First Aid for the USMLE Step 1 2011 EXPRESS workbook

page 69

Pathology
Questions
INFLAMMATION
1.

Describe the fundamental differences between the intrinsic and extrinsic pathways of apoptosis.
Name two important similarities between the pathways. (p. 220) ___________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

2.

What are the six types of necrosis? List an example of each. (p. 220) _______________________
______________________________________________________________________________
______________________________________________________________________________

3.

Name three organs that manifest irreversible ischemia with red infarcts. Name three that show pale
infarcts. (p. 221) _________________________________________________________________
______________________________________________________________________________

4.

What are the five signs and symptoms of inflammation? (p. 221) ___________________________
______________________________________________________________________________

5.

In the chart below, compare and contrast the ligand-receptor interactions required for each step of
leukocyte extravasation. (p. 222)
Ligand-Receptor
Interaction

Endothelial Cells

Leukocytes

Rolling
Tight binding
Diapedesis

Migration

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6.

First Aid for the USMLE Step 1 2011 EXPRESS workbook

What are the three ways that free radicals can be eliminated? (p. 222) ______________________
______________________________________________________________________________

7.

In the chart below, compare and contrast the characteristics of transudates and exudates. (p. 223)
Transudate

Exudate

Causes

Cellularity
Protein level
Specific gravity

8.

What three conditions are associated with a low erythrocyte sedimentation rate? (p. 223) _______
______________________________________________________________________________

9.

In the chart below, compare and contrast the characteristics of hypovolemic/cardiogenic shock vs.
septic shock. (p. 224)
Hypovolemic/
Cardiogenic Shock

Septic Shock

Cardiac output
Clinical appearance
Total peripheral
resistance

NEOPLASIA
10.

Define the following terms and provide an example of each. (pp. 225-226)
A.

Anaplaia __________________________________________________________________
__________________________________________________________________________

B.

Dysplasia _________________________________________________________________
__________________________________________________________________________

C.

Hyperplasia ________________________________________________________________
__________________________________________________________________________

D.

Hypertrophy ________________________________________________________________
__________________________________________________________________________
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First Aid for the USMLE Step 1 2011 EXPRESS workbook

E.

page 71

Metaplasia ________________________________________________________________
__________________________________________________________________________

F.

Neoplasia _________________________________________________________________
__________________________________________________________________________

11.

Describe the differences between tumor grade and tumor stage. (p. 226) ____________________
______________________________________________________________________________
______________________________________________________________________________

12.

Compare and contrast the characteristics of benign vs. malignant tumors. (p. 226)
Characteristic

Benign Tumor

Metastatic Tumor

Differentiated?
Growth
Distinct boundaries?
Metastatic potential?
13.

Match the neoplasm(s) to the condition(s) with which it is most commonly associated. (p. 227)
_____ A.
_____ B.
_____ C.
_____ D.
_____ E.
_____ F.
_____ G.
_____ H.
_____ I.
_____ J.
_____ K.
_____ L.
_____ M.
_____ N.
_____ O.
_____ P.

Acute lymphoblastic leukemia

Astrocytoma, angiomyolipoma, cardiac
rhabdomyoma
Colonic adenocarcinoma
Gastric adenocarcinoma
Esophageal adenocarcinoma
Hepatocellular carcinoma
Lymphoma
Malignant lymphoma
Malignant melanoma
Melanoma, basal cell carcinoma, and
squamous cell carcinoma of skin
Non-Hodgkins lymphoma and Kaposis
sarcoma
Sarcoma and papillary thyroid cancer
Secondary osteosarcoma and fibrosarcoma
Squamous cell carcinoma of esophagus
Squamous cell carcinoma of skin
Visceral malignancy

1.
2.
3.
4.
5.
6.

7.
8.
9.
10.
11.
12.
13.
14.
15.
16.

Acanthosis nigricans
Actinic keratosis
AIDS
Autoimmune diseases
Barretts esophagus
Chronic atrophic gastritis, pernicious
anemia, postsurgical gastric
remnants
Cirrhosis
Down syndrome
Dysplastic nevus
Immunodeficiencies
Pagets disease of bone
Plummer-Vinson syndrome
Radiation exposure
Tuberous sclerosis
Ulcerative colitis
Xeroderma pigmentosum, albinism

14.

Oncogenes are associated with a ______ (gain/loss) of function and require damage to ______
(one/both) allele(s); examples include _________________________. In contrast, tumor
suppressor genes are associated with a ______ (gain/loss) of function and require damage to
______ (one/both) allele(s); examples include _________________________. (pp. 227-228)

15.

How are tumor markers best used? (p. 228) ___________________________________________

______________________________________________________________________________

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First Aid for the USMLE Step 1 2011 EXPRESS workbook

16.

A 40-year-old otherwise healthy man is diagnosed with nasopharyngeal carcinoma. He does not
smoke or drink. What is the most likely cause of his cancer? (p. 229) ________________________

17.

An IV drug abuser who is being monitored for cirrhosis shows a sudden increase in his fetoprotein level. For which disease is he at increased risk? (p. 229) ________________________

18.

The vaccine Gardasil protects against which viruses that can cause which cancer? (p. 229) ____

______________________________________________________________________________
19.

A 70-year-old recent immigrant from Japan presents with right upper quadrant pain and loss of
appetite. Which diagnosis should be high on the differential? (p. 229) _______________________

20.

A 55-year-old woman with a 40-pack-year history of cigarette smoking presents with new-onset
cough, hemoptysis, and polyuria. What diagnosis should be high on the differential? (p. 229) ____
______________________________________________________________________________

21.

Which cancers are most common in men? In women? (p. 230) ____________________________
______________________________________________________________________________

22.

In the chart below, checkmark which primary tumors can metastasize to which organ(s). (p. 230)

Primary Tumor

Metastasize
to Brain

Metastasize
to Liver

Metastasize
to Bone

Breast
Colon
Gastrointestinal
Kidney
Lung
Pancreas
Prostate
Skin
Stomach
Testes
Thyroid

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First Aid for the USMLE Step 1 2011 EXPRESS workbook

page 73

Answers
INFLAMMATION
1.

The intrinsic pathway begins with changes in the levels of anti- and pro-apoptotic factors, leading to
increased mitochondrial permeability. The extrinsic pathway begins with ligand-receptor
interactions or perforin/granzyme release. Similarities: both require ATP, and both ultimately
activate caspases.

2.

Caseous (e.g., due to systemic fungal infection), coagulative (as occurs in the heart), fatty
(saponification of liver), fibrinoid (as occurs in blood vessels), gangrenous (limb gangrene), and
liquefactive (bacterial abscess).

3.

Red infarct: liver, lungs, and intestine. Pale infarcts: heart, kidney, and spleen.

4.

Rubor (redness), dolor (pain), calor (heat), tumor (swelling), and functio laesa (loss of function).

5.

6.

Ligand-Receptor
Interaction

Endothelial Cells

Leukocytes

Rolling

E-selection
P-selectin

Sialyl Lewis

Tight binding

ICAM-1

LFA-1

Diapedesis

PECAM-1

PECAM-1

Migration

C5a
IL-8
LTB4
Kallikrein

Various

By enzymes, by spontaneous decay, and by antioxidants.

7.

8.

Transudate

Exudate

Causes

Increased hydrostatic pressure

Decreased oncotic pressure
Sodium retention

Lymphatic obstruction
Inflammation

Cellularity

Hypocellular

Cellular

Protein level

Low

High

Specific gravity

Low

High

Congestive heart failure, sickle cell anemia, and polycythemia.

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First Aid for the USMLE Step 1 2011 EXPRESS workbook

9.
Hypovolemic/
Cardiogenic Shock

Septic Shock

Cardiac output

Low

High

Clinical appearance

Cold and clammy

Feverish

Total peripheral
resistance

Increased

Decreased

NEOPLASIA
10.

A.

Anaplasia: lacking differentiation. Examples: anaplastic oligodendroglioma, anaplastic thyroid

tumors, many other subtypes of tumors.

B.

Dysplasia: abnormal cells. Examples: cervical dysplasia, fibrous dysplasia of bone,

congenital retinal dysplasia.

C.

Hyperplasia: increase in the number of cells. Examples: parathyroid hyperplasia, benign

prostatic hyperplasia, congenital adrenal hyperplasia.

D.

Hypertrophy: increase in the size of the cell. Examples: increased muscle bulk after weight
lifting, myocardial hypertrophy, myometrium during pregnancy.

E.

Metaplasia: one type of cell is replaced by another. Examples: Barretts esophagus,

squamous metaplasia of the airways.

F.

Neoplasia: new growth, either benign or malignant. Examples: uterine fibroids, nevi,
malignant cancers.

11.
Characteristic

Benign Tumor

Metastatic Tumor

Differentiated?

Well-differentiated

May be poorly
differentiated

Growth

Slow

Erratic

Distinct boundaries?

Yes

Diffuse or locally invasive

Metastatic potential?

No

Yes

12.

Tumor grade is the degree of cellular differentiation within the tumor, and is a characteristic of the
tumor itself. In contrast, tumor stage describes the extent of tumor spread within a patient, and thus
is a better indication of a patients prognosis than tumor grade.

13.

A-8, B-14, C-15, D-6, E-5, F-7, G-4, H-10, I-9, J-16, K-3, L-13, M-11, N-12, O-2, P-1.

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First Aid for the USMLE Step 1 2011 EXPRESS workbook

page 75

14.

Oncogenes are associated with a gain of function and require damage to only one allele for
expression; examples include c-myc (Burkitts lymphoma) and ras (colon carcinoma). Tumor
suppressor genes are associated with a loss of function and require damage to both alleles for
expression; examples include NF1 (neurofibromatosis type 1) and BRCA2 (breast cancer).

15.

To confirm a diagnosis, to check for tumor recurrent, and to monitor response to therapy.

16.

Epstein-Barr Virus (EBV).

17.

Hepatocellular carcinoma. IV drug use and cirrhosis are associated with HCV, and HCV is
associated with hepatocellular carcinoma.

18.

HPV 6, 11, 16, and 18. HPV 16 and 18 have been associated with cervical cancer.

19.

Gastric cancer. The Japanese diet is high in smoked foods, which contain nitrosamine.

20.

Small cell lung carcinoma with paraneoplastic SIADH secretion.

21.

Prostate, lung, and colon/rectal cancers are the most common cancers in men; breast, lung, and
colon/rectal cancers are the most common in men.

22.

Primary Tumor
Breast

Metastasize
to Brain

Metastasize
to Liver

Metastasize
to Bone

Colon
Gastrointestinal

Kidney

Lung

Pancreas

Prostate
Skin
Stomach

Testes

Thyroid

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page 76

First Aid for the USMLE Step 1 2011 EXPRESS workbook

Notes
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All rights reserved