Immunology

Question 1

causes of secondary immune deficiency?

Answer 1

infection
old age
drugs
malignancy
nutritional disorder

Question 2

what is a granuloma?

Answer 2

an organised collection of activated macrophages and lymphocytes

Question 3

why do granulomas sometimes form?

Answer 3

inflammatory response triggered by a stimulus
failure of removal of the stimulus results in persistent cytokine production
immune cells cluster in a circle

Question 4

DDx lung granuloma

Answer 4

TB
sarcoidosis
chronic hypersensitivity pneumonitis
dust diseases eg silicosis
foreign body

Question 5

people with antibody deficiencies tend to get bacterial/viral infections

Answer 5

bacterial

Question 6

how does antibody deficiency present

Answer 6

recurrent bacterial infections

antibody mediated autoimmune disease

Question 7

selective IgA deficiency patients to tend to get infections in what system?

Answer 7

respiratory BUT most are asymptomatic

Question 8

what is hypogammaglobulinaemia

Answer 8

decrease in gammaglobulins INCLUDING immunoglobulins

Question 9

if you arent antibody deficient but you have hypogammaglobulinaemia what could be the cause?

Answer 9

protein loss or failure of protein synthesis eg by leukaemia

Question 10

NK cells kill cells that lack what?

Answer 10

MHC

Question 11

toll-like receptors respond to what?

Answer 11

PAMPS

pathogen associated molecular patterns

Question 12

TLRs are expressed on..

Answer 12

phagocytes

dendrites

Question 13

by activating TLRs, you will trigger the release of…

Answer 13

pro-inflam cytokines

type 1 interferon secretion

Question 14

TNF inhibitors block…

Answer 14

pro-inflam cytokines

Question 15

give an example of a TLR activating drug

Answer 15

imiquimod

Question 16

why are biologic drugs not hepato or nephrotoxic?

Answer 16

are normal proteins so their metabolism doesnt depend on liver/renal function

Question 17

what are biologic drugs made of?

Answer 17

artificial antibodies

Question 18

name the fastest kind of transplant rejection; how long does it take to present?

Answer 18

hyperacute

minutes-hrs

Question 19

acute cellular rejection is an example of type _ hypersensitivity

Answer 19

4

Question 20

cells involved in acute cellular rejection?

Answer 20

CD4 and CD8 T cells

Question 21

acute vascular rejection is an example of type _ hypersensitivity

Answer 21

2

Question 22

name the types of transplant rejection that occur 5-30 days after transplant

Answer 22

acute cellular rejection

acute vascular rejection

Question 23

what transplant rejection can present with vasculitis?

Answer 23

acute vascular rejection

Question 24

what transplant rejections are treated? with what?

Answer 24

hyperacute - nil
acute cellular/vascular - immunosuppression
chronic allograft failure - treat symptoms

Question 25

pathophysiology of chronic allograft failure

Answer 25

fibrosis | scarring

Question 26

which transplant rejection occurs >30 days after transplant?

Answer 26

chronic allograft fracture

Question 27

2 types of active immunisation

Answer 27

live attenuated | inactive

Question 28

what kind of T cells become memory T cells

Answer 28

effector T cells

Question 29

how does the antibody response to infection change if there is memory?

Answer 29

IgG is produced at the same time as IgM instead of after

Question 30

why do inactivated vaccines require multiple injections?

Answer 30

dont stimulate clonal expansion of B and T cells

Question 31

give an example of a whole cell inactivated vaccine

Answer 31

polio rabies cholera (think travel vaccines)

Question 32

give an example of a fractional inactivated vaccine

Answer 32

``` hep B flu HPV diphtheria tetanus HiB ```

Question 33

give an example of a live attenuated vaccine

Answer 33

``` MMR chicken pox yellow fever polio BCG for TB ```

Question 34

test for ANA?

Answer 34

ELISA

Question 35

autoantibody Ix for SLE?

Answer 35

1. ANA | 2. dsDNA and ENA if the staining pattern of ANA matches that of SLE

Question 36

rheumatoid factor is an autoantibody directed to....

Answer 36

the Fc region of IgG

Question 37

what do c-ANCA and p-ANCA mean?

Answer 37

``` c-ANCA = diffuse staining into Cytoplasm p-ANCA = Peripheral staining around nuclei ```

Question 38

NK cells are part of the innate/adaptive immune system

Answer 38

innate

Question 39

what cells are part of adaptive immunity

Answer 39

T and B lymphocytes

Question 40

the formation of what accounts for the rapid production of IgG at re-exposure to a microbe after vaccination

Answer 40

memory B cells

Question 41

why is it good to have multiple vaccines at once?

Answer 41

produces memory

Question 42

how are biological drugs metabolised?

Answer 42

broken down into amino acids (dont need liver/renal function)

Question 43

biological therapy is a form of passive/active immunity

Answer 43

passive

Question 44

methotrexate is an example of an immunosuppressant T or F

Answer 44

F, its an anti inflammatory

Question 45

what receptor does methotrexate act on?

Answer 45

adenosine A2 receptor

Question 46

liver contraindications to methotrexate?

Answer 46

any chronic liver disease | alcoholism

Question 47

you should stop a biologic if you have low eGFR T or F

Answer 47

F, biologics dont affect the kidneys or liver

Question 48

if you take away TNF what are you at risk of?

Answer 48

reactivation of TB as the granuloma will break up