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IMMUNOLOGY FINAL EXAM
1. The surface molecule on mature T cells responsible for transduction of activation
signals across the cell membrane immediately after antigen binding is:
A. T cell antigen receptor
B. CD3
C. Phospholipase C (PLC)
D. CD4
E. ZAP-70 (SyK)
2. Lepromatous leprosy is BEST characterized by which cytokine profile?
A. IL-2, IL-6 and IL-12
S. IL-2, IL-4 and IL-12
C, IL-2, IL-4 and IL-5
D. IL-4, IL-5 and IL-10
E. IL-2, IFN-gamma and TNF-alpha
3. A 24-year-old woman who presents with a "butterfly rash", arthritis, and kidney disease,
most likely has which one of the following autoantibodies?
A. Anti-keratinocyte
B. Anti-double stranded (ds) DNA
C. Anil-glomerular basement membrane
D. Anti-thyroglobulin
E. Anti-desmogleln III
4. HLA-class II (DR, DQ) gene associations with various autoimmune diseases implicate
which arm of the immune system?
A. Natural killer cell responses
B. Complement-mediated responses
C. Cytotoxic T cell (CD8+) specific responses
D. Helper T cell (CD4+) specific responses
E. None of the above
5. Which statement is TRUE regarding HIV?
A. Attenuated HIV virions provide a risk-free approach to vaccination.
B. Activation of infected CD4+ T cells results in decreased virion production.
C. gp120 does not undergo sequence variation.
D. p24, as a surface protein, is a good candidate for a protective antigen.
E. A patient with one genotype of HIV can later have several different genotypes.
6. In which age-sex group does Common Variable Immunodeficiency occur?
A. any age1emales
B. 2-6 years/males and females
C. 15-35 years/ males and females
D. infancy/males
E. 6-18 months/males
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7. An infant girl with a remarkably high white blood cell count of >100,000 cells per microliter
of blood has a perirectal abscess and gram negative bacteria in her bloodstream. There is no
family history of unusual infection. The infant's liver and spleen are greatly enlarged, and she has
a temperature elevation (104 degrees F). Immunological evaluation reveals a normal ability to
make neutrophil superoxide and serum immunoglobulins are normal for her age. T-cell
proliferation tests for phytohemagglutinin and Candida are normal, and the test for total
hemolytic complement (CH50 assay) is normal. Which diagnosis is likely to be correct?
A. Bruton's X-linked agammaglobulinemia
B. Severe combined immunodeficiency (SCID)
C. DiGeorge syndrome
D C3 Complement component deficiency
E. Leukocyte adhesion deficiency
8. During primary infection with Human Immunodeficiency Virus-1 (HIV-1), the patient
A. Always exhibits opportunistic infections.
B. Always has CD4+ T cell counts below 200 per microliter.
C. Always has a high viral load.
D. Never has noticeable symptoms.
E. Always has a positive anti-HIV ELISA.
9. A 4 year old male is diagnosed by his pediatrician as having a paramyxovirus infection
(he has the mumps). Infected macrophages would produce all EXCEPT the following
cytokines:
A. Interferon gamma
B. TNF-alpha
C. I L-1 beta
D. Interferon alpha
E. IL-8 1
10. Atopic dermatitis (AD) is a chronic inflammatory skin disease in which T cells are
induced to secrete cytokines following the highly specific binding between the T cell
receptor (TCR) and the MHC/antigen peptide complex. Which of the following
statements is FALSE regarding MHC-specific T Dell activation?
A. Cytotoxic T lymphocytes recognize antigen presented on Infected target cells.
B. Adhesion molecules aid in the interaction of T helper lymphocytes with antigen
presenting cells.
C. T cells require co-stimulation through binding of the CD-3 with the Fc receptor on
the antigen presenting cell.
D. The TCR interacts with MHC Class 11 molecules and a peptide antigen of
approximately 12-25 amino residues.
E. The interaction of CD28 with C080 (B7.1) favors IL-2 formation.
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11. An 8-month-old boy develops near fatal pneumonia due to Pneumocystis carinii.
Serum immunoglobulin analysis reveals low serum IgG and IgA, but extremely high IgM
levels. Immunization with antigens produces only lgM class specific antibodies and no
IgG class specific antibodies, even after a booster (second) immunization. Which cell
membrane protein is MOST LIKELY to be detective in this child?
A. CD40 ligand (CD154) on T-cells
B. CD56 on NK cells
C. CD 14 on monocytes
D. CD3 on T-cells
E. IgM on B-cells
12. Which general class of compounds is LEAST likely to be immunogenic?
A. Polysaccharides
B. DNA
C. Synthetic polymers (le. polyethylene or polystyrene)
D, Proteins
E. RNA
13. Which statement BEST describes T helper 3 type (Th3) lymphocytes:
A. They primarily secrete IL-2 and Interferon-gamma upon activation
B. They give help to B cells to produce IgG2a
C, They primarily secrete TGF-beta upon activation
D. They suppress T helper I cells, but not T helper 2 cells
E. They are the primary T cell in delayed type hypersensitive responses
14. Regarding T cell receptor (TCR) gene rearrangement events:
A. The gamma and delta chain genes rearrange simultaneously
B. If the alpha and beta chain genes do not rearrange successfully, then the delta
chain genes begin to rearrange.
C. If the gamma and delta chain genes do not rearrange successfully, then the
alpha chain genes begin to rearrange.
D. The TCR genes of mature T cells are all in the germline configuration
E. The alpha and delta chain genes rearrange simultaneously
15. Neutrophils are attracted to an infected area by:
A. C5a
B. C3a
C. IgM
D. C1
E. C8
16. Which statement BEST describes T helper 2 (Th2) lymphocytes:
A. They give help to B cells to produce immunoglobulin
B. They primarily secrete IL-2 and Interferon-gamma upon activation
C. They are the primary T cell in delayed type hypersensitivity responses
D. They primarily secrete TGF-beta upon activation
E. They stimulate cytotoxic T cells
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17. The Human MHC Class II genes
A. Encode THE beta.
B. Decode complement components.
C. Encode transmembrane polypetides DP, DQ and DR.
D. Encode transmembrane polypetides HLA-A, HLA-B and HLA-C.
E. Encode beta 2-microglobulin.
18. Which statement is TRUE regarding the antibody complementarity determining regions
(CDRs)?
A. The joining of the V and D gene segments is important in determining the sequence of
CDR2.
B. The proteins Ftag-1 and Rag-2 are not required for formation of CDR3.
C. The CDRs are important in determining the overall variable region structure, but
are not directly involved in antigen binding.
D. They are located In the CH2 domain of the immunoglobulin heavy chain.
E. V, D, and J gene segments contribute to the diversity of CD R3 in heavy chains.
19. In the process of antigen presentation, C D8+ T cells recognize:
A. Endogenous peptides associated with MHC class I molecules.
B. Exogenous peptides associated with invariant chain beta 2-Microglobulin.
C. Exogenous peptides associated with MHC lass II molecules.
D. Exogenous peptides associated with MHC class I molecules.
E. Endogenous peptides associated with MHC class II molecules.
20. Energy in CD4+ T helper cells results in.
A. Hyperresponsiveness to antigen challenge resulting in apoptosis
B. Loss of ability to make and secrete IL-2
C. Increased costimulatory molecule expression on suppressor cells
D. Upregulation of MHC II
E. Enhanced CD28/CD80 (B7.1) interaction
21. A 30-year-old man receives a severe injury to the right eye requiring surgical repair.
Three weeks later his left eye becomes red and painful and visual acuity is reduced.
Which one of the following autoimmune mechanisms is likely to be causing the left eye
inflammation?
A. Release of sequestered self-antigens from the right eye
B. Excessive B cell function initiated by sutures in the right eye
C. Molecular mimicry (cross reactivity) between an infection and a self antigen
D. Aberrant expression of HLA-class II antigens in the left eye caused by an
infection
E. None of the above
22. Which of the following diseases is caused by an autoantibody to a cell-surfaced receptor?
A. Systemic lupus erythematosus
B. Rheumatoid arthritis
C. Graves disease (hyperthyroidism)
D. Insulin-dependant diabetes mellitus
E. None of the above
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23. Immunological tolerance can:
A. Involve clonal deletion by apoptosis
B. involved in activation of antigen specific clones
C. Be induced during early stages of Immune development
D. Be induced in mature T and B cells
E. All the above are true of immunological tolerance
24. Host factors involved in binding and internalization of HIV by host cells include all of the
following EXCEPT.
A. CD4
B. Antibody or C3b
C. CCR5 and CXCR4 chemoldne receptors
D. Galactosyl ceramide
E. tat
25. Unconjugated, free haptens are classified as:
A. Invitrogens
B. Both immunogens and antigens
C. Antigens
D. Immunogens
E. Neither immunogens nor antigens
Match the Type of Infection with the Major Immune Defense Mechanism (BEST MATCH)
26. Myoobacte rial
27. Fungal
28. Helminth (worms)
29. Viral.
A. DTH and granulomatous reactions
B. Antibody (immune complex and
cytotoxicity)
C. ADCC and granulomatous reactions
D. DTH and antibody
E. Antibody (neutralization). CTL and
DTH
30. Immune senescence fn older individuals:
A. Results in decreased primary B cell (unction occurs despite the presence of
effective naive (primary) immune responses.
B. Results in Increased deaths from new serologic strains of organisms
C. Involves loss of memory responses
D. Can occur as a result of repeated infections
E. All the above statements are true about immune senescence
31. Tolerance resulting in reduction of anti-donor alloreactive T cells is mediated by:
A. clonal deletion
B. presence of protective antibodies
C. Anti-pliotropic antibodies
D. generation of potent regulatory cells
E. clonal anergy
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32. The Class III genes:
A. Encode beta 2-microglobulin
B. Encode proteins structurally similar to Class II molecules
C. Decode complement components
D. Encode tumor necrosis factor.
E. Encode proteins structurally similar to Class I molecules.
33. All of the following affect the antigen-binding region of immunoglobulins EXCEPT:
A. Somatic mutation
B. Isotype switching
C. Insertion of nucleotides at the D-J junction by terminal deoxynucleotide.
transferase
D. Random selection of V, D, and J gene segments
E. Pairing of different heavy and light chain V regions
34. A one month old boy develops severe respiratory syncytial virus infection and requires
ventilator support. His father is healthy, but his 21 year old mother has never enjoyed
good health since being 15 years of age. The child's T and B cell phenotyping and
function are normal. His phagocytic function and complement function are normal. His
serum IgM and IgA levels are normal, but his serum IgG level is almost zero. How
would you BEST explain the child's illness?
A. The mother has Common Variable Immunodeficiency and the child is
immunocompetent.
B. The mother has Acquired Immune Deficiency and the child has Leukocyte
Adhesion Deficiency.
C. The mother is immuinocompetent and child has severe combined immunodeficiency.
D. The mother has Leukocyte Adhesion Deficiency and the child is immunocompetent
E. The mother has selective IgA deficiency and the child is immunocompetent.
35. A protein that enhances the stability of intestinal IgA is:
A. Albumin
B. C1 inhibitor
C. Transport protein
D. Secretory place
E. Intercellular adherence molecules
36. Regarding antigen presentation, which statement is TRUE?
A. Carbohydrate antigens are loaded onto MHC Class II in the medial region of the
Golgi apparatus.
B. The presence of invariant chain limits binding of peptide with MHC Class II
molecules.
C. Exogenous peptides are carried into the rough endoplasmic reticulum by the
transporter of antigenic peptides (TAP) protein.
D. Exogenous proteins are processed through the Golgi apparatus.
E. Enzymes in lysosomes degrade LAMP proteins to allow binding of MHC Class II
proteins to peptides.
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37. Meningococcal vaccine for military recruits is used because of potential risk from:
A. Biological warfare
B. Typical travel of endemic areas
C. Crowded living conditions in barracks
D. Promiscuous sexual behavior
E. Young age
38. The Staphylococcus aureus superantigen:
A. Activates macrophages to secrete interferon gamma
B. Mediates IgE allergic reactions
C. Activates B cells through interaction with V-alpha segments
D. Causes T cells cytokine production by interaction with V-beta segments
E. Do not choose E
39. Which of the following is NOT known to occur during HIV infection?
A. Decrease in cytotoxic T cell function during the transition from asymptomatic to
symptomatic infection.
B. Production of up to 10° virions per day during the asymptomatic stage
C. Bystander killing of uninfected CD4+ T cells due to binding of gp120 and
induction of Fas expression.
D. Antibody-mediated enhancement of HIV uptake by macrophages/monocytes.
E. Elimination of integrated viral DNA resulting in 'cure' in some patients.
40. Regarding the structure of the MHC Class II molecule;
A. The complex contains a total of five immunoglobulin-like domains with beta 2 Microglobulin juxtaposed near the cell surface membrane.
B. The peptide-binding site is shared by the two domains nearest to the cell
membrane.
C. It is a transmembrane porypeptide containing three intracellular domains 1, 2, 3.
D. The molecule is expressed at the cell surface in a non-covalent association with
an invariant polypeptide.
E. It is composed of two transmembrane polypeptides, each containing two
extracellular domains.
41. All the following can induce T cell tolerance EXCEPT:
A. IV exposure
B. TGF-Beta secretion by mucosal T cells
C. low dose antigen
D. high dose antigen
E. All the above can induce T cell tolerance
42. Which statement regarding conformational epitopes is accurate?
A. Conformational epitopes are the principal structures recognized by the T cell
receptor.
B. Conformational epitopes are only associated with carbohydrate antigens.
C. Denaturatlon of protein antigens can destroy conformational epitopes.
D. Conformational epitopes consist of short sequences of 4-7 amino acids.
E. Small haptens are the best examples of conformational epitopes.
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43. Cells of the reticuloendothelial system (RES) contribute to immunity against
microorganisms by all of the following means EXCEPT:
A. Presentation of antigen
B. Synthesis and secretion of antibodies
C. Intracellular killing of pathogens
D. Recruitment of inflammatory cells
E. Cytokine production
44. C3b is involved in all of the following EXCEPT:
A. Opsonizatlon and phagocytosis of bacterial pathogens
B. Altering vascular permeability
C. Formation of C5 convertase
D. Enhancement of humoral immune responses
E. Covalent attachment to bacteria
45. Which of the following is a quantitative immunoassay?
A. Agglutination
B. Radial immunodiffusion
C. Western blot
D. Immunoelectrophoresis
E. Ouchterlony assay
46. Examples of TH2 based diseases Include:
A. asthma
B. Multiple sclerosis
C. Diabetes mellitus
D. rheumatoid arthritis
E. Crohn's disease
47. Which of the following cytokines are associated with delayed type hypersensitivity
reactions?
A. interferon-gamma
B. IL-2
C. IL-4
D. A and C
E. A, B, and C
48. Which immunosuppresive drugs inhibit calcineurin:
A. cyclosporine and tacrolimus
B. azothioprine and corticosteroids
C. tacrolimus and sirolimus
D. cyclospofne and corticosteroids
E. azathieprine and cyclosporine
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49. The use of RhoGAM to prevent Rh sensitization of a RH- mom to a Rh+ baby is an
example of which type of immunization?
A. Passive natural
B. Passive artificial
C. Active natural
D. Active artificial
E. All of the above
50. Innate immune system components include all EXCEPT the following:
A. Plasma cells
B. Skin
C. Salivary lysozyme
D. Alternate complement pathway components
E. Neutrophils
Answer the following five questions from the answers listed below:
51. The H chain has 4 constant region
A. IgA
domains and it mediates Type I
B. IgG
hypersensitivity.
C. IgM
52. The Ig that crosses the placenta from
D. IgD
mother to fetus.
E. IgE
53. The first Ig appearing in serum during
a primary immune response.
54. The principal Ig found in secretions.
55. Co-expressed with IgM on naive B
cells
56. Hyperacute rejection is prevented in patients by:
A. examination of anti-donor T cell reactivity.
B. testing recipients for the presence of anti-donor antibodies.
C. matching HLA between donor and recipient.
D. testing blood groups of donor and recipient.
E. Pre-treatment with Sirolimus
57. By standard criteria set by the Centers for Disease Control and Prevention, an HIV-infected
patient who has a CD4+ T cell count of 180 per microliter of blood but no known opportunistic
infections would be characterized as having:
A. Late symptomatic Infection (AIDS).
B. Early symptomatic infection.
C. Congenital immunodeficiency
D. Primary infection.
E. Asymptomatic infection.
58. Concanavalin A can cause:
A. Monoclonal stimulation of neutrophils and eosinophils cells
B. Polyclonal stimulation of B cells
C. Polyclonal stimulation of both B and T cells.
D. Polyclonal stimulation of T cells
E. Monoclonal stimulation of B cells
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59. Granulomatous reactions are common in:
A. Graft vs. host disease.
B. Samoidosis.
C. Staphylococcal infections.
D. Myasthenia gravis.
E. Systemic lupus erythematosus.
60. Recurrant Meningococcal Infections occur more commonly than other bacterial
infections in which complement component deficiency?
A. C3
B. C5
C. Clq
D. C2
E. C4
61. Regarding B cell gene rearrangement:
A. Lambda heavy chain genes combine V-J segments
B. Kappa and Lambda genes are both expressed simultaneously on the surface of
plasma cells
C. Kappa heavy chain genes combine V-D-J segments
D. Kappa light chain genes combine V-D-J segments
E. Lambda light chain genes combine V-J segments
62. In T cell-mediated cellular cytotoxicity:
A. Granzymes participate both in rapid cell lysis and in induction of apoptosis.
B. Naive T cells are capable of killing target cells prior to undergoing activation,
proliferation, and differentiation.
C. The cytotoxic T cell that binds to the target cell Is CD4+.
D. Fas-Fas ligand Interactions cause cell death directly by the formation of
membrane channels.
E. The T cell receptor Interacts with antigenic peptides associated with MHC Class
II proteins.
63. Which statement BEST describes children with congenital asplenia?
A. Elevated serum gamma globulin
B. Frequent episodes of hemolytic anemia
C. Increased incidence of bacterial infections
D. increased incidence of viral infections
E. Decreased complement component C5a
64. The inheritance pattern of autoimmune diseases is MOST consistent with which of these
following?
A. Recessive
B. Complex and multigenic
C. Sex-linked
D. Dominant with incomplete penetrance
E. None of the above
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65. The cytokine most responsible for isotype switch to IgE
A. IL-4
B. IFN-Gamma
C. IL-12
D. IL-2
E. IL-6
MATCHING. Choose the single BEST answer. Each answer may be used once, more than
once, or not at all. Choose the mechanism that is MOST closely associated with each of the
following observations.
66. A patient develops a severe skin
rash, joint pain, and
glomerulonephritis following repeated
administration of penicillin.
67. Effective containment of a
Mycobacterium tuberculosis infection.
68. Prior immunization with diphtheria
toxoid prevents disease when a
patient is exposed to
Coryrtabacterium diphtheriae.
69. A patient experiences sudden
difficulty in breathing and loss of
blood pressure following a bee sting.
70. A multivalent polysaccharide-protein
conjugate vaccine provides effective
protection against Streptococcus
pneumoniae infection.
A. Inactivation or neutralization
B. Antibody-mediated cytotoxicity
C. Immune complex formation
D. Anaphylactic reaction
E. Delayed type hypersensitivity
71. Which statement BEST describes children with Wiskott-Aldrich Syndrome?
A. They demonstrate decreased thrombotic events
B. They demonstrate decreased Incidence of bacterial Infections
C. They demonstrate decreased incidence of fungal infections
D. They demonstrate deficiency in reorganization of actin-binding cytoskeletal
proteins
E. They demonstrate decreased serum IgE and IgA
72. A Type II hypersensitivity reaction is BEST characterized by:
A. T lymphocyte infiltrate
B. IgE
C. Cytotoxic antibody
D. Neutrophil infiltrate
E. Eosinophil infiltrate
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73. Anaphylactic reactions involve all of the following EXCEPT:
A. Fc receptors on macrophages.
B. Histamine receptors on endothelial cells.
C. Mast cells
D. Eosinophils.
E. Plasma cells producing IgE.
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ANSWERS:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
B
D
B
D
E
C
E
C
A
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A
C
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A
A
C
E
A
B
A
C
E
E
C
A
A
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E
B
A
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B
A
D
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C
D
E
E
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C
B
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A
47.
48.
49.
50.
51.
52.
53.
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55.
56.
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60.
61.
62.
63.
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65.
66.
67.
68.
69.
70.
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72.
73.
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D
A
B
A
E
B
C
A
D
B
A
D
B
B
E
A
C
B
A
C
E
A
D
B
D
C
A