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Dr. Mel - Immunology > First Aid > Flashcards

First Aid Flashcards

1
Q

Cells in different spleen compartments

A

White pulp: T cells in PALS, B cells in follicles

Marginal zone: macrophages + specialized B cells, where APCs capture Ag from blood

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2
Q

4 findings postsplenectomy

A

Howell-Jolly bodies
Target cells
Thrombocytosis (loss of sequestration)
Lymphocytosis (loss of sequestration)

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3
Q

Abnormal thymus in 3 conditions

A

Hypoplastic: DiGeorge syndrome, Severe Combined ImmunoDeficiency

Enlarged: myasthenia gravis

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4
Q

MHC I and MHC II

A

I: HLA-A-B-C, binds TCR+CD8, on all nucleated cells, present endogenously synthesized Ag to CD8+ cells

II: HLA-DP-DQ-DR, binds TCR+CD4+, on APCs, present exogenously synthesized Ag to CD4+ cells

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5
Q

4 characteristics of NK cells

A

Enhanced activ by IL2, IL12, IFNa, IFNb
Use perforin + granzymes to induce apoptosis of virally inf + tumors cells
Kill when nonspecific activ signal +/- absence of MHC I on target cell
Kill via Ab-dependent cell-mediated cytotox

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6
Q

Major functions of B + T cells

A

B: recognize Ag, produce specific Ab, maintain immunologic memory
T: HS type IV, acute + chronic organ rejection
T CD4+: help B make Ab, recruit phagocytes, activate leukocytes
T CD8+: kill virus-inf cells

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7
Q

Positive + Negative selection of T cells

A

Positive: thymic cortex, T cells w/ TCRs binding self-MHC on cortical epith cells SURVIVE

Negative: thymic medulla, T cells w/ TCRs w/ high affinity for self Ag APOPTOSIS

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8
Q

Th1 cells

A

Secrete IFNg, IL2, lymphotoxin beta
Activates macrophages + cytotoxic T cells (cell induced imm)
Mediates delayed HS

Differentiation induced by IFNg, IL12
Inhibited by IL4, IL10 (from Th2)

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9
Q

Th2 cells

A 
Secretes IL4, IL5, IL10, IL13
Recruits eosino (parasite defense)
Promotes IgE production by B cells, regulates Ig class switching (humoral mediated imm)

Differentiation induced by IL4
Inhibited by IFNg (from Th1)

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10
Q

Regulatory T cells

A

CD3, CD4, CD25, FOXP3
Maintain specific immune tolerance (suppress CD4+8 effector fct)
Produce anti-infl cytokines (IL10, TGFb)

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11
Q

3 major roles of Ab

A

Opsonization: promotes phagocytosis
Neutralization: prevents bacterial adherence
Complement activation: activates complement, enhances opsonization+lysis

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12
Q

Thymus-independent + thymus-dependent antigens

A

Indep: Ag lacking a peptide (LPS of G-) not presented by MHC to T cells, weakly immunogenic, vaccines+boosters+adjuvants

Dep: Ag containing a peptide (diphtheria), class switching + immuno memory after direct contact of B+Th cells

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13
Q

5 positive + 2 negative acute-phase reactants

A

CRP, ferritin, fibrinogen, hepcidin, serum amyloid A

Albumin, transferrin

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14
Q

Central regulator of iron homeostasis

A

Hepcidin (lowers iron absorption + release)

Raises by high iron levels + infl
Lowers by hypoxia + erythropoiesis

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15
Q

3 pathways of complement activation

A

Classic: IgG, IgM mediated
Alternative: microbe surface molecules
Lectin: mannose, other sugars on microbe surface

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16
Q

2 inhibitors that prevent complement activation on self cells

A

DAF

C1 esterase inhibitor

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17
Q

5 characteristics of C1 esterase inhibitor deficiency

A 
Unregulated activation of kallikrein
High bradykinin (vasodilator)
Hereditary angioedema (facial+laryngeal edema)
N/V, diarrhea, abdo pain
ACE are CONTRAindicated
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18
Q

2 findings in C3 deficiency

A

High risk of severe, recurrent, pyogenic sinopulmunary infections
High susceptibility to HS III

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19
Q

C5-C9 deficiencies

A

Recurrent Neisseria bacteremias

20
Q

2 characteristics of DAF deficiency

A

Complement-mediated lysis of RBCs

Paroxysmal nocturnal hemoglobinuria

21
Q

5 cytokines secreted by macrophages

A 
IL1
IL6
IL8
IL12
TNFa
22
Q

2 cytokines secreted by all T cells + 1 by Th1 + 3 by Th2

A

All T: IL2, IL3
Th1: IFNg
Th2: IL4, IL5, IL10

23
Q

Deficiency of IL12 receptor

A

Severe mycobacterial infection

Administer IFNg

24
Q

2 roles of TNFa

A

Mediates septic shock

Causes cachexia in malignancy

25
Q

IL-2

A

By T cells
Stimulates growth of CD4+, CD8+ and B cells
Activates NK cells + monocytes (mechanism of anti-cancer effect on metastatic melanoma + renal cell carcinoma)

26
Q

Effects of bacterial toxins on immune cells

A

Superantigens (S aureus, S pyogenes): cross-link beta region of TCR + MHC II on APCs; activate any CD4+

Endotoxins/LPS (G-): bind to TLR4/CD14; activate macrophages. Not Th cells

27
Q

5 characteristics + 8 Live attenuated vaccines

A 
Lose pathogenicity
Transient growth in host
Cellular + humoral responses
Strong, lifelong immunity
CI in pregrancy + immunodeficiency
BCG, influenza (intranasal), measles, mumps, polio (Sabin), rubella, varicella, yellow fever
28
Q

4 characteristics + 4 Inactivated or killed vaccines

A 
Inactivated by heat/chemicals
Maintain epitope
Humoral response
Weaker immunity, boosters required
Rabies, influenza (injection), polio (Salk), hepatitis A
29
Q

HS Type I

A

Anaphylactic + atopic
Antibody-mediated (IgE)
Presensitized mast cells + basophils / preformed Ab
Skin test for specific IgE
Anaphylaxis: release of preformed infl mediators (histamine, tryptase)

30
Q

HS type II

A

Cytotoxic
Antibody-mediated (IgM, IgG)
Ab+complement=MAC
Direct + indirect Coombs’ tests

31
Q

HS type III

A

Immune complex (IgG-Ag) + complement
Neutrophils (lysosomal enzymes)
Ass w/ vasculitis and systemic manif

32
Q

HS type IV

A 
Delayed (1-2 days)
T-cell-mediated
APC present Ag to ThCD4+; cytokines; activate macrophages
No Ab - No complement
Patch test, PPD
33
Q

4 blood transfusion reactions

A

Allergic: HS I, against plasma proteins, ttt antihistamines
Anaphylactic: if IgA deficient give blood without IgA, ttt epinephrine
Febrile nonhemolytic: HS II, Ab against donor HLA+WBCs
Acute hemolytic: HS II, intravascular (ABO incomp) or extravascular (Ag on donor RBCs)

34
Q

Severe combined immunodeficiency

A

Several types (X-linked, autosomal recessive)
Failure to thrive, chronic diarrhea, thrush
Recurrent viral, bacterial, fungal, protozoal infections
Ttt: bone marrow transplant or infection of stem cells by retroviral vectors w/ gene for adenosine deaminase

35
Q

4 findings in Hyper-IgM syndrome

A

Class switching defect (Defect in CD40L on Th cells)
Severe pyogenic inf early in life
Opportunistic inf (Pneumocystis, Cryptosporidium, CMV)
Very low IgG, IgA, IgE

36
Q

7 findings in Leukocyte adhesion deficiency (type 1)

A

Defect in LFA-1 integrin
Impaired migration + chemotaxis
Persistent leukocytosis
Recurrent bacterial skin+mucosal inf, absent pus
Impaired wound healing
Delayed seperation of umbilical cord
High neutrophils but absent neutro at inf site

37
Q

6 findings in Chédiak-Higashi syndrome

A

Defect in LYST
Microtubule dysfunction in phago-lysosome fusion
Pancytopenia: recurrent pyogenic inf (staph+strepto), mild coag def
Partial albinism
Periph neuropathy, progressive neurodegeneration
Infiltrative lymphohistiocytosis

38
Q

5 findings in Chronic granulomatous disease

A

Defect of NADPH oxidase (low ROS, low resp burst in neutro)
No parasitic inf, No viral inf
High suscept to Catalase+ organisms
Diffuse granuloma formation (lung, liver, skin, lymph nodes)
Abnormal DHR test

39
Q

Recurrent infections in B and T cell deficiencies

A

B: bacterial
T: viral, fungal

40
Q

Recurrent infections in B and T cell deficiencies

A

B: bacterial
T: viral, fungal

41
Q

Cyclosporine + Tacrolimus (calcineurin inhibitors) major tocixity

A

Nephrotoxicity

42
Q

2 immunosuppressants in kidney transplant rejection prophylaxis

A

Sirolimus

Daclizumab, basiliximab

43
Q

3 immunosuppressants w/ pancytopenia toxicity

A

Sirolimus
Azathioprine
Mycophenolate mofetil

44
Q

2 recombinant cytokines used for bone marrow recovery

A

G-CSF (Filgrastim)

GM-CSF (Sargramostim)

45
Q

Indications of IFN-a, IFN-b, IFN-g

A

A: chronic hepatitis B and C, Kaposi sarcoma, malignant melanoma
B: multiple sclerosis
G: chronic granulomatous ds

46
Q

2 recombinant cytokines used for thrombocytopenia

A

Thrombopoietin receptor agonists (romiplostim, eltrombopag)

Oprelvekin (IL-11)

Dr. Mel - Immunology (2 decks)

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