Week 10

How many types of ERCs are in the thymus? Which part of the thymus are they in?

6 both the cortex and the medulla

T/F: HbE alleles contribute to beta-thalassemia because they produce very ineffective hemoglobin.

False, they reduce the amount of hemoglobin produced. The HbE protein is usually functional enough not to give symptoms in a homozygote. It is only when it is combined with a beta-thalassemia gene that symptoms may occur.

T/F: To enter the lymph nodes, lymphocytes pass through the subcapsular sinus then the trabecular sinus.

False, this is how lymph containing antigens and APCs gets into the lymph nodes. Lymphocytes get there via the high endothelial venules.

T/F: Alpha-hemoglobin can form homo-tetramers.

False.

T/F: Th1 cytokines are called type 1 cytokines and include IL-4, IL-5 and IL-13.

False.

T/F: The release of IL-12 from APCs results in the development of Th2 cells and subsequently IL-4, IL-5 and IL-13.

False.

T/F: HbAC gives a somewhat milder sickle cell disease compared to HbSC but worse than HbSS.

False. HbACs do not usually have problems, and HbSS is worse than HbSC.

T/F: HbSC gives a somewhat milder sickle cell disease compared to HbSS but worse than HbCC.

False. HbCCs do not usually have problems.

T/F: The alpha-thalassemia 1 allele is found in Asia and contains 1 deleted alpha-hemoglobin gene.

False. It contains 2 abnormal genes.

T/F: The release of IL-4 from APCs results in the development of Th1 cells and subsequently IL-2, TNF and IFN-gamma.

False. It is the release of IL-2 that results in this process

T/F: Neutrophils recruit macrophages by releasing IL-8, TNF-alpha, IL- 1 and PG-E2.

False. Macrophages recruit neutrophils by releasing IL-8, TNF-alpha, IL- 1 and PG-E2.

T/F: Mannan binding lectin is a signaling receptor.

False. Mannan binding lectin is a secreted PRR.

T/F: Th2 cells are associated with the production of IL-2 that promote cell mediated immune response while Th1 cells are associated with the production of IL-4 that promote an antibody response.

False. Th1 cells are associated with the production of IL-2 that promote cell mediated immune response while Th2 cells are associated with the production of IL-4 that promote an antibody response.

T/F: Most of the plasma cells created in the lymph nodes migrate to the medulla of the lymph node.

False. They migrate to the bone marrow

T/F: The alpha-thalassemia 2 allele is found in Africa and Asia and contains 2 deleted alpha-hemoglobin genes.

False. This describe alpha=thalassemia 1.

T/F: A patient with a B0 allele and a B+ allele usually has beta-thalassemia intermedia.

False; major

What might a low MCHC indicate?

Fe deficiency

A patient goes to an optometrist for an eye exam. Upon examining the muscles of the eyes, the doctor noticed that patient's right eye was not able to look to the right. Which eye muscle is responsible for eye abduction? A. Medial rectus B. Superior oblique C. Superior rectus D. Inferior oblique E. Lateral rectus

E

Hemoglobin C and E are two different variant hemoglobin subunits. They are variants of which and which hemoglobin forms respectively: A. alpha, beta B. beta, alpha C. gamma, alpha D. beta, gamma E. beta, beta F. alpha, alpha G. gamma, gamma

E

Mr. Smith tighly closes his eyes. Which muscle is primarily responsible for performing this action? A. Frontalis B. Palpebral portion of Obicularis Oculi C. Obicularis Oris D. Mentalis E. Orbital portion of Obicularis Oculi

E

Two nerves enter through the internal acoustic meatus, but only one leaves. Name the nerve that stays and the nerve that leaves. A. CN I stays and CN IV leaves B. CN VII stays and CN VIII leaves C. CN VII stays and CN IX leaves D. CN III stays and CN II leaves E. CN VIII stays and CN VII leaves

E

T/F: Lymphocytes enter the lymph nodes via afferent lymph vessels while antigens and APCs enter via high endothelial venules.

False

T/F: MCH increases or decreases inversely with MCV.

False

T/F: Palatine tonsils consist of single crypts surrounded by many nodules and lingual tonsils consist of multiple crypts in a band of nodules.

False

T/F: Sickle cell anemia can refer to heterozygotes or homozygotes.

False

T/F: Sickling in sickle cell anemia happens only when the RBC is carrying oxygenated hemoglobin.

False

T/F: Th1 is associated with antibody-mediated immunity.

False

T/F: Th2 cytokines are called type 2 cytokines and include IL-2, TNF and IFN-gamma.

False

T/F: Th2 is associated with cell-mediated immunity.

False

T/F: The cortical follicles of a lymph node contains mostly T cells and the paracortex contains mostly B cells.

False

T/F: The pharyngeal tonsils have crypts.

False

T/F: The white pulp of the spleen is primary lymphoid tissue.

False

T/F: HbCC gives a somewhat milder sickle cell disease compared to HbSS but worse than HbAS.

False, HbCCs do not usually have problems.

T/F: Hemoglobin H disease is a form of beta-thalassemia.

False, alpha

T/F: Fibroblasts generate the structural framework for all lymphoid tissues.

False, in the thymus, ERCs do this.

T/F: A patient with 2 B+ alleles usually has beta-thalassemia minor.

False, intermedia

T/F: Presence of HbBarts protein confirms the diagnosis of HbBarts disease.

False, it is found in both HbH disease and in HbBarts disease.

T/F: Lymph enters the thymus through afferent lymphatic vessels in the trabeculae.

False, lymph can only exit the thymus

T/F: Mannan binding lectin is a phagocytosis PRR.

False, mannan binding lectin is a secreted PRR.

T/F: A patient with a B0 allele or a B+ allele plus one normal allele usually has beta-thalassemia intermedia.

False, minor

T/F: Flu shots are an example of passive acquired immunity.

False, they are active acquired

T/F: The lymphoid nodules and PALS are located in the red pulp of the spleen.

False, they are in the white pulp.

T/F: Maternal antibodies are an example of active acquired immunity.

False, they are passive acquired

T/F: Rabies shots given after exposure are an example of active acquired immunity.

False, they are passive acquired because the vaccine contains antibodies

T/F: Epithelial reticular cells generate the structural framework for all lymphoid tissues.

False, they only do this is the thymus. Everywhere else, the reticular framework is produced by fibroblast reticular cells.

Which IL has the following characteristics: Produced by activated TH1 cells, which also express IL-2R** (autocrine) Promotes growth of T cells Also acts on B cells, NK cells and LAK cells

IL-2

Which IL has the following characteristics: Produced by TH1 and TH2 cells Stimulates hematopoietic cells of multiple lineages** Proinflammatory and mast cell stimulatory functions

IL-3

The poster 1/4th of the roof of the mouth is composed of which bone of the skull A. Maxilla B. Ethmoid C. Mandible D. Palatine E. Sphenoid

The roof of the mouth is composed of two bones of the skull. The anterior roof of the mouth is formed by the maxilla, but the posterior 1/4th of the roof of the mouth is formed by the palatine bone. All other options do not form the roof of the mouth.

Antigen presentation by dendritic cells, tight junctions at all locations, TNF-alpha and IL-8 and other chemotactic secretions occur at which organ?

The skin

What hemoglobin replaces zeta?

alpha

Which permanently expressed hemoglobin gene is present earliest in fetal development?

alpha

What is another name for HbA?

alpha2-beta2

What is HbS?

alpha2-betaS2 sickle cell anemia variant of hemoglobin

What is another name for HbA2?

alpha2-delta2

What is another name for HbF?

alpha2-gamma2

What # cranial nerve is abducens?

VI

How is a reticulocyte count corrected for anemia?

actual Hct/45 * ret. count

A spike in levels of what kind of molecule indicates inflammation?

acute phase proteins

Why is cell-mediated immunity a better defense against mycobacteria than antibody-mediated immunity?

because they stay inside cells and hide their antigens from the immune system.

Which hemoglobin gene shares with delta?

beta

If production of one hemoglobin chain is usually reduced when production of the other is reduced, why does beta-thalassemia lead to surplus alpha-hemoglobin?

beta-hemoglobin production is so severely reduced that alpha-hemoglobin cannot follow it down.

Which hemoglobinopathy is the result of single base substitutions including frameshifts, without many large deletions or insertions?

beta-thalassaemia

Malignancy, infections, iron overload, HIV, and diabetes are associated with what condition?

beta-thalassemia

What causes surplus alpha-hemoglobin to form precipitates and cause oxidative damage and reduced RBC lifespan?

beta-thalassemia

Which hemoglobinopathy causes production of beta-hemoglobin to be reduced to less than 50%?

beta-thalassemia intermedia

Which hemoglobinopathy is associated with splenomegaly, frequent gallstones, and bone changes including osteoporosis?

beta-thalassemia intermedia

Hemoglobin H disease is similar to which other hemoglobinopathy? What is the main difference?

beta-thalassemia intermedia Because alpha-hemoglobin is involved, hemoglobin H disease will show symptoms at birth.

Misshaping of face and bones is associated with which hemoglobinopathies?

beta-thalassemia major and intermedia Hemoglobin H disease, to a lesser extent

Which hemoglobinopathy causes production of beta-hemoglobin to be reduced to at least 50% of normal? What treatment might this patient require?

beta-thalassemia minor usually asymptomatic, sometimes mimics mild iron deficiency

Zinc, vitamin C, folate, and a splenectomy may be treatments for which condition?

beta-thallasemia

Cardiomyopathy and cirrhosis are side effects of what treatment?

blood transfusions -caused by iron overload

How do antigens get into the spleen?

blood vessels

What are the 2 primary lymphoid organs?

bone marrow & thymus

What is the only cure for beta-thalassemia major?

bone marrow transplant

What broader class of tissue does lymphoid tissue belong to?

connective tissue

Homozygosity for HbSS or beta-thalassemia both may cause what condition identifiable by electrophoresis?

continued production of HbF

How is a reticulocyte count corrected for polychromasia?

divide reticulocyte count by 2 (after correcting for anemia)

What might reticulocytes on a PBS indicate?

erythropoiesis is occuring

The dura mater attaches to which bony prominance in the anterior cranial fossa?

crista galli

What kind of framework holds lymphoid tissue together?

cross-linked reticular fibers (type III collagen) in most lymphoid tissue ERCs w intermediate keratin filaments in the thymus

What are the labryinthine tubules of the palatine tonsils called? What kind of cells are they lined by?

crypts non-keratinized stratified squamous epithelium

What is the effect of blood loss anemia on reticulocyte count?

increased

What is the effect of hemolytic anemia on reticulocyte count?

increased

What is the name for the site where adaptive lymphocytes are activated?

induction site

What is the effect of inadequate production anemia on reticulocyte count?

decreased

How does sickle cell anemia cause death?

infections or sequestration of RBCs in the spleen, liver, or pulmonary circulation. The body is trying to get rid of the sickled cells, leading to an overall shortage of RBCs

What kind of cells transfer antigens but aren't APCs? Where are they found?

microfold (M) cells They phagocytose and transfer antigens found in the lumen of the gut or lungs to the loose connective tissue (lamina propria) underneath. It also has macrophages that live inside it and deal with the antigens.

A child was playing soccer when he took a blow to the side of the head. He was immediately taken to the hospital. CT scan reveals a lens-shaped hematoma around the area where the frontal, parietal, temporal, and greater wing of the sphenoid join. What is the most likely artery involved?

middle meningeal artery

The __________________ passes through the foramen spinosum.

middle meningeal artery

What is the name for apoptosis of CFU-L cells that recognize self-antigens?

negative selection

A change of glutamate to valine causes what change in charge?

negative to neutral

Change of glutamate to lysine causes what change in charge?

negative to positive

A patient presents to your clinic with fine ptosis, pupil dilation, and eye deviation down and out. What type of nerve palsy is the patient presenting with?

oculomotor nerve palsy

What is the term for dense aggregations of lymphocytes arranged as spherical, unencapsulated clusters?

lymphoid nodules or follicles

What is the name for the enzyme made by neutrophils and cells of epithelial barriers, which hydrolyzes bacterial cell wall components, killing those cells?

lysozymes

What kind of beta-thalessaemia usually presents before 2 years of age?

major

What kind of fibers do ERCs contain?

keratin intermediate filaments

What protein binds to CHO on bacteria to initiate complement activation? Where is it found?

mannan binding lectin (a collectin) -it floats freely in blood & lymph

What kind of cells lie atop the lymphoid tissue of the pharyngeal tonsils?

pseudostratified ciliated columnar epithelium with goblet cells

Where are lymphocytes found in the palatine tonsils?

some are found in the crypts, most are found under the crypts in the loose and dense lymphoid tissue

The anterior-most portion of the middle cranial fossa is formed by which bone?

sphenoid

What factor is the stem cell hemopoietic growth factor?

stromal cell factor

Where is mannan binding lectin produced?

the liver (hepatocytes)

What is the name of the condition caused by faulty development of the 3rd and 4th pharyngeal pouches? What are the symptoms?

thymic aplasia or DiGeorge syndrome smaller thymus, poor T cell production increased susceptibility to infections

The common origin of the rectus muscles of the eye is called the ______________________.

tendinous ring

Which arteries in the spleen are surrounded by the peri-arteriolar lymphoid sheath?

the central arterioles

In which part of the lymph nodes are follicles found?

the cortex

What is the light-staining section of a secondary lymphoid nodule called? What is it made of?

the germinal center mature B cells

You see a patient with an infected pimple just lateral to the lateral canthus of their eyelid. What is the first group of lymph nodes to receive drainage from this area of the face?

parotid

What condition(s) is/are Cabot's ring bodies associated with?

pernicious anemia lead poisoning issues with erythropoiesis

What protein binds to mannose on bacteria to initiate phagocytosis? Where is it found?

phagocytosis PRRs/scavenger receptors -on macrophages and other phagocytes

Which is the last precursor stage at which an erythrocyte can divide?

polychromatophilic erythroblast

What cell immediately precedes an orthochromatophilic erythroblast?

polychromatophilic erythroblast - this is the last stage where an erythroblast can divide!!

What is another name for a reticulocyte?

polychromatophilic erythrocyte

What cell immediately precedes an erythrocyte?

polychromatophilic erythrocyte (reticulocyte)

How long does a sickle cell anemia "crisis" last?

2-3 days

What is the best immune defense that the GI tract has?

acidity of the stomach

xx

xx

What cells are found in medullary cords?

-mainly B cells and plasma cells macrophages

Where would you find high endothelial venules?

-paracortex of lymph nodes -tonsils -Peyers patches -appendix -GALT

Where in the lymph nodes are macrophages found?

-subcapsular sinuses -nodules/follicles -medullary sinuses

Your patient's pupils are normal but they are experiencing diplopia. Which nerve palsy is most likely if the patient has diplopia that is alleviated by turning the head toward the unaffected side & down? Which is most likely if the diplopia is alleviated by turning the head toward the affected side?

-trochlear, because the SO is affected & eye can't turn down and out -abducens, because the LR is affected and the eye can't turn out

What are the 4 major causes of thrombocytopenia?

1) Decreased PLT production 2) Decreased PLT survival 3) Sequestration (Hypersplenism) 4) Dilution (Transfusions)

T/F: Individuals whose APCs release IL-4 in response to Myobacterium leprae will develop tuberculoid leprosy.

False

T/F: KIR binds to PAMP and KAR binds to MHC class I.

False

There is a switch from gamma to beta hemoglobin production that happens just before birth. At what age should symptoms of sickle cell anemia become noticeable? When does diagnosis normally occur?

3-6 months 6-12 months, because symptoms are nonspecific at first

What is the embryological origin of the thymus?

3rd pharyngeal pouch mesoderm and endoderm lymphocytes are from mesoderm ERCs are from endoderm

When is gamma hemoglobin completely gone?

4 months of age

A baseball player comes into the office complaining of pain in the eye. Earlier in the week he got hit in the face by a ground ball. Of the following choices which ones are actually part of the orbit? A. Frontal, Zygomatic, Ethmoid B. Frontal, Zygomatic, Temporal C. Frontal, Lacrimal, Nasal D. Lacrimal, Nasal, Zygomatic

A

If a patient damaged his Trochlear Nerve (CN IV), what would be the position of the effected eye? A. Up, Adducted and Extorted B. Up, Abducted and Intorted C. Up, Adducted and Intorted D. Down and Abducted E. Down, Adducted and Intorted F. Down, Abducted and Extorted

A

What hemoglobinopathy is caused by a point mutation of glutamate to lysine?

A HbC-producing allele is produced (could contribute to sickle cell disease or not) or a HbE-producing allele is produced (could contribute to beta-thalassemia or not), depending on where the point mutation is.

A man presents to the emergency department with a history of stroke. He shows the ability to raise both of his eyebrows, but has no other muscle movement in the right side of his face. Which muscle is accounting for the movement that he can make on the right side? A. Occiptofrontalis m. B. Orbicularis occuli m. C. Risorius m. D. Corrugator supercilii m. E. superior rectus m.

A vThe Occipitofrontalis muscle raises the eyebrows (and wrinkles the forehead) and is the only muscle innervated by V3, not VII.

A 45 year old female comes to your office complaining of loss of sensation on certain parts of her face; she doesn't know what caused it and is afraid she has a tumor. After further testing you find that she is able to feel pain and touch on her cheeks, jaw and chin but is unable to feel anything on the tip of her nose. Which of the following nerves is affected? Choose the best answer. A. Facial Nerve B. V3 (Mandibular) branch of Trigeminal Nerve C. Trigeminal Nerve D. V2 (Maxillary) branch of Trigeminal Nerve E. V1 (Ophthalmic) branch of Trigeminal Nerve

A) Facial nerve is motor on the face B) Sensation on Chin rules out V3 C) Trigeminal is technically correct because V1 falls under Trigeminal BUT it isn't the best choice because there is enough information provided to pick a more specific answer. Trigeminal is too broad for this question D) Sensation on cheeks rules out V2 E) Even though the Ophthalmic branch mainly innervates the forehead and Eyes, it is a high yield point to know that the tip of the nose is also innervated by V1 of Trigeminal nerve

A patient shows up to your office for a routine visit. He then complains of irregular saliva in his mouth. What is the parasympathetic innervation of the parotid gland? A. CN IX B. CN V C. CN VII D. CN XII

A.

Mr. Smith is in the hospital recovering from a serious head injury after having been hit in the head by a baseball on his left side. He complains to his doctor of paralysis on the left side of his face. The doctor diagnoses Bell's palsy. The cranial nerve involved in this condition exits the skull through which of the following foramina? A. Jugular Foramen B. Stylomastoid Foramen C. Internal Acoustic Meatus D. External Acoutis Meatus E. Foramen Ovale

A. The jugular foramen is an exit point for cranial nerves IX, X and XI, NOT CN VII (facial nerve). B. Correct Answer. CN VII exits the stylomastoid foramen to provide innervation to the muscles of facial expression. C. CN VII does enter the internal acoustic meatus but exits the skull through the stylomastoid foramen. D. The external acoustic meatus is the opening into the external ear. No cranial nerves are present here. E. The mandibular branch (V3) of the trigeminal nerve exits the skull through the foramen ovale, NOT CN VII.

A patient comes into the emergency room after being hit on the side of the head by a baseball. The emergency room doctor concludes that the patient has a fracture at the pterion. Based on this damage between what two structural layers would you most likely see the hematoma? A. Dura and Bone B. Dura and Arachnoid C. Arachnoid and Pia D. Periosteum and Bone

A. The patient would have an epidural hematoma so the hematoma would pool in between the dura and the bone in the epidural space. This is the potential space that is normally not there.

Marco is a 12 y/o boy with a unremarkable past medical history. He presents to the clinic today with his mother who tells the physician that he constantly falls down the stairs and is constantly seeing double. He has also gained a good amount of weight recently. After ordering a CT/MRI of his brain, you are able to diagnose Marco with a craniopharyngioma. The enlarged pituitary gland was most likely compressing some contents in the cavernous sinus. What nerve is affected in this scenario and what is the action to TEST this muscle? A. Trochlear nerve, down and in B. Trochlear nerve, down and out C. Abducens nerve, out D. Abducens nerve, in E. Occulomotor nerve, down and out

A. The trochlear nerve, cranial nerve 4, is responsible for the action of the superior oblique muscle. To test this, we refer the H-TEST which specifically states you would go medially and inferiorly to test the superior oblique.

You see a patient with paralysis of part of his face. When you have him attempt to raise his eyebrows and show his teeth, his lips curl and brow furrows only on the left side. You suspect inflammation causing dysfunction of a nerve exiting the: A. Right stylomastoid foramen B. Left stylomastoid foramen C. Right superior orbital fissure D. Left superior orbital fissure E. Right jugular foramen F. Left jugular foramen G. Right foramen ovale H. Left foramen ovale

A. This combines neuroscience and facial anatomy with skull osteology. You should recognize that the muscles of the face are innervated by motor branches of Cranial nerve VII (the facial nerve). The patient has a Right sided Bell's palsy, since only the muscles on the left side of the face contract. Therefore, recall that the right facial nerve exits the right stylomastoid foramen. It is important to review what structures pass through each opening of the skull.

When does a lymphoid nodule go from being primary to secondary?

APCs arrive and antigens are recognized, B cells become activated and proliferate to form a germinal center.

Why does the thymus involute?

At a certain point in childhood you have most of the T cells you are going to need.

A 4 month old girl presents to the Emergency Department with what the physician suspects to be a form of meningitis. During the physical exam he palpates a clinically relevant area on top of the skull known as the anterior fontanelle to examine for an increase in intracranial pressure. After around 18 months post-partum, this area closes due to the fusion of which structures? A. lambdoid and sagittal sutures B. lambdoid, sagittal, and frontal sutures C. sagittal, coronal, and frontal sutures D. sagittal, coronal, and lambdoid sutures E. coronal and frontal sutures

At around 18 months, the coronal, sagittal, and frontal sutures fuse to form what is known as the bregma. The anterior fontanelle is no longer palpable. Clinically, the anterior fontanelle (diamond shape) is used to determine hydration (if dehydrated, inward), increased intracranial pressure (outward), and proper growth of the frontal and parietal bones.

Cytokines that have the same effect on the cells that they bind are said to be: A) Synergistic B) Redundant C) Pleiotropic D) Protagonistic E) Pluralistic

B

Ricky Bobby crashed his car during a race and was rushed into the emergency room. A new medical student was about to insert a nasopharyngeal tube but the attending physician stopped him. What did the attending physician notice? A. Patient was conscious B. Ecchymosis around the mastoid process C. Depression fracture on the frontal bone D. Swelling and tenderness on the patient's temporal bone

B

The lacrimal gland recieves its parasympathetic innervation from _____, whose fibers synapse in the ____ ganglion? A. CN V, lacrimal B. CN VII, pterygopalatine C. CN III, ciliary D. CN V, superior cervical E. CN VII, superior cervical

B

Which leukocytes are part of the adaptive immune system?

B cells and T cells

Reticulocytosis would most like be seen in patients with: A. anemia caused by inadequate production of RBCs B. Anemia caused by increased destruction of RBCs C. anemia caused by increased loss of RBCs D. hemorrhage E. hemolysis F. severe malnutrition

B, C, D, & E s: An elevation in the number of reticulocytes (young red blood cells) in blood, a sign of unusually rapid red blood cell production or compensation for hemorrhage (usually seen in healthy well nourished patients 5 days after acute blood loss. . The number of reticulocytes is normally less than 1% of the total number of the red blood cells. A higher proportion (above 1%) constitutes reticulocytosis.

Patients with anemia most likely have decreased: A. white blood cells B. red blood cells C. platelets D. RBC lifespan E. RBC production F. leukocytes G. hemorrhage H. hemolysis

B, D, E

A patient comes into the ER with a head injury, after a head CT the radiologist informs you that the patient has damage to the cribiform plate. Which cranial nerve will most likely be impaired? A. Optic Nerve B. Olfactory Nerve C. Opthalmic Nerve D. Oculomotor Nerve

B.

Which of the following neurological complications is most commonly experienced by adults with sickle cell anemia? A. Intracranial hemorrhage B. Cerebral infarction C. Seizures D. Visual changes E. Ataxia

B.

You are doing rounds in with your attending when you get a patient with a suspected skull fracture. After a taking a patient history you suspect that the fracture is somewhere within the viscerocranium. Which of the following is NOT part of the viscerocranium? A. Palatine bone B. Frontal bone C. Lacrimal bone D. Ethmoid bone E. Zygomatic bone

B.

Your patient comes to you because of a very painful rash on one side of his face. You correctly diagnose him with a Herpes Zoster infection with in the Trigeminal Nerve. If the rash is covering his right cheek, and upper lip which branch of CN V is the virus active? A. Opthalmic B. Maxillary C. Mandibular

B.

Which situation below describes an example of innate immunity? A) Antibody production by plasma cells. B) Antigen removal by cilia in the respiratory tract. C) Complement activation by antibody bound to the surface of a bacterium. D) Memory response to influenza virus E) Recognition and killing of virus-infected cells by cytotoxic T cells.

B. C is incorrect because even though the complement system is part of the innate immune system, if it is activated by an antibody that is ADCC and that is an adaptive immune function.

Lymphocytes continually recirculate through peripheral lymphoid tissue in order to A) be primed for apoptosis before they cause autoimmunity. B) efficiently encounter antigen. C) develop from stem cells into mature cells. D) phagocytose and degrade antigen. E) produce cytokines for systemic circulation.

B. B and T cells circulate until they find their antigen. When they find it they are activated and go into tissues. If they don't find it they will eventually die.

A woman presents to your office with a loss of sensation to her upper lip and sides of her nose. Through what structure does the nerve that supplies this area exit the skull? A. Foramen ovale B. Foramen rotundum C. Supraorbital fissure D. Jugular foramen E. foramen spinosum

B. CN V2

You are visiting your family after completing your first semester of medical school. You are annoyed, because despite your age, your Aunt Rose still pinches your cheeks and tells you how cute you are. When Aunt Rose pinches your cheeks, cutaneous sensation to this area is most likely conveyed by which two nerve branches? A. Maxillary branch of CNV and marginal mandibular branch of CNVII B. Maxillary branch of CNV and mandibular branch of CNV C. Opthalmic branch of CNV and mandibular branch of CNV D. Zygomatic branch of CNVII and buccal branch of CNVII

B. Cutaneous sensation to the cheek is conveyed by branches of CNV, eliminating choices A and D. (CNVII does NOT convey cutaneous sensation, but rather provides motor innervation to the muscles of facial expression.) Choice C can be eliminated since cutaneous sensation conveyed by the opthalmic branch of CNV extends only as far as the upper eyelid and tip of the nose and does not include the "cheek" region.

Your friend tells you the tip of his tongue has been inflamed for a week, which lymph nodes drain that part of the tongue? A. Submandibular lymph nodes B. Submental lymph nodes C. Deep cervical lymph nodes D. Posterior Auricular lymph nodes

B. Drainage of tongue: - Deep cervical nodes: drains median part of anterior two-thirds; Retropharyngeal - drains posterior third; submandibular: - drains lateral part of anterior two-thirds; submental - drains tip of tongue

24 y/o male presents to the clinic with what appears to be bells palsy. She must be careful because this can result in inflammation of the cornea which would lead to ulceration. This symptom results from which of the following? A. Loss of sensation to the cornea B. Absent corneal reflex C. Absence of sweat on the face D. Unable to constrict the pupil E. Lack of parotid gland secretions

B. If you have bell's palsy, you will lose the corneal reflex, the efferent portion of the corneal reflex is from facial nerve which is damaged if one has bells palsy. (blinking)

Prom is coming up and a teenage boy decides that he needs to "pop" the hideous pimple just lateral to his chin. If the popped pimple gets infected, which lymph node is draining the lesion? A. Submental lymph nodes B. Submandibular lymph nodes C. Pharyngeal lymph nodes D. Lingual lymph nodes

B. Submental lymph nodes drain chin and central lower lip, while submandibular nodes drains most of the central face.

A girl had developed repeated attacks of pneumonia almost immediately after birth. A blood test taken 3 weeks after birth showed a blood hemoglobin concentration of 4.5% (normal at that age: 15-19%). This could possibly be a serious case of: A. Sickle cell disease or α-thalassemia but not β-thalassemia B. α-thalassemia but not sickle cell disease or β-thalassemia C. Sickle cell disease or β-thalassemia but not α-thalassemia D. Sickle cell disease but not α-thalassemia or β-thalassemia E. α-thalassemia or β-thalassemia but not sickle cell disease

B. The other diseases would not show symptoms this early because they both affect beta-hemoglobin, which is not produced in large amounts until after birth.

Which of the following structures is LEAST likely to be injured following an isolated fracture of the sphenoid bone? A. Middle meningeal artery B. Facial nerve C. Maxillary nerve V2 D. Opthalmic veins

B. To answer this question, you must know the holes of the skull that the structures pass through and what bone those holes are housed in. The superior orbital fissure (D), foramen rotundum (C), and foramen spinsoum (A) are located throughout the sphenoid bone. The internal acoustic meatus (B) is within the temporal bone, and hence the facial nerve would not be affected.

A 24-year-old female presents with double vision. Upon examination, you observe that her left eye does not follow your finger horizontally to the left visual field. Damage to which structure is the likely reason for this defect? A. Left sided CN III palsy B. Left sided CN VI palsy C. Torn left medial rectus D. Left sided CN IV palsy

B. lateral rectus

Damage to the middle meningeal artery can give rise to an epidural hematoma. Which foramen does this artery pass through on its way to supplying to dura mater? A. Foramen magnum B. Foramen spinosum C. Foramen ovale D. Superior orbital fissure E. Stylomastoid foramen

B. meningeal arteries -> epidural sup. cerebral veins -> subdural cerebral arteries -> subarachnoid

A person who has two alpha-thalassemia 1 alleles would have what condition?

Barth's disease or hydrops fetalis (fatal in utero)

What is the role of Fas and FasL in immune responses?

Binding of FasL to Fas receptors induces apoptosis in cells containing Fas.

Humoral immunity can be acquired passively by A) catching a virus from a friend by shaking hands. B) receiving a vaccine of influenza virus grown in eggs. C) receiving serum from someone who has recovered from an infection. D) receiving leukocytes from an immune family member. E) sharing a drink with someone who has a cold.

C.

A patient presents to the ED complaining of a worsening headache and double vision when he looks to the left. Upon neurological exam, you find he exhibits a disconjugate horizontal gaze, with failure to abduct his left eye. Identify the cranial nerve deficit and the muscle it innervates. A. CN IV; medial rectus B. CN III; lateral rectus C. CN VI; lateral rectus D. CN IV; lateral rectus

C

A woman presents to your office with damage to her sympathetic trunk and Horner's Syndrome. Which intraocular muscle constricts the pupil, causing the miosis observed in Horner's syndrome? A. Radialis m. B. Ciliary muscle C. Sphincter pupillae m. D. Lateral rectus m. E. Superior oblique m.

C

A young woman is brought to the emergency room after being involved in a car accident. She presents with CSF rhinorrhea, darkness around the eyes and behind the ears, and appears to have impaired hearing. Since the patient was conscious, the paramedic had decided to start an artificial airway via a nasopharyngeal tube. Upon seeing this, the emergency room physician was enraged and reprimanded the paramedic for choosing this mode of airway management. What injury does the patient most likely have to warrant such a reaction? A. Epidural hematoma B. Subdural hematoma C. Basilar skull fracture D. Facial fracture E. Fractured nose

C

The 24-year-old boxing champion of the world comes into your office with increased intracranial pressure after tonight's fight. You observe periorbital ecchymosis and edema over the pterion. CT scan of the head shows fluid thats shaped like a lens and crosses to both hemispheres of the skull. What vessel is the cause of the hematoma and through which foramina does it enter the neurocranium? A. Superficial temporal artery, foramen ovale B. Cerebral vein, foramen rotundum C. Middle meningeal artery, foramen spinosum D. Middle cerebral artery, foramen lacerum E. Middle meningeal artery, foramen ovale

C

Which of the following cytokines stimulates hepatocytes to produce acute phase proteins that function as early indicators of inflammation? A) IL-2 B) IL-4 C) IL-6 D) IL-8 E) IL-10

C

The optic nerve (CN II) exits the cranial cavity by passing through which foramen and in which cranial fossae? A. Cribriform plate; Anterior cranial fossae B. Optic canal; Anterior cranial fossae C. Optic canal; Middle cranial fossae D. Optic canal; Posterior cranial fossae E. Superior orbital fissure; Middle cranial fossae

C CN II exits the skull through the optic canal which is located in the Middle cranial fossae.

The red cell distribution width (RDW) reflects: A. variation in shape of RBCs B. variation in RBC number C. variation in size of RBC D. type of RBC inclusions E. number of RBC inclusions F. anisocytosis G. pokiolocytosis

C & F Red cell distribution width (RDW) is a parameter that measures variation in red blood cell size or red blood cell volume. RDW is elevated in accordance with variation in red cell size (anisocytosis), ie, when elevated RDW is reported on complete blood count, marked anisocytosis (increased variation in red cell size) is expected on peripheral blood smear review. The reference range for RDW is as follows: RDW-SD 39-46 fL[1] RDW-CV 11.6-14.6% in adult[2] Reference ranges may vary depending on the individual laboratory and patient's age.

The mean cell hemoglobin concentration (MCHC) of RBCs is most helpful in determining the: A. variation in size of RBCs B. variation in shape of RBCs C. degree of RBC central pallor D. shape of RBCs E. average size of RBCs F. average color of RBCs G. color of individual RBCs

C, F The mean corpuscular hemoglobin concentration, a measure of the concentration of hemoglobin in a given volume of packed red blood cells. It is reported as part of a standard complete blood count. It is calculated by dividing the hemoglobin by the hematocrit. MCHC is diminished ("hypochromic") in microcytic anemias, and normal ("normochromic") in macrocytic anemias (due to larger cell size, though the hemoglobin amount or MCH is high, the concentration remains normal). MCHC is elevated ("hyperchromic") in hereditary spherocytosis, sickle cell disease and homozygous hemoglobin C disease.

A 52 year old woman comes to your office after being unable to open her mouth or jaw. She indicates that she was recently diagnosed with tetanus after stepping on a rusty nail. Which of the following muscles would most likely be paralyzed? A. masseter muscle B. medial pterygoid muscle C. lateral pterygoid muscle D. buccinator muscle

C.

A patient was diagnosed with a tumour of CN VIII where it enters the temporal bone. Which other nerve could potentially be affected as well since it enters via the same foramen? A. Optic nerve B. Mandibular branch of the trigeminal nerve C. Facial nerve D. Hypoglossal nerve E. Vagus nerve

C.

Hemoglobin S can be separated from normal hemoglobin A by electrophoresis on paper or cellulose acetate foil. The best explanation for why this is possible is because hemoglobin S: A. Is more hydrophilic than hemoglobin A B. Is more hydrophobic than hemoglobin A C. Has a different number of electrical charges than hemoglobin A D. Has a more compact shape than hemoglobin A E. Has a different molecular weight than hemoglobin A

C.

Which cranial nerves pass through foramen rotundum and foramen ovale, respectively?

CN V2 and CN V3

Two sisters are jumping on a trampoline on a hot summer day. The older sister dares the younger sister to perform a front flip. The younger sister bravely attempts a front flip but lands face down on the nearby pavement. The fall results in a horizontal fracture superior to the maxillary alveolar process. This is type of fracture is known as: A. Basilar skull fracture B. Comminuted skull fracture C. Le Fort I skull fracture D. Le Fort II skull fracture

C.

Which would NOT be an effective way to diagnose sickle cell anemia? A. Hemoglobin electrophoresis B. PCR exon 1 of the B-globin gene, followed by allele specific hybridization specific for normal and betaS alleles C. Enzymatic assay for hemoglobin activity D. PCR exon 1 of the B-globin gene, followed by restriction digest with MstII E. Restriction digest of genomic DNA with MstII, followed by Southern blot, using a B-globin gene product as probe

C.

Injury to CN VII will affect all of the following muscles EXCEPT A. Buccinator B. Orbicularis oculi C. Temporalis D. Orbicularis oris

C. Buccinator, orbicularis oculi, and orbicularis oris are innvervated by CN VII, the facial nerve. Temporalis is a muscle of mastication and receives innervation from CNV3, the mandibular division of the trigeminal nerve.

A 27-year old male was rushed to the hospital after surviving an auto-mobile accident where it was suspected that he suffered a whip-lash injury. Which symptoms would likely pinpoint to lesions beyond the superior cervical ganglion? A. Loss of function to the superior tarsal muscle, flushed face, and pupillary dilation. B. Flushed face, pupillary dilation, and protruding eyes. C. Lack of sweating, loss of function to superior tarsal muscle, and pupillary constriction. D. Pupillary constriction, profuse sweating, and loss of function to the superior tarsal muscle.

C. Sympathetic: T1superior cervical gglcarotid plexus i) Ciliary nndilator pupillae (dilates pupil) ii) Oculomotor n superior tarsal m (elevates upper eyelid) iii) Ophthalmic avasculature Homer's syndrome

There is an anastomosing blood network from both the external and internal carotid arteries. Which of these arteries directly branches off of the external carotid artery? A. Ophthalmic artery B. Supratrochlear artery C. Facial artery D. Supraorbital artery E. Angular artery

C. The facial artery is the only of these arteries that directly branches off of the external carotid artery. The ophthalmic artery is a branch off of the internal carotid artery, and it gives rise to the supratrochlear and supraorbital arteries. The angular artery is a branch of the facial artery and thus not a direct branch off the external carotid.

An 8 year old boy is brought into his pediatrician's office after he started experiencing intense headaches in the morning as well as some vomiting. His normal demeanor has also changed over the past few days. His mother has noticed that he is having difficulty in walking and he seems to be bobbing his head. These signs lead his pediatrician to send him to the hospital in order to get an MRI with contrast of his head and spine. The radiologist sees a contrast-enhancing midline tumor in the cerebellum that is compressing the fourth ventricle. These are all the hallmarks of a medulloblastoma and the pediatrician has to inform the mother and child of the diagnosis. The child is now complaining about some double vision, especially when he looks to his right. The pediatrician notices that the right eye is unable to track all the way temporally. Through which opening does the affected nerve pass? A. Optic canal B. Foramen ovale C. Superior orbital fissure D. Foramen spinosum E. Foramen lacernum F. Jugular foramen

C. The medullablastoma is raising the intracranial pressure by obstructing the ventricular system. This is creating many of the problems that the child is presenting with. The inability of the right eye to track temporally shows that the abducens nerve (CN VI) is being compromised. CN VI passes through the superior orbital fissure in order to reach the lateral rectus muscle.

Which of the following blood vessels of the face is a branch of the internal carotid artery? A. Inferior labial artery B. Superior labial artery C. Ophthalmic artery D. Angular artery E. Facial artery

C. The ophthalmic artery is the first branch of the internal carotid artery, all other choices are off the external carotid.

Upon examination of your patient, a 33-year old female, you notice 'something funny' with her right eye and want to conduct a further examination of her extraocular muscles. The H-test reveals that your patient's right eye has difficulty with adduction and elevation. After completing the test she stares blankly at you and you notice her eye rests in a down-and-out position. Which of the following muscles are still working properly in the patient? A. Superior rectus and inferior oblique B. Lateral rectus and inferior oblique C. Lateral rectus and superior oblique D. Superior oblique and inferior oblique E. Inferior rectus, medial rectus and inferior oblique F. Medial rectus, lateral rectus and superior rectus G. Superior oblique, lateral rectus and inferior rectus

C. The patient likely has oculomotor nerve palsy. The two extraocular muscles not innervated by the oculomotor nerve are the superior oblique (CN IV, Trochlear) and the lateral rectus (CN VI, abducens).

The tip of the nose gets its sensory innervation from: A. Mandibular nerve B. Facial nerve C. Ophthalmic nerve D. Occulomotor nerve E. Maxillary nerve

C. Tip of the nose gets its sensory innervation from the first division of the trigeminal nerve, which is the ophthalmic nerve or V1.

You have a patient who is an Iraq war veteran. During his deployment, a roadside IED went off near his vehicle. The explosion damaged the vehicle and gave him what was diagnosed as a concussion at the time. Following that episode, he has had diplopia and tilts his head to the right in order to compensate. On performing the H test, you ascertain that his left eye is the one with the movement deficit. His pupils are equal and reactive to light. What cranial nerve is affected? A. CN III to left eye B. CN III to right eye C. CN IV to left eye D. CN IV to right eye E. CN VI to left eye F. CN VI to right eye

C. You are correct! The stem tells you that the left eye is the one with the movement problem, so you can eliminate any choice of nerves going to the right eye. Then, you have to think about his clinical presentation--he has had head trauma, and is tilting his head to the opposite side of the deficit. This is classic for a CN IV, or trochlear nerve, palsy. CN IV is also frequently injured by blunt trauma to the head because it is a thin nerve with a long intracranial course. A patient with a CN VI palsy will turn his head TOWARD the side with the deficit to correct the diplopia, since the eye cannot turn outwards. CN III presents with a dilated pupil and "down and out" position. For neuroscience, make sure you know the nuclei associated and course of the nerves through the skull.

Which important markers are found on NK cells?

CD16, FasL (after antibody activation), CD2, CD56

What is the integrin we learned about that is present on neutrophils and facilitates firm adhesion? What other protein does it interact with?

CD18, ICAM-1 on the endothelium

What progenitor cell do dendritic cells come from?

CFU-GM or CFU-M

What type of CFU cells develop into T cells in the thymus?

CFU-L. However, 95% of them die before becoming T cells.

What progenitor cell precedes plasma cells?

CFU-LyB

What progenitor cell do thrombocytes come from?

CFU-Meg

Which cranial nerve provides the parasympathetic fibers responsible for innervating the parotid gland?

CN IX Glossopharyngeal Be sure to know the pathway of these parasympathetic fibers as they travel to the parotid: Inferior salivatory nucleus > CN IX > Tympanic n. >Tympanic plexus > Lesser petrosal n. > Otic ganglion (synapse) > auriculotemporal n. (a branch of V3) > parotid gland

Which receptor is found on NK cells, neutrophils, and macrophages and binds to IgG?

Cd16/FcgammaRIII

The expression of FasL and the subsequent binding of FasL to Fas are the result of the binding of which 2 molecules? What is the next step in this pathway?

Cd16/FcgammaRIII (receptor on NK cells) Fc of IgG (on tagged pathogens) activation of caspases to kill the target and destroy Fas Natural Killer cells

A 42 year old male reports to ER with a large contusion on the top of his head. He tells you that he was working on a construction site when a hammer fell and hit him on the top of his head, unfortunately he was not wearing his hard hat at that time. An x-ray reveals a fracture at the bregma, what two sutures come together to form the bregma? A. squamous and lambdoid B. lambdoid and coronal C. lambdoid and sagittal D. sagittal and coronal E. sagittal and lambdoid F. coronal and squamous

D

After an upper respiratory tract infection, a 10-year-old girl with sickle cell disease suddenly falls very ill. A blood test shows a hemoglobin concentration of 4%. The most likely problem is: A. Lack of erythropoietin B. Excessive formation of fibrin clots caused by excessive sickling C. Acute iron deficiency D. Trapping of erythrocytes in the spleen E. Internal bleeding

D

After having plastic surgery performed on her face, a 40-year-old woman suffered from damage to the mandibular branch of CN V. Which of the following muscles would NOT be effected by this lesion? A. Lateral pterygoid B. Medial pterygoid C. Mylohyoid D. Buccinator

D

Damage to which of the following structures would have NO effect on the secretomotor function of the lacrimal gland? A. Zygomatic nerve B. Nerve of pterygoid canal C. Pterygopalatine ganglion D. Ciliary ganglion

D

Antibody-dependent cell-mediated cytotoxicity (ADCC) is a process in which antibody-coated cells are killed by A) Antibody B) Complement C) Cytotoxic T cells. D) Cells with Fc receptors for IgG3. E) Cells with Fc receptors for IgE.

D. NK cells

During surgery for a malignant parotid gland tumor in a 69-year old woman, the main trunk of the facial nerves is lacerated. Which of the following muscles is paralyzed? A. Masseter muscle B. Stylopharyngeus muscle C. Anterior belly of the digastric muscle D. Buccinator muscle

D

Following a car accident, a patient presents with signs of increased intracranial pressure. Radiologic studies reveal a crescent shaped hematoma near the junction of the parietal and frontal lobes which does not cross the midline. Which structure impedes the collection of blood from crossing the midline? A. Falx Cerebelli B. Superior Saggital Sinus C. Tentorium Cerebelli D. Falx Cerebri E. Cavernous Sinus

D

The cranial fossa is divided into three sections: anterior, middle, and posterior. Within each section there are various foramina for the cranial nerves to exit the skull. In the middle fossa, there is an important foramina that provides exit for CN III, CN IV, CN V1, and CN VI. This aperture is also known as: A. Foramen Spinosum B. Foramen Rotundum C. Foramen Ovale D. Superior Orbital Fissure E. Foramen Magnum

D

The lacrimal gland receives its motor innervation from which cranial nerve? A. Optic nerve B. Oculomotor nerve C. Trochlear nerve D. Facial nerve E. Opthalmic division of trigeminal nerve

D

You are instructed to perform an H-Test on a patient. You ask the patient to cover their left eye and follow your finger with the right one. As you move your finger in towards the patients nose and then up, you notice that he/she is able to adduct the right eye however, there is no upward movement. What muscle is not working properly? A. Superior Rectus B. Inferior Rectus C. Superior Oblique D. Inferior Oblique E. Medial Rectus F. Lateral Rectus

D

A 42 year old man presents to the emergency room with a vesicular and erythematous rash covering the left side of his eyebrow going down to the tip of his nose including his left eye. The rash does not ross the midline and is very painful. What cranial nerve is involved? A. CNVII B. CNV2 C. CNIV D. CNV1 E. CNIII

D.

As you are walking around your grandfather's old basement, a rat the size of 'Master Splinter' hops out from a cabinet and latches onto the tip of your nose. The pain that you are experiencing is due to the innervation of what nerve, be specific ? A. C.N. III (Oculomotor N.) B. C.N. VII (Facial N.) C. C.N. V (III) (Mandibular Branch) D. C.N. V (I) (Opthalmic Branch)

D.

Horner's syndrome is a common congenital/iatrogenic disorder that affects your sympathetic chain. The three main symptoms of Horner's Syndrome are fine ptosis, miosis, and anhidrosis. What muscle is the main cause for the fine ptosis in an individual with Horner's Syndrome? A. Superior Rectus m. B. Orbicularis Oculi m. C. Levator Palpebrae m. D. Superior Tarsal m. E. Lateral Rectus m.

D.

An Elvis impersonator presents to your office for a routine checkup. When you give him the "all clear" he flashes you a perfect version of Elvis' famous smile, with his left upper-lip curling upwards. You notice that his left nostril is also flaring slightly and it occurs to you that the muscle necessary to perform this grin must be the... A. Levator anguli oris B. Levator labii superioris C. Zygomaticus major D. Levator labii superioris alaeque nasi

D. "Lifter of the upper lip and the wing of the nose." This muscle has the longest name in the human body and performs the function its name describes, including flaring the nostrils.

What cranial nerves exit the skull from the middle cranial fossa? A. C.N. I - VI B. C.N. III - VI C. C.N. I - VIII D. C.N. II - VI E. C.N. III - VIII

D. Cranial nerve I exits the skull via the anterior cranial fossa (through the cribiform plate) while Cranial Nerves II - VI exit via the middle cranial fossa. The remaining Cranial Nerves VII - XII exit the skull through the posterior cranial fossa.

A 65 year old woman came into the clinic with painful skin rashes above her left eye area. She has been having flu-like symptoms for a week. She admits of having chicken pox when she was young. Ophthalmicus is suspected. Which nerve did the Herpes zoster virus affect? A. Cranial Nerve VII (Facial Nerve) B. Ophthalmic and Maxilla division of trigeminal Nerve C. Temporal branch of Facial Nerve D. Ophthalmic division of trigeminal Nerve

D. D is correct because Varicella-zoster virus usually affect ophthalmic division of CN V affecting the eye region of the patient. It is the reactivation of varicella-zoster virus called Shingles. A & C is incorrect because Facial Nerve (CN VII) is responsible to motor innervation of facial muscles. It is not responsible for cutaneous innervations. B is incorrect. This is the classic nerve divisions affected in Trigeminal Neuralgia. Trigeminal neuralgia is characterized by episodes of brieg, intense facial pain over 1 of the 3 areas of distribution of CN V triggered by chewing, wind blowing and etc.

A patient presents with dryness of the mouth after having surgery to remove a Warthin's tumor, a benign tumor of the parotid gland. Damage to which ganglion may be suspected as a cause to his symptoms? A. pterygopalatine B. ciliary C. superior cervical D. otic E. submandibular

D. Due to the description of the location of surgery - lateral face, right below temple - damage associated with the parotid gland can be suspected. The ganglion associated with the parotid gland is the otic ganglion. The parasympathetic fibers of the lesser petrosal branch of the glossopharyngeal nerve synapse at this ganglion, from which the postganglionic fibers reach the gland by hitch-hiking on the auriculotemporal nerve (branch of CN V3).

A patient presents to the ER having been thrown from his motorcycle. He was riding without a helmet at the time of the accident and sustained major head trauma. The patient is given an emergency head CT which shows a lens shaped bleed in his left temporal region. What artery was lacerated and through what foramen does it enter the cranial vault? A. Internal carotid, Carotid canal B. Middle meningeal, Foramen Lacernum C. Middle meningeal, Foramen Ovale D. Middle meningeal, Foramen Spinosum E. Internal carotid, Foramen Rotundum

D. Lens shaped bleeds are indicative of an arterial epidural bleed with the middle meningeal being the most prevalent.

5. What is the best approach to an otherwise healthy, asymptomatic 12 month old female with the hemoglobin of 9.1 g/dl (MCV 58) on routine CBC screen and the presence of Hemoglobin Barts on her newborn screen? A. Explain to the parents that the baby may have thalassemia and obtain an electrophoresis B. Start the baby on Fe supplements and order an electrophoresis C. Start the baby on Fe supplements, recheck in a month, and if the hemoglobin is not improved then, assume the baby has thalassemia D. Counsel the family that the baby has a form of alpha thalassemia, and that no immediate other tests or Fe supplements are needed

D. Presence of HbBarts protein at the time of newborn is enough to indicate alpha thalassemia (HbH disease). Anemia increases iron uptake from the GI tract, so any option including iron supplements would be wrong. There is no reason to repeat a test already done that was diagnostic.

In an anemia workup, which should be ordered first to check for effective hematopoiesis? A. bone marrow aspirate B. bone marrow biospy C. PBS D. reticulocyte count E. serum bilirubin

D. Reticulocyte count is a blood test that measures how fast RBCs called reticulocytes (Retic) are made by the bone marrow and released into the blood. Reticulocytes are in the blood for about 2 days before developing into mature red blood cells. Normally, about 1% to 2% of the red blood cells in the blood are reticulocytes. The reticulocyte count rises when there is a lot of blood loss or in certain diseases in which red blood cells are destroyed prematurely, such as hemolytic anemia. Also, being at high altitudes may cause reticulocyte counts to rise, to help you adjust to the lower oxygen levels at high altitudes.

While dissecting your cadaver you crack through the floor of the anterior cranial fossa, remove the periorbital fat, and carefully expose the nerves and underlying musculature. You find a branching nerve that sits atop the levator palpebrae superioris. What is the name of this nerve? A. Supratrochlear nerve B. Lacrimal nerve C. Abducens nerve D. Frontal nerve E. Oculomotor nerve F. Trochlear nerve

D. The frontal nerve is a continuation of CN V1, Ophthalmic. It gives rise to the supraorbital and supratrochlear nerves.

A patient is unconscious after undergoing severe head trauma. Upon examination a lens shaped hematoma is seen compressing the left lobe of the brain. The artery that causes that this type of hematoma travels though which foramen to enter the skull? A. Foramen Magnum B. Jugular Foramen C. Foramen Rotundum D. Foramen Spinosum E. Foramen Ovale

D. The type of hematoma here is an Epidural Hematoma which is caused by the Middle Meningeal Artery which travels through the Foramen Spinosum.

A 6 year old boy is playing in a sandbox when he trips and falls. Landing on a sharp object, he develops a laceration directly under his zygomatic arch. Within a few days, he notices that it begins to pus and it is rather erythematous. Which of the following lymph nodes will proliferate and be the most apparent early on? A. Submental nodes B. Inferior deep cervical nodes C. Posterior auricular nodes D. Submandibular nodes E. Preauricular nodes

D. When in doubt, most of the drainage to your face will drain directly to your submandibular nodes. The submental nodes will only drain the chin, the lower lip and the tip of the tongue. Eventually your nodes will drain to the inferior deep cervical, however these are not as apparent clinically as the submandibular nodes.

A 56 year old woman was recently diagnosed with a stage III malignant tumor located in the right parotid gland. Before her diagnosis she was experiencing a slow loss of control of the muscles of her face. The first symptom she noticed was her inability to puff out her right cheek. What is likely cause of this specific symptom? A. Excessive secretion of paralyzing hormones from the parotid gland tumor. B. Excessive secretion of serous fluid compressing the buccal branch of the facial nerve. C. Excessive secretion of mucous fluid compressing the buccal branch of the facial nerve. D. Tumor compressing the zygomatic branch of the facial nerve. E. Tumor compressing the buccal branch of the facial nerve.

E.

Michaela was watching tv, when George stumbles in, drunk, and knocks over the tv. The tv crashes to the floor and the screen shatters, George slips and lands in the debris. At the hospital, it is revealed that he has lacerations above and below his left eye and is in a lot of pain. What cranial nerve fibers are carrying the pain signals? A. CN V3 B. CN V1 C. CN VII D. CN V2 + CNVII E. CN V1 + V2

E. A) Is incorrect because CN V3 is not involved. B) Is incorrect because it is only above the eye and does not carry signals from below the eye. C) CN VII is motor. D) CN VII is motor E) is correct since it has CN V1 for above the eye and CN V2 for below the eye.

A patient enters your office complaining of a dry, itchy eye. When asked about recent surgeries, he says, "Yes, I had one a few days ago, over this part of my face," as he outlines the region of his left parotid gland. He reports no loss in sensations of taste, hearing, smell or touch. Examination of his extra-ocular muscles, pupils, visual fields and acuity are normal. When asked to blink, the patient's left eyelid does not close completely. Further, his smile is weakened and asymmetric and he can't fully wrinkle his forehead. What nerve is most likely affected? A. Oculomotor B. Optic C. Auriculotemporal D. Ophthalmic E. Facial

E. CN VII is vulnerable to injury during parotidectomy as it passes through the parotid gland and gives off branches to the muscles of facial expression. The cornea is moistened with tears through the blinking action of orbicularis oculi. If blinking is slow or incomplete, the cornea may dry out and become infected.

The MCV is most helpful for determining the: A. variation in size of RBCs B. variation in shape of RBCs C. shape of individual RBCs D. size of individual RBCs E. average size of RBCs F. average color of RBCs

E. Mean corpuscular volume (MCV) is the average volume of red cells in a specimen. MCV is elevated or decreased in accordance with average red cell size; ie, low MCV indicates microcytic (small average RBC size), normal MCV indicates normocytic (normal average RBC size), and high MCV indicates macrocytic (large average RBC size).

A 23 year old woman comes into the ER after being in a car accident in which she injured her internal carotid artery. Which blood vessels which supply the scalp would most likely be affected? A. Occipital A. and Posterior Auricular A. B. Supratrochlear A. and Facial A. C. Supratrochlear A. and Superior Temporal A. D. Superior Thyroid A. and Supratrochlear A E. Supraorbital A. and Supratrochlear A.

E. The only arteries supplying the scalp that originate from the Internal Carotid A. are the Supratrochlear A. and Supraorbital A. All other arteries in the face and scalp region originate from the External Carotid A.

Which cells secrete hormones that aid in lymphocyte maturation?

ERCs in the thymus

What test is used to quantify cytokines?

Elispot

T/F: Individuals whose APCs release IL-12 in response to Myobacterium leprae will develop lepramatous leprosy.

False

You are in your clinical rotations and you are observing a partial parotid gland resection. Having mastered 2nd semester anatomy at Ross University, you know that the surgeon must be particularly careful not to damage what structure which runs deep to the parotid gland? A. Maxillary Artery B. Cranial Nerve VII C. Cranial Nerve IX D. Cranial Nerve V E. External Carotid Artery

Facial nerve (CN VII) runs deep to the Parotid Gland (invested by the partidomasseteric fascia, from the deep cervical fascia), which will then bifurcate into 5 different branches that innervate the muscles of facial expression. The branches can be remembered by the mnemonic, "Two Zebra's Bit My Cookie" (Temporal, Zygomatic, Buccal, Marginal Mandibular, Cervical, and not included in the mnemonic is Posterior Auricular, N. to stylhyoid, N. to Post. Belly of Digastric).

T/F: B cell receptors only recognize peptides.

False

T/F: C-reactive protein is a phagocytosis PRR.

False

T/F: IL-1beta is the membrane form and IL-1alpha is the secreted form

False

Reticulocytosis would most like be seen in patients with: A. Vitamin B12 deficiency B. Iron deficiency C. Folate deficiency D. resection of duodenum E. Resection of ileum F. small intestinal malabsorption G. large intestinal malabsorption H. massive blood loss I. severe hemolytic anemia

H & I

What is the difference between the endothelial cells that line high endothelial venules and the cells lining most other venules?

HEVs have cuboidal rather than squamous cells lining them and they express molecules that attract naive T and B cells to move through them via diapedesis

Which IL has the following characteristics: Hyperproduction promotes development of B-cell non-Hodgkin's lymphoma.

IL-14 (BCGF)

What cells are formed by ERCs and only found in the medulla of the thymus?

Hassall's corpuscles

What is a hemoglobin that consists of 4 gamma chains called?

Hb Barts. It can indicate either silent alpha thalassemia carrier (one alpha globin gene deletion), alpha thalassemia trait (two alpha globin gene deletions) or hemoglobin H disease (three alpha globin gene deletions). Deletion of four alpha globin genes is not compatible with life.

What is another name for zeta-epsilon hemoglobin?

HbGover1

What is another name for alpha-epsilon hemoglobin?

HbGover2

What is another name for zeta-gamma hemoglobin?

HbPortland

What hemoglobinopathy is caused by a point mutation of glutamate to valine?

HbS is produced - Sickle cell anemia

What inclusions are associated with denatured Hb?

Heinz's bodies

A person who has one alpha-thalassemia 1 allele and one alpha-thalassemia 2 allele would have what condition?

Hemoglobin H disease: moderately severe anemia They have HbH (or Hb-beta4), which are beta-hemoglobin tetramers Symptomatically similar to beta-thalassemia intermedia

Asplenia or hyposplenia is associated with what abnormal RBC inclusion?

Howell-Jolly bodies (small basophilic inclusions that represent remnants of a nucleus. Indicate a missing or badly performing spleen)

What is the glycoprotein we learned about that is present on endothelial cells and facilitates firm adhesion? What other protein does it interact with?

ICAM-1, CD18 on the neutrophil

Which interferon is approved for the treatment of hepatitis, Kaposi's sarcoma and leukemia? How does it treat these conditions?

IFN-alpha (Roferon) -inhibits viral replication and suppresses cell proliferation

Which interferon is approved for the treatment of MS? How does it treat these conditions?

IFN-beta -stimulates B cells -pyretic -cytostatic for tumor cells -antiviral

Which interferon treats chronic granulomatous disease by many means including increasing MHC production, inducing acute phase proteins, activating endothelial cells and phagocytes, suppressing tumor cell growth, and antiviral activity? Which cells would produce this IFN in a normal person?

IFN-gamma CD8+ cells phagocytes NK cells Th1 cells in response to IL-2 or Ag stimulation

Which IL has the following characteristics: Produced by activated APCs (B cells, dendritic cells, macrophages) Pyrogenic** Many effects on various targets: Activation of TH cells Proliferation of B cells Activation of NK cells Increased ICAM expression on vascular endothelial cells Chemotactic for macrophages and neutrophils

IL-1

Which IL has the following characteristics: Produced by activated T cells, primarily TH2, monocytes, mast cells Related to EBV Inhibition of proinflammatory cytokines from activated monocytes and macrophages*** Promotion of B cell proliferation

IL-10

Which IL has the following characteristics: Produced by stromal cells Induction of haemopoiesis*** Production of acute phase proteins by hepatocytes (pro inflammatory)

IL-11

Which IL has the following characteristics: Produced by activated APCs Promotes differentiation of TH0 to TH1 Costimulator of TH1 activity: expression of IL-2R, secretion of IL-2, INF-gamma** Enhances NK proliferation

IL-12

Which IL induces Th cells to produce IFN-gamma?

IL-12

Which IL has the following characteristics: Like IL-4, produced by TH2 cells and promotes IgE production** Possesses anti-inflammatory properties

IL-13

Which IL has the following characteristics: Produced by activated TH2 cells and mast cells Affects activation, proliferation and differentiation of B cells Isotype switch inducing factor to IgG1 and then to IgE** Also induces proliferation of TH2 cells Up-regulates MHC Class II expression on macrophages Stimulates growth of mast cells

IL-4

Which 2 cytokines work together to stimulate B cells to class switch and express IgE?

IL-4 and IL-5

Why can't Th2 and Th1 cells be produced at the same time?

IL-4, which is both produced by Th2 cells and helps activate them, inhibits the differentiation of ThP cells into Th1 cells. IFN-gamma, which is produced by Th1 cells, inhibits the differentiation of ThP cells into Th2 cells.

Which IL has the following characteristics: Similar to IL-4 Synergistic activity with IL-4 for IgE production** Induction of growth and differentiation of eosinophils

IL-5

What protein induces the synthesis of mannan binding lectin?

IL-6

Which IL has the following characteristics: Pleiotropic Similar properties with IL-1. Serves as a cofactor. Secreted by macrophages, BM stromal cells and lymphocytes Promotes proliferation and terminal differentiation of B cells Stimulates ab secretion by plasma cells Promotes differentiation of myeloid stem cells Induces production of acute phase proteins (CRP) by hepatocytes***

IL-6

Which IL has the following characteristics: Secreted by BM stromal cells and thymocytes Regulation of B & T cell development and maturation*** Induction of proinflammatory cytokines IL-1, IL-6

IL-7

Which IL has the following characteristics: Chemokine for neutrophils, T cells, basophils*** Promotes angiogenesis

IL-8 (CXCL8)

Which IL has the following characteristics: Pleiotropic cytokine mainly produced by Th2 cells Stimulates release of IL-2, IL-4, IL-6, IL-11 Stimulates cytotoxicity of CTLs and NK cells (apoptosis) May be involved in asthma pathogenesis

IL-9

What # cranial nerve is trochlear?

IV

What kind of antibody is most commonly secreted in MALT? What secretes it?

IgA plasma cells

How does the persistence of fetal Hb affect a sickle cell homozygote?

It helps the symptoms

What is the most important blood index for classifying anemia?

MCV

What is the best RBC index for classifying anemia based on morphology?

MCV The mean corpuscular volume, or "mean cell volume" (MCV), is a measure of the average red blood cell size that is reported as part of a standard complete blood count. The MCV is calculated by dividing the total volume of packed red blood cells (also known as hematocrit) by the total number of red blood cells. The resulting number is then multiplied by 10. The red blood cells get packed together when they are spun around at high speeds in a device called a centrifuge. In patients with anemia, it is the MCV measurement that allows classification as either a microcytic anemia (MCV below normal range), normocytic anemia (MCV within normal range) ormacrocytic anemia (MCV above normal range)

What protein on normal cells prevents NK cells from killing them?

MHC class I

What enzyme does a phagocyte need to generate HOCl from H2O2? What is the condition resulting from the lack of this enzyme?

MPO -nothing

What is homing?

Movement of T and B lymphocytes across HEVs into lymph nodes

What enzyme does a phagocyte need to generate oxygen radicals from NADPH and O2? What is the condition resulting from the lack of this enzyme?

NADPH oxidase chronic granulomatous disease

Which test measures the capacity of a phagocyte to perform oxidative burst & generate ROS's? What deficiencies could lead to a low score on this test?

NBT test NADPH oxidase deficiency, G6PDH deficiency

Which cells have CD2, CD56, and CD16?

NK cells

A person who has one alpha-thalassemia 2 allele and one normal allele would have what condition?

None; they produce 75% normal hemoglobin and are a silent carrier

Identify the nervous structure lying superior to the cribriform plate.

Olfactory bulb

Which precursor cell of erythrocytes is the one that loses the nucleus?

Orthochromatophilic erythroblast/normoblast loses it to become a polychromatophilic erythroblast

What kind of cell secretes alpha-defensins, lysozyme, and phospholipase in the GI tract?

Paneth cells of the GI tract

What is the main job of macrophages in the thymus? What is one other function they perform there?

Phagocytose failed thymocytes Guard the blood-thymus barrier

Following a car accident, a patient presents with diplopia. She is looking at you with her head rotated slightly to the right, claiming that this position is the only way to alleviate her diplopia. Before performing further tests, what cranial nerve has likely been damaged in this patient? A. Left trochlear nerve (CN IV) B. Right trochlear nerve (CN IV) C. Left abducens nerve (CN VI) D. Right abducens nerve (CN VI) E. Left occulomotor nerve (CN III) F. Right occulomotor nerve (CN III)

Right abducens palsy would cause the right eye to be adducted, and to compensate for this the patient may turn their head to the affected side. This aligns their eyes, and alleviates diplopia. Trochlear nerve palsy would cause the patient to hold their head down and to the opposite side of the affected eye. Occulomotor palsy would show a patient with an eye "down and out" with a dilated pupil.

What is the name of the arrangement of lymphoid tissue that forms a ring in the mouth?

Ring of Waldheyer

Sam, the designated driver, was driving his friends home from a graduation party. Although he was extremely careful, a drunk driver drove through a red light and crashed into his car. Sam was lucky and mostly came out of this unharmed, except the trochlea of his left eye was damage and no longer functioning. What would we most likely see?

Sam's left eye has a problem abducting and depressing (SO damage) He will tilt his head right & down

What four bones of the skull make up the pterion?

Sphenoid, Frontal, Temporal, Parietal

Bob, a 29 year old male, came into the clinic complaining of blurred vision when looking at far objects with his left eye and lack of sweat on his left side of his face. In his physical examination, ptosis, miosis and flushed warm dry skin are observed on the left side of his face. Which muscle is paralyzed to cause ptosis in Bob?

Superior tarsal muscle. Superior tarsal and levator palpebrae lift the eyelid, however, only superior tarsal receives sympathetic innervation from T1.

What do collectins do and how are they produced?

Surfactants. They lubricate the alveoli and bind pathogens for phagocytosis. They are produced by type II pneumocytes in the respiratory tract.

Do lymph nodes contain more T cells or B cells?

T

Does blood contain more T cells or B cells?

T

Which TLR binds to peptidoglycan? Where is this found?

TLR-2 gram-postive bacteria

Which TLR binds to dsRNA? Where is this found?

TLR-3 viruses

Which TLR binds to LPS? Where is this found?

TLR-4 gram-negative bacteria

Which TLR binds to flagellin?

TLR-5

What protein binds to mannose on bacteria to initiate intracellular signal transduction and expression of cytokine genes? Where is it found?

TLRs (toll like receptors) -on or in macrophages, endothelial cells, dendritic cells

Which TNF receptor contains a death domain, interacts with TRADD/FADD causing apoptosis, and activates transcription factor NF-kappaB?

TNF-R1

Which TNF does the following? IL-1 and PG-E2 synthesis by activated macrophages Induction of acute phase protein production Expression of MHC antigens Highly pyrogenic What secretes it and what are its receptors?

TNF-alpha Secreted by activated lymphocytes, macrophages, neutrophils and NK cells Receptors TNF-R1/TNF-R2 (both activate transcription factor NF-kappaB

Which TNF does the following? Expressed by and acts on many cell types. Similar in range and activity to another TNF but less potent Mitogenic for B cells Pyrogenic

TNF-beta Also known as lymphotoxin

A 58 y/o man with a history of poorly controlled hypertension and diabetes comes to the clinic complaining of double vision. Upon performing the H test the right eye can not deviate to the right side. The physician also noticed that the patient's face is headed towards the right. What is the most likely diagnosis for this patient? A. Right Occulomtor nerve palsy B. Left Trochlear nerve palsy C. Right Abducens nerve palsy D. Right Trochlear nerve palsy E. Left Occulomtor nerve palsy F. Left Abducens nerve palsy

The 6th cranial nerve is first and first nerve to be affected in cases of increases intracranial pressure (ICP), since it exits through the base of the brain. We have this patient with history of hypertension which over its course caused increased ICP. That then caused compression of the right abducens. If the RIGHT abducens is compressed, right lateral rectus will not be able to function properly. Patients often present with diplopia compensated by leaning towards the affected side.

What keeps aged red blood cells from re-entering circulation at the level of the splenic sinusoids?

The aged red blood cells are stiff and cannot pass through the elongated stave cells

The trigeminal nerve carries general sensory afferent fibers to all of the following areas of the face EXCEPT: A. Tip of the nose B. Tragus of the ear C. Angle of the mandible D. Mental protuberance E. Philtrum F. Inferior palpebral skin

The angle of the mandible is the correct answer because it receives sensory innervation from the Greater Auricular nerve (C2, C3) All other answer choices get their innervation from the Trigeminal Nerve. Tip of the nose - V1, Tragus of the ear V3, Mental Protuberance - V3, Philtrum - V2, Skin of the inferior palpeba (eyelid) - V2

Macrophages, the desmosomes that connect cortical epithelial cells, their basal lamina, and the basal lamina and tight junctions of capillary endothelial cells all contribute to what structure?

The blood-thymus barrier

Two girlfriends are talking about boys. One girl tells the other that she has a HUGE crush on this one guy in her class who smiles by lifting just one corner of his mouth. The other girl, being an anatomy geek, remembers the name of the facial muscle that does this and tells her friend. What is the name of the muscle that her friend just adores on her crush? A. Risorius B. Levator anguli oris C. Orbicularis oris D. Levator labii superioris

The correct answer is Levator anguli oris. It's function is to elevate the angle of the mouth. Risorius muscle allows for dimpling of the skin and/or a great wide grin. Orbicularis oris allows for puckering of the lips outwards (in a kissing motion). Levator labii superioris elevates the upper lip (not just specifically the corner of the mouth).

A 65-year-old male has a partial numbness on his face including his upper lip. What nerve is responsible for supplying sensation to the upper lip? A. External nasal n. B. Infraorbital n. C. Mental n. D. Buccal n. Commenting coming Fall 201

The infraorbital nerve exits the skull via the infraorbital foramen and innervates a large section of the maxilla, including the upper lip.

Describe thymic lobules

They are parts of the thymus divided by trabeculae containing medulla and cortex regions. The cortex contains more lymphocytes.

A person who has one alpha-thalassemia 1 allele and one normal allele would have what condition?

They have alpha-thalassemia trait (mild anemia. They produce 50% normal alpha-hemoglobin

A person who has two alpha-thalassemia 2 alleles would have what condition?

They have alpha-thalassemia trait (mild anemia. They produce 50% normal alpha-hemoglobin) remember: allele 2 = allele A = only one deletion allele 1 = allele B = 2 deletions

What is the only function of fibroblasts in the thymus?

They produce the capsule and trabeculae. ERCs provide structural support

A patient presents with bruising beneath his eyes and clear fluid leaking from his nostrils. An inexperienced resident is attempting to clear the patient's airway with a nasogastric tube. You alertly stop them because you know these are signs of basilar skull fracture, which contraindicates the use of a nasogastric tube because of potential damage having occurred to which structure?

This patient likely has a basilar skull fracture that may have damaged his cribriform plate. Signs may include: 1) periorbital ecchymosis (Raccoon Eyes), which is bruising beneath the eyes; 2) mastoid ecchymosis (battle sign), which is bruising behind the ear; 3) leakage of CSF through the nose (CSF Rhinorrhea) or 4) through the external auditory canal (CSF Otorrhea).

A 24-year old female patient comes to the clinic presenting with dry skin and a drooping eyelid. The physician also checks the patient's pupils and later diagnoses her with Horner's Syndrome. Which of the following pairs of muscles would also be affected in this patient? A. Levator palpebrae superioris and dilator pupillae B. Levator palpebrae superioris and sphincter pupillae C. Superior tarsal and sphincter pupillae D. Superior tarsal and dilator pupillae

This questions tests the student's ability to recognize the symptoms of Horner's Syndrome, which arise from problems with the sympathetic nervous system. They are classically anhydrosis, ptosis, and miosis. Answer choice D is correct because both the superior tarsal and dilator pupillae muscles have sympathetic innervation and would be affected in Horner's Syndrome. The sphincter pupillae and levator palpebrae superioris muscles receive parasympathetic innervation via CNIII and would not be involved in Horner's Syndrome, making choice A, B, and C incorrect.

T/F: A patient with 2 B+ alleles usually has beta-thalassemia intermedia.

True

T/F: A patient with a B0 allele or a B+ allele plus one normal allele usually has beta-thalassemia minor.

True

T/F: Antigens in the spleen interact with T and B cells in the marginal zone to stimulate the B cells to turn into plasma cells and form a secondary follicle.

True

T/F: B cells become immunocompetent in the bone marrow.

True

T/F: C-reactive protein is a secreted PRR.

True

T/F: Flu shots are an example of active acquired immunity.

True

T/F: HbSC gives a somewhat milder sickle cell disease compared to HbSS but worse than HbAS.

True

T/F: IFN-alpha, beta, and gamma are all acute phase proteins.

True

T/F: IL-1, IL-2, IL-6, IL- 8, IL-12, TNF-alpha, and PG-E2 are all cytokines.

True

T/F: IL-1alpha is the membrane form and IL-1beta is the secreted form

True

T/F: Individuals whose APCs release IL-4 in response to Myobacterium leprae will develop lepramatous leprosy.

True

T/F: KAR binds to PAMP and KIR binds to MHC class I.

True

T/F: Lingual tonsils have crypts.

True

T/F: Lymph exits the thymus through efferent lymphatic vessels in the trabeculae.

True

T/F: MCH increases or decreases in parallel with MCV.

True

T/F: Macrophages recruit neutrophils by releasing IL-8, TNF-alpha, IL- 1 and PG-E2.

True

T/F: Macrophages, B lymphocytes, and thymic epithelial reticular cells all contain class II MHC molecules.

True

T/F: Mast cells are part of the innate immune system.

True

T/F: Maternal antibodies are an example of passive acquired immunity.

True

T/F: Most of the plasma cells created in the lymph nodes migrate to the bone marrow.

True

T/F: Peyer's patches are an example of MALT.

True

T/F: Rabies shots given after exposure are an example of passive acquired immunity.

True

T/F: Sickle cell disease can refer to heterozygotes or homozygotes.

True

T/F: Th1 cells are associated with the production of IL-2 that promote cell mediated immune response while Th2 cells are associated with the production of IL-4 that promote an antibody response.

True

T/F: Th1 cytokines are called type 1 cytokines and include IL-2, TNF and IFN-gamma.

True

T/F: Th1 is associated with cell-mediated immunity.

True

T/F: Th2 cytokines are called type 2 cytokines and include IL-4, IL-5 and IL-13.

True

T/F: Th2 is associated with antibody-mediated immunity.

True

T/F: The alpha-thalassemia 1 allele is found in Asia and contains 2 deleted alpha-hemoglobin genes.

True

T/F: The alpha-thalassemia 2 allele is found in Africa and Asia and contains one deleted alpha-hemoglobin gene.

True

T/F: The cortical follicles of a lymph node contains mostly B cells and the paracortex contains mostly T cells.

True

T/F: The lymphoid nodules and PALS are located in the white pulp of the spleen.

True

T/F: The release of IL-12 from APCs results in the development of Th1 cells and subsequently IL-2, TNF and IFN-gamma.

True

T/F: The release of IL-4 from APCs results in the development of Th2 cells and subsequently IL-4, IL-5 and IL-13.

True

T/F: The white pulp of the spleen is secondary lymphoid tissue.

True

T/F: To enter the lymph nodes, APCs pass through the subcapsular sinus then the trabecular sinus.

True

T/F: Tonsils are an example of MALT.

True

T/F: HbE alleles contribute to beta-thalassemia by reducing the total amount of protein produced.

True, however, he HbE protein is usually functional enough not to give symptoms in a homozygote. It is only when it is combined with a beta-thalassemia gene that symptoms may occur.

T/F: B and T lymphocytes are indistinguishable by microscope.

True.

T/F: Lingual tonsils consist of single crypts surrounded by many nodules and palatine tonsils consist of multiple crypts in a band of nodules.

True.

T/F: Lymphocytes enter the lymph nodes via high endothelial venules while antigens and APCs enter via afferent lymph vessels.

True.

T/F: Mannan binding lectin is a secreted PRR.

True.

T/F: Presence of any protein at HbF, HbA or HbH excludes the diagnosis of HbBarts disease.

True.

T/F: Sickling in sickle cell anemia happens only when the RBC is carrying deoxygenated hemoglobin.

True.

T/F: T and B cells must meet their antigens before entering lymph tissue.

True.

T/F: The palatine tonsils have crypts.

True.

T/F: A patient with a B0 allele and a B+ allele usually has beta-thalassemia major.

True. A B0 gene will produce no beta Hb, and a B+ gene will produce only a small amount.

T/F: Individuals whose APCs release IL-12 in response to Myobacterium leprae will develop tuberculoid leprosy.

True. Cell-mediated immunity is needed to produce the appropriate response to protect from developing the more serious form of leprosy. IL-12 stimulates a TH1 response, which initiates proliferaton of TH1 cells which produce IFN-gamma and more IL-12 to increase efficiency of CTLs.

T/F: Hemoglobin H disease is a form of alpha-thalassemia.

True. It is the result of 3 missing genes for the alpha Hb, 2 on one allele and one on the other (one type A, missing one gene, and one type B, missing 2 genes)

T/F: To enter the lymph nodes, antigens pass through the subcapsular sinus then the trabecular sinus.

True. Sometimes they do not make it to the trabecular sinus because they could be eaten first by macrophages that line both sinuses.

T/F: Beta-hemoglobin can form homo-tetramers.

True. They are not very good at carrying oxygen, but less damaging to the cell than hemo

T/F: T cell receptors only recognize peptides.

True. This is in contract to B cell receptors, which can recognize lipids, sugars, and DNA.

What is anisocytosis?

abnormally sized RBCs

What does the width of bands signify in protein electrophoresis of Hb?

amount of protein

Which pathway do resting phagocytes derive energy from? Which pathway do they switch to when they have ingested a pathogen? Which enzyme is necessary to make the switch?

anaerobic glycolysis PPP G6P dehydrogenase

What cell immediately precedes a polychromatophilic erythroblast?

basophilic erythroblast

Pb poisoning is associated with what abnormal RBC inclusion?

basophilic stippling

What condition results from macrophages overproducing IL-1 and TNF-alpha and causes diarrhea, fever, and hypotension?

bacterial septic shock

The major duct of the Parotid gland pierces what muscle?

buccinator muscle

What do desferrioxamine and deferasirox do? When would you start treatment?

chelation therapy - they keep iron from blood transfusions from building up by keeping ferritin levels down to ~500 ng/mL -start when ferritin levels are at 1000 ng/mL

What does SDF-1 do?

chemokine

What do RANTES and eotaxin do?

chemokines

What is the name for the short cationic polypeptides produced by neutrophils and various epithelial cells that kill bacteria by disrupting the cell walls?

defensins

What hemoglobin gene comprises 3% of hemoglobin?

delta

Which are probably the best and most important APCs?

dendritic cells

What kind of cells activate T and B cells in the lymph nodes and where does this occur?

dendritic cells or other APCs

How does HbS damage the cell membranes of RBCs?

deoxy-HbS tends to aggregate, and the polymers damage the cell membrane

What kind of cells connect ERCs?

desmosomes

In an Occulomotor Nerve Palsy, which unopposed muscle is responsible for the clinical symptom of mydriasis?

dilator pupilae muscle

What is the name for the site where adaptive lymphocytes function?

effector site

T/F: C-reactive protein is a signaling PRR.

false, C reactive protein is a secreted PRR

What broader class of connective tissue cells do reticular cells belong to?

fibroblasts

What kind of cells hold on to antigens but aren't APCs? Where are they found?

follicular dendritic cells; they don't have MHCs but instead organize lymphoid cells germinal centers

What hemoglobin replaces epsilon?

gamma

Which fetal hemoglobin gene is replaced by beta-hemoglobin?

gamma (which replaces epsilon)

Where are follicular dendritic cells found?

germinal centers of lymphoid nodules

A patient presents with an inability to feel any sensation at the angle of his jaw. Which nerve is responsible for providing sensation to this area and is now damaged?

greater auricular nerve

What might normoblasts on a PBS indicate?

hemorrhage or hemolysis

What drug is used experimentally to increase HbF production in beta-thalassemia and sickle cell patients?

hydroxyuria

What is the name for paracrine factors from leukocytes and virus-infected cells that signal NK cells to kill such cells and adjacent cells to resist viral infection?

interferons, ex. IFN-alpha, IFN-beta, IFN-gamma

The layer of the scalp that allows an infection to spread to the brain is the_______________.

loose connective tissue (has potential space, between aponeurosis and pericranium)

How does mild alpha-thalassaemia affect a sickle cell homozygote?

lowers the production of alpha-hemoglobin, which lowers the production of beta-hemoglobin, leading to reduced symptoms

In which part of the lymph nodes are plasma cells found?

medulla

Does the PALS contain more T cells or B cells?

more T cells

Myeloblast, promyelocyte, and meta-myelocyte are the names for precursors of which of the following cells? macrophages T cells B cells neutrophils erythrocytes thrombocytes eosinophils basophils

neutrophils basophils eosinophils

What kind of cells lie atop the lymphoid tissue of the lingual tonsils?

non-keratinized stratified squamous epithelium

What is the difference between phagocytosis PRRs and scavenger receptors?

nothing

What is another name for a normoblast?

orthochromatophilic erythroblast Small condensed nucleus Orange-like cytoplasm can't divide any more 2 steps from being a mature erythrocyte

What cell immediately precedes a polychromatophilic erythrocyte?

orthochromatophilic erythroblast/normoblast

Where are B cells produced in the spleen?

peri-arteriolar lymphoid sheath. However, this sheath is mostly composed of T cells

What cell immediately precedes a basophilic erythroblast?

proerythroblast

What is it called when different cytokines have the same biological activity?

redundancy

Ciliated epithelium is a defense mechanism used by the ____________.

respiratory tract

What kind of fibers maintain the structure of the lymph nodes?

reticular fibers

Which membrane proteins on endothelial cells facilitate rolling adhesion?

selectins

Which of the branches of the nasocilliary nerve carry parasympathetic fibers?

short ciliary nerves

Restriction enzyme difference (MstII) and allele specific oligonucleotide hybridization are tests for what disease?

sickle cell

What might a high MCHC indicate?

sickle cell heriditary hemocytosis homozygous HbC

Gallstones, increased fetal mortality, and renal, liver, pulmonary, and brain malfunctions are results of what condition?

sickle cell anemia

What condition has splenomegaly, repeated infections, and dactylitis as symptoms?

sickle cell anemia

What condition will an HbS/beta-thalassemia heterozygote have?

sickle cell anemia if it is B0 mild sickle cell anemia if it is B+

The jugular foramen is an important channel in the posterior cranial fossa. It not only acts as a passage for three cranial nerves but also for a venous structure. What is the name of the venous structure that continues to drain into the internal jugular vein?

sigmoid sinus

An increase in circulating white blood cells and platelets, diminished responsiveness to some vaccines, and increased susceptibility to bacterial infection and heart disease are results of what treatment?

splenectomy

In which part of the spleen are old RBCs removed?

splenic cords/ cords of Bilroth

John is a 30-year-old who was recently involved in a motor vehicle accident in which he suffered an injury to the back of his head. He is otherwise fine, but has been experiencing some problems with his right eye, and claims he has been having "double vision". He says that in order to see clearly, he has to turn his head to the left and tilt his chin down. John most likely has paralysis oh which muscle?

superior oblique Based on the location of injury (back of head), trauma to the trochlear nerve can be suspected due to its greater susceptibility to injury in head traumas due to its unique characteristic of exiting its brainstem nucleus on the dorsal aspect. John's presentation of head turn to the opposite side of affected eye and chin tuck is a compensatory mechanism in trochlear nerve palsy, because the affected eye is now unable to look "down and out" and is fixed "up and in". All this information points to trochlear nerve damage for the right eye, and the only extraocular muscle this nerve innervates is the superior oblique muscle.

The cranial nerve innervating the superior oblique muscle exits the skull through what structure?

superior orbital fissue

What kind of stain is needed to see reticulocytes?

supra-vital

What is polycythemia?

too many RBCs In polycythemia, the levels of hemoglobin (Hgb), hematocrit (Hct), or the red blood cell (RBC) count may be elevated when measured in the complete blood count(CBC), as compared to normal. Hemoglobin levels greater than 16.5 g/dL (grams per deciliter) in women and greater than 18.5 g/dL in men suggest polycythemia. In terms of hematocrit, a value greater than 48 in women and 52 in men is indicative of polycythemia. The cause of polycythemia varies and is often associated with certain activities or other medical conditions, in which case it is typically described as secondary polycythemia. For instance, the body frequently compensates for decreased oxygen related to prolonged habitation of high altitudes, smoking, certain types of cancer, pulmonary disease, heart disorders, and other conditions by increasing the production of red blood cells. In such cases, the polycythemia is usually treated by addressing the underlying condition. Similarly, relative polycythemia, which is a form of the condition in which the appearance of a raised erythrocyte level is the result of a reduction of blood plasma, is treated by correcting the problem that caused the plasma decrease, such as excessively low consumption of fluids, high blood pressure, or stress. Sometimes patients will take measures to relieve symptoms of polycythemia, such as using antihistamines to combat itchy skin, while they are attempting to remedy the cause.

What condition results from polyclonal T cell activation and overproduction of IL-1 and TNF-alpha?

toxic shock syndrome - this is caused by superantigens, which activate CD4+ T cells via a MHCII/TCR/superAg complex that binds outside of the antigen-binding zone.

Within the spleen, the splenic artery branches to form the _______ arteries, which branch to form the ______ arterioles.

trabecular, central

A patient presents to your clinic with a herpes zoster outbreak along their forehead. In what ganglion was the virus lying dormant?

trigeminal ganglion

What is the embryological origin of the superior vesicle arteries?

umbilical arteries

Where is Tamm Horsfall protein found?

urine

What is an Hb with changed amino acid content called?

variant

What is pleiotropism?

when the same protein performs different biological activities

x

x

Regularly scheduled transfusions for beta-thalassemia should keep the Hb at what g/dL?

~12 g Hb/dL not to go below 9 g Hb/dL!