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Immunology for Medical Technology > 1st > Flashcards

1st Flashcards

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USMLE® Step 1 flashcards
1
Q

Immunity

A

Ability of an organism to recognize and defend itself against specific pathogens or antigens.

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2
Q

Immunology

A

science that studies the structure and functioning of the immune system.

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3
Q

Immune system

A

Made up of cells and molecules that make up the body’s defense system against disease-causing agents.
2 primary functions:
1. Recognition of, and defense against foreign substances.
2. Establishment of immunosurveillance.

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4
Q

430 BC

A

Plague of Athens, persons who recovered only could nurse the sick.

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5
Q

15th century

A

Arabs and Chinese, infecting individuals with materials from the pustules of smallpox patients, providing a mild form of disease and induced immunity.

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6
Q

1718

A

Lady Mary Wortley Montagu performed variolation.

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7
Q

1796

A

Birth of immunology
Edward Jenner improved variolation; observed milkmaid who contracted cowpox rarely contracted smallpox. Called the technique as vaccination.

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8
Q

1979

A

Smallpox was eradicated.

50 years after, most European countries initiated compulsory vaccination program.

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9
Q

Louis Pasteur

A

Formulated the germ theory of disease.
He was interested in preventing diseases caused by microorganisms.
Used vaccines to induce immunity.
Worked with the the bacteria that caused chicken cholera.
Discovered the first attenuated vaccine.

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10
Q

Attenuation or change may occur through:

A
  1. Heat
  2. Aging
  3. Chemical means
    Remains the basis for many of the immunizations that are used today.
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11
Q

Rabies vaccine discovery by Pasteur

A

He recognized that the cns was affected.
Spinal cords left to dry for a few days were less infectious to laboratory animals than fresh spinal cord.
Boy got bitten by a dog got vaccinated a series of 12 injections beginning with material from the least infectious cords and progressing to the fresher, more infectious material.

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12
Q

Other attenuated vaccines of Pasteur:

A
  1. Temperature attenuated Bacillus anthracis.
  2. Attenuated vaccines of today.
  3. Sabin Polio vaccine.
  4. Anthrax vaccine.
  5. Chicken cholera vaccine.
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13
Q

Other Types of Vaccines used today:

A
  1. Killed vaccine
    - Suspensions of toxoid
    * Attenuated bacterial toxins
    * Tetanus toxin
    - Suspensions of killed bacteria or viruses
    * Diptheria vaccine
  2. Sub-unit vaccine
    - Hepatitis B
    * Hepatitis B surface antigen
    - Meningitis
    • Neisseria meningitidis capsular antigen
      - Pneumonia
    • Streptococcus pneumoniae capsular antigen
  3. Glycoconjugate vaccine
    - Carbohydrate antigens are conjugated to proteins
    - Haemophilus influenzae Type B (HiB)
  4. Nucleic acid vaccine
    - Naked antigen DNA ( Not yet available for human use)
    - Used to immunize mice against malaria and influenzae
    - Injected into muscle to:
    • induce sustained expression of the antigen
    • Generate immune response
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14
Q

The discovery of phagocytosis:

A

Discovered by Elie Metchnikoff.
Cells that eat cells.
Immunity to disease was based on the action of these scavenger cells.

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15
Q

Birth of humoral immunity

A

Noncellular elements in the blood were responsible for protection from microorganisms.

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16
Q

Cellular vs Humoral Immunity

A

Almoth Wright linked the two theories.
Observed that certain humoral, or circulating, factors called opsonins acted to coat bacteria so that they became more susceptible to ingestion by phagocytic cells.
Non-specific serum factors known as antibodies and nonspecific factors known as acute-phase reactants increase non-specifically in any infection.

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17
Q

Functions of the Immune System

A
  1. Defense
    -3rd line of defense is a specific defense mechanism
    - resists invasion by microorganisms
    - prevents reinfection
    Sometimes defense can result to:
    - Immunosuppression (hypofunction)
    * Neutropenia (immunosuppression secondary to drugs)
    * Immunosuppression due to development of AIDS after HIV infection
    - Defense can result to hyperfunction
    * Inappropriate and abnormal response to external antigens like allergens
    > allergy
  2. Homeostasis
    - To maintain Homeostasis damaged cellular substances are digested and removed
    • Result: specific cell types remain uniform and unchanged
      - Sometimes there is hyperfunction of homeostasis
      - abnormal response where antibodies react agains normal tissues and cells
    • seen in autoimmune diseases
  3. Surveillance
    - Mutations - continually arise in the body but are normally recognized as foreign cells and destroyed.
    Hypofunction of surveillance
    - inability of immune system to perceive and respond to mutated cells
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18
Q

Properties of the Immune System

A
  1. Specificity (The immune system responds) - recognize only one epitope
  2. Recognition (The immune system remembers)
    - Memory
    - Immune system has unique ability to remember the antigen
    When foreign antigen comes > series of cellular changes occurs > formation of specific antibody or sensitized lymphocyte that attaches to a specific antigen
    - 1st time exposure to antigen - Primary immune response
    - Subsequent exposure to the same antigen - Secondary immune response
  3. Self-limitation (The immune system recognizes the enemy)
    - distinguish difference between the body’s own proteins and foreign proteins
    - failure - leads to tissue destruction
  4. Self-regulation (The immune system regulates)
    a. immune system - regulate its action
    b. Self-regulation allows the immune system to monitor itself by:
    * “turning on when antigen invades
    * turning off when invader has been eradicated
    c. Regulation prevents the destruction of healthy or host tissues.
    d. Inability to regulate results to chronic inflammation and damage to host tissues
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19
Q

4 R’s of the Immune Response:

A
  1. Responds
  2. Regulates
  3. Remembers
  4. Recognizes.
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20
Q

Natural immunity

A

born with it; innate

  • does not require prior exposure to antigen to function
  • not specific
  • has no memory
  • maybe exogenous (skin); endogenous (acid pH); phagocytic (PMNs); natural killers (NK cells)
  • considered non-adaptive or nonspecific and are the same for all pathogens or foreign substances to which one is exposed.
  • no prior exposure is required, and the response does not change with subsequent exposures
  • made up of the first and second line of defenses
  • external defense system
  • internal defense system
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21
Q

Factors influencing natural immunity:

A
  1. Nutrition
  2. Age - number one factor
  3. Fatigue
  4. Stress
  5. Genetic determinants
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22
Q

Nonspecific defense mechanisms

A 
First line of defense:
  - Skin
  - Mucous membranes
  - Secretions of skin and mucous membranes
Second line of defense
  - Phagocytic white blood cells
  - Antimicrobial proteins
  - The inflammatory response
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23
Q

Specific defense mechanisms (immune system)

A

Third line of defense:

  • Lymphocytes
  • Antibodies
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24
Q

External defense ( First line of defense)

A

Physical barrier ( epithelial cells, pH of skin surface, trapping of bacteria in mucus)

  • Age determines immune system function
  • Designed to keep microorganisms from entering the body
  • If these are overcome, the internal defense must clear invaders ASAP
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25
Q

Internal defenses ( Second line of defense)

A

categorized into cellular mechanisms and humoral factors

  • fluids secreted by cells and tissues (complement and interferon)
  • Phagocytic: the process of macrophage or neutrophil engulfing bacteria
  • Both of these systems work together to promote phagocytosis
  • Inflammation: body processes such as: cellular movement, tissue repair, chemical release, elimination of foreign material
  • inflammation brings cells and humoral factors to the area in need of healing
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26
Q

Barrier Defenses - First line of Defense

A

A. Phyiscal Barriers

  1. Skin: First Line of Defense
    - Primary organ of protection
    - Lined with normal flora to make the skin pH acidic
    - Has layers of lipid and fatty acids
    - acts as a chemical barrier- controlling the entrance and exit of substances
    - keratinized
    - Thick/ tough
    - Waterproof
    - Very effective if unbroken
    - Compacted
    - Cemented
    - Impregnated with insoluble keratin
    - Constantly flaked/ desquamated
    - Hair shaft is periodically extruded
    - Sweat glands constantly flushed
    - With normal flora
    - With layers of lipid; fatty acids
    - Site of chemical barriers - controlling the entrance and exit of substances
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27
Q

3 layers of the skin

A
  1. Epidermis - outermost layer of the skin
    - provides a waterproof barrier
    - creates skin tone
    - contain melanocytes
    - special cells that give’s skin color
    - produces the pigment melanin
    5 layers :
  2. Stratum basale - deepest layer
  3. Stratum spinosum - made of desmosomes to join adjacent cells together
  4. Stratum granulosom - made of keratinocytes
  5. Stratum lucidum - second later and varies in thickness depending on the frictional forces
  6. Stratum corneum - made of dead skin cells
  7. Dermis
    - Found beneath the epidermis
    - Contains tough connective tissue, hair follicles, and sweat glands
    - with 2 layers
  8. Papillary dermis - produces ridges (fingerprints)
  9. Reticular dermis - coarse elastic fibers, irregular connective tissue made of collagen - responsible for stretch marks or striae
  10. Hypodermis
    - “deeper subcutaneous tissue”
    - made of fat and connective tissue
    - dermo-epithelial junction
    - holds dermis and epidermis together
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28
Q

Functions of the skin

A
  1. Regulates body temperature
  2. Conserve body heat
  3. During hard exercise, blood vessels narrow so that blood is able to circulate to the contracting muscles and increase perspiration
  4. Protection
  5. Sensation
  6. Secretes sweat
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29
Q

Mucous membrane

A 
not covered by skin
Lines respiratory tract, digestive tract, eyes
Thin, moist, permeable
Moistened through:
  1. Blinking/lacrimation
  2. Flow of saliva
  3. acidic stomach
  4. defecation
  5. vomiting
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30
Q

Chemical barriers

A

Found in:

  1. Mucus
  2. Saliva
  3. Sweat
  4. Tears
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31
Q

Genetic barriers

A

exists in the negative sense

- Protection is by lack of something rather than by its presence

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32
Q

The Second Line of Defense (Non-specific)

A

A. Acute phase reactants

  • normal serum constituents that increase rapidly
  • produced primarily by hepatocytes (liver parenchymal cells) to an increase in certain intercellular polypeptides called cytokines
  • Cytokines produced: IL-1B, IL-6, and tumor necrosis factor-alpha (TNF-a)
    1. C-Reactive Protein (CRP) -
    2. Serum Amyloid A
    3. Fibrinogen
    4. Complement system proteins
    5. Mannose- Binding Protein (MBP)
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33
Q

C-Reactive Protein (CRP)

A

increases rapidly following infection, surgery, or other trauma

  • declines rapidly with cessation of the stimulus
  • plasma half-life = 19 hours
  • Pentraxins
  • 118,000 daltons
  • bind to small ribonuclear proteins; phospholipids; peptidoglycan; and other constituents of bacteria, fungi, and parasites
  • nonspecific form of antibody molecule that is able to act as a defense against microorganisms or foreign cells until specific antibodies can be produced
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34
Q

Serum Amyloid A

A

major protein

  • apolipoprotein synthesized in the liver
  • molecular weight = 11,685 daltons
  • 30 ug/ml
  • thought to play a role in metabolism of cholesterol
  • increase significantly more in bacterial infections than in viral infections
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35
Q

Fibrinogen

A

most abundant of the coagulation factors in plasma

  • forms the fibrin clot
  • 340,000 daltons
  • increases the strength of a wound and stimulates endothelial cell adhesion and proliferation
  • formation of a clot also creates a barrier that helps prevent the spread of microorganisms
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36
Q

Complement system proteins

A
  • mediation of inflammation
  • nine such proteins known as the classical cascade
  • major functions of the complement system:
  • Opsonization
  • Chemotaxix
  • lysis of cells
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37
Q

Mannose- Binding Protein (MBP)

A

trimer, acts as opsonin, calcium-dependent

- widely distributed on mucosal surfaces throughout the body

38
Q

Alpha1-Antitrypsin

A

major component of the alpha band when serum is electrophoresed

39
Q

Elastase

A

enzyme that can degrade elastin and collagen

40
Q

Monuclear Phagocyte System (MPS)

A

Composed of:

  • Lymphatic Tissue
  • Leukocytes
  • Thymus gland
  • Lymphocytes
  • Chemical mediators
  • Known before as Reticuloendothelial System (RES)
41
Q

Two types of mononuclear phagocytic cells

A
  1. Fixed macrophages

2. Free macrophages

42
Q

Blood monocytes > migrate to various tissues > Mature to macrophages > Tissue macrophages scattered in connective tissues or clustered in organs:

A 
Lungs (alveolar macrophages)
Liver ( Kupffer cells)
CNS (microglial cells)
splenic macrophages
  - lymph node macrophages
  - Tissues (Histiocytes)
  - Kidneys (mesangial cells)
43
Q

Pleuripotent hematopoeietic stem cell

A

Gives rise to WBCs, RBCs, and platelets

- may either produce other stem cells and self-regenerate

44
Q

How do hematopoeitic stem cells evolve?

A
  1. Erythropoiesis
  2. Lymphopoiesis
  3. Granulopoiesis
45
Q

Erythropoiesis

A
  • sustained by multipotent stem cell

- CFU-E is influenced by the hormone erythropoietin

46
Q

Lymphopoiesis

A
  • After maturation, it enters the peripheral blood
  • it repopulates lymph nodes or lympathic organs
  • Growth is conditioned by the thymus T cells and bone marrow for B cells
47
Q

Granulopoiesis

A

Controlled by GM-CSF

Share a common progenitor cell, CFU-GM

48
Q

How was hematopoiesis studied?

A

In vitro BM cultures were performed

49
Q

Why is the marrow the site for hematopoiesis?

A

Provieds a special environment for hematopoietic growth and development

  • BM is extravascular
  • single layer of endothelial cells separate the extravascular marrow compartment from intravascular compartment
50
Q

Stem cell factor (SCF)

A

aka KIT-ligand, KL, or steel factor

  • cytokine that binds to the c-KIT receptor (CD117)
  • a transmembrane protein and a soluble protein
51
Q

Functions of the SCF

A

plays a role in the hematopoiesis during embryonic development

52
Q

Ligand

A

molecule that binds to a receptor

53
Q

SCF evolution

A

gene encoding is on chromosome 12q22-12q24 in humans

54
Q

White Blood Cells

A

all contain nuclei and organellese unlike RBC

55
Q

Leukocytosis

A

infection or inflammation

56
Q

Neutrophilia

A

bacterial infection

57
Q

Eosinophilia

A

allergic reaction

58
Q

Lymphocytosis

A

Ag/AB reactions

59
Q

Leukopenia

A

low white cell count

60
Q

Functions of the WBC

A

fight invasion by non-self via phagocytosis or through specific responses through antibody production
Help defend the body against invasion by pathogens, and they remove toxins, wastes, and abnormal cells

61
Q

Special Characteristics of the WBC

A

Increase during stress
6000 to 9000 WBCs
Most are in the connevtive tissue proper or in organs of the lympathic system

62
Q

Characteristics of circulating WBCs

A

amoeboid movement
- migrate out of the bloodstream by squeezing thru endothelial cells (process called diapedesis)
- attracted to specific chemical stimuli (positive chemotaxis)
- prdxn and maturation of granulocytes, 14 days
Distribution:
- Marrow Reserve
- Circulating Pool - in the blood
- Marginating Pool - along the endothelium, spleen

63
Q

Neutrophils

A

9-15 um in diameter
- diurnal variation (Afternoon)
- known as Polymorphonuclear (PMNs)
- 50-70% of WBCs in PB
- 40-75% of total WBC (50-70% of storage)
Nucleus
- Coarse and clumped chromatin
- Segmented Nucleus 2-5 lobes
- Lobes are joint only by threadlike filaments
Cytoplasm
- Pink to rose-violet specific (secondary) granules
- Primary and secretory granules
Function: phagocytic
- attacking and digesting bacteria
- cytoplasm contain bactericidal compounds
- first WBC to arrive at an injury site (w/n 6 hours from injury)
- Lifespan: 24-48 hrs

64
Q

2 types of Neutrophils

A
  1. Band (immature) - horseshoe-shape
    - especially during inflammation, the bone marrow releases immature neutrophils
  2. Segmented (mature)
65
Q

Eosinophils

A

9-15 um in diameter
- 1-5% of WBCs in PB
* 2-5% of total WBC
- Diurnal variation due to ACTH influence
Nucleus
- Coarse and clumped
- bi-lobed
- joint only by threadlike filaments
Cytoplasm
- reddish-orange
- primary granules, lysosomal granules, lipid bodies and storage vesicles
- at sites of parasitic infection, or at allergic sites
- main method of attack is the exocytosis of toxic compounds
- Function weakly phagocytic, suppresses inflammation and decreases granulocyte migration
- increase in a parasitic infection
- sensitive to allergens and increase in allergic reaction

66
Q

Basophils

A

10-16 um diameter
- 1-5% of WBC in PB
- Scarcest in circulation at 0.2 to 0.5 % of total WBC
Nucleus
- Coarse and clumped
- unsegmented or bilobed
- covered by large granules
Cytoplasm
- Dark purple to black purple
- large water-soluble specific granules
Function: inflammatory mediator release
- 8-10 um in diameter
- share same morphology with Mast Cells
- migrate to injury sites and discharge the contents of their granules (motile)
* histamine
* enhances the local inflammation and attracts other WBCs
* granules contain serotonin

67
Q

Lymphocytes

A

with very complex kinetics
- relative count 20%-40%
- 20%-30%
Absolute count - 0.96 - 4.4 x 103/mm3
Categorized as specialized cells:
- Not in the end-stage in the PB
- Recirculation tissue-blood-tissue-blood
- capable of extensive genetic recombination
- mature and selected outside the BM
1. T cells: defend against foreign cells and tissues and coordinate the immune response
2. B cells: produce and distribute antibodies that attack foreign materials
- B cells were first demonstrated in special lymphatic glands of birds called Bursa of Fabricious
3. Natural Killer Cells - no antigen-specific receptor

68
Q

Lymphocyte development

A
  • controlled by environmental and hormonal stimuli separate from the granulocytes and monocytes
    • circulate all throughout
    • stimulated by specific hormone stimuli (CFU-L)
69
Q

2 Primary Lymphoid Organs

A 
Bone Marrow (B cells)
Thymus (T cells)
70
Q

Plasma cell

A

The end of a B cell maturation

Produce antibodies

71
Q

2 groups of Lymphocytes

A

T and B lymphocytes

  • Antigen-activated (macrophages and dendritic cells)
  • release macrophage-activating cytokines
72
Q

Secondary Lymphoid Tissues

A

T cells - Perifollicular and paracortical regions of lymph nodes
- Medullary cords of lymph nodes
B cells - Follicular and medullary regions of lymph nodes
- red pulp of spleen
- Follicular regions of GALT
- medullary cords of lymph nodes

73
Q

T- cell Classes:

A
  1. T helper cells
    a. TH1 Cells
    b. TH2 Cells
    c. TH17 Cells - extracellular bacteria
    d. Treg Cells - maintain self-tolerance
  2. . T cytotoxic cells
74
Q

Natural Killer Cells

A

Part of innate immunity

  • Attacks without prior sensitization
  • Targets Tumor cells and virus-laden cells
  • Derived from both BM and Thymus
  • “large granular lymphocytes” - contain peroxidase negative granules
75
Q

Markers of NK cells:

A

CD2 - adhesion/signal transduction molecule
CD8 - (variable) MHC class I receptor
CD16 (FcyII) - low affinity receptor for IgG (ab-dependet cell-mediated cytotoxicity)
CD56 - adhesion molecule

76
Q

Macrophages/Monocytes

A

2%-10% circulating leukocytes
Absolute Count - 0.096 -1.1 x103/mm3
- Promonocytes - mitotically active stage
- Attracted secondarily to acute inflamed sites
- cell in chronic inflammation
Distribution:
No storage pool
Splenic pool
Circulating pool
Marginating pool (3.5x the circulating pool)

77
Q

Tissue pool (Macrophage)

A

most abundant

  • Relatively long-lived and retains ability to multiply
  • process foreign molecule and presents them to lymphcoytes
  • serves as antigen-processing cells and APC’s (Antigen-Presenting Cell) together with dendritic cells
  • activated by the presence of antigen
  • secrete cytokines that cause increase in body temperature
78
Q

Functions of Macrophages

A
  1. Acts as professional phagocytes in innate immunity
  2. Participates in adaptive immunity as antigen-presenting cells
  3. Maintenance Functions for homeostasis
    a. Clean-up of debris and dead cells
    b. Destruction of senescent red cells and iron recycling
  4. Synthetic Functions (it can secrete)
    a. Complements
    b. Coagulation factors
    c. Prostaglandins
    d. Leukotrienes
    e. Growth factors
    f. Transferrin
79
Q

Tissue Pool of Macrophages:

A
  1. Liver - Kupffer cells
  2. Lungs - alveolar macrophages
  3. Brain - Microglial
  4. Skin - Langerhans cells
  5. Spleen - Splenic macrophages
  6. Intestines - intestinal macrophages
  7. Peritoneum - peritoneal macrophages
  8. Bone - osteoclasts
  9. Synovium - type A cell
  10. Kidneys - renal macrophages
  11. Reproductive organ macrophages
  12. Lymph nodes - dendritic cells
80
Q

Monocyte Maturation Markers:

A 
Monocyte Precursor Receptors
  1. M-CSF R
  2. Lysozyme Receptor
Mature Cell Receptors
  * CD11b/CD18
  * Macrophage Receptors
   > CD68/macrosialin - lipoprotein met
   > Sialoadhesin - cell-cell or cell-ECM interactions
CD14 - most important functional marker 
          - receptor for LPS
81
Q

The Inflammatory Response

A

non-specific defense
- in-flame - to set fire (red, hot, pain)
Inflammation is a property of the 2nd line of defense
- serves to bring defense and healing mechanisms to the site of injury

82
Q

Inflammation

A

A complex response to sublethal injury to a tissue
Sequential reaction to cell injury
It is physiologic, protective response

83
Q

Phases of Inflammatory Response

A
  1. Vascular
  2. Cellular
  3. Formation of Exudates
  4. Healing
84
Q

Chemical Mediators of the vascular response:

A 
First mediator - Histamine
2nd Mediator - Bradykinin
Prostaglandins
Other inflammatory mediators
  - Plasma proteases - protein activated under complement system
  - Leukotrienes
  - Mast Cells
  - Oxygen Free Radicals - mediators
  - Complement system
85
Q

Histamine

A

lower allergen contained in our body
a vasoamine that causes:
-dilation of local blood vessels
- Contraction of smooth muscles

86
Q

Bradykinin

A

Plasma protein formed when injury releases clotting factors (Factor Xii converts to Factor XIIa)

  • leads to vascular permeability
  • vasodilation
  • smooth muscle contraction
87
Q

Prostaglandins

A 
Induce production of platelets
derived from arachidonic acid
 - vasodilation
 - pain
 - fever
 - platelet aggregation to help in clotting
88
Q

Plasma proteases

A

protein activated under complement system

89
Q

Leukotrienes

A

formed from arachidonic acid

  • important mediator in bronchial asthma and immediate hypersensitivity reaction
  • may cause vasodilation and increased capillary permeability
90
Q

Complement system

A

primary mediator of the humoral immune system response

  • helps body produce inflammation and helps localize infectious agents
  • enhances phagocytosis
  • enhances chemotaxis
  • increase blood vessel permeability
  • cause cell lysis
91
Q

Cellular Response

A

Migration
Diapedesis
Chemotaxis
Directional migration of WBC along a concentration
Ensure accumulation of neutrophils and monocytes at the focus of injury

Immunology for Medical Technology (1 decks)

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