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: Malignant melanoma With what dz is this associated?
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).
Multiple endocrine neoplasia (MEN) types II and III
Dysplastic nevus
Thymoma - small cell lung carcinoma


2. tumor: Breast - ovarian - and gastric carcinomas What is the associated oncogene?
Erb - B2
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
APC


3. Rolling (step 1 in leukocyte extravasation)

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4. Tumor suppressor gene: p 53 chromosome? Associated tumor?
Esophagus - stomach
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.
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change


5. Neurofibromatosis 2 ('Type 2 = 22') What is the tumor suppressor gene?
Down syndrome
T = size of T umor N = N ode involvement M = M etastases
Fibroblast emigration and proliferation; deposition of ECM.
NF2


6. Fibrosis in inflammation
Squamous cell carcinoma of the skin
All (we All fall Down ) AML
Fibroblast emigration and proliferation; deposition of ECM.
Cells have increased in # (hyperplasia ) Abnormal proliferation of cells w/ loss of size - shape - and orientation (dysplasia ) <img src='220b.JPG' />


7. Oncogenic viruses: HPV What is the associated cancer?
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Increase in # of cells. Reversible.
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.
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.


8. Dz: Paget's dz of bone What is the associated neoplasm?
Ret
Secondary osteosarcoma and fibrosarcoma
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.
Ulcerative colitis


9. tumor: Gastrointestinal stromal tumor (GIST) What is the associated oncogene?
Small cell lung carcinoma
Immunodeficiency states
Erb - B2
C - kit


10. tumor: Colon carcinoma What is the associated oncogene?
Benign: hemangioma Malignant: Angiosarcoma
Ras
Beta -2 microglobulin Derived from MHC class I proteins.
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.


11. Dz: Down syndrome What is the associated neoplasm?
Blood (leukemia)
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)
All (we All fall Down ) AML
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' />


12. Dz: Barrett's esophagus (chronic GI reflux) What is the associated neoplasm?
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
Burkitt's lymphoma nasopharyngeal carcinoma
Esophageal adenocarcinoma
Xeroderma pigmentosum - albinism


13. Oncogenic viruses: HBV - HCV What is the associated cancer?
Hepatocellular carcinoma
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.
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' />


14. Neoplasm: Sarcoma With what dz is this associated?
Small cell lung carcinoma and intracranial neoplasms
Radiation exposure
Abl
Benign: Osteoma Malignant: osteosarcoma


15. Neoplasm: All (we All fall Down ) AML With what dz is this associated?
Down syndrome
CML
Pancreatic adenocarcinoma
Benign and malignant lymphomas


16. Apoptosis is characterized by...?
NF1
Radiation exposure
Bcl -2
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


17. Carcinoma vs. sarcoma
Gastrointestinal stromal tumor (GIST)
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy


18. Oncogenes
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
Squamous cell carcinoma of esophagus
[DPC = D eleted in P ancreatic C ancer'] What is the tumor suppressor gene? DPC
Gain of fxn --< cancer. Need damage to only 1 allele.


19. Wilms' tumor What is the tumor suppressor gene?
BRCA1
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.
C - kit
WT1


20. Hyperplasia
Amylin protein Derived from AE (AE = E ndocrine)
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
Increase in # of cells. Reversible.
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors


21. Amyloid structure
Esophagus - stomach
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.
Fibrous tissue formation in response to a neoplasm. Irreversible.


22. Chronic inflammation
Skin (squamous cell carcinoma) Liver (angiosarcoma)
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)


23. Hypovolemic/cardiogenic shock
Chr. 11p Assoc: Wilms' tumor
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
Renal cell carcinoma - hemangioblastoma
Malignant melanoma


24. Chemical carcinogens: Alkylating agents What is the affected organ?
Programmed cell death; ATP required. Mediated by caspases.
Blood (leukemia)
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
Thymoma - small cell lung carcinoma


25. Chemical carcinogens: Asbestos What is the affected organ?
Lung (mesothelioma and bronchogenic carcinoma)
Colonic adenocarcinoma
Blood (leukemia)
Benign: hemangioma Malignant: Angiosarcoma


26. Paraneoplastic effects of tumors: Leukemias and lymphomas Causes...? Effect?
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy
Thymoma - small cell lung carcinoma
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.


27. Chemical carcinogens: Vinyl chloride What is the affected organ?
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Liver (angiosarcoma)
Esophagus - stomach
Metastases to bone - obstructive biliary dz - Paget's dz of bone.


28. Dz: Xeroderma pigmentosum - albinism What is the associated neoplasm?
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin
IL-8 C5a Leukotriene B4 Kallikrein
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants


29. Characteristics of irreversible cell injury
Small cell lung carcinoma and intracranial neoplasms
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.
Assoc: Melanoma ('MelaN oma is N ine')
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability


30. Oncogene: abl Associated tumor?
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.
CML
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'
Malignant melanoma


31. Neoplasia
Abl
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
Immunodeficiency states
Causes: ADH Effect: SIADH


32. Tumor nomenclature: Bone What do you call a benign tumor of this tissue? .. a malignant one?
Esophagus - stomach
Benign: Osteoma Malignant: osteosarcoma
Enzymatic degradation of a cell resulting from exogenous injury.
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)


33. Type of amyloid protein: DM2 Protein? Derived from...?
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.
Assoc: Neurofibromatosis 2 ('Type 2 = 22')
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.
Amylin protein Derived from AE (AE = E ndocrine)


34. Chemical carcinogens: Nitrosamines (e.g. - in smoked foods) What is the affected organ?
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
Esophagus - stomach
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />


35. Tumor stage

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

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37. Neoplastic progression: step 2 In situ carcinoma

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38. Apoptosis (definition)
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome
Programmed cell death; ATP required. Mediated by caspases.
Ras
Small cell lung carcinoma


39. Granulomatous dz's

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40. Necrosis morphologies
Barrett's esophagus (chronic GI reflux)
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)
T = size of T umor N = N ode involvement M = M etastases
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)


41. Metastasis to bone
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.
Cells have increased in # (hyperplasia ) Abnormal proliferation of cells w/ loss of size - shape - and orientation (dysplasia ) <img src='220b.JPG' />
P 53
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.


42. Oncogene: bcl -2 Associated tumor?
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
Causes: Erythropoietin Effect: Polycythemia
Follicular and undifferentiated lymphomas (inhibits apoptosis)


43. Neoplasm: Malignant lymphomas With what dz is this associated?
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.
N euroblastoma
Immunodeficiency states
Malignant lymphomas


44. Tumor markers: Alkaline phosphatase

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45. Dz: Ulcerative colitis What is the associated neoplasm?
Sarcoma
Ulcerative colitis
Colonic adenocarcinoma
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.


46. Characteristics of ex udate
Assoc: breast cancer
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation
Paget's dz of bone


47. Neoplastic progression: step 4 Metastasis

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48. Cancer epidemiology: Lung cancer? As a cause of death overall?
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).
Increase in # of cells. Reversible.
Assoc: Melanoma ('MelaN oma is N ine')
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).


49. Tumor nomenclature: Smooth muscle 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.
BRCA2
Benign: Leiomyoma Malignant: Leiomyosarcoma
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.


50. Tumor markers: CEA
Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis)
Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)