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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. Oncogene: N - myc Associated tumor?
Small cell lung carcinoma and intracranial neoplasms
Programmed cell death; ATP required. Mediated by caspases.
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia
N euroblastoma

2. Granulomatous dz's

3. 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)
Enzymatic degradation of a cell resulting from exogenous injury.
L - myc
All (we All fall Down ) AML

4. Pancreatic cancer

5. Metastasis to liver

6. Tumor suppressor gene: BRCA1 chromosome? Associated tumor?
Assoc.: Breast and ovarian cancer
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
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
Colonic adenocarcinoma

7. Psammoma bodies
Fibrous tissue formation in response to a neoplasm. Irreversible.
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
Rb
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.

8. Male cancer epidemiology (incidence - mortality)
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Ovarian - malignant epithelial tumors
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.

9. Oncogene: bcl -2 Associated tumor?
Follicular and undifferentiated lymphomas (inhibits apoptosis)
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.
Cells have increased in # (hyperplasia ) Abnormal proliferation of cells w/ loss of size - shape - and orientation (dysplasia ) <img src='220b.JPG' />
Liver (hepatocellular carcinoma)

10. breast cancer What is the tumor suppressor gene?
Chr. 11p Assoc: Wilms' tumor
BRCA2
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)

11. Tumor nomenclature: < 1 cell type What do you call a benign tumor of this tissue? .. a malignant one?
Gastric adenocarcinoma
Melanoma - neural tumors - astrocytomas.
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
C - myc

12. Dz: Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis) What is the associated neoplasm?
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
Benign and malignant lymphomas
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />
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.

13. Neoplasm: Colonic adenocarcinoma With what dz is this associated?
IL-8 C5a Leukotriene B4 Kallikrein
Ulcerative colitis
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.
Erb - B2

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

15. Dz: Tuberous sclerosis (facial angiofibroma - seizures - mental retardation) What is the associated neoplasm?
Assoc.: Breast and ovarian cancer
Melanoma - neural tumors - astrocytomas.
Immunodeficiency states
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma

16. Causes: ADH Effect: SIADH What neoplasm would create this paraneoplastic effect?
Benign and malignant lymphomas
Small cell lung carcinoma and intracranial neoplasms
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)
Liver (angiosarcoma)

17. Neoplastic progression: step 2 In situ carcinoma

18. Chemical carcinogens: Nitrosamines (e.g. - in smoked foods) What is the affected organ?
Erb - B2
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
Melanoma - neural tumors - astrocytomas.
Esophagus - stomach

19. tumor: Gastrointestinal stromal tumor (GIST) What is the associated oncogene?
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
C - kit
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability

20. Which usually has more prognostic value - tumor stage or grade?
Usually stage < grade
Visceral malignancy (stomach - lung - breast - uterus)
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
The liver and lung are the most common sites of metastasis after regional LN's. Metastasis << primary liver tumors.

21. Oncogene: c - kit Associated tumor?
Multiple endocrine neoplasia (MEN) types II and III
WT1
L ung tumor
Gastrointestinal stromal tumor (GIST)

22. Neoplastic progression: step 3 Invasive carcinoma

23. Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness) What neoplasm would create this paraneoplastic effect?
Thymoma - small cell lung carcinoma
Colonic adenocarcinoma
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%)

24. Tumor nomenclature: Blood vessels What do you call a benign tumor of this tissue? .. a malignant one?
Barrett's esophagus (chronic GI reflux)
Benign: hemangioma Malignant: Angiosarcoma
IL-8 C5a Leukotriene B4 Kallikrein
Membrane lipid peroxidation Protein modification DNA Breakage

25. Characteristics of reversible cell injury
T = size of T umor N = N ode involvement M = M etastases
Beta -2 microglobulin Derived from MHC class I proteins.
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
Benign: lipoma Malignant: liposarcoma

26. Dysplasia
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
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.
Small cell lung carcinoma and intracranial neoplasms

27. Chemical carcinogens: Aflatoxins (produced by Aspergillus) What is the affected organ?
Enzymatic degradation of a cell resulting from exogenous injury.
Liver (hepatocellular carcinoma)
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
Immunodeficiency states

28. Chronic inflammation
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
Paget's dz of bone
Benign: lipoma Malignant: liposarcoma
Follicular and undifferentiated lymphomas (inhibits apoptosis)

29. Desmoplasia
Fibrous tissue formation in response to a neoplasm. Irreversible.
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'
Benign: lipoma Malignant: liposarcoma
Burkitt's lymphoma

30. Tumor suppressor genes
Melanoma - neural tumors - astrocytomas.
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
Benign and malignant lymphomas

31. Characteristics of trans udate
N euroblastoma
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
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention
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.

32. Dz: Xeroderma pigmentosum - albinism What is the associated neoplasm?
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin
Causes: Erythropoietin Effect: Polycythemia
BRCA1
Assoc.: Retinoblastoma - osteosarcoma

33. Substances that are chemotactic for neutrophils
C - kit
IL-8 C5a Leukotriene B4 Kallikrein
CML
Assoc.: Retinoblastoma - osteosarcoma

34. Oncogene: ras Associated tumor?
Colon carcinoma
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.
Lung (mesothelioma and bronchogenic carcinoma)

35. Primary tumors that metasize to bone

36. Paraneoplastic effects of tumors: Small cell lung carcinoma Causes...? Effect?

37. Metastasis to bone
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
APC
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.

38. Burkitt's lymphoma nasopharyngeal carcinoma What is the assocciated oncogenic virus?
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
EBV
Squamous cell carcinoma of the skin
Enzymatic degradation of a cell resulting from exogenous injury.

39. Tumor markers: Prostatic acid phospatase
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.
[aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />
Prostate carcinoma.

40. Tumor nomenclature: Smooth muscle What do you call a benign tumor of this tissue? .. a malignant one?
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
Benign: Leiomyoma Malignant: Leiomyosarcoma
C - kit
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.

41. Tumor markers: PSA
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin
Hepatocellular carcinoma
Benign and malignant lymphomas
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.

42. Leukocyte activation in inflammation
Ulcerative colitis
Renal cell carcinoma - hemangioblastoma
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.
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.

43. Fibrosis in inflammation
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Bcl -2
Colon carcinoma
Fibroblast emigration and proliferation; deposition of ECM.

44. Tumor grade
Cells have invaded basement membrane using collagenases and hydrolases Can metastasize if they reach a blood or lymphatic vessel <img src='220d.JPG' />
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
BRCA1
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.

45. Neoplasm: Sarcoma With what dz is this associated?
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.
Renal cell carcinoma - hemangioblastoma
Radiation exposure

46. Apoptosis is characterized by...?
T = size of T umor N = N ode involvement M = M etastases
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
Metastases to bone - obstructive biliary dz - Paget's dz of bone.
Esophageal adenocarcinoma

47. Female cancer epidemiology (incidence - mortality)
Fibrous tissue formation in response to a neoplasm. Irreversible.
Small cell lung carcinoma
Squamous cell carcinoma of the skin
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)

48. Tumor suppressor gene: p 16 chromosome? Associated tumor?

49. Colorectal cancer (assoc w/ FAP) What is the tumor suppressor gene?
Beta - amyloid Derived from amyloid precursor protein (APP)
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
Assoc: Colorectal cancer (assoc w/ FAP)
APC

50. Oncogene: L - myc Associated tumor?
L ung tumor
Assoc: Neurofibromatosis type 1
Down syndrome
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)