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Immunity Flashcards

1
Q

What types of hypersensitivity are there

A

Type 1 - igE antibodies
Type 2 -igG
Type 3 -immune complex formation
Type 4 -cell mediated (delayed)

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2
Q

Describe type 1 hypersensitivity

A

Atopic allergy

Mast cells activated (de granulation and release of mediators) by binding of 2 igE on allergens

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3
Q

What is the mechanism behind type 1 hypersensitivity

A

Antigen presenting cell uptake and present via MHC class ii
TH2 cell interact with CD4 T cell via cytokines
T cell produces igE antibodies
They bind to the antigen on second exposure and activate the mast cell

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4
Q

What do the mediators released by mast cells do

A

Pharmacological- blood vessels, airways, cell infiltration and accumulation
Clinical effects- hay fever, asthma, eczema, anaphylaxis

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5
Q

Define atopic

A

Allergy due to hypersensitivity- Have higher evens of igE in serum- genetically predisposed

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6
Q

What do mast cells release

A

Preformed mediators- histamine, heparin and tryptase
Newly formed- arachiodonic acid (mins)
Prostaglandins, leukotrienes, cytokines (hours)

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7
Q

What are the types of hypersensitivity in terms as what things are recognised

A

Foreign- self damaging-allergy/hypersensitivity

Self- self damaging-autoimmunity/ hypersensitivity

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8
Q

Name five type 1 hypersensitivity responses and what is the response in each

A

Systemic anaphylaxis- oedema, tracheal occlusion and increased vascular permeability, circulatory collapse, death
Acute urticaria- local increase in blood flow increased vascular permeability, itch
Allergic rhinitis- oedema of nasal muscosa and irritation
Asthma- bronchial construction and increased mucus production, airway inflammation
Food allergy- vomiting diarrhoea, pruritis, urticaria, anaphylaxis

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9
Q

What are be staged reactions to skin tests

A

Immediate- igE
Immediate and late- igE and T cells
Delayed- TH1 cells
Eczematous- igE and TH2 cells

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10
Q

What is type 2 hypersensitivity

A

Cell of membrane reactive- igG igA and igM - neutrophils and complement

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11
Q

Name some type 2 allergies

A

Allergic haemolytic anaemia blood transfusion reactions

Haemolytic disease of the newborn

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12
Q

Name some type 2 autoimmunities

A 
Autoimmune he's militia anaemia
Autoimmune thrombocytopenia
Pemphigold 
Good pastures disease
Myasthenia gravis
Graves' disease
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13
Q

Explain rhesus haemolytic disease of the newborn

A

Rhesus d negative mother has a rhesus d positive fetus
Rhesus d antigens mix with mothers blood ( at birth?)
Mother makes igG antibodies against them
New rhesus d postitive baby, igG antibodies cross the placenta and attack babies red blood cells

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14
Q

How is rhesus haemolytic disease avoided

A

Mother given rhesus prophylaxis- anti- d antibodies

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15
Q

What is type 3 hypersensitivity

A

Antibody mediated- ineffective removal of immune complexes

Involved igG igA igM, neutrophils and complement

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16
Q

Give examples of type 3 allergy and type 3 autoimmunity

A

Allergy- dermatitis, herpetoformis, allergic alveolitis

Autoimmunity- systemic lupus, erythematosus, rheumatoid arthritis

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17
Q

Explain normal removal of immune complexes

A

Usually removed via liver ( hepatic macrophages) too many produced- not removed or can become lodged in parts of the body

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18
Q

What is type 4 hypersensitivity

A 
Cell mediated 
Involved T cells 
Th cells
Macrophages
Cytotoxic T cells
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19
Q

Give examples of type 4 allergy and type 4 autoimmunity

A

Allergy- contact dermatitis, acute graft rejection, Tb, leprosy
Autoimmunity- thyroiditis, adrenalitis (addisons) gastritis ( pernicious aneamia) type1 diabetes melluitis

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20
Q

What do macrophages become in type 4 hypersensitivity

A

Multincleated giant cells

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21
Q

What are the three types of leprosy

A

Tuberculoid, borderline and lepromatous

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22
Q

Define autoimmunity

A

Damage to self tissues triggered by an adaptive immune response to the bodies own tissue components ( auto antigens)

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23
Q

How can autoimmunity be categorised

A

Organ specific eg MS

Systemic disease eg rheumatoid arthritis

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24
Q

What hypersensitivities can be autoimmune

A

2 3 and 4

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25
What is Graves' disease
Type 2 hypersensitivity autoimmunity. Autoimmune B cells make Autoantibodies that stimulate TSH receptors- overstimulation of thyroid follicular cells without any negative feedback control = hyperthyroidism, goitre, weight loss, nervousness, palpitations and irritable
26
What is the danger of someone with Graves' disease when they are pregnant What is the treatment
Anti-TSHR antibodies cross the placenta and cause the newborn to also suffer from Graves' disease Anti-TSHR antibodies cures the disease
27
What is graves ophthalmopathy
Inflammation of connective tissue behind eyes= swelling Production of mucopolysaccharides Protrusion of eyeballs
28
What is pre-tibial myxoedema
Swelling of ankles
29
What is Hashimoto's thyroiditis
Autoimmune destruction of thyroid tissue Massive infiltration of lymphocytes to the thyroid Causes hypothyroidism- weight gain/depression/fatigue
30
How can you detect Hashimoto's thyroiditis
Autoantibodies produced to thyroid per oxidase and thyroglobulin, can be detected in blood/serum samples
31
Explain pernicious anaemia
Autoimmune destruction of gastric parietal cells type 4 autoimmunity. Production of autoantibodies for intrinsic factor IF. Stops IF binding to vitamin b12 in ileum so can't absorb. B12 needed for nucleotide synthesis so no DNA = no replication especially important in fast replicating cells ie RBC
32
Explain type 1 diabetes
Insulting producing beta cells in islets of langerhans attacked and destroyed by autoreactive T cells. Leave alpha and gamma in tact
33
Explain myasthenia gravis
(Type 2) Autoantibodies inhibit Ach receptors expressed on muscle cells ( at neuromuscular junction) blocks binding and induces internalisation and degradation of receptors
34
Explain autoimmune haemolytic anaemia
Autoantibodies (type 2) opsonise erythrocytes, activating complement and flagging for destruction by phagocytes
35
What is good pastures disease
Autoantibodies ( type 2) bind to glomerular basement membranes, activate complement and neutrophils = tissue damage and eventually kidney failure Can also be to alveoli basement membrane
36
What is pemphigus vulgaris
Autoantibodies bind to intracellular substance of epidermis of skin= blistering skin reaction
37
What is systemic lupus erythematosus
Immune complexes of DNA/ anti-DNA in blood are deposited in the glomeruli= irregular staining pattern Tissue damage in the kidney glomeruli, skin, joints, CNS
38
explain rheumatoid arthritis
Immune complexes formed by rheumatoid factors | IgM and igG autoantibodies - joint damage
39
What is the classification of immune deficiency
Primary- inherited or congenital Secondary- congenital or acquired Component - adaptive (antibody/cell mediated/ combined) Innate (complement/phagocytes/NK cells)
40
What are the different infections that can characterise immunodeficiency
Fungi and viruses- T cells Bacteria - antibody, classical complement, terminal complement and phagocytes Abscesses - phagocytes
41
Which antibody defect ( primary or secondary) is more common in adults
Primary
42
Which antibody deficiency (1• or 2• ) is lymphoproliferative
Secondary
43
Which antibody deficiency is underdiagnosed
Primary
44
What can antibody defects be secondary to
Lymphoproliferative Renal/gut loss of igG Malnutrition Drugs
45
What are the primary causes of antibody deficiency
``` Hyper igM syndrome X limbed agammaglobulinaemia Common variable immune deficiency IgA deficiency IgG deficiency ```
46
What is common with and antibody deficiency
``` Bacterial infections ( ears, sinus, chest) Giardia gut infection Permanent damage esp. If diagnosis is delayed ```
47
What are other complications of antibody deficiency
Enteroviral infection malignancy Autoimmunity
48
What is Di George syndrome
T cell defect, primary immunodeficiency Defective development of thymus and other tissue in face/neck/chest due to defective 3rd and 4th pharyngeal arches = fungal and viral infections
49
What is AIDS defined as
HIV with appearance of opportunistic infections
50
How does HIV infect T cells
Bind to cd4 molecules
51
What are the early symptoms of HIV
Persistent generalised lymphadenopathy
52
How is HIV transmitted
Sexual/ blood contact
53
How is HIV diagnosed
Detection of anti-HIV antibodies in serum
54
What is sever combined immunodeficiency
Primary immunodeficiency inherited stem cell defect lack of function of b and T cells Susceptible to essentially all types of infectious agents Fatal is untreated ( bone marrow transplant)
55
What causes primary neutrophil defects
Kostmanns, cyclical neutropenia
56
What causes secondary neutrophil defects
Leukaemia Cancer chemotherapy Infections
57
What is leucocyte adages ion define u due to
Lack of production of integrins adhesion molecules
58
What is chronic granulomatous disease
Defects in enzymes involved in generation of reactive oxygen species ( needed to kill phagocytosed infection)
59
What is recurrent neisserial infections a feature of
Complement defieciency - alternative and membrane attack pathways
60
What are immunodeficiencies secondary to
Iatrogenic ( immunosuppressive treatment or radiation or surgery) Malignancies ( leukaemia, lymphoma, myeloma) Some infections- HIV, chronic malaria, measels Malnutrition Protein losing diseases Chronic diseases ( renal) Burns
61
What is acute appendicitis caused by
Lumen obstruction and bacterial infection
62
What does acute appendicitis spread to become when it perforates
General peritonitis
63
What are some outcomes of lobar pneumonia
``` Death in acute phase Death during resolution Successful resolution Abscess formation Organisation of exudate- lung fibrosis ```
64
What can neisserial infection cause
Meningitis Septicaemia Pneumonia Arthritis
65
What is an acute superficial folliculitis
Zits
66
What are the signs of inflammation
Calor- heat Pain- dolor Rubor- redness Tumor- swelling
67
What is osteomyelitis
Come infection almost always causes by bacteria and can destroy the bone
68
What do a high pulse and bp often indicate
Infection
69
What types of TB are there
Primary Miliary ( spread in blood) fibrocaseous Tuberculosis bronchopneumonia
70
What are five causes of granulomatous infection
Mycobacterium infection Insoluble organic material ( endogenous/ exogenous) Insoluble inorganic material (endogenous (urate) exogenous (silica)) Sarcoidosis Fungal infection

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