Exam2 Flashcards
(120 cards)
1
Q
endgenous pyrogens
A
pyrogens promote fever, IL-1, IL-6 and NTF
2
Q
Th1
A
IL-2, IFN-Gamma which leads to classical macrophage pathway
3
Q
Th2
A
IL-4, -5, -13, which activates alternative pathway macrophages; also activates eosinophils
4
Q
Endothelial cell contraction. This occurs
A
quickly (minutes) as a response to histamine (as
well as others), but is fleeting. Longer-term contraction is prompted by cytokines (IL-1, TNF); this type of contraction also takes longer to develop (hours)
5
Q
IL-6
A
in response hepatocytes produce C-reactive protein (CRP) and serum amyloid A (SAA) protein are known to adhere to cell walls and may act as opsonins. Fibrinogen, binds red blood cells causing them to form stacks that quickly form sediments This forms the basis for the erythrocyte sedimentation rate (ESR), a long-used test for the presence of inflammation
6
Q
C3a C5a
A
Chemotaxic for neutrophils, active mast cells to release histamine
7
Q
Histamine released by
A
Physical features - Mechanical, temperature; Immune – Binding of IgE, Compliment (C3a, C5a), Histamine releasing proteins (from leukocytes), Neuropeptides, Cytokines (IL-1, IL-8)
8
Q
glucocorticoids block what step in the arachidonic acid pathway
A
phospholipase A2, aka the beginning
9
Q
PAF effects
A
think of a vein and what will happen if you try and FULLY clot - dont want that so: vasodilation, increased platelet stickiness, vasculature permeability inc, bronchospasms
10
Q
TNF&IL-1 produced in
A
Produced in a range of cells, but esp macrophages, mast cells, endothelial cells; production stimulated by microbial products, immune complexes and T cell mediators
11
Q
TNF&IL-1 cause
A
Cause endothelial activation (leukocyte binding and recruitment), also induce systemic effects of inflammation: Fever, acute phase protein synthesis, etc.
12
Q
Important chronic inflammatory cytokines
A
IFN-γ: Stimulates classical macrophage activation; AND IL-12: Stimulate the growth and function of T cells
13
Q
NOS effects
A
mediator of vasodilation, antagonizes platelet activation, & reduces leukocyte recruitment
14
Q
Type II iNOS release factors
A
Induced by IL-1, TNF, IFN-γ and bacterial endotoxins
15
Q
Alpha-1-antitrypsin
A
neutrophil elastase inhibitor
16
Q
Alpha-2-Macroglobulin
A
inhibits a large variety of proteinases (e.g. collagenase)
17
Q
Neuropeptides
A
initiate inflammation, active in vascular tone and permeability - particularly in lung and GI, example is Substance P
18
Q
3 pathways to C3 convertase activation
A
• 1 Classical: fixation of C1 to antigen-antibody complexes
• 2 Alternative: microbe cell wall components combine with plasma proteins (factors B, D) • 3 Lectin: plasma lectin binds microbial mannose and stimulates classical pathway

19
Q
C5a, C4a, C3a
A
Activate leukocytes increasing their endothelial adhesion. Also chemotatic agents for neuts, eos, basophils and monocytes. C3a and C5a also inc vascular permeability and stimulate histamine release
20
Q
Inhibition of compliment
A
most of the time don’t want activated, C1 inhibitor blocks activation of C1 and Decay-accelerating factor (DAF) and factor H limit C3/C5 convertase formation
21
Q
Factor XII (Hageman factor)
A
Important for clotting, • Factor Xa leads to vascular permeability
• Thrombin binds to protease activated receptors on endothelial cells, activating them
• Thrombin cleaves fibrinogen creating fibrinopeptides which increase vascular
permeability and are chemotatic
• Thrombin cleaves compliment factor 5 forming factor 5a
22
Q
Whenever clotting is activated, so is the _________ system
A
fibrinolytic - multiple of these factors are ative inflammatory mediators resulting in vascular permeability, dilation and C3a formation
23
Q
Anti inflammatory mediators (endogenous)
A
Many of the mediators are destroyed by circulating enzymes and have short active periods
• Lipoxins: antagonize leukotrienes
• Compliment regulatory proteins- C1 inhibitor
• IL-10 (secreted by macrophages) down regulates activated macrophages
• TGF-beta (promotes fibrosis) is anti-inflammatory
• Intracellular compounds also antagonize pro-inflammatory cell state
24
Q
- Growth Factor Secretion
- Neovascularization
- Collagen deposition
- Collagen remodeling / retraction 5. Re-epithelialization / Regeneration
A
- Macrophage
- Endothelial cell
- Fibroblast / Myofibroblast Fibroblast
- Epithelial cells / Hepatocytes
25
Granulation tissue comprised of:
pink, soft granular appearance grossly (e.g. seen beneath scab of skin wound). Comprised of fibroblasts, new capillaries (angiogenesis), loose extracellular matrix, and inflammatory cells (predominantly macrophages)
26
local and systemic affects that adversely influence tissue repair:
Local:
-Infection, persistence of insult, trauma (early movement prior to completion of repair), trauma (foreign material)
Systemic:
- Nutritional (impaired collagen synthesis): protein deficiency, vitamin C deficiency
- Metabolic (delayed repair): diabetes, glucocorticoids (inhibit collagen synthesis)
27
prostacyclin is made through the ___ pathway in _____ cells
Cox1, epithelial
28
What activates bradykinin?
Factor XII
29
Which of the following actions of prostaglandins is INCORRECTLY matched with the form of the cyclooxygenase enzyme (COX-1 or COX-2) that synthesizes the particular prostaglandin?
A. Fever : COX-2
B. Inflammation : COX-1
C. Protection of GI cells : COX-1
D. Vasodilation in the kidney : COX-2
E.Activation of platelet aggregation : COX-1
F. Contraction of uterine smooth muscle : COX-2
G. Opening of ductus arteriosus : COX-1
D and G
30
Where is erythropoetin made?
Kidneys
31
With blood transfusions for anemia what concern must be kept in mind?
Iron overload because we don't really shed iron
32
How do we tell iron deficiency using TIBC and FE serum?
TIBC/FE serum = ??? If 55 then iron overload
33
Warm vs Cold autoimmune hemolytic anemia
Warm: IgG - treatment could be steroids, IVIG, splenectomy
Cold: IgM, complement - no real treatment options
34
High MMA (Methylmalonic Acid) implicates what type of anemia?
B12 deficiency
35
If you see both red and white pulp in a histological section, this means you are in what organ?
spleen
36
Aspirin
[irreversible inhibition of COX-1 and COX-2]: Analgesic, antipyretic, anti-inflammatory, antithrombotic activities

37
GI side effects with tNSAIDs
Interfere with gastric cytoprotection by inhibition of COX-1 PGE synthesis dyspepsia and gastric ulceration. Lowest risk with ibuprofen – highest with naproxen; PPIs (omeprazole) will protect against gastroduodenal toxicity
38
cardiovascular side effects with tNSAIDs
Lowest cardiovascular risk with naproxen – highest with ibuprofen and celecoxib
39
COX-2 Selective Inhibitor
Celecoxib, also has long half life so drug-drug metabolic interactions are possible.
40
Other effects of aspirin - drug drug interactions
Drug Interactions
Warfarin, heparin. Inhibit platelet function hemorrhage. [Avoid concomitant use]
Alcohol. Additive gastric irritation internal bleeding. [Avoid concomitant use]
41
Prostacyclin is actually
PGI2 - prostaglandin I2
42
COX2 products which two PG's primarily
E2 and I2
43
Mineralocorticoids
Principally involved in Na+ retention. Aldosterone is prototype hormone.
44
Chronic use of pharmacologic doses of glucocorticoids can ________
suppress the HPA axis and result in adrenal atrophy and insufficient adrenal response to environmental stressors adrenal crisis.
45
Mineralocorticoid pathway in zona glomerulosa has 18-OH-steroid dehydrogenase enzyme that ___________
converts corticosterone to aldosterone. Renin-angiotensin system (via angiotensin II) stimulates conversion of cholesterol to pregnenolone and corticosterone to aldosterone (independent of ACTH).
46
Binding of cortisol to cytosolic receptor releases ______________________________ regulates transcription by RNA polymerase II, activating or inhibiting transcription of target genes
stabilizing proteins (Hsp90), allowing S-R complex to dimerize and enter the nucleus and bind the glucocorticoid response element on DNA
47
How much cortisol is usually bound to plasma proteins
Bound (75%) to plasma proteins (cortisol-binding globulin [CBGs]), only free cortisol is active
48
Net physiologic result of glucocorticoid
Maintenance of glucose supply to brain (insulin antagonism)
49
Mineralocorticoids mechanism of action
Aldosterone binds to cytosolic receptor that migrates to nucleus where it induces formation of mRNA to direct synthesis of specific proteins (Na+-K+-ATPase, Na+ and K+ channels) - Insertion of protein in membrane induces increased reabsorption of Na+ from renal distal tubules that is loosely coupled to increased secretion of H+ and K+.
50
Glucocorticoids act by suppressing ___________
T-cell activation, suppressing cytokine production, and preventing mast cells and eosinophils from releasing various chemical mediators of inflammation [histamine, prostaglandins, leukotrienes and other substances] that cause tissue damage, vasodilation and edema.
51
T/F - Mineralocorticoid activity refers to salt (Na+)-retaining actions at the kidney. Glucocorticoid activity refers to metabolic effects (hyperglycemia, protein wasting, and lipid redistribution).
T
52
T/F - The natural glucocorticoid molecule, cortisol (aka hydrocortisone), possesses equal amounts of glucocorticoid and mineralocorticoid activity. The natural mineralocorticoid molecule, aldosterone, possesses essentially all mineralocorticoid activity.
T
53
T/F - 11-keto glucocorticoids are prodrugs that must be activated by 11β hydroxysteroid dehydrogenase I (11β-HSD1)
T
54
Dexamethasone
Most potent anti-inflammatory agent, used in cerebral edema, chemotherapy-induced vomiting; no mineralocorticoid action, greatest suppression of ACTH secretion at pituitary.
55
Prednisone
Most commonly used oral agent when steroid burst therapy desired; glucocorticoid and mineralocorticoid actions [13:1]; activated to prednisolone in liver. NO topical activity, not activated until first pass hepatic metabolism.
56
Alternate day schedule
can minimize adverse effects (lessens growth-suppressive effects because anti-inflammatory actions apparently outlast suppressive effect on HPA axis); make gradual transition to alternate day schedule after control of disease achieved.
57
Acute, short course, high dose (these effects are possible anytime systemic steroids are used)
Mineralocorticoid effects: Na+ and H2O retention edema increased BP, hypokalemia; Glucocorticoid effects: Glucose intolerance, mood changes (up or down), insomnia, GI upset
58
Methylprednisolone
Used if parenteral administration desired for steroid burst (no better than oral prednisone in acute exacerbations of asthma); minimal mineralocorticoid action. Oral (Medrol) and parenteral (Solu-Medrol)
59
Virchow triad
describes the three broad categories of factors that are thought to contribute to thrombosis. Hypercoagulability. Hemodynamic changes (stasis, turbulence) Endothelial injury/dysfunction. Emboli in the venous/right sided system most commonly lodge in the lungs. Emboli in the arterial/left sided system can affect any organ, but most commonly travel to the legs or brain.
Type of Embolus
Source/Cause
60
Disseminated intravascular coagulation (DIC)
a unique condition where thrombosis and hemorrhage can occur simultaneously. Generalized activation of clotting leads to widespread thrombosis with subsequent consumption of platelets and clotting factors. This creates a deficiency of platelets and clotting factors that then results in bleeding. This systemic activation of thrombin can be caused by any underlying condition that results in release of procoagulants, such as tissue factor, into the circulation or by widespread endothelial cell injury. DIC often presents clinically with anemia, respiratory insufficiency, convulsions, acute renal failure and shock. Bleeding typically dominates in acute onset of DIC, and thrombosis typically dominates with chronic DIC.
61
List the following glucocorticoids in order of increasing anti inflammatory strength
```
Hydrocortisone
Prednisone
Methylprednisolone
Fluprednisolone
Dexamethasone
Triamcinolone
```
Harry Potter Married That Fucking Dude?
1-5-5-5-10-30 in terms of multiples of anti inflammatory effect in units of Hydrocortisone
62
Which of the following oral steroids would be most dangerous to give to a patient that already suffers from high blood pressure?
Hydrocortisone
Prednisone
Methylprednisone
Fludrocortisone
Fludrocortisone - it "floods" cells by increasing Na+ intracellular concentrations
63
Which of the following steroids has no activity if administered topically?
Prednisone
Triamcinolone
Dexamethasone
Betamethasone
Prednisone - needs to be metabolized by liver to be efficacious
64
Which of the following is the correct rationale for why you can give prednisone safely to a pregnant mother without producing corticosteroid effects in the fetus?
The fetus does not have active 11B-HSD1 enzymes
The fetus does not have active 11B-HSD2 enzymes
The fetus has active 11B-HSD1
Prednisone cannot cross the placenta
The fetus does not have active 11B-HSD1 enzymes
You can give predisone to mom because the fetus can't convert it to active prednisolone. 11B-HSD1 enzyme is the enzyme that activates the drug in the adult's liver. The fetal liver is non-functional at this point so it does NOT have an active 11B-HSD1 enzyme. It does have an active 11B-HSD2 though (because this enzyme is in the kidney, which is functional in a fetus), but this INACTIVATES prednisone. Inactivating 11-HSD2 enzyme IS ACTIVE IN FETUS Activating 11-HSD1 enzyme is NOT active in fetus.
65
A child comes in with a rash requiring treatment with glucocorticoids. The attending asks what topical treatment you would recommend with a low potency. What do you recommend?
Triamcinolone
Prednisone
Cortisol
Dexamethasone
Cortisol
Cortisol is short acting. It is the least potent of the glucocorticoids (everything else is compared to its baseline potency) and has a shorter half-life. Cortisol is already ACTIVE. Its glucocorticoid activity equals its mineralcorticoid activity. Since it does not need to be activated by the liver, it can be used topically. Tramcinolone is also a topical agent with potent systemic activity. Prednisone cannot be used topically.
66
The ultimate carcinogen product of cyclic aromatic hydrocarbons is:
2-naphthylamine
Aniline
Epoxide
A strong electrophile
Epoxide
67
Which of the following is one of the definitive pathologic findings for alcoholic hepatitis in the liver?
Alcoholic hyaline
68
Thrombosis is NOT promoted by which factors?
Inflammation
Factor V Leiden
Ventricular Tachycardia
Atherosclerotic vessel narrowing
Techycardia - Virchow’s triad is 3 basic factors that promote thrombosis
endothelial injury—hypercholesterolemia, inflammation
Abnormal blood flow—stasis (atrial fibrillation, bed rest), turbulence (atherosclerotic vessel narrowing)
Hyper-coagulability—inherited (factor V Leiden), Acquired (disseminated cancer)
69
Which of the following stimulates both B and T cells to divide?
```
Anti-CD3
Interferon-gamma
Pokeweed mitogen
Concanavalin A (Con A)
Phytohemagglutinin (PHA)
```
Pokeweed mitogen
70
IFN gammas effect on macrophages
makes them "angry" macrophages
71
Plasma homocysteine is elevated in:
BOTH folate and B12 deficiency
72
You are seeing a patient in your clinic who is generally healthy but on a CBC has an ANC of 650. The rest of his CBC is normal. Which of the following is MOST LIKELY to be the cause for this patient’s neutropenia?
```
Chediak-Higashi syndrome
Acute leukemia
Cyclic neutropenia
Kostmann's syndrome
Suppression of marrow production by a viral infection
```
Suppression of marrow production by a viral infection
73
A 6 year old male with 1 week of history of vomiting and diarrhea was transferred to your medical center from a rural community hospital. Several other family members have been hospitalized. All were eating fresh ice cream made with raw eggs from their farm. The patient arrived from the outlying hospital with a high fever and in shock. He has no lymphadenopathy or hepatosplenomegaly. His CBC showed Hgb 13.1, Hct 40, WBC 22,000 with 9 seg, 36 bands, 15 metamyelocytes, 10 myelocytes, 5 promyelocytes, 1 blast, 20 lymphocytes, 4 monocytes. Platelet count 430,000. The house staff wants you to consult because of the immature cells on smear. The MOST LIKELY diagnosis is:
Acute myelogenous leukemia
Acute promyelocytic leukemia
Leukocytosis with a mild left shift
A leukemoid reaction with a severe left shift associated with a bacterial infection
A leukemoid reaction with a severe left shift associated with a bacterial infection
74
You follow a 3 year old who has had intermittent neutropenia over the past 4 months. Three counts show an ANC 300-600. One count was an ANC of 1,600. You are considering the diagnosis of cyclic neutropenia and are preparing to order twice-weekly CBCs for 8 weeks. Which of the following time cycles will help establish the diagnosis?
```
7 ± 3 days
10 ± 2 days
14 ± 4 days
21 ± 4 days
29 ± 3 days
```
21 ± 4 days
75
In beta-thalassemia minor, most hemoglobin is in which of the following forms?
HbE
76
Alpha thalasemia is worse than Beta, it can result in hydrods fetalis due to production of what type of hemoglobin?
Hb Barts - 4 gamma chains
77
Parvo B19 infects what?
erythroid precursors, exaserpates conditions like heriditary spherocytosis
78
When will you see MCMH increase in anemia cases?
Heriditary spherocytosis and autoimmune anemia
79
TYPE 1, 2, 3 & 4 Hypersensitivity
A-B-C-D
1) A - Allergic, IgE
2) B - antiBody, IgG and E
3) C - Complex, immune complex rxn
4) D - Delayed
80
Hepcidin inhibits iron transport by ___________
binding to the iron export channel ferroportin which is located on the basolateral surface of gut enterocytes and the plasma membrane of reticuloendothelial cells (macrophages)
81
A patient presents with cancer that has been reported by pathological reports to affect cells that arise from the bone marrow and enter the blood stream. After careful analysis you determine that undifferentiated B-cells cells are the clonal origin. Which of the following is the correct classification of your patient's diagnosis?
Acute Myelogenous Leukemia
Chronic Myelogenous Leukemia
Acute lymphocytic leukemia
Chronic lymphocytic leukemia
Acute lymphocytic leukemia
82
The following represent different newborn screenings with various hemoglobinopathies. Which of the following indicate that prophylactic penicillin should be started immediately?
F+A+C
F+S
F+A+Barts
F+E
F+S
This is sickle cell disease. With sickle cell disease, the spleen will deteriorate within the first few years of life and will not be able to defend against encapsulated pathogens. Start penicilin immediately and do Hematology Consult.
83
Which of the following is a correct distinction between B12 and folate deficiency?
B12 deficiency causes macrocytic anemia, while folate deficiency causes microcytic anemia
B12 deficiency takes several months to develop, while folate deficiency happens rapidly
B12 deficiency can be caused by inadequate dietary intake, while folate deficiency is only a malabsorption disease
B12 deficiency leads to decreased DNA synthesis, while folate deficiency leads to decreased RNA translation
B12 deficiency takes several months to develop, while folate deficiency happens rapidly
84
A person with ineffective or absent helper T cells would lack which of the following
IgM response to infection
IgG response to infection
IgD markers on B cells
dendritic cells
IgG response to infection
85
Which of the following correctly describes the effect carbon monoxide poisoning has on the oxygen dissociation curve and its affinity of oxygen?
it shifts to the left, decreasing O2 affinity
it shifts to the left, increasing O2 affinity
it shifts to the right, decreasing O2 affinity
it shifts to the left, increasing O2 affinity
it shifts to the left, increasing O2 affinity
86
Causes of macrocytic anemia:
B12 and folic acid insuffiency as well as alcohol abuse
87
You place human IgM in a test tube with an unknown pathogen and after 24 hours, a precipitate forms. Assuming that each antibody has become fully saturated, how many protein particles are bound to each antibody?
2
4
5
10
10 p Each Fab2 is divalent and can bind 2 antigens. IgM is a pentamer with 5 Fab2's, and can bind up to 10 antigens at the same time. /pp IgG is divalent and can bind 2 antigens IgA dimers (connected by J chain) are tetravalent and can bind 4 antigens./p
88
G6PD deficiency is an X linked mutation that affects red blood cells' ability to do which of the following?
reduce reactive oxygen
generate anaerobic energy
undergo anucleation
synthesize new proteins
reduce reactive oxygen
89
In beta-thalassemia minor, most hemoglobin is in which of the following forms?
HbA1
HbA2
HbE
HbF
HbA1
Beta-thal minor is silent carrier (B/B0). There is one normal gene and one abnormal gene. The rest of the thalassemias do not have any normal genes.br / Low-normal MCVbr / none-mild anemiabr / 89-94% HbA1, 2-6% HbA2, 2-5% HbF
90
A 48 week old baby has 94% HbF, 6% HbA2 and no HbA1. Which of the following hemoglobinopathies is most likely?
HbS trait
HbSS
B-thalassemia trait
Cooley's anemia
Cooley's anemia
This distribution of hemoglobins shows that no Beta chains are being made. This would be Beta-thalassemia major, otherwise known as Cooley's anemia/pp Cooley's Anemia= 94% F, 6% A2, no A1 (will always be transfusion dependent)/pp A is Sickle Cell trait and B is Sickle Cell Anemia. Both of these will have Beta-globin chains. /pp B-thalassemia trait = 5-20% F, 5% A2, 75-90% A1 (will not be transfusion dependent)/p
91
G6PD deficiency usually results in:
extravascular hemolysis
intravascular hemolysis
RBC deformability
reduction of spectrin
extravascular hemolysis
increased extravascular hemolysis p Can't reduce glutathione = heinz bodies because denatured globin attaches to membrane = spectrin oxidized /pp Decreased deformability of RBC's /pp Intermittent episodes of anemia, hyperbilirubinemia, etc associated with oxidative stress. /pp Blister cells, bite cells/p
92
A neutrophilic precursor cell has a diameter of 15um, lots of secondary granules, a purple cytoplasm and an indented nucleus that is less than half the diameter of the nucleus. This cell is a:
Myeloblast
promyelocyte
myelocyte
metamyelocyte
metamyelocyte
indented nucleus that is less than half its diameter = metamyelocyte. p Pink/purple cytoplasm, 14-16 diameterbr / Lots of secondary, obscure primary granulesbr / Normal range = 7.1-24.7%/p
93
Hydroxyurea has been shown to be an effective treatment of sickle cell anemia by which of the following mechanisms?
repairing vessel damage
preventing splenic sequestration
removing adherin molecules from damaged RBC's
inducing the production of fetal Hb
inducing the production of fetal Hb
Hydroxyurea induces the production of HbF which will have increased affinity for oxygen. HbF will then be in its oxygenated state more often, decreasing its liklihood of sickling. This drug may also help by decreasing WBC count.
94
A patient presents with elevated unconjugated bilirubin, decreased serum haptoglobin, and hemoglobin in his urine. Which of the following do you suspect?
extravascular hemolysis
intravascular hemolysis
high affinity autoimmune hemolysis
hereditary spherocytosis
intravascular hemolysis
intravascular hemolysis p Increased unconjugated bilirubinbr / Decreased serum haptoglobin (because it is binding to alpha-Beta dimers)br/ Hb in urine or plasmabr / Increased Metheme or Metalbuminbr / Increased LDH, AST, SGOT/p p Cold autoimmune hemolytic anemia (low affinity) (dark urine means autoimmune hemolysis either cold or warm)/p
95
A patient presents to your clinic with severe anemia due to an overdose of aspirin that has caused gastic bleeding. You recall that aspirin is an irreversible inhibitor of cyclooxygenase platelet inhibitor that will have a duration of action that is equal to platelet lifespan. If no action is taken, how long will the aspirin continue to affect platelet function in this patient?
120 days
10 days
2 days
12 hours
10 days
platelet lifespan is 7-10 days br / RBC = 120 daysbr / Platelets = 7-10 daysbr / Neutrophils = 7 hour 1/2 life
96
Which of the following physiologic responses is consistent with a DECREASE in hepcidin production?
decreased iron absorption
increased cellular levels of ferroportin
decreased iron export out of cells
increased iron saturation of ferritin
increased cellular levels of ferroportin
When Hepcidin is high, it binds to ferroportin and degrades it, so ferroportin will not be degraded in levels of low hepcidin. p When hepcidin is low, iron absorption in the duodenum is increased, there is increased export of iron out of the cell, and ferritin saturation will be decreased (as the body needs it and it shouldn't be stored)./p
97
You obtain a CBC from a 12-year-old boy that came to your office looking pale and feeling lethargic. CBC reveals that he is anemic. Which other physical sign is this patient demonstrating that could have helped you with this diagnosis?
pitting edema
tachypnea
clubbing
bradycardia
tachypnea
The most common physical signs of anemia are tachycardia (so D is opposite and therefore incorrect), tachypnea, dyspnea and pallor.
98
A B cell bearing an mu+kappa+ receptor binds an antigen and the resulting plasma cell secretes an antibody with novel biological properties. This resulting antibody is most likely:
alpha+kappa+
alpha+lambda+
mu+lambda+
mu+gamma+
alpha+kappa+
The B cell has class switched prior to becoming a plasma cell. Class switching only affects the isotype of the heavy chain (in this case alpha vs. mu). Class switching does not switch the light chain (kappa or lambda)
99
The appearance of which surface immunoglobulin signifies the transition from immature to mature B cell
IgA
IgM
IgD
IgE
IgD
100
Name the two drugs: 11-keto glucocorticoids are prodrugs that must be activated by 11β hydroxysteroid dehydrogenase I (11β-HSD1)
prednisone and cortisone
101
Which of the following is a characteristic of a mass in the right/ascending colon?
Appears apple-core like
Portrudes into the lumen
Very symptomatic from the beginning
Symptoms usually include constipation
Symptoms usually include constipation
Masses on right often can grow to a large size, protruding into the lumen. On the right side of the colon, masses can grow to a large size before producing symptoms because the fecal stream is still fairly liquid. Stool has not yet formed so constipation is not as much as an issue as it is on the left colon, where stool has already formed (and passage is hindered). Masses on the left/descending colon appear apple-core like.
102
transudates have lower concentrations of all physiologically measured solutes compared to exudates except
glucose serum concentration
103
sarcoma
a malignant tumor of connective or other nonepithelial tissue.
104
Invasion
the infiltration of adjacent tissues by malignant cells.
1. Changes “loosening up” of tumor cell-cell interactions: loss of E-cadherin, for example
2. Degradation of ECM
3. Attachment to ECM components
4. Migration of tumor cells (locomotion)
105
Metastatic Cascade
1) invasion
2) intravasation
3) extravasation (CD44)
4) colonization
106
“Paraneoplastic Syndrome” (paracrine/endocrine effects): occur in _________________
7% to 15% of patients with cancer.
107
ULTIMATE CAUSES OF DEATH FROM CANCER (NON-LEUKEMIC)
```
Infection 41.6%
Organ Failure 19.2%
Hemorrhage 8.8%
Thromboembolism 12.2%
Emaciation 7.7%
```
108
Four major variants of lung cancer with risk/prevalence
1) Squamous cell carcinoma (25-40% of cases) - linked to smoking
2) Adenocarcinoma (25-40% of cases). Most common type in women and non- smokers, although many patients are smokers. A subclass of adenocarcinoma is the bronchioloalveolar carcinoma, which is not closely linked to smoking, and among all major forms of lung cancer, has the best prognosis
3) Small cell (formerly called oat cell) carcinoma, 20-25% of cases. Strongly linked to cigarette smoking. Terrible prognosis.
4) Large cell carcinoma (10-15% of cases). An undifferentiated, high grade lung cancer in which the anaplastic appearing cancer cells may not produce either keratin or mucin.
109
Pancreatic cancer
5% survival rate at 5 years
110
Gleason grading is for ____
prostate cancer, which is generally very well tolerated. growth begins on periphery allowing it to be digitally palpatated, score is from 1 (low risk) to 10 (high risk)
111
Retuximab targets CD20, which means it is used agains _______
B cell cancers
112
Difference between old cancer treatments and newer "targeted" ones
"targeted" ones target cell processes fucked up in ONLY cancer cells
113
Nutmeg liver associated with what side of heart failure?
Right side - blood backed up in "end organs" if unable to drain in to heart so would see enlarged spleen as well
114
Kupffer cells
specialized macrophages located in the liver lining the walls of the sinusoids that form part of the reticuloendothelial system (RES) (or mononuclear phagocyte system).
115
What are the classic risk factors for development of gallstones? What are some other risk factors?
- Female gender (12% of women vs 8% of men have gallstones)
- F at: Overweight/obese people (7x risk)
- F orty: 10% of men & 20% of women have gallstones by age 60)
- F ertile - premenopausal: estrogen effect
116
Keratin pearls in cancer indicates
Non small cell cancer, squamous cell carcinoma
117
Suffix of "sarcoma" indicates
cancer is malignant
118
There is enough sequence homology between classes I and II, and immunoglobulins and T cell receptors, to indicate that they all arose from a common ancestral gene, the famous ________ domain.
immunoglobulin
119
In order of importance, what are mechanisms behind graft rejection
1) Th1s (via their lymphokines and the monocyte/macrophage inflammatory response)
2) CTL (CD8+ cytotoxic T cells or killer T cells, NOT natural killer T cells)
120
HLA-DR comprises what larger protein and what is its effect?
MHC Class II, what the T helper cells recognize
