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Immunology > Immunology Exam 5 (Vaccines, Immunoproliferative, Immundeficiency diseases) > Flashcards

Immunology Exam 5 (Vaccines, Immunoproliferative, Immundeficiency diseases) Flashcards

1
Q

What is Active Immunity? Give a few examples of active immunity.

A

Stimulation of a person’s own immune system to mount an adaptive immune response to an antigen.

Examples:
- Natural exposure to an infection (natural active)
- Administration of vaccine (artificial active)

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2
Q

What is Passive Immunity? Give a few examples of passive immunity.

A

Transfer of preformed antibodies from immunized hosts to a non-immune individual.

Examples:
- Transfer of antibodies through placenta/breast milk (natural passive)
- Passive immunotherapy (RhoGam, monoclonal Ab) (artificial passive)

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3
Q

What antibody mediates placental vs breast milk antibody transfer?

A

Placental - IgG
Breast Milk - IgA

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4
Q

Benefits of passive immunity

A
  • Provides immediate immunity
  • Can be used as immunosuppressive therapy in selected situations
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5
Q

Limitations of passive immunity

A
  • Short lived immunity
  • Can induce Type I or Type III hypersensitivities
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6
Q

What is HISG (Human Immune Serum Globulin)?

A

“Gamma globulin” - pooled serum from donors with a wide range of antibodies against numerous antigens; good for immunodeficient patients that need broad spec antibodies

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7
Q

What are Antigen-Specific Immune Globulins?

A

“Hyperimmune globulins” - made from pooled serum of donors with immunity to a particular pathogen; good to treat unimmunized individuals who have potentially been exposed to a pathogen
Ex. Rabies, Tetanus, HepA/HepB

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8
Q

What are animal globulins?

A

Usually prepared from horse serum
- Anti-toxins (tetanus, diphtheria, botulism)
- Anti-venom

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9
Q

Monoclonal antibodies

A

Made by a single clone of B cells, directed against a particular epitope of an antigen

Used for cancer, autoimmune diseases

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10
Q

Adoptive immunity

A

Transfer of cells (usually lymphs) of the immune system used to increase cell-mediated immunity

Ex. CAR-T cell therapy, HSC transplants, cancer treatment with TILs

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11
Q

Advantages and disadvantages of active immunity

A

Adv: Induces long term protection (memory cells created)
Disadv: Takes time to develop

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12
Q

Advantages and disadvantages of passive immunity

A

Adv: Immediate protection
Disadv: Short term (memory not produced)

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13
Q

Advantages and disadvantages of adoptive immunity

A

Adv: Can transfer cell-mediated immunity
Disadv: immune cells must be depleted, possible rejection (GvHD)

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14
Q

What vaccine provides immunity for Chickenpox? How is this disease spread? What are the disease complications?

A

Varicella
Air/direct contact
Blisters, bleeding disorders, encephalitis, pneumonia

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15
Q

What vaccine provides immunity for Diphtheria? How is this disease spread? What are the disease complications?

A

DTaP
Air/direct contact
Swelling of heart muscle, heart failure, coma, paralysis, death

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16
Q

What vaccine provides immunity for Hib? How is this disease spread? What are the disease complications?

A

Hib vaccine
Air/direct contact
Meningitis, epiglottis

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17
Q

What vaccine provides immunity for Hepatitis A? How is this disease spread? What are the disease complications?

A

HepA vaccine
Direct contact, contaminated food/water
Liver failure, arthralgia, kidney/pancreatic disorders

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18
Q

What vaccine provides immunity for Hepatitis B? How is this disease spread? What are the disease complications?

A

HepB vaccine
Contact w/ blood or body fluids
Liver failure, liver cancer

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19
Q

What vaccine provides immunity for Influenza? How is this disease spread? What are the disease complications?

A

Flu vaccine
Air/direct contact
Pneumonia

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20
Q

What vaccine provides immunity for Measles? How is this disease spread? What are the disease complications?

A

MMR vaccine
Air/direct contact
Encephalitis, pneumonia

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21
Q

What vaccine provides immunity for Mumps? How is this disease spread? What are the disease complications?

A

MMR vaccine
Air/direct contact
Meningitis, inflammation of testicles/ovaries

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22
Q

What vaccine provides immunity for Pertussis? How is this disease spread? What are the disease complications?

A

DTaP vaccine
Air/direct contact
Pneumonia

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23
Q

What vaccine provides immunity for Polio? How is this disease spread? What are the disease complications?

A

IPV vaccine
Air/direct contact/through mouth
Paralysis and death

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24
Q

What vaccine provides immunity for Pneumococcal? How is this disease spread? What are the disease complications?

A

PCV13 vaccine
Air/direct contact
Bacteremia, meningitis

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25
Q

What vaccine provides immunity for Rotavirus? How is this disease spread? What are the disease complications?

A

RV vaccine
Through the mouth
Severe diarrhea and dehydration

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26
Q

What vaccine provides immunity for Rubella? How is this disease spread? What are the disease complications?

A

MMR vaccine
Air/direct contact
Very serious in pregnant women, can lead to miscarriage/stillbirth/premature delivery

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27
Q

What vaccine provides immunity for Tetanus? How is this disease spread? What are the disease complications?

A

DTaP vaccine
Exposure through cuts in skin
Broken bones, breathing difficulty, death

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28
Q

What are attenuated vaccines?

A

Contain live, but weakened viruses or bacteria
Organisms grown under abnormal conditions so that they are no longer pathogenic but are still capable of stimulating the immune response
- Chick embryo passaging

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29
Q

Examples of live, attenuated vaccines for bacterial diseases

A

BCG - for M. tuberculosis/M. bovis
Typhoid fever - for Salmonella typhi

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30
Q

Examples of live, attenuated vaccines for viral infections

A

Polio (Sabin) –> orally
Influenza (nasal mist)
MMR
Varicella Zoster

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31
Q

Rubeola vs Rubella

A

Rubeola = measles (M in MMR)
Rubella = German measles (R in MMR)

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32
Q

What are some advantages and disadvantages of live, attenuated vaccines?

A

Adv: Stimulates humoral AND cell-mediated immunity

Disadv: Cannot be given to immunocompromised, potential interference by maternal antibodies, may revert to pathogenic form

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33
Q

What are inactivated (whole killed) vaccines

A

Intact viruses/bacteria that have been killed by chemicals or heat

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34
Q

Examples of inactivated (whole killed) vaccines

A

Polio (Salk) - intramuscular
Influenza - intramuscular or intradermal
Hepatitis A

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35
Q

Polio Salk vs Polio Sabin

A

Polio Salk = intramuscular vaccine for polio that is whole killed

Polio Sabin = oral vaccine for polio that is live, attenuated

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36
Q

Advantages and disadvantages of inactivated (whole killed) vaccines

A

Adv: Can be given safely to immunocompromised

Disadv: No stimulation of cell-mediated immunity, may require boosters

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37
Q

What are the different types of subunit vaccines?

A

Toxoids
Polysaccharides
Purified proteins
Recombinant proteins

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38
Q

Advantages and disadvantages of subunit vaccines

A

Adv: Induce immune response to the pathogenic components of microorganism and safe since organism isn’t in tact

Disadv: Require boosters, adjuvants, and must be multivalent

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39
Q

What is a Toxoid vaccine? What are some examples?

A

Type of subunit vaccine that has chemically inactivated bacterial toxins that are not pathogenic

Ex: Diphtheria, Tetanus

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40
Q

What is a Polysaccharide vaccine? What are some examples?

A

Type of subunit vaccine that has biochemically purified polysaccharide from bacterial capsules

Ex: Strep pneumonia, Hib vaccine, Neisseria meningitidis

Requires conjugation to a carrier protein

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41
Q

What is Hib vaccine?

A

Haemophilus influenza type b

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42
Q

What is a glycoconjugate?

A

A carrier protein that helps to induce IgG production and long-term immunity, associated with subunit vaccines

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43
Q

What is a purified protein vaccine? What are some examples?

A

Type of subunit vaccine that contains biochemically purified components of a microorganism

Ex. Bordetella pertussis

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44
Q

What is a recombinant protein vaccine? What are some examples?

A

Proteins produced by genetically modified nonpathogenic bacteria/yeast/other cells

Ex. Hepatitis B, HPV

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45
Q

What are some factors influencing immunogenicity?

A
  • Age
  • Immune status of patient
  • Vaccine composition (live vaccines are most immunogenic, subunit are least)
46
Q

What are adjuvants? What is the goal of adjuvants?

A

Substances that enhance the immune response when administered together with a vaccine’s antigen

Goal is to:
- Increase antibody titers
- Increase cell-mediated immunity
- Reduce the dose of antigen and # boosters needed

47
Q

What are the main mechanisms of actions for adjuvants?

A
  1. Modify antigen delivery systems (enhance uptake of antigens by APCs)
  2. Modify immunopotentiators (activate dendritic cells to present antigens to T cells)
48
Q

Examples of adjuvants

A
  • Aluminum salts
  • Oil in water emulsions
  • Virosomes
  • CpG
  • Ethyl-mercury
49
Q

Benefits of vaccines

A
  • Decreased morbidity and mortality
  • Herd immunity
50
Q

What is herd immunity?

A

If enough people get vaccinated, protection will be extended to nearby persons who have not been immunized.

51
Q

Adverse affects of some vaccines

A
  • Localized reactions (swelling, tenderness)
  • Generalized reactions (fever/malaise)
  • Allergic reactions (Type I or Type III hypersens.)
  • Development of disease (if live vaccine is given to immunocompromised)
52
Q

What are immunoproliferative diseases involving lymphoid cells?

A

Leukemia, lymphoma, plasma cell dyscrasia

53
Q

Malignant cells originate in bone marrow and travel to peripheral blood

54
Q

Solid tumors that arise in lymph nodes and other lymphoid tissues

55
Q

Malignant or premalignant conditions of the plasma cells, also known as monoclonal gammopathies

A

Plasma cell dyscrasia

56
Q

WHO classification of hematological malignancies are based on:

A
  • Cell lineage/morphology
  • Immunological markers/flow cytometry
  • Genetic features/molecular
  • Cytochemical staining
57
Q

What is the most common type of ALL in children?

A

Pre-B-cell ALL

58
Q

Hyperdiploidy is associated with a _______ prognosis

59
Q

What is the most common leukemia in adults?

60
Q

What disease is associated with smudge cells?

61
Q

What is a highly specific marker for Hairy Cell Leukemia?

A

CD103
TRAP stain positive

62
Q

What immunoproliferative disease is associated with Reed-Sternberg Cells?

A

Hodgkin Lymphomas

63
Q

What are the types of Non-Hodgkin Lymphomas of B cell origin?

A

Diffuse Large B-cell lymphoma
Follicular lymphoma
Mantle cell lymphoma
Burkitt lymphoma
**B-cell origin = more common

64
Q

What are the types of Non-Hodgkin Lymphomas of T-cell or NK-cell origin?

A

Mycosis fungoides
Sezary syndrome
Adult T cell leukemia
**T cells have a flower-like nucleus or cerebriform nucleus

65
Q

What are the types of Plasma Cell Dyscrasias?

A

MGUS
Smoldering Multiple Myeloma
Multiple Myeloma
Waldenstrom’s macroglobulinemia

66
Q

Describe MGUS

A

Pre-malignant condition
- Production of a monoclonal Ig (low serum concentration, less than 3.0 g/dL)
- Less than 10% bone marrow are plasma cells

67
Q

Describe Smoldering Multiple Myeloma (SMM)

A

Pre-malignant condition
- Production of a monoclonal IgG or IgA greater than or equal to 3.0 g/dL
- Plasma cell count is 10-60% of bone marrow cells

68
Q

Describe Multiple Myeloma

A

Malignancy of plasma cells
- CD38+, CD56+, CD138+
- Plasma cells make up 10% or more of the bone marrow
- Increased IgG
- CRAB features
- Bence Jones proteinuria

69
Q

What are CRAB features?

A

C - calcium increased
R - renal dysfunction
A - anemia
B - bone disease and atrophy

70
Q

What is Waldenstrom macroglobulinemia?

A

Malignant proliferation of IgM-producing B cells or plasma cells
CD19+, CD20+, CD22+, CD79a+
NO lytic bone lesions like MM
Monoclonal IgM

71
Q

What area on serum protein electrophoresis would be abnormal in someone with a monoclonal gammopathy?

A

Gamma region increased

72
Q

What is IFE?

A

Immunofixation electrophoresis, shows the amount of each IgG and kappa/lamba present to indicate where the monoclonal gammopathy is coming from

73
Q

What is immunosubtraction?

A

Use of capillary electrophoresis to identify monoclonal Ig heavy and light chain determinants

  • Monoclonal peaks will DISAPPEAR in the electrophoresis wells that contain the causative Ig, as opposed to IFE where the appearance of bands indicate the causative Ig
74
Q

What is Serum Free Light Chain Analysis?

A

Automated, latex-enhanced immunoassays for bence jones protein detection, measure free Kappa and Lambda light chain concentrations in serum

75
Q

What is the normal K:L ratio?

76
Q

Primary vs secondary immunodeficiencies

A

Primary: inherited (PIDs)

Secondary: acquired

77
Q

What is Bruton X linked Agammaglobulinemia?

A

PID, decreased to absent antibodies with a mutation to Bruton’s tyrosine kinase on the X chromosome
- Usually seen in 0-3 year old boys
- Hypersusceptibility to infections from pyogenic organisms
- Normal T cell function, Absent B cells

78
Q

What is Transient hypogammaglobulinemia of infancy?

A

Delayed development of IgG production, normal number of B cells but delayed Th maturation

79
Q

What is Selective IgA deficiency

A

Low IgA levels, most common PID that results in anti-IgA antibodies that may result in anaphylaxis if given FFP or acellular blood products

80
Q

What is CD154 deficiency?

A

Decreased levels of IgG, IgA, and IgE as a result of defect in B cell switching

81
Q

Immunodeficiencies affecting cellular and humoral immunity

A

Caused by genetic mutations that alter development of T and B cells such as SCID and PNP deficiency

82
Q

Pathogenicity of SCID (How is it inherited)

A

X linked recessive form caused by IL2RG gene mutation

83
Q

What are the combined deficiencies with associated syndromic features?

A

Wiskott-Aldrich syndrome
22q11.2 deletion (DiGeorge)
Ataxia telangiectasia

84
Q

What is Wiskott-Aldrich Syndrome?

A

Defective WASp gene
Characterized by problems with cellular cytoskeleton, adhesion, and migration
Defect in CD43
Eczema, Thrombocytopenia

85
Q

What is DiGeorge Syndrome?

A

T cell defect from faulty embryogenic development of thymus and parathyroid
- Results in aplasia to these glands, facial and vascular anomalies, associated with Zinc deficiency, hypocalcemia, heart defects, increased susceptibility to infections

22q11.2 deletion

86
Q

What is ataxia telangiectasia?

A

Affects DNA repair and VDJ gene rearrangement in T and B cells
Patient presents with ataxia, telangiectasia, and dysplastic thymus
Patient has decreased IgA and likely to develop anti-IgA

87
Q

What is Chronic Granulomatous Disease?

A

Neutrophils unable to generate oxidative burst leading to decreased killing of catalase + organisms

88
Q

Chediak-Higashi Syndrome

A

Normal number of T and B cells, but reduced control over functions
- Decreased NK cells and neutrophils, enlarged lysosomal granules, hypopigmentation

89
Q

What are the different types of tumor antigens?

A
  • Mutation-derived tumor antigens
  • Antigens from oncogenic viruses
  • Cancer/testis antigens
  • Differentiation antigens
  • Overexpressed antigens
90
Q

AFP tumor marker is associated with which type of cancer. What is it used for?

A

Liver/testicular
Screening
Diagnosis
Prognosis
Monitoring

91
Q

CA 125 tumor marker is associated with which type of cancer? What is it used for?

A

Ovarian
Screening
Diagnosis
Prognosis
Monitoring

92
Q

CA 19-9 tumor marker is associated with which type of cancer? What is it used for?

A

Pancreatic
Diagnosis
Prognosis
Monitoring

93
Q

CEA tumor marker is associated with which type of cancer? What is it used for?

A

Colorectal, breast, lung
Prognosis
Monitoring

94
Q

hCG tumor marker is associated with which type of cancer? What is it used for?

A

Testicular, trophoblastic
Diagnosis
Prognosis
Monitoring

95
Q

PSA tumor marker is associated with which type of cancer? What is it used for?

A

Prostate
Screening
Diagnosis
Prognosis
Monitoring

96
Q

Direct allorecognition

A

T cells from recipient bind to foreign HLA antigens on cells of the allograft

97
Q

Indirect allorecognition

A

Host APCs present foreign MHC antigens on graft cells to recipient Th cells

98
Q

What disease is B27 antigen on HLA associated with?

A

Ankylosing spondylitis

99
Q

What disease is B51 antigen on HLA associated with?

A

Behcet’s syndrome

100
Q

What disease is DR3 antigen on HLA associated with?

A

Gluten-sensitivity enteropathy

101
Q

What disease is DR5 antigen on HLA associated with?

A

Hashimoto’s thyroiditis

102
Q

Hyperacute GvHD
(time/onset, mechanism of injury, cause)

A

Time: minutes
Mechanism: humoral
Cause: preformed cytotoxic antibodies to donor HLA

103
Q

Accelerated GvHD (time/onset, mechanism of injury, cause)

A

Time: 2-5 days
Mechanism: cell-mediated
Cause: previous sensitization to donor antigens

104
Q

Acute GvHD (time/onset, mechanism of injury, cause)

A

Time: 7-21 days
Mechanism: cell mediated and cytotoxic antibody
Cause: allogeneic recognition of donor antigens by HLA class I

105
Q

Chronic GvHD (time/onset, mechanism of injury, cause)

A

Time: >3 months
Mechanism: cell mediated or antibody
Cause: Host vs Graft disturbances or tissue trauma

106
Q

Function of corticosteroids

A

Anti-inflammatory

107
Q

Function of antimetabolites

A

Interfere with lymphocyte maturation and division

108
Q

Function of calcineurin inhibitors

A

Block cytokine synthesis in T cells

109
Q

Function of monoclonal antibodies

A

Interfere with T cell or B cell function by binding to lymphocyte surface molecules

110
Q

Function of polyclonal antibodies

A

Animal-derived antibodies against human cells that deplete thymocytes or lymphocytes

Immunology (6 decks)

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