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Toni's Pathology > Immunology > Flashcards

Immunology Flashcards

1
Q

Muromonab

A

Anti CD3
Active rejection: corticosteroid resistant renal/heart/liver rejection
SE: fever leucopenia
Aka OKT3
Risk of anaphylaxis due to mouse murine protein
Cytokine release syndrome risk: TNFalpha + IFNgamma

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2
Q

Basiliximab

A 
Anti CD25
IL 2 alpha receptor
Reduces T cell proliferation
Prophylaxis vs allograft rejection
SE: GI disturbance
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3
Q

Tocilizumab

A

Anti IL6 receptor
For RA if anti TNF drugs fail
SE: infections, hepatotoxic, raises cholesterol
For castlemans + RA
Reduced macrophage, neutrophil + lymphocyte activation

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4
Q

Abatacept

A

Anti CTLA-4 Ig
Bind b7 protein (cd80 +86) on APCs
RA if anti TNF drugs fail
SE: infections + cough

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5
Q

What are the antiproliferative agents?

A

Cyclophosphamide
Mycophenolate mofetil
Azathioprine

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6
Q

Cyclophosphamide

A

Alkylates guanine base of DNA: b cells> t cells
For multi system connective tissue disease + cancer
SE: hair loss, BM suppression, sterility, haemorrhagic cystitis

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7
Q

Mycophenolate mofetil

A

Blocks de novo nucleotide synth: T cells > B cells
For AI, vasculitis, transplants
SE: BM suppression, hepatotoxicity

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8
Q

What are the inhibitors of cell signalling?

A

Tacrolimus
Ciclosporin
Sirolimus

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9
Q

Tacrolimus

A

Inhibits calcineurin which usually activates IL2 transcription = reduced IL2
For rejection prophylaxis
SE: diabetes

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10
Q

Ciclosporin

A

Inhibits calcineurin which usually activates IL2 transcription = reduced IL2
For rejection prophylaxis
SE: gingival hypertrophy, htn + reduced GFR

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11
Q

Sirolimus

A

Binds FKBP-1a
Blocks clonal proliferation
For rejection prophylaxis
Low nephrotoxicity

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12
Q

Prednisolone

A

Inhibits phospholipase a2
Reduces: platelet activating factor, Abs, arachidonic acid, apoptosis, trafficking phagocytes
SE: DM, adrenal suppression, cataracts, glaucoma, pancreatitis, osteoporosis, central obesity, neutrophilia, htn

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13
Q

Plasmapheresis

A

50% plasma replaced with donor plasma
For Goodpasture’s, MG, and other type II HS
SE: rebound Ab production limits efficacy

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14
Q

Adalimumab

A

Fully human anti TNF alpha mab

For RA, ank spondylitis, Crohns

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15
Q

Infliximab

A

Mouse-human chimeric Anti TNF alpha mab
For psoriasis, Crohns, RA
SE: TB, lymphoma, pneumonia, AI

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16
Q

Etanercept

A

TNF alpha mab
Fusion protein between TNF-R2 and Fc if IgG1
SE: incr risk infection, demyelination, malignancy

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17
Q

Ustekinumab

A

Anti IL 12/23 - binds to p40 subunit
For psoriasis
SE: infections + cough

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18
Q

Rituximab

A

Anti CD20 - decreases B cells
For AI disease + lymphoma
Incr risk hep B reactivation + progressive multifocal leukoencephalopathy

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19
Q

Natalizumab

A

Anti alpha-4 integrin
Prevent T cell migration
For MS + Crohns

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20
Q

Alemtuzumab

A

Anti CD 52
For CLL + MS
SE: incr susceptibility to CMV

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21
Q

Methotrexate

A

Dihydrofolate reductase inhibitor - decr DNA synth
For AI disease: RA, psoriasis, Crohns
Chemo
Abortifacient
SE: teratogenicity, hepatotoxicity, pneumonitis, pulm fibrosis, cirrhosis
Folate deficiency! Macrocytic megaloblastic anaemia

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22
Q

Components of a T cell immunosuppressive regime

A

Antiproliferative agent
T cell signalling inhibitor
Cytokine production inhibitor

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23
Q

Options for boosting the immune system

A

Vaccination
Human normal Ig
Specific Ig
Recombinant cytokines

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24
Q

Human normal Ig

A

Preformed IgG vs full range of organisms from >1000 donors
3-4 wkly admin
For: primary Ab deficiencies: Bruton’s + CVID
secondary Ab deficiencies: CLL, MM, BMT
Passive vaccination
? Anaphylaxis

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25
Q

Specific Ig

A 
Can be given to give passive vaccination for:
Rabies
VZV
Hep B
Tetanus
? Anaphylaxis
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26
Q

Recombinant cytokines

A

INF alpha: hep B, hep C + Kaposi’s sarcoma, CML, MM, hairy cell leukaemia
IFN beta: relapsing MS, MOA unknown
IFN gamma: chronic granulomatous disease

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27
Q

Allergen desensitisation

A

To reduce sx in mono allergic disorders
Good for: bee + wasp venom, grass pollen, house dust mite
Tiny doses titrated up over wks under close supervision
Maintenance dose then monthly for 3-5 yrs
Costly, laborious, risk of adverse reaction
Only treatment to alter natural course of disease

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28
Q

Azathioprine

A

Metabolised by liver to 6-mercaptopurine
Blocks de novo purine synth
For AI, transplants
SE: BM suppression, hepatotoxicity

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29
Q

Bare lymphocyte syndrome

A

Defect of regulatory factor X or class II transactivator
Absent expression of HLA molecules within thymus
Lymphocytes don’t develop
- type 1: MHC 1 absent = decr CD8
- type 2: MHC 2 absent = decr CD4 more common
B cell class switch requires CD4 so also less IgA + IgG
Assoc with sclerosing cholangitis
Unwell at 3 months

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30
Q

Di George

A

Impaired development of 3rd + 4th pharyngeal pouches
22q11.2 del 75% sporadic
= impaired development of thymus
= v low numbers mature T cells
Treatment = thymus transplant
Also infection prophylaxis, Ig replacement as req

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31
Q

Which primary immune deficiencies are T cell deficiencies?

A

Bare Lymphocyte Syndrome

Di George syndrome

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32
Q

Which primary immune deficiencies are B cell deficiencies?

A

Bruton’s agammaglobulinaemia
Selective IgA deficiency
Common variable immuno deficiency
Hyper IgM syndrome

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33
Q

Which primary immune deficiencies are mixed B + T cell deficiencies?

A

SCID

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34
Q

Which primary immune deficiencies are phagocyte deficiencies?

A

Kostmann syndrome
Leukocyte Adhesion deficiency
Chronic granulomatous disease
Cyclic neutropenia

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35
Q

Bruton’s agammaglobulinaemia

A 
X linked mutation in BTK gene 
= no mature B cells, no antibodies
Incr susceptibility to bacterial infections
\+ some viral + some toxins
Sx from ~ 3-6 months
Req IV IgG
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36
Q

Selective IgA deficiency

A

Most common immune deficiency
70% asymptomatic
Recurrent resp + gastro infections

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37
Q

Common variable immune deficiency

A

Defect in B cell differentiation- many genetic causes
Low Ig A, G + E
FTT
AI + granulomatous disease

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38
Q

Hyper IgM syndrome

A

X linked q26
CD 40 L, CD 40, AICDA or CD 154 defect
Prevents activated T cells interacting with B cells
No class switch = B cells can’t make IgA + IgG but Incr amt IgM
Less lymphoid tissue
1 yr old boys with recurrent bacterial infections, PCP + FTT
Req IV IgG

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39
Q

How are T cell deficiencies treated?

A

Infection prophylaxis

Ig replacement as required

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40
Q

How are B cell deficiencies treated?

A

Ig replacement
BMT in some
Vaccination only effective in selective IgA deficiency

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41
Q

SCID

A

Defects in lymphoid precursors
E.g. IL2 receptor or adenosine delaminates gene
Recurrent infections -> FTT + persistent diarrhoea + early infant death
Low/normal B cells, low T cells, low antibodies
BMT only established treatment
45% x linked

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42
Q

Kostmann syndrome

A 
AR HAX-1
Severe congenital neutropenia
BM: arrest of neutrophil precursor maturation 
Infections shortly after birth
Treatment: GCSF, prophylactic abx, BMT
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43
Q

Leukocyte adhesion deficiency

A

Failure to express lymphocyte adhesion markers
Neonatal bacterial infections
1: deficiency of beta -2 integrin subunit of CD18 on the leucocytes adhesion mol
2: much rarer, severe growth restriction + mental retardation
High neutrophil count + delayed umbilical cord separation
BMT

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44
Q

Chronic granulomatous disease

A

Failure of oxidative killing - NADPH oxidase defect
= decr reactive O2 species
-ve NBT test : nitrobluetetrazolium -ve DHR test : dihydrorhodamine
Pneumonia, abscesses, suppurating arthritis
Susceptible to catalase +ve: listeria, pseudomonas, aspergillus, candida, e.coli, staph aureas, serratia
Treatment: prophylactic trimethoprim, itraconazole, interferon

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45
Q

Cyclic neutropenia

A

Episodic neutropenia every 3 wks lasting a couple days
Mutations in ELA 1 gene
Treatment: GCSF

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46
Q

List the inflammatory cytokines

A

Il 1
IL 12
TNF
IL 6

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47
Q

List the anti-inflammatory cytokines

A

IL 10

TGF beta

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48
Q

Cytokine deficiencies

A

IFN gamma, IFN gamma-R, Il 12, IL 12-R
Involved in signalling betw T cells + macrophages
To stimulate TNF and Acyivate NADPH oxidase
Predisposes to: salmonella, TB, atypical mycobacteria, BCG
Unable to form granulomata

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49
Q

Reticular dysgenesis

A

Most sever for of SCID
Absolute deficiency of: neutrophils, lymphocytes, monocytes, macrophages, platelets
Fatal in early life without BMT

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50
Q

Wiskott-Aldrich syndrome

A 
X linked mutation in WASp gene
Decr IgM 
Incr IgA + E
Thrombocytopenia
Recurrent bacterial infections
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51
Q

What are the complement deficiencies?

A 
Incr susceptibility to encapsulated bacterial infection
Classical pathway deficiency
Lectin pathway deficiency 
Alternative pathway deficiency
Common + terminal pathway deficiency
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52
Q

Classical pathway deficiency

A 
Lack of C1 q/r/s
C2 (commonest) 
or C4 (removes immune complexes) 
Abnormal CH50 test
Associated with SLE + RA
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53
Q

Lectin pathway deficiency

A

V common
Up to 10% are MBL deficient
Not clinically important

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54
Q

Alternative pathway deficiency

A

Involves factors B/I/P
Usually kill bacteria
Susceptible to GBS, s.pneumoniae, h.influenzae, n.meningitidis
AP50 test abnormal

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55
Q

Common + terminal pathway deficiency

A

Lack of C 3, 5, 6, 7, 8, 9
Susceptible to meningitis + pneumonia
Assoc with membranous proliferation glomerulonephritis
Can’t form MAC to kill bacteria
Both CH50 + AP50 abnormal
Treatment: vaccination, prophylactic abx, high level suspicion

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56
Q

How might you detect deficiency of an alternative pathway factor?

A

AH50: reduced
CH50: normal

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57
Q

Hereditary angioedema

A

C1 inhibitor deficiency
Increased bradykinin
Spontaneous complement activation

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58
Q

When might high CH50 be seen?

A

Acute or chronic inflammation
Demonstrates classical and final complement pathway activity
E.g. SLE, RA

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59
Q

What might be seen with reduced C4?

A

SLE

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60
Q

What might be seen with reduced C3?

A

Membranoproliferative glomerulonephritis

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61
Q

What are the three mechanisms of mast cell activation?

A

Direct injury e.g. Toxin or drugs
IgE -R cross linking
Activated complement proteins

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62
Q

What are the three subtypes of MHC class I

A

HLA A
HLA B
HLA C

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63
Q

What are the three subtypes of MHC class II?

A

HLA DP
HLA DQ
HLA DR

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64
Q

What composes MHC class III?

A

Complement components

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65
Q

What AI condition is associated with HLA B27?

A

Ankylosing spondylitis

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66
Q

What AI condition is associated with HLA DQ2?

A

Coeliac disease

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67
Q

What AI conditions are associated with HLA DR3?

A

Graves
SLE
MG

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68
Q

What AI conditions are associated with HLA DR4?

A

DM

RA

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69
Q

What HLA markers are associated with Goodpasture’s ?

A

HLA DR2

HLA DR15

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70
Q

Azathioprine

A

6 mercaptopurine
Blocks de novo protein synthesis, blocks DNA synth
Inhibits T cell proliferation
SE: BM suppression, hepatotoxicity, hypersensitivity
For AI disease + transplants

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71
Q

Denosumab

A

Anti RANK ligand
Inhibits osteoclast function + differentiation
For osteoporosis, MM, bone mets
Toxicity: resp infections, UTIs

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72
Q

What are the type I hypersensitivity disorders?

A 
Atopic dermatitis
Food allergy
Oral allergy syndrome
Latex food syndrome
Allergic rhinitis
Acute urticaria
Anaphylaxis
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73
Q

What are the features of type I hypersensitivity?

A

IgE mediated, immed reactions
Provoked by re-exposure to allergen
Mast cell degranulation = vasodilation, SM spasm, incr permeability

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74
Q

Atopic dermatitis

A

Irritants, food, environmental factors
Defects in beta defensin predispose to S.aureas superinfection
Rx: emollients, topical steroids, abx, PUVA

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75
Q

Food allergy

A

Milk, egg, peanut, treenut, fish, shellfish
Dx: food diary, skin prick tests, RAST, challenge test
Rx: dietician, food avoidance, epi pen, control asthma

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76
Q

Oral allergy syndrome

A

Allergen -> IgE with cross reactivity to other substance
Birch pollen/ stone fruit (rosacea), ragweed/melons
Sx limited to mouth
A clinical diagnosis + skin prick test
Rx: avoid food, if ingested wash mouth + po antihistamines

77
Q

Latex food syndrome

A

Chestnut, avocado, banana, potato, tomato, kiwi, aubergine, mango, papaya, wheat, melon
Skin prick test
Avoid food

78
Q

Allergic rhinitis

A

Seasonal: grass/tree pollen
Perennial: pets/ dust mite
Occasional: latex/ animals at work
Nasal itch + obstruction, sneezing, anosmia, eye sx
Dx: clinical= pale blueish, swollen nasal mucosa, skin prick test, RAST
Rx: allergen avoidance, antihistamine, steroid nasal spray, pollen desensitisation

79
Q

Acute urticaria

A 
50% idiopathic 
50% food, drugs, latex, viral infection, febrile illness
Wheals which completely resolve in 6 wks
Clinical diagnosis
Rx: allergen avoidance + antihistamines
80
Q

What mediators are released upon mast cell degranulation?

A 
Histamine
Proteases
Serotonin
Heparin
Thromboxane
Prostaglandin
Leukotriene
Platelet activating factor
81
Q

How do antihistamines work?

A

H1 receptor antagonists
Negate effects of histamine
Take longer to take effect than IM adrenaline

82
Q

What mediators are released upon mast cell degranulation?

A 
Histamine
Proteases
Serotonin
Heparin
Thromboxane
Prostaglandin
Leukotriene
Platelet activating factor
83
Q

How do antihistamines work?

A

H1 receptor antagonists
Negate effects of histamine
Take longer to take effect than IM adrenaline

84
Q

Anaphylaxis

A

Severe systemic allergic reaction: resp difficulty + hypotension
IgE med mast cell degranulation: peanut, penicillin, stings, latex
Non IgE med mast cell degranulation: NSAIDs, IV contrast, opioids, exercise

85
Q

Management of anaphylaxis

A 
Elevate legs
100% O2
IM 500mcg adrenaline
Inhaled bronchodilators 
IV 100 mg hydrocortisone
IV 10 mg chlorphenamine 
IV fluids
86
Q

Skin prick tests

A

To confirm clinical hx, -ve test exclude IgE mediated allergy
+ve control = histamine
-ve control = dilutant
+ve result = wheal >= 2mm> -ve control
Discontinue antihistamines 48hrs prior to test

87
Q

RAST: radioallergosorbent test

quantitative specific IgE to putative allergen

A

Measures levels of IgE in serum against particular allergen
Confirms diagnosis of allergy and monitors response to anti IgE treatment
Indications: inability to stop antihistamines, anaphylaxis hx, extensive eczema

88
Q

Component resolved diagnostics

A

IgE response to a specific allergen protein
E.g.
Arah2- high risk anaphylaxis to peanuts + nuts
Arah8- localised oral reaction to peanuts + stone fruit only

89
Q

Challenge test

A

Gold standard
Double blind oral food challenge
Incr volumes of food ingested under close supervision
But risk of severe reaction

90
Q

What should be measured during acute allergic reactions?

A

Mast cell tryptase
Peak at 1-2 hrs
Baseline by 6 hrs

91
Q

Type II hypersensitivity reactions

A

IgG or IgM antibody vs cell/ matrix assoc protein

92
Q

Haemolytic disease of the newborn

A

Mat IgG vs neonatal erythrocyte antigens
Reticulocytosis + anaemia
+ve DAT
req exchange transfusion

93
Q

AIHA

A 
Vs RBC antigens e.g. Rhesus
RBC destruction by autoantibody, complement + phagocytes
= anaemia
\+ve DAT
Req steroids
94
Q

AITP

A

Vs platelet gpIIb/IIIa
Antiplatelet antibody
Req steroids, IVIG, splenectomy

95
Q

Goodpasture’s

A

Vs type IV collagen
Glomerular nephritis, pulm haemorrhage
Anti GBMab
Req steroids + immune suppression

96
Q

Pemphigus vulgaris

A

Vs epidermal cadherin: demoglein 1 + 3
Direct IF showing IgG
Req corticosteroids + immune suppression

97
Q

Graves’ disease

A

Vs TSH receptor
Hyperthyroid sx
Anti TSH receptor
Req carbimazole + propylthiouracil

98
Q

Myasthenia Gravis

A

Vs ACh receptor
Fatigueable muscle weakness
Anti ACh R Ab
IVIG, plasmapheresis, neostigmine/pyridostigmine

99
Q

Acute rheumatic fever

A

Vs M proteins on GpAstrep

Req aspirin, steroids, penicillin

100
Q

Pernicious anaemia

A

Vs intrinsic factor / gastric parietal cells
Reduced Hb, B12
Anti gastric parietal cell Ab
Req B12 supplementation

101
Q

Churg Strauss

A

Med + small vessel vasculitis
Allergy -> asthma -> systemic disease
pANCA
Req prednisolone, azathioprine, cyclophosphamide

102
Q

Wegener’s Granulomatosis

A

Med + small vessel vasculitis
Pulm haemorrhage, epistaxis, saddle nose, crescenteric GN
cANCA
Req corticosteroids, cyclophosphamide, co trimoxazole

103
Q

Microscopic Polyangitis

A

Small vessel vasculitis
Pauci immune, necrotising, purpura
pANCA
Req prednisolone, cyclophosphamide/ azathioprine, plasmapheresis

104
Q

Type II Hypersensitivity and complement

A

C1
C3a + C5a
C5-9
MAC

105
Q

Type II Hypersensitivity and complement

A

C1
C3a + C5a
C5-9
MAC

106
Q

Type III hypersensitivity

A 
IgG or IgM immune complex mediated tissue damage
Mixed essential cryoglobulinaemia
Serum sickness
Polyarteritis nodosa
SLE
107
Q

Mixed essential cryoglobulinaemia

A

Joint pain, splenomeg, skin, nerve, kidney involvement
Assoc with Hep C
Clinical dx + biopsy
Req NSAIDs, corticosteroids, plasmapheresis

108
Q

Serum sickness

A

Rashes, itching, arthralgia, LNpathy, fever, malaise
Antiserum proteins (IV non-human antiserum)
Reduced C3, immune complexes + vessel inflammation
Ex: Stop drug, steroids, antihistamines

109
Q

Polyarteritis nodosa

A

Fever, fatigue, wkness, arthralgia, skin, nerve, kidney, heart
Small + med vessel vasculitis -> multiple aneurysms
Complex deposition -> fibrinoid necrosis + neutrophil infiltration
Assoc with hep B
Clinical incr ESR, CRP, WCC, + biopsy
Rx: prednisolone + cyclophosphamide

110
Q

SLE

A

ANA +ve, anti ds DNA, anti smith = interstitial lung involvement
Reduced C4
Normal CRP, incr ESR
Drug induced= hydralyzine, procainamide, isoniazid
Rx: analgesia, steroids, cyclophosphamide

110
Q

Extrinsic allergic alveolitis

A

Aka farmers lung
Actinomycetes
Immune complex deposition in alveoli
Chronic exposure = pulmonary fibrosis, sob, cyanosis cor pulmonale

111
Q

Type IV hypersensitivity

A 
Delayed hypersensitivity, 48-72 hrs, T cell mediated
Macrophage -> IL12 -> mem CD4 Th1
Sens mem cell releases IFN gamma, IL2 + IL3 -> macrophage activ = TNF alpha production, injury + inflammation 
Contact dermatitis
T1DM
MS
RA
Crohns
Mantoux
112
Q

T1DM

A

Pancreatic beta cell proteins -> insulinitis beta cell destruction
GAD-Ab, islet cell Ab
Antibodies to tyrosine phosphatase: anti-IA-2Ab + anti phogrin Ab

113
Q

MS

A

Oligodendrocyte proteins (proteolipid + myelin basic protein) -> patchy demyelination
Perivascular inflammation
CSF: oligoclonal IgG bands on electrophoresis
Rx: corticosteroids, interferon beta
Uhthoff worse sx at higher than ambient T

114
Q

RA

A

Synovial membrane antigen -> chronic arthritis, rheum nodules, lung fibrosis
Incr ESR + CRP
Anti CCP
Rx: analgesia, steroids, DMARDs

115
Q

Contact dermatitis

A

Chemicals / poison ivy / nickel (hapten binds skin proteins)
1-2 days -> blisters/ wheals, desquamation
Clinical patch test
Rx: avoidance, corticosteroids

116
Q

Crohns

A

TH1 mediated skip lesions in GIT
Biopsy
Rx: mesalazine, infliximab, steroids

117
Q

Mantoux

A

Tuberculin

Skin induration indicates TB exposure

118
Q

CREST- limited scleroderma

A 
Calcinosis Raynauds Esophageal dysmotility Sclerodactyly Telangiectasia
Primary pulmonary htn
Only peri oral + forearm skin
TNF beta central to pathogenesis
Anti centromere Ab
119
Q

Diffuse scleroderma

A 
CREST + GIT + interstitial lung disease + renal problems
Female 4 : male 1
Anti topoisomerase
Fibrillarin Ab 
RNA pol I, II, III
120
Q

Sjogrens

A 
Dry mouth, eyes, nose + skin
Kidneys, blood vessels, lungs, liver, pancreas, PNS
Parotid + salivary gland enlargement
Anti Ro, Anti La
Schiller test
121
Q

IPEX syndrome

A 
Immune dysregulation, polyendocrinopathy, enteropathy, x link
Eczematous dermatitis, nail dystrophy
Alopecia, pemphigoid
Most affected die in first 2 yrs
BMT is only cure
122
Q

Coeliac disease

A 
Gluten -> villous atrophy + enteropathy
Constipation, diarrhoea, bloating, fatigue
Malabsorption: Fe, folate, lipid soluble vitamins, Ca deficiency 
IgA anti endomysial Ab
IgA anti tissue transglutaminase 
IgG anti Gliadin Ab = most persistent
Dermatitis herpetiformis
Linked to Downs
DQ 2 or DQ8 
Gold standard = duodenal biopsy
123
Q

cardiolipin Ab
Lupus anticoagulant
Beta2glycoprotein Ab

A

Antiphospholipid syndrome

124
Q

Anti SM
Ant LKM - 1
Anti SLA

A

AI hepatitis

125
Q

Anti rhesus blood gp antigen

A

AIHA

126
Q

Anti Gp IIb / IIIa

A

AITP

127
Q

pANCA

A

Churg strauss
Aka
eGPA

128
Q

Anti TTG
Anti EMA
DQ 2

A

Coeliac

129
Q

Anti Ro

ENA

A

Congenital heart block + maternal SLE

130
Q

Anti Jo

A

Dermatomyositis

131
Q

Anti topoisomerase

Fibrillarin

A

Diffuse scleroderma

132
Q

Anti glomerular basement membrane Ab

A

Goodpasture’s

133
Q

Anti TSH R Ab

A

Grave’s

134
Q

Thyroglobulin Ab

Thyroperoxidase Ab

A

Hashimoto’s thyroiditis

135
Q

Anti centromere Ab

A

CREST - limited scleroderma

136
Q

pANCA

A

Microscopic Polyangitis

137
Q

Anti UIRNP

Speckled pattern

A

Mixed connective tissue disease

138
Q

Anti AChR Ab

A

MG

139
Q

Gastric parietal cell Ab

IF Ab

A

Pernicious anaemia

140
Q

Anti Jo -1

tRNA synthase

A

Polymyositis

141
Q

anti mitochondrial Ab

A

PBC

142
Q

Anti CCP
Rheumatoid factor
Incr CH50
HLA DR4

A

RA

143
Q

Anti Ro

Anti La - speckled

A

Sjogrens

144
Q

ds DNA
Histone Ab
Incr CH50
HLA DR3

A

SLE

145
Q 
Glutamate decarboxylase (GAD)
HLA DR3/4
A

T1DM

146
Q

Wegener’s / GPA

A

cANCA

147
Q

PTPN22

A

Assoc with RA, SLE, T1DM

148
Q

CTLA4

A

Assoc with SLE, T1DM, AI thyroid

149
Q

Human normal Ig

A

Every 3-4 wks
Primary Ab deficiencies: CVID, Bruton’s
Secondary Ab deficiencies: CLL, MM, BMT
Passive vaccination

150
Q

Specific Ig

A 
Passive immunisation - lasts 3wks
Rabies
VZV
Hep B
Tetanus
Hep A
151
Q

Recombinant cytokines

A

INF alpha: hep B, hep C, Kaposi’s, CML, MM, hairy cell leuk
INF beta: relapsing MS
INF gamma: chronic granulomatous disease

152
Q

Pre transplant induction agents

A

Suppress T cell response:
Alemtuzumab -CD 52
Basiliximab -CD 25

153
Q

Post transplant immunosuppressant

A

Calcineurin inhibitors: Tacrolimus + ciclosporin

Mycophenolate mofetil

154
Q

Treating acute rejection

A

Cellular: steroids + IVIG

Ab mediated: IVIG + plasmapheresis

155
Q

How does HIV bind to CD4 cells?

A

Via gp 120 + gp41

CCR5 + CXcR4

157
Q

Describe progression to AIDS

A

Median timescale = 8-10 yrs post infection

10%: Rapid progressors = 2-3 yrs

157
Q

Diagnosing HIV

A

Screening: anti HIV Ab via ELISA

Confirmation: HIV Ab detected via western blot

+ve test req seroconversion ~10 wks post infection

158
Q

What CD4 count correlates with the onset of AIDS?

A
159
Q

HIV monitoring

A

Viral load: via PCR

CD4 count: via FACS - flow cytometry

161
Q

How do CD8 cells block HIV entry?

A

MIP-1a
MIP- 1b
RANTES

162
Q

APECED

A 
AIRE mutation
Normally kills T cells which bind self antigens
Mild immune deficiency
Dysfunctional parathyroids + adrenals
Hypothyroidism
Gonado failure
Alopecia + vitiligo
163
Q

Which are antigen presenting cells?

A

Macrophages
Dendritic cells
B cells

164
Q

Isograft

A

Transplant from monozygotic twin

165
Q

Allograft

A

Same species donor
Genetically different
HLA + ABO matched

166
Q

Split transplant

A

Liver that might be divided between two recipients

167
Q

Autograft

A

Transplant of tissue to same patient

E.g. Skin graft + CABG

168
Q

Xenograft

A

Transplant from another species
E.g. Porcine heart valve in aortic valve replacement
High risk rejection + disease

169
Q

Hyperactive rejection

A

Mins-hrs
Mediated by preformed antibodies vs antigens on surface of donor organ
Activates complement + clotting cascade
Rejection

170
Q

Acute cellular rejection

A 
1 wk post transplant
T cell mediated 
HLA mismatch
APCs-> CD4-> macrophages, CD8, B cells, IFN gamma, TNF alpha
Vs donor organ
171
Q

Acute vascular rejection

A

With Xenograft
Antibody reaction
Similar to hyper acute but after 4-6 days

172
Q

Chronic rejection

A

Smooth muscle growth blocks graft vessel lumens -> ischaemia + fibrosis
rf: HLA mismatch, multiple acute rejections, htn, hyperlipidaemia

173
Q

GVHD

A

Complication of allogeneic SCT

Immune cells donated recognise recipient tissue as foreign

174
Q

List some AIDS defining illnesses

A

Mycobacterium Acium intracellulare
Candida albicans oesophagutus
Toxoplasmosis

175
Q

Examples of inactivated vaccines

A

Cholera
Hep A
Rabies

176
Q

Examples of live attenuated vaccines

CI in the immunocompromised

A

MMR
Sabin polio
Typhoid
Yellow fever

177
Q

Sub unit vaccines

A 
Hep B recombinant
Pneumococcal
Diptheria
Tetanus
Pertussis
178
Q

Conjugated vaccines

Vs encapsulated bacteria

A

Influenza
Pneumococcus
Neisseria meningitidis

179
Q

INF alpha

A 
In treatment of :
Hep B
Hep C
Kaposi's sarcoma
CML
180
Q

INF beta

A

Used in MS

Unknown mech of action

182
Q

Which are antigen presenting cells?

A

Macrophages
Dendritic cells
B cells

183
Q

INF gamma

A

In treatment of:

Chronic granulomatous disease

184
Q

Auto immune hepatitis type 1

A

ANA
Anti SM Ab
Responds well to steroids
10yrs - elderly

185
Q

Auto immune hepatitis type 2

A

Paediatric population
Anti LKM Ab
Assoc with IgA deficiency

186
Q

Guillain Barré

A

Ganglioside LM1(A), P2, galactocerebroside
Ascending paralysis
Following CMV or Campylobacter
Cross reactivity betw pathogen and peripheral nerve myelin components

187
Q

PSSN: para neoplastic subacute sensory neuropathy

Assoc with small cell

A

Anti Hu proteins of peripheral nerves

188
Q

Para neoplastic cerebellar degeneration

A

Anti Purkinje cells of CNS

189
Q

Para protein assoc polyneuropathy

A

Anti myelin-assoc glycoprotein MAG

Toni's Pathology (6 decks)

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