immunology formative

Question 1

NK apart of innate or acquired

Answer 1

NK cells represent a part of innate immunity because they dont require prior learning to know which cells to kill

Question 2

what acounts for the response to reexpose to a microbe after vaccination

Answer 2

formation of memory B cells accounts for the rapid production of IgG at re-exposure to a microbe after vaccination

• repeat MMR vaccine would be fine

Question 3

targeted biological drugs

Answer 3

such as anti-TNF antibodies (adalimumab) are functionally equivalent to passive immunisation using antibodies against a microbe

Question 4

biologic drugs effect on the liver

Answer 4

biologics = antibodies
NOT metabolised in by liver –> NO hepatotoxic side effects, can give to those with liver cirrhosis

Question 5

action of biologic drugs vs glucocorticoids

Answer 5

biologics (antibodies) only target one aspect - everything else left alone (safer long term)

glucocorticoids target lots of targets

Question 6

use of immunoglobulins to treat immunodeficiency vs autoimmune

Answer 6

in autoimmune the target is more specific –> MORE POTENT

Question 7

are granulomas irreversible

Answer 7

NO

differentials - bacterial infection, neoplasm, hyperimmunity, TB

Question 8

22yr fingers change colour in cold, reoccuring in the year. PMH of recurrent mouth ulcers + pain in small joints of hands.
measurement of which antibody is most likely to aid diagnosis?

Answer 8

this condition relieas on a clinical diagnosis but a connective tissue screen (CTD) could be ordered

• raynauds is a clinical diagnosis, can have primary or secondary raynauds

Question 9

anti-jo-1

Answer 9

dermatopolymositis / polymyositisis

Question 10

60 y/o diabetic with treatment resistant psoriasis needs clinical remission of his skin before knee replacement surgery. PMH includes alcohol-related cirrhosis, TB + prostate cancer

sensible Mx?

Answer 10

although normally not first choice, anti-IL17 biologics could be chosen in this case as they are not hepatotoxic, act swiftly + pose no TB risk

• methotrexate is hepatotoxic

Question 11

62 y/o attends with visual blurring, difficulty swallowing + weakness in upper limb. he has family history of ischaeic heart disease + is an ex smoker. examination shows bilateral power loss in upper limbs, ptosis, mild facial palsy. stroke clinic shows normal CT head

measurement of which antibody is likely to aid diagnosis?

Answer 11

anti-acetylcholine receptor antibody
- myasthenia gravis

Question 12

32 y/o women with hx of recurrent upper resp infections requiring at least twice yearly oral antibiotics + intermittent diarrhoea over last 5yrs, she is other wise healthy, no regular meds. she had frequent common colds as child but no serious disease or infections

Answer 12

common variable immune deficiency (CVID)
- commonest primary deficiency
- can have adult onset + present even if no opportunistic infections in PMH
- doesnt need FH

• immunoglobulin levels + FBC could be ordered to rule out common variable immunodeficency
• could be useful to ask about autoimmune symptoms
• although selctive IgA deficiency most comminly clinically silent, it could underlie both resp + GI infections

Question 13

key contraindication of methotrexate

Answer 13

liver problems
- metabolised in liver

Question 14

manangement with Adalimunab

Answer 14

receiving passive immunisation targeted against tumour necrosis factor
- this treatment could stop being effective if she develops antibodies against the drug
- drug is a powerful anti-inflammatory because it blocks the central pro-inflammatory signalling pathway

Question 15

what does tumor necrosis factor alpha (TNF-α) increase risk of?

Answer 15

TB