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TAS Revision > Immunology and Infection > Flashcards

Immunology and Infection Flashcards

(52 cards)

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1
Q

What are helper T cells also known as?

A

CD4+ T cells

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2
Q

What are cytotoxic T cells also known as?

A

CD8+ T cells

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3
Q

What is the function of helper T cells?

A

Stimulation of the B-cells to plasma cells which produce antibodies

This process takes place in the lymph-nodes

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4
Q

What os the function of cytotoxic T-cells?

A

Destruction of viruses and fungi - through destruction of the intra-cellular organisms

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5
Q

What are the features of severe combined immunodeficiency disorder?

A

Tends to present before 3 months of age

Severe lymphopenia from birth
Severe decrease or absent immunoglobulins
No antibody response to vaccinations

No B cell function or T cell function - hence small thymus and no tonsils/ adenoids noted

Recurrent infections +/- pneumonia

Tx w. bone marrow transplant

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6
Q

What is the pathophysiology of x-linked agammaglobulinaemia?

A

Defect in B-lymphocyte development which is caused by a mutation in Bruton tyrosine kinase (BTK)

BTK is involved in signalling naive B-cells to become plasma cells which then become antibodies - hence a mutation in this means that B-cells remain naive and don’t become antibodies

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7
Q

What are the features of x-linked agammaglobulinaemia?

A

Only affects boys - presents after 6 months of life (after maternal antibodies have disappeared)

Tends to present with recurrent infections

Diagnosed by flow cytometry - shows no mature B-cells
No antibodies present (IgA, IgG, IgM, IgE)

Tx - IVIg (or subcutaneous Ig)

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8
Q

What is the pathophysiology of common variable immunoglobulin deficiency?

A

Lack of B-lymphocytes or plasma cells

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9
Q

What are the features of CVID?

A

Appears during adolescence - very rarely appears before 6 years

Low IgG and IgA - variable but no absent

Normal size of large tonsils - recurrent bacterial infections
Autoimmune complications - vitiligo, RA, AIHA

Tx - IVIg (or subcutaneous Ig)

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10
Q

What are the features of transient hypogammaglobulinaemia of infancy?

A

Presents between 6-12 months of age

Commonly associated with asthma and allergies

Normal response to vaccinations

Low IgG with or without low IgA and IgM
T cell immunity is intact

Tx - supportive
IVIg in severe cases

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11
Q

What are the features of selective IgA deficiency?

A

Defined as undetectable IgA less than 5

Most common immunodeficiency
Recurrent pneumonia is present - especially with encapsulated bacteria (strep, haemophilis, m. cataralis)

Dx - low or absent IgA

Tx - abx PRN

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12
Q

What is the structure of diphtheria?

A

Gram positive bacillus

aka Klebs-Loffler bacillus

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13
Q

What is the structure of chlamydia?

A

Gram negative bacterium

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14
Q

What is the treatment of chlamydia?

A

Doxycyline PO

Second line - erythromycin/ ofloxacin

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15
Q

What is the shape of strep. pneumonia?

A

Gram positive diplococci

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16
Q

What is the shape of h. influenzae?

A

Gran negative coccibacillus

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17
Q

Which antibiotic is given to pregnant women as bacterial meningitis prophylaxis?

A

Ciprofloxacin

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18
Q

What shape is group B strep?

A

Gram positive cocci

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19
Q

What shape is E.coli?

A

Gram negative, anaerobic, rod shaped bacteria

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20
Q

What shape is listeria?

A

Gram positive

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21
Q

What are the most common causes of bacterial meningitis in the first 4 weeks of life?

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A

Group B strep (gram +ve cocci)
E. coli (gram negative bacilli)
Listeria (gram positive bacilli)

22
Q

Which immunoglobulin is most associated with periodic fever syndrome?

23
Q

How is chronic granulomatous disease diagnosed?

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A

Dihydrorhodamine neutrophil burst assay (DHR)

24
Q

What are the features of chronic granulomatous disease?

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A

Frequent staph. aureus infections - most notably frequent skin abscesses

25
When should mast cell tryptase levels be tested?
Peak is at 2 hours Levels rise after 30 minutes so should be tested at approx. 1-2 hours post reaction
26
What is the pathophysiology of XL Hyper-IgM syndrome?
Normally CD40 ligand is required to differentiate IgM into IgA, IgE and IgG - however in hyper-IgM syndrome there is a deficiency of CD40 therefore there is a build up of IgM and lack of other immunoglobulins
27
What are the features of XL hyper-IgM syndrome?
Frequent infections - specifically pneumonia or PJP Diagnosis - High or normal IgM Low IgA, IgG, IgE Deficient CD40 ligand on activated CD4+ T-cell lymphocytes Mx - Ig replacement
28
What are the features of hyper-IgE syndrome (aka Jobs syndrome)?
Recurrent infections Coarse facial features Eczema Pneumatocele Dx - elevated IgE (100 times higher than normal)
29
What are the features of Wiskott-Aldrich syndrome?
X-lined recessive therefore only affects boys Mutation of WASp Triad of eczema, recurrent infections (due to absent T-cells) and thrombocytopenia Increased risk of lymphoma (EBV related) and leukaemia
30
What is the pathophysiology of leukocyte adhesion deficiency?
The leukocyte cannot migrate to the site of the infection due to a lack of integrin CD18 subunit which would normally adhere to the leukocyte molecule and the cellular adhesion molecules passing it to the site of infection Infection without pus
31
What are the clinical features of leukocyte adhesion defect?
Delayed umbilical cord seperation >2 months No pus present at the site of the wound Poor wound healing Persistent leucocytosis - raised leucocyte count
32
What is the investigation of choice for leukocyte adhesion defects?
Flow cytometric measurements of surface glycoproteins (CD18 and CD11)
33
What is the pathophysiology of Chediak-Higashi syndrome?
It is a protein trafficking defect which means there is a deficiency of the protein involved in moving phagocytes to the lysosomes meaning impaired phase-lysosomal function
34
What are the features of Chediak-Higashi syndrome?
Partial oculocutaneous albinism Photophobia Bleeding diathesis (due to low platelets) Peripheral neuropathy Recurrent infections
35
What is the pathophysiology of chronic granulomatous disease?
NADPH oxidase deficiency - meaning that phagocytic cells are unable to generate hydrogen peroxide or hydroxyl radicals meaning that PMNs are unable to kill the bacteria
36
What are the features of chronic granulomatous disease?
Pyogenic infections - abscess formation in different sites Failure to thrive Formation of granulomas
37
How is chronic granulomatous disease diagnosed?
Neutrophil oxidative burst test - using rhodamine die
38
What is the pathophysiology of hereditary angioedema?
Type 1 HAE occurs due to a deficiency of C1 esterase inhibitor Type 2 HAE occurs due to defective C1 esterase inhibitor
39
What are the most common causes of infective endocarditis in diabetic and immunocompromised patients?
Haemophilus Actinobacilus Cardiobacterium Eikenella Kingella
40
What are the most common causes of infective endocarditis?
In order from most common: Staphylococcus Aureus Coagulase negative Staphylococcus (more likely in patients with prosthetic material) - e.g. staph. epidermidis Streptococcus viridans
41
Describe the differing hypersensitivity reactions?
Acute - type 1 Cytotoxic - type 2 (hours to days) - type 2 Immune mediated (weeks) - type 3 Delayed - type 4
42
What is the management of HIV in children who are positive?
Antiretroviral therapy should be started in any child with a diagnosis of HIV regardless of their viral load and CD4 count
43
What is the management of HIV in neonates born to HIV positive mothers?
Anti-retroviral Tx within 72 hours of birth (ideally within 12 hours) Low risk - should start zidovudine for 4 weeks High risk - should start combination ART (zidovudine, lamivudine, nevirapine)
44
What is the treatment of choice malaria in the paediatric population?
Malarone (Proguanil with atovaquone)
45
What is the transmission of hepatitis?
Hep A - contaminated water, i.e. faecal oral transmission Hep B - vertical/ blood contact/ body fluids Hep C - Blood Hep D - vertical/ blood/ body fluids - requires patient to already be infected with Hep B. Hep E - contaminated water, i.e. faecal oral transmission
46
What are the characteristic findings of typhoid?
Relative bradycardia and fever
47
Discuss complement activation by immunoglobulins?
IgA - alternative IgG + IgM - classical IgE + IgD - cannot activate complement
48
What is the treatment of chlamydia?
Macrolides - e.g erythromycin
49
Which strains of HPV are most commonly associated with neoplasm?
HPV 16 and 18
50
What is the treatment of choice for syphilis?
Benzylpenicillin
51
What is the treatment of choice for Gonorrhoea?
Ceftriaxone
52

TAS Revision (14 decks)

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