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Flashcards in Immuno USMLE Deck (161):
1

a secondary lymphoid organ that has many afferents & 1 or more efferents. It is encapsulated, with trabeculae.

lymph node

2

fxs of lymph node (3)

1)filtration by macrophages
2)storage/proliferation of B and T cells
3)antibody production

3

this part of the lymph node is the site of B-cell localization and proliferation.

follicle

4

these follicules have pale central germinal centers and are active.

secondary follicles

5

this part of the lymph nodes consists of closely packed lymphocytes and plasma cells and sinuses that communicate with efferent lymphatic and contain reticular cells and macrophages

medulla

6

this part of the lymph node houses T cells. It is the region of the cortex between follicles and medulla. It contains high endothelial venules through which T and B cells enter from the blood. In extreme cellular immune response (i.e., viral) the this becomes greatly enlarged.

paracortex

7

paracortex is not well developed in pts with this syndrome

DiGeorge syndrome

8

this duct drains the right arm and right half of the head

right lymphatic duct

9

this duct drains the right arm and right half of the head

right lymphatic duct

10

this duct drains everything besides the right arm and right half of the head

thoracic duct

11

these are long vascular channels in red pulp with fenestrated "barrel hoop" basement membrane. Macrophages are found nearby.

sinusoids of the spleen

12

these cells are found in the periarterial lymphatic sheath (PALS) and in the red pulp of the pleen.

T cells

13

these cells are found in the follicles within the white pulp of the spleen

B cells

14

this is the site of T-cell maturation.

thymus

mneu: think of the Thymus as "finishing school" for T cells. They arrive immature and "dense" in the cortex; they are mature in the medulla.

15

the thymus is from the epithelium of this branchial pouch.

3rd

16

In the thymus, the cortex is dense with this type of T cells; while the medulla is pale with this type of T cells and epithelial reticular cells and Hassall's corpuscles.

immature
mature

17

In the corticomedulary junction only T cells with MHC restriction are chosen, this is called?
then only T cells that are non-reactive to self are chosen.
what is this called

positive selection
negative selecton

18

this type of T cell produces IL-2 & gamma interfereon in order to activate macrophages and Tc cells

Th1 cells

19

this type of T cell produces IL-4 & IL-5 to help B cells make Ab

Th2 cells

B=2nd letter of the alphabet

20

State whether this is a fx of B (Ab mediated immunity) or T (Cell mediated immunity) cells:
Host defense against infection (opsinize bacteria, neutralize toxins & viruses)

Ab mediated immunity (B cells)

21

State whether this is a fx of B (Ab mediated immunity) or T (Cell mediated immunity) cells:
Host defense against Mycobacterium tuberculosis, virus infected cells, and fungi.

Cell mediated immunity (T cells)

22

State whether this is a fx of B (Ab mediated immunity) or T (Cell mediated immunity) cells:
Host defense against Mycobacterium tuberculosis, virus infected cells, and fungi.

Cell mediated immunity (T cells)

23

State whether this is a fx of B (Ab mediated immunity) or T (Cell mediated immunity) cells:
Allergy (e.g., hay fever, type I hypersensitivity)

B (Ab mediated immunity)

24

State whether this is a fx of B (Ab mediated immunity) or T (Cell mediated immunity) cells: Allergy to poison oak, type IV hypersensitivity

Cell-mediated immunity (T cells)

25

State whether this is a fx of B (Ab mediated immunity) or T (Cell mediated immunity) cells:
Autoimmunity

B cell (Ab mediated immunity)

26

State whether this is a fx of B (Ab mediated immunity) or T (Cell mediated immunity) cells:
Graft & tumor rejection

T cell(Cell mediated immunity)

27

State whether this is a fx of B (Ab mediated immunity) or T (Cell mediated immunity) cells:
help and supression of Ab response

T cell(Cell mediated immunity)

28

MHC stands for

major histocompatibility complex

29

give the 3 class I genes

A,B,C

30

give the 3 class I genes

A,B,C

31

give the 3 MHC class II genes

DP,DQ,DR

32

this type of MHC has 1 polypeptide, with B2-microglobin

Class I

33

this type of MHC has 2 polypeptides, with an alpha and a beta chain

class II

34

this type of cells have MHC II & MHC I proteins

APCs (e.g., macrophages & dendritic cells)

35

This class of MHC are the main determinants of organ rejection

class II

36

this type of Ag loading occurs in RER (viral Ag)

MHC I

37

this type of Ag loading occurs in acidified endosome

MHC II

38

Give the 2 T-cell glycoproteins

CD4
CD8

39

helper T cells have CD_, which binds to MHC II on APCs

4

mneu: product of CD & MHC =8

40

Cytotoxic T cells have CD__, which binds to MHC I on virus infected cells

8
mneu: product of CD & MHC =8

41

this is a cluster of polypeptides associated with a T-cell receptor. It is important in signal transduction

CD3 complex

42

give the 3 Ag presenting cells

1) macrophage
2) B cell
3) dendritic cells

43

in this type of T cell activation:
1) foreign body is phagocytosed by APC
2) Foreign Ag is presented on MHC II and recognized by TCR on Th cell
3) "Costimulatory signal" is given by interaction of B7 & CD28
4)Th cell is activated to produce IL-2 and gamma-interferon

Th activation

44

In this type of T cell activation:
1) Endogenously synthesized (viral or self) proteins are presented on MHC I and recognized by TCR on Tc cell
2) IL-2 from Th cell activates killing of the virus infected cell.

Tc activation

45

_______ part of L & H chains recognize Ag.

variable

46

_______ part of H chain of IgM & IgG fixes complement

Constant

47

_______ chain contributes to Fc and Fab fractions

Heavy

48

_____ chain contributes only to Fab fraction

light

49

This fragment of Ab is constant, has a carboxy terminal, is complement-binding (IgG & IgM only) and has carbohydrate side chains

Fc fragment

50

Abs do many things to aid in host defense. This method of host defense refers to when Ab promotes phagocytosis. image. p.184

opsonization

51

Abs do many things to aid in host defense. This method of host defense refers to when Ab prevents bacterial adherance. image. p.184

neutralization

52

Abs do many things to aid in host defense. This method of host defense refers to when Ab activates compliment, enhancing opsinization and lysis. image. p.184

complement activation

53

Ab diversity is generated by:
1)random ______ of VJ (light chain or VDJ (heavy chain) genes)
2) random ______ of heavy chains with light chains
3) Somatic __________
4) addition of DNA during _________ by terminal deoxynucleotidl transferase

recombination
combination
hypermutation
genetic recombination

54

mature B lymphocytes express ______ & _____ on their surfaces.

IgM & IgD

55

mature B lymphocytes express IgM & IgD on their surfaces may differentiate by isotype switching (mediated by cytokines and CD40 ligand) into plasma cells that secrete ____,____ or _____

IgA, IgE, or IgG

56

this immunoglobin isotype is the main Ab in secondary response. It is the most abundant. It fixes complement, crosses the placenta, opsonizes bactera, & neutralizes bacterial toxins & viruses

IgG

57

This immunoglobin isotype prevents attachment of bacteria and viruses to mucous membranes, it does not fix complement. It can be a monomer or dimer. It is found on secretions. It picks up secretory component from epithelial cells before secretion.

IgA

58

this immunoglobin isotype is produces in the primary response to an antigen. It fixes complement but does not cross the placenta. The Ag receptor is on the surface of the B cells. It can be a monomer or pentamer.

IgM

59

this immunoglobin isotype is found on the surface of many B cells and in serum. Its fx is unclear.

IgD

60

this immunoglobin isotype mediates immediate (type I) hypersensitivity by inducing the release of mediators from mast cells and basophils when exposed to allergen. It mediates immunity to worms. It is the lowest Ig isotype in serum

IgE

61

This is an Ig epitope that differs among members of the same species. It can be on light or heavy chain

allotype (polymorphism)

62

This Ig epitope is common to a single class of Ig (5 classes determined by the heavy chain)

Isotype (IgG, IgA, etc.)

Isotype=iso (same) common to same class)

63

This Ig epitope is determined by the Ag binding site

Idiotype (specific for a given Ag)

Idiotype=idio (unique)
hypervariable region is unique

64

This important cytokine is secreted by macrophages. It stimulates T cells, B cells, neutrophils, fibroblasts, and epithelial cells to grow, differentate, or synthesize specific products. It is an endogenous pyrogen

IL-1

mneu:
HOT T-BONE stEAk
IL-1: fever (HOT)
IL-2: stimulates T cells (T)
IL-3: stimulates BONE marrow
IL-4: stimulates IgE (E)
IL-5: stimulates IgA (A)

65

This important cytokine is secreted by Th cells. It stimulates growth of helper and cytotoxic T cells

IL-2

mneu:
HOT T-BONE stEAk
IL-1: fever (HOT)
IL-2: stimulates T cells (T)
IL-3: stimulates BONE marrow
IL-4: stimulates IgE (E)
IL-5: stimulates IgA (A)

66

This important cytokine is secreted by activated T cells. It supports the groth and differentiation of bone marrow stem cells. It has a fx similar to GM-CSF

IL-3

mneu:
HOT T-BONE stEAk
IL-1: fever (HOT)
IL-2: stimulates T cells (T)
IL-3: stimulates BONE marrow
IL-4: stimulates IgE (E)
IL-5: stimulates IgA (A)

67

This important cytokine is secreted by Th cells. It promotes groth of B cells. It enhances class switching of IgE & IgG

IL-4

mneu:
HOT T-BONE stEAk
IL-1: fever (HOT)
IL-2: stimulates T cells (T)
IL-3: stimulates BONE marrow
IL-4: stimulates IgE (E)
IL-5: stimulates IgA (A)

68

This important cytokine is secreted by Th cells. It promotes differentiation of B cells. It enhances class switching of IgA. It stimulates production and activation of eosinophils

IL-5

mneu:
HOT T-BONE stEAk
IL-1: fever (HOT)
IL-2: stimulates T cells (T)
IL-3: stimulates BONE marrow
IL-4: stimulates IgE (E)
IL-5: stimulates IgA (A)

69

This important cytokine is secreted by Th cells and macrophages. It stimulates production of acute phase reactants and immunoglobins.

IL-6

70

This important cytokine is a major chemotactic factor for neutrophils

IL-8

71

This important cytokine is secreted by B cells and macrophages. It activates NK and Th2 cells

IL-12

72

This important cytokine is secreted by Th cells. It stimulates macrophages

gamma interferon

73

This important cytokine is secreted by macrophages. It increases IL-2 receptor synthesis by Th cells. It increases B cell proliferation. It attracts and activates neutrophils. It stimulates dendritic cell migration to lymph nodes.

TNF-alpha

74

given the cell surface proteins give the cell:
CD4,TCR,CD3,CD28,CD40L

helper T cells

75

given the cell surface proteins give the cell:
CD8,TCR,CD3

cytotoxic T cells

76

given the cell surface proteins give the cell:
IgM,B7,CD19,CD20,CD40, MHC II

B cells

77

given the cell surface proteins give the cell:
MHC II,CD14, receptors for Fc & C3b

Macrophages

78

given the cell surface proteins give the cell: Receptors for MHC I, CD16

NK cells

79

MHC I

all cells except mature red cells

80

This system is a system of proteins that interact to play a role in humoral immunity and inflammation

compliment

81

complement defends against this type of bacteria

G-

82

compliment is activated by Ig_ & Ig_ in the ______ pathway,
and activated by molecules on the surface ofmicrobes (especially endotoxin) in the ________ pathway

G & M, classic
alternate

mneu: GM makes CLASSIC cars

83

given the complements give the function:
C1,C2,C3,C4

viral neutralization

84

given the complements give the function:
C3b

opsonization

85

given the complements give the function:
C3a,C5a

anaphylaxis

86

given the complements give the function:
C5a

neutrophil chemotaxis

87

given the complements give the function:
C5b-9

cytolysis by membrane attack complex (MAC)

88

deficiency of _______ leads to hereditary angioedema (overactive complement)

C1 esterase inhibitor

89

deficiency of _______ leads to severe, recurrent pyogenic sinus and respiratory tract infections

C3

90

deficiency of _______ leads to Neisseria bacteremia

C6-C8

91

deficiency of _______ leads to leads to paroxysmal nocturnal hemoglobinuria (PNH)

DAF

92

these are proteins taht place uninfected cells in an antiviral state

interferons (alpha, beta,gamma)

93

Interferons induce the production of a 2nd protein that inhibits viral ______ by degrading viral mRNA (but not host mRNA)

protein synthesis

94

alpha and beta interferons inhibit viral ________

protein sythesis

95

gamma interferons increase ________ expresssion and antigen presintation in all cells

MHC I & II

96

interferons activate these cells to kill virus-infected cells

NK cells

97

this type of immunity is induced after exposure to foreign Ag. It has a slow onset and provides long lasting protection (memory)

active immunity

98

this type of immunity is based on recieving preformed Ab from another host. There is a rapid onset but a short life span of the Ab

passive immunity

99

what are some common exposures in which pts are given preformed Abs (passive immunity)

Tetanus Toxin
Botulism Toxin
HBV
Rabies

mneu: To Be Healed Rapidly

100

Classic examples of antigen variation include this bacteria with 2 flagellar varients

salmonella

101

Classic examples of antigen variation include this virus that undergoes antigen shift and antigen drift

influenza

102

Classic examples of antigen variation include this parasite that undergoes programmed rearrangement

trypanosomes

103

Some mechanisms for Ag variation include DNA rearrangement and RNA segment rearrangement, Which one occurs in an influenza major shift.

RNA segment rearrangement

104

this process describes when self-reactive T cells become nonreactive without costimulary molecule

anergy

105

can B cells become anergic

yes -but tolerence is lest complete than in T cells

106

this type of hypersensitivity involves aaphylactic and atopic reactions

Type I

Mneu: First and Fast (anaphylaxic)

107

In this type of hypersensitivity rxn the Ag cross-links IgE on presensitized mast cells and basophils, triggering release of vasoactive amines (i.e., histamine). A reaction develops rapildly after Ag exposure due to preformed Ab. E.g., include anaphylaxis, asthma, hives, local wheal and flare

Type I

108

This type of hypersensitivity is Ab mediated. IgM & IgG bind to Ag on "enemy" cell, leading to lysis (by complement or phagocytosis. E.g., include autoimmune hemolytic anemia, Rh dz(erythroblastosis fetalis), goodpasture's syndrome, rheumatic fever, Graves dz, bullous pemphigoid, myasthenia gravis, ITP

type II

mneu: cy-2-toxic

109

In type II hypersensitivity rxns the Ab & complement lead to this complex

membrane attack complex

110

these types of hypersensitivity reactions are Ab mediated

I,II,III

111

Immune complex, serum sickness, and Arthrus reactions describe this type of hypersensitivity reaction

type III

112

In this subtype of a type III hypersensitivity reaction Ag-Ab complexes activate complement, which attracts neutrophils; neutrophils release lysosomal enzymes. Examples include PAN, immune complex glomerulonephritis, SLE,rheumatoid arthritis.

immune complex

113

immune complexes are essentially 3 things stuck together. What are they?

Ag-Ab-C'

114

pt presents with fever, uticaria, arthralgias, proteinuria, lymphadenopathy 5-10 days after Ag exposure

serum sickness

115

This subtype of a type III hypersensitivity reaction is an immune complex dz in which Ab to the foreign proteins are produced (takes 5 days). Immune complexes form and are deposited in membranes, where they fix compliment (leads to tissue damage).

Serum Sickness

116

most serum sickness is now caused by this not serum

drugs

117

This subtype of a type III hypersensitivity reaction is a local subacute Ab mediated hypersensitivity. Intradermal injection of Ag induces Ab, which form Ag-Ab complexes in the skin. It is characterized by edema, necrosis, and activation of complement. Examples include hypersensitivity pneumonitis (farmer's lung) and thermophilic actinomycetes.

Arthrus reaction

118

these complexes cause the arthrus reaction

Ab-Ag complex

119

This type of hypersensitivity involves delayed (T cell mediated) reactions. Sensitized T lymphocytes encounter Ag and then release lymphokines which leads to macrophage activation

Type IV

mneu: 4th & last-delayed

120

Type IV hypersensitivity reactions are cell mediated--therefore are they transferable by serum

No

121

Give the 4 Ts of type IV hypersensitivity reactions

T lymphocytes, Transplant reactons, TB skin tests, Touching (contact dermatitis)

122

Use the ACID mneumonic for the types of hypersensitivity. . . .

A-Anaphylactic and Atopic(I)
C-Cytotoxic (Ab mediated[II]
I-Immune complex (III)
D-Delayed (cell mediated[IV]

123

Give the immune deficiency:
this is an X linked recessive defect in a tyrosine kinase gene associated with low levels of all classes of immunoglobins. It is Associated with recurrent BACTERIAL infections after 6 mo. of age, when levels of maternal IgG Ab decline. It occurs in BOYS (X-linked)

Bruton's agammaglobulinemia (decreased production of B cells)

124

Give the immune deficiency:
This occurs when the THYMUS and paraTHYROIDS fail to develop owing to failure of development of the THIRD and fourth pharyngeal puches. It presents with TETANY owing to hypocalcemia. Pt often has recurrent viral and fungal infections due to T-cell deficiency. Congenital defects of heart and great vessels often accompany. There is a 22q11 deletion

Thymic aplasia (DiGeorge syndrome) decrease production of T cells

125

Give the immune deficiency:
This is a defect in early stem-cell differentiation. It presents with recurrent viral, bacterial, fungal and protozoal infections. It may have multiple causes (e.g., failure to synthesize MHC II Ag, defective IL-2 receptors or adenosine deaminase deficiency.

Severe combined immunodeficiency (SCID)
decreased production of B & T cells

126

Give the immune deficiency:
Pt presents with disseminated mycobacterail infections.

IL-12 receptor deficiency
T cell activation problem

127

Give the immune deficiency:
Defect in the CD40 ligand on CD4 T helper cells leads to inability to class switch. Presents early in life with severe pyogenic infections. High levels of IgM; very low levels of IgG, IgA, & IgE

Hyper IgM syndrome
B cell activation problem

128

Give the immune deficiency:
X linked defect in the ability to mount an IgM response to capsular polysaccharides of bacteria. Associated with elevated IgA levels, normal IgE levels, and low IgM levels. Triad of symptoms includes recurrent pyogenic Infections, thrombocytopenic Purpura, Eczema (WIPE).

Wiskott-Aldrich Syndrome
B cell activation problem

129

Give the immune deficiency:
Failure of gamma-interferon production by helper T cells. Neutrophils fail to respond to chemotactic stimuli. Presents with recurrent "cold" (noninflamed) staphylococcal abscesses, eczema, coarse facies, retained primary teeth, and high levels of IgE

Jobs syndrome-
decreased activation of macrophages

130

Give the Immune deficiency:
Defect in LFA-1 adhesion proteins on phagocyts. Presents early with sever pyogenic and fungal infections and delayed seperation of umbilicus

Leukocyte adhesion deficiency syndrome
Phagocytic cell deficiency

131

Give the Immune deficiency: Autosomal recessive defect in microtubular fx and lysosomal emptying of phagocytic cells. Presents with recurrent pyogenic infxns by staphylococci and streptococci, partial albinism, and peripheral neuropathy

Chediak-Higashi dz
phagocytic cell deficiency

132

Give the Immune deficiency: Defect in phagocytosis of neutrophils owing to lack of NADPH oxidase activity or similar enzymes. Presents with marked susceptibility to opportunistic infxns with bacteria, especially S. aureus, E. coli, and Aspergillus. Diagnosis is confirmed with negative nitroblue tetrazolium dye reduction test

Chronic granulomatous dz
phagocytic cell deficiency

133

Give the Immune deficiency:
T-cell dysfunction specificallly against Candida albicans. Presents with skin and mucous membrane Candida infections.

Chronic mucocutaneous Candidiasis-
Idiopathic dysfunciton of T cells

134

Give the Immune deficiency:
Deficiency in a specific class of immunoglobulins--possibly due to a defect in isotype switching. Selective IgA deficiency is the most common selective immunoglobin deficiency. Presents with sinus and lung infections. Milk allergies and diarrhea are common.

Selective immunoglobin deficiency
Idiopathic dysfunction of B cells

135

Give the Immune deficiency:
Defect in DNA repearin enzymes with associated IgA deficiency. Presents with cerebellar problems (ataxia) and spider angiomas (telangiectasia.

ataxiatelangiectasia-
idiopathic dysfunction of B cells

136

Given the autoantibody, give the associated disorder:
antinuclear Ab (ANA)

SLE

137

Given the autoantibody, give the associated disorder: Anti-dsDNA, anti-Smith

specific for SLE

138

Given the autoantibody, give the associated disorder:
Antihistone

drug induced lupus

139

Given the autoantibody, give the associated disorder: Anti-IgG (rheumatoid factor)

rheumatoid arthritis

140

Given the autoantibody, give the associated disorder: antineutrophil (C-ANCA, P-ANCA)

Vasculutis

141

Given the autoantibody, give the associated disorder: Anticentromere

Scleroderma (CREST)

142

Given the autoantibody, give the associated disorder:
Anti-Scl-70

Scleroderma (diffuse)

143

Given the autoantibody, give the associated disorder: antimitochondrial

primary biliary cirrhosis

144

Given the autoantibody, give the associated disorder: Antigliadin

Celiac dz

145

Given the autoantibody, give the associated disorder:
Anti-basement membrane

Goodpasture's syndrome

146

Given the autoantibody, give the associated disorder:
Anti-epithelial cell

Pemphigus vulgaris

147

Given the autoantibody, give the associated disorder:
Antimicrosomal

Hashimoto's thyritis

148

Given the autoantibody, give the associated disorder: Anti-Jo-1

polymositis, dermatomyositis

149

Hive the HLA subtype that coincides with the following disorders: Psoriasis, Ankylosing spondylitis, Inflammatory bowel dz, Reiter's syndrome.

B27

mneu: PAIR

150

Give the HLA subtype which cooresponds to the following dz:
Graves' dz, celiac sprue

B8

151

Give the HLA subtype which cooresponds to the following dz:
MS, hay fever, SLE, Goodpasture's

DR2

152

Give the HLA subtype which cooresponds to the following dz: DM type I

DR3

153

Give the HLA subtype which cooresponds to the following dz:
Rheumatoid arthritis, DM type 1

DR4

154

Give the HLA subtype which cooresponds to the following dz:
Pernicous anemia (B12 deficiency) Hashimoto's thyroiditis

DR5

155

Given the autoantibody, give the associated disorder:
Steroid-responsive nephrotic syndrome

DR7

156

This type of transplant rejection is Ab mediated due to presence of preformed antidonor Ab in the transplant recipient. It occurs within minutes after transplantation.

hyperacute rejection

157

This type of transplant rejection is cell mediated due to cytotoxic T lymphocytes reacting against foreign MHCs. It occurs weeks after transplantation. It is reversible with immunosuppressants such as cyclosporin and OKT3

Acute rejection

158

This type of transplant rejection is Ab mediated vascular damage (fibrinoid necrosis) it occurs months to years after transplantation. It is irreversible.

Chronic rejection

159

This type of transplant rejection happens when grafted immunocompetent T cells proliferate in the irradiated immunocompromised host and reject cells with "foreign" proteins, resulting in severe organ dysfunction. Major symtoms include maculopapular rash, jaundice, hepatosplenomegly, and diarrhea

Graft v. Host dz

160

This type of transplant rejection is Ab mediated vascular damage (fibrinoid necrosis) it occurs months to years after transplantation. It is irreversible.

Chronic rejection

161

This type of transplant rejection happens when grafted immunocompetent T cells proliferate in the irradiated immunocompromised host and reject cells with "foreign" proteins, resulting in severe organ dysfunction. Major symtoms include maculopapular rash, jaundice, hepatosplenomegly, and diarrhea

Graft v. Host dz