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Rosh Review > Immune System Disorders > Flashcards

Immune System Disorders Flashcards

1
Q

What is lupus pernio?

A

Classic cutaneous finding in sarcoidosis

  • violaceous or infuriated erythematous papules, plaques or nodules
  • picture from Q6 Exam 1 (608653)

Tx = infliximab and methotrexate

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2
Q

TNF-alpha mechanism

A

Important for macrophage activation, neutrophil and macrophage recruitment, granuloma formation and function

Gives protection from many pathogens that are sequestered within these granulomas and eliminated by multinucleated giant cells, macrophages, and lymphocytes

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3
Q

What is Type I Hypersensitivity Reaction?

Mechanism, examples

A

Mechanism: preformed IgE antibodies crosslink with free antigens to mediate degranulation of mast cells with release of mediators including histamine
Requires two separate exposures where first causes sensitization

Anaphylaxis, urticaria, angioedema, allergies (abx, foods, hymenoptera stings)

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4
Q

What is Type II Hypersensitivity Reaction?

Mechanism, examples

A

IgG or IgM antibodies react with cell antigens with resultant complement activation and cause direct cellular damage and lysis
Requires two separate exposures to antigen where first causes sensitization

Autoimmune hemolytic anemia, erythroblastalis fetalis, Goodpasture syndrome

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5
Q

What is Type III Hypersensitivity Reaction?

Mechanism, examples

A

IgG or IgM immune complex deposition and subsequent complement activation and depositing on vessel walls, causing inflammation and tissue damage

Serum sickness, SLE, RA, poststreptococcal glomerulonephritis, arthus reaction, polyarteritis nodosa, hypersensitivity pneumonitis

Typically pupuric rash and arthralgias

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6
Q

What is Type IV Hypersensitivity Reaction?

Mechanism, examples

A

Previously sensitized T helper cells activated by antigen initiate an inflammatory cascade against cell surface bound antigens

Contact dermatitis, TB skin test, Transplant rejection, SJS, TEN, DRESS

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7
Q

Tx for hereditary/acquired angioedema from deficient or dysfunctional C1-esterase inhibitor

A

FFP - replaces C1-esterase inhibitor

Airway management and standard anaphylaxis therapy as well

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8
Q

Reactive arthritis is most commonly associated with what infections?

A
  • Campylobacter jejuni
  • Shigella dysenteriae
  • Chlamydia trachomatis
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9
Q

Clinical sx of Takayasu Arteritis

A
  • Large artery inflammation (aorta and carotids) -> carotidynia (tenderness of carotid), absent or weak peripheral pulses, unequal BPs in arms, bruits, hypertension, retinopathy, limb claudication, angina, GI sx
  • Constitutional sx = fever, malaise, weight loss
  • Arthralgias
  • Skin lesions resembling erythema nodosum or pyoderma gangrenosum
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10
Q

Four examples of small-vessel vasculitides

A
  • Granulomatosis with polyangiitis
  • Microscopic polyangiitis
  • Eosinophilic granulomatosis with polyangiitis
  • IgA vasculitis (Henoch-Schonlein purpura)
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11
Q

Dx of Takayasu arteritis

A
  • Angiogram
  • MRI
  • CTA
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12
Q

Tx of Takayasu Arteritis

A
  • Corticosteroids

- Immunosuppressive agents

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13
Q

What is the characteristic heart rate in patients who have undergone heart transplant?

A

Resting tachycardia (90-110) due to lack of vagus tone

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14
Q

Infections common in the FIRST month post transplant

A
  • Staph
  • MRSA
  • Pseudomonas
  • Strep

Most often related to the surgery itself (IV lines, intubation, nosocomial pathogens)

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15
Q

Infections common from FIRST to SIXTH month post transplant

A
  • CMV (presents with pneumonitis, GI, renal, skin, or CNS infection and can trigger or exacerbate organ rejection - tx = IV ganciclovir)
  • EBV (clinically similar to CMV, also causes a mononucleosis like syndrome)
  • Hepatitis
  • Listeria
  • Pneumocystitis
  • Aspergillosis
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16
Q

Infections common after SIX months post transplant

A
  • CMV, EBV, HSV, hepatitis B &C
  • Varicella-zoster (primary can result in disseminated disease. Seronegative patients should receive varicella-zoster immune globulin after exposure to chickenpox or zoster. Consider hospitalization in transplant patients with cutaneous zoster)
  • Increased risk for community-acquired infections
  • Strongyloides hyperinfection syndrome, TB, toxoplasmosis, fungal infections
17
Q

Cyclosporine toxicity

A

Hyperkalemia

Nephrotoxicity

18
Q

Azathioprine toxicity

A
  • BM suppression
  • Hepatotoxicity
  • Pancreatitis
19
Q

Hyperacute rejection

A

Minutes-hours post-transplant

Irreversible graft destruction due to preformed antibodies

20
Q

Acute transplant rejection

A

1-12 weeks post-transplant

Humoral/T-cell mediated

21
Q

Chronic transplant rejection

A

Months-years post-transplant

22
Q

Graft vs. Host Disease

A

Post allogeneic BMT

Rash, diarrhea

23
Q

Tx for hereditary angioedema

A

FFP contains C1 inhibitor

24
Q

What is an adverse reaction to Crofab?

A

Serum sickness - type III hypersensitivity reaction

25
Q

Presentation of serum sickness

A
  • Fevers
  • Polyarthralgias/Polyarthritis
  • Rash
  • Malaise
    Typically 7-14 days after initial exposure
26
Q

Causes of serum sickness

A

Therapeutic antibodies such as rituximab and infliximab

27
Q

What are the unique laboratory findings of pleural effusions associated with rheumatoid arthritis?

A

Low glucose, low pH, and high LDH

28
Q

What are the common causes of renal graft failure?

A
  • Nephrotoxicity from immunosuppressants
  • UTI or obstruction
  • Renal vascular stenosis or thrombosis
  • Progression of underlying disease (e.g. diabetes or hypertension)
29
Q

Common organisms associated with reactive arthritis

A
  • Chlamydia trachomatis
  • Yersinia
  • Salmonella
  • Shigella
  • Campylobacter

Less common:

  • Chlamydia pneumoniae
  • E. Coli
  • Ureaplasma urealyticum
  • Mycoplasma genitalium
30
Q

Mechanism of vincristine and vinblastine

A

Inhibit microtubule formation

31
Q

Which chemotherapeutic agent is classically known to cause hemorrhagic cystitis?

A

Cyclophosphamide

32
Q

Pathophysiology of poststreptococcal glomerulonephritis

A

Immune complex deposition

33
Q

What is a leading cause of morbidity and mortality in patients with systemic sclerosis?

A

Kidney disease

Rosh Review (22 decks)

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