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STEP 1 > Immunology > Flashcards

Immunology Flashcards

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1
Q

Which lymph node cluster drains the oral cavity, anterior tongue, and lower lip?

A

Submandibular and submental lymph nodes

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2
Q

Which lymph node cluster drains the head, neck, and oropharynx?

A

Deep cervical lymph nodes

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3
Q

Which lymph node drains the right hemithorax?

A

Right supraclavicular lymph node

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4
Q

Which lymph node drains the left hemithorax, abdomen, and pelvis?

A

Left supraclavicular lymph node (Virchow node)

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5
Q

Which lymph node cluster drains the trachea and esophagus?

A

The mediastinal lymph nodes

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6
Q

Which lymph node cluster drains the lungs?

A

The hilar nodes

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7
Q

Which body region do the axillary lymph nodes drain?

A

The upper limb, the breast, the skin above the umbilicus

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8
Q

Which body region does the celiac lymph node drain?

A

Liver, stomach, spleen, pancreas, upper duodenum

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9
Q

Which body region does the superior mesenteric lymph node drain?

A

Lower duodenum, jejunum, ileum, colon to splenic flexure

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10
Q

Which body region does the inferior mesenteric lymph node drain?

A

Colon from splenic flexure to upper rectum

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11
Q

Where would gastric cancer drain into (lymph nodes)

A

Periumbilical lymph node

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12
Q

What drains into the para-aortic lymph nodes?

A

Testes
Ovaries
Fallopian tubes
Fundus of uterus
Kidneys

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13
Q

What drains into the external iliac lymph nodes?

A

Body of uterus
Cervix
Superior bladder

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14
Q

What drains into the internal iliac lymph nodes?

A

Lower rectum to anal canal above pectinate line
Cervix, proximal vagina
Corpus cavernosum
Prostate
Inferior bladder

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15
Q

What drains into the superficial inguinal lymph nodes?

A

Distal vagina, vulva
Scrotum, urethra
**Anal canal below pectinate line””
Skin below umbilicus

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16
Q

What drains into the popliteal lymph nodes?

A

Dorsolateral foot, posterior calf

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17
Q

Describe the lymphatic drainage of the colon

A

*Until splenic flexure: superior mesenteric lymph nodes
*From splenic flexure to upper rectum: inferior mesenteric lymph nodes
*Upper rectum to anal canal above pectinate line: internal iliac
*Anal canal below pectinate line: superficial inguinal

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18
Q

What are the 3 types of activation of the complement pathway?

A
  1. Classical pathway
  2. Alternative pathway
  3. Lectin pathway
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19
Q

Explain the classical pathway of complement activation

A

The classical pathway is activated when C1 complex binds to an antigen–antibody complex (Ag–Ab). This activates C1 to cleave C4 and C2, forming C4b2b, which acts as C3 convertase. C3 convertase cleaves C3 into C3a (inflammation) and C3b (opsonization and further amplification). C3b joins with C4b2b to form C5 convertase, which cleaves C5, triggering MAC (C5b-C9) formation → cell lysis.

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20
Q

Immunoglobulins typically invovled in the classical pathway

A

IgG
IgM

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21
Q

What are the 3 outcomes of complement activation regardless of the pathway of activation?

A
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22
Q

Explain the alternative pathway of complement activation.

A

The alternative pathway is triggered directly by microbial surfaces. C3b binds to the pathogen surface. C3 convertase of the alternative pathway is then formed, and more C3 is cleaved into C3a (inflammation) and C3b (opsonization and amplification).

Additional C3b binds to form C5 convertase, leading to cleavage of C5 and formation of the membrane attack complex (MAC) for cell lysis.

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23
Q

What are the three main outcomes of complement activation, regardless of the pathway?

A
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24
Q

Which complement proteins act as anaphylatoxins?

A

C3a
C4a
C5a

Promotion of mast cell degranulation

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25
How does the lectin pathway of complement activation work?
The lectin pathway is triggered when mannose-binding lectin (MBL) bind to mannose or other sugars on microbial surfaces. This cleaves C4 and C2, forming C4b2b, the C3 convertase. This leads to C3 cleavage, C5 activation, and formation of the membrane attack complex (MAC) for pathogen lysis — similar to the classical pathway, but without antibodies.
26
What is the other formula for C3 convertase?
C4b2b
27
Recurrent infections with which organism occur in MAC complex (C5–C9) deficiency?
Neisseria species, especially Neisseria meningitidis. Patients with MAC deficiency are prone to recurrent, severe Neisseria infections because the membrane attack complex is essential for lysing Gram-negative bacteria with thin outer membranes like Neisseria.
28
what are the two primary opsonins in bacterial defense?
IgG and C3b
29
How does the CH50 test work?
The CH50 test (Total Hemolytic Complement) measures the functional activity of the classical complement pathway. It does this by mixing patient serum with antibody-coated sheep red blood cells. If the classical pathway is intact, complement activation will form the membrane attack complex (MAC), leading to cell lysis. The amount of lysis is measured spectrophotometrically. **A low CH50 suggests a deficiency in one or more components of the classical pathway (C1–C9).**
30
What are the clinical consequences of early complement deficiencies (C1–C4)?
Increased risk of severe, recurrent pyogenic sinus and respiratory tract infections and systemic lupus erythematosus (SLE) due to impaired clearance of antigen-antibody complexes (no C3b)
31
What does C1 inhibitor deficiency cause?
Hereditary Angioedema (HAE) Low C4 levels are a hallmark lab finding.
32
What is Paroxysmal Nocturnal Hemoglobinuria (PNH)?
PNH is a rare acquired hematologic disorder caused by a mutation in the PIGA gene This makes red blood cells lack protective surface proteins like CD55 and CD59, which normally inhibit complement activation. As a result, RBCs become sensitive to complement-mediated lysis, especially at night (when complement activity increases due to mild acidosis during sleep).
33
What is immune privilege?
Immune privilege refers to certain sites in the body where immune responses are limited or actively suppressed to prevent inflammation and tissue damage. These areas can tolerate the presence of antigens without triggering a strong immune reaction. Brain, eyes, testes
34
What is the difference between MHC class I and MHC class II, and which one is expressed on all cells?
35
What is positive selection, and where does it occur?
Thymic cortex
36
What is negative selection, and where does it occur?
Thymic medulla Eliminates T cells whose T-cell receptors (TCRs) bind too strongly to self-antigens presented by self-MHC molecules. Cells either undergo apoptosis or become Tregs
37
What are the 4 types of T cells that can be triggered by T helper cell activation?
Th1 Th2 Th17 Treg
38
What signals are required for Th1 activation?
IFN-gamma IL-12
39
What does Th1 activation secrete and what is its function?
IFN-gamma IL-2 Cellular immunity: activate macrophages and cytotoxic T cells.
40
What signals are required for Th2 activation?
IL-2 IL-4 Inhibited by IFN-gamma
41
What does Th2 activation secrete and what is its function?
IL-4 IL-5 IL-6 IL-10 IL-13 Activation of eosinophils and of IgE
42
What signals are required for Th17 activation?
TGF-beta IL-1 IL-6 Inhibited by IL-4 and IFN
43
What does Th17 activation secrete and what is its function?
Induce neutrophilic infiltration IL-17, IL-21, IL-22
44
What signals are required for Treg activation?
TGF-beta IL-2 Inhibited by IL-6
45
What does Treg activation secrete and what is its function?
TGF-beta IL-10 IL-35 Prevents autoimmunity
46
What surface markers do Tregs have
CD3 CD4 CD25 FOXP3
47
What are the anti inflammatory cytokines?
IL10 TGF-Beta
48
What is an important costimulatory signal for naive T cell activation through interaction with dendritic cells?
CD80/86 (B7) on dendritic interacts with CD28 on naive T cell
49
What is an important costimulatory signal for helper T cell activation through interaction with B cells?
CD40 on B cells CD40L on T cells
50
What are the Fab and Fc regions on an antibody, and which chains contribute to each?
51
What antibodies are secreted by naive B cells, as a default setting?
IgM IgD (low levels)
52
What antibodies are secreted by B cells once they are activated?
IgA IgG IgE
53
What is the difference between affinity and avidity in immunology?
54
What is the most abundant antibody isotype in the serum?
IgG
55
Which isotype of immunoglobulin crosses the placenta and confers passive immunity to newborns?
IgG
56
What is the role of IgA?
Prevents attachment of bacteria and viruses to mucous membranes Does not fix complement Produced in the GI tract by Peyer patches Released into secretions (tears, saliva, mucus) and breast milk
57
What is the form of IgA
Monomer in circulation Dimer with J chain when secreted
58
What is the form of IgM
Pentamer with J cell when secreted
59
Which antibodies are associated with warm vs cold hemolytic anemia?
Warm = IgG Cold = IgM
60
Compare affinity and avidity between IgM and IgG antibodies.
61
Which antibodies fix complement?
IgG and IgM
62
What is the "default" antibody?
IgM
63
Which antibody contributes to parasitic immunity?
IgE = eosinophil activation
64
What are the acute cytokines
IL-1 IL-6 TNF-alpha
65
Which interleukin is a major chemotactic factor for neutrophils
IL-8
66
Which IL facilitates granuloma formation in TB?
IL-12, by inducing T cell differentiation into Th1 and activating NK cells
67
What are the main roles of IL-6?
Causes fever Stimulaties production of acute-phase proteins
68
Which interleukin promotes IgE production by B cells?
IL-13
69
What disease occurs with NADPH oxidase deficiency?
Chronic granulomatous disease
70
Which organisms are patients with NADPH oxidase deficiency most susceptible to?
Catalase-positive species (staph aureus, aspergillus)
71
What are type 1 interferons
Type I interferons include interferon-α (IFN-α) and interferon-β (IFN-β). They are cytokines produced primarily by virus-infected cells as part of the innate immune response.
72
What is the B cell receptor for EBV
CD21
73
What are makers of NK cells
CD16, CD56
74
What are makers of hematopoietic stem cells
CD34
75
What are the 4 types of vaccines
Live attenuated vaccine Killed or inactivated vaccine Subunit, recombinant, polysaccharide and conjugate Toxoid vaccine mRNA vaccine
76
What kind of vaccine is the SARS-COV2 vaccine?
mRNA vaccine
77
How do mRNA vaccines work?
Deliver a synthetic strand of messenger RNA encoding a viral protein (e.g., the spike protein of SARS-CoV-2) into host cells, typically via lipid nanoparticles. B cells recognize and produce antibodies against those proteins
78
How do live attenuated vaccines work?
Live attenuated vaccines contain weakened (attenuated) versions of live pathogens that can still replicate but do not cause disease in healthy individuals. Induces **strong immune response** in the host, including cellular and humoral.
79
What vaccines are live attenuated?
Adenovirus Typhoid Polio Varicella BCG Yellow fever Influenza (intranasal) MMR Rotavirus
80
What kind of immunity do killed or inactivated vaccines confer?
Humoral immunity Usually, booster shots are required
81
What vaccines are killed or inactivated?
Hepatitis A Typhoid Rabies Influenza (intramuscular) Polio
82
What type of vaccine are corynebacterium diphtheriae and tetanus?
Toxoid vaccines Denaturated bacterial toxin with intact receptor binding site. Makes antibodies without causing disease, but booster shots usually required.
83
Describe type I hypersensitivity
Anaphylactic and atopic reactions Require sensitization (placement of IgE onto mast cells), degranulation (reaction) occurs with reexposure Fast: acute phase = immediate degranulation. Release of **histamine, tryptase and leukotrienes** Late phase: hours later, chemokines attract inflammatory cells and inflammation ensues.
84

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