USMLE Step 1 First Aid Pathology

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


2. Oncogene: c - myc Associated tumor?


3. Type of amyloid protein: Medullary carcinoma of thyroid Protein? Derived from...?
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Benign: Leiomyoma Malignant: Leiomyosarcoma
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)


4. Granulomatous dz's


5. Causes: Erythropoietin Effect: Polycythemia What neoplasm would create this paraneoplastic effect?
Assoc.: Retinoblastoma - osteosarcoma
Abl
Follicular and undifferentiated lymphomas (inhibits apoptosis)
Renal cell carcinoma - hemangioblastoma


6. tumor: Multiple endocrine neoplasia (MEN) types II and III What is the associated oncogene?
Visceral malignancy (stomach - lung - breast - uterus)
Ret
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy
HTLV-1


7. Apoptosis (definition)
Programmed cell death; ATP required. Mediated by caspases.
Neuorblastoma - lung - and gastric cancer.
Gastric adenocarcinoma
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)


8. Neoplasm: Gastric adenocarcinoma With what dz is this associated?
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
Liver (hepatocellular carcinoma)
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma


9. Cervical carcinoma (types 16 - 18) Penile/anal carcinoma What is the assocciated oncogenic virus?
N - myc
Beta -2 microglobulin Derived from MHC class I proteins.
HPV
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.


10. Pancreatic cancer


11. Oncogene: erb - B2 Associated tumor?
L ung tumor
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
Breast - ovarian - and gastric carcinomas
Assoc: Neurofibromatosis type 1


12. tumor: Follicular and undifferentiated lymphomas (inhibits apoptosis) What is the associated oncogene?
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
Bcl -2
P 53
Adult T- cell leukemia


13. Oncogenic viruses: HBV - HCV What is the associated cancer?
Membrane lipid peroxidation Protein modification DNA Breakage
Hepatocellular carcinoma
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
Assoc: Colorectal cancer (assoc w/ FAP)


14. Causes: ADH Effect: SIADH What neoplasm would create this paraneoplastic effect?
T = size of T umor N = N ode involvement M = M etastases
Enzymatic degradation of a cell resulting from exogenous injury.
Small cell lung carcinoma and intracranial neoplasms
Pancreatic adenocarcinoma


15. Psammoma bodies
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.
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.
Squamous cell carcinoma of esophagus
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: N - myc Associated tumor?
Malignant melanoma
Sarcoma
Loss of fxn --< cancer; both allels must be lost for expression of dz.
N euroblastoma


17. Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia What neoplasm would create this paraneoplastic effect?
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
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
Sarcoma
Beta -2 microglobulin Derived from MHC class I proteins.


18. Wilms' tumor What is the tumor suppressor gene?
Benign: Leiomyoma Malignant: Leiomyosarcoma
Dysplastic nevus
WT1
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC


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


20. Tumor markers: Prostatic acid phospatase
L ung tumor
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Prostate carcinoma.
Gastrointestinal stromal tumor (GIST)


21. Neoplasm: Squamous cell carcinoma of esophagus With what dz is this associated?
Cells have increased in # (hyperplasia ) Abnormal proliferation of cells w/ loss of size - shape - and orientation (dysplasia ) <img src='220b.JPG' />
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
N - myc
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.


22. Acute inflammation
Assoc: breast cancer
Colonic adenocarcinoma
Benign: -- Malignant: Leukemia - lymphoma
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.


23. Hyperplasia
Squamous cell carcinoma of the skin
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
Follicular and undifferentiated lymphomas (inhibits apoptosis)
Increase in # of cells. Reversible.


24. Leukocyte activation in 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.
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
Colon carcinoma


25. Metastasis to liver


26. Neoplasm: Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma With what dz is this associated?
Increase vascular permeability - vasodilation - endothelial injury.
Skin (squamous cell carcinoma) Liver (angiosarcoma)
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)


27. Female cancer epidemiology (incidence - mortality)
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.
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)
HBV - HCV
Breast - ovarian - and gastric carcinomas


28. tumor: Gastrointestinal stromal tumor (GIST) What is the associated oncogene?
Actinic keratosis
IL-8 C5a Leukotriene B4 Kallikrein
C - kit
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]


29. Chemical carcinogens: Nitrosamines (e.g. - in smoked foods) What is the affected organ?
Ovarian - malignant epithelial tumors
Adult T- cell leukemia
Esophagus - stomach
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma


30. Migration (step 4 in leukocyte extravasation)


31. Tumor suppressor gene: DCC chromosome? Associated tumor?
Assoc: Neurofibromatosis type 1
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)
[DPC = D eleted in P ancreatic C ancer'] What is the tumor suppressor gene? DPC
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]


32. Tumor markers: Alkaline phosphatase


33. Chemical carcinogens: Cigarette smoke What is the affected organ?
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation
Cells have increased in # (hyperplasia ) Abnormal proliferation of cells w/ loss of size - shape - and orientation (dysplasia ) <img src='220b.JPG' />
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma


34. Desmoplasia
Fibrous tissue formation in response to a neoplasm. Irreversible.
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma
Acanthosis nigricans (hyperpigmentation and epidermal thickening)
Colonic adenocarcinoma


35. Tumor suppressor gene: WT1 chromosome? Associated tumor?


36. Benign
Assoc: Neurofibromatosis type 1
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
Burkitt's lymphoma
Loss of fxn --< cancer; both allels must be lost for expression of dz.


37. Diapedesis (step 3 in leukocyte extravasation)


38. Dz: Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants What is the associated neoplasm?
Beta - amyloid Derived from amyloid precursor protein (APP)
Gastric adenocarcinoma
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
Adult T- cell leukemia


39. Dz: Acanthosis nigricans (hyperpigmentation and epidermal thickening) What is the associated neoplasm?
Visceral malignancy (stomach - lung - breast - uterus)
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
Liver (angiosarcoma)
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. Male cancer epidemiology (incidence - mortality)
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Visceral malignancy (stomach - lung - breast - uterus)
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.
HBV - HCV


41. Things that initiate Free radical injury
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
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' />
L - myc


42. Necrosis (definition)
Gastrointestinal stromal tumor (GIST)
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
Enzymatic degradation of a cell resulting from exogenous injury.
Burkitt's lymphoma


43. Tumor markers: PSA
WT1
Squamous cell carcinoma of the skin
Pancreatic adenocarcinoma
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.


44. Neoplasm: Visceral malignancy (stomach - lung - breast - uterus) With what dz is this associated?
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
Secondary osteosarcoma and fibrosarcoma
IL-8 C5a Leukotriene B4 Kallikrein
Acanthosis nigricans (hyperpigmentation and epidermal thickening)


45. Oncogenic viruses: HTLV-1 What is the associated cancer?
Abl
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
Adult T- cell leukemia
Blood (leukemia)


46. Tumor nomenclature: < 1 cell type 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.
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
Assoc: Pancreatic cancer [DPC = D eleted in P ancreatic C ancer']


47. breast cancer What is the tumor suppressor gene?
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.
BRCA2
Gain of fxn --< cancer. Need damage to only 1 allele.


48. Tumor nomenclature: Blood vessels What do you call a benign tumor of this tissue? .. a malignant one?
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)
Squamous cell carcinoma of esophagus
Benign: hemangioma Malignant: Angiosarcoma
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.


49. Rolling (step 1 in leukocyte extravasation)


50. Chemical carcinogens: Alkylating agents What is the affected organ?
Pancreatic adenocarcinoma
Blood (leukemia)
Ret
Erb - B2