STRUCTURES, CELLS, AND ANATOMY

Glomeruli

What renal structures reduce in number and function in the elderly, leading to decreased GFR and creatinine clearance

Small-bowel

What anatomical site shows a decrease in surface area due to atrophy of its villi in the elderly, potentially affecting drug absorption

Villi

What structures in the small intestine change shape in the elderly, leading to a reduction in the surface area for nutrient and drug absorption

Stomach

What upper GI organ retains food and drugs longer in the elderly due to slowed gastric emptying

Liver

What internal organ shows decreased hepatic blood flow and up to 30% decreased volume in the elderly, affecting drug metabolism

Kidneys

What organs are the primary site for drug elimination, which is decreased in the elderly due to reduced GFR

Brain

What organ system can be affected by anticholinergic effects, leading to confusion, drowsiness, and memory impairment

Prostate

What gland, when enlarged (BPH), exacerbates urinary retention caused by anticholinergic drugs

Pupil

What ocular structure undergoes dilatation due to the peripheral anticholinergic effects of certain drugs

Eyes

What anatomical structures experience dryness and blurred vision due to peripheral anticholinergic effects

Bronchi

What structures experience decreased secretions due to the peripheral anticholinergic effects of certain drugs

Heart

What organ's rate (tachycardia) can be pathologically affected by peripheral anticholinergic drugs

Intestines (Small and Large)

What parts of the GI tract are affected by constipation, a peripheral anticholinergic effect

Glomerulus

What renal structure's filtration rate estimates how much blood passes through it per minute

Glomerular basement membrane

The deposition of immune complexes on this structure causes glomerular lesions in Lupus Nephritis

Mesangium

What area within the glomerulus often shows immune complex deposition in Lupus Nephritis

Glomerular capillaries

Circumferential thickening of these structures may form a wire loop structure on light microscopy in Diffuse Lupus Nephritis (Class IV)

Bowman’s space

What structure is filled by cellular crescents produced by epithelial cells in the involved glomeruli of Class IV Diffuse Lupus Nephritis

Tubulointerstitial

What renal area, besides the glomerulus, can show nephritis involvement in Systemic Lupus Erythematosus

Skin

What organ is prominently injured in SLE, besides the joints and kidney

Joints

What anatomical structures are prominently injured in SLE, besides the skin and kidney; also the main site of damage in Rheumatoid Arthritis

Serosal membranes

What anatomical structures are prominently injured in SLE, besides the skin, joints, and kidney

Glomeruli

More than 90% sclerosis of these structures characterizes Class VI Advanced Sclerosing Lupus Nephritis

Mitral and aortic valves/leaflets

What cardiac structures are most commonly affected by Libman-Sacks Endocarditis in SLE, appearing as diffuse thickening

Pericardial membrane

What cardiac structure is inflamed (pericarditis) in SLE, potentially leading to partial or total obliteration of its cavity

Heart muscle (myocardium)

What part of the heart can undergo inflammation (myocarditis) in SLE

Dermis

Extensive deposition of dense collagen in this layer of the skin is a key finding in Systemic Sclerosis

Hair follicles and sweat glands

What skin structures are virtually absent in the dermis due to extensive collagen deposition in Systemic Sclerosis

Digital arteries

What blood vessels show intimal proliferation of the lumen in patients with systemic sclerosis

Microvasculature

Widespread narrowing of these small blood vessels leads to ischemic injury and scarring over time in Systemic Sclerosis

Lacrimal and salivary glands

What two glands undergo immunologically mediated destruction in Sjögren syndrome

Parotid gland

What salivary gland may be enlarged in half of patients with Sjögren syndrome

Kidney, heart, lungs, GI

What multiple internal organs undergo progressive fibrosis in Systemic Sclerosis

Digital arteries

What small blood vessels show intimal proliferation of the lumen in systemic sclerosis

Dermis

What skin layer shows extensive deposition of dense collagen in Systemic Sclerosis

Fingertips

What part of the hand may show ulcerated lesions in a patient suffering from Systemic Sclerosis

T-cells

What type of lymphocyte undergoes negative selection or clonal deletion in the thymus during central tolerance

B-cells

What type of lymphocyte undergoes receptor editing and deletion in the bone marrow during central tolerance

Thymus

What lymphoid organ is the site for T-cell central tolerance

Bone marrow

What lymphoid organ is the site for B-cell central tolerance

B lymphocytes

What type of immune cell produces antibody (immunoglobulin) molecules

Lymphocytes

What type of immune cell is "trained" in the thymus to distinguish self vs non-self

Dendritic cells

What cell type phagocytoses antigens and presents them through MHC class II receptors, acting as an antigen-presenting cell

CD4+ T cells (helper T cells)

What cell type receives presented antigens from APCs via MHC class II receptors and sends signals to B cells

CD8+ T cells (killer T cells)

What cell type receives presented antigens from APCs and divides into effector and memory cells

CD8+ effector T cells

What T cell subset directly fights infection after antigenic stimulation

CD8+ memory T cells

What T cell subset multiplies further in the future when the same antigen is encountered

Plasma cells

What differentiated B-cells secrete antibodies specific against donor antigen

B cells

What type of immune cell undergoes proliferation when an antigen is bound to its BCR

Keratinocytes

What cells can be stimulated by UV irradiation to produce IL-1, which promotes inflammation in autoimmunity

T-cells

What primary immune cell undergoes activation leading to fibrosis in Systemic Sclerosis by releasing cytokines that stimulate collagen genes in fibroblasts

Fibroblasts

What cells in systemic sclerosis are stimulated by cytokines (TGF-$\beta$ and IL-13) released by T-cells to transcribe genes encoding collagen

T-cells

What immune cells recognize foreign peptides complexed to self-MHC molecules using the TCR/CD3 complex

Naïve T cells

What T-cell subset is unexposed to any antigen before antigenic stimulation

Effector T cells

What T-cell subset eliminates foreign antigens by secreting cytokines (IFN$\gamma$, IL-4, IL-5) and granzyme B/perforin

Memory precursor T-cells

What T-cell subset carries the memory of a battle and can be activated upon re-exposure to the same antigen

Allograft presenting cells (APCs)

What cells, such as dendritic cells, are involved in presenting donor antigens to the recipient immune system in organ donation

Donor APCs

What immune cells migrate from the transplanted organ to the recipient’s spleen and lymph nodes in direct allorecognition

Recipient APCs

What immune cells migrate, recognize the donor organ, and present donor antigens to recipient T cells in indirect allorecognition

B cell

What basic player in immune response is the third player and secretes immunoglobulins

Naïve B cell

What B cell subset comes into contact with donor peptides in the spleen and lymph nodes to become an activated B cell

Activated B cell

What B cell subset presents donor peptides to a T helper Type 2 (Th2) cell, triggering transformation into a plasma cell

Hematopoietic Cell Transplantation (HCT) recipients

What patient population shows declining antibody titers to Vaccine Preventable Diseases (VPDs) 1–4 years post-transplant and is at increased risk of pneumococcal disease

Neutrophils

What type of white blood cell is low (neutropenia) as an adverse effect of Azathioprine, Mycophenolate mofetil, and Sirolimus

Red blood cells

What blood component is often targeted by autoantibodies in Lupus patients

Red blood cells

What nucleated cells are the exception to HLA Class I distribution (meaning they cannot be found in red blood cells)

Platelets

What blood component is often targeted by autoantibodies in Lupus patients

Lymphocytes

What white blood cells are targeted by autoantibodies in Lupus patients

Lymphocytes

What immune cells are affected by the protein tyrosine phosphatase (PTPN22), which may alter signaling and T-cell activation/negative selection

T-cells

What immune cells are inhibited in their proliferation by Leflunomide's active metabolite, A77-1726

$\beta$-cell lymphocytes

What immune cells, along with T-cells, are inhibited in their proliferation by mycophenolic acid (active product of Mycophenolate Mofetil)

CD20 B lymphocytes

What specific cells are targeted by the chimeric monoclonal antibody Rituximab

Macrophages

What immune cells' function is downregulated by TNF-$\alpha$ blocking agents

T-cells

What immune cells' function is downregulated by TNF-$\alpha$ blocking agents

T-cells

What cells' activation is inhibited by Abatacept binding to CD80 and CD86

Monocytes or macrophages

What cells produce inflammatory cytokines (IL-1, -6, -12, and TNF-$\alpha$) whose release is inhibited by Sulfasalazine's active metabolite, sulfapyridine

T-cells

What type of immune cell proliferation is inhibited by Mycophenolic acid because it inhibits nucleotide synthesis

White blood cells (WBC)

What blood component's count is low (leukopenia) as an adverse effect of Methotrexate, Cyclosporine, and other immunosuppressants

Endothelial cells

What type of cell does Mycophenolate Mofetil interfere with leukocyte adhesion to, by inhibiting E-selectin, P-selectin, and ICAM-1

Small blood vessels

Systemic Sclerosis is characterized by widespread damage to what vessels

Bloodstream

Where does peripheral tolerance occur, besides the tissues

Dermis

What layer of the skin shows vacuolar degeneration of the basal layer of the epidermis in involved areas of SLE skin lesions

Glomerular basement membrane

What renal structure receives deposits of immune complexes, resulting in glomerular lesions in Lupus Nephritis

Mesangial cells

What renal cell type undergoes proliferation in Class II Mesangial Proliferative Lupus Nephritis

Endothelial cells, mesangial cells, and epithelial cells

What three cell types proliferate in the involved glomeruli of Class IV Diffuse Lupus Nephritis

Capillary wall

What part of the glomerulus shows circumferential thickening due to subendothelial immune complex deposits in Class IV Lupus Nephritis

Lumen

Intimal proliferation of this part of the digital arteries is evident in patients with systemic sclerosis

Dermis

What layer of the skin contains extensive deposition of dense collagen in Systemic Sclerosis

Basal layer of the epidermis

What anatomical structure shows vacuolar degeneration in SLE skin lesions under microscopic examination

Dermo-epidermal junction

What location shows variable edema and deposition of immunoglobulin and complement in SLE skin lesions

Spleen and lymph nodes

What anatomical structures do donor APCs migrate to from the transplanted organ in direct allorecognition

Spleen and lymph nodes

What anatomical structures contain the naïve B cell when it comes into contact with donor peptides, becoming an activated B cell

Lacrimal and salivary glands

What two glands are destroyed by immunologically mediated processes in Sjögren syndrome

Digital arteries

Intimal proliferation of the lumen is evident in these small arteries in systemic sclerosis

Paneth and other intestinal epithelial cells

What cells express NOD2, a cytoplasmic sensor of bacteria

B-cells

What immune cells are inhibited in their function by the formation of 6-thioguanine, derived from Azathioprine

T-cells

What immune cells are inhibited in their function by the formation of 6-thioguanine, derived from Azathioprine; also suppressed by Cyclophosphamide

T-cells

What immune cells' proliferation is inhibited by Leflunomide

B cells

What immune cells' production of autoantibodies is reduced by Leflunomide

Neutrophils

What type of white blood cell is associated with low counts (neutropenia) due to adverse effects from TNF-alpha blockers and other immunosuppressants