Screening for Immunologic Dz Flashcards
1
Q
what are the 2 categories of immunologic response and what are they each initiated by
A
- humoral immunity
- cell-mediated immunity
both initiated by lymphocytes
2
Q
what is the location of most immunity and why
A
intestines
- main point of entry for pathogens
3
Q
what is the intestines role in immunity
A
help to maintain immune homeostasis
4
Q
what is the immune system composed of
A
central and peripheral lymphoid organs
peripheral = lymphoid cells circulate thru body
5
Q
what is the general function of the immune system
A
warning against exogenous microorganisms and endogenous neoplastic cells
6
Q
what is the risk of exogenous cells
A
can cause infection
7
Q
what are 4 types of exogenous micro-organisms
A
viral
bacterial
parasites
fungi
8
Q
what is humoral immunity
A
occurs in body fluids extracellularly (ie antibiotics)
9
Q
what is cell-mediated immunity
A
occurring intracellularly
- cells are working to contain and destroy
10
Q
as many risk factors are still unknown what are 2 main populations of people that should be screened
A
- previous hx of systemic or inflammatory dz
- familial hx of systemic or inflammatory dz (ie fibromyalgia, chronic pain, etc.)
11
Q
what familly hx has chronic pain been associated w (5)
A
alcoholism
depression
GI disorders
panic attacks
migraines
12
Q
what are 3 screening questions
A
- how long have you had this problem (acute vs chronic)
- has the problem gone away and then recurred
- have additional sx developed, or have other areas become symptomatic over time
13
Q
what are common sx reported (7)
A
- new onset soft tissue/joint pain
- bilateral joint pain, stiffness, swelling
- AM stiffness >1hr
- weakness
- constitutional sx
- progressive neuro sx w/i 3wks of infection or vax
- joint pain
14
Q
when are constitutional sx most commonly seen
A
esp w immunosuppressive meds (RA, lupus)
15
Q
what characteristics associated w joint pain are commonly reported sx
A
w rash, eye irritation, urinary issues
16
Q
what are general characteristics of RA
A
symmetrical
more prox joints of hands and feet
17
Q
what are 4 categories of dysfunction in the immune system
A
- immunodeficiency disorders
- hypersensitivity disorders
- autoimmune disorders
- immunoproliferative disorders
18
Q
what are 2 ex of immunoproliferative disorders
A
leukemia
lymphoma
19
Q
what is the pathophys of HIV
A
direct attack on immune system
vulnerable to opportunistic infections
20
Q
how is HIV transmitted
A
via blood contact or blood products
21
Q
describe the onset of sx in HIV
A
delayed
22
Q
describe the main medical management available for HIV and what the risk of it is
A
anti-viral therapy treatment
- delayed toxicity w long-term usage
23
Q
what are s/sx of toxicity from long-term anti-viral therapy in HIV
A
rash, nausea, HA, dizziness, fatigue, ms pains/weakness, hepatotoxicity (B CTS, asterix sign)
24
Q
what are the PT implications of someone w HIV/AIDS
A
if deconditioned, fatigued
- get back to ADLs, work/rec related
25
what does HIV inc risk of (3)
kaposi sarcoma
non-hodgkin's lymphoma
tuberculosis
26
what is a kaposi sarcoma and how can one progress
skin lesions, initially purple/red on feet, trunk, and head
can progress to malignant tumors on inner walls of heart and vessels
- possible GI involvement
27
what inc risk of non-hodgkin's lymphoma and what makes it difficult to treat
risk inc w age & further weakening of immune system
difficult to treat bc further immunosuppression not indicated since already immunocompromised
28
why is there an inc incidence of TB in HIV
immunocompromised, bacteria from TB become more active and leads to more pulmonary sx
29
what are early sx of AIDS (6)
wt loss
fevers, night sweats
changes in bowel function
- chronic diarrhea
cough, SOB, fatigue
skin changes
LBP
30
what are immunodeficiency disorders
HIV/AIDS
31
why can LBP be an early sx of AIDS
dec in activity and changes in ms mass
changes in posture
more common as Tcell count dec
- inc risk of osteopenia, osteoporosis, osteonecrosis
32
what are late sx of AIDS (5)
kaposi's sarcoma
HTN (cardiac or pulm)
opportunisti dz
dementia
distal asymmetric polyneuropathy
33
how does HIV neurologic dz affect the CNS
space occupying lesions, encephalopathy, meningitis
34
describe AIDS dementia
complex
- cognitive, motor, and behavioral functioning
35
how does HIV neurologic dz affect the PNS
inc risk of CYTOMEGALOVIRUS - ascending polyradiculopathy
- progressive weakness from LE up to flaccid paralysis
- potential for painful sensory neuropathy
- lead dec activity levels, immobility, cardiopulm decline -> PT implication for endurance
36
what are the 4 types of hypersensitivity
type 1 - anaphylaxis
type 2 - cytolytic
type 3 - immune complex
type 4 - cell-mediated or delayed
37
what is anaphylaxis
immediate systemic allergic reaction
- vasodilation (quick drop in bp), bronchospasm (difficulty breathing), hives, anaphylactic shock
38
what are 6 clinical sx of anaphylaxis
1. localized itching, edema, sneezing
2. wheezing
3. dyspnea
4. cyanosis
5. tachycardia
6. hypotension
39
what flag is anaphylaxis
RED
immediate epi-pen use, call for emergency assistance (even if pen effective)
- vocal hoarseness and chest tightness
40
what is cytolytic hypersenstivity
destruction of RBCs w transfusion reactions
- production of auto-antibodies produced against cells of body that have any foreign proteins attached to them
41
what are 2 instances that cytolytic hypersensitivity is seen
hemolytic anemia
transfusion of incompatible blood
42
what are clinical sx of cytolytic hypersensitivity (6)
HA
back/flank pain
chest pain/angina
n/v
tachycardia/hypotension
hematuria
43
what is immune complex hypersensitivity
formation or deposition of antigen-antibody complexes in tissues
- depends on tissues and where, can lead to different clinical sx
44
what are clinical sx of immune complex hypersensitivity (7)
arthralgia
uticaria (hives/rash) - skin
nephrits - kidneys
pleuritis - lungs
pericarditis - heart
fever
lymphadenopathy
45
what is cell mediated or delayed hypersensitivity
occurs 24-72hrs after exposure to antigen
46
what is the role of antigens and hypersensitivity
antigens created on first exposure
- subsequent exposures will see hypersensitivity reactions that result in cell-mediated sx
47
what are 2 instances of cell-mediated or delayed hypersensitivity
graft v host dz
contact dermatitis
48
what are sx of graft v host dz (3)
skin
GI
hepatic dysfunction
49
what are sx of contact dermatitis (3)
itching
erythema
skin lesions
50
what are autoimmune disorders
immune system attacks body cells/tissues
- immune system can't distinguish self from non-self
51
what are 5 risk factors for autoimmune disorders
genetics
sex hormones (women > men)
viruses
stress
environment
52
what are 2 types of autoimmune disorders and ex
organ specific
- thyroiditis, ulcerative colitis, insulin dependent diabests
generalized
- see more of a systemic response than one organ
53
what are ex of generalized autoimmune disorders (14 - don't memorize just to glance at)
fibromyalgia
RA
PMR
SLE
scleroderma
spondyloarthropathy
AS
Reiter's syndrome
PsA
lyme dz
MS
GBS
MG
54
what is fibromyalgia
non-inflammatory, generalized MSK pain
55
what is the etiology of fibromyalgia
controversy over exact cause
- thoughts ab abnormal biochemical or immunologic aspects: genetic predisposition + triggered by virus or inadequate thyroid hormone
56
what are risk factors of fibromyalgia (3)
women > men
less common in older adults
psychosocial factors
- childhood trauma
- family issues
- physical and/or sexual abuse
57
what are 5 clinical sx of fibromyalgia
1. widespread tender points w generalized aching
2. pain lasting > 3 mo
3. swelling, ms spasms
4. fatigue, AM stiffness, sleep disturbance
5. inc sensitivity to sensory stim
58
describe the pain experienced w fibromyalgia
more general and things that wouldn't necessarily cause pain are painful
- more centrally mediated (neuropathic if you will lol)
59
tender points seen in fibromyalgia vs trigger points
tender points:
- sx to palpation
- wide spread pain
trigger points:
- palpable difference in tissue
- myofascial pain specific to ms or region
60
what scale/tool is used to assess fibromyalgia
sx severity scale which focuses on:
- fatigue
- cognitive function
- sleep disturbance
- other systemic clusters
61
what is the PT implication of fibromyalgia sx
if not dx, refer out
- PT still part of treatment, but need other practitioners involved
prob a yellow flag then
62
what is RA
chronic, systemic, inflammatory disorder affecting synovial tissues
63
what is the etiology of RA
unknown cause
- possible genetic predisposition + environmental stim
64
what are 2 risk factors for RA
women 2-3x men
ages 20-40yo
65
what are 4 clinical sx of RA
1. variable b/w and w/i pts
2. early fatigue, malaise, diffuse ms pain
3. 1+ swollen joints, morning stiffness >45min, MTPs/MCPs
4. later swelling, tissue reaction, joint destruction
66
what will imaging show of RA
80% will have significant visible joint erosions 2yr after onset
67
when is a referral indicated in RA (3)
1. significant discomfort w compression of MTP/MCP
2. presence of 3+ swollen joints
3. >1hr morning stiffness
68
what is polymyalgia rheumatica (PMR)
systemic, rheumatic inflammatory disorder
69
etiology and risk factors of PMR
unknown cause
- possibly linked to autoimmune, viral and stress mechanisms
risk factors:
- >55yo (inc w age)
- women > men
- caucasian
70
what path is PMR linked with
giant cell arteritis
- inflammation of branches of carotid artery (sx: severe HA, TMJ dysfunction, blindness if impact opthalmic arteries)
71
what are 6 clinical sx of PMR
1. severe aching and stiffness ms > joints
2. AM pain
3. HA
4. weakness
5. fatigue
6. very high ESR
72
where is there aching/stiffness in PMR and why is this important
localized to ms
- at neck, shoulder, pelvic girdle
can help to differentiate from joint disorders
73
describe the course of dz for PMR
self limiting lasting 2-3yr
- low dose steroid tx
74
what is systemic lupus erythematosus (SLE)
chronic systemic inflammatory dz
75
discoid vs systemic lupus
discoid
- only affecting skin
- raised, scaly coin shaped lesions
- rarely progresses to systemic
systemic
- more severe, affects many systems/organs (ie skin, joints, kidneys, blood forming organs, mucous membranes) in body
76
what is the etiology and risk factors of SLE
cause is unknown
- likely immunoregulatory impacted by genetics, environment, hormone, chemical factors
risk factors:
- 15-40yo
- women 10-15x > men
77
what are 5 clinical sx of systemic lupus
1. butterfly rash
2. arthralgia and arthritis
- symmetrical, usually small joints
- can be progressive and deforming leading to osteoporosis w fx and osteomyelitis
3. polyneuropathy
- motor, sensory, or both
- starting in LE and progress up
4. neurolupus
- neuropsychiatric manifestations of dz
- cerebrovascular dz, sx, less commonly cog dysfunction
5. fever/fatigue
78
what is scleroderma
inflammation and fibrosus of body tissues (ie skin, blood vessels, synovium, skeletal ms, kidneys, heart, lungs, GI)
79
etiology of scleroderma
unknown
- mix of genetics and environment
80
what are 5 general clinical sx of scleroderma
1. raynaud's phenomenon and tightness in skin
2. calcinosis (calcium deposits in fingertips), sclerodactyly (chronic hardening and shrinking toes and fingers), telangiectasia
3. arthralgia, stiffness, arthritis
4. esophageal hypomotility
5. lung involvement (interstitial lung dz - restrictive)
81
limited vs diffuse scleroderma
limited: just affect skin (usually hands and then esophageal dysmotility)
- better prog than diffuse
diffuse: acute onset
- constitutional sx
- widespread skin involvement and internal organ involvement
82
what population is diffuse sclerodoma more common in
women, 20-55yo
83
what is spondyloarthropathy
non-infectious, inflammatory, erosive rheumatic dz of spine
84
what are 5 common risk factors of spondyloarthropathy
1. recurring, insidious onset of backache
2. first episode before 30yo
3. each episode lasts months
4. pain inc w rest, improves w movement
5. family hx of spondyloarthropathy
85
what are 3 spondolyoarthropathies
1. ankylosing spondylitis
2. reiter's syndrome
3. psoriatic arthritis
86
what is AS
chronic, progressive, inflammation of fibrous tissue
- affecting ligs, tendons, capsule attachments to bones
- primarily SIJ, spine, larger peripheral joints
87
what is the prevalence of AS
likely not a difference b/w gender
- maybe women have more milder form or more peripheral joint involvement
88
what is needed for dx
MRI
- XR not enough
89
what are 6 clinical sx of AS
1. insidious onset mid-low back pain
2. stiffness and pain >3mo
3. AM stiffness >1hr
4. <40yo
5. dec lumbar AROM (esp flex) -> bamboo/fused spine
6. extraarticular - uvitis, conjunctivitis, colitis, iritis, cardiac
90
what is there an inc risk of later on in AS (5)
1. spinal fx from minor trauma
2. atlanto-axial subluxation
3. destruction of vertebral bodies
4. spinal stenosis
5. cauda equina
91
what is reiter's syndrome
reactive arthritis after infection
- possible genetic contributions
- typically affecting knees, ankles, LE WB-ing joints
92
what is the triad of sx for reiter's syndrome
arthritis
conjunctivitis (redness, burning, irritation in eyes)
non-specific urethritis
93
what is psoriatic arthritis (PsA)
chronic, recurrent, erosive, inflammtory arthritis
94
what is the etiology of PsA
causes unknown
occurs in 1/3 of people w psoriasis
95
what is key in management of PsA
early detection for medical intervention (using biologic agents) to prevent long-term complications (joint destruction and disability from arthritis)
96
what are 5 clinical sx of PsA
1. psoriatic skin lesions
2. pitting, ridging, cracking nails
3. arthritis
4. diffuse swelling of fingers
5. inflammation of soft tissue attachment sites
97
what are characteristics of arthritis as a clinical sx of PsA (3)
1. early and severe
2. symmetric, distal distribution (DIP before MCP/MTP)
3. AM stiffness >30min
98
what is lyme dz and where is it most common
tick bite w bacterial infection
coastal NE, mid-atlantic, wis, minn, cali
99
what are early sx of lyme dz (2)
1. red rash (erythema migrans)
- focal point where bite was surrounded by red ring
2. flu-like sx (stiff neck, body ache, fatigue)
100
what are 4 late sx of lyme dz
1. arthritis (larger joints)
2. neurocog sx
- stiff neck, HAs, numbness, pain, weakness in limbs
3. sleep disturbance
4. peripheral neuropathy - doesn't follow pattern
101
what is key for treatment of lyme dz
early treatment helps w quicker and more complete recovery
- most effective
102
what is MS
inflammatory, demyelinating dz of CNS
103
what are risk factors of MS (3)
women>men
20-40yo
familial hx
104
what are 8 clinical sx of MS (just be able to recognize)
1. unilateral vision change
2. paresthesias
3. ataxia/unsteadiness
4. vertigo
5. fatigue and ms weakness
6. tremor, spasticity, hyper reflexia
7. bowel/bladder dysfunction
8. lhermitte's sign
105
what is a characteristic of MS clinical sx
rapid onset over minutes- hours
- gradual is less common
106
what is lhermitte's sign and what dz is this seen in
cervical neck flexion elicits electric shock sensation down spine and thru extremities
MS
107
what is GBS
inflammatory demyelinating dz of PNS
- abrupt onset of paralysis
- may be linked to infectious illness, vaccinations (1-3wks post)
108
what are 4 clinical sx of GBS
1. rapid and progressive weakness in 3-7 days
- symmetric, LEs -> UEs -> respiratory ms
- variable progression of paralysis
2. hyporeflexia
3. paresthesias
4. fever, malaise, nausea
109
what is the course of dz in GBS
within 6-9mo full recovery
- only ab 1/2 have lingering neuro deficits
110
where is there specifically weakness and nerve related sx common in GBS
CN and esp facial n.
111
what is MG
antibodies produced that block Ach receptors on ms, impairing function
112
what are the risk factors for MG
women 20-30yo
men >50yo
113
what are 4 clinical sx of MG
1. ms weakness and fatigue (cranial and neck ms)
- eyes, chewing, swallowing, facial expressions
2. rapid fluctuating asymmetric ptosis
3. worsens w exertion, later in day, warmer temps
4. progressing to respiratory failure
- impact ms of respiration and diaphragm -> breathing won't be as efficient
114
what are red flag immediate referrals for immunologic conditions (3)
1. anaphylactic shock (even if epipen admin)
2. joint pain w suspect infection
3. blue color to skin over joint w extreme pain (septic joint)
115
what are 3 yellow flag soon referrals for immunologic conditions
1. joint pain w constitutional sx
2. symmetrical joint sx (RA)
3. neuro sx w/i 1-3wks of infection or vax (potential for GBS)
