Therapeutics Iii Exam 3 - Immune System Questions

Front 1

What are the functions of the immune system?

Back 1

1. Primary function is to recognize and eliminate invading pathogens (must distinguish between self and non-self)
2. Mechanisms of an immune response include recognition, activation, deployment, discrimination, and regulation

Front 2

What are the two arms of the immune system?

Back 2

1. Innate immunity (non-specific)
2. Adaptive immune system (specific)

Front 3

Innate immunity is comprised of what exterior defenses?

Back 3

skin, mucus, cilia, normal flora, saliva, low pH of the stomach, skin, genitourinary tract

Front 4

Adaptive immunity is compromised of what exterior defenses?

Back 4

none

Front 5

What is the specificity of innate immunity?

Back 5

it is limited and fixed

Front 6

What is the specificity of adaptive immunity?

Back 6

it is extensive

Front 7

What memory does the innate immune system have?

Back 7

none

Front 8

What memory does the adaptive immune system have?

Back 8

extensive memory

Front 9

How long does it take for the innate immune system to respond?

Back 9

hours

Front 10

How long does it take for the adaptive immune system to respond?

Back 10

days

Front 11

What soluble factors make up the innate immune system?

Back 11

lysozymes
complement
C-reactive protein
interferons
mannose-binding lectin
antimicrobial peptides

Front 12

What soluble factors make up the adaptive immune system?

Back 12

antibodies
cytokines

Front 13

What cells make up the innate immune system?

Back 13

neutrophils
monocytes
macrophages
natural killer cells
eosinophils

Front 14

What cells make up the adaptive immune system?

Back 14

B lymphocytes
T lymphocytes

Front 15

What is self-tolerance?

Back 15

Self-tolerance is the ability to distinguish between self and nonself. Failure of self-tolerance may lead to the development of autoimmune diseases.

Front 16

What are the primary organs of the immune system?

Back 16

1. Bone marrow - primary effector cells of the immune system are derived from the pluripotent hematopoietic stem cells
2. Thymus - primary site of T cell maturation and differentiation

Front 17

What are the secondary organs of the immune system?

Back 17

1. Spleen - red pulp is the site of removal of old or damaged red cells; white pulp contains mostly B and T lymphocytes and macrophages
2. Lymph nodes - filter antigens from the lymphatics

Front 18

What makes up the physical defenses of the innate immune system?

Back 18

1. Skin
2. GI tract (stomach acid)
3. Respiratory tract (cilia, mucous)
4. Mechanical defenses (normal urine flow, tears, saliva)

Front 19

What are the 2 mechanisms by which phagocytosis occurs?

Back 19

1. Opsonin-dependent - coating of the infectious pathogen by antibody, complement or lectin must occur to phagocytosis to be initiated
2. Opsonin-independent phagocytosis - innate leukocytes use pattern recognition receptors like lipoproteins or terminal mannoses that are expressed by a large number of microorganisms; leads to immediate phagocytosis of the pathogen

Front 20

What are the first cells to respond to an area of damage or inflammation?

Back 20

neutrophils

Front 21

Maturity of neutrophils

Back 21

1. Segmented (Segs) are the most mature neutrophils and usually make up the majority of circulating neutrophils
2. Banded (Bands) are less mature and adhere to vessels of peripheral blood, lungs, spleen, and liver

Front 22

What is "left shift"?

Back 22

Left shift is a shift from more segs to more bands in circulating blood. This is a sign of infection, usually bacterial.

Front 23

What is the primary defense against non-phagocytable multicellular pathogens (like parasites)?

Back 23

eosinophils

Front 24

Where are eosinophils usually found in high numbers?

Back 24

1. Around antibody-antigen complexes
2. In tissues infected with parasites
3. Sites of allergic reactions

Front 25

What activates eosinophils?

Back 25

IgE

Front 26

What is primary role of macrophages and monocytes?

Back 26

They are phagocytes. Macrophages exist in tissue and monocytes in the blood stream. Macrophages are more active and have more Fc and complement receptors.

Front 27

What is the role of mast cells?

Back 27

They release inflammatory mediators (histamine, heparin, serotonin) and areassociated with IgE-mediated inflammation. They can phagocytize, destroy, or present bacterial antigens to T lymphocytes.

Front 28

What is the role of basophils?

Back 28

They release inflammatory mediators (histamine). They are bloodstream cells associated with IgE mediated inflammation.

Front 29

What are granulocytes?

Back 29

Cells that contain cytoplasmic granules filled with inflammatory mediators or digestive enzymes which can be released from the cell.
1. Neutrophils
2. Eosinophils
3. Basophils

Front 30

What are the major functions of the complement system?

Back 30

1. To lyse certain microorganisms and cells
2. To stimulate the chemotaxis of phagocytic cells
3. To coat (opsonize) foreign pathogens
4. Clear immune complexes

Front 31

What is the classic pathway to stimulate the complement cascade?

Back 31

Antibody binds to its target antigen and activates the frist component of complement (C1), which initiates the complement cascade. Both IgG and IgM are capable of activating complement.

Front 32

What is alternative pathway to stimulate the complement cascade?

Back 32

Relies on the inability of some bacteria to clear spontaneously produces C3b from their cell surface. Excessive buildup of this complement protein can activate the cascade.

Front 33

How does complement produce cell lysis?

Back 33

Through the formation of the cylinder shaped protein structure, the Membrane Attack Complex (MAC)

Front 34

What things differentiate the adaptive immune system from the innate immune system?

Back 34

-specificity
-memory
-ability to amplify the immune response via cytokines
-evolves with each subsequent infection

Front 35

What are the 2 different forms of T-cell receptor?

Back 35

1. Receptor found on T helper cell in association with CD4+
2. Receptor on T cytotoxic cells in association with CD8+

Front 36

What are the 4 major subgroups of T cells?

Back 36

1. T helper cells - recruit B lymphocytes to produce antibodies
2. T cytotoxic cells - kill target cells
3. T suppressor cells - inhibit certain immune responses
4. T delatyed-type hypersensitivity cells (memory cells ) - induce inflammation

Front 37

What are CD4+ cells?

Back 37

They are primarily T helper cells

Front 38

What are CD8+ cells?

Back 38

They are primarily T suppressor and T Cytotoxic cells (killers)

Front 39

What are the 2 types of CD4+ cells and what do they do?

Back 39

1. T helper type I which contribute to cellular immunity by interacting with CD8+ cells
2. T helper type II which contribute to humoral immunity by recruiting B cells

Front 40

What do T suppressor cells (CD8+) do?

Back 40

They inhibit proliferation of T and B cells. Increase production of IgA.

Front 41

What do cytotoxic T cells (CD8+) cells do?

Back 41

Attach to target cells and release cytotoxic substances (perforins), which produce cell lysis.

Front 42

What is the primary function of B lymphocytes?

Back 42

The primary function of B cells is antigen recognition and production of antibodies (humoral immunity). They can differentiate into plasma cells and memory B cells.

Front 43

General Info on Major Histocompatibility Complex.

Back 43

Made up of Human Leukocyte Antigens (HLA). There are 2 classes of HLA (Class I and II). Class I genes (HLA-A, B, and C) can be found on all nucleated cells. Class II genes (HLA-DP, DQ, and DR) are found primarily on immune cells and vascular endothelium.

Front 44

What are the antigen presenting cells?

Back 44

1. Macrophages
2. Dendritic cells
3. B cells

Front 45

What is required for T lymphocyte activation?

Back 45

1. Presentation of processed antigen with MHC
2. Co-stimulation on the antigen presenting cell (APC)

Front 46

What important roles do CD8+ T lymphocytes play?

Back 46

1. clear the body of virus infected cells
2. eradication of tumor cells
3. rejection of transplanted organs

Front 47

What are the 2 mechanisms by which cytotoxic (CD8+) T cells destroy target cells?

Back 47

1. Perforin system in which they insert a pore into the target cell leading to apoptosis
2. Fas ligand pathway in which ligand binds to the Fas receptor on the target cell and the CD8+ cell destroys the target cell

Front 48

How do B lymphocytes recognize antigens?

Back 48

1. Via its antibody
2. Via immunoglobulin located on its cell surface.

Front 49

Once activated, what happens to B lymphocytes?

Back 49

1. They become plasma cells that produce antibody
2. They become memory B cells

Front 50

General characteristics of Antibody

Back 50

It is a glycoprotein composed of heavy and light chains. The stem or heavy chain contains the Fc portion. The Fc portion activates complement and is recognized by Fc receptors on phagocytes.

Front 51

General facts about IgG

Back 51

It is the most prevalent antibody (80% of serum antibodies). It exists as a monomer. It is the only antibody that can cross the placenta.

Front 52

What is the only antibody that can cross the placenta?

Back 52

IgG

Front 53

What is the most prevalent antibody?

Back 53

IgG

Front 54

General facts about IgM

Back 54

IgM is found on the surface of B lymphocytes. It exists as a pentamer, which means it can bind 5 antigens. It lacks the Fc portion, but can still fix complement.

Front 55

Which antibody exists as a pentamer?

Back 55

IgM

Front 56

General facts about IgA

Back 56

It is found in fluid secretions (tears, saliva, nasal fluids) and in the GI tract, GU tract, and respiratory tract. It prevents pathogen colonization. It is the primary antibody secreted in nursing mothers' breast milk. It exists as a dimer.

Front 57

General facts about IgE

Back 57

IgE is the least common antibody. It is bound to Fc receptors on mast cells. It causes release of inflammatory mediators (histamine).

Front 58

General characteristics of Cytokines

Back 58

Cytokines provide communication between the divisions of the immune system. They are produced by APCs mostly promote chemotaxis for other cells and induce a state of inflammation. They are classified as regulatory or hematopoietic growth factors.

Front 59

What are the different types of cytokines?

Back 59

1. interferon
2. tumor necrosis factor
3. interleukin

Front 60

What are the 3 types of interferon and where are they produced?

Back 60

1. Alpha interferon is produced by leukocytes
2. Beta interferon is produced by fibroblasts
3. Gamma interferon is produced by T cells

Front 61

What are the functions of interferon?

Back 61

Cells that are infected by viruses produce interferon, thus preventing the viruses from infecting other cells. Interferon prevents the uptake and replication of several types of viruses. It also increases the expression of MHC molecules. It also increases the activity of NK cells.

Front 62

What is the MOA of interferon?

Back 62

As an antiviral, it interferes with viral protein production and budding.

Front 63

Interferon has antitumor effects. What tumor types is it used to treat?

Back 63

1. Hairy cell leukemia
2. Chronic myelogenous leukemia
3. Kaposi's sarcoma
4. Renal cell carcinoma
5. Multiple myeloma

Front 64

What are the major toxicities associated with interferon?

Back 64

1. Flu-like syndrome (may develop tolerance)
2. Fatigue (will not develop tolerance)
3. Cardiovascular - tachycardia and hypotension
4. Anorexia and weight loss with long term use
5. CNS toxicity with high doses
6. Myelosuppression with long term use

Front 65

What is the advantage of pegylated-IFN-alpha over plain interferon?

Back 65

It has a longer half-like and once weekly dosing.

Front 66

Where is TNF-alpha produced?

Back 66

TNF-alpha is primarily produced by monocytes.

Front 67

Where is lymphotoxin (TNF-beta) produced?

Back 67

Lymphotoxin is primarily produced by T cells.

Front 68

What are the functions of TNF

Back 68

1. Augment phagocyte activity
2. Enhance neutrophil degranulation
3. Produce fever
4. Increase the expression of adhesion molecules

Front 69

What are the 2 types of interleukins?

Back 69

1. Lymphocyte-activating factor or IL-1
2. T cell growth factor or IL-2

Front 70

What are the functions of the different interleukins?

Back 70

1. IL-1 (lymphocyte-activating factor) promotes T and B cell proliferation
2. IL-2 (T cell growth factor) stimulates T cell proliferation

Front 71

What are the different hematopoietic growth factors?

Back 71

1. Granulocyte-monocyte colony-stimulating factor (GM-CSF)
2. Granulocyte colony-stimulating factor (G-CSF)
3. Macrophage colony-stimulating factor (M-CSF)

Front 72

What is the effect of G-CSF?

Back 72

It has a narrower effect than GM-CSF or IL-3. It effects primarily late development of Neutrophils (segs). It increases migration, phagocytosis, and antibody-dependent cytotoxicity. It is the hematopoietic growth factor that is most commonly used.

Front 73

When is M-CSF used?

Back 73

M-CSF is used to increase candida and Mycobacterium-avium intracellular killing. It is rarely used.

Front 74

What are the clinical uses of hematopoietic growth factors (GM-CSF, G-CSF, M-CSF)?

Back 74

-to reduce duration of neutropenia associated with chemotherapy
-graft failure in bone marrow transplant
-for neutropenia associated with AIDS
-for stem cell harvest in BMT

Front 75

What are the adverse reactions to GM-CSF?

Back 75

1. Low-grade fever, myalgias, pain at injection site
2. Bone pain is almost always present
3. Capillary leak syndrome (pleural and pericardial effusions)

Front 76

What are the adverse reactions to G-CSF?

Back 76

1. bone pain (25% of patients)
2. myalgias
3. skin rash

Front 77

What are the sources and prinicipal effects of IL-2?

Back 77

Sources: CD4+ T lymphocytes
Effects: activation of T lymphocyes, B lymphocytes, NK cells

Front 78

What are the sources and principal effects of IL-6?

Back 78

Sources: CD4+ T lymphocytes, macrophages, mast cells, fibroblasts
Effects: T and B lymphocyte growth factor, hematopoietic growth factor, augments inflammation

Front 79

What are the sources and principal effects of TNF-alpha?

Back 79

Sources: macrophages, NK cells, T and B lymphocytes, mast cells
Effects: activation of neutrophils, endothelial cells, lymphocytes, liver cells to produce acute phase proteins

Front 80

What are the sources and principal effects of INF-alpha?

Back 80

Sources: monocytes, other cells
Effects: antiviral, activation of NK cells and macrophages, upregulation of MHC class I

Front 81

What are the sources and principal effects of INF-gamma?

Back 81

Sources: T lymphocytes NK cells
Effects: activation of macrophages, NK cells, upregulation of MHC class I and II

Front 82

What are the sources and principal effects of IL-3?

Back 82

Sources: T lymphocytes, macrophages
Effects: maturation and differentiation of hematopoietic and mast cells

Front 83

What are the sources and principal effects of G-CSF?

Back 83

Sources: macrophages, endothelial cells, fibroblasts
Effects: maturation and activation of neutrophils

Front 84

What are the sources and principal effects of GM-CSF?

Back 84

Sources: T lymphocytes, macrophages, endothelial cells, fibroblasts
Effects: maturation and activation of granulocytes, monocytes/macrophages, and eosinophils

Front 85

What are the sources and principal effects of erythropoietin?

Back 85

Sources: kidney, liver
Effects: maturation of red blood cells

Front 86

What are some examples of alterations in mechanical immunodefenses?

Back 86

-reduced gastric pH (PPI's)
-break in skin barrier
-burns
-impaired mucociliary function of the lungs (smoking)
-altered urine flow (catheter)

Front 87

What is Cluster of Differentiation (CD)?

Back 87

A test for proper amount of T and B cells.

Front 88

What is the predominant cellular distribution of CD3 antigens?

Back 88

all T lymphocytes

Front 89

What is the predominant cellular distribution of CD4 antigens?

Back 89

helper T lymphocytes, either TH1 or TH2

Front 90

What is the predominant cellular distribution of CD8 antigens?

Back 90

cytotoxic/suppressor T lymphocytes

Front 91

What is the predominant cellular distribution of CD20 antigens?

Back 91

B lymphocytes

Front 92

What is the predominant cellular distribution of CD25 antigens?

Back 92

activated T lymphocytes, B lymphocytes, interleukin-2 receptor alpha-chain (Tac)

Front 93

What is the predominant cellular distribution of CD34 antigens?

Back 93

hematopoietic progenitor cells that include the stem cell

Front 94

Which tests evaluate immune function?

Back 94

1. Delayed hypersensitivity test - tests cell mediated immunity (TB skin test)
2. Tissue biopsy
3. B lymphocyte function assessment - vaccinate then measure response
4. Cylex "ImmuKnow" Assay - determines CD4+ cell suppression

Front 95

What values do you need to know when reading the results of a Cylex "ImmuKnow" Assay?

Back 95

1. ~100 ng/ml means the person is immunocompromised and at risk for infection
2. ~250 ng/ml means the person if properly immunosuppressed in the organ transplant setting
3. >500 ng/ml means the person is immunocompetent or at risk of rejection in the transplant setting (this would not prove rejection, would still need biopsy)

Front 96

What is ATG?

Back 96

ATG is a polyclonal antibody made from rabbit (thymoglobulin-rabbit). It's action tends to be directed toward all lymphocytes. It is called flu in a bottle because it depletes lymphocytes. Premedicate with APAP, antihistamines, and steroids.

Front 97

What is Crotalidae Polyvalent Immune Fab Ovine?

Back 97

It is a polyclonal antibody. It has its own Fab region, which means it doesn't activate complement, so it can do its job with less immune response.

Front 98

What are recommendations for use of VZIg (varicella-zoster immunoglobulin)?

Back 98

-use with persons susceptible to varicella-zoster (never had chicken pox)
-use in persons with significant exposure within 96 hours
-use in persons younger than 15

Front 99

What are some uses of IVIg (IV immunoglobulin)?

Back 99

-primary immun deficiencies (agammaglobulinemia)
-viral infections (CMV treatment, HSV)
-thrombocytopenias - idiopathic thrombocytopenia pupura
-bacterial infections

Front 100

What are some common immunology related MAB drugs?

Back 100

infliximab (Remicade)
omalizumab (Xolair)
daclizumab (Zenapax)
Zevalin
Bexxar
certolizumab (Cimzia)
natalizumab (Tysabri)
benamustine (Treanda)
abatacept (Orencia)

Front 101

What is a type I allergic reaction?

Back 101

Type I reactions are considered anaphylactic. Onset is within 30 minutes and can include shock, pruritis, urticaria, angioedema, respiratory distress, laryngeal edema, and vascular collapse. It often mediated by IgE on mast cells (also histamines, leukotrienes, etc.).

Front 102

What are examples of type I allergic reactions?

Back 102

1. drug reactions
2. hay fever

Front 103

Treatment for type I allergic reactions?

Back 103

1. antihistamines
2. sympathomimetic agents (blood pressure agents)
3. corticosteroids

Front 104

What is a type II allergic reaction?

Back 104

Type II reactions are considered cytotoxic reactions. Onset is 5-12 hours. It is both IgG and IgM mediated.

Front 105

Treatment for type II allergic reactions?

Back 105

1. immunosuppressive agents (reaction is T cell activated, so we must pus back T cells)
2. corticosteroids
3. splenectomy

Front 106

What is a type III allergic reaction?

Back 106

Type III reactions are considered immune complex related reactions. Onset is 3-8 hours. They are usually associated with IgG and IgM circulating immune complexes. It is often termed "innocent bystander reaction". Treatment is anti-inflammatory agents.

Front 107

What is type IV allergic reaction?

Back 107

Type IV reactions are cell mediated, delayed hypersensitivity reactions. The onset is 24-48 hours. T lymphocytes must recognize the antigen. TB skin testing is the classic example. Treated with immunosuppressive drugs.