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Pathology · USMLE Step 1

USMLE Pathology: Infectious Disease Morphology

Granulomatous and other classic tissue response patterns to infection, distinct from the organism-identification focus of the Microbiology decks.

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What is the general term for a nodular collection of activated macrophages (epithelioid histiocytes) that forms in response to persistent, poorly degradable antigens?
Granulomatous inflammation (granuloma)
What cell type do epithelioid histiocytes differentiate from?
Activated macrophages
How do epithelioid histiocytes appear histologically?
Abundant pink cytoplasm with elongated, slipper-shaped nuclei
How are the nuclei arranged in a Langhans giant cell?
In a peripheral horseshoe or ring pattern around the edge of the cell
How are the nuclei arranged in a foreign body giant cell?
Scattered haphazardly throughout the cytoplasm
What organism classically causes caseating granulomas?
Mycobacterium tuberculosis
What is the gross (naked-eye) appearance of caseous necrosis?
Soft, friable, cheese-like white-yellow material
How does caseous necrosis appear under the microscope?
Amorphous, structureless eosinophilic debris with no visible cell outlines
What is a Ghon focus?
A peripheral lung granuloma marking the initial site of primary tuberculosis infection
A Ghon focus plus involvement of what structure together make up a Ghon complex?
The ipsilateral hilar lymph node
What is a Ghon complex called once it becomes calcified and fibrotic?
Ranke complex
Describe the gross pattern of miliary tuberculosis.
Numerous small (1-2 mm), yellow-white granulomas scattered throughout the organ
What term describes a granuloma that lacks central necrotic debris?
Noncaseating granuloma
Which systemic disease of unknown cause classically produces noncaseating granulomas in multiple organs?
Sarcoidosis
Which inflammatory bowel disease is associated with noncaseating granulomas in the bowel wall?
Crohn disease

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