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0001 STEP ONE RAPID REVIEW DX > Immunology > Flashcards

Immunology Flashcards

1
Q

HEAD AND NECK

A

CERVICAL

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2
Q

LUNGS

A

HILAR

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3
Q

TRACHEA AND ESOPHAGUS

A

MEDIASTINAL

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4
Q

UPPER LIMB, BREAST, SKIN ABOVE THE UMBILICUS

A

AXILLARY

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5
Q

LIVER, STOMACH, SPLEEN, PANCREAS, UPPER DUODENUM

A

CELIAC

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6
Q

LOWER DUODENUM, J, I, COLON TO SPLENIC FLEXURE

A

SUPERIOR MESENTERIC

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7
Q

COLON FROM SPLENIC FLECTURE TO UPPER RECTUM

A

INFERIOR MESENTERIC

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8
Q

LOWER RECTUM TO ANAL CANAL (ABOVE PECTINATE LINE) BLADDER, VAGINA (MIDDLE THIRD), PROSTATE

A

INTERNAL ILIAC

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9
Q

TESTES, OVARIES, KIDNEYS, UTERUS

A

PARA-AORTIC

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10
Q

ANAL CANAL (BELOW THE PECTINATE LINE) SKIN BELOW THE UMBILICUS (EXCEPT POPLITEAL TERRITORY) SCROTUM

A

SUPERFICIAL INGUINAL

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11
Q

DORSOLATERAL FOOT

POSTERIOR CALF

A

POPLITEAL

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12
Q

Asplenia associated with which pathogens

A 
due to decreased IgM --> decreased complement --> decreased C3b opsonization we see increased susceptiblity to ecapsulated organisms 
SHiNE SKiS
Strep Pneumo
Heam Influezae
Neisseria Meningitidis
Escherischia Coli
Salmonella
Klebsiella 
Group B Streptococci
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13
Q

HLA loci for MHC-1 and MHC-II

A

MHC-I
HLA-A; HLA-B; HLA-C
MHC-II
HLA-DR; HLA-DP; HLA-DQ

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14
Q

HLA associated with hemochromatosis

A

HLA-A3

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15
Q

HLA-B27 associated with

A 
PAIR (seronegative arthropathies)
Psoriatic 
Ankylosing Spondylitis
Inflammatory bowel disease 
Reactive Arthritis
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16
Q

HLA-DQ2/DQ8

A

Celiac

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17
Q

HLA-DR2

A

MS
Hay fever
SLE
Goodpasteur

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18
Q

HLA-DR3

A

DM-I
SLE
Graves and Hashimotos thyroiditis

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19
Q

HLA-DR4

A

Rheumatoid arthritis

DM-1

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20
Q

HLA-DR5

A

Pernicious anemia

Hashimotos

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21
Q

Natural killer cell

cytokines that enhance activity

A

IL-2
IL-12
IFN-alpha
IFN-beta

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22
Q

Natural killer cells can also kill via antibody mediated how?

A

CD16 binds FC of bound Ig

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23
Q

Cytokines secreted by macrophages

A 
IL1
IL6
IL8
IL12
TNF-alpha
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24
Q

IL-1 (osteoclast activating factor?)

A

Secreted by macrophage
Causes fever / acute inflammation / activates endothelium to express adhesion molecules
induces chemokine secretion to recruit WBCs

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25
Q

IL-2

A

Secreted by all T cells

stimulates growth of helper / cytotoxic / and regulatory T cells and NK cells (bone marrow)

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26
Q

IL-3

A

Secreted by all T cells

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

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27
Q

IL-4

A

Secreted by Th2
induces differentiation into Th2
Promotes growth of B cells
Enhances class switching to IgE and IgG

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28
Q

IL-5

A

Secreted by Th2
promotes differentiation of B cells
Enhances class switching to IgA
Stimulates growth and differentiation of eosinophils

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29
Q

IL-6

A

Secreted by macrophages
increases acute phase reactants
fever

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30
Q

IL-8

A

major chemotactic factor for neutrophils

secreted by macrophages

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31
Q

IL-12

A

Secreted by macrophages
Induces differentiation of T cells into Th1 Cells
Activates NK cells
so we are priming for the cell mediated response (like we would see in mycoplasma)

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32
Q

Interferon gamma

A

Secreted by Th1 cells also by NK cells
in response to IL-12 stimulation from macrophages
stimulates macrophages to kill phagocytosed pathogens
so its like a check and balance

mac eats pathogen - secretes IL-12
IL-12 activated T cells secretes Interferon gamma telling macrophage to destroy

Also interferon gamms activates NK cells to kill-virus infected cells.
Increases MHC expression and antigen presentation by all cells

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33
Q

IL-10

A

Secreted by TH2 cells
modulates inflammatory response (chill out factor)
Decreases the expression of MHC class II and Th1 cytokines
Inhibits the activation of macrophages and dendritic cells.
Also secreted by regulatory T cells

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34
Q

Which cytokines attenuate the immune response

A

IL-10

TGF-beta

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35
Q

T cell surface protein

A

MHC I is present on all cells (except RBC)
TCR (binds antigen-MHC complex)
CD3 (associated with TCR for signal transduction)
CD28 (binds B7 on APC)

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36
Q

Helper T cells surface protein

A

CD4

CD40L - interacts with B cell CD40

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37
Q

Cytotoxic T cell surface protein

A

CD8

38
Q

Regulatory T cell surface protein

A

CD4

CD25

39
Q

B cells

surface proteins

A

IgG - binds antigen
CD19, CD20, CD21 (receptor for EBV), CD40
MHCII
B7 interacts with Tcell CD28 (B7 acts as APC)

40
Q

Receptor for epstein barr?

A

CD21

41
Q

Macrophage cell surface receptors

A

CD14; CD40 (binds CD40L on Helper T cell)
MHCII
B7 interacts with Tcell CD28 (B7 acts as APC)
Fc and C3b - receptors for opsonization

42
Q

NK cell surface receptors

A

CD16 - binds Fc of IgG

CD56 - unique marker :)

43
Q

Marker for hematopoeitic stem cells?

A

CD34

44
Q

Anti-ACh

A

Myasthenia gravis

45
Q

Anti-basement membrane

A

Goodpasteur

46
Q

Anticardiolipin, lupus anticoagulant

A

lupus

antiphospholipid syndrome

47
Q

Anticentromere

A

Limited scleroderma - CREST syndrome

CREST - Calcinosis; raynaud phenomenon ; esophageal dysmotility ; sclerodactyly ; telangectasia

48
Q

Antidesmosome - anti-desmogelin

A

Pemphigus vulgaris - this is the one where it attack within the epithelium so you have moveable blisters :( - not tight - pop

49
Q

Anti-dsDNA

A

SLE

50
Q

Anti-smith

A

SLE

51
Q

Anti-glutamic acid decarboxylase (GAD-65)

A

DM-I

52
Q

Anti-hemidesmosome

A

Bullous-pemphigoid - this is the one where you attack at the border between epidermis and dermis - so have taught bulla

53
Q

Anti-histone

A

Drug induced lupus
Isoniazid - TB - mycolic acid cell wall inhibitor (p450 inh)
Procainamide - class Ia antiarryhthmetic
Hydralazine - BP direct vasodilator - good for black people

54
Q

Anti-Jo-1

A

Polymyositis / dermatomyositis

55
Q

Antimitochondrial

A

primary biliary cirrhosis

56
Q

Anti-SRP

A

Polymyositis / dermatomyositis

57
Q

Anti-Mi-2

A

Polymyositis / dermatomyosits

58
Q

Antimicrosomal

A

Hashimoto thyroiditis

59
Q

Antinuclear

A

SLE nonspecific

60
Q

Antithyroglobulin

A

Hashimotos

61
Q

Antiparietal cell

A

pernicious anemia

62
Q

Anti-SCl-70 (anti-DNA topoisomerase)

A

Scleroderma (Diffuse)

63
Q

Anti smooth muscle

A

Autoimmune hepatitis

64
Q

Anti-SSA, anti-SSB (anti-ro, anti-La)

A

Sjogren syndrome (attack exocrine gland - like tear ducts and salivary glands)

65
Q

Anti-TSH

A

GRAVES

66
Q

Anti-U1 RNP ribonucleoprotein

A

Mixed connective tissue disease

67
Q

IgA anti-endomysial, IgA anti-tissue transglutaminase

A

Celiac disase

68
Q

MPO-ANCA/p-ANCA

A

Microscopic polyangitis, eosinophilic granulomatosis with polyangitis (Churg-Strauss syndrome) - which is -granulomatous necrotizing vasculitis with eosinophilia - presents wtih asthma, sinusitis, skin nodules or purpura, wrist or foot drop, can also involve heart, GI, kidney

69
Q

PR3-ANCA / c-ANCA

A

Granulomatosis with polyangitis (Wegeners) - necrotizing granulomas of vasculitis / lung / and upper airway - also kidney

70
Q 
Rheumatoid factor (IgM antibody that targets IgG Fc region) 
anti-CCP (more specific) citrillin protein
A

RA

71
Q

Chronic granulomatous disease increased susceptibility to catalase (+) bugs because they can break down the H2O2 that NADPH oxidase deficient people could potentially use to make other reactive oxygen species
What bugs are these?

A 
Need PLACESS
Nocardia
Pseudomonas
Listeria
Aspergillus
Candida
E Coli
S. aureus 
Serratia
72
Q

CD18

A

Protein on phagocytes - characteristically absent in Leukocyte adhesion deficiency type I
(AR) LFA-1integrin
Impaired leukocyte migration and chemotaxis
Recurrent bacterial and skin mucosal infection
Absent pus formation
Delayed wound
Delayed umbilical separation

73
Q

So what is the problem in CD18 absence?

A

You’ve got the cells but they cant get out to fight :(

74
Q

Important chemotactic agents?

A

Leukotriene B4 (made from arachidonic acid)
5-HETE (leukotriene precursor)
C5a
IL-8

75
Q

Bronchiolar lavage demonstrating a high CD4:CD8 ration can be helpful to distinguish

A

sarcoidosis - which is characterized by noncaseating granulomas - chest x-ray will show bilateral hilar adenopathy - what can be used to distinguish

76
Q

Ataxia
Sinopulmonary infections (IgA deficiency)
Telangiectasias

A

Ataxia Telangiectasia

ATM gene - failure to repair double strand breaks

77
Q

Oculocutaneous albinism
Pyogenic infections
Progressive neurological dysfunction

A

Chediak Higashi syndrome - LYST - failure in microtubule functions leads to failure in lysosome and phagosome fusion (AR)

78
Q

Severe bacterial and fungal infections

Granuloma formation

A 
Chronic granulomatous disease - Defect in NADPH oxidase 
X-linked recessive most common 
nitroblue tetrazolium dye reduction test (-)
increased susceptibilty to catalase (+) organisms 
Need PLACESS
Nocardia
Pseudomonas 
Listeria 
Apergillus
Candida 
E Coli
S Aureus 
Serratia
79
Q

Congenital heart disease
Dysmorphic facies
Hypocalcemia***

A

DiGeorge
(CATCH22)
Recurrent viral and fungal infections -
Absence of thymus and Parathyroids because 3rd and 4th pharyngeal arch pooped out

80
Q

Severe bacterial and viral infections in infancy
chronic diarrhea
mucocutaneous candidiasis ***

A

SCID

X-linked Adenosine Deaminase deficiency most common - TRECs

81
Q

Recurrent Neisseiria infection

A

Terminal complement deficiency C5B-C9

82
Q

Recurrent infections that worsen with age
Easy bleeding
Eczema

A

Wiskott Aldrich

Xlinked WAS

83
Q

fucked up T cells (like in Digeorge) would predispose to?

A

viral
fungal
protozoan
intracellular bacteria

84
Q

region of the lymph node populated by T cells and dendritic cells

A

paracortex

85
Q

omalizumab

A

IgE MAB for add on rx in patients with severe asthma (allergic)

86
Q

B-cell disorders (3)

A

X linked Agammaglobulinemia (Defect in BTK –> not b cell maturation)
Selective IgA - can see airway and GI infections (anaphylaxis to IgA blood)
CVID - defect in B cell differentiation acquired (increased risk autoimmune/sinopulmonary) acquired 20s/30s

87
Q

T-Cell Disorders (4)

A

DiGeorge - CATCH22q11
IL12 Receptor deficiency - disseminated mycobacterial and fungal - decreased IFN-g
Autosomal dominant hyper-IgE syndrome (Job) - Deficiency in Th17 cells due to STAT3 mutation - impairs neutrophil recruitment - FATED
Chronic mucocutaneous candidiasis - T-cell dysfunction (many causes)

88
Q

JOB - FATED

A 
Facies
Abscesses (cold non-inflammed)
Teeth - retained primary
IgE increased
Dermatolgic eczema
89
Q

B and T cell Disorders (4)

A

SCID - X linked (IL-2R) or AR (Adenosine deaminase) - failure to thrive - diarrhea - need BM x - see TRECs
Ataxia Telangiectasia - ATM gene - fail to repair double strand breaks
Hyper IgM - defective CD40L on Th - class switching defect - X linked
Wiskott Aldrich - WAS - x linked - can’t reorganize cytoskeleton - WATER - Thrombocytopenia - Eczema - Recurrent infection - inreased malignancy

90
Q

ATM - triad

A

Ataxia
Angiomas
IgA deficiency
also see high afp / cerebellar atrophy

91
Q

Phagocyte Autoimmune (3)

A

Leukocyte Adhesion 1 - LFA-1 integri (CD18) impairs migration out of vasculature - delayed umbilical cord sep - Neutropenia
Chediak Higashi - LYST - microtubule dysfunction can’t fuse phago and lysosome - albinism and neuropathy - giant blobby lysosomal inclusions
Chronic Granulomatous Disease - most X-linked - NADPH oxidase problemo - Nitroblue dye (-)

0001 STEP ONE RAPID REVIEW DX (25 decks)

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