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Immunology
| Question | Answer |
|---|---|
| 1. What is sepsis? 2. What causes the physiological response of sepsis? | 1. whole body inflammation as a result of bacteremia 2. macrophages in liver and spleen secrete TNF-a into the bloodstream |
| 1. What is the first cell to act upon tissue injury? 2. What does it do? | 1. mast cells 2. release vasoactive molecules and cytokines |
| What are the primary lymphoid organs and what matures there? | 1. Thymus, T cells 2. Bone marrow, B-cells |
| 1. Where are mature B cells found 2. What is a phagolysosome? | 1. spleen, lymph nodes and gut-associated lymphoid tissue 2. A phagosome of ingested bacteria that fuses with a lysosome. |
| 1. What immune system cells arise from the lymphoid progenitor cell? 2. Which immune system cells arise from the myeloid progenitor cell? | 1. B cells, T cells and NK cells 2. WBCs, macrophages, monocytes, mast cells, dendritic cells |
| 1. The unique, 3-Dimensional shape that binds a particular antigen is called a.. 2. Genetic variations of the constant region in immunoglobulins are called | 1. idiotype 2. isotypes |
| What three gene segments combine to create the variable domain of the B cells heavy chain or the TCR β chain. | 1. V: variable 2. D: diversity 3. J: joining |
| 1. The enzyme __ insets bases randomly at the junctions of V, D and J. 2. The difference between the genes of the heavy and light chains is the presence of the __ region in the heavy chain. | 1. Tdt 2. D region |
| The process by which one chromosome of a homologous pair will be inactivated to ensure the production of only one idiotype per cell. | allelic exclusion |
| What occurs in the primary versus secondary lymphoid organs? | 1. Primary lymphoid organs - site of lymphoid cell development 2. Secondary lymphoid organs - site of antigen exposure |
| 1. On which cells are MHC class I molecules found? 2. On which cells are the MCH class II molecules found? | 1. all cells of the body 2. an antigen-presenting cells |
| 1. T helper 1 cells stimulate __ cells. 2. T helper 2 cells stimulate __ cells. | 1. macrophages and CD8 T cells 2. B cells |
| 1. The deletion of self-reactive cells in bone marrow. 2. The inactivation of self-reactive cells in the periphery. | 1. clonal deletion 2. clonal anergy |
| How do MHC antigens regulate T-cell development? | immature thymocytes that bind MHC antigens on stromal cells in the thymus too tightly or too loosely are selected for apoptosis |
| What are the two main opsonins that macrophages and neutrophils have membrane receptors for? | IgG and C3b |
| What three enzymes participate innate immunity by creating oxygen biproducts that are toxic to microbes? | 1. NADPH oxidase 2. Superoxide dismutase 3. Myeloperoxidase |
| What are the two chains of the MHC class II molecules? 2. What is the name of the third chain that acts to block the idiotype from normal cellular peptides while being synthesized within the ER? | 1. α and β 2. invariant chain |
| Two signals for B cell activation and isotype switching: | 1. IL4,5 or 6 from Th2 cell (signal 1) 2. CD40 receptor in B cell binds CD40 ligand on Th cell |
| 1. Where in the body is IgA produced? 2. Which HLA product contains the β2-microglobulin chain? | 1. submucosa 2. MCH type 1 |
| Which immunoglobulin 1. triggers mast cell granule release? 2. Acts as an opsonin? 3. activates complement? 4. transported across the placenta | 1. IgE 2. IgG 3. IgM, IgG 4. IgG |
| What activates natural killer cells (3)? | 1. Fc receptor engagement on IgG 2. IL-12 3. absence of class MHC class I on target cells |
| 1. What is contained within Natural Killer cell granules? 2. Function of CD3+ | 1. perforin & granzymes 2. transmitts signal to T cell interior upon binding of APC |
| 1. Which chromosome is the MHC gene complex located? 2. How many loci are there for each HLA class? | 1. chromosome 6 2. 3 loci |
| 1. How many chains are on each immunoglobulin? 2. What are the different heavy (H) chains? 3. What are the different light (L) chains? | 1. 4 chains: 2H + 2L 2. M, G, D, E, A 3. Kappa and Lambda |
| What is the purpose of each B cell region? 1. Fab 2. Fc receptor | 1. variable region that binds antigen 2. constant region: defines isotype, attaches B cell to plasma membrane, attaches to phagocytic cells |
| Describe the initiation of each pathway of complement activation: 1. classical pathway 2. MB-lectin pathway 3. Alternative pathway | 1. antigen-antibody complex (IgG or IgM) 2. mannose-binding lectin binds mannose on pathogen surfaces 3. pathogen surfaces |
| Which antigens are thymus independent? | those that do not have a peptide structure and cannot be recognized by T cells |
| 1. What can be said about a cell that is positive for terminal deoxyribonucleotidal transferase (Tdt)? 2. The cytokine most strongly associated with stimulation of production of myeloid cells from bone marrow is ___. | 1. It is in the process of rearranging the gene segments for synthesis of DNA in pre-B and pre-T lymphocytes 2. IL-3 |
| 1. If a healthy T cell possesses both CD4 and CD8, where in the body is it located? 2. What is the only marker found on T lymphocytes when they leave the bone marrow and before reaching the thymus? | 1. thymic cortex 2. Tdt |
| What cells are found in the following lymph node areas? 1. cortex 2. paracortex 3. medullary sinuses | 1. B lymphocyte 2. T lymphocyte 3. macrophages |
| If a drug does not illicit an immune response, but does so when coupled to another substance in a patient's blood, what is it called? | hapten |
| Place in order of filtration upon entering a lymph node: cortex, afferent ducts, subscapular sinus, medulla, efferent ducts | 1. afferent ducts 2. subscapular sinus 3. cortex 4. medulla 5. efferent ducts |
| What deficiency may a negative nitroblue tetrazolium test indicate? | failure to generate oxygen radicals possibly from a defect in NADPH oxidase (chronic granulomatous disease) |
| What recognizes the Fc receptor of the following immunoglobins? 1. IgG 2. IgA 3. IgE 4. Where does complement bind on IgG and IgM? | 1. phagocytes and NK cells 2. phagocytes 3. Mast cells 4. portion of Ig between hinge region and Fc receptor |
| Which immune system components are involved in Antibody Dependent Cell Mediated Cytotoxicity? | NK cells bind Fc receptors of immunoglobins |
| 1. Which antibodies neutralize pathogens? 2. Why those antibodies and not the rest? 3. How do they accomplish this? | 1. IgG and IgA 2. they cross the vasculature and circulate freely 3. the surround the microbe and prevent it from docking with human cell receptors |
| What are the two effector functions of Natural Killer cells? | 1. release of lytic granules to target cell 2. production of IFN-g to activate macrophages |
| 1. What is the purpose of HLA class I molecules? 2. What is the purpose of HLA class II molecules? | 1. present antigens from within cytoplasm of a cell 2. present uptake antigens |
| The 3 pathways of complement activation converge at ___. | formation of C3 convertase |
| Which cytokines do APC secrete that convert the T helper cell into: 1. Th1 cell 2. Th2 cell | 1. IL-12 2. IL-4 |
| 1. Antigens lacking a peptide component (i.e. polysaccharide capsule) undergo what immunologic response? 2. Why? | 1. stimulate release of IgM antibodies only 2. without a peptide component, these antigens cannot be presented by MHC to T cells to undergo class switching |
| Which factors help prevent complement activation on self-cells? | 1. C1 inhibitor 2. Decay-accelerating factor (DAF) |
| What do IL-1 through IL-5 do? 1. IL-1 2. IL-2 3. IL-3 4. IL-4 5. IL-5 | Hot T-Bone stEAk 1. fever (hot) 2. stimulate T cells 3. stimulates Bone marrow 4. stimulates IgE and differentiation into Th1 cells 5. stimulates IgA |
| What is the difference between type II and type III hypersensitivity reactions? | 1. type II - antibodies bind antigens on cell membranes 2. type III - antibodies bind antigens in serum and form complexes that deposit on cell membranes |
| Mechanism of septic shock caused by superantigens. | 1. Superantigens crosslink β region of TCR to MHC II of APCs. 2. IFNγ and IL2 released from Th1 cell. 3. IL-1, IL-6 and TNF-α released from macrophages |
| Mechanism of septic shock caused by gram negative bacteria. | 1. LPS binds CD14 receptor on macrophages 2. IL-1, IL-6 and TNF-α release from macrophages |
| Which complement protein 1. is an opsonin? 2. initiates anaphylaxis? 3. binds IgG to initiate the complement cascade? | 1. C3b 2. C3a, C5a 3. C1q |
| 1. The carboxyl terminal of the antibody is the __ end. 2. What does the N-terminal do? | 1. Fc 2. Binds antigen |
| What Complement defects are likely involved? 1. Recurrent Neisseria bacteremia 2. Paroxysmal nocturnal hemoglobinuria 3. Recurrent pyogenic sinus and respiratory infections | 1. deficiency of C5-C8 2. deficiency of Decay-accelerating factor (DAF) 3. C3 deficiency |
| 1. Lack of NADPH oxidase 2. ↑ IgM and ↓ IgG, IgA, IgE and caused by what defect | 1. chronic granulomatous disease 2. Hyper-IgM syndrome: defective CD40L on helper T cell = inability of B-cells to class switch |
| 1. What is the defect in X-linked agammaglobulinemia? 2. Disease with delayed separation of umbilicus and recurrent bacterial infection | 1. defect in Bruton's tyrosine kinase (BTK) → no B-cell maturation 2. Leukocyte adhesion deficiency |
| What type of sensitivity: 1. Rheumatic fever 2. Post-streptococcal glomerulonephritis 3. Tuberculosis 4. Contact dermititis 5. Rheumatoid arthritis 6. asthma | 1. Type II 2. Type III 3. Type IV 4. Type IV 5. Type II 6. Type I |
| 1. Which hypersensitivity reactions may exhibit decreased complement? 2. Which hypersensitivity reaction may exhibit increased IgE? | 1. type II and type III 2. type I |
| What is the test for hypersensitivity: 1. Type II 2. Type III | 1. direct and indirect Coombs 2. immunofluorescent staining (like in Goodpastures) |
| Young male. recurrent bacterial infections. Normal pro-B, ↓ maturation, ↓ immunoglobulins of all classes. | Bruton's (X-linked) agammaglobulinemia |
| 1. ↑ IgM; ↓↓ IgG, IgA, IgE 2. Normal number of B cells; ↓ plasma cells and Igs 3. failure of T cells to produce IFNΥ, resulting in ↓ macrophage activation | 1. Hyper-IgM syndrome 2. common variable immunodeficiency 3. Job's syndrome (hyper IgE) |
| 1. ↑ IgE; coarse faces and eczema 2. hypocalcemia, recurrent viral/fungal infections in newborn 3. recurrent staph and strep infections; partial albinism, peripheral neuropathy | 1. Job's syndrome (Hyper-IgE syndrome) 2. Thymic aplasia (DiGeorge syndrome) 3. Chediak-Higashi (defect in microtubular function with ↓ phagocytosis) |
| 1. ↓ B and T cell deficiency 2. unstable gait, IgA deficiency 3. ↓IgM, recurrent pruritic rash, ↓ platelets | 1. severe combined immunodeficiency 2. ataxia-telangiectasia 3. Wiskott-Aldrich syndrome (thrombocytopenia, infections, eczema) |
| 1. Somatic Recombination 2. Somatic Hypermutation | 1. VDJ recombination to produce diverse receptors on naive B cells 2. naive B cell recognizes antigen in periphery goes to lymph note, costimulated by Th1 cells ➞ rapid recombinations in an attempt to replicate the original antigen-bound receptor |
| Viral infected cells secrete IFN-α and IFN-β. What 2 actions do these molecules induce in nearby cells? | 1. activates a ribonuclease to degrade viral mRNA 2. activate NK cell to kill virus infected cells |
| TNFα effect on endothelial cells? | ↑ vascular permeability & ↑ expression of endothelial adhesion molecules that bind neutrophils |
| Affinity maturation. | ↑ affinity for antigen upon repeated exposure because selective survival of antigen-specific B cell |
| Give an example of each immunity: 1. natural passive 2. natural active 3. artificial passive 4. artificial active | 1. placental IgG or IgA in colostrum 2. induction of immunity after antigen exposure 3. given immunoglobulin or immune cells 4. vaccination |
| 1. Which immunoglobulins can exit the vasculature? 2. Protects IgA from being digested in the GI lumen? | 1. IgG & IgA 2. secretory chain |
| 1. What causes a Th cell to undergo anergy? 2. Where in the thymus does positive selection occur? 3. Where in the thymus does negative selection occur? | 1. presentation with MHC class II signal but no costimulator (B7) 2. cortex 3. medulla |
| What cytokines do T helper cells use to stimulate: 1. CTL 2. B cells 3. Macrophages | 1. IL-2 2. IL-4,5,6 3. IFN-γ |
| How do catecholamines, corticosteroids and lithium effect neutrophil count? | ↑ WBC count (inhibit activation of adhesion molecules → decrease marginating pool and increase circulating pool) |
| What is the pathway of bleach formation from O2 in neutrophils? | 1. O2 → O2- via NADPH 2. O2- → H2O2 via SOD 3. H2O2 → HOCl via MPO |
| 1. Leukocytes turn blue on nitroblue tetrazolium test? 2. Scratch test is used to determine which hypersensitivity? 3. Patch tests is used to determine which hypersensitivity? | 1. neutrophil respiratory burst is intact 2. Type I 3. Type IV |
| Complement component: 1. trigger mast cell degranulation 2. chemotactic for neutrophils 3. opsonin for phagocytosis | 1. C3a, C5a 2. C5a 3. C3b |
| What causes fever in the inflammatory process? | 1. IL-1 and IL-6 secreted by macrophages activate cyclooxygenase in the hypothalamus 2. cyclooxygenase ↑ PGE2 which raises temperature set point |
| Which factors: 1. ↑ selectins on endothelium 2. ↑ adhesion molecules on endothelium 3. ↑ integrins on leukocytes 4. neutrophil chemotaxis | 1. TNF, IL1 2. TNF, IL1 3. C5a, LTB4 4. C5a, LTB4, IL8 |
| What are the two signals required for activation of cytotoxic T cells? | MHC class I and IL-2 from CD4+ Th1 cell |
| What are the steps in granuloma formation? | 1. macrophage present antigen to CD4+ T cell via MHC II 2. macrophages secrete IL-12 inducing CD4+ cell to differentiate into Th1 subtype 3. Th1 cell secretes IFN-γ which converts macrophages to epithelioid histiocytes |
| What is the surface antigen found on APC's and what receptor does it bind on T lymphocytes | B7 binds CD28 on helper T lymphocytes |
| Mechanism of action: 1. Interferon γ 2. Interferon α and β | 1. ↑ MHC I and II expression and antigen presentation 2. inhibit viral protein synthesis |
| What is antibody dependent cell mediated cytotoxicity? | q. IgG bound to target pathogen is recognized by NK cells 2. NK cell kills pathogen with perforin and granzyme |
| 1. Which complement deficiency results in hereditary angioedema? 2. How? | 1. C1 esterase inhibitor deficiency 2. C1 esterase blocks Kallikrein conversion of Kininogen into Bradykinin) |
| Which immunoglobin forms 1. pentamer 2. dimer | 1. IgM 2. IgA (monomer in circulation, dimer when secreted) |
| 1. Direct Coombs test 2. Indirect Coombs test | 1. add anti-Ig antibody to patients serum to see if agglutination occurs 2. add normal RBCs to patient serum |
| On which cells are the following found: 1. selectins 2. adhesion molecules 3. integrins | 1. endothelial cells 2. (ICAMs) endothelial cells 3. leukocytes |
| Which molecules the following: 1. neutrophil rolling on endothelial cells 2. neutrophil adhesion | 1. selectins on endothelial cells 2. adhesion molecules on endothelial cells and integrins on leukocytes |
| 1. Which cytokines do Th1 cells produce that inhibit Th2 cells? 2. Which cytokines do Th2 cells produce that inhibit Th1 cells? | 1. IFN-γ 2. IL4, IL10 |
| 1. Where in the lymph node are follicles found? 2. What is the difference between primary and secondary follicles? | 1. outer cortex 2. primary follicles are dormant,secondary have active germinal centers |
| 1. Where in the lymph node does B-cell proliferation and somatic hypermutation occur? 2. | 1. germinal center of secondary follicle 2. |
| What is the lymph node draining site: 1. upper limb 2. stomach 3. duodenum, jejunum 4. sigmoid colon 5. rectum (above pectinate line) | 1. axillary 2. celiac 3. superior mesenteric 4. colic → inferior mesenteric 5. internal iliac |
| What is the lymph node draining site: 1. anal cancel (below pectinate line) 2. tetes 3. scrotum 4. thigh 5. lateral side of foot | 1. superficial inguinal 2. superficial and deep plexuses → para-aortic 3. superficial inguinal 4. superficial inguinal 5. popliteal |
| Which oganisms attack individuals with splenic dysfunction | S SHin 1. salmonella 2. S. pneumonia 3. H. influenza 4. N. meningitidis |
| 1. What are the MHC I classes? 2. What are the MHC II classes? | 1. HLA-A, HLA-B, HLA-C 2. HLA-DR, HLA-DP, HLA-DQ |
| HLA subtypes associated with disease: 1. HLA-A3 2. HLA-B27 3. HLA-B8 | 1. Hemochromatosis 2. PAIR, Psoriasis, Ankylosing spondylitis, Inflammatory bowel, Reiter's syndrome 3. Graves disease |
| HLA subtypes associated with disease: 1. HLA-DR2 2. HLA-DR3 3. HLA-DR4 4. HLA-DR5 5. HLA-DR7 | 1. multiple sclerosis, hay fever, SLE, Goodpasture's 2. DM type 1 3. Rheumatoid arthritis, DM type 1 4. pernicious anemia, Hashimoto's thyroiditis 5. nephrotic syndrome |
| 1. Which cytokines are the endogenous pyrogens? 2. Which cytokine supports growth and differentiation of bone marrow stem cells? | 1. IL-1 and IL-6 2. IL-3 |
| After exposure to these diseases, patients are given preformed antibodies (passive immunity). | To Be Healed Rapidly 1. Tetanus toxin 2. Botulinum toxin 3. HBV 4. Rabies virus |
| Which cell surface protein: 1. binds EBV? 2. is unique to NK cells 3. binds NK cells to the Fc portion of IgG | 1. CD21 2. CD56 3. CD16 |
| 1. After intradermal injection of the tDap vaccine, patient gets local swelling 2. Patient started on new drug 1 week prior, now has fever/malaise, cutaneous eruptions and arthralgias 3. Rxn characterized by RBC hemolysis following a blood transfusion? | 1. Arthus reaction (Type II hypersensitivity) 2. Serum sickness (Type III) hypersensitivity) 3. Transusion rxn (Type II) antibodies against RBC antigens (A, B, Rh) |
| What type of sensitivity rxn: 1. Rheumatic fever 2. Post-streptococcal glomerulonephritis 3. Tuberculosis 4. Contact dermititis 5. Multiple Sclerosis | 1. Type II 2. Type III 3. Type IV 4. Type IV 5. Type IV |
| What type of sensitivity rxn: 1. Guillian-Barre 2. Rheumatoid arthritis 3. asthma 4. Hashimoto's thyroiditis 5. Erythroblastosis fetalis | 1. Type IV 2. Type II 3. Type I 4. Type IV 5. Type II |
| Autoantibodies: 1. ANA 2. anti-Smith 3. Anticentromere 4. Anti-DNA topoisomerase I 5. Antigliadin | 1. SLE 2. SLE 3. Scleroderma (CREST) 4. Scleroderma (diffuse) 5. Celiac disease |
| Autoantibodies: 1. Antihistone 2. Anti-desmoglein 3. Amtimicrosomal 4. Anti-Jo-I 5. Anti-smooth muscle | 1. Drug induced lupus 2. Pemphigus vulgaris 3. Hashimoto's thyroiditis 4. Polymyositis, dermatomyositis 5. Autoimmune hepatitis |
| Autoantibodies: 1. anti-proteinase 3 2. Anti-SS-A 3. Anti-intrinsic factor 4. Anti-SS-B | 1. (c-ANCA) Wegener's granulomatosis 2. Sjogren's syndrome 3. pernicious anemia 4. Sjogren's syndrome |
| Transplants: 1. autograft 2. allogenic 3. syngeneic 4. xenograft | 1. from self 2. from nonidentical individual of same species 3. from identical twin 4. from different species |
Created by:
amichael87
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