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. Benign
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)
Breast - ovarian - and gastric carcinomas
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
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' />


2. Neoplasm: Squamous cell carcinoma of the skin With what dz is this associated?
Actinic keratosis
Leukemias and lymphomas
Colon carcinoma
Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome


3. Type of amyloid protein: DM2 Protein? Derived from...?
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)
Gastrointestinal stromal tumor (GIST)
Amylin protein Derived from AE (AE = E ndocrine)
EBV


4. Neoplastic progression: normal state - before anything goes wrong

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5. Necrosis (definition)
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
Enzymatic degradation of a cell resulting from exogenous injury.
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
Malignant lymphomas


6. Adult T- cell leukemia What is the assocciated oncogenic virus?
HTLV-1
Lung (mesothelioma and bronchogenic carcinoma)
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors
P 53


7. Characteristics of ex udate
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation
Fibroblast emigration and proliferation; deposition of ECM.
L - myc
Thymoma - small cell lung carcinoma


8. Metastasis to brain
Liver (centrilobular necrosis - fatty change)
Assoc: Neurofibromatosis type 1
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
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.


9. Dz: Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency) What is the associated neoplasm?
Squamous cell carcinoma of the skin
Squamous cell carcinoma of esophagus
Esophagus - stomach
Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome


10. Tumor nomenclature: Blood vessels What do you call a benign tumor of this tissue? .. a malignant one?
Gastrointestinal stromal tumor (GIST)
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.
Abl
Benign: hemangioma Malignant: Angiosarcoma


11. Dz: Barrett's esophagus (chronic GI reflux) What is the associated neoplasm?
Esophageal adenocarcinoma
HTLV-1
Benign and malignant lymphomas
WT1


12. Tumor markers: TRAP

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13. Apoptosis (definition)
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
Squamous cell carcinoma of esophagus
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
Programmed cell death; ATP required. Mediated by caspases.


14. Oncogene: c - kit Associated tumor?
Radiation exposure
Gastrointestinal stromal tumor (GIST)
Bladder (transitional cell carcinoma)
Adult T- cell leukemia


15. Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy What neoplasm would create this paraneoplastic effect?
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.
Leukemias and lymphomas
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
Esophagus - stomach


16. Desmoplasia
Fibrous tissue formation in response to a neoplasm. Irreversible.
BRCA2
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
Cells have invaded basement membrane using collagenases and hydrolases Can metastasize if they reach a blood or lymphatic vessel <img src='220d.JPG' />


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

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18. Chemical carcinogens: Arsenic What is the affected organ?
Benign: -- Malignant: Leukemia - lymphoma
CML
NF1
Skin (squamous cell carcinoma) Liver (angiosarcoma)


19. Characteristics of trans udate
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention
Prostate carcinoma.
Malignant lymphomas
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.


20. Chemical carcinogens: Naphthalene (aniline) dyes What is the affected organ?
Bladder (transitional cell carcinoma)
Assoc: Colorectal cancer (assoc w/ FAP)
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
Ret


21. Oncogene: c - myc Associated tumor?

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22. Diapedesis (step 3 in leukocyte extravasation)

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23. Fibrosis in inflammation
Fibroblast emigration and proliferation; deposition of ECM.
Malignant melanoma
Assoc: Pancreatic cancer [DPC = D eleted in P ancreatic C ancer']
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors


24. Oncogene: ret Associated tumor?
AIDS
Multiple endocrine neoplasia (MEN) types II and III
Colonic adenocarcinoma
Usually well - differentiated - slow growing - well - demarcated - no metastasis.


25. Retinoblastoma - osteosarcoma What is the tumor suppressor gene?
Squamous cell carcinoma of the skin
Rb
Programmed cell death; ATP required. Mediated by caspases.
Loss of fxn --< cancer; both allels must be lost for expression of dz.


26. Tumor suppressor gene: APC chromosome? Associated tumor?
Breast - ovarian - and gastric carcinomas
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' />
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
Assoc: Colorectal cancer (assoc w/ FAP)


27. Tumor suppressor gene: BRCA2 chromosome? Associated tumor?
Benign: lipoma Malignant: liposarcoma
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.
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'
Assoc: breast cancer


28. Dz: Paget's dz of bone What is the associated neoplasm?
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
Secondary osteosarcoma and fibrosarcoma
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
C - myc


29. Tumor markers: Bombesin
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.
Neuorblastoma - lung - and gastric cancer.
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
Beta -2 microglobulin Derived from MHC class I proteins.


30. Paraneoplastic effects of tumors: Renal cell carcinoma - hemangioblastoma Causes...? Effect?
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
Causes: Erythropoietin Effect: Polycythemia
Cirrhosis (alcoholic - hepatitis B or C)
C - kit


31. Chemical carcinogens: Alkylating agents What is the affected organ?
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' />
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
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.
Blood (leukemia)


32. Neurofibromatosis 2 ('Type 2 = 22') What is the tumor suppressor gene?
CML
Secondary osteosarcoma and fibrosarcoma
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
NF2


33. Malignant
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)
Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome
L - myc
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.


34. Migration (step 4 in leukocyte extravasation)

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35. tumor: Burkitt's lymphoma What is the associated oncogene?
Actinic keratosis
C - myc
Sarcoma
Melanoma - neural tumors - astrocytomas.


36. Neoplastic progression: step 3 Invasive carcinoma

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37. Chemical carcinogens: CCl4 What is the affected organ?
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin
Liver (centrilobular necrosis - fatty change)
Small cell lung carcinoma and intracranial neoplasms


38. Tumor grade
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.
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.
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' />


39. Septic shock
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation


40. Hepatocellular carcinoma What is the assocciated oncogenic virus?
C - kit
HBV - HCV
Beta -2 microglobulin Derived from MHC class I proteins.
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.


41. Breast and ovarian cancer What is the tumor suppressor gene?
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
Increase vascular permeability - vasodilation - endothelial injury.
C - myc
BRCA1


42. Oncogenes
Assoc: Pancreatic cancer [DPC = D eleted in P ancreatic C ancer']
Acanthosis nigricans (hyperpigmentation and epidermal thickening)
Causes: ADH Effect: SIADH
Gain of fxn --< cancer. Need damage to only 1 allele.


43. Tumor markers: Beta - hCG

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44. Neurofibromatosis type 1 What is the tumor suppressor gene?
[aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma
NF1
Metastases to bone - obstructive biliary dz - Paget's dz of bone.
C - myc


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

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46. TNM staging system
Tartrate - resistant acid phosphatase. Hairy cell leukemia -- a B- cell neoplasm. 'TRAP the hairy animal.'
Barrett's esophagus (chronic GI reflux)
Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome
T = size of T umor N = N ode involvement M = M etastases


47. Tumor nomenclature: Skeletal muscle What do you call a benign tumor of this tissue? .. a malignant one?
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
Assoc: Pancreatic cancer [DPC = D eleted in P ancreatic C ancer']
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
[aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma


48. Type of amyloid protein: Senile cardiac Protein? Derived from...?
Squamous cell carcinoma of esophagus
Assoc.: Retinoblastoma - osteosarcoma
NF2
Protein = transthyretin Derived from AF (AF = old F ogies)


49. Neoplasm: Gastric adenocarcinoma With what dz is this associated?
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
Xeroderma pigmentosum - albinism
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
Rb


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

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