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Immunology > Revision session > Flashcards

Revision session Flashcards

1
Q

Type I allergy mechanism

A

mast cells and IgE

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2
Q

Test for type I allergy

A

skin prick

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3
Q

Examples of type I allergy

A

Anaphylaxis
Rhinitis
Asthma

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4
Q

Mechanism of type II allergy

A

antibody and antigen

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5
Q

Mechanism of tpye III allergy

A

immune complex

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6
Q

Mechanism of type IV allergy

A

delayed hypersensitivity

CD4+ Th1 cells

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7
Q

Examples of type IV

A

allergic contact dermatitis
Hashimoto’s thyroiditis
IDDM
Myasthenia gravis

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8
Q

Test for type IV allergy

A

Patch

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9
Q

Large vessel vasculitises

A

Giant cell

Takayasu

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10
Q

Medium vessel vasculitis

A

Polyarteriitis nodosa

Kawasaki

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11
Q

ANCA positive small vessels

A

Wegener’s (cANCA)

MPA, Churg Strauss (pANCA)

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12
Q

Features of SLE

A

ANA, dsDNA

type 3 hypersensitivity

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13
Q

cANCA binds to

A

cytoplasmic proteins

PR3

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14
Q

pANCA binds to

A

perinuclear proteins

MPO

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15
Q

B cell functions

A
  • Differentiates into plasma cells producing antibodies
  • Opsonization
  • Complement activation
  • Toxin neutralization
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16
Q

T cell functions

A

Helper T cells provide B cells with signals necessary for antibody production

Cytotoxic T cells destroy virally infected cells and tumour cells

T regulatory cells suppress auto-reacitve T cells

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17
Q

Phagocyte functions

A

Engulf and destroys microbes

Antigen presentation

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18
Q

Complement functions

A

Opsonization (C3b)

Terminal components create the membrane attack complex

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19
Q

NK cell functions

A

Destroys virally infected cells and tumour cells

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20
Q
  • recurrent bacterial sinopulmonary (nasal sinuses and lungs) infections (encapsulated organisms)
  • chronic or recurrent gastroenteritis (enterovirus, giardia)
  • chronic enteroviral meningoencephalitis
  • septic arthritis (mycoplasma, ureasplasma)
  • bronchiectasia
A

B cell deficiency

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21
Q
  • fungal infections
  • severe or unusual viral infections
  • failure to thrive
  • chronic diarrhoea
  • pneumocystis jiroveci pneumonia
  • GVHD (rash, abnormal LFTs)
  • autoimmune disease
A

T cell deficiency

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22
Q
  • skin abcesses or lymphadenitis
  • bacterial pneumonia
  • poor wound healing
  • delayed separation of the umbilical cord
  • chronic gingivitis, periodontal disease, mucosal ulcerations
  • disseminated mycobacterial infection
A

Phagocyte deficiency

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23
Q
  • Recurrent Neisserial infections
  • Pyogenic bacterial infections
  • Autoimmune disease
  • Angioedema of face, hands, feet, GI tract
A

Complement deficiency

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24
Q
  • Severe or recurrent Herpes virus infections

- Hemophagocytic lymphohistiocytosis

A

NK cell deficiency

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25
Q

Investigations for B cell problems

A

Quantitative

  • FBC plus Igs
  • B cell no. by flowcytometery

Qualitative
- Look at vaccine responses to tetanus, diptheria and pneumococcal serotypes 4-6 weeks after

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26
Q

Investigations for T cell problems

A

Quantitative
- FBC with lymphocyte populations

Qualitative
- T cell proliferation

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27
Q

Investigations for phagocyte problems

A

Quantitative
- FBC with absolute neutrophil and or monocyte count

Qualitative
- neutrophil oxidative burst assay (dihydrorhodamine assay or NBT test)

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28
Q

Investigations for complement problems

A

Quantitative
- individual complement components

Qualitative
- Haemolytic activity (CH50, AP50)

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29
Q

Investigations for NK cell problems

A

Quantitative
- NK cell numbers by flow cytometery

Qualitative
- NK cell function tests

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30
Q

Examples of B cell deficiencies

A
  • Selective IgA deficiency
  • Common variable immunodeficiency disorders
  • X-linked agammaglobulinemia
31
Q

Examples of T cell deficiencies

A
  • Wiskott-Aldrich syndrome

- Digeorge syndrome

32
Q

Examples of B and T cell deficiencies

A

Severe combined immunodeficiency

Hyper IgM syndrome

33
Q

Examples of phagocyte deficiencies

A
  • Chronic granulomatous disease
  • cyclic neutropenia
  • leukocyte adhesion deficiency
34
Q

Examples of complement deficiency

A

hereditary angioedema

35
Q

Examples of NK cell deficiency

A

X-linked lymphoproliferative syndrome

primary HLH

36
Q

What causes a puffy face in hereditary angioedema?

A

Bradykinin

C1 inhibitor deficiency

37
Q

meningococcus/gonococcus

A

Terminal complement C5-9

38
Q

CVID criteria for diagnosis

A

Male/female patients with ALL of:

  • aged >4 years
  • serum IgG and IgA +/- IgM less than lower limit of normal for age
  • poor IgG response to vaccines
  • Normal or low B cell numbers
  • secondary antibody deficiency excluded (e.g drugs)
39
Q
  • history of recurrent upper and lower respiratory tract infections due to encapsulated bacteria such as H. influenza and Strep. pneumo.
  • 20% of patients develop complications with autoimmune manifestations, non-caseating granulomas in lung, lymph nodes, skin and liver, and GI and lymphoid malignancy
A

Common variable immunodeficiency disorders

40
Q

What is Dermatitis herpetiformis and where is the rash usually seen?

A

gluten sensitivity usually affects the forehead and other areas

41
Q

d acute wheeze, breathlessness, dizziness, felt faint and had a sensation of “impending doom” a few minutes after being stung by a bee

A

Anaphylaxis. IM adrenaline

42
Q

ACE inhibitors and anaphylaxis

A

ACE inhibitor treatment will increase the severity (increased oedema, hypotension) of any future reaction (to stings or immunotherapy), through increased bradykinin levels.

43
Q

When would you expect symptoms if you were allergic to house dust mites?

A

All year round, worse during winter

44
Q

Hayfever worse…

A

From May, in evenings

45
Q

Which auto antibodies can cross the placnta?

A 
TSH receptor (Graves)
Acetylcholine R (Myasthenia gravis)
Desmoglein 3 (phemphigus)
46
Q

Granuloma forming vasculitises

A

Giant cell arteritis
Takayasu
GPA
Churg-Strauss syndrome

47
Q

large/medium arteries of head and neck, HLA DR4, intimal thickening and oedema, ‘skip’ lesions, women >55 years, sudden onset blindness, polymyalgia rheumatica

A

Giant cell

48
Q

Granulomatous, aortic arch and origins of great arteries, young to middle aged women, Asian, ischaemia in arms

A

Takayasu

49
Q

Uncommon in young children, inflammation of media of arteries supplying viscera (e.g kidney, heart, liver, mesentery), aneurysm formation, thrombosis, ischaemia

A

Polyarteritis Nodosa

50
Q

HepB assoicated

A

PAN

51
Q

Mucocutaneous lymph node syndrome

A

Kawasaki’s disease

52
Q

infants and children, fever, lymphadenopathy, skin rash, oral/conjuctival erythema, coronary areritis, MI, possibly viral cause, self limiting

A

Kawasaki

53
Q

Systemic features of small vessel vasculitis

A

Malaise
Fever
Arthralgia
Weightloss

54
Q

Arthralgia

A

Joint pain

55
Q

Sites affected by GPA

A

Upper airways
Lower respiratory tract
Kidneys
Granulomatous infalmmation

56
Q

Sites affected by microscopic polyangiitis

A

Kindey

Lungs

57
Q

Sites affected by Chrug-Strauss syndrome

A

Lower airways, asthma
Eosinophilia
Eosinophilic inflammaiton

58
Q

Investigations of small vessel vasculitis

A

CRP
FBC
kidney and liver function tests
ANCA

59
Q

mainly affects the skin (purpura), gut, kidneys, joints, IgA complexes

A

Henoch Schonlein Prupura

60
Q

Decreases of C1Q or C4 put you at risk of….

A

developing auto immunity

61
Q

HLA A1 B8 CR3

A

Sjogren’s syndrome

62
Q

dry eyes, dry mouth, arthritis

A

Sjogren’s syndrome

63
Q

Investigations for Sjogren’s

A

Schirmer’s test for tear production
ANA, Ro, La
Biopsy minor salivary gland (inflammation with CD4 T-cell infiltration

64
Q

ANA, Anti Scl70 (topoisomerase)

A

Systemic scleroderma

65
Q

ANA, anti centromere

A

Limited scleroderma

66
Q

Fatiguable weakness

A

MG

67
Q

What’s overlap syndrome?

A

Symptoms of myositis and lupus

68
Q

Function of Th1 cells

A

CD4+ promote inflammation (delayed hypersensitivity)

69
Q

Function of Th2 cells

A

CD4+ anti parasite immunity

70
Q

Function fo Th17 cells

A

mucosal immunity

71
Q

combined T and B cell (antibody) deficiency, X linked, recurrent bacterial infection plus infection with cryptosporidium, pneumocystis etc

A

Hyper IgM syndrome

72
Q

defects on chromosome 22q11, 3rd and 4th pharyngeal pouch abnormalities, cleft palate, abnormal face, lack or parathyroid glands (hypocalcaemia and neonatal tetany), congenital heart disease, thymic aplasia (so impaired T cell development), normal B cells,

A

Di George syndrome

73
Q

low C4, normal C3, angioedema

A

C1 inhibitor deficiency

C1 inhibitor levels might be normal but non functional

74
Q

An 8-month-old boy was born at full-term by normal vaginal delivery. When he was 5 weeks old he developed a large abscess of the chest wall. This required incision and drainage of the pus and 4 weeks of antibiotics. At 5 months of age he developed a large abscess in his axilla and at 7 months he was admitted to hospital with a spreading infection around his nose. He was the second child born to unrelated parents. Their first son, died at 18 months of age after repeated infections.

Swab from the infection around his nose: Heavy growth of Staphylococcus aureus
C-reactive protein 186 mg/L (<8)
Haemoglobin 98g/L
White cell count 23.5x109
/L, 80% neutrophils
Glucose 4.3mmol/L (3.0-5.5)
IgG 7.1 g/L (6-13) IgA 0.9 g/L (0.7-3.0) IgM 0.5 g/L (0.4-2.5)
Complement C3 and C4 were normal
Nitroblue tetrazolium (NBT) and di-hydro-rhodamine reduction (DHR) tests were negative (normal control positive) consistent with defective neutrophil ‘respiratory burst’.

A

Chronic Granulomatous disease

Immunology (3 decks)

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