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Immunology - First Aid > Lymphoid Structures > Flashcards

Lymphoid Structures Flashcards

1
Q

What are 1º immune system organs?

A

Bone marrow (immune cell production, B cell maturation)

Thymus (T cell maturation)

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2
Q

What are 2º immune system organs?

A

Spleen
Lymph nodes
Tonsils
Peyer patches

They allow immune cells to interact with Ag

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3
Q

What are functions of lymph nodes?

A
  1. Nonspecific filtration of macrophages
  2. Storage of B and T cells
  3. Immune response activation
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4
Q

What encapsulated 2º lymphoid organ has many afferents and only 1 or more efferents?

A

Lymph node

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5
Q

What is the site of B cell localization and proliferation in lymph node?

A

Follicle (outer cortex)

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6
Q

What is the difference between 1º and 2º follicles of lymph node?

A

1º follicles: dense, dormant

2º follicles: pale central GERMINAL center, ACTIVE

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7
Q

Components of lymph node medullary cords?

A

Closely packed lymphocytes

Plasma cells

Medullary sinuses

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8
Q

Components of medullary sinuses?

A

Reticular cells

Macrophages

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9
Q

Which part of the lymph node enlarged in bacterial infection?

A

2º follicles: Germinal center (outer cortex)

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10
Q

Which part of the lymph nodes is enlarged in an extreme cellular response (eg. viral infection) ?

A

Paracortex (T cell response)

(eg, EBV and other viral infections →
paracortical hyperplasia → lymphadenopathy)

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11
Q

Paracortex of lymph node house which type of cells?

A

T cells

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12
Q

Which part of the lymph node is not well developed in DiGeorge syndrome?

A

Paracortex

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13
Q

Where do T and B lymphocytes enter the lymph node from the blood?

A

HEVs (high endothelial venules)

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14
Q

Where does B cell maturation take place?

A

Bone marrow

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15
Q

Where does T cell maturation take place?

A

Thymus

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16
Q

Germinal centers in 2º lymphoid tissues are the result of the proliferation of which cells?

A

B cells

These are clones of proliferating, Ag-specific cells

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17
Q

What is the 1st signal for the activation of B lymphocytes in 2º lymphoid organs?

A

Ag binding

and cross-links the idiotype of the Ig

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18
Q

Which mutation occurs during intense proliferative response of the B cell (formation of germinal centers)?

A

Somatic hypermutation

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19
Q

What type of mutation is somatic hypermutation?

Where does it occur?

A

Random single point mutation (in Ab idiotype)

Variable domain region

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20
Q

What is the advantage of single point mutations in Ab idiotype?

A

Increased affinity for the Ag

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21
Q

The process in which clonal selection results in the predominance of clones capable of producing antibodies with ↑affinity for Ag is called ____?

A

Affinity maturation

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22
Q 
How does isotype switching that happens with affinity maturation affect antibody avidity (↑ or ↓)
and affinity (↑ or ↓)?
A

↓ avidity

↑ affinity

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23
Q

Describe the flow of lymph in lymph node

A

Afferent lymphatic vessels

           ↓  valve

Sub-capsular sinus (cortex)

               ↓
Cortical sinus (paracortex)
           ↓

Medullary sinus

           ↓  valve

Efferent lymph vessels

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24
Q

What happens in the germinal center of a lymph node?

A

B cells activate, proliferate, differentiate, and mutate (humoral immunity)

Class (isotype) switching

Somatic hypermutation (↑ affinity to antigens)

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25
Deep cervical lymph node cluster drain which areas? ↑?
Head Neck ↑ - URTI - Inf mono - Strep Pharyng - Kawasaki's - Malignancy head/ neck/ oropharynx
26
Hilar lymph node cluster drain which areas? ↑?
Lungs ``` ↑ - Infection, inflammation Pulmonary TB (unilateral hilar) Sarcoidosis (bilateral hilar) Lung cancer Granulomatous disease ```
27
Mediastinal lymph node cluster drain which areas? ↑?
Trachea Esophagus ↑ - primary lung cancer, granulomatous disease
28
Axillary lymph node cluster drain which areas? ↑?
Upper limb Breast Skin above umbilicus ↑ - Mastitis, Breast cancer metastasis
29
Superior mesenteric lymph node cluster drain which areas? ↑?
Lower duodenum Jejunum Ileum Colon up to splenic flexure ↑ - Mesenteric lymphadenitis, Typhoid fever, Ulc. colitis, Celiac disease
30
Inferior mesenteric lymph node cluster drain which areas? ↑?
Colon from splenic flexure to upper rectum ↑ - Mesenteric lymphadenitis, Typhoid fever, Ulc. colitis, Celiac disease
31
Internal iliac lymph node cluster drain which areas? ↑?
Lower rectum to anal canal (above pectinate line) Bladder Vagina (middle third) Cervix Prostate ↑ - STDs
32
Superficial inguinal lymph node cluster drain which areas? ↑?
Anal canal (below the pectinate line) Scrotum Vulva Skin below umbilicus (except popliteal area) ↑ - STDs, pararectal abscess
33
Para-aortic lymph node cluster drain which areas? ↑?
Testes Ovaries Kidneys Uterus ↑ - metastases
34
Popliteal lymph node cluster drain which areas? ↑?
Dorsolateral foot Posterior calf ↑ - cellulitis
35
Celiac lymph node cluster drain which area? ↑?
Liver Stomach Spleen Pancreas Upper duodenum ↑ - Mesenteric lymphadenitis, Typhoid fever, Ulc. colitis, Celiac disease
36
Trachea & esophagus lymph drain into which lymph node cluster?
Mediastinal
37
Lower duodenum, jejunum, ileum, colon up to splenic flexure drain into which lymph node cluster?
Superior mesenteric
38
Anal canal (below the pectinate line), scrotum, vulva, skin below umbilicus (except popliteal area) drain into which lymph node cluster?
Superficial inguinal
39
Testes, ovaries, kidneys, uterus drain into which lymph node cluster?
Para-aortic
40
Liver, stomach, spleen, pancreas, upper duodenum drain into which lymph node cluster?
Celiac
41
Lower rectum to anal canal (above pectinate line), bladder, vagina (middle third), cervix, prostate drain into which lymph node cluster?
Internal Iliac
42
The colon, from splenic flexure to upper rectum, drains into which lymph node cluster
Inferior mesenteric
43
Right lymphatic duct drains which areas?
Upper right thoracic cavity (via Rt broncho-mediastinal trunk) above diaphragm Right arm (via Rt subclavian trunk) Right side of the head and neck (via Rt jugular trunk)
44
Thoracic duct drains which areas?
All areas except Rt thoracic cavity, Rt side of head & neck, Rt arm.
45
Thoracic duct drains into which veins?
Junction of Left subclavian vein & Left internal jugular vein (at the commencement of the brachiocephalic vein)
46
Right lymphatic duct drains into which veins?
Junction of the Right internal jugular & Rt subclavian veins
47
Sinusoids are long, vascular channels with fenestrated barrel hoop basement membrane in which part of the spleen?
Red pulp
48
What are the components of splenic red pulp?
Sinusoids Cords Plasma cells
49
Which lymphocytes are found in follicles of 2º lymphoid tissues?
B cells
50
Where are T cells located in the spleen?
White pulp - PALS PeriArteriolar Lymphatic Sheath | central artery enveloped by sheath of T cells
51
Where are B cells located in the spleen?
White pulp - follicles Marginal zone - specialized B cells
52
What are the components of splenic white pulp?
Follicle (B cells) PALS PeriArteriolar Lymphatic Sheath (T cells)
53
What is function of splenic marginal zone?
Macrophages (remove encapsulated bacteria) Specialized B cells APCs (capture blood-borne Ag for recognition by lymphocytes)
54
What are the zones of the spleen?
Hematological zone - Red pulp Immunological zone - White pulp Ag screening & processing zone - Marginal zone
55
Splenic PALS PeriArteriolar Lymphatic Sheath contain which lymphocytes?
T cells
56
High endothelial venules (HEVs) use which lymphocyte surface molecules and their counter-receptors to facilitate lymphocyte entry?
L-selectin & Peripheral lymph node addressins (PNAds)
57
Macrophages in spleen remove which type of organisms?
ENCAPSULATED - Pseudomonas aeroginosa - Neisseria meningitides - Streptococcus pnemoniae - Klebsiella pneumonia - Group B streptococci - E. coli - H. influenzae B - Salmonella - Yersinia pestis - Bacillus anthracis - Cryptococcus Neoformans
58
Splenic dysfunction lead to ↑ susceptibility to which organisms ?
Splenic dysfunction (eg. splenectomy, sickle cell disease): ↓IgM → ↓complement activation → ↓C3b opsonization → ↑ susceptibility to encapsulated organisms (pneumococcal, Hib, meningococcal)
59
Important prep for patients undergoing splenectomy?
Vaccination against encapsulated organisms | pneumococcal, Hib, meningococcal
60
What cell types seen post-splenectomy?
- Howell-Jolly bodies (nuclear remnants, basophilic DNA fragments in RBCs which haven't expelled the nucleus properly) - Target cells - Thrombocytosis (loss of sequestration of platelets and removal) - Lymphocytosis (loss of sequestration WBCs)
61
Where do T cells differentiate and mature?
Thymus
62
Which embryological structure is the thymus derived from?
Third pharyngeal pouch Thymus EPITHELIUM: third pharyngeal pouch (endoderm) Thymic LYMPHOCYTES: mesoderm
63
Lymphocytes are of mesodermal origin or mesenchymal origin?
Mesodermal
64
What are contents of thymic cortex?
Immature T cells | dense, pink
65
What are contents of thymic medulla?
Mature T cells (pale) Hassall corpuscles
66
What are Hassall corpuscles?
Thymic bodies in medulla of thymus formed from: eosinophilic type VI epithelial reticular cells arranged concentrically (central mass, consisting of one or more granular cells, and capsule formed of epithelioid cells - like rose petals)
67
Hypoplastic thymus is seen in which conditions?
DiGeorge syndrome SCID (severe combined immunodeficiency)
68
What is the common associated disorders with thymomas?
Myasthenia gravis Superior vena cava syndrome Pure red cell aplasia Good syndrome (hypogammaglobulinemia)
69
Which part of the lymph nodes is enlarged in EBV infection?
Paracortex (T cell response) | paracortical hyperplasia → lymphadenopathy
70
Oral cavity is drained by which lymph node cluster?
Submandibular
71
Malignancy of oral cavity can lead to a pathology (increase) in which lymph node cluster?
Submandibular
72
Supraclavicular lymph nodes drain which area? ↑?
Abdomen and pelvis (Virchow node) ↑ Malignancy of abdomen, pelvis
73
Mastitis & breast cancer metastasis affect which lymph node cluster?
Axillary lymph nodes
74
Hand & forearm are drained into which lymph node cluster?
Epitrochlear
75
Secondary syphilis can lead to pathology in which lymph nodes?
Epitrochlear
76
Epitrochlear lymph nodes ca ne enlarged in which pathology?
Secondary syphilis
77
Periumbilical lymph nodes drain which area? ↑?
Abdomen and pelvis (Sister Mary Joseph node) ↑ Gastric cancer
78
What happens if the thoracic duct is ruptured due to a malignancy?
Chylothorax (thoracic duct damage with chyle leakage from the lymphatic system into the pleural space, usually on the right side. Manifests as pleural effusion)
79
What is chylothorax?
Thoracic duct damage with chyle leakage from the lymphatic system into the pleural space (tumors/ iatrogenic/ idiopathic) usually on the right side. Manifests as pleural effusion
80
Gastric cancer may primarily cause the enlargement of which lymph node clusters?
Supraclavicular (Virchow node) Periumbilical (Sister Mary Joseph node)
81
APCs capture blood-borne Ag for recognition by lymphocytes in which splenic zone?
Marginal zone
82
How can the normal thymus in neonates be visualized? Main feature?
CXR 'sail-shaped'
83
By which age does the thymus normally involute?
3 years

Immunology - First Aid (15 decks)

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