1A: Dt 2 - 2

Front 1

LN follicles:
Cortex vs Paracortex (cell contents, function)

Back 1

Cortex: B cells located here, proliferate here

Paracortex: T Cells; between follicle and medulla; where blood enters

Front 2

In extreme cell immune response, this region of the LN becomes enlarged.

Back 2

Paracortex--responsible for LAD

Front 3

Patients with DiGeorge have a poorly developed _____ of the lymph node.

Back 3

Paracortex not weel dev'd (low T cell count)

Front 4

LN:
Cords vs Sinus (cell contents)
In what region are both of these located?

Back 4

Medulla:
Sinus: macs
Cords: Plasma cells

Front 5

Sinusoids of spleen:
B vs T Cell locations

Back 5

PALS--periarterial lymphatic sheet contains T cells

B cells in follicles, white pulp

Front 6

What cell type is responsible for removing encapsulated bacteria from blood?

Where is this cell located?

Back 6

Macs in spleen remove encapsulated bacteria

Front 7

Vaccine requirements for the asplenic.

Why?

Back 7

Need immunization against encapsulated bacteria--strep pneumo, h flu, n meningitidis, salmonella, klebsiella) need pneumovax, h flu vaccine, meningococcus

Bc no longer have macs to get rid of encaps bacteria

Front 8

Back 8

Howell-Jolly Bodies: Asplenic

Front 9

Back 9

Splenic infarct (wedge shape/triangle = classic sign of ischemia)

Front 10

Axillary node

Back 10

Upper limb, lateral breast

Front 11

Celiac node

Back 11

Stomach

Front 12

Superior mesenteric node

Back 12

Duodenum, jejunum

Front 13

Colic node

Back 13

Sigmoid colon

Front 14

Inferior mesenteric node

Back 14

Sigmoid colon

Front 15

Internal iliac node

Back 15

Rectum (above pectinate line)

Front 16

Superficial inguinal node

Back 16

Anal canal
Scrotum
Superficial thigh

Front 17

Superficial and deep plexuses (nodes)

Back 17

Testes

Front 18

Para-aortic node

Back 18

Scrotum

Front 19

Popliteal node

Back 19

Lateral side; dorsum of foot

Front 20

Right lymphatic duct

Back 20

Right arm, right half of head

Front 21

Thoracic duct

Back 21

Everything right lymphatic duct doesn't drain (remember Right lymphatic drains Right arm, right half of head)

Front 22

The thoracic duct drains at the_______.

Back 22

Junction of left subclavian in internal jugular vein

Front 23

Thymus:
Cortex vs Medulla (cells and processes)

Back 23

Cortex has immature T Cells
Corticomedullary junction: where selection occurs
Medulla-->mature T cells; AKA selection

Front 24

Embryologic origin of thymus.

Back 24

Thymus comes from epithelium of third branchial pouch

Front 25

Innate immune system:
Cells involved

Back 25

Nphils, macs, DCs (APCs for macs), NKCs, complement

Front 26

Adaptive immune system:
Cells involved

Back 26

T cells, B cells, circulating Abs

Front 27

NKCs:
Enzymes used
When are they activated?

Back 27

Perforins and granzymes to induce apoptosis of virally infected cells

(Only lymphocyte member of innate immunity!)

Activated when receive nonspecific activation signal on target cell and/or absence of MHC I on target cell surface

Front 28

These cytokines enhance NKC activity.

Back 28

IL-12, IFN-beta, IFN-alpha

IFN very important for inducing NKCs and cells neighboring infected cells to generate substances that will inhibit viral protein synthesis

Front 29

This cytokine stimulates T cells.

Back 29

IL-2

Front 30

This cytokine stimulates macrophages.

Back 30

IFN-gamma

Front 31

This cytokine inhibits T cells and macrophages.

Back 31

IL-10

Front 32

This cytokine stimulates B cells.

Back 32

IL-4, IL-5

Front 33

Beginning with BM, describe maturation of T cells.

Include CD markers.

Back 33

BM-->Thymus Cortex (CD4+8+)-->Positive and Negative Selection at corticomedullary jn in thymus(negatively selected cells undergo apoptosis)-->CD4+ or CD8+

Front 34

CD8+ cells:
Role
Enzymes used

Back 34

Kills virus-infected cells directly
Neoplastic cells
Donor graft cells

~NKCs

Use perforins (helps deliver granzymes) and granzymes (activates apoptosis)

CD8 binds MHC1

Front 35

These cells recognize the absence of MHC1.

Back 35

NKCs

Front 36

These cells are activated by binding MHC1.

Back 36

CD8+

Front 37

What type of cytokine induces a T helper cell to become Th1?

Back 37

IL-12

Front 38

This cytokine is elevated in times of viral infection.

Back 38

IL-12

Front 39

These cytokines are released by Th1 cells.

Back 39

IL-2-->stimulates T cells
IFN-gamma-->stimulates macs
IL-10-->inhibits Th1

Front 40

This cytokine induces formation of Th2 cells.

Back 40

IL-4 (humoral response--B cell response)

Front 41

These cytokines are released by Th2 cells.

Back 41

IL-4, 5-->stimulate B cells
IL-10-->inhibit Th cells; inhibits macs

Front 42

What is class switching and what cells undergo this?

Back 42

IgM-->IgG = class switching (for B Cells)

Front 43

Describe steps necessary to activate CD4+ cell.

Back 43

MHCII on APC recognizes TCR (T cell receptor) and presents antigen to CD4+

B7 on APC co-stimulates CD28 on T cell

T helper cells will then produce cytokines

Front 44

Describe steps necessary to activate CD8+ cell.

Back 44

CD8 activation

Virally infected cells present antigen on MHC1 molecule, TCR recognizes it; CD8 helps

Th1 cells release IL-2 and this binds IL-2 receptor on CD8+ cell (co-stimulation)

Front 45

Describe steps necessary to activate B cell.

Back 45

B cell activation
Th2 release IL-4,5,6

CD40L on Th cell binds CD40 on B cell and allow for co-stimulation

Front 46

Th1 vs Th2 cells:
General roles
Cytokines secreted by them
Cytokines inhibiting them

Back 46

Th1:
regulates cell-mediated response
Secretes IL-2, IFN-gamma
Activates macs and CD8+ cells
Inhibited by IL-10 from Th2

Th2:
Regulates humoral response
Secretes IL-4, IL-5, IL-10
Helps B cells make Ab (IgE>IgG)
Inhibited by IFN-gamma from Th1 cell

Front 47

Functions of IL-1,2,3,4,5.

Back 47

Hot T Bone StEAk

HOT: IL-1 (fever)
T: IL-2 (stimulates T cells)
Bone: IL-3 (stimulates BM)
StEak: IL-4 (IgE production)
SteAk: IL-5 (IgA production)

Front 48

B cell:
Immunoglobulins
CD Markers

Back 48

IgM
IgD

CD-19,20,21

Front 49

Epstein-Barr Virus infects this cell.

Back 49

CD21+

You drink Beer at the Barr when you're 21.

Front 50

MHC II is present on these cells.

Back 50

Macrophages
B cells (can act as presenting cells)

Front 51

Macropahges:
CD markers
Receptors

Back 51

CD14, 40, 16

Receptors for Fc and C3b (these are opsonins)

Front 52

NKCs:
CD markers
Receptors

Back 52

CD16--binds Fc of IgG

Receptor for MHCI

Front 53

CD16 is present on this cell.

Back 53

Macrophages and NKCs

Front 54

What CD markers protect host cells from complement mediated damage?

Back 54

WBC, RBC, platelets

Protected by CD55 and CD59

Front 55

What are the acute phase cytokines?
What cell releases these?

Back 55

Macrophages release IL-1, IL-6, TNF-alpha

These substances mediate fever and ramp up immune system.

Front 56

What are the 2 pathways to stimulate macrophages to make acute phase cytokines?

Back 56

1) strep pyogenes, staph aureus release super ag's: crosslink TCR to MHCII on APCs, causes uncoord'd release of IFN-gamma from Th1 and subsequent release if IL-1,6, and TNF-alpha from macs

2) Endotoxins (LPS of gram neg bact); bind CD14 (endotoxin receptor). doesn't require T helper cells.

Front 57

CD14:
Role

Back 57

Binds endotoxins (LPS) and activates macs

Front 58

This cytokine actives eosinophils.

Back 58

IL-5

Front 59

IL-1:
Role
Secreted by

Back 59

Endogenous pyrogen

Causes fever, acute inflammn

Activates endothelium to express adhesion molecules

Secreted by macs

Front 60

IL-6:
Role
Secreted by

Back 60

Endogenous pyrogen
Secreted by Th1 cells and macs

Front 61

IL-8:
Role

Back 61

Major chemotactic factor for nphils

"Clean up on aisle 8"-->neutrophils recruited by IL-8 to clear infection

Front 62

These cytokines recruit neutrophils.

Back 62

IL-8
LT-B4
C5a

Front 63

IL-12:
Role

Back 63

Activates NK and Th1 cells

Front 64

This cytokine mediates septic shock.

Back 64

TNF-alpha

Front 65

TNF-alpha:
Role

Back 65

Activates endothelium
Causes leukocyte recruitment, vascular leakage

Front 66

Anti-TNF-alpha drugs:
Examples
Uses
Considerations

Back 66

Etanercept
Infliximab
Adalimumab

These are all MAbs!

Uses: RA, ankylosing spondylitis

Must check for latent Tb prior to dosing, because will make prone to infection!

Front 67

Cytokine released by all T cells
Role?

Back 67

IL-3: Supports growth and diff of BM SC's

~GM-CSF

Front 68

Cytokines released by Th1 cells.
Role?

Back 68

IL-2:
Stimulates growth of helper and cytotoxic T cells

IFN gamma: activates macs and Th1 cells; antiviral and antitumor properties

Front 69

Cytokines released by Th2 cells.
Role?

Back 69

IL-4: induces diff into Th2 cells. Promotes growth of B cells. Class switching to IgE, IgG

IL-5: Promotes differentiation of B cells. Enhances switching to IgA. Stimulates growth and diff of ephils.

IL-10: Modulates inflamm response. Inhibits activated T cells and Th1. Activates Th2.

Front 70

This cytokine is released by regulatory T cells.

Back 70

IL-10

Front 71

Interferon:
Mechanism

Back 71

alpha and beta: inhibit viral protein synthesis

gamma: inc'd MHCI and II expression and Ag presentation in all cells

Activates NK cells to kill virus-infected cells

Front 72

IFN-alpha:
Clinical use

Back 72

HBV
HCV
Kaposi's
Leukemia
Malignant melanoma

Front 73

IFN-beta:
Clinical use

Back 73

MS

Front 74

IFN-gamma:
Clinical use

Back 74

Chronic granulomatous disease

Front 75

Aldesleukin:
Clinical use

Back 75

AKA IL-2
Renal cell carcinoma
Metastatic melanoma

Front 76

EPO:
Clinical use

Back 76

Anemias; esp in renal failure or pts undergoing chemotx

Front 77

Filgrastim:
Clinical use

Back 77

(gra stim-->granulocyte stimuln) AKA granulocyte CSF

BM recovery (after chemo)

Front 78

Sagramostim:
Clinical use

Back 78

Granulocyte macrophage colony stim factor

BM recovery (after chemo)

Front 79

This cytokine is similar to GM-CSF in its effects.

Back 79

IL-3 (Bone of Hot T Bone mnemonic)

Front 80

Oprelvekin:
Clinical use

Back 80

IL-11; use in thrombocytopenia

Front 81

Thrombopoietin:
Clinical use

Back 81

Thrombocytopenia

Front 82

HLA genes that encode MHC II.

Back 82

HLA DR
HLA DQ
HLA DP

Doctor walks into DQ to get a Dr Pepper

Front 83

CD marker displayed only by helper T cells.

Back 83

CD4

Front 84

CD marker displayed only by cytotoxic T cells.

Back 84

CD8

Front 85

CD marker displayed on all T cells.

Back 85

CD3

Front 86

CD marker displayed by B cells.

Back 86

CD19,20,21

Front 87

CD marker displayed by all NKCs.

Back 87

CD16 (binds IgG)

Front 88

CD marker that inhibits C9 binding.

Back 88

CD55, 59

Front 89

CD marker that acts as endotoxin receptor.

Back 89

CD14 (on macs)

Front 90

This cytokine promotes B cell growth and differentiation.

Back 90

IL-4,5

Front 91

This cytokine is produced by Th1 cells.

Back 91

IL2, IFNgamma

Front 92

This cytokine is produced by Th2 cells.

Back 92

IL-10

Front 93

This cytokine is involved in growth and activation of eosinophils.

Back 93

IL-5

Front 94

This cytokine inhibits macrophage activation.

Back 94

IL-10

Front 95

Pyrogens secreted by monocytes and macrophages.

Back 95

IL1,6; TNF alpha

Front 96

This cytokine inhibits Th1 cell production.

Back 96

IL-10

Front 97

This cytokine inhibits Th2 cell production.

Back 97

IFN-gamma

Front 98

This cytokine mediates inflammation.

Back 98

IL-1,6, TNF alpha

Front 99

This cytokine enhances synthesis of IgE and IgG.

Back 99

IL-4

Front 100

This cytokine enhances synthesis of IgA.

Back 100

IL-5

Front 101

This cytokine is released by virally infected cells.

Back 101

IFN-alpha, beta

Front 102

This cytokine supports growth and differentiation of BM SCs.

Back 102

IL-3

Front 103

This cytokine supports T cell proliferation, differentiation, and activation.

Back 103

IL-2

Front 104

Bond that holds antibodies together.

Back 104

Disulfide bonds holds Ab together; connect heavy chain to light chain, light chain to light chain, etc.

Front 105

Fab region of antibody:
Function
Comprising regions

Back 105

Antigen-binding
Determines idiotype--unique Ag binding pocket; only 1 antigenic specificity expressed per B cell (B Cells produce Abs!)

Composed of 2 light chain and 2 heavy chain regions

Front 106

Fc region of antibody:
Function
Comprising regions

Back 106

Constant
Carboxy terminal
Complement binding
Carbohydrate side chains
Determines isotype (IgM, IgD, etc)

2 heavy chains!

Front 107

List 5 types of heavy chains and corresponding immunoglobulins.

Back 107

Mu--IgM
Delta--IgD
Gamma--IgG
Alpha--IgA
Epsilon--IgE

Front 108

List types of light chains
Ratio?

Back 108

Lambda
Kappa

No functional difference between these 2!

Should have 2 kappa per 1 lambda

If have multiple myeloma, this ratio will be thrown off based on type of Ab creating.

Front 109

IgG structure:
Heavy and light chains

Back 109

2 gamma heavy chains
2 either lambda or 2 kappa regions (light chains)

Front 110

Terminal deoxynucleotidyl transferase:
Role

Back 110

Adds nucleotides to DNA during VJ (light chain) or VDJ (heavy chain) rearrangement

Front 111

What initiates VDJ recombination?

Back 111

Recombination activating gene complex RAG 1 and RAG2 recognize RSSs and initiate VDJ recombination

Results break in dsDNA at Recombination Signal Sequences (RSS) that flank V, D, and J regions

Front 112

Mutations in RAG genes

Back 112

Inability to initiate VDJ rearrangement and results in arrest of B and T cells development

B and T cells can't express unique Ag receptors (Antibodies)

Front 113

Half-life of IgG

Back 113

21 days--passive immunization requires monthly inoculation

Front 114

Main antibody in secondary response to antigen.

Back 114

IgA (delayed response = secondary response)

Front 115

Main antibody in primary response to antigen.

Back 115

IgM (immediate response = primary response)

Front 116

Immunoglobulin associated with allergies because it's bound by mast cells and basophils.

Back 116

IgE

Front 117

Immunoglobulin that comprises 75% of total immunoglobulin pool.

Back 117

IgG

Front 118

Immunoglobulin present in large quantities on membrane of B cells.

Back 118

IgD, IgM

Front 119

Immunoglobulin that crosses the placenta and confers immunity to neonates.

Back 119

IgG

Front 120

Immunoglobulin that can occur as dimer.

Back 120

IgA

Front 121

Immunoglobulin largely confined to intravascular pool.

Back 121

IgM (early Ab)

Front 122

Immunoglobulin distributed evenly between intravascular and extravascular pools.

Back 122

IgG

Front 123

Immunoglobulin in mucoserous secretions such as saliva, colostrum, milk, genitourinary secretions.

Back 123

IgA

Front 124

Immunoglobulin that can occur as pentamer.

Back 124

IgM

Front 125

Thymus independent Ag's vs Thymus dependent antigens:
General
Examples

Back 125

Thymus independent: no peptide component; MHC can't bind anything, ex: LPS on gram neg bact

Results in release of IgM, don't form memory

Thymus dep Ag's:
ex: vaccines, will create memory

Allows for class-switching: IgM-->IgG
Release of IL-4,5,6

Front 126

What stimulates alternative pathway of complement?

Back 126

Microbial (LPS)

Front 127

Classic PW:
What stimulates it?
Complement factor involved?

Back 127

Ag-Ab complexes


C1 = first copmlement involved
C1 esterase inhibits cleavage of C1 (prevents cascade)

Front 128

Complement factors associated with anaphylaxis.
Why?

Back 128

C3a, C5a: Anaphylaxis
C3a-->**mast cells, basophils-->histamine
-->edema, vasc perm-->BP drops bc fluid is trapped in swelling

Tx w/epi

Front 129

Complement factor associated with neutrophil chemotaxis.

Back 129

C5a: nphil chemotaxis

Front 130

Complement factors associated with membrane attack complex.

Back 130

C5b-9: makes membrane attack complex

Front 131

C1 esterase:
Role
Effect of deficiency

Back 131

C1 esterase inhibits cleavage of C1 and prevents classic PW activation

Deficiency leads to hereditary angioedema (results in elevations of bradykinin)

Front 132

Deficiency of this complement factor results in recurrent pyogenic sinus and respiratory tract infections.

Back 132

C3

Recurrent infections withstrep pneumo, h flu

Inc'd susceptibility to type III hypersens rxns (esp GN)

Front 133

Deficiency of this complement factor results in neisseria bacteremia.

Back 133

Deficiency of C5-C8--

(gonococcal and meningococcal bacteremia)

These are involved in MAC (membrane attack complex)

Front 134

Deficiency of this results in lysis of RBCs and paroxysmal nocturnal hemoglobinuria.

Back 134

Deficiency of Decay Accelerating factor (CD55)

Front 135

Paroxysmal nocturnal hemoglobinuria:
Presentation
Dx
Tx

Back 135

Hemosiderinuria-->iron deficiency anemia
Chronic intravascular hemolysis
Thrombosis

Dx with Ham's test--RBCs lyse at low pH

Tx:
Iron
Warfarin (too many platelets)
BM transplant (bc due to

Front 136

Which vaccines result in rapid immunity after exposure to the bug?

Back 136

To Be Healed Rapidly:
Give pre-formed Ab's and vaccine for:
Tetanus
Botulinum
HBV
Rabies

Also RSV (respiratory syncytial virus for premature babies in winter months)

Front 137

What is anergy?

Back 137

Self-reactive T cells become nonreactive without co-stimulatory molecule (tolerance to self)

Front 138

List granulomatous diseases

Back 138

Tb (only one that is caseating)
Fungal infections (histo, blasto)
Syphilis (gummas)
Leprosy
Cat scratch fever
Sarcoid
Crohn's
Berylliosis
Listeria
Foreign bodies
Wegner's granulomatosus
Chronic granulomatous disease

Front 139

This bacteria results in cat scratch fever.

Back 139

Bartonella henselae