IMMUNOLOGY CLERKSHIP REVIEW

EMQs

A. Mast cells/Basophils F. Plasma cells

B. B-cells G. Dendritic cells

C. Eosinophils H. Lymphocytes

D. Neutrophils I. T-cells

E. Monocytes/Macrophages

1. These cells can be identified by differential CBC count and include those that are responsible for adaptive immunity (H)

2. These effectors perform ADCC (Antibody dependent cell mediated cytotoxicity) on helminths and their larvae (C)

3. These are the most abundant phagocytes in the circulation (D)

4. These effectors differ from their precursors by a lack of specific surface receptors (F)

5. The Fc receptors on these cells are the only ones that bind Ab that has not yet bound to Ag (A)

6. These cells include some that have been assigned different names depending on wherer they are found in the body (E)

7. These cells along with those in 6 above are collectively refered to as the reticuloendothelial system (RES) (G)

8. Some malignancies of this type can often result in heavy skin infiltration by the malignant cells (I)

9- Flow cytometry question

10. A 29 yr old male presents with a chronic cough and is being investigated as a contact for Tb following a diagnosis of this disease in a friend of his. To the doctor’s surprise despite chest X- ray changes in keeping with Tb, the patient has a –ve Mantoux test. Delayed type hypersensitivity tests with Candida Ag and tetanus toxoid are also –ve and the doctor suspects cutaneous anergy (inability to mount an immune response). Which of the following tests would you do next?

A. Lymphocyte subset analysis C. HIV serology

B. Measurement of specific analysis D. SPE

11. Complement is involved in all of the following except:

A. Attraction of neutrophils to an infection site

B. Increased presence of serum proteins in the infected tissues

C. Lysis of bacteria in the absence of specific Ab

D. Sensitization of T cells to Ag

12. Ab affinity for Ag depends on:

A. Ab isotype

B. Complimentary shape of each Ab variable region for its Ag

C. Number of Fab regions in each Ab molecule

D. Whether the Ab is in the serum or on the cell surface

13. Kay was a fashionable young woman who had several piercings in her ears in which she wore different types of costume earrings. Recently her pinnae had become swollen and hot and it was painful to remove them. Her doctor thought she had nickel induced contact dermatitis. Which of the following is incorrect about this condition?

A. Skin prick test is indicated in the diagnosis

B. Type IV hypersensitivity plays a major role in the pathogenesis

C. Triggering Ag is LMW molecule that attaches to skin protein

D. Sensitization to a triggering Ag usually takes at least 7 days

14. A 12 yr old high school boy was taken to the ER because of severe abdominal pains, vomiting, and localised swelling of his face. He was also having some difficulty breahing. Patient and family history revealed that he suffered from recurrent episodes of abdominal pain since 4 yrs of age and his mom and grand mom also had a history of this. Work up revealed C4 and C1 esterase in blood. What is most likely the diagnosis?

A. SLE C. Leukocyte adhesion deficiency

B. Hereditary angioedema D. Di George syndrome

15. A 28 yr old trauma patient with type O blood received a transfusion in the A&E department. Within 30 mins the patient developed shaking chills and was feeling faint. Upon examination, the patient had an increased pulse and brownish discoloration of urine. Which of the following is correct?

A. Group O individuals do not produce anti A or anti B Ab and he was given type B blood

B. The patient was given type B and preformed IgG Ab recognised B Ag on the RBC surface

C. The reaction was mediated by IgM Ab present in Group B unit he was given which recognised Ag on the patients RBCs

D. IgM mediated against B Ag on donor cells

16. A patient with a CNS disorder is maintained on Methyldopa. Haemolytic Anemia develops which resolves shortly after the drug is withdrawn. This is MOST probably an example of:

A. Atopic Hypersensitivity

B. Cytotoxic Hypersensitivity

C. Immune complex Hypersensitivity

D. Cell mediated Hypersensitivity

17. Patients with Di George syndrome who survive beyond infancy would be capable of:

A. Rejecting bone marrow transplant

B. Mount a delayed type hypersensitivity to dinitrochlorobenzene

C. Resisting intracellular parasites D. Forming Ab to and deposited Ag

E. All of the above F. None of the above

18. The autoimmune disease SLE is characterised by production of IgG Ab against human DNA. To detect such Ab by aggregation, one would mix serum from the patient with latex beads coated with.

A. Human IgG B. Horse Ab to human IgG

C. Human DNA D. Horse Ab to human DNA

19. Diseases in which Th cells and cytotoxic CD8+ T cells probably play major roles in their pathogenesis include all of the following except:

A. Myasthenia Gravis

B. Hashimoto’s Thyroiditis C. Rheumatoid Arthritis D. Multiple Sclerosis

E. Insulin Dependent Diabetes Mellitus

20. the most common clinical consequences of C3 deficiency are/is

A. Increased incidence of tumours B. Increased susceptibility to viral infections

C. Increased susceptibility to fungal infections D. Increased susceptibility to bacterial infections

E. All of the above

21. The best way to provide immunologic protection against Tetanus Neonatorum is to:

A. Inject infant with human tetanus anti toxin B. Inject newborn with tetanus toxoid

C. Inject mother with toxoid within 72 hrs of birth of child

D. Immunise the mother with tetanus toxoid before or early in pregnancy

E. Give the child anti toxin and toxoid for both passive and active immunisation

22. Which of the following statements about CD8+ CTL is incorrect?

A. Lysis if the targets by synthesising perforin and granzymes B. Cause target cell apoptosis

C. Cannot kill CD 4 +

D. Interact with their target through paired cell surface molecules

E. Must be activated by exerting cytotoxic action

23. A line to tumour cells prepared from one mouse is injected into an MHC matched recipient. The tumour was destroyed within 5 days. When tissues from the recipient were analysed, the animal had a negligible CTL response against the tumour. Flow cytometry revealed that the tumour cells expressed very low levels of MHC Class I. The BEST explanation for the destruction of tumour cells in the recipient is:

A. CTL specific for tumour Ag killed the tumour cells

B. Mast cells released H2 and other inflammatory mediators that cleared the tumour cells

C. NK cells bind anti tumour Ab and killed tumour cells

D. NK cells recognised the absence of MHC Class I molecules and killed the tumour cells

24. Serological testing before kidney transplant reveals that the leukocytes of a prospective recipient are killed by the following anti HLA Ab in the presence of complement: anti B27, anti A1, anti A3. You can conclude that:

A. The prospective recipient expresses B27, A1, A3 HLA specificities

B. The prospective recipient does not express the above HLA specificities

C. The potential donor and prospective recipient are not siblings

D. The prospective recipient should not receive a kidney graft that expresses these HLA specificities

26. The thymus is a primary lymphoid organ that is important for T cell maturation. If the Thymus fails to develop in an infant, which of the following will most likely occur?

A. The bone marrow produces T and B cells when there is no thymus

B. Only CD4 T lymphocytes are produced C. Only CD8 T lymphocytes are produced

D. CD3 T lymphocytes are not found in the circulation

28. A9 yr old child complained to his mother that his urine looked dark and that he was passing small amounts. Him mom initially dismissed his complaints but she became worried when he woke the following with a puffy face and ankle swelling. He was taken to his GP who noted an increase in BP. Urinalysis revealed: RBC 3+, PROTEIN 1+. He had a bad sore throat a few weeks earlier. His doctor diagnosed post strep GN. Which of the following DOES NOT occur in this condition?

A. Low C3 levels are found in the early phase of this condition B. Anti strep O titres are increased

C. A kidney biopsy will show a smooth linear deposit

D. The clinical course is one of complete recovery

29. Which of the following diseases in an affected pregnant woman would NOT lead to synptoms of the same disease in her newborn infant?

A. Graves disease B. Multiple Sclerosis

C. Myasthenia Gravis D. SLE E. None of the above

30. Pentameric IgM is:

A. Found in newborn infants following in utero infection

B. Bcell Ag receptor E. A poor activator of complement system

C. Only produced by B1 cells D. Important for the protection of ECF