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Step Uno > Immunology > Flashcards

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

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2
Q

lymph drainage: upper limb and lateral breast

A

axilla

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3
Q

lymph drainage: stomach

A

celiac

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4
Q

lymph drainage: sigmoid colon

A

colic to inferior mesenteric

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5
Q

lymph drainage: rectum above pectinate line

A

internal iliac

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6
Q

lymph drainage: anal canal below pectinate line

A

superficial inguinal

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7
Q

lymph drainage: testes

A

para aortic

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8
Q

lymph drainage: scrotum

A

superficial inguinal

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9
Q

lymph drainage: thigh

A

superficial inguinal

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10
Q

lymph drainage: lateral side of dorsum of foot

A

popliteal

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11
Q

right lympatic duct vs thoracic duct

A

right drains right arm/chest/half of head. thoracic duct drains everything else

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12
Q

T cell located in spleen

A

PALS (periarterial lymphatic sheath) within white pulp

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13
Q

what in the spleen removes encapsulated bacteria?

A

macrophages

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14
Q

heme changes in asplenia

A

Howell-Jolly bodies (nuclear remnants), Target Cells, thrombocytosis

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15
Q

thymus origin

A

3rd branchial pouch

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16
Q

thymus maturation axis

A

deeper is more mature

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17
Q

selection order in thymus

A

positive then negative

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18
Q

MHC I is composed of which HLA genes and binds what?

A

HLA-A/B/C. binds TCR and CD8

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19
Q

MHC II expresses which HLA genes and binds what?

A

Expresses HLA-DR/DP/DQ. binds TCR and CD4

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20
Q

MHC I is expressed on what?

A

all nucleated cells (not RBCs)

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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

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22
Q

MHC I provides coverage for what infxn?

A

viral. it will load anything inside of cell to be checked by CD8s.

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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

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24
Q

only lymphocytic member of the innate immune system

A

natural killer cells

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25
Q

HLA A3 association

A

hemochromatosis

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26
Q

HLA B27

A

PAIR: Psoriasis, Ankylosing Spondylitis, Inflammatory Bowel Disease, Reiters syndrome

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27
Q

HLA DQ2/8

A

Celiacs

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28
Q

HLA DR2

A

MS, hayfever, sle, goodpastures

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29
Q

HLA DR3

A

Graves and type I diabetes

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30
Q

HLA DR4

A

Rheumatoid arthritis and Diabetes TYpe I

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31
Q

HLA DR5

A

pernicious anemia secondary to B12 def. Hashimoto’s thyroiditis

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32
Q

natural killer cell function

A

kills virally infected and neoplastic cells which have stopped presenting antigen on MHC I. So they bridge innate to adaptive.

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33
Q

B cell functions

A

make antibody to opsonize bacteria, neutralize virus (IgG); activate compliment (IgM and IgG); sensitize mast cells (IgE)

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34
Q

when B cells fuck up

A
  • Allergy (type I hypersen via IgE)
  • Cytotoxic (type II) and immunocomplex (type III) hypersen (IgG)
  • hyperacute and humorally mediated acute and chronic organ rejection
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35
Q

Lymph node follicle functions

A

B Cells proliferate. primary follices are dense and dormant, secondary are pale and proliferative

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36
Q

T cell major functions

A

CD4 help B cells make antibodies and make cytokines to direct others
CD 8 kill viral cells

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37
Q

what happens when T cells fuck up?

A

delayed cell mediated hypersensitivity (type IV)

acute and chronic cellular organ rejection

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38
Q

IL-12 causes helper to to become?

A

Th1 cell

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39
Q

IL-4 directs helper T cells to become

A

Th2 cell

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40
Q

only cell that can activate naive T cell

A

dendritic cell

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41
Q

all APCs

A

dendritic, marcophage, B cell

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42
Q

naive T cell activation

A

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

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43
Q

B cell activation and class switching

A

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

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44
Q

how do Th1 and Macrophages interplay

A

Th1 secrete IFN-gamma which stims macro.

Marco secretes IL-1 and TNF-alpha which stim Th1

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45
Q

Th1 secretes, activates, is inhibited by

A

secretes IFN-gamma
activates macrophages for viral immunity
inhibited by IL-4 and IL-10 (from Th2)

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46
Q

Th2 secretes, activates, inhibited by

A

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)

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47
Q

Cytotoxic T cells target what?

A

virus, neoplastic, graft

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48
Q

how do cytotoxic T’s kill?

A

cytotoxic granules containing perforin, granzyme, granulysin

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49
Q

what do T Regs express on their surface?

A

CD3, CD4, CD25 (which is IL-2 alpha chain)

50
Q

What do T Regs secrete?

A

IL-10 and TGF-Beta

51
Q

recombination of heavy vs light chain have how many parts?

A

three for heavy (VDJ) vs two for light (VJ)

52
Q

What does the Fab portion of the immunoglobulin do?

A

antigen specificity

53
Q

What makes Fc portion of Ig and what are its components?

A

the cterminal half of heavy chain. hinge (disulfides) - Ch2 (complement binding) - Ch3 (macrophage binding)

54
Q

In addition to recombination of chains how else is antibody diversity created? (3)

A
  • random combo of heavy and light chains
  • somatic hypermutation following antigen stim
  • addition of nucleotides after recombination
55
Q

B-cell immunoglobulin switching

A

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
Q

IgG

A

Main antibody in delayed reaction. Most abundant Ig. Fixes complement. Crosses placenta. Opsonizes bacteria, neutralizes bacterial toxins and viruses

57
Q

IgA

A

prevents virus and bacteria to mucus membranes. doesn’t fix complement. Monomeric in circulation and dimer when secreted. transcytosis into secretions and colostrum

58
Q

name of process of IgA crossing epithelial cells?

A

transcytosis

59
Q

IgM

A

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
Q

IgD

A

found on B cells, but no idea what it does

61
Q

IgE

A

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
Q

classical complement activation pathway begins with

A

IgG or IgM

63
Q

alternative complement pathway activation triggered by

A

microbial surface molecules

64
Q

lecthin complement pathway triggered by

A

mannose or other sugar on microbe

65
Q

C3b function

A

opsonization

66
Q

C3a and C5a function

A

anaphylaxis

67
Q

C5a function

A

neutrophil chemotaxis

68
Q

C5b-9 function

A

cytolysis by MAC

69
Q

Decay-accelerating factor and C1 esterase inhibitor

A

prevent complement activation on self cells (like RBCs)

70
Q

C1 esterase inhibitor deficency

A

hereditary angioedema. ace inhibs contraindicated

71
Q

C3 deficency

A

severe recurrent pyogenic sinus and resp tract infxn. more susceptible to type 3 hypersen rxn

72
Q

C5-9 deficiencies

A

recurrant Neisseria infxn

73
Q

lymph node medulla

A

medullary chords packed with lymphocytes and plasma cells. sinuses comunicate with efferent lymphatics and contain reticular cells and macrophages

73
Q

IL8 mnemonic

A

clean up on aisle 8 (neutrophils are the clean up crew)

74
Q

IL-12 vs IL-4

A

12 - Th1

4 - Th2

75
Q

DAF (decay accelerating factor) deficiency

A

complement mediated lysis of RBCs and paroxysmal nocturnal hemoglobinuria

76
Q

IL mnemonic 1-5

A

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
Q

IL-1

A

macrophage. pyrogen, inflam, endothelial adhesion molecules, chemokine secretion inducer

78
Q

IL-6

A

macrophage and Th2. pyrogen, acute-phase proteins

79
Q

IL-8

A

macrophage. chemotactic factor for neutrophils

80
Q

IL-12

A

macrophage and B cells . induces diff of T cells into Th1. activates NK.

81
Q

TNF-alpha

A

macrophage. mediates septic shock. activates endothelium. leukocyte recruitment, vascular leak

82
Q

IL-2

A

all T cells (secretion). stimulates growth of helper,cytotoxic,and reg T cells

83
Q

IL-3

A

secreted by all T cells. functions like GM-CSF (supports the growth and diff of bone marrow stem cells

84
Q

Interferon-gamma

A

from Th1. activates Th1 and macrophages. Suppresses Th2. Antiviral and antitumor

85
Q

IL-4

A

from Th2 cells. induces diff into Th2. promotes B cell growth. causes class switching to IgE and IgG

86
Q

IL-5

A

from Th2. promotes diff of B cells. class switching to IgA. stimulates growth and diff of eosinophils

87
Q

IL-10

A

from Th2 and T regs. dampens down inflammation. inhibits T cells and Th1.

88
Q

TGF-beta acts like _____ cause _____

A

IL-10 cause it also inhibits inflammation

89
Q

Interferon mechanism

A

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
Q

classic antigen variation examples: bacteria (3), virus, parasites

A

Bacteria: salmonella (2 flagella), Borrelia (replasping fever), Neisseria (pilus)
VIrus (influ)
Parasites (trypanosomes)

91
Q

antibody in milk?

A

IgA

92
Q

preformed antibodies are available for

A

To Be Healed Rapidly: Tetanus toxin, Botulism toxin, HBV, Rabies

93
Q

Type of immunity achieved by live attenuated vs inactivated/killed vaccine

A

Live: cellular response
Killed: humoral immunity

94
Q

live attenuated vaccines

A

measles, mumps, rubella, polio (Sabin), varicella, yellow fever

95
Q

killed/inactivated vaccines available for

A

cholera, hepatits A, polio (Salk), rabies

96
Q

which hypersensitiveity rxn are antibody mediated?

A

type 1,2,3

97
Q

type I hypersensitivity

A

Anaphylactic/atopic. IgE on Mast cell or basophil binds antigen causing degranulation (histamines, vasodialators). Very fast.

98
Q

Type II hypersensitivity

A

cytotoxic (antibody mediated). IgG/M bind antigen/cell causing opsonization, complement activation (MAC), Antibody-dependent cell-mediated cytotoxicity due to NK cells

99
Q

how to test for type II hypersensitivity?

A

direct and indirect coombs test

100
Q

receptor for EBV?

A

CD21 on B cells

101
Q

Type III hyper sensitivity

A

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
Q

serum sickness

A

after administration of serum antibodies form 5 days later then immune complexes deposit causing tissue damage . TYpe III hypersen

103
Q

arthus reaction

A

type III hypersen. local subacute antibody. injection of antigens intradermally

104
Q

type IV hypersensitivity

A

very slow. T cells bind antigen then release lymphokines to recruit macrophages which cause hell.

105
Q

pneumonic of hypersensitivities

A

ACID: I: anaphylactic II: Cytotoxic III: Immune complex IV: delayed (cell mediated)

106
Q

what are all of the type I hypersensitivities

A

anaphylactic and allergic.

anaphylactic: bee stang, food/drug allergies
allergic: rhinitis, hay fever, eczema, hives, asthma

107
Q

what are the type II hypersensitivities

A

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
Q

what are the type III hypersensitivities?

A

typically vasculitities and systemic: SLE, polyarteritis nodosa, poststreptococcal glomer, serum sickness, arthus reaction (following tetanus vaccine)

109
Q

what are the type IV hypersensitivities?

A

delayed non-antibody mediated: multiple sclerosis, Guillain-barre, Graft v host, PPD test, contact dermatitis (poison ivy ect)

110
Q

Blood transfusion allergic reaction

A

type I hyper (immediate) due to plasma proteins. give antihistamines

111
Q

Blood transfusion anaphylactic reaction

A

due to IgA blood given to IgA defiecent patient. causes shock/really bad

112
Q

Blood transfusion: febrile nonhemolytic transfusion reaction

A

type II hypersen. antibodies against HLA

113
Q

Blood transfusion: Acute hemolytic transfusion reaction

A

type II hypersen due to ABO incompatibillity (intravascular hemolysis) and other RBC antigens (extravascular hemolysis)

114
Q

B cell def leads to what?

A

bacteria more than virus/fungi (encasulated bacteria)

115
Q

T cell def lead to what?

A

virus and fungi more than bacteria (CMV, EBV, VZV, and chronic viral infxns) (candida, PCP)

116
Q

which parasites infect people with no B cells?

A

GI giardia cause they lack IgA

117
Q

which bacteria infects people without complement system?

A

Neisseria

118
Q

Hyperacute rejection

A

within minutes. preformed antibodies (type II). occludes graft vessels

119
Q

Acute rejection

A

weeks. CD8 Ts react against foreign MHC. vasculitis of graft vessels with dense intersitial lymph infiltrates. reversible with immunosupp

120
Q

Chronic rejection

A

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
Q

Graft vs host disease

A

variable time line. T cells of graft take on the recipient. maculopapular rash, jaundice, hepatosplenomegally, diarrhea. from Bone Marrow and Liver Transplant

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