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USMLE > Immuno > Flashcards

Immuno Flashcards

1
Q

Lymph drainage of anal canal above pectinate line, bladder, middle third vagina, cervix and prostate

A

Internal iliac

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2
Q

Lymph drainage of testes, ovaries, kidneys and uterus

A

Para-aortic

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3
Q

Lymph drainage of anal canal below pictinate line, skin below umbilicus, scrotum and vulva

A

Superficial inguinal

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4
Q

Right lymphatic duct drains into

A

right side of body above diaphragm

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5
Q

Thoracic duct drains into which veins

A

left subclavian and internal jugular

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6
Q

Why does splenic dysfunction or asplenia increase risk of infection by encapsulated organisms

A

decreased IgM, decreased complement activation (C3b opsonization)

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7
Q

Where does APC between macrophages and B cells occur in the spleen?

A

Marginal zone (between red pulp and white pulp)

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8
Q

Where are T cells found in the spleen?

A

PALS (periarteriolar lymphatic sheath within white pulp)

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9
Q

Where are B cells found in spleen?

A

In follicles within white pulp

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10
Q

In which two conditions is thymus hypoplastic?

A

DiGeorge (loss of 3rd pharyngeal pouch) and SCID

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11
Q

In which condition is thymus enlarged

A

Myasthenia gravis

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12
Q

What are the three loci that encode MHCII

A

HLA-DP, HLA-DQ, HLA-DR

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13
Q

What are the three loci that encode MHC I

A

HLA-A, HLA-B, HLA-C

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14
Q

Peptide loading onto MHC in RER after delivery via TAP is mechanism for which MHC molecule

A

MHC I

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15
Q

Antigen loading following release of invariant chain in acidified endosome (lysosome) is which MHC mechanism

A

MHC II

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16
Q

How do NK cells kill virally infected cells and tumor cells

A

Induce apoptosis via perforin and granzyme

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17
Q

What induces NK cell killing?

A

Exposure to nonspecific antigen signal or absence of MHC I on target cell surface

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18
Q

Which signal activates antibody-dependent cell-mediated cytotoxicity in NK cell?

A

CD16 binding Fc region of bound Ig

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19
Q

IL-2, IL-12, IFN-alpha and IFN-beta enhance activity of which immune cell

A

NK cell

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20
Q

HLA B27 type diseases

A

PAIR (non-RF arthritis): Psoriatic, Ankylosing spondylitis, IBD-associated arthritis, Reactive arthritis

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21
Q

HLA DQ2/DQ8

A

Celiac disease

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22
Q

HLA DR-4

A

Rheumatoid arthritis

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23
Q

HLA-DR3

A

Diabetes mellitus type 1, SLE, Graves, Hashimoto’s thyroiditis, Addison (hormonal diseases)

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24
Q

HLA-DR5

A

Hashimoto, Pernicious anemia (B12 deficiency)

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25
Q

3 ways antibody generates antigen-independent diversity

A
  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
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26
Q

2 mechanisms of antigen-dependent antibody specificity generation

A
  1. Somatic hypermutation and affinity maturation of variable region (Fab)
  2. Isotype switching of constant region (Fc)
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27
Q

Three ways antibodies mediate immunity

A
  1. Opsonization (promote phagocytosis)
  2. Neutralization (prevent bacterial adherence)
  3. Complement activation (enhance opsonization and lysis via MAC)
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28
Q

why do bacterial vaccines typically require boosters and adjuvants?

A

They lack antigens with a peptide component so can’t bind MHC and induce thymus-dependent immune response (weakly immunogenic)

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29
Q

Formation of memory cells requires a thymic-dependent immune response. This is typically done for which type of antigen

A

Peptides presented on MHC molecules

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30
Q

What is C-reactive protein

A

Measurement of ongoing inflammation, induces complement

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31
Q

Why is ferritin activated in immune response

A

Sequesters iron so microbes cant use it

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32
Q

Why is albumin downregulated in illness

A

reduction conserves amino acids for positive reactants

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33
Q

Why is transferrin reduced in immune response

A

Sequesters iron by macrophage

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34
Q

What causes amyloidosis in chronic illness

A

elevated serum amyloid A

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35
Q

Function of hepcidin

A

decrease iron absorption by degrading ferroportin and decreasing iron release from macrophage

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36
Q

Which cytokine stimulates acute phase reactants?

A

IL-6

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37
Q

Where are complement proteins synthesized

A

Liver

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38
Q

Function of C3b

A

Opsonization and help clear immune complexes

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39
Q

Function of C3a, C4a, C5a

A

anaphylaxis

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40
Q

Function of C5a

A

neutrophil chemotaxis

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41
Q

Function of C5b-C9

A

MAC cytolysis

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42
Q

Which enzyme is deficiency in heriditary angioedema

A

C1 esterase (ACE inhibitors contraindicated)

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43
Q

Severe recurrent pyogenic sinus and URI infections, increased susceptibility to type III HS reactions due to

A

C3 deficiency

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44
Q

List the two types of C3 convertase

A

C4b2B (Classic and Lectin pathways) or C3bBb (Alternate)

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45
Q

List the two types of C5 convertases

A

C3bBb3b convertase (Alternate) or C4b2b3b (Classic and Lectin)

46
Q

Which cytokines are secreted by macrophage

A

IL-1, IL-6, IL-8, IL-12, TNF-alpha

47
Q

Function of IL-1 (osteoclast activating factor)

A

Fever, acute inflammation

48
Q

IL-6

A

Fever and stimulate acute phase protein production

49
Q

IL-8

A

major chemotactic factor for neutrophils

50
Q

IL-12

A

Induces differentiation of T cells into TH1 cells; activate NK cells

51
Q

TNF-alpha

A

secreted by macrophages- mediates septic shock, activates endothelium, WBC recruitment, vascular leak

52
Q

Which cytokines are secreted by all T cells

A

IL-2 and IL-3

53
Q

Function of IFN-gamma

A

Secrted by NK and T cells in response to IL-12; stimulates macrophage to kill phagocytosed pathogens, inhibits differentiation of TH2

54
Q

Additional fxn of IFN-gamma

A

aactivates NK cells to kill virus-infected cells; increases MHC expression and antigen presentation by all cells

55
Q

Which two antibodies are promoted by IL-4

A

IgE and IgG

56
Q

Which antibody production is stimulated by IL-5

57
Q

Which two cytokines attenuate immune response

A

TGF-beta and IL-10

58
Q

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?

A

Interferon alpha and beta

59
Q

Which process is defective in CGD?

A

Phagolysosome respiratory burst

60
Q

Which enzyme is deficient in CGD?

A

NADPH oxidase

61
Q

Which part of the respiratory burst reaction is selenium needed?

A

Glutathione peroxidase and reductase (renewing Glutathione to neutralize ROS)

62
Q

Patients at risk of CGD are at risk of infection by which pathogens?

A

Catalase + (can neutralize their H2O2)

63
Q

Why does respiratory burst not completely shut down in CGD?

A

Phagocytes can utilize bacterial H2O2 and convert it to ROS to kill bacteria

64
Q

CD14 on macrophage is receptor for

65
Q

CD56 is a unique marker for which immune cell?

66
Q

CD34 is a marker for which cells?

A

Hematopoietic stem cells

67
Q

Which B cell surface protein is used by EBV for entry

68
Q

How do S. aureus and S. pyogenes superantigens lead to a massive release of cytokines?

A

Cross-link the beta region of TCR with MHC II on APCs

69
Q

How do endotoxins/LPS lead to sepsis?

A

Directly stimulate macrophage by binding to endotoxin receptor TL4/CD14

70
Q

Which pathogens are treated with passive immunity (antibody vaccines)

A

Tetanus toxin, Botulinim toxin, Rabies, Varicella, HBV

71
Q

Anti-histone antibodies are specific for which condition

A

Drug-induced lupus

72
Q

Anti-glutamic acid decarboxylase is specific for

73
Q

Anti-centromere is specific for

A

Limited Scleroderma (CREST)

74
Q

Anti-Scl-70 (anti-DNA topoisomerase I) is specific for

A

Scleroderma (Diffuse)

75
Q

Anti-smooth muscle is specific for

A

Autoimmune hepatitis type 1

76
Q

Anti-SSA and SSB (Ro and La) specific for

A

Sjogren syndrome

77
Q

MPO-ANCA/p-ANCA

A

Microscopic polyangiitis; Churg-Strauss syndrome (eosinophilic granulomatis with polyangiitis)

78
Q

PR3-ANCA/c-ANCA

A

Wegener polyangiitis

79
Q

anti-CCP is specific foor

A

Rheumatoid arthritis

80
Q

What is the mutation in Autosomal Dominant hyper-IgE syndrome

A

Deficient STAT3 leads to defficient T17 cells, impaired recruitment of neutrophils to sites of infection

81
Q

Coarse facies, staphylococcal abscesses, retained primary teeth, increased IgE and eczema indicate which disorder

A

hyper-IgE syndrome (Job syndrome(

82
Q

How is IL-12 receptor deficiency inherited

A

Autosomal recessive

83
Q

Which infections is a person with IL-12 deficiency prone to?

A

Fungal and mycobacterial

84
Q

What is the triad of Ataxia Telengastia

A

Ataxia (cerebellar defects), Angiomas (telengiectasia), IgA deficiency (respiratory and mucosal infections like diarrhea)

85
Q

Which gene is defective in Ataxia Telengiectasia

A

ATM, cannot repair dsDNA breaks– cell cycle arrest

86
Q

Increased AFP, low IgA, IgG and IgE, as well as cerebellar atrophy and lymphopenia indicate

A

Ataxia Telengiectasia

87
Q

Which immune cells are involved in an Acute transplant rejection?

A

CD8 T cells activated against donor MHCs (Type IV rxn)

88
Q

Which type of hypersensitivity reaction is a hyperacute transplant rejection?

89
Q

Which cells are primarily involved in Chronic Transplant rejection?

A

CD4 T cells, APCs (both type II and IV)

90
Q

morphologic features of hyperacute rejection

A

necrosis, ischemia

91
Q

morphologic features of acute rejection

A

vasculitis of graft vessels with dense lymphocytic infiltrates

92
Q

morphologic features of chronic rejection

A

proliferation of vascular smooth muscle, parenchymal atrophy, interstitial fibrosis, ateriosclerosis!

93
Q

Signs of graft v host disease

A

Maculopapular rash, jaundice, diarrhea, hepatosplenomegaly

94
Q

Two common causes of graft v host disease

A

Bone marrow and liver transplants

95
Q

Pathogenesis of graft v host disease

A

Grafted T cells proliferate and reject host cells with “foreign proteins”–> attack host organs (Type IV HS reaction))

96
Q

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.

A

Delayed Type IV Hypersensitivity reaction

97
Q

Which three hypersensitivity reaction are mediated by antibodies and B cells?

A

Types I, II, and III

98
Q

Two conditions that cause a “left shift” band of neutrophils

A

Infection, patient on corticosteroids

99
Q

Why do corticosteroids cause an increase in measured neutrophils?

A

Lead to “demargination” or detachment of neutrophils from blood vessel walls

100
Q

Which immune cells are increased in asthma

A

Eosinophils

101
Q

Function of 5-HETE

A

Leukotriene and lipoxin precursor; neutrophil and macrophage chemotaxis and neutrophil degranulation

102
Q

Class-switching is accomplished by splicing which part of Immunoglobulin molecule?

A

Heavy chain constant region

103
Q

Stimulus for class switching between CD4+ T cells and B cells

A

Interaction of CD40L from T cells and CD40 from B cells

104
Q

Which coagulation factors are depleted first in warfarin use

A

Factor VII and C

105
Q

Microvascular occlusion and hemorrhagic skin necrosis after warfarin therapy occurs likely due to deficiency in

A

Protein C or S

106
Q

Which conditions cause an elevated WBC count and an increase in bands, metamyelocytes and myelocytes?

A

Leukemoid reaction following bacterial infection; CML

107
Q

Decrease in Leukocyte alkaline phosphate with increase in WBC and myelocytes implies

108
Q

When stained with Wright-Giemsa stain, these cells appear bluish due to retained rRNA

A

Reticulocytes

109
Q

Lysing of blood cells when incubated in hypotonic saline with glycerol (release hemoglobin) suggest

A

Hereditary spherocytosis

110
Q

This syndrome presents with hypercellular and abnormally differentiated cells in bone marrow, causing aplastic anemia in >65 year olds

A

Myelodysplastic syndrome

111
Q

This type of anemia is associated with aplastic anemia, short stature, absent thumbs and increased risk of malignancy

A

Fanconi anemia

112
Q

Chronic hemolysis with breakdown of iron-containing erythrocytes can lead to iron deposition in the kidney. This is called

A

Hemosiderosis

USMLE (36 decks)

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