Immunology Flashcards
1
Q
What is produced in bone marrow?
A
immune cell production
B cell maturation
2
Q
What is produced in thymus?
A
T cell maturation
3
Q
Lymph node anatomy
A
capsule: subcapsular sinuses, trabeculae of connective tissue, trabecular sinuses
outer cortex: nodules, follicles of b cells, germinal center where B cells differentiate
inner cortex (paracortex): no nodules, T cells, high endothelial venules, eosinophilic
Medulla: cords of lymphoid tissue and medullary sinuses
encapsulated, bean shaped structures, dendritic cells, plasma cells
4
Q
Deep cervical lymph nodes
A
Drain: head, neck, oropharynx
path: Kawasaki dz
5
Q
Supraclavicular lymph nodes
A
R: L Virchow node
L: abdomen, pelvis
path: cancer of thorax, abdomen, pelvis
6
Q
Epitrochlear lymph node
A
Drain: hand, forearm
path: secondary syphilis
7
Q
Spleen anatomy
A
LUQ of abdomen, anterolateral to L kidney
Periarteriolar lymphatic sheath: T cells
Follicle: B cells
Marginal zone: macrophages, specialized b cells, antigen-presenting cells
White pulp: antibody coated bacteria are filtered our and antibodies are made by B cells, filters blood
Red pulp: old RBC destroyed
8
Q
Thymus anatomy, embryo, location, function
A
anterosuperior mediastinum
Thymus: endoderm
Thymic lymphocytes: mesoderm
cortex: immature T cells
Medulla: mature T cells
Hassall corpuscles: containing epithelial reticular cells
F: t cell differentiation and maturation
9
Q
Innate immunity
A
Neutrophils, macrophages, monocytes, dendritic cells, NK cells, complement, physical epithelial barriers
Germline encoded, nonspecific, rapid, no memory
Protein secretion: lysozyme, complement, C-reactive protein, defensisns, cytokines
Pathogen recognition: toll-like receptors, pattern recognition receptors
10
Q
Adaptive immunity (Protein secretion, Pathogen recognition, cells included, and what is it)
A
T, B cells, and circulating antibodies
variation through V(D)J recombination during lymphocyte development, high specific, memory, longer response
Protein secretion: immunoglobulin, cytokines
Pathogen recognition: memory cells
11
Q
MHC 1
A
Loci: HLA-A, HLA-B, HLA-C
binding TCR and CD8
1 long and 1 short
F: Present endogenous antigens (viral or cytosolic proteins) to CD8+ cytotoxic T cells
Expression: All nucleated cells, APCs, platelets (except RBCs)
Antigen loading: Antigen peptides loaded onto MHC I in RER after delivery via TAP (transporter associated with antigen processing)
Associated proteins: B2-microglobulin
Path: B27 PAIR psoriatic arthritis, ankylosing spondylitis, IBD-arthritis, reactive arthritis
12
Q
MHC II
A
Loci: HLA-DP, HLA-DQ, HLA-DR
TCR and CD4
2 equal length chains
Expression: APCs\Function: Present exogenous antigens (bacterial proteins) to CD4 helper T cells
Antigen loading: Antigen loaded following release of invariant chain in acidified endosome
path: DQ2/8 (celiac), DR3 (DM I, SLE, graves, Hashimoto, Addison disease), DR4 (RA, DM I, Addison disease)
13
Q
Natural Killer (NK) cells
A
innate immune system
A: perforin and granzymes to induce apoptosis of virally infx and tumor cells and antibody-dependent cell-mediated cytotoxicity
Stim: induced to kill when exposed to nonspecific activation signal on target cell, or absence of inhibitory signal on target cell surface or CD16 binds Fc region of bound IgG
Inc activity: IL-2, IL-12, IFN-a, IFN-B
14
Q
B cell
A
Action: recognize and present antigen, produce antibodies, and maintain immunologic memory
15
Q
T cells
A
CD4: help B cells make Ab and produce cytokines to recruit phagocytes and activate other leukocytes
CD8: directly kill virus-infx and tumor cells
MCH II x CD4 = 8
MCH I x CD8= 8
16
Q
Type 1 hypersensitivity
A
Immediate: Antigen crosslinks IgE on pre-sensitized mast cells -> degranulation -> histamine (runny everything), tryptase, and leukotriene release (anaphylactic)
Late: chemokines attract inflammatory cells -> inflammation and tissue damage
17
Q
Type II hypersentivity mechanism and example
A
Antibody binds to cell-surface of antigen -> opsonize -> activate phagocytosis, complement, NK cell killing-> abnormal blockage or activation of downstream effects, destruction
path: autoimmune hemolytic anemia, immune thrombocytopenia, transfusion rxn, hemolytic dz of the newborn, Goodpasture syndrome, Rheumatic fever, transplant rejection, myasthenia gravis, graves dz, pemphigus vulgaris
18
Q
Type III hypersentivity mechanism and example
A
Antigen-Antibody-Complement (IgG) creates complex -> deposits somewhere-> attracts neutrophils and release lysosomal enzymes -> causing localized damage where it has deposited
path: SLE, RA, reactive arthritis, polyarteritis nodosa, poststreptococcal glomerulonephritis, IgA vasculitis, vaccine booster
19
Q
Type IV hypersentivity
A
direct cell cytotoxicity via CD8 T cells kill targeted cells
effector CD4 T cells recognize Ag and release inflammation-inducing cytokines -> macrophage
Path: contact dermatitis, graft vs host dz
20
Q
Helper T Cell Th1
A
Reg
(+) IFN-y, IL-12
(-) IL-4, IL-10
Release: IFN-y, IL-2
Action: activate macrophages, cytotoxic T cells, infection
21
Q
Helper T Cell Th2
A
Reg: (+) IL-2, IL-4 (-) IFN-y
Release: IL-4, 5, 6, 10, 13
Action: activate eosinophils, IgE, Parasitic, allergic
22
Q
Helper T Cell Th17
A
Reg: (+) TGF-B, IL-1, IL-6 (-) IFN-y, IL-4
Release: IL-17, 21, 22
Action: induce neutrophil inflammation
23
Q
Helper T Cell Treg
A
Reg: (+) TGF-B, IL-2 (-) IL-6
Release: TGF-B, IL-10, 35
ACtion: prevent autoimmunity
24
Q
Antigen structure and function
A
Fab: determines type of ag that binds
Fc: antibody class switching
25
Cytotoxic T cells
kill virus-infected, neoplastic, and graft cells via apoptosis, release cytotoxic granules containing preformed proteins
26
T cell activation
Antigen presenting cell ingests and processes Ag -> migrates to draining lymph node -> exogenous ag presents on MHC II and recognized by T-cell receptor on CD4 cell-> co-stimulatory signal via interaction of protein on dendritic cell and naïve T cell -> activated Th cell produces cytokines
27
IgG
most abundant in serum
fixes complement, opsonizes bacteria, neutralizes bacterial toxins and viruses
crosses placenta
28
IgA
mucous membrane, breast milk, crosses epithelial cells
does not fix complement
produced in peyer patches
most produced but not in serum
29
IgE
binds mast cells and basophils
Type I hypersentivity
contribute to immunity to parasites by activating eosinophils
30
IgM
primary response to an ag
fixes complement
multiple binding site
31
Complement
Activation: IgG or IgM, microbe surface molecules, lectin
Opsonin's: C3b
Anaphylaxis: C3a, C4a, C5a
Neutrophil chemotaxis: C5a
MAC: C5b-9 neutralizing Neisseria species
32
Respiratory Burst
ROS to kill bacteria and foreign invaders -> activates catalase/glutathione peroxidase - glutathione reductase -> glucose-6-phosphatse dehydrogenase
catalase (+) organism can neutralize H2O2
33
Live attenuated Vaccine
can revert to virulent form, retain capacity of transient growth w/in host
induce cellular and humoral response, strong, lifelong
ex: MMR, typhoid
34
Killed/Inactivated
Antibody to surface antigen
pathogen is inactivated by heat or chemicals
Ex: Influenza
35
Subunit, recombinant, polysaccharide, conjugate
target specific epitopes of antigen
less adverse reactions
weaker immune response and costly
36
Toxoid vaccine
denatured bacterial toxin w/ intact receptor binding site
stimulates immune Ab response w/ ability to cause disease
protects against bacterial toxins
antitoxin levels decrease over time, needs booster shots
ex: clostridium tetani
37
mRNA vaccine
lipid nanoparticle delivers mRNA
induce cellular and humoral response, side effects (myocarditis, pericarditis)
safe in pregnancy
EX: covid
38
X-linked agammaglobulinemia def
Defect in BTK, a tyrosine kinase gene
| No B-cell maturation
39
X-linked agammaglobulinemia cause
genetics
40
X-linked agammaglobulinemia path
mutation in Burton's Tyrosine Kinase gene on x chromosome -> ineffective BTK enzyme-> B-lymphocyte precursors fail to mature into B lymphocytes, plasma cells -> differentiation stops at pre-B cell stage -> absence of B-cells in circulation -> deficiencies of all Ig -> higher risk of developing infections
41
X-linked agammaglobulinemia RF
Males, 6-18 mon, FH,
42
X-linked agammaglobulinemia comp
live vaccines autoimmune diseases, skin infections, lymphoma
43
X-linked agammaglobulinemia clinical
Recurrent bacterial and enteroviral infections after 6 months (decreased maternal IgG)
Absent B cells in peripheral blood
Decreased IgG
Absent/scanty lymph nodes and tonsils
44
Selective IgA deficiency def
isolated deficiency of IgA
45
Selective IgA deficiency cause
idiopathic
46
Selective IgA deficiency path
IgA deficiency
47
Selective IgA deficiency RF
FH
48
Selective IgA deficiency comp
Higher risk for giardiasis
| Can cause false-positive B-hCG test
49
Selective IgA deficiency clinical
asymptomatic
50
Common Variable Immunodeficiency def
defect in B-cell differentiation
51
Common Variable Immunodeficiency cause
idiopathic, mutations BAFF or ICOS
52
Common Variable Immunodeficiency path
Decreased plasma cells and immunoglobulins
53
Common Variable Immunodeficiency RF
FH
54
Common Variable Immunodeficiency comp
Increased risk for AI disease, bronchiectasis, lymphoma, sinopulmonary infections, granulomatous infiltration
55
Common Variable Immunodeficiency clinical
recurrent infections
56
Chronic Mucocutaneous Candidiasis def
T-cell dysfunction
57
Chronic Mucocutaneous Candidiasis clinical
persistent and noninvasive Candida labicans infx of skin and mucous membrane
58
Severe Combined Immunodeficiency def
combined defects in T, B lymphocyte development, function
59
Severe Combined Immunodeficiency cause
SCID, cytokine receptor defects, adenosine deaminase deficiency, mutation y-chain subunit of IL receptors, RAG mutation
60
Severe Combined Immunodeficiency path
X-linked recessive
| combined defects in T,B lymphocytes development or function
61
Severe Combined Immunodeficiency RF
male
62
Severe Combined Immunodeficiency clinical
recurrent infx, oral candidiasis (thrush), chronic diarrhea, failure the thrive, morbilliform rash
63
Spleen function
Filtration
Iron metabolism
Prevention of infection
Red blood cell and platelet storage
64
Bone marrow function
Immune cell production (origin of stem cells)
Production of cytokines in BM serves as necessary signals to B cells to differentiate by up-regulating B cell markers
B cell maturation
65
Bone marrow Microscopic Anatomy
red: hematopoietic island widely distributed throughout loose connective tissue network, large thin walled sinusoids, granulocytes, monocytes, megakaryocytes, lymphocytes,
yellow: connective tissue, adipocytes, dormant hematopoietic clusters,
reticulin: type III collagen, macrophages,
66
Bone marrow embryo
mesodermal cells in yolk sac
67
Tonsils Microscopic Anatomy
stratified squamous epithelium
antigen presenting cells
lymphoid follicles surrounded by connective tissue w/ tonsillar crypts
center contains lymphocytes
68
Tonsils Function
Filtration of macrophages, circulation of B and T cells, immune response activation
Waldeyer ring consists of lingual, palatine, pharyngeal, and tubal tonsils
69
Palatine tonsil
between the palatoglossal arch anteriorly and the palatopharyngeal arch posteriorly
stratified squamous epithelium w/ 15-20 crypts
lymphocytes, bacteria and desquamated epithelial cells
70
Lingual tonsil
small round elevations that sit on the most posterior part of the tongue base
stratified squamous epithelium one crypt
71
Tubal tonsils
posterior to the opening of the Eustachian tube (the torus tubaris) in the nasopharynx.
72
Pharyngeal tonsil
nasopharynx
attached to periosteum of sphenoid bone
ciliated pseudostratified columnar epithelium, goblet cells
73
Lymph node function
Place where T and B cells hang out
ECF excess with antigens percolates through LNs and memory T and B cells can activate against any antigen previously seem
74
Mediastinal Lymph node
trachea, esophagus
path: lung CA, TB, sarcoidosis, granulomatous dz
75
Submandibular, submental LN
D: oral cavity, ant. tongue, lower lip
P: oral cavity cancer
76
Hilar LN
D: lungs
P: lung CA, TB, sarcoidosis, granulomatous dz
77
Axillary LN
D: upper limb, breast, skin above umbilics
P: mastitis, breast ca
78
Periumbilical LN
D: abdomen, pelvis
P: gastric ca
79
Celiac LN
D: liver, stomach, spleen, pancreas, upper duodenum
p: mesenteric lymphadenitis, IBD, celiac dz
80
Superior mesenteric LN
lower duodenum, jejunum, ileum, colon (splenic flexure)
| p: mesenteric lymphadenitis, IBD, celiac dz
81
Inferior mesenteric LN
colon (splenic flexure to upper rectum)
mesenteric lymphadenitis, IBD, celiac dz
82
Para-aortic LN
testes, ovaries, kidneys, fallopian tubes, uterus
metastasis
83
External iliac LN
cervix, vagina (upper third), superior bladder, body of uterus
STI, medial foot/leg cellulitis
84
Internal iliac LN
lower rectum to anal canal, bladder, middle 1/3 vagina, cervix, prostate
STI, medial foot/leg cellulitis
85
Superficial inguinal LN
anal canal, skin below umbilicus, scrotum, vulva, vagina lower 1/3
STI, medial foot/leg cellulitis
86
Popliteal LN
dorsolateral foot, posterior calf
lateral foot/leg cellulitis
87
Interferon-gamma
Th1, secreted by NK cells and T cells in response to Ag or Il-12 from macrophages, stimulates macrophages to kill phagocytosed pathogens, inhibits differentiation of Th2, induces IgG class switch
88
IL-4
induces differentiation of T cells into Th2 cells, promotes growth of B cells, enhances class switching to IgE and IgG
89
IL-5
promotes growth and differentiation of b cells, enhances class switching to IgA, stimulates growth and differentiation of eosinophils, Th2
90
IL-10
TGF-B and IL-10 both attenuate the immune response, decreases expression of MHC class II and Th1 cytokines, inhabits activated macrophages and dendritic cells, secreted by reg T cells, Th2
91
IL-13
promotes IgE production by B cells, induces alternative macrophage activation, Th2
92
INF y
secreted by NK cells and T cells in response to antigen or IL-12 from macrophages, stimulates macrophages to kill pathogens; inhibit differentiation of Th2 cells, induces IgG
93
HLA A3
Hemochromatosis
94
HLA B8
Addison disease, Myasthenia gravis, Graves
Don’t Be late(8), Dr. Addison, or else you’ll send my patient to the grave
95
HLA B27
Psoriatic arthritis, Ankylosing spondylitis, IBD-associated arthritis, Reactive arthritis
PAIR
96
HLA C
Psoriasis
97
DQ2/DQ8
```
Celiac disease
I ate(8) (2) much gluten at Dairy Queen
```
98
DR2
Multiple sclerosis, hay fever, SLE, Goodpasture syndrome
99
DR3
Rheumatoid arthritis, DM1, Addison disease
100
DR5
Hashimoto thyroiditis
Hashimoto is an odd Dr (DR3, DR5)
101
IL-1
acute inflammation, (Macrophages and Monocytes) Fever, T-cell prolif
102
IL-2
(CD4 cells) Stimulates T cells, NK cells, CD4 and CD8
103
IL-3
Stimulates bone marrow
104
IL-6
Stimulates acute phase protein production and fever
105
IL-11
(Fibroblast) Megakaryocyte potentiator, stimulates IgG
106
TNF-alpha
activates endothelium, WCB recruitment, vascular leak
107
IL-8
chemotactic factor for neutrophils
108
IL-12
differentiation of T cell into Th1 cells, activate NK cells
109
INF-a
leukocytes) Inhibits tumor proliferation, enhances NK growth
110
INF-B
(fibroblasts)
111
Response to foreign body
albumin and fibrinogen attach to surface -> over time small proteins get replaced w/ larger proteins -> neutrophils migrate to area and adhere to protein layer -> release ROS and proteolytic enzymes -> increase vascular permeability -> monocytes turn into macrophages -> proliferation and recruitment and replace neutrophils -> release TNF alpha, IL-1b, IL-6, and IL-8 -> macrophage cover exposed surface of implant via integrins -> macrophage undergo cytoskeletal remodeling they flatten over the surface of the implant in an attempt to engulf and phagocytose it -> continue to recruit macrophages -> release degrading enzymes and ROS to break down implant -> break it down -> stops -> if don't break down -> encapsulation of implant w/ fibrous tissue
112
Structure of Complement
plasma proteins
| C1: C1s, C1r, 6C1q bind to Fc portion of antibody, require Ca
113
Function of Complement
destroy gram negative bacteria
C3b - Opsonization, allow for phagocytosis (C3b binds to lipopolysaccharides on bacteria)
C3a, C4a, C5a - Anaphylaxis, mast cells and basophils
C5a and C3a - Neutrophil, eosinophils, monocytes, and macrophage chemotaxis
C5b-9 (MAC) - Cytolysis, kills infected cells or pathogen
114
Pathway of Classic Complement
2 or more C1q bind to antibodies bound to antigen -> C1 twists exposes C1r and C1s allowing C1r to cleave C1s -> C1 cleaves C4 into C4b and C4a -> C4b binds to surface of pathogen -> C1 cleaves C2 into C2a and C2b -> C2b bind to C4b on pathogen -> C3 convertase cleaves tons of C3 into C3b and C3a -> C3b binds to C3 convertase turning it into a C5 convertase (C4b2b3b) -> cleaves C5 into C5a and C5b-> C5b binds to C6, C7, C8 bind to cell membrane and penetrate through it -> multiple C9 join and create a channel straight through pathogen membrane
115
Lectin binding pathway
mannose binding lectin protein binds to mannose on cell surface -> cleaves C4 and C2 -> C3 convertase -> C3 convertase cleaves tons of C3 into C3b and C3a -> C3b binds to C3 convertase turning it into a C5 convertase (C4b2b3b) -> cleaves C5 into C5a and C5b-> C5b binds to C6, C7, C8 bind to cell membrane and penetrate through it -> multiple C9 join and create a channel straight through pathogen membrane
116
Alternative Complement Pathway
at slow rate of cleavage of C3 into C3b and C3a-> C3b binds to cell membrane -> factor B will bind to C3b and that will allow factor B to be cleaved by factor D into Bb and Ba -> Bb will stay bound to C3b -> acts as a C3 convertase -> C3b binds to C3 convertase turning it into a C5 convertase (C4b2b3b) -> cleaves C5 into C5a and C5b-> C5b binds to C6, C7, C8 bind to cell membrane and penetrate through it -> multiple C9 join and create a channel straight through pathogen membrane
C1 inhibitor and factor I stops this
117
Control of thymus
insulin, insulin-like growth factor
118
Control of bone marrow
Stim: loss of blood, lack of iron, exercise, infection
Inhibit: immunosuppression
119
Mucous Membranes/
| MALT Anatomy
Enteroendocrine cells, local gut immunity
Peyer’s patch - Encapsulated lymphoid tissue in ileal submucosa, where they can detect large antigens that accidentally diffused across intestinal epithelium
120
Lymphatic fluid composition
albumin, oxygen, glucose, animo acids, hormones, lipids, dendritic cells and fluid
121
Lymphatic fluid function
return fluid to heart, helps large molecules like hormones and lipids enter blood, and immune surveillance
122
Lymphatic fluid transport
fluid enters capillaries -> vessels -> trunks (lumbar, Bronchomediastinal, subclavian, jugular, intestinal) -> ducts (right lymphatic or thoracic) -> veins (jugular and subclavian)
smooth muscle reacts to arterial pulse and skeletal muscle squeezing keep lymph moving
collect interstitial fluid and return it to heart
123
Synthesis of Lymphatic Fluid
when pressure in the interstitial space is higher than the lymphatic capillary mini valves open up allowing lymph to enter
124
Degradation of Lymphatic Fluids
lymph nodes remove foreign materials, enters back into heart via subclavian vein
125
Activation of Innate immune response
macrophage recognizes pathogen by bind its pattern recognition receptor on a pathogen with a certain pathogen associated molecular patterns
NK cells
126
Activation of Adaptive immune response
antigen presenting cells engulf antigen and present on MCH
127
What are the antibodies associated w/ Myasthenia Gravis?
anti-postsynaptic ACh receptor
128
What are the antibodies associated w/ SLE
Antinuclear, anticardiolipin, lupus anticoagulant, Anti-dsDNA, anti-smith, anti-histone
129
What are the antibodies associated w/ Sjogern syndrome?
anti-Ro/SSA, anti-La/SSB
130
What are the antibodies associated w/ RA?
Rheumatoid factor, Anti-cyclic citrullinated peptide
131
What are the antibodies associated w/ scleroderma?
anti-Scl-70 (anti-DNA topoisomerase I
132
What are the antibodies associated w/ limited scleroderm (CREST syndrome)?
anticentromere
133
What are the antibodies associated w/ polymyositis?
anti-synthetase, anti-SRP, anti-helicase
134
What are the antibodies associated w/ autoimmune hepatitis?
anti-smooth muscle, anti-liver/kidney microsomal-1
135
What are the antibodies associated w/ Goodpasture syndrome?
Anti-glomerular basement membrane
136
DiGeorge Syndrome cause
Microdeletion of chromo 22q11.2, TBx1
137
DiGeorge Syndrome path
mutation in TBx1 -> pouch 3 and 4 of pharyngeal pouches -> lack of thymus and parathyroid gland -> deficiency in mature T cells and hypocalcemia
138
DiGeorge Syndrome RF
FH
139
DiGeorge Syndrome comp
Heart murmur
| Frequent infections
140
DiGeorge Syndrome clinical
truncus arteriosus, tetralogy of Fallot, poor immune system function, cleft palate, long face, small teeth, broad nose, low Ca2+, delayed development with behavioral and emotional problems
141
Drug-Induced Immunodeficiencies def
impaired immune system function due to medications used in the treatment of systemic diseases
142
Drug-Induced Immunodeficiencies cause
Methyldopa, minocycline, hydralazine, isoniazid, phenytoin, sulfa drugs, etanercept, procainamide, Azathioprine, Ciclosporin, Mycophenolate mofetil, Cyclophosphamide, prednisone, omalizumab, dupilumab, secukinumab, ixekizumab, brodalumab,
143
Drug-Induced Immunodeficiencies path
drugs that suppress immune system -> infections
144
Drug-Induced Immunodeficiencies comp
life-threatening infections
145
Drug-Induced Immunodeficiencies clinical
Manifests as recurrent, severe, opportunistic infections
146
Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome def
virus that targets cells in the immune system
147
Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome cause
HIV 1 or HIV 2 (rare)
| sexual intercourse, M to M, IV drug, mother to child
148
Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome path
HIV targets CD4+ cells (macrophage, dendritic cells, T helper cells) attaches via gp120 -> another gp120 attaches to CXCR4/CCR5 receptors on cell -> virus enters the cell -> injects single stranded RNA into cell -> reverse transcriptase transcribe into a double stranded proviral DNA -> enter nucleus and attaches to DNA -> anytime immune proteins are made so is viral proteins -> during this process they will mutate and created different strains and can infect other immune cells-> leading to high levels of HIV in blood -> immune system counterattacks and controls replication (12 weeks) -> viral replication slowly increases while T cells decrease (chronic 2-10 y)
149
Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome RF
unprotected sex, multiple partners, sharing needles, unsafe injection, unsterile cutting or piercing, needle stick injuries, having sex with someone w/ STI
150
Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome comp
x4 strain destruction to T cells
151
Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome clinical
swollen lymph nodes, hairy leukoplakia (white patch on tongue), oral candidiasis
AIDS: <200 T cells, persistent fever, fatigue, weight loss, diarrhea, recurrent bacterial pneumonia, pneumocystis pneumonia, candidiasis of esophagus, Kaposi sarcoma, primary lymphoma
152
Anaphylaxis def
severe allergic reaction
153
Anaphylaxis cause
peanut, shellfish, antibiotics, insect bites, blood products (IgG)
154
Anaphylaxis path
first exposure -> antigen presenting cell pick up antigen -> presents to T cell -> activates produce cytokines -> B cell switch to IgE antibodies -> mast cells and basophils -> second exposure -> mast cells and basophils release proinflammatory molecules -> leak into blood system due to histamine, tryptase -> bronchoconstriction, blood vessel dilation, break down proteins ->
155
Anaphylaxis RF
atopy, asthma
156
Anaphylaxis comp
hypotension, MI, anaphylactic shock, LOC
157
Anaphylaxis clinical
angioedema, SOB, coughing, wheezing, abdominal cramps, vomiting, diarrhea
158
Autoimmune Hemolytic Anemia def
increased RBC breakdown due antibodies to RBC
159
Autoimmune Hemolytic Anemia cause
Warm: idiopathic, penicillin, cephalosporins, children (viral, SLE, lymphomas, leukemia)
Cold: leukemia, lymphoma, viral pneumonia, mycoplasma, infectious mononucleosis
160
Autoimmune Hemolytic Anemia path
warm >37 IgG on Rh antigen in spleen-> macrophage, neutrophils, NK cells, and T cells bind to Fc portion of antibody -> superoxide granules or phagocytosis cause conformational change induced hemolysis of RBC
cold 0-10 IgM on L, I, P antigen in liver via complement system
161
Autoimmune Hemolytic Anemia RF
immune deficiencies, malignancies, certain drugs, measles, varicella, mycoplasma, H. influenza, lymphoproliferative disorders, autoimmune disorders, exposure to cold
162
Autoimmune Hemolytic Anemia comp
gallstones, kidney damage, multiorgan failure
163
Autoimmune Hemolytic Anemia clinical
hematuria, jaundice, hemoglobinuria, bounding heart rate, SOB, fatigue, pallor, hepatosplenomegaly
164
Goodpasture Syndrome def
autoimmune disease that affects lungs and kidneys
165
Goodpasture Syndrome cause
autoimmune
166
Goodpasture Syndrome path
autoantibodies IgG to alpha 3 chain of type 4 collagen bind -> activate complement system -> ROS are released in area, MAC is formed -> damage to BM
167
Goodpasture Syndrome RF
HLA-DR15, infection, smoking, oxidative stress, hydrocarbon-based solvents
168
Goodpasture Syndrome comp
chronic kidney disease
169
Goodpasture Syndrome clinical
cough, hemoptysis, restrictive lung disease
| hematuria, proteinuria, edema, HTN
170
Myasthenia Gravis def
muscle weakness due to antibodies
171
Myasthenia Gravis cause
autoimmune disease, bronchogenic carcinoma, thymic neoplasm
172
Myasthenia Gravis path
antibodies that bind to nicotinic acetylcholine receptors on muscle cell membrane-> don't respond to contract signal and activate classical complement pathway -> inflammation, muscle cell destruction
muscle specific receptor tyrosine kinase antibodies -> target proteins in muscle cell
173
Myasthenia Gravis RF
women 20-30
| male 60-70
174
Myasthenia Gravis comp
myasthenic crisis (breathing muscles)
175
SLE (Lupus) def
a disease that systemic affect multiple organs and causing redness of skin
176
SLE (Lupus) cause
autoimmune disease, genetics,
177
SLE (Lupus) path
environmental triggers -> damaged cells release contents into cell and genetic factors cause them not to be cleared effectively -> b cell make antibodies -> antinuclear antibodies bind to antigen -> get into blood -> deposit in kidney, skin, joints, heart -> complement system -> cell to die ->
178
SLE (Lupus) path
environmental triggers -> damaged cells release contents into cell and genetic factors cause them not to be able to clear them effectively -> b cell make antibodies -> antinuclear antibodies bind to antigen -> get into blood -> deposit kidney, skin, joints, heart -> complement system -> cell to die
179
SLE (Lupus) comp
Skin scarring, Joint deformities, Kidney failure, Stroke, Heart attack, Pregnancy complications, Hip destruction (also called avascular necrosis), Cataracts
180
SLE (Lupus) comp
Kidney failure, Stroke, Heart attack, Pregnancy complications, avascular necrosis, Cataracts, DVT, hepatic vein thrombosis,
181
SLE (Lupus) clinical
relapsing and remittance
fever, joint pain, rash, weight loss, malar rash after sun exposure, discoid rash, photosensitivity of skin, ulcers of mouth or nose, serositis (pleuritis, pericarditis), myocarditis, endocarditis (vegetations form around mitral valve), arthritis, proteinuria, diffuse proliferative glomerulonephritis, seizures, psychosis, anemia, thrombocytopenia, leukopenia
182
Polyarteritis nodosa def
widespread inflammation, weakening, and damage to small and medium-sized arteries
183
Polyarteritis nodosa cause
hepatitis B, hepatitis C, hairy cell leukemia
184
Polyarteritis nodosa path
necrotizing vasculitis of the renal, coronary, and mesenteric arteries
immune complexes lead to medium vessel inflammation
185
Polyarteritis nodosa RF
men
186
Polyarteritis nodosa comp
renal failure, MI
187
Polyarteritis nodosa clinical
secondary HTN, hematuria, abdominal pain, bloody stools, livedo reticularis, palpable purpura
188
Poststreptococcal
| glomerulonephritis def
kidney glomeruli become inflamed after streptococcal infection
189
poststreptococcal
| glomerulonephritis cause
Group A beta-hemolytic Streptococci
190
poststreptococcal
| glomerulonephritis path
Group A beta-hemolytic Streptococci -> immune complexes of IgG or IgM and antigen get deposited GBM sub epithelial -> C3 complement, cytokines, oxidants, proteases -> damage podocytes -> RBC and proteins can filter through
191
poststreptococcal
| glomerulonephritis RF
children, recent impetigo or pharyngitis infx
192
poststreptococcal
| glomerulonephritis clinical
oliguria, proteinuria, hematuria, peripheral and periorbital edema
stary sky, anti-DNase B
193
granulomatous inflammation def
type of inflammation when chronic inflammation can't get rid of offending agent, development of nodules
194
granulomatous inflammation cause
tuberculosis or foreign body, sarcoidosis, leprosy, crohn's disease, cat starch disease, fungal infection, autosomal recessive and x-linked recessive for NADPH oxidase
Natural forests contain lions, tigers, frogs, snakes, and cats
195
granulomatous inflammation path
unable to kill pathogen -> macrophages turn into epithelioid cells -> epithelioid cells plus lymphocytes, multinucleated giant cell, and fibroblast come together -> cause more tissue destruction
196
granulomatous inflammation RF
FH
197
granulomatous inflammation comp
obstruction
198
granulomatous inflammation clinical
recurrent infections, bacteremia, fungemia
199
transplant rejection def
when transplanted tissue is attacked by new host immune system
200
transplant rejection cause
blood group, major histocompatibility antigen, minor blood group antigens,
201
transplant rejection path
innate immunity -> attraction, activation of phagocytes-> humoral immunity -> activation of B cells -> antibody secretion -> adaptive response -> cellular immunity -> killer T cells induce apoptosis
202
transplant rejection RF
HLA, inadequately immunosuppressed
203
transplant rejection comp
organ failure
204
transplant rejection clinical
fever, chills, dizziness, nausea, malaise, night sweats,
205
progressive systemic sclerosis (scleroderma) def
normal tissue is replaced with dense connective tissue
206
progressive systemic sclerosis (scleroderma) cause
autoimmune, anti-SCL 70, anti-RNA polymerase III, anti-centromere
207
progressive systemic sclerosis (scleroderma) path
injury to endothelial cells of small arteries -> express adhesion molecules -> T cell attach and migrate out side blood vessels -> release TGF-beta causing inflammation and damage -> release fibroblasts that produce collagen -> excessive firbosis -> reduce blood flow -> ischemia
208
progressive systemic sclerosis (scleroderma) RF
women, genetics, cytomegalovirus, parvovirus B19, silica dust, organic solvents, vinyl chloride, cocaine, 35-50, drugs
209
progressive systemic sclerosis (scleroderma) comp
painful ulcers, disfigurement, disability, renal, cardiac failure pulmonary insufficiency, interictal absorption
210
progressive systemic sclerosis (scleroderma) clinical
start in finger and move up across arm swollen doughty -> tight shiny, stiff, sclerodactyly, calcinosis
microstomia, beaked nose, Raynaud phenomena, GERD, malabsorption, cough, difficulty breathing,
211
rheumatic fever def
inflammatory condition of heart
212
rheumatic fever cause
Streptococcus pyogenes, group A beta-hemolytic
213
rheumatic fever path
antibodies are produced against M protein on Streptococcus -> cross react with body cells -> activate immune cells and release cytokines -> damage to heart
214
rheumatic fever RF
children, poverty, crowding
215
rheumatic fever comp
mitral stenosis, death to myocarditis, chronic rheumatic heart disease, infective endocarditis
216
rheumatic fever clinical
migratory polyarthritis, pancarditis, myocarditis, friction rub, subcutaneous nodules, erythema marginatum, Sydenham chorea, fever,
217
Sjögren syndrome def
autoimmune destruction of exocrine glands (lacrimal and salivary)
218
Sjögren syndrome cause
autoimmune to exocrine glands, HLA DRW52, HLA DQA1, HLA DQB1, infection
219
Sjögren syndrome path
damage to salivary glands -> parts of salivary gland get picked up by antigen presenting cells -> present antigen on MHC in lymph node -> binds to T cell -> activate B cell via cytokines -> make antibodies anti-SS-A and anti-SS-B -> enter blood T cell and antibodies -> exocrine gland -> T cell secrete cytokines, promote more immune cells to area, fibroblasts -> decreased exocrine glands
220
Sjögren syndrome RF
women, 40-60YO
221
Sjögren syndrome comp
Dental caries
| MALT lymphoma
222
Sjögren syndrome clinical
Dry, itching, redness, burning, and blurring of vision
xerostomia, difficulty tasting, swallowing, cracks and fissures
ulceration, perforation, crusting, and bleeding of nose and respiratory passages
difficulty speaking
Joint pain
Bilateral parotid enlargement
dry skin and vagina, swelling of glands, recurrent infx
223
primary amyloidosis def
deposits of proteins w/ abnormal shape that stick together and settle in tissues that cause damage to tissue
224
primary amyloidosis cause
multiple myeloma
225
primary amyloidosis path
abnormal proteins begin to build up -> clump together and can't be destroyed by proteases -> go out of cell and from b-sheets that deposit in extracellular space -> cause damage
immunoglobulin light chain gets misfolded and deposited
226
primary amyloidosis RF
men, 60-70, FH, kidney dialysis
227
primary amyloidosis comp
CHF, CHD
228
primary amyloidosis clinical
proteinuria, hypoalbuminemia, edema, hyperlipidemia, restrictive cardiomyopathy, arrhythmia, malabsorption, enlargement of liver, spleen, or tongue, reduced sensory, motor, digestion, or blood pressure
229
secondary amyloidosis def
build up of misfolded proteins in tissues
230
secondary amyloidosis cause
serum amyloid A
231
secondary amyloidosis path
serum amyloid A builds up in blood -> some misfolded into AA amyloids -> accumulate into tissue
232
secondary amyloidosis RF
Rheumatoid arthritis, IBD, cancers, familial Mediterranean fever
233
secondary amyloidosis comp
CHF, CKD
234
secondary amyloidosis clinical
proteinuria, hypoalbuminemia, edema, hyperlipidemia, restrictive cardiomyopathy, arrhythmia, malabsorption, enlargement of liver, spleen, or tongue, reduced sensory, motor, digestion, or blood pressure
235
erythema infectiosum (fifth disease) def
infection by Parvovirus B19
236
erythema infectiosum (fifth disease) cause
Parvovirus B19, respiratory droplets, infected blood transfusion, placenta
237
erythema infectiosum (fifth disease) path
respiratory tract -> travels through blood to bone marrow -> uses receptor-mediated endocytosis via p-antigen and enters erythroid progenitor cells -> replicates and produces non-structural protein 1 toxic to human cells -> RBC apoptosis -> copies of virus end up in blood -> IgG and IgM are produced -> form immune complexes (10-14) ->
238
erythema infectiosum (fifth disease) RF
children, immune-compromised
239
erythema infectiosum (fifth disease) comp
aplastic crisis, anemia, hydrops fetalis, fetal loss, pure red blood cell aplasia,
240
erythema infectiosum (fifth disease) clinical
mild fever, headache, aching muscles -> rash, joint pain (hands, wrist, knee, feet bilaterally), lace-like rash
241
Haemophilus influenzae type b def
encapsulated, gram negative, coccobacillus, non-motile, facultative anaerobic, catalase and oxidase positive
242
Haemophilus influenzae type b cause
Haemophilus influenzae via respiratory droplets
243
Haemophilus influenzae type b path
Haemophilus influenzae -> colonizes the nasopharynx, and may penetrate the epithelium and capillary endothelium
has capsule w/ pili, adhesion protiens, IgA protease, LOS
244
Haemophilus influenzae type b RF
children, splenectomy, sickle cell, cancer, congenital deficiency of complement components, acute viral infection (influenza)
245
Haemophilus influenzae type b comp
meningitis,
246
Haemophilus influenzae type b clinical
fever, sore throat, dyspnea, warm tender area of erythema on cheek or periorbital area, chills, hypotension, tachycardia, vomiting, sore neck, altered mental status, bone pain, weakness, pain swelling and tenderness of joint
H. influenzae hates your throat, lungs, head, and bones
247
influenza types
type A: 8 RNA segments, 8 hemagglutinin and neuraminidase, H3N2, H1N1
Type b: 8 RNA segments, less common,
type c: 7 RNA segment, least common, hemagglutinin-esterase-fusion
248
influenza cause
type A influenza
249
influenza path
respiratory droplets -> get in mouth, nose, lungs or touching surface -> uses hemagglutinin to bind to sialic acid sugar on epithelial cells -> endocytosis -> RNA gets worked on by RNA polymerase -> translated into proteins and new virus -> buds out of cell via neuraminidase cleaving sialic acid sugars
1-4 days
250
influenza RF
younger than 6 mon, >65, close contact w/ sick person, immunosuppression, pregnancy,
251
influenza comp
acute otitis media, bronchiolitis, croup, sinusitis, pneumonia, reye syndrome, febrile seizures,
252
measles cause
measles virus
253
measles path
airborne live up 2 hours in air or surface -> infect epithelial cells in trachea/bronchi -> hemagglutinin binds to CD46, SLAM, or Nectin-4 and fusion protein lets it get into cell -> RNA get transcribed by RNA polymerase -> translated into viral proteins -> wrapped in lipid envelope and sent out of cell -> picked up by dendritic cell and alveolar macrophage -> lymph node where it spread -> blood to more lung, intestine, brain (10-14 day)
254
measles RF
< 5 years, pregnant women, immunocompromised, unvaccinated
255
measles comp
death, pneumonia, diarrhea, encephalitis, otitis media, subacute sclerosing panecephalitis
256
measles clinical
high fever, cough, conjunctivitis, coryza -> days after rash on mucus membrane -> red, blotchy, maculopapular rash cephalocaudal progression -> after 4 day rash fades and cough remains
257
Mononucleosis def
enveloped, linear, double-stranded DNA
258
Mononucleosis cause
Epstein-Barr virus
259
Mononucleosis path
saliva or respiratory secretion -> epithelial cells it replicates viral DNA and form new proteins -> lysis of epithelial cells -> viruses travel to tonsils and attach to B cells via CD21 receptor -> virus enters latent phase and carries virus to other B cells (liver, spleen, lymph nodes) -> B cell make antibodies and CD8 t cells kill B cells
260
Mononucleosis RF
15-24, kissing, sharing drinks or food
261
Mononucleosis comp
splenic rupture, B cell lymphoma, Burkitt's lymphoma, nasopharyngeal carcinoma
262
Mononucleosis clinical
fever, pharyngitis, lymphadenopathy (posterior cervical), fatigue, tonsillitis, palatal petechiae, hepatosplenomegaly, rash (faint, non-itchy, pink macules or patches on trunk and arms)
263
Mumps def
viral polymerase enzyme, single stranded RNA, phospholipid bilayer, hemagglutinin, neuraminidase, fusion protein
264
Mumps cause
mumps virus -> enters cell RNA gets transcribed by viral polymerase -> translated -> viral proteins -> HN and F proteins bind other epithelial cells together
265
Mumps path
respiratory droplets -> mumps virus -> enters cell RNA gets transcribed by viral polymerase -> translated -> viral proteins -> HN and F proteins bind other epithelial cells together -> damage to nasopharynx
266
Mumps RF
children
267
Mumps comp
testicular atrophy, decrease in sperm count and motility
268
Mumps clinical
swelling of parotid salivary gland, ear ache, trismus, meningitis, encephalitis, headache, neck stiffness, hearing loss, difficulty w/ balance, orchitis, epididymitis, glomerulonephritis, arthritis, myocarditis, pancreatitis
269
Roseola Infantum def
double stranded linear DNA, icosahedral capsid, tegument, viral glycoproteins
270
Roseola Infantum cause
Human Herpes Virus 6
271
Roseola Infantum path
respiratory droplets -> virus attaches to dendritic cells -> travel to lymph nodes -> CD4 T cells bind and virus infects them -> DNA gets transcribed and translated in CD4 T cells -> viral proteins are made -> packaged and leave cell destroyed -> can infect monocytes, macrophages, NK cells, astrocytes, megakaryocytes, glial cells -> goes into latent state in monocytes
incubation 1-2 week
272
Roseola Infantum RF
children 6 month -2 years
273
Roseola Infantum comp
encephalitis
274
Roseola Infantum clinical
high fever, periorbital edema, acute otitis media, rhinorrhea, cough, vomiting, diarrhea, bulging fontanelle, cervical, occipital or postauricular lymphadenopathy, Nagayama spots -> maculopapular rash
275
Rubella def
single-stranded RNA, icosahedral capsid, spherical outer lipid envelope, mRNA
276
Rubella cause
rubella virus
277
Rubella path
respiratory droplets -> virus binds to receptor on endothelial cells in nasopharynx -> enters the cell -> virus gets surrounded by cell creating an endosome -> viral RNA is uncoated and nucleus, ER, and Golgi apparatus are moved close to it -> virus replicated and make proteins -> surrounded by membrane and exocytose -> spreads to lymphatic and blood vessels -> lymph nodes replicates -> enters urine, CSF, synovial fluid -> infected cells get apoptosis
pregnant female -> through placenta -> congenital rubella syndrome
278
Rubella RF
unvaccinated, coming in contact w/ someone
279
Rubella comp
congenital rubella syndrome (sensorineural hearing loss, cataracts, retinopathy, damage to retina, patent ductus arteriosus, dermal extramedullary hematopoiesis, intellectual disability, behavioral disorders, skin lesions, DM< enlarged liver and spleen)
280
Rubella clinical
asymptomatic
14 after incubation: children have fever, swelling of lymph nodes, pink macules rash spread to trunk and extremities
teen and adult: arthralgia, arthritis,
281
Scarlet Fever def
infection leading to bright red skin rash
282
Scarlet Fever cause
streptococcus pyogenes
283
Scarlet Fever path
erythrogenic toxin -> a consequence of local production of inflammatory mediators and alteration of the cutaneous cytokine and dilatation of blood vessels, intrapapillary hemolysis
284
Scarlet Fever RF
close contact with another person with scarlet fever, >3
285
Scarlet Fever comp
```
ear infection
throat abscess
sinusitis
pneumonia
meningitis
rheumatic fever
```
286
Scarlet Fever clinical
exudative pharyngitis, fever, and bright-red exanthem
287
Toxoplasmosis cause
toxoplasma gondii
288
Toxoplasmosis path
ingestion of oocytes -> oocyst wall dissolved by proteolytic enzymes in stomach/SM I -> frees sporozoites from w/in oocyst -. parasites invade intestinal epithelium surrounding cells -> differentiation into tachyzoites -> replicate inside vacuoles until host cell rupture -> release tachyzoite to tissues -> host immune response-> tachyzoite turn into bradyzoites (semi-dormant) inside host cells
289
Toxoplasmosis RF
consumption of raw/undercooked meat, ingestion of contaminated water, soil, vegs, previvor's blood transfusion, organ transplant, transplacental transmission
290
Toxoplasmosis def
a disease that results from infection with the Toxoplasma gondii parasite
291
Toxoplasmosis clinical
initial: swollen lymph nodes, headache, fever, fatigue, muscle aches, pains
chronic/latent: asymptomatic
immunocompromised: headache, confusion, poor coordination, seizures, cough, dyspnea,
