Immune System, TBP Flashcards
1
Q
Hypersensitivity reactions, type: IgE mediated
A
Type I
2
Q
Hypersensitivity reactions: TH2 cells release this substance that stimulates eosinophils
A
IL-5
3
Q
Hypersensitivity reactions: TH2 cells release this substance that activates IgE-producing b-cells
A
IL-4
4
Q
Hypersensitivity reactions: IgE binds to what cells
A
Mast cells
5
Q
Hypersensitivity reactions: Binding of antigen to IgE on mast cells result in
A
Mast cell degranulation and release of mediators
6
Q
Type I hypersensitivity: Phases
A
Early and late
7
Q
Type I hypersensitivity: Early phase occurs within
A
5-30 minutes
8
Q
Type I hypersensitivity: Early phase is due to
A
Binding of antigen to IgE bound to mast cells and release of mediators
9
Q
Type I hypersensitivity: Late phase occurs within
A
2-24 hours
10
Q
Type I hypersensitivity: Late phase is characterized by
A
Infiltration of inflammatory cells and release of mediators by these cells
11
Q
Type I hypersensitivity: Marker of anaphylaxis
A
Serum tryptase
12
Q
Hypersensitivity reactions, type: Antibody-mediated
A
Type II
13
Q
Type II hypersensitivity: Mechanisms (3)
A
1) Complement-dependent
2) Antibody-dependent cell-mediated cytotoxicity
3) Antibody-mediated cellular dysfunction
14
Q
Type II hypersensitivity mechanism: Cell types that bear receptors for Fc of IgG mediate removal of antigen
A
Antibody-dependent cell-mediated cytotoxicity
15
Q
Type II hypersensitivity mechanism: Antibodies themselves affect function of antigen
A
Antibody-mediated cellular dysfunction
16
Q
Hypersensitivity reactions, type: Immune complex-mediated
A
Type III
17
Q
Hypersensitivity reactions, type: T cell-mediated
A
Type IV
18
Q
Type IV hypersensitivity: Mechanisms
A
1) Delayed form in which CD4+ Th1 cells sensitised from previous exposure to antigen secretes IF-γ that activates macrophages
2) Cell-mediated form in which CD8+ cytotoxic T cells kill antigen-bearing cells
19
Q
Type IV hypersensitivity: Mechanisms of cell-mediated cytotoxicity
A
1) Perforin-granzyme system
2) FAS-FAS ligand system
20
Q
Type IV hypersensitivity, mechanism: Holes are produced in the plasma membrane of cells, allowing granzyme to enter cells and activate apoptosis
A
Perforin-granzyme system
21
Q
Type IV hypersensitivity, mechanism: FAS ligamnd on T lymphocytes bind to FAS on target cells leading to apoptosis
A
FAS-FAS ligand system
22
Q
Type of hypersensitivity: Bee sting
A
Type I
23
Q
Type of hypersensitivity: Drug allergy
A
Type I
24
Q
Type of hypersensitivity: Glomerulonephritis
A
Type II or III
25
Type of hypersensitivity: Transfusion reactions
Type II
26
Type of hypersensitivity: Tuberculin reaction
Type IV, CD4+-mediated
27
Type of hypersensitivity: Erythroblastosis fetalis
Type II
28
Type of hypersensitivity: Contrast media allergy
Type I
29
Type of hypersensitivity: Serum sickness
Type III
30
Type of hypersensitivity: Urticaria
Type I
31
Type of hypersensitivity: AIHA
Type II
32
Type of hypersensitivity: Graves disease
Type II
33
Type of hypersensitivity: Insect venoms
Type I
34
Type of hypersensitivity: Food allergy
Type I
35
Type of hypersensitivity: Myasthenia gravis
Type II
36
Type of hypersensitivity: Contact dermatitis
Type IV
37
Type of hypersensitivity: Transplant rejection
Type II and IV
38
Mechanisms of transplant rejection (2)
Cell-mediated or humoral mediated
39
Classifications of transplant rejection
1) Hyperacute
2) Acute
3) Chronic
40
Mechanisms by which cytotoxic T cells kill graft cells
1) Perforin-granzyme pathway
| 2) FAS-FAS ligand pathway
41
Forms of cellular rejection: Body recognises MHC molecules on surface of APCs in the graft
Direct
42
Forms of cellular rejection: Antigens of the graft are presented by recipient's cells
Indirect
43
Classification of transplant rejection: Humoral reaction due to preformed antibodies to graft endothelium
Hyperacute rejection
44
Classification of transplant rejection: Cellular or humoral reaction
Acute rejection
45
Classification of transplant rejection: 4-6 months to years following graft
Chronic rejection
46
Classification of transplant rejection: Possibly due to indirect form of cellular rejection
Chronic rejection
47
Classification of transplant rejection: Minutes following transplantation
Hyperacute
48
Classification of transplant rejection: Days to months to years following transplantation
Acute
49
Classification of transplant rejection: Cyanosis of organ and mottled parenchyma
Hyperacute
50
Classification of transplant rejection: Endothelial injury, neutrophils in arterioles, infarcts of parenchyma
Hyperacute
51
Classification of transplant rejection: Vascular changes and interstitial fibrosis
Chronic
52
Classification of transplant rejection: Interstitial mononuclear infiltrate and edema
Acute
53
Classification of transplant rejection: Interstitial hemorrhage and endothelia's (swollen endothelial cells)
Acute
54
Classification of transplant rejection: Interstitial mononuclear infiltrate and schema with loss of tissue
Chronic
55
Classification of transplant rejection: Necrotizing vasculitis, neutrophilic infiltrates, and infarcts of parenchyma
Acute
56
Classification of transplant rejection: Will respond to cyclosporine
Acute
57
Immune competent cells in the graft recognize antigens in the host
GVHD
58
GVHD: Occurs in transplant of what
1) Bone marrow transplant
2) Solid organ transplant when organ is rich in lymphocytes
3) Non-irradiated blood
59
GVHD: Forms
1) Acute
| 2) Chronic
60
GVHD, acute vs chronic: Days to weeks
Acute
61
GVHD, acute vs chronic: Skin rash
Acute
62
GVHD, acute vs chronic: Fibrosis of dermis and skin appendages
Chronic
63
GVHD, acute vs chronic: Cholestatic jaundice
Chronic
64
GVHD, acute vs chronic: Jaundice
Acute
65
GVHD, acute vs chronic: Esophageal strictures
Chronic
66
GVHD, acute vs chronic: Bloody diarrhea
Acute
67
GVHD, acute vs chronic: Immunodeficiency
Acute and chronic
68
GVHD: Infection commonly associated with immunodeficiency in GVHD
CMV pneumonia
69
General mechanism of autoimmune diseases
Loss of self-tolerance
70
Autoimmune diseases: Contributing factors to loss of self-tolerance (2)
1) Susceptibility genes such as HLA B27 in ankylosing spondyltitis
2) Infections that upregulate costimulatory proteins on APCs or molecular mimicry
71
Associated antibodies: SLE
1) Anti-dsDNA
| 2) Anti-Smith
72
Associated antibodies: Drug-induced lupus
Antihistone
73
Associated antibodies: RA
IgM vs Fc of Ig
74
Associated antibodies: Sjogren
Anti-SSA and anti-SSB
75
Associated antibodies: CREST syndrome
Anti-centromere
76
Associated antibodies: Diffuse scleroderma
Anti-scl70
77
CREST in CREST syndrome
1) Calcinosis
2) Raynaud phenomenon
3) Esophageal dysfunction
4) Sclerodactyly
5) Telangiectasia
78
SLE: Age of predilection
Child-bearing age
79
SLE: Male vs female
Female
80
SLE: Male to female ratio in children and older adults
More or less equal
81
SLE: Criteria
SOAP BRAIN MD
1) Serositis
2) Oral ulcers
3) Arthritis
4) Photosensitivity
5) Blood disorders
6) Renal involvement
7) ANA
8) Immunologic phenomena
9) Neurologic didorder
10) Malar rash
11) Discoid rash
82
SLE: # of criteria to be fulfilled for diagnosis
4/11
83
SLE: Proteinuria
>0.5g/dL
84
SLE: Presence of antiphospholipid Ab is detected by what tests
1) Positive lupus anticoagulant test
2) Abnormal level of IgG or IgM anticardiolipin
3) False-positive syphilis test
85
SLE: Best screening test
ANA
86
SLE: SLE-specific
Anti-dsDNA, anti-Sm
87
SLE: Associated with decreased risk for nephritis
Anti-Ro (SSA) and anti-La
88
SLE: Associated with neonatal lupus with congenital heart block
Anti-Ro
89
SLE: Type of hypersensitivity
Type III
90
SLE: Risk factors
Genetics and environment
91
SLE: Most common cause of death
Renal disease and intercurrent infections
92
SLE: Second most common cause of death
CNS diseases
93
SLE: Endocarditis
Libman-Sacks
94
SLE: T/F Vegetations in SLE endocarditis is sterile
T
95
SLE: LE cell
Neutrophil with phagocytized nuclei
96
SLE: Classes of nephritis
```
I - No disease
II - Increase in mesangial matrix with deposition of immune complexes
III- FPGN
IV - DPGN
V - MGN
```
97
SLE: Characteristic pattern seen in Class V SLE nephritis
Wire-loop pattern
98
Due to antibody that delays clotting in vitro and induces a hyper coagulable state in vivo
APAS
99
APAS: Classic clinical triad
1) Thrombosis
2) Thromobocytopenia
3) Recurrent abortions
100
Forms of APAS: Occurs as sole entity and not associated with SLE
Primary
101
Forms of APAS: Occurs in patients with SLE
Secondary
102
SLE: Drugs associated with drug-induced lupus
PIMCH
1) Procainamide, Penicillamine
2) Isoniazid
3) Methyldopa
4) Chlorpromazine
5) Hydralazine
6) Quinidine
103
Characteristics of drug-induced lupus that differentiates it from SLE (5)
1) Gender ratios nearly equal
2) Predominancy of anti-histone abs
3) Renal and CNS manifestations are uncommon
4) No anti-dsDNA or hypocomplementemia
5) Discontinuation of drugs lead to resolute of symptoms and lab parameters
104
RA: Men vs women
Men
105
RA: Type of arthritis
Non-suppurative, proliferative
106
RA: Joints affected
Bilateral, most commonly in hands
107
RA: Classic presentation
Morning stiffness >1 hour in duration
108
RA: Classic signs
1) Boutonniere deformity
2) Swan neck deformity
3) Baker's cyst
4) Rheumatoid nodules
109
RA: Arthritis of PIP
Swan neck deformity
110
RA: Arthritis of DIP
Boutonniere deformity
111
RA: Antibody
Rheumatoid factor
112
RA: Type of hypersensitivity reaction
Type III
113
RA: Proliferating synovial cells mixed with inflammatory cells and granulation tissue
Pannus
114
RA: Pannus formation can lead to
Ankylosis (fibrosis and calcification of joint space)
115
RA: Central fibrinoid necrosis surrounded by palisading macrophages, with an outer rim of lymphocytes and plasma cells
Rheumatoid nodules
116
Sjogren syndrome: Age of predilection
50-60 years
117
Sjogren syndrome: Men vs women
Women
118
Sjogren syndrome: Triad
1) Xerostomia
2) Xerophthalmia
3) Autoimmune disorder (usually RA)
119
Sjogren syndrome: Antibody associated with higher likelihood of having systemic manifestations
Anti-SSA
120
Sjogren syndrome: Neoplastic complication
MALToma (neoplasm of mucosa-associated lymphoid tissue
121
Autoimmune disorder associated with fibrosis of organs
Scleroderma
122
Scleroderma: Age of predilection
50-60
123
Scleroderma: Male vs female
Female
124
Scleroderma: Clinical presentations (2)
1) Limited scleroderma or CREST syndrome
| 2) Diffuse scleroderms
125
Scleroderma: Anti-Scl70 is an antibody against
DNA topoisomerase I
126
Autoimmune disorder with findings suggestive of SLE, polymyositis, RA, and systemic sclerosis
Mixed CT disorder
127
Mixed CT disorder: Associated antibodies
Anti-RNP particle containing U1
128
Mixed CT disorder: Renal disease
Little or none
129
Mixed CT disorder: Response to corticosteroids
Good
130
Autoimmune disorders, microscopic: Lymphocytic and plasmacytic infiltrate of salivary and lacrimal glands, associated with ductal damage
Sjogren syndrome
131
Autoimmune disorders, microscopic: Fibrosis involving dermis, muscularis of GIT, and alveolar septae in the lung and interlobular arteries in kidney
Scleroderma
132
Amorphous, hylaine deposition that has apple-green birefringence upon polarisation after Congo red staining
Amyloidosis
133
Amyloidosis: Due to
Abnormal production and deposition of protein
134
CKD with large kidneys (4)
1) Amyloidosis
2) HIV
3) DM
4) Polycystic kidney disease
135
Hereditary immunodeficiency states: Failure of maturation of B cells
X-linked agammaglobulinemia of Bruton
136
X-linked agammaglobulinemia of Bruton: Mutated gene
Gene for B cell tyrosine kinase
137
X-linked agammaglobulinemia of Bruton: Inheritance pattern
X-linked recessive
138
X-linked agammaglobulinemia of Bruton: Manifests by age of
6 months
139
X-linked agammaglobulinemia of Bruton: Delay in manifestation due to
Presence of maternal IgG
140
Forms of amyloidosis, associated disease: Ig light chain
Multiple myeloma
141
Forms of amyloidosis, associated disease: Serum amyloid-associated protein
Hereditary amyloidosis
142
Forms of amyloidosis, associated disease: Transthyretin
Systemic senile amyloidosis
143
Forms of amyloidosis, associated disease: Amyloid precursor protein
Alzheimer disease
144
Forms of amyloidosis, associated disease: Calcitonin
Medullary thyroid carcinoma
145
Hereditary immunodeficiency states: No one mode of inheritance
Common variable immunodeficiency
146
Hereditary immunodeficiency states: X-linked inheritance with mutation of CD40L
Hyper-IgM syndrome
147
Hereditary immunodeficiency states: Wiskott-Aldrich syndrome inheritance
X-linked recessive
148
Hereditary immunodeficiency states: B cells proliferate in response to antigen but cannot produce Ig
Common variable immunodeficiency
149
Hereditary immunodeficiency states: Defect in differentiation of B lymphocytes to IgA-producing cells
Isolate IgA deficiency
150
Hereditary immunodeficiency states: T cells fail to stimulate B cells to produce antibody other than IgM
Hyper-IgM syndrome
151
Hereditary immunodeficiency states: Defect in cytokine receptor for IL-7 which is required for lymphocyte proliferation
SCID, X-linked recessive
152
Hereditary immunodeficiency states: Accumulation of deoxy-ATP, which is toxic to lymphocytes
SCID, autosomal recessive
153
Hereditary immunodeficiency states: Recurrent infections before the age of 6 months with wide range of pathogens
SCID
154
Hereditary immunodeficiency states: Thrombocytopenia with resultant bleeding at circumcision site, eczema, and recurrent infections
Wiskott-Aldrich syndrome
155
Hereditary immunodeficiency states: Mutation in gene for adenosine deaminase
SCID, autosomal recessive
156
Hereditary immunodeficiency states: Autosomal vs X-linked SCID, male predominance
X-linked
157
Hereditary immunodeficiency states: Mutation in gene for common γ chain subunit of cytokine receptors
SCID, X-linked recessive
158
Hereditary immunodeficiency states: Recurrent pyogenic infections and pneumocystis pneumonia
Hyper-IgM syndrome
159
Hereditary immunodeficiency states: Hyper-IgM syndrome, mutated in autosomal inheritance
CD40
160
Hereditary immunodeficiency states: Recurrent sinopulmonary infections, diarrhea, and increased incidence of autoimmune diseases
Isolated IgA deficiency
161
Hereditary immunodeficiency states: Isolated IgA deficiency may be acquired due to what infections
1) Toxoplasmosis
| 2) Measles
162
Hereditary immunodeficiency states: Lymphoid follicular hyperplasia
Common variable immunodeficiency
163
Hereditary immunodeficiency states: Common variable deficiency, age of presentation
Later childhood and adolescence
164
Hereditary immunodeficiency states: Underdeveloped germinal centres in lymphoid organs
X-linked agammaglobulinemia of Bruton
165
Hereditary immunodeficiency states: Hypoplasia of tonsils and adenoids
X-linked agammaglobulinemia of Bruton
166
AIDS: HIV, type of virus
RNA retrovirus
167
AIDS: Modes of transmission
1) Sexual
2) Parenteral
3) In-utero, transplacental, or intrapartum
168
AIDS: Major capsid protein
p24
169
AIDS: Encodes p24
gag gene
170
AIDS: Encodes reverse transcriptase
pol gene
171
AIDS: Binds to CD4
gp120
172
AIDS: Binding of gp120 to CD4 results in exposure of binding site of ___ on T cells
CXCR4
173
AIDS: Binding of gp120 to CD4 results in exposure of binding site of ___ on macrophages
CCR5
174
AIDS: Binding of gp120 to CD4 results in a change in gp41 resulting in
Viral-cell fusion
175
Organs colonised by HIV
Lymphoid organs
176
Pneumonia that produces a fluffy-pink exudate in the alveolar spaces
Pneumocystis pneumonia
177
AIDS: Risk factor for pneumocystis pneumonia
CD4+ count
178
AIDS: Opportunistic infection that causes enteritis
Cryptosporidiosis
179
AIDS: Chest radiograph of pneumocystis
Diffuse interstitial ground-glass pattern
180
AIDS: Common associated malignancies (2)
1) Kaposi sarcoma
| 2) Non-Hodgkin lymphoma (B cell lymphoma of brain)
181
AIDS: Kaposi sarcoma is derived from
Blood vessels
182
AIDS: Opportunistic infection that causes pneumonia or CNS infection
Toxoplasmosis
183
AIDS: opprotunistic infection that causes meningitis
Cryptococcosis
184
AIDS: Mycobacteria that are opportunistic in patients with AIDS
M. tuberculosis and M. avium intracellulare
185
AIDS: Kaposi sarcoma is related to what virus
HHV-8
