L:\usmle review 7 - Sinoe medical homepage.

31. The correct answer is B. Nodular lymphomas of all types are derived from the B-cell line.
The translocation t(14, 18), with bcl-2 activation, is associated with these lymphomas.
An abl-bcr hybrid (bcr-c-abl; choice A) and t(9, 22) translocation (choice E) are associated with
chronic myeloid leukemia (CML).
c-myc activation (choice C) and t(8, 14) (choice D) are associated with Burkitt lymphoma.
32. A 25-year-old woman presents with pain and tenosynovitis of the wrists and ankles, and
arthralgias of other joints. She notes two prior episodes similar to the present one. She just had
her menstrual period during the previous week. Physical examination reveals ulcerated lesions
overlying the wrists and ankles. These symptoms are likely due to deficiency of which of the
following
(A)
(B)
(C)
(D)
(E)
C1 esterase inhibitor
Ciliary function
Complement (C6-C8) components
Endothelial adhesion molecules
Eosinophils
32. The correct answer is C. This patient has disseminated gonococcemia. Gonococcal arthritis
and tenosynovitis typically involve both the upper and lower extremities equally. Vesicular skin
lesions are characteristic of disseminated gonococcal disease. Females are at particular risk of
gonococcemia during menstruation, since sloughing of the endometrium allows access to the
blood supply, necrotic tissue enhances the growth of Neisseria gonorrhoeae, and there is an
alteration of the pH. Patients who have a C6-8 deficiency have an increased risk of disseminated
gonococcemia and tend to have multiple episodes. These patients are also at risk for bacteremia
from Neisseria meningitidis.