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Immuno (100) Flashcards

1
Q

Ankylosis spondylitis (allele)

A

HLA B27

RR 87

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2
Q

Goodpastures syndrome (allele)

A

HLA DR15/DR2

RR10

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3
Q

Graves’ disease (allele)

A

HLA DR 3

RR 4

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4
Q

SLE (allele)

A

HLA DR3

RR 6

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5
Q

T1DM (allele)

A

HLA DR3/4

RR 25

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6
Q

Rheumatoid arthritis (allele)

A

HLA DR4

RR 4

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7
Q 
PTPN22
Tyrosine phosphates (lymohocytes)
A

asscoc with development of RA SLE T1DM

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8
Q

CTLA4

Receptor for CD80/CD86 (T cell, inhibits activation)

A

Assoc with SLE, T1DM, Autoimmune thyroid

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9
Q

Limited cutaneous scleroderma

A 
CREST; calcinosis, raynauds, eosophageal dysmotility, sclerodactykul, telangiectasia 
\+ pulmonary HTN 
Skin inv; up to forearms + perioral 
High risk; lung fibrosis + renal crisis 
Dx; anticentrimere Abs
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10
Q

Diffuse cutaneous scleroderma

A

CREST + interstitial pulmonary disease + GIT + renal
F:M 4:1
Anti-tropoisomerase/Scl70, RNA Pol (1,2,3), fillarin Abs

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11
Q

Sjögren’s syndrome

A

Xerostomia, keratoconjunctivitis sicca, renal problems, nose, skin
Potential: kidneys, blood vessels, lungs, liver, pancreas, PNS
Potential: parotid/salivary gland enlargement
Anti Ro, Anti La
Schirmir test (tear production)
F:M 9:1
Late 40s

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12
Q

IPEX syndrome

A

Immune dysregulation + Polyendocrinopathy + enteropathy + X linked AR (&autoimmune diseases)
Eczematous dermatitis, nail dystrophy, autoimmune skin cond (e.g alopecia universalis, bullocks pemphigoid)
Most die <2yrs
RX: BMT
Males only

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13
Q

Coeliac disease

A

Failure of tolerance to glucose
Villous atrophy, enteropathy
Sx; GIT discomfort, constipation, diarrhoea, bloating, fatigue
Deficiencies; iron, fat, B12, ADEK, calcium
Dermatitis herpetiformis

Gold standard; duodenal Bx

IgAs antiEndomysial Ab, disappears with exclusion diet (spec 95%, sens 85%) | antiTransglutaminase (spec 95%, sens 90-94%)
IgG anti-gliadin antibody, most persistent (spec 30-50%, sens 57-80%)
Linked to Down’s syndrome
95% HLA DQ 2/8 (to eat or not to 8 ;-)

Ireland EMA 3-10/1000 | n.africa TGT 20/1000

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14
Q

ENAs (extractable nuclear antibodies)

A

Ro, La, Sm, U1RNP

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15
Q

Antiphospholipid syndrome (autoantibody)

A

Cardiolipin
B2 glycoprotein
Lupus anticoagulant

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16
Q

Autoimmune hepatitis (autoantibody)

A

Anti-Sm
Anti liver kidney microsome type 1 (anti-LKM-1)
Anti soluble liver antigen (anti-SLA)

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17
Q

Autoimmune haemolytic anaemia newborn (autoantibody)

A

Anti-Rh

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18
Q

Autoimmune thrombocytopenic purpura (autoantibody)

A

Anti-glycoprotein IIb/IIIa or 1b-IX

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19
Q

Churg Strauss syndrome (eGPA) (autoantibody)

A

Perinuclear/protoplasmic-staining antineutrophil cytoplasmic antibodies (pANCA)

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20
Q

Coeliac disease (autoantibody)

A

Anti tissue transglutaminase antibody IgA
Anti endomysial antibody IgA
Anti-gliadin IgG

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21
Q

Congenital heart block in infants of SLE mothers (autoantibody)

A

Anti-Ro

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22
Q

Dermatitis herpetiformis (autoantibody)

A

Anti-EMA (IgA)

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23
Q

Dermatomyositis (autoantibody)

A

Anti Jo 1 (t RNA Synthetase)

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24
Q

Diffuse cutaneous scleroderma (autoantibody)

A

Antibodies to topoisomerase/SCl 70
RNA pol (1,2,3)
Fibillarin

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25
Q

Goodpastures syndrome (autoantibody)

A

Anti GBM

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26
Q

Graves’ disease (autoantibody)

A

Anti TSH receptor antibody (stimulating antibody)

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27
Q

Hashimoto’s thyroiditis (autoantibody)

A

Antibodies to thyroglobulin and thyroperoxidase

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28
Q

Limited cutaneous scleroderma (autoantibody)

A

Anti centromere antibody

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29
Q

Microscopic polyangitis (MPA) (autoantibody)

A

pANCA perinuclear/protoplasmic staining antineutroohil cytoplasmic antibodies

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30
Q

Mixed connective tissue disease (autoantibody)

A

Anti U1RNP (speckled pattern)

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31
Q

Myasthenia Gravis (autoantibody)

A

Anti Ach receptor antibody

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32
Q

Pernicious anaemia (autoantibody)

A

Antibody to parietal cells (90%)

Antibody to intrinsic factor (10%)

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33
Q

Polymyositis (autoantibody)

A

Anti Jo 1 (tRNA Synthetase)

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34
Q

Primary biliary cirrhosis (autoantibody)

A

Anti mitochondrial antibody

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35
Q

Rheumatoid arthritis (autoantibody)

A 
Anti CCP (Cyclic Citrullinated Peptide)
rheumatoid factor (less spec)
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36
Q

Sjögren’s syndrome (autoantibody)

A 
Anti Ro 
Anti La (speckles)

60-70% = RF positive

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37
Q

SLE (autoantibody)

A 
Antibodies to dsDNA 
Antibodies to his tones (homogenous) 
Ro
La 
Sm 
U1RNP (speckled)
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38
Q

T1DM (autoantibody)

A 
Anti GAD (glutamate decarboxylase) 
Pancreatic B cells
39
Q

Wegeners granulomatosis GPA (autoantibody)

A

Cytoplasmic antineutroohil cytoplasmic antibodies (cANCA)

40
Q

Antibody replacement therapy

A 
>1000 donors 
Screened HIV HBV HCV 
IgG vs range of organisms 
Half life=18/7, every 3-4/52, IV or subcut 
1* Ab def (CIVD, Brutons etc) 
2* Ab def (CLL, MM, BMT) 
Passive vaccination
41
Q

Passive vaccination (spec immunoglobulins, exposure prophylaxis)

A

IgG vs Rabies, varicella zoster, HBV, Tetanus

42
Q

Recombinant cytokines

A

Interferon alpha

  • HCV, HBV, HHV8 (kaposis sarcoma)
  • hairy cell leukaemia, CML, Malignant myeloma
Interferon beta 
Relapsing MS (aka plan B, unknown MODA)

Interferon gamma
Chronic granulomatous disease

43
Q

Block immune checkpoints (immunotherapy)

A

Ab vs CTLA4- Ipilimumab

Blocks immune checkpoints, allows T cell activation
Rx advanced melanoma

Ab vs PD1
Pembrolizumab/Nivolumab
Blocks immune checkpoints, allows T cell activation
Rx advanced melanoma

44
Q

Corticosteroids

A

Prednisolone

MODA: Inhibits phospholipids A2 -> blocks AA -> reduces PG synthesis
Inhibits phagocyte trafficking, phagocytosis, release of proteolytic enz, lymphopeni, promotes apoptosis, blocks cytokines gene expression, decrease Ab production

Indication: AImmune/Inflammatory disease, transplant rejection

SE: transient neutrophilia, diabetes, central obesity, adrenal supression, cataracts, glaucoma, pancreatitis, osteoporosis, moon face, acne, hirsutism, HTN, dyslipidaemia, peptic ulceration, avascukar necrosis

45
Q

Cyclophosphamide (antiproliferative)

A

MODA: alkylate guanine base of DNA, prevents DNA rep, affects B>T, high doses affects all cells with high turnover

Indications: CTD, Vasculitis, anticancer agent

SE: BM suppression, infections, malignancy, teratogenic, hair loss, sterility, haemorrhaged cystitis

46
Q

Mycophenolate

Mofetil

A

MODA: inhibits IMPDH prevents guanine synthesis, blocks de novo nucleotide synthesis, prevents DNA rep, T>B

Indications: transplantation, autoimmune disease, vasculitis

SE: BM suppression, infection (v.reactivation, progressive multifocal leukoencephalopathy), malignancy, teratogenic

47
Q

Azathioprine

A

MODA: antimetabolite agent -liver-> mercaptopurine, blocks de novo purine (e.g. Adenine, guanine) synthesis, prevents Rep of DNA, pref inhibits T cell activation and proliferation

Indications: Transplantation, autoinflammatory, autoimmune

SE: BM suppression, infection, malignancy, teratogenic, hepatotoxicity, neutropenia

(TPMT polymorphism=unable to metabolise azathioprine)

48
Q

Methotrexate

A

MODA: inhibits dihydrofolate reducatase (DHFR) therefore decreases DNA synthesis

Indications: RA, Psoriasis, crowns, chemotherapy=abortifacient

SE: BM suppression, infection, malignancy, teratogenic, pneumonitis, pulmonary fibrosis, hepatotoxicity, folate deficiency (macrocytic megaloblastic anaemia)

49
Q

Plasmapheresis

A

MODA: removal of pathogenic Ab, remove plasma immunoglobulins, reinfuse or replace with albumin (plasma exchange)

Indications: severe antibody mediated disease (goodpastures syndrome, myasthenia gravis, vascular rejection), antibody mediated rejection

SE rebound ab production limits efficacy, anaphylaxis

SE

50
Q

Tacrolimus

A

MODA: (-) calcineurin, (+) transcription of IL2, reduces T call prolif

Indications: rejection prophylaxis transplant

SE: nephrotoxicity, HTN, neurotoxic, diabetogenic

51
Q

Cyclosporin

A

MODA: (-) calcineurin, (+) transcription of IL2, reduces T cell prolif

Indications: rejection prophylaxis transplant

SE: nephrotoxicity, HTN, neurotoxic, dysmorphism, gingival hypertrophy

52
Q

Sirolimus

A

MODA: blocks clonal prolif of T call

Indication: rejection prophylaxis transplant

SE: less nephrotoxic, HTN

53
Q

Tofacitinib

A

MODA: JAK inhibitor

Indication: rheumatoid arthritis

54
Q

Apremilast

A

PDE4 inhibitor

Indications: psoriasis, psoriatic arthritis

55
Q

Basiliximab

A

MODA: anti CD25 (alpha chain of IL2 receptor), (-) T cell prolif

Indication: allograft rejection

SE: infusion reactions, infection, malignancy, GIT disturbance

56
Q

Abatacept

A

MODA: anti CTLA4, reduces T Cell activation

Indications: RA

SE: infusion reaction, infection (TB, HBV, HCV), malignancy, cough

57
Q

Rituximab

A

MODA: anti CD20, depletes mature B cells (not plasma cells)

Indications: lymphoma, RA, SLE

SE: infusion reaction, infection (PML), exacerbation CV disease

58
Q

Natalizumab

A

MODA: anti-alpha4 intigrin (VCAM1, MadCAM1; rolling/arrest of leukocyte), (-) T cell migration

Indication: relapsing remitting MS, crohns

SE: infusion reactions, infections (PML), malignancy, hepatotoxicity

59
Q

Tocilizumab

A

MODA: Anti-IL6 R, reduces macrophage/T cell/B cell/neutrophil activation

Indications: castlemans disease, rheumatoid arthritis

SE: infusion reaction, infection, hepatotoxicity, hyperlipidaemia, malignancy

60
Q

Muromonab-CD3

A

Blocks CD3 R on T cells, mouse monoclonal Ab (OKT3)

Indication: active allograft rejection

SE: fever, leukopenia

61
Q

Anti-thymocyte globulin

A

MODA: Leukocyte depletion, modulation of T cell activation and migration

Indication: allograft rejection (heart, renal)

SE: infusion reaction, infection, malignancy, leukopenia

62
Q

Daclizumab

A

MODA: IL2 R antibody, targets CD 25

Indication: organ transplant rejection prophylaxis

63
Q

Efalizumab

A

MODA: Anti-CDIIa, (-) migration of T cells

64
Q

Alemtuzumab (campath)

A

MODA: monoclonal Ab vs CD52, lymohocyte depletion

Indication: CLL, MS

SE: CMV

65
Q

Infliximab

A

MODA: anti-TNFa

Indication: RA, Ankylosing spondylitis, Psoriasis, psoriatic arthritis, IBD

SE: infusion/injection site reactions, infection (TB/HBV/HCV), lupus like condition, demyelination, malignancy (lymphoma)

66
Q

Adalimumab

Fully human monoclonal antibody

A

MODA: anti-TNFa

Indication: RA, Ankylosing spondylitis, Psoriasis, psoriatic arthritis, IBD

SE: infusion/injection site reactions, infection (TB/HBV/HCV), lupus like condition, demyelination, malignancy (lymphoma)

67
Q

Certolizumab

A

MODA: anti-TNFa

Indication: RA, Ankylosing spondylitis, Psoriasis, psoriatic arthritis, IBD

SE: infusion/injection site reactions, infection (TB/HBV/HCV), lupus like condition, demyelination, malignancy (lymphoma)

68
Q

Golimumab

A

MODA: anti-TNFa

Indication: RA, Ankylosing spondylitis, Psoriasis, psoriatic arthritis, IBD

SE: infusion/injection site reactions, infection (TB/HBV/HCV), lupus like condition, demyelination, melignancy (lymphoma)

69
Q

Etanercept

A

MODA TNFalpha/TNFbeta R p75-IgG fusion protein

Indication RA, Ankylosing spondylitis, psoriasis, psoriatic arthritis

SE injection site reaction, infection (TB, HBV, HCV), lupus like conditions, demyelination, malignancy

70
Q

Ustekinumab

A

MODA Anti IL12 and IL23 (binds p40 subunit)

Indications: psoriasis, psoriatic arthritis

SE: injection site reactions, infection (TB), malignancy, cough

71
Q

Secukinumab

A

MODA: anti IL 17A

Indications: psoriasis, psoriatic arthritis, ankylosing spondylitis

SE: infection (TB)

72
Q

Denosumab

A

MODA: anti-RANK ligand antibody, inhibits RANK mediated osteoclasts differentiation and function

Indication: osteoporosis, multiple myeloma, bone metastasis

SE: infection, avascular necrosis of the jaw

73
Q

Transplant rejection; Hyperacute

A

Time: Min-Hrs
Mech: preformed Ab (+) complement
Path: thrombosis and necrosis
Rx: prevention-crossmatch (ABO groups), HLA-matching

74
Q

Transplant rejection; Acute vascular rejection

A

post xenograft transplant
similar for hyperacute
4-6/7

75
Q

Transplant rejection; Acute-cellular

A

Time: wks-mnth
Mech: CD4 mediated type IV reaction
Path: cellular infiltrate
Rx: T cell immunosuppression

76
Q

Transplant rejection; acute-antibody mediated

A

Time: wks-mnths
Mech: B cell activation- Ab vs vessels
Path: vasculitis, C4d staining
Rx: Ab removal and B cell immunosuppression

77
Q

Transplant rejection; Chronic

A

Time: Mnths-yrs
Mech: immun and non immune mech. RF; Multiple acute rejections, HTN, Hyperlipidaemia
Path: fibrosis, glomerulopathy, vasculopathy (ischaemia), bronchiolitis obliterans (lung)
Rx: Minimise organ damage

78
Q

Transplant rejection; GvHD

A

Time: days-wks
Mech: donor cells attack host
Path:skin (rash) GI (D&V, bloody stool), Liver (jaundice)
Rx: prevention/immunosuppression-corticosteroids

79
Q

Transplant immunosupression ‘‘guidelines’’

A 
Pre-transplant; anti-CD52 (alemtuzumabe), anti-CD25 (Basiliximab), OKT3/ATG
Post transplant (reduced rejection); CNI (calcineurin (-), tacrolimus, cyclosporin) + MMF (mycophenolate mofetil)/Aza _/- steroid
Acute rejection; cellular-setorids, OKT/ATG // Ab medicatied- IVIG, plasma exchange, anti-C5, anti-CD20

GvHD prophylaxis; methotrexate/cyclosporin

80
Q

HIV Rx: fusion inhibitors

A

Enfuvirtide
SE: Local reactions to injections
Hypersensitivity (0.1-1%)

81
Q

HIV Rx: Attachments inhibitors

A

Maraviroc

SE ?

82
Q

HIV Rx: NucleosideRTI

A

emitricitabine*, didanosine, lamivudine, epzicom, combivir, trizivir, Z,Z,S,A
SE: Generally rare; fever, headaches, GI disturb
Zidovudine; BMS
Zalcitabine, stavudine; peripheral neuropathy
Stavudine; Mtch toxicity
Abacavir; hypersensitivity

83
Q

HIV Rx: NucleoTideRTI

A

Tenofovir*

SE: bone and renal Tx

84
Q

HIV Rx: Non-NRTI

A

Nevirapine; Hepatitis
Delavirdine; Rash
Efavirenz*; CNS effects

85
Q

HIV Rx; integration inhibitors

A

Raltegravir, Elvitegravir

?SE

86
Q

HIV Rx: Protease (-)

A

Indinavir, fosamprenavir, nelfinavir, lopinavir, ritonavir, atazanavir, amprenavir, saquinavir
SE: hyperlipidaemia, fat redistribition, T2DM

87
Q

HIV Rx; Atripla

A

Tenofovir, Efavirenz, Emitricitabine

88
Q

Vaccination schedule

A 
2mnths; DTaP/IPV/HiB, PCV, R (oral), MenB
3mnth; DTaP/IPV/HiB, R
4mnths; DTaP/IPV/HiB, PCV, MenB
12-13mnths; HiB/MenC, MenB, PCV, MMR
3yrs 4mnths; DTaP/IPV, MMR
Females 12-13yrs; HPV (16+18)
13-19; dT/IPV, MenACWY
60+; PCV, Influenza
70+; shingles
2-7yr influenza (nasal) 
@risk; BCG
T/IPV; not immunised as child
DTaP/IPV; for preg woman 28-38/40
Travel; Cholera, HBV, HAV, Jap Encephalitis, tick bourne enceph, typhoid, yellow fever
89
Q

T Helper cells

A

TH1; cell mediated; IL2, INF gamma, TNF

TH2; Humoral response; IL4, IL5, IL6

90
Q

Live Vaccines

A 
sabin polio (oral, no longer used) 
MMR
Chicken pox
Yellow fever
BCG
Typhoid
Live attenuated; BCG, MMR, Typhoid

(HIV pos may have MMR, not BCG/YF)

91
Q

Inactivated Vaccines

A

Inactivated; Salk (polio), anthrax, cholera, bubonic plague, Hep A, Rabies, Pertussis, Influenxa
Component/subunit; HepB (HbS antigen), HPV (capsid), Influenza (Haemagglutinin, Neuraminidase)
Conjugate; Tetanus (Exotoxin), Hib, Meningococcus, Pneumococcus
Toxoids; Diphtheria, Tetanus

92
Q

Adjuvants

A

ALUM; Ags absorbed, slow releage Ag, activates Gr1+ cells-> IL4-> prime naive B cells
CpG: unmethylated DNA motif (+) TLRs on APC stim expression of costim mol
Complete Freund’s adjuvant; water in oil emulsion containing mycobacterial cell wall component (vetinary, as painful in humans)
ISCOMS; experiments multimeric Ag with adjuvant in built, cell mediate and humotsl immunr trdpondr
IL2; Hep B Sag for seroconversion

93
Q

Passive Vaccines

A

Igs, 3 wk immunity

HNIG; HepA and Measles
HBIG; HepB
HRIG; Rabies
VZIG; Varicella
Paviluzimab; monoclonal Ab for RSV

PathGuide (1 decks)

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