immune mediated disease Flashcards
(95 cards)
1
Q
What are hypersensitivity reactions divided into
A
4 types
2
Q
What is a type I hypersensitivity reaction called
A
Immediate/ Anaphylactoid
3
Q
What is a type I hypersensitivity mediated by
A
IgE mediated mast cell degranulation
4
Q
Give examples of type I hypersensitivity
A
- Hay fever
2. Anaphylaxis to insect stings or medications like penicillins
5
Q
What is a type II hypersensitivity reaction called
A
Antibody mediated Cytotoxicity
6
Q
What is a type II hypersensitivity mediated by
A
Circulating antibodies that activate complement
IgG
7
Q
Give examples of type II hypersensitivity
A
- pemphigus vulgaris,
- mucous membrane pemphigoid,
- haemolytic anaemia
8
Q
What is a type III hypersensitivity reaction called
A
Immune complex mediated
9
Q
What is a type III hypersensitivity mediated by
A
Antibody complexed with antigen circulating the vasculature
IgG
10
Q
What is a type IV hypersensitivity reaction called
A
Delayed hypersensitivity reaction
11
Q
What is a type IV hypersensitivity mediated by
A
T cell mediated
12
Q
Give examples of type IV hypersensitivity
A
- Health care workers hand dermatitis
2. Contact chelitis
13
Q
What is autoimmunity
A
Reaction of the body against itself
14
Q
What is autoimmunity referred as
A
Loss of self tolerance
15
Q
Who is more affected by autoimmune disease men or women
A
Females more than males
16
Q
How many people are affected by autoimmune disease
A
1 in 20-30
17
Q
Name the 2 forms of lupus
A
- Systemic lupus Erythematosis (SLE)
2. Discoid lupus Erythematosis (DLE)
18
Q
What does systemic lupus Erythematosis affect
A
Affects a wide range of organs
19
Q
What can systemic lupus Erythematosis cause
A
morbidity and mortality
20
Q
What is Discoid Lupus Erythematosis
A
Is lupus of the cutaneous and mucosa surfaces
21
Q
Which type of lupus has a higher morbidity
A
Systemic Lupus Erythematosis
22
Q
What is systemic lupus Erythematosis
A
A chronic inflammatory autoimmune disease of unknown cause
23
Q
In whim is systemic lupus Erythematosis more common in men or women
A
Women (90%)
24
Q
What can systemic lupus Erythematosis be due to
A
- Genetic predisposition
2. Environmental triggers
25
What autoantibodies can form in a patient with systemic lupus Erythematosis
```
DNA
RNA
nucleoproteins
Cytoplasmic components
Cell surface antigens
ECM components
```
26
How does mild systemic lupus Erythematosis
Skin rashes plus arthritis
27
How does severe systemic lupus Erythematosis present
1. Renal impairment/ failure (lupus nephritis)
2. Serious infections
3. Accelerated atherosclerosis
4. Thrombotic events
28
What is the cause of death of systemic lupus Erythematosis patients
Severe active lupus early on
OR
May be due to sequelae such as the accelerated atheroma causing stroked and myocardial infarction
29
What organs can be affected by systemic lupus Erythematosis
1. Constitutional
2. Musculoskeletal system
3. Mucocutaneous
4. Renal
5. CVS system
6. Respiratory system
7. CNS
8. Gastrointestinal
9. Haematological
10. Reticuloendothelial
30
How can systemic lupus Erythematosis affecting constitutional organs present
Fatigue
| Fever
31
How can systemic lupus Erythematosis affecting musculoskeletal systems present
1. Arthralgia
2. Non erosive poly arthritis
3. Raynaud's phenomen
4. Osteoporosis
5. Secondary sjögrens syndorme
32
How can systemic lupus Erythematosis affecting mucocutanous organs present
1. Malar rash (aka butterfly rash) across cheeks and bridge nose pathognomic of SLE
2. Photosensitivity rashes
3. Urticaria
4. Vasculitic rashes
5. Lichenoid lesion intra orally
6. Non specific oral ulcerations
33
How can systemic lupus Erythematosis affecting renal organs present
Renal impairment and failure due to nephritis or other pathologies
34
How can systemic lupus Erythematosis affecting the CNS system present
1. Mood disorders
2. Psychoses
3. Cerebrovascular disease
4. Seizures
5. Headaches
35
How can systemic lupus Erythematosis affecting the cardiovascular system present
1. Pericarditis
2. Endocarditis
3. Ischaemic heart disease
36
How can systemic lupus Erythematosis affecting the respiratory system present
Pleaural effusions
| Fibrosing alveolitis
37
How can systemic lupus Erythematosis affecting the Gastrointestinal system present
Anorexia
| Nausea and vomiting
38
How can systemic lupus Haematological affecting the Gastrointestinal system present
Anaemia
Thrombocytopenia
Leukopenia
39
How can systemic lupus Erythematosis affecting the Reticuloendothelial system present
Lymphoedenopathy
| Hepatomegaly
40
What guide the treatment of systemic lupus Erythematosis
symptoms guide treatment
41
What is the aim of systemic lupus Erythematosis management
Reduce morbidity and improve quality of life
42
What medication can we prescribe systemic lupus Erythematosis patients
1. NSAIDS and aspirin
2. Anti-coagulants
3. Anti-malarial agents
4. Corticosteroids and immunomodulators
5. Biologics
6. IV immunoglobulin and plasmapheresis
43
What is discoid lupus eryrhematosis
A limited variant or lupus restricter to the skin and mucous membrane
44
How does discoid lupus eryrhematosis present on the skin
Well demarcated raised, white, scaly plaques with varying degrees of erythema that do not typically itch
45
How does discoid lupus eryrhematosis present in the mucosa
May closely resemble oral lichen planus clinically and histopathologically has a predilection for the hard palate which is an uncommon site to be affected by idiopathic OLP
may also affect the lips including the vermilion border
46
When can discoid lupus eryrhematosis flare up
Can flare up dramatically in the sun
47
If discoid lupus eryrhematosis is seen in the mouth what can that mean
Potentially malignant
48
If you suspect a patietn has lupus what should you as a dentist do
1. Is it systemic or limited/ discoid
2. Find out if the patient has had any complication
3. Take a careful drug history
4. Find out current and past disease status
49
What is rheumatoid arthritis
Is a multi system inflammatory disease which typically targets the small joins
50
How common is rheumatoid arthritis
Affects 1% of the population
51
Does rheumatoid arthritis affect men or women more
Women more (75%)
52
List some of the non articular involvements of rheumatoid arthritis
1. Lethargy, malaise, depression
2. Anaemia
3. Generalsed lymphadenopathy
4. Pulmonary and cutaneous nodule development
5. Pericardial effusions, mitral regurgitation
6. Raynaud’s phenomenon
7. Sjögren’s syndrome
53
What criteria do we use to aid the diagnosis of rheumatoid arthritis
1. Early morning stiffness
2. Inflammatory arthritis of 3 or more defined joint areas
3. Inflammatory arthritis
4. rheumatoid nodules
5. Radiography/ ultrasons evidence of synovitis and joint destruction
54
What medication do we use to manage rheumatoid arthritis
1. NSAIDs
2. DMARDs
3. Corticosteroids
4. Biologics
55
What is the last joint to be affected in rheumatoid arthritis
TMJ
56
What is autoimmune thyroid disease an example of
Organ specific autoimmune disease
57
What do patients with thyroid disease go through
thyroid spectrum’ and go from hypo- to eu- to hyper- thyroid status or vice versa (but not necessarily so)
58
What is hypo thyroid disease
Un reactive thyroid
59
What is EU thyroid disease
Normal thyroid function
60
What is hyper thyroid disease
Over reactive thyroid
61
What does the thyroid do
It is a big player in maintaining homeostasis through the production of and actions of the carious hormones it produces
62
How does the thyroid affect basal metabolic activity
1. Increases basal metabolic rate
2. increases body temperature
3. Increases appetite
63
How does the thyroid affect CHO, lipid and protein metabolism
1. Promotes glucose catabolism to release energy
2. Stimulates protein synthesis
3. Increases lipolysis
4. Enhances cholesterol excretion in bile
64
How does the thyroid affect cardiovascular system
1. Promotes normal cardiac function
| 2. Controls heart rate and strength of the pulse
65
How does the thyroid affect the nervous system
1. Promotes normal neuronal development in foetus and infant
2. Promotes normal neuronal in adults
3. Enhances effects of sympathetic nervous system
66
How does the thyroid affect the Musculoskeletal system
1. Promotes normal body growth and maturation o f the skeleton
2. Promotes normal function and development of muscles
67
How does the thyroid affect the reproductive system
Promotes normal female reproductive ability and lactation
68
Give an example of autoimmune hyperthyroidism
Graves disease
69
What is Graves disease the most common cause of
Hyperthyroidism
70
How common is graves disease in women and men
Affects 1% of females
| Affects 0.1% of men
71
What happens in graves disease
Autoantibodies are produced versus TSH receptors on the surface of the thyroid
72
What happens if Autoantibodies are produced versus TSH receptors on the surface of the thyroid
1. The gland is therefore OVER stimulated
2. Means that MORE T3 and T4 are produced
3. The negative feedback loop does not function
73
What are the classic symptoms of graves disease
1. Weight loss
2. Heat tolerance
3. Fatigue and weakness
4. Hyperactivity
5. Irritability
6. Insomnia
7. Tremors
8. Warm moist skin
9. Hair loss
10. Tachycardia
74
Other than the common symptoms what else is characteristically seen in graves disease
1. Pre-tibial myoxedema
2. Vitiligo
3. Pernicious anaemia
4. Type 1 diavetes mellitus
5. Psychosis
7. Graves eye disease
75
What is Pre-tibial myoxedema
Swollen lumpy appearance over the skins of the lower legs or feet
76
What is Vitiligo
autoimmune patchy depigmentation of the skin due to destruction of the body’s own melanocytes
77
How does graves eye disease manifest
```
1. Proptosis and exophthalmos
2 Ophthalmoplegia
3. Diplopia
4. Blurred vision
5. Conjunctival inflammation
6. Increased tear production
```
78
What is Ophthalmoplegia
Restricted eye movements due to hypertrophied extra ocular eye muscles occupying a greater amount of the orbit pushing the glove of the eye forward
79
What is Diplopia
Double vision
80
What is the aim of initial graves disease treatment
To make the patient euthyroid once again and therefor reduce/ eliminate symptoms
81
How do we manage graves disease initially
1. Anti-thyroid drugs
2. Beta blockers
3. Radioactive iodide treatment
82
After initial treatment how might we manage graves disease
Surgery may be undertaken to reduce/ remove the goitre
83
What is hypothyroidism due to
A lack of T3 and t5
84
What are the causes of hypothyroidism
1. Hashimoto’s thyroiditis
2. Idiopathic atrophy
3. Treatment for hyperthyroidism
4. Medications such as amiodarone or lithium
5. Iodine deficiency
6. Congenital hypothyroidism
85
How common is congenital hypothyroidism
Affects 1 in 4000 births
86
How common is hypothyroidism in men and women
AFFECTS 15 per 1000 females
| Affects 1 in 1000 males
87
What are the common symptoms of hypothyroidism
1. Lethargy
2. Weight gain
3. Depression
4. Cold intolerance
5. Goitre
6. Cold dry skin
7. Bradycardia
8. Arthralgia and myalgia
88
Give an example of hypothyroidism
Hashimotos thyroiditis
89
What happens in Hashimotos thyroiditis
Autoimmune destruction of the thyroid by the lymphocytes
90
How do we manage Hashimotos thyroiditis
Replacement thyroid hormones
91
What do we need to monitor in patients with Hashimotos thyroiditis
Thyroid function tests monitored 6-12 months
92
What is lingual thyroid
An uncommon finding of an ectopic thyroid gland on the posterior dorsal of the tongue at the caecum
93
What is lingual thyroid associated with
70% of hypothyroidism cases
| Associated with cretinism
94
What can a Large ectopic lingual thyroids impair
Speech and swelling
95
Thyroid cancer accounts for how many cancers annually
0.6%
