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
mAb Tx Psoriasis
Ustekinumab (anti IL-12/23)
Guselkumab (anti IL-23)
Sekukinumab (anti IL-17A for PA and ankalosing spondylitis)
Tx RA (not DDMARD/MTX)
Rituximab (anti CD20), anti-TNFa (etanercept or adalimumab), tocilizumab (anti-IL6)
Wegener’s with severe flare
Cyclophosphamide
Worsening Crohn’s, already on Azathioprine and Prednisolone, what tx?
Infliximab (Anti-TNFa)
Malignant melanoma medical treatment
Pembrolizumab
Explanation: Pembrolizumab is anti PD-1, just like Nivolmab.
Ipilimumab is an anti CTLA-4
Rituximab target and used in
anti-CD20
Used in Lymphoma, RA, SLE
Transplant drugs
Tacrolimus, Cyclosporin Azathioprine Mycophenolate Mofetil Antithymocyte globulin (ATG Prednisolone Basiliximab (anti-CD25/IL-2) (prophylactic)
typical regime is: CNI + AZA/MMF +/- steroids
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 (inactive, active, severe disease)
Inactive: C3 and C4 normal
Active: C3 normal, C4 low
Sever: C3 and C4 low
Immune condition with chest and renal involvement
Good-pasture’s classically but can be GPA/eGPA
Features of hyperacute rejection (transplant)
Minutes-hours Pre-formed Abs to HLA activate complement –> Thrombosis and necrosis Prevent by cross-match and HLA typing
Features of acute cellular rejection (transplant)
Weeks-months. Activated by direct APCs.
CD4 cells –> type IV hypersensitivity reaction –> cellular infiltrate
Tx: T-cell immunosuppression e.g. Steroids
Memory aid: T cell = T 4
Features of acute Ab-mediated rejection (transplant)
Weeks-months B-cells –> antibodies –> attack vessels and endothelial cells –> vasculitis Complement deposition (C4d - stains positive in Ab mediated rejection). Treat with B-cell immunosuppression & remove Abs
Features of chronic rejection (transplant)
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
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 eosinophil 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
… can also be DiGeorge syndrome, but Q usually has more hints
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
Encapsulated organisms
Recurrent meningitis
Complement deficiency (C5-9) Encapsulated organism e.g. Hib or N. meningitidis
Recurrent infections, negative NBT test
Chronic Granulomatous disease
PID 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”
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)
RA, neutropenia/leukopenia and splenomegaly
Rheumatoid arthritis and splenomegaly
Felty’s
Monocytes in peripheral skin cells
Langerhands
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, both chemokine receptors
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, and another point of lifecycle with room for error
reverse transcriptase
and when DNA is used to male RNA copies for new viruses
AIRE gene - which condition?
AIPS2 (APECED)
FAS gene mutation causes which condition?
ALPS (autoimmune lymphoproliferative syndrome)
MEFV gene, periodic abdominal pain and ascites
Familial Mediterranean Fever
Nod2/CARD15
Crohn’s
DR4 and CCP
RA
HLA-B27
Ank spond
What should you check before starting azathioprine?
TPMT levels (enzyme)
Serum sickness = what type of hypersensitivity?
Type 3 Hypersensitivity
Reaction 5-10 days after foreign protein injected (e.g. penicillin), leading to Ig production and subsequent immune complex formation.
Adult with bronchiectasis, recurrent sinusitis, diarrhoea and development of atypical SLE
CVID
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
PTPN22
Tyrosine phosphatase associated with RA, SLE, T1DM
Suppresses T-cell activation
Connective tissue disease screening antibody
ANA
Calcinuerin inhibitors names and MOA
Ciclosporin and tacrolimus
Block cytokine expression
chronic granulomatous disease treatment type
IFN gamma
SE of cyclophosphamide
infertility (males >> females)
Hair loss
Haemorrhagic cystitis
SE of azathioprine
neutropenia (especially if TPMT is low)
SE of ciclosporin
Dysmorphic features (gum hypertrophy)
Hypertension
nephrotoxic
Neurotoxic
SE tacrolimus
Nephrotoxic
Hypertension
Diabetogenic
Neurotoxic
SE of Mycofenolate Mofetil
Progressive multifocal leukencephalopathy (caused by JC virus)
60yo develops rash while under general anaesthetic, what do you do?
Measure mast cell tryptase
75yo man with hypertension, tongue and periorbital swelling. Cause of swelling?
ACEi
Complement deficiency and nephritic factor
Membranoproliferative nephritis and bacterial infections
C1q deficiency
Skin conditions, childhood onset SLE (severe), infections, kidney disease
anti-CD25 mAb name and used in
Basilixumab
used in prophylaxis of allograft rejection
anti IL12/23 mAb name and used in
Ustekinumab
Crohn’s and psoriasis
anti IL-6 mAb name and used in
Tocilizumab
Used in RA and castleman’s disease (lymphoproliferative diseasea)
AI hep/PSC antibody
Anti smooth muscle Ab
(PSC also has p-ANCA and ANAs)
Goodpasteurs connective tissue thing
Type IV collagen
Mouldy hay
Extrinsic allergic alveolitis
Oligoclonal bands of IgG on CSF with myelin basic protein
MS
OKT3
A mab for hyperacute rejection (anti-CD-3, T cells)
Calcineurin inhibitor
Cyclosporin (reduces IL-2)
Tacrolimus
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 PAN
SLE pt develops bleeding from gums and nose bleeds, with low platelet count 1. Antibody target 2. 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 name and used in
Abatacept (rheumatoid arthritis)
Used in RA
Mycophenylate Mofetil MoA
Guanine synthesis (IMPDH is the enzyme)
Kveim test
Sarcoidosis
Test for HSP
Skin biopsy and immunofluoresence stain for IgA and C3
Increased CH50
acute inflammation e.g. RA
Pot strep rheumatoid fever (mechanism)
Molecular mimicry
1st exposure to allergen IL
IL-12
Cyclosporin MoA
Calcineurin inhibitor
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
Antibodies found in diabetes patients
Anti glutamic aid dehydrogenase 65 (Anti-GAD65)
Islet antigen (IA-2)
Anti-islet cell antibody
Anti-insulin antibody
Peptidyl arginine deaminase, PAD
Mutated in RA
Enzymes involved in deamination of arginine to citrulline
Dermatomyositis vs polymyositis type of hypersensitivity reaction
Dermatomyositis Type 3 (Immune complex mediated vasculitis)
Polymyositis Type 4 (CD8 cells surround myofibres)
Ix for anaphylactic shock
Serial mast cell tryptase (at 1,3 and 24 hrs after)
Blood/urine histamine levels
Ix for allergy (elective)
- skin prick (≥3mm wheal is positive)
- Lab quantification of allergen specific IgE (but often positive wihtout symptoms
- Chellenge test (Gold standard)
Dilution IM adrenaline
Dose for adults, 6-12 and <6
1: 1000
0. 5, 0.3, 0.15 ml
treatment anaphylaxis
IM adrenaline
Fluids
IV antihistamines (chlorpheniramine)
IV Hydrocortisone
Chronic uritcaria and angioedema plus takes ACEi
ACEi angioedema
(ACEi lead to accumulation of bradykinin which causes the symptoms)
most important HLA loci for translplant
-A, -B, -DR
Name live vaccines
MMR
BCG
Typhoid (oral)
Polio (oral)
VZV
Yellow Fever
Checkpoint inhibitors
ipilimumab (CTLA-4)
nivolumab pembrolizumab (PD-1)
JAK inhibitors examples and used in
Tofacitinib and baracitinib
Used in RA
Apremilast used in and MOA
Psoriasis ans psoriatic arthritis
PDE4 inhibitor
anti-IL-17 mAb name and used in
Secukinumab
used in psoriasis
denosumab target (full for VSA)
used in
receptor activator of NFkB ligand
Osteoporosis
MOA azathioprine
prevents de novo purine synthesis to prevent T>B cell activation/proliferation
MOA Mycophenylate
Blocks de novo guanosine nucleotide synthesis
T>B cells
MOA Cyclophosphamide
Alkylating agent
Alkylates guanine base of DNA
Damages DNA and prevents cell replication
Affects B cells > T cells
drugs that prevent integration of HIV genetic information into host DNA
Integrase inhibitors
e.g dolutegravir
ARVs that blocks reverse transcriptase
(non-)nucleoside reverse transcriptase inhibitors
e.g. zidovudine, abacavir
ARV that prevents assembly and release of virus
Protease inhibitors
ARV that block binding of virus to cell
Attachment inhibitors
e.g. maraviroc
MOA sirulimus
mTOR inhibitor
What natural antibody against, which confers protective immunity against HIV?
Gp120
What are the base-line treatment for immunosuppression?
Calcineurin inhibitor (cyclosporine/tacrolimus)
+
Prednisolone
+
Mycofenolate Mofetil.
Boy with abscesses has a positive NBT
Myeloperoxidase deficiency NOT chronic granulomarous, as NBT would be negative.
