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. Male cancer epidemiology (incidence - mortality)
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' />
HBV - HCV
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Adult T- cell leukemia


2. Oncogenic viruses: HTLV-1 What is the associated cancer?
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Prostate carcinoma.
IL-8 C5a Leukotriene B4 Kallikrein
Adult T- cell leukemia


3. Neoplasm: Gastric adenocarcinoma With what dz is this associated?
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Beta - amyloid Derived from amyloid precursor protein (APP)
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy


4. Dz: Paget's dz of bone What is the associated neoplasm?
Assoc: Melanoma ('MelaN oma is N ine')
Renal cell carcinoma - hemangioblastoma
Benign: Osteoma Malignant: osteosarcoma
Secondary osteosarcoma and fibrosarcoma


5. Tumor suppressor gene: APC chromosome? Associated tumor?
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
Pancreatic adenocarcinoma
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
Assoc: Colorectal cancer (assoc w/ FAP)


6. When does apoptosis occur?
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)
Melanoma - neural tumors - astrocytomas.
Amylin protein Derived from AE (AE = E ndocrine)
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability


7. Oncogene: L - myc Associated tumor?
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
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
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
L ung tumor


8. Metastasis to bone
Increase in # of cells. Reversible.
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.


9. tumor: Burkitt's lymphoma What is the associated oncogene?
Programmed cell death; ATP required. Mediated by caspases.
Usually stage < grade
Chr. 11p Assoc: Wilms' tumor
C - myc


10. 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.
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
L - myc
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)


11. Cancer epidemiology: Lung cancer? As a cause of death overall?
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
Assoc: Colorectal cancer (assoc w/ FAP)
BRCA2
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).


12. Tumor nomenclature: Fat What do you call a benign tumor of this tissue? .. a malignant one?
Benign: lipoma Malignant: liposarcoma
Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.
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' />


13. tumor: Follicular and undifferentiated lymphomas (inhibits apoptosis) What is the associated oncogene?
Bcl -2
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia
Assoc.: Retinoblastoma - osteosarcoma
Prostate carcinoma.


14. Anaplasia
Leukemias and lymphomas
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.
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
Acanthosis nigricans (hyperpigmentation and epidermal thickening)


15. Necrosis morphologies
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia
Small cell lung carcinoma
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
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


16. Type of amyloid protein: Senile cardiac Protein? Derived from...?
Protein = transthyretin Derived from AF (AF = old F ogies)
Xeroderma pigmentosum - albinism
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors


17. Tumor suppressor gene: DCC chromosome? Associated tumor?
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.
Erb - B2
Leukocyte travels btw endothelial cells and exits blood vessel; PECAM-1 is involved. <img src='218a.JPG' />
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]


18. Oncogenes
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
Increase in # of cells. Reversible.
Leukemias and lymphomas
Gain of fxn --< cancer. Need damage to only 1 allele.


19. 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)
Follicular and undifferentiated lymphomas (inhibits apoptosis)
WT1
Liver (centrilobular necrosis - fatty change)


20. Granulomatous dz's

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21. Tumor markers: CA-19-9
Pancreatic adenocarcinoma
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
Barrett's esophagus (chronic GI reflux)
Assoc: Neurofibromatosis type 1


22. Neoplasm: Colonic adenocarcinoma With what dz is this associated?
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome
Ulcerative colitis
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.
Sarcoma


23. How should tumor markers be used clinically?
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.
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.
Usually stage < grade
Visceral malignancy (stomach - lung - breast - uterus)


24. Rolling (step 1 in leukocyte extravasation)

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25. Leukocyte extravasation

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26. Dz: Tuberous sclerosis (facial angiofibroma - seizures - mental retardation) What is the associated neoplasm?
Follicular and undifferentiated lymphomas (inhibits apoptosis)
Assoc.: Breast and ovarian cancer
Gain of fxn --< cancer. Need damage to only 1 allele.
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma


27. Oncogene: abl Associated tumor?
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'
CML
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors


28. Neoplasm: Malignant lymphomas With what dz is this associated?
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia
Dysplastic nevus
Immunodeficiency states
N euroblastoma


29. Free radical injury induces cell injury thru...?
Burkitt's lymphoma
[DPC = D eleted in P ancreatic C ancer'] What is the tumor suppressor gene? DPC
Sarcoma
Membrane lipid peroxidation Protein modification DNA Breakage


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

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31. Cervical carcinoma (types 16 - 18) Penile/anal carcinoma What is the assocciated oncogenic virus?
CML
P 16
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
HPV


32. Causes: Erythropoietin Effect: Polycythemia What neoplasm would create this paraneoplastic effect?
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Renal cell carcinoma - hemangioblastoma
Hepatocellular carcinoma
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' />


33. most human cancers - Li - Fraumeni syndrome What is the tumor suppressor gene?
Fibroblast emigration and proliferation; deposition of ECM.
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'
Liver (centrilobular necrosis - fatty change)
P 53


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

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35. Tumor nomenclature: Skeletal muscle What do you call a benign tumor of this tissue? .. a malignant one?
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.
Leukocyte travels btw endothelial cells and exits blood vessel; PECAM-1 is involved. <img src='218a.JPG' />
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma


36. Neoplastic progression: step 1 Hyperplasia/dysplasia

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37. Necrosis (definition)
Colonic adenocarcinoma
Breast - ovarian - and gastric carcinomas
Tartrate - resistant acid phosphatase. Hairy cell leukemia -- a B- cell neoplasm. 'TRAP the hairy animal.'
Enzymatic degradation of a cell resulting from exogenous injury.


38. Dz: Ulcerative colitis What is the associated neoplasm?
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
C - kit
Colonic adenocarcinoma
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.


39. Tumor markers: TRAP

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40. [aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma What is the assocciated oncogenic virus?
[DPC = D eleted in P ancreatic C ancer'] What is the tumor suppressor gene? DPC
HHV-8
Multiple endocrine neoplasia (MEN) types II and III
The liver and lung are the most common sites of metastasis after regional LN's. Metastasis << primary liver tumors.


41. Type of amyloid protein: Alzheimer's dz Protein? Derived from...?
HHV-8
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Beta - amyloid Derived from amyloid precursor protein (APP)
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation


42. Tumor markers: Prostatic acid phospatase
Prostate carcinoma.
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
Acanthosis nigricans (hyperpigmentation and epidermal thickening)
L ung tumor


43. Oncogene: c - myc Associated tumor?

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44. Dz: Down syndrome What is the associated neoplasm?
All (we All fall Down ) AML
Metastasis = Spread to distant organ Must survive immune attack. 'Seed and soil' theory of metastasis: Seed = tumor embolus Soil = target organ -- liver - lungs - bone - brain... Angiogenesis allows for tumor survival Decr cadherin - Increase laminin
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
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. Tight binding (step 2 of leukocyte extravasation)

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46. Tumor markers: CA-125
Metastasis = Spread to distant organ Must survive immune attack. 'Seed and soil' theory of metastasis: Seed = tumor embolus Soil = target organ -- liver - lungs - bone - brain... Angiogenesis allows for tumor survival Decr cadherin - Increase laminin
Ovarian - malignant epithelial tumors
Small cell lung carcinoma and intracranial neoplasms
Tartrate - resistant acid phosphatase. Hairy cell leukemia -- a B- cell neoplasm. 'TRAP the hairy animal.'


47. Chemical carcinogens: Asbestos What is the affected organ?
Lung (mesothelioma and bronchogenic carcinoma)
Rb
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
Usually well - differentiated - slow growing - well - demarcated - no metastasis.


48. Causes: ADH Effect: SIADH What neoplasm would create this paraneoplastic effect?
Small cell lung carcinoma and intracranial neoplasms
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' />
Ras
Xeroderma pigmentosum - albinism


49. Characteristics of reversible cell injury
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
Burkitt's lymphoma nasopharyngeal carcinoma
Chr. 11p Assoc: Wilms' tumor
Esophageal adenocarcinoma


50. Chemical carcinogens: Cigarette smoke What is the affected organ?
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)
Beta - amyloid Derived from amyloid precursor protein (APP)
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)
N - myc