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PathGuide > Immuno (100) > Flashcards

Immuno (100) Flashcards

(93 cards)

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1
Q

Ankylosis spondylitis (allele)

A

HLA B27

RR 87

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2
Q

Goodpastures syndrome (allele)

A

HLA DR15/DR2

RR10

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3
Q

Graves’ disease (allele)

A

HLA DR 3

RR 4

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4
Q

SLE (allele)

A

HLA DR3

RR 6

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5
Q

T1DM (allele)

A

HLA DR3/4

RR 25

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6
Q

Rheumatoid arthritis (allele)

A

HLA DR4

RR 4

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7
Q 
PTPN22
Tyrosine phosphates (lymohocytes)
A

asscoc with development of RA SLE T1DM

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8
Q

CTLA4

Receptor for CD80/CD86 (T cell, inhibits activation)

A

Assoc with SLE, T1DM, Autoimmune thyroid

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9
Q

Limited cutaneous scleroderma

A 
CREST; calcinosis, raynauds, eosophageal dysmotility, sclerodactykul, telangiectasia 
\+ pulmonary HTN 
Skin inv; up to forearms + perioral 
High risk; lung fibrosis + renal crisis 
Dx; anticentrimere Abs
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10
Q

Diffuse cutaneous scleroderma

A

CREST + interstitial pulmonary disease + GIT + renal
F:M 4:1
Anti-tropoisomerase/Scl70, RNA Pol (1,2,3), fillarin Abs

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11
Q

Sjögren’s syndrome

A

Xerostomia, keratoconjunctivitis sicca, renal problems, nose, skin
Potential: kidneys, blood vessels, lungs, liver, pancreas, PNS
Potential: parotid/salivary gland enlargement
Anti Ro, Anti La
Schirmir test (tear production)
F:M 9:1
Late 40s

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12
Q

IPEX syndrome

A

Immune dysregulation + Polyendocrinopathy + enteropathy + X linked AR (&autoimmune diseases)
Eczematous dermatitis, nail dystrophy, autoimmune skin cond (e.g alopecia universalis, bullocks pemphigoid)
Most die <2yrs
RX: BMT
Males only

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13
Q

Coeliac disease

A

Failure of tolerance to glucose
Villous atrophy, enteropathy
Sx; GIT discomfort, constipation, diarrhoea, bloating, fatigue
Deficiencies; iron, fat, B12, ADEK, calcium
Dermatitis herpetiformis

Gold standard; duodenal Bx

IgAs antiEndomysial Ab, disappears with exclusion diet (spec 95%, sens 85%) | antiTransglutaminase (spec 95%, sens 90-94%)
IgG anti-gliadin antibody, most persistent (spec 30-50%, sens 57-80%)
Linked to Down’s syndrome
95% HLA DQ 2/8 (to eat or not to 8 ;-)

Ireland EMA 3-10/1000 | n.africa TGT 20/1000

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14
Q

ENAs (extractable nuclear antibodies)

A

Ro, La, Sm, U1RNP

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15
Q

Antiphospholipid syndrome (autoantibody)

A

Cardiolipin
B2 glycoprotein
Lupus anticoagulant

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16
Q

Autoimmune hepatitis (autoantibody)

A

Anti-Sm
Anti liver kidney microsome type 1 (anti-LKM-1)
Anti soluble liver antigen (anti-SLA)

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17
Q

Autoimmune haemolytic anaemia newborn (autoantibody)

A

Anti-Rh

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18
Q

Autoimmune thrombocytopenic purpura (autoantibody)

A

Anti-glycoprotein IIb/IIIa or 1b-IX

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19
Q

Churg Strauss syndrome (eGPA) (autoantibody)

A

Perinuclear/protoplasmic-staining antineutrophil cytoplasmic antibodies (pANCA)

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20
Q

Coeliac disease (autoantibody)

A

Anti tissue transglutaminase antibody IgA
Anti endomysial antibody IgA
Anti-gliadin IgG

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21
Q

Congenital heart block in infants of SLE mothers (autoantibody)

A

Anti-Ro

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22
Q

Dermatitis herpetiformis (autoantibody)

A

Anti-EMA (IgA)

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23
Q

Dermatomyositis (autoantibody)

A

Anti Jo 1 (t RNA Synthetase)

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24
Q

Diffuse cutaneous scleroderma (autoantibody)

A

Antibodies to topoisomerase/SCl 70
RNA pol (1,2,3)
Fibillarin

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25
Goodpastures syndrome (autoantibody)
Anti GBM
26
Graves' disease (autoantibody)
Anti TSH receptor antibody (stimulating antibody)
27
Hashimoto's thyroiditis (autoantibody)
Antibodies to thyroglobulin and thyroperoxidase
28
Limited cutaneous scleroderma (autoantibody)
Anti centromere antibody
29
Microscopic polyangitis (MPA) (autoantibody)
pANCA perinuclear/protoplasmic staining antineutroohil cytoplasmic antibodies
30
Mixed connective tissue disease (autoantibody)
Anti U1RNP (speckled pattern)
31
Myasthenia Gravis (autoantibody)
Anti Ach receptor antibody
32
Pernicious anaemia (autoantibody)
Antibody to parietal cells (90%) | Antibody to intrinsic factor (10%)
33
Polymyositis (autoantibody)
Anti Jo 1 (tRNA Synthetase)
34
Primary biliary cirrhosis (autoantibody)
Anti mitochondrial antibody
35
Rheumatoid arthritis (autoantibody)
``` Anti CCP (Cyclic Citrullinated Peptide) rheumatoid factor (less spec) ```
36
Sjögren's syndrome (autoantibody)
``` Anti Ro Anti La (speckles) ``` 60-70% = RF positive
37
SLE (autoantibody)
``` Antibodies to dsDNA Antibodies to his tones (homogenous) Ro La Sm U1RNP (speckled) ```
38
T1DM (autoantibody)
``` Anti GAD (glutamate decarboxylase) Pancreatic B cells ```
39
Wegeners granulomatosis GPA (autoantibody)
Cytoplasmic antineutroohil cytoplasmic antibodies (cANCA)
40
Antibody replacement therapy
``` >1000 donors Screened HIV HBV HCV IgG vs range of organisms Half life=18/7, every 3-4/52, IV or subcut 1* Ab def (CIVD, Brutons etc) 2* Ab def (CLL, MM, BMT) Passive vaccination ```
41
Passive vaccination (spec immunoglobulins, exposure prophylaxis)
IgG vs Rabies, varicella zoster, HBV, Tetanus
42
Recombinant cytokines
Interferon alpha - HCV, HBV, HHV8 (kaposis sarcoma) - hairy cell leukaemia, CML, Malignant myeloma ``` Interferon beta Relapsing MS (aka plan B, unknown MODA) ``` Interferon gamma Chronic granulomatous disease
43
Block immune checkpoints (immunotherapy)
Ab vs CTLA4- Ipilimumab Blocks immune checkpoints, allows T cell activation Rx advanced melanoma Ab vs PD1 Pembrolizumab/Nivolumab Blocks immune checkpoints, allows T cell activation Rx advanced melanoma
44
Corticosteroids
Prednisolone MODA: Inhibits phospholipids A2 -> blocks AA -> reduces PG synthesis Inhibits phagocyte trafficking, phagocytosis, release of proteolytic enz, lymphopeni, promotes apoptosis, blocks cytokines gene expression, decrease Ab production Indication: AImmune/Inflammatory disease, transplant rejection SE: transient neutrophilia, diabetes, central obesity, adrenal supression, cataracts, glaucoma, pancreatitis, osteoporosis, moon face, acne, hirsutism, HTN, dyslipidaemia, peptic ulceration, avascukar necrosis
45
Cyclophosphamide (antiproliferative)
MODA: alkylate guanine base of DNA, prevents DNA rep, affects B>T, high doses affects all cells with high turnover Indications: CTD, Vasculitis, anticancer agent SE: BM suppression, infections, malignancy, teratogenic, hair loss, sterility, haemorrhaged cystitis
46
Mycophenolate | Mofetil
MODA: inhibits IMPDH prevents guanine synthesis, blocks de novo nucleotide synthesis, prevents DNA rep, T>B Indications: transplantation, autoimmune disease, vasculitis SE: BM suppression, infection (v.reactivation, progressive multifocal leukoencephalopathy), malignancy, teratogenic
47
Azathioprine
MODA: antimetabolite agent -liver-> mercaptopurine, blocks de novo purine (e.g. Adenine, guanine) synthesis, prevents Rep of DNA, pref inhibits T cell activation and proliferation Indications: Transplantation, autoinflammatory, autoimmune SE: BM suppression, infection, malignancy, teratogenic, hepatotoxicity, neutropenia (TPMT polymorphism=unable to metabolise azathioprine)
48
Methotrexate
MODA: inhibits dihydrofolate reducatase (DHFR) therefore decreases DNA synthesis Indications: RA, Psoriasis, crowns, chemotherapy=abortifacient SE: BM suppression, infection, malignancy, teratogenic, pneumonitis, pulmonary fibrosis, hepatotoxicity, folate deficiency (macrocytic megaloblastic anaemia)
49
Plasmapheresis
MODA: removal of pathogenic Ab, remove plasma immunoglobulins, reinfuse or replace with albumin (plasma exchange) Indications: severe antibody mediated disease (goodpastures syndrome, myasthenia gravis, vascular rejection), antibody mediated rejection SE rebound ab production limits efficacy, anaphylaxis SE
50
Tacrolimus
MODA: (-) calcineurin, (+) transcription of IL2, reduces T call prolif Indications: rejection prophylaxis transplant SE: nephrotoxicity, HTN, neurotoxic, diabetogenic
51
Cyclosporin
MODA: (-) calcineurin, (+) transcription of IL2, reduces T cell prolif Indications: rejection prophylaxis transplant SE: nephrotoxicity, HTN, neurotoxic, dysmorphism, gingival hypertrophy
52
Sirolimus
MODA: blocks clonal prolif of T call Indication: rejection prophylaxis transplant SE: less nephrotoxic, HTN
53
Tofacitinib
MODA: JAK inhibitor Indication: rheumatoid arthritis
54
Apremilast
PDE4 inhibitor Indications: psoriasis, psoriatic arthritis
55
Basiliximab
MODA: anti CD25 (alpha chain of IL2 receptor), (-) T cell prolif Indication: allograft rejection SE: infusion reactions, infection, malignancy, GIT disturbance
56
Abatacept
MODA: anti CTLA4, reduces T Cell activation Indications: RA SE: infusion reaction, infection (TB, HBV, HCV), malignancy, cough
57
Rituximab
MODA: anti CD20, depletes mature B cells (not plasma cells) Indications: lymphoma, RA, SLE SE: infusion reaction, infection (PML), exacerbation CV disease
58
Natalizumab
MODA: anti-alpha4 intigrin (VCAM1, MadCAM1; rolling/arrest of leukocyte), (-) T cell migration Indication: relapsing remitting MS, crohns SE: infusion reactions, infections (PML), malignancy, hepatotoxicity
59
Tocilizumab
MODA: Anti-IL6 R, reduces macrophage/T cell/B cell/neutrophil activation Indications: castlemans disease, rheumatoid arthritis SE: infusion reaction, infection, hepatotoxicity, hyperlipidaemia, malignancy
60
Muromonab-CD3
Blocks CD3 R on T cells, mouse monoclonal Ab (OKT3) Indication: active allograft rejection SE: fever, leukopenia
61
Anti-thymocyte globulin
MODA: Leukocyte depletion, modulation of T cell activation and migration Indication: allograft rejection (heart, renal) SE: infusion reaction, infection, malignancy, leukopenia
62
Daclizumab
MODA: IL2 R antibody, targets CD 25 Indication: organ transplant rejection prophylaxis
63
Efalizumab
MODA: Anti-CDIIa, (-) migration of T cells
64
Alemtuzumab (campath)
MODA: monoclonal Ab vs CD52, lymohocyte depletion Indication: CLL, MS SE: CMV
65
Infliximab
MODA: anti-TNFa Indication: RA, Ankylosing spondylitis, Psoriasis, psoriatic arthritis, IBD SE: infusion/injection site reactions, infection (TB/HBV/HCV), lupus like condition, demyelination, malignancy (lymphoma)
66
Adalimumab | Fully human monoclonal antibody
MODA: anti-TNFa Indication: RA, Ankylosing spondylitis, Psoriasis, psoriatic arthritis, IBD SE: infusion/injection site reactions, infection (TB/HBV/HCV), lupus like condition, demyelination, malignancy (lymphoma)
67
Certolizumab
MODA: anti-TNFa Indication: RA, Ankylosing spondylitis, Psoriasis, psoriatic arthritis, IBD SE: infusion/injection site reactions, infection (TB/HBV/HCV), lupus like condition, demyelination, malignancy (lymphoma)
68
Golimumab
MODA: anti-TNFa Indication: RA, Ankylosing spondylitis, Psoriasis, psoriatic arthritis, IBD SE: infusion/injection site reactions, infection (TB/HBV/HCV), lupus like condition, demyelination, melignancy (lymphoma)
69
Etanercept
MODA TNFalpha/TNFbeta R p75-IgG fusion protein Indication RA, Ankylosing spondylitis, psoriasis, psoriatic arthritis SE injection site reaction, infection (TB, HBV, HCV), lupus like conditions, demyelination, malignancy
70
Ustekinumab
MODA Anti IL12 and IL23 (binds p40 subunit) Indications: psoriasis, psoriatic arthritis SE: injection site reactions, infection (TB), malignancy, cough
71
Secukinumab
MODA: anti IL 17A Indications: psoriasis, psoriatic arthritis, ankylosing spondylitis SE: infection (TB)
72
Denosumab
MODA: anti-RANK ligand antibody, inhibits RANK mediated osteoclasts differentiation and function Indication: osteoporosis, multiple myeloma, bone metastasis SE: infection, avascular necrosis of the jaw
73
Transplant rejection; Hyperacute
Time: Min-Hrs Mech: preformed Ab (+) complement Path: thrombosis and necrosis Rx: prevention-crossmatch (ABO groups), HLA-matching
74
Transplant rejection; Acute vascular rejection
post xenograft transplant similar for hyperacute 4-6/7
75
Transplant rejection; Acute-cellular
Time: wks-mnth Mech: CD4 mediated type IV reaction Path: cellular infiltrate Rx: T cell immunosuppression
76
Transplant rejection; acute-antibody mediated
Time: wks-mnths Mech: B cell activation- Ab vs vessels Path: vasculitis, C4d staining Rx: Ab removal and B cell immunosuppression
77
Transplant rejection; Chronic
Time: Mnths-yrs Mech: immun and non immune mech. RF; Multiple acute rejections, HTN, Hyperlipidaemia Path: fibrosis, glomerulopathy, vasculopathy (ischaemia), bronchiolitis obliterans (lung) Rx: Minimise organ damage
78
Transplant rejection; GvHD
Time: days-wks Mech: donor cells attack host Path:skin (rash) GI (D&V, bloody stool), Liver (jaundice) Rx: prevention/immunosuppression-corticosteroids
79
Transplant immunosupression ''guidelines''
``` Pre-transplant; anti-CD52 (alemtuzumabe), anti-CD25 (Basiliximab), OKT3/ATG Post transplant (reduced rejection); CNI (calcineurin (-), tacrolimus, cyclosporin) + MMF (mycophenolate mofetil)/Aza _/- steroid Acute rejection; cellular-setorids, OKT/ATG // Ab medicatied- IVIG, plasma exchange, anti-C5, anti-CD20 ``` GvHD prophylaxis; methotrexate/cyclosporin
80
HIV Rx: fusion inhibitors
Enfuvirtide SE: Local reactions to injections Hypersensitivity (0.1-1%)
81
HIV Rx: Attachments inhibitors
Maraviroc | SE ?
82
HIV Rx: NucleosideRTI
emitricitabine*, didanosine, lamivudine, epzicom, combivir, trizivir, Z,Z,S,A SE: Generally rare; fever, headaches, GI disturb Zidovudine; BMS Zalcitabine, stavudine; peripheral neuropathy Stavudine; Mtch toxicity Abacavir; hypersensitivity
83
HIV Rx: NucleoTideRTI
Tenofovir* | SE: bone and renal Tx
84
HIV Rx: Non-NRTI
Nevirapine; Hepatitis Delavirdine; Rash Efavirenz*; CNS effects
85
HIV Rx; integration inhibitors
Raltegravir, Elvitegravir | ?SE
86
HIV Rx: Protease (-)
Indinavir, fosamprenavir, nelfinavir, lopinavir, ritonavir, atazanavir, amprenavir, saquinavir SE: hyperlipidaemia, fat redistribition, T2DM
87
HIV Rx; Atripla
Tenofovir, Efavirenz, Emitricitabine
88
Vaccination schedule
``` 2mnths; DTaP/IPV/HiB, PCV, R (oral), MenB 3mnth; DTaP/IPV/HiB, R 4mnths; DTaP/IPV/HiB, PCV, MenB 12-13mnths; HiB/MenC, MenB, PCV, MMR 3yrs 4mnths; DTaP/IPV, MMR Females 12-13yrs; HPV (16+18) 13-19; dT/IPV, MenACWY 60+; PCV, Influenza 70+; shingles 2-7yr influenza (nasal) @risk; BCG T/IPV; not immunised as child DTaP/IPV; for preg woman 28-38/40 Travel; Cholera, HBV, HAV, Jap Encephalitis, tick bourne enceph, typhoid, yellow fever ```
89
T Helper cells
TH1; cell mediated; IL2, INF gamma, TNF | TH2; Humoral response; IL4, IL5, IL6
90
Live Vaccines
``` sabin polio (oral, no longer used) MMR Chicken pox Yellow fever BCG Typhoid Live attenuated; BCG, MMR, Typhoid ``` (HIV pos may have MMR, not BCG/YF)
91
Inactivated Vaccines
Inactivated; Salk (polio), anthrax, cholera, bubonic plague, Hep A, Rabies, Pertussis, Influenxa Component/subunit; HepB (HbS antigen), HPV (capsid), Influenza (Haemagglutinin, Neuraminidase) Conjugate; Tetanus (Exotoxin), Hib, Meningococcus, Pneumococcus Toxoids; Diphtheria, Tetanus
92
Adjuvants
ALUM; Ags absorbed, slow releage Ag, activates Gr1+ cells-> IL4-> prime naive B cells CpG: unmethylated DNA motif (+) TLRs on APC stim expression of costim mol Complete Freund's adjuvant; water in oil emulsion containing mycobacterial cell wall component (vetinary, as painful in humans) ISCOMS; experiments multimeric Ag with adjuvant in built, cell mediate and humotsl immunr trdpondr IL2; Hep B Sag for seroconversion
93
Passive Vaccines
Igs, 3 wk immunity ``` HNIG; HepA and Measles HBIG; HepB HRIG; Rabies VZIG; Varicella Paviluzimab; monoclonal Ab for RSV ```

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