Immune System Flashcards
What are the structures of the immune system?
WBCs and lymphoid tissues
What is the site of WBC proliferation, storage, and maturation?
Primary lymphoid organs
What are the primary lymphoid organs?
Red bone marrow (central skeleton)
Thymus
What are the sites of WBC activation called?
Secondary lymphoid organs
Cells of the innate immune system derive from what progenitors?
Myeloid
What are the secondary lymphoid organs?
Lymph nodes
Spleen
Lymphoid tissue in other organs
Hematopoetic cells differentiate into either _____ or _____ progenitors
Myeloid, lymphoid
Cells of the adaptive immune system derive from what progenitors?
Lymphoid
What cells are the exception to the rule of innate immune cells coming from myeloid progenitors and adaptive immune cells coming from lymphoid progenitors?
Natural killer (NK) cells
What are the mature myeloid progenitor cells?
Neutrophils
Eosinophils
Basophils
Monocytes/macrophages
Mast cells
What are the mature cells that come from lymphoid progenitors?
B cells
T cells
NK cells
What are the two phagocytes cells?
Monocytes/macrophages
Neutrophils
What is the lifespan of neutrophils, eosinophils, basophils, mast cells?
Days
What is the lifespan of monocytes/macrophages, B cells, T cells, and NK cells?
Months to years
What is leukocytosis?
Increased WBCs
What are the causes of leukocytosis?
Infection, inflammation, bone marrow disease, immune system disorder, severe stress/pain
What is the presentation of someone with leukocytosis?
Fever, fatigue, bleeding, bruising, frequent infections
What is leukopenia?
Decreased WBCs
What are the causes of leukopenia?
Chemo/radiation, marrow infiltrative diseases, infection, dietary deficiencies, autoimmune disorder
What is the presentation of someone with leukopenia?
Frequent/persistent infections, inflammation /ulcers in and around the mouth, HA, stiff neck, sore throat, fever/chills, night sweats
What are major histocompatibility complexes (MHCs)?
What allows for distinguishing between self and foreign
What class of MHCs are expressed by almost all nucleated cells?
Class one
What do class one MHCs do?
They tell the immune system that cells are “self cells”
Class two MHCs are only expressed by what cells?
Macrophages
Dendritic cells
B cells
What do class two MHCs do?
Present antigens of neutralized pathogens
What is the first part of the immune system to kick in?
The innate immune system
What is the innate immune system?
The part of the immune system we are born with that doesn’t change and responds to any insult the same way every time
What are the external defenses of the innate immune system?
Physical barriers, mechanical barriers, chemical barriers
What are the internal defenses of the innate immune system?
Soluble factors
Cellular components
Phagocytes
What are the physical barriers of the innate immune system?
Skin
Mucus
What are the mechanical barriers of the innate immune system?
Peristalsis
Coughing
Sneezing
What are the chemical barriers of the innate immune system?
Stomach acid, saliva, tears, cerumen
What bypasses external defenses of the immune system?
Ventilators
What are the soluble factors of the innate immune system?
Cytokines, chemokines, acute phase proteins
What are the cellular components of the innate immune system?
NK cells
Neutrophils
Monocytes
What do phagocytes do?
They readily ingest pathogens and kill them to protect against infection
What are the two principle families of phagocytes?
Neutrophils and monocytes/macrophages
What is the principle cause of susceptibility to infection?
A decrease in number of neutrophils
What do natural killer cells do?
Kill cells infected w/viruses, other extracellular microorganisms, and tumor cells
They respond to invasion by releasing cytotoxic granules and by secreting cytokines
What happens when NK cells attach to normal cells?
The inhibitory receptors are engage and the cell detaches
What happens when NK cells attach to infected cells?
The inhibitory receptor is not engaged and the NK cell destroys the infected cell
What is the second line of defense in the immune system?
Inflammation
What is the third line of defense of the immune system?
The adaptive immune system
What is the adaptive immune system?
The part of the immune system that is specific to invading pathogens and creates memory of pathogens
B lymphocytes are a part of _____ immunity
Humoral
T lymphocytes are a part of _____ immunity
Cell mediated
How long does it take for the adaptive immune system to become active?
24 hours
How long does it take for the adaptive immune system to be effective?
Days to weeks
T/f: in the thymus, cells should be programmed to recognize self or respond to specific antigens only, and if they don’t meet these two criteria, they should we eradicated in the thymus
True
Is adaptive immunity active or passive?
It can be either
What cells are involved in cell mediated immunity?
T lymphocytes
What do cell mediated responses do?
The T cells act against INTRAcellular pathogens
What are the helper cells?
CD4 and T cells
What are the effector cells?
CD8 cells and T cells
What do the helper cell do?
They regulate all immune cells and activate B cells and upregulate parts of the immune system
What do suppressor T cells do?
They help deregulate the response
What do the cytotoxic cells (CD8 and T cells) do?
They release chemicals onto cells to be destroyed
T/f: transplantation of almost any tissue is feasible, but the clinical use of transplantation to remedy diseases is still limited for many organ systems bc of rejection reactions
True
In all cases of graft rejection, what is the cause?
Incompatibility of cell surface antigens class 1 MHCs
Graft rejection is __ cell mediated
T
What are humoral immune responses?
Immune responses mediated by antibodies produced by B cells for specific antigens
The specific antigens in humoral immunity need what to become effective?
An activating factor
T/f: humoral responses have a role in creating memory cells
True
What is natural active immunity?
When a person experiences an environmental exposure to a pathogen
How long does natural active immunity last?
Usually permanently
What is artificial active immunity?
When a person is inoculated with an antigen (vaccinations)
How long does artificial active immunity last?
Usually permanently (sometimes have to be renewed)
What are different ways of getting adaptive immunity?
Natural or artificial active and passive immunity
What is natural passive immunity?
When the mother passes antibodies to the baby through the placenta or breast milk
How long does natural passive immunity last?
Temporarily
What is artificial passive immunity?
Getting inoculations of antibodies, antitoxins, or serum globulin
How long does artificial passive immunity last?
Temporarily
What are factors affecting immunity?
Aging
Nutrition
Environmental pollution and exposure to chemicals
Trauma/illness
What factors alter the immune system? (This shit is like a paragraph)
Aging
Sex/hormonal influences
Nutrition/malnutrition
Environmental pollutants
Exposure to toxic chemicals
Trauma
Burns
Sleep disturbance
Illness/disease
Meds
Hospitalization, surgery, anesthesia
Splenectomy
Stress
What factors increase exposure to pathogens?
Sexual practices
Iatrogenic procedures I don’t feel like listing but basically any tubes and shit that enter the body and bypass external defenses
Surgery and anesthesia can suppress T and B cells for up to how long?
A month
Explain the idea of exercise immunity
The idea is that the immune system can either be enhanced or suppressed during exercise depending on the intensity of it
Exercise can regulate the ability of the immune system to initiate a response against pathogens
Exercise triggers a rise in what immune cells?
Neutrophil and macrophage activation
NK cell numbers rise temporarily
T/f: exercise can cause a rise in both pro inflammatory and anti inflammatory cytokines depending on intensity
True
What is ideal exercise intensity for enhancing the immune system?
Moderate intensity exercise performed chronically over time
What kind of exercise can lead to increased susceptibility to infections?
Overtraining, strenuous/intense exercise
What is the relationship between aging, exercise, and immunity?
Regular moderate exercise in aging adults is associated with positive effects
What are the positive effects of immunity from regular moderate exercise in aging adults?
Delayed decrease in immune function
Improved response to vaccinations
Lower # of older T cells
Enhanced fxn of T cells
Lower circulating pro inflammatory cytokines
Increased NKCs and neutrophil activity
Longer telomere length in leukocytes
What causes primary immune deficiencies?
A single gene mutation that can affect the innate or adaptive system
Primary immune deficiency is usually causes by a ____ mutation
Spontaneous (but single would also be a correct answer)
What components of innate immunity may be affected in primary immune deficiency?
Complement proteins and phagocytes
What are secondary immune deficiencies?
Acquired immunodeficiency syndrome (AIDS)
What causes AIDS?
HIV virus
AIDS selectively attacks what cells?
CD4 T cells (helper cells)
What is a type 1 hypersensitivity disorder (IgE mediated or immediate type)?
Typical allergic reactions causes by inappropriate antigens being created for something that is not a pathogen
After a first exposure in a type 1 hypersensitivity disorder, what is created?
IgE antibodies
During an immune response with a subsequent exposure after the initial exposure in a type 1 hypersensitivity disorder, what happens?
Inflammation
Bronchodilation
Mucus production
Vasodilation
Anaphylaxis, food allergies, asthma, eczema, and seasonal allergies are the result of what type of hypersensitivity disorder?
Type 1 hypersensitivity disorder
What is a type 2 hypersensitivity disorder (tissue specific)?
When antibodies are created and react to antigens in a specific tissue
Autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura, good pasture syndrome, acute rheumatic fever, pemphigus vulgaris, MG, Graves’ disease, insulin resistant DM, and pernicious anemia are all what kind of hypersensitivity disorder?
Type 2 hypersensitivity disorder
What is type 3 hypersensitivity disorder (immune complex mediated)?
Antibodies react to antigens in specific tissues then the antibody-antigen complexes are released into circulation and deposited into vasculature of other tissues causing an immune response in the secondary tissues
What kind of hypersensitivity disorder are lupus, post streptococcal glomerularnephritis, polyarterins nodosa, reactive arthritis, serum sickness?
Type 3 hypersensitivity disorder
Lupus (SLE) is most common in what population?
Young women
Is lupus more common in black or white women?
Black women
Is lupus more common in Asians, Hispanics, and Native Americans or in whites?
In Hispanics, Asians, and Native Americans
Is there a genetic link in lupus?
Yes bc it is more common in 1deg relatives but we don’t know exactly what the link is yet
What is the pathology of lupus?
Deposition of antigen-antibody complexes
Involvement of auto-antibodies, vascular abnormalities, and inflammatory mediators
What are the MSK manifestations of lupus?
Arthralgia/arthritis most commonly in the hands, wrist, knees
What are the cutaneous manifestations of lupus?
A rash and/or vasculitis that worsens with UV exposure and some topical lotions and cosmetics
Classic butterfly rash across the cheeks
What are the cardiopulmonary manifestations of lupus?
Antiphospholipid antibody syndrome that leads to increased risk of thrombosis
What are the CNS manifestations of lupus?
Neuropsychiatric manifestations
Polyneuropathy
What are the renal manifestations of lupus due to?
The small size of the renal capillaries
What is involved in medical management of lupus?
Prevention of flare ups and drug therapy
What is involved in prevention of flare ups in lupus?
Avoiding sunlight
Regular exercise
Immunizations
Decreasing stress
What drugs are used in the treatment of lupus?
NSAIDs, methotrexate, anticoagulants (if antiphospholipid antibody syndrome present), antimalarials, corticosteroids for active disease, and immunosuppressants for active disease
What is involved in the PT management of lupus?
Balance activity and rest after flare up’s
Gradual return to normal activity
Pain free ROM slowly into strengthening for treatment of joints
Activity spacing/energy conservation
Progressive strengthening w/o jt stress
Monitoring for signs of infection with immunocompromised
Monitor for avascular necrosis if taking corticosteroids
Observe for cognitive impairments
Observe for signs of kidney disease
What is type 4 hypersensitivity disorder (cell mediated immunity)?
Disorder involving T cells that react to surface antigens and destroy cells that are normal healthy cells
What type of hypersensitivity disorder are RA, MS, type 2 DM, Hashimotos, IBD, autoimmune myocarditis, contact sensitivity?
Type 4 hypersensitivity disorder
Autoimmune diseases result from types _____ of hypersensitivity disorders
2-4
What is an autoimmune disease?
When the body mounts an immune response to self antigens
Are autoimmune disease generalized or tissue specific?
Can be either
T/: autoimmune diseases have a genetic components and environmental component
True
Why do we think there is a probably hormonal link in autoimmune diseases?
Bc it affects more women than men
T/f: autoimmune diseases are the failure of immunologic tolerance (failed T cell programming)
True
What is chronic fatigue syndrome?
A combo of factors leading to chronic fatigue (>6mo)
What are the risk factors for chronic fatigue syndrome?
Female
Minority
Lower SES
What is the mean age of onset of chronic fatigue syndrome?
29-35 yo
A diagnosis of chronic fatigue syndrome requires what?
A substantial reduction in ability to engage in pre illness activities persisting >6months not resulting from exertion and not alleviated by rest
Post exertional malaise
Unrefreshing sleep
Cog impairment OR orthostatic intolerance
Chronic fatigue syndrome often begins with what?
An infection or a psychological stressor
Personality factors may increase vulnerability
What are the clinical manifestations of chronic fatigue syndrome?
Overwhelming fatigue
Neurally mediated hypotension
Often cyclical
What is involved in the medical management of chronic fatigue syndrome?
Dx of exclusion
Symptom relief
Combo of drug therapy and non drug therapy
What is one of the gold standard treatments for chronic fatigue syndrome?
PT
What is involved in PT management of chronic fatigue syndrome?
Carefully controlled and graded exercise programs are effective
Must avoid overexertion
Start low and progress slow
Start with strengthening before aerobic training
Including stretching, strengthening and CV training
Close VS monitoring
Education on pacing, energy conservation, and stress management
T/f: pts with chronic fatigue syndrome often will begin to decondition secondary to inactivity
True
What is fibromyalgia?
Chronic widespread pain with allodynia to pressure pain
Disorder of pain pain processing
Are more men or women affected by fibromyalgia pts?
Women
What is the mean age at dx for fibromyalgia?
20-55 yo
What are the risk factors for fibromyalgia?
Prolonged anxiety
Trauma
Emotional stress
Rapid steroid withdrawal
Hypothyroidism
Non viral infections
BIPOLAR DISORDER
There is no known cause of fibromyalgia, but what are some of the theories out there?
Diet, virus, sleep disorder, occupational/seasonal/environmental factors, adverse childhood experience, psychological disorders
What occurs in fibromyalgia pathologically that causes the widespread chronic pain?
Increased CNS pain transmission/perception and decreased pain inhibition (central sensitization)
Autonomic NS dysfunction with increased inflammatory factors
What are the clinical manifestations of fibromyalgia?
Diffuse ms pain and/or tender points (main dx criteria)
Sleep disturbance (decreased REM sleep)
Diaphragm dysfunction
Higher level of ms activity (increased baseline ms tension)
What is involved in the medical management of fibromyalgia?
Cognitive behavioral therapy in combo with exercise (gold standard)
Meds
Education of coping strategies, work simplification, ergonomic principles, stress management, Ms relaxation techniques, physiologic quieting techniques to bring down baseline Ms tone
What is the gold standard treatment of fibromyalgia?
Cognitive behavioral therapy in combo with exercise
What is involved in PT management of fibromyalgia?
Low to mod aerobic exercise and progressive strengthening (needs to be pain free, start low and go slow)
Stretching program
Soft tissue techniques
Aquatics
Biofeedback
Trigger point therapy
US and other modalities
Chronic pain programs
