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Haem Diagnosis > mcd cram > Flashcards

mcd cram Flashcards

1
Q

type one interferons

A

polypeptides
induce antimicrobial state locally
modulate immune responses by promoting antigen presentation but antiinflammatory
activate adaptive
alpha (all cells first induced by irf 3)
plasmacytoid cells produce alpha and irf 7
ifnar is receptor

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2
Q

plasmacytoid cells

A

produce ifn alpha and express irf 7

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3
Q

irf genes

A

interferon regulatory factor

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4
Q

type two and three interferon

A

gamma and lambda
two is t cells and nk ifngr
three is il28r il10beta
resp tract and liver infection

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5
Q

stimulation of ifn production

A

pamps such as drna for viruses activate prrs - tlrs rlrs nlrs

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6
Q

prrs interferons

A

rlrs - beta
tlrs alpha
nlrs

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7
Q

how are viruses detected in cell

A

cGAS = enzyme detects dsDNA in cytoplasm
causes cGAMP production
passes to sting on er which follows same pathway as prrs with pamps

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8
Q

ifn type one signalling

A 
ifnar1 dimerises with ar2 causing jak1 and tyk2 to cross phosphorylate. 
STAT proteins are activated which cause 
inflammatory through gas, 
antiviral through isre 
and inflammatory repressor through gas

hundreds of antiviral mediators released like pkr mx ifitm3

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9
Q

interferon response

A

ifitm3 stops virus entering through endosomes

mx1/2 are gtpases that wrap form multimers and wrap around nucelocapsids of viruses

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10
Q

ifitm3

A

stops virus entering through endosomes by stopping escape so broken down by acidic endosome

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11
Q

mx1

mx2

A

GTPases that form multimers that wrap around the nucleocapsids of viruses

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12
Q

duration of ifn response?

A

few hours, can’t last due to negative regulation mediated by suppressor of cytokine signalling SOCS which turns the genes off.

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13
Q

What is viral ifn evasion mediated by

A 
HIBIBAR
Hide pamps 
Interfere with host gene expression
Block IFN induction cascades
Inhibit ifn signalling directly
Block ifn induced antiviral enzymes
Activate SOCS
Replicate in a manner insensitive to IFN
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14
Q

How does hep c evade ifn

A

NS3/4 Protease production cleaves MAVS which is the protein on the mitochondria that is activated by RLRs hence ifn beta cant be produced

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15
Q

how does flu evade ifn

A

NS1 protein binds to rig/trim/rna complex preventing ifn signalling activation

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16
Q

how does pox and herpes evade ifn

A

pox genome is hugely anti-ifn. soluble cytokine receptors produced that incapacitate immune mediators.

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17
Q

how does ebola evade ifn

A

VP35, 24, 30
Respectively blcok rig 1 complexes and rnai expression
block rnai expression
block ifn signalling.

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18
Q

Consequences of viral evasion

A

both the virus and immune system damage the body
hence can be pathalogical or immunopathological.
more ifn is needed for more severe responses like fever than for localised responses like mx induction
cytokine storm if too much ifn is made, worse in healthier people as better at making ifn

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19
Q

uses of viral evasion tactics

A

live attenuated viruses - can be made if u put viruses that cant control ifn in cells that cant make ifn. lots of replication
anti-virals, ifn used as treatment but with se’s
ifn lambda stimulates antiviral state but not inflammatory or immune response so good for treating flu.
cancercells dficient inifn can be attacked by viruses whilst normal cells produce ifn so they dot get hurt.

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20
Q

staph aureus

A 
gram +ve
most common  skin infeciton
causes scalded skin
toxic shock
food poisioning
necrotising soft tissue infections
treat with antibiotics no vaccine
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21
Q

treponema pallidum

A

syphilis
painless ulcers to rash lymphadenopathy to asymptomatic to lesions on skin bone vascular neuro manifestations
can be vertically transmitted
no vaccine antibiotics

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22
Q

Herpes

A

simplex 1&2
dna viruses
painful rash, eczema, herpeticum, encephalitis
no vaccine, antivirals

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23
Q

Varicella Zoster

A

pox, human herpes virus again
fever malaise rash becomes latent after two weeks still there can cause shingles
herpes zoster shingles painful rash
vaccine and antiviral

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24
Q

Trichophytum

A 
superficial fungal infections
dermatophyte, affects keratin areas
name is tinea and body part
yeasts as well like candida
scaly rash crumbly nails
antifungals like terbinafine
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25
Q

scabies

A 
sarcoptes scabei ite
burrows lays eggs faeces
delayed type reaction type four
eczematous rash
can cause secondary bacterial infection
topical systemic insecticides
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26
Q

viral evasion of immune response

A

mhc 1
internal viral proteins dont vary much so good targets.
includes - evading loading to tap
modulation of tapasin function and prevention of loading to mhc
interfering with mhc presentation at cell surface.

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27
Q

viral methods evading mhc

A

loading to tap
EBV - ebna1 cant be processed by proteasome
HSV icp47 blocks peptide access to tap
CMV US6 stops atp binding to tap and translocation

modulation of tapasin function and prevention of mhc transport
CMV US3 binds to tapasin and prevents peptide loading to mhc
Adenovirus E3-19k prevents recruitment of TAP to tapasin and retains the MHC in ER

interfering with mhc presentation at cell surface
KSHV kK3 protein induces polyubiquitinylation and internalisation of MHC then endosome to lysosome

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28
Q

how does ebv evade mhc

A

ebna1 cant be processed by proteasome, only processed peptides get put on mhc 1

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29
Q

How does hsv evade mhc

A

icp47 blocks peptide access to tap

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30
Q

how does cmv evade mhc

A

US6 stops atp binding to tap and translocation
and
US3 binds to tapasin and prevents peptide loading to mhc

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31
Q

how does adenovirus evade mhc

A

E3-19k prevents recruitment of TAP to tapasin and retains the MHC in ER

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32
Q

how does KSHV evade mhc

A

kK3 protein induces polyubiquitinylation and internalisation of MHC then endosome to lysosome

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33
Q

how do viruses evade nk cells

A 
if in cell that doesnt show mhc class one it will be killed
encode mhc class one analgoue to prevent this like cmv
or upregulate mhc
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34
Q

cmv in the clinic

A

most infected, only issue in immunocmpromised like during transfusions, needs elimination before procedure
produces protein ul138 that removes mrp1 (removes toxins from cells). treat with toxic drugs to stop this.

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35
Q

antigenic variation methods

A

drift is mutating to have different antigens
shift is new subtypes from animals
different serotypes are all stable and cocirculate. Polio, dengue, rhinovirus.
can be consequence of vaccine

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36
Q

how does hiv resist abs

A 
gp120
large gaps between spikes so no cross linking of ab
glycosylation masks ab epitopes
poorly accessible important bits of ag
BNABS can control load
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37
Q

dengue

A

leakage of plasma from capillaries
high haematocrit and rbc count decreased protein count
bleeding and bruising
treat with iv.

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38
Q

dengue ag variation

A

four serotypes
abs from last response bind dont neutralise so haemorrhagic fever and could lead to shock.
monocytes bound could be used for replication by virus.

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39
Q

evasion of ab response

A

glycoprotein antigen ab cant access
can make them look like apoptotic bodies so uptaken and hidden
viral filaments mean glps inaccessible in packets

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40
Q

why is measles vaccine important

A

infection erases immuno memory so raises morbidity and mortality of other diseases.

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41
Q

main bacterial virulence factors

A 
flagella movement attachment
pill adherence
capsule protect against phagocytes
endospores are metabolically dormant
biofilms aggregates embedded in polysaccharide so antibiotic resistant
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42
Q

endotoxins exotoxins

A 
exo damage bio systems
neurotoxins
enterotoxins
pyrogenic exotoxins stimulate cytokine release
tissue invasive allow bacteria to tunnel
can be other

endo lipids gram -ve released steadily so sudden antibiotic and cell death can release loads leading to septic shock

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43
Q

outbreaks

A

lots of cases short time

need to isolate strain with pcr, surveillance, reporting system

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44
Q

eu communicable resp

A 
Legionnaire
amoeba in lakes
inhalation
type iv secretion
tb, extra lipid layer can be dormant treatment good
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45
Q

eu communicable sti

A

chlamydia trachomatis
neisseria gonorrhoeae
pili antigen variation

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46
Q

eu food waterborne

A

campylobacteriosis gi uncooke dpultry adhesion, invasion, flagella etc
salmonella tthree secretion
cholera
listeriosis

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47
Q

eu vector borne

A

plague yersina pestis
q fever coxiella burnetti
smallpox

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48
Q

eu vaccine preventable

A 
clostridium diptheriae
haemophilus influenze
neisseria meningitides
streptococcus pneumnie
bordetella pertussis
clostridium tetani
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49
Q

hospital acquire

A

nosocomial

escape

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50
Q

nosocomial causes

A

catheters intubation chemo prosthetics lines prophylactic antibiotics inappropriate prescribing
dissemination carriers
concentration is density of people

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51
Q

escape

A 
resistant
Enterococcus faecium + vancomycin
Staoh aureus mrsa +
Clostridium difficile + 
Acinobacter baumanii -
Pseudomonas aeruginosa - mdr
Enterobacteriacae - mdr
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52
Q

pathogenic e coli

A

common gram -ve bacteraemia utis

cephalosporin and carbapenem resistance

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53
Q

others nosocmial

A

klebsiella pneumoniae
pseudomonias aeruginosa
mrsa

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54
Q

clinical significance of nosocomial infection and reistance

A

morbidity cost clinicians need to use old more toxic drugs to treat

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55
Q

immunity to fungi

A

phagocytes then nk which give ifn gamma then dendritic which cause t cells to differentiate then th1/17

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56
Q

fungal virulence

A

candida spores dimorphism so allows for tissue invasion
Cryptococcus capsule evades phagocytosis
aspergillus conidia inhaled invades as hyphae

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57
Q

what required for innate immunity to fungal infection?

A

Flies is a prr needed

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58
Q

human deficiencies leading to fungal infection

A

dectin 1, deficiency leads to mucocutaneous infection as impaired macrophage il6 production and binding in response.

card 9 causes chronic mucocutaneous candidiasis
card9 needed for tnf alpha responding to beta glucan and t cell th17 differentiation

tlr4 polymorphism lead to risk of aspergillosis in transplant.

plasminogen mutation

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59
Q

defence against fungus

A

neutrophils important
throw nets of chromatin to capture spores act as danger molecules to recruit effector cells
fungal morphogenesis can transition between hyphae yeast candida to modulate dendritic cell response confuses immune response

innate - mucosal immunity

treatment - adoptive immunotherapy make lots of fungal t cells in a sample and give to patients needing to fight infection
gene therapy like restoring genes that fight fungal spores. can be ifn gamma

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60
Q

fungal allergy

A 
inhalation and exaggerated response. 
aspergillus main one
can activate all types
one - ig e leukotriens histamine minutes
two - igg igm complement
three- igg igm complement one day
four - t cells lymphokines few days
61
Q

ABPA

A

allergic bronchopulmonary aspergillosis
need predisposing condition like asthma CF
high serum ige, t-one hypersensitivity skin test, aspergillus specific ige
may also have eosinophilia igg ab and radiologic abnormalities

corticosteroids
itraconazole
omalizumab ige antibodies

62
Q

endo vs ectoparasite

A

endo in body ecto on surface

63
Q

List Endoparasite examples

A

Protozoa:
Ameobae, gi tract, cysts invade enter gi parasites released cause ulcers in epithelial cells. spread via veins. microscopy of cysts

Coccidia, like malaria, fever, headache, emesis, chills, anaemia, diarrhoea, toxoplasmosis

Flagellates, diarrhoea giardiasis, trichomonas std normal std symptoms.
Ciliates, balantidum coli, other domestic mamals and primates, immunocompromised vomit dysentry

Metazoa:
roundworms, ascaris, asymptomatic, abdo pain, intestine obstruction, peumonia.
flatworms, taenia [tapeworm), asymptomatic
flukes [ schistosoma, rash fever chills myalgia.

64
Q

ectoparasite

A

scabies burrows itchy

lice, lice itchy

65
Q

blood cell time and function

A 
platelet, ten days
rbc one twenty days
neutrophil, seven ten hours
eosinophil less than neutrophil parasites
macrophage
monocyte few days phagocyte become macrophage in tissue store and release iron
basophil allergy
lymphocyte
66
Q

spherocyte

A

hereditary spherocytosis

less membrane same cytoplasm

67
Q

irregularly contracted

A

hyperchromic, no central pallor, weird shape due to oxidant damage to membrane and hb

68
Q

polychromasia

A

blue tint as young.

methylene blue is reticulocyte stain.

69
Q

target cells

A

accumulation of hb in central pallor

obstructive jaundice liver disease haemglobinopathies and hyposplenism

70
Q

elliptocytes

A

elliptic hereditary eliptocytosis iron deficiency

71
Q

fragments/shistocytes

A

abnormal stress or abnormal cell

72
Q

rouleaux

A

stacks alterations in plasma proteina

73
Q

agglutinates

A

clumps abs on rbc surface

74
Q

howel-jolly

A

nuclear remnant due to lack of splenic function

75
Q

left shift

A

increase in non-segmented neutrophils or neutrophil precursors

76
Q

toxic granulation

A

infection inflammation tissue necrosis normal in pregnancy

77
Q

hypersegmented neutrophils

A

btewlve folate deficiency

78
Q

how to interpret bloods

A

leucocytosis penia why
anaemia mcv history blood count
thrombocytosis/penia history count clues

79
Q

polycythaemia

A

high rbc hb hct
splenomegaly abdo mass cyanosis
causes: pseudo is burns
proper is blood doping physiological abnormal bone marrow high erythropoeitin

80
Q

anaemia mechanisms

A

reduced roduction, haem iron deficiency, globin thallassaemia
loss of blood
reduced rbc survival
rbc pooling in spleen splenomegaly.

81
Q

Microcytic

A

low mcv
iron deficiency chronic disease issue with haem
thalassaemia issue with globin

82
Q

normocytic

A

blood loss
rbc production failure
pooling, hypersplenism portal cirrhosis

83
Q

macrocytic

A 
megaloblastic iron folate deficiency
dna synthesis interfering drugs 
liver disease alcohol
major blood loss no iron stores lots of reticulocytes
haemolytic anaemia lyses in blood
84
Q

haemolytic anaemia

A

short survival
intrinsic = abnormality of rbcs
extrinsic = factors acting on rbcs
inherited = abnormalities in membrane hb rbc enzymes
acquired = microorganisms drugs chemicals
intravascular = acute damage
extravascular = defective rbcs removed by spleen

suspect when unexplainable normochromic normo/macrocytic
morphologically abnormal cells, more rbc breakdown, bone marrow activity increased. irreg conract, hereditary ellipticytosis
poikilocytosis sickle cells gall stones jaundice polychromic anaemia

85
Q

hereditary spherocytosis

A

inherited membrane defect. less flexible = spleen removal quickly = extravascular
more ploychromasia in response reticulocytosis = more bilirubin jaundice gall stones. splenectomy

86
Q

g6p dehydrogenase deficiency

A

protects rbcs from oxidant damage. severe intravascular haemolyis after infection or exposure to oxidant/
heinz bodies are irreg contracted denatured hb removed by spleen.

87
Q

autoimmune haemolytic

A

autoab at rbcs. splenic macrophage removes some membrane so spherocytosis. steroids splenectomy.

88
Q

ida vs acd

A

acd: no clear sign, no bone marrow infiltration, deficiency, bleeding
high crp, high eryhtrocyte sedimentation rate, high ferritin factor viii, fibrinogen
chronic infections inflammation and malignancy
due to tnf alpha interleukin release. stop iron flow to rbcs stop flow out of cells by epo. increase ferritin production more rbc death.

fe deficiency: bleeding,

ida: high transferrin low trans sat, low ferritin
acd: normal trans sat high trans low serum fe high ferritin.

89
Q

iron transport

A

ferroportin iron cell to blood
hepicidin inhibits ferroportin
transferrin holds fe in plasma
transferrin and iron taken in as a whole. ferritin shell around fe in cell

90
Q

Thal vs acd vs fe def

A 
Thal: hb low
mcv low
serum fe normal
ferritin normal
trans normal trans sat normal
acd: hb low
mcv low
serum fe low
ferritin high
normal trans
normal sats
fe def: hb low 
mcv low
serum fe low
ferritin low
trans high
trans sat high
91
Q

b 12 folate deficiency

A

needed for dna synthesis and immune integrity in al rapidly dividing cells

macrocytic cells megaloblastic anaemia. has nucleus in pink rbc. anisocytosis large rbcs hypersegmented neutrophils giant metamyelocytes.

fe folate tests thyroid function reticulocyte count blood film

folate cases - alcoholics eczema poor diet, spina bifida

b12 cases - motor neuron signs, poor diet absorption infection needs intrinsic factor - low intrinsic factor = pernicious anaemia.

92
Q

haemostasis issues

A

vessel constriction
platelet adhesion/aggregation
plug formation

93
Q

platelet adhesion aggregation

A

endothelial cells make pgl2 platelets make txa2. prostacyclin synthetase thomboxane synthetase respectively.
txa2/endoperoxidases induce pgg2 pgh2

lab test = platelt count bleeding time platelet aggregation.

94
Q

haemostasis lab tests

A

platelet count
bleeding time
platelet aggregation

aptt activated partial thromboplastin time - initiates coagulatiion through F12 to detect intrinsic/common abnormalities.

pt - prothrombin time, uses tissue factor to initiate coagulation for extrinsic and common

tct - thrombin clotting time
abnormalities in fibrinogen to fibrin.

APTT PT for bleeding disorders

APTT for heparin monitoring in thrombosis

PT for warfarin monitoring in thrombosis.

95
Q

Fibrinolysis

A

No reaction between plasminogen and tpa, with fibrin plasmin is created to degrade fibrin.
antithrombin and protein c are anticoagulants.

96
Q

Primary haemostasis

A

issue with VWF collagen or platelet.
low platelet = thrombocytopenia due to bone marrow failure, accelerated clearance, pooling in splenomegaly.
impaired function due to hereditary absence of glycoproteins or acquired from drugs.

itp, immune thrombocytopenia anti platelet antibodies splenic macrophages.
other thrombocytopenia due to failure of platelet production, shortened half lives increased pooling.

VWF disease prevents binding to collagen and stabilising factor eight.

Collagen issue

teste: menorrhagia, easy brusing, prolonged immediate bleeding. gum bleeding.
PETECHAE BRUSING

vwf assay?

97
Q

secondary haemostasis

A

crosslinked fibrin - no thrmbin burst, VIII issue. Thrombin converts fibrinogen to fibrin. Larger vessels no plugging as no cross linking of fibrin.
factor deficiency usually viii haemarthrosis hallmark.

liver disease transfusion anticoagulants

disseminated intravascular coagulation

bleeding = no bleeding superficially, bruising deep bleeding, restarts a lot, delayed but prolonged.
Test PT APTT FBC factor assays NORMAL PT AND TT WEIRD APTT IN HAEMOPHILIA

98
Q

thallasaemia

A

beta - autosomal recessive bo b+.

microcytic more rbcs target cells poikilocytosis

99
Q

transfusion

A 
scarce only from humans
aob and d+ d-
ab+ can take all oo- can give to all.
igm is ab that reacts. 
delayed haemolytic reaction is d- given d+ then d+ again as antibodies made.
100
Q

blood components in transfusion

A

red cells five weeks four degrees

fresh frozen plasma two years minus thirty. no x matching need blood group.
ffp for reversal of warfarin bleeding and abnormal coagulation pt aptt
cryoprecipitate has fibrinogen and fviii so for massive bleeding and hypofibrinogenaemia sotred at minus thirty for two years

platelets stored 22 degrees for five days constantly agitated. bone marrow failure massive bleeding surgery cardiac bypass

fractioned products fviii fix for haemophilia and fviii for vWD.
ig to treat specific illnesses. im for tetanus anti d rabies IV IG for itp or AIHA
Albumin for burns severe liver kidney conditions.

101
Q

sickle cell

A

codon six glutamic acid swapped for valine os less charged. insoluble chain. polymerises forming tactoids forming sickle structure.

Sickling stages = rigid adherent dehydrated

haemolysis anaemia gallstones aplastic crisis

blocks microvascular = infarction. pain

lungs pulmonary hypertension correlating wtih severity of haemolysis.
urinary tract haematuria renal failure

stroke cognitive impariment.

give folate penicilin vaccination analgesic

low hb reticulocytes sickles boats targets howel jolly bodies.

diagnose with solubility test

102
Q

abnormal white cell count

A

cell development from HPScells
RBC - EPO
Lymphoid - IL2
Myeloid G-CSF M-CSF

eosinophilia, infection.inflammation.cancer
malignant haematopoises

immature cells = leukaemia
both = chronic leukaemia if neutrphils and myelocytes
acute = low hb platelets

neutrophilia, infection stress Adrenaline corticosteroids neoplasia malignancy. viruses dont usually cause this

eosinophilia, parasitic allergic reactionm neoplasm hodgkins. hypereosinophilic syndrome

monocytosis tb sarcoidosis cml

lymphocytisis mature, reactive or primary disorder, immature is primary disorder. secondary = polyclonal response to infection.
primary=monoclonal

mononucleosis, young looking lymphocyte with rbc dump. glandular fever. in elderley is usually CLL. POLYCLONAL KAPPA LAMBDA IS INFECTION, MONOCLONAL CANCER.

test with southern blot analysis [monoclonal or polyclonal]

103
Q

chem PATH

A

red -no anticoagulant LFT
yelow- speed clotting, TFT LFT, U&E
grey- poison for glucose testing fluroide oxalate
purple-K EDTA tops clotting HbA1c
lots of liver enzymes like alkaline phosphatase in tissue damage.

104
Q

Virology LAb

A 
cell culture, electron microscopy
pcr
ab detection
ag detection
serotyping
quantification
genome sequencing

for resp, throat swab, broncheoalveolar lavage, sputum, Endotracheal tube.

serology, test for specific antigens, IGM IS RECENT INFECTION IGG IS LATER

hiv serology = antibody and p24 ag.

antibody avidity tests igM

immunofluorescence for viralantigens

cns disease, stool throat blood

105
Q

bacteriology

A

culture, serology, molecular, antimicrobial susceptibility

+ve skin soft tissue
-ve UT GI

staph a form clumps. coagulase test.
strep = chains.

diarrhoea - stool, salmonella shigella e coli c difficile cholera campylobacter.

mic minimum inhibitory conc. minimum ab to stop bacterial growth.

106
Q

Histopathology cytopathology

A

biopsies
resectionspecimens
frozen sections
post mortems

smears

107
Q

antibodies diagnostics

A

wash with enzyme
fluor probes
magnetic beads
drugs

indirect labelling, anti antibody by patient or artificially

produce antibodies by:
monoclonal with b cell and immortal myeloma cell
recombinant dna = isolate ab segment, display on protein, use library to screen for antigen.

used as prophylactic anti cancer t cell removal
blockcytokine

ELISA is enzyme linked immuno sorbent assay
anti a binds to enzyme reporter and turns colourless subsrate coloured.

108
Q

paraneoplastic cerebellar degeneration

A

in cancer tumour produces antigens that can be found elsewehere g breast cancer cdr2 found on cerebellum so ataxia vertigo unintelligible speech.

109
Q

immune surveillance of cancer

A

cancer cells produce antigens immune response can respond to it.
evidence is immunosuppression leads to increased risk of malignancy
controlled colonies of cancer cells
transfer of immunity between patients
men more at risk as women have better immune system

110
Q

Cancer immunity cycle

A

cancer cells release antigens and apcs take them up. present to t cells in lymph nodes, which migrate to tumours, infiltrate and kill it.

111
Q

factors affecting immune response to tumours

A

local inflammation not caused by small tumours often. no costimulation = anergy
only subtle differences between tumour antigens and self ones so hard to distinguish.

112
Q

cancer immunotherapy

A

teach immune system to react to cancer in absence of inflammation, costimulation and recognition of antigen.

113
Q

what are cancer immune responses similar to

A 
viral response.
tumour antigens are cytosilic so t cells detect via mhc class one

viruses can cause cancer. can be opportunistic due to immunosuppression, like ebv+ lymphoma/HHV8+ sarcoa in HIV
HPV e6/e7 oncoproteins so we can target these with a vaccine.

114
Q

tumour specific antigens

tumour associated antigens

A

tumour specific antigens - viral proteins that cause cancers or mutated cellular proteins

tumour associated antigens - normal proteins aberrantly expressed. for response, tolerance must be overcome like in autoimmune.

115
Q

tumour associated antigens

A

HER2, breast
MUC1,
CEA, normal in foetus,
prostate antigens

116
Q

immunotherapy vs cancers

A

intolerant to self t cells can be used if they target tumour associated antigens.

tyrosinase is a common one. involved in skin pigmentation. used for melanoma treatment leads to loss of pigmentation.

issues include autoimmune responses and tolerance due to lack of inflammation.

117
Q

types of cancer immunotherapy

A

antibody based monoclonal - anti-her2 direct antibody, conjugated antibody with radioactive particle, bispecific to target two things at once.

therapeutic vaccination, provenge for prostate, wbcs treated with protei to stimulate dendritic cell response.

checkpoint blockade- removes t cell inhibition to enhance existing response against tumour

adoptive transfer of cells is removal of tumour by surgery, extract tumour infiltrating lymphocytes and reinfuse. can also induce chimeric antigen receptors to create a new pathway for t cells to kill tumour cells.

118
Q

inflammatory dermatoses

A

eczema - can be atopic due to defective barrier of skin allowinf irritant entry. can be seborrhoeic overgrowth of malassezia

psoriasis - t cells move into dermis release cytokines causing epidermis to thicken and neutrophils to infiltrate.

acne, common, due to hyperkeritanisation, loads of dead keritanocytes in folliclem proliferation of acne bacteria and ruture leading to inflammation.

bullous pemphigoid - autoimmune igg against basement membrane leading to skin cleavage and ulcers.

pemphigus vulgaris like bullous due to loss of cell-cell adhesions

119
Q

hypersensitivity

A

type 1, IGE, asthma, allergies, sensitisation on first exposure, degranulation on second. inflammation

type 2, antibody dependent, organ specific AI like graves. AI cytopenias. insoluble antibod.

type3 - immune complex, soluble antigen binds to antibody and deposits in tissues causing clotting and damage. SLE

type iv, delayed type, t cell, graft rejection, coeliac, asthma eczema too. TH1,2 and cytotoxic. Lots of antigen leads to t cell activation of macrophages and tnf-a damage.

120
Q

Allergy

A

type i

atopy is hereditary

121
Q

atopic airway

A

apc presents to t cell

needs sensitisation. apc to t cell th1/2 treg

subsequently eosinophil degranulation and ige plasma cell production

122
Q

asthma

A 
ti tiv
narrowing airway by type i
short acting b2 agonist
inhaled steroids
long acting
oral steroids and for attack.
123
Q

transplantation

A

store organs for short periods of time cooled and perfused cornea is 96 hours exception.

immunology - abo and hla important
mismatch can be good if remove abs from plasma
HLA, test mismatches for 2x HLA A, 2x HLA B, 2x HLA DR

rejection, t cell or antibody mediated.
t cell, lymphocytes recruited, rupture BM causing local damage.
AB - vs hla and abo

treat with immunosuppressives like anti cd3 and anti b cells.

124
Q

regime of transplantation medication

A

pre, induction agent to deplete t cells

after, steroids, signal transuuction blockers, anti-proliferative agents.

125
Q

tolerance

A

central - t cell selection
peripheral, anergy, ignorance, suppression by tregs, needed for antigens not expressed in thymus.

autoimmunity breaks tolerance,
infection can cause this

acquired antigen specific active in neonates.

126
Q

autoimmune diseases

A

tii goodpastures graves
tiii sle
tiv diabetes
rheumatoid arthritis multiple sclerosis

127
Q

cancer terms

A

neoplasia new autonomous abnormal growth unresponsive to control mechanisms

dysplasia abnormal growth features of malignancy

metaplasia reversible cell type change like garrets oesophagus

128
Q

cell cycle control

A

checkpoints, metaphase checkpoint makes sure chromosomes are aligned at plate, kinetochore produces cenp e and bub when not attached to microtubule.

g1 check ready to make dna
before M check dna has been replicated correctly

129
Q

exit G0

A

EGF bind to RPTK, cross phosphorylation of tyrosine residues as it’s a heterodimer. grb2 binds to these attached to SOS. ras on membrane, sos brought closer so exchanges gdp for gtp, activating ras, causing kinase cascade.

130
Q

ERK

A

causes transcription of c-myc

sh3 and sh2

ras mutation v12 and l61
raf mek erk

final kinase activate c-myc transcription factor.s

131
Q

cyclins and shit

A

cell cycle control

cdks always present. need cyclin removal of inhib and addition of excit.

c-myc -> cyclin D -> cyclinD-Cdk4/6 -> cyclin E production which activates cell cycle.

CDK2/Cyclin E phosphorylate Rb which releases E2F which promotes transcription. e2f goes for last three cyclins at different concs.

ink4 and CIP/KIP also inhibit cdks.

cyclin b cdk 1 need removal of wee1 inhib and addiditon of cdc25 excitatory phosphate

132
Q

systemic chemo

A

alkylating, add alkyl to guanine cross linking strands to prevent uncoiling, chlorambucil

antimetabolites, purine analogues/folate antagonists methotrexate

anthracyclines, inhibit transcription and replication by intercalating nucleotides within the dna/rna strand. doxorubicin

vinca alkaloids taxanes, microtubules

topoisomerase inhibitors, prevent cupercoiling. induce permanent breaks in backbone, topotecan

133
Q

targeted chemo

A

monoclonal antibodies, target overexpression of receptor protein tyrosine kinases. bevacizumab targets vegf

small molecule inhibitors bind to kinase domain of rptks to prevent downstream signalling
eg. glivec for CML

lots of resistance

134
Q

hallmarks of cancer cells

A 
SPINAP DIE U
Self-sufficient
Pro invasive
Insensitive to anti growth signals
Non-senescent 
Anti-apoptotic
Pro-angiogenic

Dysregulated metabolism
Inflammation
Evade immune response
Unstable dna

135
Q

proliferation

A

anchorage dependency, needed for proliferation. CELL-ECM by integrins. heterodimers of a/b associate at head region. Form focal adhesions or hemi-desmosomes. Used for signalling. Outside-in, type of ECM difference in force and ecm stiffness leads to different type of cell proliferation.
Integrin+GF = strong signal to activate MAPK pathway, weak on their own.

inside-out, eg clotting, internal pathways increase affinity out head to molecules.

Controlled by density dependence , contact inhibition of locomotion

density = competition for growth factors.

contact inhibition of locomotion., non-epithelial.

stable junctions - calcium dependent cadherins inhibit proliferation. cadherin bound to beta catenin when cell-cell junctions present. if not beta catenin binds to lef1 which is a tf.

136
Q

cell motility and invasion

A

filopodia, parallel actin, cdc42

lamellopodia, branched and cross linked actin, rac

1) nucleation, actin needs to attach to inner membrane. ARP proteins form a complex actin joins it. rate limiter
2) filament elongates, profilin increases polymerisation, thymosin reduces it.
3) capping and severing, add cap like capz to limit elongation. Sever via gelsolin to speed up growth/shrinkage

crosslinking via fimbrin alpha actinin etc.

branching and stuff allows for different angles of projections for different functions, arp complex

at the back rho regulate stress fibre formation which severs old attachments alongside contractile movements.

regulated via cytoskeleton signalling pathways

137
Q

apoptosis

A

CASPASES
effector and initiator
initiator includes 2,9,8,10, have death domains like ded, have card for targeting
initiator just p20 and p10.

intrinsic - apoptosome formation from cell stress, loss of mitochondria potential, cyt c release, etc.
wheel of CARD ATPase WD40, CYT C binds to WD40 allowing card to bind to procaspase 9 and cross phosphorylate, this tgen triggers it. active process

extrinsic, deatn receptor (Fas, DR4), upregulated, allowing death ligands to bind. FADD is death domain adaptor protein. binding to death receptor, procaspase recruitment. procaspase 8 and fadd form DISC which crossphosphorylates procaspase 8 to start cascade.

FLIP is domain that incorporates into trimer but has no proteolytic activity so cant activate procaspase.

BCL 2 modulate it. Anti = bcl2 bcl xl, pro = bid bad bax bak.

EGF binding to RPTK activates MAPK and also P13K which phosphorylates PIP2 to PIP3 which binds to PKB which has anti apoptotic effects - phopshorylate bad

if no gf, bad not phosphorylated by pip3 pathway so can displace bax and bak to form a mitochondrial pore releasing cyt c.

PTEN counteracts p13k signalling so promotes apoptosis

IAPS bind to procaspases to prevent activation and bind to caspases to inhibit them directly.

138
Q

stages of apoptosis

A

1) microvilli junction loss
2) cell shirnkage
3) asymmetry lost
4) nuclear condensation
5) fragmentation of dna
6) bleb formation
7) fragmentation of cell in membrane closed bodies.

139
Q

Oncogenes and tsgs

A

protoncogenes activated by mutation amplification translocation or insertional mutagenesis.

eg. rptks egfs ras, kinases

tsgs, p53, apc, rb

140
Q

colonic benign to cancer

A

apc mutation hyperproliferation
k-ras adenoma
p53 carcinoma
metastasis

141
Q

angiogenesis

A

selection of tip cell, sprout grwoth and guidance, fusion and lumen forms, perfusion maturation.

Triggers, hypoxia hypoxia inducible trranscription factor which is controlled by protein von hippel linedlaue tsg.

vegfr2 mediator of vegf causing angiogenesis

tip cell follows vegf gradient, notch signalling selects and causes nearby cells to not be tip cells.
DII4 and notch go against each other. VEGF increases dii4 which increases adjacent notch signalling causing inhibition of vegfr2.

myeloid cells recruited to guide and support. macrophages carve tunnels

barrier forms to stabilise associated with cadherins and ang i

stabilised by pericytes. and vsmcs which are mural cells.

stabilise with ang one and two inhibiting a tie receptor causing anti inflammatory.

142
Q

anti vegf

A

therapy not too harsh as more tumour hypoxia releases more vegf signals so vasculature growth can be more eratic and dangerous. need normalised vasculature so increase efficacy of other therapies.

143
Q

dna damage repair

A

uv causes pyrimidine dimerisation leading to cancer

p53 senses dna damage. leads to repair

mechanisms: excision, direct reversal

test for damage done by new drugs from bacteria to mammals.

144
Q

colorectal

A

4th common2nd death
apc mutation prevents high cell turnover leading to proliferation.

types:
tubular nine/ten, columnar
villous, mucinous
tubulovillous

sessile flat stalk pedunculated

apc, kras, p53
polyps, adenoma, carcinoma.
due to microsatelitte instability

diet = need folates and mthfr both for dna synthesis. also vitamins for oxidant scavenging

grading is dukes, ABC1C2, limited to walls, beyond mucosa, nodes positive, apical nodes positive.

screening: affected relatives, gene trait, crohns uc

145
Q

leukaemia

A

acute
chronic
myeloid
lymphoid

ACUTE LYMPHOBLASTIC
CHRONIC LYMPHOCYTIC
ACUTE MYELOID
CHRONIC MYELOID

series of mutations in one stem cell.

AML - CELLS PROLIFERATE BUT DONT MATURE NO MATURE END CELLS

CML - MORE CELLS, BOTH IMMATURE AND MATURE.

ALL - LYMPHOBLASTS AND NO MATURATION

CLL - MATURE AND ABNORMAL

all blood film, anaemia, neutropenia, thrombocytopenia,

fbc with liver and renal function

treat with replacement of other cells chemo. must be systemic.

146
Q

breast cancer

A

all about oestrogen, recepotrs only on some luminal cells not myoepithelial cells.

in cancer oestrogen acts as growth factor.

benign is within gland
lobular has resemblance
medullary shows little resemblance
risk factors involve exposure to oestrogen so menstruation menopause pregnancy the pill

or dimerisation leads to c-myc and tgf-alpha

pre-menopause oophorectomy
post- high dose oestrogen downregulation of receptor.s

or expression is good

suppress ovaries with lhrh
tamoxifen or antagonist
aromatase inhibitors useful in post menopause as blocks main path of androgens to oestrone.

progestins

resistance to endocrine therapy

147
Q

skin cancer

A

malignant melanoma irregular margin

basal cell carcinoma peely with dilated vessels

UVB worst one. affects pyrimidines. nucleotide excision repair effective here.
p53 mutation stop sthis.

fitzpatrick phenotype is risk
white burn
white sometimes tan
white sometimes burn
white tan
asian
black

melanin protective.

malignant melanoma - lentigo isnt bad, superficial spreading is bad, ABCD diagnosis, nodular malignant is bad and dark, nodular within ssmm is bad
acral lentigious is ok
amelanotic is bad

epidermodysplasia verruciformis is autosomal causes warts.

mostly surgical

hpv can cause squamous cell carcinoma.

148
Q

prostate cancer

A

dre psa tests
heterogenous as defects on tsgs and protooncogenes.

gleason grading, two largest areas biopsied and scored then added together.

treatment: surgical

lhrh agonist
anti-androgen

need less testosterone basically.

Haem Diagnosis (9 decks)

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