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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. Tumor markers: TRAP

2. Wilms' tumor What is the tumor suppressor gene?
WT1
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
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome

3. Retinoblastoma - osteosarcoma What is the tumor suppressor gene?
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Liver (hepatocellular carcinoma)
Rb

4. Fibrosis in inflammation
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Fibrous tissue formation in response to a neoplasm. Irreversible.
Fibroblast emigration and proliferation; deposition of ECM.
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).

5. Tumor suppressor gene: DCC chromosome? Associated tumor?
Assoc: breast cancer
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
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.
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention

6. Neoplasm: Squamous cell carcinoma of esophagus With what dz is this associated?
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
Assoc: Melanoma ('MelaN oma is N ine')
NF2
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)

7. Paraneoplastic effects of tumors: Small cell lung carcinoma and intracranial neoplasms Causes...? Effect?
Causes: ADH Effect: SIADH
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
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).
Fibroblast emigration and proliferation; deposition of ECM.

8. 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)
Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.

9. Free radical injury induces cell injury thru...?
Membrane lipid peroxidation Protein modification DNA Breakage
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors
Pancreatic adenocarcinoma

10. Oncogenic viruses: HPV What is the associated cancer?
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
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.
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'

11. Oncogene: abl Associated tumor?
Increase in # of cells. Reversible.
APC
CML
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma

12. Tumor suppressor gene: BRCA1 chromosome? Associated tumor?
Squamous cell carcinoma of the skin
Assoc.: Breast and ovarian cancer
C - myc
HHV-8

13. Tumor suppressor gene: NF2 chromosome? Associated tumor?

14. Dz: Immunodeficiency states What is the associated neoplasm?
Malignant lymphomas
Bladder (transitional cell carcinoma)
Fibroblast emigration and proliferation; deposition of ECM.
APC

15. Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy What neoplasm would create this paraneoplastic effect?
All (we All fall Down ) AML
Leukemias and lymphomas
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.
Esophagus - stomach

16. Male cancer epidemiology (incidence - mortality)
Enzymatic degradation of a cell resulting from exogenous injury.
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Xeroderma pigmentosum - albinism
L ung tumor

17. tumor: Gastrointestinal stromal tumor (GIST) What is the associated oncogene?
Protein = transthyretin Derived from AF (AF = old F ogies)
Multiple endocrine neoplasia (MEN) types II and III
Esophageal adenocarcinoma
C - kit

18. Tumor markers: Prostatic acid phospatase
Prostate carcinoma.
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
Leukemias and lymphomas
Usually stage < grade

19. Tumor markers: CEA
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.
Assoc: Neurofibromatosis type 1
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)

20. Neoplasm: Visceral malignancy (stomach - lung - breast - uterus) With what dz is this associated?
Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome
Acanthosis nigricans (hyperpigmentation and epidermal thickening)
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)

21. Neoplasm: Squamous cell carcinoma of the skin With what dz is this associated?
Actinic keratosis
Breast - ovarian - and gastric carcinomas
Malignant lymphomas
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)

22. Tumor grade
Assoc: Melanoma ('MelaN oma is N ine')
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.
Beta -2 microglobulin Derived from MHC class I proteins.
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma

23. Oncogenic viruses: HBV - HCV What is the associated cancer?
Hepatocellular carcinoma
IL-8 C5a Leukotriene B4 Kallikrein
Chr. 11p Assoc: Wilms' tumor
CML

24. Neoplasm: Gastric adenocarcinoma With what dz is this associated?
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
N - myc
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]

25. Metastasis to bone
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
Sarcoma
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation
Leukocyte travels btw endothelial cells and exits blood vessel; PECAM-1 is involved. <img src='218a.JPG' />

26. Neoplasm: Colonic adenocarcinoma With what dz is this associated?
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)
Ulcerative colitis
Assoc.: Retinoblastoma - osteosarcoma
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)

27. Oncogenic viruses: HHV-8 What is the associated cancer?

28. Characteristics of reversible cell injury
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.
Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
Chr. 11p Assoc: Wilms' tumor

29. 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
Prostate carcinoma.
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.
HPV

30. Dz: Down syndrome What is the associated neoplasm?
Amylin protein Derived from AE (AE = E ndocrine)
All (we All fall Down ) AML
Erb - B2
Melanoma - neural tumors - astrocytomas.

31. Rolling (step 1 in leukocyte extravasation)

32. Necrosis is characterized by...?
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />

33. Tumor nomenclature: Epithelium What do you call a benign tumor of this tissue? .. a malignant one?
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
Sarcoma
Follicular and undifferentiated lymphomas (inhibits apoptosis)
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)

34. most human cancers - Li - Fraumeni syndrome What is the tumor suppressor gene?
Fibrous tissue formation in response to a neoplasm. Irreversible.
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.
P 53
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)

35. Tumor suppressor gene: p 53 chromosome? Associated tumor?
Hepatocellular carcinoma
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome

36. Dz: Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants What is the associated neoplasm?
L - myc
Gastric adenocarcinoma
Dysplastic nevus
Liver (hepatocellular carcinoma)

37. Tumor markers: alpha - fetoprotein
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />
Benign: hemangioma Malignant: Angiosarcoma
Causes: ADH Effect: SIADH
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)

38. Diapedesis (step 3 in leukocyte extravasation)

39. Malignant
Benign: -- Malignant: Leukemia - lymphoma
Benign: hemangioma Malignant: Angiosarcoma
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.
Tartrate - resistant acid phosphatase. Hairy cell leukemia -- a B- cell neoplasm. 'TRAP the hairy animal.'

40. Chemical carcinogens: Alkylating agents What is the affected organ?
Skin (squamous cell carcinoma) Liver (angiosarcoma)
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)
Blood (leukemia)
Usually well - differentiated - slow growing - well - demarcated - no metastasis.

41. Type of amyloid protein: DM2 Protein? Derived from...?
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy
Breast - ovarian - and gastric carcinomas
Amylin protein Derived from AE (AE = E ndocrine)

42. Apoptosis is characterized by...?
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
N euroblastoma
Amylin protein Derived from AE (AE = E ndocrine)
Liver (centrilobular necrosis - fatty change)

43. Neoplasm: All (we All fall Down ) AML With what dz is this associated?
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />
Renal cell carcinoma - hemangioblastoma
Down syndrome
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.

44. Septic shock
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.

45. Tumor nomenclature: Bone What do you call a benign tumor of this tissue? .. a malignant one?
Causes: Erythropoietin Effect: Polycythemia
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />
Benign: Osteoma Malignant: osteosarcoma
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' />

46. Dz: Radiation exposure What is the associated neoplasm?
Sarcoma
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy

47. [aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma What is the assocciated oncogenic virus?
NF2
Ras
C - myc
HHV-8

48. Anaplasia
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
Abl
HHV-8
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.

49. Oncogene: N - myc Associated tumor?
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
Benign: lipoma Malignant: liposarcoma
Bcl -2
N euroblastoma

50. Breast and ovarian cancer What is the tumor suppressor gene?
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
Amylin protein Derived from AE (AE = E ndocrine)
BRCA1
Benign: Leiomyoma Malignant: Leiomyosarcoma