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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. Resolution of inflammation
Leukemias and lymphomas
CML
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.
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.

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

3. Type of amyloid protein: Senile cardiac Protein? Derived from...?
Causes: Erythropoietin Effect: Polycythemia
Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis)
Thymoma - small cell lung carcinoma
Protein = transthyretin Derived from AF (AF = old F ogies)

4. Dysplasia
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors
Actinic keratosis
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.
C - kit

5. Diapedesis (step 3 in leukocyte extravasation)

6. Neoplasm: Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma With what dz is this associated?
Dysplastic nevus
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
AIDS
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)

7. Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome What neoplasm would create this paraneoplastic effect?
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Small cell lung carcinoma
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
CML

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

9. Tumor markers: Alkaline phosphatase

10. Breast and ovarian cancer What is the tumor suppressor gene?
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
BRCA2
Liver (hepatocellular carcinoma)

11. Dz: AIDS What is the associated neoplasm?

12. Chemical carcinogens: CCl4 What is the affected organ?
Small cell lung carcinoma
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)
Liver (centrilobular necrosis - fatty change)
Gastric adenocarcinoma

13. Tumor nomenclature: Fat What do you call a benign tumor of this tissue? .. a malignant one?
Benign: lipoma Malignant: liposarcoma
Assoc: Melanoma ('MelaN oma is N ine')
Sarcoma
[aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma

14. Tumor nomenclature: Skeletal muscle What do you call a benign tumor of this tissue? .. a malignant one?
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)
Assoc.: Retinoblastoma - osteosarcoma
Ras

15. Dz: Paget's dz of bone What is the associated neoplasm?
Follicular and undifferentiated lymphomas (inhibits apoptosis)
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)
Squamous cell carcinoma of the skin
Secondary osteosarcoma and fibrosarcoma

16. Neoplasm: Colonic adenocarcinoma With what dz is this associated?
Blood (leukemia)
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.
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.

17. tumor: Multiple endocrine neoplasia (MEN) types II and III What is the associated oncogene?
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.
Ret
Lung (mesothelioma and bronchogenic carcinoma)
Assoc.: Breast and ovarian cancer

18. Tumor markers: CA-125
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Ovarian - malignant epithelial tumors

19. Characteristics of reversible cell injury
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
BRCA2
Renal cell carcinoma - hemangioblastoma
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.

20. Neoplasm: Sarcoma With what dz is this associated?
Radiation exposure
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />
Fibrous tissue formation in response to a neoplasm. Irreversible.

21. Colorectal cancer (assoc w/ FAP) What is the tumor suppressor gene?
Membrane lipid peroxidation Protein modification DNA Breakage
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
APC
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.

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

23. Tumor markers: CA-19-9
Bladder (transitional cell carcinoma)
Malignant melanoma
Pancreatic adenocarcinoma
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.

24. Causes: Erythropoietin Effect: Polycythemia What neoplasm would create this paraneoplastic effect?
Renal cell carcinoma - hemangioblastoma
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 - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)

25. TNM staging system
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome
Leukemias and lymphomas
T = size of T umor N = N ode involvement M = M etastases
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

26. Tumor markers: TRAP

27. Malignant
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.
Normal cells w/ basal --< apical differentiation <img src='220a.JPG' />
Malignant lymphomas

28. Oncogenic viruses: HTLV-1 What is the associated cancer?
Adult T- cell leukemia
Hepatocellular carcinoma
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
APC

29. Neoplasm: Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma With what dz is this associated?
Liver (hepatocellular carcinoma)
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
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).

30. Primary tumors that metastasize to brain
Rb
Gain of fxn --< cancer. Need damage to only 1 allele.
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.
Malignant melanoma

31. Chemical carcinogens: Vinyl chloride What is the affected organ?
C - kit
WT1
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Liver (angiosarcoma)

32. Hepatocellular carcinoma What is the assocciated oncogenic virus?
Amylin protein Derived from AE (AE = E ndocrine)
The liver and lung are the most common sites of metastasis after regional LN's. Metastasis << primary liver tumors.
Assoc: Colorectal cancer (assoc w/ FAP)
HBV - HCV

33. Type of amyloid protein: Dialysis - associated Protein? Derived from...?
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
Secondary osteosarcoma and fibrosarcoma
Beta -2 microglobulin Derived from MHC class I proteins.
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma

34. Oncogene: N - myc Associated tumor?
Amylin protein Derived from AE (AE = E ndocrine)
Benign and malignant lymphomas
N euroblastoma
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma

35. Free radical degradation
Small cell lung carcinoma and intracranial neoplasms
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
Assoc: Pancreatic cancer [DPC = D eleted in P ancreatic C ancer']
APC

36. Metastasis to liver

37. Primary tumors that metasize to bone

38. Burkitt's lymphoma nasopharyngeal carcinoma What is the assocciated oncogenic virus?
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Actinic keratosis
EBV
Erb - B2

39. Leukocyte extravasation

40. Metaplasia

41. Dz: Immunodeficiency states What is the associated neoplasm?
Ovarian - malignant epithelial tumors
Cells have increased in # (hyperplasia ) Abnormal proliferation of cells w/ loss of size - shape - and orientation (dysplasia ) <img src='220b.JPG' />
Malignant lymphomas
Benign: -- Malignant: Leukemia - lymphoma

42. Tumor markers: PSA
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
Acanthosis nigricans (hyperpigmentation and epidermal thickening)
Fibroblast emigration and proliferation; deposition of ECM.
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.

43. Leukocyte activation in inflammation
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.
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.
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
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants

44. Oncogene: ret Associated tumor?
Multiple endocrine neoplasia (MEN) types II and III
IL-8 C5a Leukotriene B4 Kallikrein
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.
Skin (squamous cell carcinoma) Liver (angiosarcoma)

45. Dz: Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency) What is the associated neoplasm?
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome
Squamous cell carcinoma of esophagus
WT1
CML

46. Desmoplasia
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
Tartrate - resistant acid phosphatase. Hairy cell leukemia -- a B- cell neoplasm. 'TRAP the hairy animal.'
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)
Fibrous tissue formation in response to a neoplasm. Irreversible.

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

48. Tumor nomenclature: Bone What do you call a benign tumor of this tissue? .. a malignant one?
IL-8 C5a Leukotriene B4 Kallikrein
Benign: Osteoma Malignant: osteosarcoma
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
L - myc

49. Tumor markers: S-100
Burkitt's lymphoma
Tartrate - resistant acid phosphatase. Hairy cell leukemia -- a B- cell neoplasm. 'TRAP the hairy animal.'
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
Melanoma - neural tumors - astrocytomas.

50. Tumor stage