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Year 3 > Immunology > Flashcards

Immunology Flashcards

1
Q

CREST syndrome

A

Calcinosis - calcium deposits in connective tissues
Raynauds -
Eosophageal motility - swallowing difficulty
Sclerodactyly - thick + tight skin on fingers from too much collagen build up
Teleangiectasia - red spots on hands + face

Anti-centromere antibodies
Connective tissue disease
Autoimmune disorder, where immune system appears to stimulate production of too much collagen which builds up in the skin and internal organs, impairing their function.

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2
Q

Sarcoidosis

A

Bilateral hilar lymphadenopathy, hypercalcaemia, erythema nodosum

Granulomas develop in the body

Commonly affects lungs, skin and eyes

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3
Q

Neutrophil dysfunction

A

Severe neutropenia - overwhelming sepsis

Dental sepsis + mouth ulcers can be an important indication there is an underlying defect in neutros

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4
Q

Antibody deficiency - clinical features

A

4-6m after full term delivery signs become apparent

  • recurrent infections with encapsulated + non-encapsulated pyogenic bacteria (S pneumoniae, H influenza) - U + L RTI, middle ear, meninges, skin, joints
  • viral infections unusual apart from enterovirus
  • not usually fungal or intracellular bacteria or parasitic
  • diarrhoea + malabsorption due to bacterial overgrowth in intestine (lack IgA)
  • septic arthritis
  • granulomatous lesions in lungs can give sarcoid picture
  • onset of sx in X-linked hypogammaglobulinaemia is in 4th/5th month
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5
Q

Investigation of antibody deficiency

A
  • measure total IgG, IgA and IgM
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6
Q

Investigation of complement deficiency

A

gross defects can be assessed by capacity of pt’s serum to lyse heterologous blood cells
if abnormal - possible to screen for individual components + do functional tests on discrete aspects of cascase
gross consumption of complement components often associated with low C4 and C3 levels

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7
Q

T cell deficiency

A

Most important cause now is HIV
Secondary lymphoma due to failure of T cells to control viruses such as EBV also a problem
- 2nd cause in adults is secondary to immunosuppressive therapy e.g. after transplantation

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8
Q

Investigation of T cell deficiency

A

T cell CD4 and CD8 count extremely useful for monitoring progress of AIDS

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9
Q

Infections associated with CD4 defiency

A

Protozoan e.g. pneumocytis carinii
Intracellular bacteria e.g. TB
Fungal/yeast e.g. candida, aspergillosis
Extracellular bacteria e.g. encapsulated pneumonia
Viruses e.g. CMV, EBV, herpes virus Kaposi’s sarcoma

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10
Q

Mediators of hypersensitivity reactions

A

Type 1: IgE, mast cell degranulation
Type 2: IgG, IgM, complement
Type 3: IgG, complement
Type 4: T cells

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11
Q

Examples of hypersensitivity reactions

A

Type 1: anaphylaxis, atopy, asthma, allergic rhinitis
Type 2: Graves, incompatible transfusions, autoimmune haemolytic anaemia
Type 3: SLE
Type 4: contact dermatitis, mantoux

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12
Q

Side effects of TB drugs

A

Rifampicin - orange red urine, hepatotoxicity, decreased effectiveness of oral contraceptives

Isoniazid - peripheral neuropathy (vit B6 given)

Pyrazinamide - gout

Ethambulatol - colour blindness + vision loss

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13
Q

Effects of mast cell mediators

A

Vasodilation
Increased vessel permeability
Gland secretion
Bronchoconstriction

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14
Q

Biphasic anaphylaxis

A

2 episodes 1-8hrs apart

Mast cells refill + degranulate again

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15
Q

Anaphylaxis management

A 
ABCDE
Adrenalin 1:1000 IM (repeat after 5mins)
High flow oxygen
Fluid challenge
Bronchodilator
Corticosteroids + anti-histamines
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16
Q

Tissue specific autoimmune conditions

A

Thyroid - Graves, Hashimotos
Adrenal - Addisons
GI - pernicious anaemia

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17
Q

What can predispose to autoimmunity?

A 
Female sex
autoantibodies
HLA class DQ2 and DQ8
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18
Q

How can loss of tolerance occur?

A

Immune privelege lost e.g. penetrating eye injury
Failure of Treg cells
Molecular mimicry e.g. rheumatic fever may follow infection with haemolytic strep

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19
Q

Anti-ds DNA

A

SLE

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20
Q

Anti-mitochondrial

A

PBC

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21
Q

ASMA (Anti-smooth muscle antibody)

A

Chronic active hepatitis

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22
Q

pANCA

A

UC

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23
Q

cANCA

A

Wegeners granulomatosis

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24
Q

Anti-endomysial/gliadin/transglutamase

A

coeliac + dermatitis herpetiformis

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25
Q

Anti-centromere

A

CREST/scleroderma

26
Q

Anti-Ro

A

Sjogrens syndrome

27
Q

Anti-La

A

Sjogrens syndrome

28
Q

Anti-Jo

A

polymyositis

29
Q

Rheumatoid factor

A

RA, sjogrens (90%), SLE (30%), 5% of normal pop

30
Q

ANA (anti-nuclear antibody)

A

SLE (95%)
AIH (75%)
Sjogrens (70%)

31
Q

Anti-phospholipid syndrome

A

High risk of blood clots
Recurrent fetal loss
Thrombocytopenia

Ix: IgG and IgM cardiolipin ABs and ABs to B2-glycoprotein

32
Q

Beta-lactams

A

Penicillin G e.g. benzylpenicillin IV
Penicillin V e.g. phenoxymethyl penicillin PO - strep throat
Amoxicillin - don’t give to EBV
Co-amoxiclav - can treat B-lactamase producing Hib, strep pneuomina, staph aurerus + anaerobes
Tazocin

33
Q

Cephalosporins

A

Extended spectrum B-lactamases resistant to all cephaosporins

e.g. cefotaxime

34
Q

Carbapenems

A

e.g. meropenam

Gram -ve bacteria beta-lactamases

35
Q

Glycopeptides

A

Vancomycin - if give bolus –> red man syndrome (pruritis and red rash)
MRSA + c.diff
Nephrotoxic

36
Q

Quinolones

A

Ciprofloxacin

37
Q

Macrolides

A

Erythromycin + clarithromycin
Safe in penicillin allergy - good alternative
GI side effects (erythro)

38
Q

Aminoglycosides

A

Gentamicin
Nephrotoxic
IV or IM
Pseudomonas + gram -ve bacteria (no anaerobes or streptococci)

39
Q

Tetracyclines

A

Don’t give to children or pregnant

Chlaymdia + acne

40
Q

Folate antagonists

A

Trimethoprim

41
Q

Virus associated with Kaposis sarcoma

A

HHV-8 (human herpes virus 8)

42
Q

How can we test for HIV?

A

Venous blood HIV Ag/ab test

Finger prick/point of care test

43
Q

Stages of HIV

A
  1. Primary seroconversion
    Viral load is very high, initial drop in CD4, HIV AB (env) is rising
  2. Chronic HIV
    Viral load can drop for a long time + pt can be asymptomatic
    CD4 count can stay the same
    If become symptomatic/opportunist infection (AIDS) - viral load increases and CD4 higher
44
Q

AIDS

A

CD4 count <200 and when opportunistic infections e.g. TB, Kaposis sarcoma, lymphoma, CMV

45
Q

Diagnosis of malaria

A

Thick blood films with giemsa stain - 3 films over 48h

FBC - anaemia + thrombocytopenia with falciparum

46
Q

Torniquet test for dengue fever

A

If have dengue rash - put BP cuff on upper arm
Inflate midway between systolic + diastolic pressure for 5mins
If >20 petechiae seen per 2.5cm then +ve

47
Q

What is scleroderma?

A

State of dysregulated connective tissue deposition

48
Q

2 types of scleroderma

A

Diffuse (systemic)
Limited (CREST)

Diffuse has high mortality - pulmonary fibrosis + renal involvement
Limited doesn’t have renal involvement

49
Q

Diffuse scleroderma

A 
Truncal + acral involvement
Skin changes within 1 year of Raynauds onset 
Tendon friction rubs 
Early IS lung disease
Diffuse GIT involvement
Nailfold capillary dilation + drop-out
50
Q

Limited scleroderma

A 
Calcinosis 
Raynauds
Oesophageal dysmotility
Sclerodactyl 
Telangectiasa

Dilated nailfold capillary loops without drop-out
Late pulmonary HTN

51
Q

Sjogrens syndrome

A

Dry eyes and dry mouth

Secondary SS can occur in association with a variety of other autoimmune disorders such as SLE

Women (90%)
HLA B8, DR3 and DR2 and DRw52

ENA Ro and La

Polyclonal hypergammaglobulinaemia

52
Q

Antiphospholipid syndrome

A

Occurs in pts with lupus or pts who don’t fulfill diagnostic criteria for lupus

  • Thromboses (40%) - BOTH arterial + venous (distinguishes it from others which tend to have 1). Emboli from thrombi on heart valves may also occur
  • Recurrent fetal loss
  • Thrombocytopenia
  • IgG and IgM cardiolipin ABs and antibodies to B2-glycoprotein
53
Q

Mechanisms of self tolerance to self antigens

A

Central tolerance by clonal deletion
Peripheral tolerance
Regulatory T cells

54
Q

Central tolerance by clonal deletion

A

Central tolerance refers to mechanisms of tolerance acting during lymphocyte development in the thymus or BM
- Elimination or inactivation of B and T cells which recognise self-Ags

55
Q

How do patients with AIRE deficiency present?

A

Autoimmunity - particularly to endocrine organs

56
Q

Peripheral tolerance

A

Deletion + inactivtion acting on mature lymphocytes after they have left the primary lymphoid organs

Important in pregnancy

57
Q

Regulatory T cells

A

Protect self-tissue from aggressive inflammatory T cell responses

58
Q

Mechanisms by which auto antibodies produce disease

A

Complement dependent lysis of the target cell

Opsonisation (haemolytic anaemia)

Immune complexes (glomerulonephritis in SLE)

Receptor blockade (Myasthenia gravis, pernicious anaemia)

Receptor stimulation (Graves)

59
Q

C3 deficiency

A

Recurrent pyogenic infections

60
Q

C5-9 deficiency

A

Meningococcal infections

Defects of complement can be found by capacity of patients serum to lyse blood cells

61
Q

AB deficiency

A

Encapsulated + non-encapsulated pyogenic bacteria

Rare: viral, parasites, fungal

Test IgG, IgM, IgA and paraprotein
Test against toxins + polysaccharides to see how effective

Year 3 (14 decks)

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