Immunology Flashcards

1
Q

HLA A3

A

hemochromatosis

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2
Q

HLA B27

A

PAIR

- psoriatic arthritis, ank spon, IBD, reactive arthritis

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3
Q

HLA DQ2/DQ8

A

celiac disease

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4
Q

HLA DR2

A

MS, hay fever, SLE, goodpasture, syndrome

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5
Q

HLA DR3

A

DM 1, SLE, Graves Disease

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6
Q

HLA DR4

A

RA, DM 1

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7
Q

HLA DR5

A

pernicious anemia, Hashimoto thyroiditis

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8
Q

IL-1

A

secreted by macrophages. endogenous pyrogen, also called osteoclast activating factor. causes fever, acute inflammation. activates endothelium to express adhesion molecules, induces cytokine secretion to recruit leukocytes

  • “Hot T-bone stEAK”
  • stimulates hot (fever), T cells, bone marrow, IgE, IgA, aKute phase reactants production
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9
Q

IL-2

A

secreted by all T cells, stimulates growth of helper, cytotoxic and regulatory T cels
- can be used for tumor regression in RCC and metastatic melanoma

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10
Q

IL-3

A

secreted by all T cells

- support the growth and differentiation of BM stem cells. functions like GM-CSF

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11
Q

IL-4

A

secreted by TH2 cells

  • induces differentiation into TH2 cells, promotes growth of B cells
  • enhances class switching to IgG and IgE
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12
Q

IL-5

A

secreted by TH2 cells

  • promotes differentiation of B cells, enhances class switching to IgA
  • stimulates the growth and differentiation of eosinophils
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13
Q

IL-6

A

secreted by macrophages and TH2 cells

  • an endogenous pyrogen
  • fever and stimulates production of acute phase proteins
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14
Q

IL-8

A

secreted my macrophages

- major chemotactic factor for neutrophils

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15
Q

IL-10

A

secreted by TH2 cells and Treg

  • modulates inflammatory response, inhibits actions of activated T cells and Th1
  • enhances IL4 and 5 secretion from TH2
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16
Q

IL-12

A

secreted by macrophages and B cells

  • induces differentiation of T cells into Th1 cells
  • activates NK cells
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17
Q

TNF-alpha

A

secreted by macrophages

  • mediates septic shock, activates endothelium, causes leukocyte recruitment and vascular leak
  • mediates cachexia
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18
Q

IFN gamma

A

secreted by Th1 cells

  • has antiviral and antitumor properties
  • activates NK cells
  • increases MHC expression and antigen presentation in all cells
  • used therapeutically in CGD
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19
Q

INF alpha and beta

A
  • interferes with viral replication by halting protein synthesis in virally infected cells
  • essentially results in apoptosis
  • alpha used therapeutically in Hep B/C, Kaposi sarcoma, hairy cell leukemia, condyloma acuminatum, RCC and malignant melanoma
  • beta used therapeutically in MS
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20
Q

T cell surface receptors

A
  • TCR, CD3, CD28 (binds to B7 in APC)
  • Helper T cells have CD4 and CD40 ligand
  • Cytotoxic T cells have CD8
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21
Q

B cell surface receptors

A
  • CD19, CD20, CD21 (EBV entry), CD40

- MHC II, B7

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22
Q

macrophage cell surface receptors

A
  • CD 14, CD 40
  • MHC II, B7
  • Fc and C3b receptors
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23
Q

NK cell surface receptors

A
  • CD 16 (binds Fc of IgG)

- CD 56 (unique marker for NK)

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24
Q

Type I HS reaction

A
  • anaphylactic and atopic - free antigen cross links with IgE (aggregation of IgE-Fc receptors triggers degranulation) on mast cells/basophils triggering immediate release of histamine and tryptase (sensitive for mast cell activation)
  • delayed response due to leukotrienes
  • test: skin test for IgE
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25
Type II HS reaction
- cytotoxic "cy-2-toxic" - IgG and IgM bind fixed antigen on enemy cell, leading to cellular destruction - 3 mech: opsonization (phagocytosis or complement), complement mediated lysis (transfusion reaction), Ab dependent cell mediated tox with NK or macrophage - test: direct and indirect Coombs
26
Coombs test
- direct tests for antibodies that have adhered to antigen (test Rh + baby with Rh- mom) - indirect tests for antibodies that can adhere to other RBCs (test Rh - mom for Abs)
27
Type III HS reaction
- immune complex - IgG complexes activate complement, which attracts neutrophils that release lysosomal enzymes - ex: serum sickness, arthus reaction - III - 3 things stuck together - antigen-antibody-complement
28
serum sickness
immune complex idsease in which Abs to the foreigh proteins are produced (takes 5 days) - immune complexes form and are deposited in membranes, where they fix complement --> tisue damage - assoc with monoclonal Ab drugs - fever, urticaria, arthralgias, proteinuria, lymphadenopathy 5-10 days after antigen exposure - small vessel vasculitis with fibrinoid necrosis and intense neutrophil infiltration - hypocomplementemia
29
arthus reaction
- local subacute type III HS reaction - interdermal injection of antigen induces antibodies, which form complexes in the skin - edema, necrosis and activation of complement - test: IF staining
30
Type IV HS reaction
- delated (T cell mediated) - sensitized T cells encounter antigen and then release lymphokines (leads to macrophage activation, no Ab involved) - 4 T's - T lymphocytes, Transplant rejections, TB skin tests, Touching (contact derm)
31
What type of reactions characterize each HS reaction?
ACID - I - Anaphylactic and Atopic - II - Cytotoxic - III - Immune complexes - IV - Delayed (cell mediated)
32
Type I HS disorders
- anaphylaxis | - allergic and atopic disorders (rhinitis, hay fever, eczema, hives, asthma)
33
Type II HS disorders
- AI hemolytic anemia - pernicious anemia - ITP - erythroblastosis fetalis - acute hemolytic transfusion reactions - Rheumatic fever - Goodpasture syndrome - Myasthenia gravis - Bullous Pemphigoid - Pemphigus Vulgaris
34
Type III HS disorders
- SLE, polyarteritis nodosa, PSGN, serum sickness, arthus reaction (swelling and inflammation following tetanus vaccine)
35
Type IV HS disorder
- MS, GBS, Graft v. Host disease, PPD, contact derm
36
allergic blood transfusion reaction
- Type I HS reaction against plasma proteins in transfused blood - urticaria, pruritis, wheezing, fever - treat with antihistamines
37
anaphylactic blood transfusion reaction
- severe allergic reaction - IgA deficient pts need blood without IgA or this will happen - dyspnea, bronchospasm, hypotension, respiratory arrest, shock
38
febrile nonhemolytic transfusion reaction
- Type II HS reaction - host Abs against donor HLA antigens and leukocytes - fever, headaches, chills, flushing
39
acute hemolytic transfusion reaction
- Type II HS reaction - intravascular hemolysis due to ABO incompatibility or extravascular hemolysis due to host Ab reaction against foreign antigen on donor RBCs - complement mediated - fever, hypotension, tachypnea, tachycardia, flank pain, hemoglobinemia and jaundice
40
Bruton agammaglobulinemia
- X linked recessive defect in BTK - a tyrosine kinase gene - no B cell maturation - presents with recurrent bacterial, enteroviral and giardia infections after 6 months - normal CD19+ B cell count, dec pro-B, dec Ig of all classes - absent/scanty lymph nodes and tonsils with no germinal centers
41
selective IgA deficiency
- most common primary immunodeficiency - can see airway and GI (mucosal) infections, autoimmune disease (assoc with celiac), atopy, anaphylaxis to IgA containing products - IgA < 7 mg/dL with normal IgG and IgM levels
42
common variable immunodeficiency
- defect in B cell differentiation due to B cell or helper T cell defect (cant make immunoglobulins) - can be acquired in 20s-30s, inc risk of autoimmune disease, bronchiectasis, lymphoma, sinopulmonary infections - bacterial, enterovirus and giardia infections - decreased plasma cells, decreased immunoglobulins
43
C1 esterase inhibitor deficiency
- causes hereditary angioedema | - NO ACE inhibitors
44
C3 deficiency
increases risk of severe, pyogenic sinus and resp tract infections, inc susceptibility to type III HS reactions
45
C5-C9 deficiencies
- increased susceptibility to Neisseria infections, no ability to make MAC
46
DAC (GP1 anchored enzyme) deficiency
- causes complement mediated lysis of RBCs and PNH
47
Thymic aplasia (DiGeorge)
- 22q11 deletion, failure of 3rd and 4th pharyngeal pouches (no thymus or parathyroids) - presents with hypocalcemia, recurrent viral/fungal infections, conotruncal abnormalities (ToF, truncus arteriosus) - dec T cells, dec PTH, dec Ca - no thymic shadow
48
IL-12 receptor deficiency
- decreased Th1 response, AR - disseminated mycobacterial and fungal infections, may present after administration of BCG vaccine - decreased IFN gamma
49
AD Hyper-IgE syndrome (Job syndrome)
- deficiency of Th17 cells due to STAT3 mutation --> impaired recruitment of neutrophils to sites of infection - FATED: coarse Facies, staph Abscesses, retained Primary teeth, inc IgE, Dermatologic problems
50
Chronic mucocutaneous candidiasis
- T cell dysfunction (many causes) - non invasive candida infections of the skin and mucous membranes - absent in vitro T cell proliferation or cutaneous reaction in response to candida antigens
51
SCID
- several types, most important is adenosine deaminase deficiency (AR) - adenosine accumulation is toxic to T and B cells - FTT, chronic diarrhea, thrush - recurrent bacterial, fungal, viral and protozoal infections - no thymic shadow, no germinal centers - DO NOT GIVE LIVE VACCINES - treat with BM transplant
52
Ataxia-telangiectasia
- defects in ATM gene -- DNA double strand breaks -- cell cycle arrest - triad: Ataxia (cerebellar defects), spider Angiomas, IgA deficiency - inc AFP, dec IgA, IgG, IgE, lymphopenia and cerebellar atrophy
53
Hyper IgM syndrome
- defective CD40L on Th cells --> X linked recessive class switching defect - severe pyogenic infections early in life, opportunistic infections - inc IgM with all other lines down
54
Wiskott-Aldrich Syndrome
- WATER - Wiskott Aldrich: Thrombocytopenic purpura, Eczema, Recurrent infections - inc risk of autoimmune disease and malignancy - dec to normal IgM and IgG - inc IgE and IgA
55
Leukocyte adhesion deficiency
- defect in LFA-1 integrin (CD18) protein on phagocytes, impaired migration and chemotaxis, AR - recurrent bacterial skin and mucosal infections, no pus formation, impaired wound healing, delayed umbilical cord separation - inc neutrophils, none at infection site
56
Chediak-Higashi syndrome
- defect in lysosomal trafficking regulator gene (LYST) - microtubule disfunction in phagosome-lysosome fusion, AR - recurrent pyogenic infections by staph and strep, peripheral neuropathy, progressive neurodegeneration, infiltrative lymphohistocytosis - giant granules in neutrophils and platelets, pancytopenia and mild coag defects
57
Chronic Granulomatous Disease
- defect in NADPH oxidase, no respiratory burst and dec ROS - X linked recessive - inc susceptibility to cat + organisms - abnormal dihydrorhodamine (flow cytometry) test - nitroblue tetrazolium due reduction test is negative (neutrophils will not turn blue)
58
acute transplant rejection
- CTLs activated against donor MHCs + humoral Abs develop after transplant - leads to vasculitis of the graft vessels with dense interstitial lymphocytic infiltrate - prevent/reverse with immunosuppressants (calcineurin inhibitors)
59
chronic transplant rejection
humoral and cellular, recipient T cells react against donor antigens presented on donor MHC - irreversible damage - heart - atherosclerosis - lungs - inflammation/fibrosis of small bronchioles (bronchiolitis obliterans) - liver - vanishing bile ducts - kidney - vascular fibrosis, glomerulopathy, loss of glomeruli, atrophy
60
graft v. host disease
graft T cells proliferate in the immunocompromised host and reject host cells with "foreign" proteins --> severe organ dysfunction - rash, jaundice, diarrhea, HSmegaly - usually in BM and liver transplants - potentially beneficial for BM transplant
61
cyclosporine
- calcineurin inhibitor that blocks cyclophilin - blocks T cell activation by preventing IL-2 trascription - used for rejection ppx, psoriasis, RA - tox: nephrotox, HTN, HLD, hyperglycemia, tremor, hirsuitism, gingival hyperplasia
62
tacrolimus
- calcineurin inhibitor, binds FK506 binding protein (FKBP) - blocks T cell activation by preventing IL-2 transcription - used for rejection ppx - tox: similar to cyclosporine, inc risk of diabetes and neurotoxicity, no gingival hyperplasia or hirsuitism
63
sirolimus
aka rapamycin - mTOR inhibitor, binds FKBP - blocks T cell activation and B cell differentiation by preventing IL-2 signal transduction - used in kidney transplant rejection prophylaxis - tox: anemia, thrombocytopenia, leukopenia, insulin resistance, HLD, non-nephrotoxic - kidney "sir"vives
64
basiliximab
- monoclonal Ab blocks IL-2R - kidney transplant rejection ppx - tox: edema, HTN, tremor
65
azathioprine
- antimetabolite precursor of 6-mercaptopurine - inhibits lymphocyte proliferation by blocking nucleotide synthesis - used in rejection ppx, RA, crohns, glomerulonephritis, and other AI conditions - tox: leukopenia, anemia, thrombocytopenia - degraded by xanthine oxidase, tox increases with allopurinol
66
glucocorticoids
- inhibits NFkB - suppress both B and T cell function by dec transcription of many cytokines - used in rejection ppx, many AI d/o, inflammation - tox: hyperglycemia, osteoporosis, central obesity, muscle breakdown, psychosis, acne, HTN, cataracts, peptic ulcers
67
alemtuzumab
- targets CD52 - used in CLL - "alymtuzumab" used in chronic Lymphocytic leukemia
68
bevacizumab
- VEGF Ab | - used in colorectal cancer, RCC
69
cetuximab
- EGFR Ab | - used in stage IV colorectal cancer, head and neck cancer
70
rituximab
- CD20 Ab | - used in B cell non-Hodgkin lymphoma, RA and ITP
71
trastuzumab
- HER2/neu Ab | - used in breast cancer and gastric cancer
72
infliximab, adalimumab
- TNF alpha antibody | - used in IBD, rheumatoid arthritis, ank spon, psoriasis
73
natalizumab
- alpha 4 integrin Ab - used in MS and crohns - alpha 4 is used in leukocyte adhesion - risk of PML in pts with JC virus
74
abciximab
- glycoprotein IIb/IIIa Ab | - anti-platelet agent for prevention of ischemic complications in pts undergoing PCI
75
denosumab
RANKL Ab | - used for osteoporosis, inhibits osteoclast maturation