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. Oncogene: erb - B2 Associated tumor?
Breast - ovarian - and gastric carcinomas
APC
Amylin protein Derived from AE (AE = E ndocrine)
N euroblastoma


2. Tumor nomenclature: Fat What do you call a benign tumor of this tissue? .. a malignant one?
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
Benign: lipoma Malignant: liposarcoma
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
Multiple endocrine neoplasia (MEN) types II and III


3. 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
Esophagus - stomach
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.
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention


4. Metastasis to brain
Erb - B2
Secondary osteosarcoma and fibrosarcoma
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' />
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.


5. Oncogenic viruses: HHV-8 What is the associated cancer?

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


6. Dz: Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency) What is the associated neoplasm?
P 16
Squamous cell carcinoma of esophagus
Paget's dz of bone
Hepatocellular carcinoma


7. Primary tumors that metastasize to brain
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.
Fibroblast emigration and proliferation; deposition of ECM.
AIDS
[aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma


8. Tumor suppressor gene: BRCA2 chromosome? Associated tumor?
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
Assoc: breast cancer
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.


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

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


10. Cervical carcinoma (types 16 - 18) Penile/anal carcinoma What is the assocciated oncogenic virus?
Actinic keratosis
HPV
Ras
WT1


11. Primary tumors that metasize to bone

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


12. tumor: Follicular and undifferentiated lymphomas (inhibits apoptosis) What is the associated oncogene?
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Squamous cell carcinoma of the skin
Bcl -2
Esophagus - stomach


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

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


14. Dz: Barrett's esophagus (chronic GI reflux) What is the associated neoplasm?
Gastric adenocarcinoma
Esophageal adenocarcinoma
The liver and lung are the most common sites of metastasis after regional LN's. Metastasis << primary liver tumors.
Gastrointestinal stromal tumor (GIST)


15. Oncogenic viruses: HPV What is the associated cancer?
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Protein = transthyretin Derived from AF (AF = old F ogies)
Assoc: Neurofibromatosis 2 ('Type 2 = 22')


16. tumor: L ung tumor What is the associated oncogene?
Skin (squamous cell carcinoma) Liver (angiosarcoma)
L - myc
NF2
Liver (centrilobular necrosis - fatty change)


17. Causes: Erythropoietin Effect: Polycythemia What neoplasm would create this paraneoplastic effect?
Renal cell carcinoma - hemangioblastoma
Pancreatic adenocarcinoma
Metastases to bone - obstructive biliary dz - Paget's dz of bone.
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.


18. Oncogene: bcl -2 Associated tumor?
Malignant melanoma
Assoc: breast cancer
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)
Follicular and undifferentiated lymphomas (inhibits apoptosis)


19. Colon cancer
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention
Cirrhosis (alcoholic - hepatitis B or C)
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors


20. tumor: Colon carcinoma What is the associated oncogene?
Ras
Renal cell carcinoma - hemangioblastoma
Erb - B2
Assoc: Neurofibromatosis 2 ('Type 2 = 22')


21. Free radical degradation
Actinic keratosis
Ret
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
Down syndrome


22. Tumor markers: Alkaline phosphatase

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


23. Tumor markers: Prostatic acid phospatase
AIDS
Prostate carcinoma.
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.
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)


24. TNM staging system
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)
Ras
T = size of T umor N = N ode involvement M = M etastases
Causes: Erythropoietin Effect: Polycythemia


25. Paraneoplastic effects of tumors: Small cell lung carcinoma and intracranial neoplasms Causes...? Effect?
Causes: ADH Effect: SIADH
EBV
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.
Squamous cell carcinoma of the skin


26. Metastasis to liver

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


27. Neoplastic progression: step 3 Invasive carcinoma

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


28. Chemical carcinogens: Alkylating agents What is the affected organ?
Blood (leukemia)
Benign: -- Malignant: Leukemia - lymphoma
Causes: ADH Effect: SIADH
Malignant lymphomas


29. Tumor markers: TRAP

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


30. Leukocyte extravasation

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


31. Chronic inflammation
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
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).
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.


32. Dz: Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants What is the associated neoplasm?
Gastric adenocarcinoma
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.
HTLV-1
Beta -2 microglobulin Derived from MHC class I proteins.


33. Paraneoplastic effects of tumors: Leukemias and lymphomas Causes...? 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.
Cells have invaded basement membrane using collagenases and hydrolases Can metastasize if they reach a blood or lymphatic vessel <img src='220d.JPG' />
Assoc: Melanoma ('MelaN oma is N ine')
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy


34. Dz: AIDS What is the associated neoplasm?

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


35. 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
Gastric adenocarcinoma
Prostate carcinoma.
Leukemias and lymphomas


36. Dz: Down syndrome What is the associated neoplasm?
Chr. 11p Assoc: Wilms' tumor
All (we All fall Down ) AML
Protein = transthyretin Derived from AF (AF = old F ogies)
Barrett's esophagus (chronic GI reflux)


37. Dz: Tuberous sclerosis (facial angiofibroma - seizures - mental retardation) What is the associated neoplasm?
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma
Adult T- cell leukemia
Rb
AIDS


38. Oncogenic viruses: HBV - HCV What is the associated cancer?
Hepatocellular carcinoma
Benign: hemangioma Malignant: Angiosarcoma
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.


39. Neurofibromatosis type 1 What is the tumor suppressor gene?
NF1
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
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' />
Assoc: Neurofibromatosis 2 ('Type 2 = 22')


40. Tumor nomenclature: < 1 cell type What do you call a benign tumor of this tissue? .. a malignant one?
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
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Pancreatic adenocarcinoma
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)


41. Pancreatic cancer

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


42. Which usually has more prognostic value - tumor stage or grade?
Benign: Leiomyoma Malignant: Leiomyosarcoma
Usually stage < grade
Hepatocellular carcinoma
Assoc.: Breast and ovarian cancer


43. Melanoma - What is the tumor suppressor gene?
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
P 16
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Radiation exposure


44. Fibrosis in inflammation
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)
Fibroblast emigration and proliferation; deposition of ECM.
EBV
Ret


45. How should tumor markers be used clinically?
All (we All fall Down ) AML
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.
Gain of fxn --< cancer. Need damage to only 1 allele.
P 53


46. Amyloid structure
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.


47. Things that initiate Free radical injury
[DPC = D eleted in P ancreatic C ancer'] What is the tumor suppressor gene? DPC
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
BRCA2
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


48. Tumor markers: CA-19-9
Pancreatic adenocarcinoma
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.
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)
Sarcoma


49. Substances that are chemotactic for neutrophils
Squamous cell carcinoma of the skin
Programmed cell death; ATP required. Mediated by caspases.
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.
IL-8 C5a Leukotriene B4 Kallikrein


50. Chemical carcinogens: Arsenic What is the affected organ?
Ret
Skin (squamous cell carcinoma) Liver (angiosarcoma)
Neuorblastoma - lung - and gastric cancer.
Breast - ovarian - and gastric carcinomas