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: Gastrointestinal stromal tumor (GIST) What is the associated oncogene?
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)
C - kit


2. tumor: Colon carcinoma What is the associated oncogene?
HTLV-1
Ras
Rb
Visceral malignancy (stomach - lung - breast - uterus)


3. Neoplasm: Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma With what dz is this associated?
WT1
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
Gain of fxn --< cancer. Need damage to only 1 allele.
Tuberous sclerosis (facial angiofibroma - seizures - mental retardation)


4. Metastasis to bone
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
Liver (hepatocellular carcinoma)
Assoc: Melanoma ('MelaN oma is N ine')
Metastatic bone tumors are far more common than primary bone tumors. L ung = lytic Prostate = blastic B reast = B oth lytic and blastic.


5. Tumor markers: alpha - fetoprotein
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
Leukemias and lymphomas
Metastases to bone - obstructive biliary dz - Paget's dz of bone.
HTLV-1


6. Tight binding (step 2 of leukocyte extravasation)

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7. Tumor nomenclature: Skeletal muscle What do you call a benign tumor of this tissue? .. a malignant one?
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Bladder (transitional cell carcinoma)
Assoc: Neurofibromatosis type 1
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma


8. Fluid exudation in inflammation
Increase vascular permeability - vasodilation - endothelial injury.
Breast - ovarian - and gastric carcinomas
[DPC = D eleted in P ancreatic C ancer'] What is the tumor suppressor gene? DPC
Assoc: Melanoma ('MelaN oma is N ine')


9. Psammoma bodies
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)
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
Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis)


10. Chemical carcinogens: Naphthalene (aniline) dyes What is the affected organ?
Xeroderma pigmentosum - albinism
Small cell lung carcinoma and intracranial neoplasms
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.
Bladder (transitional cell carcinoma)


11. Primary tumors that metastasize to liver

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12. Dz: Paget's dz of bone What is the associated neoplasm?
Normally made by fetus. Hepatocellular carcinomas. Nonseminomatous germ cell tumors of the testis (e.g. - yolk sac tumor)
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.
Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome
Secondary osteosarcoma and fibrosarcoma


13. Tumor suppressor gene: NF1 chromosome? Associated tumor?
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
Small cell lung carcinoma
Melanoma - neural tumors - astrocytomas.
Assoc: Neurofibromatosis type 1


14. Neoplasm: Visceral malignancy (stomach - lung - breast - uterus) With what dz is this associated?
Acanthosis nigricans (hyperpigmentation and epidermal thickening)
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Causes: Erythropoietin Effect: Polycythemia
Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis)


15. Rolling (step 1 in leukocyte extravasation)

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16. Tumor nomenclature: Blood vessels What do you call a benign tumor of this tissue? .. a malignant one?
Benign: hemangioma Malignant: Angiosarcoma
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention
Incidence: Breast (32%) Lung (13%) Colon and rectum (13%) Mortality: Lung (23%) Breast (18%)
Malignant lymphomas


17. [aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma What is the assocciated oncogenic virus?
HHV-8
T = size of T umor N = N ode involvement M = M etastases
Beta - amyloid Derived from amyloid precursor protein (APP)
Bladder (transitional cell carcinoma)


18. Male cancer epidemiology (incidence - mortality)
Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma
Usually stage < grade
N euroblastoma
Incidence: Prostate (32%) Lung (16%) Colon and rectum (12%) Mortality: Lung (33%) Prostate (13%)


19. Oncogene: erb - B2 Associated tumor?
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
Assoc: Melanoma ('MelaN oma is N ine')
Breast - ovarian - and gastric carcinomas
Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma


20. tumor: N euroblastoma What is the associated oncogene?
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.
Breast - ovarian - and gastric carcinomas
N - myc
The liver and lung are the most common sites of metastasis after regional LN's. Metastasis << primary liver tumors.


21. Dz: Xeroderma pigmentosum - albinism What is the associated neoplasm?
Hepatocellular carcinoma
Increase vascular permeability - vasodilation - endothelial injury.
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin
Benign: hemangioma Malignant: Angiosarcoma


22. Tumor nomenclature: Bone What do you call a benign tumor of this tissue? .. a malignant one?
Assoc.: Retinoblastoma - osteosarcoma
NF1
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)
Benign: Osteoma Malignant: osteosarcoma


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

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24. Oncogenic viruses: HPV What is the associated cancer?
Benign: hemangioma Malignant: Angiosarcoma
AIDS
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Blood (leukemia)


25. Oncogene: N - myc Associated tumor?
N euroblastoma
Cells have increased in # (hyperplasia ) Abnormal proliferation of cells w/ loss of size - shape - and orientation (dysplasia ) <img src='220b.JPG' />
Ulcerative colitis
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.


26. Free radical degradation
CML
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
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />


27. Paraneoplastic effects of tumors: Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma Causes...? 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
Ulcerative colitis
Causes: PTH- related peptide - TGF- beat - TNF - IL-1 Effect: Hypercalcemia
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


28. 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)
Usually stage < grade
Squamous cell carcinoma of esophagus
Loss of fxn --< cancer; both allels must be lost for expression of dz.


29. Neoplastic progression: step 4 Metastasis

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30. Paraneoplastic effects of tumors: Small cell lung carcinoma and intracranial neoplasms Causes...? Effect?
Beta - amyloid Derived from amyloid precursor protein (APP)
Causes: ADH Effect: SIADH
Programmed cell death; ATP required. Mediated by caspases.
Assoc: Neurofibromatosis type 1


31. Amyloid structure
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
Assoc: Neurofibromatosis type 1
Immunodeficiency states
Beta - pleated sheet demonstrable by apple - green birefringence of Congo red stain under polarized light; affected tissue has waxy appearance.


32. Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness) What neoplasm would create this paraneoplastic effect?
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
Abnormal growth w/ loss of cellular orientation - shape - and size in comparizon to normal tissue maturation; commonly preneoplastic. Reversible.
Thymoma - small cell lung carcinoma


33. Leukocyte extravasation

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34. Tumor suppressor gene: DCC chromosome? Associated tumor?
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Cervical carcinoma (types 16 - 18) Penile/anal carcinoma
Abl


35. Neoplasia
Assoc: breast cancer
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
Causes: ADH Effect: SIADH
Causes: ACTH or ACTH- like peptide Effect: Cushing's syndrome


36. Tumor suppressor gene: BRCA2 chromosome? Associated tumor?
Sarcoma
T = size of T umor N = N ode involvement M = M etastases
Assoc: breast cancer
Chr. 11p Assoc: Wilms' tumor


37. Free radical injury induces cell injury thru...?
Beta -2 microglobulin Derived from MHC class I proteins.
Membrane lipid peroxidation Protein modification DNA Breakage
Visceral malignancy (stomach - lung - breast - uterus)
Follicular and undifferentiated lymphomas (inhibits apoptosis)


38. tumor: L ung tumor What is the associated oncogene?
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Follicular and undifferentiated lymphomas (inhibits apoptosis)
Abl
L - myc


39. Oncogene: ret Associated tumor?
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
Multiple endocrine neoplasia (MEN) types II and III
Acanthosis nigricans (hyperpigmentation and epidermal thickening)
CML


40. Pancreatic cancer

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41. Colorectal cancer (assoc w/ FAP) What is the tumor suppressor gene?
AL protein Derived from Ig L ight chains (multiple myeloma) (AL = L ight chains)
Sarcoma
Benign: Leiomyoma Malignant: Leiomyosarcoma
APC


42. Retinoblastoma - osteosarcoma What is the tumor suppressor gene?
Multiple endocrine neoplasia (MEN) types II and III
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
Rb
WT1


43. Tumor markers: PSA
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
HTLV-1
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />


44. Substances that are chemotactic for neutrophils
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.
IL-8 C5a Leukotriene B4 Kallikrein
N - myc
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.


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

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46. Carcinoma vs. sarcoma
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
Assoc: Colorectal cancer (assoc w/ FAP)
Bladder (transitional cell carcinoma)


47. Tumor markers: Beta - hCG

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48. Colon cancer
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
Benign: Leiomyoma Malignant: Leiomyosarcoma
Erb - B2
Malignant lymphomas


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

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50. Neoplastic progression: step 1 Hyperplasia/dysplasia

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