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Medicine year 1 > Immunology > Flashcards

Immunology Flashcards

1
Q

What are the primary lymphoid organs (2)

A

bone marrow and thymus

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2
Q

What happens in the primary lymphoid organs

A

Lymphocytes develop and mature

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3
Q

What are the secondary lymphoid organs (2)

A

spleen and lymph nodes

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4
Q

What happens in secondary lymphoid organs

A

mature lymphocytes encounter antigens, become activated, and initiate immune response

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5
Q

What are the cells involved in the innate immune system (8)

A

neutrophil
Basophil
Eosinophil
Monocyte
Dendritic cell
Nk cell
Mast cell
Macrophage

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6
Q

What cells are involved in the adaptive immune response (3)

A

B cell, T cell, plasma cells

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7
Q

What are the anatomical and physiological barriers (5)

A

skin
Sebaceous glands
Commensalism bacteria
Mucus
Coughing + sneezing

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8
Q

What does it mean if the immune response is humoral

A

It involves antibodies

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9
Q

How do innate immune cells recognise pathogens

A

Via pattern recognition receptors which bind to pathogen associated molecular patterns

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10
Q

Where are selectins found

A

on endothelial cells

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11
Q

What do selectins do

A

facilitate rolling of immune cells which then adhere to the vessel walls

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12
Q

How do immune cells arrive at the site of the infection

A

They are drawn by chemotatic signals

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13
Q

How do innate immune cells recognise pathogens

A

Via their pattern recognition receptors which intersect with the pathogen associated moleculular patterns

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14
Q

What modes of ingestion may occur in the innate immune response (3)

A

Pinocytosis
Phagocytosis
Receptor-mediated endocytosis

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15
Q

Describe pinocytosis

A

Ingestion of the fluid surrounding cells

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16
Q
A
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17
Q

What does of ingestion are used in the innate immune system (3)

A

pinocytosis, receptor mediated endocytosis, and phagocytosis

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18
Q

Describe phagocytosis (6)

A

PRRs bind to PAMPs, signalling the formation of the phagocytic cup
The cup extend around the target and forms a phagosome
The phagosome fuses with lysosomes (phagolysosome), this leads to killing of pathogens and degradation of contents
Debris are related into extracellular fluid
Pathogen derived peptides are expressed on cell surface receptors (MHC II)
Pro-inflammatory mediators are released

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19
Q

What is pinocytosis

A

Ingestion of fluid surrounding cells

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20
Q

What is endocytosis

A

molecules bound to membrane receptors are internalised

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21
Q

Which method of ingestion is important for the generation of adaptive immunity

A

endocytosis

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22
Q

What facilitates these modes of ingestion

A

opsonisation - coating of pathogens by soluble factors

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23
Q

What do mast cells release (2)

A

pre-formed pro-inflammatory mediators (degranulation)
New pro-inflammatory mediators

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24
Q

What does inflammation promote (3)

A

vascular changes
Recruitment and activation of neutrophils
Production of chemical signals to attract neutrophils

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25
Q

What are the steps of transendothelial migration (5)

A

migration to endothelium near affected tissue
Binding to adhesion molecules on endothelial cells
Migration across endothelium
Migration within tissue (due to chemotaxis)
Activation by PAMPs and TNFα

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26
Q

What are the physiological sings of acute inflammation (4)

A

redness
Heat
Swelling
Pain

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27
Q

Why is redness and heat observed in acute inflammation

A

Dilation of blood vessels increases blood flow, cell accumulation, and cell metabolism

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28
Q

Why is swelling a sing of acute inflammation

A

there is increased permeability of post-capillary venues which means that fluid accumulates in extravascular spaces

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29
Q

What methods of killing exist (2)

A

oxygen dependent
Oxygen independent

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30
Q

Describe degranulation (2)

A

release of antibacterial proteins from neutrophil granules into extracellular milieu, causing killing of pathogens and tissue damage

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31
Q

NETS (2)

A

A method of killing pathogens, neutrophil extracellular traps

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32
Q

How can neutrophils kills pathogens (3)

A

phagocytosis
Degranulation
NETS

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33
Q

What do virally infected cells produce and release

A

interferons (a type of cytokines)

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34
Q

What do interferons do (3)

A

signal to uninfected to destroy RNA
Signal neighbouring infect cells to undergo apoptosis
Activates immune cells

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35
Q

What adhesion molecule do neutrophils bind to priori to migrating across endothelium (2)

A

selectins, IcAM-1

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36
Q

What does the acute phase response involve (2)

A

changes in plasma concentration of certain proteins in response to inflammation
Production of acute phase proteins

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37
Q

What are examples of acute phase proteins (3)

A

c3
MBL
C reactive protein (CRP)

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38
Q

What does CRP do

A

Acts as an opsonin

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39
Q

What are the three pathways for activating the complement system

A

classical
Alternative
Lectin

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40
Q

Describe the classical pathway

A

IgM and IgG cause a conformational change in C1, thus activating the cascade

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41
Q

What lectin pathway for activating the complement system

A

mannose binding lectin binding to carbohydrates
Mimics c1 binding to immune complexes

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42
Q

What is the alternative pathway for activating the complement pathway

A

Spontaneous hydrolysis of c3 and its binding to bacterial cell walls

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43
Q

What happens in the complement pathway (6)

A

c3 convertase activation
C3 is broken down into C3a and c3b by c3 convertase
C5 convertase activation
C5a binds to c6, c7, and c8 to form the c5 convertase complex
C5 convertase complex inserts onto cell membrane
C9 binds to the complex, forming the membrane attack complex

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44
Q

How do the innate and adaptive immune systems communicate with each other

A

dendritic cells

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45
Q

What activated dendritic cells

A

pro-inflammatory mediators

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46
Q

Which immune response are B cells involved in

A

humoral immune response

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47
Q

Which immune response are T cells involved in

A

cellular immune response

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48
Q

What are the functions of C3a and C5a (2)

A

inflammatory mediators
Recruit phagocytes

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49
Q

Examples of complement inhibitors (5)

A

C1, Factor I, Factor H, C4 binding protein, CD59

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50
Q

What are the protein components of the adaptive immune system (2)

A

Cytokines
Antibodies

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51
Q

which is the most abundant antibody

A

IgG

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51
Q

Describe the regions found on antibodies

A

Heavy chains - have variable regions
Light chains - have constant regions

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52
Q

Which antibody is the first to be produced in an immune response

A

IgM

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53
Q

What else may antibodies be known as

A

immunoglobulins

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54
Q

Where are mature, quiescent, antigen-specific B and T cells found

A

constantly circulating between the blood, secondary lymphoid tissues, and lymphatic vessels

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55
Q

What type of antibody is IgA

A

Secretory

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56
Q

where is IgA secreted (3)

A

mucus, saliva, and tears

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57
Q

How do the innate and adaptive immune systems communicate

A

Dendritic cells

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58
Q

What activates dendritic cells

A

pro-inflammatory mediators

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59
Q

which immune response are B cells involved in

A

humoral

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60
Q

Which immune response are T cells involved in

A

cellular

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61
Q

Where are mature, quiescent, antigen-specific B and T cells found

A

circulating between the blood, secondary lymphoid tissues, and lymphatic vessels

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62
Q

which is the most abundant antibody type

A

IgG

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63
Q

Which antibody type is the first to be produced in a response

A

IgM

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64
Q

What else may antibodies be known as

A

immunoglobulins

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65
Q

What are the regions on antibodies

A

heavy chains - have variable regions
Light chains - have constant regions

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66
Q

What two functions can antibodies have

A

recognition - binding to the antigen
Effector - heavy chain region interacts with effector molecules

67
Q

what does IgA do

A

tags the pathogen for destruction

68
Q

What does IgD do (2)

A

acts as a B cell receptor
Stimulates release of IgM

69
Q

What does IgE do

A

binds to mast cells and basophils

70
Q

What does IgG do (6)

A

binds to phagocytes
Crosses placenta
Complement system activation
Nk activation
Agglutination
Neutralisation

71
Q

What does IgM do (4)

A

acts as a B cell receptor
Secretory
Agglutination
Complement system activation

72
Q

What is agglutination

A

when an antibody cross-links with multiple antigens, forming columns of antigens
A process that increases efficacy of pathogen elimination

73
Q

What are the routes a B cell can be taken to be activated (2)

A

An antigen binding to the receptor then a PRR binding to a PAMP
Or multiple antigens and receptors engage, dismissing the need for a PRR

74
Q

once activated, what happens to B cells

A

they closely proliferate and differentiate into two types of effector cells

75
Q

What are the types of effector cells that B cells can differentiate into, and what do these cells (2) do

A

Plasma cells (produce and secrete antigen-specific antibodies)
Memory B cells (long-life, circulate the body)

76
Q

What antigens can T cell recognise

A

those presented to their receptors by MHC molecules

77
Q

What types of T cells are they + what do these do (2)

A

cd4+ - regulates immune system and secretes Il-2
Cd8+ - kills infected cells

78
Q

Which class of MHC presents to cd4+

A

MHC II, only expressed on professional antigen presenting cells

79
Q

Which class of MHC presents to cd8+ cells

A

MHC I, expressed on every nucleic cell

80
Q

What does MHC stand for

A

major histocompatibility complex

81
Q

What are dendritic cells capable of doing (2)

A

Recognising and internalising pathogens/antigens

82
Q

What compound stimulates immature dendritic cells, and what is the effect

A

TNFα
Increased expression of co-stimulators molecules

83
Q

After dendritic cells have internalised and digested pathogens, what happens

A

They display pathogen-derived peptides on their surface in complex with MHC I/MHC II molecules

84
Q

What do cd4+ cells secrete

A

Il-2

85
Q

What does Il-2 do

A

stimulates cells to divide and differentiate

86
Q

What can naive cd4+ cells differentiate into

A

cd4+ effector cells

87
Q

What are the different types of cd4+ effector cells (5)

A

TH1
TH2
TH17
TFH
Regulatory T cells

88
Q

What do TH1 cells do

A

enter affected tissue
Boost killing function of macrophages by switching on expression of NADPH oxidase genes

89
Q

What does activation of NADPH oxidase genes allow

A

the macrophage’s lysosome to contain reactive oxygen species

90
Q

What are TFH Cells (2)

A

Pro-inflammatory
Secrete pro-inflammatory cytokines

91
Q

How is the immune response resolved (3)

A

macrophages switch from being pro-inflammatory to being anti-inflammatory
Macrophages secrete anti-inflammatory cytokines
Tissue repair occurs

92
Q

What long-lived adaptive immune cells can be present after the immune response is resolved (4)

A

memory cd4+ cells
Memory cd8+ cells
Memory B cells
Long-lived plasma cells

93
Q

Which antibody is more effective: IgG or IgM

A

IgG

94
Q

What is immunisation

A

the process by which an individual develops immunity to a disease (deliberate or natural)

95
Q

Vaccination

A

deliberate administration of antigenic material to acquire immunity to a certain disease

96
Q

Active immunity (2)

A

protection by the individual’s own immune system
Permanent

97
Q

Passive immunity

A

Protection transferred from another person/animal
Temporary

98
Q

Examples of passive immunity (3)

A

placental antibody transfer
Antibodies in breast milk/colostrum
Venom antidotes

99
Q

What is a hypersensitive reaction

A

an exaggeration of normal immune mechanisms that results in bystander damage to self

100
Q

What is type one hypersensitivity

A

immediate

101
Q

What is type two hypersensitivity

A

direct cell effects

102
Q

What is type three hypersensitivity

A

immune complex mediated

103
Q

what is type four hypersensitivity

A

Delayed

104
Q

What stages are involved in hypersensitivity reactions (2)

A

sensitisation
Pathological

105
Q

What happens during the sensitisation stage

A

Naive cd4+ cells are activated, converting to cd4+ TH0 cells
The receptors of mast cells and basophils combine with IgE antibodies
IgE antibodies are stabilised once bound

106
Q

What is the pathological stage of hypersensitivity (5)

A

allergen binds to IgE coated mast cell/basophil
Degranulation occurs
Vasoactive mediators are released
Expression of pro-inflammatory cytokines and Leukotrienes is increased
Eosinophils are recruited and activated

107
Q

What are the features of a type one hypersensitivity reaction (4)

A

immediate
More than one organ system involved
Presentation is influenced by site of contact
Threshold for reactions can be influenced by cofactors

108
Q

What co-factors can alter the threshold for type one hypersensitivity reactions (3)

A

alcohol, exercise, and infection

109
Q

What can be used to manage IgE mediated allergic reactions (6)

A

avoiding allergen
Anti-inflammatory agents
Adrenaline
Blocking mast cell activation
Biologics
Preventing effects of mast cell activation

110
Q

How do biologics work

A

neutralise TH2 cytokines

111
Q

What are type two hypersensitivity reactions mediated by (2)

A

IgM or IgG antibodies

112
Q

What happens in a type 3 hypersensitivity reaction (4)

A

immune complex formed
complex passes between endothelial cells of blood vessels
Complex becomes trapped on basement membrane
Causing inflammation

113
Q

How can an immune complex be formed

A

binding of multiple antigens to antibodies

114
Q

What drives type four hypersensitivity reactions

A

cd4+ cells

115
Q

What are the features of type four hypersensitivity reactions (3)

A

high numbers of macrophages at affected area
Symptoms take 24-48 hrs to manifest
Granulomas can form

116
Q

Autoimmunity

A

immune response against self-antigens

117
Q

What can high levels of auto-antibodies/aut0-reactive T cells cause (2)

A

Chronic inflammation
Tissue/organ damage

118
Q

What are the components of T cell receptors

A

Alpha and beta chains

119
Q

What allows each developing b cell to generate antibodies with a unique variable region

A

random selection and recombination of V, D, and J gene segments within Ig heavy and light chain genes

120
Q

What tolerance mechanisms exist (2)

A

Central tolerance
Peripheral tolerance

121
Q

Describe central tolerance

A

Deletion of self-reactive lymphocytes in primary lymphoid tissue during early stages of development

122
Q

Describe peripheral tolerance

A

suppression of self-reactive lymphocyte activity in peripheral tissues by regulatory T cells

123
Q

How do regulatory T cells suppress self-reactive T cells

A

producing anti-inflammatory cytokines

124
Q

What causes autoimmunity

A

a breakdown of immune tolerance to self antigens

125
Q

What factors can trigger autoimmunity (4)

A

smoking
Infections
Hormone levels
Tissue damage

126
Q

Describe superantigens

A

bacterial toxins which non-specifically activate all lymphocytes (including those that are auto-reactive)

127
Q

What are the possible responses to infection (3)

A

resolution
Latent infection
Chronic infection

128
Q

What does latent infection mean

A

the pathogen is controlled, but infection may occur again

129
Q

What does chronic infection mean

A

the immune response is defective
The pathogen is not cleared/controlled

130
Q

What are the four signs of immunodeficiency

A

Serious infections
Persistent infections
Unusual infections
Recurrent infections

131
Q

What are the two classes of immunodeficiency disorders

A

primary and secondary

132
Q

What are the types of primary immunodeficiency disorders (3)

A

Antibody deficiency disease
T cell mediated disease
Combined immunodeficiencies

133
Q

What are the B cell defects associated with antibody deficiency diseases (2)

A

reduced peripheral B cell numbers
Serum Ig levels absent/reduced

134
Q

What are the features of antibody deficiency diseases (3)

A

increases susceptibility to extracellular pathogens
Growth/developmental delay
Increased incidence of autoimmune disease + malignant tumours

135
Q

What is the pathogenesis of antibody deficiency diseases (2)

A

development of B cells is blocked
CD4+ TFH cell development is blocked

136
Q

What is the defect associated with T cell mediated immunodeficiencies

A

reduced peripheral blood T cell numbers

137
Q

What are the features of T cell mediated immunodeficiencies (3)

A

increased susceptibility to intracellular pathogens
Delayed growth/development
Increased incidence of malignant tumours

138
Q

What is the pathogenesis of T cell mediated immunodeficiency (3)

A

Thymus development problems
Blocked T cell development
Associated Ig deficiencies

139
Q

Which part of the immune system involves the gastrointestinal epithelial barrier

A

Innate

140
Q

What can the gi epithelial barrier secrete (3)

A

cytokines
Antimicrobial peptides
MUC proteins

141
Q

What is found at the base of a crypt

A

Lg5+ stem cells

142
Q

What happens at the tip (of the crypt???)

A

cell shedding

143
Q

What controls epithelial barrier growth dynamics

A

Signalling molecules

144
Q

Where are immune cells found in the GI tract

A

lamina propria

145
Q

What structures are found on the intestinal mucosa (2)

A

Peyer’s patches
Villi

146
Q

What are the components of a Peyer’s patch (4)

A

Immune cells
Lymphoid tissue
Thinner mucus layer
Specialised phagocytic cells (M cells)

147
Q

What do villi contain (3)

A

Lgr5+ stem cells
Loose connective tissue network (laminate propria)

148
Q

What can M cells do

A

transport material across the epithelial barrier via transcytosis

149
Q

How are antigens sampled (2)

A

By dendritic cells
Which extend dendrites between epithelial cells

150
Q

What happens once dendritic cells have sampled antigens (2)

A

antigens are broken down and used for presentation to lymphocytes

151
Q

what do dendrites with antigens do (2)

A

Go to T cell zone of a Peyer’s patch
Convert T cells to regulatory T cells

152
Q

What do the newly formed regulatory T cells do now (3)

A

Go to lamina propria of villi
Via lymphatics
Then secrete Il-10

153
Q

Il-10 function (2)

A

suppressing immune cell activity
Preventing unnecessary inflammation

154
Q

what is the function of MUC proteins (3)

A

Forming a scaffold
Which entangled mucus produced by goblet cells
Forming a mucus layer that gives protection

155
Q

What effect do microbes have on the epithelial barrier (2)

A

stimulate secretion of cytokines
Help regulate permeability

156
Q

What effect does the epithelial barrier have on microbes (2)

A

determines which microbes reside in the lumen
Provides mucin (a microbial energy source)

157
Q

Which cytokine promotes epithelial barrier repair

A

Il-22

158
Q

Function of integrin (3)

A

directs T cells to the gut
Interacts with a complementary protein on endothelial cells
Thus slowing the cell down and causing it to move through blood vessel to tissue and be anchored

159
Q

What does anchoring of T cells in the epithelial barrier mean

A

increased efficacy for longer

160
Q

When are TH2 cells important

A

parasitic infections

161
Q

What cell balance maintains gut health

A

T helper cells to T reg cells

162
Q

Once anchored in the epithelium, what are T cells known as

A

intraepithelial lymphocytes

163
Q

Which antibody is particularly important in the GI immune system

A

IgA

164
Q

What is the definition of the microbiome

A

The genetic material associated with all microorganisms colonising the body

165
Q

What is the most common mediator of sepsis

A

endotoxin released by gram negative bacteria

Medicine year 1 (4 decks)

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