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Immunology Flashcards

1
Q

Types of IgA

A

IgA1- Found in serum and airways

IgA2- Found in mucous and gut

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2
Q

Cryoglobulinemia types

A

Type 1 - Monoclonal - usual related to MGUS/Myelomas
Type 2 - Monoclonal IgG/IgM + Polyclonal - usually infections
Type 3- Polyclonal - Usually auto-immune and some infections.

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3
Q

MOA of PD1/PDL1 inhibitors

A

prevents the signalling for programmed apoptosis

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4
Q

MOA of CTLA4 inhibitors

A

enhances APC activation of T cells by stopping the inhibitor receptor and ligand connection of CTLA4 to CD80, allowing CD28 and CD80 to connect and allow T cell differentiation

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5
Q

PAMPs stands for

A

Pathogen associated molecular patterns.

These are detected by toll like receptors which are a type of pattern recognition receptor.

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6
Q

Role of CRP in immune system

A

Can activate the classical complement pathway

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7
Q

What is CH50

A

A test of complement activity by testing the capacity to lyse foreign erythrocytes.

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8
Q

What is AH50

A

Tests the alternative complement pathway functioning

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9
Q

Activation of classical pathway

A

antigen-antibody reaction.

1x IgM or 6x IgG

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10
Q

Activation of Alternative pathway

A

microbial cell surfaces

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11
Q

Activation of Mannose binding Lectin pathway

A

plasma lectin that binds to mannose residues on microbes

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12
Q

Classical pathway cascade

A

C1 -> C4b -> C4bC2a (C3)-> C4bC2aC3b (C5)

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13
Q

Alternative pathway cascade

A

C3 -> spontaneous C3a, C3b -> C3bBb (C3)

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14
Q

Mannose binding lectin pathway cascade

A

MBL -> MSAP1, MSAP2 -> C4b -> C4bC2a (C3) -> C4bC2aC3b (C5)

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15
Q

Test used for anaphylactic reactions

A

Tryptase

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16
Q

Management of fever + neutropenia + organ dysfunction post CAR-T T cell therapy

A

This is Cytokine release syndrome.

Mx - Tocilizumab (IL-6R antagonist)

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17
Q

Role of Basilixumab

A

CD25 inhibitor.

Prevents T cell medicated rejection

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18
Q

Hypersensitivity types

A

Type 1: Immediate reaction. Mast cell degranulation causing histamine release. IgE mediated. Eg asthma, anaphylaxis.

Type 2: IgG mediated direct attack on cells. Eg haemolytic transfusion reactions.

Type 3: Immune complex deposition disease, activates complement causing inflammation in that tissue. Eg lupus, GN, serum sickness, Arthus reaction.

Type 4: Delayed reaction from T-cell mediated response. Eg contact dermatitis, chronic graft rejection.

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19
Q

FOX P3 mutation

A

FOX P3 is a gene involved in regulatory T cells.
Loss of CD4 and CD25 suppression.

Causes IPEX syndrome- Immune dysregulation, polyendocrinopathy, enteropathy, X-linked

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20
Q

mucocutaneous candidiasis, hypoparathyroidism, and adrenal failure triad

A

AIRE deficiency (autoimmune regulatory enzyme)/autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED)

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21
Q

Castleman’s disease cause and symptoms.

A

Lymphoproliferative disorder with IL-6 overactivation.
Can be associated with HHV8
Can be associated with POEMS (polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal protein, Skin changes)

Mx - IL6 inhibitors - Siltuximab, Tocilizumab.

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22
Q

In what part of the immune system are Toll-like receptors

A

Innate immune system

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23
Q

Where is CRP produced and what stimulates it

A

In liver, stimulated by IL-6

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24
Q

Treatment for hereditary angioedema

A

Icatibant - Bradykinin antagonist

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25
Receptors in the innate immune system
Toll-like receptors
26
Cytokines released by damaged cells
IL-1beta TNF- alpha IL-12 IL-6
27
MOA Natalizumab
Blocks VLA-4 (alpha 4), so white cells cannot cross blood vessel walls into organs
28
MOA Fingolimod
Inhibits SIP-1. Stops lymphocytes leaving the lymph nodes
29
Role of C3a
inflammatory mediator
30
Role of C3b
Opsonisation
31
Deficiency of C1-esterase inhibitor causes:
High levels of C1 - Hereditary angio-oedema
32
Immunosuppressive cytokines
IL-10, TGF-beta
33
T cell for extracellular pathogens - eg fungi
TH17
34
T help cell subtypes and roles
TH1 - macrophage activation and opsonisation antibodies for intracellular pathogens TH2 - B cell activation, neutralizing antibodies. for parasites. Allergy. TH17 - Neutrophil recruitment + extracellular pathogens T reg - Anti-inflammatory
35
Role of IL 1
Promotes inflammation Inhibitor Drug - Anakinra
36
Role of IL 2
Promotes T cell growth Inhibitor drug - Basilixumab
37
Role of IL 3
Stimulates haematopoiesis. | Neutrophil activation.
38
Role of IFN gamma
Causes B cells to produce IgG subclasses for opsonisation and phagocytosis of intracellular pathogens. Causes TH cells to become TH1 to activate macrophages and responds to intracellular pathogens.
39
Role of IL 5
Stimulates Eosinophil growth Inhibitor drug - Mepolizumab, Benralizumab
40
Role of IL 6
Promotes fever and CRP production. Inhibitor drug - Tocilizumab
41
Role of IL 15
NK cell growth
42
Role of TNF beta
Attacks malignant cells
43
Role of TGF- beta
Stimulates IgA production for mucosal immunity
44
IL 12/23 inhibitor
Ustekinumab
45
IL 17 inhibitor
Secukinumab
46
Drugs causing hypersensitivity vasculitis
PTU, Frusemide, Thiazides
47
Polyarteritis Nodosa gene
ADA2
48
SCID gene
ADA1
49
Treatment for GPA
1. Cyclophosphamide 2. Azathioprine maintainence 3. Prednisolone if flare 4. Rituximab if poorly controlled
50
How does immunotherapy work for allergy
High doses of the allergen switches pathway from TH2 to TH1.
51
Most common immunodeficiency
IgA deficiency
52
Disease with recurrent respiratory infections and bronchiectasis
CVID
53
Infection type in complement deficiency
Neisserial infections
54
Disease causing granulomas + recurrent infections.
Chronic granulomatous disease - a neutrophil disorder due to defective NADPH
55
Defects in complement classical pathway cause
Autoimmune disease
56
Defects in complement alternative pathway cause
Renal disease - aHUS + C3 glomerulopathy
57
Defects in complement membrane attack complex cause
Immunodeficiency and Neiserrial infection
58
Function of AIRE
Works in the thymus for T cell selection. - If high binding affinity to antigen - apoptosis occurs as likely self. - If low binding affinity occurs - positive selection as likely pathogen.
59
Function of AIRE
Works in the thymus for T cell selection. - If high binding affinity to antigen - apoptosis occurs as likely self. - If low binding affinity occurs - positive selection as likely pathogen.
60
How do IgA1 and IgA2 differ?
In their heavy chain components
61
Where are the IgA subclasses found
IgA1 - airways and serum | IgA2 - mucosa + colon - can bind to got pathogens
62
CD marker on NK cells
CD56, CD16, CD2, IL2
63
Function of NK cells
1. Direct cytotoxicity to infected and malignant cells - by release of perforins and granzymes. 2. Mediate antibody mediated cytotoxicity through CD16. 3. Mediate T cell responses by INF gamma.
64
what is the trial for AERD (aspirin exacerbated respiratory disease)
- aspirin intolerance - asthma - nasal polyps Aspirin desensitisation can be used to treat AERD or if aspirin is required for another medical indication. Once desensitized, patients must take at least 325 mg of aspirin daily to maintain the desensitized state.
65
CD markers in Tregs
CD4 CD25
66
Regulator gene of Tregs
FOXP3
67
immune cell reliant on its release of mediators into the extracellular fluid surrounding the organism in order to carry out its role in eradication of foreign organisms.
Eosinophils
68
What is the role of somatic hypermutation in B cells?
Where B-memory cells once encountered by the antigen under go a process of re-arrangement to find the antigen that binds with the highest affinity to that antigen. Allows for selection of high affinity B cells from the base B-cell.
69
Genetic defect leading to increased Mycobacterial (TB and non-TB) infections
Defect in IFN-IL12 pathway = Mendelian susceptibility to mycobacterial diseases. Includes GATA2 and STAT1 mutations, NEMO.
70
People at high risk for latex allergy
- Health care workers - exposure to gloves. | - Patients with spina bifida - exposure to latex from recurrent catheterisations.
71
What cells have CD20
CD20 is highly expressed on B cells but not on stem cells or mature plasma cells
72
Survival prognosis for solid organ transplants - heart, lungs, kidney, liver.
Lung - 6.5 years - higher in double lung transplant - lowest 1 yr survival is in IPAH - highest 1 yr survival is in COPD (but decreases with time) - lowest 10 yr survival is ILD. Cardiac - 11 years Kidney - 90% 5 year survival Liver - 75% 5 year survival
73
Red meat allergy cause
Tick bite - alpha gal allergy
74
Reaction in serum sickness
Type 3 hypersensitivity reaction. An antigen which has antibodies directed against causing antigen-antibody or immune complexes. Normally cleared by phagocyte system, but excess immune complexes may deposit in tissues or form directly in the involved tissues. Deposition of immune complexes causes complement activation and/or recruitment of neutrophils by interaction of immune complexes with Fc IgG receptors.
75
Functions and clinical relevance of beta 2 microglobulin
1. It is a component of MHC1 markers on all cells. 2. Regulates Hepcidin expression in the liver (with HFE protein) 3. Can cause dialysis associated amyloidosis 4. Can be a marker in multiple myeloma.
76
Which cell type destroys cells with MHC1 downregulation
NK cells
77
Mutation and type of mutation in Mastocytosis
KIT - gain of function (receptor) | Stem cell factor (ligand)
78
Function of plasmacytoid dendritic cells.
Cells which recognise viruses and produce interferrons. | Are NOT phagocytic APC's like classical dendritic cells.
79
Pathogens associated with each toll-like receptor
TLR1 - Mycoplasma TLR2 - Gram Positive, viruses, Parasites, self. TLR3 - Viruses. Work through NFkB TLR4 - Gram Negative , viruses, self TLR5 - Flagella. Work through NFkB Others - TLR6 - mycoplasma TLR7/8 - ssRNA viruses TLR9/11 - protozoa. "My pink vagina never fakes orgasms" which takes a TOLL on our relationship.
80
Staph decolonisation procedure
Mucopuricin and chlorhex antiseptic wash | Do this AFTER all acute lesions have healed
81
Contra-indications to the varicella vaccine
- Anaphylaxis to varicella vaccine - Pregnancy + 28 days before - but CAN have vaccine when breastfeeding - People who have received an immunoglobulin-containing product should wait 3–11 months before receiving varicella vaccine - People who have received a varicella-containing vaccine should not receive immunoglobulin-containing products for 3 weeks after vaccination - HIV if CD4 <200 - People on steroids >1mg/kg (must stop for atleast 1m before vaccine) - 6 months after blood product transfusion - people on bDMARDs and tsDMARDs NOTE: People ≥50 years of age with mild immunocompromising conditions may receive zoster vaccine.
82
tsDMARDs and MOA
barcitinib tofacitinib MOA: Jakus kinase inhibition
83
Uses and SE of tsDMARDs
barcitinib tofacitinib SE: Infection: Infection (20% to 22%) Respiratory: Nasopharyngitis (3% to 14%) Increased serum cholesterol (5% to 9%)
84
NK cell activating receptor and ligand
ligand - MIC A | receptor - G2G
85
NK cell inhibiting receptor and ligand
ligand - MHC 1 | receptor - KIR
86
SCID mutations
Zap 70 JAK3 - autosomal recessive ILR2 mutation - X-linked
87
recurrent infections + bad teeth + fine hair + no sweating
NF-Kappa-B mutation in receptor NEMO
88
Cytokine which triggers B cells to produce IgA
TNF- beta
89
Cytokine which triggers B cell to produce IgG
IFN- gamma
90
Cytokine which triggers B cell to produce IgE and IgG4
IL4
91
Cytokine which activates neutrophils
IL 17 | - also activates TH17
92
Which cell type mediates SJS
T cells - SJS is not an IgE reaction
93
Methods of T cell activation by drugs
1. Hapten - reactive drugs are a direct T cell target and cell is attacked when it is bound to cell protein. 2. Prohapten - drug only becomes reactive when bound to cell protein 3. Pi concept - drug directly activates receptor on t cell.

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