Immuno hard to recall Flashcards
What type of anaphylaxis does aspirin cause? What is another name for this?
Non-IgE mediated anaphylaxis
Mast cell degranulation
Difference between acute vs chronic urticaria?
Acute = <6 weeks intermittent rash which appears in same site for <24 hours each time Chronic = >6 weeks
When would an urticarial rash make you suspicious of an underlying vasculitis?
If it lasts more than 24 hours in a single site
If it resolves with bruising or skin depigmentation
What does C1 inhibitor deficiency cause?
acquired angioedema
What dose of adrenaline should be given in anaphylaxis?
IM 1ml of 1:1000 (i.e. 1mg/ml)
Kostmanns syndrome is a congenital deficiency of which component of the immune system?
Neutrophil
Which infection is most common as a consequence of B cell deficiency?
Bacterial
Meningococcal infections are quite common as a result of which deficiency of the component of the immune system?
Complement
A complete deficiency in this molecule is associated with recurrent respiratory and gastrointestinal infections
IgA
Leukocyte Adhesion Deficiency is characterised by a very high count in which cell line?
neutrophils
Which crucial enzyme is vital for the oxidative killing of intracellular micro-organisms?
NADPH oxidase
Which complement factor is an important chemotaxic agent?
C3a
What type of hypersensitivity reaction is RA?
Type IV – T-cell mediated
What type of hypersensitivity reaction is T1DM?
Type IV – T-cell mediated
What type of hypersensitivity reaction is ITP?
Type II – Antibody mediated
What type of hypersensitivity reaction is Hepatitis C associated membranoproliferative glomerulonephritis type I?
Type III – Immune complex mediated
What type of hypersensitivity reaction is Goodpasture’s?
Type II – Antibody mediated
What type of hypersensitivity reaction is MG?
Type II – Antibody mediated
Antibody in SLE?
Anti-dsDNA
Antibody in Wegener’s?
c-ANCA
Antibody in RA?
anti-CCP
Antibody in PBC?
AMA
What is the specific auto-antigen that is the target of the immune system in goodpasture’s?
Type IV collagen
Tx for goodpasture’s?
prednisolone
Which cytokines exert an antiviral effect?
Interferons
Which Ig is a dimer?
IgA
Which cytokine acts on hepatocytes to induce synthesis of acute phase proteins in response to bacterial infection
IL6
What are the first immunoglobulins expressed on B cells before they undergo antibody class switching?
IgD and IgM
What is the most abundant (in terms of g/L) immunoglobulin in normal plasma?
IgG
Deficiency in which pathway predisposes to SLE?
Classical complement pathway
X-Linked Agammaglobulinaemia is due to a problem in which gene?
Bruton’s tyrosine kinase (Btk) gene
X-linked Severe Combined Immunodeficiency is due to a problem in which receptor?
IL2 receptor
Wiskott-Aldrich Syndrome is due to a problem in which gene?
WASP
Bare lymphocyte syndrome type 2 is due to a problem in which part of the immune system?
MHC class II
For which disorder would a bone marrow transplant be unhelpful but a thymic transplant may provide a cure?
DiGeorge syndrome
In acute rejection what is released by CD8 lymphocytes to kill target cells?
Granzyme B
What is a risk factor for chronic allograft rejection?
HTN
What are the 3 most important HLA types to screen for in renal transplantation when matching donor and recipient, in order of importance
HLA DR > B > A
Which lymphocytes respond to foreign HLA DR types
CD4+ T cells
Which lymphocytes respond to foreign HLA DR types
CD8+ T cells
Which immunosuppressant drug prevents DNA replication especially of T cells by impairing guanine synthesis
Mycophenolate mofetil
Which immunosuppressant drug causes a transient rise in neutrophils?
Prednisolone
SE of prednisolone?
HTN
SE of ciclosporin?
Hypertension and reduced GFR
SE of azathioprine?
Bone marrow depression
Hepatotoxicity
Hypersensitivity reactions
SE of methotrexate?
Pneumonitis, pulmonary fibrosis and cirrhosis
SE of immunoglobulin?
Anaphylaxis
Give an example of A sub-unit / conjugate vaccine
pneumococcal vaccine
What type of vaccine is oral poliomyelitis vaccine?
A live attenuated viral vaccine
Give an example of Inactivated preparations of the bacteria for vaccine
Whole cell typhoid vaccine
Give an example of a vaccine that is made using recombinant DNA technology
Hep B
Name a A feature of immunological central memory
IL2
Which live attenuated organism do BCG vaccines contain?
Mycobacterium bovis
What type of vaccine is HiB?
Conjugated
What Agent is used in humans that promotes a predominantly antibody response through the release of Il-4 that primes naïve B-cells?
Alum
What Diploid cell vaccine containing inactivated virus is given before or after exposure to those considered at risk?
Rabies
What type of vaccine is Hep A?
Inactivated
What is a A water-in-oil emulsion containing mycobacterial cell wall components that could be used to increase the immune response of a vaccine?
Freund’s adjuvant
What monoclonal antibody targets RANKL?
Denosumab
What drug class does dolutegravir belong to?
Integrase Inhibitor
The paediatric SpR is called to review a 21 day old infant who is pyrexic and appears unwell. He is noted to be hypocalcaemic and has a cleft palate. He has a fever of 39C. Blood tests reveal a neutrophil count of 8 (normal range: 1.5-8.0), absent T cells and normal B cells. What primary immunodeficiency is this patient likely to have?
DiGeorge Syndrome
What is the primary target of the antibody C-ANCA in Wegener’s?
Proteinase 3
What is the primary target of the antibody p-ANCA?
Myeloperoxidase
A patient’s autoimmune panel of bloods reveals positive anti-glycoprotein IIb antibodies. On the patient’s lower legs, there are pinprick petechiae. The patient’s platelet level is very low. What autoimmune condition is associated with this autoantibody and clinical presentation?
Autoimmune Thrombocytopenic Purpura
Encapsulated bacteria NHS?
Neisseria
Haemophilus
Streptococcus/Pneumococcus
What monoclonal antibody targets IL-17 and is involved in the treatment of psoriasis, psoriatic arthritis and ankylosing spondylitis?
Secukinumab
What immunoglobulin mediates type I hypersensitivity reactions?
IgE
What is the causative agent of Progressive Multifocal Leukoencephalopathy?
JC virus
A 5 year old girl is seen by her GP. Her mother says she is unable to sleep at night as her knees, elbows and shoulders are very red and painful, especially to touch. Her mother has also noticed small bumps under her skin. She is currently pyrexic, but the mother says she is still recovering from a bad sore throat two weeks ago.
What is the likely diagnosis?
Acute Rheumatic Fever
What is the short-term treatment for severe, life threatening antibody mediated damage or dysfunction, for example myasthenic crisis, cyroglobulinaemia or antibody mediated rejection?
Plasmapheresis
What lymphocyte lineage does azathioprine predominantly inhibit?
T lymphocytes
What assay is used as the gold-standard for diagnosis of HIV or as a confirmatory test of infection?
western blot
A 74 year old woman presents to the GP with of loss of vision and a severe headache around the sides of their head. In addition, she reports feeling generally tired and has trouble “getting going” in the morning.
An urgent referral to A&E is made. She treated urgently by the team and is admitted to hospital after blood results showed an elevated CRP. 24 hours after admission, a new set of bloods showed a moderate leukocytosis, which was not present on the previous bloods. In the absence of other symptoms, what is the most likely cause of the leukocytosis?
Corticosteroids
Which cell type secretes immunoglobulins?
Plasma cells
What is measured during an anaphylactic reaction to monitor response to treatment?
Mast Cell Tryptase
What viral enzyme is predominantly responsible for the high mutation rate of HIV and other RNA viruses?
Reverse Transcriptase
What specific cell subtype expresses both CD3 and CD4?
T Helper cells
What blood product is most commonly contaminated by bacteria?
Platelets
A 31 year old accountant reports an itchy rash over the trunk and back that has been present for the last 7 weeks. On examination, there are smooth erythematous papules with evidence of excoriation. She reports no association with food, time and has changed her washing powder to a “Non-Bio” formulation.
What condition is she suffering from?
Chronic Urticaria
What cell type is the hallmark of acute inflammation?
Neutrophils
What is the name given to a substance that increases the effectiveness of an immune reponse to a vaccination without altering the specificity of the response?
Adjuvant
A 70 year old gentleman is referred to the nephrologists for worsening kidney failure and haematuria. Over the last 3 months, he has lost 20% of his body weight, reports intermittent fevers and joint aches. He is also seeing his GP as he recently started coughing blood.
What underlying immunological condition may this patient have?
Goodpasture’s Disease
What is the inheritance pattern of reticular dysgenesis?
Autosomal recessive
An autoimmune panel of bloods reveals positive anti-dsDNA antibody at a titre of 1:1600.
What autoimmune condition is associated with this autoantibody?
SLE
Name 4 drugs which target TNF alpha
Infliximab
Adalimumab
Certolizumab
Golimumab
What is the only lymphocyte subset considered to be part of the innate immune system?
Natural killer cells
A 38 year old lady with known polycystic kidney disease received 3 units of blood over the last day due to a post-partum haemorrhage. She is complaining of shortness of breath. On examination she has mild pitting oedema of the sacrum and lower limbs. Serum BNP is elevated. She is apyrexic. What complication of blood transfusion is she suffering from?
Transfusion Associated Circulatory Overload
IgE antibodies bind semi-permanently to the surface of what cell of the innate immune system?
Mast cells
The paediatric SpR is called to review a 21 day old infant who is pyrexic and appears unwell. The parents think he has a problem with his hearing as he has been tugging at his ear. There is pain, tenderness and swelling over the mastoid process of his left ear. Blood tests reveal a neutrophil count of 0.1 (normal range: 1.5-8.0) What primary immunodeficiency is this patient likely to have?
Kostmann Syndrome
A 21 year old woman reports weight loss, tiredness, diarrhoea and non-bloody offensive smelling stools. She has had three chest infections requiring antibiotics in the last three years. Blood tests are ordered and reveals a hypochromic, microcytic anaemia with low ferritin. Anti-TTG and anti-endomysial antibodies are negative. There are normal levels of IgG, IgM and IgE. No IgA is found.
What is the most likely cause of her gastrointestinal symptoms?
Coeliac Disease
Anti-endomysial and anti-TTG are IgA autoantibodies so may be falsely negative in IgA deficiency
What does a correctable/reversible deformity of something like swan neck deformity in the hands suggest?
Suggests Jaccoud’s arthropathy as part of SLE rather than a diagnosis of rheumatoid arthritis
An arterial biopsy of a patient with a suspected arteritis reveals a “rosary bead” appearance of small aneurysms.
What vasculitis is associated with this clinical sign?
Polyarteritis Nodosa
An autoimmune panel of bloods reveals positive anti-liver kidney microsomal-1 antibody and anti-smooth muscle antibody. There is also derangement of LFTs. What autoimmune condition is associated with these autoantibodies and deranged LFTs?
Autoimmune Hepatitis
Which cytokine is predominantly responsible for T cell proliferation and survival?
IL2
Triad in Granulomatosis with Polyangitis?
Rapidly progressive glomerulonephritis
nosebleeds
haemoptysis
What is the most severe form of scid?
Reticular dysgenesis
What intracellular pro-proliferative molecule does cyclosporine and tacrolimus inhibit? What cytokine does this prevent release of?
Calcineurin
IL2
What is the specific antigen recognised by the immune system in Goodpasture’s syndrome?
Type IV collagen
What type of bacteria are conjugated vaccines effective against?
Encapsulated
A neutrophil releases preformed myeloperoxidase, defensins and neutrophil elastase. What is this process known as?
Degranulation
Prior to starting terbinafine, a systemic antifungal, what blood test should be ordered?
LFTs
Tx for Q fever?
Doxycycline or ciprofloxacin
Preggers and UTI?
nitrofurantoin
A 50 year old woman is seen by her GP with 3 days of mild headache, sneezing and coughing. She also has a sore throat. She takes ramipril for hypertension but has no other past medical history. On examination her chest is clear, there is no cervical lymphadenopathy and no visible exudate on the tonsils. What is the likely responsible organism?
Rhinovirus
