0519

Question 1

common presentation of ankylosing spondylitis

Answer 1

morning stiffness and back pain

affects sacroiliac joint and axial skel

Question 2

what is rheumatoid factor?

Answer 2

IgM Abs against self-IgG.
present in most RA pts.
NOT found in seronegative spondyloarthropathies.

Question 3

communicating hydrocele

Answer 3

when tunica vaginalis remains in communication with peritoneum.

serous fluid accumulates w/ in tunica vaginalis.

Question 4

injury due to mastectomy

Answer 4

long thoracic nerve (axillary region)-
winged scapula.
inability to abduct shoulder past 90 deg.

Question 5

complete abduction of arm over head requires?

Answer 5

serratus anterior -

supraspinatus and deltoid only abduct arm up to horizontal position

Question 6

midshaft fracture of humerus may injure…?

Answer 6

deep brachial a.

radial n.

Question 7

supracondylar fracture may injure…?

Answer 7

brachial a.

Question 8

what epidemiological parameters are influenced by disease prevalence?

Answer 8

PPV and NPV

Question 9

repeated and prolonged kneeling can cause?

Answer 9

prepatellar bursitis
“housemaid’s knee”

commonly seen in roofers, carpenters, plumbers.

Question 10

sx of prepatellar bursitis

Answer 10

knee pain.
erythema.
swelling.
inability to kneel on affected side.

Question 11

TX of tension pneumothorax

Answer 11

emergent needle thoracostomy or chest tube

Question 12

where do lung apices extend to?

Answer 12

(along with cervical pleura) above clavicle and first rib through superior thoracic aperture of neck

Question 13

what can be injured by stab wounds immediately above clavicle?

Answer 13

(lateral to manubrium)

punctured pleura = pneumothorax (tension or hemo)

Question 14

what injury could affect ansa cervicalis?

Answer 14

penetration of neck above cricoid cartilage

Question 15

what injury can affect accessory nerve?

Answer 15

posterior triangle of neck (bordered by SCM, trapezius, and clavicle)

Question 16

what mediates delayed-type hypersensitivity rxns?

Answer 16

Th1 lymphocytes - release IFN-g to recruit and stimulate macrophages.

(takes DAYS for effect)

Question 17

TX of IL-12 receptor deficiency

Answer 17

IFN-g

bc pts lack IL-12 to stimulate Th1 cells that produce IFN-g to activate macrophages and mount granulomatous imm response

Question 18

MHC involvement in polymyositis

Answer 18

increased expression of MHC proteins by MUSCLE CELLS = autoAg is presented, recognized by cytotoxic T cells that initiate muscle destruction

Question 19

what cells infiltrate endomysium in polymyositis?

Answer 19

macrophages and CD8+ T cells

Question 20

serum studies of polymyositis

Answer 20

increased creatine kinase.

anti-Jo-1 Abs.

Question 21

positive Trendelenburg test

Answer 21

injury to superior gluteal n.

weakness of gluteus medius and minimus

Question 22

inferior gluteal n. innervates?

Answer 22

gluteus maximus - injury causes difficulty rising from seated position and climbing stairs

Question 23

supraspinatus tendon injury

Answer 23

most common rotator cuff injury.

impingement between acromion and head of humerus.

Question 24

test for supraspinatus injury

Answer 24

“empty can”: abduct arms to 90 deg then flex 30 deg with thumbs pointing to floor

Question 25

when is hyperacute transplant rejection often diagnosed?

Answer 25

intraoperatively due to immediate mottling of donor organ when perfused by recipient bld

Question 26

IgA protease

Answer 26

produced by Neisseria (meningitidis and gonorrhoeae).

cleaves secretory IgA at hinge region to make it ineffective.

Question 27

what does lupus anticoagulant in SLE do?

Answer 27

10-30% of pts.
prolonged PTT.
false positive VDRL.
but no other hematologic changes.

Question 28

what syndrome can lupus anticoagulant cause?

Answer 28

antiphospholipid Ab syndrome-
elevated bld levels of antiphospholipid Ab with hypercoagulability (venous and arterial thromboembolism) and/or repeated tri 2-3 miscarriages

Question 29

antibody-dependent cellular cytotoxicity (ADCC)

Answer 29

method of killing that depends on ability of imm cell to recognize specific Ab bound to cell and trigger death of that cell without use of complement.

used by:

1. eosinophils
2. macrophages
3. NK cells

Question 30

what specific complement molecule binds IgG and IgM?

Answer 30

C1, which activates the rest of the classic complement cascade

Question 31

what blood cell does EBV prefer to infect?

Answer 31

B lymphocytes (CD21 cell surf receptor)

as a result, CD8+ cytotoxic T cells clonally expand to destroy virally infected cells– these are the cells that look REACTIVE/ATYPICAL on smear

Question 32

what are possible causes for recurrent N.gonorrhoeae infx?

Answer 32

1. antigenic variation- modify outer membrane proteins.

2. terminal complement deficiency- can’t form MAC.

Question 33

Fanconi anemia

Answer 33

caused by hypersensitivity of DNA to cross-linking agents

Question 34

Bloom syndrome

Answer 34

generalized chromosomal instability.

increased susceptibility to neoplasms.

Question 35

lymphocytic interstitial pneumonia

Answer 35

affects AIDS pts.

low CD4:CD8 ratio (vs sarcoidosis, which has high CD4:CD8 ratio)