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Step 1 > Immunology > Flashcards

Immunology Flashcards

1
Q

IL-10

A

anti-inflammatory bc it attenuates pro-inflammatory Th1 cytokines (IL2 and IFN gamma) and MHC II expression

inhibits activated dendritic cells and macrophages

released by Th2 cells and Treg

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2
Q

IL-1

A

produced by macrophages and epithelial cells

proinflamm. :
- endothelium activation
- increased chemokine expression (promoting leukocyte recruitment)
- induction of fever

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3
Q

IL-5

A

secreted by Th2 cells

promotes humoral response –> stim differentiation of BCs and IgA production

promotes growth and differentiation of eos –> possible role in allergies

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4
Q

IL-12

A

secreted by macros and BCs

induces differentiation of Th1 cells and activation of NK cells

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5
Q

Interferon-y

A

secreted by Th1

pro-inflamm:

  • activates macros
  • inc Ag presentation
  • inducing apoptosis of epithelial cells
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6
Q

TNF-alpha

A

produced by macros, NK, TCs

pro-inflamm.

  • leukocyte recruitment
  • activates endothelium (inc adhesion molecules and leuk recruitment) –> vascular leak

Mediates septic shock

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7
Q

Bradykinin

A

vasodilation, inc vascular permeability, stimulates smooth muscle contraction, mediates pain

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8
Q

leukotriene B4

A

metabolite of arachidonic acid

stimulates neutrophil migration to site of inflammation

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9
Q

Platelet-activating factor

A

vasoconstriction, bronchoconstriction, platelet stimulation

small amounts = vasodilation and inc vascular permeability

enhances leukocyte adhesion to endothelium, chemotaxis, phagocytosis and degranulation

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10
Q

Acute-phase reactant production

A

IL-1, IL-6, TNF-a stimulate hepatic secretion of APRs like fibrinogen –> ESR hence marker of inflammation

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11
Q

Pneumococcal polysaccharide vaccine (PPSV23)

A

TC independent BC response that’s less effective in children

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12
Q

Pneumococcal conjugate vaccine (PCV13)

A

covalently attached to recombinant, inactivated diphtheria toxin –> induces active immunity via a TC dependent BC response

better immunogenicity and formation of higher affinity Ab and memory cells even in children

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13
Q

capsular polysaccharide vaccines

A

PPSV23 (pneumococcal), neisseria meningitidis, HiB

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14
Q

killed bacteria vaccines

A

oral cholera

require multiple inoculations or boosters to induce and maintain immunity

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15
Q

Live attenuated bacterial vaccines

A

BCG and oral typhoid

can revert to virulent strains

contraindicated in immunocompromised hosts

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16
Q

recombinant surface protein vaccine

A

HBV

insert relevant DNA into a host organism (e.g. baker’s yeast) –> produces Ag in desired quantity

require boosters or multiple inoculations to achieve and maintain sufficient immunity

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17
Q

Inactivated toxin (toxoid) vaccines

A

diphtheria and tetanus vaccines

useful when toxin is the cause of morbidity and mortality –> produce neutralizing Ab to toxin

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18
Q

CD15

A

present on granulocytes and all Reed-Sternberg cells –> used in dx Hodgkin lymphoma

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19
Q

CD16

A

low-affinity Fc receptor found on NK cells, neutrophils, and macrophages

i.e. weak role in opsonization

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20
Q

Graft-versus-host disease

A

after allogeneic bone marrow transplant or transplant of organs rich in lymphocytes (eg, liver) or transfusion of non-irradiated blood

donor TC from graft survives –> migrates to host tissues –> recognize host MHC Ag –> sensitized –> activation –> donor CD4 and CD8 cells destroy host cells –> typically affects skin, liver, GI tract

sx = diffuse maculopapular rash of palms and soles, desquamation, diarrhea, intestinal bleeding, abdominal pain, abnormal LFTs 2/2 liver damage

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21
Q

Acute and chronic graft rejections mechanism

A

host T and B cel sensitization against graft MHC Ag –> graft failure w/o involvement of other organ systems

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22
Q

Mechanism of susceptibility to encapsulated organisms postsplenectomy

A

dec IgM –> dec complement activation –> dec C3b opsonization –> inc susceptibility

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23
Q

Encapsulated organisms

A

SHiN SKiS

Streptococcus pneumoniae
Haemophilus influenzae type B
Neisseria meningitidis
Salmonella
Klebsiella pneumoniae
Group B streptococci
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24
Q

postsplenectomy findings:

A

Howell-Jolly bodies (nuclear remnants)
Target cells
Thrombocytosis

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25
Q

costimulatory signal on dendritic cells that activate immature TC

A

B7 on DC binds CD28 on TC

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26
Q

signal 2 in activation of BCs

A

CD40 ligand on TC binds CD40 receptor on BC

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27
Q

BC class switching

A

dictated by cytokines released by Th cell –> class switching, affinity maturation, Ab production

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28
Q

Treg cells

A

promote immune tolerance

express CD3, CD4, CD25 (alpha chain of IL2 receptor)

secrete IL-10 and TGF-beta = anti-inflammatory cytokines

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29
Q

Fc region

A
  • Constant
  • Carboxy terminal
  • Complement binding at CH2 = second fragment of heavy chain (IgM and IgG only)
  • Carbohydrate side chains
  • Determines isotype (IgM, IgD, etc)
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30
Q

Ab methods of generating diversity

A
  • VJ recombination = light chain
  • VDJ recombination = heavy chain
  • Somatic hypermutation = after Ag stimulation
  • Terminal deoxynucleotidyl transferase = adds nucleotides during recombination
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31
Q

Alternative complement pathway

A

activated spontaneously or by microbial surfaces

C3–>C3b –> C3 convertase + other crap –> c3a and C3b –> c3b activates C5 convertase –> C5b + C6-9 –> MAC

32
Q

Lectin complement pathway

A

activates by microbial surfaces e.g. mannose

MBL –> C1-like complex –> C4b –> C3 convertase –> C3b –> C5 convertase –> C5b + C6-9 –> MAC

33
Q

Classic complement pathway

A

Ag-Ab mediated; only IgG and IgM

C1–> C1 complex –> C2 split –> C2a activates C3 convertase –> C3b –> C5 convertase –> C5b + C6-9 –> MAC

34
Q

C3b

A

opsonization

35
Q

C3a and C5a

A

anaphylaxis

36
Q

C5a

A

neutrophil chemotaxis

37
Q

C5b-9

A

MAC and cytolysis

38
Q

C1 esterase inhibitor deficiency

A

hereditary angioedema

normally C1 esterase inhibitor helps prevent complement activation on self cells like RBCs

ACEi contraindicated

39
Q

C3 deficiency

A

severe, recurrent pyogenic sinus and respiratory infections

inc susceptibility to type III hypersensitivity reactions bc C3b also helps clear immune complexes in addition to its job of opsonization

40
Q

C5-9 deficiencies

A

recurrent neisseria bacteremia

41
Q

DAF (GP1 anchored enzyme) deficiency

A

complement-mediated lysis of RBCs and paroxysmal nocturnal hemoglobinuria (PNH)

bc DAF1 usually helps prevent complement activation on self cells like RBCs

42
Q

IL-8

A

major chemotactic factor for neutrophils

“clean up on aisle 8”

43
Q

IL-6

A

endogenous pyrogen –> fever and production of acute phase reactants

secreted by Th2

44
Q

IL-2

A

stimulates growth of helper, cytotoxic and regulatory TCs

45
Q

IL-3

A

supports growth and differentiation of bone marrow stem cells

fxns like GM-CSF

secreted by TCs

46
Q

INF-gamma

A

secreted by Th1 cells

suppresses Th2 cells

antiviral and antitumor properties

inc MHC I and II expression and Ag presentation in all cells

47
Q

IL-4

A 
induces differentiation into Th2 cells
Promotes growth of BCs
enhances class switching to IgE and IgG
48
Q

TGF-beta

A

anti-inflammatory similar to IL-10

49
Q

Mneumonic for important cytokines

A

“Hot T-Bone stEAk”

IL 1 = fever
IL 2 = TC stimulation
IL 3 = BM stimulation
IL 4 = IgE production
IL 5 = IgA production
50
Q

Interferons

A

INTERfere with viruses

alpha and beta = inhibit viral protein synthesis via ribonuclease that’s specific for viral mRNA

gama = inc MHC I and II expression and Ag presentation in all cells

activates NK cells to kill virus-infected cells

51
Q

what is the EBV receptor on BCs?

A

CD21

52
Q

serum sickness

A

sx = fever, urticaria, arthralgias, proteinuria, LAD 5-10 days after exposure

Ab produced against foreign protein, takes ~5 days –> immune complex deposited in membranes –> fix complement –> tissue damage

more common than Arthus reaction

53
Q

Arthus reaction

A

local subacute type III reaction

intradermal injection of Ag –> Ab induction –> immune complexes in skin –> edema, necrosis and activation of complement

54
Q

Type IV hypersensitivity reactions

A

cell-mediated, not transferable by serum

4 T’s:

  • TC mediated
  • transplant rejection
  • TB skin tests
  • touching (contact dermatitis)
55
Q

Allergic reaction to blood transfusion

A

Type I hypersensitivity

sx - urticaria, pruritus, wheezing, fever

tx - antihistamines

56
Q

anaphylactic reaction to blood transfusion

A

severe. IgA deficient individuals must reveice blood products lacking IgA

sx = dyspnea, bronchospasm, hypotension, respiratory arrest, shock

57
Q

Febrile nonhemolytic transfusion reaction (FNHTR)

A

Type II hypersensitivity reaction

host Ab against donor HLA-Ag and leukocytes

sx = fever, HA, chills, flushing

58
Q

Acute hemolytic transfusion reaction (HTR)

A

Type II hypersensitivity reaction

intravascular hemolysis (ABO blood group incompatibility) or extravascular hemolysis (host Ab reaction against foreign Ag on donor RBC)

sx = fever, HoTN, tachypnea, tachycardia, flank pain, Hb-emia (intravascular), jaundice (extravascular hemolysis)

59
Q

Hyper IgE Syndrome (Job’s syndrome)

A

Th1 cells don’t produce IFN-gamma –> neutrophils can’t respond to chemotactic stimuli

FATED:
coarse Facies
cold (noninflamed) staph Abscesses
retained primary Teeth
inc IgE
Derm problems (eczema)
60
Q

Wiskott Aldrich Syndrome

A

x-linked, WAS gene on X chromosome

TCs can’t reorganize actin cytoskeleton

Triad (TIE):
Thrombocytopenic purpura
Infections
Eczema

low IgM, high IgE and A, thrombocytopenia

61
Q

Cyclosporine

A

blocks differentiation and activation of TCs by inhibiting calcineurin –> prevents production of IL-2 and receptor

use for organ rejection and AI d/o

SE = nephrotoxicity, gingival hyperplasia, hirsutism (also HTN, HLD, hypergly)

62
Q

Tacrolimus

A

binds FK-binding protein –> inhibits calcineurin and secretion of IL-2

use for organ transplant rejections

SE = same as cyclosporine but NO GINGIVAL HYPERPLASIA OR HIRSUTISM

63
Q

Sirlomius = rapamycin

A

inhibits mTOR –> inhibits TC proliferation in response to IL-2

use for kidney transplant immunosuppression + cyclosporine and steroids; also drug-eluting stents

SE = HLD, thrombocytopenia, leukopenia

64
Q

Azathioprine

A

precursor to 6MP

interferes with metabolism and synthesis of nucleic acids –> inhibits lymphocyte proliferation

use for kidney transplant, glomerulonephritis, hemolytic anemia

SE = bone marrow suppression – worsened by allopurinol because the active metabolite 6MP is also degraded by xanthine oxidase

65
Q

Muromonab = OKT3

A

monoclonal Ab binding CD3 –> blocks TCR transduction

immunuosuppression after kidney transplant

SE = cytokine release syndrome, hypersensitivity reaction

66
Q

Digoxin immune Fab

A

antidote for digoxin intoxication

67
Q

infliximab

A

targets TNF-alpha

Crohn’s, RA, psoriatic arthritis, ankylosing spondylitis

68
Q

adalimumab

A

targets TNF-alpha

Crohn’s RA, prosiatic arthritis

69
Q

Abciximab

A

targets glycoprotein IIb/IIIa

unstable angina and percutaneous coronary intervention

70
Q

Omalizumab

A

targets IgE severe asthma

71
Q

Bone marrow recovery

A

Filgrastim (GCSF)

Sargramostim (Granulocyte-macrophage colony-stimulating factor)

72
Q

alpha interferon

A

HBV, HCV, Kaposi sarcoma, leukmia, malignant melanoma

73
Q

beta interferon

A

MS

74
Q

gamma interferon

A

chronic granulomatous disease

75
Q

thrombocytopenia cytokine tx

A

oprelvekin (IL-11), TPO

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