Immunology - 1200

Q0001:What test is done to diagnose CGD?
Nitroblue tetrazolium reduction test (NBT). It is

negative in patients with CGD because there is no
production of oxygen radicals.
Q0002:What is the valence of an Ig molecule equal
to?
The number of Ags that the Ab can bind
Q0003:What is the name of the process that
ensures that each B cell produces only one heavy-
chain variable domain and one light chain?
Allelic exclusion. It is to ensure that one B
cell produces only one Ab.
Q0004:What is the major Ab of the primary immune
response?
IgM
Q0005:What form of immunity is responsible for
removal of intracellular infections?
Cell-mediated immunity
Q0006:True or false? Direct fluorescent Ab test
is used to detect Abs in a patient?
False. Direct tests detect Ags; indirect tests
detect Abs.
Q0007:What is the triad of Wiskott-Aldrich
syndrome?
Thrombocytopenia; eczema; and immunodeficiency is
the triad of this X-linked recessive disorder.
Q0008:What complement factor deficiency leads
to;? Increased susceptibility to pyogenic
infections?
C3 deficiency
to;? Recurrent gonococcal infections?
C5-C8 deficiency
to;? Leukocyte adhesion deficiency with poor
opsonization?
C1; C2; or C4 deficiency
to;? Hereditary angioedema?
C1 inhibitor (C1-INH)
Q0012:Which IgG cannot activate complement?
IgG4
Q0013:Name the T-cell CD marker;? Essential for
Ab isotype switching (for B cell binding)
CD40 ligand
Q0014:Name the T-cell CD marker;? Interacts with
MHC class I molecules
CD8
Q0015:Name the T-cell CD marker;? Expressed on
all T cells and is needed as a signal transducer
for the T cell receptor
CD3
Q0016:Name the T-cell CD marker;? Interacts with
MHC class II molecules
CD4
Q0017:Name the T-cell CD marker;Is a
costimulatory molecule in T cell activation
CD28
Q0018:What three cells are essential for T-cell
differentiation in the thymus?
Dendritic cells; macrophages; and thymic
epithelial cells
Q0019:What is the only specific Ag-presenting
cell?
B cells; macrophages and dendritic cells are
nonspecific.
Q0020:What is the tetrad of Jarisch-Herxheimer
reaction?
Rigors; leukopenia; decrease in blood pressure;
and increase in temperature
Q0021:What is the name of the B cell that
secretes Ig?
Plasma cell (mature B lymphocyte)
Q0022:What would be the result if an Ab were
cleaved with papain?
There would be two Fab and Fc regions.
Q0023:What is the bone marrow maturation time for
a phagocytic cell?
14 days
Q0024:Which leukotrienes are associated with the
late-phase inflammatory response?
LTC4 and LTD4
Q0025:What is the term for the strength of the
association between Ag and an Ab?
Affinity (one of each)
Q0026:True or false? More Ag is needed to produce
a secondary immune response than a first immune
response.
False. Fewer Ags are needed to trigger a
secondary response.
Q0027:What is the term for the strength of
association between multiple Abbinding sites and
multiple antigenic determinants?
Avidity (more than one binding site)
Q0028:What Ig mediates ADCC via K cells;
opsonizes; and is the Ig of the secondary immune
response?
IgG
Q0029:What test is used to detect anti-RBC Abs
seen in hemolytic anemia?
Coombs test
Q0030:What subset of T cells recognizes the MHC
class I Ags?
CD8+ T cells (cytotoxic);Remember; 8×1=8 (CD×8
×MHC class I=8); 4×2=8 (CD×4 MHC class II 8)
Q0031:What cell surface marker is found on
activated helper T cells?
CD40
Q0032:What are the five Ig isotypes?
IgA; IgD; IgE; IgG; and IgM
Q0033:Which integrin mediates the adhesion to
endothelial cells for migration in and out of the
blood during an immune response?
Beta2-integrins
Q0034:What type of hypersensitivity is an Ab-
mediated response against our own cells;
receptors; or membranes via IgG or IgM?
Type II hypersensitivity reaction
Q0035:What is the term to describe the limited
portion of an Ag that is recognized by an Ab?
Antigenic determinant (epitope)
Q0036:What cytokine do Th1 cells secrete to
inhibit Th2 cell function?
INF-gamma
Q0037:What three cells are essential for T-cell
maturation?
Thymic epithelial cells; dendritic cells; and
macrophages
Q0038:What is the term for a single isolated
antigenic determinant?
Hapten (not immunogenic)
Q0039:What are the two opsonizing factors?
The Fc region of IgG and C3b
Q0040:What is the most common Ig deficiency?
IgA deficiency; patients commonly present with
recurrent sinopulmonary infections and GI
disturbances.
Q0041:What is the name of the B cell–rich area
of the spleen?
Primary follicle (in the white pulp)
Q0042:What IL; produced by macrophages; is
chemotactic for neutrophils?
IL-8. It not only is chemotactic; it also acts as
an adhesive for neutrophils.
Q0043:What Ig prevents bacterial adherence to
mucosal surfaces?
IgA
Q0044:What are the three rules of clonal
selection?
1. One cell type ;2. One Ab type ;3. Random
selection of hypervariable regions; and only
cells with bound Ag undergo clonal expansion
Q0045:What is a plasma cell's life expectancy?
7 to 14 days
Q0046:What are defined by Ag-binding specificity?
Idiotypes
Q0047:What type of binding occurs with one Fab or
one idiotype of IgG?
Affinity
Q0048:What molecule that is needed to trigger T
cell activation is noncovalently linked to TCR?
CD3 molecule. It transmits signals to the inside
of the T cell to trigger activation
Q0049:What is the term for Ags that activate B
cells without T-cell signaling?
Thymus-independent Ags
Q0050:What are the three rules governing a
secondary immune response?
1. Covalent bonding between the hapten and
carrier ;2. B-cell exposure to hapten twice ;3.
T-cell exposure to carrier twice
Q0051:What type of hypersensitivity is a T cell-
mediated response to Ags that are not activated
by Ab or complement?
Type IV hypersensitivity reaction (delayed type
because of the 48–96 hour latency)
Q0052:Name the macrophages by location;? Liver
Kupffer cells
Q0053:Name the macrophages by location;? Lungs
Alveolar macrophages
Q0054:Name the macrophages by location;? CNS
Microglial cells
Q0055:Name the macrophages by location;? Kidney
Mesangial macrophages
Q0056:What is the first human disease
successfully treated with gene therapy?
Adenosine deaminase (ADA) deficiency
Q0057:What receptors are the best markers for NK
cells?
CD16 and CD56
Q0058:True or false? Ag-Ab binding is
irreversible
False. It is reversible because the Ags and Abs
are not linked covalently.
Q0059:What three major cell lines participate in
the acquired immune system?
T cells; B cells; and macrophages
Q0060:What test is used to screen for HIV?
ELISA. It detects anti-p24 IgG.
Q0061:During what stage of B-cell development is
IgM first seen on the surface?
Immature B cells
Q0062:What Ig is responsible for Antibody-
Dependent Cell-mediated Cytotoxicity of
parasites; has a high-affinity Fc receptor on
mast cells and basophils; and is responsible for
the allergic response?
IgE
Q0063:True or false? B-cell Ag receptors can be
secreted.
True. B cell antigen receptors are Abs.
Q0064:Are more Abs produced in a primary or a
secondary immune response?
More Ab is produced in less time in a secondary
immune response (shorter lag period).
Q0065:By which process do Abs make microorganisms
more easily ingested via phagocytosis?
Opsonization
Q0066:What MHC class acts to remove foreign Ags
from the body?
MHC class II Ags. This is accomplished via CD4 T
cells.
Q0067:What disorder is characterized by
autoantibodies to IF?
Pernicious anemia
Q0068:What cytokines do Th2 cells secrete to
inhibit Th1 cell function?
IL-4; IL-10; and IL-13
Q0069:What is the term for the number of Ag-
binding sites on an Ig?
Valence
Q0070:Which major cell type is found in the red
pulp of the spleen?
RBCs. That is why it is called red pulp.
Q0071:What is the name of the pathway that
produces leukotrienes?
Lipoxygenase pathway; from arachidonic acid
Q0072:What is the term to describe basophils that
have left the bloodstream and entered a tissue?
Mast cells
Q0073:What are the three major functions of
secretory IgA?
1. IgA receptor ;2. Transport of IgA across
epithelial barriers ;3. Protection of IgA from
degradative proteases
Q0074:What IL is important in myeloid cell
development?
IL-3 (3 face down is an M)
Q0075:What is the term for different classes and
subclasses of the same gene products?
Isotypes
Q0076:What is the first Ab a baby makes?
IgM
Q0077:What test; by using specific Abs to
different receptors; allows for rapid analysis of
cell types in a blood sample?
Flow cytometric analysis
Q0078:What is the name of the T cell–rich area
of the spleen?
PALS (Parietolateral lymphocytic sheath)
Q0079:What three complement fragments are also
anaphylatoxins?
C3a; C4a; and C5a
Q0080:Name the B-cell CD marker;? Required for
class switching signals from T cells
CD40
Q0081:Name the B-cell CD marker;? Receptor for
EBV
CD21; it is a complement receptor for cleaved C3
Q0082:Name the B-cell CD marker;? Used clinically
to count B cells in blood
CD19
Q0083:What immunologic test checks for a reaction
between Abs and a particular Ag? (hint: ABO
typing)
Agglutination test
Q0084:Which leukotriene is chemotactic for
neutrophils?
LTB4
Q0085:What Ig is associated with mucosal surfaces
and external secretions?
IgA
Q0086:What are the genetic variants of a molecule
within members of the same species?
Allotypes
Q0087:What cytokine do CD4 T cells secrete to
activate B cells when the specific peptide in the
groove of the MHC II molecule interacts with the
TCR?
IL-4 is secreted to activate B cells. This begins
the second step in the immune response; known as
Activation. CD4 T cells secrete INF-alpha to
activate macrophages
Q0088:Which protein prevents internal binding of
self proteins within an MHC class II cell?
Invariant chain
Q0089:What would be the result if an Ab were
cleaved with pepsin?
There would be a Fab' region; thus; it would
still be able to participate in precipitation and
agglutination.
Q0090:Why are patients with Chronic Granulomatous
Disease not prone to develop infections from
catalase-negative bacteria?
Catalase-negative bacteria secrete H2O2 as a
byproduct (remember; catalase breaks down H2O2);
allowing the neutrophils to use it as the
substrate for the other toxic metabolites.
Patients with CGD are prone to catalase-positive
bacterial infections.
Q0091:What are the two chains of the TCR that are
mainly found on the skin and mucosal surfaces?
gamma and delta chains
Q0092:Which IL is associated with increases of
IgG and IgE?
IL-4
Q0093:What branch of the immune system is
acquired in response to an Ag?
Adaptive branch. The adaptive branch of the
immune system has a slow initiation with rapid
responses thereafter.
Q0094:True or false? T cells can recognize; bind;
and internalize unprocessed Ags.
False. B cells recognize unprocessed Ags; but T
cells can recognize only processed Ags.
Q0095:What type of hypersensitivity is a result
of high circulating levels of soluble immune
complexes made up of IgG or IgM Abs?
Type III hypersensitivity reaction
Q0096:At what stage of B-cell development can IgM
or IgD be expressed on the cell surface?
Mature B cell; the memory B cell can have IgG;
IgA; or IgE on its surface.
Q0097:What T cell deficiency syndrome is
associated with facial anomalies;
hypoparathyroidism; thymic hypoplasia; and
recurrent viral and fungal infections?
DiGeorge syndrome; which is due to a failure of
the third and fourth pharyngeal pouch
development. Remember; B cell deficiencies are
associated with extracellular infection. T cell
deficiencies are associated with intracellular
infections
Q0098:What is the stimulus for the classical
pathway activation?
Ag-Ab complexes. The alternative pathway protects
without use of Abs; the pathogen is the stimulus.
Q0099:What is the first membrane-bound Ig on B
cell membranes?
IgM; IgD follows shortly thereafter.
Q0100:What region of the Ig does not change with
class switching?
Hypervariable region
Q0101:In MHC class II molecules; what chain
blocks access to the peptide-binding groove
during transportation within the cell; ensuring
that the MHC class II–peptide complex is
transported to the surface?
Invariant chain. This is essential because the
CD4 T cells have antigen receptors only for
peptides bound to the MHC II molecule. (MHC
restriction)
Q0102:What chromosome codes for HLA gene
products?
The short arm of chromosome 6
Q0103:What cells are atypical on a peripheral
blood smear in heterophil-positive mononucleosis?
T cells; not B cells
Q0104:What is the major Ig of the secondary
immune response in the mucosal barriers?
IgA
Q0105:What AR disorder is seen by age 1 to 2 with
recurrent sinopulmonary infections; uncoordinated
muscle movements; and dilation of the blood
vessels?
Ataxia-telangiectasia
Q0106:What are the four chemotactic agents?
1. C5a ;2. Leukotriene B4 ;3. IL-8 ;4. Bacterial
peptides
Q0107:What subset of CD4 helper T cells stimulate
B-cell division and differentiation?
Th2
Q0108:Which region of the variable domain
comprises the Ag-binding site of the Ab?
Hypervariable region (three per light chain;
three per heavy chain)
Q0109:True or false? The increased oxygen
consumption after phagocytosis is for ATP
production.
False; it is for the production of toxic
metabolites.
Q0110:What is the limited portion of a large Ag
that will actually be recognized and bound to an
Ab and that contains approximately five to six
amino acids or four to five hexose units?
Antigenic determinant (epitope). (Idiotypes bind
to epitopes.)
Q0111:What complement factor or factors are
associated with;? Chemotaxis?
C5a
associated with;? Membrane attack complex (MAC)?
C5–C9
associated with;? Opsonization?
C3b
associated with;? Anaphylaxis?
C3a; C4a; C5a
Q0115:What happens to the Ab specificity when
class switching occurs in mature B cells?
As the isotype is switched; the Ab specificity
does not change because it does not affect the
variable chains.
Q0116:What IL down-regulates cell mediated
immunity?
IL-10
Q0117:Name the type of graft described by these
transplants;? From one site to another on the
same person
Autograft
transplants;Between genetically identical
individuals
Isograft
transplants;? From one person to the next (the
same species)
Allograft
transplants;? From one species to another
Xenograft
Q0121:What is the name of the process in which
cells migrate toward an attractant along a
concentration gradient?
Chemotaxis
Q0122:What are the two functions of the thymus in
T-cell differentiation?
Hormone secretion for T-cell differentiation and
T-cell education to recognize self from nonself
Q0123:What is the name of the T cell–rich area
of the lymph node?
Paracortex
Q0124:What cell surface marker do all T cells
have?
CD3
Q0125:True or false? Patients with common
variable hypogammaglobinemia have B cells in the
peripheral blood.
True. Common variable hypogammaglobinemia first
appears by the time patients reach their 20s and
is associated with a gradual decrease in Ig
levels over time.
Q0126:What is the Ig associated with the primary
immune response?
IgM
Q0127:What MHC class of antigens do all nucleated
cells carry on their surface membranes?
MHC class I antigens; they are also found on the
surface of platelets.
Q0128:What Ig is responsible for activation of
complement; opsonization; and ADCC and is
actively transported across the placenta?
IgG
Q0129:What type of Ag do T cells recognize?
Processed antigenic peptides bound in the groove
of the MHC molecule
Q0130:What Ig is the major protective factor in
colostrum?
IgA
Q0131:What is the second cell involved in the
immune response?
The CD4 T cell; the APC is the first cell in the
immune response.
Q0132:What is the term for thymic induction of T
cells with high-affinity Ag receptors for self
that are programmed to undergo apoptosis?
Negative selection. This helps to prevent
autoimmune diseases.
Q0133:What five main oxidizing reactions are used
to kill ingested organisms?
1. H2O2 ;2. Superoxide ;3. Hydroxyl radical ;4.
Myeloperoxidase ;5. Hypochlorous acid
Q0134:What Ig is associated with ADCC for
parasites?
IgE
Q0135:True or false? RBCs do not have MHC class I
Ags on their surface.
True. Remember; all nucleated cells (and
platelets) have MHC class I Ags; and RBCs are not
nucleated.
Q0136:What Ig is associated with mast cell and
basophil binding?
IgE. It attaches via receptor for the Fc region
of the heavy epsilon chain
Q0137:What IL do T cells secrete to induce T-and
B-cell division?
IL-2. T cells express IL-2 receptors on their
surface to induce self-expression.
Q0138:Development of what T cell line follows low
affinity for self-MHC class II Ags in the thymus?
CD4+T cells
Q0139:What is the term for a substance secreted
by a leukocyte in response to a stimulus?
Cytokine. If a cytokine affects another class of
leukocytes; it is called an interleukin.
Q0140:What subset of CD4 T cells is responsible
for mast cell and eosinophil precursor
proliferation?
Th2 cells
Q0141:What are the four major functions of the
acquired immune system?
1. Recognize self from nonself ;2. Amplify via
cell division or complementation ;3. Control the
level of the response ;4. Remove foreign material
Q0142:What endotoxin receptor is the best marker
for macrophages?
CD14
Q0143:What is the term for the inherent ability
to induce a specific immune response?
Immunogenicity; antigenicity refers to
Ab/lymphocyte reaction to a specific substance.
Q0144:What molecule differentiates the MHC class
I from II Ag? (Hint: it's in the light chain.)
The Beta-2-microglobin. It is the separately
encoded Beta-chain for class I Ags.
Q0145:What B cell disorder is characterized by
pre-B cells in the bone marrow; no circulating B
cells in plasma; normal cell-mediated immunity;
low Igs; and appearance by 6 months of age?
Bruton X-linked hypogammaglobinemia. Tyrosine
kinase deficiency leads to inadequate B cell
maturation.
Q0146:What subtype of IgG does not bind to
staphylococcal A protein?
IgG3
Q0147:What mast cell mediator is a chemotactic
agent?
Eosinophil chemotactic factor A
Q0148:What is the major Ig of the secondary
immune response?
IgG
Q0149:What T-cell surface projection recognizes
and reacts to foreign Ags (presented by APCs)?
TCR
Q0150:What is the confirmatory test for HIV?
Western blot
Q0151:What is the name of the major chemotactic
agent released from;? Neutrophils?
Leukotriene B4 (LTB4)
agent released from;? Macrophages?
IL-8 (IL-1 and TNF-gamma also)
agent released from;? The blood serum? (Hint: it
is a complement factor.)
C5a
agent released from;? Bacteria?
F-Met-Peptides
Q0155:What cell surface marker is found on blood
B cells?
CD19
Q0156:What is the name of the B cell–rich area
in the lymph node?
Primary follicle of the cortex
Q0157:What are the four ways to down-regulate the
immune system?
1. Decrease concentrations of Ag levels ;2.
Administer IgG in high concentrations ;3. Inhibit
B cells with Ag bound to IgG (complexes) ;4. Turn
off the original T or B cell with anti-Ab
Q0158:What is the only Ig that crosses the
placenta?
IgG
Q0159:What is given to pregnant women within 24
hours after birth to eliminate Rh+ fetal blood
cells from their circulation?
Rho (D) immune globulin (RhoGAM); an anti-RhD IgG
antibody; prevents generation of RhD-specific
memory B cells in the mother.
Q0160:What IL is essential for lymphoid cell
development?
IL-7 (A 7 upside down is an L; L is for Lymphoid)
Q0161:What type of cell can never leave the lymph
node?
Plasma cell
Q0162:Via what pathway is glycolysis increased
after phagocytosis?
HMP shunt
Q0163:What is the term for a delay in the onset
of normal IgG synthesis seen in the fifth to
sixth month of life?
Transient hypogammaglobinemia of infancy; it
usually resolves by age 16 to 30 months.
Q0164:What subset of CD4 helper T-cell function
is helping the development of CD8 T cells?
Th1; they are also responsible for delayed-type
hypersensitivity (type IV)
Q0165:What is the term for the strength of the
association between Ags and Abs?
Avidity. There is a positive correlation between
valence numbers and avidity.
Q0166:What type of Ag do B cells recognize?
Free; unprocessed Ag
Q0167:What Ig is associated with Ag recognition
receptor on the surface of mature B cells?
IgD; IgM is also correct.
Q0168:Which chromosome is associated with MHC
genes?
Chromosome 6
Q0169:What is the term for processing an APC's
pinocytosed material by fusing with a lysosomal
granule and cleaving the Ag into peptide
fragments?
Ag processing; it is needed for class I
molecules. Class II molecules have an invariant
chain that protects them from breakdown.
Q0170:What is the most common precipitin test
used in clinical medicine?
Radial Immuno Diffusion (RID) for Ig levels.
Q0171:What Ig activates the complement cascade
most efficiently?
IgM
Q0172:What assay is used to identify MHC class I
molecules?
Microcytotoxic assay
Q0173:Which IL increases IgA synthesis?
IL-5. It also stimulates eosinophil
proliferation.
Q0174:What is the term for an immunogenic agent
that is too small to elicit an immune response?
Hapten; if it is coupled with a carrier; it may
become immunogenic.
Q0175:What type II hypersensitivity disorder is
defined as;? Autoantibodies directed against ACh
receptors?
Myasthenia gravis
defined as;? Autoantibodies directed against
platelet integrin?
Autoimmune thrombocytopenia purpura
defined as;? Autoantibodies against the type IV
collagen in the basement membrane of the kidneys
and lungs?
Goodpasture syndrome
defined as;? Autoantibodies directed against the
TSH receptor?
Graves disease
defined as;? Autoantibodies directed against RBC
Ag I?
Autoimmune hemolytic anemia
Q0180:What Ig activates the alternate pathway;
neutralizes bacterial endotoxins and viruses; and
prevents bacterial adherence?
IgA
Q0181:What enzyme is deficient in patients with
CGD?
NADPH oxidase is deficient; resulting in an
inability to produce toxic metabolites.
Q0182:What subtype of IgG does not activate
complement cascade?
IgG4
Q0183:What two cell lines of the immune system do
not belong to the innate branch?
T and B-cells belong to the adaptive branch;
whereas PMNs; NK cells; eosinophils; macrophages;
and monocytes belong to the innate branch.
Q0184:What subset of T cells recognizes the MHC
class II Ags?
CD4+ T cells (helper)
Q0185:What T cell line arises from low affinity
for self-MHC class I Ags in the thymus?
CD8+ T cells
Q0186:What MHC class functions as a target for
elimination of abnormal host cells?
MHC class I Ags (the endogenous pathway). This
allows the body to eliminate tumor cells; virus-
infected cells—anything the body recognizes as
nonself via CD8+ T cells.
Q0187:What are the three polymorphonuclear
leukocytes? Be specific.
Neutrophils; eosinophils; and basophils
Q0188:What disease is associated with the HLA-A3
allele
Primary Hemochromatosis
Q0189:What diseases are associated with the HLA-
B27 allele
Psoriasis; ankylosing spondylitis; inflammatory
bowel disease; and Reiter's syndrome
Q0190:What disease is associated with the HLA-DR2
and HLA-DR3 alleles
Systemic lupus erythematosus
Q0191:What diseases are associated with the HLA-
DR3 allele
Sjogren's syndrome; active hepatitis; systemic
lupus erythematosus (with HLA-DR2) and type 1
diabetes (with HLA-DR4)
Q0192:What diseases are associated with HLA-DR4
Rheumatoid arthritis and type 1 diabetes (with
HLA-DR3)
Q0193:Lymph drainage: What does the right
lymphatic duct drain?
Right arm and right half of head
Q0194:Lymph drainage: What does the thoracic duct
drain?
Everything except for the right arm and the right
half of head
Q0195:Splenic sinusoids: What are they?
Long; vascular channels in red pulp with
fenestrated "barrel hoop" basement membrane and
macrophages nearby. Adjacent to splenic cords and
contain blood.
Q0196:How can the spleen be distinguished from a
lymph node on histologic section?
Spleens have no subscapsular sinus and no cortex
or medulla. They have white pulp and red pulp.
Q0197:What does the white pulp of the spleen
contain?
Contains;1. Lymphoid follicles with germinal
centers (mostly B cells). Can see aggregation of
dark basophilic lymphocytic nuclei;2.
Characteristic central arterioles. Surrounded by
a Periarterial lymphatic sheath (PALS) which is a
collection of T-lymphocytes.
Q0198:Where is the red pulp of the spleen
located?
Around and between the lymphatic nodules of the
white pulp
Q0199:Splenic cords: What are they?
Structures containing macrophages; plasma cells;
lymphocytes; and few RBCs. Separated from each
other by splenic sinusoids.
Q0200:Thymus: Function
Site of T-cell differentiation and maturation (T
cells differentiate in the Thymus. B cells
differentiate in the Bone marrow)
Q0201:Thymus: Embryological origin
Epithelium of 3rd branchial pouches
Q0202:Lymphocytes: Embryological origin
Mesenchyme
Q0203:Thymus: What does the cortex contain and
what does it look like?
The lobules resemble lymphatic nodules except
they are angular; not round;Contains;1. Densely
packed (dark) immature T cells;2. Large
epithelial reticular cells which appear as holes
within the cortical cells.
Q0204:Thymus: What does the medulla contain and
what does it look like?
Pale;Contains;Thymic (Hassall's) corpuscles which
have a lamellated or whorled appearance due to
degenerating epithelial reticular cells.
Q0205:What percentage of T cells which enter
thymus survive?
2%
Q0206:What is positive selection of T cells?
Retention of T cells that have functioning T cell
receptors
Q0207:Where do positive and negative selection of
T-cells occur in the thymus?
At the corticomedullary junction
Q0208:What is negative selection of T cells?
Destruction of T-cells that react to self-antigen
Q0209:Innate immunity vs adaptive immunity: How
are receptors that recognize pathogens encoded?
Innate: Germline encoded;Adaptive: Undergo VDJ
recombination during development
Q0210:Innate immunity vs adaptive immunity: How
fast is response to pathogens?
Innate: Always fast; no memory response;Adaptive:
Slow on 1st exposure but memory response is
faster and more robust.
Q0211:Innate immunity or adaptive immunity:
Neutrophils
Innate immunity
Macrophages
Innate immunity
Dendritic cells
Innate immunity
Complement
Innate immunity
Q0215:Innate immunity or adaptive immunity: T
cells
Adaptive immunity
Q0216:Innate immunity or adaptive immunity: B
cells
Adaptive immunity
Circulating antibody
Adaptive immunity
Q0218:T-cell differentiation: Where do T-cell
precursors come from and where do they go?
From the bone marrow to the thymus
Q0219:T-cell differentiation: What CD?
CD3
Q0220:T-cell differentiation: What happens to T-
cell precursors when they enter the thymus; and
what are they called?
Once T-cell precursors acquire and display CD4
and CD8; they are cortical thymocytes.
Q0221:T-cell differentiation: Where is the T-cell
in its development when it undergoes positive
selection?
Both CD4 positive and CD8 positive
Q0222:T-cell differentiation: Where in the thymus
are cells which are positive for both CD4 and CD8
located?
Thymic cortex
Q0223:T-cell differentiation: Where is the T-cell
in its development when it undergoes negative
selection?
Either CD4 positive or CD8 positive; not both
Q0224:T-cell differentiation: Where in the thymus
are cells which are positive for either CD4 or
CD8 located?
Thymic medulla
Q0225:T-cell differentiation: What are the two
types of helper T cells and where do they
differentiate?
In the lymph node; helper T cells differentiate
into Th1 cells; and Th2 cells.
Q0226:Differences between Th1 and Th2 cells:
Stimulant for differentiation from archetypical
helper T cell.
Th1: IL-12 from both other Th1 cells and antigen-
presenting dendritic cells;Th2: IL-4 from other
Th2 cells and presumably an unknown factor from
dendritic cells
Cytokines produced by both types
Both: IL-2;Th1: IFN-gamma; TNF-alpha;Th2: IL-4;
IL-5; IL-6; IL-10; IL-13
Q0228:Cytokine effects: Interleukin 2
Stimulates T-cell growth and
proliferation;Mnemonic for first 5 interleukins:
Hot T-bone stEAk
Q0229:Cytokine effects: Interferon gamma
1. Inhibits Th2 cytokines;2. Induces class I and
II MHC;3. Stimulates differentiation of monocytes
into macrophages;4. Activates macrophages.
Q0230:Cytokine effects: Tumor Necrosis Factor
alpha
1. Activates macrophages; neutrophils (also
attracts them); and CD8 cells;2. Induces
neutrophil-endothelial cell adhesion;3.
Constitutional: sepsis; cachexia ("wasting
away"); fever; acute phase proteins;4. Tumor cell
lysis;5. Increased proliferation of B-cells;6.
Increased synthesis of IL-2 receptors by Th
cells;7. Stimulates dendritic cell migration to
lymph nodes.
1. Growth of B-cells;2. Growth and proliferation
of T-cells;3. Synthesis of IgE;4. Class switching
of IgG to IgE;5. Inhibits IL-8; IL-1; and TNF-
alpha;Mnemonic for first 5 interleukins: Hot T-
bone stEAk. E as in stimulates IgE production.
1. Differentiation of B cells 2. Class switching
of IgA;3. Production and activation of
eosinophils;Mnemonic for first 5 interleukins:
Hot T-bone stEAk. A as in stimulates IgA
production.
Q0233:What cytokines stimulate the acute phase
response?
1. IL-1;2. IL-6;3. TNF-alpha
Q0234:What are acute phase response proteins used
for?
1. Augment immune response (complement; Ig);2.
Regulate the extent of response (protease
inhibitors like alpha-1-antitrypsin);3. Stimulate
additional responses (alpha-2-macroglobulin)
Big picture: Stimulates Th2 while inhibiting
Th1;Specifically inhibits;1. IL-8;2. IL-1;3. TNF-
alpha;4. IFN-gamma
Q0236:What releases: Interleukin 10
1. Th2 cells;2. Macrophages
Major effects
Both: Downregulate each other;Th1: Activates all
lymphocytes and APCs; especially CD8 cells and
macrophages;Th2 cells;1. B cells: Increased
differentiation; proliferation; antibody; and
class switching;2: Activation of eosinophils
Th cells
Q0239:What releases: Tumor Necrosis Factor alpha
Macrophages (emphasized) and Th1 cells
Q0240:What releases: Interferon gamma
Th1 cells (emphasized) and NK cells
T cells (especially Th2) and mast cells
T cells (especially Th); macrophages; and
endothelial cells
Q0243:What is MHC and what codes for it?
Major Histocompatability Complex encoded by Human
Leukocyte Antigen (HLA)
Q0244:What genes code for MHC I?
1. HLA-A;2. HLA-B;3. HLA-C
Q0245:What genes code for MHC II?
1. HLA-DP;2. HLA-DQ;3. HLA-DR
Q0246:MHC I and II: What cells are they expressed
on?
I: All nucleated cells except sperm;II: Antigen
Presenting Cells
Q0247:MHC I and II: Where in the cell is antigen
loaded onto the MHC?
I: RER (mostly intracellular peptides);II:
Acidified endosome
Q0248:B cells and T cells: Effect on Ig
B cells: Make it;T cells: (CD4) Help B cells make
it and release IFN-gamma to activate macrophages
Q0249:B cells and T cells: Method of killing
B cells: IgG opsonizes bacteria and viruses;T
cells: (CD8) Directly kills virus-infected cells
Q0250:B cells and T cells: Allergy mechanism
B: Type I hypersensitivity; through IgE;T: Type
IV hypersensitivity
Q0251:B cells and T cells: Organ rejection speed
B: Fast; through antibodies;T: Slow
Q0252:CD/MHC: What binds MHC II?
CD4 T-cell receptors
Q0253:What does MHC I pair with (allosteric
interaction)
beta2-microglobulin
Q0254:CD/MHC: What binds MHC I?
CD8 T-cell receptors
Q0255:CD/MHC: What binds CD4 T-cell receptors?
MHC II on antigen presenting cells
Q0256:CD/MHC: What binds CD8 T-cell receptors?
MHC I on virus-infected cells
Big picture: Stimulates growth differentiation or
product synthesis by T cells; B cells;
neutrophils; fibroblasts; and epithelial cells;1.
Endogenous pyrogen;2. Activates T cells;3.
Upregulates adhesion molecules;4. Induces acute
phase reactants;5. Synergizes with TNF-
alpha;Mnemonic for first 5 interleukins: Hot T-
bone stEAk. Hot as in fever.
1. Professional antigen-presenting cells
(macrophages; monocytes; dendritic cells; and B
cells);2. Some non-professional antigen
presenting cells (fibroblasts; endothelial cells;
others)
Q0259:How does Interleukin 1 cause fever?
Steps;1. Migrates to the circumventricular
organs;2. Binds with endothelial receptors;3.
Receptors activate Phospholipase A2-COX2-PGE2
pathway;4. Prostaglandin E2's presence in the
hypothalamus elevates the thermoregulatory set
point and activates neuroendocrine determinants
of fever.
Q0260:What are the professional antigen
presenting cells?
1. Macrophages;2. B cells;3. Dendritic cells
Q0261:What is the CD3 complex?
Cluster of polypeptides associated with a T-cell
receptor. It is important in signal transduction.
Q0262:How are Th cells activated?
1. APC phagocytoses foreign body;2. APC presents
antigen on MHC II;3. Signal 1: Th cell's TCR
recognizes antigen;4. Signal 2 (costimulatory):
APC's B7 molecule stimulates Th cell's CD28
molecule;5. Autocrine IL-2 stimulates Th cell to
produces cytokines
Q0263:How are Tc cells activated?
1. Virus-infected cell presents endogenously
synthesized proteins on MHC I;2. Signal 1: Tc
cell's TCR recognizes antigen;3. Signal 2: IL-2
released from Th cell activates T c cell to kill
virus infected cell.
Q0264:Antibody structure/function: What are the
components of the heavy chain?
Variable: VH;Constant: CH1; CH2; CH3
components of the light chain?
Variable: VL;Constant: CL
Q0266:What part of an antibody recognizes
antigen?
Variable portion of Fab fragment
Q0267:What part of an antibody fixes complement?
Constant part of H chain of IgM and IgG
Q0268:Antibody structure/function; True or False:
Light chain contributes to Fab
True
Heavy chain contributes to Fab
True
Light chain contributes to Fc
False
Heavy chain contributes to Fc
True
Q0272:What is the middle of the variable
component of an antibody component chain called?
Hypervariable region
Q0273:Antibody structure/function: Where on an
antibody is the hypervariable region?
The majority of the variable segments excluding
the edges
Q0274:How are the four chains of an antibody
connected?
Interchain disulfide bonds at;1. between the two
heavy chains on the Fc side of the hinge
region;2. between corresponding light and heavy
chains on the Fab side of the hinge region
Q0275:What disulfide bonds does an antibody have?
Interchain: Bonds between both heavy chains and
between corresponding light and heavy
chains;Intrachain: On each segment
Q0276:Where on an antibody is the Amino terminal?
At the variable edges of the chains
Q0277:Where on an antibody is the carboxyl
terminal?
At the constant edges of the heavy chains
five Cs of Fc?
1. Constant;2. Carboxy terminal;3. Complement
binding (IgG and IgM only);4. Carbohydrate side
chains;5. Complement binding fragment
Q0279:3 main functions of the antibody
1. Opsonization;2. Neutralization (prevents
bacterial adherence);3. Complement activation
Q0280:How is antibody diversity generated?
1. Random "recombination" of VJ (light chain) or
VDJ (heavy chain) genes;2. Random combination of
heavy chains with light chains;3. Somatic
hypermutation;4. Addition of nucleotides to DNA
during "genetic recombination" by terminal
deoxynucleotidyl transferase.
Q0281:What does terminal deoxynucleotidyl
transferase do?
Addition of nucleotides to DNA during "genetic
recombination" in B cells
Q0282:What does Tdt stand for?
Terminal deoxynucleotidyl transferase
Q0283:Which immunoglobulins are expressed on the
surface of mature B cells?
IgM and IgD
Q0284:What is isotype switching?
Differentiation of B cells into plasma cells that
secrete IgG; IgA; or IgE
Q0285:What stimulates isotype switching?
Cytokines (IL-4 and IL-5) and CD40-Ligand on T-
cells
Q0286:Main antibody isotype in secondary immune
response
IgG
Q0287:Most abundant antibody isotype
IgG
Q0288:Antibody isotypes which cross placenta
IgG
Q0289:Antibody isotypes which fix complement
IgG and IgM in the classic complement
pathway;Mnemonic: GM makes classic cars
Q0290:Antibody isotypes which opsonize bacteria
IgG (and IgA weakly)
Q0291:Main antibody isotype in primary immune
response
IgM
Q0292:Antibody isotypes associated with the J
chain
IgM and IgA
Q0293:Antibody isotypes associated with the SP
IgA;SP = Secretory Protein
Q0294:Antibody isotype with longest half life
IgG (26 days compared with 5 for IgM; the next
longest)
Q0295:Antibody isotype which prevents
bacterial/viral attachment to mucous membranes
IgA
Q0296:Antibody isotype found in secretions
IgA
Q0297:Antibody isotype which mediates type I
hypersensitivity
IgE
Q0298:How does IgE cause an allergic response?
Type I hypersensitivity;1. IgE binds to basophils
or mast cells;2. IgE binds antigen;3. These cells
release histamine and leukotrienes.
Q0299:Which cells have receptors for IgE?
1. mast cells;2. basophils;3. eosinophils;4.
monocytes/macrophages;5. platelets
Q0300:Antibody isotype which mediates immunity to
worms
IgE
Q0301:Least abundant antibody isotype
IgE
Q0302:Define allotype
An individual's allele coding for the constant
portions of the antibody's heavy chains.
Q0303:Define isotype
Type of chain in an antibody;Heavy isotypes:
alpha; gamma; delta; epsilon; mu;Light isotypes:
kappa; lambda
Q0304:Define idiotype
antibodies of one idiotype share structure of
their variable region and thus; antigen binding
specificity.
Supports the growth and differentiation of bone
marrow stem cells (similar to GM-CSF). Most
important during early growth;Mnemonic for first
5 interleukins: Hot T-bone stEAk. bone; as in
bone development
T cells (emphasis on activated T cells) and
thymic epithelial cells
1. Differentiation and growth of B cells and T
cells ;2. Systemic effects (Acute Phase Response
and Fever);3. Stimulates Ig production
Th2 cells
1. Major neutrophil chemotactic and adhesion
factor;2. Angiogenesis;3. High levels associated
with schizophrenia
1. Monocytes;2. Endothelial cells;3. Fibroblasts
1. Promotes differentiation of Th cells into
Th1;2. Activates NK cells
Professional Antigen Presenting Cells;1.
Dendritic cells;2. Macrophages;3. B cells
Q0313:Important cell surface proteins and their
functions: Helper T cells
1. CD4;2. TCR;3. CD3 (Signal transduction);4.
CD28 and CD40L (Receive costimulatory activation
signal respectively from B7 and CD40 which are
both on B cells and professional APCs. These two
signaling pathways each upregulate the other.)
functions: Cytotoxic T cells
1. CD8;2. TCR;3. CD3 (Signal transduction)
functions: B cells
1. IgM;2. MHC II (Presents foreign antigens to Th
cells);2. B7 and CD40 (Costimulatory activation
signal respectively to CD28 and CD40L which are
both on T cells. These two signaling pathways
each upregulate the other.);2. CD19; CD21
(Subunits of co-receptor for BCR complex) ;4.
CD20 (Target in non-Hodgkin's lymphoma of
monoclonal antibodies like rituximab)
functions: Macrophages
1. MHC II (Presents foreign antigens to Th
cells);2. CD14 (Works with toll-like receptor 4
to bind lipopolysaccharide. Also a marker for
monocytes);3. Receptors for Fc and C3b (ie
opsonins)
functions: NK cells
1. Receptors for MHC I;2. CD16 (subunit of low-
affinity Fc receptor [ie. opsonins]);3. CD56
(adhesion molecule)
functions: Hematopoietic stem cells
CD34 (marker for this type of cell; and a
receptor for CD62L; a selectin)
Q0319:Complement: Viral neutralization
C1; C2; C3; C4
Q0320:Complement: Opsonization
C3b
Q0321:Complement: Anaphylatoxins
C3a; C5a
Q0322:Complement: Neutrophil Chemotaxis
C5a
Q0323:Complement: Membrane attack complex
C5b to C9
Q0324:Deficiency of C1 esterase inhibitor leads
to:
Hereditary angioedema (overactive complement)
Q0325:Deficiency of C3 leads to:
Severe recurrent pyogenic sinus and respiratory
tract infections
Q0326:Deficiency of C6 through C8 leads to:
Neisseria bacteremia
Q0327:What is Decay Accelerating Factor?
Prevents attachment of the alternative complement
complex (C3 convertase) to the membrane
Q0328:When is Decay Accelerating Factor missing?
In paroxysmal nocturnal hemoglobinuria
Q0329:What kind of bacteria does complement
defend against?
Gram negative bacteria
Q0330:What activates the classic complement
pathway?
IgG and IgM;Mnemonic: GM makes classic cars.
Q0331:What activates the alternative complement
pathway?
Microbe surface molecules (especially endotoxin)
Q0332:PGI2
Prostacyclin. Vasodilator and inhibits platelet
aggregation. Aspirin does not inhibit its
synthesis by endothelial cells. Synthesized from
PGH2 by prostacyclin synthase in intact
endothelial cells.
Q0333:PGH2
Synthesizes PGI2 with prostacyclin synthase in
intact endothelial cells. Precursor of
thromboxanes. Synthesized from PGG2.
Q0334:PGE2
Vasodilation; pain and fever. Synthesized from
PGH2
Q0335:TxA2
Vasoconstriction; platelet aggregation and
bronchoconstriction. Coverted from PGH2 by
thromboxane synthase.
Q0336:LTB4
chemotaxis and activation of neutrophil adhesion
molecules
Q0337:LTC4
Vasoconstriction; increased vessel permeability;
bronchoconstriction
Q0338:LTD4
bronchoconstriction
Q0339:LTE4
bronchoconstriction
Q0340:HLA DR5
pernicious anemia & juvenile RA
Q0341:HLA DR2
Goodpasture syndrome; allergy; multiple
sclerosis; & narcolepsy
Q0342:HLA DR3
celiac sprue; type I diabetes mellitus; & SLE
Q0343:HLA DR4
pemphigus vulgaris; RA; type I diabetes
Q0344:HLA DR7
steroid-responsive nephrotic syndrome
Q0345:HLA B27
psoriasis; ankylosing spnondylitis; inflammatory
bowel disease; Reiter's syndrome (PAIR)
Q0346:HLA B8
Graves' disease; celiac sprue
Q0347:HLA DR5
pernicious anemia (B12 deficiency); Hashimoto's
thyroiditis
Q0348:antinuclear antibodies (ANA)
SLE
Q0349:anti-dsDNA; anti-Smith
specific for SLE
Q0350:antihistone
drug-induced SLE
Q0351:anti-IgG (rheumatoid factor)
rheumatoid arthritis
Q0352:antineutrophil (C-ANCA; P-ANCA)
vasculitis
Q0353:anticentromere
scleroderma (CREST)
Q0354:anti-Scl-70
scleroderma (diffuse)
Q0355:antimitochondrial
primary biliary cirrhosis
Q0356:antigliadin
celiac disease
Q0357:anti-basment membrane
Goodpasture's
Q0358:anti-epithelial cell
pemphigus vulgaris
Q0359:antimicrosomal
Hashimoto's thyroiditis
Q0360:anti-Jo-1
polymyositis; dermatomyositis
Q0361:IL-1
secreted by macrophages; stimulates T cells; B
cells; neutrophils; fibroblasts; and epithelial
cells to grow; differentiate or synthesize
specific products
Q0362:this cytokine is an endogenous pyogen
IL-1
Q0363:IL-2
secreted by Th cells; stimulates growth of helper
and cytotoxic T cells
Q0364:IL-3
secreted by activated T cells; supports the
growth and differentiation of bone marrow stem
cells
Q0365:this cytokine has a function similar to GM-
CSF
IL-3
Q0366:IL-4
secreted y Th cells; promotes growth of B cells;
enhances cass switching of IgE and IgG
Q0367:IL-5
secreted by Th cells; promotes differentiation of
B cells; enhances class switching of IgA &
stimulates production and activation of
eosinophils
Q0368:IL-6
secreted by Th cells and macrophages; stimiulates
production of actute-phase reactants and
immunoglobulins
Q0369:IL-8
major chemotactic factor for neutrophils
Q0370:IL-10
secreted by Th2 cells; stimulates Th2 while
inihibiting Th1
Q0371:IL-12
secreted by B cells and macrophages; activates NK
and Th2 cells
Q0372:gamma-interferon
secreted by Th cells; stimulates macrophages
Q0373:TNF-alpha
secreted by macrophages; increases IL-2 receptor
synthesis by Th cells; increases B cell
proliferation; attracts and activates
neutrophils; stimulates dendritic cell migration
to lymph nodes
Q0374:what are the cell surface proteins on
helper T cells?
CD4; TCR; CD3; CD28; CD40L
Q0375:cell surface proteins on cytotoxic T cells
CD8; TCR; CD3
Q0376:cell surface proteins on B cells
IgM; B7; CD19; CD20; CD40; MHC II
Q0377:cell surface proteins on macrophages
MHC II; CD14; receptors for Fc and C3b
Q0378:cell surface proteins on NK cells
receptors for MHC I; CD 16
Q0379:cell surface protein on all cells except
mature RBCs
MHC I
Q0380:complement proteins involved in viral
neutralization (4)
C1; C2; C3; C4
Q0381:complement protein responsible for
opsonization
C3b
Q0382:complement proteins involved in anaphylaxis
C3a; C5a
Q0383:complement protein responsbile for
neutrophil chemotaxis
C5a
Q0384:complement proteins involved in cytolysis
by MAC
C5b-9
Q0385:rheumatoid factor and anti-SS-A
Sjogren syndrome
Q0386:HLA A3
primary hemochromatosis
Q0387:high antibody titers to ribonucleoprotein
(RNP); low titer RF and anti-ssDNA
mixed connective tissue disease
Q0388:c-ANCA
Wegener's granulomatosis
Q0389:anti-Ro/anti-SS-A
Sjogren's syndrome
Q0390:anti-SS-B
Sjogren's syndrome
Q0391:what instructs macrophages to become
epitheliod and multinucleated giant cells?
interferon-gamma
Q0392:what is the most specific marker for NK
cells?
CD56; also CD16
Q0393:cytokine that mediates the isotype switch
to IgE in B lymphocytes
IL-4; produced by Th2 cells
Q0394:what are the functions of lymph nodes?
filtration by macrophages; storage/proliferation
of B and T cells; antibody production
Q0395:what is the site of B cell localization and
proliferation?
follicle
Q0396:which follicles are dense and dormant?
primary
Q0397:which follicles have pale central germinal
centers and are active?
secondary
Q0398:these communicate with efferent lymphatics
and contain reticular cells and macrophages
medulla
Q0399:what region of the lymph node houses T
cells?
paracortex
Q0400:in an extreme cellullar immune response;
what part of the lymph node becomes greatly
enlarged?
paracortex
Q0401:this portion of the lymph node is not well
developed in patients with DiGeorge syndrome
paracortex
Q0402:what drains the right arm and the right
half of the head?
right lymphatic duct
Q0403:what drains everything but the right arm
and right half of head?
thoracic duct
Q0404:where are T cells found in the spleen?
periarterial lymphatic sheath adn red pulp (T
rex)
Q0405:where are B cells found within the spleen?
white pulp
Q0406:these are long; vascular channels in red
pulp with fenestrated "barrel hoop" basement
membrane
sinusoids of spleen
Q0407:what is found in the marginal zone of the
spleen?
APCs
Q0408:where do T cells mature? what is this
derived from embryologically?
thymus; epithelium of 3rd branchial pouches
Q0409:what part of the thymus is dense with
immature T cells?
cortex
Q0410:what part of the thymus is pale with mature
T cells and epithelial reticular cells?
medulla (M-mature/medulla)
Q0411:what part of the thymus contains Hassall's
corpuscles?
medulla
Q0412:MHC restriction occurs in what type of
selection?
positive
Q0413:nonreactive to self is associated with what
type of selection?
negative
Q0414:where do positive and negative selection
occur in the thymus?
corticomedullary junction
Q0415:these cells producse IL-2 and gamma-
interferon
Th1 cells
Q0416:these cells activate macrophages and Tc
cells
Th1 cells
Q0417:what do macrophages produces to influence
naive helper T cells to differentiate into Th1
cells?
IL-12
Q0418:what cells produce IL-4 and IL-5? what does
this do?
Th2 cells - causes B cells to differentiate into
plasma cells
Q0419:what type of cells are responsible for host
defense against infection with TB; virus-infected
cells; and fungi?
T cells
Q0420:what type of cells opsonize bacteria and
neutralize toxins and viruses?
B cells
Q0421:what type of cells are responsible for hay
fever and Type I hypersensitivity reactions?
B cells
Q0422:what type of cells are responsible for
poison oak allergy and type IV hypersensitivity?
T cells
autoimmunity?
B cells
graft and tumor rejection and regulation of
antibody response?
T cells
Q0425:what MHC class consists of 1 polypeptide
with beta2-microglobulin?
MHC class I
Q0426:what MHC class consists of 2 polypeptides;
and alpha and beta chain?
MHC class II
Q0427:what cells have MHC I proteins?
all nucleated cells
Q0428:what cells have MHC I and MHC II proteins?
APCs
Q0429:what MHC class are the main determinants of
organ rejection?
MHC class II
Q0430:where does MHC I antigen loading occur?
in RER (viral antigens)
Q0431:where does MHC II antigen loading occur?
in acidified endosome
Q0432:helper T cells have ____; which binds to
____ on antigen-presenting cells
CD4; MHC II
Q0433:cytotoxic T cells have ____; which binds to
____ on virus-infected cells
CD8; MHC I
Q0434:this is a cluster of polypeptides
associated with a T-cell receptor; it is
important in signal transduction
CD3 complex
Q0435:what does Th cell secrete that activates Tc
cell to kill virus-infected cell?
IL-2
Q0436:what do APCs express that bind to CD28 on
Th cells to create the costimulatory signal?
B7
Q0437:what part of an antibody recognizes
antigens?
variable part of L and H chains
Q0438:what part of antibody fixes complement?
constant part of H chain of IgM and IgG
Q0439:what chain contributes to both Fc and Fab
fractions?
heavy chain
Q0440:what chain contributes only to Fab
fraction?
light chain
Q0441:how is antibody diversity generated?
1. random recombination of VJ (light chain) or
VDJ (heavy chain) genes 2. random combination of
heavy chains with light chains 3. somatic
hypermutation 4. addition of nucleotides to DNA
during genetic recombination by tdt
Q0442:what mediates isotype switching?
cytokines and CD40 ligand
Q0443:what is the main antibody in the secondary
response?
IgG
Q0444:what is the most abundant antibody?
IgG
Q0445:this Ig type fixes complement; crosses the
placenta; opsonizes bacteria; and neutralizes
bacterial toxins and viruses
IgG (Goes across placenta)
Q0446:this Ig type prevents attachment of
bacteria and viruses to mucous membranes; does
not fix complement
IgA
Q0447:this Ig type is a monomer or dimer that is
found in secretions and picks up secretory
cmoponent from epithelial cells before secretion
IgA
Q0448:this Ig type is produced in the primary
response to an antigen
IgM (priMary)
Q0449:this momomer or pentamer fixes complement
but does not cross the placenta; antigen receptor
found on the surface of B cells
IgM
Q0450:this Ig type does not have a clear
function; it is found on the surface of many B
cells in serum
IgD
Q0451:this Ig mediates immediate (type I)
hypersensitivity by inducing the release of
mediators from mast cells and basophils when
exposed to allergen
IgE
Q0452:this Ig has the lowest concentration in
serum
IgE
Q0453:this Ig mediates immunity to worms
IgE
Q0454:this type of Ig epitope differs among
members among members of same species; can be on
light chain or heavy chain
allotype (polymorphism)
Q0455:this is an Ig epitope common to a single
class of Ig (5 classes; determined by heavy
chainn)
isotpe (IgG; IgA; etc.)
Q0456:this Ig epitope is determined by antigen-
binding site; specific for a given antigen
idiotype
Q0457:patients are given preformed antibodies
after exposure to what four diseases?
tetanus; botulinum; HBV; rabies (to be healed
rapidly)
Q0458:this type of immunity is based on receiving
preformed antibodies from another host
passive
Q0459:this type of immunity is induced after
exposure to foreign antigen - slow onset but
long-lasting production
active
Q0460:how does salmonella show antigen variation?
two flagellar variants
Q0461:how does nenisseria gonorrhoeae show
antigen variation?
pilus protein
Q0462:what is anergy?
self=reactive T cells become nonreactive without
costimulatory molecule
Q0463:what types of hypersensitivity are
antibody-mediated?
I; II; III
Q0464:in this type of hypersensitivity; antigen
cross=links IgE on presensitized mast cells and
basophils; triggering release of vasoactive
amines (e.g. histamine)
type I (anaphylactic and atopic)
Q0465:anaphylaxis; asthma; hives; local wheal and
flare are examples of what type of
hypersensitivity?
type I
Q0466:in this type of hypersensitivity; IgM; IgG
bind to antigen on "enemy" cell; leading to lysis
(by complement) or phagocytosis
type II (cyotoxic)
Q0467:autoimmune hemolytic anemia; Rh disease;
Goodpasture's; rheumatic fever; Grave's disease;
bullous pemphigoid; MG; and ITP are all examples
of what type of hypersensitivity?
type II
Q0468:in this type of hypersensitivity; antigen-
antibody complexes activate complement; which
attracts neutrophils; neutrophils release
lysosomal enzymes
type III
Q0469:polyarteritis nodosa; immune complex
glomerulonephritis; SLE; RA; serum sickness; and
Arthus reaction are examples of what type of
hypersensitivity?
type III
Q0470:this is an imuune complex disease in which
antibodies to foreign proteins are produced
(takes 5 days); immune complexes are formed and
deposit in membranes where they fix complement
serum sickness (type III)
Q0471:this is a local subacute antibody-mediated
hypersensitivity (type III) reaction in which
intradermal injection of antigen induces
antibodies which form Ag-Ab complexes in skin
Arthus reaction
Q0472:this type III hypersensitivity reaction is
characterized by edema; necrosis; and activation
of complement
Arthus reaction
Q0473:hypersensitivity pneumonitis (farmer's
lung) and thermophilic actinomycetes are examples
of what?
Arthus reaction
Q0474:in this type of hypersensitivity;
sensitized T lymphocytes encounter antigen and
then release lymphokines; which leads to
macrophage activation
type IV (delayed/T-cell mediated)
Q0475:transplant rejections; TB skin tests; and
contact dermatitis are examples of what type of
hypersensitivity?
type IV
Q0476:fever; urticaria; arthralgias; proteinuria;
lymphadenopathy 5-10 days after drug exposure
serum sickness
Q0477:what defends agains gram-negative bacteria?
complement
Q0478:the classic pathway is activated by what?
IgG or IgM (GM makes classic cars)
Q0479:what activates the alternate pathway?
molecules on the surface of microbes (especially
endotoxin)
Q0480:interferons induce the production of a 2nd
protein that inhibits viral protein synthesis by
doing what?
degrading viral mRNA
Q0481:these are proteins that place uninfected
cells in an antiviral state
interferons (alpha; beta; gamma)
Q0482:which interferons inhibit viral protein
synthesis?
alpha and beta interferons
Q0483:what does gamma-interferon do?
increases MHC I and II expression and antigen
presentation in all cells
Q0484:this type of rejection is due to the
presence of preformed antidonor antibodies in the
transplant recipient
hyperacute rejection
Q0485:this type of transplant rejection is cell-
mediated due to cytotoxic T lymphocytes reacting
against foreign MHCs
acute rejection
Q0486:what type of transplant rejection is
reverisble with immunosuppressants such as
cyclosporin and OKT3?
acute rejection
Q0487:this type of transplant rejection is
characterized by antibody-mediated vascular
damage (fibrinoid necrosis) and is irreversible
chronic rejection
Q0488:what are major symptoms of graft-versus-
host disease?
maculopapular rash; jaundice; hepatosplenomegaly;
and diarrhea
Q0489:what is the defect in Bruton's
agammaglobulinemia?
X-linked recessive defect in a tyrosine kinase
gene associated with low levels of all classes of
Igs
Q0490:this disorder occurs in boys and is
associated with recurrent bacterial infections
after 6 months of age; when levels of maternal
IgG antibody decline
Brutons agammaglobulinemia (B cells)
Q0491:this immune deficiency presents with tetany
owing to hypocalcemia and recurrent viral and
fungal infections
DiGeorge syndrome/thymic aplasia (T cells)
Q0492:this immune deficiency is associated with
congenital defects of heart and great vessels
DiGeorge syndrome
Q0493:what ist eh chromosomal abnormality
associated with DiGeorge syndrome?
22q11 deletion
Q0494:this is a defect in early stem cell
differentiation and presents with recurrent
viral; bacterial; fungal; and protozoal
infections
SCID - B and T cell deficiency
Q0495:failure to synthesize MHC II antigens;
defective IL-2 receptors; and adenosine deaminase
deficiency can all lead to what immune
deficiency?
SCID
Q0496:what does IL-12 receptor deficiency
(decreased activation of T cells) present with?
disseminated mycobacterial infections
Q0497:defect in CD40 ligand on CD4 T helper cells
leads to inability to class switch; presents
early in life with severe pyogenic infections
hyper-IgM syndrome (decreased activation of B
cells)
Q0498:this disorder is characterized by high
levels of IgM and very low levels of IgG; IgA;
and IgE
hyper-IgM syndrome
Q0499:this syndrome is characterized by an X-
linked defect in the ability to mount an IgM
response to capsular polysaccharides of bacteria
Wiskott-Aldrich syndrome (decreased activation of
B cells)
Q0500:what is the triad of symptoms associated
with Wiskott-Aldrich syndrome?
infections; thrombocytopenic purpura; eczema
(WIPE)
Q0501:this syndrome is associated with elevated
IgA levels; normal IgE levels; and low IgM levels
Wiskott-Aldrich syndrome
Q0502:this syndrome presents with recurrent
'cold' (noninflamed) staphylococcal abscesses;
eczema; coarse facies; retained primary teeth;
and high IgE levels
Job's syndrome (decreased activation of
macrophages)
Q0503:this syndrome is characterized by failure
of gamma-interferon production by helper T cells;
neutrophils fail to respond to chemotactic
stimuli
JOb's syndrome
Q0504:what is the defect in leukocyte adhesion
deficiency syndrome?
defect in LFA-1 adhesion proteins on phagocytes
Q0505:this syndrome presents early with severe
pyogenic and fungal infections and delayed
separation of umbilicus
leukocyte adhesion deficiency syndrome
Q0506:how is Chediak-Higashi inherited?
autosomal recessive
Q0507:this disease is marked by a defect in
microtubular function and lysosomal emptying of
phagocytic cells
Chediak-Higashi disease
Q0508:this disease presents with recurrent
pyogenic infections by staph and strep; partial
albinism; and peripheral neuropathy
Q0509:defect in phagocytosis of neutrophils owing
to lack of NADPH oxidase activity or similar
enzymes
chronic granulomatous disease
Q0510:how is the diagnosis of chronic
granulomatous disease confirmed?
negative nitroblue tetrazolium dye reduction test
Q0511:this disease presents with marked
susceptibility to opportunistic infections with
bacteria; especially S. aureus; E. coli; and
Aspergillus
Q0512:what is the defect in chronic mucocutaneous
candidiasis present?
idiopathic dysfunction of T cells specifically
against candida albicans
Q0513:what is the most comon selective
immunoglobulin deficiency? how does it present?
selective IgA deficiency - presents with sinus
and lung infections; milk allergies and diarrhea
are common
Q0514:ataxia-telangiectasia is an idiopathic
dysfunction of what type of cells?
B cells
Q0515:defect in DNA repair enzymes with
associated IgA deficiency; presents with
cerebellar problems and spider angiomas
ataxia-telangiectasia
Q0516:deficiency of what leads to hereditary
angioedema?
C1 esterase inhibitor
Q0517:deficiency of which complement protein
leads to severe; recurrent; pyogenic sinus and RT
infections?
C3
Q0518:deficiency of what complement proteins
leads to Neisseria bacteremia?
C6-C8
Q0519:deficiency of what leads to paroxysmal
nocturnal hemoglobinuria?
decay-accelerating factor
Q0520:patients with what deficiency have an
increased susceptibility to recurrent bacterial
infections; especially with encapsulated bacteria
C3 deficiency; not detected until later in life
Q0521:what is the most important immunological
protective mechanism against blood-borne
encapsulated organisms?
IgG-mediated opsonization in the spleen
Q0522:Warthin-Finkeldy giant cell is
pathognomonic for what?
measles or the live attenuated measles vaccine
Q0523:Lyme arthritis is associated with what HLA?
HLA-DR4
Q0524:patients with Wiskott-Aldrich syndrome have
a 12% chance of developing what?
non-Hodgkin's lymphoma
Q0525:test of choice to determine presence of
circulating anti-Rh antibody?
indirect Coombs test to measure IgG anti-Rh
antibody
Q0526:low levels of all antibody classes
common variable immunodeficiency
Q0527:spleen is important for removing what type
of organisms? list 3
strep pneumo; H. flu; Neisseria
Q0528:what is defective in leukocyte adhesion
deficiency?
integrins - function both in adhesion of
leukocytes to other cells and in the phagocytosis
of complement-coated material
Q0529:HLA types associated with SLE?
HLA-DR2 and HLA-DR3
Q0530:most likely sequelae of rheumatic fever?
mitral valve disease
Q0531:antitopoisomerase antibodies?
scleroderma/systemic fibrosis - likely to develop
diffuse systemic fibrosis & death from
consequences of systemic disease such as
pulmonary fibrosis or malignant hypertension
Q0532:what is responsible for strong binding
between monocytes; T lymphocytes; macrophages;
neutrophils; and dendritic cells; and injured
epithelium?
LFA-1; interacts with ICAM-1
Q0533:an increased level of what cytokine would
decrease the likelihood of a delayed-type
hypersensitivity reaction?
IL-10
Q0534:what 2 molecules exert the most powerful
chemotactic effect on neutrophils?
C5a and C8
Q0535:what are the best markers for
identification of B cells?
CD19; CD20; CD21
Q0536:IgG subclass deficiency is associated with
a deficiency with what other substrate?
IgA
Q0537:what is C-reactive protein a marker of?
non-specific inflammation - one of the most
commonly measured acute-phase reactants
Q0538:what test is done to diagnose CGD
nitroblue tetrazolium reduction test (NBT);-neg
in patients with CGD because they don't make
oxygen radicals
Q0539:what is the valence of an Ig molecule equal
to
number of Ags the Ab can bind to
Q0540:what is the name of the process that
ensures that each B cell produces only one heavy
chain variable domain and one light chain
allelic exclusion
Q0541:what is the major ab of the primary immune
response
IgM
Q0542:what form of immunity is responsible for
removal of intracellular infection
CMI
Q0543:t or f;direct fluuorescent Ab test is used
to detect Abs in a patient
false;direct test is for Ags;indirect test is for
Abs
Q0544:what is the triad of Wiskott-Aldrich?;mode
of inheritance
thrombocytopenia;eczema;immunodeficiency;-XLR
Q0545:what complement factor deficiency leads to
;1. inc pyogenic infection;2. recurrent gonoccal
infection;3. leukocyte adhesion deficiency w/
poor opsonization;4. hereditary angioedema
1. C3 def;2. C5-C8 def;3. C1; C2; or C4 def;4. C1
inhibitor
Q0546:which IgG can't activate complement
IgG4
Q0547:name the T-cell CD marker;1. essential for
Ab isotype switching (for B cell binding;2.
interacts w/ MHC class I ;2. exprssed on all T
cells and is needed as a signal transducer for
the T cell receptor;4. interacts w/ MHC II;5. is
a costimulatory molecule in T cell activation
1. CD40;2. CD8;3. CD3;4. CD4;5. CD28
Q0548:what three cells are essential for t cell
differentiation in the thymus
dendritic cells;macrophages;thymic epithelial
cells
Q0549:what is the only specific ag presenting
cell
b cell
Q0550:what is the tetrad of jarisch-herscheimer
reax
rigors;leukopenia;dec BP;(after tx for syphilis)
Q0551:what is the name of the B cell that
secretes Ig
plasma cell
Q0552:what would be the result if an Ab were
cleaved with papain
there would be two Fab and Fc regions
Q0553:what is the bone marrow maturation time for
a phagocytic cell
14 days
Q0554:which leukotrienes are assoc with the late
phase inflammatory response
LTC4;LTD4
Q0555:what is the term for the strength of the
assoc between Ag and an Ab
affinity (one of each)
Q0556:t or f;more ag is needed to produce a
secondary immune response than a first immune
response
f;fewere Ags are needed
Q0557:what is the term for the strength of
association between multiple Ab binding sites and
multiple antigenic determinants
avidity;(more than one binding site)
Q0558:what Ig mediates ADCC via k cells;
opsonizes; and is the Ig of the secondary immune
response
IgG
Q0559:what test is used to detect ant-RBC Abs
seen in hemolytic anemia
coombs test
Q0560:what subset of T cells recognizes the MHC I
CD8 cytotoxic T cells
Q0561:what cell surface marker is found on
activated helper T cells
CD40
Q0562:what re the five Ig isotypes
IgG;IgA;IgM;IgE;IgD
Q0563:which integrin mediates the adhesion to
endothelial cells for migration to and out of the
blood during an immune response
beta-2 integrins
Q0564:what type of hypersensitivity is an
ab0mediated response against our own cells;
receptors or membranes via IgG or IgM
type II
Q0565:what is the term to describe the limited
portion of an Ag that is recognized by an Ab
antigenic determinant (epitope)
Q0566:what cytokine do Th1 cells secrete to
inhibit Th2 function
INF-gamma
Q0567:what three cells are essential for T cell
maturation
thymic epi cells;dendritic cells;macrophages
Q0568:what is the term for a single isolated
antigenic determinant
hapten
Q0569:what are the two opsonizing factors
Fc region of IgG;C3b
Q0570:what is the most common Ig deficiency
IgA
Q0571:what is the name of the B cell rich area of
the spleen
primary follicle in white pulp
Q0572:what IL; produced by macrophages is
chemotactic for neutrophils
IL-8
Q0573:what Ig prevents bacterial adherence to
mucosal surfaces
IgA
Q0574:what are the three rules of clonal
selection
one cell type;one Ab type;random selection of
hypervariable regions; and only cells with bound
Ag undergo clonal expansion
Q0575:what is a plasma cell's life expectancy
7 to 14 days
Q0576:what are defined by Ag binding specificity
idiotypes
Q0577:what type of binding occurs with one Fab or
one idiotype of IgG
affinity
Q0578:what molecule that is needed to trigger T
cell activation is noncovalently linked to TCR
CD3
Q0579:what is the term for Ags that activate B
cells without T cell signaling
thymus-independent Ags
Q0580:what are the three rules governing a
secondary immune response
1. covalent binding between the hapten and
carrier;2. b cell esposure to hapten twice;3. t
cell exposure to carrier twice
Q0581:what type of hypersensitivity is a T cell
mediated response to Ags that are not activated
by Ab or complement
type IV
Q0582:name the macrophage;1. liver;2. lungs;3.
CNS;4. kidney
1. kupffer;2. alveolar;3. microglial;4. mesangial
Q0583:what is the first human disease
successfully tx with gene therapy
adenosine deaminase (ADA) def
Q0584:what receptors are the best markers for NK
cells
CD 16;CD 56
Q0585:t or f;ag-ab binding is irreversible
f
Q0586:what three major cell lines participate in
the acquired immune system
t cells;b cells;macrophages
Q0587:what test is used to screen for HIV
ELISA for anti-p24 IgG
Q0588:during what stage of b cell development is
IgM first seen on the surface
immature b cells
Q0589:what Ig is responsible for ADCC of
parasites; has a high affinity Fc receptor on
mast cells; and basophils and is responsible for
the allergic response
IgE
Q0590:t or f;b cell ag receptors can be secreted
true
Q0591:are more abs produced in a primary or
secondary immune response
secondary
Q0592:by which process do abs make microorganisms
more easily ingested via phagocytosis
opsonization
Q0593:what MHC class acts to remove foreign Ags
from the body
MHC II
Q0594:what disorder is characterized by
autoantibodies to IF
pernicious anemia
Q0595:what cytokines do Th2 cells secrete to
inhibit Th1 cell function
IL-4;IL-10;IL-13
Q0596:what is the term for the number of Ag-
binding sites on an Ig
valence
Q0597:which major cell type is found in the red
pulp of the spleen
RBC
Q0598:what is the name of the pathway that
produces leukotrienes
Lipoxygenase
Q0599:what is the term to describe basophils;
that have left the bloodstream and entered a
tissue
mast cells
Q0600:what are the three major functions of
secretory IgA
IgA receptor;transport of IgA across epi
;protection of IgA from degradation proteases
Q0601:what IL is important in myeloid cell
development
IL-3 (3 face down is an M)
Q0602:what is the term for different classes and
subclasses of the same gene products
isotypes
Q0603:what is the first Ab a baby makes
IgM
Q0604:what test by using specific Abs to
different receptors allows for rapid analysis of
cell types in a blood test
flow cytometry analysis
Q0605:what is the name of the T cell rich area of
the spleen
PALS
Q0606:what three complement fragments are also
anaphylatoxins
C3a;C4a;C5a
Q0607:name the B cell CD marker;1. req for class
switching signlas from T cells;2. receptor for
EBV;3. used clinically to count B cells in blood
1. CD40;2. CD21- a complement receptor for
cleaved C3;3. CD19
Q0608:what immunologic test checks for a reax
between Abs and a paricular Ag (hint: ABO
testing)
agglutination test
Q0609:which leukotriene is chemotactic for
neutrophils
LTB4
Q0610:what Ig is assoc w/ mucosal surfaces and
external secretions
IgA
Q0611:what are the genetic variants of a molecule
within members of the same species
allotypes
Q0612:what cytokine do CD4 t cells secrete to
activate B cells when the specific peptide in the
groove of the MHC II molecule interacts with the
TCR
IL-4 is secreted to activate B cells;-> begins
ACTIVATION;CD4 t cells also secrete INF-alpha to
activate macrophages
Q0613:which protein prevents internal binding of
self proteins within an MHC II cell
invariant chain
Q0614:what would be the result if an Ab were
cleaved with pepsin
Fab' fragment- it could still participate in
precipitation and agglutination
Q0615:why are patients with CGD not prone to
develop infection from catalase neg bacteria
catalase neg bacteria secrete H2O2 allowing the
neutrophils to use it as the substrate for other
toxic metabolites;patients with CGD are prone to
catalase pos infections;(NADPH defect)
Q0616:what are the two chains of the TCR that are
mainly found on the skin and mucosal surfaces
gamma and delta chains
Q0617:which IL is assoc with increases of IgG and
igE
IL-4
Q0618:Antinuclear antibodies (ANA)
SLE
Q0619:Anti-dsDNA
specific for SLE
Q0620:Anti-Smith
specific for SLE
Q0621:Anti-histone
specific for drug-induced lupus;(caused
by;Hydralazine; INH; Phenytoin; Procainamide)
Q0622:Anti-IgG
Rheumatoid arthritis (autoantibody also known as
rheumatoid factor)
Q0623:Antineutrophil
Vasculitis
Q0624:p-ANCA
Polyarteritis Nodosa ;1. necrotizing degeneration
of media --> aneurysms;2. small and med
arteries;3. ass'd w/ Hep B
Q0625:c-ANCA
Wegener's Granulomatosis;1. necrotizing;
granulomatous lesions in kidney and lung;2. small
arteries and veins;3. cough; ulcers of nasal
septum; RBC casts
Q0626:Anticentromere
Scleroderma
(CREsT);Calcinosis;Raynaud's;ESophageal
dysfn;Telangiectasia
Q0627:Anti-Scl-70
Scleroderma (diffuse)
Q0628:Antimitochondrial
Primary Biliary Cirrhosis (PBC)
Q0629:Antigliadin
Celiac sprue
Q0630:Anti-basement membrane
Goodpasture's Syndrome
Q0631:Anti-epithelial cell
Pemphigus vulgaris
Q0632:Antimicrosomal
Hashimoto's thyroiditis;(anti-thyroglobulin and
anti-thyroid peroxidase)
Q0633:Autoantibody;ANA
Associated Disorder;SLE
Q0634:Autoantibody;Anti-dsDNA;Anti-Smith
Associated Disorder;specific for SLE
Q0635:Autoantibody;antihistone
Associated Disorder;drug-induced lupus
Q0636:Autoantibody;Anti-IgG;(rheumatoid factor)
Associated Disorder;Rheumatoid arthritis
Q0637:Autoantibody;Antineutrophil;(P-ANCA; C-
ANCA)
Associated Disorder;Vaculitis
Q0638:Autoantibody;Anticentromere
Associated Disorder;Scleroderma (CREST)
Q0639:Autoantibody;Anti-Scl-70
Associated Disorder;Scleroderma (diffuse)
Q0640:Autoantibody;antimitochondrial
Associated Disorder;Primary biliary cirrhosis
Q0641:Autoantibody;antigliadin
Associated Disorder;Celiac Disease
Q0642:Autoantibody;Anti-basement membrane
Associated Disorder;Goodpasture's syndrome
Q0643:Autoantibody;anti-Epithelial cell
Associated Disorder;Pemphigus vulgaris
Q0644:Autoantibody;Antimicrosomal
Associated Disorder;Hashimoto's thyroiditis
Q0645:Autoantibody;Anti-Jo-1
Associated Disorder;Polymysitis;Dermatomyositis
Q0646:what is the defect in Bruton's
agammaglobulinemia?
X-linked recessive defect in a tyrosine kinase
gene associated with low levels of all classes of
Igs
Q0647:this disorder occurs in boys and is
associated with recurrent bacterial infections
after 6 months of age; when levels of maternal
IgG antibody decline
Brutons agammaglobulinemia (B cells)
Q0648:this immune deficiency presents with tetany
owing to hypocalcemia and recurrent viral and
fungal infections
DiGeorge syndrome/thymic aplasia (T cells)
Q0649:this immune deficiency is associated with
congenital defects of heart and great vessels
DiGeorge syndrome
Q0650:what ist eh chromosomal abnormality
associated with DiGeorge syndrome?
22q11 deletion
Q0651:this is a defect in early stem cell
differentiation and presents with recurrent
viral; bacterial; fungal; and protozoal
infections
SCID - B and T cell deficiency
Q0652:failure to synthesize MHC II antigens;
defective IL-2 receptors; and adenosine deaminase
deficiency can all lead to what immune
deficiency?
SCID
Q0653:what does IL-12 receptor deficiency
(decreased activation of T cells) present with?
disseminated mycobacterial infections
Q0654:defect in CD40 ligand on CD4 T helper cells
leads to inability to class switch; presents
early in life with severe pyogenic infections
hyper-IgM syndrome (decreased activation of B
cells)
Q0655:this disorder is characterized by high
levels of IgM and very low levels of IgG; IgA;
and IgE
hyper-IgM syndrome
Q0656:this syndrome is characterized by an X-
linked defect in the ability to mount an IgM
response to capsular polysaccharides of bacteria
Wiskott-Aldrich syndrome (decreased activation of
B cells)
Q0657:what is the triad of symptoms associated
with Wiskott-Aldrich syndrome?
infections; thrombocytopenic purpura; eczema
(WIPE)
Q0658:this syndrome is associated with elevated
IgA levels; normal IgE levels; and low IgM levels
Q0659:this syndrome presents with recurrent
'cold' (noninflamed) staphylococcal abscesses;
eczema; coarse facies; retained primary teeth;
and high IgE levels
Job's syndrome (decreased activation of
macrophages)
Q0660:this syndrome is characterized by failure
of gamma-interferon production by helper T cells;
neutrophils fail to respond to chemotactic
stimuli
JOb's syndrome
Q0661:what is the defect in leukocyte adhesion
deficiency syndrome?
defect in LFA-1 adhesion proteins on phagocytes
Q0662:this syndrome presents early with severe
pyogenic and fungal infections and delayed
separation of umbilicus
leukocyte adhesion deficiency syndrome
Q0663:how is Chediak-Higashi inherited?
autosomal recessive
Q0664:this disease is marked by a defect in
microtubular function and lysosomal emptying of
phagocytic cells
Q0665:this disease presents with recurrent
pyogenic infections by staph and strep; partial
Q0666:defect in phagocytosis of neutrophils owing
to lack of NADPH oxidase activity or similar
enzymes
Q0667:how is the diagnosis of chronic
granulomatous disease confirmed?
negative nitroblue tetrazolium dye reduction test
Q0668:this disease presents with marked
susceptibility to opportunistic infections with
bacteria; especially S. aureus; E. coli; and
Aspergillus
Q0669:what is the defect in chronic mucocutaneous
candidiasis present?
idiopathic dysfunction of T cells specifically
against candida albicans
Q0670:what is the most comon selective
immunoglobulin deficiency? how does it present?
selective IgA deficiency - presents with sinus
and lung infections; milk allergies and diarrhea
are common
Q0671:ataxia-telangiectasia is an idiopathic
dysfunction of what type of cells?
B cells
Q0672:defect in DNA repair enzymes with
associated IgA deficiency; presents with
cerebellar problems and spider angiomas
ataxia-telangiectasia
Q0673:deficiency of what leads to hereditary
angioedema?
C1 esterase inhibitor
Q0674:deficiency of which complement protein
leads to severe; recurrent; pyogenic sinus and RT
infections?
C3
Q0675:deficiency of what complement proteins
leads to Neisseria bacteremia?
C6-C8
Q0676:deficiency of what leads to paroxysmal
nocturnal hemoglobinuria?
decay-accelerating factor
Q0677:patients with what deficiency have an
increased susceptibility to recurrent bacterial
infections; especially with encapsulated bacteria
C3 deficiency; not detected until later in life
Q0678:what is the most important immunological
protective mechanism against blood-borne
encapsulated organisms?
IgG-mediated opsonization in the spleen
Q0679:Warthin-Finkeldy giant cell is
pathognomonic for what?
measles or the live attenuated measles vaccine
Q0680:Lyme arthritis is associated with what HLA?
HLA-DR4
Q0681:patients with Wiskott-Aldrich syndrome have
a 12% chance of developing what?
non-Hodgkin's lymphoma
Q0682:test of choice to determine presence of
circulating anti-Rh antibody?
indirect Coombs test to measure IgG anti-Rh
antibody
Q0683:low levels of all antibody classes
common variable immunodeficiency
Q0684:spleen is important for removing what type
of organisms? list 3
strep pneumo; H. flu; Neisseria
Q0685:what is defective in leukocyte adhesion
deficiency?
integrins - function both in adhesion of
leukocytes to other cells and in the phagocytosis
of complement-coated material
Q0686:HLA types associated with SLE?
HLA-DR2 and HLA-DR3
Q0687:most likely sequelae of rheumatic fever?
mitral valve disease
Q0688:antitopoisomerase antibodies?
scleroderma/systemic fibrosis - likely to develop
diffuse systemic fibrosis & death from
consequences of systemic disease such as
pulmonary fibrosis or malignant hypertension
Q0689:what is responsible for strong binding
between monocytes; T lymphocytes; macrophages;
neutrophils; and dendritic cells; and injured
epithelium?
LFA-1; interacts with ICAM-1
Q0690:an increased level of what cytokine would
decrease the likelihood of a delayed-type
hypersensitivity reaction?
IL-10
Q0691:what 2 molecules exert the most powerful
chemotactic effect on neutrophils?
C5a and C8
Q0692:what are the best markers for
identification of B cells?
CD19; CD20; CD21
Q0693:IgG subclass deficiency is associated with
a deficiency with what other substrate?
IgA
Q0694:what is C-reactive protein a marker of?
non-specific inflammation - one of the most
commonly measured acute-phase reactants
Q0695:Name the cytokine:secreted by macrophages;
stimulates just about everything; endogenous
pyrogen
IL-1
Q0696:which cytokine stimulates growth of helper
and cytotoxic T cells
IL-2
Q0697:which cytokine supports growth and
differentiation of BM stem cells
IL-3 (secreted by activated T cells)
Q0698:which cytokine promotes growth of B cells
and enhances class switching of IgE; IgG?
IL-4
Q0699:which cytokine enhances class switching of
IgA?
IL-5 (also promotes differentiation of B cells;
stimulates production and activation of
eosinophils)
Q0700:which cytokine stimulates activation and
production of eosinophils?
IL-5
Q0701:which cytokine stimulates production of
acute phase reactants and immunoglobulins?
IL-6
Q0702:which interleukin is one of the MAJOR
chemotactic factors for PMNs?
IL-8 (also; C5a)
Q0703:which cytokine stimulates Th2 and inhibits
Th1?
IL-10 (secreted by Th2 cells)
Q0704:IL-10
secreted by Th2 cells; stimulates Th2; inhibits
Th1
Q0705:which cytokine activates NK cells and Th1
cells?
IL-12 (secreted by macrophages; B cells)
Q0706:who is the "anticytokine" that inhibits
growth and activity of T cells; counteracts
effects of inflammatory cytokines; and stimulates
wound healing?
TGF-beta
Q0707:which cytokine increases IL-2 receptor
synthesis by Th cells; and increased B cell
proliferation?
TNF-alpha (also attracts and activates PMNs;
stimulates dendritic cell migration to lymph
nodes)
Q0708:which cytokine is NOT produced in Job's
syndrome--> "cold" staph abscesses
gamma-IFN (secreted by Th1 cells; stimulates
macrophages)
Q0709:what are the 2 signals required for
activation of helper T cells?
1) foreign Ag on MHC II recognized by TCR on Th
cell; 2) costim by B7-CD28
Q0710:what are the 2 signals required for
activation of cytotoxic T cells
1) endogenously synthesized proteins on MHC I
recognized by TCR; 2) IL-2 from Th cell activates
cytotoxic cell
Q0711:what kind of hypersensitivity reaction--
allergic rhinitis
type I hypersensitivity
Q0712:what kind of hypersensitivity reaction--
hemolytic anemia
type II hypersensitivity
Q0713:idiopathic thrombocytopenic purpura
Q0714:erythroblastosis fetalis
Q0715:rheumatic fever
Q0716:Goodpasture's syndrome
Q0717:bullous pemphigoid
Q0718:Graves' dz
Q0719:myasthenia gravis
Q0720:SLE
type III hypersensitivity
Q0721:rheumatoid arthritis
Q0722:polyarteritis nodosum
Q0723:post-strep glomerulonephritis
Q0724:serium sickness
Q0725:arthus reaction
Q0726:hypersensitivity pneumonitis
Q0727:type I diabetes mellitus
type IV hypersensitivity
Q0728:multiple sclerosis
Q0729:Guillain-Barre syndrome
Q0730:Hashimoto thyroiditis
Q0731:GVHdz
Q0732:PPD (TB test)
Q0733:contact dermatitis
Q0734:IgM; IgG bind to Ag on "enemy" cell-->
lysis or phagocytosis
type II (Ab-mediated) hypersensitivity
Q0735:Ag-Ab complexes activate complement which
attracts PMNs who release dangerous substances
type III (immune complex) hypersensitivity
Q0736:sensitized T cells encounter Ag and release
lymphokines to activate macrophages
type IV (delayed) hypersensitivity
Q0737:fever; urticaria; arthralgias; proteinuria;
lymphadenopathy 5-10 days after Ag exposure
(serum sickness) type III hypersensitivity
Q0738:Psoriasis
B27 HLA association
Q0739:Ankylosing Spondylitis
B27 HLA association
Q0740:IBD
B27 HLA association
Q0741:Reiter's syndrome
B27 HLA association
Q0742:Grave's
B8 HLA association
Q0743:Celiac sprue
B8 HLA association
Q0744:MS
DR2 HLA association
Q0745:hay fever
DR2 HLA association
Q0746:SLE
DR2 HLA association
Q0747:Goodpasture's
DR2 HLA association
Q0748:DM 1
DR3; DR4 HLA association
Q0749:Rheumatoid arthritis
DR4 HLA association
Q0750:Pernicious anemia
DR5 HLA association
Q0751:Hashimoto's
DR5 HLA association
Q0752:Steroid responsive nephrotic syndrome
DR7 HLA association
Q0753:x-linked recessive defect un tyrosine
kinase gene assoc with low levels of all Ig
classes. > after 6 months in bacterial infections
(maternal IgG declines); mostly in BOYS
Bruton's agammaglobulinemia - Decreased
PRODUCTION B cells
Q0754:Presents with tetany from HYPOCALCEMIA.
Viral and fungal infs from T CELL DEFICIT;Thymus
and parathyroid failure to dev - failure of 3rd
and 4th pharyngeal pouches to form;Congenital
defects of heart and great vessels. 22q11 del.
DiGeorge Syndrome - decreased PRODUCTION of T
cells - Thymic aplasia
Q0755:Prob in early stem cell differemtiation.
recurrent bact; viral; fungal; protozoan
infections. may have multiple causes (failure to
synth MHC II antigens; defective IL2 receptors;
adenosine deaminase deficiency)
SCID - B and T cells decreased PRODUCTION
Q0756:disseminated mycobacterial infections
Decreased ACTIVATION of T cells - IL-12 receptor
deficiency
Q0757:Early severe pyogenic infections;High IgM -
- Low everything else;Defective CD40L on CD4 T-
helpers so cannot class switch.
Hyper IgM syndrome - decreased ACTIVATION of B
cells
Q0758:Triad of symps;1. recurrent pyogenic
Infecs;2. Thrombocytopenic purpura;3. Eczema;x-
linked. Not able to mount IgM response to
capsular polysaccs of bacteria;High IgA;NORMAL
IgE;Low IgM.
Wiskott-Aldrich - decreased ACTIVATION of B cells
Q0759:Recurrent "cold"/non-inflamed staph
abcesses; eczema; course facies; retained primary
teeth;HIGH IgE;Failure of gamma interferon
production by T helpers.
Job's syndrome - decreased ACTIVATION of
macrophages.
Q0760:Early severe pyogenic and fungal infections
and DELAYED SEPARATION OF UMBILICUS;Defect in
LFA-1 adhesion proteins on phagocytes.
PHAGOCYTIC CELL DEFICIENCY -;Leukocyte adhesion
deficiency syndrome
Q0761:Presents recurrent pyogenic staph and
strep; PARTIAL ALBINISM; peripheral
neuropathy;Autosomal Recessive;Defect in
MICROTUBULAR FUNCTION AND LYSOSOMAL EMPTYING OF
PHAGOCYTES.
PHAGOCYTIC CELL DEFICIENCY -;Chediak-Higashi dz
Q0762:Marked suscepitibility to opport. infecs
with bacteria - esp S. aureusm E. coli; and
Aspergillus. Dx with NEGATIVE nitroblue
tetrazolium dye reduction test - lack of NADPH
oxidase activity in PMNs.
PHAGOCYTIC CELL DEFICIENCY - ;Chronic
granulomatous disease
Q0763:Candida - skin and mucous membranes. T cell
dysfunc against Candida specifically.
IDIOPATHIC DYSFUNCTION OF;T Cells;Chronic
Mucocutaneous Candidiasis
Q0764:Sinus and lung infections; milk allergies
and diarrhea common. Deficiency in one specific
Ig class - IgA def is most common. Could be due
to defect in isotype switching.
IDIOPATHIC DYSFUNCTION OF;B Cells;Selective
Immunoglobulin Deficiency
Q0765:Presents as cerebellar problems (ataxia)
and spider angiomas (telangiectasia). Defect in
DNA repair enzymes with associated IgA deficit.
IDIOPATHIC DYSFUNCTION OF;B cells;Ataxia-
telangiectasia
Q0766:Acquired in 20-30's;NORMAL B cell numbers
circulating;LOW PLASMA CELLS ;LOW Ig
IDIOPATHIC DYSFUNCTION OF;B cells;Common variable
immunodeficiency
Q0767:Rheumatoid factor
It is an antibody against the Fc portion of IgG =
RF & IgG form immune complexes;* which is itself
an antibody; IgM or IgA type.
Q0768:RF or RhF positive in;is often determined
in patients suspected in any form of arthritis
* High levels RF: generally > 20 IU/mL;*
rheumatoid arthritis: present in 80%;* Sj?gren's
syndrome: present in 60%
Q0769:false (+) RF or RhF;Blood test performed in
patients with suspected rheumatoid arthritis (RA)
* Chronic hepatitis;* Any chronic viral
infection;* Leukemia;* Dermatomyositis;*
Infectious mononucleosis;* Scleroderma;* Systemic
lupus erythematosus (SLE)
Q0770:Sj?gren's syndrome;* antibodies to Ro(SSA)
or La(SSB) antigens; or both;* > 40 years old at
the time of diagnosis & Woman >> Man
* an autoimmune disorder in which immune cells
attack and destroy the exocrine glands that
produce tears and saliva with Schirmer test(+);*
A lip biopsy can reveal lymphocytes clustered
around salivary gland
Q0771:Spondyloarthropathies
Group of related INFLAMMATORY JOINT Ds associated
with the MHC class I molecule HLA-B27
Q0772:Seronegative spondylarthropathy
Spondylarthropathy & (-)rheumatoid factor (RhF)
Q0773:Non-specific spondylarthropathy
Indicator of other rheumatological disease (in
particular rheumatoid arthritis)
Q0774:Subgroups (with increased HLA-B27
frequency)
* ankylosing spondylitis Caucasians (AS; 92%);*
ankylosing spondylitis African-Americans (AS;
50%);* reactive arthritis (Reiter's syndrome)
(RS; 60-80%);* enteropathic arthritis associated
with inflammatory bowel disease (IBD; 60%);*
Psoriatic arthritis (60%);* isolated acute
anterior uveitis (AAU; iritis or iridocyclitis;
50%); and;* undifferentiated SpA (USpA; 20-25%).
Q0775:Dx;boys afound 6 mo w/ absence of plasma
cells in tissue; recurrent bacterial infections
w/ strep; staph; h. influenzae and pneumococci;
absent or poorly defined germinal centers in LN;
no immunoglobulins;genetic problem?
Bruton's Agammaglobinemia;(Brutons = Boys =
Bacteria infect);(X-recessive)
Q0776:MCC of B-cell defect
Isolated IgA deficiency
Q0777:Dx;sinus and lung infections; milk
allergies; diarrhea
Isolated IgA deficiency;(infections of mucosal
surfaces)
Q0778:Dx;recurrent viral and fungal infections;
tetany; lymphopenia; cardiac defects; cleft
palate
Di George syndrome;;(CATCH-22; 22q11 deletion)
Q0779:Dx;severe bacterial; viral; fungal and
protozoal infections; failure-to-thrive; high
incidence of malignancy; thymic and LN hypoplasia
Severe Combined Immunodeficiency
Dz;(SCID);(no/low B or T cells)
Q0780:(3) possible causes of SCIDs
Failure to make MHC-2;;defective IL-2
receptors;Adenosine Deaminase Deficiency (ADA)
Q0781:Dx;Eczema; thrombocytopenic Purpura;
recurrent Infections; elevated IgA; low
IgM;genetic problem?
Wiscott-Aldrich syndrome;(WIPE = Wiscott; Infect;
Purpura; Eczema);(X-linked disorder)
Q0782:what is the dysfunction if patient gets
chronic Candida albicans infections?
T-cell dysfunction
Q0783:Dx;cerebellar problems; spider angiomas;
IgA deficiency;where is the defect?
Ataxia-Telangiectasia;defect;DNA reapir enzyme
Q0784:what lymphocyte surface protein deficiency
would cause an increase in mycobacterial
infections?
IL-12 receptor deficiency
Q0785:Dx;baby presents w/ severe pyogenic
infections; high IgM; very low IgG; IgA and
IgE;where is the defect?
Hyper-IgM syndrome;defect;CD40L on Th1 helper
cells;(leads to inability to class-switch)
Q0786:Dx;recurrent "cold" staph abscesses;
eczema; coarse facies; Retained Primary Teeth;
increased IgE;where is the defect?
Job's syndrome;;defect;Failure of INF-gamma by T-
cells (low Macros)
Q0787:What cell surface protein on HIV binds to
CD4 T-cells?;what does it inser into host genome?
gp120;;Proviral DNA;(via reverse transcriptase)
Q0788:what is the test for HIV?;follow-up test?
ELISA;;follow: Western Blot
Q0789:what type of genome does HIV have?
Diploid;(2 molecules of RNA)
Q0790:what is the rectangular nucleocapsid
protein (holds the 2 molecules of RNA) in HIV?
p24 capsid
Q0791:what is the product of HIV reverse
transcriptase?
dsDNA
Q0792:(2) AIDS criteria
CD4 < 200;or;CD4/CD8 ratio < 1.5
Q0793:what homozygous mutation gives immunity to
HIV?
CCR5 mutation
Q0794:Dx;lymphadenopathy; weight loss; arthritis;
photosensitivity; raynauds; pulmonary fibrosis;
endocarditis; immune-complex vasculitis;
glomerular changes;COD?
SLE;;COD;Renal failure (and infections)
Q0795:what may be the earliest lab abnormality in
some SLE patients?
False Positive test for Syphilis
Q0796:Dx;tightening of facial skin; sclerodactyly
(claw-hand); raynauds; dysphagia; pulmonary
fibrosis; HTN
Scleroderma;(CREST-syndrome also has calcinosis
and telangiectasia)
Q0797:Dx;xerostomia (dry mouth);
keratoconjunctivitis (dry eyes); RA or other CT
problem; hypergammaglobinemia; parotid
enlargement
Sjogren syndrome;[when you're JOGin' you sweat
and get dry]
Q0798:Dx;chronic inflammation of proximal
extremity muscles due to CD8 injury; possible
reddish-purple rash on face and neck; increased
CK and Adolase
Polymyositis;(w/ skin rash: Dermatomyositis)
Q0799:Dx;arthralgias; raynauds; myositis;
esophageal hypomotility; no renal
involvement;antibody?
Mixed Connective Tissue Dz;(MCTD);Ab: anti-nRNP
Q0800:Amyloid associated with;heart; muscle and
tongue; plasma cell disorders
AL (Amyloid Light chain)
Q0801:Amyloid associated with;kidney; liver;
adrenals; pancreas; LN and spleen
AA protein
Q0802:Amyloid associated with;chronic
inflammatory diseases;RA; TB; osteomyelitis;
syphilis
AA protein
Q0803:Amyloid associated with;Alzheimers;(2)
amyloid Beta-protein;;A4 amyloid
Q0804:Amyloid associated with;Insulin or glucagon
(in DM-2);(2 names)
Amylin;Islet Amyloid Polypeptide;(IAPP)
Q0805:Amyloid associated with;Elderly (called
senile Amyloidosis)
Transthyretin
Q0806:Young child presents with tetany ;and
candidiasis. Hypocalcemia ;and immunosuppression
are ;ound.
T cell deficient;(DiGeorge).
Q0807:Young child has recurrent lung ;infections
and granulomatous ;lesions. What is the defect in
;neutrophils?
NADPH oxidase (chronic ;granulomatous disease).
Q0808:A 2° lymphoid organ that has many
afferents; 1 or more efferents. Encapsulated;
with trabeculae.
Lymph node
Q0809:Lymph node definition
A 2° lymphoid organ that has many afferents; 1
or more efferents. Encapsulated; with trabeculae.
Q0810:Lymph node;function
Functions are nonspeci?c ?ltration by
macrophages; storage/proliferation ;of B and T
cells; antibody production.
Q0811:Lymph node;Follicle ;what and location
Site of B-cell localization and ;proliferation.
In outer cortex.
Q0812:Lymph node;Follicle ;1° vs 2°
1° follicles are dense and ;dormant. 2°
follicles have ;pale central germinal ;centers
and are active.
Q0813:Lymph node;Medulla description
Consists of medullary cords ;(closely packed
lymphocytes ;and plasma cells) and ;medullary
sinuses.
Q0814:Lymph node;Medullary sinuses
communicate with efferent ;lymphatics and contain
;reticular cells and macrophages.
Q0815:Lymph node;Paracortex description (cells;
location; vessels)
Houses T cells. Region of cortex between
follicles and medulla. Contains high endothelial
venules through which T and B cells enter from
blood.
Q0816:Lymph node;Paracortex wrt extreme
In an extreme cellular immune response;paracortex
becomes greatly enlarged.
Q0817:Lymph node;which part is not well developed
in patients with DiGeorge syndrome.
Paracortex
Q0818:Lymph drainage;ducts
Right lymphatic duct Drains right arm and right
half of head;Thoracic duct Drains everything
else.
Q0819:Sinusoids of spleen description
Long; vascular channels in red pulp with
fenestrated “barrel hoop” basement membrane.
Macrophages found nearby.
Q0820:Long; vascular channels in red pulp with
fenestrated “barrel hoop” basement membrane.
Macrophages found nearby.
Sinusoids of spleen
Q0821:spleen;where are T cells
in the periarterial lymphatic sheath (PALS) and
in the red pulp ;of the spleen.
Q0822:spleen;where are B cells
B cells are found in follicles within the white
pulp of the spleen.
Q0823:Site of T-cell differentiation and
maturation.
Thymus
Q0824:Thymus derivation
From epithelium of 3rd branchial ;pouches.
Lymphocytes of mesenchymal origin.
Q0825:Thymus WRT capsule
Encapsulated.
Q0826:Thymus;different areas and what happens
there
Cortex is dense with immature T cells;medulla is
pale with mature T cells and epithelial reticular
cells and contains Hassall’s corpuscles;Positive
(MHC restriction) and negative selection
;selection (nonreactive to self) occur at the
;corticomedullary junction.
Q0827:where are Hassall’s corpuscles.
Thymus medulla is pale with mature T cells and
epithelial ;reticular cells and contains Hassall
’s corpuscles.
Q0828:what are Hassall’s corpuscles.
formed from type VI epithelial reticular cells
with unclear function
Q0829:1° Lymph node draining;Upper limb and
lateral breast
Axillary
Q0830:1° Lymph node draining;Stomach
Celiac
Q0831:1° Lymph node draining;Duodenum and
jejunum
Superior mesenteric
Q0832:1° Lymph node draining;Sigmoid colon
colic to the inferior mesenteric
Q0833:1° Lymph node draining;lower rectum and
anal canal above pectinate line
internal iliac
Q0834:1° Lymph node draining;anal canal below
pectinate line
superficial inguinal
Q0835:1° Lymph node draining;testies
superficial and deep plexuses to the para-aortic
Q0836:1° Lymph node draining;scrotum
Q0837:1° Lymph node draining;superficial thigh
Q0838:1° Lymph node draining;lateral side of the
dorsum of the foot
popliteal
Q0839:Innate vs. adaptive immunity;Innate cells
Consists of neutrophils; macrophages; dendritic
cells; and complement.
Q0840:Innate vs. adaptive immunity;adaptive cells
Consists of T cells; B cells;and circulating
antibody.
Q0841:Innate vs. adaptive immunity;innate
receptor
receptors that recognize pathogens are germline
encoded
Q0842:Innate vs. adaptive immunity;adaptive
receptor
receptors that recognize pathogens undergo VDJ
recombination during lymphocyte development
Q0843:Th1 cells produce/activate
IL-2 and IFN-gamma; activate macrophages and
cytotoxic (CD8+) T cells.
Q0844:Th2 cells produce/activate
IL-4; and IL-5; provide help for B cells to make
antibody.
Q0845:produce IL-2 and IFN-gamma; activate
macrophages and cytotoxic (CD8+) T cells.
Th1 cells
Q0846:produce IL-4; and IL-5; provide help for B
cells to make antibody.
Th2 cells
Q0847:MHC what is it and what encodes it
major histocompatability complex; encoded by
Human Leukocyte ;Antigen (HLA) genes.
Q0848:MHC I ;what HLA's
HLA-A; HLA-B; HLA-C.
Q0849:MHC I ;what cells
Expressed on almost all nucleated cells.
Q0850:MHC I ;what is antigen loaded in
RER of mostly intracellular peptides.
Q0851:MHC I ;mediation
Mediates viral immunity.
Q0852:MHC I ;pairing
Pairs with beta2-microglobulin.
Q0853:Pairs with beta -microglobulin.
MHC I
Q0854:MHC II ;what HLA's
HLA-DR; HLA-DP; HLA-DQ.
Q0855:MHC II;what cells
Expressed only on antigen presenting cells
(APCs).
Q0856:MHC II ;what is antigen loaded in
Antigen is loaded in an acidi?ed endosome.
Q0857:Which MHC type;HLA-A; HLA-B; HLA-C.
MHC I
Q0858:Which MHC type;Expressed on almost all
nucleated cells.
MHC I
Q0859:Which MHC type;Antigen is loaded in RER of
mostly intracellular peptides.
MHC I
Q0860:Which MHC type;Mediates viral immunity.
MHC I
Q0861:Which MHC type;HLA-DR; HLA-DP; HLA-DQ.
MHC II
Q0862:Which MHC type;Expressed only on antigen
presenting cells (APCs).
MHC II
Q0863:Which MHC type;Antigen is loaded in an
acidi?ed endosome.
MHC II
Q0864:Which MHC type;Main determinants of organ
rejection.
MHC II
Q0865:Which lymphocyte B or T;Allergy (type I
hypersensitivity)
B : IgE
Q0866:Which lymphocyte B or T;Allergy (type IV
hypersensitivity)
T cells
Q0867:Major function of;CD4+ T cells
help B cells make antibody and produce gamma-
interferon that activates macrophages.
Q0868:Major function of ;CD8+ T cells
Kill virus-infected cells directly
Q0869:B vs T cell role in organ rejection
B cells--hyperacute (IgG);T cells---Organ
rejection (slow)
Q0870:T-cell glycoproteins;functions on just
helper T
Helper T cells have CD4; which binds to MHC II on
antigen-presenting cells.
Q0871:T-cell glycoproteins;functions on just
Cytotoxic T
Cytotoxic T cells ;have CD8; which binds to MHC I
on virus- infected cells.
Q0872:T-cell glycoproteins;functions on both
CD3 complex––cluster of ;polypeptides
associated with ;a T-cell receptor. Important ;in
signal transduction.
Q0873:name the Antigen-presenting cells:
1. Macrophage;2. B cell;3. Dendritic
cell/langerhan's in skin
Q0874:# of signals are required for T cell
activation
2
Q0875:Th activation steps
1. Foreign body is phagocytosed by APC;2. Foreign
antigen is presented on MHC II and;recognized by
TCR on Th cell (Signal 1);3. “Costimulatory
signal” is given by interaction;of B7 and CD28
(Signal 2);4. Th cell activated to produce
cytokines.
Q0876:Tc activation
1. Endogenously synthesized (viral or self)
proteins are presented on MHC I and ;recognized
by TCR on Tc cell (Signal 1);2. IL-2 from Th cell
activates Tc cell to kill virus-infected cell
(Signal 2).
Q0877:Antibodies;function of Variable part of L
and H chains
recognizes antigens
Q0878:Antibodies;what ?xes complement
Constant part of H chain of IgM and IgG ?xes
complement.
Q0879:Fc and Fab fractions. what contributes
Heavy chain contributes to Fc and Fab fractions.
Light chain contributes only to Fab fraction.
Q0880:Fc and Fab;mnemonic
Fab: antigen binding fragment;Fc;Constant;Carboxy
terminal;Complement-binding;(IgG + IgM
only);Carbohydrate;side chains;Complement
binding;fragment
Q0881:Antibody diversity is generated by: (4
things)
1. Random “recombination” of VJ (light-chain)
or VDJ (heavy-chain) genes;2. Random combination
of heavy chains with light chains;3. Somatic
hypermutation;4. Addition of nucleotides to DNA
during “genetic recombination” by terminal
deoxynucleotidyl transferase
Q0882:describe in general ;Opsonization
Antibody promotes;phagocytosis
Q0883:describe in general ;Neutralization
Antibody prevents bacterial adherence
Q0884:describe in general ;Complement activation
Antibody activates complement; enhancing
opsonization and lysis
Q0885:Antibody activates complement; enhancing
opsonization and lysis
Complement activation
Q0886:Antibody prevents bacterial adherence
Neutralization
Q0887:Antibody promotes;phagocytosis
Opsonization
Q0888:Immunoglobulin isotypes;Mature B
lymphocytes express on their surfaces
IgM and IgD
Q0889:Immunoglobulin isotypes;isotype switching
mediated by
by cytokines and CD40 ligand
Q0890:Immunoglobulin isotypes;plasma cells
secrete
IgA; IgE; or IgG.
Q0891:Immunoglobulin isotypes;IgG (what response;
how common; where it goes; what it does)
Main antibody in 2° response. Most abundant.
Fixes complement; crosses the placenta;opsonizes
bacteria; neutralizes bacterial toxins and
viruses.
Q0892:Immunoglobulin isotypes;Main antibody in 2
° response.
IgG
Q0893:Immunoglobulin isotypes;Most abundant.
IgG
Q0894:Immunoglobulin isotypes;crosses the
placenta
IgG
Q0895:Immunoglobulin isotypes;Fixes complement;
crosses the placenta; opsonizes bacteria;
neutralizes bacterial toxins and viruses
Fixes complement
Q0896:Immunoglobulin isotypes;IgA (what response;
where it goes; structure elements; what it does)
Prevents attachment of bacteria and viruses to
mucous membranes; does not ?x ;complement.
Monomer or dimer. Found in secretions. Picks up
secretory component from epithelial cells before
secretion.
Q0897:Immunoglobulin isotypes;IgA wrt complement
does not ?x ;complement
Q0898:Immunoglobulin isotypes;Prevents attachment
of bacteria and viruses to mucous membranes
IgA
Q0899:Immunoglobulin isotypes;Monomer or dimer.
Found in secretions
IgA
Q0900:Immunoglobulin isotypes;Picks up secretory
component ;from epithelial cells before
secretion.
IgA
Q0901:Immunoglobulin isotypes;what are they
IgG ;IgA ;IgM ;IgD ;IgE
Q0902:Immunoglobulin isotypes;IgM (when; what it
does; where it goes; srtucture)
Produced in the 1° response to an antigen. Fixes
complement but does not cross the placenta.
Antigen receptor on the surface of B cells.
Monomer or pentamer.
Q0903:Immunoglobulin isotypes;Monomer or
pentamer.
IgM
Q0904:Immunoglobulin isotypes;Antigen receptor on
the surface of B cells.
IgM
Q0905:Immunoglobulin isotypes;Fixes complement
but does not cross the placenta.
IgM
Q0906:Immunoglobulin isotypes;IgD (what it does;
where is it)
Unclear function. Found on the surface of many B
cells and in serum.
Q0907:Immunoglobulin isotypes;Unclear function.
Found on the surface of many B cells and in
serum.
IgD
Q0908:Immunoglobulin isotypes;IgE (role; where;
how common)
Mediates immediate (type I) hypersensitivity
Mediates immunity to worms;Lowest concentration
in serum.
Q0909:Immunoglobulin isotypes;Mediates immediate
(type I) hypersensitivity by inducing the release
of mediators from ;mast cells and basophils when
exposed to allergen.
IgE
Q0910:Immunoglobulin isotypes;Mediates immunity
to worms.
IgE
Q0911:Immunoglobulin isotypes;Lowest
concentration in serum.
IgE
Q0912:Immunoglobulin isotypes;IgE (role in
hypersensitivity mech)
by inducing the release of mediators from mast
cells and basophils when exposed to allergen.
Q0913:Ig epitopes;Allotype
Allotype (polymorphism)––Ig epitope that
differs among members of same species. Can be on
light chain or heavy chain.
Q0914:Ig epitopes;Isotype
iso (same). Common to same class;Isotype (IgG;
IgA; etc.)––Ig epitope common to a ;single
class of Ig (5 classes; determined by heavy
;chain).
Q0915:Ig epitopes;Idiotype
idio (unique). Hypervariable region is
unique;Idiotype (speci?c for a given antigen)––
Ig epitope ;determined by antigen-binding site.
Q0916:Ig epitope that differs;among members of
same species. Can be on ;light chain or heavy
chain.
Allotype (polymorphism)––
Q0917:Ig epitope common to a ;single class of Ig
(5 classes; determined by heavy ;chain).
Isotype (IgG; IgA; etc.)––
Q0918:(speci?c for a given antigen)––Ig epitope
;determined by antigen-binding site.
Idiotype
Q0919:Important cytokines;mnemonic
“Hot T-bone stEAk”;IL-1: fever (hot);IL-2:
stimulates T cells;IL-3: stimulates bone
marrow;IL-4: stimulates IgE;production;IL-5:
stimulates IgA;production
Q0920:what secretes and what is the role of;IL-1
Secreted by macrophages. Stimulates T cells; B
cells;neutrophils; ?broblasts; and epithelial
cells to ;grow; differentiate; or synthesize
speci?c products;An endogenous pyrogen.
Secreted by Th cells. Stimulates growth of
helper;and cytotoxic T cells.
Secreted by activated T cells. Supports the
growth and differentiation of bone marrow stem
cells. Has a function similar to GM-CSF.
Secreted by Th2 cells. Promotes growth of B
cells. Enhances class switching of IgE and IgG.
Secreted by Th2 cells. Promotes differentiation
of B ;cells. Enhances class switching of IgA.
Stimulates ;production and activation of
eosinophils.
Secreted by Th cells and macrophages.
Stimulates;production of acute-phase reactants
and immunoglobulins.
Major chemotactic factor for neutrophils.
Secreted by Th2 cells. Stimulates Th2
while;inhibiting Th1.
Secreted by B cells and macrophages. Activates NK
;and Th1 cells.
Q0929:what secretes and what is the role
of;gamma-interferon
Secreted by Th1 cells. Stimulates macrophages.
Q0930:what secretes and what is the role of;TNF-
alpha
Secreted by macrophages. IL-2 receptor synthesis
by Th cells. increased B-cell proliferation.
Attracts and activates neutrophils. Stimulates
dendritic cell migration to lymph nodes.
Q0931:Name the cytokine;An endogenous pyrogen.
IL-1
Q0932:Name the cytokine;Secreted by macrophages.
Stimulates T cells; B cells;neutrophils;
?broblasts; and epithelial cells to ;grow;
differentiate; or synthesize speci?c products.
IL-1
Q0933:Name the cytokine;Secreted by Th cells.
Stimulates growth of helper ;and cytotoxic T
cells.
IL-2
Q0934:Name the cytokine;Secreted by activated T
cells. Supports the growth and differentiation of
bone marrow stem cells.
IL-3
Q0935:Name the cytokine;Has a function similar to
GM-CSF.
IL-3
Q0936:Name the cytokine;Secreted by Th2 cells.
Promotes growth of B cells;Enhances class
switching of IgE and IgG.
IL-4
Promotes differentiation of B ;cells. Enhances
class switching of IgA.
IL-5
Q0938:Name the cytokine;Stimulates production and
activation of eosinophils.
IL-5
Q0939:Name the cytokine;Secreted by Th cells and
macrophages. Stimulates;production of acute-phase
reactants and immunoglobulins.
IL-6
Q0940:Name the cytokine;Major chemotactic factor
for neutrophils.
IL-8
Stimulates Th2 while inhibiting Th1.
IL-10
Q0942:Name the cytokine;Secreted by B cells and
macrophages. Activates NK and Th1 cells.
IL-12
Stimulates macrophages.
gamma-interferon
Q0944:Name the cytokine;Secreted by macrophages.
increased IL-2 receptor synthesis ;by Th cells.
increased B-cell proliferation.
TNF-alpha
Q0945:Name the cytokine;Attracts and activates
neutrophils. Stimulates dendritic cell migration
to lymph nodes.
TNF-alpha
Q0946:Cell surface proteins;Helper T cells
CD4; TCR; CD3; CD28; CD40L.
Q0947:Cell surface proteins;Cytotoxic T cells
CD8; TCR; CD3.
Q0948:Cell surface proteins;B cells
IgM; B7; CD19; CD20; CD40; MHC II.
Q0949:Cell surface proteins;Macrophages
MHC II; CD14. Receptors for Fc and C3b.
Q0950:Cell surface proteins;NK cells
Receptors for MHC I; CD16; CD56.
Q0951:Cell surface proteins;All cells except
mature red cells
MHC I.
Q0952:what cell has ;CD4
Helper T cells
Q0953:what cell has ;TCR
Helper T cells;and;Cytotoxic T cells
Helper T cells ;and;Cytotoxic T cells
Helper T cells
Q0956:what cell has ;CD40L
Helper T cells
Cytotoxic T cells
Q0958:what cell has ;IgM
B cells
Q0959:what cell has ;B7
B cells
B cells
B cells
B cells
Q0963:what cell has ;MHC II
APC's
Q0964:what cell has ;Fc receptor (FcR)
Dendritic cells;Macrophages
Q0965:what cell has ;MHC I.
All cells except mature red cells
Q0966:what cell has ;CD14. Receptors for C3b
Macrophages
Q0967:what cell has ;Receptors for C3b
Macrophages
Q0968:what cell has ;Receptors for MHC I
NK cells
NK cells
Q0970:what cell has ;CD56.
NK cells
Q0971:Membrane attack complex of complement
defends ;against
gram-negative bacteria. Activated by IgG
Q0972:Membrane attache complex ;activation in
general
Activated by IgG or IgM in the classic pathway;
(GM makes classic cars.);Activated by molecules
on the surface of microbes especially ;endotoxin)
in the alternate pathway.
Q0973:the two primary opsonins in ;bacterial
defense.
C3b and IgG
Q0974:C3b and IgG are the
two primary opsonins in ;bacterial defense.
Q0975:Roles of different complement molecules;C1
C1; C2; C3; C4––viral ;neutralization.
Q0979:Roles of different complement molecules;C3b
C3b - opsonization.
Q0980:Roles of different complement molecules;C3a
C3a; C5a––anaphylaxis.
Q0981:Roles of different complement molecules;C5a
C3a; and C5a––anaphylaxis;C5a––neutrophil
chemotaxis.
Q0982:Roles of different complement
molecules;C5b-9
C5b-9––cytolysis by membrane;attack complex
(MAC).
molecules;De?ciency of C1 esterase ;inhibitor
hereditary angioedema (overactive complement).
molecules;De?ciency of C3
severe; recurrent pyogenic ;sinus and respiratory
tract ;infections.
molecules;De?ciency of C6–C8
Neisseria bacteremia.
molecules;De?ciency of decay;accelerating factor
(DAF)
leads to paroxysmal nocturnal;hemoglobinuria
(PNH).
Q0987:Name the complement molecules involved
in/function;viral neutralization.
C1; C2; C3; C4
in/function;opsonization.
C3b
in/function;anaphylaxis.
C3a; C5a
in/function;neutrophil chemotaxis.
C5a
in/function;cytolysis by membrane attack complex
(MAC).
C5b-9
Q0992:WRT complement ;What leads to
hereditary;angioedema
De?ciency of C1 esterase ;inhibitor
Q0993:WRT complement ;What leads to severe;
recurrent pyogenic sinus and respiratory tract
infections.
De?ciency of C3
Q0994:WRT complement ;What leads to;Neisseria
bacteremia.
De?ciency of C6–C8
Q0995:WRT complement ;What leads to paroxysmal
nocturnal;hemoglobinuria (PNH).
De?ciency of decay-;accelerating factor (DAF)
Q0996:hereditary angioedema aka
overactive complement
Q0997:overactive complement aka
hereditary angioedema
Q0998:proteins that place uninfected cells in an
antiviral state.
Interferons (alpha; beta; gamma) are
Q0999:Interferon mechanism ;in general
Interferons induce the production of a 2nd
protein that inhibits viral protein synthesis by
degrading viral mRNA (but not host mRNA).
Q1000:role of the interferons and what different
ones do
1. alpha- and beta-interferons inhibit viral
protein synthesis;2. gamma-interferons increased
MHC I;and II expression and ;antigen presentation
;in all cells;3. Activates NK cells to ;kill
virus-infected cells
Q1001:when are some of the times patients given
preformed antibodies
(passive)––To Be Healed ;Rapidly;After exposure
to Tetanus toxin; Botulinum toxin; HBV; or
Rabies;
Q1002:Antigen variation examples;wrt Bacteria
Salmonella (two ?agellar variants); Borrelia
(relapsing fever); Neisseria gonorrhoeae;(pilus
protein).
Q1003:Antigen variation examples;wrt Virus
in?uenza (major = shift; minor = drift).
Q1004:Antigen variation examples;wrt Parasites
trypanosomes (programmed ;rearrangement).
Q1005:Antigen variation;wrt in?uenza major shift
and RNA segment rearrangement
Q1006:Anergy describe in different cells
Self-reactive T cells become nonreactive without
costimulatory molecule;B cells also become
anergic; but tolerance is less complete than in T
cells.
Q1007:Self-reactive T cells become nonreactive
without costimulatory molecule.
Anergy
Q1008:Hypersensitivity Mechs;Type I
Anaphylactic and atopic: antigen cross-links IgE
on presensitized mast cells and basophils;
triggering ;release of vasoactive amines (i.e;
histamine).
Q1009:Hypersensitivity Mechs;Type II
Antibody mediated– –IgM; IgG bind to antigen on
“enemy”cell; leading to lysis (by complement)
;or phagocytosis.
Q1010:Hypersensitivity Mechs;Type III
Immune complex: antigen-antibody complexes
activate complement; which attracts
neutrophils;neutrophils release lysosomal
enzymes.
Q1011:Hypersensitivity Mechs;Type IV
Delayed (T-cell-mediated): sensitized T cells
encounter antigen and then release;lymphokines
(leads to macrophage activation).
Q1012:Serum sickness;mech
antibodies to the foreign proteins are produced
(takes 5 days). Immune complexes form and are
deposited in membranes;where they ?x complement
(leads to tissue damage).
Q1013:Arthus reaction;mech
Intradermal injection of antigen induces
antibodies; which form antigen-antibody complexes
in the skin;Characterized by edema; necrosis; and
activation ;of complement.
Q1014:Intradermal injection of antigen induces
antibodies; which form antigen-antibody complexes
in the skin;Characterized by edema; necrosis; and
activation ;of complement.
Arthus reaction
Q1015:antibodies to the foreign proteins are
produced (takes 5 days). Immune complexes form
and are deposited in membranes;where they ?x
complement (leads to tissue damage).
Serum sickness
Q1016:which is more common;serum sickness or
Arthus reaction
Serum sickness
Q1017:which Hypersensitivity reactions are
antibody mediated
Types I; II; and III are all ;antibody mediated.
Q1018:Hypersensitivity ;why is Type 1 so fast
Reaction develops rapidly after antigen exposure
due to preformed antibody.
Q1019:Hypersensitivity ;how does type II do its
damage
Cy-2-toxic;Antibody and complement lead;to
membrane attack complex;(MAC).
Q1020:serum sickness ;cause and findings
Most serum sickness is now ;caused by drugs (not
serum);Fever; urticaria; arthralgias;
proteinuria; lymphadenopathy 5–10 days after
antigen exposure.
Q1021:Fever; urticaria; arthralgias; proteinuria;
lymphadenopathy 5–10 days after antigen
exposure.
serum sickness
Q1022:Mnemonic for type III Hypersensitivity
Imagine an immune complex as ;3 things stuck
together;antigen-antibody-complement.
Q1023:is Type IV Hypersensitivity transferable by
serum
Cell mediated; therefore; it is ;not transferable
by serum.
Q1024:Type IV Hypersensitivity ;mnemonic
4 T’s = T lymphocytes;Transplant rejections;TB
skin tests; Touching ;(contact dermatitis).
Q1025:Hypersensitivity mnemonic
ACID;-Anaphylactic and Atopic ;(type I);-
Cytotoxic (antibody mediated);(type II);-Immune
complex (type III);-Delayed (cell mediated)
;(type IV)
Q1026:Diseases caused by hypersensitivity;Type I
Anaphylaxis;Allergic rhinitis (hay fever)
Q1027:Diseases caused by
hypersensitivity;Anaphylaxis
Type I
hypersensitivity;Allergic rhinitis (hay fever)
Type I
Q1029:Diseases caused by hypersensitivity;Type II
Hemolytic anemia;Idiopathic thrombocytopenic
purpura;Erythroblastosis fetalis;Rheumatic
fever;Goodpasture’s syndrome;Bullous
pemphigoid;Graves’ disease;Myasthenia gravis
hypersensitivity;Hemolytic anemia
Type II
hypersensitivity;Idiopathic thrombocytopenic
purpura
Type II
hypersensitivity;Erythroblastosis fetalis
Type II
hypersensitivity;Rheumatic fever
Type II
hypersensitivity;Goodpasture’s syndrome
Type II
Q1035:Diseases caused by hypersensitivity;Bullous
pemphigoid
Type II
Q1036:Diseases caused by hypersensitivity;Graves
’ disease
Type II
hypersensitivity;Myasthenia gravis
Type II
Q1038:Diseases caused by hypersensitivity;Type
III
Lupus;Rheumatoid arthritis;Polyarteritis
nodosum;Post-streptococcal
glomerulonephritis;Serum sickness;Arthus
reaction;Hypersensitivity pneumonitis
Q1039:Diseases caused by hypersensitivity;Lupus
Type III
hypersensitivity;Rheumatoid arthritis
Type III
hypersensitivity;Polyarteritis nodosum
Type III
Q1042:Diseases caused by hypersensitivity;Post-
streptococcal glomerulonephritis
Type III
Q1043:Diseases caused by hypersensitivity;Serum
sickness
Type III
Q1044:Diseases caused by hypersensitivity;Arthus
reaction
Type III
hypersensitivity;Hypersensitivity pneumonitis
Type III
Q1046:Diseases caused by hypersensitivity;Type IV
Type 1 diabetes mellitus;Multiple
sclerosis;Guillain-Barré syndrome;Hashimoto’s
thyroiditis;Graft-versus-host disease;PPD (test
for M. tuberculosis);Contact dermatitis
Q1047:Diseases caused by hypersensitivity;Type 1
diabetes mellitus
Type IV
hypersensitivity;Multiple sclerosis
Type IV
hypersensitivity;Guillain-Barré syndrome
Type IV
hypersensitivity;Hashimoto’s thyroiditis
Type IV
Q1051:Diseases caused by hypersensitivity;Graft-
versus-host disease
Type IV
Q1052:Diseases caused by hypersensitivity;PPD
Type IV
Q1053:Diseases caused by hypersensitivity;Contact
dermatitis
Type IV
Q1054:decreased production of: B cells
Bruton’s agammaglobulinemia
Q1055:decreased production of: T Cells
Thymic aplasia (DiGeorge ;syndrome)
Q1056:decreased production of: B and T cells
severe combined immunode?ciency ;(SCID)
Q1057:Bruton’s agammaglobulinemia;mech
decreased production of: B cells ;X-linked
recessive defect in a tyrosine kinase gene
associated with low levels of all classes of
immunoglobulins.
Q1058:Bruton’s agammaglobulinemia;inheritance
X-linked recessive
Q1059:Bruton’s agammaglobulinemia;clinical
findings
recurrent Bacterial infections after 6 months of
age; when levels of maternal IgG antibody
decline. Occurs in Boys
Q1060:recurrent Bacterial infections after 6
months of age; when levels of maternal IgG
antibody decline. Occurs in Boys (X-linked).
Bruton’s agammaglobulinemia
Q1061:DiGeorge syndrome aka
Thymic aplasia
Q1062:Thymic aplasia aka
DiGeorge syndrome
Q1063:DiGeorge syndrome;mnemonic
CATCH-22 ;C = cardiac defects;A = abnormal
facies;T = thymic hypoplasia;C = cleft palate;H =
hypocalcemia (tetany)from parathyroid aplasia;22
= microdeletions in chromosome 22- 22q11 deletion
Q1064:DiGeorge syndrome;mech
decreased production of: T Cells;Thymus and
parathyroids fail to develop owing to failure of
development of the 3rd and 4th pharyngeal
pouches.
Q1065:severe combined immunode?ciency
;(SCID);mech/causes
Defect in early stem-cell
differentiation;decreased production of: B and T
Cells;May have multiple causes (e.g; failure to
synthesize MHC II antigens; defective IL-2
receptors; or adenosine deaminase de?ciency).
Q1066:severe combined immunode?ciency
;(SCID);clinical findings
recurrent viral; bacterial; fungal; and protozoal
infections.
Q1067:recurrent viral; bacterial; fungal; and
protozoal infections.
severe combined immunode?ciency ;(SCID)
Q1068:IL-12 receptor de?ciency ;mech and findings
decreased activation of: T-cells;;Presents with
disseminated mycobacterial infections.
Q1069:decreased activation of: T-cells;Presents
with disseminated mycobacterial infections.
IL-12 receptor de?ciency
Q1070:hyper-IgM syndrome ;mech
decreased activation of: B-cells;Defect in CD40
ligand on CD4 T helper cells leads to inability
to class switch.
Q1071:decreased activation of: B-cells
hyper- IgM syndrome ;Wiskott-Aldrich ;syndrome
Q1072:decreased activation of: Macrophages
Job’s syndrome
Q1073:hyper-IgM syndrome;clinical findings
Presents early in life with severe pyogenic
infections.
Q1074:hyper-IgM syndrome;lab findings
High levels of IgM; very low levels of IgG; IgA;
and IgE.
Q1075:Wiskott-Aldrich syndrome ;mech
decreased activation of: B-cells;X-linked
recessive defect in the ability to mount an IgM
response to capsular polysaccharides of;bacteria.
Q1076:Wiskott-Aldrich syndrome ;inheritance
X-linked recessive
Q1077:Defect in CD40 ligand on CD4 T helper cells
leads to inability to class switch.
hyper-IgM syndrome
Q1078:defect in the ability to mount an IgM
response to capsular polysaccharides of;bacteria.
Q1079:Wiskott-Aldrich syndrome ;clinical findings
Triad of symptoms includes recurrent pyogenic
Infections; thrombocytopenic ;Purpura; Eczema (W-
IPE).
Q1080:Wiskott-Aldrich syndrome ;lab findings
elevated IgA levels; normal IgE levels; and low
IgM levels.
Q1081:Job’s syndrome ;mech
decreased activation of: Macrophages;Failure of
gamma-interferon production by helper T cells.
Neutrophils fail to respond to ;chemotactic
stimuli.
Q1082:Job’s syndrome ;clinical findings
recurrent “cold” (nonin?amed) staphylococcal
abscesses; eczema; coarse facies; retained
primary teeth;
Q1083:Job’s syndrome ;lab findings
and high levels of IgE.
Q1084:recurrent “cold” (nonin?amed)
staphylococcal abscesses; eczema; coarse facies;
retained primary teeth;
Job’s syndrome
Q1085:Phagocytic cell de?ciency;name them
Leukocyte adhesion de?ciency syndrome;Chédiak-
Higashi ;disease ;Chronic granulomatous disease
Q1086:Leukocyte adhesion de?ciency syndrome;mech
Phagocytic cell de?ciency;Defect in LFA-1
adhesion proteins on phagocyte
Q1087:Leukocyte adhesion de?ciency
syndrome;clinical findings
early with severe pyogenic;and fungal infections
and delayed separation of umbilicus.
Q1088:early with severe pyogenic;and fungal
infections and delayed separation of umbilicus
Leukocyte adhesion de?ciency syndrome
Q1089:Chédiak-Higashi disease ;mech
Phagocytic cell de?ciency;Defect in microtubular
function and lysosomal emptying of ;phagocytic
cells.
Q1090:Chédiak-Higashi disease ;inheritance
AR
Q1091:Chédiak-Higashi disease ;clinical
presentation
Presents with recurrent pyogenic infections by
staphylococci and ;streptococci; partial
albinism; and peripheral neuropathy.
Q1092:Presents with recurrent pyogenic infections
by staphylococci and ;streptococci; partial
Chédiak-Higashi disease
Q1093:Chronic granulomatous disease;mech
Defect in phagocytosis of neutrophils owing to
lack of NADPH oxidase activity or ;similar
enzymes.
Q1094:Defect in phagocytosis of neutrophils owing
to lack of NADPH oxidase activity or ;similar
enzymes.
Chronic granulomatous disease
Q1095:Chronic granulomatous disease;Clinical
findings
Presents with marked susceptibility to
opportunistic infections ;with bacteria;
especially S. aureus; E. coli; and Aspergillus.
Q1096:Chronic granulomatous disease;Dx
Diagnosis con?rmed ;with negative nitroblue
tetrazolium dye reduction test.
Q1097:Presents with marked susceptibility to
opportunistic infections ;with bacteria;
especially S. aureus; E. coli; and Aspergillus.
Q1098:Diagnosis con?rmed ;with negative nitroblue
tetrazolium dye reduction test.
Q1099:Idiopathic dysfunction of: T cells
chronic mucocutaneous candidiasis
Q1100:chronic mucocutaneous candidiasis;Mech
Idiopathic dysfunction of: T cells;T-cell
dysfunction speci?cally against Candida albicans
Q1101:T-cell dysfunction speci?cally against
Candida albicans
chronic mucocutaneous candidiasis
Q1102:chronic mucocutaneous candidiasis;clinical
findings
skin and mucous membrane Candida infections.
Q1103:Idiopathic dysfunction of: B cells;name
them
-selective immunoglobulin ;de?ciency ;-ataxia
telangiectasia ;-common variable immunode?ciency
Q1104:selective immunoglobulin ;de?ciency;mech
Idiopathic dysfunction of: B cells;De?ciency in a
speci?c class of immunoglobulins––possibly due
to a defect in isotype ;switching.
Q1105:selective immunoglobulin ;de?ciency;most
common
Selective IgA de?ciency is the most common
Q1106:selective immunoglobulin
;de?ciency;clinical findings
sinus and lung infections; milk allergies and
diarrhea are;common.
Q1107:ataxia-telangiectasia ;mech
Idiopathic dysfunction of: B cells;Defect in DNA
repair enzymes with associated IgA de?ciency.
Q1108:ataxia-telangiectasia ;clinical findings
Presents with cerebellar ;problems (ataxia) and
spider angiomas (telangiectasia).
Q1109:common variable immunode?ciency;mech and
who
Idiopathic dysfunction of: B cells;Normal numbers
of circulating B cells; decreased plasma cells;
decreased Ig; can be acquired in 20's-30's
Q1110:Autoantibodies and associated
disorders;Antinuclear antibodies (ANA)
SLE
disorders;Anti-dsDNA
Speci?c for SLE
disorders;anti-Smith
Speci?c for SLE
disorders;Antihistone
Drug-induced lupus
disorders;Drug-induced lupus
Antihistone
Q1115:Autoantibodies and associated disorders;SLE
(general)
Antinuclear antibodies (ANA)
disorders;Speci?c for SLE
Anti-dsDNA ;anti-Smith
disorders;Anti-IgG
Rheumatoid arthritis
disorders;Rheumatoid arthritis
Anti-IgG (rheumatoid factor)
disorders;Antineutrophil
Vasculitis
disorders;Vasculitis
Antineutrophil (C-ANCA; P-ANCA)
disorders;Anti-Scl-70
Scleroderma (diffuse)
disorders;Anticentromere
Scleroderma (CREST)
disorders;Scleroderma (CREST)
Anticentromere
disorders;Scleroderma (diffuse)
Anti-Scl-70
disorders;Antimitochondrial
1° biliary cirrhosis
Q1126:Autoantibodies and associated disorders;1°
biliary cirrhosis
Antimitochondrial
disorders;Antigliadin
Celiac disease
disorders;Celiac disease
Antigliadin
disorders;Anti–basement membrane
Goodpasture’s syndrome
disorders;Goodpasture’s syndrome
Anti–basement membrane
disorders;Anti–epithelial cell (desmoglein)
Pemphigus vulgaris
disorders;Pemphigus vulgaris
Anti–epithelial cell (desmoglein)
disorders;Anti-hemidesmosomes
Bullous pemphigoid
disorders;Bullous pemphigoid
Anti-hemidesmosomes
disorders;Antimicrosomal
Hashimoto’s thyroiditis
disorders;Hashimoto’s thyroiditis
Antimicrosomal ;Antithyroglobulin
disorders;Antithyroglobulin
Hashimoto’s thyroiditis
disorders;Anti-Jo-1
Polymyositis; dermatomyositis
disorders;Polymyositis; dermatomyositis
Anti-Jo-1
disorders;Anti-SS-A
aka anti Ro ;Sjogren's syndrome
disorders;Anti-SS-B
aka anti La ;Sjogren's syndrome
disorders;Sjogren's syndrome
Anti - SSA/Ro ;Anti -SSB/La;and often ANA
positive
disorders;Anti-U1 RNP
Mixed connective tissue disease
disorders;Mixed connective tissue disease
Anti-U1 RNP (Ribonucleoprotein)
disorders;Anti-smooth muscle
Autoimmune Hepatitis
disorders;Autoimmune Hepatitis
Anti-smooth muscle
disorders;Anti-glutamate decarboxylase
DM type I
Q1148:Autoantibodies and associated disorders;DM
type I
Anti-glutamate decarboxylase
Q1149:Autoantibodies and associated disorders;C-
ANCA
Wegener's granulomatosis
Q1150:Autoantibodies and associated disorders;P-
ANCA
microscopic polyangiitis ;and focal necrotising
and crescentic glomerulonephritis;sometimes
Churg-Strauss
disorders;sometimes Churg-Strauss
P-ANCA (anti myeloperoxidase)
disorders;Wegener's granulomatosis
C-ANCA (anti Protinase 3)
disorders;focal necrotising and crescentic
glomerulonephritis.
disorders;microscopic polyangiitis
Q1155:Anti-neutrophil cytoplasmic antibodies aka
ANCA
Q1156:ANCA aka
Anti-neutrophil cytoplasmic antibodies
Q1157:perinuclear-staining antineutrophil
cytoplasmic antibodies aka
P-ANCA
Q1158:P-ANCA what letters stand for
perinuclear-staining antineutrophil cytoplasmic
antibodies
Q1159:cytoplasmic-staining antineutrophil
cytoplasmic antibodies aka
C-ANCA
Q1160:C-ANCA what letters stand for
cytoplasmic-staining antineutrophil cytoplasmic
antibodies
Q1161:HLA subtype associations;B27
PAIR;Psoriasis;Ankylosing spondylitis;
In?ammatory bowel disease; Reiter’s syndrome.
Q1162:HLA subtype associations;Psoriasis
B27
Q1163:HLA subtype associations;Ankylosing
spondylitis
B27
Q1164:HLA subtype associations;In?ammatory ;bowel
disease
B27
Q1165:HLA subtype associations;Reiter’s
syndrome.
B27
Q1166:HLA subtype associations;B8
Graves’ disease; celiac sprue.
Q1167:HLA subtype associations;celiac sprue.
B8
Q1168:HLA subtype associations;Graves’ disease
B8
Q1169:HLA subtype associations;DR2
Multiple sclerosis; hay fever; SLE; Goodpasture’
s.
Q1170:HLA subtype associations;Multiple sclerosis
DR2
Q1171:HLA subtype associations;hay fever
DR2
Q1172:HLA subtype associations;SLE
DR2
Q1173:HLA subtype associations;Goodpasture’s.
DR2
Diabetes mellitus type 1.
Q1175:HLA subtype associations;Diabetes mellitus
type 1.
DR3 and DR4
Rheumatoid arthritis; diabetes mellitus type 1.
Q1177:HLA subtype associations;Rheumatoid
arthritis
DR4
Q1178:HLA subtype associations;diabetes mellitus
type 1.
DR3 and DR4
Q1179:HLA subtype associations;Pernicious anemia
DR5
Q1180:HLA subtype associations;Hashimoto’s
thyroiditis.
DR5
Q1181:HLA subtype associations;Steroid-responsive
nephrotic syndrome.
DR7
Steroid-responsive nephrotic syndrome.
Q1183:Hyperacute rejection ;description; time;
and mechanism
Antibody mediated due to the presence of
preformed antidonor antibodies in the ;transplant
recipient. Occurs within minutes after
transplantation.
Q1184:Acute rejection ;description; time; and
mechanism
Cell mediated due to cytotoxic T lymphocytes
reacting against foreign MHCs. Occurs ;weeks
after transplantation.
Q1185:Acute rejection ;Tx
Reversible with immunosuppressants such as
cyclosporin and OKT3.
Q1186:Chronic rejection ;description; time; and
mechanism
Antibody-mediated vascular damage (?brinoid
necrosis); occurs months to years after
;transplantation. Irreversible.
Q1187:Graft-versus-host disease ;description;
time; and mechanism
Grafted immunocompetent T cells proliferate in
the irradiated immunocompromised ;host and reject
cells with “foreign” proteins; resulting in
severe organ dysfunction.
Q1188:Graft-versus-host disease ;findings
Major symptoms include a maculopapular rash;
jaundice; hepatosplenomegaly; and;diarrhea.
Q1189:The World Health Organization identifies an
alarming increase in hospital admissions
worldwide attributable to a new and unexpected
serotype of influenza A virus. The biological
attribute of influenza A virus; which allows the
sudden appearance of dramatically new genetic
variants; is also present in a limited number of
other viral families. What viruse also possesses
this biological attribute?
Rotavirus
Q1190:A 37-year-old newly married man presents
with multiple blister-like lesions on the glans
of his penis; appearing over the past 2 days. On
questioning; he recalls similar episodes over the
past 2 years. Examination is remarkable for
tender; 3-4 mm vesicular lesions on the shaft of
his penis with no apparent crusting; drainage; or
bleeding. There is also slight bilateral inguinal
adenopathy. During the asymptomatic period
between outbreaks; where would the causative
agent likely have been found?
Neurons of the sacral ganglia
Q1191:A veterinary student at a state university
is referred to the student health clinic with
complaints of fatigue; malaise; and
lymphadenopathy. She has a fever of 38.2 C
(100.8F); pronounced cervical lymphadenopathy;
and a moderate lymphocytosis. She is three months
pregnant with her first child. She is concerned
with the potential for having become infected
with Toxoplasma gondii. What stage of the
parasite is capable of crossing the placenta?
Tachyzoite
Q1192:A 54-year-old woman suffering from
influenza deteriorates and develops shaking
chills and a high fever. Physical examination is
remarkable for dullness to percussion at the left
base and decreased breath sounds on the left.
Chest x-ray confirms the diagnosis of lobar
pneumonia; presumed to be caused by Streptococcus
pneumoniae. The patient has no known drug
allergies. What antibiotic would be most
appropriate to treat the patient's condition?
Penicillin
Q1193:A patient with rheumatoid arthritis
presents to her physician and mentions that after
many years without teeth problems; she has
recently developed seven caries. This is a clue
to her clinician that she should be evaluated for
what disease?
Sjogren's syndrome
Q1194:A 46-year-old woman complains to her
physician at the time of her annual examination
of fatigue and painful lymph nodes in her neck;
which she says have been present for at least 6
months. A lymph node biopsy reveals
hypercellularity in the cortical areas; and serum
electrophoresis shows a spike of protein in the
gamma region. The abnormal immunoglobulin is
determined to be of the IgG2 isotype. An IgG2
molecule is composed of?
Two gamma2 chains and two kappa chains
Q1195:A 67-year-old black man with a history of
glucose-6-phosphate dehydrogenase (G-6-PD)
deficiency presents with fever; irritative
voiding symptoms; and perineal pain. Rectal
examination is remarkable for a boggy;
exquisitely tender prostate. A urine Gram's stain
is positive for gram-negative rods. The risk for
development of hemolytic anemia is highest if he
receives high-dose; 21-day therapy with ?
Sulfamethoxazole/trimethoprim
Q1196:A previously healthy 27-year-old man
presents with one week of increasingly severe
sore throat; fever; fatigue; and headache. His
temperature is 39 C (102.2F) orally. He has
palpable anterior cervical adenopathy and
petechiae over his trunk and oral mucosae but
lacks a pharyngeal exudate. His liver is palpable
3 cm below the right costal margin and his spleen
tip is also palpable. His sclerae are anicteric.
A blood smear appears as shown above. What is the
identity of the predominating white blood cell?
CD8+ lymphocyte
Q1197:A 24-year-old man presents with complaints
of itching on his arms and face. Physical
examination reveals well-circumscribed wheals
with raised; erythematous borders and blanched
centers. What form of hypersensitivity is this
patient probably exhibiting?
Immediate type hypersensitivity
Q1198:A 6-year-old child is brought to the
pediatrician's office complaining of a severe
sore throat. ON examination; the child is
febrile; and the throat is extremely erythematous
with obvious abscesses on the tonsillar pillars.
A rapid antigen test is positive for
Streptococcus pyogenes. At what stage of the
above growth curve would a beta-lactam antibiotic
have greatest efficacy?
log phase
Q1199:In a random quality-control test of 73
batches of Hemophilus influenzae vaccines
administered nationwide; the FDA discovered two
lots in which the capsular polysaccharide of
Hemophilus was not covalently coupled to the
Diptheria toxoid. What immunologic response would
be predicted in children receiving one of these
unusual vaccine lots?
They should produce a normal IgM response to
Hemophilus
Q1200:A 48-year-old waitress presents to a
physician with malaise; loss of appetite; nausea;
moderate fever; and jaundice. Laboratory tests
indicate a marked increase in serum
transaminases. Serology for hepatitis viruses is
performed and indicates positive results for the
presnce of HBsAg; HBc IgM antibody; and HCV
antibody. Antibody tests for HBsAb and HAV are
negative. The results indicate:
The presence of an acute HBV infection
Q1201:A febrile 23-year-old college coed presents
with fatigue and difficulty swallowing. Physical
exam reveals exudative tonsilitis; palatal
petechiae; cervical lymphadenopathy; and tender
hepatosplemonegaly. A complete blood count
reveals mild anemia; lymphocytosis with about 30%
of the lymphocytes exhibiting atypical features;
and a mild thrombocytopenia. Coombs' test is
positive. What is the most likely complication of
this syndrome?
splenic rupture
Q1202:A 25-year-old pregnant woman in her third
trimester is diagnosed with an upper respiratory
infection. What would be the most appropriate
pharmacotherapy?
Azithromycin
Q1203:A six-year-old child is brought to the
pediatrician by his mother. While playing with
friends after school; he received a puncture
wound on his hand. Although his mother washed and
disinfected it to the best of her ability; she is
now concerned about the possibility of tetanus;
and is seeking medical advice. After checking the
child's vaccination status; the physician advised
the mother that a new tetanus booster is not
necessary at this time. If bacteria have been
introduced into this child's puncture wound; what
pair of complementary molecules will be most
important in causing phagocytic cells to enter
the area of infection?
LFA-1 and ICAM-1
Q1204:A 33-year-old single mother of two young
children visits her physician because of an oral
ulcer. A review of systems is significant for
fatigue; myalgia; and joint pain. Laboratory
results demonstrate leukopenia; and a high-
titered antinuclear antibody. A speckled staining
pattern due to anti-Sm is seen with
immunofluorescence; urinary protein is elevated.
What is the most likely diagnosis?
Systemic Lupus Erythematosus
Q1205:(SYSTEM: IMMUNOLOGY; GENERAL PRINCIPLES);
An experimental study on acne is performed using
biopsy samples from acne pustules. The electron
micrograph above illustrates one of the types of
cells present in the wall of the pustules. What
characteristic would most strongly suggest that
the cell depicted above is a phagocytically
active macrophage?
Presence of receptors for IgG and complement
Q1206:(SYSTEM: MICROBIOLOGY GENERAL PRINCIPLES);
A 16-year-old high school cheerleader presents
with low grade fever; pleuritic pain; and a non-
productive cough. Her serum agglutinates
Streptococcus salivarius strain MG. Therapy
should include ?
Erythromycin
Q1207:(SYSTEM: IMMUNOLOGY; GENERAL PRINCIPLES); A
52-year-old woman reports to her family
practitioner for an annual physical examination.
She has been experiencing periods of heat
intolerance; which she has attributed to the
menopause. On examination; her physician notices
that her eyeballs seem to be unusually
protuberant and she has sinus tachycardia. Blood
tests confirm that her T3/T4 levels are elevated.
What is the mechanism of pathogenesis of her
condition?
Type II non-cytotoxic hypersensitivity
A 70-year-old man with a hisjtroy of prostate
cancer presents with a chief complaint of pain on
the right side of his chest for the past several
days. He has been receiving external beam
radiation to spinal metastases of his prostate
cancer forj the past several weeks. On
examination; there is marked tenderness along the
right side of the chest wall in a 4-6 cm stripe
from the midline to the flank. Multiple small
vesicular lesions are visible in this area on an
erythematous base. Some of the lesions are fluid-
filled; and some are crusted. How do members of
the virus family responsible for his condition
By transcribing the genomic DNA
patient with Epstein-Barr virus lymphoma enrolls
in an experimental protocol to stimulate
production of CD8+ cells specific for his EBV-
transformed cells. His peripheral blood cells are
tested with a battery of anti-HLA; A; B; and C
antibodies; followed by addition of complement;
and trypan blue dye. The wells of the microtiter
plate in which dye was taken up by the cells is
shown below: (*picture*). What molecule implanted
into the membrane of a culture of tissue
fibroblasts enriched for expression of
costimulatory molecules would serve to stimulate
the most effective cytotoxic killing?
EBNA plus HLA-A1
A 6-month-old infant is rushed to the emergency
department because he seems to be having touble
breathing. His mother was breast-feeding the
child when she noticed that he seemed to be
unable to suckle strongly; his eyelids were
drooping; and his breaths were shallow and
irregular. The child is placed on respiratory
support immediately. The mother acknowledges
adding honey to the infant's first solid foods.
Where is the genetic coding for this toxin
located?
lysogenic phage genome
A colony of Neisseria gonorrhoeae is isolated on
Thayer-Martin medium. Over the course of ten
generations in culture; this strain produces a
homogeneous antigenic type of pili. Lysates froma
culture of N. gonorrhoeae with a different pilus
type are added to the stable colonies. After
overnight incubation; the bacteria are cloned;
and their pilus expression is analyzed. In 50% of
the new colonies; a new antigenic form of pili is
now expressed. What has happened in these
cultures?
natural transformation
couple brings their son into a specialty clinic
for evaluation of recurrent bacterial infections
involving the respiratory tract. Causative agents
have included Streptococcus pneumoniae; and
Hemophilus influenzae; in spite of current
immunization status. Other family members have a
similar disorder; as noted in the pedigree above.
Bruton agmmablobulinemia
Q1213:(SYSTEM: MICROBIOLOGY; RESPIRATORY); A 9-
month-old infant is brought to the pediatrician
by her mother during a winter month. The child
has a febrile illness; which has now become
associated with labored breathing and wheezing.
Auscultation of the chest reveals expiratory
wheezes over both lung fields and there is clear
tachypnea and tachycardia. What is the first
thing that this causative agent virus does upon
entering a cell?
It transcribes its genome into messenger RNA
using a virion-associated RNA-dependent RNA
polymerase
A 34-year-old HIV-positive man without previous
opportunistic infections presents complaining of
dyspnea with daily activity. He states that he
has had a mild cough and fever but denies having
had chills; sputum production; or chest
discomfort. Physical examination is remarkable
for oral thrush and a few small; nontender
cervical lymph nodes. A chest x-ray film reveals
bilateral interstitial infiltrates; and
bronchoalveolar lavage reveals small silver-
staining cysts. IN what other patient population
in the U.S; is this organism a frequent cause of
a life-threatening pneumonia?
premature infants
Q1215:(SYSTEM: MICROBIOLOGY; RESPIRATORY); A
newborn infant develops respiratory distress
shortly after delivery and is taken to the
neonatal intensive care unit for observation. The
next day; she become febrile with persistent
dyspnea and coughing. Sputum recovered by the
respiratory therapist reveals numerous
neutrophils and gram-negative rods that grow as
pink colonies on MacConkey's agar. The infective
organism most likely belong to what genera?
Escherichia
Q1216:(SYSTEM: MICROBIOLOGY; NERVOUS); A 38-year-
old AIDS patient presents to his physician's
office in Kansas City; Missouri; complaining of
fever for the past week and an increasing
headache. He also states that sunlight hurts his
eyes and that he has been feeling nauseated and
weak. His past medical history is significant for
Pneumocytis pneumonia and a total CD4 count of
89/mm3. Current medications are
trimethoprim/sulfamethoxazole and indinavir.
Cerebrospinal fluid (CSF) reveals 4 WBC/mm3; and
budding encapsulated yeast forms grown on
Sabouraud's agar. What is an accurate description
of the morphology of the infectious form of the
Broad-based budding yeasts
Q1217:(SYSTEM: MICROBIOLOGY; NERVOUS); A 42-year-
old heart transplant patient complains to her
primary care physician about headache and nausea
14 months after transplant. A CT scan of the head
shows ring-enhancing lesions. Bacterial; fungal;
and viral cultures of the lesions are negative. A
biopsy is performed; and a hematoxylin-eosin
stain of the biopsied tissue reveals multiple
cyst-like structures. How did the infection most
likely arise?
Reactivation of latent infection
Q1218:(SYSTEM: IMMUNOLOGY; GENERAL PRINCIPLES). A
32-year-old medical technician had a history of
acute eczematous dermatitis on her hands and
wrist in the distribution of the latex gloves she
wore. The skin of her hands was dry; crusted; and
thickened. The eczematous reaction cleared after
a 2-week vacation. After 72 hours back on the
job; the eczematous dermatitis returned and
continued to grow worse. What characterizes the
technician's reaction to the latex gloves?
Type IV reaction
15-year-old boy is evaluated by a pediatrician
because of a history of multiple bacterial
pneumonias. The boy had been apparently normal up
until about age 12. In the last three years; he
had had five episodes of bacterial pneumonia that
were severe enough to require hospitalization.
Chest x-ray films taken during the present
evaluation demonstrates moderately severe
bronchiectasis. A pilocarpine-induced sweat test
is negative. T and B cell counts from peripheral
blood are normal. Delayed hypersensitivity skin
testing shows reactivity to Candida.
Immunoglobulin studies demonstrate the following:
Common variable immunodeficiency
trauma victim in the emergency department
requires a transfusion immediately. Type and
cross-match tests reveal the following: (NO
AGGLUTINATION WITH "PATIENT'S RBC PLUS SERUM FROM
AB PERSON" and "Patient's serum plus [type A; B;
AB; O; and RhD] RBC). What type of blood should
the physician order for him?
AB; RhD+
Q1221:(SYSTEM: MICROBIOLOGY; RESPIRATORY); A 54-
year-old farmer in rural Pennsylvania presents to
his physician with chronic cough. Chest x-ray
demonstrates a mass lesion with hilar
lymphadenopathy. Biopsy of the mass demonstrates
multiple; tiny yeast forms within macrophages.
Histoplasmosis
3-year-old male who is small for his age presents
with a history of pyogenic infections. Physical
examination is remarkable for a high fever;
hepatosplenomegaly; and inguinal and cervical
lymphadenopathy. A culture of a purulent
discharge from an abscess grows out
Staphylococcus aureus. Immunoglobulin and
complement levels are normal. The boy received
all of the standard immunizations without any
adverse effects. The boy's immune deficiency most
likely involves ?
phagocytic cells
Q1223:A 2-day-old baby girl suddenly develops
abdominal distention; progressive pallid
cyanosis; and irregular respirations. The newborn
also has "refused" to breast-feed for the past 18
hours. If the mother was treated for a serious
infection with antibiotics for 14 days up to and
including the day of delivery; what medication
did the mother most likely receive?
Chloramphenicol
Q1224:A previously healthy 18-month-old girl is
brought to the office with 2 days of
irritability; poor appetite; and pulling at her
left ear. She has no known allergies; and her
vaccinations are up-to-date. On examination; the
child's temperature is 102.8 F. She is easily
consoled by the mother and moves her neck
spontaneously without discomfort. There is a
clear discharge from the nares. The left tympanic
membrane is erythematous; dull; and bulging. What
virulence factor is generally ABSENT in the
strains of the causative organisms that produce
obits media; compared with those that produce
epiglotittis or meningitis?
polyribitol phosphate
Q1225:A 35-year-old Cajun man living in the
bayous of the Mississippi River basin near New
Orleans develops a tuberculosis-like illness with
formation of masses within the lungs. PPD is
negative; but the histoplasmin skin test is
positive. CT-guided biopsy of one of the lung
masses would be most likely to demonstrate ?
2-5 micrometer yeast with a thin cell wall but no
true capsule
Q1226:A Washington; D.C; letter carrier is
brought to the emergency department of a local
hospital by his wife; who fears that he is having
a heart attack. The man is suffering severe
substernal pain accompanied by a fever of 40 C
(104 F) and cough. ON radiographic examination;
there is pronounced mediastinal widening. A
sample of blood is cultured on blood agar; and
nonhemolytic; rough gray colonies are produced.
During what stage of the bacterial growth curve
shown above would the maxiumum number of the
infectious forms inhaled by this patient
produced?
stationary phase
Q1227:A 54-year-old man presents with complaints
of shortness of breath; a sore tongue; and a
"pins-and-needles" sensation in his feet.
Laboratory examination revelas macrocytosis;
anemia; and hypersegmented neutrophils.
Antibodies to intrinsic factor are detected in
the patient's serum. What class II antigen would
be most likely to play a contributing role in the
etiology of this patient's disease?
DR5
Q1228:A sexually active 18-year-old woman
presents with a fever of 38.9 C (102 F) for the
past 24 hours and lower abdominal pain and
anorexia for the past 5 days. ON physical
examination; there is generalized tenderness of
the abdomen; and the cervix is erythematous with
motion tenderness. There is no rash nor any
lesions on the external genitalia. A smear of the
odorless cervical discharge contains sloughed
epithelial cells and scant neutrophils. What
would likely be found in the exudate?
Iodine-staining intraepithelial inclusion bodies
Q1229:Approximately 1 week after starting therapy
for a complicated urinary tract infection caused
by Proteus mirabilis; a 13-year-old girl develops
leg cramps; myalgia; and arthralgias. What
medication was this patient most likely
prescribed?
lomefloxacin
Q1230:A 35-year old man develops hemiparesis;
ataxia; homonymous hemianopa; and cognitive
deterioration. An MRI of the brain demonstrates
widespread areas of abnormal T2 signal in the
white matter. An electroencephalogram is
remarkable for diffuse slowing over both cerebral
hemispheres. Brain biopsy revelas demyelination
with abnormal oligodendrocytes; some of which
contain eosinophilic inclusions. This patient's
condition is most closely related to what
diseases?
AIDS
Q1231:A bacterium cultured from the bloodstream
of an HIV-positive patient is determined by
electron microscopy to possess an envelope. The
basic structure of the envelop is diagrammed
above. The culture isolate is subjected to Gram's
staining. Provided that the laboratory
technologist conducts this test properly what
reagent will give this organism its primary color
in the staining procedure?
Safranin
Q1232:A 3-year-old male presents with a skin rash
and epistaxis. He has had several; severe
sinopulmonary infections. A careful history
reveals that his maternal uncle died of bleeding
complications following an emergency
cholecystectomy. What additional findings are
likely in this case?
low platelet count and low serum IgM levels
Q1233:A 24-year-old woman presents with a 3-day
history of fever; chills; chest pain; and cough
productive of reddish-brown sputum. Past medical
history includes a splenectomy 1 year ago. A
chest x-ray film indicates consolidation of the
right lower lobe. Blood cultures are positive for
alpha-hemolytic gram-posotive diplococci.
Immunity to the causative organism is based on ?
IgG antibodies to a surface acidic polysaccharide
Q1234:A British dairy farmer develops fever with
chills; myalgia;s headache; skin rash; and
vomiting. He is quite ill and is hospitalized.
Blood cultures demonstrate tightly coiled; thin;
flexible spirochetes shaped like a Shepherd's
crook. The spirochetes are easily cultrued in
serum-enriched nutrient agar. What organism
should be suspected?
Leptospira interrogans
Q1235:A high school student badly burned in an
automobile accident develops a skin lesions on
the burn area during his hospitalization. What is
the causative agent?
An oxidase-postive; aerobic; gram-negative
bacillus
Q1236:A newborn infant has multiple; hemorrhagic;
cutaneous lesions and does not respond to sound.
Head CT scan shows periventricular
calcifications. What infectious agent is the most
likely cause of this child's presentation?
cytomegalovirus
Q1237:A 9-month-old infant is brought to the
Health Department to receive the second dose of
OPV (ORAL POLIO VACCINE); 2 weeks after the first
vaccination. The child has mild diarrhea; so the
decision is made to defer further immunizations.
Bacteriologic examination of a stool culture is
unremarkable; however; a small; single-stranded
positive RNA virus is isolated from the specimen.
This same agent was isolated from sewage effluent
the preceding week. The viral isolate was not
inactiviated by ether. What viruse was most
likely isolated?
poliovirus
Q1238:A 55-year-old woman with type 2 diabetes
seeks treatment from her primary care physician
for painful; burning urination. She is given a
course of ampicillin; but returns to her
physician a week later with complaints of fever
and flank pain. At the time of her second visit;
her temperature is 40 C (104 F); and she is
tachycardic; with a blood pressure of 90/50 mm
Hg. She has a petechial rash on her trunk and
mucous membranes; and her fingertips show signs
of peripheral vascular coagulopathy. A blood
culture is positive for growth of gram-negative
lactose-fermenting bacilli. What substance is the
most likely cause of these symptoms?
lipid A
Q1239:A neonate is born at term with multiple
problems. He is small for gestational age and has
cataracts; hepatosplenomegaly; and
thrombocytopenia with purpura. Further studies
demonstrate patent ductus arteriosus; bone
lucency; pneumonia; and meningoencephalitis. The
mother is a 15-year-old girl who had no prenatal
care and had a mild maculopapular rash in mid-
pregnancy. What is the most likely diagnosis?
congenital rubella
Q1240:A young military recruit scheduled for
overseas assignment begins a course of
immunization. The corpsman administering the
inoculations warns the private that one of these
immunizations is likely to cause swelling and
inflammation 24-48 hours after injection and
therefore should be administered in his
nondominant arm. To what vaccine is the corpsman
referring?
tetanus
Q1241:A 3-year-old child with cystic fibrosis
presents with weight loss; irritability; and a
chronic productive cough. On physical exam; he is
febrile and lung exam reveals intercostal
retractions; wheezing; rhonchi; and rales. Chest
x-ray demonstrates pathy infiltrates and
atelectasis and Gram's stain of the sputum
reveals slighly curved; motile gram-negative rods
that grow aerobically. The microorganism
responsible for this child's pneumonia is also
the most common cause of what disease?
otitis externa
Q1242:A 14-year-old patient is brough in by his
parents because of a sore throat. ON physical
examination; he is febirle; and has pharyngeal
erythemia with a tonsillar absscess. A throat
culture on sheep blood agar yields colonies of
gram-positive cocci that are surrounded by a zone
of complete hemolysis. The organism was also
plated on mannitol salt agar; it grew well and
cuased the medium to turn yellow. What
microorganism is the most likely cause of the
patient's illness?
Staphylococcus aureus
Q1243:An 18-year-old man is evaulated for
possible immunodeficiency disease because of a
life-long history of chronic lung infections;
recurrent otitis media; and multiple episodes of
bacterial meningitis. While total IgG is normal;
the patient is found to have a selective
deficiency of IgG2. IgG2 deficiency is most
likely to be associated with a deficiency of what
substance?
IgA
Q1244:An 8-year-old child is brought in by her
mother with complaints of crampy abdominal pain;
nausea; and mild diarrhea for approximately 2
weeks. The day before this visit; she vomited up
a cylindrical white worm 30 cm in length; which
the mother preserved in a jar. What is the most
likely means by which this organism was acquired?
ingestion of eggs from human feces
Q1245:A 38-year-old primigravid woman in her
second trimester of pregnancy complains to her
obstetrician of urinary frequency and burning. A
clean catch specimen of urine is obtained and
submitted to the laboratory for culture; Gram's
stain; and biochemical analysis. Urease-positive
gram-negative bacilli with smarming motility are
detected. Where is the proton-motive force that
generates energy for flagella located in this
organism?
Cytoplasmic membrane
Q1246:An autopsy is performed on a man who
suddenly began vomiting voluminous quantitis of
blood and exanguinated. The man's stomach is
presnted in the accompanying photograph. What
organism is most likely implicated in the
pathogenesis of this disease?
Helicobacter pylori
Q1247:A new vaccine developed by the military
protects recruits against respiratory infections
causes by adenovirus serotypes 4 and 7. The
virus; which is living and non-attenuated; is
delivered in an enteric coated capsule. It
establishes an asymptomatic intestinal infection;
which stimulations production of memory cells
that disseminate throughout the body to protect
all the mucosal surfaces from subseuqnt
respiratory attack. What cytokine produced as a
result of this vaccination is most likely to
induce a protective response?
Interleukin-5
Q1248:A 73-year-old woman with a history of
diabetes presents with left ear pain and drainage
of pus from the ear canal. She has swelling and
tenderness over the left mastoid bone. What
microorganism is the most likely causative agent?
Pseudomonas aeruginosa
Q1249:A 7-year-old girl develops behavioral
changes; and her performance in school begins to
deteriorate. Several months later; she develops a
seizure disorder; ataxia; and focal neurologic
symptoms. She is eventually quadriparetic;
spastic; and unresponsive. Death occurs within a
year. This patient may have had what viral
disease at 1 year of age?
Measles
Q1250:A 36-year-old farmer has been exposed to
poison ivy on several different occasions and
usually develops severe skin lesions. He enrolls
in an immunological study at an urban medical
center. A flow cytometric measurement of T cells
rev3eals values within the normal range. An
increased serum concentration of what cytokines
would decrease the likelihood of a delayed-type
hypersensitivity reaction in this individual?
IL-10
Q1251:An 8-year-old boy is brought to the
emergency room with a 3-day history of fever of
102 degrees F and abdominal pain. He also
complains of pain in hbis right knee and right
elbow. He was seen four weeks ago because of a
sore throat and a rash. A throat culture
performed at that time grew gram-positive cocci
in chains. Amoxicillin was prescribed; but the
boy's mother did not fill the prescription. ON
physical examination; his temp is 38.7 C (101.7
F); HR is 96; and BP is 100/60. Cardiac
examination reveals a pansystolic blowing murmur
heard best at the apex. His right elbow is tender
on extension and flexion with mild swelling.
sensitivity to bacitracin
Q1252:A traveler to a foreign country develops
acute lymphatic filariasis four months after his
return to the United States. His symptoms include
scrotal inflammation; itching; and localized
scrotal swelling and tenderness of the inguinal
lymph nodes. What immune mechanism does the body
employ against the live filarial worms?
Antibody-dependent cell-mediated cytoxocitiy
Q1253:A Malaysian famiy is referred to a
specialist in Memphis; Tennessee for evaluation
of a possible genetic immunologic defect. 4 of 6
of the members of this family have displayed
increased susceptibility to extracellular
bacteria and elevated serum levels of IgM and
IgG. Analysis of serum complement protein levels
reveals near absence of component C4. This
deficiency would inhibit whihc of the following
complement activities?
Completion of the classic pathway to the
splitting of C3
Q1254:A 15-year-old boy presents to his physician
with several weeks of slowly worsening pruritis
of both of his feet. He is otherwise well and
taking no medications. On examination; he has
bilateral; erythematous; dry scaling lesions that
are most obvious in the interdigital web spaces
and on the soles. There is no bleeding or
exudate. What would most likely be found in a
potassium hydroxide (KOH) mount of a scraping of
the affected skin?
Branching; septate hyphae with arthroconidia
Q1255:A 12-year-old girl presents with a skin
abscess. The causative organism is found to be
Staphylococcus aureus. Over the past year; she
has had several similar abscesses; as well as two
bouts of aspergillosis. What is the most likely
explanation for her repeated infections?
Defective NAPDH oxidase
Q1256:A 38-year-old woman with SLE is seen by her
family physician. On her last visit; he sent
blood to the laboratory for an antinuclear
antibody panel. Based on the results; he
recommends that the patient by seen by a
nephrologist. A high titer of autoantibodies
directed against what antigen most likely
prompted his decision?
Double-stranded DNA (dsDNA)
Q1257:A small 9-month-old male with a history of
recurrent pyogenic infections is seen in a
clinic. Immunoglobulin levels and a CBC are
performed. The CBC is normal except for slight
neutropenia and thrombocytopenia. Determination
of immunoglobulin levels indicates elevated IgM;
but deficiencies of IgG and IgA. The underlying
defect involves whihc of the following molecules?
CD40 ligand (CD40L) on the T cell
Q1258:A 21-year-old college student from
Connecticut with a past history of Lyme disease
presents with chronic pain and swelling in his
right knee. He states that he has had problems
with the knee for the past two years. What HLA
allele would you expect to be present in this
individual?
HLA-DR4
Q1259:A 33-year-old woman presents with fever;
vomiting; severe irritative voiding symptoms; and
pronounced costovertebral angle tenderness.
Laboratory evaulation reveals leukocytosis with a
left shift; blood cultures indicate bacteremia.
Urinalysis shows pyuria; mild hematuria; and
gram-negative bacteria. What drug would best
treat this patient's infection?
Ampicillin and gentamicin
Q1260:A 44-year-old white female presents with
severe Raynaud's phenomenon; dysphagia; and
sclerodactyly; and facial and palmar
telangiectasis. What autoantibody is most likely
to be present in this patient?
Anti-centromere antibody
Q1261:A 6-year-old boy presents with a rash that
started as a superficial accumulation of several
small vesicles on his legs below the knees. He is
afebrile and appears normal; other than these
lesions. The child lives in the suburbs and often
plays outside in the local woods in short pants.
The lesions are honey-brown and crusted; with an
erythematous base; and are in various stages of
crusting and openness. What is the most important
laboratory test to distinguish between the genera
of potential causative agents for this condition?
Catalase test
Q1262:A research laboratory is studying
mechanisms of immunity to Babesia microti in
mice. Cells from immune mice are separated by
flow cytometry; using fluorescently labeled
anibodies directed against a variety of cell
surface markers. Infected red blood cells are
then added to the separated populations of immune
cells and observed for lysis in the absence of
complement. What cell surface marker would be
most useful in identifying a cell capable of
lysing infected cells in this system?
CD56
Q1263:What is more frequently associated with
Klebsiella pneumoniae than with Pseudomonas
aeruginosa?
upper lobe cavitation
Q1264:A 46-year-old woman presents with
complaints of feeling as if she has "sand in her
eyes" and reports difficulty swallowing such
foods as crackers or toast. A biopsy of an
enlarged salivary gland reveals lymphocytic
infiltration. There is hperplasia of the ductal
linings and signs of fibrosis and hyalinization
of the acini. What pair of tests would likely
yield positive results in this patient?
Rheumatoid factor and anti-SS-A antibody
Q1265:A 26-year-old obstetric patient becomes
acutely ill during her first trimester with
infectious mononucleosis-like symptms; but her
heterophil antibody test was negative. A careful
history reveals that the family has two cats in
the house. The approprate laboratory tests
indicate the expectant mother is infected with
Toxoplasma gondii. Months later; the woman
delivers a full-term baby with no obvious signs
of infection with the protozoan parasite. The
best test to diagnose acute infection in the
neonate would be a parasite-specific ELISA for
which isotype of immunoglobulin?
IgM
Q1266:An infectious disease specialist in New
York City is conducting a study of the effect of
cytokine administration on the progression of
multiple drug-resistant tuberculosis in HIV-
positive patients. A variety of cytokines
produced by recombinant DNA are aerosolized and
administered twice daily to a group of 20
individuals. Treatment progress is monitored by
chest x-ray and sputum culture. What cytokine is
likely to have the most beneficial effect on
macrophage intracellular killing of the
mycobacteria?
Interferon-gamma
Q1267:A 39-year-old black man presents with
complaints of anorexia; malaise; fatigue; dark
urine; and upper abdominal discomfort. He admits
to homosexuality; but denies blood transfusions;
alcohol intake; or intravenous drug abuse. On
physical examination; the patient has a
temperature of 100.2 degrees F; scleral icterus;
and jaundice. His liver is palpable below the
right costal margin; and there is moderate right
upper quadrant tenderness. Liver function test
results are as follows: total bilirubin 12.4%
SGOT 980 units; SGPT 1200 units. Serologic
findings are as follows: anti-hepatitis A IgM
negative; HBsAg positive; anti-HBc IgM positive;
He will become HBsAg negative
Q1268:An autopsy performed on a homeless middle-
aged man demonstrates scattered small nodules
within the apex of the right lung. On histologic
examination; these nodules are composed of
collections of large epithelioid macrophages and
multinucleated giant cells; surrounded by
lymphocytes and fibroblasts. Caseating necrosis
is seen in some of these lesions; and acid-fast
bacilli are demonstrated with appropriate
staining. What mediators is responsible for the
devleopment of epithelioid macrophages and
multinucleated giant cells in this context?
Interferon-gamma
Q1269:A 30-year-old woman presents to a physician
with a prominent rash over her nose and cheeks.
She also has complaints of fever; malaise; and
muscle soreness of several months duration.
Serologic studies demonstrate positive ANA with
autoantibodies to double-stranded DNA. This
patient's probable condition is associated with
what HLA type?
HLA-DR2 and HLA-DR3
Q1270:A 16-year-old girl presents to her
physician complaining of redness and a yellowish
discharge from her left eye for the past 2 days.
She reports minimal crusting upon awakening and
denies eye pain or previous trauma. Upon
examination; there is diffuse conjunctival
hyperemia associated with a mucoid discharge. The
pupils dilate normally; although there is mild
photophobia in the affected eye. Gram's stain of
the exudate shows pleomorphic; gram-negative
bacilli. To culture this organism with whole
blood agar; what must be used?
Q1271:A 22-year-old woman presents with a 1-week
history of mild lower abdominal pain and a
yellowish vaginal discharge. She describes the
pain as dull in nature; relieved slightly by
acetaminophen and worsened by intercourse.
Pelvixc examination reveals a red; swollen cervix
without motion tenderness. The mucosas is
friable. Potassium hydroxide (KOH) mount is
negative; and wet mount does not reveal clue
cells. Gram's stain of the exudate reveals gram-
negative cocci. What procedure would most likely
lead to the correct diagnosis?
Order DNA probe assays of endocervical exudates
Q1272:A new laboratory technologist receives an
orientation on her first day of hospital
employment. She is instructed on accepted
procedures for biohazardous waste disposal. All
reusable glassware is subjected to 20 minutes at
121 C at 15 pounds pressure. What would retain
pathogenicity following this treatment?
Endotoxin
Q1273:An 8-month-old baby boy is evaluated
because of repeated episodes of pneumococcal
pneumonia. Serum studies demonstrate very low
levels of IgM; IgG; and IgA. Flow cytometry of
peripheral blood cells demonstrates a near
absence of CD19+ cells; although levels of CD4+
and CD56+ cells are within normal limits. Studies
of the bone marrow reveal abnormally high numbers
of cells with cytoplasmic mu chains; but none
bearing surface IgM molecules. This patient's
condition is thought to be related to a
deficiency of what protein?
tyrosine kinase
Q1274:A patient with colorectal cancer develops
septicemia complicated by endocarditis. You would
expect the blood cultures to grow:
Streptococcus bovis
Q1275:A 24-year-old male Asian immigrant presents
with an ulcerative genital lesion. The lesion
first appeared 1 month ago as a papule with an
erythematous base; which eventually became
ulcerated and painful. On physical examination;
the man is afebrile. A tender ulcerative lesion
is present on his prepuce; and inguinal
adenopathy is evident. What would be the most
likely microscopic finding in a scraping from the
rash.
Pleomorphic gram-negative rods in parallel short
chains
Q1276:What is the role of class II MHC proteins
on donor cells in the process of graft rejection?
They are recognized by helper T cells; which then
activate cytotoxic T cells to kill the donor
donor cells.
Q1277:A psychotic; indigent man with a history of
multisubstance abuse has been involuntarily
hospitalized for 1 week. Because of persistent
diarrhea; stools are sent for ova and parasites;
revealing numerous granular; spherical; thin-
walled cysts measuring 10-20 micrometeres in
diameter. Trichrome stains show up to four nuclei
in most of the cysts. These findings are
consistent with an infection by what organism?
Entamoeba histolytica
Q1278:A 35-year-old woman presents to her
gynecologist with complains of burning on
urination for the past 2 days. Dipstick test of
her urine demonstrates marked positivity for
leukocyte esterase; but no reactivity for
nitrite. Urine culture later grows out large
numbers of organisms. What bacteria are most
likely to be responsible for this patient's
infection?
Enterococcus faecalis
Q1279:A ten-year-old immigrant child from Haiti
is brought to a free clinic complaining of
shortness of breath; wheezing; exertional
dyspnea; and occasional urticaria. A fecal
examination for ova and parasites is positive for
numerous golden-brown; oval; rough-shelleed
nematode eggs. Sputum samples are positive for
nematode larvae and eosinophilic infiltrates.
What is the mechanism of this child's lung
symptoms?
Type I hypersensitivity
Q1280:A 7-month-old child is hospitalized for a
yeast infection that does not respond to therapy.
The patient has a history of multiple; acute
pyogenic infections. Physical examination reveals
that the spleen and lymph nodes are not palpable.
A differential WBC count shows 95%$ neutrophils;
1 % lymphocytes; and 4% monocytes. A bone marrow
biopsy contains no plasma cells or lymphocytes. A
chest x-ray reveals the absence of a thymic
shadow. Tonsils are absent. These findings are
most consistent with:
severe combined immunodeficiency
Q1281:A 23-year-old woman presents to the
emergency room with pelvic pain. A Gram's stain
of her cervical discharge reveals multiple
polymorphonuclear leukocytes; but none contain
gram-negaitve diplococci. What statement best
describes the two organisms that most commonly
cause this disorder?
Both induce endocytosis by epithelial cells
Q1282:A 54-year-old HIV-positive homosexual is
brought to the emergency department by his
partner because of a sudeen detioration of mental
acuity. He complains of headache; and at the time
of examination; has nuchal rigidity; time-place
disorientation; and marked confusion. Lumbar
puncture reveals 100 white blood cells; 80%
lymphocytes; protein = 85 mg/dL; and glucose = 45
mg/dL. A simultaneous blood glucose is 90 mg/dL.
After the attending physician treats a drop of
cerebrospinal fluid with a particulate dye;
microscopic examination reveals the structures
shown above. What would most likely confirm the
diagnosis?
urease positivity
Q1283:A perimenopausal woman elects to have her
intrauterine device (IUD) removed. She has been
experiencing unusual vaginal discharge for the
past six months. When removed; the IUD is covered
with yellowish flecks. What is most likely to be
cultured from the IUD?
Actinomyces israelii
Q1284:A 54-year-old diabetic patient reports to
his physician's office complaining of an
unresolved skin lesion on his foot. The lesion
began several weeks ago as a blister and has
since become a painful; erosive; expanding sore.
On examination; the affected site is now 5 cm in
diameter; with a black necrotic center and raised
red edges. What toxin has a mechanism of action
most similar to the toxin responsible for tissue
damage in this patient?
diptheria toxin
Q1285:A 32-year-old woman consults her
gynecologist because of fever and progressively
severe pain in her left lower abdominal quadrant.
The pain began several days ago; shortly after
the onset of her menses. Pelvic examination
demonstrates bilateral adnexal tenderness; much
more marked on the left than the right. What is
the most likely pathogen?
Neisseria
Q1286:A 33-year-old G1P0 female at 6 months
gestation returns from a visit to her parent's
house in Arizona. Approximately 7 days following
her return; she develops axillary lymphadenopathy
and a low-grade fever. Her physician notices a
small papule and healing scratch on her arm on
the affected side. The patient states that she
has pet birds at home; and there was a new kitten
at her mother's house. She does not remember
receiving the scratch. What organism is most
likely responsible for this illness?
Bartonella henselae
Q1287:The mother of a 5-year-old girl claims that
her stepfather may have had inappropriate sexual
contact with the girl. Physical examination
reveals an intact hymnen and no evidence of
trauma. A vaginal swab is negative for acid
phosphatase and reveals only normal flora. What
organism was most likely isolated?
Q1288:During the course of a pre-employment
physical; a registered nurse receives an
intradermal inoculation of tuberculin. During her
employment in Pakistan; she was vaccinated with
BCG (Bacille Calmet-Gueirn). At 48 hours; there
is an 8 cm zone of erythema and induration over
the injection site. What is the most important
costimulatory signal involved in the elicitation
of this response?
B7 molecules interacting with CD 28
Q1289:A 4-year-old child presnts to a physician
with purpura. Questioning of the mother revleas
that the child has a history of eczema and
recureent pneumococcal pneumonia. Blood studies
demonstrate thrombocytopenia and a selective
decrease in IgM. Patients with this disorder have
a 12% change of developing what potentially fatal
malignancies?
Non-Hodgkin's lymphoma
Q1290:A 35-year-old woman consults an
ophthalmologist because of double vision and
droopy eyelids. She also has complaints of
generalized muscle weakness. IV injection of
edrophonium dramatically; but only briefly;
reverses her symptoms. This patient's most
probably disease has a pathophysiologic basis
that is closest to that of what condition?
Insulin resistance
Q1291:A 23-year-old man develops explosive watery
diarrhea with blood; fecal leukocytes; and mucus
approximately 3 days after eating chicken that
was improperly cooked. Curved rods were found in
the fecal smear along with red blood cells and
leukocytes. What pathogen is the most likely
cause of these symptoms?
Campylobacter jejuni
Q1292:A 16-year-old girl presents with a
painfully enlarged lymph node in her right
axilla. Peripheral blood counts are within normal
limits. The lymph node is biopsied; and numerous
granulomas filled with neutrophils and necrotic
debris are observed. What organism could produce
this disease?
Bartonella henselae
Q1293:A 4-year-old child is referred to a
specialist for the diagnosis of a potential
immunologic defect. Since the age of 14 months;
he has been plagued with repeated infections with
Candida; Staphylococcus; and Klebsiella. At the
present time; the child is suffering from a
large; painful boil on one knee. Peripheral blood
leukocytes have a negative neutrophil oxidative
index. Culture of the pus of the boil grows
Staphylococcus aureus. Which intracellular
killing mechanism is still operation in
phagocytic cells in this abscess?
defensins
Q1294:A composite virus is created in a
laboratory. The capsid of coxsackie virus A is
used to deliver the naked genomic material of
five viruses to appropate target cells. After 24
hours in culture; the total virus per culture is
determined. Use of which of the folloiwng
viruses' naked genomic material in this fashion
would result in the absence of progeny viruses?
Reovirus
Q1295:A family is referred to a genetic
counseling clinic because one of the parents is
discovered to have a reciprocal translocation
involving chromosomes 14 and 22. One of the
children of the family received an unbalanced
chromosome complements; resulting in a partial
monosomy of one chromosome. The chromosome for
whichere there is a monosomy is shown to be one
encoding immunoglobulin genes. Such an event
could result in the loss of what pair of genes
involved in the synthesis of immunoglobulins?
C gene for gamma chain and C gene for alpha chain
Q1296:A 6-year-old child is taken to a
pediatrician because of a severe sore throat that
is accompanied by a rash. Examination of the head
and neck reveals pharyngeal injection; swollen;
bright red tonsils with discrete white spots on
the surface; and enlarged anterior cervical lymph
nodes. Examination of the skin reveals a diffuse;
erythematous; symmetrical rash that blanches on
pressure; has a slightly rough sand-paper like
texture; and is most prominent on the neck;
chest; and folds of the axilla; elbow; and groin.
The strain of the organism that produces the
child's disease would be most likely to differ
from a less pathogenic strain of the same
By containing a phage
Q1297:A patient with chronic active hepatitis B
develops a low-grade fever and a generalized
petechial rash. Routine urinalysis detects
proteinuria. Needle biopsy of the kidney
demonstrates the presence of irregular deposits
of antigen-antibody complexes with underlying
areas of neutrophilic infiltration and tubular
damage. What is most important in the removal of
these immune complexes from the blood stream?
C3b
Q1298:A 27-year-old woman presents to the
emergency department complaining of 10-12
episodes of nonbloody diarrhea per day for the
past 2 days; along with severe abdominal cramsp;
nausea; vomiting; and a low-grade fever. She
states that she just returned from a vacation to
Mexico. While in Mexico; she did not drink any of
the local water and ate only cooked foods and a
few fresh salads. If fecal leukocytes are
present; the patient should most likely be
empericially treated with:
Ciprofloxacin
Q1299:Two weeks after birth; a neonate develops
sepsis; skin vesicles; and conjunctivitis. Over
the next several days; the baby's condition
deteriorates with development of seizures;
cranial nerve palsies; and lethargy. The baby
dies approximately one week after onset of
symptoms. What infectious agent would most likely
cause this clinical presentation?
Herpes simplex
Q1300:A 33-year-old woman begins seeing a new
boyfriend. Several weeks later; a week after her
menstrual period; the woman develops a painful;
swollen right knee. The most likely causative
organism has what characteristic?
Can live within neutrophils
Q1301:A 27-year-old woman has a pruritic linear;
vesicular rash on her leg. The rash developed 16
hours after she returned from a hiking trip. It
began as a swollen; erythematous streak that
developed into extremely itchy bliasters. She
goes on hiking and camping trips twice a year and
has experienced similar episodes in the past. The
rash is most likely a result of what mechanism?
Release of lymphokines from sensitized
lymphocytes
Q1302:A 32-year-old female who is 6 months
pregnant presents for prenatal care. A routine
evaluation is performed; including testing for
HIV antibody. The patient is reported to be
negative for RPR; but positive for HIV antibody
by the enzyme-linked immunoassay (EIA). The HIV
Western blot is positive for antibody to the p24
antigen. The patient should be counseled:
to have an HIV polymerase chain reaction (PCR)
test performed
Q1303:A 57-year-old man presents with an episode
of shaking chills the previous night. He has now
developed right-sided pleuritic chest pain;
fever; sweats; malaise; purulent sputum; and mild
hemoptysis. On examination; the patient is
diaphoretic but alert; with right basilar rales.
Chest X-ray films show a right lower lobe
infiltrate with blunting of the right
costophrenic angle. Why is this patient's sputum
filled with pus?
Teichoic acids and peptidoglycan are chemotactic
for neutrophils
Q1304:A medical virology laboratory coinfects
cells in a tissue culture flask with Influenza A
(H3N2) and Influenza A (H1N1). The flask is
incubated for 48 hours; and the progeny viruses
are analyzed. Four distinct variants of Influenza
A are isolated: H3N2; H1N1; H3N1; and H1N2. What
viral attribute made the production of H3N1 and
H1N2 variants possible?
segmented genome
Q1305:A newborn is infected in utero with an
enveloped virus containing double-stranded DNA.
The child develops petechiae; hepatosplenomegaly;
and jaundice. Brain calcifications are detected
on CT. With what viruse is the newborn most
likely infected?
Cytomegalovirus
Q1306:A 4-year-old child is brought into your
clinic by his mother. A week ago; the child
received an MMR vaccine; and now the child has an
unusual rash; as show here. What is the most
likely explanation for this occurrence?
A latent infection in the child has been
reactivated
Q1307:A research laboratory studying virus life
cycles has created a continuous culture of bovine
kidney fibroblasts that are suitable hosts for a
large variety of viral agents. In one experiment;
the nuclei of these cells are removed by
cytosurgery; and various viral agents are added
to the cultures. Following culture of the viruses
with the enucleated cells; the yield of
cytopathic units of virus is quantified. What
viruse would be capable of replication in
enucleated cells?
Poliovirus
Q1308:Six days after receiving several flea bites
in a rat-infested shed in Southeastern New
Mexico; a homeless 24-year-old man develops
fever; chills; and a rash that spreads from his
abdomen to cover his extremities. He is seen at
the local hospital emergency department; where
blood is drawn for analysis. Eight days later;
the public health department reports the presence
of antibody to one of the rickettsial group
antigens. What is the most likely diagnosis?
ENdemic typhus
Q1309:A 68-year-old man presents to his physician
with complaints of fatigue and night sweats.
Physical examination is remarkable for
generalized lymphadenopathy and
hepatosplenomegaly. A complete blood count shows
anemia; thrombocytopenia; and neutropenia. A
peripheral blood smear shows numerous small
lymphocytes; some of which appear to have been
disrupted during the process of making the smear.
Which marker or markers is most likely present on
the abnormal cells and could be used to
specifically identify such cells in a flow
cytometric analyzer?
CD 19 and CD 20
Q1310:A 28-year-old male intravenous drug user
presents with a febrile illness that has lasted 2
weeks. He also complains of chills; weakness;
dyspnea; cough; arthralgia; diarrhea; and
abdominal pain. On examination; a heart murmur is
present; and small; tender nodules are found on
the finger and toe pads; along with small
hemorrhages on the palms and soles. Three sets of
blood cultures are obtained from different veins.
While awaiting laboratory confirmation; an
emperic antibiotic regimen should primarily be
directed at what organism?
Q1311:A 22-year-old male military recruit
complains of a headache and stiff neck. He is
examined; blood is drawn; and a lumbar puncture
performed. The glucose in the CSF is 100 mg/dL;
and the serum glucose is 120 mg/dL. The CSF shows
3 lymphocytes and 0 neutrophils/microliter. What
conclusion concerning the interpretation of these
findings is most accurate?
There is no evidence for meningitis
Q1312:A 67-year-o0ld woman in a skilled nursing
facility complains of flu-like symptoms. After
several days; she develops high fever; dyspnea;
and a productive cough. The nurses also notice
mental status changes; and she is transported to
the nearby community hospital. A chest x-ray
shows a cavitary lesion in her left lung. What
organism would most likely be identified from
examination of her sputum?
Q1313:A sexually active 25-year-old man develops
epididymitis and orchitis. Needle biopsy
demonstrates a prominent leukocytic infiltrate
with numerous neutrophils. What organism is the
most likely cause of this man's infection?
Neisseria gonorrhoeae
Q1314:A 67-year-old man with moderate renal
dysfunction presents with influenza-like
symptoms. The patient also has a red macular rash
that first appeared on the ankles; then spread
centrally. He reports nausea; vomiting; and
profound restlessness. He states that he was
recently hiking with some friends in the
mountains; about a week ago. Rickettsia
rickettsiae is demonstrated by
immunohistochemistry on skin biopsy. What agent
would be most appropriate to treat this patient's
infection?
Doxycycline
Q1315:A 57-year-old fisherman with a history of
alcoholism is hospitalized in Gulfport;
Mississippi with a 1-day history of severe;
watery diarrhea after eating several raw oysters.
He is badly dehydrated on admission; and has
numerous fluid-filled vesicular lesions on his
legs. Within 12 hours; he becomes severely
hypotensive and dies. What pathogen is the most
likely cause of this man's death?
Vibrio vulnificus
Q1316:A man presents to a dermatologist because
of a severe mucocutaneous rash that involves most
of his body; including his palms and soles.
Questioning revleas that he is a merchant marine
who; several months previously; had an encounter
with a prostitute in Southeast Asia. What is the
most likely causative agent of this rash?
Treponemia palldium
Q1317:A number of encapsulated organisms are
capable of entering the body across the
respiratory mucosa. If these organisms enter the
bloodstream; delivery to the meninges is a risk.
Streptococcus pneumoniae; Hemophilus influenzae;
Neisseria meningitidis; and Cryptococcus
neoformans are all capable of making this
transition. What is the most important
immunological protective mechanisn against such
blood-borne encapsulated organisms?
IgG-mediated osponization in the spleen
Q1318:A 24-year-old man presents with fever;
rash; a mild headache; and a sore throat. He
denies HIV risk factors; although he is sexually
active. On examination; his temperature is 100.8
degrees Fahrenheit; and his pulse is 90/minute.
There is a diffuse; erythematous; maculopapular
rash over most of his body. Generalized
adenopathy is appreciated; and photophobia is
noted when fundoscopic examination is attempted.
If this man is not treated; what change in his
serologic status will most likely occur?
The VDRL titer would fall
Q1319:A 25-year-old man presents with a high
fever and generalized malaise. His condition
deteriorates so rapidly that his friends decide
to take him to the emergency department 24 hours
after the onset of symptoms. He has a history of
intravenous drug abuse. A test for anti-HIV
antibodies is negative. Phbysical examination
reveals a systolic murmur; and echocardiography
shows bulky vegetations attached to the tricuspid
valve leaflets. What microorganism will be most
likely isolated from this patient's blood
cultures?
Q1320:A 10-year-old boy is attending summer camp
in Texas. After 2 weeks of camp; he complains of
a sore throat; headache; cough; and malaise. On
physical examination; he also has a low-grade
fever; and keratoconjunctivitis. Within hours;
several other campers and counselors visit the
infirmary with similar symptoms. All of the
patients had been swimming in the camp swimming
pool. Eventually; more than 50% of the camp
complain of symptoms similar to the initial case
that last 5 to 7 days. What is the most likely
causative organism?
Adenovirus

Immunology - 1200

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Nitroblue tetrazolium reduction test (NBT). It is

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