TUTORIAL WEEK 3

STEP ONE
1. Febrile : symptom of fever
2. Malaise : shivering, fatigue
3. Productive cough : cough with mucus
4. Immunization : injecting of antibody into someone to give immunity

STEP TWO
1. What are the types of immunization?
2. Mechanism of immunization.
3. Mechanism of immune response.
4. What causes the febrile in a normal patient?
5. What is lymphadenopathy related to?
6. What are the types of examination that he must do?
7. What is the normal body temperature?
8. What are the normal values of white blood cells, neutrophils, and thrombocytes?
9. What is the normal respiration rate?
10. What is the relation of tobacco use and history of allergy?

STEP THREE
1. What are the types of immunization?
a. Passive and active (vaccination). Passive will produce proteins that will circulate
around the body. Active will trigger body to produce macrophages.
2. Mechanism of immunization.
a. Process when we insert an antigen that has already be modified (weakened) so
that our body could identify it and recognize the disease.
3. Mechanism of immune response.
a. T-cell activated immune response.
4. What causes the febrile in a normal patient?
a. Febrile occurs because the body tries to respond to the pathogens, needing higher
temperature to speed up the response. Body temperature is raised so that the
temperature is no longer optimal for the pathogens to multiply.
5. What is lymphadenopathy related to?
a. Fever is caused by infection of pathogen or bacteria in general. No
lymphadenopathy means no major infection that can cause the lymph nodes to be
enlarged.
6. What are the types of examination that he must do?
a. Vital signs. Lymph nodes examination and thyroid gland examination.
7. What is the normal body temperature?
 a. 36.5-37.5 degrees celsius.
8. What are the normal values of white blood cells, neutrophils, and thrombocytes?
a. Thrombocytes: 150,000-400,000.
9. What is the normal respiration rate?
a. 12-20 breaths per minute.
10. What is the relation of tobacco use and history of allergy?
a. Tobacco use could induce many diseases, like lung cancer.

STEP FOUR
1. What are the types of immunization?
a. Passive and active (vaccination). Passive will produce proteins that will circulate
around the body. Active will trigger body to produce antibodies.
b. Passive is more short term than active.
c. Passive refers to the injection of antibodies from organisms.
2. Mechanism of immunization.
a. Process when we insert an antigen that has already been modified (weakened) so
that our body could identify it and recognize the disease.
b. The route of immunization from intravenous, oral, subcutaneous (most effective),
intraperitoneal, intranasal.
3. Mechanism of immune response.
a. T-cell activated immune response.
b. Antigen-presenting cells expose the peptide to the T cells, triggering immature T
cells to turn into mature but naive T cells.
c. Antigen-presenting cells are the bridge of innate immunity and adaptive
immunity. The dendrite cells in the skin called Langerhaans cells present the
peptide from the pathogen to the lymphocyte T, therefore the T cells will be
activated.
d. T cells will differentiate into 5 types: TFH that will activate B lymphocytes, TH1
will work against intracellular bacteria, TH2, TH17, both will work against
extracellular bacteria, TH2 also will work against helminthes.
4. What causes the febrile in a normal patient?
a. Febrile occurs because the body tries to respond to the pathogens, needing higher
temperature to speed up the response. Body temperature is raised so that the
temperature is no longer optimal for the pathogens to multiply.
b. Substances such as chemokine and interleukine will go through the blood to the
hypothalamus that controls our body temperature. There, substances will alter the
body temperature to make our body not suitable for the organisms to multiply.
5. What is lymphadenopathy related to?
a. Fever is caused by infection of pathogen or bacteria in general. No
lymphadenopathy means no major infection that can cause the lymph nodes to be
enlarged.
 b. Lymph nodes serve as secondary immune organ, so if there’s infection it’s usually
near the area of the lymph nodes.
c. Accumulation of inflammatory cells in the lymph nodes in response of viral
infection.
6. What are the types of examination that he must do?
a. Vital signs. Lymph nodes examination and thyroid gland examination.
b. Bone marrow biopsy.
7. What is the normal body temperature?
a. 36.5-37.5 degrees celsius.
8. What are the normal values of white blood cells, neutrophils, and thrombocytes?
a. Thrombocytes: 150,000-400,000.
b. White blood cells: 5,000-10,000. Neutrophils: 2,500-8,000.
9. What is the normal respiration rate?
a. 12-20 breaths per minute.
10. What is the relation of tobacco use and history of allergy?
a. Tobacco use could induce many diseases, like lung cancer.
b. Allergens will induce immune system to release chemical substances like
histamine, and those substances will cause allergic symptoms to appear.
c. Factors like stress and smoking affect the immune system.

Mechanism of
immune
system and
response

Basic
Immune
System
Lymphatic Types of
circulation immunization
LO:
1. Mechanism of immune response. (innate immunity, adaptive immunity, structures that
help the response including the cells)
a. Innate immunity: skin protects from pathogens. When skin is compromised,
pathogens will enter inner part of body. Macrophages and dendritic cells present
to perform phagocytosis on bacteria/pathogens. Macrophages (type 1: carry
antigens and induce inflammation; type 2: found in GALT and BALT) also
induce cytokine, will call neutrophils when unable to fight pathogens. Neutrophils
will kill bacteria through degranulation through traps and do phagocytosis,
causing inflammation along with chemokine.
b. Adaptive immunity:
i. T cell mediated response: APC carry antigens to lymphoid tissue to
activate T cells (TCD 4/T-helper: TH1 or TH2, depending on type of
infection. TH1 is local, TH2 is allergy or diarrhea)
ii. Humoral response: B cells differentiate into plasma cells and secrete
antibodies needed to act on bacteria. Make holes in the membrane of
bacteria and induces macrophages to perform phagocytosis.
2. Route of pathogens.
a. When there are injuries, pathogens can enter the body more easily. Physical and
chemical barriers when penetrated, the second line of defense is present. The first
is called interferons (lymphocytes, macrophages, fibroblast), complement system
when activated will enhance immune reactions. Iron-binding proteins will inhibit
certain growth of bacteria (transferrin), anti-microbial proteins perform anti-
microbial activity. Natural killer cells (lymphocytes), phagocytes that specialize
in phagocytosis. Inflammation. Fever.
b. Variation of antigens and latency and escape killing and immunosuppression
enable pathogens to keep surviving despite body’s attempts to erradicate them.
Antigen variation is present in the surface of the pathogen so it cannot be easily
identified by the body (influenza). Latency is when the pathogen is inactive in the
body (herpes). Escape killing is when the pathogen has fighting mechanism
(toxoplasma gondii). Immunosuppression is when the pathogen themselves attack
the cells used in the immune system (myobacterium lepra, HIV).
c. From skin or mucosa. Skin: enters by external surface which is the skin itself or
insect bites or wounds. Mucosa: gastrointestinal, respiratory and reproductive
tracts, and blood.
3. Presentation of antigens.
a. APC exposes antigens by using MHC (type 1: presented to CD8, type 2:
presented to CD4).
b. Dendritic cells (mature): gives helper T cells that are naive in the lymph nodes 2
signals. Signal 1: MHC, received by T cells. Signal 2: poststimulatory protein B7
accepted by receptor of T cells (CD28). Both signals are given out when there is
infection. If no infection, only signal 1 is given out. Signal 1 causes T cells to
apoptosis. When both are sent, differentiation occurs. Signal 3 such as cytokine.
4. Activation of B cells.
a. First step is maturation or activation of B cells receptors (BCR). B cells will go
through selection process, for negative selection which occurs in bone marrow. B
cells that bind with self antigen will modify its receptors and go through negative
selection. When fails, apoptosis. B cells will go to lymph nodes through the high
endothelial venule (HEV). There, B cells will bind with T helper cells and will
form primary focus. It will differentiate into plasmablast. Cells that do not turn
into plasmablast will form central germinativum. Two zones of central
germinativum: light (selection of high affinity of B cells, high affinity B cells will
bind with MHC type 2 and bind with T helper cells) and dark (somatic hyper
mutation). After, isotype switching occurs. Then, B cells will become plasma
cells. Plasma cells will go to bone marrow through corda medullary or efferent
lymph nodes. Plasma cells will produce antibodies.
b. Activated by binding of common microbial constituent to the TLR or by extensive
cross linking of BCR to repeated epitopes on bacterial cell. Independent of T
cells.
5. Activation of T cells (CD4, CD8).
a. Antigen is attached to dendritic cell and is going to be transferred to the nearest
lymph nodes. The T cells will enter the paracortex of the lymph nodes and
interact with the antigen. The T cells will differentiate depending on the type of
antigen it receives. If it receives virus antigen, it will turn into cytotoxic T cells,
and will kill the infected cells. If it receives bacteria, it will turn into T helper 1 if
intracellular bacteria, it will turn into T helper 2 and T helper 17 if extracellular
bacteria.
b. T cell selection: positive and negative. Positive occurs in thymus cortex, T cells
that do not bind with MHC will apoptosis, product is from double positive
thymocytus becomes single positive thymocytus. Negative occurs in thymus
medulla, T cells will bind with self antigen will apoptosis.
6. Effectors of immune system.
a. Neutralization, opsonization, complement activation. Neutralization: antibody
will bind with antigen so antigen doesn’t bind with other cells (disarming).
Opsonization: to make phagocytosis easier by attaching to the antibody.
Complement activation: antibody will react to protease C1R and C1S and this will
cause a chain reaction that induces pathogenic destruction that will recruit mast
cells and phagocytic cells into site of infection. Mast cells will induce
inflammation. Introduction of pathogens through C3B. The creation of
membrane-attack complex and this will cause a hole is membrane of pathogens.
7. How vaccination induces immune response.
a. Injected into the body. It mainly stimulates adaptive and humoral immune system,
and cellular immunity.
b. One type of vaccination is injecting virus to patient. Example is HPV vaccine,
therefore vaccine should be given to teenagers who have not had sexual
intercourse.