Immuno Test 3

Front 1

___% of circulating lymphocytes are T-cells

Back 1

60-80%

Front 2

Early surface markers of T-cells

Back 2

CD44 and CD25

Front 3

______ are cells which are critical for T-cell differentiation

Back 3

IL-7+ stromal cells

Front 4

Premature thymocytes are CD4/CD8+ (T/F)

Back 4

False, early thymocytes lack these CD's

Front 5

What happens to most T-cells that recognize self-antigens?

Back 5

They are destroyed via apoptosis

Front 6

~2/3 of circulating T-cells are ____

Back 6

CD4+ Helper or inducer T-cells

Front 7

These T-cells produce IFN-gamma and TNF-beta, and protect against which kind of pathogens?

Back 7

TH1 cells, which protect against intracellular pathogens

Front 8

These T-cells produce IL-4, -5, -10, -13 and their function is to _____

Back 8

Th2 cells, which help B-cells produce Ab's against extracellular pathogens

Front 9

Cytotoxic T-cells are CD(?)+ and interact with ____

Back 9

CD8+ cells; interact with Ag/MHCI proteins

Front 10

T-regulatory cells are positive for which CD's?

What is their function?

Back 10

CD4 and CD25

Producing IL-10 and TGF-beta in order to downregulate the immune response, esp. to self-antigens

Front 11

How do NK cells bind antibodies?

Back 11

NK cells have CD16, which binds the Fc of IgG

Front 12

NK cells are inhibited by the presence of which cell receptor?

Back 12

MHC I

Cells with minimal expression of MHC I (ie. due to viral infection) will be deemed as "non-self" and destroyed by NK cells

Front 13

Differentiate autocrine, paracrine and endocrine stimulation

Back 13

Autocrine: stimulates the cell that secreted the messenger

Paracrine: stimulates cells in close proximity to the secreting cell

Endocrine: system-wide stimulus

Front 14

Functions of TNF-alpha

Back 14

- cause vasodilation and increase vasopermeability
- enhance Ag presentation by increasing MHC II presentation

Front 15

High levels of TNF-alpha can lead to ____

Back 15

Septic shock, for example in severe gram neg infections

Front 16

IL-6 is produced in response to ____ and has what function?

Back 16

Lipopolysaccharides; increases acute phase reactants and adaptive immune response

Front 17

TGF-beta's main function is its ability to ______

Back 17

induce antiproliferative activity

Front 18

Functions of IFN-alpha and -beta

Back 18

- interfere with viral replication
- limits spread of infection
- activates NK cells and enhances recognition of infected cells
- medication against some malignancies

Front 19

IL-2

Back 19

T-cell growth factor

Front 20

IL-4

Back 20

Regulates Th2 cells responsible for adaptive immunity

Front 21

IL-10

Back 21

- inhibits Ag presentation by macrophages/dendritic cells
- antagonist to IFN-gamma

Front 22

Which cytokines are associated with T-regulatory cells?

Back 22

TGF-beta and IL-10

Front 23

Monoclonal gammopathies are associated with ______

Back 23

Increased/abnormal production of:
- functional Ig
- structurally abnormal Ig
- just light chains (common) or heavy chains (rare)

Front 24

Multiple myeloma, malignant lymphomas and Waldenstrom's macroglobulinemia are examples of _____

Back 24

monoclonal gammopathies

Front 25

Multiple myelomas typically affect which demographic?

Back 25

>50y/o, M

Front 26

___ are present in ~80% of multiple myeloma cases

Back 26

excess free light chains (bence-jones proteins)

Front 27

The Ig class typically seen in excess in multiple myeloma is

Back 27

IgG

Front 28

Detection of paraprotein in urine may require ____

Back 28

Concentration via removal of water

Front 29

Bone marrow characteristics of multiple myeloma

Back 29

15-90% of all myeloid cells are plasma cells
- may be localized sheets of cells
- often appear binucleated

Front 30

How does multiple myeloma afffect bones?

Back 30

- "punched out" bone lesions
- induces osteoclast activity, causing diffuse osteoporosis

Front 31

Gross appearance of bone in multiple myeloma

Back 31

"punched out" bone lesions

Front 32

Multiple myeloma cells cause diffuse osteoporosis by ____

Back 32

increasing osteoclast activity

Front 33

Presenting symptoms of multiple myeloma

Back 33

bone pain/tenderness
pathologic fraction
anemia
weakness
renal issues

Front 34

Lab findings of multiple myeloma

Back 34

- M-spike on SPE
- decreased WBC and/or platelets
- inc. ESR
- rouleaux on blood smear
- hypercalcemia (2ndary to bone breakdown)
- azotemia (2ndary to increased cell metabolism)

Front 35

IgD Myelomas occur in (younger/older) patients than other cases

Back 35

younger

Front 36

Why can multiple myeloma be missed if running SPE on a plasma sample?

Back 36

Plasma samples contain fibrinogen, which may cause the M-spike to be overlooked.

Front 37

IgD multiple myeloma is associated with (better/poorer) survival rate than IgG/IgA multiple myelomas

Back 37

poorer

Front 38

How is light chain myeloma usually detected?

Back 38

urinalysis and/or hypogammaglobulinemia

Front 39

What is significant about non-secretory myelomas?

Back 39

The clinical features may be similar to secretory myelomas, but the plasma cells cannot secrete their antibodies; no M-spike, Bence Jones, etc.

Front 40

Treatment of symptoms secondary to multiple myeloma

Back 40

Anemia: RBC transfusion
Infection: antibiotics
Plasmapheresis/hemodialysis: manage excess serum protein

Front 41

Common symptoms of Waldenstrom's macroglobulinemia

Back 41

Blood hyperviscosity leading to hypertension > heart failure/stroke
- splenomegaly/hepatomegaly
- spontaneous hemorrhage due to thrombocytopenia/impaired PLT function

Front 42

Which Ig class is involved in Waldenstrom's?

Back 42

IgM

Front 43

What are the histological differences between multiple myeloma and Waldenstrom's?

Back 43

Waldenstroms: plasmacytoid lymphs in marrow
Multiple myeloma: plasma cells in marrow

Front 44

Lab findings of Waldenstroms

Back 44

- pancytopenia
- hyperurecemia 2ndary to
- inc. ESR
- rouleaux
- presence of cold agglutinin

Front 45

Heavy chain disease with excess __ chains is most common

Back 45

alpha chains

Front 46

A prominent M-spike is commonly seen in heavy chain disease (T/F)

Back 46

False, there will be a small, broad spike or no spike at all

Front 47

IFE of heavy chain disease will show...

Back 47

Absence of increase in kappa or lambda chains, with an increase in either alpha, gamma or mu chains

Front 48

IFE of polyclonal gammopathies will show...

Back 48

Increase in both kappa and lambda bands

Front 49

Alpha heavy chain disease is also known as ____

Back 49

Franklin's Disease

Front 50

Clinical symptoms of Franklin's disease

Back 50

- severe malabsorption and steatorrhea
- enlarged lymph nodes
- weight loss

Front 51

Complex organic molecules tend to stimulate a ____-cell response and simple or inorganic chemicals tend to stimulate a ___-cell response

Back 51

Complex: B-cells
Simple: T-cell

Front 52

The IgE Fc attaches to ____

Back 52

mast cell membrane

Front 53

Degranulation of mast cells leads to an increase in _____

Back 53

histamines, leukotrienes

chemotactic factors, platelet activating factors and proteinases

Front 54

Histamine

Back 54

causes increased vascular permeability, vasodilation, smooth muscle contraction and increased mucous secretions

Front 55

Atopic disease

Back 55

inherited tendency to respond to inhaled/ingested allergens

Front 56

Lab values common in allergic rhinitis

Back 56

increased serum IgE and blood/tissue eosinophilia (but not always)

Front 57

Causes of allergic rhinitis

Back 57

abnormal regulation by T-cells of B-cell differentiation, or ineffective mucosal barriers

Front 58

Cause of death from IgE/mast cell mediated allergic response

Back 58

hyperinflation of lungs and hypertrophy of bronchial smooth muscle -> asphyxiation

(eosinophils almost always v. elevated)

Front 59

Anaphylaxis

Back 59

Hypotension, abn. heart rate, organ failure, asphyxiation, death - due to immunogenic response

Front 60

Urticaria is usually caused by _____ allergens and is a _____ type allergic reaction

Back 60

food or drug; IgE/mast cell

Front 61

Immune complex/complement/neutrophil hypersensitivity is associated with

Back 61

RBC incompatibility
autoimmune response

Front 62

Immune complex/complement/neutrophil pathway is mediated by _____

Back 62

IgG or IgM
complement activation also occurs

Front 63

Immune complex/complement/neutrophil pathway activation causes these clinical symptoms

Back 63

jaundice
kidney damage
shock due to anaphylotoxins

Front 64

Immune complex disease

Back 64

Ig-Ab complexes deposit in tissues, causing inflammation, arthritis, etc.

Front 65

The T-cells involved in delayed cell-mediated hypersensitivity

Back 65

Th1 cells

Front 66

Delayed cell-mediated hypersensitivity leads to:

Back 66

accumulation of mononuclear infiltrate over several days

Front 67

Allergic contact dermatitis is caused by which kinds of antigens (examples)

Back 67

nickel, clothing dyes, poison ivy, oak

Front 68

Photoallergic contact dermatitis

Back 68

allergen requires activation by UV light before it triggers an immune response

Front 69

A ______ is essential for rapid identification of an allergen

Back 69

detailed medical history, esp. time/place when reaction first occured

Front 70

Early thymocyte antigens

Back 70

CD44 and CD25

Front 71

_____ is critical for the differentiation of early thymocytes

Back 71

stromal cells + IL-7

Front 72

When double negative thymocytes express gamma and delta chains, they become ______

Back 72

NK cells
these cells remain negative for both CD4 and CD8

Front 73

When double negative thymocytes express alpha and beta chains, they become ______

Back 73

CD4+/CD8+ T-cells after beta chain rearrangement

Front 74

double positive cells that over-recognize self antigens are _____

Back 74

induced to self-destroy
[otherwise would lead to autoimmunity]

Front 75

double positive cells that do not recognize MHC molecules are ______

Back 75

induced to self-destroy [otherwise would lead to ineffective cells]

Front 76

After selection for MHC recognition, T-cells _____

Back 76

become either CD4+ or CD8+

Front 77

CD4+ cells interact with
a. MHC-I
b. MHC-II

Back 77

MHC-II
[MHC complexed to antigens of extracellular origin]

Front 78

_____ cells protect against intracellular pathogens

_____ cells help B-cells produce Ab against extracellular pathogens

Back 78

Th1 = intracellular Ag
Th2 = extracellular Ag

Front 79

CD8+ cells intract with:
a. MHC-I
b. MHC-II

Back 79

MHC-I
[MHC complexed to a virally produced antigen]

Front 80

____ cells produce IL-10

Back 80

T regulatory cells

Front 81

function of IL-2

Back 81

T-cell lymphocyte proliferation

Front 82

When cells lack ____, the NK cell will cause cytotoxic damage to that cell

Back 82

MHC-I

Front 83

Demographic for Hashimoto's thyroiditis

Back 83

middle aged female

Front 84

Intense infiltration of the thyroid by lymphocytes, macrophages and plasma cells

Back 84

Hashimoto's thyroiditis

Front 85

Hashimoto's thyroiditis involves antibodies to ____

Back 85

thyroglobulin and thyroid peroxidase

Front 86

The primary symptom of hashimoto's thyroiditis

Back 86

goiter caused by hypothyroidism

Front 87

Pernicious anemia involves autoantibodies to _____, which is necessary for _____

Back 87

intrinsic factor - necessary for intestinal absorption of B12

Front 88

Goodpasture's syndrome involves autoantibodies specific for _____

Back 88

basement membrane antigens - esp. affecting glomeruli and lungs

Front 89

Auto-Ab binds basement membrane of glomeruli and lungs, causing inflammation, kidney damage and pulmonary hemorrhage

Back 89

Goodpasture's syndrome

Front 90

insulin-dependent DM is a disease of antibody production to ____

Back 90

beta cells of the islets of langerhans

Front 91

insulitis

Back 91

T-cell infiltration of islets of langerhans causes inflamation, cytotoxic death and recruitment of macrophages

Front 92

Graves disease involves production of _____

Back 92

an auto-Ab that resembles TSH and can bind its receptor

Front 93

Myasthenia Gravis is a disease that produces ______

Back 93

Autoantibodies to ACH receptors that prevents ACH binding; this inhibits muscle activation

Front 94

Multiple sclerosis

Back 94

inflammation of the myelin sheath of neurons

Front 95

oligoclonal gammopathy is definitive of ___

Back 95

MS

Front 96

common demographic of SLE

Back 96

female, 20-40 years old

Front 97

SLE results from autoantibodies to _____

Back 97

nuclear or histone antigens

Front 98

SLE is a _____ hypersensitivity reaction
a. Type I
b. Type II
c. Type III
d. Type IV

Back 98

Type III; there is an overwhelming antigen excess which does not allow macrophages to properly clear circulating immune complexes

Front 99

Rheumatoid factors are ___ class auto-Ab against _____

Back 99

RF is IgM directed against mainly the Fc of IgG, but sometimes is against IgM

Front 100

Rheumatoid arthritis is a type __ hypersensitivity

Back 100

type III (immune complex disease)

Front 101

Increased susceptibility to fungal, viral, acid fast or low-grade pathogen infections are usually indicative of

Back 101

T-cell deficiency

Front 102

Thymic shadow will be absent in _____

Back 102

T-cell deficiencies

Front 103

recurrence of otitis media, pneumonia or bacterial meningitis is usually indicative of

Back 103

B-cell deficiencies

Front 104

- dec. level of circulating Ig
- dec. Ab's to common Ag's (ie. ABO)
- dec. response to immunization
- dec. circulating lymphs with CD19/CD20

Back 104

B-cell deficiency

Front 105

Decreased presence of peyer's patches in the gut is indicative of _____

Back 105

B-cell deficiency

Front 106

A decreased level of antibody production in the first 2-3 years of life

Back 106

Transient Hypogammaglobulinemia of Infancy

Front 107

failure of pre-B-cells to mature caused by an inherited deficiency of cytoplasmic tyrosine kinase

Back 107

X-linked hypogammaglobulinemia (Bruton's)

Front 108

Increased susceptibility to fungal, viral, acid fast or low-grade pathogen infections are usually indicative of

Back 108

T-cell deficiency

Front 109

X-linked hypogammaglobulinemia is an inability to produce ____(enzyme)

Back 109

cytoplasmic tyrosine kinase

Front 110

Thymic shadow will be absent in _____

Back 110

T-cell deficiencies

Front 111

nephelometry of an X-linked hypogammaglobulinemia patient will show

Back 111

pan-hypogammaglobulinemia
<200 IgG
no IgM, A, D or E

Front 112

recurrence of otitis media, pneumonia or bacterial meningitis is usually indicative of

Back 112

B-cell deficiencies

Front 113

- dec. level of circulating Ig
- dec. Ab's to common Ag's (ie. ABO)
- dec. response to immunization
- dec. circulating lymphs with CD19/CD20

Back 113

B-cell deficiency

Front 114

Autoimmunity is a common result of this type of immune deficiency

Back 114

Common variable, unclassifiable immunodeficiency (also selective IgA immunodeficiency)

Front 115

Decreased presence of peyer's patches in the gut is indicative of _____

Back 115

B-cell deficiency

Front 116

A decreased level of antibody production in the first 2-3 years of life

Back 116

Transient Hypogammaglobulinemia of Infancy

Front 117

failure of pre-B-cells to mature caused by an inherited deficiency of cytoplasmic tyrosine kinase

Back 117

X-linked hypogammaglobulinemia (Bruton's)

Front 118

X-linked hypogammaglobulinemia is an inability to produce ____(enzyme)

Back 118

cytoplasmic tyrosine kinase

Front 119

nephelometry of an X-linked hypogammaglobulinemia patient will show

Back 119

pan-hypogammaglobulinemia
<200 IgG
no IgM, A, D or E

Front 120

Autoimmunity is a common result of this type of immune deficiency

Back 120

Common variable, unclassifiable immunodeficiency

Front 121

This immunodeficiency results in the production of an anti-IgA

Back 121

selective IgA deficiency