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USMLE STEP 1 > Pathology > Flashcards

Pathology Flashcards

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USMLE® Step 1 flashcards
1
Q 
Apoptosis 
What is it?
What is required?
Phys
Inflammation 
Histo 
Clean up?
A

Programmed cell death
ATP required
Cytosolic caspases mediate cellular breakdown
No inflammation
Shrinkage, Pyknosis (nuc shrinkage), Basophilia, Blebbing, Nuclear Fragmentation (karyorrhexis), Apoptotic bodies
Phagocytosis

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2
Q

Intrinsic Apoptosis Pathway
What process is it involved with?
Mechanism
Mito involvement

A

Tissue remodeling in embryogenesis and after exposure to injurious stimuli
Growth factor withdrawn from proliferating cells
Changes in proportions of anti and pro apoptotic factors lead to ↑ mito permeability and ctyochrome c release

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3
Q

Extrinsic Apoptosis Pathways

A

Fas ligand binding to Fas Receptor (CD95)

Tc cells release Perforin and Granzyme B

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4
Q

Necrosis
What causes it?
Process?
Inflammation?

A

Exogenous injury
Enzymatic degradation and protein denaturation –> Intracellular components extravasate
Inflammation

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5
Q

Coagulative Necrosis

A

Heart, Liver, Kidney

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6
Q

Liquefactive Necrosis

A

Brain, Bacterial Abscess, Pleural Effusion

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7
Q

Caseous Necrosis

A

TB, Systemic Fungi

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8
Q

Fatty Necrosis

A

Peripancreatic fat (saponification via lipase)

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9
Q

Fibrinoid Necrosis

A

Blood vessels

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10
Q

Gangrenous Necrosis
Dry
Wet
Where?

A

Dry: Ischemic Coagulative
Wet: Bacteria
Limbs and GI tract

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11
Q

Reversible Cell Injury
What is required?
PathoPhys
Histo

A

Oxygen
↓ ATP synthesis, ↓ Glycogen
Swelling (impaired Na/K pump), Chromatic clumping, Fatty Change, Ribosomal detachment

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12
Q

Pro-apoptotic Mito protein

A

Bax

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13
Q

Anti-apoptotic Mito Protein

A

Bcl-2

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14
Q

Irreversible Cell Injury
Pathway
What happens to the cell?
Histo

A

Ca influx –> caspase activation
Plasma membrane damage, Lysosomal Rupture, Mito Permeability
Pyknosis, Karyolysis, Karyorrhexis

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15
Q

Location of Brain susceptible to ischemic injury

A

ACA/MCA/PCA boundary area

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16
Q

Location of Heart susceptible to ischemic injury

A

Subendocardium of LV

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17
Q

Location of Kidney susceptible to ischemic injury

A

Straight segment of PT in medulla

Thick Ascending Limb in medulla

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18
Q

Location of Liver susceptible to ischemic injury

A

Central Vein (zone III)

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19
Q

Location of Colon susceptible to ischemic injury

A

Splenic Flexure and Rectum

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20
Q 
Red Infarcts 
What kind of infarct?
What kind of tissue?
Organs?
When?
A 
"Red = Reperfusion"
Hemorrhagic 
Tissue with collaterals 
Liver, Lungs, Intestines 
Following reperfusion
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21
Q

Hypoxic Ischemic Encephalopathy affects what kind of cells?

A

Pyramidal Cells of Hippocampus and Purkinje cells

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22
Q

Pale Infarcts
What kind of tissue?
Organs?

A

Solid tissues with a single blood supply

Heart, Kidney, Spleen

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23
Q

Reperfusion injury is due to…

A

Free Radicals

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24
Q

Hypovolemic Shock
Output
TPR
Presentation

A

Low output
↑ TPR
Cold and Clammy

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25
Q

Cardiogenic Shock
Output
TPR
Presentation

A

Low output
↑ TPR
Cold and Clammy

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26
Q 
Septic Shock
Output
TPR
Vasculature 
Presentation
A

High output
↓ TPR
Dilated arterioles, High venous return
Hot

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27
Q

Atrophy
What is it?
Possible causes?

A

Reduction in size or # of cells
↓ hormones, innervation, blood flow nutrients
↑ pressure
Occlusion of secretory ducts

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28
Q

Characteristics of Inflammation

A

Redness, Heat, Swelling, Loss of Function

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29
Q

Vascular component of inflammation

A

↑ vascular permeability, vasodilation, endothelial injury

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30
Q

Cellular component of inflammation

A

Neutrophil mediated

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31
Q 
Acute component of inflammation 
Mediators
Onset 
Duration 
Possible outcomes
A

Neutrophils, Eosinophils, Abs
Seconds to minutes
Minute to days
Resolution, Abscess, Chronic inflammation

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32
Q 
Chronic component of inflammation 
Mediators
Characteristic 
Associated with...
Outcomes
A

Mononuclear cells
Persistent destruction and repair
Blood vessel proliferation. Fibrosis
Scarring, Amyloidosis

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33
Q

Granuloma
Histo
Pathway

A

Nodular collection of Epithelioid Macrophages and Giant Cells
Th1 secretes IFNγ which activates Macs which secrete TNFα

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34
Q

Leukocyte Extravasation

Steps w/ mediators

A

1.Rolling:
Vasculature: E and P selectins. Leukocyte: Sialyl-Lewis
2. Tight Binding
V: ICAM. L: LFA1 (integrin)
3. Diapedesis (between endothelial cells)
V: PECAM. L: PECAM
4. Migration

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35
Q

Leukocyte (neutrophil) chemotactic factors

A

“CLIK”

C5a, LTB4, IL8, Kallikrein

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36
Q

How do free radicals damage cells?

A

Membrane lipid peroxidation
Protein modifications
DNA breakage

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37
Q

Free Radicals
What causes them?
How are they eliminated?

A

Radiation, Metabolism of drugs, Redox rxns, Nitric Oxide (NO), Transition metals, Leukocyte oxidative burst
Enzymes (Catalase, SOD, Glutathione Peroxidase), Decay, Antioxidants (A, C, E)

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38
Q

Free Radical Diseases

A

ROP, Bronchopulmonary Dysplasia, CCl4 –> liver necrosis (fatty change), Acetominophen OD, Hemochromatosis, Reperfusion

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39
Q

Would Healing Phases

A

Inflammatory, Proliferative, Remodeling

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40
Q

Would Healing Inflammatory Phase
When?
Mediators
What happens?

A

Immediate
Platelets, Neutrophils, Macrophages
Clot formation and ↑ permeability

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41
Q

Would Healing Proliferative Phase
When?
Mediators
What happens?

A

2-3 days after injury
Fibroblasts, Myofibroblasts, Endothelial cells, Keratinocytes, Macrophages
Deposition of granulation tissue and collagen. Angiogenesis, Epithelial cell proliferation, Dissolution of clot, Wound contraction (via myofibroblasts)

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42
Q

Would Healing Remodeling Phase
When?
Mediators
What happens?

A

1 week
Fibroblasts
Collagen III replaces Collagen I –> ↑ tensile strength of tissue

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43
Q

Granulomatous Diseases

A

TB
Fungal Infections (Histoplasmosis, Coccidioidomycosis)
Treponema Pallidum (Syphilis)
M Leprae (Leprosy)
Bartonella Henselae (cat scratch disease)
Sarcoidosis, Crohn’s Disease, Wegener’s, Churg Strauss
Berylliosis, Silicosis

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44
Q 
Transudate 
Cellularity?
Protein?
Specific gravity
Causes
A

Hypocellular
Low protein
Less than 1.012
↑ hydrostatic pressure, ↓ oncotic pressure, Na retention

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45
Q 
Exudate 
Cellularity?
Protein?
Specific gravity
Causes
A

Cellular
Protein rich
Greater than 1.02
Lymphatic obstruction or Inflammation

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46
Q

Iron Poisoning
MoA
Acute
Chronic

A

Peroxidation of membrane lipids
Acute gastric bleeding
Chronic: Metabolic acidosis, Scarring –> GI obstruction

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47
Q

Amyloidosis
What is it?
What does it cause?
Appearance of tissue?

A

Abnormal aggregation of proteins into β-pleated sheets
Cell damage and apoptosis
Waxy appearance

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48
Q

AL Amyloidosis
What kind of protein?
What disorders present with it?
Organ systems affected

A

Ig Light chains
Plasma cell disorder or Multiple Myeloma
Renal (nephrotic), Cardiac (failure, arrhythmia), Hematologic (easy bruising), Hepatomegaly, Neuropathy

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49
Q

AA Amyloidosis
What kind of protein?
What diseases?
Systems involved?

A

Amyloid A fibrils
RA, IBD, Spondyloarthropathy, Chronic Infections
Multiple systems like in AL

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50
Q

Dialysis Related Amyloidosis
What kind of protein?
What kind of pt?
Presentation

A

β2 microglobulin
ESRD on long term dialysis
Carpal tunnel syndrome and other joint issues

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51
Q

Heritable Amyloidosis
Genetics
Disease

A

Transthyretin (TTR or prealbumin) gene mutation

ATTR neurologic/cardiac amyloidosis

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52
Q

Age-Related (Senile) Amyloidosis
What kind of protein?
Organs affected
Progression

A

wt TTR
Systemic: deposited in myocardium and other sites
Slower progression of cardiac dysfunction vs AL

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53
Q

Organ Specific Amyloidosis
What is affected?
Example with protein

A

A single organ

Alzheimer’s Disease due to deposition of amyloid-β protein from APP

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54
Q

Anaplasia

A

Abnormal cells lacking differentiation

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55
Q

Desmoplasia

A

Fibrous tissue formation in response to neoplasm

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56
Q

Tumor Grade

A

Degree of cellular differentiation

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57
Q

Tumor Stage

TNM

A

Degree of localization/spread based on site and size
Tumor Size
Node Involvement
Metastases

58
Q

Tumor stage vs grade re prognostic value

A

Stage has more prognostic value

59
Q

Epithelium tumor names
Benign
Malignant

A

Adenoma, Papilloma

Adenocarcinoma, Papillary carcinoma

60
Q

Tumor of Blood Vessels
Benign
Malignant

A

Hemangioma

Angiosarcoma

61
Q

Tumor of Smooth Muscle
Benign
Malignant

A

Leiomyoma

Leiomyosarcoma

62
Q

Tumor of Striated Muscle
Benign
Malignant

A

Rhabdomyoma

Rhabdomyosarcoma

63
Q

Tumor of Connective Tissue
Benign
Malignant

A

Fibroma

Fibrosarcoma

64
Q

Tumor of Bone
Benign
Malignant

A

Osteoma

Osteosarcoma

65
Q

Tumor of Fat
Benign
Malignant

A

Lipoma

Liposarcoma

66
Q

Cachexia
Presentation
Disease with it?
Mediated by

A

Wt loss, Muscle atrophy, Fatigue
Cancer, AIDS, Heart Failure, TB
TNFα, IFNγ, IL6

67
Q

Neoplasm of Down Syndrome

A

ALL, AML

68
Q

Neoplasm of Xeroderma Pigmentosum or Albinism

A

Melanoma, Basal Cell Carcinoma, Squamous Cell Carcinoma of the Skin

69
Q

Neoplasm of Chronic Gastritis, Pernicious Anemia, Postsurgical Gastric Remnant

A

Gastric Adenocarcinoma

70
Q

Neoplasm of Tuberous Sclerosis

A

Giant Cell Astrocytoma, Renal Angiomyolipoma, Cardiac Rhabdomyoma

71
Q

Neoplasm of Actinic Keratosis

A

Squamous cell carcinoma of the skin

72
Q

Neoplasm of Barrett’s Esophagus

A

Esophageal adenocarcinoma

73
Q

Neoplasm of PVS

A

Squamous cell carcinoma of the esophagus

74
Q

Neoplasm of Paget’s Disease of Bone

A

Osteosarcoma, Fibrosarcoma

75
Q

Neoplasm of Immunodeficiency States

A

Malignant Lymphomas

76
Q

Neoplasm of AIDS

A

Malignant Lymphomas and Kaposi Sarcoma

77
Q

Neoplasm of autoimmune disease

A

Lymphoma

78
Q

Neoplasm of Acanthosis Nigricans

A

Visceral Malignancy (Stomach, Lung, Uterus)

79
Q

Neoplasm of Dysplastic Nevus

A

Malignant Melanoma

80
Q

Neoplasm of Radiation Exposure

A

Leukemia, Sarcoma, Papillary Thyroid Cancer, Breast Cancer

81
Q

abl
What kind of protein?
Tumor
Product

A

Oncogene
CML
Tyrosine Kinase

82
Q

c-myc
What kind of protein?
Tumor
Product

A

Oncogene
Burkitt’s Lymphoma
Transcription factor

83
Q

bcl2
What kind of protein?
Tumor
Product

A

Oncogene
Follicular and undifferentiated lymphoma
Anti-apoptotic molecule

84
Q

HER2/neu (c-erbB2)
What kind of protein?
Tumor
Product

A

Oncogene
Breast, Ovarian, Gastric Carcinoma
Tyrosine Kinase

85
Q

ras
What kind of protein?
Tumor
Product

A

Oncogene
Colon Carcinoma
GTPase

86
Q

L-myc
What kind of protein?
Tumor
Product

A

Oncogene
Lung Tumor
Transcription Factor

87
Q

N-myc
What kind of protein?
Tumor
Product

A

Oncogene
Neuroblastoma
Transcription Factor

88
Q

ret
What kind of protein?
Tumor
Product

A

Oncogene
MEN 2A and 2B
Tyrosine Kinase

89
Q

c-kit
What kind of protein?
Tumor
Product

A

Oncogene
GI stromal tumor
Cytokine Receptor

90
Q

Rb
What kind of protein?
Tumor
Product

A

Tummor Suppressor
Retinoblastoma, Osteosarcoma
Normally inhibits E2F thus blocking G1 –> S transition

91
Q

p53
What kind of protein?
Tumor
Product

A

Tummor Suppressor
Most human cancers, Li-Fraumeni Syndrome
Transcription factor for p21. Normally blocks G1 –> S transition

92
Q

BRCA1 and BRCA2
What kind of protein?
Tumor
Product

A

Tummor Suppressor
Breast and Ovarian Cancer
DNA repair protein

93
Q

p16
What kind of protein?
Cancer

A

Tummor Suppressor

Melanoma

94
Q

BRAF
What kind of protein?
Tumor
Product

A

Tummor Suppressor
Melanoma
B-raf

95
Q

APC
What kind of protein?
Cancer?

A

Tummor Suppressor

Colorectal cancer

96
Q

WT1
What kind of protein?
Tumor

A

Tummor Suppressor

Wilm’s Tumor (Neuroblastoma)

97
Q

NF1
What kind of protein?
Tumor
Product

A

Tummor Suppressor
Neurofibromatosis type 1
RAS GTPase activating protein (RAS GAP)

98
Q

NF2
What kind of protein?
Tumor
Product

A

Tummor Suppressor
Neurofibromatosis type 2
Merlin (Schwannomin) protein

99
Q

DPC4
What kind of protein?
Tumor
Product

A

Tummor Suppressor
Pancreatic Cancer
“Deleted in Pancreatic Cancer”

100
Q

DCC
What kind of protein?
Tumor
Product

A

Tummor Suppressor
Colon Cancer
“Deleted in Colon Cancer”

101
Q

PSA
Function
When is it elevated?
Screen utility?

A

Follow prostate carcinoma
Prostate carcinoma, BPH, Prostatitis
Questionable

102
Q

Prostatic Acid Phosphatase maker for…

A

Prostate carcinoma

103
Q

CEA marker
Name
Cancers associated with it?

A

CarcinoEmbryonic Antigen
Colorectal and Pancreatic Cancer
Gastric, Breast, and Medullary Thyroid Carcinoma

104
Q

α-FetoProtein
Normally made by
Marker for what kind of cancers?

A

Normally made by fetus

Hepatocellular carcinoma, NonSeminomatuous germ cell tumor (ovary, testis)

105
Q

βhCG: Marker for what kind of tumors?

A

Hydatidiform moles and Choriocarcinomas (Gestational trophoblastic disease)

106
Q

CA-125 marker for

A

Ovarian Cancer

107
Q

S-100 marker for

A

Melanoma, Neural tumors, Schwannomas

108
Q

ALP marker for

A

Metastases to bone, Liver, Paget’s Disease of bone

109
Q

Bombesin marker for…

A

Neuroblastoma, Lung, and Gastric Cancers

110
Q

TRAP
Name
Marker for…

A

“Trap the Hair Animal”
Tartrate Resistant Acid Phosphatase
Hairy Cell Leukemia (B cell neoplasm)

111
Q

CA-19-9 marker for

A

Pancreatic Adenocarcinoma

112
Q

Calcitonin marker for

A

Medullary Thyroid Carcinoma

113
Q

HTLV-1 leads to what cancer?

A

Adult T cell leukemia/lymphoma

114
Q

HBV and HCV lead to what cancer?

A

Hepatocellular Carcinoma

115
Q

EBV leads to what cancer?

A

Burkitt’s Lymphoma, Hodgkin’s Lymphoma, Nasopharyngeal Carcinoma, CNS lymphoma (in immunosuppressed pts)

116
Q

HPV leads to what cancer?

A

Cervical carcinoma (16, 18)
Penile/anal carcinoma
Upper Respiratory SCC

117
Q

HHV8 leads to what cancer?

A

Kaposi sarcoma, Body Cavity Fluid B cell lymphoma

118
Q

H. pylori leads to what cancer?

A

Gastric Adenocarcinoma and Lymphoma

119
Q

Liver Fluke (Clonorchis sinensis) leads to what cancer?

A

Cholangiocarcinoma

120
Q

Aflatoxin
Made by what organism?
Organ affected?
Impact?

A

Aspergillus
Liver
Hepatocellular carcinoma

121
Q

Vinyl Chloride
Organ affected?
Impact?

A

Liver

Angiosarcoma

122
Q

CCl4
Organ affected?
Impact?

A

Liver

Centriolobular Necrosis and Fatty Change

123
Q

Nitrosamines
Where are they from?
Organ affected?
Impact?

A

Smoked foods
Stomach
Gastric Cancer

124
Q

Cigarette smoke
Organ affected?
Impact?

A 
Larynx: Squamous Cell Carcinoma 
Lung: Squamous and Small cell carcinoma 
Kidney: Renal cell carcinoma 
Bladder: Transitional cell carcinoma 
Pancreas: Pancreatic adenocarcinoma
125
Q

Asbestos
Organ affected?
Impact?

A

Lung

Bronchogenic carcinoma > Mesothelioma

126
Q

Arsenic
Organ affected?
Impact?

A

Skin: Squamous Cell Carcinoma
Liver: Angiosarcoma

127
Q

Naphthalene (aniline)
Organ affected?
Impact?

A

Bladder

Transitional Cell Carcinoma

128
Q

Alkylating Agents
Organ affected?
Impact?

A

Blood

Leukemia

129
Q

Paraneoplastic ACTH
Made from…
Effect

A

Small cell carcinoma of the lung

Cushing’s syndrome

130
Q

Paraneoplastic ADH
Made from…
Effect

A

Small cell carcinoma of the lung and intracranial neoplasms

SIADH

131
Q

Paraneoplastic PTHrP
Made from…
Effect

A

Small cell carcinoma of the lung, Renal cell carcinoma, Breast cancer
HyperCa

132
Q

Paraneoplastic VitD
Made from…
Effect

A

Hodgkin’s Lymphoma and some Non-Hodgkin’s Lymphoma

HyperCa

133
Q

Paraneoplastic EPO
Made from…
Effect

A

Renal Cell Carcinoma, Hemangioblastoma, Hepatocellular carcinoma, Pheochromocytoma
Polycythemia

134
Q

Paraneoplastic Abs against presynaptic Ca channels
Made from…
Effect

A

Small Cell Carcinoma of the Lung

Lambert Eaton Syndrome

135
Q

Psammoma Bodies
Appearance
Seen in what?

A

Laminated, Concentric, Calcific Spherules
“PSaMMoma”
Papillary Adenocarcinoma of the Thyroid
Serous Papillary cystadenocarcinoma of the ovary
Meningioma
Malignant Mesothelioma

136
Q

Cancer epidemiology in Men
Incidence
Mortality

A

Prostate (32%), Lung (16%), Colon/Rectum (12%)

Lung (33%), Prostate (13%)

137
Q

Cancer epidemiology in Women
Incidence
Mortality

A

Breast (32%), Lung (13%), Colon/Rectum (13%)

Lung (23%), Breast (18%)

138
Q

Cancers that metastasize to Brain

A

Lung, Breast, GU, Osteosarcoma, Melanoma, GI

139
Q

Cancers that metastasize to Liver

A

Colon, Stomach, Pancreas

140
Q

Cancers that metastasize to Bone

What bones are more common?

A

Prostate (blastic), Breast (lytic and blastic), Lung (lytic), Thyroid, Testes
Axial skeleton

141
Q

Metastatic Brain tumors
Frequency
Location
Appearance

A

50% of brain tumors are metastatic
Gray/White Junction
Multiple well circumscribed tumors

USMLE STEP 1 (25 decks)

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