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. Psammoma bodies
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).
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
The liver and lung are the most common sites of metastasis after regional LN's. Metastasis << primary liver tumors.
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.


2. Male cancer epidemiology (incidence - mortality)
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
Neuorblastoma - lung - and gastric cancer.
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)


3. Tumor markers: Prostatic acid phospatase
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
Pancreatic adenocarcinoma
HBV - HCV
Prostate carcinoma.


4. Tumor markers: CA-125
HHV-8
NF1
Ovarian - malignant epithelial tumors
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.


5. Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia What neoplasm would create this paraneoplastic effect?
Beta - amyloid Derived from amyloid precursor protein (APP)
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
Increase in # of cells. Reversible.
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.


6. Fibrosis in inflammation
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.
Fibroblast emigration and proliferation; deposition of ECM.
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Ovarian - malignant epithelial tumors


7. Characteristics of ex udate
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)
Hepatocellular carcinoma
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation
Immunodeficiency states


8. Apoptosis is characterized by...?
HHV-8
Protein = transthyretin Derived from AF (AF = old F ogies)
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
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)


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

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10. Tumor nomenclature: Skeletal muscle What do you call a benign tumor of this tissue? .. a malignant one?
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.
[DPC = D eleted in P ancreatic C ancer'] What is the tumor suppressor gene? DPC
Enzymatic degradation of a cell resulting from exogenous injury.
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma


11. Carcinoma vs. sarcoma
NF1
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
Xeroderma pigmentosum - albinism
Benign: lipoma Malignant: liposarcoma


12. Paraneoplastic effects of tumors: Leukemias and lymphomas Causes...? Effect?
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)


13. Chemical carcinogens: Arsenic What is the affected organ?
Increase in # of cells. Reversible.
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Skin (squamous cell carcinoma) Liver (angiosarcoma)
BRCA2


14. Free radical injury induces cell injury thru...?
Membrane lipid peroxidation Protein modification DNA Breakage
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia
Squamous cell carcinoma of esophagus


15. Dz: Acanthosis nigricans (hyperpigmentation and epidermal thickening) What is the associated neoplasm?
Visceral malignancy (stomach - lung - breast - uterus)
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome


16. Retinoblastoma - osteosarcoma What is the tumor suppressor gene?
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)
Rb
Tartrate - resistant acid phosphatase. Hairy cell leukemia -- a B- cell neoplasm. 'TRAP the hairy animal.'


17. Apoptosis (definition)
Burkitt's lymphoma
Programmed cell death; ATP required. Mediated by caspases.
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.
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma


18. Things that initiate Free radical injury
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
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
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


19. Tumor suppressor gene: APC chromosome? Associated tumor?
L - myc
Metastases to bone - obstructive biliary dz - Paget's dz of bone.
Assoc: Colorectal cancer (assoc w/ FAP)
Hepatocellular carcinoma


20. Oncogenic viruses: HPV What is the associated cancer?
APC
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Assoc: Pancreatic cancer [DPC = D eleted in P ancreatic C ancer']
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation


21. Paraneoplastic effects of tumors: Renal cell carcinoma - hemangioblastoma Causes...? Effect?
Colon carcinoma
Cells have invaded basement membrane using collagenases and hydrolases Can metastasize if they reach a blood or lymphatic vessel <img src='220d.JPG' />
Causes: Erythropoietin Effect: Polycythemia
Rb


22. Tumor nomenclature: Bone What do you call a benign tumor of this tissue? .. a malignant one?
Benign: Osteoma Malignant: osteosarcoma
Skin (squamous cell carcinoma) Liver (angiosarcoma)
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors


23. Dysplasia
Increase in # of cells. Reversible.
L ung tumor
Gastric adenocarcinoma
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.


24. Oncogene: N - myc Associated tumor?
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
Fibroblast emigration and proliferation; deposition of ECM.
N euroblastoma
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.


25. Free radical degradation
BRCA1
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
N - myc
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.


26. Chemical carcinogens: CCl4 What is the affected organ?
Liver (centrilobular necrosis - fatty change)
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Multiple endocrine neoplasia (MEN) types II and III
BRCA1


27. Oncogene: c - myc Associated tumor?

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28. Adult T- cell leukemia What is the assocciated oncogenic virus?
HTLV-1
Liver (hepatocellular carcinoma)
Breast - ovarian - and gastric carcinomas
Assoc: Neurofibromatosis type 1


29. tumor: Colon carcinoma What is the associated oncogene?
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'
Ras
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
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.


30. Dz: Radiation exposure What is the associated neoplasm?
HPV
Sarcoma
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.
Benign: Leiomyoma Malignant: Leiomyosarcoma


31. Migration (step 4 in leukocyte extravasation)

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32. Which usually has more prognostic value - tumor stage or grade?
Hepatocellular carcinoma
Membrane lipid peroxidation Protein modification DNA Breakage
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.
Usually stage < grade


33. Tumor suppressor gene: DCC chromosome? Associated tumor?
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).
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
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]


34. Neoplastic progression: step 4 Metastasis

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35. Chemical carcinogens: Asbestos What is the affected organ?
Lung (mesothelioma and bronchogenic carcinoma)
Xeroderma pigmentosum - albinism
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.
Benign: Leiomyoma Malignant: Leiomyosarcoma


36. Necrosis morphologies
HBV - HCV
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
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)


37. Tumor markers: PSA
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
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.
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.


38. Breast and ovarian cancer What is the tumor suppressor gene?
AIDS
BRCA1
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention


39. tumor: Multiple endocrine neoplasia (MEN) types II and III What is the associated oncogene?
C - kit
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
Ret
Follicular and undifferentiated lymphomas (inhibits apoptosis)


40. Dz: Cirrhosis (alcoholic - hepatitis B or C) What is the associated neoplasm?
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
Sarcoma
Hepatocellular carcinoma
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' />


41. tumor: Breast - ovarian - and gastric carcinomas What is the associated oncogene?
Beta - amyloid Derived from amyloid precursor protein (APP)
Dysplastic nevus
Erb - B2
Sarcoma


42. Anaplasia
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.
Bcl -2
Benign: Osteoma Malignant: osteosarcoma
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability


43. Metastasis to bone
Melanoma - neural tumors - astrocytomas.
Enzymatic degradation of a cell resulting from exogenous injury.
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 ICAM -1 on vascular endothelium binding to LFA-1 (integrin) on the leukocyte ('Hold on tight to your CAM era') <img src='218a.JPG' />


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

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45. Neoplasm: Sarcoma With what dz is this associated?
Radiation exposure
Benign: Leiomyoma Malignant: Leiomyosarcoma
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
Benign: hemangioma Malignant: Angiosarcoma


46. Dz: Barrett's esophagus (chronic GI reflux) What is the associated neoplasm?
Esophageal adenocarcinoma
Benign and malignant lymphomas
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)
APC


47. Female cancer epidemiology (incidence - mortality)
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)
Erb - B2


48. Chemical carcinogens: Cigarette smoke What is the affected organ?
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors
Beta - amyloid Derived from amyloid precursor protein (APP)
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)
Normal cells w/ basal --< apical differentiation <img src='220a.JPG' />


49. Dz: Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis) What is the associated neoplasm?
Colon carcinoma
Benign and malignant lymphomas
Ovarian - malignant epithelial tumors
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' />


50. Neoplasm: Malignant lymphomas With what dz is this associated?
AIDS
Breast - ovarian - and gastric carcinomas
Immunodeficiency states
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)