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Med Path Exam 1 > 15 - Immunology and Immuno-pathologic mechanisms Pt II > Flashcards

15 - Immunology and Immuno-pathologic mechanisms Pt II Flashcards

1
Q

An immune reaction against self antigen is the definition of _. When is this not a bad thing?

A

Autoimmunity

Tumors

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2
Q

What are the 3 criteria for diagnosing autoimmunity?

A
  • presence of autoimmune rxn
  • evidence that rxn is not secondary to tissue damage
  • absence of well defined cause of disease
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3
Q

A break down of what process leads to pathologic autoimmunity?

A

Self tolerance

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4
Q

A state where the individual is incapable of developing an immune response to a specific antigen is _. What are the 2 types?

A
  • Immunological tolerance

- Central and peripheral tolerance

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5
Q

One mechanism of central tolerance is clonal deletion. What happens during clonal deletion?

A

Deletion of self reactive clones of cytolytic and helper T-lymphocytes

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6
Q

Why is it thought that clonal deletion of B cells is of minor importance?

A

Because there is a relatively high rate of auto-antibodies documented

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7
Q

Within the thymus, where are each of the following cells found? Lymphoid cells,epithelial cells, dendritic cells, macrophages? Which express MHC1? Which express MHC 2?

A

Lymphoid cell - Thymus - MHC1
Epithelial cells - Cortex - MHC1
Dendritic cells - Corticomedullary junction - MHC1 and 2
Macrophages - medulla - MHC1 and 2

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8
Q

Regarding central tolerance, the process where thymocytes are selected for their ability to bind self MHC molecules is _

A

Positive selection

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9
Q

Regarding central tolerance, the process of elimination of clones of thymocytes that bind self antigens is _. This also known as _

A

Negative selection

Clonal deletion

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10
Q

Clonal anergy is a tolerance mechanism important is central or peripheral tolerance?

A

Peripheral tolerance

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11
Q

What are 2 signals required for maximal stimulation of a T cell?

A

Recognition of MHC2 on antigen presenting cell (APC)

Costimulators presented by APC

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12
Q

What happens when T cells are presented with antigen in the absence of costimulators?

A

No activation / immune response, anergy of the T cell, essentially its elimination

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13
Q

Another mechanism for peripheral tolerance is suppression. What cells are characteristically involved with this process? What are the 2 major cytokines involved?

A
  • CD4+/CD25+ cells

- IL-10 and TGF-beta

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14
Q

Another mechanism of peripheral tolerance is activation induced cell death. How does this happen? What receptor / ligand pair is associated with this process?

A
  • High antigen dose + chronic stimulation leads to elimination of T-cells
  • Fas receptor and fas ligand (FasL)
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15
Q

Which is more highly expressed in the human body, self antigens or foreign antigens? What does this mean for self reactive lymphocytes?

A

Self antigens
Self reactive lymphocytes will be maximally and continually stimulated, leading to their apoptosis and elimination (activation induced cell death)

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16
Q

What is the number 1 cause of acquired immune deficiency globally?

A

Malnutrition

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17
Q

Another mechanism of peripheral tolerance is sequestration. What does this mean? What are the 3 examples provided in the lecture?

A

Antigens are kept in immuno-priviledged areas

Eye, testis, brain

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18
Q

What disease is associated with defect in Fas/FasL?

A

ALPS - Autoimmune lymphoproliferative syndrome

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19
Q

What are 2 ways infection can cause breakdown of self tolerance?

A
  • Alteration in levels of co-stimulators (e.g. on fibroblasts and epithelial cells)
  • Molecular mimicry
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20
Q

What are the 2 broad categories of autoimmune disease?

A
  • Systemic multi organ disease

- Organ systemm of cell type specific

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21
Q

Regarding lupus, is it more common in men that women? What is thought to underlie this difference in gender prevalence?

A

More common in women

Estrogen - make more tolerant

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22
Q

In what stage of life are people more likely to be affected by lupus?

A

Child bearing years, mainly women

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23
Q

What are the HLA types associated with lupus? A congenital deficiency in what 2 complement proteins may promote lupus development?

A
  • HLA types DR2 and DR3

- Deficiency of C2 and C4 complement components

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24
Q

A hallmark of SLE is B lymphocyte hyperactivity. What are 3 antibodies that are diagnostic for lupus?

A

Anti-nuclear ab
Anti-native DNA
Anti-Sm

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25
Q

A hallmark of SLE is B lymphocyte hyperactivity. What are 3 antibodies that are mentioned in our notes that alter the symptomatology of SLE disease?

A

Anti-RBC
anti- lymphocyte
Anti-phospholipid (e.g. anti cardiolipin)

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26
Q

What is the characteristic skin finding on SLE patients, especially on sun exposed areas? (2)

A
  • Butterfly (malar) rash on face

- erythematous patches

27
Q

What is a kidney finding on SLE patients?

A

Destruction of glomeruli (glomerulonephritis)

28
Q

What is the major determinant of the different manifestation of SLE in different patients?

A

The variety of auto antibody produced

29
Q

A SLE subtypes that is associated with skin manifestations only in the skin, especially the face and scalp with rare incidence of systemic manifestation is _. What type of antibody would you NOT see in this case?

A
  • Chronic discoid lupus

- Won’t see DS/native DNA antibodies

30
Q

A SLE subtype associated with skin localized and mild systemic symptoms is _. What antibody and HLA genotype is associated with this SLE subtype?

A
  • Subacute cutaneous lupus
  • Anti-SSA
  • HLA-DR3
31
Q

An SLE subtype associated with drugs that induce antinuclear antibody formation is _. What symptoms, compared to normal lupus, is usually not present in these patients?

A
  • Drug induced lupus

- No CNS or renal manifestations

32
Q

In patients with drug induced lupus, would you expect to find anti-DS-DNA antibodies? What about anti-histone antibodies? What HLA subtype is associated with this type of lupus?

A
  • Anti- DS-DNA antibody negative
  • Anti-histone antibody positive
  • HLA-DR4
33
Q

How do you treat patients with drug induced lupus?

A

Remove the drug

34
Q

What are behavior modifications that can be suggested to treat lupus?

A
  • Reduce stress

- avoid sun

35
Q

What are the 3 drugs that were presented as immunosuppresives used to treat the systemic manifestations of lupus?

A

Corticosteroids
Cytoxan
6-mercaptopurine

36
Q

Why is therapy for SLE using rituximab considered “hit or miss”?

A

Rituximab targets CD20. Plasma cells producing antibodies associated with lupus don’t have CD20 on their surfaces

37
Q

The 10 year survival for SLE patients is at about 80%. What are the 2 main causes of death in these patients?

A

-Immunosuppressive toxicity (BM aplasia,
secondary neoplasms, infectious diseases)
-Renal failure

38
Q

Rheumatoid arthritis affect more males or females? What is the age range of most patients?

A
  • More females than males

- 35-50 yrs old

39
Q

Symmetric symptoms including pain affecting 2-3 joints, stiffness that improves as the day goes along, swelling and inflammation in joints are all characteristic of _.

A

Rheumatoid arthritis

40
Q

True or false. RA may be associated with malaise, fever, fatigue, loss of appetite, weight loss, myalgias,weakness

A

True - In serious cases only

41
Q

What are joints that are most affected by RA?

A

Hands and wrists

42
Q

Is juvenile RA more or less common that adult RA? Is it more or less severe?

A

Less common, more severe

43
Q

What happens to the normal cartilage within the joints of patients with RA?

A

It is destroyed by inflammatory cells and replaced by fibrous tissue

44
Q

What is the cytokine that is secreted by infiltrating leukocytes and inflamed synovial cells that is thought to underlie the positive feedback loop associated with RA pathogenesis?

A

TNF-alpha

45
Q

What are the 3 types of hypersensitivity associated with RA? Which is particularly associated with extrarticular manifestations of RA?

A
  • Types 2, 3 and 4

- Type 3 assoc. with extra-articular manifestations of RA

46
Q

What is the autoantibody that is detected in serum of 80% of RA patients? Is it specific for RA?

A

Rheumatoid factor

Not specific

47
Q

How would the clinical course of RA be described?

A

Relapsing and remitting

48
Q

True or false: joint deformities associated with RA are progressive in only 50% of patients

A

True

49
Q

What is the classic treatment for RA?

A

Rest and aspirin

50
Q

Beyond aspirin, what are 3 types of drugs used to treat RA?

A

Corticosteroids
Cytotoxic drugs
Biological response modifiers

51
Q

What are the 3 examples of biological response modifiers used to treat RA?

A

TNF-alpha blockers
Anti-TNF-alpha antibodies
Rituximab

52
Q

What is another name for systemic sclerosis? Are males or females more likely to be affected? What are 2 genes associated with this disease?

A

Scleroderma
More females than males
HLA class 2 and Fibrillin

53
Q

Majority of the clinical findings associated with systemic sclerosis are because of _

A

Increased deposition of connective tissue in skin, intestines and blood vessels

54
Q

What are 2 antibodies used to diagnose systemic sclerosis? Which is specific for the CREST variant of systemic sclerosis?

A

Anti Scl-70 antibody

Anti-centromere antibody (specific of CREST variant)

55
Q

What lyphocyte type is thought to mediate increased release of cytokines associated with the manifestations of systemic sclerosis? What cells are thought to be hyperreactive to these released cytokines?

A

CD4+ cells cause cytokine release

Fibroblast hyperreactive to the cytokine release

56
Q

The variant of scleroderma that has widespread skin and

visceral involvement with rapid progression is _

A

Diffuse scleroderma

57
Q

The variant of scleroderma that mainly has skin involvement primarily in the face, hands and forearms is called _.

A 
CREST syndrome 
C alcinosis
R aynaud Phenomenon,
E sophageal dysmotility, 
S clerodactyly,
T elangectasia
58
Q

What is the result of vascular thickening as seen in systemic sclerosis?

A

Reduced blood flow

59
Q

What is the major cause of death in patients with systemic sclerosis?

A

Malnutrition - Because of replacement of GI submucosa with fibrosis

60
Q

What is the patient demographic of Sjogren’s syndrome?

A

50-60 y.o. females

61
Q

What are the 5 proteins (non-antibody) associated with Sjogrens?

A 
HLA-B8, 
HLA-DR3, 
HLA-DQA1,
HLA-DQB1, 
DRW52
62
Q

What are the 2 auto antibodies associated with Sjogrens?

A

Anti - SS-A (ro)

Anti - SS-B (La)

63
Q

What are the 2 glands destroyed in patients with Sjogren’s syndrome? What are the 2 likely mediators?

A
  • Lacrimal and salivary glands
  • CD4+ cells
  • Viruses (EBV, HCV, HTLV-1)
64
Q

Why do many patients with Sjogren’s go blind?

A

Loss of lacrimation leads to drying of the cornea

Med Path Exam 1 (4 decks)

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