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Aaska's path > IMMUNO > Flashcards

IMMUNO Flashcards

1
Q

most abundant cell of innate immune system

A

neutrophils

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2
Q

what cells combat parasites

A

eosinophils

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3
Q

what cells differentiate into macrophages

A

monocytes

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4
Q

liver macrophage

A

kuppfer cell

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5
Q

kidney macrophage

A

mesangial cell

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6
Q

spleen macrophage

A

sinusoidal lining cell

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7
Q

bone macrophage

A

osteoclast

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8
Q

CNS macrophage

A

microglia

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9
Q

connective tissue macrophage

A

histiocyte

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10
Q

skin macrophage

A

langerhans cells

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11
Q

dendritic cell role

A

present antigens to t cells in lymph nodes
can activate cd4 and cd8

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12
Q

dendritic cells express

A

fc receptors- to detect immune complexes
cytokines- to regulate immune response

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13
Q

what receptors do NK cells have

A

activatory
inhibitory- display HLA to prevent activation by self cells

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14
Q

activating receptors on NK cells recognise

A

heparan sulfate proteoglycans

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15
Q

NK cells will kill a cell that displays

A

an activatory receptor but NO inhibitory receptor

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16
Q

main cytokines

A

tnf alpha
IL1

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17
Q

cytokine involved in viral response

A

IFN gamma and alpha

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18
Q

classical pathway in complement cascade is activated by

A

antibody binding to specific antigen (C1 activated)

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19
Q

MBL pathway complement cascade is activated by

A

MBL binding to carbs on bacteria surface

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20
Q

alternative pathway complement cascade is activated by

A

c3 binding directly to bacterial cell wall component

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21
Q

activation of what is the major amplification step in formation of MAC

A

c3

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22
Q

what molecule attracts phagocytes

A

chemokines

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23
Q

what recognises PAMPs

A

toll like receptors
mannose receptors

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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

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25
Q

microbial killing mechanisms

A

oxidative killing
non oxidative killing

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26
Q

cd8 associated with hla class

A

I

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27
Q

cd4 associated with hla class

A

II

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28
Q

t cells are positively selected when they

A

have intermediate affinity for HA

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29
Q

how can you identify what HLA is class II

A

it will have 2 letters after it eg HLA-DR, HLA-DQ

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30
Q

what th receptor helps CD8 and macrophages

A

1

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31
Q

what th receptor helps neutrophil recruitment and generates autoantibpdies

A

17

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32
Q

what th receptor is helper t cells

A

th2

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33
Q

what antibody is produced by undifferentiated b cells

A

IgM

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34
Q

what interaction is needed for cd4 t cells to help b cells differentiate

A

CD40L: CD40

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35
Q

what chain determines antibody class

A

heavy

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36
Q

antigen is recognised by what on antibody

A

Fab

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37
Q

what mediates interaction of antibody with other immune cells

A

Fc

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38
Q

in b cell memory, response can be independent of

A

cd 4

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39
Q

secondary immune response after memory involves what antibody mainly

A

IgG

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40
Q

primary immune response before memory involves what antibody mainly

A

IgM

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41
Q

CD45 RO

A

memory T cell

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42
Q

CD45 RA

A

naive T cells

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43
Q

what are the 2 types of memory T cells

A

central- lymph nodes, mainly cd4 so assistive role

effector- liver/lungs/gut, mainly cd8 so killer role

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44
Q

what is the mantoux test used for

A

to test for previous tuberculin exposure (could be due to BCG)

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45
Q

how is the mantoux test carried out

A

inject 0.1ml of 5 tuberculin intradermally

examine arm 48-72hrs after

positive= induration develops (swelling that can be felt)= previous exposure to tuberculin

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46
Q

most severe form of reticular dysgenesis

A

autosomal recessive SCID

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47
Q

mutation in reticular dysgenesis

A

energy metabolism enzyme adenylate cyclase kinase 2 (AK2)

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48
Q

kotsmann syndrome inheritance

A

autosomal recessive

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49
Q

what protein is mutated in kotsmann syndrome

A

HAX1

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50
Q

inheritence of cyclical neutropenia

A

autosomal dominant

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51
Q

mutation in what enzyme cyclical neutropenia

A

ELA 2

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52
Q

leukocyte adhesion deficiency categorised by

A

absent pus formation
delayed umbilical cord separation
very high neutrophil count

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53
Q

chronic granulomatous disease lack of

A

NADPH oxidase

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54
Q

chronic granulomatous disease categorised by

A

granuloma formation
lymphadenopathy
hepatosplenomegaly
susceptible to catalase positive bacteria (PLACESS)

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55
Q

mx chronic granulomatous disease

A

interferon gamma

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56
Q

what does NBT test stand for

A

nitro blue tetrazolium

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57
Q

what does DHR test stand for

A

dihydrorhodamine test

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58
Q

deficiency in complement causes increase in what infections

A

encapsulated

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59
Q

encapsulated bacteria

A

nisseria
haemophilus
streptococcus

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60
Q

2 types of c3 deficiency

A

c3 deficiency
secondary c3 deficiency with nephritic factors

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61
Q

MBL deficiency manifests when

A

there is a trigger that compromises the immune system eg
chemotherapy
HIV

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62
Q

SCID presents at what age

A

3 due to coverage from maternal antibodies

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63
Q

X linked SCID immune cells

A

low/absent T and NK cells
normal/increased B cells

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64
Q

what mutation occurs in x linked SCID

A

gamma chain of IL2 receptor

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65
Q

ADA deficiency what does ADA stand for

A

adenosine deaminase deficiency

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66
Q

bare lymphocyte syndrome II is a lack of what cells

A

CD4 +

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67
Q

hyper IgM syndrome what is not expressed on activated T cells

A

CD40L

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68
Q

what antibodies are raised in Wiskott Aldrich syndrome

A

IgA and IgE

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69
Q

what gene is defective in brutons x linked hypogammaglobulinaemia

A

b cell tyrosine kinase

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70
Q

selective IgA deficiency patient have what infections

A

recurrent resp and GI

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71
Q

what infections/conditions are seen in hyper IgM syndrome

A

pneumocystis jirroveci
autoimmune disease
malignancy

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72
Q

hyper IgM syndrome inheritance

A

x linked recessive

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73
Q

t cell deficiency fungal infection

A

cryptosporidium
pneumocysitis

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74
Q

phagocyte deficiency tests

A

NBT or DHR flow cytometry

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75
Q

phagocyte deficiency mx

A

aggressive mx of infections
prophylactic antibacterials and antifungals
definitive haematopoietic stem cell transplant

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76
Q

digeorge syndrome mx

A

thymic transplant

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77
Q

what immunoglobulin is a surrogate marker for CD4

A

IgG

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78
Q

anti hemidesmosome

A

bullous pemphigoid

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79
Q

recombinant vaccines contain

A

proteins found on the surface of viruses and an adjuvant

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80
Q

conjugate vaccines contain

A

a bacterial polysaccaride conjugated to an immunogenic toxin

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81
Q

mantoux test induration positive

A

> 5mm pos in HIV
10mm pos in immunodeficient
15mm pos in normal people

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82
Q

p anca targets

A

myeloperoxidase

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83
Q

c anca targets

A

proteinase 3

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84
Q

mx chronic granulomatous disease

A

interferon gamma

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85
Q

what inhibits phospholipase a2

A

corticosteroids

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86
Q

antibody against RSV

A

pavalizumab

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87
Q

what medications inhibit calcineurin

A

tacrolimus or cyclosporin

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88
Q

calcineurin is needed for

A

t cell proliferation

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89
Q

CVID diagnostic criteria

A

low IgM and one of IgG/IgA
lack of antibody response/immunisation
more than 4 years old

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90
Q

rituximab targets

A

CD20

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91
Q

ITP antigen targeted

A

GLP IIb/IIIa

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92
Q

positive and negative controls in a skin prick test

A

pos= histamine
neg= saline

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93
Q

RANK receptor found on

A

osteoclasts

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94
Q

what cytokine is important for pathogenesis of rheumatoid arthritis, ank spon and IBD

A

TNF alpha

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95
Q

what antigen is recognised in goodpastures

A

type IV collagen

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96
Q

c anca full form

A

cytoplasmic anti neutrophil cytoplasmic antibody

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97
Q

what part of the immune system are autoimmune vs autoinflammatory conditions associated with

A

autotimmune= innate
autoinflammatory= adaptive

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98
Q

what cytokines are implicated in monogenic auto inflammatory disease

A

il1 and tnf alpha

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99
Q

familial mediterranean fever gene

A

MEFV

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100
Q

familial mediterranean fever is associated with an increased risk of

A

AA amyloidosis

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101
Q

familial mediterranean fever mx

A

colchicine daily
anakinra
etanercept

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102
Q

crohns disease gene affected

A

IBD1 gene on chromosome 16- NOD2

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103
Q

autoimmune condition failure of central tolerance

A

APS 1

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104
Q

autoimmune condition failure of peripheral tolerance

A

IPEX

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105
Q

gene affected in APS 1

A

AIRE

106
Q

gene affected in IPEX

A

Foxp3- defect in T reg cells

107
Q

autoimmune condition failure of lymphocyte apoptosis

A

ALPS

108
Q

mutation in ALPs

A

fas L

109
Q

what infection causes cold AIHA

A

mycoplasma

110
Q

inheritence of APS1, IPEX and ALPS

A

APS1= autosomal recessive
IPEX= x linked
ALPS= autosomal dominant

111
Q

IPEX sx

A

3 ds: diarrhoea, dermatitis, diabetes mellitus

112
Q

anti smooth muscle, anti LKM-1, anti SLA antibodies

A

autoimmune hepatitis

113
Q

anti glpIIb/IIIa antibody

A

autoimmune thrombocytopenic purpura

114
Q

anti hemidesmosome antibody

A

bullous pemphigoid

115
Q

anti ro antibody

A

SLE

116
Q

anti endomysial antibody

A

coeliac
OR
dermatitis herpetiformis

117
Q

anti TSH receptor antibody

A

graves

118
Q

antibodies to thyroperoxidase and thyroglobulin

A

hashimotos thyroiditis

119
Q

anti ach receptor antibody

A

maysthenia gravis

120
Q

anti mitochondrial antibody

A

PBC

121
Q

antibodies to glutamate decarboxylase

A

T1DM

122
Q

rheumatoid arthritis most specific antibody

A

anti CCP

123
Q

factors that increase anti CCP in rheumatoid arthritis

A

HLA DR4
PADI
TPT 22

124
Q

anti ds dna, anti histone, anti ribosome antibodies

A

SLE

125
Q

anti ro and anti la antibodies

A

sjogrens

126
Q

anti jo1 antibody

A

dermatomyositis
polymyositis

127
Q

anti centromere antibodies

A

CREST

128
Q

anti scl 70 antibody other name

A

anti topoisomerase

129
Q

anti scl 70/anti topoisomerase antibody

A

diffuse CREST

130
Q

how is diffuse CREST different to CREST

A

greater resp and GI involvement
involves the trunk too

131
Q

c ANCA is directed against

A

proteinase 3

132
Q

p ANCA is directed against

A

myeloperoxidase

133
Q

c ANCA

A

granulomatosis with polyangiitis (wegners)

134
Q

p ANCA

A

eosinophilis granulomatosis with polyangitis (churg strauss)
microscopic polyangitis

135
Q

goodpastures HLA association

A

DR15/DR2

136
Q

graves HLA association

A

DR3

137
Q

SLE HLA association

A

DR3

138
Q

rheumatoid arthritis HLA association

A

DR4 (4 walls in a rheum)

139
Q

coeliac HLA association

A

Dq2/DQ8 (i 8 2 much)

140
Q

differentials for anaphylaxis

A

hereditary angioedema
acute anxiety
urticaria

141
Q

anaphylaxis mx

A

elevate legs
100% oxygen
IM adrenaline 500mg
inhaled bronchodilators
IV fluids

note: antihistamines and steroids not routinely used

142
Q

positive result in skin prick test

A

wheal >2mm than negative control

143
Q

how long before skin prick test should you discontinue antihistamines?

A

48 hrs

144
Q

what are some tests for allergies

A

skin prick test
food challenge test
measure levels of IgE- RAST or component resolved diagnostics

144
Q

gold standard test for food allergy

A

double blind oral food challenge

145
Q

rash associated with coeliac

A

dermatitis herpetiformis

146
Q

test for eye dryness in sjogrens syndrome

A

schrimer

147
Q

flu response relies onf what antibody

A

anti haemagglutinin

148
Q

2 types of adjuvant

A

depot- slows down release of antigen
stimulatory- mimics action of PAMPs to increase receptor activation

149
Q

most used depot adjuvant

A

alum

150
Q

most used stimulatory adjuvant

A

CpG

151
Q

causative agent of progressive multifocal leukoencepaholapthy

A

john cunningham virus

152
Q

use of what causes exposure of john cunningham virus

A

natalizumab

153
Q

before starting azothioprine patients should

A

have TPMT levels checked- if low cant give

154
Q

azothioprine effects what cells mainly

A

t cells

155
Q

defective protein in x linked scid

A

common gamma chain

156
Q

what test is the ability of a patient’s serum to lyse sheep erythrocytes coated with rabbit anti-sheep antibodies

A

ch50

157
Q

what monoclonal antibody targets CD3 on t cells

A

muromonab

158
Q

what monoclonal antibody is used in osteoporosis

A

denosomab

159
Q

mutation in what receptor confers immunity to HIV

A

CCR5

160
Q

what assay is GS for HIV diagnosis

A

western blot

161
Q

CVID mx

A

human immunoglobulin

162
Q

which cytokine is predominantly responsible for T cell proliferation and survival

A

interleukin 2

163
Q

which subtype of T helper cells are implicated in the development of allergic diseases, such as asthma or eczema

A

T helper 2 cells

164
Q

monoclonal antibody used in psoriasis

A

ustekinumab

165
Q

mycophenolate mofetils inhibits

A

t cells

166
Q

most common primary immunodeficiency

A

selective IgA deficiency

167
Q

what test is used to measure IgE level in response to one specific antigen

A

radioallergosorbent test

168
Q

what monoclonal antibody is used for rheumatoid arthritis mx

A

tocilizumab

169
Q

what type of T cell does HIV kill

A

CD4 + T cells

170
Q

influenza vaccine response relies on

A

anti haemagglutinin antibody

171
Q

TB vaccine lasts how long

A

10-15 yrs

172
Q

live attentuated vaccines adv

A

lifelong immunity (no boosters)
all parts of immune system activated

173
Q

conjugate vaccines are used for what pathogens

A

encapsulated bacteria (NHS)

174
Q

what are some examples of DNA vaccines

A

sars-cov-2

175
Q

HIV +ve patients can/ cant have which live attentuated vaccines

A

can have MMR
cant have BCG or yellow fever

176
Q

what are some cytokines that can be given therapuetically

A

IL2
interferon alpha, beta, gamma

177
Q

interferon alpha is given for

A

ABC: interferon Alpha for hepB, hep C and CML

178
Q

interferon beta is given for

A

relapsing remitting MS

179
Q

interferon gamma is used for

A

chronic Granulomatous disease

180
Q

moa IL 2

A

increased t cell response

181
Q

ipilimumab moa

A

monoclonal antibody for CTLA4
blocking this increases t cell activation

182
Q

pembrolizumab/nivolumab moa

A

blocks PD-1
t cells remain active and kill tumor cells

183
Q

infusion rection mediated by what antibody

A

IgE

184
Q

steroids moa

A

inhibits phospholipase a2

185
Q

what immunosupressive agent causes haemorrhagic cystitis?

A

cyclophosphamide

186
Q

what drugs inhibit calcineurin

A

tacrolimus and cyclosporin

187
Q

rituximab moa

A

anti cd20

188
Q

monoclonal antibodies that are anti TNF alpha

A

infliximab
adalimumab

189
Q

monoclonal antibody used in osteoporosis

A

denosumab

190
Q

methotrexate moa

A

anti folate

191
Q

in allergies sensitisation is

A

detection of IgE against a specific allergen, not necessarily an allergy in itself

192
Q

allergen densensitisation is good for what allergens but not which others

A

bee/wasp venom, grass pollen, house dust mite

not for latex, foods

193
Q

transplant from twin

A

isograft

194
Q

transplant from same species

A

allograft

195
Q

transplant from different species

A

xenograft

196
Q

living donor transplants

A

bone marrow
kidney
liver

197
Q

what graft can be split and what does this mean

A

liver
shared by 2 recipients

198
Q

how do t cells v b cells recognise antigens

A

b cells= directly recognise antigens

t cells= recognise antigen presented by MHC on an antigen presenting cell

199
Q

HLA class 1 includes and is expressed on

A

ABC
all cells

200
Q

HLA class II includes and is expressed on

A

DR/DQ/DP
on APCs

201
Q

most important HLA to match in transplant

A

DR>B>A

202
Q

types of transplant rejection

A

T cell mediated
antibody mediated

203
Q

antibody mediated transplant rejection causes

A

intra vascular disease

204
Q

acute cellular transplant rejection is what type of hypersensitivity

A

4

205
Q

max possible HLA mismatches in a transplant rejection

A

6

206
Q

what tests can be done pre transplant to check for risk of rejection

A

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
Q

induction immunosupression for transplant

A

t cell depleting agents or KKT3/ATG

208
Q

maintenance immunosupression for transplant

A

steroid, calcineurin inhibitor, antiproliferative agent (azothioprine, mycophenolate mofetil)

209
Q

name some antiproliferative agents

A

azothioprine
mycophenolate mofetil

210
Q

post transplant risks

A

infection
malignancy (viral associated, skin cancer, other cancers)
atherosclerosis

211
Q

in GvHD whose cell attack whose

A

donor cells attack the host

212
Q

HIV uses what cell in the immune system to replicate

A

t helper cells

213
Q

via what does HIV bind to t helper cells

A

binds CD4 via gp120 and gp41

214
Q

outline how HIV disrupts the immune system

A

CD4+ t cell depletion
chronic immune activation
CD4 and CD8 t cell exhaustion
disrupts lymph node architecture
loss of Ag specific response

215
Q

HIV screening test

A

ELISA- detects anti HIV ab

216
Q

HIV confirmation test

A

western blot

217
Q

when after contraction of HIV will tests be positive

A

after 10 weeks

218
Q

CD4 count for AIDs

A

<200 cells/ microlitre blood

219
Q

HIV medication regime

A

HAART (highly active anti retroviral therapy)

2 x reverse nucleoside transcriptase inhibitor

1 x protease inhibitor

220
Q

what do protease inhibitors target in HIV

A

assembly and budding of viral proteins

221
Q

mastocytosis is infection by what

A

parasites

222
Q

what test do you have to do before starting an anti tnf alpha and why

A

mantoux
it causes activation and dessimination of latent TB

223
Q

neutralisation definition

A

when antibodies bind to target cell to prevent binding to receptors and making the target inert

224
Q

opsonisation definition

A

when antibodies bind to target to make phagocytosis more efficient

225
Q

hypersegmented neutrophils have how many lobes

A

6 or more

226
Q

cd14 is a marker of what

A

monocytes

226
Q

rosary bead arteritis

A

polyarteritis nodosa

226
Q

cd14 recognises

A

lipopolysaccaride

227
Q

what immunoglobulin is responsible for foetal protection from breastmilk

A

IgA

228
Q

what immunoglobulin is involved in haemolytic disease of the newborn

A

IgG

229
Q

what subset of lymphocytes can be considered a part of the innate immune system

A

NK cells

230
Q

most common cause of low b12

A

pernicious anaemia

231
Q

ANA staining homogenous pattern associated with what autoantibody

A

anti ds DNA

232
Q

ANA staining speckled pattern associated with what autoantibody

A

anti centromere

233
Q

what interleukins are acute phase

A

1, 6 and CRP

234
Q

other name for CREST syndrome

A

limited cutaneous systemic sclerosis

235
Q

monoclonal IgG band on electrophoresis

A

multiple sclerosis

236
Q

calcineurin is needed for proliferation of what cells

A

t lymphocytes

237
Q

what type of hypersensitivity reaction is T1DM

A

4

238
Q

HLA for SLE

A

DR3

because SLE= 3 letters

239
Q

sjorgrens patients have a higher risk of what cancer

A

MALT lymphoma

240
Q

what virus is polyarteritis nodosa associated with

A

hep B

241
Q

what nerve biopsy is done for polyarteritis nodosa

A

sural nerve

242
Q

what condition do you get PLACESS infections

A

chronic granulomatous disease

243
Q

graves disease autoantibody

A

anti thyroglobulin

244
Q

what t cells are associated with fox p3

A

t reg cells

245
Q

NOD2/CARD15

A

crohns

246
Q

azothioprine main metabolite

A

6 mercaptopurine

247
Q

x linked scid mutation in

A

gamma chain of Il2

248
Q

infections in x linked scid

A

recurrent candida

249
Q

tnf alpha full form

A

tumor necrosis factor alpha

250
Q

cytokine for t cell survival

A

interleukin 2

251
Q

reversible swan neck deformity

A

SLE

252
Q

monoclonal antibody that targets interleukin 6 for RA

A

tocilizumab

253
Q

cyclosporin vs cyclophosphamide

A

cyclosporin= inhibits T cells
cyclophosphamide= inhibits B cells

amide= a comes before b

254
Q

monoclonal antibody used for allograft rejection prophylaxis

A

basiliximab

255
Q

tisagenlecleucel is a

A

CAR-T cell

256
Q

monoclonal antibody targeting cd25 and causing depletion of all lymphocytes

A

alemtuzumab

257
Q
A

Aaska's path (9 decks)

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