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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. Chronic inflammation
HTLV-1
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin
Down syndrome

2. tumor: Follicular and undifferentiated lymphomas (inhibits apoptosis) What is the associated oncogene?
Bcl -2
L ung tumor
Assoc: Neurofibromatosis 2 ('Type 2 = 22')
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)

3. Tumor suppressor genes
Liver (hepatocellular carcinoma)
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Immunodeficiency states
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma

4. Tumor markers: TRAP

5. Chemical carcinogens: Alkylating agents What is the affected organ?
Blood (leukemia)
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
WT1
Benign: -- Malignant: Leukemia - lymphoma

6. Anaplasia
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: lipoma Malignant: liposarcoma
Beta -2 microglobulin Derived from MHC class I proteins.
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. Chemical carcinogens: CCl4 What is the affected organ?
Tartrate - resistant acid phosphatase. Hairy cell leukemia -- a B- cell neoplasm. 'TRAP the hairy animal.'
Rb
Chr. 11p Assoc: Wilms' tumor
Liver (centrilobular necrosis - fatty change)

8. Tumor nomenclature: Blood cells What do you call a benign tumor of this tissue? .. a malignant one?
Metastases to bone - obstructive biliary dz - Paget's dz of bone.
Ulcerative colitis
Hepatocellular carcinoma
Benign: -- Malignant: Leukemia - lymphoma

9. Benign
HBV - HCV
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
Fibrous tissue formation in response to a neoplasm. Irreversible.
Follicular and undifferentiated lymphomas (inhibits apoptosis)

10. Diapedesis (step 3 in leukocyte extravasation)

11. Resolution of inflammation
Causes: ADH Effect: SIADH
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.
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
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.

12. Tumor nomenclature: Skeletal muscle What do you call a benign tumor of this tissue? .. a malignant one?
Protein = transthyretin Derived from AF (AF = old F ogies)
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
HTLV-1
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma

13. Tumor markers: Bombesin
Neuorblastoma - lung - and gastric cancer.
Beta -2 microglobulin Derived from MHC class I proteins.
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)

14. Pancreatic cancer

15. Chemical carcinogens: Aflatoxins (produced by Aspergillus) What is the affected organ?
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors
BRCA2
Liver (hepatocellular carcinoma)
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

16. Oncogene: ras Associated tumor?
Colon carcinoma
Assoc: breast cancer
Beta -2 microglobulin Derived from MHC class I proteins.
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma

17. Dz: Actinic keratosis What is the associated neoplasm?
[DPC = D eleted in P ancreatic C ancer'] What is the tumor suppressor gene? DPC
Squamous cell carcinoma of the skin
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.
Loss of fxn --< cancer; both allels must be lost for expression of dz.

18. Oncogenic viruses: HBV - HCV What is the associated cancer?
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />
Hepatocellular carcinoma
Neuorblastoma - lung - and gastric cancer.
Colonic adenocarcinoma

19. Paraneoplastic effects of tumors: Small cell lung carcinoma and intracranial neoplasms Causes...? Effect?
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.
Causes: ADH Effect: SIADH
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)
Pancreatic adenocarcinoma

20. Tumor markers: PSA
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
Fibrous tissue formation in response to a neoplasm. Irreversible.
HBV - HCV
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma

21. Neoplasm: Hepatocellular carcinoma With what dz is this associated?
Assoc: Neurofibromatosis type 1
Burkitt's lymphoma nasopharyngeal carcinoma
Cirrhosis (alcoholic - hepatitis B or C)
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.

22. Tumor stage

23. Neoplasm: Esophageal adenocarcinoma With what dz is this associated?

24. Hypovolemic/cardiogenic shock
Fibrous tissue formation in response to a neoplasm. Irreversible.
Small cell lung carcinoma
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
Bcl -2

25. Tumor markers: CA-125
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Ovarian - malignant epithelial tumors
Pancreatic adenocarcinoma
Colonic adenocarcinoma

26. Paraneoplastic effects of tumors: Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma Causes...? Effect?
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia
Ulcerative colitis
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'

27. Oncogene: erb - B2 Associated tumor?
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Colon carcinoma
Hepatocellular carcinoma
Breast - ovarian - and gastric carcinomas

28. Hepatocellular carcinoma What is the assocciated oncogenic virus?
HBV - HCV
Small cell lung carcinoma and intracranial neoplasms
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.
C - myc

29. Oncogene: ret Associated tumor?
Benign: lipoma Malignant: liposarcoma
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
Multiple endocrine neoplasia (MEN) types II and III
Assoc: Pancreatic cancer [DPC = D eleted in P ancreatic C ancer']

30. Tumor nomenclature: Smooth muscle What do you call a benign tumor of this tissue? .. a malignant one?
Benign: Osteoma Malignant: osteosarcoma
Benign: Leiomyoma Malignant: Leiomyosarcoma
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome

31. Carcinoma vs. sarcoma
Thymoma - small cell lung carcinoma
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
Assoc: breast cancer
Barrett's esophagus (chronic GI reflux)

32. Dz: Cirrhosis (alcoholic - hepatitis B or C) What is the associated neoplasm?
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Hepatocellular carcinoma
Assoc.: Retinoblastoma - osteosarcoma
Liver (angiosarcoma)

33. 5 Characteristic signs of inflammation
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)
Benign: -- Malignant: Leukemia - lymphoma
Rb
Secondary osteosarcoma and fibrosarcoma

34. Neoplastic progression: step 2 In situ carcinoma

35. 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
Malignant lymphomas
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.
Increase vascular permeability - vasodilation - endothelial injury.

36. Rolling (step 1 in leukocyte extravasation)

37. Dz: Acanthosis nigricans (hyperpigmentation and epidermal thickening) What is the associated neoplasm?
Erb - B2
C - myc
Visceral malignancy (stomach - lung - breast - uterus)
N - myc

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

39. Colon cancer
Esophageal adenocarcinoma
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
[aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma

40. Leukocyte extravasation

41. Neoplasia
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
Breast - ovarian - and gastric carcinomas
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
Metastases to bone - obstructive biliary dz - Paget's dz of bone.

42. Chemical carcinogens: Cigarette smoke What is the affected organ?
Gastric adenocarcinoma
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)
Benign: hemangioma Malignant: Angiosarcoma
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)

43. tumor: Colon carcinoma What is the associated oncogene?
Ras
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Malignant melanoma
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' />

44. Neoplasm: Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma With what dz is this associated?
Follicular and undifferentiated lymphomas (inhibits apoptosis)
Rb
AIDS
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.

45. Neoplasm: Gastric adenocarcinoma With what dz is this associated?
Amylin protein Derived from AE (AE = E ndocrine)
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
Sarcoma
WT1

46. Tumor markers: CEA
Assoc: Neurofibromatosis type 1
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Lung (mesothelioma and bronchogenic carcinoma)

47. Leukocyte activation in inflammation
Melanoma - neural tumors - astrocytomas.
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.
The liver and lung are the most common sites of metastasis after regional LN's. Metastasis << primary liver tumors.

48. Tumor markers: S-100
Melanoma - neural tumors - astrocytomas.
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)
Benign and malignant lymphomas

49. Oncogene: c - kit Associated tumor?
Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis)
Paget's dz of bone
Gastrointestinal stromal tumor (GIST)
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.

50. Tumor nomenclature: Blood vessels What do you call a benign tumor of this tissue? .. a malignant one?
Benign: lipoma Malignant: liposarcoma
Benign: hemangioma Malignant: Angiosarcoma
NF1
Liver (centrilobular necrosis - fatty change)