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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.
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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. Anaplasia
Small cell lung carcinoma
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
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.
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome

2. Female cancer epidemiology (incidence - mortality)
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)
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)
Loss of fxn --< cancer; both allels must be lost for expression of dz.

3. When does apoptosis occur?
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)
Visceral malignancy (stomach - lung - breast - uterus)
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants

4. Which usually has more prognostic value - tumor stage or grade?
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
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' />
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
Usually stage < grade

5. Tumor markers: PSA
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.
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
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
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' />

6. Tumor nomenclature: < 1 cell type 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: -- Malignant: Leukemia - lymphoma
Assoc.: Retinoblastoma - osteosarcoma
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)

7. Oncogene: ret Associated tumor?
Multiple endocrine neoplasia (MEN) types II and III
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.
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
Xeroderma pigmentosum - albinism

8. Malignant
Squamous cell carcinoma of the skin
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.
BRCA1

9. Neoplasm: Hepatocellular carcinoma 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
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.
Down syndrome
Cirrhosis (alcoholic - hepatitis B or C)

10. Paraneoplastic effects of tumors: Renal cell carcinoma - hemangioblastoma Causes...? Effect?
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Causes: Erythropoietin Effect: Polycythemia
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
Ret

11. Type of amyloid protein: Dialysis - associated Protein? Derived from...?
AIDS
Beta -2 microglobulin Derived from MHC class I proteins.
Colonic adenocarcinoma
T = size of T umor N = N ode involvement M = M etastases

12. tumor: L ung tumor What is the associated oncogene?
Benign: Osteoma Malignant: osteosarcoma
L - myc
Amylin protein Derived from AE (AE = E ndocrine)
Cells have increased in # (hyperplasia ) Abnormal proliferation of cells w/ loss of size - shape - and orientation (dysplasia ) <img src='220b.JPG' />

13. Neoplasm: Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin With what dz is this associated?
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
Xeroderma pigmentosum - albinism
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy

14. Tumor suppressor gene: DPC chromosome? Associated tumor?

15. Pancreatic cancer

16. Oncogenic viruses: HTLV-1 What is the associated cancer?
Assoc.: Breast and ovarian cancer
Benign: -- Malignant: Leukemia - lymphoma
Adult T- cell leukemia
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.

17. Dz: Xeroderma pigmentosum - albinism What is the associated neoplasm?
Amylin protein Derived from AE (AE = E ndocrine)
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin
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.
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.

18. Oncogenic viruses: EBV What is the associated cancer?

19. Dz: Immunodeficiency states What is the associated neoplasm?
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
Hepatocellular carcinoma
Barrett's esophagus (chronic GI reflux)
Malignant lymphomas

20. Dz: Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants What is the associated neoplasm?
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
Gastric adenocarcinoma
Follicular and undifferentiated lymphomas (inhibits apoptosis)
Liver (angiosarcoma)

21. Chemical carcinogens: Asbestos What is the affected organ?
P 53
Lung (mesothelioma and bronchogenic carcinoma)
Liver (angiosarcoma)
IL-8 C5a Leukotriene B4 Kallikrein

22. Dz: Radiation exposure What is the associated neoplasm?
Sarcoma
L - myc
Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC

23. Tumor markers: Prostatic acid phospatase
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.
Prostate carcinoma.
Acanthosis nigricans (hyperpigmentation and epidermal thickening)
Squamous cell carcinoma of esophagus

24. Primary tumors that metastasize to liver

25. Dz: Paget's dz of bone What is the associated neoplasm?
Beta - amyloid Derived from amyloid precursor protein (APP)
Secondary osteosarcoma and fibrosarcoma
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
Neuorblastoma - lung - and gastric cancer.

26. Fluid exudation in inflammation
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)
Increase vascular permeability - vasodilation - endothelial injury.
NF1

27. Chemical carcinogens: CCl4 What is the affected organ?
Breast - ovarian - and gastric carcinomas
Benign: lipoma Malignant: liposarcoma
Assoc: breast cancer
Liver (centrilobular necrosis - fatty change)

28. Dz: Tuberous sclerosis (facial angiofibroma - seizures - mental retardation) What is the associated neoplasm?
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma
Increase vascular permeability - vasodilation - endothelial injury.
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)

29. Tumor markers: alpha - fetoprotein
Causes: Erythropoietin Effect: Polycythemia
HHV-8
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)

30. Tumor suppressor gene: p 53 chromosome? Associated tumor?
Thymoma - small cell lung carcinoma
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome
Chr. 11p Assoc: Wilms' tumor
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).

31. Tumor nomenclature: Epithelium What do you call a benign tumor of this tissue? .. a malignant one?
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
Increase vascular permeability - vasodilation - endothelial injury.
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
Tartrate - resistant acid phosphatase. Hairy cell leukemia -- a B- cell neoplasm. 'TRAP the hairy animal.'

32. Tumor suppressor gene: DCC chromosome? Associated tumor?
Hepatocellular carcinoma
Small cell lung carcinoma and intracranial neoplasms
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Malignant melanoma

33. Paraneoplastic effects of tumors: Small cell lung carcinoma and intracranial neoplasms Causes...? Effect?
IL-8 C5a Leukotriene B4 Kallikrein
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
Causes: ADH Effect: SIADH

34. tumor: N euroblastoma What is the associated oncogene?
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
Small cell lung carcinoma and intracranial neoplasms
N - myc

35. Chronic inflammation
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
Immunodeficiency states
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia

36. Oncogene: c - myc Associated tumor?

37. Substances that are chemotactic for neutrophils
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
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' />
Small cell lung carcinoma and intracranial neoplasms
IL-8 C5a Leukotriene B4 Kallikrein

38. tumor: Burkitt's lymphoma What is the associated oncogene?
Amylin protein Derived from AE (AE = E ndocrine)
C - myc
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
Bladder (transitional cell carcinoma)

39. Tumor markers: Beta - hCG

40. Apoptosis is characterized by...?
Assoc: Colorectal cancer (assoc w/ FAP)
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
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
Assoc: Neurofibromatosis type 1

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

42. Primary tumors that metasize to bone

43. Metaplasia

44. Neoplasm: Squamous cell carcinoma of the skin With what dz is this associated?
L - myc
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
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
Actinic keratosis

45. Neoplasm: Visceral malignancy (stomach - lung - breast - uterus) With what dz is this associated?
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
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.
Acanthosis nigricans (hyperpigmentation and epidermal thickening)
Chr. 11p Assoc: Wilms' tumor

46. Dz: Cirrhosis (alcoholic - hepatitis B or C) What is the associated neoplasm?
Hepatocellular carcinoma
HBV - HCV
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
Assoc.: Breast and ovarian cancer

47. Paraneoplastic effects of tumors: Thymoma - small cell lung carcinoma Causes...? Effect?

48. Primary tumors that metastasize to brain
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
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.
WT1
Colon carcinoma

49. Cervical carcinoma (types 16 - 18) Penile/anal carcinoma What is the assocciated oncogenic virus?
CML
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
HPV

50. Burkitt's lymphoma nasopharyngeal carcinoma What is the assocciated oncogenic virus?
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention
EBV
Assoc: Neurofibromatosis type 1
Actinic keratosis