PPOM 1 Block 3 Flashcards Part 1

Cells where Negri bodies are commonly found

Neurons (especially hippocampal pyramidal cells and cerebellar Purkinje cells)

What nerve compression syndrome can occur from rheumatoid arthritis wrist inflammation?

Carpal tunnel syndrome

What is the main immune defect in Common Variable Immunodeficiency (CVID)?

Impaired differentiation of B cells into plasma cells, resulting in decreased antibody production.

What are the initial laboratory tests for suspected immunodeficiency?

Complete blood count with differential, quantitative immunoglobulin levels (IgG, IgA, IgM, IgE), antibody titers to vaccines, and complement testing.

Which gastrointestinal pathogen commonly infects patients with antibody deficiencies?

Giardia lamblia

Which viral infections can cause secondary immunodeficiency?

Human immunodeficiency virus, measles virus, and rubella virus.

What medications commonly cause secondary immunodeficiency?

Immunosuppressants and systemic corticosteroids.

What is the main pathological process driving joint damage in rheumatoid arthritis?

Autoimmune synovial inflammation causing pannus formation.

What eye condition may occur in rheumatoid arthritis due to systemic inflammation?

Scleritis

What syndrome includes rheumatoid arthritis, splenomegaly, and neutropenia?

Felty syndrome.

What cytokine plays a major role in rheumatoid arthritis inflammation and is a key treatment target?

Tumor necrosis factor alpha.

What immune signaling pathway is disrupted in IL-12 receptor deficiency?

The IL-12 signaling pathway that stimulates interferon-gamma production by NK cells and T cells.

What important transfusion reaction risk exists in Selective IgA Deficiency?

Anaphylaxis to blood products or IVIG due to anti-IgA antibodies.

What is the standard treatment for Common Variable Immunodeficiency?

Immunoglobulin replacement therapy (IVIG) and antibiotics for infections.

What is the characteristic immunoglobulin pattern in Common Variable Immunodeficiency?

Low IgG with low IgA and sometimes low IgM

Which three drug classes are primarily used to treat acute gout attacks?

1. Nonsteroidal anti-inflammatory drugs

2. Corticosteroids

3. Colchicine

Which biologic agent acts as a synthetic uricase for refractory gout?

Pegloticase

Colchicine should be avoided in patients with renal or hepatic impairment taking which types of drugs?

Strong CYP3A4 inhibitors or P-glycoprotein inhibitors

Which serious toxicities can occur with prolonged colchicine use?

Neuropathy

Bone marrow suppression

What is the mechanism of action of colchicine in gout?

Inhibits microtubule polymerization and inflammatory mediator activity

Why should anti-inflammatory therapy be continued when initiating urate-lowering therapy?

Starting urate-lowering therapy can precipitate a gout flare due to uric acid redistribution

What should be done with urate-lowering therapy if a patient develops an acute gout flare while taking it?

Continue the urate-lowering therapy

Which gout medications can also treat acute pseudogout (calcium pyrophosphate disease)?

Nonsteroidal anti-inflammatory drugs

Corticosteroids

Colchicine

Which drug class reduces uric acid production by inhibiting xanthine oxidase?

Xanthine oxidase inhibitors

What hormonal therapy can be used for refractory gout?

Adrenocorticotropic hormone (ACTH)

Which cytokine inhibitor may be used for refractory gout?

Interleukin-1 inhibitor (canakinumab)

What finger deformity is characterized by hyperextension of the proximal interphalangeal joint and flexion of the distal interphalangeal joint?

Swan neck deformity

What finger deformity involves flexion of the proximal interphalangeal joint and hyperextension of the distal interphalangeal joint?

Boutonniere deformity.

What antibody is commonly present in rheumatoid arthritis and targets the Fc portion of immunoglobulin G?

Rheumatoid factor.

What antibody is highly specific for rheumatoid arthritis?

Anti–cyclic citrullinated peptide antibody.

What inflammatory markers are often elevated in rheumatoid arthritis?

Erythrocyte sedimentation rate and C-reactive protein.

What joint pattern is characteristic of rheumatoid arthritis?

Symmetric polyarthritis

What joint stiffness pattern is classic for rheumatoid arthritis?

Morning stiffness lasting longer than one hour.

What hematologic abnormality is commonly seen in rheumatoid arthritis due to chronic inflammation?

Anemia of chronic disease.

Why is probenecid ineffective in severe kidney disease?

It requires renal tubular function and is ineffective if eGFR is below 60 mL per minute

Why is probenecid ineffective in severe kidney disease?

It requires renal tubular function and is ineffective if eGFR is below 60 mL per minute

Why must patients taking probenecid maintain high urine volume?

To prevent uric acid kidney stone formation

What adverse effect is associated with probenecid therapy?

Nephrolithiasis (uric acid kidney stones)

What transporter does probenecid inhibit to increase uric acid excretion?

URAT1

What is the primary uricosuric drug used for gout?

Probenecid

What black box warning is associated with febuxostat?

Increased risk of cardiovascular death in patients with cardiovascular disease

What distinguishes febuxostat from allopurinol pharmacologically?

Non-purine xanthine oxidase inhibitor

What symptoms suggest allopurinol hypersensitivity syndrome?

Rash

Eosinophilia

Leukocytosis

Fever

Hepatitis

Renal failure

What serious hypersensitivity syndrome is associated with allopurinol?

HLA-B*5801 hypersensitivity syndrome

What active metabolite of allopurinol also inhibits xanthine oxidase?

Oxypurinol (alloxanthine)

Classic histologic finding in rabies infection

Negri bodies

Genome type of rabies virus

Negative-sense single-stranded RNA

Disease caused by JC virus

Progressive multifocal leukoencephalopathy (PML)

Treatment for HSV encephalitis

Acyclovir

Patients most at risk for JC virus reactivation

Immunocompromised patients

What two mechanisms cause tissue damage in bacterial CNS infections?

Direct bacterial injury and inflammatory response (cytokines/chemokines).

Why is inflammation dangerous in bacterial meningitis?

Increased capillary permeability → cerebral edema → increased intracranial pressure → possible brain herniation.

What virulence factor helps bacteria evade immune clearance in meningitis?

Polysaccharide capsule

CSF findings in bacterial meningitis

Increased opening pressure, neutrophils (polymorphonuclear cells), increased protein, decreased glucose.

CSF findings in viral meningitis

Lymphocytes, normal glucose, normal or mildly increased protein.

Most common meningitis causes in neonates (0–6 months).

Group B Streptococcus, E. coli, Listeria monocytogenes.

Most common meningitis causes in children and adults (6 months–60 years).

Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae type b

Most common meningitis causes in elderly (>60).

Streptococcus pneumoniae and Listeria monocytogenes.

Definition of a brain abscess.

Focal infection of the brain parenchyma.

Treatment regimen for tuberculosis meningitis.

RIPE therapy (rifampin, isoniazid, pyrazinamide, ethambutol).