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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. Tumor suppressor gene: NF1 chromosome? Associated tumor?
Squamous cell carcinoma of the skin
Assoc: Neurofibromatosis type 1
Ras
Liver (hepatocellular carcinoma)

2. Dz: Paget's dz of bone What is the associated neoplasm?
Secondary osteosarcoma and fibrosarcoma
Gastrointestinal stromal tumor (GIST)
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />
Benign: Leiomyoma Malignant: Leiomyosarcoma

3. Which usually has more prognostic value - tumor stage or grade?
Pancreatic adenocarcinoma
Burkitt's lymphoma
NF1
Usually stage < grade

4. Metastasis to bone
Assoc: Neurofibromatosis type 1
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.

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

6. Migration (step 4 in leukocyte extravasation)

7. Neoplasm: Malignant melanoma With what dz is this associated?
Dysplastic nevus
Squamous cell carcinoma of esophagus
Renal cell carcinoma - hemangioblastoma
Benign and malignant lymphomas

8. Hypovolemic/cardiogenic shock
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)
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
Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.

9. Tumor markers: CA-19-9
Follicular and undifferentiated lymphomas (inhibits apoptosis)
Programmed cell death; ATP required. Mediated by caspases.
Pancreatic adenocarcinoma
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)

10. Tumor nomenclature: Smooth muscle What do you call a benign tumor of this tissue? .. a malignant one?
Liver (hepatocellular carcinoma)
Causes: Erythropoietin Effect: Polycythemia
Adult T- cell leukemia
Benign: Leiomyoma Malignant: Leiomyosarcoma

11. Tumor markers: PSA
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
HHV-8
Assoc.: Breast and ovarian cancer
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.

12. Chronic inflammation
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
Rb
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.

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

14. Chemical carcinogens: Aflatoxins (produced by Aspergillus) What is the affected organ?
Programmed cell death; ATP required. Mediated by caspases.
All (we All fall Down ) AML
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
Liver (hepatocellular carcinoma)

15. Fluid exudation in inflammation
Increase vascular permeability - vasodilation - endothelial injury.
HPV
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.
Cells have invaded basement membrane using collagenases and hydrolases Can metastasize if they reach a blood or lymphatic vessel <img src='220d.JPG' />

16. Tumor markers: CEA
Beta - amyloid Derived from amyloid precursor protein (APP)
Down syndrome
Leukemias and lymphomas
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.

17. Tumor markers: CA-125
Small cell lung carcinoma and intracranial neoplasms
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Ovarian - malignant epithelial tumors

18. tumor: Gastrointestinal stromal tumor (GIST) What is the associated oncogene?
Bladder (transitional cell carcinoma)
Causes: ADH Effect: SIADH
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
C - kit

19. Dz: Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency) What is the associated neoplasm?
Cirrhosis (alcoholic - hepatitis B or C)
Actinic keratosis
Squamous cell carcinoma of esophagus
Erb - B2

20. Oncogene: erb - B2 Associated tumor?
Breast - ovarian - and gastric carcinomas
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.
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)
Sarcoma

21. Dz: Acanthosis nigricans (hyperpigmentation and epidermal thickening) What is the associated neoplasm?
Visceral malignancy (stomach - lung - breast - uterus)
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
Programmed cell death; ATP required. Mediated by caspases.
Benign: -- Malignant: Leukemia - lymphoma

22. most human cancers - Li - Fraumeni syndrome What is the tumor suppressor gene?
IL-8 C5a Leukotriene B4 Kallikrein
P 16
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' />
P 53

23. Neurofibromatosis type 1 What is the tumor suppressor gene?
NF1
Ras
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.
Colon carcinoma

24. Apoptosis is characterized by...?
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
Causes: Erythropoietin Effect: Polycythemia
N - myc
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.

25. tumor: L ung tumor What is the associated oncogene?
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.
Squamous cell carcinoma of the skin
Neuorblastoma - lung - and gastric cancer.
L - myc

26. Necrosis morphologies
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
Cirrhosis (alcoholic - hepatitis B or C)
Usually stage < grade
Malignant lymphomas

27. Dz: Actinic keratosis What is the associated neoplasm?
Squamous cell carcinoma of the skin
Assoc: Melanoma ('MelaN oma is N ine')
Barrett's esophagus (chronic GI reflux)
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' />

28. Characteristics of ex udate
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)
Small cell lung carcinoma
Benign: hemangioma Malignant: Angiosarcoma

29. Oncogene: c - kit Associated tumor?
Causes: ADH Effect: SIADH
Gastrointestinal stromal tumor (GIST)
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.
P 16

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

31. Paraneoplastic effects of tumors: Leukemias and lymphomas Causes...? Effect?
P 53
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy
NF2
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]

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

33. Leukocyte extravasation

34. Colorectal cancer (assoc w/ FAP) What is the tumor suppressor gene?
APC
Dysplastic nevus
Assoc.: Breast and ovarian cancer
Loss of fxn --< cancer; both allels must be lost for expression of dz.

35. Primary tumors that metastasize to liver

36. Type of amyloid protein: DM2 Protein? Derived from...?
Neuorblastoma - lung - and gastric cancer.
Ras
Amylin protein Derived from AE (AE = E ndocrine)
Chr. 11p Assoc: Wilms' tumor

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

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

39. Tumor suppressor gene: BRCA2 chromosome? Associated tumor?
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
Assoc: breast cancer
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
BRCA2

40. Septic shock
Malignant melanoma
Leukemias and lymphomas
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia

41. Benign
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma
Paget's dz of bone
Benign: lipoma Malignant: liposarcoma

42. Neoplasm: Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma With what dz is this associated?
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
AIDS
[DPC = D eleted in P ancreatic C ancer'] What is the tumor suppressor gene? DPC
Breast - ovarian - and gastric carcinomas

43. Breast and ovarian cancer What is the tumor suppressor gene?
Erb - B2
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
BRCA1

44. Retinoblastoma - osteosarcoma What is the tumor suppressor gene?
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
Ret
CML
Rb

45. Chemical carcinogens: Nitrosamines (e.g. - in smoked foods) What is the affected organ?
Enzymatic degradation of a cell resulting from exogenous injury.
Squamous cell carcinoma of the skin
Esophagus - stomach
Ulcerative colitis

46. tumor: Burkitt's lymphoma What is the associated oncogene?
Beta - amyloid Derived from amyloid precursor protein (APP)
WT1
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors
C - myc

47. Tumor suppressor gene: DCC chromosome? Associated tumor?
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Dysplastic nevus
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />

48. Tumor suppressor gene: p 53 chromosome? Associated tumor?
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome
Protein = transthyretin Derived from AF (AF = old F ogies)
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.

49. Chemical carcinogens: CCl4 What is the affected organ?
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
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
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)
Liver (centrilobular necrosis - fatty change)

50. Amyloid structure
Benign: hemangioma Malignant: Angiosarcoma
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
Down syndrome
Tartrate - resistant acid phosphatase. Hairy cell leukemia -- a B- cell neoplasm. 'TRAP the hairy animal.'