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Test your basic knowledge |
USMLE Step 1 First Aid Pathology
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Study First
Subjects
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health-sciences
,
usmle-step-1
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. Chemical carcinogens: Nitrosamines (e.g. - in smoked foods) What is the affected organ?
WT1
Esophagus - stomach
Paget's dz of bone
Liver (angiosarcoma)
2. Tumor nomenclature: Fat What do you call a benign tumor of this tissue? .. a malignant one?
HHV-8
Benign: lipoma Malignant: liposarcoma
Actinic keratosis
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
3. Neoplasm: Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma With what dz is this associated?
AIDS
Bladder (transitional cell carcinoma)
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
Benign: lipoma Malignant: liposarcoma
4. Oncogene: c - myc Associated tumor?
5. Type of amyloid protein: Secondary Protein? Derived from...?
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.
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)
Leukemias and lymphomas
Acanthosis nigricans (hyperpigmentation and epidermal thickening)
6. Tumor nomenclature: Blood vessels What do you call a benign tumor of this tissue? .. a malignant one?
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
NF1
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'
Benign: hemangioma Malignant: Angiosarcoma
7. tumor: L ung tumor What is the associated oncogene?
Barrett's esophagus (chronic GI reflux)
L - myc
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
Erb - B2
8. Characteristics of ex udate
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction 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.
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
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.
9. Oncogenic viruses: HHV-8 What is the associated cancer?
10. Colorectal cancer (assoc w/ FAP) What is the tumor suppressor gene?
Esophageal adenocarcinoma
The liver and lung are the most common sites of metastasis after regional LN's. Metastasis << primary liver tumors.
APC
Colon carcinoma
11. Amyloid structure
Fibrous tissue formation in response to a neoplasm. Irreversible.
Down syndrome
Hepatocellular carcinoma
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
12. Tumor nomenclature: Smooth muscle What do you call a benign tumor of this tissue? .. a malignant one?
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
Benign: Leiomyoma Malignant: Leiomyosarcoma
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Squamous cell carcinoma of esophagus
13. tumor: Follicular and undifferentiated lymphomas (inhibits apoptosis) What is the associated oncogene?
NF2
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' />
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Bcl -2
14. Which usually has more prognostic value - tumor stage or grade?
Liver (angiosarcoma)
Programmed cell death; ATP required. Mediated by caspases.
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.
Usually stage < grade
15. Tumor suppressor gene: Rb chromosome? Associated tumor?
Paget's dz of bone
Assoc.: Retinoblastoma - osteosarcoma
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
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
16. tumor: Breast - ovarian - and gastric carcinomas What is the associated oncogene?
L - myc
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
Erb - B2
Assoc: Neurofibromatosis type 1
17. Dz: Actinic keratosis What is the associated neoplasm?
Colon carcinoma
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)
Squamous cell carcinoma of the skin
Assoc: Melanoma ('MelaN oma is N ine')
18. Psammoma bodies
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
Malignant lymphomas
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
[DPC = D eleted in P ancreatic C ancer'] What is the tumor suppressor gene? DPC
19. tumor: Multiple endocrine neoplasia (MEN) types II and III What is the associated oncogene?
Ret
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)
NF2
Beta -2 microglobulin Derived from MHC class I proteins.
20. Neoplastic progression: step 4 Metastasis
21. Tumor nomenclature: Bone What do you call a benign tumor of this tissue? .. a malignant one?
Benign: lipoma Malignant: liposarcoma
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
Benign: Osteoma Malignant: osteosarcoma
22. Neoplasm: Benign and malignant lymphomas With what dz is this associated?
23. Type of amyloid protein: Medullary carcinoma of thyroid Protein? Derived from...?
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
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
Adult T- cell leukemia
24. Paraneoplastic effects of tumors: Small cell lung carcinoma Causes...? Effect?
25. Metastasis to bone
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
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.
26. Metastasis to brain
N - myc
WT1
Benign and malignant lymphomas
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
27. Dz: AIDS What is the associated neoplasm?
28. Tumor stage
29. Tumor suppressor gene: BRCA1 chromosome? Associated tumor?
Assoc.: Breast and ovarian cancer
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.
Sarcoma
Tartrate - resistant acid phosphatase. Hairy cell leukemia -- a B- cell neoplasm. 'TRAP the hairy animal.'
30. Tumor markers: TRAP
31. Neoplasm: Visceral malignancy (stomach - lung - breast - uterus) With what dz is this associated?
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
Blood (leukemia)
Cells have increased in # (hyperplasia ) Abnormal proliferation of cells w/ loss of size - shape - and orientation (dysplasia ) <img src='220b.JPG' />
Acanthosis nigricans (hyperpigmentation and epidermal thickening)
32. Type of amyloid protein: Primary Protein? Derived from...?
Barrett's esophagus (chronic GI reflux)
Leukocyte travels btw endothelial cells and exits blood vessel; PECAM-1 is involved. <img src='218a.JPG' />
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
Colon carcinoma
33. Oncogene: L - myc Associated tumor?
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />
P 16
L ung tumor
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
34. Oncogenic viruses: HBV - HCV What is the associated cancer?
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.
NF2
[aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma
Hepatocellular carcinoma
35. Dz: Xeroderma pigmentosum - albinism What is the associated neoplasm?
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin
Colon carcinoma
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
36. Neoplastic progression: step 2 In situ carcinoma
37. Tumor nomenclature: Skeletal muscle What do you call a benign tumor of this tissue? .. a malignant one?
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Small cell lung carcinoma and intracranial neoplasms
AIDS
38. Cervical carcinoma (types 16 - 18) Penile/anal carcinoma What is the assocciated oncogenic virus?
HPV
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome
Benign: hemangioma Malignant: Angiosarcoma
Assoc: breast cancer
39. 5 Characteristic signs of inflammation
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)
Benign: -- Malignant: Leukemia - lymphoma
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
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' />
40. Type of amyloid protein: Alzheimer's dz Protein? Derived from...?
Beta - amyloid Derived from amyloid precursor protein (APP)
N - myc
Usually stage < grade
Down syndrome
41. Cancer epidemiology: Lung cancer? As a cause of death overall?
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).
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
42. Chemical carcinogens: Naphthalene (aniline) dyes What is the affected organ?
Normal cells w/ basal --< apical differentiation <img src='220a.JPG' />
Causes: Erythropoietin Effect: Polycythemia
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
Bladder (transitional cell carcinoma)
43. 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
Assoc: breast cancer
Multiple endocrine neoplasia (MEN) types II and III
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
44. Oncogene: N - myc Associated tumor?
NF1
Xeroderma pigmentosum - albinism
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.
N euroblastoma
45. [aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma What is the assocciated oncogenic virus?
HBV - HCV
Skin (squamous cell carcinoma) Liver (angiosarcoma)
IL-8 C5a Leukotriene B4 Kallikrein
HHV-8
46. Malignant
Metastases to bone - obstructive biliary dz - Paget's dz of bone.
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.
Esophagus - stomach
Acanthosis nigricans (hyperpigmentation and epidermal thickening)
47. Female cancer epidemiology (incidence - mortality)
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
Breast - ovarian - and gastric carcinomas
Blood (leukemia)
48. Free radical degradation
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
Esophageal adenocarcinoma
Increase in # of cells. Reversible.
Usually stage < grade
49. 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)
Esophagus - stomach
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)
Lung (mesothelioma and bronchogenic carcinoma)
50. Characteristics of reversible cell injury
Rb
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
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
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)