Introduction To Immunologically Mediated Diseases Flashcards

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1
Q

Hashimotos disease MOA and symptoms and risk factors

A

MOA: igg auto abs against thyroid peroxidase(antimicrosomal) and thyroid globulin
Organ specific: thyroid gland

Symptoms:
Risk factors: genetic- HLA DR5 & DR3, environmental- smoking,drugs

Diffuse,non tender, moderate, thyromegaly
Hypothyroidism

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2
Q

Hashimoto’s thyroiditis diagnosis and treatment

A

Diagnosis :
Anti-TPO(microsomes) Abs in 90% ( non-specific)
Anti-TG Abs in 40%

Treatment:
If hypothyroid, levothyroxine

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3
Q

Pernicious anemia MOA and symptoms

A

MOA: IGg auto Abs against parietal cells or intrinsic factor
B12(cobalamin): deficiency
Organ specific: gastric parietal cells( cells excrete intrinsic factors to break down food)

Symptoms
Angular chelitis, glossitis (b12 deficiency)
Peripheral sensory neuropathy
Loss of proprioception(due to long standing b12 deficiency)
Pallor, weakness, fatigue ( due to anemia)

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4
Q

Pernicious anemia diagnosis and treatment

A

Diagnosis:
-CBC- low b12, macrocytic( megaloblastic) anemia
-inc homocysteine and methylmalonic acid
- acid secretion analysis
- endoscopy with biopsy
- historically: schilling test( used to determine how well patient can absorb b12 in intestinal tract)
Treatment:
- vitamin b12 IM ( IM because need to bypass stomach due to parietal cell damage)

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5
Q

Insulting dependent diabetes mellitus

MOA, and symptoms

A

MOA:
- T cell and microphages infiltration of beta cells-> decreased insulin

Organ specific: pancreatic, beta cells

Symptoms:

  • genetic associations: HLA DR3 &4
  • often asymptomatic ( initial symptoms diarrhea, vomiting, fruity breath, labored breathing)
  • DKA common initial presentation
  • acanthosis nigricans ( black skin rash)
  • polyuria,polydipsia,glucosuria
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6
Q

Diabetes mellitus diagnosis and treatment

A

Dx:
- oral blood glucose testing ( fasting vs. non fasting )
- HbA1c greater than or equal to 6.5( can also be used for monitoring diabetes because looks at 3 months worth)
- anti glutamic acid decarboxylase antibodies
- islet cell cytoplasmic Abs
tx:
-exogenous insulin
- pancreas transplant

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7
Q

Poststreptococcal glomerulonephritis MOA and symptoms

A

MOA:
- IGg, IGm & C3 deposition on glomerular basement membrane and Mesangium ( hypersensitivity 3)
Nephritogenic group A streptococci pharyngitis or impetigo ( molecular mimicry)
- mostly happens to kids because group A seen most in children

Organ specific: renal GBM and mesangium

Symptoms :

  • tea or cola colored urine
  • HTN
  • can range from asymptomatic to nephrotic syndrome
  • periorbital and peripheral edema
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8
Q

Poststreptococcal glomerulonephritis diagnosis and treatment

A

dx:

  • low c3 and or CH50
  • ASO titers
  • imminuoflurescence microscopy: GRANULAR

Treatment :

  • anti hypertensives
  • antibiotics
  • diuretics/ NA+ restriction
  • supportive
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9
Q

Good pastures syndrome MOA and symptoms

A

MOA:
- IGg auto abs against intrinsic Ag of glomerular basement membrane
- type 2 hypersensitivity
- mostly in adults
Organ specific- renal glomerular basement membrane

Symptoms :

  • genetic associations: HLADR2
  • rapidly progressing glomerulonephritis(he matures)
  • pulmonary hemorrhage (hemoptysis)
  • preceding URI
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10
Q

Goodpastures syndrome diagnosis and treatment

A

Dx:

  • anti GBM abs>90%
  • CXR: pulmonary infiltrate
  • light microscopy
  • Immunofluorescence miscroscopy: LINEAR

Treatment :

  • plasmapheresis
  • cyclophosphamide
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11
Q

Pemphigus vulgaris MOA and symptoms

A

MOA:
IGg auto abs against desmoglein 1 or 3 ( desmosome)

Organ- mucosal or cutaneous epithelial cell junctions

Symptoms :
- oral mucosal lesions initially
- painful Flaccid Bullard
Positive nikolsky sign

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12
Q

Pemphigus vulgaris diagnosis and treatment

A

Dx:

  • anti desmoglein 1/3 Abs
  • light miscroscopy; acantholysis
  • immunofluorescence: reticular

Tx:

  • corticosteroids
  • rituximab
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13
Q

Immune thrombocytopenia purpura MOA and symptoms

A

MOA: auto abs against GpIIb/IIIa ( receptor on platelets)

Organ- blood, platelets

Symptoms:
Children- self limiting, post viral
Adults- chronic
-purpura, mucucutaneous bleeding, splenomegly ( bleeding on nose )
- pallor, fatigue
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14
Q

Immune thrombocytopenia purpura diagnosis and treatment

A

DX:

  • CBC: isolated thrombocytopenia
  • Dx of exclusion
  • blood smear
  • bone marrow biopsy ( adults)

Tx:
Children- none
Adults- corticosteroids, rituximab, IVIB, and anti- IgD, splenectomy( last resort )
DIscontinue drugs inhibiting platelet count

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15
Q

Primary biliary cholangitis

MOA and symptoms

A

MOA:
- etiology unclear
-lymphocytic infiltrate+ granulomatous inflammation
Auto abs against mitochondria

Organ- medium sized intrahepatic bile ducts

Symptoms :

  • obstructive jaundice
  • cirrhosis, HSM, portal hypertension
  • xanthomas, steatorrhea
  • dark colored urine, light stool
  • pruritis ( itching skin)

Bile made up of cholesterol so when there is an increase in bile body takes that as a sign not to convert cholesterol to bile -> inc in cholesterol resulting in xanthomas and steatorrhea

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16
Q

Primary biliary cholangitis diagnosis and treatment

A

Dx:

  • obstructive liver labs
    - inc alk-phos, GGT,LFT, hypercholesteromia, conjugated (direct) hyperbilirubinemia
    • AMA 93%
  • increased IgM
  • liver biopsy
Tx:
Ursodeoxycholic Acid (USDA)
17
Q

Ulcerative colitis MOA and symptoms

A

MOA:

  • etiology unclear, mucosal and submucosal TH2 mediated inflammation
  • 50% just rectum
  • 30% recto colon
  • 20% whole colon

Organ: rectum

Symptoms :

  • smoking protective
  • bloody diarrhea,BRBPR, anemia, LLQ pain. Inflammation, oral ulceration , first degree sclerosis cholangitis, pyoderma gangrenosum
  • colorectal carcinoma ( higher risk )
18
Q

Ulcerative colitis diagnosis and treatment

A

Dx:

  • inc hgb/ Hct & ESR; dec albumin
  • +MPO/p-ANCA
  • stool bacterial culture
  • barium enema: lead pipe sign
  • endoscopy and biopsy

Tx:
- 5- aminosalicylic acid preparation , sulfasalazine,
6- mercaptopurine , infliximab
- colectomy

19
Q

Sjogrens syndrome MOA and symptoms

A

MOA:
- lymphocytic infiltration+ fibrosis -> destruction. First or second degree

  • non organ specific: exocrine glands, especially lacrimal and salivary

Symptoms :

  • xerostemia, kerstoconjunctivitis sicca, bilateral parotid enlargement
  • vasculitis, xerosis, pruritis, annular edema
  • marginal zone lymphoma
  • RA, hashimotos, SLE
20
Q

Sjögren syndrome treatment and diagnoses

A

Diagnosis:

  • +RF 70%, + ANA, nuclear speckled, anti RO/SSA & anti La/SSb
  • Schirmer test
  • biopsy

Tx:
Immunosuppressive drugs ( prednisone)
Pilocarpine, artificial tears

21
Q

Antiphospholipid syndrome MOA and symptoms

A

MOA:

  • auto abs vs proteins that bind phospholipids-> thrombin( acquired hypercoagulability, 1 or 2 degrees )
    • lupus anticoagulant
    • cardiolipin(IGg or IgM)
      • beta 2 glycoproteins

Non organ specific: hematologic, catastrophic APS with more than or equal 3 organ systems

Symptoms:

  • recurrent thrombosis: DVT,PE,CVA,MI
    - spontaneous abortions
  • livedo reticularis
22
Q

Antiphospholipid syndrome treatment and diagnosis

A

Diagnosis:
- Sapporo APS classification criteria
- labs at least 1 : + anticardiolipin (IGG and/or
IGm), +lupus anticoagulant, + beta glycoproteins
- clinical at least 1: vascular thrombosis, pregnancy
Morbidity

treatment :
Lifelong anticoagulants with warfarin ( heparin if pregnant )