Immune & Lymph Pathologies Flashcards
Explain the difference between Oedema and Lymphoedema
2 marks
Both are the accumulation of excess fluid between cells.
Oedema can be local or systemic & is usually associated with chemical imbalance, inflammation or poor circulation.
Lymphoedema is as a result of damage to lymphatic structures and accumulation of proteins in the interstitial fluid.
What signs &/or symptoms might lead you to consider oedema to be present in a patient?
2 marks
Tissue may be soft, puffy or boggy.
Area may be hot if inflammation is due to recent injury, or cool if oedema is long standing & due to poor circulation.
If blood/lymph movement is chronically reduced there may be pitting oedema where a pit or dimple remains in the tissue after it’s pressed by a finger.
What is mononucleosis and, apart from a sore throat, how might a patient present with the condition?
4 marks
It is a viral infection of the salivary glands and throat, that moves to the lymphatic system. Virus is usually (90%) Epstein-Barr virus, related to Herpes virus.
Symptoms may vary & be more subtle in the young.
General fatigue & malaise followed by fever, v. sore throat & swollen, tender lymph nodes - especially cervical.
Possibly swollen eye lids, jaundice, measles like rash.
Fatigue may last weeks or months.
A patient complains to you of headaches & fever. On questioning she reports painless white lesions in the mouth and a vaginal discharge. She also mentions she had a recent bacterial infection for which she has been taking antibiotics.
What thought process might go through your head?
3 marks
May have Candidiasis - C. albicans is a yeast-like fungus that lives symbiotically with other flora & fauna in the GI tract. If the balance of microbes is upset it may replicate too easily and the numbers grow out of control,
Antibiotics suppress bacteria giving the candida more opportunity to reproduce & spread.
Explain why your own health may be a significant factor in your decision as to whether or not to treat a patient with HIV/AIDS.
2 marks
AIDS is a syndrome caused by the Human Immunodeficiency Virus which attacks and disables the immune system.
This leaves the person vulnerable to a host of diseases that are not normally a threat and that I as a practitioner may be carrying.
What is an allergic reaction?
1 mark
Allergies are immune system reactions against stimuli that are not inherently hazardous.
The immune system behaves as though a benign substance is a potentially dangerous threat.
How would you explain to a patient that their respiratory problem, asthma, may be caused by their immune system?
4 marks
Asthma is a chronic disorder of the airways that interferes with breathing.
‘Foreign’ debris inhaled into the airways (eg dust), causes WBCs in the airways to generate an inflammatory reaction, releasing fluid & mucus into the airways & causing them to swell. This may completely block some of the airways making it impossible to get oxygenated air into the alveoli in the lungs & deoxygenated air out again.
What is eczema? Why might a person with eczema be more susceptible to a wide range of infections?
3 marks
Eczema is a hypersensitivity reaction with the immune system reacting over-vigorously to non-threatening stimuli. WBCs release molecules that create an inflammatory response in the skin.
Eczema causes itchy lesions which become even itchier when scratched, increasing the urge to scratch even more - itch scratch cycle. This causes the skin to become fragile & broken - easy to invade by other pathogens eg herpes simplex, fungi, warts viruses, staphylococcus etc.
Many patients, if asked, would report fatigue. What factors might make you suspect that a patient’s fatigue might be a symptom of Chronic Fatigue Syndrome / Myalgic encephalomyelitis (ME)?
5 marks
The fatigue of CFS is unending & not restored by sleep or rest, for a minimum of 6 months. In addition there must be 4 or more of the following: - Poor short term memory / confusion - Changes in sleep quality/quantity - Tender lymph nodes - Headache - Muscle/joint pain - Low grade fever - Sore throat - Disproportional post exertion pain
May also be extreme allergies, bloating, nausea, diarrhoea, cramping, chest pain, irregular heartbeat, coughing, dizziness, fainting, dry eyes & mouth, weight loss, night sweats, depression, anxiety.
It may also be associated with Fibromyalgia & IBS.
What is Anaphylaxis and what are its common triggers? Why is it potentially more dangerous than other allergic reactions?
4 marks
Anaphylaxis is an acute, severe systemic allergic reaction, leading to WBCs releasing massive amounts of histamine.
This results in a sudden drop in blood pressure (hypotension) and oedema.
If the reaction happens in the respiratory tracts it can interfere with breathing. Drop in BP may seriously affect blood supply to the brain & kidneys.
Common triggers include: Abx, blood products, contrast media in diagnostic imaging, latex, stings of bees, wasps & ants, peanuts & other nuts, eggs, fish, shellfish & cows milk.
Rheumatoid arthritis (RA) is usually associated with the musculoskeletal system, but other tissues may also be involved. Briefly explain how RA occurs and list the other tissues that may be attacked.
8 marks
RA is an autoimmune disease where the body’s immune system attacks the body’s own cells - usually the cells of synovial membranes of certain joints.
Inflammation develops with all the usual signs & symptoms - heat, pain, redness, swelling & loss of function of the effected joint. In response the synovial membrane thickens & swells, fluid accumulates inside the joint capsule - causing pressure & pain.
The inflamed tissues release enzymes that erode cartilage & bone (tendons & ligaments may also be affected). This causes the telltale deformation of the joint capsule & gnarled appearance of RA.
Other tissues attacked may include:
Whites of eyes, pleura of lungs, heart or pericardial sac, liver, blood vessels, bursae & blood.
What signs and symptoms might indicate Psoriasis in a patient?
4 marks
Signs & symptoms can be variable - they often run in cycles of flare & remission.
Skin cells normally replicate every 28-32 days, in psoriasis this occurs every 3-4 days. Instead of sloughing off, they accumulate into itchy, scaly plaques on the skin - usually on the trunk, elbows & knees.
The lesions tend to have well-defined edges, and if well established may be covered with silvery flaky scale. Small lesions close together may converge into larger ones.
They may develop under nails where they may destroy the whole nail.
If a patient reports period pains as part of her case history, what other explanation might you consider for her symptoms, and what other signs and symptoms might you expect? How would you explain the cause(s) of this condition?
5 marks
Endometriosis. This is implantation of endometrial cells anywhere outside the uterus. May be caused by retrograde backflow through uterine tubes, metamorphosis of other cells into endometrial cells - possibly by inflammation, spread by surgery, metastisis or immune anomolies.
There may be no other symptoms, especially early on, but symptoms may include spotting, urinary urgency, painful urination, diarrhoea & rectal bleeding - during menstruation. Symptoms may be cyclical - reaching a peak during menstruation.
Multiple Sclerosis (MS) is sometimes called ‘the great imitator’ why is this so? Describe the most dependable signs & symptoms of MS.
8 marks
Its initial symptoms can look like a variety of other diseases. In MS the myelin sheaths in the brain & spinal cord (CNS) are attacked by WBCs & replaced by scar tissue - this slows or obstructs electrical impulses along the neurons & may ultimately destroy them.
The result is a loss of motor control, cognitive changes, or motor &/or sensory paralysis.
It is an autoimmune disease & occurs in flares with periods of remission.
Most dependable signs & symptoms are:
- weakness, muscle spasm or cramping
- Numbness or pins & needles in various parts of the body
- Eye pain / temporary loss of vision
- Incontinence or difficulty urinating
- Sexual dysfunction
- Difficulty walking
- Loss of short term memory & ability to perform complex tasks.
- Digestive disturbances
- Fatigue
- Depression
What is Diabetes? Describe how a patient with diabetes might present to you. How might you determine from the case history whether the diabetes was Type 1 or Type 2.
10 marks
Diabetes isn’t a single disease - it’s a group of disorders which all result in hyperglycaemia.
Most cells prefer to use glucose as fuel, but the hormone insulin is required to get the glucose into cells. It’s also involved in transferring fat out of the blood and into lipid (fat) cells.
Diabetes develops when there isn’t enough insulin or insulin receptor sites in cells have developed resistance - so glucose & fat accumulate in the blood and cells have to use stored fat & proteins for fuel.
This leads to damage and narrowing of the blood vessels leading to complications like cardiovascular disease, neuropathy, oedema, ulcers & gangrene, kidney disease, blindness.
Type 1 diabetes mellitus is an autoimmune disorder - WBCs attack the beta cells in the pancreas where insulin is produced. Resulting in lifelong deficiency in insulin. Symptoms usually emerge before 30 only 5-10% of cases are this type.
Type 2 diabetes mellitus is caused by a diet high in fat & sugars. It often appears later in life (>50) & can usually be controlled with diet, exercise & possibly some drugs.
