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Immunology - First Aid > Lymphoid Structures > Flashcards

Lymphoid Structures Flashcards

1
Q

What are 1º immune system organs?

A

Bone marrow (immune cell production, B cell maturation)

Thymus (T cell maturation)

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2
Q

What are 2º immune system organs?

A

Spleen
Lymph nodes
Tonsils
Peyer patches

They allow immune cells to interact with Ag

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3
Q

What are functions of lymph nodes?

A
  1. Nonspecific filtration of macrophages
  2. Storage of B and T cells
  3. Immune response activation
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4
Q

What encapsulated 2º lymphoid organ has many afferents and only 1 or more efferents?

A

Lymph node

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5
Q

What is the site of B cell localization and proliferation in lymph node?

A

Follicle (outer cortex)

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6
Q

What is the difference between 1º and 2º follicles of lymph node?

A

1º follicles: dense, dormant

2º follicles: pale central GERMINAL center, ACTIVE

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7
Q

Components of lymph node medullary cords?

A

Closely packed lymphocytes

Plasma cells

Medullary sinuses

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8
Q

Components of medullary sinuses?

A

Reticular cells

Macrophages

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9
Q

Which part of the lymph node enlarged in bacterial infection?

A

2º follicles: Germinal center (outer cortex)

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10
Q

Which part of the lymph nodes is enlarged in an extreme cellular response (eg. viral infection) ?

A

Paracortex (T cell response)

(eg, EBV and other viral infections →
paracortical hyperplasia → lymphadenopathy)

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11
Q

Paracortex of lymph node house which type of cells?

A

T cells

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12
Q

Which part of the lymph node is not well developed in DiGeorge syndrome?

A

Paracortex

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13
Q

Where do T and B lymphocytes enter the lymph node from the blood?

A

HEVs (high endothelial venules)

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14
Q

Where does B cell maturation take place?

A

Bone marrow

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15
Q

Where does T cell maturation take place?

A

Thymus

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16
Q

Germinal centers in 2º lymphoid tissues are the result of the proliferation of which cells?

A

B cells

These are clones of proliferating, Ag-specific cells

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17
Q

What is the 1st signal for the activation of B lymphocytes in 2º lymphoid organs?

A

Ag binding

and cross-links the idiotype of the Ig

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18
Q

Which mutation occurs during intense proliferative response of the B cell (formation of germinal centers)?

A

Somatic hypermutation

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19
Q

What type of mutation is somatic hypermutation?

Where does it occur?

A

Random single point mutation (in Ab idiotype)

Variable domain region

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20
Q

What is the advantage of single point mutations in Ab idiotype?

A

Increased affinity for the Ag

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21
Q

The process in which clonal selection results in the predominance of clones capable of producing antibodies with ↑affinity for Ag is called ____?

A

Affinity maturation

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22
Q 
How does isotype switching that happens with affinity maturation affect antibody avidity (↑ or ↓)
and affinity (↑ or ↓)?
A

↓ avidity

↑ affinity

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23
Q

Describe the flow of lymph in lymph node

A

Afferent lymphatic vessels

           ↓  valve

Sub-capsular sinus (cortex)

               ↓
Cortical sinus (paracortex)
           ↓

Medullary sinus

           ↓  valve

Efferent lymph vessels

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24
Q

What happens in the germinal center of a lymph node?

A

B cells activate, proliferate, differentiate, and mutate (humoral immunity)

Class (isotype) switching

Somatic hypermutation (↑ affinity to antigens)

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25
Q

Deep cervical lymph node cluster drain which areas?

↑?

A

Head

Neck

↑

  • URTI
  • Inf mono
  • Strep Pharyng
  • Kawasaki’s
  • Malignancy head/ neck/ oropharynx
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26
Q

Hilar lymph node cluster drain which areas?

↑?

A

Lungs

↑ - Infection, inflammation
Pulmonary TB (unilateral hilar)
Sarcoidosis (bilateral hilar)
Lung cancer
Granulomatous disease
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27
Q

Mediastinal lymph node cluster drain which areas?

↑?

A

Trachea

Esophagus

↑ - primary lung cancer, granulomatous disease

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28
Q

Axillary lymph node cluster drain which areas?

↑?

A

Upper limb

Breast

Skin above umbilicus

↑ - Mastitis, Breast cancer metastasis

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29
Q

Superior mesenteric lymph node cluster drain which areas?

↑?

A

Lower duodenum

Jejunum

Ileum

Colon up to splenic flexure

↑ - Mesenteric lymphadenitis, Typhoid fever, Ulc. colitis, Celiac disease

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30
Q

Inferior mesenteric lymph node cluster drain which areas?

↑?

A

Colon from splenic flexure to upper rectum

↑ - Mesenteric lymphadenitis, Typhoid fever, Ulc. colitis, Celiac disease

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31
Q

Internal iliac lymph node cluster drain which areas?

↑?

A

Lower rectum to anal canal (above pectinate line)

Bladder

Vagina (middle third)

Cervix

Prostate

↑ - STDs

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32
Q

Superficial inguinal lymph node cluster drain which areas?

↑?

A

Anal canal (below the pectinate line)

Scrotum

Vulva

Skin below umbilicus (except popliteal area)

↑ - STDs, pararectal abscess

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33
Q

Para-aortic lymph node cluster drain which areas?

↑?

A

Testes

Ovaries

Kidneys

Uterus

↑ - metastases

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34
Q

Popliteal lymph node cluster drain which areas?

↑?

A

Dorsolateral foot

Posterior calf

↑ - cellulitis

35
Q

Celiac lymph node cluster drain which area?

↑?

A

Liver

Stomach

Spleen

Pancreas

Upper duodenum

↑ - Mesenteric lymphadenitis, Typhoid fever, Ulc. colitis, Celiac disease

36
Q

Trachea & esophagus lymph drain into which lymph node cluster?

A

Mediastinal

37
Q

Lower duodenum, jejunum, ileum, colon up to splenic flexure drain into which lymph node cluster?

A

Superior mesenteric

38
Q

Anal canal (below the pectinate line), scrotum, vulva, skin below umbilicus (except popliteal area) drain into which lymph node cluster?

A

Superficial inguinal

39
Q

Testes, ovaries, kidneys, uterus drain into which lymph node cluster?

A

Para-aortic

40
Q

Liver, stomach, spleen, pancreas, upper duodenum drain into which lymph node cluster?

A

Celiac

41
Q

Lower rectum to anal canal (above pectinate line), bladder, vagina (middle third), cervix, prostate drain into which lymph node cluster?

A

Internal Iliac

42
Q

The colon, from splenic flexure to upper rectum, drains into which lymph node cluster

A

Inferior mesenteric

43
Q

Right lymphatic duct drains which areas?

A

Upper right thoracic cavity (via Rt broncho-mediastinal trunk) above diaphragm

Right arm (via Rt subclavian trunk)

Right side of the head and neck (via Rt jugular trunk)

44
Q

Thoracic duct drains which areas?

A

All areas except Rt thoracic cavity, Rt side of head & neck, Rt arm.

45
Q

Thoracic duct drains into which veins?

A

Junction of Left subclavian vein & Left internal jugular vein
(at the commencement of the brachiocephalic vein)

46
Q

Right lymphatic duct drains into which veins?

A

Junction of the Right internal jugular & Rt subclavian veins

47
Q

Sinusoids are long, vascular channels with fenestrated barrel hoop basement membrane in which part of the spleen?

A

Red pulp

48
Q

What are the components of splenic red pulp?

A

Sinusoids

Cords

Plasma cells

49
Q

Which lymphocytes are found in follicles of 2º lymphoid tissues?

A

B cells

50
Q

Where are T cells located in the spleen?

A

White pulp - PALS PeriArteriolar Lymphatic Sheath

central artery enveloped by sheath of T cells

51
Q

Where are B cells located in the spleen?

A

White pulp - follicles

Marginal zone - specialized B cells

52
Q

What are the components of splenic white pulp?

A

Follicle (B cells)

PALS PeriArteriolar Lymphatic Sheath (T cells)

53
Q

What is function of splenic marginal zone?

A

Macrophages (remove encapsulated bacteria)

Specialized B cells

APCs (capture blood-borne Ag for recognition by lymphocytes)

54
Q

What are the zones of the spleen?

A

Hematological zone - Red pulp

Immunological zone - White pulp

Ag screening & processing zone - Marginal zone

55
Q

Splenic PALS PeriArteriolar Lymphatic Sheath contain which lymphocytes?

A

T cells

56
Q

High endothelial venules (HEVs) use which lymphocyte surface molecules and their counter-receptors to facilitate lymphocyte entry?

A

L-selectin

&

Peripheral lymph node addressins (PNAds)

57
Q

Macrophages in spleen remove which type of organisms?

A

ENCAPSULATED

  • Pseudomonas aeroginosa
  • Neisseria meningitides
  • Streptococcus pnemoniae
  • Klebsiella pneumonia
  • Group B streptococci
  • E. coli
  • H. influenzae B
  • Salmonella
  • Yersinia pestis
  • Bacillus anthracis
  • Cryptococcus Neoformans
58
Q

Splenic dysfunction lead to ↑ susceptibility to which organisms ?

A

Splenic dysfunction (eg. splenectomy, sickle cell disease):

↓IgM → ↓complement activation → ↓C3b opsonization → ↑ susceptibility to encapsulated organisms
(pneumococcal, Hib, meningococcal)

59
Q

Important prep for patients undergoing splenectomy?

A

Vaccination against encapsulated organisms

pneumococcal, Hib, meningococcal

60
Q

What cell types seen post-splenectomy?

A
  • Howell-Jolly bodies (nuclear remnants, basophilic DNA fragments in RBCs which haven’t expelled the nucleus properly)
  • Target cells
  • Thrombocytosis (loss of sequestration of platelets and removal)
  • Lymphocytosis (loss of sequestration WBCs)
61
Q

Where do T cells differentiate and mature?

A

Thymus

62
Q

Which embryological structure is the thymus derived from?

A

Third pharyngeal pouch

Thymus EPITHELIUM: third pharyngeal pouch (endoderm)

Thymic LYMPHOCYTES: mesoderm

63
Q

Lymphocytes are of mesodermal origin or mesenchymal origin?

A

Mesodermal

64
Q

What are contents of thymic cortex?

A

Immature T cells

dense, pink

65
Q

What are contents of thymic medulla?

A

Mature T cells
(pale)

Hassall corpuscles

66
Q

What are Hassall corpuscles?

A

Thymic bodies in medulla of thymus formed from:

eosinophilic type VI epithelial reticular cells arranged concentrically
(central mass, consisting of one or more granular cells, and capsule formed of epithelioid cells - like rose petals)

67
Q

Hypoplastic thymus is seen in which conditions?

A

DiGeorge syndrome

SCID (severe combined immunodeficiency)

68
Q

What is the common associated disorders with thymomas?

A

Myasthenia gravis

Superior vena cava syndrome

Pure red cell aplasia

Good syndrome (hypogammaglobulinemia)

69
Q

Which part of the lymph nodes is enlarged in EBV infection?

A

Paracortex (T cell response)

paracortical hyperplasia → lymphadenopathy

70
Q

Oral cavity is drained by which lymph node cluster?

A

Submandibular

71
Q

Malignancy of oral cavity can lead to a pathology (increase) in which lymph node cluster?

A

Submandibular

72
Q

Supraclavicular lymph nodes drain which area?

↑?

A

Abdomen and pelvis

(Virchow node)

↑ Malignancy of abdomen, pelvis

73
Q

Mastitis & breast cancer metastasis affect which lymph node cluster?

A

Axillary lymph nodes

74
Q

Hand & forearm are drained into which lymph node cluster?

A

Epitrochlear

75
Q

Secondary syphilis can lead to pathology in which lymph nodes?

A

Epitrochlear

76
Q

Epitrochlear lymph nodes ca ne enlarged in which pathology?

A

Secondary syphilis

77
Q

Periumbilical lymph nodes drain which area?

↑?

A

Abdomen and pelvis

(Sister Mary Joseph node)

↑ Gastric cancer

78
Q

What happens if the thoracic duct is ruptured due to a malignancy?

A

Chylothorax

(thoracic duct damage with chyle leakage from the lymphatic system into the pleural space, usually on the right side. Manifests as pleural effusion)

79
Q

What is chylothorax?

A

Thoracic duct damage with chyle leakage from the lymphatic system into the pleural space (tumors/ iatrogenic/ idiopathic) usually on the right side. Manifests as pleural effusion

80
Q

Gastric cancer may primarily cause the enlargement of which lymph node clusters?

A

Supraclavicular (Virchow node)

Periumbilical (Sister Mary Joseph node)

81
Q

APCs capture blood-borne Ag for recognition by lymphocytes in which splenic zone?

A

Marginal zone

82
Q

How can the normal thymus in neonates be visualized?

Main feature?

A

CXR

‘sail-shaped’

83
Q

By which age does the thymus normally involute?

A

3 years

Immunology - First Aid (15 decks)

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