Immunology

Question 0

HLA B27 associated with PAIR

Answer 0

psoriasis
Ank spond
IBD
Reiters

Question 1

Effect of IFN gamma on macrophages

Th1nk Big Mac attack

Answer 1

Th1 and NK cells Build IFN gamma

Augments macrophage ability to attack

Question 2

Sjogrens features

MAPLES

Answer 2

mouth dry
Arthritis
Parotid enlargement
Lymphoma
Eyes dry
Sicca (primary) or secondary

Question 3

Digeorge syndrome disease of Ts

Answer 3

Third and fourth pharyngeal pouches absent
Twenty two chromosome
T cells absent
Tetany from hypocalcaemia (no PTH)

Question 4

IL1

Answer 4

Produced my macrophages monocytes and dendritic cells
Activates T cells
B cells mature
Reset hypothalamus with il6, IFN, tnf

Question 5

Il2

Answer 5

Thcells
Acts on T cells and NK cells - self activation
iL2 plus 4 leads to persistent IgM and not class switch

Question 6

IL4

Answer 6

Produced by Th2 and basophils
Promotes TH2 differentiation
Acts on active B cells–> increase proliferation
Tells to become a plasma cell and produce IgE- isotope switching
Eosinophil and mast cell growth and function
Immunoregulstes to decrease macro activity

Question 7

IL5

Answer 7

Growth and diff eosinophils

Produced by Th2

Question 8

IL6

Answer 8

Th2 is major source. Also mono macro and BM cells
Promote plasma cell differentiation
Hepatocyte stimulating factor - stimulates to make acute phase reactants
Induces fever

Question 9

IL8

Answer 9

Chemokine . Attracts neuts

Macros and endothelial secrete when stimulated by IL1, TNF alpha, bacterial products so that can attract neuts

Question 10

IL10

Answer 10

Important inhibitory role
Acts on macrophages to inhibit ck production to downregulate Th1 type of THC

RELEASD by Th2

Downregulates MHC2 on APC

With IL4 decreases macro activity

Question 11

IL12

Answer 11

Major CK secreted by APCs to activate T cells and drive them down the Th1 pathway

Opposes effects Il4 on APCs

Question 12

IFN Gamma

Answer 12

Secreted by NK and Th1 and cytotoxic T cells
Angers macs
Increase MHC I , increase antigen presentation
Increase MHC 2 expression on APCs
Class switch to IgG
Down regulatory effect on TH2 function
Induces IL12 production by macrophages which inhibits tH2
IFN AND TNF mediate TB inflamm
If deficiency of IFN OR ITS RECEPTOR prone to overwhelming mycobacterial infection

Question 13

TNF alpha

Answer 13

Macrophages produce in response to gram negative and other microbial infections
Binds tumour cells and activates CAPSASE pathway–> death by apoptosis
Induces fever
Recruits cells to inflammation site
Potentiated by IFN gamma
Overproduction can lead to inflammation like arthritis or septic shock
Stimulates liver to produce acute phase proteins

Question 14

TGF beta

Transforming growth factor

Answer 14

Secreted by plt macro lympho
Class switch to IgA
Attract macro and mono
Downregulate a macro and Excess T cell function

Question 15

IL 13

Answer 15

Similar to IL4

Question 16

IFN alpha

Answer 16

Antiviral activity
Expression MHC 1
Activate NK

Question 17

IFN beta

Answer 17

Antiviral
Increase MHC 1 expression
Activate NK

Question 18

What is the trigger for chronic urticaria and angioedema?

Answer 18

High dose antihistamines

AVOID STEROIDS oral/systemic

Question 19

B cell surface markers? How do they change as time goes on??

Answer 19

CD 19 from pre-B cell to plasmablast (the one right before a mature plasma cell)
CD 20 from Pre-B cell right through to plasmablast- NOT memory or plasma B cells
CD40 from Activated B cell to Plasma cell (CD40 is the most important for interaction between B and T cells that activate the B cells)

Question 20

Which surface Igs to B cells have at different stages?

Answer 20

sIgM on Immature B cell
then
sIgM and IgD on naive B cell

Question 21

In general terms, how do you treat cellular rejection vs antibody mediated rejection?

Answer 21

Cellular: Signal 1 with cyclosporine A, Tac, Signal 2 with CTLA4 Ig (belatacept)- binds B7, Signal 3 with anti CD 35 and MTOR inhibs, “late” blockers with MMF and AZA, and depletion with ATG

Antibody: plasma exchange, andti CD20 which is ritux, and proteasome inhibitors

Question 22

What is the Banff classification?

Answer 22

International classification of renal transplant pathology, but can be used for other organs.

1. normal
2. antibody mediated (classically stain positive for C4d but not always)
3. borderline changes suspicious for T cell mediated rejection
4. acute T cell mediated rejection
5. interstitial fibrosis and tubular atrophy
6. Other changes not due to rejection

Question 23

Name some causes of long term renal allograft loss. (4)

Answer 23

Chronic allograft nephropathy from CNI toxicity, rejection
Death with functioning graft (CVD, malig)
Recurrent disease
BK nephropathy

Question 24

How does bortezomib work?

Answer 24

Proteosome inhibitor NFkB is critical for memory B cells and plasma cells. IkB inhibits NFkB but is kept in check by proteosomes which degrade IkB. Proteosome inhibitor blocks IkB degradation-->heaps of IkB to inhibit NFkB

Question 25

How does campath work? (Alemtuzumab)

Answer 25

Anti CD 52 Depletes T cells profoundly Induction therapy and immunosupression minimisation T cells then repopulate ?T regs

Question 26

How does Eculizumab work?

Answer 26

C5a complement inhibitor When anti-HLA Ab bind, they cause complement activation-->MAC Eculizumab binds C5 with high affinity and prevents cleavage to C5a and b and hence formation of the MAC

Question 27

Anaemia of chronic disease - WHICH CYTOKINES ARE RESPONSIBLE?

Answer 27

IL-1 IL-6 TNF alpha. Also IFN beta and IFN gamma

Question 28

Best screening tool for hereditary angioedema? (low levels of C1-INH protein)

Answer 28

Serum C4 is the most reliably low inbetween attacks C2 also low C1-INH low during attack Treatment is acutely IV C1 inhibitor concentrate, FFP if this is not available Prophylaxis: anabolic steroid Danazol may help

Question 29

What is Rheumatoid factor, physically?

Answer 29

An IgM molecule reacting against the patients own IgG ``` Sjogrens and Feltys see about 100% IE 50% SLE 20-30% RA 70% Gen pop 5% Systemic sclerosis 30% ```

Question 30

What do TLR do?

Answer 30

proteins of the innate immune system span membrane on dendritic and macrophages recognise structurally conserved microbe molecules activate innate immune response

Question 31

Advantages of killed vaccines

Answer 31

non virulent heat stable less likely contaminated live though are good in that can give via natural route and induce an A and G response, stronger and longer protection, virus can multiply in host and cause CD8 response

Question 32

IgA1 and 2 differ how

Answer 32

in their heavy chains IgA1 in airways and serum IgA2 in colon

Question 33

How do you define a NK cell in CD ?

Answer 33

lack CD3 have CD56 FcRIII AKA CD16 is their receptor that binds the Fc portion of the Ab for ADCC

Question 34

When do you do skin prick testing for venom?

Answer 34

if anaphylaxis not if just large local reaction and no systemic symptoms if negative, repeat several weeks later

Question 35

How does immunotherapy work?

Answer 35

Alters T cell reactivity to certain Ag which causes reduction in release of pro-allergic/inflammatory cytokines cant do for food new evidence that it is not the blocking ab so much

Question 36

Who gets flu and pneumovax

Answer 36

Flu- ATSI over 50, caucasian over 65 Pneumococcal- same Pneumococcal - splenectomy - sickle cell over 2 years old - chronic resp, heart, renal disease - CSF leak - HIV, lymphoma, myeloma, nephrotic syndrome

Question 37

If tryptase is up, why do you have to do a follow up sample when well

Answer 37

check for mastocytosis- atypical mast cells collect in liver and spleen and all over the place

Question 38

SKIN TESTING IS FOR WHEN YOU THINK IT IS IgE MEDIATED!! NOT TYPE 2,3,4!!!!

Answer 38

=