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: Arsenic What is the affected organ?
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />
Assoc: Neurofibromatosis type 1
Skin (squamous cell carcinoma) Liver (angiosarcoma)


2. Characteristics of irreversible cell injury
CML
Assoc: Pancreatic cancer [DPC = D eleted in P ancreatic C ancer']
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)


3. Neoplastic progression: step 1 Hyperplasia/dysplasia

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4. Dz: Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis) What is the associated neoplasm?
Beta - amyloid Derived from amyloid precursor protein (APP)
Erb - B2
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'
Benign and malignant lymphomas


5. Things that initiate Free radical injury
Skin (squamous cell carcinoma) Liver (angiosarcoma)
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
Bladder (transitional cell carcinoma)
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)


6. Neoplasm: Gastric adenocarcinoma With what dz is this associated?
L ung tumor
Erb - B2
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.


7. When does apoptosis occur?
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)
EBV
Usually stage < grade
Cells have invaded basement membrane using collagenases and hydrolases Can metastasize if they reach a blood or lymphatic vessel <img src='220d.JPG' />


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

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9. Tumor grade
The liver and lung are the most common sites of metastasis after regional LN's. Metastasis << primary liver tumors.
Protein = transthyretin Derived from AF (AF = old F ogies)
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' />
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.


10. Tumor nomenclature: Skeletal muscle What do you call a benign tumor of this tissue? .. a malignant one?
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
HHV-8
Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis)
EBV


11. Colorectal cancer (assoc w/ FAP) What is the tumor suppressor gene?
APC
Hepatocellular carcinoma
Small cell lung carcinoma
Assoc: Neurofibromatosis type 1


12. Tumor markers: CEA
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
Increase in # of cells. Reversible.
Causes: Erythropoietin Effect: Polycythemia
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.


13. Dz: Dysplastic nevus What is the associated neoplasm?
BRCA2
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
Malignant melanoma
Burkitt's lymphoma nasopharyngeal carcinoma


14. Chemical carcinogens: Cigarette smoke What is the affected organ?
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)


15. Adult T- cell leukemia What is the assocciated oncogenic virus?
Squamous cell carcinoma of the skin
HTLV-1
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Colonic adenocarcinoma


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

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

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18. Neoplasm: Visceral malignancy (stomach - lung - breast - uterus) With what dz is this associated?
Malignant lymphomas
Renal cell carcinoma - hemangioblastoma
Acanthosis nigricans (hyperpigmentation and epidermal thickening)
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.


19. Which usually has more prognostic value - tumor stage or grade?
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.
Ras
Usually stage < grade
Assoc: Neurofibromatosis type 1


20. Paraneoplastic effects of tumors: Renal cell carcinoma - hemangioblastoma Causes...? Effect?
Immunodeficiency states
Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma
Ras
Causes: Erythropoietin Effect: Polycythemia


21. Neoplasm: Malignant melanoma With what dz is this associated?
Dysplastic nevus
BRCA2
Burkitt's lymphoma
Ulcerative colitis


22. Dz: Ulcerative colitis What is the associated neoplasm?
Colonic adenocarcinoma
Gain of fxn --< cancer. Need damage to only 1 allele.
C - kit
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.


23. Dz: Barrett's esophagus (chronic GI reflux) What is the associated neoplasm?
Metastases to bone - obstructive biliary dz - Paget's dz of bone.
Esophageal adenocarcinoma
Gain of fxn --< cancer. Need damage to only 1 allele.
Small cell lung carcinoma


24. Dz: AIDS What is the associated neoplasm?

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25. Wilms' tumor What is the tumor suppressor gene?
P 53
Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma
Loss of fxn --< cancer; both allels must be lost for expression of dz.
WT1


26. Neoplasm: Squamous cell carcinoma of the skin With what dz is this associated?
Benign: -- Malignant: Leukemia - lymphoma
Assoc: Colorectal cancer (assoc w/ FAP)
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
Actinic keratosis


27. Colon cancer
Cells have invaded basement membrane using collagenases and hydrolases Can metastasize if they reach a blood or lymphatic vessel <img src='220d.JPG' />
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
Cirrhosis (alcoholic - hepatitis B or C)
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability


28. Tumor suppressor gene: DCC chromosome? Associated tumor?
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Thymoma - small cell lung carcinoma
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


29. Oncogene: bcl -2 Associated tumor?
Actinic keratosis
Follicular and undifferentiated lymphomas (inhibits apoptosis)
Ras
Chr. 11p Assoc: Wilms' tumor


30. Characteristics of reversible cell injury
L ung tumor
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
Follicular and undifferentiated lymphomas (inhibits apoptosis)
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)


31. Fluid exudation in inflammation
Small cell lung carcinoma and intracranial neoplasms
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Increase vascular permeability - vasodilation - endothelial injury.
Follicular and undifferentiated lymphomas (inhibits apoptosis)


32. Oncogenic viruses: HBV - HCV What is the associated cancer?
Hepatocellular carcinoma
Liver (angiosarcoma)
NF2
Enzymatic degradation of a cell resulting from exogenous injury.


33. [aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma What is the assocciated oncogenic virus?
Beta -2 microglobulin Derived from MHC class I proteins.
Melanoma - neural tumors - astrocytomas.
HHV-8
Hepatocellular carcinoma


34. Chemical carcinogens: Nitrosamines (e.g. - in smoked foods) What is the affected organ?
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Esophagus - stomach
Actinic keratosis
Ret


35. Migration (step 4 in leukocyte extravasation)

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36. Dz: Tuberous sclerosis (facial angiofibroma - seizures - mental retardation) What is the associated neoplasm?
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
Xeroderma pigmentosum - albinism
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma
Increase vascular permeability - vasodilation - endothelial injury.


37. Metastasis to brain
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Normal cells w/ basal --< apical differentiation <img src='220a.JPG' />


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

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39. Tumor suppressor gene: BRCA1 chromosome? Associated tumor?
Adult T- cell leukemia
Causes: Erythropoietin Effect: Polycythemia
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.
Assoc.: Breast and ovarian cancer


40. Tumor markers: CA-125
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Ovarian - malignant epithelial tumors
Ulcerative colitis
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />


41. Primary tumors that metastasize to brain
Tartrate - resistant acid phosphatase. Hairy cell leukemia -- a B- cell neoplasm. 'TRAP the hairy animal.'
Bcl -2
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention
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.


42. Melanoma - What is the tumor suppressor gene?
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
P 16
Adult T- cell leukemia
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.


43. Characteristics of trans udate
AIDS
Barrett's esophagus (chronic GI reflux)
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention


44. Dz: Radiation exposure What is the associated neoplasm?
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
Sarcoma
Skin (squamous cell carcinoma) Liver (angiosarcoma)


45. Retinoblastoma - osteosarcoma What is the tumor suppressor gene?
Rb
Membrane lipid peroxidation Protein modification DNA Breakage
Hepatocellular carcinoma
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.


46. How should tumor markers be used clinically?
CML
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
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.
Colonic adenocarcinoma


47. Psammoma bodies
Leukemias and lymphomas
Small cell lung carcinoma and intracranial neoplasms
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
Fibroblast emigration and proliferation; deposition of ECM.


48. Chemical carcinogens: Vinyl chloride What is the affected organ?
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.
T = size of T umor N = N ode involvement M = M etastases
Liver (angiosarcoma)
Liver (hepatocellular carcinoma)


49. Septic shock
N euroblastoma
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia
Cells have invaded basement membrane using collagenases and hydrolases Can metastasize if they reach a blood or lymphatic vessel <img src='220d.JPG' />
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.


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

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