Study Guide Immune Semester III 2017

Study Guide Immune System and Disorders

CONTENTS
Contents ………………………………………………………………………………………………...1
Foreword

………………………...

……………………………………………………………………....2
Curriculum ……………………………………………………………………………..……………......3
Block Team …………………..………………………………………………………………………....4
Facilitators Team ……….……………………………………………………………………………....6
Time Table ......................…………………………………………………….………………………..7
Assessment Method …………………………………………………………………………..………19
Learning Program …………………………………………………………………………………….20
Student Project ……………………………………………………………………………………..…50
References …………………………………………………………………………………………….51
Curriculum Mapping…………………………………………………………………………………..52

Udayana University Faculty of Medicine, DME, 2017

1

Study Guide Immune System and Disorders

FOREWORD

The Block “The Immune System and Disorders” is designed for students in order to
serve health care professionals in the diagnosis and management of allergic and other
immunological disorders. Our goals have been to present the basic and essential material
clearly and to provide the knowledge and skills due to:
-

Diagnose and manage patient with inflammation

-

Diagnose and manage patient with hypersensitivity / allergic disease

-

Diagnose and manage patient with autoimmune disease
This block try to give the essential information to assist in clinical decision making and

treatment planning on commonly allergic diseases in pediatric, internal medicine, ENT,and
skin. We also give essential information on commonly autoimmune diseases in neurology,
dermatology, pediatric and internal medicine.
Our overall goal is to transfer the basic essential information on commonly allergy –
immunological diseases that are required for the primary health care. This block will be
completed by case illustration, learning tasks to be discuss by the students in the small group
discussions and individually in order to achieve the block objectives.
The Block ″ The Immune System an Disorders ″

( ISD ) is undertaken 19 days

including skill lab, examinations. Student – centered learning as the primary approach in the
teaching-learning activities with dynamic group discussions are facilitated by tutors. Individual
learning in Campus and at home is also an important part of the learning process. To develop
good understanding of the ISD, learning activities will also be carried out as lectures, practical
and learning with the patients ( Skill Lab).

Team of Planners

ISD

Udayana University Faculty of Medicine, DME, 2017

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Study Guide Immune System and Disorders

CURRICULUM

Aims:
1. To comprehend the biology of the immune system in health and diseases
2. To diagnose and manage common immune-mediated disorders
3. To diagnose and manage common disorders of the joints and adjacent tissue

Learning Outcomes:
To be able to
1. Diagnose and manage patients with inflammation

2. Diagnose and manage patients with hypersensitivity / allergic diseases
3. Diagnose and manage patients with autoimmune diseases

Curriculum contents:
1. The biology and responses of the immune system in health and diseases
2. The common immune-mediated disorders

PLANNERS TEAM
Udayana University Faculty of Medicine, DME, 2017

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Study Guide Immune System and Disorders

No

Name

Department

Phone

Internal Medicine

082145854167

ENT

081237874447

1

dr. Tjok Istri Anom S, SpPD (Head)

2

dr. Sari Wulan DS, SpTHT-KL

3

dr. Ketut Suardamana, SpPD-KAI
(Member)

Internal Medicine

08123985811

4

Dr. dr. Ketut Suryana, Sp.PD-KAI
(Member)

Internal Medicine

08123960964

5

Dr. dr.
Ni Putu Sriwidnyani, Sp.PA

(member)

Pathology Anatomy

081337115012

6

Dr. dr. Ni Made Linawati, M.Si (member)

Histology

081337222567

7

dr. Komang Suryawati, Sp.KK (Member)

Dermatology

0817447279

9

dr. I Gusti Ayu Harry Sundariyati, S.Ked

DME

081805380277

Department

Phone

Internal Medicine

08123960964

Histology

081805629937

Pathology Anatomy

081337115012

Pediatrics

081239559559

Clinical Pathology

03617428983

LECTURERS
No

Name

1

Dr. dr. Ketut Suryana, Sp.PD-KAI

2

Dr. dr. Ni Made Linawati, Msi

3

Dr. dr. Ni Putu Sriwidyani, Sp. PA

4

dr. Komang Ayu Witarini,SpA

5

Dr. dr. I Wyn Putu Sutirta Yasa, Msi

6

Dr. dr. I Made Jawi, M.Kes

Pharmacology

08179787972

7

Dr. dr. B. K. Satriyasa, M.Repro

Pharmacology

087777790064

8

dr. Nyoman Suryawati, Sp.KK

Dermatology

0817447279

9

dr. Ketut Suardamana, Sp.PD-KAI

Internal Medicine

08123985811

11

dr. Sari Wulan Dwi Sutanegara , Sp.THTKL

ENT

081237874447

Udayana University Faculty of Medicine, DME, 2017

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Study Guide Immune System and Disorders
081338466039
12

Dr. dr. Made Oka Adnyana, Sp.S (K)

13

Neurology

0817347697

dr. Gede Kambayana, Sp.PD-KR

Internal Medicine

08124683416

14

dr. Tjok Istri Anom S, SpPD

Internal Medicine

82145854167

15

Dr. dr. Nyoman Wande, Sp.PK

Clinical Pathology

08124686885

16

dr. Pande Ketut Kurniari,SpPD

Internal Medicine

082146179796

17

dr. IB Putu Alit, SpF, DFM

Forensic

081916613459

Udayana University Faculty of Medicine, DME, 2017

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Study Guide Immune System and Disorders

FACILITATORS

No

Name

Group

Departement

Phone

1

Prof. Dr.dr. I Putu Gede Adiatmika,
M.Kes

A1

Physiology

08123811019

2

dr. I Kadek Swastika, M.Kes

A2

Parasitology

08124649002

3

dr. I Wayan Surudarma, Msi

A3

Biochemistry

081338486589

4

dr. Anak Agung Ayu Ngurah Susraini,
Sp.PA(K)

A4

Anatomy
Phatology

0811398913

5

Dr. dr. Ni Made Linawati, M.Si

A5

Histology

081337222567

6

dr. I Gusti Ayu Harry Sundariyati,
S.Ked

A6

DME

081805380277

7

dr. Yukhi Kurniawan, Sp.And

A7

Andrology

08123473593

A8

Microbiology

087862200814

A9

Radiology

08123846307

A10

Opthalmology

081916513322

8
9
10

dr. Ni Nengah Dwi Fatmawati, Sp.MK,
Ph.D
dr. Dewa Gde Mahiswara Suadiatmika,
Sp.Rad
dr. Ni Made Laksmi Utari, M.Biomed,
Sp.M

Venue
(3rd floor)
3rd floor:
R.3.01
3rd floor:
R.3.02
3rd floor:
R.3.03
3rd floor:
R.3.04
3rd floor:
R.3.05
3rd floor:
R.3.06
3rd floor:
R.3.07
3rd floor:
R.3.08
3rd floor:
R.3.21
3rd floor:
R.3.22

(REGULAR CLASS)

Udayana University Faculty of Medicine, DME, 2017

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Study Guide Immune System and Disorders
No

Name

Group

Departement

Phone

1

dr. I Wayan Sugiritama, M.Kes

B1

Histology

08164732743

2

Dr. dr. I Made Muliarta, M.Kes

B2

Physiology

081338505350

3

dr. Muliani, M.Biomed

B3

Anatomy

085103043575

4

dr. Putu Cintya D.Y, MPH

B4

Public Health

081353380666

B5

Microbiology

081338291965

B6

Public Health

08123816424

B7

Internal
Medicine

0811394108

5
6
7

Dr. dr. I Dewa Made Sukrama, Msi,
Sp.MK (K)
Dr. dr. Gde Ngurah Indraguna Pinatih.
M.Sc, Sp.GK
dr. Tjokorda Gde Dharmayuda,
Sp.PD-KHOM

8

Dr. dr. Susy Purnawati, M.KK

B8

Physiology

08123989891

9

Prof. dr. I G M. Aman, Sp.FK

B9

Pharmacology

081338770650

10

Dr.dr. Luh Putu Ratna Sundari,
M.Biomed

B10

Physiology

081933070077

Venue
(3rd floor)
3rd floor:
R.3.01
3rd floor:
R.3.02
3rd floor:
R.3.03
3rd floor:
R.3.04
3rd floor:
R.3.05
3rd floor:
R.3.06
3rd floor:
R.3.07
3rd floor:
R.3.08
3rd floor:
R.3.21
3rd floor:
R.3.22

(ENGLISH CLASS)
TIME TABLE OF THE BLOCK IMMUNE SYSTEM & DISSODERS 2017

Regular Class

Days/Date

Monday,N
ov 13,
2017

Activity

Conveyer

Venue

08.00-09.00
(60’)

· Introduction to The
Immune System and
disorders

· Dr. dr. Ketut
Suryana, SpPD-KAI

Class
Room

09.00-10.30
(90’)

Independent Learning

-

Library

10.30-12.00
(90’)

SGD

Fasilitator

Discussio
n Room

12.00-12.30
(30’)

Break

-

-

12.30-14.00
(90’)

Student Project (SP):
paper preparation

-

Discussio
n Room

14.00-15.00
(60’)

Plenary Session

· Dr. dr. Ketut
Suryana, SpPD-KAI

Class
Room

Udayana University Faculty of Medicine, DME, 2017

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Study Guide Immune System and Disorders

Tuesday,
Nov 14,
2017

08.00-08.30
(30’)

· Comprehend The
Microscopic Structure of
Limphoid Organ,Immune
Cells and MHC
· Comprehend basic
mechanism of
autoimmunity

08.30-09.00
(30’)

· Dr. dr. Ni Made
Linawati,Msi

Class
Room

· Dr. dr. Ni Putu
Sriwidyani, Sp. PA

09.00-10.30
(90’)

Independent Learning

-

Library

10.30-12.00
(90’)

SGD

· Fasilitator

Discussio
n Room

12.00-12.30
(30’)

Break

-

-

12.30-14.00
(90’)

Student Project (SP) :
paper preparation

-

Discussio
n Room

14.00-15.00
(60’)

Plenary Session

· Dr. dr. Ni Made
Linawati, Msi

Class
Room

· Dr. dr. Ni Putu
Sriwidyani, Sp. PA
Wednesda
y, Nov 15,
2017

08.00-08.30
(30’)

Forensic Serology &
Molecular

- dr. IB Putu Alit,
SpF, DFM

Class
Room

· Antihistamin

· Dr.dr.B.K.Satriyas
a,M.Repro

09.00-10.30
(90’)

Independent Learning

-

Library

10.30-12.00
(90’)

SGD

· Fasilitator

Discussio
n Room

12.00-12.30
(30’)

Break

-

-

12.30-14.00
(90’)

SP: paper preparation

-

Discussio
n Room

08.30-09.00
(30’)

Udayana University Faculty of Medicine, DME, 2017

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Study Guide Immune System and Disorders

14.00-15.00
(60’)

Plenary Session

· dr. IB Putu Alit,
SpF, DFM

Class
Room

· Dr.dr.B.K.Satriyas
a,M.Repro
Thursday,
Nov 16,
2017

Friday,
Nov 17,
2017

Monday,
Nov 20,
2017

08.00-09.00
(60’)

· Comprehend laboratory · Dr. dr. I Wayan
test of immune system
Putu Sutirta Yasa,
Msi

Class
Room

09.00-10.30
(90’)

Independent Learning

-

Library

10.30-12.00
(90’)

SGD

· Fasilitator

Discussio
n Room

12.00-12.30
(30’)

Break

-

-

12.30-14.00
(90’)

SP paper preparation

-

Discussio
n Room

14.00-15.00
(60’)

Plenary Session

· Dr. dr. I Wayan
Putu Sutirta Yasa,
Msi

Class
Room

08.00-09.00
(60’)

· Able to Diagnose and
Manage Autoimmune
Disease in Neurology

· Dr. dr. Made Oka
Adnyana, Sp.S (K)

Class
Room

09.00-10.30
(90’)

Independent Learning

-

Library

10.30-12.00
(90’)

SGD

· Fasilitator

Discussio
n Room

12.00-12.30
(30’)

Break

-

-

12.30-14.00
(90’)

SP: paper preparation

-

Class
Room

14.00-15.00
(60’)

Plenary Session

Dr. dr. Made Oka
Adnyana, Sp.S (K)

Class
Room

08.00-09.00
(60’)

· Able to diagnose and
manage allergic
diseases in ENT

· dr. Sari Wulan Dwi Class
Sutanegara, Sp THT Room
(K)

· Comprehend
Hypersensitivity
09.00-10.30
(90’)

Independent Learning

Udayana University Faculty of Medicine, DME, 2017

· dr.Tjokorda Istri
Anom Saturti,SpPD
-

Library
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Study Guide Immune System and Disorders

10.30-12.00
(90’)

SGD

· Fasilitator

Discussio
n Room

12.00-12.30
(30’)

Break

-

-

12.30-14.00
(90’)

· SP paper presentation:
Rinitis Allergy

· dr. Sari Wulan Dwi Discussio
Sutanegara, Sp THT n Room
(K)

· Rheumatic Fever

· dr.Tjokorda Istri
Anom Saturti,SpPD

Tuesday,
Nov 21,
2017

14.00-15.00
(60’)

Plenary Session

· dr. Sari Wulan Dwi Class
Sutanegara, Sp THT Room
(K)

08.00-09.00
(60’)

· Adverse drug reaction

· dr. Ketut
Suardamana,
SpPD-KAI

Class
Room

09.00-10.30
(90’)

Independent Learning

-

Library

10.30-12.00
(90’)

SGD

· Fasilitator

Discussio
n Room

12.00-12.30
(30’)

Break

-

-

12.30-14.00
(90’)

SP: paper presentation :
· Poliarthritis Nodusa

-

Discussio
n Room

· Able to diagnose and
manageanaphylaxis

· Immunomodulator

· dr. Ketut
Suardamana,
SpPD-KAI
· Dr. dr. I Made
Jawi, M.Kes

Wednesda
y, Nov 22,
2017

14.00-15.00
(60’)

Plenary Session

· dr. Ketut
Suardamana,
SpPD-KAI

Class
Room

08.00-09.00
(60’)

Able to diagnose and
manage SLE,
Rheumatoid Arthritis &
Polimyalgia Rheumatica

· dr.Gede
Kambayana,SpPDKR / dr.Pande Ketut
Kurniari,SpPD

Class
Room

09.00-10.30
(90’)

Independent Learning

-

Library

10.30-12.00
(90’)

SGD

Fasilitator

Discussio
n Room

12.00-12.30
(30’)

Break

-

-

Udayana University Faculty of Medicine, DME, 2017

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Study Guide Immune System and Disorders

12.30-14.00
(90’)

SP paper presentation:
Polimialgia Rheumatyca

· Blood Group
Incompatibility

Thursday,
Nov 23,
2017

Friday,
Nov 24,
2017

· dr.Gede
Kambayana,SpPDKR/dr.Pande Ketut
Kurniari,SpPD

Class
Room

· Dr. dr. I Wayan
Putu Sutirta Yasa,
Msi

14.00-15.00
(60’)

Plenary Session

· dr.Gede
Kambayana,SpPDKR/dr.Pande Ketut
Kurniari,SpPD

Class
Room

08.00-09.00
(60’)

· Able to diagnose and
manage Allergy and
autoimmune diseases in
Dermatology

· Dr.Nyoman
Suryawati,SpKK

Class
Room

09.00-10.30
(90’)

Independent Learning

-

Library

10.30-12.00
(90’)

SGD

· Fasilitator

Discussio
n Room

12.00-12.30
(30’)

Break

-

-

12.30-14.00
(90’)

SP paper presentation:
HSP and Eritema
Multifornis

· Dr.Nyoman
Suryawati,SpKK

Class
Room

14.00-15.00
(60’)

Plenary Session

Dr.Nyoman
Suryawati,SpKK

Class
Room

08.00-09.00
(60’)

· Able to diagnose and
manage Rheumatic
Disease of Childhood

· dr. Komang Ayu
Witarini,SpA

Class
Room

· Able to diagnose and
manage Food allergy
09.00-10.30
(90’)

Independent Learning

-

Library

10.30-12.00
(90’)

SGD

· Fasilitator

Discussio
n Room

12.00-12.30
(30’)

Break

-

-

12.30-14.00
(90’)

SP paper presentation :
Juvenile Chronic Arthritis
and Milk Allergy

· dr. Komang Ayu
Witarini,SpA

Class
Room

Udayana University Faculty of Medicine, DME, 2017

11

Study Guide Immune System and Disorders

Monday,
Nov 27,
2017

14.00-15.00
(60’)

Plenary Session

· dr. Komang Ayu
Witarini,SpA

Class
Room

08.00-09.00
(60’)

 Comprehend basic
mechanism of drug
allergy

·  Dr. dr. I Made
Jawi,M.Kes

Class
Room

 Immunopharmacology

Tuesday,
Nov 28,
2017

Wednesda
y,Nov 29,
2017

09.00-10.30
(90’)

Independent Learning

-

Library

10.30-12.00
(90’)

SGD

· Fasilitator

Discussio
n Room

12.00-12.30
(30’)

Break

-

-

12.30-14.00
(90’)

SP: paper preparation

-

-

14.00-15.00
(60’)

Plenary Session

· Dr. dr. I Made
Jawi,M.Kes

Class
Room

08.00-09.00
(60’)

Laboratory Test For
Allergy And Autoimune
Disease (BCS)

· Dr.dr. I Wayan
Wande, Sp.PK

Class
Room

09.00-10.30
(90’)

Independent Learning

-

Library

10.30-13.00
(150’)

BCS Training

Skill Lab

13.00-15.00
(120’)

BCS Discussion

· Dr.dr. I Wayan
Wande, Sp.PK &
Team

08.00-09.00
(60’)

Anaphylactic Syok
(BCS)

· dr. Tjok Istri Anom
Saturti, SpPD

Class
Room

09.00-10.30
(90’)

Independent Learning

-

Library

10.30-13.00
(150’)

BCS Training

· dr. Tjok Istri
Anom Saturti, SpPD

Skill Lab

13.00-15.00
(120’)

BCS Discussion

08.00-09.00
(60’)

SLE, RA focus on
physical examination
(BCS)

Udayana University Faculty of Medicine, DME, 2017

· dr.Gede
Kambayana,SpPDKR / dr.Pande Ketut
Kurniari,SpPD

12

Study Guide Immune System and Disorders

Thursday,
Nov 30,
2017

Monday,D
ec 4, 2017

09.00-10.30
(90’)

Independent Learning

-

Class
Room

10.30-13.00
(150’)

BCS Training

· dr.Gede
Kambayana,SpPDKR / dr.Pande Ketut
Kurniari,SpPD

Library

13.00-15.00
(120’)

BCS Discussion

· dr.Gede
Kambayana,SpPDKR / dr.Pande Ketut
Kurniari,SpPD

Skill Lab

08.00-09.00
(60’)

Skin Prick Tes

· Dr. dr. Ketut
Suryana, SpPD-KAI

09.00-10.30
(90’)

Independent Learning

-

10.30-13.00
(150’)

BCS Training

· Dr. dr. Ketut
Suryana, SpPD-KAI

13.00-15.00
(120’)

BCS Discussion

· Dr. dr. Ketut
Suryana, SpPD-KAI

Tuesday,D
ec 5, 2017

Pre-Evaluation Break

Wednesda
y,Dec 6,
2017

Evaluation

Class
Room

TIME TABLE OF THE BLOCK IMMUN SYSTEM & DISSODERS 2017
English Class
Days/Date
Time
Activity
Conveyer

Monday,N
ov 13,
2017

Venue

09.00-10.00 (60’)

 Introduction to The
Immune System and
disorders

 Dr. dr. Ketut
Suryana, SpPDKAI

Class Room

10.00-11.30 (90’)

Student Project
(SP): paper
preparation

-

Discussion
Room

11.30-12.00 (90’)

Break

-

Discussion
Room

12.00-13.30 (30’)

Independent
Learning

-

-

Udayana University Faculty of Medicine, DME, 2017

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Study Guide Immune System and Disorders

Tuesday,
Nov 14,
2017

13.30-15.00 (90’)

SGD

Facilitator

Discussion
Room

15.00-16.00 (60’)

Plenary Session

 Dr. dr. Ketut
Suryana, SpPDKAI

Class Room

09.00-09.30 (30’)

 Comprehend The
Microscopic
Structure of
Limphoid
Organ,Immune Cells
and MHC

 Dr. dr. Ni Made
Linawati,Msi

Class Room

09.30-10.00 (30’)

 Comprehend basic  · Dr. dr. Ni
mechanism of
Putu Sriwidyani,
autoimmunity
Sp. PA

10.00-11.30 (90’)

Student Project
(SP): paper
preparation

-

Library

11.30-12.00 (90’)

Break

-

Discussion
Room

12.00-13.30 (30’)

Independent
Learning

13.30-15.00 (90’)

SGD

 Fasilitator

Discussion
Room

15.00-16.00 (60’)

Plenary Session

 Dr. dr. Ni Made
Linawati, Msi

Class Room

-

-

 · Dr. dr. Ni
Putu Sriwidyani,
Sp. PA
Wednesda
y, Nov 15,
2017

9.0.9.3030’)

Forensic Serology &
Molecular

 dr. IB Putu Alit,
SpF, DFM

· Antihistamin

 Dr.dr.B.K.Satri
yasa,M.Repro

10.00-11.30 (90’)

Student Project
(SP): paper
preparation

-

Library

11.30-12.00 (90’)

Break

-

Discussion
Room

09.30-10.00 (30’)

Udayana University Faculty of Medicine, DME, 2017

Class Room

14

Study Guide Immune System and Disorders

12.00-13.30 (30’)

Independent
Learning

-

-

13.30-15.00 (90’)

SGD

 Fasilitator

Discussion
Room

15.00-16.00 (60’)

Plenary Session

 dr. IB Putu Alit,
SpF, DFM

Class Room

 Dr.dr.B.K.Satri
yasa,M.Repro
Thursday,
Nov 16,
2017

Friday,
Nov 17,
2017

09.00-10.00 (60’)

 Comprehend
laboratory test of
immune system

 Dr. dr. I Wayan
Putu Sutirta
Yasa, Msi

Class Room

10.00-11.30 (90’)

Student Project
(SP): paper
preparation

-

Library

11.30-12.00 (90’)

Break

-

Discussion
Room

12.00-13.30 (30’)

Independent
Learning

-

-

13.30-15.00 (90’)

SGD

 Fasilitator

Discussion
Room

15.00-16.00 (60’)

Plenary Session

 Dr. dr. I Wayan
Putu Sutirta
Yasa, Msi

Class Room

09.00-10.00 (60’)

 Able to Diagnose
and Manage
Autoimmune
Disease in
Neurology

 Dr. dr. Made
Oka Adnyana,
Sp.S (K)

Class Room

10.00-11.30 (90’)

Student Project
(SP): paper
preparation

-

Library

11.30-12.00 (90’)

Break

-

Discussion
Room

12.00-13.30 (30’)

Independent
Learning

-

-

13.30-15.00 (90’)

SGD

 Fasilitator

Class Room

15.00-16.00 (60’)

Plenary Session

Dr. dr. Made Oka
Adnyana, Sp.S
(K)

Class Room

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Study Guide Immune System and Disorders

Monday,
Nov 20,
2017

09.00-09.30 (30’)

09.30-10.00 (30’)

10.00-11.30 (90’)

Tuesday,
Nov 21,
2017

 Able to diagnose
and manage allergic
diseases in ENT
Comprehend
Hypersensitivity

 dr. Sari Wulan
Dwi Sutanegara,
Sp THT (K)

Class Room

dr.Tjokorda Istri
Anom
Saturti,SpPD

 SP paper
presentation: Rinitis
Allergy

 dr. Sari Wulan
Dwi Sutanegara,
Sp THT (K)

 Rheumatic Fever

dr.Tjokorda Istri
Anom
Saturti,SpPD

11.30-12.00 (90’)

Break

-

-

12.00-13.30 (30’)

Independent
Learning

-

-

13.30-15.00 (90’)

SGD

 Fasilitator

Discussion
Room

15.00-16.00 (60’)

Plenary Session

 dr. Sari Wulan
Dwi Sutanegara,
Sp THT (K)

09.00-10.00 (60’)

 Adverse drug
reaction

 dr. Ketut
Suardamana,
SpPD-KAI

Class Room

-

Class Room

 Able to diagnose
and
manageanaphylaxis
10.00-11.30 (90’)

SP: paper
presentation :
Poliarthritis
Nodusa

Class Room

dr. Ketut
Suardamana,
SpPD-KAI

 Immunomodulator

Dr. dr. I Made
Jawi, M.Kes

11.30-12.00 (90’)

Break

-

-

12.00-13.30 (30’)

Independent
Learning

-

-

13.30-15.00 (90’)

SGD

 Fasilitator

Discussion
Room

15.00-16.00 (60’)

Plenary Session

 dr. Ketut
Suardamana,
SpPD-KAI

Class Room

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Study Guide Immune System and Disorders

Wednesda
y, Nov 22,
2017

09.00-10.00 (60’)

Able to diagnose
and manage SLE,
Rheumatoid Arthritis
& Polimyalgia
Rheumatica

 dr.Gede
Kambayana,SpP
D-KR / dr.Pande
Ketut
Kurniari,SpPD

Class Room

10.00-11.30 (90’)

SP paper
presentation:
Polimialgia
Rheumatyca

 dr.Gede
Kambayana,SpP
D-KR/dr.Pande
Ketut
Kurniari,SpPD

Class Room

 Blood Group
Incompatibility

Thursday,
Nov 23,
2017

Dr. dr. I Wayan
Putu Sutirta
Yasa, Msi

11.30-12.00 (90’)

Break

-

-

12.00-13.30 (30’)

Independent
Learning

-

-

13.30-15.00 (90’)

SGD

Fasilitator

Discussion
Room

15.00-16.00 (60’)

Plenary Session

 dr.Gede
Kambayana,SpP
D-KR/dr.Pande
Ketut
Kurniari,SpPD

Class Room

09.00-10.00 (60’)

 Able to diagnose
and manage Allergy
and autoimmune
diseases in
Dermatology

 Dr.Nyoman
Suryawati,SpKK

Class Room

10.00-11.30 (90’)

SP paper
presentation: HSP
and Eritema
Multifornis

 Dr.Nyoman
Suryawati,SpKK

Class Room

11.30-12.00 (90’)

Break

-

-

12.00-13.30 (30’)

Independent
Learning

-

-

13.30-15.00 (90’)

SGD

 Fasilitator

Discussion
Room

15.00-16.00 (60’)

Plenary Session

Dr.Nyoman
Suryawati,SpKK

Class Room

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Study Guide Immune System and Disorders

Friday,
Nov 24,
2017

09.00-10.00 (60’)

 Able to diagnose
and manage
Rheumatic Disease
of Childhood

 dr. Komang
Ayu Witarini,SpA

Class Room

 Able to diagnose
and manage Food
allergy

Monday,
Nov 27,
2017

10.00-11.30 (90’)

SP paper
presentation :
Juvenile Chronic
Arthritis and Milk
Allergy

 dr. Komang
Ayu Witarini,SpA

Class Room

11.30-12.00 (90’)

Break

-

-

12.00-13.30 (30’)

Independent
Learning

-

-

13.30-15.00 (90’)

SGD

 Fasilitator

Discussion
Room

15.00-16.00 (60’)

Plenary Session

 dr. Komang
Ayu Witarini,SpA

Class Room

09.00-10.00 (60’)

 Comprehend basic  Dr. dr. I Made
mechanism of drug
Jawi,M.Kes
allergy

Class Room

 Immunopharmacol
ogy

Tuesday,
Nov 28,
2017

10.00-11.30 (90’)

Student Project
(SP): paper
preparation

-

-

11.30-12.00 (90’)

Break

-

-

12.00-13.30 (30’)

Independent
Learning

-

-

13.30-15.00 (90’)

SGD

 Fasilitator

Discussion
Room

15.00-16.00 (60’)

Plenary Session

 Dr. dr. I Made
Jawi,M.Kes

Class Room

09.00-10.00 (60’)

Laboratory Test For
Allergy And
Autoimune Disease
(BCS)

 Dr.dr. I Wayan
Wande, Sp.PK

Class Room

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Study Guide Immune System and Disorders

Wednesda
y,Nov 29,
2017

10.00-11.30 (90’)

Independent
Learning

-

Library

13.30-16.00 (150’)

BCS Training

Skill Lab

16.00-17.00

BCS Discussion

 Dr.dr. I Wayan
Wande, Sp.PK &
Team

09.00-10.00 (60’)

Anaphylactic Syok
(BCS)

 dr. Tjok Istri
Anom Saturti,
SpPD

Class Room

10.00-11.30 (90’)

Independent
Learning

-

Library

13.30-16.00 (150’)

BCS Training

Skill Lab

16.00-17.00

BCS Discussion

 dr. Tjok Istri
Anom Saturti,
SpPD

09.00-10.00 (60’)

SLE, RA focus on
 dr.Gede
physical examination Kambayana,SpP
(BCS)
D-KR / dr.Pande
Ketut
Kurniari,SpPD

10.00-11.30 (90’)

Independent
Learning

-

Class Room

13.30-16.00 (150’)

BCS Training

 dr.Gede
Kambayana,SpP
D-KR / dr.Pande
Ketut
Kurniari,SpPD

Library

16.00-17.00

BCS Discussion

 dr.Gede
Kambayana,SpP
D-KR / dr.Pande
Ketut
Kurniari,SpPD

Skill Lab

09.00-10.00 (60’)

Skin Prick Tes

 Dr. dr. Ketut
Suryana, SpPDKAI

10.00-11.30 (90’)

Independent
Learning

-

13.30-16.00 (150’)

BCS Training

 Dr. dr. Ketut
Suryana, SpPDKAI

16.00-17.00

BCS Discussion

 Dr. dr. Ketut
Suryana, SpPDKAI

Thursday,
Nov 30,
2017

Monday,D
ec 4, 2017

Udayana University Faculty of Medicine, DME, 2017

Class Room

19

Study Guide Immune System and Disorders

Tuesday,D
ec 5, 2017

Pre-Evaluation Break

Wednesda
y,Dec 6,
2017

Evaluation

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Study Guide Immune System and Disorders

Plenary session
For each task of SGD, the students are requested to prepare a group report. The reports will
be presented in a plenary session. The group will be chosen randomly by the lecturer in
charge. The group report will be evaluated by respective facilitator.

Assessment Methods
Assessment will be performed at the end of the block on December 6 th 2017. There are 100
questions for the examination that consists of Multiple Choice Question (MCQ). The borderline
to pass exam is 70.

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LEARNING PROGRAMS

Day 1
Topics

:

Introduct. to the immune system and disorders

Lecturer

:

Dr.dr. Ketut Suryana, SpPD-KAI
Abstract

1. The Immune system has evolved to protect us from pathogens. Some, such as viruses,
infect individual cells; others, including many bacteria, divide extracellularly within tissues
or body cavities.
2. The cells which mediate immunity include lymphocytes and phagocytes. Lymphocytes
recognize antigens on pathogens. Phagocytes internalize pathogens and degrade them
3. An Immune response consists of two phases. In the first phase, antigen activates specific
lymphocytes that recognize it; in the effector phase, these lymphocytes coordinate an
immune response that eliminates that source of the antigens.
4. Specificity and memory are two essential features of adaptive immune responses. The
Immune system mounts a more effective response on second and subsequent encounters
with a particular antigen.
5. Lymphocytes have specialized functions. B cells make antibodies; cytotoxic T cells kill
virally infected cells; helper T cell coordinate the immune response by direct cell-cell
interactions and the release of cytokines, which help B cells to make antibody.
6. Antigens are molecules which are recognized by receptors on lymphocytes. B lymphocytes
usually recognize intact antigen molecules, while T lymphocytes recognize antigen
fragment on the surface of other cells.
7. Clonal selection involves recognition of antigen by a particular lymphocyte; this leads to
clonal expansion and differentiation to effector and memory cells.
8. The immune system may break down. This can lead to immunodeficiency or
hypersensitivity diseases or to autoimmune diseases.
Learning task
1.
2.
3.
4.

Comprehend of immune system with clinical implications
Comprehend the lymphoid organs and describe of it’s microscopic organization
Comprehend the cellular immunity
Comprehend the mechanism of cellular and humoral immunity to infection

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Day 2

Topic
Lecturer

:The Microscopic Structure of Limphoid Organ,
Immune Cells and Histocompatibility Molecule
: dr. Ni Made Linawati, M. Si.

Abstract
The limphoid systems is responsible for the immunological defense of the body. Some
of its component organs ; lymph nodes, thymus and spleen are surrounded by connective
tissue capsules, whereas its other components, member of the diffuse lymphoid system, are
not encapsulated. The cells of the limphoid systems such as lymphocytes ( T, B and Natural
Killer), Antigen Presenting Cells (Dendritic cells, Macrophages and B lymphocytes) and other
(Neutrophils) protect the body against foreign macromolecules, viruses, bacteria, and other
invasive microorganism, and they kill virally transformed cells. Major Histocompability Complex
(MHC) molecule are important to permit APCs and cells under viral attact (or cells already
virally transformed) to present the epitopes of the invading pathogen to the T cells.
Learning Task
Vignette
A 65-year-old man had suffered from rectal bleeding during defecation for a few weeks.
Laboratory findings were normal except a slight elevation in the level of alkaline phosphatase.
Multiple polypoid lesions were observed in colonoscopic examination. The histological and
immunochemical evaluation showed atypical lymphoid cell proliferation and lymphoepithelial
lesions on the colonic mucosa, staining with CD20. After the diagnosis had been confirmed as
low grade mucosa associated lymphoid tissue lymphoma.
a. Please describe histological structure of the Mucosa associated lymphoid tissue.
b. Why M cells has important roles in mucosa immune response?
Self Assesment
1. What are primary and secondary lymphoid organ. Mention the of organ that has
function as primary and secondary lymphoid organ
2. Describe about function and microscopic structure of thymus, lymph nodes; spleen;
tonsils; and MALT
3. Describe about MHC class I and class II
Topic

:

Basic mechanism of autoimmunity

Lecturer

:

Dr. dr. Putu Sri Widyani, SpPA

ABSTRACT
Immunologic Tolerance: Is a state in which an individual is incapable of developing an immune
response against a specific antigen.
Self- tolerance: Specifically refers to a lack of immune responsiveness to one’s own tissue
antigens.
Two broad groups of mechanisms to explains the tolerant state:
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Study Guide Immune System and Disorders
• Central tolerance: This refers to deletion of self-reactive T and B lymphocytes during
maturation in central lymphoid organs (i.e. in the thymus for T cells and the bone marrow
for B cells)
• Peripheral tolerance: Self reactive T cells that escape negative selection in the thymus can
potentially wreak havoc unless they are deleted or effectively muzzled. Several backmechanisms in the peripheral tissues that silence such potentially autoreactive T cells have
been identified:
- Anergy.
- Activation-induced cell death
- Peripheral suppression by T cells.
Mechanisms of Autoimmune Disease
Breakdown of one or more of the mechanisms of self-tolerance can unleash an
immunologic attack on tissues that leads to the development of autoimmune disease.
Furthermore, the breakdown of tolerance and initiation of autoimmunity involves the interaction
of complicated immunologic, genetic, and microbial factors.
Learning task
Trigger Case
A 25-year-old woman has had increasing malaise, a skin rash of her face exacerbated by
sunlight exposure, and arthtralgias and myalgias for the past month. On physical examination
she has mild pedal edema. On auscultation a friction rub is audible over the chest. Laboratory
findings include pancytopenia and serum creatinine 3 mg/dL. Urinalysis shows hematuria and
proteinuria. A serologic test for shypilis yields a false positive result. A renal biopsy shows a
slight increase of mesangial cells and granular deposit of IgG and complement in the
mesangium and along basement membrane. The result of ANA test is positive. Finally, the
patient is diagnosed as systemic lupus erythematosus (SLE). SLE is the best example of
autoimmune disease. Does the autoimmunity result from the loss of self-tolerance, how this
happen, and why they have a broad clinical spectrum as showed in that patient? Before you
answer the question, please try to find out the following task.
Task
1.
2.

Describe the mechanism of immunological tolerance to self antigent!
Explain the mechanism of autoimmunity, including the role of susceptibility genes and
enviromental triggers!

3.

Describe the general features of autoimmune diseases!

4.

Describe the etiopathogenesis of SLE!

5.
6.

Describe the mechanism of tissue injury in SLE, and give some examples of
morphological changes in SLE!
Mention other diseases that belong to autoimmune diseases group!

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Study Guide Immune System and Disorders

Day 3
Topic

: Forensic Serology & Molecular

Lecture

: dr. IB Putu Alit, SpF, DFM

Abstract
Forensic serology is the study of serology in relation to crimes and other legal matters by using
a scientific approach.
Doctors should have knowledge about forensic serology to assist
investigators in revealing crime cases related with human’s body and health. Moreover, based
on legislations, doctors have legal duty to carry out forensic examinationwhen asked by the
investigators.
Mostly, investigators asked doctors to prove homicide, rape, assault or dispute paternity case.
To prove it, the doctors need to do serological examination of biological evidence that found on
the victim’s body, such as blood, semen, urine, and other body fluids.
Principle of serological test is the use of specific antibodies to detect a target antigen. By doing
a simple serological test, doctor can filter the type and origin of biological substances. If the
screening test gives a positive result, biological substances must be processed for DNA testing
to determine the owner of biological materials.
Vignette 1
A woman, 22 years old was found dead and naked. She suffered bruises almost on her entire
body. There were blood stains and fluid around her genital.
Learning Task
1. In above case, discuss the role of forensic serology in examining biological evidence!
2. Discuss the steps to examine blood stain and fluid around the genital!
3. Discuss the concept of species determination and individualization of blood stain and
biological fluid!
4. If in that case, there are 3 suspects, what the forensic serologist do to identify the suspect?
5. Discuss about DNA analysis for that case!
Vignette 2
A man, with blood type O, come to prove that his wife, with blood type AB, have an affair with
her boss, with blood type A. He is not sure whether he is the biological father of his child,
because his first child is male, with blood type O, and the second one is female, with blood
type AB.
Learning Task
As a doctor, what would you explain to the man?

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Study Guide Immune System and Disorders

Topic

: Antihistamine

Lecturer

: Dr. dr. Bagus Komang Satriyasa, M.Repro.

ABSTRACT
Histamine receptor antagonists represent a third approach to the deduction of
histamine-mediated responses. For over 60 years, compounds have been available that
competitively antagonize many of the actions of histamine on the smooth muscle. Compounds
that competitively block histamine at H1 receptor have been used clinically for many years,
and many H1 antagonists are currently marketed. Many are available without prescription, both
alone and in combination formulations such as “cold pills” and sleep aids. The H1 antagonists
are conveniently divided into firs generations and second generation agents. These groups are
distinguished by relatively strong sedative effect of most of the generation drugs. The first
generation agents are also more likely to block autonomic receptors. The relatively less
sedating characteristic of the second generation H1 blockers is due in part to their less
complete distribution into the central nervous system. H1 receptor antagonists block the
actions of histamine by reversible competitive antagonism at the H1 receptor; these drugs
have no effect on histamine release from storage sites. They are more effective if given before
histamine release occurs. The first generation are often the first drugs used to prevent or treat
the symptoms of allergic reactions, and the second generation H1 antagonists are used mainly
for treatment of allergic rhinitis and chronic urticaria. The drugs adverse effect are sometimes
exploited therapeutically.
Learning Task
1.
2.
3.
4.
5.

Explain two classification of H1 blockers
List two drugs the older members of the first generation agent
List three drugs the second generation of H1 blockers.
Describe mechanism and effect of H1 blockers
Describe clinical use of H1 blockers

Self assessment
1. Many H1 blocker have additional nonhistamine-related effect, these are likely to include all
of the following. EXPECT:
A. Antimuscarinic reduction in bladder tone
B. Local anesthetic effect if the drug is injected
C. Anti-motion sickness effect
D. Increase in total peripheral resistance
E. Sedation
2. Which of the following drugs will result from blockade of H1 receptor?
A. Decreased cAMP in smooth muscle
B. Decrease channel opening in enteric nerves
C. Decrease IP3 in smooth muscle
D. Increase IP3 in smooth muscle
E. Increase in total peripheral resistance
3. Which of the following drugs are used as anti-motion sickness and also for management
of chemotherapy-induced vomiting?
A. Diphenhydramine
B. Dimenhydrinate
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Study Guide Immune System and Disorders
C. Meclizine
D. Cyclizine
E. Loratadine
4. Toxicities of H1 blocker include which one of the following
A. Sedation
B. Dry mouth
C. Blurry vision
D. Vomiting
E. Hypotension

Day 4

Topic

: Laboratory test of immune system

Lecture

: Dr. dr. I Wyn Putu Sutirta Yasa, M.Si.

Abstract
Objective to comprehend laboratory test of immune system
1. Approach in the patient with immune system disease and disorders are evidence based
in immunology, history and physical examination, laboratory studies to make diagnosis.
Laboratory test of immune system (immunoassay) based on antigen-antibody
reactions. Immunoassay can be used for the detection of either antigens or antibodies.
For antigen detection, the corresponding specific antibody should be prepared as one
of reagents. The reverse is true for antibody detection.
2. The sensitivity of the immunoassays has been enhanced through the development of
types of signal detection systems and solid-phase technology. Immunoassay has been
optimized to detect less than 0.1 pg/mL of antigen in blood.
3. The can be applied to detection of haptens as small molecules, protein and protein
complexes as macromolecules, as well as of any antibody to allergens, infectious
agent, and autologous antigens.
4. Students to comprehend the overview of general principles and based of immunoassay.
High concentration of such molecules and where antigen- antibodies are mixed in
solution can be measured by precipitation techniques. Medium concentration of such
molecules and where antigen- antibodies are on solid phase can be quantified by
agglutination techniques. Very low concentration of such molecules can be quantified
by radioimmunoassay techniques or enzyme linked immunosorbent assay techniques.
Outcome of laboratory test of immunes system
Students
to comprehend the overview of general principles and based
of
immunoassay to purpose and function of laboratories are to assist students in (1) confirming
or rejection a diagnosis, (2) providing guidelines for patient management, (3) establishing a
prognosis, (4) detecting disease through case finding or screening and (5) monitoring follow up
therapy.
Learning Task
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Study Guide Immune System and Disorders
1. Explain the precipitin reactions, what are antibody excess zone, equivalence zone and
antigen excess zone
2. Explain the differential of haemagglutination and complement fixation.
3. Explain the differential of direct and indirect immunofluorescence
4. Mention the immunoassay using labeled reagents for detecting antigens and
antibodies.
5. Explain the competitive assay and two-site capture assay techniques.
Self assessment
1. Mention the principle of methods on immunoassay techniques?
2. What’s the meaning of equivalence zone?
3. Mention the reaction marked on haemagglutination methods?
4. Mention the reaction marked on complement fixation methods?
5. Mention the label used on the ELISA method?

Day 5
TOPIC

: GUILLAIN BARRE SYNDROM, MYASTHENIA GRAVIS
MULTIPLE SCLEROSIS

LECTURER

: Dr. dr. Made Oka Adnyana, Sp.S (K)
AUTOIMMUNE DISEASES IN NEUROLOGY

ABSTRACT
Autoimmunity is a misguided immune response to the body's own organs. The
nervous and immune systems have many interactions that dictate overall body health. The
nervous system is under constant monitoring from both the adaptive and innate immune
system. Deregulation of both adaptive and acquired immune responses, impairment of
crosstalk between these two systems as well as alterations in the deployment of innate
immune mechanisms can predispose the central nervous system (CNS) to autoimmunity
and neurodegeneration. Multiple sclerosis, myasthenia gravis and Guillain-Barre syndrome
(GBS) are neurologic diseases induced by abnormal autoimmunity.
Multiple sclerosis (MS) is a chronic autoimmune, inflammatory neurological disease of
CNS. MS attack the myelinated axons in the CNS, destroying the myelin and the axons to
varying degree. The course of MS is highly varied and unpredictable. In most patients, the
disease is characterized initially by episodes of reversible neurological deficits, which is
often followed by progressive neurological deterioration over time.
Myasthenia gravis (MG) is an autoimmune disease characterized by a fluctuating
pathological weakness with remissions and exacerbations involving one or several skeletal
muscle groups, mainly caused by antibodies to the acetylcholine receptor (AChR) at the
post-synaptic site of the neuromuscular junction
Guillain-Barré syndrome (GBS) is a disorder in which the body's immune system
attacks part of the peripheral nervous system. The first symptoms of this disorder include
varying degrees of weakness or tingling sensations in the legs. In many instances the
symmetrical weakness and abnormal sensations spread to the arms and upper body.
LEARNING TASK
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Study Guide Immune System and Disorders

CASE 1
A 29-year-old woman, complaining of double vision, was found to have ptosis on the right
side. The ptosis was worse in the evening and almos absent in the morning. She
admmitted to tiredness in the arms and legs, which recovered with resting.
CASE 2
A 18-year-old boy awoke one morning 2 weeks after an episode of influenza with a mild
weakness in his legs and during the day he developed pain in his back and 'pins and
needles' in his feet. He was considerably worse the next day and complained of weakness
in his arms as well, and by the evening he was unable to stand.
Case 3
A 35 year old white female. She came to Neurology Clinic for evaluation of her long-term
neurologic complaints. The patient relates that for many years she had noticed some
significant changes in neurologic functions, particularly heat intolerance precipitating a
stumbling gait and a tendency to fall. Her visual acuity also seemed to change periodically
during several years. Two months ago the patient was working very hard and was under a
lot of stress. She got sick with a flu and her neurologic condition worsened. At that time,
she could not hold objects in her hands, had significant tremors and severe exhaustion.
She also had several bad falls. The patient abruptly developed a right hemisensory deficit
after several days of work..
TASK
1. What is the most likely diagnosis in Case 1,2 and 3
2. Describe the clinical symptoms of Myasthenia Gravis, GBS and Multiple sclerosis
3. Describe the spesific diagnostic examination and laboratory test for Myasthenia
Gravis, GBS and Multiple sclerosis
4. Describe principle management for Myasthenia Gravis, GBS and Multiple sclerosis
SELF ASSESSMENT
1. Describe the diagnosis criteria of Myasthenia gravis
2. Describe the diagnosis criteria of GBS
3. Describe the diagnosis criteria for Multiple Sclerosis
4. Describe the pathogenesis of Myasthenia Gravis, GBS and Multiple sclerosis
5. Describe imunologic finding in Myasthenia Gravis, GBS and Multiple sclerosis
6. Describe the prognosis of Myasthenia Gravis, GBS and Multiple sclerosis
REFFERENCE
1 Diagnostic Criteria in Autoimmune Diseases. 2008. Yehuda Shoenfeld, Ricard Cervera,
M. Eric Gershwin editors. Humana Press.
2 Neuroimmunology In Clinical Practice.2008.Bernadette Kalman and Thomas H
Brannagan III editors. Blackwell Publishing

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Study Guide Immune System and Disorders

Day 6

Topic

: Rhinitis Alergy

Lecturer

: Dr. Sari Wulan Dwi Sutanegara , Sp THT-KL

ABSTRACT
Allergic rhinitis is an inflammation of the nasal passages, usually associated with
watery nasal discharge and itching of the nose and eyes.
Allergic rhinitis affects about 20 percent of population and ranks as one of the most
common illnesses. The symptoms occur in the nose and eyes and usually occur after exposure
to dust, danders, or certain seasonal pollens in people that are allergic to these substances.
There is strong genetic predisposition to allergic rhinitis. One parent with a history of
allergic rhinitis has about a 30 percent chance of producing offspring with the disorder. Tthe
risk increases to 50 percent if both parents have a history of allergies.
Characteristic symptoms include repetitive sneezing, rhinorrhea (runny nose), postnasal drip, nasal congestion, pruritic (itchy) eyes, ears, nose or throat, and generalized
fatigue. Symptoms can also include wheezing, eye tearing, sore throat, and impaired smell. A
chronic cough may be secondary to postnasal drip, but should not be mistaken for asthma.
Sinus headaches and ear plugging are also common.
Diagnosis of Allergic Rhinitis. After a medical history, physician will perform a physical
exam. Often, the nasal mucosa (lining of the nose) is pale or violaceous because of the
engorged veins. Nasal polyps may be seen. Classic signs of allergic rhinitis may include
swelling of the eyelids, injected sclerae (the whites of the eyes may be red), allergic shiners
(darkened areas under the lower eyelids thought to result from venous pooling of blood), and
extra skin folds in the lower eyelids.
Skin testing may confirm the diagnosis of allergic rhinitis. Initial skin testing is
performed by the prick method. Intradermal testing is performed if results of prick testing are
negative.
The goal of treatment is to reduce the allergy symptoms. Avoidance of the allergen or
minimization of contact with it is the best treatment, but some relief may be found with the
following medications: antihistamines and decongestants, nasal sprays and immunotherapy.
LEARNING TASK
CASE:
A 25 years old man complained of sneezing 5 to 10 times and watery nose everytime he
wakes up in the morning.
Task:
1.
2.
3.
4.
5.

Please do further anamnesis in this case!
If in the anamnesis his mother had asthma, what is the possible diagnosis of this case?
What is/are the differential/s diagnosis of this case?
What is/are the complication/s of this case?
How is the management of this case?

Udayana University Faculty of Medicine, DME, 2017

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Study Guide Immune System and Disorders
Self Assessment
1.
2.
3.
4.

What is the definition of allergy rhinitis?
What are the symptom and sign of allergy rhinitis?
How is the classification of allergy rhinitis?
When immunotherapy can be applied to allergy rhinitis patient?

Topic

:

Lecturer

:

Hypersensitivity
dr. Tjok Istri Anom Saturti, SpPD

ABSTRACT
There are 4 types classifications according to
Gel & Coombs
1. Type I
: Immediate hypersensitivity
2. Type II
: Cytotoxic hypersensitivity
3. Type III
: Immune complex hypersensitivity
4. Type IV
: Delayed (cell mediated) hypersensitivity
Hypersensitivity the immune response results are harmful to the heart
Type I

Type II
Type III
Type IV

: Antigen bind to IgE on the surface of mast cells à release of several mediators
within minutes. Important mediators are: Histamin, SRS-A, ECF-A, serotonin,
Prostaglandins and thromboxanes, etc. Clinical manifestations:
1. Anaphylaxis : severe bronconstriction, hypotension à shock
2. Atopy: genetic factor to induce by exposure to spesific allergens (pollens,
dust, shellfish, nuts, etc). Clinical manifestation: hay fever, asthma,
eczema, and urticaria. Treatment and prevention: Avoidance of the
responsible allergen, Hyposensitization (Desensitization) & Drug
treatment.
: Antibody is directed against antigen on an individual’s own cell (target cell) or
foreign antigen, such as transfused red blood cell. This may lead to cytotoxic
action by K Cells, or complement mediated lysis.
: Immune Complexes are deposited in the tissue. Complement is activated and
polymorphs are attracted to the site of deposition causing local tissue damage
and inflammation
: Antigen sensitized T cells release lymphokines following a secondary contact
with the same antigen. Cytokines induced inflammatory reactions activate and
attract macrophages, which release inflammatory mediators.

Learning Task
1. Make definition of the term hypersensitivity
2. Explain the biological roles of hypersensitivity
3. Make classification of hypersensitivity
4. Compare the hypersensitivity type I, II, III and IV
5. Explain principle treatment and prevention of hypersensitivity
Self Assessement
1. Hypersensitivity reaction is a general pathologic reaction which has following characteristics:
A. Never happens on the first exposure
Udayana University Faculty of Medicine, DME, 2017

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Study Guide Immune System and Disorders
B. Generally divided into 4 types
C. Is an overreaction of immune system
D. Occurred if humoral and cellular immunological status are increased
E. All above are correct
2. The followings are the feature of hypersensitivity reaction type I, except:
A. Occurs in few seconds or minutes
B. Is an IgE mediated immune response
C. IgE is bind by mast cell
D. Ia a delayed hypersensitivity
E. Histamine is a primary mediator produced
3. In hypersensitivity reaction type I, eosinophyl is activated by:
A. IL-4
B. IL-2
C. IL-5
D. IL-6
E. IL-1
4. Histamine release effect of hypersensitivity reaction type I is:
A. Vasoconstriction of blood vessels
B. Vasodilation of blood vessels
C. Capillary permeability decreased
D. Bronchus dilated
E. Hyposecretion of mucosa
5. Hypersensitivity reaction type II is a cytotoxic reaction which involves:
A. IgG and IgM
B. IgG and IgD
C. IgG and IgA
D. IgA and IgD
E.
IgD and IgE

Day 7

Topic

: Adverse drugs reaction

Lecture

: dr. Ketut Suardamana, Sp. PD

Introduction
Drug allergy or hypersensitivity is a form of Adverse Drug Re