NSG 5531CH. 9 ALT IN IMMUNITY GPT STUDY GUIDE QUESTINS WITH VERIFIED ANSWERS
ADV PATHOPHYS STUDY GUIDE
Chapter 9 – Alterations in Immunity (NSU FNP)
I. Core Definitions (HIGH-YIELD)
Hypersensitivity
- An altered/exaggerated immune response causing tissue injury/disease vs. protection in sensitized
individuals.
o Sensitization: adequate amt of antibodies or Tcells avail to cause noticeable rxn on reexposure
o Immediate hypersens Rxn: WITHIN MINS TO HRS. (anaphylaxis: systemic or cutaneous
after a bee sting, urticaria after medication administration)
▪ Antibodies & Mast Cells
▪ Requires rapid emergency care
▪ Epinephrine, Antihistamines, & airway support
o Delayed hypersens Rxn: SEVERAL HRS. (max severity occurs days after reexposure)
(contact dermatitis/poison ivy, positive TB skin test for latent tb)
▪ T-Cells & Macrophages
▪ Corticosteroids or Immunosuppressants
- An adequate/proper/good Immune Response s/s pain, swelling, redness –resolution of
injury/healing
- Immune Responses may be EXCESSIVE (systemic immunocompromise infection or cancer) or
MISDIRECTED (results in tissue injury - can be nonspecific or relate to hypersensitivity rnxs)
🔑 Exam trap: Sensitization occurs on first exposure, symptoms occur on re-exposure
Key Immune Alterations (Know These Cold) – all can be serious or life-threatening
Term Definition EXAM PEARL
Mediated by IgE + mast cells
- Exaggerated immune response to enviro antigens
- Pollen, foods, medications
Allergy IMMEDIATE
- Ex: Allergic rhinitis, asthma, anaphylaxis
- Requires antihistamines or epinephrine
Acute Symptoms
- Immune response against self-antigens
Loss of tolerance to self-
- Misdirected response against hosts’ own tissue cells
antigens
- Chronic Inflammation & Organ Damage
AuTOimmunity
- Ex: Systemic Lupus Erythematosus (SLE) &
Genetic Predisposition &
Hashimoto’s Thyroiditis
Environmental Triggers
- Requires Immunosuppressive Therapy
, - Immune response against tissues of same
species/beneficial foreign tissues Transplants, transfusions, graft
Alloimmunity
- Ex: Hemolytic Disease of the newborn rejection
- Requires Rh Immunoglobulin Administration
, 🔑 Trap:
• Allergy ≠ autoimmunity
• Alloimmunity ≠ autoimmunity
II. Hypersensitivity Reactions (TYPES I–IV)
Type I – IgE-Mediated (IMMEDIATE) ⭐⭐⭐
Mechanism
• Allergen → IgE production
• IgE binds Fc receptors on surface of mast cells (mast cell degranulation)
• Re-exposure → cross-linking → mast cell degranulation → Histamine release
• Cytotropic antibodies bind to cell surface, reagins (antibodies that bind to skin)
• 1st exposure, initial phase of vasodilation, vascular leakage, & possible smooth muscle spasm.
o Eosinophils contribute to mucosal epithelial cell damage.
o Subsequent exposures are characterized by infiltration of tissues with more eosinophils & other
inflammatory leukocytes prolonged epithelial cell damage and mucus secretion.
Receptors
• H1: bronchoconstriction, vasodilation, edema
• H2: ↑ gastric acid, ↓ histamine release from mast cells and basophils
Clinical Examples
• Anaphylaxis
• Allergic rhinitis
• Asthma
• Food allergies
🔑 EXAM TRAP:
ImmEdiate = minutes to hours
Type II – Tissue-Specific (CYTOTOXIC) ⭐⭐⭐
Antibodies (IgG or IgM) bind cell-specific antigens
Five Mechanisms (TESTED) (LPGAT)
1. Complement-mediated cell Lysis
1. (antibodies bind to antigens on cell surface, activates complement, attack complex, cell lysis)
2. Phagocytosis
1. (antibody-coated cells are marked for opsonization, macrophages engulf & remove them)
3. Neutrophils release Granules
1. (antibodies attract neutrophils, attempt to phagocytose the cell, but release toxic granules &
enzymes, damaging the tissue)
4. Antibody-dependent cell-mediated cytotoxicity (ADCC)
1. (NK cells bind to Fc portion of antibodies attached to target cells – release granzymes and
perforin – leads to apoptosis)
5. Causes Target cell malfunction (receptor stimulation or blockade)
1. (Antibodies bind to receptors on the cell surface and block or alter normal function -- i.e.
myasthenia gravis blocks acetylcholine receptors).
Examples
• Drug-induced hemolytic anemia
• Myasthenia gravis
• Graves’ disease
🔑 Trap: This is NOT immune complex disease
2
ADV PATHOPHYS STUDY GUIDE
Chapter 9 – Alterations in Immunity (NSU FNP)
I. Core Definitions (HIGH-YIELD)
Hypersensitivity
- An altered/exaggerated immune response causing tissue injury/disease vs. protection in sensitized
individuals.
o Sensitization: adequate amt of antibodies or Tcells avail to cause noticeable rxn on reexposure
o Immediate hypersens Rxn: WITHIN MINS TO HRS. (anaphylaxis: systemic or cutaneous
after a bee sting, urticaria after medication administration)
▪ Antibodies & Mast Cells
▪ Requires rapid emergency care
▪ Epinephrine, Antihistamines, & airway support
o Delayed hypersens Rxn: SEVERAL HRS. (max severity occurs days after reexposure)
(contact dermatitis/poison ivy, positive TB skin test for latent tb)
▪ T-Cells & Macrophages
▪ Corticosteroids or Immunosuppressants
- An adequate/proper/good Immune Response s/s pain, swelling, redness –resolution of
injury/healing
- Immune Responses may be EXCESSIVE (systemic immunocompromise infection or cancer) or
MISDIRECTED (results in tissue injury - can be nonspecific or relate to hypersensitivity rnxs)
🔑 Exam trap: Sensitization occurs on first exposure, symptoms occur on re-exposure
Key Immune Alterations (Know These Cold) – all can be serious or life-threatening
Term Definition EXAM PEARL
Mediated by IgE + mast cells
- Exaggerated immune response to enviro antigens
- Pollen, foods, medications
Allergy IMMEDIATE
- Ex: Allergic rhinitis, asthma, anaphylaxis
- Requires antihistamines or epinephrine
Acute Symptoms
- Immune response against self-antigens
Loss of tolerance to self-
- Misdirected response against hosts’ own tissue cells
antigens
- Chronic Inflammation & Organ Damage
AuTOimmunity
- Ex: Systemic Lupus Erythematosus (SLE) &
Genetic Predisposition &
Hashimoto’s Thyroiditis
Environmental Triggers
- Requires Immunosuppressive Therapy
, - Immune response against tissues of same
species/beneficial foreign tissues Transplants, transfusions, graft
Alloimmunity
- Ex: Hemolytic Disease of the newborn rejection
- Requires Rh Immunoglobulin Administration
, 🔑 Trap:
• Allergy ≠ autoimmunity
• Alloimmunity ≠ autoimmunity
II. Hypersensitivity Reactions (TYPES I–IV)
Type I – IgE-Mediated (IMMEDIATE) ⭐⭐⭐
Mechanism
• Allergen → IgE production
• IgE binds Fc receptors on surface of mast cells (mast cell degranulation)
• Re-exposure → cross-linking → mast cell degranulation → Histamine release
• Cytotropic antibodies bind to cell surface, reagins (antibodies that bind to skin)
• 1st exposure, initial phase of vasodilation, vascular leakage, & possible smooth muscle spasm.
o Eosinophils contribute to mucosal epithelial cell damage.
o Subsequent exposures are characterized by infiltration of tissues with more eosinophils & other
inflammatory leukocytes prolonged epithelial cell damage and mucus secretion.
Receptors
• H1: bronchoconstriction, vasodilation, edema
• H2: ↑ gastric acid, ↓ histamine release from mast cells and basophils
Clinical Examples
• Anaphylaxis
• Allergic rhinitis
• Asthma
• Food allergies
🔑 EXAM TRAP:
ImmEdiate = minutes to hours
Type II – Tissue-Specific (CYTOTOXIC) ⭐⭐⭐
Antibodies (IgG or IgM) bind cell-specific antigens
Five Mechanisms (TESTED) (LPGAT)
1. Complement-mediated cell Lysis
1. (antibodies bind to antigens on cell surface, activates complement, attack complex, cell lysis)
2. Phagocytosis
1. (antibody-coated cells are marked for opsonization, macrophages engulf & remove them)
3. Neutrophils release Granules
1. (antibodies attract neutrophils, attempt to phagocytose the cell, but release toxic granules &
enzymes, damaging the tissue)
4. Antibody-dependent cell-mediated cytotoxicity (ADCC)
1. (NK cells bind to Fc portion of antibodies attached to target cells – release granzymes and
perforin – leads to apoptosis)
5. Causes Target cell malfunction (receptor stimulation or blockade)
1. (Antibodies bind to receptors on the cell surface and block or alter normal function -- i.e.
myasthenia gravis blocks acetylcholine receptors).
Examples
• Drug-induced hemolytic anemia
• Myasthenia gravis
• Graves’ disease
🔑 Trap: This is NOT immune complex disease
2
