Immunology continued

Question 1

Age related decline in immune function

Answer 1

Decreased cell mediated immunity
Decreased T cells
Increased T suppressor number
Decreased T helper
Loss of immune memory cells
Decline in Ab titers known to Ag
Increased autoimmunity

Question 2

Diseases of immunoglobulin over production

Answer 2

Multiple Myeloma

Monoclonal Gammopathy of uncertain significance (MGUS)

Question 3

Multiple Myeloma

Answer 3

over production of plasma cells
Anemia, hypercalcemia and bone pain
M spike of SPE characteristic
Differentiated from MGUS by plasma infiltrate in bone marrow
Lytic lesions of bone (mostly in spine)
Bence- Jone proteins present in urine
Prone to infetion by strep pneumo and H influenzae

Question 4

Monoclonal Gammopathy of Uncertain significance

Answer 4

Nessecary to differentiate from Multiple Myeloma
M spike on SPE
33% risk of developing malignant disorder ta 20 years
Need to do a bone marrow aspirate to differentiate between MM and MGUS

Question 5

Immunodeficiency disorders

Answer 5

Selective IgA deficiency,

HIV

Question 6

Selective IgA deficiency

Answer 6

Most common primary disorder (genetic)
Absence of IgA with normal levels of IgG and IgM
Most asymptomatic, but may have recurrent infections (usually GI and respirtatory)
Linked with autoimmunity

Question 7

HIV

Answer 7

Attacks CD4 cells
Disease of cell mediated immunity
Monitor of CD4 and viral load for prognostic indicators of treatment
opportunistic infections with decrease CD4
Goal of treatment is to get the viral load as low as possible (CD4 above 500)

Question 8

Diseases of Autoimmunity

Answer 8

RA, Lupus, myasthenia gravis

Question 9

RA

Answer 9

Chronic inflammation of joints
Most have MHC II type or HLA
Rheumatoid factor produced by macrophages that infiltrate joint spaces

Question 10

Lupus

Answer 10

Unknown cause
Circulating immune complexes (IgG - IgM bound) present lead to glomerulonephritis and skin manifestations
ANA negative rules out
Anti dsDNA >90% positivie predictive value
More often effects women
butterfly rash to the face after sun exposure
Black finger tips

Question 11

Myasthenia Gravis

Answer 11

Self reflective anibodies bind to receptor for neurotransmitter ach
Muscle weakness and paralysis
ABX to avoid: fluroquinilones, gentamycin, azithromycin

Question 12

Type I hypersensitvity

Answer 12

Release of histamines and other mediators follow. Leads to edema and smooth muscle contraction.
IgE mediated.
Allergic asthma, allergic rhinitis, anaphylaxis

Question 13

Type III

Answer 13

Immune complex mediated
local and systemic inflammitory reactions die to immune complex formation in the tissues
RA, SLE, good pastures’s syndrome, arthus reacrtion, serum sickness

Question 14

Type II

Answer 14

Antibody mediated
IgG, IgM. antigen interactions on target cell surfaces.
Drug induced cytopenia, Myasthenia Gravis, Graves, haemolytic anemia of newborn

Question 15

Type IV

Answer 15

Delayed
Sensitized Th1 cells activate to release cytokines upon binding to antigen, resulting in macrophage and cytotoxic tcell accumulation.
Contact dermatitis
chronic transplant rejection