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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
What are the cytokines secreted by T cells?
IL-3
26
What are the cytokines secreted by Th1 cells?
Il-2, interferon gamma
27
What are the cytokines secreted by Th2 cells?
Il-4, Il-5, Il-10, Il-6
28
Il-1
secreted by macrophages endogenous pyrogen --> fever, acute inflammation; activates endothelium to express adhesion molecules; recruits leukocytes
29
Il-6
secreted by macrophages and Th cells | endogenous pyrogen --> causes fever, and stimulates acute-phase proteins
30
IL-8
secreted by macrophage | chemotactic factor for neutrophils
31
Il-12
secreted by macrophages, B cells | induces differentiation of T cells --> Th1 cells , activates NK cells
32
TNF-alpha
secreted by macrophages | mediates septic shock, activates endothelium, causes leukocyte recruitment and vascular leak
33
Il-3
secreted by T cells | supports growth and differentiation of bone marrow stem cells; acts like GM-CSF
34
Il-2
secreted by Th1 cells | stimulates growth of helper and cytotoxic T cells
35
interferon-gamma
secreted by Th1 cells activates macrophages and Th1 cells, while suppressing Th2 cells antiviral and antitumor properties
36
Il-4
``` Secreted by Th2 cells induces differentiation into Th2 cells, promotes growth of B cells, enhances class switching to IgE and IgG ```
37
Il-5
secreted by Th2 cells | promotes differentiation of b cells, enhances switching to IgA, stimulates growth and differentiation of eosinophils
38
Il-10
secreted by Th2 cells, regulatory T cells | modulates inflammatory response; inhibits actions of T cells and Th1, activates Th2
39
What are the surface proteins on cells?
TCR, CD3 (signal transduction), CD28 (binds B7 on APC) helper t cells: CD4, CD40L (binds CD40 on B cells) cytotoxic t cells: CD8
40
What are the surface proteins on B cells?
Ig, CD19, CD20, CD21 (receptor for EBV), CD40, MHC II, B7
41
What are the surface proteins on macrophages?
MHCII, B7, CD40, CD14, receptors for Fc and C3b
42
What is the Arthus reaction?
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
ANA
SLE, nonspecific
44
anti-dsDNA, anti-smith
SLE
45
anti-histone
drug induced lupus
46
anti-igG (rheumatoid factor)
rheumatoid arthritis
47
anticentromere
scleroderma (CREST)
48
anti-Scl-70
scleroderma (diffuse)
49
antimitochondrial (AMA)
primary biliary cirrhosis
50
antigliadin, antiendomysial
celiac disease
51
anti-basement membrane
goodpasture's
52
anti-desmoglein
pemphigus vulgaris
53
antimicrosomal, antithyroglobulin
Hashimotos
54
anti-Jo-1
polymyositis, dermatomyositis
55
Anti-SSA
Sjogren's
56
Anti-SSB
Sjogren's
57
Anti-U1 RNP
mixed connective tissue disease
58
Anti-smooth muscle
autoimmune hepatitis
59
Anti-glutamate decarboxylase
DM Type 1
60
c-ANCA
Wegener's granulomatosis
61
p-ANCA
other vasculitises
62
Bruton's agammaglobulinemia
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
Hyper IgM syndrome
defective CD40L on helper T cells --> inability to class switch increased IgM, decreased IgG, A, E severe pyogenic infections
64
selective Ig deficiency
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
Common variable immunodeficiency
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
Thymic aplasia (DiGeorge syndrome)
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
Il-12 receptor defiency
inecreased Th1 response (induces differentiation from T--> Th1) disseminated mycobacterial infections, decreased interferon-gamma
68
Hyper-IgE syndrome (Job's syndrome)
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
chronic mucocutaneous candidiasis
T cell dysfunction Candida albicans infections of the skin and mucous membranes
70
severe combined immunodeficiency (SCID)
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
ataxia-telangiectasia
defect in DNA repair enzymes triad of symptoms: cerebellar defects (ataxia), spider angiomas, IgA deficiency
72
Wiskott-Aldrich syndrome
X linked recessive, progressive deletion of B and T cells TIE: thrombocytopenic purpura infections eczema labs: increased IgE, IgA; decreased IgM
73
leukocyte adhesion deficiency (type 1)
defect in LFA-1 integrin (CD18) protein on phagocytes recurrent bacterial infections, absent pus formation, delayed separation of umbilicus labs: neutrophilia
74
Chronic granulomatous disease
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
cyclosporine
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
tacrolimus (FK506)
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
sirolimus (rapamycin)
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
daclizumab
Ab with high affinity for the Il-2 receptor on activated T cells
79
azathioprine
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
muromonab-CD3 (OKT3)
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
aldesleukin (interleukin-2)
renal cell carcinoma, metastatic melanoma
82
filgrastim (granulocyte colony stimulating factor)
recovery of bone marrow
83
sargramostim (granulocyte-macrophage colony stimulating factor)
recovery of bone marrow
84
alpha-interferon
hepB, hep C, Kaposi's sarcoma, leukemias, malignant melanoma
85
beta-interferon
MS
86
gamma-interferon
chronic granumatous disease
87
oprelvekin (interleukin-11)
thrombocytopenia
88
digoxin immune Fab
antidote for digoxin intoxication
89
infliximab
blocks TNF-alpha; used for crohn's RA, psoriatic arthritis, ankylosing spondylitis
90
adalimumab
blocks TNF-alpha; used for Crohn's disease, RA, psoriatic arthritis
91
abciximab
targets glycoprotein IIB/IIIa (platelet aggregator) to prevent cardiac ischemia in unstable angina and in pts treated with percutaneous coronary intervention
92
trastuzumab (herceptin)
targets erb-B2, for HER-2 overexpressing breast cancer
93
Rituximab
targets CD20 for B cell non-Hodgkin's lymphoma

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