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

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2. Neoplasia
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
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
Colon 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.


3. tumor: Breast - ovarian - and gastric carcinomas What is the associated oncogene?
NF1
Normal cells w/ basal --< apical differentiation <img src='220a.JPG' />
Erb - B2
N euroblastoma


4. Oncogenic viruses: HBV - HCV What is the associated cancer?
Hepatocellular carcinoma
Causes: Erythropoietin Effect: Polycythemia
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).
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


5. Dz: Cirrhosis (alcoholic - hepatitis B or C) What is the associated neoplasm?
All (we All fall Down ) AML
NF2
Hepatocellular carcinoma
Gastrointestinal stromal tumor (GIST)


6. Fluid exudation in inflammation
Increase vascular permeability - vasodilation - endothelial injury.
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)
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.
Down syndrome


7. Type of amyloid protein: Primary Protein? Derived from...?
Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome
Neuorblastoma - lung - and gastric cancer.
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
Assoc: Colorectal cancer (assoc w/ FAP)


8. Apoptosis (definition)
[aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma
Erb - B2
Esophagus - stomach
Programmed cell death; ATP required. Mediated by caspases.


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

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10. Oncogenic viruses: HTLV-1 What is the associated cancer?
Cells have increased in # (hyperplasia ) Abnormal proliferation of cells w/ loss of size - shape - and orientation (dysplasia ) <img src='220b.JPG' />
Causes: ADH Effect: SIADH
Adult T- cell leukemia
IL-8 C5a Leukotriene B4 Kallikrein


11. Dz: Acanthosis nigricans (hyperpigmentation and epidermal thickening) What is the associated neoplasm?
Visceral malignancy (stomach - lung - breast - uterus)
Assoc.: Breast and ovarian cancer
Benign and malignant lymphomas
NF1


12. Metaplasia

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13. Carcinoma vs. sarcoma
NF1
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia


14. Oncogenic viruses: HPV What is the associated cancer?
Sarcoma
Assoc: Melanoma ('MelaN oma is N ine')
All (we All fall Down ) AML
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma


15. When does apoptosis occur?
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)
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
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention
Tartrate - resistant acid phosphatase. Hairy cell leukemia -- a B- cell neoplasm. 'TRAP the hairy animal.'


16. tumor: Colon carcinoma What is the associated oncogene?
Melanoma - neural tumors - astrocytomas.
Ras
Small cell lung carcinoma and intracranial neoplasms
Membrane lipid peroxidation Protein modification DNA Breakage


17. Dz: Tuberous sclerosis (facial angiofibroma - seizures - mental retardation) What is the associated neoplasm?
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
Radiation exposure
Breast - ovarian - and gastric carcinomas
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma


18. Oncogene: abl Associated tumor?
Benign: Osteoma Malignant: osteosarcoma
CML
Breast - ovarian - and gastric carcinomas
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.


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

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20. Characteristics of ex udate
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
Small cell lung carcinoma and intracranial neoplasms
Chr. 11p Assoc: Wilms' tumor
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation


21. Malignant
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.
Paget's dz of bone
Colon carcinoma


22. Type of amyloid protein: Medullary carcinoma of thyroid Protein? Derived from...?
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin
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.
HTLV-1


23. Neoplasm: Gastric adenocarcinoma With what dz is this associated?
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
Fibroblast emigration and proliferation; deposition of ECM.
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.


24. 5 Characteristic signs of inflammation
Esophagus - stomach
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)
Cirrhosis (alcoholic - hepatitis B or C)


25. Oncogene: erb - B2 Associated tumor?
Hepatocellular carcinoma
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)
Assoc: Neurofibromatosis 2 ('Type 2 = 22')
Breast - ovarian - and gastric carcinomas


26. Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness) What neoplasm would create this paraneoplastic effect?
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
C - kit
Thymoma - small cell lung carcinoma
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.


27. Neoplasm: Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma With what dz is this associated?
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)
Hepatocellular carcinoma
Causes: ADH Effect: SIADH


28. Desmoplasia
Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention
Fibrous tissue formation in response to a neoplasm. Irreversible.
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'


29. Tumor suppressor gene: BRCA2 chromosome? Associated tumor?
Assoc: breast cancer
[DPC = D eleted in P ancreatic C ancer'] What is the tumor suppressor gene? DPC
Benign and malignant lymphomas
Paget's dz of bone


30. Causes: ADH Effect: SIADH What neoplasm would create this paraneoplastic effect?
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
Acanthosis nigricans (hyperpigmentation and epidermal thickening)
Liver (angiosarcoma)
Small cell lung carcinoma and intracranial neoplasms


31. Tumor markers: TRAP

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32. Chemical carcinogens: Alkylating agents What is the affected organ?
Down syndrome
Programmed cell death; ATP required. Mediated by caspases.
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
Blood (leukemia)


33. Dz: Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants What is the associated neoplasm?
Gastric adenocarcinoma
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
Erb - B2
Xeroderma pigmentosum - albinism


34. Chemical carcinogens: Arsenic What is the affected organ?
Skin (squamous cell carcinoma) Liver (angiosarcoma)
Colon carcinoma
Cells have invaded basement membrane using collagenases and hydrolases Can metastasize if they reach a blood or lymphatic vessel <img src='220d.JPG' />
Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis)


35. Tumor markers: Bombesin
Bladder (transitional cell carcinoma)
Neuorblastoma - lung - and gastric cancer.
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
Benign: -- Malignant: Leukemia - lymphoma


36. Dz: Ulcerative colitis What is the associated neoplasm?
Assoc: Melanoma ('MelaN oma is N ine')
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation
NF1
Colonic adenocarcinoma


37. Resolution of inflammation
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />
Breast - ovarian - and gastric carcinomas
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.
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.


38. Tumor nomenclature: Fat What do you call a benign tumor of this tissue? .. a malignant one?
Assoc.: Retinoblastoma - osteosarcoma
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.
Benign: -- Malignant: Leukemia - lymphoma
Benign: lipoma Malignant: liposarcoma


39. Hypovolemic/cardiogenic shock
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
Chr. 11p Assoc: Wilms' tumor
Protein = transthyretin Derived from AF (AF = old F ogies)
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)


40. Adult T- cell leukemia What is the assocciated oncogenic virus?
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)
HTLV-1
Visceral malignancy (stomach - lung - breast - uterus)
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.


41. Characteristics of irreversible cell injury
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
Bcl -2
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.


42. Tumor suppressor gene: DCC chromosome? Associated tumor?
Gastrointestinal stromal tumor (GIST)
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
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' />
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]


43. Tumor suppressor gene: APC chromosome? Associated tumor?
Normal cells w/ basal --< apical differentiation <img src='220a.JPG' />
P 16
Assoc: Colorectal cancer (assoc w/ FAP)
The liver and lung are the most common sites of metastasis after regional LN's. Metastasis << primary liver tumors.


44. Tumor markers: alpha - fetoprotein
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Adult T- cell leukemia
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)


45. Dz: Down syndrome What is the associated neoplasm?
IL-8 C5a Leukotriene B4 Kallikrein
Paget's dz of bone
All (we All fall Down ) AML
Squamous cell carcinoma of the skin


46. Tumor markers: CA-125
Ovarian - malignant epithelial tumors
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.
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' />
Pancreatic adenocarcinoma


47. Tumor markers: Prostatic acid phospatase
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.
Malignant lymphomas
Ovarian - malignant epithelial tumors
Prostate carcinoma.


48. Dz: Immunodeficiency states What is the associated neoplasm?
Malignant lymphomas
Assoc.: Breast and ovarian cancer
Normal cells w/ basal --< apical differentiation <img src='220a.JPG' />
Assoc.: Retinoblastoma - osteosarcoma


49. Tumor markers: S-100
Ret
Esophagus - stomach
Melanoma - neural tumors - astrocytomas.
Prostate carcinoma.


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

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