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80 Cards in this Set
- Front
- Back
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What is autoimmune adrenalitis?
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The most common cause of adrenal failure in countries where TB is controlled
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What is Anergy?
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An irreversible inactivation of Tcells when tcells recognize self antigen, without costimulatory molecules
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Autoimmune, males or females more?
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10:1 female to male
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Molecular mimicry happens by what vectors?
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Bacteria and viruses
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Name four examples of molecular mimicry as autoimmune dz
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1. C. jejuni and anti-ganglioside ab = Guillan Barre
2. EBV and anti-myelin = MS 3. Coxsackie virus and anti-glutamic acid = diabetes mellitus 4. Yersinia and TSH ab = Graves |
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How would molecular mimcry explain arthritic disorders?
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1.Leukocyte CD11/CD18 looks a lot like B. burdoferi.
2. HLA B27 is the explanation of Reiter's and Rxt arthritis |
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What are the 3 signs of Reiter's syndrome?
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A Rxt arthritis, conjunctivitis and urethritis in response to a virus
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What acne cream can induce autimmune dz?
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minocycline
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What is HLA?
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Human leukocyte antigen, the HLA B27 is associated with spondyloarthropathies
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What is autoimmune lymphoproliferative syndrome(ALPS)?
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1.A mutation in the FAS and FASLigand that are upstream apoptotic effectors.
2. Lymphadenopathy, splenomegaly 3. Increase hodgkins risk |
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How to link estrogen to autoimmune?
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Estrogen withdrawal leads to upregulation of GM-CSF, IL-1, IL-6 and TNF. So all the immune cells with be increased.
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Why administer IgG in an autoimmune?
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Block the Fc receptors of macrophages, and attenuate complement induced injury. Decreases immune complex formation
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What is RhoGAM and why give it for chronic ITP?
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A serum antibody. It will induce hemolytic anemia and tie up the macrophages and prevent platelet destruction.
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What is Immune Thrombocytopenic Purpura?
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ITP is ab mediated platelet destruction. Happens to IIa/IIa or Ib/IX. Destroys the platelets in the spleen
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What autoimmune is most associated with non-hodgkins lymphoma?
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Sjorgrens then SLE
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What is Rituximab and CD20?
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All mature b-cells have CD20. Rituximab will tell those b-cells to stop producing CD20 and stop making antibodies
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Primary Biliary Cirrhosis autoantibody?
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Anti-mitochondrial
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Diabetes mellitus Ab?
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Anti insulin
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Goodpasture's syndrome ab??
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Anti basement membrane
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Grave's Dz ab?
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anti TSH-R
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Hashimoto's ab?
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antithyroglobulin
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myasthenia gravis ab?
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anti ACH-R
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Pernicious anemia ab?
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Anti parietal cell and anti intrinsic factor
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Rheumatoid arthritis ab?
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anti-EBV related antigen(mimicry)
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Sjogren's syndrome ab?
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Anti salivary duct epithelium, anti-SSA and antiSSB
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Organ specific dz of the collagen system?(4)
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1. Hashimoto's/graves
2. DM 1 3. Celiac 4. MS |
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Multisystem dz of the collagen system?(4)
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1.SLE
2. RA 3. Sjogren 4. ANCA related(wegener's, churg straus, RPGN) |
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SLE epi?
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1. 12 to 1 female to male in adults and 2 to 1 in children
2. 15-45 age of onset 3. Whites the least |
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Give five criteria for Dx SLE?
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1. Malar and discoid rash
2. Oral ulcer 3. Antinuclear antibodies(ANA, anti-dsDNA and anti-Smith) 4. Arthritis 5. Renal, neurologic, and hematologic disorder |
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What is a discoid lesion?
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A rash that looks like a 1/2 dollar
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What is SLE prognosis based on?
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Usually based on the kidney dz cause thats what most die from
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What are some characteristics of male SLE?
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1. More severe
2. Mitral valve prolapse |
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What causes the malar rash?
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Immune complex deposition at the dermal/epidermal junction
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What happens to lymph nodes in SLE?
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Hyperplasia
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5 Main organ systems involved in SLE?
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1. Kidney
2. Heart 3. Skin 4. Joints 5. Lymph nodes |
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What is complete ankylosis?
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Complete fusion of the synovial membrane and loss of movement in SLE
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Why does 'onion skin' thickening of the splenic arteries occur in SLE?
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Because of the increase in smooth muscle and fibroblasts
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Describe focal segmental glomerulonephritis?
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1. Focal = few
2. Segmental = parts 3. A few glomeruli in parts of the kidney are dying because of sub epithelial IC depositions from SLE |
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Why does the lumpy bumpy occur in type 3 and smooth pattern occur in type 2?
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Type 3 is caused by random immune complex deposition and Type two is caused by uniform destruction
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Describe libman sach's endocarditis?(3)
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1. non bacterial seen in SLE
2. Most common cardiac symptom is SLE 3. APLS causes a precipiation of platelets and fibrin |
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What two things happen to the heart in SLE?
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Endocarditis and premature atherosclerosis
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What IL is increased in the spine during SLE?
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IL-6
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What are the neurologic symptoms in SLE?
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Serizures, dementia, meningitis etc
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What are 4 abnormal immune responses in SLE?
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1. Hyper active B Cells
2. Hyperactive T cells 3. Abnormal phagocytic function not as effective 4. Abnormal immunoregulation because of C2, C4 deficiency |
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What is a classic LE cell?
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1. Neutrophil or macrophage that has phagocytized the nucleus of an injured cell
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What are the best SLE tests?
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1. Anti-dsDNA
2. Anti-smith |
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How would you test for ANA and give it more credibility?
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1. Get blood
2. Add IgG and flourescent 3. Gives rim, speckled or nucleolar if positive |
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What is Rim, speckled, nucleolar, and homegenous ANA tests associated with?
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1. Rim = anti-dsDNA
2. Speckled = Mixed CT Dz 3. Nucleolar = Scleorderma 4. Homogenous = anti-histone |
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What tests for Sjorgrens?
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1.SS-A or SS-B, anti-Ro or anti-La
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Best SLE test?
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Speckled anti-Smith, but only 25% of all SLE people
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Main drug that induces SLE?
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Dilantin
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Use ANA testing in these dz?
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1. mixed CT DZ
2. Autoimmune hepatitis 3. drug induced SLE 4. SLE, sclerosis and sjorgrens |
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What are the three criteria for hughes?
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1. Thrombotic event
2. Thrombocytopenia 3. Multiple miscarriages |
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What causes Lipman sach's endocarditis?
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1. SLE
2. Proteins in the heart valve |
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Why is clotting time prolonged in APLS?
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1. Phospholipids are needed to add to the clot
2. The phospholipids are being destroyed in this syndrome |
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Why is Sjogrens a problem?
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1. Because it has a high association with malignant lymphomas
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What should you look for in Sjogrens?
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1. Swollen parotids
2. Dry eyes/mouth 3. Hypergammaglobulinemia |
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What happens when you test coagulation in sjogrens?
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1. Normal individual will have a small drop 10-15 mm
2. Sjorgrens will have an 80mm drop like multiple myeloma 3. The hypergammaglobulinemia has added so many extra cells |
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What is morphea?
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A white patch of localized skin thickening
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How should you Dx Raynauds?
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1. Exclude all other Dx
2. Make sure you get all CT symptoms listed 3. Check the nailbed capillaries 4. Check for autoantibodies |
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What is sceleroderma?
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1. Excessive fibrosis
2. Autoantibodies 3. Vascular alterations |
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What is sclerodactyly?
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Triangular fingers
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What other part of the body does scleroderma involve?
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The lungs as pulmonary fibrosis
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What is CREST syndrome?
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1. Limited Cutaneous Scleroderma
Calcinosis Raynauds Esophageal dysfunction Sclerodactyly Telangiesta |
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What is Telangiesta?
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Small dialated BV near the surface of the skin
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What does CREST do to the skin?
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The scleroderma causes scar tissue formation. Eventually destroys the BV, causes decreased circulation and necrosis in the capillaries.
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What happens in acral sclerosis?(3)
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The scleroderma at the fingertips. Causes Raynauds and sclerodactyly, Eventually necrosis.
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What is Raynauds face?
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1. Taught skin
2. Malar skin |
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What happens in the lungs of progressive systemic sclerosis?
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1. Reticulo nodular crossing
2. Increased collagen makes the lungs shorter |
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What ab for CREST and progressive scleroderma?
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1. Anti-centromere
2. Anti-Scl70 |
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What can GAD causes?
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1. Joint immobility
2. Want to use macrolytic(less free GAD) forms or Dialysis |
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What is polymyositis?(3)
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1. Chronic inflammatory myopathy
2. Inflammation, atrophy and apoptosis of SKM 3. Has Anti-synthetase ab |
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3 ANCA dz associated with vasculitis? Plus 1?
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1. Microscopic Polyangitis
2.Wegner's 3. Churg strauss Also Chronic Ulcerative Colitis |
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Describe Microscopic Polyangitis?(5)
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1. ANCA dz
2. Destruction of PMNs intravascular 3. Necrosis of endothelium 4. Crescenteric Glomerulonephritis 5. Pulmonary capillaritis |
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Describe wegener's?(6)
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1. ANCA
2. Sinusitis for 3ms 3.Hematuria 4. Cough 5. Antibiotics don't work 6. Saddle nose |
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What is phemigus?
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1. Seperation of epidermis from dermis at the desmosome
2. Areas become open sores |
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What is rheumatoid arthritis?
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A systemic inflammation of the skin, joints, lungs and BV
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What is the pathology of rheumatoid arthritis?(5)
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1. CMI synovitis
2. Synovial cell hyperplasia = pannus 3. Angiogensis 4. RANKL osteoclastic activity 5. Fibrosing ankylosis |
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What is the Pannus?
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Inflammatory matrix of B and T lymphocytes, macrophages, PMNs, capillary channels, and fibroblasts
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D/D for rheumatoid arthritis?
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1. Ghonorrhea can also invade PMNs in the synovial fluids
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