Immunology Final

What cells are involved in INNATE immunity?

What cells are involved in INNATE immunity?

Granulocytes/ phagocytes

What cells are involved in adaptive immunity?

Lymphocytes

Give an example of INNATE immunity.

Cilia, skin barrier, mucosa, pH, normal flora

What are the most important humoral components of innate immunity?

Cytokines, complement , and acute phase reactants

What are the most important humoral components of adaptive immunity?

Cytokines, antibodies

Describe the double negative stage of T- cell development.

Only has CD3 marker

Does not have CD8 or CD4 marker

Describe double positive stage in T-cell development.

Express both CD4 and CD8

Describe the Positive selection “exam”

Presentation of self-MHC molecules

Intermediate binding accepted

Then will only express either CD4 or CD8 (single positive)

Describe the negative selection stage of T-cell development.

Presentation of self-Ag

Binding signal apoptosis

Clonal deletion

Describe the Pro-B phase of B cell development.

Distinctive markers —> CD19, CD24, c-Kit

Interaction with stem cell factor on stromal cell

Rearrangement of heavy-chain genes

Describe the Pre-B cell stage of B cell development.

Synthesis of heavy-chain part of Ab occurs

Mu (u) chains accumulate in cytoplasm (IgM)

Surrogate light chains on surface

Describe the immature B cell phase of B cell development.

Possess IgM molecule on surface

Other surface proteins —> CD21, CD40, MHC class II

Apoptosis —> programmed cell death (~90%)

Describe the mature B cell phase of B cell development.

IgM and IgD on surface

IgD prolongs lifespan of B cell

Contact with Ag —> differentiate

No contact with Ag —> die in 3 days

Describe facts about MHC I

Present on all nucleated cells

Recognize/used by CD8+ cells

Cell-mediates immunity

HLA-A,B,C

Describe the facts about MHC II

HLA- DQ, DP, DR

Present on APCs

Recognized/used by CD4+ cells

Humoral immunity

Solve the case.

Patient is a 45 yo soccer mom, Black race, presents with 4-month history of feelings of depression, loss of appetite, body aches, headache, and random skin irritations that come and go. Lab results show increased white count, elevated CRP, blood and protein in urine. Phsyical exam reveals bilateral joint inflammation, dry eyes, dry mouth, and gingivitis . RF titer = 1: 1280

a. List the differential diagnosis.

b. What further testing do you recommend?

a. SLE vs RA

b. Need ANAs , Anti-Sm, Anti-CCP

What kind of hypersensitivity is shellfish allergy?

I

What type of hypersensitivity is TB skin test?

IV

What type of hypersensitivity is Goodpasture’s?

II

What kind of hypersensitivity is dermatitis reaction to cosmetics?

IV

What kind of hypersensitivity is Glomerulonephritis secondary to SLE?

III

What kind of hypersensitivity is Poison Ivy?

IV

What kind of hypersensitivity is Blood transfusion reaction?

II

What kind of hypersensitivity is Hay fever?

I

What kind of hypersensitivity is Arthus reaction?

III

What kind of hypersensitivity is Grave’s disease?

III

What kind of hypersensitivity is Allergy to cat dander?

I

What kind of hypersensitivity is synovitis in hands from RA?

III

Is Salk polio vaccine live/attenuated, killed, or subunit?

Killed

Is DTaP a live/ attenuated, killed, or subunit vaccine?

Subunit

Is MMRV a live/attenuated, killed or subunit vaccine?

Live, attenuated

Is HPV a live/attenuated, killed, or subunit vaccine.

Subunit

Is influenza (intramuscular) a live/attenuated, killed, or subunit vaccine?

Killed

Is influenza (intranasal mist) a live/attenuated, killed, or subunit vaccine?

Live/attenuated

Is the Rabies vaccine live/attenuated, killed, or a subunit vaccine?

Killed

What are the steps of phagocytosis?

Adherence, engulfment, phagosome, lysosome, phagolysosome, digestion, excretion, and/or Ag presentation

What clinical manifestation would be seen in a patient with myeloperoxidase deficiency?

Recurrent bacterial infections because defective bacterial killing, possible development of granulomas

The presence of anemia , bone pain, low platelet count, and renal issue is suggestive of which disease?

Multiple myeloma

What serological test is most useful for diagnosis? What do you expect to see in results?

a. SPE with IFE

b. Monoclonal gammopathy

An 11 month old boy is hospitalized for recurrent bouts of bacterial pneumonia, eczema, and thrombocytopenia. What is the most likely diagnosis?

If you performed flow cytometry on this patient’s sample, which cell population would you expect to be affected?

WAS

T-cells

Name the findings that characterize DiGeorge anomaly.

Partial or complete absence of thymus

Major decrease in T cells

Facial abnormalities

Cardiac defects

Hypocalcemia

Tetany

Partial or complete deletion of chromosome 22

What is a toxoid vaccine?

Modified bacterial toxin, Immunogenicity but not pathogenic

Great for immunocompromised patients

What are some examples of toxoid vaccines?

Diphtheria , tetanus , acellular pertussis toxin (DTaP, Tdap)

What kind of immunity is acquired via vaccination?

Active artificial

What kind of immunity is acquired due to active infection?

Active natural

What type of immunity is acquired from anti-venom injection?

Passive artificial

Flow cytometry results on an 8- month old boy reveal normal CD3 counts but absence of CD19 cells. What is the most likely diagnosis?

Bruton’s tyrosine kinase deficiency (Btk)

Deficiency in Btk enzyme needed during Pre-B stage for Ig gene rearrangement

Results in no mature B-cells and no Ab

Bruton’s Agammaglobulinemia

Compare clinical findings of multiple myeloma to Waldenstrom’s macroglobulinemia .

1) monoclonal gammopathy : IgM for Waldenstrom’s vs IgG for Multiple Myeloma

2) Bence Jones proteins in urine

3) Renal insufficiency

4) Anemia

5) Rouleaux — stacked RBCs

6) cold agglutinins

7) neuropathy

8.) bone pain for MM

Types of grafts for transplantation.

Autograft — self

Allograft — same species

Syngeneic — identical twins, like self

Xenograft — from another species

What are the types of transplant rejection?

Hyperacute — mins to hrs due to preformed Ab like ABO

Accelerated — first 3 days post graft; due to preformed Ab

Acute — days to months; CD8 cytotoxicity, ADCC, cytokine activity

Chronic — 1 year or more post graft; memory T-cells effect DTH; GVHD

What is direct recognition?

CD8 toxicity via MHC class I handshake

What is indirect recognition?

APC present Ag to CD4 via MHC class II handshake

What is GVHD?

When immunocompromised cells in graft attack immunocompromised cells in host