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PCM 2020 Final > hypersensitivity > Flashcards

hypersensitivity Flashcards

1
Q

What are the steps of Type I Immediate hypersensitivity?

A

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

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2
Q

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?

A

Allergic Rhinitis

Treat with antihistamines

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3
Q

Why do you treat a type I hypersensitivity with antihistamines?

A

Because of the intense release of histamines from the mast cells

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4
Q

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

A

Opsonization

Complement mediated lysis

Antibody-dependent cellular cytotoxicity

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5
Q

What are examples of type II hypersensitivity?

A

ABO mismatch, Grave’s disease, Myasthenia Gravis

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6
Q

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

What is the diagnosis?

A 
Myasthenia gravis (antibodies to acetylcholine receptor
which prevents acetylcholine from binding)
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7
Q

How do you treat myasthenia graves?

A

Acetylcholinesterase inhibitors

plasmapheresis

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8
Q

What is type II hypersensitivity?

A

IgM or IgG antibodies cause destruction to the cells

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9
Q

What are the steps of a type III hypersensitivity?

A

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

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10
Q

What are some examples of Type III hypersensitivity?

A

Systemic Lupus Erythematosus, Rheumatoid Arthritis, Farmer’s Lung

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11
Q

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?

A

Farmers lung

treat with supportive care and avoidance of antigens

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12
Q

What is type III hypersensitivity?

A

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

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13
Q

What are the steps of Type IV cell mediated hypersensitivity

A

Step 1: Antigen exposure activates sensitized T-cells

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

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14
Q

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

A

Type IV

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15
Q

How do you treat poison ivy?

A

Steroids

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16
Q

True or false: Rheumatoid arthritis effects more males than females

A

FALSE more ladies than men

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17
Q

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

A

Rheumatoid arthritis

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18
Q

What are some of the presenting symptoms with RA?

A

Joint swelling
warmth
erythema
decreased ROM

morning joint stiffness

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19
Q

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

A

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

20
Q

What are the primary joints that are affected by osteoarthritis?

A

DIP

carpometacarpal

21
Q

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

A

bilateral ring fingers

22
Q

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

A

There may be erosions on the bone near the joints

23
Q

List some of the treatments for RA

A 
– Disease-modifying anti-
rheumatic drugs (DMARDs)
– NSAIDs
– Steroids
– Physical therapy
24
Q

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

A

Increased risk of infection from immunosuppression

two fold increase in incidence and mortality from leukemia or lymphoma

increased risk of CVD

25
Q

What is juvenile idiopathic arthritis?

A

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

26
Q

When does JIA start?

A

1-3

27
Q

What is Stills disease?

A

systemic JIA

28
Q

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

A

Polyarticular

29
Q

What is used to diagnose JIA?

A

CBC

ESR

RF/ANA

Xrays

30
Q

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

A

leukocytosis and elevated protein

31
Q

What are some of the treatments for JIA?

A 
– NSAIDs
– Steroids (joint injection, systemic, eye drops)
– Methotrexate
– Anti-TNF therapy
– Stretching
– Morning baths
– Weight-bearing exercises
32
Q

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

A

Pauciarticular

33
Q

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

A

systemic lupus erythematous

34
Q

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

A

SLE

RA

35
Q

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

A

Psoriasis

36
Q

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?

A

Psoriasis

37
Q

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?

A 
– Topical steroids
– Topical vitamin D analogs
– Other topicals
– Ultraviolet light
– Systemic immunosuppression
38
Q

What is MS?

A

Multiple Sclerosis

demyelinating disorder of the CNS

39
Q

What are some of the presenting features of MS?

A

– Vision changes

– Vertigo

– Weakness

– Numbness/tingling and/or pain

– Urinary incontinence or retention

40
Q

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

A

Lhermitte’s sign

41
Q

What is the treatment for MS?

A

Immunomodulatory

Immunosupressive

IV steroids for acute exacerbations

PT

42
Q

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

A

DiGeorge syndrome

43
Q

What is the presentation in HIV patients?

A 
Flu-like symptoms
Myalgias
Fever
Anorexia
Headache
Fatigue
Pharyngitis
44
Q

What are the diagnostic measures for HIV.AIDS?

A

ELISA screen

Western blot

HIV RNA viral load

45
Q

What is the treatment for HIV/AIDS

A

Depends on the CD4 count

Highly active antiretroviral therapy (HAART)

prophylaxis of opportunistic infections

46
Q

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

A

CD4 count < 200 cells/mm3

or

Presence of an AIDS-defining illness (Cytomegalovirus, Mycobacterium avium- intracellulare, candidal esophagitis, etc.)

PCM 2020 Final (9 decks)

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