Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Haem/Onc > Immunology and Immunodeficiency, ASPHO > Flashcards

Immunology and Immunodeficiency, ASPHO Flashcards

1
Q

WBC of innate immune system?

A

neutrophils, macrophages, dendritic cells, NK cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

WBCs of adaptive immune system?

A

CD3/CD4 T, CD3/8 T, B cell cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

NK cells express?

A

CD16, 56

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

diff between CD4 and CD8 cells?

A

CD4: help B cells class switch and help CD8 T cell kill…CD8 cells have cytolytic activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

killing viruses requires?

A

NK cells, CD4, CD8 cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

killing pneumocystis, fungi requires?

A

CD4, CD8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

killing bacteria requires?

A

b cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

adaptive immune system has what two arms?

A

cellular (t cells), humoral ( b cells)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

ALC of less than ___ -____ in an infant is highly abnormal

A

1000-2000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how to measure quantity of lymphocytes?

A

lymphocyte subset ennumeration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

how to measure immune function for t and b cells?

A

NONSPECIFIC:
t: proliferation to mitogens

b: measure total immunoglobulins (GAM) and can also measure IgG subclasses

SPECIFIC:

t: -proliferation to antigen for tetanus, candida
- intradermal candida control skin test

b: antigen-specfiic antibodies:
- protein: tetanus, hep b surface antigen
- carbohydrate: anti-A adn Anti-B is someone who’s blood type O; response to 23-valent pneumovax vaccine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

3 major types of circulating immunoglob?

A

IgM, IgG, IgA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

structure of IgM, IgG, IgA?

A

IgM: pentameric
IgG: monomeric
IgA: mono-, dimeric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

which immunoglob has highest affinity?

A

IgG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

which immunoglob corsses the placenta?

A

IgG…it’s small! monomeric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

causes of immunocomproimse?

A
  • loss of physical barriers (mucosal impairment, CVCs)
  • medication (corticosteroids, cyclosporine, rituximab, etc)
  • acquired or cong defects in cell # (neutropenia, CD4 lymphopenia)
  • acquired or congen defects in cell function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

re-do protein vaccines when after SCT?

A

~9-12 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

re-do live vaccines and carbohydrate vaccines when after SCT?

A

24 mos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

alemtuzumab, ATG, methylpred (high dose) all do what to t cells?

A

lysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

cyclosprine and tacro do what to t-cells?

A

inhibit TCR activation and early cytokine production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

methotrexate, mycophenolate, sirolimus do what to t cells?

A

inhibit clonal expansion, prolilferation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

in the pre-engraftment period, day 0-30: deal with waht defect? what infections happen then?

A
  • neutropenia, catheter
  • bacterial: gram pos, neg, anaerobes
  • fungal: candida, aspergillus
  • viruses: HSV, resp
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

in the post-engraftment early period (30-100): defects? infections?

A
  • lymphopenia esp CD4
  • t cell suppressive meds
  • acute GVHD
  • catheter
    infectious: gram pos, neg, anaerobes…asperfillus…CMV, resp, EBV-Lymphoprolif disease….pneumocystitis, toxoplasma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

if hte post-engraftment late period, >100 days: defects? infections?

A
  • lymphopenia esp CD4, t cell supp meds, cGVHD, poor Ig production
  • enapsuled organisms…aspgerillus…VZV, CMV, resp, EBV-LPD… pneumocystits, toxoplasma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
organisms we target for F&N?
- gram neg rods (e. coli, pseudomonas, klebsiella), gram pos cocci (strep viridans, staph aureus, enterococcus) - prevalent but mild: coag neg staph, anaerobes
26
driving risk in F&N
severe neutropenia, presence of catheter, mucosal barrier breaktown
27
F&N management
blood cultures start antibx ASAP..dont' wait for urine anti-pseudomonal beta-lactams or 4th gen cepahlo or carbapenem
28
antibx ppx: give to who?
can consider levoflox in AML induction, relapsed ALL
29
if decide on double gram neg rod coverage, can stop that when?
after 48 hours of neg cultures
30
when can you stop antibx for F&N?
- no fever - neg cultures - strong evidence of marrow recovery
31
fungal ppx: target what?
``` yeast= candida mold= aspergillus, zygomycosis, fusarium ```
32
who gets fungal ppx?
- allo HSCT pts - pts undergoing AML induction/MDS - auto SCT recipients with neutropenia for >7 days
33
what agent should be used for fungal ppx? alternatives?
fluconazole | alt: echinocandin (caspo), posaconazole (at least 13 yrs), itraconazole for CGD pts
34
fungal orgs ataht we target for F&N?
candida, aspergillus, zygomycosis, fusarium
35
consider empirc fungal coverage for which F&N pts?
allo HSCT pts, pts undergoing AML indcution/MDS, pts with HR ALL or relapsed leukemia
36
start antifungals when for F&N?
high risk pts with at least 96 hours of F&N that's not responsive to broad spectrum antibx
37
antifungal agent to use in F&N?
echinocandin (like caspo) or liposomal amphotericin b
38
pneumocystitis jirovecci: who's at risk?
anyone with CD4 lymphopenia (high dose chemo, HSCT, solid organ transplant, primary immunodef with low CD4 count or function
39
ppx for pneumocystits jirovecii?
trimethoprim sulfamethoxazole 5 mg/kg/day divided BID three days per week
40
3 alternatives to septra for pcp ppx?
``` atovaquone dapsone inhaled pentamidine IV pentamidine etc ```
41
who gets HSV ppx?
allo transplant who is seropositive pt <30 days
42
viral ppx for HSV?
acyclovir(foscarnet if resistant)
43
who gets CMV ppx?
allo transplant who is seropos themselves or who's donor is seropositivie, give for first 100 days
44
med for CMV ppx?
ganciclovir or valganciclovir or foscarnet or cidofovir
45
who gets VZV ppx?
allo SCT pt who has had wild type varicella infection...give up to 1 yr post
46
med for VZV ppx?
acyclovir IV or PO | or valacyclovir
47
VZIg give when?
give for exposure to varicella within 96 hours
48
absence of t-cells eg?
SCID
49
present t-cells but broken eg?
WAS
50
absence of b-cells eg?
XLA
51
present but broken b cells eg?
CVID
52
absence of neutrophils eg?
SCN
53
present but broken neurphils?
CGD
54
how does SCID get diagnosed now?
detected at birth via detection of ABSENT t cell receptor excision circles= ABSENT TRECs... then check ALC, lymphocyte subsets (t cells very low or absent) -lymphocyte proliferation studies (see absent/very low proliferation of t cells to mitogens -total IgG, IgM, IgA -specific Abs if vaccinated ...remember: if no t-cells, b-cells won't work properly either!
55
explanation for normal ALC but still having scid?
maternal engraftment
56
main genes in SCID?
IL2RG (x-linked)= most common!!> JAK3, IL7R (both AR)
57
SCID management:
- protect from infection - IgG replacement - aggressive diagnosis and prompt response to infection - ppx against pneumocystis - irrad bood products! - if ADA deficiency, give peg-ADA - immediate referral to bone marrow transplant
58
XLA= x-linked agammaglobulinemia: problem? tx?
no peripheral b cells--> becomes sick at 6-9 months once no longer has mom's IgG; replacement IgG
59
milder version of WAS?
x-linked thrombocytopenia: generally no eczema,normal immune function
60
immune issue in WAS?
normal to low T clelnumber, normal B cell number but poor Ab production (carbo responses...doesn't rspond to pneumovax)
61
immune features of WAS?
``` eczema allergies high ige aiha itp vasculitis of the skin arthritis colitis ```
62
was dx how?
was protein levels on flow | gene sequencing
63
tx for was?
splenectomy supportive HSCt <5 yrs
64
x-linked lymphoprolif disease: gene? presentations? tx?
SAP - fulminant/fatal EBV;lymphoprolif; recurretn infections with hypogamma or dysgamma - transplant
65
CVID dx? issue?
decrease igg/iga/ or igm and/pr poor ab production...defects in t cell numbr or function--> autoimm, granulomatous disease, lymphoma
66
infections seen in CVID?
sinopulmonary infections, enteroviral meningoencephalitis
67
heme issues seen with CVID?
ITP, evans, AIHA, autoimmune neutropenia
68
tx for CVID?
IgG replacement, supportive care for infectious and autoimmune issues
69
ALPS: pathophys?
defect in pathways controling apoptosis of lymphocytes
70
major mutation in ALPS?
FAS
71
why are hematologists poised to see ALPS?
oftne prsent with autoimmune cytopenia
72
what are the 2 requied criteira for ALPS?
- chronic (>6 months) non malig, noninfect LAD, and/pr splenomegaly - elevated CD3+, TCR alpha beta + CD4 neg CD8 neg DNT cells
73
accessory criteria for ALPS? (2)
- defective lymphocyte apoptosis | - somatic or germline pathogenic mut
74
secondary criteira for ALPS? (4)
- elevated plasma sFASL or IL-10 or vit B12 or IL18 - typical findings on histo - autoimmune cytoepnias and hypergammaglob - fam hx of nonmalig/noninfectious lymphoprolif with or without autoimmunity
75
tx ALPS how?
- manage cytopenias: steroids, MMF, 6MP, ritxu, sirolimus - role for splenectomy is controversia - watch for lymphoma
76
immunodef indications for transplant?
``` WAS CD40ligand def XLP CGD Leuk adhesion def ```
77
conditoning for immunodef SCT?(not SCID)
busulfan (Stem cell kill) + cyclophos or fludarabine (to prevent rejection)
78
why do you not need conditioning for MSD in SCID?
profound lack of functional t-cells...HSCs can easily engraft in the thymus adn generate t-cells
79
if you have a MSD for SCID transplant do you need conditioning? t cell depletion?
no | no (matched t cells unlikely to cause GVHD)
80
if you have a haplo parent for SCID transpalnt do you need conditioning? t cell depletion?
no | yes
81
if you have an unrealted donor for SCID, do you need conditioning? t-cell dep?
yes | either one

Haem/Onc (30 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions