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. Tumor suppressor gene: p 16 chromosome? Associated tumor?

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183


2. Psammoma bodies
Esophageal 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
N - myc
[aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma


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

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183


4. Oncogene: ret Associated tumor?
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' />
Leukocyte travels btw endothelial cells and exits blood vessel; PECAM-1 is involved. <img src='218a.JPG' />
Multiple endocrine neoplasia (MEN) types II and III
Increase in # of cells. Reversible.


5. TNM staging system
Abl
Causes: ADH Effect: SIADH
Secondary osteosarcoma and fibrosarcoma
T = size of T umor N = N ode involvement M = M etastases


6. Characteristics of irreversible cell injury
Ulcerative colitis
Renal cell carcinoma - hemangioblastoma
Hepatocellular carcinoma
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability


7. Tumor nomenclature: Skeletal muscle What do you call a benign tumor of this tissue? .. a malignant one?
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Actinic keratosis
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.
Normal cells w/ basal --< apical differentiation <img src='220a.JPG' />


8. Necrosis morphologies
Lung (mesothelioma and bronchogenic carcinoma)
Squamous cell carcinoma of esophagus
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
[aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma


9. Neoplasm: Visceral malignancy (stomach - lung - breast - uterus) With what dz is this associated?
WT1
Lung (mesothelioma and bronchogenic carcinoma)
Acanthosis nigricans (hyperpigmentation and epidermal thickening)
Colonic adenocarcinoma


10. Chemical carcinogens: Asbestos What is the affected organ?
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
Lung (mesothelioma and bronchogenic carcinoma)


11. Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome What neoplasm would create this paraneoplastic effect?
N euroblastoma
Small cell lung carcinoma
Pancreatic adenocarcinoma
Loss of fxn --< cancer; both allels must be lost for expression of dz.


12. Type of amyloid protein: Senile cardiac Protein? Derived from...?
Fibrous tissue formation in response to a neoplasm. Irreversible.
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)
Protein = transthyretin Derived from AF (AF = old F ogies)
Multiple endocrine neoplasia (MEN) types II and III


13. Dysplasia
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.
N euroblastoma
Assoc.: Breast and ovarian cancer
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma


14. Chemical carcinogens: Nitrosamines (e.g. - in smoked foods) What is the affected organ?
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.
Abl
Ovarian - malignant epithelial tumors
Esophagus - stomach


15. Cancer epidemiology: Lung cancer? As a cause of death overall?
Ulcerative colitis
Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma
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).
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.


16. Tumor nomenclature: < 1 cell type What do you call a benign tumor of this tissue? .. a malignant one?
L ung tumor
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
Paget's dz of bone
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma


17. Tumor suppressor gene: BRCA1 chromosome? Associated tumor?
Assoc.: Breast and ovarian cancer
Secondary osteosarcoma and fibrosarcoma
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma


18. Neoplasm: Squamous cell carcinoma of the skin With what dz is this associated?
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia
Actinic keratosis
AIDS
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.


19. Tumor markers: Bombesin
Breast - ovarian - and gastric carcinomas
Assoc: Pancreatic cancer [DPC = D eleted in P ancreatic C ancer']
Neuorblastoma - lung - and gastric cancer.
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)


20. Tumor suppressor gene: NF1 chromosome? Associated tumor?
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy
Assoc: Neurofibromatosis type 1
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia


21. Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy What neoplasm would create this paraneoplastic effect?
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Cirrhosis (alcoholic - hepatitis B or C)
Leukemias and lymphomas
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)


22. tumor: Multiple endocrine neoplasia (MEN) types II and III What is the associated oncogene?
Ret
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.
Esophageal adenocarcinoma
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.


23. Tumor nomenclature: Blood cells What do you call a benign tumor of this tissue? .. a malignant one?
Benign: -- Malignant: Leukemia - lymphoma
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
HTLV-1
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability


24. Hypovolemic/cardiogenic shock
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
Causes: ADH Effect: SIADH
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)


25. Neoplastic progression: step 1 Hyperplasia/dysplasia

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183


26. Neoplasm: All (we All fall Down ) AML With what dz is this associated?
Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis)
T = size of T umor N = N ode involvement M = M etastases
Down syndrome
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)


27. Tumor suppressor gene: APC chromosome? Associated tumor?
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
Benign: Leiomyoma Malignant: Leiomyosarcoma
Assoc: Colorectal cancer (assoc w/ FAP)
Small cell lung carcinoma


28. Tumor markers: CA-125
Enzymatic degradation of a cell resulting from exogenous injury.
Ovarian - malignant epithelial tumors
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Bladder (transitional cell carcinoma)


29. Dz: Tuberous sclerosis (facial angiofibroma - seizures - mental retardation) What is the associated neoplasm?
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.


30. Metastasis to liver

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183


31. Oncogenic viruses: HPV What is the associated cancer?
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Colonic adenocarcinoma
Neuorblastoma - lung - and gastric cancer.
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation


32. Dz: Radiation exposure What is the associated neoplasm?
IL-8 C5a Leukotriene B4 Kallikrein
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Sarcoma


33. Breast and ovarian cancer What is the tumor suppressor gene?
Paget's dz of bone
BRCA1
HBV - HCV
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


34. Rolling (step 1 in leukocyte extravasation)

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183


35. Anaplasia
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
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.
HHV-8


36. Characteristics of trans udate
Bladder (transitional cell carcinoma)
HTLV-1
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention
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


37. Carcinoma vs. sarcoma
BRCA2
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy


38. Type of amyloid protein: Medullary carcinoma of thyroid Protein? Derived from...?
Visceral malignancy (stomach - lung - breast - uterus)
Multiple endocrine neoplasia (MEN) types II and III
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
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' />


39. Dz: Cirrhosis (alcoholic - hepatitis B or C) What is the associated neoplasm?
Hepatocellular carcinoma
Neuorblastoma - lung - and gastric cancer.
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma


40. Neoplasm: Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma With what dz is this associated?
BRCA1
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)
Assoc.: Retinoblastoma - osteosarcoma
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)


41. Dz: Ulcerative colitis What is the associated neoplasm?
Rb
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma
Colonic adenocarcinoma


42. Neoplasm: Gastric adenocarcinoma With what dz is this associated?
Squamous cell carcinoma of esophagus
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
Beta - amyloid Derived from amyloid precursor protein (APP)
Assoc: Neurofibromatosis 2 ('Type 2 = 22')


43. Apoptosis (definition)
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Visceral malignancy (stomach - lung - breast - uterus)
Programmed cell death; ATP required. Mediated by caspases.
Benign: Osteoma Malignant: osteosarcoma


44. Necrosis (definition)
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />
Enzymatic degradation of a cell resulting from exogenous injury.
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
Beta -2 microglobulin Derived from MHC class I proteins.


45. Neoplasm: Squamous cell carcinoma of esophagus With what dz is this associated?
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)
Cells have increased in # (hyperplasia ) Abnormal proliferation of cells w/ loss of size - shape - and orientation (dysplasia ) <img src='220b.JPG' />


46. Septic shock
N euroblastoma
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.
Squamous cell carcinoma of the skin
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)


47. Granulomatous dz's

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183


48. Dz: Paget's dz of bone What is the associated neoplasm?
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
T = size of T umor N = N ode involvement M = M etastases
Assoc: breast cancer
Secondary osteosarcoma and fibrosarcoma


49. Oncogene: N - myc Associated tumor?
Melanoma - neural tumors - astrocytomas.
Assoc: Neurofibromatosis type 1
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
N euroblastoma


50. Neoplasm: Sarcoma With what dz is this associated?
Esophagus - stomach
Ret
Amylin protein Derived from AE (AE = E ndocrine)
Radiation exposure