Allergy And Rheumatology Flashcards
B cell surface marker and EBV receptor
CD21
Most potent and effective APCs in the body
Dendritic cells
Antibody secreted in mucosal surfaces as dimer; most produced antibody overall
IgA
Protein molecules capable of activating up to 20% of T cell pool resulting in widespread immune response
Superantigen
Binding of an opsonized target cell to a FC receptor bearing effector cell resulting in lysis of the target
Antibody dependent cellular cytotoxicity
Opsonin complement
C3b
5 acute phase reactants that are increased during inflammation
Serum amyloid A CRP Ferritin Fibrinogen Hepcidin
2 proteins that are decreased during inflammation
Albumin and transferrin
3 complement proteins involved in anaphylaxis
C3a, 4a, 5a
Complement that induces neutrophol chemotaxis
C5a
Leukotriene involved in neutrophil chemotaxis
LTB4
3 components of slow reacting substances of anaphylaxis (SRS-A)
LTC4, D4, E4
Cytokine involve in fever and activates osteoclast
IL1
Cytokine that stimulates all types of T cell
IL2
Cytokine that activates mcrophages and increases antigen presentation
IFN gamma
Cytokine that stimulates septic shock, vascular leakage, recruitment of leukocytes
TNF alpha
Cytokine that differentiates T cells into TH1 and activates NK cells
IL12
Cytokine that stimulates bone marrow stem cells
IL3
Cytokine that modulates inflammatory response togethef with TGF-B
IL10
Cytokine that induces B cell growth and IgE production
IL 4
Major neutrophil chemotactic factor or cytokine
IL8
Cytokine that induces eosinophil growth and IgA production
IL-5
Cytokine involved in fever and stimulates acute phase proteins
IL6
Anti Ach receptor
Myasthenia gravis
Anti basement membrane
Goodpasture syndrome
Anti glutamate decarboxylase
T1 DM
Anti Jo, anti SRP, anti Mi-2
Dermatomyositis, polymyositis
Anti microsomal, anti thyroglobulin, anti- TPO
Hashimoto thyroiditis
Anti mitochondrial
Primary biliary cirrhosis
Anti smooth muscle
Autoimmune hepatitis
TSH-receptor stimulating immunoglobulin and anti-TPO
Grave’s disease
Anti centromere
Limited scleroderma, CREST syndrome
Anti Scl-70, anti topoisomerase 1
Diffuse scleroderma
Female, joint pains, pleural or pericardial effusions, photosensitive rash, hematuria or proteinuria, oral ulcers, anemia, leukopenia or thrombocytopenia, seizures or psychosis, headache, fever, myalgias, autoantibodies
SLE
Best screening and most sensitive test for SLE
ANA
SLE-specific antibodies that correlate with level of disease activity nephritis and vasculitis
Anti-dsDNA
SLE-specific antibodies with no clinical correlations
Anti-Sm
Antibodies associated with Sicca syndrome, subacute cutaneous lupus, neonatal lupus with congenital heart block and decreased risk for nephritis
Anti-Ro (SS-A)
Anti-bodies in drug-induced lupus
Anti-histone
Antibodies predisposing to recurrent fetal loss, thrombosis, detected by ELISA fir Cardiolipin and B2G1 and DRVVT
Anti-phospholipid antibody
Most serious manifestation of SLE
Nephritis
Immunosuppressive therapy for Class 3-5 lupus nephritis
Steroids + cyclophosphamide/mycophenolate mofetil
Most common pulmonary manifestation of SLE
Pleuritis with or without effusion
Most frequenf cardiac manifestation of SLE
Pericarditis
Fibrinous vegetations and endocarditis in SLE
Libman-Sacks endocarditis
Most frequent hematologic manifestation of SLE
Normocytic, normochromic anemia
Most common manifestation of diffuse CNS lupus
Cogniyive dysfunction
Most common chronic dermatitis in SLE
Discoid lupus erythematosus
Most common form of chronic inflammatory arthritis
RA
Most common cardiac and valvular manifestations of RA
Pericarditis and mitral regurgitation
Most commob cause of death in patients with RA
Cardiovascular disease
Environmental factor most implicated in RA
Smoking
Triad of neutropenia, splenomegaly, and nodular RA
Felty’s syndrome
Triad of keratoconjunctivitis sicca, xerostomia and RA
Sjogren’s syndrome
Length of time for joint symptoms tobe suggestive of RA
6 weeks or more
Synovial inflammation and proliferation, focal bone erosions, thinning of the articulat cartilage and pannus formation are pathological hallmark s of
RA
IgM against the Fc portion of IgG
Rheumatoid factor
Serum marker with higher specificity for RA than RF
Anti-CCP
Initial radiological finding in RA
Juxta-articular osteopenia
Other findings:
Soft tissue swelling
Symmetric joint space loss abf subchonral erosions
Test with greatest sensitivity for detecting synovitis, joint effusions and early bone and marrow changes in RA
MRI
DMARD of choice for RA
Methotrexate
Most common type of arthritis
OA
2 major factors contributing to the developmeng of OA
Joiny loading and joint vulnerability
Most potenf risk factor for OA
Age
Nodes found on the proximal interphalangeal joint in OA
Bouchard’s nodes
Nodes found on the distal interphalangeal joint in OA
Heberden’s nodes
Fulcrum of the longest lever arm in the body
Knee
Asymmetric joint space narrowing, subchondral sclerosis and osteophytes are radiological hallmarks of
OA
Initial analgesic of choice for OA
Acetaminophen or paracetamol
50 year old alcoholic male complaining of severe joint pain starting last night with noted swelling and redness on his right first metatarsophalangeal joint
Gouty arthritis
Inflammation of the first metatarsophalangeal joinf in gout
Podagra
Needle-shaped crystals that are negatively birefringent
Gouty arthritis
Rhomboid-shaped crystals that are weakly-positive birefringent
Psuedogout
Mainstay of treatmenf during acute attacks of gout
NSAIDs (indomethacin)
Indication for uricosuric agents
Under excretors of uric acid
Most commonlg used hypouricemic and best drug to use in urate overproducers, urate stone formers, and renal disease
Allopurinol
Target therapeutic blood uric acid level for gout
Less than or equal to 6 mg/dl
Joint most frequently affected in CPPD or pseudogout
Knee
Radiograph findings of punctate or linear radiodense deposits in fibrocartilaginous joint menisci or articular hyaline cartilage suggestive of CPPD
Chondrocalcinosis
Arthritis presenting with predominant DIP involvement, asymmetric or symmetric, involving one or more joints, dactylitis, shortening of digits and nail changes with or without silvery scaly skin lesions
Psoriatic arthritis
Nail pitting, horizontal ridging, onycholysis, yellowish discoloration of margins (oil spots), dystrophic thick subungal hyperkeratosis, salmon patches are nail changes of
Psoriasis or psoriatic arthritis
Uveitis in psoriatic arthritis
Bilateral chronic posterior uveitis
Pencil-in-cup deformity, “whiskering”, small joint ankylosis, osteolysis, periostitis, new bone formation, and telescoping of digits are radiologic characteristics of
Psoriatic arthritis
Ideal treatment for psoriatic arthritis
Anti-TNF alpha agents (infliximab, adalimumab, golimumab)
Acute nonpurulent arthritis complicating an infection elsewhere in the body
Reactive arthritis
Triad of arthritis, urethritis, and conjunctivitis
Reiter’s syndrome
6 common organisms implicated in reactive arthritis
Shigella, salmonella, yersinia, campylobacter, chlamydia, HIV
Initial treatment of choice for reactive arthritis
Indomethacin and other NSAIDs
Young adult male, insidious onset of dull pain in the lower lumbar or gluteal region, lumbar morning stiffness lasting a few hours that improves with activity and returns after inactivity with nocturnl exacerbation
Ankylosing spondylitis
Genetic marker prominent in ankylosinf spondylitis and other spondyloarthropathies
HLA-B27
Earliest manifestation of ankylosing spondylitis
Sacroiliitis
Inflammation in the fibrocartilaginous regions where a tendon, ligament or joint capsul attaches to bone characteristic of spondyloarthropathies
Enthesitis
Most common extra articulat manifestation of ankylosing spondylitis
Acute anterior uveitis
First line pharmacologic management of ankylosing spondylitis
NSAIDs
Patient with pneumonia presenting with sudden onset moderate to severe pain on the right knee with muscle spasm, decreased range of motion, swelling and redness, high fever, leukocytosis
Infectious or septic arthritis
Most common site of infectious arthritis
Knee
Most common route of infection for infectious arthritis in all age groups
Hematogenous
Most common etiologic agent for infectious arthritis among young adults and adolescents
Neisseria gonorrhea
Most common nongonococcal cause of infectious arthritis in adults of all ages
Staphylococcus aureus
Most common etiologic agent for infectious arthritis afer surgery or penetrating injuries
Staphylococcys aureus
Subset of patients with highest incidence of inectious arthritis
RA patients
Most common presentation of infectious arthritis
Monoarthritis
Sites of infectious arthritis most common among IV drug abusers
Vertebral, sacroiliac, and sternoclavicular joints
Other than antibiotics, essential treatment needed for a favorable outcome on joint function in infectious arthritis
Timely drainage of pus and necrotic debris
Late manifestation of congenital syphilis manifesting as chonic painless synovitis with effusion of large joints, particularly the knees and elbows
Clutton’s joint
Reactive symmetric form of polyarthritis that affects persons with visceral or disseminated tuberculosis
Poncet’s disease
Antibodies directed against proteinase-3 detected as diffuse granular cytopladmic staining pattern in neutrophils
c ANCA (cytoplasmic anti-neutrophil cytoplasmic antibodies)
Antibodies direced against myeloperoxidase with perinuclear or nuclear stainin in neutrophils
p ANCA
First step in the workup of a patient witb suspected vasculitis
Exclude other diseases
Granulomatous necrotizing vasculitis of the triad of upper and lower respiratory tract and kidney (sinusitis, lung involvement, glomerulonephritis, (+) cANCA
Wegener’s granulomatosis
Non-granulomatous inflammation of the small arteries and veins including venules, glomerulonephritis, usually with no upper airway involvement and no pulmonary nodules, (+) pANCA
Microscopic polyangiitis
Asthma, peripheral and tissue eosinophilia, extravascular granuloma, and vasculitis of multiple organ systems (predominant pulmonary findings)
Churg-Strauss
Necrotizing vasculitis, renal and visceral artery involvement witb aneurysmal dilatations, no pulmonary artery involvement, associated with Hepatitis B
Polyarteritis nodosa
Elderly female presenting with fever, anemia, headaches, temporal tenderness, jaw claudication, higb ESR, and accompanying stiffness, and muscle pains of the neck, shoulders, hips and thighs
Giant cell/temporal arteritis
Syndrome characterized by stiffness aching and pain in the muscles of the neck, shoulders, lower back, hips and thighs associated with giant cell arteritis
Polymyalgia rheumatica
Dreaded complication of giant cell arteritis
Ischemic optic neuropathy
Young female, systemic symptoms, arm claudication, diminished pulses on one arm, vasculitis of medium to large arteries involving the aortic arch and branches
Takayasu’s arteritis
Aka aortic arch syndrome or pulseless disease
Takayasu’s arteritis
Child with glumerolonephritis, palpable purpura over the buttocks and lower extremities, gastrointestinal symptoms, arthralgias, and history of recent respiratory infection
Henoch schonlein purpura
Most commonly encountered vasculitis in clinical practice
Cutaneous vasculitis
So far, the most effectice treatment for the systemic vasculitides
Cyclophosphamide
Cutaneous vasculitis, arthritis, peripheral neuropathy, membranoproliferative glomerulonephritis, hepatitis C, cold-precipitated agglutinins or immunoglobulins
Cryglobulinemic vasculitis
8 drugs implicated in vasculitis syndromes
Allopurinol Thiazides Gold Sulfonamides Phenytoin Penicillin Hydralazine PTU
Malar rash, Gottron’s papules, erythematous periorbital rash (heliotrope rash), shawl and face rash, mechanic’s hands, high creatinine kinase, (+) ANA, (+) Anti Jo-1, anti-SRP, and anti-Mi2
Dermatomyositis
CREST syndrome
Calcinosis Reynaud's phenomenon Esophageal dysmotility Sclerodactyly Telangiectasia
