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Immunology Flashcards

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1
Q

Lymph node structures (3)

A
  1. Follicle: B-cell localization and proliferation in outer cortex
    primary: dense and dormant
    secondary: pale central germinal centers, active
  2. Medulla: cords and sinuses (communicate with efferent lymphatics)
  3. Paracortex: T-cells (b/w follicles and medulla); have endothelial venules for T and B cells to enter blood
    ENLARGE during immune response
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2
Q

head and neck drain into…

A

cervical

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3
Q

lungs drain into…

A

hilar

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4
Q

trachea, esophagus drain into..

A

mediastinal

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5
Q

upper limb
breast
skin above umbilicus drain into…

A

axillary

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6
Q 
liver
stomach
spleen
pancreas
upper duodenum drain into...
A

celiac

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7
Q

lower duodenum
jejunum
ileum
colon to SPLENIC flexture drain into…

A

superior mesenteric

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8
Q

colon from splenic flexure to upper rectum drain into…

A

inferior mesenteric

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9
Q

lower rectum ot anal canal (above pectinate line)
bladder
vagina (middle third)
prostate drain into…

A

internal iliac

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10
Q

testes
ovaries
kidneys
uterus drain into…

A

para-aortic

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11
Q 
anal canal (below pectinate line)
skin below umbilicus (except popliteal)
scrotum drain into...
A

superfiical inguinal

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12
Q

dorsolateral foot

posterior calf drain into…

A

popliteal

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13
Q 
Spleen structures (3)
and what they contain
A
  1. red pulp - sinusoids, long vascular channels with “barrel hoop” BM
  2. white pulp
    T cells - perarteriolar lymphatic sheath (PALS)
    B cells - follicles/germinal centers
3. marginal zone
contain APCs (capture Ag for recognition) and specialized B cells
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14
Q

Splenic dysfunction

7 organisms
“SHiNE SKiS”

A

susceptibility to encapsulated organisms

decreased IgM –> low complement activation –> C3b opsonization

  1. Strep pneumoniae
  2. H influenzae type B
  3. Neisseria meningitidis
  4. E. coli
  5. Salmonella spp.
  6. Klebsiella pneumoniae
  7. GBS
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15
Q

Postsplenectomy signs (4)

A
  1. Howell-jolly bodies (nuclear remnants)
  2. Target cells
  3. Thrombocytosis (loss of sequestration)
  4. Lymphocytosis (loss of sequestration)
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16
Q

Thymus

A

T-CELL HOME

derived from 3rd pharyngeal pouch

cortex: dense, immature (+ selection)
medulla: pale, mature (- selection)

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17
Q

INNATE vs. adaptive immunity

A

neutrophils, macrophages, monocytes, dendritic cells, NK cells
rapidly
nonspecific
TLRs and pathogen associated molecular patterns (PAMPs)

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18
Q

innate vs ADAPTIVE

A 
T cells, B cells circulating Ab
develops over long period of time
specific
highly specific
immunoglobulins
memory cells
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19
Q

MHC I
HLA?
Function?

A

HLA-A, B and C

Binding TCR and CD8 (1 x 8 = 8)

present endogenously synthesized antigens to CD8 cytotoxic T cells

loaded in RER

beta 2 microglobulin

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20
Q

MHC II
HLA?
Function?

A

HLA-DR, DP, DQ

Binding TCR and CD4 (2 x 4 = 8)

expressed on APCs
present endogenously synthesized antigens to CD4 helper T cells

invariant chain

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21
Q

HLA associated with disease

A3

A

hemochromatosis

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22
Q

HLA associated with disease

B27

A

psoriatic arthritis
ankylosing spondylitis
arthritis of IBD
reactive arthritis

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23
Q

HLA associated with disease

DQ2/DQ8

A

Celiac disease

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24
Q

HLA associated with disease

DR2

A

MS
hay fever
SLE
Goodpasture syndrome

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25
HLA associated with disease | DR3
DM Type I SLE Graves disease Hashimoto thyroiditis
26
HLA associated with disease | DR4
Rheumatoid arthritis | DM type 1
27
HLA associated with disease | DR5
``` pernicious anemia (vitamin B12 def) hashimoto thyroiditis ```
28
B cell fxn
1. recognize Ag | 2. produce Ab - differentiate into plasma cells to secrete Ig
29
T cell fxn
1. CD4 T helper - help B cells make Ab and produce cytokines to recruit phagocytes and activate other leukocytes 2. CD8 T killer - kills VIRUS-infected cells delayed cell-mediated HS (type IV)
30
Th1 (helper T cell)
secrete IFN-gamma activate macrophage and CD8 activated by IFN-gamma and IL-12 inhibited by IL4 and IL10 (Th2)
31
Th2 (helper T cell)
secrete IL4, 5, 10, 13 recruit eosinophils for paraiste defense and promote B cell IgE production activated by IL-4 inhibited by IFN-gamma (Th1)
32
Treg
suppress CD4 and CD8 identified by expression of CD3, CD4, CD25, FOXP3 produce anti-inflammatory cytokines (IL-10, TGF-beta)
33
T cell activation | 2 signals
dendritic cell (APC) to naive T cell 1. MHCI/II and CD8/4, TCR 2. B7 and CD28
34
B cell activation | 2 signals
Thcell (CD4) to B cell 1. TCR and MHC II 2. CD40L and CD40
35
IgG
DELAYED response crosses the placenta most abundant
36
IgA
prevents attachment of bacteria and virus to GI | released in secretions and breast milk
37
IgM
IMMEDIATE response | antigen receptor on B cells
38
IgE
immediate (type I) hypersensitivity | lowest concentration
39
Acute phase reactants - induced by IL-6 upregulated? 5
1. CRP - phagocytosis 2. Ferritin - binds and sequesters Fe 3. Fibrinogen - coagulation, endothelial repair 4. Hepcidin - prevents Fe release from ferritin (anemia of chronic disease) 5. serum amyloid A
40
Acute phase reactants - induced by IL-6 downregulated? 2
1. albumin - conserve AA | 2. transferrin - internalized by macrophages to sequester Fe
41
Complement pathway | C3b
``` opsonization in bacterial defense enhance phagocytosis (along with IgG) ```
42
Complement pathway C3a C3a C5a
anaphylaxis
43
Complement pathway | C5a
neutrophil chemotaxis
44
Complement pathway | C5b-9
cytolysis by MAC
45
C1 esterase inhibitor deficiency
causes herditary angioedema ACEi contraindicated
46
C3 deficiency
increases risk of severe recurrent pyogenic sinu and resp tract infxns increased susceptibility to type III HS rxn
47
C5-C9 deficiencies
increased susceptibility to Neisseria bacteremia
48
DAF deficiency
complement-mediated lysis of RBC and paroxysmal nocturnal hemoglobinuria
49
IL-1 secreted by? fxn?
macrophages FEVER
50
IL-2 secreted by? fxn?
T cells stimulates T cells
51
IL-3 secreted by? fxn?
T cells stimulates bone marrow
52
IL-4 secreted by? fxn?
Th2 cells stimulate IgE production induce Th2 cells promote B cells
53
IL-5 secreted by? fxn?
Th2 cells stimulate IgA production promote B cells
54
IL-6 secreted by? fxn?
macrophages stimulate acute phase reactants
55
IL-8 secreted by? fxn?
macrophages recruits neutrophils
56
IL-10 secreted by? fxn?
Th2 cells inhibit immune response inhibit macrophages and dendritic cells
57
IL-12 secreted by? fxn?
macrophages induce Th1 cells activate NK cells
58
TNF-alpha secreted by? fxn?
macrophages septic shock! recruit WBC
59
cell surface proteins | T cells
TCR CD3 CD28 (binds B7 on APC)
60
cell surface proteins | Th
CD4 | CD40L
61
cell surface proteins | Tc
CD8
62
cell surface proteins | Tr
CD4 | CD25
63
cell surface proteins | B cells
``` Ig CD19, 20 21 CD40 MHC II B7 ```
64
cell surface proteins | macrophages
``` CD14 CD40 MHC II B7 Fc and C3b receptors (phagocytosis) ```
65
cell surface proteins | NK cells
CD16 (binds Fc of IgG) | Cd56
66
cell surface proteins | hematopoietic stem cells
CD34
67
passive vs. active immunity
passive: preformed Ab e. g. IgA in breast milk, maternal IgG pts given preformed Ab after: 1. tetanus 2. botulinum 3. HBV 4. varicella 5. rabies active: foreign Ag for memory e. g. vaccines
68
Type I HS
anaphylactic and atopic IgE histamine - rapid reaction e.g. asthma, rhinitis, eczema, bee sting
69
Type II HS
cytotoxic (Ab mediated) IgG and IgM on "enemy cell" Direct Coomb's: detect Ab on patient's RBCs (test Rh+ infant of an Rh- mother) Indirect Coomb's: detect serum Ab that can adhere to other RBC (test Rh- woman for Rh+ antibodies)
70
Type III HS
Immune complex - Ag/Ab (IgG) serum sickness: Ab to foreign proteins, immune complexes form and deposited in membranes; caused by drugs fever, urticaria, athralgia, proteinuria, LAD arthus reaction: intradermal injection of Ag induces immune complex in skin - edema, necrosis (after tetanus vaccine)
71
Type IV HS
delayed T-cell transplant rejections TB skin test contact dermatitis
72
blood transfusion rxn | urticaria, pruritis, wheezing, fever
allergic rxn Type I | treat: antihistamine
73
blood transfusion rxn | dyspnea, bronchospasm, hypotension, respiratory arrest, shock
anaphylactic rxn IgA deficiency treat: epinephrine
74
blood transfusion rxn | fever, headaches, chills, flushing
febrile nonhemolytic transfucions rxn Type III against HLA Ag and WBCs
75
blood transfusion rxn | flank pain, hemoglobinuria, jaudnice, hypotension, tachypnea, tachycardia
acute hemolytic transfusion rxn type III ABO blood group incompatibility
76
AutoAb | Myasthenia gravis
Anti-ach receptor
77
AutoAb | Goodpasture syndrome
Anti-basement membrane
78
AutoAb SLE Antiphospholipid syndrome
Anticardiolipin | lupus anticoagulant
79
AutoAb | CREST syndrome
anticentromere
80
AutoAb | pemphigus vulgaris
anti-desmosome (anti-desmoglein)
81
AutoAb | SLE
anti-dsDNA | anti-Smith
82
AutoAb | Type I DM
anti-glutamic acid decarboxylase (GAD-65)
83
AutoAb | Bullous pemphigoid
anti-hemidesmosome
84
AutoAb | drug-induced lupus
anti-histone
85
AutoAb polymyositis dermatomyositis
Anti-jo-1 anti-SRP anti Mi 2
86
AutoAb | Hashimoto thyroiditis
antimicrosomal | antithyroglobulin
87
AutoAb | primary biliary cirrhosis
AMA
88
AutoAb | SLE, nonspecific
ANA
89
AutoAb | pernicious anemia
Anti-parietal
90
AutoAb | scleroderma
Anti Scl-70 | anti DNA topoisomerase I
91
AutoAb | AI hepatitis
Anti-smooth muscle
92
AutoAb | Sjogren syndrome
Anti-SSA | anti-SSB (anti-Ro, anti-La)
93
AutoAb | Graves disease
Anti-TSH receptor
94
AutoAb | Mixed connective tissue disease
Anti-U1 RNP
95
AutoAb | Celiac disease
IgA anti-endomysial | IgA anti-tissue transglutaminase
96
AutoAb microscopic polyangiitis eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
MPO-ANCA | p-ANCA
97
AutoAb | Wegener (granulomatosis with polyangiitis)
PR3-ANCA | c-ANCA
98
AutoAb | Rheumatoid arthritis
``` Rheumatoid factor (IgM targets IgG Fc region) anti-CCP (more specific) ```
99
X linked (Bruton) agammaglobulinemia
Defect in BTK (tyr kinase) NO B-CELL MATURATION X-linked recessive bacteria + enteroviral infection (after 6 mths) low Ig of ALL CLASSES absent lymph nodes
100
Selective IgA deficiency
B-CELL asymptomatic Atopy, anaphylaxis to blood transfusion low IgA NORMAL IgG, IgM
101
Common variable immunodeficiency
B-CELL DISORDER low plasma cells low immunoglobulins
102
Thymic aplasia | DiGeorge syndrome
T-CELL disorder 22q11 deletion failure 3rd and 4th pouches (NO THYMUS AND PARATHYROIDS) tetany (hypocalcemia) viral + fungal infection TOF, truncus arteriosus LOW: T cells, PTH, Ca absent thymic shadow
103
IL-12 deficiency
T-CELL DISORDER autosomal recessive mycobacterial + fungal infections e.g. after BCG vaccine low IFN-gamma
104
autosomal dominant hyper-IgE syndrome (Job syndrome)
T-CELL DISORDER STAT3 mutation course facies cold staph abscesses retained primary teeth eczema high: IGE low: IFN-gamma
105
chronic mucocutaneous candidiasis
T-CELL DISORDER absent reaction to Candida antigens
106
SCID (severe combined immunodeficiency)
B+T cell disorder IL-2R gamma X linked adenosine deaminase autosomal recessive failure to thrive chronic diarrhea thrust viral + bacterial + fungal + protozoal BUBBLE BOY treatment: bone marrow transplant
107
ataxia-telangiectasia
B+T cell disorder defect in ATM gene 1. ataxia 2. spider angiomas 3. IgA deficiency high ATP
108
hyper-IgM syndrome
B+T cell disorder CD40L on Th cells X linked recessive pneumocystis cryptosporidium CMV
109
Wiskott-Aldrich syndrome
B+T cell disorder WAS gene X linked recessive thrombocytopenic purpura eczema recurrent infections low to normal IgG, IgM high IgE, IgA
110
leukocyte adhesion deficiency (type 1)
phagocyte dysfxn LFA-1 integrin (CD18) autosomal recessive absent pus formation impaired wound healing delayed separation of umbilical cord
111
Chediak-Higashi syndrome
``` phagocyte dysfxn LYST gene (lysosomal trafficking) autosomal recessive ``` partial albinism neurodegeneration recurrent staph and strep infections
112
Chronic granulomatous disease
phagocyte dysfxn NADPH oxidase - decreased ROS and decreased respiratory burst in neutrophils X linked recessive increased susceptibility to catalse + abrnoaml dihydrorhodamine test nitroblue tetrazolium dye reduction test -
113
transplant rejection | hyperacute
within minutes pre-existing recipient Ab Type II widespread thrombosis ischemia/necrosis tx: remove graft
114
transplant rejection | acute
wks to months CD8 vasculitis of graft vessels tx: immunosuppresants
115
transplant rejection | chronic
months to years CD4 arteriosclerosis
116
transplant rejection | graft vs. host disease
grafted T cells proliferate in IC host and reject host cells with "foreign proteins" maculopapular rash jaudnice diarrhea HSM usually in BM and liver transplants
117
immunosuppressants cyclosporine mech and tox
mech: calcineurin inhibitor - binds cyclophilin; blocks T cell activation by preventing IL-2 transcription NEPHROTOXICITY gingival hyperplasia neurotoxicity hirsutism
118
immunosuppressants | tracrolimus (FK506)
Mech: calcineurin inhibitor; blocks T cell activation by preventing IL-2 txn ``` NEPHROTOXICITY diabetes neurotoxicity gingival hyperplasia hirsutism ```
119
immunosuppressants | sirolimus (rapamycin)
Mech: mTOR inhibitor; prevent response to IL-2 use: kidney transplant + DES! tox: thrombocyotpenia, leukopenia, insulin resistance, hyperlipidemia
120
immunosuppressants daclizumab basiliximab
monoclonal Ab; block IL-2R use: kidney transplant edema, htn, tremor
121
immunosuppressants | azathioprine
antimetabolite precursor of 6-mercaptopurine; inhibit lymphocyte proliferation by blocking nucleotide synthesis toxicity increased by allopurinol
122
immunosuppressants | glucocorticoids
inhibit NF-kB, decrease transcription of cytokines ``` hyperglycemia osteoporosis central obesity muscle breakdown psychosis acne htn cataracts avascular necrosis ``` can cause iatrogenic cushing syndrome

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