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ALI ALMOMANI
ALI ALMOMANI
-1Which of the following does not protect body surfaces:
A Skin.
B Mucus.
C Gastric acid.
D Salivary amylase
E Gut microflora.
Ans : D
-2Pattern recognition receptors (PRR) include:
A LPS.
B PAMPs.
C Lipoteichoic acid.
D Lectin-like molecules.
E Unmethylated CpG sequences
Ans : D
-3The mononuclear phagocyte system does not include:
A Monocytes.
B Kupffer cells.
C Kidney mesangial cells.
D Lymph node medullary macrophages.
E Endothelial cells.
Ans : E
- 4A polymorphonuclear neutrophil (PMN):
A Is a bone marrow stem cell.

B Is closely similar to a mast cell.
C Contains microbicidal cytoplasmic granules.
D Is not a professional phagocytic cell.
E Has granules which stain with eosin.
Ans : C
-5Neutrophil defensins are:
A Anti-toxins.
B Oxygen-dependent.
C Enzymes.
D Glycolipids.
E Peptide antibiotics.
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Ans : e
-6Acute inflammation characteristically involves:
A Constriction of arterioles.
B Capillary endothelial cell enlargement.
C Influx of macrophages.
D Influx of mast cells.
E Influx of neutrophils.
Ans : e
- -7Lysozyme:
A Is a cytoplasmic organelle.
B Activates complement.
C Is a proteolytic enzyme.
D Splits peptidoglycan.
E Is released by mast cells.
Ans : d
-8Which of the following is not an acute phase protein:
A Serum amyloid P component.

B Chondroitin sulfate.
C C-reactive protein.
D Mannose binding lectin.
E Fibrinogen.
Ans : b
-9Natural killer (NK) cells do not:
A Respond to interferon.
B Contain perforin.
C Contain tumor necrosis factor (TNF).
D Kill only by damaging the target cell outer membrane.
E Contain serine proteases.
Ans : d
-10Eosinophils do not:
A Stain with basic dyes.

B Contain a major basic protein.
C Contain peroxidase.
D Give a respiratory burst on activation.
E Have C3b receptors.
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Ans : a
-11An investigator injects an experimental animal with a newly discovered bacterial strain to
evaluate T-lymphocyte activation. It is found that bacterial engulfment by macrophages
results in the presentation of bacterial-derived peptide ligands to CD4+ T lymphocytes.
Which of the following cell-surface molecules on the macrophage is most directly involved in
the presentation of the processed peptides?
(A) CD28
(B) Class II MHC
(C) Fcε receptor
(D) Interleukin-2 (IL-2) receptor
(E) Membrane immunoglobulin
Ans : b
-12If an error is detected during meiosis and cannot be repaired, the cell may
a) Undergo apoptosis
b) Revert back to the previous stage of meiosis
c) Recombine regions of DNA
d) None of the above
Ans : a
-13Which immune cell is responsible for the quickest release of histamine that causes the
red itchy welts associated with allergies?
A-mast cell
B-lymphocyte
C-eosinophil
D-basophil
Ans : a
-14Naturally acquired active immunity would be most likely acquired through which of the
following processes?
a. vaccination
b. drinking colostrum
c. natural birth
d. infection with disease causing organism
followed by recovery.
Ans : d
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-15Which of the following convey the longest lasting immunity to an infectious agent?
a. Naturally acquired passive immunity

b. Artificially acquired passive immunity
c. Naturally acquired active immunity
d. All of these
e. None of these
Ans : c
-16Which of the following substances will not stimulate an immune response unless they are
bound to a larger molecule?
a. Antigen
b. Virus
c. Hapten
d. Miligen
e. Antibody
Ans: c
-17B and T cells are produced by stem cells that are formed in:
a. Bone marrow
b. The liver
c. The circulatory system
d. The spleen
e. The lymph nodes
Ans : a
-18B cells mature in the……….. while T cells mature in the
a. Thymus/bone marrow and gut associated lymphoid tissue (GALT)

b. Spleen/bone marrow and GALT
c. Bone marrow and GALT/Thymus
d. Liver/Kidneys
Ans : c
-19Which of the following immune cells/molecules are most effective at destroying

intracellular pathogens?
a. T helper cells
b. B cells
c. Antibodies
d. Complement
e. T cytolytic cells
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Ans : e
-20A living microbe with reduced virulence that is used for vaccination is considered:
a. A toxoid
b. Dormant
c. Virulent
d. Attenuated
e. Denatured
Ans : d
-21B cells that produce and release large amounts of antibody are called:
a. Memory cells
b. Basophils
c. Plasma cells
d. Killer cells
e. Neutrophils
Ans : c
-22The specificity of an antibody is due to
a. its valence
b. The heavy chains
c. The Fc portion of the molecule
d. The variable portion of the heavy and light chain
Ans : d
-23In agglutination reactions, the antigen is a………

in precipitation reactions, the antigen is
a……………
a. whole cell/soluble molecule

b. Soluble molecule/whole cell
c. Bacterium/virus
d. Protein/carbohydrates
e. Protein/Antibody
Ans : a
-24B Cells are activated by
a. Complement
b. Antibody
c. Interferon
d. Memory cells
e. Antigen
Ans : e
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-24Fusion between a plasma cell and a tumor cell creates a
a. Myeloma
b. Natural killer cell
c. Lymphoblast
d. Lymphoma
e. Hybridoma
Ans : e
-25Monoclonal antibodies recognize a single:
a. Antigen
b. Bacterium
c. Epitope
d. B cell
e. Virus
Ans : c
-26Cell mediated immunity is carried out by………….. while humoral immunity is mainly
carried out by..………………
a. B cells/T cells
b. Epitopes/Antigens
c. T cells/B cells
d. Antibodies/Antigens
e. Antibodies/Phagocytes
Ans : c
-27The ability of the immune system to recognize self antigens versus nonself antigen is an
example of:
a. Specific immunity
b. Tolerance
c. Cell mediated immunity
d. Antigenic immunity
e. Humoral immunity
Ans : b
-28The ability of an organism to resist infections by the pathogens is called:
a) Infection
b) Hypersensitivity
c) Immunity
d) Allergy
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Ans : c
-29Which of the following compounds is NOT found in tears?
a) Lysozyme
b) Lactoferin
c) IgA
d) IgE
Ans : d
-30Name the cytokines which released in response to virus infection?
a) Interferons
b) Monokines
c) Lymphokines
d) Interleukins
Ans : a
-31Name the first cell which recruited at the place of infection.
a) Nk cells
b) Basophils
c) Nutrophils
d) Macrophages
Ans : c
- 32Which of the following antibody gives a primary immune reaction?
a) IgG
b) IgM
c) IgA
d) IgE
Ans : b
-33Which of these is NOT a characteristic feature of adaptive immunity?
a) Immunogenic memory
b) Antigen no-specific
c) Self/ non-self recognition
d) Diversity
Ans : b
-34Synthesis of antibodies takes place by which of the following cells?
a) Bone marrow cells

b) T-cells
c) B-cells
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d) Lymph
Ans : c
-35Which immunoglobulin can pass through placenta?
a) IgD
b) IgE
c) IgM
d) IgG
Ans : d
-36Name the class of immunoglobulin which has a pentameric structure?
a) IgE
b) IgG
c) IgA
d) IgM
Ans : d
-37Which of these immunoglobulins is present in external secretion?
a) IgG
b) IgM
c) IgA
d) IgE
Ans : c
-38Name the class of immunoglobulin which takes part in hypersensitivity reaction?
a) IgG
b) IgE
c) IgA
d) IgM
Ans : b
-39Name the cell which receives antigen presented by MHC molecule.
a) Nk cells
b) B-cells
c) T-cells
d) Macrophages
Ans : c
-40Name the class of MHC which is recognized by CD4 TH cell.
a) MHC cannot recognize T cells

b) MHC III
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c) MHC I
d) MHC II
Ans : d
-41Name the part of processed antigen that binds to the MHC molecule and recognized by
T-cells?
a) Immunoglobulin
b) Agretope
c) Epitope
d) Chaperone
Ans : b
- 42Which MHC molecule recognizes CD8 TC cells?
a) MHC I
b) MHC II
c) MHC III
d) HLA-C
Ans : a
-43Mark the one, which is NOT a lymphoid progenitor cell.
a) Monocyte
b) B-cell
c) T-cell
d) NK cells
Ans : a
-44What is the origin of B-cell?
a) Pancreas
b) Liver
c) Thymus
d) Bone marrow
Ans : d
-45Chediak-Higashi syndrome is caused due to deficiency of:
a) Nutrophils
b) Nk cells
c) Basophils
d) Mast cell
Ans : b
ALI ALMOMANI
-46Which of the following is NOT polymorphonuclear leukocytes?
a) Eosinophils
b) Mast cell
c) Macrophages
d) Basophils
Ans : c
-47Which of the following cells has a high affinity receptor for IgE?
a) Dendritic cell
b) Mast cells
c) Eosinophils
d) Basophils
Ans : d
-48Name the molecule which constitutively expressed on the dendritic cell?
a) Class I MHC
b) Class II MHC
c) APC
d) Antigen
Ans : b
-49Name the dendritic cell, which does not function as antigen presenting cell?
a) Follicular dendritic cell

b) Langerhans cell
c) Myeloid dendritic cell
d) Lymphoid dendritic cell
Ans : a
-50Which of the tracing is NOT the role of T-cell receptor complex?
a) α and β chain
b) CD3
c) CD19
d) CD40L
Ans : c
-51Name the syndrome occurs in children due to deficiency of the thymus.
a) Acromegaly
b) Gigantism
c) Cushing syndrome
d) DiGeorge syndrome
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Ans : d
-52Which of the following steps is NOT involved in the activation of T-cell?
a) Double positive cell converts to single positive T-cell

b) Foreign peptide bound to MHC provide signals
c) CD28 of TCR interacts with B7 of APC
d) CD23 has ITAM, which transducer signals
Ans : a
-53Name the cytokines which act as a T-cell growth factor?
a) IL-3
b) IL-2
c) IL-4
d) IL-5
Ans : b
-54Cytokinin which acts as a growth factor of B-cell is
a) IFNγ
b) IL-10
c) IL-13
d) TNFβ
Ans : c
-55Mark the correct role of cytosolic T-cells.
a) Help in B-cell activation

b) Produce cytotoxin
c) Proliferate T-cell
d) Kill the target cell
Ans : d
-56Which of the following acts as a coreceptor for B-cell activation?
a) CD28
b) IL-2
c) IgA
d) CD19
Ans : d
-57Mark the one which is NOT used in generating antibody diversity?
a) Combinatorial V(D)J joining

b) Juntional and insertional diversification
c) Somatic hypermutation
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d) Binary fission
Ans : d
-58What is the name of the hypervariable region of immunoglobin, which is responsible for
its diversity?
a) CDR
b) Hinge region
c) Epitope
d) Agretope
Ans : a
-59Innate immunity present since birth and it has no memory.
a) True
b) False
Ans : a
-60Which of these is NOT a characteristic feature of adaptive immunity?
a) Immunogenic memory
b) Antigen no-specific
c) Self/ non-self recognition
d) Diversity
Ans : b
-61A complement component which is strongly chemotactic for neutrophils is:
A- C9
B- C5a
C- C3
D- C3b
E- C5b
Ans: B
-62Acute inflammation can be initiated by:
A - Mast cell activation.

B- Influx of neutrophils.
C- An increase in vascular permeability.
D - C3.
E-Lysozyme.
Ans : A
-63Specific antibodies are readily detectable in serum following primary contact with
antigen after:
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A -10 min
B-1h
C- 5–7 days
D- 3–5 weeks
E- Only following a second contact with antigen
Ans : s
-64IgM:
A - Is usually of high affinity.

B - Is most commonly tetrameric.
C - Has the same number of constant domains as IgG.
D - Is a weak bacterial agglutinator.
E - Is the main class of the 'natural antibodies.'
Ans : E
-65The Fc receptor with the highest affinity of the following five receptors is:
A -CD64.
B -FcgRII.
C -CD16.
D -FceRI.
Ans : D
-66NK cells lack receptors with:
A -Specificity for MHC class II molecules.

B -Specificity for MHC class I molecules.
C -C-type lectin domains.
D -Immunoglobulin-like domains.
Ans : A
-67The MHC class I heavy chain consists of:
A -Beta2-microglobulin.
B -Three Ig-type domains.
C -A truncated MHC class II heavy chain.
D -Three globular domains.
E -Two globular domains.
Ans : D
-68MHC class III genes encode:
A -Complement component C3.

B -Tumor necrosis factor.
C -IL-2.
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D -Beta2-microglobulin.
Ans : b
-69Expression of MHC genes is:
A -Codominant.
B -Dominant for maternal genes.
C -Dominant for paternal genes.
D -Dependent on thymic selection.
Ans : A
-70Each chain of the T-cell receptor consists of:
A -An Ig heavy chain.

B -Two Ig-type domains.
C -A fibronectin-type domain.
D -Glycolipid molecules.
Ans : B
-71In class I MHC pathway of antigen presentation , peptides generated in cytosol are
transported to endoplasmic reticulum in which of the following ways
a- By ATP-dependent transporter via TAP

b- By receptor-mediated endocytosis
c- Via the proteasome
d- Through membrane pores
Ans : A
-72Which of the following is the principal cytokine that causes increase in the expression of
class II MHC by the antigen presenting cells
a- IFN alpha
b- IFN gamma
c- IL-6
d- IFN beta
Ans : b
-73All of the following are MHC-encoded except
a- Alpha one and alpha two of MHC I

b- Alpha 3 of MHC I
c- Beta macroglobulin of MHC I
d- Ig-like molecules of both MHC types
Ans : c
-74MHC class III genes encode

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a C3.
b- Tumor necrosis factor. TNF
c- IL-2.
d- Beta2-microglobulin.
Ans : b
-75Acute inflammation characteristically involves:
A. Constriction of arterioles.
B. Capillary endothelial cell enlargement.
C. Influx of macrophages.
D. Influx of mast cells.
E. Influx of neutrophils.
Ans : E
-76Which cell type produces antibodies:
A. Macrophages
B. T-lymphocytes
C. NK
D. Plasma cells ( B- Cell )
Ans : D
-77Which of the following can be accurately called a cytokine?
A. A cell surface antigen receptor on lymphocyte

B. An antibody secreted by a B cell
C. A protein secreted by a T lymphocyte that activates a macrophage
D. A lipid secreted by a Natural Killer cell that activates a B cell
Ans : C
-78Which of the following is correct
A. Respiratory epithelium has type 1 MHC, not type II

B. Erythrocytes express type I MHC BUT not type II
C. Erythrocytes express type II MHC BUT not type 1
D.macrophages express type I MHC BUT not type II
Ans : A
-79around the central arteriole in the spleen has:
A. Macrophages
B. T Cells
C. B Cells
D. NK cells
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Ans : b
-80Defects in neutrophil NADPH oxidase system produce:
A Chronic granulomatous disease.

B Chediak-Higashi disease.
C Leukocyte adhesion deficiency.
D Hashimoto's disease.
Ans : A
-81The major factor in regulating immune system
a- Antibodyconcentration
b- Antigen concentration
c- Platelet concentration
d- I nterferon concentration
Ans : b
-82The function of the complement:
a-Stimulate phagocytosis and lysis of infected cells

b- Cross-link allergens and participate in allergic reactions
c- Phagocytosisofantigens
d- Mediate release of histamine
Ans : A
-83All of the following are correct about lymphocytes except
a- Contain large nucleus that occupies most of the cytoplasm

b- B lymphocytes can differentiate into plasma cells
c- Cytotoxic T lymphocytes can eliminate tumor cells
d- All lymphocytes are part of the adaptive immune system
Ans : d
-84A1-year-old boy with recurrent infections comes to the clinic for evaluation.He has a
history of multiple systemic fungal infections. The child was a normal home delivery and was
immunized for the usual diseases. On examination, the child has subclinical hypocalcaemia
and mental retardation. After an extensive workup, a diagnosis of DiGeorge syndrome is
made. Which immune system cells does DiGeorge syndrome directly affect?
A- Blymphocyte
B- Tlymphocyte
C- Macrophage
D- Dendritic cell
E- Langerhans cell
Ans : b
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-85The immunoglobulin that can bind to the Fc epsilon receptor on cell surfaces and is most
commonly implicated in medical conditions such as allergy, asthma, and anaphylactic shock
is:
A- IgA
B- IgG
C- IgM
D- IgE
Ans : d
-86Which of the following is true about peripheral T-cell tolerance?
A- Antigen given by mouth provokes a greater response than antigen given by injection.
B- The kidneys are immune-privileged sites.
C- Repeated exposure to the same antigen leads to an incrementally large rresponse.
D- Costimulation is required for an immune response.
Ans : d
-88Which of the following is characteristic of the innate immune system?
A- Each receptor binds one specific organism.

B- It responds slowly the first time it recognizes a given invading pathogen.
C- It responds equally rapidly each time it recognizes a given pathogen.
D- It has memory for pathogens.
Ans : c
-89Which of the following is true about immunoglobulin M?
A- It has a dimeric structure.

B- It is small enough to enter tissues and cross the placenta.
C- It is secreted invthe gut.
D- It is produced early in an immune response.
Ans : d
-90A16-year-old boy is injured while playing football.He does not remember the last time
he had a tetanus shot, so the attending physician administers a tetanus toxoid vaccine. This
kind of immunity would be best classified as:
A- Naturalactive
B- Naturalpassive
C- Artificialactive
D- Artificial passive
E- Acquired passive
Ans : c
Dr. Ibrahim Mahmoud Infinity Academy
IMMUNOLOGY
Mid | Questions
1. Which of the followings represent the best example of naturally acquired active immunity
that convey the longest immunity to the host:
a. Vaccine
b. Colostrum milk
c. Infection with a MO that cause disease and then recovery
d. Intravenous Ig
2. Which of the following substances stimulate immune response only if they are bound to
larger molecules:
a. Viruses
b. Proteins Ag
c. Hapten
d. All of the above
3. B and T cells in Adults are produced by stem cells that are formed in:
a. Bone marrow
b. liver
c. spleen
d. lymph nodes
4. The antigenic determinant of an Antigen is called:

a. Epitopes
b. Idiotypes
c. Isotypes
d. CDRs
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5. Which of the following immune components are most effective at destroying intracellular
pathogens?
a. B cells
b. Antibodies
c. Complements
d. Cytotoxic T cells
6. All of the followings participate in protection at body surfaces, except:

a. Salivary amylase
b. Gut microflora
c. Mucus
d. Skin
e. Gastric acidity
7. Acute inflammation characteristically involves:

a. Constriction of arterioles
b. Early influx of macrophages
c. Influx of mast cells
d. Influx of neutrophils
8. Which of the followings is correct about MHC:

a. Respiratory epithelium has class I MHC only
b. Erythrocytes have class I MHC but not class II
c. Erythrocytes have Class II MHC but not Class II
d. Macrophages have class I MHC only
9. Immunological unresponsiveness to self-antigens is called:

a. Memory
b. Tolerance
c. Autoimmune diseases
d. ADCC
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10. Which of the followings is correct about Interferons:

a. Are found only in mammalian species
b. Only affect infected cells
c. Are viral-specific
d. None of the above is true
11. Specific antibodies are detectable in serum following primary contact with antigen after:
a. 1 h
b. 5–7 days
c. 3–5 weeks
d. Only following a second contact with antigen
12. Which of the following is correct regarding clonal selection hypothesis?

a. Lymphocyte specificity is determined by exposure to antigen
b. Clones of lymphocytes specific for antigens develop prior to exposure to the antigens
c. Antigen binding to a lymphocyte receptor selects that lymphocyte to die
d. Each clone of lymphocytes express receptors for many different antigens
13. Major basic proteins are found in:

a. Neutrophils
b. Eosinophils
c. NK Cells
d. Macrophages
14. Which of the following cells is located around arterioles in spleen (periarteriolar):
a. B lymphocytes
b. NK cells
c. T lymphocytes
d. Dendritic Cells
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15. All of the following are related to the adaptive immune system, except:
a. Distinguish self from none-self
b. Rarely malfunction
c. Specific
d. Antigen recognition molecules
e. Pattern recognition molecules
f. B + E
16. Which of the following immunodeficiency causes the patient to be susceptible to Neisseria
Organisms:
a. B lymphocytes defect
b. Early complement components defect
c. T lymphocytes defect
d. Late complement component defect
e. Phagocyte defect
17. Extracellular microorganisms are optimally eliminated by:

a. Macrophages only
b. Complement only
c. Antibodies only
d. Macrophages, antibodies and complement
18. The easiest type of organ transplantation (regarding immunology) is:

a. Liver
b. Bone marrow
c. Kidney
d. Cornea
19. Differentiated B cells that produce and release large amounts of antibody are called:
a. Memory cells
b. Basophils
c. Plasma cells
d. Killer cells
e. Neutrophils
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20. The specificity of an antibody is determined by:

a. Its valency
b. The heavy chains only
c. The Fc region
d. The variable region of heavy and light chain
21. Monoclonal Ab are produced by Fusion between a plasma cell and a tumor cell, what is the
cell that is formed by this fusion?
a. Myeloma
b. Natural killer cell
c. Hybridoma
d. Lymphoblast
22. The basic structure of Ig subunit is composed of:

a. 2 identical heavy and 2 different light chains
b. 2 different heavy and 2 different light chains
c. 2 different heavy and 2 identical light chains
d. 2 identical heavy and 2 identical light chain
23. Which of the following gene segments do NOT contribute to antigen binding:
a. VL
b. CL
c. VH
d. D
e. J
24. Unmethylated cytosine & guanine sequences (CpG) binds to:

a. TLR-7
b. TLR-5
c. TLR-9
d. TLR-2
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25. Flagella of bacteria is recognized by:

a. TLR-7
b. TLR-5
c. TLR-9
d. TLR-2
26. Double stranded RNA is recognized by:

a. TLR-7
b. TLR-5
c. TLR-3
d. TLR-2
27. Single stranded RNA of viruses is recognized by:

a. TLR-7
b. TLR-5
c. TLR-3
d. TLR-2
28. LPS of gram-negative bacteria is recognized by:

a. TLR-7
b. TLR-4
c. TLR-3
d. TLR-2
29. Which of the followings is true regarding recombination of V, D and J gene segments:
a. Only occur in mature B-cells
b. Only occurs in light chains
c. Only occur in heavy chains
d. Affected by recombinase enzymes
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30. Which of the following statements about IgG is Incorrect?

a. Neutralizes bacterial toxins
b. Can fix complement
c. Crosses the human placenta
d. Opsonizes bacteria
e. Appears early in the primary immune response
31. IgA in mucus secretions:

a. Has no J-chain
b. Has no secretory component
c. Is dimeric
d. Activates the classical complement pathway
32. Regarding IgM:

a. Is usually of high affinity
b. Is most commonly tetrameric
c. Has the same number of constant domains as IgG
d. causes weak bacterial agglutination
e. the main class of “natural antibodies”
33. The T-cell receptor that bind B7 ligand on professional antigen-presenting cell is:
a. CD28
b. CD2
c. LFA-1
d. ICAM-1
e. VCAM-1
34. Regarding CD4:

a. an intracellular glycoprotein
b. Bind processed peptide
c. Bind to MHC class II on antigen-presenting cells
d. highly polymorphic
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35. Regarding Natural killer cells, which of the followings is true:

a. Are a predominant cell in adaptive immunity
b. Have the ability to kill a cell without prior sensitization
c. Unlike other cells of the immune system, do not produce cytokines
d. Kill cells that over-express class I MHC molecules, such as tumor cells
36. The first Ig heavy chain to be expressed on the surface of a newly produced B-cell is:
a. IgD
b. IgE
c. IgG
d. IgM
37. Which of the following cytokines directly increases mucus production:

a. IL-23
b. IL-13
c. IL-25
d. IL-33
38. A chromosome in which T-cell receptor alpha chain gene rearrangement has occurred lacks
which of the following gene segments:
a. Joining (J)
b. Diversity (D)
c. Variable (V)
d. Constant (C)
39. Using only random VDJ recombination, from 40 V, 30 D and 6 J gene segments, the number of
possible variable regions of an antigen receptor molecule would be:
a. 40
b. 76
c. 7,200
d. 1.4 × 106
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40. In class I MHC pathway of antigen presentation, peptides generated in cytosol are
transported to endoplasmic reticulum in which of the following ways:
a. By ATP-dependent transporter TAP
b. By receptor-mediated endocytosis
c. Via proteasome
d. By passive diffusion
41. Which of the following is the principal cytokine that causes increase in the expression of class
II MHC by the antigen presenting cells:
a. IFN alpha
b. IFN gamma
c. IFN beta
d. TNF
42. Which of the following is a human class I MHC molecule:

a. CD8
b. HLA-B
c. HLA-DR
d. HLA-DP
43. MHC genes present on chromosome:

a. 1
b. 6
c. 13
d. X
44. The required number of complexes of a microbial peptide and a particular class II MHC allele
on the surface of an APC to initiate a cell response specific for the viral peptide is:
a. only One
b. All the MHC molecules on the cell must be complexed with the peptide
c. About 0.1% of the total number of class II MHC molecules on the cell surface
d. Greater than 106
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45. Which of the following statements about microbial antigen presentation is correct:
a. Class I MHC molecules display peptides derived mainly from cytosolic microbial
proteins for recognition by CD8+ T cells
b. Class I MHC molecules display peptides derived mainly from cytosolic microbial proteins
for recognition by CD4+ T cells
c. Class II MHC molecules display peptides derived mainly from cytosolic microbial proteins
for recognition by CD4+ T cells
d. Class II MHC molecules display peptides derived mainly from extracellular microbial
proteins for recognition by CD8+ T cells
e. Class II MHC molecules display peptides derived mainly from extracellular microbial
proteins for recognition by B cells
46. All of the following are MHC-encoded except:

a. Alpha 1 and alpha 2 of MHC class I
b. Alpha 3 of MHC class I
c. Beta microglobulin of MHC class I
d. Ig-like molecules of both MHC types
47. Which of the following statements about MHC polymorphism is true?

a. HLA-A, HLA-B, and HLA-C represent three different alleles of the same gene
b. Many unrelated people have identical MHC alleles
c. Only class I MHC genes are polymorphic; class II MHC genes are not.
d. Most of polymorphic residues in MHC are located in the peptide binding groove
e. MHC polymorphism is a result of somatic recombination
48. The enzyme that break the Immunoglobulin into 2 identical Fab & 1 Fc is:
a. Papain
b. Pepsin
c. VDJ recombinase
d. Caspases
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49. The enzyme that break the Immunoglobulin into 1 bivalent F(abʹ)2 fragment & peptide
fragments of Fc is:
a. Papain
b. Pepsin
c. VDJ recombinase
d. Caspases
50. Which of the followings is MHC-encoded:

a. C3
b. Tumor necrosis factor (TNF)
c. IL-2
d. Beta2-microglobulin
51. c-Kit is an example of:

a. non-receptor tyrosine kinase
b. Receptor tyrosine kinases (RKT)
c. G protein-coupled receptors “seven transmembrane”
d. Notch receptors
52. Chemokines receptors are example of:

d. Notch receptors
53. Integrin receptors are example of:

d. Notch receptors
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54. Which of the followings is Incorrect:

a. CD8 binds class 1 HLA
b. CD4 binds class 2 HLA
c. B7 binds to CD44
d. Zeta (CD247) chain has three ITAMs
55. The major molecules responsible for rejection of transplant is:

a. B cells
b. T cells
c. MHC molecule
d. Antibodies
56. The Most important growth promoting cytokines produced early in the first 2-4 hours after
activation is:
a. IL-12
b. IL-4
c. IL-5
d. IL-2
57. Th17 cells are associated with which of the following WBCs:
a. Dominated by neutrophils & some eosinophils
b. Dominated by neutrophils & some monocytes
c. Eosinophils
d. Macrophages
58. All of the followings are functions of TH1 cells except:

a. Activation of macrophages through CD40L-CD40 binding
b. Activation of macrophages through IFN gamma
c. Direct killing & destruction of phagocytosed intracellular MO
d. T cell-dependent activation of B cells
e. Classical macrophage activation
12 | P a g e
59. Which of the following markers identifies activated memory cells:

a. CD8
b. CD3
c. CD4
d. CD45R0
e. CD45RA
60. The source of Ab flexibility is:

a. C domain of heavy chain
b. V domain heavy chain
c. C domain of light chain
d. V domain of light chain
e. Hinge region
61. Which of the following cytokines produced by TH1 & inhibit its action:
a. IL-10
62. The effect of CCR7:

a. Proliferation
b. Migration
c. Activation
d. Maturation
63. All of the following are related to BCR, except:

a. CD247
64. Which of the followings is the most important in allergic diseases:

a. IL-4
b. IgG
c. IL-17
d. IL-6
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65. Antigens are delivered to the secondary lymphoid tissues (spleen, lymph nodes) via:
a. αβ T cells
b. γδ T cells
c. Macrophages
d. Dendritic cells
66. Which of the followings activate macrophages to kill intracellular bacteria and stimulates IgG
production?
a. TH1 cell subset
b. TH2 cell subset
c. TH17 cell subset
d. CTL
67. What is the histological site of double negative (DN) T lymphocytes in thymus:
a. Cortex zone
b. Subcapsular zone
c. Medullary zone
d. Paracortical zone
68. What is the immunologic consequence of mutation in CD40L (CD154)?

a. Acquired immune deficiency syndrome (AIDS)
b. X-linked hyper-IgM syndrome
c. Systemic inflammatory response syndrome (SIRS)
d. X-linked agammaglobulinemia
69. False about cytokines of immune system:

a. Cytokines of adaptive system are secreted in very low level
b. IL-2 is secreted for 8 hours and has both autocrine and paracrine effects
c. IL-1 is secreted in high level and has endocrine effect
d. IL-10 level fall at the end of the immune response
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70. All of the following are non-receptor tyrosine kinase except:

a. TCR
b. some cytokine receptors
c. BCR
d. platelet-derived growth factor receptor
e. Integrin receptors
71. All of the following are example of MHC class II gene loci, except:
a. HLA-DP
b. HLA-DQ
c. HLA-DR
d. HLA-A
e. HLA-DM
72. Which one of the following statements is correct regarding MHC:

a. Class II is important for antigen recognition by B cell receptor
b. Not important in organ transplantation
c. MHC molecules should be identical in blood transfusion between two persons
d. It is inherited as a block called haplotype
e. Class III MHC is important in antigen presentation to T cells
73. A marker of NKT & NK:

a. CD56
74. All are functions of IL-5, except:

a. stimulates growth of eosinophils
b. activates mature eosinophils
c. stimulates production of IgA antibodies
d. stimulates production of IgE antibodies
e. stimulates differentiation of eosinophils
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75. All these mechanisms are used for processing of extracellular antigens except:
a. Phagocytosis
b. endocytosis
c. Exocytic vesicle
d. Invariant chain
e. Proteasome
76. Important for the second signal to T helper cells:

a. TCR
b. LFA-1
c. CD28
d. CD40
e. CD3
77. X-linked hyper-IgM syndrome is a result of defect in:

a. CD40L (CD154)
b. CD40
c. CD3
d. BCR
78. A surface marker of pluripotent stem cell:

a. CD34
b. CD44
c. A + B
79. The supramolecular cluster of receptor-ligand on surface of contacting T cell and APC is called:
a. Hybridization
b. Conjugation
c. Immunological synapse
d. Immunological groove
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80. Immune deficiency with tetany due to hypocalcemia:

a. Di-George syndrome
81. The HLA gene sequences of two unrelated individuals are unlikely to be the same. Which one
of the following is correct?
a. There is a very high rate of mutation of the HLA genes during fetal life
b. HLA genes are polymorphic
c. HLA gene segments are recombined
d. There is a high rate of mutation of the HLA genes in the bone marrow
e. During meiosis, HLA genes mutate
82. Which of the following statement is true of TH1 cells:

a. TH1 cells secrete IL-4
b. TH1 cells help induce IgE production by B cells
c. TH1 cells simulate Eosinophil activation
d. TH1 cells secretes interferon gamma
83. Nuclear protein AIRE is involved in:

a. Negative selection of T cells
b. Positive selection of T cells
c. Negative selection of B cells
d. Positive selection of B cells
84. Which of the following statement is true about TH2 cells:

a. TH2 cells secrete IL-4 & IL-10
b. TH2 cells secrete GM-CSF
c. TH2 cells are responsible for cytotoxic T cell activation.
d. None of the above statements are true
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85. HLA-B35 and HLA-A2 refer to:

a. 2 alleles found in 1 locus on chromosome 6
b. 2 alleles found in 2 loci on chromosome 6
c. All of the above
d. None of the above
86. MHC class I and MHC class II:

a. Constitutively expressed by most cells
b. Expressed by macrophage and dendritic cells
c. Constitutively associated with Hapten
d. Express INF gamma
87. Properdin complement pathway (alternative pathway) include all of the following except:
a. Factor B
b. Factor D
c. C1q
d. C3b
e. C9
88. TCR alpha chain gene segment involve all of the followings, except:
a. L gene segment
b. V gene segment
c. D gene segment
d. J gene segment
89. In the early stage of a primary immune response, dendritic cells present antigen to helper T
cells. In this process, to which protein are antigen peptides are bound?
a. Membrane IgM & IgD
b. IgG bound to plasma membrane FcRγ receptor.
c. IgE bound to plasma membrane FcRε receptor
d. Class I MHC
e. Class II MHC
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90. The T-cell receptor antigen recognition signal is transduced by:

a. The TCR alpha chain.
b. The TCR beta chain
c. CD2
d. CD3
91. Expression of MHC genes is:

a. Codominant
b. Dominant for maternal genes
c. Dominant for paternal genes
d. Dependent on thymic selection
e. Dependent on the antigenic exposure of the individual
92. NK cells lack receptors with:

a. Specificity for MHC class I molecules
b. Specificity for MHC class II molecules
c. C-type lectin domains
d. Ig-like domains
e. Specificity for the Fc region of IgG
93. Has no role in lymphocyte recirculation:

a. LFA-1
b. VLA-4
c. MADCAM
d. CD62L
e. CD70
94. Heavy chain genes rearrangement of TCR happens in:

a. Pro-T cell
b. Pre-T cell
c. Immature T cell
d. Naïve T cell
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95. The percentage of human peripheral blood T-cells bearing a gamma delta T-cell receptor is:
a. 30 - 80%
b. 1 - 5%
c. 100%
d. 0%
96. Not found on mature resting T cell:

a. CD5
b. CD2
c. CD3
d. MHC I
e. MHC II
97. Extensive allelic polymorphism found in MHC:

a. DR
b. DQ
c. DP
d. A
e. C
98. All of the followings participate in protection against helminths infections, except:
a. IgE
b. Mast cells
c. Eosinophils
d. TH2
e. TH17
99. All of the followings are receptors of macrophages, except:

a. TLR
b. CR1
c. Fc gamma receptor
d. Chemokine receptors
e. CD4
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100. Human MHC gene are found on:

a. Chromosome 6
101. Which one of the following is the most professional antigen presenting cell:
a. Neutrophils
b. Dendritic cells
c. Mast cell
d. B cell
102. Herpes virus evade the immune response by decreasing MHC expression, which of the
followings is the most important in fighting herpes virus:
a. Cytotoxic T cells
b. Macrophages
c. NK cells
d. Neutrophils
103. Which of the following diseases occurs with the absence of thymus & hypocalcemia and
tetany?
a. Di-George syndrome
b. Severe combined immunodeficiency disease (SCID)
c. Chronic granulomatous disease (CGD)
d. Bare lymphocyte syndrome (BLS)
e. Wiskott Aldrich syndrome (WAS)
104. Which of the following diseases affect neutrophils:

a. Severe combined immunodeficiency disease (SCID)
b. Chronic granulomatous disease (CGD)
c. Bare lymphocyte syndrome (BLS)
d. Wiskott Aldrich syndrome (WAS)
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105. A child presents with a maculopapular rash on extremities and trunk. Petechiae is found
on the trunk and mucous membranes. Lab tests show a Neisseria infection and the physician
is concerned about meningococcemia. Which of the following is the most likely?
a. C3 deficiency
b. C5-C9 deficiency
c. Leukocyte adhesion deficiency (LAD)
d. Hyper IgM syndrome
106. Hematopoietic stem cells & progenitor cells look similar under light microscope:
a. True
b. False
107. M cell is:

a. A mucosal B cell that secretes IgM
b. Lamina propria macrophages that ingest bacteria
c. Alveolar macrophage that secrete surfactant
d. Specialized intestinal epithelial cells that transport antigens into Peyer's patches
e. Intestinal dendritic cell that make T cells tolerate food antigens
108. Functionally similar to Membrane attack complex (MAC):

a. Perforin
109. Important for homing of lymphocytes to lymph node:

a. CCR7
110. A patient presents in the winter months with swollen lips. Uncontrolled activation of
classical complement pathway is responsible for the swelling. Records show the patient has
C1 inhibitor deficiency. Which of the following does this patient have?
a. C5-C9 deficiency
b. Hereditary angioedema
c. Severe combined immunodeficiency disease (SCID)
d. C3 deficiency
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111. A major function of TH1 cells is to activate macrophages. Which molecules expressed by
TH1 cells are essential for this function:
a. IL-1 and TNF
b. CD8 and Fas ligand
c. IL-17 and NO
d. IFNγ and CD40 ligand
e. IL-4 and ICOS
112. Autoimmune lymphoproliferative syndrome is caused by:

a. Mutation in Fas mediated apoptosis
113. Activated macrophages perform all of the following functions EXCEPT:

a. Production of lysosomal enzymes & ROS to kill phagocytosed microbes
b. Presentation of antigen to helper T cells
c. Secretion of inflammatory cytokines such as tumor necrosis factor and IL-1
d. Production of nitric oxide, which helps kill microorganisms
e. Inhibition of fibroblast proliferation and angiogenesis within damaged tissues
114. Increase in acute phase reaction, except:

a. C3 & C4
b. a1 antitrypsin & haptoglobin
c. Fibrinogen
d. IL-10
115. All of the followings are related to NK cells, except:

a. Perforin
b. Interferon gamma
c. CD16
d. Phagocytic cell
116. All of the following can be performed by the Ab and doesn’t need complement, except:
a. Neutralization of toxins
b. Prevention of MO attachment at mucosal sites
c. Formation of MAC to destroy the MO
d. All of the above need complements
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117. Which of the following is Wrong regarding collectins:

a. Lectin head binds glycolipids or glycoproteins on pathogen
b. Lectin head binds glycolipids or glycoproteins on dying cells
c. Required in APCs for degradation & presentation of pathogens
d. Part of the adaptive immune system
118. All of the following gene segments contribute to Light chain of Ig, except:
a. L segment
b. V segment
c. D segment
d. J segment
e. C segment
119. Respiratory (oxidative) burst enzymes, include:

a. NADPH produce hydrogen peroxide
b. Myeloperoxidase produce hypochlorous acid
c. Inducible Nitric oxide synthase produce Nitric oxide
d. All of the above
120. Which of the following is the mechanism where a cytokine produced by TH2 cells
contributes to atopic disease (allergy)?
a. IL-17 stimulates TNF production by macrophages
b. IL-5 induces basophil degranulation
c. IL-13 activates eosinophils
d. IL-4 induces B cell class switching to IgE
e. IL-22 causes mast cell degranulation
121. Alternative macrophage activation is characterized by which one of the following?

a. Reactive oxygen species (ROS) generation
b. IL-1 production
c. IL-10 and TGFβ secretion
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122. The correct sequence of rearrangement of TCR & BCR gene segment is:
a. (D) to J, then V to (D)J
123. Which pair of molecules are found in cytotoxic T lymphocyte (CTL) granules and are
important for CTL killing of target cells?
a. Perforin and Fas ligand
b. P-selectin and tumor necrosis factor
c. Major basic protein and granzyme
d. C9 and IFNγ
e. Perforin and granzyme
124. Membrane attack complex (MAC) include all of the followings, except:
a. C3
b. C6
c. C7
d. C8
e. C9
125. Which subset of T cells is most likely to promote acute neutrophilic inflammatory
responses that defend against extracellular bacteria and fungi:
a. TH1
b. TH2
c. TH17
d. CTL
126. TdT expression during T lymphocyte development occurs mostly at:

a. Pro-T cell
b. Pre-T cell
c. Immature T cell
d. Mature T cell
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127. Administration of human immunoglobulin containing anti–rabies virus antibodies is an

example of:
a. Active humoral immunity
b. Passive humoral immunity
c. Active cell-mediated immunity
d. Passive cell-mediated immunity
128. IL-5 stimulates the production of:

a. Mast cells
b. Eosinophils
c. Basophils
d. Macrophages
129. Which of the followings is correct regarding CRP:

a. CRP production by liver increased by TNF
b. CRP act as opsonin and stimulate phagocytosis
c. CRP activate complement through lectin pathway
d. all of the above is true
130. All of the followings present on APC, except:

a. B7-1
b. B7-2
c. CD40
d. TNF Receptor
e. CD40L
131. Which of the followings is a surface receptor specific for B cells:

a. CD34
b. CD19
c. CD4
d. CD8
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132. Plasmacytoid Dendritic cells mainly secret:

a. TNF
b. IL-4
c. Type I interferons
d. IL-17
133. Which of the following is not of a myeloid origin:

a. Eosinophils
b. Neutrophils
c. NKT cells
d. Mast cells
134. Acute phase reactant product:

a. IL-6
b. IL-1
c. CRP
d. TNF
135. Stimulate the liver to produce acute phase reactant, except:

a. IL-6
b. IL-1
c. CRP
d. TNF
136. Which of the following can be accurately called a cytokine?

a. Cell surface antigen receptor on lymphocyte
b. An antibody secreted by a B cell
c. A protein secreted by a T lymphocyte that activates a macrophage
d. A lipid secreted by a Natural Killer cell that activates a B cell
e. A nuclear protein that regulates lymphocyte gene expression
27 | P a g e
137. The mechanism that determine that a double positive T cell will become CD4 or CD8
(coreceptor commitment) includes:
a. Stochastic (Probabilistic)
b. Instructional (depending on binding of MHC)
c. A + B
138. Which of the followings is the enzymatic part of C3 convertase in the alternative pathway:
a. Factor B
139. Which of the following displays lipid antigens for recognition by NKT cells?
a. CD1
b. CD3
c. MHC II
d. MHC I
140. What is the function of alternative Macrophages activation:

a. Phagocytosis
b. Antigen presentation to T helper cells
c. Antibody dependent cell mediated cytotoxicity
d. kill microbes
e. Tissue Remodeling & repair
141. A common marker between T reg & Helper T cells:

a. CD4
142. Type III Hypersensitivity result from:

a. Deficiency in early lectin & classical complement pathways
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143. Regarding oral tolerance, all of the followings are true except:
a. T suppressor cells produce IL-10 & TGF-b
b. Most of intraepithelial cells are of T cells of γδ T cells subtype
c. γδ T cells subtype has limited diversity
d. Majority of γδ T cells are derived from bone-marrow-derived HSC
144. Signal transduction in BCR complex is the function of:

a. CD3
b. Zeta chains
c. Ig alpha & Ig beta
d. CD4
145. Signal transduction in TCR complex is the function of:

a. CD3
b. Zeta chains
d. CD4
e. A + B
146. Types 1 Interferons mostly affect:

a. Viruses
147. Which of the following cells can induce a very strong apoptotic signal in their target cells:
a. TH1 cells
b. TH17 cells
c. Cytotoxic T cell
d. B lymphocyte
148. Chronic granulomatous disease is diagnosed by:

a. Negative (abnormal) NBT test (Nitro-blue tetrazolium)
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149. Which fraction of the serum protein electrophoresis contain most of the immunoglobulin?
a. Alpha wave
b. Beta wave
c. Gamma wave
150. All of the following molecules contain ITAMS, EXCEPT:

a. CD3
b. Zeta chains
d. TCR beta chain
151. Which of the following processes that represent TdT role in adding more diversity of
specificity of antibodies:
a. Recombination
b. Allelic exclusion
c. Junctional diversity
d. All of the above
152. An example of secreted pattern recognition molecule:

a. Mannan binding lectin (MBL)
153. a plasma cell secretes:

a. Antibody of a single specificity related to that on the surface of the parent B-cell
b. Antibody of two antigen specificities
c. The antigen it recognizes
d. Many different types of antibody
e. Lysozyme
154. Which of the following is not part of class II MHC:

a. Ubiquitin
b. Invariant chain
c. HLA-DM
d. Cathepsin
30 | P a g e
155. Which one of the molecules is responsible for exit the lymphocytes from the lymph node:
a. S1PR1
b. Integrins
c. selectins
d. Immunoglobulins
156. All of the followings are inhibitor\regulator of the complement system, except:
a. Factor H & Factor I
b. Factor D
c. C1 inhibitor
d. Decay-accelerating factor (DAF)
157. Opsonin:
a. Facilitate phagocytosis by binding to the surface of MO
158. The most specialized macrophage is:

a. Giant cells
b. Tissue macrophages
c. Alveolar macrophages
d. Glial cells
e. Osteoclasts
159. Which one of the following cytokines is a chemokine:

a. IL-6
b. IL-1
c. IL-8
d. IL-2
31 | P a g e
160. Which one of the following is responsible for moving the lymphocytes from the blood to
the lymph node:
a. Efferent lymphatic vessel
b. Afferent lymphatic vessels
c. High endothelial venule
d. CD44
161. Has a role in recruitment of PMN to site of infections:

a. IL-17
b. IL-8
c. TNF & IL-1
d. All of the above
162. An example of a lymphocyte that hasn’t been exposed to antigen is:

a. Memory lymphocytes
b. Effector lymphocytes
c. Naïve T lymphocytes
d. Plasma cells
163. IL-1 causes fever in acute phase of inflammation by affecting the hypothalamus. How?
a. Increase prostaglandin production
164. Least common WBCs in the peripheral blood:

a. PMN
b. Lymphocytes
c. Eosinophils
d. Monocytes
e. Basophiles
165. The WBC that is never seen in peripheral blood:

a. Mast cell
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166. All of the following are correct about acquired immunity except:
a. Antigen specific
b. Immediate & rapid response after antigen exposure
c. Antigen dependent
d. Immunological memory
e. Discriminate between self and none-self
167. Deficiency of early complements (C3) causes:

a. Systemic lupus erythematosus (SLE)
b. Hyper IgM syndrome
c. X-linked agammaglobulinemia
d. Severe Combined Immunodeficiency (SCID)
168. Only in alternative complement pathway:

a. Factor D & Factor B
169. Deficiency of NADPH oxidase result in:

a. Hyper IgM syndrome
b. X-linked agammaglobulinemia
c. Severe Combined Immunodeficiency (SCID)
d. Chronic granulomatous disease (CGD)
170. Positive and negative selection occurs in:

a. Double negative T cells
b. Double positive T cells
c. Single positive T cells
d. Naïve T cells
171. The differentiation and maturation of lymphocytes in bone marrow will be activated by:
a. MHC
b. Positive and negative control
c. Cytokines hormones
d. DNA rearrangement
33 | P a g e
172. A complement and an opsonin:

a. C3b & C3d
b. C5a
c. C5b
d. C1 inhibitor
173. A complement and chemotactic factor:

a. C3a, C4a, C5a
174. Which one of the following is a primary immune organ:

a. Lymph node
b. Thymus
c. Spleen
d. Long bone cortex
175. White and red pulp is a histological characteristic of:

a. Thymus
b. Lymph node
c. Spleen
d. All of the above
176. Which of the following does NOT interfere with the regulation of c3b convertase?
a. Factor S
b. factor I
c. factor B
d. DAF (decay accelerating factor)
177. Which of the following is wrong about properdin?

a. It's the only known positive regulator of complement activation
b. It stabilizes C3 convertase of the classical pathway
c. Properdin deficiency is a rare X-linked disease
d. Properdin deficiency results in the lack of opsonization
34 | P a g e
178. Which of the followings is dependent & linked to the adaptive immune system:
a. Classical pathway for complement activation
179. All of the followings are common features of NK & macrophages, except:
a. Non-specific
b. Innate system
c. Antigen presenting cell (APC)
d. Perforin
e. C + D
180. J chain present in:

a. IgG
b. IgD
c. IgE
d. IgM & IgA
181. Stimulates hematopoiesis:

a. IL-5
b. IL-4
c. G-CSF & GM-CSF
d. IFN gamma
182. All of the followings are related to immune response against intracellular pathogens,
except:
a. Interferons
b. TH1 cells
c. NK cells
d. Cytotoxic T cells
e. TH2 cells
35 | P a g e
183. All of the followings are correctly matched except:

a. CD69 and S1PR1
b. CD44 and hyaluronan
c. CTLA4 and B7
d. CD28 and B7
e. IL-4 and TH1
184. Which of the followings protect the cell from Respiratory (oxidative) burst enzymes:
a. Catalase
185. The correct order of anaphylatoxin strength is:

a. C5a > C3a > C4a
b. C4a > C3a > C5a
c. C3a > C4a > C5a
d. C5a > C4a > C3a
186. Class I MHC is found on all human cells & platelets except:
a. RBCs
187. Which of the followings represent a Pattern recognition receptor:

a. LPS
b. DAMP
c. MBL
d. Unmethylated CpG sequences
188. Common between TCR & BCR genes:

a. Found as gene segments
189. Important inhibitory cytokine for downregulation of immune response:

a. IL-8
b. IL-1
c. IL-10
d. TNF
36 | P a g e
190. All of the followings are specific immune responses except:

a. Adaptive immunity
b. Passive Immunity
c. Acquired immunity
d. Innate immunity
191. Intracellular MO within macrophages are killed more readily in the presence of:
a. IgG
b. Properdin
c. IFN gamma
d. Anaphylatoxin
192. The secondary, but not the primary, immune response is based on:
a. The bonus effect of multivalency
b. Complement activation
c. Mast cell degranulation
d. Memory
e. Clonal selection
193. Correct about the complimentary determining regions (CDR):

a. Restricted to light chain
b. Found only in the constant region of Ig
c. Bind to Fc receptors
d. Concerned with Antigen binding
e. Occurs at the C-termini of the Ig peptide chain
194. A common structure between BCR and TCR that can be found in other molecules:
a. Immunoglobulin domain
195. Ig idiotypes are found in:

a. Constant region of heavy chain
b. Constant region of light chain
c. Hinge region
d. Variable region of both heavy and light chains
37 | P a g e
196. The Fab region of Ig is responsible for:

a. C1q fixation
b. Binding to antigen
c. Binding to Fc receptors
d. Binding to macrophages
e. The ability of Ig to cross the human placenta
197. Complement receptor on RBCs for clearance of Ab-Ag complexes is:

a. CR1
b. CR2
c. CR3
d. CR4
198. Lymphocyte circulation is __________ in comparison to RBCs:

a. Active
199. The MHC class I heavy chain consists of:

a. Beta2-microglobulin
b. Three Ig-type domains
c. A truncated MHC class II heavy chain
d. Three globular domains
e. Two globular domains
200. Not of myeloid origin:

a. Eosinophils
b. Basophiles
c. Neutrophils
d. Natural killer
38 | P a g e
201. The MHC class II region genes in the mouse are located:
a. On a different chromosome to the class I region genes
b. On a different arm, but on the same chromosome as the class I region genes.
c. On chromosome 6.
d. Adjacent to a class I gene
202. MHC class III genes encode:

a. Complement component C3
b. Tumor necrosis factor
c. IL-2
e. HLA-DQ
203. Extensive allelic polymorphism is found in MHC:

a. DR beta
b. B DR alpha
c. beta2-microglobulin
d. Class I alpha3 domain
e. Class II beta2 domain
204. TCR is:

a. Homodimer
b. Heterodimer
c. heterotrimer
d. single polypeptide chain
205. All of the followings are functions of complements, except:

a. Opsonization
b. Anaphylatoxin
c. Stimulate B cells by CR2
d. Stimulate cytotoxic T cells by CR1
e. Clearance of immune complexes
f. Mast cell degranulation
39 | P a g e
206. Each chain of T-cell receptor consists of:

a. An Ig heavy chain
b. Two Ig-type domains
c. A fibronectin-type domain
d. Glycolipid molecules
e. Four Ig-type domains
207. Antibody dependent cellular cytotoxicity (ADCC) by NK cells using IgG depend on which
receptor:
a. FcyRIII (CD16)
208. The intermolecular forces which contribute to the interaction between antibody and
antigen are:
a. electrostatic
b. van der Waals
c. hydrophobic
d. hydrogen bonds
e. a combination of the above
209. Which of the following statements is Wrong about affinity?

a. A measure of the strength of binding of antigen to antibody
b. The association constant of Ag/Ab equilibrium
c. Same as Avidity
d. Related to the free energy change of Ag/Ab interaction
e. Related to specificity
210. The site for B lymphocyte maturation is:

a. Bone marrow
b. Thymus
c. MALT
d. NALT
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211. The antigen moiety on APC that is recognized by alpha-beta TCR is:
a. The native protein antigen plus MHC
b. Processed antigen peptide plus MHC
c. Processed peptide only
d. Native protein antigen only
e. MHC alone
212. Common surface markers for stem cells & pro cells:
a. CD43
213. Positive selection:

a. Survival of T cells that bind self MHC
214. Negative selection:

a. Apoptosis of T cells that bind self Ag with strong affinity
215. Processing of cytosolic proteins involves which of the followings:

a. Transport into late endosomes
b. Proteasome mediated cleavage
c. Displacement of invariant chain
d. Displacement of beta2 microglobulin
e. Binding to MHC class II groove
216. The deep layer of keratinocyte secrets ________ upon injury:

a. IL-8 & TNF
217. The first phase of adaptive immune response is:

a. Cognitive phase
b. Activation phase
c. Effector phase
d. Clonal expansion
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218. Antigen processing for presentation by MHC class II involves:

a. LMP-2
b. Tap 1 & Tap 2
c. Proteasome mediated cleavage
d. HLA-DM
219. The processes peptide binding to the MHC class I groove:

a. Usually more than 11 AA long
b. Hangs over the end of the groove
c. Bind to the groove through 2 anchor residues
d. Mainly recognized by CDR2 of TCR
e. Derived from exogenous protein taken by endocytosis
220. TCR recognition of peptide-MHC class II depends on:

a. Covalent binding.
b. Very high affinity interactions
c. CDR-mediated binding
d. A minimum of 2 peptides occupying the binding groove of each MHC molecule
e. The presence of beta2 microglobulin
221. Regarding CD1, which of the followings is correct:

a. Is MHC encoded
b. Structurally similar to MHC class II molecules
c. Can present antigens to gamma delta, but not alpha beta T-cells
d. Can present lipid antigens
e. Is encoded by a single gene
222. The most important complement that is shared by all complement activation pathways is:
a. C3
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223. Alpha beta T-cells recognizing MHC plus processed peptide can:
a. produce antibody by themselves to directly eliminate extracellular organisms
b. Release histamine
c. Scavenge unwanted metabolic products
d. Directly kill viruses
e. Recognize an intracellular infection
224. An epitope:
a. the area on an antigen that contacts antibody
b. the area on an antibody which contacts antigen
c. Requires both antigen-binding arms of the antibody molecule for its recognition.
d. usually composed of a linear sequence of amino acids.
e. usually associated with a concave region of the antigen
225. Alpha beta T-cell receptors recognize:

a. Native antigen.
b. Free linear antigenic peptide
c. MHC beta2-microglobulin
d. Linear antigen peptide in the MHC groove
e. Lipid and glycolipid antigens associated with the MHC
226. Correct regarding secondary immune response, except:

a. Faster
b. Produce more memory cells
c. Produce more Ab
d. Produce IgM
227. Peptides produced by processing of cytosolic proteins:

a. Generated in late endosomal vacuoles
b. Enter the endoplasmic reticulum by diffusion
c. Presented at the cell surface with MHC class II to CD4 T-helpers
d. Presented at the cell surface with MHC class II to CD8 cytotoxic T-cells.
e. Presented at the cell surface with MHC class I to CD8 cytotoxic T-cells
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228. Eomesodermin transcription factor is found in:

a. CTL
b. TH17
c. TH1
d. TH2
e. NKT
229. The antibody that has no subtypes, has a very low plasma concentration, and has a
receptor on Mast cells is:
a. IgM
b. IgG
c. IgE
d. IgA
e. IgD
230. Antigenic peptides in the MHC class I groove:

a. Are usually over 12 residues in length
b. Are usually under 12 residues in length
c. Extend beyond the groove
d. Usually have 3 or more invariant anchor residues
e. Do not vary at non-anchor residues
231. Which of the followings is correct regarding the thoracic duct:

a. Enter the spleen
b. Directly drain to lymph nodes
c. Forms the interface between blood and lymph
d. Transport T cells from the bone marrow to thymus
e. Considered part of lamina propria
232. When antigen reaches a lymph node in a primed animal:

a. There is increase in output of cells in efferent lymphatics over the following 24 hours
b. There is decrease in output of cells in efferent lymphatics over the following 24 hours
c. There is an immediate output of activated blast cells
d. It is transported to the spleen
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233. The specialized cell type involved in the entry of lymphocytes into lymph nodes are called:
a. M-cells
b. Mesangial cells
c. PALS
d. HEV endothelial cells
e. P-Selectins
234. Paracortical zone of lymph node contains:

a. Dendritic cells
b. Plasma cells
c. Macrophages
d. B cells
e. T cells
235. Which of the following lymphoid tissues is unencapsulated:

a. Thymus
b. Lymph node
c. Spleen
d. MALT
236. Most important for survival of memory Cells, CD4 & CD8:
a. IL-7
237. Important only for survival of CD8 but not CD4:

b. IL-15
238. When Langerhans' cells differentiate into fully mature dendritic cells (DCs) they:
a. Downregulate CD1 expression
b. Increase their endocytic activity
c. Increase expression of B7-1
d. Decrease expression of B7-2
e. Become resistant to infection by HIV-1
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239. The germinal center is important site for:

a. Hematopoiesis
b. maturation of B cells
c. maturation of T cells
d. maturation of eosinophils
240. Lymphocytes in lamina propria produces large amounts of:

a. IgD
b. IgA
c. Gamma delta TCR
d. Isolated secretory component
241. An example of an immunological privileged site is:

a. Bone marrow
b. Skin
c. Testis
d. Lung
e. Waldeyer's ring
242. LFA-1 belongs to which family of molecules:

a. Complement receptors
b. Cytokine receptors
c. Integrins
d. Selectins
243. CD8 is a marker of:

a. B cells
b. Cytotoxic T cells
c. Hepper T cells
d. Activated macrophages
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244. Protein tyrosine kinase activity following T-cell stimulation:

a. Phosphorylates and activates phospholipase C gamma (PLC gamma)
b. Is an inherent property of the T-cell receptor alpha and beta chains.
c. Is an inherent property of CD3
d. Is unrelated to phosphorylation of the CD3-associated zeta chains
245. The early increase in phospholipase C gamma activity following T-cell stimulation:
a. Represents a sensitive regulatory negative feedback control mechanism
b. Dephosphorylates protein tyrosine kinase inhibitors
c. Accelerates hydrolysis of diacylglycerol
d. Accelerates hydrolysis of phosphatidylinositol diphosphate
e. Accelerates hydrolysis of inositol triphosphate
246. An example of Ig superfamily:

a. Membrane-bound Ig
b. TCR
c. Class I MHC
d. CD4 receptor
e. CD28 costimulatory receptor
f. ICAM-1 adhesion molecule
g. All of the above
247. The nuclear AP-1 site responsible for 90% of IL-2 enhancer activity binds:
a. The Oct – 1 transcriptional factor
b. The Fos/Jun transcription factors
c. The nuclear factor of activated T-cells (NFAT)
d. The NF-kappa B transcriptional factor
e. Polyclonal mitogenic agents such as concanavalin A
248. Hematopoietic stem cell surface marker:

a. CD34
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249. In the immunological synapse:

a. The acetylcholine receptor in expressed on the T-cell
b. Production of substance P by the antigen-presenting cell is a key event
c. The initial interaction between TCR and MHC is unstable
d. Adhesion molecule pairs eventually move to the center of the synapse
e. The B7–CD28 interaction is redundant
250. The carrier T-cell epitope on a thymus-dependent antigen:

a. Behaves like a Hapten
b. Needs to be polymeric
c. Need not be physically connected to the B-cell epitope
d. Is a carbohydrate
e. Stimulates help for the B-cell response
251. Cross-linking of B-cell surface receptors:

a. Is a characteristic feature of thymus-dependent antigens
b. Lowers the intracellular Ca+2 concentration
c. Rapidly phosphorylates Ig-alpha and Ig-beta chains of the surface Ig receptor
d. Requires contiguity of 2 B-cell epitopes of different specificity on the same antigen
molecule.
e. Cannot be achieved by anti-idiotypic antibodies
252. The TCR link to MHC class II-peptide complex is enhanced by interaction of the following
with the MHC class II:
a. LFA-1
b. CD4
c. CD8
d. CD2
253. The main xo-stimulatory signal for activation of resting T cells is provided through:
a. CD4
b. CD8
c. CD28
d. LFA-1
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254. Common surface marker for all T cells:

a. CD4
b. CD8
c. CD20
d. CD3
255. Which of the followings is the earliest step in activation of T cells signaling:
a. Activation of phospholipase C
b. Activation of protein kinase C
c. Production of inositol triphosphate
d. Activation of protein kinases
e. Mobilization of intracellular Ca+2
256. A cytokine receptor that is a member of the hemopoietin receptor family:

a. IL-8 receptor
b. IL-2 receptor
c. IL-1 receptor
d. TNF alpha receptor
257. IFN-gamma and TNF alpha can act synergistically because:

a. they downregulate expression of MHC class I
b. IFN-gamma downregulates expression of TNF receptors
c. they upregulate expression of MHC class II
d. Because they both bind to the same receptor
e. Because they cross-link IFN-gamma and TNF beta receptors
258. Dendritic cells can be activated by which ligands found on TH cells:

a. TCR
b. CD40L
c. CD28
d. B7
e. CD40
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259. Which one of the following cytokines can mediate release of acute phase proteins from
the liver?
a. IL-10
b. TGF beta
c. IL-6
d. IL-12
e. IL-8
260. Which of the following is the earliest site of hematopoiesis in the embryo:
a. Bone marrow
b. Liver
c. Spleen
d. Yolk sac
e. Thymus
261. Which of the followings is unable to bind Fc receptors:

a. Ab processed by pepsin
262. Which Ig class crosses the placenta to provide a high level of passive immunity at birth?
a. IgM
b. IgA
c. IgG
d. IgE
e. IgD
263. Which of the following molecules does not belong to the Ig superfamily:
a. Immunoglobulin
b. T-cell receptor
c. Beta2-microglobulin
d. LFA-1
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264. P-selectin pairs with:

a. LFA-3
b. LFA-1.
c. ICAM-1
d. Sialyl Lewis X
e. Beta2 integrin molecules
265. Binding of platelet activating factor (PAF) to its receptor on the neutrophil:
a. Initiates binding of neutrophils to P-selectin
b. Initiates neutrophil rolling
c. Causes histamine release
d. Upregulates LFA-1
266. Neutrophil chemotaxis is mediated by:

a. C5b
b. IL-8
c. CCL2
d. E-selectin
267. Secretory IgA protects external mucosal surfaces by:

a. Triggering mast cells
b. Recruiting phagocytic cells
c. Preventing microbial adherence to the mucosa
d. Binding to epithelial cells
e. Its secretory piece
268. The inducing and signature cytokine for TH2 cells are:
a. IL-4
269. Protection against worm infestations is particularly associated with an increase in:
a. IgA
b. IgG
c. IgE
d. IgM
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270. C3 convertase of the classical pathway:

a. C4b2a
271. C5 convertase of the classical pathway:

a. C4b2aC3b
272. The circulation of a two-month-old breast-fed baby will contain maternal:

a. IgM
b. IgA “note: from milk but not absorbed”
c. IgG
d. IgE
e. IgD
273. Which of the followings represent the receptor for Epstein bar virus (EBV):
a. Complement receptor 2 (CR2) “also called CD21”
b. CD1
c. TLR3
d. CD80
274. C3 convertase of the alternative pathway:

a. “C3bBb”
275. C5 convertase of the alternative pathway

a. “C3bBbC3b”
276. Septic shock associated with G-ve bacteria is mostly due to:
a. Lipopolysaccharides (LPS)
b. Platelets aggregation
c. Decrease cytokines release
d. Peptidoglycans
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277. Correct about Angioneurotic edema:

a. Autosomal dominant
b. Caused by deficiency of C1 inhibitor
c. Excessive C2a kinin & bradykinin causes the symptoms
d. All of the above
278. The part of Lymph node that contains only B cells:

a. Germinal center
b. Paracortical area
c. Cortex
d. Medulla
279. Strongest stimulator of Interferon:

a. Double stranded RNA (dsRNA)
280. Which of the following mainly supports an immune response against intracellular viruses:
a. Expression of MHC class I genes
b. Expression of IL-10
c. Expression of IL-4
d. Expression of IL-17
281. All of the following molecules are involved in lymphocytes homing and trafficking, except:
a. CD44
b. CD69
c. CCR7
d. CD80
282. Function similar to stem cell factor (SCF):

a. IL-1
b. IL-7
c. IL-4
d. IL-2
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283. Uses neonatal Fc receptor that causes prolongation of its half-life:

a. IgA
b. IgE
c. IgG
d. IgM
e. IgD
284. The most important component of the immune system against tumors is:
a. Helper T cells
c. B cells
d. Macrophages
285. The most important component against tumor cells with decreased MHC expression is:
a. Helper T cells
c. Natural Killers
d. B cells
e. Macrophages
286. Shortest serum half-life:

a. IgA
b. IgM
c. IgG
d. IgE
e. IgD
287. Effects of corticosteroids on immune system include:

a. Impair phagocyte chemotaxis
b. Impair antigen processing by macrophages
c. Decrease IL-1, IL-8, TNF, GM-CSF, prostaglandins and nitric oxide
d. Decrease IL-2 & apoptosis of lymphocytes at high doses
e. All of the above
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288. Regarding IgM:

a. Has 10 Fc
b. Has 5 Fc
c. Has 10 Fab
d. Has 5 Fab
e. B + C
289. C1q of the classical pathway is activated by:

a. Fc portion of two IgG or one IgM
290. All of the followings are phagocytic cells, except:

a. PMN
b. Macrophages
c. Monocytes
d. Natural Killers
291. All of the following are correctly match between Ig and its valency:
a. IgG = 2
b. IgA = 4
c. IgM = 10
d. IgE = 8
292. Father of vaccination (first successful vaccination):

a. Edward Jenner
293. The time required for adaptive immune system to fully mobilize:
a. 7-10 days
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294. The most variable CDR in Ig structure is:

a. CDR1
b. CDR2
c. CDR3
295. The most Ig that is produced daily by healthy persons:

a. IgM
b. IgA
c. IgG
d. IgE
e. IgD
296. All of the following Ab have J chain except:

a. IgA dimer
b. Synthetic IgA trimer
c. IgG
d. IgM
e. Synthetic IgD dimer
297. The part of antibody structure that bind the antigen is:
a. Double strand bonds between two cysteine (disulfide bridge)
b. Two heavy chains
c. Hypervariable specific CDR
d. Allotypes
298. Class III MHC genes of humans encode all of the following except:
a. TAP
b. Proteasome
c. TNF
d. TGF beta
e. C4 and C2
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299. Mutation in the transcription factor CIITA will lead to:

a. Bare lymphocyte syndrome
b. SLE
c. Marfan syndrome
d. Hereditary angioedema
300. CD8 binding site on MHC class I molecule is present on:

a. Alpha 1
b. Alpha 2
c. Alpha 3
d. Beta 2
301. Which of the following is the principal cytokine that causes increase in expression of
class II MHC by the antigen presenting cells:
a. IFN alpha
b. IFN gamma
c. IL-6
d. IFN beta
302. All of the following are MHC-encoded, except:

a. Alpha 1 and alpha 2 of MHC I
b. Alpha 3 of MHC I
c. Beta2 Microglobulin of MHC I
d. None of the above is true
303. Job’s syndrome results from mutation in of:

a. STAT6
b. STAT3
c. STAT4
d. STAT1
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304. All of the followings maybe expressed on T- cells surface, except:

a. LFA-2
b. LFA-1
c. CD40
d. VLA-4
e. ICOS
305. Affinity and avidity are usually equal when:

a. Antibody is derived from a single clone with equal affinity
b. Antibody is derived from human origin
c. Antibody has only one binding site to antigen
d. Antibody has high cross reactivity
e. Antibody has low valency
306. The binding of antigen to antibody:

a. Is irreversible
b. Depends on covalent interactions
c. Occurs solely by potent hydrophobic bonding
d. Depends on spatial complementary
e. Is always of high affinity
307. Correct regarding MHC Class II:

a. Play essential role in processing endogenous antigens
b. Protein processing occurs mainly in cellular proteasome
c. Binding to antigenic peptides occurs in endoplasmic reticulum
d. Expressed mainly on dendritic cells, macrophages , B lymphocytes , endothelial cells and
thymic epithelial cells
e. Present in all nucleated human cells
308. Molecule of acute phase of infections synthesized in liver during bacterial and viral infection is:
a. CPR
b. chemokines
c. Complement
d. Immunoglobulin
e. Interleukin
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309. During processing of antigens, peptide are transmitted to ER for binding to MHC 1 by:
a. Calnexin
b. Calreticulin
c. Ubiquitin
d. TAP protein
310. Which of the following cells lack MHC class I protein:

a. RBCs
b. WBCs
c. Spleen
d. Liver
e. Skin
311. A patient who was ill 10 days ago with a viral illness and had high levels of IgM and no IgG
antibodies to that virus in his blood , your interpretation would be :
a. The patient had acute infection to that virus without prior exposure
b. The patient had previous exposure to the virus with no acute infection
c. The patient had recent re-exposure to the virus
d. The patient was immune to the virus at the time of exposure
e. The patient has deficiency of adaptive immunity
312. Which malignancy the use of local BCG mycobacterium injection is successful?
a. skin cancer
b. urinary bladder cancer
c. brain cancer
d. renal cell carcinoma
e. breast cancer
313. Which of the following is NOT a member of Ig superfamily protein in the immune system :
a. B cell receptor
b. T cell receptor
c. MHC class I molecule
d. CD4 coreceptor of T cells
e. chemokine receptor
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314. IL -2 receptor (alpha) is also called?

a. PD – L2
b. CTLA – 4
c. C. Foxp3
d. B7-1
e. CD25
315. Which type of the following group of diseases is genetically based but is rare?
a. primary immunodeficiency
b. autoimmune diseases
c. atopy
d. secondary immunodeficiency
e. allergy
316. Regarding dendritic cells, which is not correct:

a. classical DCs – are the numerous dendritic cell subset in lymphoid organs
b. Langerhans cells – dendritic that is popular in epidermis they serve the same role for
antigens encountered in the skin
c. plasmacytoid DC – resemble plasma cells morphologically and acquire the morphology and
functional properties of dendritic cells
d. plasmacytoid DCs – its main function is the secretion of large amount of type I interferons in
response to viral infections
e. classical DCs – express high levels of TLR7, and TLR9
317. PLASMA CELL derived from B cells are different in:

a. display more MHC class II
b. IS MORE EFFICIENT antigen presenting cells
c. recognize different epitopes
d. release soluble immunoglobins
e. are capable of activating T helper cells
318. The huge variety of antibody specificities in our bodies is achieved by:
a. having a large number of genes that code for Ig-related products
b. VDJ recombination
c. positive selection in the bone marrow
d. random mutations
e. site – direct mutagenesis followed by high proliferation
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319. A Fab fragment:

a. is produced by pepsin treatment
b. is produced by separation of heavy and light chains
c. does not have the ability to induce activation of Fc receptors
d. lacks light chains
e. has no interchain disulfide bonds
“The more the things have changed, the more they stay the same”
Good Luck in Your Exam
61 | P a g e
Concept : T cell activation
1- Male patient who is infected with candida albicans , his host defense mechanism is
mainly due to :
a- TH1
b- TH2
c- TH17
d- TH1 & TH2
e- None of the above
2- Respectively the inducing and signature cytokines for TH2 are

a- IL-12 , IFN
b- IL-4 , IFN
c- IFN , IFN
d- IL-6 , IL-1
e- IL-4 ,IL-4
3- Which of the following cytokines produced by TH1 cells mainly inhibit their further
differentiation
a- IL-10
b- IL-12
c- IL-4
d- IFN
e- IL-23
4- job's syndrome is characterized by

a- high IgM levels
b- low IgM levels
c- high IgE levels
d- low IgE levels
e- none of the above
5- All of the following are true except :

a- CD28 receptors have 20-50 folds lower affinity to B7 than CTLA4
b- CTLA4 receptors have 20-50 folds HIGHER affinity to B7 than CTLA4
c- high B7 levels can bind CD 28
d- low B7 levels can bind CTLA4
e- CTLA4 -B7 interaction will block CD40 -CD40L binding
6- Regarding the eomesodermin. , where it is found
a- CTL
b- TH17
c- TH1
d- TH2
e- NKT
7- All are found on the T cell surface except

a- CD28
b- CD40
c- CD40L
d- LFA1
e- LFA2
8- WHICH TYPE OF CELL IS STIMULATED DURING THE INFECTION OF PNEUMOCYSTIS

JIROVACI:
a- CD8+CTLS
b- CD4+ TH1
c- CD4+ TH2
d- CD4+ TH17
e- B cell
9- DEFICIENCY IN WHICH OF THE FOLLOWING WILL LEAD TO EXTREMELY INCREASED

INTRACELLULAR MO INFECTION:
a- IL-2
b- IL-1
c- IL-22
d- IL-12
e- IFN
10- WHICH OF THE FOLLOWING IS NOT CORRECTLY MATCHED:

a- CD 2 & ICAM1
b- CD69 & S1PR1
c- CD44 & hyaluronin
d- CTLA4 & B7
e- CD28 & B7
11- WHICH TYPE OF CELL IS STIMULATED DURING THE INFECTION OF LISTERIA:
a- CD8+CTLS
b- CD4+ TH1
c- CD4+ TH2
d- CD4+ TH17
e- B cell
12- JOPS SYNDROME IS RESULT FROM MUTATION IN WHICH OF THE FOLLOWING

TRANSCRIPTIONAL REGULATOR
a- STAT-1
b- STAT-3
c- STAT-4
d- STAT-6
e- GATA-3
13- The differentiation of each major CD4+ T cell subset is controlled by a subset defining
transcription factor . which of the following correctly pairs each subset with its
transcription factor
a- TH1: T-bet , TH2: GATA3 , TH17: ROR ᵞT
b- TH1: GATA3, TH2: T-bet , TH17: ROR ᵞT
c- TH1: T-bet , TH2: ROR ᵞT , TH17: GATA3
d- TH1: ROR ᵞT, TH2: GATA3 , TH17: T-bet
e- TH1: GATA3, TH2: ROR ᵞT , TH17: T-bet
14- TH17
a- Neutrophils & some monocytes
b- Eosinophils
c- Basophils
d- Mast cells
e- Macrophages
15- Lack of IL-4 in mice will cause

a- Increased IgE
b- Decrease IgE
c- Increased IgA
d- Decreased IgA
e- Normal IgA and IgE
16- all are true except :
a- CTLA-4 mainly controls initial T cell activation in lymphoid organs
b- PD-1 is mainly involved in programmed T cell death by apoptosis
c- PD-1 mainly limits responses of differentiated effectors cells in peripheral tissues
d- CTLA-4 binds B7 with 20-50 fold higher affinity than CD28
e- both CTLA 4 and PD1 are inhibitory protein receptors of the CD28 family
17- WHICH OF THE FOLLOWING CYTOKINES PRODUCED BY TH1 TO INHIBIT ITS ACTION:
a- IL1
b- IL5
c- IL13
d- IL10
e- IL22
18- The most important costimulators for naïve T cell activation are which of the following?
a- ICOS Ligand
b- B7-1 and B7-2
c- PD-L1 and PD-L2
d- OX40 –Ligand
e- FAS Ligand
19- CTLA-4-Ig is a soluble recombinant protein containing the ligand binding portion of
CTLA-4 fused to the Fc portion of IgG. It is an approved drug used to treat autoimmune
diseases. How does it work?
a- Binds to CTLA-4 on T cells and induces inhibitory signals
b- Binds to CTLA-4 and blocks its ability to bind to B7-1 and B7-2
c- Binds to B7-1 and B7-2 on antigen presenting cells, and blocks their ability to bind to
CD28 on T cells
d- Binds to inhibitory Fc receptors on B cells and inhibits the production of
autoantibodies
e- Binds to cytotoxic T lymphocytes and blocks their ability to kill other cells
20- TH2 cells are defined in part by production of which of the following cytokines?
a- TNF
b- IL-1
c- IL-2
d- IL-4
e- IFNγ
21- A major function of T H1 cells is to activate macrophages. Which molecules expressed by
TH1 cells are essential for this function?
a- IL-1 and TNF
b- CD8 and Fas ligand
c- IL-17 and NO
d- Interferon γ and CD40 ligand
e- IL-4 and ICOS
22- Which of the following is one way a cytokine made by TH2 cells contributes to atopic
disease (allergy)?
a- IL-17 stimulates TNF production by macrophages
b- IL-5 induces basophil degranulation
c- IL-13 activates eosinophils
d- IL-4 induces B cell class switching to IgE
e- IL-22 causes mast cell degranulation
23- Which type of T cell is most likely to promote acute neutrophillic inflammatory
responses that defend against extracellular bacteria and fungi?
a- TH1
b- TH2
c- TH17
d- CTL
e- T follicular helper
24- T-cell mediated suppression:

a- Is always mediated by CD8+ T-cells.
b- Is always mediated by CD4+ T-cells.
c- Can be due to Th2 cells suppressing Th1 by IL-4 or IL-10.
d- Does not exist.
e- Cannot transfer suppression to another animal
25- Suppression of Th2 by Th1 cells may be mediated by:

a- IL-1.
b- IL-3.
c- IL-4.
d- GM-CSF.
e- Interferon-gamma.
26- Th1 cells secrete:
a- CD4.
b- IL-4.
c- IL-5.
d- IL-6.
e- Interferon-gamma
27- The cytokine which is most involved in the class switch to IgE production is:
a- IL-1
b- IL-2
c- TGF beta
d- IL-4
e- IL-5
28- cell CD40L provides a costimulatory signal to B-cells by ligating:

a- Surface Ig
b- MHC class II
c- CD28
d- CD19
e- CD40
29- The main costimulatory signal for activation of resting T-cells is provided by ligation of:
a- CD28
b- Surface Ig
c- LFA-1
d- VLA-4
e- IL-2
30- The T-cell ligand binding B7 on a professional antigen-presenting cell is:

a- CD28
b- CD2
c- LFA-1
d- ICAM-1
e- VCAM-1
31- When a resting naive T-cell engages its specific MHC/peptide complex displayed on the
surface of a fibroblast it :
a- Undergoes blast cell formation
b- Produces IL-2.
c- Moves from Go to G1 of the cell cycle.
d- Becomes anergic.
e- Secretes IL-1.
32- After Ag recognition, there is ↑ in CD4

a- >50,000 fold expansion
b- 1000 -10,000 fold expansion
c- 10000 -100,000 fold expansion
d- 100 -1000 fold expansion
e- >500,000 fold expansion
33- What is The Most important growth promoting cytokines produce early 2-4 h after
activation ?
a- IL - 12
b- IL - 2
c- IL-13
d- IL- 4
e- IL- 5
34- Which of the following cause allergic disease?

a- IL5 by activating monocytes
b- IL4 by promoting binding of eosinophils and mast cells
c- IL10 by inhibition of macrophages
d- IL13 by activating neutrophils
e- IL21 by its own activity
35- STAT3 mutation

a- Decrease level of IgA
b- Increase level of IgM
c- Increase level of IgD
d- Decrease level of IgE
e- Increase level of IgG
36- All present on APC except

a- B7-1
b- B7-2
c- CD40
d- TNFR
e- ICOS (CD40L)
Concept : effector functions of CMI
37- Regarding CTL mediated cytotoxicity of target cell which is wrong

a- Principal mechanism is Perforin/Granzyme-mediated killing
b- Granzymes cleave proteins after aspartate residues
c- Serglycin assemble complex containing perforin & granzymes
d- Granulysin can alter permeability of target cell
e- Granule-independent mechanism is CD4-CD40L -mediated killing
38- WHICH OF THE FOLLOWING IS NOT TRUE REGARDING ANTIBODY DEPENDENT CELL
MEDIATED CYTOTOXICITY
a- Natural killer (NK) cells bind to IgG antibody-coated cells by FcγRIIIA receptors and
destroy these cells
b- Natural killer (NK) cells bind to IgG antibody-coated cells by FcγRIIIB receptors and
destroy these cells
c- It used to refer to NK defense
d- Uses IgG isotype for opsonization
39- generation and survival of Treg depend on :

a- TGF B and IL-10
b- TGF B and IL-2
c- IL-1 & IL-6
d- IL-1
e- IL-6
40- The combination of TCR and costimulatory signals induces naïve T cells to express IL-2
and high affinity IL-2 receptors. This results in which of the following functional
responses by the T cell?
a- Clonal expansion
b- Interferon γ expression
c- CD40 ligand expression
d- Granule exocytosis
e- Migration out of a lymph node
41- Which pair of molecules are found in cytotoxic T lymphocyte (CTL) granules and are
important for CTL killing of target cells?
a- Perforin and Fas ligand
b- selectin and tumor necrosis factor
c- Major basic protein and granzyme B
d- C9 and interferon-γ
e- Perforin and granzyme B
42- Reactivation of EBV happens by a defect in

a- Memory T cells
b- CTL
c- TH1
d- TH2
e- TH17
43- The cytokine of TH-17 cells responsible for barrier functions:

a- IL-17
b- IL-4
c- IL-2
d- IL-22
e- IL-6
44- Activated macrophages perform all of the following functions EXCEPT:

a- Inhibition of fibroblast proliferation and angiogenesis within damaged tissues
b- Production of lysosomal enzymes and reactive oxygen species that kill phagocytosed
microbes
c- Presentation of antigen to helper T cells
d- Secretion of inflammatory cytokines such as tumor necrosis factor and interleukin-1
e- Production of nitric oxide, which helps kill microorganisms
45- Alternative macrophage activation is characterized by which one of the following?

a- Reactive oxygen species (ROS) generation
b- IL-1 production
c- Microbial killing
d- IL-10 and TGFβ secretion
e- IL-4 and IL-13 secretion
46- Intracellular parasites within macrophages are killed more readily in the presence of:
a- Antibody
b- Kinins
c- Properdin
d- Gamma-interferon
e- Anaphylatoxin
47- T cell surface receptors for antigen partly recognize:

a- Cytokines
b- MHC
c- ADCC
d- Antibody
e- IL-2
48- Deletions in the T-cell CD154 (CD40L) gene produce:

a- The hyper–IgM syndrome.
b- Congenital X-linked agammaglobulinemia.
c- IgA deficiency.
d- Wiskott–Aldrich Syndrome.
e- Deficiency in cytotoxic T-cell activity
49- IFN-gamma and TNF (TNF alpha) can act synergistically:

a- To downregulate expression of MHC class I.
b- Because IFN-gamma downregulates expression of TNF receptors.
c- To upregulate expression of MHC class II.
d- Because they both bind to the same receptor.
e- Because they cross-link IFN-gamma and TNF beta receptors.
50- WHICH OF THE FOLLOWING VIRUSES CONTAIN GENE HOMOLOGUE TO HUMAN GENE
CODING IL-10
a- HIV
b- HSV
c- VZV
d- EBV
e- HPV
51- The T-cell receptor for antigen is:

a- Derived from the immunoglobulin gene pool by alternative splicing.
b- A tetramer.
c- A homodimer.
d- A heterodimer.
e- A single chain molecule.
Concept : regional immunity
52- the total number of lymphocytes in skin is …... the number in serum
a- Equal
b- Twice
c- three times
d- five times
e- ten times
53- imprinting of effector cells with gut homing molecules takes place in :
a- GALT & mesenteric lymph nodes
b- lamina propria
c- peripheral blood
d- Thymus and bone marrow
e- Spleen
54- All of the following are disease in intestinal mucosa Except?

a- celiac disease
b- inflammatory bowel diseases
c- crohn’s disease
d- ulcerative colitis
e- atopic dermatitis
55- Progressive multifocal leukoencephalopathy

a- JC virus
b- HSV type 1
c- HSV type 2
d- VZV
e- Measles
56- Which of the following is a common feature important to immune defense in skin and
gastrointestinal tract
a- Production of mucus
b- keratin layer
c- epithelial cell barrier
d- all of the above
57- Mucin are mostly :

a- lipids only
b- glycosylated lipids
c- glycosylated proteins
d- oligosaccharides
e- proteins only
58- the total number of lymphocytes in GIT is -----of lymphocytes in circulation :

a- Equal
b- Twice
c- three times
d- five times
e- ten times
59- Which of the following is not included in mucosal associated lymphoid tissues?
a- tonsils
b- Peyre’s patches
c- Axillary lymph nodes
d- mesenteric lymph nodes
e- adenoids
60- which of the following Ig needs neonatal Fc Receptor for transport :

a- IgG only
b- IgA and IgM
c- IgA only
d- IgM only
61- Which is true related to microglia :

a- low activation threshold and CD200
b- high activation threshold and CD200L
c- normal activation threshold and CD200
d- low activation threshold and CD200L
e- high activation threshold and CD200
62- which of the following is a distinct feature of FEMALE genital mucosal immune system :
a- dominance of IgM AB and lack of prominent MALT
b- dominance of IgA AB and lack of prominent MALT
c- dominance of IgG AB and lack of prominent MALT
d- dominance of IgE AB and lack of prominent MALT
e- dominance of IgD AB and lack of prominent MALT
63- An example of a privileged immunological site is the:

a- Bone marrow
b- Skin
c- Testis
d- Lung
e- Waldeyer's ring
64- In celiac disease there is T-cell sensitivity to:

a- Vitamin B12.
b- Gluten.
c- Alpha adrenergic receptors.
d- Gastric H+/K+ dependent ATPase.
e- Myelin basic protein.
65- Defensins are an important part of the innate defense against bacterial invasion in the
gut, and abnormalities in defensin production have been associated with various
diseases. Which of the following statement about defensins is true?
a- Defensins are peptides that exert lethal toxic effects on bacteria by blocking
protein synthesis
b- In the small bowel, the α-defensins are produced by Paneth cells located at the
base of crypts
c- Human defensins are secreted in a fully active form by cells in the gut after IL-1
stimulation
d- Mast cell granules are rich in α-defensins
e- Defensins are not produced in the colon
66- What are M cells?

a- A type of mucosal B cell that secretes IgM
b- Lamina propria macrophages that ingest bacteria that have invaded through the
intestinal epithelium
c- Alveolar macrophage that secrete surfactant
d- Specialized intestinal epithelial cells that transport antigens or microbes into Peyer’s
patches
e- A type of intestinal dendritic cell that tolerizes T cells to food antigens
67- The human skin contains about 10 billion T cells. Most of these T cells have which of the
following phenotypes?
a- Memory T cells
b- Naïve T cells
c- Th17 cell
d- Regulatory T cells
e- CD8+ T cells
68- The only example (exception) to autoimmunity against immune-privileged tissue is

(WHICH ONE OF THE FOLLOWING IS A CONTRADICTION TO IMMUNE PRIVILEGED
CONCEPT)
a- Atopic dermatitis
b- Sympathetic ophthalmia
c- Ulcerative colitis
d- Psoriasis
e- Allograft rejection
69- WHICH ONE OF THE FOLLOWING IS NOT RELATED TO SKIN HOMING :

a- CCL17 – CCR4
b- CCL20 – CCR6
c- CCL27 –CCR10
d- Vitamin A / retenoic acid
e- CLA
70- Neutrophil defensins are:

a- Anti-toxins.
b- Oxygen-dependent.
c- Enzymes.
d- Glycolipids.
e- Peptide antibiotics
71- Uses M cells for invasion

a- Salmonella typhi
b- Salmonella paratyphi
c- Salmonella typhimerium
d- Salmonella enterica
72- Which of the following Ig contribute to humoral immunity against gut luminal microbes
a- IgA and IgG
b- IgG and IgM
c- IgA and IgM
d- IgA , IgG and IgM
e- IgA only
Concept : Receptor rearrangement
73- Percentage of selected T cell

a- 5%
b- 50%
c- 75%
d- 25%
e- 10%
74- Transforming ------------- T cells into single positive cells takes place in the -------
a- Double negative , subcapsular area
b- Double positive , cortex
c- Double negative , medulla
d- Double positive , medulla
e- Double negative , cortex
75- Positive and negative selection are important to ensure that T cells
a- Can’t bind to foreign antigens
b- Can’t bind to self-antigens
c- Can bind to foreign antigens
d- Can bind to self-antigens
76- Heavy chain is expressed in which stage of B cell development

a- Pro-B cell stage
b- Pre-B cell stage
c- Immature B cell stage
d- Mature B cell stage
e- Stem cell stage
77- Correct about light chain

a- Alpha and beta
b- Lambda and kappa
c- CD3
d- A and B
e- B and C
78- Double negative cells are present in

a- Thymus subcapsular zone
b- Thymus cortex
c- Thymus corticomedullary junction
d- Thymus medulla
e- Lymph node cortex
79- A chromosome on which T-cell receptor alpha chain gene rearrangement has occurred
lacks which of the following gene segments:
a- Joining (J).
b- Diversity (D).
c- Variable (V).
d- Constant (C).
e- TCR beta chain
80- Proliferation of lymphocytes progenitors is enhanced by

a- IL22
b- IL13
c- IL7
d- IL4
e- IL2
81- Functional receptors (TCR, BCR) are created during maturation by
a- Allelic exclusion
b- Positive selection
c- Negative selection
d- Somatic recombination
82- VDJ is used to generate

a- Variable part of heavy chain
b- Variable part of light chain
c- Variable part of TCR beta chain
d- Variable part of TCR alpha chain
e- A and C
83- Because of junctional diversity, antibody and TCR molecules show the greatest
variability at the junctions of
a- V and J regions CDR1
b- V and C regions CDR2
c- V and C regions CDR3
d- V and D regions CDR2
e- V and J rejoins CDR3
84- Prothymocytes are

a- TCR+CD3+CD4+CD8
b- TCR -CD3-CD4-CD8-
c- TCR +CD3-CD4-CD8-
d- TCR +CD3+CD4-CD8-
e- TCR-CD3+CD4-CD8-
85- Positive selection

a- the process that preserves T cells that recognize self MHC (with self-peptides) with
low avidity
b- the process in which thymocytes whose TCRs bind strongly to self-peptide antigens
in association with self MHC molecules are deleted
c- Rearrangement of antigen receptor gen
d- Inability of B cell to express any other variable region after a B cell produces a
functional immunoglobulin gene during V(D)J recombination
86- Negative selection

low avidity
87- Allelic exclusion

low avidity
88- False regarding γδ T cells

a- CD4-, CD8-, CD3+ T cells
b- Frequent in mucosal epithelium
c- Can do antibody class switch
d- Require extensive processing and MHC presentation
e- Sense peptide and non-peptide Ag
89- the earliest stage of B cells

a- pre-B cells
b- Pro-B cells
c- Immature B cells
d- Follicular B cells
e- B1 cells
90- IgH is present on the surface of

a- pre-B cells
b- Pro-B cells
c- Immature B cells
a- Prethymocytes
b- Double positive T cells
91- surrogate light chains are present on the surface of

a- pre-B cells
b- Pro-B cells
c- Immature B cells
d- Prethymocytes
e- Double positive T cells
92- False regarding Receptor editing of B cells

a- Changing the variable part on the heavy chain
b- replacing VJ of light chain with new VJ Kappa or lambda
c- If editing in B cells fail then clonal deletion will occur
d- important mechanism for maintaining tolerance
93- Which of the following gene clusters do not contribute to antigen binding:
a- VL
b- CL
c- VH
d- D
e- J
94- Recombination of V, D and J Ig gene segments:

a- Only occurs in mature B-cells.
b- Only occurs in light chains.
c- Involves heptamer-spacer-heptamer flanking sequences.
d- Does not occur until the mRNA stage.
e- Is effected by recombinase enzymes.
95- The first immunoglobulin heavy chain class to be expressed on the surface of a newly
produced B-cell is:
a- IgA
b- IgD
c- IgE
d- IgG
e- IgM
96- Using only random VDJ recombination, from 40 V, 30 D and 6 J gene segments, the
number of possible variable regions of an antigen receptor molecule would be:
a- 40
b- 76
c- 7,200
d- 1.4 × 106
e- 1.4 × 109
97- rearrangement on the sister chromatid is suppressed is called:

a- Allelic exclusion.
b- Class switching.
c- Productive rearrangement.
d- Clonal selection.
e- Gene shuffling.
98- In the thymic medulla the majority of gamma delta T-cells are:
a- CD4+CD8+
b- CD4+CD8–
c- CD4–CD8+
d- CD4–CD8–
e- Surface Ig+
Concept : B cell activation and humoral immunity
99- The type and amount of antibodies produced vary according to all of the following
except
a- the type of antigen driving the immune response
b- the involvement of T cells
c- duration of exposure to the antigen
d- prior history of antigen exposure
e- the anatomic site at which activation occurs
100- T-dependent humoral immune responses occurs in

a- Parafollicular zone
b- Germinal center
c- Subcapsular zone
d- Medulla
101- All are T-independent except

a- Lipids
b- Polysaccharides
c- Nucleic acids
d- Proteins
102- Delivery of small antigens to the follicles is done by

a- Afferent lymphatic vessels
b- Efferent lymphatic vessels
c- High endothelial venules
d- Subcapsular sinus macrophage
e- Conduits
103- All of the following are required for B cell activation in T-independent fashion
except
a- Recognizing the antigen by membrane Igs
b- Signal transduction to inside cells by Ig alpha and beta
c- Recognizing C3d complement by CR2
d- Cytokines production by T helper cells
e- Activation of Toll-like receptors (TLRs) by PAMP
104- False about antibody response against T-independent Antigens except

a- Low affinity antibody
b- Mainly IgM
c- Natural antibodies
d- Short-lived plasma cells
e- Memory B cells
105- The key enzyme required for isotype switching (and affinity maturation) is
a- Ligase
b- Artemis endonuclease
c- RAG
d- activation induced deaminase (AID)
e- TdT
106- One of the following is T-dependent Ag :

a- Lipid molecules
b- Nucleic acids
c- Polysaccharides
d- Proteins
107- Production of antibodies after primary exposure starts after

a- Few hours
b- Few minutes
c- Two weeks
d- One week
e- One second
108- The main antibody in primary response

a- IgM
b- IgA
c- IgG
d- IgD
e- IgE
109- The main antibody in secondary response

a- IgM
b- IgA
c- IgG
d- IgD
e- IgE
110- One of the following statements is incorrect

a- In spleen Follicular B lymphocytes respond better to protein Ags
b- In spleen antibody response is mainly T-dependent
c- Marginal zone B cells in spleen respond to carbohydrates and lipid
d- B-1(CD5) cells in mucosal tissues respond to carbohydrates and lipid
e- In MALT antibody response is mainly T-dependent
IgA production by follicular B cell is stimulated by
a- IFN-gamma
b- IL-2
c- IL-5
d- IL-4
e- A and B
111- IgE production by follicular B cell is stimulated by

a- IFN-gamma
b- IL-2
c- IL-5
d- IL-4
e- A and B
112- Affinity maturation and isotype switching are mediated by

a- Marginal zone reaction
b- Follicular reaction
c- Red pulp reaction
d- Germinal center reaction
e- PALS reaction
113- EBV can evade/invade immunity by recognition of which receptor

a- BCR IgM
b- BCR IgD
c- CR2/CD21
d- TLR
114- Functional responses induced by Ag binding to BCR include all except

a- Expression of proteins that promote survival and cell cycling
b- Increased MHC & B7 expression
c- Increased expression of cytokine receptors
d- Decreased expression of CCR7
e- Migration from follicle to T cell area
115- Hyper IgM syndrome

a- Autosomal dominant
b- Autosomal recessive
c- Polygenic
d- X-linked dominant
e- X-linked recessive
116- Hyper IgM syndrome is due to mutation in

a- CD40L
b- CD40
c- BCR
d- CR2/CD21
e- IgM
117- All are parts of germinal center reaction except :

a- Somatic mutation
b- Affinity maturation
c- Isotype switching
d- Memory cells formation
e- Low-affinity antibodies
118- Antibody of primary response :

a- IgA
b- IgD
c- IgE
d- IgG
e- IgM
119- Principal function of IgM is

a- Complement activation
b- Phagocytosis
c- Ab-dependent cell-mediated cytotoxicity
d- Barrier immunity
120- One of the following is pentamer :

a- IgA
b- IgD
c- IgE
d- IgG
e- IgM
121- Immunity against helminths :

a- IgG1 & IgE
b- IgG2 & IgE
c- IgG3 & IgE
d- IgG4 & IgE
e- IgE ONLY
122- Mucosal immunity :

a- IgA
b- IgD
c- IgE
d- IgG
e- IgM
123- Neonatal immunity :

a- IgG1 only
b- IgG1 & IgG2
c- IgG2 & IgG3
d- IgG1 & IgG3
e- IgG 3 ONLY
124- All are stimulatory except :

a- FCᵞRI
b- FCᵞRIIA/C
c- FCᵞRIIB
d- FCᵞRIIIA
e- FCᵞRIIIB
125- One of the following is adaptive mechanism

a- Classical complement pathway
b- Alternative complement pathway
c- Lectin complement pathway
d- Common complement pathway
126- False about C1q

a- Hexamer
b- collagen-like threads that end with globular heads
c- recognize and bind to the Fc region of the antibodies
d- one IgM antibody is enough to activate C1q
e- one IgG antibody is enough to activate C1q
127- C3 convertase of the classical pathway :

a- C4b2a
b- C4b3b2a
c- C4a2b
d- C3bBb
e- (C3b)2Bb
128- C5 convertase of the classical pathway :

a- C4b2a
b- C4b3b2a
c- C4a2b
d- C3bBb
e- (C3b)2Bb
129- C3 convertase of the alternative pathway :

a- C4b2a
b- C4b3b2a
c- C4a2b
d- C3bBb
e- (C3b)2Bb
130- C5 convertase of the alternative pathway :

a- C4b2a
b- C4b3b2a
c- C4a2b
d- C3bBb
e- (C3b)2Bb
131- the most abundant complement protein :

a- C1
b- C2
c- C3
d- C5
e- C9
132- Hereditary Angioneurotic Edema

a- C1 inhibitor deficiency
b- C1 deficiency
c- C3 convertase deficiency
d- C5 convertase deficiency
e- Properdin deficiency
133- Paroxysmal Nocturnal Hemoglobinuria (PNH) caused by :

b- Early complement deficiency
c- Late complement deficiency
d- CD59 deficiency
e- C1 deficiency
134- susceptibility to infections caused by pyogenic bacteria such as staphylococcus is

caused by :
d- Decay accelerating factor (DAF) deficiency
e- C1 deficiency
135- Recurrent Neisseria infection
e- C1 deficiency
136- SLE associated with

a- C1 deficiency
b- C2 deficiency
c- C1 inhibitor deficiency
e- C5 convertase deficiency
137- Which of the following is wrong regarding the complement system

a- Complement proteins bind non-covalently to the microbial surface
b- Activation is inhibited by regulatory proteins that are present on normal host cells
and absent from microbes
c- They are a sequence of proteolysis
d- Activated by microbes alone, or by antibodies that are attached to microbes and
other antigens
e- All of the above
138- Which pathway in complement activation is adaptive immune response

a- classical pathway
b- alternative pathway
c- lectin pathway
d- mannose pathway
139- which of the following complement components act as an enzyme

a- C3
b- C5
c- C6
d- C7
e- C8
140- Which of the following isn’t true of T independent antibody response:

a- Mainly IgM
b- Short lived plasma cells
c- No isotope switching
d- No affinity maturation
e- Peptide (protein) antigens
141- Alternative and classical complement pathways , meet at

a- C1
b- C5
c- C3
d- C5 convertase
e- All of the above
142- The term reactive lysis usually refers to a sequence of events involving:
a- Natural killer (NK) cells.
b- Cytotoxic T-lymphocytes (CTL).
c- Antibody-dependent cellular cytotoxicity (ADCC).
d- Th1 cells.
e- Complement.
143- Angioneurotic edema

a- C1 deficiency
b- C3 deficiency
c- C1 inhibitor deficiency
d- C3 convertase deficiency
e- STAT 3 mutation
144- Which of the following events initiates activation of the alternative complement
pathway?
a- C1q binding to a microbial surface
b- Spontaneous cleavage of C3 to C3b
c- Complement receptor 1 (CR1) binding of C3b
d- Factor I cleavage of C3
e- Mannose-binding lectin (MBL) binding to a microbial surface
145- Children with C3 deficiency are at high risk for serious bacterial and fungal
infections. Which of the following explains the importance of C3 in defense against
these microbes?
a- Fragments of C3 generated by both classical and alternative pathway C3 convertases
serve as important opsonins for phagocytosis of the microbes
b- Fragments of C3 generated only by the classical pathway C3 convertase serve as
important opsonins for phagocytosis of the microbes
c- Fragments of C3 generated only by the alternative pathway C3 convertase serve as
important opsonins for phagocytosis of the microbes
d- Fragments of C3 generated by both classical and alternative pathway C3 convertases
bind to microbes and serve as ligands recognized by activating receptors on NK cells
e- Fragments of C3 generated by both classical and alternative pathway C3 convertases
serve as important stimulants of helper T cell cytokine secretion
146- All of the following are accurate statements about neonatal immunity EXCEPT:
a- Transfer of maternal IgG across the placenta is mediated by an Fc receptor
structurally similar to class I MHC.
b- IgA is absorbed in the gut from breast milk and re-secreted by the infant into the
bronchial mucosa.
c- IgA secretion into breast milk involves transport through breast epithelial cells, and
is dependent on the poly-Ig receptor.
d- Transport of IgG across the neonatal intestinal epithelium is mediated by an Fc
receptor structurally similar to class I MHC.
e- Loss of maternal antibodies is partly responsible for increased frequency of
infections in infants at about 6 months of age.
147- Respectively the receptors that are required to transport IgM, IgG, IgA to the
lumen of GIT are
a- Neonatal Fc receptor, Poly-Ig receptor, Neonatal Fc receptor
b- Neonatal Fc receptor, Poly-Ig receptor, Poly-Ig receptor
c- Poly-Ig receptor , Neonatal Fc receptor , Neonatal Fc receptor
d- Poly-Ig receptor, Neonatal Fc receptor , Poly-Ig receptor
e- Poly-Ig receptor, Poly-Ig receptor, Neonatal Fc receptor
148- Complement component C3 is cleaved by:

a- C3b
b- C3bBb
c- Factor B
d- Factor D
e- Factor H
149- The membrane attack complex consists of:

a- OH.
b- Colicins
c- C3b3bBb
d- C5b,6,7,8,9
e- Properdin
150- C3b :
a- Is chemotactic.
b- Is an anaphylatoxin.
c- Opsonizes bacteria.
d- Directly injures bacteria.
e- Is the inactive form of C3.
151- A complement component which is strongly chemotactic for neutrophils is:

a- C9
b- C5a
c- C3
d- C3b
e- C5b
152- Several of the complement components are:

a- Glycolipids
b- Cytokines
c- Enzymes
d- Hormones
e- Antibodies
153- IgG antibodies:

a- Are the earliest class to appear in an immune response.
b- Are normally dimeric in mucosal secretions.
c- Remain of low affinity.
d- Inhibit antibody responses through the Fc gamma receptor FcgRIIB1 on B-cells.
e- Augment antibody responses through the Fc gamma receptor FcgRIIB1 on Bcells
154- Agglutination is a function of

a- IgA and IgM
b- IgG and IgM
c- IgD and IgE
d- IgA and IgG
e- IgM only
155- Most neutralizing antibodies in the blood

a- IgM
b- IgA
c- IgG
d- IgE
e- IgD
156- Most neutralizing antibodies in the mucosal organs

a- IgM
b- IgA
c- IgG
d- IgE
e- IgD
157- Activation of complement by lectin or alternative pathway is done by

a- IgM
b- IgA
c- IgG
d- IgE
e- IgD
158- Feedback inhibition of B cell activation

a- IgM
b- IgA
c- IgG
d- IgE
e- IgD
159- Opsonization
a- IgM
b- IgA
c- IgG
d- IgE
e- IgD
160- ADCC uses

a- FcγRIIIA
b- FcγRIIA
c- FcγRIIB
d- FcγRIIC
e- FcγRI
161- IVIG binds

a- FcγRIIIA
b- FcγRIIA
c- FcγRIIB
d- FcγRIIC
e- FcγRI
162- mediate the killing and expulsion of some helminthic Parasites carrying IgE
a- FcγRIIIA
b- FcγRIIA
c- FcγRIIB
d- FcγRIIC
e- FcεRI
163- Not an opsonin

a- IgG
b- C3b
c- i C3b
d- C5a
e- C4b
164- Complement receptor on RBC

a- CR1
b- CR2
c- CR3
d- CR4
165- Receptor for epstein barr virus on B cells

a- CR1
b- CR2
c- CR3
d- CR4
166- removes Bb from the alternative pathway C3 convertase

a- Factor H
b- DAF
c- Factor I
d- C1INH
e- CD59
f- A and B
167- inactivates C3b

a- Factor H
b- DAF
c- Factor I
d- C1INH
e- CD59
f- A and B
168- binds to sites on activated C1r and C1s shutting down their proteolytic activity
a- Factor H
b- DAF
c- Factor I
d- C1INH
e- CD59
f- A and B
169- on normal tissue cells which inhibit association of C9 with C5b-8

a- Factor H
b- DAF
c- Factor I
d- C1INH
e- CD59
f- A and B
170- Deficiency of which of the following predisposes the person to frequent bouts of
bacterial infections mainly gram negative bacteria
a- C2
b- C3
c- C9
d- C1INH
e- CD59
171- Deficiency of which of the following frequently found in patients with lupus
erythematosus (SLE)
a- C2
b- C3
c- C9
d- C1INH
e- CD59
172- Found on platelets

a- FcγRI
b- FcγRIIA
c- FcγRIIB
d- FcγRIIIB
e- FcγRIIIA
f- FcεRI
g- FcεRII
173- High affinity for Ig

a- FcγRI
b- FcγRIIA
c- FcγRIIB
d- FcγRIIIB
e- FcγRIIIA
f- FcεRI
g- FcεRII
h- A and F
174- Binds IgE

a- FcγRI
b- FcγRIIA
c- FcγRIIB
d- FcγRIIIB
e- FcγRIIIA
f- FcεRI
g- FcεRII
175- On mast cells , basophils and eosinophils

a- FcγRI
b- FcγRIIA
c- FcγRIIB
d- FcγRIIIB
e- FcγRIIIA
f- FcεRI
g- FcεRII
176- On NK cells
a- FcγRI
b- FcγRIIA
c- FcγRIIB
d- FcγRIIIB
e- FcγRIIIA
f- FcεRI
g- FcεRII
177- On Langerhans cells

a- FcγRI
b- FcγRIIA
c- FcγRIIB
d- FcγRIIIB
e- FcγRIIIA
f- FcεRI
g- FcεRII
178- Feedback inhibition of B cell

a- FcγRI
b- FcγRIIA
c- FcγRIIB
d- FcγRIIIB
e- FcγRIIIA
f- FcεRI
g- FcεRII
179- The most common type of B cells

a- Follicular
b- Marginal
c- B1 cells
d- Plasma cells
180- Somatic hypermutation takes place in

a- Light zone of germinal center
b- Dark zone of germinal center
c- Outside the lymph node
d- Parafollicular area
181- B cell recognition of antigen on follicular DC and selection of high affinity B cells
a- Light zone of germinal center
b- Dark zone of germinal center
c- Outside the lymph node
d- Parafollicular area
https://en.wikipedia.org/wiki/David_Vetter
Glory Batch–Scripts Committee MCQ Chapters: 1,2,3,4,13,20,21
BOOK QUESTOINS
Yaman Odat & Aref Qarqash
Yaman Odat & Aref Qarqash
1|P a ge
MCQ
1- A 1-year-old boy with recurrent infections comes to the clinic for evaluation. He has a
history of multiple systemic fungal infections. The child was a normal home delivery and
was immunized for the usual diseases. On examination, the child has subclinical
hypocalcaemia and mental retardation. After an extensive workup, a diagnosis of
DiGeorge syndrome is made. Which immune system cells does DiGeorge syndrome
directly affect?
A- B lymphocyte
B- T lymphocyte
C- Macrophage
D- Dendritic cell
E- Langerhans cell
2- Antigen presentation is an important aspect of immune function. Several cell types are
capable of presenting the antigen to immune cells. What cell type is least likely to be
called a professional antigen-presenting cell?
A- B lymphocyte
B- T lymphocyte
C- Macrophage
D- Dendritic cell
E- Langerhans cell
3- A 16-year-old boy is injured while playing football. He does not remember the last time he
had a tetanus shot, so the attending physician administers a tetanus toxoid vaccine. This
kind of immunity would be best classified as:
A- Natural active
B- Natural passive
C- Artificial active
D- Artificial passive
E- Acquired passive
2|P a ge
4- A child with recurrent pyogenic sinopulmonary infections comes to the clinic with fever
and sinusitis. On workup of this patient, it is discovered that the neutrophils of the child
do not show the oxidative burst phenomenon. A diagnosis of chronic granulomatous
disease is made. Because neutrophils are part of the innate immune response, the
characteristic that most likely corresponds to cells of the innate immune system is:
A- Memory response
B- Specificity
C- Lag time for primary response
D- Present at birth
E- Acquired response to antigens
5- 5-year-old boy has a history of poor growth and development. The reason in part for her
retarded growth was multiple episodes of infections since birth. She comes to the clinic
with a middle ear infection; the pus from the ear grows catalase-positive Staphylococcus
aureus. Neutrophils isolated from the patient were unable to produce reactive oxygen
species. What is the most likely abnormality in this patient?
A- NADPH oxidase
B- Sulfhydryl oxidase
C- L-amino acid oxidase
D- Monoamine oxidase
6- Digestion of an immunoglobulin with pepsin yields F(ab)2 fragments. Several clinical trials
using F(ab)2 fragments are being conducted for their use as blocking molecules. What is
the immune phenomenon that is most likely to be seen with an F(ab)2 fragment?
A- Complement fixation
B- Opsonization
C- Antigen neutralization
D- Immunoglobulin polymerization
E- React with Fc receptor
3|P a ge
7- The immunoglobulin that can bind to the Fc epsilon receptor on cell surfaces and is most
commonly implicated in medical conditions such as allergy, asthma, and anaphylactic
shock is:
A- IgA
B- IgG
C- IgM
D- IgD
E- IgE
8- What is the nature of genetic expression of MHC genes?

A- Dominant
B- Recessive
C- Codominant
D- Mitochondrial inheritance
E- Pleiotropic
9- A 22-year-old woman with a history to bee stings receives immunotherapy injections with
small but increasing doses of a bee venom allergen to which she is allergic. What is the
rationale for this treatment?
A- Stimulation of TH2 responses to bee venom
B- Stimulation of TH17 responses to bee venom
C- Inhibition of TH17 responses to bee venom
D- Reduced TH2 responses
E- Stimulation of IgE production to bee venom
10- A 20-year-old woman is injured in a car accident while driving without a seat belt fastened,
and is brought to the emergency department. Internal bleeding is suspected and an
emergency laparotomy is performed, which reveals a ruptured spleen necessitating
splenectomy. The patient is at significant risk for developing:
A- A complement defect leading to meningococcal infection
B- A neutrophil defect, leading to staphylococcal infection
C- AIDS
D- Defects in antibody production and phagocytosis leading to infections with
encapsulated organisms
E- Defects in interferon gamma, leading to tuberculosis
4|P a ge
11- According to the recommendations of the Healthcare Infection Control Practices Advisory
Committee and the Advisory Committee on Immunization Practices, all health care
providers should be vaccinated annually against influenza. Inactivated influenza vaccine or
live attenuated influenza vaccine can be used. What statement is correct regarding the
inactivated influenza vaccine?
A- Induces an antibody response
B- Induces cytotoxic T lymphocyte response
C- Induces antibody and cytotoxic T lymphocyte response
12- Which of the following is an example of passive immunity?

A- Influenza vaccination
B- Administration of anti-tetanus antibody after an injury
C- Kidney transplantation
D- Whooping cough vaccine
E- Immunotherapy for grass pollen allergy
13- A 23-year-old woman develops influenza during the course of a winter outbreak. She has
severe symptoms and laboratory abnormalities. Which of the following is not a feature of
the acute-phase response to flu?
A- She has lost her appetite and not eaten for 4 days.
B- She has a fever of 39.6°C.
C- She has an elevated C-reactive protein level of 122 (reference range, <12).
D- Her chest radiograph shows diffuse changes.
E- Her erythrocyte sedimentation rate is 49 (reference range, <7).
14- A 13-year-old girl became unwell 8 minutes after eating a chocolate bar that contained
traces of peanuts. Which of the following would not support a diagnosis of peanut allergy?
A- History of hay fever and asthma when exposed to cats
B- She had hives 10 minutes after eating peanuts 1 year ago and has tried to avoid them
since
C- Blood test showing IgE specific for peanuts
D- Positive skin prick testing with peanut extract
E- Blood test showing IgG specific for peanuts
F- A hair sample sent for allergy testing had positive results.
5|P a ge
15- A 24-year-old medical student orders Chinese food. He explains to the restaurant that he is
allergic to peanuts, and the person who took the order guarantees the food will contain
none. An hour later, the student's roommate finds him dead on the kitchen floor.
Postmortem examination shows evidence of asphyxiation but no other anatomical
changes. The only laboratory abnormality is a very high mast cell tryptase level of 573 μg/L
(reference range, 13μg/L). Which of the following diagnoses is most likely correct?
A- Anaphylaxis
B- Bacterial food poisoning
C- Choking
D- Strangulation
E- None of the above
16- A 34-year-old man develops a boil (furuncle) on the chest. The pus consists mainly of
neutrophils. Which of the following statements about neutrophils is true?
A- Neutrophils in the pus may have been circulating in the blood for several weeks before
extravasating to the site of infection.
B- In the majority of cases, neutrophils respond to viral infection.
C- Neutrophils are attracted to the site of infection by interleukin-4 secreted by Th2 cells.
D- Neutrophils arriving at the site of infection recognize pathogens by a variety of means
and attempt to phagocytose them.
E- Most neutrophils survive the encounter with infection and migrate back into the blood.
17- A 58-year-old man underwent cancer chemotherapy 10 days ago. He is now feeling unwell
and has a fever (39.8°C). He has a very low neutrophil count of 380/uL. Which of the
following statements about neutropenic sepsis is true?
A- A thorough examination will reveal pus at the site of infection so that appropriate
therapy can be selected.
B- Although the innate immune system is damaged, the adaptive immune system usually
responds to these infections and the risk of death is low.
C- Because bacteria can spread through the blood unimpaired, the main risk is pus
formation in vital organs, such as the brain.
D- Other components of the innate immune system recognize the infection and secrete
large amounts of cytokines, which lead to a dramatic fall in blood pressure and cardiac
output.
E- Because so few neutrophils are present, an acute-phase response does not develop.
6|P a ge
18- The HLA gene sequences of two unrelated individuals are unlikely to be the same. Which
one of the following is correct?
A- There is a very high rate of mutation of the HLA genes during fetal life.
B- HLA genes are polymorphic.
C- HLA gene segments are recombined.
D- There is a high rate of mutation of the HLA genes in the bone marrow.
E- During meiosis, HLA genes mutate.
19- A 19-year-old woman ruptured her spleen in a car accident. The spleen is removed
surgically. Which of the following statements regarding her risk of infection is true?
A- The increased risk of infection only lasts 3 months until the spleen grows back.
B- She is at high risk of viral infections such as shingles (varicella zoster).
C- The risk of infection would be reduced by having a bone marrow transplant.
D- She is at risk of invasive infections by bacteria such as Pneumococcus.
E- She is at high risk of infection by the fungus Candida.
20- A 32-year-old has a 1-month history of unilateral lumps in his groin. He is otherwise well.
The lumps are consistent with enlarged right-sided inguinal lymph nodes. Two nodes are
palpated, both of which are about 1 cm and soft. Which infection are these nodes most
consistent with?
A- Epstein-Barr virus (infectious mononucleosis)
B- HIV
C- Fungal infection of the foot
D- Tuberculosis
E- Hepatitis B
21- Which of the following is true about peripheral T-cell tolerance?

A- Antigen given by mouth provokes a greater response than antigen given by injection.
B- The kidneys are immune-privileged sites.
C- Repeated exposure to the same antigen leads to an incrementally larger response.
D- Costimulation is required for an immune response.
E- Regulatory T cells overcome tolerance.
7|P a ge
22- Which one of the following is a true comparison of the innate and adaptive immune
systems?
A- The innate immune system responds within seconds to the first encounter with a
pathogen.
B- The innate immune system uses genetic recombination to produce its receptors.
C- The innate immune system uses memory to improve its response to pathogens with
each successive exposure.
D- The innate immune system can be primed to respond to pathogens using vaccination.
E- The innate immune system evolved after the adaptive immune system
23- Which of the following is true about T-cell maturation in the thymus?
A- Thymic T-cell maturation continues throughout life.
B- Immature T cells encounter pathogen-derived peptides in the thymus.
C- Immature T cells encounter self antigens in the thymus.
D- Immature T cells that do not recognize self MHC are allowed to survive.
E- T cells that bind with high affinity to self antigen and self are allowed to survive.
24- Which of the following is not true about B-cell development?

A- B cells are not produced after puberty.
B- Most B cells spend time in the bone marrow during development.
C- B cells use gene rearrangement to produce receptors.
D- B cells are the only cells that undergo somatic mutation.
E- B cells can give rise to leukemia.
25- Which of the following is true about the mucosa-associated immune system?
A- Vaccination at one mucosal surface (eg, the nose) will lead to immunity at another
mucosal site (eg, the gut).
B- Immunoglobulin E is secreted into the small intestine.
C- Most of the lymphocytes in the gut are B cells.
D- More than 50% of food proteins trigger an immune response.
8|P a ge
26- Which of the following is true about immunoglobulin M?

A- It has a dimeric structure.
B- It is small enough to enter tissues and cross the placenta.
C- It is secreted in the gut.
D- It is produced early in an immune response.
E- It has a trimeric structure.
27- Which of the following is characteristic of the innate immune system?

A- Each receptor binds one specific organism.
B- It responds slowly the first time it recognizes a given invading pathogen.
C- It responds equally rapidly each time it recognizes a given pathogen.
D- It has memory for pathogens.
E- It includes T and B cells.
28- Which of the following about Toll-like receptors (TLRs) is true?

A- They recognize common molecular motifs, such as lipopolysaccharide, found on large
numbers of pathogens.
B- TLR genes undergo genetic recombination in order to produce a diverse range of very
specific molecules.
C- They are expressed only on the cells of the innate immune system, which migrate to
body surfaces to detect infection.
D- They participate in antigen presentation to T cells.
E- They participate in antigen presentation to B cells.
Question 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Answer B B C D A C E C D C A B D E A D D B D C
Question 21 22 23 24 25 26 27 28
Answer D A C A A D C A
9|P a ge
|Page٠
IMMUNOLOGY
PAST YEARS QUESTIONS
Presented to you by: Mohammed Shatnawi
1- What is nonspecific immune system?

a. Innate
b. Adaptive
2- Immunological unresponsiveness to self-antigens is called?

A.Tolerance
B. Tolerogen
C. Memory
D. Acquired immunity
E. ADCC
3- Administration of human immunoglobulin preparations containing anti–rabies

virus antibodies
a. Active humoral immunity
b. Passive humoral immunity
c. Active cell-mediated immunity
d.Passive cell-mediated immunity
4- Specific antibodies are readily detectable in serum following primary contact

with antigen after:
a. 1 hour
b. 3-5 weeks
c. 5-7 days
d. 10 minutes
|Page١
5- Which of the following can be accurately called a cytokine?
a. A cell surface antigen receptor on lymphocyte
b. An antibody secreted by a B cell
c. A protein secreted by a T lymphocyte that activates a macrophage
d. A lipid secreted by a Natural Killer cell that activates a B cell
e. A nuclear protein that regulates lymphocyte gene expression
6- Around the central arteriole in the spleen, we have:

A. Macrophages
B. T Cells
C. B Cells
D. NK cells
E. Dendritic Cells
7- What is not a cellular component of the innate immune system?

a. Macrophages
b. natural killer cells
c. B cells
d. Eosinophils
8- Which of the following contain major basic protein ?

a. Neutrophils
b. Eosinophils
c. NK Cells
d. Macrophages
e. B cells
|Page٢
9. Which surface receptors are specific for B cells :
a. CD 34
b. CD 19
c. CD 4
d. CD 3
10 . Interferons ?
a. Induce enzyme synthesis in the target cell
b. found only in mammalian
c. specific to individual virus
d. target only infected cells
e. have 5 types
11. Plasmacytoid Dendritic cells mainly secrete:

a. Type I interferons
b. Tissue Necrosis Factor
c. IL- 5
12. Which of the following does not protect body surfaces:

a. Skin
b. Mucus
c. Gastric acid
d. Salivary amylase
e. Gut microflora
13. Acute inflammation characteristically involves:

A. Constriction of arterioles
B. Capillary endothelial cell enlargement
C. Influx of macrophages
D. Influx of mast cells
E. Influx of neutrophils
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14. A plasma cell secretes:
a. Antibody of a single specificity related to that on the surface of the parent B-cell
b. Antibody of two antigen specificities
c. The antigen it recognizes
d. Many different types of antibody
e. Lysozyme
15. MHC genes encode:

a. Complement component C2
b. Tumor necrosis factor
c. Complement component c4
e. DM
16. Which of the following is not of myeloid origin:

a. Eosinophils
. b. basophils
c. Neutrophils
d. NK cells
e. Mast cells
17 . Which of the following Is correct:

a. chemokines' effect on Integrins is calledChemokinesis
b. CXCR1 cytokine receptor binds CX3CL
c. rolling doesn't change the cytoskeleton of the leukocyte
d. Effector T cells carry all selectins
|Page٤
18. Which of the following is correct
a. Respiratory epithelium has type 1 MHC, not type II
b. Erythrocytes express type I MHC BUT not type II
c. Erythrocytes express type II MHC BUT not type 1
d. macrophages express type I MHC BUT not type II
e. Dendritic Cell express type II MHC BUT not type I
19. Extensive allelic polymorphism is found in MHC:

A. DRbeta
B. DRalpha
C. beta2-microglobulin
D. Class I alpha3 domain
E. Class II beta2 domain
20. s1p1 is:

a. protein mediator
b. lipid mediator
c. carbohydrate mediator
d. cytokine
21. Which of the following is correct?

a. In bone marrow,least differentiated hematopoietic cells have CD34 markers
b. T cells mature in bone marrow
c. Least differentiated hematopoietic cells have CD19 markers
22. According to the clonal selection hypothesis, which of the following is correct
A. Lymphocyte specificity is determined by exposure to an antigen
B. Clones of lymphocytes specific for antigens develop prior to exposure to the antigens
C. Each clone of lymphocytes express receptors for many different antigens
D. Antigen binding to secreted antibody stimulates proliferation of the B cell that secreted the
antibody
|Page٥
23. Which of the following displays lipid antigens for recognition by NKT cells?
A. CD1
B. CD2
C. CD3
D. CD4
E. CD8
24. The required number of complexes of a microbial peptide and a particular

class II MHC allele onthe surface of an antigen-presenting cell to initiate a T cell
response specific for the viral peptide is
A. One
B. All the MHC molecules on the cell must be complexed with the peptide
C. About 0.1% of the total number of class II MHC molecules on the cell surface
D. Greater than 106
25. Which of the following statements about microbial antigen presentation is

correct
A. Class I MHC molecules display peptides derived mainly from cytosolic microbial proteins for
recognition by CD8+ T cells
B. Class I MHC molecules display peptides derived mainly from cytosolic microbial proteins
forrecognition by CD4+ T cells
C. Class II MHC molecules display peptides derived mainly from cytosolic microbial proteins
D. Class II MHC molecules display peptides derived mainly from extracellular microbial proteins
E. Class II MHC molecules display peptides derived mainly from extracellular microbial proteins
forrecognition by B cells
|Page٦
26. ALL OF THE FOLLOWING ARE CORRECT ABOUT ACQUIRED
IMMUNITY EXCEPT
a. Antigen specific
b. Immediate/ rapid response after antigen exposure
c. antigen dependent
d. immunological memory
e. discriminates between self/ nonself
27. Earliest sign of initial T cell activation:

a. CD69
b. CD 19
c. CD 21
d. CD 8
28. What happens first in when tissues are injured?

a. cytokines release
b. Neutrophil influx
c. lymphocytes activation
29. Acquired immunity is specific, in contrast to innate immune system which is:
a. slow
b. Has immunological memeory
c. Genetically determinant
d. antigenic specific
|Page٧
30. Which of the following is not part of class 2 MHC:
a.ubiquitin
b. clip
c. invariant chain
d. cathepsins
31. What is the function of alternative activation:

A. Phagocytes
B. Antigen presenting to T helper cells
C. Antibody dependent cell mediated cytotoxicity
D. kill microbes
E. Tissue Remodeling
32. Regarding the immune cells, which of the following is true?

a. In bone marrow, the hematopoietic stem cell and the progenitor cell loo; identical under
themicroscope
b. in monocyte-macrophage system , all the cells are monocytes or monocyte derivative
c. Granulocytes come from the lymphoid lineage .
33. High endothelial venules in lymph bind to :

a. L- selectin
b. P selectin
c. L ligands
|Page٨
34. LYSOZYME:
a. Is a cytoplasmic organelle
b. Activates complement
c. Is a proteolytic enzyme
d. Splits peptidoglycan
e. Is released by mast cells
35. Chemokineareclassified according :

a. N – terminal cysteine
b. Structure
c. function
d. target
36. WHICH ONE OF THE MOLECULES IS RESPONSIBLE FOR EXIT THE

LYMPHOCYTESFROM THE LYMPH NODE :
a. S1PR1
b. Integrins
c. selectins
d. Immunoglobulins
37. Which one of the following is the most professional antigen presenting cell :
a. Neutrophils
b. Macrophages
c. Dendritic cells
d. Microglial cells
e. Mast cell
|Page٩
38. Which one of the cytokines is a chemokine:
a. IL-6
b. IL-1
c. IL-8
d. IL-2
39. Which one of the following is responsible for moving the lymphocytes from
the blood to the lymphnode:
a. Efferent lymphatic vessel
b. Afferent lymphatic vessels
c. High endothelial venule
40. Moving of the molecules according to the chemical gradient is called

a. Chemotaxis
b. degranulation
c. phagocytosis
d. none of the above
41. Type of the lymphocyte that hasn’t been exposed to antigen is called
a. Memory lymphocytes
b. Effector lymphocytes
c. Naïve T lymphocytes
d. plasma cells
e. cytotoxic T cell
| P a g e ١٠
42. The differentiation and maturation of lymphocytes in the bone marrow will
beactivated by
a. MHC
b. Positive and negative control
c. cytokines hormones
d. DNA rearrangement
43. Which one of the following is a primary immune organ

a. Lymph node
b. Thymus
c. Spleen
44. Which one of the following will cause rolling adhesion

a. Integrin
b. Selectin
c. modules
45. All of the following are MHC encoded except

a. Alpha 1 of MHC class I
b. Alpha 2 of MHC class I
c. Beta macroglobulin of MHC I
d. Alpha 3 of MHC class I
46. The function of the complement is:

a. stimulate phagocytosis of infected cell
b.cross link allergens
c. Phagocytose antigens
d. mediate release of histamine
| P a g e ١١
47. All of the following are correct about lymphocytes except:
a. They are separated from the myeloid pathway in the bone marrow
b. They contain large nucleus and distinct cytoplasm
c. all lymphocyte are part of the adaptive immunie system
48. Which one of the following consist of white and red pulps
a. Spleen
b. Thymus
c. Lymph node
49. LYSOZYME :
a. Is a cytoplasmic organelle
b. Activates complement
c. Is a proteolytic enzyme
d. Splits peptidoglycan
e. Is released by mast cells
50. The basic ig unit is composed of

a. 2 identical heavy and 2 identical light chains
b. 2 identical heavy and 2 different light chains
c. 2 different heavy and 2 identical light chains
d. 2 different heavy and 2 different light chains
e. Non-covalently bound polypeptide chains
51. Which of the following statements does not apply to IgG

a. Appears early in the primary immune response
b. Neutralizes bacterial toxins
c. Can fix complement
d. Crosses the human placenta
e. Opsonizes bacteria
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52. IGM :
a. Is usually of high affinity
b. Is most commonly tetrameric
c. Has the same number of constant domains as IgG
d. Is a weak bacterial agglutinator
e. Is the main class of the 'natural antibodies
53. IGD :
a. Is pentameric
b. Is resistant to proteolytic degradation
c. Is present mainly as a surface receptor on B-cells
d. Is present with unusual frequency in myelomas
e. Is abundant in milk
54. IGE
a. Is abundant in saliva
b. Binds strongly to mast cells
c. Cannot bind to macrophages
d. Activates the complement cascade
e. Has an insignificant role in worm infestations
55. Which one of the following will not affect the antigen immunogenicity
a. Foreignness
b. Chemical composition
c. structure
d. Physical nature
e. Genetic background (species,individual)
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56. ALL OF THE FOLLOWING ARE TRUE ABOUT ANTIBODIES EXCEPT :
a. Found on b lymphocytes surface
b. Complement fix
c. Predominate the primary immune response
d. Are glycoproteins
e. They are molecule with single, defined A.A sequence
57. Clonal selection occurs when antigen is encountered by

A. Neutrophils
B. Mast cells
C. T-cells
D. Basophils
E. Eosinophils
58. A complement component which is strongly chemotactic for neutrophils is :

A. C9
B. C5a
C. C3
D. C3b
E. C5b
59. The mononuclear phagocyte system does not include :

A. Monocytes
B. Kupffer cells
C. Kidney mesangial cells
D. Lymph node medullary macrophages
E. Endothelial cells
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60. A polymorphonuclear neutrophil (PMN ) :
A. Is a bone marrow stem cell
B. Is closely similar to a mast cell
C. Contains microbicidal cytoplasmic granules.
D. Is not a professional phagocytic cell
E. Has granules which stain with eosin
61. Eosinophils do not:

A. Stain with basic dyes
B. Contain a major basic protein
C. Contain peroxidase
D. Give a respiratory burst on activation
E. Have C3b receptors
62. Intracellular parasites within macrophages are killed more readily in the
presence of :
A. Antibody
B. Kinins
C. Properdin
D. Gamma-interferon
E. Anaphylatoxin
63. Secondary antibody responses are better because :

A. They provide defense against unrelated antigens
B. The antibody can be made by both T and B cells
C. Complement-fixing antibodies are made
D. They do not require T-cell help
E. They are stronger and faster
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64. The secondary, but not the primary, immune response is based on :
A. Memory
B The bonus effect of multivalency
C. Complement activation
D. Mast cell degranulation
E. Clonal selection
65. A Fab fragment :

A. produced by pepsin treatment.
B. produced by separation of heavy and light chains.
C. Binds antigen
D. Lacks light chains.
E. Has no interchain disulfide bonds
66. The complementarity determining regions

A. Are restricted to light chains .
B. Are in the constant part of the lg molecule .
C. Bind to Fc receptors
D. Are concerned in antigen recognition.
E. Occur at the C - terminal end of the peptide chains
67. Ig idiotypes are found:

A. In the constant region of the heavy chain.
B. In the constant region of the light chain.
C. In the hinge region .
D. In the variable region of both heavy and light chains.
E. Only in the light chain
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68. A B-cell is able to make cell-surface and secreted versions of antibody using
A. Different gene pools
B. Differential splicing ( alternative splicing )
C. Different heavy chain class but the same light chain
D. Different light chain class but the same heavy chain
E. F(ab')2 fragments
69. The percentage of human peripheral blood T-cells bearing a gamma delta T-
cell receptor is
A. 30–80%
B. 1-5%
C. 100%
D. 0%
E. Only present during mycobacterial infections
70. The MHC class I heavy chain consists of :

A. Beta2-microglobulin
B. Three Ig-type domains
C. A truncated MHC class II heavy chain
D. Three globular domains
E. Two globular domains
71. MHC class III genes encode :

A. Complement component C3
B. Tumor necrosis factor
C. IL-2
D. Beta2-microglobulin
E. HLA-DQ
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72. Expression of MHC genes is :
A. Codominant
B. Dominant for maternal genes
C. Dominant for paternal genes
D. Dependent on thymic selection
E. Totally dependent on the antigenic exposure of the individual
73. The molecules mediating signal transduction following antigen binding to cell
surfaceimmunoglobulin on a B-cell are called:
A. Fc
B. Ig-alpha and Ig –beta
C. MHC
D. CD4
E. CD8
74. Each chain of the T-cell receptor consists of :

A. An Ig heavy chain
B. Two Ig-type domains
C. A fibronectin-type domain
D. Glycolipid molecules
E. Four Ig-type domains
75. The T-cell receptor for antigen is :

A. Derived from the immunoglobulin gene pool by alternative splicing.
B. A tetramer
C. A homodimer
D. A heterodimer
E. A single chain molecule
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76. hapten is:
A. An epitope
B. A paratope
C. A small chemical grouping which reacts with preformed antibodies
D. A carrier
E. An immunogen
77. The T- cell receptor antigen recognition signal is transduced by:

A. TCR alpha chain.
B. The TCR beta chain.
C. CD1
D. CD2
E. CD3
78. MHC class II molecules are found on

A . Virtually all cells in the body .
B .B cells, dendritic cells and macrophages
C. Only gamma-interferon activated cells
D. Virtually all nucleated cells in the body
E. Only on virally-infected cells
79. The antiqen moiety on an antigen-presenting cell recognized by the alpha beta
T-cell receptor is:
A. Native protein antigen plus major histocompatibility complex (MHC) molecule
B. Processed (peptide) antigen plus MHC
C. Processed peptide antigen.
D. Native antigen
E. MHC alone
80. The processing of cytosolic protein involves:

A. Transport into late endosomes .
B. Proteasome-mediated cleavage.
C. Displacement of invariant chain .
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D. Displacement of beta 2 -micro microglobulin.
E. Binding to the MHC class II groove
81. TCR recognition of peptide-MHC class II depends on:

A. Covalent binding
B. Very high affinity interactions
C. CDR-mediated binding
D. A minimum of 2 peptides occupying the binding groove of each MHC molecule
E. The presence of beta2 microglobulin
82. CD1:
A. Is encoded in the MHC region
B. Structurally is most similar to MHC class II molecules
C. Can present antigens to gamma delta, but not alpha beta, T-cells
D. Can present lipid antigens
E. Is encoded by a single gene
83. An epitope :
A. Is the area on an antigen which contacts antibody
B. Is the area on an antibody which contacts antigen
C. Requires both antigen-binding arms of the antibody molecule for its recognition
D. Is usually composed of a linear sequence of amino acids
E. Is usually associated with a concave region of the antigen
84. Peptides produced by processing of cytosolic proteins largely

A. Are generated in late endosomal vacuoles
B. Enter the endoplasmic reticulum by diffusion
C. Are presented at the cell surface with MHC class II to CD4 T-helpers
D. Are presented at the cell surface with MHC class II to CD8 cytotoxic T-cells
E. Are presented at the cell surface with MHC class I to CD8 cytotoxic T-cells
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85. Antigenic peptides in the MHC class I groove
A. Are usually over 12 residues in length
B. Are usually under 12 residues in length
C. Extend beyond the groove
D. Usually have 3 or more invariant anchor residues
E. Do not vary at non-anchor residues
86. The thoracic duct

A. Enters the spleen.
B . Directly drains the lymph nodes.
C. Forms the interface between the lymph and blood.
D. Transports T-cells from the bone marrow to the thy
E. is a part of the lamina propria
87. Which of the following lymphoid tissues is unencapsulated:

A. Thymus
B. Lymph node
C. Spleen
D. Tonsil
E. MALT
88. When Langerhans' cells differentiate into fully mature dendritic cells (DCs)
they :
A. Downregulate CD1 expression
B. Increase their endocytic activity
C. Increase expression of B7.1
D .Decrease expression of B7.2
E. Become resistant to infection by HIV-1
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89. The spleen is largely involved with the response to antigens which are in the
A. Tissues
B. Blood
C. Gut
D. Lungs
E. Urogenital tract
90. An example of a privileged immunological site is the

A. Bone marrow
B. Skin
C. Testis
D. Lung
E. Waldeyer's ring
91. LFA-1 belongs to which family of molecules

A. Complement receptors
B. Cytokine receptors
C. Integrins
D. VLA
E. Selectins
92. In the immunological synapse

A. The acetylcholine receptor in expressed on the T-cell
B. Production of substance P by the antigen-presenting cell is a key event
C. The initial interaction between TCR and MHC is unstable
D. Adhesion molecule pairs eventually move to the center of the synapse
E. The B7–CD28 interaction is redundant
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93. Activation of resting B-cells by T-helpers depends directly upon costimulatory
interactionbetween:
A.CD40and CD40L .
B. B7 and CD28 .
C. B7and CTLA 4.
D. CD4 and MHC class II
94. IFN-gamma and TNF (TNF alpha) can act synergistically :

A. To downregulate expression of MHC class I
B. Because IFN-gamma downregulates expression of TNF receptors
C. To upregulate expression of MHC class II
D. Because they both bind to the same receptor
E. Because they cross-link IFN-gamma and TNF beta receptors
95. Prior to isotype switching , B cells express :

A. IgA alone
B. IgA and IgM
C. IgM and IgD
D. IgD alone
E. no surface Ig
96. Which one of the following cytokines can mediate release of acute phase
proteins from the liver ?
A. IL-10
B. TGF beta
C. IL-6
D. IL-12
E. IL-8.
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97. Dendritic cells can be driven from a resting state to an activated state by the
T-cell surfacemolecule:
A. TCR
B. CD40L
C. CD28
D. B7
E. CD40
98. Th1 cells secrete

A. CD4
B. IL-4
C. IL-5
D. IL-6
E. Interferon-gamma
99. Negative feedback on adaptive B-cell responses is mediated by :

A. Antigen specific IgM
B. Antigen specific IgG
C. Just antigen neutralization
D. Fc gamma receptors on macrophages
E. F(ab')2 anti-mu
100. IgG antibodies :

A. Are the earliest class to appear in an immune response
B. Are normally dimeric in mucosal secretions
C. Remain of low affinity
D. Inhibit antibody responses through the Fc gamma receptor FcgRIIB1 on B-cells
E. Augment antibody responses through the Fc gamma receptor FcgRIIB1 on Bcells
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101. Which of the following is the earliest site of hematopoiesis in the embryo
A. Bone marrow
B. Liver
C. Spleen
D. Yolk sac
E. Thymus
102. Which immunoglobulin class crosses the placenta to provide a high level of
passive immunity atbirth ?
A. IgA
B. IgD
C. IgE
D. IgG
E .IgM
103. P-selectin pairs with :

A. LFA-3
B. LFA-1
C. ICAM-1
D. Sialyl Lewisx
E. Beta2 integrin molecules
104. Classical NK cells

A. Have rearranged T-cell receptor genes
B. Are unaffected by IFN alpha
C. Are more active against targets with upregulated MHC class I
D. Can kill certain virally-infected cells
E. Can kill all virally-infected cells
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105. Protection against worm infestations is particularly associated with an
increase in
A. IgD
B. IgE
C. IgG
D. IgA
E. IgM
106. In class I MHC pathway of antigen presentation, peptides generated in

cytosol are transportedto endoplasmic reticulum in which of the following ways
a- By ATP-dependent transporter via TAP
b- By receptor-mediated endocytosis
c- Via the proteasome
d- Through membrane pores
e- By passive diffusion
107. Which of the following is a human class I MHC molecule

a- CD8
b- HLA-B
c- HLA-DR
d- HLA-DP
108. Alpha beta T-cell receptors recognize

A. Native antigen
B. Free linear antigenic peptide
C. MHC beta2-microglobulin
D. Linear antigen peptide in the MHC groove
E. Lipid and glycolipid antigens associated with the MHC.
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109. If a plasma cell becomes cancerous, it will become which type of cancer
a- Acute myeloid leukemia
b- Essential thrombocytosis
c- Chronic lymphocytic leukemia
d- Multiple myeloma
e- Acute lymphoblastic leukemia
110. Th17 cells are associated with the following

a-Dominated by neutrophils & some eosinophils
b- Dominated by neutrophils & some monocytes
c- Eosinophils
d- Macrophages
111. A major function of TH1 cells is to activate macrophages. Which molecules

expressed by TH1cells are essential for this function ?
a- IL-1 and TNF
b- CD8 and Fas ligand
c- IL-17 and NO
d- Interferon γ and CD40 ligand
e- IL-4 and ICOS
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112. Which of the following is one way a cytokine made by TH2 cells contributes
to atopic disease(allergy)
a- IL-17 stimulates TNF production by macrophages
b- IL-5 induces basophil degranulation
c- IL-13 activates eosinophils
d- IL-4 induces B cell class switching to IgE
e- IL-22 causes mast cell degranulation
113. Alternative macrophage activation is characterized by which one of the

following ?
a- Reactive oxygen species (ROS) generation
b- IL-1 production
c- Microbial killing
d- IL-10 and TGFβ secretion
e- IL-4 and IL-13 secretion
The End
GOOD LUCK
& May the odds be ever in your favour
By: Mohammed Shatnawi
| P a g e ٢٨

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ALI ALMOMANI

-1Which of the following does not protect body surfaces:

-2Pattern recognition receptors (PRR) include:

-3The mononuclear phagocyte system does not include:

- 4A polymorphonuclear neutrophil (PMN):

A Is a bone marrow stem cell.

-5Neutrophil defensins are:

-6Acute inflammation characteristically involves:

-8Which of the following is not an acute phase protein:

A Serum amyloid P component.

-9Natural killer (NK) cells do not:

A Stain with basic dyes.

b) Revert back to the previous stage of meiosis

c) Recombine regions of DNA

d) None of the above

a. Naturally acquired passive immunity

-18B cells mature in the……….. while T cells mature in the

a. Thymus/bone marrow and gut associated lymphoid tissue (GALT)

-19Which of the following immune cells/molecules are most effective at destroying

-22The specificity of an antibody is due to

-23In agglutination reactions, the antigen is a………

a. whole cell/soluble molecule

-24B Cells are activated by

-24Fusion between a plasma cell and a tumor cell creates a

-25Monoclonal antibodies recognize a single:

-28The ability of an organism to resist infections by the pathogens is called:

-29Which of the following compounds is NOT found in tears?

-30Name the cytokines which released in response to virus infection?

-31Name the first cell which recruited at the place of infection.

- 32Which of the following antibody gives a primary immune reaction?

-33Which of these is NOT a characteristic feature of adaptive immunity?

-34Synthesis of antibodies takes place by which of the following cells?

a) Bone marrow cells

-35Which immunoglobulin can pass through placenta?

-36Name the class of immunoglobulin which has a pentameric structure?

-37Which of these immunoglobulins is present in external secretion?

-38Name the class of immunoglobulin which takes part in hypersensitivity reaction?

-39Name the cell which receives antigen presented by MHC molecule.

-40Name the class of MHC which is recognized by CD4 TH cell.

a) MHC cannot recognize T cells

- 42Which MHC molecule recognizes CD8 TC cells?

-43Mark the one, which is NOT a lymphoid progenitor cell.

-44What is the origin of B-cell?

-45Chediak-Higashi syndrome is caused due to deficiency of:

-46Which of the following is NOT polymorphonuclear leukocytes?

-48Name the molecule which constitutively expressed on the dendritic cell?

a) Follicular dendritic cell

-50Which of the tracing is NOT the role of T-cell receptor complex?

-51Name the syndrome occurs in children due to deficiency of the thymus.

-52Which of the following steps is NOT involved in the activation of T-cell?

a) Double positive cell converts to single positive T-cell

-53Name the cytokines which act as a T-cell growth factor?

-54Cytokinin which acts as a growth factor of B-cell is

-55Mark the correct role of cytosolic T-cells.

a) Help in B-cell activation

-56Which of the following acts as a coreceptor for B-cell activation?

-57Mark the one which is NOT used in generating antibody diversity?

a) Combinatorial V(D)J joining

-59Innate immunity present since birth and it has no memory.