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: |
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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 |
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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: |
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Definition
| Ultraviolet Light and Radiation |
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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: |
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Definition
| IgE-mediated allergy to sulfamethoxazole |
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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: |
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Definition
| A disruption of blood and lymph flow |
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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? |
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Definition
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Term
| The clinical importance of chemokines and HIV infection is documented by: |
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Definition
| Δ32 single-allele mutant CCR5 receptors are observed in long-term survivors. |
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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? |
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Definition
| Neutrophil Function Assay |
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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? |
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Definition
| Perform a non-antibody HIV test on the infant |
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Term
| The elevated serum IgE levels seen in patients with HIV infection are correlated with? |
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Definition
| HIV Disease Progression - result of loss of T cell regulation that matches with disease progression |
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Term
| Name 2 consequences of immune deficiency |
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Definition
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Term
| Name 7 Disruptions of Innate and Adaptive Immunity |
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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) |
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Term
| How does sickle cell disease decrease cellular immunity? |
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Definition
- Microinfarction of spleen & autosplenectomy
- Decreased clearance of bacteria |
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Term
| How does sickle cell disease impair humoral immunity? |
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Definition
1. Impaired pneumococcal production
2. Impaired activation of alternative complement pathway |
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Term
| How does diabetes mellitus impair cellular immunity? |
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Definition
T cell cytopenia, Decreased LPR
Decreased chemotaxis and phagocytosis |
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Term
| How does diabetes mellitus decrease humoral immunity? |
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Definition
| Decreased antibody response to vaccines |
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Term
| Name 3 causes of malnutrition |
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Definition
1. Poor protein intake
2. Intestinal Malabsorption
3. Protein loss (enteral, renal) |
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Term
| Name 3 pathophysiological results of malnutrition. |
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Definition
1. Loss of serum albumin
2. Vitamin Deficiency
3. Micronutrient Deficiency |
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Term
| Name 5 harmful effects of malnutrition on the immune system. |
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Definition
1. Decreased lymphocyte production
2. Absent Type IV Hypersensitivity
3. Decreased phagocytic activity
4. Low serum antibody levels
5. Increased infections |
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Term
| How do glucocorticoids suppress inflammatory response? |
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Definition
| Bind to nuclear receptor, receptor binds to promoter region, suppresses the transcription/translation of inflammatory cellular products |
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Term
| How does cyclosporin suppress the immune response? |
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Definition
Inhibits calcineurin
Normally, calcineurin dephosphorylates NFAT, which promotes the transcription of IL-2 (a promoter of T cell activation and proliferation) |
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Term
| Describe the physical affects of trauma. |
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Definition
Loss of epithelial barrier
Vasodilation
Blood vessel permeability
Cell activation
Cytokine release |
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Term
| How does trauma suppress the immune system? |
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Definition
Increased access for pathogens
Increased activated inflammatory cells
Tissue Damage
Release of IL-10, TGF-B, and Prostaglandins |
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Term
| How does high altitude, radiation, and UV light affect the immune system? |
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Definition
T cell anergy
Poor antigen presentation
Severe immunosuppression |
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Term
| How does high altitude, radiation, and UV light affect humoral immunity? |
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Definition
| Defective response secondary to cellular immunity depression |
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Term
| How does being extremely young affect cellular immunity? |
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Definition
Immaturity of lymphoid organs
Decreased immunologic memory, NK cell |
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Term
| How does being extremely young affect the humoral immunity? |
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Definition
Absence of maternal IgG
Decreased production of cytokine and complement |
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Term
| How does being elderly affect cellular immunity? |
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Definition
T cell oligoclonality (many devoted to 1 type of thing)
Decreased naive T cells
Restricted B cell diversity repertoire |
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Term
| How does being elderly affect humoral immunity? |
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Definition
Limited response to vaccines
Decreased production of hematopoietic growth factors |
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Term
| Which group in the USA has had the greatest increase in HIV+ individuals? |
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Definition
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Term
| Describe the cellular levels at different stages within the HIV course. |
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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 |
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Term
| How many T cells is normal for adults vs. children? |
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Definition
Adults = 500
Children = 1500 (0-1y), 1000(1-5y), 500(6-12y) |
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Term
| How do you diagnose HIV in adults? |
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Definition
| Enzyme immunoassay + western blot |
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Term
| How do you diagnose HIV in children |
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Definition
2 non-antibody tests (DNA PCR, Culture)
Cord blood will be a false positive |
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Term
| How do HIV get into cells? |
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Definition
Through chemokine receptors (using their GP120+gp41)
CD4+CCR5 |
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Term
| What are the advantages to having a single or double mutation at CCR5? |
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Definition
Double mutation - can't get infected
Single mutation - slow progressing disease |
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Term
| Describe the viral load progression in adults. |
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Definition
Acute rise and fall by 3-6 weeks
Establish viral set point |
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Term
| Describe the viral burden progression in children. |
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Definition
Pediatric (vertical) infection
High rise 2-4 weeks after birth |
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Term
| Name 3 targets of HIV drug therapy. |
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Definition
1. Reverse transcriptase
2. Glycosylation packaging of virion
3. Entry Inhibitors |
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Term
| Name 3 sanctuaries for HIV which mandate that HAART must be taken for life. |
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Definition
1. CNS (protected by BBB)
2. Semen (protected by blood-testis barrier)
3. CD4+ T cells (non-replicating, long life) |
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Term
| When must you start treatment in an established infection in adults? |
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Definition
| When the CD4+ T cell count goes below 500. |
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Term
| What do you do about acute HIV infections in adults, infants and children? |
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Definition
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Term
| Why do patients have hypersensitivity reactions to HAART treatments? |
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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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