DISEASES OF THE IMMUNE SYSTEM Flashcards by Lili Popp

A 25 year old male commercial sex worker tested positive for HIV ,no symptoms reported, CD4 count +AD0- 350 u/L . What is his disease category?

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Exercise has the following effects on the immune system:
a. high intensity exercise may activate the acute phase reaction
b. Low to moderate exercise may lead to impairment of the immune system
c. Low to moderate exercise is known to induce the release of mast cells

a. high intensity exercise may activate the acute phase reaction

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The concept of molecular mimicry is the presumptive pathogenic mechanisms in the following diseases
a. Type 1 DM
b. Graves disease
c. Rheumatic heart disease
d. SLE

c. Rheumatic heart disease

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Most common cause of distal sensory polyneuropathy in HIV infections

toxic effects of anti-retrovirals

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A 6 year old child while playing on their backyard was attacked by a swarm of bees, the child immediately
developed itchy rashes with intense swelling of the face. What type of hypersensitivity reaction is this ?

Type I IgE mediated reaction

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Which is the proper sequence of HIV infection of a CD4 T cell:
a. release of viral genomic RNA- gp120 binds to CD4 - gp41 membrane penetration
b. gp41 binds to CD4 - gp41 membrane penetration- release of viral genomic RNA
c. gp120 binds to CD4- gp41 membrane penetration - release of viral genomic RNA

c. gp120 binds to CD4- gp41 membrane penetration - release of viral genomic RNA

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Innate immunity is characterized by the following:
a. all the above
b. possess antigen specificity
c. activated even without prior sensitization

c. activated even without prior sensitization

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Its main function is to regulate the immune response:

Suppressor T cells

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Most of the systemic manifestations in systemic lupus erythematosus ( SLE ) is largely due to:

circulating immune complexes

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Function of a CD4 T cells
A. suppresses the immune response
B. role in the inflammatory response
C. complement activation.
D. phagocytosis

phagocytosis

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Patients with pure B cell immunodeficiency are at risk of developing the following infections:
a. Viral
b. Fungal
c. Parasitic
d. Bacterial

d. Bacterial

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Possible explanation/s why auto-immune disorders are more frequent in females:
a. the role of the X chromosome
b. all of the choices are correct
c. increased susceptibility to infections
d. more prone to anemia

a. the role of the X chromosome

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Contact dermatitis is a result of activation of the following components of the immune system:
a. mast cells 
b. IgE
c. Cytotoxic T cells
d. IgG and IgM

c. Cytotoxic T cells

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AIDS is characterized by:
a. life threatening opportunistic infections, secondary benign neoplasms and CNS infections
b. life threatening opportunistic infections, secondary malignant neoplasms and CNS infections
c. life threatening opportunistic infections, secondary malignant neoplasms and CNS manifestations

c. life threatening opportunistic infections, secondary malignant neoplasms and CNS manifestations

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All of the following are characteristics of a Class II MHC molecule:
a. present in all nucleated cells
b. recognized by CD8 T cells
c. encoded by genes HLA DP, DQ, DR
d. encoded by genes HLA A, B, C

c. encoded by genes HLA DP, DQ, DR

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AIDS is characterized by:

life threatening opportunistic infections,
secondary malignant neoplasms and,
CNS manifestations

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Most of the systemic manifestations in systemic lupus erythematosus ( SLE ) is largely due to:

circulating immune complexes

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Fibromyalgia syndromes are characterized by the following, EXCEPT:
a. an underlying disorder is easily identifiable
b. a variety of biochemical, physiologic and neurologic abnormalities are seen
c. chronic widespread pain
d. an abnormality of pain processing

a. an underlying disorder is easily identifiable

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Majority of the events in the clinical latency stages of HIV infection are seen in the

lymphoid tissues

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Which of the following disease pairing and etiology is CORRECT:
a. Myasthenia gravis- cytotoxic T cells attacking acetylcholine receptors
b. Graves disease- antibodies attacking TSH receptors
c. Anaphylactic shock- IgG initiated cytotoxicity

b. Graves disease- antibodies attacking TSH receptors

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CD8 T cells usually attacks this part of the renal allograft:

Renal vasculature

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These are antibody producing cells:

Plasma cells

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Which of the following tissue damage/effect in SLE is correct:
a. Heart- Libman Sacks endocarditis
b. Pleural cavity - fibrinous pleuritis
c. Joints- rheumatoid arthritis
d. Eyes- retinopathy

Heart- Libman Sacks endocarditis

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Natural or nonspecific immunity
Acts as the body’s first line of defense to prevent the entry of pathogens and is actually capable of resolving most threats

INNATE IMMUNITY

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describe: Epithelia -defensis (strong antibacterial, antifungicida, antiviral activity), lymphocytes Macriphages and Neutrophils Dendritic cells: (most important antigen presenting cell)

Epithelia -defensis, lymphocytes Macriphages and Neutrophils Dendritic cells: (most important antigen presenting cell)

Describe: Natural killer (NK) cells: Mast cells: Complement system:

Natural killer (NK) cells: natural surveillance Mast cells: basophils Complement system: group of proteins

Cellular Receptors for microbes, products of damaged cells and foreign substance

TOLL LIKE RECEPTORS (TLR): NF kB, IFN regulatory (IFR) NOD like receptors (NLR) and the inflammasome Others : C type lectin receptors ( CLR ), RIG like receptors ( RLR’s ), G protein coupled receptors, Mannose receptors

What are the Reactions of the innate immunity:

Inflammatory response Antiviral defense Sends danger signals to stimulate adaptive immunity

Characterized by specificity and memory. The goal of this comprehensive line of defense is to specifically recognize the threat, promote an effective immune response, destroy/remove the invading pathogen, and establish long-term memory.

Adaptive Immunity

What are involved? Humoral; Cellular;

Humoral; Involves antibodies Cellular; T-cells

TISSUES OF THE IMMUNE SYSTEM

Generative lymphoid organs Peripheral lymphoid organs

Give examples of Generative lymphoid organs

Thymus (origin of T cells) , bone marrow (origin ff B cells)

Give examples of Peripheral lymphoid organs

Lymph nodes, spleen, cutaneous and mucosal lymphoid systems

Class of MHC gene that is present in all nucleated cells and platelets a chains encoded by 3 genes HLA-A, B, C

Class I MHC

These are effects of exercise on? Regular moderate exercise , resistance training and long-lasting endurance exercise is known to induce proinflammatory cytokines High intensity exercise can induce the acute phase reaction activating the complement system and releasing cytokines such as TNF’s, IFNs, ILs and other cytokines

effects on the inflammatory response

Class of MHC gene that is Display peptides derived from proteins like viral and tumor antigens in the cytoplasm produced by the cells ->nasa loob lang ng cell Recognized by CD8+ T cells

Class I MHC

Class of MHC gene that is Mainly expressed in cells that present ingested cells and those cells that respond to helper T cell encoded in the D region with 3 subregions- HLA-DP, HLA-DQ, HLA-DR -> galing sa labas

Class II MHC

Class of MHC gene that is Presents antigens internalized from vesicles from extracellular microbes and proteins Recognizes CD4+cells

Class II MHC

Messenger molecules

CYTOKINES

Cytokines contribute to different types of immune responses how? innate immune response: ? Adaptive immune response -?

innate immune response: inflammation and inhibit viral replication, TNF Adaptive immune response - produced mostly by CD4+ T cells for lymphocyte proliferation and differentiation to activate effector cells, IL-2, IL-4, IL-5, IL-17, IFN g

These are effects of exercise on? Increases levels of __ and increases phagocytic activities of both __ and __ Duration and intensity of exercise is proportional to the increase in neutrophils The effect on macrophage function is still unclear

Effects on neutrophils ( PMN’s ) and macrophages

T or F intense physical activity or long duration exercises may lead to impairment of the immune system

TRUE

These are effects of exercise on? Number and activity of __ cells increases immediately and during exercise regardless of duration and intensity __ enhancement falls off once accustomed to the level of exercise – more of a reaction to physiologic stress Intense exercise of long duration __ cells concentration and activity may fall off at pre-exercise value

effects on natural killer (NK) cells

These are effects of exercise on? Anti-inflammatory effects IL-6 and release of other anti-inflammatory cytokines IL-1ra and IL-10

effects on the inflammatory response

How long does it take for the immune system to recover after a severe exercise?

It takes 6-24 hours for the immune system to recover after a severe exercise

HYPERSENSITIVITY DISORDERS

Regular exercise is associated with

enhanced responses to vaccinations lower numbers of exhausted/senescent T cells increased T-cell proliferative capacity lower circulatory levels of inflammatory cytokines increased neutrophil phagocytic activity lowered inflammatory response to bacterial challenge greater NK cell cytotoxic activity longer leukocyte telomere lengths in aging humans

exercise may delay ___ and exercise-induced ___ is a normal regulatory process that removes certain damaged cells without a pronounced inflammatory response, thereby ensuring optimal body function

apoptosis

T or F HYPERSENSITIVITY DISORDERS can results from an imbalance between effectors of the environment response and the control mechanisms

FALSE results from an imbalance between effectors of the immune response and the control mechanisms

T or F HYPERSENSITIVITY DISORDERS are often associated with inheritance of some susceptibility genes ● mechanism of tissue injury similar to defense against infectious pathogens

TRUE

Development of allergies

○ genetically determined- 5q31 ○ role of environmental factors ○ increasing incidence in developed countries

All of these are disease caused by TYPE I HS except: Anaphylaxis Chicken Pox Bronchial Asthma Allergic rhinitis sinusitis (hay fever) Food Allergies

Chicken pox

Clinical Syndrome Clinical & Pathologic Manifestation of Bronchial Asthma

airway obstruction caused by bronchial smooth mm. hyperactivity; inflammation and tissue injury caused by late-phases reaction

Clinical Syndrome Clinical & Pathologic Manifestation of Allergic rhinitis sinusitis (hay fever)

increased mucus secretion; inflammation of upper airways, sinuses

Fibrinoid necrosis in an artery. The wall of the artery is bright pink with dark neutrophils

TYPE III Immune complex mediated

Clinical Syndrome Clinical & Pathologic Manifestation of Anaphylaxis

Fall in blood pressure (shock) cause by vascular dilation; airway obstruction due to laryngeal edema

TYPE III IMMUNE COMPLEX MEDIATED DISEASES

Systematic lupus erythematosus Poststreptococcal glomerulonephritis Polyarteritis nedosa Reactive arthritis Serum sickness Arthus reaction (experimental)

T CELL MEDIATED DISEASES

Rhematoid arthritis Multiple sclerosis Type 1 diabetes mellitus Inflammatory bowel disease Psoriasis Contact sensitivity

T or F Autoimmune diseases tend to be chronic, with relapses and remissions but damage often progressive Clinical and pathologic response to an autoimmune disease is determined by nature of underlying disease

TRUE

MECHANISMS OF AUTO-IMMUNITY inheritance of susceptibility genes → ?? environmental triggers → ??

inheritance of susceptibility genes → breakdown of self tolerance environmental triggers → activation of self reactive lymphocytes

Multi-organ autoimmune disease with a wide array of antibodies particularly ANA’s Chronic, remission and relapses

SYSTEMIC LUPUS ERYTHEMATOUS (SLE)

1997 REVISED CRITERIA FOR SLE DIAGNOSIS *11 criterion but for diagnosis atleast 4 must be present

MALAR RASH DISCOID RASH PHOTOSENSITIVITY ORAL ULCERS ARTHRITIS SEROSITIS RENAL DISORDER NEUROLOGIC DISORDER HEMATOLOGIC DISORDER IMMUNOLOGIC DISORDER ANTINUCLEAR ANTIBODY

What is the least common and most common lesion in the kidney?

Minimal mesangial lupus nephritis – class I- least common Diffuse lupus nephritis – class IV - most common

Exposure to what drugs will cause drug induces lupus?

Exposure to Hydralazine, procainamide, D-penicillamine, anti- TNF therapy

Fibromyalgia or fibromyalgia syndrome (FMS) is a?

a chronic muscle pain syndrome

capsular thickening, follicular hyperplasia some vessels may show concentric intimal and smooth muscle hyperplasia – onion skinning occurs where?

Spleen

defined as chronic widespread pain with allodynia or hyperalgesia (very sensitive to stimulus that is not pain inducing) to pressure pain, and is classified as one of the largest groups of soft-tissue pain syndromes (not a disease).

Fibromyalgia

considered a systemic problem involving biochemical, neuroendocrine, and physiologic abnormalities, with widespread multiple tender points as one of the key symptoms in contrast to myofascial pain

Fibromyalgia

Fibromyalgia Risk factors/Triggers

Prolonged anxiety and emotional stress, trauma (e.g., motor vehicle accident work injury, surgery) rapid steroid withdrawal Hypothyroidism viral and nonviral infections Exposure to tobacco products

These are type of? Rheumatoid arthritis Inflammatory myopathies Mixed connective tissue diseases ( MCTD )

OTHER AUTOIMMUNE DISEASES

The following are examples of AUTOIMMUNE DISEASES except: Mixed connective tissue diseases ( MCTD ) Myocardial Infarction Polyarteritis nodosa ( PAN ) and other vasculitides IgG4 related disease

Myocardial Infarction

Active immunity is characterized by the following: A. possess antigen specificity C. with long term memory B. prior sensitization is needed for activation D. all of the choices are correct

B. prior sensitization is needed for activation

Treatment for Fibromyalgia

education and support stress management nutrition and lifestyle training Medications Local modalities and techniques for muscle pain Conditioning and aerobic exercise

A process in which T cells and antibodies produced against graft antigens react against and destroy the tissue grafts

ALLOGRAFT REJECTION

MAJOR ROUTES OF TRANSMISSION of AIDS

Sexual transmission - 75% Parental transmission Parental transmission Needlestick injuries

Disease caused by the retrovirus human immunodeficiency virus ( HIV ) characterized by profound immunosuppression leading to opportunistic infections, secondary neoplasms and neurologic manifestations

AIDS

MECHANISMS OF ALLOGRAFT REJECTION AND RECOGNITION

Recognition of graft antigens by T and B cells

Hallmark of AIDS

Cell mediated immunity

AIDS

Adult patient with fever, weight loss , diarrhea, generalized LAD, multiple opportunistic infections, neurologic disease and secondary neoplasms may have?

AIDS

Pacing, energy conservation , stress management, and balancing life activities prevents worsening of fatigue and maintains an even flow of energy from day to day among patients with CFS

Exercise and chronic fatigue syndrome

Carefully controlled and graded exercise is the center of effective intervention for CFS

Exercise and chronic fatigue syndrome

All of the following are characteristics of a Class I MHC molecule: A. present in all nucleated cells C. recognized by CD4 T cells B. encoded by genes HLA DP, DQ & DR D. all of the choices are correct.

A. present in all nucleated cells

These are antibody producing cells: A. T cells B. Monocytes C. Neutrophils D. Plasma cells.

D. Plasma cells.

Immunity from vaccination is an example of: A. Innate active immunity B. Adaptive active immunity. C. Innate passive immunity D. Adaptive passive immunity

B. Adaptive active immunity.

SLE is a result of activation of the following components of the immune system: A. immune complexes C. mast cells B. Cytotoxic T cells

C. mast cells

The duration and intensity of exercise has this effect on neutrophils: A. directly proportional. B. inversely proportional C. no effect

A. directly proportional.

Intense exercise has this/these effect/s on the immune system: A. impairment of the immune system B. activation of the complement system C. enhances phagocytic activity of the NK cells D. induce the release of mast cells

A. impairment of the immune system

Which of the following disease pairing and etiology is CORRECT: A. Anaphylactic shock- IgE mediated response B. TB- immune complex deposition on the alveolar cells C. Myasthenia gravis- cytotoxic T cells attacking acetylcholine receptors. D. Grave's disease- antibodies blocking TSH receptors

A. Anaphylactic shock- IgE mediated response

The concept of molecular mimicry is the presumptive pathogenic mechanisms in the following diseases: A. Grave's disease B. Type 1 DM, C. Post streptococcal glomerulonephritis D. Inflammatory bowel disease

C. Post streptococcal glomerulonephritis

The concept of self tolerance to our own antigens is a result of: A. T cell anergy B. receptor editing on the T cell surface C. production of regulator B cells D. all of the choices are correct

A. T cell anergy

Clinico-pathologic features of SLE: A. organ specific auto-immune disorder B. relapses are common C. produces very few auto-anti-bodies

B. relapses are common

In the indirect pathway of graft rejection, activated macrophages attacks this part of the graft: A. renal vasculature B. mesangium C. Bowman's capsule

A. renal vasculature

HIV infections to the CNS is usually carried by the:

monocytes

Distal sensory polyneuropathy in HIV infections is due to: A. result of muscle wasting B. bone and soft tissue infections C. toxic effects of anti-retrovirals. D. comorbidities not related to the disease like diabetes mellitus

C. toxic effects of anti-retrovirals.