MedGems Immuno Flashcards
Bullous pemphigoid antibodies
anti-hemidesmosome
high anti-GBM levels
Goodpasture’s syndrome
Rule out what infection before starting infliximab
TB
What antigen is injected intradermally as part of the mantoux screening test for tuberculosis?
tuberculin purified protein derivative
What is the target of the antibody P-ANCA?
myeloperoxidase
VZV what type of vaccine
live attenuated
Infections by what type of bacteria are more common in patients deficient in the complement protein C3?
encapsulated
A 21 year old woman reports weight loss, tiredness, diarrhoea and non-bloody offensive smelling stools. She has had three chest infections requiring antibiotics in the last three years. Blood tests are ordered and reveals a hypochromic, microcytic anaemia with low ferritin. Anti-TTG and anti-endomysial antibodies are negative. There are normal levels of IgG, IgM and IgE. No IgA is found.
What is the most likely cause of her gastrointestinal symptoms?
Coeliac Disease
Particular caution should be noted in the diagnosis of coeliac disease, as the common autoantibodies that are used for diagnosis are of the type IgA (Anti-Endomysial and Anti-Tissue Transglutaminase).
Hence, in IgA deficiency (1 in 600 people), they may be falsely negative.
IgA levels should always be assessed at the same time when assessing for coeliac disease.
What hematological cells create a “respiratory burst” in order to kill phagocytosed pathogens?
neutrophils
What monoclonal antibody targets IL-17 and is involved in the treatment of psoriasis, psoriatic arthritis and ankylosing spondylitis?
secukinumab
IgE antibodies bind semi-permanently to the surface of what cell of the innate immune system?
mast cells
A patient is investigated for a primary immunodeficiency. Lymphocyte counts are normal. However, IgG and IgA are low. There is an excess of IgM. What condition is this patient likely to have?
Hyper IgM
Hyper IgM is characterised by high levels of IgM in blood and reduction in levels of other immunoglobulin classes. IgM is the first antibody to be created during the immune response - all other classes of antibody require a process called class switching to occur. Class switching requires activation of CD40 on the surface of B lymphocytes to occur. When CD40 is defective, only IgM can be produced. Typically this leads to increased infection risk, particularly Pneumocystis pneumonia.
What type of bacteria are conjugated vaccines effective against?
encapsulated
What type of hypersensitivity is T cell mediated?
Type 4
What immune cell releases granzyme and perforin when activated?
T killer cells
What drug is given prophylactically to infants at high risk of developing life threatening RSV infection?
Pavilizumab
What lymphocyte lineage does cyclosporine predominantly inhibit?
T lymphocytes
CD8 is specifically a marker of what type of immune cell?
T killer cells
What assay is used as the first line test for HIV infection?
Enzyme Linked Immunosorbent Assay
What antiretroviral drug is given as IV monotherapy during labour to prevent vertical transmission of HIV-1?
Zidovudine
What monoclonal antibody targets CD20 and is used in the treatment of lymphomas?
rituximab
What is the minimum number of Fc receptors on the surface of mast cells that must bind to an antigen to cause mast cell degranulation?
2
What antigen does the immune system erroneously target in autoimmune thrombocytopenic purpura?
Glycoprotein IIb/IIIa
An prenatal autoimmune panel of bloods reveals positive anti-Ro antibody in the blood of a pregnant woman with SLE. What cardiological condition is her unborn baby at risk of?
Congenital heart block
What serine protease released by neutrophils causes hepatitis and emphysema in patients deficient in alpha-1 antitrypsin?
Neutrophil elastase
Which cell surface receptor allows cells of the innate immune system to bind to immunoglobulins?
Fc
What viral enzyme is predominantly responsible for the high mutation rate of HIV and other RNA viruses?
Reverse Transcriptase
In skin prick testing, what is used as a positive control?
Histamine
A 50 year old man is seen by the rheumatologists. The rheumatologists take a thorough history and the symptoms he experiences include: exquisitely painful fingers when entering the chilled aisle of his local supermarket, difficulty swallowing large bites of food, tight skin on his hands and around his mouth. In addition, he is easily fatigable and often feels feverish. His CRP is raised and an autoantibody is detected.
In the absence of other signs, what is the most likely diagnosis?
Limited Systemic Sclerosis
Which cytokine is important in the pathogenesis of rheumatoid arthritis, anyklosing spondylitis and inflammatory bowel disease?
Tumour Necrosis Factor Alpha
What type of vaccine uses weakened strains of a pathogen?
Live attenuated
What is the specific antigen recognised by the immune system in Goodpasture’s syndrome?
Type IV collagen
What autoantibody is associated with Microscopic Polyangitis?
P-ANCA
p-ANCA
UC, Eosinophilic Granulomatosis with Polyangiitis, Primary Sclerosing Cholangitis or Microscopic Polyangiitis
c-ANCA
Granulomatosis with polyangiitis (Wegner’s)
How long before skin prick testing must antihistamines be stopped to allow for accurate interpretation?
48 hrs
The paediatric SpR is called to review a 2 day old infant who is jaundiced, pyrexic and appears very unwell. The parents think he has a problem with his hearing as he did not cry when the fire alarm went off on the ward. He has a fever of 40.1C. Blood tests reveal an absolute neutropenia and absolute lymphocytopenia. What primary immunodeficiency is this patient likely to have?
Reticular dysgenesis
What immunoglobulin mediates type I hypersensitivity reactions?
IgE
The rabies and hepatitis A vaccinations are examples of what type of vaccination?
Inactivated
A neutrophil releases preformed myeloperoxidase, defensins and neutrophil elastase. What is this process known as?
Degranulation
What type of hypersensitivity reaction results when circulating antibodies directly react with self antigens leading to tissue damage?
Type II
What intracellular pro-proliferative molecule does cyclosporine and tacrolimus inhibit?
Calcineurin
What lymphocyte lineage does azathioprine predominantly inhibit?
T cells
What is the maximum number of viral capsids that a molecule of IgM may bind to?
10
What HLA allele is found in 90% of patients with coeliac disease?
HLA-DQ2
What HLA allele is associated with Graves disease?
DR3
A 80 year old woman was given a blood transfusion yesterday due to low haemoglobin. All observations normal. Infusion site is unremarkable. She feels like she has a fever. What complication of blood transfusion is this patient suffering from?
Febrile non-haemolytic transfusion reaction
What protein is defective in X linked Severe Combined Immunodeficiency?
Common Gamma Chain
A mutation in what protein is the most common cause of Hyper IgM syndrome?
CD40 ligand
positive anti-glycoprotein IIb antibodies
Autoimmune Thrombocytopenic Purpura
What test is the ability of a patient’s serum to lyse sheep erythrocytes coated with rabbit anti-sheep antibodies?
CH50
What mouse monoclonal antibody targets CD3 on the surface of T cells?
Muromonab
A 5 year old girl is seen by her GP. Her mother says she is unable to sleep at night as her knees, elbows and shoulders are very red and painful, especially to touch. Her mother has also noticed small bumps under her skin. She is currently pyrexic, but the mother says she is still recovering from a bad sore throat two weeks ago.
Acute Rheumatic Fever
Rheumatic fever is now a rare type II hypersensitivity reaction that may occur post-streptococcal infection.
The condition is diagnosed using Jones’ criteria:
Major criteria
Polyarthritis
Carditis
Subcutaneous nodules
Erythema marginatum (Rash on the trunk/arms which spread outward. Worse with heat)
Sydenham’s chorea (Involuntary movements of the face and arms)
Minor criteria
Fever
Arthralgia
Raised ESR/CRP
Leukocytosis
The Meningitis C vaccination is an example of what type of vaccination?
Conjugate
HIV infected CD4+ cells are killed by the immune system. What cell type is responsible for this?
T killer cells
Mutation in what cell surface receptor may confer immunity from HIV?
CCR5
Ritonavir is an example of what class of antiretroviral drug?
Protease inhibitor
What assay is used as the gold-standard for diagnosis of HIV or as a confirmatory test of infection?
Western blot
What enzyme, deficient or defective in chronic granulomatous disease, is responsible for the “respiratory burst” that may kill phagocytosed pathogens?
NADPH oxidase
What cell type of the adaptive immune system recognises MHC Class I on epithelial cells?
T killer cells
Defective gene in Bruton’s agammagobulinaemia
BTK gene
What cell type gives pus its yellow/white appearance?
Neutrophils
What monoclonal antibody targets alpha4 integrin and is used in the treatment of relapsing remitting multiple sclerosis?
Natalizumab
What is the long term management of Common Variable Immunodeficiency?
Normal Human Immunoglobulin
Cytokine responsible for T cell proliferation and survival
Interleukin 2
What is the long term management of Bruton’s agammagobulinaemia?
Normal Human Immunoglobulin
Which subtype of T helper cells are implicated in the development of allergic diseases, such as asthma or eczema
Th2
What is the descriptor given to a solution of antibodies that recognise multiple antigens?
Polyclonal
What lymphocyte lineage does mycophenolate mofetil predominantly inhibit?
T lymphocytes
What class of medication is a contraindication to skin prick testing, unless stopped at least two days prior to testing?
Anti-histamines
A 31 year old accountant reports an itchy rash over the trunk and back that has been present for the last 7 weeks. On examination, there are smooth erythematous papules with evidence of excoriation. She reports no association with food, time and has changed her washing powder to a “Non-Bio” formulation.
What condition is she suffering from?
Chronic urticaria
A 31 year old woman presents to their GP with tiredness and offensive smelling diarrhoea with no blood. Since the diarrhoea has started, she has complained of recurrent bouts of skin infections and food poisoning like symptoms.
She is anti-TTG and anti-endomysial antibody positive. A full STI screen is negative. FBC is unremarkable. Albumin and levels of IgA, IgG, IgE and IgM are very low.
What condition has her uncontrolled coeliac disease caused that has led to her functional immunosuppression?
Protein losing enteropathy
What drug class does dolutegravir belong to?
Integrase inhibitor
Immunoglobulins may bind to bacteria to allow phagocytosis to occur. What is this process known as?
Opsonisation
What first-line test can be used to quantify the IgE mediated response to specific allergens?
Skin prick test
Zidovudine is an example of what class of antiretroviral agents?
Nucleoside Reverse Transcriptase Inhibitor
What test can be used to measure the levels of serum IgE directed against brazil nut antigens?
Radioallergosorbent test
What type of vaccine uses injection of preformed antigenic proteins to induce immunity?
Subunit vaccine
What monoclonal antibody targets the IL-6 receptor and is involved in the treatment of rheumatoid arthritis?
Tocilizumab
Infliximab, adalimumab, certolizumab and golimumab target what cytokine?
TNF-alpha
What is the name given to a substance that increases the effectiveness of an immune reponse to a vaccination without altering the specificity of the response?
Adjuvant
Immunoglobulins may bind to multiple pathogens at once in order to enhance phagocytosis.
What is this process known as?
Agglutination
Mastocytosis suggests an infection by what class of organism?
Parasites
What monoclonal antibody targets RANKL?
Denosumab
A 34 year old man has severe Crohn’s disease. His gastroenterologist wishes to start an anti-TNF drug to see if it controls his symptoms better. What first-line test should the patient undergo before starting adalimumab?
Mantoux
What cell type expresses the T cell receptor, CD4 and recognises MHC Class II?
T helper cells
Immunoglobulins may bind to cell surface receptors on viruses, to prevent viral binding and entry of human cells.
What is this function of immunoglobins known as?
Neutralisation
What specific T cell subtype expresses both CD3 and CD4?
T helper cells
What is the name given to the immunological process that must have occurred prior to a hyperacute transplant rejection?
Sensitisation
Congenital absence of C4 (Complement) predisposes to what autoimmune disease?
SLE
What HIV protein is involved in initial binding to CD4?
gp120
What condition arises when donor lymphocytes, contained within a solid organ, attack the recipient’s cells and tissues?
GvHD
HLA types DR, DQ and DP are what class of the major histocompatibility complex?
2
CD14 is typically a marker of what type of immune cell?
Monocytes
What is the autoantibody found in myasthenia gravis?
Anti Acetylcholine Receptor Antibody
A severe asthmatic presents to their GP for the third time in three years complaining of blocked sinuses. However, over the last 6 months, she has also had unintentional weight loss and reports intermittent fevers. She also has an indistinct erythematous macular rash on both her ankles.
A Full Blood Count reveals an eosinophilia (>10% of white blood cells).
What rare immunological condition may be responsible for her symptoms?
Eosinophilia granulomatosis with polyangiitis
Patients affected typically have severe allergies or sinus problems, which progress to severe asthma prior to the systemic vasculitis.
It is treated with corticosteroids.
Immunoglobulin in breast milk and responsible for passive immunity of the newborn
IgA
In haemolytic disease of the newborn, what maternal class of immunoglobulin is responsible for destruction of neonatal erythrocytes?
IgG
What type of vaccine uses pathogens that are unable to replicate?
Inactivated
What is the short-term treatment for severe, life threatening antibody mediated damage or dysfunction, for example myasthenic crisis, cyroglobulinaemia or antibody mediated rejection?
Plasmapheresis
What is the only lymphocyte subset considered to be part of the innate immune system?
Natural killer cells
A 75 year old gentleman presents to his GP with recurrent nosebleeds and coughing blood. He now has bloody urine. He has felt generally unwell for a while, but puts this down to his family visiting him less. He has lost weight and reports some loss of sensation in his hands and feet. He is concerned he may have a bleeding problem. His temperature is 38C and CRP is elevated.
Urine dip is positive for protein and blood.
The patient is negative for anti-GBM antibodies.
Results of kidney function tests are given below:
Urea Elevated
Creatinine Elevated
eGFR 40 (normal >90)
A previous blood test performed three weeks ago was normal and an eGFR at that time was 80ml.
What underlying immunological condition may this gentleman have?
Granulomatosis with polyangiitis
A depressed 40 year old vegan presents to their GP with progressive tiredness. She is on treatment for Hashimoto’s thyroiditis and has daily multivitamin supplementation. Her sister is also hypothyroid.
A routine blood panel reveals a macrocytic anaemia. Serum B12 levels are low.
What is the most likely cause of the low B12?
Pernicious anaemia
An ANA test using indirect immunofluorescence suggests a homogenous pattern of ANA staining. What autoantibody is this pattern of ANA staining associated with?
Anti-dsDNA
Which interleukin is classically responsible for inducing fever?
Acute phase proteins include: IL-1, IL-6 and CRP.
CSF shows oligoglonal bands of IgG
Multiple sclerosis
What type of hypersensitivity reaction is Type 1 Diabetes?
Type IV
What lymphocyte lineage does tacrolimus predominantly inhibit?
T lymphocytes
What specific malignancy are people with Sjogren’s syndrome at greater risk of?
MALT lymphoma
What is the most abundant leukocyte found in peripheral blood?
Neutrophils
A tumour cell has mutated and no longer expresses endogenous peptides and MHC Class I on the surface. What immune cell would recognise and kill this mutated cell?
Natural killer cell
What virus is polyarteritis nodosa associated with?
Hepatitis B
What is the maximum number of viral capsids that a molecule of IgG may bind to?
2
What blood product is most commonly contaminated by bacteria?
PLatelets
A 70 year old gentleman is referred to the nephrologists for worsening kidney failure and haematuria. Over the last 3 months, he has lost 20% of his body weight, reports intermittent fevers and joint aches. He is also seeing his GP as he recently started coughing blood.
What underlying immunological condition may this patient have?
Goodpasture’s
The family of a 13 year old boy with a known latex allergy have kept a food diary after they noticed some foods make his skin itchy. They noticed that bananas, potatoes, tomatoes and mangos may precipitate an outbreak. What specific allergic condition does he suffer from?
Latex Food Syndrome
What specific class of antiretroviral medication does abacavir belong to?
Nucleoside Reverse Transcriptase Inhibitors
What primary immunodeficiency is suggested by recurrent infections with the following catalase positive organisms: E Coli, Staphylococcus Aureus, Listeria spp, Klebiella spp, Serratia marcescens and Candida species?
Chronic granulomatous disease
A 23 year old gentleman presents to their GP complaining of difficulty swallowing and feeling generally run down for the last 6 months. On examination, a white pseudomembrane is found covering the the soft palate. When swabbed, the membrane is easily removed but there is pinprick bleeding. What complication of immunodeficiency is this patient suffering from?
Oral candidiasis
What autoantibody, sometimes detectable in Graves’ disease, is a useful clinical marker in monitoring thyroid cancer?
Anti-thyroglobulin
What monoclonal antibody targets CD25 and is used in the prophylaxis and treatment of allograft rejection?
Basiliximab
What disease is Tofacitinib used in?
rheumatoid arthritis
In the absence of other symptoms, what is the most likely cause of the leukocytosis?
Corticosteroids
Eosinophillia suggests an infection by what class of organism?
parasites
A 15 day old infant is brought to A&E by their concerned parents. He has been feeding poorly (<80% of normal) and is producing fewer wet nappies. He is quite sleepy.
On examination there are multiple discharging abscesses approximately half a centimeter in diameter visible around his umbilical cord stump. They are swollen and very red. The child’s father says his dad has a problem with white blood cells and takes injections for it. He is unsure what it is. The child is pyrexial at 38c and has a heart rate of 150bpm. A full blood count reveals a low neutrophil count. He was born at full term.
What primary immunodeficiency is this child likely to have?
Kostmann syndrome
HIV belongs to what family of viruses?
Retroviridae
What class of medication is tisagenlecleucel?
Chimeric Antigen Receptor T cells
What subset of T helper cells are associated with the transcription factor FoxP3?
T regulatory cells
What is the descriptor given to a solution of antibodies that recognise one antigen only?
Monoclonal
What monoclonal antibody targets CD52 and causes depletion of all lymphocyte subsets?
Alemtuzumab
What cell type is the hallmark of acute inflammation?
Neutrophils
What is the maximum number of viral capsids that a molecule of secretory IgA may bind to?
4
CD20 is typically a marker of what type of immune cell?
Mature B cells
What condition may be precipitated by mutations in NOD2/CARD15?
Crohn’s disease
