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ICS Immunology Flashcards

1
Q

What are the two types of immune responses in humans?

A

Innate and Acquired

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2
Q

What type of immunity is the first line of defense?

A

Innate

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3
Q

Which WBCs are most abundant in humans?

A

Neutrophil

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4
Q

Which antigen presenting cell is considered a professional at activating lymphocytes?

A

Dendritic cell

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5
Q

Which of the following is not a component of innate immune system

a) Skin
b) Antimicrobial peptides
c) Antibodies
d) Mucosa

A

Correct answer= C

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6
Q

Antigen presenting cells process and present antigens for recognition by

A) Neutrophils
B) Red blood cells
C )Eosinophils
D) T cells

A

Correct answer= D

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7
Q

Which of the following are features of the adaptive immune response
A) Does not require prior contact with the pathogen
B) It works with B and T lymphocytes
C) Lacks specificity
D) Distinguishes “self” from “non-self”
E) Enhanced by complement

A

Correct answer= B

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8
Q 
Which of the following is not part of the Elimination phase of complement activation?
A) Opsonisation
B) Production of interferons
C) Target cell lysis
D) Chemoattraction of leukocytes
E) Phagocytosis
A

Correct answer= B

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9
Q

Which of the following vaccines are administered as live attenuated vaccine in the UK- Hepatitis A, Tetanus, MMR, Flu, BCG?

A

Correct answer= MMR and BCG

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10
Q

Which of the following vaccines are delivered as polysaccharide vaccines- Pneumococcal disease, Influenza type B, rabies, Salmonella typhi, meningococcal disease?

A

Correct answer=
Pneumococcal disease
Salmonella typhi
Meningococcal disease

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11
Q 
Influenza vaccine is targeted towards 'at risk' groups in the UK. Which of the following aren't  classified as 'at risk'? 
 A) Asthmatics
 B) Diabetics
 C) The obese of any age
 D) 6 months of age
A

Correct answer= D

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12
Q 
Which of the following is not an organ-specific auto-immune disease?
A) Type 1 diabetes
B) Graves disease
C) Ulcerative colitis
D) Hashimoto's thyroiditis
E) Sjorgren's syndrome
A

Correct answer= C

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13
Q

Which of the following is not a classical PAMPs?
A) Flagellin, a protein found in bacterial flagella
B) Lipopolysaccharide (LPS) from the outer membrane of gram-negative bacteria
C) Peptidoglycan, found in bacterial cell walls
D) Lipoarabinomannan of mycobacteria
E) Interleukin 12

A

Correct answer= E

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14
Q

Is innate or adaptive immunity more specific?

A

Adaptive is more specific

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15
Q

Is memory present in innate or adaptive immunity?

A

Adaptive immunity has memory

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16
Q

What cells are present in innate immunity?

A

Neutrophils, NK cells, Macrophages

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17
Q

What cells are present in adaptive immunity?

A

T cells and B cells

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18
Q

Name some soluble factors in immunity

A

Complement proteins
Antibodies
Cytokines and chemokines

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19
Q

What are the layers that form when centrifuging a blood sample?

A
  • Upper fluid= 55% = plasma
  • Middle layer= Buffy coat
  • Lower layer= 45%= haemocrit
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20
Q

What is plasma composed of?

A

90% Water, some electrolytes, proteins, lipids, sugars

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21
Q

What is a buffy coat?

A

The middle layer that forms when centrifuging a blood sample. It is formed of leukocytes

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22
Q

What is haemocrit?

A

The cell component of a blood sample- including erythrocytes, platelets etc

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23
Q

What is serum?

A

Plasma without fibrinogen and clotting factors

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24
Q

Where are leukocytes made and by what process?

A

Made in the bone marrow by haematopoiesis

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25
Q

Name 3 polymorphonuclear leukocytes?

A
  • Neutrophils
  • Eosinophils
  • Basophils
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26
Q

Name 3 mononuclear leukocytes?

A
  • Monocytes
  • T cells
  • B cells
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27
Q

Name the different types of T cells

A

T-regs
T-helper (CD4, Th1 and Th2)
Cytotoxic T cells (CD8)

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28
Q

What are complement proteins?

A

Group of 20 serum proteins secreted by the liver that are activated as part of the immune system and cause a cascade.

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29
Q

What are the modes of action of complement proteins?

A
  • Direct lysis
  • Attraction of leukocytes to the site of infection
  • Coat invading organism
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30
Q

Name the classes of antibody

A

IgG, IgA, IgM, IgD, IgE

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31
Q

What is an epitope?

A

The part of the antigen that binds to the antibody/ receptor binding site

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32
Q

What is the role of interferons?

A

Induce a state of antiviral resistance in uninfected cells

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33
Q

What is the role of colony stimulating factors?

A

Involved in directing the division and differentiation of bone marrow stem cells (Precursors to leukocytes)

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34
Q

What is the role of tumour necrosis factor?

A

Mediates inflammation and cytotoxic reactions

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35
Q

What is the role of chemokines?

A

Attracts leukocytes

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36
Q

Name some cytokines

A

Interferons, Interleukins, Colony stimulating factors, tumour necrosis factors, chemokines

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37
Q

Name some exterior defenses used by the innate immune system

A
  • Skin
  • Mucous and cilia in bronchi
  • Flushing of the urinary tract
  • Low pH and commensals of vagina
  • Lysozyme in tears
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38
Q

What are the hallmarks of inflammation?

A
  • Increased blood supply
  • Increased vascular permeability
  • Increased leukocyte transendothelial migration (extravasation)
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39
Q

What are the steps of phagocytosis?

A
  1. Binding
  2. Engulfment
  3. Phagosome formation
  4. Phagolysosome
  5. Membrane disruption
  6. Secretion
  7. Antigen presentation
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40
Q

What are PAMPs?

A

Pathogen associated molecular patterns= Common features of pathogens that can be detected by the innate immune system.

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41
Q

Name some PAMPs

A

CpG motifs, Double stranded RNA etc.

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42
Q

What are PRRs?

A

Pattern recognition receptors= A family of proteins which recognises and binds to a variety of pathogen ligands
Includes TLR, NLR

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43
Q

Give some examples of Cell-associated PRRs?

A

TLRs, NLRs, Mannose Receptors

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44
Q

What are toll-like receptors?

A

Receptors found on macrophages, dendritic cells and neutrophils. They recognise and bind to PAMPs. This causes second messengers to cause secretion of inflammatory mediators and stimulate immune cells.

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45
Q

What does TLR4 recognise?

A

Lipopolysaccharies on gram -ve bacteria

Drives signalling

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46
Q

What do pattern recognition receptors recognise?

A

PAMPS (pathogen associated molecular patterns)

DAMPS (Damage associated molecular patterns)

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47
Q

What does NOD2 recognise?

A

Muramyl dipeptide, a breakdown product of peptidoglycan, and this activates inflammatory signalling pathways

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48
Q

What does mannose receptor recognise?

A

Fungi

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49
Q

What is MHC?

A

Major histocompatibility complex. Has a major role in initiating T cell responses, and acts as a safety mechanism to prevent the immune system being activated too easily= proteins that mark a cell as self

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50
Q

Describe MHC I

A

Intracellular, and found on the surface of most cells of the body (Except erythrocytes). Cytotoxic T cells require an antigen to be associated with MHC I proteins before they kill the cell containing the pathogen

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51
Q

Describe MHC II

A

Extracellular and found mainly on the surface of B cells, macrophages and Dendritic cells. T Helper cells require MCH II proteins before they can help B cells.

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52
Q

Briefly describe neutrophils

A

Polymorphonuclear leukocyte with 6-12 hr lifespan. Most abundant WBC in blood, and first line cells in acute infection= release chemotaxins and cytokines. Granular.

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53
Q

Briefly describe macrophages

A

Express CD16- Involved in phagocytosis, with months lifespan. Functions to remove anything foreign or dead. Have lysosomes.
Link between adaptive and innate immunity

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54
Q

Briefly describe eosinophils

A

Make up 5% of blood, and lifespan of 8-12 days. Granules. Associated with parasitic infection. Neutralises histamine.

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55
Q

Briefly describe Basophils

A

Make up 2% of blood, with lifespan of 2 days. Known as circulating mast cells. Role in immunity and allergic response= releases histamine

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56
Q

List the cells/ complexes involved in adaptive immunity

A
  1. Antigen presenting cells
  2. Major histocompatibility complex
  3. T helper cells
  4. Cytotoxic T cells
  5. B cells
  6. Antibodies
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57
Q

What are IgM antibodies role?

A

1st response to antigen

Can’t cross the placenta

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58
Q

What are IgD antibodies roles?

A

B cell activation

Can’t cross placenta

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59
Q

What are IgG antibodies roles?

A 
Most common form 
Crosses placenta (Passive immunity to fetus)
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60
Q

What are IgA antibodies roles?

A

Secreted from mucous membranes

In colostrum

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61
Q

What are IgE antibodies roles?

A

Histamine reactions and allergies

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62
Q

What is an antigen?

A

A molecule that reacts with preformed antibody and specific receptors on T and B cells

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63
Q

What is affinity?

A

A measure of binding strength between an epitope and an antibody binding site- the higher the affinity the better

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64
Q

What are the functions of the complement pathway?

A

Lyse microbes directly
Increase chemotaxis
Opsonisation

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65
Q

Briefly describe the mechanism of the complement pathway

A

Pore-like channels in membrane so water, ions and small molecules enter microbe which disrupts intracellular environment and kills the microbe

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66
Q

What are the three mechanisms of C3 cleavage in the complement?

A

Classical pathway
Alternative pathway
Lectin pathway

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67
Q

What starts the classical pathway?

A

Antibody-antigen immune complexes

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68
Q

What starts the alternative pathway?

A

Foreign surfaces= antigens

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69
Q

What starts the lectin pathway?

A

Lectin binding to mannose on pathogens surfaces

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70
Q

What cells can act as antigen presenting cells?

A

Dendritic cells

Also B cells and macrophages

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71
Q

What is major histocompatibility complex formed of?

A

Proteins that mark a cell as self

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72
Q

Where are T cells formed?

A

Produced in the bone marrow and mature in the thymus

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73
Q

What is the major role of T cells?

A

Recognise the antigen displayed by APCs, and produce cytokines

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74
Q

What is the lifespan of a T cell?

A

hrs-years

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75
Q

What are CD8 cells?

A

Cytotoxic T cells
Induce apoptosis in infected body cells using perforin. Expresses Fas Ligand which binds to Fas 🡪 apoptosis. Recognise Ag in the context of MHC I.

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76
Q

What are CD4 cells?

A

T helper cells= help immune response for intracellular pathogens and help B cells make antibodies. Include TH1 and TH2

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77
Q

What are specific roles of Th1 cells?

A

Cell-mediated immunity. Regulate monocytes and macrophages.

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78
Q

What are the specific roles of Th2 cells?

A

Humoral immunity. Regulators of eosinophils, basophils, and mast cells. Stimulates B cells.

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79
Q

How do Th1 cells cause B cells to produce antibodies?

A
  1. APC presents Ag with MHC II to CD4
  2. Stimulation with high levels of IL-12 activates naieve cells to Th1
  3. Th1 goes into secretory lymphoid tissue
  4. Activated Th1 proliferates
  5. Th1 cell recognises Ag on infected cell via T cell receptor
  6. This induces B cell to produce antibodies via IL-2 secretion
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80
Q

What are the roles of treg cells?

A

Suppresses autoimmunity (Anti inflammatory), and down regulates other T cell subsets via IL-10. Antagonist to Th17 cells.

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81
Q

How are babies protected against diptheria, tetanus, streptococcus, rubella, mumps and polio?

A

Natural passive immunty by the transfer of maternal antibodies across the placenta in a developing foetus

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82
Q

Give some uses of passive artificial immunisation

A
  • Botulism, tetanus and diptheria= given anti toxin

- Hepatitis, measles and rabies= Given prophylactically after exposure

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83
Q

Briefly describe active immunisation

A
  1. Engage innate immune system
  2. Elicit danger signals that activate the immune system, triggers PAMPs and engage TLR receptors
  3. Activate specialist APCs
  4. Engage adaptive immune system= Generate memory T and B cells
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84
Q

Which lasts longer- active or passive immunity?

A

Active immunity

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85
Q

Why is influenza vaccine repeated annually?

A
  • It is important to maintain high levels of antibody

- Influenza mutates frequently so new vaccines must be given

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86
Q

Why is influenza dangerous?

A

It has a rapid onset, and infection can be established before immunological memory can be activated

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87
Q

Which vaccines are given via a living whole organism (Attenuated)?

A

TB (BCG) , Polio sabin, Typhoid, MMR

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88
Q

Which vaccines are given as dead organisms?

A

Anthrax, cholera, hepatitis A, Influenza, Rabies, Polio Salk

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89
Q

What vaccines are given as toxoids (inactivated endotoxins)?

A

Diptheria, neurotoxins

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90
Q

What vaccines are given as capsular polysaccharide vaccines?

A

Pneumococcal disease, salmonella typhi, meningococcal disease

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91
Q

Why may attenuated vaccines be used or not used?

A

+ Full immune response, only single dose required

- Immunocompromised patients may become infected, vaccine needs to be refrigerated

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92
Q

Why may killed, inactivated pathogen vaccines be used or not used?

A

+No risk of infection, less critical storage

- Only activates humoral response, booster vaccines

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93
Q

Why may toxoid vaccines be used or not used?

A

+ Safer as no risk of infection, easier to store

- Less powerful immune response, and booster vaccines needed

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94
Q

What are some pros and cons of passive artificial infection?

A

+ Immediate protection even in immunocompromised patients

- Short lived, serum sickness

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95
Q

What are the three types of subunit vaccines?

A

Toxoids, polysaccharides and recombinant vector vaccines

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96
Q

What is an adjuvant?

A

Any substance that is added to a vaccine to stimulate the immune system ensuring a powerful immune response

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97
Q

Give some examples of adjuvants

A

Whole killed organisms, taxoids, proteins or chemicals

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98
Q

What are notifiable diseases?

A

Diseases, infections and conditions specifically listed as notifable under the public health regulations of 1988.

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99
Q

Why are there notifiable diseases?

A

To detect changes in disease spread, and allows interventions targetted at vulnerable group
It also allows investigation into who may have been exposed.

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100
Q

List some notifiable diseases

A 
MMR diseases 
Cholera
Food poisoning 
Meningitis
Rabies
Leprosy 
SARS
TB
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101
Q

How does meningococcal infection present?

A

Meningitis or septicaemia

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102
Q

What are some complications of meningococcal infection?

A

Brain abcess, brain damage, seizure disorders, hearing impairment, focal neurological disorders, organ failure, gangrene, death

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103
Q

How is meningococcal infection spread?

A

Inhaling respiratory secretion from the throat or mouth, or by direct contact (kissing)

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104
Q

What is the treatment of meningococcal infection?

A

Antibiotic therapy of cefotaxime and ceftriaxone

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105
Q

Who is “at risk” for flu vaccine?

A
  • Those 65 and over
  • Certain medical conditions including asthma and diabetes
  • Long-star residential care
  • Frontline health or social care workers
  • Those that are the main carer for someone at risk
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106
Q

What vaccines are given to 8 week old babies?

A

Infanrix hexa- Hep B, Diptheria, tetnus, polio, pertussis, haemophilius influenza B,
Meningococcal B (Bexsero)
Rotavirus

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107
Q

What vaccines are given to 12 week old babies?

A

Infanrix hexa booster
Rotavirus booster
Pneumococcal

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108
Q

What vaccines are given at 17 weeks?

A

Infanrix hexa booster

Bexsero Booster

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109
Q

What vaccines are given at one year?

A

Haemophilius influenza B and Men C
Pneumococcal booster
MMR
Meningococcal B booster

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110
Q

What vaccines are given at 3 years 4 months?

A

Diptheria, tetanus, pertussis, and polio boosters

MMR booster

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111
Q

What vaccine is given to boys and girls aged 12-13?

A

Human papillomavirus

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112
Q

What vaccines are given at 14 years old?

A

Tetanus, diptheria and polio boosters

Meningococcal groups A, C, W and Y

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113
Q

What vaccine is given at 70 years old?

A

Shingles

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114
Q

Where are B cells produced?

A

Produce and mature in the bone marrow

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115
Q

What can B cells differentiate into?

A

Plasma cells and memory cells

116
Q

What is clonal expansion?

A

When a specific B cell divides, producing new B cells that recognise the same antigen (occurs at lymph nodes)

117
Q

What is the major purpose of the complement pathway?

A

To remove or destroy antigens, either by direct lysis or opsonisation

118
Q

What is opsonisation?

A

A process by which an antigen becomes coated with substances that make it more easily engulfed by phagocytic cells

119
Q

What is the major component of complement activation?

120
Q

What is C3b?

A

The major fragment of activated C3

Mediates a number of vital biological activities particularly opsonisation and lysis of pathogens

121
Q

What is activated during complement activation?

A

C3 component

122
Q

What is C3a?

A

The minor fragment of activated C3. It acts to enhance inflammation

123
Q

What complement proteins are involved in the classical pathway?

A

C1, C4 and C2

124
Q

Briefly explain the classical pathway

A

Antigen:antibody complexes are formed, which activates C1, C4 and C2. This can then activate C3 convertase.

125
Q

What are the primary lymphoid organs?

A

Bone marrow and thymus

126
Q

What are the secondary lymphoid organs?

A

Lymph nodes, spleen, sites of DC and T cell interactions

127
Q

What is a tertiary lymphoid organ?

A

Any accumulations of lymphocytes and stromal cells in an organised structure outside of a secondary lymphoid organ

128
Q

What is within the white pulp of the spleen?

A

Lymphatic tissue, mainly made up of white blood cells

129
Q

What is within the red pulp of the spleen?

A

Blood filled cavities and splenic cords. These contain different types of red and white blood cells

130
Q

What complement elements are involved in formation of MAC?

A

C3b

C5b-C9

131
Q

What complement elements increase chemotaxis?

132
Q

What complement elements aid in opsonisation?

133
Q

What does C5-9 formation cause?

A

MAC formation= Cell lysis

134
Q

What does C3b formation cause?

A

Opsonisation

Removal of immune complexes

135
Q

What does C5a, C4a and C3a formation cause?

A

Inflammation and cell recruitment

136
Q

What is haematopoeisis?

A

The production of all cellular components of the blood and blood plasma

137
Q

What are the two main intracellular granules in neutrophils?

A

Primary lysozymes= Myeloperoxidases

Secondary granules= Specific molecules like lactoferrin and respiratory burst component

138
Q

What is the function of lactoferrin?

A

Binding and transport of iron ions, antibacterial, antiviral

139
Q

Where is lactoferrin found?

A

Within the secondary granules of neutrophils

140
Q

What chromosome codes for MHC?

A

Chromosome 6

141
Q

Give an example of a type 1 hypersensitivity reaction

A

Anaphylaxis, asthma, Hay fever

142
Q

Give an example of a type 2 hypersensitivity reaction

A

Goodpasture’s syndrome

Haemolytic anaemia

143
Q

Give an example of a type 3 hypersensivity reaction

A

SLE
Serum Sickness
Granulatoma
Farmers lung

144
Q

Give an example of a type 4 hypersensitivity reaction

A

TB
Contact dermatitis
Rheumatoid arthritis
IBD

145
Q

What is the mechanism of type 1 hypersensitivity?

A

Production of IgE antibodies

146
Q

What is the mechinism of type 2 hypersensitivity?

A

Antibody binds to an antigen on the target cell, leading to phagocytosis

147
Q

What is the mechanism of type 3 hypersensitivity?

A

Deposition of antigen-antibody complexes

148
Q

What is the mechanism of type 4 hypersensitivity?

A

Activate T lymphocytes

149
Q

What are the clinical features of anaphylaxis?

A

CVS – vasodilation, increased vascular permeability, lowered BP
Respiratory – dyspnoea, mucus production
Skin – rash, swelling
GI – pain, vomiting

150
Q

What happens in reoxposure to an irritant in anaphylaxis?

A
  1. Allergen bind to IgE
  2. Causes receptor cross linking, triggering a signal transduction cascade
  3. Mast cell degranulation and release of pharmacologically active substances= Histamine, Slow Reacting Substance-A (SRS-A), prostaglandins – induces inflammation,
151
Q

Which is more potent; Histamine or SRS-A?

152
Q

Which type of antibody crosses the placenta?

153
Q

Which type of antibody is in the colostrum?

154
Q 
Which of the following is not a component of the innate immune system?
A) Complement system
B) Toll-like receptors
C) Macrophages
D) T helper cells 
E) C-reactive protein
A

Correct answer= D

155
Q 
Which of the following is a type 3 hypersensitivity reaction-
A) Tuberculosis
B) Goodpasture’s Disease
C) Systemic Lupus Erythematosus
D) Contact Dermatitis
E) Anaphylaxis
A

Correct answer= C

156
Q 
Which of the following antibodies is implicated in asthma?
IgG
IgA
IgM
IgE
IgD
A

Correct answer= D

157
Q 
Which of the following antibodies is implicated in the secondary response to infection? 
IgG
IgA
IgM
IgE
IgD
A

Correct answer= A

158
Q

What drugs can be used to treat anaphylaxis?

A 
IM Adrenaline
IV hydrocortisone
IV Chlorphenamine
IV Fluids
Oxygen
159
Q

What is the process of the alternative pathway?

A
  1. C3 undergoes spontaneous and continuous cleavage into C3a and C3b
  2. C3b is then able to combine with factor D and B to form the active enzyme C3bBb also known as C3 convertase
  3. C3bBb can go on to break down more C3 producing more C3a and C3b
160
Q

What is the process of the lecthin pathway?

A

Mannose binding lectin binds mannose on pathogen surfaces, activating C3 convertase

161
Q

What would a complement deficiency cause?

A

Recurrent infections

162
Q

What is systemic lupus erythrematous?

A

An autoimmune disease, resulting in impaired clearance of apoptotic cells and immune complexes

163
Q

What is atopy?

A

Inherited tendency for overproduction of IgE antibodies to common environmental antigens

164
Q

Briefly define haemolytic disease of the newborn

A

The mother is RhD negative but the baby is RhD positive. When the mothers blood is exposed to baby’s blood, mothers immune system recognises the foreign blood and begins making antibodies against baby’s blood. The first baby is unaffected, but the mother is sensitised to rhesus postive blood. If mother’s second baby also has RhD positive blood, then antibodies are produced immediately, and begin destroying babies’ erythrocytes, resulting in haemolysis of the foetus and newborn.

165
Q

Which type of hypersensitivity reaction is independent of antibodies?

A

Type 4 reaction

166
Q

What is an allergy?

A

Abnormal response to a harmless foreign material

167
Q

What cell type releases histamine?

A

Mast cells

Basophils

168
Q

What types of chains are in antibodies?

A

2 identical heavy chains and two identical light chains

169
Q

How may different types of heavy chains are there?

170
Q

How many different types of light chains are there?

171
Q

Which region of the antibody binds to the antigen?

A

Variable regions

172
Q

What is an interleukin?

A

A cytokine that acts between cell of the immune system

173
Q

What is a chemokine?

A

A group of proteins that direct the movement of leukocytes from the blood stream into the tissues or lymph nodes by binding to specific receptors

174
Q

What cells release CXCL?

A

Neutrophils

175
Q

What cells release CCL?

A

Monocytes, lymphocytes, eosinophils, and basophils

176
Q

What is VDJ recombination?

A

The diversity of T cell receptors and antibody/ Immunoglobulins on B cells

177
Q

Describe hyperacute transplant rejection

A

Occurs minutes to hours following transplantation, due to performed circulating cytotoxic antibody which reacts with MHC class I antigens in the donor organ.

178
Q

Describe acute transplant rejection

A

Occurs a few days or weeks following transplantation in up to 20% of all transplants. Associated with increased expression of MHC class I and class II antigens in inflamed grafts, and with early infiltration of CD8+ T lymphocytes.

179
Q

What are the two phases of transplant rejection?

A

Afferent and efferent

180
Q

What drugs can be used to prevent graft rejection?

A

Ciclosporin, azathioprine, corticosteroids and specific monoclonal antibodies.

181
Q

What is immunodeficiency?

A

Deficiency in the immune response, can either acquired or inherited

182
Q

What cell type is implicated in HIV?

A

CD4+ T cells

183
Q

What is Hypogammaglobulinemia?

A

Low immunoglobulins

184
Q

List some organ specific autoimmune diseases

A

Type 1 diabetes mellitus
Hashimoto’s thyroiditis
Pernicious anaemia
Multiple sclerosis

185
Q

Describe how you would identify a bacteria as Salmonella using Microbiology tests including differentiating it from Shigella

A

Salmonella is a gram-negative bacilli. Gram Stain= Pink.

  • Bacilli Appearance= Rod shaped.
  • MacConkey Agar tests for fermentation of lactose, Salmonella does not therefore plate remains clear (fermenters go pink).
  • Do serotyping (API strip) to confirm Salmonella vs Shigella.
186
Q

HIV can be diagnosed by measuring the level of a specific white blood cell. Which type of cell is measured? What level indicates AIDS?

A

CD4+ count

<200

187
Q

HIV is a global condition. Name 3 at risk groups for HIV and the age group for which 50% of all new infections worldwide occur

A

At risk Groups= Men who have sex with men, IVDU, Commercial sex workers.
Age group: 19-24yo

188
Q

Name the different types of polymorphonuclear leukocytes and which is the most abundant.

A

Polymorphonuclear Leukocytes: Neutrophil, Basophil, Eosinophil.
Most abundant = Neutrophil.

189
Q

List some allergic diseases

A

Anaphylaxis, allergic asthma, allergic rhinitis, eczema, allergic conjunctivitis, oral allergy syndrome, angioedema

190
Q

What immunglobulin is used in allergy?

191
Q

What are the major cells involved in allergy which express high affinity IgE receptors?

A

Mast cells, eosinophils, basophils

192
Q

List some mediators of allergic responses

A

Cytokines, Chemokines, lipids, small molecules

193
Q

What is the high affinity receptor for IgE?

A

Fc(epsilon)RI

194
Q

What effects does histamine have?

A

Vasodilation, increased vascular permeability, bronchoconstriction= allowing for neutrophil extravasation

195
Q

What is the low affinity receptor for IgE?

A

Fc(Epsilon)RII

Also known as CD23

196
Q

What is the function of low affinity receptor IgE ?

A

Regulation of IgE synthesis

197
Q

What cell is the main effector cell in IgE mediated immunit?

A

Mast cells

198
Q

What is c-kit protein?

A

The protein that is required for mass cell development

199
Q

What compounds to mast cells carry?

A

Histamine, chemotactic factors, proteases, proteoglycans
Leukotrienes. Prostaglandin D2, Platelet activating factor
Cytokines

200
Q

What is the serum marker of allergy?

201
Q

What is the function of prostaglandin D2?

A

It is a potent inducer of smooth muscle contraction

202
Q

What do mast cell cytokines do?

A

Promote a Th2 response and lead to B cell class switching, leading to IgE production

203
Q

What do mast cell chemotactic factors do?

A

Lead to eosinophil attraction and activation

204
Q

List some allergens

A

Latex, venoms, foods, drugs, pollens, dust mite faeces

205
Q

Why is prior sensitization required for allergy?

A

To have production of IgE (without prior sentisiation, there won’t be an immune response)= APC activated T helper cell, which uses IL4 to cause a class switch of antibodies on B cells to IgE, and uses IL21 to activate these B cells to become IgE plasma cells. IgD is class switched to IgE and IgE mast cells form

206
Q

What happens on second exposure to an allergen?

A

The allergen cross links IgE on mast cells using the Fc(epsilon) receptor, which degranulate and release histamine

207
Q

What is the effect of prostaglandin release from mast cells?

A

Bronchospasm

208
Q

What is the role of IL4 in type 1 reactions?

A

It is responsible for class switching of antibodies into IgE immunoglobulins

209
Q 
Which type of cytokine causes B cells to produce IgE?
A) IL-1
B) IL-3
C) IL-4
D) IL-5
E) IL-13
A

Correct answer= C

210
Q

What is cross linking?

A

One allergen binding to two seperate antibodies

211
Q 
What type of T cell plays an important role in type 1 hypersensitivity reactions? 
A) Th-1
B) Th-2
C) Th-17
D) TC
E) Treg
A

Correct answer= B

212
Q

Which IL’s are anti-inflammatory?

A

IL-4 and IL-10

213
Q

What does TLRR2 detect?

A

Lipoteichoic acid on gram +ve bacteria

214
Q

What is the main pattern recognition receptor responsible for detecting gram +Ve bacteria?

215
Q

What is the main pattern recognition receptor responsible for detecting gram -Ve bacteria?

216
Q

In general, where would you find a TLR that detects genetic material?

A

Endosomes within cells

217
Q

In general, where would you find a TLR that does not detect genetic material?

A

Cell membranes

218
Q

In general, where would you find a NLR?

219
Q

How are macrophages formed?

A

They are derived from circulating monocytes and activated by INF gamma

220
Q

Is TNF-Alpha pro or anti-inflammatory?

A

Major pro-inflammatory (causes fever and neutrophil chemotaxis)

221
Q

What cells produce TNF-alpha?

A

Macrophages

222
Q

How do neutrophils kill pathogens?

A

Neutrophils are attracted to the site via IL-8. They kill by internalising bacteria and degranulating their contents into a phagolysosome. Major components include alpha-defensins and lactoferrin.
They can also kill via respiratory burst

223
Q

What enzymes do NK cells contain?

A

Granules contain perforin and granzymes that induce apoptosis and cell lysis

224
Q

How does a NK cell recognise self from non-self?

A

Recognise self and non-self by the presence of MHC-I on cell surfaces

225
Q

What receptor do NK cells have which aid in killing?

226
Q

What 3 things must occur for a response to happen when immune cells come together?

A
  1. Binding of primary receptors e.g. TCR to MHC II.
  2. Binding of co-stimulatory molecules e.g. CD28/CTLA4 to CD80/CD86.
  3. A robust release of the appropriate cytokines.
227
Q

What is meant by “naive cell”?

A

It has not yet encountered an antigen

228
Q

What are the roles of Th17 cells?

A

Leads to inflammation via IL-17. Active at mucosal membranes. Antagonist to Treg cells.

229
Q

What is CD3 a marker of?

230
Q

What are CD19 and CD20 a marker of?

A

Mature B cells

231
Q

What is an effector B cell?

A

Plasma cell

232
Q

What are the stages of B cell activation?

A
  • Clonal expansion
  • Somatic hypermutation
  • Improved affinity (or disadvantageous mutations)
  • Selection
  • Class switching
  • Differentiation into plasma or memory cells
233
Q

What is the role of the constant region of an antibody?

A

Constant region determines Antibody type and therefore effector function.

234
Q

What is the role of the fab region of an antibody?

A

Fab region (antigen-binding fragment) bind epitopes of antigen.

235
Q

What is the role of the Fc region of an antibody?

A

Fc region (fragment crystallizable region) is the area that binds Fc receptors on immune cell surfaces

236
Q

Which cell type is raised in bacterial infection?

A

Neutrophils= Neutrophilia especially in pyogenic infections

237
Q

Which cell type is raised in viral infections?

A

Lymphocytes= Lymphocytosis

238
Q 
Which of the following antibodies is implicated in the primary response to infection? 
IgG
IgA
IgM
IgE
IgD
239
Q

What is a hypersensitivity reaction?

A

Undesirable response to antigenic, allergenic, self material. This requires a pre-sensitized state of the host.

240
Q

What is the negative phase of a vaccine?

A

A period after initial antigen exposure where ones immunity is actually lower than before encountering the antigen

241
Q

What is the role of IL-1?

A

Acute inflammation, Induces fever

242
Q

What cells produce IL-10 and what is its role?

A

Produced by Th2 cells

Inhibits Th1 cytokine production (anti inflammatory)

243
Q

What is HLA-A3 associated with?

A

Haemochromatosis

244
Q

What is HLA-B27 associated with?

A

Ankylosing spondylitis
Reiter’s syndrome
Acute anterior uveitis

245
Q

What is HLA-DQ2/DQ8 assocaited with?

A

Coeliac’s disease

246
Q

What is HLA-DR3 associated with?

A

Dermatitis herpetiformis
Sjogren’s syndrome
Primary biliary cirrhosis

247
Q

What is HLA-DR4 associated with?

A

Type 1 diabetes mellitus

Rheumatoid arthritis

248
Q 
The immune system is made up of both innate and adaptive aspects and involves a variety of cells. Which is the most abundant white blood cell in humans?
Basophils
CRP 
Neutrophils
Mast Cells
Lymphocytes
249
Q 
A mother brings her 3-year-old child to the GP saying he has a fever and is generally unwell. The GP suspects the they have a viral infections such as respiratory syncytial virus. What cell would you expect to be raised in this patient?
Mast Cell
Microglia  
Neutrophils
Macrophages
Lymphocytes
250
Q 
A 34-year-old male comes into the GP complaining of haemoptysis. He notes that he wakes up at night due to waking up in a pool of sweat and mentions he recently returned from a holiday in Pakistan. The GP suspects tuberculosis. Which of the following cytokines is primarily responsible for activating macrophages?
IL-2 
IL-4
TNFα
IL-1β
IFN-γ
251
Q 
A 5-year-old girl is brought to the GP after repeated episodes of allergic rhinitis and eczema. Which cytokine is involved in atopy and, amongst other things, causes class switching of immunoglobulins to IgE?
IL-4 
IL-17 
IL-5
IL-1β
IFN-γ
252
Q 
A 35-year-old woman presents to her GP complaining of unintentional weight loss, palpitations, and oligomenorrhoea. She is subsequently diagnosed with Graves disease by a specialist. Given their involvement in autoimmunity, where does T cell maturation occur? 
Spleen
Bone Marrow
Bursa of Fabricius 
Thymus 
Liver
253
Q 
It’s your first day on placement and you take a history from an elderly gentleman who is currently running a high-grade fever. You later find out he is currently suffering from a Pseudomonas aeruginosa infection. Which pattern recognition receptor is most likely to detect this infection?
TLR2
TLR6
TLR4
NOD-2
RIG1
254
Q 
It’s your second day on placement and you take a history from an elderly gentleman who is currently running a high-grade fever. You later find out he is currently suffering from a Streptococcus pneumoniae infection. Which pattern recognition receptor is most likely to detect this infection?
TLR2
TLR6
TLR4
NOD-2
RIG1
255
Q 
An intravenous drug user presents to A&E complaining of fever, a hot painful red lump, and general malaise. The F1 who clerked them suspects an MRSA infection. Which white blood cell is most likely to be raised in this patient?
Neutrophil
Mast Cell
Basophil
Lymphocyte 
Dendritic cell
256
Q 
An infant presents to hospital with a fever, shortness of breath and a cough producing yellow sputum. She has had many previous admissions due to similar infections and has been diagnosed with a deficiency in mannose binding lectin (MBL). Which substance is failing to trigger a complement cascade reaction in this patient?
IgE
IgM
C3 Convertase
Pathogen surface carbohydrates. 
Membrane attack complex
257
Q 
A 13-year-old boy has been brought to the GP by his dad after having a sore throat and a cough for the last week. After an examination, the GP concludes that he likely has a viral infection that will resolve without other treatment. Which immune cells are responsible for directly combating this type of infection through apoptosis? 
Basophils 
Plasma Cells 
T helper cells Neutrophils 
Cytotoxic T-cells
258
Q 
A 10-year-old boy presents with an itchy rash on his elbows. The rash is red and there are excoriation marks. He has a past history of hay fever and has generally dry skin. The GP diagnoses him with eczema and he is prescribed hydrocortisone. Which antibody is responsible for mediating type 1 hypersensitivity?
IgG
IgA
IgM
IgE
IgD
259
Q 
An office worker has recently taken time off due to contracting the flu. A few weeks later other members of their office start showing flu symptoms. The worker asked his GP if he is at risk of contracting the flu again. Which antibody is responsible for secondary responses to a previous infection?
IgG
IgA
IgM
IgE
IgD
260
Q 
A mother is concerned about infection of her newborn child. She asks her GP about best to protect their child from infections. Which is the most abundant antibody in colostrum?
IgG
IgA
IgM
IgE
IgD
261
Q 
A 38-year-old male attends the human immunodeficiency virus (HIV) clinic for routine blood tests for monitoring of his condition. The number of which of the following cells is used to measure the progression of disease in HIV positive patients?
Neutrophils
B Cells
NK cells 
CD4 T cells 
CD8 T cells
262
Q 
A 34-year-old man is referred to the gastroenterologist due to persistent epigastric pain and nausea. He returned travelling from south-east Asia ten weeks ago. Blood tests reveal iron deficiency anaemia, and faecal microscopy reveals the presence of hookworm eggs. Which immune cell is responsible for the defense against helminths (parasitic worms)?
Basophils
Eosinophils 
Neutrophils 
Macrophages 
Dendritic Cells
263
Q 
A 14-year-old boy complains of a 3-day history of fatigue, aches and pains, and fever. Upon examination his temperature is 38ºC and his tonsils are inflamed. He is suspected to have a bacterial infection which will be fought by his adaptive immune system. Which of the following cell-surface proteins are found on cytotoxic T-cells?
CD4 
CRP 
MHC I
CD 8 
MHC II
264
Q 
A 65-year-old man is admitted to hospital following a fall. He subsequently developed hospital-acquired pneumonia. Given the most likely causative microorganism, which molecule is responsible for presenting its antigenic material to immune cells?
CD4 
MHC III 
MHC I
TCR
MHC II
265
Q 
A father brings their 6-year-old boy to the GP complaining of an incredibly lengthy chest infection and recurrent gastritis. He is referred to an immunologist. His bloods extremely low levels of IgA and IgG. He is diagnosed with common variable immunodeficiency (CVID). Which adaptive cell type is essential in aiding class switching of B cells? 
Natural Killer T cells. 
Th17 cells 
Th2 cells 
Th1 cells
Dendritic Cells
266
Q

A 24-year-old lady collapses after being stung by a wasp. You run to her aid and find marked facial oedema and a loud wheeze. You suspect anaphylaxis. Which type of immunoglobulin (Ig) is associated with this kind of reaction?

IgG
IgA
IgM
IgE
IgD
267
Q

What is Anti-CCP associated with?

A

Rheumatoid arthritis

268
Q

What is Anti-IgG (RF) associated with?

A

Rheumatoid arthritis

269
Q

What is Anti-dsDNA assocaited with?

270
Q

What is Anti-Nuclear antibodies associated with?

271
Q

What is anti-histone assocaited with?

A

Drug induced lupus

272
Q

What is anti Ro and Anti lo associated with?

A

Sjorgrens syndrome, SLE

273
Q

What is anti-phospholipid associated with?

A

Antiphospholipid syndrome

274
Q

What is anti-mitochondrial antibody associated with?

A

Primary biliary cirrhosis

275
Q

What is anti-thyroid peroxidase assocaited with?

A

Hashimoto thyroiditis

276
Q

What is anti-thyroglobulin associated with?

A

Hashimoto thyroiditis

277
Q

What is anti-Ho associated with?

A

Dermatomyositis and polymyositis

278
Q

What is anti-basement membrane associated with?

A

Goodpasture syndrome

279
Q

What is anti-gliadin IgA associated with?

280
Q

What is anti-endomysial IgA associated with?

281
Q

What is anti-transglutanase IgA associated with?

282
Q

What is p-ANCA associated with?

A

Microscopic polyangitis

Churg-strauss syndrome

283
Q

What is C-ANCA assocaited with?

A

Wegener granulomatosis

284
Q

What is anti-glutamic acid decarboxylase associated with?

A

Diabetes type 1

285
Q

What TLR is associated with flagellin?

286
Q

What TLR is double stranded DNA associated with?

Phase 2a (31 decks)

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