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. Neoplasm: Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin With what dz is this associated?
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' />
Ras
Benign: hemangioma Malignant: Angiosarcoma
Xeroderma pigmentosum - albinism


2. Neoplasm: Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma With what dz is this associated?
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
Cells have increased in # (hyperplasia ) Abnormal proliferation of cells w/ loss of size - shape - and orientation (dysplasia ) <img src='220b.JPG' />
Esophagus - stomach


3. Metastasis to bone
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)
Gastric adenocarcinoma
Esophageal adenocarcinoma
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.


4. Oncogene: c - kit Associated tumor?
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
[DPC = D eleted in P ancreatic C ancer'] What is the tumor suppressor gene? DPC
Melanoma - neural tumors - astrocytomas.
Gastrointestinal stromal tumor (GIST)


5. 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
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
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.
WT1


6. Oncogene: bcl -2 Associated tumor?
L ung tumor
Neuorblastoma - lung - and gastric cancer.
Assoc.: Breast and ovarian cancer
Follicular and undifferentiated lymphomas (inhibits apoptosis)


7. Chronic inflammation
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
Liver (hepatocellular carcinoma)
Assoc.: Retinoblastoma - osteosarcoma
Skin (squamous cell carcinoma) Liver (angiosarcoma)


8. tumor: N euroblastoma What is the associated oncogene?
Sarcoma
N - myc
[aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma
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.


9. Leukocyte extravasation

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10. Dz: Cirrhosis (alcoholic - hepatitis B or C) What is the associated neoplasm?
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)
Hepatocellular carcinoma
Erb - B2
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention


11. Hyperplasia
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
Increase in # of cells. Reversible.
Metastases to bone - obstructive biliary dz - Paget's dz of bone.
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.


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

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13. Hypovolemic/cardiogenic shock
BRCA2
Beta -2 microglobulin Derived from MHC class I proteins.
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.


14. Dz: Ulcerative colitis What is the associated neoplasm?
Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma
Colonic adenocarcinoma
[DPC = D eleted in P ancreatic C ancer'] What is the tumor suppressor gene? DPC
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.


15. Oncogenes
Gain of fxn --< cancer. Need damage to only 1 allele.
Ovarian - malignant epithelial tumors
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)


16. Carcinoma vs. sarcoma
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />
Gastric adenocarcinoma


17. Chemical carcinogens: Cigarette smoke What is the affected organ?
Assoc: Pancreatic cancer [DPC = D eleted in P ancreatic C ancer']
Liver (hepatocellular carcinoma)
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)


18. Neoplastic progression: step 2 In situ carcinoma

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19. Type of amyloid protein: Senile cardiac Protein? Derived from...?
Protein = transthyretin Derived from AF (AF = old F ogies)
Lung (mesothelioma and bronchogenic carcinoma)
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />
Breast - ovarian - and gastric carcinomas


20. Neoplastic progression: step 1 Hyperplasia/dysplasia

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21. Tumor markers: PSA
Beta - amyloid Derived from amyloid precursor protein (APP)
Gastrointestinal stromal tumor (GIST)
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.


22. Which usually has more prognostic value - tumor stage or grade?
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' />
Usually stage < grade
BRCA2
Dysplastic nevus


23. Apoptosis (definition)
Programmed cell death; ATP required. Mediated by caspases.
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
Melanoma - neural tumors - astrocytomas.
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma


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

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25. Type of amyloid protein: Dialysis - associated Protein? Derived from...?
Gastric adenocarcinoma
Beta -2 microglobulin Derived from MHC class I proteins.
Assoc: Neurofibromatosis type 1
EBV


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

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27. Resolution of inflammation
Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma
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.
Blood (leukemia)


28. Tumor nomenclature: Fat What do you call a benign tumor of this tissue? .. a malignant one?
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.
Xeroderma pigmentosum - albinism
EBV
Benign: lipoma Malignant: liposarcoma


29. Neoplastic progression: step 3 Invasive carcinoma

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30. Neoplasm: Malignant lymphomas With what dz is this associated?
Immunodeficiency states
Causes: ADH Effect: SIADH
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
Down syndrome


31. Tumor markers: CA-125
C - kit
Ovarian - malignant epithelial tumors
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
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.


32. most human cancers - Li - Fraumeni syndrome What is the tumor suppressor gene?
P 53
The liver and lung are the most common sites of metastasis after regional LN's. Metastasis << primary liver tumors.
BRCA2
WT1


33. Free radical degradation
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
Liver (centrilobular necrosis - fatty change)
Causes: ADH Effect: SIADH
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.


34. Dz: AIDS What is the associated neoplasm?

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35. Tumor suppressor gene: p 53 chromosome? Associated tumor?
Thymoma - small cell lung carcinoma
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy


36. [aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma What is the assocciated oncogenic virus?
C - kit
Benign: lipoma Malignant: liposarcoma
HHV-8
Barrett's esophagus (chronic GI reflux)


37. Burkitt's lymphoma nasopharyngeal carcinoma What is the assocciated oncogenic virus?
Hepatocellular carcinoma
Ret
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia
EBV


38. Wilms' tumor What is the tumor suppressor gene?
Xeroderma pigmentosum - albinism
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'
T = size of T umor N = N ode involvement M = M etastases
WT1


39. Oncogene: ras Associated tumor?
Colon carcinoma
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Assoc: Melanoma ('MelaN oma is N ine')
Lung (mesothelioma and bronchogenic carcinoma)


40. Dz: Acanthosis nigricans (hyperpigmentation and epidermal thickening) What is the associated neoplasm?
Hepatocellular carcinoma
Visceral malignancy (stomach - lung - breast - uterus)
Cirrhosis (alcoholic - hepatitis B or C)
NF2


41. When does apoptosis occur?
Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)
L ung tumor


42. Oncogene: L - myc Associated tumor?
Assoc: Pancreatic cancer [DPC = D eleted in P ancreatic C ancer']
HBV - HCV
L ung tumor
Adult T- cell leukemia


43. Dz: Xeroderma pigmentosum - albinism What is the associated neoplasm?
Leukocyte travels btw endothelial cells and exits blood vessel; PECAM-1 is involved. <img src='218a.JPG' />
All (we All fall Down ) AML
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin
Malignant melanoma


44. Tumor suppressor gene: NF1 chromosome? Associated tumor?
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' />
Squamous cell carcinoma of the skin
Assoc: Neurofibromatosis type 1
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


45. Tumor suppressor gene: p 16 chromosome? Associated tumor?

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46. Chemical carcinogens: Vinyl chloride What is the affected organ?
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
Liver (angiosarcoma)
Pancreatic adenocarcinoma
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.


47. tumor: Gastrointestinal stromal tumor (GIST) What is the associated oncogene?
C - kit
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
Leukemias and lymphomas


48. Oncogene: N - myc Associated tumor?
Protein = transthyretin Derived from AF (AF = old F ogies)
N euroblastoma
Malignant melanoma
HPV


49. 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
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
All (we All fall Down ) AML
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)


50. Migration (step 4 in leukocyte extravasation)

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