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USMLE Step 1 First Aid Pathology

Subjects : health-sciences, usmle-step-1

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. Paraneoplastic effects of tumors: Small cell lung carcinoma and intracranial neoplasms Causes...? Effect?
Neutrophils exit from blood vessels at sites of injury and inflammation in 4 steps: 1.) Rolling 2.) Tight binding 3.) Diapedesis 4.) Migration <img src='218a.JPG' />
BRCA1
Visceral malignancy (stomach - lung - breast - uterus)
Causes: ADH Effect: SIADH

2. Dz: Barrett's esophagus (chronic GI reflux) What is the associated neoplasm?
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.
Esophageal adenocarcinoma
Paget's dz of bone
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)

3. Oncogene: erb - B2 Associated tumor?
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
Acanthosis nigricans (hyperpigmentation and epidermal thickening)
Breast - ovarian - and gastric carcinomas
Gain of fxn --< cancer. Need damage to only 1 allele.

4. Neoplasm: Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin With what dz is this associated?
Small cell lung carcinoma
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Tumor markers should not be used as the primary tool for cancer Dx. They may be used to confirm Dx - to monitor for tumor recurrence - and to monitor response to therapy.
Xeroderma pigmentosum - albinism

5. Granulomatous dz's

6. Characteristics of reversible cell injury
AIDS
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
Acanthosis nigricans (hyperpigmentation and epidermal thickening)

7. Tumor suppressor gene: p 53 chromosome? Associated tumor?
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome
NF2
Protein = transthyretin Derived from AF (AF = old F ogies)
Loss of fxn --< cancer; both allels must be lost for expression of dz.

8. Oncogene: N - myc Associated tumor?
N euroblastoma
Renal cell carcinoma - hemangioblastoma
WT1
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)

9. Tumor markers: CA-19-9
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
Pancreatic adenocarcinoma
Gastric adenocarcinoma
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)

10. Leukocyte activation in inflammation
P 16
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation
Benign and malignant lymphomas

11. Hyperplasia
Increase in # of cells. Reversible.
Programmed cell death; ATP required. Mediated by caspases.
Benign and malignant lymphomas
Down syndrome

12. Diapedesis (step 3 in leukocyte extravasation)

13. Primary tumors that metastasize to brain
Acanthosis nigricans (hyperpigmentation and epidermal thickening)
Assoc.: Retinoblastoma - osteosarcoma
L ung B reast S kin (melanoma) K idney (renal cell carcinoma) G I L ots of B ad S tuff K ills G lia.
Metastasis = Spread to distant organ Must survive immune attack. 'Seed and soil' theory of metastasis: Seed = tumor embolus Soil = target organ -- liver - lungs - bone - brain... Angiogenesis allows for tumor survival Decr cadherin - Increase laminin

14. Type of amyloid protein: Alzheimer's dz Protein? Derived from...?
Immunodeficiency states
Increase in # of cells. Reversible.
Beta - amyloid Derived from amyloid precursor protein (APP)
Assoc.: Retinoblastoma - osteosarcoma

15. Benign
Malignant lymphomas
Beta -2 microglobulin Derived from MHC class I proteins.
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
Usually well - differentiated - slow growing - well - demarcated - no metastasis.

16. Adult T- cell leukemia What is the assocciated oncogenic virus?
P rostate - T hyroid - T estes - B reast - L ung - K idney 'P.T. B arnum L oves K ids' Metastases from breast and prostate are mosot common.
HTLV-1
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
Sarcoma

17. Amyloid structure
Leukocyte travels btw endothelial cells and exits blood vessel; PECAM-1 is involved. <img src='218a.JPG' />
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
Breast - ovarian - and gastric carcinomas

18. Tumor suppressor gene: DCC chromosome? Associated tumor?
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
Blood (leukemia)

19. tumor: Breast - ovarian - and gastric carcinomas What is the associated oncogene?
Enzymatic degradation of a cell resulting from exogenous injury.
N - myc
Bcl -2
Erb - B2

20. Neoplasm: Benign and malignant lymphomas With what dz is this associated?

21. Neoplasm: Sarcoma With what dz is this associated?
Secondary osteosarcoma and fibrosarcoma
Radiation exposure
P 16
Xeroderma pigmentosum - albinism

22. tumor: CML What is the associated oncogene?
Enzymatic degradation of a cell resulting from exogenous injury.
EBV
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma
Abl

23. Tumor suppressor gene: NF1 chromosome? Associated tumor?
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Assoc: Neurofibromatosis type 1
Causes: ADH Effect: SIADH
Ovarian - malignant epithelial tumors

24. Causes: Erythropoietin Effect: Polycythemia What neoplasm would create this paraneoplastic effect?
Renal cell carcinoma - hemangioblastoma
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />
P 16
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma

25. Dz: Paget's dz of bone What is the associated neoplasm?
Small cell lung carcinoma
Secondary osteosarcoma and fibrosarcoma
Esophageal adenocarcinoma
Cells have invaded basement membrane using collagenases and hydrolases Can metastasize if they reach a blood or lymphatic vessel <img src='220d.JPG' />

26. Dz: Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis) What is the associated neoplasm?
Benign and malignant lymphomas
Renal cell carcinoma - hemangioblastoma
P 53
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma

27. Chronic inflammation
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />
Beta - amyloid Derived from amyloid precursor protein (APP)
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.

28. Tumor nomenclature: Skeletal muscle What do you call a benign tumor of this tissue? .. a malignant one?
NF1
L - myc
Thymoma - small cell lung carcinoma
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma

29. Tumor nomenclature: Bone What do you call a benign tumor of this tissue? .. a malignant one?
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
P 16
Benign: Osteoma Malignant: osteosarcoma
The liver and lung are the most common sites of metastasis after regional LN's. Metastasis << primary liver tumors.

30. Dz: Ulcerative colitis What is the associated neoplasm?
Benign: -- Malignant: Leukemia - lymphoma
Radiation exposure
Colonic adenocarcinoma
BRCA1

31. Dz: Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency) What is the associated neoplasm?
Squamous cell carcinoma of esophagus
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)
Leukocyte travels btw endothelial cells and exits blood vessel; PECAM-1 is involved. <img src='218a.JPG' />

32. Dz: Acanthosis nigricans (hyperpigmentation and epidermal thickening) What is the associated neoplasm?
Gastrointestinal stromal tumor (GIST)
Gastric adenocarcinoma
Visceral malignancy (stomach - lung - breast - uterus)
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)

33. Tight binding (step 2 of leukocyte extravasation)

34. How should tumor markers be used clinically?
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.
Tumor markers should not be used as the primary tool for cancer Dx. They may be used to confirm Dx - to monitor for tumor recurrence - and to monitor response to therapy.
Abnormal cells lacking differentiation; like primitive cells of the same tissue - often equated w/ undifferentiated malignant neoplasms. Little or no resemblance to tissue of origin. Irreversible.
Chr. 11p Assoc: Wilms' tumor

35. Retinoblastoma - osteosarcoma What is the tumor suppressor gene?
NF1
Rb
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy

36. Breast and ovarian cancer What is the tumor suppressor gene?
Visceral malignancy (stomach - lung - breast - uterus)
Sarcoma
Increase in # of cells. Reversible.
BRCA1

37. Chemical carcinogens: Asbestos What is the affected organ?
Lung (mesothelioma and bronchogenic carcinoma)
Small cell lung carcinoma
Squamous cell carcinoma of the skin
Mediated by ICAM -1 on vascular endothelium binding to LFA-1 (integrin) on the leukocyte ('Hold on tight to your CAM era') <img src='218a.JPG' />

38. Neoplasm: Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma With what dz is this associated?
Down syndrome
AIDS
Pancreatic adenocarcinoma
The liver and lung are the most common sites of metastasis after regional LN's. Metastasis << primary liver tumors.

39. Tumor stage

40. Melanoma - What is the tumor suppressor gene?
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
1 adult cell type is replaced by another. Often 2' to irritation and/or environmental exposure (e.g. - squamous metaplasia in trachea and bronchi of smokers) Reversible.
Down syndrome
P 16

41. breast cancer What is the tumor suppressor gene?
C - myc
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention
Benign: -- Malignant: Leukemia - lymphoma
BRCA2

42. Neoplasm: Esophageal adenocarcinoma With what dz is this associated?

43. Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia What neoplasm would create this paraneoplastic effect?
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
Radiation exposure
Assoc.: Breast and ovarian cancer
Lung cancer deaths have plateaued in males - but continue to Increase in females. Cancer is the 2nd leading cause of death in the USA (heart dz is 1st).

44. Primary tumors that metasize to bone

45. Wilms' tumor What is the tumor suppressor gene?
Increase vascular permeability - vasodilation - endothelial injury.
Fibroblast emigration and proliferation; deposition of ECM.
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy
WT1

46. Anaplasia
Cirrhosis (alcoholic - hepatitis B or C)
Beta -2 microglobulin Derived from MHC class I proteins.
Abnormal cells lacking differentiation; like primitive cells of the same tissue - often equated w/ undifferentiated malignant neoplasms. Little or no resemblance to tissue of origin. Irreversible.
P 16

47. Apoptosis is characterized by...?
Cell shrinkage - nuclear shrinkage and basophilia (pyknosis) - membrane blebbing - pyknotic nuclear fragmentation (karyorrhexis) - nuclear fading (karyolysis) - and formation of apoptotic bodies - which are then phagocytosed. No significant inflammat
Prostate carcinoma.
NF2
Burkitt's lymphoma

48. Dz: Immunodeficiency states What is the associated neoplasm?
Follicular and undifferentiated lymphomas (inhibits apoptosis)
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Malignant lymphomas
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)

49. Neoplasm: Squamous cell carcinoma of esophagus With what dz is this associated?
Squamous cell carcinoma of the skin
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)

50. Tumor nomenclature: < 1 cell type What do you call a benign tumor of this tissue? .. a malignant one?
Cells have invaded basement membrane using collagenases and hydrolases Can metastasize if they reach a blood or lymphatic vessel <img src='220d.JPG' />
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
Dysplastic nevus
Membrane lipid peroxidation Protein modification DNA Breakage