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125 Cards in this Set
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acute phase reactants (3)
and what cell type releases them 2 ways they are released |
TNF-alpha
IL-1 IL-6 (overall immune stimulators) macrophages activated by: -superantigens (MHC II with TCR and CD4), timulate IFN-gamma release -endotoxins (stimulate CD14 on macrophages directly, causing release) |
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what is bug that is spore former that is not clostridium or bacillus?
which clostridium can i never remember that forms spores? |
coxiella burneti
(causes q fever) clostridium perfringes |
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antibiotic resistance is conferred by
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plasmids (except strep pneumo, H. flu, Neisseria which like to do by transformation)
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what is only gram positive with endotoxin?
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Listeria
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how does C3a cause hypotension and edema in endotoxin?
what is main cause for septic shock? |
C3a causes release of histimine (basophil.mast cell degranulation) which causes hypotension and edema
septic shock immune mediated- NO released |
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staph aureus toxins (lots)
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alpha toxin- hemolysis
beta toxin- sphingomyelinase A,B,C proteins of gamma toxin- hemolysis and leukocidin Hemolysin Leukocidin Enterotoxins A-E TSST-1 Exfoliative toxin |
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3 strep pyo toxins
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Streptolysin O- hemolysis
Streptolysin S- hemolysis Erythrogenic toxin- skin rash and fever in scarlet fever |
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diptheria toxin, if gets to circulation (via scraping pseudomembrane, etc) particularly toxic to what 2 places
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Heart (most mortality from cardiotoxicity)
nerves |
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bordetella pertussis toxin acts how?
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ADP-ribosylating enzyme that causes increased cAMP by inhibiting Gi
inhibits chemokine receptors --> lymphocytosis |
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what G protein do the 4 cAMP inducing bugs activate?
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vibrio cholera and ETEC--> Gs
pertussis--> inhibits Gi bacillus anthracis--> trick question, doesn't because it is an adenylyl cyclase |
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5 enterotoxin bugs (make electrolyte imbalances causing dairrhea)
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e coli
staph aureus vibrio cholera shigella salmonella |
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is legionella intracellular or extracellular?
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either (facultative intracellular)
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Lowenstein-Jensen agar grows
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TB (takes 3-4 weeks)
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sabouraud's agar grows
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fungi
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spore formation occurs in what phase of bacterial growth curve
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stationary phase (at top of curve)
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Bacterial DNA uptake:
Transformation Conjugation Transposition Trasnduction |
Transofrmation- taking up from environment (SHiN likes)
Conjugation- sex pili transfer (F+ or Hfr) Transposition - DNA that can jump from chromosome to plasmid, vice versa, can take extra info Transduction- by phage (generalized-lytic, specialized-lysogenic) |
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gram positive organisms will be what color?
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Purple-Blue!
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endocarditis cause in drug users
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staph epidermidis
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most common cause of:
sinusitis otitis media pneumonia meningitis |
step pneumo
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what is bacteria that can cause endocarditis if prior damage to valves and undergo dental procedure? prophylaxis?
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strep mutans (form of strep. viridens)
prophylax with penicillin |
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beefy red tongue indicates
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scarlet fever
(strawberry tongue) |
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what gram positive can cause biliary tract infections?
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enterococci
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2 drugs for obligate anaerobes
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metronidazole, clindamycin
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tetanus booster every?
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10 years
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lymphadenopathy is expansion of what area?
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paracortex (in infection, location of T cells)
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medullary sinus contains
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macrophages
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medullary chords contains
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plasma cells
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where are T cells in spleen? lymph node?
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spleen- are our "PALS" - periarterial lymphatic sheath
lymph node- paracortex |
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what cells remove encapsulated bacteria in spleen?
what decreases in splenic dysfxn? |
macrophages
dec. IgM, dec. complement activation, dec. C3b opsonization |
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lymph node drainage from breast and upper limb
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axillary
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lymph node drainage from stomach
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celiac nodes
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lymph node drainage from duodenum, jejunum
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superior mesenteric
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lymph node drainage from sigmoid colon
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colic -->inferior mesenteric
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lymph node drainage rectum above pectinate line
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some internal iliac, anal canal
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lymph node drainage below pectinate line
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superficial inguinal
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scrotom lymph node drainage
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superficial inguinal
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lymph node drainage superficial thigh
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superificial inguinal
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lateral side of dorsum of foot
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popliteal
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right lymphatic duct drains
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right half of head, right arm
rest of lymph drains through thoracic duct |
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where does thoracic duct drain
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at jxn of left subclavian vein and internal jugular vein
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thymus:
-positive and negative selection happen where? -where are mature T cells? |
both positive (reactive with MHC) and negative (do not bind too tightly to MHC) occur at CORTICMEDULLARY JXN
Mature in Medulla |
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components of innate immunity (5)
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macrophages
PMNs dendritic cells NK cells complement (all cells with nondiscriminate killing, encoded by germline) |
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what process characterizes components of adaptive immunity
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undergo VDJ recombination
(t cells, b cells, ab) |
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NK cells:
-3 cytokines that activate -2 substances they use for apoptosis -kill when cell doesn't have what? |
-activated by IL-12, INF-beta, INF alpha (anti-viral cytokines)
-granzyme, perforin -MHC class I expression |
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T cells that are CD4+ and CD8+ are found where?
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in thymus cortex
screened for positive MHC recognition at corticomedullary junction, then get either CD4+ or CD8+ and go through negative selection also at corticomedullary junction |
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cytokine that stimulate:
t cells b cells macrophages inhibits t cells and macrophages |
t cell- IL-2
b cells IL 4,5 macrophages INF gamma inhibits t cells and macrophages IL-10 |
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what cytokine stimulates Th1 helper t cells?
it secretes what 2 cytokines? |
IL-12 (also stimulates NK cells)
secretes IL-2 (t cell stimulator), IFN-gamma (macrophage stimulator, also inhibits Th2 cells) |
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Th2 cells secrete what 3 cytokines, stimulate what cell type
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IL-4, IL-5 (stimulate B cells and humoral response)
IL-10 (inhibits Th1 cells--> less macrophages and CD8 cells) |
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B7 and CD 28 involved in what
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T helper cell activation (2nd costimulatory signal in addition to MHC II/TCR&CD4 recognition)
CD 28 receptor on T helper cell |
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how do we identify cell surface proteins on immune cells?
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flow cytometry
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2 Igs on B cells?
MHC class? 1 cell surface receptor that activates, that is activating |
IgM and IgD
MHC class II (has I as well) CD 40 (activates B cell class switching) B7 (costimulatory factor for T cells) |
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EBV receptor
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CD 21
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CD16 function, what cells have (2)
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recognize Fc portion of Ig (opsonization)
NK cells macrophages |
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CD 55, CD 59 fxn
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prevent compliment activation
on RBCs, WBCs, platelets |
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what CD is specific for WBCs
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CD 14
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3 chemoattractants for PMNs
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IL-8, C5a, Leukotriene B4
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IL-2 activates what cell class, 2 drugs that inhibit?
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both helper and cytotoxic t cells
cyclosporine tacrolimus (immunosuppressive drugs) |
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IFN-gamma:
activates what cells (2) increases expression of inhibits what (and how) |
activates macrophages and Th1 cells.
increases expression of MHC I and II puts nearby cells in a anti-viral state by making ribonuclease that degrades viral mRNA (inhibits protein synthesis) |
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drug uses of IFN-alpha (5)
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Hep B
Kaposis's sarcoma Leukemia Lymphoma Melanoma |
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drug use of IFN-beta
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MS
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Drug use of IFN-gamma
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chronic granulomatous disease
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which IL produces IgG? eosinophilia?
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IL-4 - IgE and IgG
IL-5 - IgA and eosinophilia |
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IL-10 secreted by (2)
inhibits what cells (2) |
secreted by regulatory and Th2 cells
inhibits Th1 and macrophages (which decrease inflammatory response) |
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Aldesleukin mech
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IL-2
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Filgrastim
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GCSF (bone marrow recovery)
has gra (granulocyte) and stim (stimulation) |
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Sargramostim
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GMCSF (bone marrow recovery)
has gra (granulocyte) and stim (stimulating) |
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Oprelvekin
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thombocytopenia
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where are disulfide bonds in the antibody structure (3 places)
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connecting heavy chain (CH2) segments
connecting heavy and light chain fab fragment (between CH1 and CL) inside heavy chains and light chains |
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what does constant portion of antibody structure consist of?
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2 linked heavy chains
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what determines ab isotype?
IgA IgE IgM IgD IgG |
types of heavy chain!
epsilon- IgE gamma- IgG alpha- IgA mu- IgM delta- IgD gamma- IgG |
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what is normal ratio of kappa:lambda light chain
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2:1 (twice kappa)
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terminal deoxynucleotidyl transferase function
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adds nucleotides during recombination of VJ (light chain) or VDJ (heavy chain)
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mutation of RAG 1 or RAG 2 genes causes
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(Recombination Activating Gene Complex 1 and 2)
cause arrest of T and B cell development |
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how long does passive immunization last?
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about a month
IgG half life= 21 days |
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2 forms of IgA
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monomer in circulation (but does not fix complement)
dimer (only dimreized Ig) if secreted |
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most abundant Ig?
least abundant? |
IgG
IgE |
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which Ig is mostly confined to the intravascular pool?
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IgM
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Thymus independant antigens- 2 types, why does thymus not respond?
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lipopolysaccharide (gram - outer membrane) and polysaccharide capsule
MHC needs polypeptide to bind and recognize, so can ONLY DEVELOP IgM IMMUNITY (therefore no memory) |
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what is stimulus for:
classic alternative pathway? alternative pathway? |
Classic - starts from antigen-antibody complex (IgM or IgG, starts with C1)
Alternative pathway- starts from C3 interaction on microbial surfaces |
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what is starting point for classical cascade, enzyme involved
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binding of antibody-antigen complex, starts with C1
C1 cleaved by C1 esterase to begin cascade |
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what deficiency causes hereditary angioedema?
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C1 esterase deficiency
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2 complement components that can cause anaphylaxis
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C3a (mast and basophil granule release, histimine)
C5a (PMN chemoattractant) |
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recurrent sinopulmonary tract infections, glomerulonephritis
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C3 deficiency
specifically get repeated strep pneumo and H. flu infections, and increases type III hypersensitivity |
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DAF deficiency causes?
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paroxysmal nocturnal hemoglobinuria (GPI anchored enzyme gone, leads to lysis of rbcs)
C1 esterase inhibitor can also cause hemolysis |
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iron-deficient anemia
hemosiderinuria thrombosis? dx? tx? |
Paroxysmal Nocturnal Hemoglobinuria
(DAF/ CD55 and 59 absence) dx- RBCs lyse at low pH tx- iron, warfarin, blood transfusion |
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active vs passive immunity
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active- after exposure to foreign antigens, IgG response
passive- given preformed antibodies |
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5 passive immunity diseases used
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Ready To Be Healed Rapidly
RSV Tetanus Botulinum HBV Rabies |
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eczema is what type hypersensitivity rxn
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type 1
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both hypersensitivity type 2 and 3 end in what-mediated tissue damage?
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macrophages
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give drug, 5-10 days later get fever, urticaria, arthralgias, proteinuria, lymphadenopathy
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serum sickness (immune complexes deposit in tissues, fix complement)
type III hypersensitivity |
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injection that causes local edema, maybe necrosis, and inflammation 5-12 hours after injection?
hypersensitivity type? |
arthus reaction
type III hypersensitivity |
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name hypersensitivity type:
-polyarteritis nodosum -hypersensitivity pneumonitis -rheumatoid arthritis |
type III hypersensitivity
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Diabetes Type I
Hashimoto's thyroiditis MS Guillan-Barre examples of what type of disease (not autoimmune) |
type 4 hypersensitivity
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antismith ab
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SLE
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antihistone
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drug-induced lupus
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Anti-IgG
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Rheumatoid arthritis
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Anticentromere
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CREST
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Anti-Scl-70 ab
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anti-DNA topoisomerase II
diffuse scleroderma |
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anti-DNA topoisomerase II ab
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diffuse scleroderma
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antimitochondrial ab
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primary biliary cirrhosis
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antiendomysial ab
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Celiac's
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anti-desmoglein ab
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pemphigus vulgaris
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antimicrosomal ab
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Hashimoto's thyroiditis
Kaleigh has microsomal amounts of fat |
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Anti-Jo-1 ab
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dermatomyositis/ polymyositis
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Anti-SSA / Anti-SSB ab
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Sjogrens syndrome, SLE
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anti-Ro ab
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Sjogrens syndrome, SLE
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anti-La ab
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Sjogren's syndrome, SLE
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anti-U1 RNP (ribonucleoprotein) ab
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mixed connective tissue disorder
"anti-U boat missions were done by scraggly mariners (with lots of collagen in their faces) |
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anti-smooth muscle ab
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autoimmune hepatitis
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anti-glutamate decarboxylase ab
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diabetes mellitus type 1
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p-ANCA (2)
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microscopic polyangiitis
Churg-Strauss Syndrome |
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MPO-ANCA
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Pauci-Immune Crescentic Glomerulonephritis
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Immunodeficiencies
Recurrent bacterial infections after 6 months? inheritance, problem |
Bruton's agammaglobulinemia
Boys (x-linked) B-cell problem (decrease all Igs) |
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Thymic aplasia (Digeorge syndrome)
-what type of infections? -what missing? |
T cells missing (and parathyroids) from missing 3rd and 4th pharyngeal pouches
viral, protozoan, fungal infections also get tetralogy and great vessel defects |
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chronic diarrhea
failure to thrive mucocutaneous candidiasis, recurrent viral infections or PCP in kids? |
SCID
adenosine deaminase def. no thymic shadow (like digeorge) |
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Hyper IgM syndrome:
2 inheritances, associated defects |
x-linked = absent CD ligand
AR = absent CD-40 |
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Wiskott-Aldrich triad
Ig findings, inheritance |
thrombocytopenic purpura
eczema (on trunk, weird place) recurrent pyogenic infections no IgM (high IgA) X-linked |
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ataxia with poor eye pursuit of moving targets?
complications? increased serum substance? |
Ataxia-Telangectasia
-telangectasias develop at 5yo -genetic repair defect, so increased risk of leukemia/lymphoma (avoid radiation) -increased AFP |
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pt with recurrent sinopulmonary infections, gets a blood transfusion and has an anaphylactic reaction?
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selective IgA deficiency
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negative nitroblue tetrazolium dye test indicates?
rx- ? prophylaxis? |
Chronic Granulomatous Disease
E. Coli, Staph aureus, klebsiella, aspergillus, candida rx- IFN-gamma prophylaxis with TMP-SMX |
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partial albinism
recurrent respiratory and skin infections neurological disorders will see what |
Chideki-Higashi
Huge cytoplasmic granules in PMNs |
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eczema, multiple noninflammatory abscesses, course facial features, 2 rows of teeth?
what increased, what deficient |
Hyperimunoglobulin E syndrome (Job Syndrome)
IgE increased decrease in IFN-gamma |
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what is problem in leukocyte adhesion deficiency
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abnormal integrins
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match with each rejection (hyperacute, acute, chronic)
obliterative vascular fibrosis fibrinoid necrosis with ischemia vasculitis with lymphocytic infiltrate |
hyperacute (type2)- vascular fibrinoid necrosis
acute- vasculitis chronic- obliterative vascular fibrosis |
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4 x-linked immunodeficiencies
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Wiskott aldrich
Bruton's agammaglobulinemia Chronic granulomatous hyper IgM WBC + H |
