DISEASES OF THE IMMUNE SYSTEM Flashcards
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?
A2
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
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
Most common cause of distal sensory polyneuropathy in HIV infections
toxic effects of anti-retrovirals
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
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
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
Its main function is to regulate the immune response:
Suppressor T cells
Most of the systemic manifestations in systemic lupus erythematosus ( SLE ) is largely due to:
circulating immune complexes
Function of a CD4 T cells
A. suppresses the immune response
B. role in the inflammatory response
C. complement activation.
D. phagocytosis
phagocytosis
Patients with pure B cell immunodeficiency are at risk of developing the following infections:
a. Viral
b. Fungal
c. Parasitic
d. Bacterial
d. Bacterial
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
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
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
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
AIDS is characterized by:
life threatening opportunistic infections,
secondary malignant neoplasms and,
CNS manifestations
Most of the systemic manifestations in systemic lupus erythematosus ( SLE ) is largely due to:
circulating immune complexes
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
Majority of the events in the clinical latency stages of HIV infection are seen in the
lymphoid tissues
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
CD8 T cells usually attacks this part of the renal allograft:
Renal vasculature
These are antibody producing cells:
Plasma cells
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
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
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
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
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.
