Immunologic Disease Flashcards by Lindsey Rogers

We know the function of the immune system already. However, immunity is provided by what cells in the immune system?

lymphoid cells

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Name 4 General S&S of Immune System Disorder

1) Change in skin/nails
2) Fever
3) Lymph node TTP or enlargement
4) Anaphylactic Rxn
5) Muscle/joint involved (swelling/stiff/weak or pain)
6) Sleep disturbance
7) Raynaud’s phenomenon

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A cytopathogenic virus that can cause AIDs is __. It can be transmitted via bodily fluids and the greatest mode of transmission are (2).

1) HIV (Human Immunodeficiency Virus)
2) Unprotected sex & Percutaneous transmission

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RFs for HIV include sex workers, injectable drug users, gay people, transgender, and __(3)_.

1) blood/dialysis/organ recipients
2) babies/fetuses of mothers w/ HIV
3) pts w/ STDs

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There are __ stages of HIV. The most contagious stage of HIV which also can present with flu-like S&S is __.

1) 3 stages
2) Stage 1: Acute HIV infection

Flu-like S&S w/ appear w/in 2-3 wks post-infection. They include fever, diarrhea, malaise/fatigue, & myalgias

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Stage __ is clinical latency or HIV inactivity/dormancy. Generalized __ may occur.

1) Stage 2
2) lymphadenopathy (lymph node swelling)

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Stage 3 is advanced HIV infection, or AIDS!! Pt presents with fatigue, fever, night sweats, thrush/yeast infections, & prolonged recovery. Name 3 more S&S of this HIV Stage.

ADC = AIDS Dementia Complex

1) a low CD4 count (<200)
2) vulnerable to infection and ADC
3) HIV wasting/dementia

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AIDS is when HIV results in ___ WBC destruction and this leads to the immune system being severely compromised. Name 4 opportunistic infections/diseases that can infect pts w/ AIDS.

1) CD4
2) Tb, Syphilis, Herpes simplex virus 1, Bacterial pneumonia, GI disorders, Skin infections, Salmonella, Toxoplasmosis, Bacterial lymphadenopathy

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Conditions associated with AIDs include Kaposi’s __, ___ Lymphoma, & HIV __ Disease.

1) Kaposi’s Sarcoma
2) Non-Hodgkin’s Lymphoma
3) HIV Neurologic Disease

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1) Name 3 HIV neurologic diseases that may involved demyelination of CNS/PNS tissues.
2) Name 5 S&S of these

We discussed these in neuro

1) MG, MS, GBS
2) Concentration & memory deficits, Personality changes, HA, Seizure, Paralysis, motor deficits, Numb/tingling, radiculopathy

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An excessive response from immune sys. leads to undesirable rxns & chronic disease states are __ disorders.

Hypersensitivity Disorders

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There are 4 types of hypersensitivity disorders but we will discuss Type 1: Immediate Rxns.
Type 1 is commonly assoc. w/ __.

Allergies

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Hypersensitivity Type 1 Disorder Pathophysiology:

Pt sensitized by a specific __. Antibodies bound to __ cells, then bind to the antigen.
Results in release of __ & inflammatory cytokines.

1) allergen
2) mast
3) histamine

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__ is a sudden hypersensitivity rxn that can be fatal. 2 or more red flags can indicate this is occurring, what are those red flags? (3)

1) Anaphylaxis
2) reduced BP, resp. dysfxn, and skin/mouth changes (swollen, hives, itch-flush)

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__ __ is a non-inflammatory disorder with generalized MSK pain + TTP and other S&S.

NOT an autoimmune disorder but common in pts w/ autoimmune diseases

Fibromyalgia Syndrome (FMS)

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There’s controversy over whether FMS has abnormal biochemical or immunological aspects, but potential triggers include (3). FMS pain is __ mediated/sensitized, therefore less likely d/t __ input.

1) viral infection, traumatic event, stress
2) centrally
3) nociceptive input

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FMS prevalence is only 2-8% of the pop, being more common in the __ gender and less common in __ age adults.

1) females
2) older adults; Age of onset usually preadolescents to early postmenopausal women

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5 primary FMS S&S

1) Myalgia
2) Swelling
3) Stiffness
4) Tender points of palpation
5) Muscle spasms and/or nodules

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__ is an autoimmune systemic inflammatory disease that interferes w/ synovial membrane, resulting in bony degradation of bilat/symmetric joints, most commonly (3). RA can also impact __ & most likely d/t __ & infection triggering auto-immune response (environment).

1) RA (Victoria’s Dx)
2) wrist, hands, & feet joints
3) organs
4) genetics

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RA is more rare than FMS, more likely in __ gender, and common in __ ages.

1) female
2) 30-50s

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__ __ and __ is key to prevent progression of joint destruction in early RA. What are 3 RED FLAGS for referral of a pt w/ early inflamm. S&S?

1-3) Early dx & tx
4) 1. Severe discomfort on compression of MCP & MTP joints
2. 3 or more swollen joints
3. Morning stiffness lasting longer than 60 mins

RA MSK Manifestations

Feet S&S: MTP head subluxation, __ tendon shortening
Hand S&S: MCP sublux., __ deviation of fingers, (2 deformities)
Wrist: tenosynovitis, CTS, interosseous atrophy, bony ankylosis

Both Feet and Hands can have an ASYMPTOMATIC tendon rupture+swelling

1) extensor
2) ulnar
3) Swan neck, boutonniere deformities

The shld, elbows, and C-spine can also be affected by RA. What are clinical manifestations?
C-spine (1), Elbow (3), Shld (4)

Shld: adhesive capsulitis/limited mobility, dislocation, sudden RCM tears
Elbow: flex contracture, sup/pron loss, Ulnar N compresssion
C-Spine: C1/C2 laxity can lead to SC compression

S&S for RA also include redness/warmth in a __, unexplained wt __, fever, or weakness in add. to joint pain, & symptoms last ____ weeks.

1) joint
2) loss
3) >2 weeks

Name 4 extra-articular manifestations of RA

Rheumatoid Nodules, Atherosclerosis, Arteritis, Anemia, Neuropathy, Scleritis, Pericarditis, Lymphadenopathy, Splenomegaly, CV disease, Interstitial lung disease

# American College of Rheumatology & European League Against Rheumatism CS Classification Criteria for Rheumatoid Arthritis tests pts w/ at least 1 joint swelling & synovitis not explained by anything else. A score of ___ is needed to dx RA. What 4 components are being assessed for criteria?

1) > 6/10 2) #/size of joints involved, serology, Acute-phase reactants, Duration of S&S

With an unknown cause, what is the most common inflammatory rheumatic disease in the elderly population (>50 y/o)? What race is this disease most common in?

1) Polymyalgia Rheumatica 2) white

S&S of polymyalgia rheumatica include bilat __ muscle pain/aching/stiff, morning __ >30 mins, fatigue/malaise or anorexia, & _(3)_.

1) PROXIMAL muscles groups (vs RA) 2) morning stiffness 3) low-grade fever, HAs, VISION LOSS

This chronic disease injures the skin, joints, kidneys, NS, & mucous membranes. Its more common in minorities, women, and common age onset is 15-40 y/o.

Systemic Lupus Erythematosus (SLE) (Lindsey's Dx!)

What is this key S&S of SLE called?

Malar the pretty red butterfly :)

SLE S&S include constitutional S&S, skin changes, MSK changes, NS involvement, and others! Specifically name these S&S.

**Constitutional**: fever, arthralgia/myalgias, HA, wt loss **Skin**: malar & rash on arms/hands/fingers, Raynaud's Phenomenon **MSK**: arthralgia/arthritis **NS**: Peripheral Neuropathy, CVA/CVD, seizures, psychosis **Other**: ulcers (mouth/nose/vagina), kidney/pulm involved, anemia, photosensitivity

__ is a chronic, multi-system disease that causes inflammation & fibrosis of many body parts. 2 sub categories are __.

1) Scleroderma 2) Localized & Systemic

Localized scleroderma is __ and confined to skin or subtissue. It is more common in __ gender, __ race, and commonly dx at __ y/o & kids __ y/o.

1) benign 2) women 3) white 4&5) 50 y/o or 2-4 y/o

Localized is usually just sclerosis of the __ and __ contractures, but __, __, __, & __ involvement can develop

1&2) fingers & flexion contractures 3-6) pulmonary, esophageal, renal, & cardiac

Localized scleroderma S&S include multiple circular sclerotic __ on skin, __pigmentations, muscle __, sclerodactyly (shiny thin skin) and telangiectasia

1) plaques 2) hyperpigmentation 3) atrophy *telangiectasia: small, widened vessels on the skin*

Systemic scleroderma is uncommon, has __-organ involvement, with a __ mortality rate. EARLY S&S include _(2)_.

1) multi-organ 2) high 3) Raynaud's phenomenon & GERD

Unique S&S of diffused systemic scleroderma: _(long/short)_ hx of Raynaud's phen., **prox.** skin sclerosis, severe __ fibrosis, & incr. risk of __ & __ involvement.

1) SHORT 2) lung/pulmonary 3&4) renal & cardiac involvement

S&S of limited systemic scleroderma: _(long/short)_ hx of Raynaud's phen., **dist.** skin sclerosis, Pulmonary __, severe __ disease

1) LONG 2) Pulm. HTN 3) Severe GUT diease

A group of noninfectious, inflamm., erosive rheumatic conditions that target Spinal & Peripheral joints are __. What are 4 types specific disorders? Of these, which only affect peripheral joints?

1) Spondyloarthropathy 2) Ankylosing Spondylitis (AS), Psoriatic arthritis (PsA), Reactive Arthritis (ReA), Inflammatory Bowel Disease (IBD)-related arthritis 3) PsA, ReA *may have extra-articular manifestions, refer to pic*

Take a moment to review clinical criteria for spondyloarthropathy.

*Main takeaway is early SIJ imaging*

# Modified New York Criteria: AS Dx 1) Imaging shows bilat sacroilitis gr. __ OR unilat sacroilitis gr. __ to __ +PLUS+ 2/3 Clinical Criteria: 1) LBP/stiff __ mo., allev. by __, NOT __ 2) Limited motion of L-spine (sag & fron. planes) 3) Limited __ __

1) Bilat. sacroilitis gr. 2 or more OR Unilat. sacroilitis gr. 3-4 +PLUS+ 1) LBP/stiff =/>3 months, allev. by exercise, NOT rest 2) limited L spine motion 3) Limited chest expansion ## Footnote May want to review AS notes from C-spine lecture as well (pictured)

ReA, aka __ syndrome, presents after a bacterial infection of __ or __ tract. It's essentially a triad of __, __, & nonspecific __. Risk is higher for adults, __ after enteric infection, and __ after venereal infection.

1) Reiter's 2&3) GI or urogenital tract 4-6) arthritis, conjunctivitis, & nonspecific urethritis 7) women 8) men

Name 5 ReA unique S&S

1) Bilateral conjunctivitis and iritis (eye irritation) 2) Urethritis 3) Plantar fasciitis 4) Small joint involvement 5) Low back and buttock pain Other: Low-grade fever, Skin resembling psoriasis, Anorexia/wt loss, Polyarthritis (mult. joints involved), SIJ changes

PsA has mult., heterogenous, MSK, & derm/skin features. There is NO validated dx __. It occurs in 1/3 of pts with __, both sexes equally, & ages 20-30s. Onset of arthritis is acute or insidious & is preceded by __ disaese.

1) criteria 2) psoriasis 3) skin

S&S of PsA include ankylosis of the spine, morning stiffness >30 mins, uveitis/mouth ulcers/urethritis, & colitis. What are 3 other S&S of PsA?

**Skin lesions:** dry, erythematous, often overlapping silver-scaled papules & plaques **Nail lesions:** pitting, ridging, cracking, onycholysis(separation of nail from the nail bed), brown-yellow discoloration, & destruction of the nail **Arthritis**: symmetric distal distribution

Lyme disease is caused by a bite from a __ __ infected with spiral bacterium or spirochete. S&S include red rash, __-like S&S, __ MSK pain, & NS S&S _(name these 4)_.

1) deer tick 2) flu-like symptoms 3) migratory 4) **NS**: severe HA, numb/pain/weak UE/LEs or radiculopathy, incoordination, COGN DYSFUNCTION

Less common S&S of Lyme are __ problems, and __ abnormalities. Late Lyme Infection S&S include __ (intermittent or chronic), encephalopathy, neurocogn dysfunction, or __ neuropathy.

1) eye 2) heart 3) arthritis 4) peripheral

MG impacts __ junction. Early onset is more likely in __ gender & younger (20-30s), and Late onset is more likely in __ gender & older (> __ y/o).

1) NM 2) women 3&4) men & > 50 y/o

MG Symptom intensity fluctuates. Name 4 unique S&S of MG.

- Muscle fatigue & proximal muscle weakness aggr. by exertion - Ptosis, Diplopia - Dysarthria, Bulbar involvement, Alteration in voice quality, Dysphagia, choking - Nasal regurgitation - Pain - Resp. failure from progressive involvement of respiratory muscles

**Red Flags that Require Immediate Medical Attn:** 1) Anaphylactic shock - esp. these S&S _(3)_ 2) ReA - new onset of joint pain with a recent __ 3) dusky __ or erythema joint + TTP is a sign of a __ joint.

1) Voice hoarse, difficulty breathing, chest discomfort/tightness 2) New joint pain w/ recent **surgery** hx 3) blue or red joint + TTP is a sign of a **septic** (infected) joint.

**Red Flags for REFERRAL if pt is direct access:** 1) new joint pain w/in __ wks of surgery, esp + constitutional s&s, rash, or skin lesions 2) __ swelling/pain in peripheral joints 3) NS s&s w/in __ wks of previous infection or vaccination 4) SC compression with __ __ 5) B&B incontinence in anyone with __ 6) (+) Ptosis tests for __ (ice pack, rest test, sleep tests)

1) 6 wks 2) symmetric 3) 1-3 wks 4) cervical RA 5) AS 6) MG

Whew..finally the end!! Take a second to review some clues for IDing immune system dysfunction.