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Step 1 Clues > immunity > Flashcards

immunity Flashcards

1
Q

invovled with humoral immunity

cells and infection

A

B-cell
Neutrophils
Bacterial infections

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2
Q

protect the tissues

cell mediated immunity

A

T-cells
macrophages
nonbacterial infections

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3
Q

T-cell

3rd pharyngeal pouch missing
hypocalcemia

Chro 22

A

DiGeorge syndrome

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4
Q

T-cell

candida infection on skin and mucous membranes

T-cell can’t fight candida

A

Chronic mucocutaneous candidiasis

chronic fatigue syndrome

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5
Q

Steroids
anti-inflammatory and physiologic actions

A
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6
Q

steroid best for crossing membrane

A

Dexamethasone

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7
Q

Steriod good for cortisol replacement

A

hydrocortisone

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8
Q

Steriod good for fluid replacement

A

Fludrocortisone

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9
Q

which drug prolong longevity of transplanted organs

ihibits calcineurin

A

cyclosporine

gingival hyperplasia, hirsutism, renal failure

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10
Q

decrease T-cell activation

by decreasing IL-2 transcription

A

Tacrolimus

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11
Q

inhibit mTOR kinase

decrease response to IL-2

A

Sirolimus( rapamycin)

tyrosine kinase inhibitor

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12
Q

2 tyrosine kinase inhibitor

A

sirolimus
imatinib

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13
Q

Cells involve in a TRAP pos leukemia

A

75% B cell
25% T-cell

hairy

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14
Q

T-cells characterise by indented cell membrane

A

mycosis Fungoides
Sezary Syndrome

lymphoma

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15
Q

enzyme involve with SCID

affects all rapidly dividing cell

A

Adenosin deaminase

X-linked recessive

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16
Q

eczema, Normal Ig-A/E levels
mc in Boys(X-linked R)
Thrombocytopenia

A

wiskott-Aldridge syndrome

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17
Q

needed for class switching

A

IL-4 defect
CD-40 ligand defect
Tyrosine kinase defect

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18
Q

Normal B-cell count defective function
early onset
defective cell signaling

x-linked recessive

A

Burton’s Agammaglobulinemia
Agamma globulinenia

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19
Q

like Bruton’s

Lacking B-cells function with normal count

late onset

A

CVID

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20
Q

cellular components of Leukemias

A

98% B cells
2% T-cells in periphery

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21
Q

1 plasma cell cancer

A

plasmacytoma

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22
Q

multiple plasma cell cancer
multiple osteolytic lesion

A

Multiple myeloma

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23
Q

finding of MM

A

Rouleaux formation
hi Ca
Ig-G M-Spike
Kappa light chains(Bence jones proteinuria

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24
Q

Heavy chain disease

A

Ig-A MM of bowel wall
Ig-A plasma cell visible
Malabsorption

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25
Q

Selective Ig-A def

A

Mucosal infections
transfusion anaphylaxis
May run with Selective Ig-G2

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26
Q

main opsin to coat encapsulated organism

A

Ig-G2

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27
Q

IgG 2 defect Sign

A

Recurrent encapsulated organism infection

may run with selective Ig-A def

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28
Q

what is the G-pos encapsulated bug

A

Strep Pneumo

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29
Q

G-Neg encapsulated org

A

Salmonella
Klebsiella
H. flu B
pseudomonas
neisseria
citrobacter

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30
Q

High Ig-E
red-hair female
defective neutrophils

A

Job’s syndrome

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31
Q

Neutrophil defects conditions

A

myeloperoxidase def
NADPH-oxidase (CGH)
absolute neutropenia

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32
Q

neutrophil defect

recurrent gram-pos infection

A

myeloperoxidase def

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33
Q

neutrophil

x-linked R
dihydrorhodamine pos
Neg NBT test

A

CGD:NADPH-oxidase

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34
Q

low absolute Neutropenia at risk for

<1500
<1000
<500

A

staph and pseudomonas

1 antibiotic=staph
2 antibiotic=pseudomonas

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35
Q

what you see with macrophage defect

A

NADPH-Oxidase def (CGD)
Chediak-Higashi

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36
Q

Albinism, Lysosomal inclusions

can’t digest pathogen

A

chediak-Higashi syndrome

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37
Q

two populations with highest incidence of HIV

A

heterosexual Black women
Elderly

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38
Q

Lowest HIV risk population

A

Pre-pubertal female

vaginal acidity gained at puberty..HIV💕acidic mucosae& CD-4 receptors

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39
Q

location for the most CD4 receptors

A

female cervix
Bld vessels
Macrophages (everywhere they go)
T-helper cells (attacked first)
CNS
Testes

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40
Q

T/F HIV penetrats cells

A

F

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41
Q

cancers common in HIV

where CD4 is aboundant

A

Cervical cancer
Kaposi Sarcoma
CNS
testicular lymphomas
Anal cancer (HPV)

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42
Q

portal of entry for HIV RNA injection

A

GP41

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43
Q

HIV attachment of cell

needs CCR5

A

GP120

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44
Q

Used for HIV assembly

A

P17 and P24

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45
Q

Use for HIV RNA integration with host

A

Polymerase protein

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46
Q

when to screen pregnant woman for HIV

A

1st tri and 3rd tri

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47
Q

use >90 days after HIV exposure

A

Ora-Quick

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48
Q

use for screening only in the first 18 months of life

A

PCR

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49
Q

AIDs defining: CD4 count<200

Peds<20%

A

PJP prophylaxis

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50
Q

HIV CD 4 count <100

A

Toxoplasmosis

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51
Q

HIV

at CD4 count<50
Peds CD4 < 10%

A

Begin HAART therapy

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52
Q

HIV prevention

PrRP

A

tenofeovire/emtricitabine

pericoital period and HIV neg partner

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53
Q

HIV

Post Exposure prophalaxis (PEP)

A

RET: Raltegravire
Emtricitabine
Tenofovire

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54
Q

T/F

HIV infected mother avoid breastfeeding

A

T

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55
Q

T/F

antiviral for new born up to 1st 6 month

A

T

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56
Q

use in mother with detectable HIV viral load

A

IV Azothioprine
PEP: RET

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57
Q

HIV entry inhibitor

A

enfuvirtide

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58
Q

CCR5 receptor antagonist

A

Maraviroc

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59
Q

Reverse transcriptase inhibitor

A

AZT
3TC
4DT
DDI
DDC

Abacavir (ABC)
Didanosine (ddI)
Emtricitabine (FTC)
Lamivudine (3TC)
Stavudine (d4T)

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60
Q

protease inhibitors

A

indinarvire
Saquinavir

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61
Q

integras inhibitors

A

Raltegrase
Elvitegravir

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62
Q

prevent megaloblasic anemia with _________for PJP treatment

Trimethoprim/sulfamethoxazole

A

Leucovorin
pentamindine aerosol

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63
Q

Blocks Dihydrofolate Reductase

A

trimethoprim
Pyrimethamine
methotrexate

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64
Q

Block PABA

A

sulfamethoxazole
sulfacetamide
sulfinpyrazone
sulfasalazine
sulfadiazine

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65
Q

Mycobacterium Avium intracellular treatment

A

clarithromycin
azithromycin

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66
Q

Block translocase.

A

macrolide
clinamycin
Lincomycin

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67
Q

MOA of vasovagal syncope post vaccine administration

hypovolumic and bradycardic

A

stress-induced cardioinhibitory and vasodepressor response

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68
Q

What is an antigen

A

molecule that sets off immune response

Haptens
Immunogen

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69
Q

most important factor that determines immunogenicity

A

Variability

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70
Q

What do macrophages do for a living

A

ingest
phagocitize
Digest
Present
MHC II complex
Variable Beta region
Invariant chain is displaced
IL-1 is released

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71
Q

what is immunogen

Carrier effect use in vaccines: eg: DTAP

A

Hapten + something else

large enough to attract immune response

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72
Q

IL-1 function

A

fever
nonspecific symptoms of illness(low energy state)
Recruits T-helper cells

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73
Q

Fever effect

A

causes secretion of Ig-A
rapid response of immue cells
raise BP by 10 for 1degree rise in temp

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74
Q

Infections that cause Heart Block

A

legionella
lyme disease
chaga’s disease
Diphtheria
Typhoid fever

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75
Q

what does fever mean

A

IL-1 show up
fever pattern can be diagnostic
104=medical emergency

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76
Q

make less immunogenic

detergent

A

disrupts the adhsion of pathogen membrane

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77
Q

make less immunogenic

antiseptic/disinfectant

A

destroys membrane and inactivate endotoxin
99% killer

phenol is mc
iodine –hospital use

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78
Q

sterilization

spores killer

A

121 degree C with vaporized heat for 15mn

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79
Q

most immunogenic bacteria

A

Shigella

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80
Q

two arms of immune system

A

hemoral
cell mediated

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81
Q

where do macrophages go?

A
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82
Q

T-cell and macrophages respond to

A

virus
fungus
mycobacteria
protozoa
parasite
collagen vascular Dz
neoplasm

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83
Q

first sign of cell injury

A

NA/K pump stops
swelling

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84
Q

swelling and neurophils show up

A

acute inflammation

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85
Q

seen in chronic inflammation

cell
biopsy
x-ray

A

t-cells and macrophages
fibroblas: fibrosis on biopsy
calcification on x-rays

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86
Q

cells involved with immediate hypersensitivity

A

mast cells and eosinophils

no complement

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87
Q

cytotoxic deliberate attack on self

A

type II HSensitivity

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88
Q

consumptive complement,
tissue damage,
immune complex deposition

A

Type III hyperS

not an attack on self

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89
Q

cells involve with type 4

A

T-cell
Macrophages

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90
Q

Begins MAC complex

A

C-5b

91
Q

MAC complex perforator

A

C-9

92
Q

mcc of death in angioedema

A

suffocation (airway)

93
Q

angioedema is caused by

A

hi C5-A
C-1 esterase inhibitor defect

94
Q

Drugs that cause angioedema

except

A

pril and sartan

candy

95
Q

RH is a problem only when

A

mom is neg and day is positive

96
Q

RhoGam given

A

1st: post delivery
2nd: 28wk every pregnacy
repeat at each delivery

97
Q

differency between acute and chronic rejection

A

fibrosis/calcification on biopsy

98
Q

antibody

SLE antibodies

A

AntiSmith
Double stranded DNA
Cardiolipin

99
Q

antibody

Drug Induced SLE antibody

A

Histone

100
Q

antibody

Progressive Systemic Sclerosis

A

Topoisomerase

101
Q

antibody

Graves

A

TSH Receptor

102
Q

antibody

CREST

A

Centromere

103
Q

antibody

Goodpasture’s

A

Type 4 collagen

104
Q

antibody

Primary Biliary Cirrhosis

A

Mitochondria

105
Q

antibody

Alopecia Areata

A

Hair follicle

106
Q

antibody

Rheumatoid Arthritis

A

anticyclic citrullinated peptide (anti-CCP)

107
Q

antibody

Multiple Sclerosis

A

Myelin Receptors

108
Q

antibody

Celiac Sprue

A

Gliaden/gluten

109
Q

antibody

Type I Diabetes

A

Islet cell receptor

110
Q

antibody

Vitiligo

A

Melanocyte

111
Q

antibody

Myasthenia Gravis

A

Acetylcholine receptor

112
Q

antibody

Mixed Connective Tissue Diseas

A

Ribonuclear protein

113
Q

antibody

Pernicious anemia

A

Intrinsic factor

114
Q

antibody

Pemphigus vulgaris

A

Desmosome

115
Q

antibody

Bullous pemphigoid

A

Hemidesmosome

116
Q

antibody

Hashimoto’s

A

Thyroglobulin
Microsomal

117
Q

antibody

Scleroderma

A

Smooth Muscle
SCL-70

118
Q

antibody

Sjogren’s

A

Rho
La

119
Q

antibody

wegener’s

A

proteinase
c-ANCA

120
Q

antibody

Idiopathic Thrombocytic Purpura

A

Glycoprotein IIb/IIIa

121
Q

antibody

Polyarterits Nodosa

A

p-ANCA

122
Q

B cells develop in ______ and differentiate in ________

A

bone marrow
Germinal center of lymphoid

123
Q

drug that target B cell

A

Rituximab

124
Q

TCell develop in ______ mature in _______ and differentiate in _________

A

Bone marrow
thymus
paracortex of lymphoid tissue

125
Q

drug that target t-cells

monoclonal antibody

A

Muromonab

126
Q

IL-1 inhibitor

A

Anakinra

127
Q

IL-2 inhibitor

A

cyclosporin
Tacrolimus
Daclizumab

128
Q

IL-4 function and inhibitor

A

Isotype switching
Dupilumab

129
Q

IL-5 function and drug

A

Isotype switch to Ig-A
Mepolizumab

130
Q

how do T- cell talk to B cell

A

CD-40 ligand

131
Q

pre B-cell marker

A

Mu chain visible in cytoplasm

132
Q

immature B-cell marker

A

Ig-M on surface

133
Q

Mature B-Cell marker

A

Ig-M(monomer) and Ig-D on membrane

134
Q

how do you stimulate B-cells

A

Endotoxin
Pokeweed mitogen
track growth with labelled thymidine

135
Q

IG-M

primary response

A

Arrives in 3 days
Peaks in 2 weeks
Lasts for 2 months

136
Q

IG-G arrives

A

in 2 weeks
Peaks in 2 months
Lasts for 1 year

137
Q

vaccine schedule

DPT, IPV, HiB, S. Pneumo

A

2,4,6,18,5-6yr

Ig-G last for 2 months

138
Q

when does memory develop

A

12 month
completes at 15 months

Ig-G only

139
Q

memory response time

Ig-G has highest affinity

A

Arrives in 3 days
Peaks at 5 years
Lasts for 10 years

140
Q

MMR schedule

A

15m, 5-6yr
pre-college

141
Q

varicellla schedule

A

15m
5-6yrs

142
Q

Hep B schedule

A

Ig-G and vaccine in delivery room
2m, 15,

143
Q

Live vaccines

A

BCG
OPV (Sabin)
Yellow fever
Smallpox
MMR
Varicella
Rotavirus

BOYS MVP

144
Q

which vaccine needed at 6

A

only half dose diphtheria (D-d)

145
Q

isotype refers to

A

antibody class

G,A,M,D,E

146
Q

idiotype refers to

A

the actual antigen binding site

147
Q

Macrophage function and
t-cell diffenentiation

A

Macrophage ingests antigen
Macrophage forms a phagosome
Lysosome digests the antigen
Macrophage presents the antigen
Antigen binds to MHC-II complex
Interluken released

148
Q

how do T-cell talk to macrophages

A

T: B-7 molecule to CD-28

149
Q

Thymic T cell marker

A

CD 3, CD4/8

150
Q

what control clonal deletion

A

thymosin
thymopoietin

151
Q

what are immunoprivileged sites

A

Brain
thymus
cornea
testicle

152
Q

CD8 expresses ____ and function as

A

MHC I
T suppressor: stop infection spread
T-cytotoxic: destory infected cell

153
Q

MHC II

CD4 function

A

T-Helper
speaks to B cell CD40 ligand
to macrophages via B7/CD28

154
Q

T helper 1 response to

A

cell mediated

155
Q

T helper 2 response to

A

humoral

156
Q

T-cell secrete

A

all interleukin except IL-1
produce intereron gamma and TNF gamma
controls B- cell and macrophages

157
Q

NKiller cells marker

A

CD16/56
immunosurveillance

cancer killer at 1 cell stage

158
Q

enhance NK cell ability with

A

levamisole

159
Q

A MAN SPENDS HIS HEALTH CHASING GREAT WEALTH

A

THEN HE SPENDS HIS WEALTH TRYING TO GET BACK HIS HEALTH

160
Q

What are the Granulocytes

A

Neutrophils (60%) Never
Lymphocytes (30%) Let
Monocytes (8%) Mom
Eosinophils (2%) Eat
Basophils (1%) Beans

161
Q

Gram stain steps

A

Step 1: add crystal violet (binds to exposed peptidoglycan)
Step 2: add iodine (seals blue color into wall)
Step 3: wash with alcohol (washes off excess crystal violet)
Step 4: add saffron (colors outer membranes)

162
Q

use for staining mycobacterium

A

Acid fast
pink pathogen

163
Q

partially acid fast bugs

A

Norcardia G-pos
Cryptosporidium (protozoa)

164
Q

most abundant granulocyte

A

Neutrophils (60%)

165
Q

who’s the first line of defends

A

Neutophils
10% circulating
90% marginated

4.5—peak at 3day

166
Q

catalase pos bug

A

staph A.
Pseudomonas A.
Neisseria Family

167
Q

how to make an abscess soup

A

O2 burst peak @ 7days
Free radical kills everything
create anaerobic area

168
Q

bug

abscesses 1-3 days

A

staph A

169
Q

bug

abscess 4-7 days

A

S. pyogenes

170
Q

abscess past 7 days

A

anaerobic

MC in Brain

171
Q

neutropenic management

A

any fever: cover Staph and pseudomonas

fever persist after 48hr cover for fungus

172
Q

MCC of neutorpenia

A

viral
drugs

173
Q

what mediates monocyte transformation

marker

A

interferon

CD4 receptors

174
Q

mcc of monocytosis

A

viral

175
Q

conditions with extreme monocytosis

A

salmonella typhi
TB
EBV
Listeria
Syphilis

176
Q

primary response to allergen

A

Allergen ingested forms Phagosome
Digested
Presented to T-lymphocytes on MHC 2 complex (bind to V-beta region)
T-cells bind to B-cells by CD-40 ligand
T-cells produced IL-4
B-cells produced Ig-E

177
Q

secondary response to allergen

A

Ig-E binds to allergen
burries F-c portion in mast cell
mast cell degranulates

178
Q

Mast cells release

A

histamine (immediates)
SRS-A(4-8 hrs)
ECF-A

179
Q

acute symptoms of allergies is caused by

A

Histamine

redness flushing, wheezing, itching, warmth, swelling, conjuntivitis

180
Q

what is reponsible for late symptoms of allergies

A

Slow reacting substance of anaphylaxis (SRS-A)

181
Q

function of SRS-A

A

most potent bronchoconstrictor

182
Q

attracts eosinophils in allergic reactions

A

eosinophil chemotactic factor of anaphylaxis

ECF-A

183
Q

function of eosinophils

A

counter-regulator of Mast cell
coats parasite

184
Q

Released from eosinophils

A

histaminase
arylsulfatase
Heparin

185
Q

1st Gen antihistamines

A

Block H-1 receptors
strong anticholinergic(sympathetic)
Tachyphylaxis

186
Q

drugs

1st gen antihistamines

A

diphenhydramine
Hydroxyzine
Dramamine
Meclizine
Phenylpropanolamine
phentermine

187
Q

MOA of 2nd Gen antihistamines

A

H-2 receptor blocker
use for urticaria
used mc for GI peptic ulcer dz

188
Q

Drug

2nd Gen antihistamines

A

Cimetidine
Ranitidine
Nizatidine
Famotidine

block 70% of acid output

189
Q

least sedative

3rd gen Antihistamine

A

Terfenadine
Loratadine
Astermizole

list not complete

190
Q

cofactor for antithrombin III

A

heparin

191
Q

heparin Blocks

A

thrombin and factor10927

192
Q

follow heparin with INR or PTT

A

PTT

193
Q

What do you do when PTT is too high with heparin treatment

A

protamine sulphate

194
Q

use ______if patient is bleeding with Heparin therapy

A

FFP

195
Q

Effect of Heparin

break clot

A

bleeding
hyperlipidemia(++ Hormone-sensitive lipase)
thrombocytopenia (hapten=autoimmune)

196
Q

Benefit of low molecular weight heparin

A

standardized
no need for PTT
fewer bleeding
lower incident of HIT

197
Q

allergies rashes

type 1

A

urticaria
erythema multiforme
Stevens-johnson syn
Toxic epidermal necrolysis

198
Q

allergic rashes

type 4 HS

A

Atopic dermatitis
contact dermatitis
Eczema

Eczema: spongiotic and Nummular

199
Q

Asthma types

A

intrinsic asthma–born with..++cold
Extrinsic –environmental–dust mite

200
Q

Eosinophilia

conditions

A

Neoplasia
Allergies and Addison’s dz
Asthma
Collagen Vascular Dz
Parasites

201
Q

left shift means

A

increase bands

202
Q

Bands are

A

Immature neutrophils with maximum germ killing ability

Myeloperoxidase and NADPH-Oxidase

203
Q

precursors of mast cells

A

Basophils

semilar granules

204
Q

what is the normal Leukocytes

A

penia< 4-12k<cytosis

205
Q

viruses that mc cause leukocytes suppression

A

B-19
Hep E/C

all viruses can cause this

206
Q

drug

leukopenia

A

vinblastin
AZT
chloramphenicol
Benzene

207
Q

drug

agranulocytosis

A

Carbamazepine
Ticlopidine
clozapine

208
Q

Causes of leukocytosis

High WBC, high Alkaline phospatase

A

stress demargination
infectiosn
leukemoid reaction(hi band, Blast <5%)
Leukemia (hi Band, Blast >5%)
myelodysplastic syndrome

209
Q

In Leukemia
Acute
Chronic
means?

A

Acute: starts in BM
Chronic: starts in Periphery

210
Q

lymph node cancer

A

lymphomas

211
Q

myelodysplastic syn involves all cell lines
high or low

T/F

A

T

212
Q

hodgkins lymphomas marker

A

CD 30

213
Q

Most malignant lymph nodes

A

supraclavicular
Epitrochlear
Inguinal

214
Q

jaw mass or abdominal mass

non-hodgkin’s lymphoma

MC

A

follicular lymphoma
BCL-2
T(14/18)

215
Q

associated with Burkitt’s Lymphoma

A

BCL-2
C-Myc
T8/14
EBV
starry sky appearance

216
Q

staging

one group of lymph nodes involved

A

Stage 1

217
Q

staging

two groups of lymph nodes on same side of diaphragm involved

A

Stage 2

218
Q

Stage

two or more groups of lymph nodes on both sides of diaphragm involved

A

Stage 3

219
Q

staging

metastases

A

Stage 4

220
Q

Myelodysplastic Syndromes

Hyperproliferative:

A

Polycythemia Rubra Vera
Essential thrombocythemia

221
Q

Myelodysplastic Syndromes

Hypoproliferative

A

Aplastic Anemia
Myelophthisic Anemia (myelofibrosis; agnogenic myeloid dysplasia)

222
Q

Aplastic Anemia: Drugs

A

Chloramphenicol
AZT
Benzene
Vinblastine

223
Q

Aplastic Anemia: Viruses

low retic count

A

Parvovirus B-19: 90%
Hepatitis E: pregnant women
Hepatitis C: occasional

Step 1 Clues (27 decks)

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