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CP1 > Immunology > Flashcards

Immunology Flashcards

1
Q

Describe the common presentations of allergy (type 1 hypersensitivity).

A 
May present as atopies: Eczema, asthma, rhinitis 
Features of an allergy reaction are:
Rash
Urticaria
Wheeze
Abdominal cramps
Hypotension

plus In anaphylaxis
Angioedema
Ango animi
Laryngeal oedema

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2
Q

What important factors should you ask about when taking a history investigating a possible allergy?

A 
Precipitating factors
Time of year
What actually happened
Past medical history
Drug history
Any family history
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3
Q

Describe the tests (and their limitations) used in the investigation of possible allergy

A

Skin prick test: Negative control used to decrease change of dermographism
Total IgE: Not allergen specific
Antigen specific IgE: Avoids dermographism, more specific
Challenge tests: Used to confirm negativity, only use in very safe environments

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4
Q

Outline tests for, diagnosis and management of anaphylaxis

A

Adrenaline 0.5ml 1:1000im
Oxygen
Anti histimine
Corticosteroids

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5
Q

Outline tests for, diagnosis and management of urticaria

A

Treat with antihistimines - certirizine hydrochloride

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6
Q

Outline tests for, diagnosis and management of angioedema.

A

Patients should be checked for compliment protein levels

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7
Q

Outline tests for, diagnosis and management of allergic rhinitis

A

Anti histimines
Intranasal corticosteroids
Local cromones

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8
Q

Outline the general principles in the assessment of a patient who has taken an overdose.

A

Take a good history!

If unconscious: ABCDE

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9
Q

Describe the clinical features of alcohol intoxication.

A 
in-corodination
Stupor
Unconsciousness
comma
Hypoglycaemia
Hypothermia
Hypotension
Respiratory depression
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10
Q

Describe the clinical features of paracetamol overdose

A 
Nausea and vomiting
Tender hepatic edge
Jaundice
Hypoglycaemia
Renal failure
Hepatic encephalopathy
Coagulopathy
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11
Q

List the indications and contraindications for the passage of a urethral catheter.

A 
Indications
Post surgery
Monitoring in unconscious patient
Obstructed urethra
Pre surgery
Longer term for neurogenic bladder and incontenance, post surgery

Contraindications:
Pelvic trauma
Blood around meatus
Acute prostatitis

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12
Q

List the alternatives for bladder drainage when urethral catheterisation is contra-indicated

A

Supra-pubic catheterisation

Ultrasound guided drainage.

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13
Q

List the factors which are risks for poor wound healing 8

A 
Infection
Hypoxia
Poor surgical technique
Previous radiation to the area
Sepsis
Systemic disease
Foreign body
Steroid treatment
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14
Q

List what is measured in a U&E investigation

A

Sodium
Potassium
urea
Creatinine

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15
Q

Given a patient’s weight, calculate the extracellular, intra-cellular and intravascular volume

A

60% of bodyweight is due to water.
2/3rds of that is intracellular
1/3rd is extracellular (25% is intravascular, meaining that 1/12 of total body water is intravascular volume.)
In women and obese patients, this figure may be 50%.

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16
Q

Calculate sensible and insensible fluid and electrolyte losses in routine post-operative care

A

Sensible (urine) 1500ml/day
Non-sensible (sweat, feces, breath) 1000-1500ml/day
Sodium and potassium 0.7-1mmol/kg

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17
Q

Calculate sensible and insensible fluid and electrolyte losses in a febrile patient (Temp 40C)

A

for every 1 degree celsius 10% more water is lost via insensible exit routes.

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18
Q

List the main endogenous factors that affect renal control of sodium and water excretion

A 
RAAS system, stimulated by:
Baroreceptors
Osmoreceptors
ADH
ANP
Hypothalamus - thirst
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19
Q

List the symptoms and physical findings of dehydration 8

A 
Dry mucosal surfaces
Reduced skin turgor
Dry axilla
Postural hypotension
Tachycardia
Change in consciousness
Dark urine
Sunken eyes
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20
Q

List the electrolyte composition of normal saline 0.9 Crystalloid

A

154Mmol/L of Na and Cl.

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21
Q

List the electrolyte composition of Hartmens/Ringer lactate. Crystalloid

A

130Mmol/L of Na, 109 of Cl, 28 of lactate, 4 of K and 1.5 of Ca.

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22
Q

List the electrolyte composition of 5% dextrose in water crystalloid.

A

50g/L of glucose

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23
Q

List the electrolyte composition of dextrose saline 0.18%

A

30Mmol/L of NaCl and 40g/L of glucoes

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24
Q

List the electrolyte composition of albumin solution colloid

A

Available as 4% and 20% solutions.

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25
Q

Define shock.

A

An acute circulatory failure with an inadequate or inappropriately distributed tissue perfusion, resulting in generalised cellular hypoxia or inability to use oxygen.

26
Q

List the types of shock 5 and their causes

A

Hypovolaemic: Haemorrhage, massive dehydration, burns
Cardiogenic: Massive MI, tamponade, PE, VT/VF
Septic: Infection - usually gram negative
Neurogenic: Spinal injury
Anaphylactic: Allergens

27
Q

Describe the effect of shock on the brain

A

Regional glucose uptake changes
Reflexes reduced
Cortical activity reduced
Brain suffers as cannot hibernate

28
Q

Describe the effect of shock on the heart

A

The heart may cause vasodilation, resulting in hypotension.

29
Q

Describe the effect of shock on the kidneys

A

Kidneys can hibernate in deeper levels of shock but integral to the maintenance of BP

30
Q

Describe the effect of shock on the lungs

A

Still receive good oxygen perfusion
However immune complexes are deposited and increased vascular permeability causes the recruitment of immune cells
Result DIC and ARDS

31
Q

Describe the effect of shock on the gut

A

One of the first organs to suffer
Splanchnic, autonomic nerve cause vasoconstriction, resulting in ischaemia
This results in the breakdown of the gut barrier and bacteraemia.

32
Q

Describe the effect of shock on the liver

A

Reperfusion injuries

33
Q

Describe the effect of shock on the bones

A

Massive build up of lactate and reperfusion injuries, however, resistant to ischaemia for 3 hours

34
Q

List the physical findings that characterise hypovolaemic shock 8

A 
Cold pale skin
poor cap refil
Oligo/anuria
Confusion, drowsiness, irritability
Tachycardia
Normal BP but may result in hypotension
Sweating
Metabolic acidosis may be present with respiratory compensation.
35
Q

List the physical findings that characterise cardiogenic shock 5

A 
Muffled heart sounds
gallop rhythm
pulsus alternans
Raised JVP
Basal crackles
36
Q

List the physical findings that characterise neurogenic shock

A

Shock with no cardiac response e.g. increase in heart rate

37
Q

List the physical findings that characterise anaphylactic shock 12

A 
Tachycardia
Warm peripheries
Hypotension
Peripheral oedema
Pallor 
cyanosis
Urticaria
Erythema
Angioedema
Nausea and vomiting
Abdominal cramps
Diarrhoea
38
Q

List the physical findings that characterise septic shock 6

A 
Warm peripheries
Pyrexia and rigors
nausea and vomiting
coma 
Jaundice
hypotension
39
Q

List physical findings that may suggest the presence of a bleeding disorder. 5

A 
Bruises/purpura
Bleeding
Haematoma
Haemarthrosis
Liver disease
40
Q

List the laboratory tests that would be helpful in the diagnosis of bleeding disorders 5

A 
FBC
PTT
APTT
TT
Correction tests
41
Q

List the factors that contribute to infection following a surgical procedure. 9

A 
Length of stay in hospital
Long procedure/poor surgical technique
Foreign bodies
Malnutrition
Age
Previous radiation
Immunosuppression
Obesity
Diabetes
42
Q

Describe the pathological basis of fibroadenomas and how they present

A 
Women <30
Abborations of normal breast tissue
'Breast mice'
Smooth, rounded, well circumscribed lumps
May be multiple of them.
Not usually fixed to the chest wall
43
Q

Describe the pathological basis of fibroadenosis and cyts and how they present

A

Women aged 30-50
May occur simultaneously
Often cyclical
Feel like bubble wrap

44
Q

Describe the aetiology, morphology and pathological consequences of carcinoma of the breast

A

May be in-situ or invasive.
2 main types - ductal or lobular
Most common form of cancer in women
May present with rashes, discharge, mass, dimpling, skin changes, rashes, local oedema
Mass feels spiky and may be tethered to underlying tissue.

45
Q

List the risk factors for carcinoma of the breast 8

A 
Female gender
Obesity
HRT
OCP
Early menarche/late menopause
age
Nulliparity
Not breast feeding for long enough
46
Q

Describe the diagnostic approach used in the diagnosis of a breast lump

A

Triple assessment:
History and physical assessment
Mammography and USS
Biopsy

47
Q

What noises may be heard during an obstructed airway?

A

Stridor - Anaphylaxis

Gargles

48
Q

Specify a definition of pain

A

Pain is an unpleasant sensory and/or emotional experience associated with actual or perceived tissue damage.

49
Q

Describe the adverse physiological effects of pain

A

Trouble sleeping, coughing, moving around, breathing

depression

50
Q

Describe the WHO pain ladder

A

Mild to moderate pain - non-opoids NSAIDs and paracetamol
Moderate to severe pain - mild opiods e.g. codeine
Severe pain - Strong opiods e.g. morphine

51
Q

Describe the WHO (World Health Organisation) checklist in patients undergoing electric surgical procedures

A

Patient wristband must be compared to consent form constantly.
Involves a kit check and an anaesthetics check as well as a sign in and out.

52
Q

Outline the causes of post-operative nausea and vomiting

A

More common in females, young people, those who do not smoke.
Due to:
Analgesics and anaesthetics used

53
Q

Describe the typical presenting symptoms and signs of a patient presenting with single regional pain resulting from an overusage/strain injury

A

Localised pain that occurs with movement.
Pain doesn’t get worse over time.
Usually only occurs over a certain range of movements
Patient can usually recall when injury occurred
May be associated with local inflammation and tenderness.
No systemic features.

54
Q

Differentiate between back pain arising from MSK structures from referred pain arising from other organs or systems

A

MSK pain usually in lumbar region, whereas organ pain usually thoracic region.
MSK pain is usually associated with exercise.
MSK pain usually short and self limiting whereas organ may be chronic and progressive
MSK pain may also have a sudden onset, recurrent and relieved by rest unlike organ pain.

Risk factors:
Age
Female gender
Other chronic illnesses
Dissatisfaction with job
Poor rating of self health
Poor posture
Pregnancy
55
Q

Describe the typical presenting symptoms and signs of a patient presenting with joint inflammation and/or joint damage and link with systemic disease.

A

Inflammation presents with: swelling, redness, warmth
Stiffness that lasts longer than 15 minutes in the morning suggests inflammation.
Inflammatory pain is generally worse with rest and gets better with exercise.
Sepsis, inflammatory arthritis and gout present as inflammatory joint pain.

56
Q

Describe the symptoms 4 and signs 6of osteoarthritis and specify the relative prevalence of knee, hip and hand osteoarthritis.

A 
Hip and knee OA affect 25% and 40% of the population.
Symptoms include:
Pain on exercise, relieved after
Joint gelling
Joint instability
Loss of function
Signs:
Decreased motility
Swelling
Bony swelling
Crepitus on movement
Joint effusion
Muscle wasting
57
Q

Describe the symptoms, signs and pattern of joint involvement in rheumatoid arthritis

A

Pain and stiffness in the small joints of the hands and feet.
Patient feels tired and unwell
Pain is worse in the morning and may get better throughout the day.
May improve slightly upon exercise

58
Q

What is osteoarthritis?

A

A decrease in bone density, leading to an increased risk of bone fractures.

59
Q

What are the symptoms of osteoarthritis?

A 
Usually asymptomatic until fracture occurs
May have
Kyphosis
Decreased height
Abnormal protuberance
Spinal tenderness
60
Q

What are the risk factors for osteoporosis? 10

A 
Hyperparathyroidism
Oestrogen deficiency
Vitamin D deficiency
Steroid use
Smoking
Alcohol abuse
Being white
Chronic renal/liver failure
Previous fracture
Myeloma

CP1 (10 decks)

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