Immune Flashcards
1
Q
under function abnormality of immune
A
HIV
immunosuppression
2
Q
over function abnormality of immune
A
autoimmune disease
3
Q
unhelpful abnormality of immune
A
transplant
4
Q
2 types of immunity
A
innate and acquired/adaptive
5
Q
first line of defense
A
innate immunity
6
Q
has external and internal defense
A
innate
7
Q
2 types of innate immunity
A
non-specific
non-adaptive
8
Q
same response for different pathogens (virus, fungi)
Includes inflammation phagocytes
A
non specific innate immunity
9
Q
no memory of pathogen
A
non adaptive innate immunity
10
Q
Specificity and Memory increase for?
A
adaptive or acquired immunity
11
Q
Transplacental antibodies, breast milk
A
passive immunity
12
Q
vaccine, natural infection
A
active immunity
13
Q
first response external responses
A
physical and chemical
14
Q
skin, mucus, cough, sneeze
A
physical/mechanical barrier
15
Q
lysozyme (tears)
A
chemical/biochemical barrier
16
Q
2 factors of internal defense
A
soluble
cellular
17
Q
cytokines are what kind of internal defense
A
soluble factor
18
Q
neutrophils, natural killer cells are what kind of internal defense
A
cellular factors
19
Q
internal defenses create what
A
PAMPs
20
Q
what does PAMPs stand for
A
pathogen associated molecular patterns
21
Q
example of PAMPs
A
interferons
22
Q
Start local reaction
Inc vascular permeability, change blood flow, WBC migration
A
PAMPs
23
Q
the 3 ways how our body recognizes self vs non-self
A
MHC class I genes class II genes
24
Q
Membrane proteins to present antigens to T cellsspecificity
HLA: Genes from Chromosome 6
Autoimmune diseases prevalent – RA, graft vs host disease, etc
A
MHC
25
HLA-A, HLA-B, HLA-C
On all nucleated cells; maternal + paternal genes
class I genes
26
HLA-DR, HLA-DP, HLA-DQ
On skin cells, dendritic cells, monocytes/macrophages, B cells, activated T cells
class II genes
27
any foreign substance that causes immune ponse
Bacteria, virus, transplant tissue
Must activate B cell receptors
antigen
28
SPECIFIC, superficial pieces of antigen that bindsto T cell receptor or antibody
epitope
29
made by B cells, interact with epitope
antibody
30
Innate immunity
| Ingest ???? and kill them to prevent infection
pathogens
31
phagocytes Initiate immune response via release of
interleukin-1
32
first defense
| Die after phagocytosispus
neutrophils
33
Filter debris after neutrophils, clean up bacteria
| Macrophage takes epitope and presents it to CD4 or T4
monocyte
| macrophages
34
allergic reaction
eosinophils
| basophils
35
```
Functions:
Initiate immune response
Increased temperature (fever) via hypothalamusIncreased serotonin (sleep,nausea)
Lowers pain threshold via prostaglandin
```
interleukin-1 functions
36
Coat pathogens so they are targeted by phagocytes
Released by cells infected with virus to protect healthy cells Inhibit tumor growth
Decreases the rate of infection
interferon
37
Function: kill infected cells, tumor cells
natural killer cells
38
Large, granular lymphocytes
| Stored in blood and spleengo to infected tissue with inflammatory cytokines
natural killer cells
39
NO antigen specific receptors, USE activating or inhibitory receptors
natural killer cells
40
Mediated by B cell antibodies
humoral immunity
41
Attack free floating pathogens
B cells made in bone marrow and then spread through lymph system
B cell clones react to foreign antigens
Need signal from helper T cells to start to proliferate
Plasma cells are mature B cells that produce large quantity of antibodies
Memory B cells
humoral immunity
42
B cells make 5 types of antibodies:
Ig"letter"
| GMADE
43
(antiviral, antibacterial, transplacental)
| 2nd common antibody
IgG
44
primary response antibody
IgM
45
(mucus membrane, breast milk, respiratory, GI)
| antibody
IgA
46
(antigen receptor
| antibody
IgD
47
parasites, allergies
| antibody
IgE
48
Directly attack antigens, destroy/neutralize
Activate death cascade in complement systemActivate allergic response
Stimulate antibody-mediated hypersensitivity
immunoglobins
49
Protection against intracellular “hidden” pathogens
cell mediated immunity
50
Helper T cellslymphokines stimulate B cells, activate macrophages, help NK cellsSuppressor T cells
CD4 T cells
51
Cytotoxic T cellsMemory T cells
CD8 T cells
52
T cells do what to immune response?
amplify or reduce
53
5 phases of immune response
```
recognition
amplification
effector
termination
memory
```
54
immune receptors bind to pathogens, antibodies bind
recognition phase
55
soluble factors and phagocytes recruited
| Proliferate T and B cells, replicate
amplification phase
56
remove antigens via lysis, phagocytosis, cytotoxic T cells
effector phase
57
dampen immune response when antigen is gone
termination phase
58
T and B cells for quick response
memory phase
59
to enhance immune function, what kind of exercise do you do?
moderate exercise
60
what kind of exercise do you do to suppress immune function?
strenuous exercise
61
Failure of self vs non-self
Systemic (ie. Systemic Lupus Erythematosus)Organ specific (ie. Hashimotos)
autoantibodies created
autoimmune disorders
62
```
Risk Factors:
Genetics (HLA)
Hormonal (women)Environmental
Medications
Virus
Stress
```
autoimmune disorders
63
```
Pathogenesis
T cells not activated
Overstimulation of organ functionCross reaction to epitopes
Autoantibodies
```
autoimmune disease
64
Symptoms: most include increased inflammatory response (-itis, -algia)
Ie. Vasculitis, arthralgia
autoimmune disease
65
Treatment:
Must balance suppression of autoimmune reaction and regular immune function
autoimmune diseases
66
systemic and progressive disease
lupus
67
```
Types:
Discoid/cutaneous (skin)
Systemic (flare, remission)Drug-Induced
```
lupus
68
unknown etiology for this disease
lupus
69
```
Risk factors:
Genetics- familial with first degree relatives
Triggers:
Antibiotics (sulfa)
Stress- neuroendocrine
UV light
Infections
Hormones/Pregnancy- low dose estrogen BCP
```
Epstein-Barr virus
lupus
70
Incidence: 1.8 to 7.6/100,000 per yearWomen (10:1), 15-40 yo
| African Ams, Hispanics> Caucasians
lupus
71
Comorbidities of other autoimmune dysfunction (thyroid, anemia)
lupus
72
Cause of death: organ failure, infection or CVD (accelerated atherosclerosis)Compliance with tx difficult in child bearing women
lupus
73
3 mechanisms for what?
Autoantibodies (generalized)
Vascular abnormalities (vasculitis) Accelerated atherosclerosis
Inflammatory mediators
for lupus to begin
74
general lupus sx
fatigue
fever
weight loss
75
MSK lupus sx
arthralgia
76
skin lupus sx
butterfly rash
77
cardiopulmonary lupus sx
pleuritis
| myocarditis
78
CNS lupus sx
depression
79
renal lupus sx
kidney failure
80
SLICC classification criteria
1 clinical or immunologic
OR
biopsy proven lupus nephritis with ANAs
81
```
Acute/cutaneous lupus- butterfly rash, discoid
rash
Alopecia
Synovitis of two joints with 30 mins of AM stiffnessSerositis (pleurisy, pericardial pain)
Renal involvement
Neurologic manifestations
Hemolytic anemia
Leukopenia
Thrombocytopenia
```
what kind of criteria?
clinical criteria for lupus
82
(+) ANA (antinuclear antibody)(+) DNA antibody
High ESR and CRP
what kind of criteria?
immunologic criteria for lupus
83
lupus diagnosis
ANA test
84
Mild cases: NSAIDs for pain and inflammation, avoid UV light, exerciseTarget symptoms:
Cardiac- corticosteroid-sparing drugs (methotrexate), anticoagulants
Skin, arthritis, renal- antimalarial drugs (Plaquenil)
Immunosuppression (Cytoxan)
treatment for?
lupus
85
Prognosis:
Early detection prevents organ damageCVD
Lymphoma
Renal disease
lupus
86
Prednisone, Decadron, Hydrocortisone
Blocks prostaglandins that trigger allergies, inflammation
corticosteroids
87
corticosteroids do what?
help decrease inflammation for autoimmune disorders
88
```
Decreased WBC
Weight gain
Facial swelling (cushinoid)
Increased fat in neck/abdomen (buffalo hump)AVN –Avascular necrosis
Bruising
DM
HTN
Osteoporosis
Acne
Cataracts
Muscle atrophy
Mood swings
```
negative side effects for using?
corticosteroids
89
another option besides corticosteroids to help reduce immune response
immunosuppressants
90
Antimetabolites
Alkalating agents
Mycophenolate
Cyclosporine
immunosuppressants
91
Side Effects:
Infection, malignancy, liver toxicity, kidney disease, easy bruising,
Pancreatitis
using immunosuppressants
92
2 functions of immune system
protect self
| create effector response to target invader
93
Autoimmune disease of GI tract
IBD
94
chronic, inflammatory disorder usually of the colon,ileum Affects 3 layers of bowel; exacerbations and remissions
crohns disease
95
inflammation of the mucosa in the colon/rectum, can spread proximally
ulcerative colitis
96
Genetics, immune system
Incidence: All age groups, both genders, between 15 to 35 yo
More common in those from eastern Europe, Jews of European decent, urban dwellers, northern climates, developed countries
IBD
97
Higher cytokines production
Interleukin 1, IgM, IgA, and IgG levels
IBD
98
diarrhea, abdominal pain, GI bleeding, weight loss, fever, malaise, skin rash
common sx b/w what
crohns disease and ulcerative colitis
99
Abdominal mass (granuloma)Skip lesions
Growth retardation (peds)
Thickened bowel wall
Fissures, fistulas
sx for?
crohns disease
100
Bloody stools
Severe diarrhea
IgG₁ (colon epithelial antibody)Cancer fairly common
signs and sx for?
ulcerative colitis
101
Diagnosis
Biopsy: endoscopy, colonoscopy
Blood test: infection, anemia, Ig levels
IBD
102
```
Treatment
Medical followed by maintenance
Sulfa, 5 aminosalicylates (UC)
Glucocorticoids
Monoclonal antibody
Immunosuppressant
Surgery (UC cure, CD symptoms)
```
IBD
103
PT Implications
Cancer risk
Low back pain, hip pain, SI joint pain DDX
Osteoporosis (dec absorption, steroid use)Hydration
Psych factors: anger, anxiety, depression
IBD
104
```
Chronic muscle pain syndrome with allodynia or hyperalgesia to pressure pain
Hypersensitive to pain stimuli
Reduced pain inhibition`
```
fibromyalgia
105
```
Comorbidities:
Inflammatory disease (RA, SLE)
Metabolic dysfunction (thyroid)Cancer
```
fibromyalgia
106
Incidence:
Most common MSK disorder in the USWomen>men (90% women)
Childbearing ages 20-55 yo
fibromyalgia
107
```
Risk Factors: “triggers”
Prolonged psychological stress (anxiety, PTSD, bipolar)Trauma (MVA)
Steroid withdrawal
Hypothyroidism
Viral infections
```
fibromyalgia
108
```
Diffuse muscle pain, tender points
Fatigue, exhaustion, disordered sleep
Migraines
Irritable bowel syndrome
Psychological sx: depression, anxiety
Diaphragm not primary respiratory muscleMuscle “over activity”
```
signs and sx for
fibromyalgia
109
exacerbated by stress
fibromyalgia
110
Widespread (4 quadrant) pain above and below the waist for at least 3 mos
Subjective report of pain when pressure is applied to 11 of the 18 common tender points
2 criteria diagnosis for
fibromyalgia
111
```
CBC, thyroid levels
Spine xray for OP
Sleep studies
EMG
Psychological testing
```
diagnosis of exclusion
112
```
Education
Stress management
Nutrition, lifestyle modification
Cognitive behavioral strategies
Muscle tender points
Acupuncture, massage, biofeedback
Aerobic exercise, ergonomics, energy conservation
```
tx for?
fibromyalgia
113
```
Medications
Antidepressants, antianxiety
Muscle relaxers
Analgesics (NSAID, acetaminophen)Anticonvulsants
```
fibromyalgia
114
```
At least 4 of the following:
Post exertional malaise >24 hrs
Nonrestorative sleep
Impaired memory or concentrationMuscle pain
Polyarthralgia without edema
New headaches
Tender lymph nodes
Sore throat (persistent, recurring)
```
chronic fatigue syndrome
115
what 2 things for CFS dont cross over to fibromyalgia?
tender lymph nodes
| sore throat that is persistent and recurring
116
Rule out: mononucleosis, Lyme disease, thyroid disorders, DM, MS, cancer, depression, bipolar disorder
dx of exclusion for?
CFS
117
```
Treatment
Lifestyle changes: dec stress, dec exertion, diet, sleep
Medications: analgesics, antidepressants, SSRI, antianxietyPsychological: cognitive behavioral therapy
PT: graded exercise
```
CFS
