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Flashcards in Immunology Deck (33):
1

What are the centor criteria?

Identify the likelihood of a bacterial infection in patients with a sore throat
One point each for:
Anterior cervical lymphadenopathy
Tonsillar exudates
Fever
Absence of cough
Score of 4 indicates bacterial tonsillitis is likely

2

Name some diseases in which they may be presence of salivary gland enlargement

Lymphoma
Sarcoid
Parotid tumour
Calculi
Viruses such as mumps
Alcohol excess

3

Which organs are involved in thermoregulation in response to cold?

Brown fat: metabolism
Muscles: shivering
Blood vessels: constriction
Thyroid: hormone increases metabolism

4

Which organs are involved in thermoregulation in response to heat?

Lungs: increase respiratory rate
Skin: perspiration
Blood vessels: dilation

5

Which area of the Brainstem is responsible for thermoregulation?

Hypothalamus

6

What is fever?

Rectal temperature above 38ºC
Oral temperature above 37.8ºC
Tympanic temperature above 38ºC
Complex physiologic response to disease mediated by pyrogenic
cytokines and characterized by a rise in core temperature, generation of acute phase reactants, and activation of immune systems

7

What are some causes of fever?

Infection
Inflammatory
Connective Tissue Disorder
Malignancy
Endocrine / Metabolic
Tissue Destruction
Thromboembolism
Allergy / Drugs / Other

8

What are some infective causes of fever?

Bacterial
Viral
Fungal
Parasitic
Origin of infection may be obvious or may require careful assessment for diagnosis, e.g. infective endocarditis, tuberculosis or other occult long-term infection

9

What are some inflammatory causes of fever?

Phlebitis, thyroiditis, ulcerative colitis, Crohn’s disease, pancreatitis, familial Mediterranean fever, sarcoidosis, pemphigus (blistering skin, autoimmune), severe or exfoliative dermatitis, bullous pemphigoid

10

What are some connective tissue disorders which cause fever?

Rheumatoid arthritis, systemic lupus erythematosus,
polyarteritis nodosa, polymyositis, dermatomyositis, giant cell arteritis

11

What is polyarteritis nodosa?

Systemic vasculitis typically involving small or medium sized muscular arteries, typically renal or visceral

12

What are malignancy causes for fever?

Carcinoma (especially lung cancer, renal cancer), sarcomas,
lymphoma

13

What endocrine and metabolic disorders can cause fever?

Thyroid disease, gout, porphyria (abnormal metabolism of haemoglobin)

14

What types of tissue destruction can cause fever?

Surgery, infarction, haemolysis, crush syndrome, rhabdomyolysis

15

What are some thromboembolic causes of fever?

Pulmonary embolism, deep vein thrombosis

16

What blood disorders may result in fever?

Aplastic anaemia, agranulocytosis, leukaemias

17

What allergic conditions may lead to fever?

Allergic reactions, transfusion reactions, Henoch-Schönlein purpura

18

What is a rigor?

Sudden feeling of cold with shivering accompanied by a rise in temperature, with sweating

19

60 year man on haemodialysis with a metallic aortic valve with suspected infective endocarditis. Which investigations does he need? And what might they show?

ECG: show prolonged PR interval
Echo: vegetations on aortic valve with aortic root abscess

20

What is a fever of unknown origin?

Temperature greater than 38.3°C on several occasions
More than 3 weeks' duration of illness
Failure to reach a diagnosis despite 1 week of inpatient investigation

21

What is the acute management for anaphylaxis?

High flow oxygen
0.5mg IM adrenaline
10mg IV chlorphenamine
200mg hydrocortisone IV
500ml 0.9% saline stat

22

Which interleukin is responsible for stimulating hepatic synthesis of acute phase proteins and is involved in fever, anaemia and cachexia?

IL-6

23

Which interleukin is a chemoattractant?

IL-8

24

Give an example of an anti inflammatory interleukin?

IL-10

25

Which molecules are involved in the rolling of neutrophils along a vessel in migration?

Selectins

26

Which molecules are involved in adhesion to vessel wall by neutrophils in migration?

Integrins

27

What is endothelin?

Potent vasoconstrictor

28

What does nitric oxide do to vessels and platelets?

Inhibit platelet aggregation and adhesion
Vasodilation by activating guanylate cylase

29

Describe some characteristics of IgA

Found in secretions: salvia, tears, mucous
Provides localised protection on mucous membranes
Most commonly produced immunoglobulin in the body
Transported across interior of cell via transcytosis

30

Name some characteristics of IgG

Enhance phagocytosis of bacteria and viruses
Fixes complement and passes to the foetal circulation
Most abundant isotype in blood serum

31

What are risk factors for acute graft versus host disease?

HLA disparity
Increasing age of recipient
Donor and recipient gender disparity
Type and status of underlying disease
Transplant conditioning regimen intensity
ABO compatibility
Performance score
White/black race
CMV sero status
Doses of prophylactic immunosuppression medication

32

What features are characteristic of acute graft versus host disease?

Maculopapular rash
Anorexia
Profuse diarrhoea
Nausea
Vomiting
Ileus
Cholestatic hepatitis

33

What immunological changes are seen in HIV?

Reduction in CD4 count
Increased B2 microglobulin
Decreased IL2 production
Polyclonal B cell activation
Decreased NK function
Reduced delayed hypersensitivity reactions