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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. Metaplasia

2. Dz: Down syndrome What is the associated neoplasm?
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' />
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy
Liver (centrilobular necrosis - fatty change)
All (we All fall Down ) AML

3. Dz: Actinic keratosis What is the associated neoplasm?
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
All (we All fall Down ) AML
Increase vascular permeability - vasodilation - endothelial injury.
Squamous cell carcinoma of the skin

4. Oncogene: bcl -2 Associated tumor?
NF2
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
The liver and lung are the most common sites of metastasis after regional LN's. Metastasis << primary liver tumors.
Follicular and undifferentiated lymphomas (inhibits apoptosis)

5. tumor: Multiple endocrine neoplasia (MEN) types II and III What is the associated oncogene?
Protein = transthyretin Derived from AF (AF = old F ogies)
Multiple endocrine neoplasia (MEN) types II and III
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors
Ret

6. Leukocyte activation in inflammation
Assoc: Melanoma ('MelaN oma is N ine')
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.

7. Neoplastic progression: step 1 Hyperplasia/dysplasia

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

9. tumor: Burkitt's lymphoma What is the associated oncogene?
C - myc
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability

10. Tumor suppressor gene: BRCA2 chromosome? Associated tumor?
Increase in # of cells. Reversible.
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
Assoc: breast cancer
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)

11. Apoptosis (definition)
Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis)
Programmed cell death; ATP required. Mediated by caspases.
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)

12. Malignant
C - kit
Assoc.: Breast and ovarian cancer
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.

13. Oncogenic viruses: HPV What is the associated cancer?
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)
C - kit
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention

14. [aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma What is the assocciated oncogenic virus?
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Assoc: Neurofibromatosis 2 ('Type 2 = 22')
HHV-8
Melanoma - neural tumors - astrocytomas.

15. Tumor nomenclature: Smooth muscle What do you call a benign tumor of this tissue? .. a malignant one?
APC
Usually stage < grade
Benign: Leiomyoma Malignant: Leiomyosarcoma
Assoc: Pancreatic cancer [DPC = D eleted in P ancreatic C ancer']

16. Dz: Acanthosis nigricans (hyperpigmentation and epidermal thickening) What is the associated neoplasm?
Visceral malignancy (stomach - lung - breast - uterus)
Assoc: breast cancer
P 16
Actinic keratosis

17. Metastasis to bone
BRCA1
N euroblastoma
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
Acanthosis nigricans (hyperpigmentation and epidermal thickening)

18. Hyperplasia
Squamous cell carcinoma of the skin
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />
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.
Increase in # of cells. Reversible.

19. Pancreatic cancer

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

21. Oncogene: ras Associated tumor?
N euroblastoma
Colon carcinoma
Erb - B2
Bladder (transitional cell carcinoma)

22. Neoplasm: Hepatocellular carcinoma With what dz is this associated?
Cirrhosis (alcoholic - hepatitis B or C)
Ovarian - malignant epithelial tumors
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' />
Adult T- cell leukemia

23. Type of amyloid protein: Medullary carcinoma of thyroid Protein? Derived from...?
Increase vascular permeability - vasodilation - endothelial injury.
Barrett's esophagus (chronic GI reflux)
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)

24. Tumor markers: Beta - hCG

25. Neoplasm: Malignant lymphomas With what dz is this associated?
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors
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
Immunodeficiency states
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.

26. Tumor nomenclature: Fat What do you call a benign tumor of this tissue? .. a malignant one?
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />
Benign: lipoma Malignant: liposarcoma

27. Tumor suppressor genes
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Xeroderma pigmentosum - albinism
Liver (hepatocellular carcinoma)
Fibroblast emigration and proliferation; deposition of ECM.

28. Neoplastic progression: step 4 Metastasis

29. Type of amyloid protein: Senile cardiac Protein? Derived from...?
Paget's dz of bone
AIDS
Gastrointestinal stromal tumor (GIST)
Protein = transthyretin Derived from AF (AF = old F ogies)

30. Granulomatous dz's

31. Dz: Ulcerative colitis What is the associated neoplasm?
Colonic adenocarcinoma
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors
C - myc
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma

32. Tumor suppressor gene: Rb chromosome? Associated tumor?
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
Assoc.: Retinoblastoma - osteosarcoma
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
Increase in # of cells. Reversible.

33. Cancer epidemiology: Lung cancer? As a cause of death overall?
Acanthosis nigricans (hyperpigmentation and epidermal thickening)
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)
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).

34. Neoplasm: Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma With what dz is this associated?
Actinic keratosis
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
HPV
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)

35. Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia What neoplasm would create this paraneoplastic effect?
Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma
Ulcerative colitis
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
Sarcoma

36. Neoplasia
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)
Malignant melanoma
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)

37. Fluid exudation in inflammation
Causes: Erythropoietin Effect: Polycythemia
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors
Increase vascular permeability - vasodilation - endothelial injury.
Assoc: Pancreatic cancer [DPC = D eleted in P ancreatic C ancer']

38. Tumor markers: Bombesin
Actinic keratosis
Neuorblastoma - lung - and gastric cancer.
Abl
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)

39. Dz: Paget's dz of bone What is the associated neoplasm?
APC
Secondary osteosarcoma and fibrosarcoma
P 16
NF1

40. Breast and ovarian cancer What is the tumor suppressor gene?
Renal cell carcinoma - hemangioblastoma
The liver and lung are the most common sites of metastasis after regional LN's. Metastasis << primary liver tumors.
Ret
BRCA1

41. Type of amyloid protein: Primary Protein? Derived from...?
Fibroblast emigration and proliferation; deposition of ECM.
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
Down syndrome
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)

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

43. Chemical carcinogens: Vinyl chloride What is the affected organ?
Liver (angiosarcoma)
Malignant lymphomas
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)

44. 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.
Burkitt's lymphoma nasopharyngeal carcinoma
Usually stage < grade
Assoc.: Breast and ovarian cancer

45. Wilms' tumor What is the tumor suppressor gene?
WT1
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
Ret
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.

46. Tumor grade
Liver (centrilobular necrosis - fatty change)
[aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma
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.
Small cell lung carcinoma

47. Tumor markers: CEA
Programmed cell death; ATP required. Mediated by caspases.
Breast - ovarian - and gastric carcinomas
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.
Rb

48. Chemical carcinogens: Alkylating agents What is the affected organ?
HBV - HCV
IL-8 C5a Leukotriene B4 Kallikrein
L - myc
Blood (leukemia)

49. Dz: Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis) What is the associated neoplasm?
Benign and malignant lymphomas
Gastric adenocarcinoma
Dysplastic nevus
Actinic keratosis

50. Things that initiate Free radical injury
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
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
Loss of fxn --< cancer; both allels must be lost for expression of dz.