IMMUNO Flashcards
1
Q
most abundant cell of innate immune system
A
neutrophils
2
Q
what cells combat parasites
A
eosinophils
3
Q
what cells differentiate into macrophages
A
monocytes
4
Q
liver macrophage
A
kuppfer cell
5
Q
kidney macrophage
A
mesangial cell
6
Q
spleen macrophage
A
sinusoidal lining cell
7
Q
bone macrophage
A
osteoclast
8
Q
CNS macrophage
A
microglia
9
Q
connective tissue macrophage
A
histiocyte
10
Q
skin macrophage
A
langerhans cells
11
Q
dendritic cell role
A
present antigens to t cells in lymph nodes
can activate cd4 and cd8
12
Q
dendritic cells express
A
fc receptors- to detect immune complexes
cytokines- to regulate immune response
13
Q
what receptors do NK cells have
A
activatory
inhibitory- display HLA to prevent activation by self cells
14
Q
activating receptors on NK cells recognise
A
heparan sulfate proteoglycans
15
Q
NK cells will kill a cell that displays
A
an activatory receptor but NO inhibitory receptor
16
Q
main cytokines
A
tnf alpha
IL1
17
Q
cytokine involved in viral response
A
IFN gamma and alpha
18
Q
classical pathway in complement cascade is activated by
A
antibody binding to specific antigen (C1 activated)
19
Q
MBL pathway complement cascade is activated by
A
MBL binding to carbs on bacteria surface
20
Q
alternative pathway complement cascade is activated by
A
c3 binding directly to bacterial cell wall component
21
Q
activation of what is the major amplification step in formation of MAC
A
c3
22
Q
what molecule attracts phagocytes
A
chemokines
23
Q
what recognises PAMPs
A
toll like receptors
mannose receptors
24
Q
what cell is involved in pus formation and why
A
neutrophils
pahocytosis depletes their glycogen reserve so they die, release enzymes and cells are broken down= pus
25
microbial killing mechanisms
oxidative killing
non oxidative killing
26
cd8 associated with hla class
I
27
cd4 associated with hla class
II
28
t cells are positively selected when they
have intermediate affinity for HA
29
how can you identify what HLA is class II
it will have 2 letters after it eg HLA-DR, HLA-DQ
30
what th receptor helps CD8 and macrophages
1
31
what th receptor helps neutrophil recruitment and generates autoantibpdies
17
32
what th receptor is helper t cells
th2
33
what antibody is produced by undifferentiated b cells
IgM
34
what interaction is needed for cd4 t cells to help b cells differentiate
CD40L: CD40
35
what chain determines antibody class
heavy
36
antigen is recognised by what on antibody
Fab
37
what mediates interaction of antibody with other immune cells
Fc
38
in b cell memory, response can be independent of
cd 4
39
secondary immune response after memory involves what antibody mainly
IgG
40
primary immune response before memory involves what antibody mainly
IgM
41
CD45 RO
memory T cell
42
CD45 RA
naive T cells
43
what are the 2 types of memory T cells
central- lymph nodes, mainly cd4 so assistive role
effector- liver/lungs/gut, mainly cd8 so killer role
44
what is the mantoux test used for
to test for previous tuberculin exposure (could be due to BCG)
45
how is the mantoux test carried out
inject 0.1ml of 5 tuberculin intradermally
examine arm 48-72hrs after
positive= induration develops (swelling that can be felt)= previous exposure to tuberculin
46
most severe form of reticular dysgenesis
autosomal recessive SCID
47
mutation in reticular dysgenesis
energy metabolism enzyme adenylate cyclase kinase 2 (AK2)
48
kotsmann syndrome inheritance
autosomal recessive
49
what protein is mutated in kotsmann syndrome
HAX1
50
inheritence of cyclical neutropenia
autosomal dominant
51
mutation in what enzyme cyclical neutropenia
ELA 2
52
leukocyte adhesion deficiency categorised by
absent pus formation
delayed umbilical cord separation
very high neutrophil count
53
chronic granulomatous disease lack of
NADPH oxidase
54
chronic granulomatous disease categorised by
granuloma formation
lymphadenopathy
hepatosplenomegaly
susceptible to catalase positive bacteria (PLACESS)
55
mx chronic granulomatous disease
interferon gamma
56
what does NBT test stand for
nitro blue tetrazolium
57
what does DHR test stand for
dihydrorhodamine test
58
deficiency in complement causes increase in what infections
encapsulated
59
encapsulated bacteria
nisseria
haemophilus
streptococcus
60
2 types of c3 deficiency
c3 deficiency
secondary c3 deficiency with nephritic factors
61
MBL deficiency manifests when
there is a trigger that compromises the immune system eg
chemotherapy
HIV
62
SCID presents at what age
3 due to coverage from maternal antibodies
63
X linked SCID immune cells
low/absent T and NK cells
normal/increased B cells
64
what mutation occurs in x linked SCID
gamma chain of IL2 receptor
65
ADA deficiency what does ADA stand for
adenosine deaminase deficiency
66
bare lymphocyte syndrome II is a lack of what cells
CD4 +
67
hyper IgM syndrome what is not expressed on activated T cells
CD40L
68
what antibodies are raised in Wiskott Aldrich syndrome
IgA and IgE
69
what gene is defective in brutons x linked hypogammaglobulinaemia
b cell tyrosine kinase
70
selective IgA deficiency patient have what infections
recurrent resp and GI
71
what infections/conditions are seen in hyper IgM syndrome
pneumocystis jirroveci
autoimmune disease
malignancy
72
hyper IgM syndrome inheritance
x linked recessive
73
t cell deficiency fungal infection
cryptosporidium
pneumocysitis
74
phagocyte deficiency tests
NBT or DHR flow cytometry
75
phagocyte deficiency mx
aggressive mx of infections
prophylactic antibacterials and antifungals
definitive haematopoietic stem cell transplant
76
digeorge syndrome mx
thymic transplant
77
what immunoglobulin is a surrogate marker for CD4
IgG
78
anti hemidesmosome
bullous pemphigoid
79
recombinant vaccines contain
proteins found on the surface of viruses and an adjuvant
80
conjugate vaccines contain
a bacterial polysaccaride conjugated to an immunogenic toxin
81
mantoux test induration positive
>5mm pos in HIV
>10mm pos in immunodeficient
>15mm pos in normal people
82
p anca targets
myeloperoxidase
83
c anca targets
proteinase 3
84
mx chronic granulomatous disease
interferon gamma
85
what inhibits phospholipase a2
corticosteroids
86
antibody against RSV
pavalizumab
87
what medications inhibit calcineurin
tacrolimus or cyclosporin
88
calcineurin is needed for
t cell proliferation
89
CVID diagnostic criteria
low IgM and one of IgG/IgA
lack of antibody response/immunisation
more than 4 years old
90
rituximab targets
CD20
91
ITP antigen targeted
GLP IIb/IIIa
92
positive and negative controls in a skin prick test
pos= histamine
neg= saline
93
RANK receptor found on
osteoclasts
94
what cytokine is important for pathogenesis of rheumatoid arthritis, ank spon and IBD
TNF alpha
95
what antigen is recognised in goodpastures
type IV collagen
96
c anca full form
cytoplasmic anti neutrophil cytoplasmic antibody
97
what part of the immune system are autoimmune vs autoinflammatory conditions associated with
autotimmune= innate
autoinflammatory= adaptive
98
what cytokines are implicated in monogenic auto inflammatory disease
il1 and tnf alpha
99
familial mediterranean fever gene
MEFV
100
familial mediterranean fever is associated with an increased risk of
AA amyloidosis
101
familial mediterranean fever mx
colchicine daily
anakinra
etanercept
102
crohns disease gene affected
IBD1 gene on chromosome 16- NOD2
103
autoimmune condition failure of central tolerance
APS 1
104
autoimmune condition failure of peripheral tolerance
IPEX
105
gene affected in APS 1
AIRE
106
gene affected in IPEX
Foxp3- defect in T reg cells
107
autoimmune condition failure of lymphocyte apoptosis
ALPS
108
mutation in ALPs
fas L
109
what infection causes cold AIHA
mycoplasma
110
inheritence of APS1, IPEX and ALPS
APS1= autosomal recessive
IPEX= x linked
ALPS= autosomal dominant
111
IPEX sx
3 ds: diarrhoea, dermatitis, diabetes mellitus
112
anti smooth muscle, anti LKM-1, anti SLA antibodies
autoimmune hepatitis
113
anti glpIIb/IIIa antibody
autoimmune thrombocytopenic purpura
114
anti hemidesmosome antibody
bullous pemphigoid
115
anti ro antibody
SLE
116
anti endomysial antibody
coeliac
OR
dermatitis herpetiformis
117
anti TSH receptor antibody
graves
118
antibodies to thyroperoxidase and thyroglobulin
hashimotos thyroiditis
119
anti ach receptor antibody
maysthenia gravis
120
anti mitochondrial antibody
PBC
121
antibodies to glutamate decarboxylase
T1DM
122
rheumatoid arthritis most specific antibody
anti CCP
123
factors that increase anti CCP in rheumatoid arthritis
HLA DR4
PADI
TPT 22
124
anti ds dna, anti histone, anti ribosome antibodies
SLE
125
anti ro and anti la antibodies
sjogrens
126
anti jo1 antibody
dermatomyositis
polymyositis
127
anti centromere antibodies
CREST
128
anti scl 70 antibody other name
anti topoisomerase
129
anti scl 70/anti topoisomerase antibody
diffuse CREST
130
how is diffuse CREST different to CREST
greater resp and GI involvement
involves the trunk too
131
c ANCA is directed against
proteinase 3
132
p ANCA is directed against
myeloperoxidase
133
c ANCA
granulomatosis with polyangiitis (wegners)
134
p ANCA
eosinophilis granulomatosis with polyangitis (churg strauss)
microscopic polyangitis
135
goodpastures HLA association
DR15/DR2
136
graves HLA association
DR3
137
SLE HLA association
DR3
138
rheumatoid arthritis HLA association
DR4 (4 walls in a rheum)
139
coeliac HLA association
Dq2/DQ8 (i 8 2 much)
140
differentials for anaphylaxis
hereditary angioedema
acute anxiety
urticaria
141
anaphylaxis mx
elevate legs
100% oxygen
IM adrenaline 500mg
inhaled bronchodilators
IV fluids
note: antihistamines and steroids not routinely used
142
positive result in skin prick test
wheal >2mm than negative control
143
how long before skin prick test should you discontinue antihistamines?
48 hrs
144
what are some tests for allergies
skin prick test
food challenge test
measure levels of IgE- RAST or component resolved diagnostics
144
gold standard test for food allergy
double blind oral food challenge
145
rash associated with coeliac
dermatitis herpetiformis
146
test for eye dryness in sjogrens syndrome
schrimer
147
flu response relies onf what antibody
anti haemagglutinin
148
2 types of adjuvant
depot- slows down release of antigen
stimulatory- mimics action of PAMPs to increase receptor activation
149
most used depot adjuvant
alum
150
most used stimulatory adjuvant
CpG
151
causative agent of progressive multifocal leukoencepaholapthy
john cunningham virus
152
use of what causes exposure of john cunningham virus
natalizumab
153
before starting azothioprine patients should
have TPMT levels checked- if low cant give
154
azothioprine effects what cells mainly
t cells
155
defective protein in x linked scid
common gamma chain
156
what test is the ability of a patient's serum to lyse sheep erythrocytes coated with rabbit anti-sheep antibodies
ch50
157
what monoclonal antibody targets CD3 on t cells
muromonab
158
what monoclonal antibody is used in osteoporosis
denosomab
159
mutation in what receptor confers immunity to HIV
CCR5
160
what assay is GS for HIV diagnosis
western blot
161
CVID mx
human immunoglobulin
162
which cytokine is predominantly responsible for T cell proliferation and survival
interleukin 2
163
which subtype of T helper cells are implicated in the development of allergic diseases, such as asthma or eczema
T helper 2 cells
164
monoclonal antibody used in psoriasis
ustekinumab
165
mycophenolate mofetils inhibits
t cells
166
most common primary immunodeficiency
selective IgA deficiency
167
what test is used to measure IgE level in response to one specific antigen
radioallergosorbent test
168
what monoclonal antibody is used for rheumatoid arthritis mx
tocilizumab
169
what type of T cell does HIV kill
CD4 + T cells
170
influenza vaccine response relies on
anti haemagglutinin antibody
171
TB vaccine lasts how long
10-15 yrs
172
live attentuated vaccines adv
lifelong immunity (no boosters)
all parts of immune system activated
173
conjugate vaccines are used for what pathogens
encapsulated bacteria (NHS)
174
what are some examples of DNA vaccines
sars-cov-2
175
HIV +ve patients can/ cant have which live attentuated vaccines
can have MMR
cant have BCG or yellow fever
176
what are some cytokines that can be given therapuetically
IL2
interferon alpha, beta, gamma
177
interferon alpha is given for
ABC: interferon Alpha for hepB, hep C and CML
178
interferon beta is given for
relapsing remitting MS
179
interferon gamma is used for
chronic Granulomatous disease
180
moa IL 2
increased t cell response
181
ipilimumab moa
monoclonal antibody for CTLA4
blocking this increases t cell activation
182
pembrolizumab/nivolumab moa
blocks PD-1
t cells remain active and kill tumor cells
183
infusion rection mediated by what antibody
IgE
184
steroids moa
inhibits phospholipase a2
185
what immunosupressive agent causes haemorrhagic cystitis?
cyclophosphamide
186
what drugs inhibit calcineurin
tacrolimus and cyclosporin
187
rituximab moa
anti cd20
188
monoclonal antibodies that are anti TNF alpha
infliximab
adalimumab
189
monoclonal antibody used in osteoporosis
denosumab
190
methotrexate moa
anti folate
191
in allergies sensitisation is
detection of IgE against a specific allergen, not necessarily an allergy in itself
192
allergen densensitisation is good for what allergens but not which others
bee/wasp venom, grass pollen, house dust mite
not for latex, foods
193
transplant from twin
isograft
194
transplant from same species
allograft
195
transplant from different species
xenograft
196
living donor transplants
bone marrow
kidney
liver
197
what graft can be split and what does this mean
liver
shared by 2 recipients
198
how do t cells v b cells recognise antigens
b cells= directly recognise antigens
t cells= recognise antigen presented by MHC on an antigen presenting cell
199
HLA class 1 includes and is expressed on
ABC
all cells
200
HLA class II includes and is expressed on
DR/DQ/DP
on APCs
201
most important HLA to match in transplant
DR>B>A
202
types of transplant rejection
T cell mediated
antibody mediated
203
antibody mediated transplant rejection causes
intra vascular disease
204
acute cellular transplant rejection is what type of hypersensitivity
4
205
max possible HLA mismatches in a transplant rejection
6
206
what tests can be done pre transplant to check for risk of rejection
complement depednat cytotoxicity- does recipeint serum kill donor lymphocytes
flow cytometry- does recipient serum bind to donor lymphocytes
solid phase- does recipient serum contain abs to individual HLA
207
induction immunosupression for transplant
t cell depleting agents or KKT3/ATG
208
maintenance immunosupression for transplant
steroid, calcineurin inhibitor, antiproliferative agent (azothioprine, mycophenolate mofetil)
209
name some antiproliferative agents
azothioprine
mycophenolate mofetil
210
post transplant risks
infection
malignancy (viral associated, skin cancer, other cancers)
atherosclerosis
211
in GvHD whose cell attack whose
donor cells attack the host
212
HIV uses what cell in the immune system to replicate
t helper cells
213
via what does HIV bind to t helper cells
binds CD4 via gp120 and gp41
214
outline how HIV disrupts the immune system
CD4+ t cell depletion
chronic immune activation
CD4 and CD8 t cell exhaustion
disrupts lymph node architecture
loss of Ag specific response
215
HIV screening test
ELISA- detects anti HIV ab
216
HIV confirmation test
western blot
217
when after contraction of HIV will tests be positive
after 10 weeks
218
CD4 count for AIDs
<200 cells/ microlitre blood
219
HIV medication regime
HAART (highly active anti retroviral therapy)
2 x reverse nucleoside transcriptase inhibitor
1 x protease inhibitor
220
what do protease inhibitors target in HIV
assembly and budding of viral proteins
221
mastocytosis is infection by what
parasites
222
what test do you have to do before starting an anti tnf alpha and why
mantoux
it causes activation and dessimination of latent TB
223
neutralisation definition
when antibodies bind to target cell to prevent binding to receptors and making the target inert
224
opsonisation definition
when antibodies bind to target to make phagocytosis more efficient
225
hypersegmented neutrophils have how many lobes
6 or more
226
cd14 is a marker of what
monocytes
226
rosary bead arteritis
polyarteritis nodosa
226
cd14 recognises
lipopolysaccaride
227
what immunoglobulin is responsible for foetal protection from breastmilk
IgA
228
what immunoglobulin is involved in haemolytic disease of the newborn
IgG
229
what subset of lymphocytes can be considered a part of the innate immune system
NK cells
230
most common cause of low b12
pernicious anaemia
231
ANA staining homogenous pattern associated with what autoantibody
anti ds DNA
232
ANA staining speckled pattern associated with what autoantibody
anti centromere
233
what interleukins are acute phase
1, 6 and CRP
234
other name for CREST syndrome
limited cutaneous systemic sclerosis
235
monoclonal IgG band on electrophoresis
multiple sclerosis
236
calcineurin is needed for proliferation of what cells
t lymphocytes
237
what type of hypersensitivity reaction is T1DM
4
238
HLA for SLE
DR3
because SLE= 3 letters
239
sjorgrens patients have a higher risk of what cancer
MALT lymphoma
240
what virus is polyarteritis nodosa associated with
hep B
241
what nerve biopsy is done for polyarteritis nodosa
sural nerve
242
what condition do you get PLACESS infections
chronic granulomatous disease
243
graves disease autoantibody
anti thyroglobulin
244
what t cells are associated with fox p3
t reg cells
245
NOD2/CARD15
crohns
246
azothioprine main metabolite
6 mercaptopurine
247
x linked scid mutation in
gamma chain of Il2
248
infections in x linked scid
recurrent candida
249
tnf alpha full form
tumor necrosis factor alpha
250
cytokine for t cell survival
interleukin 2
251
reversible swan neck deformity
SLE
252
monoclonal antibody that targets interleukin 6 for RA
tocilizumab
253
cyclosporin vs cyclophosphamide
cyclosporin= inhibits T cells
cyclophosphamide= inhibits B cells
amide= a comes before b
254
monoclonal antibody used for allograft rejection prophylaxis
basiliximab
255
tisagenlecleucel is a
CAR-T cell
256
monoclonal antibody targeting cd25 and causing depletion of all lymphocytes
alemtuzumab
257
