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Theo's Path > Hypersensitivity disorders > Flashcards

Hypersensitivity disorders Flashcards

1
Q

Rash in response to irritants/food/environment most present in first year of life

A

A. Atopic dermatitis (eczema) - type 1 hypersensitivity

Predisoposition to S. auerus superinfection

Mx - emmolient, topical steroids

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2
Q

Facial swelling, weals, and wheeze in after eating at a seafood restaurant

A

A. Shellfish (food) allergy - type 1 hypersensitivity

Others: milk, egg, nut

Ix - skin prick, food diary, RAST challenge

Mx - avoidance, Epipen

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3
Q

Allergy due to cross-reactivity of antigen, symptoms limited to mouth (anaphylaxis in 2%)

A

A. Oral allergy syndrome -type 1 hypersensitivity

Ix - skin prick
Mx - avoidance, wash mouth + antihistamine

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4
Q

Allergy to latex confers allergy to certain foods

A

A. Latex food syndrome - type 1 hypersensitivity

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5
Q

Nasal itch, coryza, sneezing in response to pollen/dust mites/ animals

A

A. Allergic rhinitis - type 1 hypersensitivity

Ix - skin prick and RAST
Mx - avoidance, steroid nasal spray, antihistamine etc.

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6
Q

Idiopathic or triggered IgE mediated wheals which resolve in six weeks

A

A. Acute urticaria - type 1 hypersensitivity

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7
Q

Eight steps in acute management of anaphylaxis

A
  1. Elevate legs
  2. 100% oxygen
  3. IM adrenaline 500mcg
  4. Inhaled bronchodilators
  5. IV Hydrocortisone 100mg
  6. IV Chlorphenamine 10mg
  7. IV fluids
  8. Call for help
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8
Q

What is a positive result in skin prick testing?

A

A. Wheal >2mm larger than negative control

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9
Q

What is the mechanism behind type 2 hypersensitivity?

A

A. IgG or IgM reacts with cell/matrix self antigen.

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10
Q

Causes neonatal jaundice (<24h) due to rhesus incompatibility

A

A. Haemolytic disease of the newborn - type 2 hypersensitivity

Ix - DAT +ve
Mx - Transfusion

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11
Q

Destruction of RBCs by autoantibody, complement and FcR+ phagocytes

A

A. Autoimmune Haemolytic Anaemia - type 2 hypersensitivity

Ix - DAT+
Mx - Steroids

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12
Q

Bruising and bleeding due to reaction with GpIIb/IIIa on platelets

A

A. Autoimmune Thrombocytopaenic Purpura - type 2 hypersensitivity

Ix - Antiplatelet ab
Mx - Steroids, IVIG, anti-D antibody, splenectomy

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13
Q

Glomerulonephritis + pulmonary haemorrhage

A

A. Goodpasture’s syndrome - type 2 hypersensitivity

Ix - Anti GBM ab (linear smooth if staning of IgG on basement membrane)
Mx - steroids and immunosuppresion

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14
Q

Non-tense blistering of skin and bullae. Nikolsky’s sign is positive (rubbing of skin results in separation of the outermost layer)

A

A. Pemphigus vulgaris - type 2 hypersensitivity to epidermal cadherins (demoglein 1 and demoglein 3)

Ix - immunofluoresence showing IgG deposition
Mx - steroids and immunosuppression

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15
Q

Anti-TSH-R Ab

A

A. Graves disease - type 2 hypersensitivity

Mx - carbimazole and propylthiouracil

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16
Q

Fatiguable muscle weakness and double vision, with abnormal EMG tensilon test

A

A. Myasthenia gravis - type 2 hypersensitivity

Ix - Anti ACh-R Ab
Mx - neostigmine, pyridostigmine, IVIG and plasmaphoresis (severe)

17
Q

Presents with one or more of carditis, arthritis, Sydenham’s chorea, erythema marginatum and subcutaneous nodules 2-4 weeks post Strep throat infection

A

A. Acute Rheumatic Fever - type 2 hypersensitivity to M proteins on Group A Strep

Ix - Jones criteria
Mx - aspirin, steroids, penicillin

18
Q

Megaloblastic anaemia, may present alongside other autoimmune disease

A

A. Pernicious anaemia - type 2 hypersensitivity to intrinsic factor and gastric parietal cells

Ix - Anti Gastric Parietal cell Ab/ Anti-IF Ab
Mx - Dietary B12 or IM B12

19
Q

History of asthma or allergic rhinitis, followed by eosinophilia

A

A. Churg-Strauss (eGPA) - type 2 hypersensitivity causing medium and small vessel vasculitis

Ix - p-ANCA
Mx - prednisolone, AZA, cyclophosphamide

20
Q

Presents with sinus problems, lung cavitations and haemorrhage, typically with crescenteric glomerulonephritis

A

A. Wegener’s (GPA) - type 2 hypersensitivity affecting medium and small vessels

Ix - c-ANCA
Mx - Steroids, AZA, co-trimoxazole

21
Q

May present with constitutional symptoms, nephritic syndrome and purpura or livedo racemosa (irregular broken circles on skin)

A

A. Microscopic polyangitis - type 2 hypersensitivity affecting small vessels

Ix - p-ANCA
Mx - steroids, cyclophosphamide

22
Q

Persistent itchy wheals lasting more than 6 weeks

A

A. Chronic urticaria - type 2 hypersensitivity to NSAIDs, cold, food, etc.

Ix - challenge test, ESR, skin prick
Mx - avoidance, preventative antihistamine, IM adrenaline if throat swelling

23
Q

What is the mechanism of type 3 hypersensitivity?

A

A. IgG or IgM immune complex (soluble Ag) mediated tissue damage

24
Q

Presents with joint pain, splenomegaly, skin, nerve and kidney involvement. Associated with Hep C.

A

A. Mixed essential cryoglobulinaemia - type 3 hypersensitivity against hepatitis C antigens

Ix - clinical/ biopsy
Mx - NSAIDs, steroids, plasmaphoresis

25
Q

Presents with rashes, itching, joint pain, LNpathy, fever and malaise 7-12 days following treatment with certain drugs e.g. penicillins

A

A. Serum sickness - type 3 hypersensitivity to foreign proteins in antiserum

Ix - low C3, immune complexes in blood
Mx - stop drug, steroids, antihistamines, analgesia

26
Q

Presents with fever, fatigue, weakness, joint pain, skin, nerve and kidney involvement, pericarditis and MI. Associated with Hep B

A

A. Polyarteritis Nodosa - type 3 hypersensitivity to HBV/HCV Ag

27
Q

Presents with 4 of: serositis, seizure, apthous ulcer, arthritis, photosensitivity, discoid rash, malar rash, haematology, kidney involvement
ANA+, anti-dsDNA/anti-SM abs

A

A. SLE - type 3 hypersensitivity to intracellular components

Ix - low C4, low C3 (marker of active/severe disease), Abs: dsDNA, Ro, La, SM, cardiolipin, raised ESR
Mx - analgesia, steroids, cyclophosphamide

28
Q

What is the mechanism underlying type 4 (delayed) hypersensitivity disorders?

A

A. T-cell mediated destruction of cells

29
Q

Anti-GAD (glutamate decarboxylase) antibodies

A

A. Type 1 diabetes mellitus - type 4 hypersensitivity

30
Q

CSF shows oligoclonal bands of IgG on electrophoresis. Treated with INF-B and steroids.

A

A. Multiple sclerosis - type 4 hypersensitivity to oligodendrocyte proteins (Myelin basic protein, proteolipid protein)

31
Q

Anti-CCP antibodies are 95% specific for this disease, but not very sensitive (negative result doesn’t exclude disease)

A

A. Rheumatoid arthritis - type 4 hypersensitivity to antigen in synovial membrane

Rheumatoid Factor is 85% sensitive and aids diagnosis

32
Q

Reaction to contact with chemicals, poison ivy and nickel

A

A. Contact dermatitis - type 4 hypersensitivity

33
Q

Skip lesions which may show transmural inflammation on biopsy, which is gold standard

A

A. Crohn’s disease -type 4 hypersensitivity

NOD2 mutation in 30%

Mx - mesalazine, steroids, TNF-a antagonists e.g. infliximab

Theo's Path (9 decks)

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