Download immunology final exam

Name: ____________________________
IMMUNOLOGY
FINAL EXAM
November 15, 2010
9:30-11:30 AM
84 questions, 272 total Points
16 pages
INSTRUCTIONS
1. Use only a No. 2 pencil.
2. Write your name legibly at the top of the FIRST PAGE of the exam.
3. Write and code entire student ID number on the Scantron form.
4. Write in NAME, FINAL, November 15, and your row and seat number on the
front of the form.
5. Fill answer boxes on the Scantron completely; printed numeral should not be
visible. Do not make extraneous marks on the form.
6. Mark box A through E, one only. Use A for TRUE and B for FALSE. Each
question is intended to have a single best answer.
7. Erase carefully and completely; if in doubt, get a new Scantron.
8. Check your Scantron form before handing it in to see that all questions have been
answered.
9. When you are done turn in your exam together with your Scantron.
QUESTIONS 1-5: [4 POINTS] MULTIPLE CHOICE Choose the single best answer
1. A mother is blood type A, Rh+, her newborn child is B, Rh–. The newborn’s blood is
likely to contain substantial levels of antibodies to:
a)
b)
c)
d)
e)
anti-A
anti-A and anti-Rh
anti-B
anti-B and anti-Rh
none of the above
2. A congenital T cell deficiency will result in markedly increased susceptibility to
infection by:
a)
b)
c)
d)
e)
extracellular bacteria
both extracellular and intracellular bacteria
extracellular bacteria and fungi
intracellular bacteria and fungi
extracellular bacteria and viruses
3. The process of somatic hypermutation increases the diversity of antigen-combining
sites in:
a)
b)
c)
d)
IgG
TcR
both
neither
4. CD4 is expressed on:
a)
b)
c)
d)
e)
TH cells
macrophages
NK cells
both (a) and (b)
all of the above
5. Which of the following represents part of the process of lymphocyte "recirculation"?
a)
b)
c)
d)
e)
exit of pre-T-cell from bone marrow into blood
exit of a naïve B-cell from lymph node into blood
entry of an effector TH1 cell into a site of inflammation
both (a) and (b)
all of the above
2
QUESTIONS 6-10: [2 POINTS] MULTIPLE CHOICE. Choose from the following;
each choice may be used once, more than once or not at all
a) IgA
b) IgD
c) IgE
d) IgG
e) IgM
6. _____ Most efficient at complement fixation
7. _____ Predominates in nu/nu (“nude”) mouse serum
8. _____ Exists predominantly as membrane bound form
9. _____ Predominates in secondary responses
10. _____ Binds to macrophage Fc receptors
QUESTIONS 11-21: [4 POINTS] MULTIPLE CHOICE Choose the single best
answer
11. Barak Obama has been tissue-typed as HLA- A(26);B(17,21), his wife Michelle as
A(11,28);B(21,35), and their daughter Sasha as A(11);B(21). Which of the following
is the least likely phenotype for Sasha’s sister Malia?
a)
b)
c)
d)
e)
A(11);B(21)
A(28);B(21,35)
A(11,26);B(17,21)
A(11,26);B(17,35)
A(26,28);B(17,35)
12. (See question #11) If you wanted to use a FACS (fluorescence-activated cell sorter) to
recover fetal cells from Michelle’s blood during a subsequent pregnancy in order to
do prenatal genetic testing on the fetus, your best choice of fluorescent-labeled
antibodies would be:
a)
b)
c)
d)
e)
anti-A11 and B21
anti A26 alone
anti-A11 and A28
anti-B17 and B21
anti-B21 alone
3
13. Disease symptoms are most directly the result of the presence of “M-protein” in:
a)
b)
c)
d)
MGUS
B cell lymphoma
Multiple myeloma
Waldenström’s macroglobulinemia
14. A virus may greatly reduce T-cell mediated killing of infected cells by causing
downregulation of the expression of:
a)
b)
c)
d)
HLA-A
HLA-C
either (a) or (b)
none of the above
15. A major advantage of a live viral vaccine over a killed one is that the live vaccine will
provide more effective:
a)
b)
c)
d)
e)
isotype switching
immune complex clearance
Class I presentation
Class II presentation
Treg response
16. During the generation of a humoral response following immunization with a
hapten/carrier, T-cells will be presented with carrier peptides associated with which
of the following?
a)
b)
c)
d)
MHC Class I
MHC Class II
both
neither
17. The “Coomb’s reagent” used to develop agglutination reactions is an antibody
directed against:
a)
b)
c)
d)
e)
A and B blood group antigens
Rh antigen
C3b
FcR
IgG
4
18. Development of a GvH reaction would be most likely if whole blood from a donor
whose genotype is HLA (B18/18) were transfused into a recipient who is HLA:
a)
b)
c)
d)
B18/18
B27/27
B14/18
B27/35
19. All of the following are true regarding the original descriptions of acquired immune
deficiency syndrome EXCEPT:
a) An increase in Kaposi's sarcoma among previously healthy homosexual men
in San Francisco.
b) An increase in Pneumocystis carinii pneumonia among previously health
homosexual men in San Francisco.
c) An inversion in the CD4 to CD8 ratio in previously healthy homosexual men
in San Francisco due to an increase in the total number of CD8 positive
lymphocytes in the blood.
d) An increase in Kaposi's sarcoma among previously healthy intravenous drug
users in New York City.
e) An increase in Pneumocystis carinii pneumonia among previously healthy
intravenous drug users in New York City.
20. The newest autoantibody described in Rheumatoid arthritis is anti-cyclic citrullinated
peptide (anti CCP). Which of the following statements is FALSE?
a)
b)
c)
d)
Presence of anti-CCP is associated with severe Rheumatoid arthritis
Citrullinated peptides are recognized by the T cell in conjunction with MHC II
Presence of anti-CCP is the result of polyclonal B cell stimulation
Arginine is replaced with citrulline
21. The symptoms of One-Shot Serum Sickness typically last no longer than a week or
two because:
a)
b)
c)
d)
antibodies have a relatively short half-life
complement is consumed
antigen is removed
all of the above
5
QUESTIONS 22-25: [2 POINTS] MULTIPLE CHOICE Choose the single best
answer
DNA from various sources was digested with the restriction enzyme EcoRI, separated by
electrophoresis and hybridized with a radioactive probe specific for human Cκ, resulting
in the Southern blot shown on the right. The germ-line band at 2.5kb is indicated. Which
of the four lanes in the blot represents the pattern you would most likely see using DNA
from each of the following cell sources?
a
b
c
d
22. ______ T-cell leukemia
23. ______ Normal lymph node
2.5kb
24. ______ Waldenström’s Macroglobulinema
25. ______ Fetal thymus
QUESTIONS 26-50: [4 POINTS] MULTIPLE CHOICE Choose the single best
answer
26. The idiotypic epitope expressed on the membrane of an Ig-bearing B-cell lymphoma
is best described as:
a)
b)
c)
d)
a virally encoded antigen
a tumor-associated antigen (TAA)
a tumor specific antigen (TSA)
an oncofetal antigen
27. Based on the principles of MHC-restricted recognition, Marge Simpson’s cytotoxic
T-cells specific for measles virus will be able to kill virus-infected cells derived from:
a)
b)
c)
d)
e)
her mother Jacqueline
her father Clancy
her daughter Maggie
both (a) and (b)
all of the above
6
28. During the production of a hybridoma line, if the cell mixture following fusion is
placed in culture with the drug aminopterin but with no hypoxanthine or thymidine,
the result would be:
a)
b)
c)
d)
e)
proliferation only of unfused plasmacytoma cells
proliferation only of unfused B cells
proliferation of both fused cells and unfused plasmacytoma cells.
proliferation of all cells in the mix
no cells in the mix would proliferate
29. You have affinity-purified the isohemagglutinin antibodies from a type A donor, and
have a dialyzable form of the B blood group antigen. If you analyze this antibody by
Equilibrium Dialysis which of the following patterns would you expect to see?
_r
c
a
_r
c
1
2
r
_r
c
b
1
5
r
10
_r
c
_r
c
d
c
2
r
5
r
10
e
2
4
r
30. During the cell interactions involved in generating a cytotoxic T-cell response, the TC
cell receives the necessary “Signal 1” through which of the following interactions?
a)
b)
c)
d)
e)
B7 with CD28
IL-2 with IL-2R
TCR with MHC Class I
TCR with MHC Class II
IgD with antigen
31. Peripheral neuropathy is most frequently associated with?
a)
b)
c)
d)
Multiple myeloma
IgA MGUS
IgG MGUS
IgM MGUS
7
32. Histological examination of a patient’s lymph node showed an absence of germinal
centers but with intact primary follicles, and reduced cellularity of the parafollicular
cortex. This pattern is most consistent with:
a)
b)
c)
d)
e)
Chronic Granulomatous Disease
Di George Syndrome
Bruton’s Agammaglobulinemia
Severe Combined Immunodeficiency
iatrogenic immunodeficiency
33. Which of the following is FALSE regarding opportunistic infections in adult patients
with AIDS?
a) Marked increase of infections with obligate intracellular bacteria (such as
Mycobacterium avium intracellulare).
b) Marked increase of fungal infections with yeasts such as Pneumocystis carinii
(pneumonia).
c) Marked increase of infections with common extracellular bacteria, such as
Streptococcus pneumoniae.
d) Reactivation of DNA viruses such as Varicella zoster (shingles).
e) All the above statements are correct.
34. Opsonization may be mediated by the presence on phagocytic cells of:
a)
b)
c)
d)
Fc receptors
complement receptors
either (a) or (b)
none of the above
35. Antigen combining sites whose affinity has been improved by the process of somatic
hypermutation may be present in:
a)
b)
c)
d)
e)
IgG
IgM
T cell receptors
both (a) and (b)
all of the above
8
36. As part of the team working on the world-wide eradication of polio, you’re carrying
out Complement Fixation assays to determine the titers of anti-viral antibody in the
serum of subjects following vaccination. The assay is a conventional one in which
you add a standard amount of viral antigen and complement to serial dilutions of the
subjects’ sera, then add indicator cells. Your results for one subject are shown below:
Lysis with
Lysis with
Test
added
no added
Sample Dilution
antigen
antigen
-------------------------------------------#1
1:10
1:20
+
1:40
+
+
1:80
+
+
Based on these results, you conclude that this sample has an antibody titer of:
a)
b)
c)
d)
e)
1:10
1:20
less than 1:20
less than 1:40
you can draw no valid conclusion regarding the antibody titer
37. The greatest risk of developing Rheumatoid arthritis is seen in association with:
a)
b)
c)
d)
β2-microglobulin
HLA-B27
HLA-DRB1 shared epitope
TRAF locus
38. The mitogen lipopolysaccharide (LPS) can stimulate an effective antibody response
in “nude” (nu/nu) mice. This is because LPS is:
a)
b)
c)
d)
efficiently presented by the B-cell’s MHC Class II
actively phagocytosed by dendritic cells
a TD antigen
able to stimulating Toll-Like Receptors (TLR) on B-cells
39. It is critically important to avoid administering any live vaccine to a patient who
might have:
a)
b)
c)
d)
Bruton’s agammaglobulinemia
DiGeorge syndrome
both
neither
9
40. Yvonne was given penicillin for a urinary tract infection, and ten days later she
returned to the clinic complaining of a headache, itchy lumps on her skin and aching
and swollen joints in her hands and feet. The immune reaction which cause her
symptoms is most likely:
a)
b)
c)
d)
e)
an innate immune response
complement-mediated hemolysis
complement-mediated tissue damage
cell-mediated immunity
an IgE-mediated allergic response
41. The likelihood of a kidney transplant between two HLA haplo-identical siblings
being accepted with no rejection reaction is close to:
a)
b)
c)
d)
e)
0%
25%
50%
75%
100%
42. The swelling at the site of an allergy skin test 15 minutes after introduction of antigen
is caused by the infiltration of large numbers of:
a)
b)
c)
d)
e)
eosinophils
polymorphonuclear neutrophils
mast cells
mononuclear cells
none of the above
43. The mechanism of receptor blockade will contribute most importantly to maintaining
self-tolerance to
a)
b)
c)
d)
e)
HLA-DQ
IgD heavy chains
albumin
CD4
complement receptors
44. A negative result with the Nitro Blue Tetrazolium (NBT) test indicates that there is a
defect in:
a)
b)
c)
d)
e)
complement fixation
opsonization
NK cell activity
intracellular killing of bacteria
T cell differentiation
10
45. Hypocalcemic tetany which develops immediately after birth is associated with which
immunodeficiency state?
a)
b)
c)
d)
e)
Bruton’s agammaglobulinemia
SCID
DiGeorge Syndrome
Complement deficiency
Chronic Granulomatous Disease
46. You’ve immunized a rabbit with a human λIgD myeloma protein and collected its
serum. If you want to prepare an absorbed antiserum that is class-specific, you would
begin by passing it over column bearing:
a)
b)
c)
d)
e)
κIgD
λIgA1
κIgE
λIgD
κIgG4
47. A dendritic cell may become activated by receiving a signal from:
a)
b)
c)
d)
e)
a TH cell
B7/CD28 recognition
cross-linking of antigen-specific membrane Ig
microbe-derived products
CD4/Class II interaction
48. The MLR (Mixed Lymphocyte Reaction) is used to help determine donor/recipient
compatibility for :
a)
b)
c)
d)
e)
HLA-A
HLA-B
HLA-D
(a) and (b)
all of the above
49. The maximum number of different HLA Class I molecules that may be expressed by
a single memory B cell is close to:
a)
b)
c)
d)
e)
1
2
4
6
16
11
50. An Rh-negative woman is tested by Indirect Coombs at twenty eight weeks of
pregnancy with positive results. This indicates that:
a)
b)
c)
d)
e)
the father is Rh-positive
her erythrocytes are coated with antibody
the fetus is Rh negative
both (a) and (b)
all of the above
QUESTIONS 51-54: [2 POINTS] MULTIPLE CHOICE Choose the single best
answer. Each choice may be used once, more than once or not at all.
The results of FACS analysis of a mixed cell population are shown below. For each of
the following choose the quadrant (a, b, c or d) in which the cells in question would
appear.
4
10
A
B
C
D
3
51.
B cells
10
52.
pre-T cells
10
53.
predominant thymic lymphocytes
54.
Treg cells
CD4
2
1
10
0
10
0
10
1
10
2
10
CD8
QUESTIONS 55-59 [2 POINTS] Choose from the following Gell & Coombs
categories; each choice may be used once, more than once or not at all
a)
b)
c)
d)
Type I
Type II
Type III
Type IV
55.
Poison oak rash
56.
Allergy skin test
57.
One-Shot Serum Sickness
58.
“Smooth” distribution of IgG in glomeruli
59.
Grave’s Disease
12
3
10
4
10
QUESTIONS 60-70: [4 POINTS] ANSWER USING THE FOLLOWING KEY:
a)
b)
c)
d)
e)
If 1, 2 and 3 are correct
If 1 and 3 are correct
If 2 and 4 are correct
If only 4 is correct
If all are correct
60. Which of the following antigen preparations would be suitable for use in an
agglutination test?
1.
2.
3.
4.
leukocytes
HSA-coated latex particles
erythrocytes
DNP-HSA
61. Which of the following antibodies could be used for paternity testing?
1.
2.
3.
4.
anti-Km
anti-G1
anti-G3m
anti-lambda
62. Which of the following cells might eventually differentiate into an immunoglobulinbearing memory cell?
1.
2.
3.
4.
memory B-cell
hematopoietic stem cell
naïve B-cell
naïve T-cell
63. Development of a GvH reaction is a significant risk following transplantation of
which of the following organs into an immunosuppressed recipient?
1.
2.
3.
4.
bone marrow
liver
lung
heart
13
KEY: A. 1, 2 and 3; B. 1 and 3; C. 2 and 4; D. 4 only; E. all
64. In a patient suffering from selective IgA deficiency, there is likely to be greatly
reduced levels of expression in his serum of:
1.
2.
3.
4.
lambda
Km
G3m
A2m
65. Cell surface markers shared by B-cells and activated dendritic cells include:
1.
2.
3.
4.
HLA-DR
HLA-A
B7
IgM
66. Which of the following represents “tertiary” lymphoid tissue?
1.
2.
3.
4.
germinal centers in thymus
dendritic cells in skin
lymphoid follicles in synovium
plasma cells in bone marrow
67. Leukocytes that enter lymph nodes through high endothelial venules (HEVs) include:
1.
2.
3.
4.
TC cells
B-cells
TH cells
PMNs
68. Which of the following antigens could be used in an Ouchterlony assay
1.
2.
3.
4.
C5a
DNP
IgG
Sheep red blood cells
14
KEY: A. 1, 2 and 3; B. 1 and 3; C. 2 and 4; D. 4 only; E. all
69. The amount of DNA in a cell will decrease during which of the following
differentiation steps?
1.
2.
3.
4.
naïve B-cell to memory B-cell
stem cell to naïve B-cell
IgG3 B-memory cell to IgG2 B-memory cell
naïve B-cell to IgM-secreting plasma cell
70. “Antigen dependent differentiation” includes the differentiation of:
1.
2.
3.
4.
stem cell to TH-cell
virgin T cell to memory cell
Common Lymphocyte Precursor to TC cell
B-cell to plasma cell
15
QUESTIONS 71-84 TRUE/FALSE [2 points] A = TRUE, B = FALSE
71. _____ Genes within the human HLA complex encode Class I and Class II molecules
and β2-microglobulin.
72. _____ In the peripheral blood, high affinity Fc receptors for IgE may be found on
basophils.
73. _____ Cytotoxic T-cells kill their targets by complement-mediated lysis.
74. _____ The IgE bound to a particular mast cell in the skin is likely to be monospecific,
but not monoclonal.
75. _____ Following activation, a dendritic cell may leave the skin and enter the
circulation where it will interact with an antigen-specific T-cell.
76. _____ A deficiency in complement component C4 will affect both the classical and
MBL pathways for complement fixation.
77. _____ Complement receptors on human erythrocytes selectively bind the membrane
attack complex (MAC).
78. _____ Non-identical human twins frequently share a common placental circulation
79. _____ Immunodeficiency which results from cancer chemotherapy is iatrogenic.
80. _____ “Enhancing antibodies” contribute to more rapid graft rejection.
81. _____ Germinal centers are sites in which B-cells undergo both clonal proliferation
and isotype switching.
82. _____ Receptor blockade represents one mechanism of “peripheral” tolerance
83. _____ Clonal deletion represents one mechanism of “central” tolerance.
84. _____ In the Mishell & Dutton “hot thymidine” experiments, antigen-specific B-cells
are killed before they begin proliferating.
16