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USMLE Step 1 First Aid Pathology

Subjects : 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. Oncogene: c - kit Associated tumor?
Assoc: breast cancer
Gastrointestinal stromal tumor (GIST)
Liver (hepatocellular carcinoma)
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.

2. Oncogene: L - myc Associated tumor?
Burkitt's lymphoma
HTLV-1
L ung tumor
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).

3. Chemical carcinogens: Asbestos What is the affected organ?
Lung (mesothelioma and bronchogenic carcinoma)
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
N euroblastoma
P 53

4. Hyperplasia
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Increase in # of cells. Reversible.
Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma
Assoc: Neurofibromatosis 2 ('Type 2 = 22')

5. Tumor markers: Prostatic acid phospatase
Small cell lung carcinoma
Burkitt's lymphoma nasopharyngeal carcinoma
Prostate 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.

6. Neoplasm: Sarcoma With what dz is this associated?
Radiation exposure
[aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma
CML
Benign and malignant lymphomas

7. Tumor suppressor gene: Rb chromosome? Associated tumor?
Assoc.: Retinoblastoma - osteosarcoma
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
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: Melanoma ('MelaN oma is N ine')

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

9. tumor: CML What is the associated oncogene?
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.
Abl
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
Tartrate - resistant acid phosphatase. Hairy cell leukemia -- a B- cell neoplasm. 'TRAP the hairy animal.'

10. Cancer epidemiology: Lung cancer? As a cause of death overall?
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
Increase vascular permeability - vasodilation - endothelial injury.
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).
Ras

11. Type of amyloid protein: Dialysis - associated Protein? Derived from...?
Increase in # of cells. Reversible.
Beta -2 microglobulin Derived from MHC class I proteins.
Loss of fxn --< cancer; both allels must be lost for expression of dz.
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)

12. Oncogene: abl Associated tumor?
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.
Acanthosis nigricans (hyperpigmentation and epidermal thickening)
CML
Enzymatic degradation of a cell resulting from exogenous injury.

13. Tumor suppressor gene: DCC chromosome? Associated tumor?
L ung tumor
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
P 53

14. Primary tumors that metasize to bone

15. Tumor suppressor gene: p 16 chromosome? Associated tumor?

16. Causes: ADH Effect: SIADH What neoplasm would create this paraneoplastic effect?
EBV
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.
Small cell lung carcinoma and intracranial neoplasms

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

18. Dz: Down syndrome What is the associated neoplasm?
All (we All fall Down ) AML
Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis)
AIDS
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).

19. Diapedesis (step 3 in leukocyte extravasation)

20. Chemical carcinogens: Aflatoxins (produced by Aspergillus) What is the affected organ?
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
Visceral malignancy (stomach - lung - breast - uterus)
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />
Liver (hepatocellular carcinoma)

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

22. Male cancer epidemiology (incidence - mortality)
C - myc
P 53
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Immunodeficiency states

23. Tight binding (step 2 of leukocyte extravasation)

24. Oncogene: c - myc Associated tumor?

25. Type of amyloid protein: Medullary carcinoma of thyroid Protein? Derived from...?
Xeroderma pigmentosum - albinism
Pancreatic adenocarcinoma
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Renal cell carcinoma - hemangioblastoma

26. Dz: Actinic keratosis What is the associated neoplasm?
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy
Squamous cell carcinoma of the skin

27. Neurofibromatosis 2 ('Type 2 = 22') What is the tumor suppressor gene?
NF2
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'

28. Metastasis to bone
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' />
Gain of fxn --< cancer. Need damage to only 1 allele.
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
Hepatocellular carcinoma

29. Neoplasm: Squamous cell carcinoma of the skin With what dz is this associated?
Actinic keratosis
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation
HHV-8
Enzymatic degradation of a cell resulting from exogenous injury.

30. Neoplasm: Gastric adenocarcinoma With what dz is this associated?
Protein = transthyretin Derived from AF (AF = old F ogies)
Membrane lipid peroxidation Protein modification DNA Breakage
Liver (angiosarcoma)
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants

31. Tumor suppressor gene: BRCA2 chromosome? Associated tumor?
Assoc: breast cancer
Metastases to bone - obstructive biliary dz - Paget's dz of bone.
Assoc: Neurofibromatosis 2 ('Type 2 = 22')
Normal cells w/ basal --< apical differentiation <img src='220a.JPG' />

32. Tumor nomenclature: Bone What do you call a benign tumor of this tissue? .. a malignant one?
Benign: Osteoma Malignant: osteosarcoma
Visceral malignancy (stomach - lung - breast - uterus)
Causes: ADH Effect: SIADH
Leukemias and lymphomas

33. Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome What neoplasm would create this paraneoplastic effect?
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
Assoc: breast cancer
Small cell lung carcinoma
All (we All fall Down ) AML

34. Chronic inflammation
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
Ulcerative colitis
Xeroderma pigmentosum - albinism
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

35. Neoplasm: Malignant lymphomas With what dz is this associated?
Liver (hepatocellular carcinoma)
Colonic adenocarcinoma
Gastric adenocarcinoma
Immunodeficiency states

36. Paraneoplastic effects of tumors: Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma Causes...? Effect?
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia
Increase vascular permeability - vasodilation - endothelial injury.
Fibroblast emigration and proliferation; deposition of ECM.

37. Migration (step 4 in leukocyte extravasation)

38. Metaplasia

39. Primary tumors that metastasize to liver

40. Pancreatic cancer

41. Causes: Erythropoietin Effect: Polycythemia What neoplasm would create this paraneoplastic effect?
HPV
Cells have invaded basement membrane using collagenases and hydrolases Can metastasize if they reach a blood or lymphatic vessel <img src='220d.JPG' />
Abl
Renal cell carcinoma - hemangioblastoma

42. Oncogene: bcl -2 Associated tumor?
Follicular and undifferentiated lymphomas (inhibits apoptosis)
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.
Tartrate - resistant acid phosphatase. Hairy cell leukemia -- a B- cell neoplasm. 'TRAP the hairy animal.'
'HCG' H ydatidiform moles C horiocarcinomas G estational trophoblastic tumors

43. Cervical carcinoma (types 16 - 18) Penile/anal carcinoma What is the assocciated oncogenic virus?
Small cell lung carcinoma
HPV
Dysplastic nevus
Leukocyte travels btw endothelial cells and exits blood vessel; PECAM-1 is involved. <img src='218a.JPG' />

44. Neurofibromatosis type 1 What is the tumor suppressor gene?
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
NF1

45. Chemical carcinogens: Nitrosamines (e.g. - in smoked foods) What is the affected organ?
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.
Cells have increased in # (hyperplasia ) Abnormal proliferation of cells w/ loss of size - shape - and orientation (dysplasia ) <img src='220b.JPG' />
Esophagus - stomach

46. Chemical carcinogens: Vinyl chloride What is the affected organ?
Liver (angiosarcoma)
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Ras

47. Granulomatous dz's

48. Apoptosis (definition)
Actinic keratosis
Programmed cell death; ATP required. Mediated by caspases.
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.

49. Tumor suppressor gene: p 53 chromosome? Associated tumor?
Adult T- cell leukemia
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
Ras

50. Tumor nomenclature: Smooth muscle What do you call a benign tumor of this tissue? .. a malignant one?
Benign: Leiomyoma Malignant: Leiomyosarcoma
Small cell lung carcinoma and intracranial neoplasms
Amylin protein Derived from AE (AE = E ndocrine)
HPV