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0

How quickly does an acute transplant rejection take to happen?

Weeks

1

What is the MOA of an acute transplant rejection?

Donor T cells are activated due to MHC incompatibilty?

2

What are the symptoms of GVHD?

Gradual loss of organ function: maculopapular rash, jaundice, LFTs, HSM, diarrhea,desquamation

3

What is the pathogenesis of chronic transplant rejection?

T cell and Ab mediated vascular damage --> fibrosis

4

Systolic flow murmur that does not change with preload
Wide pulse pressure
Brisk carotid upstroke

High output heart failure

5

What is the defect in RTA 1?

Defect in the collecting tubule's ability to secrete H+

6

What are the associated features of RTA 1?

Urine Ph greater than 5.5
Hypokalemia
Increased risk for calcium phosphate kidney stones due to increased urine PH and bone resorption

7

What is the defect in RTA 2?

Defect is in the proximal tubule's ability to reabsorb bicarb

8

What are the associated features of RTA II?

Hypokalemia
Urine ph below 5.5

9

What are people with RTA 2 at risk for?

Hypophosphatemic rickets

10

What is the defect in RTA 4?

Hypoaldosteronism or lack of collecting tubule response to hypoaldosteronism --> get hyperkalemia which impairs ammoniagenesis in the proximal tubule so you have decreased buffering capacity and decreased urine ph. (Less than 5.3)

11

What is the complication with RTA I?

Nephrolithiasis with calcium phosphate kidney stones.

Phosphate is no longer being used to buffer because no acid being secreted, so binds calcium instead

12

What is the complication with RTA II?

Rickets and osteomalacia due to hypophosphatemia

13

What is the complication with RTA 4?

Hyperkalemia

14

What drugs can cause RTA 1?

Lithium
Amphotericin

15

What drugs can cause RTA 2?

Carbonic anhydrase inhibitors

16

What drugs can cause RTA 4?

Amiloride
Spironolactone
Heparin

17

What does pre renal AKI look like?

Urine sodium less than 20
BUN/Cr is increased (above 20 because of increased Aldo, increased absorption of Na and H2O so additional BUN in the blood because BUN follows water)
FeNa is less than 1% because normally you don't want to excrete too much sodium. Tubules are still working
Urine osmolality is over 500

18

What does intrinsic renal failure look like?

Urine osmolality will be less than 350 (because cant concentrate the urine
Urine Na will be greater than 40 because cant reabsorb properly due to damaged tubules
FeNa will be greater than 2 %
BUN/Cr will be decreased (less than 15) because wasting everything

19

What does post renal AKI look like?

Urine osmolality will be decreased less than 350
Urine sodium will be greater than 40
FeNa will be greater than 2
All because back up is causing damage to the tubules so looks like intrinsic but BUN/Cr is above 15

20

What are the sx of a nonhemolytic febrile rxn to a transfusion?

Fevers, chills, rigors, malaise 1-6 hours after

21

What is the tx of a nonhemolytic febrile transfusion rxn?

Stop the transfusion
Acetaminophen

22

What is the mechanism behind a nonhemolytic febrile transfusion reaction?

Cytokine formation in storage

23

What is the mech behind a minor allergic rxn to a transfusion?

Ab formation against other donor proteins

24

What are the sx of minor allergic rxn to a transfusion?

Urticaria

25

What is the tx of minor allergic rxn to a transfusion?

Antihistamines

26

What is the mech of a hemolytic transfusion rxn?

Antibody formation after donor RBCS from ABO incompatibility or antigen mismatch

27

What is the tx of a hemolytic transfusion rxn?

Stop the transfusion immediately
Give IVF and maintain good urine output

28

What are the sx of a hemolytic transfusion rxn?

Fever, chills, nausea, flushing, burning at IV site, tachy, hypotension DURING or shortly after transfusion

29

What is lentigo maligna?

Melanoma that arises in a lentigo on sun damaged skin of the face
Stays at the junction of dermis and epidermis and only grows radially

30

What is supeficial spreading melanoma?

Most common type
Has a dominant radial growth
Affects younger adults
Presents on trunk in men and on legs in women

31

What is nodular melanoma?

Rapid early vertical growth
Appear as reddish-brown nodule with ulceration or hemorrhage
Poor prog

32

What is acral lentiginous melanoma?

Begins on the hands and feet in dark skimmed people.
Slowly spreading patch
Not related to UVB

33

What does L4 do?

Motor: foot dorsiflexion (tibial is anterior)
Sensory: medial aspect of the lower leg

34

What does L5 do?

Motor: big toe dorsiflexion (extensor hallucis longus)
Foot eversion (Peroneus)
Sensory: dorsum of foot and lateral leg

35

What does S1 do?

Motor: Plantar flexion, hip extension
Sensory: plantar and lateral foot

36

What are normal right atrial pressures?

Between 4-6 mmHg

37

What is a normal pulmonary artery pressure?

25/15 mmHg

38

What is a normal PCWP?

6-12 mmHg

39

What are the sx of transfusion related lung injury?

RDS and pulmonary edema

40

What is the cause of transfusion related lung injury?

Donor antileukocyte abs

41

What is an anaphylactic rxn to transfusion due to?

Recipient anti-IgA abs

42

What is a primary hypotension reaction to a transfusion?

Transient hypotension within minutes of transfusion

43

What causes primary hypotension reaction to transfusion?

Bradykinin in blood products (normally degraded by ACE)

44

Who usually gets primary hypotension reaction?

People on ACEi

45

How does bacterial sepsis from transfusions present?

Fever, chills, shock, DIC within minutes

46

How do you treat anaphylactic rxns?

IM epi
Glucocorticoids
Antihistamines
Vasopressors and mechanical ventilation

47

What should patients with IgA deficiency receive for blood products?

IgA deficient plasma and washed red cells

48

What are the sx of a delayed hemolytic transfusion reaction?

Fever
Hemolytic anemia
2-10 days after transfusion

49

What is a delayed hemolytic transfusion reaction caused by?

Anamnestic Ab Response against minor RBCS antigen

50

What are the diagnostic criteria for acute hemolytic transfusion rxn?

Happens within a hour
Positive direct Coombs
Pink plasma
Hburia

51

What is the tx for delayed hemolytic reaction?

None

52

Low serum C3, lumpy bumpy appearance on EM, after a skin or throat infection

Post infectious GN