Immuno

Question 1

Which cytokines are anti-inflammatory?

Answer 1

TGF-beta

IL-10

Question 2

Which cytokines are pro-inflammatory?

Answer 2

IL-1
IL-4
IL-5
IL-12

Question 3

How does selective IgA deficiency present?

Answer 3

Selective IgA: deficiency of IgA due to failure of B cells to class switch.

Recurrent sinopulm and GI infections.

When transfuse blood, even O- there are small amounts of foreign IgA. Therefore, pt makes IgG Ab against these resulting in rash, bronchospasm and death.

Question 4

What is the presentation of Leukocyte Adhesion Deficiency?

Answer 4

Delayed separation of the umbilical cord.

Question 5

What is chronic granulomatous disease and how does it present?

Answer 5

Chronic Granulomatous disease:
X-linked mutation of NADPH oxidase
can’t produce ROS, H2O2 etc.

impaired resp burst inhibits phagocyte killingRecurrent infection with catalase-positive bacteria and fungi (catalase will metabolize what little H2O2 there is)

Dx: Nitroblue Tetrazolium Test - neutrophils do NOT turn blue.

Question 6

Recurrent infection with what organisms indicate humoral immunodeficiency?

Answer 6

S. pneumoniae
H. influenzae
Moraxella(Otitis Media!)

Question 7

Infection with what orgs indicate T cell deficiency?

Answer 7

Pneumocystis

Mucocutaneous candidiasis

Question 8

What is activated in delayed type IV hypersensitivity? Examples in clinical practice?

Answer 8

Macrophages, CD4, CD8, NK T cells

Candidiasis - injecting antigen into skin, look for induration

Question 9

What are the two major effectors of anaphylaxis?

Answer 9

Histamine Tryptase - mast cell degranulation releases tryptase

Question 10

What are the impt functions of IL1 thru IL6? (Mnemonic)

Answer 10

Hot T-bone stEAK 
IL1 = fever
IL2 = T cells 
IL3 = bone marrow
IL4 = IgE
IL5 = IgA, eosinophils 
IL6 = aKute phase proteins

Question 11

Chronic rejection of lung transplant leads to?

Answer 11

Bronchiolitis Obliterans - inflam, narrowing, and fibrosis of the small arterioles -> dyspnea, wheezing, nonproductive cough

Question 12

What factor mediates cachexia?

Answer 12

TNFalpha

Question 13

Impt factors in leukocyte adhesion cascade

Answer 13

Margination: hemoconcentration, dec. wall shear stress

Rolling: Sialylated glycoprotein = P/E-selectin endothelium

Activation: Adhesion: CD18 = ICAMiMigration: PECAM1

Question 14

What is the presentation of Ataxia-Telangiectasia?

Answer 14

Ataxia - cerebellar atrophy
Telangiectasia - oculocutaneous

Recurrent sinopulmonary infections

Increased risk of cancer; sensitive to ionizing radiation

Dec. IgA, Inc. AFP
Defect in DNA repair enzyme that repairs double stranded breaks.

Question 15

What conditions associated with defective DNA repair enzymes

Answer 15

Ataxia-Telangiectasia
Xeroderma Pigmentosum 
Fanconi Anemia
Bloom Syndrome
HNPCC

Question 16

Markers of macrophage-monocyte lineage?

Answer 16

CD14

Question 17

Function of IL8. Other molecules that also function the same?

Answer 17

Neutrophil Chemotaxis: 
IL8
Leukotriene B4
c5a
n-formylated peptides
5-HETE (leukotriene precursor)

Question 18

What do the suffixes in drugs means?- mab - cept- nib

Answer 18

mab = monoclonal abcept = receptor molecule 
nib = kinase inhibitor

Question 19

What is an inducible enzyme that is normally undetectable in most tissues, except in the case of inflammation?

Answer 19

COX2

COX1 is constitutively expressed.

Question 20

How are antigens loaded onto MHC I vs. MHC II?

Answer 20

MHC I: loaded in RER after delivery from cytosol via TAP (transporter associated with antigen processing) peptide transporter

MHC II: MHC- invariant chain complex formed in the RER -> Golgi body -> Endosome compartment. Invariant chain degraded and peptide loaded.

Question 21

Will have red pulp expansion of spleen in what disease?

Answer 21

Portal HTN from hepatic disease -> congestion of blood in spleen from splenic vein.

Question 22

Increased susceptibility to Neisseria occurs with what immune system impairment?

Answer 22

C5-C9 deficiency - can’t form MAC.

Question 23

C1 esterase inhibitor deficiency causes? What is contraindicated in these patients?

Answer 23

Hereditary Angioedema (C1 esterase inhibits kallikrenin which converts kikinogen to bradykinin)

ACEi are contraindicated!!!

Question 24

Serum sickness

Answer 24

Type III hypersensitivity

Pt: Usually drugs acting as haptens (infliximab, venom antitoxin) -> 7-10d later develop sx.

fever, urticaria, arthralgias, proteinuria, LAD - small vessel vasculitis: fibrinoid necrosis - intense neutrophil infiltration

Patho: IC deposition, with activation of complement Low C3, C4 levels

Question 25

Case: Researchers find that individuals with particular HLA haplotypes do not mount an antibody response to specific polypeptide viral antigens. What is failing to occur?

Answer 25

Antigen PRESENTATION by macrophages. If the viral antigen is not bound by MHC I, they cannot get presented.