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Y3 TRANSITION > Immunology > Flashcards

Immunology Flashcards

1
Q

List causes of secondary immune deficiency

A 
Physiological (age, prematurity)
Infection (HIV, measles)
Treatments (immunosuppressants, chemo, CCS)
Malignancy (haematological, mets)
Biochemical (malnutrition, RF, DM)
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2
Q

What is a granuloma?

A

An organised collection of activated macrophages and lymphocytes triggered by antigens or inert foreign materials

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3
Q

List differential diagnosis of lung granuloma

A 
Sarcoidosis
Mycobacterial disease e.g. TB, leprosy
Berylliosis, silicosis and other dust diseases
Chronic hypersensitivity pneumonitis
Foreign bodies
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4
Q

How do antibody deficiencies commonly present?

A

Recurrent bacterial infections (typically RT or GI)

Antibody-mediated AI diseases (thrombocytopaenia, AI haemolytic anaemia)

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5
Q

State two common primary antibody deficiencies

A

Common variable immune deficiency (IgG, IgM, IgA)

Selective IgA deficiency

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6
Q

State two secondary causes of recurrent bacterial infections and hypogammaglobulinaemia

A 
Protein loss (nephrotic syndrome)
Failure of protein synthesis (CLL, myeloma, NHL)
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7
Q

What are the three types of complement pathways activated by an antigen on the microbial surface?

A

Alternative pathway
Lectin pathway
Classical pathway

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8
Q

Describe the alternative complement pathway

A

Activated when C3b protein binds to a microbe and triggers the formation of C5, C5b –> 9 and then cell lysis

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9
Q

Describe the lectin complement pathway

A

Starts with MBL protein and when activated triggers a cascade of C4 and C2 protein (C3 convertase) eventually causing lysis

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10
Q

Describe the classical complement pathway

A

Initiated by IgG and IgM complexes and when activated triggers a cascade of C4 and C2 protein (C3 convertase) eventually causing lysis

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11
Q

List functions of complement

A

Opsonization (better eating of bugs by phagocytes)
Lysis (direct killing by punching cells)
Chemotaxis (calling in troops)

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12
Q

What is the consequence of complement deficiency?

A

Predisposes to bacterial infection especially meningitis

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13
Q

What are NK cells?

A

Kill cells that lack MHC molecules on surface (including cancer cells) and have no long term memory - part of innate immunity

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14
Q

What is the consequence of NK cell defects?

A

Predispose to recurrent VZV, HSV, CMV, HPV NK cells

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15
Q

What are toll-like receptors?

A

Expressed on phagocytes and dendrites and act as burglar alarms for microbes by responding to PAMPs, causing the release of cytokines

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16
Q

TLR dysfunction can lead too..

A

Immunodeficiency (too little)

Autoimmunity (too much)

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17
Q

What do TNF inhibitors block?

A

Pro-inflammatory cytokines e.g. TNF alpha preventing granuloma formation

18
Q

What is the mechanism behind biologic drugs?

A

Artificial antibodies that block the body’s own proteins (TNF) so they act like passive immunisation

19
Q

List the types of transplant rejection and the time at which they occur

A

Hyperacute rejection (minutes to hours)
Acute cellular rejection (5-30 days)
Acute vascular rejection (5-30 days)
Chronic allograft failure (>30 days)

20
Q

Vaccination produces memory in B cells. What is meant by this?

A

Long-lived memory B cells are generate during the primary immune response that survive after the antigen has been eliminated
These can reactivate in response to a second encounter with that specific antigen producing IgG quickly

21
Q

Vaccination produces memory in T cells. What is meant by this?

A

Vaccination stimulates rare T cells and induces a strong T cell response
Some become effector cells which either die by apoptosis after antigen has gone or become memory cells

22
Q

Which antibody is produced first in a primary infection?

A

Immediate IgM response

IgG produced later

23
Q

Which antibodies are produced in secondary infection?

A

IgG antibody response is greater and more prolonged

24
Q

List advantages of inactivated vaccines

A

Elicit good antibody responses

Usually safe

25
Q

List disadvantages of inactivated vaccines

A

Killed organisms don’t stimulate a good response

Requires multiple injections as no clonal expansion

26
Q

What is meant by a whole cell inactivated vaccine? Give an example

A

Whole organism used

Polio (or ‘6 in 1’)

27
Q

What is meant by a fractional inactivated vaccine? Give some examples

A

Only part of the organism used in the vaccine
Subunit (Hepatitis B)
Toxoid (Diphtheria, tetanus)
Pure polysaccharide (HIB)

28
Q

List advantages of activated vaccines

A

All relevant effector mechanisms elicited
Localised strong response
Usually only one dose

29
Q

List disadvantages of inactivated vaccines

A

May not be safe (can cause virulence, infection in immunocomprimised)
Fragile (stored carefully)

30
Q

Give an example of a viral live attenuated vaccine

A

Measles
Mumps
Rubella

31
Q

Give an example of a bacterial live attenuated vaccine

A

BCG

32
Q

Measurement of which antibody is likely to aid diagnosis of SLE?

A

Anti-ds DNA

33
Q

Measurement of which antibody is likely to aid diagnosis of coeliac disease?

A

Anti-TTG igA antibody

34
Q

Measurement of which antibody is likely to aid diagnosis of myasthenia gravis?

A

Anti-AchR antibody

35
Q

Measurement of which antibody is likely to aid diagnosis of Sjogren’s syndrome?

A

Anti-Ro

36
Q

Measurement of which antibody is likely to aid diagnosis of rheumatoid arthritis?

A

Anti-cyclic citrullinated protein (CCP)

37
Q

Measurement of which antibody is likely to aid diagnosis of polymyositis?

A

Anti-Jo-1

38
Q

Measurement of which antibody is likely to aid diagnosis of systemic sclerosis?

A

Diffuse: anti-Scl-70
Limited: anti-centromere antibody

39
Q

In what situations would biologics be used as first line over other immunosuppressants?

A

Liver cirrhosis/renal failure

TB risk

40
Q

What are the features of primary immunodeficiency?

A

Adult onset

History of opportunistic infections

41
Q

State the main clinical side effect of methotrexate

A

Hepatotoxicity

Y3 TRANSITION (10 decks)

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