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Test 2 Flashcards

1
Q

What is RSS?

A

Recombination signal sequence

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2
Q

What’s the significance of RSS 23/12?

A

12 can’t combine with 12, 23 can’t combine with 23. they have to combine 12-23. This makes sure that a V-region will get set up with a J region.

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3
Q

What’s a TdT?

A

Terminal deoxynucleotydal transferase

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4
Q

How does TdT add diversity?

A

It adds random nucleotides to insure diversity

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5
Q

How does the heavy chain recombine?

A

The D-J regions combine (closer to the C region) then the V region combines with the D-J (you end up with V-D-J) which codes the Heavy chain (inner parts of the antibody)

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6
Q

What’s the process of RAG and TdT receptor rearrangements?

A
  1. RAG: cuts DNA at specific sites
  2. TdT: adds random bases
  3. DNA repair enzymes resolve the DNA breaks
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7
Q

What is the HV 1,2,3 on the antibody?

A

It’s the very end of the antibody that binds to antigens (so it’s very “hypervariable”) There are 3 regions on both the light and heavy chain. So there are 6 total region per receptor

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8
Q

Which HV (hypervariable regions) are the most diverse and why?

A

HV3 (cdr3) on both heavy and light chain.

Because it’s where the final recombination takes places between V-DJ heavy and V-J light. So it’s more variable

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9
Q

What gender is affected by x-linked agammaglobulinemia more?

A

Males

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10
Q

What happens with XL agammaglobulinemia?

A

The body can’t produce mature b-cells (can’t fight infection well)

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11
Q

What is the Bruton Tyrosine Kinase?

A

Gene on X-chromosome produces BTK…which helps with B-cell maturation (H and L chain rearrangement)

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12
Q

What is passive immunity?

A

Transfer of antibodies from one person to another

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13
Q

What is CVID (common variable immunodeficiency)??

A

Problems with late b-cell maturation (in secondary tissues) treated same as xl-agamma. Usually acquired by mutation of late b-cell development.

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14
Q

What are the differences between TCR’s and B cells?

A

TCR’s only see antigen peptide that’s on a MHC

B cells have antibodies that can go out and see any antigen

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15
Q

What does TCR bind to?

A

The MHC

and the Antigen being presented

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16
Q

What MHC class is endogenous?

A

MHC class I

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17
Q

What MHC class is exogenous?

A

MHC class II

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18
Q

What is SIRS?

A

systemic inflammatory response syndrome (a variety of processes)

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19
Q

What is sepsis?

A

2 SIRS criteria and infection. Bad stuff

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20
Q

What is severe sepsis?

A

Sepsis plus organ dysfunction

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21
Q

What is septic shock?

A

Sepsis plus hypotension despite fluid resuscitation

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22
Q

What is MODS?

A

Multiple organ dysfunction syndrome (altered organ function in an acutely ill patient, will die without treatment)

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23
Q

What are some of the manifestations of sepsis?

A 
fever (fever beaver)
hypotension (hippo)
LOC (loss of consciounceness)
increase WBC (with left shift)
Tachycardia
Tachypnea
Hyperglycemia (hiker glue man)
Edema (edamame)
Microthrombi (microtrombones)
DIC (disseminated intracellular coagulation)
Decrease O2 pressure
Oliguria (old gopher urinating)
High output heart failure
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24
Q

What’s the key for Proinflammation and Antiflammation balance?

A

When you get infection you have “Proinflammatory” and if the “anti-inflammatory” doesn’t respond similar to the proinflammation you can get death. (you can get too much or too little anti-inflammatory both of which end in death)

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25
What to look for in children Sepsis SIRS?
Bad temperature (fever, chills) Tachycardia/Bradycardia Respiratory Rate (they are normally faster anyways) High or Low WBC (or 10% left shift)
26
Why do neonates have problems with sepsis?
``` Fever is bad Less IgG produced Declining maternal IgG Less cytokines produced Decreased function of neutrophils ```
27
What is SBI?
Serious bacterial infection
28
What would cause you to worry about SBI in 0-3 month olds?
fever above 38
29
What are the three SBI's common in infants?
Meningitis Bacteremia UTI (most common) .......0-30 days is the worst.
30
What are the 3 bacterial pathogens in neonate SBI's?
Group B strep E. Coli (and other Gram -) Listeria Monocytogenes
31
What is GBS (group B strep) like?
Gram + Beta hemolytic Landfield Group B
32
CMV torch picmonic
side toe mega virus torch Nonspecific torch (jaundice, trombone peanut, hepatosplenomegaly) Headphones on caesar while peeing(deafness, seizures, urine culture) re-tarred book in uterus Pear on cow with vent Tiki mask with rash
33
CMV picmonic
``` Side toe mega virus Envelope on owl High five hand on harp DNA train track Baby with torch Nuclear monkey Nun with hat files Band-Aid sarcophagus with red eyes Train plants ```
34
Ganciclovir picmonic
``` Gandolf with clover Side toe mega virus Moon compromised (patients) G-iguana on a log DNA bridge break up Polly Mirror parrot (inhibition) He-man blood (hematologic effects) Frodo toxic (nephrotoxicity) ```
35
Rubella Torch picmonic
``` Red Bell torch Non specific torch symptoms (jaundice, hepatosplenomegaly, thrombo-cytopenia) Cadillac Duck artery Lung hippo plates Blueberry muffin Glock Headphones ```
36
Toxoplasma Gondii Picmonic
``` Gandhi in Tux with plasma TV Propeller protozoa Torch Symptoms Sisters on the Meat Cat poop Pregnant women (crosses the placenta) Brain (with lesions) in HIV patients Ring enhancing lesions Pirate moth man (pyrimethamine) Sulfur dice (sulfadiazine) ```
37
Varicella Zoster picmonic
``` Varsity Zorro with envelope Harp on 3 tree ds DNA line Chicken with head on fire (chicken pox, encephalitis) Nude Mona (in adults) Door on the root with tri-gems shingles on the roof Giant nuclear shell Cow-drying on the line Tank test (Tzank smear) Apple cycops (aciclovir) ```
38
Herpes Simplex Virus picmonic
``` Two Harp sister viruses with envelopes ds DNA line (with cow drying) Type 1 Harp Carrot in eyes (keratoconjunctivitis) Ginger in the mouth (gingivostomatitis) Brain on fire (encephalititis) 3 gems Type 2 harp (in the tutu) Baby with the harps (neonatal herpes) Torch in babies hand Resting in the "sac" sacral ganglia Genital gentleman in vest (genital vesicles) Tank test (tzank smear) Giant nuclear shell Apple Cyclops (acyclovir) ```
39
Sepsis assessment picmonic
``` Snake and assessor Infection spreading Fever Beaver hippo with Blood pressure LOC Increase WBC's Tack Cardiac Tack P lung Hiker Glue man (hyperglycemia) Edamame (edema) ```
40
Severe Sepsis and Septic Shock picmonic
``` Micro trombones DICe (disseminated intra-cellular coagulation) Decreased O2 bottle Old gopher urinating (oliguria) High output cardiac failure MODS ```
41
What is IAP? neonates
Intrapartum Antibacterial Prophylaxis
42
What antibiotics are given for IAP? neonates
1. Penicillin 2. Cefazolin 3. Clindamycin (last resort if susceptible)
43
When does screening occur for IAP
35-37
44
What TORCH infection leads to hearing loss and microcephaly?
CMV
45
What 2 clinical signs are common with Rubella
``` Cataracts Heart defect (Patent Ductus Arteriosus) ```
46
What are 2 clinical signs for T. gondii?
Hydrocephalus | Chorioretinitis
47
What are the 4 origins of antibiotics?
1. accident from mold or bacteria (synthesized on it's own) 2. accident...drug made for something else, and it's antibiotic as well 3. Targeted at metabolic pathways 4. Manipulated old antibiotics
48
What is MIC? antibiotics
Minimum inhibitory concentration (the minimum concentration needed to kill the bug)
49
What are the two dilution tests?
Broth macrodilution | Automated broth microdilution
50
What are the two diffusion tests?
Disk diffusion test | E-test method
51
E-coli picmonic
``` E-Coal Eye Graham cracker Devil (neg) with rod (bacillus) Toilet (diarrhea) Purple plate with green sheen Pink Monkey (pink on makonkey plate) Fern in Milk (lactose fermenting) Lip-kiss Apple With Snake P-pili pylonephritis cystitis K cap men in tights (with baby) K cap nude mona H Ant with Gems and flagella ```
52
Lysteria Monocytogenes picmonic
``` Lizard Monacle Jeans Graham cracker angel with Cockeyed rod and evil LPS balloon (only graham pos. with endotoxin) In a cell In a cold Cell By a tumble weed (tumbling motility) Actin Rocket at the Beta Fish Positive Cat ```
53
Syphilis picmonic
``` Sysiphis greek god Tripod pendulum (treponema pallidum) Mobile spirochete Chain car Condom latte Rash on palms/feet Granny llama Gum (granulomatous gummas) Aorta Orca (aortitis) Table Door Neurons Vase in a Vase Argyle Robertson pupils Pencil man Jewish Hercules ```
54
Streptococcus Agalactiae picmonic
``` Galactic stripper B-costume Cockeyed Graham cracker angel Beta fish Negative cat Resisting Bass Vagina flower Baby Nude Mona Men in tights Sepsis snake Camp factor with Staph oreos 35-37 weeks Pencil Man ```
55
Onychomycychosis picmonic
Turbine sucking fins (terbinafine medication) Dermatologist toes itch (dermatophytosis) Girl "on-a-mic-nail fungus" (onychomychosis) Inhibits the Square Whale (inhibits squalene epoxidase)
56
Staph Aureus characteristics picmonic
``` Staph of Oreos Positive Graham cracker angel with cockeyes Positive Cat Positive Clogs on the cat (coagulase pos) Beta Fish Protein apple (protein A virulence) Dead Pac Man (inhibits phagocytosis) Mr. SAw (MRSA) Resistant to B-lactams on PBP ```
57
What organism causes impetigo?
Staph Aureus (picmonic skin suit guy)
58
What organism causes furuncles, and cellulitis?
Staph Aureus (picmonic skin suit man)
59
Staph aureus Disease picmonic
Staph of Oreos Skin suit man (skin diseases, impetigo, furuncles, zits, cellulitis) Abscess guy (skin abscesses) Nude Mona Shocked Tampon (toxic shock) MHC tutu with Tennis balls (toxin binds MHC 2, TCR) Exfoliating scalded man (Scalded skin syndrome, exfoliative toxin) Bacteria -in-donut-Cards (bacterial endocarditis) Egg salad toilet Skeleton on fire (osteomyelitis)
60
What causes Tinea corporis, versicolor?
Fungus ringworm (Fungus in a Tin cup being poured onto the skin of a worm)
61
Molluscum Contagiosum picmonic
``` Double stranded DNA Line Small fox with envelope Nun ice-cathedral Cow fox Contagious Mollusks with umbilical lesions ```
62
When is a Tzank smear used?
VZV HSV CMV
63
What's the difference in "transient" vs "continuous" bacteremia?
Transient: comes and goes (it clears pretty quick) Continuous: comes and stays (it can't clear fast enough)
64
What is Rheumatic fever?
disease that occurs bc of inadequately treated strep throat, or scarlet fever
65
What causes Rheumatic Heart disease (rare)
Rheumatic fever, scars the heart valves
66
What causes IE (infective endocarditis) 5 steps
``` Turbulent blood flow (blood flow is messed up) Endothelial cells get activated Fibrin and platelets deposit Bacteria seeds that area Bacteria grow on the fibrin biofilm ```
67
What are the BIG 3 organisms that cause IE (infectious endocarditis)?
Staph A Strep Enterococci
68
Enterococci picmonic
``` Intestine Cockeyed Positive Graham Cracker Angel with Salt (grows in harsh salt environments) Negative Cat in the Bile Nile river In-donut-cards (endocarditis) Colon flowers (normal colonic flora) UTI on fire Resisting pencil man Resisting Van-mice ```
69
What kind of organism causes IE in IVDU's?
Yeast
70
What are the two 'culture negative' organisms that cause IE?
Coxiella burnetii | Bartonella sp.
71
What are complications of IE?
``` Heart Failure Infarcts Stroke Glomerulonephritis Mycotic aneurysms Abscesses ```
72
What causes Omenn's syndrome?
RAG mutation (get scids)
73
What has more diversity....TCR or BCR?
TCR
74
What does CD3 do? (in the TCR)
It chaperones TCR to the surface
75
Which cells express Class I MHC?
All cells
76
Which cells express MHC Class II
Antigen Presenting Cells
77
What does CD8 attach to?
MHC class I
78
What does CD4 attach to ?
MHC class II
79
What are the binding regions on MHC class I?
alpha/alpha
80
What are the binding regions on MHC class II?
Alpha/Beta
81
What genes are the most polymorphic?
MHC class 1/2
82
What do TAP proteins do? MHC
transporter for peptide to take it to the ER (where it hooks onto the MHC)
83
What does ERAP do? MHC
chops the peptide down to the right size (9 amino acids) then MHC travels to surface
84
What does the invariant chain do? MHC class 2
It's the cork in the MHC class 2 that blocks protein (becomes a small clip later) from getting into the binding site. Clip comes off in vesicle allowing peptide to bind
85
What MHC class does endosome vesicles? Extracellular
MHC class 2
86
What MHC class does intracellular?
MHC class 1
87
What's Bare lymphocyte syndrome?
No expression of MHC class 1, so no activity with T cells
88
What's Bare Lymphocyte Syndrome type 1?
deficient in TAP protein (which lets the peptide in the ER for placing in the MHC).
89
What does the 3rd pharyngeal pouch do?
epithelial Thymus
90
What's hassals corpuscle?
graveyard in thymus
91
Where is positive T cell selection?
cortex
92
Where is negative T cell selection?
Medulla
93
What happens to the thymus in DiGeorge Syndrome?
Thymus doesn't develop as well.
94
What does the Notch pathway do?
Notch ligand (thymus) hooks onto Notch1 (early Tcell) which then cuts and the Notch 1 goes to the Tcell nucleus to start the pathway.
95
Is Beta (TCR) like the heavy or light chain?
Heavy (2 chances to rearrange)
96
What does IL-7 do in the Thymus?
induces proliferation of T-cells in the thymus
97
What is AIRE? in the thymus?
It helps the thymus make tissue specific "self antigens" for negative selection
98
What is APECED? (type 1 APS)
mutations in AIRE (thymus) causes auto immune disease
99
What is CD80/86?
It's a B7 protein on mature dendritic cells (that can then activate Tcells
100
Where are the T cells in the lymph node?
paracortical (between medulla and cortex)
101
How are B cells and T cells segregated? zones
Chemokines
102
What chemokine attracts T cells and DC's?
CCR7
103
What chemokine attracts Bcells?
CXCR5
104
What is B7 good for on APC's?
It's the second handshake on APC's (to the CD 28 on Naive T cell) but only when there's an infection
105
What happens with the CTLA-4 on Tcells?
After a few days of CD 28-B7 interaction the Tcell needs rest, and the CTLA-4 inhibits the B7.
106
If you block CD40/40L or B7/CD28 what happens?
It inhibits the immune system (for transplant patients)
107
What does cSMAC vs pSMAC do? (t-cell and apc)
cSMAC is signaling receptors | pSMAC is adhesion
108
What is the phosporylation cascade in Tcell activation?
MHC binds to TCR This phosporylates ITAM Zap70 binds to ITAM and gets phosphorylated Zap70 is then activated by LcK This all leads to IL-2mRNA production (this leads to clonal expansion)
109
What is IL-2 for in Tcell activation?
it helps with clonal expansion
110
What are 6 cytokines that drive Tcell clonal expansion
``` IL-2, IL 4, IL 7, IL 15, IL 21, IFN ```
111
What causes SCID?
defect in the gamma chain (so low tcells and Bcells)
112
What is BAFF?
B cell activating factor (in the periphery)
113
How many % of Bcells in the spleen are in the follicle?
90%
114
What does the spleen filter in the marginal zone?
blood
115
Once Bcell passes negative selection what Ig does it have?
IgM | IgD
116
What are the 4 possibilities for B cell differentiation?
1. Antibody secretion 2. isotype switching 3. Affinity maturation 4. Memory Bcell
117
Which Bcell differentiation is Tcell independent?
Antibody secretion
118
WHat are the three signals for Tcell activation?
1. MHC/TCR and CD4 2. CD28/B7 3. cytokine from apc
119
What are the differentiated CD4 helper T cells?
``` Th17 Th1 Th2 Tfh Treg ```
120
When does Tcell produce CD40L?
When its activated
121
What does Th1 secrete to help activate macrophages?
IFNg
122
What T cell enhances the DC cell to do its work?
Th1
123
What T cell enhances the macrophages in delayed type hypersensitivity tests?
Th1
124
What do Th1 secrete?
IL-2 | IFNg
125
What response is Th1?
Inflammatory
126
What response is Th2?
Allergic, parasites
127
What does Th2 mainly bind to and activate?
Mast cells
128
What's the process for Th2?
IL-4....activates Tcell....GATA-3....becomes Th2....secretes IL-4,IL-5, IL-10
129
What does Th2 and IL-10 do to macrophages?
Inhibit macrophages (inhibit inflammation)
130
What does perforins and granzymes do to a cell? from Cytotoxic T
Perforin: punches a hole Granzymes: destroys the cell
131
What are the two types of leprosy?
tuberculoid and lepromatous
132
Which leprosy is fast moving, infectious, and has low Tcell responsiveness?
Lepromatous leprosy
133
What type of Tcell works with tuberculous, and tuberculoid leprosy?
Th1
134
What T cell is the main cause of autoimmunity?
Th17
135
What Tcell activates neutrophils most?
Th17 (through IL-17)
136
What does ITAM do in Bcells?
Initiate Bcell activation through phosphorylation? (ITIM = inhibition)
137
What is the Bcell equivalent of CD3 on tcell?
Ig-alph/beta
138
How is complement important in Bcell activation?
It reduces the amount of antigen needed (CR1 bcell cleaves C3 pathogen...C3 binds to CR2 bcell)
139
What are the possible sources of 2nd signal for Bcell activation?
``` Tcell (CD28) Microbe toxin (LPS) ```
140
Do Tcell independent bcell responses have memory cells?
No, not many
141
Do thymus dependent bcell reactions have isotype switching and memory cells?
Yes
142
What is CD40L/CD40 on the bcell/tcell interaction for?
Stimulates proliferation of Bcell
143
What is the B7/CD28 on bcell/tcell interaction for?
Induces Tcell to make CD40L
144
If you have Hyper IgM syndrome what don't you produce?
No CD40L's, and no germinal centers (lots of IgM)
145
What happens with Isotype switching?
The C regions (constant) gets switched with AID
146
What makes makes isotype switching important?
The different c regions accomplish different tasks (IgM=complement, IgG=mast cell)
147
What are two ways to make unique isotypes? Bcell
``` Isotype switching (switch the C regions) Affinity maturation: Somatic hypermutation (mutate the Variable C-regions) ```
148
What is AID? and what does it help induce?
Activation induced cytidine deaminase......Helps with Isotype switching
149
What does AID result in?
mutations in the C region, recombine and make a new C. (DNA bubble cause the C's get taken out)
150
What's a second way to get hyper IgM immunodeficiency? other than CD40L deficiency
AID deficiency
151
If BCR and the FcReceptor are both engaged by antigen and FcAntibody what happens?
Negative feedback, antibody production slows down (there's enough antibody already)
152
What's the FoxP3 transcription for?
Treg cells
153
What does Th1 respond to?
infection (activates macrophages)
154
What does Th2 respond to?
Allergic (activates mast cells)
155
Thank Goodness its Friday, said the regulator Fox(p3) Thank goodness its friday, he opens a ten pack of beer.
TGF-b induces FoxP3 to make a Treg (which secretes TGF-b, IL-10)
156
The best Tcells (#1) live in Tibet, 12 years olds, they love to interfere before and after events. In Tibet they start at 12 years old and change to 2 year olds because of macrophages.
IL-12, IFN-g induces T-bet, which becomes Th1 and secretes IFN, IL-2
157
Bunch of angry gators with allergies are always 2nd place (Th2) because they start with 4 teeth, and they need 5 teeth to win. Some end with five some end with 4
IL-4 induces GATA-3 which makes a Th2 cell which secretes IL-4,IL-5 (IL-10 also helps by suppressing macrophages. slide #20)
158
17 year old wakes up and ROARS at 6am. "Thank goodness it's friday" Gets out of school at 17:00 and at 6pm workouts out their "neuts" and get fungal infections
TGF, IL-6 induces RORyT to become a T17 cell, which secretes IL-17 and IL-6
159
A 6 year old wants to become a follicular cell so he eats BcLva and turns into a 21 year old follicle
IL-6 induces BcL6 to become a Tfh cell which secretes IL-21
160
What does IL-2 (from Th1 cells) help with?
proliferating Tcells
161
What is DC licensing?
When a Th1 enhances a DC cell to get to work
162
What are the two molecules used by CD8 Cytotoxic T cells to kill cells?
Perforin (makes a hole) | Granzymes (tears up the cell from the inside)
163
Difference in Tuberculoid leprosy vs Lepramatous leprosy?
Tuberculoid: slow, low infection, contained locally, Ig Normal, Tcells respond normal Lepramatous: fast growth in macrophages, high infection, disseminated, hyper gammaglobulinemia, Low Tcell
164
What cytokine is most likely to cause autoimmunity?
IL-17
165
What other types of Tcells can make Tfh cells?
All the Th cells have the ability to transform into a Tfh cell (Tfh cell helps Bcells become plasma cells, or memory B)
166
What three things is Tfh required for?
1. germinal center formation 2. Isotype switching 3. Bcell memory
167
If a Tfh cell doesn't have good CD40L what will happen?
Germinal centers won't form, IgM will be the only Ig in circulation
168
If you don't get a good "stats" "Job" when you're "17" you'll get boils and abscesses.
Job's syndrome: IL-17 malfunction
169
What are the two different pathways that CD8 cytotoxic Tcells can use for killing a cell?
1. Perforin then granzymes 2. Fas/FasL ......both pathways use caspase
170
What is CD25 a receptor for?
IL-2
171
What's an IPEX patient missing?
Treg cells
172
What are peripheral induced Treg cells called?
Adaptive
173
What are thymus derived Treg cells called?
natural
174
What are two causes of impetigo? treatment
group a Strep Staph A penicillin
175
What does pus equal?
Staph A
176
What does crust equal?
Strep a.
177
What is Staph Epidermis known for?
prosthetic joint infections
178
What does is the pathogen in Animal bites? gram (-)rod
Pasteurella Multocida
179
What is Vibrio vulnificus?
Salt water environment bug, gram (-)
180
What causes the Rose gardener/fish tank rash?
Sporotrichoid (sporothrix schenckii) Roses have spores.
181
What causes Cellulitis/erysipilis most often?
Strep Pyogenes ( group A)
182
What pathogen is most likely found in IVDU's?
pseudomonas.
183
What are 2 oral anaerobes? (gram neg)
Fusobacterium | Bacteroides fragilis
184
What are 2 oral anaerobes? (gram pos)
Actinomyces | Propionibacterium
185
What are 2 obligates aerobes?
M. tuberculosis | Pseudomonas aeruginosa
186
What are 2 obligate anaerobes?
Clostridium perfringens | Bacteroides fragilis
187
What are 2 facultative anaerobes?
E coli Staph A (most bacteria are)

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