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152 Cards in this Set
- Front
- Back
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what part of the lymph node is the site of B cell proliferation |
follicle
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what part of the lymph node contains T cells and HEVs
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paracortex
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what cells make up the PALS
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T cells
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splenic dysfunction greatly increases risk of infection via what 4 organisms
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Salmonella, S. pneumoniae, H. influenzae, and N. meningitidis
("SHiNS") |
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organ containing Hassall's corpuscles
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thymus
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type of immunity consisting of neutrophils, macrophages, dendritic cells, NK cells, and complement
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innate
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type of immunity consisting of T cells, B cells, and antibodies
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adaptive
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what gene encodes MHC I and II
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HLA (human leukocyte antigen)
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which interleukins induce the transformation of a helper T cell into TH1 and TH2 cells
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IL-12 induces Th1 cell formation
IL-4 induces Th2 cell formation |
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what are the antigen presenting cells
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macrophages, dendritic cells, and B cells
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what are the costimulatory signals required for CD4 cell activation
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B7 and CD28
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what cytokines do Th1 cells secrete
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IL-2 and IFN-y
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structural portion of the antibody that binds antigens and determines the idiotype
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Fab
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MOST abdundant immunoglobulin
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IgG
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immunoglobulin responsible for opsonization
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IgG
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major immunoglobulin in secodary (delayed) responses to antigens
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IgG
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immunoglobulin found in tears, saliva, mucus, and breast milk
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IgA
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major immunoglobulin in primary (immediate) responses to antigens
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IgM
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mature B lymphocytes always express what 2 immunoglobulins
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IgM and IgD
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immunoglobulin responsible for type 1 hypersensitivity and binds to mast cells and basophils
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IgE
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what component is responsible for opsonization
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C3b
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what component is responsible for anaphylaxis
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C3a and C5a
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defective complement enzyme that causes hereditary angioedema
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C1 esterase inhibitor
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deficiency of which complement leads to severe, recurrent pyogenic infection
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C3
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deficiency of C5-C8 increases risk for what
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bacteremia secondary to Neisseria infection
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cytokine that mediates septic shock
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TNF-a
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interleukin that causes fever
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IL-1
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interleukin that stimulates T cells
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IL-2
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interleukin that stimulates bone marrow
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IL-3
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interleukin that stimulates IgE production
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IL-4
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interleukin that stimulates IgA production
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IL-5
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interleukin that recruits neutrophils
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IL-8
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interleukin that activates NK cells
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IL-12
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cytokine that activates macrophages
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IFN-y
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interleukin that stimulates eosinophils
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IL-5
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interleukin secreted by regulatory T cells that mediates the inflammatory response
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IL-10
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CD receptor for EBV
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CD-21
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process in which self-reactive T cells become nonreactive without a costimulatory molecule
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anergy
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What is the FIRST immunoglobulin produced in ALL types of hypersensitivity reaction-- no exceptions
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IgM
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Primary site of drainage for the upper limb and lateral breast
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axillary nodes
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Primary site of drainage for the stomach
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celiac nodes
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Primary site of drainage for the rectum above the pectinate line
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internal iliac nodes
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Primary site of drainage for the anal canal below the pectinate line
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superficial inguinal nodes
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Primary site of drainage for the testes
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para-aortic nodes (aka lumbar nodes from the superficial and deep plexuses)
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which disease(s) are associated with the HLA subtype A3
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hemochromatosis
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which disease(s) are associated with the HLA subtype B27
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Psoriasis, Ankylosing spondylitis, IBS, and Reiter's syndrome
("PAIR") |
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which disease(s) are associated with the HLA subtype B8
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Graves disease
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which disease(s) are associated with the HLA subtype DR2
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MS, hay fever, SLE, Goodpasture's
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which disease(s) are associated with the HLA subtype DR3
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type 1 diabetes
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which disease(s) are associated with the HLA subtype DR4
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Rheumatoid arthritis and type 1 diabetes
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which disease(s) are associated with the HLA subtype DR5
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Pernicious anemia and Hashimoto's thyroiditis
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which disease(s) are associated with the HLA subtype DR7
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nephrotic syndrome (responsive to seroids)
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Th1 cells are inhibited by what interleukin
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IL-10
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Th2 cells are inhibited by what cytokine
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IFN-y
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which T helper cells regulate cell-mediated immunity
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Th1 cells
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which T helper cells regulate humoral immunity
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Th2 cells
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which immunoglobulin is shaped as a pentamer
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IgM
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complement protein responsible for neutrophil chemotaxis
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C5a
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pathogenesis of type I hypersensitivity
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foreign antigen binds to IgE and present to a mast cell or basophil- this triggers the release of histamine causing a rapid allergic reaction
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which conditions have type I hypersensitivity
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anaphylaxis (eg. bee sting or food allergy)
atopic disorders (i.e. rhinitis, hay fever, eczema, hives, asthma) |
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pathogenesis of type II hypersensitivity
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antibody mediated: IgM and IgD bind to the foreign antigen and induce lysis or phagocytosis (via macrophages and neutrophils)
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which type of hypersensitivity is elicited by a radioimmunosorbent assay
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type 1 hypersensitivity
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which type of hypersensitivity is elicited by a Coombs test
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type II hypersensitivity
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which conditions have type II hypersensitivity
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hemolytic anemia
pernicious anemia ITP erythroblastosis fetalis acute hemolytic transfusion rxn rheumatic fever goodpastures bullous pemphigoid pemphigus vulgaris graves disease myasthenia gravis |
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pathogenesis of type III hypersensitivity
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antigen-antibody immune complexes (usually IgG) are formed when presented with a foreign antigen- this activates complement proteins
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immunofluorescent staining can test for which type of hypersensitivity
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type III hypersensitivity
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which conditions have type III hypersensitivity
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SLE
rheumatoid arthritis polyarteritis nodosum poststreptococcal glomerulonephritis serum sickness arthus reaction hypersensitivity pneumonitis (aka farmer's lung) |
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what is serum sickness
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a condition normally caused by drugs (not serum) in which antibodies to a foreign protein are produced and leads to immune complex deposits in the membranes causing tissue damage
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time frame for serum sickness to develop
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5 days after exposure to foreign drug
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what is the arthus reaction
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intradermal injection of an antigen induces antibodies which forms immune complexes in the skin
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time frame for an arthus reaction to develop
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24 hours after injection
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pathogenesis of type IV hypersensitivity
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a delayed T-cell mediated response to foreign antigens- causes the release of lymphokines which activates macrophages (No antibodies or immune complexes are involved!)
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patch test (eg. PPDs) test for which type of hypersensitivity
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type IV hypersensitivity
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which conditions exhibit type IV hypersensitivity
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type 1 diabetes mellitus
MS Guillain-Barre Hashimoto's thyroiditis graft versus host disease PPD (TB) contact dermatitis (i.e. poison ivy or nickel allergy) |
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antinuclear autoantibodies (ANA) suggest what disease
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nonspecific for SLE
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anti-dsDNA and anti-Sm antibodies suggest what disease
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specific for SLE
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anti-histone antibodies suggest what disease
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drug-induced SLE
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Anti-IgG (Fc portion) antibodies suggest what disease
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rheumatoid arthritis
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Anti-centromere antibodies suggest what disease
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scleroderma (CREST)
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anti-Scl70 antibodies suggest what disease
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scleroderma (diffuse)
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antimitochondrial antibodies suggest what disease
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primary biliary cirrhosis
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antigliadin and antiendomysial antibodies suggest what disease
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celiac disease
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anti-basement membrane (type IV collagen) antibodies suggest what disease
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Goodpasture's syndrome
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anti-desmoglein antibodies suggest what disease
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pemphigus vulgaris
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antimicrosomal and antithyroglobulin antibodies suggest what disease
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Hashimoto's thyroiditis
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anti-Jo-1 antibodies suggest what disease
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polymyositis or dermatomyositis
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anti-SSA and anti-SSB antibodies suggest what disease
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Sjogrens
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anti-U1 RNP antibodies suggest what disease
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mixed connective tissue disease
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anti-smooth muscle antibodies suggest what disease
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autoimmune hepatitis
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anti-glutamate decarboxylase antibodies suggest what disease
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type I diabetes
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c-ANCA antibodies suggest what disease
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Wegener's granulomatosis
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p-ANCA antibodies suggest what disease
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polyangiitis
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anti-phospholipid antibodies suggest what condition
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DVT
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anti-GpIIb/IIIa antibodies suggest what disease
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ITP
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disease caused by a defect in BTK (tyrosine kinase gene) leading to a block in B-cell differentiation
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Bruton's agammaglobulinemia
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genetic mode of inheritance of Bruton's
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X-linked recessive
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Is Bruton's more common in boys or girls
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boys (because it's X-linked recessive)
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1 year old boy presents with recurrent bacterial infections; labs reveal decreased levels of all immunoglobulins and decreased number of B cells
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Bruton's agammaglobulinemia
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disease caused by a defective CD40L on the helper T cells leading to the inability of class switching
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Hyper-IgM syndrome
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8 month old presents with recurrent severe pyogenic infections; labs reveal very low levels of all immunoglobulins except IgM (which are increased)
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hyper-IgM syndrome |
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disease characterized by defect in isotype switching
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Selective Ig deficiency
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MOST common selective Ig deficiency
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IgA deficiency
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8 month old infant presents with recurrent sinus and lung infections, milk allergies, and diarrhea; he also has anaphylactic reactions on exposure to blood products containing a certain immunoglobulin
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selective IgA deficiency
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disease caused by a defect in B-cell maturation
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common variable immunodeficiency (CVID)
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30 y/o patient presents with malaise, lymphadenopathy, and an unintentional 15lb weight loss over the last 6 months; PMH is positive for recurrent sinus and pulmonary infections as well as SLE; lab values reveal decreased plasma cells and immunoglobulins; a preliminary diagnosis of lymphoma is made; what is the underlying condition that can explain not only the current presentation but also the PMH?
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common variable immunodeficiency (CVID) |
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disease characterized by a gene deletion leading to a failure of the development of the 3rd and 4th pharyngeal pouches
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DiGeorge syndrome (thymic aplasia)
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gene deletion in DiGeorge syndrome
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22q11 deletion
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young child presents with tetany; cultures for C. tetani are negative; PMH is positive for recurrent viral and fungal infection as well as a congenital heart defect; lab values show decreased levels of PTH; xray has an absent thymic shadow
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DiGeorge syndrome
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2 organs MOST affected directly by DiGeorge syndrome
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parathyroids and thymus both fail to develop (leading to tetany and T-cell deficiency)
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2 congenital heart defects associated with DiGeorge syndrome
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truncus arteriosus and tetralogy of fallot
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disease caused by a failure to produce IFN-y causing an inability of neutrophils to respond to chemotaxis
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Hyper-IgE syndrome (aka Job's syndrome)
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teenager presents with very coarse facial features and eczema; PMH is positive for recurrent staphylococcal abscesses and the patient still has most of their baby teeth; lab values reveal increased levels of a certain immunoglobulin
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Hyper-IgE syndrome (Job's syndrome)
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this disease can be caused by 1 of 3 things: either a defect in the IL-2 receptors, an adenosine deaminase deficiency, or a failure to synthesize MHCII antigens
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Severe Combined immunodeficiency (SCID)
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MOST common cause of SCID and why
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defect in IL-2 receptor because it's an X-linked condition
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treatment of SCID
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bone marrow transplant
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disease caused by a defect in DNA repair enzymes causing an inactivation of tumor suppressor genes
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ataxia-telangiectasia
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patient presents with ataxia, spider angiomas on the face, recurrent sinus/lung infections, and milk allergies; labs reveal decreased levels of IgA
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ataxia-telangiectasia
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patient presents with purpura on the skin and eczema; PMH is positive for recurrent infections; labs reveals increased IgE and IgA but decreased IgM
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Wiskott-Aldrich syndrome
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disease caused by a defect in the LFA-1 integrin protein (CD18) on phagocytes
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type 1 leukocyte adhesion deficiency
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patient presents with recurrent non-purulent bacterial infections and a delayed separation of the umbilicus; labs show neutrophilia
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type 1 leukocyte adhesion deficiency
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disease caused by a defect in microtubular function causing decreased phagocytosis
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Chediak-Higashi syndrome |
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patient presents complaining of numbness and tingling sensation in his extremities; PMH is positive for recurrent staph and strep infection; during the PE, it's noted that the patient has partial areas of albinism
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Chediak-Higashi syndrome
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disease caused by a lack of NADPH oxidase
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chronic granulomatous disease
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a negative nitroblue tetrazolium dye reduction test suggests what disease
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chronic granulomatous disease
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which organisms in particular are people with chronic granulomatous disease susceptible to
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catalase positive organisms (i.e. S. aureus, E. coli, and Aspergillus)
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pathogensis of hyperacute graft rejection
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antibody mediated (type II hypersensitivity) against donor tissue
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time frame for hyperacute graft rejection
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occurs within minutes
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pathogenesis of acute graft rejection
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cell-mediated due to cytotoxic T cells reacting against foreign MHC
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time frame for acute rejection
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occurs within weeks
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DOC to help reverse acute graft rejection
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cyclosporine
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pathogenesis of chronic graft rejection
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T-cell and antibody-mediated vascular damage of donor tissue leading to fibrosis (irreversible)
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time frame for chronic graft rejection
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months to years
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condition characterized by grafted immunocompetent T cells proliferating in response to foreign tissue and thus rejecting it; observable signs will include a maculopapular rash, jaundice, hepatosplenomegaly, and diarrhea
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graft-versus-host disease
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this drug acts by inhibiting calcineurin and thus preventing the production of IL-2
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cyclosporine
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the nephrotoxicity of cyclosporine can be prevented by administering what drug
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mannitol
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this drug is usually combined with cyclosporine to help treat the immunosuppression after a kidney transplant
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sirolimus (aka rapamycin)
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SE of sirolimus
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hyperlipidemia, thombocytopenia, leukopenia
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monoclonal antibody with high affinity for IL-2 receptor
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daclizumab
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MOA of azothioprine
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precursor of 6-mercaptopurine that blocks the metabolism of purines
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major SE of azothioprine
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bone marrow suppression
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drug that is contraindicated in people taking azothioprine post-kidney transplant
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allopurinol because mercaptopurine is metabolized by xanthine oxidase which is inhibited by allopurinol
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monoclonal antibody with high affinity for CD3
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muromonab (OKT3)
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Filgrastim and Sargramostin are used for what
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to help replenish bone marrow
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treatment of chronic granulomatous disease
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IFN-y
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IFN-B can be used to help treat what disease
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multiple sclerosis
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hypothesized MOA of IFN-B
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inhibition of T cell activation/proliferation and inhibition of leukocyte migration across the BBB
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infliximab and adalimumab have high affinity for what
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TNF-alpha
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abciximab has a high affinity for what
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GpIIb/IIIa
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trastuzumab has a high affinity for what
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erb-B2
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trastuzumab can be used to help treat what
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breast cancer that over-expresses HER-2
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infliximab and adalimumab can be used to treat what
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Crohn's disease, rheumatoid arthritis, and psoriasis
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which hypersensivity activates complement
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type III
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