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Flashcards in Immunology Deck (117)
1

To what nodes do the rectum and anus respectively drain?

Rectum - internal iliac, anus - superficial inguinal

2

What do the right lymphatic duct and thoracic duct drain respectively?

RLD - right arm and right half of head, thoracic duct - everything else (left side, trunk, and right leg)

3

Where are the T and B cells found in the spleen?

T cells - PALS (white pulp), B cells - Follicles (white pulp)

4

Encapsulated organisms

Salmonella, S pneumoniae, H flu, N meningitidis

5

What is seen on a blood smear postsplenectomy?

Howell-Jolly bodies (nuclear remnants), Target cells, Thrombocytosis

6

HLA subtype associated with hemochromatosis

A3

7

Disorders associated with HLA-B27 (4)

Psoriasis, Ankylosing Spondylitis, IBD, Reiters

8

HLA subtype associated with Graves

B8

9

HLA subtype associated with MS, hay fever, SLE, and Goodpastures

DR2

10

HLA subtype associated with DM

DR3 and DR4

11

HLA subtype associated with RA

DR4

12

HLA subtype associated with pernicious anemia and hashimotos

DR5

13

What cytokines enhance NK cell activity?

IL-12, IFN-B and IFN-A

14

Which cytokine increases Th1 development and what cytokines are mainly produced by Th1 cells

IL-12. They make IL-2 and IFN-G. Th1 response mainly increases cell-mediated response (CD8 functioning)

15

Which cytokine increases Th2 and which cytokines are mainly produced by Th2 cells?

IL-4. They make IL-4 and IL-5. Th2 mainly supports humoral responses (IgE more than IgG)

16

What cells are developing T cells checked for reaction against in the process of negative selection?

Thymic medullary epithelial and dendritic cells

17

Interaction of what two molecules is responsible for signal 2 in the process of helper t cell activation?

B7 (APC) and CD28 (CD4 cell)

18

What cytokine (produced by Th cells) needs to be present when a CD8 cell decides to kill a virus infected cell?

IL-2

19

What two molecules interact when a Th cell activates a B cell (in addition to the cytokines the Th cell is secreting)?

CD40L (Th2 cell) and CD40 (B cell)

20

What cyotkines inhibit the Th1 and Th2 responses respectively?

Th1 inhibited by IL-10 (from Th2 cells), Th2 inhibited by IFN-g (from Th1 cells)

21

What are the two main things that bind to the Fc portion of Ig?

Complement and Macrophages (macrophages bind closer to the base, complement higher up)

22

Where does isotype switching occur?

Lymph node follicles

23

Which two Igs activate the classic complement pathway?

IgG and IgM

24

Which complement component is most important in opsonization?

C3b

25

Which Ig is most important in opsonization?

IgG

26

What is contraindicated in C1 esterase inhibitor deficiency?

ACE inhibitors

27

Susceptibility to what is increased in C3 deficiency?

Type 3 hypersensitivity reactions (C3 clears immune complexes)

28

What is given to patients lacking IL-12R and why?

IFN-G to help them mount a better granulomatous response

29

List the cytokines secreted by each of the following - macrophages, all T cells, Th1 cells, and Th2 cells

Macrophages - IL-1, IL-6, IL-8, IL-12, TNF-a. All T Cells - IL-3. Th1 - IL-2, IFN-G. Th2 - IL-4, IL-5, IL-10

30

What two cytokines are important in inhibiting inflammation?

TGF-B and IL-10

31

How do interferons improve antiviral efforts?

They stimulate uninfected cells to produce ribonuclease that inhibits viral mRNA

32

What is the main role of platelet activating factor?

It is chemotactic for neutrophils

33

What cell surface marker is typically used to identify macrophages?

CD14

34

What cell markers are present on NK cells?

CD16 (binds Fc of IgG) and CD56 (unique to NK)

35

Give the CD ranges which typically correspond to each of the following - T-cells, Myeloid cells, B cells

T - 1 to 8, Myeloid - 11 to 15, B - 19 to 23

36

Two main bacteria with superantigens

Strep pyogenes and Staph aureus

37

What is the action of LPS?

Directly stimulates macrophages by binding CD14

38

Preformed antibodies are given after exposure to what entities?

Tetanus toxin, Botulinum toxin, HBV, Rabies virus

39

List live attenuated vaccines

MMR, polio (sabin), varicella, yellow fever

40

List killed vaccines

Cholera, flu, Hep A, polio (Salk), Rabies

41

About how long does serum sickness take to develop and what will be found?

Around 5 days. Will find low C3 levels

42

Most common cause of serum sickness and findings

Bactrim. Fever, urticaria, arthralgias, proteinuria, lymphadenopathy (5-10 days after exposure)

43

Antimitochondrial antibodies

PBC, also gallbladder GVHD

44

Anti-desmoglein antibodies

Pemphigus vulgaris

45

Antimicrosomal antibodies

Hashimotos

46

Anti-Jo-1 antibodies

Polymyositis, dermatomyositis

47

Anti-U1 RNP antibodies

Mixed connective tissue disease

48

Anti-smooth muscle antibodies

Autoimmune hepatitis

49

Anti-glutamate decarboxylase antibodies

T1DM

50

What is the main fungal or parasitic infection seen in pts with no B cells and why?

GI Giardiasis (due to lack of IgA)

51

Defect and genetics of Brutons agammaglobulinemia

X recessive. Defect in BTK, a tyrosine kinase prevents pre-B cells from becoming immature B cells

52

Recurrent bacterial infections, intact thymus, decreased number of B cells and Ig of all classes

Brutons agammaglobulinemia

53

Defect of Hyper-IgM syndrome

Defective CD40L

54

Severe pyogenic infections early in life, high IgM and low other Igs

Hyper-IgM

55

Sinus and lung infections, milk allergies and diarrhea, anaphylaxis on exposure to blood products with IgA, decreased secretory IgA

Selective Ig deficiency

56

Which B cell disorder can be acquired in 20s or 30s?

CVID

57

What is the defect in common variable immunodeficiency?

Failure of B-cells to mature. Normal numbers of b-cells found but decreased plasma cells and Ig

58

Genetics and embryology of DiGeorge

22q11 deletion. Failure of 3rd and 4th pharyngeal pouches to develop

59

Defects in DiGeorge besides hypocalcemia and immunodeficiency

Congenital heart and great vessel defects

60

Jobs syndrome

Hyper-IgE due to Th cells failing to produce IFN-g (neutrophils cant respond to chemotactic stimuli)

61

Coarse facies, non-inflammed staph abscesses, retained primary teeth, eczema

Jobs syndrome (Hyper Ig-E due to Th cell failure)

62

Two major causes of SCID, which is more common, and the pathogenesis of each

Defective IL-2R (more common) - decreased T-cell activation, and ADA deficiency - Buildup of adenosine, which is toxic to B and T cells, decreased DNA synthesis

63

Cerebellar defects, spiger angiomas, IgA deficiency

Ataxia-telangiectasia (defect in ATM gene, which codes for DNA repair enzymes)

64

Defect and genetics of Wiskott-Aldrich

X recessive. Deletion of B and T cells

65

Thrombocytopenic purpura, Infections, Eczema. High IgE and IgA with low IgM

Wiskott-Aldrich

66

Defect and genetics of Chediak-Higashi

AR. Defect in lysosomal regulator trafficking gene

67

Recurrent infections, partial albinism, peripheral neuropathy (nystagmus)

Chediak-Higashi

68

Lab finding in chronic granulomatous disease

Negative nitroblue tetrazolium dye reduction test (due to lack of respiratory burst in neutrophils)

69

Findings in GVHD

Skin, liver, intestine - Maculopapular rash, jaundice, hepatosplenomegaly, diarrhea. Most common in BM and liver transplants.

70

Main targets of chronic rejection

Recipient CD8 cells target blood vessels. Exception is chronic lung rejection, where small airways are targeted, causing bronchiolitis obliterans

71

Cyclosporine

Blocks differentiation and activation of T cells by inhibiting calcineurin (preventing production of IL-2 and IL-2R). Nephrotoxic, causes gout

72

Tacrolimus

Inhibits calcineurin (and thus IL-2 and IL-2R production). Causes nephrotoxicity, peripheral neuropathy, HTN, pleural effusion, hyperglycemia

73

Sirolimus

Inhibits mTOR (thus inhibiting T-cell proliferation in response to IL-2)

74

Daclizumab

Monoclonal antibody for IL-2R on activated T cells

75

Azathioprine

Antimetabolite precursor of 6-MP (interferes with nucleic acid synthesis). Watch with allopurinol

76

Muromonab

Monoclonal antibody to CD3

77

Aldesleukin

IL-2 analog. Use in RCC, metastatic melanoma

78

Uses of IFN-a

Hep B and C, Kaposi, Leukemia, Malignant melanoma

79

Uses of IFN-B

MS

80

Uses of IFN-G

Chronic granulomatous disease

81

Oprelvekin

IL-11 analog, use in thrombocytopenia

82

Infliximab

Antibody to TNF-a. Use in Crohns, RA, psoriatic arthritis, ankylosing spondylitis

83

Adalimumab

Antibody to TNF-a. Use in Crohns, RA, psoriatic arthritis

84

Abciximab

Antibody to IIb/IIIa. Use in unstable angina and percutaneous coronary intervention

85

Trastuzumab

Antibody to ERB-B2. Use in Her-2 expressing breast cancer

86

Rituximab

Antibody to CD20. Use in B-cell NHL

87

Omalizumab

Antibody to IgE. Last line for severe asthma

88

Type of hypersensitivity used to kill helminths

Type 2. IgE antibodies coat the eggs, Eosinophils recognize and release major basic protein

89

Markers for Reed-Sternberg cells

CD15 and CD30

90

Marker for ALL

CD10 (also called CALLA)

91

Most common pathogen in cellulitis

Group A Strep (pyogenes)

92

What metal is required by the enzyme that converts granulation tissue (Collagen type 3) to scar tissue (Collagen type 1)?

Zinc

93

What can chronically draining sinuses predispose to?

Squamous cell carcinoma

94

What cells are the main players in type 4 hypersensitivity?

Helper T cells and Macrophages

95

Two portions of the tubule most susceptible to hypoxia

Straight portion of the proximal tubule and medullary portion of the thick ascending limb

96

Main disease associated with cryoglobulins

Hepatitis C

97

Irritation of what receptor leads to dyspnea in heart failure?

The J receptor in the lungs

98

Three major causes of lymphedema

Mastectomy, W Bancrofti, Chlamydia Trachomatis (lymphogranuloma venarium)

99

Quick way to estimate serum osmolarity

Double sodium and add 10

100

Tonicity of normal saline

0.9 percent

101

What is a good general rule for interpreting low serum sodium levels?

If serum sodium is below 120 it is very likely to be SIADH

102

What drugs produce SIADH?

Oral sulfonylureas (eg chlorpropramide)

103

What is the usual tonicity of diarrhea?

In babies it is hypotonic, in adults it is isotonic

104

What is the tonicity of sweat?

Hypotonic

105

Non pharmacologic treatment for edematous states and SIADH respectively

Edematous state - Restrict salt and water, SIADH - restrict water

106

Treatment for hypovolemic shock

Give normal saline until BP normal. Then replace what they lost (sweating - half normal saline, adult diarrhea - isotonic saline, DI - 5 percent dextrose)

107

Most common cause of shock in the hospital

Septic shock from E coli due to indwelling urinary catheters

108

Formula for O2 content

(1.34 x Hb x O2saturation) + pO2

109

Mixed venous oxygen content in the different types of shock

Septic shock - High, Cardiogenic and hypovolemic - Low

110

TPR in the different types of shock

Septic - low. Cardiogenic and hypovolemic - high

111

LVEDV in the different types of shock

Septic - low, Hypovolemic - low, Cardiogenic - high

112

Young African American woman comes in with microscopic hematuria. First step in management?

Get a sickle cell screen. O2 tension is low enough in renal medulla to cause sickling in sickle trait patients

113

What effect do progesterone and estrogen have on respiration?

Cause a respiratory alkalosis due to overstimulation of respiratory center. Pregnant women have AV fistulas in lungs which go away after delivery

114

Respiratory status in endotoxic shock

Respiratory alkalosis (endotoxins stimulate resp center)

115

Acid base status in salicylate overdose

Mixed. Respiratory alkalosis due to overstimulation of resp center and metabolic acidosis due to acid ingestion. Similar to endotoxic shock (mixed Ralk with Macid)

116

What should you associate inspiratory stridor in a child with?

H flu (epiglottitis)

117

Where is the obstruction in croup?

Trachea. Look for steeple sign