Immunology

Question 1

Broad causes of secondary immune deficiency?

Answer 1

Physiological (extremes of age)
Infection
Treatment interventions
Malignancy
Biochemical and nutritional disorders

Question 2

Examples of infections causing secondary immune deficiency?

Answer 2

HIV

Measles

Question 3

Examples of treatment interventions causing secondary immune deficiency?

Answer 3

Immunosuppressives
Anti-cancer
Corticosteroids

Question 4

Examples of malignancies causing secondary immune deficiency?

Answer 4

Lymphoma, leukaemia, myeloma

Metastatic cancer

Question 5

Examples of biochemical and nutritional disorders causing secondary immune deficiency?

Answer 5

Malnutrition
Renal insufficiency
Diabetes (T1+2)
Mineral deficiencies

Question 6

Definition of granuloma?

Answer 6

An organised collection of activated macrophages and lymphocytes

Question 7

Why do granulomas form?

Answer 7

non-specific inflammatory response triggered by diverse antigens or foreign bodies- stimulus not removes- persistent

Question 8

Differential of lung granulomas?

Answer 8

Sarcoidosis
TB
Leprosy
Silicosis (other dust diseases)
Chronic hypersensitivity pneumonitis
Foreign bodies

Question 9

2 presentations of antibody deficiencies?

Answer 9

Recurrent bacterial infection

Antibody mediated autoimmune disease (e.g. ITP, haemolytic anaemia)

Question 10

Function of natural killer cells?

Answer 10

Kill cells that lack MHC (molecules on surface)- no antigen specificity

Question 11

Primary causes of recurrent infections and low immunoglobulins?

Answer 11

CVID- common variable immune deficiency

Specific antibody deficiency (IgA very common!)

Question 12

Secondary causes of recurrent infections and low immunoglobulins?

Answer 12

Protein loss- nephrotic syndrome

Low protein production- CLL, myeloma, NHL

Question 13

What is complement?

Answer 13

Proteins secreted by liver that interact with pathogens to mark them for destruction by phagocytes
(promotes inflammation)

Question 14

Examples of live attenuated vaccines?

Answer 14

MMR
Chickenpox
Yellow fever
Rotavirus
BCG

Question 15

Examples of inactivated whole cell vaccines?

Answer 15

Polio
Hep A
Rabies
Cholera

Question 16

Examples of inactivated fractional vaccines?

Answer 16

Hep B
Influenza
HPV
Anthrax
Diphtheria
Tetanus
Haemophilus influenza type B

Question 17

How do vaccinations produce memory?

Answer 17

Generate long-lived memory B cells (last years) and effector T cells/memory T cells

Question 18

What does immune memory cause during secondary infection?

Answer 18

Ability to clear infection during incubation period, before the onset of clinical features, by rapidly producing IgG

Question 19

Pros of inactivated vaccines?

Answer 19

Quick and easy and safe

Question 20

Cons of inactivated vaccines?

Answer 20

Not very potent- don’t stimulate good immune response

Question 21

Pros of live attenuated vaccines?

Answer 21

Strong, localised response

One dose

Question 22

Cons of live attenuated vaccines?

Answer 22

May cause infection

Must be handled carefully

Question 23

What type of hypersensitivity is a hyperacute rejection of transplant and why does it occur?

Answer 23

Type II hypersensitivity

Due to preformed antibodies

Question 24

2 types of acute transplant rejection?

Answer 24

Acute cellular rejection (type IV hypersensitivity)

Acute vascular rejection (type II hypersensitivity)

Question 25

What does chronic allograft failure lead to?

Answer 25

Fibrosis and scarring

Question 26

What are "toll-like receptors" and what do they respond to?

Answer 26

Allow innate recognition of invaders, respond to PAMPS (pathogen-associated molecular patterns), then allow cytokine/IF1 release

Question 27

Where are "toll-like receptors" expressed?

Answer 27

Phagocytes + dendrites

Question 28

Function of TNF-alpha?

Answer 28

Immediate-early "alarm" signal in response to stressors (microbes, stress, chemicals etc.)

Question 29

How do TNF-inhibitors work?

Answer 29

By blocking pro-inflammatory cytokines

Question 30

How do biologic drugs work?

Answer 30

Artificial antibodies that block the body's own proteins | passive immunisation

Question 31

Examples of biologics?

Answer 31

Adalimumab Pembrolizumab Secukinumab

Question 32

How are biologics metabolised?

Answer 32

THEY AREN'T natural proteins so not metabolised by body Safe in renal/liver disease

Question 33

Do biologics act as immunosuppressants?

Answer 33

NO

Question 34

Autoantibody for coeliac?

Answer 34

Tissue transglutaminase IgA antibody

Question 35

Autoantibody for myasthenia gravis?

Answer 35

Anti-acetylcholine receptor antibody

Question 36

Autoantibody for rheumatoid arthritis?

Answer 36

Anti-CCP

Question 37

Autoantibodies for SLE?

Answer 37

Anti-dsDNA, anti-Sm, ANA

Question 38

Autoantibodies for Sjogren's?

Answer 38

Anti-Ro, anti-La

Question 39

Is methotrexate an immunosuppressant?

Answer 39

NO (anti-inflammatory) | Safe in cancers/TB

Question 40

When is methotrexate contraindicated?

Answer 40

Liver disease | Pregnancy

Question 41

Autoantibody for myositis?

Answer 41

Anti-Jo

Question 42

Autoantibody for MCTD?

Answer 42

Anti-RNP

Question 43

Autoantibody for limited systemic sclerosis?

Answer 43

Anti-centromere

Question 44

Autoantibody for diffuse systemic sclerosis?

Answer 44

Anti-Scl-70

Question 45

Autoantibodies for APS?

Answer 45

Anti-cardiolipin and lupus anti-coagulant

Question 46

Autoantibody for small vessel vasculitis?

Answer 46

ANCA