immunology_flashcards
What are the primary lymphoid organs?
Include both the bone marrow and thymus; sites of B and T cell development
What is the thoracic duct?
Carries lymphocytes from lymph nodes back to blood circulation
What is the thymus?
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
What is the germinal centre?
Area within secondary lymphoid tissue where B cells proliferate and undergo affinity maturation and isotope switching
Which medication is most likely to have caused antibody deficiency?
Rituximab
What is the most likely diagnosis for a patient with recurrent chest infections, antibody deficiency, and absent B cell count?
Thymoma with antibody deficiency / Goods syndrome
Which conditions are most likely to present in patients with CD4 T cell counts of >350?
Shingles, pulmonary TB, pneumococcal pneumonia
Recurrent infections with high neutrophil count but no abscess formation. What is the diagnosis?
Leukocyte adhesion deficiency
Recurrent infections with hepatosplenomegaly and abnormal dihydrorhodamine test (does not fluoresce). What is the diagnosis?
Chronic granulomatous disease
Recurrent infections with no neutrophils on FBC. What is the diagnosis?
Kostmann syndrome
Infection with atypical mycobacterium and normal FBC. What is the diagnosis?
IFN gamma receptor deficiency
Severe chicken pox, disseminated CMV infection. What is the diagnosis?
Classical natural killer cell deficiency
Meningococcus meningitis with family history of sibling dying of same condition aged 6. What is the diagnosis?
C7 deficiency
Membranoproliferative nephritis and abnormal fat distribution. What is the diagnosis?
C3 deficiency with presence of a nephritic factor
Severe childhood onset SLE with normal levels of C3 and C4. What is the diagnosis?
C1q deficiency
Recurrent infections when neutropenic following chemotherapy but previously well. What is the diagnosis?
MBL deficiency
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?
X-linked SCID
Young adult with chronic infection with Mycobacterium marinum. What is the diagnosis?
IFN gamma receptor deficiency
Recurrent infections in childhood, abnormal facial features, congenital heart disease, normal B cells, low T cells, low IgA and IgG. What is the diagnosis?
22q 11.2 deletion syndrome
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?
Bare lymphocyte syndrome type II
Adult with bronchiectasis, recurrent sinusitis and development of atypical SLE. What is the diagnosis?
Common variable immunodeficiency
Recurrent bacterial infections in a child, episode of pneumocystis pneumonia, high IgM, absent IgA and IgG. What is the diagnosis?
X linked hyper IgM syndrome due to CD40 ligand mutation
1 year old boy. Recurrent bacterial infections. CD4 and CD8 T cells present. B cells absent, IgG, IgA, IgM absent. What is the diagnosis?
Bruton’s X linked hypogammaglobulinaemia
Recurrent respiratory tract infections, absent IgA, normal IgM and IgG. What is the diagnosis?
IgA deficiency
What proportion of the world population has kidney disease?
11%
5 years on, what are the chances of survival for a patient who has just started dialysis for end stage kidney failure?
35%
The most important antigenic determinant of rejection in current clinical practice for kidney transplantation is:
Human leucocyte antigens / major histocompatibility complex
A potential donor is described as being 1:1:0 MM. What does this mean?
1 MM A locus, 1 MM B locus, 0 MM DR locus
The main effector cells in T-cell mediated rejection are
T cells and monocytes / macrophages
A patient has an episode of acute T cell-mediated rejection 2 months post transplantation. What additional drug would most commonly be administered?
Corticosteroids
Which cell is injured in the effector phase of antibody-mediated rejection?
Endothelial
What pathology is this image showing?
c. Hypertensive arteriosclerosis
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.
Yes
Would a standard transplant procedure go smoothly?
No - There are antibodies already detected against some of the donors HLA epitopes.
Would the recipient benefit from treatment to remove the anti-DR1 and DQ5 before transplantation?
Yes
Which of the following is an example of a monogenic auto-inflammatory disease?
Familial Mediterranean fever
Which of the following is an example of a monogenic auto-immune disease?
IPEX syndrome due to FoxP3 mutation
Which of the following is an example of a polygenic auto-inflammatory disease?
Crohn’s disease
Which of the following is an example of Gel and Coombs type III hypersensitivity?
SLE
Which of the following antibodies are characteristically found in Myasthenia Gravis?
Anti-acetylcholine receptor antibody
Which of the following antibodies are characteristically found in Pernicious Anaemia?
Anti-intrinsic factor antibody
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?
Systemic lupus erythematosus
What is the diagnosis with Positive anti-neutrophil cytoplasmic antibodies (ANCA), Negative ANA, Normal complement, Raised ESR and CRP?
ANCA associated vasculitis
The purpose of vaccination is to stimulate and enhance immunological memory. Which type of cells mediate immunological memory?
B and T lymphocytes
Which of the following vaccines should NOT be given to an immunosuppressed individual?
BCG - bacilli Calmette-Guerin
A 23 year old has metastatic melanoma. Which of the following may reduce disease progression?
Nivolumab, an antibody specific for PD-1
Which drug is likely to have caused osteoporosis, weight loss, easy bruising, and high blood glucose in a young woman with SLE?
Prednisolone
For which disease is Rituximab, a monoclonal antibody specific for CD20 on B cells, an effective treatment?
Rheumatoid arthritis
Which of the following are true about management of psoriasis and psoriatic arthritis?
Treatment options include inhibition of TNF alpha, IL23 or IL17A or use of a PD4 blocker or ciclosporin
