Step 1 Express 2018-Pathology

First Aid Express 2018 workbook: PATHOLOGY

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Pathology Questions CELLULAR INJURY 1.

Define the following terms. (p 206) A.

Hyperplasia________________________________________________________________ __________________________________________________________________________

B.

Metaplasia _________________________________________________________________ __________________________________________________________________________

C.

Dysplasia __________________________________________________________________ __________________________________________________________________________

2.

Describe the fundamental differences between between the intrinsic and extrinsic pathways pathways of apoptosis. Name two important similarities between the pathways. (p 208) ___________________________ 208) ___________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

3.

Describe the fundamental differences between apoptosis and necrosis. What are the six types of necrosis? List an example of each. (pp 208-209) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

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4.


Name three organs that manifest irreversible ischemia with red infarcts. Name three that show pale infarcts. (p 210) _________________________________________________________________ ______________________________________________________________________________

5.

What conditions are associated with a low erythrocyte sedimentation rate? (p 212) ____________ ______________________________________________________________________________

6.

Which cells and proteins mediate the acute phase of inflammation? (p 212) __________________ ______________________________________________________________________________ ______________________________________________________________________________

7.

In the chart, compare and contrast the ligand-receptor interactions required for each step of leukocyte extravasation. (p 213) Ligand-Receptor Interaction

Endothelial Cells

Leukocytes

Rolling

Tight binding Diapedesis

Migration

8.

In cases of chronic inflammation, what types of cells infiltrate tissue? (p 214) What is the key cell of granulomas? _________________ ______________________________________________________________________________

9.

What are the four ways that free radicals can be eliminated? Under what conditions might these mechanisms fail? (p 216) _________________________________________________________ ______________________________________________________________________________



10.

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In the chart, compare and contrast the characteristics of transudates and exudates. (p 217)

Transudate

Exudate

Causes Cellularity Protein level

NEOPLASIA 11.

Compare and contrast the characteristics of benign vs malignant tumors. (p 220)

Characteristi c

Benign Tumor

Metastatic Tumor

Differentiated? Growth Distinct boundaries? Metastatic potential? 12.

Describe the differences between tumor grade and tumor stage. (p 220) ____________________ ______________________________________________________________________________

13.

Match the neoplasm(s) to the condition(s) with which it is most commonly associated. (p 221) _____ A.

Anti-NMDA receptor encephalitis

1. Acanthosis nigricans

_____ B.

Cushing syndrome

2. Lymphoma

_____ C.

Gastric adenocarcinoma

3. Neuroblastoma in children

_____ D.

Hypercalcemia + elevated calcitriol level

4. Ovarian teratoma

_____ E.

Myasthenia gravis

5. Pancreatic adenocarcinioma

_____ F.

Opsoclonus-myoclonus ataxia syndrome

6. Renal cell carcinoma

_____ G.

Polycythemia

7. Small cell lung cancer

_____ H.

Trousseau syndrome

8. Thymoma


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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/l oss) of function and require damage to ______ (one/both) allele(s); examples include __________________________. (p 222)

15.

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 223) _______________________

16.

A 70-year-old who eats smoked salmon every day presents with abdominal pain and loss of appetite. Which diagnosis should be high on the differential? (p 223) _______________________________

17.

A 55-year-old woman with a 40-pack-year history of cigarette smoking presents with new-onset cough, hemoptysis, and oliguria. What diagnosis should be high on the differential? (pp 221, 223) ______________________________________________________________________________

18.

How are tumor markers best used? (p 224) ___________________________________________ ______________________________________________________________________________

19.

An IV drug abuser who is being monitored for cirrhosis shows a sudden increase in his α-fetoprotein level. For which disease is he at increased risk? (p 224) _________________________________ ______________________________________________________________________________



20.

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Match the site of metastatic tumor with the immunohistochemical stain used to locate its origin. (p 225)

21.

_____ A. Chromogranin and s ynaptophysin

1. Astrocytes

_____ B. Cytokeratin

2. Epithelial cells

_____ C. Desmin

3. Mesenchymal tissue

_____ D. GFAP

4. Muscle

_____ E. Neurofilament

5. Neural crest cells

_____ F. PSA

6. Neuroendocrine cells

_____ G. S-100

7. Neurons

_____ H. TRAP

8. Prostatic epithelium

_____ I. Vimentin

9. Tartrate-resistant acid phosphatase

Which cancers are most common in men? In women? What is the overall leading cause of death in the United States? (p 226) ________________________________________________________

______________________________________________________________________________


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An swers CELLULAR INJURY 1.

2.

A.

Hyperplasia: increase in the number of cells.

B.

Metaplasia: one type of cell is replaced by another.

C.

Dysplasia: disordered, non-neoplastic cell growth.

The intrinsic pathway begins with changes in the levels of anti- and proapoptotic 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.

3.

Apoptosis occurs without any inflammation, whereas necrosis causes local inflammation. The six types of necrosis are coagulative (as occurs in the heart), liquefactive (bacterial abscess), caseous (eg, due to systemic fungal infection), fat (saponification of pancreas), fibrinoid (as occurs in blood vessels), and gangrenous (limb gangrene).

4.

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

5.

Sickle cell anemia, polycythemia, heart failure, microcytosis, and hypofibrinogenemia, among others.

6.

Neutrophils, eosinophils, mast cells, basophils, toll-like receptors, arachidonic acid metabolites, complement, and Hageman factor.



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7.

8.

Ligand-Receptor Interaction

Endothelial Cells

Leukocytes

Rolling

E-selectin P-selectin GlyCAM-1

Sialyl-LewisX Sialyl-LewisX L-selectin

Tight binding

ICAM-1 VCAM-1

CD11/18 integrins VLA-4 integrins

Diapedesis

PECAM-1

PECAM-1

Migration

C5a IL-8 LTB4 Kallikrein Platelet-activating factor

Various

Mononuclear cells, including macrophages, lymphocytes, and plasma cells. The key cell of granulomas is epitheloid macrophages.

9.

By scavenging enzymes (catalase, superoxide dismutase, and glutathione peroxidase), by spontaneous decay, by antioxidants (vitamins A, C, and E), and by certain metal carrier proteins (transferrin and ceruloplasmin). Deficiencies in free radical elimination can occur in individuals with genetic mutations that result in abnormal/absent enzymes, or with vitamin deficiencies.

10. Transudate

Exudate

Causes

Increased hydrostatic pressure Decreased oncotic pressure Sodium retention

Lymphatic obstruction Inflammation Malignancy

Cellularity

Hypocellular

Cellular

Protein level

Low

High


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NEOPLASIA 11.

12.

Characteristi c

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

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 patient’s prognosis than is tumor grade.

13.

A-4, B-7, C-1, D-2, E-8, F-3, G-6, H-5.

14.

Oncogenes are associated with a gain of function and require damage to only one allele for expression; examples include c-myc (Burkitt lymphoma) and kras (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.

Epstein-Barr virus (EBV).

16.

Gastric cancer. Smoked foods contain large amounts of nitrosamine.

17.

Small cell lung carcinoma with paraneoplastic SIADH secretion.

18.

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

19.

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

20.

A-6, B-2, C-4, D-1, E-7, F-8, G-5, H-9, I-3

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 women. The overall leading cause of death in the United States is cardiovascular disease.


Step 1 Express 2018-Pathology

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