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
Endothelial Cells Leukocytes
Interaction

Rolling

Tight binding

Diapedesis

Migration

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6. 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/
Septic Shock
Cardiogenic 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 page 71

E. 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. Acute lymphoblastic leukemia 1. Acanthosis nigricans
_____ B. Astrocytoma, angiomyolipoma, cardiac 2. Actinic keratosis
rhabdomyoma 3. AIDS
_____ C. Colonic adenocarcinoma 4. Autoimmune diseases
_____ D. Gastric adenocarcinoma 5. Barretts esophagus
_____ E. Esophageal adenocarcinoma 6. Chronic atrophic gastritis, pernicious
_____ F. Hepatocellular carcinoma anemia, postsurgical gastric
_____ G. Lymphoma remnants
_____ H. Malignant lymphoma 7. Cirrhosis
_____ I. Malignant melanoma 8. Down syndrome
_____ J. Melanoma, basal cell carcinoma, and 9. Dysplastic nevus
squamous cell carcinoma of skin 10. Immunodeficiencies
_____ K. Non-Hodgkins lymphoma and Kaposis 11. Pagets disease of bone
sarcoma 12. Plummer-Vinson syndrome
_____ L. Sarcoma and papillary thyroid cancer 13. Radiation exposure
_____ M. Secondary osteosarcoma and fibrosarcoma 14. Tuberous sclerosis
_____ N. Squamous cell carcinoma of esophagus 15. Ulcerative colitis
_____ O. Squamous cell carcinoma of skin 16. Xeroderma pigmentosum, albinism
_____ P. Visceral malignancy

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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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)

Metastasize Metastasize Metastasize

Primary Tumor
to Brain to Liver 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.
Ligand-Receptor
Endothelial Cells Leukocytes
Interaction

E-selection
Rolling Sialyl Lewis
P-selectin

Tight binding ICAM-1 LFA-1

Diapedesis PECAM-1 PECAM-1

C5a
IL-8
Migration Various
LTB4
Kallikrein

6. By enzymes, by spontaneous decay, and by antioxidants.

7.
Transudate Exudate

Increased hydrostatic pressure

Lymphatic obstruction
Causes Decreased oncotic pressure
Inflammation
Sodium retention

Cellularity Hypocellular Cellular

Protein level Low High

Specific gravity Low High

8. Congestive heart failure, sickle cell anemia, and polycythemia.

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9.

Hypovolemic/
Septic Shock
Cardiogenic Shock

Cardiac output Low High

Clinical appearance Cold and clammy Feverish

Total peripheral
Increased Decreased
resistance

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

May be poorly
Differentiated? Well-differentiated
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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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.

Metastasize Metastasize Metastasize

Primary Tumor
to Brain to Liver to Bone

Breast
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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