immunology_flashcards

Question 1

What are the primary lymphoid organs?

Answer 1

Include both the bone marrow and thymus; sites of B and T cell development

Question 2

What is the thoracic duct?

Answer 2

Carries lymphocytes from lymph nodes back to blood circulation

Question 3

What is the thymus?

Answer 3

Site of deletion of T cells with inappropriately high or low affinity for HLA molecules and of maturation of T cells into CD4+ or CD8+ cells

Question 4

What is the germinal centre?

Answer 4

Area within secondary lymphoid tissue where B cells proliferate and undergo affinity maturation and isotope switching

Question 5

Which medication is most likely to have caused antibody deficiency?

Answer 5

Rituximab

Question 6

What is the most likely diagnosis for a patient with recurrent chest infections, antibody deficiency, and absent B cell count?

Answer 6

Thymoma with antibody deficiency / Goods syndrome

Question 7

Which conditions are most likely to present in patients with CD4 T cell counts of >350?

Answer 7

Shingles, pulmonary TB, pneumococcal pneumonia

Question 8

Recurrent infections with high neutrophil count but no abscess formation. What is the diagnosis?

Answer 8

Leukocyte adhesion deficiency

Question 9

Recurrent infections with hepatosplenomegaly and abnormal dihydrorhodamine test (does not fluoresce). What is the diagnosis?

Answer 9

Chronic granulomatous disease

Question 10

Recurrent infections with no neutrophils on FBC. What is the diagnosis?

Answer 10

Kostmann syndrome

Question 11

Infection with atypical mycobacterium and normal FBC. What is the diagnosis?

Answer 11

IFN gamma receptor deficiency

Question 12

Severe chicken pox, disseminated CMV infection. What is the diagnosis?

Answer 12

Classical natural killer cell deficiency

Question 13

Meningococcus meningitis with family history of sibling dying of same condition aged 6. What is the diagnosis?

Answer 13

C7 deficiency

Question 14

Membranoproliferative nephritis and abnormal fat distribution. What is the diagnosis?

Answer 14

C3 deficiency with presence of a nephritic factor

Question 15

Severe childhood onset SLE with normal levels of C3 and C4. What is the diagnosis?

Answer 15

C1q deficiency

Question 16

Recurrent infections when neutropenic following chemotherapy but previously well. What is the diagnosis?

Answer 16

MBL deficiency

Question 17

Severe recurrent infections from 3 months, CD4 and CD8 T cells absent, B cells present, Igs low. Normal facial features and cardiac echocardiogram. What is the diagnosis?

Answer 17

X-linked SCID

Question 18

Young adult with chronic infection with Mycobacterium marinum. What is the diagnosis?

Answer 18

IFN gamma receptor deficiency

Question 19

Recurrent infections in childhood, abnormal facial features, congenital heart disease, normal B cells, low T cells, low IgA and IgG. What is the diagnosis?

Answer 19

22q 11.2 deletion syndrome

Question 20

6 month baby with two recent serious bacterial infections. T cells present – but only CD8+ population. B cells present. IgM present but IgG low. What is the diagnosis?

Answer 20

Bare lymphocyte syndrome type II

Question 21

Adult with bronchiectasis, recurrent sinusitis and development of atypical SLE. What is the diagnosis?

Answer 21

Common variable immunodeficiency

Question 22

Recurrent bacterial infections in a child, episode of pneumocystis pneumonia, high IgM, absent IgA and IgG. What is the diagnosis?

Answer 22

X linked hyper IgM syndrome due to CD40 ligand mutation

Question 23

1 year old boy. Recurrent bacterial infections. CD4 and CD8 T cells present. B cells absent, IgG, IgA, IgM absent. What is the diagnosis?

Answer 23

Bruton’s X linked hypogammaglobulinaemia

Question 24

Recurrent respiratory tract infections, absent IgA, normal IgM and IgG. What is the diagnosis?

Answer 24

IgA deficiency

Question 25

What proportion of the world population has kidney disease?

Answer 25

11%

Question 26

5 years on, what are the chances of survival for a patient who has just started dialysis for end stage kidney failure?

Answer 26

35%

Question 27

The most important antigenic determinant of rejection in current clinical practice for kidney transplantation is:

Answer 27

Human leucocyte antigens / major histocompatibility complex

Question 28

A potential donor is described as being 1:1:0 MM. What does this mean?

Answer 28

1 MM A locus, 1 MM B locus, 0 MM DR locus

Question 29

The main effector cells in T-cell mediated rejection are

Answer 29

T cells and monocytes / macrophages

Question 30

A patient has an episode of acute T cell-mediated rejection 2 months post transplantation. What additional drug would most commonly be administered?

Answer 30

Corticosteroids

Question 31

Which cell is injured in the effector phase of antibody-mediated rejection?

Answer 31

Endothelial

Question 32

What pathology is this image showing?

Answer 32

c. Hypertensive arteriosclerosis

Question 33

You are given the HLA genotype of a potential live donor and a recipient, and the recipient’s anti-HLA serology. Do you agree? Do you agree the liver donor could be the recipient's son? There is one mismatch for each HLA type. 50% match.

Answer 33

Yes

Question 34

Would a standard transplant procedure go smoothly?

Answer 34

No - There are antibodies already detected against some of the donors HLA epitopes.

Question 35

Would the recipient benefit from treatment to remove the anti-DR1 and DQ5 before transplantation?

Answer 35

Yes

Question 36

Which of the following is an example of a monogenic auto-inflammatory disease?

Answer 36

Familial Mediterranean fever

Question 37

Which of the following is an example of a monogenic auto-immune disease?

Answer 37

IPEX syndrome due to FoxP3 mutation

Question 38

Which of the following is an example of a polygenic auto-inflammatory disease?

Answer 38

Crohn’s disease

Question 39

Which of the following is an example of Gel and Coombs type III hypersensitivity?

Answer 39

SLE

Question 40

Which of the following antibodies are characteristically found in Myasthenia Gravis?

Answer 40

Anti-acetylcholine receptor antibody

Question 41

Which of the following antibodies are characteristically found in Pernicious Anaemia?

Answer 41

Anti-intrinsic factor antibody

Question 42

What is the diagnosis with Positive antinuclear antibodies (ANA), Anti-dsDNA+ve, Low C3 and C4, High ESR, Negative for Ro, La, Sm, RNP, SCL70, Centromere, Jo-1, ANCA?

Answer 42

Systemic lupus erythematosus

Question 43

What is the diagnosis with Positive anti-neutrophil cytoplasmic antibodies (ANCA), Negative ANA, Normal complement, Raised ESR and CRP?

Answer 43

ANCA associated vasculitis

Question 44

The purpose of vaccination is to stimulate and enhance immunological memory. Which type of cells mediate immunological memory?

Answer 44

B and T lymphocytes

Question 45

Which of the following vaccines should NOT be given to an immunosuppressed individual?

Answer 45

BCG - bacilli Calmette-Guerin

Question 46

A 23 year old has metastatic melanoma. Which of the following may reduce disease progression?

Answer 46

Nivolumab, an antibody specific for PD-1

Question 47

Which drug is likely to have caused osteoporosis, weight loss, easy bruising, and high blood glucose in a young woman with SLE?

Answer 47

Prednisolone

Question 48

For which disease is Rituximab, a monoclonal antibody specific for CD20 on B cells, an effective treatment?

Answer 48

Rheumatoid arthritis

Question 49

Which of the following are true about management of psoriasis and psoriatic arthritis?

Answer 49

Treatment options include inhibition of TNF alpha, IL23 or IL17A or use of a PD4 blocker or ciclosporin