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 nomenclature: Epithelium What do you call a benign tumor of this tissue? .. a malignant one?
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
Renal cell carcinoma - hemangioblastoma
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma


2. Resolution of inflammation
Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome
Down syndrome
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.
BRCA2


3. Female cancer epidemiology (incidence - mortality)
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.
Assoc.: Retinoblastoma - osteosarcoma
Skin (squamous cell carcinoma) Liver (angiosarcoma)
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)


4. Characteristics of ex udate
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.
Ovarian - malignant epithelial tumors
Benign: Leiomyoma Malignant: Leiomyosarcoma
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation


5. Burkitt's lymphoma nasopharyngeal carcinoma What is the assocciated oncogenic virus?
EBV
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.
Multiple endocrine neoplasia (MEN) types II and III
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' />


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

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7. [aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma What is the assocciated oncogenic virus?
Hepatocellular carcinoma
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
Assoc: Colorectal cancer (assoc w/ FAP)
HHV-8


8. Oncogene: c - myc Associated tumor?

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9. Oncogenes
Fibrous tissue formation in response to a neoplasm. Irreversible.
N - myc
Gain of fxn --< cancer. Need damage to only 1 allele.
Esophagus - stomach


10. Neoplasm: Benign and malignant lymphomas With what dz is this associated?

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11. Hepatocellular carcinoma What is the assocciated oncogenic virus?
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
AIDS
HBV - HCV
Esophageal adenocarcinoma


12. Cervical carcinoma (types 16 - 18) Penile/anal carcinoma What is the assocciated oncogenic virus?
Burkitt's lymphoma nasopharyngeal carcinoma
HPV
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
Causes: ADH Effect: SIADH


13. Tumor suppressor gene: BRCA2 chromosome? Associated tumor?
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
Squamous cell carcinoma of esophagus
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia
Assoc: breast cancer


14. Tumor suppressor gene: NF1 chromosome? Associated tumor?
Assoc: Neurofibromatosis 2 ('Type 2 = 22')
Benign: Leiomyoma Malignant: Leiomyosarcoma
Assoc: Neurofibromatosis type 1
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.


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

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16. Tumor markers: CEA
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.
Pancreatic adenocarcinoma
Hepatocellular carcinoma
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)


17. Dz: Paget's dz of bone What is the associated neoplasm?
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.
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
Secondary osteosarcoma and fibrosarcoma
Sarcoma


18. Neoplasm: Hepatocellular carcinoma With what dz is this associated?
T = size of T umor N = N ode involvement M = M etastases
Benign: -- Malignant: Leukemia - lymphoma
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.
Cirrhosis (alcoholic - hepatitis B or C)


19. Cancer epidemiology: Lung cancer? As a cause of death overall?
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)
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).
Ret
Assoc: Colorectal cancer (assoc w/ FAP)


20. Substances that are chemotactic for neutrophils
HTLV-1
HBV - HCV
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.
IL-8 C5a Leukotriene B4 Kallikrein


21. Tumor markers: CA-125
Small cell lung carcinoma and intracranial neoplasms
Actinic keratosis
Ovarian - malignant epithelial tumors
P 16


22. Tumor markers: Beta - hCG

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23. Chemical carcinogens: Vinyl chloride What is the affected organ?
N - myc
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia
Liver (angiosarcoma)


24. Which usually has more prognostic value - tumor stage or grade?
Metastases to bone - obstructive biliary dz - Paget's dz of bone.
APC
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
Usually stage < grade


25. Malignant
Loss of fxn --< cancer; both allels must be lost for expression of dz.
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.
N - myc
P 16


26. Neoplasm: Malignant lymphomas With what dz is this associated?
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)
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
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
Immunodeficiency states


27. Chronic inflammation
HTLV-1
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
The liver and lung are the most common sites of metastasis after regional LN's. Metastasis << primary liver tumors.
Loss of fxn --< cancer; both allels must be lost for expression of dz.


28. Neoplasm: Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma With what dz is this associated?
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)
Squamous cell carcinoma of esophagus
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.
CML


29. Paraneoplastic effects of tumors: Renal cell carcinoma - hemangioblastoma Causes...? Effect?
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' />
Membrane lipid peroxidation Protein modification DNA Breakage
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)
Causes: Erythropoietin Effect: Polycythemia


30. Type of amyloid protein: Medullary carcinoma of thyroid Protein? Derived from...?
Colonic adenocarcinoma
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Squamous cell carcinoma of esophagus
Skin (squamous cell carcinoma) Liver (angiosarcoma)


31. Neoplasm: Squamous cell carcinoma of the skin With what dz is this associated?
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
Actinic keratosis
Enzymatic degradation of a cell resulting from exogenous injury.
Multiple endocrine neoplasia (MEN) types II and III


32. Neoplasm: Colonic adenocarcinoma With what dz is this associated?
Ulcerative colitis
Benign: lipoma Malignant: liposarcoma
Squamous cell carcinoma of esophagus
Fibroblast emigration and proliferation; deposition of ECM.


33. Type of amyloid protein: Dialysis - associated Protein? Derived from...?
Beta -2 microglobulin Derived from MHC class I proteins.
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
T = size of T umor N = N ode involvement M = M etastases
[DPC = D eleted in P ancreatic C ancer'] What is the tumor suppressor gene? DPC


34. Characteristics of irreversible cell injury
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
WT1
L ung tumor
Metastases to bone - obstructive biliary dz - Paget's dz of bone.


35. Necrosis morphologies
[DPC = D eleted in P ancreatic C ancer'] What is the tumor suppressor gene? DPC
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma
Assoc: breast cancer
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)


36. Neoplasm: All (we All fall Down ) AML With what dz is this associated?
Melanoma - neural tumors - astrocytomas.
Down syndrome
Assoc: Neurofibromatosis 2 ('Type 2 = 22')
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation


37. Psammoma bodies
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
Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome
Gain of fxn --< cancer. Need damage to only 1 allele.
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'


38. Migration (step 4 in leukocyte extravasation)

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39. Neoplasm: Sarcoma With what dz is this associated?
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'
Beta - amyloid Derived from amyloid precursor protein (APP)
Ret
Radiation exposure


40. TNM staging system
T = size of T umor N = N ode involvement M = M etastases
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.
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Normal cells w/ basal --< apical differentiation <img src='220a.JPG' />


41. Oncogene: c - kit Associated tumor?
Sarcoma
Secondary osteosarcoma and fibrosarcoma
Gastrointestinal stromal tumor (GIST)
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.


42. tumor: Multiple endocrine neoplasia (MEN) types II and III What is the associated oncogene?
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
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' />
Ret
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)


43. Neoplasm: Visceral malignancy (stomach - lung - breast - uterus) With what dz is this associated?
Ulcerative colitis
Acanthosis nigricans (hyperpigmentation and epidermal thickening)
CML
Colon carcinoma


44. Tumor markers: S-100
Leukocyte travels btw endothelial cells and exits blood vessel; PECAM-1 is involved. <img src='218a.JPG' />
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Blood (leukemia)
Melanoma - neural tumors - astrocytomas.


45. Neoplasm: Malignant melanoma With what dz is this associated?
CML
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
Dysplastic nevus
Bcl -2


46. Metastasis to liver

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47. tumor: CML What is the associated oncogene?
Abl
Pancreatic adenocarcinoma
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.
Prostate carcinoma.


48. tumor: Follicular and undifferentiated lymphomas (inhibits apoptosis) What is the associated oncogene?
Bcl -2
Adult T- cell leukemia
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)
Dysplastic nevus


49. Causes: Erythropoietin Effect: Polycythemia What neoplasm would create this paraneoplastic effect?
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
Renal cell carcinoma - hemangioblastoma
P 53
Protein = transthyretin Derived from AF (AF = old F ogies)


50. Tumor nomenclature: Skeletal muscle What do you call a benign tumor of this tissue? .. a malignant one?
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Bcl -2