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FRACP NOSH 2020 > Immunology > Flashcards

Immunology Flashcards

1
Q

Cytokines function = IL 1

Name 2 IL-1 inhibitors

Uses?

A

Fever, induces other cytokines,
T cell stimulation

Canakinumab (SC)
Anakinra (SC)

Used in RA, periodic syndromes

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2
Q

Which cells express MHC Class 1?

What does this activate?

A

Basically all somatic cells

CD8 cytotoxic T cells

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3
Q

What is the 2 signal model of T cell activation?

A

2 signals required for T cell activation.

Signal 1 = interaction of CD3 with MHC

Signal 2 = costimulation (e.g. CD28 with B7)

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4
Q

What types of immune response are Th1 cells most active in?

A

Pro-inflammatory

Involved in:

  • eradication of intracellular organisms e.g. viruses, mycobacteria
  • Type IV hypersensitivity
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5
Q

What types of immune response are Th2 cells most active in?

A

Important in IgE / eosinophil synthesis

Involved in:

  • parasitic infections
  • allergy and asthma
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6
Q

What types of immune response are Th17 cells most active in?

A

Involved in:

  • early response to extracellular pathogens
  • chronic inflammatory responses
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7
Q

What main cytokines are produced by Th1 cells?

A

IFN-gamma

TNF-alpha

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8
Q

What main cytokines are produced by Th2 cells?

A

IL-4
IL-5
IL-6
IL-13

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9
Q

What main cytokines are produced by Th17 cells?

A

IL 17

IL 21, 22, 23

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10
Q

What main inhibitory cytokines are produced by Treg cells?

A

IL-10

TGF-beta

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11
Q

What is the main interleukin involved in gout pathogenesis?

A

IL-1

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12
Q

What does TLR3 pathway deficiency result in?

A

Severe HSV encephalitis

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13
Q

What defect causes chronic granulomatous disease?

A

Molecular defect in 1 or more subunits of NADPH oxidase. This is what is usually responsible for respiratory burst by neutrophils to kill intracellular organisms

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14
Q

What is the classical complement pathway triggered by?

A

Antibody-antigen complexes with IgM or IgG

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15
Q

What is the lectin pathway of complement triggered by?

A

Mannose-binding lectin binding to mannose on pathogen surfaces

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16
Q

What is the alternative pathway of complement triggered by?

A

Background low level of C3 circulating, which spontaneously activates to C3b. Then comes across pathogen surface and binds, leading to pathway activation

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17
Q

What is opsonisation?

A

Coating of target by C3b to promote its elimination -> enhanced uptake by phagocytic cells

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18
Q

What is eculizumab?

What is it used in?

A

C5 monoclonal antibody

Atypical HUS
PNH

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19
Q

What are the classical conditions found with early complement pathway deficiencies?

A

SLE, GN

Immune complexes diseases in general -> complement has role in clearing these from the circulation

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20
Q

What are the classical conditions found with late complement pathway deficiencies?

A

Disseminated neisseria infections

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21
Q

What is the pathophysiology of Hereditary angiooedema?

Main management?

A

Deficiency of C1 esterase inhibitor, which usually controls complement activation.
Thus -> Excessive classical pathway activation -
- Bradykinin release -> angio-oedema

Mx = Icatibant = bradykinin 2 receptor antagonist

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22
Q

What are the 5 antibody heavy chain isotypes?

Which can cross the placenta?

A 
IgG
IgM
IgA
IgE
IgD

IgG crosses placenta

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23
Q

Which cells express MHC Class 2?

A

Professional APCs

  • dendritic cells
  • macrophages
  • B cells
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24
Q

What do VDJ genes code for?

A

The variable portions on immunoglobulin

25
Q

Where does affinity maturation of B cells occur?

A

Germinal centres -> secondary lymphoid tissue

26
Q

What is isotype switching of B cells?

A

Activated B cells changing surface immunoglobulin isotype expression -> e.g. from IgM to IgG

27
Q

What infections are commonly seen in CVID?

A

Recurrent sinopulmonary infection
GIT - diarrhoea
Skin

28
Q

What non-infective complications are seen in CVID?

A

Autoimmunity

Malignancy -> NHL, gastric

29
Q

Which immunoglobulins are most commonly low in CVID?

A

IgG, IgA, sometimes IgM

30
Q

What are the live vaccines? (5)

A 
Measles, mumps, rubella (MMR combined vaccine)
Rotavirus
Smallpox
Chickenpox
Yellow fever
31
Q

What is the key defect which causes X-linked agammaglobulinaemia?

A

Mutation or absence of Bruton’s Tyrosine Kinase, which is essential for B cell development

32
Q

When is the onset of X-linked agammaglobulinaemia clinically noted?

A

6 months of age, when maternal IgG wears off

33
Q

Why can IgA deficienct patients get anaphylaxis from blood products?

A

If blood contains IgA -> patient may have Anti-IgA antibodies

34
Q

How is specific antibody deficiency detected?

A

Response to vaccination is impaired

35
Q

What cell marker is present on all T cells?

A

CD3

36
Q

What is the role of AIRE ?

A

Autoimmune regulator - required to turn on tissue-specific self-antigens in thymus, to educate T cells to detect self vs non-self. For avoidance of autoimmunity

37
Q

What are the 3 key features found in APECED (autoimmune poly-endocrine syndrome Type 1)?

A

Chronic mucocutaneous candidiasis
Hypoparathyroidism
Addison’s

38
Q

What is Abatacept?

A

CTLA-4 Ig
- this binds to B7 to turn off T cells / prevent activation

Used for RA

39
Q

What is Hyper IgM Syndrome caused by?

A

Absent CD40 to CD40 Ligand co-stimulation
This is key for B cell differentiation, so without this, B cells cannot isotype switch.
Thus high IgM, no IgG or IgA

40
Q

What is the key growth factor for T cell expansion?

A

IL-2

41
Q

What is the key regulatory factor for Treg cells?

A

FOXP3

42
Q

What is the key defect in IPEX?

A

Defect in FOXP3, which is required for Treg cells

Thus will get rampant autoimmune manifestations

43
Q

What infection does deficiency of Th1 cells put you at risk of? (2)

A

Non-tuberculous mycobacteria

Invasive salmonella

44
Q

Which T cells are most important in fighting candida infection?

A

Th17 cells

45
Q

Which interleukin is most central to Psoriasis?

A

IL-17

46
Q

Which T cells are most involved in atopic disease?

A

Th2 cells

47
Q

What is the pathophysiology of SCID?

A

Deficiency in a component critical for T cell function and development

Leads to vulnerability to infections, plus increased risk of malignancy and autoimmunity

48
Q

What are the two main functions of NK cells?

A

To kill

  • virally infected cells
  • tumour cells
49
Q

Other than AChR antibodies, what antibody can be tested for in myasthenia gravis?

A

Anti-MuSK

50
Q

What are the key antibodies to test for in suspected SLE?

A

ANA
Anti-sm antibody
Anti-dsDNA

51
Q

What is Anti-mitochondrial antibody associated with?

A

Primary biliary cirrhosis

52
Q

What is Anti-VGCC ab associated with?

A

Lambert-Eaton Myasthenic Syndrome

53
Q

What is Liver kidney microsome type 1 antibodies (anti-LKM-1) associated with?

A

Autoimmune hepatitis

54
Q

What are anti-smooth muscle (SM) antibodies associated with?

A

Chronic autoimmune hepatitis

55
Q

What is anti-U1RNP ab associated with?

A

Mixed connective tissue disease

56
Q

What is the most common infection associated with urticaria?

A

Mycoplasma

57
Q

What is expressed on plasma cells?

A

CD38

58
Q

Who needs tetanus Ig after a dirty wound?

A

Uncertain vax hx

Humoral immunodeficiency

FRACP NOSH 2020 (18 decks)

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