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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. Oncogenic viruses: HTLV-1 What is the associated cancer?
APC
Adult T- cell leukemia
Increase in # of cells. Reversible.
Fibroblast emigration and proliferation; deposition of ECM.

2. Type of amyloid protein: Alzheimer's dz Protein? Derived from...?
Abl
Beta - amyloid Derived from amyloid precursor protein (APP)
Squamous cell carcinoma of the skin
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.

3. Dz: Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis) 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).
Xeroderma pigmentosum - albinism
Benign and malignant lymphomas
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.

4. Oncogene: c - myc Associated tumor?

5. Substances that are chemotactic for neutrophils
Leukocyte travels btw endothelial cells and exits blood vessel; PECAM-1 is involved. <img src='218a.JPG' />
IL-8 C5a Leukotriene B4 Kallikrein
Radiation exposure
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)

6. Neoplastic progression: step 4 Metastasis

7. tumor: Burkitt's lymphoma What is the associated oncogene?
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
C - myc
Skin (squamous cell carcinoma) Liver (angiosarcoma)
Loss of fxn --< cancer; both allels must be lost for expression of dz.

8. Oncogene: ret Associated tumor?
Multiple endocrine neoplasia (MEN) types II and III
Gastric adenocarcinoma
AIDS
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.

9. Cervical carcinoma (types 16 - 18) Penile/anal carcinoma What is the assocciated oncogenic virus?
Metastases to bone - obstructive biliary dz - Paget's dz of bone.
NF2
HPV
Fibroblast emigration and proliferation; deposition of ECM.

10. Neoplasm: Colonic adenocarcinoma With what dz is this associated?
Small cell lung carcinoma
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'
Assoc: Pancreatic cancer [DPC = D eleted in P ancreatic C ancer']
Ulcerative colitis

11. When does apoptosis occur?
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)
HHV-8
Down syndrome

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

13. Necrosis morphologies
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
Radiation exposure
BRCA2
Gain of fxn --< cancer. Need damage to only 1 allele.

14. Chemical carcinogens: Aflatoxins (produced by Aspergillus) What is the affected organ?
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)
Paget's dz of bone
Liver (hepatocellular carcinoma)
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.

15. Oncogenes
Gain of fxn --< cancer. Need damage to only 1 allele.
Cirrhosis (alcoholic - hepatitis B or C)
Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.

16. Free radical injury induces cell injury thru...?
Secondary osteosarcoma and fibrosarcoma
Amylin protein Derived from AE (AE = E ndocrine)
Immunodeficiency states
Membrane lipid peroxidation Protein modification DNA Breakage

17. Diapedesis (step 3 in leukocyte extravasation)

18. Dz: AIDS What is the associated neoplasm?

19. Dz: Tuberous sclerosis (facial angiofibroma - seizures - mental retardation) What is the associated neoplasm?
Benign: lipoma Malignant: liposarcoma
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.

20. Breast and ovarian cancer 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.
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)

21. 5 Characteristic signs of inflammation
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />
Protein = transthyretin Derived from AF (AF = old F ogies)
Thymoma - small cell lung carcinoma

22. Migration (step 4 in leukocyte extravasation)

23. Dz: Down syndrome What is the associated neoplasm?
All (we All fall Down ) AML
Protein = transthyretin Derived from AF (AF = old F ogies)
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Thymoma - small cell lung carcinoma

24. Burkitt's lymphoma nasopharyngeal carcinoma What is the assocciated oncogenic virus?
Lung (mesothelioma and bronchogenic carcinoma)
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
Colon carcinoma
EBV

25. Tumor grade
Immunodeficiency states
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
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.
Liver (centrilobular necrosis - fatty change)

26. Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia What neoplasm would create this paraneoplastic effect?
Gain of fxn --< cancer. Need damage to only 1 allele.
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).
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
Benign: Leiomyoma Malignant: Leiomyosarcoma

27. 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.
Follicular and undifferentiated lymphomas (inhibits apoptosis)
Fibrous tissue formation in response to a neoplasm. Irreversible.
Liver (angiosarcoma)

28. Leukocyte activation in inflammation
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.
Barrett's esophagus (chronic GI reflux)
C - kit

29. Chemical carcinogens: CCl4 What is the affected organ?
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.
Liver (centrilobular necrosis - fatty change)
APC
Colonic adenocarcinoma

30. Neoplasm: Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma With what dz is this associated?
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.
Follicular and undifferentiated lymphomas (inhibits apoptosis)
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin

31. Tumor markers: Bombesin
Erb - B2
Neuorblastoma - lung - and gastric cancer.
Blood (leukemia)
Paget's dz of bone

32. Tumor nomenclature: Bone What do you call a benign tumor of this tissue? .. a malignant one?
Benign: Osteoma Malignant: osteosarcoma
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.
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
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.

33. Wilms' tumor What is the tumor suppressor gene?
Leukemias and lymphomas
WT1
Programmed cell death; ATP required. Mediated by caspases.
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).

34. Metastasis to brain
Radiation exposure
Colon carcinoma
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.

35. Granulomatous dz's

36. Colon cancer
Hepatocellular carcinoma
NF1
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC

37. Tumor markers: alpha - fetoprotein
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
Ret
Acanthosis nigricans (hyperpigmentation and epidermal thickening)

38. most human cancers - Li - Fraumeni syndrome What is the tumor suppressor gene?
Esophageal adenocarcinoma
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
P 53

39. Apoptosis (definition)
Programmed cell death; ATP required. Mediated by caspases.
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.
Benign: Osteoma Malignant: osteosarcoma
Increase in # of cells. Reversible.

40. TNM staging system
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma
T = size of T umor N = N ode involvement M = M etastases
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).

41. How should tumor markers be used clinically?
Down syndrome
The liver and lung are the most common sites of metastasis after regional LN's. Metastasis << primary liver tumors.
CML
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.

42. Tumor nomenclature: Blood cells What do you call a benign tumor of this tissue? .. a malignant one?
Benign: hemangioma Malignant: Angiosarcoma
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)
Benign: -- Malignant: Leukemia - lymphoma
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.

43. Tumor nomenclature: Epithelium What do you call a benign tumor of this tissue? .. a malignant one?
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
P 16

44. tumor: N euroblastoma What is the associated oncogene?
N - myc
Gastrointestinal stromal tumor (GIST)
Benign: -- Malignant: Leukemia - lymphoma
Usually well - differentiated - slow growing - well - demarcated - no metastasis.

45. Oncogene: c - kit Associated tumor?
Gastrointestinal stromal tumor (GIST)
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.

46. Neoplasm: Squamous cell carcinoma of the skin With what dz is this associated?
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma
The liver and lung are the most common sites of metastasis after regional LN's. Metastasis << primary liver tumors.
Abl
Actinic keratosis

47. Oncogene: ras Associated tumor?
T = size of T umor N = N ode involvement M = M etastases
Benign: -- Malignant: Leukemia - lymphoma
Colon carcinoma
Thymoma - small cell lung carcinoma

48. Hypovolemic/cardiogenic shock
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Leukocyte travels btw endothelial cells and exits blood vessel; PECAM-1 is involved. <img src='218a.JPG' />
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.

49. Tumor suppressor gene: APC chromosome? Associated tumor?
Malignant melanoma
Chr. 11p Assoc: Wilms' tumor
Assoc: Colorectal cancer (assoc w/ FAP)
The liver and lung are the most common sites of metastasis after regional LN's. Metastasis << primary liver tumors.

50. Benign
HTLV-1
Abl
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
Usually well - differentiated - slow growing - well - demarcated - no metastasis.