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. Neoplasia
Acanthosis nigricans (hyperpigmentation and epidermal thickening)
Burkitt's lymphoma
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
CML


2. Oncogene: L - myc Associated tumor?
Amylin protein Derived from AE (AE = E ndocrine)
L ung tumor
Causes: ADH Effect: SIADH
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.


3. Tumor markers: Bombesin
Fibrous tissue formation in response to a neoplasm. Irreversible.
Bladder (transitional cell carcinoma)
Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis)
Neuorblastoma - lung - and gastric cancer.


4. Free radical injury induces cell injury thru...?
[DPC = D eleted in P ancreatic C ancer'] What is the tumor suppressor gene? DPC
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)
Membrane lipid peroxidation Protein modification DNA Breakage
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.


5. Dz: Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency) What is the associated neoplasm?
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
Squamous cell carcinoma of esophagus
Bladder (transitional cell carcinoma)
Gain of fxn --< cancer. Need damage to only 1 allele.


6. Dz: Radiation exposure What is the associated neoplasm?
Sarcoma
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)
BRCA2
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.


7. Oncogene: ret Associated tumor?
Burkitt's lymphoma nasopharyngeal carcinoma
Abl
Squamous cell carcinoma of esophagus
Multiple endocrine neoplasia (MEN) types II and III


8. Hyperplasia
Hepatocellular carcinoma
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.
Increase in # of cells. Reversible.
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin


9. Colorectal cancer (assoc w/ FAP) What is the tumor suppressor gene?
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
[aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma
Enzymatic degradation of a cell resulting from exogenous injury.
APC


10. Dz: Down syndrome What is the associated neoplasm?
All (we All fall Down ) AML
Assoc.: Breast and ovarian cancer
Assoc: breast cancer
Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome


11. Neoplasm: Malignant lymphomas With what dz is this associated?
All (we All fall Down ) AML
BRCA1
[DPC = D eleted in P ancreatic C ancer'] What is the tumor suppressor gene? DPC
Immunodeficiency states


12. Desmoplasia
Bladder (transitional cell carcinoma)
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.
C - kit
Fibrous tissue formation in response to a neoplasm. Irreversible.


13. Tumor nomenclature: Smooth muscle What do you call a benign tumor of this tissue? .. a malignant one?
Skin (squamous cell carcinoma) Liver (angiosarcoma)
Squamous cell carcinoma of the skin
Protein = transthyretin Derived from AF (AF = old F ogies)
Benign: Leiomyoma Malignant: Leiomyosarcoma


14. Paraneoplastic effects of tumors: Leukemias and lymphomas Causes...? Effect?
Liver (hepatocellular carcinoma)
Fibroblast emigration and proliferation; deposition of ECM.
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.
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy


15. Tumor suppressor gene: BRCA2 chromosome? Associated tumor?
C - kit
Malignant melanoma
Assoc: breast cancer
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.


16. Tumor markers: CA-125
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' />
Renal cell carcinoma - hemangioblastoma
Ovarian - malignant epithelial tumors
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


17. Tumor markers: alpha - fetoprotein
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'
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.
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
All (we All fall Down ) AML


18. Tumor suppressor gene: BRCA1 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).
Assoc.: Breast and ovarian cancer
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
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.


19. Type of amyloid protein: Medullary carcinoma of thyroid Protein? Derived from...?
Squamous cell carcinoma of esophagus
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia
Melanoma - neural tumors - astrocytomas.


20. tumor: Burkitt's lymphoma What is the associated oncogene?
WT1
Cells have increased in # (hyperplasia ) Abnormal proliferation of cells w/ loss of size - shape - and orientation (dysplasia ) <img src='220b.JPG' />
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.
C - myc


21. Tumor markers: Prostatic acid phospatase
[aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma
Prostate carcinoma.
Pancreatic adenocarcinoma
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


22. Oncogenic viruses: HTLV-1 What is the associated cancer?
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
Adult T- cell leukemia
Benign: hemangioma Malignant: Angiosarcoma
Squamous cell carcinoma of the skin


23. Wilms' tumor What is the tumor suppressor gene?
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'
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
Follicular and undifferentiated lymphomas (inhibits apoptosis)
WT1


24. Tumor stage

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25. Psammoma bodies
Visceral malignancy (stomach - lung - breast - uterus)
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
Adult T- cell leukemia
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.


26. Paraneoplastic effects of tumors: Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma Causes...? Effect?
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia
Increase in # of cells. Reversible.
Multiple endocrine neoplasia (MEN) types II and III
Assoc: Melanoma ('MelaN oma is N ine')


27. tumor: L ung tumor What is the associated oncogene?
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
Skin (squamous cell carcinoma) Liver (angiosarcoma)
L - myc
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


28. Neoplasm: Hepatocellular carcinoma With what dz is this associated?
EBV
Liver (centrilobular necrosis - fatty change)
Cirrhosis (alcoholic - hepatitis B or C)
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)


29. Chemical carcinogens: Asbestos What is the affected organ?
Lung (mesothelioma and bronchogenic carcinoma)
CML
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.
Bladder (transitional cell carcinoma)


30. Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia What neoplasm would create this paraneoplastic effect?
Ulcerative colitis
P 53
Membrane lipid peroxidation Protein modification DNA Breakage
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma


31. Tumor nomenclature: Fat What do you call a benign tumor of this tissue? .. a malignant one?
HHV-8
NF2
Fibrous tissue formation in response to a neoplasm. Irreversible.
Benign: lipoma Malignant: liposarcoma


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

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33. Tumor markers: TRAP

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34. Oncogene: bcl -2 Associated tumor?
Melanoma - neural tumors - astrocytomas.
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Benign: hemangioma Malignant: Angiosarcoma
Follicular and undifferentiated lymphomas (inhibits apoptosis)


35. Causes: ADH Effect: SIADH What neoplasm would create this paraneoplastic effect?
Increase vascular permeability - vasodilation - endothelial injury.
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.
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Small cell lung carcinoma and intracranial neoplasms


36. Type of amyloid protein: Alzheimer's dz Protein? Derived from...?
Beta - amyloid Derived from amyloid precursor protein (APP)
Protein = transthyretin Derived from AF (AF = old F ogies)
Assoc: breast cancer
Follicular and undifferentiated lymphomas (inhibits apoptosis)


37. Neurofibromatosis 2 ('Type 2 = 22') What is the tumor suppressor gene?
Sarcoma
NF2
Blood (leukemia)
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />


38. Neoplasm: Squamous cell carcinoma of the skin With what dz is this associated?
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
Liver (centrilobular necrosis - fatty change)
Benign and malignant lymphomas
Actinic keratosis


39. Hepatocellular carcinoma What is the assocciated oncogenic virus?
N euroblastoma
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia
HBV - HCV
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)


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

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41. Tumor grade
Tartrate - resistant acid phosphatase. Hairy cell leukemia -- a B- cell neoplasm. 'TRAP the hairy animal.'
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
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.
Prostate carcinoma.


42. Tumor suppressor genes
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Metastases to bone - obstructive biliary dz - Paget's dz of bone.
Bladder (transitional cell carcinoma)
Benign and malignant lymphomas


43. Chronic inflammation
P 53
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
Hepatocellular carcinoma


44. Tumor suppressor gene: DCC chromosome? Associated tumor?
Chr. 11p Assoc: Wilms' tumor
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Visceral malignancy (stomach - lung - breast - uterus)
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma


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

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46. Neurofibromatosis type 1 What is the tumor suppressor gene?
Erb - B2
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
NF1
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.


47. Neoplasm: Sarcoma With what dz is this associated?
Radiation exposure
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.
Causes: Erythropoietin Effect: Polycythemia
Lung (mesothelioma and bronchogenic carcinoma)


48. Apoptosis is characterized by...?
Burkitt's lymphoma
Liver (hepatocellular carcinoma)
N euroblastoma
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


49. Neoplasm: Squamous cell carcinoma of esophagus With what dz is this associated?
Bcl -2
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)
Xeroderma pigmentosum - albinism
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)


50. Which usually has more prognostic value - tumor stage or grade?
Pancreatic adenocarcinoma
Protein = transthyretin Derived from AF (AF = old F ogies)
Usually stage < grade
Renal cell carcinoma - hemangioblastoma