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Immunology BPT > Immunology > Flashcards

Immunology Flashcards

1
Q

What are the key differences between the innate and adaptive immune systems?

A

Innate
- Rapid, first line of defence
- Antigen- independent (non specific)
- No immunological memory on subsequent exposure

Adaptive
- Slower, second-line of defence
- Antigen- dependent and specific
- Has immunological memory - can respond quick on subsequent exposure to a previous antigen

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2
Q

What are the main classifications of vasculitis and some examples of these

A
  1. Large vessel vasculitis (GCA and Takaysu arteritis)
  2. Medium vessel vasculitis (Polyarteritis nodosa, Kawasaki)
  3. Small vessel arteritis (garnulomatosis with polyangiitis, microscopic polyangiitis, eosinophilic granulomatosis polyangiitis)
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3
Q

What are the two types of small vessel vasculitis

A

ANCA and immune-mediated

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4
Q

Name the different types of ANCA

A

cANCA (against peroxidase 3) and pANCA (against myeloperoxidase)

cANCA predominant - Granulomatosis with polyangiitis

pANCA predominant - microscopic vasculitis and eosinophilic GPA

Note: cANCA vasculitis is associated with higher rates of relapse

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5
Q

what are the markers of activity in ANCA vasculitis

A

CRP and ESR

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6
Q

what diseases are associated with elevated ANCA levels

A

Very high levels: small vessel vasculitis

Higher than normal levels:
- Resp: ILD, cystic fibrosis
- Gastro: UC and, to lesser extent, Crohns
- Rheum: RA, SLE

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7
Q

What are the clinical features of granulomatosis polyangiitis

A
  • ENT: chronic rhinitis/otitis, mucositis, conjuncitivitis/iritis, corneal ulcers, ulceration of nasal septum which can cause perforation “Saddle nose”, gingivitis “strawberry gums”
  • RESP: bilateral peripheral lung lesions - granulomatous necrotising lesions. Can manifest as symptoms of pneumonia (cough, dyspnea, pleuritic chest pain)
  • RENAL: pauci-immune rapidly progressive GN (hematuria and rbc casts)
  • SKIN (lower limbs): non-blanching papules, Livedo reticularis
  • CARDIAC: pericarditis, myocarditis
  • CNS: mononueritis multiplex
  • CONSTITUTIONAL: fatigue, fever, weight loss, malaise, arthralgia
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8
Q

How do you diagnose GPA

A

Gold standard is biopsy (lung or renal):
- necrotising granulomatous inflammation
- giant cells
- macrophages

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9
Q

What investigations would you do to investigate GPA

A

Urine: UA (hematuria), ACR/PCR, casts

Bloods: ANCA, leukocytosis, thrombocytosis, normocytic anemia, ESR/CRP, raised creatinine

Imaging: CXR/CT chest

Biopsy

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10
Q

What is the first lie induction treatment for GPA

A

Severe disease: glucocorticosteroids + rituximab OR cyclophosphamide

Non-severe disease: MTX + glucocorticosteroids

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11
Q

What is the maintenance treatment for GPA

A

Any one of these: rituximab or MTX or azathioprine or mycophenolate

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12
Q

What is the rate of relapse for patients with GPA

A

50-70%

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13
Q

Name 3 complications of GPA vasculitis

A

Due to disease
o Nasal deformity
o Renal impairment
o Respiratory insufficiency

Due to treatment
o CYC: infections and balder cancer in 16% after 15 years
o Prednisolone related complication

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14
Q

What type of vasculitis is Polyarteritis Nodosa

A

medium vessel vasculitis (necrotising inflammation)

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15
Q

What are some clinical features of PAN?

A

Renal: hypertension, renal infarct
Skin: purpuric rash, subcutaneous nodules, vesicular lesions, levido reticularis
GIT: abdo pain, PR bleeding, N/V, melena
CNS: mononueritis multiplex

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16
Q

Which organ is not typically involved in PAN which is involved in GPA?

A

Lungs

17
Q

What sites does PAN normally occur

A

bifurcation of arteries

18
Q

What virus is commonly associated with PAN

A

Hep B

19
Q

What virus is cryoglobulinemia vasculitis associated with

A

Hep C

20
Q

Does PAN have granulomas as part of its typical histopathology on a biopsy sample

A

No. PAN has necrotising inflammation characterised by fibrinoid necrosis (no granulomas or eosinophils)

21
Q

What are some typical CT angiogram findings of PAN

A

Aneurysms
Stenosis
Occlusion of vessels

22
Q

what is the pharmacological management of PAN

A

Severe: prednisone + CYC

Non-severe: prednisone + MTX or azathioprine

Note: does not include rituximab as there are not auto-Ab in Its pathogenesis

23
Q

What demographic is mostly affected by Kawasaki vasculitis

A

children of Asian ethnicity

24
Q

What demographic

A

Immunology BPT (1 decks)

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