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522 (dog & cat class) > Fever/Immune > Flashcards

Fever/Immune Flashcards

1
Q

what is the difference between fever and hyperthermia?

A

fever: raised thermoregulatory set point

hyperthermia: no alteration in thermoregulatory set point

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2
Q

what are the broad categories of disease that cause fever?

A

Neoplasia
Infection
Immune-mediated disease
Inflammation

NIII

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3
Q

what is a fever of unknown origin?

A
  • fever persists long enough that many common or self-limiting causes are ruled out
  • initial diagnostics do not reveal fever (hx, PE, CBC/chem/UA, imaging)
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4
Q

what are the steps to the initial approach for fevers?

A
  1. clinical signs: usually non-specific
  2. history + signalment
  3. PE: may help you localize
  4. diagnostics: look for focus of disease
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5
Q

autoimmune diseases are mostly mediated by what cells? why is this important to know?

A

Th2 cells and/or autoantibodies

  • autoantibody prod by lymphocytes
  • opsonized cells (marked for clearance)
  • inflammatory cytokines/chemokines

these are the treatment targets

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6
Q

what is the difference between primary and secondary autoimmune diseases?

A

primary: no underlying cause ID, dx of exclusion
secondary: underlying cause ID

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7
Q

what is systemic lupus erythematosus (SLE)?

A

multi-systemic autoimmune disorder, constituents of the cell nucleus, damage via opsonization, interference with cellular physiology, immune complexes

causes a wide range of presentations

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8
Q

what signalments are systemic lupus erythematosus (SLE) most common in?

A

middle-aged dogs (3-7 yrs)
GSD, Nova Scotia duck tollers, sheltie, collie, old English sheepdog, afghan hound, beagle, poodle, Irish setter

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9
Q

what are the most common presentations of SLE?

A
  • fever
  • lameness or joint swelling
  • proteinuria
  • cutaneous
  • lymphadenopathy
  • blood dycrasias
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10
Q

how do you dx SLE?

A

diagnosis of exclusion! rule out all other ddx first

Antinuclear Antibody Test (ANA)
- measures autoantibodies against DNA, RNA, histones in nucleus
- patients must have compatible signs!
- ELISA, FAT
- limitations

Lupid erythematosus (LE) cells
- neutrophils containing phagocytized nucleus
- not sensitive, but specific
- joint, pericardial, pleural, blister, peritoneal, CSF fluid

to diagnose, you need 2+ C/S and a +ANA, or 3+ C/S and a -ANA

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11
Q

what is the treatment for SLE?

A
  • immunosuppressive therapy
  • supportive care
  • adjunct therapy (based on cell lines/tissues involved)
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12
Q

what is the prognosis of SLE?

A

variable, relapse possible

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13
Q

what are the 4 types of non-inflammatory joint disease?

A

developmental joint disease, degenerative, trauma, tumor

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14
Q

what is inflammatory joint disease?

A

neutrophilic inflammation in the joints

can be septic or sterile

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15
Q

what are the two types of inflammatory joint disease?

A

infectious and immune-mediated

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16
Q

how do you tell the difference between an infectious or immune-mediated inflammatory joint disease based on clinical signs and presentation?

is this definitive?

A

septic more likely:
- single swollen/painful joint
- hx of sx or trauma of/near joint
- previous/current infection (hematogenous spread)

sterile more likely:
- multiple joints affected (often smaller/distal joints)
- hx of recent Abx or vaccination

NO NOT DEFINITIVE

17
Q

how can you tell FOR SURE whether an inflammatory joint disease is immune-mediated vs infectious?

A

sample those joints!!!

18
Q

when should you do joint fluid analysis?

A
  • solitary joint disease w/ signs of local inflammation or systemic illness
  • evidence of polyarthritis (pain, effusion, warmth)
  • fever of unknown origin
19
Q

tell me what normal joint fluid looks like

A

clear, colourless, viscous

cytology: low cellularity, mixture of mononuclear cells (macrophages, lymphocytes), <10% neutrophils

20
Q

tell me what abnormal joint fluid looks like

A

turbid/cloudy, discoloured, thin

cytology: high cellularity, >20% neutrophils, ± bacteria

21
Q

you have a cytology of joint fluid that you know came from an inflammatory joint diseased joint. how can you tell if it’s normal, sterile inflammatory, septic, or degenerative/traumatic?

A

normal: mostly mononuclear cells, occasional neutrophils <10%, low cellularity

sterile: mostly non-degen neutrophils, high cellularity

septic: degen neutrophils ± bac t, high cellularity

degen or trauma: mostly mononuclear cells, low or slightly increased cellularity

22
Q

what is the difference b/t erosive and non-erosive polyarthritis?

A

erosive has sub-chondral bone destruction

23
Q

what are the two categories of immune-mediated inflammatory joint disease?

A

erosive and non-erosive

24
Q

which is more common, erosive or non-erosive immune-mediated inflammatory joint disease?

A

non-erosive

25
Q

which is more common, primary or secondary non-erosive immune-mediated inflammatory joint disease?

A

primary

26
Q

what does IMPA stand for?

A

non-erosive immune-mediated polyarthritis

27
Q

what is non-erosive immune-mediated polyarthritis?

A

IMPA

immune-complex deposition in synovium (type 3 hypersensitivity)

28
Q

what are some causes of IMPA?

A

idiopathic (most common), SLE, reactive (secondary), other (breed-assoc, vaccine-assoc)

29
Q

who typically gets primary/idiopathic IMPA?

A

middle aged dogs

no sex or breed predilections

30
Q

what are the 4 types of secondary/reactive IMPA?

A
  • infectious (anywhere in body, but not in joint)
  • medications (Abx, vaccines)
  • neoplasia
  • dietary elements (uncommon)
31
Q

what are the IMPA C/S?

A

joint specific:
- lameness –> stiff gait or “walking on eggshells
- joint pain or swelling
- reluctance to move

nonspecific signs
polysystemic signs (derm, pallor/bleeding, ulcers)

less than 50% may be lame or have palpable joint effusion and are presented for vague signs of systemic illness

32
Q

how do you diagnose IMPA?

A
  • arthrocentesis: neutrophilic inflammation in multiple joints (non-degenerative), negative culture (always culture!!! urine or blood)
  • look for secondary or concurrent disease!! (PE, CBC/chem/UA, etc)
  • joint radiographs ±
  • SNAP 4Dx Plus or Accuplex (anaplasma, Borrelia, Erlichia, heartworm)

522 (dog & cat class) (31 decks)

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