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Path Past Papers > Immuno > Flashcards

Immuno Flashcards

1
Q

EBV and amoxicillin/ampicillin/cephalosporin

A

Causes hypersensitivity reaction in presence of EBV - not true allergy

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2
Q

Ibrutinib can be used in which leukemia?

A

CLL

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3
Q

Tx Psoriasis

A

Ustekinumab (anti IL-12/23)

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4
Q

Tx RA (not DDMARD/MTX)

A

Rituximab (anti CD20), anti-TNFa (etanercept or adalimumab), tocilizumab (anti-IL6)

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5
Q

Wegener’s with severe flare treatment

A

Cyclophosphamide

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6
Q

Worsening Crohn’s, already on Azathioprine and Prednisolone, what tx?

A

Infliximab (Anti-TNFa)

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7
Q

Malignant melanoma medical treatment

A

Pembrolizumab

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8
Q

Rituximab

A

RA or Lymphoma

anti-CD20

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9
Q

Transplant drugs

A 
Tacrolimus, Cyclosporin
Azathioprine
Mycophenolate Mofetil
Antithymocyte globulin (ATG)
Prednisolone
Basiliximab (anti-CD25/IL-2) (prophylactic)
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10
Q

Type I hypersensitivity

A

Allergy/Atopic eczema

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11
Q

Type II hypersensitivity

A

Auto-immune/auto-inflammatory e.g. Graves

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12
Q

Type III hypersensitivity

A

Complex mediated e.g. SLE

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13
Q

Type IV hypersensitivity

A

Delayed e.g. contact dermatitis, diabetes

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14
Q

CD40L associated

A

Hyper IgM

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15
Q

GPA’s other name

A

Wegener’s Granulomatosis

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16
Q

eGPA’s other name

A

Churg-Strauss Syndrome

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17
Q

Monitoring SLE

A

C3, C4

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18
Q

Chest and renal

A

Good-pasture’s classically but can be GPA/eGPA

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19
Q

Hyperacute rejection (transplant)

A

Minutes-hours

Pre-formed Abs activate complement
–> Thrombosis and necrosis

Prevent by cross-match and HLA typing

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20
Q

Acute cellular rejection (transplant)
When?
Mechanism?
Treatment?

A

Weeks-months

CD4 cells –> type IV hypersensitivity reaction –> cellular infiltrate

Tx: T-cell immunosuppression e.g. Steroids

Memory aid: T cell = T 4

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21
Q

Acute Ab-mediated rejection (transplant)

A

Weeks-months

B-cells --> antibodies --> attack vessels and endothelial cells --> vasculitis
Complement deposition (C4d)

B-cell immunosuppression & remove Abs

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22
Q 
Chronic rejection (transplant)
Timeline?
Mechanism?
Treatment?
RFs?
A

Months-years

Various immune+non-immune mechs –> fibrosis, GN?, ischaemia

Tx: minimise organ damage

RF: multiple acute rejections, HTN, hyperlipidaemia

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23
Q

GvHD

A

Days-weeks (T cell mediated)

Rash, bloody D&V, & jaundice

Tx: Immunosuppress with steroids

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24
Q

Acute vascular rejection

When?

A

4-6 days post transplant after xenograft - presents similarly to hyperacute

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25
Q

H1 vs H2 antagonisst

A 
H1 = antihistamines
H2 = reducing gastric acid
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26
Q

Itchy skin when running in cold for an hour

A

Acute urticarial –> H1 antagonist

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27
Q

Hereditary angioedema treatment

A

C1q esterase inhibitor (reduces swelling)

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28
Q

Measure of mast cell degranulation

A

Mast cell tryptase levels

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29
Q

Chemokine promoting eoosinophil growth

A

IL-5

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30
Q

Tingly mouth after eating apples, melons etc.

A

OAS (Sxs limited to mouth)

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31
Q

Woman with flushed face, breathing problems (happened multiple times) and hepatomegaly

A

Hereditary angioedema

Tx: C1 esterase inhibitor

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32
Q

Kid with rash on extensor surfaces, IgE mediated

A

Atopic dermatitis

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33
Q

Hypertensive and diabetic with angioedema - potential cause?

A

ACE inhibitor

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34
Q

Absent T cells and normal B cells

A

X-linked SCID

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35
Q

1m baby, serious bacterial infections
Normal CD8, no CD4
B cells present
IgM present, IgG absent

A

Bare Lymphocyte Syndrome (Type 2)

Absent expression of MHC Class II molecules

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36
Q 
Jaundiced 4m baby, FTT, recurrent infections
raised ALP, low CD4, defect protein regulates MHC class 2
A

Bare Lymphocyte Syndrome (Type 2)

Associated with sclerosing cholangitis –> jaundice

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37
Q

Recurrent strep. pneumonia

FHx of having it and dying young

A 
Complement deficiency
(Encapsulated organism)
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38
Q

Child with recurrent infections, improved with age, now delay in language and speech

A

DiGeorge

Immune function improves with age
Can be associated with lots of speech/language issues and LDs as well as rest of CATCH-22

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39
Q

Loss of the terminal complement pathway - most at risk from?

A

Encapsulated organisms

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40
Q

Recurrent meningitis

A

Complement deficiency (C5-9)

Encapsulated organism e.g. Hib or N. meningitidis

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41
Q

Primary immunodeficiency causing atypical granulomas

A

IFNy/IL12 or receptor deficiency

Predisposed to mycobacterial infections
Inability to form granulomas hence atypical

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42
Q

Recurrent infections
negative NBT test
negative dihydrorhodamine test

A

Chronic Granulomatous disease

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43
Q

6m boy, sevete FTT & recurrent infections

No T cells, B cells normal

A

X linked SCID

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44
Q

Alternative complement pathway components

A

Factor B, I & P

“BIP”

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45
Q

Lady with spinal fracture due to TB

A

IFNy/IL12 or receptor deficiency

Mycobacteria susceptible –> Pott’s disease

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46
Q

Felty’s syndrome (3 features)

A

Rheumatoid arthritis, neutropenia and splenomegaly

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47
Q

Rheumatoid arthritis and splenomegaly

A

Felty’s

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48
Q

Monocytes in peripheral skin cells

A

Langerhans

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49
Q

Cells that express Foxp3 and CD25

A

Treg

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50
Q

Responsible for killing cancerous cells + inhibited by MHC-I

A

NK cells

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51
Q

PEP exists against (3)

A

Rabies, HIV, tetanus

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52
Q

Routine vaccine that is not given to immunocompromised patients

A

MMR

If oral steroids in past 3 months delay vaccine

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53
Q

Vaccine target HA

A

Influenza

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54
Q

Every 5 years post splenectomy

A

Pneumococcal

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55
Q

Adaptive response to HIV:

Neutralising antibodies against what?

A

anti-gp120 and anti-gp41

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56
Q

Adaptive response to HIV:

Non-neutralising antibodies against what?

A

anti-p24 & gag IgG

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57
Q

Co-receptor required for HIV entry into CD4

A

CCR5 & CXCR4

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58
Q

HIV binding to CD4

  1. Initial binding
  2. Conformational change
  3. Co-receptors
  4. What are they co-receptors on?
A
  1. gp120
  2. gp41
  3. CCR4 & CXCR5
  4. Macrophages
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59
Q

Intrastructural support for HIV

A

gag protein

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60
Q

Chemokines which block CCR5 (inhibit HIV entry into cell)

A

MIP-1a, MIP-1b, and RANTES

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61
Q

HIV enzyme that copies with errors

A

Reverse Transcriptase

RT

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62
Q

AIRE gene - which condition?

A

Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy
(APECED)

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63
Q

FAS gene mutation causes which condition?

A

ALPS (autoimmune lymphoproliferative syndrome)

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64
Q

MEFV gene, periodic abdominal pain and ascites

A

Familial Mediterranean Fever

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65
Q

Nod2/CARD-15

A

Crohn’s

Chromosome 16

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66
Q

DR4 and CCP

A

RA

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67
Q

HLA-B27, sacroiliitis

A

Ank spond

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68
Q

What should you check before starting azathioprine?

A

TPMT levels (enzyme)

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69
Q

Adult with bronchiectasis, recurrent sinusitis, diarrhoea and development of atypical SLE

A

Common variable immunodeficiency

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70
Q

What does IPEX stand for?

A

Immune dysregulation (autoimmune conditions)
Polyendocrinopathy
Enteropathy
X-linked inheritance syndrome

Absolute deficiency of Treg cells (Foxp3 mutation)
BMT is only cure

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71
Q

CTLA4 receptor on t cells

A

associated with AI conditions like diabetes and thyroid disease

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72
Q

PTPN22

A

Tyrosine phosphatase associated with RA

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73
Q

CGD treatment type

A

IFN gamma

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74
Q

SE of cyclophosphamide

A

infertility

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75
Q

SE of azathioprine

A

neutropenia (especially if TPMT is low)

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76
Q

SE of cyclosporin

A

Hypertension

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77
Q

SE of Mycofenolate Mofetil

A

Progressive multifocal leukencephalopathy (caused by JC virus)

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78
Q

60yo develops rash while under general anaesthetic, what do you do after stopping the anaesthetic?

A

Measure mast cell tryptase

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79
Q

75yo man takes ACEi, inhalers, metformin - presents with tongue and periorbital swelling. Cause of swelling?

A

ACEi

1% have drug-induced angioedema

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80
Q

C1q deficiency

A

Skin conditions, childhood onset SLE (severe), infections, kidney disease

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81
Q

anti-CD25

A

Basilixumab

CD25 is the alpha chain of IL-2 receptor

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82
Q

anti IL12/23

A

Ustekinumab

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83
Q

anti IL-6

A

Tocilizumab

84
Q

AI hep/PSC antibody

A

Anti smooth muscle Ab

85
Q

Goodpasteurs connective tissue thing

A

Type IV collagen

86
Q

Mouldy hay

A

Extrinsic allergic alveolitis (EAA)/ Hypersensitivity pneumonitis

87
Q

Oligoclonal bands of IgG on CSF with myelin basic protein

A

Multiple Sclerosis

88
Q

OKT3

A

A mab for hyperacute rejection

89
Q

Calcineurin inhibitor

A

Cyclosporin (reduces IL-2)

90
Q

Medication that inhibits DNA synthesis in an attempt to prevent proliferation of T cells (post transplant)

A

Azathioprine

91
Q

IVDU who has multiple aneurysms

A

Hep B is associated with polyarteritis nodosa

92
Q

SLE pt develops bleeding from gums and nose bleeds, with low platelet count

  1. Antibody target
  2. name of condition developed
A
  1. Glycoprotein IIb-IIIa

2. Autoimmune thrombocytopenic purpura

93
Q

Drug that prevents cell replication by damaging DNA (B cells more than T cells)

A

Cyclophosphamide

Used in SLE, wegeners, leukemias, CTD

94
Q

CTLA4-immunoglobulin fusion protein

A

Abatacept (rheumatoid arthritis)

95
Q

Mycophenylate Mofetil MoA

A

Guanine synthesis (IMPDH is the enzyme)

96
Q

Kveim test

A

Sarcoidosis

97
Q

Test for HSP

A

immunofluoresence

98
Q

Increased CH50

A

acute inflammation e.g. RA

99
Q

Pot strep rheumatoid fever (mechanism)

A

Molecular mimicry

100
Q

1st exposure to allergen IL

A

IL-12

101
Q

Dermatomyositis appearance on immunofluoresence

A

Speckled (Anti-Jo1)

102
Q

Lipiduria

A

Minimal change disease (increase in lipids to try to maintain oncotic pressure)

103
Q

TNF-ß is central in diagnosis of which condition?

A

CREST

104
Q

Allergy

  • Cold Urticaria
  • Oral allergy syndrome
  • Lactose intolerance
  • Drug reaction
  • Penicillin allergy
  • Type 1 hypersensitivity latex allergy
  • Type 3 hypersensitivity latex allergy
  1. A teenage girl who when she goes cross country running gets an erythematous rash on her legs. It is well controlled by antihistamines
  2. Man can eat apple pie. But if he eats fresh apples and pears, he gets inflamed lips
  3. Man has an allergic reaction during surgery and who’s lips becomes swollen/oedematous when blowing up balloons as his daughter’s birthday party
  4. Bloated after drinking milk but not IgE mediated
  5. A girl with a sore throat is given penicillin and develops a rash. She is found to have EBV
A
  1. Cold Urticaria
  2. Oral allergy syndrome
  3. Type 1 hypersensitivity latex allergy
  4. Lactose intolerance
  5. Drug reaction
    Sore throat = EBV
    EBV can provoke penicillin rash but not true allergy
105
Q

What does the monospot antibody test test for?

A

Infectious mononucleosis (EBV)

106
Q

What cell stays in its immature form in the periphery, and when it matures goes to present things to T cells in lymph nodes?

A

Dendritic cells

107
Q

Which cell is increased in cases of parasitic infection?

A

Eosinophils

108
Q

Which cell undergoes positive & negative selection in thymus?

A

T lymphocytes

109
Q

When infection, this cell responsible for production of pus (when it dies)

A

Neutrophils

110
Q

Boy with abscesses has positive nitro blue tetrazolium

A

Myeloperoxidase deficiency

111
Q

Girl found to have no CD4 cells, but CD8 cells & B cells present

A

Bare lymphocyte syndrome 2

112
Q

Which cancer can the Bruton tyrosine kinase inhibitor ibrutinib be used in?

a. Bruton’s
b. CML
c. AML
d. ALL
e. CLL

A

e. CLL

113
Q

Rhesus D -ve woman having haematopoietic stem cell transplant (HSCT) & is CMV IgG -ve. What is the most important thing to ensure in the transplant

a. HLA of donor and recipient identical
b. Related to recipient and HLA identical
c. HLA haploidentical
d. CMV IgG negative
e. Donor not Rhesus match

A

d. CMV IgG negative

114
Q

Which of these vaccines must not be given to a pregnant woman:

a. MMR
b. Hep B
c. DTP
d. Influenza
e. Meningococcus

A

a. MMR (as contains live Rubella virus)

115
Q

What cell in the body is likely to bind to MHC1 presenting cells

a. Natural killer cells
b. CD4+ cells
c. CD8+ cells
d. Eosinophils
e. Neutrophils

A

c. CD8+ cells (- aka: Killer T cells, T-killer cells, Cytotoxic T cells, CD8+ T cells)

116
Q

There are 5 special drug treatments. Which drug can be used to treat some malignancies and affects T cell activity?

a. Infliximab
b. Pembrolizumab
c. Rituximab
d. Denosumab
e. Imatinib

A

c. Rituximab – Targets B cells + causes inactivation of T cells

Infliximab – Binds to TNF-a which is soluble (in blood) and located on outer membrane of T cells (transmembrane) + similar immune forms of TNF-a. Thus preventing binding of TNF-a to its receptor. This is used loads: Psoriasis, Crohn’s, Rheumatoid

Pembrolizumab – blocks programmed cell death protein 1 receptor (PD1 receptor

117
Q

What does Denosumab target?

A

Receptor activator of nuclear factor kappa-B Ligand (RANKL)

118
Q

A Turkish man has a fever (and has a history of recurrent chest infections). Tests show a mutation in the MEFV gene. What does he have?

A

Familial Mediterranean Fever

119
Q

Which mixed pattern auto-inflammatory condition has over 90% heritability and effects the sacroiliac joint?

A

Ankylosing Spondylitis

120
Q

Which common condition can be treated with drugs that target with TNF, IL-17 and IL-12/23?

A

Psoriasis

121
Q
  • A. Which immune cell is produced in the bone marrow then migrates to site of injury, has oxidative and non-oxidative killing methods and dies once job is done
  • B. Foxp3+ cells, they mature in the thymus
  • What immune cells detects antigen in the periphery and moves to lymph nodes?
  • What immune cell detects MHC1 and kills virus infected/cancer cells. Is inhibited by MHC I.
  • What immune cells is targeted by HIV?
A
  • Neutrophils
  • Treg
  • Dendritic cell
  • NK cells
  • Memory CD4+
122
Q

Receptor mutation/cytokine that could be protective against HIV?

A

CCR5/MIP-1a or b

123
Q

What type of hypersensitivity (Gel & Coombs classification) is myasthaenia gravis?

A

Type II

124
Q

IPEX affects what type of immune cell

A

Treg (Foxp3)

125
Q

Lady with SLE, has spherocytes, low Hb, raised bilirubin. How do you test for diagnosis?

A

Direct antiglobulin test (AIHA due to SLE)

126
Q

What is the definition of herd immunity threshold?

A

1 - (1/R0)

127
Q

16 year old girl has pleuritic chest pain, joint pain, positive ANA and Anti-Sm, no liver enzyme derangement, raised ESR. Diagnosis?

A

SLE

128
Q

Chimeric antigen receptor T-cell therapy against CD19: what type of haematological malignancy does it target?

A

B cell (ALL, some non-Hodgkin lymphomas)

129
Q

Kid has low calcium, cleft palate, low T cells?

A

DiGeorge

130
Q

55 y/o woman develops dry mouth and eyes alongside fatigue and arthralgia of the small joints in her hands. Investigations:
Urate normal
ESR 64 (raised)
IgG 22 (raised)
Rheumatoid factor 120 (raised)
Anti-CCP antibody 0.9 (negative)
Speckled anti-nuclear antibody titre 1:640 (raised)
Rank the following diagnoses by likelihood:
a. Gout
b. Osteoarthritis and keratoconjunctivitis sicca
c. Osteogenesis imperfecta
d. Primary Sjogren’s syndrome
e. Rheumatoid arthritis

A

d. Primary Sjogren’s syndrome
b. Osteoarthritis and keratoconjunctivitis sicca
e. Rheumatoid arthritis
a. Gout
c. Osteogenesis imperfecta

131
Q

22 y/o woman presents with mild SLE. Rank the following test results by likelihood of appearing in this case:

a. Absent IgG
b. Low complement C3
c. Positive ANA
d. Positive C3 nephritic factor
e. Positive ds-DNA

A

c. Positive ANA
e. Positive ds-DNA
b. Low complement C3
a. Absent IgG
d. Positive C3 nephritic factor

132
Q

A young man with periodic fevers has an MEFV mutation. What is the diagnosis?

A

Familial Mediterranean fever

133
Q

What condition does JC virus reactivation cause in an immunosuppressed person?

A

Progressive multifocal leukoencephalopathy

134
Q

CAR-T cells against CD19 treat haematological malignancy of what cell type?

A

B-cell

135
Q

Which condition features involvement of kidneys and upper and lower airways, and is associated with cANCA with cytoplasmic staining pattern and specificity for proteinase 3?

A

Granulomatosis with polyangiitis (Wegener’s granulomatosis)

136
Q

A 3 y/o child with recurrent bacterial and fungal infections has a negative dihydrorhodamine test (does not oxidise). What is the diagnosis?

A

Chronic granulomatous disease

137
Q

CD40L mutation is associated with which immunodeficiency?

A

Hyper IgM syndrome

138
Q

Which drug should be given immediately via intramuscular injection in anaphylaxis?

A

Adrenaline

139
Q

What is the name of a fully differentiated B-cell that makes antibodies?

A

Plasma cell

140
Q

What type of lymphocyte is deficient in an individual with bare lymphocyte syndrome and an HLA class II mutation?

A

T-cells

141
Q

Which antibody is seen in Graves’ disease?

A

Anti-TSH receptor

142
Q

Which cytokine type is involved in allergy to food and insect venom?

A

IgE

143
Q

Which condition is Denosumab most commonly used to treat?

A

Osteoporosis

144
Q

A 5 m/o baby has recurrent infections and an IL2RG (interleukin 2 common gamma chain mutation), what is the diagnosis?

A

X-linked SCID

145
Q

In histology of antibody-mediated rejection of allogeneic kidney transplant, where would the inflammatory infiltrate be seen?

a. Adipose tissue
b. Capillaries
c. Capsule
d. Interstitium
e. Tubules

A

b. Capillaries

146
Q

Which of the following is vaccinated against with a conjugate vaccine with a polysaccharide and protein carrier?

a. HIV
b. M. tuberculosis
c. Rabies
d. S. pneumoniae
e. V. cholerae

A

d. S. pneumoniae

147
Q

Which of the following cells exists in an immature form in the periphery where they recognise pathogens, then mature and become adapted for presenting antigen to T-cells In lymph nodes?

a. B lymphocytes
b. Dendritic cells
c. Eosinophils
d. Erythrocytes
e. Plasma cells

A

b. Dendritic cells

148
Q

Which of the following enhances T-cell immunity and may be used to treat malignancy?

a. Infliximab (anti TNFa)
b. Pembrolizumab (anti PD1)
c. Rituximab (anti CD20)
d. Tocilizumab (anti IL6)
e. Ustekinumab (anti IL12/23)

A

b. Pembrolizumab (anti PD1)

149
Q

Which of the following disease may respond to plasmapheresis?

a. Ankylosing spondylitis
b. Goodpasture syndrome
c. IgA vasculitis
d. Primary Sjogren’s syndrome
e. Takayasu’s arteritis

A

b. Goodpasture syndrome

150
Q

Development of anti-parietal cell antibodies is associate with which disease?

a. Graves’ disease
b. Multiple sclerosis
c. Pernicious anaemia
d. Rheumatoid arthritis
e. Type 1 diabetes mellitus

A

c. Pernicious anaemia

151
Q

Failure to regulate cryopyrin-driven neutrophil activation is characteristic of which disease?

a. Autoimmune lymphoproliferative syndrome
b. Behcet’s syndrome
c. Familial Mediterranean fever
d. Microscopic polyangiitis
e. Ulcerative colitis

A

c. Familial Mediterranean fever

152
Q

21 y/o woman with joint pain, fevers, and pleuritic chest pain. Investigations:

ESR 67 (high)
CRP 1.7 (normal)
ANA 1:1280 (positive)
dsDNA antibody 901 (positive)
C3 level 0.92 (normal)
C4 level 0.12 (low)
What is the most likely diagnosis?
a.	Dermatomyositis
b.	Granulomatosis with polyangiitis
c.	Lyme arthritis
d.	SLE
e.	Sjogren’s syndrome
A

d. SLE

153
Q

Which of the following is a standard immunosuppressive regime post-allograft?

a. Azathioprine, mycophenolate mofetil, prednisolone
b. Cyclophosphamide, methotrexate, rituximab
c. Cyclosporin, rapamycin, tacrolimus
d. Dapsone, methotrexate, prednisolone
e. Mycophenolate mofetil, prednisolone, tacrolimus

A

e. Mycophenolate mofetil, prednisolone, tacrolimus

154
Q

Gel and Coombs type 3 hypersensitivity is mediated by which mechanism?

a. Activation of complement by antibody binding to a cellular antigen
b. Activation of pre-existing IgE bound to antigen
c. CD8+ cell-mediated cell destruction
d. Deposition of antibody-antigen complexes in blood vessel walls
e. Modulation of cell function by antibody binding to cell surface receptor

A

d. Deposition of antibody-antigen complexes in blood vessel walls

155
Q

Which of the following is a mixed pattern autoinflammatory autoimmune disease characterised by inflammation of the sacroiliac joints?

a. Ankylosing spondylitis
b. Gout
c. Obstetric cholestasis
d. Osteoarthritis
e. Rheumatoid arthritis

A

a. Ankylosing spondylitis

156
Q

Which of the following drugs can be used to manage Rheumatoid arthritis?

a. Adalimumab (anti-TNFa)
b. Basiliximab (Anti-CD25)
c. Denosumab (anti-RANKL)
d. Pembrolizumab (anti-PD1)
e. Secukinumab (anti-IL17)

A

a. Adalimumab (anti-TNFa)

157
Q

Which leukocyte subset should be monitored in HIV patients?

a. B cells
b. CD4+ T-cells
c. CD8+ T-cells
d. Monocytes
e. NK cells

A

b. CD4+ T-cells

158
Q

Which type of vaccine should not be given to immunosuppressed people?

a. Conjugate
b. Live attenuated
c. Subunit
d. Toxoid
e. Lipid adjuvant

A

b. Live attenuated

159
Q 
Immunology
A.	Interferon gamma
B.	Interferon alpha
C.	TNFalpha
D.	Etanercept
E.	Basiliximab
F.	Tocilizumab
G.	Natalizumab
H.	Denosumab
I.	Human Ig
  1. Ankylosing spondylitis
  2. Resistant Psoriasis
  3. Chronic granulomatous disease treatment
  4. Osteoporosis
  5. Hyper IgM syndrome
A
  1. Etanercept (TNFa antagonist; RhA, psoriasis, AnkSpondy)
  2. Etanercept
  3. IFN gamma
  4. Denosumab (RANKL inhibitor on osteoclasts)
  5. Human Ig
160
Q

A 60 year old lady with recurrent chest infections now has reduced total serum protein and has autoimmune thrombocytopenia - diagnosis?

A

Common variable immunodeficiency

161
Q

A 12 year old boy has recurrent chest infections and has an ear infection. He doesn’t have any B Cells - diagnosis?

A

Bruton’s agammaglobulinaemia

162
Q

Boy with recurrent abscesses has a negative NBT test - diagnosis?

A

Chronic granulomatous disease

163
Q

A boy’s father has TB. The same boy develops a mycobacterium infection, following their BCG - diagnosis?

A

Interferon gamma deficiency

164
Q

Young boy with normal number of B cell numbers and absence of CD8+ and CD4+

A

X-linked severe combined immunodeficiency

165
Q

Normal B and T cells, high IgM but absence of IgA, IgE and IgG

A

Hyper IgM syndrome

166
Q

Lady with spinal fracture due to severe TB

A

Interferon gamma receptor deficiency

167
Q

Patient with recurrent pneumococcal infections and meningitis

A

Complement deficiency e.g. C7

Think pneumococcal and meningococcal!! - Encapsulated bacteria

168
Q

Immunotherapy ued to treat osteoporosis when the patient cannot tolerate bisphosphonates

A

Denosumab (RANKL inhibitor on osteoclasts)

169
Q

Immunotherapy used to treat malignant melanoma, involved in T cell checkpoints

A

Ipilimumab (CTLA4 inhibitor, boosts immune system by blocking T cell checkpoints) or nivolumab (PD-1 inhibitor, boosts immune system by blocking T cell checkpoints)

170
Q

Immunotherapy used to treat Lymphoma and Rheumatoid arthritis

A

Rituximab (CD20 inhibitor, depletes mature B cells; lymphoma, SLE, RhA, CLL)

171
Q

Immunotherapy used to prevent transplant rejection, by blocking T cell activation and IL2 production

A

Tacrolimus or cyclosporin (Inhibit calcineurin; rejection prophylaxis in transplant)

172
Q

Immunotherapy used to treat severe ankylosing spondylitis not controlled by NSAIDs

A

Etenercept (TNFa antagonist; RhA, psoriasis, AnkSpondy)

173
Q

Cells that express Foxp3 and CD25

A

Treg cells

174
Q

Derived from monocytes and resident in peripheral

A

Macrophages

175
Q

Allergy

  1. When they eat cherries, apples, pears and hazelnuts, they get itchy mouths
  2. Hypertensive and diabetic, with angioedema
  3. Kid with rash on extensor surfaces, IgE mediated
  4. Woman with flushed face, problems breathing that has happened multiple times with enlarged liver
  5. Patient wondering why they get allergic symptoms every summer, clear discharge from the nose
A
  1. Oral allergy syndrome
  2. ACEi
  3. Atopic dermatitis/eczema
  4. Hereditary angioedema
  5. Hayfever/allergic rhinitis
176
Q

Transplant complications

  1. Can lead to development of post transplantation lymphoproliferative disease
  2. Causes progressive multifocal leukoencephalopathy
  3. Mechanism behind GVHD
  4. Mechanism behind antibody mediated rejection
  5. Mechanism behind cellular rejection
B-cell mediated
Donor WBCs attack host tissue
T-cell mediated
JC virus
Epstein-Barr virus
A
  1. Epstein-Barr virus
  2. JC virus
  3. Donor WBCs attack host tissue
  4. B-cell mediated
  5. T-cell mediated
177
Q

Severe ankylosing spondylitis - NSAID & TNF inhibitor not been successful. What else can you target?

A

IL17/IL23

178
Q

45yo woman with autoimmune diseases, low IgM, IgA and IgE; full blood count is normal. Diagnosis?

A

Common variable immunodeficiency

179
Q

Patient with GI conditions, lack of which substance leads to B12 being malabsorbed?

A

Intrinsic factor

180
Q

Patient with microcytic anaemia abdominal symptoms. Duodenal biopsy showed crypt hyperplasia and non-caseating granulomas, lymphocytes. Diagnosis?

A

Crohn’s disease

181
Q

Which immunoglobulin is found in mucosa?

A

IgA

182
Q

Patient with subtotal villous atrophy, tall crypts. Diagnosis?

A

Coeliac disease

183
Q

Immunodeficiency with common gamma chain problem?

A

X-linked SCID

184
Q

A woman is a donor for kidney to a child, what is the max number of HLA mismatches possible?

A

6

185
Q

Someone with aphthous ulcers, conjunctivitis, diarrhoea & abdo pain. Diagnosis?

A

Crohn’s disease

186
Q

Which type of cell does Rituximab target?

A

Mature B cells (not plasma cells)

187
Q

cANCA positive man with glomerulonephritis and lung changes, what does he have?

A

Granulomatosis with polyangiitis (Wegener’s granulomatosis)

188
Q

What cells does Nivolumab target?

A

Nivolumab = PD1 inhibitor

Targets T cells

189
Q

Which vaccines are polysaccharide and conjugate vaccines?

A

Pneumococcal vaccine, Men C, HiB, Men ACWY

190
Q

Woman with periorbital purple rash (heliotrope) and rash on knees, which enzyme is elevated?

A

t-RNA Synthetase

dermatomyositis

191
Q
  1. What type of hypersensitivity causes serum sickness?
A

III (immune-complex mediated)

192
Q

What is the effect of the gene mutation in familial Mediterranean fever?

A

Increased IL-1 production

193
Q

Mechanism of hyperacute allograft rejection

A

Preformed antibodies against HLA or ABO

194
Q

Which allergy is more likely to present in child than adult?

a. Oral allergy syndrome
b. Egg
c. Bee
d. Pollen

A

Egg

195
Q

HIV - what natural antibody against, which confers protective immunity against HIV? Or something similar

a. HIV – GAG
b. HIV – gp120
c. CXCR4
d. Protease
e. Reverse transcriptase

A

b. HIV – gp120

196
Q

Patient with coeliac. What would you see on biopsy?

a. Intraepithelial leukocytes
b. Intraepithelial eosinophils
c. Intraepithelial macrophages
d. Intraepithelial neutrophils
e. Intraepithelial lymphocytes

A

e. Intraepithelial lymphocytes

197
Q

Child born with abnormal facies and congenital cardiac abnormalities also has normal B cells but abnormal T cells, what genetic mutation do they have?

A

22q11.2 deletion syndrome/ DiGeorge syndrome

198
Q

Which of these vaccines must not be given to a pregnant woman?

a. MMR
b. Hep B
c. DTP

A

a. MMR

199
Q

What cell in the body binds to MHC1?

A

CD8+ - binds

NK cells - inhibited by

200
Q

A Girl develops a throat infection. She is given amoxicillin, and a rash develops. It is later found out that she has infectious mononucleosis, and her symptoms persist:

a. Drug reaction
b. Penicillin allergy
c. Mastocytosis

A

a. Drug reaction

201
Q

Woman who has mouth/lip swelling following a dental procedure, and her mother reports a similar history in the past

a. Serum like reaction
b. C1 inhibitor deficiency

A

b. C1 inhibitor deficiency

202
Q

Man has intermittent mouth & tongue swelling for the past 2 years, which is unresponsive to over-the-counter anti-histamines, is on aspirin and ACE inhibitor. What is the likely cause?

a. Irritant dermatitis
b. Drug induced reaction
c. Serum like reaction
d. C1 inhibitor deficiency
e. Carcinoid Tumour

A

b. Drug induced reaction

1% of people get this reaction ACEi and some NSAIDs

203
Q

Which type of cell is matured in thymus?

A

T cells

204
Q 
A 56 year old female presents with dryness of her eyes, confirmed with ocular staining, and intermittent swelling of her submandibular glands. Rank the following investigations in order of specificity forconfirmation of her diagnosis, with (1) having the highest specificity and (5) the lowest.
A. Raised neutrophil count
B. Raised C-reactive protein
C. Positive anti-Ro antibody
D. Positive anti-nuclear antibody
E. Raised immunoglobulin G
A 
C. Positive anti-Ro antibody
D. Positive anti-nuclear antibody
E. Raised immunoglobulin G
A. Raised neutrophil count
B. Raised C-reactive protein
205
Q 
Platlets 162 x 109/L (150-400)
CRP 34 mg/L (<5)
ESR 86 mm/hr (<20)
Complement C3 0.84 g/L (0.70-1.70)
Complement C4 0.50 g/L (0.16 0.54)
Anti-nuclear antibody: negative
Anti-nuclear cytoplasmic antibody: weak (1+) c-ANCA +ve
His renal, liver and bone profiles are normal. He has been investigated for possible infection and all results are negative, including blood film for malaria and elispot for Mycobacterium tuberculosis. Results for the anti-myeloperoxidase (MPO) and anti-proteinase 3 (PR3) 
antibodies are pending. Rank the following in order of likelihood of diagnosis, with (1) being the most likely and (5) being theleast.
Granulomatosis with polyangiitis (GPA)
Lymphoma
Chronic granulomatous disease
Systemic lupus erythematosus
Microscopic polyangiitis (MPA)
A 
Lymphoma
Granulomatosis with polyangiitis (GPA)
Microscopic polyangiitis (MPA)
Systemic lupus erythematosus
Chronic granulomatous disease

Path Past Papers (38 decks)

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