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autoimmune Flashcards

1
Q

What does autoimmune refer to?

A

abnormal immune response directed toward a self-antigen

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2
Q

What is activated during an autoimmune response

A

B or T lymphs or both

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3
Q

T or F autoimmune diseases are idiopathic.

A

T

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4
Q

What are possible factors that may contribute?

A
  1. Genetic susceptibility to class 1 or 2 antibodies
  2. enviroment
  3. infections
  4. decreased cytokine production
  5. loss of regulatory T cells
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5
Q

What is ankylosing spondylitis?

A

rheumatic disorder producing inflammation of axial skeleton and large peripheral joints

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6
Q

ankylosing spondylitis affects whom?

A
  1. M:F ratio 3:1

20-40 y/o with a genetic link

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7
Q

ankylosing spondylitis

symptoms

A 
back pain
stiffness
decreased chest expansion
low grade fever, fatigue, anorexia
weight loss/ anemia
iritis

starts in thoraco-lumbar and expands sup. and inf.

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8
Q

ankylosing spondylitis has what lab test?

A
  1. HLA B27: not specific

ESR, CRP, IgG

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9
Q

ankylosing spondylitis shows what in diagnosis?

A 
sclerosis in Si joints
marginal sydesmophytes
shiny corner sign
bamboo spine trolly tracts
dagger sign 
poker spine

all on xray`

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10
Q

autoimmune hemolytic anemia

what happens

A

autoantibodies attack RBC’s

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11
Q

autoimmune hemolytic anemia

who?

A

any age

more females

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12
Q

autoimmune hemolytic anemia

signs and symptoms

A

severe anemia
splenomegaly
increased unconjugated bilirubin
jaundice

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13
Q

autoimmune hemolytic anemia

tests

A
  1. Coomb’s
  2. Direct
  3. antiglobulin test
  4. CBC: increased MCHC
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14
Q

autoimmune hemolytic anemia

diagnosis

A

usually warm antibodies

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15
Q

celiac causes?

A

nontropical sprue/ celiac sprue

decreased gluten tolerance

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16
Q

celiac affects whom?

A

sensitivity to gluten w/ a genetic history

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17
Q

Celiac causes

signs

A

diarrhea
fatigue
weight loss
mouth ulcers

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18
Q

celiac

lab test

A

tTGA-IgA (antibody)

tissue transglutaminase

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19
Q

celiac

diagnosis

A

removal of gluten products

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20
Q

Crohn’s causes

A

regional enteritis

inflammation of distal ileum and colon, but may be entire GI tract

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21
Q

Crohn’s affects whom?

A

Female = Male
under 30 y/o
peak at 14-24 y/o

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22
Q

Crohn’s

signs and symptoms

A 
right lower quadrant pain
diarrhea
anorexia
weight loss
malnutrition
1/3 fistulas and fissures

INFLAMMATION AND OBSTRUCTION

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23
Q

Crohn’s T or F

lab test is IgM antibody agglutination test

A

F

no test

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24
Q

Crohn’s

diagnosis

A

barium enema xray
string sign
apthous & linear ulcers in GI
skip and cobblestone lesions

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25
What is DM1?
Juvinile Diabetes mellitus panceas produces little or no insulin due to genetic or immune-related destruction of beta cells
26
DM1 affects whom?
people under 30
27
DM1 | signs and symptoms
DKA (diabetic ketoacidosis) polyuria and polydipsia weight loss
28
DM1 | tests
blood glucose Hgb A1c HLA-Dr3 HLA-DR4
29
DM1 | diagnosis
labs case history clinical presentation
30
fibromyalgia produces what signs and symptoms?
1. stiff, achy, tender pain in muscles tendons and adjacent soft tissuee 2. poor sleep and fatigue 3. anxiety 4. IBS (irritable bowel syndrome)
31
fibromyalgia affects whom?
more females | young to middle aged
32
T or F | fibromyalgia has no known tests.
T
33
fibromyalgia | diagnosis
``` 1. CH possible precipitating factors: 1. stress 2. trauma 3 virus 4 lyme 5. cold 6 damp must exclude other pathologies ```
34
T or F Goodpasture's is a hypersensitivity disorder.
T
35
T or F | Goodpasture's affects kidneys first then lungs
F | vice-versa
36
Goodpasture' affects whom?
both sexes equally 18-30 50-65
37
Goodpasture's has what signs and symptoms?
hemoptysis/ pulmonary hemorrhage hematuria/ glomerulonephritis iron deficiancy anemia
38
Goodpasture' tests
1. urinalysis 2. blood: BUN/Creatinine anti-basement antibodies HLA-DRw
39
Goodpasture's | diagnosis
chest x-rays: bilateral patchy consolidations
40
What is the most common form of Graves' disease?
thyrotoxicosis
41
Graves' is caused by
hypermetabolism of thyroid and increased thyroid hormones
42
Graves' affects whom?
more females than males genetic history of thyroid or AI disease
43
Graves' exhibit what signs and symptoms
exoptalmia goiter pretibial myxedema skin: warm, moist, fine increased sweating frequent bowels fatigue/weight loss/ insomnia/ nervous
44
Graves' tests
TSH free T4 Thyroid antibodies: LATS/ TSI/ TGI
45
Graves' diagnosis
history physical exam lab tests Plummer's ds. (2nd most common cause of thyrotoxicosis
46
What is the most common aquired demylenating neuropathy?
Guillian Barre
47
Gullian Barre affects whom?
anyone
48
Gullian Barre AKA
Landry's ascending paralysis
49
Gullian Barre signs and symptoms
symmetric weakness and paresthesia starting in legs and moving to arms DTR's lost respiratory and autonomic dysfnx.
50
Can gullian barre be fatal?
yes
51
Gullian Barre has what tests?
increased CSF protein evidence of recent infection: most common campylobacter jejuni
52
Gullian Barre diagnosis
nerve biopsy: shows de and remyelination clinical symptoms.
53
Hashimoto's akas
thyroiditis | myxedema
54
Hashimotos's is
chronic thyroid gland inflammation with lymphocytic infiltration due to Ai
55
Hashimoto's affects whom
females
56
Hashimoto's signs ans symptoms
``` weight gain/ puffiness enopthalmia slurred speech/ thick toungue cold intolerance constipation ```
57
Hashimoto's lab tests
1. free T$/T3 2. TSH 3. TPO antibodies (antithyroid peroxidase) 4. anti-microsomal antibodies 5. anti-thyrogloulin antibodies
58
hashimoto's diagnosis
history physical exam lab tests
59
WHAt does ITP mean?
Immue thrombocytopenic purpura
60
Antibodies attack platelets during
ITP
61
ITP affects whom?
children: acute adults: chronic
62
ITP | signs and symptoms
sudden mucosal bleeding (epistaxis, gum, increased menstaration) subcutaneous bleeding (petechia, eccymosis)
63
ITP | lab tests
NO GOLD STANDARD autoantibodies:platelet ratio decreased platelets CBC:normal RBC and WC
64
ITP | diagnosis
bleeding symptoms must rule out SLE platelet antibody test is non specific
65
What is the most common demylenating disease of the CNS?
multiple sclerosis
66
What is MS possibly associated with?
temperate climate
67
MS affects whom?
F:M = 2:1 rare in children and adults over 50
68
MS | signs and symptoms
numbness, tingling, pain, burning, itching cognitive problems late: slurred speech and dementia
69
MS | lab test
CSF: oligoclonal bands increased IgG
70
MS | diagnosis
MRI: high signal (white) plaque lesions at the brain and spinal cord Lhermitte's sign: pos
71
What causes decreased AcH receptors that lead to episodes of muscles weakness?
Myasthenia Gravis
72
Myasthenia Gravis affects whom?
more females than males | 20-40
73
Myasthenia Gravis | signs and symptoms
Eyes; ptosis/ diplopia muscle fatigue post exercise dysartria, dysphagia, proximal limb weakness ``` later: quadriparesis bulbar symptoms (voice chocking nasal regurgitation ```
74
Myasthenia Gravis | lab test
AcH receptor antibody
75
Myasthenia Gravis | diagnosis
case history: signs and symptoms edrophonium IV drug:mm function improves electrophysiological testing
76
What is a skin disorder characterized by bullae and erosions of surface and mucosla areas?
Pemphigus
77
T or F | pemphigus can be fatal.
T
78
Pemphigus affects whom?
middle aged and elderly high incidence in brazil
79
Pemphigus | signs and symtoms
Bullae and extensive skin erosions starts in mouth and goes all over any stratified epithelium painful ulcers
80
Pemphigus | lab tests
Tzanck test immunoflorescent IgG on lesions
81
Pemphigus | diagnosis
CH of mucosal ulcers Nikolsky sign: epidermis detaches from underlying skin
82
What develops in 50% of patients with Giant cell arteritis (GCA)?
Polymalgia rheumatica
83
Polymalgia rheumatica causes
pain and stiffnes in proximal muscles without atrophy and weakness
84
Polymalgia rheumatica affects whom
people over 50
85
Polymalgia rheumatica | signs and symptoms
pain and stiffness in muscles of: back, neck, hip, shoulders, thighs no weakness or atrophy malaise, fever, weight loss stiffness after inactivity (gelling phen.)
86
Polymalgia rheumatica | lab test
increased ESR and CRP normal:CK-MM, AST CBC:normocytic normochromic anemia
87
Polymalgia rheumatica | diagnosis
differential: RA and MM normal: EMG, mm. biopsy
88
What is characterized by inflammation and degenerative changes in muscle (poly) and skin (derm) that leads to symetrical weakness & atrophy of limb girdles?
polymyositis & dermatomyositis
89
polymyositis & dermatomyositis affects whom?
F:M= 2:1 40-60 5-15
90
polymyositis & dermatomyositis signs and symptoms
polymyositis: proximal muscle weakness and atrophy fever/fatigue/weight loss dermatomyositis: rash periorbital edema w/ heliotrope hue (purple)= pathognomonic lesions: dusky and red skin may split
91
polymyositis & dermatomyositis | lab test
All mm. enzymes increased CK, AST, LDH thymic antibodies: Jo-1, PM-1
92
polymyositis & dermatomyositis | diagnosis
``` CH proximal mm weakness skin rash increased mm enzymes muscle biopsy: definitive EMG changes ```
93
Chronic recurrent skin pathology with dry, well-marginated scaly, silvery plaques and patches describes what?
Psoriasis
94
Psoriasis affects whom?
10-40 y/o but really any age
95
Psoriasis signs and symptoms
characteristic lesions: scalp, extensor surfaces buttoks, sacral area, penis
96
Psoriasis lab tests include skin antibodies IgM and IgG. T or F
F no tests
97
Psoriasis | diagnosis
insection of lesions | case history
98
What is the difference between Raynaud's disease and Raynaud's phenomenon?
disease is bilateral w/ no underlying cause phenomenon has an recognizable underlying cause
99
Raynaud's is characterized by
spasm of arterioles with intermitten pallor and cyanosis
100
Raynaud's affects whom?
more females | 20-40
101
Raynaud's signs and symptoms
arteriole spasm (acral: nose, fingers, tongue) intermitten pallor or cyanosis
102
What tests for Raynaud's?
no tests
103
Raynaud's diagnosis
presentation: blanching or cyanosis of digits precipitated by cold or emotions can occur with scleraderma bone resorption to the distal tufts of the digit
104
Rheumatoid Arthritis aka
felty syndrome
105
Felty's=
splenomegaly & neutropenia
106
Still's disease=
Juvenile RA
107
What is characterized by symmetric inflammation of peripheral joints advancing to destruction of joints & periarticular areas?
RA
108
RA affects whom?
females more than males 30-50 genetic link
109
RA | signs and symptoms
slow, progressive joint stiffness fatigue, weakness, anorexia "peripheral joint involvement advancing to tissues and organs"
110
RA | lab tests
IgM RF: not specific for RA increased ESR, CRP joint fluid: increased PMN's HLA's DRbeta1 DR4 anemia: N, N (normocytic normochromic)
111
RA diagnosis
``` Based on 4 of 7 criteria that must be present for 6 weeks: 1. stiffness greater than one hour 2. arthritis in 3 or more joints 3. arthritis in hand joints 4. systemic arthritis 5 rheumatoid nodules 6. Serum RF antibody 7. x-ray changes rat bite reosions, deviations, ligamentous laxity ```
112
What is characterized by dry mouth, eyes, mucous membranes and often accompanies rheumatoid pathologies?
Sjogren's syndrome
113
Sjogren's syndrome affects whom?
more females | late 40s
114
Sjogren's syndrome | signs and symptoms
occular symptoms (dryness) for more than 3 months sicca=dryness xerostomia= dry mouth
115
Sjogren's syndrome | lab tests
schirmer test rose bengal test increased ESR, CRP anemia develops SS-B antibodies, but non-specific
116
Sjogren's syndrome | diagnosis
CH labs: non-specific salivary gland test and biopsy increased immune antibodies generally
117
What is a connetctive tissue disorder affecting joints, kidneys, heart, vessel walls and serous areas?
Systemisc Lupas Erythematosis
118
SLE affects whom?
more females | 15-50
119
SLE | signs and symptoms
acute or chronic onset constitutional symptoms (febrile rash/ alopecia "butterfly rash on face" arthralgias lung/kidney/heart (Libman-Sacks)
120
SLE | lab tests
ANA/FANA Ds-DNA antibody smith antibody DNA and Smith Ab are specific but not sensitive
121
SLE | diagnosis
symptoms/ rash/ arthalgias Lab Tests can mimic RA of the hands due to ligamentous laxity which would include ulnar deviation, swan and boutonnieres deformity but will lack rat bit erosions
122
What is CREST involved with?
Scleroderma
123
What characterizes scleroderma?
diffuse fibrosis and degeneration of skin vascular supply, articulations and internal organs (GI, lung, heart, kidneys)
124
Scleroderma affects whom?
F:M = 4:1 | 30-50
125
Scleroderma signs and symptoms
thickening of the skin (esp. acral parts) raynaud's phenomenon multi-organ: renal and lung
126
Scleroderma | lab tests
nonspecific: anti-Sci-70/ autoantibodies eosinophilia
127
Scleroderma | diagnosis
clinical presentation: CREST ``` Calcinosis Raynauds Esophageal dysfunction Sclerodactyly Telangiectasia ``` x-ray: bone resorption to the distal tufts of the digits
128
Temporal arteritis aka
giant cell
129
What is characterized by cranial artery involvement (large blood vessels: carotid system) vessels with elastic tissue
Temporal arthritis
130
Temporal arthritis affects whom?
slightly more females | over 50
131
Temporal arthritis | signs and symptoms
bitemporal headache visual disturbances jaw claudication polymyalgia rheumatica (40%)
132
Temporal arthritis | lab test
Big increase in ESR anemia: N, N (normocytic, normochromic) maybe increase in ALK. Phos
133
Temporal arthritis | diagnosis
biopsy of arteries | radiological exam of the tempotral artery with ultrasound yields a halo sign or a MRI with gadolinium based contrast
134
What is characterized by granulomatous arteritis of aorta and its branches?
Takyasu's
135
Takyasu's affects whom?
F:M = 8:1 | 15-30
136
Takyasu's | signs and symptoms
non-descriptive constitutional (fatigue, malaise, night sweats, weight loss, arthralgias) progression: vascular changes: syncope, TIA's, HTN, decreased pulses
137
Takyasu's | lab tests
NA non specific increased ESR and CRP increased IgM globulins
138
Takyasu's | diagnosis
arteriograms showing occlusion or narrowing of aa
139
What is characterized by granulomatous inflammation of respiratory tract then progressins to vasculitis and glomerulonephritis?
Wegener's granulomatosis
140
Wegener's granulomatosis affects whom?
more males any age possible hypersensitivity history
141
Wegener's granulomatosis | signs and symptoms
upper respiratory tract nasal mucosa: red, raised, friable, bleeds fever/fatigue/weight loss/ anorexia
142
Wegener's granulomatosis | lab tests
ANCA (antineutrophilic cytoplasmic antibodies) increased ESR and CRP anemia leukocytosis renal function: increased creatinine/ BUN
143
Wegener's granulomatosis | diagnosis
pulmonary & renal biopsies | lab tests

Anatomy (22 decks)

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