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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. Chemical carcinogens: Asbestos What is the affected organ?
Lung (mesothelioma and bronchogenic carcinoma)
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Dysplastic nevus
Assoc: Pancreatic cancer [DPC = D eleted in P ancreatic C ancer']

2. Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness) What neoplasm would create this paraneoplastic effect?
Benign: hemangioma Malignant: Angiosarcoma
APC
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
Thymoma - small cell lung carcinoma

3. Neoplasm: Malignant lymphomas With what dz is this associated?
Causes: ADH Effect: SIADH
Immunodeficiency states
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
Esophageal adenocarcinoma

4. Free radical degradation
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
P 16
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
Barrett's esophagus (chronic GI reflux)

5. Female cancer epidemiology (incidence - mortality)
Liver (hepatocellular carcinoma)
C - myc
Amylin protein Derived from AE (AE = E ndocrine)
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)

6. Tumor markers: S-100
Melanoma - neural tumors - astrocytomas.
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)
Programmed cell death; ATP required. Mediated by caspases.
Hepatocellular carcinoma

7. Fluid exudation in inflammation
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome
Assoc.: Retinoblastoma - osteosarcoma
Increase vascular permeability - vasodilation - endothelial injury.

8. Metaplasia

9. Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome What neoplasm would create this paraneoplastic effect?
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
Liver (angiosarcoma)
Benign: lipoma Malignant: liposarcoma
Small cell lung carcinoma

10. Substances that are chemotactic for neutrophils
IL-8 C5a Leukotriene B4 Kallikrein
Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />
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.

11. Tumor suppressor gene: Rb chromosome? Associated tumor?
AA protein Derived from serum amyloid - associated (SAA) protein (chronic inflammatory dz) (AA = A cute - phase reactant)
Small cell lung carcinoma and intracranial neoplasms
Cells have invaded basement membrane using collagenases and hydrolases Can metastasize if they reach a blood or lymphatic vessel <img src='220d.JPG' />
Assoc.: Retinoblastoma - osteosarcoma

12. Male cancer epidemiology (incidence - mortality)
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Esophageal adenocarcinoma
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)
Secondary osteosarcoma and fibrosarcoma

13. Oncogene: erb - B2 Associated tumor?
Breast - ovarian - and gastric carcinomas
Liver (centrilobular necrosis - fatty change)
Malignant melanoma
Rb

14. tumor: CML What is the associated oncogene?
Normal cells w/ basal --< apical differentiation <img src='220a.JPG' />
Abl
Assoc.: Retinoblastoma - osteosarcoma
Membrane lipid peroxidation Protein modification DNA Breakage

15. Tumor nomenclature: Blood vessels What do you call a benign tumor of this tissue? .. a malignant one?
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Benign: hemangioma Malignant: Angiosarcoma
Causes: ADH Effect: SIADH

16. breast cancer What is the tumor suppressor gene?
Gain of fxn --< cancer. Need damage to only 1 allele.
BRCA2
Amylin protein Derived from AE (AE = E ndocrine)
Barrett's esophagus (chronic GI reflux)

17. Neoplasia
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
All (we All fall Down ) AML
Benign and malignant lymphomas

18. Cancer epidemiology: Lung cancer? As a cause of death overall?
Renal cell carcinoma - hemangioblastoma
Thymoma - small cell lung carcinoma
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).
Chr. 11p Assoc: Wilms' tumor

19. Granulomatous dz's

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

21. Chemical carcinogens: CCl4 What is the affected organ?
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)
HPV
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.

22. Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia What neoplasm would create this paraneoplastic effect?
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' />
Squamous cell carcinoma of esophagus
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
Assoc.: Breast and ovarian cancer

23. Primary tumors that metasize to bone

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

25. Tumor markers: Beta - hCG

26. Dz: Immunodeficiency states What is the associated neoplasm?
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' />
Malignant lymphomas
Xeroderma pigmentosum - albinism
P 53

27. Neoplasm: Squamous cell carcinoma of esophagus With what dz is this associated?
Normal cells w/ basal --< apical differentiation <img src='220a.JPG' />
Squamous cell carcinoma of esophagus
Skin (squamous cell carcinoma) Liver (angiosarcoma)
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)

28. tumor: N euroblastoma What is the associated oncogene?
N - myc
T = size of T umor N = N ode involvement M = M etastases
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
Malignant lymphomas

29. Benign
Benign: Leiomyoma Malignant: Leiomyosarcoma
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
Blood (leukemia)
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.

30. Type of amyloid protein: Primary Protein? Derived from...?
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'
Colonic adenocarcinoma
N - myc

31. Burkitt's lymphoma nasopharyngeal carcinoma What is the assocciated oncogenic virus?
[DPC = D eleted in P ancreatic C ancer'] What is the tumor suppressor gene? DPC
EBV
N - myc
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.

32. Oncogene: bcl -2 Associated tumor?
Barrett's esophagus (chronic GI reflux)
Ulcerative colitis
Follicular and undifferentiated lymphomas (inhibits apoptosis)
P 53

33. Adult T- cell leukemia What is the assocciated oncogenic virus?
Usually well - differentiated - slow growing - well - demarcated - no metastasis.
Breast - ovarian - and gastric carcinomas
HTLV-1
Adult T- cell leukemia

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

35. Metastasis to bone
Ret
Beta - amyloid Derived from amyloid precursor protein (APP)
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
HTLV-1

36. tumor: Colon carcinoma What is the associated oncogene?
Malignant melanoma
Ras
Protein = transthyretin Derived from AF (AF = old F ogies)
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)

37. Free radical injury induces cell injury thru...?
Gastric adenocarcinoma
N - myc
Secondary osteosarcoma and fibrosarcoma
Membrane lipid peroxidation Protein modification DNA Breakage

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

39. Characteristics of ex udate
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin
Cellular Protein - rich Specific gravity < 1.020 Due to: Lymphatic obstruction Inflammation
Assoc: Neurofibromatosis 2 ('Type 2 = 22')
WT1

40. Neurofibromatosis type 1 What is the tumor suppressor gene?
Leukocyte travels btw endothelial cells and exits blood vessel; PECAM-1 is involved. <img src='218a.JPG' />
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)
NF1

41. Oncogene: L - myc Associated tumor?
Liver (hepatocellular carcinoma)
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' />
L ung tumor
Squamous cell carcinoma of esophagus

42. Dz: Radiation exposure What is the associated neoplasm?
Fibroblast emigration and proliferation; deposition of ECM.
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.
Barrett's esophagus (chronic GI reflux)
Sarcoma

43. [aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma What is the assocciated oncogenic virus?
HHV-8
C olon < S tomach < P ancreas < B reast < L ung 'C ancer S ometimes P enetrates B enign L iver.'
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.

44. Tumor markers: TRAP

45. Dz: Barrett's esophagus (chronic GI reflux) What is the associated neoplasm?
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Squamous cell carcinoma of the skin
Esophageal adenocarcinoma
All (we All fall Down ) AML

46. Tumor markers: CEA
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
Carcinoembryonic Ag. Very nonspecific - but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric and breast carcinomas.
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy

47. Oncogenes
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.
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
Gain of fxn --< cancer. Need damage to only 1 allele.
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma

48. Dz: Dysplastic nevus What is the associated neoplasm?
Assoc: Pancreatic cancer [DPC = D eleted in P ancreatic C ancer']
N - myc
HHV-8
Malignant melanoma

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

50. Neoplasm: Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma With what dz is this associated?
AIDS
Causes: ADH Effect: SIADH
Dysplastic nevus
Benign: hemangioma Malignant: Angiosarcoma