Immuno Flashcards

1
Q

Hypersensitivity reactions

A

I: IgE-mediated. allergic asthma or anaphylaxis

II: cytotoxic, ab-dependent. Autoimmune hemolytic anemia, immune thrombocytopenia

III: Ag-Ab complex. Serum-sickness like syndrome of acute Hep B

IV: delayed rxn, T-cell mediated. Dermatitis, PPD test

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2
Q

Immune thrombocytopenia (ITP)

A

acquired thrombocytopenia
AutoAb-mediated destruction of PLTs

Tx:

  • PLTs >=30K, asxs, minor mucocutaneous bleeding: observe
  • PLT <30K, asxs, minor mucocutaneous bleeding: corticosteroids
  • Urgent mgmt bleeding or prior to urgent procedure: IVIG
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3
Q

High risk of postop complications in pts w/ IBD

A

pts on steroid therapy within 4 weeks before surgery
Greater incidence of infection-related complications (abscess)

5-ASA acts on bowel lining, different from aspirin, don’t need to be stopped before surgery

Anti-TNF in 3 months prior to surgery has not been shown to affect wound healing

Preop hypoalbuminemia is strong predictor of postop morbidity and mortality

Thiopurines (azathioprine) within 6 weeks of surgery have increased risk of postop morbidity, anastomotic leak/sepsis

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4
Q

Management of ITP

A

1st line: steroids
2nd line: IVIg
3rd line: Rituximab, romiplostim (after splenectomy failure); splenectomy if med mgmt fails

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5
Q

Factors associated with Radiation Resistance

A
Hypoxia
Smoking status
Inherent tumor cell characteristics
Repopulation
Tumor location
Tumor grade
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6
Q

Management of Periop Steroids in pts at risk for HPA Axis suppression (20mg/day pred for >3 weeks)

A

Minor/ambulatory surgery (local anesthetic, hernia): Take normal AM dose of PO steroid day of surgery, no supplemental steroids

Mod stress (leg revascularization): Take normal AM dose of PO steroid day of surgery. Before induction: hydrocortisone 50mg IV. POD 0-2: hydrocortisone 25mg q8h x 24h, POD 2: PO outpt dose

Major stress (cardiac, abd, thoracic): Take normal AM PO dose day of surgery. Before induction: hydrocortisone 100mg IV, POD 0-2: hydrocortison 50mg q8h x24h, POD 2: hydrocortisone 25mg q8h, POD 3-4: outpt dose

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7
Q

Management of periop steroids in pts at intermediate risk for HPA axis suppression (5-20mg/d pred for >=3 weeks)

A

Eval of HPA axis suppression periop to determine need for additional stress dose steroids

Cortisol levels, ACTH stimulation test

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8
Q

Graft-versus-host disease (GVHD)

A

T-cell-mediated disease

3 steps:

1) damage to recipient tissue as part of conditioning process for stem cell transplant (circulating immune cells are destroyed) -> translocation of microbes and activation of innate immune system
2) Differentiation of donor T-cells into Th2 and Th17. Recognize host as foreign, activate JAK1/2, TLR, cause release of proinflammatory CKs (IL-6, IFG), cause host tissue destruction (donor NK cells targeting MHC-1 cells)
3) Tissue dysregulation from CKs -> host tissue failure (skin, gut), fail to regenerate after being destroyed

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9
Q

Transfusion-related acute lung injury (TRALI)

A

Recipient cells target donor cells

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10
Q

Chronic GVHD

A

Dysregulation of donor T regulatory cells, resultant fibrosis

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11
Q

Phases of wound healing

A

Inflammatory (1-3 days)
Proliferative (4 days - 3 weeks)
Remodeling (3 - 8 weeks)

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12
Q

MPs in wound healing

A

Arrive at wound w/in 3-5 days after injury.
Release growth factors, proliferation of immune cells, initiate angiogenesis
Phagocytize tissue/bacteria/other phagocytes
Participate in regeneration and are essential for found healing

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13
Q

First cells in wound

A

NPs

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14
Q

Hodgkin Lymphoma staging

A

Stage I: Dz located in single lymphatic site
Stage II: Dz in 2+ sites either above or below diaphragm
Stage III: Dz located above & below diaphragm
Stage IV: Disseminated dz. Involves non-lymph tissue

add “b” designation if patient also has B sxs: night sweats, weight loss, pruritus

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15
Q

Delayed immune hemolytic reaction

A

ABO-compatible RBCs containing a specific antigen, RhD Duffy or Kell, transfused in pts with preformed alloantibodies.
Development of new Ab from previous blood transfusions
Abs are to minor Age - Rh, Duffy, Kell
Prevent by retyping & screening pt’s blood to ID new Abs
Can occur up to 30 days after transfusion
Sxs appear in 3-10 days - fever, malaise, unconjugated hyperbilirubinemia, declining Hg/Hct

Dx: Direct Coombs test + peripheral smear

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16
Q

Tumor lysis syndrome

A

hematuria, leukocytosis, hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia, AKI

Phosphate binds calcium. CaPhos crystals precipitate in kidneys –> AKI

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17
Q

Pt w/ Crohn’s disease, on azathioprine, noted with TI mass, received treatment (chemo) then noted with hyperkalemia, AKI, hyperphosphatemia, hematuria

A

tumor lysis syndrome from aggressive lymphoma (non-Hodgkin B cell lymphoma)

18
Q

Howell-Jolly bodies

A

nuclear remnants in RBCs
usually cleared by spleen

Seen on peripheral smear after splenectomy

19
Q

Heinz bodies

A

aggregates of denatured Hg

Found in G6PD deficiency pts

20
Q

Pappenheimer bodies

A

Iron-containing blue granules in RBCs

Seen in pts w/ siderblastic anemia

21
Q

DIC

A

Acquired coagulopathy. Excessive thrombin, diffuse microthrombi generation. consumptive thrombocytopenia, depletion of coagulation factors.

Prolonged PT and PTT. High fibrin split products, Low fibrinogen.

22
Q

Thoracic duct

A

Originates at cisterna chyli at midline L1-L2
Course superiorly through aortic hiatus at T10-12 (to right of aorta)
Runs along right of midline, crosses R -> L at T4-6
Empties into junction of L subclavian and L IJ vein

Carries chylomicrons and LCFA.

23
Q

Renal transplant rejection types

A

Hyperacute: min - hrs. preformed Abs, complement activation. endothelial damage, inflammation, thrombosis. Prevent by pre-transplant crossmatch, ABO type match

AcuTe: weeks - months. T cell-mediated, acquired Ab response. Lymphocytic infiltration, complement deposition, parenchymal necrosis. Prevent by initial immunosuppressive T cell depletion following by tapered T-cell inactivation

Chronic: months - years. T & B cells, donor-specific Ab. parenchymal replacement with fibrous tissue, intimal smooth muscle proliferation leading to vessel occlusion. prevent acute rejection episodes, limit ischemia/reperfusion at transplant

24
Q

Neutropenic enterocolitis

A

CT: thick colon, no evidence of bowel perf
Diarrheal dz in HIV patients

MCC AIDS-related diarrhea = CMV
2/2 reactivation of latent infection
RFs: CMV viremia, advanced immunosuppression (CD4 <50)
Stool studies: viral inclusion bodies
Endoscopy: ulcers, erosions

Tx: noon NPO/IVFs, Abx, Antiretroviral, +ganciclovir or valganciclovir (if CD4<50).

25
hemolytic vs nonhemolytic transfusion reactions
febrile non hemolytic: host ab against donor leukocytes. CKs from donor. stop transfusion. tx sxs hemolytic: ABO incompatibility - host Ab against donor RBCs. tx stop transfusion, IVFs
26
Source and Effects of IL-1
MPs, monocytes T-cell & APC stimulation, B-cell growth, Ab production Induces fever through activity on hypothalamus
27
Source and Effects of IL-2
Activated T-cells T-cell growth & proliferation (CD4 cell)
28
Source and Effects of IL-4
T-cells, mast cells B-cell proliferation IgE production Involved in asthma exacerbation
29
Source and Effect of IL-5
T-cells, mast cells Eosinophil growth and modulation Involved in asthma exacerbation
30
Source and Effect of IL-6
Activated T-cells Induces inflammation Lymphocyte differentiation
31
Source and Effects of IL-8
MPs NP stimulation/recruitment, demargination, degranulation Inhibition of endothelial adhesion Implicated in obesity, cystic fibrosis
32
Source and Effects of IL-10
Activated T-cells, B-cells, monocytes Type 1 T-helper cell suppression Down-regulates MHC II Ags
33
Source and Effects of IL-12
MPs, B-cells NK cell stimulation Enhances IFN-gamma expression of B-cells
34
Source and Effects of IL-13
Type 2 T-helper cells IgE production Assoc w/ asthma and allergy exacerbation
35
Cells that stain CD3+ and recognize HLA-1 molecules
CD8+ cytotoxic T-cell Causes release of lysosomal granules containing perforin, holes in cell membranes, granzymes responsible for cell lysis, promote apoptosis through CD95 (Fas) rec
36
Primary lymphoid organs
Generate lymphocytes from immature cells Liver Bone Thymus
37
Secondary lymphoid organs
Maintain current lymphocytes and initiate adaptive immune response ``` LNs Spleen Peyers patches Tonsils Adenoids ```
38
Mechanisms of apoptosis
Extrinsic: binding death rec -> recruitment of Fas associated death domain protein -> activation of caspase 3 intrinsic: protein mediators (Bcl-2) -> increased mitochondrial membrane permeability -> release of mitochondrial cytochrome C -> activates caspase 3
39
Caspase
mediates organized breakdown of nuclear DNA --> apoptosis
40
Ipilimumab (Yervoy)
CTLA-4 inhibitor, upregulates CD4
41
Nivolumab (Opdivo)
PD1 inhibitor, up regulates CD4
42
Pembrolizumab
Tx of metastatic melanoma | PD1 inhibitor