USMLE Step 1 First Aid Pathology

Instructions:

• Answer 50 questions in 15 minutes.
• If you are not ready to take this test, you can study here.
• 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. Apoptosis (definition)
Assoc.: Breast and ovarian cancer
IL-8 C5a Leukotriene B4 Kallikrein
Programmed cell death; ATP required. Mediated by caspases.
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.


2. Tumor suppressor gene: BRCA1 chromosome? Associated tumor?
Assoc: Melanoma ('MelaN oma is N ine')
Cells have invaded basement membrane using collagenases and hydrolases Can metastasize if they reach a blood or lymphatic vessel <img src='220d.JPG' />
Blood (leukemia)
Assoc.: Breast and ovarian cancer


3. Hypovolemic/cardiogenic shock
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)
Adult T- cell leukemia
Ovarian - malignant epithelial tumors


4. Type of amyloid protein: DM2 Protein? Derived from...?
TB (caseating) Syphilis Listeria monocytogenes Wegener's granulomatosis Leprosy Bartonella Some fungal pneumonias Sarcoidosis Crohn's dz *Granuloma formation is IL-2 - interferon - gamma mediated.
Amylin protein Derived from AE (AE = E ndocrine)
Malignant lymphomas
Neuorblastoma - lung - and gastric cancer.


5. Metastasis to brain
Gain of fxn --< cancer. Need damage to only 1 allele.
Radiation exposure
WT1
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.


6. Neoplastic progression: step 1 Hyperplasia/dysplasia

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7. Granulomatous dz's

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8. Type of amyloid protein: Medullary carcinoma of thyroid Protein? Derived from...?
Gain of fxn --< cancer. Need damage to only 1 allele.
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />
N euroblastoma


9. Tumor nomenclature: Fat What do you call a benign tumor of this tissue? .. a malignant one?
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.
Ret
Benign: lipoma Malignant: liposarcoma
Malignant melanoma


10. Oncogene: N - myc Associated tumor?
N euroblastoma
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)
Adult T- cell leukemia


11. Oncogene: L - myc Associated tumor?
L ung tumor
Liver (centrilobular necrosis - fatty change)
Increase vascular permeability - vasodilation - endothelial injury.
NF1


12. Tumor markers: Bombesin
Neoplastic cells hae not invaded basement membrane. High nuclear/cytoplasmic ratio and clumped chromatin Neoplastic cells encompass entire thickness Tumor cells are monoclonal <img src='220c.JPG' />
Adult T- cell leukemia
Neuorblastoma - lung - and gastric cancer.
Malignant lymphomas


13. Things that initiate Free radical injury
Radiation exposure Metabolism of drugs (phase I) Redox rxtn Nitric oxide Transition metals Leukocyte oxidative burst *Reperfusion after anoxia induces free radical production (e.g. - superoxide) and is a major cause of injury after thrombolytic thera
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)
Chr. 11p Assoc: Wilms' tumor
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


14. Tumor nomenclature: Smooth muscle What do you call a benign tumor of this tissue? .. a malignant one?
Actinic keratosis
APC
Benign: Leiomyoma Malignant: Leiomyosarcoma
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.


15. Neoplasm: Gastric adenocarcinoma With what dz is this associated?
Small cell lung carcinoma and intracranial neoplasms
Fibroblast emigration and proliferation; deposition of ECM.
[aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants


16. Characteristics of reversible cell injury
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.
Barrett's esophagus (chronic GI reflux)
Bladder (transitional cell carcinoma)


17. Colorectal cancer (assoc w/ FAP) What is the tumor suppressor gene?
APC
Benign and malignant lymphomas
Assoc: Colorectal cancer (assoc w/ FAP)
L - myc


18. Neoplasm: Colonic adenocarcinoma With what dz is this associated?
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
Benign and malignant lymphomas
Ulcerative colitis
NF2


19. Benign
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
Lung (mesothelioma and bronchogenic carcinoma)
Programmed cell death; ATP required. Mediated by caspases.
Follicular and undifferentiated lymphomas (inhibits apoptosis)


20. Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness) What neoplasm would create this paraneoplastic effect?
Radiation exposure
Thymoma - small cell lung carcinoma
Follicular and undifferentiated lymphomas (inhibits apoptosis)
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).


21. Tumor suppressor gene: BRCA2 chromosome? Associated tumor?
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome
Benign: Osteoma Malignant: osteosarcoma
Ovarian - malignant epithelial tumors
Assoc: breast cancer


22. most human cancers - Li - Fraumeni syndrome What is the tumor suppressor gene?
Multiple endocrine neoplasia (MEN) types II and III
P 53
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)
Assoc: Neurofibromatosis type 1


23. Tumor markers: PSA
Cirrhosis (alcoholic - hepatitis B or C)
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)


24. Malignant
Adult T- cell leukemia
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)
AIDS


25. Tumor nomenclature: Epithelium What do you call a benign tumor of this tissue? .. a malignant one?
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
P 53
Colon carcinoma


26. Primary tumors that metastasize to liver

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27. Type of amyloid protein: Dialysis - associated Protein? Derived from...?
Beta -2 microglobulin Derived from MHC class I proteins.
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
Ovarian - malignant epithelial tumors
Hepatocellular carcinoma


28. Neurofibromatosis type 1 What is the tumor suppressor gene?
Ret
NF1
Esophageal adenocarcinoma
Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis)


29. Dz: AIDS What is the associated neoplasm?

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30. Diapedesis (step 3 in leukocyte extravasation)

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

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32. tumor: Follicular and undifferentiated lymphomas (inhibits apoptosis) What is the associated oncogene?
Lung (mesothelioma and bronchogenic carcinoma)
EBV
Cirrhosis (alcoholic - hepatitis B or C)
Bcl -2


33. Tumor suppressor gene: NF2 chromosome? Associated tumor?

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34. Desmoplasia
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy
P 53
Ret
Fibrous tissue formation in response to a neoplasm. Irreversible.


35. Tight binding (step 2 of leukocyte extravasation)

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36. Neoplasm: Secondary osteosarcoma and fibrosarcoma With what dz is this associated?

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37. Dz: Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants What is the associated neoplasm?
Gastric adenocarcinoma
Amylin protein Derived from AE (AE = E ndocrine)
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.
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


38. Tumor suppressor gene: NF1 chromosome? Associated tumor?
P 53
Assoc: Neurofibromatosis type 1
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin
Colon carcinoma


39. Chemical carcinogens: Asbestos What is the affected organ?
Ras
Colonic adenocarcinoma
Lung (mesothelioma and bronchogenic carcinoma)
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation


40. Chemical carcinogens: Aflatoxins (produced by Aspergillus) What is the affected organ?
Assoc: breast cancer
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Liver (hepatocellular carcinoma)
Acanthosis nigricans (hyperpigmentation and epidermal thickening)


41. Neoplasm: Visceral malignancy (stomach - lung - breast - uterus) With what dz is this associated?
Gastric adenocarcinoma
Follicular and undifferentiated lymphomas (inhibits apoptosis)
Acanthosis nigricans (hyperpigmentation and epidermal thickening)
Assoc: breast cancer


42. Hyperplasia
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)
Increase in # of cells. Reversible.
Radiation exposure Metabolism of drugs (phase I) Redox rxtn Nitric oxide Transition metals Leukocyte oxidative burst *Reperfusion after anoxia induces free radical production (e.g. - superoxide) and is a major cause of injury after thrombolytic thera


43. Paraneoplastic effects of tumors: Leukemias and lymphomas Causes...? Effect?
Multiple endocrine neoplasia (MEN) types II and III
Assoc.: Breast and ovarian cancer
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy


44. Oncogenic viruses: HPV What is the associated cancer?
Thymoma - small cell lung carcinoma
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants


45. Neoplasm: Sarcoma With what dz is this associated?
Radiation exposure
Blood (leukemia)
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.
Neuorblastoma - lung - and gastric cancer.


46. tumor: Gastrointestinal stromal tumor (GIST) What is the associated oncogene?
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.
Fibrous tissue formation in response to a neoplasm. Irreversible.
C - kit
Liver (hepatocellular carcinoma)


47. Rolling (step 1 in leukocyte extravasation)

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48. Oncogene: ras Associated tumor?
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy
Colon carcinoma


49. tumor: L ung tumor What is the associated oncogene?
L - myc
C - kit
Abl
Cirrhosis (alcoholic - hepatitis B or C)


50. Tumor suppressor gene: p 53 chromosome? Associated tumor?
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome
Gastrointestinal stromal tumor (GIST)
Ret
Prostate carcinoma.