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Differential Diagnosis > Immunologic Disease > Flashcards

Immunologic Disease Flashcards

1
Q

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

A

lymphoid cells

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2
Q

Name 4 General S&S of Immune System Disorder

A

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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3
Q

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

A

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

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4
Q

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

A

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

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5
Q

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

A

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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6
Q

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

A

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

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7
Q

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

A

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

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8
Q

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.

A

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

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9
Q

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

A

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

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10
Q

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

A

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

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11
Q

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

A

Hypersensitivity Disorders

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12
Q

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

A

Allergies

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13
Q

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.

A

1) allergen
2) mast
3) histamine

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14
Q

__ 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)

A

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

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15
Q

__ __ 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

A

Fibromyalgia Syndrome (FMS)

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16
Q

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.

A

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

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16
Q

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

A

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

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17
Q

5 primary FMS S&S

A

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

also can include other S&S from image
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18
Q

__ 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).

A

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

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19
Q

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

A

1) female
2) 30-50s

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20
Q

__ __ 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?

A

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

21
Q

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

A

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

22
Q

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

A

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

23
Q

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

A

1) joint
2) loss
3) >2 weeks

24
Q

Name 4 extra-articular manifestations of RA

A

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

25
Q

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?

A

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

26
Q

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?

A

1) Polymyalgia Rheumatica
2) white

27
Q

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

A

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

28
Q

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.

A

Systemic Lupus Erythematosus (SLE)

(Lindsey’s Dx!)

29
Q

What is this key S&S of SLE called?

A

Malar
the pretty red butterfly :)

30
Q

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

A

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

31
Q

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

A

1) Scleroderma
2) Localized & Systemic

32
Q

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.

A

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

33
Q

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

A

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

34
Q

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

top=sclerotic __ on skin / bottom=sclerodactyly
A

1) plaques
2) hyperpigmentation
3) atrophy

telangiectasia: small, widened vessels on the skin

telangiectasia
35
Q

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

A

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

36
Q

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

A

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

37
Q

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

A

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

38
Q

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?

A

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

39
Q

Take a moment to review clinical criteria for spondyloarthropathy.

A

Main takeaway is early SIJ imaging

40
Q

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 __ __

Bamboo sign on imaging
A

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

May want to review AS notes from C-spine lecture as well (pictured)

41
Q

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.

A

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

42
Q

Name 5 ReA unique S&S

A

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

43
Q

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.

A

1) criteria
2) psoriasis
3) skin

44
Q

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?

A

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

45
Q

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).

A

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

46
Q

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

A

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

47
Q

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

A

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

48
Q

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

A
  • 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
49
Q

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.

A

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.

50
Q

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)

A

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

51
Q

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

A

Differential Diagnosis (3 decks)

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