Case 9 Flashcards
(251 cards)
1
Q
What molecules recognise a virus in the immediate innate immune response?
A
Defensins, Lactoferrin, Lysozyme
Preformed soluble effector molecules
2
Q
What cells recognise a virus in the immediate innate immune response?
A
Macrophages, Mast cells, Conventional Dendritic Cells
Some memory T cells and NK cells
3
Q
How does Influenza A target the mucus barrier to infection?
A
Cytolytic. Causes acute cell death of ciliated respiratory epithelial cells and removal of mucous secreting cells.
Blocks muco-ciliary escalator
4
Q
Sentinel Cells
A
First line of defence.
Macrophages, Dendritic cells and a few NK cells.
5
Q
PRRs recognises
A
PAMPs
6
Q
Which Toll-like Receptors are found within endosomes?
A
TLR 3, 7, 8, 9
7
Q
TLR3 detects…
A
dsRNA
8
Q
TLR7 detects…
A
single stranded viral RNA
9
Q
TLR8 detects…
A
single stranded viral RNA
10
Q
TLR9 detects…
A
Unmethylated CpG-rich DNA
intracellular viral infection
11
Q
Which Toll-like receptors detect viral glycoproteins?
A
TLR 1, 2, 4, 6
12
Q
Which TLRs are found on the plasma membrane?
A
TLR1, 2, 4, 6
13
Q
Genetic defect in TLR3 signalling pathway is associated with…
A
Recurrence of Herpes Simplex Encephalitis
14
Q
How does TLR3 detect HSV-1 (a DNA virus)?
A
HSV-1 produces a dsRNA intermediate during transcription.
TLR3 detects ds RNA.
15
Q
Epstein-Barr Virus infects what type of human cells?
A
B cells
16
Q
Pyrogens released by macrophages on detection of a virus
A
IL-6,
TNF-alpha
IL-1 Beta
17
Q
How do pyrogenic cytokines increase body temperature?
A
Act on hypothalamus to produce PGE2 (innervation of SNS, non-shivering thermogenesis and vasoconstriction)
Act on muscle to increase fat and protein utilisation,
18
Q
TLR activation leads to….
A
Transcription of type 1 interferons (alpha and beta)
19
Q
RIG-1
A
Interferon Stimulated Gene
Rig-like receptor involved in triggering interferon expression
20
Q
MD-5
A
Interferon Stimulated Gene
Rig-like receptor involved in triggering interferon expression
21
Q
IFITM3
A
Interferon Stimulated Gene
Prevents entry of enveloped viruses into cytoplasm by trapping them at plasma membrane.
22
Q
Where are RLRs located?
A
cytosol
23
Q
Interferon Response Factors
A
Activated by PRRs on detection of PAMPs
Enter nucleus and initiate transcription of type 1 interferons
24
Q
Effect of Ebola on IFNs
A
Shuts off supply of interferons, preventing the antiviral state.
25
What do cytosolic RLRs detect?
Abnormal RNA
26
A majority of Interferon production in conducted by...
Plasmacytoid Dendritic Cells (pDCs)
| Contain extensive rough endoplasmic reticulum.
27
Plasmacytoid Dentritic Cells are located...
Blood and lymphoid tissue
28
Plasmacytoid cells express TLRs...
7 and 9
29
Conventional Dendritic Cells - role...
Activation of naive T cells
30
Conventional dendritic cells are located (in the absence of infection)...
In peripheral tissues
31
Why are MMR vaccines not given singly and a week apart?
Interferon response to first vaccine would suppress replication of the second vaccine - diminished immune response.
Would need to be given 30 days apart (child is vulnerable to infection at this time)
32
NK cells release...
Perforins
Granzymes
IFN-g
33
Effect on macrophages of IFN-g release from NK cells
Makes macrophages more efficient at phagocytosis
34
Function of conventional dendritic cells
Transports antigen from site of infection to secondary lymphoid tissues
35
Cells which express MHC I
Found on surface of all nucleated cells.
36
MHC I display non-self proteins to...
Cytotoxic T lymphocytes
37
MHC II display non-self proteins to...
T Helper Cells
38
CD4
Glycoprotein expressed by T Helper Cells
| Involved in detection of MHC II
39
CD8
Glycoprotein expressed by cytotoxic T cells.
| Involved in detection of MHC I
40
Vaccination into deltoid will reach which secondary lymphoid tissue?
Axillary node
41
Vaccination into quadriceps will reach which secondary lymphoid tissue?
Inguinal node
42
Route of administration of influenza vaccine in children
Oral/Nasal
43
Route of administration of Rotavirus vaccination
Oral/Nasal
44
cDCs in Peyer's Patches and Mesenteric Lymph Nodes of Intestines detect pathogen.
Immunoglobulin produced in adaptive immune response is?
IgA
45
cDCs in Axillary/Inguinal Lymph Nodes of Intestines detect pathogen.
Immunoglobulin produced in adaptive immune response is?
IgG
46
CCR7
Directs cDC to nearest draining lymph node
47
Lymph from upper body eventually reaches...
Right lymphatic duct
48
Lymph from lower body eventually reaches...
Thoracic duct
49
Intracellular antigens processed into peptides by
Proteasome
50
Extracellular antigens processed into peptides by...
Endosome used to bring antigen into cell
51
Why are live-attenuated vaccines the best way to achieve a CTL response?
Only live viruses can replicate intracellularly and be presented by MHC class I
52
CD4 and CD8 are examples of...
Co-receptors
53
Function of US6 protein in Human Cytomegalovirus
```
|nhibits peptide loading of MHC class I.
Allows virus to evade recognition mechanisms.
```
54
2 Signals for full activation of CTLs by cDCs
1. Binding of TCR with MHC:Peptide complex
| 2. Binding of C7 (upregulated by step 1) with C28 on surface of CTL
55
Swelling of lymph nodes occurs due to proliferation of which cells?
CD8 T cells/ Cytotoxic T Cells
56
Function of IL-2
Promotes proliferation and differentiation of T cells (into memory and effector cells)
57
On detecting virally infected target cells, CTLs release...
Perforins and Granzymes
58
TH1 cells
Migrate to infected tissues from lymph node to help macrophages
59
Function of Follicular Helper T cells
Stimulate somatic hypermutation of variable region of immunoglobulins on the surface of B cells.
60
Antibody on surface of B cells (prior to somatic hypermutation)
IgM
61
Activated Induced Cytidine Deaminase
Catalyses somatic hypermutation
62
Hyper IgM Syndrome
Mutation in gene which codes for AID.
| B cells can only express IgM on their surface.
63
Linked Recognition
B cells and T cells must recognise epitopes of the same molecular complex in order to interact.
i.e. Both cells must recognise the antigen to interact.
64
Conjugate vaccines used for...
Encapsulated bacteria (covered in polysaccharide coat)
65
Conjugate vaccines consist of...
Protein and polysaccharide
66
What type of RNA is mRNA?
Positive, single stranded
67
Function of envelope of a virus
Syncytia formation - allows virus to utilise membranes of host cells.
68
Non-enveloped viruses are found...
In GI tract (since enveloped viruses cannot survive here)
69
DNA viruses mutate less frequently than RNA viruses because...
DNA polymerases have a proofreading function (RNA polymerases do not)
70
Treatment for Genotype 1 Hep C Infection
Sofosbuvir (nucleotide analogue)
Ledipasvir (inhibits viral infection)
Ribavirin (guanosine analogue, blocks RNA synthesis)
71
Interferons are not used for treatment of infection since...
They cause suicidal thoughts in patients
72
Pandemic
An epidemic that becomes very widespread, affecting a whole region/continent (may be worldwide).
High mortality.
73
Forms of Hepatitis spread by contaminated food and water..
A and E
74
HPV serotype causing cervical carcinoma
16 and 18
75
HPV vaccine protects against what percentage of cervical carcinomas?
70%
76
Inactivated polio vaccine protects against...
PV1, PV2 and PV3
77
Herpangina and Hand-Foot and Mouth Disease are caused by...
Cocksackie A Virus
78
Clinical Presentation of Cocksackie A virus
Sores in and around the mouth
79
Form of Hepatitis causing Hepatocarcinomas
Hep C
80
Clinical Presentation of Dengue Virus
```
Haemorrhagic Fever:
Flushing of face and chest,
Oedema,
Bleeding,
Samll red and purple spots (Petechiae)
```
81
Vaccination needed to go on a trip down the Amazon river
Yellow Fever
82
Major complications of pertussis infection
```
Weight loss (vomiting)
Cerebral Hypoxia (Dyspnoea from cough)
Bronchopneumonia
```
83
Pertussis infection lasts...
2-3 months
84
Effect of cytotoxin produced by B.Pertussis
Stops cilia from beating.
| Unable to clear mucus from lungs.
85
Whole Cell Pertussis Vaccine
Reactogenic (seizures, high fever and brain damage)
| Longer lived immunity
86
Acellular Pertussis
Non Reactogenic
| Short lived immunity
87
Immunity resulting from whole Cell Pertussis vaccine is mediated by...
TH17 and TH1
88
Immunity resulting from Acellular Pertussis vaccine is mediated by...
TH2
89
Definition of an adjuvant
Substance which enhances immune response to antigens by bringing antigen into contact with immune system
90
Examples of adjuvants
Aluminium phosphate
| Aluminium hydroxide
91
Molecule responsible for reactogenesis in Whole Cell Pertusis
Endotoxin
92
How does TH17 elicit immunity to B.Pertussis?
Releases IL-17 which recruits more neutrophils from bone marrow.
Neutrophils mop up extracellular bacteria.
93
Rubalavirus
Virus causing mumps
94
Spread of Mumps
Direct contact or droplet
95
Early symptoms of mumps
```
Fever
Malaise
Headache
Anorexia
Photophobia
Earache
```
96
Late symptoms of mumps
Swelling of salivary/parotid glands ('Hamster face')
Hearing loss
Orchitis
Oophorytis (7%)
97
Complications of mumps
Encephalitis
Meningitis
Parotitis (Parotid glands)
Permanent Deafness
98
Diagnosis of mumps
Saliva (Mumps-specific IgM)
Urine
Observations
High serum amylase levels
99
Treatment of mumps
Treatment of symptoms e.g. Pyrexia using paracetamol
100
Genes coding for MHC are located on..
Chromosome 6
101
Why is herd immunity not effective against tetanus?
Tetanus is not transmitted from person to person
102
HPV strain causing genital warts
6 and 11
103
Spread of HPV
Skin-to-skin
104
Diagnosis of cervical cancer
Pap smear
105
Cervarix
2 in 1 HPV vaccine
| Protects against HPV 16 and 18
106
Gardasil
4 in 1 HPV vaccine
| Protects against HPV 6, 11, 16 and 18
107
Side effects of HPV Vaccine
Fever, Nausea, Rash, Itch, Headache, Dizziness
108
Structure of HPV Vaccine
L1 capsid protein of HPV
| No viral DNA, non infectious
109
Neutralising antibodies
IgG and IgA
| Block viral entry and uncoating
110
Antibody which transports across epithelium
IgA
111
Antibody which diffuses into extravascular sites
IgG
112
Antibodies which activate complement
IgM, IgG, IgA
113
Antibody which activates mast cells
IgE
114
Mechanism of neutralising action of IgA and IgG
Block attachment of virus
Block endocytosis of virus
Block uncoating of virus in endosome.
115
Why is intranasal administration of influenza vaccine more effective than injected?
Stimulates production of mucosal IgA antibodies.
Site of infuenza infection is mucosa.
Injection stimulates production of IgGs
116
Advantage of Live attenuated Sabin Poliovirus vaccine
Elicits a strong mucosal IgA response - intestinal immunity
117
Disadvantage of Injected Salk Poliovirus Vaccine
Does not produce intestinal immunity - less effective at preventing spread of poliovirus in a population.
118
Antibody involved in opsonisation
IgG
119
Phosphatidylserine
Membrane lipid found on surface of apoptotic cells.
| Recognised by macrophages clearing debris from apoptosis.
120
Memory response (i.e. to an antigen the immune system has encountered before)
Faster
Longer duration
Greater quantity (by 100-1000x)
Higher affinity of Abs
121
Virulence of Hib
Encapsulated in polysaccharide coat.
Prevents fixation by alternative pathway.
Requires high affinity IgG to overcome this.
122
Main cause of meningitis in the UK
Haemophilus Influenza B
123
Early symptoms of meningitis
Fever
Irritability
Vomiting
Loss of appetite
124
Symptoms of meningitis in babies
```
High pitched, moaning cry
Drowsy
Stiff with jerky movements
Pale and blotchy skin
Turning blue
Fever with cold hands and feet
Non blanching rash
```
125
Transmission of Hib
Aerosol (coughing and sneezing)
126
Proteins usually used in conjugate vaccines
Tetanus or diphtheria toxoid proteins
127
Principle antibody of all bodily secretions
IgM
128
B cells exposed to IL-4
Isotype switching to IgE
129
End result of Hib vaccination
Secretion of high affinity, opsonising IgG
130
Examples of encapsulated bacteria:
```
Hib
Steptococcus Pneumoniae
Neiseria Meningitidis
E. Coli
Klebsiella Pneumoniae
```
131
Immunisations at 2 months
DTaP/IPV/Hib
PCV
Rotavirus
132
Immunisations at 3 months
DTaP/IPV/Hib
Men C
Rotavirus
133
Immunisations at 4 months
DTaP/IPV/Hib
| PCV
134
Immunisations at 12-13 months
Hib/MenC
PCV
MMR
135
Immunisations at 40 months
DTaP/IPV
| MMR
136
DTap/IPV/Hib immunisation given at
2, 3 and 4 months
137
Rotavirus immunisation given at
2 and 3 months
138
Route of administration of rotavirus vaccine
Oral
139
What type of vaccine is MMR?
Live attenuated
140
Purpose of Yellow Card Scheme (Vaccinations)
Reporting of all suspected reactions to vaccinations
141
Shingles vaccine is given to...
Patients over 70yrs
142
Course for Hep B Vaccination
3 dose = 0, 1, and 6 months
4 dose = 0, 1, 2 and 12 months
Single booster 5 years later
143
Immunisations for Health Care Workers
```
Influenza,
BCG,
Hep B,
VZV
MMR
```
144
Immunisations for patients over 65
Flu
| PPV (Pneumococcal Infection)
145
Immunisations for patients over 70
Shingles
146
Immunisations for injecting drug users
Hep A and Hep B
147
Immunisations for MSM (Men who have Sex with men)
Hep A and Hep B
148
Immunisations for pregnant women
Influenza
| Pertussis (aP)
149
HLA genes code for...
MHCs
150
Viral Envelope
Layer on the outside of a viral capsid, making the virus more fragile.
Makes it sensitive to drying out.
151
How are viruses able to grow in a short period of time? (Burst/Yield)
Grow by assembly of preformed components
152
mRNA is
Positive ssRNA
153
Enzymes used to generate cDNA in retroviruses
Reverse transcriptase and RNA-ase H
154
Plasma associated viraemia occurs in...
Polio (acute)
155
Cell-associated viraemia occurs in...
Epstein-Barr Virus (affects B cells)
HIV (affects T cells)
Human Cytomegalovirus (affects myeloid cells)
156
Influenza incubation period
1-2 days
157
Herpes simplex incubation period
5-8 days
158
Measles incubation period
9-12 days
159
Mumps incubation period
17-20 days
160
How does Herpes Virus become persistent?
Downregulates MHC expression - B cells do not recognise infected cells.
161
How does HIV become a persistent virus?
Rapid mutation enables it to evade CTLs.
| Since T cells are generated for a specific virus, they cannot kill mutated HIV.
162
How are Hep B and Hep C similar?
Transmission via bodily fluids (semen, vaginal secretions, blood)
163
Viruses using the lung as primary tissue of replication:
Rhinovirus
Measles
Influenza
(Adenovirus, Coronavirusm Parainfluenza, Respiratory Syncytial virus)
164
Paramyxoviruses...
Measles
| Respiratory syncytial virus and parainfluenza virus
165
Difference between Parainfluenza virus and Respiratory Syncytial Virus
PIV in children <3yrs
RSV in children >3yrs
Both are paramyxoviruses causing respiratory infection in immunocompetent children.
166
What is croup?
Barking cough
| Stridor when breathing in
167
Surface proteins found in lipid envelope of Influenza Virus
Hemagglutinin
Neuraminidase
(M2 ion channel protein found additionally in Influenza A)
168
Complications of Influenza
Otitis Media
Pneumonia
Bronchitis
Myocarditis
169
Symptoms of influenza
```
Headache
Shivers
Myalgia
Cough
Fatigue
```
170
How does onset of common cold compare to influenza
Influenza = sudden onset
| Common cold = Prolonged onset
171
Duration of severe symptoms of influenza
8-10 days
172
Epidemic caused by...
Antigenic Drift - progressive small changes in envelope proteins through mutation.
173
Antigenic Drift
Progressive small changes in envelope proteins through mutation
Leads to epidemic
174
Pandemic caused by..
Antigenic Shift - Sudden massive changes in envelope proteins through reassortment.
175
Antigenic Shift
Sudden massive changes in envelope protein through reassortment
Leads to pandemic
176
MOA of Amantadine
Inhibits M2 ion channel in viral envelope - preventing viral replication
177
Amantadine is used in treatment of
Influenza A
178
ADRs of Amantadine
GI disturbance, CNS effects
179
MOA of Feramivir/Oseltamavir
Neuraminidase inhibition.
Protein found in viral envelope which allows virus to bud from host cell.
Prevents viral replication.
180
ADRs of Feramivir/Oseltamavir
GI disturbance, Headache, Neuropsychiatric events
181
Feramivir/Oseltamavir used in the treatment of...
Influenza A and B
182
Contraindication for live attenuated vaccine
Immunosuppressed
183
Types of Influenza Vaccine:
Injection (Enzira, Fluzone)
Nasal Spray (Flumist) - USA
184
Influenza Vaccine recommended for:
```
People >65yo
Chronic Respiratory Disease (e.g. Asthma)
CVD
Renal Disease
Diabetes Mellitus
Immunocompromised
In residential long-stay accommodation
```
185
Symptoms of Measles
Enanthema/Koplik Spots - red spots in mouth
Makulopapulous Exanthema - red spots on skin
Tracheobronchitis
Laryngitis
Fever
186
Complication of Measles
Subacute Sclerosing Panencephalitis (delayed CNS disease, no cure)
187
Subacute Sclerosing Panencephalitis
Complication of persistent measles.
| Elevated measles virus in CSF.
188
Satellite Virus to Hep B
Hep D
189
Symptoms of Viral Hepatitis
Icterus (yellowing of sclera and skin surrounding eyes)
Palmar Erythema
Ascites
Caput Medusae
190
Treatment of Hep B
Reverse Transcriptase Inhibitors - Tenofovir or Lamivudine
191
Hepadnavirus causes
Hepatitis B
192
Flavivirus causes
Hepatitis C
193
Features of Liver Cirrhosis
```
Gynaecomastia
Testicular Atrophy
Oedema
Ascites
Spider naevi
Impaired immunity
Splenomegaly
```
194
Why does liver cirrhosis cause gynaecomastia and testicular atrophy?
Impaired metabolism of oestrogen
195
Why does liver cirrhosis cause splenomegaly?
Portal Hypertension
196
Why does liver cirrhosis cause oedema and ascites?
Low albumin, increased hydrostatic pressure of blood.
197
Interferon alpha therapy is used for
Hepatitis B and C
198
ADRs of interferon therapy
Flu-like symptoms, anorexia, fatigue
199
Picorna Virus Causes
Hepatitis A
200
Transmission of Hepatitis A
Faeco-oral
201
Risk factor for Hep A
Poor sanitation
Travellers
Homosexual men
202
Hep E is caused by
Calicivirus
203
NANB (Hepatitis)
Non A and Non B
204
Dysfunctional cell in HIV
T cell
205
Pneumocystis Carinii
Opportunistic bacteria causing pneumonia in patients with HIV
206
Karposi's Sarcoma
Lesions in skin, mucous membranes, nose, throat and lymph nodes.
Caused by poorly controlled HIV.
207
How does HIV lead to AIDS?
Depletion of CD4 T cells
| Allowing opportunistic infection to occur e.g. thrush
208
First line treatment for HIV
2 x Nucleoside reverse transcriptase inhibitors
Plus
Non nucleoside RT inhibitor OR
Protease Inhibitor
209
Nucleoside Reverse Transcriptase Inhibitors (treatment of HIV)
Abacavir
Lamivudine
Tenofovir
210
Protease inhibitors (treatment of HIV)
Amprenavir
Darunavir
Fosamprenavir
211
Why does immunocompromise increased risk of cancer?
Immunocompromised patients are less likely to be able to control cancer growth.
212
MOA of Aciclovir
DNA polymerase inhibitor (guanosine analogue)
213
ADRs of Aciclovir
Abdominal pain
Diarrhoea
(topical) inflammation
Irritation
214
Contraindications of Aciclovir
Elderly (may cause adverse neurological reactions)
215
Indication of Aciclovir
HIV
| VZV
216
MOA of Zidovudine
Reverse transcriptase inhibitor
| Thymidine analogue
217
ADRs of Zidovudine
GI disturbance
Fatigue
Flu-like symptoms
218
Contraindications of Zidovudine
Haemopoietically Suppressed
| i.e. Low Hb +/- low neutrophils
219
Indication for Zidovudine
HIV
220
Indication of Oseltamavir
Influenza
221
Contraindication of Oseltamavir
Pregnancy (BUT benefit:risk analysis may be carried out in pandemic situation)
222
ADRs of Oseltamavir
```
GI disturbance
Abdominal Pain
Dyspepsia
Headache
Nausea and Vomiting
```
223
MOA of Ribavirin
Nucleoside mimetic
Causes viral hypermutation during RNA synthesis
224
Indication of Ribavirin
Hep C
225
Contraindications of Ribavirin
Pregnancy (Terratogenic)
| Cardiovascular Disease
226
Common ADR of Ribavirin
Depression
227
Serious ADR of Ribavirin
Haemolytic Anaemia
228
Symptoms of Rubella
```
Rash
Fever
Swollen lymph nodes
Aching joints
Cold-like symptoms
```
229
Treatment of Rubella
Paracetamol/Ibuprofen
Drinking water
Treat cold-like symptoms
230
Describe the rubella rash
Small red-pink spots.
Starts behind ears, spreads to head and neck, then trunk
231
Features of congenital rubella syndrome
```
Small head
Eye defects
Heart problems
T1DM
Over/Underactive thyroid
```
232
Ruth Griffiths Assessment
Formal assessment of development
233
Tonic Neck Reflex
"Fencing Reflex" seen in newborns (up to 1 month)
When the head is turned to one side, the arm and leg on that side are extended. The arm and leg on the other side are flexed.
234
Primitive reflexes seen in newborns:
Tonic neck reflex
Grip reflex
Step reflex
Crawl reflex
235
Average weight of newborn
3.5kg
236
Average length of newborn
50cm
237
Average OFC (Head circumference) of newborn
35cm
238
How many days after birth is weight gain seen?
10
239
When a 0-3 month old is supine...
Head is turned to one side
240
When a 0-3 month old is prone...
Props on forearms
241
Gross motor function in 0-3 month old:
Prone - props on forearms
Supine - head turned to one side
Minimal head lag when pulled to sit
242
In child development, when should a child begin to sit?
5-9 months
243
Gross motor function in 3-6 month old:
Rolls from prone to supine
Pushes up on extended arms when prone
Sitting (5-9 months)
244
When does stranger anxiety develop?
9 months
245
Protoimperative vs protodeclarative pointing
Protoimperative - point at something you want (9 months)
| Protodeclarative - point at something to show interest (1 year)
246
Gross motor function at 1 year old
Walking (average 13 months)
Cruising (with support)
Crawls up stairs
247
Pincer grasp develops at...
1 year
248
Cognitive function in 1 year old:
Knows function for objects
| i.e. comb for hair, hoover for floor
249
Gross motor function in 2 year old:
Running
Kicking
Stairs (2 feet/step)
250
Fine motor function in 2 year old:
Scribbling
Builds 2-3 cube tower
Turning of pages
Hand preference
251
Speech and language function in 2 year old:
50 words
| some 2 word phrases
