MODEL QS FOR FUTURE ALL INDIA PRE PG EXAM

Discussion in 'NEET 2013 All india Exam' started by Guest, Jan 25, 2010.

  1. Guest

    Guest Guest

    epilepsy is defined as ___ (2) seizures
    recurrent
    unprovoked

    "recurrent" in epilepsy means at least ___ seizures separated by ___
    2
    24 h

    T/F: seizures with an identifiable cause constitute epilepsy
    false

    seizures with an identifiable cause are called
    acute symptomatic seizures

    epilepsy happens becaused of ___ (2) cortical electrical activity
    increased
    synchronized

    3 causes of epilepsy
    channelopathy
    decreased inhibition
    axonal sprouting
  2. Guest

    Guest Guest

    What is defined as a brain tumor?
    A tumor in regions of brain, malignant or benign, based upon microscopic appearance of mass

    Where do 50-25% of astrocytomas occur?
    Cerebellum - majority low-grade histology

    According to the WHO classification system for astrocytomas, what is classified at Grade I?
    Pliocytic or subependymal giant-cell astrocytoma

    What is classified as Grade II?
    Pilomyxoid, diffuse, or polymorphic astrocytoma

    What is classified as Grade III astrocytoma?
    Anaplastic astrocytomas

    What is classified as Grade IV astrocytoma?
    Glioblastoma muliforme
    Giant-cell glioblastoma or gliosarcoma

    How do Grade III and IV differ from Grade I or II?
    Higher mitotic activity
    Grade IV = vascular changes & necrosis
  3. Guest

    Guest Guest

    T or F: The majority of Astrocytomas that develop in the brain stem are benign.
    False - majority malignant histology

    What percentage of astrocytomas occur in the optic pathway?
    5% - most low-grade histology

    T or F: 7% of astrocytoma occur in the cerebral hemispheres
    False - 7% in hypothalamus (low grade)
    25% in cerebral hemispheres (equal low-grade & malignant)

    What type of brain tumor has a rapid onset of symptoms?
    Brainstem Glioma (anaplastic astrocytoma or glioblastoma of brainstem)

    Are the majority of brainstem glioma's operable?
    No - less than 10% will survive longer than 18mo from time of diagnosis
  4. Guest

    Guest Guest

    Does Medulloblastoma grow fast or slow?
    Fast - aggressively metastasizes through CNS & extraneurally into BM & viscera

    In what type of brain tumor does 2/3 of the cases occur as infratentorial lesions, often in the posterior fossa?
    Ependymoma - 9% of all Pedi brain tumors

    What are examples of a Grade I ependymoma?
    Grade I = Subependymomas (benign, slow growing)
    Myxopapillary ependymomas (variant w/favorable prognosis)

    What is a Grade II ependymoma?
    Grade II = Classical ependymoma

    What classifies a Grade III ependymoma?
    anaplastic, although may develop through malignant progression from low-grade
    - typically anaplastic on initial biopsy

    What percentage of Pedi brain tumors do Craniopharyngioma's account for?
    6-9%

    Where do Craniopharyngioma arise from in the brain?
    The sella (adjacent to pituitary gland, the hypothalamus, & optic nerve

    What is considered the second most common neoplasm & most common solid tumor in children?
    Tumors of the CNS

    What percentage of CNS tumors are located in the posterior fossa (infratentorial region)?
    60% - eg., cerebellar astrocytomas, medulloblastomas, ependymomas

    What percentage of CNS tumors are located in the supratentorial region?
    40% - eg., astrocytomas, hypothalamic, & optic pathway tumors, craniopharyngiomas
  5. Guest

    Guest Guest

    What are some possible chromosomal sites of oncogenesis in brain tumors?
    - Chromosome 17 in Medulloblastoma & astrocytoma
    - Chromosome 10 in glioblastoma

    What is diagnosis often difficult to establish?
    Symptoms mimic common childhood illnesses & vary depending on location & growth rate of tumor

    T or F: Posterior Fossa symptoms are commonly associated with increased ICP
    True - (eg., HA, vomiting, ataxia, nystagmus, diplopia)

    What are cranial nerve deficits typically indicative of?
    Brainstem involvement - from tumor, infiltration, & compression of surrounding structures(hydrocephalus)

    What are symptoms of supratentorial involvement?
    Hemiparesis
    Seizures
    Visual changes
    Intellectual problems

    How do midline tumors in the hypothalamus/pituitary region present?
    - Visual changes
    - Endocrine abnormalities
    - Increased ICP
  6. Guest

    Guest Guest

    What consists of the "classic triad" of symptoms from increased ICP?
    1. morning headaches
    2. lethargy
    3. n/v

    What are the more common initial signs of increasing ICP?
    Subacute - declining academic performance; personality changes, fatigue, & vague intermittent HA.

    What are some signs of increased ICP in younger children?
    - Increased irritability
    - Increased Head Circ
    - Bulging fontanel (s)
    - "sun setting" sign

    What is the "sun setting" sign?
    LImited upward gaze &
    Forced downward deviation of eyes

    What are VP shunts used for? Ventriculoperitoneal shunting is surgery to relieve increased pressure inside the skull due to excess cerebrospinal fluid (CSF) on the brain (hydrocephalus).
    Post surgical & to treat persistent hydrocephalus not resolved after tumor resection or biopsy
  7. Guest

    Guest Guest

    What is Hemoglobin A1c (HgA1c) and what should be your target HgA1c?
    It the average blood sugar reading over the past 3 months. The target HgA1c is <6.5?.

    What is an ideal fasting blood sugar for someone with type 1 and type 2 diabetes?
    An ideal fasting blood sugar is between 70-130mg and <140mg at bedtime.

    What is the ideal post-meal ( 2-hours after a meal) glucose level?
    The target post-meal blood sugar level should be <160mg.

    What is the target lipid level (LDL and TG) for someone with type 1 and type 2 diabetes?
    Ideally patients with diabetes should have their LDL<100 (<70 if heart or vascular disease is already present). The triglyceride level should be <250 (<150 if heart disease is already present
  8. Guest

    Guest Guest

    What is an ideal blood pressure in patients with type 1 and 2 diabetes?
    An ideal blood pressure in patients with type 1 and type 2 diabetes is <130/80.

    How do sulfonylurea agents work?
    Sulfonylurea agents work by stimulating the pancreas to secrete insulin.

    How does metformin work?
    Metformin works by decreasing the output of glucose from the liver, increases the uptake of glucose in the tissue, and decreases the absorption of glucose in the gut.

    How often should I check my blood sugar?
    You should check your blood sugar first thing in the morning, before and ocasionally after meals, and at night before bed when taking insulin.

    What are some macrovascular diseases caused by diabetes?
    Some macrovascular diseases caused by diabetes include, heart attack (myocardial infarction), stroke (cerebral vascular accident), and peripheral vascular disease (PVD) or arteriosclerosis
  9. Guest

    Guest Guest

    What are cranial nerve deficits typically indicative of?
    Brainstem involvement - from tumor, infiltration, & compression of surrounding structures(hydrocephalus)

    What are symptoms of supratentorial involvement?
    Hemiparesis
    Seizures
    Visual changes
    Intellectual problems

    How do midline tumors in the hypothalamus/pituitary region present?
    - Visual changes
    - Endocrine abnormalities
    - Increased ICP

    What consists of the "classic triad" of symptoms from increased ICP?
    1. morning headaches
    2. lethargy
    3. n/v

    What are the more common initial signs of increasing ICP?
    Subacute - declining academic performance; personality changes, fatigue, & vague intermittent HA.

    What are some signs of increased ICP in younger children?
    - Increased irritability
    - Increased Head Circ
    - Bulging fontanel (s)
    - "sun setting" sign
  10. Guest

    Guest Guest

    What is the "sun setting" sign?
    LImited upward gaze &
    Forced downward deviation of eyes

    What are VP shunts used for?
    Post surgical & to treat persistent hydrocephalus not resolved after tumor resection or biopsy

    What surgical procedure could eliminate the need for a permanent VP shunt?
    Endoscopic Anterior Third Ventriculostomy (creating an opening in floor of 3rd ventricle to establish CSF pathways)

    What is the gold standard test when diagnosing a brain tumor?
    MRI of the brain

    What imaging is needed if there is an infratentorial tumor?
    MRI of the spine

    Why would one need an MRA (Magnetic Resonance Angiography)?
    If there is concern about the vascularity of the tumor

    What would a PET scan be used to evaluate?
    The metabolic activity of the tumor

    What diagnosis requires a BMA and biopsy?
    Medulloblastoma

    Why should we consider the tumor's rate of cell growth?
    High-grade tumors have a poorer prognosis

    What has improved survival for patient's w/brain tumors?
    Surgical accessibility
    - 95% w/low-grade tumors are cured
    - w/high-grade tumors when 95% of tumor is removed
  11. Guest

    Guest Guest

    T or F: Infants with malignant tumors have a favorable prognosis
    False - infants have a poor prognosis

    What is the primary treatment for brain tumors?
    Surgical resection

    What advances have improved surgical outcomes?
    Techniques with MRI and stereotactic, or MRI computer-guided surgery - minimizes injury to healthy brain tissue

    What is one of the risks associated with post-surgical complications?
    Posterior Fossa Syndrome

    Mutism, speech disturbances, dysphagia, decreased motor function, cranial nerve palsies & emotional lability are symptoms of what?
    Posterior Fossa Syndrome

    How quickly can s/s of Posterior Fossa Syndrome present?
    24-100+ hours after surgery

    What are the four classes of enzymes?
    1. serine proteases
    2. carbonic anhydrases
    3. restriction endonucleases
    4. nucleoside monophosphate (NMP) kinases

    Which class(es) of enzymes require the addition of water to a substrate?
    1. serine proteases
    2. carbonic anhydrases
    3. restriction endonucleases

    Which class(es) of enzymes do require the prevention of water to a substrate?
    4. nucleoside monophosphate (NMP) kinase

    What is an example of a serine protease?
    chymotrypsin
  12. Guest

    Guest Guest

    1. Lymphocytic gastritis is a rare condition characterized by an increased number of lymphocytes in the gastric epithelium. On average, 3 to 8 lymphocytes occur per 100 epithelial cells in normal gastric mucosa, and a minimum of 30 lymphocytes per 100 epithelial cells is usually required for this diagnosis. Budesonide (9 mg/day) effectively induces clinical remission in patients with lymphocytic colitis and significantly improves histology results after 6 weeks.

    2. The anticholinesterase antibody test is about 90% sensitive in diagnosing myasthenia gravis (MG); it is especially helpful in persons without outward clinical features of MG.

    3. Swallowing saliva is a key protective mechanism against gastroesophageal reflux injury. Saliva has a neutral pH, which helps to neutralize the gastric refluxate, and the swallowed saliva initiates a peristaltic wave that strips the esophagus of refluxed material (clearance).

    4. Screening efforts for adenocarcinoma of the esophagus should be directed toward those at greatest risk of developing cancer: i.e., older white men with more than 5 years of reflux symptoms.

    5. Antireflux surgery is an important alternative for patients with medically refractory gastroesophageal reflux disease (GERD). Important preoperative considerations to tailor the antireflux surgery include esophageal length, esophageal dysmotility, and prior abdominal surgery. For the short esophagus with normal motility, the surgical options are transthoracic Belsey or Nissen or Collis gastroplasty. For esophagus of normal lenghth, but hypomotility the surgical options are laparoscopic or open Toupet or Hill procedure or transthoracic Belsey procedure.

    6. Most cases of achalasia appear to be acquired and it is uncommon before the age of 25, with a clear-cut age-related increase thereafter. Most commonly, the disease occurs in middle adult life (ages 30 to 60) and affects both sexes and all races nearly equally.

    7. Sildenafil (Viagra) blocks phosphodiesterase type 5 (the enzyme responsible for degradation of cyclic guanosine monophosphate [cGMP]), which results in increased cGMP levels within smooth muscle and consequent relaxation. The drug is effective in short-term reduction of lower esophageal sphincter (LES) pressures in patients with achalasia.

    8. Gastric cancer is one of the tumors found in hereditary nonpolyposis colon cancer syndrome (HNPCC), and about 10% of patients with HNPCC develop gastric cancer. Families with specific mutations in the E-cahedrin gene (CDH1) have been reported to have a 100% chance of developing diffuse gastric cancer.

    9. Patients identified to have a gastric carcinoid tumor should have the gastrin level checked to evaluate for hypergastrinemia. If the gastrin level is elevated, evaluation for acholorhydria should be conducted, and if gastrin is elevated and the patient is not achlorhydric (atrophic gastritis), an evaluation for Zöllinger-Ellison syndrome (gastrinoma) should be performed.Zollinger–Ellison syndrome is a triad of gastric acid hypersecretion, severe peptic ulceration, and non-beta cell islet tumor of pancreas (gastrinoma). In this syndrome increased levels of the hormone gastrin are produced, causing the stomach to produce excess hydrochloric acid. Often the cause is a tumor (gastrinoma) of the duodenum or pancreas producing the hormone gastrin. Gastrin then causes an excessive production of acid which can lead to peptic ulcers in almost 95% of patients.

    10. Although identifiable etiologies are apparent in most cases of gastroparesis , the singular most common cause remains idiopathic at about 35%. This suggests that there may be many yet-to-be-defined inheritable and infectious etiologies.
  13. Guest

    Guest Guest

    What is the "challange" of a serine protease (such as chymotrypsin)?
    promote a reaction that is almost immeasurably slow at neutral pH in the absence of a catalyst.

    What is the "challange" of carbonic anhydrase?
    To achieve a high absolute rate of reaction

    What is the "challange" of restriction endonucleases?
    Attaining a high degree of specificity

    What is the "challange" of NMP kinases?
    To transfer a phosphoryl group from ATP to a nucleotide and not to water.

    What are the four common strategies to catalyze specific reactions?
    1. covalent catalysis
    2. general acid-base catalysis
    3. catalysis by approximation
    4. metal ion catalysis
  14. Guest

    Guest Guest

    What are some microvascular diseases caused by diabetes?
    Some microvascular diseases caused by diabetes are kidney disease (nephropathy) and vision loss (retinopathy).

    What are some differences between type 1 and type 2 diabetes?
    Type 1 diabetics do not produce their own insulin. Type 1 is usually developed at a younger age patients who are usually lean. Type 2 diabetes usually develop later in life. Type 2 diabetics are usually overweight. There is also a strong family history of the disease.

    What is the initial treatment in patients with Type 2 diabetes?
    The initial treatment for type 2 diabetes should focus on diet and exercise. This will help to overcome “insulin resistance.”

    What Body Mass Index (BMI) is considered overweight? Obese?
    A BMI of >25 is considered overweight and a BMI >30 is considered obese

    What is the significance of a HgA1c of >8.5%?
    Oral diabetics usually only lower HgA1c by 1-2 %. Usually when the HgA1c is >8.5% insulin should be strongly considered.
  15. Guest

    Guest Guest

    ▪ Iron-deficiency anemia is a late manifestation of a prolonged iron deficit.
    ▪ Children ages 1 to 2 years and adolescent girls are at highest risk for iron-deficiency anemia.
    ▪ Iron deficiency is associated with developmental delays, behavioral disturbances, and learning impairments that may be irreversible.
    ▪ Dietary counseling and screening are the keys to prevention and identification of iron deficiency in infants and children.
    ▪ Children with mild to moderate anemia may be presumed to have iron deficiency without other testing and started on iron supplementation if they are at high risk due to their age or dietary history.
    ▪ If a patient fails to respond to iron therapy or the history does not suggest iron deficiency, an alternate explanation for anemia should be considered.
  16. Guest

    Guest Guest

    T or F: Radiation is the oldest treatment for brain tumors
    True

    What is radiation treatment used for in the treatment of brain tumors?
    Treat Malignant tumors or deep benign lesions w/large amount of residual disease

    How does radiation get rid of a brain tumor?
    It targets the tumor cells DNA and affects the ability of cells to continue dividing

    What has improved accuracy of radiation treatment and therefore minimal damage to healthy tissue?
    3D imaging using CT & MRI, and focused irradiation

    What age group is radiation therapy delayed in?
    Younger than 3yrs - detrimental to a developing brain

    What does standard radiation therapy typically consist of in terms of dose?
    200 cGy per treatment daily;
    - total dose 5,500 - 6,000 cGy to local field
  17. Guest

    Guest Guest

    Poliovirus characteristics:
    1. # serotypes
    2. capsid
    3. genome
    4. transmission (2)
    5. seasonality?
    1. 3
    2. icosehedral
    3. + strand RNA
    4. f-o, o-o
    5. summer-fall (temporate climate)

    1. Most common outcome from poliovirus infection
    2. Severe outcome in 0.1-2.0% pts
    1. No clinical sxs

    2. assymmetric, paralytic poliomyelitis (sensory intact)

    1. Non-infectious sequela of poliovirus infection
    2. When does it occur?
    3. Possible mechanism
    1. post-polio syndrome: deterioration of muscles originally affected

    2. decades later

    3. loss of nerves from original infection
  18. Guest

    Guest Guest

    How many genera of picornavirus are there?
    5

    What are the genera of picornavirus based on?
    physical properties
    serological relatedness
    nucleotide sequence

    Which genera does poliovirus belong to?
    enterovirus

    T/F: poliovirus is acid sensitive
    F. can survive <pH 3

    limited replication of poliovirus occurs in ___. extensive replication occurs in ___, the natural habitat
    oropharynx
    lower intestinal tract

    What are enteroviruses sensitive to?
    chlorine (0.3 to 0.5 p.p.m)
    formaldehyde

    T/F: presence of organic matter may protect poliovirus
    T
  19. Guest

    Guest Guest

    What are the two targets of anti-epileptics?
    Na channels and GABA

    Which Anti Epileptics are handy for neuralgia?
    Carbamazepine:trigeminal
    Gabapentin: Peripheral Neuropathy

    Which antiepileptic can you use in pregnancy?
    Phenobarbital. Which one can never be used in pregnancy
    Carbamazepine is teratogenic. Valproate Causes Neural Tube Issues (Spina Bifida)

    If a pregnant woman has a seizure due to Eclampsia, what can you use?
    Benzozdiazepine. What is the first line therapy for seizures of Eclampsia?
    MgSO4

    what oncogene is characteristically expressed in Burkitt lymphoma?
    c-myc, but not in Burkitt-like lymphomas

    which subtypes of Burkitt lymphoma exist?
    endemic african, nearly all associated with EBV-infection

    sporadic, 20% associated with EBV-infection

    Aids-associated, 30-40% associated with EBV-infection

    what are characteristic genetic abnormalities in Burkitt lymphoma?
    reciprocal translocation of the c-MYC gene on chromosome 8, the translocation partner usually is the IgH locus, or less commonly the Ig kappa or Ig lambda ligh-chain loci

    most with t(8;14), much less common with t(8;22) or t(2;8)

    what are the therapy principles in Burkitt lymphoma?
    high-dose combination chemotherapy with CNS prophylaxis

    what is the median age in Burkitt lymphoma and Burkitt-like lymphoma?
    30 years in Burkitt, 55 years in Burkitt-like lymphoma

    which NHL is most common in children?
    Burkitt lymphoma

    which is the most common site involved in Burkitt's lymphoma?
    gastrointestinal tract

    which other aggressive NHL is similar morphologically to Burkitt's lymphoma?
    DLBCL=Diffuse large B-cell lymphoma (DLBCL
  20. Guest

    Guest Guest

    SUPERFICIAL FIBROMATOSES
    Morbidity and Mortality
    ▸▸ Benign, recurring lesion
    ▸▸ Dupuytren disease may be bilateral (50% of cases)
    ▸▸ Superficial fibromatoses may coexist in different locations in the same patient
    ▸▸ Possible association between superficial fibromatoses and trauma, alcoholism, or other diseases (diabetes, epilepsy, chronic lung disease, among others)
    ▸▸ No association with deep fibromatoses Sex, Race, and Age Distribution
    ▸▸ Middle- to advanced-aged adults
    ▸▸ Predominates in male individuals (three to four times more frequent than in female individuals)
    ▸▸ More common in Northern Europeans
    ▸▸ Plantar lesions more common in children and adolescents
    Gross Findings
    ▸▸ Single or multiple nodules
    ▸▸ Size: 0.5 to 2 cm
    Microscopic Findings
    ▸▸ Monotonous, fascicular lesion composed of nonatypical fibroblasts in a collagenous background
    ▸▸ Mitotic figures visible
    ▸▸ Extracellular collagen abundant in long-standing lesions
    ▸▸ Hypercellularity frequent in plantar fibromatosis
    Genetics
    ▸▸ Trisomy 7 and 8, and loss of Y in Dupuytren disease
    ▸▸ Trisomy 8 and 14 in Ledderhose disease
    Immunohistochemical Findings
    ▸▸ Positivity for vimentin
    ▸▸ Focal expression of smooth muscle actin
    ▸▸ Negativity for CD34, keratins, EMA, and S-100 protein
    Differential Diagnosis
    ▸▸ Synovial sarcoma
    ▸▸ MPNST
    ▸▸ Fibrosarcoma
    ▸▸ Desmoid-type fibromatosis
  21. Guest

    Guest Guest

    TRUE or FALSE: Lepromatous Leprosy involves a T-Helper SubType-1 response.
    FALSE

    Symptoms that might be seen in a disease that involves overproduction of cytokines include:

    A.) Septic Shock

    B.) Fever

    C.) None of the Above

    D.) A & B
    A & B

    You are on rounds, shadowing a clinical pharmacy specialist in the Infectious Disease Department at your local hospital. Patient X is demonstarting abnormally low levels of leukocyte specific CAMS. In this patient, what might you expect to see?

    I. Little to no extravasation of lymphocytes, monocytes and granulocytes.

    II. A very healthy individual with no signs of infection

    III. Poor wound healing

    A.) I only

    B.) II Only

    C.) I and III

    D.) II and III

    E.) I, II, III
    I and III
  22. Guest

    Guest Guest

    What is negative and possitive selection
    Lymphocytes with high affinity for self antigens undergo negative selection and apoptosis. Lymphocytes with low affinity for self-antigens are allowed to survive through positive selection

    CD4 molecules
    On the surface of T lymphocytes that interact with MHC-II, and will become helper T cells

    CD8 molecules
    On the surface of T lymphocytes that interact with MHC-I, and will become cytotoxic T cells

    Cell markers: μ+
    pre-B cells in bone marrow with heavy chains

    Cell markers: Tdt+
    Progenitor B cells in bone marrow without heavy chains or pre-thymic/thymic cortex T cells
  23. Guest

    Guest Guest

    B cell markers
    CD19, CD20, IgM, B7, CD40, CD20, MHC-II

    T cell markers
    CD4, CD8, CD3, TCR

    B-cell rich areas of the lymph node
    The cortex. Contains primary follicles.

    T-cell rich area of the lymph node
    The paracortex.

    Define: antigen
    Substance that is foregin, complex and with molecular weight over 5,000Kd that can induce an immune response

    Define: epitope
    The portion of the antigen to which the Ig idiotype binds. Antigen should have two epitopes to induce a response.

    Define: hapten
    Single antigenic determinants. An antigen with a single epitope. Needs to form an hapten-carrier complex to induce an immune response
  24. Guest

    Guest Guest

    What is mantle cell lymphoma?
    Mantle cell lymphoma (MCL) is the result of a malignant transformation of a B lymphocyte in the
    outer edge of a lymph node follicle, called the mantle zone. The transformed B lymphocyte
    (lymphoma cell) grows in an uncontrolled way and the accumulated lymphoma cells form tumors
    in lymph nodes leading to their enlargement. The lymphoma cells can enter the lymphatic
    channels and the blood and spread to other lymph nodes or tissues such as the marrow, liver and
    gastrointestinal tract.
    There are nearly 59,000 new cases of NHL in the United States each year. MCL patients represent
    about six percent of all new cases of NHL per year or about 3,500 new cases. MCL occurs more
    frequently in older adults – the average age at diagnosis is the mid-60s.

    what proportion of NHL are MCL?
    6%

    mnemonic M=13, C=3, L=12 --> 28 --> check difference is 6

    what are the key points for mantle cell lymphoma (MCL)?
    older adults; intermediate-grade uncurable refractory lymphoma with disseminated disease at presentation, with generalized lymphadenopathy, common splenomegaly and often early leukemic phase

    what is the M:F ratio in MCL?
    M:F = 4:1

    what is the median age in MCL?
    60 years

    What are the causes of mantle cell lymphoma?
    About 85% of patients with mantle cell lymphoma (MCL) have a genetic change involving
    chromosome 11 and chromosome 14, called a “reciprocal translocation,” and abbreviated as
    t(11;14). In a sense, this genetic alteration can be considered to be the cause of the disease, since it may be a result of the constant mutations occurring in many cells, possibly independent of the
    effects of an outside (environmental) factor

    what are the frequencies of lymphadenopathy and splenomegaly in MCL?
    generalized lymphadenopathy in 90%

    splenomegaly in 60%

    hepatomegaly in 30%

    what is the cytogenetic abnormality associated with MCL?
    t(11;14)

    mnemonic 11 plus median survival (3) equals 14

    what is the prognosis in MCL?
    not curable with conventional chemotherapy, with a median survival of 3 years

    what are typical immunophenotypic findings in MCL?
    B-cell markers: CD5+, CD23- and CD10- (cALLa)

    overexpression of cyclin D1

    what are the therapy principles in MCL?
    CHOP or CVP +/- rituximab

    or

    hyper-CVAD comprises hyperfractionated cyclophosphamid, vincristin, doxorubicin and dexamethasone alternating with high-dose methotrexat and cytarabin
  25. Guest

    Guest Guest

    11. Hepatitis D virus (HDV) infection ONLY occurs in persons previously or co-infected with hepatitis B virus. Do not waste money on HDV tests unless the clinical suspicion is high and HBV is present.

    12. Pretreatment characteristics that predict a favorable response to antiviral therapy for hepatitis C include infection with genotype 2 or 3, low viral load (less than 400,000 IU/mL), liver biopsy with little or no fibrosis, age younger than 40 years at time of treatment, and low body weight.

    13. Ribavirin is teratogenic, and male and female patients with hepatitis C virus infection should be advised to practice effective contraception during therapy and for 6 months after treatment.

    14. When active hepatitis B (HBV) and C (HCV) infections are present, as evidenced by a positive HCV-RNA and high level viremia by HBV-DNA polymerase chain reaction assay, the patient should be treated with the recommended dose of interferon for hepatitis B in conjunction with ribavirin for hepatitis C.
  26. Guest

    Guest Guest

    What is a typical spinal dose of radiation?
    Usually 2,400 cGy

    What type of radiation can be used for brain tumors that result in lower morbidity but higher total dose given?
    Hyperfractionated radiation treatment = 100 cGy BID (at least 6 hrs apart); total dose 7,200 cGy

    T or F: Chemo is a standard treatment for only some brain tumors
    True - with or as an adjuvant to radiation therapy

    List the chemo most commonly used to treat Pedi brain tumors
    1. Vincristine (Oncovin)
    2. Carmustine (BCNU)
    3. Lomustine (CCNU)
    4. Carboplatin (CBDCA)
    5. Cisplatin (Platinol)
    6. Etoposide (VP16)
    7. Cyclosphosphamide (Cytoxan)
    8. Thiotepa (Thiotepa)
    9. Temozolomide (Temodar)
    10. Irinotecan (CPT-11)
  27. Guest

    Guest Guest

    Leukocyte adhesion deficiency
    Absense of CD18 (β chain of LFA-1 integrin). No adhesion of leukocytes. Omphalitis, no abscess or pus formation.

    Chemoattractants for neutrophils
    IL-8, C5a, LTB4, formyl methionyl peptides from microorganisms

    Opsonins
    Fc portion of IgG, C3b. Macrophages and eosinophils have recptors

    NADPH oxidase
    Synthesizes superoxide radicals for respiratory burst

    Myeloperoxidase
    Lysosomal enzyme converts H2O2 + Cl- --> hypochlorite (bleach) which is microbicidal
  28. Guest

    Guest Guest

    How long does it take to heal a superficial partial thickness burn?
    3-5 days

    What is an example of a superficial partial thickness burn
    sunburn

    What layer of skin is involved in a superficial partial thickness burn?
    epidermis ONLY

    How long do deep partial thickness burns take to heal?
    7-28 days

    What does a deep partial thickness burn look like?
    puffy, blisters, Painful!

    What is true of 40% of burn victims?
    They are on drugs or alcohol

    What layers of skin are involved in a deep partial thickness burn?
    All of the epidermis and some of the dermis (but not all)
  29. Guest

    Guest Guest

    What are major risk factors for becoming a burn victim?
    having difficulty with activities of daily living (old people)

    What types of burns are treated the same?
    deep partial thickness and full thickness burns are treated the same. deep partial thickness burns can turn into full thickness burns

    What happens to burns over time
    They worsen.

    How do full thickness burns appear?
    skin may look dry, have extensive eschers, white patches

    Is a full thickness burn painful?
    No and yes. The area's nerve endings will be destroyed, but wil have pain from varying degress of burns surrounding the worst part of the burn.

    What types of burns are included in a total body surface area burn calculation?
    deep partial thickness and full thickness only

    What types of burns on children are suspicious?
    Straight line burns, because they do not occur in nature and may be indicative of abuse

    What is an escher?
    non-elastic leathery covering that develops on severe burns- not mobile and can cause decreased distal perfusion

    If can be surmised if the area of entrance for an electrical burn is small?
    There is greater internal tissue damage

    What are priority problems for people with hand burns?
    risk for infection and contractures

    What is a circumferential burn bad?
    Causes decrease in distal perfusion, if it is on the abdomen, it may restrict bellow's effect and inhibit lung capacity.

    In addition to tissue burns, what complications can arise from electrical burns?
    cardiac arrthymias, seizures, intracranial hemorrhage

    How do you remove tar from a burn?
    wait until it cools, use mayonnaise or a petroleum product

    What is the priority for a chemical burn?
    Irrigate, irrigate, irrigate.
    ensure healthcare worker safety

    What will the labs of a burn victim look like?
    -Low bicarb
    -low pH
    -elevated lactate level

    What intervention is appropriate for an elevated lactate level?
    fluid resuscitation until the lactate level goes down

    As the body tries to compensate for extensive burns, what can occur?
    hypovolemic shock (decreased bp, increased hr-unless on betablockers, oliguria, metabolic acidosis)

    What is lost from a burn?
    -protective barrier against infection
    -loss of body fluids and temperature control
    -destruction of sweat and sebacceous glands
    -destruction of sensory receptors (full thickness)
    -hypovolemic and diuretic stages

    What is Eclampsia again?
    Seizures and Coma from some pre-pregnancy cause. This is the eclamptic convulsion. What is pre-eclampsia?
    Higher blood pressure and proteinuria. Cerebral Blindness is a known cerebral sign in pre-eclamsia. ICerebral signs are nonspecific. nausea, vomiting. This disease may have to do with exposure to paternal antigens.

    Which anti-epileptics cause blood disorders?
    Carbamazepine causes dyscraisias (agranulocytosis, or aplastic anemia). Megaloblastic Anemia is phenytoin.

    Who has SLE symptoms
    Phenytoin

    Which anti-epileptic causes megaloblastic anemia
    Phenytoin. What else can it cause? At the Gums?
    Gingival Hyperplasia

    Is mitral valve prolapse (MVP) always pathologic?
    Some studies show that up to 13% of normal children have some degree of posterior leaflet prolapse on echocardiography. There is a spectrum of anatomic abnormalities, the most minor of which are a variation of normal. Children with clinical features of mitral valve insufficiency constitute the pathologic category. Whenever auscultation reveals the classic findings of MVP, referral to a pediatric cardiologist is recommended. This allows for evaluation of the child for possible accompanying cardiac abnormalities (e.g., mitral insufficiency, secundum atrial septal defects) and confirmation of the diagnosis.

    What connective tissue diseases may be associated with MVP?
    Marfan syndrome, Ehlers-Danlos syndrome, pseudoxanthoma elasticum, osteogenesis
    imperfecta, and Hurler syndrome.

    During physical examination, what patient maneuvers can increase the
    likelihood of detecting MVP on auscultation?
    In patients with MVP, the leaflets of the mitral valve apparatus billow into the left atrium.
    Maneuvers that decrease left ventricular size and volume (and thus increase the relative size of the leaflets) increase the likelihood of hearing the click or murmur. These include the straining phase of a Valsalva maneuver, inspiration, and change from a supine to a sitting position or from a squatting to a standing position. The left lateral decubitus position may also be facilitative

    True or false? Hyperkalemia increases the effect of digoxin.
    False. hyperkalemia decreases digoxin's activity, while hypokalemia, hypomagnesemia, and hypercalcemia all increase digoxin toxicity.

    Which antispasmodic blocks the release of Ca 2+from the SR and is used in the treatment of malignant hyperthermia?
    Dantrolene

    Which overdose carries a higher mortality rate, that of benzodiazepines or barbiturates?
    Barbiturate overdose and benzodiazepine withdrawal carry the highest mortality rates.

    What antiviral agent is used in the treatment of drug-induced Parkinson's disease?
    Amantadine

    Are the following responses associated with histamines H1 or H2 receptor activation?
    • Edema
    H 1
  30. Guest

    Guest Guest

    In Prune Belly Syndrome:
    A The bladder is neuropathic. (False)
    B Bilateral severe hydronephrosis is always found. (True)
    C Only two vessels are usually present in the umbilical cord. (False)
    D Bilateral cyptorchidism is present in most cases. (True)
    E Bladder extrophy may be associated. (False)

    The following investigations are useful in locating an ectopic testis:
    A Radionucleotide scan (False)
    B Ultrasound scan (True)
    C Testosterone response to HCG (False)
    D Abdominal x-ray (False)
    E Chromosomes (False)

    The following are recognised complications of circumcision:
    A Delayed healing (True)
    B Bleeding (True)
    C Pain (True)
    D Damage to the glans (True)
    E Infection (True)

    Regarding the diagnosis of urinary tract infection in infants:
    A A bag urine will confirm it. (False)
    B Ultrasound scan of kidneys, ureters and bladder should be performed in all suspected cases. (False)
    C DMSA scan should be performed in confirmed cases. (True)
    D IVP is the only investigation required in most cases. (False)
    E MCUG should be performed in suspected cases. (False)
  31. Guest

    Guest Guest

    Hepatitis C Virus (HCV) - Causative Agent
    flavivirus

    Hepatitis C Virus (HCV) - Reservoirs
    humans

    Hepatitis C Virus (HCV) - Transmission
    contact with blood serum - intimate contact (not sexual contact)

    Hepatitis C Virus (HCV) - Organs Involved
    liver

    Hepatitis C Virus (HCV) - Signs/Symptoms
    similar to HBV (fever, rash, arthritis) - chronic liver disease

    Hepatitis C Virus (HCV) - Diagnosis/Lab ID
    blood test for HCV antibodies

    Hepatitis C Virus (HCV) - Treatment
    pegylated interferon sustains activity - ribavirin suppress viral multiplication - does not cure, but prevent or lessons damage to liver

    Hepatitis C Virus (HCV) - Prevention
    NO vaccine

    Hepatitis C Virus (HCV) - Other Information
    over 4 million americans infected - liver transplants from failure

    Hepatitis C Virus (HCV) is referred to as "____ ____"
    "silent epidemic"

    there over __ ____ americans infected with HCV
    4 million
  32. Guest

    Guest Guest

    Different types of causes of thrombocytopenia
    Qualitative (Acquired/inherited)
    Quantitative

    What are the Qualitative (acquired) causes of thrombocytopenia
    - Antiplatelet agents
    - Liver disease
    - Cardiopulmonary bypass
    - Uremia
    - Myeloproliferative

    What are the antiplatelet agents responsible commonly responsible for thrombocytopenia
    - NSAIDs
    - Dipyramidole
    - Ticlopidine/Clopidogrel
    - GP IIb/IIIa receptor antagonists
  33. Guest

    Guest Guest

    Cryoglobulinemia

    Cryoglobulinemia refers to the presence in plasma of cold-insoluble immunoglobulins,5 and is a secondary finding associated with several disease states. Cryoglobulins are commonly present in low concentrations, therefore approximately 90 percent of patients are asymptomatic or have minimal symptoms.6 Symptoms occur when the abnormal protein precipitates at the temperatures present in superficial venules in the skin and acral parts of the body. Cryoglobulinemia syndromes are divided into three main types based on the Ig composition of the precipitate. Type I cryoglobulinemia results from the accumulation of monoclonal IgG, IgM, or IgA. It is most commonly seen in association with lymphoproliferative disorders, such as myeloma, Waldenström macroglobulinemia, or lymphoma. Type II, or mixed cryoglobulinemia involves formation of complexes composed of polyclonal IgG with monoclonal Igs, typically IgM with anti-IgG specificity. Exposure to exogenous antigens appears to cause polyclonal Ig production, with activity against bacteria, viruses, and fungi. Mixed cryoglobulinemia is commonly seen secondary to hepatitis C virus (HCV) infection,7 other causes including HIV, collagen vascular disorders, and hematologic neoplasias.8,9 In mixed cryoglobulinemia secondary to HCV infection, the presence of active cutaneous vasculitis correlates with increased levels of the B-cell-attracting chemokine 1 (CXCL 13
    It manifests with petechiae of the legs, palpable purpura, and necrotic skin ulcerations. First-line treatment of HCV-associated mixed cryoglobulinemia includes use of interferon-, often with adjunct glucocorticoids or plasmapheresis.11 Direct treatment of the HCV infection with ribavirin and interferon therapy ameliorates this associated lymphoproliferative disorder.12 Deposition of immune complexes on vessel walls leads to tissue damage in the vasculature, nerves, joints, and skin leading to the hallmark findings of mixed cryoglobulinemia: weakness, arthralgia, and purpura. This purpura often is palpable and is accompanied by areas of hemorrhagic necrosis and occasionally follicular pustular purpura. Other cutaneous manifestations include lower extremity ulcerations, urticaria, Raynaud phenomena, and subungual purpura (. Type III cryoglobulinemia associates polyclonal IgG and IgM complexes, also resulting in symptoms of mixed cryoglobulinemia.6 It is associated with a variety of infections, systemic lupus erythematous (SLE), and poststreptococcal glomerulonephritis.
  34. Guest

    Guest Guest

    Are the following responses associated with histamines H1 or H2 receptor activation?
    • Gastric acid secretion
    H 2

    Are the following responses associated with histamines H1 or H2 receptor activation?
    • SA nodal activity
    H 2

    Are the following responses associated with histamines H1 or H2 receptor activation?
    • Pain and pruritus
    H 1

    Are the following responses associated with histamines H1 or H2 receptor activation?
    • Bronchial smooth muscle activity
    H 1

    Are the following responses associated with histamines H1 or H2 receptor activation?
    • Inotropic action and automaticity
    H 2

    True or false? The lack of dopamine production in the substantia nigra leads to the extrapyramidal dysfunction, characteristically seen in patients with Parkinson's disease.
    True. The lack of dopamine leads to an excess of ACh, hence extrapyramidal dysfunction.
  35. Guest

    Guest Guest

    Thromboplastin
    acts on prothrombin to form thrombin, CALCIUM MUST BE PRESENT FOR THIS TO OCCUR.

    Fibrinogen
    protein found in blood plasma, produces fibrin

    Fibrin
    netlike substance in the blood that traps red and white blood cells and plaetlets and forms a matrix (skeleton) of the clot.

    Anticoagulants
    prevent formation of blood clots/THROMBI by a complex clotting mechanism of blood and INCREASING THE TIME IT TAKES FOR BLOOD TO CLOT.

    PROTAMINE SULFATE
    given to counteract HEPARIN, OVERDOSE

    Two major categories of Anticoagulants
    1. Coumarin and Indanedione
    2. Heparin
  36. Guest

    Guest Guest

    Describe the poliovirus genome layout
    one ss(+)RNA
    5'-VPg-Long UTR-P1-P2-P3-Short UTR-polyA Tail-3'

    T/F: the genomic poliovirus RNA is infectious by itself
    T

    Which end of the poliovirus genome has the shorter UTR
    3' end

    What is the poliovirus 3' UTR important for?
    synthesis of (-) strand for replication of genome

    What is the poliovirus 5' UTR important for?
    translation of the RNA and possibly packaging of genome into capsids

    How many proteins does the genome encode? How long is/are this/these protein(s)?
    one polyprotein (2100-2400 amino acids), cleaved to make 20 proteins

    What is VPg? How long is it?
    A small basic protein 23 amino acids long

    Describe the poliovirus morphology
    non-enveloped
    27-30 nm
    icosahedral capsid with 20 capsomer

    How long is the genome stretched out?
    2500 nm
  37. Guest

    Guest Guest

    What cells differentiate from the lymphoid progenitor
    T progenitors and B progenitors give rise to thymocytes and B lymphocytes. These differentiate into helper and cytotoxic T lymphocytes and plasma cells. Lymphoid progenitor turns into NK cell.

    What cells differentiate from the myeloid progenitor
    Granulocyte progenitor into monocytes and neutrophils. Monocytes differentiate into macrophages and dendritic cells. Eosinophils. Basophil progenitor turns into basophils and mast cells. Megakaryocytes give rise to platelets and the erythroid progenitor turns into erythrocytes

    Characteristics of monocytes
    Are found in the bloodstream, have horseshoe-shaped nucleus

    Characteristics of macrophages
    Found in tissues and have ruffled membrane with cytoplasm, vacuoles and vesicles

    Chatacteristics of neutrophils
    Found in the bloodstream, multilobed nucleus and small pink granules

    Characteristics of eosinophils
    Found in the bloodstream, have bilobed nucleus with large pink granules

    Characteristics of basophils
    Found in the bloodstream, have bilobed nucleus with large blue granules

    Characteristics of mast cells
    Found in tissues, mucosa and epithelia. Have small nucleus and cytoplasm with large blue granules. Release histamine

    Characteristics of lymphocytes
    Found in the bloodstream and lymphoid tissue. Have large, dark nucleus with a small cytoplasm
  38. Guest

    Guest Guest

    Naïve B cell receptors
    Membrane-bound IgM and IgD

    Describe the structure of immunoglobulins
    2 heavy chains and 2 light chains united by disulfide bonds and a flexible hinge region. Th carboxy terminal of the heavy chains for the FC fragment and anchor IgM and IgG to the membrane and are the constant isotype. The N-terminal of all four molecules face the extracellular space and form the FAB fragment with an idiotype that uniquely bninds a single antigen.

    What are the molecules of the B cell transduction complex
    Ig-α, Ig-β, CD19, CD20
  39. Guest

    Guest Guest

    Courmarin and Indanedione ACTION
    limits formation of blood coagulation factors II, VII, IX, and X in the liver by interfering with Vitamin K, LIMIT THE EXTENSION OF EXISTING BLOOD CLOTS OR THROMBI

    Heparin Action
    stops reactions that lead to the clotting of blood/formation of fibrin clots, increases the action of antithrombin III (HEPARIN COFACTOR) and several other coagulation factors (FACTOR X/Xa).

    Low-molecular Weight Heparin
    PREVENTS DEEP VEIN THROMBOSIS.

    Thrombi
    clots made of fibrin, platelets, and cholesterol.

    Emboli
    small pieces of a blood clot that circulate in blood, block vessels in areas of the heart.

    Thrombophlebitis
    inflammation and blood clot in a vein.
  40. Guest

    Guest Guest

    True or false? The lack of dopamine production in the substantia nigra leads to the extrapyramidal dysfunction, characteristically seen in patients with Parkinson's disease.
    True. The lack of dopamine leads to an excess of ACh, hence extrapyramidal dysfunction.

    Which PG maintains patency of the ductus arteriosus and is used in the treatment of primary pulmonary HTN?
    PGI 2

    Which CNS ACh receptor or receptors are excitatory? Inhibitory?
    M 1=Muscarinic receptors 1 and nicotinic receptors are excitatory in the CNS and M 2 receptor is inhibitory.

    True or false? Beta2-Adrenergic agents are used in the management of an acute asthmatic attack.
    True. They are useful in the early-phase response to an asthmatic attack.

    Do local anesthetics bind to the activated or inactivated sodium channels?
    Inactivated
  41. Guest

    Guest Guest

    What are the different types of gastric lymphoma?
    MALT lymphomas (also known as extramarginal zone B-cell lymphoma) are low grade and show lymphoepithelial lesions (lymphoma cells infiltrating the gland epithelium). They extend deep into the muscularis mucosae, unlike reactive lymphoid hyperplasia, which is generally more superficial and a major differential diagnosis in these cases. These cells are CD20 (B-cell marker) positive, may coexpress CD43, and are CD5 negative, CD10 negative and positive for bcl-2 protein. Helicobacter organisms may be seen. Distinction between reactive infiltrate versus neoplastic can be difficult in small biopsy specimens. Flow cytometry and cytogenetics are other useful studies. Gene rearrangement studies generally help determine the clonality in atypical lymphoid aggregates. The other lymphomas that can involve the GI tract include mantle cell lymphoma, large B-cell lymphoma, enteropathylike T-cell lymphoma, and Burkitt lymphoma.
  42. Guest

    Guest Guest

    Anticoagulant Therapy Uses
    - prevent new clot formation.
    - stop existing clots from growing.
    - It is used in patients with heart valve disease, dysrhythmias, hemodialysis, and patients on bed rest.

    Heparin USE
    IMMEDIATE EFFECT IS NEEDED.

    Coumarin USE
    LONGTERM THERAPY

    COUMARIN IS POSSIBLY EFFECTIVE FOR
    TRANSIENT CEREBRAL ISCHEMIC ATTACKS (TIA)

    Indanedione (Phenindione) USES
    treat pulmonary emboli and as prophylaxis in deep vein thrombosis, myocardial infarction, rheumatic heart disease w/ valve damage, and atrial dysrhythmias.

    Low Intensity Coumadin Therapy USE
    prothrombin time ratio between 1.2 and 1.5 decreases risk of stroke

    Do local anesthetics bind to the activated or inactivated sodium channels?
    Inactivated

    What is the drug of choice for treating Tourette syndrome?
    Pimozide

    What mosquito is responsible for the transmission of malaria?
    Anopheles mosquito

    What enzyme is inhibited by disulfiram?
    Acetaldehyde dehydrogenase

    Which diuretic is used as an adrenal steroid antagonist?
    Spironolactone

    What drug is given transdermally for chronic pain but can cause chest wall rigidity if given IV?
    Fentanyl
  43. Guest

    Guest Guest

    COUMARIN AND HEPARIN MOST COMMON ADVERSE REACTIONS
    EXCESSIVE BLEEDING AND THROMBOCYTOPENIA

    Early signs of overdosage or internal bleeding include
    bleeding gums, oozing from cuts, unexplained bruising/nosebleeds, heavy/unexpected menses.

    Warfarin ADVERSE REACTIONS
    alopecia, rash, urticaria, cramping, diarrhea, intestinal obstruction, nausea, paralytic ileus, vomiting, excessive uterine bleeding, hemorrhage, with excessive dosage, leukopenia, and fever

    What is the drug of choice for penicillin-resistant gonococcal infections?
    Spectinomycin

    What is the DOC for treating torsade de pointes?
    Magnesium

    Is heparin contraindicated in pregnancy?
    No. Heparin is safe in pregnancy, but warfarin is contraindicated in pregnancy because of its ability to cross the placenta.

    What oral antifungal agent is used to treat dermatophyte infections by disrupting microtubule structure and depositing keratin?
    Griseofulvin

    Which anticonvulsant can cause teratogenic craniofacial abnormalities and spina bifida?
    Carbamazepine

    What is the path of fluid in the body when a burn occurs?
    Initially, entire body swells and third spaces fluid, then they become hypovolemic. A few days later they will enter a diuretic stage

    How long does the hypovolemic stage last?
    onset to 72 hours

    What are characteristics of the hypovolemic stage?
    -rapid fluid shifts
    -implications of edema
    -vascular compensation (short lived)
    -possible dehydration
    -changes in serum electrolytes and protein

    What are the major electrolytes affected during the hypovolemic stage?
    sodium and chloride
  44. Guest

    Guest Guest

    a1-ANTITRYPSIN DEFICIENCY
     PATHOPHYSIOLOGY—production of an abnormal protease inhibitor (homozygous ZZ) with impaired transport out of the liver. Serum level is only 10–15% of normal ! increased protease activity leads to emphysema and cirrhosis (10%)
     DIAGNOSIS—a1-antitrypsin levels
     TREATMENTS—similar to COPD, a1-antitrypsin replacement

    BRONCHIOLITIS OBLITERANS
     PATHOPHYSIOLOGY—severe inflammation of bronchioles ! airflow obstruction. Very different from bronchiolitis obliterans organizing pneumonia (BOOP)/cryptogenic organizing pneumonia (COP), a parenchymal lung disorder
     CAUSES—infection (viral, mycoplasma), inflammatory (ulcerative colitis, rheumatoid arthritis), transplant (bone marrow, lung), toxic fumes, idiopathic
     TREATMENTS—bronchiolitis obliterans (with an organizing intraluminal exudate and proliferative granulation tissue polyp) is usually steroid responsive. Constrictive bronchiolitis (late, fibrotic, concentric) is not responsive to glucocorticoids
  45. Guest

    Guest Guest

    What are the molecules of the B cell transduction complex
    Ig-α, Ig-β, CD19, CD20

    Describe the T cell receptor
    Has two chains - α and β. The carboxy terminals anchor the molecules to the membrane while the N-terminals form the idiotype which binds a small peptide sequence presented by antigen-presenting cells

    What are the molecules of the T cell transduction complex
    CD3

    Define VDJ recombination
    It’s the process by which B cell Ig heavy chain gene's (and T cell β chain gene's) V, D and J segments are randomly recombined and spliced to form the unique N terminal sequence or idiotype of the B and T receptors
  46. Guest

    Guest Guest

    Heparin ADVERSE REACTIONS
    hyptertension, headache, hematoma, irritation/pain at injection site, conjunctivitis, tearing of eyes, rhinitis, erectios, hemorrhag,e thrombocytopenia, shortness of breath, wheezing, chills, fever, alopecia.

    Heparin DRUG INTERACTIONS
    Increase heparin: coumarin, indanedione, methimazole.
    Increase risk of bleeding when taken with heparin: acetysalicylic acid, coumarin, dextran, NSAIDS.
    Increase risk of GI bleeding/hemorrhage when used with heparin: ASA, corticotropin, ethacrynic acid, glucocorticoids, and NSAIDS.
  47. Guest

    Guest Guest

    What are the three Beta-lactamase inhibitors?
    1. Clavulanic acid
    2. Sulbactam
    3. Tazobactam

    Which anticonvulsant used in the treatment of bipolar disorder is refractory to lithium?
    Carbamazepine

    Are antineoplastic agents that work on actively proliferating cells schedule or dose dependent?
    Schedule dependent; antineoplastic agents that work on nonproliferating cells are dose dependent

    Which class of diuretics is used to treat metabolic alkalosis, acute mountain sicknesses, and glaucoma and to aid in the elimination of acidic drug overdoses?
    Carbonic anhydrase inhibitors (acetazolamide and dorzolamide)
  48. Guest

    Guest Guest

    Define: hapten
    Single antigenic determinants. An antigen with a single epitope. Needs to form an hapten-carrier complex to induce an immune response

    Leukocyte adhesion deficiency
    Absense of CD18 (β chain of LFA-1 integrin). No adhesion of leukocytes. Omphalitis, no abscess or pus formation.

    Chemoattractants for neutrophils
    IL-8, C5a, LTB4, formyl methionyl peptides from microorganisms

    Opsonins
    Fc portion of IgG, C3b. Macrophages and eosinophils have recptors

    NADPH oxidase
    Synthesizes superoxide radicals for respiratory burst

    Myeloperoxidase
    Lysosomal enzyme converts H2O2 + Cl- --> hypochlorite (bleach) which is microbicidal

    Pathophysiology of CGD =Chronic granulomatous disease (CGD
    Deficiency of NADPH oxidase with no production of superoxide radical and H2O2 which is the substrate for myeloperoxidase to produce bleach. In catalase(-) infections myeloperoxidase uses H2O2 produced by the bacteria. If it's catalase(+), H2O2 is degraded by the bacterial catalase and theres insuficient respiratory burst response to kill Staph, pseudomona, serratia, aspergillus. Dx.: with negative nitroblue tetrazolium test

    MHC-I and MHC-II coreceptors on T cells
    MHC-I --> CD8; MHC-II --> CD4

    LFA-1
    On T cells binds ICAM-1 on macrophages to increase cell-cell adherence during antigen presentation
  49. Guest

    Guest Guest

    Coumadin DRUG INTERACTIONS
    Increase PT response when used with Coumadin: allopurinol, ASA, anabolic steroids, antibiotics, androgens, sedatives, antacids, dextran, quinine, salicylates, thyroid drugs, vitamin E.
    Decrease PT/INR response when used with coumadin: adrenocorticosteroids, antacids, antihistamines, barbiturates, contraceptives, thiazide diuretics, and vitamin K.

    Nursing Implications with Coumarin
    - Coagulation, PT, INR tests ordered.
    - Weight base dosing
  50. Guest

    Guest Guest

    Which class of diuretics is used to treat metabolic alkalosis, acute mountain sicknesses, and glaucoma and to aid in the elimination of acidic drug overdoses?
    Carbonic anhydrase inhibitors (acetazolamide and dorzolamide)

    What estrogen receptor agonist in bone is used in the treatment and prevention of osteoporosis?
    Raloxifene

    Which tetracycline is used in the treatment of SIADH?
    Demeclocycline

    How is the eye affected by use of opioids?
    With opioid use the pupils become pinpoint (miosis) because of increased cholinergic activity.

    Name the antimicrobial agent whose major side effect is listed.
    • Grey baby syndrome
    Chloramphenicol

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