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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. Chemical carcinogens: Naphthalene (aniline) dyes What is the affected organ?
Bladder (transitional cell carcinoma)
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.
P 53
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors

2. Neoplasm: Gastric adenocarcinoma With what dz is this associated?
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
AIDS
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
HBV - HCV

3. Neoplasm: Squamous cell carcinoma of esophagus With what dz is this associated?
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.
BRCA1
Assoc: Neurofibromatosis type 1
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)

4. Tumor markers: alpha - fetoprotein
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis)
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
Colon carcinoma

5. Neoplasm: All (we All fall Down ) AML With what dz is this associated?
Benign: Leiomyoma Malignant: Leiomyosarcoma
Down syndrome
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
L ung tumor

6. Anaplasia
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: Rhabdomyoma Malignant: Rhabdomyosarcoma
Leukocyte travels btw endothelial cells and exits blood vessel; PECAM-1 is involved. <img src='218a.JPG' />
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.

7. Primary tumors that metastasize to brain
Assoc.: Breast and ovarian cancer
Squamous cell carcinoma of esophagus
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.
NF1

8. Dz: Ulcerative colitis What is the associated neoplasm?
Ovarian - malignant epithelial tumors
Bcl -2
Colonic adenocarcinoma
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)

9. Breast and ovarian cancer What is the tumor suppressor gene?
Assoc.: Retinoblastoma - osteosarcoma
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />
Colon carcinoma
BRCA1

10. Which usually has more prognostic value - tumor stage or grade?
Xeroderma pigmentosum - albinism
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
Usually stage < grade
Cells have invaded basement membrane using collagenases and hydrolases Can metastasize if they reach a blood or lymphatic vessel <img src='220d.JPG' />

11. Neoplasm: Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma With what dz is this associated?
Liver (hepatocellular carcinoma)
AIDS
Benign: -- Malignant: Leukemia - lymphoma
Normal cells w/ basal --< apical differentiation <img src='220a.JPG' />

12. Benign
Secondary osteosarcoma and fibrosarcoma
Increase vascular permeability - vasodilation - endothelial injury.
Colon carcinoma
Usually well - differentiated - slow growing - well - demarcated - no metastasis.

13. Neoplastic progression: step 4 Metastasis

14. Tumor nomenclature: Bone What do you call a benign tumor of this tissue? .. a malignant one?
Benign: hemangioma Malignant: Angiosarcoma
Burkitt's lymphoma nasopharyngeal carcinoma
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
Benign: Osteoma Malignant: osteosarcoma

15. Neurofibromatosis 2 ('Type 2 = 22') What is the tumor suppressor gene?
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
Bcl -2
NF2
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention

16. Oncogene: N - myc Associated tumor?
N euroblastoma
Assoc: breast cancer
C - myc
Liver (hepatocellular carcinoma)

17. Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome What neoplasm would create this paraneoplastic effect?
Xeroderma pigmentosum - albinism
Small cell lung carcinoma
P 53
Squamous cell carcinoma of the skin

18. Paraneoplastic effects of tumors: Renal cell carcinoma - hemangioblastoma Causes...? Effect?
Pancreatic adenocarcinoma
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation
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
Causes: Erythropoietin Effect: Polycythemia

19. Desmoplasia
Radiation exposure
Gastric adenocarcinoma
Fibrous tissue formation in response to a neoplasm. Irreversible.
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma

20. Type of amyloid protein: Alzheimer's dz Protein? Derived from...?
Beta - amyloid Derived from amyloid precursor protein (APP)
Small cell lung carcinoma and intracranial neoplasms
Causes: Erythropoietin Effect: Polycythemia
Secondary osteosarcoma and fibrosarcoma

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

22. Paraneoplastic effects of tumors: Small cell lung carcinoma and intracranial neoplasms Causes...? Effect?
Thymoma - small cell lung carcinoma
Membrane lipid peroxidation Protein modification DNA Breakage
Causes: ADH Effect: SIADH
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.

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

24. Rolling (step 1 in leukocyte extravasation)

25. Dz: Down syndrome What is the associated neoplasm?
Enzymatic degradation of a cell resulting from exogenous injury.
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
All (we All fall Down ) AML
Gastric adenocarcinoma

26. Dz: Immunodeficiency states What is the associated neoplasm?
Follicular and undifferentiated lymphomas (inhibits apoptosis)
Beta - amyloid Derived from amyloid precursor protein (APP)
Malignant lymphomas
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia

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

28. 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
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
Ras

29. Tumor markers: PSA
[aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma
Benign: Leiomyoma Malignant: Leiomyosarcoma
Assoc: Pancreatic cancer [DPC = D eleted in P ancreatic C ancer']
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.

30. tumor: Multiple endocrine neoplasia (MEN) types II and III What is the associated oncogene?
Increase in # of cells. Reversible.
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
Ret
N euroblastoma

31. Dz: Acanthosis nigricans (hyperpigmentation and epidermal thickening) What is the associated neoplasm?
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
Visceral malignancy (stomach - lung - breast - uterus)
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.

32. Dysplasia
Immunodeficiency states
Visceral malignancy (stomach - lung - breast - uterus)
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.

33. Paraneoplastic effects of tumors: Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma Causes...? Effect?
CML
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia
P 16
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.

34. Neoplastic progression: step 3 Invasive carcinoma

35. Dz: Radiation exposure What is the associated neoplasm?
Membrane lipid peroxidation Protein modification DNA Breakage
Immunodeficiency states
Sarcoma
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' />

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

37. most human cancers - Li - Fraumeni syndrome What is the tumor suppressor gene?
Leukemias and lymphomas
P 53
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia
Small cell lung carcinoma

38. Oncogene: c - myc Associated tumor?

39. Chemical carcinogens: Asbestos What is the affected organ?
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
Small cell lung carcinoma and intracranial neoplasms
Lung (mesothelioma and bronchogenic carcinoma)
Benign: lipoma Malignant: liposarcoma

40. Acute inflammation
Assoc: Colorectal cancer (assoc w/ FAP)
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.
BRCA2
Squamous cell carcinoma of the skin

41. 5 Characteristic signs of inflammation
Enzymatic degradation of a cell resulting from exogenous injury.
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)
Causes: Erythropoietin Effect: Polycythemia
Esophageal adenocarcinoma

42. Free radical degradation
HBV - HCV
Assoc.: Retinoblastoma - osteosarcoma
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)

43. Type of amyloid protein: Senile cardiac Protein? Derived from...?
Protein = transthyretin Derived from AF (AF = old F ogies)
L ung tumor
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
Hepatocellular carcinoma

44. Tumor suppressor genes
The liver and lung are the most common sites of metastasis after regional LN's. Metastasis << primary liver tumors.
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Programmed cell death; ATP required. Mediated by caspases.

45. tumor: Follicular and undifferentiated lymphomas (inhibits apoptosis) What is the associated oncogene?
Bcl -2
Burkitt's lymphoma nasopharyngeal 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
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.

46. Tumor markers: CA-125
NF2
Ovarian - malignant epithelial tumors
Burkitt's lymphoma nasopharyngeal carcinoma
Chr. 11p Assoc: Wilms' tumor

47. Tumor markers: Bombesin
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' />
Neuorblastoma - lung - and gastric cancer.
Cells have increased in # (hyperplasia ) Abnormal proliferation of cells w/ loss of size - shape - and orientation (dysplasia ) <img src='220b.JPG' />
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)

48. Oncogenic viruses: HBV - HCV What is the associated cancer?
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.
Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma
Amylin protein Derived from AE (AE = E ndocrine)
Hepatocellular carcinoma

49. Characteristics of reversible cell injury
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Prostate carcinoma.
Causes: ADH Effect: SIADH
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change

50. Causes: ADH Effect: SIADH What neoplasm would create this paraneoplastic effect?
Small cell lung carcinoma and intracranial neoplasms
Immunodeficiency states
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.