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Immunology Flashcards

1
Q

what are the constitutive/ physical barriers to infection?

A

SKIN
tightly packed keritanised skin cells
low pH of skin

MUCOSA
secretory igA
lyzozyme
lactoferin- starves invading bacteria of iron
cilia

COMMENSAL BACTERIA
skin microflora
gut microflora

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2
Q

what are the specific names for macrophages in each of these organs:

liver
kidney
spleen
bone
lung
neural tissue
connective tissue
skin

A

liver- kupfer cells
kidney- mesangial cell
spleen- sinusoidal lining cells
bone- osteoclast
lung- alveolar macrophage
neural tissue- microglia
connective tissue- histocyte
skin- langerhans cells

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3
Q

briefly describe oxidative killing of microbia

A

NADPH oxidase complex converts oxygen to ROS (eg. superoxide, hydrogen peroxide)

myeloperoxidase catalyses production of hydroclorus acid which is antimicrobial

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4
Q

describe non oxidative killing of microbia

A

granular release of lyzozyme and lactoferrin into the phagolysosome

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5
Q

What happens during phagocytosis

A

phagocyte engulfs microbia via endocytosis. This process depleats phagocytes glycogen reserves leading to cell death

build up of dead neutrophils at site of infection –> abscess

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6
Q

what is migration of dendritic cells to lymph nodes mediated by?

A

CCR7 on DC recognise the chemokines CCL19 and CCL21

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7
Q

cell markers on T cells

A

all express CD3 (TCR)
CD8+ cells are cytotoxic T cells
CD4+ cells are T helper cells

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8
Q

Which HLA subtypes are there in class II and which cells express?

A

HLA-DR, HLA-DQ, HLA-DP
class II expressed by APCs
recognised by CD4+ cells

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9
Q

What are the different effector subtypes of CD4+ cells and what are their actions

A

Th1 cell-
polarised by IL12, IFNg
helps CD8+ and macrophages.
secretes IL2, IFNg, TNFa, IL10

Th2
polarised by IL4 and IL6
secretes IL4, IL5, IL13, IL10
helps humoral response

Th17
polarised by IL6, TGFb
helps neutrophil recruitment and generation of autoantibodies
secretes IL17, I21, IL22

Tfh
polarised by IL6, IL1b, TNFa
follicular helper T cells in B cell maturation
secretes IL2, IL10, IL21

Treg
polarised by TGFb
regulates T cell response expressing foxp3

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10
Q

Which HLA subtypes are there in class I and which cells express?

A

HLA A, B, C
expressed by ALL cells
recognised by CD8+ cells

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11
Q

How do CD8+ cells directly kill

A

secretes perforin and granzymes into cell –> apoptosis

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12
Q

which portion of Abs recognise antigens and which portion interacts with other components of the immune system?

A

Fab –> pathogen/antigen
Fc –> immune cells

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13
Q

briefly describe the different pathways of complement

A

classical:
Ab-Ag complex causes a conformational change of Ab, exposing binding site for C1 which activates cascade

mannose:
activated by direct binding of mannose binding lectin to mannose on bacteria cell surface carbohydrates . Directly stimulates activation of C4 and C2 (but not C1)

Alternate:
triggered by binding of C3 to bacterial cell wall eg. LPS or teichoic acid

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14
Q

Primary immune deficiencies:

feature of IgA deficiency

A

recurrent resp and GI infections

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15
Q

Primary immune deficiencies:

Kostmann syndrome

A

autosomal recessive severe congenital neutropenia
(eg <500/ul)

no pus formation

due to mutation oin HCLS1-associated protein X-1 (HAX1)

positive NBT test

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16
Q

Primary immune deficiencies:

Cyclic neutropenia

A

autosomal dominant
episodic neutropenia every 4-6 weeks and lasts ~6days

mutation in neutrophil elastase (ELA-2)

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17
Q

Primary immune deficiencies:

Reticular dysgenesis

A

failure of stem cells to differentiate along the myeloid or lympoid lineage
(failure of production of granulocytes, lymphocytes, monocytes and platelets)

fatal in very early life

autosomal recessive
mutation in mitochondrial energy metabolism enzyme AK2

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18
Q

Primary immune deficiencies:

Leukocyte adhesion deficiency

A

neutrophils lack CD18 (b2 integrin subunit) so cant adhere to endothelial cells and transmigrate

feature:
- very high neutrophil count in blood
- absence of pus formation
- delayed umbilical chord separation

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19
Q

Primary immune deficiencies:

chronic granulomatous disease

A

X-linked
deficient in NADPH so fails to make ROS
impaired killing on pathogens
–> excessive inflammation and neutrophil/macrophage accumulation

non caseating granuloma formation, hepatosplenomegaly, lyphadenopathy

susceptable to PLACESS microbes (pseudomonas, listeria, aspergillus, candida, E.coli, staph aureus, serratia)

Ix:
negative Nitro-blue tetrazolium test (pos: yellow-> blue when incontact with hydrogen peroxide)

normal neutrophil count

Mx:
IFNg

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20
Q

Primary immune deficiencies:

deficiency of IL-12 and IFNg

A

susceptibility to mycobacteria, BCG and salmonella

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21
Q

Primary immune deficiencies:

complement deficiencies

A

deficiency in C1, C2 or C4 (C2 most common)

almost all with C2 deficiency have SLE

increased susceptibility to encapsulated bacteria:
-Haemophilus influenzae type B (Hib)
-Streptococcus pneumoniae (pneumococcus)
-Neisseria meningitides (meningococcus)
-Group B streptococcus (GBS)
-Salmonella typhi.

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22
Q

Primary immune deficiencies:

severe combined immunodeficiency (SCID)

A

unwell by 3 months of age
before protected by maternal IgG

  • infections of all types
  • failure to thrive
  • persistent diarrhoea

FHx of early infant death

diminished T cells and non-functional B cells

hypoplasia and atrophy of the thymus

mucosal associated lymphoid tissue (MALT)

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23
Q

X-linked SCID

A

45% of SCID
- X-linked recessive
mutation of gamma chain of IL2 receptor on chromosome Xq13.1

inability to respond to cytokines causes arrest of T cell and NK cell development and production of immature B cells

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24
Q

Di George syndrome

A

22q11.2 deletion
developmental defect of pharyngeal pouch (embryological abnormality in 3rd and 4th brachial arches)

CATCH-22
Cardiac abnormalities
Atresia (oesphageal)
[Abnormal face (high forehead, low set ears)]
Thymic aplasia
Clef palate
Hypocalcaemia/hypoparathyroidism
22- chromosome

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25
Investigtions for phagocytic immune deficiencies
Nitro blue tetrazolium test: yellow - blue in the presence of hydrogen peroxide ROS DRH flow cytometry reaction DRH- rhodamine in the presence of hydrogen peroxide which is very fluorescent
26
investigations for complement deficiencies
CH50 and AP50 tests
27
investigations for lymphocyte deficiencies
WCC, lymphocyte subsets, serum Ig, protein electrophoresis
28
autoimmune polyendocrine syndrome type 1(APS1)
monogenetic autoimmune disease autosomal recessive abnormality in tolerance defect in AIRE so failure of central tolerance --> autoreactive T and B cells Features: multiple autoimmune diseases hypothyroidism, addisons, hypopaarathyroidism, T1DM, vitiligo, enteropathy
29
Immune dysregulation, polyendocrinopathy, enteropathy (IPEX)
X linked abnormality of Tregs mutation in FOXP3 features: T1DM, hypothyroidism, enteropathy diabetes, diarrhoea and dermatitis
30
autoimmune lymphoproliferative syndrome (ALPS)
abnormality of lymphocyte apoptosis autosomal dominant mutation in Fas pathyway features: autoimmune cytopenias lymphoma 'APOPtosis to the ALPS would be FASt'
31
HLA associations with Ankylosing spondylitis
HLA B27
32
HLA associations with goodpastures syndrome
HLA DR15/DR2 'Dr Too Good'
33
HLA associations with Graves disease
HLA DR3
34
HLA associations with SLE
HLA DR3 'SLE and DR3'
35
HLA associations with T1DM
HLA DR3/DR4
36
HLA associations with RA
HLA DR4 'RA-dR4'
37
autoantibodies and associated condition: anti-Smooth muscle
autoimmune hepatitis or primary sclerosing cholangitis
38
autoantibodies and associated condition p-ANCA
eosinophilic granulomatosis with polyangiitis (aka: Churg strauss syndrome) blood vessels of lungs, GIT and peripheral nerves most commonly affected
39
autoantibodies and associated condition anti-Jo1
dermomyositis with interstitial pulmonary involvement --> autoimmune inflammation of muscle fibre in skin and polymyositis
40
autoantibodies and associated condition anti-cyclic citrullinated protein
RA
41
autoantibodies and associated condition anti-centromere
CREST syndrome (limited cutaneous form of systemic sclerosis)
42
autoantibodies and associated condition anti-double stranded DNA
SLE
43
autoantibodies and associated condition anti-parietal cell
pernicious anaemia
44
autoantibodies and associated condition anti-TSH
graves
45
autoantibodies and associated condition anti-topoisomerase
diffuse systemic scleroderma
46
autoantibodies and associated condition anti-mitochondrial
Primary billiary cirrhosis
47
autoantibodies and associated condition c-ANCA
Granulomatosis with polyangiitis (aka wengers granulomatosis)
48
autoantibodies and associated condition anti-cardiolipin
antiphospholipid syndrome SLE syphilis?
49
autoantibodies and associated condition anti-ribonucleoprotein and anti-U1RNP ab
mixed connective tissue disease
50
autoantibodies and associated condition anti-glutamic acid decarboxylase
T1DM
51
autoantibodies and associated condition anti-Ro and anti-La
Sjogrens and SLE
52
autoantibodies and associated condition anti-intrinsic factor
pernicious anaemia
53
autoantibodies and associated condition anti-endomysial
Coeliac and dermatitis herpatiformia
54
Primary immune deficiencies: Bruton's agammaglobulinaemia
X linked disease mutation of BTK gene which expresses tyrosine kinase 'BruTonsX(K)' mutation inhibits B cell maturation and therefore low Ig levels bloods: notmal T cell low B cell, absent plasma cells low IgA, IgM and IgG
55
immune deficiencies: hyper IgM syndrome
mutation in CD40 ligand on T cells required in the germinal centre development of B cells - unable to class switch and thereofre leads to high IgM - deficient IgA, IgG and IgE
56
Wiskott Aldrich syndrome
X-linked mutation in WASp gene WAS protein expressed in developing haematopoetic stem cells mutation is linked to development of lymphomas, thrombocytopenias and eczema Sx: easy bruising, nose bleeds, GI bleeds, petechiea, recurrent bacterial infections caused by haemophilus influenzae and strep pneumoniea
57
what are you at risk of of with hyposplenism
risk of infections by encapsulated bacteria, for example strep pneumoniea (spleen has lots of lymoid tissue) - vaccinations and prophylactic Abx
58
clinical features of dermatomyositis
heliotrope rash around eyes gottrons papules on dorsum of finger proximal limb weakness
59
features of CREST syndrome
Calcinosis Raynauds Esphageal dysmotilisty Sclerodactyly Telangectasia hypergammaglobulinaemia anaemia raised ESR
60
Features of Sjogrens syndrome
Dry eyes (confirmed by schirmers test) dty mouth parotid swelling fatigue arthralgia myalgia autoimmune destruction of exocrine glands salivary gland biopsy reveals infiltrate of T and B
61
features of granulomatosis with polyangiitis
saddle nose deformity (due to perforated septum) pulmonary haemorrhage (haemoptysis) glomerulonephritis (haematuria)
62
examples of type I hypersensitivity reaction
Anaphylaxis food allergy oral allergy syndrome allergic rhinitis atopic dermatitis acute urticaria
63
examples of type II hypersensitivity reaction
ANY DISEASE WITH AUTOANTIBODIES TO ANTIGEN ATTACHED TO TISUE autoimmune haemolytic anaemia AITP Goodpastures syndrome Graves myesthenia gravis pernicious anaemia
64
examples of type III hypersensitivity reaction
SLE Mixed essential cryoglobulinaemia serum sickness polyarteritis nodosa
65
examples of type IV hypersensitivity reaction
T1DM multiple sclerosis RA contact dermatitis Mantoux test Chrons disease
66
what is a type I hypersensitivity reaction?
immediate IgE mediated reaction provoked by are-exposure to an allergen mast cell release of histamines
67
what is a type II hypersensitivity reaction?
IgG or IgM autoantibody reacting to self tissue or matrix
68
what is a type III hypersensitivity reaction?
IgG or IgM immune complexes reacting to a soluble antigen causing tissue damage
69
what is a type IV hypersensitivity reaction?
delayed type hypersensitivity which is T cell mediated
70
autoantibodies in hashimotos thyroiditis
anti-TPO and anti-thyroglobulin
71
autoantibodies in hashimotos thyroiditis
anti-TPO and anti-thyroglobulin
72
autoantibodies in T1DM
anti-glutamate decarboxylase and anti- pancreatic B cells
73
autoantibodies in ITP/AITP
anti-glycoprotein IIb-IIa or Ib-IX Ab
74
autoantibodies in goodpastures syndrome and features
anti-glomerular basement membrane Abs glomerulonephritis and pulmonary haemorrhage
75
What antibody tests are there for coeliac?
anti-endomysial Ab (95% specific, 85% sensitive) anti-transglutaminase Ab (95% sensitive, 95% specific) anti-gliadin antibody (30-50% specific, 60% sensitive)
76
Associations with coeliac
Trisomy 21 Dermatitis herpatiformis DQ2 or DQ8 (2 8 or not to eat)
77
What primary immune deficiency is associated with delayed umbilical chord detachment
leukocyte adhesion deficiency type 1
78
Conditions that may lead to impaired primary barrier function
Coeliac --> impaired mucociliary clearance Keratoconjunctivitiis sicca--> dry eyes (lysozyme in tears)
79
What measures total complement activity?
CH50 (measures all components of classical and final pathways (C1-9) AH50 measures components of alternative pathway
80
what is reduced C3 and C4 associated with?
SLE
81
What is reduced C3 but normal C4 associated with?
membranoproliferative glomerulonephritis
82
What is the role of IgD?
found on cell surface of immature B cells and plays a role in lymphocyte activation
83
HLA associations with coeliac
HLA DQ2 'DQ2 i need a poo'
84
Features of APECED
mild immune deficiency dysfunctional parathyroid dysfunctional adrenal hypothyroidism gonadal failure alopecia vitiligo Mutation of AIRE gene
85
what are some mechanisms of autoimmunity?
molecular mimicry and cross reactivity defect in central tolerance (AIRE gene mutation) defect in peripheral tolerance immune regulation (FOXP3 defect) IL2 therapy associated with autoimmune thyroid disease Release of 'hidden' atigens after damage eg. Dresslers syndrome where MI causes release of proteins and generation of auto-Abs --> pericarditis
86
What is Von Gierke's disease
Glycogen storage disease casued by a deficiency in G6PD present with severe hypoglycaemia and neutropenia
87
What is a positive Nikolsky's sign indicative of?
Pemphigus vulgaris
88
how long after transplantation would an acute cellular reaction occur?
~1 week
89
MOA of cyclosporine
inhibits protein phosphate calcineurin which reduces IL2 secretion from T cells and T cell proliferation
90
MOA of azathioprine
metabolised to 6-mercaptopurine which acts as a purine analogue and prevents DNA synthesis mostly affecting lymphocytes
91
MOA of methotrexate
anti-metabolite and anti-folate drug inhibits dihydrofolate reductase used in the synthesis of nucleoside thymidine, essential for DNA synthesis
92
MOA of corticosteroids
inhibits phospholipid A2 preventing prostaglandin production and other inflammatory --> Blocks arachidonic acid and prostaglandin formation and so reduces inflammation Also decreases traffic of phagocytes to site of infection by interfering with adhesion molecules --> high neutrophils sequestration of lymphocytes to tissue --> low lymphocyte count blocks cytokine gene expression decreased Ab production
93
function of IL2R mAb and example
eg. daclizumab targets CD25 of IL2 receptors expressed on activated T cells esp used in kidney transplant
94
MOA of rituximab
targets CD20 on B cells used in lymphomas
95
development of lymphomas, thrombocytopenia and eczema
Wiscott-Aldrich syndrome
96
mutation in MHC III
common variable immunodeficiency
97
mechanism of action of mycophenolate mofetil and indicaiton
anti-metabolite which prevents guanine synthesis blovks de novo nucleotide synthesis preventing DNA replication targets T cells more then B cells used in transplantation, autoimmune diseases and vasculitis
98
what is progressive multifocal leukoencephalopathy a complication of
from the JC virus in immunosupressed pts ge. after mycophenolate mofetil therapy
99
mechanism of action of tacrolimus
inhibirts calcineurin preventing T cell proliferation/ function via reduced IL2 expression
100
side effects of cyclosporin
gingival (gum) hypertrophy nephrotoxicity HPTN neurotoxic
101
mechanism of action of infliximab
anti-TNFa
102
what is the receptor binding and membrane binding glycoprotein on influenza
haemagglutanin
103
what does influenza bind to on human cells?
sailic acid on RBCs
104
examples of toxoid vaccines
diphtheria tetanus
105
what are adjuvents, examples and how do they work
ALUM- most common. antigens absorbed into alum so are released at a slower steady rate in the body which improves B cell priming stimulatory ajuvants mimic the action of PAMPs on TLRs to boost immune response eg: CpG- activates TLRs on APCs Freunds ajuvent- water in oil emulsion containing mycobacterial cell wall components. not clinically used
106
what are mRNA vaccines complexed with in vaccine
lipids
107
how do adenovirus vector vaccines work?
DNA of virus (eg. Sars-CoV-2) into viral vector (adenovirus) Infect cells in vivo Transcription/translation to produce protein Stimulates immune response including T cells and B cells with production of antibodies
108
How do dendritic cell vaccines work
take out DCs and pump them with tumour specific antigens - incubate with recombinant protein - conjugated with GMCSF -APC back into patient which can stimulate immune response against tumour
109
Examples of cytokine therapy and what is it used for
IL-2 therapy for renal cell cancer IFNgamma used in chronic granulomatous disease to boost oxidative phosphorylation
110
Examples of therapies that replace missing parts of immune response
Haematopoetic SCT Ab replacement (IVIg)
111
Indications for Ab replacement
Brutons X linked hyper IgM common variable immuno def Haem malignancy post exposure prophylaxis
112
Examples of ID with post exposure prophylaxis Abs given
VZV in non immune preganat women Hep B Rabies Tetanus
113
example of virus specific T cell therapy
EBV related B lymphoproliferative disease
114
Cancers where tumour infiltrating lymphocyte T cell therapy is uesd
head and neck melanoma lung gynae
115
Uses for CAR-T cell therapy
ALL Non-Hodgkins lymphome
116
examples of immune checkpoint blcockade
anti-PD1- Abs- prevents PD1 from binding to PD!L and therefore prevent programmed cell death of T cells anti-CTLA4- CD80/86 on APC bind to CT4A4 which blocks nagative regulation of T cells
117
exaples of PD1 checkpoint blockade and what is it used for
Pembrolizumab and Nivolumab used in melanoma
118
example of CTLA4 checkpoint blockade and what is it used for
Ipilimumab melanoma
119
function of CTLA4
inhibitory checkpoint on t cells. completes with CD28 to bind to CD80/86 on APCs
120
which vaccine should NOT be given to an immunosuppresed person (inc pts with RA, IBD on immunosupressive drugs)
BCG Yellow fever
121
side effects of steroids
diabetes, central obesitiy, chushingoid, adrenal supression cataracts, glaucoma, peptic ulcer, pancreatitis, avascular necrosis psychosis infection
122
examples of drugs that inhibit DNA synthesis (anti proliferative agents) affecting lymphocytes prodominently
cyclophosphamide (most toxic) mycophenolate mofetil azathioprine
123
side effects of anti proliferative agents
Bone marrow suppression Infection - Malignancy - Teratogenic
124
complications of cyclophosphamide
Toxic to proliferating cells: Bone marrow depression Hair loss Sterility (male>>female) Haemorrhagic cystitis -->Toxic metabolite acrolein excreted via urine Malignancy: Bladder cancer Haematological malignancies Non-melanoma skin cancer Infection -->Pneumocystis jiroveci
125
side effects of azathioprine
Bone marrow suppression Some people have a thiopurine methyltransferase polymorphism which means they can’t metabolise azathioprineso are very susceptible Hepatotoxicity
126
risks of mycophenolate therapy
infection: - herpes virus reactivation - Progressive multifocal leukoencephalopathy (JC virus)
127
mechanism of plasmaphoresis and diseases its used in
remove pathogenic Ab and replaced with albumin. type 2 hypersensitivity reactions (eg. MG, goodpastures)
128
role of calcineurin
involved in expression of IL2 stimulates NFATc which upregulates IL2 expression
129
examples of drugs that inhibit calcineurin
Tacrolimus cyclosporin
130
examples of mTOR inhibitors and how do they work
sirolimus rapamycin mTOR involved in IL2 pathway
131
mechanism of tofacitinib (jakinibs)
inhibits JAK-STAT pathway so blocks cytokine production
132
mechanism of anti-thymocyte globulin
lymphocyte depletion modulation of T cell activation and migration
133
Drugs that target CD25 and whats the pathway that is affected
Basiliximab and daclizumab blocks IL2 induced T cell proliferation
134
how does anti-CTLA4-Ig fusion protein work
eg. abatacept blocks the interaction between CD28 and CD80/86 so prevents ????
135
mechanism of rituximab
anti-CD20 expressed on mature B cells - depletes B cells but not plasma cells
136
mechanism of TNFa blockers and indications for use
TNFa pivitol in inflammation affecting many cell types inhibition leads to a broad effect on immune response used in: RA, IBD, psoriasis, ank spond, familial Mediterranean fever
137
side effects og TNFa blcockers
TNFa is important in protection against TB other infections HBV/HCV lupus like conditions demyelination
138
function of IL1
secretion dirven by procaspase within the inflammasome used in familial mediterranean fever, gout, adult onset stills disease
139
function of IL6 and indication for blockade
affects T and B cells affects synoviocytes affects osteoclast activation IL6 receptor blocker used in RA
140
IL pathwyas key in eosinophilic pathway and eczema, asthma
IL4/5/13
141
mechanism of blockade used in osteoporosis
anti-RANK-ligand which blocks osteoclast stimulation and reduces bone resorption
142
risks of immunosupressive therapy
INFECTION: TB risk - epdemiology, IGRA/manteaux test --> prophylactic TB treatment HBV/HCV JCV activation HIV MALIGNANCY: lymphoma (EBV associated) non melanoma skin cancer dysregulation of immune response leading to autoimmune conditions - lupus like disease, antiphospholipid, vasculitis, demyelination
143
describe john cunningham virus disease
Common polyomavirus that can reactivate - Infects and destroys oligodendrocytes -Progressive multifocal leukoencephalopathy -Associated with use of multiple immunosuppressive agents - AIDS defining disease
144
what do mast cells release when activated by allergen in allergy
histamine tryptase proteoglycans cytokines
145
mechanism of symptoms of allergic reactions
skin: urticaria, angiooedema degranulation causes vasodilation to skin or mucosa- more blood flow = red and leakage Itching due to nerve stimulation respiratory: bronchoconstriction, nasal discharge, sneezing GI: oedema of intestine= gut discomfort CVS: vasodilation
146
management of anaphylaxis
1. remove trigger 2. lie pt flat and lift legs (fluid bolus) 3. IM adrenaline 4. A-E 5. IV fluids 6. repeat adrenaline if no change after 5 mins
147
mechanism of adrenaline in anaphylaxis
vasoconstriction (a1) bronchodilation (b2) acts on B2 receptor on immune cells preventing degranulation
148
why not to give anti-histamines in anaphylaxis?
doesnt do anything to vasculature or bronch but does improve urticaria so may be decieving that the pt is improving when they are still in anaphylaxis
149
what are released from mast cells minutes to hours after (late phase reaction)
leukotriene prostaglandins prostacyclins thromboxane A2
150
what inherited immunodeficiency is particularly associated with recurrent meningococcal disease
complement deficincies (encapsualted bacteria)
151
important condition to screen for in SLE pts. and how is it done
anti-phosopholipid syndrome anti-cardiolipin Ab anti-b2glycoprotein 1 ab lupus anticoagulant test
152
tests for complement
C3, C4 levels CH50 AP50
153
features of antiphospholipisd syndorme
thrombocytopenia livedo reticularis (mottled rash) libmann sacks endocarditis
154
pathophysiology of SLE
abnormality in clearance of apoptotic cells abnormalities in cellular
155
drugs used in SLE
prednisolone anifrolumab azathioprine hydroxychloroquine Rituximab Belimumab Mycophenolate Mofetil (more than aza and cyclo as steroid sparing) Cyclophosphamide
156
what is Rheumatoid factor
antibody against Fc portion of IgG moderate sensitivity and specificity to RA Sjorgrens may have positive RF
157
what increases your risk of RA and why
smoking PADI polymorphism gingivitis --> leads to increased citrullination of proteins which can form Abs to
158
first line tx of RA
DMARDS - methotrexate - sulhasalazine - hydroxychloroquine -IL6 receptor blockers - TNFa blockers - anti CD20 - CTLA4 fusion protein
159
what to screen for when starting on immunosupressants
TB, HBV, HCV exposure prior Hx of septic arthritis that may not have fully cleared inc risk of melanoma so skin protection
160
what is ESR and why is it raised in myeloma
measures rate of fall of erythrocytes in plasma in a centrifuge clumping of RBC in myeloma causes them to fall more rapidly
161
what inherited immunodeficiencies leads to increased risk of viral infections eg. recurrent otitis media and URTI
immunoglobulin deficiencies eg. Brutons X linked agammaglobulinaemia
162
Pathogenic antibody in bullous pemphigoid
anti-hemidesmosome (adhesion molecules of BM)
163
pathogenic antibody in pemphigus vulgaris
anti-desmoglein 1&3
164
What viral enzyme is predominantly responsible for the high mutation rate of HIV and other RNA viruses?
reverse transcriptase
165
what is the defective protein in XSCID
common gamma chain
166
mechanism of the CH50 test
looks at complement activity tests the ability for the patient serum to lyse sheep RBCs coated in rabbit anti sheep antibodies
167
what mAb is used in osteoporosis and what is the target?
denosumab targets RANKL
168
what is measured in anyphylaxis to monitor response to treatment
mast cell tryptase
169
what is the specific target of p-ANCA Abs
myeloperoxidase
170
what is the specific target of c-ANCA Abs
proteinase 3
171
gold standard test for diagnosing food allergy
double blind oral food challenge
172
most common inherited primary immunodeficiency
selective IgA deficiency

Pathology and final year (21 decks)

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