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Joshua's Path > Immunology > Flashcards

Immunology Flashcards

1
Q

gottrens papules

A

dermatomyositis

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2
Q

ANA diffuse type binding

A

SLE(or RA)

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3
Q

ANA nucleolar binding

A

Systemic sclerosis

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4
Q

ANA speckled binding

A

Mixed connective tissue disease

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5
Q

difference between diffuse and limited systemic sclerosis?

A

trunk involvement in Diffuse type(scl70)

They also get pulmonary interstitial disease and more liekly to have kidney involvement

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6
Q

causes of erythema nodosum

A

I:strep (scarlet/rheumatic fever), yersinia, campylobacter, tb
I: Sarcoidosis. IBD, bechets,
M: pre non hodgkins lymphoma

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7
Q

caseating granuloma

A

TB

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8
Q

bilateral parotid enlargement

A 
stones
HIV
mumps
sarcoidosis
alcohol
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9
Q

3 signs of sarcoidosis

A 
hypergammagolbulinaemia
hypercalcaemia (granulomas hydroxylate vit d, causing raised calcium)
Raised ACE (abnormality of capilliaries in lung where ACE made)
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10
Q

what is osteocalcin

A

measure of osteoblast activity

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11
Q

what infection is assocaited with polyarteritis nodosa

A

Hep B

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12
Q

‘palpable’ purpura

A

vasculitis

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13
Q

finding on temporal artery biopsy with GCA

A

lumen narrowing
multiple grandulomas with multinuclear giant cells
lymphocytic infiltration of the tunica media

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14
Q

3 areas of pathology in granulomatosis with polyangitis

A

ENT
Lung
Kidney

c-anca binds to proteinase 3

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15
Q

3 areas of pathology in eosinophilic granulomatosis with polyangitis

A 
Asthma
Eosinophilia
Vasculitis
perinuclear-anca(p-anca) binds to myeloperoxidase
(churg strauss)
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16
Q

when would you see an onion skin artery

A

systemic sclerosis

due to collagen deposisiton can cause hypertensive crisis due to high ACE

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17
Q

What infections are those with a neutrophil deficiency at risk of

A 
PLACESS
pseudomonas
listeria
aspergillus
candida
e.coli
staoh aureus
serratia
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18
Q

India ink stain

A

cryptococcus

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19
Q

groccott stain

A

actinomyces

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20
Q

which drugs have an ability to disrupt biofilms

A

rifampicin and ciprofloxacin to a lesser extent

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21
Q

What is the most important part of managing a prosthesis infection

A

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

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22
Q

how many people crry c dif

A

5%
spore forming - germinate and multiple then toxins cause damage
alcohol gel doesnt kill them. drying is what kills bacteria normally.

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23
Q

what are the indicators of a sever c dif infection

A 
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

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24
Q

C.dif treatment?

A

Metronidazole - 400mg TDS
severe - Vancomycin 125mg QDS
Very sever with ileus or vom - both higher dose with colonic dilation

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25
Q

C.dif treatment?

A

Metronidazole - 400mg TDS
severe - Vancomycin 125mg QDS
Very sever with ileus or vom - both higher dose with colonic dilation

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26
Q

what does pseudomembarnous colitis look like?

A

wet cornflakes

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27
Q

What test would you do to confirm IgE sensitivity DURING an acute episode?

A

mast cell tryptase

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28
Q

Anaphylaxis management?

A 
oxygen
adrenaline
antihistamines - chlophenamine
bronchodilators
steroids
fluids
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29
Q

What complement changes do you see in SLE

A

low levels of C3 and c4

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30
Q

HLA of ank spond

A

HLA b27

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31
Q

HLA of goodpastures

A

DR2 and DR15

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32
Q

HLA of graves and SLE

A

DR3

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33
Q

HLA of T1DM

A

dr3/4

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34
Q

HLA of RA

A

DR4

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35
Q

What do you have to measure before starting azothioprine

A

tpmt

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36
Q

What disease should you not use anti-tnf therapy in?

A

lupus - can precipitate

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37
Q

What causes serum sickness

A

penicillin

symptoms come on after a few days

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38
Q

What do you need to consider when assessing if someone is likely to have an immunodeficiency?

A 
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.
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39
Q

What is the treatment for brutons

A

every 3 weeks give human serum poolked immunoglobulin

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40
Q

1858t allele

A

PTPN22 increases RA, SLE, type 1 diabetes

41
Q

What antibody is associated with PSC? what would you see on USS?

A

p anca
bile duct dilatation - these are the preserved segments while the others have undergone stricturing and scarring.
bile duct beading

42
Q

what does anti GAD stand for

A

glutamic acid decarboxylase

43
Q

saddle shaped nose

A

wegeeners

44
Q

rejection of transplant in minutes/hours?

A

hyperacute rejection - pre formed antibodies and is prevnted by HLA cross matching

45
Q

what is protein losing enteropathy

A

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

46
Q

MHC class 3 deficiency

A

common variable immunodeficicney

aswell as c2 and c4 and factor B

47
Q

myelin basic protein? what is th eother protein?

A

MS
proteolipid protein
IgG attack of oligodendrocytes
CSF banding electrophoresis

48
Q

what is attacked in ITP? treatment?

A

glp2b/3a on platelets

steroids
anti D

49
Q

anagrelide is treatment for what?

A

ET

50
Q

treatment for SLE

A

corticosteroids

then cyclophosphamide or other anti proliferative agents

51
Q

which anti proliferative agent affects B cells and which affects t cells predominantly?

A 
cyclo B
myco T (and azo)
52
Q

dermatomyositis autoantibody?

symptoms?

A

anti JO-1
heliotrope rash around the eyes

gottrens papules on fingers
proximal limb weakness.

53
Q

which anti prolif alkylates guanine and which blocks synthesis de novo

A

cyclo - alk

myco and azo - novo

54
Q

what is cresenteric glomerulonephritis also known as?

A

rapidly progressive GN

55
Q

What is th emost common cytokine deficiency and what does it predispoe to?

A

il12/r and IFNgamma/r

bcg, mycobacterium, salmonella

56
Q

what is a kuppfer cell

A

macrophage

57
Q

what is a dendritic cells function

A

to phagocytose and be an APC and primes the adaptive immune system

58
Q

difference between autoinflam and autoimmune

A

innate - A inflammatory

adaptive - A immune

59
Q

MONOgenic autoinflam diseases

A

NLRP3 - cryopyrin
TNF recepter (associated periodic syndrome)
familial med - MEFV - pyrin marenostrin (recessive)

60
Q

MEFV

A

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

61
Q

Colchicine MOA

A

binds to tubulin in neutrophils making it difficult for them to migrate and secrete chemokines

62
Q

what other treatments can be used in mediterranian fever

A

tnf alpha blockers such as etanercept

63
Q

AIRE gene

A

responsible for presentation of self antigens APECED - adisons, hypothyroid, candidiasis due to il17 and 22 loss

64
Q

FAS associated disease

A

no apoptosis ALPS syndrome autoimmune lymphoproliferative syndrome
TNFR6
get cytopenias

65
Q

FOXp3 gene

A

IPEX - immune dysregulation polyendocrinopathy , enteropathy x linked

t reg development.
peripheral tolerance

66
Q

genes associated with chrons

A

IBD1 - CARD15 - NOD2 -

NFkBpredisposition

67
Q

what diseasesa are associated with CTLA4 and PTPN22

A

RA, SLE, t1DM, autoimmune thyroid disease

68
Q

PADI enzymes

A

RA

69
Q

Anti phospholipid antibodies

A

anti cardiolipin and lupus anticoagulant.(not an anticoagulant in the body)

70
Q

difuse scleroderma

A

anti topoisomerase scl70

71
Q

limited scleroderma

A

anti centromere

72
Q

jo-1 (t-RNA synthetase)

A

dermatomyositis

73
Q

anti - mi2

A

myositis (derm over poly)

74
Q

Chuyrg strauss antibodies?

A

eosinophilic granulomatosis with polyangitis

P ANCA
myeloperoxidase

75
Q

other name for wegeners

A

GPA - granulomatosis with polyangitis

76
Q

P-ANCA

A

MPA/eGPA

77
Q

Central memory characteristics

A

CCR7 positive

tend to be in CD4 population in the lymph nodes and tonsils and produce IL2 to help other cells

78
Q

Effector memory characteristics

A

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

79
Q

what do CCR7 and CD62L do?

A

help mediate extravasation and rolling and so these cells are found in lymph rather than the liver lungs and gut.

80
Q

water in oil emulsion containing mycobacterial cell wall componemnts

A

Complete freunds adjuvant - used in animals as painful in humans

81
Q

adjuvant which provides slow release, activating Gr1 positive cells to produce IL4 and prime the b cell response

A

ALUM

82
Q

adjuvant activating TLRs on APCs to stimulate expression of costimulatory moleculesq

A

CpG

83
Q

What is the most important HLA type in transplant prediction

A

DR then B then A

84
Q

Direct presentation

A

comes from the donars APCs

85
Q

Indirect

A

comes from your own APCs

86
Q

Acute rejection uses what type of antigen presentation

A

direct. from the donar APCs

87
Q

what does hypertension do in the context of transplat

A

increases likelihood of rejection

88
Q

What are the 3 phases of rejection?

A

recognition
activation
Effector phase

89
Q

What are the main 2 ways in which rejection occurs

A

t cell and antibody

90
Q

how do t cells kill transplant cells

A

granzyme b perforin, fas ligand

this is a type 4 sensitivity reaction

91
Q

how do macrophages assist in transplant rejection

A

proteolytic enzyme release and oxygen and nitrogen radicals and cytokins

92
Q

How do antibodies cause rejection

A

bind to graft endothelium - capillaries etc.

they also recruite complement

93
Q

What drugs should be given to induce transplant immunosuppresion

A

anti-CD25 - basiliximab

Anti-CD52 - alemtuzamab

94
Q

What should be given throiughout the life of the recipient for transplant

A

usually calcineurin inhibitors or anti proliferatives such as cyclophosphamide, mycophenylate, or azothiprine

95
Q

What should be given in acute t cell mediated rejection

A

steroids frst
anti thymocyte globulim
muromonab

96
Q

What should be given in antibody mediated rejection

A

b cell depletion :
IvIg
plasma exchange
anti cd20 and anti C5 (eculizumab)

97
Q

What does bechets affect

A

all small and large vessels

causes: ulcers, anterior uveitis, joint pain maybe

98
Q

one use for interferon beta

A

MS highly relaps9ing remitting PAST

Joshua's Path (9 decks)

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