Immunology Flashcards
1
Q
lymph node paracortex
A
T cells (this is between follices and medulla). contain High Endothelial venules where T and B cells enter blood. This is maldeveloped in DiGeorge syndrome
2
Q
lymph drainage: upper limb and lateral breast
A
axilla
3
Q
lymph drainage: stomach
A
celiac
4
Q
lymph drainage: sigmoid colon
A
colic to inferior mesenteric
5
Q
lymph drainage: rectum above pectinate line
A
internal iliac
6
Q
lymph drainage: anal canal below pectinate line
A
superficial inguinal
7
Q
lymph drainage: testes
A
para aortic
8
Q
lymph drainage: scrotum
A
superficial inguinal
9
Q
lymph drainage: thigh
A
superficial inguinal
10
Q
lymph drainage: lateral side of dorsum of foot
A
popliteal
11
Q
right lympatic duct vs thoracic duct
A
right drains right arm/chest/half of head. thoracic duct drains everything else
12
Q
T cell located in spleen
A
PALS (periarterial lymphatic sheath) within white pulp
13
Q
what in the spleen removes encapsulated bacteria?
A
macrophages
14
Q
heme changes in asplenia
A
Howell-Jolly bodies (nuclear remnants), Target Cells, thrombocytosis
15
Q
thymus origin
A
3rd branchial pouch
16
Q
thymus maturation axis
A
deeper is more mature
17
Q
selection order in thymus
A
positive then negative
18
Q
MHC I is composed of which HLA genes and binds what?
A
HLA-A/B/C. binds TCR and CD8
19
Q
MHC II expresses which HLA genes and binds what?
A
Expresses HLA-DR/DP/DQ. binds TCR and CD4
20
Q
MHC I is expressed on what?
A
all nucleated cells (not RBCs)
21
Q
MHC I is loaded with antigens how
A
loaded with peptide antigen in RER. it pairs with Beta2 microglobulin to aid in transport to cell surface
22
Q
MHC I provides coverage for what infxn?
A
viral. it will load anything inside of cell to be checked by CD8s.
23
Q
MHC II is expressed where and how does it load?
A
expressed on antigen presenting cells. antigen loading follows release of invariant chain in an acidified endosome
24
Q
only lymphocytic member of the innate immune system
A
natural killer cells
25
HLA A3 association
hemochromatosis
26
HLA B27
PAIR: Psoriasis, Ankylosing Spondylitis, Inflammatory Bowel Disease, Reiters syndrome
27
HLA DQ2/8
Celiacs
28
HLA DR2
MS, hayfever, sle, goodpastures
29
HLA DR3
Graves and type I diabetes
30
HLA DR4
Rheumatoid arthritis and Diabetes TYpe I
31
HLA DR5
pernicious anemia secondary to B12 def. Hashimoto's thyroiditis
32
natural killer cell function
kills virally infected and neoplastic cells which have stopped presenting antigen on MHC I. So they bridge innate to adaptive.
33
B cell functions
make antibody to opsonize bacteria, neutralize virus (IgG); activate compliment (IgM and IgG); sensitize mast cells (IgE)
34
when B cells fuck up
- Allergy (type I hypersen via IgE)
- Cytotoxic (type II) and immunocomplex (type III) hypersen (IgG)
- hyperacute and humorally mediated acute and chronic organ rejection
35
Lymph node follicle functions
B Cells proliferate. primary follices are dense and dormant, secondary are pale and proliferative
36
T cell major functions
CD4 help B cells make antibodies and make cytokines to direct others
CD 8 kill viral cells
37
what happens when T cells fuck up?
delayed cell mediated hypersensitivity (type IV)
| acute and chronic cellular organ rejection
38
IL-12 causes helper to to become?
Th1 cell
39
IL-4 directs helper T cells to become
Th2 cell
40
only cell that can activate naive T cell
dendritic cell
41
all APCs
dendritic, marcophage, B cell
42
naive T cell activation
1: dendritic cell uptakes and presents on MHC I and II which is recognized by TCR
2: signal 2 costimulates with B7 and CD 28
3: T cell activates
43
B cell activation and class switching
1: Helper T cell activation
2: B cell receptor endocytosis of antigen which then presents on MHC II to Th cell which was activated in step 1.
3: CD40 receptors on B cells bind to CD40L on Th (signal 2)
4: Th cell secrretes cytokines that cause Ig class switching/affinity maturation/antibody production
44
how do Th1 and Macrophages interplay
Th1 secrete IFN-gamma which stims macro.
| Marco secretes IL-1 and TNF-alpha which stim Th1
45
Th1 secretes, activates, is inhibited by
secretes IFN-gamma
activates macrophages for viral immunity
inhibited by IL-4 and IL-10 (from Th2)
46
Th2 secretes, activates, inhibited by
Th2 secretes IL-4, IL-5, IL-10, IL-13
activates eosinophils (parasites) and IgE production from B cells
inhibted by IFN-gamma(from Th1)
47
Cytotoxic T cells target what?
virus, neoplastic, graft
48
how do cytotoxic T's kill?
cytotoxic granules containing perforin, granzyme, granulysin
49
what do T Regs express on their surface?
CD3, CD4, CD25 (which is IL-2 alpha chain)
50
What do T Regs secrete?
IL-10 and TGF-Beta
51
recombination of heavy vs light chain have how many parts?
three for heavy (VDJ) vs two for light (VJ)
52
What does the Fab portion of the immunoglobulin do?
antigen specificity
53
What makes Fc portion of Ig and what are its components?
the cterminal half of heavy chain. hinge (disulfides) - Ch2 (complement binding) - Ch3 (macrophage binding)
54
In addition to recombination of chains how else is antibody diversity created? (3)
- random combo of heavy and light chains
- somatic hypermutation following antigen stim
- addition of nucleotides after recombination
55
B-cell immunoglobulin switching
mature B cells express IgM and IgD on their surfaces. Following cytokine and CD40-L stimulation they becomes plasma cells which secrete IgA, IgE, or IgG
56
IgG
Main antibody in delayed reaction. Most abundant Ig. Fixes complement. Crosses placenta. Opsonizes bacteria, neutralizes bacterial toxins and viruses
57
IgA
prevents virus and bacteria to mucus membranes. doesn't fix complement. Monomeric in circulation and dimer when secreted. transcytosis into secretions and colostrum
58
name of process of IgA crossing epithelial cells?
transcytosis
59
IgM
produced as the immediate antigen response. fixes complement but can't cross placenta. Monomer on B cell, pentamer in circulation (better to trap stuff)
60
IgD
found on B cells, but no idea what it does
61
IgE
binds mast cell and basophils, crosslink when exposed to allergen. mediates type I hypersensitivity by causing histamine release. immunity against worms by activating eosinophils
62
classical complement activation pathway begins with
IgG or IgM
63
alternative complement pathway activation triggered by
microbial surface molecules
64
lecthin complement pathway triggered by
mannose or other sugar on microbe
65
C3b function
opsonization
66
C3a and C5a function
anaphylaxis
67
C5a function
neutrophil chemotaxis
68
C5b-9 function
cytolysis by MAC
69
Decay-accelerating factor and C1 esterase inhibitor
prevent complement activation on self cells (like RBCs)
70
C1 esterase inhibitor deficency
hereditary angioedema. ace inhibs contraindicated
71
C3 deficency
severe recurrent pyogenic sinus and resp tract infxn. more susceptible to type 3 hypersen rxn
72
C5-9 deficiencies
recurrant Neisseria infxn
73
lymph node medulla
medullary chords packed with lymphocytes and plasma cells. sinuses comunicate with efferent lymphatics and contain reticular cells and macrophages
73
IL8 mnemonic
clean up on aisle 8 (neutrophils are the clean up crew)
74
IL-12 vs IL-4
12 - Th1
| 4 - Th2
75
DAF (decay accelerating factor) deficiency
complement mediated lysis of RBCs and paroxysmal nocturnal hemoglobinuria
76
IL mnemonic 1-5
Hot T-Bone stEAk:
| IL1: fever (hot), IL2 (T all), IL3 (bone marrow growth), IL4 (IgE and G via Th2), IL5 (IgA via B cells and eosinophils)
77
IL-1
macrophage. pyrogen, inflam, endothelial adhesion molecules, chemokine secretion inducer
78
IL-6
macrophage and Th2. pyrogen, acute-phase proteins
79
IL-8
macrophage. chemotactic factor for neutrophils
80
IL-12
macrophage and B cells . induces diff of T cells into Th1. activates NK.
81
TNF-alpha
macrophage. mediates septic shock. activates endothelium. leukocyte recruitment, vascular leak
82
IL-2
all T cells (secretion). stimulates growth of helper,cytotoxic,and reg T cells
83
IL-3
secreted by all T cells. functions like GM-CSF (supports the growth and diff of bone marrow stem cells
84
Interferon-gamma
from Th1. activates Th1 and macrophages. Suppresses Th2. Antiviral and antitumor
85
IL-4
from Th2 cells. induces diff into Th2. promotes B cell growth. causes class switching to IgE and IgG
86
IL-5
from Th2. promotes diff of B cells. class switching to IgA. stimulates growth and diff of eosinophils
87
IL-10
from Th2 and T regs. dampens down inflammation. inhibits T cells and Th1.
88
TGF-beta acts like _____ cause _____
IL-10 cause it also inhibits inflammation
89
Interferon mechanism
activates antiviral state. alpha/beta inhibit viral protein synth (via viral specific ribonuclease). gamma upregulates MHCI/II and antigen presentation globally. activates NK cells/macrophages.
90
classic antigen variation examples: bacteria (3), virus, parasites
Bacteria: salmonella (2 flagella), Borrelia (replasping fever), Neisseria (pilus)
VIrus (influ)
Parasites (trypanosomes)
91
antibody in milk?
IgA
92
preformed antibodies are available for
To Be Healed Rapidly: Tetanus toxin, Botulism toxin, HBV, Rabies
93
Type of immunity achieved by live attenuated vs inactivated/killed vaccine
Live: cellular response
Killed: humoral immunity
94
live attenuated vaccines
measles, mumps, rubella, polio (Sabin), varicella, yellow fever
95
killed/inactivated vaccines available for
cholera, hepatits A, polio (Salk), rabies
96
which hypersensitiveity rxn are antibody mediated?
type 1,2,3
97
type I hypersensitivity
Anaphylactic/atopic. IgE on Mast cell or basophil binds antigen causing degranulation (histamines, vasodialators). Very fast.
98
Type II hypersensitivity
cytotoxic (antibody mediated). IgG/M bind antigen/cell causing opsonization, complement activation (MAC), Antibody-dependent cell-mediated cytotoxicity due to NK cells
99
how to test for type II hypersensitivity?
direct and indirect coombs test
100
receptor for EBV?
CD21 on B cells
101
Type III hyper sensitivity
Immune complex mediated. ANtibody-antigen complexes activate complement (type III has those three) which recruits neutrophils which release lysosomal enzymes. Serum sickness and Arthus reaction
102
serum sickness
after administration of serum antibodies form 5 days later then immune complexes deposit causing tissue damage . TYpe III hypersen
103
arthus reaction
type III hypersen. local subacute antibody. injection of antigens intradermally
104
type IV hypersensitivity
very slow. T cells bind antigen then release lymphokines to recruit macrophages which cause hell.
105
pneumonic of hypersensitivities
ACID: I: anaphylactic II: Cytotoxic III: Immune complex IV: delayed (cell mediated)
106
what are all of the type I hypersensitivities
anaphylactic and allergic.
anaphylactic: bee stang, food/drug allergies
allergic: rhinitis, hay fever, eczema, hives, asthma
107
what are the type II hypersensitivities
they are generally tissue specific/where antigen is. Heme, derm, plus some.
Autoimmune hemolytic anemia, pernicious anemia, idiopathic thrombocytopenic purpura, erythroblastosis fetalis, acute hemolytic transfusions, Rheumatic fever, goodpastures, Bullous pemphigoid, pemphigus vulgaris
108
what are the type III hypersensitivities?
typically vasculitities and systemic: SLE, polyarteritis nodosa, poststreptococcal glomer, serum sickness, arthus reaction (following tetanus vaccine)
109
what are the type IV hypersensitivities?
delayed non-antibody mediated: multiple sclerosis, Guillain-barre, Graft v host, PPD test, contact dermatitis (poison ivy ect)
110
Blood transfusion allergic reaction
type I hyper (immediate) due to plasma proteins. give antihistamines
111
Blood transfusion anaphylactic reaction
due to IgA blood given to IgA defiecent patient. causes shock/really bad
112
Blood transfusion: febrile nonhemolytic transfusion reaction
type II hypersen. antibodies against HLA
113
Blood transfusion: Acute hemolytic transfusion reaction
type II hypersen due to ABO incompatibillity (intravascular hemolysis) and other RBC antigens (extravascular hemolysis)
114
B cell def leads to what?
bacteria more than virus/fungi (encasulated bacteria)
115
T cell def lead to what?
virus and fungi more than bacteria (CMV, EBV, VZV, and chronic viral infxns) (candida, PCP)
116
which parasites infect people with no B cells?
GI giardia cause they lack IgA
117
which bacteria infects people without complement system?
Neisseria
118
Hyperacute rejection
within minutes. preformed antibodies (type II). occludes graft vessels
119
Acute rejection
weeks. CD8 Ts react against foreign MHC. vasculitis of graft vessels with dense intersitial lymph infiltrates. reversible with immunosupp
120
Chronic rejection
months to years. CD8T/NK think that foreign MHC I is self but presenting nonself peptides. Irreversible. t and antibody mediated vascular damage, fibrosis, obliterative
121
Graft vs host disease
variable time line. T cells of graft take on the recipient. maculopapular rash, jaundice, hepatosplenomegally, diarrhea. from Bone Marrow and Liver Transplant
