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Flashcards in Immunology Deck (232):
1

Medulla of lymph node

Medullary cords with closely packed lymphocytes and plasma cells

2

Medullary sinuses

Contain reticular cells and macros communicate with efferent lymphatics.

3

paracortex

Houses T cells. Between cortex between follicles and medulla. High endothelial venules

4

Which part of lymph node enlarged in immune response?

paracortex. This part is also underdeveloped in digeorge syndrome

5

stomach drains to

celiac node

6

duodenum drains to

superior mesenteric node

7

sigmoid colon drains to

colic then inferior mesenteric

8

rectum drains to

internal iliac nodes

9

anal canal below pectinate drains to

superficial inguinal

10

testes drain to

superficial and paraaortic

11

scrotum drains

superficial inguinal node

12

thigh drains

superficial inguinal node

13

lateral dorsum of foot drains

popliteal

14

right lymphatic duct drains

right arm, right chest, right half of head

15

thoracic duct drains

everything beisdes what the right lymphatic duct drains

16

structure of sinusoids of spleen

vascular channels in red pulp with barrel hoop basement membrane

17

T cells of spleen found in

periarterial lymphatic sheath in white pulp

18

B cells of spleen found in

follicles on outer edge of white pulp

19

Macrophages of spleen are especially important for

removing encapsulated bacteria

20

What are the encapsulated organisms?

Strep
HiB
Neisseria
Salmonella
Klebsiella
Group B

21

Findings in a blood smear after a splenectomy

howell jolly bodies
target cells
thrombocytosis

22

Cortex of thymus

immature T cells

23

medulla of thymus

pale with mature T cells
epithelial reticular cells coming together to make hassall's corpuscles

24

positive selection (MHC restriction) occurs

in the cortex of thymus

25

negative selection (nonreactive to self) occurs

in the medulla of thymus

26

MHC I is expressed on all nucleated cells except for

RBCs

27

B2 microglobulin

part of MHC1, helps to transport molecule to cell surface

28

loading of antigen in MHC II

release of invariant chain in acidified endosome

29

loading of antigen in MHC1

in RER with intracellular peptides

30

HLA A3

hemochromatosis

31

HLA DQ2/DQ8

celiac

32

HLA DR2

multiple sclerosis
SLE
Goodpasteur's

33

HLA DR3

Graves' Diabetes type 1

34

HLA DR4

rheumatoid arthritis, diabetes type 1

35

HLA DR5

pernicious anemia
Hashimoto's thyroiditis

36

when do NK cells kill?

Exposed to a nonspecific activation signal on target or absence of class I MHC

37

NK activity enhanced by

IL-2, IL-12, IFN beta, IFN a

38

When an immature T cell enters the thymus, it immediate gets what receptors?

CD4+ CD8+ AND TCR

39

SIgnal for Helper T cells to become Th1 cells

IL-12

40

Signal for helper T cells to become Th2 cells

IL-4

41

Positive selection

T Cells expressing TCRs able to bind self MHC survive

42

negative selection

T cells expressing TCRs with a high affinity for self antigens= apop

43

costimulatory signal

B7 expressed by DC
CD28 expressed by naive T cell

44

What happens after the primary and costimulatory signal is given by dendritic cell to naive T cell?

Naive T cell expresses IL-2 which binds to IL-2R on itself stimulating the naive T cell to differentiate

45

What happens after the primary and costimulatory signal is given by Th4 cell to naive B cell?

the helper T cell, after being activated by dendritic cell
-->B cell presents antigen on MHC II to activated T cell
-->TCR recognizes correct antigen and releases IL4 and IL5 which stimulate the B cell to differentiate into IgG, IgE, and IgA

46

What is the only APC that can activate a naive T cell?

the dendritic cell

47

Describe the costimulatory signal for B cell activation

CD 40 on B cell
CD40 L on Th cell

48

Th1 cell secretes

IFN-y

49

Th2 cell secretes

IL4, 5, 10, 13

50

Th1 cell activates

macrophages

51

Th2 cell activates

Eosinophils
IgE production by B cells

52

Th1 cell inhibited by

IL4 and IL10

53

Th2 inhibited by

IFN-y

54

How do macrophages and lymphocytes tickle or stimulate each other?

lymphocytes release IFN-y
macrophages release IL1 and TNF-a
--> they help each other out

55

Hyper IgM caused by

Defective CD 40 and 40L interaction

56

Contents of cytotoxic T cells (CD8)

granules with
1. perforin: makes holes so can deliver bombs
2. granzyme: serine protease, activates apoptosis
3. granulysin: antimicrobial, induces apoptosis

57

Treg cells express which cell surface markers

CD3, CD4, and CD25

58

Treg cells produce

IL10 and TGFbeta

59

heavy chain makes up which portions of antibody

Fc and Fab

60

light chain makes up which portion of antibody

Fab

61

CD25 is also known as

alpha chain of IL-2 receptor.

62

complement binds which part of antibody

medial portion of Fc

63

macrophage binds which part of antibody

distal to where complement binds, between CH2 and CH3

64

three components of the Fc region

carboxyterminal end
complement binding at CH2 (IgG and IgM)
Carbohydrage side chains

65

light chains made up of

VJ

66

heavy chains made up of

VDJ

67

stomatic hypermutation occurs after

antigen stimulation of B cell. BUT B cells are "born" with their random VJ/VDJ combinations.

68

What enzyme is responsible for generating the VD/VDJ recomination?

terminal deoxynucleotidyl transferase
--Adds nucleotides to DNA during recombination

69

isotype switching

When B cells secrete things other than IgM

70

Mature B lymphocytes express what on their surface

IgM AND IgD

71

Which antibody can cross the placenta?

IgG

72

Which antibodies can fix complement?

Only IgG and IgM

73

which antibody is responsible for delayed response to an antigen?

IgG

74

How does IgA work?

Prevents attachment of bacteria to mucous membranes

75

IgA form in circulation?

monomer. dimer when secreted

76

Which Ig is the antigen receptor of the surface of B cells?

IgM

77

thymus independent antigens

antigens lack a peptide component and cannot be presented by MHC to T cells (ex: LPS or capsular antigen)
-->as a result, NO immunologic memory
-->but antibodies are released

78

Thymus dependent antigens

There IS a protein component (diptheria) and class switching occurs

79

Classic complement pathway

IgG or IgM mediated

80

Lectin pathway

mediated by Mannose on microbe

81

Alternative pathway turned on by

PAMP pathogen associated molecular pattern

82

C3b

opsonization

83

C5a

neutrophil chemotaxis

84

What starts the alternative pathway?

C3-->C3b
AND
D converts B into Bb
=C3bBb

85

what starts the lectin pathway?

MBL activates a C1 like complex
--cleaves C2 AND C4
--otherwise, same as classic pathway

86

primary opsonins

IgG
C3b

87

What prevents complement activation on self cells?

Decay accelerating factor
C1 esterase inhibitor

88

complement disorder with hereditary angioedema

C1 esterase inhibitor deficiency

89

What drug is contraindicated in C1 esterase inhibitor deficiency?

ACE inhibitors

90

severe pyogenic sinus and respiratory tract infections with increased type III hypersensitivity--type of complement deficiency

C3 deficiency. C3 helps clear immune complexes

91

Recurrent neisseria bacteremia

C5-9 deficiency

92

Complement mediated lysis of RBCs and PNH

DAF deficiency

93

What does IL-1 do to endothelium?

induces adhesion molecule expression

94

IL6

fever and acute phase proteins

95

IL8

neutrophil chemotaxis

96

IL12

Differentiation into Th1 cells
Activates NK cells

97

IFN-y

Increase MHC I and II expression.

98

Interferon a and b mechanism

Produce a ribonuclease=degradation of viral mRNA

99

IFN is defense against

VIRUSES
--they all activate NK cells to kill virus infected cells

100

Cell surface proteins on T cells

TCR
CD3
CD28

101

CD proteins on Th4

CD4, CD40L

102

B cell CD proteins

CD19, 20, 21
40, MHCII, B7

103

Receptor for epstein barr virus

CD21

104

Macrophage receptors

CD14 (binds LPS)
CD40
MHC II
B7

105

NK cell receptors

CD16 (binds Fc)
CD56 (unique marker)

106

Superantigens secreted by which bugs?

S aureus (TSST-1)
S pyogenes (exotoxin A)
-->NOTE THAT ALL T CELLS ARE ACTIVATED from cross linking fo TCR to MHC II on APCs

107

LPS stimulates

macrophages!

Thelper cells are NOT involved. Massive secretion of TNF alpha

108

Salmonella antigen variation

flagella

109

neisseria gonorrhea antigen variation

pilus protein

110

what other bugs have antigen variation?

trypanosomes
borrelia

111

When do you give passive immunization?

Tetanus
Botox
Rabies
HBV

112

Live vaccines activate a

cellular response

113

killed vaccines activate a

humoral immunity

114

examples of killed vaccines

Rabies
Influenza (shot)
Polio (salk)
HAv
Cholera

115

marker of mast cell degranulation

tryptase

116

Explain Type II hypersensitivity

IgM/G bind to antigen
--opsonization
--complement lysis
--Antibody dependent cell mediated cytotoxicity, NK cells

117

How to test for type II hypersen

Direct and indirect coombs'

118

serum sickness

immune complex disease where immune complexes bind and deposit where they fix complement=tissue damage

119

arthus rxn

Intradermal injection induces antibodies and complexes in the skin.
---edema, necrosis, activation of complement

120

When would you see serum sickness?

5-10 days after exposure

121

most serum sickness is caused by

drugs

122

Sx: serum sickness

fever, urticaria, arthralgias, protienuria, lymphadenopathy

123

Test for arthus rxn

immunofluorescen staining

124

Describe process of type IV hypersensitivity

t lymphocytes activate macrophages and secrete lymphokines

125

Examples of type IV hypersensitivity

multiple sclerosis
guillain barre
graft versus host disease
contact dermatitis
tranplant
TB skin test

126

allergic rhinitis and hay fever

Type I hypersensitivity

127

Four types of blood transfusion reactions

allergic rxn
anaphylactic
febrile nonhemolytic
acute hemolytic transfusion

128

concern when giving blood transfusion to pt with celiac's

many celiac's pts are deficient in IgA
--must receive blood products that lack IgA

129

Febrile nonhemolytic transfusion rxn

type II hypersensitivity. Host antibodies against donor HLA antigens

130

sx of febrile nonhemolytic TR

fever, chills, flushing

131

Acute hemolytic transfusion rxn

type II hypersensitivity. Intravascular hemolysis or extravascular hemolysis

132

Sx of acute hemolytic transfusion rxn

fever, hemoglobinemia, jaundice (extravascular)
flank pain, hypotension

133

Anti-histone antibody

Drug induced lupus

134

anticentromere

CREST

135

antiScl70 (DNA topo I)

Diffuse scleroderma

136

antimitochondrial

primary biliary cirrhosis

137

IgA antiendomyseal

celiac

138

anti-desmoglein

pemphigus vulgaris

139

antimicrosomal

hashimotos
also antithyroglobulin

140

Anti Jo-1, Anti-SRP, Anti-Mi2

polymyositis
dermatomyositis

141

Anti-SSA/SSB

sjogren

142

anti-smooth muscle

autoimmune hep

143

anti glutamate decarboxylase

t1D

144

p-ANCA

microscopic polyangiitis, churg strauss

145

c-ANCA

granulomatosis with polyangiitis

146

anti-glutamate decarb

type 1 diabetes

147

anti-U1 RNP

mixed CT disease

148

No B cells: susceptible to which bacteria?

Encapsulated

149

No complement: susceptible to which bacteria?

Neisseria

150

No granulocyte: susceptible to which bacteria?

Staph
Serratia
Nocardia

151

No T cells: susceptible to what bacteria?

everything. Sepsis!

152

No T cells, susceptible to which viruses?

CMV
EBV
VZV

153

how do you test for type IV hypersensitivity?

candida extract skin test

154

Does the absence of anti-dsDNA of anti-Smith rule out possibility of SLE?

NO--these are highly specific for ruling in

155

recurrent Candida
PCP


No T cells

156

Recurrent giardia infection

No B cells (no IgA)

157

Recurrent candida and aspergillus

No granulocytes

158

recurrent bacterial infections 6 months after birth
-normal proB
-low B cells
-low Ig (all types)

Bruton's X linked agammaglobulinemia

159

Cause of bruton' x linked agamma?

Defect in Bruton tyrosine kinase so NO B CELL MATURATION

160

asymptomatic but recurrent sinopulmonary/GI infections. Also history of celiacs or other autoimmune.

Selective IgA deficiency.

161

what do pts with selective IgA deficiency test false positive for?

beta HcG. cuz of heterophile antibody

162

what is a heterophile antibody?

induced antibody that is characterized by broad reactivity with antibodies of other animal species

163

pt in 20's and 30s suddenly present with lymphoma and sinupulmonary infections. Normal B cell number but decreased plasma cells and immunoglobulin

CVID

164

Cause of CVID

defect in B cell maturation

165

pts with CVID increased risk of

autoimmune dz

166

pt has tetany, recurrent viral/fungal infections

DiGeorge syndrome

167

lab findings in Digeorge

absent thymic shadow
--low PTH
--low T cells
--low calcium

168

cause of DiGeorge

22q11 =failure of 3rd and 4th branchial pouches to form


(also cause of tetraology of fallot and persistent truncus arteriosus! cool!)

169

disseminated mycobacterial infections

IL-12 receptor deficiency

170

lab findings in IL12 receptor deficiency

decreased IFN-y

171

coarse facies
staphylococcal absecess
primary teeth retained
Eczema

Hyper IgE (Job's syndrome)

172

Cause of hyper IgE (Job's)

Th1 cells fail to produce IFN-y
--neutrophils fail to go where they need to go
--will have lots of Th2 cells

173

candida infections of skin and mucous membranes

Chronic mucocutaneous candidiasis
--caused by T cell dysfunction

174

Failure to thrive, chronic diarrhea
--recurrent fungal, viral, bacterial infections

SCID

175

XRay and lymph node biopsy findings in SCID

Absence of thymic shadow
No germinal centers in lymph nodes
No B cells
--Decreased Tcell recombinant excision circles
--decreased T cells on flow cytometry

176

cause of SCID

1. Defective IL2 (most common)
2. Adenosine deaminase deficiency

177

Ataxia, spider angiomas, and IgA deficiency

ataxia telangiectasia

178

Cause of ataxia telangiectasia

Defects in ATM gene: codes for DNA repair enzymes

179

Lab findings in Ataxia telangiectasia

Increased AFP

180

Severe pyogenic infections early in life

Hyper IgM

181

Cause of hyperIgM

defective CD40L cannot class switch

182

thrombocytopenic purpura
infections
eczema

wiskott aldrich syndrome

183

Cause of wiskott aldrich

WAS gene defective. T cells unable to reorganize actin cytoskeleton

184

inheritance of wiskott aldrich

X linked

185

Lab findings of wiskott aldrich

Increased IgE, IgA
Decreased IgM
Low platelets

186

Recurrent bacterial infections, no pus, and delayed separation of umbilical cord

leukocyte adhesion deficiency

187

Cause of Leukocyte adhesion deficiency

Defect in LFA-1 integrin (CD-18)

188

lab findings in leukocyte adhesion deficiency

neutrophilia

189

recurrent pyogenic infections by staph and strep
PARTIAL albinism and peripheral neuropathy

chediak higashi

190

Cause of chediak higashi

Defect in lysosomal trafficking regulator gene (LYST). Microtubule dysfunction in phagosome-lysosome fusion

191

inheritance of chediak higashi

Autosomal recessive

192

giant granules in neutrophils

lab findings in chediak higashi

193

abnormal dihydrorhodamine flow cytometry test

chronic granulomatous disease

194

susceptibility to catalase positive organisms (S aureus, E coli, aspergillus)

chronic granulomatous disease

195

cause: Chronic granulomatous disease

lack of NADPH oxidase. Cannot make reactive oxygen species in neutrophils

196

Susceptible to BOTh catalase positive and negative orgs

myeloperoxidase deficiency. Cannot turn H2O2 into an O2 radical...EVEN though H2O2 is provided by catalase negative organisms!

197

syngeneic graft

From identical twin

198

acute rejection time frame

weeks

199

chronic rejection time frame

months to years

200

hyper acute rejection: type of hypersensitivity rxn?

Type II. preformed antibodies in transplant recipient attack donor cells (blood mismatch)

201

occlusion of graft vessels causing ischemia and necrosis

hyperacute rejection

202

vasculitis of graft vessels with dense intertitial lymphocytic infiltrate

acute rejection

203

Fibrosis of graft tissue and blood vessels

chronic rejection.

204

mechanism of acute rejection

Cell mediated
-CTL react against foreign MHC
-Reversible

205

which rejection is NOT reversible?

chronic

206

macropapular rash, jaundice, hepatosplenomegaly and diarrhea in a transplant pt

GVH disease

207

which types of transplants most susceptible to GVH disease?

bone marrow and liver transplants (rich in lymphocytes)

208

Mech: cyclosporin

blocks diff and activation of T cells
--inhibits calcineurin.
--No IL2 and IL2R

209

tox of cyclosporine

nephrotoxicity
hypertension
hyperlipidemia/glycemia
gingival hyperplasia
hirsutism

210

Mech: tacrolimus

Binds FK binding protein, inhibiting calcineurin

211

tox of tacrolimus (FK506)

same as cyclosporin, but NO gingival hyperplasia and NO hirsuitism

212

Sirolimus (rapamycin) mechanism

Inhibits mTOR and T cell proliferation

213

Use of sirolimus

tranplant and drug eluting stent

214

toxicity: sirolimus

hyperlipidemia, thrombocytopenia, leukopenia

215

mechanism: azathioprine

precursor of 6 MP
--interferes with synthesis of nucleic acids
--toxic to lymphocytes

216

Use azathioprine

kidney transplant
--GN and hemolytic anemia

217

Muromonab-CD3 (OKT3) mech

Binds CD3 and blocks T cell signal

218

Tox of muromonab

cytokine release syndrome, hypersensitivity

219

use: muromonab

kidney transplant

220

Omalizumab

Anti-IgE for sever asthma

221

aldesleukin

IL-2

222

Use: aldesleukin

RCC
metastatic melanoma

223

EPO

renal failure anemia

224

filgrastim

GCSF

225

sargramostim

GMCSF

226

alpha IFN use:

Hep B, C
kaposi's
leukemia
malignant melanoma

227

B IFN

multiple sclerosis

228

y interferon

chronic granulomatous disease

229

Oprelvekin

thrombocytopenia

230

Use: filgrastim/sargramostim:

Recovery of bone marrow

231

trastuzumab

HER 2 antibody

232

Describe the process of inflammatory leukocyte migration

1. margination
2. rolling: with sialyl acid binding to L, E or P selectin (induced by cytokines)
3. activation of integrins
4. MAC-1 and LFA-1 integrins bind ICAM-1 on leukocyte
5. transmigration