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Immunology Flashcards

1
Q

What primary lymph node does the stomach drain to?

A

celiac

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2
Q

What lymph node does the duodenum and jenjunum drain to?

A

superior mesenteric

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3
Q

What lymph node does the sigmoid colon drain to?

A

colic –> inferior mesenteric

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4
Q

What lymph node does the rectum above the pectinate line drain to?

A

internal iliac

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5
Q

What lymph node does anal canal below the pectinate line drain to?

A

superficial inguinal

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6
Q

What lymph node does the testes drain to?

A

superficial and deep plexuses –> para-aortic

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7
Q

What lymph node does the scrotum drain to?

A

superficial inguinal

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8
Q

What lymph node does the thigh (superficial) drain to?

A

superficial inguinal

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9
Q

What lymph node does the lateral side of the dorsum of the foot drain to?

A

popiteal

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10
Q

What organisms are pts with splenectomies more susceptible to?

A 
"S SHiN"
Salmonella
S. pneumoniae
H. influenzae
N. meningitis
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11
Q

What disease is the HLA A3 associated with?

A

hemochromatosis

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12
Q

What diseases is HLA B27 associated with?

A

“PAIR”

psoriasis, ankylosing spondylitis, inflammation bowel disease, reiter’s syndrome

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13
Q

What disease is HLA B8 associated with?

A

Graves’ disease

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14
Q

What disease is HLA DR2 associated with?

A

MS, hay fever, SLE, Good pasture’s

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15
Q

What disease is the HLA DR3 associated with?

A

DM Type 1

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16
Q

What disease is the HLA D4 associated with?

A

RA, DM Type 1

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17
Q

What disease is the HLA D5 associated with?

A

pernicious anemia –> B12 deficiency, Hashimoto’s

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18
Q

What disease is HLA D7 associated with?

A

steroid-responsive nephrotic syndrome

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19
Q

What cytokines enhance NK cell activity?

A

IL-12, interferon-B, interferon-alpha

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20
Q

What are the two signals needed for helper T-cell activation?

A
  1. foreign antigen is presented on MHC II and recognized by TCR on T cell
  2. costimulatory signal by interaction of B7 and CD28
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21
Q

What are the two signals needed for cytotoxic T cell activation

A
  1. endogenously synthesized protein presented on MHC1 and recognized by TCR on T cell
  2. IL-2 from Th1 cell activates cytotoxic T cell to kill virus-infected cell
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22
Q

What are the two signals needed for B-cell class switching?

A
  1. Il-4, Il-5, Il-6, !l-10 from Th2 cell

2. CD40 receptor on B cell binds CD40 ligand on TH2 cell

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23
Q

What are the four ways that antibody diversity is created?

A

random “recombination” of VJ or VDJ genes

  1. random combination of heavy and light chains
  2. somatic hypermutation
  3. addition of nucleotides to DNA during recombination by terminal deoxynucleotidyl transferase
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24
Q

What are the cytokines secreted by macrophages?

A

Il-1, Il-6, Il-8, IL12, TNF-alpha

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25
Q

What are the cytokines secreted by T cells?

A

IL-3

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26
Q

What are the cytokines secreted by Th1 cells?

A

Il-2, interferon gamma

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27
Q

What are the cytokines secreted by Th2 cells?

A

Il-4, Il-5, Il-10, Il-6

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28
Q

Il-1

A

secreted by macrophages
endogenous pyrogen –> fever, acute inflammation; activates endothelium to express adhesion molecules; recruits leukocytes

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29
Q

Il-6

A

secreted by macrophages and Th cells

endogenous pyrogen –> causes fever, and stimulates acute-phase proteins

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30
Q

IL-8

A

secreted by macrophage

chemotactic factor for neutrophils

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31
Q

Il-12

A

secreted by macrophages, B cells

induces differentiation of T cells –> Th1 cells , activates NK cells

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32
Q

TNF-alpha

A

secreted by macrophages

mediates septic shock, activates endothelium, causes leukocyte recruitment and vascular leak

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33
Q

Il-3

A

secreted by T cells

supports growth and differentiation of bone marrow stem cells; acts like GM-CSF

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34
Q

Il-2

A

secreted by Th1 cells

stimulates growth of helper and cytotoxic T cells

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35
Q

interferon-gamma

A

secreted by Th1 cells
activates macrophages and Th1 cells, while suppressing Th2 cells

antiviral and antitumor properties

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36
Q

Il-4

A 
Secreted by Th2 cells
induces differentiation into Th2 cells, promotes growth of B cells, enhances class switching to IgE and IgG
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37
Q

Il-5

A

secreted by Th2 cells

promotes differentiation of b cells, enhances switching to IgA, stimulates growth and differentiation of eosinophils

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38
Q

Il-10

A

secreted by Th2 cells, regulatory T cells

modulates inflammatory response; inhibits actions of T cells and Th1, activates Th2

39
Q

What are the surface proteins on cells?

A

TCR, CD3 (signal transduction), CD28 (binds B7 on APC)

helper t cells: CD4, CD40L (binds CD40 on B cells)

cytotoxic t cells: CD8

40
Q

What are the surface proteins on B cells?

A

Ig, CD19, CD20, CD21 (receptor for EBV), CD40, MHC II, B7

41
Q

What are the surface proteins on macrophages?

A

MHCII, B7, CD40, CD14, receptors for Fc and C3b

42
Q

What is the Arthus reaction?

A

a local subacute antibody-mediated hypersensitivity (type 3) rxn; intradermal injection of antigen induces antibodies which form antigen-ab complexes in the skin (ie swelling after tetenus shot)

findings: edema, necrosis, activation of complement

43
Q

ANA

A

SLE, nonspecific

44
Q

anti-dsDNA, anti-smith

A

SLE

45
Q

anti-histone

A

drug induced lupus

46
Q

anti-igG (rheumatoid factor)

A

rheumatoid arthritis

47
Q

anticentromere

A

scleroderma (CREST)

48
Q

anti-Scl-70

A

scleroderma (diffuse)

49
Q

antimitochondrial (AMA)

A

primary biliary cirrhosis

50
Q

antigliadin, antiendomysial

A

celiac disease

51
Q

anti-basement membrane

A

goodpasture’s

52
Q

anti-desmoglein

A

pemphigus vulgaris

53
Q

antimicrosomal, antithyroglobulin

A

Hashimotos

54
Q

anti-Jo-1

A

polymyositis, dermatomyositis

55
Q

Anti-SSA

A

Sjogren’s

56
Q

Anti-SSB

A

Sjogren’s

57
Q

Anti-U1 RNP

A

mixed connective tissue disease

58
Q

Anti-smooth muscle

A

autoimmune hepatitis

59
Q

Anti-glutamate decarboxylase

A

DM Type 1

60
Q

c-ANCA

A

Wegener’s granulomatosis

61
Q

p-ANCA

A

other vasculitises

62
Q

Bruton’s agammaglobulinemia

A

X-linked recessive defect in BTK, a tyrosine kinase gene that blocks B-cell differentiation/maturation; normal pro-B but decreased B cells, decreased immunoglobulins

recurrent bacterial infections after 6 months

63
Q

Hyper IgM syndrome

A

defective CD40L on helper T cells –> inability to class switch

increased IgM, decreased IgG, A, E

severe pyogenic infections

64
Q

selective Ig deficiency

A

defect in isotype switching, IgA most common

sinus and lung infections, milk allergies and diarrhea

anaphylaxis occurs on exposure to blood products with IgA

65
Q

Common variable immunodeficiency

A

Defect in B cell maturation; many causes

increased risk of autoimmune disease, lymphoma, sinopulmonary infections

normal number of B cells, but decreased plasma cells and immunoglobulin

66
Q

Thymic aplasia (DiGeorge syndrome)

A

22q11 deletion; failure to develop 3rd and 4th pharyngeal pouches

tetany (hypocalcemia), recurrent viral/fungal infections (T-cell deficiency), congenital heart and great vessel defects

Thymus and parathyroids fail to develop

67
Q

Il-12 receptor defiency

A

inecreased Th1 response (induces differentiation from T–> Th1)

disseminated mycobacterial infections, decreased interferon-gamma

68
Q

Hyper-IgE syndrome (Job’s syndrome)

A

Th cells fail to produce Interferon-gamma –> inability of neutrophils to respond to chemotactic stimuli

FATED
course Facies
cold (noninflamed) staphlococcal Abscesses
retained primary Teeth
increased igE
Dermatologic problems (eczema)
69
Q

chronic mucocutaneous candidiasis

A

T cell dysfunction

Candida albicans infections of the skin and mucous membranes

70
Q

severe combined immunodeficiency (SCID)

A

several types: defective IL-2 receptor (most common, X-linked), ADA deficiency, failure to synthesize MHC II antigens

recurrent viral, bacterial, fungal and protozoal infections due to both B and T cell deficiency

tx: bone marrow transplant
labs: decreased IL-2 receptor, increased adenine (toxic to B and T cells since decreased DNA synthesis)

71
Q

ataxia-telangiectasia

A

defect in DNA repair enzymes

triad of symptoms: cerebellar defects (ataxia), spider angiomas, IgA deficiency

72
Q

Wiskott-Aldrich syndrome

A

X linked recessive, progressive deletion of B and T cells

TIE:
thrombocytopenic purpura
infections
eczema

labs: increased IgE, IgA; decreased IgM

73
Q

leukocyte adhesion deficiency (type 1)

A

defect in LFA-1 integrin (CD18) protein on phagocytes

recurrent bacterial infections, absent pus formation, delayed separation of umbilicus

labs: neutrophilia

74
Q

Chronic granulomatous disease

A

lack of NADPH oxidase –> decreased reactive oxygen species and absent respiratory burst in neutorphils

increased susceptibility to catalase-positive organisms

labs: negative nitroblue tetrazolium dye reaction test

75
Q

cyclosporine

A

binds to cyclophilins –> blocks differentiation and activation of T cells by inhibiting calcineurin –> preventing production of IL-2 and its receptor

use: suppresses organ rejection after transplantation, some autoimmune disorders
toxicity: predisposes pt to viral infections and lymphoma; nephrotic

76
Q

tacrolimus (FK506)

A

binds to FK binding protein, inhibiting secretion of IL-2 and other cytokines

use: immunosuppressive used in organ transplant pts
toxicity: nephrotoxicity, peripheral neuropathy, hypertension, pleural effusion, hyperglycemia

77
Q

sirolimus (rapamycin)

A

inhibits mTOR, inhibits T-cell proliferation in response to IL-2

use: immunosuppression after kidney transplantation in combination with cyclosporine and corticosteroids
toxicity: hyperlipidemia, thrombocytopenia, leukopenia

78
Q

daclizumab

A

Ab with high affinity for the Il-2 receptor on activated T cells

79
Q

azathioprine

A

antimetabolite precursor of 6-mercaptopurine that interferes with the metabolism and synthesis of nucleic acids; toxic to proliferating lymphocytes

use: kidney transplantation, autoimmune disorder
toxicity: bone marrow suppresion, metabolized by xanthine oxidase so toxic effects increase by allopuriniol

80
Q

muromonab-CD3 (OKT3)

A

ab that binds to CD3 on the surface of T cells, blocks signal transduction

use: immunosuppression after kidney transplantation
toxicity: cytokine relase syndrome, hypersensitivity reaction

81
Q

aldesleukin (interleukin-2)

A

renal cell carcinoma, metastatic melanoma

82
Q

filgrastim (granulocyte colony stimulating factor)

A

recovery of bone marrow

83
Q

sargramostim (granulocyte-macrophage colony stimulating factor)

A

recovery of bone marrow

84
Q

alpha-interferon

A

hepB, hep C, Kaposi’s sarcoma, leukemias, malignant melanoma

85
Q

beta-interferon

A

MS

86
Q

gamma-interferon

A

chronic granumatous disease

87
Q

oprelvekin (interleukin-11)

A

thrombocytopenia

88
Q

digoxin immune Fab

A

antidote for digoxin intoxication

89
Q

infliximab

A

blocks TNF-alpha; used for crohn’s RA, psoriatic arthritis, ankylosing spondylitis

90
Q

adalimumab

A

blocks TNF-alpha; used for Crohn’s disease, RA, psoriatic arthritis

91
Q

abciximab

A

targets glycoprotein IIB/IIIa (platelet aggregator) to prevent cardiac ischemia in unstable angina and in pts treated with percutaneous coronary intervention

92
Q

trastuzumab (herceptin)

A

targets erb-B2, for HER-2 overexpressing breast cancer

93
Q

Rituximab

A

targets CD20 for B cell non-Hodgkin’s lymphoma

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