BASIC SCIENCES Flashcards
What are the 5 types of hypersensitivity reactions?
clue: ACIDS
Type I Allergic
Type II Cytotoxic/Antibody mediated
Type III Immune complex IgG/IgM mediated
Type IV Delayed/Cell mediated
Type V Antibodies bind to cell surface receptors either stimulating or blocking them
Examples of Type 1 hypersnesitivity reactions
IgE mediated
Anaphylaxis
Atopy (eg asthma, hayfever, eczema)
(Diagnosed by plasma tryptase)
Examples of type II Hypersensitivity reactions
Mediated by IgG or IgM on cell surfaces
Clue: PAIR GAP
Pemphigous vulgaris/bullous pemphigoid
Autoimmune haemolytic anaemia
ITP
Rheumatic fever
Goodpasteure’s syndrome
Acute haemolytic transfusion reactions
Pernicious anaemia
Examples of type 3 Hypersenitivity reactions
Free antigen and antibody (IgG,IgA) combine (immune complex deposition)
Clue: PESS
Post-streptococcal glomerulonephritis
Extrinsic allergic alveolitis (espescially the acute phase)
Serum sickness
SLE
Examples of type 4 hypersensitivity reactions
T cell mediated (cell mediated)
Clue: T G(2)AMES
Tuberculosis
Graft versus host disease
Gullain-Barre syndrome
Allergic contact dermatitis
Multiple sclerosis
Extrinsic allergic alveolitis (espescially the chronic phase)
Scabies
Type 5 hypersensitivity reactions examples
Antibodies that recognise and bind to the cell surface receptors. This is either stimulating them or blocking ligand binding
Clue: type V
GraVes disease
Myasthenia GraVis
type of hypersensitivity reaction Atopy (eczema, asthma, hayfever)
Type 1
what type of hypersensitivity reaction is anaphylaxis
Type 1
Type of hypersensitivity reaction Autominautoimmune haemolytic anaemia
Type 2
Type of hypersensitivity reaction ITP
type 2
Type of hypersensitivity reaction Goodpasteure syndrome
Type 2
Type of hypersensitivity reaction Pernicious anaemia
type 2
Type of hypersensitivity reaction Acute haemolytic transfusion reactions
Type 2
Type of hypersensitivity reaction rheumatic fever
type 2
Type of hypersensitivity reaction Pemphigus vulgaris/bullous pemphigoid
Type 2
Type of hypersensitivity reaction Serum sickness
Type 3- immune complex mediated
Type of hypersensitivity reaction SLE
Type 3 hypersensitivity reaction -immune complex mediated
Type of hypersensitivity reaction Post-streptococcal glomerulonephritis
Type 3 -immune complex mediated
Type of hypersensitivity reaction Extrinsic allergic alveolitis
Type 3 (immune complex mediated) espescially in the acute phase
Type 4 (cell mediated) espescially in the chronic phase
Type of hypersensitivity reaction Tuberculosis/tuberculin skin reaction
Type 4 (cell mediated)
Type of hypersensitivity reactionGraft versus host disease
Type 4 (cell mediated)
Allergic contact dermatitis
Type 4 (cell mediated)
Type of hypersensitivity reaction Scabies
Type 4 (cell mediated)
Type of hypersensitivity reaction Multiple sclerosis
Type 4
Type of hypersensitivity reaction Gullain-Barre syndrome
Type 4 (cell mediated)
Type of hypersensitivity reaction Myasthenia Gravis
Type 5 hypersensitivity
Antibodies that recognise and bind to ceel surface receptors. This is either stimulating them or blocking them.
Grave’s disease
Type 5 hypersensitivity reaction
Antibodies that recognise and bind to the cell surface receptors. This is either stimulating them or blocking ligand binding
What is the hallmark sign ofmast cell degranulation?
Classical wheal and flare
HLA association of Haemochromatosis
HLA-A3
HLA Association of Behcet’s disease HLA B51 is a split of B5
HLA-B5
21 Hydroxylase deficiency
HLA-B47
Psoriasis
HLA-CW6
HLA type in T1 DM
HLA-DR3 + HLA-DR4 (but more with HLA-DR4)
HLA type in Steroid responsive nephrotic syndrome
HLA-DR7
HLA type in Narcolepsy
HLA DR2
HLA type in Goodpasteure’s syndrome
HLA-DR2
Autoimmune hepatitis
HLA-DR3
HLA type in Primary Biliary Cirrhosis
HLA-DR3
HLA type in Dermatitis herpetiformis
HLA-DR3
HLA type in Coeliac disease (95% associated with HLA DQ2)
HLA-DR3
HLA type in rheumatoid arthritis
HLA-DR3
HLA type in What is Felty’s syndrome
Triad of rheumatoid arthritis, splenomegally and neutropenia
More strongly (thanregular rheumatoid arthritis) with (95%) HLA-DR4
Function of CD1
HLA molecule that presents lipid molecules
Function of CD2
Found on thymocytes, T cells, and some natural killer cell that act as ligand for CD58 and CD59 and is involved in signal transduction and cell adhesion molecules
Function of CD3
The signalling component of the T cell receptor
Function of CD4
Co-receptor for HLA type 2
Also a receptor used by HIV to enter cells
Function of CD8
Co-receptor for HLA class 1;
Also found on a subset of myeloid dendritic
In Diffuse systemic sclerosis the specifc Ab anti-RNA Polymerase III is associated with increased risk of which 3 conditions?
1) Rapidly progressive Diffuse skin thickening,
2) sclerodermic renal crisis,
3) Gastric antral vascular ectasia (GAVE) disease
Which Ab may cause neonatal lupus and congenital heart block
anti-Ro (SSA)
2nd most specific ab for SLE (after anti-Smith)
anti-DSNA
Which Ab is most associated with neuropsychiatric manifestations of SLE
anti-ribosomal P
Which Ab is most associated with lupus nephritis
anti-DSNA
In diffuse systemic scleroderma anti-Scl-70 is associated with increased risk of……
Interstitial lung disease
(risk is increased even in limited disease if this antibody is present)
In Diffuse systemic scleroderma the anti-U3 RNP antibody is associated with……… (COMPP)
Cariomyopathy
early severe Organ involvement
Myopathy
Pulmonary HTN
episodes of Pseudo-obstruction and malabsorption
Most specific ab for SLE
anti-Smith ab
In limited SSc and scleroderma sine scleroderma (ssSSc) the anti-centromere Ab is associated with…..
1) Pulmonary HTN
2) Oesophageal Involvement
nb Interstitial lung disease, cardiomyopathy and scleroderma renal crisis are rare
what is overlap syndrome?
= Mixed Connective Tissue Disease + Scleromyositis
“Overlap syndromes” refers to a diverse group of conditions that have clinical features of, and meet classification criteria for, more than 1 well-characterized rheumatic disease. They usually present subacutely with clinical manifestations that can include different organ systems.
A rheumatological disorder with features suggestive of several kinds of connective tissue disease, but not definitively diagnostic of any single syndrome
Regarding Overlap syndrome anti U1RNP is associated with MIXED CONNECTIVE TISSUE DISEASE. what are its features….. (early and 3 late)
Early: non-specific general malaise, athralgias, myalgias, low grade fever
Later:
1) Raynaud’s phenomenon. Puffy hands
2) Severe non-erosive arthritis
3) Pulmonary HTN (without interstitial lung disease)
nb in contrast to SLE CNS involvement is rare
Cut off for significant ANA antibodies
1:160
Which Ab is most associated with drug induced lupus
anti-histone antibodies
In overlap syndrome - Scleromyositis is associated with anti PM/Scl. What are it’s clinical features…..
1) Arthritis and myositis
2) Raynaud’s disease
3) Benign course and good response to steroid
4) ILD
nb cardiac and renal involvement is rare
which Ab is most associated with subacute cutaneous Lupus (SCLE)
anti-Ro (SSA)
Regarding Idiopathic inflammatory myositis specific antibodies pp307: Anti-aminoacyl-tRNA (antisynthase) is associated with which autoantibodies directed against aminoacyl-tRNA synthetases:
anti Jo 1 (75% of all the antisynthetases), PL-7, PL-12 etc
systemic sclerosis 90-95% are ANA +ve. Which specific 3 Abs are associated with Limited Sclerosis
1) Anti-centromere, 2) anti-Th/To, 3) anti-U11/U12RNP
which Ab is most related to disease activity in SLE
anti-DSNA
Main clinical features of Antisynthetase syndrome ( a rare inflammatory disease related to dermatomyositis and polymyositis)…….. (MP FIRM)
Myositis,
polyarthritis,
Fever,
Interstitial lung disease,
Raynaud’s phenomenon,
Mechanic’s hands
which Ab is associated with primary Sjogren’s syndrome
anti-La (SSB)
classic Dermatomyositis is associated with which auto-antibody….
Anti Mi-2 (present in 18-35% of patients)
Regarding Overlap syndrome anti U1RNP is associated with MIXED CONNECTIVE TISSUE DISEASE. what are its features….. (early and 3 late)
Early: non-specific general malaise, athralgias, myalgias, low grade fever
Later:
1) Raynaud’s phenomenon. Puffy hands
2) Severe non-erosive arthritis
3) Pulmonary HTN (without interstitial lung disease)
nb in contrast to SLE CNS involvement is rare
Skin features of dermatomyositis (pp307)….
Photosensitive
Macular rash over back and shoulder
Heliotrope rash over cheek
Gottron’s papules- roughened red plaques over extensor surfaces of the fingers
Nail fold capillary dilatation
most sensitive ab for SLE (if negative highly unlikely SLE is right dx)
ANA
Regarding SLE AntiDSDNA I assocociated with
1) close relation to disease activity
2) lupus nephritis
Which Ab is most associated with Libman-Sacks endocarditis
anti-beta-2 glycoprotein 1
In Diffuse systemic scleroderma the anti-U3 RNP antibody is associated with……… (COMPP)
Cariomyopathy
early severe Organ involvement
Myopathy
Pulmonary HTN
episodes of Pseudo-obstruction and malabsorption
In limited SSc and scleroderma sine scleroderma (ssSSc) the anti-centromere Ab is associated with…..
1) Pulmonary HTN
2) Oesophageal Involvement
nb Interstitial lung disease, cardiomyopathy and scleroderma renal crisis are rare
what is autoimmune necrotising myopathy………..
Anti-SRP (signal recognition particle) antibody (Ab) related myositis is a group of necrotizing myositis with rapidly progressive, severe, proximal muscle weakness followed by atrophy of affected muscles and extremely high creatine phosphokinase (CPK) levels at presentation. The histology of muscle biopsy reveals that it has sparse inflammatory infiltrate, but significant muscle necrosis and endomysial capillary involvement
systemic sclerosis 90-95% are ANA +ve. Which specific Abs are associated with Diffuse scleroderma
1) anti-Scl-70 (75% of pts), 2) anti RNA polymerase III, 3) anti U3 RNP
which autoantibody is associated with autoimmune necrotising myopathy
anti-SRP
In overlap syndrome - Scleromyositis is associated with anti PM/Scl. What are it’s clinical features…..
1) Arthritis and myositis
2) Raynaud’s disease
3) Benign course and good response to steroid
4) ILD
nb cardiac and renal involvement is rare
Regarding Idiopathic inflammatory myositis specific antibodies pp307: Anti-aminoacyl-tRNA (antisynthase) is associated with which autoantibodies directed against aminoacyl-tRNA synthetases:
anti Jo 1 (75% of all the antisynthetases), PL-7, PL-12 etc
Which myositis specific antibody is associated with increased risk of ILD….
anti Jo1
which myositis specific antibodies are associated with overlap syndromes with muscular involvement…….
Anti-Pm-Scl, (?U1/U2RNP), Ku, SnRNP, Ro, La
which myositis specific antibody is associated with autoimmune myositis…..
anti TIF1-gamma
Main clinical features of Antisynthetase syndrome ( a rare inflammatory disease related to dermatomyositis and polymyositis)…….. (MP FIRM)
Myositis,
polyarthritis,
Fever,
Interstitial lung disease,
Raynaud’s phenomenon,
Mechanic’s hands
classic Dermatomyositis is associated with which auto-antibody….
Anti Mi-2 (present in 18-35% of patients)
which myositis specific antibody is associated with inclusion body myositis…..
anti cN1A
Which autoantibody is most specific for autoimmune hepatitis….
anti-smooth muscle antibody (anti SMA)
Anti-liver/kidney microsome type 1 (LKM-1) auto-antibody is associated with which disease…
Autoimmune hepatitis
Skin features of dermatomyositis (pp307)….
Photosensitive
Macular rash over back and shoulder
Heliotrope rash over cheek
Gottron’s papules- roughened red plaques over extensor surfaces of the fingers
Nail fold capillary dilatation
Autoimmune hepatitis is characteristically associated with elevated levels of which class of immunoglobulin….
Ig G
Primary Biliary Cholangitis is associated with which autoantibody?
anti-mitochondrial antibody (AMA)
What is the target of the anti-mitochondrial antibody in primary biliary cholangitis…
pyruvate dehydrogenase complex
What is the immunological association of ulcerative colitis?
pANCA antigen
Regarding SLE AntiDSDNA I assocociated with
1) close relation to disease activity
2) lupus nephritis
what is autoimmune necrotising myopathy………..
Anti-SRP (signal recognition particle) antibody (Ab) related myositis is a group of necrotizing myositis with rapidly progressive, severe, proximal muscle weakness followed by atrophy of affected muscles and extremely high creatine phosphokinase (CPK) levels at presentation. The histology of muscle biopsy reveals that it has sparse inflammatory infiltrate, but significant muscle necrosis and endomysial capillary involvement
What is the immunological association of Crohn’s disease?
ASCA (anti-saccharomyces Cerevisiae antibodies)
which autoantibody is associated with autoimmune necrotising myopathy
anti-SRP
which myositis specific antibody is associated with autoimmune myositis…..
anti TIF1-gamma
Antibodies in Coeliac Disease…
first line for dx: Tissue transglutaminase (TTG) antibodies (Ig A)
Anti-casein antibodies are also found in some patients
nb Anti-gliadin antibody (IgA or IgG) are NOT recommended by NICE
which myositis specific antibodies are associated with overlap syndromes with muscular involvement…….
Anti-Pm-Scl, (?U1/U2RNP), Ku, SnRNP, Ro, La
Helper T cells expresse CD4 and
also expresses CD3, TCR & CD28.
They produce IL2.
How do they recognize antigen?
