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YEAR 4 SEMESTER 1 CDM > LECTURE 3 - finished > Flashcards

LECTURE 3 - finished Flashcards

1
Q

What are some differences between ESR and CRP?

A
  • Serum CRP levels are more sensitive for the evaluation and monitoring of inflammation than ESR
  • CRP is independent of factors that affect ESR
  • CRP correlates better with disease activity
  • CRP level rise 4 to 6 hours after tissue injury (i.e. much earlier than other acute-phase reactants)
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2
Q

What are ANA’s?

A

ANAs are autoantibodies that target specific protein antigens present in the body’s cell nuclei

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3
Q

What is Rheumatoid Factor? What are the most common?

A
  • RF is a group of autoantibodies that are directed against the Fc portion of the host’s own IgG antibodies
  • Most RF is IgM, hence the most commonly measured RF is IgM
  • The other RFs include IgG, IgE, and IgAs
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4
Q

What % of RA patients are seronegative?

A

20%

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5
Q

In which people can ANA’s be detected in the serum?

A

Normal people
- 25-30% have a +ve test with a titre of 1:40

People with rheumatic conditions

People with auto-immune conditions

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6
Q

How does immunofluorescence microscopy work?

A

They use reagent cell nucleus and apply the patients serum sample containing ANA’s. The ANA’s bind to the antigens on the cell surface. The problem is that we cant see the ANA’s or the antigens, so they created an ANA antibody which is tagged with a fluorescent molecule attached. This then attaches to the ANA’s which are attached to the antigens. We can then view these fluorescent antibodies under the microscope.

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7
Q

What can large amounts of circulating cryoglobulins cause?

A 
Bruising
Rashes
Joint pain
Weakness
Raynauds phenomenon
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8
Q

What does CRP test/detect?

A

• C-reactive protein is a test that detects the presence of inflammation due to:
– Tissue injury
– Autoimmune disease
– Infection etc

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9
Q

What is ESR increased in?

A

E Increases Fun In Parties At Night

  • conditions causing increased serum Fibrinogen e.g. pregnancy, malignancy etc
  • Inflammatory conditions e.g. tb, pneumonia, ra
  • conditions with increased Plasma protein levels e.g. multiple myeloma (increased globulins)
  • Age
  • extensive tissue Necrosis e.g. ami, trauma
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10
Q

What are some non-rheumatic conditions RF is positive in?

A 
Bacterial endocarditis
Infections
- Hepatitis
- TB
Malignancy
Pulmonary disease
- Sarcoidosis
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11
Q

In what conditions is CRP and ESR both elevated?

A

Caitie and Emily Both yell NIIIIIT

  • Neoplasms
  • Infection
  • Infarction
  • Inflammatory arthritis
  • Trauma
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12
Q

What titer of ANA’s indicates an autoimmune condition?

A

> 1 : 640

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13
Q

What is complement testing used for?

A
  • Diagnose and monitor the activity and treatment of autoimmune diseases such as SLE and RA
  • Diagnose the cause of recurrent microbial infections
  • Monitor immune complex-related conditions such as glomerulonephritis, vasculitis etc
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14
Q

What conditions are cryoglobulins present in?

A

Crying is present in VAG Infections

Vasculitic conditions
Autoimmune conditions (e.g. SLE, RA)
Glomerulonephritis
Infections (e.g. cirrhosis, endocarditis)

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15
Q

Where is CRP synthesised? What is it released in response to?

A

The liver

It is released in response to cytokines such as interleukins IL-1 and IL-6.

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16
Q

What are the 3 main consequences of complement activation?

A
  • opsonisation of pathogens
  • recruitment of inflammatory cells
  • direct killing of pathogens
17
Q

What are the most widely measured acute phase reactants?

A

CRP and ESR

18
Q

What can precipitated cryoglobulins lead to?

A

Thrombosis: Increased blood viscosity slows blood flow

Ischaemic necrosis: Due to small blood vessel blockage (e.g. skin ulcers, gangrene)

Vasculitis: Cryoglobulins activate the immune system leading to immune complex formation and deposition in tissues, causing inflammation, bleeding the thrombosis.

19
Q

What are nuclear antigens?

A

Nuclear antigens (NA) are antigens that are found in the nuclei of cells

20
Q

What can cause a false positive in ESR?

A

E can give you false positive News About HPV

  • Nephrotic syndrome (loss of plasma albumin)
  • Anemia (affects RBC shape, size & number)
  • Hypergammaglobulinemia
  • increased Plasma protein levels
  • increased plasma Viscosity
21
Q

What is complement?

A

An immunte system consisting of plasma and membrane proteins that provide innate defense against microbial pathogens

22
Q

Describe what ESR is and basically how it is performed

A

When anticoagulated whole blood is allowed to stand, RBCs settle down under the influence of gravity

The ESR is a measure of the height that erythrocytes fall through plasma in a Wintrobe tube over a period of 1 hour (i.e. mm/h)

The ESR is rough measure of the abnormal concentrations of acute phase proteins and immunoglobulins in the serum

23
Q

Who has APLA’s?

A

• Normal people may have transiently raised APLAs following acute medical illness and infections

• People with:
– SLE
– Antiphospholipid antibody syndrome: (A syndrome is characterised by venous thromboembolism, arterial thrombosis, or pregnancy morbidity (individually or in combination), together with antiphospholipid antibodies and lupus anticoagulant)

24
Q

When is ANA testing indicated?

A

Ana indicates PMSSS

The ANA test is ordered when someone shows ssx consistent with a systemic autoimmune disorder such as:

  • Polymyositis
  • MCTD
  • Scleroderma
  • SLE
  • Sjögren syndrome
25
Q

When in ESR indicated?

A

Emily is like CAIT but not quite…CAI

ESR is ordered when a condition or disease is suspected of causing inflammation somewhere in the body, especially:
• Infections
• Cancers
• Autoimmune diseases – especially:
– temporal arteritis
– systemic vasculitis
– polymyalgia rheumatica
26
Q

When is cryoglobulin testing indicated?

A

Crying is indicated when we have to BJ Rays Weak Rod

The cryoglobulin test is ordered in people with ssx suggestive of cryoglobulinaemia:
• Bruising
• Joint pain
• Weakness
• Raynaud's phenomenon
• Rashes
NOTE: all of these ssx can be due to SLE
27
Q

What conditions is hypocomplementaemia seen in?

A

Disorders characterised by immune complex formation and deposition

  • SLE
  • Cryoglobulinaemia
28
Q

List 4 inflammatory molecules

A
  • interleukins (IL-6, IL-1)
  • tumour necrosis factor α (TNF-α)
  • interferon gamma (IFN-γ)
  • transforming growth factor β (TGF-β)
29
Q

List 4 autoimmune conditions ANA’s can be elevated in

A

– autoimmune hepatitis
– primary autoimmune cholangitis
– primary biliary cirrhosis
– Crohn’s disease

30
Q

What does CRP do? (4)

A

CRP does CPCP

• Activates complement
• Stimulates phagocyte function
• Augments cell mediated cytotoxicity
• Activates platelet aggregation
ie it amplifies the immune response
31
Q

What are some rheumatic conditions RF is positive in?

A

Rachel Rhaises Really Small Smelly Dogs

RA (50%-90%)
SLE ( 15%-30%)
Systemic Sclerosis (20%-30%)
Dermatomyositis and Polymyositis (5%-10%)

32
Q

When is CRP indicated?

A

CRP is usually ordered when an individual is suspected of having:
• a serious bacterial infection
• to monitor conditions such as RA and SLE, diagnose relapses and to determine whether treatment is effective

33
Q

When is antiphospholipid antibody testing indicated?

A

SPURT

Antiphospholipid antibody testing is used to help determine the cause of:
• Symptoms indicative of autoimmune disease (esp. SLE)
• Prolonged PTT test
• Unexplained thrombotic episodes
• Recurrent miscarriages
• Thrombocytopenia

34
Q

What are antiphospholipid antibodies (APLA’s)?

A

Antiphospholipid antibodies are a group of antibodies directed against phospholipid-associated proteins such as:
• Prothrombin
• Cardiolipin
• β2-glycoprotein 1 etc

35
Q

What does RF do?

A
  • RF attaches to antibody molecules to form immune complexes that deposit in a variety of tissues, especially synovium and blood vessels
  • Deposition of immune complexes results in complement activation and inflammation
36
Q

What are some examples of typical nuclear antigens?

A
  • DNA (esp. double stranded DNA)
  • Histones
  • Sm (= Smith ag found in ≈30% of SLE Patients; has a role in mRNA synthesis)
  • Nuclear ribonucleoprotein (nRNP)
37
Q

What are cryoglobulins?

A

Cryoglobulins are a group of abnormal serum immunoglobulins that precipitate at low temperatures (<37 degrees)

38
Q

What are acute phase reactants?

A

Acute-phase reactants are proteins whose plasma concentration:
• increases (positive acute-phase proteins)
Or
• decreases (negative acute-phase proteins)

  • by at least 25% during inflammatory states

YEAR 4 SEMESTER 1 CDM (12 decks)

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