Clinical Immunology Flashcards

1
Q

What are the most competent phagocytes found in the human body?

A

neutrophils (most abundant type of WBCs); formed from stem cells of bone marrow; short lived and highly motile; one of the “first responders” of inflammatory cells to migrate towards the site of inflammation; recruited to the site of injury within minutes of trauma… they are the hallmarks of acute inflammation

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2
Q

What is a leukemoid reaction?

A

describes an elevation in WBC count, or leukocytosis….physiological response to stress or infection

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3
Q

What is another name for leukemoid reaction?

A

margination: movement of leukocytes out of circulation towards the site of infection

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4
Q

Describe the process of a phagocyte (neutrophil) from circulation to movement to the inflamed area?

A

phagocytes in circulation undergo margination (movement from circulation to the site of inflammation)… then diapedesis (the entire process of blood vessel escape)… then exudation into the inflamed tissue

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5
Q

What is the difference in innate and adaptive immunity?

A

Innate is what you’re born with….. ability to ward off infections… comes from maternal to fetal circulation and from other antibodies found in breast milk

Adaptive is developed after exposure to a foreign body…. lymphocytes get activated and you produce antibodies

The innate immune system, also known as non-specific immune system and first line of defense,[1] comprises the cells and mechanisms that defend the host from infection by other organisms in a non-specific manner. This means that the cells of the innate system recognize and respond to pathogens in a generic way, but unlike the adaptive immune system (which is only found in vertebrates), it does not confer long-lasting or protective immunity to the host.[2] Innate immune systems provide immediate defense against infection, and are found in all classes of plant and animal life.

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6
Q

What immune system will respond to pathogens and organisms as a first line of defense in a generic way?

A

innate

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7
Q

What type of immune system will confer long-lasting or protective immunity to the host?

A

adaptive

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8
Q

What is the complement system?

A

a biochemical cascade of the immune system that complements or “helps” the ability of antibodies to clear pathogens or mark them for destruction by other cells

cascade is composed of plasma proteins, synthesized in the liver, primarily by hepatocytes

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9
Q

What is the adaptive immune system?

A

The adaptive immune system, also known as the acquired immune system or, more rarely, as the specific immune system, is composed of highly specialized, systemic cells and processes that eliminate or prevent pathogen growth. One of the two main immunity strategies found in vertebrates (the other being innate immunity), acquired immunity creates immunological memory after an initial response to a specific pathogen, leading to an enhanced response to subsequent encounters with that same pathogen. This process of acquired immunity is the basis of vaccination.

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10
Q

The immune system that is very specific, has a slow response, and is based on “memory” is called __________.

A

adaptive

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11
Q

The immune system that is non-specific, has a fast response (minutes), and no “memory” is called ______.

A

innate

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12
Q

Describe the primary and secondary response after exposure of an antigen.

A

IgM (basic antibody produced by B cells) is the LARGEST antibody in circulation and is the first to appear in an initial response to an antigen; the spleen is the major site of IgM production….. they reappear with subsequent exposure, but to a lesser extent…. IgG (a protein complex composed of 4 peptide chains): each IgG has 2 antigen binding sites…. it represent approx 75% of serum immnoglobulins in humans….it is the most ABUNDANT antibody in circulation… they are synthesized and secreted by plasma B cells… binds to many kinds of pathogens protecting the body from infection…. it represent maturation of the body’s immune response so it is involved in the secondary response… appears within 24-48 hours after antigenic stimulation

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13
Q

Which antibody is associated with type II and III hypersensitivity reactions?

A

IgG

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14
Q

What is the only antibody isotype that has receptors to facilitate passage through the human placenta, thereby providing protection to the fetus in utero?

A

IgG

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15
Q

What are the primary antibodies transmitted to a baby during breastfeeding?

A

Along with IgA secreted in the breast milk, residual IgG absorbed through the placenta provides the neonate with humoral immunity before its own immune system develops. Colostrum contains a high percentage of IgG, especially bovine colostrum. In individuals with prior immunity to a pathogen, IgG appears about 24–48 hours after antigenic stimulation.

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16
Q

What are the primary characteristics of IgM and IgG?

A

Immunoglobulin G or IgG is the antibody that is found most abundantly in the human body. It is found in all bodily fluids and it protects the human body against bacterial and viral attacks.

Immunoglobulin M on the other hand is found mainly in the lymph fluid and in blood. This is the first antibody that is produced by the human fetus. It is also the first antibody that is produced in case of an exposure to a particular disease.

IgG and IgM are usually measured together by your doctor when you go in for a test. When they are evaluated together, they give your doctor a better idea about the functioning of your immune system.

An important difference between the two antibodies is related to exposure. While IgM antibodies are usually found in a human body after it has been exposed to a disease, IgG is the long term response of the body to a disease. For instance, if a kid is exposed to chickenpox, he will show elevated results of IgM in the blood in the period following the exposure. Once the child gets the disease, he acquires long term immunity against it by developing IgG antibodies. While IgM is an indicator of a current infection, an IgG indicates a recent or past exposure to the illness.

17
Q

If a patient has indicator of IgG level for a certain pathogen, does this indicate active disease?

A

No. IgM is indicative of active exposure…. IgG can indicate recent or past exposure to the illness

18
Q

At what age do newborns own antibodies begin to surpass the remainder of maternal antibodies?

A

6 months…. based on chart from ppt…… maternal IgG level starts around 3 months gestation and is gone around 10 months after birth

19
Q

What is the basic definition of a hypersensitivity reaction?

A

an accelerated immune response to non-pathogenic antigens; undesirable reactions produced by the normal immune system…including allergies and autoimmunity

20
Q

Does the following description describe Type I, II, III, or IV hypersensitivity???:
Immune complex disease; mediated by IgG and neutrophils; IgG binds to antigen on foreign cell leading to cellular destruction via neutrophils and subsequent release of lysosomal enzymes; deposition of damaged tissue…. kidneys, joints, digits; example: RA, SLE

A

Type III

21
Q

Does the following description describe Type I, II, III, or IV hypersensitivity???:
Involves B cells, mast cells and basophils; rhinitis to anaphylaxis; allergy (immediate)

A

Type I

22
Q

Does the following description describe Type I, II, III, or IV hypersensitivity???:
Cell mediated; involves T cells that will find the antigen and activate macrophages; examples: Mantoux skin test, contact dermatitis, metal joint replacement, multiple sclerosis, chronic transplant rejection; involves extensive host tissue damage

A

aka delayed type hypersensitivity or cell mediated memory immune response: TYPE IV

23
Q

Does the following description describe Type I, II, III, or IV hypersensitivity???:
IgM, IgG, and complement mediated; testing includes both direct and indirect COOMBS test; cytotoxic; antibody dependent; phagocytosis

A

Type II

24
Q

The following are examples of what type of hypersensitivity reaction?
Allergies, anaphylaxis, bronchial asthma

A

Type I

25
Q

The following are examples of what type of hypersensitivity reaction?
contact dermatitis, multiple sclerosis, mantoux skin test

A

Type IV

26
Q

The following are examples of what type of hypersensitivity reaction?
SLE, reactive arthritis, RA

A

Type III

27
Q

The following are examples of what type of hypersensitivity reaction?
autoimmune hemolytic & pernicious anemia, vasculitis, goodpasture syndrome, acute rheumatic fever, myasthenia gravis, graves disease (hyperthyroidism), insulin resistant diabetes

A

Type II

28
Q

What hypersensitivity reaction is the “antibody producing” type?

A

Type II

29
Q

What is the classic sign and treatment of immediate hemolytic transfusion reaction?

A

free Hgb in blood and urine; stop infusion, keep IV line open, maintain diuresis, treat hypotension, manage coagulopathy, promote renal perfusion

30
Q

Describe Rh hemolytic disease.

A

Rh positive fetal erythrocytes enter maternal circulation which is Rh negative….. Rh antibodies are created by the maternal circulation…. then the Rh antibodies cross the placenta into fetal circulation…. agglutination (cells compact together to keep antibodies from invading them) of fetal Rh positive erythrocytes leads to hemolytic disease in the newborn

typically occurs only in some second or subsequent pregnancies of Rh negative women where the fetus’s father is Rh positive, leading to a Rh+ pregnancy. During birth, the mother may be exposed to the infant’s blood, and this causes the development of antibodies, which may affect the health of subsequent Rh+ pregnancies.

31
Q

What is the purpose of RhoGAM and when should it be administered?

A

Most Rh disease can be prevented by treating the mother during pregnancy or promptly (within 72 hours) after childbirth. The mother has an intramuscular injection of anti-Rh antibodies (Rho(D) Immune Globulin), sold under the brand name RhoGAM. This is done so that the fetal Rhesus D positive erythrocytes are destroyed before her immune system can discover them. This is passive immunity and the effect of the immunity will wear off after about 4 to 6 weeks (or longer depending on injected dose) as the anti-Rh antibodies gradually decline to zero in the maternal blood.

32
Q

What are some factors that can lower the immune system?

A

nutritional deficits, iatrogenic disorders (immunosuppression), trauma, emotional distress