Immunologic Disease Flashcards
We know the function of the immune system already. However, immunity is provided by what cells in the immune system?
lymphoid cells
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
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
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
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
Stage __ is clinical latency or HIV inactivity/dormancy. Generalized __ may occur.
1) Stage 2
2) lymphadenopathy (lymph node swelling)
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
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
Conditions associated with AIDs include Kaposi’s __, ___ Lymphoma, & HIV __ Disease.
1) Kaposi’s Sarcoma
2) Non-Hodgkin’s Lymphoma
3) HIV Neurologic Disease
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
An excessive response from immune sys. leads to undesirable rxns & chronic disease states are __ disorders.
Hypersensitivity Disorders
There are 4 types of hypersensitivity disorders but we will discuss Type 1: Immediate Rxns.
Type 1 is commonly assoc. w/ __.
Allergies
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
__ 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)
__ __ 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)
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
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
5 primary FMS S&S
1) Myalgia
2) Swelling
3) Stiffness
4) Tender points of palpation
5) Muscle spasms and/or nodules
__ 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
RA is more rare than FMS, more likely in __ gender, and common in __ ages.
1) female
2) 30-50s
__ __ 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
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.
