Approach to Hypersensitivity and Autoimmune Conditions Flashcards
1
Q
4 steps of Type I Hypersensitivity
A
- antigen exposure
- IgE cross linking on mast cell/basophil
- Mediator (histamine, PG, leukotriene, tryptase) release
- Sx within min of exposure & can return 4-8 hrs later
2
Q
Sx of Type I Hypersensitivity
A
urticaria (hives), rhinitis, wheezing, diarrhea, vomiting, hypotension, and anaphylaxis
3
Q
Examples of Type I Hypersensitivity
A
Pollen allergies, dust mite allergy, bee sting
4
Q
3 mechanisms of Type II Cytotoxic Hypersensitivity
A
- Opsonization (for phagocytosis)
- Complement-mediated lysis
- Ab-dependent cellular cytotoxicity
5
Q
2 Ig types involved in Type II Cytotoxic Hypersensitivity related cell destruction
A
IgG and IgM
6
Q
Examples of Type II Cytotoxic Hypersensitivity
A
ABO mismatch, Graves dz, Myasthenia gravis
7
Q
Characteristics of Myasthenia gravis (Type II hypersensitivity)
A
Ptosis, mechanism: prevents Ach from binding Ach-R.
8
Q
3 steps of Type III Immunocomplex Hypersensitivity
A
- Antigen-antibody complex formation
- Activates complement/neutrophil invasion into tissues
- Tissue inflammation leading to sx
9
Q
Sx of Type III Immunocomplex Hypersensitivity
A
fever, urticaria (hives), generalized lymphadenopathy, arthritis, glomerulonephritis, vasculitis, SOB
10
Q
Examples of Type III Immunocomplex Hypersensitivity
A
SLE, RA, Farmer’s Lung
11
Q
2 steps of Type IV Cell-Mediated Hypersensitivity
A
- Antigen exposure activates sensitized T-cells
- Tissue inflammation 48-96 hrs after antigen exposure
12
Q
Examples of Type IV Cell-Mediated Hypersensitivity
A
poison ivy rash, ppd for TB testing
13
Q
Example of? (hint a hypersensitivity)
A
Type IV Cell-mediated hypersensitivity
14
Q
Name the condition:
- Autoimmune systematic inflammatory dz affecting synovial membranes
- Granulation tissue in joint spaces and erodes articular cartilage and bone
A
RA
15
Q
For RA:
A
16
Q
Presentation of RA:
- joint ____, (color) , (temperature) , and ___ ROM
- morning, >1 hr ______
- sites most affected: list 5
- lab findings:
- or - rheumatoid factor
- or - anti CCP antibody
- elevated or normal ESR and CRP
A
- joint swelling (soft), erythema, warmth, decreased ROM
- morning >1 hr stiffness
- PIP, MCP (boutonniere deformity), wrist, knees ankles
- lab findings:
- rheumatoid factor
- anti CCP antibody
- elevated ESR and CRP
17
Q
Patients with RA are at increased risk for 3 things:
A
- infection from immunosuppresion
- leukemia/lymphoma
- CV disease
18
Q
Name the condition:
- Collagen vascular disorder w/ persistent inflammation in 1+ joints for 6+ weeks in patients < 16 yo
A
Juvenile idiopathic arthritis (JIA, aka juvenile RA)
19
Q
For JIA:
A
20
Q
Which of the 3 JIA presentations is the following?
- Large joints, asymmetric
- Iridocyclitis (inflammation involving ciliary body)
- Uveitis
A
Pauciarticular
21
Q
Which of the 3 JIA presentations is the following?
- Large and small joints, symmetric
A
Polyarticular
22
Q
Which of the 3 JIA presentations is the following?
- Recurrent, high fevers
- Myalgias, pericarditis, lymphadenopathy, etc.
- Anemia, leukocytosis
A
Systemic (Still’s Disease)
23
Q
Workup for JIA
A
- CBC
- ESR (erythrocyte sedimentation rate)
- RF/ANA (rheumatoid factor/antinuclear antibody)
- X-rays
- Synovial fluid (check for leukocytosis/elevated protein)
24
Q
Name JIA presentation corresponding to complication
- Sx wax and wane over time
- half get destructive arthritis, complete resolution rare
- 70% go into remission after several yrs
A
- Polyarticular
- Systemic (Still’s disease)
- Pauciarticular
25
Name the condition:
* Inflammatory disorder common among African Americans characterized by reccurent occurence/remissions, secondary to autoantibody formation and immune complex deposition
Systemic Lupus Erythematosus (SLE)
26
For SLE:
27
To be diagnosed with SLE how many of the following sx does a patient need to have?
* Pleuritis, pericarditis, myocarditis
* Oral aphthous ulcers
* Arthritis
* Photosensitivity
* Hemolytic anemia, thrombocytopenia, leukopenia, lymphopenia
* Proteinuria or urinary cellular casts
* Positive ANA
* Positive anti-dsDNA, anti-SM, antiphospholipid
* Lupus cerebritis, seizures, psychosis
* Malar rash (photosensitive butterfly rash)
–Discoid rash
At least 4
28
Name the condition:
* Erosions: very rare
* Morning stiffness: minutes
* Deforming arthritis: uncommon
* ESR and CRP slightly elevated
SLE
29
Name the condition:
* Erosions: common
* Morning stiffness: hours
* Deforming arthritis: common
* ESR and CRP significantly elevated
RA
30
2 reasons patients usually die from SLE:
1. end organ damage
2. opportunistic infections due to immunosuppresion
31
Name that condition:
* Chronic, hyperproliferative inflammatory disorder characterized by thick adherent scales
* Males and females equally affected w/ genetic component
Psoriasis
32
Presentation of Psoriasis:
* Mild \_\_\_\_\_
* *_(color)_* plaques w/ adherent *_(color)_* scales
* Involves _____ surface
* Bilateral or unilateral?
* _____ pitting
* Can potentially worsen to \_\_\_\_\_
* Mild pruritus (itch)
* Salmon pink plaques w/ adherent silver white scales
* Involves extensor surface
* Bilateral
* Nail pitting
* Can potentially worsen to arthritis
33
Workup for Psoriasis
PE: Auspitz sign – pinpoint bleeding after remove scale
Biopsy (sometimes)
34
Name that condition:
* Demyelinating disorder of the CNS
* Peak incidence around 20-40 yo
* Females \> males and maybe genetic component
MS
35
Presentation of multiple sclerosis (MS):
* Hint: the "MS rollercoster"
While riding the **MS** rollercoster I felt **electricified** but upon getting off, I had trouble walking. My legs were **weak, tingling and numb**. I was **dizzy**, my **vision was blurred.** I needed to **sit on the toilet for a while** to recover.
* Vision changes
* Vertigo
* Weakness
* Numbness/tingling and/or pain
* Urinary incontinence or retention
* Lhermitte’s sign – electrical sensation running down spine and LE with neck flexion
36
Workup for MS
* MRI
* CSF
37
Clinical signs that suggest a primary immunodeficiency disease
38
Which of the 4 primary immunodeficiencies is the following?
* Present in first 3-4 months of life
* Disseminated intracellular diseases
T cell
39
Example of T cell primary immunodeficiency
DiGeorge Syndrome (Thymic Aplasia, Chromosome 22 del)
40
Which of the 4 primary immunodeficiencies is the following?
* Present after 6 months of age (maternal antibodies disappear)
* Sinopulmonary and GI infections
B cell
41
Which of the 4 primary immunodeficiencies is the following?
* Combination of T-cell and B-cell features
T cell / B cell combined
42
Which of the 4 primary immunodeficiencies is the following?
* Sinopulmonary and soft tissue infections
Phagocytic
43
Example of B cell primary immunodeficiency
Common Variable Immunodeficiency (CVID)
* presents w/ spenolmegaly, lymphadenopathy
44
Example of T cell / B cell combined primary immunodeficiency
Severe Combined Immunodeficiency (SCID)
* Onset 3 mos
* Presents w/ diarrhea, pneumonia, failure to thrive, otitis
45
Example of phagocytic cell primary immunodeficiency
Chediak–Higashi syndrome
* albinism, neuropathy
46
Name that condition:
* Spread almost exclusively through body fluid transmission
* Male \> female
HIV/AIDS
47
Presentation of Human Immunodeficiency Virus, Acquired Immunodeficiency Syndrome (HIV/AIDS):
* Initially \_\_\_\_\_, followed by \_\_\_\_\_-like sx
* Initially asymptomatic, followed by flu-like symptoms
48
Workup for HIV/AIDS
* ELISA
* Western Blot
* HIV RNA viral load
49
Diagnosis of AIDS requires (2 possibilities):
* CD4 count \<200 OR
* Presence of AIDS defining illness (virus induced sx)
50
