Immunopath Flashcards
A. Interferon gamma
B. Interferon alpha
C. TNFalpha
D. Etanercept
E. Basiliximab
F. Tocilizumab
G. Natalizumab
H. Denosumab
- Ankylosing spondylitis
- Resistant Psoriasis
- Chronic granulomatous disease treatment
- Osteoporosis
- Ankylosing spondylitis – Etanercept
- Resistant Psoriasis – Etanercept
- Chronic granulomatous disease treatment – IFN gamma
- Osteoporosis – Denosumab
Which immune cell is produced in the bone marrow then migrates to site of injury, has oxidative and non-oxidative killing methods and dies once job is done
Neutrophil
Foxp3+ cells, they mature in the thymus
Treg
What immune cells detects antigen in the periphery and moves to lymph nodes
Dendritic cell
What immune cell detects MHC1 and kills virus infected/cancer cells. Is inhibited by MHC I
NK cells or CD8+
What immune cells is targeted by HIV
Memory CD4+
SLE with recurrent clotting - which antibody?
Anti-cardiolipin
Mechanism of familial mediterranean fever
Failure to regulate cryopyrin driven activation of neutrophils
Man can eat apple pie. But if he eats fresh apples and pears, he gets inflamed lips
Oral allergy syndrome
A women with known SLE presents with an exacerbation of her SLE/worsening symptoms,
what would you measure?
C3 and C4 levels
A 60 year old lady with recurrent chest infections now has reduced total serum protein and has autoimmune thrombocytopenia - which primary immunodeficiency?
CVID
A Girl is found to have no CD4 cells, but CD8 cells and B cells are present
Bare lymphocyte 2
A boy’s father has TB. The same boy develops a mycobacterium infection, following their BCG
Interferon gamma deficiency (basically ans to any immunodeficiency question with TB )
Used to treat osteoporosis when the patient cannot tolerate bisphosphonates
denosumab
Used to treat malignant melanoma, involved in T cell checkpoints
Ipilimumab or nivolumab
Used to treat Lymphoma and Rheumatoid arthritis
Rituximab
Used to prevent transplant rejection, by blocking T cell activation
Tacrolimus/ cyclosporin
Used to treat severe ankylosing spondylitis not controlled by NSAIDs
Etanercept
In its immature form it is specialised to phagocytose pathogens, and in its mature form it is specialised to present to other cells
Dendritic cells
Derived from monocytes and resident in peripheral tissues
Macrophage
Autoimmune and autoinflammatory diseases - FAS pathway
ALPS
Autoimmune and autoinflammatory diseases - MEFV
Familial Mediterranean Fever
Which virus can lead to development of post transplantation lymphoproliferative disease
EBV
Causes progressive multifocal leukoencephalopathy
John Cunningham Virus
Receptor mutation/ cytokine that can be protective in HIV?
CCR5/ MIP-1a or b
What type of hypersensitivity (Gel and Coombs classification) is myasthenia gravis and what cell?
Type 2 (plasma cell/B cell)
IPEX affects which type of cell
Treg
Chimeric antigen receptor T-cell therapy against CD19: what type of haematological malignancy does it target?
ALL, some non-Hodgkin lymphomas
Ankylosing spondylitis – they’ve tried NSAID and TNF inhibitor, what else can you target?
IL-17 (secukimumab)
45yo woman with autoimmune diseases, low IgM, IgA and IgE; full blood count is normal?
CVID
Immunodeficiency with common gamma chain problem?
X-linked SCID
A random woman is a donor for kidney to a child, what is the max number of HLA mismatches possible?
6
Which type of cell does Rituximab target?
Mature B cells
Nivolumab is a PD1 inhibitor, what cells does it target?
T cells
Woman with periorbital purple rash (heliotrope) and rash on knees, which enzyme is elevated?
Creatine kinase (dermatomyositis)
What Type Hypersensitivity causes serum sickness?
3
What is the effect of the gene mutation in familial Mediterranean fever?
Increased IL-1 production
Which of the following are most often used for prophylaxis against allograft rejection?
a. Mycophenolate mofetil, prednisolone, tacrolimus
b. Mycophenolate mofetil, prednisolone, azathioprine
c. Cyclosporin, tacrolimus and rafamycin
Mycophenolate mofetil, prednisolone, tacrolimus
Which of the following can be used to treat rheumatoid arthritis?
a. Adalimumab: TNFalpha
b. Basiliximab: Anti CD25
c. Denosumab: Anti-RANKL
d. Secukinumab: Anti-IL17
Adalimumab
Patient with coeliac. What would you see on biopsy?
Intraepithelial __________
Intraepithelial lymphocytes
Which condition is caused by reactivation of human polyoma virus 2 (John Cunningham (JC) virus) in immunosuppressed people?
Progressive Multifocal Leukoencephalopathy
Doctors should measure the level/activity of which enzyme before prescribing
azathioprine?
TPMT - Thiopurine methyltransferase
5 month baby has failure to thrive and recurrent infections. Investigations - mutation affecting IL2RG gene, which encdoes IL2 common gamma chain.
What is the diagnosis?
X linked SCID (X linked is related to the IL2)
CAR T-cells are engineered to bind to CD19. They have immunoglobulin
variable fragments to CD19 linked to cytoplasmic T-cell activation domains.
They are effective in treating haem malignancies of which cell type?
ALL, B cell lymphomas
Mutation of CD40 ligand is associated with which form of primary immunodeficiency?
Hyper IgM syndrome
Denosumab is a monoclonal antibody specific for RANKL. What condition is it used to treat?
Osteoporosis, multiple myeloma, bone mets
In a histology slide showing antibody mediated rejection of a renal allograft, where is the inflammatory infiltrate seen?
a) Capillaries
b) Capsule
c) Interstitium
d) Tubules
e) Adipose tissue
Interstitium
Which of the following is a mixed pattern auto-inflammatory auto-immune disease characterised by sacroiliac joint inflammation
a) Ankylosing spondylitis
b) Osteitis condensans illi
c) Osteoarthritis
d) Rheumatoid arthritis
e) Gout
Ankylosing spondylitis - all the HLA-B27 conditions (psoriatic arthritis, behcet’s - note: not rheumatoid arthritis, which is auto immune)
Conjugate vaccines?
NHS
Neisseria Meningitidis
Haemophilus Influenzae
Strep Pneumonia
(and also tetanus)
Failure to regulate cryopyrin driven activation of neutrophils is characteristic of which of the following diseases?
a) Auto-immune lymphoproliferative syndrome (ALPS)
b) Behcet’s disease
c) Familial Mediterranean fever
d) Microscopic polyangiitis
e) Ulcerative colitis
Familial Mediterranean Fever
Which of the following monoclonal antibody therapies enhances T-cell immunity and is used in management of some malignancies?
a) Infliximab (anti-TNFalpha)
b) Pembrolizumab (anti-PD1)
c) Rituximab(anti-CD20)
d) Tocilizumab (anti-IL6R)
e) Ustekinumab (anti-IL12/23)
Pembrolizumab / Nivolumab, both for melanoma
Which one of the following agents is effective as a biological disease modifying anti-rheumatic drug (b-DMARD) as part of rheumatoid arthritis management?
a) Adalimumab
b) Basiliximab
c) Denosumab
d) Pembrolizumab
e) Secukinumab
Adalimumab (anti-TNF alpha)
or Etanercept, Infliximab
Which one of the following is a standard immunosuppressive regimen for patients who received an allograft?
a) Azathioprine, mycophenolate mofetil, prednisolone
b) Cyclophosphamide, methotrexate, rituximab
c) Cyclosporine,rapamycin,tacrolimus
d) Mycophenolate mofetil, prednisolone, tacrolimus
Mycophenolate mofetil, prednisolone, tacrolimus
Which of the following immune-mediated diseases may respond to treatment with plasmapheresis?
a) Ankylosing spondylitis
b) Goodpasture syndrome
c) IgA vasculitis
d) Sjogren’s syndrome
e) Takayasu’s arteritis
Goodpasture - Plasmapharesis for severe Ab-mediated (type 2) disease, eg myasthenia gravis
Which medication is most likely to be contributing to his current presentation (JC virus activation)?
Mycophenolate mofetil is associated with reactivation of JC virus, which causes progressive multifocal leucoencephalopathy. PML, a demyelinating disease of the CNS, has a very variable presentation that may include: Clumsiness, Progessive weakness, Visual speech and personality changes
Which cell surface marker, involved in MHC class II recognition, is a target
of HIV-1 protein envelope binding during viral entry?
CD4
note: GP120 is part of the virus
A 8 year old boy is brought to clinic by his fathers, following a recent hospital admission with suspected anaphylaxis. His medical history is significant for myopia and dermatographism. Which investigation is most appropriate in identifying possible allergens?
IgE Rast - you would not do skin prick in someone with hx of anaphylaxis
Which of the following describes an adaptation of mucosal surfaces which
helps them prevent infection?
Low oxygen tension
Lactoferrin
Tightly packed keratinocytes
Secretory IgM production
Low pH
Lactoferrin - Mucosal surfaces contain lactoferrin which starves invading bacteria of oxygen
A child presents with recurrent infections, a high neutrophil count during infections, but no pus. Which of the following explains the pathophysiology of his condition?
Deficient CD11a/18
Deficient NADPH oxidase complex
Bone marrow failure
Deficient IL12 receptor
Failure of development of the pharyngeal pouch
Deficient CD11a/18 - leukocyte adhesion deficiency
Which of the following tests is most useful for diagnosing latent TB in a
patient who has previously received the BCG vaccine?
Chest x-ray
TST (Mantoux test)
IGRA (Quantiferon/Elispot test)
Sputum smear and Ziehl-Neelson stain
Sputum culture on Lowenstein-Jensen media
IGRA - for latent, will not detect bcg vacc
A patient with Sjögren’s syndrome has a salivary gland biopsy. What cells are the most common infiltrating cell type likely to be seen?
Lympohocytes - as with most other autoimmune conditions
Which leucocyte actively participates in an acute inflammatory reaction, contains myeloperoxidase within its primary granules and alkaline phosphatase in its secondary granules?
Neutrophil
Which liver enzyme can be measured in the blood and specifically suggests obstructive jaundice if levels are found to be raised?
gamma glutamyl-transferase (ALP is not specific enough for an answer i think, because it’s raised in bone stuff as well)
A 23 year old female presents with a facial rash, arthralgias, mouth ulcers, hair fall and pleuritic chest pain. What is the most likely diagnosis?
Systemic lupus erythematosus
What is the maximum number of HLA class I mismatches that may occur if a parent acts as a kidney donor for a child
3 out of 6 (siblings can have 6/6 mismatches)
hyper IgM syndrome - what mutation?
CD40 gene
Antibodies bind to which cell type during the effector phase of antibody mediated rejection of solid organ allografts?
endothelial cells of the graft
Which cytokine is key in promoting the development and terminal differentiation of eosinophils?
IL-5
c1q deficiency
SLE
Crohn’s treatment (monoclonal antibody) after no response to steroids and 5- ASA? (there are 2 answers)
Natalizumab, vedolizumab
A 26 year old person had silicone breast implants inserted 2 years ago. They are now asymmetrical, and one has become much harder than before. The leaking implants are removed and sent to pathology. Which inflammatory cell is most prominent on histological examination?
Eosinophil
Macrophage giant cell
Mast cell
Neutrophil
Plasma cell
Macrophage giant cell
A 32 year old female has worsening dysphagia. Physical examination finds hypertension and sclerodactyly. The histology report on skin biopsy describes dermal fibrosis with loss of adnexal structures. She has autoantibody directed against DNA topoisomerase (anti Scl-70). Which is the best dx for this person?
Dermatomyositis
Mixed connective tissue disorder
Progressive systemic sclerosis
Sjogren’s syndrome
Systemic lupus erythematosus
Progressive systemic sclerosis
Alum is-effective as an adjuvant for vaccination. Which of the following best describes its mechanism of action?
Enhancement of CD4+ T cell response
Enhancement of the innate immune response
Promotion of B cell differentiation
Suppression of CD& T ceil response
Suppression of the T reg response
Enhancement of innate immune response
Which biologic disease modifying anti- rheumatic drug (DMARD) targeting a specific cytokine pathway would be expected to show efficacy in RA but not psoriatic arthritis?
Adalirnumab (anti-tumour necrosis factor alpha antibody)
Etanercept (tumour necrosis factor receptor - Ig fusion protein
Secukimumab (anti-interleukin 17antibody)
Tocilizumab (anti-interleukin 6 receptor antibody)
Ustekinumab (Ab specific for p40 of interleukin 12 and interleukin 23)
Tocilizumab
Cigarette smoking is associated with development of rheumatoid arthritis. Which is the most likely mechanism underpinning this association?
Nicotine acts as.an immune checkpoint inhibitor
Nictoine as an inhibitor of T reg
Peptide from nicotine binds to the shared epitope of HLADR1 and DR4
Smoking increases citrullination of proteins in the lung
Smoking results in high levels of hydrogen cyanide which stimulated production of RF
Smoking increases citrullination of proteins in the lung
Which agent is an Interleukin 6 (IL-6) inhibitor, indicated for treatment of severe COVID-19 infection with hypoxia?
Anakinra
Nafamostat
Palivizumab
Ruxalitinib
Tocilizumab
Tocilizumab
