Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Year 5 Histopathology > 5s: Immune Disorders* > Flashcards

5s: Immune Disorders* Flashcards

1
Q

SOAP BRAIN MD for SLE (Systemic Lupus Erythematosus)

A
  • Serositis
  • Oral ulcers
  • Arthritis
  • Photosensitive rash
  • Blood (all counts low)
  • Renal (proteinuria)
  • ANA = used to screen for ANY nuclear antigens
  • Immunological (anti-dsDNA)
  • Neurological (psych, seizures)
  • Malar rash
  • Discoid rash
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the three auto-antibodies in SLE

dsh

A

Anti-dsDNA (MOST SPECIFIC) = most specific (30%), not very sensitive

Anti-smith (Sm) = specific (20%), not very sensitivie

  • NB: all anti-ENAs (RNPs: anti-Ro, La, Sm, U1RNP) found in SLE

Anti-histone (drug-related e.g. hydralazine)

  • patients taking hydralazine for HTN may develop SLE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How do we measure anti-dsDNA?

A

Incubate patient’s serum with Crithidia Luciliae (a protozoa)

  • has big mitochondrion with dsDNA (kinetoplast)
  • if the patient has anti-dsDNA antibodies, it will bind to the DNA

Measured using ELISA

NB: old test looks for LE cells (neutrophils that have taken up denatured nuclei)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How do we measure anti-dsDNA?

A

Incubate patient’s serum with Crithidia Luciliae (a protozoa)

  • has big mitochondrion with dsDNA (kinetoplast)
  • if the patient has anti-dsDNA antibodies, it will bind to the DNA

Measured using ELISA

NB: old test looks for LE cells (neutrophils that have taken up denatured nuclei)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Skin histology of SLE (3)

A
  • lymphocytic infiltration of dermis
  • vacuolisation (cell dissolution) of basal epidermis
  • Extravasation of RBCs → rash
  • IF (antibody to IgG) will show immune complex deposition of the epidermis-dermis junction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Renal histology of SLE (1)

A

Thick glomerular capillaries (wire-loop)

IF to visualise immune complex deposition (dark areas on EM)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Renal histology of SLE (1)

A

Thick glomerular capillaries (wire-loop)

IF to visualise immune complex deposition (dark areas on EM)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What heart problem is associated with SLE?

A

Libman-Sacks Endocarditis

  • non-infective form of endocarditis
  • emboli, HF, murmurs
  • Vegetations = lymphocytes, neutrophils, fibrin stands etc.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Investigation of connective tissue disease

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Investigation of connective tissue disease

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Lupus can affect complement

A

Active lupus can cause secondary deficiency of classical pathway (C1,2,4) complement due to production of immune complexes depleting complement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What susceptibility allele is associated with SLE?

A

HLA-DR⅔

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do we treat SLE?

A

Mainly analgesia, steroids

Cyclophosphamide (chemo)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

SLE summary

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is Scleoderma (systemic sclerosis)? and its types?

A

fibrosis and excess collagen (localised form is called morphoea in the skin)

Diffuse = involves the trunk (CREST + GIT + interstitial pulmonary disease and renal problems), F>M

Limited = NOT the trunk (CREST) → high risk of lung fibrosis and renal crisis

  • Calcinosis (i.e. calcium deposit on tip of thumb)
  • Raynaud’s phenomenon
  • Eosophageal dysmotility
  • Sclerodactlyly
  • Telangiectasia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the autoantibodies in systemic sclerosis (diffuse vs limited) which one has a specific pattern

A

Diffuse

  • Topoisomerase/Scl70
  • RNA Pol I/II/III
  • Fibrillarin (NUCLEOLAR PATTERN)

Limited

  • Anti-centromere antibody
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Skin histology in SS

A

Increased depth and amount of collagen → reduced skin elasticity

  • difficulty swallowing and stomach dysmotility due to excess collagen within the lining
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Vascular histology

A
  • Top picture is a normal artery with 3 layers
  • Bottom picture is a small artery in a patient presenting to A&E with a renal crisis (characterised by very high blood pressure)
    • There is intimal proliferation giving an onion skin appearance
    • Lumen effectively obliterated and some small thrombi form
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Vascular histology

A
  • Top picture is a normal artery with 3 layers
  • Bottom picture is a small artery in a patient presenting to A&E with a renal crisis (characterised by very high blood pressure)
    • There is intimal proliferation giving an onion skin appearance
    • Lumen effectively obliterated and some small thrombi form
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is mixed connective tissue disease?

A

Overlap of several connective tissue diseases

  • SLE
  • Polymyositis
  • Scleroderma
  • Dermatomyositis
21
Q

What autoantibody for mixed connective tissue disease?

A

ANA → Anti-U1RNP antibody

  • shows a speckled pattern
22
Q

What areas does sarcoidosis affect?

A
  • Joints (arthritis, bone cysts)
  • Lungs (fibrosis, lymphocytosis → increased CD4_ cells in BAL)
  • Heart (any layer: pericardium, myocardium, endocardium)
  • Neuro (meningitis, CN lesions)
  • Parotids (bilateral enlargement)
  • Skin (lupus pernio, erythema nodosum)
  • Lymphadenopathy (painless, rubbery)
  • Eyes (uveitis, karatoconjunctivitis)
  • Liver (hepatitis, cirrhosis, cholestasis)
  • HYPERCALCAEMIA/HYPERCALCIURIA → renal calculi + nephrocalcinosis
  • Constitutional (malaise, fever, night sweats)
23
Q

Other than sarcoidosis, what other conditions can cause bilateral parotid enlargement

A

mumps

alcohol

Sjogren’;s syndrome

24
Q

What is sarcoidosis

epidemiology

investigations

histology findings

A

Multisystem disease of unknown origin, young adults, non-caseating granulomas

Afro-Caribbeans more severe, F>M

Lungs most commonly involved

Ix: DIAGNOSIS OF EXCLUSION

  • CXR = bilateral hilar lymphadenopathy (ddx TB lymphoma, bronchial caner)
  • increased Ca2+ (ectopic 1a-hydroxylase release by activated macrophages), increased ESR, increased ACE, transbronchial biopsy

Histology:

  • non-caveating granulomas
  • Schauman and asteroid bodies (inclusions of protein and calcium)
25
Sarcoidosis histology
**NON-CASEATING GRANULOMA** (ball of activated macrophages) composed of: * histiocytes (epithelioid cells) * Multinucleated giant cells of Langerhans (peripheral nuclei) - fused macrophages → **horsehoe** appearance * lymphocytes → NO necrosis within granuloma (non-caveating)
26
Ix for sarcoidosis (3)
**Hypergammaglobulinaemia** **Raised ACE** **Hypercalcaemia (**vit D hydroxylation (1a-hydroxylase) _by activated macrophages)_
27
Summary of vasculitides
28
Summary of vasculitides
29
Features of vasculitides
Palpable purpuric rash nail fold infarcts primary (image) secondary to another condition (e.g. infective endocarditis. SLE)
30
Temporal arteritis (GCA, giant cell arteritis), features, ix, histology, and mx
* elderly, _scalp tenderness, temporal headache_, jaw claudication, blurred vision, non-palpable temporal pulse * associated with _poly myalgia rheumatica_ * ix: raised **ESR**, **temporal artery biopsy → narrowing of lumen and lymphocytic infilitration of the tunica MEDIA,** \>50 y/o * histology: granulomatous transmural inflammation + giant cells + skip lesions * mx = **oral prednisolone**
31
Takayasu arteritis
**Pulseless** disease = no pulse, low BP in arms, cold hands **JAPANESE WOMEN** vascular symptoms = absent pulse, bruits, claudication
32
What is Polyarteritis Nodosa (PAN), its features and its associations?
inflammation of _gut/_**_renal_** _vessels_ * fever, fatigue, weakness, arthralgia, skin/nerve/kideny involvement, pericarditis, MI * 30% have underlying **HepB** * necrotising arteritis → heals by **fibrosis** * polymorphs, lymphocytes, and eosinophils will infiltrate * arteritis is focal and sharply demarcated * Associations: **rosary beads** on angiograms (microaneurysms), **HBV** Ix: clinical criteria and biopsy **(raised ESR/WCC/CRP), rosary sign** Tx: **prednisolone and cyclophosphamide**
33
What is Kawasaki's disease
34
What is Buerger's disease (thomboangitis obliterans)? Ix
* Inflammation of arteries of extremities (tibial/radial) * pain, ulceration of toes/feet/fingers * **heavy smokers,** men \<35 * ix = _angiogram_ **(corkscrew appearance** from segmental occlusive lesions)
35
What is the triad for Granulomatosis with Polyangitis (Wegener's granulomatosis)? tx
1. URT = sinusitis, epistaxis, **saddle nose** 2. LRT = cavitation, **pulmonary haemorrhage** 3. Kidneys = crescentic **glomerulonephritis** → haematuria + proteinuria tx = prednisolone, cyclophosphamide, co-trimoxazole
36
Granulomatosis with Polyangitis (Wegener's granulomatosis) autoantibody?
**cANCA (anti-PR3)** +ve (directed against proteinase 3)
37
Triad for Churg Strauss Syndrome (Eosinophilic Granulomatosis with Polyangiitis) and tx
1. asthma, allergic rhinitis (allergy → asthma → systemic disease) 2. eosinophilia 3. vasculitis **later systemic involvement** **male dominance** **tx** = prednisolone, azathioprine, cyclophosphamide
38
What is Churg-Strauss syndrome autoantibody
P-ANCA (directed against myeloperoxidase)
39
What is Microscopic Polyangiitis? autoantibody, tx
_Pulmonary Renal_ syndrome: * pulmonary haemorrhage * glomerulonephritis **pANCA** (anti-MPO) +ve tx: prednisolone, cyclophosphamide/azathioprine, plasmapheresis
40
What is HSP?
IgA mediated small vessel vasculitis * \<10 y/o * preceding URTI, purpuric rash (lower libs extensors + buttocks), colicky abdominal pain, GLOMERULONEPHRITIS, arthritis, orchitis IgA nephropathy is commonest glomerulonephritis
41
Summary of vasculitides
42
What is Sjogren's syndrome?
M:**F**=1:9 Onset in late 40s **Dry mouth** (xerostomia), **eyes** (keratoconjunctivitis sicca), **nose and skin** May affect kidneys, blood vessels, lungs, liver, pancreas and PNS **Anti-Ro and anti-La (speckled pattern)** antibodies present Use _Schirmer test_ to measure production of tears-assessing for dry eye May get parotid or salivary gland enlargement → may lead to **parotid lymphoma (MALT)**
43
Which autoantibody can you see in congenital heart block in infants of mothers with SLE?
Anti-Ro antibody
44
Describe dermatomyositis and what you can see O/E, autoantibody
* They will have **proximal** muscle pain and weakness * **High CK** * **Gottron's papules** (erythematous rash over the knuckles) + **periorbital rash** **T3 RESPONSE** **Anti-Jo-1 (t-RNA Synthetase)**
45
Dermatomyositis and polymyositis
46
What is this? SLE Scelorderma Sarcoidosis
SLE
47
What is this? SLE, scleroderma, sarcoidosis
scleroderma
48
What is this? SLE Scleroderma Sarcoidosis
Sarcoidosis

Year 5 Histopathology (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions