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DIT day 1 and 2
| Question | Answer |
|---|---|
| What do you treat an acidic drug OD (salylate) with? | NaHCO3 |
| What do you treat a basic drug OD (amphetamines) with? | NH4CL |
| Name the 3 Alz drugs | Donepezil, Galantamine, Rivastigmine |
| How do you tx MG? | ACHE inhibitors, corticosteroids, thymectomy, plasmaphoresis |
| What is the result of excess parasymp activity? | DUMBBELSS |
| What drugs inhibit parasympathetic activity? | "Trops"=aTROPine, homaTROPine, TROPicamide, benzTROPine, ipraTROPium, and scopalamine. 1st 3 drugs can be used mydriasis and beztropine for parkinsons |
| Which drugs are used for tx of urge type of urinary incontinence? | Oxybutynin, Tolterodine, Darifenacin and solifenacin, trospium |
| Drug for post op neurogenic ileus, urinary retention, MG, reversing NMJ blockade from paralytic agents | Neostigmine |
| Pyridostigmine | for MG |
| Edrophonium | Dx MG |
| Physostigmine | glaucoma and "PHixes" Atropine OD. |
| Ecothiophate | Glaucoma |
| Clonidine | Centrally acting a2-agonist, decrease central adrenergic outflow. Especially good for tx of TX in pts with renal disease |
| How do you tx a pt. who has HTN and BPH? | Give a -zosin. If pt doesn't have HTN then just give Tamsulosin |
| Good drug in an elderly patient who is depressed, has poor appetite and is not sleeping well. | Mirtazapine |
| Drug for anaphylaxis | Epi |
| 1st line for cardiogenic shock | Dobutamine |
| 1st line for septic shock | NE |
| HOw do you dx glaucoma | cupping of the optic disk (cup:disc ratio greater than 1:2) or tonometry |
| Saturday night palsy | compression of radial n against spiral groove of the humerus |
| Lecithinase that causes gas gangrene | alpha toxin of clostridium perfringins |
| Toxin inhibits adenylate cyclase and leads to whooping cough | Pertussis tox (AB tox) |
| Toxin that stimulates adenylate cyclase=>get CL- and H2O into gut=Diarrhea | Cholera toxin and heat labile tox of ETEC |
| Tox that destroys leukocytes | Leukocidin. Tox of Staph aureus |
| Tox composed of edema factor, lethal factor and protective antigen | Cytotoxin of bacillus anthracis |
| tox that causes scarlet fever | erythrogenic and pyrogenic toxins of strep pyogenes |
| Tox that blocks the release of the inhibitory NT glycine | tetanospasmin toxin. |
| What are the acute phase cytokines? | IL-1, IL-6, TNF-a |
| What organisms don't take up gram stain? and why? | Ricketsia (inside cell), Chlamydia (inside cell), legionella (inside cell), mycoplasma (no cell wall), Mycobacterium (high lipid content) , treponema (too thin to see). |
| which bac are encapsulated? | Some killers have nice shiny bodies: Strep.pneumonia, klebsiella, H.influenza, Nisseria meningititid, Salmonella and Strep B. |
| Which bac are spore formers? | Gram + rods=clostridium and bacillius and also coxiella Burnetii |
| which skin infections can be caused by both strep pyogenes and staph aureus | Folliculitis, Cellulitis, and impetigo |
| What bac commonly cause death in neonates? | Group B strep, Ecoli, listeria |
| SCID | defect in early stem cell differentiation. Caused by Adenosine deaminase deficiency |
| What disease presents with this triad: SEvere recurrent infection, chronic diarrhea, and failure to thrive | SCID |
| Which disease has the following: Immunodeficiency, Thrombocytopenia ,Purpura, Trunkal eczema, and recurrent pyogenic infections | Wiskott Aldrich |
| If a pt comes in and has cerebellar ataxia and poor smooth pursuit of moving targets what is the likely dx and what test do you order? | IgA deficiency=Ataxia telangiectasia. Order alpha fetal protein. It will be increased in these patients |
| What is the treatment of CHronic granulomatous disease? | Prophylactic TMP-SMX and INF-gamma can also be helpful |
| Which organisms are pts susceptible to when they have Chronic Granulomatious disease? | S.aureus, Ecoli, Klebsiella spp.,Aspergillus spp., Candida spp. |
| What is defective in Chediak-Higashi Disease? | Defecive LYST gene (lysosomal transport), so defective phagocytic lysosome. |
| What disease has the following triad: Partial albinism, recurrent respiratory tract and skin infections, neurologic disorders. | Chediak-Higashi Disease |
| Which CD marker is found on all T cells except NK cells? | CD3 |
| Which CD markers are used to ID B cells? | CD 19,20,21 |
| Which CD marker is found on all NK cells and binds the constant region of IgG? | CD 16 (also found on macrophages) |
| Which CD markers inhibit C9 binding? | CD55 & 59 |
| What endotoxin receptor (CD marker) is found on macrophages? | CD 14 |
| Which cytokines promote B cell growth and differentiation? | IL-4,5 |
| Which cytokines are produced by Th1 cells? | IL-2 and INF-gamma |
| Which cytokines are produced by Th2 cells? | IL-4,5,10 |
| Which pyogens are secreted by monocytes and macrophages? | IL-1,6, TNF-a (acute phase cytokines) |
| Which cytokine inhibits Th1 cell produciton? | IL-10 |
| Which cytokine inhibits Th2 cell production? | INF-gamma |
| Which cytokines mediate inflammation? | IL-1,6, TNF-a |
| Which cytokines are released by virally infected cells? | INF-a and Beta |
| Which cytokine supports growth and differentiation of bone marrow stem cells? | IL-3 (just like GM-CSF) |
| Which cytokines supports T-cell proliferation,differentiation, and activation? | IL-2 |
| What initiates the VDJ recombination process that occurs in B and T cells? | breaks in the dsDNA at Recombination signal sequences (RSSs) that flank the VDJ region. Recombination is started by recombination activating gene complex (RAG 1 & 2), these recognize RSSs. |
| Which IG isotype is present in large quantities on the membrane of many B cells? | IgD and IgM |
| Which IG isotype can occur as a dimer? | IgA |
| Which IG isotype is largely confined to the intravascular pool and is the predominant early antibody frequently seen in immune response to infectious organisms w/ complex antigens? | IgM |
| WHich IG isotype is distributed evenly b/w the Intravascular and extravascular pools | IgG |
| Which part of the Lymph node contains high endothelial venules through which T and B cells enter from the blood? | Paracortex |
| Which part of the lymph node is not very well developed in patients with DiGeorge syndrome? | Paracortex |
| How does the lymph node respond to an EXTREME cellular immune response, like a viral infection? | Paracortex enlarges |
| Drainage site of upper limb and lateral breast? | Axillary nodes |
| Drainage site of stomach? | Celiac nodes |
| Drainage site of duodenum and jejunum? | Superior mesenteric |
| Drainage site of Sigmoid colon? | Colic to inferior mesenteric |
| Drainage site of Rectum (lower above pectinate line)? | Internal iliac part, anal canal |
| Drainage site of anal canal below? | Superficial inguinal pectinate line |
| Drainage site of testes? | Superficial and deep plexuses to para-aortic |
| Drainage site of scrotum? | superficial inguinal |
| Drainage site of thigh (superficial) | Superficial inguinal |
| Drainage site of lateral side of dorsum of foot | Popliteal |
| Which duct drains the right arm and right half of the head? | R.lymphatic duct |
| Which duct drains everything except the right arm and right half of the head? | Thoracic duct (at junction of L.subclavian and internal juglar v) |
| Where are T cells found in the Lymph node vs. the spleen? | They are found in the "P" structures. Paracortex of the node and PALS(periarterial lymphatic sheath)in the spleen |
| Where are the B cells found in the lymph node vs. the spleen? | Found in the follicles of both. Note the b cells are in the follicles w/in the white pulp of spleen |
| WHere does the Thymus originate from? | epithelium of 3rd brachial pouches |
| Which cells are found in the cortex of the thymus? | immature T cells |
| Which cells are found in the medulla of the tymus? | mature T cells and epithelial reticular cells and also contains Hassall's corpuscles |
| Where in the thymus does +/- selection take place? | at the corticomedullary junction |
| Which cells express MHC I? MHC II? | MHC I expressed by all nucleated cells, not RBCs. MHC II expressed ONLY on APCs |
| What induces a NK cell to kill? | when exposed to a nonspecific activation signal on target cell and/or to absence of class I MHC on cell surface. |
| What is the mechanism NK cells use to kill target cells? | use perforin and granzymes (grenades!) to induce apoptosis |
| What is the difference b/w NK cells and cytotoxic T cell (which both kill virally infected cells)? | NK cells recognize the ABSENCE of MHC I vs. Cytotoxic Tcells use their CD8 to recognize the persence of MHC I that will be presenting a problematic molecule. |
| Which cytokines enhance NK cells? | IL-12, IFN-beta, INF-a |
| WHen is there more IL-12 aound? | When there are more virally infected cells. T-helper cells get IL-12 signal to differentiate into Th1. (remember that Th1 cells will secrete INF-gamma which activates macrophages, then macrophages procude IL-12 which furthur promotes production of Th1). |
| Describe the mechanism by which Helper T cells are activated-what are the signals needed? | Signal 1= APC presents antigen via MHC II, its recognized by TCR on Th cell. Signal 2="costimulatory signal" given by interaction of B7(on APC) and CD28 (on Th cells). Activated Th cells produce cytokines. |
| Describe the mechanism by which cytotoxic T cells are activated-what are the signals needed? | Signal 1=Endogenously sythesized (viral or self) proteins are presented on MHC I and recognized by TCR on Tc Cell. Signal 2= IL-2 from Th cell activates Tc cell to kill virus-infected cell. |
| Describe the mechanism by which B cell class switching occurs-what are the signals needed? | Signal 1= IL-4,5,6 from Th2. Signal 2= CD40 receptor on B cells binds CD40 ligand on Th cells. |
| Which types of cells can cytotoxic T cells kill? | virus-infected, neoplastic, and donor graft cells by inducing apoptosis. |
| Which portion of the antibody structure and which type of antibody fixes Complement? | Fc portion of IgM and IgG |
| Describe some characteristics unique to the Fc region of the antibody struction | Constant, Carboxy terminal end, Complement binding (at CH2 area), Carbohydrate side chains, Determines isotype (IgM, IgD etc.) |
| *How is antibody diversity generated? | 1)Random "recombination" of VJ (light) or VDJ (heavy). 2)Random combo of heavy and light chains. 3)Somatic hypermutation. 4)Addition of nucleotides to DNA during "recombination" by terminal deoxynucleotidyl transferase. |
| Can LPS result in immunologic memory? | NO, because LPS lacks a peptide component! It stimulates the release of IgM antibodies only. It can't be presented to T cells. Thus, it is Thymus INDEPENDENT. |
| Which antigens are Thymus DEPENDENT? | antigens containing a protein component (eg. conjugated H.influenza vaccine). Get immunologic memory b/c get contact of Bcells w/ Th cells which will cause the release of IL-4,5,6 and cause class switch in B cells to make specific antibodies (so memory) |
| What are the 2 primary opsonins in bacterial defense? | C3b and IgG. C3b aids of clearance of immune complexes. Mnemonic=3Cb Binds Bacteria (opsiniation). |
| What is the role of Decay-accelerating factor (DAF) and C1 esterase? | Help prevent compliment activation of self-cells (RBCs). Note: CD55 & CD59 are components of DAF. |
| Which C' molecule(s) cause Anaphylaxis? | C3a and C5a. "a" for Aniphylaxis |
| Which C' molecule(s) cause neutrophil chemotaxis? | C5a |
| Which C' molecule(s) are associated with cytolysis by membrane attack complex? | C5b-9 |
| Deficiency of C1 esterase leads to what condition? | Hereditary angioedema. |
| What is the result of a C3 deficiency? | leads to severe, recurrent pyogenic sinus and respiratory tract infections (esp.strep.pneumo and H.flu); increase susceptibility to type III hypersensitivity reactions |
| What is the result of a C5-8 deficiency? | Leads to Neisseria bacteremia |
| What is the result of a DAF deficiency/ | leads to complement-mediated lysis of RBCs and paroxysmal nocturnal hemoglobiuria (PNH) |
| How do you dx PNH? | Ham's test=RBC lyse at low pH or flow cytometry for CD55 and CD59 |
| Tx for Rh(-) mom who you suspect has a Rh-D(+) baby? | Dose anti-Rh-D immunoglobulin at 28wks, at any traumatic accident (MVA), and within 3d of delivery. Also after an abortion or miscarriage. |
| What are the clinical features of Erythroblastosis fetalis? | Anemia due to hemolysis of RBC by mom Ab, Jaundice (maybe Kernicterus), hydrops fetalis, IU death |
| What is the mechanism by which superantigens cause inflammation? | They cause INF-gamma release form Tcells=>INF-gamma stimulates macrophages=>macrophages release IL-1,6 and TNF-a which are acute phase reactants! |
| What is the mechanism by which Endotoxins/LPS cause inflammation? | they DIRECTLY stimulate macrophages by binding to endotoxin receptor CD14, Th cells are NOT involved. |
| When would you give a patient PREFORMED antibodies? | after expose to Tetanus tox, Botulinum tox, HBV, RSV,or Rabies virus. Mnemonic=Pts are given preformed antibodies To Be Healed Rapidly. |
| Which Hypersensitivity rxn:Poststrep GN? | Type III |
| Which Hypersensitivity rxn:Asthma? | Type I |
| Which Hypersensitivity rxn:Rheumatic fever? | Type II |
| Which Hypersensitivity rxn:Tb skin test? | Type IV |
| Which Hypersensitivity rxn: Allergies, Anaphylaxis, and hay fever? | Type I |
| Which Hypersensitivity rxn:Polyarteritis nodosa | Type III |
| Which Hypersensitivity rxn: serum sickness | Type III |
| Which Hypersensitivity rxn:ABO blood type incompatibility | Type II |
| Which Hypersensitivity rxn:Poison Ivy | Type IV |
| Which Hypersensitivity rxn:Eczema | Type I |
| Which Hypersensitivity rxn:Contact dermatitis | Type IV |
| Which Hypersensitivity rxn:Goodpasture's syndrome | Type II |
| WHich diseases/conditions will result in an elevated ESR? | Polymyalgia rheumatica, temporal arteritis, Disease activity in RA and SLE, infection, inflammation (osteomyelitis), and malignancy |
| YOung kid presents w/ tetany from hypocalcemia and candidiasis resulting from immunosuppression, what cell type is deficient? | DiGeorge syndrome, he has a T cell deficiency. |
| Young kid has recurrent lung infections and graulomatous lesions, what is the defect in the neutrophils? | NADPH oxidase |
| Mom brings in her 2yr old kid who has had multiple viral and fungal infections and is found to be hypocalcemic, which of the 3 types of germ cells gives rise to the missing structure in this child? | Failure of endodermal pouches to develop. He has DiGeorge syndrome (missing thymus) |
| Kid has an immune disorder in which there is a repeated Stap abscesses. It's found that the neurtrophils fail to respond to chemotactic stimuli. Dx? | Hyper-IgE syndrome=Job's syndrome |
| Which drugs are composed of antibodies against TNF? | Infliximab, Adalimumab, Etanercept |
| After a bone marrow transplant, a patient suffers from dermatitis, enteritis, and hepatitis. What disease is occuring? | Graft vs. host disease |
| Which transplant rejection type involves antibody mediated process (typeII) due to the presence of PREFORMED antidonar antibodies in transplant reciepient? | Hyperacute rejection, which occurs in minutes.Get occlusion of graft vessles=>ischemia and necrosis |
| Which transplant rejection type involves cell mediated process due to cytotoxic T cells reacting against foreign MHCs? | Acute rejection, occurs weeks after, get vasculitis of graft vessels with dense intersitital lymphocytic infiltrate. |
| Which transplant rejection type involves Tcell and antibody mediated vascular damage? | Chronic rejection, which occurs months to years after transplantation. |
| Which of the following transplant rejection processes are reversible: Chronic vs. Acute? | Acute is reversible with immunosuppression and Chronic is irreversible |
| Defective CD40L on helper T cells-what disease is this? | Hyper-IgM syndrome. Inability to class switch from IgM to other Igs. So have a decrease in IgG, IgA, and IgE |
Created by:
shelybel
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