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1

examples of delayed-type hypersensitivity reactions

(1) contact dermatitis
(2) granulomatous inflammation
(3) tuberculin skin test
(4) candida extract skin reaction

2

delayed-type HSR mediated by..

T-lymphocytes (not Ab or complement).

reaction takes 1-2 days, bc antigen taken up by dendritic cells, present to CD4+ cells on MHC II.

Th1 cells secrete IFN-gamma, recruit & stimulate macrophages --> monocytic infiltrate.

[also occurs when 'walling off' TV

3

increased WBC post-corticosteroids

falsely elevated. due to demargination (release from vascular walls) of cells

4

2 disorders of mast cells

urticaria pigmentosum. systemic mastocytosis

5

what two factors drive angiogenesis

VEGF and FGF
-vascular ENDOTHELIAL growth factor
- fibroblast growth factor

VEGF: angiogenesis in variety of tissues: normal, chronically inflammed, healing, neoplastic. increases endothelial cell motility and proliferation --> new capillaries.

FGF-2: made by many cells. significantly involved in (1) promotion of endothelial cell proliferation, migration, and differentiation. also: impt in (2) embryogenesis (stimulating angioblast production)

[FGF: angiogenesis, embryonic develoment, hematopoiesis, wound repair]

6

somatomedin C

IGF-1

synthesized by growth-hormone influenced hepatocytes. stimulate cell growth and multiplication.

7

barrier to angiogenesis

laminin in basement membranes

8

non-viral-dependent nucleotides analogues

cidofovir (activated by cellular kinase) & tenofovir

9

rx for thymidine kinase-deficient (acyclovir-resistant) varicella?

fosacarnet: (PYROPHOSPHATE analog viral DNA polymerase inhibitor)

cidofovir: broad spectrum NUCLEOTIDE. analogue of cytidine monophosphate (activated by CELLULAR kinase)

10

factitious disorder vs. malingering

both CONSCIOUSLY creates symptoms.

factitious: for 1' gain (sick role/medical attn)

malingering: for 2' gain (avoid work, compensation)

11

munchausen syndrome

chronic factitious disorder

12

conversion disorder

unconscious; somatic.

post-stressor.

sudden neurological symptoms (loss of sensory/motor) with NO physical evidence.

13

somatic disorder vs. factitious & malingering

somatic disorder syndromes (i.e. conversion, hypochondriaisis, somatization) are UNCONSCIOUS

factitious & malingering: CONSCIOUS

14

somatization disorder (vs. conversion disorder)

somatoform disorder, several symptoms

usu begins <30 y/o. impact social/occupation.

4 pain
2 GI
1 sexual
1 neuro

with no physical exam / imaging evidence

(differs from conversion, which has specific NEURO and POST-STRESSOR)

15

hypochondriasis

somatoform disorder

preoccupation/fear of having serious illness despite medical evaluation & assurance.

often, mistinterpretation of normal bodily symptoms (gas = colon cancer). associated w/ Dr. shopping

16

body dysmorphic disorder

think body is pathologically flawed, when in fact, it is not.

17

chromosome 3p deletion

VHL

18

von-Hippel Lindau

autosomal DOMINANT.

cerebellar hemangioblastomas, clear cell renal carcinoma, and pheochromocytoma.

RCC develops in 40% of patients.

tumor supressor

19

cerebellar hemangioblastoma, clear cell renal carcinoma, pheochromocytoma

VHL (tumor supressor chr. 3)

20

location of RB

chr. 13

(osteosarcoma and retinoblastoma)

21

location of NF-1

chr. 17

22

WT-1 location

chr. 11

23

location of chemoreceptor trigger zone (area postrema)

dorsal surface of medulla, caudal end of fourth ventricle.

24

adhesion molecules

integrin, cadherin, selectin, Ig superfamily members

25

laminins bind to

collagen, fibronectin, laminin in ECM

26

fibronectin

large glycoproteins produced by fibroblasts & some epithelial cells. binds to integrin, matrix collagen, glycosaminoglycans. mediations cell adhesion

27

heparan sulfate

proteoglycan component of ECM.

associated w/ reticular fibers and basal laminae. helps w/ endothelial cell attachment to BM.

does not bind to cell surface integrins.

28

hyaluronic acid

glucuronic-acid containing glycosaminoglycan in ECM.

contributes to water retention in ECM -> lubricant properties. viscous, gel-like consistency.

29

elastic fibers

core of elastin protein surrounded by fibrillin

30

keratan sulfate

galactose-containing glycosaminoglycan. role in maintaining type I collagen fibril organization in cornea.