Tip:
Highlight text to annotate it
X
now go into this second application have
immuno in terms of taking what we learn in the first part of our discussions
and a planet to clinical vignettes
so the second part is
starting with the first question is
thirty-year-old male print presents to the emergency department
with difficulty breathing and
abdominal pain
so it's pretty generic so it's not a very specific at this point
but on examination you noticed a few scenarios of non pitting edema with the
preview election of the face
okay so he's got a demon in the face
his lips are swollen what when
you most likely find in the compliment analysis at this patient's blood
the best thing to do a lot of times of these questions is to make the diagnosis
and then they're going to ask you
for example
and some uh... technology or some pathogenesis of that particular
diagnosis he got a guy was flown lip swollen face
non-paid in indiana and taking it in cheerleading
now is just a matter of answering the question of what's the mechanism and and
you again
and so industrial uh... the answers in number c looks quite good
you have low c_-one esterase inhibitor which is really the definition pub
ngo in vietnam
and quote c_-four
why the low c_-four is because if u
are not essentially
and you don't have that inhibitor you just going to continue to activate
complement and by activating that classical compliment you're going to use
up your c_ four
said he remembered uh... how that system works in terms of classical compliment
just to review very quickly
is you had fourteen twenty three
by six seven eight nine dry and so this uh... c_-one
mister raises what's gonna split this uh... q r s complex of c_-one and then
you're gonna eventually start to go into and split the zen you get uh...
eventually your uh... your c_-three convert days
between these guys that argument and that giving you your c three b ok c
three b n c three eight so as you might imagine as you can see right there you
get use out that c_-four
because nothing has been inhibit this from continuing to act
and again you get to keep
you gonna keep activating compliment
seeing any get that adina
and uh...
this can be a life threatening situation
number two is in the patient about what is the mediating redeemer
and the answer there is going to be a
the bad too active peptides
c three a
and c five a day
so
as we talked about it
with regard to
classical complement pathway like we just looked at
you get the end of the toxins c four a
c_-three a_n_c_ five-day
and those are going to act on the mast cells right
so the mass ill tell the receptors
for c five a
and then that's gonna cars you to secrete
histamine from the mass l if you look at the other hand terry knows in the fields
where they associate with parasitic infections as well as
any kind of that i do u mediated allergies like we talked about before
those are gonna be recruited
and and and have a an in the event of an allergic reaction macrophages
they're gonna be recreated to the site with i'll eight would be wild one thing
and also need to feels would be repeated
by your c_-five a is a chemotactic furniture pills
and prepared and that stabilizes if you recall the alternative complement
pathway
and work really talking about the classical car pathway c_-three convert
aise
itni review what bad guys is that's that that piece to see three convert is in
the classical
pathway
we get four b right
uh... we had fourteen
twenty-three writes that he had the c_-three convert exacting right here and
that's gonna split the three day
are three and three a and three b
and remembered three-b_ sits on
sits on the bad guy
and the compliment
and their macrophages have a receptor
complement receptor one on the macrophages which enables them top
sanitized the next question is weddings in india tightness this more lesser
a definition uh... a definition that sometimes you might see
on a test question is probably not particularly high yield
but um... if you go through the answers there
uh... cases it's an antigenic
determined that if you're only on the fab fragments of the peso
know exactly bhai spats with others indians had said i think i had to be
looking in anybody
okay
so you got this portion is the fad portion rally talked about
fat man i was thinking batman because this is the portion that's gonna s_n_c_
bind to the bad guy
and then these isotype switching right where you got you know your heavy chaney
a lighting is isotype switching
said so
that is not if you switch for example from my g m two hygiene she arrived to
your own g_-eight
here not to mention a missed this portion here
this portion of the fabric gin
which is part of the e_u_ type ok saddam confusing the attack
uh... like icing on the chilling on the ngos battening down confusing the
attacks without isotype okay
this part right here
is it not going to change it and i supplied switch where'd you get your
gonna get it the switching them the heavy chain are not this combination
have been getting attacked
so the answer that question is gonna be uh... actually yes true
age antigenic determinant did appear only on the fab
fragments
and then the other part that's actually choose well here's
if its ban on with it you die
media types entice erie uh... which is a very interesting as a low confusing it's
capable of blocking reactions
with an appropriate captains to remember what happened
is is that happen
is
a protein that is not
big enough emits of itself to promote in intergenic response in the new response
so deeply backs
so he's a little guy and he pingbacks
on a bigger protein
so this is the happen
and then it becomes too essentially unhappy tope
and at the tokyo well animated it had the effect of unhappy toe
an inept itself is going to buy
uh... you know to despair tell perry this is an important per se but i'm just
trying to explain to you
um... where the word happened comes from
so where this is the news business sometimes in some drug therapies
particularly into your at their peak
they're still trying to work this out to the reason why they go through the use
of the you're familiar with this term sitting on some question
is it bad xlii wealthy
a hindi above
number four is your patients suffering from chronic inflammatory
and al condition
all right so
again were thinking
too much are not an apple case it's chronic inflammatory condition that's
too much in the enemies who have been on the back your mind
now you recommend a new therapy
that actually
infection patient with the parasite
now that they're that theory behind why are you intensely infecting your patient
with the parasite
uh... will help resolve your patients gastrointestinal problems is what
so essentially
this is a sort of one of those
uh... it's a way of asking aside a kind question actually i was told this um...
byhalia by dean of a medical school one time
and the answer is a sense it was built around a
p recital cause a class which tied g_-eight
no that's not true okay that tide g_a_ class switching has to do with the mic
patni ko salam unity
okay so that don't have to do with care sites
bt respectful cause the a switch from the teacher one response
kahkhin high information to eighty eight to response in that actually instru
parasites will induce
anti h two responses remember the usual suspects for dealing with care sites
argument be teenage two-sided kinds
malicious go through those will get a chance to do that because though it's
fun or if we can cure care inside a kind
so remember teens to response
how do we get
from silly goatee p tape start to use a both separate
and that we can even go to t h one
the diet
unity tells my personal favorite all you get a ta stu era in this guy is gonna be
by l four and this is going to be by interfering gamma this history me when
we've gone over this but decided kindly remember that the lowly monica nowadays
is it's ten
uh... four good buddy pink guide
it's friday
the thirteenth okay
uh...
bio their team
and that you also get
five and six is a part of this and say six-pack of beer into alcohol and friday
uh... might have
fives not really friday but it works for me
uh... in any case the let's look at this
say remember about their sites
i help four
yes that's which died she
bright and said that ideas you recall is def is very helpful and he recites
and then all looking here
yellow snow fields is a is i l
five ok so you can see where the parasite that clearly in this family
antes tu side of times
so you don't get this
massive auto information where you got each one airfare i'm down mighty enya
where you're getting mazzella massive proliferation in macrophages
um... in by the way
interferon gamma is called a maktoob page activating factor so that
that basically
exudes macrophages to keep fighting to keep sitting inside kinds to keep going
into the tissues
that's uh... that's a long winded answer but it's a very odd fundamental question
to understanding
the whole sordid differentiation between the two tax beside the kinds
number five education is
repeated infections with cammy bit albert cams
and respiratory viruses since she was three months old
went to the pond axioms in econ to indicate
so he had i can't figure out what type of
uh... immunodeficiency does she have this is clearly immune deficiency
on so
kinney gallon weekend is actually you need a cell-mediated response for this
and so in this case um...
yet have a cell-mediated response
sushi you know you're not gonna wanna give her something that is going to
require
uh... that is going to require
your immune system to react to pathogen
i knew you don't want to give somebody
with cell-mediated i'd efficiency ally vaccine
similarly you'd never get alive xy into an h_i_v_ patient anytime i think of
cell-mediated immune deficiency
i think of the mother of all cell-mediated immune deficiencies which
is h_i_v_ on and so
in this case
which one of these is alive act c_n_b_c_ jeanne yes that's a lie vaccine
on and not listed here which i live which we talked about fame and their
cell and
measles mumps rubella docile and that same
uh... but they're not listed so it is the correct answer
number six is
indication about which of the following threats of immunity is most likely
deficient
and we just talked about it essentially the dates it's going to be your cellular
immunity your t_-cell immunity and again
sometimes if you know one piece of information like the fact that h_i_v_
allowed time jeff candidiasis impex
uh... esophageal candidiasis is one of the and i dipped aids defining lesions
if you will see you can kind of feedback to
that might jog your mind that in fact that is
um... cell-mediated verses any immunity with regard to this particular patient
number seven
is that
uh... well let's go through
uh...
these it immune deficiencies in number six just to be clear about it
so if you have any maybe meaning the deficiency
you probably have issues with at something like a b_t_u_ tax and a scene
will be able to fight
staff are useful talk more about that
uh... if you had that the seas cellular immune to be cell you have a lot of
bacterial infections
if you had leasing leukocytes uh... way you know you
again you would have more of a generalized immune deficiency in if you
had defective ideally are attacked that that you would have
i'd g_i_ problems and sign a pulmonary infections
number seven is in a laboratory experiment with knockout mice you
observed
the mice to be prone to bacteria and viral fungal infections as well as some
cancers
okay so what is knocked out in the room in the minds ok set these transgenic
mice
actually starts on the end the day at the lab to ridicule me now
uh... institute for human robber ology university of maryland has hole
our room full of his *** down my sister he said
want for christmas but on at any rate
they will pull out some keep a little
a component of the little guys immune system and then they see well what
happens now so this guy i mean he's basically uh... easing her you can't buy
anything about tearing of i don't know fungal
and some cancers
so which in these would really abby sort of a piano
and you know and efficiency
aso let's look at it number eight years at the b seven you can them in this one
b seven dash two
cd eight f eighty six morelli let the main things by a hundred names but it
means the same thing phyllis is pretend that you have h_i_v_ because in this
case
not have it easy cell with your t_-cell receptor
being presented
something really delicious by the a_m_a_'s c-class to molecule
oh there's not the coasting alot or a molecule with year uh...
like i said b seven cd tat eighty eighty six yeah yeah d
with this cv
twenty-eight
so what does that mean that means that you cannot
now a t_-cell response in the story
it's better than sexy looks quite
attractive
bien cd eleven
that's part of a i cam and permit he
that's not gonna take out every aspect of your immune system
cd forty l that's on the t_-cell that isotype switching
again that's gonna be you know you would have too much i g m its i cant take out
every aspect and again seen in forty is the same thing set for
in terms of isotype switching except for its on the be self
said the best answer is a
memory depletion is prone to new places dat immuno suppressing drugs
taking after eight liver transplant
that's one of the promise of these drugs is that you suppress your immune system
so that you don't start
actually ampere new oregon they just got
but at the same time immune system does
help you fight cancers
this is the problem uh... with this particular patient
this is due in part the last
of the following static on so here we are trying to warn dolly i do you have
to know anything about liver transplants and i have to do anything
about might accept we need to know
uh... which decided kinds is that they but basically immuno competent like you
get a really strong immune response to be able to leave eliminate things like
and cytotoxic t cell type of a response
ita teach one response
so a m thinking and ia four
estes isotype switching nesties two that's not very attractive i helped by
vizio she feels yes i can kill cancer
i helped and that's the party pooper side the kind it's going to shut down
the teach one responses remembrance can inhibit you from
from ultimately getting interferon gamma
a looking down bergiy is interferon gamma that sounds good if you are in
other words if you lose your interfering gamma you're not going to be able to
uh... you not going to be able to push that teacher one response
and again it's a strong responses can increase
a couple of things mubarek talked about one
interviewing affair and gamma and being a macrophage activating factor
but also your incase cells
there and not finish all t_-cell but they're really getting killing tumor
cells
and remember
i tell to which you would get an increase of what he did get each one
um... in easter pushing a at this type aside a time
enduring k cells
you're gonna get this left this uh... luca connectivity killer are perfect for
that just makes it an even more confident killer
within the presence of iowa to which again if you have the teach one response
city answer is d interfering gamma
you deliver your first job but the remnants of yet barren field and bilkul
corps did not follow up in the appropriate time what can be a possible
cause of this
so
you know it was classic questions but the sense that you think about the the
pathogenesis evidence that you have been bilkul court
and the clean up crews are filming inter fills and using for anything hard facts
you name it you know that nature fills in the first to fight and they're gonna
chill out there me all that degree
and then you know we take other he types of healing
but what's gonna happen here it is that
that's not happened the need to fill scan somehow get to the fire
so what does that mean that means that more than likely that they can
that the d_c_ into the into the at tissue
so let's look at the answers and defect in cv three deputies the receptor makes
no sense to talk about nature fills ninety cells
movie eddie pectin sierra one
that's a compliment receptor that's
again not talking about nature fills the thing about like optimization are red
blood cells have sierra one which enables them to haul off
immune complexes t_v_ ad to the trash can is wing or c_i_d_ pectin kelly crime
it may be picking kelly cryin member type rents but c_-five a c five a day
you wouldn't be able to an
he wouldn't be able to have uh... this sort of reaction
and about the permeability
r_d_ a defect in cd eleven
a dash uh... cd eighteen yes that is the i cam molecule
um... on the often the feeling of that enables the macrophages
immune cells in each of phil's to stick
question eleven your patients suffering from autoimmunity
and it's your desired
too
reduce the ability of immune cells to stick to the end of billing now the last
question it was
your china basically injuries that because your
your patient didn't have the ability
team sticking with you patient with the patient in those
it easy molecules that cd eleven
and an eighteen
this question is is the opposite they have a hot on the on the issues in other
words
yeah i mean cells in the wrong place in there they're they're getting through
but you don't want them to you
so the question is how are you gonna read and prevent them from sticking to
their in detail and so this setback inordinate issue with the ministry grant
the box
uh... what essentially which is the second
so let's look at the interstate
t_g_a_ pay their well in black teens yep beta
what would you be blocking
expressing about that changing update is gonna is again and decrease the
expression of iron ons and of uh...
and that
is sort of an inmate immune interns and have reacted boxes bcs
he'd yet they that
with cn thing it does it will increase the expression of a i've regs
um... so t g f beta
okay so it's getting increasingly i regs
para it's going to decrease on
you know you're
reactive oxygen capability
uh... so
those two are gonna work too well that's essentially going to home
okay you know that's not anything to do with uh... in
anything to do with the patient
be cnf
bhakti neff is again one rights they remember that
the mediators with you're looking at
deferment he jim's you've got
worrying that i can make him tml
and i'll one ok bargaining increase
argumentation that can be camp so that straight away that's a great answer
you're accurate their on because again
you wanna keep those cells from getting into the tissue could that were there
i think damage
c exile five right would you want to turn it back at the lesson of bills and
i'll worries isotype switching so
i tried to you so worked in pushing at each team response to your best answer
is going to be be which is
tea in half
you'd wanna target that and again makes sense because cnf
intake and amp
is one of largest selling drugs
in the world