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USMLE Step 1 > Immunology > Flashcards

Immunology Flashcards

1
Q

Which LNs drain the lower rectum to anal canal (above pectinate), bladder, vagina (mid third) cervix and prostate?

A

Internal iliacs

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2
Q

Which LNs drain anal canal below pectinate line, skin below umbilicus, scrotum and vulva

A

Superficial inguinal

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3
Q

Which LNs drain testes, ovaries, kidney and uterus

A

Para-aortic

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4
Q

Which LN drains lower duodenum to splenic flexure?

A

Superior mesenteric

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5
Q

Findings in post-splenectomy

- blood and blood smear

A
  • Howell-Jolly bodies
  • Target cells
  • Thrombocytosis
  • Lymphocytosis
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6
Q

Thymus hypoplasia seen in:

A
  • DiGeorge syndrome and SCID
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7
Q

Thymoma associated with which 2 conditions:

A

Myasthenia gravis

Superior vena cava syndrome

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8
Q

HLA-B27 associated with which diseases

A

PAIR - seronegative arthropathies

Psoriatic arthritis, ankylosing spondylitis, IBD-associated arthritis, reactive arthritis

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9
Q

HLA subtype associated with celiac disease

A

“I ate (8) too (2) much gluten at Dairy Queen”

DQ2/DQ8

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10
Q

Describe IPEX syndrome

A

Immune dysregulation, Polyendocrinopathy, Enteropathy, X-linked syndrome
Genetic deficiency of FOXP3 –> autoimmunity (no T-reg)
Findings:
- polyendocrinopathy, enteropathy, dermatologic conditions eg nail dystrophy, dermatitis etc
- Assoc with DM in male infants

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11
Q

Positive acute phase reactants and functions

A
  • CRP: opsonin, fixes complement
  • Ferritin: binds and sequesters iron
  • Hepcidin: decreases iron absorption and iron release –> cx anaemia of chronic disease
  • fibrinogen: coagulation, endothelial repair
  • serum amyloid A
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12
Q

Negative acute phase reactants

A
  • Albumin

- Transferrin

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13
Q

Susceptibility to Neisseria bacteraemia suggests which complement deficiency?

A

C5-C9 deficiency

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14
Q

C3 deficiency cx increased susceptibility to:

A

Recurrent pyogenic sinus and respiratory tract infections

Type III hypersensitivity reactions

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15
Q

2 types of complement regulatory proteins and their deficiency pathologies:

A
  • C1 esterase inhibitor deficiency: hereditary angiodema (with decreased C4 levels)
  • CD55 deficiency (decay-accelerating factor deficiency): RBC lysis and paroxysmal nocturnal hemoglobinuria
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16
Q

Functions of the NB interleukins

A

“Hot T-bone stEAK”
IL-1: fever (hot)
IL-2: stimulate T-cells
IL-3: stimulates bone marrow
IL-4: stimulate IgE production (class switching)
IL-5: stimulate IgA (and eosinophil) production
IL-6: stimulate aKute-phase proteins

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17
Q

Deficiency of which enzyme results in chronic granulomatous disease

A

NADPH oxidase

- increased risk of infection by catalase +ve species (S aureus, Aspergillus)

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18
Q

Receptor for Epstein-Barr virus

A

“You can drink Beer at the Bar when you’re 21”

B-cell, Epstein-Barr, CD21

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19
Q

Define anergy

A

State in which immune cell cannot be activated by exposure to its antigen - needs co-stimulatory signal
a mechanism of self-tolerance

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20
Q

Exposure to which toxins/viruses should preformed antibodies be given?

A

“To Be Healed Very Rapidly”

  • Tetanus toxin
  • Botulinum toxin
  • HBV
  • Varicella
  • Rabies
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21
Q

Examples of live attenuated vaccines

A

MMR, varicella, BCG, influenza (intranasal), rotavirus, yellow fever, polio (sabin)

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22
Q

Examples of inactivated/killed vaccines

A

“RIP Always”

Rabies, Influenza (IM), Polio (Salk), Hep A

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23
Q

Serum sickness and arthus reactions are eg of which hypersensitivity

A

Type III

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24
Q

4 types of immune blood transfusion reactions

Time of onset of the symptoms

A
  1. Allergic/anaphylactic (min - 2-3hours)
  2. Febrile non-hemolytic (1-6hours)
  3. Acute hemolytic transfusion reaction (within 1 hr)
  4. Transfusion-related lung injury (TRALI) (within 6 hours)
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25
Mechanism and sx of febrile non-hemolytic transfusion reaction
Type II hypersensitivity Host Ab against donor HLA antigens and WBCs (not RBCs!) Fever, headaches, chills, flushing
26
Mechanism and sx of acute hemolytic transfusion reaction
Type II hypersensitivity ABO incompatibility --> intravascular hemolysis Host Ab against foreign Ag on donor RBCs --> extravascular hemolysis Fever, shock (hypotension, tachypnoea, tachycardia), flank pain, hemoglobinuria (intravas hemolysis), jaundice (extravasc hemo)
27
Mechanism and sx of TRALI
Donor anti-leukocyte Ab against host neutrophils and pulmonary endothelial cells
28
Which auto-Ab found in T1DM
anti-glutamic acid decarboxylase, islet cell cytoplasmic Ab
29
Anti-desmoglein and Anti-hemidesmosome found in:
Pemphigus vulgaris | Bullous pemphigoid
30
Auto-Ab seen in: - myasthenia gravis - Goodpasture syndrome - Antiphospholipid syndrome
- Anti-ACh receptor - Anti-glomerular BM - Anti-B2 glycoprotein, anti- cardiolipin, lupus anticoagulant
31
Auto-Ab seen in: - limited scleroderma (CREST) - diffuse scleroderma - Sjogren - MCTD
- Anti-centromere - Anti-Scl-70 - Anti-SSA, anti-SSB (anti-Ro, anti-La) - Anti-U1 RNP
32
Auto-Ab seen in: - Hashimoto thyroiditis - Graves
- antimicrosomal, antithyroglobulin, anti-thyroid peroxidase | - anti-TSH receptor
33
Auto-Ab seen in polymyositis and dermatomyositis
antisynthetase (eg anti-Jo-1), anti-SRP, anti-helicase
34
Auto-Ab see in: - primary biliary cirrhosis - Autoimmune hepatitis - Pernicious anemia
- antimitochondrial - anti-smooth muscle (SM) - anti-intrinsic factor, antiparietal cell
35
Auto-Ab seen in RA
- Rheumatoid factor, anti-CCP
36
Auto-Ab in SLE
Anti-dsDNA, anti-Smith, anti-histone (drug-induced lupus), anticardiolipin, lupus anticoagulant
37
Auto-Ab in celiac disease
IgA anti-endomysial, IgA anti-tissue transglutaminase
38
Auto-Ab seen in: - Microscopic polyangiitis, Churg-Strauss - Granulomatosis with polyangiitis (GPA)
- p-ANCA/MPO-ANCA | - c-ANCA/PR3-ANCA
39
Recurrent bacterial and enteroviral infections after 6 months suggestive of which B-cell disorder:
Bruton (X-linked) agammaglobulinemia - Defect in BTK (tyrosine kinase) - no B-cell - Boys (X-linked recessive)
40
Findings in Bruton agammaglobulinemia:
- absent B-cells in peripheral blood - Decreased Igs all classes - Absent/scanty LNs and tonsils
41
Susceptibility to giardiasis suggestive of which B-cell disorder
Selective IgA deficiency
42
Presentation and findings in selective IgA deficiency
The A's - Asymptomatic, Airway and GI infections, Autoimmune ds, Atopy, Anaphylaxis to IgA-containing products - decreased IgA with normal IgG and IgM levels
43
Which B-cell disorder presents after 2 years of age
Common variable immunodeficiency: - Increased autoimmune ds, bronchiectasis, lymphoma, sinopulmonary infections - Decreased plasma cells and Igs
44
List the T-cell disorders
- Thymic aplasia (DiGeorge) - IL-12 receptor deficiency - Autosomal dominant hyper-IgE syndrome - Chronic mucocutaneous candidiasis
45
Presentation of tetany, recurrent fungal/viral infections, and conotruncal abnormalities (TOF/truncus) suggestive of
DiGeorge syndrome | - Because of hypocalcemia, T-cell deficiency
46
Lab and CXR findings in DiGeorge syndrome
Low T-cells, low PTH, low Ca2+ | Absent thymic shadow on CXR
47
IL-12 receptor deficiency: - genetics - presentation
- AR, decreased TH1 response - disseminated microbacterium and fungal infections; may present after BCG vaccination - Decreased INFy
48
Presentation of AD Hyper-IgE syndrome
FATED - coarse FAcies - cold staph Abscesses - retained primary Teeth - increased IgE - Derm probs - eczema
49
Increased IgE, eosinophils and decreased IFNy suggestive of
AD Hyper-IgE syndrome
50
Non-invasive candida albicans infection of skin and mucous membranes with absent T-cell response to candida Ag suggestive of:
Chronic mucocutaneous candidiasis
51
List the combined B and T cell disorders
- Severe combined immunodeficiency - Ataxia telangiectasia - Hyper-IgM syndrome - Wiskott-Aldrich syndrome
52
Defective IL-2R gamma chain found in
SCID
53
Ataxia-telangiectasia - genetics - findings
- Defects in ATM gene --> failure to repair DNA double stranded breaks --> cell arrest - Increased AFP - Decreased IgA, IgG, IgE - Lymphopenia, cerebellar atrophy - risk of lymphoma and leukemia
54
Triad in ataxia telangiectasia
- Ataxia (cerebellar defects) - Telangiectasia (spider angiomas) - IgA deficiency
55
Opportunistic infections with pneumocystis, crytosoridium and CMV suggestive of:
Hyper-IgM syndrome
56
Cause of hyper-IgM syndrome
``` Defective CD40L on Th cells --> class switching defect X-linked recessive ```
57
Normal or raised IgM with low IgG, IgA and IgE suggestive of:
Hyper-IgM syndrome
58
Genetics of Wiskott-Aldrich syndrome
WASp gene mutation Inability of leukocytes and platelets to reorganise actin cytoskeleton --> defective Ag presentation X-linked recessive
59
Presentation of Wiskott-Aldrich syndrome
``` WATER W-iskott A-ldrich - Thrombocytopenia - Eczema - Recurrent (pyogenic) infections ```
60
Decreased to normal IgM and IgG with raised IgE and IgA suggestive of:
Wiskott Aldrich
61
B cell deficiency predisposed to which bacterial infections
``` Encapsulate "Please SHINE my SKiS" - Pseudomonas - Streptococcus pneumoniae - Haemophilus influenzae type B - Neisseria meningitidis - E coli - Salmonella - Klebsiella - Group B Strep ```
62
Granulocyte (neutrophil) deficiency predispose to which bacteria
``` Staphyloccocus Burkholderia cepacia Pseudomonas Serratia Nocardia ```
63
Complement deficiency predisposes to which bacterial infection
Early factors: encapsulated | Late (C5-9): Neisseria
64
T cell deficiency predispose to which viral infections
CMV, EBV, JC virus, VZV | chronic infection with respiratory/GI viruses
65
B cell deficiency predispose to which viral infections
Enteroviral encephalitis | Poliovirus
66
Candida is associated with deficiency of which cell types
Local - T-cell | systemic - neutrophils
67
GI giardiasis is associated with deficiency of which cell
B cells
68
Types of transplant rejections and their timelines
Hyperacute - within min Acute - weeks to months Chronic - months to years Graft-vs-host disease - varies
69
Pathogenesis of different types of transplant rejections
Hyperacute - Type II hypersensitivity and complement Acute - CD8+ Chronic - CD4+ and type II and IV Graft-vs-host - Graft T-cells proliferates in immunocomp host --> Type IV
70
Graft-vs-host disease - Signs and Sx - Common organ transplants
Maculopapular rash, jaundice, HSM, diarrhoea | Liver and Bone marrow transplants
71
2 types of calcineurin inhibitors and their mechanisms
Cyclosporine: binds cyclophilin Tacrolimus (FK506): binds FK506 binding protein both blocks T cell activation by inhibiting IL2 transcription
72
Other uses for calcineurin inhibitors
Psoriasis | RA
73
Toxicity of calcineurin inhibitors
Both nephrotoxic!! - HPT, hyperlipid, neurotoxic, gingival hyperplasia, hirsutism in cyclosporine - increased risk of DM and neurotoxic in tacrolimus, no gingival hyperplasia/hirsutism
74
Which immunosuppressants used for kidney transplants
Sirolimus (Rapamycin) | Basiliximab
75
Sirolimus (Rapamycin) - mechanism - other toxicity
- mTOR inhibitor, block T and B cell activation/diff by preventing response to IL-2 - PanSirtopenia, insulin resistance, hyperlipid "kidney Sir-vives"
76
Mechanism and toxicity of Basiliximab
Monoclonal Ab - blocks IL-2R | Edema, HPT, tremor
77
Azathioprine - mechanism - other uses - toxicity
- Prodrug of 6-mercaptopurine - inhibits de novo purine synthesis - RA, Crohn's, Glomerulonephritis - Pancytopenia
78
Which immunosuppresant used for lupus nephritis | - which viral infection is it associated with?
Myophenolate | CMV
79
Organ specific examples of chronic transplant rejection
- lungs: bronchiolitis obliterans - heart: accelerated atherosclerosis - kidney: chronic graft nephropathy - liver: vanishing bile duct syndrome
80
Artificial leukocytosis seen in which immunosuppressant
Corticosteroids | - cx by demargination of WBCs
81
Mechanism of corticosteroids
Inhibits NF-kB Decrease transcription of cytokines NB for T and B cells Induces T cell apoptosis

USMLE Step 1 (11 decks)

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