Immunology Flashcards
1
Q
Kupffer Cell
A
Liver macrophage
2
Q
Mesangial Cell
A
Kidney macrophage
3
Q
Microglia
A
Neural macrophage
4
Q
Langerhans Cell
A
Skin macrophage
5
Q
Isotype Switching and Somatic Hypermutation happen where?
A
Germinal Centre
6
Q
Memory response caused by which type of immunoglobulin?
A
IgG
7
Q
Congenital neutropaenia
A
Kostmann Syndrome
HAX1 mutation
8
Q
Neutropaenia every 6 weeks
A
Cyclic neutropaenia
Neutrophil Elastase mutation
9
Q
Very high neutrophils in blood, none in tissue
A
Leukocyte Adhesion Deficiency: lack CD18 –> neutrophils can’t exit blood
10
Q
Recurrent chickenpox
A
NK Deficiency
11
Q
SLE caused by deficiency of which complement pathway?
A
Classical Pathway Deficiency
12
Q
Which renal disease causes complement deficiency?
A
Membranous Glomerulonephritis = nephritic factors attack C3
13
Q
High forehead, low-set ears, hypocalcaemia
A
DiGeorge Syndrome
14
Q
DiGeorge Syndrome is due to deletion of what?
A
Chromosome 22q11.2
15
Q
Do not respond to immunisations
A
Common Variable Immune Deficiency (very low IgG)
16
Q
Gene locus in Coeliac
A
HLA-DQ2
17
Q
Confirmation of Coeliac diagnosis
A
Upper GI endoscopy + distal duodenal biopsy
18
Q
Periodic fevers, amyloid A amyloidosis and red rash
A
Familial Mediterranean Fever
19
Q
Hypoparathyroidism and Addison’s
A
APS1 and APECED = defect in autoimmune regulator (AIRE) = transcription factor for T cell tolerance in thymus
20
Q
Crohn’s caused by this mutations
A
NOD2 mutation in chromosome 16
NOD2 stimulates NFkB
21
Q
Inflammation of entheses (insertion of ligament/tendon) and sacro-iliitis
A
Ankylosing Spondylitis
22
Q
Anti-GAD65 and anti-IA2 antibodies
A
Type I Diabetes
23
Q
Drooping eyelids and weakness after repetitive activity
A
Myasthenia Gravis
24
Q
Autoimmune condition featuring crescentic nephritis on biopsy
A
Goodpasture’s Disease
25
Tensilon Test
Myasthenia Gravis
| = edrophonium (anti-cholinesterase) prolongs life of ACh…
26
Rheumatoid Arthritis associated with these alleles
HLA DR1 and DR4
27
Porphyromonas gingivalis gum infection causes which autoimmune disease?
Rheumatoid Arthritis
28
Rheumatoid Arthritis associated with these polymorphisms
PAD2 and PAD4
| PTPN22
29
Anti-Ro and anti-La
Sjogren's
30
Heliotrope rash
Dermatomyositis
31
Severe side effect of cyclophosphamide
Haemorrhagic cystitis = toxic metabolite acrolein excreted in urine
32
People susceptible to bone marrow suppression with azathioprine
Thiopurine Methyltransferase (TPMT) polymorphism = can’t metabolise azathioprine…
33
Severe side effects of mycophenolate
Progressive Multifocal Leukoencephalopathy (JC virus which destroys oligodendrocytes)
Herpes reactivation
34
Side effect of ciclosporin
Dysmorphia
35
Side effect of rituximab
Progressive Multifocal Leukoencephalopathy
36
Side effects of anti-TNFa
Lupus-like condition
Demyelination
Melanoma
37
Side effect of denosumab
Avascular necrosis of jaw
38
Which malignancies are increased in transplant patients?
Virus-associated
- Kaposi Sarcoma (HHV8)
- Lymphoproliferative Disease (EBV)
39
Definition of AIDS
CD4 < 200
40
Definition of positive skin-prick test
>3mm greater than negative control
41
Biomarker of anaphylaxis
Serial mast cell tryptase
42
Gold-standard test for allergy
Challenge Testing
43
Antibodies deposited along GBM in "smooth linear pattern"
Goodpasture's
44
Low T cells with cleft palate
```
DiGeorge Syndrome = CATCH:
Cardiac
Atresia (oesophagus)
Thymus absent
Cleft Palate
Hypocalcaemia
```
45
Mutation of MHC III causes this disease
Common Variable Immunodeficiency (recurrent chest infections)
46
Negative NBT Test (i.e. stays colourless)
Chronic Granulomatous Disease = deficiency of NADPH oxidase
(NADPH oxidase turns NBT blue)
-->have NORMAL neutrophil count as their numbers are fine, just their mechanism of killing
47
Deficiency in either MHC I or MHC II
Bare Lymphocyte Syndrome
| -causes jaundice
48
Recurrent resp and GI infections
| Anaphylaxis after 2nd blood transfusion from same donor
Selective IgA Deficiency Disease
- IgA = mucosal immunity, so have recurrent resp and GI infections
- Anaphylaxis after blood transfusions due to donor IgA (2nd transfusion only as need to make antibodies against donor IgA in 1st transfusion)
49
Low IgM
| Raised IgA and IgG
Wiskott-Aldrich Syndrome
50
Deficiency in this enzyme causes SCID
Adenosine deaminase
51
BCG vaccine contains this live attenuated organism
Mycobacterium bovis
52
Vaccine made of detoxified exotoxin product of the microbe
Tetanus
53
Vaccine made using recombinant DNA
Hep B
54
Vaccine given to sero-negative women only
Rubella
55
Vaccine available in live attenuated (oral) and inactivated --> excreted in stools
Poliomyelitis
56
Conjugate vaccine given to neonates
HiB
57
Adjuvant that promotes antibody response via IL-4 (which primes naive B cells)
Alum
58
Which immunity is induced by vaccines: active or passive?
Active
59
Immunosuppressant causing gum hyperplasia
Cyclosporine A
60
1. Steroid used to prevent rejection
| 2. Steroid used to treat rejection
1. Prednisolone
| 2. Methylprednisolone
61
Anti-Jo1
Dermatomyositis
62
Anti-topoisomerase
Diffuse systemic scleroderma
63
Dry mouth and eyes
| Joint pain
Sjogren's Syndrome (exocrine glands destroyed)
| --> diagnose dry eyes using Schirmer's Test
64
Antibodies in Sjogren's
Anti-Ro and Anti-La ... also Rheumatoid Factor
65
Saddle-shaped nose, with haemoptysis and haematuria
Wegener's Granulamatosis
66
Target of IgG in Goodpasture's
Type IV collagen (found in GBM and lung basement membrane!)
67
Polyarteritis nodosa with these infections
Hepatitis B and C -- look out for "IVDU" in the question!
68
22 year old female who has recently undergone surgery presents with difficulties breathing and swelling of the face, hands and feet. She also complains of severe abdominal pains. She has experienced similar problems in the past.
C1 inhibitor deficiency = Hereditary Angioedema
69
HLA associated with psoriatic arthritis
HLA-B27
70
HLA associated with dermatitis herpetiformis
HLA-DR3
71
Which cells mediate:
1. Hyperacute organ rejection
2. Acute and chronic organ rejection
1. B cells
| 2. T cells
72
Complements that can activate mast cells to cause allergic symptoms
C3a and C5a
73
What type of hypersensitivity in:
- SLE
- Rheumatoid arthritis
- Serum sickness
- Post-strep glomerulonephritis
Type III = antibody-antigen complexes depsoit
- SLE = dsDNA
- Rheumatoid arthritis = Fc region of IgG
- Post-strep = strep wall antigens
74
What type of hypersensitivity in:
- T1 DM
- MS
- Contact dermatitis
- Hashimoto's
Type IV = T cells
- T1 DM = beta cells
- MS = myelin protein
- Contact dermatitis = environmental chemicals
- Hashimoto's = thyroglobulin
75
What type of hypersensitivity in:
- Autoimmune Haemolytic Anaemia
- ITP
- Goodpasture's
- Pernicious anaemia
Type II = antibodies bind to cell-based antigen
- Autoimmune Haemolytic Anaemia = RBCs
- ITP = platelets
- Goodpasture's = GBM
- Pernicious anaemia = parietal cells
76
What type of hypersensitivity in:
- Graves
- Myasthenia Gravis
Type V = antibodies bind to cell surface receptor
- Graves = TSH receptor
- Myasthenia Gravis = ACh receptor
77
Immunoglobulin which passes through:
1. Placenta
2. Breast milk
1. IgG
| 2. IgA
78
First immunoglobulin secreted in response to infection
IgM
79
Cell surface marker associated with Reed-Sternberg cells
CD15
80
Complement deficiency predispose to which type of infection?
Encapsulated bacterial (meningococcus, pneumococcus...)
81
Which kidney disease causes secondary complement deficiency?
Membranous Glomerulonephritis = nephritic factors attack C3
82
Enzyme deficiency causing SCID
Adenosine Deaminase (ADA) Deficiency
83
Condition where you lack MHC II
Bare Lymphocyte Syndrome
- -> lack CD4 (have normal CD8 and B cells)
- ->low IgG and IgA as lack help from CD4!
84
Condition where you lack mature B cells
Bruton’s X-Linked Agammaglobulinaemia
= abnormal B cell tyrosine kinase
-only in boys as X-linked!
85
Condition where you have lots of IgM, but no other immunoglobulin
Hyper IgM Syndrome
=mutation in CD40 ligand (expressed on T cells)
-->IgM B cells can’t enter germinal centre
-->no isotype switching
86
Hyper IgM predisposes you to this infection
Pneumocystis jiroveci
87
B cell deficiency associated with Coeliac
Selective IgA Deficiency
88
Monogenic auto-inflammatory disorder
Familial Mediterranean Fever
89
Immunoglobulin that is a dimer
IgG = most abundant immunoglobulin
90
Immunoglobulin that is a pentamer
IgM
91
HLA DR3
Graves
SLE
Myasthenia Gravis
92
HLA DR4
T1DM
| Rheumatoid Arthritis
93
SLE deficient in which complement pathway?
Classical (C1, 2, 4) = clears immune complexes and apoptotic cells
94
Autograft
Isograft
Allograft
Xenograft
```
Autograft = own
Isograft = twin
Allograft = same species
Xenograft = different species
```
95
Azathioprine converted to this metabolite, which prevents DNA synthesis
6-mercaptopurine
96
Corticosteroids inhibit....
Phospholipase A2
97
How does HIV enter CD4?
gp120 binds to CXCR4 on surface of CD4
| CCR5 is on surface of macrophages!
98
Important side effects of anti-TNF
Lupus-like condition
Demyelination
Cancer
99
Denosumab inhibits...
RANK ligand (inhibiting osteoclast)
100
Specific test for dry eyes in Sjogren's
Schirmer's Test
101
Anti-CCP target what in rheumatoid?
Filaggrin
102
Anti-centromere
Limited systemic scleroderma (CREST)
103
Anti-thyroid peroxidase and anti-thyroglobulin
Hashimoto's
104
Abnormal FoxP3 --> dysfunctional Tregs
IPEX (X-linked)
- Diabetes
- Eczema
- Enteropathy
105
Mutations in AIRE (important for central tolerance)
APECED Syndrome Type 1
| -->hyothyroid, alopecia and vitiligo
106
Anti-CD25 (part of IL-2R), prevents allograft rejection
Basiliximab
107
CTLA4 fusion protein, for rheumatoid arthritis
Abatacept
108
Monoclonal used in highly-active MS and last-resort for Crohn's
Natalizumab = anti-α4 integrin
109
Denosumab inhibits
RANK ligand
110
Anti-IL-12 and anti-IL-23 used in psoriasis and Crohn's
Ustekinumab
| Side effect = TB
111
Most severe form of influenza
Influenza A
112
Bird flu is this strain if influenza
H5N1
113
What is anti-SCL-70?
Anti-topoisomerase in systemic sclerosis!
114
Biologic used in psoriasis
Ustekinumab = anti-IL-12 and anti-IL-23
115
Mechanism of cyclophosphamide
Alkylating agent --> alkylates guanine base of DNA --> damages DNA
116
Mechanism of mycophenolate
Anti-metabolite = Stops synthesis of new guanine --> prevents DNA replication
117
Immunosuppressant used in multi-system vasculitis (like Wegener's)
Cyclophosphamide
118
Which type of antihistamine used in allergy: H1, 2, 3 or 4?
```
H1 antagonist
(H2 = gastric mucosa)
```
119
Neutralising antibodies are formed against this HIV molecule
gp120
120
Non-neutralising antibodies are formed against this HIV molecule
p24
121
Co-receptors required for HIV entry into cells
CCR5 and CXCR4
122
What is CD40L deficiency?
Hyper IgM Syndrome!
123
Who can have falsely negative anti-TTG?
IgA Deficient (as anti-TTG is IgA)
124
Single gene mutation involving FOXP3 --> abnormal T regulatory cells
IPEX
125
Mutated pyrin-marenostrin
Familial Mediterranean Fever
126
Tests for Chronic Granulomatous Disease
NBT Test (does not change yellow to blue) and DHR Test (no fluorescence)
127
Recurrent atypical Mycobacterium infections
IFN-γ receptor deficiency
128
Initiates Classical Complement
| Deficiency associated with SLE
C1q
129
Test used to diagnose Di George
FISH = detects microdeletions (22q11)
130
Recurrent meningococcal infections
Complement Deficiency
131
Recurrent resp and CNS infections (in a boy)
Bruton's X-Linked Agammaglobulinaemia
132
Defect in Bruton's X-Linked Agammaglobulinaemia
Abnormal B cell tyrosine kinase --> pre-B cells do not mature
133
Most specific test in Sjogren's
Anti-La
134
Components of Classical Complement Pathway
C1, 2, 4 -- C1 binds to antibody-antigen complexes, activating cascade
135
Components of Alternative Complement Pathway
C3 and Factors B, I, P -- C3 binds to bacterial cell wall parts (like LPS)
136
Components of MBL Pathway
C2 and C4 -- MBL binds to microbial cell surface carbs, stimulating Classical Pathway
137
Complement Pathway dependent of adaptive immune system
Classical (C1 binds to antibody-antigen complexes)
138
What complement gets activated in the major amplification step of the cascade?
C3
139
Membrane Attack Complex via which complements?
C5-9
140
Membrane Attack Complex formation defect (C5-9 deficiency) results in...
Meningococcal infections
141
Deficiency in Classical Complement Pathway associated with...
Immune-complex diseases (SLE)
142
Most common mode of inheritance in Di George
90% sporadic!
143
Low IgM, eczema and low platelets
Wiskott-Aldrich Syndrome
144
Recurrent PCP infections in a child
SCID (low T cells)
145
Recurrent Aspergillus infection
Chronic Granulomatous Disease (neutrophils can't kill)
146
Hereditary Angioedema = deficiency in what?
C1 inhibitor protein --> have low C4 during attacks
147
Dose used in anaphylaxis
0.5mg of 1:1000
148
Antibody which correlates with disease severity in SLE
Anti-dsDNA
149
Positive hydrogen breath test, increased stool osmolality
Lactose Intolerance
150
Cause of commonest SCID
X-linked recessive mutation of common gamma chain on chr X (cytokine receptor)
151
Cause of SCID in girls
Adenosine Deaminase (ADA) Deficiency
152
DiGeorge is due to developmental defects in what during pregnancy?
3rd and 4th pharyngeal pouches = source of thymus and parathyroids
153
Deficiency in this complement increases risk of encapsulated organisms
C3
154
HLA in Reactive Arthritis
HLA-B27
155
HLA in Dermatitis Herpetiformis
HLA-DR3
156
HLA in Rheumatoid Arthritis
HLA-DR4
157
First immunoglobulin in response to infection
IgM = IgNow!
158
Immunoglobulin deficiency predisposing towards encapsulated organisms
IgG Deficiency
159
Biologic against alpa-4-integrin
Natalizumub
160
Calcineurin Inhibitors inhibit secretion of this cytokine
IL-2 (promotes T cell proliferation)
161
Diagnosis of coeliac in IgA deficient
Go straight to duodenal biopsy
162
Coeliac antibody that remains for 12 months after gluten-free diet
Anti-gliadin
163
Cytokine in central memory
IL-2
164
Vaccine made using recombinant DNA technology
Hep B
165
Antigen assembled in a multimeric form and saponin that provokes a strong serum antibody response.
Immunostimulatory complexes (ISCOMS)
166
Type of collagen targeted in Goodpasture's
Type IV collagen
