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A subsequent transfusion Immunology/Apply knowledge of fundamental biological may lead to an Arthus reaction if IgG anti-IgA is characteristics/Immune deficiency/Hypersensitivity/3 present or an anaphylactic reaction if IgE anti-IgA 12 generic 100 mg pletal free shipping. Immunology/Apply knowledge of fundamental biological characteristics/Immune deficiency/ Hypersensitivity/2 3 purchase 100 mg pletal free shipping. Which of the following symptoms in a young child Answers to Questions 1–4 may indicate an immunodeficiency syndrome? Recurrent bacterial, fungal, and viral infections recurrent bacterial, fungal, and viral infections D. Weight loss, rapid heartbeat, breathlessness manifested after the disappearance of maternal IgG. Immunology/Apply knowledge of fundamental Immunodeficiency disorders may involve deficiencies biological characteristics/T cell/Testing/1 in production and/or function of lymphocytes and phagocytic cells or a deficiency in production of a 2. Choice of laboratory tests is young patient suspected of having an immune based upon the patient’s clinical presentation, age, dysfunction disorder? White blood cells that are decreased in number or abnormal in appearance may indicate Immunology/Apply knowledge of fundamental further testing. Which test should be performed when a patient IgA-deficient person who has formed anti-IgA has a reaction to transfused plasma products? Red cell enzymes IgA is usually absent from secretions, but the B-cell Immunology/Evaluate laboratory and clinical data to count is usually normal. What is the “M” component in monoclonal or cell line produced in a monoclonal gammopathy gammopathies? Monoclonal antibody or cell line Immunology/Apply knowledge of fundamental biological characteristics/Immunoglobulins/Testing/1 106 3. A child suspected of having an inherited humoral Answers to Questions 5–9 immunodeficiency disease is given diphtheria/ tetanus vaccine. B In an immunodeficient patient, the expected his level of antibody to the specific antigens is levels of specific antibody to the antigens in the measured. Which result is expected for this patient vaccine would be decreased or not present. An increase in IgG-specific antibody but not of plasmacytoid lymphocytes involving both the IgM-specific antibody bone marrow and lymph nodes. Increased levels of nonspecific antibody secrete monoclonal IgM and are in transition from B Immunology/Evaluate laboratory data/ cells to plasma cells. In contrast to multiple myeloma, Immunoglobulins/Testing/2 osteolytic bone lesions are not found. D DiGeorge’s syndrome is caused by a developmental spike on an electrophoretic pattern? Wiskott–Aldrich syndrome cytometry is most helpful in determining numbers Immunology/Evaluate laboratory data to make and subpopulations of T cells. In testing for DiGeorge’s syndrome, what type antisera indicate excessive light-chain excretion. C Serum-free light chains are a sensitive indicator identifications/T cells/Testing/2 of a monoclonal gammopathy. Increased polyclonal Fab fragments to quantitate immunoglobulin heavy- or light-chain D. Immunology/Evaluate laboratory data to make identifications/Immunoglobulins/Testing/2 9. Free monoclonal light chains are often present in the serum of multiple myeloma patients, and may be useful for disease monitoring. Which of the following assays would be recommended to detect the presence of serum-free light chains? Immunology/Apply principles of basic laboratory procedures/Complement/Testing/1 11. Immunodeficiency disorders such as common The inflammatory response seen in malignancy variable immunodeficiency and acute infections gives rise to an increase in C. Bacterial, viral, fungal, or parasitic infections caused by an inherited deficiency in complement Immunology/Evaluate laboratory data to make constitutes only about 1% of immunodeficiency identifications/Complement/Testing/2 diseases. All of the following tests measure phagocyte a deficient serum level of only one complement function except: factor. Di Hydro rhodamine reduction assay tests are used to diagnose chronic granulomatous C. It causes B-cell proliferation and increased production of antibody, interferon, and other cytokines. A patient had surgery for colorectal cancer, after Answers to Questions 1–3 which he received chemotherapy for 6 months.

The Swollen Leg 519 Treatment Once the diagnosis of a venous thromboembolic event has been con- firmed and discount 50mg pletal otc, occasionally 50mg pletal sale, before it has been confirmed and, if the index of suspicion is high, the patient should be anticoagulated. In addition to conventional anticoagulation, a small subset of patients may benefit from thrombolytic therapy. Many patients have contraindications or relative contraindications to the use of thrombolysis that obviate their use. It is believed to be due to antibodies directed against platelet complexes with heparin. Response to warfarin is variable depending on the patient’s liver function, diet, age, and concomitant medications. Multiple studies have shown that starting warfarin therapy in addition to heparin is safe and effective. Warfarin has a long half-life, variable depending on the patient, and must be withheld for several days prior to any significant intervention. The weight-based heparin dosing nomogram compared with a “standard care” nomogram: a randomized controlled trial. Comparison of subcutaneous low-molecular-weight heparin with intravenous standard heparin in proximal deep-vein thrombosis. Comparison of once-daily subcutaneous fragmin with continuous intra- venous unfractionated heparin in the treatment of deep vein thrombosis. Subcutaneous low-molecular-weight heparin compared with continuous intravenous unfractionated heparin in the treatment of proximal deep vein thrombosis. Subcutaneous low-molecular-weight heparin compared with continuous intravenous heparin in the treatment of proximal-vein thrombosis. They have a predictable anticoagulant effect based on body weight, so that laboratory moni- toring is unnecessary. Acomparison of six weeks with six months of oral anticoagulant therapy after a first episode of venous thromboembolism. The duration of oral anticoagulant therapy after a second episode of venous thromboembolism. Comparison of once-daily subcutaneous fragmin with continuous intravenous unfractionated heparin in the treatment of deep vein thrombosis. Subcutaneous low-molecular- weight heparin compared with continuous intravenous unfractionated heparin in the treatment of proximal deep vein thrombosis. Subcutaneous low-molecular-weight heparin compared with continuous intravenous heparin in the treatment of proximal-vein throm- bosis. The most commonly performed surgical intervention is the placement of an inferior cava filtration device. Most commonly, cava filters are placed for relative contraindications to anticoagulation or, increasingly, for pulmonary embolus prophylaxis for patients who cannot be anticoagulated safely. Simple procedures, such as high ligation of the greater saphenous vein at the saphenofemoral junc- tion, are reasonable for superficial thrombosis of the greater saphenous vein. More significant operations, such as iliofemoral venous thrombec- tomy or surgical pulmonary embolectomy, have a role, but fortunately they only rarely need to be employed. While the likelihood of this being the case is low in the absence of injury, stasis, or history of a hypercoagulable state, it would be reasonable to interrogate her venous anatomy with a venous duplex scan. Signs include venous telangiectasias, swelling, and varicose veins, as well as lipodermatosclerosis and venous ulceration. Lipoder- matosclerosis represents a constellation of skin changes, including thickening of the skin, hemosiderin deposition of the skin, and a dry scaly dermatitis of the skin. Treatment of venous thrombosis with intravenous unfractionated heparin in the hospital as compared with subcutaneous low- molecular-weight heparin administered at home. Risk factors associated with varicose veins may include prolonged stand- ing, heredity, female sex, parity, and history of phlebitis. The diagnosis of deep venous insufficiency generally is made clinically based on history and clinical exam. Various volumes of the leg are then calculated with the patient in several posi- tions (Fig. Particular attention currently is being paid to communicating veins, those that connect the deep and super- ficial venous systems. Incompetence of the perforating veins has been implicated in the development of venous stasis ulcers. Typical recording of volume changes during a standard sequence of postural changes and exercise: patient in a supine position with the legs ele- vated 45° (a); patient standing with weight on the nonexamined leg (b); patient performing a single tiptoe movement (c); patient performing 10 tiptoe move- ments (d); patient again standing with weight on the nonexamined leg (e). Air- plethysmography and the effect of elastic compression on venous hemody- namics of the leg. Copyright © 1987 The Society for Vascular Surgery and The American Association for Vascular Surgery. With permission from The Society for Vascular Surgery and The American Associa- tion for Vascular Surgery. The Swollen Leg 523 Treatment Conservative, nonoperative, treatment for chronic venous insuffi- ciency has been and remains the primary therapy.

Reactive hypoglycemia is characterized by delayed or excessive insulin output after eating and is very rare discount pletal 100mg fast delivery. High fasting insulin levels (usually > 6 μg/L) are seen in insulinoma buy 100mg pletal overnight delivery, and patients with insulinoma almost always display fasting hypoglycemia, especially when the fast is extended to 48–72 hours. In hypoglycemia, low levels indicate an exogenous insulin source, whereas high levels indicate overproduction of insulin. Which statement regarding glycated (glycosylated) Answers to Questions 11–14 Hgb (G-Hgb) is true? C G-Hgb results from the nonenzymatic attachment of the β chain a sugar such as glucose to the N-terminal valine of B. Will be abnormal within 4 days following an are three G-Hgb fractions designated A1a, A1b, and episode of hyperglycemia Alc. Hemoglobin A1c makes up about 80% of glycated hemoglobin, and is used to determine Chemistry/Correlate laboratory data with physiological the adequacy of insulin therapy. The time-averaged processes/Glycated hemoglobin/2 blood glucose is approximated by the formula 12. A glycated hemoglobin test should Chemistry/Evaluate laboratory data to recognize health be performed at the time of diagnosis and every and disease states/Glucose/2 6 months thereafter if the result is < 6. Levels do not need to be done fasting performed every 3 months until control is B. Samples should be measured within 2 hours of 2–3 months prior to blood collection, the dietary collection status of the patient on the day of the test has no D. Refrigerated whole-blood Chemistry/Apply knowledge to recognize sources of samples are stable for up to 1 week. Hgb A is 1C error/Glycated hemoglobin/2 assayed by cation exchange high-performance liquid chromatography or immunoassay 14. Which stationary phase is used for the (immunoturbidimetric inhibition) because both measurement of hemoglobin A1c by high methods are specific for stable Hgb A1C, and do performance liquid chromatography? Normal hemoglobin A has a weak positive charge at an acidic pH and binds weakly to the resin. Glycated hemoglobin has an even weaker positive charge and is eluted before hemoglobin A. Abnormal hemoglobin molecules S, D, E, and C have a higher positive charge than hemoglobin A and are retained longer on the column. According to American Diabetes Association whole-blood hemolysate, and identify the cause criteria, which result is consistent with a diagnosis and best course of action. Te result is not reportable because labile Chemistry/Evaluate laboratory data to recognize health hemoglobin A1c is present and disease states/Glucose/2 D. Te result is reportable; neither hemoglobin F or C interfere Answers to Questions 15–17 Chemistry/Evaluate laboratory data to recognize problems/Glycated hemoglobin/3 15. Which statement best describes the use of the completely separated from Hgb A and does not 1c Hgb A1C test? Labile hemoglobin is formed initially when the aldehyde of glucose reacts with the N-terminal valine of the β globin chain. This Shiff base is reversible but is converted to Hgb A1c by rearrangement to a ketoamine. A fasting glucose of 126 or higher on two consecutive occasions indicates diabetes. A fasting glucose of 99 mg/dL is considered Peak Calibrated Retention Peak normal. May be used only to monitor persons with type 2 diabetes Chemistry/Correlate clinical and laboratory data/ Glycated hemoglobin/2 210 Chapter 5 | Clinical Chemistry 18. What is the recommended cutoff for the early Answers to Questions 18–21 detection of chronic kidney disease in diabetics using the test for microalbuminuria? The term microalbuminuria is defined as albumin excretion ≥ 30 mg/g creatinine Chemistry/Evaluate laboratory data to recognize health but ≤ 300 mg/g creatinine. The use of the albumin and disease states/Glucose/2 to creatinine ratio is preferred to measures of 19. In addition to measuring blood glucose, Hgb A1c, albumin excretory rate (μg/min) because the latter and microalbumin, which test should be done on is subject to error associated with timed specimen diabetic persons once per year? Estimated glomerular filtration rate have diabetes, it is not sensitive enough to manage Chemistry/Select method/Carbohydrates/2 glucose control on a daily basis, and has been 20. Which testing situation is appropriate for the use replaced by whole-blood glucose monitoring or of point-of-care whole-blood glucose methods? Screening for type 2 diabetes mellitus ketone test is a useful screening test for diabetic and B. Diagnosis of diabetes mellitus other forms of ketosis, the plasma β hydroxybutyrate C.