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~immunology~

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gsafsaf's version from 2015-06-29 04:55

HLA subtypes

Question Answer
A3Hemochromatosis
A3MHC I
B27Psoriatic arthritis
B27Ankylosing spondylitis
B27IBD related arthritis
B27Reactive (Reiter's) arthritis
B27MHC I
DQ2Celiac
DQ8Celiac
DQ2MHC II
DQ8MHC II
DR2MS
DR2Hay fever
DR2SLE
DR2Goodpastures
DR2MHC II
DR3DM1
DR3SLE
DR3Graves
DR3Hashimoto
DR3MHC II
DR4Rheumatoid arthritis
DR4DM1
DR4MHC II
DR5Pernicious anemia
DR5Hashimoto
DR5MHC II
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Immunoglobulin isotypes

Question Answer
Main Ab in 2ndary response to antigenIgG
Ab in primary response to antigenIgM
Fixes complementIgG
Fixes complementIgM
Does not fix complementIgA
Unclear functionIgD
Mediates immunity a/g worms via eosinophilsIgE
[Lowest] in serumIgE
Most produced overallIgA
Most abundant in serumIgG
Binds mast cells and basophilsIgE
Mediates Type I HSR & releases histamineIgE
Crosses the placentaIgG
Monomer on B cellIgM
Pentamer when secretedIgM
Prevents bacteria/viruses from attaching to mucous membranesIgA
Monomer in circulationIgA
Dimer when secretedIgA
Produced by Peyer patchesIgA
Released into secretions and breast milkIgA
Opsonizes bacteriaIgG
Neutralizes bacterial toxins + virusesIgG
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Complement

Question Answer
Classic pathway activationIgG or IgM
Alternative pathway activationmicrobe surface molecules
Lectin pathway activationmannose or other sugars on microbe surface
C3b functionopsonization
C3a functionanaphylaxis
C4a functionanaphylaxis
C5a functionanaphylaxis
C5b-9 functioncytolysis by MAC
The two primary opsonins in bacterial defense; enhance phagocytosisC3b + IgG
Helps clear immune complexesC3b
Help prevent complement activation on self cellsDAF aka CD55 + C1 esterase inhibitor
C1 esterase inhibitor deficiencyHereditary angioedema. ACEi = c/i
C3 deficiencyIncreased risk of severe, recurrent pyogenic sinus + respiratory infxns
Increased susceptibility to Type III HSRC3 deficiency
C5-9 deficienciesincreased susceptibility to Neisseria bacteremia
Causes complement-mediated lysis of RBCs/ paroxysmal nocturnal hemoglobinuriaDAF deficiency
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Cytokines

Question Answer
IL-1fever, acute inflammation
What cytokine activates endothelium to express adhesion molecules?IL-1
What cytokine induces chemokine secretion to recruit WBCs?IL-1
IL-6fever, production of acute-phase reactants
What cytokine induces production of C-reactive protein?IL-6
What cytokine induces production of Hepcidin?IL-6
What cytokine induces production of serum amyloid A?IL-6
IL-8major chemotactic factor for neutrophils
What cytokine recruits neutrophils to clear infections?IL-8
IL-12induces T cell differentiation into Th1 cells
What cytokines activate NK cells?IL-2 + IL-12
IL-2Stimulates growth of helper, cytotoxic, and regulatory T cells
IL-3Supports growth and differentiation of bone marrow stem cells
What cytokine functions like GM-CSFIL-3
IFN-gammasecreted by NK cells
What cytokine is secreted in response to macrophage IL-12 secretion?IFN-gamma
What cytokine activates NK cells to kill virus-infected cells?IFN-gamma
What cytokine is used as prophylaxis in pts w CGD?IFN-gamma
IL-4induces differentiation into Th2 cells
What cytokine promotes B cell growth?IL-4
What cytokine enhances class switching to IgE and IgG?IL-4
IL-5Promotes B cell differentiation
What cytokine stimulates IgA production?IL-5
What cytokine stimulates growth an differentiation of eosinophils?IL-5
IL-10Attenuates the immune response
What cytokine inhibits activated macrophages and dendritic cells?IL-10
What cytokine decreases expression of MHC II and Th1 cytokines?IL-10
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Cell surface proteins

Question Answer
MHC IPresent on all nucleated cells (i.e. not mature RBCs)
CD28T cells; binds B7 on APC
CD4, CD25Regulatory T cells
CD4, CD40LHelper T cells
CD19, CD20, CD21, CD40B cells
CD21Receptor for EBV
MHC II, B7B cells, NK Cells
CD34Hematopoietic stem cells
CD16NK cells (binds Fc of IgG)
CD56Unique marker for NK cells; absent in pts w paroxysmal nocturnal hemoglobinuria
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Auto-Abs

Question Answer
Anti-ACh receptorMyasthenia gravis
Anti-BMGoodpastures
Anticardiolipin, lupus anticoagulantSLE, antiphospholipid syndrome
Anti-desmosome (anti-desmoglein)Pemphigus vulgaris
Anti-dsDNA, anti-SmithSLE
Anti-glutamic acid decarboxylase (GAD-65)DM1
AntihemidesmosomeBullous pemphigoid
Anti-histoneDrug-induced lupus
Anti-Jo-1, anti-SRP, anti-Mi-2Polymyositis, dermatomyositis
Antimicrosomal, antithyroglobulinHashimoto
Antimitochondrial1' biliary cirrhosis
Antinuclear antibodiesSLE, nonspecific
Antiparietal cellPernicious anemia
Anti-Scl-70 (anti-DNA topoisomerase I)Scleroderma (diffuse)
Anti-smooth muscleAutoimmune hepatitis
Anti-SSA, Anti-SSB (anti-Ro, anti-La)Sjogren syndrome
Anti-TSH receptorGraves disease
Anti-U1 RNPMixed connective tissue disease
IgA anti-endomysial, IgA anti-tissue transglutaminaseCeliac disease
MPO-ANCA/p-ANCAMicroscopic polyangitis, eosinophilic granulomatosis with polyangitis (Churg-Strauss)
PR3-ANCA/c-ANCAGranulomatosis with polyangitis (Wegeners)
Rheumatoid factor (IgM that targets IgG Fc region)Rheumatoid arthritis, sensitive
anti-CCPRheumatoid arthritis, specific
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Immunodeficiencies, B-Cell disorders

Question Answer
Defect in BTK tyrosine kinase geneX-linked (Bruton) agammaglobulinemia
No B-cell maturation X-linked (Bruton) agammaglobulinemia
XLR X-linked (Bruton) agammaglobulinemia
Recurrent bacterial and entoviral infxns after 6months of life X-linked (Bruton) agammaglobulinemia
Absent/scarce lymph nodes + tonsils + B cells + immuglobulins of all classes X-linked (Bruton) agammaglobulinemia
Most common 1' immunodeficiencySelective IgA deficiency
Majority asymptomatic, airway + GI infxn + anaphylaxisSelective IgA deficiency
Unknown cause of defectSelective IgA deficiency
Decreased IgA, normal IgG+IgMSelective IgA deficiency
Many causes of defect in B-cell differentiationCommon variable immunodeficiency
Acquired in 20s-30sCommon variable immunodeficiency
Increased risk of autoimmune disease, bronchiectasis, lymphoma, sinupulmonary infxnCommon variable immunodeficiency
Decreased plasma cells, decreased immunoglobulinsCommon variable immunodeficiency
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T cell disorders

Question Answer
failure of 3 + 4 pharyngeal pouchesDiGeorge
Tetany, tetralogy of fallot, cleft palate, truncus arteriosis, recurent infxnsDiGeorge
Decreased T cells, PTH, Ca2+DiGeorge
Decreased Th1 responseIL12 receptor deficiency
Autosomal recessiveIL12 receptor deficiency
May present after BCG vaccine administrationIL12 receptor deficiency
Decreaased IFN-gammaIL12 receptor deficiency
Deficiency of Th17 cells due to STAT3 mutationAD hyper-IgE syndrome (Job syndrome)
coarse facies, cold staph abscesses, retained primary teeth, eczemaAD hyper-IgE syndrome (Job syndrome)
Increased IgE, decreased IFN-gammaAD hyper-IgE syndrome (Job syndrome)
Noninvasive Candida albicans infxnsChronic mucocutaneous candidiasis
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B + T cell disorders

Question Answer
Most common type -- X-linked, defective IL-2R gamma chainSCID
Not MC, autosomal recessive adenosine deaminase deficiencySCID
Failure to thrive, chronic diarrhea, thrush, viral-bacterial-protozoal infxnsSCID
Rx - bone marrow transplant w NO concern for rejectionSCID
Absence of thymic shadowSCID
Defects in ATM gene --> cell cycle arrestAtaxia-telangiectasia
Cerebellar defects, spider angiomas, IgA deficiencyAtaxia-telangiectasia
Non-homologous endjoining repair mutationAtaxia-telangiectasia
Decrease in IgA, IgG, IgE, increase AFPAtaxia-telangiectasia
Severe decrease IgA, IgG, IgE, increase IgMHyper IgM syndrome
Defective CD40L on Th cells - class switching defectHyper IgM syndrome
XLRHyper IgM syndrome
XLRWiskott-Aldrich syndrome
Severe pyogenic infxns early in live, pneumocystis, cryptosporidium, CMVHyper IgM syndrome
Mutation in WAS gene-T cells unable to recognize actin cytoskeletonWiskott-Aldrich syndrome
Thrombocytopenic purpura, eczema, recurrent infxnsWiskott-Aldrich syndrome
Fewer and smaller plateletsWiskott-Aldrich syndrome
low to normal IgG, IgM, High IgE, IgAWiskott-Aldrich syndrome
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Phagocyte disorders

Question Answer
AR Defect in LFA-1 integrin (CD18)Leukocyte adhesion deficiency Type I
Impaired migration and chemotaxis Leukocyte adhesion deficiency Type I
Reccurrent bacterial skin + mucosal infxns, no pus formation Leukocyte adhesion deficiency Type I
Delayed umbilical cord separation Leukocyte adhesion deficiency Type I
Increased neutrophils, but absence of neutrophils at infection sites Leukocyte adhesion deficiency Type I
AR Defect in Lysosomal trafficking regulator gene (LYST)Chediak-Higashi syndrome
Recurrent pyogenic infxns w staph + strep, peripheral neuropathy, neurodegenerationChediak-Higashi syndrome
Partial albinismChediak-Higashi syndrome
Giant granules in granulocytes and plateletsChediak-Higashi syndrome
Pancytopenia + mild coagulation defectsChediak-Higashi syndrome
XLR Defect of NADPH oxidase; decreased ROS; decreased neutrophil respiratory burstCGD
Increased susceptibility to catalase + (Nocardia, Pseudomonas, Listeria, Aspergillus, Candida, E.coli, S aureus, Serratia)CGD
Abnormal dihydrohodamine testCGD
Negative nitroblue tetrazolium dye reduction testCGD
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Transplant Rejection

Question Answer
HyperacuteWidespread thrombosis of graft vessels --> ischemia/necrosis
HyperacuteGross mottling + cyanosis
HyperacuteType II HSR
Acute + ChronicCellular + humoral
AcuteVasculitis of graft vessels with dense interstitial lymphocytic infiltrate
AcutePrevent/reverse w immunosuppressants
AcuteCD4 deposition, neutrophil/lymphocyte infiltrate, necrotizing vasculitis, endothelitis
ChronicRecipient T cells react to secrete cytokines that proliferate vascular SM and induce parenchymal fibrosis
ChronicPredominantly arteriosclerosis
ChronicVascular wall thickening + luminal narrowing
GVHDMaculopapular rash, jaundice, diarrhea, hepatosplenomegaly
GVHDusually in bone marrow + liver transplants
GVHDpotentially beneficial in bone marrow transplant for leukemia
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Immunosuppressants

Question Answer
Cyclosporine + Tacrolimuscalcineurin inhibitors + prevent IL-2 txn in order to block T-cell activation
CyclosporineNephrotoxic, gout, gingival hyperplasia, hirsutism, HTN, hyperlipidemia, neurotoxicity
Tacrolimus + SirolimusBinds to FK506 binding protein
TacrolimusNephrotoxic, risk of DM, neurotoxicity
SirolimusmTOR inhibitor aka Rapamycin
Sirolimus + Daclizumab + BasiliximabKidney transplant rejection prophylaxis
SirolimusPrevents RESPONSE to IL-2 in order to block T-cell and B-cell differentiation
Sirolimus + AzathioprineAnemia, thrombocytopenia, leukopenia
Sirolimusinsulin resistance, hyperlipidemia
SirolimusSynergistic w cyclosporine
Daclizumab + basiliximabBlock IL-2 receptor, edema, HTN, tremor
Azathioprineblocks nucleotide synthesis to inhibit lymphocyte proliferation
AzathioprineDegraded by xanthine oxidase, so increased levels when pt takes allpurinol
Glucocorticoidsinhibit NF-kB to suppress both B & T cell function by decreasing txn of cytokines
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Recombinant cytokines

Question Answer
AldesleukinIL-2
AldesleukinRCC
Epoetin alfaEPO
Epoetin alfaAnemias (esp. in renal failure)
FilgrastimG-CSF
SargramostimGM-CSF
Filgrastrim + SargramostimRecovery of bone marrow
Romiplostim, eltrombopag, oprelvekinThrombocytopenia
OprelvekinIL-11
IFN-alphachronic HBV, HCV, kaposi sarcoma
IFN-alpha + adesleukinmetastatic melanoma
IFN-betaMS
IFN-gammaCGD
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Therapeutic Abs

Question Answer
Alemtuzumab CD52, CLL
BevacizumabVEGF, colorectal cancer, RCC
CetuximabEGFR, Stage IV colorectal cancer, head + neck cancer
RituximabCD20, B-cell non-Hodgkin lymphomam CLL, RA, ITP
TrastuzumabHER2/neu, breast cancer
Adalimumab, infliximabSoluble TNF-alpha, IBD, RA, ankylosing spondylitis, psoriasis
Eculizumabcomplement protein C5, paroxysmal nocturnal hemoglobinuria
Natalizumabalpha4-integrin, MS, Crohns, risk of PML in pts with JC virus
AbciximabPlatelet glycoproteins IIb/IIIa, antiplatelet agent to prevent ischemia w percutaneous coronary intervention
DenosumabRANKL, osteoporosis
OmalizumabIgE, allergic asthma
PalivizumabRSV F protein, prophylaxis for high risk infants (premies)
Ranibizumab, bevacizumabVEGF, neovascular age-related macular degeneration
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