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. Oncogene: abl Associated tumor?
WT1
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
CML
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.


2. Paraneoplastic effects of tumors: Renal cell carcinoma - hemangioblastoma Causes...? Effect?
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia
Hepatocellular carcinoma
Causes: Erythropoietin Effect: Polycythemia
Small cell lung carcinoma


3. Substances that are chemotactic for neutrophils
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
IL-8 C5a Leukotriene B4 Kallikrein
Erb - B2
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin


4. Adult T- cell leukemia What is the assocciated oncogenic virus?
Radiation exposure
HTLV-1
Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome
Esophagus - stomach


5. Dz: AIDS What is the associated neoplasm?

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6. Neoplasm: Malignant lymphomas With what dz is this associated?
Follicular and undifferentiated lymphomas (inhibits apoptosis)
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
Actinic keratosis
Immunodeficiency states


7. Tumor suppressor genes
Paget's dz of bone
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)


8. Tumor markers: CA-19-9
Leukocyte travels btw endothelial cells and exits blood vessel; PECAM-1 is involved. <img src='218a.JPG' />
Pancreatic adenocarcinoma
Causes: Erythropoietin Effect: Polycythemia
WT1


9. Dz: Immunodeficiency states What is the associated neoplasm?
Benign: Osteoma Malignant: osteosarcoma
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.
Leukocyte travels btw endothelial cells and exits blood vessel; PECAM-1 is involved. <img src='218a.JPG' />
Malignant lymphomas


10. Dz: Barrett's esophagus (chronic GI reflux) What is the associated neoplasm?
Esophageal adenocarcinoma
Rb
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC


11. Neoplasm: Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma With what dz is this associated?
Blood (leukemia)
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)
Assoc: Colorectal cancer (assoc w/ FAP)
AIDS


12. Migration (step 4 in leukocyte extravasation)

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13. Apoptosis is characterized by...?
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
Secondary osteosarcoma and fibrosarcoma
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Fibrous tissue formation in response to a neoplasm. Irreversible.


14. Hyperplasia
Increase in # of cells. Reversible.
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.
Barrett's esophagus (chronic GI reflux)


15. Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia What neoplasm would create this paraneoplastic effect?
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
Renal cell carcinoma - hemangioblastoma
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
Follicular and undifferentiated lymphomas (inhibits apoptosis)


16. breast cancer What is the tumor suppressor gene?
P 16
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
BRCA2
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)


17. Neoplastic progression: step 3 Invasive carcinoma

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18. Tumor suppressor gene: p 53 chromosome? Associated tumor?
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' />
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome
Prostate carcinoma.
Bladder (transitional cell carcinoma)


19. Chemical carcinogens: Arsenic What is the affected organ?
Skin (squamous cell carcinoma) Liver (angiosarcoma)
Multiple endocrine neoplasia (MEN) types II and III
NF1
Cells have increased in # (hyperplasia ) Abnormal proliferation of cells w/ loss of size - shape - and orientation (dysplasia ) <img src='220b.JPG' />


20. Necrosis (definition)
Skin (squamous cell carcinoma) Liver (angiosarcoma)
T = size of T umor N = N ode involvement M = M etastases
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Enzymatic degradation of a cell resulting from exogenous injury.


21. Type of amyloid protein: Alzheimer's dz Protein? Derived from...?
Blood (leukemia)
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy
Beta - amyloid Derived from amyloid precursor protein (APP)
Assoc: Colorectal cancer (assoc w/ FAP)


22. Dz: Tuberous sclerosis (facial angiofibroma - seizures - mental retardation) What is the associated neoplasm?
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
Assoc.: Retinoblastoma - osteosarcoma
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.'


23. Type of amyloid protein: Medullary carcinoma of thyroid Protein? Derived from...?
Acanthosis nigricans (hyperpigmentation and epidermal thickening)
Rb
[aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)


24. Paraneoplastic effects of tumors: Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma Causes...? Effect?
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' />
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).


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

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26. Benign
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
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' />
P 16


27. Chemical carcinogens: Cigarette smoke What is the affected organ?
Down syndrome
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.
Neuorblastoma - lung - and gastric cancer.
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)


28. Chemical carcinogens: Aflatoxins (produced by Aspergillus) What is the affected organ?
Liver (hepatocellular carcinoma)
Follicular and undifferentiated lymphomas (inhibits apoptosis)
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.
CML


29. Type of amyloid protein: DM2 Protein? Derived from...?
Causes: ADH Effect: SIADH
Malignant lymphomas
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
Amylin protein Derived from AE (AE = E ndocrine)


30. Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness) What neoplasm would create this paraneoplastic effect?
C - kit
Adult T- cell leukemia
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.
Thymoma - small cell lung carcinoma


31. Fibrosis in inflammation
Adult T- cell leukemia
Fibroblast emigration and proliferation; deposition of ECM.
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)
Liver (centrilobular necrosis - fatty change)


32. Type of amyloid protein: Dialysis - associated Protein? Derived from...?
HPV
Adult T- cell leukemia
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
Beta -2 microglobulin Derived from MHC class I proteins.


33. Retinoblastoma - osteosarcoma What is the tumor suppressor gene?
Actinic keratosis
Rb
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
Melanoma - neural tumors - astrocytomas.


34. Tumor nomenclature: Skeletal muscle What do you call a benign tumor of this tissue? .. a malignant one?
HHV-8
Paget's dz of bone
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma


35. Resolution of inflammation
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.
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Actinic keratosis
Bladder (transitional cell carcinoma)


36. Causes: ADH Effect: SIADH What neoplasm would create this paraneoplastic effect?
Small cell lung carcinoma and intracranial neoplasms
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.
T = size of T umor N = N ode involvement M = M etastases
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)


37. Dz: Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis) What is the associated neoplasm?
Benign and malignant lymphomas
IL-8 C5a Leukotriene B4 Kallikrein
WT1
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.


38. Tumor markers: TRAP

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39. Oncogenic viruses: HBV - HCV What is the associated cancer?
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />
Hepatocellular carcinoma
WT1
Causes: ADH Effect: SIADH


40. most human cancers - Li - Fraumeni syndrome What is the tumor suppressor gene?
P 53
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.
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
Pancreatic adenocarcinoma


41. Neoplasm: Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma With what dz is this associated?
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)
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' />
Mediated by ICAM -1 on vascular endothelium binding to LFA-1 (integrin) on the leukocyte ('Hold on tight to your CAM era') <img src='218a.JPG' />
Amylin protein Derived from AE (AE = E ndocrine)


42. Septic shock
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention
Liver (centrilobular necrosis - fatty change)
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.


43. Primary tumors that metasize to bone

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44. Neurofibromatosis type 1 What is the tumor suppressor gene?
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />
NF1


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

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46. Necrosis morphologies
Leukocyte travels btw endothelial cells and exits blood vessel; PECAM-1 is involved. <img src='218a.JPG' />
Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
L - myc


47. Tumor nomenclature: Fat What do you call a benign tumor of this tissue? .. a malignant one?
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
Mediated by ICAM -1 on vascular endothelium binding to LFA-1 (integrin) on the leukocyte ('Hold on tight to your CAM era') <img src='218a.JPG' />
Bcl -2
Benign: lipoma Malignant: liposarcoma


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

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49. Neoplastic progression: step 2 In situ carcinoma

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50. Colon cancer
Malignant lymphomas
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
Colon carcinoma