Chapter 1

INTRODUCTION
Chapter 2
BACTERIAL STRUCTURE
1) Enumerate the functions of:

a) Ribosomes
i.site of protein synthesis
ii.elective target for antibiotic action
b) Mesosomes
1.involved in cell division and sporulation
2.membranous support for respiratory enzymes
c) Cytoplasmic membrane
1. -selective transport
2. -excretion of extracellular enzymes
3. -respiration
4. -cell wall biosynthesis
5. -reproduction
6. -chemotactic system
d) Cell wall
1. maintain characteristic shape of bacterium
2. -support against high internal osmotic pressure of protoplasm(5-25atm)
3. -cell division
4. -staining affinity of organism
e) Capsule
1. -protection against antibacterial agents
2. -protection from phagocytosis (considered as virulence factor)
3. -attachment to target surface to establish infection
f) Flagella
1.-movement of bacteria towards regions with higher concentration of nutrients and solutes
2.or away from disinfecting substances (negative chemotaxis)
g) Fimbriae (pili)
1. -adherence and attachment to host surfaces to establish infection
2. -conjugation

Chapter 3
BACTERIAL GROWTH
Chapter 4
BACTERIOPHAGES
1. Structure of bacteriophage

Chapter 5
BACTERIAL GENETICS
Chapter 6
BACTERIAL VARIATIONS

1.
a)
b)
2.

3. Enumerate:
a) Methods of gene transfer among bacteria
1. Transformation
2. Conjugation
3. Transduction
a. Specialized transduction
b. Generalized transduction
b) Types of mutation.
Single-base mutation
Silent mutation
Missense mutation
Frame-shift mutation

Chapter 7
GENETIC RECOMBINATION
1. Enumerate:
a)requirements for an ideal cloning vector
1. -as small as possible
2. -well characterized regarding gene location and nucleotide sequence
3. -possess a single cleavage site for at least 1 restriction endonuclease

4. -capable of autonomous replication within the host cell

5. -carry selective marker
b)commonly used cloning vectors
1. -plasmids
2. -bacteriophage
3. -cosmides
4. -animal viruses
c)applications of recombinant DNA technology
1. -mapping of microbial genome
2. -production of biological product of medical importance,e.g. hormones
a. production of recombinant vaccines
3. -preparation of genetic probes
4. -gene therapy
d)the properties of host organisms used for cloning properties
1. -strains used should be free of any restriction activity
2. -nucleic acid of host easily saparable from that of cloning vector

Chapter 8
ANTIMICROBIAL THERAPY
1. Enumerate:
a. Methods for in vitro susceptibility testing:
1. Disc Diffusion method
2. Dilution method (eg. tube broth dilution)
3. Gradient diffusion (E test) method
b. Possible indications for combined therapy
1. severely ill patient suspected of having serious infection
2. febrile neutropenia
3. to delay the emergence og drug-resistant mutants
4. to achieve bactericidal action through synergistic effect
5. mixed infections
c. Indications for empiric therapy:
1. in seriously ill patient after collecting specimens for culture
2. in closed lesion (no available sample)

Chapter 9
DISINFECTION AND STERILIZATION

2- Enumerate

a)

Main methods of disinfection

1-

Boiling water :

a.Boiling at 1000C for 20 minutes achieves high disinfection.

B.useful in emergencies if no sterilizer is available.
2-

Pasteurization:

a(hot water at temperatures lower than 100o C)

b.e.g pasteurization of milk
i.by heating at 63oC for 30 min. or at 72oC for 20 sec.,
ii.followed by rapid cooling,
iii.destroys important pathogenic organisms
iv.e.g. Mycobacterium tuberculosis, Brucella, Salmonella, and Coxiella burnetti.
3-

Ultraviolet Radiation:
a.low energy,
b.non-ionizing radiation present in sun rays or artificially produced by mercury lamps.
C. UV radiations have extremely weak penetration power
d.used only for air and surface disinfection,
e. in operating rooms and laboratory safety cabinets.

4-

Chemical disinfection

b)Main methods of sterilization

I.

Heat
1.Moist heat or steam sterilization.
2.Dry heat sterilization.

II. Low temperature (cold) sterilization methods:

A-Chemical
1.ethylene oxide gas.
2.liquid sterilization process: commonly used liquid sterilants include:
i. -Glutaraldehyde
ii. -Liquid peracetic acid
iii. -hydrogen peroxide 6%
B-Plasma sterilizers
III. Other sterilization methods

1.Ionizing radiation.
2.Filtration.
3.Microwaves.
c)Advantages and disadvantages of:

Steam sterilization

advantages
1.A good ability of saturated
steam to penetrateinto loaded
porous items.

disadvantages
1.Some items cannot
withstand steam at high
temperatures.

2.Liberation of latent heat of 2.Steam sterilization is not

vaporization after cooling due suitable for sterilizing
to condensation of the steam. powders and oils.
3.Absence of toxicity
4.Low costs.

Hot air sterilization

1.The capability of being used 1.Slow and uneven

for sterilizing powders,
penetration of heat into the
waterless oils and glassware. materials to be sterilized.
2.Absence of a corroding
effect.

2.A necessity for prolonged

exposure.

3.Low costs.
Gas (E.O)

3.Damage to the rubber items

and some fabrics
Capability of the instrument 1.long duration of the
that cannot be subjected to the sterilization cycle
steam/hot air sterilization
2.high costs
without any damage
3.toxicity

Membrane filter

1.filter more rapidly

2.they dont affect the filtrate
in any way
3.they adsorb very little of the
substances being filtered
4.remove microorganism from
air supplied to critical areas

4. Mention one method used for sterilization (disinfection) of

a. skin-chemical (biguanides-chlorhexidine)
b.air in operation room-ultraviolet radiation
c. milk-pasteurization
d. disposable plastic syringes@glove-irradiation
e. glassware-sterilization (dry heat)
f. hormones,vitamins@blood products-filtration
g. floor,walls@furnitures-chemical (quaternary ammonium compound)
5.Mention one use for each of the following methods
a. Incineration
i.For dead animal bodies,
ii.infectious hospital waste such as used surgical
dressing and needles.
b. Hot air sterilizers
i.Sterilization of powders,
ii.waterless oils
iii.glassware.
c. UV radiation
i.For air and surface disinfection,
ii. in operating rooms and laboratory safety cabinets.
d. Alcohol
i.Disinfection of thermometers,
ii. external surfaces of stethoscopes
iii.skin antiseptics
(by themselves or in mixture with iodine or chlorhexidine)
e. Iodophores
-For antiseptic purposes
f. Hydrogen peroxide
-Disinfection of endoscopes and antiseptic for open wound
g. Glutaraldehyde
-For high level disinfection or sterilization of the instruments such as
i. endoscopes,
ii. respiratory and anaesthesia equipments.
h. Red heat
-i.Sterilization of inoculating wires,
ii.loops
iii.point of forceps.
i. Bacteria filters
-Sterilization of fluids which would not withstand heat such as
i.antibiotic solutions,
ii.blood products,
iii.hormones
iv.vitamins

j. Ionizing radiation
-Sterilization of prepacked heat-sensitive power items such as
i.bone grafts,
ii. surgical sutures,
iii.disposable plastics syringes,
iv. gloves,
v. catheters,
vi. plastics Petri dishes
vii. intravenous infusion set.
k. Chlorine-active compounds
i.Decontamination of the blood splashes and laboratory working surfaces.
ii.Linen bleaching.
iii.Disinfection of water for domestic use.
l. Phenolics
-Cleaning of floors ,walls and furnitures
m. Peracetic acid
-High level disinfection or sterilization of the instruments such as endoscopes
n. Biguanides (chlorhexidine)
i.Disinfection of the skin and mucous membrane (as a mouth wash).
ii.often combined with detergents for hand washing or with alcohol as a handrub.

Chapter 10
BACTERIAL PATHOGENESIS
Chapter 11
OVERVIEW OF THE IMMUNE SYSTEM
2. Enumerate:

a. the different lymphoid organ

-there are 2 types of lymphoid organ:
1-primary(central) lymphoid organ
a.places where lymphocytes complete their maturation
b.they are: i =>the bone marrow - where the B cells complete their maturation
ii=>the thymus - where the T cells complete their maturation
2-secondary(peripheral) lymphoid organ
a.places where lymphocytes meet the antigens, leading to activation of the lymphocytes
b.they are:
i.=>the lymph node
I.the B lymphocytes in follicles and in the cortex of the lymph node,
II.T lymphocytes diffusely distributed in the paracortical area
ii.=>the spleen
I.the lymphocytes surrounds the arterioles entering the organ,forming the white pulp.

II. inner part called periarteriolar lymphoid sheath

III. containing mainly T cells and is surrounded by a Bcells corona
iii.=>GALT(gut associated lymphoid tissue) - includes the tonsils, adenoids, appendix and Payer's Patches
iv.=>BALT(bronchial)
*includes the tonsils, adenoids, appendix and Payer's patches
*diffusely organized
*protect the respirator epithelium
v=>other mucosal sites
b) changes which occurs when a naive lymphocyte recognizes an antigen
-the changes which occur are:
1-activation : become lymphoblast
2-proliferation : rapid multiplication
3-differentiation : change into effector cells ~
i.B cells changes into plasma cells, capable of secreting
antibody
ii.cytotoxic T cells becomes capable of killing infected cells
iii.helper T cells becomes capable of producing cytokines

Chapter 12
INNATE IMMUNITY
1. Enumerate
a) Mechanical barriers and surface secretions as a mechanism of innate immunity.
1.intact skin and mucous membrane
a.barrier that cannot be penetrated by most microorganisms.
2.the sticky mucous covering mucous membrane
a.traps any foreign material.
3.cilia of respiratory tract epithelium
a.sweep foreign material out.
4.blinking, sneezing, and coughing reflexes
a.expel foreign particles.
5.sweat and sebaceous secretions
a.contain substances that inhibit microorganisms.
6.saliva, tears, and mucous secretions of respiratory, alimentary and genitourinary tracts
a.contain lysozyme which is bactericidal.
7.gastric and vaginal acidity
a. inhibit growth of microorganism.
8.the flushing action of saliva, tears and urine
a.helps in washing microbes from the body.
b) humoral defence mechanism.
1.lysozyme: enzyme that lysis bacteria by destroying the peptidoglycan of their cell wall.
2.complement: group of plasma protein that act to attack extracellular pathogen.

3.acute phase protein: present at very low levels in normal serum but rise dramatically after onset of
infection.
4.interferon: 2 types of interferons. Type 1 is innate immunity and type 2 is part of acquired
immunity

Chapter 13
ANTIGENS
2. Enumerate: Factors affecting immunogenicity
a) Foreigness
b) Molecular size
c) chemical nature
d) route of administration
e) dosage
f) adjuvants
g) host factors

Chapter 14
T-CELL MEDIATED IMMUNITY
Chapter 15
CYTOKINES
1) Enumerate
a.General characteristis of cytokines
I. They are highly potent being acting at very low concentration
II. Not specific to antigen that produce them
III. Act through high affinity cell surface receptor
IV. Their action is transient
V. They act in an autocrine or paracrine manner
VI. They are pleiotropic-same cytokines may have multiple effects
VII. Different cytokines may have same activity(redundancy)
VIII. They may act sequentially(network interaction),increase effect of other(synergy) or as antagonist
a. Cytokines that mediate innate immunity
a. IFN-
b. IFN-
c. IL-12
d. TNF-
e. IL-1
f. IL-6
g. Chemokines
h. IL-10
b. Cytokines that mediated acquired immunity
a. TH-1 IL-1,IFN-,TNF-
b. TH-2 IL-4,IL-5,TGF-

c.
c. Cytokines that stimulate haematopoiesis
a. IL-3
b. IL-7
c. GM-CSF
d. Pro-inflammatory cytokines
a. TNF-
b. IL-1
c. IL-6

Chapter 16
THE HUMORAL IMMUNE RESPONSE
2. Enumerate: applications of monoclonal antibodies(Ab) ~pg 81
a) diagnostic applications widely used in different kinds of serological reaction for Ag detection
i.
determination of lymphocytes markers e.g CD markers
ii.
detection of HLA Ag (tissue typing)
iii.
detection & typing of viruses
iv.
hormonal assays
v.
detection of tumor Ag
b) therapeutic applications
i.
antitumor therapy;
a. use of tumor specific monoclonal Ab
b.linked to cytotoxic drugs (magic bullet therapy)
ii.
immunosuppressive therapy in graft rejection
a.monoclonal Ab against CD3 on T cells
iii.
ttt of drug toxicity e.g digitalis
iv.
passive immunotherapy in some viral diseases
v.
prevention of Rh incompatibility
a.monoclonal anti-Rh D

Chapter 17
COMPLEMENT
Chapter 18
IMMUNITY TO MICROBES
Chapter 19
TUMOR IMMUNOLOGY
3.Enumerate
i.Evasion of the Immune Response
a- immunocompromised host
b- related to tumour antigens:

I.
-tumours lack antigens that can stimulate immune response
II.
-tumours cant be processed and presented with MHC
III.
-amount too small to stimulate immune response
IV. -sheded antigens block antibodies and T cells from reacting with tumour cell
c- tumours located at inaccessible to the immune system
d- poor in expressionof MHC 1 molecules
e- fibrin coating,masking of tumour antigens
f- tumours secrete substances that suppress the immune response
-ii.Characteristic of ideal tumor makers
1) Released only from tumor tissue
2) Specific for a given tumor type
3) Detectable early upon tumor formation
4) Its concentration in the blood is proportional to the tumor mass
5) Present in all patients with the tumor

Chapter 20
HYPERSENSITIVITY
Chapter 21
TRANSPLANTATION IMMUNOLOGY
2) Enumerate.
a.Types of graft
1) Autograft
2) Isograft
3) Allograft
4) Xenograft

a.graft from one part of body to another.

b.Not foreign and do not elicit rejection
a.graft between genetically individual (eg: identical twins).
b.Do not express antigen and not rejected.
a.between genetically different individual of same species.
b.express antigen which are recognize as foreign by the recipient.
a.represent maximal genetic disparity
b. rapidly rejected.

b. Types of rejection
1) Acute rejection

a.takes days or weeks to develop

b.for t- cell activation
2) Hyperacute rejection- a.take place within minutes,
b.caused by preformed anti-donor antibodies

1) Chronic or late rejection-

a.take place months or years after transplantation,

b.depending on genetic disparity.

c. Antigen responsible for immune rejection

1) Blood group antigen of the ABO system

2) MHC antigen
3) Minor histocompatibility complex antigens.

Chapter 22
Tolerance and Autoimmunity
3.Enumerate
a. Factors influencing the induction tolerance
i. high doses of antigen tolarize B-cells while minute doses given repeatedly tolarize T-cells
ii. protein antigen are more tolerogenic in soluble form than in aggregated or particulate
form
iii. to maintain acquired tolarance, the tolerogen must persist or repeatedly admnistered
iv. giving the antigen together with immunosuppresant
v. prenatal or neonatal period
b. Mechanism of tissue damage in autoimmune disorders
i. cytotoxic reactions (type II)
ii. immune complex deposition (type III)
iii. cell-mediated reactions (type IV)
iv. in Graves disease,
a.anti-thyroid antibodies react with thyroid gland cells,
b.increasing the response of cell receptors to TSH,
c.thus stimulates secretion of excess thyroxin,
d.leading to thyrotoxicosis.

Chapter 23
IMMUNODEFICIENCY DISEASES
1. Mention the patient presentation in(or the effect of):
a) Defects of migration of phagocytic cells
i.defects in migration leads to
I.failure of neutrophils and monocytes to migrate from blood stream to sites of infection,despite
their presence in large numbers in the blood.
ii.patient present with infections of skin,mouth,and respiratory tract,but with little pus formation.
b) Defects intracellular killing of phagocytic cells
i.phagocytes cannot produce reactive oxygen radicals,
I.lead to decrease ability to kill intracellular as well as ingested bacteria
i.male children present with chronic bacterial infectionsI.some cases lead to formation of granules.
c) Defect of early component of classical pathway
o
accumulation of immune complex and local tissue damage
d) Defect of early component of alternative pathway
o
pyogenic infection
e) Defect of terminal complement (C5-C9)of complements(MAC)

increased susceptibility to capsulated organism Neisseria meningitides

f) Defect of complement C1 inhibitor

i.uncontrolled activation of the classical pathway of complement activation
a.C2 activation
b.generation C2a(vasoactive amine)-fluid accumulation in tissues and swelling of epiglottis
c.may lead to suffocation and death.Hereditary Angioedema
g) X-linked agamaglobulinemia
a.in infants:
i.symptomatic
ii.natural loss of antibodies at the age 5-6 months
iii.suffer from chronic bacterial infection such as otitis,bronchitis, and pneumonia.
h) Transient hypogammaglobunaemiaof infancy
i.infants have recurrent infections
ii.poor response to the vaccines taken routinely at that age.
i) Deficiency of natural killer cell
o
patients suffer from certain viral diseases and malignancies
j) Thymic aplasia and hypoplasia(Di George Syndrome)
o develop recurrent and chronic viral,bacterial,fungal and protozoal infections
k) Combined T and B cell deficiency(SCID)
a.patients present during the first few months with
i.failure to thrive,
ii.continuous diarrhea,
iii.viral and fungal infections.

4. Enumerate
a. Causes of secondary immunodeficiency(ID)
may acquired a transient or permanent immunologic impairment later in life.
1. Malnutrition in poor and under development country
2. Human Immunodeficiency Virus (HIV) causes Acquired Immune Deficiency Syndrome
(AIDS).the virus infects CD4 Th cells
3. Other virus infection lead to transient ID eg. Measles
4. Severe bacterial infection eg. Tuberculosis
5. Parasitic manifestation eg. Schistosomiasis
6. Malignancies specially Hodgkins disease and leukaemias
7. Others eg.
i.Treatment with X-rays,
ii.cytotoxic drugs, steroids,immunosuppressive drugs

iii.burn with severe loss of body fluids.

8. chronic debilitating disease eg. Diabetes and renal failure
b. Causes in which immunodeficiency is suspected
1. increased in frequency of infection
2. failure clearance of infection rapidly despite adequate therapy
3. dissemination of local infection to distant sites
4. occurrences of opportunistic infection
5. failure to thrive in infant and children
6. development of certain kinds of tumour

Chapter 24
ANTIGEN-ANTIBODY REACTION
4.Mention the type of Ag-Ab reaction in each of the following tests
1. Blood grouping Slide agglutination
2. Elek's test Precipitation
3. Antistreptolysin O Passive agglutination
4. Diagnosis of rabies in brain of rabid animals Complement fixation
5. Diagnosis of newborns with erythroblastosis fetalis Coomb's (antiglobulin) test
6. Immunologic pregnancy test Passive agglutination
7. VDRL test for syphilis Flocculation
8. Quantitation of hormones Radioimmunoassay
9. Detection of viral infections Haemagglutination inhibition test
10. Detection of anti-Rh in the mother's serum indirect Coomb's (antiglobulin) test