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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
What is involved in the secondary immune response
IgG
26
Which cytokine is implicated in the acute phase response and systemic inflammation
Tumour necrosis factor alpha
27
What is lambert eaton myasthenic syndrome assosiated with
voltage gated calcium channel antibodies
28
Presentation of lambert eaton myasthenic syndrome
Weakness of limbs Symptoms worse in hot weather Symptoms better in exercise Reflexes reduce but increase with muscle use
29
What is felty syndrome
A rare condition seen in patients with RA characterised by a triad of 1. RA 2. Splenomegaly 3. Neutropenia
30
Syptoms of felty syndrome
Recurren infections Abdo pain (due to splenomegaly) Weight loss Fatigue Lymphadenopathy Skin ulcers May be eye involvement
31
Abs of felty syndrome
anti-CCP Abs Positive RF
32
Which HLA is seen in felty syndrome
HLA-DR4
33
SLE may be diagnosed if they meet 4 of the following 11 criteria
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)
34
Presentation of PMR
Proximal muscle pain Stiffness
35
Joint aspirate of pseudogout
SMall rhomboid shaped, weakly positive birefringent crystals Calcification of joint cartirges (chondrocalcinosis) May show numerous neurophils
36
Assosiations of charcots joint
Sensory neuropathies - DM - tertiary syphillis - synringomyelia
37
Crystals of gout
Needle shaped Negatively birefringent crystals
38
Occurence of dysphagia and raynauds incidcates what
Underlying connective tissue disorder Particularly CREST syndrome - calcinosis cutis - raynauds - oesophageal hypomotility - sclerodactyly - telengiectasia or progressive systemic sclerosis
39
Most common organism cause of septic arthritis
staph A
40
Features of GCA
Headache Visual loss Jaw claudication Raised inflammatory markers Reactive thrombocytosis
41
Diagnostic test for GCA and is this accurate
Temporal artery biopsy No - the biopsy may be negative in the prescence of GCA due to skip lesions
42
Investigation of acromegaly
IGF-1 (insulin like growth factor)
43
What is a risk factor for avascular necrosis of the femoral head?
Long term corticosteriod use
44
What is an indication for biologic therapy in AS and what would you use
Failure to control symptoms after 2 different NSAIDs Etanercept or adalimumab
45
Bony outgrowths in OA
Proximal - bouchards nodes Distal - Herbedens nodes
46
HLA assosiations of RA
DR1 DR4
47
HLA assosiations of PSC
DR1 DR4
48
HLA assosiations of inflammatory arthropities and IBD
HLA B27
49
Which autoantibodies are most specific to RA
Anti-CCP
50
Deficiency of which complement component is particularly assosiated with recurrent meningococcal infections
C5
51
Which interleukin drives natural killer cell activation
Interleukin-12
52
Mechanism of action of allopurinol
Xanthine oxidase inhibitor
53
Features of AS
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
1st line treatment of AS when inadequate response to NSAIDs
Adalimumab
55
Investigation of for sacroiliitis in patients with early ankylosing spondylitis
MRI of sacroiliac joints
56
Assosiations of HLA-B27
AS Post gonococcal arthritis Acute anterior uveitis Reactive arthritis
57
Assosiations of HLA-DR2
Narcolepsy Goodpastures
58
Assosiations of HLA-DR3
Autoimmune hepatitis PBC T1DM Dermatitis herpetiformis Sjogrens
59
Assosiations of HLA-DR4
RA T1DM (>DR3)
60
aSSOSATIONS OF dr4+dr4
t1dm
61
Assosiation of HLA-B47
21-hydroxylase deficiency
62
Assosiation of HLA-A3
Haemachromatosis
63
Assosiation of HLA B5
Bechets disease
64
Assosiation of C3 deficiency
Recurrent bacterial infections
65
C1 deficiency presents with what
Hereditary angioedema
66
Presentation of psoriatic arthritis
Nail pitting Dactylitis (sausage fingers) Symmetric polyarthritis in a rheumatoid pattern
67
Diffuse cutaneous systemic sclerosis Abs
Anti-SCL-70
68
Limited cutaneous systemic sclerosis Abs
Anti-centomere
69
When should allopurinol treatment be started
2 weeks after the acute attack has settled
70
Indications for allopurinol
Recurrent attacks Tophi Renal disease Uric acid renal stones Prophylaxis if on cytotoxics or diuretics
71
What is deposited in gout vs psuedogout
gout - monosodium urate monohydrate pseudogout - calcium pyrophosphate dihydrate
72
Joint aspiration in pseudogout
Weakly positive birefringent rhomboid/brick shaped crystals
73
Poor prognostic features of RA
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
CXR findings in AS
Apical fibrosis
75
Antibodies assosiated with SLE, sjogrens and neonatal heart block
Anti Ro
76
What morphine metabolite accumulates in renal impairment leading to resp depression
Morphine-6-glucronide
77
What happens with gram staining in septic athritis
50% of septic arthritis have negative gram staining
78
Foods assosiated with latex allergy
Avocado Banana Chestnut Fig Kiwi Pepper Peach Tomato
79
Biochemical Features that occur in hereditary angioedema
Elevated bradykinin Reduced C1 inhibitor levels Reduced C4
80
What joint pathology is assosiated with haemachromatosis
Pyrophosphate arthropathy
81
Features of osteomalacia
Calcium lower end of normal Raised ALP Low Vit D Painful proximal neuropathy
82
What does rituximab target
CD20 (receptor found on B lymphocytes)
83
Features of adult onset stills disease
Daily fevers Oligoarthrtis Macular rash Sore throat Myalgia
84
Treatment of enteropathic arhthirits (assosiated with IBD)
1. Sulfasalazine 2. Methotrexate
85
Antibodies of drug induced lupus
Anti-histone antibodies (also anti nuclear antibodies)
86
What is the importance of the P1 receptor
Inducing apoptosis
87
Features of polyarteritis nodosa
Constitutional upset Abdo pain HTN Mononeuritis
88
Presentation of trochanteric bursitits
Lateral hip pain Worse on resisted abduction
89
Where is the pain in illiopsoas bursitis
Medial pain over the area of the femoral triangle
90
What is raloxifene and what can it be used in
Selective oestrogen receptor modulator Osteoporosis
91
S/Es raloxifene
Hot flushes Leg cramps Increased risk of clots
92
Two primary causes of death in systemic sclerosis / scleroderma
Pulmonary fibrosis Kidney disease
93
What kind of drug is piroxicam
NSAID
94

MRCP - Part 1 (20 decks)

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