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PCM II Final > Approach to Hypersensitivity and Autoimmune Conditions > Flashcards

Approach to Hypersensitivity and Autoimmune Conditions Flashcards

1
Q

4 steps of Type I Hypersensitivity

A
  1. antigen exposure
  2. IgE cross linking on mast cell/basophil
  3. Mediator (histamine, PG, leukotriene, tryptase) release
  4. Sx within min of exposure & can return 4-8 hrs later
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2
Q

Sx of Type I Hypersensitivity

A

urticaria (hives), rhinitis, wheezing, diarrhea, vomiting, hypotension, and anaphylaxis

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3
Q

Examples of Type I Hypersensitivity

A

Pollen allergies, dust mite allergy, bee sting

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4
Q

3 mechanisms of Type II Cytotoxic Hypersensitivity

A
  • Opsonization (for phagocytosis)
  • Complement-mediated lysis
  • Ab-dependent cellular cytotoxicity
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5
Q

2 Ig types involved in Type II Cytotoxic Hypersensitivity related cell destruction

A

IgG and IgM

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6
Q

Examples of Type II Cytotoxic Hypersensitivity

A

ABO mismatch, Graves dz, Myasthenia gravis

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7
Q

Characteristics of Myasthenia gravis (Type II hypersensitivity)

A

Ptosis, mechanism: prevents Ach from binding Ach-R.

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8
Q

3 steps of Type III Immunocomplex Hypersensitivity

A
  1. Antigen-antibody complex formation
  2. Activates complement/neutrophil invasion into tissues
  3. Tissue inflammation leading to sx
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9
Q

Sx of Type III Immunocomplex Hypersensitivity

A

fever, urticaria (hives), generalized lymphadenopathy, arthritis, glomerulonephritis, vasculitis, SOB

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10
Q

Examples of Type III Immunocomplex Hypersensitivity

A

SLE, RA, Farmer’s Lung

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11
Q

2 steps of Type IV Cell-Mediated Hypersensitivity

A
  1. Antigen exposure activates sensitized T-cells
  2. Tissue inflammation 48-96 hrs after antigen exposure
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12
Q

Examples of Type IV Cell-Mediated Hypersensitivity

A

poison ivy rash, ppd for TB testing

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13
Q

Example of? (hint a hypersensitivity)

A

Type IV Cell-mediated hypersensitivity

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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

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15
Q

For RA:

A
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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
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17
Q

Patients with RA are at increased risk for 3 things:

A
  • infection from immunosuppresion
  • leukemia/lymphoma
  • CV disease
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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)

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19
Q

For JIA:

A
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20
Q

Which of the 3 JIA presentations is the following?

  • Large joints, asymmetric
  • Iridocyclitis (inflammation involving ciliary body)
  • Uveitis
A

Pauciarticular

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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

  1. Sx wax and wane over time
  2. half get destructive arthritis, complete resolution rare
  3. 70% go into remission after several yrs
A
  1. Polyarticular
  2. Systemic (Still’s disease)
  3. Pauciarticular
25
Q

Name the condition:

  • Inflammatory disorder common among African Americans characterized by reccurent occurence/remissions, secondary to autoantibody formation and immune complex deposition
A

Systemic Lupus Erythematosus (SLE)

26
Q

For SLE:

A
27
Q

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

A

At least 4

28
Q

Name the condition:

  • Erosions: very rare
  • Morning stiffness: minutes
  • Deforming arthritis: uncommon
  • ESR and CRP slightly elevated
A

SLE

29
Q

Name the condition:

  • Erosions: common
  • Morning stiffness: hours
  • Deforming arthritis: common
  • ESR and CRP significantly elevated
A

RA

30
Q

2 reasons patients usually die from SLE:

A
  1. end organ damage
  2. opportunistic infections due to immunosuppresion
31
Q

Name that condition:

  • Chronic, hyperproliferative inflammatory disorder characterized by thick adherent scales
  • Males and females equally affected w/ genetic component
A

Psoriasis

32
Q

Presentation of Psoriasis:

  • Mild _____
  • (color) plaques w/ adherent (color) scales
  • Involves _____ surface
  • Bilateral or unilateral?
  • _____ pitting
  • Can potentially worsen to _____
A
  • Mild pruritus (itch)
  • Salmon pink plaques w/ adherent silver white scales
  • Involves extensor surface
  • Bilateral
  • Nail pitting
  • Can potentially worsen to arthritis
33
Q

Workup for Psoriasis

A

PE: Auspitz sign – pinpoint bleeding after remove scale

Biopsy (sometimes)

34
Q

Name that condition:

  • Demyelinating disorder of the CNS
  • Peak incidence around 20-40 yo
  • Females > males and maybe genetic component
A

MS

35
Q

Presentation of multiple sclerosis (MS):

  • Hint: the “MS rollercoster”
A

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
Q

Workup for MS

A
  • MRI
  • CSF
37
Q

Clinical signs that suggest a primary immunodeficiency disease

A
38
Q

Which of the 4 primary immunodeficiencies is the following?

  • Present in first 3-4 months of life
  • Disseminated intracellular diseases
A

T cell

39
Q

Example of T cell primary immunodeficiency

A

DiGeorge Syndrome (Thymic Aplasia, Chromosome 22 del)

40
Q

Which of the 4 primary immunodeficiencies is the following?

  • Present after 6 months of age (maternal antibodies disappear)
  • Sinopulmonary and GI infections
A

B cell

41
Q

Which of the 4 primary immunodeficiencies is the following?

  • Combination of T-cell and B-cell features
A

T cell / B cell combined

42
Q

Which of the 4 primary immunodeficiencies is the following?

  • Sinopulmonary and soft tissue infections
A

Phagocytic

43
Q

Example of B cell primary immunodeficiency

A

Common Variable Immunodeficiency (CVID)

  • presents w/ spenolmegaly, lymphadenopathy
44
Q

Example of T cell / B cell combined primary immunodeficiency

A

Severe Combined Immunodeficiency (SCID)

  • Onset 3 mos
  • Presents w/ diarrhea, pneumonia, failure to thrive, otitis
45
Q

Example of phagocytic cell primary immunodeficiency

A

Chediak–Higashi syndrome

  • albinism, neuropathy
46
Q

Name that condition:

  • Spread almost exclusively through body fluid transmission
  • Male > female
A

HIV/AIDS

47
Q

Presentation of Human Immunodeficiency Virus, Acquired Immunodeficiency Syndrome (HIV/AIDS):

  • Initially _____, followed by _____-like sx
A
  • Initially asymptomatic, followed by flu-like symptoms
48
Q

Workup for HIV/AIDS

A
  • ELISA
  • Western Blot
  • HIV RNA viral load
49
Q

Diagnosis of AIDS requires (2 possibilities):

A
  • CD4 count <200 OR
  • Presence of AIDS defining illness (virus induced sx)
50
Q
A

PCM II Final (10 decks)

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