Dit Set# 3: Lectures 27-39

Front 1

Lecture 27: Endocrine 6

Back 1

Thyroid Basics and Hyperthyroidism

Front 2

What primary hormone is increased or decreased in the following diseases?
- Cushing syndrome
-Conn syndrome
-Addison disease

Back 2

Cushing-- increased Cortisol

Conn-- increased aldosterone

Addison disease-- decreased aldosterone, decreased cortisol

Front 3

What is the drug of choice for anaphylactic shock? Cardiogenic shock? Septic shock?

Back 3

Anaphylactic shock: Epinephrine

Cardiogenic shock: Dobutamine (Stimulates β2 receptors)

Septic shock: Norepinephrine (Stimulates α1 WITHOUT β2 Thus, clamps down the vessels)

Front 4

What cancers are associated with RET gene mutation?

Back 4

MEN 2A

MEN 2B

Medullary papillary thyroid carcinoma

Front 5

Graves’ Disease (very high yield): What does in cause, what are the lab features, and what 2 drugs are used to treat it?

Back 5

•Causes Hyperthyroidism

Clinically will see in a patient:
- Increased T3 and T4
- Decreased TSH
- Increased resin radioactive T3 uptake (specific for Graves’ Disease)
- Increased radioactive iodine scan

Drugs: methmazole, thyropropioluracil

Front 6

A 35-year-old woman presents with diffuse goiter and hyperthyroidism. What are the most likely relative values of TSH and thyroid hormones?

Back 6

Graves’ Disease

Decreased TSH

Increased thyroid hormone (free T3 or T4)

Front 7

What is the most common location for ectopic thyroid tissue?

Back 7

Tongue

Front 8

How would pregnancy affect serum thyroid hormone levels?

Back 8

Increased thyroid binding globulin (TBG)

Increased total T4 and total T3

Normal free T4 and T3

Front 9

What two medications can be given to inhibit synthesis of thyroid hormone in patients with hyperthyroidism?

Back 9

Methimazole

Propylthiouracil

Front 10

Which of the 2 previous drugs blocks the peripheral conversion of T4 to T3?

Back 10

Propylthiouracil (PTU)

Front 11

Lecture 28: Endocrine 7

Back 11

Hypothyroidism and Thyroid Cancer

Front 12

In the dark, both pupils are dilated. (see image) In the light, the control pupil is miotic while the pupil given drug X remains mydriatic. What is drug X?

Back 12

Sympathetic agonist: Epinephrine

Anticholinergenic: Atropine

Front 13

What are some of the clinical uses for somatostatin?

Back 13

Pituitary excesses:
-Acromegaly
-TSH-secreting tumor
-ACTH-secreting tumor

GI endocrine excess
-Carcinoid syndrome
-Zollinger-Ellison syndrome
-VIPoma
-Glucagonoma
-Insulinoma

Diarrhea

Reduce splanchnic blood circulation
-Cirrhosis with bleeding esophageal varices
-Bleeding peptic ulcers

Front 14

What is the name given to a thyroid hormone-secreting teratoma?

Back 14

Struma ovarii

Front 15

What type of carcinoma like to secrete calcitonin *****
High Yield

Back 15

Medullary carcinoma

Proliferation of parafollicular (C) cells

Associated with MEN2A & 2B

-These like to secrete calcitonin *** HIGH YIELD ***

Front 16

During a thyroidectomy the parathyroid glands and recurrent laryngeal nerve can get damaged. What will this result in?

***HIGH YIELD***

Back 16

Parathyroid glands- Will affect calcium (Ca+2) levels

Recurrent laryngeal nerve (Branch of the Vagus nerve), Innervates the thyroid and vocal cords. Damage will cause ------>Hoarseness

Front 17

What is the mechanism of action of propylthiouracil? What other drug works like PTU? What are their side effects?

Back 17

Acts by blocking the addition of iodine to tyrosine groups on the thyroglobulin (blocks thyroid peroxidase)

Also inhibits the peripheral conversion of T4 to T3 in the tissue

Methimazole: only blocks synthesis of thyroid hormone in the gland, does NOT affect peripheral conversion

Side effects
-Rash
-Agranulocytosis
-Aplastic anemia

Front 18

Rapid- Fire Fact: Most common thyroid cancer

Back 18

Papillary

Front 19

Rapid- Fire Fact: Cold intolerance

Back 19

Hypothyroidism

Front 20

Rapid- Fire Fact: Enlarged thyroid cells with ground- glass nuclei

Back 20

Orphan- Annie eye nuclei of Papillary cancer of the thyroid

Front 21

Lecture 29: Immunology I

Back 21

Immunology Basics

Front 22

What are the differences between oligodendroglia and Schwann cells?

Back 22

•Oligodendroglia
-Found in the CNS
-Each cell myelinates multiple axons

•Schwann cells
-Found in the PNS
-Each cell myelinates ONLY ONE axon (remember that peripheral axons are very long, so each axon has multiple Schwann cells myelinate it)

Front 23

Describe the sensory innervation of the tongue.

Back 23

•Anterior 2/3rd of the tongue
-Taste – CN VII
-Sensation – CN V3

•Posterior 1/3rd of the tongue
-Taste and sensation – CN IX and CN X

Front 24

What is the location of the B cells in a lymph node?
***High Yield***

Back 24

Follicle

Front 25

What is the location of T cells in a lymph node?
*** High Yield***

Back 25

Paracortex

Front 26

Where can B cells and T cells be found in the lymph nodes?

Back 26

•B cells – follicle of the cortex
•T cells – paracortex

Front 27

Which MHC are found in T helper cells? Which MHC are found in cytotoxic T cells?

Back 27

•Helper T cells – MHC 2
•Cytotoxic T cells – MHC 1

Front 28

Lecture 30: Immunology 2

Back 28

Antigen Presentation

Front 29

A 48-year-old woman has been suffering with progressive lethargy and extreme sensitivity to cold temperatures. What is the most likely diagnosis?

Back 29

•Hypothyroidism: most common cause – Hashimoto thyroiditis

Front 30

What is the most common salivary gland tumor?

Back 30

•Pleomorphic adenoma

Front 31

What are the different sinuses that can become infected and cause sinusitis?

Back 31

•Maxillary sinuses
•Frontal sinuses
•Ethmoidal air cells
•Sphenoidal sinuses

Front 32

What characteristic finding would you see on electron microscopy of a dendritic cell with Langerhans cell histiocytosis?

Back 32

•Birbeck granules (appearance of tennis rackets)

Front 33

What molecules are expressed on the surface of antigen presenting dendritic cells?

Back 33

•MHC I

•MHC II

•B7 co-stimulatory signal (CD 80 or CD 86)

•CD40

•CD80

•CD86

Front 34

What are 3 cell types that are known for presenting antigens to T cells?

Back 34

•B cells

•Dendritic cells

•Macrophages

Front 35

Lecture 31: Immunology 3

Back 35

T cells

Front 36

What are the various clinical uses for the following sympathomimetics?
-Dopamine
-Clonidine
-Amphetamine
-Terbutaline
-Epinephrine

Back 36

•Dopamine
-Shock

•Clonidine
-HTN
-HTN urgency
-Renal disease

•Amphetamine
-ADHA
-Weight loss
-Daytime sleepiness
-Narcolepsy
-Major depressive disorder (especially while waiting for and anti-depressant to kick in)

•Terbutaline
-Asthma
-Tocolysis

•Epinephrine
-Anaphylactic shock

Front 37

Where can you find nicotinic acetylcholine receptors in the body?

Back 37

•Neuromuscular junction
•Autonomic ganglion

Front 38

What structures are derived from the branchial pouches?

Back 38

•1st branchial pouch
oMastoid air cells
oMiddle ear cavity
oEustachian tubes

•2nd branchial pouch
o Lining of the palatine tonsil

•3rd branchial pouch
oThymus
oInferior parpthyroids

•4th branchial pouch
oSuperior parathyroids

Front 39

Important cytokines: IL-2, IFN-y, IL-10, IL-4 and IL-5

Back 39

•IL-2
o T cell stimulator
o Target of drugs in inflammatory diseases

•Interferon gamma (IFN-y)
o Stimulates macrophages

•IL-10
o Inhibits T cells and macrophages

•IL-4 and IL-5
o B cell stimulators

Front 40

Corticomedullary junction (KNOW)

Back 40

Where Positive and Negative selection takes place
Negative= apoptosis

Front 41

What brachial pouch is the thymus derived from?

Back 41

Derived from epithelium of 3rd brachial pouch

Outer layer= cortex (contains immature T cells)

Middle= medulla(contains mature T cells)

T cells mature as they move from the cortex to the medulla selection

Front 42

Which cytokines are produced by Th1 cells? Which cytokines are produced by Th2 cells?

Back 42

•Th1 cells
IL-2: Stimulates cytotoxic T cells (CD8 cells)
IFN-y: Stimulates macrophages

•Th2 cells
IL-4 & IL-5: stimulates B cells and Antibody production
IL10: Inhibits Th1

Front 43

Which cytokines inhibit Th1 cells? Which inhibit Th2 cells?

Back 43

•Inhibit Th1 cells: IL-10

•Inhibit Th2 cells: IFN-y

Front 44

How do cytotoxic T cells kill virus-infected cells and Neoplastic cells?

Back 44

Induce apoptosis by releasing cytotoxic granules (perforin and granzyme)

Apoptosis can be mediated by the Fas-FAS ligand interaction

Front 45

Lecture 32: Immunology 4

Back 45

Monocytes and macrophages

Front 46

What are the common side effects of β-blockers?

Back 46

Bradycardia

AV block

Decrease myocardial contractility (May trigger CHF)

Bronchoconstriction (non-selective β-blockers)

Increase blood glucose slightly

Mask sympathetic symptoms of hypoglycemia

Front 47

What is the medication of choice for the treatment of atrial fibrillation due to hyperthyroidism?

Back 47

Drugs for Heart rate control in A-fib:
-Nondihydropyridine CCB (diltiazem)

-β-blocker (propranolol)
Will decrease HR
Block some of the adrenergic symptoms of hyperthyroidism
Some B-blockers can decrease T3 slightly

Treat the hyperthyroidism
•Methimazole
•Radioactive iodine

Front 48

What is the precursor molecule of ACTH synthesis?

Back 48

Pro-opiomelanocortin (POMC)

Front 49

Encapsulated bacteria

Back 49

“Even Some Killers Have Pretty Nice Capsules”

•Escherichia coli

•Streptococcus pneumonia**

•Klebsiella pneumonia

•Haemophilus influenza**

•Pseudomonas aeruginosa

•Neisseria meningitides**

•Cryptococcus neoformans

Pts without a spleen need to get a vaccine for the organisms we have vaccines against (denoted by **)

Front 50

Which cytokine more than any other should be known as the macrophage-activating cytokine?

Back 50

IFN-y


* IL-10 interferes with macrophage activity

Front 51

What are the acute phase cytokines that are produced by macrophages?

Back 51

TNF-y

IL-1

IL-6

Front 52

What is the function of macrophages in the spleen?

Back 52

Removal of encapsulated bacteria

Removal of dysfunctional cells (especially RBCs)

Front 53

What name is given to RBCs partially digested by splenic macrophages?

Back 53

Degmacytes (bite cells)

Front 54

Lecture 33: Biochem 1

Back 54

RNA

Front 55

What gene complex gives rise to a protein that initiates VDJ recombination in B and T cell development?

Back 55

Recombination activating gene complexes (RAG)

RAG-1 and RAG-2

Front 56

What are the different types of collagen, and where can they be found in the body?

Back 56

“Strong, slippery, bloody, BM”

Type 1 (strong)
-Tendon
-Bone
-Dentin
-Skin
-Fascia
-Cornea

Type II (slippery)
-Cartilage
-Vitreous body

Type III (bloody)
-Blood vessels
-Granulation tissue
-Uterus
-Fetal tissue

Type IV (BM)
-Basement membrane (lamina)

Front 57

What medication inhibits the cellular sodium ATPase? What is its clinical application?

Back 57

Digitoxin (digitalis): Cardiac glycoside

Clinical application
-CHF: Positive inotropic (increases contractility)
-Atrial fibrillation (decrease AV node conduction and control HR)

Front 58

Stop codon mRNA —KNOW!!!

Back 58

“U Go Away, U Are Away, U Are Gone”

UGA

UAA

UAG

Front 59

Regulation of Transcription ***High Yield***

Back 59

Operon

Transcription Factors

Common structural motifs

Operator region

Response elements: Enhancer region and Repressor region

Front 60

What does the Operon consist of?

Back 60

Structural genes that are transcribed + promoter region (coding region) + all regulatory regions

Front 61

What are transcription Factors and where do they bind?

Back 61

Proteins that must bind to the promoter region

Promoter regions:
-25 Hogness/Pribnow/TATA box
-75 CAAT box ( in eukaryotes)

Front 62

What are the different structures that allow transcription factors and other proteins to interact with DNA?

Back 62

Helix-loop-helix: allows the transcription factor/ protein in incorporate into the major groove of DNA

Helix-turn- helix

Zinc finger

Leucine zipper

Front 63

What does the operator region do?

Back 63

Binds repressor (stops transcription), or inducer (starts transcription), located between the promoter region and start site

Front 64

What do Response elements (Enhancer region and Repressor region) determine?

Back 64

The rate of transcription

Response elements increase or decrease the rate of transcription when bound by protein factors

Location may be close to, far from, or within the promoter region

Front 65

Where is rRNA synthesized?

Back 65

Synthesized in the nucleolus

Front 66

Where are mRNA and tRNA synthesized?

Back 66

Synthesized in the nucleoplasm

Front 67

How are introns spliced out of eukaryotes?

Back 67

Spliceosomes

Introns stay in the nucleus when they are cut out of the RNA sequence

Front 68

What amino acid frequently has more coding sequences in the mRNA than are represented in the peptide that is created from that mRNA?

Back 68

Methionine

There is more methionine (AUG) in the mRNA than there will be in the protein

Front 69

What is the difference between an intron and an exon?

Back 69

Introns-- noncoding segments of DNA which stay in the nucleus

Exons-- coding sequences for specific protein products that leave the nucleus

Front 70

How is transcription of the lac operon regulated?

Back 70

Lac Operon is regulated by 2 main things

CAP: facilitates RNA polymerase binding and promotes β-galactosidase production
-Must have CAP in order to transcribe the gene but CAP is inhibited by excess glucose levels

Lac repressor: inhibits/blocks transcription
-Inhibits β-galactosidase production
-When lactose is present, the lac repressor can’t bind to the operator site

Lac operon is only “switched on” when glucose is absent and lactose is present

Front 71

What environmental conditions must be met in order for the lac operon to allow expression of β-galactosidase in lactose-fermenting bacteria?

Back 71

Glucose must be absent and excess lactose must be present

Front 72

Lecture 34: Biochem 2

Back 72

Protein

Front 73

What are the mRNA stop codons?

Back 73

UAG
UAA
UGA

Front 74

What substance inhibits RNA polymerase II in eukaryotes causing liver damage?

Back 74

α-Amanitin-- found in lethal mushrooms

Front 75

Which amino acids are modified by the Golgi apperatus? ***HIGH YIELD***

Back 75

Serine
Threonine
Asparagine

Front 76

Where does aminoacyl tRNA synthetase work?

Back 76

3’ end (hydroxy end)

Where the AA is charged onto the tRNA molecule so that it can generate the polypeptide

Front 77

Translocation requires:
KNOW

Back 77

Elongation Factor G – prokaryotes

Elongation Factor -2 – eukaryotes

Front 78

What enzyme matches amino acids to tRNA?

Back 78

Aminoacyl-tRNA synthetase

Front 79

What antibiotics are inhibitors of prokaryotic protein synthesis at the 50s ribosome?

Back 79

“Buy AT 30, CCELL’S at 50”

Chloramphenicol

Clindamycin

Erythromycin (macrolides)

Lincomycin

Linezolid

Streptogramins


Aminoglycosides

Tetracyclines

Front 80

What antibiotics are inhibitors of prokaryotic protein synthesis at the 30s ribosomal subunit?

Back 80

Aminoglycosides

Tetracyclines

Front 81

Lecture 35: Immunology 5

Back 81

B cells and Antibodies

Front 82

What medications are known for having anticholinergic side effects?

Back 82

•Typical neuroleptics
-Thioridazine
-Chlorpromazine

•1st generation antihistamines
•Tricyclic antidepressants
•Amantadine

Front 83

Describe the usefulness of the dexamethasone suppression test.

Back 83

Determining the different causes of Cushing syndrome

Normal individual
-Low dose –--> cortisol decreased

Ectopic ACTH-producing tumor
-Low dose and High dose –---> cortisol remains high

ACTH-producing pituitary tumor
-Low dose –----> cortisol remains high
-High dose –----> cortisol decreased

Cortisol-producing adrenal tumor
-Low dose and High dose –---> cortisol increased/ remains high

Front 84

What enzyme of the adrenal steroid synthesis pathway is inhibited by ketoconazole?

Back 84

Desmolase

Front 85

B cell surface markers
KNOW

Back 85

CD19

CD20

CD21

IgM

IgD

Front 86

Characteristics of antibody structure

Just read

Back 86

Variable part of L and H chains recognizes antigens

Fc portion of IgM and IgG fixes complement

Heavy chain contributes to Fc and Fab fractions

Light chain contributes only to Fab fraction

Front 87

Fab

Back 87

Antigen- binding fragment

Determines idiotype: unique antige-binding pocket; only 1 antigenic specificity expressed per B cell

Front 88

Fc

Back 88

Constant

Carboxy Terminal

Complement binding at CH2 (IgG + IgM only)

Carbohydrate side chains

Determines isotype (IgM, IgD, etc.)

Front 89

Antibody diversity is generated by:

Back 89

Random "recombination" of VJ (light chain) or V(D) J (heavy- chain) genes

Random combination of heavy chains with light chains

Somatic hypermutation (following antigen stimulation)

Addition of nucleotides to DNA during recombination by terminal deoxynucleotidyl transferase

Front 90

Immunoglobulin Structure

Just read

Back 90

Immunoglobulins are glycoproteins consisting of 2 identical heavy (H) chains and 2 identical light (L) chains linked by disulfide bonds in a Y shape

Variable regions exist on both the L and H chains

The H chain is composed of Fc and Fab fragment.

The L chain is composed of Fab fragment only.

The Fab is the antigen-binding fragment.

The Fc fragment is constant and, in the case of immunoglobulin (Ig) M and IgG, it is complement binding. It also contains a carboxy terminal and carbohydrate side chains.

Front 91

What are 3 antibody functions?

Back 91

Opsonization-- in which the antibody promotes phagocytosis

Neutralization-- in which the antibody prevents bacterial adherence to cells and membranes

Complement activation-- in which antibody activates complement, enhancing opsonization and lysis

Front 92

Allotype, Isotype, Idiotype

Back 92

Allotypes: are Ig epitopes that are different among the members of the same species. It is secondary to polymorphisms in the constant portion of the H chain or L chain. When trying to find appropriate transplant donors, allotypes are matched.

Isotype-- an Ig epitope that is common to a single class of immunoglobulins. For example, IgG, IgM, and IgA are different isotypes of Ig. It is determined by the constant region of the H chain

Idiotype-- an Ig epitope that is specific for a given antigen. It is determined by the antigen- binding site contributed by the variable and hypervariable regions

Front 93

Associated with allergies because it is bound by mast cells and basophils and causes them to degranulate and release their histamine

Back 93

IgE

Front 94

Comprises 70-75% of the total immunoglobulin pool

Back 94

IgG

Front 95

Present in large quantities on the membrane of many B cells

Back 95

IgD

IgM

Front 96

Crosses the placenta and , additionally, confers immunity to neonates in the first few months of life

Back 96

IgG

Front 97

Can occur as a dimer

Back 97

IgA

Front 98

Largely confined to the intravascular pool and is the predominant early antibody frequently seen in the immune response to infectious organisms with complex antigens

Back 98

IgM

Front 99

Distributed evenly between the intravascular and extravascular pools

Back 99

IgG

Front 100

The predominant immunoglobulin in mucoserous secretions such as saliva, colostrums, milk, tracheobronchial secretions, and genitourinary secretions

Back 100

IgA

Front 101

Can be a pentamer

Back 101

IgM

Front 102

Which cellular organelles are particularly important to plasma cell function?

Back 102

•Plasma cell function
-Rough endoplasmic reticulum
-Golgi apparatus

Front 103

What initiates recombination of V(D)J sequences?

Back 103

Recombination activating gene complex (RAG 1 and RAG 2)

Front 104

Lecture 36: Immunology 6

Back 104

Immunization and Autoantibodies

Front 105

Name of monocytes in Blood, alveoli, intestines

Back 105

Macrophages

Front 106

Name of monocytes in connective tissue

Back 106

Histocytes

Front 107

Name of monoctyes in the Liver

Back 107

Kupffer cells

Front 108

Name of monocytes in Kidney

Back 108

Mesangial cells

Front 109

Name of monocytes in the Brain

Back 109

Microglia

Front 110

Name of monocytes in the bone

Back 110

Osteoclasts

Front 111

Which types of proteins are responsible for fostering the progression through the cell cycle?

Back 111

Cyclins
Cyclin-dependent kinases

Front 112

What structural motifs allow for proteins to bind DNA?

Back 112

Helix-Loop-Helix
Helix-Turn-Helix
Zinc Finger Motif
Leucine Zipper Protein

Front 113

What are the autoantibodies in Lupus and CREST Scleroderma?

****

Back 113

•ANA
-Screening test for Lupus (important to know)
-Non-specific (seen in other diseases)

•Anti-centromere
-Seen with CREST scleroderma

Front 114

Which viral vaccines are potentially dangerous to patients with an egg allergy?

Back 114

Egg-based: Flu, Yellow fever

Front 115

What autoimmune disease is associated with anti-dsDNA antibodies?

Back 115

SLE (renal disease)

Front 116

What stain is used to identify amyloid microscopically, and how is its appearance described?

Back 116

•Congo red stain -- apple green birefringence under polarized light

Front 117

Lecture 37: Immunology 7

Back 117

Granulocytes, Cytokines, and Immunosuppressants

Front 118

What hematologic changes would you expect to see in a patient without a functional spleen?

Back 118

Target cells
Thrombocytosis
Howell-Jolly bodies in RBCs

Front 119

What are the different RNA polymerases in eukaryotes?

Back 119

RNA polymerase I – makes rRNA

RNA polymerase II – makes mRNA

RNA polymerase III – makes tRNA

Front 120

In what order is there an abnormal breakdown of elastin?

Back 120

α1-antitrypsin deficiency

*Excessive breakdown of elastin in the lung ---> emphysema

Front 121

DDx for Eosinophilia

Back 121

“DNAAACP”

Drugs

Neoplasm

Atopic disease
-Allergy
-Asthma
-Eczema

Addison disease
-Primary adrenal insufficiency

AIN (Acute interstitial nephritis)

Collagen vascular disease
-Systemic lupus
-Chrug-Strauss vasculitis

Parasites
-Ascaris (Loeffler eosinophilic pneumonitis)

Front 122

What are the actions of IL-1 through IL-5?

Back 122

“Hot T-Bone stEAk”

IL-1 – Fever (“hot”)

IL-2 – T cells

IL-3 – Bone marrow

IL-4 – IgE and IgG production

IL-5 – IgA production, and eosinophils

Front 123

Neutrophil's Chemotactic Agents

KNOW

Back 123

IL-8

C5A

Leukotrine B4

Front 124

Cyclosporine MOA & SE

Back 124

MOA: binds cyclophilins; the complex blocks the differentiation and activation of T cells by inhibiting calcineurin, thus preventing of IL-2 and its receptor

Use: Prevent organ rejection & in autoimmune disorders

SE: NEPHROTOXICITY

Front 125

Tacrolimus (FK506) (Protopic) MOA & SE

Back 125

MOA: binds to FK-binding protein, inhibiting calcineurin and secretion of IL-2 and other cytokines

Use: Potent immunosuppressive used in organ transplant recipients

SE: Nephrotoxicity

Side effects: Nephrotoxicity and Neurotoxicity

Front 126

Pimecrolimus (Elidel)

Back 126

Given topically for excema
Not used systemically

Front 127

Azathioprine

Back 127

MOA: antimetabolic precursor of 6-mercaptopurine that interferes with the metabolism and synthesis of nucleic acids; toxic to proliferating lymphocytes

Use: kidney transplant, autoimmune disorders (including glomerulonephritis and hemolytic anemia)

Toxicity: bone marrow suppression, active metabolite mercaptopurine is metabolized by xanthine oxidase; thus toxic effects may be increased by allopurinal

Front 128

Muromonab

Back 128

MOA: monoclonal antibody that binds to CD3 on the surface of T cells, blocks cellular interaction with CD3 protein responsible for T-cell signal transduction

Use: Immunosuppression after kidney transplantation

SE: Cytokine Release syndrome, hypersensitivity reaction

Front 129

Daclizumab

Back 129

High affinity for IL-2 on T cells (CD25)

Front 130

Mycophenolate

Back 130

Inhibits inosinephosphate dehydrogenase which is needed for the production of Guanine

Uses: transplants and lupus neuritis

Front 131

Aflixamab, adenlinonab, etanercept

Back 131

Anti- TNF alpha agents

Chromes diseases, RA, Psoriatic arthritis, Ankylosing spondylitis, Inflammatory bowel disease, Reactive arthritis (Reiter Syndrome)

Front 132

Absixamab

Important to know

Back 132

Glycoprotein 2B3A inhibitor on platelet (inhibit platelet activity)

Used in CVD

Front 133

Trastuzumab (Herceptin)

Back 133

Useful for treating breast cancer expressing HER-2

Front 134

Rituximb

Back 134

CD20 antagonist
Treatment of B cell non-Hodgkin lymphoma

Front 135

Umbilizimab

Back 135

Anti- IgE

Used: type 1 hypersensitivity, severe asthma

Front 136

Cytokines that promote B cell growth and differentiation

Back 136

IL-4

IL-5

Front 137

Cytokines that are produced by Th1 cells

Back 137

IL-2

Interferon-y

Front 138

Cytokines that are produced by Th2 cells

Back 138

IL-4

IL-5

IL-10

Front 139

Cytokines involved in growth and activation of eosinophils

Back 139

IL-5

Front 140

Cytokines secreted by helper T cells and activates macrophages

Back 140

Interferon-y

Front 141

Cytokine that inhibits macrophage activation

Back 141

IL-10

Front 142

Pyrogenes secreted by monocytes and macrophages

Back 142

IL-1

IL-6

TNF- a

Front 143

Inhibits production of Th1 cells

Back 143

IL-10

Front 144

Inhibits production of Th2 cells

Back 144

Interferon- y

Front 145

Cytokines that mediate inflammation

Back 145

IL-1

IL-6

TNF- a

Front 146

Enhances synthesis of IgE and IgG

Back 146

IL-4

Front 147

Enhances synthesis of IgA

Back 147

IL-5

Front 148

Released by virus-infected cells

Back 148

Interferon- a

Interferon- B

Front 149

Supports growth and differentiation of bone marrow stem cells

Back 149

IL-3

Front 150

Supports T cell proliferation, differentiation, and activation

Back 150

IL-2

Front 151

Precursor of 6-mercaptopurine

Back 151

Azathioprine

Front 152

Antibody that binds to CD3 on T cells

Back 152

Muromonab

Front 153

Antibody that binds IL-2 receptor on activated T cells

Back 153

Daclizumab

Front 154

Inhibits inosine monophosphage (IMP) dehydrogenase

Back 154

Mycophenolate mofetil

Front 155

Inhibits calcineurin resulting in the loss of IL-2 production and blockage of T cell differentiation and activation

Back 155

Cyclosporine

Front 156

Binds FK-binding protein (FKBP) leading to loss of IL-2 production

Back 156

Tacrolimus

Front 157

Binds FKBPI2 leading to inhibition of mTOR and T cell proliferation

Back 157

Sirolimus

Front 158

Used for lupus nephritis

Back 158

Cyclosporine

Azathioprine

Mycophenolate mofetil

Front 159

Metabolized by xanthine oxidase, therefore increasing allopurinol toxicity

Back 159

Azathioprine

6-Mercaptopurine

Front 160

What malignancy is associated with mycophenolate mofetil?

Back 160

Lymphoma

Front 161

Why is mycophenolate mofetil not used in pregnancy?

Back 161

Congenital malformation of the ear and face

1st trimesters miscarriage

Teratogenic

Front 162

Lecture 38: Immunology 8

Back 162

Complement and Hypersensitivity

Front 163

What enzyme is responsible for tRNA charging? What enzyme catalyzes peptide bond formation?

Back 163

tRNA charging -- Aminoacyl-tRNA synthetase

Catalyzes peptide bond formation -- Peptidyltransferase

Front 164

Which cytokines are secreted by the two different types of helper T cells?

Back 164

Th1 makes: IL-2 & IFN-y

Th2 makes:
-IL-4
-IL-5
-IL-10
-IL-13

Front 165

What substances are utilized by natural killer cells to induce apoptosis in other cells?

Back 165

Granzymes

Perforin

Front 166

Hypersensitivity ***HIGH YIELD – 4 star/5 star topic***

What are the characteristics of Type I hypersensitivity?

Back 166

Free antigen cross-linking IgE of pre-sensitized mast cell and basophils

Wheal and flare

Allergy, asthma, anaphylaxis, excema, Hay fever, hives

Front 167

What are the characteristics of Type II Hypersensitivity?

Back 167

Antibodies against self

Complement mediated damage, macrophages, NK cells

Starts with antiself antibody

Diagnosis: Test= Coon’s test

Examples:
Hemolytic anemia
Pernicious anemia
ITP
Erthyroblastosis fatalsis transfusion reaction
Rheumatic fever
Goodpasture syndrome
Pemphigus vulgaris
Grave’s disease
Myathenia Gravis

Front 168

What are the characteristics of Hypersensitivity III?

Back 168

Antibodies against soluble antigens deposited in tissues

Excess antibody- antigen complexes saturate the tissues


Activates complement & neutrophils

Examples:
Serum sickness
Arthrous reaction
Systemic lupus
RN
Polyarthritis nodous
Post streptococcous glomerularnephritis

Front 169

Characteristics of Hypersensitivity Type IV?

Back 169

T cell-mediated, delayed hypersensitivity

Examples:
Posion ivy
PPD skin test
Type I diabetes
MS
Guillia- Barre
Hashimoto’s thyroiditis
Graft vs. Host disease
Contact dermatitis

Front 170

Type IV hypersensitivity-- Contact Dermatitis *****

Back 170

•Poison ivy
•Poison oak
•Nickel allergy
-Seen in places on the body where you would commonly be exposed to nickel (watch area, belt buckle, buckle of sandals, jewelry)—I have this so, I’ll know if you ever buy me cheap jewelry muwahahaha… look at that--------- it’s sparklely!!!)

Front 171

A patient suffers from recurrent Neisseria infections. What complement proteins are deficient?

Back 171

Any of the Membrane Attack Complex (MAC) complement proteins C5, C6, C7, C8, C9

Front 172

What complement is responsible for neutrophil chemotaxis?

Back 172

Complement C5a

Front 173

Lecture 39: Immunology 9

Back 173

Immunodeficiencies

Front 174

Which type of collagen is abnormal in Alport syndrome?

Back 174

Type IV collagen

Front 175

Which type of collagen is abnormal in Ehlers-Danlos syndrome?

Back 175

Type III collagen

Front 176

What are the mRNA stop codons?

Back 176

UGA
UAA
UAG

Front 177

Thymic aplasia (DiGeorge) *****

Back 177

3rd and 4th pouches fail to develop
-No thymus = no T cells
-No parathyroids = Low Ca2+ & tetany

Congenital defects in heart/great vessels

Recurrent viral, fungal,protozoal infections

90% have a chrom 22q11 deletion (detect with FISH)

Front 178

Chromosome 22q11 Deletions *****

Back 178

Associated with DiGeorge syndrome


Associated with heart and great vessel malformations

“CATCH 22”

Front 179

Severe Combined Immunodeficiency (SCID) *****

Back 179

Defect in early stem cell differentiation

Can be cause by at least 7 different gene defects-- KNOW: ADENOSINE DEAMINASE DEFICIENCY

Last defense is cytotoxic NK cells

Presentation triad:
1) Severe recurrent infections
-Chronic mucocutaneous Candidiasis
-Fatal or recurrent RSV, VZV, HSV, HSV, measels, flu, parainfluenza
-PCP pneumonia

2) Chronic diarrhea

3) Failure to thrive

No thymic shadow on newborn CXR

Front 180

Wiskott-Aldrich Syndrome *****

Back 180

“WAITER”

Wiskott

Aldrich

Immunodeficiency

Thrombocytopenia and purpura

Eczema

Recurrent pyogenic infections
-No IgM v. capsular polysaccharides of bacteria
-Low IgM, high IgA
- X-linked

Truncal eczema – associated with Wiskott-Aldrich

Front 181

Chronic Granulomatous Disease (CGD) ***HIGH YIELD***

Back 181

Lack of NADPH oxidase activity ----> impotent

Susceptible to organisms with catalase (S. aureus, E. coli, Klebsiella spp., Aspergillus spp., Candida spp.)

Dx: (-) nitroblue tetrazolium (NBT) dye
- No yellow to blue-black oxidation (because phagocytes do not engulf the dye)

Prophylactic TMP-SMX

IFN-y also helpful

Front 182

Bruton Agammaglobunlinemia *****

Back 182

X-linked (Boys)

B cell deficiency-- defective tyrosine kinase-- low levels of all immunoglobulins

Recurrent bacterial infections after 6 mos

Front 183

IgA deficiency *****

Back 183

Most common

Most appear healthy

Sinus and lung infections

1/600 European decent

Associated with atophy, asthma

Possible anaphylaxis to blood transfusions and blood products

Front 184

Chronic mucocutaneous Candidiasis *****

Back 184

T cell dysfunction v. C. albicans

Rx: ketoconazole

Front 185

Hyper- IgM syndrome (3 types) High IgM & Low Ig *****

Back 185

X-linked: no CD ligand

AR: no CD40

NEMO deficiency

Can't switch to other Ig isotypes

Front 186

What are the X-linked immunodeficiencies?

Back 186

Wiskott- Aldrich

Bruton's Agammaglobinemia

Chronic granulomatous disease (can be inherited in other ways)

Hyper-IgM syndrome

Front 187

Ataxia- Telangiectasia *****

Back 187

IgA deficiency

Cerebellar ataxia, and poor smooth pursuit of moving target with eyes

Telangiectasias of face >5yo

Increased cancer risk: lymphoma and acute leukemias

Radiation sensitivity (try to avoid x-rays)

+/- Increased AFP in children > 8mos

Average age of death: 25 yo

Front 188

Chediak- Higashi Syndrome*****

Back 188

Defective LYST gene (lysosomal transport)

Defective phagocyte lysosome ----> giant cytoplasmic granules in PMNs are diagnostic

Presentation triad (KNOW)
1. Partial albinism

2. Recurrent respiratory tract and skin infections

3. Neurologic disorders

Front 189

Job syndrome (Hyperimmunoglobulin E syndrome) *****

Back 189

Deficient IFNy -- PMNs fail to respond to chemotactic stimuli (C5a, LTB4)

High levels of IgE and eosinophils

Presentation triad:
1. Eczema

2. Recurrent cold S. aureus abscesses (think biblical Job with boils)

3. Coarse facial features: broad nose, prominent forehead ("frontal bossing"), deep set eyes, and "doughy" skin

Also common to have retained primary teeth resulting in 2 rows of teeth

Front 190

Leukocyte Adhesion Deficiency Syndrome *****

Back 190

Abnormal integrins ---> inability of phagocytes to exit circulation

Phagocytes can not integrate into tissues

Delayed separation of umbilicus

Front 191

What would you expect to see in a patient with Wiskott-Aldrich syndrome?

Back 191

“WAITER”

Wiskott

Aldrich

Immunodeficiency

Thrombocytopenia and purpura

Eczema

Recurrent pyogenic infections

Deficiency of IgM antibodies, and elevated IgA antibodies

Front 192

What is the cause of chronic granulomatous disease? What infections are these individuals susceptible to?

Back 192

Caused by absence of NADPH oxidase

Phagocytes can’t generate oxygen-free radicals

Susceptible to infections by:
Staph aureus
E. coli
Klebsiella
Aspergillus
Candida

All have CATALASE

Front 193

A young child presents with tetany from hypocalcemia, and candidiasis resulting from immunosuppression. What cell type is deficient in this patient?

Back 193

DiGeorge Syndrome:

T cell deficiency

Thymic aplasia

Parathyroid dysfunction  hypocalcemia

Front 194

Rapid fire fact: Most common infections seen in chronic granulomatous disease

Back 194

Staph aureus

E. coli

Klebsiella

Aspergillus

Candida

Front 195

Rapid fire fact: Eczema, recurrent URI, high serum IgE

Back 195

Hyperimmunoglobulin E syndrome – (Job syndrome)

Front 196

Rapid fire fact: Large lysosmal vesicles in phagocytes

Back 196

Chediak-Higashi disease

Front 197

Thyroid development 4 stars****

Where does the Thyroid diverticulum come from?

Back 197

Thyroid diverticulum arises from the floor of the primitive pharynx and descends into the neck

Front 198

What connects the thyroid diverticulum to the tongue?

Back 198

Thyroglossal duct

Which normally disappears, but may persist as pyramidal lobe of thyroid

Foramen cecum is the normal remnant of the thyroglossal duct

Front 199

What is the most common site of ectopic thyroid tissue?

Back 199

Tongue

Front 200

How does a thyroglossal duct cyst present?

Back 200

As an anterior midline neck mass that moves with swallowing

Front 201

How does a persistent cervical sinus present?

Back 201

Causes a branchial cleft cyst in the lateral neck

Front 202

What would you suspect to be the cause of hyperthyroidism in a patient presenting with the symptoms of hyperthyroidism in addition to each of the following findings?

Findings: Extremely tender thyroid gland

Back 202

Subacute (de Quervain's) thyroiditis

*This is a transient hyperthyroidism

Front 203

FInding: pretibial myxedema

Back 203

Grave's disease

Front 204

Finding: Pride in recent weight loss, medical professional

Back 204

Thyroid hormone abuse

Front 205

Finding: Palpation of multiple thyroid nodules

Back 205

Toxic multinodular goiter

Front 206

Finding: Palpation of a single thyroid nodule

Back 206

Toxic thyroid adenoma

Front 207

Finding: Recent study using IV contrast (iodine)

Back 207

Jod-Basedown phenomenon

Front 208

Finding: eye changes-- proptosis, edema, injection

Back 208

Grave's disease

Front 209

History of thyroidectomy or radioablation of thyroid

Back 209

Too much exogenous thyroid hormone

Front 210

What type of thyroid cancer matches each of the following statements?

- Most common type of thyroid cancer (70-75%)

Back 210

Papillary carcinoma

Front 211

-Second most common type of thyroid cancer (10%)

Back 211

Follicular carcinoma

Front 212

-Activation of receptor tyrosine kinase

Back 212

Papillary carcinoma

Medullary carcinoma

Front 213

-Hashimoto thyroiditis is a risk factor

Back 213

B-cell lymphoma

Front 214

- Cancer arising from parafollicular C cells

Back 214

Medullary Carcinoma

Front 215

- Commonly associated with either a RAS mutation or a PAX8- PPRP gamma I rearrangement (lower yield)

Back 215

Follicular carcinoma

Front 216

-Commonly associated with rearrangements in RET oncogene or NTRKI

Back 216

Papillary carcinoma

Front 217

- Most common mutation in the BRAF gene (serine/ threonine kinase)

Back 217

Papillary carcinoma

Front 218

Lymph drainage 4 stars ****

Where does the upper limb/ lateral breast drain to?

Back 218

Axillary nodes

Front 219

Where does the lymph from the stomach drain to?

Back 219

Celiac nodes

Front 220

Where does the lymph from the duodenum and jejunum drain to?

Back 220

Superior mesenteric nodes

Front 221

Where does the lymph from the sigmoid colon drain to?

Back 221

Colic nodes and then to ----> Inferior mesenteric nodes

Front 222

Where does the lymph from the Rectum drain to?

Back 222

Internal iliac nodes

Front 223

Where does the lymph from the anal canal above the pectinate line drain to?

Back 223

Internal iliac nodes

Front 224

Where does the lymph from the testes drain to?

Back 224

Para-arotic nodes

Front 225

Where does the lymph from the scrotum drain to?

Back 225

Superficial Inguinal nodes

Front 226

Where dose the lymph from the thigh drain to?

Back 226

Superficial inguinal nodes

Front 227

Where does the lymph from the lateral side of the dorsum of the foot drain to?

Back 227

Popliteal lymph nodes

Front 228

What drains into the right lymphatic duct?

Back 228

Right arm and Right half the head

Obstruction of the right lymphatic duct will cause NON-pitting edema in these regions

Front 229

Where does the thoracic duct enter back into the circulation?

Back 229

Junction of the Left Subclavian Trunk & Left Internal Jugular Vein

Front 230

All T cells have CD____

Back 230

3

Front 231

Cytotoxic T cells= CD___

Back 231

8

Front 232

Helper T cells= CD___

Back 232

4

Front 233

What do Th1 cells activate?

Back 233

Macrophages and cytotoxic T cells

Front 234

What doe Th2 cells activate?

Back 234

Plasma cells to make antibodies

Front 235

A potentiate stimulator of T cells is?

Back 235

IL-2

Front 236

What Human leukocyte antigen molecules code for
MHC 1?

Back 236

HLA-A

HLA-B

HLA-C

Front 237

What HLA molecules code for MHC 2?

Back 237

HLA- DR

HLA- DQ

HLA- DP

Dr. going into DQ to get a Dr Pepper

Front 238

What condition is associated with HLA-A3?

Back 238

Hemochromatosis

Front 239

What condition is associated with HLA-B27?

Back 239

"PAIR"

Psoriatic arthritis

Ankylosing spondylitis

Inflammatory bowel disease

Reiter' Syndrome

Also called the Seronegative arthropathies because they don't have an elevation in Rheumatoid factor

Front 240

What condition is associated with HLA- DR3 and HLA- DR4?

Back 240

Diabetes Mellitus Type I

Front 241

What are the different types of Dendritic cells?

Back 241

Langerhans-- from immature epithelial tissue in epidermal layers of skin (CALT)

Interstital-- from immature non-epithelial, interstitial tissue; in all interstitial spaces of virtually all organs except the brain

Front 242

What are follicular dendritic cells?

Back 242

Do not arise from bone marrow like the dendritic cells

Do not express class II MHC---> do not present antigen to Th cells

Exclusively reside in lymph node

Important in the maturation and diversification of B cells

Front 243

What is the clinical use of Dopamine?

Back 243

Tx: Shock

Front 244

Clinical use of Clonidine?

Back 244

HTN

HTN urgency

Renal Disease

Front 245

Clinical use of Amphetamine?

Back 245

ADHA

Weight loss

Daytime sleepiness

Narcolepsy

Major Depressive Disorder

Front 246

Clinical Use of Terbutaline?

Back 246

Asthma

Tocolysis (suppress premature labor)

Front 247

Clinical use of Epinephrine?

Back 247

Anaphylactic shock

Front 248

What structures are derived from the 1st brachial pouch?

Back 248

Mastoid air cells

Middle ear cavity

Eustachian tubes

Front 249

What structures are derived from the 2nd brachial pouch?

Back 249

Lining of the palatine tonsil

Front 250

What structures are derived from the 3rd branchial pouch?

Back 250

Thymus

Inferior parathyroids

Front 251

What structures are derived from the 4th branchial pouch?

Back 251

Superior parathryroids

Front 252

Tho ---> Th1 through which cytokine?

Back 252

IL-12

Front 253

Tho ---> Th2 through which cytokine?

Back 253

IL-4

Front 254

What is the 2 step process for T helper cell activation?

Back 254

1. T cell receptor + CD4 complex with MHC II + antigen

2. CD 28 on the Th cell recognizes B7 on the APC

*B7= costimulatory signal (aka CD80 or CD87)

Front 255

What is the 2 step process for Cytotoxic T cell activation?

Back 255

1. TCR + CD8 complex with MHC I + viral protein

2. CD28 recognizes B7

Front 256

What are the 4 main steps in B cell activation?

Back 256

1. Endocytosis of antigen by B cell

2. Antigen is presented to a Th cell by using the MHC 2 found on APCs

3. Use of co-stimulatory signal of CD40 receptor on B cells and CD40 ligand on Th cell

4. Steps 1-3 -----> Th2 cell to generate IL-4, IL-5, IL- 6

Front 257

By which surface markers are NK cells identified?

Back 257

CD 16

CD 56

Front 258

What interleukins enhance NK cell activity?

Back 258

IL- 12

IL-2

INF - B

INF -a

Front 259

Do NK cells secrete IFN- y?

Back 259

Yes

Front 260

What cells are CD16 found on?

Back 260

NK cells

Macrophages

Monocytes

Neutrophils

*Binds to the constant region of antibodies as well

Front 261

How does CD 16 recognize and kill immunglobulin coated cells?

Back 261

Antibody Dependent Cell Mediated Cytotoxicity

(ADCC)

Front 262

Describe the maturation and migration of monocytes?

Back 262

Leave bone marrow for blood -----> circulate 8 hours to mature -----> migrate into tissue to become macrophages

Front 263

What are monocytes in the blood, alveoli, and intestines called?

Back 263

Macrophages

Front 264

What are monocytes in the connective tissue called?

Back 264

Histiocytes

Front 265

What are monocytes in the liver called?

Back 265

Kupffer cells

Front 266

What are monocytes in the kidney called?

Back 266

Mesangial cells

Front 267

What are monocytes in the bone called?

Back 267

Osteoclasts

Front 268

What are monocytes in the brain called?

Back 268

Microglia

Front 269

What surface markers does macrophages have?

Back 269

CD40

CD16-- binds to constant region of immunoglobulins

CD14-- binds lipopolysaccharide or endotoxin of Gram (-) bacteria

Front 270

What type of cytokines do macrophages secrete?

Back 270

Acute phase cytokines:

IL-1

IL-6

TNF - a

Front 271

What are the actions of IFN- y secreted from Th1 cells and NK cells?

Back 271

Stimulates macrophages

Stimulates NK cells to kill virally infected cells

Front 272

What are actions of INF- a and INF- B produced from virally infected cells?

Back 272

Place neighboring cells in an anti-viral state by:

-Inhibiting cellular protein synthesis thus blocking replication

-Encouraging the activation of ribonuclease that degrades viral RNA

- Can also induce the lytic activity of NK cells

Front 273

What other cytokines (besides IL-1, IL-6, & TNF- a) mediate inflammation?

Back 273

C Reactive Protein (CRP)

Complement

Coagulation factors

Ferritin

* These are made in hepatocytes

Front 274

Where are T-cells found in the spleen?

Back 274

PALS ---- Periarterial Lymphatic Sheath of the spleen

Front 275

Where are B - cells found in the spleen?

Back 275

Follicles of the white pulp

Front 276

What are common findings in Post Splenectomy patients?

Back 276

Increased Howell- Jolly Bodies

Increased Target cells

Increased Thrombocytosis

Front 277

With increased splenomegaly you will tend to have ________

Back 277

Thrombocytopenia because the spleen sequesters platelets

Front 278

What does Th2 cells secrete that stimulate B cells?

Back 278

IL-4

IL-5

Front 279

When B cells encounter antigens what do they produce?

Back 279

Plasma cells

Memory B cells

Front 280

As you age what happens to your number of memory B cells?

Back 280

Memory B cells Decrease

* This is why vaccine effectiveness decreases and people need boosters

Front 281

What organelle are plasma cells rich in?

Back 281

Rough ER

Front 282

Plasmacytoma is also know as

Back 282

Multiple Myeloma

Front 283

Do Multiple myelomas secrete polyclonal antibodies or monoclonal antibodies?

Back 283

Monoclonal antibodies

* Will see a monoclonal antibody spike and a shift in the lamba: kappa ratio

Front 284

What histological feature is characteristic of MM?

Back 284

Russell bodies--- immunoglobulin acculumations within plasma cells

Front 285

What are the surface proteins of Helper T cells?

Back 285

CD4

CD3

TCR

CD28

CD40

Front 286

What are the surface proteins of cytotoxic T cells?

Back 286

CD3

CD8

TCR

Front 287

What are the surface proteins of Macrophages?

Back 287

CD14

CD 40

CD 16

MHC II

B7

Front 288

What are the surface proteins of NK cells?

Back 288

CD 16

CD 56

Front 289

What surface protein do all self cells have except RBCs?

Back 289

MHC i

Front 290

Where are disulfide bonds in an antibody?

Back 290

1. Connecting the 2 heavy chains

2. Connecting light chain to heavy chain

3. Within the light chains and heavy chains they know

Front 291

What are the different heavy chains types?

Back 291

Mu--- IgM

Delta--- IgD

Gamma--- IgG

Epsilon--- IgE

Front 292

What are the 2 different types of light chains?

Back 292

Lamba

Kappa

Front 293

What is the normal Kappa: Lamba ratio in humans?

Back 293

2: 1

Front 294

V (D) J recombination highlights

Just read

Back 294

Rearrangements of the DNA segment named variable (V), diversity (D), and joining ( J )

The recombination process begins with breaks in the dsDNA at Recombination Signal Sequences (RSS) that flank the V, D, J coding regions

V (D) J recombination is initiated by the recombination activating gene complex (RAG 1 and RAG 2) which recognize the RSS

Mutations in either of the RAG genes in mice causes an inability to initiate V (D) J rearrangements and an arrest in B & T cell development

Front 295

Where does the rearrangement process begin?

Back 295

Recombination signal sequences

Front 296

What initiates the recombination process?

Back 296

Recombination activating gene complexes (RAG 1 & RAG 2) by recognizing the RSSs

Front 297

Key characteristics of IgG

Back 297

Most abundant type in blood

Delayed immune response (not involved in acute infection)

Fixes complement

Crosses placenta

Opsonizes Bacteria

Neutralizes bacterial toxins and viruses

Half- life is 21 days

Front 298

Key characteristics of Ig A

Back 298

Secreted by MALT

Circulation (monomer)

Secreted (dimer)

Can cross through the epithelial cells to get into the gut lumen--- transcytosis

Found in:
Secretions
Tears
Saliva
Mucus secretion
Breast milk

Front 299

Key characteristics of IgM

Back 299

Primary immune response (associated with acute infections)

Does NOT cross placenta

Surface of B cells (monomer)

Circulation (pentamer)

Front 300

IgD is one what cell surface?

Back 300

Immature B cells

Front 301

What are the key characteristics of IgE?

Back 301

Binds to:
Mast cells
Basophils
Eosinophils

Mediates:
Type I hypersensitivity
Parasitic worm infections (by activating eosinophils)

Front 302

What are some examples of live attenuated virus vaccine?

Back 302

Smallpox

Yellow fever

Chickenpox (Varicella/ VZV)

Sabin's polio virus (oral polio)

MMR

Influenza (intranasal)

"Live! One night only! See Small Yellow Chickens get vaccinated with Sabin's and MMR! It's INcrediable
* Live attenuated vaccines induce humoral and cell-mediated immunity

Front 303

What are some examples of inactivated (killed) virus vaccine?

Back 303

Rabies

Influenza (intramuscular/ injected)

Salk Polio (injected)

Hepatitis A

"SalK= Killed"
"RIP Always"

*Also Cholera

* Killed vaccines only indue humoral immunity

Front 304

Yellow fever, Influenza, and a small amount of MMR are
________ based vaccines

Back 304

Egg- based

* Pts allergic to eggs need to have a scratch test done before getting these vaccines

Front 305

What component must killed virus vaccines have?

Back 305

Thymus- dependent antigen

Front 306

What is the difference between Thymus- dependent and Thymus- independent antigen?

Back 306

Thymus- independent: lacks a polypeptide component and therefore cannot be presented to T cells on their MHC
- Example: lipopolysaccharide the endotoxin of Gram neg. bacteria
- Will NOT result in memory immune system

Thymus- dependent: have a peptide component that will induce MHC and will rest in making a memory immune system

Front 307

What disorders are associated with antinuclear antibodies (ANA)?

Back 307

Systemic Lupus (SLE)

Nonspecific

Front 308

What disorder is associated with Anti-dsDNA?

Back 308

Lupus RENAL disease

Front 309

What disorder is associated with Anti- smith?

Back 309

SLE

Front 310

What disorder is associated with antihistone?

Back 310

Drug- induced lupus

Front 311

What disorder is associated with Rheumatoid factor and
anti- CCP?

Back 311

Rheumatoid arthritis

Front 312

What disorder is associated with Anticentromere?

Back 312

Scleroderma (CREST syndrome)

Front 313

What disorder is associated with Anti- Scl- 70 (anti-DNA topoisomeraseI)?

Back 313

Scleroderma (diffuse)

Front 314

What disorder is associated with antimitochondrial?

Back 314

Primary biliary cirrhosis

Front 315

What disorder is associated with IgA antiendomysial, IgA anti-tissue transglutaminase?

Back 315

Celiac disease

Front 316

What disorder is assoc. with anti-basement membrane?

Back 316

Goodpasture's syndrome

Front 317

What disorder is assoc. with anti-desmolgein?

Back 317

Pemphigus Vulgaris

Front 318

What disorder is assoc. with antimicrosomal and antithyroglobulin?

Back 318

Hashimoto's thyroiditis

Front 319

Anti-Jo-1

Anti- SRP

Anti- Mi-2

Back 319

Polymyositis

Dermatomyositis

Front 320

Anti- SSA (anti- Ro) & Anti- SSB (anti- La)

Back 320

Sjorgen's syndrome

Front 321

Anti- U1 RNP (ribonucleoprotein)

Back 321

Mixed connective tissue disease

Front 322

Anti- smooth muscle

Back 322

Autoimmune hepatitis

Front 323

Anti- glutamate decarboxylase

Back 323

TYpe 1 diabetes mellitus

Front 324

c-ANCA (PR3- ANCA)

Back 324

Granulomatosis with polyangitis (Wegener's)

Front 325

p- ANCA (MPO- ANCA)

Back 325

Microscopic polyangiitis

Churg- Strauss syndrome

Front 326

Immunologic amyloidosis:

Protein?

Fibril?

Back 326

Protein: Ig Light Chains

Fibril: AL (primary)

Can occur as a plasma cell disorder or associated with multiple myeloma

Front 327

Secondary amyloidosis:

Protein?

Fibril?

Back 327

Protein: Serum Amyloid A

Fibril: Amyloid A

Seen in chronic diseases like RA, IBD, spondyloarthropathy, chronic infections

Front 328

Senile amyloidosis:

Protein?

Fibril?

Back 328

Protein: Transthyretin

Fibril: ATTR

Front 329

Type 2 amyloidosis:

Protein?

Fibril?

Back 329

Protein: Amylin

Fibril: AIAPP

Front 330

Medullary thyroid CA amyloidosis:

Protein?

Fibril?

Back 330

Protein: Calcitonin

Fibril: A-CAL

Front 331

Alzheimer's amyloidosis:

Back 331

Protein: B- amyloid

Fibril: APP

Front 332

Dialysis associated amyloidosis:

Back 332

Protein: B2- microglobin

Fibril: AB2M

Front 333

What Hypersensitivity is responsible for each of the following clinical problems?

Poststreptococcal glomerulonephritis

Back 333

Type III

Front 334

Asthma is a ____ HS reaction

Back 334

Type I

Front 335

Rheumatic Fever is a ________ HS reaction

Back 335

Type II

Front 336

TB skin test is a _________ HS reaction

Back 336

Type IV

Front 337

Allergies, anaphylaxis, and hay fever is a ___________ HS reaction

Back 337

Type I

Front 338

Polyarteritis Nodosa is a _______ HS reaction

Back 338

Type III

Front 339

Serum sickness is a ____________ HS reaction

Back 339

Type III

Front 340

ABO blood type incompatibility is a ________ HS reaction

Back 340

Type II

Front 341

Poison ivy is a __________ HS reaction

Back 341

Type IV

Front 342

Eczema is a _____________ HS reaction

Back 342

Type I

Front 343

Contact dermatitis is a ________ HS reaction

Back 343

Type IV

Front 344

Goodpasture syndrome is a ______________ HS reaction

Back 344

Type II

Front 345

What are the key characteristics of Bruton Agammaglobulinemia?

Back 345

X-linked

B- cell deficiency---> defective Tyrosine Kinase gene---> Low levels of all immunoglobulins

Recurrent bacterial infections after 6mos

Front 346

What are the key characteristics of IgA deficiency?

Back 346

Most common Ig deficiency

Most appear healthy

Sinus and lung infections

1/600 European descent

Associated with atopy, asthma

Possible anaphylaxis to blood transfusions and blood products

Front 347

What is the start codon that codes for methionine?

Back 347

AUG

Front 348

What are the requirements for transcription to start?

Back 348

Transcription factors binding to the promoter region

Inducers binding to the operator region

Front 349

What prevents transcription?

Back 349

Repressor binding to an operator region

Front 350

What increases or decreases the rate of transcription?

Back 350

Response elements binding to an enhancer or repressor region

Front 351

What is the result of a promoter region mutation?

Back 351

Commonly results in a substantial decrease in the amount of mRNA that is transcribed

Front 352

What is B- galactosidase?

Back 352

Breaks down the dimer molecule of lactose into glucose and galactose

It is necessary for a prokaryote to be a lactate fermenter

Front 353

What are the 3 eukaryotic polymerases?

Back 353

I- rRNA

II- mRNA

III- tRNA

Front 354

What can polymerase II be inhibited by?

Back 354

a- amantin a mushroom toxin that can cause hepatotoxicity and possibly liver failure

Front 355

What drug inhibits prokaryotic RNA polymerase?

Back 355

Rifampin

Front 356

What are the R's of Rifampin?

Back 356

rRNA polymerase

Revs up cytochrome P450 (induces)

Red secretions (like red urine)

Front 357

What are the 2 mechanisms which terminate prokaryotic RNA transcription?

Back 357

Rho factor--- RNA dependent ATPase removes a polymerase from the template

Rho independent mechanism

Front 358

Describe the mechanism of Rho independent termination

Back 358

GC rich DNA---->

GC same strand binding forms stem- loop in RNA (hairpin)---->

Causes a pause in RNA polymerase--->

Subsequent weak RNA bonds (uracil rich region)---->

Separation of RNA polymerase

Front 359

What is RNA called after it has been transcribed, but before it has left the nucleus?

Back 359

hnRNA (heterogenous nuclear RNA)

Front 360

What processes must occur to the hnRNA for it to leave the nucleus and become mRNA?

Back 360

Capping of the 5' end via S- adenosyl- methionine (SAM)

Polyadenylation on the 3' end (AAUAAA)

Splicing of the introns via spliceosomes

Front 361

What is the structure of tRNA?

Back 361

Cloverleaf

Front 362

What are the ribosomal subunits of prokaryotes?

Back 362

30S + 50S= 70S

Front 363

What are the ribosomal subunits of eukaryotes?

Back 363

40S + 60S= 80S

Front 364

What occurs during post-translation modification?

Back 364

N-terminal or C- terminal can be trimmed off

Polypeptide can be covalently modified by: phosphorylation, glycosylation, hydroxylation