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USMLE Step 1-2015 > Immuno > Flashcards

Immuno Flashcards

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USMLE® Step 1 flashcards
1
Q

Cervical node

A

Head and neck

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2
Q

Hilar node

A

Lungs

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3
Q

Mediastinal node

A

Trachea and esophagus

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4
Q

Axillary

A

Upper limb, breast, skin above umbilicus

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5
Q

Celiac

A

Liver, stomach spleen, pancreas, upper duodenum

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6
Q

Superior mesenteric

A

Lower duodenum, jejunum, ileum, colon to splenic flexure

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7
Q

Inferior mesenteric

A

Colon from splenic flexure to upper rectum

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8
Q

Internal iliac

A

Lower rectum to anal canal (above pectinate line), bladder, vagina (middle third), prostate

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9
Q

Para-aortic

A

Testes, ovaries, kidneys, uterus

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10
Q

Superficial inguinal

A

Anal canal (below pectinate line), skin below umbilicus (ie. thighs and except popliteal territory), scrotum

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11
Q

Popliteal

A

Lateral portion of dorsum foot, posterior calm

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12
Q

Right lymphatic duct

A

Drains right side of body above the diaphragm

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13
Q

Thoracic duct

A

Drains everything else besides right lymphatic duct

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14
Q

Deep inguinal

A

Glans penis and superficial nodes

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15
Q

Thoracic duct drains junction of

A

left subclavian and internal jugular veins

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16
Q

In a viral infection, what regions of the lymph node enlarges?

A

Paracortex in an extreme cellular immune response

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17
Q

How to T/B cells enter paracortex from blood?

A

through high endothelial (postcapillary) venules.

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18
Q

All cells express MHC I except what cell?

A

RBCs

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19
Q

HLA subtypes associated with diseases?

A3

A

Hemochromatosis

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20
Q

HLA subtypes associated with diseases?

B21

A

PAIR

Psoriatic arthritis, Ankylosing spondylitis, Inflammatory bowel disease, Reactive arthritis

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21
Q

HLA subtypes associated with diseases?

DQ2/DQ8

A

Celiac disease

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22
Q

HLA subtypes associated with diseases?

DR2

A

Multiple sclerosis, hay fever, SLE, goodpasture syndrome

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23
Q

HLA subtypes associated with diseases?

DR3

A

Diabetes mellitus type I, SLE, GRaves, Hashimoto thyroiditis

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24
Q

HLA subtypes associated with diseases?

DR4

A

Rheumatoid arthritis, diabetes mellitus type 1 (“4 walls in the “rheum” (room”

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25
Q

HLA subtypes associated with diseases?

DR5

A

Pernicious anemia–>vitamin B12 deficiency, hashimoto thyroiditis

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26
Q

Activity of NK cells enchanced by?

A

IL-2, IL-12, IFN alpha, IFN beta

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27
Q

How are regulatory T cells identified?

A

By expression of CD3, CD4, CD25, and FOXP3 (serves as transcrption factor and absense of it leads to autoimmune diseaseS)

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28
Q

Regulatory T cells produce what?

A

anti-inflammatory cytokines (IL-10, TGF-Beta)

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29
Q

TH1 cell secretes?

A

IFN-gamma, IL2

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30
Q

TH2 cell secretes?

A

IL-4,5, 10, 13

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31
Q

TH1 cell activated by and inhibited by what?

A

activated: IL-12, IFN-gamma
inhibited: IL-4, IL-10

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32
Q

TH2 cells activated by and inhibited by what?

A

Activated: IL-2
Inhibited: IFN-gamma

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33
Q

Primary immediate response to antigen

A

IgM

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34
Q

Secondary delayed response to antigen

A

IgG

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35
Q

What are the two forms of IgA?

A

Monomer (in circulation)
Dimer (when secreted that consists of J-chain, two immunoglobulin monomers and secretory component that is glycopeptide wraps around IgA to protect it like a suit of armor for harsh environment)

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36
Q

What are the two forms of IgM?

A

Monomer (on B cell)

Pentamer (when secreted-5 IgM molecules joined together at their Fc regions by the J peptide)

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37
Q

Acute-phase reactants notably change in response to what?

A

IL-6 (an TNF alpha and IL-1)

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38
Q

What are acute phase reactants a marker of?

A

Acute/chronic inflammatory states

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39
Q

Positive (upregulated) acute phase reactants

A

C-reactive protein (opsonin; fixes complement and facilitates phagocytosis)
Ferritin (binds and sequesters iron to inhibit microbial iron scavenging)
Fibrinogen (coagulation factor, promotes endothelia repair; correlates with ESR)
Hepcidin (prevents release of iron bound by ferritin)
Serum amyloid A (prolonged elevation can lead to amyloidosis)

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40
Q

Negative (downregulated) acute phase reactants

A

Albumin (reduction conserves AA for positive reactants)

Transferrin (internalized by macrophages to sequester iron)

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41
Q

Function: C3b, IgG

A

opsonization (2 primary opsonins in bacterial defense)

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42
Q

Function: C3a, C4a, C5a

A

anaphylaxis

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43
Q

Function: C5a

A

neutrophil chemotaxis

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44
Q

Function: C5b-C9

A

MAC

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45
Q

Function: CD55

A

Decay acclerating factor (aka DAF) helps accelerate decay of C3 convertase to help protect against complement.

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46
Q

C1 esterase inhibitor deficiency

A

Hereditary angioedema (episodes of non-pitting, painless, well-circumscribed edema). ACE inhibitors contraindicated

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47
Q

C3 deficiency

A

Incrases risk of severe, recurrent pyogenic sinus and respiratory infections; increases suceptibility to type III hypersensitivity rxns (especially glomerulonephritis)

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48
Q

C5-C9 deficiencies

A

Terminal complement deficiency increases suceptibility to recurrent Neisseria bacteremia

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49
Q

DAF (GPI-anchored enzyme) deficiency

A

Causes complement-mediated lysis of RBCS and paroxysmal nocturnal hemoglobinuria

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50
Q

IL-1
Secreted by?
Function?

A

Macrophages
Also called osteoclast activating factor. Causes fever, acute inflammation. Activates endothelium to express adhesion molecules. Induces chemokine secretion to recruit WBCs

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51
Q

IL-6
Secreted by?
Function?

A

Macrophages

Causes fever and stimulates production of acute-phase proteins

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52
Q

IL-8
Secreted by?
Function?

A

Macrophages

Major chemotactic factor for neutrophils

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53
Q

IL 12
Secreted by?
Function?

A

Macrophages

Function: Induce differentiation of T cells into Th1 cells. Activates NK cells

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54
Q

TNF-alpha
Secreted by?
Function?

A

Macrophages

Mediates septic shock. Activates endothelium. Causes WBC recruitment, vascular leak

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55
Q

IL-2
Secreted by?
Function?

A

All T cells
Stimulates growth of helper,cytotoxic, and regulatory T cells, and NK cells. Increase activity of T cells and NK cells thought to be responsible for IL-2’s anti-cancer effect on metastatic melanoma and renal cell carcinoma

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56
Q

IL-3
Secreted by?
Function?

A

All T cells

Supports growth and differentiation of bone marrow cells. Functions like GM-CSF

57
Q

IFN-gamma
Secreted by?
Function?

A

Secreted by NK cells in response to IL-12 from macrophages; stimulates macrophages to kill phagocytosed pathogens. Also activates NK cells to kill virus-infected cells. Increases MHC expression and antigen presentation by all cells

58
Q

IL-4
Secreted by?
Function?

A 
Th2 cells
Induces differentiation of Th0 cells into Th2 cells. Promotes growth of B cells. Enchances class switching to IgE and IgG
"BEG 4 it"--> B-cell growth, Class switch to IgE/IgG, 4 for IL-4
59
Q

IL-5
Secreted by?
Function?

A 
Th2 cells
Promotes differentation of B cells. Enchances class switching to IgA. Stimulates growth and differentiation of eosinophils
60
Q

IL-10
Secreted by?
Function?

A

Modulates inflammatory response. Decreases expression of MHC Class II and Th1 cytokines. Inhibits activated macrophages and dendritic cells. also secreted by regulatory T cells

61
Q

What cytokines attenuate immune response

A

IL-10, TGF-B

62
Q

Hot T-bone stEAK

A 
IL-1-fever
IL-2 (stimulates T cells)
IL-3 (growth and differentiation of bone marrow cells)
IL-4 (stimulates IgE production)
IL-5 (Stimulates IgA production)
IL-6-stimulates aKute-phase protein
63
Q

T cell receptors

A

TCR, CD3, CD28

64
Q

Helper T cells

A

CD4, CD40L, TCR, CD3, CD28

65
Q

Cytotoxic T cells

A

CD8, TCR, CD3, CD28

66
Q

B cells

A

Ig (binds antigen), CD 19, 20, 21, 40 MHC II, B7

67
Q

Macrophages

A

CD14, 40 MHC II, B7, Fc and C3b receptors (enhanced phagocytosis)

68
Q

NK Cells

A

CD 16 (binds Fc of IgG), CD56 (unique marker for NK)

69
Q

Heamtopoietic stem cells

A

CD 34

70
Q

Bacteria, viruses and parasites with classic examples of antigenic variation

A

Bacteria-Salmonella (2 flaggelar variants), N gonnorhoeae (pilus protein), Boreilla recurrentis (relapsing fever)

Viruses (HCV, HIV, influenza)

Protazoa (trypanosomes)

71
Q

After exposure to what should unvaccinated patients be given preformed antibodies (passive)

A

Tetanus toxin, Botulinum toxin, HBV, Varicella, Rabies virus

“ To Be Healed Very Rapidly”

72
Q

What two situations can combined passive and active immunizations be given for?

A

Hepatitis B and rabies exposure

73
Q

What is best way to prevent neonatal tetanus and why?

A

vaccination of toxoid vaccine of women to allow transfer of protective IgG antitoxin antibodies across placenta to the fetus

74
Q

Function of toxoid vaccine?

A

Produce antitoxin antibodies

75
Q

Only live attenuated vaccine given to ppl with HIV

A

MMR with CD4>200

76
Q

Live attenuated vaccines

A

Polio, varicella, yellow fever, MMR, Rotavirus, intranasal influenza

Attention (attenuated viral vaccines)! Please Vaccinate Young Infants w/ MMR Regularly (Polio (oral, sabin), varicella, yellow fever, MMR, Rotavirus, intranasal infleunza

77
Q

Inactiated or killed vaccine

A

Rabies, Influenza (injection), Polio (Salk), hepatitis A (RIP Always)

78
Q

Which two vaccines should you not use if you are allergic to eggs?

A

Influenza/yellow fever vaccine

79
Q

Why does sabin provide more protection via stronger IgA mucosal response than salk?

A

Increase in mucosal IgA offers immune protection at site of viral entry by inhibiting attachement to intestinal epithelia l cells. Stimulation of local secretory IgA production best promoted when corresponding mucosal surfaces are directly stimulated by antigen

80
Q

When does serum sickness occur?

A

Generally 5-10 days after antigen expsoure

81
Q

When does arthrus reaction occur?

A

Generally 4-12 hours after characterized by edema, necrosis, and complement activation

82
Q

Type of hypersensitivity

Eczema

A

Type 1

83
Q

Hives

A

Type 1

84
Q

Asthma

A

Type 1

85
Q

Contact dermatitis

A

Type IV

86
Q

Swelling and inflammation following tetanus vaccine

A

Type III (example of arthus reaction)

87
Q

SLE

A

Type III

88
Q

GVHD

A

Type IV

89
Q

Multiple sclerosis

A

Type IV

90
Q

Polyarteritis nodosa

A

Type III

91
Q

PSGN

A

Type III

92
Q

Acute hemolytic transfusion reactions

A

Type II

93
Q

Autoimmune hemolytic anemia

A

Type II

94
Q

Graves disease

A

Type II

95
Q

PPD skin test

A

Type IV

96
Q

Rheumatic fever

A

Type II

97
Q

Pernicious anemia

A

Type II

98
Q

Guillian barre

A

Type II

99
Q

Myasthenia gravis

A

Type II

100
Q

Erythroblastosis fetalis

A

Type II

101
Q

Antimitochondrial ab

A

Primary biliary chirrhosis

102
Q

Antinuclear ab

A

SLE, nonspecific

103
Q

Anti-smooth muscle

A

Autoimmune hepatitis

104
Q

Anti-SSA anti-SSB (anti-Ro, anti-La)

A

Sjogren syndrome

105
Q

Anti-TSH receptor

A

Graves disease

106
Q

Anti-U1 RNP (ribonucleoprotein)

A

MCTD

107
Q

MPO-ANCA/p-ANCA

A

Microscopic polyangiitis, eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)

108
Q

B cell deficiencies tend to produce more suceptibility to ______ while T cell deficiencies tend to have more suceptibility to __________

A

Bacterial and protozoal infections

Viral and bacterial infections

109
Q

Graft from self

A

Autograft

110
Q

Graft from identical twin or clone

A

Syngeneic graft (isograft)

111
Q

Graft from nonidentical individual of same species

A

Allograft

112
Q

Graft from different species

A

Xenograft

113
Q

One of main determinants of severity of rejection for transplant btwn donor and recipient

A

Difference in MHC antigens

114
Q

GVHD is most likely a complication of what and why?

A

Bone marrow and liver transplants (rich in lymphocytes)

115
Q

Main toxicity of calcineurin inhibitors

A

Both are highly nephrotoxic

116
Q

Cytokine treatment for RCC or metastatic melanoma

A

Aldesleukin (IL-2)

117
Q

Cytokine treatment Anemias (especially in renal failure)

A

Epoetin alfa (erythropoietin)

118
Q

Cytokine treatment for recovery of bone marroy

A

Filgastrim (G-CSF) or Sargramostim (GM-CSF)

119
Q

IFN alpha use

A

Chronic hep B/C, kaposi sarcoma, malignant melanoma

120
Q

IFN beta use

A

MS

121
Q

IFN gamma use

A

CGD

122
Q

Treatment with cytokines for thrombocytopenia

A

Romiplostim, eltrombopag, oprelevekin (IL-11)

123
Q

Alemtuzumab
Target?
clinical use?

A

CD52

CLL

124
Q

Bevacizumab
Target?
Clinical use?

A

VEGF

Colorectal cancer, renal cell carcinoma

125
Q

Cetuximab
Target?
Clinical use?

A

EGFR

Stage IV colorectal cancer, head and neck cancer

126
Q

Rituximab
Target?
Clinical use?

A

B-cell non hodgkin lymphoma, CLL, rheumatoid arthritis, ITP

127
Q

Trastuzumab
Target?
Clinical use?

A

Her2/neu

Breast cancer

128
Q

Adalimumab, infliximab
Target?
Clinical use?

A

Soluble TNF-alpha

IBD, RA, ankylosing spondylitis, psoriasis

129
Q

What is a decoy TNF-alpha receptor and not a monoclonal antibody

A

Etanercept

130
Q

Eculizumab
Target?
Clinical use?

A

Complement protein C5

Paroxysmal nocturnal hemoglobinuria

131
Q

Natalizumab
Target?
Clinical use?

A 
alpha4 integrin (involved in WBC adhesion)
Multiple scelrosis, Crohn disease
132
Q

Abciximab
Target?
Clinical use?

A

Gp IIb/IIIa platelet glycoproteins

Antiplatelet agents for prevention of ischemic complications in patients undergoing percutaneous coronary intervention

133
Q

Denosumab
Target?
Clinical use?

A

RANKL

Osteoporosis; inhibit osteoclast maturation

134
Q

Digoxin immune Fab
Target?
Clinical use?

A

Digoxin

Antidote for digoxin toxicity

135
Q

Omalizumab
Target?
Clinical use?

A

IgE

Prevents IgE from binding to FcRI in allergic asthma patients

136
Q

Palivizumab
Target?
Clinical use?

A

RSV F protein

RSV prophylaxis for high-risk infants

137
Q

Ranibizumab, bevacizumab
Target?
clinical use?

A

VEGF

Neovascular age-related macular degeneration

138
Q

Drain all cutaneous lymph from umbilicus to feet, including external genitalia and anus (up to dentate/pectinate line)

A

Superficial inguinal node

139
Q

Method by which aspirin is an irreversible inhibitor?

A

acetylation

USMLE Step 1-2015 (18 decks)

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