Lecture 27+28

Question 1

somatic recombination

Answer 1

V(D)J joining

v = variable 
D = diverse (heavy chain) 
J = joining  

Non-homologous DNA recombination

this happens during the antigen-independent phase

RAG 1 and RAG2 help out

Question 2

junctional diversity

Answer 2

unlimited

• Addition or removal of nucleotides among V(D)J
joints
• The largest contribution to diversity of antigen
receptors

Question 3

heavy chain rearrangement

Answer 3

pro B cell = DJ

pre B cell = VDJ

light chain rearrangement happens in immature cells

Question 4

how does nucleotides get added

Answer 4

tDt

Question 5

AID

Answer 5

activation induced deaminase

a somatic hypermutation that leads to BCR variability

improves affinity

converts cytosine to uracil

Question 6

class switching

Answer 6

Requires: T-cell activation through CD40-CD40L interactions

regulated by IL4 (IgE,IgG) and IFN gamma

AID also has a role in class switching

Question 7

TCR rearrangement

Answer 7

analogous to BCR

the beta chain rearrangement occurs in pre t cell
follow by alpha chain in the immature T cell

does not have hypermutation or class switching

Question 8

IL1, IL6, and TNF

Answer 8

acute inflammation

TNF has a role in neutrophil activation

Question 9

IFN alpha and IFN beta

Answer 9

antiviral

Question 10

IFN gamma

Answer 10

activation of macrophages, increase of MHC

expression….Chronic inflammation

Question 11

IL8

Answer 11

neutrophil attractant

chemokine

Question 12

IL5

Answer 12

eosinophil activation

Question 13

IL4

Answer 13

class switch to IgE

Question 14

IL7

Answer 14

development of lymphocytes from pro to pre cells

Question 15

IL3

Answer 15

development of myelocytes

Question 16

IL10 and TGF beta

Answer 16

downregulation of immune response

Question 17

IL12

Answer 17

Produce by macrophages to activate Th1 cells.

Important in granuloma formation

Question 18

Reason’s swiss cheese model

Answer 18

have active factors (accident happening) or latent factors (accidents waiting to happen)

different safeguards may prevent accidents
barriers which as the CPOE

Question 19

root cause analysis

Answer 19

used to identify the causative factors that underlie variations in performance

typically will evaluate a sentinel event

identifies the cause and improves systems and processes to decrease the odds of the event happening again

retrospective approach
what, how, and why did this happen

Question 20

Fishbone (Ishikawa) Cause-and-Effect Diagram

Answer 20

identify system cause of error and develop action plans that include strategies that reduce the risk of future similar events

Question 21

Failure Mode and Effects Analysis (FMEA)

Answer 21

A systematic and proactive process of anticipating failures, determining the impact of those failures and determining the likelihood of that failure being
detected before it occurs

the goal is to prevent patient problems before they occur

errors will always occur

Question 22

Plan-Do-Study-Act (PDSA) Cycle

Answer 22

Four-step cycle that allows one to quickly implement “relatively small-scale” change,
solve problems, and iteratively or continuously improve processes