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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. Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy What neoplasm would create this paraneoplastic effect?
Chr. 11p Assoc: Wilms' tumor
Causes: ADH Effect: SIADH
Leukemias and lymphomas
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy

2. 5 Characteristic signs of inflammation
Metastases to bone - obstructive biliary dz - Paget's dz of bone.
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)
Benign: -- Malignant: Leukemia - lymphoma
Burkitt's lymphoma

3. Type of amyloid protein: DM2 Protein? Derived from...?
Cirrhosis (alcoholic - hepatitis B or C)
Acanthosis nigricans (hyperpigmentation and epidermal thickening)
Abl
Amylin protein Derived from AE (AE = E ndocrine)

4. Neoplasm: Gastric adenocarcinoma With what dz is this associated?
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants

5. tumor: Breast - ovarian - and gastric carcinomas What is the associated oncogene?
Squamous cell carcinoma of the skin
Down syndrome
Metastases to bone - obstructive biliary dz - Paget's dz of bone.
Erb - B2

6. Dz: Ulcerative colitis What is the associated neoplasm?
Colonic adenocarcinoma
P 16
N euroblastoma
Amylin protein Derived from AE (AE = E ndocrine)

7. Paraneoplastic effects of tumors: Small cell lung carcinoma Causes...? Effect?

8. Dz: Immunodeficiency states What is the associated neoplasm?
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin
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.
Causes: Erythropoietin Effect: Polycythemia

9. Necrosis (definition)
Squamous cell carcinoma of esophagus
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.
Enzymatic degradation of a cell resulting from exogenous injury.
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.

10. Characteristics of reversible cell injury
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Gain of fxn --< cancer. Need damage to only 1 allele.
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)

11. Oncogene: ret Associated tumor?
Liver (angiosarcoma)
Multiple endocrine neoplasia (MEN) types II and III
Benign: hemangioma Malignant: Angiosarcoma
Abl

12. Metastasis to liver

13. Tumor nomenclature: Blood vessels What do you call a benign tumor of this tissue? .. a malignant one?
HPV
Follicular and undifferentiated lymphomas (inhibits apoptosis)
Benign: hemangioma Malignant: Angiosarcoma
Leukocyte travels btw endothelial cells and exits blood vessel; PECAM-1 is involved. <img src='218a.JPG' />

14. Malignant
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)
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.

15. Which usually has more prognostic value - tumor stage or grade?
Usually stage < grade
Esophageal adenocarcinoma
Breast - ovarian - and gastric carcinomas
Assoc: Neurofibromatosis 2 ('Type 2 = 22')

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

17. Neurofibromatosis 2 ('Type 2 = 22') What is the tumor suppressor gene?
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.
L ung tumor
NF2
Enzymatic degradation of a cell resulting from exogenous injury.

18. Characteristics of trans udate
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention
Erb - B2
HPV

19. Neoplasm: Squamous cell carcinoma of the skin With what dz is this associated?
Actinic keratosis
C - kit
Lung (mesothelioma and bronchogenic carcinoma)
Assoc: Pancreatic cancer [DPC = D eleted in P ancreatic C ancer']

20. Fibrosis in inflammation
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)
AIDS
Fibroblast emigration and proliferation; deposition of ECM.
Programmed cell death; ATP required. Mediated by caspases.

21. Type of amyloid protein: Secondary Protein? Derived from...?
Adult T- cell leukemia
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma

22. Septic shock
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
Immunodeficiency states
P 53

23. Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness) What neoplasm would create this paraneoplastic effect?
Squamous cell carcinoma of esophagus
Dysplastic nevus
T = size of T umor N = N ode involvement M = M etastases
Thymoma - small cell lung carcinoma

24. Neoplasm: Colonic adenocarcinoma With what dz is this associated?
Chr. 11p Assoc: Wilms' tumor
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)
Fibroblast emigration and proliferation; deposition of ECM.
Ulcerative colitis

25. Oncogenes
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
Gain of fxn --< cancer. Need damage to only 1 allele.
Ras

26. Oncogene: L - myc Associated tumor?
Increase in # of cells. Reversible.
L ung tumor
Renal cell carcinoma - hemangioblastoma
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.

27. Colon cancer
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
Blood (leukemia)
Assoc: Neurofibromatosis 2 ('Type 2 = 22')
Benign: Leiomyoma Malignant: Leiomyosarcoma

28. Oncogene: ras Associated tumor?
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)
Squamous cell carcinoma of the skin
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />
Colon carcinoma

29. Apoptosis is characterized by...?
NF2
Liver (hepatocellular carcinoma)
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
Ovarian - malignant epithelial tumors

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

31. Apoptosis (definition)
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
Adult T- cell leukemia
Programmed cell death; ATP required. Mediated by caspases.
Increase in # of cells. Reversible.

32. Tumor markers: TRAP

33. breast cancer What is the tumor suppressor gene?
BRCA2
Rb
HTLV-1
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.

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

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

36. Oncogene: c - myc Associated tumor?

37. Cancer epidemiology: Lung cancer? As a cause of death overall?
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
NF2
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).
Small cell lung carcinoma and intracranial neoplasms

38. Dz: Actinic keratosis What is the associated neoplasm?
Squamous cell carcinoma of the skin
Assoc.: Retinoblastoma - osteosarcoma
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.
Erb - B2

39. Pancreatic cancer

40. Causes: ADH Effect: SIADH What neoplasm would create this paraneoplastic effect?
Small cell lung carcinoma and intracranial neoplasms
Benign: lipoma Malignant: liposarcoma
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.
Benign: -- Malignant: Leukemia - lymphoma

41. Dz: AIDS What is the associated neoplasm?

42. Tumor markers: Alkaline phosphatase

43. Free radical degradation
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
Usually stage < grade
C - kit
NF2

44. Male cancer epidemiology (incidence - mortality)
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).

45. Melanoma - What is the tumor suppressor gene?
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation
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.
P 16

46. Hypovolemic/cardiogenic shock
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
C - myc
Ret
Hepatocellular carcinoma

47. Type of amyloid protein: Primary Protein? Derived from...?
Cirrhosis (alcoholic - hepatitis B or C)
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
BRCA1
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)

48. Free radical injury induces cell injury thru...?
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' />
Assoc: Neurofibromatosis 2 ('Type 2 = 22')
Membrane lipid peroxidation Protein modification DNA Breakage
N euroblastoma

49. most human cancers - Li - Fraumeni syndrome What is the tumor suppressor gene?
WT1
P 53
Benign: lipoma Malignant: liposarcoma
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC

50. Tumor nomenclature: < 1 cell type What do you call a benign tumor of this tissue? .. a malignant one?
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)
Erb - B2
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention