Immuno Flashcards
EBV and amoxicillin/ampicillin/cephalosporin
Causes hypersensitivity reaction in presence of EBV - not true allergy
Ibrutinib can be used in which leukemia?
CLL
Tx Psoriasis
Ustekinumab (anti IL-12/23)
Tx RA (not DDMARD/MTX)
Rituximab (anti CD20), anti-TNFa (etanercept or adalimumab), tocilizumab (anti-IL6)
Wegener’s with severe flare treatment
Cyclophosphamide
Worsening Crohn’s, already on Azathioprine and Prednisolone, what tx?
Infliximab (Anti-TNFa)
Malignant melanoma medical treatment
Pembrolizumab
Rituximab
RA or Lymphoma
anti-CD20
Transplant drugs
Tacrolimus, Cyclosporin Azathioprine Mycophenolate Mofetil Antithymocyte globulin (ATG) Prednisolone Basiliximab (anti-CD25/IL-2) (prophylactic)
Type I hypersensitivity
Allergy/Atopic eczema
Type II hypersensitivity
Auto-immune/auto-inflammatory e.g. Graves
Type III hypersensitivity
Complex mediated e.g. SLE
Type IV hypersensitivity
Delayed e.g. contact dermatitis, diabetes
CD40L associated
Hyper IgM
GPA’s other name
Wegener’s Granulomatosis
eGPA’s other name
Churg-Strauss Syndrome
Monitoring SLE
C3, C4
Chest and renal
Good-pasture’s classically but can be GPA/eGPA
Hyperacute rejection (transplant)
Minutes-hours
Pre-formed Abs activate complement
–> Thrombosis and necrosis
Prevent by cross-match and HLA typing
Acute cellular rejection (transplant)
When?
Mechanism?
Treatment?
Weeks-months
CD4 cells –> type IV hypersensitivity reaction –> cellular infiltrate
Tx: T-cell immunosuppression e.g. Steroids
Memory aid: T cell = T 4
Acute Ab-mediated rejection (transplant)
Weeks-months
B-cells --> antibodies --> attack vessels and endothelial cells --> vasculitis Complement deposition (C4d)
B-cell immunosuppression & remove Abs
Chronic rejection (transplant) Timeline? Mechanism? Treatment? RFs?
Months-years
Various immune+non-immune mechs –> fibrosis, GN?, ischaemia
Tx: minimise organ damage
RF: multiple acute rejections, HTN, hyperlipidaemia
GvHD
Days-weeks (T cell mediated)
Rash, bloody D&V, & jaundice
Tx: Immunosuppress with steroids
Acute vascular rejection
When?
4-6 days post transplant after xenograft - presents similarly to hyperacute
H1 vs H2 antagonisst
H1 = antihistamines H2 = reducing gastric acid
Itchy skin when running in cold for an hour
Acute urticarial –> H1 antagonist
Hereditary angioedema treatment
C1q esterase inhibitor (reduces swelling)
Measure of mast cell degranulation
Mast cell tryptase levels
Chemokine promoting eoosinophil growth
IL-5
Tingly mouth after eating apples, melons etc.
OAS (Sxs limited to mouth)
Woman with flushed face, breathing problems (happened multiple times) and hepatomegaly
Hereditary angioedema
Tx: C1 esterase inhibitor
Kid with rash on extensor surfaces, IgE mediated
Atopic dermatitis
Hypertensive and diabetic with angioedema - potential cause?
ACE inhibitor
Absent T cells and normal B cells
X-linked SCID
1m baby, serious bacterial infections
Normal CD8, no CD4
B cells present
IgM present, IgG absent
Bare Lymphocyte Syndrome (Type 2)
Absent expression of MHC Class II molecules
Jaundiced 4m baby, FTT, recurrent infections raised ALP, low CD4, defect protein regulates MHC class 2
Bare Lymphocyte Syndrome (Type 2)
Associated with sclerosing cholangitis –> jaundice
Recurrent strep. pneumonia
FHx of having it and dying young
Complement deficiency (Encapsulated organism)
Child with recurrent infections, improved with age, now delay in language and speech
DiGeorge
Immune function improves with age
Can be associated with lots of speech/language issues and LDs as well as rest of CATCH-22
Loss of the terminal complement pathway - most at risk from?
Encapsulated organisms
Recurrent meningitis
Complement deficiency (C5-9)
Encapsulated organism e.g. Hib or N. meningitidis
Primary immunodeficiency causing atypical granulomas
IFNy/IL12 or receptor deficiency
Predisposed to mycobacterial infections
Inability to form granulomas hence atypical
Recurrent infections
negative NBT test
negative dihydrorhodamine test
Chronic Granulomatous disease
6m boy, sevete FTT & recurrent infections
No T cells, B cells normal
X linked SCID
Alternative complement pathway components
Factor B, I & P
“BIP”
Lady with spinal fracture due to TB
IFNy/IL12 or receptor deficiency
Mycobacteria susceptible –> Pott’s disease
Felty’s syndrome (3 features)
Rheumatoid arthritis, neutropenia and splenomegaly
Rheumatoid arthritis and splenomegaly
Felty’s
Monocytes in peripheral skin cells
Langerhans
Cells that express Foxp3 and CD25
Treg
Responsible for killing cancerous cells + inhibited by MHC-I
NK cells
PEP exists against (3)
Rabies, HIV, tetanus
Routine vaccine that is not given to immunocompromised patients
MMR
If oral steroids in past 3 months delay vaccine
Vaccine target HA
Influenza
Every 5 years post splenectomy
Pneumococcal
Adaptive response to HIV:
Neutralising antibodies against what?
anti-gp120 and anti-gp41
Adaptive response to HIV:
Non-neutralising antibodies against what?
anti-p24 & gag IgG
Co-receptor required for HIV entry into CD4
CCR5 & CXCR4
HIV binding to CD4
- Initial binding
- Conformational change
- Co-receptors
- What are they co-receptors on?
- gp120
- gp41
- CCR4 & CXCR5
- Macrophages
Intrastructural support for HIV
gag protein
Chemokines which block CCR5 (inhibit HIV entry into cell)
MIP-1a, MIP-1b, and RANTES
HIV enzyme that copies with errors
Reverse Transcriptase
RT
AIRE gene - which condition?
Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy
(APECED)
FAS gene mutation causes which condition?
ALPS (autoimmune lymphoproliferative syndrome)
MEFV gene, periodic abdominal pain and ascites
Familial Mediterranean Fever
Nod2/CARD-15
Crohn’s
Chromosome 16
DR4 and CCP
RA
HLA-B27, sacroiliitis
Ank spond
What should you check before starting azathioprine?
TPMT levels (enzyme)
Adult with bronchiectasis, recurrent sinusitis, diarrhoea and development of atypical SLE
Common variable immunodeficiency
What does IPEX stand for?
Immune dysregulation (autoimmune conditions)
Polyendocrinopathy
Enteropathy
X-linked inheritance syndrome
Absolute deficiency of Treg cells (Foxp3 mutation)
BMT is only cure
CTLA4 receptor on t cells
associated with AI conditions like diabetes and thyroid disease
PTPN22
Tyrosine phosphatase associated with RA
CGD treatment type
IFN gamma
SE of cyclophosphamide
infertility
SE of azathioprine
neutropenia (especially if TPMT is low)
SE of cyclosporin
Hypertension
SE of Mycofenolate Mofetil
Progressive multifocal leukencephalopathy (caused by JC virus)
60yo develops rash while under general anaesthetic, what do you do after stopping the anaesthetic?
Measure mast cell tryptase
75yo man takes ACEi, inhalers, metformin - presents with tongue and periorbital swelling. Cause of swelling?
ACEi
1% have drug-induced angioedema
C1q deficiency
Skin conditions, childhood onset SLE (severe), infections, kidney disease
anti-CD25
Basilixumab
CD25 is the alpha chain of IL-2 receptor
anti IL12/23
Ustekinumab
anti IL-6
Tocilizumab
AI hep/PSC antibody
Anti smooth muscle Ab
Goodpasteurs connective tissue thing
Type IV collagen
Mouldy hay
Extrinsic allergic alveolitis (EAA)/ Hypersensitivity pneumonitis
Oligoclonal bands of IgG on CSF with myelin basic protein
Multiple Sclerosis
OKT3
A mab for hyperacute rejection
Calcineurin inhibitor
Cyclosporin (reduces IL-2)
Medication that inhibits DNA synthesis in an attempt to prevent proliferation of T cells (post transplant)
Azathioprine
IVDU who has multiple aneurysms
Hep B is associated with polyarteritis nodosa
SLE pt develops bleeding from gums and nose bleeds, with low platelet count
- Antibody target
- name of condition developed
- Glycoprotein IIb-IIIa
2. Autoimmune thrombocytopenic purpura
Drug that prevents cell replication by damaging DNA (B cells more than T cells)
Cyclophosphamide
Used in SLE, wegeners, leukemias, CTD
CTLA4-immunoglobulin fusion protein
Abatacept (rheumatoid arthritis)
Mycophenylate Mofetil MoA
Guanine synthesis (IMPDH is the enzyme)
Kveim test
Sarcoidosis
Test for HSP
immunofluoresence
Increased CH50
acute inflammation e.g. RA
Pot strep rheumatoid fever (mechanism)
Molecular mimicry
1st exposure to allergen IL
IL-12
Dermatomyositis appearance on immunofluoresence
Speckled (Anti-Jo1)
Lipiduria
Minimal change disease (increase in lipids to try to maintain oncotic pressure)
TNF-ß is central in diagnosis of which condition?
CREST
Allergy
- Cold Urticaria
- Oral allergy syndrome
- Lactose intolerance
- Drug reaction
- Penicillin allergy
- Type 1 hypersensitivity latex allergy
- Type 3 hypersensitivity latex allergy
- A teenage girl who when she goes cross country running gets an erythematous rash on her legs. It is well controlled by antihistamines
- Man can eat apple pie. But if he eats fresh apples and pears, he gets inflamed lips
- Man has an allergic reaction during surgery and who’s lips becomes swollen/oedematous when blowing up balloons as his daughter’s birthday party
- Bloated after drinking milk but not IgE mediated
- A girl with a sore throat is given penicillin and develops a rash. She is found to have EBV
- Cold Urticaria
- Oral allergy syndrome
- Type 1 hypersensitivity latex allergy
- Lactose intolerance
- Drug reaction
Sore throat = EBV
EBV can provoke penicillin rash but not true allergy
What does the monospot antibody test test for?
Infectious mononucleosis (EBV)
What cell stays in its immature form in the periphery, and when it matures goes to present things to T cells in lymph nodes?
Dendritic cells
Which cell is increased in cases of parasitic infection?
Eosinophils
Which cell undergoes positive & negative selection in thymus?
T lymphocytes
When infection, this cell responsible for production of pus (when it dies)
Neutrophils
Boy with abscesses has positive nitro blue tetrazolium
Myeloperoxidase deficiency
Girl found to have no CD4 cells, but CD8 cells & B cells present
Bare lymphocyte syndrome 2
Which cancer can the Bruton tyrosine kinase inhibitor ibrutinib be used in?
a. Bruton’s
b. CML
c. AML
d. ALL
e. CLL
e. CLL
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
d. CMV IgG negative
Which of these vaccines must not be given to a pregnant woman:
a. MMR
b. Hep B
c. DTP
d. Influenza
e. Meningococcus
a. MMR (as contains live Rubella virus)
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
c. CD8+ cells (- aka: Killer T cells, T-killer cells, Cytotoxic T cells, CD8+ T cells)
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
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
What does Denosumab target?
Receptor activator of nuclear factor kappa-B Ligand (RANKL)
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?
Familial Mediterranean Fever
Which mixed pattern auto-inflammatory condition has over 90% heritability and effects the sacroiliac joint?
Ankylosing Spondylitis
Which common condition can be treated with drugs that target with TNF, IL-17 and IL-12/23?
Psoriasis
- 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?
- Neutrophils
- Treg
- Dendritic cell
- NK cells
- Memory CD4+
Receptor mutation/cytokine that could be protective against HIV?
CCR5/MIP-1a or b
What type of hypersensitivity (Gel & Coombs classification) is myasthaenia gravis?
Type II
IPEX affects what type of immune cell
Treg (Foxp3)
Lady with SLE, has spherocytes, low Hb, raised bilirubin. How do you test for diagnosis?
Direct antiglobulin test (AIHA due to SLE)
What is the definition of herd immunity threshold?
1 - (1/R0)
16 year old girl has pleuritic chest pain, joint pain, positive ANA and Anti-Sm, no liver enzyme derangement, raised ESR. Diagnosis?
SLE
Chimeric antigen receptor T-cell therapy against CD19: what type of haematological malignancy does it target?
B cell (ALL, some non-Hodgkin lymphomas)
Kid has low calcium, cleft palate, low T cells?
DiGeorge
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
d. Primary Sjogren’s syndrome
b. Osteoarthritis and keratoconjunctivitis sicca
e. Rheumatoid arthritis
a. Gout
c. Osteogenesis imperfecta
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
c. Positive ANA
e. Positive ds-DNA
b. Low complement C3
a. Absent IgG
d. Positive C3 nephritic factor
A young man with periodic fevers has an MEFV mutation. What is the diagnosis?
Familial Mediterranean fever
What condition does JC virus reactivation cause in an immunosuppressed person?
Progressive multifocal leukoencephalopathy
CAR-T cells against CD19 treat haematological malignancy of what cell type?
B-cell
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?
Granulomatosis with polyangiitis (Wegener’s granulomatosis)
A 3 y/o child with recurrent bacterial and fungal infections has a negative dihydrorhodamine test (does not oxidise). What is the diagnosis?
Chronic granulomatous disease
CD40L mutation is associated with which immunodeficiency?
Hyper IgM syndrome
Which drug should be given immediately via intramuscular injection in anaphylaxis?
Adrenaline
What is the name of a fully differentiated B-cell that makes antibodies?
Plasma cell
What type of lymphocyte is deficient in an individual with bare lymphocyte syndrome and an HLA class II mutation?
T-cells
Which antibody is seen in Graves’ disease?
Anti-TSH receptor
Which cytokine type is involved in allergy to food and insect venom?
IgE
Which condition is Denosumab most commonly used to treat?
Osteoporosis
A 5 m/o baby has recurrent infections and an IL2RG (interleukin 2 common gamma chain mutation), what is the diagnosis?
X-linked SCID
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
b. Capillaries
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
d. S. pneumoniae
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
b. Dendritic cells
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)
b. Pembrolizumab (anti PD1)
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
b. Goodpasture syndrome
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
c. Pernicious anaemia
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
c. Familial Mediterranean fever
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
d. SLE
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
e. Mycophenolate mofetil, prednisolone, tacrolimus
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
d. Deposition of antibody-antigen complexes in blood vessel walls
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. Ankylosing spondylitis
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. Adalimumab (anti-TNFa)
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
b. CD4+ T-cells
Which type of vaccine should not be given to immunosuppressed people?
a. Conjugate
b. Live attenuated
c. Subunit
d. Toxoid
e. Lipid adjuvant
b. Live attenuated
Immunology A. Interferon gamma B. Interferon alpha C. TNFalpha D. Etanercept E. Basiliximab F. Tocilizumab G. Natalizumab H. Denosumab I. Human Ig
- Ankylosing spondylitis
- Resistant Psoriasis
- Chronic granulomatous disease treatment
- Osteoporosis
- Hyper IgM syndrome
- Etanercept (TNFa antagonist; RhA, psoriasis, AnkSpondy)
- Etanercept
- IFN gamma
- Denosumab (RANKL inhibitor on osteoclasts)
- Human Ig
A 60 year old lady with recurrent chest infections now has reduced total serum protein and has autoimmune thrombocytopenia - diagnosis?
Common variable immunodeficiency
A 12 year old boy has recurrent chest infections and has an ear infection. He doesn’t have any B Cells - diagnosis?
Bruton’s agammaglobulinaemia
Boy with recurrent abscesses has a negative NBT test - diagnosis?
Chronic granulomatous disease
A boy’s father has TB. The same boy develops a mycobacterium infection, following their BCG - diagnosis?
Interferon gamma deficiency
Young boy with normal number of B cell numbers and absence of CD8+ and CD4+
X-linked severe combined immunodeficiency
Normal B and T cells, high IgM but absence of IgA, IgE and IgG
Hyper IgM syndrome
Lady with spinal fracture due to severe TB
Interferon gamma receptor deficiency
Patient with recurrent pneumococcal infections and meningitis
Complement deficiency e.g. C7
Think pneumococcal and meningococcal!! - Encapsulated bacteria
Immunotherapy ued to treat osteoporosis when the patient cannot tolerate bisphosphonates
Denosumab (RANKL inhibitor on osteoclasts)
Immunotherapy used to treat malignant melanoma, involved in T cell checkpoints
Ipilimumab (CTLA4 inhibitor, boosts immune system by blocking T cell checkpoints) or nivolumab (PD-1 inhibitor, boosts immune system by blocking T cell checkpoints)
Immunotherapy used to treat Lymphoma and Rheumatoid arthritis
Rituximab (CD20 inhibitor, depletes mature B cells; lymphoma, SLE, RhA, CLL)
Immunotherapy used to prevent transplant rejection, by blocking T cell activation and IL2 production
Tacrolimus or cyclosporin (Inhibit calcineurin; rejection prophylaxis in transplant)
Immunotherapy used to treat severe ankylosing spondylitis not controlled by NSAIDs
Etenercept (TNFa antagonist; RhA, psoriasis, AnkSpondy)
Cells that express Foxp3 and CD25
Treg cells
Derived from monocytes and resident in peripheral
Macrophages
Allergy
- When they eat cherries, apples, pears and hazelnuts, they get itchy mouths
- Hypertensive and diabetic, with angioedema
- Kid with rash on extensor surfaces, IgE mediated
- Woman with flushed face, problems breathing that has happened multiple times with enlarged liver
- Patient wondering why they get allergic symptoms every summer, clear discharge from the nose
- Oral allergy syndrome
- ACEi
- Atopic dermatitis/eczema
- Hereditary angioedema
- Hayfever/allergic rhinitis
Transplant complications
- Can lead to development of post transplantation lymphoproliferative disease
- Causes progressive multifocal leukoencephalopathy
- Mechanism behind GVHD
- Mechanism behind antibody mediated rejection
- Mechanism behind cellular rejection
B-cell mediated Donor WBCs attack host tissue T-cell mediated JC virus Epstein-Barr virus
- Epstein-Barr virus
- JC virus
- Donor WBCs attack host tissue
- B-cell mediated
- T-cell mediated
Severe ankylosing spondylitis - NSAID & TNF inhibitor not been successful. What else can you target?
IL17/IL23
45yo woman with autoimmune diseases, low IgM, IgA and IgE; full blood count is normal. Diagnosis?
Common variable immunodeficiency
Patient with GI conditions, lack of which substance leads to B12 being malabsorbed?
Intrinsic factor
Patient with microcytic anaemia abdominal symptoms. Duodenal biopsy showed crypt hyperplasia and non-caseating granulomas, lymphocytes. Diagnosis?
Crohn’s disease
Which immunoglobulin is found in mucosa?
IgA
Patient with subtotal villous atrophy, tall crypts. Diagnosis?
Coeliac disease
Immunodeficiency with common gamma chain problem?
X-linked SCID
A woman is a donor for kidney to a child, what is the max number of HLA mismatches possible?
6
Someone with aphthous ulcers, conjunctivitis, diarrhoea & abdo pain. Diagnosis?
Crohn’s disease
Which type of cell does Rituximab target?
Mature B cells (not plasma cells)
cANCA positive man with glomerulonephritis and lung changes, what does he have?
Granulomatosis with polyangiitis (Wegener’s granulomatosis)
What cells does Nivolumab target?
Nivolumab = PD1 inhibitor
Targets T cells
Which vaccines are polysaccharide and conjugate vaccines?
Pneumococcal vaccine, Men C, HiB, Men ACWY
Woman with periorbital purple rash (heliotrope) and rash on knees, which enzyme is elevated?
t-RNA Synthetase
dermatomyositis
- What type of hypersensitivity causes serum sickness?
III (immune-complex mediated)
What is the effect of the gene mutation in familial Mediterranean fever?
Increased IL-1 production
Mechanism of hyperacute allograft rejection
Preformed antibodies against HLA or ABO
Which allergy is more likely to present in child than adult?
a. Oral allergy syndrome
b. Egg
c. Bee
d. Pollen
Egg
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
b. HIV – gp120
Patient with coeliac. What would you see on biopsy?
a. Intraepithelial leukocytes
b. Intraepithelial eosinophils
c. Intraepithelial macrophages
d. Intraepithelial neutrophils
e. Intraepithelial lymphocytes
e. Intraepithelial lymphocytes
Child born with abnormal facies and congenital cardiac abnormalities also has normal B cells but abnormal T cells, what genetic mutation do they have?
22q11.2 deletion syndrome/ DiGeorge syndrome
Which of these vaccines must not be given to a pregnant woman?
a. MMR
b. Hep B
c. DTP
a. MMR
What cell in the body binds to MHC1?
CD8+ - binds
NK cells - inhibited by
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. Drug reaction
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
b. C1 inhibitor deficiency
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
b. Drug induced reaction
1% of people get this reaction ACEi and some NSAIDs
Which type of cell is matured in thymus?
T cells
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
C. Positive anti-Ro antibody D. Positive anti-nuclear antibody E. Raised immunoglobulin G A. Raised neutrophil count B. Raised C-reactive protein
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)
Lymphoma Granulomatosis with polyangiitis (GPA) Microscopic polyangiitis (MPA) Systemic lupus erythematosus Chronic granulomatous disease
