immunopathology Flashcards
1
Q
Type I hypersensitivity mediator
A
IgE
mast cell and basophil degranulation
2
Q
Type II hypersensitivity mediator
A
cytotoxic
IgG, IgM
cell lysis and necrosis
3
Q
what type of cells are normally affected by Type II
A
haemopoeitic cells
4
Q
Type III hypersensitivity reaction mediator
A
immune complex
5
Q
Type III associated disease
A
SLE
6
Q
type IV hypersensitivity mediator
A
antigen specific T cell mediated cytotoxicity
CD4+
7
Q
type IV hypersensitivity reaction associated disease
A
contact dermatitis
Tuberculin skin test
8
Q
how is IgE produced
A
Th2 cell activates B cell
Th2 secretes IL-4
9
Q
what is the atopic triad
A
asthma, rhinitis, eczema
10
Q
what is rhinitis
A
hayfever
antihistamines
11
Q
what is asthma
A
inflammation and hyper-reactivity of small airways
damage to airways due to late phase response
12
Q
what is atopic dermatitis
A
eczema
intense itching/ blistering/ skin cracking
13
Q
diagnostic tests in allergic disease
A
specific IgE skin prick test intra-dermal test oral challenge test basophil activation test complement resolved diagnostics
14
Q
gold standard of allergy diagnosis
A
oral challenge test
15
Q
treatment of allergies
A
antihistamines
steroids
adrenaline
16
Q
major food allergens
A
milk egg legumes - peanut, soybean, tree nuts fish crustaceans cereal grains
17
Q
adaptive immune mediated inflammation
A
T cells and B cells
slow response
response months - years
18
Q
innate immune mediated inflammation
A
PRRs no memory fast short macrophages dendritic cells - present to T cells Neutrophils mast cells, basophils, eosinophils complement cytokines chemokines - attract other cells
19
Q
autoinflammation
A
spontaneous attacks of systemic inflammation
no source of infection
absence of high auto-antibodies and T cells
no evidence of autoantigenic exposure
innate immunity
neutrophils and macrophages
therapy - anti-cytokine
20
Q
autoimmunity
A
adaptive immune system recognises and targets the body's own molecules cells and tissues T-cells - recognise B-cells - autoantibodies inflammation secondary to this action adaptive immunity therapy - anti B and T cells
21
Q
example of autoinflammation
A
crohn’s
22
Q
example of autoimmunity
A
RA, SLE
23
Q
causes of autoimmune disease
A
genes environment - sex - age - sequestered antigens - infection, trauma, smoking immune regulation changes in amount or nature of autoantigens e.g. citrullination in RA
24
Q
gene mutated in T1 diabetes, rheumatoid, autoimmune thyroid disease
A
PTPN22 - T cells activated more strongly
25
organ specific autoimmune disease
single organ
autoantigens of that organ
e.g. autoimmune thyroid disease
26
systemic autoimmune disease
several organs at once
autoantigens in most cells of body
e.g. connective tissue diseases
27
are autoimmune diseases more common in men or women
women
28
what does Hashimoto's thyroiditis cause
hypothyroidism
29
what does graves disease cause
hyperthyroidism
30
what happens in myosthenia gravis
autoantibodies block ACh receptor
31
what is pernicious anaemia
antibodies block IF so B12 isn't absorbed
32
what happens in lupus
antibodies against antigens in nucleus combine with targets to form immune complexes in circulation
immune complexes deposit in any organ, activate complement and cause inflammation
33
non-specific diagnostic tests of autoimmune diseases
```
inflammatory markers
e.g. ESR
CRP
Ferritin
Fibrinogen
Haptoglobin
Albumin
Complement
```
34
disease specific diagnostic tests of autoimmune diseases
autoantibody testing
| HLA typing
35
in which disease do you find autonuclear antibodies
lupus
36
what is rheumatoid factor?
antibody directed against the Fc portion of IgG
37
which diseases are rheumatoid factor found in?
rheumatoid arthritis
chronic infections
vasculitis
38
which disease is ACPA used for
rheumatoid arthritis
| more erosive and severe disease
39
what are ACPA
anti-neutrophilic cytoplasmic antibodies
40
what antibody is found in primary biliary sclerosis
anti-mitochondrial Ab
41
what antibody is found in autoimmune hepatitis
anti smooth muscle and anti liver/kidney/ microsomal abs
42
which autoantibodies are found in DM
islet cell antibodies
anti-GAD65 and 67
anti-insulinoma antigen 2
insulin autoantibodies IAA
43
immunodeficiency
immune system is not effective enough to protect against infection
44
primary immunodeficiency
inherent defect within immune system - genetic
45
secondary immunodeficiency
immune system affected due to external causes
46
phagocyte deficiency
chronic granulomatous disease
| IRAK4 deficiency
47
symptoms of chronic granulomatous disease
recurrent abcesses
| staphylococcus, Klebsiella, serretia, aspergillus
48
treatment of chronic granulomatous disease
haematopoeitic stem cell transplant
| antobiotics
49
complement function
lyse foreign cells if the foreign cells are covered in antibody
50
C2, C4 deficiency
SLE, infections, myositis
51
C5-C9 - membrane attack complex
repeated episodes of bacterial meningitis
52
primary antibody deficiency
X linked agammaglobinaemia
53
IgA deficiency
less serious
| higher risk of autoimmune diseases
54
secondary antibody deficiency due to drugs
RA - methotrexate and infliximab, rituximab, azathioprine, ciclosporin, prednisolone, cyclophosphamide
55
defects in T cells
SCID
56
SCID
b cell need T cell help
no T cells
recurrent infection with opportunistic infections, bacteria, viruses, candida, pneumocystis
57
treatment of SCID
antbiotics, antivirals, antifungals
| haematopoetic stem cell transplant
58
immunomodulation
manipulating immune system using immunomodulatory drugs to achieve desired immune response
59
immunostimulation
immunization
replacement therapies
immune stimulants
60
passive immunization
specific high titre antibody from donor to recipient
61
uses of passive immunization
```
Hep B prophlaxis and treatment
botulism
VZV pregnancy
diptheria
snake bites
```
62
active immunization
stimulate development of a protective immune response and immunological memory
63
pooled human immunoglobulin use
treatment of antibody deficient states
64
G-CSF/GM-CSF
increase production of mature neutrophils
65
alpha-interferon
hep C
66
B-interferon
MS
67
immunosuppression agents
```
corticosteroids
cytotoxic/ agents
anti-proliferative/ activation agents
DMARD's
biologic DMARDs
```
68
corticosteroids action
```
decreased neutrophil margination
reduced cytokines
inhibition phospholipase A2
lymphopenia
decreased T cell proliferation
reduced immunoglobulins production
```
69
side effects of steroids
```
diabetes
hyperlipaemia
poor wound healing
osteoporosis
glaucoma and cataracts
psychiatric complications
```
70
uses of steroids
CTD, vasculitis, RA
crohn's, polymyalgia rheumatica
lymphoma
allograft rejection
71
Drugs targeting lymphocytes
antimetabolites
calcineurin inhibitors
M-TOR inhibitors
IL-2 receptor mABs
72
calcineurin/m-TOR use
transplantation
| autoimmune diseases
73
mechanism of action of methotrexate
folate antagonists
74
side effects of methotrexate
all - BM supression, GI upset, hepatitis, infections
| MTX - pneumonitis
75
anti-cytokines
Anti-TNF
Anti-IL-6
Anti- IL-1
76
what is rituximab
chimeric mAb against CD20 B cell surface
| lymphomas, leukaemias, transplant rejection, autoimmune disorders
77
adoptive immunptherapy
BMT
| SCT
78
uses of BMT, SCT
SCID
lymphomas and leukaemias
inherited metabolic disorders
autoimmune diseases
79
when is allergen specific immunotherapy used?
allergic rhinoconjunctivitis
| anaphylaxis to insect venoms
80
deficiency in normal gut flora e.g. by antibiotics
C.Diff
| candida
81
qualitative neutrophil defects
lose ability to kill or chemotaxis
82
quantitative neutrophil defects
less in number
| cancer treatment, bm malignancy, aplastic anaemia, drugs
83
qualitative chemotaxis
rare, congenital
84
qualitative killing power
chronic granulomatous disease - risk of s. aureus infections
85
quantitative neutrophil defect infections
high mortality
empirical therapy
pseudomonal infections
86
neutropenic patients
bacterial - e. coli, s. aureus, coag neg staph
| fungal - candida, aspergillus
87
treatment of neutropenic patient infection
broad spectrum antibiotics
antipseudomonal penicillin +/- gentamicin
2nd line treatment - a carbapenem
88
T-cell deficiencies
congenital - T helper dysfunction
acquired - drugs e.g. ciclosporin after transplantation
acquired - viruses e.g. HIV
89
T-cell deficiency diseases - what type of infections?
opportunistic pathogens
90
bacterial pathogens in T cell deficiencies
listeria monocytogenes, mycobacteria
91
Viral pathogens in T cell deficiencies
HSV, CMV, VZV
92
treatment of viral infections in T cell deficiencies
aciclovir and ganciclovir
93
fungal infections in T cell deficiencies
candida
| cryptococcus
94
T cell deficiencies protozoan and parasitic infections -
cryptosporidium parvum - diarrhoea
over 3 wk illness
symptomatic treatment
Toxoplasma gonadii - cats
95
what is hypogammaglobinaemias
antibody deficiencies
96
hypergammaglobaemias
congenital - X-linked agammaglobinaemia
| aquired - multiple myeloma and burns
97
bacterial infection in antibody deficiency
encapsulated bacteria e.g. s. pneumoniae
98
parasitic infection in antibody deficiency
giardia lamblia
99
complement deficiency infections
frequent, serious S.Pneumoniae infections
| N. meningitidis
100
what are biologics
antibodies or other peptides
101
what do biologics do
inhibit inflammatory cytokine signals e.g. TNF
102
where are biologics used
severe rheumatoid arthritis
103
risks of infection when using biologics
TB, HZV, legionella, pneumophilia, listeria monocytogenes
