Immunology Flashcards
19 year old male presents to A&E with severe respiratory difficulty, light-headedness and a red itchy rash. On examination he has laryngeal oedema, bilateral wheezing across the lung fields and is hypotensive. He has recently been taking antibiotics for a chest infection.
All Answer Choices A. Acute Urticaria B. Food allergy C. Chronic Urticaria D. Allergic asthma E. Anaphylaxis F. Contact dermatitis G. Drug allergy H. Allergic Rhinitis I. Angioedema J. Allergic bronchopulmonary Aspergillosis
E. Anaphylaxis
A 3 year old girl is brought into A&E by her parents. She has had vomiting and diarrhoea since early yesterday evening when she was at a birthday party. On examination she has urticaria.
All Answer Choices A. Acute Urticaria B. Food allergy C. Chronic Urticaria D. Allergic asthma E. Anaphylaxis F. Contact dermatitis G. Drug allergy H. Allergic Rhinitis I. Angioedema J. Allergic bronchopulmonary Aspergillosis
B. Food allergy
A 40 year old man presents to his GP complaining of loss smell and nasal itching and discharge. On examination his nasal mucosa are swollen and have a bluish tinge. His symptoms improve with a corticosteroid spray
All Answer Choices A. Acute Urticaria B. Food allergy C. Chronic Urticaria D. Allergic asthma E. Anaphylaxis F. Contact dermatitis G. Drug allergy H. Allergic Rhinitis I. Angioedema J. Allergic bronchopulmonary Aspergillosis
H. Allergic Rhinitis
A 25 year old woman presents to her GP complaining of itchy, red wheals on her torso which have been present for 7 weeks. She can not remember how they started but has noticed they are worse in the heat and when she exercises.
All Answer Choices A. Acute Urticaria B. Food allergy C. Chronic Urticaria D. Allergic asthma E. Anaphylaxis F. Contact dermatitis G. Drug allergy H. Allergic Rhinitis I. Angioedema J. Allergic bronchopulmonary Aspergillosis
C. Chronic Urticaria
A 30 year old women presents to her GP with a red, itchy, oozing rash around her neck and fingers
All Answer Choices A. Acute Urticaria B. Food allergy C. Chronic Urticaria D. Allergic asthma E. Anaphylaxis F. Contact dermatitis G. Drug allergy H. Allergic Rhinitis I. Angioedema J. Allergic bronchopulmonary Aspergillosis
F. Contact dermatitis
A 55 year old man with history of angina was advised to take a tablet before a long flight. After taking the pill, he suddenly finds that he has difficulty breathing, feels nauseous and is itching.
All Answer Choices A. Chronic urticaria B. C1 inhibitor deficiency C. Idiopathic angioedema D. Panic attack E. Acute urticaria F. IgE mediated anaphylaxis G. Coeliac disease H. Extrinsic allergic alveolitis I. Mast cell degranulation J. Allergic asthma K. Urticarial vasculitis
I. Mast cell degranulation
Mast cell degranulation is not IgE mediated
A 24 year old medical student develops worsening swelling of the hands and feet and abdominal pain before her final year medical exams. She says that similar milder episodes have occurred preciously.
All Answer Choices A. Chronic urticaria B. C1 inhibitor deficiency C. Idiopathic angioedema D. Panic attack E. Acute urticaria F. IgE mediated anaphylaxis G. Coeliac disease H. Extrinsic allergic alveolitis I. Mast cell degranulation J. Allergic asthma K. Urticarial vasculitis
B. C1 inhibitor deficiency
The simple answer is that C1 inhibitor has a number of functions, in addition to inhibiting the activation of C1. For example,
it also inhibits activation of the kinin pathway, the clotting pathway and the fibrinolytic pathway. It does this through
inhibition of factor XII, activated factor XI, and kallikrein as well as C1.
It’s likely that activation of the kinin pathway and production of bradykinin mediates the angioedema associated with this
condition.
A 50 year old Irish woman presents to her GP with episodes of diarrhoea, which is difficult to flush, abdominal pain, weight loss and fatigue. She also describes a blistering itchy rash on her knees.
All Answer Choices A. Chronic urticaria B. C1 inhibitor deficiency C. Idiopathic angioedema D. Panic attack E. Acute urticaria F. IgE mediated anaphylaxis G. Coeliac disease H. Extrinsic allergic alveolitis I. Mast cell degranulation J. Allergic asthma K. Urticarial vasculitis
G. Coeliac disease
Coeliac disease is associated with a superficial, blistering skin rash ‘dermatitis herpetiformis’, which is intensely itchy
A 26 year old male who has been suffering from ‘flu-like’ symptoms with fever presents to the GP after developing skin rash in the last few days.
All Answer Choices A. Chronic urticaria B. C1 inhibitor deficiency C. Idiopathic angioedema D. Panic attack E. Acute urticaria F. IgE mediated anaphylaxis G. Coeliac disease H. Extrinsic allergic alveolitis I. Mast cell degranulation J. Allergic asthma K. Urticarial vasculitis
E. Acute urticaria
Acute urticaria is defined being present for less than 6 weeks, whereas chronic urticaria persists
for more than 6 weeks. In both cases the urticarial rash is intermittent, comes and goes and normally
persists in a single site for less than 24 hours.
A 35 year old woman presents with persistent itchy wheels for the last 2 months. She noticed that when this is at its worst, she also has a fever and feels generally unwell. After an acute attack, she has bruising and post-inflammatory residual pigmentation at the site of the itching.
All Answer Choices A. Chronic urticaria B. C1 inhibitor deficiency C. Idiopathic angioedema D. Panic attack E. Acute urticaria F. IgE mediated anaphylaxis G. Coeliac disease H. Extrinsic allergic alveolitis I. Mast cell degranulation J. Allergic asthma K. Urticarial vasculitis
K. Urticarial vasculitis
Urticarial rashes that last more than 24 hours in a single site, resolve with bruising or skin depigmentation
may raise the possibility of an underlying vasculitis. In this instance a skin biopsy of the urticarial
lesion is useful to confirm/repute presence of a vasculitis
A 19 year old male presents to A&E with increasing breathlessness. On examination his blood pressure is 90/55 mmHg and his respiratory rate is 28/min. He shows you a generalised red itchy skin rash, and examination of his chest reveals bilateral inspiratory and expiratory wheezes throughout.
All Answer Choices A. Hereditary angioedema B. Allergic bronchopulmonary aspergillosis C. Allergic rhinitis D. Anaphylaxis E. Acute angioedema F. Allergic conjunctivitis G. Contact hypersensitivity H. Chronic urticaria I. Allergic asthma J. Acute urticaria
D. Anaphylaxis
The combination of hypotension, respiratory distress, urticaria and bronchoconstriction is very suggestive of anaphylaxis
A 35 year old woman presents with a two day history of a red itchy skin rash which started soon after her first scuba-diving lesson. She is otherwise well.
All Answer Choices A. Hereditary angioedema B. Allergic bronchopulmonary aspergillosis C. Allergic rhinitis D. Anaphylaxis E. Acute angioedema F. Allergic conjunctivitis G. Contact hypersensitivity H. Chronic urticaria I. Allergic asthma J. Acute urticaria
J. Acute urticaria
This rash is very suggestive of acute urticaria. The temporal association with scuba diving may indicate an allergy to latex (in wet suits).
A 22 year old woman presents with an intermittently itchy and desquamating skin rash on her abdomen which is unresponsive to antihistamines
All Answer Choices A. Hereditary angioedema B. Allergic bronchopulmonary aspergillosis C. Allergic rhinitis D. Anaphylaxis E. Acute angioedema F. Allergic conjunctivitis G. Contact hypersensitivity H. Chronic urticaria I. Allergic asthma J. Acute urticaria
G. Contact hypersensitivity
This rash is typical of contact hypersensitivity. The distribution of the rash suggests that the specific agent is nickel, which used to be a component of the studs of jeans and is commonly found in the metal used in belts
A 40 year old man complains of loss of smell with nasal itching and discharge over 4 weeks. He also describes morning sneezing. He is otherwise in good health. On examination his nasal mucosa are swollen and hyperaemic.
All Answer Choices A. Hereditary angioedema B. Allergic bronchopulmonary aspergillosis C. Allergic rhinitis D. Anaphylaxis E. Acute angioedema F. Allergic conjunctivitis G. Contact hypersensitivity H. Chronic urticaria I. Allergic asthma J. Acute urticaria
C. Allergic rhinitis
The combination of sneezing, rhinorrhea and loss of smell is very suggestive of allergic rhinitis
This 45 year old woman presents to A&E with tongue swelling and acute respiratory tract obstruction. She has longstanding hypertension and received a renal transplant two years previously. She has no history of allergic disease. On examination her blood pressure is stable, and examination of her lung fields reveal normal breath sounds. Her current medication includes cyclosporine, azathioprine, captopril and nifedipine.
All Answer Choices A. Hereditary angioedema B. Allergic bronchopulmonary aspergillosis C. Allergic rhinitis D. Anaphylaxis E. Acute angioedema F. Allergic conjunctivitis G. Contact hypersensitivity H. Chronic urticaria I. Allergic asthma J. Acute urticaria
E. Acute angioedema
This woman has angioedema of the tongue, without symptoms suggestive of a generalised allergic reaction. Isolated angioedema may be allergic in origin, but 94% of cases angioedema presenting to A&E are drug induced and the majority of these are associated with ACE inhibitors (eg captopril).
A 19 year old male presents to A&E with increasing breathlessness. On examination his blood pressure is 90/55 mmHg and his respiratory rate is 28/min. He shows you a generalised red itchy skin rash, and examination of his chest reveals bilateral inspiratory and expiratory wheezes throughout.
A. IV adrenaline 0.3mL of 1:1000 B. IM adrenaline 1mL of 1:10000 C. Inhaled antihistamines D. IM adrenaline 1mL of 1:1000 E. Intraarticular corticosteroids F. Venom immunotherapy G. IM adrenaline 0.5 mL of 1:1000 H. PO antihistamines I. Inhaled corticosteroids J. None of the above K. Intranasal antihistamines L. IV antihistamines M. Intracardiac adrenaline
D. IM adrenaline 1mL of 1:1000
The most important treatment of anaphylaxis is adrenaline, which should be given intramuscularly. (Note for final year pharm: 1:1000 means 1mg/mL; 1:10000 means 0.1mg/mL ; 1% means 1g/dL)
A 35 year old woman presents with a two day history of a red itchy skin rash which started soon after her first scuba-diving lesson. She is otherwise well.
A. IV adrenaline 0.3mL of 1:1000 B. IM adrenaline 1mL of 1:10000 C. Inhaled antihistamines D. IM adrenaline 1mL of 1:1000 E. Intraarticular corticosteroids F. Venom immunotherapy G. IM adrenaline 0.5 mL of 1:1000 H. PO antihistamines I. Inhaled corticosteroids J. None of the above K. Intranasal antihistamines L. IV antihistamines M. Intracardiac adrenaline
H. PO antihistamines
- Severe acute urticaria is effectively treated with a short course of oral anti-histamines
A 22 year old woman is presents with this intermittently itchy and desquamating skin rash which is unresponsive to antihistamines
A. IV adrenaline 0.3mL of 1:1000 B. IM adrenaline 1mL of 1:10000 C. Inhaled antihistamines D. IM adrenaline 1mL of 1:1000 E. Intraarticular corticosteroids F. Venom immunotherapy G. IM adrenaline 0.5 mL of 1:1000 H. PO antihistamines I. Inhaled corticosteroids J. None of the above K. Intranasal antihistamines L. IV antihistamines M. Intracardiac adrenaline
J. None of the above
Contact hypersensitivity should be treated by avoidance of the sensitising agent, in this case nickel
This 45 year old woman presents to A&E with tongue swelling and acute respiratory tract obstruction. She has longstanding hypertension and received a renal transplant two years previously. She has no history of allergic disease. On examination her blood pressure is stable, and examination of her lung fields reveal normal breath sounds. Her current medication includes cyclosporine, azathioprine, captopril and nifedipine.
A. IV adrenaline 0.3mL of 1:1000 B. IM adrenaline 1mL of 1:10000 C. Inhaled antihistamines D. IM adrenaline 1mL of 1:1000 E. Intraarticular corticosteroids F. Venom immunotherapy G. IM adrenaline 0.5 mL of 1:1000 H. PO antihistamines I. Inhaled corticosteroids J. None of the above K. Intranasal antihistamines L. IV antihistamines M. Intracardiac adrenaline
IM adrenaline 0.5 mL of 1:1000
A 40 year old man complains of loss of smell with nasal itching and discharge over 4 weeks. He also describes morning sneezing. He is otherwise in good health. On examination his nasal mucosa are swollen and hyperaemic.
A. IV adrenaline 0.3mL of 1:1000 B. IM adrenaline 1mL of 1:10000 C. Inhaled antihistamines D. IM adrenaline 1mL of 1:1000 E. Intraarticular corticosteroids F. Venom immunotherapy G. IM adrenaline 0.5 mL of 1:1000 H. PO antihistamines I. Inhaled corticosteroids J. None of the above K. Intranasal antihistamines L. IV antihistamines M. Intracardiac adrenaline
PO antihistamines
Oral antihistamines and intranasal corticosteroids are the mainstay of treatment of mild allergic rhinitis. (As intranasal corticosteroid is not an option available, the “single best” answer here is oral antihistamines.)
Cytokines exerting an anti-viral effect
A. Alternative complement pathway B. Natural Killer cells C. IgM D. IgA E. Interferons F. Major histocompatability complex class 2 G. Major histocompatability complex class 1 H. Classical complement pathway I. IgG J. IL6 K. IgE L. Innate immune system M. CD8+
E. Interferons
Immunoglobulin dimer
A. Alternative complement pathway B. Natural Killer cells C. IgM D. IgA E. Interferons F. Major histocompatability complex class 2 G. Major histocompatability complex class 1 H. Classical complement pathway I. IgG J. IL6 K. IgE L. Innate immune system M. CD8+
D. IgA
MHC associated with Th1 cells
A. Alternative complement pathway B. Natural Killer cells C. IgM D. IgA E. Interferons F. Major histocompatability complex class 2 G. Major histocompatability complex class 1 H. Classical complement pathway I. IgG J. IL6 K. IgE L. Innate immune system M. CD8+
F. Major histocompatability complex class 2
Acts on hepatocytes to induce synthesis of acute phase proteins in response to bacterial infection
A. Alternative complement pathway B. Natural Killer cells C. IgM D. IgA E. Interferons F. Major histocompatability complex class 2 G. Major histocompatability complex class 1 H. Classical complement pathway I. IgG J. IL6 K. IgE L. Innate immune system M. CD8+
J. IL6
Arise in the first few days after infection and are important in defence against viruses and tumors
A. Alternative complement pathway B. Natural Killer cells C. IgM D. IgA E. Interferons F. Major histocompatability complex class 2 G. Major histocompatability complex class 1 H. Classical complement pathway I. IgG J. IL6 K. IgE L. Innate immune system M. CD8+
B. Natural Killer cells
MHC associated with Th2 cells
A. Alternative complement pathway B. Natural Killer cells C. IgM D. IgA E. Interferons F. Major histocompatability complex class 2 G. Major histocompatability complex class 1 H. Classical complement pathway I. IgG J. IL6 K. IgE L. Innate immune system M. CD8+
F. Major histocompatability complex class 2
MHC associated with cytotoxic T cells
A. Alternative complement pathway B. Natural Killer cells C. IgM D. IgA E. Interferons F. Major histocompatability complex class 2 G. Major histocompatability complex class 1 H. Classical complement pathway I. IgG J. IL6 K. IgE L. Innate immune system M. CD8+
G. Major histocompatability complex class 1
Along with IgD, is one of the first immunoglobulins expressed on B cells before they undergo antibody class switching
A. Alternative complement pathway B. Natural Killer cells C. IgM D. IgA E. Interferons F. Major histocompatability complex class 2 G. Major histocompatability complex class 1 H. Classical complement pathway I. IgG J. IL6 K. IgE L. Innate immune system M. CD8+
C. IgM
The most abundant (in terms of g/L) immunoglobulin in normal plasma
A. Alternative complement pathway B. Natural Killer cells C. IgM D. IgA E. Interferons F. Major histocompatability complex class 2 G. Major histocompatability complex class 1 H. Classical complement pathway I. IgG J. IL6 K. IgE L. Innate immune system M. CD8+
I. IgG
Deficiencies in this predispose to SLE
A. Alternative complement pathway B. Natural Killer cells C. IgM D. IgA E. Interferons F. Major histocompatability complex class 2 G. Major histocompatability complex class 1 H. Classical complement pathway I. IgG J. IL6 K. IgE L. Innate immune system M. CD8+
H. Classical complement pathway
Kostmanns syndrome is a congenital deficiency of which component of the immune system?
All Answer Choices A. Bacterial B. B lymphocyte C. MHC Class I D. T lymphocyte E. Neutrophil F. MHC Class II G. Fungal H. Complement I. Viral J. Mast cell K. Parasitic
E. Neutrophil
Which component of the innate immune system is usually one of the first to respond to infection through a cut?
All Answer Choices A. Bacterial B. B lymphocyte C. MHC Class I D. T lymphocyte E. Neutrophil F. MHC Class II G. Fungal H. Complement I. Viral J. Mast cell K. Parasitic
E. Neutrophil
Which infection is most common as a consequence of B cell deficiency?
All Answer Choices A. Bacterial B. B lymphocyte C. MHC Class I D. T lymphocyte E. Neutrophil F. MHC Class II G. Fungal H. Complement I. Viral J. Mast cell K. Parasitic
A. Bacterial
Meningococcal infections are quite common as a result of which deficiency of the component of the immune system?
All Answer Choices A. Bacterial B. B lymphocyte C. MHC Class I D. T lymphocyte E. Neutrophil F. MHC Class II G. Fungal H. Complement I. Viral J. Mast cell K. Parasitic
H. Complement
Produced by the liver, when triggered, enzymatically activate other proteins in a biological cascade and are important in innate and antibody mediated immune response?
All Answer Choices A. Bacterial B. B lymphocyte C. MHC Class I D. T lymphocyte E. Neutrophil F. MHC Class II G. Fungal H. Complement I. Viral J. Mast cell K. Parasitic
H. Complement
A complete deficiency in this molecule is associated with recurrent respiratory and gastrointestinal infections.
All Answer Choices A. C3a B. Macrophages C. AP50 D. IgM E. IgG F. NADPH oxidoase G. CH50 H. Myeloperoxidase I. MAC J. C3b K. IgA L. C1 M. Neutrophils
K. IgA
Leukocyte Adhesion Deficiency is characterised by a very high count in which ?
All Answer Choices A. C3a B. Macrophages C. AP50 D. IgM E. IgG F. NADPH oxidoase G. CH50 H. Myeloperoxidase I. MAC J. C3b K. IgA L. C1 M. Neutrophils
M. Neutrophils
Which crucial enzyme is vital for the oxidative killing of intracellular micro-organisms?
All Answer Choices A. C3a B. Macrophages C. AP50 D. IgM E. IgG F. NADPH oxidoase G. CH50 H. Myeloperoxidase I. MAC J. C3b K. IgA L. C1 M. Neutrophils
F. NADPH oxidoase
Which complement factor is an important chemotaxic agent?
All Answer Choices A. C3a B. Macrophages C. AP50 D. IgM E. IgG F. NADPH oxidoase G. CH50 H. Myeloperoxidase I. MAC J. C3b K. IgA L. C1 M. Neutrophils
A. C3a
What is the functional complement test used to investigate the classical pathway?
All Answer Choices A. C3a B. Macrophages C. AP50 D. IgM E. IgG F. NADPH oxidoase G. CH50 H. Myeloperoxidase I. MAC J. C3b K. IgA L. C1 M. Neutrophils
G. CH50
