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 suppressor gene: WT1 chromosome? Associated tumor?

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2. 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)
Skin (squamous cell carcinoma) Liver (angiosarcoma)
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.


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
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Benign and malignant lymphomas
Colon carcinoma


4. Oncogene: ras Associated tumor?
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.
Skin (squamous cell carcinoma) Liver (angiosarcoma)
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
Colon carcinoma


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

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6. Characteristics of trans udate
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.
BRCA1
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention
HPV


7. Characteristics of irreversible cell injury
C - kit
Fibroblast emigration and proliferation; deposition of ECM.
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
Increase in # of cells. Reversible.


8. Dz: AIDS What is the associated neoplasm?

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

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10. Colon cancer
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
Leukocyte travels btw endothelial cells and exits blood vessel; PECAM-1 is involved. <img src='218a.JPG' />
Multiple endocrine neoplasia (MEN) types II and III
Esophageal adenocarcinoma


11. Tumor markers: alpha - fetoprotein
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
Assoc: Pancreatic cancer [DPC = D eleted in P ancreatic C ancer']
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
Protein = transthyretin Derived from AF (AF = old F ogies)


12. Hepatocellular carcinoma What is the assocciated oncogenic virus?
Multiple endocrine neoplasia (MEN) types II and III
Loss of fxn --< cancer; both allels must be lost for expression of dz.
HBV - HCV
Lung (mesothelioma and bronchogenic carcinoma)


13. Resolution of inflammation
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.
Pancreatic adenocarcinoma
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
Squamous cell carcinoma of the skin


14. Type of amyloid protein: Dialysis - associated Protein? Derived from...?
Beta -2 microglobulin Derived from MHC class I proteins.
[DPC = D eleted in P ancreatic C ancer'] What is the tumor suppressor gene? DPC
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
Normal cells w/ basal --< apical differentiation <img src='220a.JPG' />


15. Dz: Ulcerative colitis What is the associated neoplasm?
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).
Colonic adenocarcinoma
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
Abl


16. Benign
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.
Sarcoma
Hepatocellular carcinoma
Usually well - differentiated - slow growing - well - demarcated - no metastasis.


17. Chemical carcinogens: Nitrosamines (e.g. - in smoked foods) 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
Benign and malignant lymphomas
Esophagus - stomach
Gastrointestinal stromal tumor (GIST)


18. Neoplastic progression: step 1 Hyperplasia/dysplasia

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19. Melanoma - What is the tumor suppressor gene?
Bladder (transitional cell carcinoma)
Squamous cell carcinoma of esophagus
P 16
Rb


20. Neoplasm: Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma With what dz is this associated?
Esophagus - stomach
Benign and malignant lymphomas
EBV
AIDS


21. Tumor suppressor gene: BRCA2 chromosome? Associated tumor?
Small cell lung carcinoma
Normal cells w/ basal --< apical differentiation <img src='220a.JPG' />
L - myc
Assoc: breast cancer


22. Tumor nomenclature: Bone What do you call a benign tumor of this tissue? .. a malignant one?
Benign: Osteoma Malignant: osteosarcoma
Fibroblast emigration and proliferation; deposition of ECM.
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
EBV


23. 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
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.
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' />
Beta - amyloid Derived from amyloid precursor protein (APP)


24. Dz: Xeroderma pigmentosum - albinism What is the associated neoplasm?
C - myc
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)


25. Paraneoplastic effects of tumors: Small cell lung carcinoma and intracranial neoplasms Causes...? Effect?
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Skin (squamous cell carcinoma) Liver (angiosarcoma)
Esophagus - stomach
Causes: ADH Effect: SIADH


26. Dz: Barrett's esophagus (chronic GI reflux) What is the associated neoplasm?
Esophageal adenocarcinoma
Liver (angiosarcoma)
N euroblastoma
Secondary osteosarcoma and fibrosarcoma


27. Tumor markers: S-100
Benign: Osteoma Malignant: osteosarcoma
Chr. 11p Assoc: Wilms' tumor
Melanoma - neural tumors - astrocytomas.
NF2


28. Leukocyte activation in inflammation
Increase vascular permeability - vasodilation - endothelial injury.
Burkitt's lymphoma
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.
NF1


29. Apoptosis (definition)
Adult T- cell leukemia
Beta - amyloid Derived from amyloid precursor protein (APP)
Cirrhosis (alcoholic - hepatitis B or C)
Programmed cell death; ATP required. Mediated by caspases.


30. Malignant
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
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.
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.
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


31. Male cancer epidemiology (incidence - mortality)
Liver (hepatocellular carcinoma)
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)


32. Type of amyloid protein: DM2 Protein? Derived from...?
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
Benign: -- Malignant: Leukemia - lymphoma
Assoc: breast cancer
Amylin protein Derived from AE (AE = E ndocrine)


33. Neoplasm: Visceral malignancy (stomach - lung - breast - uterus) With what dz is this associated?
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
Immunodeficiency states
Acanthosis nigricans (hyperpigmentation and epidermal thickening)


34. Tumor markers: TRAP

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35. Type of amyloid protein: Secondary Protein? Derived from...?
WT1
Benign and malignant lymphomas
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)


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

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37. Adult T- cell leukemia What is the assocciated oncogenic virus?
Assoc: Melanoma ('MelaN oma is N ine')
Normal cells w/ basal --< apical differentiation <img src='220a.JPG' />
HTLV-1
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma


38. Tumor markers: PSA
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Assoc: Neurofibromatosis 2 ('Type 2 = 22')
N - myc


39. Desmoplasia
Down syndrome
Fibrous tissue formation in response to a neoplasm. Irreversible.
Squamous cell carcinoma of the skin
Cells have invaded basement membrane using collagenases and hydrolases Can metastasize if they reach a blood or lymphatic vessel <img src='220d.JPG' />


40. Colorectal cancer (assoc w/ FAP) What is the tumor suppressor gene?
Assoc: Neurofibromatosis type 1
C - kit
APC
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)


41. Tumor grade
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.
Pancreatic adenocarcinoma
Lung (mesothelioma and bronchogenic carcinoma)
P 53


42. Oncogene: c - myc Associated tumor?

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43. Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy What neoplasm would create this paraneoplastic effect?
Leukemias and lymphomas
Immunodeficiency states
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
[aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma


44. Tumor nomenclature: Skeletal muscle What do you call a benign tumor of this tissue? .. a malignant one?
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Assoc: breast cancer
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.
Hepatocellular carcinoma


45. Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness) What neoplasm would create this paraneoplastic effect?
Thymoma - small cell lung carcinoma
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).
Chr. 11p Assoc: Wilms' tumor
Burkitt's lymphoma nasopharyngeal carcinoma


46. Tumor suppressor gene: p 53 chromosome? Associated tumor?
IL-8 C5a Leukotriene B4 Kallikrein
Benign: lipoma Malignant: liposarcoma
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.


47. Chemical carcinogens: Vinyl chloride What is the affected organ?
Prostate carcinoma.
Liver (angiosarcoma)
Actinic keratosis
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)


48. Amyloid structure
IL-8 C5a Leukotriene B4 Kallikrein
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
Squamous cell carcinoma of esophagus
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.


49. Tumor nomenclature: Blood cells What do you call a benign tumor of this tissue? .. a malignant one?
CML
Liver (hepatocellular carcinoma)
Membrane lipid peroxidation Protein modification DNA Breakage
Benign: -- Malignant: Leukemia - lymphoma


50. 5 Characteristic signs of inflammation
Dysplastic nevus
Membrane lipid peroxidation Protein modification DNA Breakage
Assoc.: Retinoblastoma - osteosarcoma
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)