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. Dz: AIDS What is the associated neoplasm?

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2. Primary tumors that metastasize to liver

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3. Paraneoplastic effects of tumors: Small cell lung carcinoma and intracranial neoplasms Causes...? Effect?
Multiple endocrine neoplasia (MEN) types II and III
Renal cell carcinoma - hemangioblastoma
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
Causes: ADH Effect: SIADH


4. Male cancer epidemiology (incidence - mortality)
Small cell lung carcinoma
AIDS
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]


5. Oncogenic viruses: HPV What is the associated cancer?
Esophageal adenocarcinoma
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma


6. Tumor nomenclature: Bone What do you call a benign tumor of this tissue? .. a malignant one?
Prostate carcinoma.
Benign: Osteoma Malignant: osteosarcoma
Metastases to bone - obstructive biliary dz - Paget's dz of bone.
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)


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

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8. Free radical degradation
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
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.
Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis)
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin


9. Type of amyloid protein: Senile cardiac Protein? Derived from...?
Protein = transthyretin Derived from AF (AF = old F ogies)
Secondary osteosarcoma and fibrosarcoma
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' />
HTLV-1


10. Tumor nomenclature: Blood vessels What do you call a benign tumor of this tissue? .. a malignant one?
Benign: hemangioma Malignant: Angiosarcoma
HTLV-1
C - myc
C - kit


11. Colorectal cancer (assoc w/ FAP) What is the tumor suppressor gene?
Prostate carcinoma.
APC
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)


12. Necrosis (definition)
Enzymatic degradation of a cell resulting from exogenous injury.
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention


13. Granulomatous dz's

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14. Characteristics of reversible cell injury
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
APC
Burkitt's lymphoma nasopharyngeal carcinoma
Colonic adenocarcinoma


15. Tumor suppressor gene: Rb chromosome? Associated tumor?
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.
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
N - myc
Assoc.: Retinoblastoma - osteosarcoma


16. Dz: Acanthosis nigricans (hyperpigmentation and epidermal thickening) What is the associated neoplasm?
Liver (hepatocellular carcinoma)
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention
Colonic adenocarcinoma
Visceral malignancy (stomach - lung - breast - uterus)


17. Resolution of inflammation
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.
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: Osteoma Malignant: osteosarcoma
Cells have increased in # (hyperplasia ) Abnormal proliferation of cells w/ loss of size - shape - and orientation (dysplasia ) <img src='220b.JPG' />


18. [aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma What is the assocciated oncogenic virus?
HHV-8
Follicular and undifferentiated lymphomas (inhibits apoptosis)
Thymoma - small cell lung carcinoma
Assoc: Melanoma ('MelaN oma is N ine')


19. Diapedesis (step 3 in leukocyte extravasation)

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20. Neoplasm: All (we All fall Down ) AML With what dz is this associated?
Assoc: Pancreatic cancer [DPC = D eleted in P ancreatic C ancer']
Burkitt's lymphoma nasopharyngeal 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
Down syndrome


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

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22. Type of amyloid protein: Alzheimer's dz Protein? Derived from...?
Normal cells w/ basal --< apical differentiation <img src='220a.JPG' />
Beta - amyloid Derived from amyloid precursor protein (APP)
Adult T- cell leukemia
N - myc


23. Tumor stage

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24. Chemical carcinogens: Aflatoxins (produced by Aspergillus) What is the affected organ?
Liver (hepatocellular carcinoma)
Colonic adenocarcinoma
Leukocyte travels btw endothelial cells and exits blood vessel; PECAM-1 is involved. <img src='218a.JPG' />
[aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma


25. Neoplastic progression: step 4 Metastasis

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26. Dz: Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency) What is the associated neoplasm?
Benign: hemangioma Malignant: Angiosarcoma
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.
Assoc: Neurofibromatosis type 1
Squamous cell carcinoma of esophagus


27. Necrosis is characterized by...?
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.


28. Dz: Tuberous sclerosis (facial angiofibroma - seizures - mental retardation) What is the associated neoplasm?
[aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma
Secondary osteosarcoma and fibrosarcoma
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma


29. Neoplasm: Squamous cell carcinoma of the skin With what dz is this associated?
Tartrate - resistant acid phosphatase. Hairy cell leukemia -- a B- cell neoplasm. 'TRAP the hairy animal.'
Beta -2 microglobulin Derived from MHC class I proteins.
Ret
Actinic keratosis


30. Desmoplasia
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Fibrous tissue formation in response to a neoplasm. Irreversible.
Benign: lipoma Malignant: liposarcoma
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change


31. 5 Characteristic signs of inflammation
Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
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.


32. Adult T- cell leukemia What is the assocciated oncogenic virus?
Skin (squamous cell carcinoma) Liver (angiosarcoma)
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' />
HTLV-1
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.


33. Neoplasm: Colonic adenocarcinoma With what dz is this associated?
HHV-8
T = size of T umor N = N ode involvement M = M etastases
Ulcerative colitis
Skin (squamous cell carcinoma) Liver (angiosarcoma)


34. Tumor nomenclature: Smooth muscle What do you call a benign tumor of this tissue? .. a malignant one?
Benign: Leiomyoma Malignant: Leiomyosarcoma
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)


35. Paraneoplastic effects of tumors: Small cell lung carcinoma Causes...? Effect?

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36. Breast and ovarian cancer What is the tumor suppressor gene?
Assoc: breast cancer
BRCA1
Gain of fxn --< cancer. Need damage to only 1 allele.
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)


37. 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).
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.
N - myc
All (we All fall Down ) AML


38. Type of amyloid protein: Secondary Protein? Derived from...?
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).


39. Tumor markers: CA-125
Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis)
Ovarian - malignant epithelial tumors
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
Gastrointestinal stromal tumor (GIST)


40. Fluid exudation in inflammation
Xeroderma pigmentosum - albinism
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
Increase vascular permeability - vasodilation - endothelial injury.
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)


41. Tumor suppressor gene: BRCA2 chromosome? Associated tumor?
[aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma
Neuorblastoma - lung - and gastric cancer.
Assoc: breast cancer
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.


42. Tumor suppressor gene: APC chromosome? Associated tumor?
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)
Cells have increased in # (hyperplasia ) Abnormal proliferation of cells w/ loss of size - shape - and orientation (dysplasia ) <img src='220b.JPG' />
Assoc: Colorectal cancer (assoc w/ FAP)


43. Amyloid structure
Prostate carcinoma.
HPV
Benign: hemangioma Malignant: Angiosarcoma
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.


44. Dz: Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis) What is the associated neoplasm?
Abl
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy
EBV
Benign and malignant lymphomas


45. Characteristics of trans udate
Pancreatic adenocarcinoma
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention
CML


46. Oncogene: c - kit Associated tumor?
Colon carcinoma
Normal cells w/ basal --< apical differentiation <img src='220a.JPG' />
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention
Gastrointestinal stromal tumor (GIST)


47. Type of amyloid protein: Medullary carcinoma of thyroid Protein? Derived from...?
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
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.
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
Burkitt's lymphoma nasopharyngeal carcinoma


48. Tumor markers: Prostatic acid phospatase
Prostate carcinoma.
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />
Esophagus - stomach
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors


49. Neoplastic progression: step 3 Invasive carcinoma

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50. Neoplasm: Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma With what dz is this associated?
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.
[aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma
Gastric adenocarcinoma
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)