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. Tumor nomenclature: Fat What do you call a benign tumor of this tissue? .. a malignant one?
Gastrointestinal stromal tumor (GIST)
Multiple endocrine neoplasia (MEN) types II and III
Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome
Benign: lipoma Malignant: liposarcoma


2. TNM staging system
Erb - B2
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)
T = size of T umor N = N ode involvement M = M etastases


3. Paraneoplastic effects of tumors: Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma Causes...? Effect?
Amylin protein Derived from AE (AE = E ndocrine)
Cirrhosis (alcoholic - hepatitis B or C)
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia
HTLV-1


4. Tumor grade
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)
Sarcoma
IL-8 C5a Leukotriene B4 Kallikrein
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.


5. Tumor suppressor gene: BRCA2 chromosome? Associated tumor?
Assoc: breast cancer
BRCA1
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' />
Enzymatic degradation of a cell resulting from exogenous injury.


6. Dysplasia
L ung tumor
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
HHV-8
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.


7. most human cancers - Li - Fraumeni syndrome What is the tumor suppressor gene?
Esophagus - stomach
P 53
HTLV-1
Gastric adenocarcinoma


8. Characteristics of reversible cell injury
Secondary osteosarcoma and fibrosarcoma
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma


9. Oncogenic viruses: HTLV-1 What is the associated cancer?
Adult T- cell leukemia
Gastrointestinal stromal tumor (GIST)
Down syndrome
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.


10. Dz: Actinic keratosis What is the associated neoplasm?
Squamous cell carcinoma of the skin
Small cell lung carcinoma and intracranial neoplasms
Thymoma - small cell lung carcinoma
Fibrous tissue formation in response to a neoplasm. Irreversible.


11. Primary tumors that metasize to bone

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12. Tumor markers: CA-125
Esophageal adenocarcinoma
Ovarian - malignant epithelial tumors
Follicular and undifferentiated lymphomas (inhibits apoptosis)
Small cell lung carcinoma and intracranial neoplasms


13. Tumor suppressor gene: Rb chromosome? Associated tumor?
Assoc.: Retinoblastoma - osteosarcoma
P 53
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.
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.


14. Tumor markers: Alkaline phosphatase

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15. Chemical carcinogens: Naphthalene (aniline) dyes What is the affected organ?
Bladder (transitional cell carcinoma)
Metastases to bone - obstructive biliary dz - Paget's dz of bone.
P 53
Hepatocellular carcinoma


16. Neoplasm: Malignant lymphomas With what dz is this associated?
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
Immunodeficiency states
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy


17. Neoplasm: All (we All fall Down ) AML With what dz is this associated?
Down syndrome
CML
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
BRCA1


18. Apoptosis is characterized by...?
Benign: Leiomyoma Malignant: Leiomyosarcoma
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
Dysplastic nevus
Blood (leukemia)


19. Oncogenes
Bladder (transitional cell carcinoma)
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' />
Gain of fxn --< cancer. Need damage to only 1 allele.
C - kit


20. Neoplasm: Malignant melanoma With what dz is this associated?
Sarcoma
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
Dysplastic nevus
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.


21. Hypovolemic/cardiogenic shock
Assoc: Melanoma ('MelaN oma is N ine')
Blood (leukemia)
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
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' />


22. Neurofibromatosis type 1 What is the tumor suppressor gene?
NF1
C - kit
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)


23. tumor: Follicular and undifferentiated lymphomas (inhibits apoptosis) What is the associated oncogene?
Bcl -2
Benign: -- Malignant: Leukemia - lymphoma
Protein = transthyretin Derived from AF (AF = old F ogies)
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)


24. Dz: AIDS What is the associated neoplasm?

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25. Oncogene: abl Associated tumor?
CML
Fibroblast emigration and proliferation; deposition of ECM.
Gastrointestinal stromal tumor (GIST)
Colonic adenocarcinoma


26. Dz: Immunodeficiency states What is the associated neoplasm?
Immunodeficiency states
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />
Malignant lymphomas
Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma


27. Neoplasm: Visceral malignancy (stomach - lung - breast - uterus) With what dz is this associated?
Usually stage < grade
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Prostate carcinoma.
Acanthosis nigricans (hyperpigmentation and epidermal thickening)


28. Tumor markers: TRAP

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29. Neoplasm: Squamous cell carcinoma of esophagus With what dz is this associated?
Liver (angiosarcoma)
Normal cells w/ basal --< apical differentiation <img src='220a.JPG' />
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
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


30. Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness) What neoplasm would create this paraneoplastic effect?
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
Malignant melanoma
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)
Thymoma - small cell lung carcinoma


31. Neoplasm: Sarcoma With what dz is this associated?
L ung tumor
Membrane lipid peroxidation Protein modification DNA Breakage
Ulcerative colitis
Radiation exposure


32. Causes: ADH Effect: SIADH What neoplasm would create this paraneoplastic effect?
Small cell lung carcinoma and intracranial neoplasms
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.
Esophageal adenocarcinoma
Burkitt's lymphoma


33. Neoplasm: Squamous cell carcinoma of the skin With what dz is this associated?
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
Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma
Actinic keratosis
Liver (hepatocellular carcinoma)


34. Tumor suppressor genes
Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis)
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Multiple endocrine neoplasia (MEN) types II and III


35. Oncogenic viruses: HPV What is the associated cancer?
Chr. 11p Assoc: Wilms' tumor
Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis)
Assoc: Melanoma ('MelaN oma is N ine')
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma


36. tumor: Burkitt's lymphoma What is the associated oncogene?
C - myc
Follicular and undifferentiated lymphomas (inhibits apoptosis)
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)
Burkitt's lymphoma nasopharyngeal carcinoma


37. Chemical carcinogens: Aflatoxins (produced by Aspergillus) What is the affected organ?
Liver (hepatocellular carcinoma)
Ras
Benign: hemangioma Malignant: Angiosarcoma
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.


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

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39. Tumor nomenclature: Epithelium What do you call a benign tumor of this tissue? .. a malignant one?
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
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
BRCA1
Assoc.: Retinoblastoma - osteosarcoma


40. Oncogene: L - myc Associated tumor?
Squamous cell carcinoma of esophagus
L ung tumor
Cells have invaded basement membrane using collagenases and hydrolases Can metastasize if they reach a blood or lymphatic vessel <img src='220d.JPG' />
BRCA2


41. Oncogene: c - kit Associated tumor?
Assoc: Neurofibromatosis type 1
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).
Assoc: Melanoma ('MelaN oma is N ine')
Gastrointestinal stromal tumor (GIST)


42. Adult T- cell leukemia What is the assocciated oncogenic virus?
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 and malignant lymphomas
HTLV-1
Ret


43. Oncogene: c - myc Associated tumor?

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44. Hepatocellular carcinoma What is the assocciated oncogenic virus?
HBV - HCV
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)


45. Cervical carcinoma (types 16 - 18) Penile/anal carcinoma What is the assocciated oncogenic virus?
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' />
HPV
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)


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

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47. Tumor suppressor gene: BRCA1 chromosome? Associated tumor?
Prostate carcinoma.
Blood (leukemia)
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Assoc.: Breast and ovarian cancer


48. Which usually has more prognostic value - tumor stage or grade?
NF2
Visceral malignancy (stomach - lung - breast - uterus)
Usually stage < grade
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).


49. How should tumor markers be used clinically?
Liver (hepatocellular carcinoma)
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.
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
Fibroblast emigration and proliferation; deposition of ECM.


50. Oncogenic viruses: EBV What is the associated cancer?

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