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First Aid
| Question | Answer |
|---|---|
| In which section of the lymph node are T cells housed? | Paracortex |
| Where can the paracortex be found within a lymph node? | Between the follicles and medulla |
| The medulla of a lymph node contains sinuses and medullary cords. Which immune cells make up the cords? | Packed lymphocytes and plasma cells |
| Lymph node follicles can be primary or secondary. Contrast the activity status of B cells in each follicle. | Primary follicles are dormant, while secondary follicles are active germinal centers |
| Do lymph nodes generally have more afferent or efferent lymphatic vessels? | Afferent; each lymph node usually has many afferent channels, w/one or more efferent vessels |
| Lymph nodes are encapsulated immune system organs. Their capsules extend to form what structure within lymph nodes? | Trabeculae |
| A pt presents w/painful cervical lymphadenopathy. He asks you what lymph nodes do. What are their 3 functions? | Nonspecific filtration of lymph by macrophages, B-cell & T-cell storage, & activation of immune responses |
| In which section of the lymph node do B cells localize & proliferate? | Follicle |
| A lymph node has both primary & secondary follicles in its outer cortex. What is the difference between them? | Primary: dense, dormant; secondary: pale germinal centers, active |
| Name the area surrounding a germinal center in a secondary follicle. | Mantle zone |
| The medulla of the lymph node contains medullary cords and sinuses. What is the function of medullary sinuses? | Communication w/efferent lymphatics; contain macrophages & reticular cells |
| The paracortex of a lymph node contains high endothelial venules. Which immune cells enter the lymph node through these vessels? | T cells and B cells |
| A woman presents w/a severe viral upper respiratory infection. Which section of her cervical lymph nodes will be enlarged? | Paracortex (enlarges in extreme cellular immune response, such as a viral infection) |
| A young boy w/DiGeorge syndrome has a viral illness. On physical exam, what size do you expect his lymph nodes to be? | Abnormally small; the lymph node paracortex is underdeveloped in pts w/DiGeorge syndrome |
| Contrast the lymph drainage for the anal canal above and below the pectinate line. | Internal iliac nodes drain above the pectinate line; superficial inguinal drain below the pectinate line |
| A pt is diagnosed with bilateral multilobar pneumonia. To which lymph node cluster would drainage flow? | Hilar (lungs) |
| A 3 yo child is diagnosed w/strep pharyngitis. To which lymph node cluster would drainage flow? | Cervical (head and neck) |
| A child w/Kawasaki disease will probably have significant lymphadenopathy of what area of the body? | Cervical (head and neck) |
| Into which lymph node cluster do the trachea & esophagus drain? | Mediastinal |
| In a granulomatous disease, such as sarcoidosis, what 2 lymph node regions will most likely be pathologically enlarged? | Mediastinal and hilar |
| Into which lymph node cluster do the upper limbs & skin above the umbilicus drain? | Axillary |
| A woman is diagnosed w/breast cancer. In determining the severity, which lymph node cluster should be examined? | Axillary |
| Into which lymph node cluster do the stomach, upper duodenum, liver, spleen, & pancreas drain? | Celiac |
| Into which lymph node cluster do the lower duodenum, jejunum, ileum, & part of the colon drain? | Superior mesenteric |
| What areas of the body are drained by the superficial inguinal nodes? | Vulva, anal canal below pectinate line, subumbilical skin, & scrotum |
| A man is diagnosed w/colon cancer at the transverse colon. To which lymph node cluster would drainage flow? | Superior mesenteric (colon to splenic flexure) |
| A woman is diagnosed w/colon cancer at the sigmoid colon. To which lymph node cluster would drainage flow? | Inferior mesenteric (colon from splenic flexure to the upper rectum) |
| A man is diagnosed w/colorectal carcinoma at the upper rectum. To which lymph node cluster would drainage flow? | Inferior mesenteric (colon from splenic flexure to the upper rectum) |
| A man contracts typhoid fever from contaminated food. What group(s) of lymph nodes might exhibit pathologic involvement from his infection? | Celiac, superior mesenteric, & inferior mesenteric |
| Into which lymph node cluster do the testes, ovaries, & uterus drain? | Para-aortic |
| A young child is diagnosed w/pyelonephritis. To which lymph node cluster would drainage flow? | Para-aortic |
| The bladder, middle 3rd of the vagina, cervix, prostate, & lower rectum drain into which group of lymph nodes? | Internal Iliac |
| A screening CT scan of a man's abdomen & pelvis shows enlarged superficial inguinal lymph nodes. Is a genital exam warranted? | Yes, superficial inguinal lymph nodes drain the scrotum; the anal canal & subumbilical skin should also be examined |
| A diabetic man develops cellulitis w/an abscess at the dorsolateral area of his right foot. Which lymph node cluster will collect drainage? | Popliteal (posterior calf & dorsolateral foot) |
| A young man contracts lymphogranuloma venereum from unprotected sex. Which lymph node regions may exhibit pathologic involvement? | Internal iliac & superficial inguinal; lymphogranuloma venereum is a sexually transmitted infection |
| A man's endoscopy reveals a duodenal tumor. Is screening of >1 lymph node territory required? | Yes; because celiac lymph nodes drain upper duodenum & superior mesenteric lymph nodes drain lower duodenum, both should be investigated |
| A pt has thrombosis at the junction of the left subclavian and internal jugular veins. Where in the body will you see resultant lymphedema? | Entire body except for right half above the diaphragm (drained by right lymphatic duct), as flow in the thoracic duct is probably impaired |
| A lactating mother is diagnosed w/right-sided mastitis. Which major lymphatic duct will carry drainage into venous circulation? | Right lymphatic duct (drains the right side of the body above the diaphragm) |
| Where does the thoracic duct drain? | The junction of the left internal jugular vein & the left subclavian vein |
| A 67 yo smoker presents with a diagnosis of primary lung cancer. What lymph node cluster is most likely to be enlarged? | Hilar |
| After a pt undergoes splenectomy, there is ↓ C3b opsonization. This is caused by ↓ levels of which antibody? | IgM |
| What is the function of the marginal zone in the spleen? | Location for antigen-presenting cells (APCs) to capture antigens; antigens will later be recognized by lymphocytes |
| The white pulp of the spleen is split into 2 histologic sections. In which section can B cells be found? | Follicles |
| A frozen section of the spleen is prepared after splenectomy. In which histologic section of the spleen are T and B cells found? | White pulp |
| The white pulp of the spleen is split into 2 histologic sections. In which section can T cells be found? | Peri-arteriolar lymphatic sheath (PALS) |
| The spleen can be found anterior to the left kidney in the LUQ of the abdomen. What numbered ribs protect the spleen? | 9th–11th ribs |
| A frozen section of the spleen is prepared after splenectomy. In which histologic section of the spleen are long, vascular channels found? | Red pulp (w/a fenestrated "barrel hoop" basement membrane) |
| In the spleen, APCs capture blood-borne antigens for later recognition by lymphocytes. In which histologic section does this occur? | Marginal zone, between the red & white pulp; also houses specialized B cells |
| A pt is diagnosed w/Streptococcus pneumoniae. Which immune cells in the spleen work to remove streptococci? | Macrophages near the sinusoids of the spleen eliminate encapsulated bacteria |
| A pt w/sickle cell disease becomes susceptible to meningococcemia. What is the most likely cause? | Splenic dysfunction: ↓ IgM, ↓ complement activation, ↓ C3b opsonization → higher susceptibility to encapsulated organisms |
| A pt undergoes splenectomy after a motor vehicle accident & subsequent splenic laceration. To which bacteria is the pt most susceptible? | Encapsulated organisms (pneumococcus, Hib, meningococcus) |
| A CBC reveals thrombocytosis & lymphocytosis. Peripheral blood smear reveals nuclear remnants & target cells. Most likely cause? | Splenectomy; nuclear remnants are probably Howell-Jolly bodies |
| What is the mechanism of action underlying the hematologic thrombocytosis & lymphocytosis seen after splenectomy? | Loss of sequestration & removal in the spleen |
| A 35 yo woman has progressive weakness of the ocular muscles and extremities, especially at night. Which mediastinal organ may be enlarged? | Thymus (can be enlarged in myasthenia gravis) |
| An infant has a hypoplastic thymus. Which immunodeficiencies are the most likely causes? | DiGeorge syndrome and severe combined immunodeficiency (SCID) |
| In what region of the mediastinum is the thymus found? | Anterior superior mediastinum |
| What is the function of the thymus? | The thymus is the primary site of T-cell differentiation and maturation |
| Which pharyngeal pouch is the thymus derived from? | Third (the thymus) |
| Which histologic section of the thymus holds immature T cells? | Cortex (dense w/immature T cells) |
| The thymus is the site of T-cell maturation. Which histologic section of the organ holds mature T cells and epithelial reticular cells? | Medulla (pale w/Hassall corpuscles containing epithelial reticular cells) |
| A pt is diagnosed w/a thymoma. What 2 disorders are associated w/this benign tumor? | Superior vena cava syndrome and myasthenia gravis |
| What is the contour of the neonatal thymus on CXR (see image) | "Sail-shaped," thymus involutes w/age |
| What are the 2 primary immune system organs? | Bone marrow and thymus |
| Bone marrow is a primary immune system organ. What is its function? | Bone marrow produces immune cells and matures B cells |
| The thymus is a primary immune system organ. What is its function? | Thymus matures T cells |
| What are the 4 secondary immune system organs? | Spleen, lymph nodes, tonsils, & Peyer patches |
| What is the function of secondary immune system organs (ie, spleen, tonsils, lymph nodes, Peyer patches)? | They are the sites of immune cells' interaction w/antigens |
| How does the adaptive immune response differ during 1st and 2nd exposures to an antigen? | Adaptive immunity is slow to develop on 1st exposure but fast on any subsequent exposures |
| Through which mechanism does the adaptive immune system develop a highly specific defense against pathogens? | V(D)J recombination during lymphocyte development results in variation; hence, microbial resistance is not inherited |
| A girl's innate immune system responds to bacteria. Which receptors are activated, and which molecular patterns do they look for? | TLRs are activated and look for bacterial pathogen-associated molecular patterns (PAMPs) such as LPS and flagellin |
| What is the benefit of germline-encoded target antigen recognition of the innate immune system? | It allows innate immunity to be both fast and nonspecific; however, resistance is heritable |
| What are the 3 components responsible for adaptive immunity? | T cells, B cells, & circulating antibodies |
| On the 1st day of a viral infection, a girl has ↑ neutrophils & fever resulting from what property of this arm of the immune response? | The innate immune system is responsible for the initial response to a pathogen; its cell receptors are germline encoded & nonspecific |
| A pt has elevated lysozymes, complement, CRP, & defensins. Which arm of the immune system is probably involved? | Innate immunity |
| A boy's innate immune system responds to a virus. Which receptors are activated, & which molecular patterns do they look for? | TLRs are activated; they look for viral pathogen-associated molecular patterns (PAMPs), such as nucleic acids |
| Toll-like receptor (TLR) activation via pathogen-associated molecular patterns (PAMPs) leads to activation of what cellular protein complex? | NF-κB, which functions as a transcription factor |
| A man who had childhood measles develops no disease despite repeat exposure. How does this response work? | Memory B and T cells are activated in the adaptive immune response & release immunoglobulins targeting the measles virus |
| Name the various components of the innate immune system. | Neutrophils, monocytes, macrophages, dendritic cells, natural killer cells, complement, secreted enzymes, epithelial barriers |
| A hospital receives a set amount of money per service rendered. The money is then divided among all providers. What payment model is this? | Bundled payment; regardless of ultimate cost, the money must be divided among all providers/facilities involved |
| A pt's physician receives a set payment in 1 yr regardless of how many times the pt visits the hospital. What payment model is this? | Capitation, which is generally used by some HMOs |
| A 42 yo pt pays for each individual healthcare service he receives, albeit at a discounted price. What payment model is this? | Discounted fee-for-service |
| A 65 yo woman pays for every individual service she receives from her PCP. What type of payment model is this? | Fee-for-service; the pt pays for each individual service |
| A 56 yo pt undergoes elective surgery. He pays for all pre- and post-op care expenses through a single payment. What payment model is this? | Global payment |
| A 67 yo pt with Medicare gets all of her health care at a private HMO. What part of Medicare does she have? | People with Medicare Part C get hospital care and basic medical treatment from approved private companies |
| A 45 yo unemployed homeless man with diabetes asks what insurance he can get. What is the most appropriate response? | Medicaid is for people with limited income and/or resources; it is funded by the state and federal governments |
| A 45 yo woman with ESRD has Medicare and is hospitalized for pneumonia. Which part of Medicare covers her hospitalization? | Part A: hospitAl/hospice; the others: B: Basic medical bills, C: delivery of parts A+B (Combo) by private Companies, D: prescription Drugs |
| Which part of Medicare covers prescription drugs? | Part D |
| A 71 yo pt presents for his 3-mo diabetes checkup. What part of Medicare covers this visit? | Medicare Part B covers basic medical bills such as doctor's fees and diagnostic testing |
| An 83 yo man is hospitalized with a COPD exacerbation. What part of Medicare covers his hospitalization? | Medicare Part A covers hospitalizations; also covers home hospice care |
| A 73 yo uninsured man presents with low back pain. For what type of health insurance is he eligible? | MedicarE is for the Elderly (over 65), those under 65 with certain disabilities, and those with end-stage renal disease |
| Name the type of insurance, created from amendments to the Social Security Act, that is available to a 70 yo woman. | Medicare |
| A homeless man with no income presents with swelling of his right foot. For what type of health insurance is he eligible? | He is eligible for Medicaid (MedicaiD is for the Destitute) |
| For which type of government-funded insurance are pts undergoing dialysis eligible? | Medicare is for people 65 or older and for people with certain disabilities, such as end-stage renal disease |
| What are the names of the 2 federal social healthcare programs that originated from amendments to the Social Security Act? | Medicare and Medicaid |
| Which insurance is a joint federal and state health assistance program for people with limited income/resources? | Medicaid |
| A 92 yo terminally ill pt has a life expectancy of <6 mo. What type of care is appropriate for this pt? | Hospice care |
| What is the principle of double effect? | In hospice care, the pt's comfort and pain relief supercede adverse side effects of treatment |
| What health insurance programs are available for pts in hospice care? | Medicare, Medicaid, and most private health insurance plans |
| What is the maximum life expectancy someone may have and still qualify for hospice services? | 6 mo |
| Which type of medical care focuses on providing comfort and palliation instead of a definitive cure? | Hospice care |
| In an effort to improve pt comfort/pain during hospice care, what medications can be administered? | Opioids, sedatives, and anxiolytic medications are often used during end-of-life care |
| What are the top 3 causes of death in children <1 year of age? | Congenital malformations, preterm birth, and SIDS |
| What are the top 3 causes of death in children aged 1 to 14 years? | Unintentional injury, cancer, and congenital malformations |
| What are the top 3 causes of death in people aged 15 to 34 years? | Unintentional injury, suicide, and homicide |
| What are the top 3 causes of death in people aged 35 to 44 years? | Unintentional injury, cancer, and heart disease |
| What are the top 3 causes of death in people aged 45 to 64 years? | Cancer, heart disease, and unintentional injury |
| What are the top 3 causes of death in people 65+ years of age? | Heart disease, cancer, and chronic respiratory disease |
| Which organizations do not require referral from a PCP to see a specialist? | Exclusive provider organizations and preferred provider organizations |
| Which organizations require referral from a PCP to see a specialist? | Health maintenance organizations and point of service plans |
| In which organizations are pts restricted to a limited panel of providers and hospitals? | Exclusive provider organizations and health maintenance organizations; except in emergencies |
| In which organizations are pts not restricted to a limited panel of providers and hospitals? | Point of service plans and preferred provider organizations |
| Give 1 common drawback of point of service and preferred provider organization insurance plans. | They both have higher copays and deductibles for services |
| In a health maintenance organization, describe the limitations (if any) related to seeing providers outside of the network. | Except in emergencies, pts are restricted to a limited panel of providers who are in the network |
| What important criterion must be met for all services rendered within a health maintenance organization? | All services must meet established, evidence-based guidelines, or they will be denied |
| In a point of service medical insurance plan, describe the limitations (if any) related to seeing providers outside of the network. | Pts may see providers outside of the network, but will incur higher costs (eg, copays, deductibles, out-of-pocket expenses) |
| In a preferred provider organization, describe the limitations (if any) related to seeing providers outside of the network. | No limitations; all services have equally higher copays and deductibles |
| In an exclusive provider organization, describe the limitations (if any) related to seeing providers outside of the network. | Except in emergencies, pts are restricted to a limited panel of doctors, specialists, and hospitals |
| A 65-year-old woman pays for every individual service she receives from her primary care provider. What type of payment model is this? | Fee-for-service; the patient pays for each service received |
| A 56-year-old patient undergoes elective surgery. He pays for all pre- and post-op care expenses with a single payment. What payment model is this? | Global payment |
| A patient's physician receives a set payment in 1 year regardless of how many times the patient visits the hospital. What payment model is this? | Capitation, which is generally used by some health maintenance organizations (HMOs) |
| A 42-year-old patient pays for each healthcare service he receives, albeit at a discounted price. What payment model is this? | Discounted fee-for-service |
| A hospital receives a set amount of money per service rendered. The money is then divided among all providers. What payment model is this? | Bundled payment; regardless of final cost, the money must be divided among all providers/facilities involved |
| Generally speaking, how can readmissions to the hospital be reduced? | Discharge planning and outpatient follow-up appointments |
| Mood disorders, alcohol disorders, and diabetes mellitus with complications are the top 3 diagnoses for readmission in which insured (or uninsured) patient group? | Uninsured patients |
| Maintenance of chemo/radiotherapy, mood disorders, and complications of care are the top 3 diagnoses for readmission in which insured (or uninsured) patient group? | Private insurance patients |
| Mood disorders, schizophrenia/psychotic disorders, and diabetes mellitus with complications are the top 3 diagnoses for readmission in which insured (or uninsured) patient group? | Medicaid patients |
| Congestive heart failure, septicemia, and pneumonia are the top 3 diagnoses for readmission in which insured (or uninsured) patient group? | Medicare patients |
| A patient is admitted for wound infection 7 days after discharge following laparoscopic cholecystectomy. Is this considered a readmission? | Yes; readmission is rehospitalization for any reason within 30 days of the original admission |
| What action on CpG islands inactivates transcription of DNA? | DNA methylation (CpG Methylation makes DNA Mute) |
| During what phase of the cell cycle does synthesis of DNA and histones occur? | S phase |
| What subset of eukaryotic DNA does not use histones? | Mitochondrial DNA |
| What amino acids give histones their ⊕ charge? | Lysine and arginine |
| An experiment is done to tie nucleosome beads together in a string to stabilize chromatin. Which protein facilitates this process? | Histone H1 |
| What 2 modifications to histones decrease DNA transcription? | Methylation and deacetylation |
| What is the charge of histone octamers? | ⊕, via lysine and arginine, giving the histones affinity for negatively charged DNA |
| What is transcriptionally inactive DNA called? | Heterochromatin: it is highly condensed and sterically inaccessible to replication enzymes |
| A researcher adds DNA solution to a polyacrylamide gel. Toward which side of the gel would the DNA move? | Toward the positively charged electrode, also called the anode (Phosphate groups give DNA an overall ⊖ charge) |
| What is transcriptionally active DNA called? | Euchromatin; it is less condensed and is accessible to replication enzymes: Euchromatin is Expressed |
| When wrapped twice around a histone core, DNA is called what? | A nucleosome |
| What are the 8 subunits that make up a nucleosome core? | 2 of each of 4 histone types: H2A, H2B, H3, and H4; H1 linkers are outside the nucleosome |
| A scientist introduces a chemical in a cell that increases protein synthesis. What process relaxes the DNA and increases transcription? | Acetylation (histone Acetylation makes DNA Active) |
| What chromatin conformation (E in image) is less condensed on EM and is more accessible to a transcription factor during transcription? | Euchromatin |
| A scientist induces Barr body (inactive X chromosome) formation. How does it appear on EM (H in image)? | It appears darker and more condensed (this is HeteroChromatin, which is Highly Condensed) |
| What is the end product of uracil methylation? | Thymine |
| In which type of nucleic acid is thymine found? | DNA |
| Which type of bond links nucleotides? | 3′-5′ Phosphodiester bond |
| In which type of nucleic acid is uracil found? | RNA |
| What are the components of a nucleoside? | Base + (deoxy)ribose |
| How many hydrogen bonds are there between adenine and thymine? | 2 |
| How many hydrogen bonds are there between guanine and cytosine? | 3 |
| DNA1 has 60% C-G bonds, whereas DNA2 has 70% A-T bonds. Which DNA has a higher melting point? | DNA1; C-G bonds have 3 H bonds (stronger [think Crazy Glue]); A-T bonds have only 2 H bonds) |
| Name the 2 purine bases. | Adenine and guanine (PURines [A,G]: PURe As Gold) |
| What base does deamination of 5-methylcytosine form? | Thymine |
| Name the 3 pyrimidine bases. | Cytosine, Uracil, and Thymine (PYrimidines: [C,U,T]: CUT the PY [pie]) |
| When nucleotides are joined, which end is the "attacking" end, and which is the "target" end? | The 5′ end of the nucleotide bears a triphosphate group (target) of 1 nucleotide and is the target of the 3′ hydroxyl (attack) by a second nucleotide |
| What are the 5′ and 3′ components of a phosphodiester bond? | 5′ triphosphate group and 3′ hydroxyl group |
| What base does deamination of cytosine yield? | Uracil |
| What base does deamination of adenine yield? | Hypoxanthine |
| Which amino acids are necessary for purine synthesis? | Glycine, Aspartate, Glutamine (GAG) |
| What base does deamination of guanine form? | Xanthine |
| What base does deamination of 5-methylcytosine form? | Thymine |
| What provides the energy to bond nucleotides? | Triphosphate groups yield energy for bonding 3'-5' ends to create a phosphodiester bond |
| You conduct Pavlov's classical conditioning experiment. When you ring a bell, a dog salivates. What is the unconditioned stimulus? | Food: salivation is an involuntary response to it, so food represents an unconditioned, rather than a conditioned, stimulus |
| A child returning to the clinic cries as the doctor wearing a white coat enters the room. His crying represents what type of conditioning? | Classical conditioning: he cries because he associates a white coat with a shot he received from someone wearing white coat in the past |
| You conduct Pavlov's classical conditioning experiment. When you ring a bell, a dog salivates. What is the learned/conditioned stimulus? | The bell: it triggers a natural response (salivation) because it was previously associated with food |
| A man feels euphoria when injecting heroin. What type of conditioning would lead to repeat injection of heroin? | Positive reinforcement (operant conditioning) |
| How do classical and operant conditioning differ with respect to voluntariness to do the action involved? | Classical is usually involuntary (eg, salivating); operant is usually voluntary |
| A patient takes naloxone as part of his recovery. Now opiates do not cause euphoria, so he stops abusing them. What is this effect called? | Extinction, in which removal of positive reinforcement eventually leads to elimination of behavior |
| What is operant conditioning? | Learning in which a specific action is elicited as result of its production of a punishment or reward |
| How do positive punishment and negative reinforcement differ in operant conditioning? | Applying aversive stimulus to ↓ behavior is positive punishment; removing aversive stimulus to ↑ behavior is negative reinforcement |
| A patient is hostile toward her female psychiatrist. History reveals a troubled past with her mother. What term describes this behavior? | Transference: patient projects feelings about formative or other important persons onto physician |
| Differentiate between transference and countertransference. | Transference: patient projecting feelings onto physician; countertransference: physician projecting feelings onto patient |
| A psychiatrist gets angry at a patient who abuses cats. The psychiatrist's father also abused cats. What term describes this behavior? | Countertransference: doctor projects feelings about formative or other important persons onto patient |
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