Immunology Flashcards
1
Q
IgA deficiency affects what type of surface?
A
Mucosal surfaces
2
Q
Which cell type is affected in reticular dysgenesis?
A
Neutrophils (reduced production)
3
Q
Which mutation is associated with reticular dysgenesis?
A
Enzyme adenylate kinase 2
4
Q
Which primary immune deficiency is defined as an autosomal recessive congenital failure of neutrophil maturation?
A
Kostmann syndrome
5
Q
Which enzyme is affected in cyclic neutropenia?
A
Neutrophil elastase
6
Q
What is the inheritance pattern of cyclic neutropenia?
A
Autosomal dominant episodic neutropenia every 4-6 weeks
7
Q
Which primary immune deficiency is associated a very high neutrophil account, and delayed umbilical cord separation?
A
Leukocyte adhesion deficiency
8
Q
Which adhesion molecules are insufficiently expressed in Leukocyte adhesion deficiency?
A
CD11a/CD18 and CD11b/CD18
9
Q
Which neonatal complication is associated with leukocyte adhesion deficiency?
A
Delayed umbilical cord separation
10
Q
What neutrophil pathology is observed in leukocyte adhesion deficiency?
A
Neutrophilia (raised neutrophil count)
11
Q
Which primary immunodeficiency is characterised by deficient NADPH oxidase?
A
Chronic granulomatous disease
12
Q
Which investigations are indicated for establishing the diagnosis of deficiency oxidative killing?
A
Nitro-Blue Tetrazolium test
and
DHR flow cytometry
13
Q
What NBT test result is observed in chronic granulomatous disease?
A
Negative
(dye normally changes colour from yellow to blue following the interaction with hydrogen peroxide)
14
Q
In DHR flow cytometry test, DHR is oxidised to what, following the interaction with hydrogen peroxide?
A
Rhodamine
15
Q
What is the management for chronic granulomatous disease (NADPH oxidase deficiency)?
A
Interferon gamma
16
Q
What enzyme is deficient in chronic granulomatous disease?
A
NADPH oxidase (oxygen is not converted to superoxide)
17
Q
In chronic granulomatous disease (NADPH oxidase deficiency), which types of organisms proliferate?
A
Catalase positive bacteria
PLACES
Pseudomonas
Listeria
Aspergillus (mould)
Candida (fungus)
Staph aureus
Serratia
18
Q
Deficiency of which interleukin predisposes individuals to mycobacteria?
A
IL-12 and IFN-y (Inability to form granulomas - as infected macrophages typically produce IL12)
19
Q
Which factors are associated with the alterantive pathway?
A
Factor B, D, P (properdin)
20
Q
Alternative pathway complement deficiencies predisposes the host to which type of bacteria?
A
Encapsulated organisms
21
Q
What role does properdin have in the complement cascade?
A
Stabilises C3 convertase - triggers the membrane attack complex (MAC
22
Q
Classical pathway complement deficiency is associated with which type III hypersensitivity disorder?
A
SLE
23
Q
Which complement (C) is the divergence point for all complement pathways?
A
C3
24
Q
C3 deficiency predisposes the host to recurrent infected by which type of bacteria (Name 3)?
A
(esp. encapsulated – meningococcus, streptococcus, haemophiles)
25
Secondary C3 deficiency is associated with what type of factors?
Nephritic factors - C3 auto-antibodies
26
X-linked SCID is associated with which mutation?
Gamma-chain of IL2 receptor
27
What is the observed phenotype for X-linked SCID?
Very low or absent T and NK cell
Normal or increased B cells
28
What role does IL-2 receptors have?
Respond to cytokines to promote T cell and NK cell development
29
What is the phenotype observed in adenosine deaminase deficiency?
* Very low or absent T cell and NK cell numbers
* Very low or absent B cell numbers
30
What role does adenosine deaminase have?
Lymphocytes require ADA for cell metabolism
31
Which mutation is associated with DiGeorge Syndrome?
TBX1
32
Which chromosomal aberration is associated with DiGeorge syndrome?
22q11.2.
33
What is the diagnosis for the following features:
* Cardiac abnormalities (especially tetralogy of Fallot)
* Abnormal facies (high forehead, low set ears)
* Thymic aplasia (T cell lymphopenia)
* Cleft palate
*Hypocalcaemia/hypoparathyroidism
DiGeorge syndrome
(22q11.2 deletion syndrome)
34
What is the developmental defect associated with DiGeorge Syndrome regarding primary immune deficiency?
Thymic aplasia
Pharyngeal pouch
35
What are the clinical manifestations associated with DiGeorge syndrome
(22q11.2 deletion syndrome)?
Remember CATCH-22:
* Cardiac abnormalities (especially tetralogy of Fallot)
* Abnormal facies (high forehead, low set ears)
* Thymic aplasia (T cell lymphopenia)
* Cleft palate
* Hypocalcaemia/hypoparathyroidism
* 22 – chromosome (Detected by FISH cytogenetic analysis).
36
What is the B/T cell phenotype observed in DiGeorge Syndrome?
Normal number of B cells
Reduced numbers of T cells
37
Bare lymphocyte syndrome is associated an absent expression of which molecule?
MHC-II molecules
38
Which T cell is deficient in bare lymphocyte syndrome Type II?
CD4+ cells
39
CD40L deficiency is associated with which type of primary immune deficiency?
Hyper-IgM syndrome
40
Which CD ligand is deficient in Hyper IgM syndrome?
CD40L
41
What is the inheritance pattern for Wiskott-Aldrich Syndrome ?
X-linked recessive
42
Which cell type is affected in Bruton's X-linked hypogammaglobulinaemia?
B-cells
(Pre-B cells cannot develop to mature B cells)
43
Which enzyme is defective in Bruton's X-linked hypogammaglobulinaemia?
Tyrosine kinase
44
CD40L mutation results in what primary immune deficiency?
Hyper IgM syndrome
45
What effect does HyperIgM syndrome have on immunoglobulins?
Elevated Serum IgM
Undetectable IgA, IgE, IgG
46
Which primary immune deficiency is characterised by a marked reduction in IgG with low IgA and IgM?
Common variable immune deficiency
47
In a DHR flow cytometry test, what is the positive reaction?
Oxidised to rhodamine – strongly fluorescent following interaction with hydrogen peroxide.
48
What are the positive responses for a NBT test?
* Nitro-Blue Tetrazolium test
- Dye that changes colour from yellow to blue, following interaction with hydrogen peroxide.
49
What are the antibiotic prophylaxis for immunodeficiency?
Septrin (co-trimoxazole)
50
What is the definitive therapy for phagocyte deficiency?
Haematopoietic stem cell transplantation
51
What are the diagnostic tests for complement deficiency?
CH50 (classical pathway)
AP50 (Alternative pathway)
52
Which interleukins are responsible for causing fever?
IL-1, and IL-6
53
Which cytokines are implicated in monogenic auto-inflammatory disease?
TNF-alpha and IL-1
54
What is the inheritance pattern for Familial Mediterranean Fever?
Autosomal recessive
55
Which gene is implicated in Familial Mediterranean Fever?
MEFV
56
Which enzyme is raised in Familial Mediterranean Fever?
Pro-caspase 1 - increases TNF-alpha and IL-1
57
What is the clinical presentation for Familial Mediterranean Fever?
Clinical Presentation – periodic fevers lasting 48-96 hours, associated with:
* Abdominal pain (peritonitis)
* Chest pain (pleurisy and pericarditis)
* Arthritis
* Rash
58
What is the long term risk associated with Familial Mediterranean Fever?
AA amyloidosis
59
Why is the risk of AA amyloidosis increased in Familial Mediterranean Fever?
Liver produces serum amyloid AA as an acute phase protein - deposition in kidneys, liver and spleen = nephrotic syndrome (proteinuria) + renal failure.
60
AL amyloidosis is associated with what?
Multiple myeloma
61
What is the medical management for Familial Mediterranean Fever?
Colchicine
Anakinra
Etanercept
62
What is the mechanism of action for Colchicine?
Binds to tubulin in neutrophils - disrupts function in migration/cytokine
63
What is the mechanism of action of anakinra?
IL-receptor antagonist
64
What is the mechanism of action for etanercept?
TNF-alpha inhibitor
65
Name a TNF-alpha inhibitor
Etanercept
66
Name 2 pattern recognition receptors?
Toll-like receptors and mannose receptors
67
Antibodies bind to which type of receptors?
Fc receptors
68
Which enzyme is implicated in oxidative killing?
NADPH oxdiase
69
NADPH oxidase complex converts oxygen to which type of reactive oxygen species?
Superoxide and hydrogen peroxide
70
Which bactericidal enzymes are implicated in non-oxidative killing of bacteria in phagolysome?
lysozyme and lactoferrin
71
What is the site of T-cell maturation?
Thymus
72
What is the site of B cell maturation?
Bone marrow
73
Name 3 secondary lymphoid organs
Lymph nodes
Spleen
Mucosal-associated lymphoid tissue (MALT)
74
What role does the thymus play in T-cell maturation?
Positive and negative selection
75
Which CD factor is expressed by all T-cells?
CD3
76
CD8+ bind to which MHC molecule?
MHC-I
77
CD4+ binds to which MHC molecule?
MHC-II
78
Role of Th1 cells?
Helps CD8 and macrophages produce IL-2, IFN-Y and TNF.
79
Role of Th2 cells?
Humoral response - Helper T cell produce IL-4,5,6
80
Which cell is recruited by Th17 cells?
Neutrophils
81
Which IL is secreted by Th17 cells (3 types)?
IL-17, 21, 22
82
What is expressed by T regulatory cells?
CD25 and FoxP3
83
Which type of T cells promote germinal centre reactions and B-cell differentiation
T follicular helper cells
84
Which factors and enzymes are released by CD8 T cells?
Perforin
Granzymes
85
Which cytokines are secreted by CD8 T-cells?
TNF-alpha and IFN-gamma
86
Which is the first type of immunoglobulin is produced by B-cells?
IgM
87
Which ligand interaction supports B-cell differentiation?
CD40L:CD40 interaction
88
What two processes do B-cells undergo?
Isotype switching
Somatic hypermutation
89
Which antibody region is the variable region?
FAB - light chains
90
Where are central memory cells made?
High endothelial venules (HEVs)
Lymph nodes
91
What protein is used for the Mantoux test?
Purified protein derivative
92
Threshold for positive mantoux test?
>10 mm in diameter
93
Positive NBT test colour?
Blue
94
Negative NBT test colour?
Yellow
95
Which IL causes fever?
IL-1, IL-6
96
Clinical presentation of familial mediterranean fever?
Clinical Presentation – periodic fevers lasting 48-96 hours, associated with:
* Abdominal pain (peritonitis)
* Chest pain (pleurisy and pericarditis)
* Arthritis
* Rash
97
Which gene is implicated in Crohn's disease?
NOD2 and iBD1 gene.
98
What doses NOD2 code for?
Cytoplasmic microbial sensor
99
What is the management for Crohns disease?
Corticosteroid
Anti-TNF-alpha antibodies
100
Failure of central tolerance is associated with a defect in what gene?
Autoimmune regulator gene (AIRE)
101
Failure of peripheral tolerance is associated with which gene?
Foxp3
102
Molecular self-mimicry is associated with what condition?
Rheumatic fever
Ankylosing spodylitis
103
Name a monogenic autoimmune disease of central tolerance?
Autoimmune polyendocrine syndrome type 1 (APS1)
Auto-immune polyendocrinopathy-candidiasis-ectodermal dystrophy syndrome (APECED)
104
What is the inheritance pattern for autoimmune polyendocrine syndrome type 1?
Autosomal recessive
105
Which endocrine autoimmune disorders are associated with APS1?
* Multiple auto-immune endocrine diseases: Hypothyroidism, Hypoparathyroidism (85%), Addison’s (78%), Diabetes, Vitiligo, candidiasis (98% - anti-IL17 and anti-IL22 antibodies)
106
Mutations in which gene is associated with IPEX?
Foxp3
107
Name a monogenic autoimmune disease associated with peripheral tolerance?
Immune dysregulation polyendocrinopathy enteropathy (IPEX)
108
what are the clinical features associated with IPEX?
Three Ds - diabetes mellitus, diarrhoea, dermatitis
109
Which cells are affected in IPEX (peripheral tolerance defect)?
Treg cells
Autoreactive B cells
Failure to negatively regulate T cells
110
What is the inheritance pattern for ALPS?
Autosomal dominant
111
Goodpasture disease - allele
HLA-DR15
112
Graves disease - allele
HLA-DR3
113
HLA allele in rheumatoid arthritis
HLA-DR4
114
Which antibody is associated with bullous pemiphigoid?
Anti-hemidesmosome
115
Coeliac disease -antibody
Coeliac disease
Anti-tissue transglutaminase antibody (IgA), Anti-endomysial antibody (IgA)
116
Neonatal complication is the context of Anti-Ro antibody (to mothers with SLE)?
Congenital heart block
117
Which antibody in SLE is associated with congenital heart block?
Anti-Ro
118
Which antibody is implicated in dermatitis herpetiformis?
Anti-endomysial antibodies
119
Goodpasture's antibody
Anti-GBM antibody
120
Graves disease is associated with with autoantibody?
TSH-receptor antibody
121
Hashimoto's thyroiditis is associated with which two autoantibodies?
Antibodies to Thyroglobulin and Thyroperoxidase
122
Anti-Ach Receptor Antibody is associated with what autoimmune disease?
Myasthenia Gravis
123
Autoantibodies associated with pernicious anaemia?
AB to gastric parietal cells
Intrinsic factor
124
Anti-mitochondrial antibody is associated with which autoimmune condition?
Primary biliary cirrhosis
125
Antibodies to glutamase decarboxylase is associated with which disease?
T1DM
126
Which autoantibodies is associated with autoimmune TTP?
Anti-Glycoprotein IIb-IIIa or Ib-IX Antibody
127
Which specific autoantibody is implicated in rheumatoid arthritis?
Anti-CCP
128
Which joint is spared rheumatoid arthritis?
Distal interphalangeal joints
129
What are the hand deformities associated with rheumatoid arthritis?
Swann neck, Boutinnier's, Z-thumb and ulnar deviation
130
Which autoantibody is associated with SLE?
Anti-dsDNA antibody
131
Which type of rash is associated with SLE?
Malar rash
132
Anti-Ro and Anti-La autoantibodies are associated with which autoimmune disorder?
Sjogren's disease
133
Dermatomyositis is associated with which autoantibody?
Anti-Jo antibody
134
Which characteristic rash is associated with Dermatomyositis?
Heliotrope rash
135
Gottron's papules are associated with which autoimmune disorder?
Dermatomyositis
136
What is the characteristics of polymyositis?
Respiratory weakness
Diffuse myopathy
Dysphagia
137
Which enzyme is elevated in Dermatomyositis ?
Creatine kinase
138
CREST is associated with which autoantibodies?
Anti-centromere
139
What are the features associated with CREST?
* Calcinosis
* Raynaud’s
* Oesophageal dysmotility
* Sclerodactyly
* Telangiectasia
140
Anti-Scl70 antibodies are associated with what autoimmune disorder?
Diffuse CREST
141
cANCA is directed against which enzyme?
Proteinase 3
142
Granulomatosis with Polyangiitis
(Wegner’s) is associated with which type of antibody?
cANCA
143
pANCA is associated with which type of polyangitis?
Eosinophilic Granulomatosis with Polyangiitis (Churg Strauss)
Microscopic polyangitis
144
pANCA is directed against which enzyme?
Myeloperoxidase
145
Allergic asthma is associated with which polyangitis?
Eosinophilic Granulomatosis with Polyangiitis (Churg Strauss)
146
Which acute post-transfusion reaction is associated with a transient rise in temperature?
Febrile. non-haemolytic transfusion reaction
147
What is the management for febrile non-haemolytic transfusion reaction?
Paracetamol - stop/taper transfusion
148
Allergic transfusion reaction is associated with what presentation?
Mild urticarial rash + pruritus accompanied by heeze caused by allergy to donor plasma proteins
149
What is the management for allergic transfusion reactions?
IV antihistamines
150
ABO incompatibility is mediated by what Immunoglobulin?
IgM
151
What is the primary cause of ABO incompatibility post-transfusion?
Failure of bedside check
152
Which blood product is susceptible to bacterial contamination?
Platelets (stored at room temperature)
153
Which patients are at an increased risk of anaphylaxis post-transfusion?
Patients with IgA deficiency
154
What two pulmonary post-transfusion reactions are severe?
Transfusion-associated circulatory overload
Transfusion-related acute lung injury
155
Which drug is indicated in the management of TACO?
Diuretics
156
Which pulmonary acute transfusion reaction is associated with fever?
Transfusion-related acute lung injury
157
What are the clinical features of TRALI?
Dyspnoea, low oxygen saturations, fever, high HR, high BP.
158
What CXR findings are implicated in TRALI?
Bilateral pulmonary infiltrates during/within 6 hours of transfusion due to circulatory overload.
159
Which antibodies are implicated in the pathophysiology of TRALI?
Anti-WBC antibodies in donor blood - aggregate to pulmonary capillaries and release neutrophil proteolytic enzymes
160
Which two antigens are implicated in delayed haemolytic transfusion reaction?
Duffy and Kidd
161
What prophylactic measure is implicated in mitigating CMV post-transfusion infection
Leucodepletion/irradiation
162
What is the consequence of parvovirus infection post-transfusion?
Red cell aplasia
163
What are the consequences of transfusion-associated graft versus host disease?
Diarrhoea, liver failure, skin desquamation, bone marrow failure, death
164
Which antigen is implicated in the pathophysiology of post-transfusion purpura?
Human platelet antigen 1a negative patients
165
Which test checks for ffDNA in maternal circulation?
* Kleihauer test
166
Which Ig is implicated in the pathophysiology of Type 1 hypersensitivity disorders?
IgE
167
Mast cell degranulation in T1HD results in the release of what?
histamine, proteases, prostaglandin, cytokines, platelet activating factors and leukotrienes.
168
What are the physiological effects of mast cell degraulation?
- Increased vascular permeability.
- Peripheral vasodilation
- Smooth muscle contraction – increased mucous secretions, bronchospasms, abdominal cramping.
- Rhinitis
169
How is a diagnostic of food allergy made?
Food diary and skin prick testing
170
Diagnostic test for latex food syndrome?
Skin prick testing
171
Which is deficient in hereditary angioedema?
C1 inhibitor
172
What is used as a positive control for skin prick testing?
Histamine
173
How long should anti-histamines be discontinued for prior to skin prick testing?
48 hours
174
Which allergen is associated with peanuts and nuts?
Ara h2
175
Ara h8 protein is associated with what?
Oral reactions to peanut and stone fruit
176
What quantitative test is used to measure IgE in serum>
RAST
177
What is the diagnostic test to food allergens?
Challenge test
178
During an acute allergic reaction, what should be measured?
Measure mast cell tryptase
179
What type of hypersensitivity reaction is characterised by auto-antibody production?
Type 2
180
Evan's syndrome is characterised by what?
ITP + AIHA
181
Autoimmune thrombocytopenia purpura is associated with which antigen?
Glycoprotein iib, and iiia
182
What hypersensitivity reaction is Goodpasture's syndrome?
Type-2
183
What is the antigen implicated in goodpasture's syndrome?
Collage type IV
184
Which antibody is associated with Goodpasture's syndrome?
Anti-GBM antibody
185
What is the histological appearance of goodpasture's syndrome?
Linear smooth deposition of IgG deposits on the basement membrane
186
What is the antigen in pemphigus vulgaris?
Desmoglein-3
187
What antibody is associated with Myasthenia gravis?
Anti-Acetylcholine receptor
188
What is the diagnostic tests implicated with Myasthenia Gravis?
Tensilon test and EMG
189
What type of hypersensitivity reaction is acute rheumatic fever?
Type II
190
Which criteria is used to diagnose Acute rheumatic fever?
Jones Criteria
191
Churg-Strauss Syndrome is associated with which antibody?
p-ANCA
192
p-ANCA is targeted against what?
myeloperoxidase
193
Wegener’s Granulomatosis
(GPA)
- antibody?
C-ANCA
194
c-ANCA target?
Proteinase 3
195
Serum sickness is which type of hypersensitivity?
3
196
Which antigen is implicated in serum sickness?
Reaction to Proteins in Antiserum (Penicillin)
197
What angiographic sign is seen with polyarteritis nodosa?
Rosary-bead/pearl sign
198
Which antibody is associated with drug-induced SLE?
Anti-histone
199
What is the most specific antibody for SLE?
Anti-Sm
200
C1q deficiency is associated with which type 3 hypersensitivity reaction?
SLE
201
Contact dermatitis and tubercilin-type hypersensitivity is what type of hypersensitivity reaction?
Type IV
202
Which cell type mediates a type IV hypersensitivity reaction?
T-cell mediated
203
What forms part of an intradermal TB injection?
Purified protein derivative
204
Which antigen is implicated in type 1 DM?
Glutamate Decarboxylase
205
Antigen in multiple sclerosis?
Myelin basic protein
206
CSF finding for MS?
Oligoclonal bands
207
What is the most specific auto-antibody for RA?
Anti-CCP
208
Prednisolone inhibits which enzyme?
phospholipase A2
209
BK virus causes what?
Haemorrhagic cystitis
210
Mycophenolate mofetil inhibits what?
Anti-metabolic, inhibits IM PDH - inhibits guanine synthesis
211
Mycophenolate mofetil can activate which virus?
John Cunningham virus
212
Reaction of the JC virus can result in what?
progressive multifocal leukoencephalopathy
213
What is the active metabolite of azathioprine?
6-mercaptopurine
214
What should be checked prior to azathioprine therapy?
TPMT
215
Methotrexate inhibits which enzyme?
Dihydrofolate reductase
216
What is the management option for severe Goodpasture disease and type-ii disease?
Plasmapheresis
217
What can be administered to reduce ABO incompatibility and AB-mediated transplant rejection?
Plasmapheresis
218
Tacrolimus is what class of drug?
Calcineurin inhibitor
219
Calcineurin inhibitors e.g., tacrolimus and cyclosporin reduce what IL-expression?
IL-2
220
What are the complications associated with calcineurin inhibitors?
Nephrotoxic, hypertension, neurotoxic, dysmorphism, gingival (gum) hypertrophy
221
Tofacitinib inhibits what?
JAK1/3 inhibitor
222
Apremilast inhibits which enzyme?
PDE4
223
Name an Anti-CD25 inhibitor indicated in prophylaxis for allograft rejection?
Basiliximab
224
What does Basiliximab target?
Anti-CD25 - alpha chain of iL-2 - inhibits t-cell proliferation
225
Abatacept is implicated in the management of which disease?
Rheumatoid arthritis
226
What is the target for Abatacept?
Anti-CTLA4-Ig fusion protein
227
Rituximab is indicated for which conditions?
Rheumatoid arthritis, lymphoma, SLE
228
What is the target for rituximab?
Anti-CD20
229
Which monoclonal antibody is implicated in the management for severe inflammatory bowel disease?
Vedolizumab
230
Vedolizumab targets what?
Anti-alpha-4-beta-7 intergrin
231
Which monoclonal antibody targets alpha-4-beta-10-intergrin and is used in Crohn's disease?
Natalizumab
232
What is the target for Tocilizumab?
Anti-IL-6 Receptor
233
Tocilizumab is used to treat which 2 conditions?
Rheumatoid arthritis and Castleman's disease
234
Muromonab targets what?
CD3 on T-cells
235
Name 2 anti-TNF-alpha drugs
Infliximab, adalimumab
236
Etancerpt targets what?
TNF-alpha receptor
237
Which drug is an anti-iL17?
Secukinumab
238
Secukinumab is used to treat what?
psoriasis, psoriatic arthritis, ankylosing spondylitis
239
Which term describes a transplant from a twin?
Isograft
240
Which term describes a transplant from the same species?
Allograft
241
Which term describes a transplant between two difference species?
Xenograft
242
Name 3 types of HLA Class 1 expressed by all cells?
A, B, C
243
Which cells present MHC-II?
CD4+ Cells
244
Which HLA antigen is the most important to mitigate mismatch?
HLA-DR
245
The effector phase of T-cell mediated graft rejection involves which type of T-cells and ligand?
- Cytotoxic T cells – Release of toxins (granzyme B), punch homes in target cells (perforin), apoptotic cell death (Fas ligand).
246
What are the histological features associated with T-cell mediated rejection?
Histological Features:
* Lymphocytic interstitial infiltration
* Ruptured tubular basement membrane.
* Tubulitis (inflammatory cells within the tubular epithelium).
* Macrophages, recruited by the T-cells.
247
Antibody-mediated rejection is associated with which cell type?
Endothelium - intra-vascular disease
248
What can prevent hyperacute graft rejection?
Crossmatch ABO groups and HLA-matching
249
What is the maximum HLA mismatches for a parent-child transplant?
3
250
What three HLAs are matched?
HLA-A, HLA-B, HLA-DR
251
what are the three types of assays to assess for cross-reactivity in transplant?
1. Cytotoxicity/Complement dependent cytotoxicity – Does recipient serum kill donor lymphocytes.
2. FACS/Flow cytometry – Does recipient serum bind to donor lymphocytes.
3. Solid phase/Luminex – Does recipient serum contain antibodies to individual HLA molecules.
252
What induction immunosuppressive regimen is used pre-transplant?
Anti-CD52 Alemtuzumab or anti-CD25 basiliximab or OKT3/ATG.
253
Name a proteasome inhibitor?
bortezomib
254
What drugs are used for the maintenance therapy post-transplant?
Steroid + calcineurin inhibitor + antiproliferative agent (azathioprine/mycophenolate mofetil).
255
What are the symptoms of graft-versus-host disease?
- Symptoms: Skin desquamation, rash, GI disturbance (nausea, vomiting, abdominal pain, diarrhoea, bloody stool), liver failure (jaundice), BM failure.
256
Which drug is the prophylaxis for GVHD?
Methotrexate/cyclosporine, irradiate blood components for immunosuppressed patients.
257
What is the management for GVHD?
Corticosteroids
258
Which opportunistic infections are increased post-transplant?
CMV, BK virus, Pneumocystis carinii.
259
Kaposi-sarcoma is associated with which virus?
HHV8
260
Which cardiovascular risk is increased post-transplant?
Myocardial infarction secondary to atherosclerosis
261
What antibodies are associated with Sjogren's syndrome?
Anti-Ro and Anti-La
262
Which sex is affected the most in Sjogren's syndrome?
Female predominance 9:1
263
What are the characteristic features of Sjogren's disease?
- Dry eyes – keratoconjunctivitis sicca, corneal ulcers, keratitis.
- Dry mouth – increased caries
- Major salivary gland swelling – parotid submandibular.
- Extra glandular manifestations – Fatigue, arthritis, arthralgia/myalgia
- Pulmonary – interstitial lung disease
264
Which test is used to diagnose Sjogren;s syndrome?
Schirmer test
Positive Rose Bengal testing
265
Which HLA-haplotype is associated with ankylosing spondylitis?
HLA-B27
266
Which haplotype is associated with coeliac disease?
DQ2 and DQ8 HLA
267
What histological findings are associated with coeliac disease?
villous atrophy, crypt hyperplasia and increased intra-epithelial lymphocytes.
268
Derm manifestation associated with Coeliac disease?
* Dermatitis herpetiformis
269
Which IgA is most sensitive in coelaic disease?
* IgA TGT (anti-transglutaminase antibody) ~95% specific, 90-94% sensitive
270
Herd immunity threshold calculation?
Herd Immunity Threshold=1-1/R0
271
Name a Pattern recognition receptor?
Toll-like receptors, retinoic acid-inducible gene 1-like receptors, NLRs.
272
Influenza and polio (IPV) are what type of vaccines?
Inactivated
273
MMR and yellow fever are what type of vaccine?
Live attenuated
274
Name 2 toxoid vaccines?
Diptheria and tetanus
275
What type of vaccine are NHS?
* Conjugate
276
Which vaccines are administered at 2 months?
DTaP/IPV/HiB/Hep B
(6 in 1 injection)
oral rotavirus
Men B
277
Which 3 vaccines are administered at 3 months?
DTaP/IPV/HiB/Hep B
(6 in 1 injection)
Oral rotavirus
PCV
278
When is the MMR administered for the first time?
12 months (second is 3 years 4 months)
279
Which 2 vaccines are given during pregnancy?
Influenza and DtAP/IPV - pertussis
280
Name 6 additional travel vaccinations
Cholera, Hepa A, HepB, Jap encephalitis, Tick-borne encephalitis, Typhoid, Yellow Fever.
281
Which vaccine is given after 70-years of age?
Shingles
282
When is the PPV vaccine given?
65-years of age
283
Which 2 vaccines can HIV positive patients not receive?
BCG and yellow fever
284
Which is a commonly used depot adjuvant?
Alum
285
Which is the most commonly used stimulatory adjunct?
CpG
286
Which interferon is given as cytokine therapy in hepatitis B and C?
* Interferon alpha
287
ribavirin is used to treat what?
Hepatitis C
288
Which monoclonal antibody is used to treat advanced melanoma?
* Ipilimumab
289
* Ipilimumab targets what?
CTLA-4
290
What is the target for Pembrolizumab/Nivolumab?
PD-1
291
What CD marker on T-cells are responsible for co-stimulation?
CD28
292
JCV infects which type of cell?
oligodendrocytes
293
Which virus is a common cause of graft loss in renal transplant patients?
BK virus
