RHEUMA/ ALLERGO Flashcards
B cell surface marker and EBV receptor
CD21
- Highly phagocytic APCs [antigen presenting cells) in the body
- Function as link between innate and adaptive immune systems
Dendritic cells
Major receptor for antigen in B cells (2)
lgM and lgD
Majority of total serum immunoglobulin
IgG
Only immunoglobulin able to cross the placenta
IgG
Antibody secreted in mucosal surfaces as dimer, most produced antibody overall
IgA
Immunoglobulin Produced in the primary (immediate) response to an antigen
IgM
immunoglobulin associated with cold autoimmune hemolytic anemia.
IgM
Protein molecules capable of activating up to 20% of T-cell pool resulting in widespread immune response
superantigen
Binding of an opsonized target cell to a FC receptor bearing effector cell resulting in lysis of the target by the effector cell
ADCC (antibody dependent cellular cytotoxicity)
- Expressed in all nucleated cells,
- Present endogenous intracellular antigens to CD8 cytotoxic T-cells
MHC 1a or MHC 2
MHC(Major Histocompatibility Complex) la
Expressed only on APCs and present exogenous or extracellularly engulfed antigens to CD4 T-helper cells
MHC 1 or MHC2
MHC 2
Secrete IFN-y, which enhances the ability of monocytes and macrophages to kill microbes thet ingest
TH1 or TH2
TH1
Secretes IL4, 5, 6, 13 recruiting eosinophils stimulating antibody production
TH1 or TH2
TH2
Cells that release cytotoxic granules (perforin, granzyme B) and activates apoptosis
cytotoxic T cells
Facilitates phagocytosis by coating antigen
Opsonins
(lgG and C3b)
Proteins that are decreased during inflammation (2)
albumin
transferrin
Complement proteins involved in anaphylaxis (anaphylatoxins) – 3
C3a, 4a, 5a
complement protein which induces neutrophil chemotaxis
C5a
The key effector cell in allergic rhinitis, asthma, anaphylaxis and urticaria
mast cell
Neutrophil chemotaxis
Leukotriene LTB4
Most cost-effective means of managing allergic rhinitis
allergen avoidance
autoantibody associated with
myasthenia gravis
Anti-Ach Receptor
autoantibody associated with
Goodpasture’s syndrome
anti GBM
autoantibody associated with
type 1 DM (2)
- Anti-glutamic acid decarboxylase,
- islet cell cytoplasmic antibodies
autoantibody associated with
Dermatomyositis and Polymyositis (3)
- Antisynthetase (eg, anti-Jo-1),
- anti-SRP,
- anti helicase (anti-Mi-2)
autoantibody associated with
Hashimoto’s thyroiditis (2)
- Anti-Thyroglobulin,
- Anti-TPO
autoantibody associated with
primary biliary cirrhosis
Anti-Mitochondrial
autoantibody associated with
autoimmune hepatitis
Anti-smooth muscle, anti-liver /kidney microsomal-1
autoantibody associated with
Grave’s disease (1)
Anti-TSH receptor
autoantibody associated with
Mixed Connective Tissue Disease (1)
Anti-Ul RNP (Ribonucleoprotein)
autoantibody associated with
Limited scleroderma and CREST syndrome (1)
vs
diffuse scleroderma (1)
Anti-Centromere
vs
Anti Scl-70
autoantibody associated with
Sjogren Syndrome (2)
- Anti Ro (SS-A),
- Anti-LA (SS-B)
Best screening test for SLE (most sensitive)
ANA
SLE-specific antibodies that correlate with level of disease activity, nephritis and vasculitis
anti dsDNA
SLE-specific antibodies with no clinical correlations
anti Sm
Antibodies associated with Sicca syndrome, subacute cutaneous lupus, neonatal lupus with congenital heart block and decreased risk for nephritis
anti-Ro (SS-A)
Antibodies in drug-induced lupus
anti-histone
Positive test in serum correlates with depression or psychosis due to CNS lupus
anti-ribosomal P
Most serious manifestation of SLE
nehpritis
Antibodies predisposing to recurrent fetal loss, thrombosis, detected by ELISA for Cardiolipin and B2Gl and DRVVTfor lupus anticoagulant
antiphospholipid antibody
Most common pulmonary manifestation of SLE
Pleuritis with or without effusion
Most frequent cardiac manifestation of SLE
pericarditis
Fibrinous vegetations and endocarditis in SLE
Libman-Sacks Endocarditis (LSE)
Most frequent hematologic manifestation of SLE
Normo normo anemia
Most common manifestation of diffuse CNSlupus
cognitive dysfunction
Most common chronic dermatitis in SLE
discoid lupus erythematosus
Most common form of chronic inflammatory arthritis
RA
most common cardiac and valvular manifestation in RA
pericarditis and mitral regurgitation
Syndrome with the Triad of neutropenia, splenomegaly and nodular R
Felty’s syndrome
Length of time for joint symptoms to be suggestive of RA
6 weeks or more
Pathologic hallmarks of RA (3)
- Synovial inflammation and proliferation,
- focal bone erosions,
- thinning of the articular cartilage
lgM against the Fc portion of lgG
Rheumatoid factor
Serum marker with higher specificity for RA than RF
Anti-CCP
Initial radiological finding in RA
Periarticular osteopenia
Test with greatest sensitivity for detecting synovitis, joint effusions and early bone and marrow changes in RA
MRI
DMARD of choice for RA
methotrexate
Most common type of arthritis
OA
2 major factors contributing to the development of OA
Joint loading and joint vulnerability
Most potent risk factor for OA
age
Nodes found on the PIP joint in QA
Bouchard’s nodes (Mnemonic·B of Bouchard comes first in the alphabet before H of Heberden’s)
Nodes found on the DIP joint in OA
Heberden’s nodes
Fulcrum of the longest lever arm in the body
Knee
Radiographic hallmark of QA
osteophytes
Initial analgesic of choice for OA
acetaminophen or paracetamol
Inflammation of the first MTP joint in gout
Podagra
Describe crystals in gouty arthritis
Needle-shaped crystals that are negatively birefringent (yellow under parallel light and blue under perpendicular light)
Describe crystals in pseudogout
Rhomboid-shaped crystals that are weakly positively birefringent
Mainstay of treatment during acute attack of gout (3)
NSAIDs{lndomethacin], colchicine, or glucocorticoids
Urate-lowering therapy should be initiated in any patient who already has tophi or chronic goutv arthritis.
True or False
True
Indication for uricosuric agents
Under excretors of uric acid
(<600mg in 24 hour urine sample)
Most commonly used hypouricemic and best drug to use in urate overoroducers, urate stone formers and renal disease
Allopurinol
Target theraoeutic blood uric acid level for gout
Less than or equal to 6mg/dl
Joint most frequentlv affected in CPPD or pseudogout
knee
Radiograph findings of punctate or linear radiodense deposits in fibrocartilaginous joint menisci or articular hyaline cartilage suggestive of CPPD
chondrocalcinosis
Arthritis presenting with predominant involvement, asymmetric or symmetric, involving one or more joints, dactylitis, shortening of digits and nail changes with or without silvery scaly skin lesions
psoriatic arthritis
Uveitis in psoriatic arthritis
Bilateral chronic posterior uveitis
5 patterns of psoriatic arthritis (from most to least common)
Classic “pencil in cup” deformity is seen in what type of arthritis
psoriatic arthritis
Marginal erosions with adjacent bony proliferation (“whiskering”) is seen in what type of arthritis
psoriatic arthritis
Ideal treatment for psoriatic arthritis
anti TNF alpha agents
Acute non purulent arthritis complicating an infection elsewhere in the body
reactive arthritis
triad of reactive arthritis
- arthritis,
- urethritis,
- and conjunctivitis
Common organisms implicated in ReA. Give 3
- Chlamydia,
- Shigella,
- Salmonella,
- Yersinia
- Campylobacter,
- E coli
Initial treatment of choice for ReA
NSAIDS
Young adult male, insidious onset of dull pain in the lower lumbar or gluteal region, lumbar morning stiffness lasting a few hours that improves with activity and returns after inactivity with nocturnal exacerbation
ankylosing spondylitis
gene that plays a direct role in AS pathogenesis
HLA-B27
Earliest changes in AS
Synovitis and myxoid marrow
lnnammation in the fibrocartilaginous regions where a tendon, ligament or joint capsule attaches to bone characteristic of SpA
enthesitis
Associated with prominent edema of the adjacent bone marrow and is often characterized by erosive lesions that eventually undergo ossification.
enthesitis
Most common extra-articular manifestation of AS
acute anterior uveitis
First line pharmacologic management for AS
NSAIDS
Most common site of infectious arthritis
knee
Most common route of infection for infectious arthritis in all age groups
hematogenous
Most common etiologic agent for infectious arthritis among young aduuts and adolescents (sexually active)
Neisseria gonorrhea
Most common nongonococcal cause of infectious arthritis in adults of all age groups
Staph aureus
Most common etiologic agent for infectious arthritis after surgery or penetrating injuries
Staph aureus
Subset of patients with highest incidence of infectious arthritis
RA patients
Most common presentation of infectious arthritis is polyarthritis. True or False
Monoarthritis
Sites of infectious arthritis common among IV drug abusers (3)
- Spine,
- sacroiliac
- and sternoclavicular joints
Other than antibiotics, essential treatment needed for a favorable outcome on joint function in infectious arthritis
Timely drainage of pus and necrotic debris
Late manifestation of congenital syphilis manifesting as chronic painless synovitis with effusion of large joints, particularly the knees and elbows
Clutton’s joints
Reactive symmetric form of polyarthritis that affects persons with visceral or disseminated tuberculosis
Poncet’s disease
Antibodies directed against proteinase-3 detected as diffuse granular cytoplasmic staining pattern in neutrophils
cANCA( cytoplasmic anti-neutropbil antibodies)
Antibodies directed against myeloperoxidase with perinuclear or nuclear staining in neutrophils
pANCA(perinuclear antineutrophil cytoplasmic antibodies)
First step in the workup of a patient with suspected vasculitis
Exclude other diseases
Granulomatous necrotizing vasculitis of the triad of upper and lower respiratory tract and kidney (sinusitis, lung involvement, glomerulonephritis), [+J cANCA
Wegener’s granulomatosis
Necroitzing inflammation of small arteries and veins including venules, glomerulonephritis, usually with no upper airway involvement and no pulmonary nodules, (+) pANCA
Microscopic polyangiitis
cANCA : Wegener’s granulomatosis
pANCA: Microscopic polyangiitis
True or False
True
WHAT DISEASE:
Asthma, peripheral and tissue eosinophilia, extravascular granuloma and vasculitis of multiple organ systems (predominant pulmonary findings)
Churg-Strauss syndrome
Necrotizing vasculitis, renal and visceral artery involvement with aneurysmal dilatations, no pulmonary aassociated with Hepatitis B infection
Polyarteritis nodosa
WHAT DISEASE :
Elderly female presenting with fever, anemia, headaches, temporal tenderness, jaw claudication, high ESR,and accompanying stiffness and muscle pains of the neck, shoulders, hip and thighs
Giant cell/temporal arteritis
Syndrome characterized by stiffness aching and pain in the muscles of the neck, shoulders, lower back, hips and thighs associated with giant cell arteritis
Polymyalgia rheumatica
Dreaded complication of giant cell arteritis
lschemic optic neuropathy
WHAT DISEASE :
Young female, systemic symptoms, arm claudication, diminished pulses on one arm, vasculitis of medium to large arteries involving the aortic arch and branches
Takayasu arteritis (also known as Aortic Arch Syndrome or Pulseless Disease)
WHAT DISEASE:
Child with glomerulonephritis, palpable purpura over the buttocks and lower extremities, gastrointestinal symptoms, arthralgias, and history of recent respiratory infection
Henoch Schonlein Purpura (HSP) (lmmunoglobulin A vasculitis)
Most commonly encountered vasculitis in clinical practice
cutaneous vasculitis
The most effective drug therapy for the systemic vasculitides is
cyclophosphamide
WHAT DISEASE
Cutaneous vasculitis, arthritis, peripheral neuropathy, membranoproliferative glomerulonephritis, Hepatitis C, coldprecipitated agglutinins or immunoglobulins
Cryglobulinemic vasculitis
Components of CREST syndrome (limited scleroderma)
- Calcinosis
- Raynaud’s phenomenon
- Esophageal dysmotility
- Sclerodactyly
- Telangiectasia
Chronic, slowly progressing autoimmune disease characterized by lymphocytic infiltration of the exocrine glands resulting in xerostomia and dry eyes (keratoconjunctivitis sicca)
Sjogren’s syndrome
