1. What is self tolerance?
    the immune system doesn’t attack its own cells under normal circumstances
  2. How does the body determine what is "self" and what is foreign
    proteins on the cell membrane
  3. Define antigens. how many types?
    • Cell surface proteins that are not self; these are capable of stimuating an immune response
    • 2types:
    • -complex proteins (pollen)
    • -low molecular weight substances (drugs)
  4. TF: Cancer cells are detected as non-self by the immune system
    True; the mutation of the cell into cancer causes the body to see the cell as foreign
  5. When does the immune system peak?
    In the 20's and the 30's
  6. How does having a blood transfusion weaken immunity
    Even with the right blood type, there are HLA-antigens on the WBCs and the immune system will recognize these as non self.
  7. What are the components of the immune system?
    • bone marrow
    • WBCs
    • Lymphoid tissue
    • Physical barrier (skin, membranes, cilia)
    • Chemical barriers (flora, mucus, secretion, acids, tears, enzymes)
  8. Where are the lymphcytes stored?
  9. Where do the T cells mature and proliferate
    Thymus gland
  10. What parts of the body filter out materials
    • lymph nodes
    • tonsils
    • adenoids

    Note that the spleen filters out old/injured RBCs
  11. The tissue in which systems are involved in anaphylaxis
    • GI
    • respiratory
  12. What are the three processes required for immunity
    • Natural immunity:
    • -inflammation
    • Acquired immunity:
    • -antibody mediated immunity
    • -cell mediated immunity
  13. Distinguish between the presence of natural and acquired immunity
    • Natural or innate immunity is present at birth.
    • Acquired of Adaptive immunity develops after birth
  14. Distinguish between the responses of natural and acquired immunity
    • Natural immunity has a consistent response despite repeated exposure and is responsbile for inflammation.
    • Acquired immunnity has a specific, escalating response and it gets more and more marked
  15. TF: Natural (innate) immunity promotes the development of acquired immunnity
  16. What do the WBCs do in natural immunity?
    They release cell mediators and engulf foreign bodies
  17. TF: the natural immune response is an immediate response
  18. What are the vascualr changes that are involved in the inflammatory response
    • vasodilation
    • increased capillary permeability
    • increased blood flow
    • local tissue congestion
  19. What are the cellular changes that are involved in the inflammatory response
    • phagocytosis
    • increased leukocytes (granulocytes & monocytes)
    • chemical mediator release (mast cells and macrophages)
  20. The WBCs are granular and nongranular. distinguish
    • Granular:
    • neutrophils
    • basophils
    • eosinophils

    • Non-granular:
    • monocytes
    • macrophages
    • lymphocytes
  21. What are the three types of lymphocytes
    • B-cells (antibody mediated/humoral mediated)
    • T-cells (cell mediated)
    • NK cells (natural killer)
  22. B-cell. matures where?type of? produce?
    • matures in bone marrow
    • type of lymphcyte<-agranulocyte<-WBC
    • produce antibodies (immunoglobulins)
  23. T-cell. matures where?type of? it's types?
    • matures in thymus
    • type of lymphcyte<-agranulocyte<-WBC
    • has the following types:
    • -K, killer cytoxic cell
    • -H, helper cells
    • -R, regulatory, suppressor cells
  24. TF: Both B-cells and T-cells (lymphocytes) recognize antigens
  25. the b cells involved in the humoral (antibody mediated response) differentiate into what two types of cells
    • plasma cells that release the antibodies
    • memory cells that remember them for next time
  26. Discuss the escalating response when you exposed to the same antigen again
    The memory cells remembers and kicks it the next time you are exposed to the same antigen
  27. What cells ingest the foreign material?
    The granulocytes and the macrophages

    Remember that the granulocytes are all the -phils.
  28. What cell releases the chemical mediators
    eosinphils (granulocyte)
  29. TF: the phagocytic immune response triggers the inflammatory response
  30. What response dominates in bacterial infection
    Antibody immune or humoral response
  31. What response dominates in fungal and viral infection
    Cell mediated response
  32. Describe antigens and antibodies
    • Antigens are cell surface proteins that are recognized by B and T cells
    • Antibodies are large proteins that contain binding sites for the antigens
    • This binding facilitates phagocytosis
  33. What is the complement activation system
    actions trigered by some classes of antibodies that can remove or destroy antigens
  34. What are the antibodies
    • IgG -activates compliment; most important in bacteria
    • IgM - small amount; early
    • IgA- present in most body fluids: GI, GU, respiratory
    • IgE - allergies
    • IgD
  35. stages of the immune response
    • recognition
    • proliferation
    • response
    • effector

    Think: I recognize profanity and respond effectively
  36. TF: The antigen antibody complex causing clumping
    True: makes it easier for phagocytes
  37. With transplants, what kind of immune response is going on

    Think: not bacteria, so must be cell response that attacks directly
  38. What do the three types of T cells do?
    • HKR:
    • Helper cells: activates and secretes cytokines
    • Killer cells: use cytokines and cytolytic enzymes to immobilize
    • Regulator cells: regulate the degree of response
    • THINK: Help Kill Regularly
  39. What does the complement system do that is activated by the antigen-antibody complex
    • punctures bacteria cell's membrane
    • assist in disposal of inflammation byproducts
  40. What's an example of the hypersensivity immune system?
  41. What's an example of the autoimmmunity immune system?
    • rheumatoid arthritis
    • lupus erythmatosus
    • scleroderma
    • gout
  42. Describe IgE and allergic reactions
    • involves macrophages, B-cells and T-cells
    • IgE binds with antigen trigger mast to release chemical mediators
    • IgE producing cells are located in the respiratory and intestinal mucosa
    • can be biphasic because of continuous release of mediators
  43. How does the low molecular weight substances type of antigen initiate antibody responses
    by attaching to other proteins why
  44. There are two types of chemical mediators of allergic reactions. What are they. describe
    • There is a primary and secondary allergic reaction.
    • The primary reaction occurs immediately and involves mast cells
    • The secondary reaction occurs in response to the primary mediators released by the mast cells
  45. Ther are four types of hypersensitivies
    • Type I immediate (asthma, allergies, anaphylaxis)
    • Type II cytotoxic (MG, thrombocytopenia, hemolytic anemia)
    • Type III immune complex mediated (SLE, RA)
    • Type IV delayed (contact dermitis, GVHD, organ rejection)

    Remember: allergies, anemia, arthritis, a new organ
  46. What do you expect to see in anaphalyxis
    • widespread blood vessel dilation
    • bronchoconstriction
    • decreased cardiac output
    • hypotension too
    • edema
    • pulmonary edema
    • nausea
    • vomiting
    • abdmominal cramping

    Note: both HR and BP are decreased and this can be biphasic
  47. What is the most common cause of anaphylaxis
  48. TF: The risk of anaphylaxis is increased with urban environments
    False; it is increased in rural environments
  49. Which route (parental or oral) contributes more to anaphylaxis
  50. People that take what drugs and miss dosages are at an increased risk of anaphylaxis
    • monoclonal antibodies
    • cytokines
  51. What drugs are commonly involved in anaphylaxis
    • antibiotics
    • allopurinol (for gout)
    • NSAIDs
    • narcotics
    • streptokinases (like TPA)
    • vaccines
  52. What drugs do you use to treat anaphylaxis
    • epinephrine
    • antihistimines
    • H2 antagonists
    • corticosteroids
    • fluids
  53. What happens in a cytotoxic Type II hypersensitvity reaction; examples
    Examples: hemolytic anemias, hemolytic transfusion reactions, myathenia gravis

    • IgG and IgM work together and the body identies something normal in the body as foreign. Develops antibodies to attack own body
    • damage is mostly in kidneys and joints b/c the complexes form increase vascular permeability and cause tissue damage.
  54. What happens in Type III, immune complex hypersensitivity reactions
    T-cells and moncytes are involved in autoimmune inflammatory response
  55. TF: Rheumatoid arthritis can affect the blood vessels, myocardium, kidneys, lungs
    yes, because it is an inflammatory systemic disease
  56. what are the blood tests used to diagnose rheumatoid arthritis?
    • rheumatoid factor
    • ANA
    • E sedimentation rate
    • compliment level
  57. What types of meds are given for rheumatoid arthritis
    • analgesics
    • antipyretics
    • anti-inflammaotry
    • immunosuppresants
    • steroids
    • biologial response modifiers (etanercept, remicade)
  58. TF: Gout is a form of inflammatory arthritis
  59. What is the treatment of acute gout?
    • colchicine
    • NSAIDs
  60. What is the treatment of chronic gout?
    • allopurinol
    • diet: low alcohol, organ meats, red meats, sardines,
    • increase fluids (be careful with diuretics)
  61. With chronic gout, what other illnesses present and/or develop
    • tophi - deposits under skin (fingers, ears)
    • renal calculi
  62. SLE develops from abnromall suppressor T cell production
  63. What drugs do we use to treat lupus
    • corticosteroidds
    • NSAIDs
    • alkylating agent (chemo?)
  64. Scleroderma. mortality. presentation
    • autoimmune disease
    • higher mortality than lupus
    • hard skin
    • renal failure
    • pulmonary hypertension
    • ulcers
    • esophagitis
    • joint inflammation

    SKIN Is like wood
  65. Type IV delayed hypersensitivity reactioons are mediated by which cell
    T- cell reactions. antibodies nor complement are involved.
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