12 April wk6-B

Question 1

Patient has DM, cholelithiasis, and diarrhea/steatorrhea. What is this a classic triad for?

Answer 1

Somatostatinoma

Question 2

What are the classic Sx of a somatostatinoma?

Answer 2

Triad: DM, diarrhea/steatorrhea, cholelithiasis Can also have weight loss and abdominal pain

Question 3

How would esophageal cancer present?

Answer 3

Dysphagia to solids and/or liquids, regurgitation of undigested food, aspiration pneumonia Risk Factors: alcohol, tobacco, acid reflux

Question 4

How would gallbladder cancer present?

Answer 4

Biliary colic, jaundice, calcifications within the gallbladder wall as seen on US

Question 5

What is a characteristic sign of a glucagonoma besides hyperglycemia, weight loss?

Answer 5

A scaling rash called necrolytic migratory erythema

Question 6

What is hemochromatosis?

Answer 6

AR disease that causes too much iron storage in cells leading to bronze DM

Question 7

What are the effects of somatostatin?

Answer 7

Decreases release of: insulin, glucagon, gastric acid, GH, all pancreatic and small intestine fluids Decreases contraction of gallbladder Acid stimulates its secretion and Vagal stimulation decreases it

Question 8

What are the two lab findings that are diagnostic of SLE?

Answer 8

Anti-Smith antibodies Anti ds-DNA antibodies

Question 9

What disease groups should be considered when a patient presents with chronic fatigue, weight loss, unexplained fevers?

Answer 9

Autoimmune disease Malignancy Chronic infection from HIV or TB

Question 10

What diseases present with a malar rash?

Answer 10

SLE Dermatomyositis Pellagra

Question 11

What are the classic findings in SLE?

Answer 11

Malar rash, photosensitivity, discoid rash, oral ulcers, arthritis, renal disease, anti-Smith Ab, anti-dsDNA Ab, ANA can also be present but is not diagnostic or specific.

Question 12

When would you see anti-centromere Ab’s?

Answer 12

Limited Cutaneous Systemic Sclerosis or CREST Syndrome Calcinosis Raynaud’s Esophageal Dysmotility Sclerodactyly Telangectasia Patient has hardened skin, reduced ROM of hands and face, subQ calcifications and difficulty swallowing

Question 13

When would you see anti SS-a and SS-b Ab’s?

Answer 13

Sjogren’s Syndrome

Question 14

When would you see elevated antistrepolysin AB? What are the other classic features of the disease?

Answer 14

Acute Rheumatic Fever Young patient with history of sore throat Migratory arthritis, pancarditis, chorea, erythema marginatum, subQ nodules, arthralgia, fever

Question 15

How can NSAID use affect the kidneys?

Answer 15

By blocking COX enzymes they prevent the production of PGE2 which dilates the afferent arterioles to the kidney. Without it, the kidneys have reduced perfusion and can cause ischemic injury.

Question 16

Patient is found to have eosinophils and RBC’s in the urine and has a fever, rash, and azotemia. What is the condition and what agents can cause it?

Answer 16

Eosinophils in the urine is a classic finding in Acute Interstitial Nephritis It is a type of allergic reaction to an agent This is classically caused by certain drugs that act as haptens and increase antigenicity: Penicillins, Sulfonamides, NSAID’s, diuretics, rifampin, isoniazid

Question 17

What is a kidney complication of Acyclovir?

Answer 17

Can deposit crystals in the renal tubules

Question 18

What are the most common pulmonary infections of HIV patients?

Answer 18

Pneumocystis Jiroveci TB Histoplasmosis capsulatum

Question 19

Features of Pneumocystis jiroveci

Answer 19

Most common pulmonary infection of HIV patients with low CD4 T-cell counts and not on prophylactic therapy. It is a disc-shaped yeast transmitted by inhalation and presents as exertional dyspnea, non-productive cough and fever. Lung lavage shows the yeast on silver stain and HE shows honeycomb lung. Common in lungs of animals and doesn’t cause a problem unless immunecompromised Extracellular pathogen often seen in cysts containing several nuclei Most common cause of death in AIDS patients Considered normal flora because so common Also found in kids with mirasmus Treat and prophylax with TMP-SMX

Question 20

Features of Histoplasma capsulatum

Answer 20

Dimorphic fungus that is a yeast in the body and a mold when cultured Soil fungus found in the Ohio and Mississippi river valleys Inhaled mold usually infects the lungs but can also disseminate Most commonly seen as yeast inside macrophages and PMNs CXR: granulomatous foci, miliary appearance Sx: Fever, pulmonary illness, weight loss, hepatomegaly Virulence factors: urease, ammonia, bicarbonate to blunt killing of phagolysosome T-Cell immunity essential–HIV patients susceptible

Question 21

What is the classic sign on histology of a CMV infection?

Answer 21

Owl-Eye Cowdry A inclusions

Question 22

What are the classic age groups for ALL, CLL, HCL, AML, CML?

Answer 22

ALL: most common leukemia of kids CLL: over 50 HCL: around 50, male predominates AML: most common leukemia of adults, around 65 CML: 30-60, male predominates

Question 23

Describe the lineage of cells produced by hematopoiesis

Answer 23

Question 24

What is terminal deoxynucleotidyl transferase (TdT)?

Answer 24

TdT is a marker for pre B and T cells

Used to identify ALL

Question 25

What disease is known for having Auer Rods?

Answer 25

AML

Acute Myelogenous Leukemia