Immunology Flashcards
1
Q
lymph node follicle function
A
B cell localisation and proliferation
2
Q
follicles are found in
A
the outer cortex
3
Q
types of follicles
A
primary - dense and dormant
secondary - pale germinal centre, active
4
Q
closely packed lymphocytes and plasma cells
A
lymph node medulla
5
Q
reticular cells + mpg
A
medullary lymphatics
6
Q
lymph paracortex holds
A
T cells
7
Q
function of paracortex
A
endothelial vessels letting T and B cells enter blood
8
Q
mediastinal lymph nodes
A
trachea and oesophagus
9
Q
lymph drainage for skin above umbilicus
A
axillary
10
Q
para-aortic lymph node drainage
A
testes, ovaries, kidneys, uterus
11
Q
superficial inguinal lymph nodes
A
anal canal below pectinate line, skin below umbilicus (not popliteal area), scrotum/ vulva
12
Q
right lymphatic duct
A
right side of body above diaphragm
13
Q
thoracic duct
A
everything that isn’t right lymphatic duct –> left subclavian&internal jugular
14
Q
barrel hoop basement membrane
A
spleen
15
Q
white pulp - T cells
A
periarteriolar lymphatic sheath
16
Q
White pulp - B cells
A
follicles
17
Q
Marginal zone of spleen
A
between white and red pulp
contains mpg + specialised B cells
18
Q
where do antigen presenting cells present in the spleen?
A
marginal zone
19
Q
Splenic dysfunction causes
A
decreased IgM, complement, C3b
20
Q
Asplenic organism infection
A
Encapsulates - Please SHINE my SKiS Pseudomonas aeuriginosa Strep pneumoniae Haem flu B N. meningitidis E.coli Salmonella Klebsiella pneumoniae Group B Strep
21
Q
Where is the thymus derived from?
A
Third pharyngeal pouch
22
Q
Types of T cell in the thymus
A
medulla - mature
cortex - immature
23
Q
Hassall corpuscles are found in
A
the medulla of the thymus
24
Q
what do hassall corpuscles contain?
A
epithelial reticular cells
25
myasthenia gravis neck lump
enlarged thymus
26
innate immunity secreted proteins
lysozyme, complement, CRP, defensins
27
TLR
toll like receptor used to recognise pathogens in innate immunity
28
e.g. of pathogen-associated molecular pattern and what recognises it
innate immunity e.g. LPS toxin
29
MHC encoded by
HLA genes
30
MHC I coded by
HLA - A, B, C
31
MHC II coded by
HLA - DP, DQ, DR
32
Where is MHC I expressed?
All nucleated cells
33
What does MHC I do?
presents to CD8 cytotoxic cells
| viral/ cytosolic proteins (endogenous)
34
How do MHC I expressing cells load antigens?
in RER, delivered via TAP
35
B2-microglobulin
MHC I
36
What expresses MHC II?
APCs
37
What does MHC II do?
bacterial proteins (exogenously synthesised antigens)
38
HLA A3
Hemochromatosis
39
HLA B8
Addison's disease, myasthenia gravis
40
HLA DQ2/8
Celiac disease
41
HLA DR2
MS, hay fever, SLE, Goodpasture syndrome
42
HLA DR3
SLE, DM-1, Grave's, Hashimoto's, Addison's
43
HLA DR4
RA, DM-1, Addison
44
HLA DR5
Pernicious anaemia, Hashimoto's
45
perforin + granzymes
NK cells
46
NK cells increased activity
IL-2, IL-12, INF-a, IFN-b
47
When do NK cells activate?
activation signal
No MHC-I molecules
antibody dependent
48
What does antibody-dependent cell-mediated cytotoxicity and how?
NK cells activated by CD16 binding the Fc of I
49
CD4 cells
help B cells make antibodies, produce cyokines
50
CD8 cells
kill virus infected cells
51
autoimmune polyendocrine syndrome-1
AIRE deficiency
| doesn't apoptose autoimmune reacting T cells
52
Th1 cells secrete
IFN-y
53
What do Th1 cells do?
activate mpg, and Tk cells
54
Th1 differentiation
INF-y, IL-12
55
Th1 inhibition
IL- 4, 10
56
Th2 cells secrete
IL-4, 5, 10, 13
57
What do Th2 cells do?
recruit eosinophils for parasites, promotes IgE from B cells
58
Differentiation of Th2 cells
IL-4
59
Inhibition of Th2 cells
IFN-y
60
What is factor released by antigen presenting cells?
IL-12
61
Mpg stimulated by
IFN-y
62
Regulatory T cells
supress CD4+8
63
Regulatory T cells express
CD3, 4, 25, FOXP3
64
Regulatory T cells produce
IL-10, TGF-B
| anti-inflammatory
65
antigen presenting cells
B cell, mpg, dendritic cells
66
naive t-cell acitvation by
dendritic cell
67
proliferation of T cells
CD28, B7 (CD80/86)
68
Class switching relies on
CD40 on Th hells (CD4)
69
variable Ig region
Fab
70
Fc region
fixed
71
Heavy chain
Fc and Fab regions
72
Light chain
Fab only
73
Fc region of IgM and IgG
fix complement
74
What determines the Ig isotype?
Fc region
75
VJ
light chain
76
V(D)J
heavy chain
77
how does antibody diversity happen?
random addition of nucleotides to DNA during recombination
| Uses terminal deoxynucleotidyl transferase
78
where do B cells undergo isotype switching?
germinal centre of lymph node
79
what is isotype switching mediated by?
cytokines and CD40L
80
IgG
```
secondary response to antigen
serum
fixes complement
crosses placenta
opsonizes bacteria
neutralises bacterial toxins and viruses
```
81
IgA
dimer (with J chain)
prevents bacteria/virus attachment to mucous membranes
Peyer's patches produce, released in secretions
most produced antibody
82
IgM
primary response to antigen
fixes complement
does not cross placenta (mummy only)
pentomer (J chain)
83
IgD
surface of many B cells and in serum
84
IgE
mast cells + basophils
cross links when exposed to allergen
type I hypersensitivity (histamine)
low concentration in serum
85
what has to be present to allow for presenting?
peptide components
86
e.g. of bacteria with no peptide components
gram -ve bacteria
| can't be presented
87
Upragulated in the acute phase
```
inFlammation Fuels A High Concentration
Ferritin
Fibrinogen
Amyloid A
Hepcidin
CRP
```
88
Hepcidin
decreases iron absorbtion, release from mpg --> anaemia of chronic disease
89
Classic complement pathway activation
IgG or IgM anigen-antibody complex
90
Lectin complement pathway activation
mannose/ sugar
91
Alternative complement pathway activation
spontaneous and microbial surfaces
92
C3a, 4a, 5a
anaphylaxis
93
C5a
neutrophil chemotaxis
94
what do opsonins do? what are they?
C3b, IgG
| enhance phagocytosis, help clear immune complexes
95
what helps inhibit complement activation on self cells?
DAF (CD55)
| C1 esterase
96
C1 esterase inhibitor deficiency
hereditary angioedema - unregulated kallikrein activation
| don't use ACE inhibitors
97
C3 deficiency
increase risk of sinus and resp infections, type III hypersensitivity
98
C5-9 deficiencies
increases susceptibility to neisseria bacteremia
99
DAF deficiency
complement mediated lysis of RBCs (PNH)
100
IL stimulation pneumonic
```
Hot T-Bone stEAK
1 - fever
2 - T cells
3 - bone marrow
4 - IgE
5 - IgA
6 - aKute phase proteins
```
101
IL-1
fever, acute inflammation, osteoclasts, recruit WBC
102
IL-6
fever, acute phase proteins
103
IL-12
NK cells, Th1
104
TNF-a
spetic shock, activates endothelium, WBC recruitment, vascular leak
105
Mpgs secrete
IL-1, 6, 8, 12, TNF-a
106
Secreted by T cells
IL-2, 3
107
IL-3
bone marrow stem cells
108
IL-4
T --> Th2, B cell growth, IgE --> IgG
109
IL-5
B cell growth, --> IgA, eosinophils
110
IL-10
anti-inflammatory, decreases MHC II + Th1, inhibits mpg, dentritic cells
111
Interferons
interfere with viruses
112
T cell receptors which are co-receptors for HIV
CXCR4/CCR5
113
regulatory T cell cell surface proteins
CD4, CD25
114
B cell surface proteins
CD19, 20, 21, 40
115
Receptor for EBV
CD21 on B cells
116
Mpg surface proteins
CD14, 40, CCR5, MHC II, B7, Fc, C3b
117
NK cells surface proteins
CD16, Cd56
118
Haematopoietic stem cell surface protein
CD34
119
anergic
can't be activated
120
bacterial toxin superantigens
cross link, no need for costimulation
121
how do endotoxins activate mpgs?
TLR4/CD14 binding
122
passive vaccination
To Be Healed Very Rapidly
| Tetanus, botulinum, HBV, Varicella, Rabies
123
live attenuated vaccines
BCG, MMR, influenza, polio, varicella, yellow fever
124
live attenuated vaccine response
cellular and humoral
125
inactivated/ killed vaccine response
humoral response
126
inactivated/killed vaccines
RIP Always
| Rabies, Influenza, Polio (salk), hepA
127
hypersensitivities
ACID
| Anaphylaxis, cytotoxic, immune complex, delayed
128
type I
free antigen cross links IgE
129
IgE reaction type I
vasoactive amine release
130
delayed anaphylactic response
arachidonic acid metabolites
131
type II reaction
IgM, IgG bind to fixed antigen
| shouldn't bind
132
type III
IgG activates complement, neutrophils release lysosomal enzymes
133
type III associated with
SLE, PAN, strep glomerulonephritis, serum sickness
134
serum sickness
type III
| antibodies to forein proteins are produced, deposited in membranes and fix complement --> tissue damage
135
Arthus reaction
type III, immune complex formation in skin
136
Type IV
delayed T cell mediated, release cytokines
137
e.g. type IV
contact dermatitis, GVHD, MS
138
transfusion, urticaria, pruitus, wheeze, fever
allergic reaction
I hypersensitivity against plasma proteins
antihistamine
139
transfusion, fever, headache, chills, flushing
febrile nonhemolytic transfusion reaction
| II hypersensitivity, host antibodies against donor HLA antigens and WBCs
140
transfusion, fever, hypotension, tachypnea, tachy, flank pain, hemoglobinuria, jaundice
acute hemolytic transfusion reaction
| type II - ABO issue or extravascular hemolysis
141
Anti ACh
Myasthenia rgavis
142
Anti-basement membrane
Goodpasture's
143
Anticentromere
Scleroderma
144
Anti-desmoglein
pemphigus vulgaris
145
anti-smith
SLE
146
Anti-glutamic acid decarboxylase
DM-1
147
antihemidesmosome
bullous pemphigoid
148
anti-histone
drug induced lupus
149
anti-Jo-1, anti-SRP, anti-Mi-2
polymyositis, dermatomyositis
150
antimicrosomal, antithyroglobulin
hashimoto's
151
anti-mt
primary biliary cirrhosis
152
antiphospholipase A2 R
primary membranous nephropathy
153
anti-Scl-70
scleroderma
154
anti-smooth muscle
autoimmune hepatitis 1
155
Anti-SSA/ SSB =
| linked with
Ro, La
| Sjogren's
156
Anti-U1 RNP
mixed CTD
157
voltage gated Ca channel antibodies
Lambert-Eaton
158
anti-CCP
RA
159
BTK gene
is
defect
causes
tyrosine kinase gene
X linked (Bruton) a-y-globulinaemia
no mature B cells
160
recurrnet bacterial and enteroviral infections after 6 months, decreased Ig, absent tonsils
a-y-globulinaemia
161
most comon primary immunodeficiency
selective IgA deficiency
162
airway and GI infection, atopy, anaphylaxis to IgA
selective IgA deficiency
163
defect in B cell differentiation
common variable immunodeficiency
164
immunodeficiency in 20-30s
common variable immunodeficiency
165
decreased plasma cells, decreased Ig, autoimmune disease, 25yrs
common variable immunodeficiency
166
tetany, recurrent odd infections, heart defects
DiGeorge
| don't develop 3rd and 4th pharyngeal pouches
167
decreased INF-y, bacterial and fungal infections, had BCG vaccine recently
IL-12 receptor deficiency
168
coarse facies, cold abscesses, retained primary teeth, eczema
autosomal dominant hyper-IgE syndrome
| Job syndrome
169
Job syndrome
Th17 deficiency - STAT3 mutation
170
no thymic shadow
severe combined immunodeficiency - SCID
| IL-2R chain
171
failure to thrive, diarrhoea, thrush, recurrent infection
SCID
172
Defect in ATM gene causes, called
can't repair DNA breaks
| Ataxia-telangiectasia
173
ataxia, spider angioma, IgA deficiency
ataxia-telangectasia
174
raised AFP, low IgA, G, E, lymphopenia, cerebellar atrophy
ataxia-telangectasia
175
defective CD40L, causes, called
Low IgG, A, E
Normal/ High IgM
pyogenic infection
Hyper-IgM syndrome
176
WAS gene defect - issue, called
T cells cannot recognise actin cytoskeleton
| Wiskott-Aldrich
177
thrombocytopenia, eczema, recurrent infection, high IgE, IgA
Wiskott-Aldrich
178
defect in LFA-1 integrin
leukocyte adhesion deficiency
179
recurrent bacterial skin and mucosal infection, absent pus, impaired wound healing
called
what about neutrophils?
Leukocyte adhesion deficiency
| Lots of neutrophils, not at infection site
180
LYST defect, called, causes
Chediak-Higashi
| microtubule dysfunction
181
recurrent pyogenic infection from stap and strep, albinism, peripheral neuropathy, neurodegeneration
will see
called
giant granulocytes, pancytopenia, coagulation defect
| Chediak-Higashi
182
defect of NADPH oxidase
chronic granulomatous disease
| can't kill phagocytosed catalase positive material
183
increased susceptibility to catalse positive organisms
chronic granulomatous disease
184
abnormal dihydrorhodamine test
chronic granulomatous disease
185
catalase positive organisms
Nocardia, Pseudomonas, Listeria, Aspergillus, Candida, E coli, Staph, serriatia, B cepacia, H pylori
186
hyperacute transplant rejection
thrombosis of graft vessels
187
acute transplant rejection
Tk cells, IV hypersensitivity
188
Chronic transplant rejection
Th cells, II and IV hypersensitivity
189
Cyclosporine, tacrolimas
calcineurin inhibitor, prevents IL-2 transcription
190
cyclosporine use
transplant rejection prophylaxis, psoriasis, RA
191
cyclosporine s.e.
nephrotoxicity, htn, hyperlipidaemia, neurotoxicity, gingival hyperplasia, hirsuitism
192
Binds FK506
tacrolimus, sirolimus
193
use tacrolimus
transplant rejection prophylaxis
194
tacrolimus s.e.
diabetes, nephrotoxicity, htn, hyperlipidaemia
195
sirolimus =
rapamycin
196
sirolumis use, s.e
kidney transplant rejection prophylaxis
| pancytopenia, insulin resistance, hyperlipidaemia
197
daclizumab, basiliximab
block IL-2R
198
use daclizumab, basiliximab, s.e.
kidney transplant rejection prophylaxis
| edema, htn, tremor
199
azathioprine
inhibits lymphocyte proliferation by blocking necleotide synthesis
200
use azathioprine, s.e.
transplant rejection, RA, Crohn's, glomerulonephritis, autoimmune conditions
leukopenia, anemia, thrombocytopenia
201
c.e. azathioprine
allopurinol (both degraded by xanthine oxidase)
202
mycophenolate mofetil
inhibits IMP dehydrogenase - prevents B and T cell synthesis
203
use mycophenolate mofetil, s.e.
transplant rejection, lupus nephritis
| GI, pancytopenia, htn, hypergylcaemia, CMV infection
204
corticosteroids action
inhibit NF-kB
| decrease cytokine transcription
205
aldesleukin
is
for
IL-2
RCC
met. melanoma
206
filgrastim
is
for
G-CSF
| recovery of bone marrow
207
Sargramostim
is
for
GM-CSF
| Recovery of bone marrow
208
IFN-a use
chronic hep B and C, Kaposi sarcoma, malignant melanoma
209
IFN-y use
chronic granulomatous disease
210
Romiplostim, eltrombopag
is
use
thrombopoetin receptor agonist
| thrombocytopenia
211
oprelvekin
is
use
IL-11
| thrombocytopenia
212
Alemtuzumab, for
CD52
| CLL, MS
213
Bevacizumab, for
VEGF
| Colorectal ca, RCC
214
Cetuximab, for
EGFR
| IV colorectal ca., head and neck ca
215
Rituximab, for
CD20
| B cell lymphoma, CLL, RA, ITP
216
Trastuzumab
HER-2
217
Adalimumab, certolizumab, infliximab, use
soluble TNF-a
| IBD, RA, AS, psoriasis
218
eculizumab, use
complement C5 protein
| PNH
219
Natalizumab use
a4-integrin
| MS, Crohn's
220
Natulizumab + JC virus
PML risk
221
denosumab
RANKL, OP
222
omalizumab, use
IgE, allergic asthma
223
palivizumab, for
RSV F protein
| RSV prophylaxis
224
Ranibizumab, bevacizumab
| for
VEGF
| Neovascular age-realted macular degeneration
225
N-acetylcyctine
given in pcm overdose, precursor to GSG (glutathione)
226
What is oxidative burst?
the method of producing free radicals to kill phagocytosed material
227
What is decreased in hyper IgE syndrome?
decreased TNF-y
