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MRCP - Part 1 > Immunology/Rheum > Flashcards

Immunology/Rheum Flashcards

1
Q

WHat is needed post transplant to reduce rejection

A

Immunosuppresion

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2
Q

Types of transplant

A

Autograft
Allograft
Xenograft
Stem cell

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3
Q

Autograft transplant

A

Transplantation within the individual

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4
Q

Allograft transplant

A

Transplant within the same species i.e. human to human who is non genetically identical

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5
Q

Xenograft transplant

A

Transplant from one species to another

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6
Q

Compatibility between donor and recipient is based on

A

ABO Blood group
Tissue typing
Cross matching
Panel reactive antibody test

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7
Q

Type 1 (allergic reactions) Abs

A

IgE antibodies
Mast cells
Basophils

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8
Q

Type II (antibody dependent cytotoxic reactions) Abs

A

IgG antibodies

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9
Q

Examples of type 1 reactions

A

Hayfever
Allergies/anaphylaxis
Ezcema
Asthma

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10
Q

Examples of type II reactions

A

Drug induced haemolytic anaemia
Acute transfusion reactions
Goodpastures syndrome

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11
Q

Type III reactions

A

Immune complex reactions

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12
Q

Examples of type III reactions

A

Serum sickness
SLE
Post strep glomerulonephrtisis

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13
Q

Cells of type IV reactions

A

Helper T cells
Cytotoxic T cells

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14
Q

Examples of type IV reactions

A

Contact dermaitis
BCG immunisation

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15
Q

Most common cause of hypothyroidism worldwide

A

Iodine defieincy

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16
Q

How is congential hypothyroidism screened

A

Guthrie (heel prick) test

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17
Q

Causes of primary hypothyroidism

A

Hashimotos thyroidis (autoimmune)
Iodine deficiency
Drugs
- amoidarone
- lithium
- anti-thyroid meds
Neck RTx
Radioiodine treatment / surgery
Congenital
De quervians thyroiditis (subacute thyroiditis)

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18
Q

What blood test is used to diagnose Hashimotos

A

Anti-thyroid peroxidaseT

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19
Q

Two types of immune system

A

Innate
Adaptive

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20
Q

Cells of innate immunity

A

Antigen presenting cells such as dendritic cells

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21
Q

Cells of adaptive immunity

A

Includes B cells and T cells

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22
Q

What is the first line of defence against infection

A

Innate immunity

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23
Q

Two parts of the adaptive immune system

A

Humoral
Cellular

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24
Q

What is involved in the primary immune response

A

IgM

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25
Q

What is involved in the secondary immune response

A

IgG

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26
Q

Which cytokine is implicated in the acute phase response and systemic inflammation

A

Tumour necrosis factor alpha

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27
Q

What is lambert eaton myasthenic syndrome assosiated with

A

voltage gated calcium channel antibodies

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28
Q

Presentation of lambert eaton myasthenic syndrome

A

Weakness of limbs
Symptoms worse in hot weather
Symptoms better in exercise
Reflexes reduce but increase with muscle use

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29
Q

What is felty syndrome

A

A rare condition seen in patients with RA characterised by a triad of
1. RA
2. Splenomegaly
3. Neutropenia

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30
Q

Syptoms of felty syndrome

A

Recurren infections
Abdo pain (due to splenomegaly)
Weight loss
Fatigue
Lymphadenopathy
Skin ulcers
May be eye involvement

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31
Q

Abs of felty syndrome

A

anti-CCP Abs
Positive RF

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32
Q

Which HLA is seen in felty syndrome

A

HLA-DR4

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33
Q

SLE may be diagnosed if they meet 4 of the following 11 criteria

A

Malar rash
Discoid rash
Photosensitivity
Oral ulcers
Arthritis
Serositis (pleuritis or pericarditis)
Renal disorder
Neurological disorder (seizures or psychosis)
Haematological disorder (haemolytic anaemia or leukopenia <4 on two or more occassions, lymphopenia 1.5 on two or more occassions or thrombocytopenia)
Immunological disorders (raised anti native DNA antibody binding, or anti-sm antibody or positive antiphospholipid Abs)
Antinuclear antibody raised in titre (in abscence of known drugs to cause drug induced lupus)

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34
Q

Presentation of PMR

A

Proximal muscle pain
Stiffness

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35
Q

Joint aspirate of pseudogout

A

SMall rhomboid shaped, weakly positive birefringent crystals
Calcification of joint cartirges (chondrocalcinosis)
May show numerous neurophils

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36
Q

Assosiations of charcots joint

A

Sensory neuropathies
- DM
- tertiary syphillis
- synringomyelia

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37
Q

Crystals of gout

A

Needle shaped
Negatively birefringent crystals

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38
Q

Occurence of dysphagia and raynauds incidcates what

A

Underlying connective tissue disorder
Particularly CREST syndrome
- calcinosis cutis
- raynauds
- oesophageal hypomotility
- sclerodactyly
- telengiectasia
or progressive systemic sclerosis

39
Q

Most common organism cause of septic arthritis

40
Q

Features of GCA

A

Headache
Visual loss
Jaw claudication
Raised inflammatory markers
Reactive thrombocytosis

41
Q

Diagnostic test for GCA and is this accurate

A

Temporal artery biopsy
No - the biopsy may be negative in the prescence of GCA due to skip lesions

42
Q

Investigation of acromegaly

A

IGF-1 (insulin like growth factor)

43
Q

What is a risk factor for avascular necrosis of the femoral head?

A

Long term corticosteriod use

44
Q

What is an indication for biologic therapy in AS and what would you use

A

Failure to control symptoms after 2 different NSAIDs
Etanercept or adalimumab

45
Q

Bony outgrowths in OA

A

Proximal - bouchards nodes
Distal - Herbedens nodes

46
Q

HLA assosiations of RA

47
Q

HLA assosiations of PSC

48
Q

HLA assosiations of inflammatory arthropities and IBD

49
Q

Which autoantibodies are most specific to RA

50
Q

Deficiency of which complement component is particularly assosiated with recurrent meningococcal infections

51
Q

Which interleukin drives natural killer cell activation

A

Interleukin-12

52
Q

Mechanism of action of allopurinol

A

Xanthine oxidase inhibitor

53
Q

Features of AS

A

lower back and buttock pain / stiffness in the mornings
Pain improves with movement
Assosiated with plantar fascitis
Reduced chest expansion
Limit of forward and lateral flexion of spine

54
Q

1st line treatment of AS when inadequate response to NSAIDs

A

Adalimumab

55
Q

Investigation of for sacroiliitis in patients with early ankylosing spondylitis

A

MRI of sacroiliac joints

56
Q

Assosiations of HLA-B27

A

AS
Post gonococcal arthritis
Acute anterior uveitis
Reactive arthritis

57
Q

Assosiations of HLA-DR2

A

Narcolepsy
Goodpastures

58
Q

Assosiations of HLA-DR3

A

Autoimmune hepatitis
PBC
T1DM
Dermatitis herpetiformis
Sjogrens

59
Q

Assosiations of HLA-DR4

A

RA
T1DM (>DR3)

60
Q

aSSOSATIONS OF dr4+dr4

61
Q

Assosiation of HLA-B47

A

21-hydroxylase deficiency

62
Q

Assosiation of HLA-A3

A

Haemachromatosis

63
Q

Assosiation of HLA B5

A

Bechets disease

64
Q

Assosiation of C3 deficiency

A

Recurrent bacterial infections

65
Q

C1 deficiency presents with what

A

Hereditary angioedema

66
Q

Presentation of psoriatic arthritis

A

Nail pitting
Dactylitis (sausage fingers)
Symmetric polyarthritis in a rheumatoid pattern

67
Q

Diffuse cutaneous systemic sclerosis Abs

A

Anti-SCL-70

68
Q

Limited cutaneous systemic sclerosis Abs

A

Anti-centomere

69
Q

When should allopurinol treatment be started

A

2 weeks after the acute attack has settled

70
Q

Indications for allopurinol

A

Recurrent attacks
Tophi
Renal disease
Uric acid renal stones
Prophylaxis if on cytotoxics or diuretics

71
Q

What is deposited in gout vs psuedogout

A

gout - monosodium urate monohydrate
pseudogout - calcium pyrophosphate dihydrate

72
Q

Joint aspiration in pseudogout

A

Weakly positive birefringent rhomboid/brick shaped crystals

73
Q

Poor prognostic features of RA

A

RF positive
Poor functional status at presentation
HLA DR4
Early erosions on xrays (in < 2 years)
Female
Extra articular features e.g. nodules
Insidious onset
Anti-CCP antibodies

74
Q

CXR findings in AS

A

Apical fibrosis

75
Q

Antibodies assosiated with SLE, sjogrens and neonatal heart block

76
Q

What morphine metabolite accumulates in renal impairment leading to resp depression

A

Morphine-6-glucronide

77
Q

What happens with gram staining in septic athritis

A

50% of septic arthritis have negative gram staining

78
Q

Foods assosiated with latex allergy

A

Avocado
Banana
Chestnut
Fig
Kiwi
Pepper
Peach
Tomato

79
Q

Biochemical Features that occur in hereditary angioedema

A

Elevated bradykinin
Reduced C1 inhibitor levels
Reduced C4

80
Q

What joint pathology is assosiated with haemachromatosis

A

Pyrophosphate arthropathy

81
Q

Features of osteomalacia

A

Calcium lower end of normal
Raised ALP
Low Vit D
Painful proximal neuropathy

82
Q

What does rituximab target

A

CD20 (receptor found on B lymphocytes)

83
Q

Features of adult onset stills disease

A

Daily fevers
Oligoarthrtis
Macular rash
Sore throat
Myalgia

84
Q

Treatment of enteropathic arhthirits (assosiated with IBD)

A
  1. Sulfasalazine
  2. Methotrexate
85
Q

Antibodies of drug induced lupus

A

Anti-histone antibodies
(also anti nuclear antibodies)

86
Q

What is the importance of the P1 receptor

A

Inducing apoptosis

87
Q

Features of polyarteritis nodosa

A

Constitutional upset
Abdo pain
HTN
Mononeuritis

88
Q

Presentation of trochanteric bursitits

A

Lateral hip pain
Worse on resisted abduction

89
Q

Where is the pain in illiopsoas bursitis

A

Medial pain over the area of the femoral triangle

90
Q

What is raloxifene and what can it be used in

A

Selective oestrogen receptor modulator
Osteoporosis

91
Q

S/Es raloxifene

A

Hot flushes
Leg cramps
Increased risk of clots

92
Q

Two primary causes of death in systemic sclerosis / scleroderma

A

Pulmonary fibrosis
Kidney disease

93
Q

What kind of drug is piroxicam

MRCP - Part 1 (20 decks)

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