Immunological & Rheumatoligical Disorder Stuff

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hlarson
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250029
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Immunological & Rheumatoligical Disorder Stuff
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2013-12-01 18:40:00
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Immunological Rheumatoligical Disorder Stuff
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Immunological & Rheumatoligical Disorder Stuff
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  1. Smooth functioning of the immune system depends on the following features
    • Diversity
    • Sepcificity
    • Memory
    • Clonal expansion
    • Specialization
    • Contraction
    • Nonreactivity to self
  2. Main effector cells of the adaptive immune response are composed mainly of 3 cell types
    • B lymphocytes
    • T lymphocytes
    • Natural killer cells
  3. What strategy does the B lymphocyte employ to combat microbes
    They secrete antibodies that bind to extra-cellular microbes to enhance ingestion and destruction by phagocytes

    These antibodies also prevent extracellular microbes from further infecting host cells
  4. What strategy does the T lymphocyte employ to combat microbes?
    They destroy host cells infected w/ intracellular microbes to eliminate the infection
  5. What strategy does the natural killer cell employ to combat microbes?
    • They transfer granzymes into targeted cells, like viruses, resulting in cell destruction
    • through apoptosis rather than lysis
  6. Things to pay attention to when seeing a peds pt w/ a suspected immunodeficiency
    • -thorough history w/ delineation of prior infections 
    • -complete physical exam
    • -review of previous diagnostic studies 
    • -particular attention to chronologic patterns of infection or apparent flares of disease & correlation w/ symptoms or lab results & can be highly suggestive of defects in specific aspects of the immune response
  7. Evaluation of T cell function is important b/c
    • Determines its role in the cellular immune response
    • Delineating its role as a contributing factor to the humoral immune response
  8. Plasma cells are derived from
    B cells
  9. Plasma cells are the only cells in the body capable of
    Producing and secreting immunoglobulin
  10. B cell functionality may be initially evaluated by
    quantitative imunglobulin specifically titers of IgA, IgG, and IgM
  11. Complement describes a family of circulating proteins that act together to promote
    • opsonization
    • bacteriolysis
    • phagocytosis of microorganisms
  12. Cryoglobulins are
    Immnoglobulins that precipitate as serum is cooled below core body temp.

    These precipitates can be seen in a multitude of diseases, incl. the vasculitides, chronic infections or autoimmune disorders
  13. Principal pathophysiologic event in anaphylaxis is
    The activation of mast cells and to a lesser extent, basophils
  14. Antigen specific IgE is produced in genetically susceptible individuals in response to
    exposure to any variety of allergens.
  15. Specific IgE binds to
    high-affinity IgE receptors on the surface of mast cells and is available to bind to allergen.
  16. Allergen reexposure via antigen presenting cells causes
    aggregation of receptor bound IgE and this cross linking sets off a series of intercellular signals that very rapidly lead to mast cell activation.
  17. What chemicals can cause anaphylaxis
    • Radiocontrast media
    • Components of insect venom
    • Opiate analgesics
    • Vancomycin
  18. What medications can cause anaphylaxis
    • Vancomycin
    • NSAIDs – inhibition of the cyclo-oxygenase enzyme, shifting eicosonoid metabolism toward production of leukotrienes
    • Angiontensin converting enzyme inhibitors – increase the concentrations of bradykinin through effects on the kinin-kallikrien forming system
  19. What physical factors can also cause mast cell activation & anaphylaxis
    exercise & exposure to cold - through as-yet unidentified mechanisms
  20. where are preformed mediators stored
    intracellular granules
  21. which preformed mediator is the most important?
    histamine
  22. Examples of other preformed mediators are
    • Protease – tryptase, carboxypeptidase, chymase
    • Proteoglycans – heparin & chondroitin sulfate
  23. Which organs do the preformed and newly formed mediators affect most importantly
    • The vasculature
    • The heart
    • The lungs
  24. How is the vasculature affected by mediators?
    • Vasodilation
    • Increased permeability
  25. What does the impact of the mediators on the vasculature result in?
    Distributive and hypovolemic hypotension Shock
  26. How is the heart affected by mediators – esp histamine?
    • Vasospasm of coronary arteries
    • Shortening diastole – by effecting the sinoatrial node
    • Decreasing coronary blood flow
    • Delays in atrioventricular conduction
  27. What does the impact of the mediators on the heart result in?
    Cardiogenic shock
  28. How are the lungs affected by mediators?
    • Laryngeal edema – d/t increased vascular permeability in the larynx
    • Bronchospasm – stimulated bronchial smooth mm contraction
    • Increased viscosity of the mucous
  29. What does the impact of the mediators on the lungs result in?
    Significant bronchoiolar mucus plugging
  30. Nonlife threatening manifestations of anaphylaxis include
    • Flushing
    • Pruritis
    • Urticarial/angioedema
    • Rhinorrhea
    • Sneezing
    • Conjunctivitis
    • Headache
  31. Primary immunodeficiency diseases (PID) affect
    • neutrophils
    • macrophages
    • dendritic cells
    • complement proteins
    • natural killer cells
    • t lymphocytes
    • b lymphocytes
  32. factors to consider when beginning to evaluate a peds patient who may have primary immunodeficiency disease
    • birth hx w/ maternal risk factors, length of gestation, birth weight, neonatal problems - delayed separation of the umbilical cord, jaundice, respiratory problems
    • growth & development over time - any problems w/ FTT, any motor (fine or gross) development, language, cognitive
    • immunization hx
    • medication (past & present)
    • family history
    • infection history
  33. HIV infection occurs when the
    virus enters the body and binds to CD4 receptors on host T lymphocytes
  34. Juvenile Idiopathic Arthritis (JIA)
    autoimmune disease w/ genetic and environmental components
  35. Arthritis is definied clinically
    as the presence of joint swelling accompanied by warmth or tenderness or limitation of motion with tenderness on motion
  36. Systemic Lupus Erythematosus (SLE) is
    a multisystem inflammatory autoimmune disease
  37. SLE is characterized by
    the presence autoantibodies, especially antinuclear antibodies
  38. Vasculitis can be
    the result of conditions or diseases such as autoimmune disorders and drug reactions
  39. vasculitic disorders are characterized by
    necrosis and inflammation of the blood essels

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