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Blood/Lymphatic/Endocrine/Immune > Conditions of the Immune System > Flashcards

Conditions of the Immune System Flashcards

1
Q

What are some of the risk factors associated with AIDS?

A

Unprotected sex with multiple partners
IV drug use/Accidental needle stick
Recipient of blood products prior to 1985
Transfusion of contaminated blood or blood products containing HIV: Blood, semen, breast milk

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2
Q

What fluids carry HIV?

A

Blood
Body Fluids: semen, vaginal secretions, CSF, synovial, pleural, peritoneal, pericardial and amniotic fluids

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3
Q

What are some of the initial symptoms of acute retroviral syndrome?

A

Flu-like symptoms; Fever, myalgia
Sore throat
LAO
Fever
Generalized rash
Headache

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4
Q

What lab findings indicates that HIV has progressed to AIDS?

A

CD4 T-cell counts <200

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5
Q

What are the AIDS-defining illnesses?

A

Kaposi’s Sarcoma
Candidiasis
Cryptococcosis: meningitis and pneumonia
Cryptosporidiosis
CMV
Mycobacterium avium complex
Pneumocyctis jirovecii pneumonia (PCP)
HSV, VZV
Toxoplasmosis: encephalitis
Tuberculosis

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6
Q

What is the name of a common medication used to tread HIV and AIDS?

A

Zidovudine (ZDU)
Azidothymidine (AZT)

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7
Q

What are the common signs and symptoms of IgA deficiency?

A

Recurrent infection of GI and sinopulmonary systems, atopic disorders

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8
Q

What diseases show syndesmophytes?

A

Bony growths of the spine
Ankylosing spondylitis: Syndesmophytes are bony growths that often occur in the spine and can cause fusion of the joints

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9
Q

Ankylosing spondylitis (AS) is associated with what marker in the blood?

A

HLA-B27 antigen

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10
Q

AS is associated with the intestinal infection?

A

Klebsiella Pneumoniae

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11
Q

Who is most affected by AS, men or women?

A

M:F = 5:1; usually 20-40 years olf

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12
Q

What is the most common initial complaint with AS?

A

Insidious onset of low back pain, stiffness, prolonged morning stiffness ( 30 minutes), worse at night buttock pain

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13
Q

What are some of the other signs and symptoms of AS?

A

Back pain that is worse in the morning, better with continued motion
Stooped or flexed posture in advanced disease
Decreased chest expansion

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14
Q

What are some of the sequelae of AS?

A

Neurological Complications
Anterior uveitis
Aortitis
Spinal Fractures

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15
Q

What is a common radiographic finding in a patient with AS?

A

Bamboo spine

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16
Q

What autoimmune condition is associated with muscle weakness increased by activity and relieved by rest?

A

Myasthenia Gravis

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17
Q

What are the antibodies found in myasthenia gravis?

A

Acetylcholine receptor and/or muscle specific tyrosine kinase antibodies

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18
Q

What are some of the ocular symptoms of myasthenia gravis?

A

Ptosis (most common initially): upper eyelid droops over eye
Diplopia: See two of the same images; due to eye muscle weakness

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19
Q

What category of drug is used to palliate myasthenia gravis symptoms?

A

Acetycholinesterase inhibitor drugs

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20
Q

What muscles are commonly affected by polymyositis ?

A

Polymyositis: Idiopathic inflammatory myopathy that causes symmetrical, proximal muscle weakness; Shoulder and Hip

Dermatomyositis: idiopathic inflammatory myopathy of muscles and skin that occurs in children and adults. Although it frequently affects the skin and muscles, it may also affect the joints, the esophagus, the lungs, and less commonly, the heart

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21
Q

What are some of the systemic symptoms of polymyositis?

A

Fever
Fatigue
Muscle pain and tenderness
Weight loss
Dysphagia

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22
Q

What is the usual timing of onset with polymyositis?

A

Gradually develops over 3-6 months

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23
Q

What is a typical lab finding with polymyositis?

A

Elevated serum CK, LDH, Aldolase

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24
Q

What are the common signs and symptoms of reactive arthritis?

A

Reactive Arthritis referred as Reiter Syndrome is a autoimmune condition that develops following an infection

1) Develops in reaction to bacteria usually enteric (Salmonella, Shigella or Campylobacter or Yersinia) or sexually transmitted (Chlamydia)

2) Non-gonococcal urethritis or cervicitis
3) Conjunctivitis, iritis, blurred vision
4) Inflammation of spine (spondylitis) and lower back joints (sacroiliitis)
5) Asymmetric polyarthritis is lower extremities

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25
Q

What is the conventional treatment of reactive arthritis?

A

NSAIDs, Antibiotic therapy, systemic corticosteroids are reserved for severe cases

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26
Q

Soft tissue swelling or joint effusions from RA typically affect which joints?

A

Symmetric joint involvement of metacarpophalangeal (MCP) and proximal interphalangeal joints (PIP)

Morning stiffness for >1 hour, improves with use, aggravated by rest
Bilateral Ulnar Deviation
Boutonniere Deformity
-Extension of DIP joint and flexion of PIP joint together

Other joints involved
-Knees, cervical spine, hips
-Shoulders, elbows

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27
Q

What common disease may have a positive rheumatoid factor?

A

RA
Sjogren’s Syndrome
Mixed Connective Tissue Disease
Systemic Lupus Erythematous

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28
Q

What are the radiographic changes that are diagnostic of RA?

A

PA hand and wrist x-ray which show erosions and bony decalcification localized in joint

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29
Q

What are some disease that demonstrate joint space narrowing?

A

RA , OA and gout

30
Q

What is the usual presentation of RA?

A

RA is bilaterally symmetrical in its presentation of arthritis, morning stiffness >1 hr, >3 joints affected

31
Q

What are some of the hallmark deformities seen in RA?

A

Ulnar deviation
Swan neck deformity
Boutonniere’s Deformity

32
Q

What are some of the signs of juvenile RA?

A

Flexion deformities
Hypertrophied epiphyses
Cutaneous Erythema
Decreased ROM
Knee, hip and elbow frequently involved
Eye involvement

33
Q

Which bacterial infection has been associated with RA development?

A

*Proteus mirabilis
Mycoplasma
EBV
Rubella

34
Q

What drugs are used to treat RA?

A

Methotrexate, sulfasalazine (DMARDs), hydroxychloroquine
Adalimumab (DMARDs)

35
Q

When is the worst tine of day typically for RA?

A

Morning stiffness

36
Q

What nutrients are used to treat RA?

A

EFAs, Vitamin A, C, D, and E, curcumin

37
Q

What are some of the signs and symptoms of Scleroderma (Systemic sclerosis)?

A

Excess collagen production that targets the skin, GI, lungs, and Kidney

Skin thickening/harding
GERD, dysphafia
Raynaud’s Phenomenon
Fatigue Arthralgia

38
Q

What are some of the sequelae of scleroderma?

A

Renal Failure

39
Q

What herbs are used for scleroderma?

A

Centella asiatica
Crategus spp
Vaccinium myrtillus

40
Q

What nutrients are used to treat scleroderma?

A

Vitamin D & E

41
Q

What is the crest variant seen with scleroderma?

A

Calcification
Raynaud’s phenomenon
Esophageal dysmotility
Sclerodactyly (tapered, claw-like fingers)
Telangietasias (superficial dilated blood vessels)

42
Q

What is the autoimmune disease that produces antibodies against the salivary lacrimal glands?

A

Sjogren Syndrome
Autoimmune condition characterized as destruction of minor salivary glands and lacrimal glands caused by lymphocytic infiltration

43
Q

What are the signs and symptoms of Sjogren’s syndrome?

A

Xerophthalmia (dry eyes)
Xerostomia (dry mouth)
Dental caries, oral candidiasis, angular cheilitis (inflammation and fissuring at the labial commissures)
Vaginal Dryness
Parotitis

44
Q

What should be ordered on a lab work up for Sjogren’s?

A

(+) ANA, RF, anti-SSA, anti-SSB

45
Q

What population is most at risk for systemic lupus erythematous SLE?

A

Women, before the age of 40

SLE: autoimmune syndrome w/ antibodies directed against DNA with diverse clinical manifestations

46
Q

What will be seen on a urine dipstick with advanced SLE?

A

Marked proteinuria

47
Q

What are some of the signs and symptoms of SLE?

A

MD SOAP BRAIN
Malar Rash
Discoid Rash (sores)

Serositis
Oral Ulcers
ANA
Photosensitivity

Blood
Renal
Arthritis
Immune
Neurologic

48
Q

What joints are most affected by SLE?

A

Hands
Knees
Wrists

49
Q

Describe the discoid rash seen in SLE.

A

Immunocomplex deposition along basement membrane that may cause scarring

Erythematous patches or plaques with scaling. Typically across the cheeks, ears, and nose (sparing nasal folds). Typically not painful or itchy.

50
Q

What organs systems can be affected in SLE?

A

Renal: Proteinuria, Cellular Cast
Neurological: Seizures, psychosis, depression, headache
Cardiopulmonary: Serositis- pleural effusion with friction rub; Interstitial lung disease
GI: Heaptosplenomegaly
Skin: Malar butterfly/Discoid rash/Photosensitivity/Oral Ulcers
Musuloskeletal (joints)
Hematological

51
Q

What should be ordered for lab work up for SLE?

A

ANA, *anti-dsDNA, ESR, *anti-Smith, anti-RNP, anti-SSA, anti-SSB

*Specific for SLE

52
Q

What are the common signs and symptoms of temporal (giant cell) arteritis?

A

Unilateral temporal headache
Tenderness over temporal artery
Pain with chewing
Blurred vision
Fever

53
Q

What conditions is associated with temporal arteritis?

A

Polymyalgia rheumatica

54
Q

What age group is most affected by temporal arteritis?

A

> 50 years old

55
Q

What test should you order if you suspect temporal arteritis?

A

ESR which will be > 100

56
Q

What age group commonly develops Henoch Shonlein purpura (HSP)?

A

98% before age 10

57
Q

What are the common signs and symptoms of HSP?

A

Palpable dark red or purple lesions located on lower extremities and buttocks
Arthralgia
Abdominal Pain
Fever, malaise

58
Q

What test should be ordered in a patient you suspect HSP? What would you see?

A

Urinalysis: Hematuria and proteinuria, diagnosed clinically; not based on laboratory findings

59
Q

What are some causes of HSP?

A

Viral URI, drug reaction to PCN or sulfa drugs, immunizations, may be idiopathic

60
Q

What are common treatment of HSP?

A

Resolves within 4 weeks; rest hydration and pain management

61
Q

What conditions are commonly associated with necrotizing vasculitis?

A
  • Rare condition that involves inflammation of the blood vessel walls leading to ischemia and subsequently necrosis

Polyarteritis nodosa
Rheumatoid Arthritis
Scleroderma
Systemic Lupus Erythematosus
Wegener’s granulomatosis

62
Q

What disease is characterized by segmental inflammation and necrosis of medium-sized muscular arteries?

A

Polyarteritis Nodosa (PAN)
-Necrotizing medium vessel vasculitis involving renal, coronary, mesenteric arteries

63
Q

What organ systems are at greatest risk for polyarteritis nodosa?

A

Organ infarction in:
Kidneys (renal failure)
Heart ( Acute MI)
Bowels ( Blood Diarrhea )
Skin ( Ischemic Ulcer)
Testicular (testicular pain)

64
Q

Polyarteritis in which of the organ systems has the worse prognosis?

A

GI or renal involvement

3 or more of the following 10 to be diagnosis with PAN
Weight loss
Myalgias, weakness or leg tenderness
Livedo reticularis
Neuropathy
Testicular pain or tenderness
Diastolic BP >90 mmHg
Elevated Cr or BUN
Hepatitis B Positive
Arteriographic abnormality
Biopsy of Artery

65
Q

Antinuclear Antibody Patterns in Autoimmune Disease

A
66
Q

What are the 4 types of hypersensitivity reactions?

A

Type I: Immediate or anaphylactic
Type II: Cytotoxic
Type III: Immune Complex
Type IV: Delayed

67
Q

What are some common triggers for angioedema?

A

40% idiopathic
Hypersensitivity (Allergic reactions)
Physical Stimuli
Autoimmune disease or infection
Acquired angioedema occurs with urticaria

Drug Reactions: Especially ACE inhibitors, NSAIDs

68
Q

What viruses are associated with chronic fatigue syndrome (CFS)?

A

CFS disorder characterized by a state of chronic fatigue that persists for than 6 months, has no clear, and is accompanied by cognitive difficulties which is not relieved by rest

EBV and CMV

69
Q

What are some of the common signs and symptoms of CFS?

A

Concurrent presence of at least 4 of the following symptoms for a minimum of 6 months:
Impairment of short-term memory or concentration, severe enough to cause significant decline function
Sore throat; tender cervical or axillary lymph nodes
Muscle pain
Multi-joint pain with no swelling or redness
New headache
Unrefreshing sleep, insomnia
Post-exertion malaise lasting > 24h

70
Q

What are the common signs and symptoms of fibromyalgia?

A

Widespread body pain > 3 months: both sides of the body, above and below the waist
Fatigue
Morning Stiffness
Non-restorative Sleep
Diagnosis of exclusion

71
Q

What is a possible mechanism that underlies fibromyalgia pain?

A

Mitochondria Dysfunction and oxidative stress

Blood/Lymphatic/Endocrine/Immune (3 decks)

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