Bbc: Session 6: 50-56

Front 1

What kind of neoplasm is a multiple myeloma and what do the myeloma cells produce?

Back 1

-plasma cell neoplasm (SOLID)
-myeloma cells produce:
excess intact IgG or IgA and excess LIGHT chains
osteoclast activating factor (IL-6 which produces osteolytic lesions--> punched out lesions)
IL-1 which is another potent osteoclast

Front 2

A patient presents with flame cells, fatigue, weaknessm skin and mucosal bleeding, headached, visual problems, and neurological problems. What are flame cells and what is this disorder due to?

Back 2

Flame cells - eosinophilic neoplastic plasma cells
Waldenstrom's macroglobulinemia which is due to overproduction of IgM (huge molecule that tremendously thickens the blood

Front 3

What is atherosclerosis due to (including risk factors) and what cytokines are involved?

Back 3

-due to high LDL cholesterol (contains foam cells) in large or medium sized arteries with a calcium covering
-smoking and homocysteine (fix by giving B12) excess are risk factors
-IL-1 and TNF-alpha

Front 4

Compare and contrast hyaline and hyaline arteriosclerosis.

Back 4

both affect small arteries and arterioles but hyaline is called nephrosclerosis with kidney
hyperplastic: affects media, has an onion skin appearance, and is compensatory resulting from malginant HTN (>210 / or >150)
hyaline: affects BM, from inflammation and use; from HTN, old age, DIABETES MELLITUS

Front 5

What are the blood vessels affected by the different types of arteritis?

Back 5

large vessels - giant cell, Takayasu
medium vessels - Polyarteritis nodosa, Kawasaki, thromboangiitis obliterans
small vessels - Wegener's, Henoch-Schonlein, hypersensitivty arteritis, Churg-Strauss, microscopic polyangiitis, thromboangiitis obliterans

Front 6

Compare and contrast Polyarteritis nodosa and microscopic polyangitts

Back 6

both are due to WBCs invading BV walls to cause inflammatory damage but PAN - medium sized arteries and microscopic is small BV

PAN: secondary to HBV, HCV, or hair cell leukemia; fever, ab pain and melena, renal disease (without glomerulonephritis) with HTN, neuritis of motor neurons, diffuse myalgia, fatal in most untreated

microscopic: usually initated by reaction to drugs, +p-ANCA, causes severe glomerulonephritis (to become RPGN) and pulmonary capillartiis, palpable purpura, hemoptysis, hematuria, mylagia

Front 7

What do you do if you suspect a person has giant cell arteritis and what is the systemic form of this disease called?

Back 7

start them on steroids immediately
polymylagia rheumatica - flu-like symptoms with arthralgia and myalgia

Front 8

A patient has a history of asthma and presents with recurrent attacks of asthma that are not being affected by their medication. What type of vasculittis do they have and how does it present?

Back 8

Churg-Strauss
granulomas + WBC infiltrates in BV wall, massive eosinophil invasion in both vessel wall and surrounding tissues
+p-ANCA
affects mostly BV of skin, nerves, muscles, LUNG, HEARt
death usually results from coronary vessel destruction +/- myocarditis
mostly confined to occuring in patients with a history of asthma

Front 9

What is a vasculitis that causes a positive anti-human oral mucosa antibodies and can be confused with herpes and how does it present?

Back 9

Behcet's syndromee is a vaculitis of veins and venules
recurrent painful oral and genital ulcerations +/- uveitis, iritis, arthritis of knees
may cause life-threatening brain and GI damage
males get it much more severely

Front 10

A patient presents with aortic regurgitation and "tree-barking" of the initma, what cuased this and what do they have?

Back 10

Trponema pallidum causes an obliterative endarteritis of vasa vasorum of thoracic aorta and results in a syphilitic = luetic aneusym (tertiary syphillis)

Front 11

How does an aortic dissection present?

Back 11

major risk facotr is hypertension, Marfan's syndrome,
horrible,tearing chest pain that radiates to the back, different pulses

Front 12

What is the different between micro and mycotic aortic dissection?

Back 12

micro = small cerebral aneursyms due to HTN or small retinal aneuryms secondary to diabetes
mycotic = due to infections of vessel wall; usually BACTERIAL; infection damages the media, allowing for wall weakening (infection is in the wall itself)

Front 13

What are the DOC for mycobacterium avium complex (MAC) in a person with HIV?

Back 13

clarithromycin, ethambutol, rifampin

Front 14

For people with HIV, what is the DOC for the treatment and prophylaxis of Pneumocystis? prophylaxis and treatment for toxoplasmosis?

Back 14

TMP-SMX for all
another DOC for toxoplasmosis = pyrimthamine + sulfadiazine + leucovorin

Front 15

For a person with HIV, what are the DOC for prophylaxis against coccidiodomycosis? for prophylaxis or histoplasmosis?

Back 15

coccidiomycosis - fluconcazole or itraconazole
histoplasmosis - itraconazole

Front 16

What is the DOC for mycoplasma pneumoniae?

Back 16

macrolides

Front 17

What is the DOC in penicillin allergic patients?

Back 17

erythromycin

Front 18

What is the DOC for anaerobic infections that occur above the diaphragm?

Back 18

Clindamycin

Front 19

What purine analog is used to treat ALL?

Back 19

mercaptopurine

Front 20

What pyrimidine analogs treat nonlymphocytic leukemias?

Back 20

cytarabine

Front 21

What pyrimidine analog is used to treat slow growing tumors, such as breast, colorectal, and gastric tumors?

Back 21

5-FU (florouracil)

Front 22

What is the main drug class used in HAART and what drugs belong to this class?

Back 22

nucleoside reverse transcriptase inhibitors (NRTIs)
Didanosine
Lamivudine
Tenofovir
Zidovudine
Emtricitabine

Front 23

What are the drug combos that can be used for HIV therapy and when should they be initiated?

Back 23

2 NRTIs (usually tenofovir + emtricitabine) + (1 NNRTI OR 1 boosted PI OR 1 integrase inhibitor OR 1 CCR5 antagonist) --> (NOT FUSION INHIBITORS)

start: anyone who is HIV + anddddd
CD4 <350
AIDS defining illness
HIV associated nephropathy
current Hep B infection
pregnant

Front 24

How do you treat HIV + pregnant women?

Back 24

2 NRTIs + 1 PI
lopinavir + zidovudine + lamivudine
C-section

Front 25

With regard to folate metabolism, which drugs inhibit dihydropteroate synthase (only in bacteria-making folate) and which drugs inhibit dihydrofolate reductase (bacteria and eukaryotes-using folate)?

Back 25

synthase - sulfamethozazole, sulfadizine, sulfasoxazole, dapsone
reducatase - trimethoprim, pyrimethamine, methotrexate

Front 26

When do you administer MMR and HBV vaccines to patients with HIV?

Back 26

MMR - patients with CD4 >500
HBV - patients who have never been exposed

Front 27

What drugs inhibit translation at the 30 and 50s?

Back 27

30s - aminoglycosides (bacterioCIDAL), tetracyclines (bacteriostatic)
50s - chloramphenicol (bacteriostatic), erthromycin (bacteriostatic and other macrolides), clinidamycin (protein syn inhibitor reserved for fighting special infections)

Front 28

What is a protein synthesis inhibitor in Eukaryocytes?

Back 28

Diphteria toxin

Front 29

What are the 4 anti-folate drugs, what does this inhibit and what adverse effect can it lead to?

Back 29

pyrimethamine
trimethamine
all sulfa antibiotics
dapsone

inhibits DNA replication

can lead to megaloblastic anemia

Front 30

What drug causes psuedotumor cerebri and who should this drug be avoided in?

Back 30

tetracyclines (obese, fertile women)

Front 31

What drug causes aplastic anemia and grey baby syndrome?

Back 31

chloramphenicol

Front 32

DOC for UTI treatment

Back 32

TMP-SMX

Front 33

What drug causes fever, malaise, bone pain, conjunctivitis, rash, and chest pain and what is this reaction called?

Back 33

"cytarabine syndrome"
cytarabine (pyrimadine analog used to treat non-lymphocytic anemia) causes it

Front 34

What antibiotics work by inhibiting DNA replication?

Back 34

dactinomycin, doorubicin, bleomycin, (first three treat cancer becausecytoxic to human cells); fluoroquinolones

Front 35

What drug causes risk of joint cartilage injury esp Achille's tendon rupture in kids <16 and what can cuase a false-positive urine assay for opiates?

Back 35

Fluroquinoles

Front 36

What type of pain does atlas dysfunction typically cause?

Back 36

retro-orbital pain

Front 37

What does the spinal cord end in most people and where is the site of a typical lumbar puncture? 35

Back 37

Spinal cord ends at L1-2
Lumbar puncture is L4-5

Front 38

What is the difference between sacralization and lumbarixation? 36

Back 38

sacralization - one or both of the transverse processes of L5 articulate with the sacrum
lumbarization - SI failes to fuse with the rest of the sacrum, instead remaining as a separate vertebral segment

Front 39

Where can spina bifida occur and over how many segments does it usually occur? 37

Back 39

most common in sacral, lumbar, and lower thoracic regions and usually extends for 3-6 vertebral segments

Front 40

What is associated with a "Scotty dog" collar on x-ray and what is this caused by? 38

Back 40

Spondylolysis
fracture, disintegration or dissolution of a vertebra
causes achy low back pain exacerbated by any activity
on xray the pars interarticularis fracture is seen

Front 41

What is spondylolithesis and what is the congenital type called? 39

Back 41

anterior displacement of one vertebrae with respect to the vertebrae inferior to it, most common bw L4-L5 and represents a beheaded scotty dog
congenital type = type 1 - dysplastic spondylolisthesis which is a deficiency of L5 or sacral neural arch and deficiencies of superior sacral facets more common in girls

Front 42

What are the types of spondylolithesis? 40

Back 42

Type I = congenital type = dysplastic spondylolithesis
Type II = isthmic sponylolithsis - most common in people less an 50 type due to PATHOLOGY OF PARS INTERARTICULARIS
Type III = degenerative type - not seen in those less than 40
Type IV = Traumatic spondylolithesis - least common type
Type V = pathologic spondylolithesis - due to bone disease secondary to disorders such as cancer, Pagets, osteogenesis imperfecta etc

Front 43

What is the difference between ankylosis and spondylosis? 41

Back 43

ankylosis - abnormal immbolity of the joint - if true, then immobility is due to fusion of bones that form the joint and causes restriction of movement which can be accompanies by muscle spasms and achiness if neural structures are impinged
spondylosis - degenerative changes of the IV discs accompanied by ankylosis of adjacent vertebral bodies, leading to a narrowed spinal canal or neural foramen which causes chronic achy low back pain

Front 44

What is the most common and second most common anomalies of the lumbar area?

Back 44

most common = asymmetry of the joint facets known as zygopophyseal tropism
second most common = sacralization