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autoimmune Flashcards

1
Q

What does autoimmune refer to?

A

abnormal immune response directed toward a self-antigen

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2
Q

What is activated during an autoimmune response

A

B or T lymphs or both

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3
Q

T or F autoimmune diseases are idiopathic.

A

T

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4
Q

What are possible factors that may contribute?

A
  1. Genetic susceptibility to class 1 or 2 antibodies
  2. enviroment
  3. infections
  4. decreased cytokine production
  5. loss of regulatory T cells
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5
Q

What is ankylosing spondylitis?

A

rheumatic disorder producing inflammation of axial skeleton and large peripheral joints

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6
Q

ankylosing spondylitis affects whom?

A
  1. M:F ratio 3:1

20-40 y/o with a genetic link

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7
Q

ankylosing spondylitis

symptoms

A 
back pain
stiffness
decreased chest expansion
low grade fever, fatigue, anorexia
weight loss/ anemia
iritis

starts in thoraco-lumbar and expands sup. and inf.

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8
Q

ankylosing spondylitis has what lab test?

A
  1. HLA B27: not specific

ESR, CRP, IgG

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9
Q

ankylosing spondylitis shows what in diagnosis?

A 
sclerosis in Si joints
marginal sydesmophytes
shiny corner sign
bamboo spine trolly tracts
dagger sign 
poker spine

all on xray`

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10
Q

autoimmune hemolytic anemia

what happens

A

autoantibodies attack RBC’s

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11
Q

autoimmune hemolytic anemia

who?

A

any age

more females

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12
Q

autoimmune hemolytic anemia

signs and symptoms

A

severe anemia
splenomegaly
increased unconjugated bilirubin
jaundice

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13
Q

autoimmune hemolytic anemia

tests

A
  1. Coomb’s
  2. Direct
  3. antiglobulin test
  4. CBC: increased MCHC
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14
Q

autoimmune hemolytic anemia

diagnosis

A

usually warm antibodies

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15
Q

celiac causes?

A

nontropical sprue/ celiac sprue

decreased gluten tolerance

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16
Q

celiac affects whom?

A

sensitivity to gluten w/ a genetic history

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17
Q

Celiac causes

signs

A

diarrhea
fatigue
weight loss
mouth ulcers

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18
Q

celiac

lab test

A

tTGA-IgA (antibody)

tissue transglutaminase

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19
Q

celiac

diagnosis

A

removal of gluten products

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20
Q

Crohn’s causes

A

regional enteritis

inflammation of distal ileum and colon, but may be entire GI tract

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21
Q

Crohn’s affects whom?

A

Female = Male
under 30 y/o
peak at 14-24 y/o

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22
Q

Crohn’s

signs and symptoms

A 
right lower quadrant pain
diarrhea
anorexia
weight loss
malnutrition
1/3 fistulas and fissures

INFLAMMATION AND OBSTRUCTION

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23
Q

Crohn’s T or F

lab test is IgM antibody agglutination test

A

F

no test

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24
Q

Crohn’s

diagnosis

A

barium enema xray
string sign
apthous & linear ulcers in GI
skip and cobblestone lesions

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25
Q

What is DM1?

A

Juvinile Diabetes mellitus

panceas produces little or no insulin due to genetic or immune-related destruction of beta cells

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26
Q

DM1 affects whom?

A

people under 30

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27
Q

DM1

signs and symptoms

A

DKA (diabetic ketoacidosis)
polyuria and polydipsia
weight loss

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28
Q

DM1

tests

A

blood glucose
Hgb A1c
HLA-Dr3
HLA-DR4

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29
Q

DM1

diagnosis

A

labs
case history
clinical presentation

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30
Q

fibromyalgia produces what signs and symptoms?

A
  1. stiff, achy, tender pain in muscles tendons and adjacent soft tissuee
  2. poor sleep and fatigue
  3. anxiety
  4. IBS (irritable bowel syndrome)
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31
Q

fibromyalgia affects whom?

A

more females

young to middle aged

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32
Q

T or F

fibromyalgia has no known tests.

A

T

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33
Q

fibromyalgia

diagnosis

A 
1. CH
possible precipitating factors:
1. stress
2. trauma
3 virus
4 lyme
5. cold
6 damp
must exclude other pathologies
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34
Q

T or F Goodpasture’s is a hypersensitivity disorder.

A

T

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35
Q

T or F

Goodpasture’s affects kidneys first then lungs

A

F

vice-versa

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36
Q

Goodpasture’ affects whom?

A

both sexes equally

18-30
50-65

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37
Q

Goodpasture’s has what signs and symptoms?

A

hemoptysis/ pulmonary hemorrhage
hematuria/ glomerulonephritis
iron deficiancy anemia

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38
Q

Goodpasture’ tests

A
  1. urinalysis
  2. blood: BUN/Creatinine
    anti-basement
    antibodies
    HLA-DRw
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39
Q

Goodpasture’s

diagnosis

A

chest x-rays: bilateral patchy consolidations

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40
Q

What is the most common form of Graves’ disease?

A

thyrotoxicosis

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41
Q

Graves’ is caused by

A

hypermetabolism of thyroid and increased thyroid hormones

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42
Q

Graves’ affects whom?

A

more females than males

genetic history of thyroid or AI disease

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43
Q

Graves’ exhibit what signs and symptoms

A

exoptalmia
goiter
pretibial myxedema

skin: warm, moist, fine
increased sweating
frequent bowels
fatigue/weight loss/ insomnia/ nervous

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44
Q

Graves’ tests

A

TSH
free T4
Thyroid antibodies: LATS/ TSI/ TGI

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45
Q

Graves’ diagnosis

A

history
physical exam
lab tests

Plummer’s ds. (2nd most common cause of thyrotoxicosis

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46
Q

What is the most common aquired demylenating neuropathy?

A

Guillian Barre

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47
Q

Gullian Barre affects whom?

A

anyone

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48
Q

Gullian Barre AKA

A

Landry’s ascending paralysis

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49
Q

Gullian Barre signs and symptoms

A

symmetric weakness and paresthesia starting in legs and moving to arms

DTR’s lost

respiratory and autonomic dysfnx.

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50
Q

Can gullian barre be fatal?

A

yes

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51
Q

Gullian Barre has what tests?

A

increased CSF protein

evidence of recent infection: most common campylobacter jejuni

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52
Q

Gullian Barre diagnosis

A

nerve biopsy: shows de and remyelination

clinical symptoms.

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53
Q

Hashimoto’s akas

A

thyroiditis

myxedema

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54
Q

Hashimotos’s is

A

chronic thyroid gland inflammation with lymphocytic infiltration due to Ai

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55
Q

Hashimoto’s affects whom

A

females

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56
Q

Hashimoto’s signs ans symptoms

A 
weight gain/ puffiness
enopthalmia
slurred speech/ thick toungue
cold intolerance
constipation
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57
Q

Hashimoto’s lab tests

A
  1. free T$/T3
  2. TSH
  3. TPO antibodies (antithyroid peroxidase)
  4. anti-microsomal antibodies
  5. anti-thyrogloulin antibodies
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58
Q

hashimoto’s diagnosis

A

history
physical exam
lab tests

59
Q

WHAt does ITP mean?

A

Immue thrombocytopenic purpura

60
Q

Antibodies attack platelets during

61
Q

ITP affects whom?

A

children: acute
adults: chronic

62
Q

ITP

signs and symptoms

A

sudden mucosal bleeding (epistaxis, gum, increased menstaration)

subcutaneous bleeding (petechia, eccymosis)

63
Q

ITP

lab tests

A

NO GOLD STANDARD

autoantibodies:platelet ratio
decreased platelets

CBC:normal RBC and WC

64
Q

ITP

diagnosis

A

bleeding symptoms
must rule out SLE

platelet antibody test is non specific

65
Q

What is the most common demylenating disease of the CNS?

A

multiple sclerosis

66
Q

What is MS possibly associated with?

A

temperate climate

67
Q

MS affects whom?

A

F:M = 2:1

rare in children and adults over 50

68
Q

MS

signs and symptoms

A

numbness, tingling, pain, burning, itching

cognitive problems

late: slurred speech and dementia

69
Q

MS

lab test

A

CSF: oligoclonal bands

increased IgG

70
Q

MS

diagnosis

A

MRI: high signal (white) plaque lesions at the brain and spinal cord

Lhermitte’s sign: pos

71
Q

What causes decreased AcH receptors that lead to episodes of muscles weakness?

A

Myasthenia Gravis

72
Q

Myasthenia Gravis affects whom?

A

more females than males

20-40

73
Q

Myasthenia Gravis

signs and symptoms

A

Eyes; ptosis/ diplopia
muscle fatigue post exercise
dysartria, dysphagia, proximal limb weakness

later: quadriparesis
bulbar symptoms (voice chocking nasal regurgitation
74
Q

Myasthenia Gravis

lab test

A

AcH receptor antibody

75
Q

Myasthenia Gravis

diagnosis

A

case history: signs and symptoms
edrophonium IV drug:mm function improves

electrophysiological testing

76
Q

What is a skin disorder characterized by bullae and erosions of surface and mucosla areas?

77
Q

T or F

pemphigus can be fatal.

78
Q

Pemphigus affects whom?

A

middle aged and elderly

high incidence in brazil

79
Q

Pemphigus

signs and symtoms

A

Bullae and extensive skin erosions

starts in mouth and goes all over any stratified epithelium

painful ulcers

80
Q

Pemphigus

lab tests

A

Tzanck test

immunoflorescent IgG on lesions

81
Q

Pemphigus

diagnosis

A

CH of mucosal ulcers

Nikolsky sign: epidermis detaches from underlying skin

82
Q

What develops in 50% of patients with Giant cell arteritis (GCA)?

A

Polymalgia rheumatica

83
Q

Polymalgia rheumatica causes

A

pain and stiffnes in proximal muscles without atrophy and weakness

84
Q

Polymalgia rheumatica affects whom

A

people over 50

85
Q

Polymalgia rheumatica

signs and symptoms

A

pain and stiffness in muscles of: back, neck, hip, shoulders, thighs

no weakness or atrophy
malaise, fever, weight loss

stiffness after inactivity (gelling phen.)

86
Q

Polymalgia rheumatica

lab test

A

increased ESR and CRP

normal:CK-MM, AST

CBC:normocytic normochromic anemia

87
Q

Polymalgia rheumatica

diagnosis

A

differential: RA and MM
normal: EMG, mm. biopsy

88
Q

What is characterized by inflammation and degenerative changes in muscle (poly) and skin (derm) that leads to symetrical weakness & atrophy of limb girdles?

A

polymyositis & dermatomyositis

89
Q

polymyositis & dermatomyositis affects whom?

A

F:M= 2:1

40-60
5-15

90
Q

polymyositis & dermatomyositis signs and symptoms

A

polymyositis: proximal muscle weakness and atrophy
fever/fatigue/weight loss

dermatomyositis: rash
periorbital edema w/ heliotrope hue (purple)= pathognomonic
lesions: dusky and red
skin may split

91
Q

polymyositis & dermatomyositis

lab test

A

All mm. enzymes

increased CK, AST, LDH

thymic antibodies: Jo-1, PM-1

92
Q

polymyositis & dermatomyositis

diagnosis

A 
CH
proximal mm weakness
skin rash
increased mm enzymes
muscle biopsy: definitive EMG changes
93
Q

Chronic recurrent skin pathology with dry, well-marginated scaly, silvery plaques and patches describes what?

94
Q

Psoriasis affects whom?

A

10-40 y/o

but really any age

95
Q

Psoriasis signs and symptoms

A

characteristic lesions: scalp, extensor surfaces buttoks, sacral area, penis

96
Q

Psoriasis lab tests include skin antibodies IgM and IgG. T or F

A

F no tests

97
Q

Psoriasis

diagnosis

A

insection of lesions

case history

98
Q

What is the difference between Raynaud’s disease and Raynaud’s phenomenon?

A

disease is bilateral w/ no underlying cause

phenomenon has an recognizable underlying cause

99
Q

Raynaud’s is characterized by

A

spasm of arterioles with intermitten pallor and cyanosis

100
Q

Raynaud’s affects whom?

A

more females

20-40

101
Q

Raynaud’s signs and symptoms

A

arteriole spasm (acral: nose, fingers, tongue)

intermitten pallor or cyanosis

102
Q

What tests for Raynaud’s?

103
Q

Raynaud’s diagnosis

A

presentation: blanching or cyanosis of digits precipitated by cold or emotions

can occur with scleraderma bone resorption to the distal tufts of the digit

104
Q

Rheumatoid Arthritis aka

A

felty syndrome

105
Q

Felty’s=

A

splenomegaly & neutropenia

106
Q

Still’s disease=

A

Juvenile RA

107
Q

What is characterized by symmetric inflammation of peripheral joints advancing to destruction of joints & periarticular areas?

108
Q

RA affects whom?

A

females more than males
30-50
genetic link

109
Q

RA

signs and symptoms

A

slow, progressive joint stiffness
fatigue, weakness, anorexia

“peripheral joint involvement advancing to tissues and organs”

110
Q

RA

lab tests

A

IgM RF: not specific for RA

increased ESR, CRP

joint fluid: increased PMN’s HLA’s
DRbeta1
DR4

anemia: N, N (normocytic normochromic)

111
Q

RA diagnosis

A 
Based on 4 of 7 criteria that must be present for 6 weeks:
1. stiffness greater than one hour
2. arthritis in 3 or more joints
3. arthritis in hand joints
4. systemic arthritis
5 rheumatoid nodules
6. Serum RF antibody
7. x-ray changes rat bite reosions, deviations, ligamentous laxity
112
Q

What is characterized by dry mouth, eyes, mucous membranes and often accompanies rheumatoid pathologies?

A

Sjogren’s syndrome

113
Q

Sjogren’s syndrome affects whom?

A

more females

late 40s

114
Q

Sjogren’s syndrome

signs and symptoms

A

occular symptoms (dryness) for more than 3 months

sicca=dryness

xerostomia= dry mouth

115
Q

Sjogren’s syndrome

lab tests

A

schirmer test

rose bengal test
increased ESR, CRP

anemia develops
SS-B antibodies, but non-specific

116
Q

Sjogren’s syndrome

diagnosis

A

CH
labs: non-specific

salivary gland test and biopsy

increased immune antibodies generally

117
Q

What is a connetctive tissue disorder affecting joints, kidneys, heart, vessel walls and serous areas?

A

Systemisc Lupas Erythematosis

118
Q

SLE affects whom?

A

more females

15-50

119
Q

SLE

signs and symptoms

A

acute or chronic onset

constitutional symptoms (febrile rash/ alopecia “butterfly rash on face”

arthralgias
lung/kidney/heart (Libman-Sacks)

120
Q

SLE

lab tests

A

ANA/FANA

Ds-DNA antibody

smith antibody

DNA and Smith Ab are specific but not sensitive

121
Q

SLE

diagnosis

A

symptoms/ rash/ arthalgias
Lab Tests

can mimic RA of the hands due to ligamentous laxity which would include ulnar deviation, swan and boutonnieres deformity but will lack rat bit erosions

122
Q

What is CREST involved with?

A

Scleroderma

123
Q

What characterizes scleroderma?

A

diffuse fibrosis and degeneration of skin vascular supply, articulations and internal organs (GI, lung, heart, kidneys)

124
Q

Scleroderma affects whom?

A

F:M = 4:1

30-50

125
Q

Scleroderma signs and symptoms

A

thickening of the skin (esp. acral parts)

raynaud’s phenomenon

multi-organ: renal and lung

126
Q

Scleroderma

lab tests

A

nonspecific: anti-Sci-70/ autoantibodies

eosinophilia

127
Q

Scleroderma

diagnosis

A

clinical presentation: CREST

Calcinosis
Raynauds
Esophageal dysfunction
Sclerodactyly
Telangiectasia

x-ray: bone resorption to the distal tufts of the digits

128
Q

Temporal arteritis aka

A

giant cell

129
Q

What is characterized by cranial artery involvement (large blood vessels: carotid system) vessels with elastic tissue

A

Temporal arthritis

130
Q

Temporal arthritis affects whom?

A

slightly more females

over 50

131
Q

Temporal arthritis

signs and symptoms

A

bitemporal headache
visual disturbances
jaw claudication
polymyalgia rheumatica (40%)

132
Q

Temporal arthritis

lab test

A

Big increase in ESR

anemia: N, N (normocytic, normochromic)

maybe increase in ALK. Phos

133
Q

Temporal arthritis

diagnosis

A

biopsy of arteries

radiological exam of the tempotral artery with ultrasound yields a halo sign or a MRI with gadolinium based contrast

134
Q

What is characterized by granulomatous arteritis of aorta and its branches?

A

Takyasu’s

135
Q

Takyasu’s affects whom?

A

F:M = 8:1

15-30

136
Q

Takyasu’s

signs and symptoms

A

non-descriptive constitutional (fatigue, malaise, night sweats, weight loss, arthralgias)

progression: vascular changes: syncope, TIA’s, HTN, decreased pulses

137
Q

Takyasu’s

lab tests

A

NA non specific

increased ESR and CRP
increased IgM globulins

138
Q

Takyasu’s

diagnosis

A

arteriograms showing occlusion or narrowing of aa

139
Q

What is characterized by granulomatous inflammation of respiratory tract then progressins to vasculitis and glomerulonephritis?

A

Wegener’s granulomatosis

140
Q

Wegener’s granulomatosis affects whom?

A

more males
any age

possible hypersensitivity history

141
Q

Wegener’s granulomatosis

signs and symptoms

A

upper respiratory tract
nasal mucosa: red, raised, friable, bleeds

fever/fatigue/weight loss/ anorexia

142
Q

Wegener’s granulomatosis

lab tests

A

ANCA (antineutrophilic cytoplasmic antibodies)

increased ESR and CRP

anemia
leukocytosis
renal function: increased creatinine/ BUN

143
Q

Wegener’s granulomatosis

diagnosis

A

pulmonary & renal biopsies

lab tests

Anatomy (22 decks)

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