Immuno Flashcards
(98 cards)
1
Q
medulla of lymph node is made up of medullary cords and sinuses. what types of cells are in the cords and sinuses? (2 each)
A
cords: lymphocytes and plasma cells
sinuses: reticular cells (type of fibroblasts) and macrophages
2
Q
where are T cells in lymph node? (thus this part is underdeveloped in diGeorge syndrome)
A
paracortex
3
Q
lung drains to ____ lymph nodes
A
hilar
4
Q
trachea and esophagus drains to ____ lymph nodes
A
mediastinal
5
Q
upper limb, breast, skin above umbilicus drains to ____ lymph nodes
A
axillary
6
Q
colon from splenic flexure to upper rectum drains to ____ lymph nodes
A
inferior mesenteric
intestines above that -> superior mesenteric
7
Q
liver, stomach, spleen, pancreas, upper duodenum drains to ____ lymph nodes
A
celiac
8
Q
kidneys and utuerus drains to ____ lymph nodes
A
para-aortic (as do testis and ovaries)
9
Q
lower rectum to anal canal above pectinate line, bladder, middle third of vagina, cervix, prostate drains to ____ lymph nodes
A
internal iliac
10
Q
anal canal below pectinate line, skin below umbilicus, scrotum, vulva drains to ____ lymph nodes
A
superficial inguinal
11
Q
dorsolateral foot, posterior calf drains to ____ lymph nodes
A
popliteal
12
Q
lymph drainage pathway for right and left side of body
A
right side above diaphragm: R lymphatic duct -> junction of right sublcavian vein and IJVs
lower right and all of left: thoracic duct -> junction of left sublcavian and IJVs
13
Q
spleen is protected by which ribs?
A
9-11. left side
14
Q
where are T cells and B cells found in spleen?
A
T cells in pariarteriolar lymphatic sheath (PALS) in white pulp
B cells in follicles in white pulp
BOTH in WHITE pulp
15
Q
molecluar/immune pathway by which splenic dysfunction or asplenia increases susceptibility to encapuslated organisms
A
decreased IgM -> decreaesd complement -> decreased C3b opsonization
16
Q
4 things you would see in blood after splenectomy
A
- Howell-Jolly bodies
- target cells
- thrombocytosis (loss of sequestration and removal)
- lymphocytosis (loss of sequestration)
17
Q
which mediastinum is thymus located in?
A
anterosuperior mediastinum
18
Q
lymphocytes have what embryonic origin?
A
mesenchyme
19
Q
MHC are encoded by which genes?
A
HLA
MHCI has one letter (HLA-A, HLA-B, HLA-C)
MHCII has 2 letters (HLA-DP, DQ, DR)
20
Q
is MHC I or II 2 equal length chains?
A
II
21
Q
is MHC I or II 2 one short and one long chain?
A
I
22
Q
is MHC I or II has Beta2-microglobulin associated?
A
I
23
Q
is MHC I or II has invariant chain associated?
A
II
24
Q
perforin and granzymes are used by which immune cells?
A
NK cells and CD8 killer T cells
25
what happens in genetic deficiency of FOXP3?
that's in T-reg cells. results in IPEX syndrome
Immune dysregulation
Polyendocrinopathy
Enteropathy
X-linked
+ skin and nail stuff (autoimmune derm stuff)
associated w/ diabetes in male infants!
26
what is the 2nd activating signal (for proliferation and surivival specifically) for CD4+ T cells? (first one is MHC binding obvis)
B7 on dendritic cell (APC) binds to CD28 on T cell
27
2nd activating signal for B cells
CD40 ligand on T cells, CD40 receptor on B cells. activates the T CELL, which then activates the B cell by IL-4 and IL-5
28
what is CD14
on macrophages. a co receptor for TLR4, recognizes LPS
29
TLR activation leads to upregulation of what nuclear transcription factor?
NF-kB
30
what are the 4 mediator/molecules that attract neutrophils?
1. LTB4 leukotriene
2. C5a
3. IL-8
4. bacterial products
31
what are the 4 mediator/molecules that attract neutrophils?
1. LTB4 leukotriene
2. C5a
3. IL-8
4. bacterial products
32
4 things that activate mast cells
tissue trauma
C3a
C5a
IgE cross link
33
histamines increases vascular permeability at 1._____ and vasodilates 2.______
1. postcapillary venules (endothelial contraction)
| 2. arterioles
34
early and late phase mediators of mast cell activation
early: histamine
late: leukotrienes
note: this is diff from atopic asthma where early phase is mast cells so both histamine and leukotrienes, and late phase is eosinophils that release MBP
35
Kinin system is activated by what protein produced in liver?
Hageman factor aka Factor XII
36
bradykinin's effect
same as histamine + pain
37
3 etiologies/pathogenesis of SCID and inheritance pattern
1. cytokine receptor defect IL-2R gamma chain (needed for B and T cell activation) (X-linked)
2. ADA deficiency (product buildup toxic to lymphocytes) (autosomal recessive)
3. MHCII deficiency
38
x-linked/Bruton's agammaglobulinemia
| gene mutated? when does it present?
BTK gene = Bruton tyrosine kinase -> disordered B cell maturation ->agammaglobulinemia
6 months after birth (when maternal antibodies fade)
39
absent or scanty lymph nodes and tonsils, recurrent infections
brutons/x-linked agammaglobulinemia. BTK gene
40
CVID. presentation? pathogenesis?
defective B cell DIFFERENTIATION. (not maturation, like bruton's) -> decreased plasma cells and immunoglobulins
increased sinus and enteric infections, presents later (2+ years) than bruton's (6 months)
41
hyper IgM syndrome is due to mutated ____ on T cells or ____ on B cells
inheritance pattern?
t cells CD40 ligand
B cells CD40 receptor
can't activate the helper T cell -> no B cell activation -> no class switching. also failure to make germinal centers
x linked recessive
42
kid has thrombocytopenia, recurrent infections, and eczema. what gene mutation does he have? inheritance pattern?
it's wiskott aldrich syndrome
WASP gene(reorganize actin cytoskeletin -> antigen presentatino), X-linked recessive
43
C1 esterase inhibitor deficiency has decreased levels of what complement mediator?
C4
44
what part of antibody determines isotype (IgM, D, etc)
Fc region
45
ROLLING:
| involves ___ on endothelial cells, which bind to ___ on leukocytes
selectins on endothelial cells
| sialyl Lewis X on leukocytes
46
ADHESION: involves _____ on endothelium (upregulated by _______) and _______ on leukocytes (upregulated by _____)
TNF and IL-1 upregulate ICAM and VCAM on endothelium
C5a and LTB4 upregulate integrins on luekocytes
47
Leukocyte adhesion deficiency has a defect in what protein on what cells?
LFA-1 integrin (CD18) protein on phagocytes
48
which kinds of blood vessels do leukocytes transmigrate across?
postcap venules
49
phagocytosis is enhanced by which Ig?
IgG (like C3b)
50
```
pt has: repeated infections
neutropenia
giant granules in leukocytes
defective primary hemostasis
albinism
peripheral neuropathy
```
dx? pathogenesis?
Chediak Higashi syndrome
| all problems arise from defective lysosomal protein trafficking.
51
in MPO deficiency, patients are mostly asympto but may have increased risk for _____ infections.
what color will nitroblue tetrazolium test show?
Candida
blue aka normal. b/c that's for testing NADPH oxidase activity
NOTE: if absent cutaneous rxn to candida antigens, it's actually chronic mucocutaneous candidiasis, where T cell dysfunction
52
T cell receptor complex is made of TCR + _____
CD3
53
cells and mediators mediating granuloma formation
macrophages MHCII and IL-12 -> CD4+ T cells -> Th1 subtype, secrete IFN-y -> convers macrophages into epithelioid histiocytes and giant cells
TNF-a from macrophages also induces and maintains
54
features of Digeorge syndrome: CATCH22
Cardiac defects (conotruncal,tetralogy of Fallot)
Abnormal facies
Thymic hypo or aplasia (absent shadow on x ray)
Craniofacial stuff (bifid uvula, cleft palate)
Hypo PTH, hypo Ca2+ -> tetany
22q11 microsome deletion
55
AIRE mutation results in what condition?
autoimmune polyendocrine syndrome
56
Fas receptor is CD__
CD95
57
Fas apoptosis pathway mutation results in what condition?
autoimmune lymphoproliferative syndrome (ALPS)
58
how do T regs turn down immunie response?
release IL-10 and TGF-B (anti-inflammatory)
| surface CTLA4 binds B7 on APC cells to block 2nd signal activation for CD4 helper cells
59
thymus cortex or medulla where does positive and negative selection happen?
cortex: + selection
medulla : - selection
so maturation proceeds as cells move INWARD. hey it's like androgen -> estrogen from theca cells to granulosa cells, also outward to in.
60
HLA-B27 is associated w/ what autoimmune dzs? B a perfect(7) pair(2) PAIR
Psoriatic arthritis
Ankylosing spondylitis
IBD associated arthritis
Reactive arthritis
61
deficiency of which complement proteins is associated w/ SLE?
the clearance onces. C1q, C4, C2
62
clinical features of SLE: RASH OR PAIN
Rash (malar or discoid)
Arthritis (nonerosive)
Serositis (eg, pleuritis, pericarditis)
Hematologic disorders (eg, cytopenias)
Oral/nasopharyngeal ulcers (usually painless)
Renal disease
```
Photosensitivity
Antinuclear antibodies (sensitive)
Immunologic disorder (anti-dsDNA, anti-Sm) (specific)
Neurologic disorders (eg, seizures, psychosis)
```
63
pretty much all the stuff in SLE is caused by IC deposition aka type III hypersensitivity rxn, except ________
hematologic. cytopenias due to antibodies against the blood cells
64
antiphospholipid antibody is specifically directed against what?
the proteins bound to phospholipids. ex: anticardiolipin, anti-B2 glycoprotein I, lupus anticoagulant
65
main feature of antiphospholipid antibody syndrome
hypercoagulable state (even tho falsely elevated PTT due to lupus anticoagulant antibody)
its what causes the thromboses -> pregnancy loss, DVT, stroke)
66
______ antibody is present in drug induced lupus
antihistone antibody
67
what type of hypersensitivty mediates Sjogren syndrome
type IV. lymphocyte mediated damage. (w/ fibrosis)
68
antibodies present in Sjogren syndrome (3)
antinuclear antibodies,
rheumatoid factor (can be in the absence of rheumatoid arthritis),
antiribonucleoprotein antibodies: SS-A (anti-Ro) and/or SS-B (anti- La) (these can also be present in SLE)
69
which antibody in Sjogren or SLE can cross placenta and cause neonatal lupus and congenital heart block?
Anti SSA (antiribonucleoprotein antibodies)
70
pts with sjogren syndrome have increased risk for what kind of lymphoma?
B cell marginal cell lymphoma
71
what molecular mediators in scleroderma?
endothelial dysfunction -> less NO, more endothelin -> inflammation
secretion of TGF-Beta and PDGF -> fibrosis
72
immune dz that can cause pulmonary HTN
diffuse scleroderma (lung involvement can have interstitial fibrosis and pulm HTN)
73
diffuse scleroderma has what antibodies?
anti Scl 70 = anti DNA topoisomerase I
74
mixed connective tissue dz has what autoantibody?
anti U1 ribonucleprotein antibody
75
naive mature B cells express which 2 Igs?
IgM, IgD
76
IgA picks up secretory component from epithelial cells, which does what?
protects the Fc portion from luminal proteases
77
CD55 deficiency -> _______
cd55 = decay accelerating factor = DAF
paroxysmal nocturnal hemoglobinuria
78
what cytokine is released in response to IL-12 and increases MHC expression and antigen expression on all cells?
IFN-y
79
CD marker for NK cells
CD56
80
CD marker for hematopoietic stem cells
CD34
81
what type of hypersensitivity rxn is hyperacute transplant rejection
type II
| it's bc of preformed antibodies to donor antigens
82
what type of hypersensitivity rxn of polyarteritis nodosa
type III
83
what type of hypersensitivity rxn is serum sickness and Arthurs rxn?
III
84
what type of hypersensitivity rxn is contact dermatitis?
IV
85
anti phospholipase A2 receptor
primary membranous nephropathy
86
autosomal dominant hyper IgE syndrome is due to what gene mutation?
clinical presentation? FATED
STAT3 mutation -> Th17 deficiency -> decreased recruitment of neutrophils
```
Facies (coarse)
Abscesses (s. aureus, noninflamed)
Teeth (primary teeth retained)
Eosinophils and IgE increased
Derm stuf (eczema)
```
bonus: bone fractures from minor trauma. IFN-y decreased
87
Ataxia-telangiectasia has increased what serum marker?
| decreased which Igs?
AFP
decreased IgA, IgG, IgE
88
Ataxia-telangiectasia has increased risk of what?
lymphoma and leukemia (but they also have lymphopenia!)
89
pt comes in w/ spider angiomas and IgA deficiency. what other thing do they have? what is the genetic basis?
cerebellar atrophy w/ ataxia. this is ataxia-telangiectasia. ATM gene defect -> can't detect DNA damage -> cell cycle proceeds -> mutations accumulate
90
which Ig's are elevated in Wiskott Aldrich syndrome?
IgA, IgE
91
inheritance pattern of CGD? which tests are abnormal?
X linked recessive
dihydrorhodamine (flow cytometry) test = decreased green fluorescence
nitroblue tetrazolium dye reduction test doesn't turn blue
92
mediators of acute transplant rejection and presentation? hypersensitivity type?
IV: CD8 T cells against donor MHCs
II: antibodies/humoral
presents as vasculitis of graft vessels w/ dense interstitial lymphocytic infiltrate
93
mediators of chronic transplant rejection and presentation? hypersensitivity type?
IV and II: CD4 T cells activated by recipient APCs presenting donor peptides (like MHC)
```
cytokines -> proliferation of vascular smooth muscle, parenchymal atrophy, interstitial fibrosis. Dominated by arteriosclerosis.
Organ-specific examples:
Bronchiolitis obliterans (lung)
Accelerated atherosclerosis
(heart)
Chronic graft nephropathy
(kidney)
Vanishing bile duct syndrome
(liver)
```
94
graft vs host dz presentation?
Maculopapular rash, jaundice, diarrhea, hepatosplenomegaly. severe organ dysfunction.
GI/rectal infiltrate of lymphocytes
95
transmigration/diapedesis of WBCs involves ___ on leukocyte and ____ on vessel
PECAM (CD31) on both!
96
Hageman factor is important mediator in DIC from gram negative sepsis. what 3 pathways does it activate?
1. coagulation and fibrinolytic systems
2. complement
3. Kinin system
97
Fc receptor on cells i CD___
CD16
98
how do you know that neutrophils are immature? like if there's a lot of them a left shift has occured?
decreased Fc receptors (CD16)
