Autoimmune diseases & chronic inflammation

Question 1

Which gene region is the most common genetic susceptibility in?

Answer 1

HLA region

Question 2

How does autoimmunity cause clinical disease? (3)

Answer 2

• Auto-reactive B cells & auto-antibodies
• Auto-reactive T cells
• General inflammation

Question 3

How do auto-reactive B cells and auto-antibodies cause clinical disease?

Answer 3

Directly cytotoxic&raquo_space; activate complement and interfere with normal physiological function

Question 4

How do auto-reactive T cells cause clinical disease?

Answer 4

Directly cytotoxic&raquo_space; inflammatory cytokine production

Question 5

What are the 2 types of autoimmune disease?

Answer 5

• Organ specific (eg. thyroid)

- Systemic (eg. connective tissue)

Question 6

What is Hashimotos thyroiditis?

Answer 6

Thyroid follicle destruction&raquo_space; 1* hypothyroidism

Question 7

What is Graves’ disease?

Answer 7

Thyroid gland over-stimulation by anti-TSH autoantibody&raquo_space; hyperthyroidism

Question 8

What are scleroderma, polymyositis and Sjogrens syndrome?

Answer 8

Connective tissue diseases

Question 9

What are non-specific diagnostic tests for autoimmune diseases?

Answer 9

Inflammatory markers (ESR/CRP/albumin)

Question 10

What are disease-specific diagnostic tests for autoimmune diseases?

Answer 10

Autoantibodies, HLA typing

Question 11

What is rheumatoid factor (RF)?

Answer 11

Antibody (IgM, IgG, IgA) directed against Fc portion of IgG

- increased with rheumatoid arthritis, but not specific

Question 12

What is Anti-CCP (ACPA)

Answer 12

Useful prognostic marker for rheumatoid arthritis

-more specific than RF

Question 13

What is systemic lupus erythematosus?

Answer 13

Connective tissue disease&raquo_space; malar rash, mouth ulcers, alopecia, pleural effusion.

Question 14

What is the test for systemic lupus erythematosus?

Answer 14

Anti-nuclear antibodies

Question 15

What is the treatment for systemic lupus erythematosus?

Answer 15

Immunosuppression

Question 16

What is ANCA vasculitis?

Answer 16

Inflammation of small vessels (polyangitis)

Question 17

What are the 3 forms of ANCA vasculitis?

Answer 17

Microscopic
Granulomatosis
Eosinophilic granulomatosus

Question 18

What is the test for Raynaud’s?

Answer 18

Anticentromere antibodies&raquo_space; ANA positive

Question 19

What is a granuloma?

Answer 19

A mass of granulation tissue where lots of macrophages clump together

Question 20

How long do people suffer from chronic liver disease?

Answer 20

6+ months

Question 21

What is cirrhosis (liver)?

Answer 21

Nodule formation & fibrosis

Question 22

What are the consequences of cirrhosis?

Answer 22

Portal hypertension
Bleeding oesophageal varices
Oedema
^Infection

Question 23

What are ascites?

Answer 23

Accumulation of fluid in peritoneal cavity

-marker of late-stage liver disease

Question 24

What layers of skin are affected with skin ulcers?

Answer 24

Epidermis and dermis

Question 25

What are the causes of leg ulcers?

Answer 25

Vascular (90%) | Other (eg. inflammation, infection, neuropathy)

Question 26

What are the risk factors for venous leg ulcers?

Answer 26

Valve incompetence, DVT, obesity, immobility

Question 27

What are the risk factors for arterial leg ulcers?

Answer 27

Diabetes, smoking, ^BP, obesity

Question 28

What is the difference in presentation of venous and arterial leg ulcers?

Answer 28

Venous - relatively painless & superficial | Arterial - painful, leg cramp, paraesthesia

Question 29

What are the main causes of neuropathic leg ulcers?

Answer 29

Diabetes B12 deficiency Alcohol

Question 30

What are rare causes of leg ulcers? (3)

Answer 30

- Pustule (rapid breakdown) - Pyoderma gangrenosum - Malignancy

Question 31

What is healing by 1st intention? (leg ulcers)

Answer 31

Restoration by fibrous adhesion >> thin scar without granulation tissue

Question 32

What is healing by 2nd intention? (leg ulcers)

Answer 32

``` Wounds with lots of tissue loss; >> phagocytosis removes debris >> granulation tissue fills in defects >> organisation >>fibrous scar >> scar contraction to close wound ```

Question 33

What is ankle brachial pressue indices(ABPI)?

Answer 33

Ratio of systolic BP in foot:arm. | -1.0 = non significant arterial disease

Question 34

How are leg ulcers managed?

Answer 34

Treat underlying cause (debride necrotic tissue), ulcer & any infection

Question 35

What are the 3 types of thrombosis?

Answer 35

Arterial Cardiac Venous (main >>P.E.)

Question 36

Where do venous thrombi normally occur?

Answer 36

Sites of vascular stasis | -95% around valves in legs

Question 37

What are thrombi composed of?

Answer 37

Platelets, fibrin, RBCs

Question 38

What are the potential outcomes of DVT? (4)

Answer 38

Propagation Embolisation Dissolution Organisation & recanalisation

Question 39

What are the main types of emboli?

Answer 39

``` Thrombus (99%) Atheromas Infective Tumour Gas Fat ```

Question 40

What are the symptoms of a pulmonary embolus? (4)

Answer 40

``` Sharp chest pain Breathlessness Coughing Fainting (Swollen leg if DVT) ```

Question 41

What is the 2-level wells score?

Answer 41

DVT & P.E. diagnosis chart - 2+ points suggests DVT likely - 4+ points suggests P.E. likely

Question 42

What are the tests for a pulmonary embolus?

Answer 42

``` Chest x-ray Bloods (D-dimer) CT pulmomary angiogram VQ scan Doppler ultrasound ```

Question 43

What is D-dimer?

Answer 43

A protein in blood when a clot has broken down

Question 44

How are pulmonary emboli managed?

Answer 44

PHARMACOLOGICAL - low weight heparin, vitamin K antagonist, anticoagulants MECHANICAL - compression stockings, IVC filter

Question 45

What is a paradoxical embolism?

Answer 45

Cerebral infarction from thrombus in deep calf that passes through a patent foramen ovale