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?
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Adult T- cell leukemia
Cells have increased in # (hyperplasia ) Abnormal proliferation of cells w/ loss of size - shape - and orientation (dysplasia ) <img src='220b.JPG' />
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma


2. Necrosis is characterized by...?
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
Fibrous tissue formation in response to a neoplasm. Irreversible.
Renal cell carcinoma - hemangioblastoma
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.


3. tumor: Gastrointestinal stromal tumor (GIST) What is the associated oncogene?
C - kit
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
Gain of fxn --< cancer. Need damage to only 1 allele.
Assoc: Colorectal cancer (assoc w/ FAP)


4. Tumor markers: Bombesin
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.
Neuorblastoma - lung - and gastric cancer.
Beta - amyloid Derived from amyloid precursor protein (APP)
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


5. Neoplasm: Squamous cell carcinoma of the skin With what dz is this associated?
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy
Actinic keratosis


6. Dz: Xeroderma pigmentosum - albinism What is the associated neoplasm?
Cirrhosis (alcoholic - hepatitis B or C)
P 16
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin
Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis)


7. Pancreatic cancer

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8. Dz: Down syndrome What is the associated neoplasm?
C - myc
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
All (we All fall Down ) AML
Liver (angiosarcoma)


9. Dz: Cirrhosis (alcoholic - hepatitis B or C) What is the associated neoplasm?
Cirrhosis (alcoholic - hepatitis B or C)
Assoc: Colorectal cancer (assoc w/ FAP)
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />
Hepatocellular carcinoma


10. Chemical carcinogens: Arsenic What is the affected organ?
Radiation exposure
Increase vascular permeability - vasodilation - endothelial injury.
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' />
Skin (squamous cell carcinoma) Liver (angiosarcoma)


11. Hypovolemic/cardiogenic shock
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
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.
Barrett's esophagus (chronic GI reflux)
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.


12. Causes: Erythropoietin Effect: Polycythemia What neoplasm would create this paraneoplastic effect?
Burkitt's lymphoma
Renal cell carcinoma - hemangioblastoma
Blood (leukemia)
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors


13. Septic shock
Beta - amyloid Derived from amyloid precursor protein (APP)
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.
Burkitt's lymphoma nasopharyngeal carcinoma
Xeroderma pigmentosum - albinism


14. Tumor nomenclature: Fat What do you call a benign tumor of this tissue? .. a malignant one?
Thymoma - small cell lung carcinoma
Benign: lipoma Malignant: liposarcoma
BRCA1
Erb - B2


15. Oncogene: N - myc Associated tumor?
BRCA2
Ulcerative colitis
N euroblastoma
Protein = transthyretin Derived from AF (AF = old F ogies)


16. Type of amyloid protein: Senile cardiac Protein? Derived from...?
Esophagus - stomach
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' />
Protein = transthyretin Derived from AF (AF = old F ogies)
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />


17. Tumor suppressor gene: BRCA2 chromosome? Associated tumor?
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome
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: breast cancer


18. Neoplasm: Squamous cell carcinoma of esophagus With what dz is this associated?
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
Malignant melanoma
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]


19. Female cancer epidemiology (incidence - mortality)
Breast - ovarian - and gastric carcinomas
Beta -2 microglobulin Derived from MHC class I proteins.
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)


20. Dz: Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants What is the associated neoplasm?
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.
Colonic adenocarcinoma
Gastric adenocarcinoma
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.


21. Primary tumors that metastasize to liver

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22. Malignant
The liver and lung are the most common sites of metastasis after regional LN's. Metastasis << primary liver tumors.
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy


23. Tumor markers: Alkaline phosphatase

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24. Metastasis to bone
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
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.
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
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.


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

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26. Dz: Actinic keratosis What is the associated neoplasm?
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)
Squamous cell carcinoma of the skin
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
AIDS


27. Dz: AIDS What is the associated neoplasm?

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28. Metastasis to liver

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29. Psammoma bodies
BRCA2
Renal cell carcinoma - hemangioblastoma
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
The liver and lung are the most common sites of metastasis after regional LN's. Metastasis << primary liver tumors.


30. Tumor stage

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31. Tumor nomenclature: Skeletal muscle What do you call a benign tumor of this tissue? .. a malignant one?
Ras
Rb
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma


32. Retinoblastoma - osteosarcoma What is the tumor suppressor gene?
C - myc
NF1
Rb
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.


33. Benign
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.
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
Benign and malignant lymphomas
Skin (squamous cell carcinoma) Liver (angiosarcoma)


34. Chemical carcinogens: Vinyl chloride What is the affected organ?
The liver and lung are the most common sites of metastasis after regional LN's. Metastasis << primary liver tumors.
Assoc.: Retinoblastoma - osteosarcoma
Liver (angiosarcoma)
Paget's dz of bone


35. Oncogene: bcl -2 Associated tumor?
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.
Pancreatic adenocarcinoma
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Follicular and undifferentiated lymphomas (inhibits apoptosis)


36. Neoplasm: Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma With what dz is this associated?
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
Xeroderma pigmentosum - albinism
Benign: lipoma Malignant: liposarcoma


37. Tumor suppressor gene: Rb chromosome? Associated tumor?
HBV - HCV
Assoc.: Retinoblastoma - osteosarcoma
IL-8 C5a Leukotriene B4 Kallikrein
AIDS


38. Primary tumors that metastasize to brain
Metastases to bone - obstructive biliary dz - Paget's dz of bone.
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.
Malignant lymphomas
P 16


39. Oncogene: L - myc Associated tumor?
Burkitt's lymphoma
L ung tumor
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
Cell shrinkage - nuclear shrinkage and basophilia (pyknosis) - membrane blebbing - pyknotic nuclear fragmentation (karyorrhexis) - nuclear fading (karyolysis) - and formation of apoptotic bodies - which are then phagocytosed. No significant inflammat


40. Tumor suppressor gene: BRCA1 chromosome? Associated tumor?
Assoc.: Breast and ovarian cancer
L - myc
Usually stage < grade
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia


41. Primary tumors that metasize to bone

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42. Fibrosis in inflammation
Fibroblast emigration and proliferation; deposition of ECM.
[DPC = D eleted in P ancreatic C ancer'] What is the tumor suppressor gene? DPC
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)
Adult T- cell leukemia


43. Type of amyloid protein: Medullary carcinoma of thyroid Protein? Derived from...?
Fibroblast emigration and proliferation; deposition of ECM.
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Pancreatic adenocarcinoma


44. tumor: Colon carcinoma What is the associated oncogene?
Hepatocellular carcinoma
Ras
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)
Cirrhosis (alcoholic - hepatitis B or C)


45. Tumor markers: PSA
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
Actinic keratosis
P 53
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


46. When does apoptosis occur?
Hepatocellular carcinoma
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin
Lung (mesothelioma and bronchogenic carcinoma)
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)


47. Dz: Ulcerative colitis What is the associated neoplasm?
Colonic adenocarcinoma
Barrett's esophagus (chronic GI reflux)
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.


48. Characteristics of reversible cell injury
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
Breast - ovarian - and gastric carcinomas
P 53
Small cell lung carcinoma


49. Tumor suppressor genes
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis)
Down syndrome
Esophageal adenocarcinoma


50. Wilms' tumor What is the tumor suppressor gene?
Assoc: breast cancer
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.
Sarcoma
WT1