Immunology Flashcards
1
Q
Muromonab-CD3 (OKT3)
A
Target: CD3
Use: Prevent acute rejection
2
Q
Digoxin immune Fab
A
Target: Digoxin
Use: Digoxin toxicity
3
Q
Infliximab
A
Target: TNF-alpha
Use: Crohn’s, RA, psoriatic arthritis, ankylosing spondylitis
4
Q
Adalimumab
A
Target: TNF-alpha
Use: Crohn’s, RA, psoriatic arthritis
5
Q
Abciximab
A
Target: Gp2b/3a
Use: PCI; unstable angina
6
Q
Trastuzumab (Herceptin)
A
Target: Her2
Use: Her2 overexpressing BRCA
7
Q
Rituximab
A
Target: CD20
Use: B-cell non-Hodgkins lymphoma
8
Q
Omalizumab
A
Target: IgE
Uses: Additional line treatment for severe asthma
9
Q
Anti-nuclear Ab
A
Non-specific AI, SLE
10
Q
Anti-dsDNA Ab
A
SLE
11
Q
Anti-Smith Ab
A
SLE
12
Q
Anti-histone Ab
A
Drug-induced SLE
13
Q
Anti-CCP Ab
A
RA
14
Q
Anti-centromere Ab
A
CREST
15
Q
Anti-Scl-70 Ab
A
Scleroderma
16
Q
Anti-DNA topoisomerase I Ab
A
Scleroderma
17
Q
Anti-mitochondrial Ab
A
PBC
18
Q
Anti-TTG
A
Celiac disease
19
Q
Anti-GBM
A
Goodpasture’s
20
Q
Anti-desmoglein Ab
A
Pemphigus vulgaris
21
Q
Anti-microsomal Ab
A
Hashimoto’s
22
Q
Anti-thyroglobulin Ab
A
Hashimoto’s
23
Q
Anti-Jo-1 Ab, anti-SRP Ab
A
Polymyositis, dermatomyositis
24
Q
Anti-SSA Ab (anti-Ro)
A
Sjogren’s
25
Anti-SSB Ab (anti-La)
Sjogren's
26
Anti-smooth muscle Ab
AI hepatitis
27
Anti-glutamate decarboxylase Ab
DM1
28
c-ANCA (PR-3 ANCA)
Wegener's (GWP)
29
p-ANCA (MPO-ANCA)
CS, Microscopic polyangiitis
30
HLA A3
Hemochromatosis
31
HLA B27
Psoriasis, AS, IBD, Reiter's
32
HLA DQ2/DQ8
Celiac disease
33
HLA DR2
MS, SLE, Goodpasture's, Hay Fever
34
HLA DR3
DM1, Grave's
35
HLA DR4
DM1, RA
36
HLA DR5
Pernicious anemia, Hashimoto's
37
Describe the different regions of a lymph node
Cortex = follicle (primary/secondary B cells)
Paracortex = T cells + HEV
Medullary cords = plasma cells + lymphocytes
Medullary sinuses = macrophages + reticular
38
Where in the lymph node are the high endothelial venules?
Post-capillary venules in the paracortex
39
What is the difference between a primary and secondary LN follicle?
Primary: inactive (dormant)
Secondary: Pale, germinal centers (active)
40
What is the difference between medullary cords and sinuses in a lymph node?
Cords: Plasma cells
Sinuses: Macrophages + reticular cells
41
Lymph drainage: upper limb + lateral breast
Axillary nodes
42
Lymph drainage: stomach
Celiac nodes
43
Lymph drainage: duodenum and jejunum
SM nodes
44
Lymph drainage: sigmoid colon
Colic / IM nodes
45
Lymph drainage: rectum (AP)
Internal iliac
46
Lymph drainage: anal canal (BP)
Superficial inguinal
47
Lymph drainage: scrotum
Superficial inguinal
48
Lymph drainage: superficial thigh
Superficial inguinal
49
Lymph drainage: testes
Para-aortic
50
Lymph drainage: lateral dorsum of foot
Popliteal
51
In what zone of the spleen are APC's found?
Marginal zone (between red/white pulp)
52
What are the 2 major divisions of the spleen
Red pulp
| White pulp w/ PALS & Follicles
53
What is the role of splenic macrophages?
Removal of encapsulated bacteria (i.e. SHiN SKiS)
54
Howell-Jolly bodies
Post-splenectomy
55
The thymus is derived from what branchial pouch?
3rd
56
Lymphocytes in the thymus are derived from what cell line?
Mesenchymal
57
Positive vs. Negative selection in the thymus
Positive: Cortex
Negative: Medulla
58
Where are Hassall's corpuscles found?
Thymic medulla
59
NK cells are of myeloid or lymphoid origin
Lymphoid
60
NK cells use _________________ & __________________ to induce necrosis/apoptosis of virally infected and tumor cells.
Perforin & Granzyme
| * Apoptosis
61
IL-2, IL-12, IFN-alpha & IFN-beta enhance the activity of...
NK cells
62
NK cells' activity is enhanced by which cytokines?
IL-2, IL-12, IFN-alpha & IFN-beta
63
Which MHC pairs with beta-2 microglobulin?
MHC 1
64
Expressed on all nucleated cells: MHC1 or MHC2?
MHC-1
65
T/F MHC-1 expressed on RBC
False! No nuclei
66
MHC1 or MHC2: Antigen is loaded following release of invariant chain in an acidified endosome.
MHC2
67
HLA-A, B, C vs. HLA-DP, DQ, DR
Which is MHC-1 vs. 2?
ABC = MHC1
| DP, DQ, DR = MHC2
68
In MHC1, Ag is loaded in what organelle?
RER
69
Cytotoxic hypersensitivity: T2 or T3 HSR?
T2
70
Hypersensitivity: IgM or IgG
IgG
71
Which Ig neutralizes virus: IgM or IgG?
IgG
72
Th1 vs. Th2 helper T cells: Il-12 vs. IL-4
Th1: Il-12
Th2: Il-4
73
Which are the only Ag presenting cells that have the ability to activate naive T cells?
Dendritic cells
74
The professional Ag presenting cells
1. Dendritic cells
2. B cells
3. Macrophages
75
Co-stimulatory signals for T-cell vs. B-cell activation
T-cell: B7/CD28
| B-cell: CD40L/CD40
76
Th1 cytokines are stimulated by... & inhibited by...
| What do they secrete?
IL-12
Inhibited: IL-4, 10
Secrete: IFN-gamma
77
Th2 cytokines are stimulated by... & inhibited by...
IL-4
Inhibited: IFN-gamma
Secrete IL-4, 5, 10, 13
78
Activated lymphocytes release which cytokine?
IFN-gamma
79
Activated macrophages release which cytokines?
IL-1, TNF
80
Cytotoxic T cells release what 3 substances to induce apoptosis?
1. Perforin
2. Granzyme: serine protease / induce apoptosis
3. Granulysin: antimicrobicidal / apoptosis
81
Anti-inflammatory cytokines, such as, _____ & _____ are released by activated T-regs.
IL-10 & TGF-beta
82
T-regs help maintain specific immune tolerance by suppressing CD4 & CD8 T-cell effector functions. They express which cell surface receptors?
CD3, 4, 25 (alpha-chain of IL-2 R)
83
CD25
Expressed on cell surface of T-regs
84
T/F In opsonization, Ab promotes phagocytosis
T
85
Antibody idiotype vs. isotype
Idiotype: Ag diversity
Isotype: IgG, IgM, etc.
86
Which chain contributes to both Fab & Fc component of Ab: heavy or light chain?
Heavy chain (Light chain only contributes Fab)
87
Complement and Macrophages bind to Fab or Fc portion of Ab?
Fc
Complement: CH2
Macrophage: CH2 & CH3
88
Mature lymphocytes express ... on their surfaces
IgM & IgD
89
Mature lymphocytes may differentiate by isotype switching into plasma cells that secrete IgE, IgA, IgG. What interaction mediates this?
CD40/CD40L
90
Somatic hypermutation
Making the Ab's even more specific for the Ag
91
Who crosses placenta: IgG or IgM
IgG
92
B cells have Ag receptor for IgG or IgM
Both!
93
Most abundant Ig
IgG
94
Least abundant Ig
IgE
95
Ig that is a monomer in circulation, but dimer when secreted
IgA
96
Ig that is pentameric when not bound to B cells
IgM
97
Ig that cross-links when bound to eosionphils
IgE
98
Ig part of colostrum
IgA
99
Role of tdt
Adds nucelotides for random recombination of VJ, VDJ chains during Ab maturation
100
Thymus independent Ag vs. Thymus dependent Ag
Independent: Ag lack peptide component; cannot be presented by MHC to T cells (i.e. LPS from cell envelope of GN bacteria and polysaccharide capsular Ag). No immunologic memory
Dependent: Protein component (i.e. diptheria vaccine / class switching occurs)
101
MAC of complement defends against G+ or G- bacteria
Gram negative
102
What activates classical complement pathway?
IgM or IgG
103
What activates alternative complement pathwat?
Microbe surface molecules
104
What activates lectin complement pathway?
Mannose or other sugar on microbe surface
105
The two primary opsonins.
C3b & IgG
106
Role of C3b
Opsonization
107
Role of C3a and C5a
Anaphylataxis
108
Which complement component is an anaphylataxin and promotes neutrophil chemotaxis?
C5a
109
What is the role of C5b-9?
Cytolysis by MAC
110
Two inhibitors of complement activation
1. DAF (CD55)
| 2. C1 esterase inhibitor
111
C3 convertase: Classical pathway vs. Alternative pathway
Classical: C4b2a
Alternative: C3bBb
112
C5 convertase: Classical pathway vs. Alternative pathway
Classical: C4b2a3b
Alternative: C3bBb3b
113
ACE inhibitors are contraindicated in what disorder of complemenet?
Hereditary angioedema (C1 esterase inhibitor)
114
C3 deficiency results in...
Severe, recurrent pyogenic sinus and RT infections; increased susceptibility to type 3 HSR
115
C5-C9 deficiency results in recurrent...
Neisseria bacteremia
116
DAF (GPI enzyme) deficiency results in...
Complement-mediated lysis of RBC's and PNH
117
What cytokines are secreted by macrophages? What are their roles?
```
IL-1
IL-6
IL-8
IL-12
TNF-alpha
```
118
What cytokines are secreted by all T cells? What are their roles?
IL-2
| IL-3
119
What cytokines are secreted by Th1 cells? What are their roles?
IFN-gamma:
120
What cytokines are secreted by Th2 cells? What are their roles?
IL-4:
IL-5:
IL-10:
IL-13:
121
What is the mechanism of IFN?
Proteins that place uninfected cells in an antiviral state; unduce the production of ribonucease that inhibits viral protein synthesis by degrading viral mRNA, but no host mRNA.
Alpha, Beta: inhibit viral protein synthesis
Gamma: Increase MHC 1 & 2 expression
Activates NK cells
122
All cells except for mature _______ have MHC 1.
RBC
123
Major chemotactic factor for neutrophils
IL-8 (and C5a)
124
T cell cell surface proteins
TCR
CD3 (associated with TCR for signal transduction)
CD28 (binds B7 on APC)
125
B cell receptor for EBV
CD21
126
B cell surface markers
CD19, 20, 21, 40
| MHC2, B7
127
Macrophage cell surface markers
CD14, CD40
MHC2, B7
Fc, C3b receptors
128
NK cell surface markers
CD16 (binds Fc of IgG), CD56
129
What are superantigens?
S. aureus, S. pyogenes; cross link beta-region of T cell receptor to the MHC Class 2 on APC's. Can activate any T cell leading to massive cytokine storm
130
Endotoxins/LPS directly stimulate macrophages by binding to
CD14; Th1 cells are not involved
131
Several examples of Ag variation
Bacteria:
Salmonella: 2 flagellar variants
B. burgdorferi: Relapsing fever
N. gonorrohea: Pilus protein
Virus:
Influenza shift/drift
Parasite:
Trypanosomes - programmed rearrangement
132
Infuenza major shift
DNA rearrangement and RNA reassortment
133
Difference between antigenic drift and shift
Drift: minor over time
Shift: major over short period of time
134
Role of IL1-5
Hot T-Bone stEAk
```
IL-1: Fever
IL-2: T cell
IL-3: BM
IL-4: IgE
IL-5: IgA
```
135
IL-1
An endogenous pyrogen; causes fever and acute inflammation. Activates endothelium to express adhesion molecules; induces chemokine secretion to recruit WBC's
136
An endogenous pyrogen; causes fever and acute inflammation. Activates endothelium to express adhesion molecules; induces chemokine secretion to recruit WBC's
IL-1
137
Il-6
Endogenous pyorgen. Secreted by macrophages, Th2. Causes fever and stimulates production of acute phase proteins.
138
Endogenous pyorgen. Secreted by macrophages, Th2. Causes fever and stimulates production of acute phase proteins.
Il-6
139
IL-8
Major chemotactic factor for neutrophils.
140
IL-12
Induces differentiation into Th1 cells, activates NK cells.
141
Induces differentiation into Th1 cells, activates NK cells.
IL-12
142
TNF-alpha
Mediates septic shock; activates endothelium. Causes leukocyte recruitment, vascular leak
143
Mediates septic shock; activates endothelium. Causes leukocyte recruitment, vascular leak
TNF-alpha
144
Stimulates growth of helper, cytotoxic and regulatory T cells
IL-2
145
Cytokine that functions like GM-CSF
IL-3
146
This cytokine activates macrophages and Th1 cells; suppresses Th2 cells. Has antiviral and antitumor properties.
IFN-gamma
147
This cytokine induces differentiation into Th2 cells. Promotes growth of B cells and class switching of IgE & IgG.
IL-4
148
This cytokine enhances class switching to IgA. It stimulates the growth and differentiation of eosinophils
IL-5
149
________ has a similar action to IL-10 because it is involved in inhibiting inflammation.
TGF-beta
150
Modulates inflammatory response. Inhibits Th1 and T cells. Also secreted by Tregs.
IL-10
151
Passive immunity examples
To Be Healed Rapidly
| - Tetanus, Botox, HBV, Rabies
152
This type of immunity involves receiving pre-formed Ab. Rapid onset of action; short life-span of Ab (3 weeks). Examples include IgA in breast milk, antitoxin, humanized mAb
Passive immunity
153
This type of immunity involves exposure to foreign Ag. It is slow and long lasting.
Active immunity
154
Live attenuated vaccines induce .... response
Cellular
155
Inactivated, or killed vaccines, induce ... response
Humoral
156
Booster shots are required for live or killed vaccines?
Killed (aka inactivated)
157
Examples of vaccines inducing cellular response
* Live attenuated
| MMR, Sabin-oral, VZV, Yellow fever
158
Examples of vaccines inducing humoral response
* Killed, inactivated
| Cholera, HAV, Salk polio, rabies
159
3 mechanisms of cytotoxic hypersensitivity
1. Opsonization
2. Complement mediated
3. ADCC
160
Test for type 2 hypersensitivity reaction
Coombs
161
Serum sickness & Arthus reaction are Type 2 or Type 3 HSR?
Type 3
162
Most serum sickness is now caused by ________ acting as ___________. P/W fever, urticaria, arthralgia, proteinuria, LAD 5-10 days 2/2 Ag exposure
Drugs; haptens.
163
Local, subacute T3 hypersensitivity reaction. Intradermal injection of Ag induces Ab, which form complexes in the skin
Arthus reaction
164
Any Ab involved in T4 HSR?
No
165
Contact dermatitis is what type of HSR reaction?
Type 4
166
Type of HSR: Anaphylaxis
1
167
Type of HSR: Allergic and atopic disorders
1
168
Type of HSR: AIHA
2
169
Type of HSR: Pernicious anemia
2
170
Type of HSR: ITP
2
171
Type of HSR: Erythroblastialis fetalis
2
172
Type of HSR: Acute hemolytic transfusion reaction
2
173
Type of HSR: Rheumatic fever
2
174
Type of HSR: Goodpasture's syndrome
2
175
Type of HSR: Bullous pemphigold and pemphigus vulgaris
2
176
Type of HSR: SLE
3
177
Type of HSR: PAN
3
178
Type of HSR: PSGN
3
179
Type of HSR: Serum sickness
3
180
Type of HSR: Swelling/inflammation 2/2 tetanus rxn
3
181
Type of HSR: MS
4
182
Type of HSR: GBS
4
183
Type of HSR: GVHD
4
184
Type of HSR: PPD test
4
185
Type of HSR: Contact dermatitis, i.e. poison ivy, nickel allergy
4
186
Type 1 HSR against plasma proteins in transfused blood. What to treat with?
Allergic reaction; anti-histamine
187
Febrile non-hemolytic transfusion reaction
T2 HSR against donor HLA Ag on leukocytes
188
Acute hemolytic transfusion reaction
T2 HSR against ABO [IV or EV hemolysis]
189
Anti-glutamate DC Ab
DM1
190
Recombinant IL-2 is called ____________-
| Can be used to treat....
* Aldesleukin
| RCC, Metastatic melanoma
191
Which therapeutic Ab can be used to treat severe asthma?
Omalizumab (IgE)
192
IL-2 R antagonist
Basiliximab, Daclizumab
193
Recurrent bacterial infections after 6 months 2/2 opsoinization defect.
XLR/Bruton's agammaglobulinemia
| * Defect in BTK kinase (tyrosine kinase / no B cell maturation)
194
Most common primary immunodeficiency
Selective IgA deficiency
195
What immunodeficiency p/w false positive beta-HCG due to presence of heterophile Ab
IgA deficiency
196
Defect in B-cell maturation; acquired in 20-30s. Increased risk of AI disease, lymphoma, sinopulmonary infections.
CVID
197
22q11 deletion
DiGeorge; failure of 3rd and 4th pharyngeal pouches
198
IL-12 deficiency p/w
Disseminated mycobacterial infections; decreased IFN-gamma
199
Hyper-IgE syndrome also called ... p/w
Job syndrome; Coarse facies, cold staph abscesses, retained primary teeth, increased IgE, eczema
200
Recurrent candida infections
Chronic mucocutaneous candidiasis
201
Several types of this disorder that p/w FTT, chronic diarrhea, thrush and pan-infections. Absence of thymic shadow, germinal centers and B cells
SCID
* ADA deficiency
* IL2 receptor deficiency
202
Defects in ATM gene, which codes for DNA repair enzymes. Serum marker?
Ataxia-telangiectasia
| AFP, low IgA
203
Defective CD40L on helper T cells
Hyper IgM syndrome
204
T cells unable to reorganize actin cytoskeleton in this disorder. What is the inheritance?
Wiskott-Aldrich Syndrome (XLR)
| * TBOpenia, infections, eczema [decreased IgM]
205
Defect in Cd18 (LFA-1) integrin on phagocytes
LAD Type 1
206
Recurrent bacterial infections, lack of pus, delayed separation of umbilical cord
LAD Type 1
207
AR defect in lysosomal trafficking regulator (LYST); aka microtubule dysfunction in phagosome-lysosome fusion
Chediak-Higashi Syndrome
208
Chediak-Higashi Syndrome p/w
| Histology?
P/W: recurrent pyogenic infections, partial albinism and peripheral neuropathy; giant granules in PMN's
209
Recurrent pyogenic infections, partial albinism and peripheral neuropathy; giant granules in PMN's
Chediak-Higashi Syndrome
210
Absent didydrorhodamine flow cytometry
CGD (Nitroblue tetrazolium dye reduction test no longer preferred)
211
Patients with which disorder p/w increased frequency of catalase + infections, i.e. S. aureus, E. coli, Aspergillus
CGD (NADPH oxidase)
212
What is a syngeneic graft?
From identical twin or clone
213
What is the difference between an autograft and an allograft?
Auto: From self
Allo: From other
214
Vasculitis of graft vessels with dense interstitial lymphocytic infiltrate
Acute graft rejection; cell-mediated 2/2 CTL reacting against foreign MHC. Reversible with IS
215
Maculopapular rash, jaundice, HSM, diarrhea
GVHD
216
No thymic shadow in...
DiGeorge & SCID
217
Treatment of Bruton's X-linked agammaglobulinemia
IVIG
218
X-linked disorder of BTK kinase
XLA
219
Wiskott-Aldrich Syndrome has elevated levels of which Ig?
IgA
220
Cobalophilin is also referred to
R-binder
221
Anti-microsomal Ab are seen in...
Hashimoto's thyroiditis
222
Symmetric priximal muscle weakness; characteristic heliotrope rash; elevated serum muscle enzymes; myopathic changes on EMG and muscle bx abnormalities
Polymyosititis, dermatomyositis
223
Anti-IgG Ab
RF/ Rheumatoid arthritis
224
NADPH oxidase deficiency results in...
CGD
225
T/F PNPP deficiency causes SCID with near normal levels of Ig
True
226
The most common paraneoplastic syndromes a/w thymoma
RBC aplasia, MG, hypogammaglobulinemia
227
Derivatives of neural crest cells
Adrenal medulla, Schwann cells, sensory and autonomic ganglia; melanocytes
228
Neuroectoderm gives rise to...
CNS, astrocytes, oligodendrocytes, pineal gland
229
T/F DPT vaccine is contraindicated in patients with a hx of seizure disorder
T
230
Eczema is a Type ___ HSR
Type 1
231
Anti-MPO Ab
P-ANCA (CA, Microscopic polyangiitis)
232
Anti-Proteinase 3 Ab
C-ANCA (Wegener's)
233
CD59
MAC inhibitory factor (think PNH)
234
Genetic defect in ataxia telangiectasia? Associated with a deficiency of what Ig?
Defect in DNA repair enzymes; IgA
235
T/F Exposure to hydrocarbons in dry cleaning solvents has been associated with Goodpasture's syndrome
T
236
Large lysosome vesicles in neutrophils are characteristic of
Chediak-Higashi disease
237
Low IgM with elevated IgE & IgE are characteristic of
Wiskott-Aldrich Syndrome
238
T/F In ITP, platelets can be larger than normal
True
239
Drepanocytes
Sickle cells
240
Pappenheimer bodies
Excess iron (siderosomes)
241
Mutation in fatty aldehyde DH gene
Sjogren-Larsson syndrome: a/w congenital ichthyosis and mental retardation/spastic paraplegia
242
A toxoid is a toxin that...
Has been modified to the extent that it is no longer toxic but still maintains some antigenic similarity; therefore toxoid cross-reacts with the toxin
243
What type of vaccine is diptheria vaccine?
Toxoid
244
T/F Rheumatic fever is an autoimmune disease.
True (T2 HSR)
245
T/F In DiGeorge's syndrome, the patient's BM contains a full assortment of immune system progenitors
True
