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DIT day 1 and 2

What do you treat an acidic drug OD (salylate) with? NaHCO3
What do you treat a basic drug OD (amphetamines) with? NH4CL
Name the 3 Alz drugs Donepezil, Galantamine, Rivastigmine
How do you tx MG? ACHE inhibitors, corticosteroids, thymectomy, plasmaphoresis
What is the result of excess parasymp activity? DUMBBELSS
What drugs inhibit parasympathetic activity? "Trops"=aTROPine, homaTROPine, TROPicamide, benzTROPine, ipraTROPium, and scopalamine. 1st 3 drugs can be used mydriasis and beztropine for parkinsons
Which drugs are used for tx of urge type of urinary incontinence? Oxybutynin, Tolterodine, Darifenacin and solifenacin, trospium
Drug for post op neurogenic ileus, urinary retention, MG, reversing NMJ blockade from paralytic agents Neostigmine
Pyridostigmine for MG
Edrophonium Dx MG
Physostigmine glaucoma and "PHixes" Atropine OD.
Ecothiophate Glaucoma
Clonidine Centrally acting a2-agonist, decrease central adrenergic outflow. Especially good for tx of TX in pts with renal disease
How do you tx a pt. who has HTN and BPH? Give a -zosin. If pt doesn't have HTN then just give Tamsulosin
Good drug in an elderly patient who is depressed, has poor appetite and is not sleeping well. Mirtazapine
Drug for anaphylaxis Epi
1st line for cardiogenic shock Dobutamine
1st line for septic shock NE
HOw do you dx glaucoma cupping of the optic disk (cup:disc ratio greater than 1:2) or tonometry
Saturday night palsy compression of radial n against spiral groove of the humerus
Lecithinase that causes gas gangrene alpha toxin of clostridium perfringins
Toxin inhibits adenylate cyclase and leads to whooping cough Pertussis tox (AB tox)
Toxin that stimulates adenylate cyclase=>get CL- and H2O into gut=Diarrhea Cholera toxin and heat labile tox of ETEC
Tox that destroys leukocytes Leukocidin. Tox of Staph aureus
Tox composed of edema factor, lethal factor and protective antigen Cytotoxin of bacillus anthracis
tox that causes scarlet fever erythrogenic and pyrogenic toxins of strep pyogenes
Tox that blocks the release of the inhibitory NT glycine tetanospasmin toxin.
What are the acute phase cytokines? IL-1, IL-6, TNF-a
What organisms don't take up gram stain? and why? Ricketsia (inside cell), Chlamydia (inside cell), legionella (inside cell), mycoplasma (no cell wall), Mycobacterium (high lipid content) , treponema (too thin to see).
which bac are encapsulated? Some killers have nice shiny bodies: Strep.pneumonia, klebsiella, H.influenza, Nisseria meningititid, Salmonella and Strep B.
Which bac are spore formers? Gram + rods=clostridium and bacillius and also coxiella Burnetii
which skin infections can be caused by both strep pyogenes and staph aureus Folliculitis, Cellulitis, and impetigo
What bac commonly cause death in neonates? Group B strep, Ecoli, listeria
SCID defect in early stem cell differentiation. Caused by Adenosine deaminase deficiency
What disease presents with this triad: SEvere recurrent infection, chronic diarrhea, and failure to thrive SCID
Which disease has the following: Immunodeficiency, Thrombocytopenia ,Purpura, Trunkal eczema, and recurrent pyogenic infections Wiskott Aldrich
If a pt comes in and has cerebellar ataxia and poor smooth pursuit of moving targets what is the likely dx and what test do you order? IgA deficiency=Ataxia telangiectasia. Order alpha fetal protein. It will be increased in these patients
What is the treatment of CHronic granulomatous disease? Prophylactic TMP-SMX and INF-gamma can also be helpful
Which organisms are pts susceptible to when they have Chronic Granulomatious disease? S.aureus, Ecoli, Klebsiella spp.,Aspergillus spp., Candida spp.
What is defective in Chediak-Higashi Disease? Defecive LYST gene (lysosomal transport), so defective phagocytic lysosome.
What disease has the following triad: Partial albinism, recurrent respiratory tract and skin infections, neurologic disorders. Chediak-Higashi Disease
Which CD marker is found on all T cells except NK cells? CD3
Which CD markers are used to ID B cells? CD 19,20,21
Which CD marker is found on all NK cells and binds the constant region of IgG? CD 16 (also found on macrophages)
Which CD markers inhibit C9 binding? CD55 & 59
What endotoxin receptor (CD marker) is found on macrophages? CD 14
Which cytokines promote B cell growth and differentiation? IL-4,5
Which cytokines are produced by Th1 cells? IL-2 and INF-gamma
Which cytokines are produced by Th2 cells? IL-4,5,10
Which pyogens are secreted by monocytes and macrophages? IL-1,6, TNF-a (acute phase cytokines)
Which cytokine inhibits Th1 cell produciton? IL-10
Which cytokine inhibits Th2 cell production? INF-gamma
Which cytokines mediate inflammation? IL-1,6, TNF-a
Which cytokines are released by virally infected cells? INF-a and Beta
Which cytokine supports growth and differentiation of bone marrow stem cells? IL-3 (just like GM-CSF)
Which cytokines supports T-cell proliferation,differentiation, and activation? IL-2
What initiates the VDJ recombination process that occurs in B and T cells? breaks in the dsDNA at Recombination signal sequences (RSSs) that flank the VDJ region. Recombination is started by recombination activating gene complex (RAG 1 & 2), these recognize RSSs.
Which IG isotype is present in large quantities on the membrane of many B cells? IgD and IgM
Which IG isotype can occur as a dimer? IgA
Which IG isotype is largely confined to the intravascular pool and is the predominant early antibody frequently seen in immune response to infectious organisms w/ complex antigens? IgM
WHich IG isotype is distributed evenly b/w the Intravascular and extravascular pools IgG
Which part of the Lymph node contains high endothelial venules through which T and B cells enter from the blood? Paracortex
Which part of the lymph node is not very well developed in patients with DiGeorge syndrome? Paracortex
How does the lymph node respond to an EXTREME cellular immune response, like a viral infection? Paracortex enlarges
Drainage site of upper limb and lateral breast? Axillary nodes
Drainage site of stomach? Celiac nodes
Drainage site of duodenum and jejunum? Superior mesenteric
Drainage site of Sigmoid colon? Colic to inferior mesenteric
Drainage site of Rectum (lower above pectinate line)? Internal iliac part, anal canal
Drainage site of anal canal below? Superficial inguinal pectinate line
Drainage site of testes? Superficial and deep plexuses to para-aortic
Drainage site of scrotum? superficial inguinal
Drainage site of thigh (superficial) Superficial inguinal
Drainage site of lateral side of dorsum of foot Popliteal
Which duct drains the right arm and right half of the head? R.lymphatic duct
Which duct drains everything except the right arm and right half of the head? Thoracic duct (at junction of L.subclavian and internal juglar v)
Where are T cells found in the Lymph node vs. the spleen? They are found in the "P" structures. Paracortex of the node and PALS(periarterial lymphatic sheath)in the spleen
Where are the B cells found in the lymph node vs. the spleen? Found in the follicles of both. Note the b cells are in the follicles w/in the white pulp of spleen
WHere does the Thymus originate from? epithelium of 3rd brachial pouches
Which cells are found in the cortex of the thymus? immature T cells
Which cells are found in the medulla of the tymus? mature T cells and epithelial reticular cells and also contains Hassall's corpuscles
Where in the thymus does +/- selection take place? at the corticomedullary junction
Which cells express MHC I? MHC II? MHC I expressed by all nucleated cells, not RBCs. MHC II expressed ONLY on APCs
What induces a NK cell to kill? when exposed to a nonspecific activation signal on target cell and/or to absence of class I MHC on cell surface.
What is the mechanism NK cells use to kill target cells? use perforin and granzymes (grenades!) to induce apoptosis
What is the difference b/w NK cells and cytotoxic T cell (which both kill virally infected cells)? NK cells recognize the ABSENCE of MHC I vs. Cytotoxic Tcells use their CD8 to recognize the persence of MHC I that will be presenting a problematic molecule.
Which cytokines enhance NK cells? IL-12, IFN-beta, INF-a
WHen is there more IL-12 aound? When there are more virally infected cells. T-helper cells get IL-12 signal to differentiate into Th1. (remember that Th1 cells will secrete INF-gamma which activates macrophages, then macrophages procude IL-12 which furthur promotes production of Th1).
Describe the mechanism by which Helper T cells are activated-what are the signals needed? Signal 1= APC presents antigen via MHC II, its recognized by TCR on Th cell. Signal 2="costimulatory signal" given by interaction of B7(on APC) and CD28 (on Th cells). Activated Th cells produce cytokines.
Describe the mechanism by which cytotoxic T cells are activated-what are the signals needed? Signal 1=Endogenously sythesized (viral or self) proteins are presented on MHC I and recognized by TCR on Tc Cell. Signal 2= IL-2 from Th cell activates Tc cell to kill virus-infected cell.
Describe the mechanism by which B cell class switching occurs-what are the signals needed? Signal 1= IL-4,5,6 from Th2. Signal 2= CD40 receptor on B cells binds CD40 ligand on Th cells.
Which types of cells can cytotoxic T cells kill? virus-infected, neoplastic, and donor graft cells by inducing apoptosis.
Which portion of the antibody structure and which type of antibody fixes Complement? Fc portion of IgM and IgG
Describe some characteristics unique to the Fc region of the antibody struction Constant, Carboxy terminal end, Complement binding (at CH2 area), Carbohydrate side chains, Determines isotype (IgM, IgD etc.)
*How is antibody diversity generated? 1)Random "recombination" of VJ (light) or VDJ (heavy). 2)Random combo of heavy and light chains. 3)Somatic hypermutation. 4)Addition of nucleotides to DNA during "recombination" by terminal deoxynucleotidyl transferase.
Can LPS result in immunologic memory? NO, because LPS lacks a peptide component! It stimulates the release of IgM antibodies only. It can't be presented to T cells. Thus, it is Thymus INDEPENDENT.
Which antigens are Thymus DEPENDENT? antigens containing a protein component (eg. conjugated H.influenza vaccine). Get immunologic memory b/c get contact of Bcells w/ Th cells which will cause the release of IL-4,5,6 and cause class switch in B cells to make specific antibodies (so memory)
What are the 2 primary opsonins in bacterial defense? C3b and IgG. C3b aids of clearance of immune complexes. Mnemonic=3Cb Binds Bacteria (opsiniation).
What is the role of Decay-accelerating factor (DAF) and C1 esterase? Help prevent compliment activation of self-cells (RBCs). Note: CD55 & CD59 are components of DAF.
Which C' molecule(s) cause Anaphylaxis? C3a and C5a. "a" for Aniphylaxis
Which C' molecule(s) cause neutrophil chemotaxis? C5a
Which C' molecule(s) are associated with cytolysis by membrane attack complex? C5b-9
Deficiency of C1 esterase leads to what condition? Hereditary angioedema.
What is the result of a C3 deficiency? leads to severe, recurrent pyogenic sinus and respiratory tract infections (esp.strep.pneumo and H.flu); increase susceptibility to type III hypersensitivity reactions
What is the result of a C5-8 deficiency? Leads to Neisseria bacteremia
What is the result of a DAF deficiency/ leads to complement-mediated lysis of RBCs and paroxysmal nocturnal hemoglobiuria (PNH)
How do you dx PNH? Ham's test=RBC lyse at low pH or flow cytometry for CD55 and CD59
Tx for Rh(-) mom who you suspect has a Rh-D(+) baby? Dose anti-Rh-D immunoglobulin at 28wks, at any traumatic accident (MVA), and within 3d of delivery. Also after an abortion or miscarriage.
What are the clinical features of Erythroblastosis fetalis? Anemia due to hemolysis of RBC by mom Ab, Jaundice (maybe Kernicterus), hydrops fetalis, IU death
What is the mechanism by which superantigens cause inflammation? They cause INF-gamma release form Tcells=>INF-gamma stimulates macrophages=>macrophages release IL-1,6 and TNF-a which are acute phase reactants!
What is the mechanism by which Endotoxins/LPS cause inflammation? they DIRECTLY stimulate macrophages by binding to endotoxin receptor CD14, Th cells are NOT involved.
When would you give a patient PREFORMED antibodies? after expose to Tetanus tox, Botulinum tox, HBV, RSV,or Rabies virus. Mnemonic=Pts are given preformed antibodies To Be Healed Rapidly.
Which Hypersensitivity rxn:Poststrep GN? Type III
Which Hypersensitivity rxn:Asthma? Type I
Which Hypersensitivity rxn:Rheumatic fever? Type II
Which Hypersensitivity rxn:Tb skin test? Type IV
Which Hypersensitivity rxn: Allergies, Anaphylaxis, and hay fever? Type I
Which Hypersensitivity rxn:Polyarteritis nodosa Type III
Which Hypersensitivity rxn: serum sickness Type III
Which Hypersensitivity rxn:ABO blood type incompatibility Type II
Which Hypersensitivity rxn:Poison Ivy Type IV
Which Hypersensitivity rxn:Eczema Type I
Which Hypersensitivity rxn:Contact dermatitis Type IV
Which Hypersensitivity rxn:Goodpasture's syndrome Type II
WHich diseases/conditions will result in an elevated ESR? Polymyalgia rheumatica, temporal arteritis, Disease activity in RA and SLE, infection, inflammation (osteomyelitis), and malignancy
YOung kid presents w/ tetany from hypocalcemia and candidiasis resulting from immunosuppression, what cell type is deficient? DiGeorge syndrome, he has a T cell deficiency.
Young kid has recurrent lung infections and graulomatous lesions, what is the defect in the neutrophils? NADPH oxidase
Mom brings in her 2yr old kid who has had multiple viral and fungal infections and is found to be hypocalcemic, which of the 3 types of germ cells gives rise to the missing structure in this child? Failure of endodermal pouches to develop. He has DiGeorge syndrome (missing thymus)
Kid has an immune disorder in which there is a repeated Stap abscesses. It's found that the neurtrophils fail to respond to chemotactic stimuli. Dx? Hyper-IgE syndrome=Job's syndrome
Which drugs are composed of antibodies against TNF? Infliximab, Adalimumab, Etanercept
After a bone marrow transplant, a patient suffers from dermatitis, enteritis, and hepatitis. What disease is occuring? Graft vs. host disease
Which transplant rejection type involves antibody mediated process (typeII) due to the presence of PREFORMED antidonar antibodies in transplant reciepient? Hyperacute rejection, which occurs in minutes.Get occlusion of graft vessles=>ischemia and necrosis
Which transplant rejection type involves cell mediated process due to cytotoxic T cells reacting against foreign MHCs? Acute rejection, occurs weeks after, get vasculitis of graft vessels with dense intersitital lymphocytic infiltrate.
Which transplant rejection type involves Tcell and antibody mediated vascular damage? Chronic rejection, which occurs months to years after transplantation.
Which of the following transplant rejection processes are reversible: Chronic vs. Acute? Acute is reversible with immunosuppression and Chronic is irreversible
Defective CD40L on helper T cells-what disease is this? Hyper-IgM syndrome. Inability to class switch from IgM to other Igs. So have a decrease in IgG, IgA, and IgE
Created by: shelybel



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