First Aid USMLE STEP 1 flashcards
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site in lymph node of B cell localization and proliferation
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follicle
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site in lymph node that houses T cells
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paracortex
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What pharyngeal pouch is the thymus derived from?
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third
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present endogenously synthesized antigens?
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MHC I
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present exogenously synthesized antigens?
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MHC II
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antigen peptides are loaded onto MHC I in RER after delivery via TAP?
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MHC I
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antigen loaded following release of invariant chain in an acidifed endosome?
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MHC II
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Tcell that directly kills virus infected cells?
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CD8 T cell
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What part of the thymus does positive selection of T cells occur in?
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cortex
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What part of the thymus does negative selection of T cells occur in?
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medulla
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Deficiency of autoimmune regulator AIRE in negative selection leads to what syndrome?
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autoimmune polyendocrine syndrome-1
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Helper T cell type that secrets IFN-y?
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Th1 cell
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Helper T cell type that secretes IL4, IL5, IL10, and IL13?
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Th2 cell
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The anti inflammatory cytokines?
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IL 10 and TGF B
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Immunoglobulin that can cross the placenta?
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IgG
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Complement protein for opsonization?
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C3b
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Complement proteins for anaphylaxis?
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C3a, C4a, C5a
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complement protein for neutrophil chemotaxis?
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C5a
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complement protein that helps clear immune complexes?
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C3b
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Complement disorder that causes hereditary angioedema due to unregulated activation of kallidrein which leads to inc bradykinin and Ace inhibitors are contraindicated?
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C1 esterase inhibitor deficiency
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complement disorder that inc risk of severe, recurrent pyogenic sinus and respiratory tract infections and inc susceptibility to type III hypersensitivity reactions?
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C3 deficiency
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complement disorder that inc susceptibility to recurrent Neisseria bacteremia?
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C5-C9 deficiency
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Causes complement-mediated lysis of RBCs and paroxysmal nocturnal hemoglobinuria?
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DAF (GPI-anchored enzyme) deficiency
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Cytokine that induces differentiation of T cells into TH1 cells and activates NK cells?
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IL-12
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Disease with NADPH oxidase deficiency and patients are at higher risk for infection by catalase positive species?
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Chronic granulomatous disease
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The live attenuated vaccines?
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BCG, intranasal influenza, MMR, sabin polio, varicella, yellow fever
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The inactivated or killed vaccines?
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Rabes, influenza (injection), Polio (salk), hep A (RIP Always)
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In anaphylaxis, what do mast cells release?
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histamine and tryptase
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The hypersensitivity reaction that is anaphylactic and atopic?
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Type I
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The hypersensitivity reaction that is cytotoxic (antibody mediated)?
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Type II
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The hypersensitivity reaction that is immune complex-antigen antibody mediated?
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Type III
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The hypersensitivity reaction that is delayed (T cell mediated?
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Type IV
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Anti-ACh receptor autoantibody is assoc with which disorder?
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Myasthenia gravis
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Anti-basement membrane autoantibody is assoc with which disorder?
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Goodpasture syndrome
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Anticardiolipin and lupus anticoagulant are assoc with which disorders?
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SLE, antiphospholipid syndrome
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Anticentromere autoantibody is assoc with which disorder?
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Limited scleroderma (CREST syndrome)
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Anti-desmoglein (anti desmosome) is assoc with which disorder?
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Pemphigus vulgaris
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Anti-dsDNA and anti Smith autoantibodies are assoc with which disorder?
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SLE
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Anti-glutamic acid decarboxylase (GAD 65) autoantibody is assoc with which disorder?
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Type I diabetes mellitus
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Antihemidesmosome autoantibody is assoc with which disorder?
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Bullous pemphigoid
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Anti histone autoantibody is assoc with which disorder?
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Drug induced lupus
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Anti-jo-1, anti sRP and anti Mi 2 autoantibodies are assoc with which disorders/
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polymyositis, dermatomyositis
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Antimicrosomal, antithyroglubulin autoantibodies are assoc with which disorder?
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Hashimoto thyroiditis
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Antimitochondrial autoantibody is assoc with which disorder?
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primary biliary cirrhosis
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Antinuclear (ANA) autoantibody is assoc with which disorder?
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SLE (non specific)
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Antiparietal cell autoantibody is assoc with which disorder?
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pernicious anemia
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Antiphospholipase A2 receptor autoantibody is assoc with which disorder?
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primary membranous nephropathy
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Anti-Scl-70 (anti DNA topoisomerase I) autoantibody is assoc with which disorder?
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scleroderma (diffuse)
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Anti smooth muscle autoantibody is assoc with which disorder?
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autoimmune hepatitis type I
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Anti SSA, anti SSB (anti Ro, anti La) autoantibodies are assoc with which disorder?
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Sjogren syndrome
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Anti TSH receptor autoantibody is assoc with which disorder?
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Graves disease
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Anti U1 RNP (ribonucleoprotein) autoantibody is assoc with which disorder?
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mixed connective tissue disease
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Voltage gated clacium channel antibodies are assoc with which disorder?
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Lambert Eaton syndrome
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IgA anti endomysial, Ig A anti tissue transglutaminase autoantibodies are assoc with which disorder?
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Celiac disease
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MPO-ANCA/p-ANCA autoantibodies are assoc with which disorders?
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Microscopic polyangiitis, eosinophilic granulomatoisis with polyangiitis (Churg Strauss syndrome)
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PR3-ANCA/c-ANCA autoantibodies are assoc with which disorder?
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Granulomatosis with polyangiitis (Wegeners)
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IgM antibody that targets IgG Fc region autoantibody is assoc with which disorder?
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Rhematoid arthritis
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Anti-CCP (more specific) autoantibody is assoc with which disorder?
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Rheumatoid arthritis
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Defect in BTK, a tyrosine kinase gene, which leads to no b cell maturation and recurrent bacterial and enteroviral infections after 6 months?? (dec Ig of all classes)
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x linked (Bruton) agammaglobulinemia
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Most common primary immunodeficiency with inc risk for mucosal infeciton, especially viral, although most patients are asymptomatic?
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Selective IgA deficiency
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Caused by a defect in B-cell differentiation with an inc risk of autoimmune disease, bronchiectasis, lymphoma, and sinupulmonary infections??
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Common variable immunodeficiency
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Caused by failure to develop 3rd and 4th pharyngeal pouches leading to absent thymus and parathyroids? Presentation includes tetany (hypocalcemia), recurrent viral/fungal infections, and conctruncal abnormalities?
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DiGeorge syndrome
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Caused by a dec Th1 response and is autosomeal recessive? Presentation includes disseminated mycobacterial and fungal infections?
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IL-12 receptor deficiency
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Caused by a deficiency of Th17 cells due to STAT3 mutation which leads to imparied recuritment of neutrophils to sites of infection? Presentation includes coarse facies, cold staphylococcal abscesses, retained primary teeth, inc IgE, and dermatologic problems (eczema)?
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Job syndrome
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Caused by T cell dysfunction and presentation includes Candida albicans infections of skina dn mucous membranes?
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Chronic mucocutaneous candidiasis
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Caused by several types including defective Il 2R gamma chain and adenosine deaminase deficiency and presentation includes failure to thrive, chronic diarrhea, thrush, rureent viral, bacterial, fungal, and protozoal infections for defective cell mediated and humoral immunity?
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Severe combined immunodeficiency (SCIDs)
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Caused by defects in ATM gene leading to failure to repair DNA double strand breaks and cell cycle arrest and presentation includes cerebellar defects, spider angiomas, and IgA defciency (pulmonary infections)?
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Ataxia telangiectasia
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Commonly due to defective CD40L on Th cells leading to a class switching defect causing severe pyogenic infections early in life as well as opportunistic infection with Pneumocystis, cryptosporidium and CMV?
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Hyper IgM syndrome
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Caused by mutation in WAS gene and T cells are unable to reorganize actn cytoskeleton and the presentation includes thrombocytopeniza, Eczema, and recurrent infections?
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Wiskott Aldrich syndrome
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caused by a defect in integrin protein on phagocytes which leads to imparied migration and chemotaxis and presentation includes recureent bacterial sin and mucosal infections, absent pus formation, impaired wound healing and delayed separation of the umbilical cord (> 30 days)?
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Leukocyte adhesion deficiency (type 1)
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Caused by protein trafficking defect characterized by impaired phagolysosome formation and presentation includes recurrent pyogenic infections by staph and strep, partial albanism, perpheral neuropathy, nystagmus, giant granules in leukocytes and pancytopenia?
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Chediak Higashi syndrome
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Caused by a defect of NADPH oxidase and the nitroblue tetrazolium dye reuction test is obsolete?
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Chronic granulomatous disease
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chronic granulomatous disease has susceptibility to which type of organisms?
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catalase positive orangisms
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type of rejection that had pre existing recipient antibodies that react to donor antigen and is a type II hypersensitivity reaciton?
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hyperacute
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type of rejection that is cellular (cd8 tcells are activated against donor MHCs and is type 4 hypersensitivity) and humoral from abs that develop after transplant?
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acute
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type of transplant rejection that is type II and IV hypersensitivity with both cellular and humor components and cd4 t cells respond to recipent APCs presnting donor peptides including allogeneic MHC?
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chronic
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Type of transplant rejection in which grafted immunocompetent t cells preliferate in the immunocompromised host and reject host cells with foregin protiens and is a type 4 hypersensitivity and presents with a maculopapular rash?
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graft vs host disease
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type of apoptoic path that occurs when a regulating factor is withdrawn from a proliferating cell population and is regulated by Bcl-2 family of proteins such as BAX and BAK (proapoptotic) and Bcl2 (antiapoptotic)?
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intrinsic
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type of apoptotic path that is caused by cytotoxic t cell releasing perforin and granzyme B or a Fas-FasL interaction?
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extrinsic
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Caused by defective Fas-FasL interactions?
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autoimmune lymphoproliferative syndrome
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Reaction of neuronal cell body to axonal injury and is characterized by inc protein synthesis, round cellular swelling, displacement of the nucleus to the periphery, and dispersion of Nissl substance throughout cytoplasm?
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chromatolysis
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Dengeneration of axon distal to site of injury?
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Wallerian degeneration
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Ca deposition in abnormal tissues secondary to injury or necrosis and is not directly associated with serum Ca levels?
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Dystrophic calcification
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Widespread deposition of Ca in normal tissue secondary to hypercalcemia and patients are usually not normocalcemic?
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Metastatic calcification
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Caused by defective margination and rolling and has dec Sialyl-Lewis?
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Leukocyte adhesion deficiency type 2
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Wound contraction is mediated by what?
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myofibroblasts
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Tissue mediator that stimulates angiogenesis?
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VEGF and FGF
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Heritable amyloidosis is due to a mutation in what gene?
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transthyretin
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A yellow brown wear and tear pigment associated with normal aging formed by oxidation and polymerization of autophagocytosed organellar membranes?
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Lipofuscin
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Bugs that you use a Giemsa stain for?
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Chlamydia, Borrelia, Rickettsia, Trypanosomes, Plasmodium (Certain Bugs Really Try my Patience)
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Periodic acid Schiff stain is used to diagnose what?
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Whipple disease (Tropheryma whipplei)
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Fungi (Coccidiodies, Pneumocystis jirovecii), Legionella, and H pylori use what stain?
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Silver stain
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What stain is confirming for syphilis?
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FTA-ABS
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Lowenstein Jensen agar is used to isolate which bacteria?
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M tuberculosis
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Eaton agar is used to isolate which bacteria?
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M pneumoniae
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Sabouraudd agar is used to isolate what bug?
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fungi
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Which bugs are obligate intracellulars?
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Rickettsia, chlamydia, coxiella
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Transformation is a feature of what bacteria?
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S. Pneumo, H influenzae type b, Neisseria (SHiN)
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Specialized transduction in which 5 bacterial toxins are encoded in a lysogenic phage?
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Group A strep erythrogenic toxin, Botulinum toxin, Cholera toxin, Diphtheria toxin, Shiga toxin (ABCD'S)
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The bacteria whose toxins inactivate elongation factor2 (EF 2)?
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C diphtheriae and Pseudomonas
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The bacteria whose toxins inactivate 60S ribosome by removing adenine from rRNA?
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Shigella and EHEC
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ETEC toxin that overactivates cAMP?
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Heat labile
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ETEC toxin that overactivates cGMP?
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heat stable
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Bacteria whose toxin (edema toxin) mimics the adenylate cyclase enzyme (inc cAMP)?
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B. anthracis
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Bacteria whose toxin overactivates adenylate cyclase (Inc cAMP) by permanently activating Gs?
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V cholerae
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Bacteria whose toxin overactivates adenylate cyclase by diabling Gi and impairing phagocytosis to permit survival of microbe?
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B pertussis
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Bacteria whose toxin is a phospholipase (lecithinase) that degrades tissue and cell membranes?
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C perfringens
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The only bacterium with a polypeptide capsule (contains D glutamate)?
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B anthracis
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What do you treat nocardia infections with?
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sulfonamides
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What do you treat actinomyces infections with?
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Penicillin
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What is the antibiotic for prophylaxis for M avium intracellulare when the CD4 count is less than 50?
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azithromycin
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Factor of Mycobacteria that inhibits macrophage maturation and induces release of TNF alpha?
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Cord factor
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Factor o mycobacteria that inhibits phagolysosomal fusion?
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sulfatides
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Type of leprosy that has a negative skin test and is characterized by low cell mediated immunity with a humoral Th2 response?
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Lepromatous
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type of leprosy that is characterized by high cell mediated immunity with a largely TH1 type immune response and a positive skin test?
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Tuberculoid
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Which bacteria are lactose fermenting?
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Kelebsiella, E coli, Enterobacter and Serratia (MacConKEE'S)
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A rapidly progressive necrotic cutaneous lesion caused by Pseudomonas bacterema typically seen in immunocompromised patients with neutropenia?
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Ecthyma gangrenosum
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E coli virulence factor that causes cystitis and pyelonephritis?
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fimbriae
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E coli virulence factor that causes pneumonia and neonatal meningitis?
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K capsule
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E coli virulence factor that causes septic shock?
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LPS endotoxin
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Bacteria that is catalase, oxidase, and urease positive?
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H pylori
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A icterohemorrhagic leptospirosis that is a severe form with jaundice and azotemia from liver and kidney dysfunciton, fever, hemorrhage, and anemia?
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Weil disease
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Treatment for Lyme disease?
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doxycycline
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Flu like syndrome after antibiotics are started (esp in syphilis) due to killed bacteria (usually spirochetes) releasing toxins?
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Jarisch-Herxheimer reaction
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Involved in bacterial vaginosis that presents as a gray vaginal discharge with a fishy smell and is nonpainful and is associated with sexual activity and is characterized by Clue cells?
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Gardnerella vaginalis
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Which type of Rickettsial disease rash spares the palms and soles?
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Typhus (typhi and prowazekii)
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What bacteria causes reactive arthritis, follicular conjunctivitis, nongonococcal urethritis, and PID?
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Chlamydia trachomatis
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What does the chlamydial cell wall lack that most bacterial walls have and renders B lactam antibiotics less effective?
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peptidoglycan
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Fungi that are characterized by broad base budding?
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Blastomycosis
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Fungus that forms germ tubes at 37 C?
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Candida
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Treatment and prophylaxis for Pneumocystis jirovecii?
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TMP-SMX
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Tx for sporothrix involves either itraconazole or this?
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potassium iodide
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casues rapidly fatal meningoencephalitis and is transmitted by freshwater that enters the cribiformplate and you will find amoebas in the spinal fluid?
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Naegleria fowleri
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type of malaria that has a 48 hour cycle?
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P vivax/ovale
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type of malaria that has sever, irregular fever patterns?
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P falciparum
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type of malaria that has a 72 hour cycle?
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P malariae
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Disease characterized by fever and hemolytic anemia predominantly in northeastern US and asplenia inc the risk of severe disease? It also is transmitted by a tick
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Babeiosis
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Vaginitis characterize by foul smelling greenish discharge, itching and burning, and strawberry cervix and is transmitted sexually?
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Trichomonas vaginalis
