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. Neoplasia
APC
[aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.


2. tumor: Breast - ovarian - and gastric carcinomas What is the associated oncogene?
Erb - B2
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
L ung tumor
Beta -2 microglobulin Derived from MHC class I proteins.


3. Colorectal cancer (assoc w/ FAP) What is the tumor suppressor gene?
Increase in # of cells. Reversible.
Breast - ovarian - and gastric carcinomas
APC
WT1


4. Tumor suppressor gene: BRCA1 chromosome? Associated tumor?
Ras
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
Liver (angiosarcoma)
Assoc.: Breast and ovarian cancer


5. Apoptosis is characterized by...?
Increase in # of cells. Reversible.
Small cell lung carcinoma
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma
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


6. Male cancer epidemiology (incidence - mortality)
Assoc: Colorectal cancer (assoc w/ FAP)
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome


7. Dz: Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency) What is the associated neoplasm?
Multiple endocrine neoplasia (MEN) types II and III
Squamous cell carcinoma of esophagus
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
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.


8. Substances that are chemotactic for neutrophils
IL-8 C5a Leukotriene B4 Kallikrein
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.
Ovarian - malignant epithelial tumors
Barrett's esophagus (chronic GI reflux)


9. Tumor suppressor gene: DCC chromosome? Associated tumor?
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.
Leukemias and lymphomas
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)


10. Dz: Actinic keratosis What is the associated neoplasm?
Breast - ovarian - and gastric carcinomas
Paget's dz of bone
Ovarian - malignant epithelial tumors
Squamous cell carcinoma of the skin


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

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12. Tumor nomenclature: Bone What do you call a benign tumor of this tissue? .. a malignant one?
Down syndrome
Assoc.: Retinoblastoma - osteosarcoma
Benign: Osteoma Malignant: osteosarcoma
Benign: -- Malignant: Leukemia - lymphoma


13. Oncogenes
Down syndrome
Gastrointestinal stromal tumor (GIST)
APC
Gain of fxn --< cancer. Need damage to only 1 allele.


14. Characteristics of trans udate
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.
APC
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC


15. Tumor suppressor gene: p 53 chromosome? Associated tumor?
Bcl -2
Assoc: Pancreatic cancer [DPC = D eleted in P ancreatic C ancer']
Gastric adenocarcinoma
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome


16. Dz: Acanthosis nigricans (hyperpigmentation and epidermal thickening) What is the associated neoplasm?
Rb
Visceral malignancy (stomach - lung - breast - uterus)
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Colon carcinoma


17. Tumor markers: alpha - fetoprotein
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)


18. Oncogene: L - myc Associated tumor?
Ulcerative colitis
Assoc: Pancreatic cancer [DPC = D eleted in P ancreatic C ancer']
L ung tumor
Gastric adenocarcinoma


19. Neoplasm: Visceral malignancy (stomach - lung - breast - uterus) With what dz is this associated?
Acanthosis nigricans (hyperpigmentation and epidermal thickening)
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
Liver (hepatocellular carcinoma)
Breast - ovarian - and gastric carcinomas


20. Characteristics of reversible cell injury
Gastrointestinal stromal tumor (GIST)
Programmed cell death; ATP required. Mediated by caspases.
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
Tartrate - resistant acid phosphatase. Hairy cell leukemia -- a B- cell neoplasm. 'TRAP the hairy animal.'


21. Dz: Tuberous sclerosis (facial angiofibroma - seizures - mental retardation) What is the associated neoplasm?
Benign: lipoma Malignant: liposarcoma
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Visceral malignancy (stomach - lung - breast - uterus)


22. Dysplasia
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome
Increase vascular permeability - vasodilation - endothelial injury.
Neuorblastoma - lung - and gastric cancer.
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.


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

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

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25. Oncogene: c - kit Associated tumor?
Gastrointestinal stromal tumor (GIST)
CML
Visceral malignancy (stomach - lung - breast - uterus)
IL-8 C5a Leukotriene B4 Kallikrein


26. Cancer epidemiology: Lung cancer? As a cause of death overall?
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.
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).
Down syndrome
HBV - HCV


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

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28. Characteristics of ex udate
Hepatocellular carcinoma
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
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation
Enzymatic degradation of a cell resulting from exogenous injury.


29. Type of amyloid protein: Dialysis - associated Protein? Derived from...?
WT1
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.
Beta -2 microglobulin Derived from MHC class I proteins.
Bcl -2


30. Migration (step 4 in leukocyte extravasation)

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31. Type of amyloid protein: Secondary Protein? Derived from...?
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)
Secondary osteosarcoma and fibrosarcoma
Assoc: Neurofibromatosis type 1
P 16


32. Tumor nomenclature: Blood cells What do you call a benign tumor of this tissue? .. a malignant one?
HTLV-1
Visceral malignancy (stomach - lung - breast - uterus)
Neuorblastoma - lung - and gastric cancer.
Benign: -- Malignant: Leukemia - lymphoma


33. Dz: Radiation exposure What is the associated neoplasm?
Cells have invaded basement membrane using collagenases and hydrolases Can metastasize if they reach a blood or lymphatic vessel <img src='220d.JPG' />
NF1
Sarcoma
Chr. 11p Assoc: Wilms' tumor


34. Chemical carcinogens: CCl4 What is the affected organ?
Acanthosis nigricans (hyperpigmentation and epidermal thickening)
Cells have invaded basement membrane using collagenases and hydrolases Can metastasize if they reach a blood or lymphatic vessel <img src='220d.JPG' />
Liver (centrilobular necrosis - fatty change)
Malignant lymphomas


35. Paraneoplastic effects of tumors: Small cell lung carcinoma and intracranial neoplasms Causes...? Effect?
Immunodeficiency states
Small cell lung carcinoma
Causes: ADH Effect: SIADH
Leukocyte travels btw endothelial cells and exits blood vessel; PECAM-1 is involved. <img src='218a.JPG' />


36. tumor: Burkitt's lymphoma What is the associated oncogene?
All (we All fall Down ) AML
C - myc
Benign: -- Malignant: Leukemia - lymphoma
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)


37. Carcinoma vs. sarcoma
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
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.
Small cell lung carcinoma and intracranial neoplasms


38. Chemical carcinogens: Arsenic What is the affected organ?
C - kit
NF2
Abl
Skin (squamous cell carcinoma) Liver (angiosarcoma)


39. Tumor nomenclature: Smooth muscle What do you call a benign tumor of this tissue? .. a malignant one?
APC
Ovarian - malignant epithelial tumors
Benign: Leiomyoma Malignant: Leiomyosarcoma
Loss of fxn --< cancer; both allels must be lost for expression of dz.


40. Neurofibromatosis 2 ('Type 2 = 22') What is the tumor suppressor gene?
NF2
Bcl -2
Acanthosis nigricans (hyperpigmentation and epidermal thickening)
Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma


41. Oncogene: N - myc Associated tumor?
N euroblastoma
Assoc.: Retinoblastoma - osteosarcoma
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
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)


42. Dz: Down syndrome What is the associated neoplasm?
All (we All fall Down ) AML
Beta - amyloid Derived from amyloid precursor protein (APP)
Adult T- cell leukemia
Liver (centrilobular necrosis - fatty change)


43. Dz: Dysplastic nevus What is the associated neoplasm?
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'
Malignant lymphomas
Malignant melanoma


44. Tumor stage

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45. Neoplasm: Squamous cell carcinoma of the skin With what dz is this associated?
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.
Fibroblast emigration and proliferation; deposition of ECM.
Assoc: Melanoma ('MelaN oma is N ine')
Actinic keratosis


46. Chemical carcinogens: Nitrosamines (e.g. - in smoked foods) What is the affected organ?
Esophagus - stomach
Colon carcinoma
EBV
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.


47. Tumor grade
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia
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.
Barrett's esophagus (chronic GI reflux)
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.


48. Tumor markers: Alkaline phosphatase

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49. Adult T- cell leukemia What is the assocciated oncogenic virus?
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)
Malignant melanoma
HTLV-1


50. Necrosis (definition)
EBV
Radiation exposure
BRCA2
Enzymatic degradation of a cell resulting from exogenous injury.