Week 1 Flashcards
Most common infections in CVID?
Sinus
Pulmonary
What immune system rejects skin transplants?
Adaptive (memory)
What are autologous transplants?
Same person gives and receives transplants
What are syngeneic transplants?
Donor and recipient are genetically identical
What are allogeneic transplants?
Donor and recipient are genetically different but same species
What are Xenogeneic transplants?
Donor and recipient are genetically different and of different species
How many tcells can react to foreign antigens?
a lot! (1 in 10)
What is direct alloantigen recognition?
Tcell recognizes unprocessed allogeneic MHC molecule on transplant APC
What is indirect alloantigen presentation?
Presentation of processed peptide of allogeneic MHC molecule bound to self MHC molecule
What MHC does the tcell bind more tightly to….direct or indirect?
Direct (it binds to the MHC directly and doesn’t need the peptide alone)
How many MHC class 1 do we have?
6 (three on each chromosome)
What is hyperacute rejection?
pre-existing antibodies that reject a transplant (ABO blood types)
How do mothers have Rh/HLA problems with pregnancy?
They get introduced to the babies (fathers) HLA during birth and it creates antibodies against it for the second pregnancy
What is chronic rejection mediated by ? and what happens?
CD4 t-cells
The smooth muscle in the vessels proliferates a lot and plug the vessel.
What does cyclosporin do?
It inhibits calcineurin (which inhibits Tcell activation) Immunosuppression
What type of tissue graft is GVHD (graft vs host disease)?
Bone marrow
What does IL-2 do?
growth factor stimulates proliferating of Th cells
What is acute rejection?
Primarily caused by infiltration of Tcells into the allograft
What is chronic rejection?
interactions between allograft and cytokines, cell-to-cell interactions, CD4 and CD8 tcells
What is induction therapy?
Lots of immunosuppression in the early transplant period
What are the 4 drug classes for immunosuppression?
- Glucocorticoids
- Calcineurin inhibitors
- Antimetabolites/Anti-proliferative
- Biologicals (antibodies)
What do glucocorticoid drugs do?
block cytokine activation (IL-2, IL-1, IL-6, IFN-g, IL-3)
What are two calcineurin inhibitors?
Cyclosporine
Tacrolimus
What do calcineurin inhibitors do?
Blocks Calcineurin (which activates IL-2)
What are the most common Salt Lake STD’s?
Chlamydia (then gonorrhea)
What is Urethritis?
Visible dripping
WBC’s seen on a urethral gram stain
What is cervicitis?
Vaginal discharge
Friable cervix
What is Mycoplasma genitalium?
associated with urethritis, cervicitis, endometritis, PID
How to diagnose Gonorrhea?
Gram Neg Diplococci
NAAT (nucleic acid amplification test)
What drugs are glucocorticoids? and what are the Toxicities?
Prednisone….Methylprednisolone
Cushings syndrome, osteoporosis, Hyper things
What are complications of gonorrhea and chlamydia?
Infertility
Epididymitis
PID
Reactive arthritis
What are the two Calcineurin Inhibitor drugs? Toxicities?
Cyclosporine….Tacrolimus
Nephrotoxic
What are the three Antimetabolites drugs? toxicities
Mycopheollate Mofetil (myelosuppression)
Azathioprine (myelosuppression)
Sirolimus…Everolimus (anemia, leukopenia, hyperlipidemia)
What makes up Bacterial Vaginosis?
White vaginal discharge
Fishy smell with KOH
Metronidazole
What’s a trichomonas?
anaerobic flagellated protozoa
What bacteria would cause UTI after a honeymoon?
Staph Saprophyticus
What type of bacteria causes a UTI with stones (staghorn)?
Proteus
Which type of HPV causes warts?
6 or 11
Which type of HPV causes cancer?
16 or 18
What do HPV cells look like?
raisins with lots of air space around them (6 or 11)
How is vaginal candidiasis treated?
Nystatin (pore forming)
Fluconazole
What does Trichomonas Vaginalis?
Green and Frothy
What does vaginal candidiasis look like?
White and Cheesy
HAART
Highly Active Anti Retroviral Therapy
What are the 5 genes important in HIV?
Gag Pol Env Tat Rev
What are gp120 and gp41?
HIV antigens that show up.
What are the 5 steps of HIV entry and maturation?
- entry
- Reverse transcriptase (RNA to be DNA)
- Integration
- Assembly, budding, release
- Maturation
How many receptors does HIV need to get into a cell?
2
Which cells express CD4 for HIV???
CD4 Tcells
Dendritic cells
Macrophages
Which cells are attacked by HIV?
CD4
Which cells help hold back the HIV?
CD8
At what CD4 count are you considered to have AIDS?
less than 200
What causes AcutE hepatitis?
A and E
What causes Chronic hepatitis?
C
What causes Both acute and chronic?
B
How is Hep A spread?
Contamination (food borne)
Hepatitis B picmonic
“Happy-Tie Bee” is holding the “10%” above the “crone” who’s also holding the “90%” baby. There are “C-roses” on the liver. and the “Liver car-gnome” drive away from the “man-bra Glowing mare” who is drinking to much syrup “serum”. The “polly-artist draws a nodosum” (polyarteritis nodosum)
Hepatitis B Characteristics Picmonic
“happy-tie Bee” is going “reverse” in his train. on the “circular” track. He’s pulling three (months) “envelopes” with a “pregnant mom” “sex symbols” and “IV drugs”.
How to test for Hep B?
Surface Antigen (if seen again after 6 months chronic)
What is the HBV e antigen?
shows that HBV is replicating rapidly
What is HBV e antigen in chronic patients?
No HBeAG
you have antibody-ABe
How are HepD and HepB connected ??
If you can’t get HepB you won’t get Hep D…won’t work
Hep C picmonic
“happy-tie Cat” is in the brothel. There are “blood transmission” cats with “rare risk Sex” but the “IVDU cat” is getting sick. The “lucky 7” slot machine is “letting out condoms” on the “C-rose liver”
What Ig is favored with intramuscular injections?
IgG
How does excess BAFF affect autoimmunity?
If there’s excess BAFF autoimmune Bcells won’t apoptos like they should
Who should get tested for HIV?
everyone
What are the two tests for HIV?
Elisa
Western Blot
What does a Kaposi Sarcoma lesion look like?
Purplish highly vascular lesions
What virus causes Kaposi sarcoma?
Human Herpes Virus 8
Which receptors are needed for HIV to get into the CD4 Tcell?
CD4 receptor
R5 or X4
How many different drugs are necessary for HIV therapy?
At least 2 (or resistance happens)
What happens if you only prescribe one kind of drug for HIV?
Resistance occurs and HIV increases
What happens if an “Acid-Ase” doesn’t get to the lysosome because of a missing signal (mannose)?
The “Acid-ase” will be sent to the “constituitive” pathway which leads straight out into the blood. (Inclusion cells)
Tay Sachs disease picmonic
“Tie Sax-ophone” is with the “GM2 car and the Gangster on sidewalk (ganglioside)” who is fighting the “Cherry red eye’s macula”
What disease can be treated with enzyme replacement disease?
Lysosomal Storage disease (crumpled tissue paper)
How is Rheumatic fever an autoimmune disease?
Antibodies cross react with heart tissue and Strep antigens
How is Graves disease an autoimmune disease?
Antibodies bind and cause Hyperthyroidism (excessive thyroid hormone)
How is Myasthenia gravis an autoimmune disease?
(muscle weakness) Antibodies against AcTH receptors of muscles.
What is the current therapy for SLE (lupus)?
Anti-BAFF
What are the three Type 4 autoimmunities?
Diabetes
Rheumatoid Arthritis
Multiple Sclerosis
What are three Type 2 autoimmunities?
Graves disease
Rheumatic Fever
Myasthenia Gravis
What is a one of the Type 3 autoimmunities?
Systemic Lupus Erythematosus
What is different about Type 2 autoimmune vs Type 4?
Type 2: auto-reactive antibody
Type 4: Tcell component and antibody
What is the target for Rheumatoid arthritis treatments?
TNF
B-cells
What is Multiple sclerosis?
Auto-immune attack of the myelin sheath
Which cells are involved in multiple sclerosis?
Th1
Th17
IFN-g
What cell mediates antibody dependent cytotoxicity autoimmunity?
NK cells
What does Hashimoto’s thyroiditis do?
Hypothyroidism (thyroid also has “ectopic lymph nodes”)
What can cause autoimmunity in the eyes?
One eye can receive trauma and the “eye” proteins go to the lymph and activate Tcells which then attack both eyes.
What types of cells are in tumors along with tumor cells?
Lymphocytes
Macrophages
What are four ways tumor cells escape the immune system?
Don’t produce tumor antigen
Don’t produce MHC class 1
Production of immunosuppressive cytokines
Cleavage of MIC from the surface (no NK cell help)
Which types of immune cells are upregulated in tumor growth?
Bcells
Th2
Treg
Which types of HPV are protected for by the vaccine?
6
11
16
18
Which cytokines is given to help suppress tumors?
IL-2 (only 5% successful, highly toxic)
CTLA-4 blockage
anti- PD-1
What is antigenic shift
rapid reassortment of two different viruses (bird and human virus)
How does borrelia hermsii do phase variation?
varies it’s outer coat proteins over time
What’s a serotype?
antibodies for variable capsular carb residues
What cytokine is superantigen stabilization going to produce which will cause toxic shock?
TNF-a
What is “Paroxysmal Nocturnal Hemoglobulinuria”?
Complement attacks RBCs (lack of DAF)
What is chronic granulomatous disease?
NADPH oxidase deficient
What causes hyper IgM syndrome? (4 things)
cd40L…..NEMO (X-linked)
AID….CD40 (autosomal)
What causes SCID?
RAG deficient
What causes Omenn syndrome?
RAG deficient
What causes Bare lymphocyte syndrome?
Tap1 (no cd8 cells)
Tap2 (no cd4 cells)
What happens with Bare Lymphocyte syndrome?
No MHC expression so Tcells aren’t expressed.
What causes Pre-B cell receptor deficiency?
Lambda 5 mutation
Pre-B cell receptor doesn’t get chaperoned to the surface which means no Bcells!
What causes x-linked agamma globulinemia?
Bruton Tyrosine kinase mutation (No mature bcells…no antibodies)
What causes APECED?
Mutations in AIRE
What causes IPEX?
FOXp3 deficient (Treg)
SCIDs picmonic
The “X” man is looking at the door with the broken “IL-2 receptor” lock. The “dentist singing dog-ammo tied up (adenosine, deaminase deficiency)” are tied up to the “MHC tutu” and the “bone train plant (bone marrow transplant)”
What caused LAD? leukocyte adhesion deficiency
Defective CD18 (macrophages can’t get into infected tissues)
What causes Chediak Higashi syndrome?
Defect in vesicle fusion (no phagocytosis)
Endosomes don’t fuse with lysosomes
What does deficiency of “transcription factor C2Ta” cause?
Bare lymphocyte Type 2
If you have a mutation in CCR5 receptor what disease are you immune against?
HIV
What is most critical in HIV progression?
Decreasing CD4 count (200 is tipping point)
What cells (with different haplotypes) can help with HIV progression?
HLA
Why do older people get immunodeficient?
Less production of Tcells and Bcells (lower specificity)
Do older people have pro-inflammatory tendencies or anti-inflammatory tendencies? What cytokine causes
Pro-inflammatory
NF-kB
