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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
Anti-centromere
CREST/scleroderma
26
Anti-Ro
Sjogrens syndrome
27
Anti-La
Sjogrens syndrome
28
Anti-Jo
polymyositis
29
Rheumatoid factor
RA, sjogrens (90%), SLE (30%), 5% of normal pop
30
ANA (anti-nuclear antibody)
SLE (95%) AIH (75%) Sjogrens (70%)
31
Anti-phospholipid syndrome
High risk of blood clots Recurrent fetal loss Thrombocytopenia Ix: IgG and IgM cardiolipin ABs and ABs to B2-glycoprotein
32
Beta-lactams
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
Cephalosporins
Extended spectrum B-lactamases resistant to all cephaosporins e.g. cefotaxime
34
Carbapenems
e.g. meropenam | Gram -ve bacteria beta-lactamases
35
Glycopeptides
Vancomycin - if give bolus --> red man syndrome (pruritis and red rash) MRSA + c.diff Nephrotoxic
36
Quinolones
Ciprofloxacin
37
Macrolides
Erythromycin + clarithromycin Safe in penicillin allergy - good alternative GI side effects (erythro)
38
Aminoglycosides
Gentamicin Nephrotoxic IV or IM Pseudomonas + gram -ve bacteria (no anaerobes or streptococci)
39
Tetracyclines
Don't give to children or pregnant | Chlaymdia + acne
40
Folate antagonists
Trimethoprim
41
Virus associated with Kaposis sarcoma
HHV-8 (human herpes virus 8)
42
How can we test for HIV?
Venous blood HIV Ag/ab test Finger prick/point of care test
43
Stages of HIV
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
AIDS
CD4 count <200 and when opportunistic infections e.g. TB, Kaposis sarcoma, lymphoma, CMV
45
Diagnosis of malaria
Thick blood films with giemsa stain - 3 films over 48h FBC - anaemia + thrombocytopenia with falciparum
46
Torniquet test for dengue fever
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
What is scleroderma?
State of dysregulated connective tissue deposition
48
2 types of scleroderma
Diffuse (systemic) Limited (CREST) Diffuse has high mortality - pulmonary fibrosis + renal involvement Limited doesn't have renal involvement
49
Diffuse scleroderma
``` 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
Limited scleroderma
``` Calcinosis Raynauds Oesophageal dysmotility Sclerodactyl Telangectiasa ``` Dilated nailfold capillary loops without drop-out Late pulmonary HTN
51
Sjogrens syndrome
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
Antiphospholipid syndrome
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
Mechanisms of self tolerance to self antigens
Central tolerance by clonal deletion Peripheral tolerance Regulatory T cells
54
Central tolerance by clonal deletion
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
How do patients with AIRE deficiency present?
Autoimmunity - particularly to endocrine organs
56
Peripheral tolerance
Deletion + inactivtion acting on mature lymphocytes after they have left the primary lymphoid organs Important in pregnancy
57
Regulatory T cells
Protect self-tissue from aggressive inflammatory T cell responses
58
Mechanisms by which auto antibodies produce disease
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
C3 deficiency
Recurrent pyogenic infections
60
C5-9 deficiency
Meningococcal infections Defects of complement can be found by capacity of patients serum to lyse blood cells
61
AB deficiency
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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