Immune system

Q1)
A 20-year-old man presents with low back pain and stiffness. Radiographic
examination finds extensive calcification of the vertebral and paravertebral
ligaments, producing a bamboo spine. Rheumatoid factor is not identified
in his peripheral blood. This patients abnormalities are most likely the
result of a disorder that is most closely associated with which one of the
following HLA types?
a.HLA-A3
b. HLA-B27
c. HLA-BW47
d. HLA-DR3
e. HLA-DR4

Q2)
Ten minutes after being stung by a wasp, a 30-year-old man develops
multiple patches of red, irregular skin lesions over his entire body.
These lesions (urticaria) are pruritic, and a new crop of lesions develops
the next day. Which one of the following statements correctly describes
an important component of the pathomechanism of this immune
response?
a.Activated T lymphocytes stimulate smooth-muscle cells
b. IgA is attached to basophils and mast cells
c. IgA is attached to lymphocytes and eosinophils
d. IgE is attached to basophils and mast cells
e. IgE is attached to lymphocytes and eosinophils

Q3)
After receiving incompatible blood, a patient develops a transfusion
reaction in the form of back pain, fever, shortness of breath, and
hematuria. Which one of the following statements best classifies this
type of immunologic reaction?
a.Systemic anaphylactic reaction
b. Systemic immune complex reaction
c. Delayed type hypersensitivity reaction
d. Complement-mediated cytotoxicity reaction
e. T cell-mediated cytotoxicity reaction

Q4)
A 28-year-old woman presents with increasing fatigue, arthritis, shortness
of breath, and a bimalar, photosensitive, erythematous rash. Biopsies from
this rash reveal liquefactive degeneration of the basal layer of the
epidermiswith a perivascular lymphoid infiltrate. Immunofluorescence
examinationreveals linear deposits of IgG and complement at the dermalepidermal junction in a granular pattern. Physical examination finds
bilateral pleural effusions, the fluid from which when examined
histologically reveals multiple oval amorphic eosinophilic bodies being
phagocytized by phagocytic leukocytes. Which of the following is the most
likely diagnosis?
a.Dermatomyositis
b. Rheumatoid arthritis
c. Sjogrens syndrome
d. Systemic amyloidosis
e. Systemic lupus erythematosus

Q5)
A 36-year-old woman presents with increased trouble swallowing. Physical
examination finds hypertension and sclerodactyly, while laboratory
examination finds an autoantibody against DNA topoisomerase (anti-Scl70). Which of the following biopsies is most characteristic of this disorder?
a.A conjunctival biopsy that reveals noncaseating granulomas
b. A peripheral nerve biopsy that reveals rare acid-fast bacteria
c. A skin biopsy that reveals dermal fibrosis with an absence of adnexal
structures
d. A subcutaneous fat biopsy that reveals an infiltrate of plasma cells and
Eosinophils
e. A temporal artery biopsy that reveals fragmentation of the internal
elastic lamina

Q6)The major immunoglobulin class in normal adult human serum is

Q7) The predominant antibody found in a primary immune response is
Q8) Which immunoglobulin class is found on the surface of mast cells?
Q9) Which immunoglobulin class is a major component of mucosal
secretions?
Q10) Which immunoglobulin class can cross the placenta?
A.IgA
B.IgG
C.IgM
D.IgE
E.IgD

Q11)
Which of the following cells are important in an innate immune
response to extracellular bacteria?
A.T lymphocytes
B.B lymphocytes
C.Neutrophils
D.Eosinophils
E.Mast cells

Q12)
Which one of the following is the most potent and effective
antigenpresenting cell (APC)?
a.Monocytes-macrophages
b. Mast cells
c. T lymphocytes
d. B lymphocytes
e. Dendritic-Langerhans cells

Q13)
A newborn infected with group B streptococcus would produce and
secrete antibody of which of the following class(es)?
a.IgM only
b. IgG only
c. IgM and IgG
d. Neither IgM nor IgG
e. IgA only

Q14)
A 25-year-old woman has had increasing malaise, a skin rash of her face
exacerbated by sunlight exposure, and arthralgias and myalgias for the
past month. On physical examination she has mild pedal edema. On
auscultation, a friction rub is audible over the chest. Laboratory findings
include pancytopenia and serum creatinine 3 mg/dL. Urinalysis shows
hematuria and proteinuria. A serologic test for syphilis yields a falsepositive result. A renal biopsy shows a slight increase in mesangial cells
and granular deposits of IgG and complement in the mesangium and along
the basement membrane. Which of the following mechanisms is most likely
involved in the pathogenesis of her disease?
(A) Activation of TH17 cells
(B) Defective clearance of apoptotic nuclei
(C) Increased production of IFN-
(D) Molecular mimicry
(E) Superantigen activation of T cells

Q15)
A 31-year-old woman notices that when she is outside in the sun for more
than 1 hour, she develops a rash on her face. Laboratory studies show
hemoglobin, 10.9 g/dL; hematocrit, 32.9%; platelet count, 156,800/mm3;
and WBC count, 4211/mm3. Urinalysis shows no blood or glucose; there
is 3+ proteinuria. The ANA test result is positive with a titer of 1 : 2048 and
a diffuse homogeneous immunofluorescent staining pattern. Which of the
following complications is most characteristic of her illness?
A) Bronchoconstriction
B) Cerebral lymphoma
C) Hemolytic anemia
D) Keratoconjunctivitis
E) Sacroiliitis
F) Sclerodactyly

Q1)
A 20-year-old man presents with low back pain and stiffness. Radiographic
examination finds extensive calcification of the vertebral and paravertebral
ligaments, producing a bamboo spine. Rheumatoid factor is not identified
in his peripheral blood. This patients abnormalities are most likely the
result of a disorder that is most closely associated with which one of the
following HLA types?
a.HLA-A3
b. HLA-B27
c. HLA-BW47
d. HLA-DR3
e. HLA-DR4

b. HLA-B27

Q2)
Ten minutes after being stung by a wasp, a 30-year-old man develops
multiple patches of red, irregular skin lesions over his entire body.
These lesions (urticaria) are pruritic, and a new crop of lesions develops
the next day. Which one of the following statements correctly describes
an important component of the pathomechanism of this immune
response?
a.Activated T lymphocytes stimulate smooth-muscle cells
b. IgA is attached to basophils and mast cells
c. IgA is attached to lymphocytes and eosinophils
d. IgE is attached to basophils and mast cells
e. IgE is attached to lymphocytes and eosinophils

d. IgE is attached to basophils and mast

cells

Q3)
After receiving incompatible blood, a patient develops a transfusion
reaction in the form of back pain, fever, shortness of breath, and
hematuria. Which one of the following statements best classifies this
type of immunologic reaction?
a.Systemic anaphylactic reaction
b. Systemic immune complex reaction
c. Delayed type hypersensitivity reaction
d. Complement-mediated cytotoxicity reaction
e. T cell-mediated cytotoxicity reaction

A-Q3)
A blood transfusion reaction is a type II hypersensitivity reaction that is
mediated by antibodies reacting against antigens present on the surface
of blood group antigens or irregular antigens present on the donors red
blood cells. Type II hypersensitivity reactions result from attachment of
antibodies to changed cell surface antigens or to normal cell surface
antigens. Complement-mediated cytotoxicity occurs when IgM or IgG
binds to a cell surface antigen with complement activation and
consequent cell membrane damage or lysis.
Systemic anaphylaxis is a type I hypersensitivity
Systemic immune complex reactions are found in type III reactions
Delayed type hypersensitivity is type IV
T cellmediated cytotoxicity leads to lysis of cells by cytotoxic T cells in
response to tumor cells, allogenic tissue, and virus-infected cells. These
cells have CD8 antigens on their surfaces.

Q4)
A 28-year-old woman presents with increasing fatigue, arthritis, shortness
of breath, and a bimalar, photosensitive, erythematous rash. Biopsies from
this rash reveal liquefactive degeneration of the basal layer of the
epidermiswith a perivascular lymphoid infiltrate. Immunofluorescence
examinationreveals linear deposits of IgG and complement at the dermalepidermal junction in a granular pattern. Physical examination finds
bilateral pleural effusions, the fluid from which when examined
histologically reveals multiple oval amorphic eosinophilic bodies being
phagocytized by phagocytic leukocytes. Which of the following is the most
likely diagnosis?
a.Dermatomyositis
b. Rheumatoid arthritis
c. Sjogrens syndrome
d. Systemic amyloidosis
e. Systemic lupus erythematosus
e. Systemic lupus erythematosus

Q5)
A 36-year-old woman presents with increased trouble swallowing. Physical
examination finds hypertension and sclerodactyly, while laboratory
examination finds an autoantibody against DNA topoisomerase (anti-Scl70). Which of the following biopsies is most characteristic of this disorder?
a.A conjunctival biopsy that reveals noncaseating granulomas
b. A peripheral nerve biopsy that reveals rare acid-fast bacteria
c. A skin biopsy that reveals dermal fibrosis with an absence of adnexal
structures
d. A subcutaneous fat biopsy that reveals an infiltrate of plasma cells and
Eosinophils
e. A temporal artery biopsy that reveals fragmentation of the internal
elastic lamina

c. A skin biopsy that reveals dermal fibrosis

with an absence of adnexal structures

Q6)The major immunoglobulin class in normal adult human serum is

Q7) The predominant antibody found in a primary immune response is
Q8) Which immunoglobulin class is found on the surface of mast cells?
Q9) Which immunoglobulin class is a major component of mucosal
secretions?
Q10) Which immunoglobulin class can cross the placenta?
A.IgA
B.IgG
6.B

C.IgM

7 .C

D.IgE
E.IgD

8. D
10 .B

9.A

Q11)
Which of the following cells are important in an innate immune
response to extracellular bacteria?
A.T lymphocytes
B.B lymphocytes
C.Neutrophils
D.Eosinophils
E.Mast cells

C. Neutrophils

Q12)
Which one of the following is the most potent and effective
antigenpresenting cell (APC)?
a.Monocytes-macrophages
b. Mast cells
c. T lymphocytes
d. B lymphocytes
e. Dendritic-Langerhans cells

e. Dendritic-Langerhans cells

Q13)
A newborn infected with group B streptococcus would produce and
secrete antibody of which of the following class(es)?
a.IgM only
b. IgG only
c. IgM and IgG
d. Neither IgM nor IgG
e. IgA only

A) A normal newborn can make IgM antibody in response to challenge

with antigen. If IgG is detected in the newborn, it is most likely the result
of placental transfer from the mother.

Q14)
A 25-year-old woman has had increasing malaise, a skin rash of her face
exacerbated by sunlight exposure, and arthralgias and myalgias for the
past month. On physical examination she has mild pedal edema. On
auscultation, a friction rub is audible over the chest. Laboratory findings
include pancytopenia and serum creatinine 3 mg/dL. Urinalysis shows
hematuria and proteinuria. A serologic test for syphilis yields a falsepositive result. A renal biopsy shows a slight increase in mesangial cells
and granular deposits of IgG and complement in the mesangium and along
the basement membrane. Which of the following mechanisms is most likely
involved in the pathogenesis of her disease?
(A) Activation of TH17 cells
(B) Defective clearance of apoptotic nuclei
(C) Increased production of IFN-
(D) Molecular mimicry
(E) Superantigen activation of T cells

Q14)
(B) This young woman has a classic picture of systemic lupus
erythematosus (SLE)facial skin rash that is worsened by sunlight
and renal failure with proteinuria and hematuria from immune complex
deposition in the glomeruli. Defective clearance and hence increased
burden of nuclear apoptotic bodies is considered a fundamental
mechanism that underlies SLE. This along with loss of self-tolerance to
nuclear antigens gives rise to the pathogenic DNA-anti DNA immune
complexes.
Activation of TH17 cells occurs in many other immunologic disorders
such as inflammatory bowel disease.
IFN- is a product of CD4+ T cells and NK cells.
There is no evidence of delayed hypersensitivity or NK cell dysfunction in
SLE.
Molecular mimicry occurs when a microbial antigen cross-reacts with a
normal tissue as in rheumatic fever.
Widespread and non-specific activation of T cells by superantigens
occurs in toxic shock syndrome.

Q15)
A 31-year-old woman notices that when she is outside in the sun for more
than 1 hour, she develops a rash on her face. Laboratory studies show
hemoglobin, 10.9 g/dL; hematocrit, 32.9%; platelet count, 156,800/mm3;
and WBC count, 4211/mm3. Urinalysis shows no blood or glucose; there
is 3+ proteinuria. The ANA test result is positive with a titer of 1 : 2048 and
a diffuse homogeneous immunofluorescent staining pattern. Which of the
following complications is most characteristic of her illness?
A) Bronchoconstriction
B) Cerebral lymphoma
C) Hemolytic anemia
D) Keratoconjunctivitis
E) Sacroiliitis
F) Sclerodactyly

(C) This woman has systemic lupus erythematosus (SLE). Patients with
SLE can develop anti-RBC antibodies, which can cause hemolytic
anemia. Cytopenias, including leukopenia, thrombocytopenia, and
anemia, also are common.
Bronchoconstriction is a feature of bronchial asthma and can occur in
allergies as a predominantly type I hypersensitivity reaction.
Cerebral lymphomas are rare, but may occur in immunodeficient patients,
particularly patients with AIDS.
Keratoconjunctivitis can be seen in Sjgren syndrome as a result of
decreased tear production from lacrimal gland inflammation.
Sacroiliitis is a feature of many of the spondyloarthropathies, such as
ankylosing spondylitis.
Sclerodactyly is seen in scleroderma.