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. tumor: Burkitt's lymphoma What is the associated oncogene?
Fibroblast emigration and proliferation; deposition of ECM.
C - myc
T = size of T umor N = N ode involvement M = M etastases
[aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma


2. Colon cancer
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
HTLV-1
Visceral malignancy (stomach - lung - breast - uterus)
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC


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

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4. Migration (step 4 in leukocyte extravasation)

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

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6. Neoplasia
Esophageal adenocarcinoma
C - myc
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
P 53


7. Necrosis morphologies
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
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)


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

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9. Oncogenic viruses: HPV What is the associated cancer?
Degree of localization/spread based on site and size of 1' lesion - spread to regional LNs - presence of metastases; spread of tumor in a specific pt. S tage = S pread
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Assoc: Neurofibromatosis type 1
Cirrhosis (alcoholic - hepatitis B or C)


10. Tumor markers: Prostatic acid phospatase
All (we All fall Down ) AML
Liver (hepatocellular carcinoma)
Prostate carcinoma.
Breast - ovarian - and gastric carcinomas


11. Causes: Erythropoietin Effect: Polycythemia What neoplasm would create this paraneoplastic effect?
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.
Breast - ovarian - and gastric carcinomas
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' />
Renal cell carcinoma - hemangioblastoma


12. Oncogenic viruses: HTLV-1 What is the associated cancer?
Assoc.: Breast and ovarian cancer
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)
Adult T- cell leukemia
BRCA1


13. Tumor nomenclature: Epithelium What do you call a benign tumor of this tissue? .. a malignant one?
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.
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
L ung tumor


14. Oncogene: c - kit Associated tumor?
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors
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.
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
Gastrointestinal stromal tumor (GIST)


15. Tumor suppressor gene: Rb chromosome? Associated tumor?
Assoc.: Retinoblastoma - osteosarcoma
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Colon carcinoma
Assoc: Colorectal cancer (assoc w/ FAP)


16. Tumor nomenclature: < 1 cell type What do you call a benign tumor of this tissue? .. a malignant one?
Blood (leukemia)
HTLV-1
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
HHV-8


17. Neoplasm: Squamous cell carcinoma of esophagus With what dz is this associated?
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
EBV
C - myc
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)


18. Diapedesis (step 3 in leukocyte extravasation)

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19. Neoplastic progression: step 3 Invasive carcinoma

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20. Characteristics of reversible cell injury
Skin (squamous cell carcinoma) Liver (angiosarcoma)
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
Malignant melanoma


21. Apoptosis (definition)
Small cell lung carcinoma and intracranial neoplasms
HTLV-1
Programmed cell death; ATP required. Mediated by caspases.
Assoc: Neurofibromatosis 2 ('Type 2 = 22')


22. Primary tumors that metastasize to liver

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23. Hypovolemic/cardiogenic shock
HBV - HCV
Benign and malignant lymphomas
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)


24. Tumor markers: CA-125
L - myc
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
Ovarian - malignant epithelial tumors
Fibroblast emigration and proliferation; deposition of ECM.


25. tumor: Colon carcinoma What is the associated oncogene?
Ras
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
Programmed cell death; ATP required. Mediated by caspases.
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.


26. Malignant
L ung tumor
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'
Acanthosis nigricans (hyperpigmentation and epidermal thickening)


27. most human cancers - Li - Fraumeni syndrome What is the tumor suppressor gene?
Follicular and undifferentiated lymphomas (inhibits apoptosis)
P 53
Cirrhosis (alcoholic - hepatitis B or C)
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).


28. Female cancer epidemiology (incidence - mortality)
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)
Burkitt's lymphoma nasopharyngeal carcinoma
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)
WT1


29. Dz: Xeroderma pigmentosum - albinism What is the associated neoplasm?
Gastrointestinal stromal tumor (GIST)
Assoc: Melanoma ('MelaN oma is N ine')
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)


30. Tumor markers: Beta - hCG

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31. Type of amyloid protein: DM2 Protein? Derived from...?
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.
Amylin protein Derived from AE (AE = E ndocrine)
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.


32. Oncogene: L - myc Associated tumor?
L ung tumor
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.
The liver and lung are the most common sites of metastasis after regional LN's. Metastasis << primary liver tumors.
Multiple endocrine neoplasia (MEN) types II and III


33. Dz: Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis) What is the associated neoplasm?
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.
C - kit
Benign and malignant lymphomas
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.


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

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35. Leukocyte activation in inflammation
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.
Ovarian - malignant epithelial tumors


36. Neoplasm: All (we All fall Down ) AML With what dz is this associated?
Multiple endocrine neoplasia (MEN) types II and III
Down syndrome
NF1
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.


37. Dz: Tuberous sclerosis (facial angiofibroma - seizures - mental retardation) What is the associated neoplasm?
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.
CML
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />


38. Tumor suppressor gene: NF1 chromosome? Associated tumor?
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
Assoc: Neurofibromatosis type 1
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' />
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]


39. Tumor stage

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40. Tumor markers: S-100
Melanoma - neural tumors - astrocytomas.
Chr. 11p Assoc: Wilms' tumor
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).


41. Hyperplasia
Esophageal adenocarcinoma
Increase in # of cells. Reversible.
Paget's dz of bone
Usually stage < grade


42. Neoplastic progression: step 2 In situ carcinoma

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43. Type of amyloid protein: Secondary Protein? Derived from...?
Skin (squamous cell carcinoma) Liver (angiosarcoma)
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)
CML
Barrett's esophagus (chronic GI reflux)


44. TNM staging system
T = size of T umor N = N ode involvement M = M etastases
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
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.
Liver (hepatocellular carcinoma)


45. Tumor nomenclature: Fat What do you call a benign tumor of this tissue? .. a malignant one?
Benign: lipoma Malignant: liposarcoma
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Beta -2 microglobulin Derived from MHC class I proteins.
Amylin protein Derived from AE (AE = E ndocrine)


46. Retinoblastoma - osteosarcoma What is the tumor suppressor gene?
Rb
Esophagus - stomach
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Sarcoma


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

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48. Type of amyloid protein: Alzheimer's dz Protein? Derived from...?
Colonic adenocarcinoma
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
Beta - amyloid Derived from amyloid precursor protein (APP)
Programmed cell death; ATP required. Mediated by caspases.


49. Tumor suppressor gene: p 53 chromosome? Associated tumor?
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome
Chr. 11p Assoc: Wilms' tumor
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
Assoc: Melanoma ('MelaN oma is N ine')


50. Tumor markers: TRAP

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