Test 2 Flashcards
What is RSS?
Recombination signal sequence
What’s the significance of RSS 23/12?
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.
What’s a TdT?
Terminal deoxynucleotydal transferase
How does TdT add diversity?
It adds random nucleotides to insure diversity
How does the heavy chain recombine?
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)
What’s the process of RAG and TdT receptor rearrangements?
- RAG: cuts DNA at specific sites
- TdT: adds random bases
- DNA repair enzymes resolve the DNA breaks
What is the HV 1,2,3 on the antibody?
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
Which HV (hypervariable regions) are the most diverse and why?
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
What gender is affected by x-linked agammaglobulinemia more?
Males
What happens with XL agammaglobulinemia?
The body can’t produce mature b-cells (can’t fight infection well)
What is the Bruton Tyrosine Kinase?
Gene on X-chromosome produces BTK…which helps with B-cell maturation (H and L chain rearrangement)
What is passive immunity?
Transfer of antibodies from one person to another
What is CVID (common variable immunodeficiency)??
Problems with late b-cell maturation (in secondary tissues) treated same as xl-agamma. Usually acquired by mutation of late b-cell development.
What are the differences between TCR’s and B cells?
TCR’s only see antigen peptide that’s on a MHC
B cells have antibodies that can go out and see any antigen
What does TCR bind to?
The MHC
and the Antigen being presented
What MHC class is endogenous?
MHC class I
What MHC class is exogenous?
MHC class II
What is SIRS?
systemic inflammatory response syndrome (a variety of processes)
What is sepsis?
2 SIRS criteria and infection. Bad stuff
What is severe sepsis?
Sepsis plus organ dysfunction
What is septic shock?
Sepsis plus hypotension despite fluid resuscitation
What is MODS?
Multiple organ dysfunction syndrome (altered organ function in an acutely ill patient, will die without treatment)
What are some of the manifestations of sepsis?
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
What’s the key for Proinflammation and Antiflammation balance?
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)
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)
Why do neonates have problems with sepsis?
Fever is bad Less IgG produced Declining maternal IgG Less cytokines produced Decreased function of neutrophils
What is SBI?
Serious bacterial infection
What would cause you to worry about SBI in 0-3 month olds?
fever above 38
What are the three SBI’s common in infants?
Meningitis
Bacteremia
UTI (most common)
…….0-30 days is the worst.
What are the 3 bacterial pathogens in neonate SBI’s?
Group B strep
E. Coli (and other Gram -)
Listeria Monocytogenes
What is GBS (group B strep) like?
Gram +
Beta hemolytic
Landfield Group B
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
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
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)
Rubella Torch picmonic
Red Bell torch Non specific torch symptoms (jaundice, hepatosplenomegaly, thrombo-cytopenia) Cadillac Duck artery Lung hippo plates Blueberry muffin Glock Headphones
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)
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)
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)
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)
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
What is IAP? neonates
Intrapartum Antibacterial Prophylaxis
What antibiotics are given for IAP? neonates
- Penicillin
- Cefazolin
- Clindamycin (last resort if susceptible)
When does screening occur for IAP
35-37
What TORCH infection leads to hearing loss and microcephaly?
CMV
What 2 clinical signs are common with Rubella
Cataracts Heart defect (Patent Ductus Arteriosus)
What are 2 clinical signs for T. gondii?
Hydrocephalus
Chorioretinitis
What are the 4 origins of antibiotics?
- accident from mold or bacteria (synthesized on it’s own)
- accident…drug made for something else, and it’s antibiotic as well
- Targeted at metabolic pathways
- Manipulated old antibiotics
What is MIC? antibiotics
Minimum inhibitory concentration (the minimum concentration needed to kill the bug)
What are the two dilution tests?
Broth macrodilution
Automated broth microdilution
What are the two diffusion tests?
Disk diffusion test
E-test method
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
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
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
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
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)
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
What organism causes impetigo?
Staph Aureus (picmonic skin suit guy)
What organism causes furuncles, and cellulitis?
Staph Aureus (picmonic skin suit man)
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)
What causes Tinea corporis, versicolor?
Fungus ringworm (Fungus in a Tin cup being poured onto the skin of a worm)
Molluscum Contagiosum picmonic
Double stranded DNA Line Small fox with envelope Nun ice-cathedral Cow fox Contagious Mollusks with umbilical lesions
When is a Tzank smear used?
VZV
HSV
CMV
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)
What is Rheumatic fever?
disease that occurs bc of inadequately treated strep throat, or scarlet fever
What causes Rheumatic Heart disease (rare)
Rheumatic fever, scars the heart valves
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
What are the BIG 3 organisms that cause IE (infectious endocarditis)?
Staph A
Strep
Enterococci
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
What kind of organism causes IE in IVDU’s?
Yeast
What are the two ‘culture negative’ organisms that cause IE?
Coxiella burnetii
Bartonella sp.
What are complications of IE?
Heart Failure Infarcts Stroke Glomerulonephritis Mycotic aneurysms Abscesses
What causes Omenn’s syndrome?
RAG mutation (get scids)
What has more diversity….TCR or BCR?
TCR
What does CD3 do? (in the TCR)
It chaperones TCR to the surface