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First Aid for the USMLE Step 1 2020, Thirtieth
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BY u/verified-idiot

To the only girl i've ever loved, to soufia.
BLUE new in FA 2020

YELLOW text of FA 2019 was edited; the note box next to the yellow highlight will show the difference between
them the old text and the new text of FA 2020

Some pages might look scary! because of note boxes and highlighting , but it is not, my recommendation for
you is to study your book and after than look for the new stuff and edits.. I DONT recommend comparing while
you are studying since it will consume your time.




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,HIGH-YIELD PRINCIPLES IN

Immunology


“I hate to disappoint you, but my rubber lips are immune to your charms.” ` Lymphoid Structures 96
—Batman & Robin
` Cellular Components 99
“The fully engaged heart is the antibody for the infection of violence.”
—Mark Nepo ` Immune Responses 104
Learning the components of the immune system and their roles in ` Immunosuppressants 120
host defense at the cellular level is essential for both the understanding
of disease pathophysiology and clinical practice. Know the immune
mechanisms of responses to vaccines. Both congenital and acquired
immunodeficiencies are very testable. Cell surface markers are high
yield for understanding immune cell interactions and for laboratory
diagnosis. Know the roles and functions of major cytokines and
chemokines.




95

, 96 SEC TION II IMMUNOLOGY ``
IMMUNOLOGY—LYMPHOID STRUCTURES



``
IMMUNOLOGY—LYMPHOID STRUCTURES

Immune system 1° organs:
organs ƒ Bone marrow—immune cell production, B cell maturation
ƒ Thymus—T cell maturation
2° organs:
ƒ Spleen, lymph nodes, tonsils, Peyer patches
ƒ Allow immune cells to interact with antigen


Lymph node A 2° lymphoid organ that has many afferents, 1 or more efferents. Encapsulated, with trabeculae
A B . Functions are nonspecific filtration by macrophages, circulation of B and T cells, and
immune response activation.
Follicle Site of B-cell localization and proliferation. In outer cortex. 1° follicles are dense and quiescent. 2°
follicles have pale central germinal centers and are active.
Medulla Consists of medullary cords (closely packed lymphocytes and plasma cells) and medullary sinuses.
Medullary sinuses communicate with efferent lymphatics and contain reticular cells and
macrophages.
Paracortex Contains T cells. Region of cortex between follicles and medulla. Contains high endothelial
venules through which T and B cells enter from blood. Not well developed in patients with
DiGeorge syndrome.
Paracortex enlarges in an extreme cellular immune response (eg, EBV and other viral infections
paracortical hyperplasia lymphadenopathy).


A B



Afferent
lymphatic

Follicles 1º follicle
Paracortex 2º follicle


Germinal center
Mantle zone
Medullary cords
Cortex

Postcapillary Vein
venule
Artery
Capillary
supply

Efferent
lymphatic


Trabecula Medullary sinus
Capsule
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