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General Pathology > Chapter 4 > Flashcards

Chapter 4 Flashcards

1
Q

Hypersensitivity reactions

A

injurious immune reactions
inappropriate targeting or inadequate control
causes secondary tissue injury

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2
Q

Hypersensitivity reactions are caused by what 3 factors?

A

Autoimmunity, microbial reactions, environmental reactions

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3
Q

4 Types of Hypersensitivity reactions

A 
ACID
Type I: Allergies
Type II: Cytotoxic
Type III: Immune complex
Type IV: Delayed
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4
Q

Reactions to Harmless environmental antigens

A

Type I Hypersensitivity

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5
Q

Reaction categorized by:

  1. activation of Helper T cells
  2. Increased IgE antibody productions
  3. Mast cell deregulation (histamine)
A

Type I hypersensitivity

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6
Q

Deregulation of mast cells releases what?

A

Histamine

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7
Q

Release of histamine causes

A

vasodilation (edema), increase in mucous secretion, brochoconstriction

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8
Q

True or False. Type I hypersensitivity produces a local reaction

A

False, it can produce both a local reaction or a severe anaphylaxis

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9
Q

Type I hypersensitivity reactions take how long to manifest?

A

Minutes

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10
Q

Examples of Type I Hypersensitivity

A

Hay fever, hives, eczema, asthma, anaphylaxis

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11
Q

Type II Hypersensitivities cause…

A

opsonization (phagocytosis), inflammation, various non-injurious forms of dysfunction

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12
Q

Examples of Type II Hypersensitivities

A

ABO incompatibility, Acute Rheumatic Fever, Goodpasture Syndrome, Grave’s Disease

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13
Q

How do you diagnose Type II hypersensitivities?

A

Coombs’ test

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14
Q

Hypersensitivity reaction characterized by immune complex formation

A

Type III Hypersensitivity

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15
Q

Characterized by:

  1. Antigen exposure (IgG production)
  2. Antigen-antibody complexes go into tissues
  3. Complement activation causes inflammation
A

Type III Hypersensitivity

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16
Q

Inflammation of vessel walls, kidneys, and joints

A

Local complement activation from Type III Hypersensitivity

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17
Q

Fever, Arthritis, Vasculitis, Proteinuria, Lymphadenopathy

A

Systemic complement activation from type III Hypersensitivity

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18
Q

Examples of Type III Hypersensitivities

A

Lupus (SLE), Polyarteritis Nodosa (PAN), Reactive Arthritis (Reiter Syndrome), Serum Sickness

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19
Q

Immune complexes

A

deposited into vessel walls

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20
Q

Immune complexes cause tissue damage including ___

A

Fibrinoid Necrosis

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21
Q

Amount of time after exposure that Antigen-antibody complexes deposit into tissues?

A

5-10 days

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22
Q

T-Cell mediated inflammation

AKA “delayed” antibody independent

A

Type IV Hypersensitivity

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23
Q

Two types of Type IV hypersensitivity

A

Cytokine-mediated

Direct Cytotoxicity

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24
Q

Cytokine mediated type IV hypersensitivity

A

Involves CD4+ T cells
activates neutrophils and macrophages
can commonly progress into chronicity

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25
Q

Direct cytotoxicity type IV hypersensitivity

A

CD8+ T cells attack antigenic cells
Protease –> damage or apoptosis
delayed reaction, possible granuloma formation
e.g. poison ivy, TB, MS, Type 1 diabetes

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26
Q

Failed self-tolerance = self-reactive T & B cells

A

Autoimmune disorder

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27
Q

Central tolerance

A

apoptosis in thymus or marrow

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28
Q

Peripheral tolerance

A

inactivation or apoptosis of T & B cells

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29
Q

Prime targets of autoimmune tissue damage

A

connective tissue & vessels

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30
Q

Genetic factor associated with autoimmune

A

HLA alleles

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31
Q

HLA alleles

A

locus on genes on chromosome 6

regulate immune system by encoding for antigen-presenting proteins

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32
Q

these special T cells are able to present antigens to other cells to stimulate specific antibody production

A

T cells that have HLA genes

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33
Q

If someone comes back with a positive ANA test, they most likely have _____

A

Lupus

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34
Q

lupus is most common in what demographic?

A

African American women of childbearing age

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35
Q

Autoantibody-mediated tissue injury

A

autoantibodies against various cells (type II)

immune complex deposition (type III)

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36
Q

Lupus causes vessel injury by:

A

increasing risk of thrombosis with
fibrinoid necrosis
acute necrotizing vasculitis
intimal thickening

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37
Q

Lupus causes renal failure by:

A

Glomerulonephritis
characterized by proteinuria, hematouria, and urinary red blood cell casts which can pass through the glomerulus if it is damaged

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38
Q

Lupus can only be diagnosed if the patient presents with at least _ out of 11 of the criteria

A

4

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39
Q

photosensitivity caused by lupus can present as

A 
Malar rash (butterfly)
Discoid rash (erythema, raised, scaling)
dermoepidermal degeneration caused by IgG deposits
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40
Q

serositis caused by lupus can present as:

A

pluritis or pericarditis

atypical chest pain

41
Q

This causes verrucous (wart-like) vegetations on the mitral valve and is a symptom of lupus

A

Libman-Sacks Endocarditis

42
Q

Pancytopenia

A

decrease in red blood cells, white blood cells, and platelets

43
Q

Risks for developing Lupus

A

sex hormones (estrogen - hormone replacement therapy), UV light, smoking, infections

44
Q

most common causes of death in lupus patients are:

A

renal failure, coronary artery disease, infection due to pancytopenia

45
Q

Having lupus puts you at an increased risk for this type of cancer

A

B cell lymphoma

46
Q

Sjogren Syndrome

A

CD4+ T cells (Type IV) unknown antigen

damage ductal epithelial cells

47
Q

Sjogren syndrome can cause damage in these two glands most commonly

A

Lacrimal and salivary

48
Q

Lacrimal gland destruction

A

called keratoconjunctivitis sicca

dry eyes –> inflammation, erosion, ulceration

49
Q

Salivary gland destrution

A

called xerostomia

dry mouth –> fissuring, ulcerations

50
Q

Sjogren syndrome can less commonly affect

A

vagina, nasopharynx (laryngitis), upper airways (bronchitis), kidneys, CNS, Muscles

51
Q

Diagnosis for Sjogren syndrome

A

+ ANA

52
Q

Isolated Sjogren syndrome

A

Sicca syndrome

53
Q

Sjogren can be secondary to what autoimmune disorder most commonly

A

RA

54
Q

Age range for women to develop Sjogren

A

35-45 years

55
Q

Sjogren increases risk by 40x for this cancer

A

B cell lymphoma

56
Q

Systemic Sclerosis (scleroderma)

A

extensive fibrosis in multiple tissues

vascular destruction of small arteries

57
Q

Systemic sclerosis most commonly is found in what demographic?

A

Women age 40-60

58
Q

Limited Systemic sclerosis

A

CREST Syndrome

59
Q

CREST syndrome

A

Calcinoisis, Raynaud, esophageal dismotility (fibrosis of lower 2/3), sclerodactyly (hard, eroded skin), telangiectasia (spider veins)

60
Q

diffuse systemic sclerosis

A

rapid/widespread skin involvement, early visceral involvement, aggressive

61
Q

Congenital immune deficiency disorders

A

rare, early onset

62
Q

X-linked agammaglobulinemia

A 
Bruton disease
6 months male
failed B cell maturation
bacterial/viral infections: otitis media, pharygitis, sinusitis
treatable with IgG infusions
63
Q

Common variable immunodeficiency

A

decreased antibody response to infection
normal B cells, no plasma cells
increased GI infections
increased risk for autoimmunity

64
Q

Isolated IgA deficiency

A

decrease IgA production in mucous membranes
can be asymptomatic
recurrent URTIs or Diarrhea
very common in caucasians

65
Q

Hyper-IgM syndrome

A

High or nomral IgM
Low IgG, IgA, IgE
recurrent pyogenic bacterial infections
70% are x linked (male)

66
Q

severe combined immunodeficiency

A

bubble boy
lyphopenia (low T & B cells) & lymphoid atrophy
highly vulnerable to all microbial infections
most common among Native Americans

67
Q

Examples of secondary immunodeficiency

A

infection, malnutrition, aging, cancer

Therapy-induced immunosuppression (MC)

68
Q

Mechanisms of acquired immunodeficiency

A

suppression of marrow

lymphocyte dysfunction

69
Q

AIDS

A

caused by HIV

destroys CD4+ T cells & macrophages via apoptosis or cytotoxicity

70
Q

screening for HIV in blood transfusions

A

p24 antigen via ELISA or western blot

71
Q

HIV resistance gene

A

CCR5

72
Q

Stages of AIDS

A

Acute, Chronic, Crisis

73
Q

Acute stage AIDS

A

pyrexia, pharygitis, myalgia, viremia
~3-6 weeks after infection
decreased viremia after 12 weeks

74
Q

Chronic stage AIDS

A

2-10 years after infection
MC general lymphadenopathy
steady decline of CD4+ T cells, steady incline of viral load
infections: candidiasis, VZV

75
Q

Crisis stage AIDS

A

1mo), diarrhea, weight loss, CNS defects

opportunistic infections & neoplasms

76
Q

Cachexia

A

loss of lean muscle mass

77
Q

common opportunistic neoplasms in crisis stage AIDS

A

Kaposi sarcoma, Burkitt Lymphoma, Primary CNS lymphoma, Cervical cancer

78
Q

Ontogenic viruses

A

Kaposi sarcoma herpes virus, Epstein barr virus, HPV

79
Q

Amyloidosis is caused by (2)

A
  1. many inflammatory or inherited conditions

2. failed phagocytosis

80
Q

Amyloid

A

non-branching fibrillar proteins

81
Q

Test for Amyloidosis

A

Congo Red Dye = apple-green birefringence

tissue biopsy, serum & urine

82
Q

Three types of Amyloid protiens

A
  1. Amyloid Light (AL)
  2. Amyloid Associated (AA)
  3. β-amyloid (Aβ)
83
Q

Amyloid Light (AL)

A

B Cell proliferation: plasma cells (multiple myeloma)

immunoglobulin light chains, Bence-Jones protiens

84
Q

Amyloid-Associated (AA)

A

Liver: Serum-Associated Amyloid (SAA)

Chronic inflammation: TB, RA, Ankylosing spondylitis, IBD, osteomyelitis

85
Q

β-Amyloid (Aβ)

A

amyloid precursor protein: cerebral plaques

alzheimer disease

86
Q

People with Down Syndrome have a 100% chance of developing ________ by age 40, why?

A

Alzheimer Disease due to the multiplication of the genes that are in charge of amyloid production

87
Q

Primary Systemic Amyloidosis

A 
(MC) malignant plasma cells
AL proteins (multiple myeloma)
88
Q

Secondary (reactive) Systemic Amyloidosis

A

Chronic inflammation

AA proteins

89
Q

Aging Associated Systemic Amyloidosis

A

Elderly Patients, Senile Systemic Amyloidosis

90
Q

Localized Amyloidosis

A

single organ/tissue

AL proteins

91
Q

Localized Amyloidosis in tongue

A

macroglossia

92
Q

Localized Amyloidosis in kidney

A

enlarged, pale, firm, decreased function

most common organ associated, very severe

93
Q

Localized Amyloidosis in Brain

A

Aβ plaques, Alzheimer Disease

94
Q

Localized Amyloidosis in Spleen

A

Splenomegaly, firm, decreased function

95
Q

Localized Amyloidosis in Liver

A

massive hepatomegaly, pale, decreased function

96
Q

Localized Amyloidosis in Heart

A

Cardiomegaly, decreased function

Restrictive Cardiomyopathy

97
Q

Localized Amyloidosis in Wrist Ligaments

A

Carpal tunnel syndrome
Seen in patients on long term dialysis since the Amyloid proteins are not completely filtered out and can accumulate in the body

98
Q

Amyloidosis is most likely to be lethal if it involves

A

Kidney or heart

99
Q

Prognosis of amyloidosis

A

1-3 years post diagnosis

worse if associated with multiple myeloma

General Pathology (6 decks)

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