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Y2 - Dermatology > Immunology > Flashcards

Immunology Flashcards

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Dermatology Board Prep flashcards
1
Q

What factors contribute to skin’s immunological function?

A

Structure - keratin layer, stratification
Cells - immune cells and keratinocytes
Cytokines, chemokines, antimicrobial peptides
Genetics

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2
Q

What is hypersensitivity?

A

Immune response that causes collateral damage to self by exaggeration of normal immune mechanism

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3
Q

What is autoimmunity?

A

Reaction to host tissue

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4
Q

How do keratinocytes contribute to the immune response?

A

Activated by UV, sensitisers
Sense pathogens via cell surface receptors
Produce anti-microbial peptides that can kill pathogens
Produce cytokines and chemokines

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5
Q

How do keratinocytes contribute to the immune response?

A 
Dendritic cell (APC)
Process lipid antigens and microbial fragments and present them to effector T cells in order to activate them
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6
Q

Where in the skin are CD4+ and 8+ T cells found?

A

CD8+ are in the epidermis and the dermis

CD4+ are in the dermis

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7
Q

Which CD4+ helper T cells are associated with which conditions?

A

Th1 - psoriasis
Th2 - atopic dermatitis
Th17 - both

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8
Q

What is the difference in action between Th1 and Th2 CD4+ T cells?

A

Th1 - activate macrophages to destroy microorganisms and release IL2, IFN gamma
Th2 - help B cells to make antibodies and release IL4, IL5 and IL6

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9
Q

What is a plasmacytoid dendritic cell?

A

One that produces IFN alpha

Found in diseased skin

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10
Q

What is a dermal dendritic cell?

A

One involved in antigen presenting and secreting cytokines and chemokines

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11
Q

What are other examples of cells in the dermis that contribute to the immune response?

A

Macrophages
Neutrophils
Mast cells

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12
Q

What are the effectors of IgE-mediated immune response?

A

Mast cells

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13
Q

Which mediators do mast cells release?

A

Pre-formed: tryptase, chemise, TNF, histamine

Synthesised: interleukins, TNF, interferons, prostaglandins

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14
Q

What chromosome is the MHC associated with?

A

6

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15
Q

What is the function of class I MHC?

A

Found on almost all cells
Presents antigens to cytotoxic T cells
Present endogenous antigens

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16
Q

What is the function of class II MHC?

A

Found on antigen presenting cells
Present to T helper cells
Present exogenous antigens

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17
Q

What is the basic function fo MHC?

A

Control the immune response through recognition of self and non-self

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18
Q

What are examples of skin conditions associated with inappropriate immune response and inflammation

A

Psoriasis

Atopic eczema

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19
Q

What is the underlying pathology of psoriasis?

A

Altered tissue structure and function due to inflammation

20
Q

What are the symptoms of psoriasis?

A

Erythematous, itchy plaques on the extensors of the skin and the scalp
Nail signs
Arthritis and joint disease

21
Q

How is the immune system involved in psoriasis?

A

Keratinocytes release factors the stimulate production of IFN alpha and release interleukins and TNF
TH1 and TH17 activated
CD8+ cells activated
Dermofibroblasts release epidermal growth factors

22
Q

Which skin conditions are autoimmune?

A

Psoriasis
Vitiligo
SLE

23
Q

What is allergy?

A

An immune response to a normally harmless substance

24
Q

What is type 1 hypersensitivity?

A

Allergy

25
Q

What is the timescale of a type 1 hypersensitivity reaction?

A

Immediate (minutes to 2 hours)

26
Q

What are the routes of exposure for type 1 hypersensitivity, and examples of alleges for each?

A

Skin contact (nuts)
Inhalation (pollen)
Ingestion (latex)
Injection (bee sting, medication)

27
Q

What is the pathophysiology of type 1 hypersensitivity?

A

Antigen binds to APC, which present to T cells
Th2 cells release interleukins
B cells are activated and release IgE, mast cells are activated
Mast cells degranulate and release mediators

28
Q

What are the symptoms of a type 1 hypersensitivity reaction?

A

Urticaria
Angioedema
Wheezing
Anaphylaxis

29
Q

What is urticaria?

A

Very itchy patches or erythema

Hives, wheals

30
Q

What is angioedema?

A

Localised swelling of subcutaneous tissue or mucus membranes

31
Q

What is anaphylaxis?

A

Severe, life threatening generalised or systemic hypersensitivity reaction

32
Q

In what ways does anaphylaxis affect the airways, breathing and circulation?

A

Airways - pharyngeal or laryngeal oedema
Breathing - bronchospasm with tachypnoea
Circulation - hypotension, tachycardia

33
Q

What are the investigations that can be done for type 1 hypersensitivity?

A
  1. Specific IgE
  2. Skin prick test
  3. Challenge test
    Serum mast cell try-tase level during anaphylaxis to confirm true anaphylaxis
34
Q

What is that management for type 1 hypersensitivity?

A 
Allergen avoidance
Antihistamines (first line)
Corticosteroids (second line)
Adrenaline autoinjector (in anaphylaxis)
Sodium chromoglycate
35
Q

What is the pathophysiology of type 2 hypersensitivity?

A

IgG and IgM mediated
Cytotoxic
Antibodies directed against cell surface antigens mediated cell destruction via complement activation

36
Q

What are examples of type 2 hypersensitivity reactions with skin manifestations?

A

Blood transfusion reactions

Autoimmune haemolytic anaemia

37
Q

What is the pathophysiology of type 3 hypersensitivity?

A

Immune complex mediated
Antigen-antibody complexes deposited in various tissues induce complement activation and inflammatory response mediated by neutrophils

38
Q

What are examples of type 2 hypersensitivity reactions with skin manifestations?

A

Serum sickness
Necrotising vasculitis
Rheumatoid arthritis
SLE

39
Q

What is the timescale for type 4 hypersensitivity?

A

Delayed - after 24-48 hours

40
Q

What are some examples of type 4 hypersensitivity reactions with skin manifestations?

A

Contact dermatitis
Tubercular lesions
Skin graft reactions

41
Q

What is the pathophysiology of type 4 hypersensitivity?

A

APCs present take up antigen and present to T cells
Activated T cells cause apoptosis of keratinocytes and production of cytokines and chemokines
Cytokines activate macrophages which mediate direct cellular damage

42
Q

What are examples of acute connect dermatitis allergens?

A

Direct skin contact - preservatives in cosmetics
Airbourne contact - fragrances
Injection - tattoo

43
Q

What is the clinical presentation of acute contact dermatitis?

A

Reaction in the area of skin in contact with allergen

44
Q

What is the investigation of acute contact dermatitis?

A

Patch testing

45
Q

What is irritant contact dermatitis?

A

Non-immunological process - not an allergy

Caused by contact with agents that abrade, irritate and traumatise the skin directly

46
Q

What are examples of common irritant contact dermatitis?

A

Nappy rash

Lip lick dermatitis

Y2 - Dermatology (12 decks)

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