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. Hypovolemic/cardiogenic shock
[DPC = D eleted in P ancreatic C ancer'] What is the tumor suppressor gene? DPC
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
Lung (mesothelioma and bronchogenic carcinoma)
L - myc


2. Neoplasm: Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma With what dz is this associated?
Pancreatic adenocarcinoma
AIDS
Rb
Assoc: breast cancer


3. Dz: Tuberous sclerosis (facial angiofibroma - seizures - mental retardation) What is the associated neoplasm?
Benign: lipoma Malignant: liposarcoma
P 16
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy


4. most human cancers - Li - Fraumeni syndrome What is the tumor suppressor gene?
Prostate carcinoma.
Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma
P 53
Secondary osteosarcoma and fibrosarcoma


5. Cervical carcinoma (types 16 - 18) Penile/anal carcinoma What is the assocciated oncogenic virus?
Cirrhosis (alcoholic - hepatitis B or C)
HPV
HHV-8
L ung tumor


6. Tumor suppressor gene: BRCA2 chromosome? Associated tumor?
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
Fibroblast emigration and proliferation; deposition of ECM.
Assoc: breast cancer
Ulcerative colitis


7. Rolling (step 1 in leukocyte extravasation)

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8. tumor: Multiple endocrine neoplasia (MEN) types II and III What is the associated oncogene?
Ret
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.
Tartrate - resistant acid phosphatase. Hairy cell leukemia -- a B- cell neoplasm. 'TRAP the hairy animal.'
Neuorblastoma - lung - and gastric cancer.


9. Dz: Xeroderma pigmentosum - albinism What is the associated neoplasm?
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' />
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin
Pancreatic adenocarcinoma
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' />


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

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11. Primary tumors that metastasize to brain
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
Cells have increased in # (hyperplasia ) Abnormal proliferation of cells w/ loss of size - shape - and orientation (dysplasia ) <img src='220b.JPG' />
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
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.


12. Tumor nomenclature: Blood cells What do you call a benign tumor of this tissue? .. a malignant one?
Cells have invaded basement membrane using collagenases and hydrolases Can metastasize if they reach a blood or lymphatic vessel <img src='220d.JPG' />
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma
N - myc
Benign: -- Malignant: Leukemia - lymphoma


13. Apoptosis (definition)
N - myc
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
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' />
Programmed cell death; ATP required. Mediated by caspases.


14. Oncogene: N - myc Associated tumor?
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
Adult T- cell leukemia
N euroblastoma
Leukocyte travels btw endothelial cells and exits blood vessel; PECAM-1 is involved. <img src='218a.JPG' />


15. tumor: CML What is the associated oncogene?
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.
AIDS
Abl
Programmed cell death; ATP required. Mediated by caspases.


16. Leukocyte extravasation

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

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18. Oncogene: c - myc Associated tumor?

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19. Neoplasm: Gastric adenocarcinoma With what dz is this associated?
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.


20. Dz: Acanthosis nigricans (hyperpigmentation and epidermal thickening) What is the associated neoplasm?
HHV-8
Visceral malignancy (stomach - lung - breast - uterus)
Fibrous tissue formation in response to a neoplasm. Irreversible.
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.


21. Neoplasm: Squamous cell carcinoma of esophagus With what dz is this associated?
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
N - myc
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change


22. Tumor suppressor gene: DCC chromosome? Associated tumor?
Malignant lymphomas
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)


23. Tumor nomenclature: Blood vessels What do you call a benign tumor of this tissue? .. a malignant one?
Rb
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
Benign: hemangioma Malignant: Angiosarcoma
Assoc.: Retinoblastoma - osteosarcoma


24. Tumor nomenclature: Fat What do you call a benign tumor of this tissue? .. a malignant one?
Assoc: Neurofibromatosis type 1
Assoc: Neurofibromatosis 2 ('Type 2 = 22')
Causes: ADH Effect: SIADH
Benign: lipoma Malignant: liposarcoma


25. Chemical carcinogens: Asbestos What is the affected organ?
Liver (angiosarcoma)
Colon carcinoma
Assoc: Neurofibromatosis 2 ('Type 2 = 22')
Lung (mesothelioma and bronchogenic carcinoma)


26. Tumor markers: TRAP

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27. Septic shock
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
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.
Secondary osteosarcoma and fibrosarcoma


28. Anaplasia
Leukocyte travels btw endothelial cells and exits blood vessel; PECAM-1 is involved. <img src='218a.JPG' />
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.
Burkitt's lymphoma
BRCA1


29. Chemical carcinogens: Arsenic What is the affected organ?
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.
All (we All fall Down ) AML
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Skin (squamous cell carcinoma) Liver (angiosarcoma)


30. Dz: Paget's dz of bone What is the associated neoplasm?
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome
Secondary osteosarcoma and fibrosarcoma
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).
Beta -2 microglobulin Derived from MHC class I proteins.


31. Hepatocellular carcinoma What is the assocciated oncogenic virus?
Ret
HBV - HCV
Radiation exposure
Secondary osteosarcoma and fibrosarcoma


32. Chemical carcinogens: CCl4 What is the affected organ?
Liver (centrilobular necrosis - fatty change)
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
Erb - B2
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change


33. Malignant
Abl
Prostate carcinoma.
Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis)
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.


34. Tumor suppressor gene: BRCA1 chromosome? Associated tumor?
Assoc.: Breast and ovarian cancer
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia
N - myc
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors


35. Migration (step 4 in leukocyte extravasation)

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36. Tumor markers: CA-125
Melanoma - neural tumors - astrocytomas.
Assoc: Neurofibromatosis type 1
Ovarian - malignant epithelial tumors
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation


37. Female cancer epidemiology (incidence - mortality)
Pancreatic adenocarcinoma
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)


38. tumor: Gastrointestinal stromal tumor (GIST) What is the associated oncogene?
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)
Increase vascular permeability - vasodilation - endothelial injury.
C - kit
Breast - ovarian - and gastric carcinomas


39. Tumor markers: alpha - fetoprotein
Liver (angiosarcoma)
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
Gastrointestinal stromal tumor (GIST)


40. tumor: Burkitt's lymphoma What is the associated oncogene?
C - myc
Leukemias and lymphomas
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
Neuorblastoma - lung - and gastric cancer.


41. Wilms' tumor What is the tumor suppressor gene?
Thymoma - small cell lung carcinoma
WT1
Normal cells w/ basal --< apical differentiation <img src='220a.JPG' />
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.


42. Type of amyloid protein: Primary Protein? Derived from...?
IL-8 C5a Leukotriene B4 Kallikrein
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
Assoc: breast cancer
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.


43. Oncogenic viruses: HPV What is the associated cancer?
Usually stage < grade
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome
Benign: lipoma Malignant: liposarcoma


44. Oncogene: L - myc Associated tumor?
L ung tumor
Metastases to bone - obstructive biliary dz - Paget's dz of bone.
BRCA1
Benign: lipoma Malignant: liposarcoma


45. Neoplasm: Colonic adenocarcinoma With what dz is this associated?
Ulcerative colitis
Assoc: Colorectal cancer (assoc w/ FAP)
BRCA1
[aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma


46. Neoplasm: Malignant lymphomas With what dz is this associated?
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)
Liver (angiosarcoma)
Immunodeficiency states


47. Dz: Radiation exposure What is the associated neoplasm?
Sarcoma
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
EBV
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation


48. Tumor suppressor gene: APC chromosome? Associated tumor?
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
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.
Assoc: Colorectal cancer (assoc w/ FAP)


49. Neoplasm: Squamous cell carcinoma of the skin With what dz is this associated?
Actinic keratosis
Metastases to bone - obstructive biliary dz - Paget's dz of bone.
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention
Blood (leukemia)


50. Dz: Dysplastic nevus What is the associated neoplasm?
Burkitt's lymphoma
Lung (mesothelioma and bronchogenic carcinoma)
APC
Malignant melanoma