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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. Neoplasm: Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin With what dz is this associated?
Xeroderma pigmentosum - albinism
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
Bladder (transitional cell carcinoma)
Benign and malignant lymphomas

2. Tumor nomenclature: < 1 cell type 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%)
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
Assoc: Colorectal cancer (assoc w/ FAP)

3. Paraneoplastic effects of tumors: Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma Causes...? Effect?
BRCA1
Causes: Erythropoietin Effect: Polycythemia
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.

4. Paraneoplastic effects of tumors: Leukemias and lymphomas Causes...? Effect?
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
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.
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy

5. breast cancer What is the tumor suppressor gene?
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
BRCA2
HTLV-1
EBV

6. Tumor markers: CA-125
Ovarian - malignant epithelial tumors
Follicular and undifferentiated lymphomas (inhibits apoptosis)
All (we All fall Down ) AML
Small cell lung carcinoma

7. Dz: Acanthosis nigricans (hyperpigmentation and epidermal thickening) What is the associated neoplasm?
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Visceral malignancy (stomach - lung - breast - uterus)
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
The liver and lung are the most common sites of metastasis after regional LN's. Metastasis << primary liver tumors.

8. When does apoptosis occur?
Secondary osteosarcoma and fibrosarcoma
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' />
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)

9. Female cancer epidemiology (incidence - mortality)
Paget's dz of bone
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)
AIDS
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)

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

11. Retinoblastoma - osteosarcoma What is the tumor suppressor gene?
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation
HHV-8
Beta -2 microglobulin Derived from MHC class I proteins.
Rb

12. Oncogene: L - myc Associated tumor?
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
L ung tumor
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma

13. Tumor nomenclature: Fat What do you call a benign tumor of this tissue? .. a malignant one?
All (we All fall Down ) AML
Benign: lipoma Malignant: liposarcoma
Small cell lung carcinoma and intracranial neoplasms
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)

14. Neoplasm: Gastric adenocarcinoma 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.
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC

15. Amyloid structure
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
Hepatocellular carcinoma
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />
Radiation exposure

16. Oncogenes
Tartrate - resistant acid phosphatase. Hairy cell leukemia -- a B- cell neoplasm. 'TRAP the hairy animal.'
Normal cells w/ basal --< apical differentiation <img src='220a.JPG' />
Gain of fxn --< cancer. Need damage to only 1 allele.
Protein = transthyretin Derived from AF (AF = old F ogies)

17. Leukocyte activation in inflammation
Breast - ovarian - and gastric carcinomas
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)
Amylin protein Derived from AE (AE = E ndocrine)
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.

18. Type of amyloid protein: Alzheimer's dz Protein? Derived from...?
Actinic keratosis
Gastric adenocarcinoma
Beta - amyloid Derived from amyloid precursor protein (APP)
Increase in # of cells. Reversible.

19. Type of amyloid protein: Senile cardiac Protein? Derived from...?
Protein = transthyretin Derived from AF (AF = old F ogies)
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
Liver (hepatocellular carcinoma)
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)

20. Things that initiate Free radical injury
Normal cells w/ basal --< apical differentiation <img src='220a.JPG' />
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
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
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.

21. Tumor grade
WT1
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
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.
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)

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

23. tumor: N euroblastoma What is the associated oncogene?
N - myc
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
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.
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)

24. Tumor nomenclature: Blood vessels What do you call a benign tumor of this tissue? .. a malignant one?
Benign: hemangioma Malignant: Angiosarcoma
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)

25. Neoplasm: Squamous cell carcinoma of the skin 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).
Protein = transthyretin Derived from AF (AF = old F ogies)
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
Actinic keratosis

26. Adult T- cell leukemia What is the assocciated oncogenic virus?
Barrett's esophagus (chronic GI reflux)
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' />
HTLV-1
Normal cells w/ basal --< apical differentiation <img src='220a.JPG' />

27. Metaplasia

28. Paraneoplastic effects of tumors: Renal cell carcinoma - hemangioblastoma Causes...? Effect?
Cells have invaded basement membrane using collagenases and hydrolases Can metastasize if they reach a blood or lymphatic vessel <img src='220d.JPG' />
C - kit
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)
Causes: Erythropoietin Effect: Polycythemia

29. Chemical carcinogens: Alkylating agents What is the affected organ?
Assoc: Neurofibromatosis 2 ('Type 2 = 22')
Blood (leukemia)
Membrane lipid peroxidation Protein modification DNA Breakage
Small cell lung carcinoma

30. Chronic inflammation
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' />
Hepatocellular carcinoma
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
Bladder (transitional cell carcinoma)

31. Characteristics of reversible cell injury
Leukemias and lymphomas
HTLV-1
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.
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change

32. Colorectal cancer (assoc w/ FAP) What is the tumor suppressor gene?
Skin (squamous cell carcinoma) Liver (angiosarcoma)
Cirrhosis (alcoholic - hepatitis B or C)
Membrane lipid peroxidation Protein modification DNA Breakage
APC

33. Tumor markers: Bombesin
Neuorblastoma - lung - and gastric cancer.
Assoc: Melanoma ('MelaN oma is N ine')
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.
Fibrous tissue formation in response to a neoplasm. Irreversible.

34. Granulomatous dz's

35. tumor: L ung tumor What is the associated oncogene?
Hepatocellular carcinoma
Thymoma - small cell lung carcinoma
L - myc
Metastases to bone - obstructive biliary dz - Paget's dz of bone.

36. Dz: Dysplastic nevus What is the associated neoplasm?
Malignant melanoma
Benign: Leiomyoma Malignant: Leiomyosarcoma
IL-8 C5a Leukotriene B4 Kallikrein
L ung tumor

37. Oncogene: c - kit Associated tumor?
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
Gastrointestinal stromal tumor (GIST)

38. Benign
Lung (mesothelioma and bronchogenic carcinoma)
C - kit
NF2
Usually well - differentiated - slow growing - well - demarcated - no metastasis.

39. Dz: Cirrhosis (alcoholic - hepatitis B or C) What is the associated neoplasm?
Hepatocellular carcinoma
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
Adult T- cell leukemia
Malignant melanoma

40. Causes: ADH Effect: SIADH What neoplasm would create this paraneoplastic effect?
Esophageal adenocarcinoma
Renal cell carcinoma - hemangioblastoma
Small cell lung carcinoma and intracranial neoplasms
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />

41. Tumor suppressor gene: BRCA1 chromosome? Associated tumor?
Assoc.: Breast and ovarian cancer
N euroblastoma
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome
Metastases to bone - obstructive biliary dz - Paget's dz of bone.

42. tumor: Gastrointestinal stromal tumor (GIST) What is the associated oncogene?
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.
HPV
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
C - kit

43. Type of amyloid protein: Dialysis - associated Protein? Derived from...?
Beta -2 microglobulin Derived from MHC class I proteins.
C - kit
Normal cells w/ basal --< apical differentiation <img src='220a.JPG' />
Assoc: Neurofibromatosis 2 ('Type 2 = 22')

44. Dz: Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants What is the associated neoplasm?
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation
Gastric adenocarcinoma
Benign: lipoma Malignant: liposarcoma
HBV - HCV

45. Type of amyloid protein: DM2 Protein? Derived from...?
Blood (leukemia)
Amylin protein Derived from AE (AE = E ndocrine)
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
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change

46. Neoplasm: All (we All fall Down ) AML With what dz is this associated?
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'
Lung (mesothelioma and bronchogenic carcinoma)
P 53
Down syndrome

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

48. Dz: Paget's dz of bone What is the associated neoplasm?
Prostate carcinoma.
Secondary osteosarcoma and fibrosarcoma
Increase in # of cells. Reversible.
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma

49. Septic shock
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Ret
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.
Assoc.: Retinoblastoma - osteosarcoma

50. Dz: Radiation exposure What is the associated neoplasm?
Sarcoma
Gastric adenocarcinoma
Malignant melanoma
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome