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Diseases and Syndromes > First-Aid: Immunology > Flashcards

First-Aid: Immunology Flashcards

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1
Q

Palivizumab

A

Target: RSV F protein
Use: RSV prophylaxis for infants
vizu virus

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2
Q

Omalizumab

A

Target: IgE
Use: Allergic asthma, prevents IgE binding to FceRI

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3
Q

Digoxin immune Fab

A

Target: Digoxin
Use: Antidote for digoxin toxicity

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4
Q

Denosumab

A

Target: RANKL
Use: Osteoporosis, inhibits osteoclast maturation (mimics osteoprotegrin)
OS osteoclasts

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5
Q

Abciximab

A

Target: Glycoprotein IIb/IIIa
Use: Anti-platelet, prevents ischemia in coronary intervention
IIb x IIIa = “cix”

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6
Q

Infliximab and adalimumab

A

Target: TNF-a
Use: IBD, rhematoid arthritis, ankylosing spondylitis, psoriasis
RA “inflix” pain in “da lim”bs

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7
Q

Natalizumab

A

Target: a4-integrin
Use: MS, Chron disease
Risk: PML in patients with JC virus
(a4-integrin facilitates leukocyte adhesion)

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8
Q

Trastuzumab

A

Target: HER2/neu
Use: Breast cancer, gastric cancer
HER2 – “2”

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9
Q

Rituximab

A

Target: CD20
Use: B-cell NH’s lymphoma, rheumatoid arthritis (with MTX), ITP

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10
Q

Cetuximab

A

Target: EGFR
Use: Stage IV colorectal cancer, head and neck cancer

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11
Q

Bevacizumab

A

Target: VEGF
Use: Colorectal cancer, renal cell carcinoma

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12
Q

Alemtuzumab

A

Target: CD52
Use: CLL
“lem” for lymph

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13
Q

IFN-y

A

Use: chronic granulomatous disease

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14
Q

IFN-B

A

Use: Multiple sclerosis

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15
Q

IFN-a (x8)

A

Use: Chronic Hep B and Hep C, Kaposi sarcoma, hairy cell leukemia, condyloma acuminatum, renal cell carcinoma, malignant melanoma

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16
Q

Aldesleukin (interleukin-2)

A

Use: Renal cell carcinoma, metastatic melanoma

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17
Q

Sargramostim (granulocyte-macrophage colony stimulating factor)

A

Use: recovery of bone marrow

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18
Q

Filgrastim (granulocyte colony-stimulating factor)

A

Use: recovery of bone marrow

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19
Q

Oprelvekin (interleukin-1)

A

Use: Thrombocytopenia

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20
Q

Thrombopoietin

A

Use: Thrombocytopenia

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21
Q

Epoetin alfa (erythropoietin)

A

Use: anemias (especially in renal failure)

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22
Q

Glucocorticoids

A

Target: NF-kB, decrease transcription, suppress B/T cells
Use: Transplant rejection prophylaxis , many autoimmune disorders, inflammation
Tox: Hyperglycemia, osteoporosis, central obesity, muscle breakdown, psychosis, acne, hypertension, cataracts, peptic ulcers
Note: Can cause iatrogenic Cushing syndrome

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23
Q

Azathioprine

A

Mech: antimetabolite precursor of 6-mercaptopurine, blocks nucleotide synthesis and inhibits lymphocyte proliferation
Use: Transplant rejection prophylaxis, RA, Chron, glomerulonephritis, other autoimmune
Tox: Leukopenia, anemia, thrombocytopenia
Note: toxicity increased by allopurinol, since 6-MP is degraded by xanthine oxidase
“purine” “prine”

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24
Q

Basiliximab

A

Mech: monoclonal Ab to IL-2R
Use: Kidney transplant rejection prophylaxis
Tox: Edema, HTN, tremor

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25
Sirolimus (Rapamycin)
Mech: mTOR inhibitor, binds FKBP. Prevents IL-2 signal transduction, thereby blocking T-cell activation and B cell differentiation. Use: Kidney transplant rejection prophylaxis Tox: Anemia, thrombocytopenia, leukopenia, insulin resistance, hyperlipidemia. NOT nephrotoxic. Note: Kidney "sir-vives" Synergistic with cyclosporine. Used in drug eluting stents.
26
Tacrolimus
Mech: Calcineurin inhibitor, binds FK506 binding protein (FKBP), blocks T-cell activation by preventing IL-2 transcription. Use: transplant rejection prophylaxis Tox: Diabetes and nephrotoxicity, similar to cyclosporine but without gingival hyperplasia or hirsutism Note: "-limus" drugs bind FKBP
27
Cyclosporine
Mech: Calcineurin inhibitor, binds cyclophilin, blcoks T-cell activation by preventing IL-2 transcription. Use: transplant rejection prophylaxis, psoriasis, RA Tox: Nephrotoxicity, HTN, hyperlipidemia, hyperglycemia, tremor, hirsutism, gingival hyperplasia
28
Hyperacute rejection
Onset: minutes Mech: Recipient antibodies, Type II reaction, activation of complement Path: Widespread thrombosis --> ischemia and necrosis Treat: graft must be removed
29
Acute rejection
Onset: Weeks to months Mech: Cellular or humoral. Cytotoxic T-cell react to donor MHCs, or host antibodies develop after transplant, leading to a syndrome similar to that seen in hyperacute Path: Vasculitis of graft vessels with dense interstitial lymphocytic infiltrate Treat: prevent/reverse with immunosuppression
30
Chronic rejection
Onset: months to years Mech: Recipient MHC percieve donor MHC as recipient and react against donor antigens presented. has both cellular and humoral components. Path: Heart - atherosclerosis, Lungs - bronchiolitis, Liver - vanishing bile ducts, Kidney - vascular fibrosis and glomerulopathy Irreversible damage.
31
Graft-vs-host disease
Onset: variable Mech: Graft T-cells proliferate in immunocompromised host and attack host cells Path: Sever organ dysfunction. Maculopapular rash, jaundice, diarrhea, HSM. Notes: Often found in bone marrow and liver transplants (rich in lymphocytes). Can be beneficial in leukemia (graft-vs-tumor effect)
32
Chronic granulomatous disease
Immune def: phagocyte decreased ROS. NADPH oxidase defect, absent respiratory burst in neutrophils, X-linked recessive. Presents: Increased sus. to catalase + organisms (PLACESS) Findings: Abnormal flow cytometry dihydrohodamine test. Negative tetrazolium dye reduction test (out of favor).
33
Catalase + organisms (PLACESS)
Pseudomonas, listeria, Aspergillus, Candida, E. coli, S. aureus, Serratia
34
Chediak-Higashi syndrome
Immune def: phagocyte microtubule dysfunction in phagosome-lysosome fusion. Defective LYST gene, autosomal recessive. Presents: Recurrent pyogenic infections by staph and strep. Partial albinism, peripheral neuropathy, progressive neurodegeneration, infiltrative lymphohistiocytosis. Findings: giant granules in neutrophils and platelets. Pancytopenia, mild coag defects.
35
Leukocyte adhesion deficiency (Type 1)
Immune def: phagocyte impaired migration and chemotaxis, impaired LFA-1 integrin (CD18) on lymphocytes, autosomal recessive. Presents: Recurrent bacterial skin/mucosal infections. Absent pus formation, impaired healing. Delayed separation of umbilical cord (>30 days). Find: Increased neutrophils, but absence of neurtophils at infection sites
36
Wiskott-Aldrich syndrome
Immune def: T-cells unable to recognize actin cytoskeleton. WAS gene, X-linked recessive. Presents: (WATER) Thrombocytopenia, eczema, recurrent infections. Increased risk of autoimmunity and malignancy. Find: Elevate IgE and IgA, low-normal IgM and IgG. Fewer and smaller platelets.
37
Hyper-IgM syndrome
Immune def: Th cells, class switching defect, defective CD40L. x-linked recessive. Presents: Sever pyogenic infections in early life. Opportunistic Pneumocystis, Cryptosporidium, and CMV. Find: Elevated IgM, Massively decreased IgG, IgA and IgE
38
Ataxia-telangiectasia
Immune def: T-cell cell cycle arrest. Defect in ATM gene, so DNa double strand breaks cause arrest. Presents: (AAA-triad) cerebellar defects, spider angiomas, and IgA deficiency. Find: Increased AFP, decreased IgA, IgG, IgA. Lymphopenia, cerebellar atrophy.
39
Severe Combined Immunodeficiency (SCID)
Immune def: T-cell disorder, several types. 1) IL-2R gamma chain defect, X-linked 2) adenosine deaminase deficiency (autosomal recessive) Presents: Failure to thrive, chronic diarrhea, thrush, recurrent infections of all sorts. Treat with bone marrow transplant. There won't be any rejection, so that's cool. find: Decreased T-cell receptor excision circles. Absent thymic shadow on CXR, absent germinal centers on lymph node biopsy, and absent T-cells on flow.
40
Chronic mucocutaneous candidiasis
Immune def: T-cell dysfunction, many causes Presents: Candida infections on skin and mucous Find: No T-cell proliferation or cutaneous reaction in response to Candida.
41
Autosomal dominant hyper IgE syndrome (Job syndrome)
Immune def: Th17 cell deficiency due to STAT3 mutation -> impaired recruitment of neutrophils Presents: (FATED) coarse facies, cold staph abscesses, retained primary teeth, increase in IgE, Dermatologic problems (eczema). Find: Increased IgE, decreased IFN-y
42
IL-12 receptor deficiency
Immune def: decreased Th1 response, autosomal recessive. Presents: Disseminated fungal and mycobacterial infections, sometimes after admin of BCG vaccine. Find: Decreased IFN-y
43
Thymic aplasia (DiGeorge syndrome)
Immune def: failure of 3rd and 4th pharyngeal pouches with absent thymus and parathyroids, 22q11 deletion Presents: Tetany (hypocalcemia), recurrent viral/fungal infectons (T-cell mediated), other conotruncal abnormalitites (ToF, truncus arteriosis) Find: decreased T-cells, decreased PTH, decreased calcium. Absent thymic shadow on CXR. Detect 22q11 mutation on FISH.
44
Common variable immunodeficiency
Immune def: B-cell differentiation defect. Many causes. Presents: can be acquired mid-life, increased risk of autoimmune, bronchiectasis, lymphoma, sinopulmonary infections Find: decreased plasma cells, decreased immunoglobulins
45
Selective IgA deficiency
Immune def: Unknown mechansim. Decreased IgA (
46
X-linked (Bruton) agammaglobulinemia
Immune def: No B-cell maturation. Defect in BTK gene (a tyrosine kinase), X-linked recessive Presents: Recurrent bacterial and enteroviral infections after 6 months post-birth. Find: Normal CD19 B-cell count, but decreased pro-B, Ig of all classes, and scanty lymph nodes and tonsils.
47
Lack of B-cells makes patient vulnerable to...?
Encapsulated organisms (SHiNE SKiS) Strep pneum, Haemophilus influenza B, Neisseria mening, E coli, Salmonella, Klebsiella pneum, group B Strep AND Enteroviral encephalitis, poliovirus (DO NOT GIVE LIVE VACCINE) AND GI giardiasus, since no IgA. Bacterial infections predominate
48
Lack of T-cells makes patient vulnerable to...?
Sepsis AND CMV, JCV, EBV, VZV, and chronic respiratory/GI viruses AND Candida, PCP
49
Lack of granulocytes makes patient vulnerable to...?
Staph, Burkholderia cepacia, Serratia, Nocardia, AND Candida, Aspergillus
50
Lack of complement makes patient vulnerable to...?
Neisseria (since no membrane attack complex)
51
Anti-ACh receptor Abs
Myasthenia gravis
52
Anti-basement membrane Abs
Goodpasture syndrome
53
Anti-cardiolipin Abs, lupus anticoagulant
SLE, antiphospholipid syndrome
54
Anticentromere Abs
Limited scleroderma (CREST syndrome)
55
Anti-desmoglein Abs
Pemphigus vulgaris
56
Anti-dsDNA ab, anti-smith Abs
SLE (these are both subtypes of ANAs)
57
Anti-glutamate decarboxylase Abs
Type 1 DM
58
Anti-hemidesmosome Abs
Bullous pemphigoid
59
Antihistone Abs
Drug-induced lupus
60
Anti-Jo-1, anti-SRP, anti-Mi-2 Abs
Polymyositis, dermatomyositis
61
Antimicrosomal, antithyroglobulin Abs
Hashimoto thyroiditis
62
Antimitochondrial Abs
1* biliary cirrhosis
63
Antinuclear Abs
SLE, nonspecific
64
Anti-Scl-70 (anti-DNA topoisomerasa 1) Abs
Scleroderma (diffuse)
65
Anti-smooth muscle
Autoimmune hepatitis
66
Anti-SSA, anti-SSB (anti-Ro, anti-La) Abs
Sjogren syndrome (no tears or saliva or lubrication)
67
Anti-TSH receptor Abs
Graves disease
68
Anti-U1 RNP (ribonucleoprotein) Abs
Mixed connective tissue disease
69
c-ANCA (PR3-ANCA)
Granulomatosis with polyangiitis (Wegener)
70
IgA antiendomysial, IgA anti-tissue translgutaminase
Celiac disease
71
p-ANCA (MPO-ANCA)
Microscopic polyangiitis, Churg-Strauss syndrome
72
Rhematoid factor (antibody, most often IgM, specific to IgG Fc region, anti-CCP
Rhuematoid arthritis

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