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. Oncogene: ras Associated tumor?
Radiation exposure
Causes: ADH Effect: SIADH
Colon carcinoma
Squamous cell carcinoma of the skin


2. TNM staging system
Causes: ADH Effect: SIADH
T = size of T umor N = N ode involvement M = M etastases
Protein = transthyretin Derived from AF (AF = old F ogies)
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />


3. Dz: Acanthosis nigricans (hyperpigmentation and epidermal thickening) What is the associated neoplasm?
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors
Assoc: Neurofibromatosis type 1
BRCA2
Visceral malignancy (stomach - lung - breast - uterus)


4. Dysplasia
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'
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
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.


5. Tumor suppressor gene: NF1 chromosome? Associated tumor?
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
The liver and lung are the most common sites of metastasis after regional LN's. Metastasis << primary liver tumors.
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Assoc: Neurofibromatosis type 1


6. Metaplasia

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7. Tumor suppressor gene: DCC chromosome? Associated tumor?
Small cell lung carcinoma and intracranial neoplasms
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)


8. Oncogene: bcl -2 Associated tumor?
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
Follicular and undifferentiated lymphomas (inhibits apoptosis)
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.
Liver (hepatocellular carcinoma)


9. breast cancer What is the tumor suppressor gene?
Bcl -2
BRCA2
Xeroderma pigmentosum - albinism
Bladder (transitional cell carcinoma)


10. Neoplastic progression: step 2 In situ carcinoma

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11. Chemical carcinogens: Naphthalene (aniline) dyes What is the affected organ?
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />
HPV
Bladder (transitional cell carcinoma)
Actinic keratosis


12. Tumor nomenclature: Smooth muscle What do you call a benign tumor of this tissue? .. a malignant one?
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Malignant melanoma
Benign: Leiomyoma Malignant: Leiomyosarcoma
Actinic keratosis


13. Neoplastic progression: step 3 Invasive carcinoma

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14. Type of amyloid protein: Medullary carcinoma of thyroid Protein? Derived from...?
Enzymatic degradation of a cell resulting from exogenous injury.
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
AIDS
Tartrate - resistant acid phosphatase. Hairy cell leukemia -- a B- cell neoplasm. 'TRAP the hairy animal.'


15. tumor: Breast - ovarian - and gastric carcinomas What is the associated oncogene?
L - myc
Malignant melanoma
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome
Erb - B2


16. Neoplasm: Squamous cell carcinoma of esophagus With what dz is this associated?
Bcl -2
Burkitt's lymphoma nasopharyngeal carcinoma
Neuorblastoma - lung - and gastric cancer.
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)


17. Burkitt's lymphoma nasopharyngeal carcinoma What is the assocciated oncogenic virus?
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
Assoc.: Retinoblastoma - osteosarcoma
EBV
APC


18. Chemical carcinogens: Cigarette smoke What is the affected organ?
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)
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.
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
NF1


19. Things that initiate Free radical injury
The liver and lung are the most common sites of metastasis after regional LN's. Metastasis << primary liver tumors.
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
Fibrous tissue formation in response to a neoplasm. Irreversible.
Normal cells w/ basal --< apical differentiation <img src='220a.JPG' />


20. Tumor suppressor genes
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Breast - ovarian - and gastric carcinomas
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)


21. Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness) What neoplasm would create this paraneoplastic effect?
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />
Thymoma - small cell lung carcinoma
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />
Cells have invaded basement membrane using collagenases and hydrolases Can metastasize if they reach a blood or lymphatic vessel <img src='220d.JPG' />


22. Tumor markers: Alkaline phosphatase

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23. Dz: Dysplastic nevus What is the associated neoplasm?
Renal cell carcinoma - hemangioblastoma
Malignant melanoma
Benign: hemangioma Malignant: Angiosarcoma
Squamous cell carcinoma of esophagus


24. Neoplasm: Malignant melanoma With what dz is this associated?
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia
P 16
Squamous cell carcinoma of esophagus
Dysplastic nevus


25. Oncogene: erb - B2 Associated tumor?
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).
Breast - ovarian - and gastric carcinomas
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)


26. Dz: Barrett's esophagus (chronic GI reflux) What is the associated neoplasm?
Benign: -- Malignant: Leukemia - lymphoma
Xeroderma pigmentosum - albinism
Adult T- cell leukemia
Esophageal adenocarcinoma


27. Hypovolemic/cardiogenic shock
Assoc.: Breast and ovarian cancer
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Gastrointestinal stromal tumor (GIST)
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.


28. tumor: L ung tumor What is the associated oncogene?
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
Cells have increased in # (hyperplasia ) Abnormal proliferation of cells w/ loss of size - shape - and orientation (dysplasia ) <img src='220b.JPG' />
L - myc
Ulcerative colitis


29. Colon cancer
Radiation exposure
Ret
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
Assoc: breast cancer


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

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31. Tumor suppressor gene: BRCA2 chromosome? Associated tumor?
T = size of T umor N = N ode involvement M = M etastases
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
Assoc: breast cancer
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)


32. Primary tumors that metastasize to brain
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.
Dysplastic nevus
Colon carcinoma
NF1


33. Dz: Cirrhosis (alcoholic - hepatitis B or C) What is the associated neoplasm?
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
Hepatocellular carcinoma
L ung tumor
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy


34. Neoplastic progression: step 4 Metastasis

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35. Melanoma - What is the tumor suppressor gene?
Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome
Ulcerative colitis
P 16
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)


36. Chemical carcinogens: Arsenic What is the affected organ?
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
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)
Liver (hepatocellular carcinoma)


37. Paraneoplastic effects of tumors: Small cell lung carcinoma and intracranial neoplasms Causes...? Effect?
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)
Increase vascular permeability - vasodilation - endothelial injury.
Causes: ADH Effect: SIADH
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.


38. Tumor nomenclature: Skeletal muscle What do you call a benign tumor of this tissue? .. a malignant one?
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
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.
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors
Malignant lymphomas


39. Diapedesis (step 3 in leukocyte extravasation)

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40. Substances that are chemotactic for neutrophils
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
IL-8 C5a Leukotriene B4 Kallikrein


41. Tumor suppressor gene: APC chromosome? Associated tumor?
Squamous cell carcinoma of the skin
Increase in # of cells. Reversible.
Assoc: Colorectal cancer (assoc w/ FAP)
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)


42. Neoplasm: All (we All fall Down ) AML With what dz is this associated?
Down syndrome
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
Esophagus - stomach
Assoc: Colorectal cancer (assoc w/ FAP)


43. Tumor stage

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44. Neoplasm: Esophageal adenocarcinoma With what dz is this associated?

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45. Neoplasm: Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma With what dz is this associated?
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
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
Colonic adenocarcinoma
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)


46. Tumor suppressor gene: DPC chromosome? Associated tumor?

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47. Malignant
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome
Benign: hemangioma Malignant: Angiosarcoma
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.
Breast - ovarian - and gastric carcinomas


48. Dz: Radiation exposure What is the associated neoplasm?
Sarcoma
HPV
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin
Gain of fxn --< cancer. Need damage to only 1 allele.


49. Characteristics of reversible cell injury
HPV
Small cell lung carcinoma and intracranial neoplasms
Benign and malignant lymphomas
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change


50. Tumor nomenclature: Blood cells What do you call a benign tumor of this tissue? .. a malignant one?
Benign: -- Malignant: Leukemia - lymphoma
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
HPV