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Pathology Buzzwords - Pastpapers > Immuno > Flashcards

Immuno Flashcards

1
Q

EBV and amoxicillin/ampicillin/cephalosporin

A

Causes hypersensitivity reaction in presence of EBV - not true allergy

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2
Q

Ibrutinib can be used in which leukemia?

A

CLL

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3
Q

mAb Tx Psoriasis

A

Ustekinumab (anti IL-12/23)

Guselkumab (anti IL-23)

Sekukinumab (anti IL-17A for PA and ankalosing spondylitis)

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4
Q

Tx RA (not DDMARD/MTX)

A

Rituximab (anti CD20), anti-TNFa (etanercept or adalimumab), tocilizumab (anti-IL6)

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5
Q

Wegener’s with severe flare

A

Cyclophosphamide

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6
Q

Worsening Crohn’s, already on Azathioprine and Prednisolone, what tx?

A

Infliximab (Anti-TNFa)

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7
Q

Malignant melanoma medical treatment

A

Pembrolizumab

Explanation: Pembrolizumab is anti PD-1, just like Nivolmab.

Ipilimumab is an anti CTLA-4

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8
Q

Rituximab target and used in

A

anti-CD20

Used in Lymphoma, RA, SLE

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9
Q

Transplant drugs

A

Tacrolimus, Cyclosporin Azathioprine Mycophenolate Mofetil Antithymocyte globulin (ATG Prednisolone Basiliximab (anti-CD25/IL-2) (prophylactic)

typical regime is: CNI + AZA/MMF +/- steroids

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10
Q

Type I hypersensitivity

A

Allergy/Atopic eczema

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11
Q

Type II hypersensitivity

A

Auto-immune/auto-inflammatory e.g. Graves

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12
Q

Type III hypersensitivity

A

Complex mediated e.g. SLE

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13
Q

Type IV hypersensitivity

A

Delayed e.g. contact dermatitis, diabetes

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14
Q

CD40L associated

A

Hyper IgM

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15
Q

GPA’s other name

A

Wegener’s Granulomatosis

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16
Q

eGPA’s other name

A

Churg-Strauss Syndrome

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17
Q

Monitoring SLE (inactive, active, severe disease)

A

Inactive: C3 and C4 normal

Active: C3 normal, C4 low

Sever: C3 and C4 low

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18
Q

Immune condition with chest and renal involvement

A

Good-pasture’s classically but can be GPA/eGPA

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19
Q

Features of hyperacute rejection (transplant)

A

Minutes-hours Pre-formed Abs to HLA activate complement –> Thrombosis and necrosis Prevent by cross-match and HLA typing

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20
Q

Features of acute cellular rejection (transplant)

A

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

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21
Q

Features of acute Ab-mediated rejection (transplant)

A

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

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22
Q

Features of chronic rejection (transplant)

A

Months-years Various immune+non-immune mechs –> fibrosis, GN, ischaemia –> Tx: minimise organ damage RF: multiple acute rejections, HTN, hyperlipidaemia

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23
Q

GvHD

A

Days-weeks (T cell mediated) Rash, bloody D&V, & jaundice Tx: Immunosuppress with steroids

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24
Q

Acute vascular rejection

A

4-6 days post transplant after xenograft - presents similarly to hyperacute

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25
Q

H1 vs H2 antagonisst

A

H1 = antihistamines H2 = reducing gastric acid

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26
Q

Itchy skin when running in cold for an hour

A

Acute urticarial –> H1 antagonist

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27
Q

Hereditary angioedema treatment

A

C1q esterase inhibitor (reduces swelling)

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28
Q

Measure of mast cell degranulation

A

Mast cell tryptase levels

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29
Q

Chemokine promoting eosinophil growth

A

IL-5

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30
Q

Tingly mouth after eating apples, melons etc.

A

OAS (Sxs limited to mouth)

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31
Q

Woman with flushed face, breathing problems (happened multiple times) and hepatomegaly

A

Hereditary angioedema Tx: C1 esterase inhibitor

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32
Q

Kid with rash on extensor surfaces, IgE mediated

A

Atopic dermatitis

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33
Q

Hypertensive and diabetic with angioedema - potential cause?

A

ACE inhibitor

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34
Q

Absent T cells and normal B cells

A

X-linked SCID

… can also be DiGeorge syndrome, but Q usually has more hints

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35
Q

1m baby, serious bacterial infections Normal CD8, no CD4 B cells present IgM present, IgG absent

A

Bare Lymphocyte Syndrome (Type 2) Absent expression of MHC Class II molecules

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36
Q

Jaundiced 4m baby, FTT, recurrent infections raised ALP, low CD4, defect protein regulates MHC class 2

A

Bare Lymphocyte Syndrome (Type 2) Associated with sclerosing cholangitis –> jaundice

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37
Q

Recurrent strep. pneumonia FHx of having it and dying young

A

Complement deficiency (Encapsulated organism)

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38
Q

Child with recurrent infections, improved with age, now delay in language and speech

A

DiGeorge Immune function improves with age Can be associated with lots of speech/language issues and LDs as well as rest of CATCH-22

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39
Q

Loss of the terminal complement pathway

A

Encapsulated organisms

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40
Q

Recurrent meningitis

A

Complement deficiency (C5-9) Encapsulated organism e.g. Hib or N. meningitidis

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41
Q

Recurrent infections, negative NBT test

A

Chronic Granulomatous disease

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42
Q

PID causing atypical granulomas

A

IFNy/IL12 or receptor deficiency Predisposed to mycobacterial infections Inability to form granulomas hence atypical

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43
Q

Recurrent infections negative NBT test negative dihydrorhodamine test

A

Chronic Granulomatous disease

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44
Q

6m boy, sevete FTT & recurrent infections No T cells, B cells normal

A

X linked SCID

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45
Q

Alternative complement pathway components

A

Factor B, I & P “BIP”

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46
Q

Alternative complement pathway components

A

Factor B, I & P “BIP”

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47
Q

Lady with spinal fracture due to TB

A

IFNy/IL12 or receptor deficiency Mycobacteria susceptible –> Pott’s disease

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48
Q

Felty’s syndrome (3 features)

A

RA, neutropenia/leukopenia and splenomegaly

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49
Q

Rheumatoid arthritis and splenomegaly

A

Felty’s

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50
Q

Monocytes in peripheral skin cells

A

Langerhands

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51
Q

Cells that express Foxp3 and CD25

A

Treg

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52
Q

Responsible for killing cancerous cells + inhibited by MHC-I

A

NK cells

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53
Q

PEP exists against (3)

A

Rabies, HIV, tetanus

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54
Q

Routine vaccine that is not given to immunocompromised patients

A

MMR

If oral steroids in past 3 months delay vaccine

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55
Q

Vaccine target HA

A

Influenza

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56
Q

Every 5 years post splenectomy

A

Pneumococcal

57
Q

Adaptive response to HIV: Neutralising antibodies against what?

A

anti-gp120 and anti-gp41

58
Q

Adaptive response to HIV: Non-neutralising antibodies against what?

A

anti-p24 & gag IgG

59
Q

Co-receptor required for HIV entry into CD4

A

CCR5 & CXCR4, both chemokine receptors

60
Q

HIV binding to CD4

  1. Initial binding
  2. Conformational change
  3. Co-receptors
  4. What are they co-receptors on?
A
  1. gp120
  2. gp41
  3. CCR4 & CXCR5
  4. Macrophages
61
Q

Intrastructural support for HIV

A

gag protein

62
Q

Chemokines which block CCR5 (inhibit HIV entry into cell)

A

MIP-1a, MIP-1b, and RANTES

63
Q

HIV enzyme that copies with errors, and another point of lifecycle with room for error

A

reverse transcriptase

and when DNA is used to male RNA copies for new viruses

64
Q

AIRE gene - which condition?

A

AIPS2 (APECED)

65
Q

FAS gene mutation causes which condition?

A

ALPS (autoimmune lymphoproliferative syndrome)

66
Q

MEFV gene, periodic abdominal pain and ascites

A

Familial Mediterranean Fever

67
Q

Nod2/CARD15

A

Crohn’s

68
Q

DR4 and CCP

A

RA

69
Q

HLA-B27

A

Ank spond

70
Q

What should you check before starting azathioprine?

A

TPMT levels (enzyme)

71
Q

Serum sickness = what type of hypersensitivity?

A

Type 3 Hypersensitivity

Reaction 5-10 days after foreign protein injected (e.g. penicillin), leading to Ig production and subsequent immune complex formation.

72
Q

Adult with bronchiectasis, recurrent sinusitis, diarrhoea and development of atypical SLE

A

CVID

73
Q

What does IPEX stand for?

A

Immune dysregulation (autoimmune conditions) Polyendocrinopathy Enteropathy X-linked inheritance syndrome Absolute deficiency of Treg cells (Foxp3 mutation) BMT is only cure

74
Q

PTPN22

A

Tyrosine phosphatase associated with RA, SLE, T1DM

Suppresses T-cell activation

75
Q

Connective tissue disease screening antibody

A

ANA

76
Q

Calcinuerin inhibitors names and MOA

A

Ciclosporin and tacrolimus

Block cytokine expression

77
Q

chronic granulomatous disease treatment type

A

IFN gamma

78
Q

SE of cyclophosphamide

A

infertility (males >> females)

Hair loss

Haemorrhagic cystitis

79
Q

SE of azathioprine

A

neutropenia (especially if TPMT is low)

80
Q

SE of ciclosporin

A

Dysmorphic features (gum hypertrophy)

Hypertension

nephrotoxic

Neurotoxic

81
Q

SE tacrolimus

A

Nephrotoxic

Hypertension

Diabetogenic

Neurotoxic

82
Q

SE of Mycofenolate Mofetil

A

Progressive multifocal leukencephalopathy (caused by JC virus)

83
Q

60yo develops rash while under general anaesthetic, what do you do?

A

Measure mast cell tryptase

84
Q

75yo man with hypertension, tongue and periorbital swelling. Cause of swelling?

A

ACEi

85
Q

Complement deficiency and nephritic factor

A

Membranoproliferative nephritis and bacterial infections

86
Q

C1q deficiency

A

Skin conditions, childhood onset SLE (severe), infections, kidney disease

87
Q

anti-CD25 mAb name and used in

A

Basilixumab

used in prophylaxis of allograft rejection

88
Q

anti IL12/23 mAb name and used in

A

Ustekinumab

Crohn’s and psoriasis

89
Q

anti IL-6 mAb name and used in

A

Tocilizumab

Used in RA and castleman’s disease (lymphoproliferative diseasea)

90
Q

AI hep/PSC antibody

A

Anti smooth muscle Ab

(PSC also has p-ANCA and ANAs)

91
Q

Goodpasteurs connective tissue thing

A

Type IV collagen

92
Q

Mouldy hay

A

Extrinsic allergic alveolitis

93
Q

Oligoclonal bands of IgG on CSF with myelin basic protein

A

MS

94
Q

OKT3

A

A mab for hyperacute rejection (anti-CD-3, T cells)

95
Q

Calcineurin inhibitor

A

Cyclosporin (reduces IL-2)

Tacrolimus

96
Q

Medication that inhibits DNA synthesis in an attempt to prevent proliferation of T cells (post transplant)

A

Azathioprine

97
Q

IVDU who has multiple aneurysms

A

Hep B is associated with PAN

98
Q

SLE pt develops bleeding from gums and nose bleeds, with low platelet count 1. Antibody target 2. name of condition developed

A
  1. Glycoprotein IIb-IIIa 2. Autoimmune thrombocytopenic purpura
99
Q

Drug that prevents cell replication by damaging DNA (B cells more than T cells)

A

Cyclophosphamide Used in SLE, wegeners, leukemias, CTD

100
Q

CTLA4-immunoglobulin fusion protein name and used in

A

Abatacept (rheumatoid arthritis)

Used in RA

101
Q

Mycophenylate Mofetil MoA

A

Guanine synthesis (IMPDH is the enzyme)

102
Q

Kveim test

A

Sarcoidosis

103
Q

Test for HSP

A

Skin biopsy and immunofluoresence stain for IgA and C3

104
Q

Increased CH50

A

acute inflammation e.g. RA

105
Q

Pot strep rheumatoid fever (mechanism)

A

Molecular mimicry

106
Q

1st exposure to allergen IL

A

IL-12

107
Q

Cyclosporin MoA

A

Calcineurin inhibitor

108
Q

Dermatomyositis appearance on immunofluoresence

A

Speckled (Anti-Jo1)

109
Q

Lipiduria

A

Minimal change disease (increase in lipids to try to maintain oncotic pressure)

110
Q

TNF-ß is central in diagnosis of which condition?

A

CREST

111
Q

Antibodies found in diabetes patients

A

Anti glutamic aid dehydrogenase 65 (Anti-GAD65)

Islet antigen (IA-2)

Anti-islet cell antibody

Anti-insulin antibody

112
Q
A
113
Q

Peptidyl arginine deaminase, PAD

A

Mutated in RA

Enzymes involved in deamination of arginine to citrulline

114
Q

Dermatomyositis vs polymyositis type of hypersensitivity reaction

A

Dermatomyositis Type 3 (Immune complex mediated vasculitis)

Polymyositis Type 4 (CD8 cells surround myofibres)

115
Q

Ix for anaphylactic shock

A

Serial mast cell tryptase (at 1,3 and 24 hrs after)

Blood/urine histamine levels

116
Q

Ix for allergy (elective)

A
  • skin prick (≥3mm wheal is positive)
  • Lab quantification of allergen specific IgE (but often positive wihtout symptoms
  • Chellenge test (Gold standard)
117
Q

Dilution IM adrenaline

Dose for adults, 6-12 and <6

A

1: 1000
0. 5, 0.3, 0.15 ml

118
Q

treatment anaphylaxis

A

IM adrenaline

Fluids

IV antihistamines (chlorpheniramine)

IV Hydrocortisone

119
Q

Chronic uritcaria and angioedema plus takes ACEi

A

ACEi angioedema

(ACEi lead to accumulation of bradykinin which causes the symptoms)

120
Q
A
121
Q

most important HLA loci for translplant

A

-A, -B, -DR

122
Q

Name live vaccines

A

MMR

BCG

Typhoid (oral)

Polio (oral)

VZV

Yellow Fever

123
Q

Checkpoint inhibitors

A

ipilimumab (CTLA-4)

nivolumab pembrolizumab (PD-1)

124
Q

JAK inhibitors examples and used in

A

Tofacitinib and baracitinib

Used in RA

125
Q

Apremilast used in and MOA

A

Psoriasis ans psoriatic arthritis

PDE4 inhibitor

126
Q

anti-IL-17 mAb name and used in

A

Secukinumab

used in psoriasis

127
Q

denosumab target (full for VSA)

used in

A

receptor activator of NFkB ligand

Osteoporosis

128
Q

MOA azathioprine

A

prevents de novo purine synthesis to prevent T>B cell activation/proliferation

129
Q

MOA Mycophenylate

A

Blocks de novo guanosine nucleotide synthesis

T>B cells

130
Q

MOA Cyclophosphamide

A

Alkylating agent
Alkylates guanine base of DNA
Damages DNA and prevents cell replication

Affects B cells > T cells

131
Q

drugs that prevent integration of HIV genetic information into host DNA

A

Integrase inhibitors

e.g dolutegravir

132
Q

ARVs that blocks reverse transcriptase

A

(non-)nucleoside reverse transcriptase inhibitors

e.g. zidovudine, abacavir

133
Q

ARV that prevents assembly and release of virus

A

Protease inhibitors

134
Q

ARV that block binding of virus to cell

A

Attachment inhibitors

e.g. maraviroc

135
Q

MOA sirulimus

A

mTOR inhibitor

136
Q

What natural antibody against, which confers protective immunity against HIV?

A

Gp120

137
Q

What are the base-line treatment for immunosuppression?

A

Calcineurin inhibitor (cyclosporine/tacrolimus)

+

Prednisolone

+

Mycofenolate Mofetil.

138
Q

Boy with abscesses has a positive NBT

A

Myeloperoxidase deficiency NOT chronic granulomarous, as NBT would be negative.

Pathology Buzzwords - Pastpapers (7 decks)

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