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Toni's Pathology > Immunology > Flashcards

Immunology Flashcards

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1
Q

Muromonab

A

Anti CD3
Active rejection: corticosteroid resistant renal/heart/liver rejection
SE: fever leucopenia
Aka OKT3
Risk of anaphylaxis due to mouse murine protein
Cytokine release syndrome risk: TNFalpha + IFNgamma

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2
Q

Basiliximab

A 
Anti CD25
IL 2 alpha receptor
Reduces T cell proliferation
Prophylaxis vs allograft rejection
SE: GI disturbance
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3
Q

Tocilizumab

A

Anti IL6 receptor
For RA if anti TNF drugs fail
SE: infections, hepatotoxic, raises cholesterol
For castlemans + RA
Reduced macrophage, neutrophil + lymphocyte activation

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4
Q

Abatacept

A

Anti CTLA-4 Ig
Bind b7 protein (cd80 +86) on APCs
RA if anti TNF drugs fail
SE: infections + cough

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5
Q

What are the antiproliferative agents?

A

Cyclophosphamide
Mycophenolate mofetil
Azathioprine

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6
Q

Cyclophosphamide

A

Alkylates guanine base of DNA: b cells> t cells
For multi system connective tissue disease + cancer
SE: hair loss, BM suppression, sterility, haemorrhagic cystitis

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7
Q

Mycophenolate mofetil

A

Blocks de novo nucleotide synth: T cells > B cells
For AI, vasculitis, transplants
SE: BM suppression, hepatotoxicity

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8
Q

What are the inhibitors of cell signalling?

A

Tacrolimus
Ciclosporin
Sirolimus

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9
Q

Tacrolimus

A

Inhibits calcineurin which usually activates IL2 transcription = reduced IL2
For rejection prophylaxis
SE: diabetes

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10
Q

Ciclosporin

A

Inhibits calcineurin which usually activates IL2 transcription = reduced IL2
For rejection prophylaxis
SE: gingival hypertrophy, htn + reduced GFR

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11
Q

Sirolimus

A

Binds FKBP-1a
Blocks clonal proliferation
For rejection prophylaxis
Low nephrotoxicity

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12
Q

Prednisolone

A

Inhibits phospholipase a2
Reduces: platelet activating factor, Abs, arachidonic acid, apoptosis, trafficking phagocytes
SE: DM, adrenal suppression, cataracts, glaucoma, pancreatitis, osteoporosis, central obesity, neutrophilia, htn

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13
Q

Plasmapheresis

A

50% plasma replaced with donor plasma
For Goodpasture’s, MG, and other type II HS
SE: rebound Ab production limits efficacy

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14
Q

Adalimumab

A

Fully human anti TNF alpha mab

For RA, ank spondylitis, Crohns

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15
Q

Infliximab

A

Mouse-human chimeric Anti TNF alpha mab
For psoriasis, Crohns, RA
SE: TB, lymphoma, pneumonia, AI

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16
Q

Etanercept

A

TNF alpha mab
Fusion protein between TNF-R2 and Fc if IgG1
SE: incr risk infection, demyelination, malignancy

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17
Q

Ustekinumab

A

Anti IL 12/23 - binds to p40 subunit
For psoriasis
SE: infections + cough

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18
Q

Rituximab

A

Anti CD20 - decreases B cells
For AI disease + lymphoma
Incr risk hep B reactivation + progressive multifocal leukoencephalopathy

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19
Q

Natalizumab

A

Anti alpha-4 integrin
Prevent T cell migration
For MS + Crohns

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20
Q

Alemtuzumab

A

Anti CD 52
For CLL + MS
SE: incr susceptibility to CMV

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21
Q

Methotrexate

A

Dihydrofolate reductase inhibitor - decr DNA synth
For AI disease: RA, psoriasis, Crohns
Chemo
Abortifacient
SE: teratogenicity, hepatotoxicity, pneumonitis, pulm fibrosis, cirrhosis
Folate deficiency! Macrocytic megaloblastic anaemia

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22
Q

Components of a T cell immunosuppressive regime

A

Antiproliferative agent
T cell signalling inhibitor
Cytokine production inhibitor

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23
Q

Options for boosting the immune system

A

Vaccination
Human normal Ig
Specific Ig
Recombinant cytokines

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24
Q

Human normal Ig

A

Preformed IgG vs full range of organisms from >1000 donors
3-4 wkly admin
For: primary Ab deficiencies: Bruton’s + CVID
secondary Ab deficiencies: CLL, MM, BMT
Passive vaccination
? Anaphylaxis

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25
Specific Ig
``` Can be given to give passive vaccination for: Rabies VZV Hep B Tetanus ? Anaphylaxis ```
26
Recombinant cytokines
INF alpha: hep B, hep C + Kaposi's sarcoma, CML, MM, hairy cell leukaemia IFN beta: relapsing MS, MOA unknown IFN gamma: chronic granulomatous disease
27
Allergen desensitisation
To reduce sx in mono allergic disorders Good for: bee + wasp venom, grass pollen, house dust mite Tiny doses titrated up over wks under close supervision Maintenance dose then monthly for 3-5 yrs Costly, laborious, risk of adverse reaction Only treatment to alter natural course of disease
28
Azathioprine
Metabolised by liver to 6-mercaptopurine Blocks de novo purine synth For AI, transplants SE: BM suppression, hepatotoxicity
29
Bare lymphocyte syndrome
Defect of regulatory factor X or class II transactivator Absent expression of HLA molecules within thymus Lymphocytes don't develop - type 1: MHC 1 absent = decr CD8 - type 2: MHC 2 absent = decr CD4 more common B cell class switch requires CD4 so also less IgA + IgG Assoc with sclerosing cholangitis Unwell at 3 months
30
Di George
Impaired development of 3rd + 4th pharyngeal pouches 22q11.2 del 75% sporadic = impaired development of thymus = v low numbers mature T cells Treatment = thymus transplant Also infection prophylaxis, Ig replacement as req
31
Which primary immune deficiencies are T cell deficiencies?
Bare Lymphocyte Syndrome | Di George syndrome
32
Which primary immune deficiencies are B cell deficiencies?
Bruton's agammaglobulinaemia Selective IgA deficiency Common variable immuno deficiency Hyper IgM syndrome
33
Which primary immune deficiencies are mixed B + T cell deficiencies?
SCID
34
Which primary immune deficiencies are phagocyte deficiencies?
Kostmann syndrome Leukocyte Adhesion deficiency Chronic granulomatous disease Cyclic neutropenia
35
Bruton's agammaglobulinaemia
``` X linked mutation in BTK gene = no mature B cells, no antibodies Incr susceptibility to bacterial infections + some viral + some toxins Sx from ~ 3-6 months Req IV IgG ```
36
Selective IgA deficiency
Most common immune deficiency 70% asymptomatic Recurrent resp + gastro infections
37
Common variable immune deficiency
Defect in B cell differentiation- many genetic causes Low Ig A, G + E FTT AI + granulomatous disease
38
Hyper IgM syndrome
X linked q26 CD 40 L, CD 40, AICDA or CD 154 defect Prevents activated T cells interacting with B cells No class switch = B cells can't make IgA + IgG but Incr amt IgM Less lymphoid tissue 1 yr old boys with recurrent bacterial infections, PCP + FTT Req IV IgG
39
How are T cell deficiencies treated?
Infection prophylaxis | Ig replacement as required
40
How are B cell deficiencies treated?
Ig replacement BMT in some Vaccination only effective in selective IgA deficiency
41
SCID
Defects in lymphoid precursors E.g. IL2 receptor or adenosine delaminates gene Recurrent infections -> FTT + persistent diarrhoea + early infant death Low/normal B cells, low T cells, low antibodies BMT only established treatment 45% x linked
42
Kostmann syndrome
``` AR HAX-1 Severe congenital neutropenia BM: arrest of neutrophil precursor maturation Infections shortly after birth Treatment: GCSF, prophylactic abx, BMT ```
43
Leukocyte adhesion deficiency
Failure to express lymphocyte adhesion markers Neonatal bacterial infections 1: deficiency of beta -2 integrin subunit of CD18 on the leucocytes adhesion mol 2: much rarer, severe growth restriction + mental retardation High neutrophil count + delayed umbilical cord separation BMT
44
Chronic granulomatous disease
Failure of oxidative killing - NADPH oxidase defect = decr reactive O2 species -ve NBT test : nitrobluetetrazolium -ve DHR test : dihydrorhodamine Pneumonia, abscesses, suppurating arthritis Susceptible to catalase +ve: listeria, pseudomonas, aspergillus, candida, e.coli, staph aureas, serratia Treatment: prophylactic trimethoprim, itraconazole, interferon
45
Cyclic neutropenia
Episodic neutropenia every 3 wks lasting a couple days Mutations in ELA 1 gene Treatment: GCSF
46
List the inflammatory cytokines
Il 1 IL 12 TNF IL 6
47
List the anti-inflammatory cytokines
IL 10 | TGF beta
48
Cytokine deficiencies
IFN gamma, IFN gamma-R, Il 12, IL 12-R Involved in signalling betw T cells + macrophages To stimulate TNF and Acyivate NADPH oxidase Predisposes to: salmonella, TB, atypical mycobacteria, BCG Unable to form granulomata
49
Reticular dysgenesis
Most sever for of SCID Absolute deficiency of: neutrophils, lymphocytes, monocytes, macrophages, platelets Fatal in early life without BMT
50
Wiskott-Aldrich syndrome
``` X linked mutation in WASp gene Decr IgM Incr IgA + E Thrombocytopenia Recurrent bacterial infections ```
51
What are the complement deficiencies?
``` Incr susceptibility to encapsulated bacterial infection Classical pathway deficiency Lectin pathway deficiency Alternative pathway deficiency Common + terminal pathway deficiency ```
52
Classical pathway deficiency
``` Lack of C1 q/r/s C2 (commonest) or C4 (removes immune complexes) Abnormal CH50 test Associated with SLE + RA ```
53
Lectin pathway deficiency
V common Up to 10% are MBL deficient Not clinically important
54
Alternative pathway deficiency
Involves factors B/I/P Usually kill bacteria Susceptible to GBS, s.pneumoniae, h.influenzae, n.meningitidis AP50 test abnormal
55
Common + terminal pathway deficiency
Lack of C 3, 5, 6, 7, 8, 9 Susceptible to meningitis + pneumonia Assoc with membranous proliferation glomerulonephritis Can't form MAC to kill bacteria Both CH50 + AP50 abnormal Treatment: vaccination, prophylactic abx, high level suspicion
56
How might you detect deficiency of an alternative pathway factor?
AH50: reduced CH50: normal
57
Hereditary angioedema
C1 inhibitor deficiency Increased bradykinin Spontaneous complement activation
58
When might high CH50 be seen?
Acute or chronic inflammation Demonstrates classical and final complement pathway activity E.g. SLE, RA
59
What might be seen with reduced C4?
SLE
60
What might be seen with reduced C3?
Membranoproliferative glomerulonephritis
61
What are the three mechanisms of mast cell activation?
Direct injury e.g. Toxin or drugs IgE -R cross linking Activated complement proteins
62
What are the three subtypes of MHC class I
HLA A HLA B HLA C
63
What are the three subtypes of MHC class II?
HLA DP HLA DQ HLA DR
64
What composes MHC class III?
Complement components
65
What AI condition is associated with HLA B27?
Ankylosing spondylitis
66
What AI condition is associated with HLA DQ2?
Coeliac disease
67
What AI conditions are associated with HLA DR3?
Graves SLE MG
68
What AI conditions are associated with HLA DR4?
DM | RA
69
What HLA markers are associated with Goodpasture's ?
HLA DR2 | HLA DR15
70
Azathioprine
6 mercaptopurine Blocks de novo protein synthesis, blocks DNA synth Inhibits T cell proliferation SE: BM suppression, hepatotoxicity, hypersensitivity For AI disease + transplants
71
Denosumab
Anti RANK ligand Inhibits osteoclast function + differentiation For osteoporosis, MM, bone mets Toxicity: resp infections, UTIs
72
What are the type I hypersensitivity disorders?
``` Atopic dermatitis Food allergy Oral allergy syndrome Latex food syndrome Allergic rhinitis Acute urticaria Anaphylaxis ```
73
What are the features of type I hypersensitivity?
IgE mediated, immed reactions Provoked by re-exposure to allergen Mast cell degranulation = vasodilation, SM spasm, incr permeability
74
Atopic dermatitis
Irritants, food, environmental factors Defects in beta defensin predispose to S.aureas superinfection Rx: emollients, topical steroids, abx, PUVA
75
Food allergy
Milk, egg, peanut, treenut, fish, shellfish Dx: food diary, skin prick tests, RAST, challenge test Rx: dietician, food avoidance, epi pen, control asthma
76
Oral allergy syndrome
Allergen -> IgE with cross reactivity to other substance Birch pollen/ stone fruit (rosacea), ragweed/melons Sx limited to mouth A clinical diagnosis + skin prick test Rx: avoid food, if ingested wash mouth + po antihistamines
77
Latex food syndrome
Chestnut, avocado, banana, potato, tomato, kiwi, aubergine, mango, papaya, wheat, melon Skin prick test Avoid food
78
Allergic rhinitis
Seasonal: grass/tree pollen Perennial: pets/ dust mite Occasional: latex/ animals at work Nasal itch + obstruction, sneezing, anosmia, eye sx Dx: clinical= pale blueish, swollen nasal mucosa, skin prick test, RAST Rx: allergen avoidance, antihistamine, steroid nasal spray, pollen desensitisation
79
Acute urticaria
``` 50% idiopathic 50% food, drugs, latex, viral infection, febrile illness Wheals which completely resolve in 6 wks Clinical diagnosis Rx: allergen avoidance + antihistamines ```
80
What mediators are released upon mast cell degranulation?
``` Histamine Proteases Serotonin Heparin Thromboxane Prostaglandin Leukotriene Platelet activating factor ```
81
How do antihistamines work?
H1 receptor antagonists Negate effects of histamine Take longer to take effect than IM adrenaline
82
What mediators are released upon mast cell degranulation?
``` Histamine Proteases Serotonin Heparin Thromboxane Prostaglandin Leukotriene Platelet activating factor ```
83
How do antihistamines work?
H1 receptor antagonists Negate effects of histamine Take longer to take effect than IM adrenaline
84
Anaphylaxis
Severe systemic allergic reaction: resp difficulty + hypotension IgE med mast cell degranulation: peanut, penicillin, stings, latex Non IgE med mast cell degranulation: NSAIDs, IV contrast, opioids, exercise
85
Management of anaphylaxis
``` Elevate legs 100% O2 IM 500mcg adrenaline Inhaled bronchodilators IV 100 mg hydrocortisone IV 10 mg chlorphenamine IV fluids ```
86
Skin prick tests
To confirm clinical hx, -ve test exclude IgE mediated allergy +ve control = histamine -ve control = dilutant +ve result = wheal >= 2mm> -ve control Discontinue antihistamines 48hrs prior to test
87
RAST: radioallergosorbent test | quantitative specific IgE to putative allergen
Measures levels of IgE in serum against particular allergen Confirms diagnosis of allergy and monitors response to anti IgE treatment Indications: inability to stop antihistamines, anaphylaxis hx, extensive eczema
88
Component resolved diagnostics
IgE response to a specific allergen protein E.g. Arah2- high risk anaphylaxis to peanuts + nuts Arah8- localised oral reaction to peanuts + stone fruit only
89
Challenge test
Gold standard Double blind oral food challenge Incr volumes of food ingested under close supervision But risk of severe reaction
90
What should be measured during acute allergic reactions?
Mast cell tryptase Peak at 1-2 hrs Baseline by 6 hrs
91
Type II hypersensitivity reactions
IgG or IgM antibody vs cell/ matrix assoc protein
92
Haemolytic disease of the newborn
Mat IgG vs neonatal erythrocyte antigens Reticulocytosis + anaemia +ve DAT req exchange transfusion
93
AIHA
``` Vs RBC antigens e.g. Rhesus RBC destruction by autoantibody, complement + phagocytes = anaemia +ve DAT Req steroids ```
94
AITP
Vs platelet gpIIb/IIIa Antiplatelet antibody Req steroids, IVIG, splenectomy
95
Goodpasture's
Vs type IV collagen Glomerular nephritis, pulm haemorrhage Anti GBMab Req steroids + immune suppression
96
Pemphigus vulgaris
Vs epidermal cadherin: demoglein 1 + 3 Direct IF showing IgG Req corticosteroids + immune suppression
97
Graves' disease
Vs TSH receptor Hyperthyroid sx Anti TSH receptor Req carbimazole + propylthiouracil
98
Myasthenia Gravis
Vs ACh receptor Fatigueable muscle weakness Anti ACh R Ab IVIG, plasmapheresis, neostigmine/pyridostigmine
99
Acute rheumatic fever
Vs M proteins on GpAstrep Req aspirin, steroids, penicillin
100
Pernicious anaemia
Vs intrinsic factor / gastric parietal cells Reduced Hb, B12 Anti gastric parietal cell Ab Req B12 supplementation
101
Churg Strauss
Med + small vessel vasculitis Allergy -> asthma -> systemic disease pANCA Req prednisolone, azathioprine, cyclophosphamide
102
Wegener's Granulomatosis
Med + small vessel vasculitis Pulm haemorrhage, epistaxis, saddle nose, crescenteric GN cANCA Req corticosteroids, cyclophosphamide, co trimoxazole
103
Microscopic Polyangitis
Small vessel vasculitis Pauci immune, necrotising, purpura pANCA Req prednisolone, cyclophosphamide/ azathioprine, plasmapheresis
104
Type II Hypersensitivity and complement
C1 C3a + C5a C5-9 MAC
105
Type II Hypersensitivity and complement
C1 C3a + C5a C5-9 MAC
106
Type III hypersensitivity
``` IgG or IgM immune complex mediated tissue damage Mixed essential cryoglobulinaemia Serum sickness Polyarteritis nodosa SLE ```
107
Mixed essential cryoglobulinaemia
Joint pain, splenomeg, skin, nerve, kidney involvement Assoc with Hep C Clinical dx + biopsy Req NSAIDs, corticosteroids, plasmapheresis
108
Serum sickness
Rashes, itching, arthralgia, LNpathy, fever, malaise Antiserum proteins (IV non-human antiserum) Reduced C3, immune complexes + vessel inflammation Ex: Stop drug, steroids, antihistamines
109
Polyarteritis nodosa
Fever, fatigue, wkness, arthralgia, skin, nerve, kidney, heart Small + med vessel vasculitis -> multiple aneurysms Complex deposition -> fibrinoid necrosis + neutrophil infiltration Assoc with hep B Clinical incr ESR, CRP, WCC, + biopsy Rx: prednisolone + cyclophosphamide
110
SLE
ANA +ve, anti ds DNA, anti smith = interstitial lung involvement Reduced C4 Normal CRP, incr ESR Drug induced= hydralyzine, procainamide, isoniazid Rx: analgesia, steroids, cyclophosphamide
110
Extrinsic allergic alveolitis
Aka farmers lung Actinomycetes Immune complex deposition in alveoli Chronic exposure = pulmonary fibrosis, sob, cyanosis cor pulmonale
111
Type IV hypersensitivity
``` Delayed hypersensitivity, 48-72 hrs, T cell mediated Macrophage -> IL12 -> mem CD4 Th1 Sens mem cell releases IFN gamma, IL2 + IL3 -> macrophage activ = TNF alpha production, injury + inflammation Contact dermatitis T1DM MS RA Crohns Mantoux ```
112
T1DM
Pancreatic beta cell proteins -> insulinitis beta cell destruction GAD-Ab, islet cell Ab Antibodies to tyrosine phosphatase: anti-IA-2Ab + anti phogrin Ab
113
MS
Oligodendrocyte proteins (proteolipid + myelin basic protein) -> patchy demyelination Perivascular inflammation CSF: oligoclonal IgG bands on electrophoresis Rx: corticosteroids, interferon beta Uhthoff worse sx at higher than ambient T
114
RA
Synovial membrane antigen -> chronic arthritis, rheum nodules, lung fibrosis Incr ESR + CRP Anti CCP Rx: analgesia, steroids, DMARDs
115
Contact dermatitis
Chemicals / poison ivy / nickel (hapten binds skin proteins) 1-2 days -> blisters/ wheals, desquamation Clinical patch test Rx: avoidance, corticosteroids
116
Crohns
TH1 mediated skip lesions in GIT Biopsy Rx: mesalazine, infliximab, steroids
117
Mantoux
Tuberculin | Skin induration indicates TB exposure
118
CREST- limited scleroderma
``` Calcinosis Raynauds Esophageal dysmotility Sclerodactyly Telangiectasia Primary pulmonary htn Only peri oral + forearm skin TNF beta central to pathogenesis Anti centromere Ab ```
119
Diffuse scleroderma
``` CREST + GIT + interstitial lung disease + renal problems Female 4 : male 1 Anti topoisomerase Fibrillarin Ab RNA pol I, II, III ```
120
Sjogrens
``` Dry mouth, eyes, nose + skin Kidneys, blood vessels, lungs, liver, pancreas, PNS Parotid + salivary gland enlargement Anti Ro, Anti La Schiller test ```
121
IPEX syndrome
``` Immune dysregulation, polyendocrinopathy, enteropathy, x link Eczematous dermatitis, nail dystrophy Alopecia, pemphigoid Most affected die in first 2 yrs BMT is only cure ```
122
Coeliac disease
``` Gluten -> villous atrophy + enteropathy Constipation, diarrhoea, bloating, fatigue Malabsorption: Fe, folate, lipid soluble vitamins, Ca deficiency IgA anti endomysial Ab IgA anti tissue transglutaminase IgG anti Gliadin Ab = most persistent Dermatitis herpetiformis Linked to Downs DQ 2 or DQ8 Gold standard = duodenal biopsy ```
123
cardiolipin Ab Lupus anticoagulant Beta2glycoprotein Ab
Antiphospholipid syndrome
124
Anti SM Ant LKM - 1 Anti SLA
AI hepatitis
125
Anti rhesus blood gp antigen
AIHA
126
Anti Gp IIb / IIIa
AITP
127
pANCA
Churg strauss Aka eGPA
128
Anti TTG Anti EMA DQ 2
Coeliac
129
Anti Ro ENA
Congenital heart block + maternal SLE
130
Anti Jo
Dermatomyositis
131
Anti topoisomerase | Fibrillarin
Diffuse scleroderma
132
Anti glomerular basement membrane Ab
Goodpasture's
133
Anti TSH R Ab
Grave's
134
Thyroglobulin Ab | Thyroperoxidase Ab
Hashimoto's thyroiditis
135
Anti centromere Ab
CREST - limited scleroderma
136
pANCA
Microscopic Polyangitis
137
Anti UIRNP | Speckled pattern
Mixed connective tissue disease
138
Anti AChR Ab
MG
139
Gastric parietal cell Ab | IF Ab
Pernicious anaemia
140
Anti Jo -1 | tRNA synthase
Polymyositis
141
anti mitochondrial Ab
PBC
142
Anti CCP Rheumatoid factor Incr CH50 HLA DR4
RA
143
Anti Ro | Anti La - speckled
Sjogrens
144
ds DNA Histone Ab Incr CH50 HLA DR3
SLE
145
``` Glutamate decarboxylase (GAD) HLA DR3/4 ```
T1DM
146
Wegener's / GPA
cANCA
147
PTPN22
Assoc with RA, SLE, T1DM
148
CTLA4
Assoc with SLE, T1DM, AI thyroid
149
Human normal Ig
Every 3-4 wks Primary Ab deficiencies: CVID, Bruton's Secondary Ab deficiencies: CLL, MM, BMT Passive vaccination
150
Specific Ig
``` Passive immunisation - lasts 3wks Rabies VZV Hep B Tetanus Hep A ```
151
Recombinant cytokines
INF alpha: hep B, hep C, Kaposi's, CML, MM, hairy cell leuk INF beta: relapsing MS INF gamma: chronic granulomatous disease
152
Pre transplant induction agents
Suppress T cell response: Alemtuzumab -CD 52 Basiliximab -CD 25
153
Post transplant immunosuppressant
Calcineurin inhibitors: Tacrolimus + ciclosporin | Mycophenolate mofetil
154
Treating acute rejection
Cellular: steroids + IVIG | Ab mediated: IVIG + plasmapheresis
155
How does HIV bind to CD4 cells?
Via gp 120 + gp41 | CCR5 + CXcR4
157
Describe progression to AIDS
Median timescale = 8-10 yrs post infection | 10%: Rapid progressors = 2-3 yrs
157
Diagnosing HIV
Screening: anti HIV Ab via ELISA Confirmation: HIV Ab detected via western blot +ve test req seroconversion ~10 wks post infection
158
What CD4 count correlates with the onset of AIDS?
159
HIV monitoring
Viral load: via PCR CD4 count: via FACS - flow cytometry
161
How do CD8 cells block HIV entry?
MIP-1a MIP- 1b RANTES
162
APECED
``` AIRE mutation Normally kills T cells which bind self antigens Mild immune deficiency Dysfunctional parathyroids + adrenals Hypothyroidism Gonado failure Alopecia + vitiligo ```
163
Which are antigen presenting cells?
Macrophages Dendritic cells B cells
164
Isograft
Transplant from monozygotic twin
165
Allograft
Same species donor Genetically different HLA + ABO matched
166
Split transplant
Liver that might be divided between two recipients
167
Autograft
Transplant of tissue to same patient | E.g. Skin graft + CABG
168
Xenograft
Transplant from another species E.g. Porcine heart valve in aortic valve replacement High risk rejection + disease
169
Hyperactive rejection
Mins-hrs Mediated by preformed antibodies vs antigens on surface of donor organ Activates complement + clotting cascade Rejection
170
Acute cellular rejection
``` 1 wk post transplant T cell mediated HLA mismatch APCs-> CD4-> macrophages, CD8, B cells, IFN gamma, TNF alpha Vs donor organ ```
171
Acute vascular rejection
With Xenograft Antibody reaction Similar to hyper acute but after 4-6 days
172
Chronic rejection
Smooth muscle growth blocks graft vessel lumens -> ischaemia + fibrosis rf: HLA mismatch, multiple acute rejections, htn, hyperlipidaemia
173
GVHD
Complication of allogeneic SCT | Immune cells donated recognise recipient tissue as foreign
174
List some AIDS defining illnesses
Mycobacterium Acium intracellulare Candida albicans oesophagutus Toxoplasmosis
175
Examples of inactivated vaccines
Cholera Hep A Rabies
176
Examples of live attenuated vaccines | CI in the immunocompromised
MMR Sabin polio Typhoid Yellow fever
177
Sub unit vaccines
``` Hep B recombinant Pneumococcal Diptheria Tetanus Pertussis ```
178
Conjugated vaccines | Vs encapsulated bacteria
Influenza Pneumococcus Neisseria meningitidis
179
INF alpha
``` In treatment of : Hep B Hep C Kaposi's sarcoma CML ```
180
INF beta
Used in MS | Unknown mech of action
182
Which are antigen presenting cells?
Macrophages Dendritic cells B cells
183
INF gamma
In treatment of: | Chronic granulomatous disease
184
Auto immune hepatitis type 1
ANA Anti SM Ab Responds well to steroids 10yrs - elderly
185
Auto immune hepatitis type 2
Paediatric population Anti LKM Ab Assoc with IgA deficiency
186
Guillain Barré
Ganglioside LM1(A), P2, galactocerebroside Ascending paralysis Following CMV or Campylobacter Cross reactivity betw pathogen and peripheral nerve myelin components
187
PSSN: para neoplastic subacute sensory neuropathy | Assoc with small cell
Anti Hu proteins of peripheral nerves
188
Para neoplastic cerebellar degeneration
Anti Purkinje cells of CNS
189
Para protein assoc polyneuropathy
Anti myelin-assoc glycoprotein MAG

Toni's Pathology (6 decks)

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