Immunology Flashcards
gottrens papules
dermatomyositis
ANA diffuse type binding
SLE(or RA)
ANA nucleolar binding
Systemic sclerosis
ANA speckled binding
Mixed connective tissue disease
difference between diffuse and limited systemic sclerosis?
trunk involvement in Diffuse type(scl70)
They also get pulmonary interstitial disease and more liekly to have kidney involvement
causes of erythema nodosum
I:strep (scarlet/rheumatic fever), yersinia, campylobacter, tb
I: Sarcoidosis. IBD, bechets,
M: pre non hodgkins lymphoma
caseating granuloma
TB
bilateral parotid enlargement
stones HIV mumps sarcoidosis alcohol
3 signs of sarcoidosis
hypergammagolbulinaemia hypercalcaemia (granulomas hydroxylate vit d, causing raised calcium) Raised ACE (abnormality of capilliaries in lung where ACE made)
what is osteocalcin
measure of osteoblast activity
what infection is assocaited with polyarteritis nodosa
Hep B
‘palpable’ purpura
vasculitis
finding on temporal artery biopsy with GCA
lumen narrowing
multiple grandulomas with multinuclear giant cells
lymphocytic infiltration of the tunica media
3 areas of pathology in granulomatosis with polyangitis
ENT
Lung
Kidney
c-anca binds to proteinase 3
3 areas of pathology in eosinophilic granulomatosis with polyangitis
Asthma Eosinophilia Vasculitis perinuclear-anca(p-anca) binds to myeloperoxidase (churg strauss)
when would you see an onion skin artery
systemic sclerosis
due to collagen deposisiton can cause hypertensive crisis due to high ACE
What infections are those with a neutrophil deficiency at risk of
PLACESS pseudomonas listeria aspergillus candida e.coli staoh aureus serratia
India ink stain
cryptococcus
groccott stain
actinomyces
which drugs have an ability to disrupt biofilms
rifampicin and ciprofloxacin to a lesser extent
What is the most important part of managing a prosthesis infection
Removal of the prosthesis if possible, and adequate debridement. sequestration causes walling off and remain quiescent. immune system doesnt clean the prosthetic material well. including heart valves etc
how many people crry c dif
5%
spore forming - germinate and multiple then toxins cause damage
alcohol gel doesnt kill them. drying is what kills bacteria normally.
what are the indicators of a sever c dif infection
HR>90 WCC>15 indications of colitis T>38.5 rising creatinine - renal failure diue to dehydration
ribotype 027 is severe causes more toxin release
NOT bristol stool chart
C.dif treatment?
Metronidazole - 400mg TDS
severe - Vancomycin 125mg QDS
Very sever with ileus or vom - both higher dose with colonic dilation
C.dif treatment?
Metronidazole - 400mg TDS
severe - Vancomycin 125mg QDS
Very sever with ileus or vom - both higher dose with colonic dilation
what does pseudomembarnous colitis look like?
wet cornflakes
What test would you do to confirm IgE sensitivity DURING an acute episode?
mast cell tryptase
Anaphylaxis management?
oxygen adrenaline antihistamines - chlophenamine bronchodilators steroids fluids
What complement changes do you see in SLE
low levels of C3 and c4
HLA of ank spond
HLA b27
HLA of goodpastures
DR2 and DR15
HLA of graves and SLE
DR3
HLA of T1DM
dr3/4
HLA of RA
DR4
What do you have to measure before starting azothioprine
tpmt
What disease should you not use anti-tnf therapy in?
lupus - can precipitate
What causes serum sickness
penicillin
symptoms come on after a few days
What do you need to consider when assessing if someone is likely to have an immunodeficiency?
Recurrent illness Severe illnesses unusual organisms opportunistic organisms unusual sites of infection other problems such as end organ damage or failure to thrive, family history.
What is the treatment for brutons
every 3 weeks give human serum poolked immunoglobulin
1858t allele
PTPN22 increases RA, SLE, type 1 diabetes
What antibody is associated with PSC? what would you see on USS?
p anca
bile duct dilatation - these are the preserved segments while the others have undergone stricturing and scarring.
bile duct beading
what does anti GAD stand for
glutamic acid decarboxylase
saddle shaped nose
wegeeners
rejection of transplant in minutes/hours?
hyperacute rejection - pre formed antibodies and is prevnted by HLA cross matching
what is protein losing enteropathy
can occur as a result of gastrointestinal disease such as IBD or coeliac and causes loss of protein whihc in turn reduces production of immunogloblin and causes increased number of infections
MHC class 3 deficiency
common variable immunodeficicney
aswell as c2 and c4 and factor B
myelin basic protein? what is th eother protein?
MS
proteolipid protein
IgG attack of oligodendrocytes
CSF banding electrophoresis
what is attacked in ITP? treatment?
glp2b/3a on platelets
steroids
anti D
anagrelide is treatment for what?
ET
treatment for SLE
corticosteroids
then cyclophosphamide or other anti proliferative agents
which anti proliferative agent affects B cells and which affects t cells predominantly?
cyclo B myco T (and azo)
dermatomyositis autoantibody?
symptoms?
anti JO-1
heliotrope rash around the eyes
gottrens papules on fingers
proximal limb weakness.
which anti prolif alkylates guanine and which blocks synthesis de novo
cyclo - alk
myco and azo - novo
what is cresenteric glomerulonephritis also known as?
rapidly progressive GN
What is th emost common cytokine deficiency and what does it predispoe to?
il12/r and IFNgamma/r
bcg, mycobacterium, salmonella
what is a kuppfer cell
macrophage
what is a dendritic cells function
to phagocytose and be an APC and primes the adaptive immune system
difference between autoinflam and autoimmune
innate - A inflammatory
adaptive - A immune
MONOgenic autoinflam diseases
NLRP3 - cryopyrin
TNF recepter (associated periodic syndrome)
familial med - MEFV - pyrin marenostrin (recessive)
MEFV
pyrin marenostrin (negative regulator of procaspase 1 which drives IL1 and nfkappa b which all activate tnf alpha
Jews
periodic fevers
abdo pain due to peritonitis
Colchicine MOA
binds to tubulin in neutrophils making it difficult for them to migrate and secrete chemokines
what other treatments can be used in mediterranian fever
tnf alpha blockers such as etanercept
AIRE gene
responsible for presentation of self antigens APECED - adisons, hypothyroid, candidiasis due to il17 and 22 loss
FAS associated disease
no apoptosis ALPS syndrome autoimmune lymphoproliferative syndrome
TNFR6
get cytopenias
FOXp3 gene
IPEX - immune dysregulation polyendocrinopathy , enteropathy x linked
t reg development.
peripheral tolerance
genes associated with chrons
IBD1 - CARD15 - NOD2 -
NFkBpredisposition
what diseasesa are associated with CTLA4 and PTPN22
RA, SLE, t1DM, autoimmune thyroid disease
PADI enzymes
RA
Anti phospholipid antibodies
anti cardiolipin and lupus anticoagulant.(not an anticoagulant in the body)
difuse scleroderma
anti topoisomerase scl70
limited scleroderma
anti centromere
jo-1 (t-RNA synthetase)
dermatomyositis
anti - mi2
myositis (derm over poly)
Chuyrg strauss antibodies?
eosinophilic granulomatosis with polyangitis
P ANCA
myeloperoxidase
other name for wegeners
GPA - granulomatosis with polyangitis
P-ANCA
MPA/eGPA
Central memory characteristics
CCR7 positive
tend to be in CD4 population in the lymph nodes and tonsils and produce IL2 to help other cells
Effector memory characteristics
NEGATIVE for CCR7 and have low CD62 and so are not in lymph nodes they are found in CD8 cells and produce perforin and ifn gamma
what do CCR7 and CD62L do?
help mediate extravasation and rolling and so these cells are found in lymph rather than the liver lungs and gut.
water in oil emulsion containing mycobacterial cell wall componemnts
Complete freunds adjuvant - used in animals as painful in humans
adjuvant which provides slow release, activating Gr1 positive cells to produce IL4 and prime the b cell response
ALUM
adjuvant activating TLRs on APCs to stimulate expression of costimulatory moleculesq
CpG
What is the most important HLA type in transplant prediction
DR then B then A
Direct presentation
comes from the donars APCs
Indirect
comes from your own APCs
Acute rejection uses what type of antigen presentation
direct. from the donar APCs
what does hypertension do in the context of transplat
increases likelihood of rejection
What are the 3 phases of rejection?
recognition
activation
Effector phase
What are the main 2 ways in which rejection occurs
t cell and antibody
how do t cells kill transplant cells
granzyme b perforin, fas ligand
this is a type 4 sensitivity reaction
how do macrophages assist in transplant rejection
proteolytic enzyme release and oxygen and nitrogen radicals and cytokins
How do antibodies cause rejection
bind to graft endothelium - capillaries etc.
they also recruite complement
What drugs should be given to induce transplant immunosuppresion
anti-CD25 - basiliximab
Anti-CD52 - alemtuzamab
What should be given throiughout the life of the recipient for transplant
usually calcineurin inhibitors or anti proliferatives such as cyclophosphamide, mycophenylate, or azothiprine
What should be given in acute t cell mediated rejection
steroids frst
anti thymocyte globulim
muromonab
What should be given in antibody mediated rejection
b cell depletion :
IvIg
plasma exchange
anti cd20 and anti C5 (eculizumab)
What does bechets affect
all small and large vessels
causes: ulcers, anterior uveitis, joint pain maybe
one use for interferon beta
MS highly relaps9ing remitting PAST
