Transition block: immunology

Question 1

What is methotrextate?

Answer 1

a DMARD

Question 2

How often is methotrexate given?

Answer 2

once a week

Question 3

When can methotrexate not be used?

Answer 3

liver disease

Question 4

What is a granuloma?

Answer 4

an organised collection of activated macrophages and lymphocytes

Question 5

When are granulomas seen in the lungs

Answer 5

Sarcoidosis
Mycobacterial disease, e.g. Tuberculosis, leprosy
Leprosy (some forms)
Berylliosis, silicosis and other dust diseases
Chronic stage of hypersensitivity pneumonitis
Foreign bodies

Question 6

How does antibody deficiency present?

Answer 6

recurrent bacterial infection (RTI and GI)

antibody mediated autoimmune disease (ITP and autoimmune haemolytic anaemia)

Question 7

Are primary antibody deficiencies common?

Answer 7

yes

selective IgA deficiency is seen in 1:600

Question 8

What is common variable immune defiency (CVID)?

Answer 8

low IgG, IgA and IgM results in recurrent bacterial infection

Question 9

Name some secondary causes of hypogammaglobulinaemia

Answer 9

protein loss (eg nephrotic syndrome) or failure of protein synthesis (eg. lymphoproliferative disorders)

Question 10

What is opsonization?

Answer 10

the process by which the pathogen is marked for ingestion and eliminated by the phagocytes

Question 11

What does complement deficiency predispose to ?

Answer 11

bacterial infection esp meningitis

Question 12

What is a NK cell?

Answer 12

part of the innate immune system

kills cells that lack MHC

Question 13

What are toll-like receptors?

Answer 13

receptors on phagocytes that are activated by microbes to release pro-inflammatory cytokines and type 1 interferon secretion

Question 14

What do toll-like receptors respond to?

Answer 14

PAMPS

pathogen associated molecular patterns

Question 15

What do TNF-inhibitors block?

Answer 15

pro-inflammatory cytokines

Question 16

Can the body form antibodies against TNF-inhibitors?

Answer 16

yes as they are foreign proteins

Question 17

what are biologic drugs?

Answer 17

artificial antibodies that block the body’s own proteins

Question 18

Are biologic drugs renal or hepatotoxic?

Answer 18

no

Question 19

Name a biologic and its target

Answer 19

adalimumab

anti-TNF

Question 20

Are biologic drugs active or passive immunization?

Answer 20

passive so have to be injected every couple of weeks

Question 21

What does vaccination produce?

Answer 21

effector T cells

memory B cells which will undergo clonal expansion when re-exposed and produce IgG

Question 22

Give a pro and a con for an inactivated vaccine

Answer 22

made quickly and are safe

not very potent so requires boosters

Question 23

Give some inactivated vaccines

Answer 23

polio, hep B, pertussis, diptheria, tetanus, h. influenzae B

Question 24

Give a pro and a con for a live attenuated vaccine

Answer 24

relevant mechanisms and strong response

may cause infection in immuno-compromised, fragile

Question 25

Give some live attenuated vaccines

Answer 25

MMR

Question 26

Can you give immunoglobulins in immunosuppressive or autoimmune conditions?

Answer 26

autoimmune

- overwhelms the body so it pees out the autoimmune antibodies that the kidney would normally keep

Question 27

Which antibodies are present in SLE?

Answer 27

anti-DS DNA

Question 28

Which antibodies are present in rheumatoid arthritis?

Answer 28

RF and anti-CCP

Question 29

Which antibodies are present in Sjogren’s?

Answer 29

anti-Ro and anti-La

Question 30

Give a risk of biologic therapy

Answer 30

breakdown of a TB granuloma causing active infection

- except IL-17

Question 31

Which antibodies are present in mysathenia gravis?

Answer 31

anti-AcH receptor

Question 32

Can primary immunodeficiency present in adulthood?

Answer 32

yes
vague presentation of increased infections
2/3rd of IgA deficiency are asymptomatic