Immunology Flashcards
What are the centor criteria?
Identify the likelihood of a bacterial infection in patients with a sore throat
One point each for:
Anterior cervical lymphadenopathy
Tonsillar exudates
Fever
Absence of cough
Score of 4 indicates bacterial tonsillitis is likely
Name some diseases in which they may be presence of salivary gland enlargement
Lymphoma Sarcoid Parotid tumour Calculi Viruses such as mumps Alcohol excess
Which organs are involved in thermoregulation in response to cold?
Brown fat: metabolism
Muscles: shivering
Blood vessels: constriction
Thyroid: hormone increases metabolism
Which organs are involved in thermoregulation in response to heat?
Lungs: increase respiratory rate
Skin: perspiration
Blood vessels: dilation
Which area of the Brainstem is responsible for thermoregulation?
Hypothalamus
What is fever?
Rectal temperature above 38ºC
Oral temperature above 37.8ºC
Tympanic temperature above 38ºC
Complex physiologic response to disease mediated by pyrogenic
cytokines and characterized by a rise in core temperature, generation of acute phase reactants, and activation of immune systems
What are some causes of fever?
Infection Inflammatory Connective Tissue Disorder Malignancy Endocrine / Metabolic Tissue Destruction Thromboembolism Allergy / Drugs / Other
What are some infective causes of fever?
Bacterial Viral Fungal Parasitic Origin of infection may be obvious or may require careful assessment for diagnosis, e.g. infective endocarditis, tuberculosis or other occult long-term infection
What are some inflammatory causes of fever?
Phlebitis, thyroiditis, ulcerative colitis, Crohn’s disease, pancreatitis, familial Mediterranean fever, sarcoidosis, pemphigus (blistering skin, autoimmune), severe or exfoliative dermatitis, bullous pemphigoid
What are some connective tissue disorders which cause fever?
Rheumatoid arthritis, systemic lupus erythematosus,
polyarteritis nodosa, polymyositis, dermatomyositis, giant cell arteritis
What is polyarteritis nodosa?
Systemic vasculitis typically involving small or medium sized muscular arteries, typically renal or visceral
What are malignancy causes for fever?
Carcinoma (especially lung cancer, renal cancer), sarcomas,
lymphoma
What endocrine and metabolic disorders can cause fever?
Thyroid disease, gout, porphyria (abnormal metabolism of haemoglobin)
What types of tissue destruction can cause fever?
Surgery, infarction, haemolysis, crush syndrome, rhabdomyolysis
What are some thromboembolic causes of fever?
Pulmonary embolism, deep vein thrombosis
What blood disorders may result in fever?
Aplastic anaemia, agranulocytosis, leukaemias
What allergic conditions may lead to fever?
Allergic reactions, transfusion reactions, Henoch-Schönlein purpura
What is a rigor?
Sudden feeling of cold with shivering accompanied by a rise in temperature, with sweating
60 year man on haemodialysis with a metallic aortic valve with suspected infective endocarditis. Which investigations does he need? And what might they show?
ECG: show prolonged PR interval
Echo: vegetations on aortic valve with aortic root abscess
What is a fever of unknown origin?
Temperature greater than 38.3°C on several occasions
More than 3 weeks’ duration of illness
Failure to reach a diagnosis despite 1 week of inpatient investigation
What is the acute management for anaphylaxis?
High flow oxygen 0.5mg IM adrenaline 10mg IV chlorphenamine 200mg hydrocortisone IV 500ml 0.9% saline stat
Which interleukin is responsible for stimulating hepatic synthesis of acute phase proteins and is involved in fever, anaemia and cachexia?
IL-6
Which interleukin is a chemoattractant?
IL-8
Give an example of an anti inflammatory interleukin?
IL-10
Which molecules are involved in the rolling of neutrophils along a vessel in migration?
Selectins
Which molecules are involved in adhesion to vessel wall by neutrophils in migration?
Integrins
What is endothelin?
Potent vasoconstrictor
What does nitric oxide do to vessels and platelets?
Inhibit platelet aggregation and adhesion
Vasodilation by activating guanylate cylase
Describe some characteristics of IgA
Found in secretions: salvia, tears, mucous
Provides localised protection on mucous membranes
Most commonly produced immunoglobulin in the body
Transported across interior of cell via transcytosis
Name some characteristics of IgG
Enhance phagocytosis of bacteria and viruses
Fixes complement and passes to the foetal circulation
Most abundant isotype in blood serum
What are risk factors for acute graft versus host disease?
HLA disparity Increasing age of recipient Donor and recipient gender disparity Type and status of underlying disease Transplant conditioning regimen intensity ABO compatibility Performance score White/black race CMV sero status Doses of prophylactic immunosuppression medication
What features are characteristic of acute graft versus host disease?
Maculopapular rash Anorexia Profuse diarrhoea Nausea Vomiting Ileus Cholestatic hepatitis
What immunological changes are seen in HIV?
Reduction in CD4 count Increased B2 microglobulin Decreased IL2 production Polyclonal B cell activation Decreased NK function Reduced delayed hypersensitivity reactions
