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RACP paeds Qld Group > Immunology > Flashcards

Immunology Flashcards

1
Q

which cytokines stimulate CRP production

A

IL-1 and Il-6

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2
Q

deficiency of which complement component is associated with most severe pyogenic infections

A

C3

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3
Q

Role fo C3B

A

opsonisation

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4
Q

Role C3a and C5a

A

anaphylotoxins- generate chemotaxic gradients; mediate phagocyte migration to area

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5
Q

Role of C5-C9

A

membrane attack complex
Osmotic lysis of microbe

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6
Q

most common complement deficiency

A

C2

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7
Q

which complement defiicnecy most associated with SLE

A

C1

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8
Q

which complement deficinecy is most associated with Nesseria infections

A

C5-C9

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9
Q

what do CH50 and AH50 test for

A

activity of classical and alternative complement pathways respectively

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10
Q

Drug reaction with eosinophilia and systemic symptoms (DRESS)

A

severe adverse drug reaction, up to 2-8 weeks after offending drug
T cell mediated hypersensitivity (type 4)
Usually carbamazepine, phenytoin, lamotrigine, allopurinol, vanc, sulfonamide abx
Characterized by:
-extensive skin rash, mucosal involvement in 50%, usually rash very widespread
- fever
-lymphadenopathy
- eosinophilia
- leucoytosis
neutrophilia
- liver injury with abn LFTs
Rx: if severe: glucocorticoids

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11
Q

GVHD

A

GVHD occurs when lymphocytes from donated blood are either not recognised by the patient or the patient’s immune system is unable to destroy them. The skin, bone marrow, and gastrointestinal track are most often affected. It occurs 4-30 days after transfusion but usually occurs in the second week post transfusion. It is rare and difficult to treat but can be prevented by the use of irradiated blood products.
Children with immunodeficiency (either primary or secondary to chemotherapy), haematological malignancy or haematopoeic cell transplantation, and premature low birth weight babies are at risk. Children in these groups should receive irradiated blood.
Biopsy: satellite dyskeratosis
Presents with fever, rash, diarrhoea, hyperbilirubinemia, cholangitis , deranged LFTs

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12
Q

difference between TREC and KREC

A

TREC is a by-product of the T-cell receptor gene recombination- used for SCID, di george, CHARGE, ataxia telangiectasia
KREC is a by-product of the B-cell receptor recombination- used for XLA

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13
Q

T cell development

A

BM–> thymus for t cell university
Initially double negative
Then double positive - CD4+CD8+
Positive selection- recognise MHC I or II (only survive if bind moderately)
Negative selection- recognise self antigens presented on MHC but dont bind too strongly (or this would cause autoimmunity)
Class depends if they recognise antigen on MHC1 (become CD8) or MHC2 (become CD4)
Then once they are either CD4 or CD8 they leave the thymus as naive T cells and go into the lymph nodes to wait for antigen presenting cells

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14
Q

T helper cell subsets

A
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15
Q

which cytokine causes T cell proliferation

A

Il-2

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16
Q

which cell type is IL-2 mainly secreted by ?

A

CD4 Th cells

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17
Q

what is the immunophenotype of most common type of SCID

A

T-B+NK-
(x linked, IL2Rg mutation encoding IL-2 receptor gamma chain)

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18
Q

what does IL-2 do?

A

Produced by CD4 Th cells

Promotes T cell proliferation
Differentiation of T cells into regulatory T cells and memory T cells
Stimulates naive CD4 T cell differentiation into Th1 and Th2 cells , reduces differentiation into Th17
Increases cell killing activity of NK cells and cytotoxic T cells

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19
Q

which 2 immunoglobulins can fix complement

A

IgM, IgG

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20
Q

what cell types do IgE bind to?

A

mast cells and basophils

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21
Q

DDx hypogammaglobulinemia

A

Excessive loss- A1AT ( losing in gut), nephrotic syndrome, intestinal lymphangiectasia
BUT even if losing IgG, unlikely to be able to lose IgM as such a big molecule

22
Q

why is pneumovax 23 not a very effective vaccine?

A

polysaccharide vaccine
T cell independant
Mainly IgM produced
Relatively short lived plasma cells

there is a particularly poor polysaccharide response before 2 years

23
Q

B cell maturation

A
24
Q

Th2 cells release which cytokines

A

Il-4, Il-5, Il-13

25
Q

Th1 cells release which cytokines

A

IFN-y
Il-2
which target macrophages

26
Q

Th17 cells release which cytokines

A

Il-17
Il-22
these target neutrophils

27
Q

Role of IL-12

A

Released by APC (macrophages, dendritic cells) and drives the differentiation from undifferentiated T helper cells to Th1 cells
Also activates NK cells, which secrete IFN-g which also promoted Th1 cell development
*Th1 cells also secrete IFN-g which amplifies differentiation of other Th1 cells, also NK cells produce IFNg

28
Q

Role of interferon gamma

A

Released by Th1 cells, CD8 T cells, and NK cells
Activates macrophages and makes them better at killing pathogens
Promotes secretion of IL-12 to maintain positive feedback loop
Increases production of TNF-a

29
Q

Role of IL-1

A

Produced by macrophages/dendritic cells
Pro inflammatory cytokine
Chemokine production –> increases migration of phagocytes to site of infection, vasodilation
Endogenous pyrogen –> fever

30
Q

Role IL-3

A

Growth factor for hematopoeitic stem cells
Regulates the growth and differentiation of hematopoietic progenitor cells and functionally activates mature neutrophils or macrophages.

31
Q

Role IL-4

A

Differentiation of Th0 cells into Th2 cells
Promotes B cell activation and class switching to IgE

32
Q

Role IL-5

A

Activation of eosinophils
Class switching to IgA

33
Q

Role IL-6

A

Proinflammatory cytokine released by macrophages in response to PAMPS
Mediates fever and acute phase response as well as the production of neutrophils in the bone marrow.
It supports the growth of B cells and is antagonistic to regulatory T cells.
It is capable of crossing the blood–brain barrier and initiating synthesis of PGE2 in the hypothalamus, thereby changing the body’s temperature setpoint.

34
Q

cell marker on hematopoetic stem cells

A

CD34

35
Q

what receptor do all T cells have

A

CD3+

36
Q

Activation of naive T cell

A

T cell receptor binds to antigen on MHC I or 2
Costimulation - CD28 on T cell binds to B7 on APC
Once both signals received, Th cells increase expression of IL-2 and IL-2 receptors (autocrine signal) causing clonal expansion and proliferation/differentiation into Th1 and Th2 cells

37
Q

what cell surface marker do all leukocytes share

A

CD45

38
Q

Th17 cells role

A

Fights some extracellular bacteria eg Klebsiela, Neisseria, Staph aureus and fungal infectins

Secrete IL-17 and IL-22

Hyper IgE (Jobs syndrome) due to impaired Th17 differentiation

39
Q

Regulatory T cells

A

Suppress CD4, CD8 cells, B cells and NK cells
Differentiation driven by TGF-beta
Produce IL-10 and TGF-b

Cell surface receptors: CD4, CD25

40
Q

TGF beta

A

inhibitory cytokine
Released by many lymphocytes and macrophages
Drives differentiation of Th cells to T reg cells

41
Q

IL-10 role

A

anti-inflammatory cytokine secreted by macrophages + T reg cells

IL-10 suppresses many functions of natural killer (NK) cells and T cells, primarily by preventing antigen-presenting cells (APCs) from producing proinflammatory cytokines, such as IL-12, and from up-regulating molecules involved in antigen presentation and lymphocyte activation

42
Q

what are the main cytokines produced by Th1 cells

A

IL-2
IFN-gamma

—> macrophage activation
Activation and proliferation/differentiation of Th cells
Activation of cytotoxic T cells
Class switching to IgG

43
Q

Role IL-13

A

Mucous production and peristalsis of gut to help remove helminths/parasites

44
Q

Role T follicular helper cells

A

Found in lymph nodes
Produce IL-21 –> drives B cell proliferation

Tfh play an essential role in the formation of germinal centres (GCs), B cells within GCs undergo rapid proliferation and antibody diversification, allowing the production of many types of antibody + differentiation into memory B cells

45
Q

Role of IFN-g

A

Macrophage stimulation
Produced by helper T cells, cytotoxic T cells and NK cells

46
Q

what % of kids outgrow a peanut allergen by adulthood

A

20%

14% for tree nut allergy (lowest)

47
Q

hypersensitivity reactions

A

Type 1- IgE mediated
Type 2- IgG/IgM mediated (eg transfusion reaction, autoimmune hemolytic anemia, Graves, Goodpastures, myasthenia gravis)
Type 3- immune complex deposition (eg SLE, serum sickness, glomerulonephritis)
Type 4- T cell (eg contact dermatitis, tuberculin reaction, T1DM, multiple sclerosis, rheumatoid arthritis)

48
Q

STAT3 mutation

A

Hyper IgE syndrome

49
Q

antibody associated with anterior uveitis in JIA

A

ANA

50
Q

enthesis associted anterior uveitis

A

HLA B27

RACP paeds Qld Group (46 decks)

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