Plate 1. Infant with fetal alcohol syndrome. Note short palpebral fissures, mild ptosis, nostrils, smooth philtrum, and narrow vermillion of the upper lip. See Figure 2-1, p. 26. (From Gilbert-Barness E. Potter’s pathology of the fetus, infant, and child, 2nd ed. Philadelphia: Elsevier, 2007, Fig. 4.1.12.)
Plate 2. Xanthelasma. Multiple soft, yellow plaques involving the lower eyelid. Xanthelasma is usually a normal finding with no significance but is classically seen on the USMLE because of its association with hypercholesterolemia. Screen affected patients with a fasting lipid profile. See Figure 5-1, p. 52. (From Yanoff M, Duker JS. Ophthalmology, 3rd ed. Philadelphia: Mosby, 2008, Fig. 12-9-18.)
Plate 3. Allergic contact dermatitis of the leg caused by an elastic wrap. Notice the well-marginated distribution that differentiates it from cellulitis. See Figure 6-1, p. 55. (From Auerbach PS. Wilderness medicine, 6th ed. Philadelphia: Mosby, 2011.)
Plate 4. Tinea corporis. Red ring-shaped lesions with scaling and some central clearing. See Figure 6-2, p. 56. (From Kliegman RM. Nelson textbook of pediatrics, 19th ed. Philadelphia: Saunders, 2011.)
Plate 5. Pityriasis rosea. Small oval plaques as well as multiple small papules are present. See Figure 6-3, p. 59. (From Habif TP. Clinical dermatology, 5th ed. St. Louis: Mosby, 2009.)
Plate 6. Lichen planus. Flat-topped, purple polygonal papules of lichen planus. See Figure 6-4, p. 60. (From Kliegman RM. Nelson textbook of pediatrics, 19th ed. Philadelphia: Saunders, 2011.)
Plate 7. Erythema multiforme. “Bull’s-eye” annular lesions with central vesicles and bullae. See Figure 6-5, p. 60. (From Goldman L. Goldman’s Cecil medicine, 24th ed. Philadelphia: Saunders, 2011.)
Plate 8. Erythema nodosum on the legs of a young woman. See Figure 6-6, p. 61. (From Hochberg MC. Rheumatology, 5th ed. Philadelphia: Mosby, 2010.)
Plate 9. Bullous pemphigoid. Tense subepidermal bullae on an erythematous base. See Figure 6-7, p. 61. (From Goldman L. Goldman’s Cecil medicine, 24th ed. Philadelphia: Saunders, 2011.)
Plate 10. Dermatitis herpetiformis is characterized by pruritus, urticarial papules, and small vesicles. See Figure 6-8, p. 62. (From Feldman M. Sleisenger and Fordtran’s gastrointestinal and liver disease, 9th ed. Philadelphia: Saunders, 2010; Courtesy Dr. Timothy Berger, San Francisco, Calif.)
Plate 11. Melanoma (superficial spreading type). See Figure 6-9, p. 63. (From Goldman L. Goldman’s Cecil medicine, 24th ed. Philadelphia: Saunders, 2011.)
Plate 12. Keratoacanthoma on the right upper lid. Lesions are solitary, smooth, dome-shaped red papules or nodules with a central keratin plug. See Figure 6-10, p. 64. (From Albert DM. Albert & Jakobiec’s principles and practice of ophthalmology, 3rd ed. Philadelphia: Saunders, 2008.)
Plate 13. Keloid of the earlobe after piercing. See Figure 6-11, p. 64. (From Kliegman RM, Stanton BF, St. Geme JW III, et al. Nelson textbook of pediatrics, 19th ed. Philadelphia: Saunders, 2011.)
Plate 14. An ulcerated basal cell carcinoma with rolled borders on the posterior ear. See Figure 6-12, p. 65. (From Abeloff DA, Armitage JO, Niederhuber JE, et al. Abeloff’s clinical oncology, 4th ed. Philadelphia: Churchill Livingstone, 2008.)
Plate 15. Squamous cell carcinoma on the lower lip. See Figure 6-13, p. 65. (From Rakel RE, Rakel DP. Textbook of family medicine, 8th ed. Philadelphia: Saunders, 2011. © Richard P. Usatine.)
Plate 16. Multiple actinic keratoses visible as thin, red, scaly lesions. See Figure 6-14, p. 66. (From Goldberg DJ. Procedures in cosmetic dermatology: lasers and lights, Vol 1, 2nd ed. Saunders, 2008.)
Plate 17. Nailbed melanoma. See Figure 6-15, p. 67. (From Goldman L, Schafer AI. Goldman’s Cecil medicine, 24th ed. Philadelphia: Saunders, 2011.)
Plate 18. Paget disease of the nipple. Note the erythematous plaques around the nipple. See Figure 6-16, p. 67. (From Lentz GM, Lobo RA, Gershenson DM, Katz VL. Comprehensive gynecology. 6th ed. Philadelphia: Mosby, 2011. Originally from Callen JP. Dermatologic signs of systemic disease. In Bolognia JL, Jorizzo JL, Rapini RP [eds]. Dermatology. Edinburgh: Mosby, 2003, p 714.)
Plate 19. Multiple patterned café au lait spots in a child with McCune-Albright syndrome. See Figure 10-2, p. 86. (From Eichenfield LF, Frieden IJ, Esterly NB. Neonatal dermatology, 2nd ed. Philadelphia: Saunders, 2008, Fig. 22-3.)
Plate 20. Colonoscopic photograph of a pale colon cancer easily seen against the dark background of pseudomelanosis coli. See Figure 12-3, p. 95. (From Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran’s gastrointestinal and liver disease, 9th ed. Philadelphia: Saunders, 2010, Fig. 124-8. Courtesy Juergen Nord, MD, Tampa, Fla.)
3 1 4 5
2
A
B
Plate 21. Mucosal pathology in celiac disease. A, Duodenal biopsy specimen of a patient with untreated celiac disease. The histologic features of severe villus atrophy (arrow 1), crypt hyperplasia (arrow 2), enterocyte disarray (arrow 3), and intense inflammation of the lamina propria and epithelial cell layer (arrow 4) are evident. B, Repeat duodenal biopsy after 6 months on a strict gluten-free diet. There is marked improvement, with well formed villi (arrow 5) and a return of the mucosal architecture toward normal. See Figure 12-5, p. 97. (From Feldman M, Friedman LS, Brandt LJ. Sleisenger and Fordtran’s gastrointestinal and liver disease, 9th ed. Philadelphia: Saunders, 2010, Fig. 104-2.)
Plate 22. Chronic viral hepatitis. Portal-portal bridging fibrosis is seen in longstanding chronic hepatitis C. See Figure 12-8, p. 102. (From Odze RD, Goldblum JR. Surgical pathology of the GI tract, liver, biliary tract, and pancreas, 2nd ed. Saunders, 2009, Fig. 38-10.)
Trachea
Proximal esophagus Tracheoesophageal fistula
Bronchi Distal esophagus
Plate 23. Tracheoesophageal fistula. Diagram of the most common type of esophageal atresia and tracheoesophageal fistula. See Figure 12-11, p. 108. (From Gilbert-Barness E. Potter’s pathology of the fetus, infant and child, 2nd ed. Philadelphia: Mosby, 2007, Fig. 25.6.)
A
B
Plate 24. Abdominal wall defects. A, Omphalocele with intact sac. B, Gastroschisis with eviscerated multiple bowel loops to the right of the umbilical cord. See Figure 12-13, p. 110. (From Sabiston DC, Townsend CM. Sabiston textbook of surgery: the biological basis of modern surgical practice, 19th ed. Philadelphia: Saunders, 2012, Fig. 67-20.)
Plate 25. Henoch-Schönlein purpura in a 7-year-old child. Note typical red-purple rash on the lower extremities. See Figure 12-14, p. 111. (From Marx JA, Hockberger RS, Walls RM. Rosen’s emergency medicine: concepts and clinical practice, 7th ed. Mosby, 2009, Fig. 170-10. Courtesy Marianne Gausche-Hill, MD.)
A
B
Plate 26. Edward syndrome. A, Note the small head, prominent occiput, and low-set, malformed ears. B, Clenched hand with overlapping fingers. See Figure 14-2, p. 127. (Kanski JJ. Clinical diagnosis in ophthalmology, 1st ed. Philadelphia: Mosby, 2006, Fig. 15.10. Courtesy BJ Zitelli and HW Davis).
Plate 27. Turner syndrome. This 13-year-old female demonstrates the classic webbed neck and triangular facies of Turner syndrome. She has sexual infantilism and short stature. See Figure 14-3, p. 128. (Moshang T, ed. Pediatric endocrinology: the requisites in pediatrics, 1st ed. St. Louis: Mosby 2005, Plate 8-2.)
Plate 28. Marfan syndrome. Arachnodactyly in a patient with Marfan syndrome. See Figure 14-4, p. 129. (Stamper RL, Lieberman MF, Drake MV. Becker-Shaffer’s diagnosis and therapy of the glaucomas, 8th ed. Philadelphia: Mosby 2009, Fig. 19.41.)
Plate 29. Pigment gallstones within an otherwise unremarkable gallbladder are a marker for hemolytic anemia. See Figure 17-1, p. 145. (From Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Kotran pathologic basis of disease, professional edition, 8th ed. Philadelphia: Saunders, 2009, Fig. 18-53.)
Plate 30. Sickle cells show a sickle or crescent shape resulting from the polymerization of hemoglobin S. This smear also shows target cells and boat-shaped cells with a lesser degree of polymerization of hemoglobin S than in a classic sickle cell. See Figure 17-2, p. 145. (From Goldman L, Schafer AI. Goldman’s Cecil medicine, 24th ed. Philadelphia: Saunders, 2011, Fig. 160-7.)
Plate 31. Megaloblastic changes of macrocytosis and a hypersegmented neutrophil. See Figure 17-3, p. 146. (From Rakel RE, Rakel DP. Textbook of family medicine, 8th ed. Philadelphia: Saunders, 2011, Fig. 39-4; The American Society of Hematology Image Bank image #2611. Copyright 1996 American Society of Hematology, used with permission.)
Plate 32. Iron-deficiency anemia. Pale red blood cells with enlarged central pallor. See Figure 17-4, p. 146. (From McPherson R, Pincus M. Henry’s clinical diagnosis and management by laboratory methods, 21st ed. Philadelphia: Saunders, 2006, Fig. 31-2.)
Plate 33. Basophilic stippling. Irregular basophilic granules in red blood cells; often associated with lead poisoning and thalassemia. See Figure 17-5, p. 147. (From McPherson R, Pincus M. Henry’s clinical diagnosis and management by laboratory methods, 21st ed. Philadelphia: Saunders, 2006, Fig. 29-23.)
Plate 34. Bite cells with Heinz bodies. See Figure 17-6, p. 147. (Courtesy Dr. Robert W. McKenna, Department of Pathology, University of Texas Southwestern Medical School, Dallas, Texas.)
Plate 35. Howell-Jolly bodies in peripheral blood erythrocytes. These nuclear remnants indicate lack of splenic filtrative function. See Figure 17-7, p. 148. (From Orkin SH, et al. Nathan and Oski’s hematology of infancy and childhood, 7th ed., Philadelphia: Saunders, 2009, Fig. 14-4.)
Plate 36. Teardrop red blood cells, usually seen in myelofibrosis. See Figure 17-8, p. 148. (From Goldman L, Ausiello D. Cecil medicine, 23rd ed. Philadelphia: Saunders, 2008, Fig. 161-13.)
Plate 37. Schistocytes and helmet cells. Red blood cell fragments seen with microangiopathic hemolytic anemia and disseminated intravascular coagulation. See Figure 17-9, p. 148. (From McPherson R, Pincus M. Henry’s clinical diagnosis and management by laboratory methods, 21st ed. Philadelphia: Saunders, 2006, Fig. 29-19.)
Plate 38. Hereditary elliptocytosis. Blood film reveals characteristic elliptical red blood cells. See Figure 17-10, p. 149. (From McPherson RA, Pincus MR. Henry’s clinical diagnosis and management by laboratory methods, 22nd ed. Saunders, 2011, Fig. 30-16.)
Plate 39. Acanthocytes. Irregularly spiculated red blood cells, frequently seen in abetalipoproteinemia or liver disease. See Figure 17-11, p. 149. (From McPherson R, Pincus M. Henry’s clinical diagnosis and management by laboratory methods, 21st ed. Philadelphia: Saunders, 2006, Fig. 29-20.)
Plate 40. Target cells are frequently seen in hemoglobin C disease and liver disease. See Figure 17-12, p. 149. (From McPherson R, Pincus M. Henry’s clinical diagnosis and management by laboratory methods, 21st ed. Philadelphia: Saunders, 2006, Fig. 29-18.)
Plate 41. Echinocytes, or burr cells (arrows), are the hallmark of uremia. See Figure 17-13, p. 150. (Hoffman R, et al. Hematology: basic principles and practice, 5th ed. Philadelphia: Churchill Livingstone, 2008, Fig. 156-1.)
Plate 42. Microangiopathic hemolytic anemia demonstrating red blood cell fragments, anisocytosis, polychromasia, and decreased platelets. See Figure 17-14, p. 150. (From Tschudy MM, Arcara KM, editors. The Harriet Lane handbook, 19th ed. Philadelphia: Mosby, 2011, Plate 7.)
A Plate 43. Rouleaux formation of stacked red blood cells seen in multiple myeloma. See Figure 17-15, p. 150. (From Goldman L, Ausiello D. Cecil medicine, 23rd ed. Philadelphia: Saunders, 2008, Fig. 161-19.)
B
Plate 44. Malaria. Peripheral blood film examples of various stages of Plasmodium falciparum. A, Small ring forms. B, A crescentic gametocyte with centrally placed chromatin. See Figure 17-16, p. 151. (From Hoffman R, et al. Hematology: basic principles and practice, 5th ed. Philadelphia: Churchill Livingstone, 2008, Fig. 159-5.)
Plate 45. Ringed sideroblasts seen in sideroblastic anemia. See Figure 17-17, p. 151. (From Goldman L, Ausiello D. Cecil medicine, 23rd ed. Philadelphia: Saunders, 2008, Fig. 163-5.)
Plate 46. Patch testing. A battery of common and suspected allergens is applied to the back with a patch for 48 hours and then removed. The skin is then examined at 96 hours. Irritant reactions disappear, allergic ones do not.This patient has many positive reactions of varying intensity. See Figure 19-1, p. 166. (From Habif TP. Clinical dermatology, 5th ed. St. Louis: Mosby, 2009, Fig. 4-30.)
Plate 48. Palmar lesions of secondary syphilis. See Figure 20-4, p. 179. (From Mandell GL, Bennett JE, Dolin R. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases, 7th ed. Philadelphia: Churchill and Livingstone, 2009, Fig. 238-5.)
Plate 47. Penile chancre in a patient with primary syphilis. See Figure 20-3, p. 179. (From Wein WS, et al, editors. Campbell-Walsh urology, 10th ed. Philadelphia: Saunders, 2011, Fig. 13-7.)
Plate 49. “Slapped cheek” appearance of erythema infectiosum. See Figure 20-5, p. 180. (From Baren JM, Rothrock SG, Brennan JA, Brown, L: Pediatric emergency medicine, 1st ed. Philadelphia: Saunders, 2007, Fig. 123-5.)
Plate 50. Herpes zoster. Grouped vesicopustules on an erythematous base. See Figure 20-6, p. 181. (From Marx JA. Rosen’s emergency medicine, 7th ed. Philadelphia: Mosby, 2009, Fig. 118-28. Courtesy David Effron, MD.)
Plate 51. Impetigo. Multiple crusted and oozing lesions. See Figure 20-7, p. 183. (From Kliegman RM, Stanton BF, St. Geme JW III, Schor NF. Nelson textbook of pediatrics, 19th ed. Philadelphia: Saunders, 2011, Fig. 657-1.)
Plate 52. Sharply defined erythema and edema, characteristic of erysipelas. See Figure 20-10, p. 188. (From Zaoutis LB, Chiang VW. Comprehensive pediatric hospital medicine, 1st ed. Philadelphia: Mosby, 2007, Fig. 156-2.)
Plate 53. Scalded appearance from widespread desquamation seen in staphylococcal scalded skin syndrome. See Figure 20-11, p. 189. (From Baren JM, Rothrock SG, Brennan JA, Brown L. Pediatric emergency medicine, 1st ed. Philadelphia: Saunders, 2007, Fig. 126-4.)
Plate 54. Henoch-Schönlein purpura. Nonblanchable macules and papules on the buttocks and lower extremities. See Figure 22-2, p. 197. (From Taal MW. Brenner and Rector’s the kidney, 9th ed. Philadelphia: Saunders: 2011, Fig. 59-20.)
Plate 55. Auer rods vary from prominent, as in this cell, to thin and delicate. See Figure 26-1, p. 241. (From McPherson RA, Pincus MR. Henry’s clinical diagnosis and management by laboratory methods, 22nd ed. Philadelphia: Saunders, 2011, Fig. 33-25.)
Plate 56. Chronic myelogenous leukemia showing myeloid blast phase. See Figure 26-2, p. 241. (From Hoffman R, Benz EJ Jr, Shattil SJ, et al. Hematology: basic principles and practice, 5th ed. Philadelphia: Churchill Livingstone, 2008, Figure 69-5A.)
Plate 57. A young boy from South America with typical endemic Burkitt lymphoma presenting in the mandible. See Figure 26-3, p. 242. (From Jaffe ES, Harris NL, Vardiman JW, et al. Hematopathology, 1st ed. St. Louis: Saunders, 2010, Fig. 24-1. Courtesy Prof. Georges Delsol, Toulouse, France.)
Plate 58. Café-au-lait patches as well as multiple axillary freckles in a 14-year-old boy. See Figure 26-5, p. 244. (From Hoyt CS, Taylor D. Pediatric ophthalmology and strabismus, 4th ed. Edinburgh: Saunders, 2012, Figure 65.4.)
Plate 59. A patient with superior vena cava syndrome and the characteristic venous dilation and facial edema. See Figure 26-7, p. 247. (From Abeloff MD, Armitage JO, Niederhuber JE, et al. Abeloff’s clinical oncology, 4th ed. Philadelphia: Churchill Livingstone, 2008, Fig. 54-3.)
Plate 60. Kaposi sarcoma. See Figure 26-14, p. 259. (From Hoffman R, Benz EJ Jr, Shattil SJ, et al. Hematology: basic principles and practice, 5th ed. Philadelphia: Churchill Livingstone, 2008, Fig. 121-35.)
Plate 61. Primary nodular malignant melanoma found on back of patient. See Figure 26-15, p. 259. (From Yanoff M, Sassani JW. Ocular pathology, 6th ed. Philadelphia: Mosby, 2008, Fig. 17.8A.)
Plate 62. A thick, sharply marginated focal leukoplakia of the ventral/lateral tongue with a uniform erythematous periphery. See Figure 26-16, p. 260. (From Flint PW, Haughey BH, Niparko JK, et al. Cummings otolaryngology: head & neck surgery, 5th ed. Philadelphia: Mosby, 2010, Fig. 91-5C.)
Plate 63. A 12-year-old boy with orbital cellulitis. Note the poor elevation of the affected eye. See Figure 27-1, p. 265. (From Hoyt CS, Taylor D. Pediatric ophthalmology and strabismus, 4th ed., Edinburgh: Saunders, 2012, Fig. 13.10 Ai, Aii.)
Plate 64. Varicella dendritic keratitis. Numerous dendrites are seen in this slit lamp photograph with fluorescein staining of the dendritic lesions from active viral growth in the corneal epithelium. See Figure 27-2, p. 265. (From Krachmer JH, Mannis MJ. Cornea, 3rd ed., Philadelphia: Mosby, 2010, Fig. 80.2.)
Plate 65. Leukocoria (white pupillary reflex) is the most common presenting feature of retinoblastoma and may be first noticed in family photographs. See Figure 29-1, p. 279. (From Kanski JJ. Clinical diagnosis in ophthalmology, 1st ed. St. Louis: Mosby, 2006, Fig. 9.94. Courtesy U. Raina.)
Plate 66. Infantile hemangioma. These lesions grow rapidly during the first few months of life once they appear (20% at birth), but they are asymptomatic unless they bleed, become infected, or obstruct a vital structure. Complete resolution is typical before the age of 7 years, and no treatment is usually required. See Figure 29-2, p. 282. (From du Vivier A. Atlas of clinical dermatology, 3rd ed. New York: Churchill Livingstone, 2002, p. 117, with permission.)
Plate 67. Osteoarthritic hands with Heberden (distal interphalangeal) and Bouchard (proximal interphalangeal) nodes on both index fingers and thumbs. See Figure 35-2, p. 316. (From Canale ST, Beaty JH. Campbell’s operative orthopaedics, 11th ed. Philadelphia: Mosby, 2007, Fig. 70-4.)
Plate 68. Psoriasis. Typical oval plaque with well-defined borders and silvery scale. See Figure 35-3, p. 318. (From Habi TP. Clinical dermatology, 5th ed. St. Louis: Mosby, 2009, Fig. 8-1.)
Plate 69. Erythema migrans rash of Lyme disease. Bull’s eye lesion on lateral thigh. See Figure 35-5, p. 319. (From Firestein GS, Budd RC, Gabriel SE, et al. Kelley’s textbook of rheumatology, 9th ed. Philadelphia: Saunders, 2012, Fig. 110-1.Courtesy Juan Salazar, MD, University of Connecticut Health Center.)
Plate 70. Dermatomyositis. Heliotrope (violaceous) discoloration around the eyes and periorbital edema. See Figure 35-6, p. 321. (From Habif TP. Clinical dermatology, 5th ed. Philadelphia: Mosby, 2009, Fig. 17-19.)
Plate 71. Sharply demarcated, symmetric, depigmented areas of vitiligo. See Figure 40-1, p. 337. (From Kliegman RM, Stanton BF, St. Geme III JW, et al. Nelson textbook of pediatrics, 19th ed. Philadelphia: Saunders, 2011, Fig. 645-4.)
