete and partial moles

MN: Hydatidiform mole: benign tumor in chorionic villus; look like grapes

b. More common at the extremes of age

c. Occurs in 1:1200 pregnancies in the United States

Occurs in 1:200 pregnancies in Indonesia

d. Complete mole is the most common type.(1) The entire placenta is neoplastic.

(2) Dilated, swollen villi without fetal blood vessels or parts (Fig. 22-16A)(3) Ovum 46, XX (90% of cases)

MN: Complete mole: MC type; whole placenta neoplastic; no fetal blood vessels or parts; 46,XX

(both male Xs)(a) Ovum lacks maternal chromosomes.

(b) Chromosomes are paternally-derived.

Duplication of 23X sperm in ovum (46XX; most common), or Two separate 23X or Y sperm enter ovum (called dispermy;

46XX or 46XY)

MN: Complete mole: dilated villi with no fetal parts

MN: Complete mole: empty ovum; fertilization by 23X sperm that has duplication of its

chromosomes (46XX; most common)

MN: Complete mole: empty ovum; fertilization by 2 separate sperm (23X or Y; dispermy); 46XX

or 46XY

(4) Increased risk for developing choriocarcinoma (15% 20%)

(5) Clinical findings

(a) Vaginal bleeding at 6 to 16thweek gestational age (80% 90%)

(b) Severe vomiting (hyperemesis gravidarum; 8%)

(c) Preeclampsia is present in 1% of patients.(d) Uterus is too large for gestational age (~30%).(e) Increased beta-hCG for gestational age (>100,000; 15%)

(f) Bilateral theca lutein cysts (15%)Develop in response to high levels of beta-hCG

(g) Snowstorm appearance with ultrasound (Fig. 22-16B)

MN: Complete mole: US with snowstorm appearance; too large for gestational age

(6) Treatment


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(a) Dilation and curettage Must remove all the material

(b) Follow patient with beta-hCG levels Should go down to zero

e. Partial mole(1) Normal villi are intermixed with neoplastic villi.

(2) Fetal parts are intermixed with neoplastic villi Amnion and fetal vessels with fetal erythrocytes are present within the

mesenchyme of the villi.

MN: Partial mole: normal villi intermixed with neoplastic villi; fetal parts intermixed with

neoplastic villi

MN: Partial mole: fertilization of 23X ovum by 2 sperm either X or Y (69XXY most common)

(a) Ovum triploid (69 XXY in 70% of cases; XXX in 27% of cases)(b) Most commonly due to fertilization 23X ovum by 2 sperm that are

either 23X or Y producing an ovum with 69XXY (most common) orXXX.

(3) Preeclampsia in 5% of patients(4) No risk for developing a choriocarcinoma

(5) Clinical findings(a) Incomplete or missed abortion (90%)(b) Vaginal bleeding (75%)

(c) Uterine enlargement 5% of patients(d) Theca lutein cysts and hyperemesis gravidarum extremely rare(e) Majority have beta-hCG


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Page 518 Copy and insert as a page into bookE.2.c. Dual-photon absorptiometry

(1) Non invasive test that evaluates bone marrow density (BMD)(2) The World Health Organization uses a T-score to define osteoporosis.

(a) It is calculated by subtracting the mean BMD (in g/cm2) of a young-adult reference

population from the patient's BMD and dividing this by the standard deviation (SD) of

the young-adult reference population.(b) Using the T-score, osteoporosis is defined as2.5 SD and below.

Page 531

3. Lyme diseasea. Epidemiology

(1) Transmitted..(2) Ticks acquire the spirochete by feeding on an infected animal host (reservoir for the disease).

(a) Preferred reservoirs are the white-footed mouse for nymphs and white-tailed deer foradults.

(b) Nymphs are responsible for the majority of human cases (90%), particularly in thesummer months.

Page 538Table 23-3 Please add additional sentence

Knee joint injuries

(Fig. 23-23C)

Unhappy triad: most common internal derangement of theknee joint. Valgus injury (acute): damage to the lateral

meniscus, medial collateral ligament, anterior cruciateligament. If chronic, the medial meniscus is mostcommonly injured rather than the lateral meniscus.

Page 561 Copy and insert as a page into bookI. Erythema multiforme (make a copy of the addition and put insert it in the book)

1. Type IV immunologichypersensitivityreaction of skin that is triggered by3. Stevens-Johnson syndrome (SJS)

a. Recently separated from EM as a distinct entitity.b. Type IV hypersensitivity reaction that primarily involves the skin and mucous

membranes (e.g., mouth, genitals) Infections (e.g., HIV, group A streptococcus), drugs (antibiotics most common

[penicillin, sulfa drugs]), and maligancies have been implicated; however, most

cases are idiopathic.c. Erosions develop on the mucous membranes and small blisters develop on purpuric or

erythematous macules on the skin (different from target lesions of EM)d. It can be fatal.

MN: SJS: involves skin/mucous membranes; type IV HSR

4. Toxic epidermal necrolysis syndrome (TENS)a. Idiosyncratic reaction most commonly drug-induced (e.g., sulfonamides, NSAIDS,

anticonvulsants)b. May occur alone or overlap with SJS

MN: TENS: necrosis, skin detachment; overlap with SJS

c. Characterized by extensive areas of erythema, necrosis, and bullous detachment of the

epidermis and mucous membranes exfoliation of skin

d. Mucous membrane involvement can result in gastrointestinal bleeding, respiratoryfailure, and genitourinary complications.


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e. It can be fatal.5. Treatment of EM

Page 566

I. Cerebral Edema, Pseudotumor Cerebri (Idiopathic Intracranial Hypertension)..

Page 571II.A.2. Maternal findings

Increased maternal alfa fetoprotein (AFP) in serum or amniotic fluid in anencephaly,meningocele, myelomeningocele, but notspinal bifida occulta

Page 581

Table 25-1 Copy and insert as a page into bookTABLE 26-1. CEREBROSPINAL FLUID (CSF) FINDINGS IN VIRAL, BACTERIAL,

AND FUNGAL MENINGITIS

CSF FEATURE BACTERIAL VIRAL FUNGUS

Total cell count Increased Usually normal or

slightly increased

Usually normal or

slightly increased

Differential count Predominantlyneutrophils;tuberculosis usuallylymphocytes

First 2448 hours,neutrophils, thenswitches to lympho-cytes after 48 hours

Lymphocytes

CSF glucose Decreased Normal: exceptionsmumps, herpes, LCM

Decreased

CSF protein Increased Increased IncreasedGram stain Frequently positive

(60%90%)Culture positive (65%

90%)

Negative Frequently positive

LCM, lymphocytic choriomeningitis

Page 582

Change heading to Table 25-3 and line up Severe Dementia sentence as shown below

TABLE 25-3 SLOW VIRUSES AND SPONGIFORM ENCEPHALOPATHY OF THE CENTRALNERVOUS SYSTEM

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