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. Chemical carcinogens: Vinyl chloride What is the affected organ?
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Liver (angiosarcoma)
Benign and malignant lymphomas
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.


2. Colorectal cancer (assoc w/ FAP) What is the tumor suppressor gene?
APC
Leukocyte travels btw endothelial cells and exits blood vessel; PECAM-1 is involved. <img src='218a.JPG' />
Xeroderma pigmentosum - albinism
Malignant lymphomas


3. Paraneoplastic effects of tumors: Leukemias and lymphomas Causes...? Effect?
Lung (mesothelioma and bronchogenic carcinoma)
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy
Ovarian - malignant epithelial tumors
Visceral malignancy (stomach - lung - breast - uterus)


4. Free radical injury induces cell injury thru...?
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.
Membrane lipid peroxidation Protein modification DNA Breakage
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.


5. Tumor markers: CA-19-9
Fibroblast emigration and proliferation; deposition of ECM.
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
Pancreatic adenocarcinoma
Protein = transthyretin Derived from AF (AF = old F ogies)


6. Oncogenic viruses: HHV-8 What is the associated cancer?

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7. tumor: N euroblastoma What is the associated oncogene?
Ret
N - myc
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)


8. Cervical carcinoma (types 16 - 18) Penile/anal carcinoma What is the assocciated oncogenic virus?
Burkitt's lymphoma nasopharyngeal carcinoma
CML
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).
HPV


9. tumor: Burkitt's lymphoma What is the associated oncogene?
Multiple endocrine neoplasia (MEN) types II and III
Esophagus - stomach
C - myc
Assoc.: Retinoblastoma - osteosarcoma


10. tumor: CML What is the associated oncogene?
Abl
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
N - myc


11. Tumor nomenclature: Epithelium What do you call a benign tumor of this tissue? .. a malignant one?
NF1
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
Burkitt's lymphoma


12. Type of amyloid protein: DM2 Protein? Derived from...?
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin
N - myc
Lung (mesothelioma and bronchogenic carcinoma)
Amylin protein Derived from AE (AE = E ndocrine)


13. Tumor suppressor gene: BRCA2 chromosome? Associated tumor?
Beta - amyloid Derived from amyloid precursor protein (APP)
Leukemias and lymphomas
BRCA2
Assoc: breast cancer


14. Benign
Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome
Liver (angiosarcoma)
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
IL-8 C5a Leukotriene B4 Kallikrein


15. Acute inflammation
Beta -2 microglobulin Derived from MHC class I proteins.
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
BRCA1
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.


16. How should tumor markers be used clinically?
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy
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.
BRCA1
Hepatocellular carcinoma


17. Free radical degradation
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).
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
Ulcerative colitis
Small cell lung carcinoma


18. Characteristics of irreversible cell injury
Melanoma - neural tumors - astrocytomas.
WT1
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
[aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma


19. Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy What neoplasm would create this paraneoplastic effect?
Leukemias and lymphomas
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).
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.
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


20. Neoplastic progression: step 1 Hyperplasia/dysplasia

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21. Cancer epidemiology: Lung cancer? As a cause of death overall?
Benign and malignant lymphomas
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.
Assoc: breast 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).


22. Neurofibromatosis 2 ('Type 2 = 22') What is the tumor suppressor gene?
Bladder (transitional cell carcinoma)
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
NF2
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)


23. Causes: ADH Effect: SIADH What neoplasm would create this paraneoplastic effect?
Visceral malignancy (stomach - lung - breast - uterus)
Small cell lung carcinoma and intracranial neoplasms
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
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)


24. Oncogenes
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.
Pancreatic adenocarcinoma
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
Gain of fxn --< cancer. Need damage to only 1 allele.


25. Leukocyte activation in inflammation
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.
Beta -2 microglobulin Derived from MHC class I proteins.
Rb
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)


26. Chemical carcinogens: Asbestos What is the affected organ?
Lung (mesothelioma and bronchogenic carcinoma)
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
Malignant lymphomas


27. Paraneoplastic effects of tumors: Small cell lung carcinoma and intracranial neoplasms Causes...? Effect?
Immunodeficiency states
Causes: ADH Effect: SIADH
Secondary osteosarcoma and fibrosarcoma
Barrett's esophagus (chronic GI reflux)


28. Metaplasia

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29. Tumor markers: CA-125
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
Ovarian - malignant epithelial tumors


30. Fibrosis in inflammation
Leukemias and lymphomas
Fibroblast emigration and proliferation; deposition of ECM.
Barrett's esophagus (chronic GI reflux)
All (we All fall Down ) AML


31. Tumor markers: S-100
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma
Melanoma - neural tumors - astrocytomas.
Benign: Leiomyoma Malignant: Leiomyosarcoma
Assoc: Colorectal cancer (assoc w/ FAP)


32. Necrosis is characterized by...?
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
Bladder (transitional cell carcinoma)
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma


33. tumor: Colon carcinoma What is the associated oncogene?
Actinic keratosis
P 16
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
Ras


34. Type of amyloid protein: Secondary Protein? Derived from...?
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' />
Usually stage < grade
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]


35. Breast and ovarian cancer What is the tumor suppressor gene?
Acanthosis nigricans (hyperpigmentation and epidermal thickening)
BRCA1
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
[aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma


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

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37. Hypovolemic/cardiogenic shock
Benign: lipoma Malignant: liposarcoma
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' />
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.


38. Paraneoplastic effects of tumors: Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma Causes...? Effect?
Benign: Leiomyoma Malignant: Leiomyosarcoma
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia
Assoc: Colorectal cancer (assoc w/ FAP)
P 53


39. Tumor nomenclature: Blood vessels What do you call a benign tumor of this tissue? .. a malignant one?
Benign: hemangioma Malignant: Angiosarcoma
Increase vascular permeability - vasodilation - endothelial injury.
T = size of T umor N = N ode involvement M = M etastases
P 53


40. Dz: AIDS What is the associated neoplasm?

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41. Metastasis to brain
Assoc: Neurofibromatosis 2 ('Type 2 = 22')
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Benign: hemangioma Malignant: Angiosarcoma
Bcl -2


42. Necrosis morphologies
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
Beta - amyloid Derived from amyloid precursor protein (APP)
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)


43. Pancreatic cancer

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44. Leukocyte extravasation

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45. Oncogenic viruses: HBV - HCV What is the associated cancer?
Ret
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
Fibrous tissue formation in response to a neoplasm. Irreversible.
Hepatocellular carcinoma


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

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47. Oncogene: c - myc Associated tumor?

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48. Apoptosis (definition)
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Burkitt's lymphoma
Programmed cell death; ATP required. Mediated by caspases.
Ovarian - malignant epithelial tumors


49. Neoplasia
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
HBV - HCV
Gastric adenocarcinoma
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma


50. Chemical carcinogens: Nitrosamines (e.g. - in smoked foods) What is the affected organ?
Esophagus - stomach
Visceral malignancy (stomach - lung - breast - uterus)
[DPC = D eleted in P ancreatic C ancer'] What is the tumor suppressor gene? DPC
Benign: lipoma Malignant: liposarcoma