ID and Immunology Flashcards
What is sjogrens
Autoimmune condition affecting exocrine glands mainly the tear and salivary glands
Risk factors for sjogrens
Middle aged women
Rheumatoid and SLE associated
Infections of glands
Aetiology of sjogrens
Genetic- HLA associations
Environment- infection of glands
Specific ABs tested for in sjogrens
Anti-SS-A (Ro)
Anti-SS-B (La)
these are ribonuclear proetins found in gland cells
Symptoms of sjogrens
Keratoconjunctivits Xerostomia Dry skin Dryness in vagina leading to pain Difficulty talking as larynx affected
What are symptoms associated with xerostomia
Dry mouth
Difficulty tasting and swallowing
Cracks and fissures in mouth
Symptoms of keratoconjunctivitis
Dry and itchy eyes
Blurred vision
Burning eye pain
Investigations for sjogrens
Test exocrine function - saliometry - schirmers test Confirmatory - anti-SS-A - anti-SS-B - lip biopsy will show T cell infiltration, macrophages and thickening of inner duct wall
What is most likely diagnosis of someone returning from africa with a fever
Malaria
How does malaria present
Cyclical fever Malaise Headache Vomiting Diarrorhoea
First line treatment of malaria
Quinines
What is confirmatory test for malaria
Thick and thin blood films
What is main test for infective mononucelosis
Paul Bunnell
Other than malaria what else can you get from mosquitos
Dengue fever
Presentation of dengue fever
Quick onset fever
Facial flushing
Retrobulbar pain
Maculopapular rash
What is primary TB
Initial infection post exposure that is normally asymptomatic
What is post primaryTB
Happens a few weeks post exposure and presents with pulmonary symptoms
How does reinfection with TB occur
Latent TB can lie in granulomas
What infective agent causes pneumocystic pneumonia
Pneumocystic jerovecii- fungal
What is common lung complication of HIV
PCP
How does PCP present
Dry cough
Fevers
Night sweats
How does PCP appear on CXR
Widespread infiltrates
How does mycoplasma atypical pneumonia present
Dry cough
Myalgia
Arthralgia
Most common cause of infective exacerbated COPD
Haemophillus influenzae
Who does klebsiella penemoniae present in
Elderly
Immunocompromised
Alcoholics
How does klebsiella pneumoniae present
Cavitating lesion causing haemoptysis and prurulent sputum
When does staph aureus infection most commonly happen
After influenza infection
What is problem of staph aureus infection
Life threatening as causes cavitating lesion
How does cholera present
Normally mild diarrorhoea but sometimes can be profuse “rice water stools”
What organism causes typhoid
Salmonella typhi
Early presentation of typhoid
Fever Headache Malaise Diarrorhoea or constipation Maculopapular rash on trunks-> rose spots
What infection presents with rose spots
Salmonella typhi
Most common cause of travellers diarrorhoea
Enterotoxigenic E.Coli
Which infection is common in transplant patients
CMV
Who does CMV occur in
Immunocompromised transplant patients- opportunistic virus
How does varicella zoster virus present
Prodromal illness of malaise, headache, fever then vesicular rash all over face and scalp- sometimes the trunk
Most common outbreak of diarrorhoea in children
Rotavirus
How are vasculitis’ split up
Small vessel
Medium
Large
How does mechanism for small vessel vasculitis differ from that for large and medium
In lage and medium immune system attacks endothelium directly due to molecular mimicry whereas in small is indirect
What happens physiologically in vasculitis
Damage to vessel walls leading to weaker walls within which aneurysms develop, fibrin deposited and clots form thus making the vessels narrower leading to ischaemia
Generalised sx of vasculitidies
Fever
Weight loss
Lethargy
2 large vessel vasculitidies
GCA
Takayasu
What is affected in takayasu
Aortic arch
Sx depend on branch- carotid ->neuro sx. Subclavian->reduced pulses
Who does Takayasu normally occur in
Asian women under the age of 40
Investigations and findings of Takayasu
ESR raised
Biopsy showing granulomas
1 medium sized vasculitidies need to know and 1 dont
Polyarteritis nodosa
Kawasaki
What vessels are affected in kawasakis
Coronary arteries
What condition is associated with polyarteritis nodosa
Hep B
Organs affected in polyarteritis nodosa and their effect
Kidney- HTN Brain- TIA Coronary arteries Gut- mesenteric ischaemia Skin- lesions Nerves
What are particularly common to polyarteritis nodosa
Aneurysms- see beaded appearance on angio
What do you see on angio of polyarteritis nodosa
Beaded appearance due to aneurysms
Pathophysiology of Wegners
Ig CANCA produced against protein of neutrophils
What is proper name of Wegners
Granulomatosis with polyangiitis
Who does Wegners normally occur in
Middle aged men
Which organs are affected in Wegners and their affects
Nasopharynx- chronic pain from sinusitis, bloody mucus, saddle nose deformity
Lung- SOB, haemoptysis
Kidney- oligouria, HTN
Are relapses common in Wegners
Yes
Small vessel vasculitides need to know
Microscopic polyangiitis
Henoch schonlein purpura
Eosinophillic granulomatosis with polyangiitis
Antibody in Wegners
C-ANCA IgG
Antibody in microscopic polyangiitis
P-ANCA
Differences between Wegners and microscopic polyangiitis
Wegners affects nose
Granulomas in wegners
Wegners C-ANCA vs P-ANCA in MP
What is name given to shape of nose in Wegners
Saddle nose deformity
What is the other name for Eosinophillic granulomatosis with polyangiitis
Churg strauss syndrome
What organs does churg strauss syndrome affect
Wegners one GI Skin Nerve Heart
What is churg strauss often confused with
Asthma and allergies
Antibody for churg strauss
P-ANCA
Blood finding for churg strauss
Increased eospinophils
Biopsy finding for Churg strauss syndrome
Granulomas
What are risk factors for churg strauss syndrome
Asthma
Allergies
Which already have eosinophilia
What are checklists for tonsilitis
Centor
Feverpain
Investigations for EBV
FBC
Blood film
Monospots to look for heterophile antibodies
Be more specific can do EBV specific ABs
What happens when give amoxicillin to EBV patient
Maculopapular rash
Treatment for tonsilitis
Penicillin
If allergic give erithomycin
Blood findings of EBV
Lymphocytosis
Anaemia
Thrmobocytopenia
Examination findings of EBV
Hepatosplenomegaly
Posterior cervical ymphadenopathy
Tonsillar exudates
Management of EBV after treatment of cause
Let sexual partners know
Avoid contact
Avoid contact sports within 6 weeks
How does EBV present on blood film
Atypical activated lymphocytes
How does SLE normally present
Malar rash Athritis Glomerulonephritis Alopecia Pericarditis Pleurisy
What is shared with myositis, SLE, sjogrens and systemic sclerosis
ANA
What is problem with ANA use
Common in titres up to 1/80 in older women
How do titre results work
Denominator is the number of titres done until the ABs arent present
What is elevated in SLE
ESR not CRP niche ANA Anti DsDNA Anti Ro Anti smith RF pos C3 (complement)
What does it mean if C3 elevated in SLE
Disease well progressed
Examination findings sjogrens
Red eyes
Fissures in mouth
Dry skin
Swollen parotid glands
What does sjogrens increase risk of
Lymphoma
What are associated symptoms of myositis’
ILD
Calcinosis
Raynauds
Derm changes seen in dermatomyositis
Helioptrope
Gattrons papules
Shawl sign
Mechanics hand
What is a heliotrope rash
Red/purple rash under eyes or on eyelids
Where are gottrons nodules found
On the knuckles
What is shawl sign
Extreme reddening of chest area or on back
What are mecahnics hands
Blisters of the hands that make look like have lived a mechanics life
Difference in skin presentation of limited vs diffuse scleroderma
Limited affects distal limbs and face
Diffuse all over
What is a halo on US indicative of
GCA
Antibodies found in systemic sclerosis
Anti- centromere
Anti-Scl70
Antibody in diffuse vs limited scleroderma
Limited-anti centromere
Diffuse- anti Scl70
Complications of diffuse scelorderma
ILD
Kidney problems
Complication of limited scleroderma
Pulmonary HTN
CREST symptoms
Calcinosis Raynauds Eosophageal dysmobility Sclerodactyly Telengiectasia
Limb symptoms of Takayasu
Limb claudication
What is presentation of PMR
Shoulder and hip pain, tenderness and stiffness
Reduced mobility
What is danger of PMR
Can develop to GCA with artery involvement
What inflammation do you get with PMR
Bursitis and synovitis
Where is bursitis in PMR
Subacromial
Trochanteric