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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. Cancer epidemiology: Lung cancer? As a cause of death overall?
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
P 16
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).

2. Breast and ovarian cancer What is the tumor suppressor gene?
Assoc: Neurofibromatosis 2 ('Type 2 = 22')
Assoc.: Breast and ovarian cancer
N euroblastoma
BRCA1

3. Paraneoplastic effects of tumors: Small cell lung carcinoma and intracranial neoplasms Causes...? Effect?
Membrane lipid peroxidation Protein modification DNA Breakage
N euroblastoma
C - kit
Causes: ADH Effect: SIADH

4. tumor: Multiple endocrine neoplasia (MEN) types II and III What is the associated oncogene?
Ret
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
L ung tumor

5. Primary tumors that metasize to bone

6. Tumor markers: alpha - fetoprotein
AIDS
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
Assoc.: Retinoblastoma - osteosarcoma
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.

7. Psammoma bodies
The liver and lung are the most common sites of metastasis after regional LN's. Metastasis << primary liver tumors.
Degree of localization/spread based on site and size of 1' lesion - spread to regional LNs - presence of metastases; spread of tumor in a specific pt. S tage = S pread
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.
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

8. Metastasis to bone
Skin (squamous cell carcinoma) Liver (angiosarcoma)
Abl
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
BRCA2

9. Carcinoma vs. sarcoma
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
HTLV-1
NF1

10. Tumor suppressor gene: NF1 chromosome? Associated tumor?
Assoc: Neurofibromatosis type 1
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Tartrate - resistant acid phosphatase. Hairy cell leukemia -- a B- cell neoplasm. 'TRAP the hairy animal.'
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).

11. tumor: CML What is the associated oncogene?
Abl
Increase in # of cells. Reversible.
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
Assoc: Melanoma ('MelaN oma is N ine')

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

13. Necrosis is characterized by...?
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma
Metastases to bone - obstructive biliary dz - Paget's dz of bone.

14. Neoplasm: Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma With what dz is this associated?
AIDS
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' />
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
Beta -2 microglobulin Derived from MHC class I proteins.

15. Type of amyloid protein: Primary Protein? Derived from...?
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
Bladder (transitional cell carcinoma)
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
P 53

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

17. Chemical carcinogens: Vinyl chloride What is the affected organ?
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Liver (angiosarcoma)
[DPC = D eleted in P ancreatic C ancer'] What is the tumor suppressor gene? DPC
Causes: ADH Effect: SIADH

18. Oncogene: c - myc Associated tumor?

19. Dysplasia
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.
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma

20. Colon cancer
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.
Blood (leukemia)
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.

21. Oncogene: L - myc Associated tumor?
L ung tumor
Erb - B2
Lung (mesothelioma and bronchogenic carcinoma)
Acanthosis nigricans (hyperpigmentation and epidermal thickening)

22. Tumor stage

23. tumor: Gastrointestinal stromal tumor (GIST) What is the associated oncogene?
Sarcoma
C - kit
Liver (centrilobular necrosis - fatty change)
Leukemias and lymphomas

24. Free radical degradation
Assoc.: Retinoblastoma - osteosarcoma
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
C - myc
N - myc

25. Necrosis (definition)
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma
Enzymatic degradation of a cell resulting from exogenous injury.
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)

26. Neoplasm: Sarcoma With what dz is this associated?
Liver (hepatocellular carcinoma)
Radiation exposure
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.

27. Type of amyloid protein: Dialysis - associated Protein? Derived from...?
Beta -2 microglobulin Derived from MHC class I proteins.
Metastases to bone - obstructive biliary dz - Paget's dz of bone.
Lung (mesothelioma and bronchogenic carcinoma)
Chr. 11p Assoc: Wilms' tumor

28. Tumor nomenclature: < 1 cell type What do you call a benign tumor of this tissue? .. a malignant one?
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
CML
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)

29. Paraneoplastic effects of tumors: Small cell lung carcinoma Causes...? Effect?

30. Neoplasm: Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin With what dz is this associated?
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.
Xeroderma pigmentosum - albinism
Enzymatic degradation of a cell resulting from exogenous injury.
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC

31. Oncogene: ret Associated tumor?
N - myc
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.
Multiple endocrine neoplasia (MEN) types II and III
Assoc: Neurofibromatosis type 1

32. Dz: Actinic keratosis What is the associated neoplasm?
Squamous cell carcinoma of the skin
HBV - HCV
EBV
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)

33. Dz: Barrett's esophagus (chronic GI reflux) What is the associated neoplasm?
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin
Esophageal adenocarcinoma
Assoc: Neurofibromatosis 2 ('Type 2 = 22')
Cirrhosis (alcoholic - hepatitis B or C)

34. Metaplasia

35. Tumor nomenclature: Blood vessels What do you call a benign tumor of this tissue? .. a malignant one?
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Gastric adenocarcinoma
Benign: hemangioma Malignant: Angiosarcoma
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.

36. Tumor nomenclature: Epithelium What do you call a benign tumor of this tissue? .. a malignant one?
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
Causes: Erythropoietin Effect: Polycythemia
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.
Pancreatic adenocarcinoma

37. Tumor markers: Alkaline phosphatase

38. Tumor grade
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.
Xeroderma pigmentosum - albinism
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)

39. Type of amyloid protein: Senile cardiac Protein? Derived from...?
Beta - amyloid Derived from amyloid precursor protein (APP)
Protein = transthyretin Derived from AF (AF = old F ogies)
Assoc: breast cancer
Ras

40. Dz: Ulcerative colitis What is the associated neoplasm?
Lung (mesothelioma and bronchogenic carcinoma)
Colonic adenocarcinoma
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />
HBV - HCV

41. Oncogene: erb - B2 Associated tumor?
Breast - ovarian - and gastric carcinomas
Gastric adenocarcinoma
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.
Malignant lymphomas

42. Neoplasm: Gastric adenocarcinoma With what dz is this associated?
Abl
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
IL-8 C5a Leukotriene B4 Kallikrein
Renal cell carcinoma - hemangioblastoma

43. Tumor nomenclature: Fat What do you call a benign tumor of this tissue? .. a malignant one?
Cells have increased in # (hyperplasia ) Abnormal proliferation of cells w/ loss of size - shape - and orientation (dysplasia ) <img src='220b.JPG' />
Burkitt's lymphoma nasopharyngeal carcinoma
Benign: lipoma Malignant: liposarcoma
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome

44. Neoplasm: Colonic adenocarcinoma With what dz is this associated?
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).
Ulcerative colitis
Bcl -2
Pancreatic adenocarcinoma

45. Hypovolemic/cardiogenic shock
Leukemias and lymphomas
Assoc: Neurofibromatosis 2 ('Type 2 = 22')
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
Degree of localization/spread based on site and size of 1' lesion - spread to regional LNs - presence of metastases; spread of tumor in a specific pt. S tage = S pread

46. Neurofibromatosis type 1 What is the tumor suppressor gene?
NF1
AIDS
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
Enzymatic degradation of a cell resulting from exogenous injury.

47. Colorectal cancer (assoc w/ FAP) What is the tumor suppressor gene?
Esophageal adenocarcinoma
APC
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia
Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome

48. Characteristics of ex udate
Erb - B2
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).

49. Dz: Dysplastic nevus What is the associated neoplasm?
Breast - ovarian - and gastric carcinomas
Rb
Malignant melanoma
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.

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