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dr taher classes HK > CVS 11 > Flashcards

CVS 11 Flashcards

1
Q

types of inflammatory bowel disease HLA classification

A

Crohns and UC

HLA b27

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2
Q

other HLAB27

A

PAIR

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3
Q

which one of the IBD has granuloma formation

and which type of T helper response

A

Crohns

TH1

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4
Q

cytokines needed for granuloma

A

IL2 and IFN gamma

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5
Q

MHC classes and IBD

A

Crohns MHC I

UC MHCII

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6
Q

MHC I is present on which types of cells

A

all nucleated cells including platelets and virally infected cells EXCEPT RBC

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7
Q

MHCI antigen presentation

A

Endogenous pathway
large endogenous peptide is broken down to a proteosome—- transported to ER by TAP (molecular channel) —- loaded on the MHC I—- shuttled through golgi to the cell membrane

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8
Q

structure of MHC I and MHC II

A

MHCI —- heavy alpha 1 2 3 and small B2 globulin

MHC II — alpha 1 alpha 2 beta 1 beta 2 and INVARIANT chain

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9
Q

MHC II is present on

A

macrophages
dendritic cells
B lymphocytes

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10
Q

antigen processing of MHC II

A

EXOgenous
antigen is brought inside from extracellular site by phagocytosis (crush antigen) (phagolysosome)——- MHC II binds with phagolysosome —– the acidic ph in lysosome destroys the INVARIANT CHAIN—— free peptide binding groove exposed and antigen binds here

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11
Q

HLA A1

A

SLE

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12
Q

HLA A3

A

hemochromatosis

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13
Q

HLA B8

A

addison/ graves/ myasthenia gravis

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14
Q

HLA B27

A

PAIR

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15
Q

what does seronegative spondyloarthropathies mean?

A

negative for rheumatoid factor

which is igM against Fc of IgG

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16
Q

HLA C

A

psoriasis

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17
Q

HLA DQ2 DQ8

A

celiac disease

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18
Q

HLA DR2

A

multiple sclerosis/ SLE / hay fever/ Good pasture

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19
Q

HLA DR 3

A

Diabetes/ addison/ graves/ MGravis/ HASHIMOTO

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20
Q

HLA DR4

A

Diabetes/ addison

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21
Q

HLA DR5

A

HASHIMOTO/ RA/ Pernicious anemia

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22
Q

crohn disease mannifestation

A 
SISTER 
Skip lesions
Ileum affected m/c site
Sacharomyces cerevisae antibody
Transmural 
Extra fibrosis and FISTULA
Radiology string sign

Rectum is SPARED!!

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23
Q

Ulcerative colitis mannifestation

A 
Ulcers in mucosa submucosa (not muscularis)
Continuous retrograde
Originates rectum
Lead pipe
Increased cancer risk
Toxic megacolon
Increased growth from mucosa (pseudo polyps)
Severe symptoms
24
Q

types of fistulas in crohsn

A

entero enteric
entero vesicular
entero cutaneous (abd wall)
perianal

25
Q

enterovesicular fistula characteristic finding

A

pneumoturia

26
Q

other symptoms of crohns

A

fever fatigue
cobble stone mucosa (wavy appearance)
CREEPING fat — mesenteric fat wraps around bowel)
edematous and fibrosis of bowel (thickening)

27
Q

other symptoms of crohns

A

EYE – uveitis (iris, cilliary, choroid)
MOUTH — apthous ulcers
JOINT — arthritis
RASH — pyoderma gangrenosum, erythema nodosum

INCREASE RISK OF CALCIUM OXALATE STONES

28
Q

how does crohns increase risk of calcium oxalate stonse

A

normally calcium + oxalate —- forms salts in gut and is excreted
due to malabp calcium undergoes saponification with fat — oxalate has no calcium to bind to — it gets absp in the gut — filtered to the kidney and forms calcium oxalate stones here

29
Q

risk of calcium oxalate stones is also increased in?

A

increased ascorbic acid VIT C
most stones are formed in acidic conditions except
1. calcium PHosPHate
2. ammonium mg PHosPHate

30
Q

mnemonic for acidic vs alkaline stones

A

most stones form at low PH except

  1. calcium PHosPHate
  2. ammonium mg PHosPHate
31
Q

blood bag has these components

A

Acid — to shift O2 curve to right … o2 unloading
Citrate —– binds calcium — no coagulation
Dextrose —- RBC nutrition — increases 2,3 BPG

32
Q

radioopaque stones

A

almost all are radio opaque except radioLUcent

uric acid stones

33
Q

shape of calcium oxalate stones

A

envelope/dumbells

34
Q

shape of calcium phosphate stones

A

wedge shape

35
Q

shape of uric acid stones

A

rhomboid rossettes

36
Q

shape of ammonium magnesium phosphate stones

A

coffin lid

37
Q

shape of cysteine stones

A

hexagonal

38
Q

treatment of calcium phosphate stones

A 
haydrate
low sodium 
thiazide diuretics 
citrate 
remmber phosphate stones precipitate in alkaline media so giving citrate can  help
39
Q

who has risk of uric acid stones

A 
lesch nyhan 
tumor lysis syndrome 
uricosuric drugs (probenacid, sulfinpyrazon)
HIGH dose aspirin
von gierke disease (hepatic glucose 6 psptase)
thiazide 
niacin 
male 
diabetes
HTN
obesity 
alcohol 
red meat
40
Q

what kind of crystals are seen in gout under polarized light

A

negatively birefringent crystals
yeLLow when paraLLel light
blue wen perpendicular light

41
Q

tophus can be seen in

A

olecranon bursa
external ear
achiles tendon

42
Q

pseudogout what kind of crystal?

A

calcium phosphate in the joint

Positive birefingent

43
Q

risk factors for pseudogout

A

hemochromatosis
trauma
hyperpartahyroidism

44
Q

what can be seen on imaging in pseudo gout

A

chondrocalcinosis

blue when parallel to light

45
Q

what happens in tumor lysis syndrome

A

hyperkalemia postassium leaves damaged celsl
hyperphosphatemia
hyperuricemia due to nucleic acids broken down
free calcium decrease (ca + phosphate) — tetany

46
Q

struvite staghorn calculus in adults and children

A

Adults —- Ammonium magnesium phosphate

Children —- cysteine

47
Q

causes for ammonium magnesium phosphate stones

A 
urease producing bacteria 
PUNCHKISS
Proteus
Ureaplasma urealyticum
Nocardia
Cryptococcus
H pylori
KI klebsiella
S. epidermis ( NO sensitive)
S. saprophyticus (NO resistant)
48
Q

cysteine stones are linked to which condition

A 
AR COLA
Cysteine
Ornithine
Lysine
Arginine

normally it is abspd in PCT

49
Q

how to diagnose cystinuria

A

sodium cyanide nitropruside —- turns blue

50
Q

what can be seen on histology in crohns disease

A

paneth cells metaplasia

abcess —- perforation —– peritonitis

51
Q

treatment for crohns

A

steroids
azathioprine ( PRPP amidotransferase -)
TNF alpha (infliximab / adalimumab)
cipro/ metronidazole

52
Q

does UC have granulomas?

A

NO

53
Q

perinuclear anti neutrophil cytoplasmic antbodies seen in P ANCA

A

primary sclerosing cholangitis
microscopic polyangitis
churg straus

54
Q

what can be seen in UC

A

haustras are lost
toxic megacolon
crypt abcess
primary sclerosing cholangitis

55
Q

treatment for ulcerative colitis

A

5 amino salicylic acid (mesalamine)
6mp/ azathioprine
colectomy

56
Q

sulfasalazine breaks down into

A
  1. sulfapyridine (RA)

2. 5 amino salicylic acid (UC)

dr taher classes HK (24 decks)

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