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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. Tumor markers: S-100
Xeroderma pigmentosum - albinism
Melanoma - neural tumors - astrocytomas.
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' />
Visceral malignancy (stomach - lung - breast - uterus)

2. Neoplasm: All (we All fall Down ) AML With what dz is this associated?
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
Metastases to bone - obstructive biliary dz - Paget's dz of bone.
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Down syndrome

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

4. Paraneoplastic effects of tumors: Small cell lung carcinoma and intracranial neoplasms Causes...? Effect?
Causes: ADH Effect: SIADH
Tartrate - resistant acid phosphatase. Hairy cell leukemia -- a B- cell neoplasm. 'TRAP the hairy animal.'
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />
[DPC = D eleted in P ancreatic C ancer'] What is the tumor suppressor gene? DPC

5. Fluid exudation in inflammation
Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis)
Increase vascular permeability - vasodilation - endothelial injury.
NF1
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' />

6. Neurofibromatosis type 1 What is the tumor suppressor gene?
Membrane lipid peroxidation Protein modification DNA Breakage
NF1
HTLV-1
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)

7. Benign
Abl
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
Ulcerative colitis
Usually well - differentiated - slow growing - well - demarcated - no metastasis.

8. Tumor markers: alpha - fetoprotein
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />
Programmed cell death; ATP required. Mediated by caspases.
Actinic keratosis

9. Cancer epidemiology: Lung cancer? As a cause of death overall?
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
Thymoma - small cell lung carcinoma
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
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).

10. Free radical degradation
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
Xeroderma pigmentosum - albinism
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
Melanoma - neural tumors - astrocytomas.

11. Type of amyloid protein: Medullary carcinoma of thyroid Protein? Derived from...?
Increase in # of cells. Reversible.
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
Small cell lung carcinoma and intracranial neoplasms

12. Dz: Cirrhosis (alcoholic - hepatitis B or C) What is the associated neoplasm?
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma
Bcl -2
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

13. Tumor markers: PSA
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors
Assoc: Melanoma ('MelaN oma is N ine')

14. most human cancers - Li - Fraumeni syndrome What is the tumor suppressor gene?
Assoc: breast cancer
Acanthosis nigricans (hyperpigmentation and epidermal thickening)
P 53
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)

15. Primary tumors that metastasize to liver

16. Metastasis to brain
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
Beta - amyloid Derived from amyloid precursor protein (APP)

17. Dz: Immunodeficiency states What is the associated neoplasm?
Fibrous tissue formation in response to a neoplasm. Irreversible.
Malignant lymphomas
HTLV-1
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)

18. Desmoplasia
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Fibrous tissue formation in response to a neoplasm. Irreversible.
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' />

19. Chemical carcinogens: Asbestos What is the affected organ?
Prostate carcinoma.
Beta - amyloid Derived from amyloid precursor protein (APP)
Malignant melanoma
Lung (mesothelioma and bronchogenic carcinoma)

20. When does apoptosis occur?
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)
Usually stage < grade
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.

21. Anaplasia
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.
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'
Benign: Osteoma Malignant: osteosarcoma
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome

22. Metaplasia

23. Melanoma - What is the tumor suppressor gene?
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
P 16
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC

24. Migration (step 4 in leukocyte extravasation)

25. tumor: Burkitt's lymphoma What is the associated oncogene?
HHV-8
Normal cells w/ basal --< apical differentiation <img src='220a.JPG' />
Radiation exposure
C - myc

26. Oncogene: abl Associated tumor?
Beta -2 microglobulin Derived from MHC class I proteins.
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)
CML
Gain of fxn --< cancer. Need damage to only 1 allele.

27. Neoplasm: Gastric adenocarcinoma With what dz is this associated?
Pancreatic adenocarcinoma
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
IL-8 C5a Leukotriene B4 Kallikrein
Fibrous tissue formation in response to a neoplasm. Irreversible.

28. Free radical injury induces cell injury thru...?
Membrane lipid peroxidation Protein modification DNA Breakage
AIDS
Ovarian - malignant epithelial tumors
NF1

29. Neoplastic progression: step 3 Invasive carcinoma

30. Neoplasm: Malignant lymphomas With what dz is this associated?
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Immunodeficiency states
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)

31. Paraneoplastic effects of tumors: Leukemias and lymphomas Causes...? Effect?
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
Benign and malignant lymphomas
Liver (hepatocellular carcinoma)
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy

32. Chemical carcinogens: Nitrosamines (e.g. - in smoked foods) What is the affected organ?
Small cell lung carcinoma
Esophagus - stomach
Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma
Renal cell carcinoma - hemangioblastoma

33. Tumor nomenclature: Skeletal muscle What do you call a benign tumor of this tissue? .. a malignant one?
Down syndrome
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
Assoc: Neurofibromatosis 2 ('Type 2 = 22')

34. Tumor markers: Prostatic acid phospatase
Prostate carcinoma.
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
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' />
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.

35. Apoptosis (definition)
Assoc: Neurofibromatosis type 1
Programmed cell death; ATP required. Mediated by caspases.
HHV-8
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.

36. Neurofibromatosis 2 ('Type 2 = 22') What is the tumor suppressor gene?
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.
Chr. 11p Assoc: Wilms' tumor
NF2
Gain of fxn --< cancer. Need damage to only 1 allele.

37. Chemical carcinogens: Naphthalene (aniline) dyes What is the affected organ?
EBV
Bladder (transitional cell carcinoma)
Gastrointestinal stromal tumor (GIST)
Liver (centrilobular necrosis - fatty change)

38. Neoplasm: Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin With what dz is this associated?
Bcl -2
Follicular and undifferentiated lymphomas (inhibits apoptosis)
Tartrate - resistant acid phosphatase. Hairy cell leukemia -- a B- cell neoplasm. 'TRAP the hairy animal.'
Xeroderma pigmentosum - albinism

39. Primary tumors that metasize to bone

40. Metastasis to liver

41. Rolling (step 1 in leukocyte extravasation)

42. Tumor nomenclature: Fat What do you call a benign tumor of this tissue? .. a malignant one?
Xeroderma pigmentosum - albinism
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.
Benign: lipoma Malignant: liposarcoma
P 53

43. Tumor suppressor gene: p 53 chromosome? Associated tumor?
Lung (mesothelioma and bronchogenic carcinoma)
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Increase in # of cells. Reversible.

44. Dz: Xeroderma pigmentosum - albinism What is the associated neoplasm?
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin
Hepatocellular carcinoma
CML
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)

45. Neoplastic progression: step 4 Metastasis

46. Tight binding (step 2 of leukocyte extravasation)

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

48. Acute inflammation
Beta -2 microglobulin Derived from MHC class I proteins.
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
Membrane lipid peroxidation Protein modification DNA Breakage
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.

49. Tumor suppressor genes
CML
Benign: -- Malignant: Leukemia - lymphoma
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Immunodeficiency states

50. Neoplasm: Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma With what dz is this associated?
AIDS
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).
Actinic keratosis
Radiation exposure