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. Neoplasm: Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin With what dz is this associated?
Beta -2 microglobulin Derived from MHC class I proteins.
Xeroderma pigmentosum - albinism
Radiation exposure
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change


2. Chemical carcinogens: CCl4 What is the affected organ?
Liver (centrilobular necrosis - fatty change)
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
HBV - HCV
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma


3. Type of amyloid protein: Medullary carcinoma of thyroid Protein? Derived from...?
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention
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.
HTLV-1


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

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5. Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy What neoplasm would create this paraneoplastic effect?
P 16
Leukemias and lymphomas
HBV - HCV
Lung (mesothelioma and bronchogenic carcinoma)


6. Apoptosis is characterized by...?
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
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
1 adult cell type is replaced by another. Often 2' to irritation and/or environmental exposure (e.g. - squamous metaplasia in trachea and bronchi of smokers) Reversible.


7. Migration (step 4 in leukocyte extravasation)

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8. Dysplasia
Visceral malignancy (stomach - lung - breast - uterus)
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.
Small cell lung carcinoma
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.


9. Colorectal cancer (assoc w/ FAP) What is the tumor suppressor gene?
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
APC
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Gastrointestinal stromal tumor (GIST)


10. Tumor markers: PSA
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
Skin (squamous cell carcinoma) Liver (angiosarcoma)
L ung tumor


11. Amyloid structure
HBV - HCV
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.
Benign and malignant lymphomas
Squamous cell carcinoma of esophagus


12. Neoplastic progression: step 2 In situ carcinoma

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13. Necrosis is characterized by...?
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Barrett's esophagus (chronic GI reflux)


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

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15. Tumor suppressor gene: APC chromosome? Associated tumor?
Benign: Leiomyoma Malignant: Leiomyosarcoma
Melanoma - neural tumors - astrocytomas.
Rb
Assoc: Colorectal cancer (assoc w/ FAP)


16. Metastasis to brain
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Follicular and undifferentiated lymphomas (inhibits apoptosis)
Visceral malignancy (stomach - lung - breast - uterus)
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />


17. Causes: ADH Effect: SIADH What neoplasm would create this paraneoplastic effect?
Paget's dz of bone
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
Rb
Small cell lung carcinoma and intracranial neoplasms


18. Carcinoma vs. sarcoma
BRCA2
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
HPV
Lung (mesothelioma and bronchogenic carcinoma)


19. Fibrosis in inflammation
EBV
Assoc: breast cancer
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
Fibroblast emigration and proliferation; deposition of ECM.


20. Retinoblastoma - osteosarcoma What is the tumor suppressor gene?
Paget's dz of bone
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Rb
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).


21. Metastasis to bone
L - myc
EBV
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.


22. Tumor suppressor gene: DCC chromosome? Associated tumor?
L - myc
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />
Fibroblast emigration and proliferation; deposition of ECM.


23. Granulomatous dz's

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24. Pancreatic cancer

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25. Tumor markers: TRAP

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26. tumor: CML What is the associated oncogene?
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
Abl
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.


27. Neoplasm: Benign and malignant lymphomas With what dz is this associated?

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28. Chemical carcinogens: Naphthalene (aniline) dyes What is the affected organ?
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.
BRCA2
Bladder (transitional cell carcinoma)
Normal cells w/ basal --< apical differentiation <img src='220a.JPG' />


29. Tumor markers: Alkaline phosphatase

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30. Dz: Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants What is the associated neoplasm?
Gastric adenocarcinoma
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'
Assoc: most human cancers (crap!) - Li - Fraumeni syndrome


31. Type of amyloid protein: Primary Protein? Derived from...?
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
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
Skin (squamous cell carcinoma) Liver (angiosarcoma)


32. Tumor suppressor gene: BRCA2 chromosome? Associated tumor?
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)
Assoc: breast cancer
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
BRCA2


33. Tumor grade
BRCA2
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)
Benign: Leiomyoma Malignant: Leiomyosarcoma
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.


34. Neoplastic progression: step 4 Metastasis

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35. Oncogene: bcl -2 Associated tumor?
Follicular and undifferentiated lymphomas (inhibits apoptosis)
WT1
Gain of fxn --< cancer. Need damage to only 1 allele.
L ung tumor


36. When does apoptosis occur?
P 16
Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome
HTLV-1
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)


37. Tumor suppressor gene: Rb chromosome? Associated tumor?
Loss of fxn --< cancer; both allels must be lost for expression of dz.
AIDS
Assoc.: Retinoblastoma - osteosarcoma
Assoc.: Breast and ovarian cancer


38. Wilms' tumor What is the tumor suppressor gene?
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.
WT1
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma


39. Colon cancer
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
[aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma
Prostate carcinoma.


40. Primary tumors that metastasize to liver

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41. Tumor nomenclature: Smooth muscle What do you call a benign tumor of this tissue? .. a malignant one?
Dysplastic nevus
Lung (mesothelioma and bronchogenic carcinoma)
Benign: Leiomyoma Malignant: Leiomyosarcoma
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />


42. Necrosis morphologies
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
Causes: Erythropoietin Effect: Polycythemia
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.


43. Fluid exudation in inflammation
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Increase vascular permeability - vasodilation - endothelial injury.
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
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.


44. Characteristics of irreversible cell injury
EBV
Liver (hepatocellular carcinoma)
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)


45. Burkitt's lymphoma nasopharyngeal carcinoma What is the assocciated oncogenic virus?
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation
EBV
WT1


46. Causes: Erythropoietin Effect: Polycythemia What neoplasm would create this paraneoplastic effect?
Liver (hepatocellular carcinoma)
Gastric adenocarcinoma
Renal cell carcinoma - hemangioblastoma
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' />


47. Psammoma bodies
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)
Leukocyte travels btw endothelial cells and exits blood vessel; PECAM-1 is involved. <img src='218a.JPG' />
Neuorblastoma - lung - and gastric cancer.


48. Dz: Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency) What is the associated neoplasm?
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)
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.
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.
Squamous cell carcinoma of esophagus


49. [aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma What is the assocciated oncogenic virus?
HHV-8
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)
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.
[DPC = D eleted in P ancreatic C ancer'] What is the tumor suppressor gene? DPC


50. Chemical carcinogens: Vinyl chloride What is the affected organ?
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
[DPC = D eleted in P ancreatic C ancer'] What is the tumor suppressor gene? DPC
Liver (angiosarcoma)