Immunology

Question 1

CD14

Answer 1

It is a TLR present on macrophages that recognizes LPS

Question 2

Activation of TLRs leads to what

Answer 2

Upregulation of NF-kappa B

Question 3

Actions of prostaglandins

Answer 3

Vasodilation of arteriole
Increased vascular permeability
Fever and pain (PGE2)

Question 4

Leukotrienes

Answer 4

Attract and activate neutrophils

Also mediate vasoconstriction, bronchospasm, and increase vascular permeability

Question 5

What process allows for increased vascular permeability?

Answer 5

Contraction of endothelial pericytes

Question 6

Activation of classic complement pathway

Answer 6

Binds an IgG or IgM that are bound to an antigen

Question 7

Activation of the alternative complement pathway

Answer 7

Complement directly to microorganisms

Question 8

Activation of lectin complement pathway

Answer 8

MBL binds mannose on microorganisms

Question 9

C3a and C5a

Answer 9

Trigger mast cell degranulation

Question 10

C5a

Answer 10

Chemotactic for neutrophils

Question 11

C3b

Answer 11

Opsonin for phagocytosis

Question 12

MAC (C5b-C9)

Answer 12

Lyses microbes by creating holes in cell membrane

Question 13

Bradykinin actions

Answer 13

Pain, vasodilation, and increased vascular permeability

Question 14

What leads to fever during acute inflammation?

Answer 14

Pyrogens –> macrophages to release IL1 and TNF –> increase COX activity in hypothalamus –> increased PGE2

Question 15

Steps of neutrophil entry into tissue

Answer 15

Margination: vasodilation slows blood so neutrophils flow to the periphery
Rolling: SLX on neutrophils bind selectins which slow neutrophil movement
Adhesion: Integrins (CD18) on neutrophils bind ICAM 1 on endothelial cells
Transmigration (PECAM-1)
Chemotaxis (bacteria, leukotrienes, C5a, IL-8)

Question 16

Leukocyte Adhesion Deficiency

Answer 16

Deficiency in CD18 (integrin)

Delayed separation of the umbilical cord, increased circulating neutrophils, recurrent bacterial infections

Question 17

Chediak-Higashi Syndrome

Answer 17

Protein trafficking defect characterized by impaired phagolysosome formation

Increased pyogenic infections, neutropenia, giant granules in leukocytes, albinism, peripheral neuropathy

Question 18

Chronic granulomatous disease

Answer 18

Defective NADPH oxidase –> poor O2 dependent killing

Granulomas are caused by catalase-positive organisms

Question 19

Anti-inflammatory mediators

Answer 19

IL-10 and TGF-beta (secreted by macrophages)

Question 20

IL-8

Answer 20

Released by macrophages to call more neutrophils to the site of inflammation

Question 21

Di George Syndrome

Answer 21

Developmental failure of 3rd and 4th pharyngeal pouches due to 22q11 deletion

No thymus (T cell deficiency), hypocalcemia, abnormal heart/great vessels/face

Question 22

SCID causes

Answer 22

Cytokine receptor defects
adenosine deaminase deficiency 
MHC class II deficiency

Question 23

X-linked agammaglobulinemia

Answer 23

Complete lack of immunoglobulin due to disordered B-cell maturation (BTK mut)

Susceptible to: bacterial, enterovirus, and giardia infections after 6 months of life

Question 24

Hyper IgM Disease

Answer 24

Due to mut in CD40 which means that class switching cannot occur

Question 25

Wiskott-Aldrich syndrome

Answer 25

Due to X-linked mut in WASP gene Thrombocytopenia, Eczema, Recurrent infections

Question 26

Describe look of.... Neutrophils Lymphocytes Plasma Cells

Answer 26

Multi-lobular nucleus One center nucleus Nucleus off to side

Question 27

T cell receptor complex

Answer 27

MHC recetor + CD3

Question 28

T cell activation

Answer 28

Binding of MHC/antigen complex AND B7 (APC) binds CD28 for CD4 T cells IL-2 for CD8 T cells

Question 29

TH1 Cells

Answer 29

Secrete IL-2 --> activated CD8 cells | Secretes IFN-gamma --> activates macrophages

Question 30

TH2 Cells

Answer 30

``` Secrete IL-4 --> class switching to IgG and IgE IL-5 --> class switching to IgA, eosinophil chemotaxis, and maturation of B cells IL-10 --> inhibits TH1 cells ```

Question 31

Cytotoxic killing by CD8 T cells

Answer 31

Express FasL and binds Fas on target cells | Secrete perforins and granzymes --> apoptosis

Question 32

What is expressed on naive B cell surface

Answer 32

IgM and IgD

Question 33

B cell activation

Answer 33

Antigens can directly bind IgM or IgD on surface or | CD40 receptor on B cell binds CD40L on TH cells

Question 34

Causes of non-caseating granulomatous inflammation

Answer 34

``` Reaction to foreign material Sarcoidosis Beryllium exposure Crohn disease Cat scratch disease ```

Question 35

Causes of caseating granulomatous inflammation

Answer 35

TB | Fungal infections

Question 36

Granuloma formation

Answer 36

Macrophages present antigens to CD4 T cells | Macrophages --> IL-12 --> TH1 --> IFN-gamma --> converts macrophages to epithioid histiocytes and giant cells

Question 37

SLE

Answer 37

Autoimmune that can be Type II or Type III HSR Malar rash, arthritis, heart issues, diffuse proliferative glomerulonephritis, anemia ANA and anti-dsDNA

Question 38

Drug induced lupus

Answer 38

Hydralazine, procainamide, isoniazid Antihistone antibody

Question 39

Anti-ribonucleoprotein antibodies

Answer 39

Anti-SS-A or Anti-SS-B | Sjogrens syndrome

Question 40

Anti-DNA topoisomerase I (Scl-70)

Answer 40

Generalized Scleroderma

Question 41

CREST syndrome antibody

Answer 41

Anti-centromere Calcinosis, Raynaud, esophageal dysmotility, sclerodactyly, telangiectasias

Question 42

U1 ribonucleoprotein antibody

Answer 42

Mixed connective tissue disorders

Question 43

Macrophages release

Answer 43

``` IL-1 --> endogenous pyrogen TNF-alpha --> vascular leak/septic shock IL-6 --> actute phase reactants IL-8 --> attracts neurtrophils IL-12 --> promotes TH1 ```

Question 44

Natural killer cells

Answer 44

CD16 --> binds Fc on IgG --> antibody dependent cellulary cytotoxicity CD56 (NCAM)

Question 45

CD25

Answer 45

Regulatory T cells

Question 46

Graft vs Host Disease

Answer 46

Mostly with bone marrow transplant | Donated CD8 T cells react with recipient cells

Question 47

Joints affected in RA

Answer 47

MCP and PIP | They also get subcutaneous nodules when RF positive

Question 48

Large vessel vasculitis

Answer 48

Temporal arteritis (giant cell) Jaw claudication, headache, --> blindness High ESR and granulomas Takayasu Weak pulses in one arm a d high ESR Granulomas in aortic arch and branches

Question 49

Medium vessel vasculitis

Answer 49

Kawasaki Diffuse red rash, strawberry tongue, --> coronary aneurysms Beurgers Male smokers with gangrene Polyarteritis Nodosa Immune complex mediated w/ Hep B Nodules, palpable purpura, and renal failure Beads on a string, fibrinoid necrosis of vessels

Question 50

Small vessel vasculitis

Answer 50

Henoch-Schonlein purpura Follows a URI in children (IgA + C3 deposition) Palpable purpura, GI issues, nephritis Churg-strauss p-ANCA, asthma, sinusitis, neuropathy Granulomatous necrotizing vasculitis Microscopic polyangiitis p-ANCA, hemoptysis, kidney failure, purpura Wegerners c-ANCA, sinusitis, otitis media, hemoptysis, renal Granulomas