MedEd Immuno 2 Flashcards
1
Q
what is oral allergy syndrome
A
allergy sx limited to mouth
2
Q
when does the allergy not happen in oral allergy syndrome
A
cooked !
allergens are heat labile
3
Q
in oral allergy syndrome, why can you be allergic to things other than allergen
A
cross reactive IgE to foods eg pollen –> stone fruit
4
Q
2 examples of mixed IgE and cell mediated type 1 reaction
A
atopic dermatitis
eosinophilic oesophagitis
5
Q
example of non IgE mediated allergic disease
A
coeliac
(lymphocytic destruction)
6
Q
Ix for allergy
A
skin prick test
IgE bloods
oral challenge
7
Q
benefits of skin prick test
A
easy to do
cheap
high negative predictive value
8
Q
cons of skin prick test
A
need to stop antihistamines before
poor positive predictive value
affected by severe derm diseases (eg rlly bad eczema)
risk of anaphylaxis
9
Q
what is IgE blood test aka
A
RAST
10
Q
benefits of IgE blood test
A
prediction of allergy RISK
11
Q
when is IgE blood test good
A
if skin prick test not possible
12
Q
what is gold standard allergy test
A
oral food challenge
13
Q
cons of oral food challenge
A
high risk of anaphylaxis
time consuming
difficult in little kids to see if they get sx
close supervision
14
Q
what is the prerequisite for type 2 reactions
A
breakdown in self selection
15
Q
examples of type 2 reaction
A
goodpastures
pemphigus vulgaris
graves
myasthenia gravis
16
Q
how is type 2 and type 3 different
A
type 3 is a soluble Ag, type 2 is on your cells
17
Q
example of type 3 reaction
A
SLE
polyarteritis nodosa
18
Q
what type of damage is done in type 3 reactions
A
fibrinoid necrosis
19
Q
effects of cd4 response
A
reactive oxygen species generation
lysozymes
inflam
20
Q
effects of cd8 response
A
apoptosis from
- perforin
- granzyme
21
Q
4 examples of type 4 reactions
A
contact dermatitis
tuberculin skin test
T1DM
Hashimoto’s
22
Q
important determinants of transplant rejection
A
HLA / MHC
ABO blood group
23
Q
what chr is HLA encoded on
A
6
24
Q
types of HLA 1
A
A B C
25
types of HLA 2
DR DQ DP
26
which cells have HLA 1 or 2
all have 1
APCs have 2
27
which groups are most important to match
DR > B > A
28
what is the chance your sibling is your perfect HLA match
1/4
29
3 pathways by which t cells recognise transplant --> rejection
direct - donor APC present's donor MHC to recipient t cells
indirect - recipient APC present's donor peptides to recipient's t cells
semi direct - recipient APC presents parts of MHC to recipient t cells
30
in what scenarios are anti HLA ABs made
not naturally occurring
pre formed - transplant, transfusion, pregnancy
post-formed - graft damage
31
which ABs involved in B cell mediated rejection occur naturally
anti A / B (blood group)
32
where do the ABs bind to transplant to cause rejection
endothelium of BV of graft
33
mx of transplant rejection
screen for it
- ABs - before / during / after
- T cell - biopsy
34
definitive diagnosis of transplant rejection
biopsy - inflammation
35
name induction immunosuppressants (pre op)
anti thymosite globulin (ATG)
anti CD52
anti CD25
36
name baseline immunosuppressants
calcineurin inhibitor
azothioprine or MMF
steroids
37
tx of t cell rejection
methylprednisolone IV then oral
38
tx of b cell rejection
plasma exchange
IVIG
anti CD5 / 20 (stops B cells producing ABs)
39
autologous vs allogenic SCT
autologous = patients own stem cells
allogenic = HLA matched donor SCs
40
when is autologous vs allogenic SCT used
autologous = MM, lymphoma, solid tumours
allogenic = leukaemia, myelodysplasia
41
which type of SCT has higher relapse rate
autologous
42
which type of SCT is more tolerable
autologous
43
which type of SCT has GVHD risk
allogenic
44
is GVHD reversible
NO
45
what is GVHD
donor lymphocytes attack recipient's tissues
- GI / skin / bone Sx
46
which type of SCT needs immunosuppression
allogenic
47
how can the immune system be boosted (4)
vaccination
replacement of missing components
cytokines
checkpoint inhibition
48
3 requirements of a vaccination
generates immunological memory
no adverse reactions
practical
49
how can vaccines be enhanced
adjuvants
- boost response without affecting specificity
- more persistent Ag or assisted activation
50
example of vaccine adjuvant
aluminium salts
51
what is a depot adjuvant of vaccines
more persistent Ag
52
what is a stimulant adjuvant of vaccines
assisted activation
53
examples of live attenuated vaccine
MMR
VZV
BCG
oral polio (Sabin)
typhoid
yellow fever
54
pros of live attenuated vaccines
lifelong immunity possible (no boosters)
multi strain protection
all phases of immune system activated
55
cons of live attenuated vaccines
reversion to virulence possible
risk if immunocompromised
complex storage - refrigeration etc
56
examples of inactivated vaccines
influenza
polio - salk
cholera
plague
hep A
rabies
pertussis
57
examples of component vaccines
hep B
HPV
influenza recombinant
58
examples of toxoid vaccines
diptheria
tetanus
59
pros of inactivated / component vaccines
no reversion to virulence
safe if immunocompromised
easier storage
cheap
60
cons of inactivated / component vaccines
poor immunogenicity
repeated boosters needed
do not follow natural infection route eg SC for flu
61
examples of conjugate vaccines
meningitis
influenza
strep pneumonia
tetanus
62
pros of conjugate vaccines
effective against encapsulated bacteria
good for kids
63
cons of conjugate vaccines
poor immunogenicity
repeated boosters
do not follow normal route of infection
64
examples of DNA / RNA vaccines
covid pfizer
covid AZ
65
pros of DNA / RNA vaccines
non infectious and non integrating
66
cons of DNA / RNA vaccines
possible autoimmunity response
need target that envokes a good immune response
67
what is a live attenuated vaccine
live pathogen modified to limit pathogenesis
68
what is an inactivated / component vaccine
inactivated = destroyed pathogen
component = isolated Ag protein
69
what is a conjugate vaccine
polysaccharide + Ag protein carrier
70
what are DNA / RNA vaccines
pathogen's DNA/RNA delivered to host via viral vector / lipids
71
which vaccines are good against encapsulated bacteria
conjugate vaccines
72
which vaccines can't immuncompromised people have
live attenuated
73
which vaccines are completely safe for immunocompromised people
inactivated / component
74
pneumonic for encapsulated bacteria (and for examples of conjugate vaccines)
NHS
n. meningitis
h. influenza
strep pneumonia
75
3 types of replacement of missing components for immune boosting
haematopoeitic stem cell transplant
ABs
T cell transfer
76
what type of ABs can be given to boost immune system
normal Ig
specific Ig
77
who gets normal Ig replacement
AB deficiencies eg alpha gamma globulinaemia, hyper IgM, CVID (all primary) or cancer / BMT (secondary)
78
when is specific Ig replacement done
post exposure eg hep B, rabies, VZV
79
3 examples of T cell transfer use
virus specific
tumour infiltrating
CART
80
when is IL2 replacement given
renal cancer
81
2 effects of IFN alpha replacement
antiviral
anti cancer
82
examples of antiviral IFN alpha replacement
Hep B / C
83
examples of anticancer IFN alpha replacement
kaposi's sarcoma
hairy cell leukaemia
CML
melanoma
84
when can IFN g replacement be given
chronic granulomatous disease
- increase macrophage function
85
when can IFN b replacement be given
relapsing remitting MS
- this is reducing the immune system tho
86
what is the point of giving checkpoint inhibitors
anti cancer
- immunosuppressive signals upregulated by cancer - removing the immune brakes = boosted immune response
87
name 2 checkpoint inhibitors and their method of action
ipilimumab (CTLA4) - allows t cell activation
nivolumab (PD1) - prevents t cell death
88
2 examples of when checkpoint inhibitors can be used
advanced melanoma
metastatic renal cell carcinoma
89
how do steroids suppress the immune system
affect transcription
90
2 descriptors of the effect of steroids
widespread
not immediate
91
how do steroids affect prostaglandins
inhibit phospholipase a2 --> reduces prostaglandins -->
less inflammation
92
3 effects of steroids on phagocytes
reduced trafficking --> neutrophil count RISES
reduced phagocytosis
reduced enzyme release
93
4 effects of steroids on lymphocytes
lymphopenia
cytokine gene expression blocked
reduced AB production
pro-opportunistic
94
how do anti proliferative agents suppress the immune system
inhibit DNA synthesis
95
3 examples of anti proliferative agents
azothioprine
cyclophosphamide
mycophenolate mofetil
96
what type of cells do anti proliferative agents affect the most
cells with rapid turnover
97
2 types of cell signalling inhibitors used to dampen immune system
calcineurin inhibitors
mTOR inhibitors
98
how do calcineurin inhibitors dampen immune system
reduce IL2 expression --> reduce cell proliferation / function
99
2 examples of calcineurin inhibitors
tacrolimus
cyclosporine
100
what conditions are calcineurin inhibitors used in
transplant
psoriasis
SLE
101
how do mTOR inhibitors dampen immune system
inhibit t cell proliferation and function
102
2 examples of mTOR inhibitors
rapamycin
sirolimus
103
when are mTOR inhibitors used
transplant
104
2 drugs that target T cell surface Ags
basiliximab
abatacept
105
how does basiliximab dampen immune system
inhibits t cell proliferation
106
use of basiliximab
rejection prophylaxis
107
how does abatacept dampen immune system
fusion protein that blocks T cell activation
108
use of abatacept
RA
109
example of b cell surface Ag targeting agents
rituximab
110
how does rituximab dampen immune system
depletes mature b cells
111
use of rituximab
NHL
112
how does vedlizumab work
prevents leucocyte migration
113
use of vedlizumab
IBD
114
what does basiliximab bind to
cd25
115
what does abatacept bind to
cd80 / 86
116
what does rituximab bind to
cd20
117
what does vedlizumab bind to
alpha 4 beta 7 integrin
118
name 2 TNFa blockers and common indications for use
infliximab
adalimumab
RA / psoriatic arthritis
119
what can infliximab be used for
RA
ank spon
psoriasis / psoriatic arthritis
IBD
120
what does etanercept target and what is it used for
TNF alpha and beta
ank spon, JIA, RA, psoriatic arthritis
121
what does ustekinumab target and what is it used for
p40 subunit of IL12/23
psoriasis, psoriatic arthritis, crohns
122
what does secukinumab target and what is it used for
IL17A
psoriasis, psoriatic arthritis, ank spon
123
what does natalizumab target and what is it used for
a4b1 integrin
MS
124
what does denosumab target and what is it used for
RANK ligand
osteoporosis
125
what does toculizumab target and what is it used for
IL6R
RA, castleman's disease
126
when is plasma exchange used and what is being removed
severe AB mediated disease
- goodpastures (anti GBM)
- MG (anti Ach R)
- humoural transplant rejection / ABO incompatability (anti HLA/AB)
127
limitation of plasma exchange & solution
rebound AB production
- prescribe anti proliferative (MFM)
128
generic SEs of immunosuppression
infection - atypicals and more severe
malignancy - EBV lymphoma, melanoma, non melanoma skin cancer
- AID
129
SE of steroids
metabolic - DM, dyslipidaemia, osteoporosis, adrenal suppression
peptic ulcers
avascular necrosis
cataracts, glaucoma
pancreatitis
130
important prescribing note with steroids & reason why
do not stop suddenly - adrenal suppression --> crisis **key one
131
SEs of cyclophosphamide
haemorrhagic cystitis **key one
bladder cancer
non melanoma skin cancer
infertility M>F
PCJ pneumonia
132
SEs of MMF
PML (JC virus reactivation) ** key one
herpes reactivation
133
SE of azothioprine
BM suppression **key one
134
SE of all cell surface Ag agents
infusion reactions
135
Se of rituximab
worsening CVD
PML
136
SE of abatacept
TB
Hep B/C
137
SE of vedlizumab
hepatotoxic
PML
138
SE of TNFa/b ABs
TB
Hep B/C
lupus like disease
demyelination
139
SE of toclizumab
dyslipidaemia
hepatotoxicity
140
SE of denosumab
avascular necrosis of jaw **key one
141
what test should you do prior to starting AZ
TPMT
142
how is HIV detected
ABs - serology
Ag = direct confirmation of viral particles
RNA / DNA = direct confirmation of viral genetic material
143
when will HIV ABs be positive
after seroconversion 15-45 days
144
in whom can't you use AB test to detect HIV infection
neonates - passive transfer from mother
145
describe HIV lifecycle
binding to host cell
fusion with host cell membrane
reverse transcription
integration
replication
assembly
budding
146
which class of drugs inhibit HIV lifecycle at binding to host cell
CCR5 inhibitors
147
which class of drugs inhibit HIV lifecycle at fusion with host cell membrane
fusion inhibitors
148
which class of drugs inhibit HIV lifecycle at reverse transcription
NRTIs or NNRTIs
149
example of NRTI and use
tenofovir - PrEP
150
which class of drugs inhibit HIV lifecycle at integration
integrase inhibitors
151
which class of drugs inhibit HIV lifecycle at budding
protease inhibitors
152
when should HIV+ patients be given ART
immediately after Dx - no longer wait for low CD4 etc
153
what types of drugs would a newly Dx HIV+ patient be given
2 NRTIs and a protease inhibitor
