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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. Free radical degradation
NF2
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
Liver (angiosarcoma)

2. Tumor markers: CEA
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Paget's dz of bone
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.

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

4. Neurofibromatosis type 1 What is the tumor suppressor gene?
Secondary osteosarcoma and fibrosarcoma
Fibroblast emigration and proliferation; deposition of ECM.
Benign: Leiomyoma Malignant: Leiomyosarcoma
NF1

5. Desmoplasia
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.
Fibrous tissue formation in response to a neoplasm. Irreversible.
Leukemias and lymphomas
APC

6. Type of amyloid protein: Dialysis - associated Protein? Derived from...?
Beta -2 microglobulin Derived from MHC class I proteins.
Cells have invaded basement membrane using collagenases and hydrolases Can metastasize if they reach a blood or lymphatic vessel <img src='220d.JPG' />
Abl
[DPC = D eleted in P ancreatic C ancer'] What is the tumor suppressor gene? DPC

7. Burkitt's lymphoma nasopharyngeal carcinoma What is the assocciated oncogenic virus?
Cells have increased in # (hyperplasia ) Abnormal proliferation of cells w/ loss of size - shape - and orientation (dysplasia ) <img src='220b.JPG' />
Metastases to bone - obstructive biliary dz - Paget's dz of bone.
EBV
Beta - amyloid Derived from amyloid precursor protein (APP)

8. Causes: Erythropoietin Effect: Polycythemia What neoplasm would create this paraneoplastic effect?
Barrett's esophagus (chronic GI reflux)
Renal cell carcinoma - hemangioblastoma
Causes: Erythropoietin Effect: Polycythemia
Follicular and undifferentiated lymphomas (inhibits apoptosis)

9. Oncogenic viruses: HBV - HCV What is the associated cancer?
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' />
Hepatocellular carcinoma
Burkitt's lymphoma
Pancreatic adenocarcinoma

10. Neoplasm: Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma With what dz is this associated?
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
Malignant lymphomas
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)
Small cell lung carcinoma

11. Chemical carcinogens: Alkylating agents What is the affected organ?
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
Blood (leukemia)
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin
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' />

12. Leukocyte activation in inflammation
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.
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.

13. Tumor suppressor gene: BRCA2 chromosome? Associated tumor?
Assoc: breast cancer
P 16
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)

14. Neurofibromatosis 2 ('Type 2 = 22') What is the tumor suppressor gene?
Xeroderma pigmentosum - albinism
Liver (centrilobular necrosis - fatty change)
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.
NF2

15. Neoplastic progression: step 2 In situ carcinoma

16. Type of amyloid protein: Alzheimer's dz Protein? Derived from...?
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
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 - amyloid Derived from amyloid precursor protein (APP)
Hepatocellular carcinoma

17. Hyperplasia
Small cell lung carcinoma and intracranial neoplasms
Melanoma - neural tumors - astrocytomas.
Increase in # of cells. Reversible.
L - myc

18. Acute inflammation
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.
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.
Colon carcinoma
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.

19. [aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma What is the assocciated oncogenic virus?
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />
HHV-8
Ovarian - malignant epithelial tumors
Assoc: Neurofibromatosis 2 ('Type 2 = 22')

20. Chemical carcinogens: Arsenic What is the affected organ?
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
Benign: lipoma Malignant: liposarcoma
Skin (squamous cell carcinoma) Liver (angiosarcoma)
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)

21. Oncogenic viruses: EBV What is the associated cancer?

22. Type of amyloid protein: Medullary carcinoma of thyroid Protein? Derived from...?
Benign: hemangioma Malignant: Angiosarcoma
Pancreatic adenocarcinoma
Burkitt's lymphoma
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)

23. Dz: Ulcerative colitis What is the associated neoplasm?
Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome
Colonic adenocarcinoma
Renal cell carcinoma - hemangioblastoma
Loss of fxn --< cancer; both allels must be lost for expression of dz.

24. Metastasis to liver

25. Neoplasm: Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin With what dz is this associated?
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.
Causes: ADH Effect: SIADH
Xeroderma pigmentosum - albinism
HPV

26. Colon cancer
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
C - myc
Assoc: Melanoma ('MelaN oma is N ine')
Chr. 11p Assoc: Wilms' tumor

27. Chemical carcinogens: CCl4 What is the affected organ?
Liver (centrilobular necrosis - fatty change)
L ung tumor
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
Cells have increased in # (hyperplasia ) Abnormal proliferation of cells w/ loss of size - shape - and orientation (dysplasia ) <img src='220b.JPG' />

28. Tumor nomenclature: Blood vessels What do you call a benign tumor of this tissue? .. a malignant one?
P 53
Benign: hemangioma Malignant: Angiosarcoma
Ret
Benign: lipoma Malignant: liposarcoma

29. Tumor nomenclature: Epithelium What do you call a benign tumor of this tissue? .. a malignant one?
C - myc
Skin (squamous cell carcinoma) Liver (angiosarcoma)
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.

30. Type of amyloid protein: DM2 Protein? Derived from...?
Benign: Leiomyoma Malignant: Leiomyosarcoma
Amylin protein Derived from AE (AE = E ndocrine)
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
Cirrhosis (alcoholic - hepatitis B or C)

31. Tumor markers: alpha - fetoprotein
Amylin protein Derived from AE (AE = E ndocrine)
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
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
Abl

32. Dz: Acanthosis nigricans (hyperpigmentation and epidermal thickening) What is the associated neoplasm?
Assoc.: Retinoblastoma - osteosarcoma
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Visceral malignancy (stomach - lung - breast - uterus)
Malignant melanoma

33. Breast and ovarian cancer What is the tumor suppressor gene?
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Radiation exposure
BRCA1

34. tumor: Colon carcinoma What is the associated oncogene?
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors
Ras
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.
Cells have increased in # (hyperplasia ) Abnormal proliferation of cells w/ loss of size - shape - and orientation (dysplasia ) <img src='220b.JPG' />

35. tumor: N euroblastoma What is the associated oncogene?
Down syndrome
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention
N - myc
Assoc: Neurofibromatosis 2 ('Type 2 = 22')

36. Tumor suppressor genes
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma
Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome
P 16
Loss of fxn --< cancer; both allels must be lost for expression of dz.

37. Necrosis (definition)
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)
Enzymatic degradation of a cell resulting from exogenous injury.
Assoc.: Retinoblastoma - osteosarcoma
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).

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

39. Tumor nomenclature: Smooth muscle What do you call a benign tumor of this tissue? .. a malignant one?
Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis)
Metastases to bone - obstructive biliary dz - Paget's dz of bone.
Benign: Leiomyoma Malignant: Leiomyosarcoma
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)

40. tumor: L ung tumor What is the associated oncogene?
Chr. 11p Assoc: Wilms' tumor
L - myc
Xeroderma pigmentosum - albinism
Membrane lipid peroxidation Protein modification DNA Breakage

41. Tumor nomenclature: < 1 cell type What do you call a benign tumor of this tissue? .. a malignant one?
Erb - B2
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
Fibroblast emigration and proliferation; deposition of ECM.
BRCA1

42. Oncogene: c - myc Associated tumor?

43. Colorectal cancer (assoc w/ FAP) What is the tumor suppressor gene?
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).
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' />
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' />
APC

44. TNM staging system
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
T = size of T umor N = N ode involvement M = M etastases
Esophagus - stomach

45. Dz: Actinic keratosis What is the associated neoplasm?
Squamous cell carcinoma of the skin
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.
Hepatocellular carcinoma
Leukocyte travels btw endothelial cells and exits blood vessel; PECAM-1 is involved. <img src='218a.JPG' />

46. Tumor nomenclature: Fat What do you call a benign tumor of this tissue? .. a malignant one?
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
Thymoma - small cell lung carcinoma
Sarcoma
Benign: lipoma Malignant: liposarcoma

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

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

49. Tumor suppressor gene: NF1 chromosome? Associated tumor?
Assoc: Neurofibromatosis type 1
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' />
Bcl -2
Secondary osteosarcoma and fibrosarcoma

50. Fibrosis in inflammation
Fibroblast emigration and proliferation; deposition of ECM.
Normal cells w/ basal --< apical differentiation <img src='220a.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.
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome