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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. Neoplasm: Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin With what dz is this associated?
Xeroderma pigmentosum - albinism
HBV - HCV
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
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

2. Things that initiate Free radical injury
Immunodeficiency states
T = size of T umor N = N ode involvement M = M etastases
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
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.

3. Oncogenic viruses: HPV What is the associated cancer?
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Assoc: Neurofibromatosis 2 ('Type 2 = 22')
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' />
L ung tumor

4. Benign
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
Melanoma - neural tumors - astrocytomas.
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma

5. Apoptosis is characterized by...?
Multiple endocrine neoplasia (MEN) types II and III
Usually stage < grade
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
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

6. Characteristics of reversible cell injury
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
Assoc: Pancreatic cancer [DPC = D eleted in P ancreatic C ancer']
Hepatocellular carcinoma
Colonic adenocarcinoma

7. Tumor nomenclature: Skeletal muscle What do you call a benign tumor of this tissue? .. a malignant one?
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Small cell lung carcinoma
AIDS

8. tumor: Burkitt's lymphoma What is the associated oncogene?
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
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.
C - myc
L ung tumor

9. Resolution of inflammation
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy
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.
Erb - B2
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma

10. Chronic inflammation
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' />
Causes: Erythropoietin Effect: Polycythemia
Assoc: breast cancer
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.

11. Hepatocellular carcinoma What is the assocciated oncogenic virus?
HBV - HCV
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />
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' />
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.

12. Burkitt's lymphoma nasopharyngeal carcinoma What is the assocciated oncogenic virus?
Fibrous tissue formation in response to a neoplasm. Irreversible.
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'
EBV

13. Tumor suppressor gene: p 53 chromosome? Associated tumor?
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
Radiation exposure
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

14. Paraneoplastic effects of tumors: Renal cell carcinoma - hemangioblastoma Causes...? Effect?
Squamous cell carcinoma of the skin
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
Causes: Erythropoietin Effect: Polycythemia
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.

15. Anaplasia
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.
Assoc: Neurofibromatosis 2 ('Type 2 = 22')
HPV
All (we All fall Down ) AML

16. Migration (step 4 in leukocyte extravasation)

17. Paraneoplastic effects of tumors: Small cell lung carcinoma and intracranial neoplasms Causes...? Effect?
Causes: Erythropoietin Effect: Polycythemia
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
Causes: ADH Effect: SIADH
Ulcerative colitis

18. Tumor markers: S-100
APC
Burkitt's lymphoma
HHV-8
Melanoma - neural tumors - astrocytomas.

19. Tumor nomenclature: Blood vessels What do you call a benign tumor of this tissue? .. a malignant one?
Assoc.: Breast and ovarian cancer
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
AIDS
Benign: hemangioma Malignant: Angiosarcoma

20. Dz: Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants What is the associated neoplasm?
Gastric adenocarcinoma
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />
CML
[DPC = D eleted in P ancreatic C ancer'] What is the tumor suppressor gene? DPC

21. Chemical carcinogens: Alkylating agents What is the affected organ?
Assoc.: Breast and ovarian cancer
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)
Esophageal adenocarcinoma
Blood (leukemia)

22. Rolling (step 1 in leukocyte extravasation)

23. Neoplastic progression: step 1 Hyperplasia/dysplasia

24. Breast and ovarian cancer What is the tumor suppressor gene?
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.
BRCA1
Benign: Osteoma Malignant: osteosarcoma
Benign: lipoma Malignant: liposarcoma

25. Tumor nomenclature: Fat 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.
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'
Down syndrome
Benign: lipoma Malignant: liposarcoma

26. 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)
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' />
Breast - ovarian - and gastric carcinomas
Sarcoma

27. Type of amyloid protein: Medullary carcinoma of thyroid Protein? Derived from...?
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Assoc: Colorectal cancer (assoc w/ FAP)
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)

28. Diapedesis (step 3 in leukocyte extravasation)

29. Dz: Tuberous sclerosis (facial angiofibroma - seizures - mental retardation) What is the associated neoplasm?
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma
Barrett's esophagus (chronic GI reflux)
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' />

30. Type of amyloid protein: Alzheimer's dz Protein? Derived from...?
Paget's dz of bone
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
Beta - amyloid Derived from amyloid precursor protein (APP)

31. Neoplasm: All (we All fall Down ) AML With what dz is this associated?
Down syndrome
HBV - HCV
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
Esophagus - stomach

32. Tumor markers: CEA
Benign: Osteoma Malignant: osteosarcoma
L - myc
Multiple endocrine neoplasia (MEN) types II and III
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.

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

34. Type of amyloid protein: DM2 Protein? Derived from...?
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
Paget's dz of bone
Amylin protein Derived from AE (AE = E ndocrine)
APC

35. Tumor grade
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.
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
Adult T- cell leukemia
Cells have invaded basement membrane using collagenases and hydrolases Can metastasize if they reach a blood or lymphatic vessel <img src='220d.JPG' />

36. Dz: Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis) What is the associated neoplasm?
Cells have increased in # (hyperplasia ) Abnormal proliferation of cells w/ loss of size - shape - and orientation (dysplasia ) <img src='220b.JPG' />
Burkitt's lymphoma
Benign and malignant lymphomas
HPV

37. Tumor nomenclature: Blood cells What do you call a benign tumor of this tissue? .. a malignant one?
Benign: -- Malignant: Leukemia - lymphoma
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.
Liver (centrilobular necrosis - fatty change)
Neoplastic cells hae not invaded basement membrane. High nuclear/cytoplasmic ratio and clumped chromatin Neoplastic cells encompass entire thickness Tumor cells are monoclonal <img src='220c.JPG' />

38. Neoplasm: Benign and malignant lymphomas With what dz is this associated?

39. Metastasis to bone
Radiation exposure
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.

40. Leukocyte extravasation

41. Metastasis to brain
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Benign and malignant lymphomas
Renal cell carcinoma - hemangioblastoma

42. Acute inflammation
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
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: Osteoma Malignant: osteosarcoma

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

44. Carcinoma vs. sarcoma
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
Erb - B2
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
Melanoma - neural tumors - astrocytomas.

45. Which usually has more prognostic value - tumor stage or grade?
C - myc
Usually stage < grade
Assoc: Pancreatic cancer [DPC = D eleted in P ancreatic C ancer']
HBV - HCV

46. Oncogene: ras Associated tumor?
Liver (angiosarcoma)
Colon carcinoma
Skin (squamous cell carcinoma) Liver (angiosarcoma)
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

47. tumor: Multiple endocrine neoplasia (MEN) types II and III What is the associated oncogene?
Ret
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
Gain of fxn --< cancer. Need damage to only 1 allele.

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

49. Paraneoplastic effects of tumors: Leukemias and lymphomas Causes...? Effect?
Gastrointestinal stromal tumor (GIST)
Gastric adenocarcinoma
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy

50. Neoplasm: Squamous cell carcinoma of esophagus With what dz is this associated?
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
Benign and malignant lymphomas
Causes: Erythropoietin Effect: Polycythemia