21

Question 1

What gives rise to the jugular venous a, c, and v waves?

Answer 1

a wave- atrial contraction
c wave- ventricular contraction
v wave- atrial filling against tricuspid valve

Question 2

Which heart murmur is associated with weak pulses?

Answer 2

Aortic stenosis (pulsis paris et tardis)

Question 3

What are 4 high yield findings associated with Elhers Danlos Syndrome?

Answer 3

• easy bleeding/ bruising
• hypermobile joints w/ frequent dislocaiton
• hyper mobile skin
• aneurysms (esp berry!)

Question 4

Describe the process mediating type I hypersensitivity.

How long does this take?

Answer 4

Free Ag x-links IgE on presensitized mast/ basophils–>
Degranulation of histamine and bradykinin–>
Vasodilation, ^ vascular permeability –>
Edema/ urticaria/ hives
Takes 15 min

Question 5

Describe the process mediating type II hypersensitivity:

Answer 5

Abs (potentially autoAbs) + CELLULAR Ags–>

Complement/ MQ phagocytosis/NK cells destroy

Question 6

Describe the process mediating type III hypersensitivity:

Answer 6

Abs + SOLUBLE Ags in blood–>
Ab/Ag complex deposition in tissue–>
Complement/ MQ phagocytosis/ NK cells destroy

Question 7

Describe the process mediating type IV hypersensitivity.

How long does this take?

Answer 7

T cell + Ag–>
T cell releases IL2, IFN-g –>
Activation of MQs, tissue damage
Takes 4-12 hrs

Question 8

Describe activation of the classical complement pathway.

What is one inhibitor of this process?

Answer 8

IgG/IgM + Ag–> C1 ACTIVATION

*Inhibited by C1 INHIBITOR/ ESTERASE INHIBITOR protein

Question 9

Describe activation of the alternative complement pathway:

Answer 9

Does not require Abs

Can self activate/ bind microbial surface directly

Question 10

Describe activation of the lectin pathway:

Answer 10

Mannose biniding protein–> Mannose on microbial surface

Question 11

Common end result for all complement pathways:

Answer 11

MAC COMPLEX + CELL DISTRACTION

C5b, 5, 7, 8, 9

Question 12

Hereditary angioedema:
What is the deficient protein/ disease presentation
What should you be wary about when prescribing drugs to these patients?

Answer 12

Deficient C1 esterase inhibitor –> ^ Bradykinin
Patients present with angioedema surprise
NEVER GIVE ACEi’s !!!

Question 13

Deficient C3 Protein: How does this present?

Answer 13

Recurrent sinus infections/ RTIs

• strep penumo
• H flu
• ^ risk of Type III hypersensitivities

Question 14

Deficient MAC forming proteins:

How does this present?

Answer 14

Deficient C5b, 6, 7, 8, 9

- ^ risk neisseria bacteremia

Question 15

DAF/ CD55 Deficiency:

How does this present?

Answer 15

This deficiency causes failure in protection of “self” from complement mediated destruction
- Red cell lysis/ PNH

Question 16

Describe Paroxysmal nocturnal hemoglobinuria:

• What are the two deficient membrane surface molecules
• List 3 clinical features

Answer 16

• Deficient CD55 (GPI anchor for DAF)
• Deficient CD59 (MAC inhibitory protein)

Patients present with:

• chronic intravascular hemolysis
• hemosidenuria
• thrombosis

Question 17

Describe Paroxysmal nocturnal hemoglobinuria:

• 2 methods of dx
• 3 methods of tx

Answer 17

• Ham’s Test (cells will lyse in low pH)
• Flow cytometry for CD55 and CD59

Treat with transfusion, warfarin, Eculizumab

Question 18

Two opsonins in complement pathway:

Answer 18

C3b, IgG

Question 19

Two mediators of anaphylaxis in complement away (chemokine):

Answer 19

C3a–> mast, basophil activation

C5a –> recruits neutrophils

Question 20

Asthma 
Bee sting allergy 
Eczema 
Peanut Allergy 
Seasonal allergic rhinitis are all...

Answer 20

Type I hypersensitivity

Question 21

Acute hemolytic transfusion reaction 
Acute rheumatic fever 
Graves Disease 
ITP 
Myathemia Gravis are all...

Answer 21

Type II hypersensitivity

Question 22

Arthur’s reaction
PAN
Post-strep GN
RA are all…

Answer 22

Type III hypersensitivity

Question 23

Contact Dermatitis
GVHD
MS are all…

Answer 23

Type IV hypersensitivity

Question 24

A patient who suffers from recurrent neisseria infections may have…

Answer 24

MAC formers’ deficiency (C5b, 6, 7, 8, 9)

Question 25

Which complement is responsible for neutrophil chemotaxis:

Answer 25

C5a