Final Exam: immune deficiency - malignant bone tumor

Question 1

B cell deficiency increases susceptibility to _______; while T lymphocytes increase susceptibility to _________

Answer 1

Bcell = Bacterial infection

TLymph =Viral and fungal infections

Question 2

A specialized protein in the blood usually formed in response to antigen

Answer 2

Antibody

Question 3

An agent which initiates production of specific antibodies against itself

Answer 3

Antigen

Question 4

An agent which alone is not antigenic but exhibits antigenic properties when attached to other protein molecules

Answer 4

Haptens

Question 5

Type 1 hypersensitivity is

Answer 5

• Anaphylactic
• Mediated by IgE bound to mast cells and basophils
• Results in rapid release of histamine

Question 6

What are examples of local type 1 hypersensitivity reactions (3)?

Answer 6

Hay fever, food allergies, skin reactions

Question 7

What are examples of systemic type 1 hypersensitivity reactions (2)?

Answer 7

Widespread vasodilation

Bronchospasm

Question 8

Type 2 hypersensitivity

Answer 8

• antibodies directed toward antigens located on cell surfaces or in ECM

Question 9

Antibody dependent mechanisms of Type II hypersensitivity (3)

Answer 9

1. Complement mediated mechanisms: lysis of target cell, opsonization, phagocytosis e.g. transfusion or drug reactions
2. Antibody dependent cytotoxicity: NK cells target tissue elements with bound antibody
3. Antireceptor antibodies: non-cytotoxic mechanisms, antibodies activate or block cell membrane receptors e.g. Graves’ disease — antibodies mimic TSH; myasthenia gravis — antibodies block ACh receptors

Question 10

Graves’ disease

Answer 10

antibodies mimic TSH

Question 11

Myasthenia gravis

Answer 11

antibodies block ACh receptors

Question 12

Type 3 hypersensitivity

Answer 12

Is an immune complex injury

Question 13

Immune complex

Answer 13

Antigen and antibody that form in blood and tissue fluids

Activate complement and elicit inflammatory responses and tissue damage

Question 14

What is the type 3 hypersensitivity that is:

Formation of circulating immune complexes in sensitized host

Answer 14

Serum sickness

Question 15

**What is the type 3 hypersensitivity that is:

Multiple autoantibodies contribute to injury of various structures

Answer 15

Systemic lupus erythematosus (SLE)

Question 16

**What is the type 3 hypersensitivity that is:

Associated with local immune complex injury

Answer 16

Arthus reaction

Question 17

Type 4 hypersensitivity

Answer 17

Delayed hypersensitivity

Sell mediated, especially T-lymphocytes. Skin rashes in certain virus infections and in contact dermatitis, and granulomatous diseases

Question 18

Example of type 4 hypersensitivity (3)

Answer 18

Tuberculosis
Leprosy
Acute rheumatic fever

Question 19

A system of cell surface proteins know as major histocompatability (MHC) antigens

Answer 19

Human leukocyte antigens (HLA)

Question 20

MHC gene products are grouped into 3 classes:

Answer 20

Class I: presented on nucleated cells and platelets

Class I & II associated with antigen presenting and production of cell surface glycoproteins

Class III: genes are associated with complement

Question 21

HLA-B27

Answer 21

90X greater chance of developing ankylosing spondylitis

Note: HLA-DR3/4 = type 1 diabetes

Question 22

Chronic multisystem inflammatory disease that commonly affects skin, kidneys, serosal membranes, joints, heart, CNS

Answer 22

Systemic lupus erythematosus (SLE)

Question 23

***Classic triad of SLE

Answer 23

Butterfly rash
Joint pain
Fever

Question 24

***Endocarditis is characterized by

Answer 24

patchy vegetation’s on exposed surfaces of valves

Question 25

***What are (6) environmental risk factors for SLE?

Answer 25

``` UV light Drugs Psoralens (figs, parsnips) Estrogen (e.g. pregnancy) Viruses Stress ```

Question 26

***How do you diagnose lupus?

Answer 26

ANA: Antinuclear antibodies to double stranded DNA and smith antigens Note: Serum ANA levels correlate with severity of disease. Note #2: ANA is sometimes present in non-SLE population too.

Question 27

SLE heart problems include

Answer 27

Pericarditis Myocarditis ***Endocarditis: patchy vegetation’s on exposed surfaces of valves

Question 28

Overproduction of collagen throughout the body

Answer 28

Scleroderma

Question 29

**Describe diffuse and localized patterns of scleroderma

Answer 29

Diffuse: early widespread skin involvement with rapid progression and visceral effects (ANA) Localized: only skin of face and fingers. CREST syndrome (calcinosis, raynaud’s phenom, esophageal dysfunction, sclerodactyly, telangiectasias)

Question 30

What is CREST syndrome?

Answer 30

Combined effects known of localized scleroderma: - Calcinosis — calcific deposits - Raynaud’s phenomenon — CT disorders fingers and toes turn cyanotic and whitish - Esophageal dysfunction — scarring around esophagus - Sclerodactyly - shortening digits - Telangiectasias - micro exposed BV on face (ecchymosis)

Question 31

What is the differentiating factor between polymyositis and myasthenia gravis?

Answer 31

Polymyositis spaces the extra-ocular muscles

Question 32

What 6 organs are affected in scleroderma?

Answer 32

``` Skin GI tract Musculoskeletal Kidneys Lungs Heart ```

Question 32

Polymyositis is

Answer 32

Inflammatory damages to skeletal m — groups of muscles degenerate

Question 32

What are the 3 factors of dermatomyositis (which is polymyositis + skin issues)

Answer 32

Butterfly rash Helicotrope eyelids Purple bumps on knuckles

Question 32

4 questions in 1: What is the 1˚ cause of osteoporosis (2)? What is the 2˚ cause of osteoporosis (4)? Do they present differently? Do you see serum changes?

Answer 32

1˚ Being an old female (menopausal) 2˚ diet/lifestyle, preggo, vitamin D deficiency, endocrine disorders No, 1˚ and 2˚ present the same way. No serum changes: composition the same, quantity decreased.

Question 33

What does osteoporotic bone look like (3)?

Answer 33

Catfish vertebra Schmorl’s nodes Vertebral collapse (dowager hump)

Question 34

What is Osteomalacia associated with and why?

Answer 34

Poor calcification of bone matrix; vitamin D deficiency usually

Question 35

What serum changes will you notice with osteomalacia?

Answer 35

Low calcium, low phosphate, HIGH alkaline posphatase

Question 36

Looser’s zones associated with

Answer 36

Osteomalacia “soft bones” Looser’s zones are pseudofractures

Question 37

Osteomalacia for young people is called?

Answer 37

Rickets (juvenile osteomalacia)

Question 38

Rickets (juvenile osteomalacia) is associated with skeletal deformities (4)

Answer 38

- Rachitic rosary - “Pigeon breast” - Harrison’s groove - Craniotabes

Question 39

Ostoemyelitis is associated with what bone deformity?

Answer 39

Brodie’s abscess: common in tibia

Question 40

Infection of marrow and bone

Answer 40

Osteomyelitis

Question 41

Pyogenic osteomyelitis vs tuberculous osteomyelitis

Answer 41

Pyogenic — infection of hematogenous origin Tuberculous — Pulmonary Tb can lead to lesions of bone and if its in the spine its Pott’s Disease

Question 42

Von recklinghausen’s disease of bone is associated with what disease

Answer 42

Hyperparathyroidism. Less common now because people are being treated

Question 43

Characteristics of Von recklinghausen’s disease of bone (2)?

Answer 43

- moth eaten x-ray - brown tumors *not all inclusive

Question 44

Paget’s disease (osteitis deformans) is what kind of bone disease and how does it present?

Answer 44

Hyperosteolytic bone disease; thick + porous

Question 45

Histologically Paget’s disease

Answer 45

Tile-like mosaic

Question 46

Bone scan for Paget’s disease shows

Answer 46

Increased activity (hyperosteolytic)

Question 47

Monostotic lesions versus polyostotic lesions in Paget’s disease

Answer 47

Mono: tibia - 15% of cases Poly: multiple sites - 85% of cases

Question 48

Stages of Paget’s disease progression (3)

Answer 48

- Hot (osteoclastic phase) - Mixed (osteolytic, osteoblastic) - Cold (burned out stage)

Question 49

2˚ metastatic cancer is ___% more common that 1˚ bone tumors.

Answer 49

70%

Question 50

___% of metastatic bone disease is osteolytic (not osteoblastic)

Answer 50

70%

Question 51

4 most common malignant bone tumors

Answer 51

1. Osteosarcoma 40% 2. Chondrosarcoma — slooooooow and LARGE, 40-60 yo 3. Ewing’s sarcoma — 10-15yo. Need to rule out infection as differential diagnosis 4. Giant Cell Tumor — soap bubbly appearance

Question 52

Codman’s triangle is associated with what malignant bone tumor

Answer 52

Osteosarcoma

Question 53

What malignant bone tumor occurs in 40-60 you and is sloooooow and LARGE

Answer 53

Chondrosarcoma

Question 54

What malignant bone tumor occurs in 10-15yo and has a differential diagnosis of infection?

Answer 54

Ewing’s sarcoma

Question 55

What malignant bone tumor has soap bubbly appearance

Answer 55

Giant Cell Tumor