Flashcards in Immunology Deck (93):
What primary lymph node does the stomach drain to?
What lymph node does the duodenum and jenjunum drain to?
What lymph node does the sigmoid colon drain to?
colic --> inferior mesenteric
What lymph node does the rectum above the pectinate line drain to?
What lymph node does anal canal below the pectinate line drain to?
What lymph node does the testes drain to?
superficial and deep plexuses --> para-aortic
What lymph node does the scrotum drain to?
What lymph node does the thigh (superficial) drain to?
What lymph node does the lateral side of the dorsum of the foot drain to?
What organisms are pts with splenectomies more susceptible to?
What disease is the HLA A3 associated with?
What diseases is HLA B27 associated with?
psoriasis, ankylosing spondylitis, inflammation bowel disease, reiter's syndrome
What disease is HLA B8 associated with?
What disease is HLA DR2 associated with?
MS, hay fever, SLE, Good pasture's
What disease is the HLA DR3 associated with?
DM Type 1
What disease is the HLA D4 associated with?
RA, DM Type 1
What disease is the HLA D5 associated with?
pernicious anemia --> B12 deficiency, Hashimoto's
What disease is HLA D7 associated with?
steroid-responsive nephrotic syndrome
What cytokines enhance NK cell activity?
IL-12, interferon-B, interferon-alpha
What are the two signals needed for helper T-cell activation?
1. foreign antigen is presented on MHC II and recognized by TCR on T cell
2. costimulatory signal by interaction of B7 and CD28
What are the two signals needed for cytotoxic T cell activation
1. endogenously synthesized protein presented on MHC1 and recognized by TCR on T cell
2. IL-2 from Th1 cell activates cytotoxic T cell to kill virus-infected cell
What are the two signals needed for B-cell class switching?
1. Il-4, Il-5, Il-6, !l-10 from Th2 cell
2. CD40 receptor on B cell binds CD40 ligand on TH2 cell
What are the four ways that antibody diversity is created?
random "recombination" of VJ or VDJ genes
2. random combination of heavy and light chains
3. somatic hypermutation
4. addition of nucleotides to DNA during recombination by terminal deoxynucleotidyl transferase
What are the cytokines secreted by macrophages?
Il-1, Il-6, Il-8, IL12, TNF-alpha
What are the cytokines secreted by T cells?
What are the cytokines secreted by Th1 cells?
Il-2, interferon gamma
What are the cytokines secreted by Th2 cells?
Il-4, Il-5, Il-10, Il-6
secreted by macrophages
endogenous pyrogen --> fever, acute inflammation; activates endothelium to express adhesion molecules; recruits leukocytes
secreted by macrophages and Th cells
endogenous pyrogen --> causes fever, and stimulates acute-phase proteins
secreted by macrophage
chemotactic factor for neutrophils
secreted by macrophages, B cells
induces differentiation of T cells --> Th1 cells , activates NK cells
secreted by macrophages
mediates septic shock, activates endothelium, causes leukocyte recruitment and vascular leak
secreted by T cells
supports growth and differentiation of bone marrow stem cells; acts like GM-CSF
secreted by Th1 cells
stimulates growth of helper and cytotoxic T cells
secreted by Th1 cells
activates macrophages and Th1 cells, while suppressing Th2 cells
antiviral and antitumor properties
Secreted by Th2 cells
induces differentiation into Th2 cells, promotes growth of B cells, enhances class switching to IgE and IgG
secreted by Th2 cells
promotes differentiation of b cells, enhances switching to IgA, stimulates growth and differentiation of eosinophils
secreted by Th2 cells, regulatory T cells
modulates inflammatory response; inhibits actions of T cells and Th1, activates Th2
What are the surface proteins on cells?
TCR, CD3 (signal transduction), CD28 (binds B7 on APC)
helper t cells: CD4, CD40L (binds CD40 on B cells)
cytotoxic t cells: CD8
What are the surface proteins on B cells?
Ig, CD19, CD20, CD21 (receptor for EBV), CD40, MHC II, B7
What are the surface proteins on macrophages?
MHCII, B7, CD40, CD14, receptors for Fc and C3b
What is the Arthus reaction?
a local subacute antibody-mediated hypersensitivity (type 3) rxn; intradermal injection of antigen induces antibodies which form antigen-ab complexes in the skin (ie swelling after tetenus shot)
findings: edema, necrosis, activation of complement
drug induced lupus
anti-igG (rheumatoid factor)
primary biliary cirrhosis
mixed connective tissue disease
DM Type 1
X-linked recessive defect in BTK, a tyrosine kinase gene that blocks B-cell differentiation/maturation; normal pro-B but decreased B cells, decreased immunoglobulins
recurrent bacterial infections after 6 months
Hyper IgM syndrome
defective CD40L on helper T cells --> inability to class switch
increased IgM, decreased IgG, A, E
severe pyogenic infections
selective Ig deficiency
defect in isotype switching, IgA most common
sinus and lung infections, milk allergies and diarrhea
anaphylaxis occurs on exposure to blood products with IgA
Common variable immunodeficiency
Defect in B cell maturation; many causes
increased risk of autoimmune disease, lymphoma, sinopulmonary infections
normal number of B cells, but decreased plasma cells and immunoglobulin
Thymic aplasia (DiGeorge syndrome)
22q11 deletion; failure to develop 3rd and 4th pharyngeal pouches
tetany (hypocalcemia), recurrent viral/fungal infections (T-cell deficiency), congenital heart and great vessel defects
Thymus and parathyroids fail to develop
Il-12 receptor defiency
inecreased Th1 response (induces differentiation from T--> Th1)
disseminated mycobacterial infections, decreased interferon-gamma
Hyper-IgE syndrome (Job's syndrome)
Th cells fail to produce Interferon-gamma --> inability of neutrophils to respond to chemotactic stimuli
cold (noninflamed) staphlococcal Abscesses
retained primary Teeth
Dermatologic problems (eczema)
chronic mucocutaneous candidiasis
T cell dysfunction
Candida albicans infections of the skin and mucous membranes
severe combined immunodeficiency (SCID)
several types: defective IL-2 receptor (most common, X-linked), ADA deficiency, failure to synthesize MHC II antigens
recurrent viral, bacterial, fungal and protozoal infections due to both B and T cell deficiency
tx: bone marrow transplant
labs: decreased IL-2 receptor, increased adenine (toxic to B and T cells since decreased DNA synthesis)
defect in DNA repair enzymes
triad of symptoms: cerebellar defects (ataxia), spider angiomas, IgA deficiency
X linked recessive, progressive deletion of B and T cells
labs: increased IgE, IgA; decreased IgM
leukocyte adhesion deficiency (type 1)
defect in LFA-1 integrin (CD18) protein on phagocytes
recurrent bacterial infections, absent pus formation, delayed separation of umbilicus
Chronic granulomatous disease
lack of NADPH oxidase --> decreased reactive oxygen species and absent respiratory burst in neutorphils
increased susceptibility to catalase-positive organisms
labs: negative nitroblue tetrazolium dye reaction test
binds to cyclophilins --> blocks differentiation and activation of T cells by inhibiting calcineurin --> preventing production of IL-2 and its receptor
use: suppresses organ rejection after transplantation, some autoimmune disorders
toxicity: predisposes pt to viral infections and lymphoma; nephrotic
binds to FK binding protein, inhibiting secretion of IL-2 and other cytokines
use: immunosuppressive used in organ transplant pts
toxicity: nephrotoxicity, peripheral neuropathy, hypertension, pleural effusion, hyperglycemia
inhibits mTOR, inhibits T-cell proliferation in response to IL-2
use: immunosuppression after kidney transplantation in combination with cyclosporine and corticosteroids
toxicity: hyperlipidemia, thrombocytopenia, leukopenia
Ab with high affinity for the Il-2 receptor on activated T cells
antimetabolite precursor of 6-mercaptopurine that interferes with the metabolism and synthesis of nucleic acids; toxic to proliferating lymphocytes
use: kidney transplantation, autoimmune disorder
toxicity: bone marrow suppresion, metabolized by xanthine oxidase so toxic effects increase by allopuriniol
ab that binds to CD3 on the surface of T cells, blocks signal transduction
use: immunosuppression after kidney transplantation
toxicity: cytokine relase syndrome, hypersensitivity reaction
renal cell carcinoma, metastatic melanoma
filgrastim (granulocyte colony stimulating factor)
recovery of bone marrow
sargramostim (granulocyte-macrophage colony stimulating factor)
recovery of bone marrow
hepB, hep C, Kaposi's sarcoma, leukemias, malignant melanoma
chronic granumatous disease
digoxin immune Fab
antidote for digoxin intoxication
blocks TNF-alpha; used for crohn's RA, psoriatic arthritis, ankylosing spondylitis
blocks TNF-alpha; used for Crohn's disease, RA, psoriatic arthritis
targets glycoprotein IIB/IIIa (platelet aggregator) to prevent cardiac ischemia in unstable angina and in pts treated with percutaneous coronary intervention
targets erb-B2, for HER-2 overexpressing breast cancer