BRS path mistake?

[sleepymed]

Hi,

I'm taking the USMLE in May but we're still doing path at the moment and i've been following along with the BRS path book. In the neoplastic and proliferative disorders chapter it says that infectious mononucleosis is characterized by circulating atypical lymphocytes (so far so good), but then it says that they are reactive CD8+ T lymphocytes. In our path lab we learned that they were reactive B cells. I was wondering which of the two you guys had learned.

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[protomd]

EBV infects pharyngeal B lymphos which go on to lymph nodes and the spleen to induce a humoral and cellular response. The humoral response is what u look for to diagnose mono (heterophilic antibodies) and the cellular response is marked by CD8+ T lymphos and NK cells. If these cellular responses are messed up, then it can eventually develop into uncontrolled lymphomas (burkitt's). hope that helps.





I'm taking the USMLE in May but we're still doing path at the moment and i've been following along with the BRS path book. In the neoplastic and proliferative disorders chapter it says that infectious mononucleosis is characterized by circulating atypical lymphocytes (so far so good), but then it says that they are reactive CD8+ T lymphocytes. In our path lab we learned that they were reactive B cells. I was wondering which of the two you guys had learned.

[/QUOTE]

 

[funkless]

I'm doing this without a reference, so be sure to double check, but infectious mononucleosis is absolutely a proliferation of CD8+ T lymphocytes.

In a nutshell, the EBV infects the B cells (I'm guessing this causes surface expression of some immunogenic protein). Helper T cells react against the infected B cells and cause a proliferation of killer T cells, which cause the huge rise in WBCs, the cervical lymphadenopathy, etc.



Having said all this, you're right not to blindly trust review books. There are errors or inconsistencies in most, if not all, of them.

 

[sleepymed]

that helps clear it up. thanks

 

[ertugrul]

Inf.monenucleosis infects B cells and this leads occurring of atypical T cells against B cells in advance

 

[drbetty]

1. page 76. Autoimmunity -->Genetic factors
"incidence of type 2 diabetes is increased in HLA DR3/DR4 positive individuals" - I think it should be type 1 diabetes?? (see First Aid pg 196 and HY immunology pg 23 table 5.1)

2. page 128. Polyarteritis nodosa (PAN) - "There is no association with ANCA." see Robbins pg 539 (Goljan & old editions of First Aid also incorrectly state an association with p-aNCA I believe)

3. page 144. Diseases of the Myocardium-->Restrictive cardiomyopathy
stiffening of the heart muscle impairs DIASTOLIC filling - reduced compliance of the heart is the primary defect (contractile/systolic function may be okay)

please feel free to agree/disagree

 

[guitarguy09]

2. page 128. Polyarteritis nodosa (PAN) - "There is no association with ANCA." see Robbins pg 539 (Goljan & old editions of First Aid also incorrectly state an association with p-aNCA I believe)

please feel free to agree/disagree

This is taken from eMedicine at http://www.emedicine.com/NEURO/topic314.htm
"Wegener granulomatosis (WG) involves both pulmonary and renal systems. WG is associated almost exclusively with the cytoplasmic type of antineutrophil cytoplasmic antibody (c-ANCA) but not with the perinuclear type of antineutrophil cytoplasmic antibody (p-ANCA). In PAN, both c- and p-ANCA can be found, although p-ANCA more commonly is associated with the condition."

 

[drbetty]

This is taken from eMedicine at http://www.emedicine.com/NEURO/topic314.htm
"Wegener granulomatosis (WG) involves both pulmonary and renal systems. WG is associated almost exclusively with the cytoplasmic type of antineutrophil cytoplasmic antibody (c-ANCA) but not with the perinuclear type of antineutrophil cytoplasmic antibody (p-ANCA). In PAN, both c- and p-ANCA can be found, although p-ANCA more commonly is associated with the condition."

hmm conflicting sources. i use emedicine often, too. however, uptodate states that there is no association btw PAN & ANCA:

http://www.utdol.com/utd/content/topic.do?topicKey=vasculit/9668&type=A&selectedTitle=1~45

"Unlike many of the other vasculitides (eg, microscopic polyarteritis, Wegener's granulomatosis), polyarteritis nodosa is not typically associated with antineutrophil cytoplasmic antibodies (ANCA)"

also here:
http://www.utdol.com/utd/content/topic.do?topicKey=glom_dis/16776

 

[drbetty]

pg 265

Ammonium magnesium phosphate stones are radioOPAQUE, not radiolucent. Uric acid stones are the type that are uniquely radiolucent on X-ray.