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Flashcards in Immunology Deck (93):
1

What primary lymph node does the stomach drain to?

celiac

2

What lymph node does the duodenum and jenjunum drain to?

superior mesenteric

3

What lymph node does the sigmoid colon drain to?

colic --> inferior mesenteric

4

What lymph node does the rectum above the pectinate line drain to?

internal iliac

5

What lymph node does anal canal below the pectinate line drain to?

superficial inguinal

6

What lymph node does the testes drain to?

superficial and deep plexuses --> para-aortic

7

What lymph node does the scrotum drain to?

superficial inguinal

8

What lymph node does the thigh (superficial) drain to?

superficial inguinal

9

What lymph node does the lateral side of the dorsum of the foot drain to?

popiteal

10

What organisms are pts with splenectomies more susceptible to?

"S SHiN"
Salmonella
S. pneumoniae
H. influenzae
N. meningitis

11

What disease is the HLA A3 associated with?

hemochromatosis

12

What diseases is HLA B27 associated with?

"PAIR"

psoriasis, ankylosing spondylitis, inflammation bowel disease, reiter's syndrome

13

What disease is HLA B8 associated with?

Graves' disease

14

What disease is HLA DR2 associated with?

MS, hay fever, SLE, Good pasture's

15

What disease is the HLA DR3 associated with?

DM Type 1

16

What disease is the HLA D4 associated with?

RA, DM Type 1

17

What disease is the HLA D5 associated with?

pernicious anemia --> B12 deficiency, Hashimoto's

18

What disease is HLA D7 associated with?

steroid-responsive nephrotic syndrome

19

What cytokines enhance NK cell activity?

IL-12, interferon-B, interferon-alpha

20

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

21

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

22

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

23

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

24

What are the cytokines secreted by macrophages?

Il-1, Il-6, Il-8, IL12, TNF-alpha

25

What are the cytokines secreted by T cells?

IL-3

26

What are the cytokines secreted by Th1 cells?

Il-2, interferon gamma

27

What are the cytokines secreted by Th2 cells?

Il-4, Il-5, Il-10, Il-6

28

Il-1

secreted by macrophages
endogenous pyrogen --> fever, acute inflammation; activates endothelium to express adhesion molecules; recruits leukocytes

29

Il-6

secreted by macrophages and Th cells
endogenous pyrogen --> causes fever, and stimulates acute-phase proteins

30

IL-8

secreted by macrophage
chemotactic factor for neutrophils

31

Il-12

secreted by macrophages, B cells
induces differentiation of T cells --> Th1 cells , activates NK cells

32

TNF-alpha

secreted by macrophages
mediates septic shock, activates endothelium, causes leukocyte recruitment and vascular leak

33

Il-3

secreted by T cells
supports growth and differentiation of bone marrow stem cells; acts like GM-CSF

34

Il-2

secreted by Th1 cells
stimulates growth of helper and cytotoxic T cells

35

interferon-gamma

secreted by Th1 cells
activates macrophages and Th1 cells, while suppressing Th2 cells

antiviral and antitumor properties

36

Il-4

Secreted by Th2 cells
induces differentiation into Th2 cells, promotes growth of B cells, enhances class switching to IgE and IgG

37

Il-5

secreted by Th2 cells
promotes differentiation of b cells, enhances switching to IgA, stimulates growth and differentiation of eosinophils

38

Il-10

secreted by Th2 cells, regulatory T cells
modulates inflammatory response; inhibits actions of T cells and Th1, activates Th2

39

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

40

What are the surface proteins on B cells?

Ig, CD19, CD20, CD21 (receptor for EBV), CD40, MHC II, B7

41

What are the surface proteins on macrophages?

MHCII, B7, CD40, CD14, receptors for Fc and C3b

42

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

43

ANA

SLE, nonspecific

44

anti-dsDNA, anti-smith

SLE

45

anti-histone

drug induced lupus

46

anti-igG (rheumatoid factor)

rheumatoid arthritis

47

anticentromere

scleroderma (CREST)

48

anti-Scl-70

scleroderma (diffuse)

49

antimitochondrial (AMA)

primary biliary cirrhosis

50

antigliadin, antiendomysial

celiac disease

51

anti-basement membrane

goodpasture's

52

anti-desmoglein

pemphigus vulgaris

53

antimicrosomal, antithyroglobulin

Hashimotos

54

anti-Jo-1

polymyositis, dermatomyositis

55

Anti-SSA

Sjogren's

56

Anti-SSB

Sjogren's

57

Anti-U1 RNP

mixed connective tissue disease

58

Anti-smooth muscle

autoimmune hepatitis

59

Anti-glutamate decarboxylase

DM Type 1

60

c-ANCA

Wegener's granulomatosis

61

p-ANCA

other vasculitises

62

Bruton's agammaglobulinemia

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

63

Hyper IgM syndrome

defective CD40L on helper T cells --> inability to class switch

increased IgM, decreased IgG, A, E

severe pyogenic infections

64

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

65

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

66

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

67

Il-12 receptor defiency

inecreased Th1 response (induces differentiation from T--> Th1)

disseminated mycobacterial infections, decreased interferon-gamma

68

Hyper-IgE syndrome (Job's syndrome)

Th cells fail to produce Interferon-gamma --> inability of neutrophils to respond to chemotactic stimuli

FATED
course Facies
cold (noninflamed) staphlococcal Abscesses
retained primary Teeth
increased igE
Dermatologic problems (eczema)

69

chronic mucocutaneous candidiasis

T cell dysfunction

Candida albicans infections of the skin and mucous membranes

70

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)

71

ataxia-telangiectasia

defect in DNA repair enzymes

triad of symptoms: cerebellar defects (ataxia), spider angiomas, IgA deficiency

72

Wiskott-Aldrich syndrome

X linked recessive, progressive deletion of B and T cells

TIE:
thrombocytopenic purpura
infections
eczema

labs: increased IgE, IgA; decreased IgM

73

leukocyte adhesion deficiency (type 1)

defect in LFA-1 integrin (CD18) protein on phagocytes

recurrent bacterial infections, absent pus formation, delayed separation of umbilicus

labs: neutrophilia

74

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

75

cyclosporine

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

76

tacrolimus (FK506)

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

77

sirolimus (rapamycin)

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

78

daclizumab

Ab with high affinity for the Il-2 receptor on activated T cells

79

azathioprine

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

80

muromonab-CD3 (OKT3)

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

81

aldesleukin (interleukin-2)

renal cell carcinoma, metastatic melanoma

82

filgrastim (granulocyte colony stimulating factor)

recovery of bone marrow

83

sargramostim (granulocyte-macrophage colony stimulating factor)

recovery of bone marrow

84

alpha-interferon

hepB, hep C, Kaposi's sarcoma, leukemias, malignant melanoma

85

beta-interferon

MS

86

gamma-interferon

chronic granumatous disease

87

oprelvekin (interleukin-11)

thrombocytopenia

88

digoxin immune Fab

antidote for digoxin intoxication

89

infliximab

blocks TNF-alpha; used for crohn's RA, psoriatic arthritis, ankylosing spondylitis

90

adalimumab

blocks TNF-alpha; used for Crohn's disease, RA, psoriatic arthritis

91

abciximab

targets glycoprotein IIB/IIIa (platelet aggregator) to prevent cardiac ischemia in unstable angina and in pts treated with percutaneous coronary intervention

92

trastuzumab (herceptin)

targets erb-B2, for HER-2 overexpressing breast cancer

93

Rituximab

targets CD20 for B cell non-Hodgkin's lymphoma