Pages 434-438

Question 1

A 40 yo female comes in with a Hx of dyspnea especially after climbing stairs. HR and pulse are normal. After doing pulmonary function test, results show an elevated FEV1/FVC ratio. She also has a slight facial droop that has been worsening over the months. What pathology is associated with these symptoms, and what findings are prominent on imaging?

Answer 1

The pt has Sarcoidosis and hilar nodes are prominent on CXR known as potato sac lymph adenopathy bilaterally. The facial droop is due to Bell’s palsy.

Question 2

A physician orders a biopsy for an African descent patient with positive HX for Sarcoidosis. What will be found int he biopsy (appearance and inclusions)?

Answer 2

Epithelioid granulomas containing Asteroid and Schuamann bodies

Question 3

A physican orders lab test for a 40 yo female with interstitial fibrosis suspected of Sarcoidosis. What metabolites will be elevated and the mechanism behind the pathology

Answer 3

Hypercalcemia. Sarcoidosis causes increased activation 1 alpha hydroxylase int eh kidney. This mediates Vitamin D activation and leads to increased Ca reabsorption

Question 4

A 60 yo female comes into the ER complaining of severe pain in her hips. She previously stated that she has been having intermittent pain in her forehead. What disease is she affected by at the moment? Which lab results will be found?

Answer 4

Polymyalgia Rheumatica –> Assoc with GCA. Lab reults will show elevated ESR, CRP

Question 5

A 40 yo female comes to her family physician complaining of pain and stiffness in her muscles. She also feels lethargic during the day, and is having trouble sleeping at night. What Dx do the physician make and what does he prescribe?

Answer 5

Fibromyalgia

TX with SNRI/TCA and regular exercise

Question 6

A patients come in a malar rash and redness on her hands. The physician also notices that the patient’s hands look roughed up as if she has been working outside with her hands. What is the Dx and TX?

Answer 6

Dermatomyositis with perimysial inflammation from CD4 Th cells. Tx with corticosteroids + MTX

Question 7

Immunopathologically how does Polymyositis differ from dermatomyositis?

Answer 7

Polymyositis- Cd8 +CTL induced endomysial inflammation

Dermatomyositis - CD4+ Th cells induced permysial inflammation

Question 8

A 40 yo female comes in with a Hx of dyspnea especially after climbing stairs, and has lost 10 lbs of weight in the last 3 months. HR and pulse are normal. She also feels tired easily and feels weakness in washing dishes in the morning and prefers to do them at night time. What pathology is associated with these symptoms, and what underlying mechanism is associated with it?

Answer 8

Patient has Lambert Eaton syndrome where the Abs are destroying her presynaptic Ca Ch and decrease ACh release in the NMJ. LE syndrome is associated with Small CC of the lung which explains the dyspnea and cachexia b/c

Question 9

How does Myasthenia Gravis differ from LE with regards to muscle movement? Why?

Answer 9

Muscle weakness worsens as the day progresses b/c Abs are against the AcH receptor. As the day ends the ACh receptors decrease which causes increased weakness later.

Question 10

A 45 yo female comes into her physician and complains of increased tightness and puffiness in her skin. She also shows that fingertips around her nails feel rougher than usual. What is the physician worried about after confirming his DX with these lab results to be positive?

Answer 10

The patient is positive for anti topisomerase I Ab (SCl-70) as and has Diffuse systemic Scleroderma. These patients have a high mortality rate with renal and pulmonary sclerosis.

Question 11

Name the findings in Limited Scleroderma (5 S/S) and the Ab associated with the path?

Answer 11

Limited Scleroderma is associated with anti centromere AB

CREST syndrome

1) Calcinosis
2) Raynaud’s phenomenon
3) Esophageal dysmotility
4) Sclerodactyly
5) Telengectasia

Question 12

Name the pathology associated with this dermal morphology: honey crusts

Answer 12

Impetgio caused by GAS

Question 13

Name the pathology associated with this dermal morphology: transient smooth plaque/papule known as wheal

Answer 13

Urticaria

Question 14

Name the pathology associated with this dermal morphology: bulla

Answer 14

Bullous pemphigoid,

Question 15

Name the pathology associated with this dermal morphology: flaking off skin, scales

Answer 15

Psoriasis Eczema

Question 16

Hemidesmosomes connect ————— to ————? Which pathology is associated with it?

Answer 16

keratin in basal cells ; basement membrane. Bullous pemphigoid

Question 17

Which layer of the epidermis produces progenitor cells

Answer 17

Stratum Basale

Question 18

Which layer of the epidermis has diffuse layers of keratin?

Answer 18

Stratum Corneum

Question 19

Which layer of the epidermis has desmosomes? Which pathology is associated with them

Answer 19

Stratum spinosum. Auto immune destruction of desmosomes is observed in pemphigous vulgaris

Question 20

Which structure allows for communication in gaps junctions?

Answer 20

Connexons (channel proteins)

Question 21

Loss of these filaments with these abnormal proteins in this junction leads to metastasis?

Answer 21

Mutated E-cadherins without actin filaments in Zonula adherens (Adherens JXN)

Question 22

Which tumors is MG associated with

Answer 22

Thymoma

Question 23

Which type of hypersensitivity is Vitiligo associated with

Answer 23

Type IV

Question 24

Failure of NC to migrate to the skin and decreased number of melanocytes

Answer 24

Piebaldism

Question 25

normal migration of NC cells with decreased melanin granules

Answer 25

Albinism

Question 26

What two conditions can lead to freckle like hyperpigmentation of the face in females?

Answer 26

1) Pregnancy

2) OCP usage

Question 27

Differentiate b/w Acantholysis and Acanthosis (pathologies associated with it)

Answer 27

Acanthosis- epidermal hyperplasia (nigricans in metabolic syndrome)

Acantholyis- separation of epidermal cells (pemphigus vulgaris