Hypersensitivity Reactions Overview

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Questions and Answers

Which symptom is commonly associated with aortic stenosis?

  • Palpitations
  • Exertional dyspnea (correct)
  • Pleuritic chest pain
  • Bradycardia

What is a characteristic finding during the physical examination of aortic stenosis?

  • Weak and delayed pulse (correct)
  • Wheeze on expiration
  • Diastolic murmur
  • S3 heart sound

What management strategy is recommended for asymptomatic patients with aortic stenosis?

  • Continuous beta-blocker therapy
  • Regular echocardiography follow-up (correct)
  • Immediate surgical intervention
  • Daily diuretics

Which medication should be used with caution in patients with aortic stenosis?

<p>Vasodilators (A)</p> Signup and view all the answers

Under what condition is surgical intervention indicated for aortic stenosis?

<p>Patient is symptomatic or has severe stenosis (D)</p> Signup and view all the answers

In a Type III hypersensitivity reaction, where do antigen-antibody complexes typically deposit?

<p>In tissues, after circulating in blood or body fluids. (A)</p> Signup and view all the answers

Which of the following is a characteristic feature of a Type IV hypersensitivity reaction?

<p>It is a delayed reaction mediated by T-cells. (A)</p> Signup and view all the answers

What is the primary immune mediator involved in Type I hypersensitivity reactions?

<p>IgE antibodies (A)</p> Signup and view all the answers

What is the underlying mechanism of a Type II hypersensitivity reaction?

<p>IgG or IgM antibodies bind to antigens on cell surfaces, triggering cell destruction. (A)</p> Signup and view all the answers

Which type of hypersensitivity reaction is associated with contact dermatitis from poison ivy?

<p>Type IV (A)</p> Signup and view all the answers

In Systemic Lupus Erythematosus (SLE), a Type III hypersensitivity reaction, where do the antigen/antibody complexes primarily deposit causing tissue damage?

<p>In multiple organs. (B)</p> Signup and view all the answers

Which of the following is an example of a Type II hypersensitivity reaction?

<p>Hemolytic anemia (B)</p> Signup and view all the answers

What is the typical treatment for a non-severe case of contact dermatitis resulting from a Type IV hypersensitivity reaction?

<p>Topical corticosteroids (A)</p> Signup and view all the answers

Which of the following best describes the mechanism of Type III hypersensitivity?

<p>Immune complexes deposit in tissues, activating complement. (B)</p> Signup and view all the answers

What is the primary difference in the appearance of rashes between a Type I and Type IV hypersensitivity?

<p>Type I is widespread, while Type IV is localized. (D)</p> Signup and view all the answers

Which of these is an example of alloimmunity?

<p>Rejection of a transplanted organ. (A)</p> Signup and view all the answers

In the clinical example provided, a patient with hay fever has what type of hypersensitivity reaction?

<p>Type I (C)</p> Signup and view all the answers

In the clinical example provided, a patient with hemolytic disease of the newborn has what type of hypersensitivity reaction?

<p>Type II (A)</p> Signup and view all the answers

In the clinical example provided, a patient with post-streptococcal glomerulonephritis has what type of hypersensitivity reaction?

<p>Type III (C)</p> Signup and view all the answers

In the clinical example provided, a patient who was exposed to poison ivy and has contact dermatitis has what type of hypersensitivity reaction?

<p>Type IV (D)</p> Signup and view all the answers

Which of the following is a common risk factor for megaloblastic anemia in the elderly?

<p>Celiac disease (A), Chronic alcohol abuse (C)</p> Signup and view all the answers

In a patient with folate deficiency, which of the following laboratory parameters would be expected to be elevated?

<p>MCV (B)</p> Signup and view all the answers

A patient presents with fatigue, dyspnea, and tingling in their lower extremities. Which laboratory test would be most helpful in diagnosing their condition?

<p>Serum B-12 level (D)</p> Signup and view all the answers

Which of the following is a common cause of drug-induced hemolytic anemia?

<p>Antibiotics (B)</p> Signup and view all the answers

A patient with sickle cell trait is considered to have which of the following?

<p>Autosomal recessive disorder (D)</p> Signup and view all the answers

Which of the following is a characteristic of anemia of chronic disease?

<p>Functional iron deficiency (C)</p> Signup and view all the answers

What is the primary cause of anemia in patients with chronic renal failure?

<p>Decreased erythropoietin production (A)</p> Signup and view all the answers

Which of the following factors increases afterload on the heart?

<p>Hypertension (C)</p> Signup and view all the answers

Which of the following conditions directly affects the heart's contractility?

<p>Ischemia (B)</p> Signup and view all the answers

What is the primary mechanism by which atherosclerosis contributes to coronary artery disease?

<p>Narrowing or blockage of the coronary arteries (C)</p> Signup and view all the answers

Which of the following is a non-modifiable risk factor for coronary artery disease?

<p>Family history (D)</p> Signup and view all the answers

John, a 55-year-old male, presents with chest pain, shortness of breath, and fatigue. Which of the following laboratory findings would best support a diagnosis of coronary artery disease?

<p>Elevated triglycerides (C)</p> Signup and view all the answers

In John's case, his elevated LDL cholesterol and low HDL cholesterol are considered which type of risk factor for CAD?

<p>Modifiable (D)</p> Signup and view all the answers

John's chest pain radiating to his left arm is a classic symptom of which cardiac condition?

<p>Angina (A)</p> Signup and view all the answers

Which of the following ECG findings is suggestive of myocardial ischemia?

<p>ST-segment depression (C)</p> Signup and view all the answers

What is the primary pathophysiological mechanism underlying aortic stenosis?

<p>Reduced blood flow from the left ventricle into the aorta. (A)</p> Signup and view all the answers

What are the hallmark physical exam findings associated with aortic regurgitation?

<p>A high-pitched, blowing diastolic murmur. (B)</p> Signup and view all the answers

In the context of heart failure, what does NYHA Stage C represent?

<p>The patient experiences symptoms that affect their daily function, leading to alterations in their daily life. (A)</p> Signup and view all the answers

Which of the following is a recognized risk factor for aortic regurgitation?

<p>History of rheumatic fever. (C)</p> Signup and view all the answers

In the context of heart failure, what specific condition is commonly associated with right-sided heart failure occurring without left-sided heart failure?

<p>Long-standing pulmonary issues (COPD). (C)</p> Signup and view all the answers

Which of the following medications may be used to manage symptoms of heart failure and fluid overload?

<p>Diuretics. (A)</p> Signup and view all the answers

What is the primary pathophysiological consequence of aortic stenosis?

<p>Increased workload on the left ventricle due to pressure overload. (B)</p> Signup and view all the answers

Which of the following is a common risk factor for the development of heart failure?

<p>Hyperlipidemia. (A)</p> Signup and view all the answers

What is the purpose of a stress test in the management of heart failure?

<p>To assess the extent of ischemia and possible coronary angiography. (B)</p> Signup and view all the answers

When contractility is decreased in heart failure, what happens to the left ventricular end-diastolic volume (LVEDV)?

<p>It increases. (D)</p> Signup and view all the answers

In NYHA functional classification, which stage indicates the most severe limitation of physical activity?

<p>Stage IV. (B)</p> Signup and view all the answers

Which of the following is NOT a recognized risk factor for aortic stenosis?

<p>Regular exercise. (C)</p> Signup and view all the answers

What is the definitive treatment for aortic regurgitation, if indicated?

<p>Aortic valve replacement. (B)</p> Signup and view all the answers

What is the primary immunoglobulin involved in Type 1 hypersensitivity reactions?

<p>IgE (D)</p> Signup and view all the answers

In the management of heart failure, what does the term "preload" refer to?

<p>The amount of blood in the ventricle at the end of diastole. (B)</p> Signup and view all the answers

What is the primary pathophysiological change that occurs in the left ventricle as a result of aortic stenosis?

<p>Dilatation and hypertrophy. (D)</p> Signup and view all the answers

Which of the following symptoms are systemic responses associated with anaphylactic reactions?

<p>Wheezing and hypotension (D)</p> Signup and view all the answers

What type of hypersensitivity reaction is primarily characterized by tissue specificity and cytotoxic effects?

<p>Type 2 (A)</p> Signup and view all the answers

Which autoimmune condition is an example of a Type 2 hypersensitivity reaction?

<p>Graves' disease (B)</p> Signup and view all the answers

In Type 3 hypersensitivity reactions, immune complexes cause tissue damage primarily by depositing in which locations?

<p>Blood vessel walls and joints (B)</p> Signup and view all the answers

What is the main treatment used to reverse the effects of severe Type 1 hypersensitivity reactions?

<p>Epinephrine (B)</p> Signup and view all the answers

Which of the following best describes a key characteristic of Graves' disease as a Type 2 hypersensitivity reaction?

<p>Autoantibody-mediated overstimulation (D)</p> Signup and view all the answers

What triggers the formation of immune complexes in Type 3 hypersensitivity reactions?

<p>Combination of soluble antigens with antibodies (D)</p> Signup and view all the answers

Which of the following is a typical cause of secondary immunodeficiency?

<p>Malnutrition (B)</p> Signup and view all the answers

What is a key feature of Common Variable Immunodeficiency (CVI)?

<p>Impaired antibody response (D)</p> Signup and view all the answers

Which lab value is typically decreased in iron deficiency anemia?

<p>Serum iron level (D)</p> Signup and view all the answers

What type of vaccine is contraindicated for severely immunocompromised individuals?

<p>Live attenuated vaccines (B)</p> Signup and view all the answers

Which of the following conditions is most likely to result in increased susceptibility to infections due to encapsulated bacteria?

<p>Common Variable Immunodeficiency (A)</p> Signup and view all the answers

In which condition would you expect normal to increased serum ferritin levels?

<p>Sideroblastic anemia (A)</p> Signup and view all the answers

Which factor is a common feature of all anemias?

<p>Impaired oxygen transport (C)</p> Signup and view all the answers

What is the typical serum iron level in thalassemia?

<p>Normal (B)</p> Signup and view all the answers

Which statement best describes the immunoglobulin levels in Common Variable Immunodeficiency (CVI)?

<p>Low levels of IgG, IgA, and IgM (D)</p> Signup and view all the answers

Which vaccine is considered safe for immunocompromised individuals?

<p>Inactivated polio vaccine (D)</p> Signup and view all the answers

What is an expected laboratory result in a patient with anemia of chronic disease?

<p>Decreased transferrin saturation (C)</p> Signup and view all the answers

Which of the following best describes the Mean Corpuscular Hemoglobin Concentration (MCHC) in most microcytic anemias?

<p>Consistently low (B)</p> Signup and view all the answers

What type of anemia is characterized by an increased RBC distribution width alongside low serum iron levels?

<p>Iron deficiency anemia (C)</p> Signup and view all the answers

What is a possible consequence of immunocompromised individuals receiving live vaccines?

<p>Development of the disease (C)</p> Signup and view all the answers

Flashcards

Hypersensitivity Type 1

Allergic reactions mediated by IgE causing local inflammation and systemic symptoms.

Anaphylactic Reaction

Severe systemic reaction with hypotension and bronchoconstriction, life-threatening.

Hypersensitivity Type 2

Cytotoxic reactions targeting specific tissues, can cause damage or alter function.

Grave's Disease

Type 2 hypersensitivity where autoantibodies overstimulate the thyroid without destroying it.

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Cytotoxic Reaction

Type 2 hypersensitivity involving tissue-specific immune responses like blood transfusion reactions.

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Hypersensitivity Type 3

Immune complex-mediated reactions causing inflammation and tissue damage.

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Immune Complex Deposition

Formation of antigen-antibody complexes that lead to local inflammation in tissues.

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Common Symptoms of Hyperthyroidism

Symptoms include increased metabolism, sweating, tremors, and exophthalmos.

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Type 2 Hypersensitivity

Organ-specific reaction where antibodies bind to cell surface antigens.

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Type 3 Hypersensitivity

Not organ-specific; antibodies bind to soluble antigens forming immune complexes.

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Rheumatoid Arthritis

A type 3 hypersensitivity where immune complexes deposit in joints.

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Systemic Lupus Erythematosus (SLE)

A type 3 hypersensitivity involving autoimmunity and multi-organ tissue damage.

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Flare-ups in SLE

Episodes of worsened symptoms triggered by various factors like stress or sunlight.

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Type 4 Hypersensitivity

Delayed response mediated by T-cells, not involving antibodies.

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Type I vs Type IV Rash

Type I rash appears immediately; Type IV rash develops days later.

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Contact Dermatitis

A type IV hypersensitivity reaction from skin contact with allergens, like poison ivy.

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Antihistamines vs. Type IV

Antihistamines target Type I reactions; not effective for Type IV.

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IgE Mechanism

IgE binds to allergens causing mast cell degranulation and histamine release.

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IgG/IgM Mechanism

IgG or IgM antibodies bind to antigens on cell surfaces leading to destruction.

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Immune Complex Formation

Type 3 hypersensitivity where antigen-antibody complexes form and deposit in tissues.

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Delayed-Type Hypersensitivity

A specific response where T-cells react to antigens after exposure.

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RhoGAM

Preventive treatment for Rh-negative mothers to avoid Type II hypersensitivity.

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Post-Streptococcal Glomerulonephritis

A Type 3 reaction involving immune complexes from strep throat affecting kidneys.

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Aortic Stenosis Symptoms

Classic triad includes ejection murmur, weak pulses, and heart failure signs.

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Systolic Ejection Murmur

Loud, harsh murmur best heard at right second intercostal space, radiating to carotids.

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Weak and Delayed Pulse

Weak and delayed due to reduced stroke volume; known as pulsus parvus et tardus.

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S4 Gallop

S4 heart sound occurs due to left ventricular hypertrophy and reduced compliance.

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Management of Aortic Stenosis

Includes monitoring, medical management, and indications for surgery.

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Primary Immunodeficiency

An immune deficiency resulting from single gene defects.

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Secondary Immunodeficiency

Immune deficiency caused by other diseases or conditions.

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Common Variable Immunodeficiency (CVI)

A condition characterized by impaired antibody production.

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Symptoms of CVI

Frequent infections, chronic diarrhea, autoimmune disorders.

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Vaccine Types for Immunocompromised

Different vaccines based on immune system status.

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Live Attenuated Vaccines

Vaccines dangerous for severely immunocompromised patients.

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Inactivated Vaccines

Safe for immunocompromised individuals as they contain no live pathogens.

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mRNA Vaccines

Vaccines that are effective for immunocompromised individuals.

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Iron Deficiency Anemia

A type of anemia caused by insufficient iron.

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Symptoms of Anemia

Fatigue, weakness, and pallor due to low RBCs or hemoglobin.

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Ferritin

A protein that stores and releases iron in the body.

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RBC Distribution Width (RDW)

Measure of variability in RBC size, important in anemia diagnosis.

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Thalassemia

A genetic blood disorder affecting hemoglobin synthesis.

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Mean Corpuscular Hemoglobin Concentration (MCHC)

Average concentration of hemoglobin in RBCs.

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Management of CVI

Involves immunoglobulin therapy and antibiotics.

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Megaloblastic Anemia

Characterized by large, immature red blood cells and decreased mature RBCs, often due to vitamin B12 or folate deficiencies.

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At-risk Groups for Megaloblastic Anemia

Individuals such as vegetarians, elderly, and those with malabsorption syndromes are at risk due to dietary deficiencies.

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Folate Deficiency

A type of deficiency leading to megaloblastic anemia, often seen in alcoholics and individuals with low dietary intake.

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Vitamin B12 Deficiency Symptoms

Symptoms include fatigue, dyspnea, peripheral neuropathy (numbness and tingling).

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Hemolytic Anemia

Condition where red blood cells are destroyed, often due to blood type mismatches or autoimmune reactions.

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Sickle Cell Anemia

A type of hemolytic anemia caused by a mutation leading to abnormal hemoglobin; can be normocytic during steady state.

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Anemia of Chronic Disease

Associated with chronic conditions, leading to normocytic or microcytic anemia due to inflammation and cytokine production.

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Anemia in Chronic Renal Failure

Occurs due to decreased EPO production, resulting in normocytic normochromic anemia.

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Stroke Volume

The volume of blood pumped out by each ventricle per heartbeat; part of cardiac output calculation.

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Coronary Artery Disease (CAD)

Narrowing/blockage of coronary arteries from atherosclerosis, leading to ischemia and possible heart attacks.

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CAD Risk Factors

Includes age, genetics, hypertension, smoking, obesity, poor diet; can be modifiable or non-modifiable.

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Angina Symptoms

Chest pain radiating to arms and shortness of breath; indicates myocardial ischemia.

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Low-Density Lipoprotein (LDL)

Bad cholesterol that can lead to heart disease when elevated; inversely related to HDL.

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Myocardial Ischemia Indicators

ST-segment depression on ECG often indicates reduced blood supply to the heart muscle.

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Lifestyle Modifications

Changes in habits like smoking cessation and dietary adjustments to improve health.

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Pharmacotherapy

Use of medications like statins and beta-blockers for managing heart conditions.

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Pathophysiology of Heart Failure

Condition where cardiac output is insufficient to meet oxygen demands.

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Decreased Contractility

Reduced ability of the heart muscle to contract, leading to lower stroke volume.

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Left Ventricular End-Diastolic Volume (LVEDV)

Volume of blood in the left ventricle at end diastole; increases with heart failure.

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Right Heart Failure

Failure of the right side of the heart, often due to left-sided failure or lung issues.

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Stage A Heart Failure

Patients have risk factors for heart failure but show no symptoms or damage yet.

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NYHA Stage II

Mild symptoms; slight limitation in physical activity but comfortable at rest.

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Aortic Regurgitation

Condition where the aortic valve fails to close, causing blood backflow into the left ventricle.

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Diastolic Murmur

A high-pitched, blowing sound heard during diastole indicative of aortic regurgitation.

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Aortic Stenosis

Narrowing of the aortic valve, causing increased pressure in the left ventricle.

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Risk Factors for Aortic Stenosis

Factors include age, bicuspid aortic valve, and rheumatic fever leading to stenosis.

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Signs of Heart Failure

Common symptoms include dyspnea, orthopnea, and fatigue.

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Management of Aortic Regurgitation

Includes monitoring, medications like diuretics and vasodilators, and possible surgery.

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Beta-Blockers

Medications used to lower heart rate and manage symptoms of heart failure.

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Study Notes

Hypersensitivity Reactions

  • Four types: Type 1, Type 2, Type 3, Type 4
  • Type 1: Immediate hypersensitivity (allergic reactions)
    • Mediated by IgE antibodies
    • Mast cell degranulation releases histamine
    • Local symptoms: itching, rash
    • Systemic symptoms: wheezing, hypotension, bronchoconstriction (anaphylaxis)
    • Treatment: epinephrine
  • Type 2: Cytotoxic hypersensitivity
    • Antibody-mediated destruction of cells
    • Tissue-specific (e.g., Graves' disease, incompatible blood transfusions)
    • Macrophages play a role
    • Antibodies (IgG or IgM) bind to cell surface antigens, leading to cell lysis or dysfunction
  • Type 3: Immune complex-mediated hypersensitivity
    • Antigen-antibody complexes form in the blood and deposit in tissues
    • Triggers inflammation and tissue damage
    • IgG or IgM antibodies bind to soluble antigens, forming complexes
    • Complexes deposit in small blood vessels, causing damage (e.g., rheumatoid arthritis, SLE)
  • Type 4: Delayed hypersensitivity
    • Cell-mediated response by T cells
    • Does not involve antibodies
    • Macrophages and T cells involved.
    • Delayed reaction-several days after contact with allergen (e.g., poison ivy)
    • Rash is localized to the site of the allergen

Differentiating Type 1 vs. Type 4 Reactions

  • Type 1: Immediate, widespread rash
  • Type 4: Delayed, localized rash (e.g., contact dermatitis)

Treatment of Type 4 Reactions

  • Topical corticosteroids

Hypersensitivity Mechanisms

  • Type 1: IgE, mast cells, histamine, basophils
  • Type 2: IgG, IgM, complement, phagocytes
  • Type 3: IgG, IgM, complement, neutrophils
  • Type 4: T cells (CD8+, CD4+), macrophages

Clinical Applications of Hypersensitivity (Examples)

  • Type 1 (Allergic Rhinitis): Pollen exposure triggers sneezing, runny nose, etc. Treated with antihistamines and avoidance.
  • Type 2 (Hemolytic Disease of the Newborn): Rh factor incompatibility. Prevented with RhoGAM.
  • Type 3 (Post-Streptococcal Glomerulonephritis): Strep throat leads to kidney inflammation. Treated with supportive care.
  • Type 4 (Poison Ivy): Contact with urushiol oil leads to a delayed rash. Treated with topical corticosteroids.

Primary and Secondary Immunodeficiencies

  • Primary: Single gene defects (e.g., B-lymphocyte deficiency)
  • Secondary: Due to other conditions (e.g., malnutrition, HIV, pregnancy)

Common Variable Immunodeficiency (CVI)

  • Characterized by impaired antibody production
  • Increased susceptibility to infections

Features of CVI

  • Low immunoglobulin levels (IgG, IgA, IgM)
  • Increased infections (respiratory, gastrointestinal)
  • Potential for autoimmune disorders

Vaccine Considerations in Immunocompromised Individuals

  • Live attenuated vaccines are contraindicated in severely immunocompromised patients.
  • Inactivated and subunit/mRNA vaccines are generally safe.
  • Vaccination of close contacts can help with herd immunity.

Hematology

  • Anemia: Reduced red blood cell count. -Iron deficiency anemia: Low serum ferritin, low serum iron, high TIBC, low transferrin saturation. -Thalassemia: Increased serum ferritin (possible), normal/increased TIBC, normal/increased transferrin saturation. -Anemia of chronic disease: Normal to increased serum ferritin, normal RDW, normal to increased serum iron, slightly decreased TIBC, normal to decreased transferrin saturation. -Sideroblastic anemia: Normal to increased serum ferritin, increased RDW, normal to increased serum iron, normal TIBC, normal to increased transferrin saturation). -Mean Corpuscular Hemoglobin Concentration (MCHC): Normal or low in many types of anemias, low in iron deficiency, sideroblastic anemia, thalassemia. High MCHC seen in Hereditary spherocytosis.
  • Megaloblastic anemia: Large, immature RBCs. Caused by B12 or folate deficiency. -Folate deficiency: Low folate, normal/low RBCs, high MCV, normal MCHC, normal/elevated reticulocyte count. -Vitamin B12 deficiency: Low B12, normal/low RBCs, increased MCV, normal MCHC.

Hemolytic Anemia

  • RBC destruction
  • Risk factors: Mismatched blood types, autoimmune reactions to own blood cells, drug reactions.
  • Sickle cell anemia: Abnormal hemoglobin, normocytic (during steady state), hemolytic.
  • Thalassemia: Inherited, decreased hemoglobin production, many possible genetic mutations.
  • Anemia of chronic disease: Associated with chronic conditions, impaired erythropoiesis, functional iron deficiency.
  • Anemia of chronic kidney disease: Decreased EPO production, normocytic, normochromic.

Cardiac Content

  • Normal Blood Flow: Blood flows through the heart in a specific pathway. -Stroke Volume, Cardiac Output, Heart Sounds: Cardiac output measures the blood pumped per minute.
  • Preload, Afterload, Contractility: These factors affect heart function. -Increased preload increases stroke volume, decreased preload decreases stroke volume, increased afterload decreases stroke volume, decreased afterload increases stroke volume.

Coronary Artery Disease (CAD)

  • Pathophysiology: Atherosclerosis narrows coronary arteries, reducing blood flow.
  • Risk Factors: Age, genetics, hypertension, hyperlipidemia, smoking, diabetes, obesity, physical inactivity, poor diet, chronic inflammation, stress
  • Secondary causes of dyslipidemia: Diabetes mellitus, obesity, hypothyroidism, chronic kidney disease, liver disease, medications, other endocrine disorders.

Heart Failure

  • Underlying pathophysiology: Less cardiac output to meet body's demands.
  • Stages of heart failure are based on structural and functional changes as well as the patient's symptoms. NYHA functional classifications describe the impact on a patient's activity.
  • Differentiating between right and left heart failure

Heart Valve Disorders

  • Aortic Regurgitation: Blood flows backward into the ventricle during diastole, causing volume overload and eventually heart failure. Risk Factors: Congenital defects, rheumatic fever, infective endocarditis, aortic root disease, age
  • Physical Exam Findings: Diastolic murmur, bounding pulses
  • Management: Monitoring, medical (diuretics, vasodilators), and surgical (valve replacement)
  • Aortic Stenosis: Narrowing of aortic valve restricts blood flow, leading to pressure overload and left ventricular hypertrophy. Risk factors: Age, bicuspid aortic valve, rheumatic fever, hyperlipidemia, radiation therapy.
  • Physical Exam Findings: Systolic ejection murmur, weak/delayed pulse

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