6906925
Descripción
Fichas por Nneka Okorocha, actualizado hace más de 1 año
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Creado por Nneka Okorocha
hace alrededor de 8 años
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| Pregunta | Respuesta |
| Allergy Hx | 1. How long 2. How much before you react 3. How long for symptoms to come 4. Associations: swelling, SOB? 5. Symptom severity 6. Happened before + what was the reaction then 7. Food? Cooked or raw? |
| Order of procedure when Ptn presents w/ allergy | 1. Hx 2. Skin prick test 3. Blood total IgE, specific IgE or tryptase |
| Interpretation of Total IgE & Specific IgE | Total - indicates allergy/atopy (non-immediate allergy), may be high if 'threat' is constant i.e. old/dust Specific - rises in presence of a specific allergy may increase total IgE No IgE doesn't mean no allergy |
| Why might ptns. with chronic urticaria not respond to allergy test? | ~30% due to autoimmune disease |
| Interpretation of Serum Tryptase | >11.4 shows mast cell activity High after anaphylaxis (15mins to 3hrs) Test again 24-48hrs PERSISTENT = MASTOCYTOSIS |
| What are C1 [esterase] inhibitors | Ensure inhibition of complement proteins Stop overreaction Deficiency may lead to hypersensitivity Causes intermittent angioedema Ddx anaphylaxis/allergy BUT this is intermittent, usually adolescents |
| Screening tests in C1 esterase inhibitor deficiency | Normal C1-INH levels are 16-33mg/dL Serum C1 and C4 levels done Abnormal can be due to: 1. Inherited angioedmea 2. SLE 3. Malnutrition 4. Septicaemia (>in infection) 5. Lupus nephritis (kidney disease) |
| What organisms are clues for: T cell Deficiency and Infection | Viruses: CMV, VAZ, HSV, EBV, measles, resp viruses Bacteria (cocci, staph. aureus, pseudomonas): Mycobacteria, salmonella, Listeria Fungi: Candida, aspergillus, histoplasma, PCP, crypto Protozoa (giardia lamlia): toxoplasma Clinical (resp and GI sepsis): Systemic viral fungal infections, early malignancy |
| What organisms are clues for: B & T Cell Deficiency | Same as for T-cell! But here bacteria can also cause S. typhi |
| What organisms act as clue for: Phagocyte Deficiency | Bacteria: S.aureus and mycobacteria infections Fungi: Candida and aspergillus Clinical (sepsis and resp): lymphadenitis, skin/mouth infections, liver and lung abscesses, granulomas |
| Which organisms are clues for : Complement Deficiency | Bacteria: meningococcus Fungi: Candida Clinical: Systemic bacterial infections + autoimmune disease |
| Screening for Common Variable Immune Deficiency (CVID) | Presents with recurrent infection (rest, conjunctivitis, GI infection) General finding is: HYPOGAMMAGLOBULINAEMIA IgG of <4.5 IgA or IgM below the normal limit Ptn. will also lack immune response to protein antigens or immunisation Usually above 4yrs old Usually associated with: Autoimmune diseases Malignancies Granulomatous disease Dermatological manifestations |
| Diagnosis of Immune Deficiency | 2 major infections or 1 major + 1 recurrent minor Unusual sites/organisms Unresponsive to Abx! Skin disease Chronic diarrhoea Mouth ulcers Family Hx |
| Pathophysiology of C1-INH deficiency | SERPIN inhibits 1. C1 2. F12 of coal. cascade 3. Kallikrein (incr. bradykinin by cleaving HMWK) SERPIN deficiency means C1 & Kallikrein are increased (Incr. bradykinin = vasodilation, muscle contraction, natriuresis, all lowering BP) |
| How does C1-INH present? | Can be acquired by splenic lymphoma ANGIO OEDEMA (skin, oropharynx, GIT), NO RASH Asphyxia, N+V and diarrhoea Low C2, C4 (normal C1 and C3) |
| Investigation of: Complement Dysfunction | CH50 and AP50 C3 and C4 If CH50 and AP50 abnormal and C3 and C4 normal then final/terminal common pathway deficiency |
| Complement Dysfunction: Classical Pathway | C1, C2 (commonest), C4 Outcome: SLE!! |
| Complement Dysfunction: Mannose Binding Lectin | MBL deficiency Outcome: increased infection in immunocompromised i.e. HIV, Ab def., chemo |
| Complement Dysfunction: Alternative Pathway | B, I , P deficiency Outcome: Infection!! Especially with meningococcus, pneumococcus, H.influenzae, Hib FX of infection |
| Complement Dysfunction: Terminal/final pathway | C5-9 deficiency Inability to make MAC Outcome: Infection!! Especially with meningococcus, pneumococcus, H.influenzae, Hib FX of infection |
| Autoantibodies | ANA: SLE Anti-CCP: Rheumatoid arthritis Anti-mitochondrial Ab: Primary biliary cirrhosis Anti-phospholipid Ab: Antiphospholipid syndrome Anti-transglutaminase: Coeliac, dermititis herpetiformis |
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