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USMLE Step 1. > Immunology > Flashcards

Immunology Flashcards

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USMLE® Step 1 flashcards
1
Q

Cervical node drainage

A

Head and neck

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2
Q

Hilar node drainage

A

Lungs

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3
Q

Mediastinal node drainage

A

Trachea and esophagus

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4
Q

Axillary node drainage

A

Upper limb, breast, skin above belly button

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5
Q

Celiac node drainage

A

Liver, stomach, spleen, pancreas, upper duodenum

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6
Q

Superior mesenteric node drainage

A

Lower duodenum, jejunum, ileum, colon to splenic flexure

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7
Q

Inferior mesenteric node drainage

A

colon from splenic flexure to upper rectum

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8
Q

Internal iliac node drainage

A

Lower rectum to anal canal (above pectinate line), bladder, vagina (middle third), prostate

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9
Q

Para-aortic node drainage

A

Testes, ovaries, kidneys, uterus

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10
Q

Superficial inguinal node drainage

A

Anal canal (below pectinate line), skin below belly button (not popliteal territory), scrotum

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11
Q

Popliteal node drainage

A

Dorsolateral foot, posterior calf.

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12
Q

Right lymphatic duct drainage

A

Right side of body above diaphragm

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13
Q

Thoracic duct drainage

A

Everything RLD doesn’t drain. Goes into subclavian and Internal jugular veins

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14
Q

Encapsulated organisms to look out for

A

1) Strep Pneumo
2) H. flu
3) N. meningitidis
4) E. Coli
5) Salmonella
6) Klebsiella
7) Group B Strep

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15
Q

Part of lymph node underdeveloped in DiGeorge Syndrome

A

paracortex - houses T cells and provides a route for T and B cells to enter blood.

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16
Q

MHC 1

A

HLA- A, B, C

Binds to TCR and CD8

Expressed on all nucleated cells. Not on RBCs

Present endogenously made antigens (viral or cytosolic proteins) to CD8+ cytotoxic T cells.

Antigen peptides loaded onto MHC1 in RER after delivery via TAP (a transporter associated with antigen processing)

Associated with B2-microglobulin

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17
Q

MHC 2

A

HLA- DR, DP, DQ

Binds to TCR and CD4

Expressed on APCs

Presents exogenously made antigens (bacterial proteins) to CD4+ helper T cells.

Antigen loaded following release of invariant chain in an acidified endosome

Associated with Invariant chain (a protein).

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18
Q

HLA A3

A

Hemochromatosis

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19
Q

HLA B27

A

Psoriatic Arthritis, Ankylosing spondylitis, IBD, Reactive arthritis (Reiter Syndrome). PAIR.

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20
Q

HLA DQ2/DQ8

A

Celiac disease

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21
Q

HLA DR2

A

MS, hay fever, SLE, Goodpasture

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22
Q

HLA DR3

A

Diabetes mellitus type 1, SLE, Graves, Hashimoto thyroiditis

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23
Q

HLA DR4

A

Rheumatoid arthritis, diabetes mellitus type 1

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24
Q

HLA DR5

A

Pernicious anemia leading to vitamin B12 deficiency Hashimoto thyroiditis

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25
Q

Enhances NK cell activity

A

IL-2, IL-12, IFN alpha, IFN beta

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26
Q

Th1 cells

A

Secrete IFN-gamma

Activated by IFN-gamma and IL-12 (from Macrophage)

Inhibited by IL-4, IL- 10 (from Th2)

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27
Q

Th2 cells

A

Secrete IL4, IL-5, IL-10, IL-13

Activated by IL-4

Inhibited by IFN-gamma (from Th1)

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28
Q

Acute phase reactants

A

released by liver. Their concentrations change in response to inflammation. Chronic made by liver too. Induced by IL-6

CRP, Ferritin, Fibrinogen, Hepcidin, Serum amyloid A, Albumin, Transferrin

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29
Q

C-reactive protein

A

(Positive) upregulated in immune response.

Opsonin - fixes complement and facilitates phago. Measured clinically as a sign of ongoing inflammation.

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30
Q

Ferritin

A

(Positive) Upregulated in IR.

Binds and sequesters iron to inhibit microbial iron scavenging

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31
Q

Fibrinogen

A

(Positive) Upregulated in IR.

Coagulation factor that promotes endothelial repair - correlates with ESR.

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32
Q

Hepcidin

A

(Positive) Upregulated in IR.

Prevents release of Iron bound by ferritin (anemia of chronic disease)

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33
Q

Serum Amyloid A

A

(Positive) Upregulated in IR.

Prolonged elevationcan lead to amyloidosis

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34
Q

Albumin

A

(Negative) Downregulated in IR

Reduction conserves amino acids for positive reactants

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35
Q

Transferrin

A

(Negative) Downregulated in IR

Internalized by macrophages to sequester iron.

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36
Q

C1 esterase inhibitor deficiency

A

Causes hereditary angioedema. ACE inhibitors are contraindicated.

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37
Q

C3 deficiency

A

Increases risk of severe, recurrent pyogenic sinus and respiratory infections. Higher susceptibility to type 3 hypersensitivity rxns

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38
Q

C5-C9 deficiencies

A

Terminal complement deficiency increases risk to recurrent Neisseria bacteremia

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39
Q

DAF (GPI-anchored enxyme) deficiency

A

causes complement-mediated lysis of RBCs and paroxysmal nocturnal hemoglobinuria

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40
Q

cytokines released by macrophages

A

IL-1, IL-6, IL-8, IL-12, TNF-alpha

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41
Q

cytokines released by ALL T cells

A

IL-2, IL-3

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42
Q

cytokines released by Th1 cells

A

IFN-gamma

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43
Q

cytokines released by Th2 cells

A

IL-4, IL-5, IL-10

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44
Q

IL-1

A

“osteoclast-activating factor”

causes fever, acute inflammation. Activates endothelium to express adhesion molecules. Induces chemokine secretion to recruit WBCs

45
Q

IL-6

A

Causes fever and stimulates production of acute-phase proteins

46
Q

IL-8

A

Major chemotactic factor for neutrophils

47
Q

IL-12

A

Induces differentiation of T cells into Th1 cells. Activates NK cells.

48
Q

TNF-alpha

A

Mediates septic shock. Activates endothelium. Causes WBC recruitment, vascular leak.

49
Q

IL-2

A

Stimulates growth of helper, cytotoxic, and regulatory T cells. Also NK cells.

50
Q

IL-3

A

Supports growth and differentiation of bone marrow stem cells. Functions like GM-CSF

51
Q

IFN-gamma

A

secreted by NK cells in response to IL-12 from macrophages. Stimulates macrophages to kill phagocytosed pathogens.

Also activates NK cells to kill virus-infected cells. Increases MHC expression and antigen presentation by all cells.

52
Q

IL-4

A

Induces differentiation into Th2 cells. Promotes growth of B cells. Enhances class switching to IgE and IgG

53
Q

IL-5

A

Promotes differentiation of B cells. Enhances class switching to IgA. Stimulates growth and differentiation of eosinophils.

54
Q

IL-10

A

Modulates inflammatory response. Lowers expression of MHC class II and Th1 cytokines. Inhibits activated macrophages and dendritic cells. Also secreted by Treg.

TGF-Beta and IL-10 aTENuate the immune response.

55
Q

Chronic granulomatous disease

A

Patients cannot make superoxide radical and therefore can’t generate ROS.

Can still utilize H2O2 generated by invading organisms to make ROS. However, Cat (+) organisms can neutralize their own H2O2… higher risk of infection from these organisms.

56
Q

Cell surface proteins on all nucleated cells

A

MHC1. Not on RBCs (no nucleus)

57
Q

Cell surface proteins on T cells

A

TCR (binds antigen-MHC complex)

CD3 (associated with TCR for signal transduction)

CD28 (binds B7 on APC)

58
Q

Cell surface proteins on Th cells

A

CD4, CD40L

59
Q

Cell surface proteins on Tcytotox

A

CD8

60
Q

Cell surface proteins on Treg

A

CD4, CD25

61
Q

Cell surface proteins on B cells

A

Ig (binds antigen)

CD19, CD20, CD21 (receptor for EBV), CD40

MHC2, B7

62
Q

Cell surface proteins on Macrophages

A

CD14, CD40

MHC2, B7

Fc and C3b receptors (enhanced phagocytosis)

63
Q

Cell surface proteins on NK cells

A

CD16 (binds Fc of IgG), CD56 (unique marker for NK)

64
Q

Cell surface proteins on Hematopoietic stem cells

A

CD34

65
Q

Chronic granulomatous disease

A

Patients cannot make superoxide radical and therefore can’t generate ROS. Deficiency in NADPH oxidase.

Can still utilize H2O2 generated by invading organisms to make ROS. However, Cat (+) organisms can neutralize their own H2O2… higher risk of infection from these organisms.

66
Q

X-Linked (Bruton) agammaglobulinemia

A

Defect in BTK (tyrosine kinase gene) leading to no B cell maturation. X-linked recessive and higher in boys.

Presents w/ recurrent bacterial and enteroviral infections after age 6 months (lower maternal IgG at this time)

You’ll find absent B cells in peripheral blood, lower Ig of all classes, and absent/scanty lymph nodes and tonsils.

67
Q

Selective IgA deficiency

A

Unknown cause, but most common primary immunodeficiency

P/w: Majority asymptomatic. You can see airway and GI infections, autoimmune disease, atopy, anaphylaxis to IgA containing products.

You’ll find lower IgA with normal IgG, IgM levels

68
Q

Common variable immunodeficiency

A

Defect in B-cell differentiation from many causes.

p/w: can be acquired in 20s-30s; higher risk of autoimmune diseases, bronchiectasis, lymphoma, sinopulmonary infections.

You’ll find lower plasma cells, lower immunoglobulins.

69
Q

Thymic aplasia (DiGeorge Syndrome)

A

22q11 deletion; failure to develop 3rd and 4th pharyngeal pouches leadings to absent thymus and parathyroids

P/w: tetany (hypocalcemia), recurrent viral/fungal infections (T Cell deficiency), conotruncal abnormalities (e.g. tetralogy of fallot, truncus arteriosus)

Findings: low T cells, low PTH, low Ca

Absent thymic shadow on CXR. 22q11 deletion detected by FISH

70
Q

IL-12 receptor deficiency

A

lower Th1 response. Autosomal recessive

Disseminated mycobacterial and fungal infections; may present after administration of BCG vaccine

Findings: low IFN-gamma

71
Q

Autosomal dominant hyper-IgE Syndrome (Job Syndrome)

A

deficiency of Th17 cells due to STAT3 mutation leads to impaired recruitment of neutrophils to sites of infection.

p/w: FATED - coarse Facies, cold (noninflamed) staphlococcal Abscesses, retained primary Teeth, higher IgEEEE, Derm problems (eczema)

Findings: high IgE, Low IFN-gamma

72
Q

Chronic mucocutaneous candidiasis

A

T cell dysfunction from many causes.

p/w: noninvasive candida albicans infections of skin and mucous membranes

73
Q

Severe Combined Immunodeficiency

A

Dif types: Defective IL-2R gamma chain (most common, X-linked). Adenosine deaminase deficiency also possible (Auto recess)

p/w: Failure to thrive, chronic diarrhea, thrush, recurrent viral, bacterial, fungal and protozoal infections. Tx = bone marrow transplant (no rejection concern)

Findings: Low T cell receptor excision circles (TRECS). No Thymic shadow on CXR. No germinal centers (lymph node biopsy), No T cells (flow cytometry)

74
Q

Ataxia-Telangiectasia

A

Defects in ATM gene leads to failure to repair DNA ds breaks leading to cell cycle arrest.

Triad: cerebellar defects (ataxia), spider angiomas (telangiectasia), IgA deficiency

Findings: Higher AFP (alpha fetoprotein), Lower IgA, Low IgG, Low IgE

Lymphopenia, cerebellar atrophy

75
Q

Hyper-IgM Syndrome

A

Defective CD40L on Th cells leads to class switching defect. X recessive.

p/w: Severe pyogenic infections early in life; opportunistic infection with Pneumocystis, Crypto, CMV

Findings: High IgM. Very low IgG, IgA, IgE

76
Q

Wiskott-Aldrich Syndrome

A

Mutation in WAS gene (X recess); T cells unable to reorganize actin cytoskeleton

p/w: Thrombocytopenic purpura, eczema, recurrent infections. Higher risk of autoimmune diseases and malignancy

Findings: Low to normal IgG, IgM. High IgE, IgA, Fewer and smaller platelets

77
Q

Chronic granulomatous disease

A

Patients cannot make superoxide radical and therefore can’t generate ROS. Deficiency in NADPH oxidase.

Can still utilize H2O2 generated by invading organisms to make ROS. However, Cat (+) organisms can neutralize their own H2O2… higher risk of infection from these organisms.

Nocardia, Pseudomonas, Listeria, Aspergillis, Candida, E Coli, S aureus, Serratia

Findings: Abnormal dihyrdorhodamine (flow cytometry) test. Nitroblue tetrazolium dye reduction test is negative

78
Q

Leukocyte adhesion deficiency (type 1)

A

Defect in LFA-1 integrin (CD18) protein on phagoctyes leads to impaired migration and chemotaxis. Auto recess.

Recurrent bacterial skin and mucosal infection, absent pus formation, impaired wound healing, delayed separation of umbilical cord (>30 days).

Findings: High neutrophils. Absence of neutrophils at infection sites.

79
Q

Chediak-Higashi Syndrome

A

Defect in lysosomal trafficking regulator gene (LYST). Microtubule dysfunction in phagosome-lysosome fusion; auto recess

Recurrent pyogenic infections by staph and strep, partial albinism, peripheral neuropathy, progressive neurodegeneration, infiltrative lymphohistiocytosis

Findings: Giant granules in granulocytes and platelets. Pancytopenia. Mild coagulation defects.

80
Q

Cyclosporine

A

Inhibits calcineurin. It binds to cyclophilin to do this. Blocks T cell activation by preventing IL-2 transcription.

Use in transplant rejection prophylaxis, psoriasis, RA.

Toxicity: Nephrotoxicity, HTN, hyperlipidemia, neurotox, gingival hyperplasia, hirsutism

81
Q

Tacrolimus (FK506)

A

Inhibits calcineurin - binds FK506 binding protein (FKBP). Blocks T cell activation by preventing IL-2 transcription

Use in transplant rejection prophylaxis

Toxicity: Nephro, similar to cyclosporine, increases risk of diabetes and neurotox - no gingival hyperplasia or hirsutism.

82
Q

Sirolimus (Rapamycin)

A

mTOR inhibitor, binds FKBP. Blocks T cell activation and B cell differentiation by preventing response to IL-2.

Use in Kidney transplant rejection prophylaxis

Toxicity: Anemia, thrombocytopenia, leukopenia, insulin resistance, hyperlipidemia, NOT NEPHROTOX

Kidney SIRvives. Works well with cyclosporine. Also used in drug-eluting stents.

83
Q

Daclizumab, basiliximab

A

Monoclonal antibodies - block IL-2R

Use in kidney transplant rejection prophylaxis

Toxicity - Edema, HTN, tremor

84
Q

Azathioprine

A

Antimetabolite precursor of 6-mercaptopurine (6-MP). Inhibits lymphocyte proliferation by blocking nucleotide synthesis.

Use in transplant rejection prophylaxis, RA, Crohn, glomerulonephritis, other autoimmune disorders

Toxic: Leukopenia, anemia, thrombocytopenia

6-MP degraded by XO so toxicity is increased by allopurinol

85
Q

Glucocorticoids

A

Inhibit NF-kB. Suppress both B and T cell function by lowering transcription of many cytokines.

Use in transplant rejection prophylaxis (immunosuppression), many autoimmune disorders, inflammation.

Toxic: Hyperglycemia, osteoporosis, central obesity, muscle breakdown, psychosis, acne, HTN, cataracts, avascular necrosis

Can cause iatrogenic Cushing syndrome.

86
Q

Anti-ACh receptor antibody

A

Myasthenia gravis

87
Q

Anti-basement membrane antibody

A

Goodpasture syndrome

88
Q

Anticardiolipin, lupus anticoagulant antibodies

A

SLE, antiphospholipid syndrome

89
Q

Anticentromere antibody

A

Limited scleroderma (CREST Syndrome)

90
Q

Anti-desmosome (anti-desmoglein) antibodies

A

Pemphigus vulgaris

91
Q

Anti-dsDNA, ant-Smith antibodies

A

SLE

92
Q

Anti-glutamic acid decarboxylase (GAD-65) antibodies

A

Type 1 diabetes mellitus

93
Q

Antihemidesmosome antibodies

A

Bullous pemphigoid

94
Q

Anti-histone antibodies

A

Drug-induced lupus

95
Q

Anti-Jo-1, anti-SRP, anti-Mi-2 antibodies

A

Polymyositis, dermatomyositis

96
Q

Antimicrosomal, antithyroglobulin antibodies

A

Hashimoto thyroiditis

97
Q

Antimitochondrial antibodies

A

Primary biliary cirrhosis

98
Q

Antinuclear antibodies

A

SLE, nonspecific

99
Q

Antiparietal cell antibodies

A

Pernicious anemia

100
Q

Anti-Scl-70 (anti-DNA topoisomerase I) antibodies

A

Scleroderma (diffuse)

101
Q

Anti-smooth muscle antibodies

A

Autoimmune hepatitis

102
Q

Anti-SSA, anti-SSB (anti-Ro, anti-La) antibodies

A

Sjogren Syndrome

103
Q

Anti-TSH receptor antibodies

A

Graves disease

104
Q

Anti-U1 RNP (ribonucleoprotein) antibodies

A

Mixed connective tissue disease

105
Q

IgA anti-endomysial, IgA anti-tissue transglutaminase antibodies

A

Celiac Disease

106
Q

MPO-ANCA/p-ANCA antibodies

A

Microscopic polyangiitis

Eosinophilic granulomatosis with polyangiitis (Churg-Strauss Syndrome)

107
Q

PR3-ANCA/c-ANCA antibodies

A

Granulomatosis with polyangiitis (Wegener)

108
Q

Rheumatoid factor (IgM antibody that targets IgG Fc region), anti-CCP (more specific) antibodies

A

Rheumatoid Arthritis

USMLE Step 1. (19 decks)

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