Immuno Flashcards
1
Q
Lymph drainage of anal canal above pectinate line, bladder, middle third vagina, cervix and prostate
A
Internal iliac
2
Q
Lymph drainage of testes, ovaries, kidneys and uterus
A
Para-aortic
3
Q
Lymph drainage of anal canal below pictinate line, skin below umbilicus, scrotum and vulva
A
Superficial inguinal
4
Q
Right lymphatic duct drains into
A
right side of body above diaphragm
5
Q
Thoracic duct drains into which veins
A
left subclavian and internal jugular
6
Q
Why does splenic dysfunction or asplenia increase risk of infection by encapsulated organisms
A
decreased IgM, decreased complement activation (C3b opsonization)
7
Q
Where does APC between macrophages and B cells occur in the spleen?
A
Marginal zone (between red pulp and white pulp)
8
Q
Where are T cells found in the spleen?
A
PALS (periarteriolar lymphatic sheath within white pulp)
9
Q
Where are B cells found in spleen?
A
In follicles within white pulp
10
Q
In which two conditions is thymus hypoplastic?
A
DiGeorge (loss of 3rd pharyngeal pouch) and SCID
11
Q
In which condition is thymus enlarged
A
Myasthenia gravis
12
Q
What are the three loci that encode MHCII
A
HLA-DP, HLA-DQ, HLA-DR
13
Q
What are the three loci that encode MHC I
A
HLA-A, HLA-B, HLA-C
14
Q
Peptide loading onto MHC in RER after delivery via TAP is mechanism for which MHC molecule
A
MHC I
15
Q
Antigen loading following release of invariant chain in acidified endosome (lysosome) is which MHC mechanism
A
MHC II
16
Q
How do NK cells kill virally infected cells and tumor cells
A
Induce apoptosis via perforin and granzyme
17
Q
What induces NK cell killing?
A
Exposure to nonspecific antigen signal or absence of MHC I on target cell surface
18
Q
Which signal activates antibody-dependent cell-mediated cytotoxicity in NK cell?
A
CD16 binding Fc region of bound Ig
19
Q
IL-2, IL-12, IFN-alpha and IFN-beta enhance activity of which immune cell
A
NK cell
20
Q
HLA B27 type diseases
A
PAIR (non-RF arthritis): Psoriatic, Ankylosing spondylitis, IBD-associated arthritis, Reactive arthritis
21
Q
HLA DQ2/DQ8
A
Celiac disease
22
Q
HLA DR-4
A
Rheumatoid arthritis
23
Q
HLA-DR3
A
Diabetes mellitus type 1, SLE, Graves, Hashimoto’s thyroiditis, Addison (hormonal diseases)
24
Q
HLA-DR5
A
Hashimoto, Pernicious anemia (B12 deficiency)
25
3 ways antibody generates antigen-independent diversity
1. VDJ (heavy chain) and VJ (light chain) recominbation
2. Random addition of nucleotides by TdT
3. Random combination of heavy chains with light chains
26
2 mechanisms of antigen-dependent antibody specificity generation
1. Somatic hypermutation and affinity maturation of variable region (Fab)
2. Isotype switching of constant region (Fc)
27
Three ways antibodies mediate immunity
1. Opsonization (promote phagocytosis)
2. Neutralization (prevent bacterial adherence)
3. Complement activation (enhance opsonization and lysis via MAC)
28
why do bacterial vaccines typically require boosters and adjuvants?
They lack antigens with a peptide component so can't bind MHC and induce thymus-dependent immune response (weakly immunogenic)
29
Formation of memory cells requires a thymic-dependent immune response. This is typically done for which type of antigen
Peptides presented on MHC molecules
30
What is C-reactive protein
Measurement of ongoing inflammation, induces complement
31
Why is ferritin activated in immune response
Sequesters iron so microbes cant use it
32
Why is albumin downregulated in illness
reduction conserves amino acids for positive reactants
33
Why is transferrin reduced in immune response
Sequesters iron by macrophage
34
What causes amyloidosis in chronic illness
elevated serum amyloid A
35
Function of hepcidin
decrease iron absorption by degrading ferroportin and decreasing iron release from macrophage
36
Which cytokine stimulates acute phase reactants?
IL-6
37
Where are complement proteins synthesized
Liver
38
Function of C3b
Opsonization and help clear immune complexes
39
Function of C3a, C4a, C5a
anaphylaxis
40
Function of C5a
neutrophil chemotaxis
41
Function of C5b-C9
MAC cytolysis
42
Which enzyme is deficiency in heriditary angioedema
C1 esterase (ACE inhibitors contraindicated)
43
Severe recurrent pyogenic sinus and URI infections, increased susceptibility to type III HS reactions due to
C3 deficiency
44
List the two types of C3 convertase
C4b2B (Classic and Lectin pathways) or C3bBb (Alternate)
45
List the two types of C5 convertases
C3bBb3b convertase (Alternate) or C4b2b3b (Classic and Lectin)
46
Which cytokines are secreted by macrophage
IL-1, IL-6, IL-8, IL-12, TNF-alpha
47
Function of IL-1 (osteoclast activating factor)
Fever, acute inflammation
48
IL-6
Fever and stimulate acute phase protein production
49
IL-8
major chemotactic factor for neutrophils
50
IL-12
Induces differentiation of T cells into TH1 cells; activate NK cells
51
TNF-alpha
secreted by macrophages- mediates septic shock, activates endothelium, WBC recruitment, vascular leak
52
Which cytokines are secreted by all T cells
IL-2 and IL-3
53
Function of IFN-gamma
Secrted by NK and T cells in response to IL-12; stimulates macrophage to kill phagocytosed pathogens, inhibits differentiation of TH2
54
Additional fxn of IFN-gamma
aactivates NK cells to kill virus-infected cells; increases MHC expression and antigen presentation by all cells
55
Which two antibodies are promoted by IL-4
IgE and IgG
56
Which antibody production is stimulated by IL-5
IgA
57
Which two cytokines attenuate immune response
TGF-beta and IL-10
58
Which glycoproteins stimulate cells neighboring virally-infected ones to produce enzymes that will selectively degrade viral nucleic acid and protein, thus interfering with viral response?
Interferon alpha and beta
59
Which process is defective in CGD?
Phagolysosome respiratory burst
60
Which enzyme is deficient in CGD?
NADPH oxidase
61
Which part of the respiratory burst reaction is selenium needed?
Glutathione peroxidase and reductase (renewing Glutathione to neutralize ROS)
62
Patients at risk of CGD are at risk of infection by which pathogens?
Catalase + (can neutralize their H2O2)
63
Why does respiratory burst not completely shut down in CGD?
Phagocytes can utilize bacterial H2O2 and convert it to ROS to kill bacteria
64
CD14 on macrophage is receptor for
PAMPS
65
CD56 is a unique marker for which immune cell?
NK cell
66
CD34 is a marker for which cells?
Hematopoietic stem cells
67
Which B cell surface protein is used by EBV for entry
CD 21
68
How do S. aureus and S. pyogenes superantigens lead to a massive release of cytokines?
Cross-link the beta region of TCR with MHC II on APCs
69
How do endotoxins/LPS lead to sepsis?
Directly stimulate macrophage by binding to endotoxin receptor TL4/CD14
70
Which pathogens are treated with passive immunity (antibody vaccines)
Tetanus toxin, Botulinim toxin, Rabies, Varicella, HBV
71
Anti-histone antibodies are specific for which condition
Drug-induced lupus
72
Anti-glutamic acid decarboxylase is specific for
T1DM
73
Anti-centromere is specific for
Limited Scleroderma (CREST)
74
Anti-Scl-70 (anti-DNA topoisomerase I) is specific for
Scleroderma (Diffuse)
75
Anti-smooth muscle is specific for
Autoimmune hepatitis type 1
76
Anti-SSA and SSB (Ro and La) specific for
Sjogren syndrome
77
MPO-ANCA/p-ANCA
Microscopic polyangiitis; Churg-Strauss syndrome (eosinophilic granulomatis with polyangiitis)
78
PR3-ANCA/c-ANCA
Wegener polyangiitis
79
anti-CCP is specific foor
Rheumatoid arthritis
80
What is the mutation in Autosomal Dominant hyper-IgE syndrome
Deficient STAT3 leads to defficient T17 cells, impaired recruitment of neutrophils to sites of infection
81
Coarse facies, staphylococcal abscesses, retained primary teeth, increased IgE and eczema indicate which disorder
hyper-IgE syndrome (Job syndrome(
82
How is IL-12 receptor deficiency inherited
Autosomal recessive
83
Which infections is a person with IL-12 deficiency prone to?
Fungal and mycobacterial
84
What is the triad of Ataxia Telengastia
Ataxia (cerebellar defects), Angiomas (telengiectasia), IgA deficiency (respiratory and mucosal infections like diarrhea)
85
Which gene is defective in Ataxia Telengiectasia
ATM, cannot repair dsDNA breaks-- cell cycle arrest
86
Increased AFP, low IgA, IgG and IgE, as well as cerebellar atrophy and lymphopenia indicate
Ataxia Telengiectasia
87
Which immune cells are involved in an Acute transplant rejection?
CD8 T cells activated against donor MHCs (Type IV rxn)
88
Which type of hypersensitivity reaction is a hyperacute transplant rejection?
Type II
89
Which cells are primarily involved in Chronic Transplant rejection?
CD4 T cells, APCs (both type II and IV)
90
morphologic features of hyperacute rejection
necrosis, ischemia
91
morphologic features of acute rejection
vasculitis of graft vessels with dense lymphocytic infiltrates
92
morphologic features of chronic rejection
proliferation of vascular smooth muscle, parenchymal atrophy, interstitial fibrosis, ateriosclerosis!
93
Signs of graft v host disease
Maculopapular rash, jaundice, diarrhea, hepatosplenomegaly
94
Two common causes of graft v host disease
Bone marrow and liver transplants
95
Pathogenesis of graft v host disease
Grafted T cells proliferate and reject host cells with "foreign proteins"--> attack host organs (Type IV HS reaction))
96
Dendritic cells take up antigen, present to CD4 T cells on MHC II. Stimulated TH cells release interferon-gamma and recruit macrophages. Macrophages "wall off" antigen infection and form granuloma. Identify this reaction.
Delayed Type IV Hypersensitivity reaction
97
Which three hypersensitivity reaction are mediated by antibodies and B cells?
Types I, II, and III
98
Two conditions that cause a "left shift" band of neutrophils
Infection, patient on corticosteroids
99
Why do corticosteroids cause an increase in measured neutrophils?
Lead to "demargination" or detachment of neutrophils from blood vessel walls
100
Which immune cells are increased in asthma
Eosinophils
101
Function of 5-HETE
Leukotriene and lipoxin precursor; neutrophil and macrophage chemotaxis and neutrophil degranulation
102
Class-switching is accomplished by splicing which part of Immunoglobulin molecule?
Heavy chain constant region
103
Stimulus for class switching between CD4+ T cells and B cells
Interaction of CD40L from T cells and CD40 from B cells
104
Which coagulation factors are depleted first in warfarin use
Factor VII and C
105
Microvascular occlusion and hemorrhagic skin necrosis after warfarin therapy occurs likely due to deficiency in
Protein C or S
106
Which conditions cause an elevated WBC count and an increase in bands, metamyelocytes and myelocytes?
Leukemoid reaction following bacterial infection; CML
107
Decrease in Leukocyte alkaline phosphate with increase in WBC and myelocytes implies
CML
108
When stained with Wright-Giemsa stain, these cells appear bluish due to retained rRNA
Reticulocytes
109
Lysing of blood cells when incubated in hypotonic saline with glycerol (release hemoglobin) suggest
Hereditary spherocytosis
110
This syndrome presents with hypercellular and abnormally differentiated cells in bone marrow, causing aplastic anemia in >65 year olds
Myelodysplastic syndrome
111
This type of anemia is associated with aplastic anemia, short stature, absent thumbs and increased risk of malignancy
Fanconi anemia
112
Chronic hemolysis with breakdown of iron-containing erythrocytes can lead to iron deposition in the kidney. This is called
Hemosiderosis
