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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.
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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: Follicular and undifferentiated lymphomas (inhibits apoptosis) What is the associated oncogene?
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.
Esophageal adenocarcinoma
Bcl -2
Leukemias and lymphomas

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

3. Neoplasm: Hepatocellular carcinoma With what dz is this associated?
Benign: hemangioma Malignant: Angiosarcoma
Cirrhosis (alcoholic - hepatitis B or C)
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.
L ung tumor

4. Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome What neoplasm would create this paraneoplastic effect?
Immunodeficiency states
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
Liver (angiosarcoma)
Small cell lung carcinoma

5. Dz: Paget's dz of bone What is the associated neoplasm?
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
Secondary osteosarcoma and fibrosarcoma
AIDS
Leukemias and lymphomas

6. Tumor suppressor gene: BRCA1 chromosome? Associated tumor?
Cirrhosis (alcoholic - hepatitis B or C)
Assoc.: Breast and ovarian cancer
NF1
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.

7. Chemical carcinogens: Arsenic What is the affected organ?
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.
Ovarian - malignant epithelial tumors
Skin (squamous cell carcinoma) Liver (angiosarcoma)
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]

8. Tumor markers: alpha - fetoprotein
Immunodeficiency states
Skin (squamous cell carcinoma) Liver (angiosarcoma)
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
The liver and lung are the most common sites of metastasis after regional LN's. Metastasis << primary liver tumors.

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

10. Neoplastic progression: normal state - before anything goes wrong

11. Chronic inflammation
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.
Liver (centrilobular necrosis - fatty change)
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
Burkitt's lymphoma

12. Granulomatous dz's

13. Characteristics of reversible cell injury
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma
Sarcoma

14. Hepatocellular carcinoma What is the assocciated oncogenic virus?
Assoc: breast cancer
Bcl -2
Pancreatic adenocarcinoma
HBV - HCV

15. Malignant
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
EBV
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.
Sarcoma

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

17. Oncogenic viruses: HBV - HCV What is the associated cancer?
Benign: Leiomyoma Malignant: Leiomyosarcoma
Assoc: Neurofibromatosis type 1
Hepatocellular carcinoma
Adult T- cell leukemia

18. Tumor suppressor gene: DCC chromosome? Associated tumor?
Liver (centrilobular necrosis - fatty change)
Ret
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Esophageal adenocarcinoma

19. Causes: Erythropoietin Effect: Polycythemia What neoplasm would create this paraneoplastic effect?
Renal cell carcinoma - hemangioblastoma
C - myc
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia
Squamous cell carcinoma of the skin

20. Metastasis to bone
Squamous cell carcinoma of esophagus
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
HPV

21. tumor: N euroblastoma What is the associated oncogene?
N - myc
Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis)
Secondary osteosarcoma and fibrosarcoma
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.

22. Tumor nomenclature: Smooth muscle What do you call a benign tumor of this tissue? .. a malignant one?
Benign: Leiomyoma Malignant: Leiomyosarcoma
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
Burkitt's lymphoma
Neuorblastoma - lung - and gastric cancer.

23. Tumor markers: S-100
Usually stage < grade
Ret
Pancreatic adenocarcinoma
Melanoma - neural tumors - astrocytomas.

24. Adult T- cell leukemia What is the assocciated oncogenic virus?
Multiple endocrine neoplasia (MEN) types II and III
Benign: -- Malignant: Leukemia - lymphoma
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
HTLV-1

25. Chemical carcinogens: Nitrosamines (e.g. - in smoked foods) What is the affected organ?
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)
Esophagus - stomach
APC
Assoc: Colorectal cancer (assoc w/ FAP)

26. Neoplasm: Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin 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.
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
Xeroderma pigmentosum - albinism
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)

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

28. Resolution of inflammation
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.
Esophagus - stomach
Chr. 11p Assoc: Wilms' tumor
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.

29. Paraneoplastic effects of tumors: Renal cell carcinoma - hemangioblastoma Causes...? Effect?
Melanoma - neural tumors - astrocytomas.
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)
Causes: Erythropoietin Effect: Polycythemia
Benign: hemangioma Malignant: Angiosarcoma

30. Neoplastic progression: step 2 In situ carcinoma

31. Oncogene: erb - B2 Associated tumor?
Breast - ovarian - and gastric carcinomas
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
IL-8 C5a Leukotriene B4 Kallikrein
Leukemias and lymphomas

32. Paraneoplastic effects of tumors: Leukemias and lymphomas Causes...? Effect?
Ret
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy
Xeroderma pigmentosum - albinism
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.

33. Characteristics of irreversible cell injury
Ulcerative colitis
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.
Normal cells w/ basal --< apical differentiation <img src='220a.JPG' />
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability

34. Dz: Ulcerative colitis What is the associated neoplasm?
Colonic adenocarcinoma
Sarcoma
Tartrate - resistant acid phosphatase. Hairy cell leukemia -- a B- cell neoplasm. 'TRAP the hairy animal.'
Malignant lymphomas

35. Breast and ovarian cancer What is the tumor suppressor gene?
Lung (mesothelioma and bronchogenic carcinoma)
Gastric adenocarcinoma
BRCA1
Usually stage < grade

36. Type of amyloid protein: Primary Protein? Derived from...?
Ovarian - malignant epithelial tumors
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
Benign: lipoma Malignant: liposarcoma
NF2

37. Paraneoplastic effects of tumors: Small cell lung carcinoma and intracranial neoplasms Causes...? Effect?
Causes: ADH Effect: SIADH
Beta -2 microglobulin Derived from MHC class I proteins.
Liver (angiosarcoma)
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.

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

39. Tight binding (step 2 of leukocyte extravasation)

40. Dz: Immunodeficiency states What is the associated neoplasm?
Benign: -- Malignant: Leukemia - lymphoma
Paget's dz of bone
C - kit
Malignant lymphomas

41. Necrosis (definition)
Beta - amyloid Derived from amyloid precursor protein (APP)
Enzymatic degradation of a cell resulting from exogenous injury.
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.

42. Neoplasia
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
Benign and malignant lymphomas
Liver (angiosarcoma)
Liver (centrilobular necrosis - fatty change)

43. Melanoma - What is the tumor suppressor gene?
Benign: lipoma Malignant: liposarcoma
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
P 16
Xeroderma pigmentosum - albinism

44. Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia What neoplasm would create this paraneoplastic effect?
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
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
HPV
C - kit

45. Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy What neoplasm would create this paraneoplastic effect?
Multiple endocrine neoplasia (MEN) types II and III
Benign: Osteoma Malignant: osteosarcoma
Liver (centrilobular necrosis - fatty change)
Leukemias and lymphomas

46. tumor: Gastrointestinal stromal tumor (GIST) What is the associated oncogene?
Fibrous tissue formation in response to a neoplasm. Irreversible.
Assoc: Neurofibromatosis 2 ('Type 2 = 22')
C - kit
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin

47. 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)
Tartrate - resistant acid phosphatase. Hairy cell leukemia -- a B- cell neoplasm. 'TRAP the hairy animal.'
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy
Increase vascular permeability - vasodilation - endothelial injury.

48. Hypovolemic/cardiogenic shock
Gastrointestinal stromal tumor (GIST)
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
Assoc: Colorectal cancer (assoc w/ FAP)

49. Dz: AIDS What is the associated neoplasm?

50. Tumor suppressor gene: NF1 chromosome? Associated tumor?
Assoc: Neurofibromatosis type 1
HHV-8
C - kit
Lung (mesothelioma and bronchogenic carcinoma)