immunology

Question 1

Have a major role in innate immunity. Kill pathogens by oxidative free radicals. Can test function using the NBT (nitroblue tetrazdium) test. Important in the defence against bacterial and fungal infection.

Answer 1

neutrophil

Question 2

Respond to pathogen peptides bound to HLA class 1 molecules. Directly kill infected cells via the production of perforin, inducing apoptosis. Protect against viral infections and tumours.

Answer 2

CD8 T cell

Question 3

Antibody producing cells. Fully differentiated.

Answer 3

plasma cell

Question 4

Respond to pathogen peptides bound to HLA class II molecules. Activate other lymphocytes. Produce cytokines and influence phagocyte function. Immunoregulatory cells.

Answer 4

CD4 T cell

Question 5

Found within the bloodstream as monocytes. Phagocytic.

Answer 5

macrophage

Question 6

A component of this pathway is vital in opsonisation of pathogens. When bound to antigen can indirectly activate phagocytes.

Answer 6

complement

Question 7

The immunoglobulin that binds to allergen in a Type I hypersensitivity reaction.

Answer 7

IgE

Question 8

A mast cell degradation product that can be measured during an acute episode of anaphylaxis.

Answer 8

Serum tryptase

Question 9

Seen in high quantities with chronic Type I hypersensitivity reactions, particularly as an infiltrate. Within the lungs, may contribute to chronic yellow sputum production.

Answer 9

Eosinophils

Question 10

A 25 year old woman visits her GP. She is normally fit and well, but has been finding running increasingly difficult, particularly when it is cold. She complains of feeling short of breath and wheezing. There are no abnormal findings on examination and no significant past medical history.

Answer 10

Intrinsic asthma

Question 11

A 68 year old man is admitted to hospital having become increasing short of breath over the past two days. He has had a cough for many months, but is now coughing up green sputum. He already takes tiotropium and salmeterol. He is a smoker, smoking 20 cigarettes per day for the past 40 years.

Answer 11

Acute infective exacerbation of COPD

Question 12

A 12 year old boy is brought to the GP by his parents. He says he feels like he sometimes can’t get air in, and his mother is worried he has hayfever as it seems to be worse in the summer. He has a past history of eczema and his father has asthma and says he has allergies. On auscultation he has a generalised wheeze.

Answer 12

Atopic asthma

Question 13

A 40 year old woman has been treated for asthma for several years, and has known allergies to various allergens including the house dust mite. She has been escalated through the available therapy and is still poorly controlled, with frequent exacerbations and hospital admissions. She already takes a beta-2 adrenoceptor agonist, an inhaled and an oral steroid and several add-on treatments. She is particularly worried about steroid side effects.

Answer 13

Subcutaneous omalizumab

Question 14

A 66 year old man with a long-standing history of COPD is finding it increasingly difficult to breathe, despite being on several different medications. He tells his GP that he cannot cough as easily and struggles to expectorate sputum. He is already receiving physiotherapy.

Answer 14

Oral carbocysteine

Question 15

A 20 year old woman visits her GP complaining of occasional shortness of breath, brought on by exercise. She wheezes and has a night-time cough but no other symptoms. She has a salbutamol inhaler as required and no other medication, has no known allergies, and is otherwise fit and well.

Answer 15

Inhaled beclomethasone

Question 16

An 18 year old man is admitted to hospital acutely short of breath. He cannot speak in full sentences and is audibly wheezing. He has been given a beta-2 adrenoceptor agonist and steroids, and his doctor wishes to give him a further inhaled drug.

Answer 16

Nebulised ipratropium

Question 17

A 68 year old man with long-standing COPD has been prescribed several medications. However, he is struggling to cope at home, and when he is examined you see is SaO2 is 82% with a PaO2 of 7.25kPa.

Answer 17

Domicilary oxygen

Question 18

A 22 year old woman with asthma on an inhaled steroid has been using a reliever inhaler for some time, but is finding she is now wheezing and feels more breathless when she exercises.

Answer 18

Inhaled long acting beta-2 adrenoceptor agonist

Question 19

A 59 year old man presents to his GP with a cough that he has been suffering from for at least six months. He tells you he brings up clear phlegm daily, but that it has occasionally been green and unpleasant when he gets a cold. He has come in today because he heard that long term coughs should be checked by a doctor. He smokes approximately 40 cigarettes a day, and has been smoking for over 30 years. He is much more breathless when walking around than he used to be.

Answer 19

COPD with features of chronic bronchitis

Question 20

A 78 year old woman is admitted to hospital short of breath. She feels that even sitting talking to you is too much effort, and she is struggling to get up to the bathroom without help. She is generally unwell, with a temperature of 38.2, but no other investigations have been returned yet. She has a 50 pack-year smoking history. She has a cough, which she says is normal for her, but she is bringing up thick yellow sputum, which she does not normally. She takes regular inhaled medicines, but feels these are not helping her as they usually do.

Answer 20

Acute exacerbation of COPD

Question 21

A 35 year old woman visits her GP complaining of shortness of breath. She finds she feels her chest is tight and that she is struggling to breathe. This mostly affects her at home, and tends not to be as bad any other time. She is coughing at night, but this is non-productive. On examination she has a generalised wheeze, but no other abnormal findings. When you are discussing your thoughts, she mentions that her and her partner recently bought a kitten, and wonders if this is the cause of her problem.

Answer 21

Extrinsic allergic asthma