Module
IMMUNE RESPONSE
8. Examination programme
8.1. Anatomy
1. Primary and secondary organs of immune system, their macroscopic structure, sceletotopy,
organotopy and holotopy.
2. Age-related structural changes of organs of immune system.
3. Groups of regional lymph nodes. Lymph flow into regional lymph nodes from various organs and
distinct regions of human body.
4. System of lymphatic vessels. Origin, location, course and structural features of lymphatic
capillaries, lymphatic vessels, lymphatic trunks and ducts. Paired and unpaired lymphatic trunks.
Confluence of lymphatic trunks and connections between lymphatic trunks and ducts. Lymph flow
into lymphatic trunks from distinct organs and regions of human body.
5. Thoracic duct, its origin, length and tributaries. Organs and regions of human body that are
drained by the thoracic duct.
6. Right lymphatic duct, its origin, length and tributaries. Organs and regions of human body that
are drained by the right lymphatic duct.
8.2. Histology and Embriology
1. Histological structure, functions and age-related changes of the bone marrow.
2. Histological structure, developmental features, significance and age-related changes of the
thymus.
3. Histological structure, functions and characteristic blood circulation of the spleen.
4. Histological structure, functions, developmental features and age-related changes of the lymph
node.
5. Morphological and functional characteristics of cells participating in the immune response.
8.3. Biochemistry
1. Structure and functional regions of antibodies. Antibody-antigen interaction.
2. Classes of immunoglobulins, peculiarities of their structure; distribution and functions of
immunoglobulins.
3. Antigen receptor structure and function of B-lymphocyte and T-lymphocyte.
8.4. Physiology
1. Blood and its function.
2. Erytrocytes, hemoglobin, their function. Hemoglobin compounds.
3. Hematocrit.
4. Leucocytes, lyphocytes and their funcions.
5. Plazma proteins and other components, their function.
6. Osmotic blood pressure. Haemolisis: types and mechanisms.
7. Erythrocytes sedimentation rate (ESR), its detection and significance. Creactive protein, its
significance.
8. Blood groups and its detection. Types of blood. Rhesus factor. Blood transfussion.
9. HLA system and its role in the organ and tissue transplantation.
8.5. Pathological Physiology
1. Inflammation, its conception, etiology and pathogenesis.
2. Effect of mediators (cellular, humoral) during the inflammation.
3. General changes of the body functions during inflammation (fever, erythrocyte sedimentation
rate and etc.)
4. I type of hypersensitivity reactions; etiology and pathogenesis, changes of the body functions.
Anaphylactic shock.
5. II type of hypersensitivity reactions; etiology and pathogenesis, changes of the body functions.
6. III type of hypersensitivity reactions; etiology and pathogenesis, changes of the body functions.
7. IV type of hypersensitivity reactions; etiology and pathogenesis, changes of the body functions.
8.6. Microbiology
1. Nature, properties and variants of antigens. Antigenic determinants and structural basis of antigen
binding.
2. Surface antigens of immune system cells, methods of determination. Importance of surface
antigens detection in immune diagnosis.
3. Variety and immunological function of cells, responsible for cellular and humoral immune
response, ways of activation and cells interaction.
4. The antigen-presenting cells. Antigen processing and peptide presentation by MHC class I and II
molecules.
5. Cytokines – mediators and regulators of innate and specific immunity in organism. Their types,
properties, mechanisms of action.
6. Cell-mediated immune response, ways of activation and cells interaction. T cells activation and
differentiation, dependent on antigen.
7. Antibody-mediated immunity. Activation and differentiation of B cells and antibody responses.
8. Pathogenic action of bacteria toxins: endotoxin and exotoxins mediated toxicity, mechanisms of
action and clinical manifestation.
9. The complement system, ways of activation and role in immune pathogenesis.
10. Anaerobic gram-positive infection agents (Clostridium): epidemiology, virulence factors,
diseases caused by them. Laboratory diagnosis and modes of control.
11. Anaerobic gram-negative infection agents(Bacteroides, Prevotella, Porphyromonas):
epidemiology, virulence factors, diseases caused by them. Laboratory diagnosis and modes of
control.
8.7. Pathological Anatomy
1. Morphogenesis of inflamation, its morphological manifestations, course, outcomes and
significance.
2. Causative factors of the serous and fibrinous inflammation, morphological manifestations,
outcomes and significance.
3. Causative factors of the purulent inflammation, morphological manifestations, outcomes and
significance.
4. Morphological manifestations of the specific immune reactions and immunogenesis.
5. Morphology, outcomes and significance of peculiar specific immune response (immune
granulomas).
6. Morphological peculiarities of the tuberculous and other kinds of immune granulomas.
7. Hyperergic immune reactions, its types and morphological peculiarities.
8. Classification of the immunodeficiencies, its morphological manifestations and significance.
9. Amyloidosis, its essence and pathogenesis, classification, morphology and significance.
10. Anemias, its classiffication, pathogenesis, general and pecular morphological features of various
forms, complications and causes of death.
11. Neutropenia (agranulocytosis), thrombocytopenia, its pathogenesis, morphology, complications
and causes of death.
12. Myeloid neoplasms, its classification, morphology, complications and causes of death.
13. Lymphoid neoplasms, its classification, morphology, complications and causes of death.
14. Hodgkin lymphoma, its morphology, complications and causes of death.
15. Radiation disease, its morphology, complications and causes of death.
8.8. Essentials of Medical Diagnostics
1. Main complaints of the allergic patients, clinical meanings.
2. I type of the allergic reactions: allergens, clinical signs, clinical and laboratory examination.
3. II type of the allergic reactions: allergens, clinical signs.
4. III type of the allergic reactions: allergens clinical signs.
5. IV type of the allergic reactions: allergens, clinical signs, clinical and laboratory examination.
6. Urticaria, angioedema: conception, etiology, signs.
7. Anaphylactic shock: conception, etiology, signs.
8. Syndrome of atopy.
8.9. Pharmacology
1. The classification of non-steroidal anti-inflammatory drugs (NSAIDs) according to chemical
properties and selectivity to cyclo-oxygenase (COX); the most important medicines of this group;
mechanisms of anti-inflammatory effect and anti-platelet action; mechanisms of analgesic and
antipyretic effects; reversible and irreversible inhibition of cyclo-oxygenase by NSAIDs; the
pharmacological effect and undesirable effects of these agents associated with its mode of action;
the relevance of this mode of action on the administration of medicines.
2. The mechanism of anti-inflammatory effect of acetylsalicylic acid and differences compared with
other NSAIDs; the clinical use of acetylsalicylic acid (ASA) associated with its mode of action;
mechanisms of anti-platelet action of acetylsalicylic acid the relevance of this mode of action on the
administration of medicines; the benefits and risks of treatment with ASA; pharmacologic effects of
NSAIDs on the organs and systems; the mechanism of long-term gastrointestinal effects;
precautions helping avoid such gastrointestinal side effects; the mechanism of renal effect of
NSAIDs; toxic effects of NSAIDs for pregnant women and foetus; the mechanism of these effects;
how to identify the long-term side effects of ASA; the main signs of salicylism; the benefits and
risks of short-term and long-term use of ASA.
3. The mechanism of action of selective cyclooxygenase-2 inhibitors and differences compared with
non-selective NSAIDs; the benefits and risks of selective COX inhibitors; the risk of cardiovascular
effects of selective COX inhibitors and mechanism of this effect.
4. Description of paracetamol (acetaminophen); the mechanism of action and pharmacological
effect of paracetamol to CNS and peripheral organs; the antipyretic mechanism of action of
paracetamol; the association of undesirable effects of paracetamol with it mechanism of action; the
mechanism of hepatotoxicity of paracetamol and known risk factors of paracetamol hepatotoxicity.
6. The classification of antihistamines (anti-H1) and the most important agents of this group;
differences between groups of anti-H1 medicines; most important pharmacokinetic properties of
anti-H1 agents and generations of anti-H1 medicines in association with its pharmacokinetic
properties; the pharmacological effect and clinical use of antihistamines (anti-H1); the toxicity of
anti-H1 medicines associated with its short-term and long-term dosage; what anti-H1 agents can
cause cardiovascular side effects and mechanisms of its cardiotoxicity.
6. The classification of glucocorticoids and mineralcorticoids (according to potency and duration of
action) and the most important agents of this group; the mechanism of action of glucocorticoids and
relevance of this mode of action for anti-inflammatory and immunosuppressant activity; the
undesirable effects of glucocorticoids, associated with its short-term and long-term dosage; the
possible clinical usage of glucocorticoids; the benefits and risks of treatment with glucocorticoids.
7. The mechanism of action and pharmacological effect of immunosuppressants immunophilins
(cyclosporine, tacrolimus and sirolimus) and possible clinical usage.
8. The mechanism of action and pharmacological effect of immunosuppressant mycophenolate
mofetil and possible clinical usage.
9. The mechanism of action and pharmacological effect of cytotoxic immunosuppressants
(azathioprine, cyclophosphamide and others) and possible clinical usage.
10. The mechanism of action and pharmacological effect of immunosuppressants TNF-α inhibitors
(etanercept, thalidomide and others) and possible clinical usage.
11. The mechanism of action and pharmacological effect of immunosuppressants monoclonal and
polyclonal antibodies (omazilumab, infliximab, antilymphocite immunoglobulin, others
immunoglobulins and others) and possible clinical usage.
12. The overall undesirable effects of immunosuppressants associated with its mechanism of action
and specific side effects.
8.10. General Surgery
1. The impact of immunocompromising diaseases and other factors (diabetes, tuberculosis, anemia,
malignant diseases, HIV, radiation sickness, chronic alcoholism, drug addiction, malnutrition,
hypovitaminosis, longlasting hormontherapy, chemotherapy, radiotherapy, exhaustion) on infection
and healing processes of the patients.
2. Furuncule, carbuncule. Etiology, pathogenesis, signs, diagnostics, principles of management,
prevention.
3. Abscess and cellulitis, hydradenitis. Etiology, pathogenesis, types, signs, diagnostics, principles
of management. Closed surgical treatment of abscesses.
4. Erysipelas: etiology, pathogenesis, signs, diagnostics, clinical forms, complications, principles of
management, prevention. Lymphangitis and lymphadenitis: etiology, pathogenesis, types, signs,
diagnostics, principles of management, prevention.
5. Trombophlebitis: etiology, pathogenesis, types, signs, diagnostics, principles of management,
prevention.
6. Mastitis. Etiology, classification (types, forms, localization). Diagnostics, signs, principles of
management, prevention.
7. Felon: etiology, pathogenesis, signs, diagnostics. Classification of felon. Local and general
symptoms of felon. Principles of management.
8. Acute and chronic osteomyelitis: etiology, clinical signs, complications, principles of diagnostics
and management.
9. Abscesses of perirectal soft tissues: etiology, pathogenesis, classification, signs, diagnostics,
principles of management.
10. Arthritis. Etiology, signs, diagnostics, principles of management. Bursitis, tendonitis and
tendovaginitis. Etiology, pathogenesis, signs, diagnostics, principles of management.
11. Anaerobic infection. Types, causative agents. Clostridial and non-clostridial anaerobic infection.
Specificities of signs of an anaerobic infection, diagnostics, principles of management.
12. Gas gangrene. Etiology, pathogenesis, signs, diagnostics, principles of management, prevention.
13. Tetanus. Causes, signs, diagnostics, principles of reatment, prevention.
14. Generalized surgical infection (sepsis). Etiology, pathogenesis, signs, prevention. Principles of
local and general treatment of sepsis.
15. Specific surgical infection. Types. Tuberculosis of joints and bones. General signs, complicatios.
Principles of treatment.
8.11. Infectious Diseases
1. Pathogenesis of HIV infection.
2. The changes of the immune system caused by HIV infection and their laboratory evaluation.
8.12. Radiology
1. Principles of the radiological diagnostics of inflammatory reactions.
2. Roenthgenological diagnostic signs of the granulomas.
3. Roenthgenological diagnostic signs of the nonspecific immune reactions.
4. Roenthgenological diagnostic signs of the pneumonias.
5. Value of the radiological investigations for evaluation of the inflammatory processes.