Anaphylactic shock - Answer-Anaphylactic: is the outcome of a widespread
hypersensitivity to an allergen that triggers a reaction known as anaphylaxis.
Immunologic causes are related to inflammatory and vasodilatory effects triggered by a
pathologic allergic reaction to an antigen. Production of Mast cells, immunoglobulin E
(IgE), and low-affinity IgE receptor(FceRI) is induced by cellular response to the antigen
and contributes to the induction by cellular manifestations and anaphylactic severity.
Physiologic alterations related to inflammatory and immune response, similar to
neurogenic shock, are massive; vasodilatation, peripheral pooling, and relative
hypovolemia lead to decreased tissue perfusion and impaired cellular metabolism.
Anaphylactic shock is often severe and has immediate symptoms, including itchy rash,
throat swelling, and low blood pressure, related to the massive vasodilatation and
systemic inflammation that may progress to death in minutes if emergency treatment is
not rendered. Vascular effects include vasodilatation and increased vascular
permeability resulting in peripheral pooling and tissue edema. Symptoms include:
gastrointestinal (nausea, abdominal pain, vomiting, and diarrhea) cutaneous (erythema,
pruritus, urticaria, or angioedema), respiratory (SOB, coughing, rhinorrhea, tightening of
throat, difficulty swallowing, wheezing), cardiovascular (diaphoresis, pallor,
hypotension), or hematologic (fever, hemolysis). Other ominous signs are anxiety,
confusion, or impaired mentation. Treatment begins with the removal of the antigen.
Epinephrine is administered to decrease mast cell and basophil degranulation, cause
vasoconstriction, and reverse airway constriction. Volume expanders (LR) are given
intravenously to reverse the relative hypovolemia, and antihistamines and
corticosteroids are given to stop the inflammation reacti
/.Antigen Tumor Markers - Answer-Alpha-Fetoprotein (AFP)
-ANTIGEN
-Associated with Hepatocellular carcinoma (HCC)
-Used for screening in patients w/cirrhosis or hepatitis
-Can also be elevated in non-seminoma germ cell cancers
Bence Jones Proteins
-ANTIGEN (found in urine)
-Associated with Multiple Myeloma (detection/monitoring)
-Not found on routine UA, need protein electrophoresis
-Indicates plasma cell degeneration
-Can also be elevated in leukemia, lymphoma & bone mets.
Cancer Antigen 19-9 (CA 19-9)
-ANTIGEN
-Elevated with pancreatic & hepatobiliary cancer
-Rapid increase can indicate recurrence in treated patients
-5% cannot make the protein
Cancer Antigen - 125 (CA-125)
,-ANTIGEN
-Elevated in ovarian cancer (80 - 90%)
-Good prognostic indicator: precipitous fall after 2 cycles of chemo
-Rise in levels is good early predictor of recurrence
Carcinoembryonic Antigen (CEA)
-ANTIGEN
-GI cancers, CRC (extent, prognosis, response to tx)
-Also found in other cancers (breast, SCLC, other GI cancers)
-Smokers have elevated baseline levels
-20% of CRC/breast cancer patients do not make CEA
Prostate Specific Antigen (PSA)
-ANTIGEN
-Screening/response to tx/recurrence for prostate cancer
-High sensitiviy, low specificity (infection, enlargement, inflammation can also raise
PSA)
-Have to double levels if patient is taking BPH medication
HER 2 (neu)
-ANTIGEN (test performed in breast cancer tissue)
-Increased HER 2 protein levels associated w/more aggressive breast cancers
-Can serve as target for trastuzumab (Herceptin)
CA 15-3
-ANTIGEN
-Elevated in 70-80% of patients w/metastatic breast cancer
CA 27.29
-ANTIGEN
-Used for monitoring response to tx in metastatic breast cancer
/.Atopic dermatitis: which Ig, clinical manifestations, patho, lab results Continued -
Answer-AD has a constellation of clinical features that include frequent exacerbations,
severe pruritus, and a characteristic appearance with redness, edema, and scaling.
Microscopic epidermal cracks that allow water to be expelled and irritants, allergens,
and microbes to enter further inflammation drying, and cracking. Itching is the hallmark
of AD and rubbing and scratching are responsible for many of the clinical skin changes.
Histamine level is elevated in AD lesions but not considered a major pruitogen because
blockage on H1 and H2 receptors alone is ineffective at relieving itch.
In young children, the rash appears primarily on the face, scalp, trunk, and extensor
surface areas of the arms and legs. In older children and adults, the rash tends to be
found on the neck, antecubital and popliteal fosse and hands and feet. Lichenification
(thickening of the epidermis from constant scratching) is more common in adults with
chronic eczema.
There is no specific lavatory features of AD that van be used for diagnostic purposes.
Most affected individuals show increased serum levels of immunoglobulin (IgE),
interleukin-4 and interleukin-13, eosinophils, and positive skin test to a variety of
common food and inhalant allergens.
, /.Atopic dermatitis: which Ig, clinical manifestations, patho, lab results. - Answer-is more
common in infancy and childhood; however, some individuals are affected throughout
life. Also known as atopic eczema, is the most common cause of eczema in children.
25% of children and 2-3% of adults. Onset is usually from two to six months of age and
most cases occur within the first five years of life. More than half the individuals with AD
develop asthma and allergies later in life. Positive skin tests to a variety of common food
and inhalant allergens are seen in approximately 80% of individuals.
In AD, memory T cells in the blood express cutaneous lymphocyte antigen (CLA), which
leads to the homing of lymphocytes to the skin. Inflammation is associated with the
activation of TH2 phenotype with a switch to TH1 cells in the chronic phase of the
disease. There is a release of numerous cytokines, chemokine, interferon-gamma
(IFN~y), and granulocyte-macrophage colony-stimulating factor (GM-CSF). Activation of
mast cells, eosinophils, macrophages, and IgE-medicated auto reactivity to epidermal
proteins contribute to the inflammation.
Deficiency in filaggrin protein leads to a defect of the epidermal barrier that causes
transepidermal water loss and allows easy penetration of pathogens and allergens
through skin and systemic hyperactive immune response. Keratinocytes are deficient in
their ability to express toll-like antimicrobial peptides and may predispose such
individuals to skin colonization and infection with Staphlyococcus aureus, viruses, and
fungi.
/.autosomal dominant disorders - Answer-autosomal dominant disorder: fatal genetic
disorder in which symptoms do not show until middle age
characterized by deterioration of mental functions and uncontrollable movements
huntington's disease
autosomal dominant disorder: dwarfism (one form)
achondroplasia
autosomal dominant disorder: affects the connective tissue of the skeletal
system+eyes+circulatory system
affects individuals have long limbs, vision problems and are susceptable to aortic
rupture
marfan sydrome
a gene is referred to as "sex linked" if it's located on a
sex chromosome (an x or y)
/.autosomal recessive disorders - Answer-what are 4 autosomal recessive disorders?
tay sachs, albinism, cystic fibrosis, and phenylketonuria/PKU
autosomal recessive disorder: characterized by failure to produce pigment
very suceptible to UV rays
albinism
autosomal recessive disorder: affects people of jewish decent
tay sachs
