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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. Oncogenes
Gain of fxn --< cancer. Need damage to only 1 allele.
Gastric adenocarcinoma
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />
Squamous cell carcinoma of esophagus

2. Tumor suppressor gene: WT1 chromosome? Associated tumor?

3. Type of amyloid protein: Senile cardiac Protein? Derived from...?
Membrane lipid peroxidation Protein modification DNA Breakage
Protein = transthyretin Derived from AF (AF = old F ogies)
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).

4. Chemical carcinogens: Aflatoxins (produced by Aspergillus) What is the affected organ?
Erb - B2
Liver (hepatocellular carcinoma)
Esophagus - stomach
Gastric adenocarcinoma

5. Migration (step 4 in leukocyte extravasation)

6. Neoplastic progression: step 2 In situ carcinoma

7. Oncogene: abl Associated tumor?
Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome
CML
Breast - ovarian - and gastric carcinomas
Pancreatic adenocarcinoma

8. Female cancer epidemiology (incidence - mortality)
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)
Malignant lymphomas
Assoc: Colorectal cancer (assoc w/ FAP)
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'

9. Cervical carcinoma (types 16 - 18) Penile/anal carcinoma What is the assocciated oncogenic virus?
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
Squamous cell carcinoma of esophagus
HPV
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />

10. Tumor markers: S-100
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.
Melanoma - neural tumors - astrocytomas.
Abl
EBV

11. Dz: Actinic keratosis What is the associated neoplasm?
Colonic adenocarcinoma
Squamous cell carcinoma of the skin
[aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.

12. Which usually has more prognostic value - tumor stage or grade?
Usually stage < grade
Cells have increased in # (hyperplasia ) Abnormal proliferation of cells w/ loss of size - shape - and orientation (dysplasia ) <img src='220b.JPG' />
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.
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).

13. Neoplastic progression: normal state - before anything goes wrong

14. Tumor suppressor gene: BRCA2 chromosome? Associated tumor?
Benign: Osteoma Malignant: osteosarcoma
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
Gastric adenocarcinoma
Assoc: breast cancer

15. Neurofibromatosis type 1 What is the tumor suppressor gene?
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)
Abl
NF1

16. Neoplasm: Malignant melanoma With what dz is this associated?
Dysplastic nevus
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
Gastrointestinal stromal tumor (GIST)
Colon carcinoma

17. Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness) What neoplasm would create this paraneoplastic effect?
Thymoma - small cell lung carcinoma
Paget's dz of bone
Ovarian - malignant epithelial tumors
Follicular and undifferentiated lymphomas (inhibits apoptosis)

18. Characteristics of ex udate
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis)
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.

19. Psammoma bodies
Laminated - concentric - calcific spherules seen in: 1.) Papillary adenocarcinoma of thyroid 2.) Serous papillary cystadenocarcinoma of ovary 3.) Meningioma 4.) Malignant mesothelioma PS aMM oma: P apillary (thyroid) S erous (ovary) M eningioma M eso
Acanthosis nigricans (hyperpigmentation and epidermal thickening)
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.
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)

20. Oncogenic viruses: HTLV-1 What is the associated cancer?
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.
Adult T- cell leukemia
Melanoma - neural tumors - astrocytomas.
Hepatocellular carcinoma

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

22. Neoplasm: Malignant lymphomas With what dz is this associated?
Immunodeficiency states
T = size of T umor N = N ode involvement M = M etastases
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.
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.

23. Dz: Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants What is the associated neoplasm?
Gastrointestinal stromal tumor (GIST)
HHV-8
Gastric adenocarcinoma
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma

24. Tumor suppressor gene: DCC chromosome? Associated tumor?
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
HBV - HCV
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation

25. Tumor nomenclature: < 1 cell type What do you call a benign tumor of this tissue? .. a malignant one?
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
Benign: Osteoma Malignant: osteosarcoma
Secondary osteosarcoma and fibrosarcoma
Laminated - concentric - calcific spherules seen in: 1.) Papillary adenocarcinoma of thyroid 2.) Serous papillary cystadenocarcinoma of ovary 3.) Meningioma 4.) Malignant mesothelioma PS aMM oma: P apillary (thyroid) S erous (ovary) M eningioma M eso

26. TNM staging system
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
HTLV-1
T = size of T umor N = N ode involvement M = M etastases
Programmed cell death; ATP required. Mediated by caspases.

27. Desmoplasia
Assoc: Melanoma ('MelaN oma is N ine')
Fibrous tissue formation in response to a neoplasm. Irreversible.
NF1
All (we All fall Down ) AML

28. Male cancer epidemiology (incidence - mortality)
Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
AIDS

29. Chemical carcinogens: Naphthalene (aniline) dyes What is the affected organ?
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
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />
Bladder (transitional cell carcinoma)
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation

30. When does apoptosis occur?
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)
Colonic adenocarcinoma
Melanoma - neural tumors - astrocytomas.
L - myc

31. Tumor markers: CA-125
Benign: -- Malignant: Leukemia - lymphoma
Ovarian - malignant epithelial tumors
Renal cell carcinoma - hemangioblastoma
Assoc.: Retinoblastoma - osteosarcoma

32. Dz: Cirrhosis (alcoholic - hepatitis B or C) What is the associated neoplasm?
[DPC = D eleted in P ancreatic C ancer'] What is the tumor suppressor gene? DPC
Restoration of normal structure. Granulation tissue -- highly vascularized - fibrotic. Abscess -- fibrosis surrounding pus. Fistula -- abnormal communication. Scarring -- collagen deposition resulting in altered structure and fxn.
Hepatocellular carcinoma
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability

33. Oncogene: N - myc Associated tumor?
Blood (leukemia)
Abl
N euroblastoma
NF2

34. Chemical carcinogens: Alkylating agents What is the affected organ?
Blood (leukemia)
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
Thymoma - small cell lung carcinoma
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)

35. Granulomatous dz's

36. Tumor stage

37. Neoplastic progression: step 4 Metastasis

38. Primary tumors that metasize to bone

39. tumor: CML What is the associated oncogene?
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
Liver (angiosarcoma)
Abl
Ret

40. Dz: Barrett's esophagus (chronic GI reflux) What is the associated neoplasm?
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
N euroblastoma
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome
Esophageal adenocarcinoma

41. Tumor nomenclature: Bone What do you call a benign tumor of this tissue? .. a malignant one?
Benign: Osteoma Malignant: osteosarcoma
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Hepatocellular carcinoma
Degree of cellular differentiation based on histologic appearance of tumor. Usually graded I- IV based on degree of differentiation and number of mitoses per high - power field; character of tumor itself.

42. Chemical carcinogens: Arsenic What is the affected organ?
Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome
[aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma
Skin (squamous cell carcinoma) Liver (angiosarcoma)
Benign: Osteoma Malignant: osteosarcoma

43. Paraneoplastic effects of tumors: Leukemias and lymphomas Causes...? Effect?
Programmed cell death; ATP required. Mediated by caspases.
HPV
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy
Gain of fxn --< cancer. Need damage to only 1 allele.

44. Tumor markers: CA-19-9
IL-8 C5a Leukotriene B4 Kallikrein
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' />
Pancreatic adenocarcinoma
Cells have increased in # (hyperplasia ) Abnormal proliferation of cells w/ loss of size - shape - and orientation (dysplasia ) <img src='220b.JPG' />

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

46. [aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma What is the assocciated oncogenic virus?
Assoc: Neurofibromatosis type 1
Thymoma - small cell lung carcinoma
HHV-8
Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis)

47. Pancreatic cancer

48. Free radical degradation
Breast - ovarian - and gastric carcinomas
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
NF2
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability

49. Characteristics of trans udate
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention
Xeroderma pigmentosum - albinism
Breast - ovarian - and gastric carcinomas

50. Metastasis to brain
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
Increase in # of cells. Reversible.
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Programmed cell death; ATP required. Mediated by caspases.