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USMLE Step 1 > Immunology - First Aid / Pathoma > Flashcards

Immunology - First Aid / Pathoma Flashcards

1
Q

Cervical lymph drainage

A

Head and neck

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2
Q

Hilar lymph drainage

A

Lungs

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3
Q

Mediastinal lymph drainage

A

Trachea and esophagus

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4
Q

Axillary lymph drainage

A

Upper limb, breast, and skin above umbilicus

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5
Q

Celiac lymph drainage

A

liver, stomach, spleen, pancreas, upper duodenum

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6
Q

Superior mesenteric lymph drainage

A

Lower duodenum, jejunum, ileum, colon to splenic flexure

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7
Q

Inferior Mesenteric lymph drainage

A

Colon from splenic flexure to upper rectum

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8
Q

Internal iliac lymph drainage

A

Lower rectum to anal canal (above pectinate line), bladder, vagina (middle third), prostate

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9
Q

Para-aortic lymph drainage

A

Testes, ovaries, kidneys, uterus

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10
Q

Superficial inguinal lymph drainage

A

Anal canal (below pectinate line), skin below umbilicus (except popliteal territory), scrotum

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11
Q

Popliteal lymph drainage

A

Dorsolateral foot, posterior calf

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12
Q

End lymphatic drainages

A

Right lymphatic duct: drains right side of body above diaphragm
Thoracic duct: drain everything else into junction of left subclavian and internal jugular veins

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13
Q

What chromosome are HLA genes on?

A

Chromosome 6

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14
Q

HLA subtype assoc. diseases: A3

A

Hemochormatosis

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15
Q

HLA subtype assoc. diseases: B27

A 
PAIR
Psoriatic arthritis
Ankylosing spondylitis
arthritis of Inflammatory Bowel Disease
Reactive arthritis (Reiter syndrome)
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16
Q

HLA subtype assoc. diseases: DQ2/DQ8

A

Celiac disease

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17
Q

HLA subtype assoc. diseases: DR2

A 
(memory hook: MHGs gave me headaches in DR 2)
Multiple sclerosis
hay fever
Goodpasture syndrome
SLE
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18
Q

HLA subtype assoc. diseases: DR3

A 
DHGS
T1DM
Hashimoto thyroiditis
Graves disease
SLE
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19
Q

HLA subtype assoc. diseases: DR4

A

Rheumatoid arthritis
T1DM

(memory hook: a Rheum has 4 walls)

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20
Q

HLA subtype assoc. diseases: DR 5

A 
Pernicious anemia (Vit B12 deficiency)
Hashimoto thyroiditis
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21
Q

What induces NK cell activity

A

IL2, IL12, IFN alpha, IFN beta.

Innate immune cell that uses perforin and granzyme to induce apoptosis of virally infected cells or tumor cells.
Either recognizes lack of MHC, a nonspecific activation signal, or Ab dependent when Fc region binds CD16 on NK cell.

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22
Q

Th1

A

Activated by INF gamma and IL12.

Secretes IFN gamma.
Activates macs and CD8+ T cells.

*Note that IL4 and IL10 (from Th2) inhibit it

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23
Q

Th2

A

Activated by IL4.

Secretes IL4, IL5, IL10, IL13. 
Recruits eosinophils for parasite defense and promotes class switching of B cells.

*Inhibited by IFN gamma from Th1 cells

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24
Q

Tregs

A

Activating signal = TGFß and IL2

CD3, CD4, CD25, and FOXP3 +
Need IL2 to survive.
Help maintain specific immune tolerance by suppressing CD4 and CD8 T cell effector functions.
Activated Tregs produce anti-inflammatory cytokines (IL10, TGFß)

**Inhibit second signal for T cells by upregulating CTLA4 which binds up B7?

25
Co-stimulatory signals
T cell activation: Bind to either MHC I or MHC II w/TCR (depending on what T cell type it is); Second signal is B7 on it's CD28 rs. B cell activation: Present antigen to Th, bind via MHC II and TCR, Th cell then upregulates CD40L to bind B cells CD40! Th cell releases cytokines that induce class switch/maturation/Ab production/etc.
26
Acute phase reactants | Stimulated by IL6
*Produced by liver in acute and chronic inflammatory states. ``` Positive/Upregulated: C-reactive protein Ferritin Fibrinogen (ESR) Hepcidin (anemia of chronic disease) Serum Amyloid A ``` Negatiave/Downregulated: Albumin Transferrin (internalized by macs to sequester iron)
27
C1 esterase inhibitor deficiency
Hereditary angioedema. | ACEi's are contraindicated
28
C3 deficiency
Increases risk severe, recurrent pyogenic sinus infections and RTIs. Increases susceptibility to type III hypersensitivity reactions (immune complex diseases).
29
C5-C9 deficiencies
Terminal complement deficiencies all increase susceptibility to recurrent Neisseria bacteremia, since MAC can't be formed
30
Delay accelerating factor (DAF) deficiency / CD55
This is an inhibitor of complement. | Deficiency means complement mediated lysis of RBCs and paroxysmal nocturnal hemoglobinuria
31
Chemotactic factors for PMNs
LTB4, C5a, IL8, bacterial products
32
Complement for opsonization
C3b | *Note that IgG and C3b are two primary opsonins in bacterial defense, enhance phagocytosis
33
Complement for anaphylaxis
C3a, C4a, C5a
34
Complement for MAC
C5-C9
35
Secreted by macrophages
IL1: fever; inflammation; osteoclasts IL6: stimulates acute phase reactants IL8: chemotaxis for PMNs IL12: drives Th0 to Th1; activates NK cells TNF alpha: Causes cachexia in malignancy/chronic inflammation; mediates septic shock. Activates endothelium
36
Secreted by ALL T cells
IL2: stimulates growth of helper/ cytotoxic/ Tregs/ NK cells IL3: growth/differentiation of bone marrow (acts like GM-CSF)
37
Secreted by Th1 cells
IFN gamma
38
Secreted by Th2 cells
``` IL4 (enhances class switching to IgE and IgG) IL5 (enhances class switching to IgA) IL10 ```
39
Which cytokines attenuate the immune response?
TGFß | IL10
40
Antigenic variation
Bacteria: Salmonella (2 flagellar variants) Borrelia recurrentis (relapsing fever) N. gonorrhoeae (pilus protein) ``` Viruses: Influenza HIV HCV Rhinovirus? ``` Parasites: Trypanosomes Mechanisms: Antigenic shift: point mutations Antigenic drift: reassortment
41
Which infections to give passive immunity?
``` "To Be Healed Very Rapidly" Tetanus Botulinum Hepatitis B virus Varicella Rabies ``` Which to also give active immunization to? HBV Rabies exposure
42
Blood transfusion reactions
Allergic reaction: Type 1 HS against plasma proteins in transfused blood Anaphylactic reaction: severe allergic reaction, ex. IgA deficient individual given blood with IgA in it Febrile nonhemolytic transfusion reaction: Type 2 HS with host Ab against donor HLA antigens/WBCs Acute hemolytic transfusion rx: would see a positive DAT/Coombs test Ex. intravascular hemolysis: ABO blood group incompatibility Ex. extravascular hemolysis: host Ab reaction against foreign antigen on donor RBCs
43
Autoantibodies
Page 213 of First Aid!!
44
Systemic lupus erythematous
Type III HSR. ``` Antinuclear antibody (ANA) - sensitive, but not specific Anti-dsDNA or anti-Sm antibodies - highly specific! ``` Note there are: Anti-phospholipid Ab in about 1/3 of pts: anticardiolipin, anti-ß2-glycoprotein I, and lupus anticoagulant (which can falsely elevate PPT and cause Budd Chiari) Anti-histone Ab w/drug induced lupus: procainamide, hydralazine, and isoniazid
45
X linked agammaglobulinemia
Bruton's agammaglobulinemia. | Defect in BTK, a tyrosine kinase. No B cells in peripheral blood.
46
Common Variable Immunodeficiency
Defect in B cell differentiation | Decreased plasma cells, decreased Ig.
47
Selective IgA deficiency
mc primary immunodeficiency. | No IgA, nl IgG and IgM
48
Thymic aplasia (DiGeorge syndrome)
22q11 deletion | "CATCH 22" - cleft palate, abnl facies, thymic aplasia, cardiac defects, hypocalcemia from parathyroid aplasia
49
IL12 rs deficiency
Decreased Th1 response. | Auto recessive.
50
Autosomal dominant hyper-IgE syndrome (Job syndrome)
Deficiency of Th17 cells due to STAT3 mutation. "FATED" - coarse Facies, cold/noninflammed staph Abscess, retained primary Teeth, increased IgE, Dermatologic problems (eczema)
51
Chronic mucocutaneous candidiasis
T cell dysfunction. Many causes.
52
SCID (severe combined immunodeficiency)
Auto rec. type: Adenosine deaminase deficiency | mc X linked type: IL2R defective
53
Ataxia telangiectasia
Defects in ATM gene - failure to repair DNA double strand breaks (ie defect of nonhomologous end joining) IgA/IgG/IgE deficiency, ataxia/cerebellar atrophy, spider angiomas, increased AFP, lymphopenia
54
Hyper IgM syndrome
``` Defective CD40L on Th cells leading to class switching defect. Lots of IgM; not really any other Ig. ```
55
Wiskott Aldrich Syndrome
X linked mutation on WAS gene and T cells are unable to reorganize actin cytoskeleton. Basically: Bleeding (TPP), Eczema, and recurrent infections
56
Leukocyte adhesion deficiency
Defect in LFA integrin (CD18) on phagocytes leads to impaired migration and chemotaxis. *Increased PMNs in blood since they can't access sites outside of blood
57
Chediak Higashi syndrome
Defect in lysosomal trafficking regulator gene (LYST). Microtubule dysfunction in phagosome-lysosome fusion. ie PMNs can take shit up, but they can't break it down.
58
Chronic granulomatous disease
Defect of NAPDH oxidase (which leads to decreased ROS and oxidative burst) Increased suscpetibility to catalase positives: "Need PLACESS" Nocardia, Pseudomonas, Listeria, Aspergillus, Candida, E. coli, S. aureus, Serratia
59
Encapsulated bacteria
``` "SHiNE SKiS" Streptococcus pneumoniae Haemophilus influenzae Neisseria meningitidis Escherichia coli. Salmonella. Kelbsiella pneumonia group B Strep ```

USMLE Step 1 (9 decks)

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