Immunology Flashcards
1
Q
Medulla of lymph node
A
Medullary cords with closely packed lymphocytes and plasma cells
2
Q
Medullary sinuses
A
Contain reticular cells and macros communicate with efferent lymphatics.
3
Q
paracortex
A
Houses T cells. Between cortex between follicles and medulla. High endothelial venules
4
Q
Which part of lymph node enlarged in immune response?
A
paracortex. This part is also underdeveloped in digeorge syndrome
5
Q
stomach drains to
A
celiac node
6
Q
duodenum drains to
A
superior mesenteric node
7
Q
sigmoid colon drains to
A
colic then inferior mesenteric
8
Q
rectum drains to
A
internal iliac nodes
9
Q
anal canal below pectinate drains to
A
superficial inguinal
10
Q
testes drain to
A
superficial and paraaortic
11
Q
scrotum drains
A
superficial inguinal node
12
Q
thigh drains
A
superficial inguinal node
13
Q
lateral dorsum of foot drains
A
popliteal
14
Q
right lymphatic duct drains
A
right arm, right chest, right half of head
15
Q
thoracic duct drains
A
everything beisdes what the right lymphatic duct drains
16
Q
structure of sinusoids of spleen
A
vascular channels in red pulp with barrel hoop basement membrane
17
Q
T cells of spleen found in
A
periarterial lymphatic sheath in white pulp
18
Q
B cells of spleen found in
A
follicles on outer edge of white pulp
19
Q
Macrophages of spleen are especially important for
A
removing encapsulated bacteria
20
Q
What are the encapsulated organisms?
A
Strep HiB Neisseria Salmonella Klebsiella Group B
21
Q
Findings in a blood smear after a splenectomy
A
howell jolly bodies
target cells
thrombocytosis
22
Q
Cortex of thymus
A
immature T cells
23
Q
medulla of thymus
A
pale with mature T cells
epithelial reticular cells coming together to make hassall’s corpuscles
24
Q
positive selection (MHC restriction) occurs
A
in the cortex of thymus
25
negative selection (nonreactive to self) occurs
in the medulla of thymus
26
MHC I is expressed on all nucleated cells except for
RBCs
27
B2 microglobulin
part of MHC1, helps to transport molecule to cell surface
28
loading of antigen in MHC II
release of invariant chain in acidified endosome
29
loading of antigen in MHC1
in RER with intracellular peptides
30
HLA A3
hemochromatosis
31
HLA DQ2/DQ8
celiac
32
HLA DR2
multiple sclerosis
SLE
Goodpasteur's
33
HLA DR3
Graves' Diabetes type 1
34
HLA DR4
rheumatoid arthritis, diabetes type 1
35
HLA DR5
pernicious anemia
| Hashimoto's thyroiditis
36
when do NK cells kill?
Exposed to a nonspecific activation signal on target or absence of class I MHC
37
NK activity enhanced by
IL-2, IL-12, IFN beta, IFN a
38
When an immature T cell enters the thymus, it immediate gets what receptors?
CD4+ CD8+ AND TCR
39
SIgnal for Helper T cells to become Th1 cells
IL-12
40
Signal for helper T cells to become Th2 cells
IL-4
41
Positive selection
T Cells expressing TCRs able to bind self MHC survive
42
negative selection
T cells expressing TCRs with a high affinity for self antigens= apop
43
costimulatory signal
B7 expressed by DC
| CD28 expressed by naive T cell
44
What happens after the primary and costimulatory signal is given by dendritic cell to naive T cell?
Naive T cell expresses IL-2 which binds to IL-2R on itself stimulating the naive T cell to differentiate
45
What happens after the primary and costimulatory signal is given by Th4 cell to naive B cell?
the helper T cell, after being activated by dendritic cell
- ->B cell presents antigen on MHC II to activated T cell
- ->TCR recognizes correct antigen and releases IL4 and IL5 which stimulate the B cell to differentiate into IgG, IgE, and IgA
46
What is the only APC that can activate a naive T cell?
the dendritic cell
47
Describe the costimulatory signal for B cell activation
CD 40 on B cell
| CD40 L on Th cell
48
Th1 cell secretes
IFN-y
49
Th2 cell secretes
IL4, 5, 10, 13
50
Th1 cell activates
macrophages
51
Th2 cell activates
Eosinophils
| IgE production by B cells
52
Th1 cell inhibited by
IL4 and IL10
53
Th2 inhibited by
IFN-y
54
How do macrophages and lymphocytes tickle or stimulate each other?
lymphocytes release IFN-y
macrophages release IL1 and TNF-a
--> they help each other out
55
Hyper IgM caused by
Defective CD 40 and 40L interaction
56
Contents of cytotoxic T cells (CD8)
granules with
1. perforin: makes holes so can deliver bombs
2. granzyme: serine protease, activates apoptosis
3. granulysin: antimicrobial, induces apoptosis
57
Treg cells express which cell surface markers
CD3, CD4, and CD25
58
Treg cells produce
IL10 and TGFbeta
59
heavy chain makes up which portions of antibody
Fc and Fab
60
light chain makes up which portion of antibody
Fab
61
CD25 is also known as
alpha chain of IL-2 receptor.
62
complement binds which part of antibody
medial portion of Fc
63
macrophage binds which part of antibody
distal to where complement binds, between CH2 and CH3
64
three components of the Fc region
carboxyterminal end
complement binding at CH2 (IgG and IgM)
Carbohydrage side chains
65
light chains made up of
VJ
66
heavy chains made up of
VDJ
67
stomatic hypermutation occurs after
antigen stimulation of B cell. BUT B cells are "born" with their random VJ/VDJ combinations.
68
What enzyme is responsible for generating the VD/VDJ recomination?
terminal deoxynucleotidyl transferase
| --Adds nucleotides to DNA during recombination
69
isotype switching
When B cells secrete things other than IgM
70
Mature B lymphocytes express what on their surface
IgM AND IgD
71
Which antibody can cross the placenta?
IgG
72
Which antibodies can fix complement?
Only IgG and IgM
73
which antibody is responsible for delayed response to an antigen?
IgG
74
How does IgA work?
Prevents attachment of bacteria to mucous membranes
75
IgA form in circulation?
monomer. dimer when secreted
76
Which Ig is the antigen receptor of the surface of B cells?
IgM
77
thymus independent antigens
antigens lack a peptide component and cannot be presented by MHC to T cells (ex: LPS or capsular antigen)
- ->as a result, NO immunologic memory
- ->but antibodies are released
78
Thymus dependent antigens
There IS a protein component (diptheria) and class switching occurs
79
Classic complement pathway
IgG or IgM mediated
80
Lectin pathway
mediated by Mannose on microbe
81
Alternative pathway turned on by
PAMP pathogen associated molecular pattern
82
C3b
opsonization
83
C5a
neutrophil chemotaxis
84
What starts the alternative pathway?
C3-->C3b
AND
D converts B into Bb
=C3bBb
85
what starts the lectin pathway?
MBL activates a C1 like complex
- -cleaves C2 AND C4
- -otherwise, same as classic pathway
86
primary opsonins
IgG
| C3b
87
What prevents complement activation on self cells?
Decay accelerating factor
| C1 esterase inhibitor
88
complement disorder with hereditary angioedema
C1 esterase inhibitor deficiency
89
What drug is contraindicated in C1 esterase inhibitor deficiency?
ACE inhibitors
90
severe pyogenic sinus and respiratory tract infections with increased type III hypersensitivity--type of complement deficiency
C3 deficiency. C3 helps clear immune complexes
91
Recurrent neisseria bacteremia
C5-9 deficiency
92
Complement mediated lysis of RBCs and PNH
DAF deficiency
93
What does IL-1 do to endothelium?
induces adhesion molecule expression
94
IL6
fever and acute phase proteins
95
IL8
neutrophil chemotaxis
96
IL12
Differentiation into Th1 cells
| Activates NK cells
97
IFN-y
Increase MHC I and II expression.
98
Interferon a and b mechanism
Produce a ribonuclease=degradation of viral mRNA
99
IFN is defense against
VIRUSES
| --they all activate NK cells to kill virus infected cells
100
Cell surface proteins on T cells
TCR
CD3
CD28
101
CD proteins on Th4
CD4, CD40L
102
B cell CD proteins
CD19, 20, 21
| 40, MHCII, B7
103
Receptor for epstein barr virus
CD21
104
Macrophage receptors
CD14 (binds LPS)
CD40
MHC II
B7
105
NK cell receptors
CD16 (binds Fc)
| CD56 (unique marker)
106
Superantigens secreted by which bugs?
```
S aureus (TSST-1)
S pyogenes (exotoxin A)
-->NOTE THAT ALL T CELLS ARE ACTIVATED from cross linking fo TCR to MHC II on APCs
```
107
LPS stimulates
macrophages!
Thelper cells are NOT involved. Massive secretion of TNF alpha
108
Salmonella antigen variation
flagella
109
neisseria gonorrhea antigen variation
pilus protein
110
what other bugs have antigen variation?
trypanosomes
| borrelia
111
When do you give passive immunization?
Tetanus
Botox
Rabies
HBV
112
Live vaccines activate a
cellular response
113
killed vaccines activate a
humoral immunity
114
examples of killed vaccines
```
Rabies
Influenza (shot)
Polio (salk)
HAv
Cholera
```
115
marker of mast cell degranulation
tryptase
116
Explain Type II hypersensitivity
IgM/G bind to antigen
- -opsonization
- -complement lysis
- -Antibody dependent cell mediated cytotoxicity, NK cells
117
How to test for type II hypersen
Direct and indirect coombs'
118
serum sickness
immune complex disease where immune complexes bind and deposit where they fix complement=tissue damage
119
arthus rxn
Intradermal injection induces antibodies and complexes in the skin.
---edema, necrosis, activation of complement
120
When would you see serum sickness?
5-10 days after exposure
121
most serum sickness is caused by
drugs
122
Sx: serum sickness
fever, urticaria, arthralgias, protienuria, lymphadenopathy
123
Test for arthus rxn
immunofluorescen staining
124
Describe process of type IV hypersensitivity
t lymphocytes activate macrophages and secrete lymphokines
125
Examples of type IV hypersensitivity
```
multiple sclerosis
guillain barre
graft versus host disease
contact dermatitis
tranplant
TB skin test
```
126
allergic rhinitis and hay fever
Type I hypersensitivity
127
Four types of blood transfusion reactions
allergic rxn
anaphylactic
febrile nonhemolytic
acute hemolytic transfusion
128
concern when giving blood transfusion to pt with celiac's
many celiac's pts are deficient in IgA
| --must receive blood products that lack IgA
129
Febrile nonhemolytic transfusion rxn
type II hypersensitivity. Host antibodies against donor HLA antigens
130
sx of febrile nonhemolytic TR
fever, chills, flushing
131
Acute hemolytic transfusion rxn
type II hypersensitivity. Intravascular hemolysis or extravascular hemolysis
132
Sx of acute hemolytic transfusion rxn
fever, hemoglobinemia, jaundice (extravascular)
| flank pain, hypotension
133
Anti-histone antibody
Drug induced lupus
134
anticentromere
CREST
135
antiScl70 (DNA topo I)
Diffuse scleroderma
136
antimitochondrial
primary biliary cirrhosis
137
IgA antiendomyseal
celiac
138
anti-desmoglein
pemphigus vulgaris
139
antimicrosomal
hashimotos
| also antithyroglobulin
140
Anti Jo-1, Anti-SRP, Anti-Mi2
polymyositis
| dermatomyositis
141
Anti-SSA/SSB
sjogren
142
anti-smooth muscle
autoimmune hep
143
anti glutamate decarboxylase
t1D
144
p-ANCA
microscopic polyangiitis, churg strauss
145
c-ANCA
granulomatosis with polyangiitis
146
anti-glutamate decarb
type 1 diabetes
147
anti-U1 RNP
mixed CT disease
148
No B cells: susceptible to which bacteria?
Encapsulated
149
No complement: susceptible to which bacteria?
Neisseria
150
No granulocyte: susceptible to which bacteria?
Staph
Serratia
Nocardia
151
No T cells: susceptible to what bacteria?
everything. Sepsis!
152
No T cells, susceptible to which viruses?
CMV
EBV
VZV
153
how do you test for type IV hypersensitivity?
candida extract skin test
154
Does the absence of anti-dsDNA of anti-Smith rule out possibility of SLE?
NO--these are highly specific for ruling in
155
recurrent Candida
| PCP
No T cells
156
Recurrent giardia infection
No B cells (no IgA)
157
Recurrent candida and aspergillus
No granulocytes
158
recurrent bacterial infections 6 months after birth
- normal proB
- low B cells
- low Ig (all types)
Bruton's X linked agammaglobulinemia
159
Cause of bruton' x linked agamma?
Defect in Bruton tyrosine kinase so NO B CELL MATURATION
160
asymptomatic but recurrent sinopulmonary/GI infections. Also history of celiacs or other autoimmune.
Selective IgA deficiency.
161
what do pts with selective IgA deficiency test false positive for?
beta HcG. cuz of heterophile antibody
162
what is a heterophile antibody?
induced antibody that is characterized by broad reactivity with antibodies of other animal species
163
pt in 20's and 30s suddenly present with lymphoma and sinupulmonary infections. Normal B cell number but decreased plasma cells and immunoglobulin
CVID
164
Cause of CVID
defect in B cell maturation
165
pts with CVID increased risk of
autoimmune dz
166
pt has tetany, recurrent viral/fungal infections
DiGeorge syndrome
167
lab findings in Digeorge
absent thymic shadow
- -low PTH
- -low T cells
- -low calcium
168
cause of DiGeorge
22q11 =failure of 3rd and 4th branchial pouches to form
| also cause of tetraology of fallot and persistent truncus arteriosus! cool!
169
disseminated mycobacterial infections
IL-12 receptor deficiency
170
lab findings in IL12 receptor deficiency
decreased IFN-y
171
coarse facies
staphylococcal absecess
primary teeth retained
Eczema
Hyper IgE (Job's syndrome)
172
Cause of hyper IgE (Job's)
Th1 cells fail to produce IFN-y
- -neutrophils fail to go where they need to go
- -will have lots of Th2 cells
173
candida infections of skin and mucous membranes
Chronic mucocutaneous candidiasis
| --caused by T cell dysfunction
174
Failure to thrive, chronic diarrhea
| --recurrent fungal, viral, bacterial infections
SCID
175
XRay and lymph node biopsy findings in SCID
```
Absence of thymic shadow
No germinal centers in lymph nodes
No B cells
--Decreased Tcell recombinant excision circles
--decreased T cells on flow cytometry
```
176
cause of SCID
1. Defective IL2 (most common)
| 2. Adenosine deaminase deficiency
177
Ataxia, spider angiomas, and IgA deficiency
ataxia telangiectasia
178
Cause of ataxia telangiectasia
Defects in ATM gene: codes for DNA repair enzymes
179
Lab findings in Ataxia telangiectasia
Increased AFP
180
Severe pyogenic infections early in life
Hyper IgM
181
Cause of hyperIgM
defective CD40L cannot class switch
182
thrombocytopenic purpura
infections
eczema
wiskott aldrich syndrome
183
Cause of wiskott aldrich
WAS gene defective. T cells unable to reorganize actin cytoskeleton
184
inheritance of wiskott aldrich
X linked
185
Lab findings of wiskott aldrich
Increased IgE, IgA
Decreased IgM
Low platelets
186
Recurrent bacterial infections, no pus, and delayed separation of umbilical cord
leukocyte adhesion deficiency
187
Cause of Leukocyte adhesion deficiency
Defect in LFA-1 integrin (CD-18)
188
lab findings in leukocyte adhesion deficiency
neutrophilia
189
recurrent pyogenic infections by staph and strep
| PARTIAL albinism and peripheral neuropathy
chediak higashi
190
Cause of chediak higashi
Defect in lysosomal trafficking regulator gene (LYST). Microtubule dysfunction in phagosome-lysosome fusion
191
inheritance of chediak higashi
Autosomal recessive
192
giant granules in neutrophils
lab findings in chediak higashi
193
abnormal dihydrorhodamine flow cytometry test
chronic granulomatous disease
194
susceptibility to catalase positive organisms (S aureus, E coli, aspergillus)
chronic granulomatous disease
195
cause: Chronic granulomatous disease
lack of NADPH oxidase. Cannot make reactive oxygen species in neutrophils
196
Susceptible to BOTh catalase positive and negative orgs
myeloperoxidase deficiency. Cannot turn H2O2 into an O2 radical...EVEN though H2O2 is provided by catalase negative organisms!
197
syngeneic graft
From identical twin
198
acute rejection time frame
weeks
199
chronic rejection time frame
months to years
200
hyper acute rejection: type of hypersensitivity rxn?
Type II. preformed antibodies in transplant recipient attack donor cells (blood mismatch)
201
occlusion of graft vessels causing ischemia and necrosis
hyperacute rejection
202
vasculitis of graft vessels with dense intertitial lymphocytic infiltrate
acute rejection
203
Fibrosis of graft tissue and blood vessels
chronic rejection.
204
mechanism of acute rejection
Cell mediated
- CTL react against foreign MHC
- Reversible
205
which rejection is NOT reversible?
chronic
206
macropapular rash, jaundice, hepatosplenomegaly and diarrhea in a transplant pt
GVH disease
207
which types of transplants most susceptible to GVH disease?
bone marrow and liver transplants (rich in lymphocytes)
208
Mech: cyclosporin
blocks diff and activation of T cells
- -inhibits calcineurin.
- -No IL2 and IL2R
209
tox of cyclosporine
```
nephrotoxicity
hypertension
hyperlipidemia/glycemia
gingival hyperplasia
hirsutism
```
210
Mech: tacrolimus
Binds FK binding protein, inhibiting calcineurin
211
tox of tacrolimus (FK506)
same as cyclosporin, but NO gingival hyperplasia and NO hirsuitism
212
Sirolimus (rapamycin) mechanism
Inhibits mTOR and T cell proliferation
213
Use of sirolimus
tranplant and drug eluting stent
214
toxicity: sirolimus
hyperlipidemia, thrombocytopenia, leukopenia
215
mechanism: azathioprine
precursor of 6 MP
- -interferes with synthesis of nucleic acids
- -toxic to lymphocytes
216
Use azathioprine
kidney transplant
| --GN and hemolytic anemia
217
Muromonab-CD3 (OKT3) mech
Binds CD3 and blocks T cell signal
218
Tox of muromonab
cytokine release syndrome, hypersensitivity
219
use: muromonab
kidney transplant
220
Omalizumab
Anti-IgE for sever asthma
221
aldesleukin
IL-2
222
Use: aldesleukin
RCC
| metastatic melanoma
223
EPO
renal failure anemia
224
filgrastim
GCSF
225
sargramostim
GMCSF
226
alpha IFN use:
Hep B, C
kaposi's
leukemia
malignant melanoma
227
B IFN
multiple sclerosis
228
y interferon
chronic granulomatous disease
229
Oprelvekin
thrombocytopenia
230
Use: filgrastim/sargramostim:
Recovery of bone marrow
231
trastuzumab
HER 2 antibody
232
Describe the process of inflammatory leukocyte migration
1. margination
2. rolling: with sialyl acid binding to L, E or P selectin (induced by cytokines)
3. activation of integrins
4. MAC-1 and LFA-1 integrins bind ICAM-1 on leukocyte
5. transmigration
