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PCM II Exam 1 > immuno > Flashcards

immuno Flashcards

1
Q

Type I IMME$IDATE Hypersensitivity Disorders

A

IgE Ab mediated disorder,

typically allergy or anti parasitic

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2
Q

Type I Immediate Hypersensitivity Disorders

activates what?

A

mast cells and
chemical mediators
that increase vessel permeability and alter smooth muscle tone

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3
Q

Type __ Immediate Hypersensitivity Disorders is often associated with

______- familiar predisposition for developing allergic reaction

A

I

ATOPY

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4
Q

s/s of type 1 immediate hypersensitivity

A
  1. allergic conjunctivis
  2. allergic rhinitis
  3. atopic dermatitis (eczema)
  4. diarrhea and cramping
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5
Q

Allergic rhinitis is

A

pale, boggle and blue nasal mucosa

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6
Q

what. type of reaction occurs with Hypersensitivity to bee/wasp/hornet sting

A

type 1 immediate hypersensitivity

anaphalyasic d/t bee sting was the MCC of death d/t venous bites

CV collapse (1) -> laryngeal swelling (2) most common causes of deat

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7
Q

tx for bee sting

A

SQ EPI

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8
Q

Type II Cytotoxic Hypersensitivity Disorders

A

Antibody-mediated cytotoxic reaction that involves complement activation.

Lysis follows.

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9
Q

Type II Cytotoxic Hypersensitivity Disorders involves recruitment of

A

inflammatory cells
NK cells
autoAB against receptors

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10
Q

what can cause Type II Cytotoxic Hypersensitivity Disorders

A
  1. ABO mismatch
  2. IgM mediated cold autoimmune hemolytic anemia
  3. Hyperacute transplant rejection
  4. goodpasteurs
  5. Rheumatic fever
  6. Newborn Rh/ABO hemolytic dz)
  7. Myasthania gravis
  8. Graves
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11
Q

Goodpasture’s Syndrome involves

A

Antiglomerular and pulmonary capillary basement membrane Ab

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12
Q

Rheumatic Fever

A

cross-reactivity of Ab and antigens on certain strains of group A streptococci)

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13
Q

Newborn Rh hemolytic disease (

A

anti-D IgG Ab from mom cross placenta and attach to +D-antigen fetal cells

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14
Q

Newborn ABO hemolytic disease

A 
type O (anti-A & anti-B IgG Ab) from mom cross placenta and attach to A or B fetal
cells)
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15
Q

Myasthenia gravis

A

antibodies against ACh receptors

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16
Q

Graves disease

A

(IgG thyroid stimulating immunoglobulin “Ab” against TSH receptor)

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17
Q

Type III Immunocomplex Hypersensitivity Disorders

A

Circulating complexes of antigen bound to IgG or IgM deposit in target tissue -> compliment activation -> activate neutrophils/macrophages which damage tissues.

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18
Q

Type III Immunocomplex Hypersensitivity Disorders

First exposure:
Second exposure

A
  1. exposed to antigen, form Ab

2. deposition of the ant-ab complex that deposits in tissue

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19
Q

Arthus reaction

A

immunocomplex disease that occurs 4-8 hours after Ant exposure. usually resolve in 1-3 days

key: pigeons, chicken coops, rodents, parakeets, fowl, rodents, hay,

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20
Q

what can cause Arthus reaction

A
  1. • Farmers lung – exposure to actinomyces antigen in the air causes antibodies to form in the lungs. Exposure to antigen causes local immunocomplex formation in lung
  2. Bird fanciers lungs d/t pigeons, parakeets, fowl, rodents
  3. serum sickness
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21
Q

what is serum sickness

A

allergic reaction d/t injection of serum: causes fever, urticarial, generalized lymphadenopathy, arthritis, glomerularnephritis, and vasculitits.

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22
Q

Type IV Hypersensitivity Disorders

A

T cell mediated = Cellular immunit

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23
Q

_____ are not required for Type IV disorders

A

ANTIBODIES because CD4 helper T cells cause delayed reaction hypersensitivity (DRH), CD8 cytotoxic T cells are cytolytic to target cells

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24
Q

what can cause Type IV Hypersensitivity Disorders

A
  1. Allergic Contact Dermatitis (Poison Ivy, Nickel, soaps) - pre-exposed and then re exposed
  2. PPD skin. test
  3. Cell mediated response to intracellular pathogens with granuloma formation (late phase dz of farmers lung)
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25
Q

Rheumatoid Arthritis (RA)

Onset:
Highest risk:
Presents as

A

any age; but peaks between 30-50
women, smokers and those with FH of dz
pain and stiffness in multiple joints, most often the wrists, PIPS and MCPs

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26
Q

_________ are not typically impacted by RA.

A

DIPS lumbar spine

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27
Q

in RA, ________ lasting more than one hour suggests an inflammatory etiology.

A

morning stiffness

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28
Q

ROS with RA

A

fatigue
weightloss
anemia

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29
Q

what can we see in exam

A
  1. Boggy swelling caused by synovitis

2. synovial thickening may be palpable on joint

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30
Q

doc use________ to differentiate the inflammatory
arthritis in RA from another
etiology, including lupus, systemic sclerosis,
psoriatic arthritis, sarcoidosis,
crystal arthropathy, and
spondyloarthropathy

A

history. and physical examination

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31
Q

RA first line of treatment

A

methotrexate

-DMARDS (disease modifying antirheutmic drugs, glucocorticoids is dz activity. is high

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32
Q

key. to tx RA

A

TREAT EARLY. waiting longer b4. tx = poorer prognosis

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33
Q

goal of RA tx

A

remission or the lowest disease activity possible.

To reach goal: Medications are titrated. and frequent physician visits are required to monitor response to therapy.

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34
Q

Juvenile Rheumatoid Arthritis (JRA)

Present as:
Diagnosis criteria:
It is a diagnosis of ____________, meaning

A

painless joint inflammation present in variable degrees and normal results on rheumotologic tests. kids will often have a limp .

chronic arthritis lasting 6 wks in at last 1 joint and exclusion of other causes of symptoms in a person under 16 or a classic cause of systemic onset.

diagnosis of exclusion: must rule out other causes of joint dz

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35
Q

do we use labs for JRA

A

lab tests do not rule in or out.

diagnosis is CLINICAL!

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36
Q

The primary morbidity associated with juvenile rheumatoid arthritis is caused by

A

idiopathic inflammatory eye disease.

thus, eye doc should screen kids with artitirst for silentt uvetis to help prevent morbidity

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37
Q

Systemic lupus erythematosus (SLE) is 2x as prevalent in ____ persons as in white persons, and it is 10 times more common in _____ than in ____

A

BLACK FEMALES

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38
Q

path of SLE

A

recurrent with periods of remission, followed by flares

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39
Q

Most common sx of SLE

A

fatigue, weight loss,
fever
arthralgia and myalgia (joint/muscle pain ARE PRESENT IN ALMOST ALL PTS WITH SLE)

40
Q

Systemic lupus erythematosus (SLE)

ROS

A

autoimmune dz that affects many systems: skin, MSK, renal, neuropsych

pan +

41
Q

SLE exam

Less common signs/symptoms include

A

malar rash (31%)

42
Q

These 4 signs/symptoms provide the strongest evidence in favor of SLE

A
  1. discoid rash, coin shaped
  2. malar rash
  3. unexplained serizures or psychosis
  4. photosensitivity
43
Q

Diagnostic Criteria of SLE

A

begins with.

  1. high amount of suscpecian
  2. must meet 4/11 diagnostic criteria to diagnose with 95%. specificity. and 85%. sensitibity
44
Q

11 diagnostic criteria for SLE

A

malar or discoid rash; photosensitivity; oral ulcers;
arthritis; serositis; abnormal ANA titers; and renal,
neurologic, hematologic, or immunologic disorders

45
Q

If we suspect SLE, wat do we do

A
  1. check to see if at least 4 ACR criteria are present -> dx

2. Check ANA: - -> very low prob. If high-> chance of SLE

46
Q

tx SLE

A
  1. Hydroxychloroquine (Plaquenil) reduces arthritis pain associated
    with SLE.
  2. glucocorticoids +immunosuprresant to preserve renal function
  3. glucocorticoids +mycophenolate or cyclophosphamide is perf to achieve remission in patient with SLE nephritis
47
Q

what I s Psoriasis

A

inflammatory skin condition that is often associated with systemic manifestations

48
Q

hx: psoriasis

A

any age: most likely. between 15-30

1/3 of pts with this have a first. degree relative with it

49
Q

assx with psoriasis

A
  1. smoking increase risk and severity
  2. obesity. and olcool are assx: not causitibve
  3. stress
  4. direct skin trauma (koebner phenomenon)
50
Q

Psoriasis is associated with several comorbidities, including

A

CV disease,
lymphoma, and
depression

51
Q

can HIV cause psoriasis

A

no.

but HIV can make psoriasis worse

52
Q

psoriasis exam

Diagnosis is based on the _____
_____ psoriasis is the most common form

A

red, scaly. skin lesions with additional manifestations in nails and joints

PLAQUE

53
Q

if you see a RASH OR NAIL PITTING. WYD?

A

joint exam

54
Q

tx psoriasis

A
  1. corticosteroids, vitD analogs, tazarotene -> mild
  2. systemic bioicial tx
  3. TNF inhibits for psoriatic arthritis
55
Q

Graves disease is the most common cause of hyperthyroidism in the United States
Autoimmune disorder in which

A

thyroid-stimulating antibodies activate thyroid-stimulating hormone (TSH) receptors,

56
Q

Graves disease hx

risk factors
clinical presentations:

A

F and personal or FH of autoimmune disorder

hyperthyroidism can rage from asymptomatic-> thyroid storm

57
Q

most common manifestations of hyperthyroidism

A 
adrenergic symptoms (e.g., palpitations, heat intolerance, diaphoresis, tremor, stare [an appearance of a fixed look due to
retraction of eyelids], lid lag, hyperdefecation
58
Q

Treatment hyperthyroid disorders

A

beta blockers

methimazole (anti-thyroid meds)

59
Q

______) is the MC form of thyroiditis

A

Chronic Autoimmune thyroiditis (Hashimoto thyroiditis)

60
Q

what is hashimotos

A

immune cells attack your thyroid, limiting its production of thyroid hormone production.

61
Q

Hashimoto presentation

A

w/wo non tenger goiter
hypothyroidism
leveled TPO antibody. level (more specific to Hashimoto)

62
Q

Risk factors for Hasimoto’s thyroiditis include

A

F and personal or FH of autoimmune disorder

higher rates in: those with T1DM, Turner syndrome, ADDisons, Hep c

63
Q

Exam - Symptoms & Signs of hashimoto

A

fullness in neck, fatigue, weight gain, cold intolerance, muscle pain

64
Q

Treatment

_________ ameliorates the hypothyroidism and may reduce goiter size.

A

levothyroxine

65
Q

most common types of 1ID. (primary immunodeficiency)

A
  1. Antibody ****
  2. combined B-cell and T-cell,
  3. phagocytic,
  4. complement disorders
66
Q 
Antibody Disorders (55% of 1ID Worldwide)
Children with these diseases tend to hav
A

bacterial fungal infections with. unusual shit, severe or reccurent infections with common things

67
Q

are the most common type of 1ID disease.

A

antibody disorders (55%

68
Q

Antibody disorders can be broadly characterized by the

A

absence or presence of B cells.

69
Q

When B cells are present, disorders are further characterized by whether the

A

quality. and quantity of B cells are normal

70
Q

_______of 1ID is the strongest predictor of disease

A

FH

71
Q

types of AB disorders

A
  1. Agammaglobulemia: (X-linked Bruton tyrosine kinase def): born absent of B cells, all Igs are decreased
  2. Hypogammaglobulinemia- low or def in IGs or abnormal response of Igs to vaccinations
72
Q

In the United States, _____ deficiency is the most common type of B-cell disorder.

A

IgA

73
Q

common sx of hypogammaglob

A

ear, sinus and pulmonary infections

74
Q

T-Cell Disorders (10% of 1ID)

A

presence of absence of T cells. bc they. are. important for B cell functioning, most T cell def lead to combined T and. B cell disorder

75
Q

T-cell disorders usually present _______.

Most serious form of T-cell disorder, S________presents in infants as an emergent condition with lifethreatening
infections.

A

EARLY IN LIFE

SCID (severe combined immunodeficiency)

76
Q

Diarrhea, failure to thrive, opportunistic infections, and severe routine infections in a child younger than ________ should raise
suspicion for SCID and/or HIV.

A

3 months

77
Q

Phagocytic disorders are the result of abnormalities in ______________/

.
CHRONIC GRANULOMATOUS DZ is the most common phagocytic disorder in the ESID registry. Usually diagnosed by _________

A

monocytes, neutrophils

  1. yo.
78
Q

Chronic granulomatous disease: first manifestation could be ____.
Infections are related to what?

A

omphalitis (infection of umbilical stump)

inability. of our body. to kill catalase + organisms

79
Q

Complement Disorders (2% of 1ID)- 25 proteins compliments the actions of Ab to kill bacteria.

These disorders involve infections with ______

def of C3 ->
Def of C5-C9 -?
A

encapsulated organisms.

  • C3-> S.pneumonia and H influence
  • C5-C9: Neisseria meningitidis infections such as meningitis, sepsis, and arthritis.
80
Q

why is it hard to identify kids who need eval for 1ID

A

The most common presentations of a primary immunodeficiency disease in children are recurrent ear, sinus, and pulmonary infections;
diarrhea; and failure to thrive. These conditions are also common in children who do not have an immunodeficiency disease

81
Q

Three most helpful warning signs for primary immunodeficiency disease were:

A
    • FH
  2. Diagnosis of sepsis tx with IV Abs
  3. failure. to thrive
82
Q

who should be screened. for P1D?

A
  1. child with recurrent serious infection, who has a + FH OR is from an ethnicity assx with higher parental chances. (African American)
83
Q

A child with recurrent infections in a single anatomic location is more likely to have an wha

what. about if two or. more sights?t

A

anatomic defect than an immunodeficiency.

2 or more. sites-> suspect immodeficiency

84
Q

Acute HIV infection (aka primary HIV infection or acute retroviral syndrome)

A

period just after initial HIV infection, typically before seroconversion

85
Q

Acute HIV infection (aka primary HIV infection or acute retroviral syndrome)

what is it

A

period just after initial HIV infection, typically before seroconversion

some pts asymptomatic, but often manifests with transient symptoms related. to high levels of HIV replication and subsequent immune response

86
Q

-Misdiagnosis of HIV is common because symptoms

A

symptoms of acute HIV infection (e.g., fever, rash, malaise, sore throat) mimic other, more prevalent
conditions, such as influenza.

87
Q

signs sx of acute HIV infection

A

fever, sore thoat, malaise/fatigue, weight loss, ulcers, rash, myalgia/ arthralhia

88
Q

Differential Diagnosis of Acute HIV Infection

most common

A 
Epstein-Barr virus
, Influenza,
 Streptococcal pharyngitis, 
Viral/noninfectious gastroenteritis, 
Viral URI
89
Q

Acute HIV infection is often described as __________, with the most prevalent symptoms being fever, fatigue,
myalgias/arthralgias, rash (typically an erythematous maculopapular exanthem), and headache.

A

mononucleosis-or influenza-like

90
Q

should we diagnose anyone with acute HIV?

A

no.
be aware of the communities that do have it but retain a low threshold to consider cute infection in anyone presenting with sx. Exam should be thorough and assess activities that involve HIV exposure; INCLUDING HETEROSEXUAL sex

91
Q

HIV clinically resembles a __________ and should be considered in newborns and adolescents who have

A

T-cell immunodeficiency disorders like SCID

diarrhea, failure to thrive, unusual opportunistic infections

92
Q

Exam of acute HIV

A

big spleen

93
Q

testing HIV

A
  1. HIV viral load: measures. HIV/ DNA or HIV RNA using RCR testing
  2. ELISA

time from infection -> detection: 11012 days

94
Q

how can we diagnose type III

A

Arthus reaction

chicken, mushroom works, rodents, any type of farmer farming relating thing,

–> deposits in lungs

95
Q

Type IV

A
  1. poison ivy- has linear vascular lesions
  2. PPD skin test
    3.

PCM II Exam 1 (5 decks)

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