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This patient most likely has which of the following categories of organ-specific amyloidosis Physical examination reveals facial dysmorphology allergy to yellow 5 symptoms cheap promethazine online master card, including cleft palate and low-set ears allergy medicine yorkie buy 25 mg promethazine with mastercard. Two months later allergy partners asheville nc generic promethazine 25mg visa, the patient develops double vision and numbness in the fingers of her left hand. Over the next several months, some of these plaques diminish in size, while others appear in new locations. These plaques would most likely show selective loss of which of the following proteins About 18 months later, the patient experiences another episode of weakness and requires assistance when walking. Neurologic examination reveals ataxia, dysarthria, decreased vibratory sensation in her legs, absent abdominal reflexes, increased deep tendon reflexes, and a Babinski sign on the left. Fifteen years after the onset of symptoms, the patient becomes bedridden and dies. Which of the following histopathologic findings would be expected in these plaques Examination of the brain at autopsy shows bilateral atrophy of the gyri, particularly in the frontal and hippocampal cortex. His mother died in a psychiatric institute, and his maternal grandfather committed suicide. Physical and neurologic examinations reveal dysarthria, lower-limb areflexia, extensor plantar reflexes, and sensory loss. Ten hours after admission, the patient complains of a severe headache and blurred vision. On examination, the patient shows reduced facial expression, a resting tremor, cogwheel rigidity, and bradykinesia (slowness of voluntary movements). The spherical, eosinophilic inclusions in the cytoplasm of this pigmented neuron are composed of which of the following proteins On examination, the patient appears stiff and stooped, shows an expressionless face, and speaks in a monotonous voice. A tremor of his fingers is apparent but ceases when he tries to reach for something. At autopsy, the substantia nigra of the patient (right) differs from that of a normal brain (left). This pathologic finding is associated with which of the following biochemical changes Physical and neurologic examinations reveal horizontal diplopia, strabismus, amblyopia, nystagmus, ataxia, and peripheral neuropathy. Examination of the brain at autopsy shows calcification and brownish discoloration of atrophic mammillary bodies. Petechiae in the quadrigeminal plate and periaqueductal regions of the midbrain are also observed. Which of the following best explains the pathogenesis of these clinical and pathologic findings The boy appears irritable and agitated, and his parents state that he has difficulty swallowing fluids. At autopsy, the brain stem shows infiltrates of lymphocytes around small blood vessels and evidence of neuronophagia. A hematologic evaluation reveals a megaloblastic anemia that is not reversed by folate therapy. Peripheral neuropathy in this patient is most likely associated with which of the following pathologic findings Which of the following is a potentially lethal complication of systemic dehydration in this patient At autopsy, there are cystic cavities within the frontal and temporal lobes, corresponding to the areas of prior hemorrhage. These cavities were formed in large measure due to the phagocytic activity of which of the following cell types

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Diagnosis: Dermatitis herpetiformis the answer is C: Granular distribution of immune complexes in the basement membrane zone allergy testing roseville ca promethazine 25mg. Epidermal cellular damage initiated by light or other exogenous agents causes the release of a large number of antigens allergy treatment for dogs paws buy discount promethazine on-line, some of which may return to allergy medicine can i give my dog proven promethazine 25mg the skin in the form of immune complexes. Diagnosis: Systemic lupus erythematosus 13 14 10 15 16 11 282 17 Chapter 24 the answer is C: Propionibacterium sp. Acne vulgaris is a selflimited, inflammatory disorder of the sebaceous follicles that typically afflicts adolescents, results in the intermittent formation of discrete papular or pustular lesions, and may lead to scarring. The development of acne is related to excessive hormonally induced production of sebum, abnormal cornification of portions of the follicular epithelium, and an inflammatory response to the anaerobic diphtheroid Propionibacterium acnes. Lichen planus is a hypersensitivity reaction with lymphocytic infiltrates at the dermal-epidermal junction. The processed antigen induces local macrophage activation and lymphocytic proliferation. Macrophages and T lymphocytes disrupt the stratum basalis resulting in reactive epidermal proliferation (hyperkeratosis). The site of pathologic injury is at the dermal-epidermal junction, where there is a striking infiltrate of lymphocytes, many of which surround apoptotic keratinocytes. In late stages, the dermal infiltrate becomes dense to the point of forming tumor nodules. The elaborated C5a complement component attracts neutrophils, which degranulate and release lysosomal enzymes, resulting in endothelial damage and fibrin deposition. Allergic contact dermatitis (choice A) is associated with external contact with an allergen. Diagnosis: Hypersensitivity angiitis, cutaneous necrotizing vasculitis 21 the answer is C: Migration of Langerhans cells into dermal lymphatics. Allergic contact dermatitis is a model of spongiotic dermatitis, a reaction pattern in which there is edema in the epidermis. In the initial 24 hours following reexposure to the offending plant (elicitation phase), numerous lymphocytes and macrophages accumulate about the superficial venular bed and extend into the epidermis. The epidermal keratinocytes are partially separated by the edema fluid, creating a spongelike appearance (spongiosis). During the sensitization phase, low molecular weight haptens combine with carrier proteins at the cell membrane of Langerhans cells. Cytokine production leads to the accumulation of more T cells and macrophages and to epidermal cell injury. Freckles, or ephelides, are small, brown macules that occur on sun-exposed skin, especially in people with fair skin. The pigmentation of a freckle deepens with exposure to sunlight and fades when light exposure ceases. Freckles show hyperpigmentation of the basal keratinocytes without a concomitant increase in the number of melanocytes. The disease also displays variable structural and functional involvement of internal organs, including the kidneys, lungs, heart, esophagus, and small intestine. Patients with early scleroderma usually present with Raynaud phenomenon or nonpitting edema of the hands or fingers. In late stages of the disease, the skin over large parts of the body is thickened, densely fibrotic, and fixed to the underlying tissue. Although scleroderma can affect the kidney, polyuria/polydipsia (choice D) is most commonly a complication of diabetes. His tongue, inner side of the lips, and buccal mucosa are covered with white, slightly elevated, soft patches (shown in the image). A biopsy (shown in the image) discloses infiltrates of lymphocytes forming focal germinal centers. She has a high fever, and her lower jaw and entire neck are swollen, red, and painful. Throat culture reveals a mixed bacterial flora, containing both A 16-year-old girl presents with a sore throat of 4 months in duration. This developmental lesion most likely arises as a remnant of which of the following anatomic structures

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