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S. Yokian, M.A.S., M.D.

Deputy Director, Burrell College of Osteopathic Medicine at New Mexico State University

Decreased plasma oncotic pressure Endothelial damage Increased hydrostatic pressure Increased vascular permeability Lymphatic obstruction 46. Which one of the listed clinical scenarios best illustrates the concept of active hyperemia? A 22-year-old second-year medical student who develops a red face after being asked a question during a lecture b. A 37-year-old male who develops massive swelling of the scrotum due to infection with Wucheria bancrofti c. A 69-year-old male who dies secondary to progressive heart failure and at autopsy is found to have a "nutmeg" liver d. A 6-year-old boy who develops the sudden onset of intense scrotal pain due to testicular torsion. A 71-year-old female who develops perifollicular hemorrhages due to a deficiency of vitamin C 50 Pathology 47. Grossly display features of recanalization Grossly have lines of Zahn Grossly have the appearance of "chicken fat" overlying "currant jelly" Microscopically appear attached to the wall of the blood vessel Microscopically have alternating layers of cells and platelets 50. Deep leg veins Lumen of left ventricle Lumen of right ventricle Mesenteric veins Superficial leg veins General Pathology 51 51. He is taken to the emergency room, where he is evaluated and immediately taken to surgery. There his left testis is found to be markedly hemorrhagic due to testicular torsion. Arterial occlusion Septic infarction the collateral blood supply of the testis the dual blood supply of the testis Venous occlusion 52. A young child who presents with megaloblastic anemia is found to have increased orotate in the urine due to a deficiency of orotate phosphoribosyl transferase. The combination of a primary defect, such as bilateral renal agenesis, along with its secondary structural change is best referred to by which one of the listed terms? As a general rule, familial disorders that involve abnormalities of structural proteins (rather than deficiencies of enzymes) and present during adulthood (rather than childhood) have what type of inheritance pattern? Autosomal dominant Autosomal recessive Mitochondrial X-linked dominant X-linked recessive 52 Pathology 55. Myotonic dystrophy Limb-girdle dystrophy Facioscapulohumeral dystrophy Duchenne muscular dystrophy Polymyositis 56. Assume that both parents are carriers for the abnormal gene that causes cystic fibrosis. The Hardy-Weinberg principle states that, given a frequency of a certain allele A of p and a frequency q of another allele a at the same locus on the same autosomal chromosome in a population with random mating (panmixia), then the number of heterozygous carriers is equal to a. A 6-year-old female is being evaluated for recurrent episodes of lightheadedness and sweating due to hypoglycemia. Physical examination reveals an enlarged liver and a single subcutaneous xanthoma. Laboratory examination reveals increased serum uric acid and cholesterol with decreased serum glucose levels. Following oral administration of fructose, there is no increase in blood glucose levels. A liver biopsy specimen reveals increased amounts of glycogen in hepatocytes, which also have decreased levels of glucose-6-phosphatase. In tissues affected by the predominant form of Niemann-Pick disease, which one of the following is found at abnormally high levels? Physical examination reveals a child with short stature, coarse facial features (low, flat nose, thick lips, widely spaced teeth, facial fullness), a large tongue, and clear corneas. Laboratory examination reveals increased urinary levels of heparan sulfate and dermatan sulfate. Metachromatic granules (Reilly bodies) are found in leukocytes from a bone marrow biopsy. Hyperphenylalaninemia Tyrosinemia Tyrosinase-positive oculocutaneous albinism Alkaptonuria Maple syrup urine disease 62. Which one of the listed processes is the most likely cause of an aneuploid karyotype? A reciprocal translocation between two acrocentric chromosomes Deletion of both ends of a chromosome with fusion of the damaged ends Division of the centromere along a transverse plane Failure of homologous chromosomes or paired chromatids to separate Two breaks within a single chromosome with reincorporating of the inverted segment 63.

A 38-year-old woman with congenital hydrocephalus presented with a 1-week history of decreased level of consciousness, headaches, and emesis. She had undergone numerous ventriculoperitoneal shunt placements in the past, with the last one placed 5 years before this presentation. The patient was afebrile and had no meningeal signs, but she was somnolent and arousable only by deep stimuli. The patient was taken to surgery, where all foreign material was removed, and she was treated with penicillin for an additional 10 weeks. This patient illustrates the chronic, relatively asymptomatic nature of this disease, the need to remove the shunt and other foreign bodies, and the need to treat for a prolonged period of time. Bifidobacterium and Eubacterium Bifidobacterium and Eubacterium species are commonly found in the oropharynx, large intestine, and vagina. These bacteria can be isolated in clinical specimens but have a very low virulence potential and usually represent clinically insignificant contaminants. Confirmation of their etiologic role in an infection requires their repeated isolation in large numbers from multiple specimens and the absence of other pathogenic organisms. Members of the genus Veillonella are the predominant anaerobes in the oropharynx, but they represent less than 1% of all anaerobes isolated in clinical specimens. These anaerobes are the predominant bacteria on most mucosal surfaces, outnumbering aerobic bacteria 10- to 1000-fold. Despite the abundance and diversity of these bacteria, most infections are caused by relatively few species (Table 31-3). The genus Bacteroides is composed of more than 90 species and subspecies, with Bacteroides fragilis the most important member of this genus. A characteristic common to most species in the genus Bacteroides is that their growth is stimulated by bile. Bacteroides species are pleomorphic in size and shape and resemble a mixed population of organisms in a casually examined Gram stain (Figure 31-9). Most gram-negative anaerobes respond weakly to Gram stain, so stained specimens must be carefully examined. Although Bacteroides species grow rapidly in culture, the other anaerobic gram-negative rods are fastidious, and cultures may have to be incubated for 3 days or longer before the bacteria can be detected. Propionibacterium Propionibacteria are small gram-positive rods often arranged in short chains or clumps (Figure 31-8). They are commonly found on the skin (in contrast with the Actinomyces), conjunctiva, and external ear, and in the oropharynx and female genital tract. Propionibacteria are also commonly isolated in blood cultures, but this finding usually represents contamination with bacteria on the skin at the phlebotomy site. Production of a low-molecularweight peptide by the bacteria residing in sebaceous follicles attracts leukocytes. This capsule is also antiphagocytic, similar to other bacterial capsules, and it is the major virulence factor in B. Finally, proteases are produced by some Porphyromonas and Prevotella species that degrade immunoglobulins. Catalase and superoxide dismutase, which inactivate hydrogen peroxide and the superoxide free radicals (O2-), respectively, are present in many pathogenic strains. This toxin causes morphologic changes of the intestinal epithelium via F-actin rearrangement, with the resultant stimulation of chloride secretion and fluid loss. Physiology and Structure Bacteroides have a typical gram-negative cell wall structure, which can be surrounded by a polysaccharide capsule. Epidemiology As already stated, anaerobes colonize the human body in large numbers (functioning to stabilize the resident bacterial flora), prevent colonization by pathogenic organisms from exogenous sources, aid in the digestion of food, and stimulate host immunity. These normal protective organisms produce disease only when they move from their endogenous homes to normally sterile sites. Thus the organisms in the resident flora are able to spread by trauma or disease from the normally colonized mucosal surfaces to sterile tissues or fluids. It is important to realize, however, that the mixture of organisms that appear on healthy mucosal surfaces differs from the mixture in diseased tissues. Studies of the microbial population, or microbiome, of healthy mucosal surfaces show a complex mixture of many species of bacteria. However, the organism constitutes less than 1% of the colonic flora and is rarely isolated from the oropharynx or genital tract of healthy people unless highly selective techniques are used.

Syndromes

• Antibiotics such as neomycin rubbed on the surface of the skin
• Infections such as hepatitis that are considered to be active
• Drowsiness
• Difficulty starting movement, such as starting to walk or getting out of a chair
• Shortness of breath 
• Infection
• 1+ means 25% of cells are affected