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Immunology Flashcards

1
Q

To what nodes do the rectum and anus respectively drain?

A

Rectum - internal iliac, anus - superficial inguinal

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2
Q

What do the right lymphatic duct and thoracic duct drain respectively?

A

RLD - right arm and right half of head, thoracic duct - everything else (left side, trunk, and right leg)

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3
Q

Where are the T and B cells found in the spleen?

A

T cells - PALS (white pulp), B cells - Follicles (white pulp)

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4
Q

Encapsulated organisms

A

Salmonella, S pneumoniae, H flu, N meningitidis

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5
Q

What is seen on a blood smear postsplenectomy?

A

Howell-Jolly bodies (nuclear remnants), Target cells, Thrombocytosis

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6
Q

HLA subtype associated with hemochromatosis

A

A3

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7
Q

Disorders associated with HLA-B27 (4)

A

Psoriasis, Ankylosing Spondylitis, IBD, Reiters

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8
Q

HLA subtype associated with Graves

A

B8

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9
Q

HLA subtype associated with MS, hay fever, SLE, and Goodpastures

A

DR2

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10
Q

HLA subtype associated with DM

A

DR3 and DR4

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11
Q

HLA subtype associated with RA

A

DR4

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12
Q

HLA subtype associated with pernicious anemia and hashimotos

A

DR5

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13
Q

What cytokines enhance NK cell activity?

A

IL-12, IFN-B and IFN-A

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14
Q

Which cytokine increases Th1 development and what cytokines are mainly produced by Th1 cells

A

IL-12. They make IL-2 and IFN-G. Th1 response mainly increases cell-mediated response (CD8 functioning)

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15
Q

Which cytokine increases Th2 and which cytokines are mainly produced by Th2 cells?

A

IL-4. They make IL-4 and IL-5. Th2 mainly supports humoral responses (IgE more than IgG)

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16
Q

What cells are developing T cells checked for reaction against in the process of negative selection?

A

Thymic medullary epithelial and dendritic cells

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17
Q

Interaction of what two molecules is responsible for signal 2 in the process of helper t cell activation?

A

B7 (APC) and CD28 (CD4 cell)

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18
Q

What cytokine (produced by Th cells) needs to be present when a CD8 cell decides to kill a virus infected cell?

A

IL-2

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19
Q

What two molecules interact when a Th cell activates a B cell (in addition to the cytokines the Th cell is secreting)?

A

CD40L (Th2 cell) and CD40 (B cell)

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20
Q

What cyotkines inhibit the Th1 and Th2 responses respectively?

A

Th1 inhibited by IL-10 (from Th2 cells), Th2 inhibited by IFN-g (from Th1 cells)

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21
Q

What are the two main things that bind to the Fc portion of Ig?

A

Complement and Macrophages (macrophages bind closer to the base, complement higher up)

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22
Q

Where does isotype switching occur?

A

Lymph node follicles

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23
Q

Which two Igs activate the classic complement pathway?

A

IgG and IgM

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24
Q

Which complement component is most important in opsonization?

A

C3b

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25
Q

Which Ig is most important in opsonization?

A

IgG

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26
Q

What is contraindicated in C1 esterase inhibitor deficiency?

A

ACE inhibitors

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27
Q

Susceptibility to what is increased in C3 deficiency?

A

Type 3 hypersensitivity reactions (C3 clears immune complexes)

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28
Q

What is given to patients lacking IL-12R and why?

A

IFN-G to help them mount a better granulomatous response

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29
Q

List the cytokines secreted by each of the following - macrophages, all T cells, Th1 cells, and Th2 cells

A

Macrophages - IL-1, IL-6, IL-8, IL-12, TNF-a. All T Cells - IL-3. Th1 - IL-2, IFN-G. Th2 - IL-4, IL-5, IL-10

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30
Q

What two cytokines are important in inhibiting inflammation?

A

TGF-B and IL-10

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31
Q

How do interferons improve antiviral efforts?

A

They stimulate uninfected cells to produce ribonuclease that inhibits viral mRNA

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32
Q

What is the main role of platelet activating factor?

A

It is chemotactic for neutrophils

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33
Q

What cell surface marker is typically used to identify macrophages?

A

CD14

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34
Q

What cell markers are present on NK cells?

A

CD16 (binds Fc of IgG) and CD56 (unique to NK)

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35
Q

Give the CD ranges which typically correspond to each of the following - T-cells, Myeloid cells, B cells

A

T - 1 to 8, Myeloid - 11 to 15, B - 19 to 23

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36
Q

Two main bacteria with superantigens

A

Strep pyogenes and Staph aureus

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37
Q

What is the action of LPS?

A

Directly stimulates macrophages by binding CD14

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38
Q

Preformed antibodies are given after exposure to what entities?

A

Tetanus toxin, Botulinum toxin, HBV, Rabies virus

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39
Q

List live attenuated vaccines

A

MMR, polio (sabin), varicella, yellow fever

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40
Q

List killed vaccines

A

Cholera, flu, Hep A, polio (Salk), Rabies

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41
Q

About how long does serum sickness take to develop and what will be found?

A

Around 5 days. Will find low C3 levels

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42
Q

Most common cause of serum sickness and findings

A

Bactrim. Fever, urticaria, arthralgias, proteinuria, lymphadenopathy (5-10 days after exposure)

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43
Q

Antimitochondrial antibodies

A

PBC, also gallbladder GVHD

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44
Q

Anti-desmoglein antibodies

A

Pemphigus vulgaris

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45
Q

Antimicrosomal antibodies

A

Hashimotos

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46
Q

Anti-Jo-1 antibodies

A

Polymyositis, dermatomyositis

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47
Q

Anti-U1 RNP antibodies

A

Mixed connective tissue disease

48
Q

Anti-smooth muscle antibodies

A

Autoimmune hepatitis

49
Q

Anti-glutamate decarboxylase antibodies

50
Q

What is the main fungal or parasitic infection seen in pts with no B cells and why?

A

GI Giardiasis (due to lack of IgA)

51
Q

Defect and genetics of Brutons agammaglobulinemia

A

X recessive. Defect in BTK, a tyrosine kinase prevents pre-B cells from becoming immature B cells

52
Q

Recurrent bacterial infections, intact thymus, decreased number of B cells and Ig of all classes

A

Brutons agammaglobulinemia

53
Q

Defect of Hyper-IgM syndrome

A

Defective CD40L

54
Q

Severe pyogenic infections early in life, high IgM and low other Igs

55
Q

Sinus and lung infections, milk allergies and diarrhea, anaphylaxis on exposure to blood products with IgA, decreased secretory IgA

A

Selective Ig deficiency

56
Q

Which B cell disorder can be acquired in 20s or 30s?

57
Q

What is the defect in common variable immunodeficiency?

A

Failure of B-cells to mature. Normal numbers of b-cells found but decreased plasma cells and Ig

58
Q

Genetics and embryology of DiGeorge

A

22q11 deletion. Failure of 3rd and 4th pharyngeal pouches to develop

59
Q

Defects in DiGeorge besides hypocalcemia and immunodeficiency

A

Congenital heart and great vessel defects

60
Q

Jobs syndrome

A

Hyper-IgE due to Th cells failing to produce IFN-g (neutrophils cant respond to chemotactic stimuli)

61
Q

Coarse facies, non-inflammed staph abscesses, retained primary teeth, eczema

A

Jobs syndrome (Hyper Ig-E due to Th cell failure)

62
Q

Two major causes of SCID, which is more common, and the pathogenesis of each

A

Defective IL-2R (more common) - decreased T-cell activation, and ADA deficiency - Buildup of adenosine, which is toxic to B and T cells, decreased DNA synthesis

63
Q

Cerebellar defects, spiger angiomas, IgA deficiency

A

Ataxia-telangiectasia (defect in ATM gene, which codes for DNA repair enzymes)

64
Q

Defect and genetics of Wiskott-Aldrich

A

X recessive. Deletion of B and T cells

65
Q

Thrombocytopenic purpura, Infections, Eczema. High IgE and IgA with low IgM

A

Wiskott-Aldrich

66
Q

Defect and genetics of Chediak-Higashi

A

AR. Defect in lysosomal regulator trafficking gene

67
Q

Recurrent infections, partial albinism, peripheral neuropathy (nystagmus)

A

Chediak-Higashi

68
Q

Lab finding in chronic granulomatous disease

A

Negative nitroblue tetrazolium dye reduction test (due to lack of respiratory burst in neutrophils)

69
Q

Findings in GVHD

A

Skin, liver, intestine - Maculopapular rash, jaundice, hepatosplenomegaly, diarrhea. Most common in BM and liver transplants.

70
Q

Main targets of chronic rejection

A

Recipient CD8 cells target blood vessels. Exception is chronic lung rejection, where small airways are targeted, causing bronchiolitis obliterans

71
Q

Cyclosporine

A

Blocks differentiation and activation of T cells by inhibiting calcineurin (preventing production of IL-2 and IL-2R). Nephrotoxic, causes gout

72
Q

Tacrolimus

A

Inhibits calcineurin (and thus IL-2 and IL-2R production). Causes nephrotoxicity, peripheral neuropathy, HTN, pleural effusion, hyperglycemia

73
Q

Sirolimus

A

Inhibits mTOR (thus inhibiting T-cell proliferation in response to IL-2)

74
Q

Daclizumab

A

Monoclonal antibody for IL-2R on activated T cells

75
Q

Azathioprine

A

Antimetabolite precursor of 6-MP (interferes with nucleic acid synthesis). Watch with allopurinol

76
Q

Muromonab

A

Monoclonal antibody to CD3

77
Q

Aldesleukin

A

IL-2 analog. Use in RCC, metastatic melanoma

78
Q

Uses of IFN-a

A

Hep B and C, Kaposi, Leukemia, Malignant melanoma

79
Q

Uses of IFN-B

80
Q

Uses of IFN-G

A

Chronic granulomatous disease

81
Q

Oprelvekin

A

IL-11 analog, use in thrombocytopenia

82
Q

Infliximab

A

Antibody to TNF-a. Use in Crohns, RA, psoriatic arthritis, ankylosing spondylitis

83
Q

Adalimumab

A

Antibody to TNF-a. Use in Crohns, RA, psoriatic arthritis

84
Q

Abciximab

A

Antibody to IIb/IIIa. Use in unstable angina and percutaneous coronary intervention

85
Q

Trastuzumab

A

Antibody to ERB-B2. Use in Her-2 expressing breast cancer

86
Q

Rituximab

A

Antibody to CD20. Use in B-cell NHL

87
Q

Omalizumab

A

Antibody to IgE. Last line for severe asthma

88
Q

Type of hypersensitivity used to kill helminths

A

Type 2. IgE antibodies coat the eggs, Eosinophils recognize and release major basic protein

89
Q

Markers for Reed-Sternberg cells

A

CD15 and CD30

90
Q

Marker for ALL

A

CD10 (also called CALLA)

91
Q

Most common pathogen in cellulitis

A

Group A Strep (pyogenes)

92
Q

What metal is required by the enzyme that converts granulation tissue (Collagen type 3) to scar tissue (Collagen type 1)?

93
Q

What can chronically draining sinuses predispose to?

A

Squamous cell carcinoma

94
Q

What cells are the main players in type 4 hypersensitivity?

A

Helper T cells and Macrophages

95
Q

Two portions of the tubule most susceptible to hypoxia

A

Straight portion of the proximal tubule and medullary portion of the thick ascending limb

96
Q

Main disease associated with cryoglobulins

A

Hepatitis C

97
Q

Irritation of what receptor leads to dyspnea in heart failure?

A

The J receptor in the lungs

98
Q

Three major causes of lymphedema

A

Mastectomy, W Bancrofti, Chlamydia Trachomatis (lymphogranuloma venarium)

99
Q

Quick way to estimate serum osmolarity

A

Double sodium and add 10

100
Q

Tonicity of normal saline

A

0.9 percent

101
Q

What is a good general rule for interpreting low serum sodium levels?

A

If serum sodium is below 120 it is very likely to be SIADH

102
Q

What drugs produce SIADH?

A

Oral sulfonylureas (eg chlorpropramide)

103
Q

What is the usual tonicity of diarrhea?

A

In babies it is hypotonic, in adults it is isotonic

104
Q

What is the tonicity of sweat?

105
Q

Non pharmacologic treatment for edematous states and SIADH respectively

A

Edematous state - Restrict salt and water, SIADH - restrict water

106
Q

Treatment for hypovolemic shock

A

Give normal saline until BP normal. Then replace what they lost (sweating - half normal saline, adult diarrhea - isotonic saline, DI - 5 percent dextrose)

107
Q

Most common cause of shock in the hospital

A

Septic shock from E coli due to indwelling urinary catheters

108
Q

Formula for O2 content

A

(1.34 x Hb x O2saturation) + pO2

109
Q

Mixed venous oxygen content in the different types of shock

A

Septic shock - High, Cardiogenic and hypovolemic - Low

110
Q

TPR in the different types of shock

A

Septic - low. Cardiogenic and hypovolemic - high

111
Q

LVEDV in the different types of shock

A

Septic - low, Hypovolemic - low, Cardiogenic - high

112
Q

Young African American woman comes in with microscopic hematuria. First step in management?

A

Get a sickle cell screen. O2 tension is low enough in renal medulla to cause sickling in sickle trait patients

113
Q

What effect do progesterone and estrogen have on respiration?

A

Cause a respiratory alkalosis due to overstimulation of respiratory center. Pregnant women have AV fistulas in lungs which go away after delivery

114
Q

Respiratory status in endotoxic shock

A

Respiratory alkalosis (endotoxins stimulate resp center)

115
Q

Acid base status in salicylate overdose

A

Mixed. Respiratory alkalosis due to overstimulation of resp center and metabolic acidosis due to acid ingestion. Similar to endotoxic shock (mixed Ralk with Macid)

116
Q

What should you associate inspiratory stridor in a child with?

A

H flu (epiglottitis)

117
Q

Where is the obstruction in croup?

A

Trachea. Look for steeple sign

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