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1
Q

dyspnea

A

Difficult breathing

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2
Q

hemoptysis

A

Coughing blood

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3
Q

pruritis

A

Itching

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4
Q

purpuric maculopapular

A

Purple rash

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5
Q

Disseminated varicella infection is a rare disease seen in

A

immunocompromised

patients

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6
Q

Disseminated infection with varicella presents as

A

pneumonia, hepatitis, intravascular coagulopathy, encephalitis

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7
Q

Themortalityrateofdisseminatedvaricellainfectionis

A

55%

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8
Q

A depletion in the body’s natural immune system, or in some component of it.

A

Immunodeficiency

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9
Q

Having an immune system that has been impaired by disease or treatment

A

Immunocompromised

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10
Q

Having the capability to suppress the immune system, capable of immunosuppression.

A

Immunosuppressive

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11
Q

Any infection that arises subsequent to a pre- existing infection; but especially a nosocomial infection

A

Secondary infection

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12
Q

Nosocomial

A

A disease originated in a hospital

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13
Q

is a state in which the immune system’s ability to fight infectious disease is compromised or entirely absent

A

Immunodeficiency (or immune deficiency)

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14
Q

…………..Deficiencies more frequent than……………

A

Acquired deficiencies

primary immune deficiencies

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15
Q

problems of the immune system that are not genetic and which are caused by external factors.

A

Secondary immune deficiencies or acquired deficiencies

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16
Q

A person who is undergoing immunosuppression or whose immune system is weak for other reasons is said to be

A

immunocompromised

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17
Q

Reasons for weak immune system

A

chemotherapy, HIV, and Lupus

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18
Q

Distinction between primary versus secondary immunodeficiencies are based on

A

whether the cause originates in the immune system itself or is it due to insufficiency of a supporting component of it or an external decreasing factor of it

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19
Q

In most acquired cases, withdrawal of the external condition causing the deficiency can result in

A

restoration of immune function

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20
Q

most serious Acquired immunodeficiency is

A

HIV

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21
Q

most frequent causes of secondary immunodeficiencies in developed countries are

A

cancers involving the bone marrow and various therapies

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22
Q

……. results in deficiencies of virtually all components of the immune system and is a common cause of immunodeficiency in developing countries.

A

Protein-calorie malnutrition

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23
Q

Immunosuppressive drugs used to prevent ……and drugs for……, including some of the newer therapies (e.g……..&……) are causes of acquired immunodeficiencies

A

graft rejection
inflammatory diseases
TNF antagonists, costimulation blockade

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24
Q

How does human immunodeficiency virus infection (HIV) cause acquired immunodeficiency

A

Depletion of CD4+ helper T cells

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25
Q

How do irradiation and chemotherapy cause acquired immunodeficiencies

A

Decreased bone marrow precursors for all leukocytes

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26
Q

How dos immunosuppressives for graft rejection and inflammatory diseases cause acquired immunodeficiency

A

Depletion or functional impairment of lymphocytes

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27
Q

How does involvement of bone marrow by cancers cause acquired immunodeficiency

A

Reduced site of leukocyte development

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28
Q

How does proteins calories malnutrition causes acquired immunodeficiency

A

Metabolic derangements inhibit lymphocyte malnutrition and function

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29
Q

How does removal of spleen cause acquired immunodeficiency

A

Decreased phagocytosis of microbes

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30
Q

Bone marrow affecting cancer

A

Metastases, leukemia

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31
Q

Iatrogenic

A

Illness caused by medical examination or treatment

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32
Q

Iatrogenic immunosuppression is most often due to

A

drug therapies that kill or functionally inactivate lymphocytes or block the function of cytokines made by innate immune cells and lymphocytes.

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33
Q

The most commonly uses anti inflammatory and immunosuppressive drugs are

A

corticosteroids and cyclosporine, respectively

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34
Q

Widely used immunosuppressive

A

Anti cytokines antibodies

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35
Q

Various chemotherapeutic drugs are administered to patients with cancer, and these drugs are usually……. to proliferating cells, including…….

A

Cytotoxic

mature and developing lymphocytes as well as other leukocyte precursors.

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36
Q

Cancer chemotherapy is almost always accompanied by

A

y a period of immunosuppression and risk for infection.

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37
Q

Many specific diseases directly or indirectly cause immunosuppression, like :

A

• Many types of cancer, particularly those of the bone marrow and blood cells
(leukemia, lymphoma, multiple myeloma),
• Certain chronic infections.

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38
Q

Bone marrow tumors, including cancers metastatic to marrow and leukemias that arise in the marrow, may interfere with……. In addition, tumors may produce substances that interfere with…….

A

the growth and development of normal lymphocytes and other leukocytes

lymphocyte development or function.

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39
Q

Viruses that impair immune responses

A

Measles, human T cell lymphotropic virus 1 (HTLV-1)

They both do so by infecting lymphocytes

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40
Q

cancer treatment that can temporarily affect bone marrow.

A

Radiotherapy

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41
Q

Chronic infections with Mycobacterium tuberculosis and various fungi frequently result in

A

anergy to many antigens

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42
Q

Chronic parasitic infections may also lead to …… for example……

A

immunosuppression

depressed T cell function, in chronic malarial infections

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43
Q

Reasons for spleenectomy

A

treatment of certain hematologic diseases such as autoimmune hemolytic anemia and thrombocytopenia, in which red cells and platelets, respectively, are destroyed by phagocytes in the spleen, or infarction in sickle cell disease.

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44
Q

Patients without spleens are more susceptible to infection by some organisms, particularly bacteria such as…..&……. which have …………..rich capsules and are normally cleared by…….

A

pneumococci and meningococci,
polysaccharide-rich capsules
opsonization and phagocytosis.

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45
Q

One secondary immunodeficiency that has been recognized for some time but has an unknown cause is

A

hypogammaglobulinemia

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46
Q

hypogammaglobulinemia is confused with

A

CVID, a condition that shows genetic predisposition

Common variable immunodeficiency

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47
Q

Symptoms of hypogammaglobulinemaia

A

recurrent infection

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48
Q

hypogammaglobulinemaia typically manifests in

A

young adults who have very low but detectable levels of total immunoglobulin with normal T-cell numbers and function (some cases do involve T cells defects which grow more severe)

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49
Q

natural factors in immune function

A

Extremes of age

The very young and elderly suffer from impairments to immune function not typically seen during the remainder of the life span

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50
Q

How can diabetes result in an immunodeficiency disorder

A

because white blood cells do not function well when the blood sugar level is high

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51
Q

Other Causes of immunodeficiency

A 
• Trauma
• Injections
• Operative and other incisions
• Internal foreign bodies
• Major surgery
• Monoclonal antibodies and related small molecules
• Transfusion (which may lead to iron overload)
• Environmental toxins
• Excess weight
. Chronic disease 
. Chronic mental stress
. Lack of sleep
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52
Q

How does Chronic mental stress cause immunodeficiencies

A

Stress releases hormones like cortisol that suppresses inflammation (inflammation is initially needed to activate immune cells) and the action of white blood cells.

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53
Q

How does lack of sleep cause immunodeficiencies

A

Sleep is a time of restoration for the body, during which a type of cytokine is released that fights infection; too little sleep lowers the amount of these cytokines and other immune cells.

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54
Q

Protein-calorie malnutrition is associated with

A

impaired both innate and adaptive immunity

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55
Q

Much of the morbidity and mortality in malnourished people is due to

A

infections

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56
Q

hypoproteinemia is associated with depression in

A

T-cell numbers and function

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57
Q

Primary malnutrition leads to

A

atrophy of the lymphoid organs, profound T-lymphocyte deficiency, and increased susceptibility to pathogens, reactivation of viral infections, and development of opportunistic infections.

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58
Q

imbalance between the nutrients the body needs and the nutrients it gets.

A

Malnutrition

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59
Q

types of malnutrition

A

overnutrition

Under nutrition

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60
Q

Animal studies have found that deficiencies in …….can alter immune responses

A

zinc, selenium, iron, copper, folic acid, and vitamins A, B6, C, D, and E

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61
Q

Examples of Secondary Immunodeficiencies
Endocrine
Gastrointestinal
Hematologic

A

Diabetes millitus

Hepatic insufficiency, hepatitis, intestinal lymphangiectasia, protein-losing enteropathy

Aplastic anemia, cancers (eg, chronic lymphocytic leukemia, multiple myeloma, Hodgkin lymphoma), graft-vs-host disease, sickle cell disease, splenectomy

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62
Q

Examples of Iatrogenic immunodeficiencies

A

Certain drugs, such as chemotherapeutic drugs, immunosuppressant’s, corticosteroids; radiation therapy; splenectomy

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63
Q

Examples of nutritional immunodeficiencies

A

Alcohol use disorder, undernutrition

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64
Q

Physiologic reasons of immune deficiency

A

Physiologic immunodeficiency in infants due to immaturity of the immune system, pregnancy

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65
Q

Renal examples of immunodeficiencies

A

Nephrotic syndrome, renal insufficiency, uremia

66
Q

Rheumatologic examples of immunodeficiency

A

Systemic lupus erythematosus

67
Q

Infectious reasons of immunodeficiency

A

Viral infections (eg, cytomegalovirus, Epstein-Barr virus, HIV, measles virus, varicella- zoster virus), bacterial infections, rare bacterial infections with superantigens (antigens that can activate large numbers of T cells, resulting in massive cytokine production, most notably from Staphylococcus aureus), mycobacterial infections

68
Q

Barrier defects of the mucous membranes are critical for the pathogenesis of respiratory, gastrointestinal, and urinary tract infection. This is associated with changes in

A

microbial flora.

69
Q

T-cell defects and thymic function in malnutrition are similar to that seen in

A

congenital thymic aplasia

70
Q

Primary immunodeficiencies (PIDs) are now included under the term

A

inborn errors of immunity

IEI

71
Q

How many defined IEI

A

450 genetically defined diseases.

72
Q

transient or persistent impairment of the function of cells or tissues of the immune system, caused by factors that are not intrinsic to the immune syste

A

Secondary immunodeficiency

73
Q

In the last five decades, the most studied secondary immunodeficiency has been…. that’s caused by …..

A

acquired immunodeficiency syndrome (AIDS)

HIV

74
Q

HIV infected individuals who receive….. retain their immune function and do not develop AIDS

A

antiretroviral therapy

75
Q

individuals who receive antiretroviral therapy can still get

A

chronic inflammation that contributes to
the development of comorbidities: non-AIDS malignancies, cardiovascular events, renal
and hepatic diseases, bone disorders and neurocognitive impairment.

76
Q

is the most prevalent cause of immunodeficiency worldwide

A

Malnutrition

77
Q

Laboratory testing indicated in the assessment of immunodeficiency includes

A

blood cell counts and lymphocyte phenotyping to measure neutrophils, monocytes, T cells, B cells and NK cells. Measurement of serum immunoglobulins G, A, M and E levels and antibody responses to prior immunizations for humoral immunity and Serum albumin and total protein level.

78
Q

Serum albumin and total protein levels tests are useful to identify……, which raises the suspicion of either……

A

malnutrition or hypoproteinemia

protein-losing diseases.

79
Q

The management of a patient with secondary immunodeficiency should be focused on

A

improvement of the primary condition, and when possible, the removal of the offending environmental factor

80
Q

when protein-losing enteropathy leads to hypogammaglobulinemia, what should be treated

A

treatment of the enteropathy restores normal serum immunoglobulin levels.

81
Q

General measures to consider for the patient with a secondary immunodeficiency include measures to

A

reduce exposure to infections, antibiotic prophylaxis, and immunoglobulin replacement and immunizations.

82
Q

Examples of antiinflammatory and immunosuppressive small molecule agents

A

corticosteroids, methotrexate, cyclosporin

83
Q

Groups of immunosuppressive medications

A
  1. antiinflammatory and immunosuppressive small molecule agents
  2. protein kinase inhibitors and biological agents
84
Q

Examples of protein kinase inhibitors and biological agents

A

anti- CD20 antibodies

85
Q

Glucocorticoids is a type of

A

corticosteroids

86
Q

representatives of immunosuppressive anti inflammatory medications and kinase inhibitors/biological agents respectfully

A

glucocorticoids and rituximab

87
Q

Glucocorticoids are widely used because of their

A

potent anti-inflammatory action that results in reduction of symptoms in autoimmune and allergic disease

88
Q

……..&……….are two of the most used medications of antiinflammatory and immunosuppressive small molecule agents

A

Prednisone and dexamethasone

89
Q

Prednisone and dexamethasone immunosuppressive action is mediated by multiple molecular mechanisms, such as

A

inhibition of NFK beta pathways, followed by the suppression of the proinflammatory cytokines IL-1, IL-2, IL-6, TNF-α and IFNγ, and prostaglandins.

90
Q

glucocorticoids induce……, increased …..and release of ….from the bone marrow, which is translated into lymphopenia and neutrophilia. Glucocorticoids reduce ……and other mediators of allergic disease.

A

anergy and apoptosis of lymphocytes

neutrophil detachment from the endothelium into the peripheral blood

immature neutrophils

histamine secretion, IgE, IL-4, IL-5

91
Q

Immunosuppression is proportional to…

A

the duration of treatment and to the dose.

92
Q

Side effects of glucocorticoids

A

cataracts, osteoporosis, adrenal axis suppression, hypertension, Cushing syndrome and diabetes mellitus.

93
Q

The use of topical forms of glucocorticoids, such as…… significantly reduce the risk of these adverse effects because of

A

ointments and nasal sprays

their minimal systemic bioavailability

94
Q

biological agents might be classified in

A

monoclonal antibodies and competitive inhibitors of receptor binding.

95
Q

most prescribed biological agents.

A

Anti-CD20 antibodies and tumor necrosis factor (TNF)-alpha inhibitors

96
Q

Six anti-CD20 monoclonal antibodies have been developed:

A

rituximab, veltuzumab, ocrelizumab, ofatumumab, binutuzumab and ublituximab.

97
Q

first agent of this group to be developed for clinical use.

A

Rituximab

98
Q

Side effects of Rituximab

A

hypogammaglobulinemia and increased risk of infections

99
Q

….% patients in a tertiary care center receiving at least one dose of rituximab developed infections.
….% had low serum IgG level and….% had persistently low B cell counts one year after stopping rituximab.

A

47.9%
13.7%
51%

100
Q

clinical indication for the use of rituximab, such as refractory autoimmune cytopenia might represent

A

manifestation of an IEI.

101
Q

the assessment of humoral immunity before rituximab treatment has been suggested to rule-out a….

A

preexisting antibody deficiency.

102
Q

Before taking rituximab……… should be considered in patients with recurrent infections or a severe depression of the humoral immune function.

A

antibiotic prophylaxis and immunoglobulin supplementation

103
Q

…..monoclonal antibodies binding TNF-alpha and….. fusion protein TNF- alpha receptor antagonist have been approved for the treatment of…

A

4, 1

inflammatory bowel disease, rheumatoid arthritis, ankylosing spondylitis and psoriasis.

104
Q

major concern with the use of these biological agents is

A

the central role of TNF-alpha in anti-mycobacterial immunity.

105
Q

To reduce their risk of tuberculosis reactivation and severe disease, patients receiving TNF-alpha inhibitors are recommended to undergo

A

tuberculosis screening before treatment and receive antibiotic prophylaxis if the screening is positive.

106
Q

Other drugs are associated with harmful effects in the immune system that are not clearly related to the pharmacologic activity of the molecule

A

antiepileptic medications -phenytoin, carbamazepine, levetiracetam- may cause antibody deficiency

107
Q

persistent antigen stimulation induces decreased T cell effector functions, a condition known as

A

T cell exhaustion.

108
Q

HIV Targets ….. and induces….

A

CD4 T cells

T cell lymphopenia

109
Q

HIV infection targets CD4 T cells and induces T cell lymphopenia through several mechanisms:

A

HIV-induced apoptosis, apoptosis caused by nonspecific immune activation, viral cytopathic effect, T cell cytotoxicity to HIV-infected cells and autophagy

110
Q

Because of advances in……, HIV infection can now be controlled but not eradicated

A

anti-retroviral therapy

111
Q

HIV infects other cells expressing CD4, such as……. which become………

A

microglial cells, liver Kupffer cells and renal tubular epithelial cells

viral reservoirs(pools)

112
Q

HIV patients receiving anti-retroviral therapy often have

A

Incomplete immune-reconstitution of CD4 T cells with a predominant proportion of activated cells

113
Q

In most treated HIV patients chronic inflammation is common, leading to

A

development of malignancies, metabolic syndrome and cardiovascular disease

114
Q

Measles virus

Measles is a highly infectious virus shown to result in immunosuppression that can persist for

A

months to years after initial infection in immunocompetent hosts

115
Q

Proposed mechanisms of measles immunosuppression include

A

T and B cell lymphopenia, inhibition of lymphocyte proliferation, skewing towards T helper 2 cytokine responses and decreased B cell and T cell memory cells

116
Q

immunosuppressive effect of measles was initially demonstrated over a hundred years ago, when

A

it was noted a loss of the tuberculin skin test positive response during the acute phase of measles infection

117
Q

Mycobacterium tuberculosis infection affects …..%

A

one third of world’s population

118
Q

….. leading cause of mortality by an infectious disease.

A

Mycobacteria

119
Q

In Mycobacterium tuberculosis Apoptosis and necrosis of antigen presenting cells are accelerated due to

A

mycobacteria replication

120
Q

Patients with mycobacterial infection demonstrate decreased…….., increased production of …..and suppression of…….

A

lymphoproliferative responses

IFN-γ

IL-17+ CD4 T cells

121
Q

Furthermore, damaging inflammatory reactions induces significant regulatory T cell activity, which attenuates the ability of

A

monocyte-derived and alveolar macrophages to restrict mycobacterial growth

122
Q

The COVID-19 pandemic, caused by

A

severe acute respiratory syndrome coronavirus 2

123
Q

Several changes in the immune system have been reported in patients with severe SARS Cov-2 infection like

A

impaired IFN-alpha signaling, reduced number and function of NK cells, and peripheral CD4 and CD8 T cell lymphopenia.

124
Q

In severe COVID19 cases, a massive inflammatory response develops in …. with …. cytokines increase which causes…

A

The lungs
Serum
T cell exhaustion, lung tissue destruction and hypoxia,

125
Q

The infant mortality due to sepsis is….. per 100,000 live births in the United States

A

16.1

126
Q

all immune parameters are lower at birth than in adulthood except for

A

lymphocyte and neutrophil cell count

127
Q

Neonatal adaptive immunity is biased towards the…… immune phenotype rather than ….phenotype.

A

T helper 2 (TH2)

TH1

128
Q

Peripheral blood mononuclear cells from newborns demonstrate reduced ……..responses with decreased production of……

A

Tolllike receptor (TLR)

pro-inflammatory cytokines.

129
Q

Neutrophils from neonates have decreased expression of surface adhesion molecules leading to……

A

impaired tissue migration,

130
Q

Impaired production of IL-12p70 in neonates results in

A

non-productive activation and failure to differentiate into effector cytotoxic T cells

131
Q

The protective maternal IgG that is mostly transferred during the

A

third trimester is limited in the premature

132
Q

responses to scheduled immunizations for pre term neonates are adequate, with exception of the

A

hepatitis B vaccine for newborns under 2000g

133
Q

Immune system changes due to aging, or immunosenescence, include

A

decreases in the TLR function, chemotaxis, phagocytosis and cytokine production

134
Q

NK cells from elderly population are predominantly the mature CD14+CD56+bright subset with reduced

A

cytotoxicity function, cytokine function and migration capacity.

135
Q

Aging of the adaptive immune system is often described as a shift from

A

naïve to memory T and B cells

136
Q

infections lead to malnutrition as result of

A

limited food intake and absorption

137
Q

Direct effects of malnutrition in lymphoid organs include

A

thymic atrophy, thymocyte apoptosis, decreased levels of secretory IgA and reduced cellularity in the spleen and lymph nodes.

138
Q

Children with protein energy malnutrition (PEM) have shown reduced serum levels of

A

IL-1, IL-6, TNF-and complement system components and impaired neutrophil chemotaxis and function, NK cell cytotoxicity and dendritic cell maturation.

139
Q

malnourished individuals show reduced numbers of

A

memory and effector T cells, reduced delayed type hypersensitivity, impaired T cell responses and fewer circulating B cells.

140
Q

Protein-losing enteropathy (PLE) occurs secondary to

A

gastrointestinal (GI) loss of protein

141
Q

We consider IgG replacement for patients with low

A

Less than 2 standard deviations below the mean

IgG level or absent responses to pneumococcal immunization

142
Q

Uremia causes dysfunction in dendritic cells which causes

A

Decreased antigen presentation and co stimulaton

143
Q

Uremia causes dysfunction in monocytes which causes

A

Decreased phagocytosis

144
Q

Uremia causes dysfunction in nk which causes

A

Decreased Activation

145
Q

Uremia causes dysfunction in neutrophils which causes

A

Increased apoptosis, TLR2, TLR4 expression

146
Q

Uremia causes dysfunction in B cells which causes

A

Decreased naive B cells population, B cells activation, increased apoptosis

147
Q

Uremia causes dysfunction in T cells which causes

A

Decreased function of effector T cells, decreased naïve t cell population, decreased IL2 Production, increased CD4+ CD28 T cell population

148
Q

Vitamin D deficiency causes

A

Increased risk of respiratory infections in children

149
Q

Vitamin E deficiency causes

A

Reduced infections of the elderly

150
Q

Vitamin c deficiency causes

A

Exaggerated inflammation in murine models

151
Q

Vitamin a deficiency causes

A

Impaired epithelial barrier function

Reduced CD4 & CD8 T cells

152
Q

Zinc deficiency leads to

A 
Thymus apoptosis 
Lymphopenia
Reduced Th1 cytokines 
Impaired phagocytosis 
Impaired mucousal immunity
153
Q

hypogammaglobulinemia is treated by

A

immunoglobulin therapy

154
Q

hypoproteinemia is associated with

A

depression in T-cell numbers and function

155
Q

the profound fall in cell - mediated immunity that accompanies measles infection has been attributed to specifi c suppression
of

A

IL - 12 production by viral cross - linking of monocyte surface CD46

156
Q

Spleen function

A

antibody production

Acts as a filter to remove pathogens through phagocytic cells

157
Q

Infections associated with asplenia include

A

sepsis with encapsulated bacteria, namely, S. pneumoniae and H. influenzae, and with Babesia, a protozoan that infects erythrocytes and causes fever and hemolysis with asplenia, malaria infection can be more severe

158
Q

Diabetes Mellitus usually affects…. system and it causes

A

Innate
Effects in neutrophil functions and NET formation
Low cytokines production

159
Q

Space travel causes

A

CD4 and CD8 T cell lymphopenia and impaired CD4 T cell function

160
Q

Thymectomy in infants results in

A

T cell lymphopenia, with CD4 T cells typically affected more than CD8 T cells

TBL (2 decks)

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