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Alya Cards Pathology Robbins basis > Ch 6 > Flashcards

Ch 6 Flashcards

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1
Q

Type 1 hypersensitivity mediated by which cell?

A

Mast cells

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2
Q

Type II hypersensitivity is mediated by which mediator?

A

Antibody

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3
Q

What is an example of Type II hypersensitivity?

A

Mismatched blood transfusion haemolysis

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4
Q

The process of which humans recognise self vs non self cells is called?

A

Self tolerance

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5
Q

The leading cause of death in HIV patients is

A

Opportunistic TB

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6
Q

What is the definition of ‘Window Period of HIV infection’?

A

The time between HIV infection and seroconversion (usually 2-3 weeks post infection)

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7
Q

Immunotherapy: how does this treatment achieve its effect?

A

Stimulates IgG to combine with antigens

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8
Q

Which cells are involved in rejection of an organ transplant?

A

T cells

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9
Q

What is the most useful marker in determining severity of HIV infection?

A

CD4+ counts

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10
Q

What is the role of HAART therapy in HIV?

A

Slows progression of disease

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11
Q

What are the components of the innate immune system?

A
  1. Epithelial barrier eg skin
  2. Monocytes/macrophages
  3. Phagocytes and dendritic cells, NK cells
  4. Complement
    5.plasma cells
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12
Q

What is the function of dendritic cells?

A

They phagocytose antigens and present the peptides to be recognised by T cells

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13
Q

What is the difference between TOLL like receptors vs NOD like receptors (location, function)?

A
  1. TOLL: located on plasma membrane, detect microbial molecules
  2. NOD: in the cytosol, detects molecules associated with necrotic cells, microbes
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14
Q

What is the role of TOLL like receptors?

A

Recruit leukocytes

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15
Q

Which pathways do TLR are able to recruit leukocytes?

A
  1. NF-KB (cytokine secretion and exp of adhesion molecules)
  2. IRF (Interferon regulatory factors) - produce Type 1 interferon/cytokines
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16
Q

What is the role of RIG-like receptors?

A

Detect viral nucleic acids–> produce antiviral cytokines (IFN A)

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17
Q

What is an interferonopathy?

A

Excessive production of IFN, leads to systemic inflammation (STING: stimulator of interferon genes)

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18
Q

Flare up associated with gout is an example of which receptor activation?

A

NOD like receptor

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19
Q

What is the function of NK cells? 2

A
  1. Detect IgG coated targets and destroy them
  2. Secrete cytokines eg IFN G to activate macrophages
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20
Q

What receptor does NK cells express?

A

CD16 (an IgG receptor)

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21
Q

How is NK cells regulated (self tolerance)? 2

A
  1. Type I MHC molecules on healthy cells
  2. Interleukins
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22
Q

Which interleukin activates NK cells to kill?

A

IL-12

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23
Q

Which interleukins stimulate proliferation of NK cells? 2

A

IL2 and IL15

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24
Q

What are the 2 types of adaptive immunity?

A
  1. Humoral immunity (extra cellular, B cell)
  2. Cellular immunity (Intracellular, T cells)
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25
What are the components of adaptive immunity?
Lymphocytes and their cytokines Antibodies/immunoglobulins
26
What is the role of Helper T cells?
Activate B cells to make antibodies and activate other leukocytes eg phagocytes
27
CD8+ cells recognise antigens presented by MHC ___ cells
I
28
CD4+ cells respond to antigen presented on MHC ___cells
II
29
What proteins do at cells express to assist their functional responses?
CD3, CD4, CD8, CD28
30
What is the role of CD4+ T cells?
Secrete cytokines to assist macrophages and B lymphocytes to fight infection
31
What is the role of CD8+ T cells?
Cytotoxic: they directly kill host cells
32
What Ig (2) do all B cells express to bind antigen?
IgM and IgD
33
Active B cells that produce antibodies are called ___
Plasma cells
34
What are the primary lymphoid organs? 2
Thymus (T cells) Bone marrow (B cells)
35
What are the secondary lymphoid organs?
LN Spleen Mucosal and cutaneous lymphoid tissues
36
The primary co stimulators (2) for T cells that is recognised by CD28 receptor?
CD80 and CD86
37
CD4+ T cells differentiate to effector cells known as (2)
Th1 and Th2
38
What do Th1 secrete?
IFN G
39
What does Th2 secrete?
IL-4
40
What is the role of Th2 cells?
Secrete IL-4 to turn B cells into IgE secreting plasma cells
41
What is the mechanism of Immediate Type I hypersensitivity?
IgE antibody --> mast cell release of vasoactive amines
42
What are examples of Type I hypersensitivity?
Allergies Asthma Anaphylaxis
43
What is the mechanism of Type II Hypersensitivity?
Antibody mediated: production of IgG and IgM which binds to cell/tissues This gets phagocytosed/lysis by activated complement
44
What are 2 examples of Type II hypersensitivity?
1. Haemolytic anemia 2. Good pastures syndrome
45
What is Type III hypersensitivity?
Deposition of antibody complexes onto target tissues
46
What is an example for Type III hypersensitivity? 3
1. lupus 2. Glomerulonephritis 3. Serum sickness
47
Fibrinoid necrosis is likely associated with (type of hypersensitivity)
III
48
What is Type VI hypersensitivity?
Activated T cell lymphocytes: release of cytokines (CD4+) and T cell mediated cytotoxicity (CD8+)
49
Oedema and/or granuloma formation is part of (Type of Hypersensitivity)
VI
50
What are 4 examples of Type VI hypersensitivity?
1. Type I diabetes 2. Contact dermatitis 3. TB 4. Multiple sclerosis
51
The propensity to develop a hypersensitivity reaction is called?
Atopy
52
Graves disease is an example of (hypersensitivity type)
Type II
53
Myasthenia gravis is (type of hypersensitivity)
Type II
54
Post streptococcal glomerulonephritis is an example of (hypersensitivity)?
Type III
55
Type VI hypersensitivity involved which T cell?
CD4+ T cell
56
Delayed hypersensitivity is also known as
Type VI
57
Type VI hypersensitivity: which Th is involved?
Th1 (secrete IL-12) -primary Th17 (IL-17 and IL-22)
58
What is the role of IL-12 in Type VI hypersensitivity?
To amplify Th1 response
59
Immune tests: diagnosis of fungal/bacterial or coccidioidomycosis
Complement fixation (IgM/IgG to detect titers of certain antigens)
60
Where does the acquired immune response begin for circulating antigens?
Spleen
61
Leukocytes that become inactive are called?
Anergy
62
What are the 2 types of tolerance in immunity?
1. Central tolerance 2. Peripheral tolerance
63
What is Central tolerance?
Immature/naive lymphocytes that recognise self antigens undergo apoptosis. B cells undergo switching to new antigen receptors
64
What is peripheral tolerance?
Mature lymphocytes that recognise self antigens become inactive (anergy) or suppressed by T cells
65
What factors lead to failure of immune self tolerance? 2
1. Inherit susceptibility genes 2.infections/injury exposes self antigens and activate APCs
66
Central tolerance occurs in (tissue sites 2)
Central tissues: thymus (T cells), Bone marrow (B cells)
67
Autoimmune polyendocrine syndrome: what gene defect and what immune tolerance failed?
AIRE gene Central tolerance
68
What is the mechanism of which T cells will respond to an antigen?
1. Need to be presented to T cell by APC 2. Need co stimulators to activate response eg CD28
69
Regulatory T cells are produced in response to ___
Recognition of self antigens
70
What CD do regulatory T cells express?
CD4+ (have high levels of CD25)
71
___ and ____(1 interleukin, 1 factor) are required to maintain regulatory T cells
IL-2 and FOXP3
72
Immunosuppressive cytokines that inhibit leukocyte activation? 2
IL-10 TGFB
73
What is the defective allele in ankylosing spondylitis?
HLA B27 (class I HLA allele)
74
Myocarditis secondary to streptococcus is an example of which immune phenomenon?
Molecular mimicry
75
What is molecular mimicry?
Immune response to microbes causes activation of leukocytes (microbes sharing similar amino acids as self antigen)
76
What is epitope spreading?
Immune response to one self antigen, leads to tissue damage and release of more self antigens
77
What phenomenon explains the chronicity of autoimmune disease?
Epitope spreading
78
Double stranded DNA and sm ab are found in which proportion of lupus patients?
DNA (40-60%) Smith (20-30%)
79
Which autoantibody is specific for rheumatoid arthritis?
CCP (cyclic citrulinaged peptides)
80
Which antibody is specific for systemic sclerosis?
DNA topoisomerase I (30-70% patients have positive)
81
Nephritis in lupus are associated with which antibody?
Ds-DNA
82
Congenital SLE/congenital heart block is associated with which antibody?
Anti Ro (SSA)
83
Which antigen determines rejection of donor organ?
HLA antigen on donor
84
What are the classifications for graft rejection? 3
1. Hyperacute 2. Acute 3. Chronic
85
What is hyperacute rejection?
Preformed antibodies specific for antigens on graft endothelial cells
86
What is acute graft rejection?
T cells and antibodies react to graft alloantigens (CD8 direct damage, or CD4 inflammatory cytokines)
87
What pathway does acute rejection use when antibodies bind to vascular endothelium?
Classical pathway
88
What is chronic graft rejection?
Same as acute but gradual sclerosis and takes months to years
89
What are primary immunodeficiencies?
Genetically determined defects in innate immune system eg NK cells, phagocytes, complement, T/B cells Usually manifest 6mo age -2 years
90
What defects can occur in primary immunodeficiency? 4
1. Defective leukocyte adhesion eg leukocyte adhesion deficiency I/II 2. Defects to phagolysosome function/cannot fuse with lysosomes eg chediak-higashi SX 3. Defects to microbicidal activity (phagocyte oxidase) eg chronic granulomatous disease 4.Defective TLR signalling herplex simplex encephalitis (TLR3)
91
What is the most common complement deficiency?
C2 deficiency (classic pathway)
92
X-linked SCID: what is the defect?
Common gamma chain of cytokine receptor (leads to failure of IL7 signalling, defective lymphopoisis)
93
What is the mutation in autosomal recessive SCID?
Adenosine deaminase
94
SCID is mainly caused by defect in which immune cell type?
T cells mostly B cell can also be affected They get bacterial, viral and fungal infections
95
What is the mutation of X linked Agammaglobulinemia/Bruton?
Failure of pre B cells and pro B cells to become mature B cells (tyrosine kinase mutation)
96
What are the characteristics of Brutons disease? 5
B cells are low or absent in circulation Low serum Ig (all types) CD19 expressed (pre B cell marker) LN, Peyer's patches, appendix, tonsils underdeveloped Normal T cells
97
What is Digeorge syndrome?
Thymic hypoplasia: failure of T cell development in the thymus (failure of development of 3&4th pharyngeal pouches) Loss of chromosome 22q11
98
What do the 3&4th pharyngeal pouches give rise to? 4
Thymus Thyroid (C cells) Ultimobrachial body Parathyroid
99
What is hyper IgM syndrome?
Too much IgM, low IgE/G/A: B cells cannot undergo class switching B cell defect or CD4 Th cell defect (CD40 or cytidine deaminase)
100
What is seen in patient blood count in hyper IgM syndrome?
Normal B and T cells High IgM Low IgE/G/A
101
What is common variable immunodeficiency?
Hypogammaglobinemia (low all Ig, sometimes just low IgG) BAFF mutation (B cells cannot survive or differentiate) Presents similar to Brutons (can have hyper proliferation of lymphoid tissues)
102
What is X linked lymphoproliferative disease?
SAP (SLAM associated protein) deficiency Recurrent EBV infections (cannot activate NK/T cells)
103
What are the clinical features of AIDS?
Fever >1 mo High viral load Fatigue Weightloss Diarrhoea Lymphadenopathy Neurological Secondary tumours Opportunistic infections eg TB
104
What are the type of progressors (AIDS)?
1. Rapid progressors 2. Long term non progressors (VL <500) 3. Elite controllers (VL 50-70) Able to control as have high CD4 and CD8 T cells responses
105
Which test is most sensitive/best screening method for HIV?
ELIZA
106
Which is the most specific test for HIV?
Western blot
107
Which test is best to detect HIV in the Window period?
P24 Ag assay
108
What is the most common AIDS pneumonia infection?
Pneumocystis pneumonia (TB is the most opportunistic overall, not pneumonia)
109
Most common cancer in AIDS/HIV?
NHL
110
The most common fungal infection in AIDS/HIV?
Candidiasis
111
What is the most neuro disease in AIDS?
AIDs dementia complex
112
Most common organism to cause pneumonia in HIV?
Streptococcus
113
The most common haemolytic manifestation in AIDS?
Autoimmune haemolytic anemia
114
The most common space occupying lesion in HIV/AID?
Toxoplasmosis ('tumor' = primary CNS lymphoma)
115
Urethritis is characteristic of (syndrome)
Reiters
116
Xerostomia is classically associated with (syndrome)
Sjogrens
117
Difficulty swallowing is classically associated with (syndrome)
Scleroderma
118
Which immune syndrome classically has positive syphilis result?
Lupus (anticardiolipin antibodies)
119
What is the effect of lupus anticoagulant in VIVO?
Thrombosis
120
Which CD molecule HIV binds to enter cells?
CD4+
121
What are the co-receptors that allow HIV to infiltrate T cells/Lymphocytes
Chemokines receptor (CCR5, CXCR4)
122
Elevated anti-streptolysin titre (ASO) is suggests (condition)
Previous Group A strep infection
123
In most people with SLE, which Ig is increased?
IgG
124
Treatment of graft vs host disease?
Methotrexate
125
Which medication is used to minimise risk of transplant rejection?
Cyclosporin
126
What is the effect of anti-red cell ab in SLE?
Pancytopenias Anemias Thrombocytopenia
127
What is the common infection in slsective IgA deficiency?
Sinopulmonary infections and diarrhoea (strep/bacteria causing)
128
Which organisms (class) do T cells defend against?
Viral and fungal
129
HIV patient with red/purple skin lesions probably has (cancer)
Kaposi sarcoma
130
Kaposi sarcoma is classically associated with (virus)
Human Herpes virus 8
131
Anti-histone antibodies are associated with (immune disease)
Drug induced SLE
132
Anti-U1 ribonucleoprotein antibodies suggest (disease)
Mixed connective tissue disease
133
Glomerulus looks like this. Disease?
'wire loop' capillaries suggest SLE
134
Wiskott-Aldrich presentation?
Eczema Thrombocytopenia Viral and bacterial infections Lymphoma risk
135
Late phase hypersensitivity Type I: what are the involved inmune cells? 3
Neutrophils Eosinophils CD4+
136
What is an Arthus reaction?
Localised immune-complex reaction (eg from vasculitis). Causes decreased C3 and C4 complements
137
Congo red stain gives this appearance on BX. Suggests?
Amyloid 'apple green'
138
Amyloid is seen in which kinds of diseases?
Chronic inflammatory eg rheumatoid
139
Limited vs diffuse scleroderma: differences?
Diffuse involves lung
140
Polymyositis mechanism?
Muscle lysis from CD8+ T cells
141
Digeorge syndrome presentation
Thymic/parathyroids/aorta/heart involvement Hypocalcemic tetany T cell dysfunction: viral and fungal infections
142
Which immune cell participates in dermal fibrosis (scleroderma)?
CD4
143
Which CD cell is involved in polymyositis?
CD8+
144
Which WBC expresses MHC II?
Monocytes
145
What are the 3 major symptoms of Reiter syndrome?
Urethritis Arthritis Conjunctivitis
146
What is the mechanism of Good pastures syndrome?
Antibody directed to Type VI collagen (anti basement membrane)
147
Delayed type hypersensitivity (Type VI) involves which immune cell?
CD4+
148
Inheritance of Wiskott-Aldrich?
X linked
149
Which marker is associated with amyloid associated heart failure in elderly?
Transthyretin

Alya Cards Pathology Robbins basis (12 decks)

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