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. Pancreatic cancer

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

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3. Oncogenic viruses: HPV What is the associated cancer?
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
BRCA2
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Lung (mesothelioma and bronchogenic carcinoma)


4. most human cancers - Li - Fraumeni syndrome What is the tumor suppressor gene?
Prostate carcinoma.
Blood (leukemia)
P 53
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


5. Tumor grade
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
HBV - HCV
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
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.


6. Substances that are chemotactic for neutrophils
Small cell lung carcinoma
IL-8 C5a Leukotriene B4 Kallikrein
Cells have invaded basement membrane using collagenases and hydrolases Can metastasize if they reach a blood or lymphatic vessel <img src='220d.JPG' />
Prostate carcinoma.


7. Chemical carcinogens: CCl4 What is the affected organ?
The liver and lung are the most common sites of metastasis after regional LN's. Metastasis << primary liver tumors.
Liver (centrilobular necrosis - fatty change)
Small cell lung carcinoma and intracranial neoplasms
Rb


8. Neoplasm: Squamous cell carcinoma of the skin With what dz is this associated?
Actinic keratosis
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.
Cells have increased in # (hyperplasia ) Abnormal proliferation of cells w/ loss of size - shape - and orientation (dysplasia ) <img src='220b.JPG' />


9. Tumor suppressor gene: BRCA2 chromosome? Associated tumor?
Squamous cell carcinoma of the skin
Assoc: breast cancer
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.
BRCA1


10. Dz: Barrett's esophagus (chronic GI reflux) What is the associated neoplasm?
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'
Assoc: Neurofibromatosis 2 ('Type 2 = 22')
Esophageal adenocarcinoma


11. Characteristics of irreversible cell injury
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
Esophagus - stomach
Assoc: Neurofibromatosis type 1
Normal cells w/ basal --< apical differentiation <img src='220a.JPG' />


12. Primary tumors that metastasize to brain
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.
Liver (angiosarcoma)
Gastrointestinal stromal tumor (GIST)


13. Tumor suppressor gene: NF1 chromosome? Associated tumor?
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: Osteoma Malignant: osteosarcoma
Assoc: Neurofibromatosis type 1
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.


14. 5 Characteristic signs of inflammation
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.
Liver (angiosarcoma)
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma


15. tumor: N euroblastoma What is the associated oncogene?
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
HHV-8
N - myc
C - myc


16. Granulomatous dz's

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17. Characteristics of reversible cell injury
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
Usually stage < grade
Liver (angiosarcoma)


18. Tumor nomenclature: Blood cells What do you call a benign tumor of this tissue? .. a malignant one?
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
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.
Neuorblastoma - lung - and gastric cancer.
Benign: -- Malignant: Leukemia - lymphoma


19. Tumor nomenclature: Skeletal muscle What do you call a benign tumor of this tissue? .. a malignant one?
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.
Assoc: Melanoma ('MelaN oma is N ine')
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)


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

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

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22. Neoplasm: Malignant lymphomas With what dz is this associated?
Barrett's esophagus (chronic GI reflux)
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin
Immunodeficiency states
Benign: Osteoma Malignant: osteosarcoma


23. Tight binding (step 2 of leukocyte extravasation)

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24. Neoplasm: Visceral malignancy (stomach - lung - breast - uterus) With what dz is this associated?
Assoc: Neurofibromatosis 2 ('Type 2 = 22')
Acanthosis nigricans (hyperpigmentation and epidermal thickening)
Assoc: breast cancer
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)


25. Dz: Cirrhosis (alcoholic - hepatitis B or C) What is the associated neoplasm?
Assoc: Neurofibromatosis type 1
Hepatocellular carcinoma
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />
BRCA1


26. Chemical carcinogens: Aflatoxins (produced by Aspergillus) What is the affected organ?
Liver (hepatocellular carcinoma)
Fibrous tissue formation in response to a neoplasm. Irreversible.
Malignant lymphomas
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy


27. Paraneoplastic effects of tumors: Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma Causes...? Effect?
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma


28. Dz: Tuberous sclerosis (facial angiofibroma - seizures - mental retardation) What is the associated neoplasm?
Cirrhosis (alcoholic - hepatitis B or C)
Ulcerative colitis
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)


29. Melanoma - What is the tumor suppressor gene?
Metastases to bone - obstructive biliary dz - Paget's dz of bone.
P 16
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)


30. Fluid exudation in inflammation
Malignant melanoma
P 16
Increase vascular permeability - vasodilation - endothelial injury.
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome


31. Neoplasm: Colonic adenocarcinoma With what dz is this associated?
Cells have invaded basement membrane using collagenases and hydrolases Can metastasize if they reach a blood or lymphatic vessel <img src='220d.JPG' />
Ulcerative colitis
Visceral malignancy (stomach - lung - breast - uterus)
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)


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

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33. Free radical injury induces cell injury thru...?
Membrane lipid peroxidation Protein modification DNA Breakage
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Gastric adenocarcinoma
Small cell lung carcinoma and intracranial neoplasms


34. tumor: Multiple endocrine neoplasia (MEN) types II and III What is the associated oncogene?
Membrane lipid peroxidation Protein modification DNA Breakage
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Ret
Esophagus - stomach


35. Burkitt's lymphoma nasopharyngeal carcinoma What is the assocciated oncogenic virus?
N euroblastoma
Membrane lipid peroxidation Protein modification DNA Breakage
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' />
EBV


36. Metastasis to brain
Paget's dz of bone
Down syndrome
WT1
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.


37. Tumor suppressor gene: p 53 chromosome? Associated tumor?
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome
Blood (leukemia)
Neuorblastoma - lung - and gastric cancer.
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin


38. Tumor suppressor gene: BRCA1 chromosome? Associated tumor?
Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma
Assoc.: Breast and ovarian cancer
Normal cells w/ basal --< apical differentiation <img src='220a.JPG' />
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)


39. Septic shock
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
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.


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

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41. Paraneoplastic effects of tumors: Small cell lung carcinoma and intracranial neoplasms Causes...? Effect?
Assoc: Colorectal cancer (assoc w/ FAP)
Assoc.: Breast and ovarian cancer
Causes: ADH Effect: SIADH
Radiation exposure


42. Neoplastic progression: step 3 Invasive carcinoma

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43. Neoplastic progression: step 2 In situ carcinoma

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44. Causes: Erythropoietin Effect: Polycythemia What neoplasm would create this paraneoplastic effect?
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' />
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)
Renal cell carcinoma - hemangioblastoma


45. Migration (step 4 in leukocyte extravasation)

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46. [aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma What is the assocciated oncogenic virus?
Assoc: Melanoma ('MelaN oma is N ine')
HHV-8
Protein = transthyretin Derived from AF (AF = old F ogies)
Visceral malignancy (stomach - lung - breast - uterus)


47. Cancer epidemiology: Lung cancer? As a cause of death overall?
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
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).
IL-8 C5a Leukotriene B4 Kallikrein
Hepatocellular carcinoma


48. Chemical carcinogens: Arsenic What is the affected organ?
Skin (squamous cell carcinoma) Liver (angiosarcoma)
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
Burkitt's lymphoma nasopharyngeal carcinoma
Liver (angiosarcoma)


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

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

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