1. Lymph drainage sites:
    Superior Mesenteric
    Colic -> Inferior Mesenteric
    Internal Iliac
    Superficial inguinal
    • Axillary - upper limb, lateral breast
    • Celiac - stomach
    • Superior Mesenteric - duodenum, jejumum
    • Colic -> Inferior Mesenteric - sigmoid colon
    • Internal Iliac - rectum
    • Superficial inguinal - anal canal, scrotum, thigh
    • Para-aortic - testes
    • Popliteal - dorsum of foot
  2. Macrophages in the spleen remove what?
    • Encapsulated Bacteria - "even some killers have pretty nice capsules"
    • E. coli
    • S.pneumoniae
    • Klebsiella pneumoniae
    • H. influenzae
    • Psuedomonas aeruginosa
    • N. meningitidis
    • Cryptococcus neoformans
  3. Innate immune cells
    • neutrophils
    • macrophages
    • dendritic cells (APCs)
    • NK cells
    • complement made by hepatocytes
  4. Adaptive immune cells
    T cells, B cells, circulating antibodies

    • VDJ recombination
    • responds to vaccines
  5. MHC I
    expressed on all cells except RBCs

    binds TCR on CD8 cells to present antigen

    HLA-A, B and C (one digit, MHC I)
  6. MHC II
    expressed ONLY on APCs!!

    binds TCR on CD4 (T Helpers)

    HLA-DR, DQ, DP (two digits, MHC II)

    a doctor goes to dairy queen to get a doctor pepper
  7. HLA Subtypes:
    • A3 - hemochromatosis
    • B27 - Psoriasis and arthritis, Ankylosing spondylitis, IBD, Reiter's syndrome
    • DR3 and 4 - Diabetes Mellitus
    • DR4 - RA
  8. Have CD16 and 56
    respond to IL-12, IFN-B and IFN-a

    binds to constant region of antibodies on phagocytes presenting antigens
    Natural Killer Cells
  9. Image Upload 1
    Mast Cell found in tissues

    mediates Type I Hypersensitivity

    degranulate histamine, heparin, eosinophil chemotactic factors
  10. Image Upload 2
    Lymphocyte - can be a T or B cell
  11. Dendritic cell
    professional APC, expresses MHC II, CD 80 and 86

    also have MHC I and Fc Receptors
  12. Image Upload 3
    Plasma cell - antibody machine

    "Clock face" chromatin, abundant RER

    If you see a ton of monoclonal antibodies - consider multiple myeloma
  13. multiple myeloma is a neoplasm of what?
    plasma cells
  14. Neutrophils
    multilobe nucleus

    acute response cell

    most numerous in WBCs
  15. Monocyte
    • kidney shaped nucleus
    • becomes macrophage in tissues, monocyte in blood
  16. Macrophage
    CD 14 is specific marker

    also has CD40 (as an APC), B7

    activated by INFy
  17. Eosinophil
    Bilobed nucleus, very pink cell

    Good for helminthic infections

    produces histaminase to calm things down after mast cell degranulation
  18. Basophil
    found in blood only

    mediates allergic reaction

    very dark spotty cell
  19. Carries markers CD 19, 20, 21
    IgM and IgD on surface, as well as CD40, MHC II
    B cell
  20. Carries CD3 on cell surface
    both T cells
  21. Self cells present with this type of MHC
    MHC I - to cytotoxic T cells
  22. Blood types: universal donor? universal recipient?
    • donor - O
    • recipient - AB
  23. If you transfuse the wrong type of blood, what type of hypersensitivity reaction will you get?
    Type II
  24. Dendritic cells in the skin are called Langerhans cells. What do you see histologically in these cells on electron microscopy?
    Tennis rackets - Birbeck Granules
  25. what 3 cell types are known for presenting antigen to T cells?
    • Dendritic cells
    • Macrophages
    • B cells
  26. what hematologic changes would you see in a patient without a functional spleen?
    • howell-jolly bodies
    • target cells
    • thrombocytosis
  27. T cell differentiation:

    What cell markers appear in which stage?
    T cell precursor
    Primoridal T cell
    • T cell precursor - none
    • Primordial - all (CD4 and CD8)
    • Cytotoxic - CD8
    • Helpers - CD4
  28. IL2 and INFy are made by _ which activate what cells?
    Th1 cells

    activate macrophages and CD8's
  29. IL4, IL5 and IL-10 are made by _ which activate what cells?
    Th2 cells

    help B cells make antibodies
  30. Th1 cells are INDUCED by what cytokines? INHBITED by what cytokines?
    • induced:
    • IL-12 (viruses secrete)

    • inhibited:
    • IL-10 (from Th2 cell)
  31. Th2 cells are INDUCED by what cytokines? INHIBITED by what cytokines?
    Induced: IL-10

    Inhibited: IFNy produced by Th1 cells
  32. Helper T cell activation
    • APC presents antigen on MHC II to TCR on T cell
    • B7 on APC interacts with CD28 (costimulation)
    • Th cells produce cytokines
  33. Cytotoxic T cell activation:
    • Any cell presents antigen on MHC I to TCR on cytotoxic t cell
    • IL-2 from nearby Th1 cell activates cytotoxic T cell
  34. B cell activation and class switching
    • Helper T is activated (MHC II) and releases IL4,5,6 and 10.
    • CD40 on B cell binds CD40L on Th2 cell
    • B7 CD28 costimulation
  35. Regulatory T cells
    suppress CD4 and CD8 function

    express CD3, CD4 and CD25 ono surface - produce IL-10 and TNFb (anti-inflammatory cytokines)

    protect from autoimmune disease
  36. Different types of monocytes:

    blood, alveoli, intestines
    • blood, alveoli, intestines - macrophages
    • CT - histiocytes, dendritic cells
    • Liver - Kupffer Cells
    • Kidney - mesangial cells
    • Brain - microglia
    • Bone - Osteoclasts
    • Joints - A cells
  37. Important cytokines - function: IL-1
    Hot T Bone StEAK

    mediates fever
  38. Important cytokines - function: IL-2
    Hot T Bone StEAK

    stimulates t cell function
  39. Important cytokines - function: IL-3
    Hot T Bone StEAK

    stimulates bone marrow
  40. Important cytokines - function: IL-4
    Hot T Bone StEAk

    stimulates IgE and IgG production
  41. Important cytokines - function: IL-5
    Hot T Bone StEAk

    stimulates IgA and eosinophil production
  42. Important cytokines - function: IL-6
    general - fever
  43. Important cytokines - function: IL-8
    Neutrophil Chemotaxis (remember CILK)
  44. Important cytokines - function: IL-10
    Th2 cell activation

    shuts down Th1 cells
  45. Important cytokines - function: IL-12
    Induces Th1 cells and activates NK cells
  46. Important cytokines - function: TNFa
    Mediates septic shock!
  47. Antibody structure
    2 light chains, 2 heavy chains, together by S-S (disulfide) bond

    2 regions - Fab (antigen binding) *light chains only contribute to Fab* and Fc (constant)
  48. Complement and Macrophages bind to which part of the antibody structure?
    Fc - constant region
  49. Name 5 types of heavy chains seen in antibodies
    • Mu - IgM
    • Delta - IgD
    • Gamma - IgG
    • Alpha - IgA
    • Epsilon - IgE
  50. Name 2 types of light chains seen in antibodies
    Lambda and Kappa

    2 Kappa to every Lambda is normal - if not, consider multiple myeloma
  51. What are three functions of antibodies?
    • Opsonization - like sugar on bugs for APC's
    • Neutralization - blocks binding regions on bugs
    • Complement activation
  52. Antibody diversity
    Recombination of VJ (light chains) or VDJ (heavy chains) genes

    initiated by recombination of RAG1 and RAG2 - recombination activating gene complexes.
  53. What happens if RAG genes mutate?
    No T or B cells!
  54. Name the live attenuated vaccines
    • Smallpox
    • Yellow Fever
    • MMR
    • Chickenpox
    • Sabin's polio
  55. Name the killed vaccines
    • Rabies
    • Salk Polio (K for killed)
    • Influenza
    • HAV
  56. do you need a booster for live attenuated vaccines?
  57. Mature B lymphocytes express what immunoglobulins on their surfaces?
    IgM or IgD
  58. Main antibody in delayed antigen response
  59. Most abundant antibody in blood
  60. antibody that fixes complement, crosses the placenta
  61. antibody that fixes complement but does NOT cross placenta
  62. antibody secreted as monomer or dimer
  63. antibody that is in secretion, mucous membranes, and breast milk
  64. antibody produced in immediate response to antigen
  65. antibody secreted as pentamer
  66. antibody that binds mast cells and basophils
  67. antibody that mediates Type I hypersensitivity, lowest concentration in serum
  68. Antinuclear (ANA) antibodies
    SLE, nonspecific
  69. Anti-ds DNA, Anti-Smith antibodies
  70. Antihistone antibodies
    Drug-induced lupus
  71. Anti-IgG
    Rheumatoid Arthritis
  72. Anticentromere
    Scleroderma (CREST)
  73. Anti-Scl70 (anti DNA topoisomerase I)
    Diffuse Scleroderma
  74. Antimitochondrial (AMA)
    Primary Biliary Cirrhosis
  75. antiendomysial
    Celiac disease
  76. Anti-basement membrane
    Goodpasture's Syndrome
  77. Anti-desmoglein
    Pemphigus Vulgaris
  78. Antihemidesmoglein
    Bullous Pemphigus
  79. Antimicrosomal, antithyroglobulin
    Hashimoto's Thyroiditis
  80. Anti-Jo-1
    Polymyositis, Dermomyositis
  81. Anti Ro or Anti La
    Sjogren's Syndrome

    also anytime you see Anti-SS A or B
  82. Anti-U1 RNP (ribonucleoprotein)
    Mixed Connective Tissue Disease
  83. Anti-smooth muscle
    Autoimmune hepatitis
  84. Anti-glutamate decarboxylase, anti-glutamic acid
    Type I diabetes mellitus
  85. c-ANCA
    Wegener's Granulomatosis
  86. p-ANCA
    Microscopic Polyangitis, Churg-Strauss Disease
  87. mpo-ANCA
    pauci immune crescentic glomerulonephritis
  88. anti TSH receptor
    Graves Disease
  89. anti ACh receptor
    Myasthenia Gravis
  90. Amyloidosis
    B pleated sheets - too much protein, deposited in tissues and vasculature
  91. Which cellular organelles are particularly important to plasma cell function?
    Golgi and RER - protein synthesis
  92. Drug: inhibits Calcineurin which acts as
    IL-2 Inhibitor
    used for Transplant Rejection
    Nephrotox (Mannitol diuresis prevents)
  93. Drug:

    XFK -> IL-2 secretion

    used for Organ transplants and eczema
    Tox: peripheral neuropathy, nephropathy
  94. Drug: XFK -> MTOR -> IL-2

    Used for kidney transplants with cyclosporine
    Rapamycin (sirolimus)
  95. Drug:

    monoclonal antibody against IL-2 receptors on t cells

    used in kidney transplants
  96. Drug:

    Inhibits nucleic acid synth
    precursor of 6-mercaptopurine
    used for glomerulonephritis and hemolytic anemia
    metabolized by xanthine oxidase

    tox: aplastic anemia
  97. Drug:

    MAB against CD3 on T cells

    used for kidney transplant
  98. Drug:

    inhibits inosine monophosphate dehydrogenase
    prevents production of GUANINE
    Used for Transplants, lupus nephritis
  99. Drugs:

    Targets TNFa

    Crohn's, RA, psoriatic arthritis and HLA-B27 seronegative arthropathies, ankylosing spondylolysis
    • Infliximab
    • Etanercept
    • Adalimumab
  100. Drug:

    platelet activity
    targets glycoprotein IIb/IIIa
    used for unstable angina
  101. Drug: HER2+ breast cancer
  102. Drug:

    CD20 on B cell non-Hodgkins Lymphoma
  103. Drug:

    used for Type I hypersensitivity, IgE type, asthma
  104. What are the three most "acute" cytokines?
    IL-1, IL-6 and TNFa
  105. What drug affects TNFa and causes phocomelia?
  106. Complement Pathway: mediated by IgM or IgG, antigen/antibody complexes. Starts with C1.
    Classic Pathway
  107. Complement Pathway: starts spontaneously with C3 from microbial surface endotoxins.
    Alternative Pathway
  108. Complement: C3b
  109. Complement: C3a
  110. Complement: C5a
    anaphylaxis, neutrophil chemotaxis
  111. Complement: C5b - 9
    Membrane Attack Complex
  112. Complement deficiencies: hereditary angioedema
    C1 esterase inhibitor deficiency (can't stop classical pathway)
  113. Complement deficiencies: severe recurrent pyogenic infections, glomerulonephritis, increased type III reactions
    C3 deficiency
  114. Complement deficiencies: recurrent Neisseria bacteremia
    (C5b-C9) MAC deficiency
  115. Complement deficiencies: Paroxysmal nocturnal hemoglobinuria

    RBC's are unprotected from complement

    Dx: Ham's Test (RBC's lyse at low pH)
  116. Erythroblastosis Fetalis
    Rh- Mom, Rh+ babies

    jaundice, kernicterus, hydrops fetalis
  117. Type I Hypersensitivity
    Anaphylactic and Atopic (allergies)

    IgE, Mast Cells, Basophils
  118. Type II Hypersensitivity
    Antibody mediated

    IgM, IgG

    Direct/Indirect Coombs tests
  119. Type III Hypersensitivity
    Immune complex mediated


    Serum sickness and Arthrus reaction

    Immunofluorescence test
  120. Type IV Hypersensitivity
    T cell mediated

  121. Hypersensitivity Reaction: Wheal and Flare
  122. Hypersensitivity Reaction: hay fever
  123. Hypersensitivity Reaction: hemolytic or pernicious anemia
  124. Hypersensitivity Reaction: Idiopathic Thrombocytopenic Purpura (ITP)
    II (antibodies to platelets)
  125. Hypersensitivity Reaction: Erythroblastosis Fetalis
  126. Hypersensitivity Reaction: Transfusion reactions
  127. Hypersensitivity Reaction: Rheumatic Fever
  128. Hypersensitivity Reaction: Goodpasture's
  129. Hypersensitivity Reaction: Bullous Pemphigus or Pemphigus Vulgaris
  130. Hypersensitivity Reaction: Graves Disease and Myasthenia Gravis
  131. Hypersensitivity Reaction: SLE
  132. Hypersensitivity Reaction: RA or polyarteritis nodosum
  133. Hypersensitivity Reaction: Post-strep glomerulonephritis or pneumonitis
  134. Hypersensitivity Reaction: Serum sickness, arthrus reaction
  135. Hypersensitivity Reaction: Type I Diabetes Mellitus
  136. Hypersensitivity Reaction: Multiple Sclerosis
  137. Hypersensitivity Reaction: Guillain Barre
  138. Hypersensitivity Reaction: Hashimotos Thyroiditis
  139. Hypersensitivity Reaction: Graft vs Host
  140. Hypersensitivity Reaction: PPD or contact dermatitis (poison ivy)
  141. Immune Disease:

    X linked recessive (boys)
    BTK (tyrosine kinase) gene defect
    Recurrent bacterial infections
    decreased immunoglobins
    Brutons Agammaglobulinemia
  142. Immune Disease:

    Defective CD40L - no class switching
    Severe infections at young age
    Hyper IgM Syndrome
  143. Immune Disease:

    defect in isotype switching - deficient in one Ig
    lung infections, diarrhea, dairy allergy
    IgA deficiency
  144. Immune Disease:

    22q11 deletion, failure of 3rd and 4th pharyngeal pouches

    No T's, PTH

    Tetany, Troussaus (tighten cuff), Chevsteks (cheek)
    DiGeorge Syndrome
  145. Immune Disease:

    No IFNy production

    2 rows of teeth, doughy skin, excess cold absecesses
    coarse facies, eczema (derm probs), IgE in blood
    Job Syndrome (Hyper IgE)
  146. What are the X-linked recessive immune diseases?
    • Brutons
    • Wiskott Aldrich
    • Chronic Granulomatous Disease
  147. Immune Disease:

    adenosine deaminase deficiency
    No thymus, failure to thrive, recurrent infections, diarrhea

    No B or T cells (adenine toxic to these)
  148. Immune Disease:

    defect in ATK gene

    visual problems with smooth pursuits, ataxia, spider angiomas, increased IgA
  149. Immune Disease:

    X linked recessive
    Infections, Eczema, Thrombocytopenic purpura
    • WAITER
    • Wiskott Aldrich
    • Infections, Eczema, Thrombocytopenic purpura, Recessive
  150. Immune Disease:

    Umbilicus fails to detach, recurrent infections
    Defect in LFA-1 integrin
    Leukocyte Adhesion Deficiency
  151. Immune Disease:

    recurrent staph and strep infections
    peripheral neuropathy

    microtubule dysfunction in lysosome/phagosome fusion
    Chediak Higashi disease
  152. Immune Disease:

    Lack of NADPH oxidase

    increased susceptibility to catalase + organisms (S. aureaus, E. coli, Aspergillus)

    Nitroblue tetrazolium dye test - if NEGATIVE test, then you have this disease
    Chronic Granulomatous Disease
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