Quiz About Diseases: Trivia Exam!

The most probable causative agent in this case is Plasmodium falciparum. The patient's symptoms of paroxysmal attacks of chills, fever, and sweating are consistent with malaria, which is caused by the Plasmodium parasite. The examination of a stained blood specimen revealing ring-like and crescent-shaped forms within the erythrocytes is also characteristic of Plasmodium infection. Dracunculus medinensis causes Guinea worm disease, Trypanosoma gambiense causes African sleeping sickness, Wuchereria bancrofti causes lymphatic filariasis, and Schistosoma mansoni causes schistosomiasis, none of which present with the same symptoms and blood findings as described in the case.

The presence of an abdominal mass and the biopsy findings of a high-grade malignant tumor composed of lymphoid cells with a "starry-sky appearance" suggest a diagnosis of Burkitt lymphoma. Burkitt lymphoma is strongly associated with Epstein-Barr virus (EBV) infection. EBV is a DNA virus that is known to be involved in the pathogenesis of various lymphoproliferative disorders, including Burkitt lymphoma. Therefore, EBV is the most likely virus associated with this patient's clinical condition.

The best prognostic indicator of survival in this patient is the tumor stage. Tumor stage refers to the extent of the cancer and whether it has spread to nearby lymph nodes or other parts of the body. It provides important information about the aggressiveness of the cancer and helps determine the appropriate treatment options. A higher tumor stage is generally associated with a poorer prognosis and lower survival rates. Therefore, knowing the tumor stage is crucial for predicting the patient's outcome and guiding their management.

The most probable etiologic agent in this case is Diphyllobothrium latum. This is because the patient presented with symptoms of fatigue, dizziness, and persistent diarrhea, which are commonly associated with Diphyllobothrium latum infection. Additionally, the fact that characteristic parasite ova were found in the stool further supports this diagnosis. Diphyllobothrium latum is a tapeworm that is commonly acquired through the consumption of raw or undercooked fish, making it likely that the patient contracted the infection from the restaurant that specialized in raw seafood.

The correct answer is Heparin and Lepirudin. Heparin is a commonly used anticoagulant that can be used during pregnancy. However, in this case, the patient developed drug-induced thrombocytopenia, which is a known side effect of heparin. Therefore, heparin was withdrawn and Lepirudin, a direct thrombin inhibitor, was given as an alternative anticoagulant. Lepirudin does not induce the formation of antiplatelet antibodies, making it a suitable choice for this patient.

Human T-Leukemia viruses (HTLV) HTLV-1, -2 and -5 are associated with leukemias and lymphomas. HTLV-1 has been established as the causative agent of Human Adult Acute T-cell lymphocytic leukemia (ATLL) as well as a nervous system degenerative disorder: Tropical spastic paraparesis (HAM/TSP). HTLV-1 was isolated in 1980 from the cells of a patient with a cutaneous T-cell lymphoma. Transmission occurs primarily by sexual contact and by exchange of contaminated blood, e.g., in transfusions and intravenous drug use. Clusters of HTLV-associated disease are found in certain geographic areas (southern Japan, Melanesia, the Caribbean, Central and South America, and parts of Africa). Although less than 1% of people worldwide have HTLV-1 antibody, more than 10% of the population in endemic areas are seropositive, and antibody may be found in 50% of relatives of virus-positive leukemia patients. HTLV-viruses have a marked affinity for mature T cells with the viral promoter-enhancer sequences in the long terminal repeat may be responsive to signals associated with the activation and proliferation of T cells. The provirus is found in all leukemic cells of ATLL cases. HTLV-1 has no viral oncogene. Two special genes (in addition to the standard retroviral genes gag, pol, and env) called tax and hbz play a role in oncogenesis by regulating mRNA transcription and translation through transactivation. Transcriptional regulator protein tax causes activation of cellular interleukin-2 IL-2 (T- cell growth factor) and its receptor IL-2R. Stimulation of viral mRNA synthesis, and induction of NF-kB, leads to T cell growth increasing the likelihood that the cells will become malignant. ATLL is poorly responsive to therapy. The 5-year survival rate for patients with this cancer is < 5%.

The image shows a lymph node biopsy with signet ring cells. Signet ring cells are characteristic of signet ring carcinoma, which is most commonly found in the stomach. This is supported by the patient's presenting symptoms of weight loss and anorexia, as well as the presence of left supra-clavicular lymphadenopathy. Squamous cell carcinoma of the esophagus, transitional cell carcinoma, renal cell carcinoma, and malignant lymphoma are less likely to present with these specific findings.

The most likely concern in this case is splenic rupture. The patient's symptoms of sore throat, fever, and lymphadenopathy, along with the positive test for heterophile antibodies, are consistent with infectious mononucleosis. Splenic rupture is a potential complication of infectious mononucleosis, especially in young males. This can occur due to enlargement and inflammation of the spleen, which can lead to its rupture and cause severe abdominal pain and potentially life-threatening bleeding. Prompt diagnosis and management are important to prevent this complication.

The patient's signs and symptoms, including hyperpigmentation of the skin, multiple bruises, hypertension, and high blood sugar levels, are consistent with Cushing's syndrome. This syndrome is caused by excessive production of cortisol, which is regulated by ACTH. The lung tumor in this patient is most likely a small cell lung carcinoma, which can produce ACTH and lead to Cushing's syndrome.

NOTICE THE "AURER RODS"
Acute promyelocytic leukemia is a subtype of acute myelogenous leukemia (AML), a cancer of the blood and bone marrow. It is also known as acute progranulocytic leukemia; APL; AML with t(15;17)(q22;q12), PML-RARA and variants; FAB subtype M3 and M3 variant. In APL, there is an abnormal accumulation of immature granulocytes called promyelocytes. The disease is characterized by a chromosomal translocation involving the retinoic acid receptor alpha (RARα or RARA) gene and is unique from other forms of AML in its responsiveness to all trans retinoic acid (ATRA) therapy.

Follicular lymphoma is the most common of the indolent non-Hodgkin's lymphomas, and the second-most-common form of non-Hodgkin's lymphomas overall.
A translocation between chromosome 14 and 18 results in the overexpression of the bcl-2 gene. As the bcl-2 protein is normally involved in preventing apoptosis, cells with an overexpression of this protein are basically immortal. The bcl-2 gene is normally found on chromosome 18, & the translocation moves the gene near to the site of the immunoglobulin heavy chain enhancer element on chromosome 14.

T(8;14) =Burkitts
T(9;22) = CML

ENTRY INHIBITORS:
Enfuvirtide
Only for HIV-1
MOA: binds to Gp-41 of viral envelope and prevents conformation ∆ req. for fusion --> inhibits viral fusion
AE --> Eosinophilia
Maraviroc
Viral: R5 HIV-1 (CCR5-tropic HIV-1)
MOA: binds specifically to CCR5
Uses: R5 HIV-1 infection (req. to be screen for R5)
NNRTI’s:
Allosteric (non-competitive) inhibition of RT
Do not require phosphorylation to become active
Met. by cyt. P-450
Only effective in HIV-1

Delaviridine
Protein bound
Contraindicated: pregnancy and p-450 drug
Efavirenz
Adverse: ↑ [cholesterol]
Contraindicated: Prego (esp. 1st trim.)
Nevirapine
Used for prevention of transmission of HIV from mom to newborn (single-dose administration!)

Infectious mononucleosis occurs with infection by the Epstein–Barr virus.
The infection is spread via saliva, and has an incubation period of four to seven weeks. Symptoms usually persist for two to three weeks, but fatigue is often more prolonged.
The length of time that an individual remains contagious is unclear, but may be the highest during the first six weeks following infection. Some studies indicate that a person can spread the infection for many months after symptoms are completely gone, with one particular study indicating as long as 18 months.
The virus replicates first within epithelial cells in the pharynx (which causes pharyngitis, or sore throat), and later primarily within B cells (which are invaded via their CD21). The host immune response involves cytotoxic (CD8-positive) T cells against infected B lymphocytes, resulting in enlarged, atypical lymphocytes (Downey cells).

When the infection is acute (recent onset, instead of chronic), HETEROPHILE ANTIBODIES are produced.
Similar symptoms can be caused by cytomegalovirus, adenovirus, and Toxoplasma gondii, but will result in a NEGATIVE HETEROPHILE ANTIBODY TEST

Muromonab-CD3 is an immunosuppressant drug given to reduce acute rejection in patients with organ transplants. It is a monoclonal antibody targeted at the CD3 receptor, a membrane protein on the surface of T cells
As it is of Mouse origing think of "migh-T-mouse"

An alkylating antineoplastic agent is an alkylating agent used in cancer treatment that attaches an alkyl group (CnH2n+1) to DNA.[1] The alkyl group is attached to the guanine base of DNA, at the number 7 nitrogen atom of the purine ring. Since cancer cells, in general, proliferate faster and with less error-correcting than healthy cells, cancer cells are more sensitive to DNA damage — such as being alkylated. Alkylating agents are used to treat several cancers. However, they are also toxic to normal cells (cytotoxic), leading to damage, in particular in cells that divide frequently, as those in the gastrointestinal tract, bone marrow, testicles and ovaries, which can cause loss of fertility. Most of the alkylating agents are also carcinogenic. Hyperthermia is especially effective at enhancing the effects of alkylating agents. The following three groups are almost always considered "classical". Nitrogen mustards[7] Cyclophosphamide Mechlorethamine or mustine (HN2) (trade name Mustardgen) Uramustine or uracil mustard Melphalan Chlorambucil Ifosfamide Nitrosoureas Carmustine Lomustine Streptozocin Alkyl sulfonates Busulfan Thiotepa and its analogs are usually considered classical but can be considered nonclassical.

The most probable diagnosis in this case is amoebiasis. The patient's symptoms of chronic diarrhea, mucus, and blood in the stool, along with sigmoidoscopy findings of pseudo polyps and flask-shaped ulcers in the colon, are consistent with amoebic colitis. The presence of abscesses in the liver and lung on CT scan further supports the diagnosis, as amoebiasis can cause extra-intestinal manifestations such as liver and lung abscesses. Hydatid disease, giardiasis, taeniasis, and cyclosporiasis do not typically present with the same combination of symptoms and findings seen in this patient.

The statement "Patients in the left of the diagram metabolize the drug only very slowly" is false. The figure shows a tri-modal distribution, indicating that there are three distinct groups of patients with different rates of drug metabolism. Therefore, the patients in the left of the diagram do not metabolize the drug only very slowly, as there are other groups with even slower metabolism.

Quinidine gluconate would be the most appropriate drug for treating this patient because the symptoms and laboratory findings are consistent with a diagnosis of severe malaria caused by Plasmodium falciparum. Quinidine is an effective antimalarial drug that is commonly used for severe cases of malaria. It works by killing the malaria parasites in the blood and helping to control the symptoms of the infection. Other antimalarial drugs like chloroquine, primaquine phosphate, mefloquine, and pyrimethamine may be used for treating less severe cases or for prophylaxis, but for severe cases caused by P. falciparum, quinidine gluconate is the treatment of choice.

PNP-deficiency is a rare autosomal recessive metabolic disorder that results in severe combined immunodeficiency. PNP-deficiency is extremely rare. Only 33 patients with the disorder in the United States have been documented. In the United Kingdom, only one child has been diagnosed with this disorder For this reason, it will probably be on the STEP. The disorder is caused by a mutation of the purine nucleoside phosphorylase (PNP) gene, located at chromosome 14q13.1.[3][4] PNP is a key enzyme in the purine salvage pathway, and is required for purine degradation. Specifically, it catalyzes the conversion of inosine and guanosine to hypoxanthine. A deficiency of it leads to build up of elevated deoxy-GTP (dGTP) levels resulting in T-cell toxicity and deficiency.[4][5] In contrast to adenosine deaminase deficiency (another deficiency of purine metabolism), there is minimal disruption to B cells.[6] PNP deficiency is inherited in an autosomal recessive manner.[1] This means the defective gene responsible for the disorder is located on an autosome (chromosome 14 is an autosome), and two copies of the defective gene (one inherited from each parent) are required in order to be born with the disorder. The parents of an individual with an autosomal recessive disorder both carry one copy of the defective gene, but usually do not experience any signs or symptoms of the disorder.