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USMLE | Immune System

Normal processes

Development of cells of the adaptive immune response, including positive and negative selection during immune development

Structure, production, and function

    • granulocytes, natural killer cells, macrophages, mast cells, dendritic cells, cell receptors (eg, complement receptors and toll-like receptors), cytokines, chemokines
    • T lymphocytes, including T-lymphocyte receptors, accessory molecules (eg, CD3, CD4, CD8, B7), cell activation and proliferation, cytotoxic T lymphocytes, and memory T lymphocytes
    • B lymphocytes and plasma cells, including B-lymphocyte receptors, immunoglobulins, cell activation and proliferation, including development of antibodies and memory B lymphocytes
    • host defense mechanisms, host barriers to infection, mucosal immunity (eg, gut- associated lymphoid tissue and bronchus-associated lymphoid tissue), anatomical locations of T and B lymphocytes

Cellular basis of the immune response and immunologic mediators

    • antigen processing and presentation in the context of MHC I and MHC II molecules (eg, TAP, beta-2 microglobulin), intracellular pathways, mechanisms by which MHC is expressed on the surface; including distribution of MHC I and MHC II on different cells, mechanisms of MHC I and MHC II deficiencies, and the genetics of MHC
    • regulation of the adaptive immune response (eg, peripheral tolerance, anergy, regulatory T lymphocytes, termination of immune response, and B-T lymphocyte interactions)
    • activation, function, and molecular biology of complement (eg, anaphylatoxins) functional and molecular biology of cytokines (eg, IL 1-15)

Basis of immunologic diagnostics (eg, antigen-antibody reactions used for diagnostic purposes, ELISA, immunoblotting, antigen-antibody changes over time, ABO typing)

Principles of immunologic protection

    • vaccine production and mechanisms of vaccine action biologically active antibodies (eg, monoclonal antibodies, polyclonal antibodies including IVIG, VZIG, rabies immunoglobulin)

Effect of age on the function of components of the immune system

Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis

Disorders associated with immunodeficiency deficiency primarily of humoral immunity: common variable immunodeficiency; hyper IgM syndrome; hypogammaglobulinemia/agammaglobulinemia, X-linked (Bruton); selective immunodeficiency (eg, IgA, IgM, IgE)

deficiency/dysfunction primarily of cell-mediated immunity: adenosine deaminase

    • deficiency; DiGeorge syndrome; severe combined immunodeficiency disease
    • (SCID); Wiskott-Aldrich syndrome; granulomatosis; allergic reactions (insect bites)

complement deficiency: alternative pathway component deficiency (C2, C3b, C3bB, C36B6); classical pathway component deficiency (C1q, C1r, C1-C5); terminal component deficiency (C5b-C9; terminal complement complex); C1 esterase inhibitor deficiency, hereditary angioedema; mannose-binding lectin (MBL) deficiency; membrane attack complex deficiency

deficiency of phagocytic cells and natural killer cells: Chediak-Higashi disease; chronic granulomatous disease and other disorders of phagocytosis; leukocyte adhesion deficiency

HIV/AIDS: HIV1 and HIV2; AIDS; AIDS complications (eg, neuropathy, dementia, renal insufficiency); immunology of AIDS; immune reconstitution syndrome (IRS); secondary infections; noninfectious complications

Immunologically mediated disorders

hypersensitivity reactions: type 1, 2, 3, including anaphylaxis; type 4; drug reactions;

      • serum sickness

transplantation: rejection; graft-vs-host disease

Adverse effects of drugs on the immune system: Jarisch-Herxheimer reaction; drugs affecting the immune system (eg, prednisone, azathioprine, cyclosporine, methotrexate, monoclonal antibody drugs [eg, abciximab, adalimumab; bevacizumab, infliximab, omalizumab, rituximab]); vaccine adverse effects


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