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USMLE S1 > Immunology > Flashcards

Immunology Flashcards

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USMLE® Step 1 flashcards
1
Q

explain 2 types of acute transplant rejection

A

cellular - CD8+ T cells against graft MHC I (type 4 HS)

humoral - similar to hyperacute but antibodies develop after transplant

vasculitis of graft vessels with dense lymphocytic infiltrate

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2
Q

what does Th2 cell secrete?

A

IL-4/5/6/10/13

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3
Q

lymph drainage to:

internal iliac

A

lower rectum to pectinate line.

bladder

uppper 1/3 vagina

cervix and prostate

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4
Q

bevacizumab

target and indication

A

VEGF

CRC, RCC, NSCLC

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5
Q

what are the 4 TNF-alpha monoclonals?

A

adalimumab, certolizumab, golimumab, infliximab

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6
Q

what does Th1 activate?

A

macrophages and cytotoxic T cells

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7
Q

infection in complement deficiency?

A

encapsulated bacteria in early (C1-4) deficiency

Neisseria sepsis in C5-9 deficiency

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8
Q

what markers identify T reg cells?

A

CD3, CD4, CD25 and FOXP3

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9
Q

function of IFN-gamma

A

from Th1 cells, stimulates macrophages to do phagocytosis/killing

inhibits Th2

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10
Q

what factor is released from macrophages that stimulates T helper cell differentiation?

what type of Th cell?

A

IL-12

Th1, which then secretes IFN-gamma that activates more macrophages

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11
Q

post transfusion

1 hour, evidence of shock and haemolysis; flank pain

diagnosis, type of reaction, pathogenesis

A

acute haemolytic transfusion reaction

type 2

antibodies against donor RBC proteins

(ABO blood group incompatability - intravascular haemolysis; any other RBC protein - extravascular haemolysis)

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12
Q

azathioprine

mechanism, indication, side effects

extra consideration

A

precursor to 6-mercaptopurine; blocks PRPP amidotransferase and purine synthesis. inhibits lymphocyte proliferation

RA, crohn’s, glomerulonephritis

pancytopenia; toxicity increased by allopurinol as 6-MP degraded by xanthine oxidase

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13
Q

in T cell maturation both positive and negative selection occurs in the thymus.

what process occurs in what anatomic zone of the thymus?

A

positive selection happens first in cortex

negative selection follows in medulla

cells go from out to in, then leave via central reticular network into the circulation

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14
Q

what are 4 consequences of splenectomy illustrated on FBC/blood smear?

A
  • Howel-Jolly bodies (nuclear remnants)
  • Target cells (sagging cell membrane)
  • thrombocytosis
  • lymphocytosis
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15
Q

BTK deficiency is what disease?

A

bruton X-linked agammaglobulinaemia

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16
Q

what proteins are negative (downregulated) actue phase reactants?

A

albumin - save the amino acids for producing positive ACRs

transferrin - internalised by macrophages to reduce iron scavenging

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17
Q

INF-beta indication

A

multiple sclerosis

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18
Q
A
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19
Q

anti-beta2 glycoprotein antibody

disease?

A

anti-phospholipid antibody syndrome

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20
Q

omalizumab

mechanism and indication

A

IgE blocker

refractory allergic asthma

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21
Q

what is the mechanism for susceptability to encapsulated organisms with splenic dysfunction?

A

decreased IgM, decreases complement activation, decreased C3b opsonization

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22
Q

what are 4 types of transplant rejection?

A

hyperacute (minutes)

acute (weeks to months)

chronic (months to years)

GvHD (variable)

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23
Q

parasitic infection in B cell deficiency

A

Giardia lambia, because there is no IgA

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24
Q

function IL 12

A

Th1 differentiation

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25
Q

what are the steps needed for B cell activation by T cells?

A

B cell presents antigen on MHC II, binds TCR

CD40 binds CD40L on T cell

T cell releases cytokines promoting class switching, affinity maturation and antibody production

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26
Q

post transfusion

1 hour, urticaria, itching, fever, wheeze, respiratory difficulty

diagnosis, type of hypersensitivity

pathogenesis

consideration for special group of patients

A

allergic/anaphylactic reaction

type 1 hypersensitivity

mast cell degranulation against plasma proteins.

IgA deficient patients must have IgA deplete blood

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27
Q

what is caused by DAF deficiency?

A

paroxysmal nocturnal haemoglobinuria

complement-mediated lysis of RBCs

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28
Q

function of TNF-alpha

A

endothelium activation; leak and WBC recruitment

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29
Q

association with DR5

A

pernicious anaemia

hashimoto thyroiditis

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30
Q

what signals activate NK cells to kill a target cell?

A

lack of MHC I

non-specific activation signal from target cell

CD16 binding to Fc region of antibody (cell-mediated antibody-dependent toxicity)

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31
Q

viral infections in T cell deficiency

A
  • infectious mono - EBV and CMV
  • JC virus
  • VZV
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32
Q

fungal infections in T cell deficiency

A

candida, pneumocystis jirovecii , cryptococcus

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33
Q

nitroblue tetrazolium test fails to turn blue…

A

chronic granulomatous disease

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34
Q

lymph drainage to:

inferior mesenteric

A

colon from splenic flexure to rectum

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35
Q

diagnosis?

A

giant granules in platelets and granulocytes

Chediak Hiagshi syndrome

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36
Q

what is the rheumatoid factor?

A

IgM antibody against IgG

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37
Q

where are T cells in the spleen?

A

periarteriolar lymphatic sheath (PALS)

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38
Q

thymoma is associated with which conditions?

A

myasthenia gravis

superior vena cava syndrome

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39
Q

what is the macrophage receptor for PAMPs?

A

CD14

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40
Q

decrease T cell receptor excision circles (TRECs) suggests what?

A

SCID

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41
Q

bortezomib

target and indication?

A

26S proteasome blocker

promotes apoptosis in multiple myeloma

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42
Q

DQ2/DQ8

A

coeliac

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43
Q

how is an antigen loaded onto MHC I?

A

through ‘transporter assoicated with antigen processing’ (TAP) bound on RER

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44
Q

cytokines that activate NK cells

A

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

(2, 12, a, b)

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45
Q

post transfusion

1 hour fever, headache, chills, flushing

type of reaction, pathogenesis

A

febrile non-haemolytic transfusion reaction

type 2

antibodies against HLA antigens and WBCs

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46
Q

IFN alpha indication

A

chronic hepatitis C and B

kaposi sarcoma, MM, hairy cell leukamia

condyloma acuminata

RCC

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47
Q

DR2 (4)

A

MS, hey fever, SLE, goodpasture

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48
Q

explain both pneumococcal vaccines

A

polysaccharide - protects against more (23) subtypes of strep pneumo. less immunogenic, fades after 5 years. Not immunogenic in children < 2 y/o, poor humoural immunity

conjugate - 13-valent bound to diptheria toxoid. T and B cell recruitment. higher and longer-lasting Ab levels. IgA produced so less mucosal carry = herd immunity

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49
Q

ezcema, thrombocytopenia, recurrent infections…

diagnosis?

A

Wiskcott-Aldrich syndrome

WA:TER

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50
Q

denosumab

mechanism and indication

A

RANKL blocker

osteoporosis

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51
Q

hard and fast rule –

B cell/T cell deficiency susceptable to which organisms?

A

B cell - bacteria

T cell - fungal/viral

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52
Q

lymph drainage to:

celiac (5)

A

liver, stomach, spleen, pancreas, upper duodenum

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53
Q

lymph drainage to:

cervical nodes

A

head and neck

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54
Q

function of IL-5

A

induces B cells & eosinophils

class switching to IgA

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55
Q

treatment for IL-12 receptor deficiency?

why does this work?

A

IFN-gamma

IFN-gamma and IL-12 are the cytokines responsible of the maturation of Th0 cells into Th1 cells. If IL-12 signalling is deficienct it can be overcome with IFN-gamma supplimentation

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56
Q

abciximab

function and indication

A

GpIIb/IIIa blocker

thrombosis prophylaxis during percutaneous coronary intervention

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57
Q

function IL 6

A

fever and acute phase reactants

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58
Q

antimitochondrial antibody

disease?

A

PBC

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59
Q

oprelvekin function and indication?

A

IL-11 analogue, thrombopoesis

thrombocytopenia

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60
Q

lymph drainage to:

hilar nodes

A

lungs

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61
Q

anti-TPO antibody

what disease?

A

hashimoto thyroiditis

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62
Q

defect in CD18 is what disease?

findings on blood smear?

A

Leukocyte adhesion deficiency (type 1)

CD18 a.k.a. LFA-1 integrin

impaired chemotaxis and migration

many leukocytes in peripheral blood but none at site of infection

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63
Q

NK cells use what as effector enzymes?

A

perforins and granzyme

attacks viral infected cells and tumour cells

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64
Q

bacterial infection with B cell deficiency

A

Please SHINE my SKiS

pseudomonas, strep pneumo, HiB, N meningitidis, E Coli, Salmonella, Klebs, GBS

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65
Q

association HLA B8 (3)

A

addison disease, myasthenia gravis, Graves disease

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66
Q

what type of bacteria are mainly attacked by complement/MAC?

A

gram negative

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67
Q

which antibody has the lowest serum concentration?

A

IgE

68
Q

what is the function of a seconary lymphoid organs?

A

allow immune cells to interact with antigens

69
Q

what is the cause of hereditary angioedema?

what is the mechanism?

diagnosis using blood test? contraindication in this condition?

A

C1 esterase inhibitor deficiency

unregulated activation of kallikrien, activation of bradykinin

characterised by low C4 levels

ACE inhibitors

70
Q

what is the inheritance of hyper IgM syndrome?

A

X linked recessive

71
Q

decreased number of plasma cells in blood and decreased numbers of Ig, but some present across all classes

diagnosis?

A

common variable immunodeficiency

high risk of bronchiectasis, autoimmunity, lymphoma

72
Q

what are the complement fragments that cause anaphylaxis?

A

C3a C4a C5a

73
Q

functio of IL-2

A

growth of all T cells and NK cells

74
Q

etanercept

mechanism?

A

decoy receptor for TNF-alpha

75
Q

basiliximab

mechanism, indication, side effects

A

blocks IL-2R

kidney transplant specifically

oedema, hypertension and tremor

76
Q

lymph drainage to:

para-aortic

A

testes/ovaries

kidney

uterus

77
Q

lymph drainage to:

superior mesenteric

A

lower duodenum, jejunum, ileum, colon to splenic flexure

78
Q

association B27

A

seronegative arthropathy

psoriatic, reactive, enteropathic, ank spond

79
Q

hypertension, gingival hyperplasia, hirsuitism

what drug side effects?

A

cyclosporine

80
Q

tacrolimus

mechanism, use, toxicity

A

calcineurin inhibitor, binds FK-binding protein (other name for drug is FK506).
blocks NFAT, blocks IL-2

psoriasis and transplant

81
Q

findings = cerebellar atrophy and lymphopenia, with decreased IgA, IgG and IgE

A

Ataxia-Telangictasia syndrome

82
Q

function of IL-10

A

attenuates immune response

83
Q

which antibodies activate compliment?

A

IgM and IgG

84
Q

what are the two main opsonins against bacteria?

A

C3b and IgG

85
Q

lymph drainage to:

popliteal nodes

A

dorsolateral foot

posterior calf

86
Q

what isotype of anitbody is implicated in HSP?

what is the diagnostic test for this disease?

A

IgA

skin biopsy showing IgA immune complex deposition in blood vessels

87
Q

macrophage surface markers?

A

CD14/TLR

CD40, CCR5 (can get HIV there too)

MHC II/B7

Fc and C3b receptors (regognise IgG and C3b as opsonins)

88
Q

lymph drainage to:

superficial inguinal nodes (3)

A

below pectinate line

scrotum/vulva

skin below umbilicus (except pop fossae)

89
Q

antimicrosomal antibody

disease?

A

hashimoto thyroiditis

90
Q

what are the 4 opsonins?

A

IgG

C3b

MBL

CRP

91
Q

examples of inactivated or killed vaccines?

A

influenza (shot)

Rabies

Polio (Salk)

hepatitis A

92
Q

anti-smooth muscle antibody

disease?

A

autoimmune hepatitis type 1

93
Q

filgrastim indication?

A

G-CSF - granulocyte stimulation only

94
Q

what are the two signals for T cell activation?

A

MHC I or II with TCR

B7 with CD28

95
Q

late separation of umbilical cord

what is the time in days? diagnosis?

A

> 21 days

leukocyte adhesion deficiency type 1, CD18 deficiency. cannot make CAMs on endothelial surface

96
Q

what is the function of C5a?

A

neutrophil chemotaxis

97
Q

telangictasia, cerebellar defects, IgA deficiency…

what’s the disease and what is the gene mutation?

A

Ataxia-Telangictasia syndrome

ATM mutation

98
Q

explain chronic transplant rejection

A

CD4+ T cells activated by host APCs processing donor proteins from graft.

Activates both humoural and cellular response (type 2 and 4 HS)

histo - dominated by arteriolosclerosis

99
Q

how is the structure of IgM different on B cells and in the circulation?

A

single antibody on B cell surface

pentamer in circulation

100
Q

Trastuzumab

target and indication

A

HER2/neu

breast CA, gastric CA

‘HER2 - tras2zumab’

101
Q

recurrent infection, partial albinism, peripheral neuropathy..

diagnosis? pathogenesis? defective gene?

susceptable to which organisms?

A

Chediak-Higashi syndrome

lysosome-phagosome fusion defect

defect in LYST gene

Staphylococcus and Streptococcus pyogenic infection

102
Q

what is the principle of anti PD-1 therapy?

A

cancer.

PD-1 expressed on T cells, PD-L1 produced on target cells. PD-L1 neutralises cytotoxic T cells as a mechanism to promote self-tolerance.

PD-L1 overexpression on tumour cells is common.

PD-1 block restores cytotoxicity to T cells allowing cancer clearance

103
Q

lymph drainage to:

mediastinal

A

trachea and oesophagus

104
Q

when does Bruton’s present?

A

>6/12 old BOY

X linked and loss of maternal IgG

105
Q

what are the inhibitors of complement?

A

DAF (CD55) and C1 esterase inhibitor

106
Q

what stimulates Th2 development?

A

IL-2 and IL-4

107
Q

anti-glutamic acid decarboxylase antibody

what disease?

A

T1Dm

108
Q

what inhibits Th2 differentiation?

where is this produced?

A

IFN-gamma

Th1 cells

109
Q

corticosteroids

mechanism, side effects, 2 special considerations

A

blocks NF-kB, blocks transcription of cytokines. induced T cell apoptosis

cushings, osteoporosis, hyperglyaemia/insulin resistance, amennhoroea, adrenal atrophy, peptic ulcers, psychosis, cataracts, avascular necrosis of femoral head

demargination of WBCs causes artificial leukocytosis. do not stop abruptly

110
Q

how is an antigen loaded onto MHC II?

A

following invariant chain release in acidified endosome

111
Q

what are the different anti-ABO antibodies and in which patient groups do they occur?

A

patient blood group A and B - anti-B or anti-A respectively, both IgM

patient blood group O - both anti-B and anti-A, IgG

112
Q

explain the difference between Sabin and Salk vaccination

A

both for poliomyelitis

Sabin - live attenuated oral. better. stronger immunogenicity and direct mucosal stimulation prompts lasting duodenal IgA production

Salk - inactivated poliovirus. Cannot replicate so less immunogenic. Still gives serum IgG/IgM response. Better for immunocompromised.

113
Q

functino of IL-3

A

like GM-CSF

114
Q

risk of vertical transmission of HBV if mother is HBeAg positive and negative

how do we handle the children?

A

HBeAg + ve = 95%

HBeAg - ve = 20%

if foetus is infected with HBV vertically, there is 90% chance for conversion to chronic HBV. As such, passive (HBIG) and active (recombinant HBV vaccine) immunisation is given to all babies of HBV +ve mothers.

115
Q

IFN gamma indication

A

chronic granulomatous disease

116
Q

what isotype is anti-D given in obstetrics?

A

pooled IgG

117
Q

what are the two B cell activating cytokines and what isotypes do they favour?

A

IL-4 = IgE and IgG

IL-5 = IgA and eosinophils

118
Q

explain hyperacute transplant rejection

A

pre-existing anitbodies in host react to donor antigen (type 2 HS)

complement mediated

thrombosis in graft vessels, ishaemia and necrosis

119
Q

association with DR3 (5)

A

T1DM, SLE, graves, hashimoto, addison

120
Q

what ribs overlie the spleen?

A

9 - 11th

121
Q

what is the gene defect in Wiskkott-Aldrich syndrome?

A

WASp

122
Q

function of IL-4

A

induces Th2 cells

induces B cells

makes IgE and IgG

123
Q

what is the cut off for HIV patients in CD4+ count that want MMR and varicella vaccine?

A

CD4+ T cells > 200

124
Q

what is the difference between a 1ary and 2ary lymph node follicle?

A

1ary - dormant, only dense dark tissue

2ary - active, big pale central germinal centre

125
Q

cyclosporine

mechanism, use, toxicity

A

calcineurin inhibitor by binding cyclophilin; NFAT blocked, IL-2 blocked

psoriasis, RA

nephrotoxic

126
Q

four organ specific examples of chronic transplant rejection

A

lung - bronchiolitis obliterans

heart - accelerated artherosclerosis

kidney - chronic graft nephropathy

liver - vanishing bile duct syndrome

127
Q

what cell surface marker do you use to identify NK cells?

A

CD56

128
Q

what is the deficiency in hyper-IgM syndrome?

A

CD40L on Th cells

129
Q

what inhibits Th1 cells and where does it come from?

A

IL-4 and IL-10

from Th2 cells

130
Q

alemtuzumab

target and indication

A

CD52

CLL and MS

131
Q

what antibody is secreted in breast milk?

A

IgA

132
Q

eculizumab

mechanism and indication

A

anti-complement C5

PNH

133
Q

daclizumab

mechanism and indication

A

CD25 (part of IL-2 receptor) blocker

relapsing MS

134
Q

which bugs cleave IgA J chain?

A

Neisseria gonorrhoeae/meningitidis, Strep pneumo, haemophilus influenzae

135
Q

examples of live attenuated vaccines?

up to 9

A

BCG, influenza (intranasal), measles, mumps, polio (Sabin), rotavirus, rubella, varicella, yellow fever

136
Q

rituximab

target and indication

A

CD20

B-cell non-hodgkin lymphoma

CLL, RA, ITP

137
Q

MMF

mechanism, indication, side effects

A

inhibits IMP dehydrogenase, prevents purine synthesis

Lupus nephritis

GI effects, pancytopenia, HTN, hyperglycaemia

138
Q

C5-C9 deficiency results in what?

A

unable to form MAC but still able to opsonise

recurrent Neisseria bacteraemia

139
Q

antiphospholipase A2 antibody

disease?

A

membranous nephropathy

140
Q

palivizumab

mechanism and indication

A

blocks RSV proteins

prophylaxis for at risk infants

141
Q

main role of LTB4?

A

neutrophil chemotaxis to the site of inflammation

142
Q

how does staphylococcus superantigen work?

A

cross link the beta subunit of TCR to MHC II, meaning that any T cell will be activated becuase there is no specific antigen required. massive stimulation of cytokines.

TCR/MHC II binding also activates macrophages to secrete IL-1 and TNF-alpha

143
Q

liver transplant patient presents with maculopapular rash, jaundice, diarrhoea, HSM…

diagnosis?

what other transplant is likely to suffer this disease?

A

GvHD

bone marrow

144
Q

post transfusion

3 hours, respiratory distress and noncardiogenic pulmonary oedema

diagnosis, type of reaction, pathogenesis

A

TRALI (transfusion-related acute lung injury)

GvH

donor anti-leukocyte antibodies attacking neutrophils and endothelial cells in the host pulmonary vasculature

145
Q

what does Th1 secrete?

A

INF-gamma, IL-2

146
Q

function IL 1

A

fever and inflammation

endothelium adhesion molecules

WBC recruitment

147
Q

association DR4 (3)

A

RA, T1DM, addison

148
Q

indication for anti-TNFalpha?

A

IBD, RA, ank spond, psoriatic arthritis

149
Q

anti-histone antibody

disease?

A

drug-induced lupus

150
Q

sargramostim indication?

A

granulocyte and monocyte stimulation

GM-CSF

151
Q

assoc HLA A3

A

haemochromatosis

152
Q

cetuximab

target and indication

A

EGFR- epidermal growth factor receptor

CRC, head and neck CA

153
Q

which cytokine induces actue phase reactact secretion from the liver?

A

IL-6

154
Q

anti-desmoglein antibody

disease?

A

pemphigus vulgaris

a.k.a. anti-desmosome

155
Q

function of IL-8

A

neutrophil chemotaxis

‘clean up on aisle 8’

156
Q

what are the antiinflammatory cytokines released by T reg cells?

A

IL-10 and TGF-beta

157
Q

anti-U2 ribonucleoprotein (RNP)

disease?

A

mixed CTD

158
Q

mast cells are bound to IgE through high affinity receptor Fc epsilonRI.

what must happen at this receptor to stimulate mast cell degranulation?

A

a multivalent antigen must come in contact with the cell, localising many different IgE’s to the same place on in the cell. Fc epsilonRI aggregation leads to activation of downstream pathway and degranulation

159
Q

dihydrorhodamine test abnormal (reduced green flourescence)…

diagnosis?

A

chronic granulomatous disease

160
Q

what is activated by Th2?

A

eosinophils for parasites

promotes IgE from B cells

161
Q

lymph drainage to:

axillary

A

upper limb

breast

skin above umbilicus

162
Q

what are the blood and histological findings of serum sickness?

what HS reaction is this?

A

Type 3 HS - immune-complex mediated

blood - hypocomplementaemia (complement-fixing IgG/IgM is activated)

histo - small vessel fibrinoid necrosis and neutrophil infiltration

163
Q

sirolimus (rapamycin)

mechanism, indications, side effects

A

inhibits mTOR by binding FKBP, prevents response to IL-2

specifically kidney transplant, drug-eluting stents

pancytopenia, insulin resistance, hyperlipidaemia

164
Q

what is the B cell receptor that targets EBV to them?

A

CD21

165
Q

what exposure requires emergency administration of preformed antibodies?

A

tetanus

botulinum

HBV

Varicella

Rabies virus

To Be Healed Very Rapidly

166
Q

how does endotoxin/LPS work to activate the immune system?

A

bind to CD14/TLR to activate macrophages, Th not involved

USMLE S1 (16 decks)

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