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all STEP 1 > Immuno facts > Flashcards

Immuno facts Flashcards

1
Q

Type I interferons - induction and effects.

A
  • dsRNA induces expression of IFN-alpha and beta.
  • IFN-alpha and beta act through JAK/STAT to induce PKR and RNaseL.
    • Used to treat hep B, hep C, condyloma accuminata, and hairy cell leukemia
  • RNaseL degrades all RNA within the cell.
  • PKR phosphorylates ELF2, which prevents transcription initiation.
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2
Q

Type II interferons - induction and effects.

A
  • IFN-gamma is secreted by T-cells, NK-cells, and macrophages in response to antigens and mitogens.
  • Promotes TH1 differentiation.
  • Promotes MHC class II expression. Activates macrophages.
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3
Q

Lupus antibodies?

Lupus criteria?

A

Antibodies:

  • ANA (sensitive but not specific)
  • anti-dsDNA and anti-Smith (specific)
  • anti-histone (drug-induced): HIP: INH, procainamide, hydralazine

Criteria: SOAP BRAIN MD. Need 4.

  • Serositis
  • Oral ulcers
  • Arthritis
  • Photosensitivity
  • Blood changes (penias)
  • Renal - wire loop lesions, nephrotic syndrome
  • ANA
  • Immunologic changes
  • Neurologic changes (seizures, psychosis)
  • Malar rash
  • Discoid rash
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4
Q

Scleroderma antibodies?

CREST?

A

Systemic sclerosis: anti-scl-70 - anti-DNA topoisomerase I

CREST: anti-centromere

  • Calcinosis
  • Raynaud phenomenon
  • Esophageal dysmotility
  • Sclerodactyly
  • Telangiectasias
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5
Q

Capsule vaccines? What must they have to generate IgG?

A

Pneumococcus, HiB, N. Meningitidis

Must be conjugated to a protein; T-cells cannot recognize polysaccharide-only antigens

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6
Q

Live attenuated vaccines?

A

Induces mainly Th1 cell-mediated response.

  • Measles, mumps, rubella
  • Varicella
  • Polio (sabin - not used)
  • Yellow fever
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7
Q

Inactivated or killed vaccines?

A

Induces mainly Th2 IgG antibody response.

  • Cholera
  • Hepatitis A
  • Polio (Salk - currently used)
  • Rabies
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8
Q

Toxoid vaccines

A
  • Diphtheria
  • Tetanus
  • Botulinum
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9
Q

Allergic reactions: Immediate hypersensitivity vs Antibody-dependent cell-mediated cytotoxicity

A
  • Immediate hypersensitivity
    • Atopic type I hypersensitivity reaction
    • IgE binds allergen
    • IgE crosslinks receptors on mast cells and basophils, which release histamine, bradykinin, heparin, elastase & arylsulfatase, leukotrienes
  • Antibody-dependent cell-mediated cytotoxicity
    • Parasite binds IgE
    • IgE crosslinks receptors on eosinophils, which release major basic protein and histaminase
    • Or, tumor cell binds IgG (eg rituximab, trastuzumab, alemtuzumab, etc)
    • crosslinks CD16 Fc-receptors on NK cells, resulting in IFN-gamma release and cell kill.
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10
Q

Histologic correlates of

  • Hyperacute rejection
  • Acute rejection
  • Chronic rejection
A
  • Hyperacute: vascular fibrinoid necrosis, neutrophil infiltration. Secondary to complement activation from preformed antibody reaction against HLA.
  • Acute: dense interstitial lymphocytic infiltrate. Cytotoxic T-cell damage, CD4+ and CD8+ present.
  • Chronic: fibrosis and vascular obliteration. Caused by antibody-mediated intimal injury and smooth muscle proliferation.
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11
Q

Describe the mechanism and receptors for neutrophil

margination, rolling, adhesion & crawling, transmigration

A
  • Margination
    • hemoconcentration and decreased shear stress, vascular leakage
  • Rolling
    • Neutrophil: Sialyl-Lewis X, PSGL1, L-selectin
    • Endothelium: E-selectin and P-selectin (weibel-palade). Induced by cytokines.
  • Activation
    • Increased chemokine concentration leads neutrophils to express Mac-1 and LFA-1 (CD18 beta 2)
  • Tight adhesion and crawling
    • Neutrophil: Mac-1 and LFA-1; VLA-4
    • Endothelium: ICAM; VCAM
  • Transmigration: PECAM
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12
Q

Infection with PCP or Candida is a sign of what kind of immunodeficiency?

Encapsulated organisms? E.g. recurrent ear infx from H. influenzae, S. pneumoniae, Moraxella

A

Cell-mediated (T-cell defect).

Humoral immunodeficiency (B-cell defect).

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13
Q

What does the Candida skin test measure?

A

Cell-mediated immunity:

Macrophages, CD4+ T-cells, CD8+ T-cells, NK cells

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14
Q

Type II hypersensitivity. How mediated? How tested? Difficult Examples?

A

Type II: soluble antibodies against tissue.

Damage is mediated by complement activation (classical pathway: C1->C4,2->C3 convertase)

Test via indirect or direct (for HA) coombs.

  • Rheumatic fever (vs PSGN)
  • Goodpasture’s (!)
  • Bullous pemphigoid, pemphigus vulgaris
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15
Q

Macrophage surface marker?

A

CD14

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16
Q

Type IV hypersensitivity (5)

A

T-cell mediated. Delayed. Mechanism of acute rejection.

MS

GBS

GVHD

PPD

contact dermatitis (eg urushiol, nickel)

17
Q

Macrophage cell surface proteins involved in signaling

A
  • CD14 - mediates LPS and LTA uptake
  • CD40 - receptor for secondary activation signal (CD40L from TH1); B-cells have this also.
  • B7 - costim for T-cells (receptor is CD28)
  • MHC II (and MHC I)
18
Q

Compare and contrast MHC I and MHC II loading

What are the HLA associated-diseases?

A
  • Components
    • MHC I: alpha chains, beta-2 microglobulin. Held together by peptide-loading complex (TAP, tapasin, et al)
    • MHC II: alpha and beta chains. Held together by invariant chain / CLIP.
  • Loading
    • MHC I: loaded in ER
    • MHC II: loaded in acidified endosome.
  • Where expressed
    • MHC I: all nucleated cells (not on RBCs)
    • MHC II: professional APCs.
  • HLA-associated diseases:
    • HLA-A3: hemochromatosis
    • HLA-B27: Ulcerative colitis-associated: Psoriasis, Ankylosing spondylitis, IBD, Reiter’s
    • HLA-DR2: MS, hay fever, SLE, Goodpasture’s
    • HLA-DR3: DMI, Graves’
    • HLA-DR4: RA, DMI
    • HLA-DR5: Pernicious anemia, Hashimoto’s
19
Q

Unique marker for NK cells?

A

CD56. Also have CD16 which is an Fc receptor.

20
Q

Complement deficiencies:

C1 esterase?

C3?

C5-9?

A
  • C1-esterase: hereditary angioedema
  • C3 deficiency: recurrent bacterial infections
  • C5-9 deficiency: recurrent Neisseria
21
Q

B-cell deficiency: which parasite and bacterial infections?

A

Parasite: Giardia (no IgA)

Bacteria: encapsulated

22
Q

Agranulocytosis: which organisms are you vulnerable to?

A

Staph, Burkholderia, Serratia, Nocardia

Candida, Aspergillus

23
Q

How does common variable immunodeficiency present?

A

Isolated decrease in plasma cells and immunoglobulin. Normal # of B cells.

24
Q

Type III hypersensitivity reactions. Presentation vs type II? How tested for? Examples?

A

Immune complexes with antigen deposit in tissue. Systemic and vasculitic sx vs Type II localized dmg.

Test via immunofluorescence to look for complexes.

  • SLE
  • Polyarteritis Nodosa
  • PSGN
  • Serum sickness - abx derived from animals
  • Arthus reaction (follows tetanus vaccine)

all STEP 1 (34 decks)

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