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Derm > Immunology -Vishy > Flashcards

Immunology -Vishy Flashcards

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Dermatology Board Prep flashcards
1
Q

What are the layers of the epidermis from outermost–> innermost?

A 
Stratum Corneum 
Stratum Lucidum 
Stratum granulosum 
Stratum spinosum 
Stratum basale
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2
Q

Where is Dsg1 found in the epidermis? What about Dsg 3? What diseases are associated with autoantibodies produced against these?

A
  • Dsg3 is in the deep epidermis–> pemphis vulgaris (IgG)

- Dsg 1 is more in the superficial epidermis–> pemphis (IgG)

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3
Q

What is filaggrin responsible for? What results from a mutation in filaggrin?

A

fillaggrin is responsible for the terminal differentiation of the epidermis

-a mutation in fillagrin leaves the body more susceptible to bacterial and hypersensitivity reactions (atopic dermatitis)

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4
Q

What are the immune cells of the epidermis called? What is their function?

A

langerhans cells
-antigen presenting cells that phagocytose and pinocytose material to conjugate with MHC I or II and then enter lymphatic circulation to present to T cells

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5
Q

How are extracellular antigens processed for T cell recognition?

A

Extracellular anitgens –> endosome–> paired with MHC class II –> presented to CD4+T cells for recognition

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6
Q

How are intracellular antigens processed for T cell recognition?

A

Intracellular–> proteosome compartment –> antigenic peptide –> RER using TAP (transporter protein)
-conjugated with MHC I in the ER –> recognized by CD8 T cells

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7
Q

How many signals are required an antigen presenting cells to stimulate T cell proliferation?

A

2 signals:
1=Class II MHC on APC + TCR on T cell

2=

  • ICAM-1 on APC presenting to LFA-1 on T cells
  • B7-1/B7-2 on APC presenting to CD 28 on T cell
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8
Q

What happens after full activation of T cells? What can a person get if this does not occur?

A

after full activation, CD28 will disappear and CTLA 4 will appear.

  • CTLA-4 will bind CD80/86 and inactivate the immune cells
  • without inactivation, can get autoimmunity
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9
Q

What do Th1 cells secrete? Th2 cells? What are their functions?

A

Th1 cells secrete IL-2 and IFN-gamma –> important in neutophil and macrophages activation

Th2 cells secrete IL-4, IL-6 and IL-10. These stimulate B cells to produce certain classes of antibodies

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10
Q

What cytokines stimulates a T cell to exhibit a Th1 cell response? What cytokine stimulates a Th2 response?

A

IL-12 stimulates Th1

IL-10 stimulates Th2

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11
Q

What receptor is found on both basophil and mast cells? What does this bind to? Where are basophils and mast cells found?

A

Fc receptors on their surfaces bind to IgE

basophils are found in low numbers in the blood

Mast cells are in the dermis

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12
Q

What happens during the initial allergen encounter with an antigen? Subsequent allergen encounters?

A
  • initial encounter: CD4 –> Th2 –> IL4 and IL5 produced ==> mast cells coated with IgE (bound by the Fc receptors)
    subsequent: cross-linking of antigen to IgE on mast cells causes mast cell degranulation that releases vasoactive amines, cytokines, lipids
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13
Q

What types of physiological responses take place with a type I hypersensitivity reaction?

A
  • constriction of bronchiole lumen
  • vasoconstriction of the blood vessels
  • endothelial vasodilation –> fluid loss and cell migration which causes urticaria
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14
Q

What are the 2 phases of atopic dermatitis? W T cell predominates in each phase? What type of infection is a person with more susceptible to in each phase?

A

acute:

  • Th2 predominates–> produce IL4 and IL5. DCs produce IL-10.
  • IgE and allergic reaction
  • No INF gamma production=susceptible to bacterial infection of the skin

chronic

  • CD4 Th1 predominates
  • DCs produce IL12–> Th1 –> INF gamma produced (less susceptible to bacteria)
  • Less plasmacytoid DCs=more susceptible to viral infections (less INF alpha and beta)
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15
Q

What molecule on T cells allow them to leave circulation and go to the skin? Where can these be found in atopic dermatitis?

A

CLA (cutaneous lymphocyte associated antigen)

can be detected in the dermis and epidermis

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16
Q

What type of hypersensitivity reaction is Goodpasture’s syndrome? What do the antibodies attack?

A

Type II hypersensitivity

antibodies attack the glomerulus basement membrane –> bind to type IV collagen in the basement membrane of blood vessels in kidneys and lungs –> fix complement

17
Q

What are some other types of type II hypersensitivity reactions causing skin diseases?

A
  • pemphigus vulgaris
  • pemphigus foliaceus
  • bullous pemphigoid
  • linear IgA disease
18
Q

What are the autoantibodies attacking in pemphigus vulgaris?

A

Dsg3 (in the base of the epidermis)

SEVERE

19
Q

What are the autoantibodies attacking in pemphigus foliaceus?

A

Dsg 1 in the superficial dermis

Not as severe because the deeper parts of the skin are not exposed

20
Q

What are the autoantibodies attacking in bullous pemphigoid? Where are these found in the epidermis?

A

BPAg1 and BPAg2 in the basal layer of the epidermis

does not expose the deeper skin when they pop==> not as bad as vulgaris

21
Q

What are the autoantibodies attacking in Linear Immunoglobulin A disease? Where are these found?

A

BPAg2

in the basal layer ==> blisters form but no acantholysis

22
Q

What is taking place in a type III hypersensitivity reaction?

A

-antibody (IgG) attaching to a soluble antigen forms complexes –> may deposit in blood vessels (vasculitis), synovial joints (arthritis), glomerular basement membrane (glomerulonephritis) and the choroid plexus

23
Q

What type of hypersensitivity reaction is taking place in dermatitis herpetiformis? What is reacting to what?

A

type III hypersensitivity

produce IgA to gluten –> immune complex carried to different parts of the body and activates complement

24
Q

What are the hallmarks of a type IV hypersensitivity reaction? What are some examples of this

A

TH cells that have been sensitized by an antigen develop a Th1 response ==> macrophage recruitment and activation (about 24 hours after repeat exposure) causing inflammation

-TB skin test, contact dermatitis, poison ivy

25
Q

What type of immune cell is responsible for presenting the antigen to T cells? What determines if the person will develop an induration?

A

Langerhans cells

if the person was sensitized (previously exposed T cells) then the T cells will travel back to the skin and cause an induration

26
Q

What is scleroderma?

A

autoimmune chronic multisystem fibrosis resulting in collagen deposits in different parts of the body

can present with Raynauds, difficulty swallowing from loss of esophageal motility, SOB, heartburn, renal failure and diarrhea (affects everything basically)

27
Q

What is lupus? What are the common manifestations of lupus?

A

lupus: autoantibodies against histone proteins

  • arthralgias and arthritis
  • skin: malar and other rashes
  • pleurtitis and pericarditis
  • fetal loss (if preggo)
28
Q

What is psoriasis? What immune cells are responsible for this reaction?

A

-autoimmune T cell disease causing thickening of the epidermis

  • T cells activated==> release cytokines to trigger keratinocytes to replicate and proliferate
  • T cells in the dermis and epidermis
29
Q

What are the 3 proposed causes of psoriasis?

A
  1. streptococcal infeciton triggered
  2. super antigen theory –> triggers T cells
  3. no pathway with CTLA so get sustained T cell activation ==> excessive keratinocyte proliferation
30
Q 
Which of the following skin diseases is characterized by biphasic T cell responses during acute and chronic stages of the disease? 
A. scleroderma 
B. Dermatits herpetiformis 
C. atopic dermatitis 
D. IgA linear disease
A

C. atopic dermatitis

acute=more susceptible to bacteria

chronic=more susceptible to viral infecitons

31
Q 
A 60 year old male has complaints of hemoptysis and hematuria. Laboratory tests confirm the presence of antibodies against glomerular basement membrane protein. He is suffering from:
A. Bullous pemphigoid disease
B. Linear IgA disease 
C. SLE 
D. Goodpasture's syndrome
A

D. Goodpasture’s syndrome

32
Q 
Which of the following skin disease is considered a type I hypersensitivity reaction? 
A. Pemphigus vulgaris 
B. Pemphigus foliaceus 
C. Goodpastures syndrome 
D. Dermatitis herpetiformis 
E. Urticaria
A

E. Urticaria

(all others are type II reactions

Derm (19 decks)

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