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Autoimmunity Quiz

Autoimmunity Quiz. Emily Matthews ( e.k.matthews@warwick.ac.uk ) Chris Lancaster ( c.j.lancaster@warwick.ac.uk ) Jake Turner ( jake.turner@warwick.ac.uk ) . Question 1. Define autoimmunity ( 4 marks). 1) WHAT? An immune response to self antigens.

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Autoimmunity Quiz

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  1. Autoimmunity Quiz Emily Matthews (e.k.matthews@warwick.ac.uk) Chris Lancaster (c.j.lancaster@warwick.ac.uk) Jake Turner (jake.turner@warwick.ac.uk)

  2. Question 1 Define autoimmunity ( 4 marks) 1) WHAT? An immune response to self antigens 2) WHY? Due to a failure of immunological tolerance 3) IT CAUSES? Leading to immune-mediated damage to specific tissues 4) CAUSED BY? Usually due to a combination of genetic & environmental factors

  3. Question 2 What is tolerance? (1 mark) Unresponsiveness of the immune system to an antigen Name TWO types of tolerance (think: location) (2 marks) Central Peripheral Give TWO mechanisms of central tolerance (2 marks) Clonal deletion (by apoptosis) Clonal anergy (inactivated by regulatory T lymphocytes)

  4. Question 3 Environmental causes of autoimmune conditions: Explain how the following could lead to autoimmune disease: Streptococcal infection → Rheumatic fever (2 marks) Trauma to eye (2 marks) Cross-reaction of antibodies against streptococci with myocardial antigen/heart valve antigen causing heart valve damage. An example of molecular/antigen mimicry (b) Trauma causes antigens to be revealed which are normally sequestered from immune system. Body has NOT developed tolerance to these self-antigens, so autoantibodies react

  5. Question 4a Name the following signs of autoimmune conditions i C A B ii 3 marks 1 mark 1 mark iii

  6. Question 4b Identify the likely autoimmune condition from the sign C A B 1 mark 1 mark 1 mark Autoimmunity Quiz

  7. Question 4c Identify an autoantibody raised in this condition C A B 1 mark 1 mark 1 mark Autoimmunity Quiz

  8. Question 4 : Answers C A B Sign: Butterfly rash (note nasolabial groove sparing) Disease: Systemic Lupus Erythematosus AA: ANA e.g. anti-dsDNA, anti-cardiolipin Signs: (i) Boutonnière deformity (ii) Ulnar deviation of MCP (iii) Swan-neck deformity Disease: Rheumatoid arthritis AA: RhF, anti-CCP Sign: Exopthalmos Disease: Grave’s Disease AA: TSHR autoantibodies

  9. A ‘fun’ list N.B. I’ve used acronyms: remember in an exam WRITE EVERYTHING OUT IN FULL!

  10. Question 5 Describe the joint position of a finger in: Swan neck deformity (b) Boutonnière deformity

  11. Question 6a • A patient with Rheumatoid arthritis presents with: • Dry mouth • Scratchy, dry eyes • Rashes Bonus Marks Medical terms Xerostomia Xerophthalmia Which secondary autoimmune condition should be suspected? Sjögren’s Syndrome / Sicca Syndrome N.B. Sjorgren’s / Sicca can also present on its own, i.e. as a primary condition List TWO diagnostic tests • Schirmer’s test • Slit lamp examination • Saliva flow test • Autoantibodies (anti-La = most specific) • Ultrasound of salivary glands (hypoechoic lesions & loss of tissue) • Biopsy of lip or salivary gland (lymphocytic infiltration tissue damage & loss) N.B. Be able to describe these (just a sentence)

  12. Question 6b Sicca / Sjögren’sSyndrome: State THREE treatments/management CONSERVATIVE MEDICAL SURGICAL Artificial tears, regular sips of fluid, artificial saliva, (awareness of lymphoma risk) DMDs: Topical cyclosporin Lacrimal plugs Autoimmunity Quiz

  13. Question 7 Grave’s Disease: State THREE treatments/management CONSERVATIVE MEDICAL SURGICAL N/A Thioamides: Carbimazole or propylthiouracil(inhibtthyroid peroxidase enzyme required to convert iodine → thyroid hormone) Radioiodine Partial or total thyroidectomy Autoimmunity Quiz

  14. Clarifications Thyrotoxicosis = excess thyroid hormone Usually due to hyperthyroidism Most common cause is Grave’s disease Exopthalmos = “appearance of protruding eyes” caused by proptosis(eye protrudes beyond orbit) and lid retraction Autoimmunity Quiz

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