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RACP 2023 > IMMUNOLOGY > Flashcards

IMMUNOLOGY Flashcards

1
Q

Types of vasculitis?

A

LARGE
- GCA: granuloma assoc
- Takayasu: granuloma assoc

MED
- Kawasaki
- PAN
- Thromboangiitis obliterans

Small
- Paucity: Granuloma- EGPA, GPA, Non granuloma- MPA
- Immune complexes: Cryoglobin, HSP, CTD, malignancy
- Other: Behcets

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2
Q

Most specific signs for GCA?

A

Limb claudication
Jaw claudication

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3
Q

Treatment for GCA/PMR?

A

Steroids
Tocilizumab if can’t tolerate steroids
Aspirin reduces mortality

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4
Q

Takayasu arteritis classic px?

A

Female
Young
Women
Aorta/Abdominal aorta/ BP

Biopsy: granulomas

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5
Q

PAN presentation and classic associations?

A

Renovascular HTN
Mononeuritis multiplex

NO; pulm haemorrhage, GN

Assoc: hep B/C

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6
Q

PAN treatment?

A

Treat cause!!!!!
If no cause: steroids and immunopression

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7
Q

How to differentiate MPO/GPA/EGPA?

A

MPA: no upper airway, granulomatous
GPA: granulomas, upper airway
EGPA: sinusitis, asthma, eosinophilia, granulomas, MPO +, assoc mononeuritic multiplex

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8
Q

Treatment MPA/GPA?

A

Ritux/cyclo/steroid induction

Ritux maintenance

NO PLASMA EXCHANGE

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9
Q

Significance of ANCA titres in monitoring vasculitis?

A

Unclear of significance of titre
- if still (+): poor prognosis

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10
Q

HSP (IgA vasculitis) classic hx and sign?

A

Hx: gastro/resp infection preceding
OE: leukocytoclastic rash over buttocks, LL

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11
Q

Cryoglobulinemia associations and type?

A

I: MM
II: hep B/C, Sjogrens
III: AI inflammation e.g. RF

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12
Q

Cryoglobulinemia key feature on blood tests?

A

Low complement

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13
Q

Cryoglobulinemia treatment?

A

Steroids
Plasma exchange
Treat cause

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14
Q

Behcets treatment?

A

Topical
Steroids
Inflix if refractory

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15
Q

Cogan’s Syndrome treatment?

A

Vesibulo-auditory
Keratitis
Aortitis

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16
Q

Which drugs can cause vasculitis?

A

Same drugs that can cause SLE
- HCT, BB, ACEI
- Hydralazine
- Isoniazid
- Phenytoin, CMZ
- Minocycline
- PTU
- TNF alpha inhibitors
- Statins
- Lithium/ chloperamazine
- Procainamide

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17
Q

Live vaccines?

A

MOBY JVH

MMR
Oral typhoid
BCG
Yellow fever
Japanese encephalitis
Varicella
Herpes Zoster

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18
Q

Pregnancy vaccines?

A

Before
- MMR
- Hep B
- Pneumococcal
- Varicella

During
- inactive influenza
- whooping cough

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19
Q

Vaccinations for asplenia?

A

Protect Me I’m Immunocompromised = ENCAPSULATED ORGANISMS
- Pneumococcal (conjugated then polysaccharide)
- Meningococcal
- Influenza
- Hemophilus Influenzae

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20
Q

Management of an asplenic patient?

A

Amoxicillin 250mg daily / phenocymethylpenicillin 250mg BD
Sick: Amoxi 2g STAT –> delabel/ densesitise OR cefuroxime 500mg

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21
Q

Egg vaccines?

A

Q fever
Yellow fever

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22
Q

Difference between conjugated and polysaccharide vaccines?

A

Conjugate: more immunogenic, covers less serotypes
Unconjugated:

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23
Q

How is a T cell primed to fight?

A

APC presents to CD4+
Costimulatory molecules B7 and CD28 activates cell
Differentiates into Th classes

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24
Q

What is each Th class associated with?

A

Th1
- IGN-gamma
- macrophages
- intracellular pathogens
- inflammation

Th2
- IL4,5,13
- Eosinophils
- Parasites
- allergy

Th7
- IL 17, 22
- neutrophils
- extracellular
- AI

Tfh
- IL21
- B cells
- extracellular
- AI

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25
Q

Role of immunotherapy in allergy?

A

YES
- bee/wasp
- allergic rhinitis

NO
- large local reactions

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26
Q

Effect of immunotherapy in allergy?

A

Changes TH2 –> TH1 and IgG
Reduces risk of severe reaction

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27
Q

Hypersensitivity type I: mediator and examples?

A

MEDIATOR
- IgE
- Sensitisation changes to Th2; next time allergen encountered, antigen binds on IgE (on mast cells), cross links and activates –> mediator production

EXAMPLES
- Anaphylaxis
- Urticaria
- Angioedema
- Asthma
- Rhinitis
- Allergic oncjunctivities
- Bee venom
- Penicillin/contrast
- Pollen
- Latex

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28
Q

Hypersensitivity type II: mediator and examples?

A

MEDIATOR
- IgG –> MAC

EXAMPLES
- hemolytic anemia
- transfusion reactions
- HITTS
- RF
- Good pastures

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29
Q

Hypersensitivity type III: mediator and examples?

A

MEDIATOR
- antibody/antigen complex

EXAMPLES
- GN
- Vasculitis
- RF
- MPGN
- IgA nephropathy
- SLE
- SOMETIMES VENOM

30
Q

Hypersensitivity type IV: mediator and examples?

A

MEDIATOR
- T cell –> Th1

EXAMPLES
- SJS
- TENS
- TB skin test
- contact dermatitis
- DM
- interstitial nephritis
- DILI
- Scabies
- Erythema multiforme

31
Q

How long does tryptase remain elevated for?

A

5 hours

32
Q

New treatment options for:
- Allergic rhinitis
- Atopic dermatitis

A

Allergic rhinitis: Omalizumab, Immunotherapy

Atopic dermatitis: Topical dupilumimab

33
Q

Key features and diagnosis for mammalian meat allergy?

A

Pork/beef/lamb; takes time to manifest

IgE to alpha-gal

34
Q

Key features and diagnosis for wheat dependent exercised induced anaphylaxis?

A

Wheat –> exercise –> 1-4 hours later symptoms

IgE to omega gliadin

35
Q

Features of systemic mastocytosis + diagnosis?

A

Features
- recurrent anaphylaxis
- symptoms from organs infiltration
- typical symptoms: urticaria, flushing, pruritus
- causes: venom, drugs, exercise

Diagnosis
- KIT mutation
- biopsy –> mast cells
- serum tryp persistently > 20
- CD 25 on mast cells

36
Q

HAE testing results? C4, C1 quan, C1 func, C1q
- Type 1
- Type 2
- Type 3
- Acquired

A

Type 1: all low, C1q normal
Type 2: C4, C1 func low, C1q normal
Type 3: all normal –> FX11 def?
Acquired: All low, C1q low

37
Q

HAE treatment?

A

Icatibant: Bradykinin receptor competitive antagonist

38
Q

Cross reactivity between penicillin and cephalosporins?

A

2%

39
Q

Cross reactivity between penicillin and carbapenems?

A

1%

40
Q

Which drugs share same R1 side chains?

A

Amoxicillin, Ampicillin, cephalic, cefaclor

41
Q

If a drug is reacting to amoxicillin and other beta lactase, what is it reacting to?

A

beta lactam ring

42
Q

If a drug is reacting to amoxicillin and amp/cephalex/ cefaclor, what is it reacting to?

A

R1 side chain

43
Q

What hypersensitivity drug reaction can sulphonamides cause?

A

type IV

44
Q

What causes allergy in sulphonamide?

A

Arylamine group

45
Q

Cut offs for skin detachment in SJS/TEN?

A

SJS < 10%
TEN > 30%

46
Q

Key signs for SJS/TENS

A

Nikolsky: skin peels
Lutz: fluctuates

47
Q

B cell immunodeficiency most likely to cause?

A

Encapsulated
Sinopulmonary
GI

48
Q

T cell immunodeficiency most likely to cause?

A

Viral
Fungal

MOST SEVERE

49
Q

TLR deficiency 3/4/5 causes:

A

3: Legionella
4: sepsis gram -
5: herpes simplex encephalitis

50
Q

Early classical pathway deficiency causes:

A

AI diseases - SLE

51
Q

Late complement pathway deficiency causes

A

encapsulated organisms

52
Q

HLH diagnosis + tx

A

CD25
Elevated CXCL9
Hyperlipidemia
Fever
Splenomegaly
Elev ferritin
Low fibrinogen
No NK cell activity

TX: etoposide, T cell therapies

53
Q

How does COVID infect a cell?

A

Spike protein interacts with ACE2/ TMPRSS2 to facilitate fusion with membrane –> virus uptake

54
Q

Paxclovid MoA

A

Nirmatrelevir + ritonavir
- ritonavir boosts norma
- nirmatrelevir anti protease

55
Q

Remdes MoA

A

Inhibits RNA polymerase –> halts replication

56
Q

Molnupirivir MoA

A

incorporate into RNA –> halts replication

57
Q

Baracitinib MoA

A

JAK 12 inhibitor

58
Q

Toclizumab MoA

A

IL 6 inhibitor

59
Q

Evusheld MoA

A

antispike antibodies

60
Q

Pfizer and Moderna - describe vaccine type and MoA

A

mRNA

- mRNA code for spike polyprotein delivered to host cells
	○ Synthesises viral protein 
	○ Expressed on cell surface does NOT go to blood 
- Immune system reacts to spike protein
61
Q

Novovax - describe vaccine type and MoA

A

protein subunit

- Contains compounds that BEST stimulate immune system
62
Q

AZ - describe vaccine type and MoA

A

Viral vector

- Packages DNA into virus vector  --> carries into host cells
	○ Uses adenovirus vector from monkeys --> DOES NOT CAUSE RESPONSE FROM IMMUNE SYSTEM 
	○ Released into cytoplasm Host enzymes transcribe mRNA --> spike proteins --> expressed on cell
63
Q

Which hypersensitivities mainly cause drug allergies?

A

IgE
T cell mediated

64
Q

Cross reactivity percentage with carbapenems when you have an allergy to penicillin?

A

1%

65
Q

Most common drug related causes of IgE hypersensivity?

A

NSAIDs
penicillin
Contrasts
Cephalopthin

66
Q

Purpose of skin testing in drug allergies? Which drugs?

A

Limited group of IgE mediated

Available for: penicillin G and V, amoxicillin, ampicillin, cefaclor

67
Q

Common causes of SJS/TENS?

A

Bactrim
Cephalosporins 1+2
Penicillins
Anticonvulsants esp CMZ if HLAB*1501
NSAIDs esp oxicam
Allopurinol

68
Q

Immunotherapy indications + CI?

A

Allergic rhinitis
Bee/wasp anaphylaxis

CI
- asthma
- pregnancy

69
Q

Mechanism of immunotherapy?

A

Th2 –> Th1

Promotes IL10 and TGF-beta; inhibits IL4/5/13

Changes IgE –> IgG

70
Q

Sarcoidosis implicates which cell type as part of the inflammatory process?

A

T cell ylmphocytes

RACP 2023 (17 decks)

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