sys-5 pics

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sys-5 pics
2013-08-07 15:09:01
sys pics

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  1. CML
    see spectrum of myeloid differentiation, mature neutrophils

    BCR-ABL along Chr 22
  2. ABL-apoptosis
    BCR_ABL philadelphia and no apoptosis, cell proliferation
  3. acute leukemia (AML)-disease of elderly
    pallor, fever, oral, petechie, basphillic blasts, precursor cells
  4. M4/M5 FAB classificaiton for acute leukemoa
    gum hyperplasia(only 3-6 months if untrates)
  5. unfavorable cytogenetics(-5/-7)
    intermediate Diplod-Y
    allogenic stem cell transplantation is the best b/c no chemo
  6. ALL
    L1L2L3 pre-B, pre-T cells, starry sky, Burkitss lumphoma
  7. ALL prognostics
    favorable for younger and negative CNS, and more T-cells than B-cells
  8. Acute leukemia complucations
    mucositis, infections, candida, gum hyperplasia esp with monocyte leukemias
  9. graft vs host
    breakdown of graft in bone marrow translants
  10. CLL
    night sweats and weight loss, mature lymphocytes in bld no myeloid precurosrs
  11. MM
    • M-spike class ic dinsing in proteins on gel
    • light chains get deposited in kidney
    • rouleauz formations in peripheral smears
    • plasma cells make only one Ab type
  12. MM-plasma cells
    very basophillic in marrow
  13. MM-x-ray
    bone lesions
  14. allogenic transplant
    give CD34 positive cells and GF
  15. histocompatibiliry
    • parents have 50% matching
    • siblings have 25%
    • can use autologous graft to avoid host vs graft disease
  16. Type IV Th1
    macrophage activation- contact derm, tuberculin
  17. Th2 type 4
    IgE, soluble Ag, chronic asthma, rhinitis
  18. CTL-Type 4
    cell-associated Ag, cytotoxic, graft REJCTion
  19. TYpe IV response
    insects, metals, giladin via celiac, tuberculin
  20. Type 4 delayed vs inital
    • delayed has llangerhans cells from skin that present to Th1,
    • initial just Th1 
  21. differentiation of CD4, cytokines?
    CD4 effector T-cells cytokines?
    • IL-2
    • INF-gamma,IL-17
  22. delayed Type IV
    perivascular ciffing, local T-cell inflamm reaction(tuberculin)

    GRANulomas form as special DTH via Th1
  23. type IV graft rejection
    • direct and indirect
    • direct- APCs within graft tissue, CD8,4
    • indirect-APCs within host, only CD4
  24. chronic rejection
    • acute rejection control via immunosuppressive drugs
    • but vascular changes, and glomeruli SCARs
  25. graft vs host diease
    immune competent cells are transplanted into immune crippled recipient; donor t-cells ATTACK host
  26. immunosupression
    • block transcrption of IL-s cyclosporine
    • steroids block inflammation
    • azathiprine inhibit leukocyte development
  27. atopy
    genetic tendency to develop hypersensitivity
  28. 40% of population atopic with
  29. hay fever
    flu like symtoms without fever, avoid allergen
  30. uticaria
    hives, itchy red papules on skin
  31. angioedema
    can be heriditary and chronic 
    non-pitting edema of lips, tonge, eyelids, hands, no itching but burning(food, physical, immune-mediated, complement)

    antihistamines or antileukotrienes for acute cases
  32. hereditary angioedemea involves
    auto domin., deficiency of C1 esterase that controls complement actiation
  33. systemic anaphylasix has
    bronchospasm, laryngeal edema, uticaria, hypotension, arrthmia, nausea, GI spasms
  34. vasovagal syncope
    • sweating nausea hypotension, but NO uticaria
    • fatal outcomes due to hyptension and airway obstruction
  35. contact derm\contact stomatitis,
    rare in oral mucosal b/c low densty of immune cells
    previously sensitizes, mostly omen
  36. drug allergy 
    • type A-predictable and dose depedent
    • type B- 10-15% bot dose dependent(PCN)
  37. low vs high MW
    hypersenstivty vs allergic
  38. drug allergy clinically
    • dermatologic w/ angioedema, uticaria,
    • organ involvement pulmonary, hepatic, nephrotic
  39. drug rxns may lead to
    • anaphylactic shock consider timing
    • was this the first time? rarely occur before 1 week
    • immunosupression agent
  40. lab tests
    • IgE Ab test
    • in vivo skin test, patch
    • RAST-in vitro but expensive
  41. type I common
    urticaria, angioedema, anaphlaxis is serious
  42. sometimes immune suppress agents need to 
    suppress cardiac and pulmonary responses