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Maddie’s Immunity > Autoimmunity > Flashcards

Autoimmunity Flashcards

1
Q

Define autoimmunity. (2)

A

An immune response against the host due to the loss of immunological tolerance to self-antigens.

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2
Q

Define autoimmune disease. (2)

A

A disease caused by the tissue damage or disturbed physiological responses due to an autoimmune response.

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3
Q

Describe the two types of autoimmune reaction. (4)

A

Organ specific - autoantibodies against a one-organ antigen. Can still have systemic effects.
Non-organ specific - widely distributed antigens

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4
Q

Describe the consequences of an autoimmune reaction. (3)

A

A hypersensitivity reaction is prompted, leading to tissue fibrosis that impairs function and will be unresponsive to treatment.

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5
Q

Name three autoimmune diseases that can be passed onto foetuses and present in the newborn. Explain why these can. (5)

A

Graves’ disease, SLE and DMII. These have autoantibodies that are IgG, so can be passed on to the baby through the placental circulation.

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6
Q

Name the self antigen, the result, the organ specificity and the type of hypersensitivity for: Hashimoto’s thyroiditis. (5)

A

Antigen: thyroid peroxidase and thyroglobulin
Result: hypothyroidism
Organ specific
Type of hypersensitivity: IV

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7
Q

Name the self antigen, the result, the organ specificity and the type of hypersensitivity for: DMI (4)

A

Antigen: pancreatic islet cells
Result: hyperglycaemia
Organ specific
Type of hypersensitivity: IV

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8
Q

Name the self antigen, the result, the organ specificity and the type of hypersensitivity for: Multiple Sclerosis (4)

A

Antigen: myelin sheath
Result: demyelination
Organ specific
Type of hypersensitivity: IV

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9
Q

Name the self antigen, the result, the organ specificity and the type of hypersensitivity for: Goodpasture’s Disease (5)

A

Antigen: glomerular / alveolar basement membrane
Result: glomerulonephritis
Organ specific
Type of hypersensitivity: II

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10
Q

Name the self antigen, the result, the organ specificity and the type of hypersensitivity for: Addison’s Disease (5)

A

Antigen: steroid-21 hydroxylase in adrenal cortex
Result: adrenal insufficiency
Organ specific
Type of hypersensitivity: unknown (II / IV)

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11
Q

Name the self antigen, the result, the organ specificity and the type of hypersensitivity for: Graves’ Disease (4)

A

Antigen: thyroid stimulating hormone receptor
Result: hyperthyroidism
Organ specific
Type of hypersensitivity: II

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12
Q

Name the self antigen, the result, the organ specificityand the type of hypersensitivity for: Myasthenia Gravis (4)

A

Antigen: acetylcholine receptors in neuromuscular junction
Result: skeletal muscle weakness
Organ specific
Type of hypersensitivity: II

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13
Q

Name the self antigen, the result, the organ specificity and the type of hypersensitivity for: Pernicious anaemia (4)

A

Antigen: intrinsic factor in the terminal ileum
Result: B12 deficiency
Organ specific
Type of hypersensitivity: II

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14
Q

Name the self antigen, the result, the organ specificity and the type of hypersensitivity for: Autoimmune haemolytic anaemia (4)

A

Antigen: red blood cell antigens
Result: anaemia
Not organ specific
Type of hypersensitivity: II

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15
Q

Name the self antigen, the result, the organ specificity and the type of hypersensitivity for: Rheumatoid arthritis (4)

A

Antigen: rheumatoid factor on IgG
Result: inflammatory arthritis
Not organ specific
Type of hypersensitivity: IV

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16
Q

Name the self antigen, the result, the organ specificity and the type of hypersensitivity for: SLE (5)

A

Antigen: dsDNA and histone proteins
Result: multisystem disease
Not organ specific
Type of hypersensitivity: III

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17
Q

Name the self antigen, the result, the organ specificity and the type of hypersensitivity for: Sjogens’ Syndrome (5)

A

Antigen: nuclear antigens
Result: dry eyes and mouth, arthritis
Not organ specific
Type of hypersensitivity: IV

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18
Q

Describe the six criteria for diagnosing autoimmunity. (6)

A

1 - presence of autoantibodies or autoreactive T cells.
2 - levels of autoantibodies correlate to disease severity.
3 - autoantibodies / autoreactive T cells are found at the site of tissue damage.
4 - transfer of autoantibodies or autoreactive T cell into a healthy host will induce the disease in the host.
5 - clinical benefit provided by immunomodulatory therapy.
6 - Family history

19
Q

Name four factors that increase the risk of developing autoimmune disease. (4)

A

Hormonal
Infectious
Drugs
Genetics.

20
Q

Describe the effects of hormones on the chances of developing an autoimmune disease. (3)

A

All autoimmune diseases are more common in women (esp SLE, Hashimoto’s, Graves). Suggests a link with oestrogen or prolactin.

21
Q

Describe the links between certain autoimmune diseases and infections. (6)

A

Strep pyogenes M protein and Rheumatoid arthritis
Campylobacter jejuni glycoproteins and Guillian-Barré
Coxsakieviruse nuclear protein and DMI.

22
Q

Describe the links between certain autoimmune diseases and drugs. (10)

A 
D penicilamine (used for RA) and SLE, glomerulonephritis, and myasthenia Gravis. 
Methyl-dopa (antihypertensive) and haemolytic anaemia 
Hydralazine (antihypertensive), procainamide (anti-arrythmic) and isoniazid (anti-TB) associated with SLE.
23
Q

Describe the types of autoantibody. Give two examples of each. (8)

A

Primary - autoantibody is responsible directly for the tissue damage - Graves’, myasthenia Gravis.
Secondary - autoantibody is associated with the disease but finding it is not diagnostic alone - SLE, RA.

24
Q

Describe the treatments of: Hashimoto’s thyroiditis

A

Replacement therapy - levothyroxine

25
Q

Describe the treatments of: DMI

A

Replacement therapy - insulin

26
Q

Describe the treatments of: Multiple Sclerosis

A

Anti-inflammatory drugs / MABs

27
Q

Describe the treatments of: Goodpasture’s Disease

A

Plasmapheresis

Dialysis

28
Q

Describe the treatments of: Addison’s Disease

A

Replacement therapy - aldosterone

29
Q

Describe the treatments of: Graves’ Disease

A

Anti-thyroid drugs (carbemazole)
Plasmapheresis
Surgery

30
Q

Describe the treatments of: Myasthenia Gravis

A

Acetylcholineesterase inhibitors

Immunosuppressants eg pyridostigmine

31
Q

Describe the treatments of: Pernicious anaemia

A

Replacement therapy - B12 injections

32
Q

Describe the treatments of: Autoimmune haemolytic anaemia

A

Anti-inflammatory drugs

Splenectomy

33
Q

Describe the treatments of: RA

A

Immunosuppression / MABs

34
Q

Describe the treatments of: SLE

A

Immunosuppression / MABs.

35
Q

Describe the occurrence of SLE. (3)

A

More common in women (ratio of 9:1)

Afro-Caribbean > south Asian > Caucasian

36
Q

Describe the symptoms characteristic of Lupus. (13)

A 
A RASH POINts Medical Diagnosis 
ANA positive 
Renal abnormalities 
Arthralgia / arthritis 
Serositis 
Haematological abnormalities 
Photosensitivity 
Oral ulcers
Immunological abnormalities 
Neurological abnormalities
Malar rash 
Discoid rash 
4 / 11 = SLE
37
Q

Describe the treatments available for SLE. (8)

A

Patient education - lifestyle modification, sunscreen use.
Start DMARDs - hydroxychloroquine, azathioprine.
Use steroids - prednisolone
In severe cases - IV cyclosphamide

38
Q

Describe the predisposing factors to getting Rheumatoid arthritis. (4)

A

Female : male = 3 : 1
No racial predilection
Genetic factors
Environmental factors - smoking, bad oral hygiene

39
Q

Describe the important things to focus on in a history about either SLE or RA. (10)

A

Pain, stiffness, swelling, patten of joints involved (often small joints of fingers).
Acute or chronic? Family history? Response to treatments?
Any secondary symptoms - skin, eyes, lungs, malaise, sweats, weight loss, poor appetite, fever.

40
Q

Describe the correct approach to examination of a patient with Lupus. (13)

A

The “Glove and Sweater” approach
Hands:
- Raynauds, joint pain/swelling, rash.
Torso:
- proximal muscle weakness, limb weakness
- hair loss, eye/mouth dryness, nose bleeds, ulcers, photosensitivity
- pleuritic chest pain, pericardial rub

41
Q

Describe the investigations you would do if suspecting Lupus. (4)

A

Routine bloods - FBC, U+E, LFT, CRP, creatinine.

Lupus bloods - antibodies against nucleus, dsDNA, phospholipids.

42
Q

Give one secondary symptom that is found in RA but not in SLE. (2)

A

Caplan’s Syndrome - lung nodules and RA.

43
Q

Describe the investigations you would do if RA was suspected. (5)

A

Routine bloods - FBC, U+E, LFT, CRP, creatinine.
RA bloods - Rheumatoid factor autoantibody, antineuclear.
X rays and USS of joints and chest.

44
Q

Describe the treatments available for RA. (4)

A

Combinations common.
DMARDs early - methotrexate, hydroxychloroquine.
Use of steroids: prednisolone

Maddie’s Immunity (4 decks)

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