I - Immune Modulation

Question 1

Describe how Ag exposure leads to immune memory

Answer 1

Ag exposure —> APC —> clonal expansion following exposure to Ag —> IgM T cells or IgG/A —> immunological memory

Question 2

Where does IgM act on to produce plasma cells

Answer 2

Germinal centre

Question 3

Which AB has higher affinity, IgG or IgM

Answer 3

IgG > IgM

Question 4

Which type of memory cells have higher affinity / longevity

Answer 4

B cell memory cells

Question 5

How do AB prevent influenza infection

Answer 5

Influenza and RBC reaction is inhibited by ABs to haemaglutanin

Question 6

What type of reaction is Mantoux test for TB

Answer 6

Type 4 mediated reaction

Question 7

Examples of live attenuated vaccines (7)

Answer 7

MMR
BCG
Yellow fever
Zostavax
Typhoid (oral)
Polio (Sabin oral)
Influenza nasal spray

Question 8

Who can’t have live attenuated vaccines

Answer 8

Imm supp

Question 9

4 benefits of live attenuated

Answer 9

Establishes infection
Broad imm response against multiple Ag
T&B cell response
1 dose for life

Question 10

3 cons of live attenuated vaccines

Answer 10

Rare - can revert to virulence
Spread to contacts potentially
Storage issues

Question 11

5 examples of inactivated vaccines

Answer 11

Influenza
Cholera
Hep a
Pertussis
Raboies

Question 12

3 examples of subunit vaccines

Answer 12

Hep B s Ag
HPV capsid
Flu (not used much)

Question 13

2 examples of toxoid vaccines

Answer 13

Diphtheria
Tetanus

Question 14

4 benefits of inactivated / component vaccines

Answer 14

No reversion to virulence
Cheap
Easy to store
Imm supp

Question 15

3 cons of inactivated / component vaccines

Answer 15

Multi dose
Narrower immune response
Poor immunogenicity

Question 16

Who gets conjugate vaccines mainly

Answer 16

Kids

Question 17

Example of conjugate vaccine

Answer 17

HiB

Question 18

What is the conjugate vaccine made of

Answer 18

Polysaccaride and protein

Question 19

How do adjuvant vaccines work

Answer 19

Mimic PAMPs on TLR to activate adaptive imm resp

Question 20

What adjuvants are added to adjuvant vaccines

Answer 20

Aluminium salts or lipids

Question 21

2 benefits of mRNA vaccines

Answer 21

Non infectious
Non integrating

Question 22

Wha type of vaccine is Covid AZ

Answer 22

Adenoviral vector

Question 23

On whom are dendritic cell vaccines used

Answer 23

Oncology pts

Question 24

Give an example of dendritic cell vaccine

Answer 24

Provenge for prostate cancer

Question 25

How does cytokine therapy help immunity

Answer 25

Stimulate T cells
Enhance macrophage function
Antiviral

Question 26

How can replacing missing components help the immune response (give eg)

Answer 26

Bone marrow transplant / haematopoeitic stem cell transplant

Question 27

Indications for AB replacement

Answer 27

Primary AB def - x linked gamma globulinaemia
Secondary AB def - CLL / MM

Question 28

Why would you replace specific Ig

Answer 28

Post exposure prophylaxis

Question 29

When would Ig be given for hep B

Answer 29

Needle stick injury

Question 30

When would rabies Ig be given

Answer 30

Post bite

Question 31

When would VZV Ig be given

Answer 31

Women <20 weeks pregnant
Imm supp

Question 32

Give 3 types of adoptive cell transfer (ACT)

Answer 32

Virus specific T cells
Tumour infiltrating T cells
Manipulated T cells - CART cells

Question 33

When would virus specific ACT be done

Answer 33

Anti EBV in post transplant pt

Question 34

When would tumour infiltrating T cell ACT be used

Answer 34

Melanoma

Question 35

How does targeting PD1 allow tumour lysis

Answer 35

PD1 = programmed death 1 (its a checkpoint inhibitor)
Present on APC / tumour cells - AB to PD1 = blocks neg reg of tumour cells

Question 36

Which cancers can anti PD1 be used on

Answer 36

Melanoma
Renal cell carcinoma
Now loads of cancers

Question 37

Complications of checkpoint inhibitors

Answer 37

Autoimmunity eg thyroid disease