hypersensitivity

Question 1

What are the steps of Type I Immediate hypersensitivity?

Answer 1

Step 1: Antigen exposure
Step 2: IgE cross-linking on mast cell/basophil surfaces
Step 3: Histamine, leukotriene, prostaglandin, tryptase (mediators) release
Step 4: Symptoms of urticaria, rhinitis, wheezing, diarrhea, vomiting, hypotension, and anaphylaxis within minutes of exposure
May have symptom return 4-8 hours after exposure Example: Pollen allergies, dust mite allergy, bee sting

Question 2

6 year old male presents in early spring with rhinitis and sneezing x 1 week. No fevers or sick contacts.

What is your diagnosis? How would you treat?

Answer 2

Allergic Rhinitis

Treat with antihistamines

Question 3

Why do you treat a type I hypersensitivity with antihistamines?

Answer 3

Because of the intense release of histamines from the mast cells

Question 4

In a type 2 hypersensitivity, what are the 3 ways in which IgM and IgG destroy cells?

Answer 4

Opsonization

Complement mediated lysis

Antibody-dependent cellular cytotoxicity

Question 5

What are examples of type II hypersensitivity?

Answer 5

ABO mismatch, Grave’s disease, Myasthenia Gravis

Question 6

25 year old female comes in with complaint of fatigue and blurry vision.
Ptosis on exam.

What is the diagnosis?

Answer 6

Myasthenia gravis (antibodies to acetylcholine receptor
which prevents acetylcholine from binding)

Question 7

How do you treat myasthenia graves?

Answer 7

Acetylcholinesterase inhibitors

plasmapheresis

Question 8

What is type II hypersensitivity?

Answer 8

IgM or IgG antibodies cause destruction to the cells

Question 9

What are the steps of a type III hypersensitivity?

Answer 9

Step 1: Antigen-antibody complex formation
Step 2: Complexes activate complement and neutrophil infiltration
of tissue
Step 3: Tissue inflammation leading to symptoms of fever, urticaria, generalized lymphadenopathy, arthritis, glomerulonephritis, vasculitis

Question 10

What are some examples of Type III hypersensitivity?

Answer 10

Systemic Lupus Erythematosus, Rheumatoid Arthritis, Farmer’s Lung

Question 11

58 year old male presents in the afternoon with fever, chills, cough, chest tightness, and shortness of breath. He notes no symptoms this morning while doing his normal farming chores.
Crackles on lung exam.
CXR normal.

What is likely the diagnosis?

Answer 11

Farmers lung

treat with supportive care and avoidance of antigens

Question 12

What is type III hypersensitivity?

Answer 12

immune complexes (antigen+antibody) activate pathways that lead to clinical symptoms.

Question 13

What are the steps of Type IV cell mediated hypersensitivity

Answer 13

Step 1: Antigen exposure activates sensitized T-cells

Step 2: T-cell activation leads to tissue inflammation 48-96 hours
after exposure to antigen

Question 14

Poison Ivy and PPD testing for TB are examples of which type of hypersensitivity?

Answer 14

Type IV

Question 15

How do you treat poison ivy?

Answer 15

Steroids

Question 16

True or false: Rheumatoid arthritis effects more males than females

Answer 16

FALSE more ladies than men

Question 17

_____ _____ is a Systemic inflammatory disease affecting synovial membranes because granulation tissues develops in joint spaces and erodes into articular cartilage and bone

Answer 17

Rheumatoid arthritis

Question 18

What are some of the presenting symptoms with RA?

Answer 18

Joint swelling
warmth
erythema
decreased ROM

morning joint stiffness

Question 19

What are the most common joints that are affected in RA?

Answer 19

PIP, MCP, wrist, knees, and ankles are most commonly affected

Question 20

What are the primary joints that are affected by osteoarthritis?

Answer 20

DIP

carpometacarpal

Question 21

When there is MCP joint swelling, there are commonly boutonniere deformaties, what finger are these found on?

Answer 21

bilateral ring fingers

Question 22

What will an X-ray of a person with RA look like

Answer 22

There may be erosions on the bone near the joints

Question 23

List some of the treatments for RA

Answer 23

– Disease-modifying anti-
rheumatic drugs (DMARDs)
– NSAIDs
– Steroids
– Physical therapy

Question 24

What are some of the risks of RA treatment, what is the patient more susceptible to?

Answer 24

Increased risk of infection from immunosuppression

two fold increase in incidence and mortality from leukemia or lymphoma

increased risk of CVD

Question 25

What is juvenile idiopathic arthritis?

Answer 25

A collagen vascular disorder with persistent inflammation in 1 or more joints for 6+ weeks in a patient that is less than 16 years old

Question 26

When does JIA start?

Answer 26

1-3

Question 27

What is Stills disease?

Answer 27

systemic JIA

Question 28

When a child comes in with large and small joints that are symmetric, what type of JIA do they have?

Answer 28

Polyarticular

Question 29

What is used to diagnose JIA?

Answer 29

CBC ESR RF/ANA Xrays

Question 30

The synovial fluid of a patient with JIA will show what?

Answer 30

leukocytosis and elevated protein

Question 31

What are some of the treatments for JIA?

Answer 31

``` – NSAIDs – Steroids (joint injection, systemic, eye drops) – Methotrexate – Anti-TNF therapy – Stretching – Morning baths – Weight-bearing exercises ```

Question 32

In this type of JIA, 70% of the patients go into remission.

Answer 32

Pauciarticular

Question 33

This is an inflammatory disorder that is caused by autoantibody formation and immune complex deposition

Answer 33

systemic lupus erythematous

Question 34

ESR and CRP may be slightly elevated in ____, but are generally significantly elevated in untreated ____

Answer 34

SLE RA

Question 35

_______ is a Chronic, hyperproliferative inflammatory disorder characterized by thick adherent scales

Answer 35

Psoriasis

Question 36

A patient presents with salmon pink plaques with adherent silver white scale along the extensor surfaces. Upon physical examination you also notice nail pitting. What is your diagnosis?

Answer 36

Psoriasis

Question 37

A patient presents with salmon pink plaques with adherent silver white scale along the extensor surfaces. Upon physical examination you also notice nail pitting. What is your treatment?

Answer 37

``` – Topical steroids – Topical vitamin D analogs – Other topicals – Ultraviolet light – Systemic immunosuppression ```

Question 38

What is MS?

Answer 38

Multiple Sclerosis demyelinating disorder of the CNS

Question 39

What are some of the presenting features of MS?

Answer 39

– Vision changes – Vertigo – Weakness – Numbness/tingling and/or pain – Urinary incontinence or retention

Question 40

_______ ______ is an electrical sensation running down the spine and lower extremities with neck flexion

Answer 40

Lhermitte's sign

Question 41

What is the treatment for MS?

Answer 41

Immunomodulatory Immunosupressive IV steroids for acute exacerbations PT

Question 42

A T cell immunodeficiency is present in the first 3-4 months of life, what is an example of this?

Answer 42

DiGeorge syndrome

Question 43

What is the presentation in HIV patients?

Answer 43

``` Flu-like symptoms Myalgias Fever Anorexia Headache Fatigue Pharyngitis ```

Question 44

What are the diagnostic measures for HIV.AIDS?

Answer 44

ELISA screen Western blot HIV RNA viral load

Question 45

What is the treatment for HIV/AIDS

Answer 45

Depends on the CD4 count Highly active antiretroviral therapy (HAART) prophylaxis of opportunistic infections

Question 46

In order to receive an AIDS diagnosis, what criteria do you have to meet?

Answer 46

CD4 count < 200 cells/mm3 or Presence of an AIDS-defining illness (Cytomegalovirus, Mycobacterium avium- intracellulare, candidal esophagitis, etc.)