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Lecture 11
Exam 2
42
Immunology
Professional
02/01/2011

Additional Immunology Flashcards

 


 

Cards

Term
Upon a home visit of Child Protective Services, a 2-year-old boy is found to be lethargic, irritable, moon-faced with dermatitis and generalized edema. The child has orange-tinted sparse hair and purulent drainage from both ear canals and nostrils with fetid breath. This child’s condition is likely based upon:
Definition
Protein-Energy Malnutrition

Protein-energy malnutrition can result from lack of proteins, and micronutrients, carbohydrates (marasmus), or just protein and micronutrients with a high carbohydrate diet (Kwashiorkor) as in this case
Term
A 56-year-old airline pilot with 30 years of experience begins to suffer from repeated sinus infections and pneumonia on two occasions 3 months apart. He complains of being tired and without energy, and his urine tests positive for protein. An immunoelectrophoresis of his serum protein reveals a sharp intense band in the gamma globulin region. The cause of this pilots medical condition is most likely related to:
Definition
Ultraviolet Light and Radiation
Term
A 20 year-old HIV-infected woman being treated for the last year with HAART developed pulmonary lymphoid hyperplasia due to Pneumocystis jirovecii (bronchoalveolar lavage). Ten days into treatment of the pneumonia with trimethoprim-sulfamethoxazole, the patient developed a generalized rash without peeling or mucous membrane involvement. This rash is best explained by:
Definition
IgE-mediated allergy to sulfamethoxazole
Term
A 20-year-old soldier receives a shrapnel wound of his abdomen that requires prolonged abdominal surgery to remove fragments. His post-operative course is difficult with many wound infections and re-operations at the military medical center. These repeated abdominal infections are most likely due to:
Definition
A disruption of blood and lymph flow
Term
A 15-year-old adolescent male suffers from repeated upper and lower respiratory tract infections that cultures show to be due to pneumococcal organisms. The onset of these infections was coincident with a gradual enlargement of his spleen beginning at 1-year-of-age. He does not respond with antibody production after immunization with pneumococcal antigens. Which condition does this patient have?
Definition
Sickle Cell Disease
Term
The clinical importance of chemokines and HIV infection is documented by:
Definition
Δ32 single-allele mutant CCR5 receptors are observed in long-term survivors.
Term
A five week-old girl born to an HIV-infected mother presented with nodular pulmonary infiltrates, failure-to-thrive and wasting. The infant’s WBC was 33,400 (HIGH), CD4+ T cell count 5,647, CD8+ T cell count 1,686 cells/μL; serum IgG was 714, IgA 34 and IgM 71 mg/dL; (all other values normal) and the HIV DNA PCR test was negative. Fine needle biopsy of the lung showed a granuloma with branching fungal elements. Which additional laboratory test on the baby would be most likely to lead to the correct diagnosis?
Definition
Neutrophil Function Assay
Term
A childless professional couple adopts a 6-month old child from a mid-developed country. Within a month the infant develops respiratory distress, fever, lymph-adenopathy, and hepatosplenomegaly. Serological tests for CMV and EBV are negative but that for HIV is positive (confirmed in a second test). The birth mother's HIV test was said to be negative at the time of delivery. What would be the correct action?
Definition
Perform a non-antibody HIV test on the infant
Term
The elevated serum IgE levels seen in patients with HIV infection are correlated with?
Definition
HIV Disease Progression - result of loss of T cell regulation that matches with disease progression
Term
Name 2 consequences of immune deficiency
Definition
Infection
Tumor
Term
Name 7 Disruptions of Innate and Adaptive Immunity
Definition
1. Environmental Stress
2. Extreme Age: Young or Old
3. Malnutrition
4. Surgery/Trauma - Splenectomy
5. Immunosuppressive Drugs
6. Genetic and Metabolic Disease
7. Infectious Disease (HIV)
Term
How does sickle cell disease decrease cellular immunity?
Definition
- Microinfarction of spleen & autosplenectomy
- Decreased clearance of bacteria
Term
How does sickle cell disease impair humoral immunity?
Definition
1. Impaired pneumococcal production
2. Impaired activation of alternative complement pathway
Term
How does diabetes mellitus impair cellular immunity?
Definition
T cell cytopenia, Decreased LPR
Decreased chemotaxis and phagocytosis
Term
How does diabetes mellitus decrease humoral immunity?
Definition
Decreased antibody response to vaccines
Term
Name 3 causes of malnutrition
Definition
1. Poor protein intake
2. Intestinal Malabsorption
3. Protein loss (enteral, renal)
Term
Name 3 pathophysiological results of malnutrition.
Definition
1. Loss of serum albumin
2. Vitamin Deficiency
3. Micronutrient Deficiency
Term
Name 5 harmful effects of malnutrition on the immune system.
Definition
1. Decreased lymphocyte production
2. Absent Type IV Hypersensitivity
3. Decreased phagocytic activity
4. Low serum antibody levels
5. Increased infections
Term
How do glucocorticoids suppress inflammatory response?
Definition
Bind to nuclear receptor, receptor binds to promoter region, suppresses the transcription/translation of inflammatory cellular products
Term
How does cyclosporin suppress the immune response?
Definition
Inhibits calcineurin
Normally, calcineurin dephosphorylates NFAT, which promotes the transcription of IL-2 (a promoter of T cell activation and proliferation)
Term
Describe the physical affects of trauma.
Definition
Loss of epithelial barrier
Vasodilation
Blood vessel permeability
Cell activation
Cytokine release
Term
How does trauma suppress the immune system?
Definition
Increased access for pathogens
Increased activated inflammatory cells
Tissue Damage
Release of IL-10, TGF-B, and Prostaglandins
Term
How does high altitude, radiation, and UV light affect the immune system?
Definition
T cell anergy
Poor antigen presentation
Severe immunosuppression
Term
How does high altitude, radiation, and UV light affect humoral immunity?
Definition
Defective response secondary to cellular immunity depression
Term
How does being extremely young affect cellular immunity?
Definition
Immaturity of lymphoid organs
Decreased immunologic memory, NK cell
Term
How does being extremely young affect the humoral immunity?
Definition
Absence of maternal IgG
Decreased production of cytokine and complement
Term
How does being elderly affect cellular immunity?
Definition
T cell oligoclonality (many devoted to 1 type of thing)
Decreased naive T cells
Restricted B cell diversity repertoire
Term
How does being elderly affect humoral immunity?
Definition
Limited response to vaccines
Decreased production of hematopoietic growth factors
Term
Which group in the USA has had the greatest increase in HIV+ individuals?
Definition
Young women
Term
Describe the cellular levels at different stages within the HIV course.
Definition
CD4+ Cells = initial sharp decrease then plateau for many years, sharp decrease again during end stages
Plasma Viral Titer = sharp rise then fall initially, plateau for many years, sharp rise at the end stages
Symptoms: intially many that fade, no symptoms for many years, symptoms reemerge and increase at end stages
Term
How many T cells is normal for adults vs. children?
Definition
Adults = 500
Children = 1500 (0-1y), 1000(1-5y), 500(6-12y)
Term
How do you diagnose HIV in adults?
Definition
Enzyme immunoassay + western blot
Term
How do you diagnose HIV in children
Definition
2 non-antibody tests (DNA PCR, Culture)
Cord blood will be a false positive
Term
How do HIV get into cells?
Definition
Through chemokine receptors (using their GP120+gp41)
CD4+CCR5
Term
What are the advantages to having a single or double mutation at CCR5?
Definition
Double mutation - can't get infected
Single mutation - slow progressing disease
Term
Describe the viral load progression in adults.
Definition
Acute rise and fall by 3-6 weeks
Establish viral set point
Term
Describe the viral burden progression in children.
Definition
Pediatric (vertical) infection
High rise 2-4 weeks after birth
Term
Name 3 targets of HIV drug therapy.
Definition
1. Reverse transcriptase
2. Glycosylation packaging of virion
3. Entry Inhibitors
Term
Name 3 sanctuaries for HIV which mandate that HAART must be taken for life.
Definition
1. CNS (protected by BBB)
2. Semen (protected by blood-testis barrier)
3. CD4+ T cells (non-replicating, long life)
Term
When must you start treatment in an established infection in adults?
Definition
When the CD4+ T cell count goes below 500.
Term
What do you do about acute HIV infections in adults, infants and children?
Definition
Give therapy.
Term
Why do patients have hypersensitivity reactions to HAART treatments?
Definition
Increased IgE level inversely related to CD4+ T cell count (not related to history of allergy)
B/c of cytokine profiles: TH2>TH1
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