COMBANK Random 4

Question 1

How would rib 4 present in an exhalation dysfunction?

Answer 1

the anterior aspect of rib 4 moves caudally, the posterior rib angle will be prominent to palpation, and there will be anterior narrowing of the intercostal space below the exhaled rib

Question 2

How would rib 4 present in an inhalation dysfunction?

Answer 2

the depressed edge of the posterior 4th rib angle would be found in an inhalation dysfunction where the anterior border is superior and the posterior border is depressed

Question 3

What kind of rib dysfunction shows lateral narrowing of the intercostal spaces?

Answer 3

exhalation dysfucntion at ribs with bucket-handle motion, 6-10

Question 4

Which leukemia presents most commonly in males during their 8th decade of life with Sx of painless cervical lymphadenopathy, early satiety and ab discomfort d/t enlarged spleen (HSmegaly), mucocutaneous bleeding and petechiae d/t to thrombocytopenia, anemia, and neutropenia?

Answer 4

CLL

Question 5

What will be shown in microscopic exam of CLL?

Answer 5

absolute lymphocytosis, large atypical cells, cleaved cells, prolymphocytes, and SMUDGE CELLS (fragile lymphocytes damaged during slide prep)

Question 6

What surface antigens will B-lymphocytes express in CLL?

Answer 6

CD19, CD21, CD23, and CD5 (normally present in mantle zone of lymphoid follicles)

Question 7

What surface antigens will B-lymphocytes express in follicular lymphoma?

Answer 7

CD10, CD19, and CD20 (no 23 or 5)

Question 8

What will molecular genetics demonstrate in follicular lymphoma?

Answer 8

t(14; 18) chromosomal translocation involving BCL-2

Question 9

Who does follicular lymphoma normally present in?

Answer 9

middle aged women

arises in germinal centers

Question 10

Who does mantle cell lymphoma normally present in?

Answer 10

males in 6th decade

Question 11

What B-cell antigens and translocation will be present in mantle cell lymphoma?

Answer 11

CD19, CD20, CD22, and CD5 with t(11; 14) translocation

Question 12

What is the most commmon presenting Sx in multiple myeloma?

Answer 12

bone pain - lumbar spine most common d/t osteoclast activating factor IL-1 and IL-6 producing lytic lesions in skeleton

Question 13

What will peripheral blood smear show in multple myeloma?

Answer 13

rouleaux formation of RBCs

Question 14

What is the etiology of multiple myeloma?

Answer 14

proliferation of malignant plasma cells d/t overproduction of monoclonal Ig, most commonly IgG - characterized by monoclonal M spike

Question 15

What will histologic exam reveal of multiple myeloma?

Answer 15

plasma cels with eccentric and smooth nuclei with a perinuclear halo or pale zone and a basophilic cytoplasm

Question 16

What is seen on urine protine electrophoresis in multiple myeloma?

Answer 16

Bence Jones proteins - kappa and lambda chains

Question 17

What are complications of multiple myeloma?

Answer 17

renal failure from amyloid deposition, hypercalcemia, Bence jones proteinuria, pneumococcal infection (most common cause of death)

Question 18

What is a characteristic finding in polycythemia vera?

Answer 18

pruritis following a warm shower d/t mast cell degranulation and release of histamine

Question 19

What do the microvascular thrombotic events lead to in PV?

Answer 19

erythromelalgia and acral parasthesias

Question 20

What is the genetic mechanism behind PV?

Answer 20

mutation in tyrosine kinase JAK 2

Question 21

What asthmatic drug prevents mast cell degranulation?

Answer 21

cromolyn or nedocromil, sympathomimetic agents, and CCBs

Question 22

How does theophylline function as an anti-asthmatic?

Answer 22

directly relaxes airway smooth muscle

Question 23

What drug is used as an anti-inflammatory prophylaxis for asthma and what is MOA?

Answer 23

Nedocromil - inhibits release of histamine, leukotrienes, and slow-reacting substance of anaphylaxis

Question 24

What is the cause of galactosemia?

Answer 24

It is an AR carbohydrate metabolism disorder caused by deficiency of galactose-1-phosphate uridyltransferase which converts galactose-1-phosphate and UDP glucose to UDP galactose and glucose-1-phosphate

Question 25

What are the clinical manifestations of galactosemia in infants and what stimulates these effects?

Answer 25

Stimulated when nonates are exclusively fed lactose-containing substances
Sx include liver failure, renal tubular dysfunction, failure to thrive, infantile cataracts , and increased risk for severe neonatal E. coli sepsis

Question 26

How is Dx of galactosemia made?

Answer 26

quantitative erythrocyte galactose-1-phosphate uridyltransferase (GALT) analysis