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. Neoplastic progression: step 4 Metastasis

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2. TNM staging system
T = size of T umor N = N ode involvement M = M etastases
Benign: hemangioma Malignant: Angiosarcoma
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
Hepatocellular carcinoma


3. Chemical carcinogens: Naphthalene (aniline) dyes What is the affected organ?
Increase vascular permeability - vasodilation - endothelial injury.
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin
Bladder (transitional cell carcinoma)
Assoc: breast cancer


4. Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia What neoplasm would create this paraneoplastic effect?
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
T = size of T umor N = N ode involvement M = M etastases


5. Tumor suppressor gene: DPC chromosome? Associated tumor?

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6. Dz: Barrett's esophagus (chronic GI reflux) What is the associated neoplasm?
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)
Esophageal adenocarcinoma
Assoc: Pancreatic cancer [DPC = D eleted in P ancreatic C ancer']


7. Which usually has more prognostic value - tumor stage or grade?
Down syndrome
Usually stage < grade
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
Paget's dz of bone


8. Colorectal cancer (assoc w/ FAP) What is the tumor suppressor gene?
Benign: Leiomyoma Malignant: Leiomyosarcoma
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
APC
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)


9. Tumor suppressor gene: Rb chromosome? Associated tumor?
Fibrous tissue formation in response to a neoplasm. Irreversible.
Assoc.: Retinoblastoma - osteosarcoma
Ulcerative colitis
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention


10. Metastasis to liver

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11. Oncogenic viruses: HBV - HCV What is the associated cancer?
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' />
Ret
Hepatocellular carcinoma
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)


12. Chemical carcinogens: Alkylating agents What is the affected organ?
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.
Blood (leukemia)


13. Dz: Actinic keratosis What is the associated neoplasm?
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Liver (angiosarcoma)
Benign: Leiomyoma Malignant: Leiomyosarcoma
Squamous cell carcinoma of the skin


14. Neoplastic progression: normal state - before anything goes wrong

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15. Oncogenic viruses: HTLV-1 What is the associated cancer?
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
Down syndrome
Adult T- cell leukemia
Burkitt's lymphoma


16. tumor: Follicular and undifferentiated lymphomas (inhibits apoptosis) What is the associated oncogene?
Bcl -2
Follicular and undifferentiated lymphomas (inhibits apoptosis)
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma


17. Leukocyte activation in inflammation
Bcl -2
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.
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.
Follicular and undifferentiated lymphomas (inhibits apoptosis)


18. Psammoma bodies
AIDS
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Chr. 11p Assoc: Wilms' tumor
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


19. Granulomatous dz's

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20. Characteristics of irreversible cell injury
Benign and malignant lymphomas
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)
Burkitt's lymphoma
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability


21. Neurofibromatosis 2 ('Type 2 = 22') What is the tumor suppressor gene?
CML
NF2
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma


22. 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.
Liver (centrilobular necrosis - fatty change)
C - kit
N - myc


23. Tumor markers: Alkaline phosphatase

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24. Tumor markers: alpha - fetoprotein
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)


25. Diapedesis (step 3 in leukocyte extravasation)

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26. Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness) What neoplasm would create this paraneoplastic effect?
Thymoma - small cell lung carcinoma
P 53
NF1
N - myc


27. Melanoma - What is the tumor suppressor gene?
Secondary osteosarcoma and fibrosarcoma
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors
P 16
NF1


28. Tumor markers: CA-125
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin
Ovarian - malignant epithelial tumors
Beta -2 microglobulin Derived from MHC class I proteins.
AIDS


29. Characteristics of ex udate
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation
Actinic keratosis
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
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.


30. Characteristics of trans udate
Neuorblastoma - lung - and gastric cancer.
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention
Benign: hemangioma Malignant: Angiosarcoma
Cells have increased in # (hyperplasia ) Abnormal proliferation of cells w/ loss of size - shape - and orientation (dysplasia ) <img src='220b.JPG' />


31. Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy What neoplasm would create this paraneoplastic effect?
Tartrate - resistant acid phosphatase. Hairy cell leukemia -- a B- cell neoplasm. 'TRAP the hairy animal.'
Ulcerative colitis
Leukemias and lymphomas
T = size of T umor N = N ode involvement M = M etastases


32. breast cancer What is the tumor suppressor gene?
Small cell lung carcinoma
BRCA1
Benign and malignant lymphomas
BRCA2


33. Tumor suppressor genes
Secondary osteosarcoma and fibrosarcoma
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)


34. Rolling (step 1 in leukocyte extravasation)

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35. Neoplastic progression: step 3 Invasive carcinoma

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36. Tumor nomenclature: Smooth muscle What do you call a benign tumor of this tissue? .. a malignant one?
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />
Benign: Leiomyoma Malignant: Leiomyosarcoma
Ras
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


37. Male cancer epidemiology (incidence - mortality)
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Causes: ADH Effect: SIADH
Burkitt's lymphoma
IL-8 C5a Leukotriene B4 Kallikrein


38. Chronic inflammation
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.
AIDS
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
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.


39. Dz: Dysplastic nevus What is the associated neoplasm?
EBV
Visceral malignancy (stomach - lung - breast - uterus)
Malignant melanoma
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)


40. Neoplasm: Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma With what dz is this associated?
Benign: hemangioma Malignant: Angiosarcoma
Radiation exposure
NF2
AIDS


41. Tumor nomenclature: Epithelium What do you call a benign tumor of this tissue? .. a malignant one?
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
EBV
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma


42. Neoplasm: Visceral malignancy (stomach - lung - breast - uterus) With what dz is this associated?
Gain of fxn --< cancer. Need damage to only 1 allele.
Acanthosis nigricans (hyperpigmentation and epidermal thickening)
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.
T = size of T umor N = N ode involvement M = M etastases


43. Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome What neoplasm would create this paraneoplastic effect?
CML
Usually stage < grade
Small cell lung carcinoma
IL-8 C5a Leukotriene B4 Kallikrein


44. Dz: Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency) What is the associated neoplasm?
Squamous cell carcinoma of esophagus
Squamous cell carcinoma of the skin
HBV - HCV
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)


45. Paraneoplastic effects of tumors: Small cell lung carcinoma and intracranial neoplasms Causes...? Effect?
HPV
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy
Causes: ADH Effect: SIADH
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.


46. Tumor markers: Prostatic acid phospatase
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.
Prostate carcinoma.
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants


47. Neoplastic progression: step 1 Hyperplasia/dysplasia

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48. Neoplasia
Membrane lipid peroxidation Protein modification DNA Breakage
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
Small cell lung carcinoma
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.


49. Neoplasm: Squamous cell carcinoma of the skin With what dz is this associated?
Paget's dz of bone
Actinic keratosis
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
Malignant melanoma


50. Chemical carcinogens: CCl4 What is the affected organ?
Normal cells w/ basal --< apical differentiation <img src='220a.JPG' />
Usually stage < grade
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.
Liver (centrilobular necrosis - fatty change)