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Immunology Flashcards

1
Q

What are the signs and symptoms of anaphylaxis?

A

Airway and breathing- bronchospasm, wheezing, tongue swelling, stridor, hoarse voice
Circulation- vasodilation, tachycardia, hypotension, cardiac arrest
Neurological- feeling faint, decreased cerebral blood flow, confusion, light headedness, feeling of impending doom
GI- pain, vomitting, diarrhoea, smooth muscle contraction.
Skin-Itching due to histamine and bradykinin release.

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2
Q

Name some common allergens.

A 
Pollen
Food
Medications
Blood donations
Latex
Anaesthetics
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3
Q

What are the mediators of Type 1 hypersensitivity reactions?

A

IgE, mast cell degranulation

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4
Q

What are the mediators of Type 2 hypersensitivity reactions?

A

IgG, IgM, complement

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5
Q

What are the mediators of Type 3 hypersensitivity reactions?

A

IgG, complement

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6
Q

What are the mediators of Type 4 hypersensitivity reactions?

A

T cells

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7
Q

Give examples of Type 1 hypersensitivity reactions.

A 
Asthma
Atopy- dermatitis/ eczema
Anaphylaxis
Allergic rhinitis
Food allergy
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8
Q

Give examples of Type 2 hypersensitivity reactions.

A

Grave’s disease
Incompatible transfusions
Autoimmune hemolytic anaemia
TTP

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9
Q

Give examples of Type 3 hypersensitivity reactions.

A

Arthus reaction
Serum sickness
SLE
RA

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10
Q

Give examples of Type 4 hypersensitivity reactions.

A

Contact dermatitis
Mantoux test
Coeliac
TB

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11
Q

What are the 4 key antibiotics given in Tuberculosis infections?

A

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

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12
Q

What are the side effects of the 4 antibiotics used in TB?

A

Rifampacin- Dark urine, hepatotoxicity, decreased effectiveness of the oral contraceptive pill

Isoniazid- Peripheral neuropathy- Vit B6 given alongside, clumsiness/ unsteadiness

Pyrazinamide- Gout

Ethambutol- Eye damage- colour blindness and vision loss

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13
Q

Which components of the immune system are involved in response to viral infections?

A

INF alpha and beta
Cytotoxic T cells
Natural killer cells

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14
Q

Which type of T helper cell is involved in Autoimmunity, inflammation, intracellular pathogens?

A

Th1

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15
Q

What is released from mast cells?

A

Histamine
Prostaglandins
Leukotreines
Tryptase

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16
Q

What are the effects of mast cell mediators?

A

Vasodilation and tachycardia
Increased vessel permeability
Gland secretion
Bronchoconstriction

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17
Q

Which allergy usually appears first in life?
Rhinitis
Asthma
Dermatitis and food allergy

A

Dermatitis and food allergy

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18
Q

What genetic defect may there be for atopic dermatitis to occur?

A

Filaggrin defect= membrane disruption

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19
Q

What are the signs and symptoms of immediate (<1 hour) drug reactions?

A 
Vomit and diarrhoea
Tachycardia, hypotension
Wheeze, stridor
Urticaria (hives), angioedema
Loss of consciousness
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20
Q

What are the signs and symptoms of delayed (>1 hour) drug reactions?

A

Myalgia and arthralgia
Fever
GI upset
Itching and rash

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21
Q

How can a suspected Penicillin allergy be investigated?

A

Blood tests: look for eosinophils, plateles, haemolytic anaemia
Measure Tryptase: after 2 hours (peak) and 24 hours- this represents mast cell degranulation

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22
Q

What is Chronic Spontaneous Urticaria?

A

NOT anaphylaxis or allergy
Itching and rash, slow to resolve
Can have panic attack and angioedema

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23
Q

What is a biphasic anaphylaxis reaction?

A

2 episodes 1-8 hours apart

Mast cells refill and degranulate again

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24
Q

How soon after exposure does anaphylaxis usually occur?

A

Within 60 minutes

Later onset = less severe

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25
What are the potential differential diagnoses for anaphylaxis?
Vocal cord dysfunction Chronic urticaria Hypotension due to shock, sepsis, blood loss, MI Syncope. faint- but would appear white not blue
26
How is anaphylaxis managed?
ABCDE Adrenalin IM 0.5mls (1:1000) repeat after 5 mins if no improvement High flow oxygen Fluid challenge (500-1000mls) for hypotension Bronchodilator Supportive management to prevent a biphasic reaction eg. Corticosteroids, anti histamines
27
In mastocytosis, which blood test level is always raised?
Tryptase
28
What is positive selection and where does it occur?
In the thymic cortex, imposed by cortical epithelial cells. | Developing T cells which recognise self peptide on MCH can continue maturing.
29
What is negative selection and where does it occur?
In the cortico-medullary junction of the thymus. | Developing T cells which have autoreactive TCRs are removed via apoptosis.
30
What are 2 examples of peripheral tolerance?
1. Immune privelege- physical barries eg BBB, cells in testes express Fas which induces apoptosis in any T cells. 2. TReg cells- downregulate immune responses
31
How can loss of tolerance occur (3 methods)?
1. Immune priveledge lost eg. penetrating eye injury 2. Failure of TReg cells 3. Molecular mimicry- eg. Rheumatic fever may follow infection with Haemolytic strep
32
What can predispose to autoimmunity?
Female sex Autoantibodies HLA class DQ2 and DQ8
33
Which HLA classes are associated with coeliac disease?
HLA DQ2 in 95% | HLA DQ8
34
When should coeliac disease be suspected?
Diarrhoea, weight loss, anaemia
35
What are the key histological features of coeliac disease?
Villous atrophy Crypt hyperplasia Raised intra epithelial WBCs
36
What are the risk factors for rheumatoid arthritis?
``` Smoking Female HLA DR4 CCP autoantibodies Lung infections ```
37
What blood results/ antibodies will be found in rheumatoid arthritis?
CRP Raised RF Raised CCP autoantibodies C3 and C4 Raised NO dsDNA antibodies, ANA low
38
What are the key features of rheumatoid arthritis?
Symmetrical polyarthritis Synovial joints of hands and feet Morning stiffness
39
What systemic features may be present in rheumatoid arthritis?
Necrotising granulomas Vasculitis Atherosclerosis
40
How does rheumatoid arthritis appear on Xray?
Loss of joint space Soft tissue swelling Joint deformity
41
What is the treatment for Rheumatoid Arthritis?
Immunosuppression: Steroids NSAIDs Anti TNFalpha eg. Infliximab
42
What will be found on a urine dip in a patient with SLE?
Protein and blood | SLE can lead to nephrotic syndrome, due to kidneys being blocked with immune complexes
43
What blood results/antibodies will be found in a patient with SLE?
ANA high dsDNA high ENA (extractable nuclear antigens) Sm and RNP CRP normal/ low C3 and C4 low (no acute phase response)
44
What is the treatment for SLE?
Immunosuppression- NSAIDs, hydroxychloroquinine, Azathiaprine, Methotrexate Anti B cells (Rituximab/Belimumab)
45
What are some of the key clinical features of SLE?
``` Malar rash Discoid rash Malaise Fatigue Alopecia Raynaud's Oral/ nasal ulcers Synovitis Serositis ```
46
What blood results/ antibodies will be found in vasculitis?
CRP high ESR high ANCA antibodies (pANCA in Microscopic Polyarteritis, cANCA in Wegener's Granulomatosus)
47
What is vasculitis?
Autoimmune condition Autoantibodies against neutrophil enzymes, leads to neutrophil activation and damage to small blood vessels, and acute renal syndromes.
48
What is the treatment for vasculitis?
Steroids Cyclophosphamide Anti B cell (Rituximab, Belimumab)
49
What is Antiphospholipid Syndrome?
``` Where antiphospholipid antibodies cause: Recurrent abortions Arterial or venous thrombi Pre-eclampsia Migraine Stroke ``` Is associated with SLE or can present alone
50
Which autoantibodies are found in antiphospholipid syndrome?
Anti-Cardiolipin
51
Which autoantibodies are found in SLE?
ANA | Anti dsDNA
52
Which autoantibodies are found in Primary Biliary Cholangitis?
AMA
53
Which autoantibodies are found in Goodpastures disease?
Anti GBM
54
Which autoantibodies are found in Rheumatoid arthritis?
Anti CCP
55
What does scleroderma result in?
Skin, blood vessel and muscle changes | Collagen deposition
56
What is CREST?
A syndrome due to Scleroderma: ``` C-Calcium deposition R- Raynaud's E-Oesophageal reflux S- Sclerodactyly (skin thickening) T- Telangiectasia (spider veins) ```
57
What are the main types of innate immunodeficiency?
1. Neutrophil defect 2. Complement defects 3. NK defects 4. Cytokine/ TLR defects 5. Splenectomy
58
What are the main types of adaptive immunideficiency?
1. B cell/ antibody defects | 2. T cell defects
59
How do neutrophil defects present?
Neutropenic sepsis; bacterial or fungal infection WITHOUT pus
60
What are the causes of neutrophil defect?
Drugs- chemo Leukaemia Adhesion defect eg. LFA-1 deficiency Respiratory burst defect eg. Chronic Granulomatous Disease
61
What treatments are used for neutrophil defect?
G-CSF | Antifungals, Antibiotics
62
How do patients with a splenectomy usually present?
Septicaemia | Infection with pneumococcus, meningococcus and malaria
63
Which Ig in the spleen normally opsonises encapsulated bacteria?
IgM
64
What is the treatment for patients who have had a splenectomy?
Penicillin prophylaxis | Vaccination: Meningococcus C, Haem B and Pneumococcal
65
How do patients with NK defects present?
Viral infections eg. CMV, Herpes Zoster
66
How do patients with complement (C3) defects present?
Pyogenic infections
67
How do patients with complement (C5-9) defects present?
Neisseria or meningitis infections
68
How do patients with complement (C1,2,4) defects present?
Immune complex diseases
69
How do patients with Cytokine/TLR defects present?
Recurrent intracellular bacterial infections eg. Atypical mycobacterium avium
70
How do patients with B cell/ Antibody defects present?
1. Pneumonia, sinusitis, otitis 2. Campylobacter (diarrhoea), Strep pneumonia, Haem influenza 3. Pyogenic infections from encapsulated and non encapsulated bacteria 4. Diarrhoea and malabsoprtion 5. Aged 4 or 5 months
71
What are the causes of B cell defects?
1. Genetic (present >6 months of age) in males 2. BTK deficiency 3. B cell malignancy eg. CLL 4. HIV 5. Immunosuppression
72
How can B cell defects be diagnosed?
Serum Igs and electrophoresis Paraprotein? Lymphocyte count will be normal (as B cells only count for 10%) Give vaccines- eg. HIb and Meningitis and look for immune response
73
How can B cell defects be treated?
Replace Igs | Antibiotics
74
When does a T cell defect present in a patient?
Presents from birth- with failure to thrive, and opportunistic infections.
75
What is Di Georg'es Syndrome?
A type of T cell defect; due to defective thymus. | Presents with opportunistic infections: Candida, EBV, P.Carini
76
What are the features of Di George's syndrome?
Small jaw Abnormal ears Cleft palate Lymphopenia
77
What is the commonest cause of CD4 cell deficiency?
HIV
78
Which infections do HIV patients get?
1. Intracellular: TB, Salmonella, Pneumocystis 2. Viruses: Kaposi's sarcoma, CMV, EBV 3. Encapsulated bacteria- pneumonia 4. Fungi and yeast- Candida, cryptococcus 5. Protozoa- Pneumocystis, cryptosporidiosis, toxoplasmosis
79
What is a likely cause of a chest infection in a HIV patient?
Pneumocystis (fungi)
80
Which type of T helper cell is involved in secreting regulatory cytokines and restricting co-stimulatory availability for other T cells?
Treg
81
Which type of T helper cell is involved in protection against extracellular helminths, promoting B cell class switching to IgE and involved in allergy and asthma?
Th2
82
Which type of T helper cell is involved in protection against fungi, extracellular bacteria, autoimmunity and epithelial barriers?
Th17
83
Which interferons are most important for protection against viruses?
IFN aplha and beta
84
Which interferons are most important for protection against intracellular (non viral) infections?
IFN gamma
85
Which cytokines are important in protection against parasitic infections?
Il 4 and Il5 Secreted frorm Th2 cells
86
Which cells are the main phagocytes for extracellular bacteria?
Neutrophils
87
What is the most common antibody deficiency?
IgA deficiency
88
In Hyper IgM syndrome, there are low levels of which 2 antibody classes?
Low IgG and IgA Presents with Pneumocystis and Crptosporidiosis
89
BTK deficiency presents around what age?
6 months
90
The autoantigen 21 hydroxylase is found in which condition?
Addison's
91
What % of RA patients have both RF and anti CCP in their serum?
70%
92
Which antibody is most useful for predicting SLE disease severity?
Anti dsDNA
93
60-70% patients with CREST have which antibodies?
Anti centromere
94
Sjogrens syndrome patients usually have dry what?
Dry eyes | Dry mouth
95
Which autoantibodies are present in Sjorgens syndrome?
ENA Ro and La
96
Which cytokine is linked with IgE production?
Interleukin 4
97
What are the effects of histamine?
Increased blood flow Increased permeability Itching due to nerve stimulation Smooth muscle contraction
98
Eosinophils are attracted to which cytokine?
Interleukin 5
99
Asthma, hayfever and eczema are associated with which subset of T helper cells?
Th2
100
Give an example of a H1 receptor antagonist drug.
Loratidine | Cetirizine

Year 3 (22 decks)

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