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RB Y1 Respiratory > hypersensitivity > Flashcards

hypersensitivity Flashcards

1
Q

type 1 hypersensitivity reaction

A

allergic - immediate

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2
Q

what is the definition of allergy

A

IgE mediated antibody response to an external antigen

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3
Q

what is the hypothesis for the reason of inc prevalence of allergy

A

hygiene hypothesis

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4
Q

where do mast cells reside

A

tissues

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5
Q

what preformed substances do mast cells produce

A

histamine, tryptase and heparin

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6
Q

what substances do mast cells synthesise on demand

A

Leukotrienes, prostaglandins, cytokines including IL4 and TNF

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7
Q

what effect do mast cells have

A

inflammatory cascade

  • inc blood flow
  • SM contraction
  • inc vascular permeability
  • inc secretions at mucosal surface
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8
Q

what are the functions of mast cells

A

important in defence against parasites, and wound healing

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9
Q

what receptors do mast cells express

A

Fc receptor

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10
Q

what is extrinsic asthma

A

response to external antigen

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11
Q

what is extrinsic asthma mediated by

A

IgE

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12
Q

what is the clinical manifestation of bronchoconstriction

A

wheeze

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13
Q

what is the clinical manifestation of mucosal oedema and inc secretion

A

sputum production

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14
Q

why is sputum often yellow

A

Infiltration of lymphocytes and eosinophils into bronchioles

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15
Q

what are some other names for urticaria

A

hives
nettle rash
blisters

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16
Q

what is angioedema

A

Self-limited, localised swelling of subcutaneous tissues or mucous membranes

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17
Q

is angioedema pitting oedema

A

no

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18
Q

CF of anaphlaxis

A 
sense of impending doom 
hypotension 
urticaria 
itch
diarrhoea and abdo pain 
arrhythmia 
flush and sweat
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19
Q

can mast cells degranulate spontaneously

A

yes

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20
Q

what can u get urticaria in response to

A

pressure or heat

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21
Q

what drugs can cause mast cell degranulation

A

morphine and other opiates

aspirin and NSAIDs

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22
Q

what is samters triad

A

asthma, nasal polyps and salicylate sensitivity

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23
Q

what is aspirin induced asthma treated with

A

CysLt receptor antagonists

eg montelukast

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24
Q

what is aspirin indued asthma triggered by

A

aspirin and also other classical NSIDs (diclofenac and ibuprofen)

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25
Q

how would you test for anaphylaxis

A

evidence of mast cell degranulation - serum tryptase

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26
Q

what is the gold standard test for support a allergy diagnosis

A

skin prick test

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27
Q

what should be stopped 48 hours before a skinprick test

A

antihistamines

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28
Q

what other allergy investigations are available

A

specific IgE test and challenge test

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29
Q

specific IgE test

A

measure amount of IgE in serum against specific allergen

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30
Q

is total IgE useful in the diagnosis of allergic disease

A

no

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31
Q

in anaphylaxis what is the rise in tryptase proportional to

A

the drop in BP

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32
Q

what is sodium cromoglycate

A

a mast cell stabiliser

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33
Q

how is sodium cromoglycate used

A

topical spray

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34
Q

who is sodium cromoglycate used in

A

kids especially

35
Q

what is symbicort

A

budesonide and formoterol

36
Q

what is serotide

A

fluticasone and salmeterol

37
Q

what is anaphylaxis managed with

A

self injectable adrenaline

38
Q

what effect does adrenaline have

A

act on B2 ADR to constrict arterial SM

  • inc BP there by limiting vascular leakage
  • dilates bronchial SM thereby dec airflow obstruction
39
Q

what is immunotherapy

A

controlled exposure to inc amounts of allergen

40
Q

what are type II hypersensitivity reactions

A

direct cell killing

41
Q

type II hypersensitivity

A

antibody binds to cell surface antigen activating complement and causing opsonisation

42
Q

type II hypersensitivity - what do B cells produce

A

IgM or IgG antibody against membrane protein - bind to cell surface antigen

43
Q

what is involved in the classical complement pathway

A

CI 2 and 4

44
Q

what is the main complement pathway thing

A

C3

45
Q

what does C3 activate

A

MAC

46
Q

what can MAC do

A

direct killing of encapsulated bacteria by punching holes in bacterial cell membranes

47
Q

what does C3 do - 3 things

A

chemotaxis
solubilisation of immune complexes
opsonisation

48
Q

chemotaxis

A

inc vascular permeability inc the traffic of ells to the site of infection

49
Q

what do opsonins act as

A

bridge between pathogen and receptor

50
Q

what can complement fragments act as

A

opsonins - C3b

51
Q

what is an example of type II hypersensitivity

A

transfusion ABO reaction

52
Q

what is immediate haemolytic transfusion reaction

A

overwhelming systemic inflammatory response

53
Q

what is autoimmune haemolytic anaemia

A

antibodies bind to red cells

54
Q

what is Idiopathic thrombocytopaenic purpura

A

antibodies bind to platelets

55
Q

what is goodpastures syndrome

A

antibodies bind to glomerular basement membrane

56
Q

what is myasthenia gravis

A

antibodies bind to ACh receptor

57
Q

what is guillan barré

A

antibodies bind to perisperhal nerve glycoprotein

58
Q

what is graves disease

A

antibodies bind o TSH receptor

59
Q

what is pemphigus vulgaris

A

antibodies bind to epithelial cell cement

60
Q

what diseases may be transferred to neonate

A

myasthenia gravis, idiopathic thrombocytopaenic purpura, Rhesus disease

61
Q

how do u manage type II hypersensitivity reactions

A

plasmapheresis - removal of pathogenic antibody

62
Q

what is type III hypersensitivity reaction

A

immune complex mediated

63
Q

type III hypersensitivity reaction

A

generalised reaction resulting from immune complex deposition in blood vessel walls, skin joints and glomeruli where they cause a chronic inflammatory response

64
Q

III hypersensitivity reaction example

A

farmers lung

65
Q

what are the agents of farmers lung

A

Aspergillus fumigatus

Micropolyspora faeni

66
Q

what are the agents in bird fanciers lung

A

Avian serum proteins

67
Q

what are the agents in malt workers lung

A

aspergillus clavatus

68
Q

what are the agents in cheese workers lung

A

Aseprgillus clavatus

Penicillum casei

69
Q

what are the agents in maple bark strippers lung

A

Cryptostroma corticale

70
Q

what causes breathlessness in hypersensitivity pneumonitis

A

Alveolitis, caused by activated phagocytes and complement – results in decreased efficiency of gas transfer

71
Q

what is SLE

A

antibodies produced against the contents of cell nuclei, form immune complexes which are deposited etc

72
Q

what does complex deposition in joints result in

A

arthralgia

73
Q

what does deposition of IgG immune complexes in glomeruli cause

A

renal dysfunction

74
Q

what does immune complex in skin cause

A

vasculitic purpura

75
Q

how do u diagnose type III reactions

A

specific IgG to putative antigen

76
Q

how does one manage type III reactions

A

dec inflammation - corticosteroids

dec antibody production - IS

77
Q

type IV

A

delayed

78
Q

what cell mediates type IV

A

T cell

79
Q

what is the pathophysiology of type IV

A

initial sensitisation to antigen primes the T cells

subsequent exposure activates the primed T cells which recruit other cells and release enzymes

80
Q

an example of type IV

A

nickel hypersensitivity

81
Q

non autoimmune type IV diseases

A

TB, sarcoidosis, leprosy, cellular rejection of solid organ transplant

82
Q

autoimmune type IV diseases

A

diabetes, psoriasis, rheumatoid arthritis

83
Q

what is a granuloma

A

organised collection of activated macrophages and lymphocytes

RB Y1 Respiratory (33 decks)

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