Immunology Flashcards
1
Q
HLA class I
- Presents to
- Main subtypes
A
- CD8+ T cells
2. Groups A, B and C
2
Q
HLA class II
- Presents to
- Main subtypes
A
- CD4+ T cells
2. Groups DR, DQ, DP
3
Q
Most important subtypes for HLA matching
A
HLA A, B and DR
4
Q
Screen for HLA type using which technique?
A
PCR-based DNA sequence analysis
5
Q
Screen for anti-HLA antibodies using which three techniques?
A
- Cytotoxicity assays
- Flow cytometry
- Solid phase assays
6
Q
Anti-CD52 (suppresses T cell response, used for pre-transplant induction)
A
Alemtuzumab
7
Q
Anti-CD25 (suppresses T cell response, used for pre-transplant induction)
A
Basiliximab
8
Q
Baseline immunosuppressants used post-transplant to reduce rejection
A
Calcineurin inhibitors, mycophenolate mofetil and azathioprine
9
Q
Anti-CD20 (destroys B cells)
A
Rituximab
10
Q
Treatment of episodes of acute rejection:
- cellular?
- antibody-mediated?
A
Cellular: steroids, ATG, OKT3
Antibody-mediated: IVIG, plasma exchange, anti-C5 (Eculizumab), anti-CD20 (Rituximab)
11
Q
Eliminate host immune system before haematopoietic stem cell transplant using?
A
Cyclophosphomide
12
Q
GVHD prophylaxis
A
Methotrexate / cyclosporin
13
Q
Treat acute GVHD with?
A
Corticosteroids
14
Q
Kaposi’s sarcoma associated virus
A
HHV8
15
Q
Live vaccines
A
MMR Chickenpox Yellow fever Typhoid BCG Polio (oral sabin)
16
Q
CD45 RO T cells
A
Memory T cells
17
Q
CD45 RA T cells
A
Naive T cells
18
Q
Central memory T cells found in lymph nodes and tonsils
A
More CD4, CCR7+ve and CD62L+ve (allow entry via high endothelial venules), produce IL2
19
Q
Effector memory T cells founds in liver, lungs and gut
A
More CD8, CCR7-ve, CD62L-ve, produce perforin and IFN-gamma
20
Q
T helper cell response
- Th1
- Th2
A
Th1 = cell mediated, involves cytokines IL-2, IFN-gamma, TNF Th2 = antibody mediated, involves cytokines IL-4, IL-5, IL-6
21
Q
Pavalizumab
A
Monoclonal antibody for RSV
22
Q
Adjuvant which provides slow-release antigen to help prime immune response. Activates Gr1+ cells to produce IL-4 –> helps prime naive B cells. Stimulates monocytes into DCs (primes adaptive response).
A
ALUM
23
Q
Unmethylated motif with 2 purines at 5’ end and 2 pyrimidines at 3’ end - acts as an immunostimulatory adjuvant. Activates TLRs (PRRs) on APCs stimulating expression of costimulatory molecules.
A
CpG
24
Q
Water-in-oil emulsion containing mycobacterial cell wall components. Mainly for animals, painful for humans.
A
Complete Freund’s adjuvant
25
Experimental - multimeric antigen with adjuvant built in
ISCOMS
26
Passive vaccine HNIG
Hep A and measles
27
Encapsulated bacteria
```
Streptococcus pneumoniae
Group B Strep.
Haemophilus influenzae
Neisseria meningitidies (meningococcus)
Klebsiella
Salmonella typhi
```
28
Test for classical pathway deficiency
CH50
29
Test for alternative pathway deficiency
AP50
30
Type I hypersensitivity reaction
Immediate IgE-mediated
31
Type II hypersensitivity
Antibody reacts with cellular antigen
32
Type III hypersensitivity
Antibody reacts with soluble antigen to form an immune complex
33
Type IV hypersensitivity
Delayed type hypersensitivity - T cell mediated
34
Diseases associated with ANA
SLE, Sjogren's syndrome, systemic sclerosis, dermatomyositis, polymyositis
35
Rheumatoid arthritis antibody
Anti-CCP
36
Crescentic nephritis
Goodpasture's disease
37
What is rheumatoid factor?
IgM anti-IgG
38
C1 esterase deficiency
Hereditary angioedema
39
Smooth linear deposition of antibody along GBM
Goodpasture's disease
40
"Lumpy-bumpy" pattern of antibody complex deposition in basement membrane
SLE
41
Causes of high ESR
Myeloma, SLE and Sjogrens
42
Low complement indicates?
Severe disease activity
43
What type of reaction is dermatomyositis?
Type III (perivascular CD4 T cells and B cells)
44
What type of reaction is polymyositis?
Type IV (CD8 T cells kill myofibres via perforin / granzymes)
45
Associated with ANCA and chronic Hep B
Polyarteritis nodosa
46
Small vessel vasculitis (ANCA associated)
Microscopic polyangiitis
Granulomatosis with polyangiitis (Wegener's)
Eosinophilic granulomatosis with polyangitis (Churg-Strauss)
47
Small vessel vasculitis (immune complex associated)
Goodpasture's disease
IgA nephropathy (Berger's)
Cryoglobulinaemia
48
Haematuria a couple of days after URTI
Berger's IgA nephropathy
49
Haematuria a few weeks after URTI
Post-streptococcal glomerulonephritis
50
c-ANCA
Wegener's granulomatosis with polyangiitis
51
p-ANCA
Churg-Strauss (eGPA) and microscopic polyangiitis
52
Acute transplant rejection is:
1. Mediated by what cell type?
2. Treated how?
1. T cells
| 2. Corticosteroids
53
Treatment of antibody-mediated rejection
IVIG and plasmapharesis
54
Order of importance of HLA types in transplant rejection
HLA DR > B > A
55
Drug blocking DNA synthesis, especially of T cells
Mycophenolate mofetil
56
Causes a transient increase in neutrophil count
Prednisolone
57
Anti-TNF alpha
Infliximab and Adalimumab
58
Side effect is gingival hypertrophy
Ciclosporin
59
Test to confirm anaphylaxis
Mast cell tryptase levels (peak 1-2 hours, normalised by 6 hours)
60
Causes of IgE-mediated mast cell degranulation--> anaphylaxis
Peanut, penicillin, wasp or bee venom, latex
61
Causes of non-IgE-mediated mast cell degranulation --> anaphylaxis
Aspirin and NSAIDs, IV contrast media, opioid analgesics, exercise
62
Cause of drug-induced angioedema
ACE inhibitors
63
Inactivated vaccines
```
Hep A
Rabies
Whole cell ertussis
Influenza
Polio (salk)
```
64
Component vaccines
Hep B (HbS)
HPV (capsid)
Influenza (haemagglutinin, neuraminidase)
65
Conjugate vaccines
Tetanus (exotoxin)
| HiB
66
Toxoid vaccines
Diptheria
| Tetanus
67
Preferred host target of HIV
CD4+ T cells
68
HIV: attachment inhibitor
Maraviroc
69
HIV: fusion inhibitor
Enfuvirtide
70
HIV: nucleoside reverse transcription inhibitor
Zidovudine (aka azidothymidine)
71
HIV: non-nucleoside reverse transcription inhibitor
Efavirenz
72
HIV: integrase inhibitor
Raltegravir
73
HIV: protease inhibitor
Saquinavir
74
Th1 CD4+ T cells produce
IL-2, IFN-gamma and lymphotoxin
75
Th2 CD4+ T cells produce
IL-4, IL-5 and IL-10
76
Th17 cells secrete
IL-17 and IL-22
77
T reg cells express and secrete
Express CD25 and FoxP3
| Secrete IL-10
78
Tr1 cells secrete
IL-10 and TGF beta
79
Ankylosing spondylitis HLA association
HLA B27
80
Goodpasture's syndrome HLA association
HLA DR15 / DR2
81
Graves disease HLA association
HLA DR3
82
SLE HLA association
HLA DR3
83
T1DM HLA association
HLA DR3 / DR4
84
Rheumatoid arthritis HLA association
HLA DR4
85
Antiphospholipid syndrome Ab
Anti-cardiolipin
Anti-beta2 glycoprotein
Lupus anticoagulant
86
Autoimmune hepatitis Ab
Anti-smooth muscle antibody
Anti-LKM-1
Anti-SLA (soluble liver antigen)
87
AIHA Ab
Anti-Rh blood group antigen
88
Autoimmune thrombocytopenic purpura Ab
Anti-glycoprotein IIb-IIIa
| Anti Ib-IX antibody
89
Churg-Strauss syndrome (eGPA) Ab
p-ANCA
90
Coeliac disease Abs
Anti-TTG IgA
| Anti-Endomysial IgA
91
Antibody causing congenital heart block in mothers with SLE
Anti-Ro antibody
92
Dermatitis herpetiformis Ab
Anti-endomysial IgA
93
Dermatomyositis Ab
Anti-Jo-1 (t-RNA synthetase)
94
Diffuse cutaneous scleroderma Ab
Anti-Scl70 (anti-topoisomerase)
RNA pol I, II, III
Fibrillarin (nucleolar pattern)
95
Goodpasture's syndrome Ab
Anti-GBM
96
Graves disease Ab
Anti-TSH receptor antibody (stimulatory)
97
Hashimoto's thyroiditis Ab
Anti-thyroglobulin
| Anti-thyroperoxidase
98
Limited cutaneous scleroderma (CREST) Ab
Anti-centromere
99
Microscopic polyangiitis Ab
p-ANCA
100
Mixed connective tissue disease Ab
Anti-U1RNP (speckled pattern)
101
Myasthenia gravis Ab
Anti-ACh receptor
102
Pernicious anaemia Ab
Anti-gastric parietal cell (90%)
| Anti-intrinsic factor (50%)
103
Polymyositis Ab
Anti-Jo-1 (t-RNA synthetase)
104
Primary biliary cirrhosis Ab
AMA
105
Rheumatoid arthritis Ab
```
Anti-CCP
Rheumatoid factor (less specific)
```
106
Sjogren's syndrome Ab
Anti-Ro
Anti-La (speckled pattern)
60-70% Rh factor positive
107
SLE Ab
Anti-dsDNA
| Histones, Ro, La, Sm, U1RNP (speckled)
108
T1DM Ab
Anti-GAD
| Pancreatic beta cells
109
Wegener's granulomatosis (GPA) Ab
c-ANCA
110
Polyarteritis nodosa Ab
ANCA
| also associated with chronic Hep. B
111
Give check point inhibitors e.g. CTLA4 to treat what?
Melanoma
112
Anti CD28 (rheumatoid arthritis)
Abatacept
113
Anti alpha 4 integrin (MS)
Natalizumab
114
Anti IL-6 R (RhA)
Tocilizumab
115
Autosomal recessive form of severe SCID presenting at a few days old. Failure of production of neutrophils, lymphocytes, monocytes/macrophages, and platelets. Failure of stem cells to differentiate along myeloid or lymphoid lineage.
Reticular dysgenesis
116
Mutation in AK2
Reticular dysgenesis
117
Specific failure of neutrophil maturation. Autosomal recessive severe congenital neutropenia. HAX1 mutation.
Kostmann syndrome
118
ELA-2 neutrophil elastase mutation. Autosomal dominant episodic neutrophenia every 4-6 weeks. Failure of neutrophil maturation.
Cyclic neutropenia
119
CD18 deficiency. Neutrophilia. No pus.
Leukocyte adhesion deficiency
120
Absent respiratory burst due to deficiency of component of NADPH oxidase. X-linked. NBT test abnormal. Normal neutrophil count. Excessive inflammation and granuloma formation. Lymphadenopathy and hepatosplenomegaly.
Chronic granulomatous disease
121
Treatment of chronic granulomatous disease
Interferon gamma therapy
122
IL-12 and INF-gamma deficiency leads to what?
Inability to form granulomas. Susceptible to mycobacteria and salmonella.
123
Deficiency in early classical pathway (C1/2/4) leads to what?
Increased susceptibility to infection and increased load of self-antigens (SLE)
124
Factor B/I/P deficiency leads to?
Recurrent infections with encapsulated bacteria
125
MBL deficiency leads to?
Only causes problems if there is a concurrent cause of immune impairment
126
Any defect in complement pathway leading to problem with MAC causes?
Increased infections with encapsulated bacteria:
Neisseria meningitidis
Strep. pneumoniae
Haemophilus influenzae
127
Mutation of gamma chain of IL-2 receptor
X-linked SCID (v. low T cells, normal B cells)
128
DiGeorge CATCH-22
```
Cardiac abnormalities
Abnormal facies
Thymic aplasia (low T cells and IgG/IgA)
Cleft palate
Hypocalcaemia / hypoparathyroidism
22q11 microdeletion
```
129
Absent MHC class II --> profound deficiency of CD4+ T cells and IgG/IgA
Bare lymphocyte syndrome
130
Immune deficiency associated with sclerosing cholangitis
Bare lymphocyte syndrome
131
Btk gene mutation. No circulating immunoglobulin after 3 months.
Bruton's X-linked hypogammaglobulinaemia
132
Mutation in CD40 ligand gene causes T cell defect and IgM only
HyperIgM syndrome
133
Low IgG, IgA and IgE due to mutation of MHC III (aberrant class switching)
Common variable immune deficiency, presents in adulthood
134
Low IgM, raised IgA and IgE
Wiskott-Aldrich Syndrome
