Immunology Flashcards
causes of secondary immune deficiency?
infection old age drugs malignancy nutritional disorder
what is a granuloma?
an organised collection of activated macrophages and lymphocytes
why do granulomas sometimes form?
inflammatory response triggered by a stimulus
failure of removal of the stimulus results in persistent cytokine production
immune cells cluster in a circle
DDx lung granuloma
TB sarcoidosis chronic hypersensitivity pneumonitis dust diseases eg silicosis foreign body
people with antibody deficiencies tend to get bacterial/viral infections
bacterial
how does antibody deficiency present
recurrent bacterial infections
antibody mediated autoimmune disease
selective IgA deficiency patients to tend to get infections in what system?
respiratory BUT most are asymptomatic
what is hypogammaglobulinaemia
decrease in gammaglobulins INCLUDING immunoglobulins
if you arent antibody deficient but you have hypogammaglobulinaemia what could be the cause?
protein loss or failure of protein synthesis eg by leukaemia
NK cells kill cells that lack what?
MHC
toll-like receptors respond to what?
PAMPS
pathogen associated molecular patterns
TLRs are expressed on..
phagocytes
dendrites
by activating TLRs, you will trigger the release of…
pro-inflam cytokines
type 1 interferon secretion
TNF inhibitors block…
pro-inflam cytokines
give an example of a TLR activating drug
imiquimod
why are biologic drugs not hepato or nephrotoxic?
are normal proteins so their metabolism doesnt depend on liver/renal function
what are biologic drugs made of?
artificial antibodies
name the fastest kind of transplant rejection; how long does it take to present?
hyperacute
minutes-hrs
acute cellular rejection is an example of type _ hypersensitivity
4
cells involved in acute cellular rejection?
CD4 and CD8 T cells
acute vascular rejection is an example of type _ hypersensitivity
2
name the types of transplant rejection that occur 5-30 days after transplant
acute cellular rejection
acute vascular rejection
what transplant rejection can present with vasculitis?
acute vascular rejection
what transplant rejections are treated? with what?
hyperacute - nil
acute cellular/vascular - immunosuppression
chronic allograft failure - treat symptoms
pathophysiology of chronic allograft failure
fibrosis
scarring
which transplant rejection occurs >30 days after transplant?
chronic allograft fracture
2 types of active immunisation
live attenuated
inactive
what kind of T cells become memory T cells
effector T cells
how does the antibody response to infection change if there is memory?
IgG is produced at the same time as IgM instead of after
why do inactivated vaccines require multiple injections?
dont stimulate clonal expansion of B and T cells
give an example of a whole cell inactivated vaccine
polio
rabies
cholera
(think travel vaccines)
give an example of a fractional inactivated vaccine
hep B flu HPV diphtheria tetanus HiB
give an example of a live attenuated vaccine
MMR chicken pox yellow fever polio BCG for TB
test for ANA?
ELISA
autoantibody Ix for SLE?
- ANA
2. dsDNA and ENA if the staining pattern of ANA matches that of SLE
rheumatoid factor is an autoantibody directed to….
the Fc region of IgG
what do c-ANCA and p-ANCA mean?
c-ANCA = diffuse staining into Cytoplasm p-ANCA = Peripheral staining around nuclei
NK cells are part of the innate/adaptive immune system
innate
what cells are part of adaptive immunity
T and B lymphocytes
the formation of what accounts for the rapid production of IgG at re-exposure to a microbe after vaccination
memory B cells
why is it good to have multiple vaccines at once?
produces memory
how are biological drugs metabolised?
broken down into amino acids (dont need liver/renal function)
biological therapy is a form of passive/active immunity
passive
methotrexate is an example of an immunosuppressant T or F
F, its an anti inflammatory
what receptor does methotrexate act on?
adenosine A2 receptor
liver contraindications to methotrexate?
any chronic liver disease
alcoholism
you should stop a biologic if you have low eGFR T or F
F, biologics dont affect the kidneys or liver
if you take away TNF what are you at risk of?
reactivation of TB as the granuloma will break up
