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 suppressor gene: APC chromosome? Associated tumor?
Assoc: Colorectal cancer (assoc w/ FAP)
WT1
Benign: -- Malignant: Leukemia - lymphoma
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'


2. Carcinoma vs. sarcoma
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Ret
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
Blood (leukemia)


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

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4. Breast and ovarian cancer What is the tumor suppressor gene?
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.
Leukocyte travels btw endothelial cells and exits blood vessel; PECAM-1 is involved. <img src='218a.JPG' />
Xeroderma pigmentosum - albinism
BRCA1


5. Neoplasm: Squamous cell carcinoma of the skin With what dz is this associated?
Xeroderma pigmentosum - albinism
Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma
Assoc.: Retinoblastoma - osteosarcoma
Actinic keratosis


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

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7. Tumor nomenclature: Blood vessels What do you call a benign tumor of this tissue? .. a malignant one?
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
Gastrointestinal stromal tumor (GIST)
Benign: hemangioma Malignant: Angiosarcoma
Liver (centrilobular necrosis - fatty change)


8. Neoplasm: All (we All fall Down ) AML With what dz is this associated?
Increase in # of cells. Reversible.
Down syndrome
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy
Cirrhosis (alcoholic - hepatitis B or C)


9. Tumor markers: CA-19-9
Ulcerative colitis
Pancreatic adenocarcinoma
NF1
Gain of fxn --< cancer. Need damage to only 1 allele.


10. Chronic inflammation
Erb - B2
Paget's dz of bone
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
Malignant melanoma


11. Chemical carcinogens: Naphthalene (aniline) dyes What is the affected organ?
Bladder (transitional cell carcinoma)
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.
AIDS
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)


12. Neoplasm: Sarcoma With what dz is this associated?
Beta - amyloid Derived from amyloid precursor protein (APP)
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
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.
Radiation exposure


13. Necrosis (definition)
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
Multiple endocrine neoplasia (MEN) types II and III
Esophagus - stomach
Enzymatic degradation of a cell resulting from exogenous injury.


14. tumor: L ung tumor What is the associated oncogene?
Radiation exposure
Multiple endocrine neoplasia (MEN) types II and III
L - myc
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)


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

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16. Psammoma bodies
Small cell lung carcinoma and intracranial neoplasms
WT1
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
Cirrhosis (alcoholic - hepatitis B or C)


17. Primary tumors that metastasize to brain
Immunodeficiency states
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)
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.
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.


18. tumor: Breast - ovarian - and gastric carcinomas What is the associated oncogene?
Assoc: Pancreatic cancer [DPC = D eleted in P ancreatic C ancer']
C - kit
Erb - B2
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.


19. tumor: Follicular and undifferentiated lymphomas (inhibits apoptosis) What is the associated oncogene?
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).
Immunodeficiency states
Bcl -2
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)


20. Which usually has more prognostic value - tumor stage or grade?
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.
Usually stage < grade
IL-8 C5a Leukotriene B4 Kallikrein
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.


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

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22. Neoplasm: Squamous cell carcinoma of esophagus With what dz is this associated?
Secondary osteosarcoma and fibrosarcoma
Protein = transthyretin Derived from AF (AF = old F ogies)
HTLV-1
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)


23. Oncogenic viruses: HPV What is the associated cancer?
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Gastrointestinal stromal tumor (GIST)
Prostate carcinoma.
Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis)


24. Type of amyloid protein: Alzheimer's dz Protein? Derived from...?
HHV-8
Beta - amyloid Derived from amyloid precursor protein (APP)
Radiation exposure
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)


25. Neoplasm: Visceral malignancy (stomach - lung - breast - uterus) With what dz is this associated?
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).
HBV - HCV
Assoc.: Retinoblastoma - osteosarcoma
Acanthosis nigricans (hyperpigmentation and epidermal thickening)


26. Anaplasia
Lung (mesothelioma and bronchogenic carcinoma)
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
Cells have invaded basement membrane using collagenases and hydrolases Can metastasize if they reach a blood or lymphatic vessel <img src='220d.JPG' />
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.


27. Tumor suppressor gene: p 53 chromosome? Associated tumor?
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
Assoc: Melanoma ('MelaN oma is N ine')
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome
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' />


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

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29. Type of amyloid protein: Dialysis - associated Protein? Derived from...?
Beta -2 microglobulin Derived from MHC class I proteins.
Causes: Erythropoietin Effect: Polycythemia
P 16
Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis)


30. Chemical carcinogens: Arsenic What is the affected organ?
Malignant melanoma
Skin (squamous cell carcinoma) Liver (angiosarcoma)
Colon 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.


31. Oncogene: N - myc Associated tumor?
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
N euroblastoma
Cirrhosis (alcoholic - hepatitis B or C)


32. Tumor markers: TRAP

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33. Metastasis to bone
Follicular and undifferentiated lymphomas (inhibits apoptosis)
Colon carcinoma
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.


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

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35. Dz: Cirrhosis (alcoholic - hepatitis B or C) What is the associated neoplasm?
Esophageal adenocarcinoma
Tartrate - resistant acid phosphatase. Hairy cell leukemia -- a B- cell neoplasm. 'TRAP the hairy animal.'
Hepatocellular carcinoma
[aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma


36. Dz: Down syndrome What is the associated neoplasm?
Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma
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
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
All (we All fall Down ) AML


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

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38. Hepatocellular carcinoma What is the assocciated oncogenic virus?
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
HBV - HCV
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'
Breast - ovarian - and gastric carcinomas


39. 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
IL-8 C5a Leukotriene B4 Kallikrein
NF1
Erb - B2


40. Dz: Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis) What is the associated neoplasm?
Beta -2 microglobulin Derived from MHC class I proteins.
L - myc
Benign and malignant lymphomas
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation


41. Resolution of inflammation
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
P 16
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.
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.


42. Retinoblastoma - osteosarcoma What is the tumor suppressor gene?
Increase in # of cells. Reversible.
Benign: lipoma Malignant: liposarcoma
Rb
NF1


43. Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome What neoplasm would create this paraneoplastic effect?
Small cell lung carcinoma
Xeroderma pigmentosum - albinism
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Benign: hemangioma Malignant: Angiosarcoma


44. Neoplastic progression: step 3 Invasive carcinoma

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45. Chemical carcinogens: CCl4 What is the affected organ?
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
Abl
HTLV-1
Liver (centrilobular necrosis - fatty change)


46. Oncogenic viruses: HBV - HCV What is the associated cancer?
Hepatocellular carcinoma
Gain of fxn --< cancer. Need damage to only 1 allele.
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
Benign: -- Malignant: Leukemia - lymphoma


47. 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).
Actinic keratosis
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' />
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)


48. Chemical carcinogens: Asbestos What is the affected organ?
Esophagus - stomach
Lung (mesothelioma and bronchogenic carcinoma)
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.
Leukocyte travels btw endothelial cells and exits blood vessel; PECAM-1 is involved. <img src='218a.JPG' />


49. Necrosis morphologies
Malignant lymphomas
Bladder (transitional cell carcinoma)
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
Acanthosis nigricans (hyperpigmentation and epidermal thickening)


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

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