Immunology Questions by DR Taher [PDF]

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IMMUNOLOGY-DR TAHER



IMMUNOLOGY QUESTIONS BY DR TAHER 1-The peripheral blood leukocytes of a healthy donor were stained with fluorescentlabeled monoclonal antibodies to CD3, CD4, CD8, and CD20. They were then processed through a fluorescence-activated cell sorter. In which quadrant of which graph would the sensitized cells responsible for the tuberculin test response be found?



A.Graph A quadrant 1 B.Graph A quadrant 2 C.Graph A quadrant 3 D.Graph A quadrant 4 E.Graph B quadrant 1 F.Graph B quadrant 2 G.Graph B quadrant 3 H.Graph B quadrant 4 I.Graph C quadrant 1 J.Graph C quadrant 2 K.Graph C quadrant 3 L.Graph C quadrant 4



2-An 11-year-old male is brought in by his parents as a new patient for fever, fatigue, joint pain, and rash. The patient had a fever and sore throat several weeks ago that lasted a while but finally resolved after treatment with oral hydration and acetaminophen. The joint pain began a few days ago, comes and goes, and involves multiple joints, particularly the knees and elbows. The rash began approximately 2



IMMUNOLOGY-DR TAHER days ago. Physical examination reveals a fever of 38.6ºC (101.4ºF), rash (shown in the accompanying figure), and heart murmur with friction rub. The oropharynx is devoid of inflammation or exudates, but laboratory results show an elevated erythrocyte sedimentation rate and elevated anti–streptolysin O titer. The patient’s current symptoms are most likely due to which of the following A.Autoantibodies directed against desmoglein



B.Autoantibodies directed against the Fc portion of IgG



C.Immune response to infection cross-reacting with self antigens



D.Inability of the immune system to clear the original infection



E.Insufficient glutathione stores



3-A 17-year-old female presents to the emergency department in labor. She has received no prenatal care. Reluctantly she admits that she is a sex worker and intravenous drug user. She tests positive for HIV using the preliminary screening test and has a CD4 T cell count of 800 cells/μL. She delivers a healthy baby girl vaginally. The next day the mother’s HIV viral load is determined to be 700 copies/mL. Which of the following methodologies would best determine the infection status of the infant?



A. Enzyme-linked immunoassay detecting anti-HIV antibodies B. Enzyme-linked immunoassay detecting HIV antigens C. PCR D. Reverse transcriptase PCR E. Western blot 4-A 20-year-old male sustains a partial amputation of his left hand while operating an industrial saw. In the hour-long drive to the local doctor’s office, the man loses a significant amount of blood. The local doctor decides to transfuse the patient with blood from the patient’s co-worker; the co-worker reports to have type O negative blood. Within 15 minutes of transfusion, the patient becomes febrile and flushed,



IMMUNOLOGY-DR TAHER complains of back pain, and develops hypotension. Which of the following is most likely responsible for the patient’s symptoms following the transfusion?



A. Activation of complement B. Activation of macrophages by helper T cells C. Activation of mast cells D. Activation of the coagulation cascade E. Cytotoxic killing of donor red blood cells F. Deposition of antibody complexes in the vasculature 5-A 3-year-old male is hospitalized with edema, hematuria, and proteinuria. Immunofluorescent study of a kidney biopsy reveals granular deposits along the glomeruli. His history is significant for an infection 3 weeks ago. Which of the following best describes the symptoms of the infection that most likely precipitated his current symptoms?



A. A desquamating rash covering the entire body B. A localized, crusted rash on the face C. A vesicular, pruritic rash covering the entire body D. Fever, cough, coryza, rash, and Koplik spots in the mouth E. Fever, rhinitis, and severe paroxysmal cough 6-A 28-year-old female presents to the prison infirmary for treatment of a laceration on her left arm. The physician takes a detailed medical history and notes the following:



Born in United States to Mexican parents 14-pack/year smoker History of intravenous drug use History of cocaine use History of genital warts and recurrent genital lesions



Based on her intravenous drug history alone, for which of the following in the table below should the physician consider testing?



IMMUNOLOGY-DR TAHER



Row Hepatitis A Hepatitis B Hepatitis C HIV Herpes Simplex Virus Human Papilloma Virus Syphilis A✓✓✓✓



✓



B✓✓✓✓✓ C



✓✓



D ✓✓✓



✓



E ✓✓✓✓✓✓



A. Row A B. Row B C. Row C D. Row D E. Row E 7-A particularly virulent strain of Staphylococcus aureus is being tested for factors that contribute to virulence. When this organism is incubated with human serum, levels of complement components C4 and C2 do not decrease. Which of the following is inhibited by this virulent strain?



A. Activation of the alternative pathway B. Formation of the membrane attack complex C. IgG-mediated activation D. IgM-mediated activation E. Lectin-mediated activation 8- A 24-year-old African American male football player is struggling to maintain his weight. He is eating less and complains of general malaise and weakness in spite of following a strict diet regimen to attain his desired weight. Physical examination reveals elevated blood pressure and periorbital edema. Further workup shows microscopic hematuria on urinalysis. One week ago, the patient had sore throat that resolved on its own. A renal biopsy is performed, and light microscopy reveals the following: Which of the following is most likely causing the damage to his kidneys?



IMMUNOLOGY-DR TAHER



A. B. C. D. E.



Antibody-antigen complexes deposits in glomeruli Glomerular capillary wall thickening Glycosylation of proteins in glomerular cells IgA deposits in mesangium Proliferation of glomerular cells



9-A 6-month old girl is brought to her new pediatrician with a three-day history of fever. A review of her medical history reveals a consistently high WBC count and delayed umbilical cord separation. Her history is also significant for an infection of her umbilical cord stump with Staphylococcus aureus characterized by cellulitis, but notably without pus, and her WBC count at the time was markedly elevated (45 X 109/L). Analysis of her WBCs by flow cytometry is shown below. Which of the following pairs of markers was most likely used to determine the nature of this girl's immunodeficiency? Marker A Marker B



A. CD3 CD132 (common gamma chain)



B. CD3 CD154 (CD40L)



C. CD16 CD18



D. CD16



IMMUNOLOGY-DR TAHER MHC Class II



E. CD19 IgA



10-A 2-month-old girl is presented, with her 6-year-old brother, to a health clinic to receive routine immunizations. The family recently emigrated to the U.S. from China, and neither child has received previous immunizations. The mother is told that both children will be getting the pneumococcal vaccines, but the girl will be getting a different vaccine than her brother. The vaccine given to the girl, compared to that given the boy, contains an extra component that modifies the induced immune response. What type of molecule is this extra component?



A. Bacterial capsular polysacccharide B. Lipopolysaccharide C. Peptidoglycan D. Secreted bacterial protein E. Bacterial DNA 11-A 55-year-old man with a history of renal transplantation 5 years prior with a gradually rising plasma creatinine level for the past 6 months presents with swelling of the lower extremities. Physical examination revels pitting edema, blood pressure of 190/80 (150/70 one year prior), and nephrotic range proteinuria. Which of the following cells and molecules are the dominant instigators of this patient's pathologic process?



A. Eosinophils and IgE antibodies B. Lymphocytes, antibodies, and complement C. Lymphocytes and cytokines D. Neutrophils E. Neutrophils, monocytes, antibodies, and complement



IMMUNOLOGY-DR TAHER 12-A 32-year-old woman develops weakness of her left lower extremity. Five years previously, she had an episode of vision loss in her right eye that resolved over several weeks. A lumbar puncture shows the following results:



CSF protein: 43 mg/dL CSF glucose: 67 mg/dL CSF cell count: 0 nucleated cells CSF electrophoresis: 7 oligoclonal bands Serum electrophoresis: 0 oligoclonal bands



Her illness most likely involves which of the following mechanisms?



A. Antibodies against neurotransmitter receptors B. Cell-mediated destruction of myelin C. Damage to peripheral nerves D. Infarction of ischemic brain tissue E. Infection of cerebrospinal fluid 13-A 4-month-old infant is hospitalized with pneumonia. He has had several ear infections and one previous bout of pneumonia since birth. Laboratory analysis of his white blood cells reveals marked neutropenia, and a blood film reveals that his neutrophils, eosinophils, and granulocytes have giant granules.



What other finding would be noted in patients with the same genetic defect?



A. Eczema B. Oculocutaneous albinism C. Omphalitis D. Thrombocytopenia E. Thymic aplasia 14-A 47-year-old woman presents with fatigue, weakness, joint stiffness, joint pain, and skin discoloration. The skin of her fingers, hands, and face is thickened and hard, causing contracted fingers and decreased facial expressions. Other vague



IMMUNOLOGY-DR TAHER symptoms involving multiple organ systems are also present. Which of the following is most likely to be identified in this patient’s serum?



A. Anti-gliadin antibodies B. Anti-histone antibodies C. Anti-Scl-70 antibodies D. Anti-Smith antibodies E. Anti-SSA antibodies 15-A 3-year-old boy is seen by a pediatric specialist after developing cellulitis for the third time in 4 months. The doctor notes that the boy has pale hair, blue eyes, and patchy hypopigmentation of the skin. Attempts at funduscopic examination reveal moderate photophobia. Oral ulcers are also noted. Blood testing reveals neutropenia and hypergammaglobulinemia. Blood smear will most likely reveal which of the following?



A. Lymphocytosis B. Elevated reticulocytes C. Mononuclear cells with “owl’s eye” nuclei D. Granulocytes with giant granules E. Irregularly shaped lymphocytes 16-In comparisons of the efficacy of the live attenuated intranasal influenza vaccine (FluMist) and the injectable killed virus vaccine, it has been shown that the intranasal vaccine provides much greater protection. Which of the following statements most likely explains this finding?



A. Killed viral vaccines produce humoral immunity B. Intramuscular inoculation produces anti-hemagglutinin antibodies C. Intramuscular inoculation produces IgM antibodies D. Intranasal inoculation produces mucosal memory cells E. Intranasal inoculation stimulates IL-2 secretion 17-A patient being studied for an unusual immunologic disorder is found to lack class I MHC molecules, and homogenized lymphocyte precipitates are found to lack TAP1 molecules. Which of the following vaccines would most likely be ineffective in this patient?



IMMUNOLOGY-DR TAHER



A. Diphtheria, Tetanus, acellular Pertussis (DTaP) B. Human papillomavirus C. Measles, mumps, rubella (MMR) D. Neisseria meningitidis E. Streptococcus pneumoniae 18-A 6-month-old boy is seen by his pediatrician for epistaxis. The patient has a history of multiple bacterial and viral respiratory tract infections and eczema. Serum IgM is decreased, IgG is normal, and IgA and IgE are increased. The mean diameter of platelets is decreased. Which of the following is the most likely defect?



A. Absence of a cytoskeletal signaling protein B. Absence of interleukin-11 C. Absence of NK cells D. Failure of dsDNA repair E. Thymic hypoplasia 19-Marriage licenses in all 50 states of the United States require proof of rubella antibody titer. The antibody isotype detected in this assay that would confer protection to any fetus has which of the following descriptions?



A. A dimeric molecule found in secretions B. A monomeric cell surface antigen receptor C. An opsonin D. A pentameric complement activator E. Mast cell binding antibody 20-An investigator is conducting a study of immune responses to tumor cells in two groups of mice. Group 1 is inoculated with tumor cells transfected with the interleukin-2 gene. Group 2 is inoculated with nontransfected tumor cells. It is observed that the immune response in Group 1 is enhanced compared to the immune response in Group 2. This difference in immune response is best explained by enhanced proliferation of which of the following cell types in Group 1?



A. Dendritic cells



IMMUNOLOGY-DR TAHER B. Macrophages C. Neutrophils D. Plasma cells E. Tc lymphocytes 21-A strain of inbred mice is developed that spontaneously develop hypergammaglobulinemia, autoimmune disease, and excessive numbers of T cells in the blood. Which of the following is the most likely genetic defect?



A. Absence of complement B. Absence of Fas C. Absence of interferon-γ D. Absence of perforin E. Absence of tumor necrosis factor 22-A 3-year-old boy is discovered to have a genetic mutation that results in deficient production of IL-11. A bone marrow smear would most likely show a deficiency in which of the following cell types?



A. T lymphocytes B. B lymphocytes C. Erythrocytes D. Megakaryocytes E. Polymorphonuclear cells 23-Cells passing through the thymic cortex are exposed to normal self antigens during their development. Which of the following is true of the most important molecule in the production of single-positive CD4+ helper cells?



A. It is composed of two chains of similar length. B. It is expressed on all nucleated cells. C. Its configuration is maintained by β-2 microglobulin. D. Its gene products are A, B, and C. E. It presents peptides created inside the cell.



IMMUNOLOGY-DR TAHER 24-A 12-month-old child is referred to a specialist because of recurrent bacterial infections and failure to thrive. A lymph node biopsy reveals the absence of germinal centers. Which of the following markers is likely to be absent from this child’s peripheral blood leukocytes?



A. CD3 B. CD4 C. CD8 D. CD14 E. CD19 25-A 12-month-old boy is referred to a specialist due to a history of repeated bacterial infections. When the child’s peripheral blood leukocytes are incubated with opsonized bacteria, production of oxygen and halide radicals is reduced compared to normal controls. What is the most likely defect in this child?



A. Catalase B. Lactoferrin C. Myeloperoxidase D. NADPH oxidase E. Superoxide dismutase 26-An outbreak of parainfluenza virus in a nursing home necessitates hospitalization for several affected residents. The patients with more severe disease were observed to be making high amounts of interleukins 4, 5, 6, and 10. What cell is responsible for this pattern of interleukin production?



A. Macrophage B. Natural killer cell C. Th1 lymphocyte D. Th2 lymphocyte E. Th17 lymphocyte F. Treg lymphocyte 27-A patient recovering from a laminectomy is brought to the emergency room suffering from high fever, hypotension, and a diffuse erythematous rash that is desquamating over the palms of his hands. Blood cultures are positive for



IMMUNOLOGY-DR TAHER Staphylococcus aureus. Which of the following sets of results is most likely to characterize this patient’s condition?



IL-1 IL-6 IFN-γ TNF-α A. ↓ ↑ ↓ ↑ B. ↓ ↓ ↓ ↓ C. ↑ ↑ ↑ ↑ D. ↑ ↑ --- ↑ E. ↑ ↓ ↓ ↓ 28-Transgenic mice are generated that are incapable of expressing MHC invariant chain. Which of the following components of host defense is likely to be most directly altered in these mice?



A. Immunoglobulin M synthesis B. Cytotoxic T lymphocyte activation C. Interleukin-2 (IL-2) secretion D. Natural killer cell activation E. Neutrophilic phagocytosis 29-A patient presents to the emergency room with dyspnea, tachycardia, and diaphoresis following ingestion of peanuts. What was the first immunoglobulin produced in response to this antigen?



A. IgA B. IgD C. IgE D. IgG E. IgM 30-A “knockout” mouse strain has been developed with a complete defect in a single gene product. The B and T lymphocyte counts in this strain are within normal parameters. Serum antibody measurements reveal high titers of IgM without significant presence of IgG, IgA, or IgE. Which of the following deficiencies best explains this mouse’s condition?



IMMUNOLOGY-DR TAHER A. B7 B. CD4 C. CD40L D. Interleukin-4 E. Tumor necrosis factor-α 31-A G1P1 36-year-old woman presents to the emergency room with complaints of sudden swelling of the face and tongue, and difficulty breathing. She claims that 30 minutes ago, she was playing pillow fight with her 5-year-old daughter. Her daughter threw the pillow onto her face, and a few minutes later, her face and tongue swelled up. On further questioning, she remembers that her uncle used to have similar symptoms. She denies any recent use of a new medication or food. She has no other allergies and is up-to-date with her immunizations. She has a past medical history of an ovarian cyst managed by oral contraceptive pills, which is the only medication she is taking. On physical examination, there is extensive perioral and periorbital swelling and redness. She is not able to close her mouth completely, due to increase in tongue size. She appears to be in minor distress. She is provided oxygen and steroids. The steroids do not decrease the swelling as expected. What is the missing component that characterizes the most likely cause of her symptoms?



A. Alpha-1 antitrypsin B. C1 esterase inhibitor C. C3 D. C5–C9 complex E. CD 55 and CD 59 32-A 4-month-old female with repeated respiratory and skin infections develops an infection with an opportunistic pathogen. She is referred to a specialist who determines that she has specific mutations in recombination activating genes -1 and -2 that inhibit the functions of both proteins. Which of the following is likely to have the most nearly normal activity in this patient?



A. B cell secretion of antibodies against the Streptococcus pneumoniae capsule B. CD4 T cell response against Listeria monocytogenes C. CD8 T cell killing of Chlamydia trachomatis D. Macrophage activation and killing of Histoplasma capsulatum E. Mast cell degranulation in response to Ascaris lumbricoides F. Neutrophil killing of Staphylococcus aureus



IMMUNOLOGY-DR TAHER 33-A 14-hour-old infant female born with jaundice develops pallor, hepatosplenomegaly, and a rising unconjugated bilirubin level. She was born vaginally in an uncomplicated delivery to a 24-year-old mother from Mexico who received no prenatal care. The mother reports that this is her second pregnancy, and that both pregnancies were normal. Suspecting hemolytic disease of the newborn, the attending physician orders laboratory tests. Which of the following is the most appropriate pairing of a particular Coombs test with its best diagnostic use?



Mother's Test Baby's Test A. Test: Direct Detects: RhD antigen in the blood Test: Indirect Detects: Maternal anti-RhD antibodies B. Test: Direct Detects: Maternal anti-RhD antibodies Test: Indirect Detects: RhD antigen in the maternal blood C. Test: Indirect Detects: Maternal anti-RhD bound to fetal red blood cells Test: Direct Detects: Maternal anti-RhD antibodies



D. Test: Indirect Detects: RhD antigen in the blood Test: Direct Detects: Maternal anti-RhD bound to fetal red blood cells E. Test: Indirect Detects: Maternal anti-RhD antibodies Test: Direct Detects: Anti-RhD bound to fetal red blood cells 34-A 16-month-old Caucasian male is presented to the emergency department with a history of fever and productive cough for the last 24 hours. His past medical history is significant for several hospitalizations for severe respiratory infection and jaundice 2 weeks after delivery. Physical examination reveals crusting and dryness of his right elbow and left wrist. His CBC shows a WBC count of 9,500 and platelet count of 55,000. What is the inheritance pattern of this disease?



A. Autosomal dominant



IMMUNOLOGY-DR TAHER B. Autosomal recessive C. Trinucleotide repeats D. X-linked dominant E. X-linked recessive F. 22q11 deletion 35-A 4-year-old patient has a history of recurrent pyogenic infections caused by Staphylococcus aureus. Microscopic examination of tissue that has been affected shows few neutrophils. The mother reports that her child had a delay in the separation of the umbilical cord following birth. Physical examination reveals that the child has poorly formed scars at sites of previous injuries. Neutrophil analysis shows a defect in a cell membrane molecule involved in tight adhesion. Which of the following is the most likely molecule causing this child’s increased susceptibility to infection?



A. Addressin B. E-selectin C. IL-1 D. Integrin E. TNF 36-A 7-year-old male has a history of recurrent infections with Staphylococcus aureus. Further genetic testing shows a defect leading to a decrease of expression of E-selectins. A decrease in E-selectin expression would cause which of the following abnormalities in neutrophil function?



A. Abnormal neutrophil rolling in leukocyte emigration B. Decreased phagocytosis of bacteria opsonized with IgG C. Decreased respiratory burst in neutrophils after phagocytosis D. Inadequate tight adhesion in leukocyte emigration E. Microtubule dysfunction in phagosome-lysosome fusion 37-A 17-year-old man requires a blood transfusion after sustaining a gunshot wound. Due to a medical error, the man, who is blood type A, is given type B blood. Within an hour of receiving the transfusion, his blood pressure dramatically drops, he becomes tachycardic, develops a fever, and begins to wheeze and have difficulty breathing. This man's symptoms were mediated by which of the following?



IMMUNOLOGY-DR TAHER A. Cytotoxic T cell–mediated destruction of the donor red blood cells B. Deposition of host antibody-donor red blood cell immune complexes C. IgM-mediated destruction of the donor red blood cells D. Induction a localized inflammatory response mediated by Th1 T cell–activated macrophages E. Mast cell and eosinophil degranulation 38-A 23-year-old woman has received corticosteroid therapy for an autoimmune disease for several months. She presents to the emergency room with a 2-cm area of cellulitis in the skin of her lower leg. She states that the infection was only a blemish 2 days ago, but it has now dramatically and rapidly worsened. The most likely explanation for the aggressive nature of this woman's infection is impaired:



A. Activation of the complement system B. B cell antibody production C. Blood supply to the affected area D. Lipooxygenase activity E. Neutrophil adherence 39-A 69-year-old man is admitted to the hospital for a painless lower GI bleed. His hemoglobin drops from 12 to 9 in 4 hours. His type and screen shows antibodies to B and Rh. What type of blood should he receive?



A. A+ or O+ B. AC. B+ or O+ D. BE. A- or OF. O+ or O40-A 25-year-old woman has been treated for diabetes type 1 with insulin since the age of 10. What other disease is she more likely to develop in her lifetime?



A. Goodpasture syndrome B. Inflammatory bowel disease C. Multiple sclerosis



IMMUNOLOGY-DR TAHER D. Psoriasis E. Systemic lupus erythematosus



41-A group of experimental rats are inoculated with tetanus toxoid (TT) three times, 7 days apart, over a 3-week period. The last injection of TT is mixed with anthrax toxoid (AT). Two days after the last injection, the rats are bled and their sera analyzed for the presence of antibodies to TT and AT. Which of the following antibodies would be present in most elevated titers?



A. IgG against TT B. IgG against TT and IgM against AT C. IgG against TT and AT D. IgG and IgM against TT E. IgM against AT F. IgM against TT and IgG against AT 42-The Salk polio vaccine is effective at preventing infectious virus from entering the central nervous system, but does not prevent gastrointestinal replication of virulent virus. Which of the following best explains this observation?



A. It does not elicit cell-mediated immunity. B. It does not elicit neutralizing antibody. C. It elicits antibodies against CD155 in the central nervous system. D. It elicits IgG, but not secretory IgA. E. It only protects against one serotype. 43-A 32-year-old woman with allergies to dog and cat dander volunteers to participate in a clinical study. Basophils isolated from her blood are cultured with anti-IgE monoclonal antibodies. After 5 minutes, the cells are washed, and placed in culture in new medium. The supernatant liquid from these cells after 8 hours of culture was injected into the skin and compared to the control liquid collected after 5 minutes. In which of the following activities would the second liquid collection be more powerful than the first?



A. Edema B. Leukocyte chemotaxis



IMMUNOLOGY-DR TAHER C. Mucus secretion D. Smooth muscle spasm E. Vasodilation



44-A biotech company has developed a new line of compounds prepared by proteolytic digestion of purified anti-nickel antibodies. Compound A is prepared with papain. Compound B is prepared with pepsin. Which one of the two compounds is most useful as a positive control reagent for a nickel agglutination assay?



A. Compound A, because it contains the Fc fragment B. Compound A, because it can activate complement needed for the agglutination assay C. Compound B, because it contains the Fc fragment D. Compound B, because it contains F(Ab)’2 fragment E. Compound B, because it contains FAb fragment F. Compound B, because it can still bind to the Fc receptors necessary for agglutination



45-A patient who has suffered repeated neisserial septicemias is found to have a genetic deficiency of complement component 6. When plasma from this patient is incubated with these organisms, which of the following outcomes is most likely?



Anaphylatoxins Opsonins Bacterial Lysis A. Absent Absent Absent B. Absent Absent Normal C. Absent Normal Normal D. Normal Absent Absent E. Normal Normal Absent F. Normal Normal Normal 46-During a clinical trial, a researcher investigates the effect of intravenous administration of a synthetic glycoprotein, similar in function to IL-5. If this therapy is to be effective in the treatment of patients with selective IgA deficiency, which of the following characteristics of IL-5 must be taken into account to ensure similar biologic function?



IMMUNOLOGY-DR TAHER



A. Activation of a specific cell surface receptor B. Display of cross-species functionality C. Down-regulation of cell growth D. Production by Th2 cells E. Stimulation of eosinophilia 47-Lymphocyte recirculation is mediated by an interaction between molecules expressed on high endothelial venules and lymphocytes. Which of the following molecules found on lymphocytes is responsible for this attraction?



A. Addressin B. E-selectin C. Ig-CAMs D. Integrin E. L-selectin 48-A 2-year-old child who has suffered recurrent bacterial infections and delayed wound healing is evaluated for immunologic deficiency. The numbers of CD19+ and CD3+ cells in the peripheral blood are within normal limits, but neutrophil counts are elevated to almost twice normal values. A nitroblue tetrazolium dye test is normal. What is the most likely defect in this child?



A. Addressin B. CD18 C. Chemokine receptors D. E-selectin E. L-selectin 49-Endothelial cells in areas of inflammation increase expression of E-selectins in response to injury. The increased expression of E-selectins results directly in which of the following neutrophil functions?



A. Activation B. Adherence C. Chemotaxis



IMMUNOLOGY-DR TAHER D. Demargination E. Rolling F. Transmigration 50-Radiolabeled autologous neutrophils were injected intravenously into a patient with an occult bacterial infection, and this treatment was followed by whole-body scintigraphy. Which of the following molecules would be found in the highest concentration in areas with elevated radioactive signal?



A. C3b B. C5a C. Hageman factor D. Interleukin-1 E. Prostaglandin 51-An outbreak of parainfluenza virus in a nursing home necessitates hospitalization for several affected residents. The patients with more severe disease were observed to be making high amounts of interleukins 4, 5, 6, and 10. What cell is responsible for this pattern of interleukin production?



A. Macrophage B. Natural killer cell C. Th1 lymphocyte D. Th2 lymphocyte E. Th17 lymphocyte F. Treg lymphocyte 52-A 64-year-old man complains of difficulty breathing and a productive cough. Physical examination reveals a fever and blood-tinged sputum containing acid-fast bacilli. There are several radiologic opacities in the upper lobe of the left lung. Needle biopsy of one of these masses reveals lymphocytes and activated macrophages. Which of the following cytokines is most strongly associated with the formation of this lesion?



A. Interferon-α B. Interferon-γ C. Interleukin-1



IMMUNOLOGY-DR TAHER D. Interleukin-2 E. Transforming growth factor-β 53-One of the drugs used to treat multiple sclerosis is glatiramer acetate. Its mechanism of action is thought to involve a switch in T cell response from a proinflammatory to an antiinflammatory response. If this is true, which of the following cytokines would be found in the serum of a patient who has been taking this drug for several months?



A. IFN-γ B. IL-1 C. IL-10 D. IL-12 E. TNF-α 54-A patient recovering from a laminectomy is brought to the emergency room suffering from high fever, hypotension, and a diffuse erythematous rash that is desquamating over the palms of his hands. Blood cultures are positive for Staphylococcus aureus. Which of the following sets of results is most likely to characterize this patient’s condition?



IL-1 IL-6 IFN-γ TNF-α A. ↓ ↑ ↓ ↑ B. ↓ ↓ ↓ ↓ C. ↑ ↑ ↑ ↑ D. ↑ ↑ --- ↑ E. ↑ ↓ ↓ ↓ 55-A junior high school student is brought to a specialist for evaluation of recurrent pharyngeal and cutaneous infections with pyogenic bacteria. Review of pertinent history reveals six instances of streptococcal pharyngitis and impetigo over the past 5 years, three of which have resulted in development of poststreptococcal glomerulonephritis. Which of the following laboratory findings explain this patient’s condition?



A. Deficiency of CD18 B. Depressed interferon-gamma production C. Low serum C1, 4. and 2



IMMUNOLOGY-DR TAHER D. Low serum C3b E. Negative nitroblue tetrazolium dye test 56-A 6-year-old boy is brought to the emergency room by his mother. He has developed shortness of breath, wheezing, and raised itching wheals on his skin. What is the mechanism for the development of urticaria in this case?



A. Antibody- and complement-mediated inflammation B. Eosinophil infiltration and degranulation C. Interleukin-8 activation of neutrophils D. Th1 cell activation of macrophages and Tc E. Vasodilation and increased vascular permeability 57-A 6-year-old boy is brought to the pediatrician because of abrupt onset of malaise, fever, and nausea. On examination, the child has mild hypertension and periorbital edema, and urinalysis is positive for protein (3.0 g/day) and red blood cell casts. He recovered uneventfully from a sore throat 2 weeks ago. Which of the following is most likely to be found in a kidney biopsy at this time?



A. Diffuse capillary wall thickening B. Focal and segmental glomerulosclerosis and hyalinosis C. Granular IgG and C3 in the glomerular basement membrane D. Hyaline change in the glomeruli E. Linear IgG and C3 deposits with fibrin in crescents 58-A 23-year-old man presents to an urgent care clinic, complaining of stomach pain, diarrhea, and excessive burping. He says he has always been "a little sickly," but his symptoms worsened after a recent camping trip. Physical examination reveals a temperature of 37.3ºC (99.1°F) and mild rales on auscultation. The physician prescribes an antibiotic, which the patient takes faithfully, but his symptoms do not improve. He is then referred to a gastroenterologist, who performs an esophagogastroduodenoscopy to rule out infection. The duodenal biopsy demonstrates the following, but unexpectedly, it also reveals a total absence of plasma cells in the lamina propria, which should normally be abundant. Based on these findings, what immune deficiency should be considered in the differential diagnosis? A.Common variable immunodeficiency B.DiGeorge syndrome



IMMUNOLOGY-DR TAHER C.Job syndrome D.Selective IgA deficiency E.Wiskott-Aldrich syndrome



59-Two patients, both with a recent history of streptococcal infection, are being treated by the same physician. Patient A presents with fever, dyspnea, and polyarthritis. A diagnosis of rheumatic fever is made. Patient B presents with edema and hematuria, leading to a diagnosis of poststreptococcal glomerulonephritis. Which of the following best describes how the mechanisms of these two diseases differ?



A. IgM antibodies mediate rheumatic fever, whereas IgG antibodies mediate poststreptococcal glomerulonephritis. B. The antibodies in poststreptococcal glomerulonephritis cause cytotoxic damage, while the antibodies in rheumatic fever cause dysregulation of cellular function. C. The antibodies in rheumatic fever activate complement, but in poststreptococcal glomerulonephritis, the antibodies do not. D. The antibodies in rheumatic fever are cross-reactive to human antigens. In poststreptococcal glomerulonephritis, they are not. E. The two diseases are caused by infection with different species of streptococci. 60-A 19-year-old male presents to a family physician with rhinitis and an itchy rash. He recently moved into his girlfriend’s apartment and began having symptoms the following day. His symptoms go away when he leaves the apartment and begin within minutes of returning. He indicates that they are at their worst when he and his girlfriend sit on the couch with her cat. Physical examination reveals an erythematous rash over his face, trunk, and arms. Which of the following is causing this man’s symptoms?



A. Activation of complement along the mucosa B. Dysregulation of tissues by antibodies C. Formation and deposition of immune complexes D. Granulocyte degranulation E. Macrophage and T cell activation along the mucosa 61-A 29-year-old woman with a long history of recurrent respiratory infections and chronic diarrhea is injured in a motor vehicle accident. On arrival to the emergency



IMMUNOLOGY-DR TAHER room, her hematocrit is markedly decreased, so a blood transfusion is initiated. Soon afterward, she develops a rash over her entire body, her blood pressure drops, and the patient goes into cardiac arrest. In addition to the motor vehicle accident, what contributed most to the patient’s death?



A. Clonal proliferation of immature lymphocytes B. Congenital athymia C. Defective chloride transporter D. Inability to produce IgA E. Viral infection of CD4 T-cells 62-A 5-month-old baby presents to his pediatrician with a recurrence of oral candidiasis. He is small for age by both height and weight measures. He has needed treatment for protracted diarrhea and has been prone to severe illness from intercurrent viral infections. Which of the following tests would the physician expect to be abnormal?



A. CH 50 B. Nitroblue tetrazolium test C. Ultrasonography of the abdomen D. Complete blood count, including lymphocyte count E. Complete blood count, including neutrophil count F. Complete blood count with peripheral blood smear 63-A 9-year-old girl presents to the emergency room with swelling of her right arm and difficulty breathing. She was walking past a gardener mowing the lawn when wood chips from the mower hit her arm. She noticed the swelling start soon thereafter and began having shortness of breath. When subcutaneous epinephrine and diphenhydramine is administered with little effect, hereditary angioedema is suspected. Which of the following lab results is expected in her blood work?



A. High C1 esterase inhibitor levels B. High C5 levels C. Low C3 levels D. Low C4 levels E. Normal complement levels



IMMUNOLOGY-DR TAHER 64-A female neonate with low birth weight is evaluated because of dysmorphic facial features and generalized cyanosis. Shortly after delivery, she developed seizures, which were determined to result from severe hypocalcemia. What additional findings would be likely in this individual?



A. Decreased IgA levels B. Diminished numbers of CD3+ cells C. Elevated IgM levels D. Increased alpha-fetoprotein E. Torturous vascular dilatations 65-A healthy 9-month-old child is vaccinated, and antibody production is measured over the next 2 months. What can be inferred about the vaccine administered? A.Bacterial capsule B.Hapten C.Killed virus D.Toxoid E.Whole bacterium



66-During his annual physical examination, a 50-year-old African American man complains to his physician of fatigue, swollen cervical lymph nodes, and pain in his spine and ribs. Serum electrophoresis shows a spike of protein in the gamma region. The abnormal immunoglobulin is determined to be of the IgG isotype. An IgG molecule is composed of which of the following?



A. One alpha, one gamma, and two kappa chains B. One gamma chain and two kappa chains C. Two gamma chains, one kappa, and one lambda chain D. Two gamma chains and two kappa chains E. Two mu chains and two kappa chains 67-A 12-month-old boy is referred to a specialist due to a history of repeated bacterial infections. When the child’s peripheral blood leukocytes are incubated with



IMMUNOLOGY-DR TAHER opsonized bacteria, production of oxygen and halide radicals is reduced compared to normal controls. What is the most likely defect in this child?



A. Catalase B. Lactoferrin C. Myeloperoxidase D. NADPH oxidase E. Superoxide dismutase 68-Scientists studying the homing mechanisms of naive and mature lymphocytes toward secondary lymphoid organs find these cells expressing the same adhesion molecules as the embryonic trophoblast cells prior to implantation in the uterine endometrium during the first week of migration of the fertilized zygote. Which of the following adhesion molecules was most likely studied for these two independent mechanisms by these groups of scientists?



A. ICAM-1 B. L- selectins C. P-selectins D. PECAM-1 E. VCAM-1 69-A 65-year-old man with diagnosis of multiple myeloma has a serum spike of 5.4 g/dL of IgG. On testing the urine, whole immunoglobulin is not identified, but elevated protein is detected. Which letter correctly denotes the source of the urine protein in this case? A.A B.B C.C D.D E.E