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USMLE Step 1 > Immunology > Flashcards

Immunology Flashcards

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USMLE® Step 1 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
Q

Mechanism and sx of febrile non-hemolytic transfusion reaction

A

Type II hypersensitivity
Host Ab against donor HLA antigens and WBCs (not RBCs!)
Fever, headaches, chills, flushing

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26
Q

Mechanism and sx of acute hemolytic transfusion reaction

A

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)

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27
Q

Mechanism and sx of TRALI

A

Donor anti-leukocyte Ab against host neutrophils and pulmonary endothelial cells

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28
Q

Which auto-Ab found in T1DM

A

anti-glutamic acid decarboxylase, islet cell cytoplasmic Ab

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29
Q

Anti-desmoglein and Anti-hemidesmosome found in:

A

Pemphigus vulgaris

Bullous pemphigoid

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30
Q

Auto-Ab seen in:

  • myasthenia gravis
  • Goodpasture syndrome
  • Antiphospholipid syndrome
A
  • Anti-ACh receptor
  • Anti-glomerular BM
  • Anti-B2 glycoprotein, anti- cardiolipin, lupus anticoagulant
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31
Q

Auto-Ab seen in:

  • limited scleroderma (CREST)
  • diffuse scleroderma
  • Sjogren
  • MCTD
A
  • Anti-centromere
  • Anti-Scl-70
  • Anti-SSA, anti-SSB (anti-Ro, anti-La)
  • Anti-U1 RNP
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32
Q

Auto-Ab seen in:

  • Hashimoto thyroiditis
  • Graves
A
  • antimicrosomal, antithyroglobulin, anti-thyroid peroxidase

- anti-TSH receptor

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33
Q

Auto-Ab seen in polymyositis and dermatomyositis

A

antisynthetase (eg anti-Jo-1), anti-SRP, anti-helicase

34
Q

Auto-Ab see in:

  • primary biliary cirrhosis
  • Autoimmune hepatitis
  • Pernicious anemia
A
  • antimitochondrial
  • anti-smooth muscle (SM)
  • anti-intrinsic factor, antiparietal cell
35
Q

Auto-Ab seen in RA

A
  • Rheumatoid factor, anti-CCP
36
Q

Auto-Ab in SLE

A

Anti-dsDNA, anti-Smith, anti-histone (drug-induced lupus), anticardiolipin, lupus anticoagulant

37
Q

Auto-Ab in celiac disease

A

IgA anti-endomysial, IgA anti-tissue transglutaminase

38
Q

Auto-Ab seen in:

  • Microscopic polyangiitis, Churg-Strauss
  • Granulomatosis with polyangiitis (GPA)
A
  • p-ANCA/MPO-ANCA

- c-ANCA/PR3-ANCA

39
Q

Recurrent bacterial and enteroviral infections after 6 months suggestive of which B-cell disorder:

A

Bruton (X-linked) agammaglobulinemia

  • Defect in BTK (tyrosine kinase)
  • no B-cell
  • Boys (X-linked recessive)
40
Q

Findings in Bruton agammaglobulinemia:

A
  • absent B-cells in peripheral blood
  • Decreased Igs all classes
  • Absent/scanty LNs and tonsils
41
Q

Susceptibility to giardiasis suggestive of which B-cell disorder

A

Selective IgA deficiency

42
Q

Presentation and findings in selective IgA deficiency

A

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
Q

Which B-cell disorder presents after 2 years of age

A

Common variable immunodeficiency:

  • Increased autoimmune ds, bronchiectasis, lymphoma, sinopulmonary infections
  • Decreased plasma cells and Igs
44
Q

List the T-cell disorders

A
  • Thymic aplasia (DiGeorge)
  • IL-12 receptor deficiency
  • Autosomal dominant hyper-IgE syndrome
  • Chronic mucocutaneous candidiasis
45
Q

Presentation of tetany, recurrent fungal/viral infections, and conotruncal abnormalities (TOF/truncus) suggestive of

A

DiGeorge syndrome

- Because of hypocalcemia, T-cell deficiency

46
Q

Lab and CXR findings in DiGeorge syndrome

A

Low T-cells, low PTH, low Ca2+

Absent thymic shadow on CXR

47
Q

IL-12 receptor deficiency:

  • genetics
  • presentation
A
  • AR, decreased TH1 response
  • disseminated microbacterium and fungal infections; may present after BCG vaccination
  • Decreased INFy
48
Q

Presentation of AD Hyper-IgE syndrome

A

FATED

  • coarse FAcies
  • cold staph Abscesses
  • retained primary Teeth
  • increased IgE
  • Derm probs - eczema
49
Q

Increased IgE, eosinophils and decreased IFNy suggestive of

A

AD Hyper-IgE syndrome

50
Q

Non-invasive candida albicans infection of skin and mucous membranes with absent T-cell response to candida Ag suggestive of:

A

Chronic mucocutaneous candidiasis

51
Q

List the combined B and T cell disorders

A
  • Severe combined immunodeficiency
  • Ataxia telangiectasia
  • Hyper-IgM syndrome
  • Wiskott-Aldrich syndrome
52
Q

Defective IL-2R gamma chain found in

A

SCID

53
Q

Ataxia-telangiectasia

  • genetics
  • findings
A
  • 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
Q

Triad in ataxia telangiectasia

A
  • Ataxia (cerebellar defects)
  • Telangiectasia (spider angiomas)
  • IgA deficiency
55
Q

Opportunistic infections with pneumocystis, crytosoridium and CMV suggestive of:

A

Hyper-IgM syndrome

56
Q

Cause of hyper-IgM syndrome

A 
Defective CD40L on Th cells --> class switching defect
X-linked recessive
57
Q

Normal or raised IgM with low IgG, IgA and IgE suggestive of:

A

Hyper-IgM syndrome

58
Q

Genetics of Wiskott-Aldrich syndrome

A

WASp gene mutation
Inability of leukocytes and platelets to reorganise actin cytoskeleton –> defective Ag presentation
X-linked recessive

59
Q

Presentation of Wiskott-Aldrich syndrome

A 
WATER
W-iskott A-ldrich
- Thrombocytopenia
- Eczema
- Recurrent (pyogenic) infections
60
Q

Decreased to normal IgM and IgG with raised IgE and IgA suggestive of:

A

Wiskott Aldrich

61
Q

B cell deficiency predisposed to which bacterial infections

A 
Encapsulate
"Please SHINE my SKiS"
- Pseudomonas
- Streptococcus pneumoniae
- Haemophilus influenzae type B
- Neisseria meningitidis
- E coli
- Salmonella
- Klebsiella
- Group B Strep
62
Q

Granulocyte (neutrophil) deficiency predispose to which bacteria

A 
Staphyloccocus
Burkholderia cepacia
Pseudomonas 
Serratia
Nocardia
63
Q

Complement deficiency predisposes to which bacterial infection

A

Early factors: encapsulated

Late (C5-9): Neisseria

64
Q

T cell deficiency predispose to which viral infections

A

CMV, EBV, JC virus, VZV

chronic infection with respiratory/GI viruses

65
Q

B cell deficiency predispose to which viral infections

A

Enteroviral encephalitis

Poliovirus

66
Q

Candida is associated with deficiency of which cell types

A

Local - T-cell

systemic - neutrophils

67
Q

GI giardiasis is associated with deficiency of which cell

A

B cells

68
Q

Types of transplant rejections and their timelines

A

Hyperacute - within min
Acute - weeks to months
Chronic - months to years
Graft-vs-host disease - varies

69
Q

Pathogenesis of different types of transplant rejections

A

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
Q

Graft-vs-host disease

  • Signs and Sx
  • Common organ transplants
A

Maculopapular rash, jaundice, HSM, diarrhoea

Liver and Bone marrow transplants

71
Q

2 types of calcineurin inhibitors and their mechanisms

A

Cyclosporine: binds cyclophilin
Tacrolimus (FK506): binds FK506 binding protein
both blocks T cell activation by inhibiting IL2 transcription

72
Q

Other uses for calcineurin inhibitors

A

Psoriasis

RA

73
Q

Toxicity of calcineurin inhibitors

A

Both nephrotoxic!!

  • HPT, hyperlipid, neurotoxic, gingival hyperplasia, hirsutism in cyclosporine
  • increased risk of DM and neurotoxic in tacrolimus, no gingival hyperplasia/hirsutism
74
Q

Which immunosuppressants used for kidney transplants

A

Sirolimus (Rapamycin)

Basiliximab

75
Q

Sirolimus (Rapamycin)

  • mechanism
  • other toxicity
A
  • mTOR inhibitor, block T and B cell activation/diff by preventing response to IL-2
  • PanSirtopenia, insulin resistance, hyperlipid

“kidney Sir-vives”

76
Q

Mechanism and toxicity of Basiliximab

A

Monoclonal Ab - blocks IL-2R

Edema, HPT, tremor

77
Q

Azathioprine

  • mechanism
  • other uses
  • toxicity
A
  • Prodrug of 6-mercaptopurine - inhibits de novo purine synthesis
  • RA, Crohn’s, Glomerulonephritis
  • Pancytopenia
78
Q

Which immunosuppresant used for lupus nephritis

- which viral infection is it associated with?

A

Myophenolate

CMV

79
Q

Organ specific examples of chronic transplant rejection

A
  • lungs: bronchiolitis obliterans
  • heart: accelerated atherosclerosis
  • kidney: chronic graft nephropathy
  • liver: vanishing bile duct syndrome
80
Q

Artificial leukocytosis seen in which immunosuppressant

A

Corticosteroids

- cx by demargination of WBCs

81
Q

Mechanism of corticosteroids

A

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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