Download Bases of clinical immunology

Module 1
Bases of Clinical immunology and allergology
Tests
1. Following statements regarding the epidemiology of HIV infection are correct
EXCEPT
A. the risk of transmission following skin puncture from a needle contaminated with
blood from an HIV-infected patient is less than 0.5 percent
B. *most cases of AIDS are now among I/V drug users
C. the risk of transmission from a single donor unit of blood is approximately 1/500,000
D. most pediatric cases of AIDS arise because of vertical transmission from an infected
mother
E. there is no convincing evidence that saliva can transmit HIV
2. What statements best describes the role of polymerase chain reaction (PCR) in the
diagnosis of HIV infection?
A. *It should be used if the western blot is indeterminate
B. It is a useful screening test
C. It should be used if two consecutive serologic tests (ELISA) are positive
D. It should be used if the initial serologic test is positive, but the second is negative
E. It has no real role
3. Following statements concerning the ataxia-telangiectasia syndrome are correct
EXCEPT
A. it is inherited in an autosomal recessive manner
B. *the cause is adenosine deaminase deficiency
C. malignancy is a common cause of death
D. bronchiectasis may occur
E. both humoral and cellular limbs of the immune system are affected
4. What statements regarding central nervous system disease in patients with HIV
infection is correct?
A. *The most common cause of central nervous system disease is the AIDS dementia
complex
B. The most common cause of seizures is cryptococcal meningoencephalitis
C. Antiretroviral agents have no role
D. The most common finding on MRI is multiple white matter lesions
E. Actual histologic evidence of direct HIV involvement is rare
5. What is the LEAST common immunologic manifestation of HIV infection?
A. Cutaneous reactions to drugs
B. *Anaphylactic reactions to drugs
C. Anticardiolipin antibodies
D. Oligoarticular arthritis
E. Fibromyalgia
6. What histologic subtype of lymphoma occurs most commonly in patients infected with
HIV?
A. *Immunoblastic (large cell) lymphoma
B. Small, noncleaved (Burkitt's) lymphoma
C. Small, cleaved (follicular) lymphoma
D. Primary central nervous system lymphoma
E. Hodgkin's disease, mixed cellularity
7. True statements about isolated immunoglobulin A deficiency include which of the
following?
A. *The incidence of atopic disease is high.
B. The reduced number of IgA-bearing B cells accounts for the reduced serum IgA
levels.
C. Bone marrow transplantation is needed
D. Secretory IgA levels usually are normal.
E. Nothing above
8. True statements about isolated immunoglobulin A deficiency include which of the
following?
A. *The risk of adverse reactions to transfusions is increased.
B. The reduced number of IgA-bearing B cells accounts for the reduced serum IgA
levels.
C. Bone marrow transplantation is needed
D. Secretory IgA levels usually are normal.
E. Nothing above
9. True statements about isolated immunoglobulin A deficiency include which of the
following?
A. *The incidence of autoimmune disese is increased.
B. The reduced number of IgA-bearing B cells accounts for the reduced serum IgA
levels.
C. Bone marrow transplantation is needed
D. Secretory IgA levels usually are normal.
E. Nothing above
10. Listed cells are effectors except:
A.
T-cytotoxic.
B.
NK-cell.
C.
Plasma cell.
D.
*T-helper.
E. None of above
11. Total count of the immune globulines?
A.
6.
B.
3.
C.
4.
D.
*5.
E.
2.
12. The markers are of T-cells except:
A.
CD4.
B.
CD8.
C.
CD3.
D.
*CD19.
E.
None of above
13. Theese immune mediators are lymphokines except:
A.
IL-2.
B.
*IL-1.
C.
IL-4.
D.
Gamma-IFN.
E.
IL-5.
14. What type of immunoglobulins has the most important role in case of acute
respiratory infection?
A.
*IgA.
B.
IgM.
C.
IgG.
D.
IgD.
E.
IgE
15. The main function of plasma cells?
A. participation in immune cooperation.
B. *immunoglobulin production.
C. IFN production.
D. participation in neoplasia control.
E. immunosuppression.
16. The main function of NK-cells?
A. participation in immune cooperation.
B. immunoglobulin production.
C. IFN production.
D. *participation in neoplasia control.
E. immunosuppression.
17. Class of immunoglobulin increases in case of helminth invasion?
A. IgA.
B. IgM.
C. IgG.
D. IgD
E. *IgE.
18. Class of immunoglobulin can go through placenta?
A. IgA.
B. IgM.
C. *IgG.
D. IgD.
E. IgE.
19. The medicines could be useful in case of anaphylactic reactions except:
A.
epinephrine
B.
diphenhydramine
C.
*zaditen
D.
dobutamine
E.
betametason
20. AIDS is caused by a human retrovirus that kills
A. B lymphocytes
B. lymphocyte stem cells
C. *CD4-positive T lymphocytes
D. CD8-positive T lymphocytes
E. None of above
21. Chemically induced tumors have tumor-associated transplantation antigens that
A. are always the same for a given carcinogen
B. *are different for two tumors of different histologic type even if induced by the same
carcinogen
C. are very strong antigens
D. do not induce an immune response
E. None of above
22. After binding to its specific antigen, a B lymphocyte may switch its
A. immunoglobulin light-chain isotype
B. *immunoglobulin heavy-chain class
C. variable region of the immunoglobulin heavy chain
D. constant region of the immunoglobulin light chain
E. Nothing above
23. Complement fixation refers to
A. the ingestion of C3b-coated bacteria by macrophages
B. the destruction of complement in serum by heating at 56 °C for 30 minutes
C. *the binding of complement components by antigen-antibody complexes
D. the interaction of C3b with mast cells
E. none of above
24. Children with a genetic deficiency of C6 have
A. decreased resistance to viral infections
B. increased hypersensitivity reactions
C. increased frequency of cancer
D. *decreased resistance to Neisseria bacteremia
E. none of above
25. Cells - natural killer cells are
A. B cells that can kill without complement
B. cytotoxic T cells
C. increased by immunization
D. *able to kill virus-infected cells without prior sensitization
E. none of above
26. Primary immune response in an adult human requires approximately how much time to
produce detectable antibody levels in the blood?
A. 12 hours
B. 3 days
C. *1 week
D. 3 weeks
E. 6 weeks
27. BEST method to demonstrate IgG on the glomerular basement membrane in a kidney
tissue section is the
A. precipitin test
B. complement fixation test
C. agglutination test
D. *indirect fluorescent-antibody test
E. none of above
28. Whan following substances is NOT released by activated helper T cells?
A. *Alpha interferon
B. Gamma interferon
C. Interleukin-2
D. Interleukin-4
E. None of above
29. Delayed hypersensitivity reaction is characterized by
A. edema without a cellular infiltrate
B. an infiltrate composed of neutrophils
C. *an infiltrate composed of helper T cells and macrophages
D. an infiltrate composed of eosinophils
E. None of above
30. An antigen found in relatively high concentration in the plasma of normal fetuses and a
high proportion of patients with progressive carcinoma of the colon is
A. viral antigen
B. *carcinoembryonic antigen
C. alpha-fetoprotein
D. heterophil antigen
E. none of above
31. If an individual was genetically unable to make J chains, which immunoglobulin(s)
would be affected?
A. IgG
B. IgM
C. IgA
D. IgG and IgM
E. *IgM and IgA
33. The class of immunoglobulin present in highest concentration in the blood of a human
newborn is
A. *IgG
B. IgM
C. IgA
D. IgD
E. IgE
34. Antigen-presenting cells that activate helper T cells must express which one of the
following on their surfaces?
A. IgE
B. Gamma interferon
C. Class I MHC antigens
D. *Class II MHC antigens
E. Nothing above
35. Performans a complement fixation test for antibody, the reactants should be added in
what sequence? (Ag = antigen; Ab = antibody; C = complement; EA = antibody-coated indicator
erythrocytes.)
A. Ag + EA + C/wait/ + patient's serum
B. C + patient's serum + EA/wait/ + Ag
C. Ag + patient's serum + EA/wait/+ C
D. *Ag + patient's serum + C/wait/+ EA
E. No one in the list
36. Which one of the following properties of antibodies is NOT dependent on the structure
of the heavy-chain constant region?
A. Ability to cross the placenta
B. Isotype (class)
C. Ability to fix complement
D. *Affinity for antigen
E. None of above
37. Role of the macrophage during an antibody response is to
A. make antibody
B. lyse virus-infected target cells
C. activate cytotoxic T cells
D. *process antigen and present it
E. none of above
38. To which of the following classes of immunoglobulines do the allergy-mediating
antibodies belong?
A.
IgA
B.
IgG
C.
IgM
D.
IgD
E.
*IgE
39. What antibody classes is the first to be produced in an immune response to a given
antigen?
A.
IgA
B.
IgG
C.
*IgM
D.
IgD
E.
IgE
40. In most normal persons, what percentage of the total serum immunoglobulins is IgG?
A.
10 %
B.
25 %
C.
50 %
D.
60 %
E.
*Over 70 %
41. Which one of the following immunoglobulins is the principal immunoglobulin in
exocrine secretion?
A.
*IgA
B.
IgG
C.
IgM
D.
IgD
E.
IgE
42. Which of the following statements about IgM is true?
A.
It is a reagenic antibody
B.
*It is important in the first few days of the primary immune response
C.
It increases in serum concentration after IgG has reached its peak serum
concentration
D.
It is the smallest of the immunoglobulin molecules
E.
It is involved in the allergic reaction
43. Molecular weight of IgG?
A.
10 kilodaltons
B.
15 kilodaltons
C.
*150 kilodaltons
D.
200 kilodaltons
E.
900 kilodaltons
44. Molecular weight of IgD?
A. 10 kilodaltons
B. 15 kilodaltons
C. *150 kilodaltons
D. 200 kilodaltons
E. 900 kilodaltons
45. Molecular weight of IgE?
A. 10 kilodaltons
B. 15 kilodaltons
C. 150 kilodaltons
D. *200 kilodaltons
E. 900 kilodaltons
46. Molecular weight of IgM?
A. 10 kilodaltons
B. 15 kilodaltons
C. 150 kilodaltons
D. 200 kilodaltons
E. *900 kilodaltons
47. Molecular weight of IgA?
A. 10 kilodaltons
B. 15 kilodaltons
C. *160 kilodaltons
D. 200 kilodaltons
E. 900 kilodalton
48. Actively acquired immunity can be coused by all of the following except?
A. The specific disese
B. Exposure to subclinical doses of the disease-causing organism
C. Vaccination with the appropriate antigen
D. *Injection with immune serum containing appropriate antibody
E. The specific disease @ Vaccination with the appropriate antigen
49. All of the following are characteristics of the human immunodeficiency virus except?
A. it binds to the CD4 molecule preferentially
B. it contains gp120 and gp41 envelope proteins
C. it is the causative agent of AIDS
D. *it contains DNA within its core
E. it contains a reverse transcriptase within its core
50. What components determines the class-specific antigenicity of immunoglobulines?
A. J chain
B. T chain
C. Light chain
D. *Heavy chain
E. Secretory components
51. What substances may be passively transferred from the mother to the fetus during the
third trimester of the pregnancy?
A. *IgG
B. Anti-Rh antibody
C. Natural isohemagglutinins
D. IgM
E. None of above
52. Substance which protects the mucosal surfaces of the respiratory, intestinal, and
genitourinary tract from pathogenic organism?
A. *IgA
B. IgG
C. IgM
D. IgD
E. IgE
53. Highest level in normal adult?
A. IgA
B. *IgG
C. IgM
D. IgD
E. IgE
54. Highest level in normal 1-day-old infant?
A. IgA
B. *IgG
C. IgM
D. IgD
E. IgE
55. Implicated in atopic response
A. IgA
B. IgG
C. IgM
D. IgD
E. *IgE
56. Produced by B-cells in response to antigen
A. IgA
B. IgG
C. *IgM
D. IgD
E. IgE
57. Longest half-life
A. IgA
B. *IgG
C. IgM
D. IgD
E. IgE
58. What statements best describes the rheumatoid factor?
A. It is the antigen initiating the rheumatoid inflammatory process
B. It is an antibody against cellular DNA
C. It consists primarily of DNA
D. *It is an antibody against immunoglobulin
E. None of above
59. Which of the following tests is the most sensitive type of serologic test?
A. Virus neutralization
B. *ELISA
C. Nucleic acid hybridization
D. Hemadsorption
E. Nothing
60. Human immunodeficiency virus (HIV)-1 has been shown to be transmitted by all of
the following mechanisms except
A. sexual contact
B. perinatal infection
C. shared needles
D. *mosquitoes
E. blood transfusion
61. What is a typical immune complex disease?
A. Klippel-Feil syndrome
B. Urticaria pigmentosa
C. *SLE
D. Gastric ulcer
E. Osteoarthritis
62. High titer of rheumatoid factor are found in what percentage of patients with RA?
A. 5 %
B. *70 %
C. 25 %
D. 50 %
E. 100 %
63. Protective maternal antibodies that transit to the fetal circulation belong to which of
the following isotype?
A. IgA
B. IgM
C. *IgG
D. IgE
E. IgD
64. What is the most common site of immune complexes?
A. both ureters
B. cardiac septum
C. *capillaries in the renal glomerulus
D. posterior lobe of the pituitary gland
E. musculs
65. Correct statements regarding immune-complex disease include which of the
following?
A. *Normally, most immune complexes are removed by the reticuloendothelial system
B. Symptoms of the disease are very specific
C. Renal manifestation are not frequent
D. Skin rash is the first symptom
E. Treatment is unknown
66. Right statements regarding immune-complex disease include which of the following?
A. *Signs and symptoms stem from the deposition of immune complexes in tissues other
than those of the reticuloendothelial system
B. Symptoms of the disease are very specific
C. Renal manifestation are not frequent
D. Skin rash is the first symptom
E. Treatment is unknown
67. About immune-complex disease true statements include which of the following?
A. *Persistence of immune complexes in the circulation seems to be a requirement for the
development of renal manifestations
B. Symptoms of the disease are very specific
C. Renal manifestation are not frequent
D. Skin rash is the first symptom
E. Treatment is unknown
68. True statements regarding immune-complex disease include which of the following?
A. *Renal lesions depend on antigen-antibody combinations in which antigen is in slight
excess
B. Symptoms of the disease are very specific
C. Renal manifestation are not frequent
D. Skin rash is the first symptom
E. Treatment is unknown
69. True statements regarding immune-complex disease include which of the following?
A. *The rash of cutaneous necrotizing vasculitis may be an example of immune-complex
disease
B. Symptoms of the disease are very specific
C. Renal manifestation are not frequent
D. Skin rash is the first symptom
E. Treatment is unknown
70. Which of the following statements about IgM is true?
A. It is a reagenic antibody
B. *It is important in the first few days of the primary immune response
C. It increases in serum concentration after IgG has reached its peak serum concentration
D. It is the smallest of the immunoglobulin molecules
E. It is involved in the allergic reaction
71. All of the following statements regarding the epidemiology of HIV infection are
correct EXCEPT
A. the risk of transmission following skin puncture from a needle contaminated with
blood from an HIV-infected patient is less than 0.5 percent
B. *most cases of AIDS are now among IV drug users
C. the risk of transmission from a single donor unit of blood is approximately 1/500,000
D. most pediatric cases of AIDS arise because of vertical transmission from an infected
mother
E. there is no convincing evidence that saliva can transmit HIV
72. Each of the following would be an acceptable initial therapeutic regimen for an HIVinfected patient EXCEPT
A. zidovudine/didanosine
B. *zidovudine monotherapy
C. didanosine monotherapy
D. zidovudine/zalcitabine
E. zidovudine/lamivudine
73. The statements best describes the role of polymerase chain reaction (PCR) in the
diagnosis of HIV infection?
A. *It should be used if the western blot is indeterminate
B. It is a useful screening test
C. It should be used if two consecutive serologic tests (ELISA) are positive
D. It should be used if the initial serologic test is positive, but the second is negative
E. It has no real role
74. The following statements concerning the ataxia-telangiectasia syndrome are correct
EXCEPT
A. it is inherited in an autosomal recessive manner
B. *the cause is adenosine deaminase deficiency
C. malignancy is a common cause of death
D. bronchiectasis may occur
E. both humoral and cellular limbs of the immune system are affected
75. All the following statements concerning the HLA D region on the sixth human
chromosome are correct EXCEPT
A. *it is located inside the major histocompatibility gene complex
B. it encodes proteins involved in the mixed lymphocyte response
C. it encodes proteins expressed only on certain immune effector or closely related cells
D. siblings matched for HLA-A, -B, and -C antigens will usually be matched at the D
region
E. it is located close to genes encoding for complement components
76. The following statements regarding infections in prosthetic joints is true EXCEPT
A. the majority of infections are acquired intraoperatively or immediately postoperatively
B. *prosthetic joint sepsis is invariably heralded by joint pain, swelling erythema, and
warmth
C. diagnosis is best made by needle aspiration of the joint
D. successful treatment usually requires complete removal of the prosthesis
E. the risk of infection is increased in patients undergoing a repeat total joint replacement
77. Correct statements about isolated immunoglobulin A deficiency include which of the
following?
A. *The incidence of atopic disease is high
B. The risk of adverse reactions to transfusions is low
C. The incidence of autoimmune disease is decreased
D. Secretory IgA levels usually are normal
E. The reduced number of IgA-bearing B cells accounts for the reduced serum IgA levels
78. Process of hyperacute graft rejection occurs due to:
A. *preexisting antibodies
B. T-cytotoxic lymphocytes
C. NK-cells
D. T-suppressors
E. None of above
79. Process of acute graft rejection occurs due to:
A. preexisting antibodies
B. *antibodies produced after transplantation
C. NK-cells
D. T-suppressors
E. None of above
80. Process of chronic graft rejection occurs due to:
A. preexisting antibodies
B. *T-cytotoxic lymphocytes
C. antibodies produced after transplantation
D. T-suppressors
E. None of above
81. Type of drugs which are not usefull for graft rejection prevention:
A. corticosteroids
B. cytotoxics
C. antilymphocyte globulin
D. *non-steroid anti-inflammatory drugs
E. antilymphocyte serum
82. Most selective immunosuppressive drug is:
A. azathiprine
B. *cyclosporin
C. metotrexat
D. mercaptopurine
E. cyclophosphamidum
83. Process of GVHD (graft versus host reaction) occurs due to incorrect selection of:
A. heart
B. kidney
C. *bone marrow
D. lymphatic node
E. lung
84. Process of GVHD (graft versus host reaction) occurs due to incorrect selection of:
A. bones
B. kidney
C. *intestine
D. lymphatic node
E. lung
85.The class I of HLA antigens contains of the next locci:
A. A, B and C
B. DR, DP and DQ
C. *A, B, C, E, F and G
D. A, B, C and D
E. A, B, C, D and DR
86. The class II of HLA antigens contains of the next locci:
A. A, B and C
B. *DR, DP and DQ
C. A, B, C, E, F and G
D. A, B, C and D
E. A, B, C, D and D
87. Patient - recipient of a 2-haplotype MHC-matched kidney from a relative still needs
immunosuppression to prevent graft rejection because
A. graft-versus-host disease is a problem
B. class II MHC antigens will not be matched
C. *minor histocompatibility antigens will not be matched
D. complement components will not be matched
E. none of above
88. The bone marrow transplantation in immunocompromised patients presents which major
problem?
A. *Potentially lethal graft-versus-host disease
B. High risk of T cell leukemia
C. Inability to use a live donor
D. Delayed hypersensitivity
E. None of above
89. What is the role of class II MHC proteins on donor cells in graft rejection?
A. They are the receptors for interleukin-2, which is produced by macrophages when they
attack the donor cells
B. *They are recognized by helper T cells, which then activate cytotoxic T cells to kill the
donor cells
C. They induce the production of blocking antibodies that protect the graft
D. They induce IgE which mediates graft rejection
E. None of above
90. The grafts between genetically identical individuals (ie, identical twins)
A. are rejected slowly as a result of minor histocompatibility antigens
B. are subject to hyperacute rejection
C. *are not rejected, even without immunosuppression
D. are not rejected if a kidney is grafted, but skin grafts are rejected
E. there is no clear information about this question
91. Individuals with severely reduced C3 levels tend to have
A. increased numbers of severe viral infections
B. *increased numbers of severe bacterial infections
C. low gamma globulin levels
D. frequent episodes of hemolytic anemia
E. there is no clear information about this question
92. Individuals with a genetic deficiency of C6 have
A. decreased resistance to viral infections
B. increased hypersensitivity reactions
C. increased frequency of cancer
D. *decreased resistance to Neisseria bacteremia
E. there is no clear information about this question
93. Minor histocompatibility antigens on cells
A. are detected by reaction with antibodies and complement
B. are controlled by several genes in the major histocompatibility complex
C. are unimportant in human transplantation
D. *induce reactions that can cumulatively lead to a strong rejection response
E. none of above
94. The hemolytic disease of the newborn caused by Rh blood group incompatibility
requires maternal antibody to enter the fetal bloodstream. Therefore, the mediator of this disease
is
A. IgE antibody
B. *IgG antibody
C. IgM antibody
D. IgA antibody
E. IgD antibody
95. The patient is a child who has no detectable T or B cells. This immunodeficiency is
most probably the result of a defect in
A. the thymus
B. the bursal equivalent
C. T cell-B cell interaction
D. *stem cells originating in the bone marrow
E. none of above
96. What is the BEST method of reducing the effect of graft-versus-host disease in a bone
marrow recipient?
A. Matching the complement components of donor and recipient
B. Administering alpha interferon
C. *Removing mature T cells from the graft
D. Removing pre-B cells from the graft
E. None of above
97. Regarding ABO and Rh blood types, which one of the following is the MOST accurate?
A. People with type O are called universal recipients because they have antibodies
against H substance but not against A and B antigens
B. If the father is Rh-positive and the mother is Rh-negative, hemolytic disease of the
newborn only occurs when the child is Rh-negative
C. People who are Rh-negative usually have antibodies to the Rh antigen because they are
exposed to cross-reacting antigen located on bacteria in the colon
D. *If type A blood is transfused into a person with type B blood, complement will be
activated and the membrane attack complex will cause lysis of the type A red cells
E. None of above
98. The susceptibility to the yeast Candida can occure in?
A. congenital agammaglobulinemia
B. *congenital thymic aplasia (DiGeorge syndrome)
C. common variable hypogammaglobulinemia
D. SLE
E. RA
99. What is the most important reason that autoimmune diseases are a complex genetic
trait?
A. Disease can be inherited in eighther a resseive or a dominant manner
B. Disease is dependent on genes that interact with each other (referred to as epistasis)
C. Genetic heterogeneity
D.*Disease is dependent on multiple genetic contribution, each with low penetrance
E. There has been no selection against the disease-assosiated alleles, which does occur in
many single gene disorders
100. Genetics of RA shows which of the following?
A. *HLA-DR is the most important genetic influence on susceptibility to RA
B. Concordance of RA between identical twins is more then 75 %
C. Environmental influences play a minimal role in the RA susceptibility
D. RA is caused by interaction between HLA-DR and Klebsiella pneumoniae
E. RA is caused by interaction between HLA-DR and Streptococcus
101. What of the following statements regarding the renal involvement associated with
systemic lupus erythematosus is true?
A. Clinically apparent renal disease occurs in 90 percent of affected persons
B. Interstitial nephritis is a rare finding on renal biopsy
C. *Renal biopsy is not initially necessary in patients with deteriorating renal function
and active urine sediment
D. Renal disease is uncommon in patients with high-titer anti-double-stranded DNA
antibodies
E. Urinalysis in affected persons usually reveals proteinuria but little sediment and no red
blood cells
102. Each of the following agents has been demonstrated to alter the course of
rheumatoid arthritis EXCEPT
A. gold
B. *Vit E
C. methotrexate
D. D-penicillamine
E. hydroxychloroquine
103. What of the following systemic manifestations is LEAST characteristic of early
adult rheumatoid arthritis?
A. *Fever
B. Weight loss
C. Muscle wasting
D. Vague musculoskeletal symptoms
E. Fatigue
104. What condition is LEAST likely to occur in late extraarticular seropositive
rheumatoid arthritis?
A. Neutropenia
B. Dry eyes
C. Leg ulcers
D. Sensorimotor polyneuropathy
E. *Hepatitis
105. The drug-induced systemic lupus erythematosus (SLE) can be characterized by
which of the following statements?
A. *Twenty percent of patients receiving procainamide develop drug-induced lupus
B. Nephritis is a frequent consequence of hydralazine-induced lupus
C. Most patients on hydralazine develop a positive antinuclear antibody (ANA) test;
however, only 10 percent suffer from lupuslike symptoms
D. There are males prevalens in the structure of drug-induced systemic lupus
erythematosus
E. Treatment is unknown
106. True statements concerning the use of nonsteroidal anti-inflammatory drugs
(NSAIDs) in the treatment of rheumatoid arthritis include which of the following?
A. The mechanism of action of NSAIDs is the blockade of 5-lipoxygenase
B. The newer NSAIDs are more efficacious than aspirin
C. *The newer NSAIDs induce platelet dysfunction
D. NSAIDs can not exacerbate allergic rhinitis and asthma
E. The mechanism of NSAID-induced azotemia is unrelated to these drugs' ability to
disrupt arachidonic acid metabolism
107. Accurate statements about rheumatoid factors include which of the following?
A. They are associated with multiple sclerosis
B. *They are associated with several conditions in which there is chronic antigenic
stimulation
C. Their presence in the serum of persons with rheumatoid arthritis does not correlates
with a worse prognosis than that for persons with seronegative disease D. Their presence
correlates with articular manifestations of rheumatoid arthritis
E. They frequently do not appear in the serum of persons with rheumatoid arthritis until
late in the course of the illness
108. Clinical characteristics associated with rheumatoid arthritis include
A.* prolonged morning stiffness
B. migratory polyarthritis
C. arthritis involving the distal interphalangeal joints
D. headache
E. palpatations
109. The rheumatoid factor is:
A. IgG against IgM
B. IgG against IgG
C. IgM against IgM
D. *IgM against IgG
E. IgG against IgE
110. All the criteria are diagnostic for systemic lupus erythematosus except:
A.
serositis
B.
arthritis
C.
leucopenia
D.
renal failure
E.
*pancreatitis
111. All the mechanisms could be triggers of autoimmunity except:
A.
*ligand-receptor interaction
B.
antigen mimicry
C.
releasing of seqestered antigenes
D.
loss of suppressor cell function
E.
antibody mimicry
112. What is the target in Goodpasture's syndrome?
A.
glomerular basement membrane
B.
membrane of pulmonary capillares
C.
*glomerular basement membrane and membrane of pulmonary capillares
D.
glomerular basement membrane and cartilages synovial membrane
E.
membrane of pulmonary capillares and cartilages synovial membrane
113. All the medicines could be useful in case of SLE except:
A.
prednisone
B.
betametasone
C.
indometacin
D.
heparin
E.
*epinephrine
114. The types of autoantibodies which are common for SLE except:
A.
antinuclear
B.
anti-DNA
C.
antimiocardial
D.
antiphospholipid
E.
*anti-DNP
115. Which clinical feature is commonly found in patients with SLE?
A.
*Vasculitis is the basic lesion
B.
A linear deposition of immunoglobulin in their glomerular basement membrane
occurs with nephritis
C.
Thyroid receptor antibody is present
D.
Rheumatoid factor is rarely present
E.
None of above
116. Which one of the following statement best describes the rheumatoid factor?
A.
It is the antigen initiating the rheumatoid inflammatory process
B.
It is an antibody against cellular DNA
C.
It consists primarily of DNA
D.
*It is an antibody against immunoglobuline
E.
It is a protein
117. Match the following condition (autoimmune hemolytic anemia) with the type of
hypersensitivity reaction most closely related to it?
A. Type I (anaphylactic) hypersensitivity reaction
B.* Type II (cytotoxic) hypersensitivity reaction
C. Type III (immune complex) hypersensitivity reaction
D. Type IV (delayed) hypersensitivity reaction
E. None of above
118. Which of the following statements about the immunoglobulin genes that encode
rheumatoid factor is true?
A. *They are present in normal people
B.They are present only in patient with RA
C. They are found in normal people and in patients with RA but are somatically mutated
in patients with arthritis
D. They are never found in the germline
E. None of above
119. The pain in RA typically begins in the
A. *Forefoot
B. Midefoot
C. Hindfoot
D. Ankle
E. B, D
120. Which of the following is a possible diagnostic feature identified in the RA
synovium?
A. Increased neutrophil infiltration
B. Hyperplasia of the intimal lining layer and infiltration of the mononuclear cells in the
synovial sublining
C. Increased vascularity and cellularity of the synovial sublining
D. *Massive infiltration by plasma cells and macrophages in the synovial sublining
E. A, B
121. About methotrexate, the DMARD most commonly used to treat RA, which of the
following statements is true?
A.
Methotrexate absorption after oral administration is approximately 90 % and is
similar from one patients to the next
B.
*Data suggest that folic acid given in a dose up to 3 mg per day does not interfere
with a therapeutic effect of methotrexate
C.
When giving methotrexate parenterally, intramuscular administration is preferred
over subcutaneous because of grater bioavailability
D.
Methotrexate has been shown to be effective steroid-sparing in the treatment of
polymyalgia rheumatica
E.
A, C
122.What of the following is/are recommended before initiating anti-TNF-α treatment?
A.
PPD skin test
B.
Pregnancy test
C.
Evaluation of signs of infection
D.
Evaluation for history of canser
E.
*All of above
123. Which of the following statements about treatment of RA is true?
A.
Primary therapy with NSAIDs without the use of a DMARD is reasonable
approach to RA
B.
Biologocal response modifiers are the best approach for all patients
C.
*Initiation and escalation of DMARDs until the disease is controlled is paramount
to the treatment of this disease
D.
Combination therapies significantly increase the risk of side effects
E.
None of above
124. Medical therapy for Crohn's disease can be described by all the following statements
EXCEPT
A.
Metronidazole is useful if the perineal area is involved
B.
Azathioprine may reduce steroid requirements
C.
The frequency of recurrence is not altered by prophylactic therapy with steroids
D.
The frequency of recurrence is not altered by prophylactic therapy with
sulfasalazine
E.
*Sulfasalazine is contraindicated in the treatment of pregnant women who have
Crohn's disease
125. Which of the following statements about IgM is true?
A.
It is a reagenic antibody
B.
* It is important in the first few days of the primary immune response
C.
It increases in serum concentration after IgG has reached its peak serum
concentration
D.
It is the smallest of the immunoglobulin molecules
E.
It is involved in the allergic reaction
126. Produced by B-cells in response to antigen
A.
IgA
B.
IgG
C.
*IgM
D.
IgD
E.
IgE
127. The longest half-life
A.
IgA
B.
*IgG
C.
IgM
D.
IgD
E.
IgE
128. All the cells are effectors except:
A.
T-cytotoxic.
B.
*NK-cell.
C.
Plasma cell.
D.
T-helper.
E. None of above
129. How many types of the immune globulines do you know?
A.
6.
B.
3.
C.
4.
D.
*5.
E.
2.
130. All the markers are of T-cells except:
A.
CD4.
B.
CD8.
C.
CD3.
D.
*CD19.
E.
None of above
132. All the immune mediators are lymphokines except:
A.
IL-2.
B.
*IL-1.
C.
IL-4.
D.
Gamma-IFN.
E.
IL-5.
133. What type of immunoglobulins has the most important role in case of acute
respiratory infection?
A.
*IgA.
B.
IgM.
C.
IgG.
D.
IgD.
E.
IgE
134. What is the function of plasma cells?
A. participation in immune cooperation.
B. *immunoglobulin production.
C. IFN production.
D. participation in neoplasia control.
E. immunosuppression.
135. What is the function of NK-cells?
A. participation in immune cooperation.
B. immunoglobulin production.
C. IFN production.
D. *participation in neoplasia control.
E. immunosuppression.
136. What class of immunoglobulin increases in case of helminth invasion?
A. IgA.
B. IgM.
C. IgG.
D. IgD
E. *IgE.
137. What class of immunoglobulin can go through placenta?
A. IgA.
B. IgM.
C. *IgG.
D. IgD.
E. IgE.
138. All the medicines could be useful in case of anaphylactic reactions except:
A.
epinephrine
B.
diphenhydramine
C.
*zaditen
D.
dobutamine
E.
betametason
139. AIDS is caused by a human retrovirus that kills
A.
B lymphocytes
B.
lymphocyte stem cells
C.
*CD4-positive T lymphocytes
D. CD8-positive T lymphocytes
E. None of above
140. Hyperacute graft rejection occurs due to:
A. *preexisting antibodies
B. T-cytotoxic lymphocytes
C. NK-cells
D. T-suppressors
E. None of above
141. Acute graft rejection occurs due to:
A. preexisting antibodies
B. *antibodies produced after transplantation
C. NK-cells
D. T-suppressors
E. None of above
142.Chronic graft rejection occurs due to:
A. preexisting antibodies
B. *T-cytotoxic lymphocytes
C. antibodies produced after transplantation
D. T-suppressors
E. None of above
143. What type of drugs are not usefull for graft rejection prevention:
A. corticosteroids
B. cytotoxics
C. antilymphocyte globulin
D. *non-steroid anti-inflammatory drugs
E. antilymphocyte serum
E. IgD
144. The most selective immunosuppressive drug is:
A. azathiprine
B. *cyclosporin
C. metotrexat
D. mercaptopurine
E. cyclophosphamidum
145. GVHD (graft versus host reaction) occurs due to incorrect selection of:
A. heart
B. kidney
C. *bone marrow
D. lymphatic node
E. lung
146. GVHD (graft versus host reaction) occurs due to incorrect selection of:
A. bones
B. kidney
C. *intestine
D. lymphatic node
E. lung
147. Large granular lymphocytes which can kill virus-infected cells as part of innate
immunity are called:
A.
neutrophils
B.
*natural killer cells
C.
monocytes
D.
lymphocytes
E.
mast cells
148. Interferon action is:
A.
*primarily antiviral
B.
to disrupt cytoplasmic membranes
C.
to protect primary infected cells
D.
found in high levels in phagocytic granules
E.
kill cells infected by viruses
149. Primary lymphoid organes are:
A.
thymus
B.
bursa of Fabricius.
C.
bone marrow.
D.
*all of the above are correct
E.
all of the above are false
150. Natural killer cells are involved in:
A.
allograft rejection.
B.
tumour rejection.
C.
non-specific killing of virus transformed target cells.
D.
type II of allergy
E.
*all of the above.
151. C3 is cleaved to form C3a and C3b by C3-convertase. C3b is involved in all of the
following EXCEPT:
A.
*altering vascular permeability
B.
promoting phagocytosis
C.
forming alternative-pathway C3 convertase
D.
forming C5 convertase.
E. can bind to macrophages
152. CD3 surface antigen is expressed only by:
A.
*T cells.
B.
В cells.
C.
monocytes.
D.
granulocytes.
E.
mast cells
153. A T helper lymphocyte recognizes an antigen presented by an antigen-presenting-cell
(APC) if the antigen is associated with:
A.
HLA class I antigen.
B.
Surface immunoglobulin.
C.
*HLA class II antigen.
D.
CD 8 antigen.
E.
All of the above.
154. T-killer cells are important in controlling
A.
*virus infections
B.
allergy
C.
autoimmunity
D.
antibodies synthesis
E.
all of these
155. Which one of the following substances is released by activated helper Th1 cells?
A.
Alpha interferon
B.
*Gamma interferon
C.
Interleukin-5
D.
Interleukin-6
E.
bradikidin
156. All of the following are organs of immune system, except:
A.
GALT
B.
spleen
C.
lymph nodes
D.
*thyroid gland
E.
tonsil gland
157. An example of a nonspecific chemical barrier to infection is:
A.
NK cells
B.
unbroken skin
C.
cilia in trachea
D.
*lysozyme in saliva
E.
all of these
158. Which of the following is the end product of the complement system?
A.
properdin
B.
membrane attack complex
C.
cascade reaction
D.
complement factor C1
E.
*complement factor C9
159. Why does lysozyme destroy bacteria cells?
A.
because inhibits protein synthesis
B.
because activates lysosome’s enzymes
C.
because inhibits mRNA
D.
*because attacks of peptidoglycan
E.
because stimulates proteolytic enzymes
160. Which of the following pairs is mismatched
A.
vagina --- lactobacilli
B.
eye --- lysozyme
C.
oropharynx --- anaerobes
D.
mucus --- lactoferrin
E.
*skin --- Gram negative
161. Primary defense mechanisms of the gastrointestinal tract include all except:
A.
*lysozyme
B.
secretory IgA
C.
mucus
D.
bile
E.
acidity in stomach
162. Lysozyme:
A.
aggregates bacteria
B.
captures free iron
C.
*breaks down the bacterial cell wall
D.
enhances phagocytosis
E.
is antiviral
163. Stem cells arise from:
A.
yolk sac.
B.
foetal liver.
C.
bone marrow.
D.
*all of the above.
E.
all of the above are wrong
164. Which do T cells assist in the functions of certain B cells and other T cells.
A. Sensitized
B. Cytotoxic
C. *Helper
D. Natural killer
E. K cells
165. Each of the following statements concerning class II MHC proteins is correct
EXCEPT:
A.
*They are found on the surface of both B and T cells
B.
They have a high degree of polymorphism
C.
They are involved in the presentation of antigen by macrophages
D.
They have a binding site for CD4 proteins
E.
They are main in succefull transplantation
166. Find the correct statements concernin haptens:
A.
A hapten can combine with an antibody
B.
A hapten cannot induce an antibody by itself; rather, it must be bound to a
carrier protein to be able to induce antibody
C.
Haptens are big molecules of protein
D. Haptens must be processed by CD8 cells to become immunogenic
*
E. Haptens must be processed by MHC II to become immunogenic
167. Humoral factor of a nonspecific resistance to infection is
A.
NK cells
B.
unbroken skin
C.
*lysozyme in saliva
D.
cilia in trachea
E.
all of these
168. C3a and C5a can cause
A.
A bacterial lysis
B.
*B vascular permeability
C.
C phagocytosis of IgE coated bacteria
D.
D aggregation of C4 and C2
E.
E activate protein synthesis
169. The most common type of circulating white cell is the:
A.
*neutrophil
B.
lymphocyte
C.
basophil
D.
eosinophil
E.
monocyte
170. The following is not part of the defense mechanisms of the neutrophil:
A.
lactoferrin
B.
superoxide anion
C.
*lysozyme
D.
free radicals
E.
hydrogen peroxide
171. Interferon action is:
A.
*primarily antiviral
B.
to disrupt cytoplasmic membranes
C.
to protect primary infected cells
D.
found in high levels in phagocytic granules
E.
kill virus direct
172. The earliest stages of B cell differentiation
A.
Occur in the embryonic thymus
B.
Require the presence of antigen
C.
Involve rearrangement of K chain gene segments
D.
Involve rearrangement of surrogate light chain gene rearrangement
E. *Involve rearrangement of heavy chain gene segments
173. Antigen-presenting cells process antigen to?
A.
B-cells
B.
T-killers
C.
NK-cells
D.
Mast cells
E.
*T-helpers
174. An antigen is
A.
a hapten that combines with an antibody,
B.
*a substance that incites an antibody response and can combine specifically with
these antibodies.
C.
a small molecule that attaches to cells.
D. a carbohydrate
E. a protein that combines with antibodies.
175. The classic complement pathway is initiated by interaction of Cl with
A.
antigen
B.
factor B
C.
*antigen-IgG complexes
D.
bacterial lipopolysaccharides
E.
factor D and I
176. Natural killer cells are:
A.
B cells that can kill bacteria without complement
B.
cytotoxic T cells
C.
increased by immunization
D.
*able to kill virus-infected cells without prior sensitization
E.
Tγλ cells
177. Secondary lymphoid organ/s is/are:
A.
lymph nodes.
B.
spleen.
C.
mucosa-associated lymphoid tissue.
D.
GALT
E.
*all of the above
178. Natural killer cells take part in:
A.
allograft rejection.
B.
tumour rejection.
C.
non-specific killing of virus transformed target cells.
D.
cytothoxic and cytolytic reactions
E.
*all of the above
179. Human T lymphocytes:
A.
Are found mainly in the cortex region of the lymph node.
B.
Are found in the red .pulp of the periarteriolar lymphoid sheath (PALS) of the spleen.
C.
*Make up 65-85% of the peripheral blood lymphocytes.
D.
All of the above.
E.
None of the above.
180. The portion of an antigen molecule that stimulates an antibody response is called the
A.
specific receptor
B.
*epitope
C.
antibody determinant.
D. active center.
E. antigen binding place.
181. Complement lyses cells by
A.
enzymatic digestion of the cell membrane
B.
activation of adenylate cyclase
C.
*insertion of complement proteins into the cell membrane
D.
inhibition of elongation factor 2
E.
production of lysozyme
182. Which one of the following substances is released by activated helper Th2 cells?
A.
α interferon
B.
β interferon
C.
TNF
D.
*Interleukin-6
E.
serotonin
183. Choose among the listed central organs of immune system:
A.
GALT, spleen
B.
* thymus, bone marrow
C.
lymph nodes, thymus,
D.
thyroid gland, tonsil gland
E.
bone narrow, spleen
184. Monocytes are leukocytes that develop into
A.
*granular, phagocytes
B.
agranular, macrophages
C.
agrunular, mast cells
D.
granular, T cells
E.
granular, B cells
185. Which of the following normal component of serum has antiviral activity?
A.
complement
B.
collagenase
C.
*interferon
D.
lysozyme
E.
lysosome
186. Lymphocytes which can kill tumor cells, virus-infected cells as part of innate
immunity are called:
A.
mast cells
B.
neutrophils
C.
monocytes
D.
lymphocytes
E.
*natural killer cells
187. Which is action of α and β interferons :
A.
*activate antiviral enzymes in cells infected by viruses
B.
disrupt cytoplasmic membranes
C.
protect primary infected cells
D.
found in high levels in phagocytic granules
E.
stimulate production by infected cells syntetaise and proteinkinase
188. What is function of natural killer?
A.
Inhibit macrophages.
B.
Activates B-cells.
C.
*Kill tissue cells infected by viruses
D.
take part in type I of allergy
E.
all of the above.
189. C3b is involved in all of the following EXCEPT:
A.
*altering vascular permeability
B.
promoting phagocytosis
C.
forming alternative-pathway C3 convertase
D.
forming C5 convertase.
E. can bind to macrophages
190. Choose in the following statements concerning class I MHC proteins noncorrect:
A.
They are cell surface proteins on virtually all cells
B.
They are recognition elements for cytotoxic T cells
C.
They are codominantly expressed
D.
*They are important in the skin test response to Mycobacterium
tuberculosis
E.
They are absent onto red blood cells
191. What are cells expressed CD3 surface antigen:
A.
*T cells.
B.
В cells.
C.
monocytes.
D.
granulocytes.
E.
mast cells
192. What is function of T-killer cells?
A.
*take part in antiviral immunity
B.
allergy
C.
autoimmunity
D.
antibodies synthesis
E.
all of these
193. Cl must interact in the classic complement pathway with:
A.
antigen
B.
factor B
C.
*antigen-IgG complexes
D.
bacterial lipopolysaccharides
E.
factor D and I
194. Which substances can produce Th1 cells?
A.
Alpha interferon
B.
*Gamma interferon
C.
Interleukin-5
D.
Interleukin-6
E.
bradikidin
195. Which do from following cell markers belong for B lymphocyte?
A.
CD 38 marker.
B.
CD 25 marker.
C.
CD 4 marker.
D.
CD 3 marker
E.
*CD 19 marker.
196. Which do T cells activate the functions of B cells and other T cells.
A.
Sensitized
B.
*Helper
C.
Cytotoxic
D. Natural killer
E. K cells
197. Choose the main ability of Natural killer cells:
A.
They can kill cells by complement depending lysis
B.
They are cytotoxic T cells
C.
Their level increases by immunization
D.
They able to kill virus-infected cells without prior sensitization
E. *They opsonisses phagocytes
198. Which do one of the following substances released by activated helper T cells can
activate T killers?
A.
trasfer factor
B.
*Gamma interferon
C.
Interleukin- 6
D.
Interleukin-4
E. lymphotoxin
199. Which factor of a nonspecific resistance to infection has antiviral activity:
A.
*NK cell
B.
unbroken skin
C.
lysozyme in saliva
D.
cilia in trachea
E.
all of these
200. Which of the following is the first product of the activation of the complement
system?
A.
properdin
B.
membrane attack complex
C.
cascade reaction
D.
*complement factor C1(C1q,C1r,C1s)
E.
complement factor C5
201. Macrophages develop from:
A.
phagocytes
B.
monocytes,
C.
*mast cells
D.
T cells
E.
B cells
202. Show what is necessery for activation complement system by classic pathway?
A.
factor B
B.
*antigen-antibody complex
C.
antigen-IgA complexes
D.
bacterial capsula
E.
endotoxin
203. Match the types of immunity after vaccination:
A.
Innate
B.
naturally acquired active
C.
naturally acquired passive
D.
*artificially acquired active
E.
artificially acquired passive
204. Match the types of immunity after recovery from disease:
A.
innate
B.
*naturally acquired active
C.
naturally acquired passive
D.
artificially acquired active
E.
artificially acquired passive
205. Match the types of immunity after administration antitoxic serum:
A.
innate
B.
naturally acquired active
C.
naturally acquired passive
D.
artificially acquired active
E.
*artificially acquired passive
206. Match the types of immunity after transfer of immunity from mother to fetus:
A.
innate
B.
naturally acquired active
C.
*naturally acquired passive
D.
artificially acquired active
E.
artificially acquired passive
207. Match the types of immunity of humans to cat and dog distemper:
A.
*innate
B.
naturally acquired active
C.
naturally acquired passive
D.
artificially acquired active
E.
artificially acquired passive
208. About complement (everything is true,except):
A.
the nonspecific factor of immunity
B.
contains in all biological liquids, except for spinal fluid and liquids of the forward
chamber of an eye
C.
termolabile
D.
*The highest titer in spinal fluid
E.
System of the proteins capable to self-organizing
209. Complement(everything is true, except):
A.
stimulates phagocytosis
B.
possesses antigenic properties
C.
*possesses oncogenic properties
D.
Defines bactericidal action of serum
E.
Possesses cytolytic activity
210. The Classical way of activation complement is carried out:
A.
without participation of antibodies
B.
at participation properdin
C.
without formation membrane attack complex
D.
*at formation of an antigen – antibody complex
E.
at formation L-transformations
211. The titer of complement:
A.
a minimum quantity causing partial hemolysis of red blood cells in hemolytic
system
B.
*a minimum quantity causing full hemolysis
C.
a maximum quantity causing full hemolysis
D.
minimum quantity at which hemolysis is absent
E.
the maximum quantity causing partial hemolysis
212. Immune hemolysis test is used with the purpose:
A.
definitions of group of blood
B.
*titrations of complement
C.
definitions of osmotic stability of red blood cells
D.
serological identification of microorganisms
E.
estimations of phagocytic activity of neutrophils
213. CD4 and CD8 both:
A.
bind to Class II MHC
B.
function in signal transduction
C.
bind to B7
D.
*T cells
E.
B1 and B2 cells
214. Which of the following pairs of cytokines could be said to have antagonistic
activities?
A.
IL-1 and TNF-α
B.
IL-12 and IFN-γ
C.
*IL-10 and IFN-γ
D.
IL-4 and IL-5
E.
IFN-γ and IL-2
215. Which of the following cytokines does function as an endogenous pyrogen?
A.
IL-2
B.
*IL-1
C.
IL-6
D.
TNF-α
E.
IFN-γ
216. Which of the following classes of MHC proteins are produced only by antigen
presenting cells?
A.
Class I
B.
*Class II
C.
Class III
D.
Class II & Class III
E.
Class I & Class III
217. Which of the following cell types are known to have Fc receptors on their surface?
A.
follicular dendritic cells
B.
macrophages
C.
basophils
D.
eosinophils
E.
*all of the above
218. The thymus is considered to be:
A.
*a primary lymphoid organ
B.
a secondary lymphoid organ
C.
a reticuloendothelial organ
D.
a specialized lymph node
E.
a complement producing organ
219. Antibody-secreting cells are called:
A.
*plasma cells
B.
T cell blasts
C.
macrophages
D.
B lymphoblasts
E.
pre-B lymphocytes
220. The antigen binding specificity of an antibody is due to:
A.
the constant regions of the light chains
B.
the variable framework regions of the heavy & light chains
C.
the variable regions of the heavy chains
D.
*the hypervariable regions of both heavy & light chains
E.
the constant regions of the heavy chains
221. Immunoglobulin molecules would be found positioned in the plasma membrane of
which of the following types of cells?
A.
*B lymphocytes
B.
Monocytes
C.
T lymphocytes
D.
both a & c
E.
NK cells
222. A major role of macrophages is to present foreign antigens to:
A.
other APCs
B.
B lymphocytes
C.
*Th lymphocytes
D.
Neutrophils
E.
NK cells
223. Cytotoxic T cells can kill target cells by inserting into their membranes proteins
called:
A.
perforations
B.
*perforins
C.
perforinse
D.
performins
E.
perporins
224. Programmed cell death in animal cells is known as:
A.
A poptos
B.
a poptosis
C.
a pop tosis
D.
apopstasis
E.
*apoptosis
225. The effects of antibody on bacteria include each of the following EXCEPT:
A.
Lysis of gram-negative bacteria in conjunction with complement
B.
Enhancement of phagocytosis
C.
*Inhibition of bacterial metabolism
D.
Inhibition of adherence of bacteria to mucosal surfaces
E.
Neutralization of toxins
226. The MAIN host defense against bacterial exotoxins is
A.
Activated macrophages secreting proteases
B.
*IgG and IgM neutralizing antibodies
C.
Helper T cells
D.
Modulation of host cell receptors in response to the toxin
E.
Cleave exotoxins by antibodies
227. The fragment required for an IgG molecule to bind complement is
A.
Fab
B.
*Fc
C.
Variable part of a L-chain
D.
Variable part of a H-chain
E.
Constant parts of the L-chains
228. The antibody-binding site is formed primarily by
A.
The constant regions of H and L chains
B.
*The hypervariable regions of H and L chains
C.
The hypervariable regions of H chains
D.
The variable regions of H chains
E.
The variable regions of L chains
229. The class of immunoglobulin present in highest concentration in the blood of a
human is
A.
*IgG
B.
IgM
C.
IgA
D.
IgD
E.
IgE
230. The major role of T cells in the immune response includes which one of the
following?
A.
*Recognition of epitopes presented with major histocompatibility complex
molecules on all surfaces
B.
Complement fixation
C.
Phagocytosis
D.
Production of antibodies
E.
Take part in atopic reaction
231. Which one of the following statements best describes immunoglobulin structure?
A.
*The amino acid sequence variation of the heavy chains is different than that
observed in light chains
B.
In humans, there are approximately twice as many Ig molecules with H and L
chains
C.
In the three-dimensional structure of Ig, there is little, if any, flexibility in the
hinge region between the Fc and two Fab portions
D.
IgM is a monomeric structure
E.
Ig structural studies have been difficult because there is no readily available
model protein
232. Which immunoglobulin has no known function, but is present on the surface of B
lymphocytes? It may function as an antigen receptor.
A.
IgG
B.
IgM
C.
IgE
D.
IgA
E.
*IgD
233. Which of the following is the immunoglobulin that is initially seen on the primary
immune response? It is present as a monomer on B cell surfaces but as a pentamer in serum.
A.
IgG
B.
*IgM
C.
IgE
D.
IgA
E.
IgD
234. Which immunoglobulin mediates immediate hypersensitivity and is involved in
immune response to parasitic infections?
A.
IgG
B.
IgM
C.
*IgE
D.
IgA
E.
IgD
235. Which immunoglobulin is the primary antibody in saliva, tears, and intestinal and
genital secretions?
A.
IgG
B.
IgM
C.
IgE
D.
*IgA
E.
IgD
236. Which immunoglobulin is the predominant antibody in the secondary immune
response? It has four subclasses.
A.
*IgG
B.
IgM
C.
IgE
D.
IgA
E.
IgD
237. Isotypes refer to variations in the
A.
light chain variable region.
B.
light chain constant region.
C.
heavy chain variable region.
D.
*heavy chain constant region.
E.
Any of the above.
238. Which of the following is the major immunoglobulin in human serum, accounting
for 80% of the immunoglobulin pool?
A.
IgA
B.
IgD
C.
IgE
D.
*IgG
E.
IgM
239. Which immunoglobulin is the least prevalent?
A.
IgA
B.
IgD
C.
*IgE
D.
IgG
E.
IgM
240. Compared to the secondary antibody response, the primary response
A.
*has a longer lag phase.
B.
has a more rapid log phase.
C.
persists for a longer plateau period.
D.
attains a higher IgG titer.
E.
produces antibodies with a higher affinity for the antigen.
241. Monoclonal antibodies are produced by
A.
lymphocytes.
B.
myeloma cells.
C.
*hybridomas.
D.
spleen cells.
E.
plasma cells.
242. Monoclonal antibodies are routinely used in all of the following EXCEPT
A.
the typing of tissue.
B.
the identification and epidemiological study of infectious microorganisms.
C.
the identification of tumor antigens.
D.
the classification of leukemias.
E.
*the manipulation of the immune response.
243. Which of the following DOES NOT play a role in antigen presentation?
A.
MHC class I molecules
B.
MHC class II molecules
C.
*MHC class III molecules
D.
All of the above
E.
None of the about
244. Which of the following is used for typing when a patient is being prepared for an
organ transplant?
A.
MHC class I molecules
B.
*MHC class II molecules
C.
MHC class III molecules
D.
All of the above
E.
None of the above
245. B-cells do which of the following?
A.
Proliferate and differentiate into plasma cells
B.
Respond to antigens by making antibodies
C.
Act as antigen-processing cells
D.
*All of the above
E.
None of the above
246. Direct immunofluorescence tests use a labelled antibody to identify.
A.
*an unknown microbe
B.
an unknown antibody
C.
fixed complement
D.
precipitins
E.
level of immunoglobulines in serum
247. An immunoglobulin is a
A.
protein.
B.
carbohydrate.
C.
*glycoprotein.
D.
fatty acid.
E.
nucleic acid.
248. Isotypes refer to variations in the
A.
light chain variable region.
B.
light chain constant region.
C.
heavy chain variable region.
D.
*heavy chain constant region.
E.
Any of the above.
249. Which of the following involves separation of antigens by size on a gel, followed by
diffusion and precipitation?
A.
Flow cytometry
B.
Double diffusion immunoassay
C.
*Immunoelectrophoresis
D.
Direct immunosorbent assay
E.
Indirect immunosorbent assay
250. Which category of hypersensitivity BEST describes hemolytic disease of the
newborn caused by Rh incompatibility?
A.
Atopic or anaphylactic
B.
*Cytotoxic
C.
Immune complex
D.
Delayed
E.
Autoimmune
251. The principal difference between cytotoxic (type II) and immune complex (type III)
hypersensitivity is
A.
the class (isotype) of antibody
B.
*the site where antigen-antibody complexes are formed
C.
the participation of complement
D.
the participation of T cells
E.
interraction between antigen and antibody
252. Pollen is which type of allergen?
A.
contactant
B.
ingestant
C.
injectant
D.
*inhalant
E.
insectant
253. B cells are responsible for which allergies?
A.
asthma
B.
*anaphylaxis
C.
tuberculin reactions
D.
both a and b
E.
none of above
254. An example of a type III immune complex disease is
A.
*serum sickness
B.
contact dermatitis
C.
graft rejection
D.
atopy
E.
none of above
255. Localized anaphylaxis involving the skin is called
A.
hay fever
B.
asthma
C.
shock.
D.
*hives
E.
none of abou
256. Immunotherapy to prevent generalized anaphylaxis is done by injecting dilute doses
of
A.
IgG antibodies
B.
antihistamine.
C.
IgE antibodies.
D.
*offending antigen
E.
offending antibody
257. Which of the following is most commonly involved in graft rejections?
A.
ABO antigens
B.
ABO antibodies
C.
MHC antigens
D.
MHC antibodies
E.
*a and c are correct
258. A hypersensitive reaction occurs
A.
during the first exposure to an antigen.
B.
in individuals with diseases of the immune system.
C.
*on a second or subsequent exposure to an antigen.
D.
during autoimmune diseases.
E.
in immunologically-deficient individuals.
259. Farmer's lung is the result of
A.
sensitized T cells .
B.
*immune complex reactions
C.
Type I hypersensitivity.
D.
cytotoxic reactions
E.
Urticaria
260. A delayed hypersensitivity reaction is characterized by
A.
edema without a cellular infiltrate
B.
an infiltrate composed of neutrophils
C.
*an infiltrate composed of helper T cells and macrophagcs
D.
an infiltrate composed of eosinophils
E.
none of above
261. Which allergies are T-cell mediated?
A.
type I
B.
type II
C.
*type III
D.
type IV
E.
none of above
262. The contact with allergen that results in symptoms is called the
A.
sensili/mg dose
B.
degranulation dose
C.
*provocative dose
D.
desensitizing dose
E.
none of above
263. The direct, immediate cause of allergic symptoms is the action of
A.
the allergen directly on smooth muscle
B.
the allergen on B lymphocytes
C.
*allergic mediators released from masl cells and basopluls
D.
IgE on smooth muscle
E.
none of above
264. Type II hypersensitivities are due to
A. IgE reacting with mast cells
B. activation of cytotoxic T cells
C. *IgG-allergen complexes that clog epithelial tissues
D. complement-induced lysis of cells in the presence of antibodies
E.
none of above
265. A positive tuberculin skin test is an example of
A.
*delayed-type allergy
B.
acute contact dermatitis
C.
autoimmunity
D.
eczema
E.
none of above
266. Which of the following would be a Type IV, or delayed hypersensitivity?
A.
hayfever
B.
*allergic contact dermatitis
C.
glomerulonephritis
D.
penicillin reaction
E.
blood transfusion reaction
267. Allergic contact dermatitis is mediated by
A.
*sensitized T cells.
B.
IgG antibodies.
C.
IgE antibodies.
D.
basophils and mast cells.
E.
sensitized macrophages.
268. Immediate hypersensitivities are mediated by
A.
allergens
B.
macrophages
C.
*humoral antibodies
D.
antigens
E.
T cells
269. Production of IgE and degranulation of masl cells are involved in
A. contact dermatitis
B. *anaphylaxis
C. Arthus reaction
D. both a and b
E.
none of above
270. Rheumatoid arthritis is an that affects the
A.
immunodeficiency disease, muscles
B.
autoimmune disease, nerves
C.
allergy, cartilage
D.
*autoimmune disease, joints
E.
none of above
271. The symptoms of an immune complex reaction are due to
A.
allergen
B.
histamines ies.
C.
autoimmune antigens.
D.
IgE.
E.
*autoimmune antibodies
272. Reaction of antigen with IgE antibodies attached to mast cells causes
A.
precipitation .
B.
complement fixation .
C.
*degranulation.
D.
agglutination
E.
asthma
273. Immunotherapy for hypersensitivities probably works because of
A.
*the production of IgG blocking antibodies
B.
development of suppressor T cells .
C.
saturation of IgE antibodies.
D.
All of the above
are correct
E.
Only a and b are correct
Situation tasks
1. A patient undergoing evaluation for possible infection with M. tuberculosis develops a
skin wheal 48 h after intradermal placement of TB purified-protein derivative (PPD). Which of
the following cellular events accounts for these findings?
A. IL-7-induced B-cell activation and secretion of antibodies
B. IL-3-mediated B-cell activation and induction of help for T-cell activation
C. *Monocyte-derived IL-6 activation of T cells
D. Complement-mediated endothelial cell damage
E. CD44-mediated monocyte adhesion to endothelial cells
2. A 25-year-old woman presents with a history of recurrent expectoration of foulsmelling sputum and intermittent fevers. Chest x-ray discloses characteristic "tram-tracking"
bronchial thickening. Physical examination reveals coarse rhonchi in the right chest and
splenomegaly. Blood test results are normal except for low levels of serum IgG and IgA. Her
past medical history is remarkable for frequent upper respiratory infections and for a history of
diarrhea 3 years ago due to Giardia lamblia infection. The most appropriate therapy would be
A. corticosteroids
B. corticosteroids and an alkylating agent
C. *monthly intravenous immunoglobulin
D. splenectomy
E. bone marrow transplantation
3. All of the following statements regarding the epidemiology of HIV infection are
correct EXCEPT
A. the risk of transmission following skin puncture from a needle contaminated with
blood from an HIV-infected patient is less than 0.5 percent
B. *most cases of AIDS are now among I/V drug users
C. the risk of transmission from a single donor unit of blood is approximately 1/500,000
D. most pediatric cases of AIDS arise because of vertical transmission from an infected
mother
E. there is no convincing evidence that saliva can transmit HIV
4. Which of the following statements best describes the role of polymerase chain reaction
(PCR) in the diagnosis of HIV infection?
A. *It should be used if the western blot is indeterminate
B. It is a useful screening test
C. It should be used if two consecutive serologic tests (ELISA) are positive
D. It should be used if the initial serologic test is positive, but the second is negative
E. It has no real role
5. All the following statements concerning the ataxia-telangiectasia syndrome are correct
EXCEPT
A. it is inherited in an autosomal recessive manner
B. *the cause is adenosine deaminase deficiency
C. malignancy is a common cause of death
D. bronchiectasis may occur
E. both humoral and cellular limbs of the immune system are affected
6. Which of the following statements regarding central nervous system disease in patients
with HIV infection is correct?
A. *The most common cause of central nervous system disease is the AIDS dementia
complex
B. The most common cause of seizures is cryptococcal meningoencephalitis
C. Antiretroviral agents have no role
D. The most common finding on MRI is multiple white matter lesions
E. Actual histologic evidence of direct HIV involvement is rare
7. Which of the following is the LEAST common immunologic manifestation of HIV
infection?
A. Cutaneous reactions to drugs
B. *Anaphylactic reactions to drugs
C. Anticardiolipin antibodies
D. Oligoarticular arthritis
E. Fibromyalgia
8. Which histologic subtype of lymphoma occurs most commonly in patients infected
with HIV?
A. *Immunoblastic (large cell) lymphoma
B. Small, noncleaved (Burkitt's) lymphoma
C. Small, cleaved (follicular) lymphoma
D. Primary central nervous system lymphoma
E. Hodgkin's disease, mixed cellularity
9. A 68-year-old woman presents to her internist for a routine checkup. Her physical
examination is normal and routine laboratory evaluation is also normal except for an elevated
total protein of 90 g/L (9.0 g/dL). Further workup includes the following: serum protein
electrophoresis that reveals an M spike (proved to be IgG-K on immunoelectrophoresis) of 19
g/L (1.9 g/dL), an unremarkable urine protein electrophoresis, bone marrow aspirate and biopsy
that discloses normal hematopoesis and 3 percent bone marrow plasma cells, and a negative
skeletal survey. The proper course of action at this point is to
A. obtain quantitative immunoglobulin levels
B. obtain beta-microglobulin level
C. begin therapy with melphalan and prednisone
D. begin therapy with high-dose prednisone
E. *reassure the patient; no additional action is required at this time
10. True statements about human T cells include which of the following?
A. They are the principal cells in the cortical "germinal centers" and medullary cords of
lymph nodes
B. They carry membrane-bound IgD on their surface
C. *They constitute 70 to 80 percent of circulating blood lymphocytes
D. They arise from stem cells in the thymus
E. They are the main effectors of antibodydependent, cell-mediated cytotoxicity
11. Human immunoglobulin A (IgA) can be described by which of the following
statements?
A. It is the predominant immunoglobulin in plasma
B. It exists in four subclasses, of which IgA2 is predominant
C. *It can prevent attachment of microorganisms to epithelial cell membranes
D. It is prominent early in the immune response and is the major class of antibody in cold
agglutinins
E. It has the shortest half-life of the five classes of immunoglobulin
12. Correct statements about isolated immunoglobulin A deficiency include which of the
following?
A. *The incidence of atopic disease is high.
B. The reduced number of IgA-bearing B cells accounts for the reduced serum IgA
levels.
C. Bone marrow transplantation is needed
D. Secretory IgA levels usually are normal.
E. Nothing above
13. Correct statements about isolated immunoglobulin A deficiency include which of the
following?
A. *The risk of adverse reactions to transfusions is increased.
B. The reduced number of IgA-bearing B cells accounts for the reduced serum IgA
levels.
C. Bone marrow transplantation is needed
D. Secretory IgA levels usually are normal.
E. Nothing above
14. Correct statements about isolated immunoglobulin A deficiency include which of the
following?
A. *The incidence of autoimmune disese is increased.
B. The reduced number of IgA-bearing B cells accounts for the reduced serum IgA
levels.
C. Bone marrow transplantation is needed
D. Secretory IgA levels usually are normal.
E. Nothing above
15.
Chemically induced tumors have tumor-associated transplantation antigens that
A. are always the same for a given carcinogen
B. *are different for two tumors of different histologic type even if induced by the same
carcinogen
C. are very strong antigens
D. do not induce an immune response
E. None of above
16.
After binding to its specific antigen, a B lymphocyte may switch its
A. immunoglobulin light-chain isotype
B. *immunoglobulin heavy-chain class
C. variable region of the immunoglobulin heavy chain
constant region of the immunoglobulin light chain
Nothing above
17.
Complement fixation refers to
A. the ingestion of C3b-coated bacteria by macrophages
B. the destruction of complement in serum by heating at 56 °C for 30 minutes
C. *the binding of complement components by antigen-antibody complexes
D. the interaction of C3b with mast cells
E. none of above
18.
Individuals with a genetic deficiency of C6 have
A.
decreased resistance to viral infections
B.
increased hypersensitivity reactions
C.
increased frequency of cancer
D.
*decreased resistance to Neisseria bacteremia
E.
none of above
19.
Natural killer cells are
A. B cells that can kill without complement
B. cytotoxic T cells
C. increased by immunization
D. *able to kill virus-infected cells without prior sensitization
E. none of above
20. A primary immune response in an adult human requires approximately how much time
to produce detectable antibody levels in the blood?
A. 12 hours
B. 3 days
C. *1 week
D. 3 weeks
E. 6 weeks
21. The BEST method to demonstrate IgG on the glomerular basement membrane in a
kidney tissue section is the
A. precipitin test
B. complement fixation test
C. agglutination test
D. *indirect fluorescent-antibody test
E. none of above
22.
Which one of the following substances is NOT released by activated helper T cells?
A. Alpha interferon*
B. Gamma interferon
C. Interleukin-2
D. Interleukin-4
E. None of above
23. A delayed hypersensitivity reaction is characterized by
A. edema without a cellular infiltrate
B. an infiltrate composed of neutrophils
C. *an infiltrate composed of helper T cells and macrophages
D. an infiltrate composed of eosinophils
E. None of above
24. An antigen found in relatively high concentration in the plasma of normal fetuses and a
high proportion of patients with progressive carcinoma of the colon is
A. viral antigen
B. *carcinoembryonic antigen
C. alpha-fetoprotein
D. heterophil antigen
E. none of above
25.
Antigen-presenting cells that activate helper T cells must express which one of the
following on their surfaces?
A. IgE
B. Gamma interferon
C. Class I MHC antigens
D. *Class II MHC antigens
E. Nothing above
26.
In setting up a complement fixation test for antibody, the reactants should be added
in what sequence? (Ag = antigen; Ab = antibody; C = complement; EA = antibody-coated
indicator erythrocytes.)
A.
Ag + EA + C/wait/ + patient's serum
B.
C + patient's serum + EA/wait/ + Ag
C.
Ag + patient's serum + EA/wait/+ C
D.
*Ag + patient's serum + C/wait/+ EA
E.
No one in the list
27.
Which one of the following properties of antibodies is NOT dependent on the
structure of the heavy-chain constant region?
A.
Ability to cross the placenta
B.
Isotype (class)
C.
Ability to fix complement
D.
*Affinity for antigen
E.
None of above
28.
The role of the macrophage during an antibody response is to
A. make antibody
B. lyse virus-infected target cells
C. activate cytotoxic T cells
D. *process antigen and present it
E. none of above
29. The mother of a 4-year-old child notes that her child is sleeping poorly and scratching
his anal area. You suspect the child may have pinworms. Which one of the following is the
BEST method to make that diagnosis?
A. Examine the stool for the presence of cysts
B. Examine the stool for the presence of trophozoites
C. Examine a blood smear for the presence of microfilaria
D. Determine the titer of IgE antibody*
E. Nothing above
30.
A 22-year-old woman had fever to 100 °F and anorexia for the past 2 days, and this
morning she appears jaundiced. On examination, her liver is enlarged and tender. She has a
total bilirubin of 5 mg/dL (normal < 1) and elevated transaminases. She received the complete
course of the hepatitis B vaccine 2 years ago but has not had the hepatitis A vaccine. The results of
her hepatitis serologies are as follows: HAV-IgM-negative, HAV-IgG-positive, HBsAg-negative,
HBsAb-positive, HBcAb-negative, HCV-Ab-positive. Of the following, which one is the
MOST accurate?
A. She probably has hepatitis A now, probably has not been infected with HBV, and
probably had hepatitis C in the past
B. She probably has hepatitis A now, probably has been infected with HBV in the past,
and probably had hepatitis C in the past
C. *She has been infected with HAV in the past, probably has not been infected with
HBV, and probably has hepatitis C now
D. She has been infected with HAV in the past, probably has hepatitis B now, and
probably had hepatitis C in the past
E. None of above
31.
Regarding the function of the different classes of antibodies, which one of the
following statements is the MOST accurate?
A. IgA acts as an antigen receptor on the surface of B cells
B. IgG activates the alternative pathway of complement, resulting in the production of C3a
that degrades the bacterial cell wall
C. *IgG binds to the bacterial surface and makes the bacteria more easily ingested by
phagocytes
D. IgM defends against worm parasites, such as hookworms
E. IgE blocks the binding of viruses to the gut mucosa
32.
Regarding the primary and secondary anamnestic immune responses, which one of
the following statements is MOST accurate?
A. The IgM made in the primary response is made primarily by memory B cells
B. The lag phase is shorter in the primary response than in the secondary response
C. In the primary response, memory B cells are produced, but memory T cells are not
D. Antigen must be processed and presented in the primary response but not in the
secondary response
E. *The amount of IgG made in the secondary response is greater than the amount made in
the primary response
33. Which of the following statements about IgM is true?
A.
It is a reagenic antibody
B.
*It is important in the first few days of the primary immune response
C.
It increases in serum concentration after IgG has reached its peak serum
concentration
D.
It is the smallest of the immunoglobulin molecules
E.
It is involved in the allergic reaction
34. Actively acquired immunity can be coused by all of the following except?
A. The specific disese
B. Exposure to subclinical doses of the disease-causing organism
C. Vaccination with the appropriate antigen
D. *Injection with immune serum containing appropriate antibody
E. The specific disese @ Vaccination with the appropriate antigen
35. All of the following are characteristics of the human immunodeficiency virus except?
A. it binds to the CD4 molecule preferentially
B. it contains gp120 and gp41 envelope proteins
C. it is the causative agent of AIDS
D. *it contains DNA within its core
E. it contains a reverse transcriptase within its core
36. Which of the following components determines the class-specific antigenicity of
immunoglobulines?
A. J chain
B. T chain
C. Light chain
D. *Heavy chain
E. Secretory components
37. Which one of the following substances may be passively transferred from the mother
to the fetus during the third trimester of the pregnancy?
A. *IgG
B. Anti-Rh antibody
C. Natural isohemagglutinins
D. IgM
E. None of above
38. Which one of the following statements best describes the rheumatoid factor?
A. It is the antigen initiating the rheumatoid inflammatory process
B. It is an antibody against cellular DNA
C. It consists primarily of DNA
D. *It is an antibody against immunoglobulin
E. None of above
39. Which of the following tests is the most sensitive type of serologic test?
A. Virus neutralization
B. *ELISA
C. Nucleic acid hybridization
D. Hemadsorption
E. Nothing
40. The human immunodeficiency virus (HIV)-1 has been shown to be transmitted by all
of the following mechanisms except
A. sexual contact
B. perinatal infection
C. shared needles
D. *mosquitoes
E. blood transfusion
41. Which one of the following is a typical immune complex disease?
A. Klippel-Feil syndrome
B. Urticaria pigmentosa
C. *SLE
D. Gastric ulcer
E. Osteoarthritis
42. High titer of rheumatoid factor are found in what percentage of patients with RA?
A. 5 %
B. *70 %
C. 25 %
D. 50 %
E. 100 %
43. Which of the following is the most common site of immune complexes?
A. both ureters
B. cardiac septum
C. *capillaries in the renal glomerulus
D. posterior lobe of the pituitary gland
E. musculs
44. A woman of 36 years is on the 12-th week of the first pregnancy. We know from the
history that she was treated for infertility. She visited friends and contacted with child who
developed rubella in 2 days after meeting. Woman doesn’t know if she has ever been infected
with rubella. What is the adequate tactics?
A. Monitory of the specific Ig G and Ig M with the ELISA*
B. Interruption of the pregnancy
C. Immune globulin injection
D. Cyclovin administration
E. Interferon administration
45. True statements regarding immune-complex disease include which of the following?
A. *Normally, most immune complexes are removed by the reticuloendothelial system
B. Symptoms of the disease are very specific
C. Renal manifestation are not frequent
D. Skin rash is the first symptom
E. Treatment is unknown
46. Right statements regarding immune-complex disease include which of the following?
A. *Signs and symptoms stem from the deposition of immune complexes in tissues other
than those of the reticuloendothelial system
B. Symptoms of the disease are very specific
C. Renal manifestation are not frequent
D. Skin rash is the first symptom
E. Treatment is unknown
47. Regarding immune-complex disease true statements include which of the following?
A. *Persistence of immune complexes in the circulation seems to be a requirement for the
development of renal manifestations
B. Symptoms of the disease are very specific
C. Renal manifestation are not frequent
D. Skin rash is the first symptom
E. Treatment is unknown
48. True statements regarding immune-complex disease include which of the following?
A.* Renal lesions depend on antigen-antibody combinations in which antigen is in slight
excess
B. Symptoms of the disease are very specific
C. Renal manifestation are not frequent
D. Skin rash is the first symptom
E. Treatment is unknown
49. True statements regarding immune-complex disease include which of the following?
A. *The rash of cutaneous necrotizing vasculitis may be an example of immune-complex
disease
B. Symptoms of the disease are very specific
C. Renal manifestation are not frequent
D. Skin rash is the first symptom
E. Treatment is unknown
50. Which of the following statements about IgM is true?
A. It is a reagenic antibody
B. *It is important in the first few days of the primary immune response
C. It increases in serum concentration after IgG has reached its peak serum concentration
D. It is the smallest of the immunoglobulin molecules
E. It is involved in the allergic reaction
51. All of the following statements regarding the epidemiology of HIV infection are
correct EXCEPT
A. the risk of transmission following skin puncture from a needle contaminated with
blood from an HIV-infected patient is less than 0.5 percent
B. *most cases of AIDS are now among IV drug users
C. the risk of transmission from a single donor unit of blood is approximately 1/500,000
D. most pediatric cases of AIDS arise because of vertical transmission from an infected
mother
E. there is no convincing evidence that saliva can transmit HIV
52. Each of the following would be an acceptable initial therapeutic regimen for an HIVinfected patient EXCEPT
A. zidovudine/didanosine
B. *zidovudine monotherapy
C. didanosine monotherapy
D. zidovudine/zalcitabine
E. zidovudine/lamivudine
53. Which of the following statements best describes the role of polymerase chain
reaction (PCR) in the diagnosis of HIV infection?
A. It is a useful screening test
B. *It should be used if the western blot is indeterminate
C. It should be used if two consecutive serologic tests (ELISA) are positive
D. It should be used if the initial serologic test is positive, but the second is negative
E. It has no real role
54. All the following statements concerning the HLA D region on the sixth human
chromosome are correct EXCEPT
A. *it is located inside the major histocompatibility gene complex
B. it encodes proteins involved in the mixed lymphocyte response
C. it encodes proteins expressed only on certain immune effector or closely related cells
D. siblings matched for HLA-A, -B, and -C antigens will usually be matched at the D
region
E. it is located close to genes encoding for complement components
55. Each of the following statements regarding infections in prosthetic joints is true
EXCEPT
A. the majority of infections are acquired intraoperatively or immediately postoperatively
B. *prosthetic joint sepsis is invariably heralded by joint pain, swelling erythema, and
warmth
C. diagnosis is best made by needle aspiration of the joint
D. successful treatment usually requires complete removal of the prosthesis
E. the risk of infection is increased in patients undergoing a repeat total joint replacement
56. Right statements about isolated immunoglobulin A deficiency include which of the
following?
A. *The incidence of atopic disease is high
B. The risk of adverse reactions to transfusions is low
C. The incidence of autoimmune disease is decreased
D. Secretory IgA levels usually are normal
E. The reduced number of IgA-bearing B cells accounts for the reduced serum IgA levels
57. What diseases are not contraindication for liver transplantation:
A. malignancy
B. terminal renal insufficiency
C. terminal cardiovascular insufficiency
D. *terminal liver insufficiency
E. polyorganic failure
58. A recipient of a 2-haplotype MHC-matched kidney from a relative still needs
immunosuppression to prevent graft rejection because
A. graft-versus-host disease is a problem
B. class II MHC antigens will not be matched
C. *minor histocompatibility antigens will not be matched
D. complement components will not be matched
E. none of above
59. Bone marrow transplantation in immunocompromised patients presents which major
problem?
A. *Potentially lethal graft-versus-host disease
B. High risk of T cell leukemia
C. Inability to use a live donor
D. Delayed hypersensitivity
E. None of above
60. What is the role of class II MHC proteins on donor cells in graft rejection?
A. They are the receptors for interleukin-2, which is produced by macrophages when they
attack the donor cells
B. *They are recognized by helper T cells, which then activate cytotoxic T cells to kill the
donor cells
C. They induce the production of blocking antibodies that protect the graft
D. They induce IgE which mediates graft rejection
E. None of above
61. Grafts between genetically identical individuals (ie, identical twins)
A. are rejected slowly as a result of minor histocompatibility antigens
B. are subject to hyperacute rejection
C. *are not rejected, even without immunosuppression
D. are not rejected if a kidney is grafted, but skin grafts are rejected
E. there is no clear information about this question
62. Patients with severely reduced C3 levels tend to have
A. increased numbers of severe viral infections
B. *increased numbers of severe bacterial infections
C. low gamma globulin levels
D. frequent episodes of hemolytic anemia
E. there is no clear information about this question
63. Children with a genetic deficiency of C6 have
A. decreased resistance to viral infections
B. increased hypersensitivity reactions
C. increased frequency of cancer
D. *decreased resistance to Neisseria bacteremia
E. there is no clear information about this question
64.
The minor histocompatibility antigens on cells
A. are detected by reaction with antibodies and complement
B. are controlled by several genes in the major histocompatibility complex
C. are unimportant in human transplantation
D. *induce reactions that can cumulatively lead to a strong rejection response
E. none of above
65. Individuals of blood group type AB
A. are Rh(-)-negative
B. *are "universal recipients" of transfusions
C. have circulating anti-A and anti-B antibodies
D. have the same haplotype
E. none of above
66.
Graft and tumor rejection are mediated primarily by
A. non-complement-fixing antibodies
B. phagocytic cells
C. helper T cells
D. *cytotoxic T cells
E. none of above
67.
Hemolytic disease of the newborn caused by Rh blood group incompatibility
requires maternal antibody to enter the fetal bloodstream. Therefore, the mediator of this disease
is
A. IgE antibody
B. *IgG antibody
C. IgM antibody
D. IgA antibody
E. IgD antibody
68.
Your patient is a child who has no detectable T or B cells. This immunodeficiency
is most probably the result of a defect in
A. the thymus
B. the bursal equivalent
C. T cell-B cell interaction
D. *stem cells originating in the bone marrow
E. none of above
69. Each of the following statements concerning class I MHC proteins is correct EXCEPT:
A. They are cell surface proteins on virtually all cells
B. They are recognition elements for cytotoxic T cells
C. They are codominantly expressed
D. *They are important in the skin test response to Mycobacterium tuberculosis
E. They are not important for the immune responce
70. Which one of the following is the BEST method of reducing the effect of graftversus-host disease in a bone marrow recipient?
A. Matching the complement components of donor and recipient
B. Administering alpha interferon
C. *Removing mature T cells from the graft
D. Removing pre-B cells from the graft
E. None of above
71. Regarding ABO and Rh blood types, which one of the following is the MOST accurate?
A. People with type O are called universal recipients because they have antibodies
against H substance but not against A and B antigens
B. If the father is Rh-positive and the mother is Rh-negative, hemolytic disease of the
newborn only occurs when the child is Rh-negative
C. People who are Rh-negative usually have antibodies to the Rh antigen because they are
exposed to cross-reacting antigen located on bacteria in the colon
D. *If type A blood is transfused into a person with type B blood, complement will be
activated and the membrane attack complex will cause lysis of the type A red cells
E. None of above
72. Susceptibility to the yeast Candida can occure in?
A. congenital agammaglobulinemia
B. *congenital thymic aplasia (DiGeorge syndrome)
C. common variable hypogammaglobulinemia
D. SLE
E. RA
73. A male heterozygous for Rh factor mates with Rh negative female. On the basis of
genetic theory, it could be predicted that
A. no offspring would be Rh positive
B. 25 % of the offspring would be Rh positive
C. *50 % of the offspring would be Rh positive
D. 100 % of the offspring would be Rh positive
E. 5 % of the offspring would be Rh positive
74. A thin, 19-year-old woman is evaluated because of chronic cough productive of green
sputum. She reports a long-standing history of loose bowel movements and intermittent
abdominal bloating. Physical examination is notable for bilateral nasal polyps, crackles in the
upper lung zones bilaterally, and early digital clubbing. Which of the following is the best initial
test to evaluate this patient for cystic fibrosis?
A.Gene mutation test (buccal swab or blood test)
B.*Quantitative pilocarpine iontophoresis sweat chloride test
C. 72-hour fecal fat test
D. Measurement of nasal potential difference
E. Sputum culture
75. Patient F., male, 16 years old was behind other children in development since early
childhood and still has moderate mental retardation. He is short, has dismorphic body, his face is
round, flattened, his eyes are narrow and slanted, and there are epicantial folds in the corners of
his eyes. There is only one transversal flexor line on his palms. What is the probable etiology of
this state?
A. * Chromosome abnormality
B. Gene abnormality
C. Maternal alcohol abuse during pregnancy
D. Pathological delivery
E. Infection in mother during pregnancy
76. What is the most important reason that autoimmune diseases are a complex genetic
trait?
A. Disease can be inherited in eighther a resseive or a dominant manner
B. Disease is dependent on genes that interact with each other (referred to as epistasis)
C. Genetic heterogeneity
D.*Disease is dependent on multiple genetic contribution, each with low penetrance
E. There has been no selection against the disease-assosiated alleles, which does occur in
many single gene disorders
77. The genetics of RA shows which of the following?
A. *HLA-DR is the most important genetic influence on susceptibility to RA
B. Concordance of RA between identical twins is more then 75 %
C. Environmental influences play a minimal role in the RA susceptibility
D. RA is caused by interaction between HLA-DR and Klebsiella pneumoniae
E. RA is caused by interaction between HLA-DR and Streptococcus
78. A 55-year-old man with chronic hepatitis C is being considered for liver
transplantation. The patient has cirrhosis that was documented by liver biopsy 10 years ago. For
the past 3 months, he has had ascites and edema, which are poorly controlled with diuretics.
Lactulose
was
recently
begun
because
of
confusion.
Which of the following combinations of laboratory studies will be most helpful in estimating his
survival over the next 6 months?
A. *Serum total bilirubin and INR
B. Serum aspartate aminotransferase and gamma globulin
C. Serum alanine aminotransferase and hepatitis C RNA (HCV RNA)
D. Serum alkaline phosphatase and ammonia
E. Serum albumin and γ-glutamyltransferase
79.
A 20 year old woman presents with bilateral conductive deafness, palpable
purpura on the legs and hemoptysis. Radiograph of the chest shows a thin-walled cavity in left
lower zone. Investigations reveal total leukocyte count
12000/mm3, red cell casts in the urine and serum creatinine 3mg/dL. What is the most probable
diagnosis?
A.
Henoch-Schonlein purpura
B.
Polyarteritis nodosa
C.
*Wegener's granulomatosis
D.
Disseminated tuberculosis
E. Disseminated tuberculosis @ Polyarteritis nodosa
80. In polyarteritis nodosa, aneurysms are seen in all, except:
A.
Kidney
B.
*Lung
C.
Liver
D.
Pancreas
E. Liver @ pancreas
81.
A patient presents with melaena normal renal function, hypertension and
mononeuritis multiples. The most probable diagnosis is A.
*Classical polyarteritis nodosa
B.
Microscopic polyangiitis
C.
Henoch-Schonlein purpura
D.
Buerger's disease
E. Henoch-Schonlein purpura @ Buerger's disease
82.
A 19 year old woman presents with bilateral conductive deafness, palpable
purpura
on
the
legs
and
hemoptysis.
Radiograph
of
the
chest
shows a thin-walled cavity in left lower zone. Investigations reveal total leukocyte count
12000/mm3,
red
cell
casts
in
the
urine
and
serum
creatinine 3 mg/dL. What is the most probable diagnosis?
A.
Henoch-Schonlein purpura
B.
Polyarteritis nodosa
C.
*Wegener's granulomatosis
D.
Disseminated tuberculosis
E. Behcet's syndrome
83. B/L hilar lymphadenopathy, along with noncaseating granulomas is a characteristic
feature of:
A.
*Sarcoidosis
B.
Scleroderma
C.
SLE
D.
Stein-leventhal syndrome
E. Pneumonia
84.
Following cranial nerve is most commonly involved in patients with sarcoidosis:
A.
II Cranial nerve.
B.
Ill Cranial nerve.
C.
*VII Cranial nerve.
D.
IX Cranial nerve.
E. None of above
85.
All are correct regarding sarcoidosis except:
A.
*Often cavitate
B.
Spontaneous remission is usual
C.
Tuberculine test is negative
D.
B/L hilar lymphadenopathy.
E. Spontaneous remission is usual @ Tuberculine test is negative
86.
A woman is admitted with complains of low-grade fever of 6 weeks duration.
Chest radiograph reveals bihilar adenopathy with clear
lung fields. All of the following investigations will be useful in differential diagnosis except:
A. *CD4/CD8 counts in the blood
B. Chest X-ray
C. Angiotensin converting enzyme (ACE) in blood
D. Biopsy
E. Ches t X-ray @ Biopsy
87. All the following are features of Scleroderma except:
A.
Dysphagia
B.
Raynaud's phenomenon
C.
Skin contracture
D.
*Calcification in all the long bones
E. Calcification of the soft tissues
88. A 35 year old lady complains dysphagia, Raynaud's phenomenon, sclerodactyly.
Investigations show antinuclear antibody. The likely diagnosis is:
A.
Systemic lupus erythematosis
B.
*Systemic sclerosis
C.
Mixed connective tissue disorder
D.
Rheumatoid arthritis
E. Polymiositis
89. Vasanti, 28-year-old, presents with complaints of tightness of fingers. There is also
history of dysphagia. Which of the following is the probable diagnosis:
A.
Dermatomyositis
B.
*Scleroderma
C.
Rheumatoid arthritis
D.
Polyarteritis nodosa
E. Rheumatoid arthritis
90.
All of the following may be associated with Sjogron syndrome, except:
A.
Dry eyes
B.
Dry mouth
C.
Parotid gland enlargement
D.
*Systemic manifestations
E. Dry eyes @ Dry mouth
91.
Sicca syndrome is associated with all, Except:
A.
*Midline granuloma
B.
Chronic active hepatitis
C.
Rheumatoid arthritis
D.
Scleroderma
E. SLE
92. Primary idiopathic polymyositis does not involve:
A.
Pelvic girdle muscles
B.
Neck muscles
C.
*Ocular muscles
D.
Pharyngeal muscle.
E. Ocular muscles @ Pharyngeal muscle
93.
Which is NOT a feature of polymyositis?
A.
Pharyngeal muscle involvement
B.
Gottron's rash
C.
Proximal muscle involvement
D.
*Pain in limbs
E. Muscle weekness
94.
A 23-year old woman has experienced episodes of myalgias, pleural effusion,
pericarditis and arthralgias without joint deformity over course of several years. The best
laboratory screening test to diagnose her disease would be:
A.
CD4 lymphocyte count
B.
Erythrocyte sedimentation rate
C.
*Antinuclear antibody
D.
Assay for thyroid hormones
E. GBC
95. A 48-year-old man has had fever, weight loss, arthralgias, pleuritic chest pain, and
midabdominal pain for the last 2 months. One week ago he noticed difficulty dorsiflexing his
right great toe. Blood pressure is 150/95 mmHg (he has always been normotensive), and
laboratory studies reveal anemia of chronic disease, high erythrocyte sedimentation rate, and
polymorphonuclear leukocytosis. The chest x-ray is clear. The most likely diagnosis is
A. Giant cell arteritis
B. Allergic granulomatosis
C. Wegener's granulomatosis
D. *Polyarteritis nodosa
E. Hypersensitivity vasculitis
96. Which of the following statements regarding the renal involvement associated with
systemic lupus erythematosus is true?
A. Clinically apparent renal disease occurs in 90 percent of affected persons
B. Interstitial nephritis is a rare finding on renal biopsy
C. *Renal biopsy is not initially necessary in patients with deteriorating renal function
and active urine sediment
D. Renal disease is uncommon in patients with high-titer anti-double-stranded DNA
antibodies
E. Urinalysis in affected persons usually reveals proteinuria but little sediment and no red
blood cells
97. Each of the following agents has been demonstrated to alter the course of rheumatoid
arthritis EXCEPT
A. gold
B. *omega-3 fatty acids
C. methotrexate
D. D-penicillamine
E. hydroxychloroquine
98. A woman who has rheumatoid arthritis suddenly develops pain and swelling in the
right calf. The most likely diagnosis is
A. ruptured plantaris tendon
B. pes anserinus bursitis
C. *ruptured popliteal cyst
D. thrombophlebitis
E. Achilles tendonitis
99. Which of the following systemic manifestations is LEAST characteristic of early
adult rheumatoid arthritis?
A. *High fever
B. Weight loss
C. Muscle wasting
D. Vague musculoskeletal symptoms
E. Fatigue
100. Which of the following conditions is LEAST likely to occur in late extraarticular
seropositive rheumatoid arthritis?
A. Neutropenia
B. Dry eyes
C. Leg ulcers
D. Sensorimotor polyneuropathy
E. *Hepatitis
101. Arthritis associated with psoriasis can be manifest in several different ways. Each of
the following is characteristic of psoriatic arthritis EXCEPT
A. asymmetric oligoarticular arthritis
B. *rheumatoid factor-positive symmetric polyarthritis
C. arthritis of distal interphalangeal joints
D. severe destructive polyarthritis (arthritis mutilans)
E. spondylitis and sacroiliitis with or without peripheral arthritis
102. In which of the following clinical situations would a diagnosis of ankylosing
spondylitis most likely be correct?
A. *For the last 10 years, a 28-year-old man has had low back pain and stiffness, worse at
night and relieved with activity
B. For the last 5 years, a 32-year-old man has had low back pain made worse with
activity but improved with bed rest
C. For the last 10 years, a 34-year-old man has had intermittent bouts of mild low back
pain; now, however, he suddenly is unable to dorsiflex his right great toe
D. For the last 10 years, a 65-year-old man has had low back pain radiating down both
posterior thighs to the knees
E. For the last 15 years, a 72-year-old man has had progressive low back pain made
worse with walking but improved with rest and leaning forward
103. A 26-year-old woman with systemic lupus erythematosus (SLE) is noted to have a
prolonged partial thromboplastin time. This abnormality is associated with
A. leukopenia
B. drug-induced lupus
C. central nervous system vasculitis
D. central nervous system hemorrhage
E. *deep venous thrombosis
104. A patient with diffuse cutaneous scleroderma (systemic sclerosis) who had been
stable for several years is recently noted to have hypertension. This patient is at significant risk
of dying from
A. thrombotic stroke
B. central nervous system hemorrhage
C. *renal failure
D. pulmonary hypertension
E. pulmonary fibrosis
105. For the last two years, a 27-year-old man has had recurrent episodes of asymmetric
inflammatory oligoarticular arthritis involving his knees, ankles, and elbows lasting from 2 to 4
weeks. He also states he has had recurrent, painful "canker sores" in his mouth for the last 10
years. Now, he presents with fever, arthritis, mild abdominal pain, severe headache, and
superficial thrombophlebitis in the left leg. The most likely diagnosis in this man is
A. regional enteritis
B. systemic lupus erythematosus
C. *Behcet's syndrome
D. Whipple's disease
E. ulcerative colitis
106. A 37-year-old woman with Raynaud's phenomenon complains of progressive
weakness with inability to arise out of a sitting position without assistance. On examination, the
patient has swollen "sausage-like" fingers, alopecia, erythematous patches on the knuckles, facial
telangiectasias, and proximal muscle weakness. Laboratory evaluation includes a normal CBC
and serum chemistries, except for creatine phosphokinase (270 U/L and aldolase 500 30 U/L.
The following serologic profile is found: rheumatoid factor is positive at 1:1600; ANA is also
positive at 1:1600 with a speckled pattern and very high titers of antibodies against the
ribonuclease-sensitive ribonucleoprotein component of extractable nuclear antigen. This patient
probably has
A. early rheumatoid arthritis
B. systemic sclerosis
C. systemic lupus erythematosus
D. dermatomyositis
E. *mixed connective-tissue disease
107. An 18-year-old man presents with abdominal pain, nausea, and vomiting. He also
notes the onset of a rash and painful joints. Physical examination is remarkable for the presence
of palpable purpura distributed over the buttocks and lower extremities as well as guaiac-positive
stool. Laboratory evaluation is remarkable for urinalysis that discloses mild proteinuria and red
blood cell casts. Other serum studies are normal. Skin biopsy would likely reveal
A. necrotizing angiitis
B. eosinophilic angiitis
C. *leukocytoclastic vasculitis
D. extravasated red blood cells without vasculitis
E. mast cell infiltration
108. All the following physical findings may be seen in osteoarthritis EXCEPT
A. Heberden's nodes
B. Bouchard's nodes
C. bony crepitus on joint movement
D. *boutonniere deformity
E. positive "shrug" sign
109. A 50-year-old woman has had Raynaud's phenomenon of the hands for 15 years.
The condition has become worse during the last year, and she has developed arthralgias and
arthritis involving the hands and wrists as well as mild sclerodactyly and difficulty swallowing
solid foods. Laboratory studies reveal a positive serum antinuclear antibody assay at a dilution of
1:160. Anticentromere antibodies are present in high titers; antiribonucleoprotein antibodies are
not detectable. The most likely diagnosis of this woman's disorder is
A. *systemic sclerosis
B. mixed connective-tissue disease
C. overlap syndrome
D. dermatomyositis
E. systemic lupus erythematosus
110. A 27-year-old woman with systemic lupus erythematosus is in remission; current
treatment is azathioprine, 75 mg/d, and prednisone, 5 mg/d. Last year she had a life-threatening
exacerbation of her disease. She now strongly desires to become pregnant. Which of the
following is the LEAST appropriate action?
A. Advise her that the risk of spontaneous abortion is high
B. Warn her that exacerbations can occur in the first trimester and in the postpartum
period
C. *Tell her it is unlikely a newborn will have lupus
D. Advise that fetal loss rates are higher if anticardiolipin antibodies are detected in her
serum
E. Stop the prednisone just before she attempts to become pregnant
111. Which of the following is LEAST likely to be seen in Sjogren's syndrome?
A. Dental caries
B. Corneal ulceration
C. Renal tubular acidosis
D. Lymphoma
E. *Cardiac fibrosis
112. Drug-induced systemic lupus erythematosus (SLE) can be characterized by which of
the following statements?
A. *Twenty percent of patients receiving procainamide develop drug-induced lupus
B. Nephritis is a frequent consequence of hydralazine-induced lupus
C. Most patients on hydralazine develop a positive antinuclear antibody (ANA) test;
however, only 10 percent suffer from lupuslike symptoms
D. There are males prevalens in the structure of drug-induced systemic lupus
erythematosus
E. Treatment is unknown
113. Correct statements concerning the use of nonsteroidal anti-inflammatory drugs
(NSAIDs) in the treatment of rheumatoid arthritis include which of the following?
A. The mechanism of action of NSAIDs is the blockade of 5-lipoxygenase
B. The newer NSAIDs are more efficacious than aspirin
C. *The newer NSAIDs induce platelet dysfunction
D. NSAIDs can not exacerbate allergic rhinitis and asthma
E. The mechanism of NSAID-induced azotemia is unrelated to these drugs' ability to
disrupt arachidonic acid metabolism
114. True statements concerning the use of nonsteroidal anti-inflammatory drugs
(NSAIDs) in the treatment of rheumatoid arthritis include which of the following?
A. The mechanism of action of NSAIDs is the blockade of 5-lipoxygenase
B. The newer NSAIDs are more efficacious than aspirin
C. *It is necessary to increase dose every day (D) NSAIDs can exacerbate allergic rhinitis
and asthma
D. The mechanism of NSAID-induced azotemia is unrelated to these drugs' ability to
disrupt arachidonic acid metabolism
E. None of above
115. Accurate statements about rheumatoid factors include which of the following?
A. *They are antibodies to the Fc fragment of immunoglobulin G
B. They are associated with multiple sclerosis
C. Their presence in the serum of persons with rheumatoid arthritis does not correlates
with a worse prognosis than that for persons with seronegative disease
D. Their presence correlates with articular manifestations of rheumatoid arthritis
E. They frequently do not appear in the serum of persons with rheumatoid arthritis until
late in the course of the illness
116. Accurate statements about rheumatoid factors include which of the following?
A. They are associated with multiple sclerosis
B. *They are associated with several conditions in which there is chronic antigenic
stimulation
C. Their presence in the serum of persons with rheumatoid arthritis does not correlates
with a worse prognosis than that for persons with seronegative disease D. Their presence
correlates with articular manifestations of rheumatoid arthritis
E. They frequently do not appear in the serum of persons with rheumatoid arthritis until
late in the course of the illness
117. Accurate statements about rheumatoid factors include which of the following?
A. They are associated with multiple sclerosis
B. Their presence in the serum of persons with rheumatoid arthritis does not correlates
with a worse prognosis than that for persons with seronegative disease
C. *Their presence in the serum of persons with rheumatoid arthritis correlates with a
worse prognosis than that for persons with seronegative disease
D. Their presence correlates with articular manifestations of rheumatoid arthritis
E. They frequently do not appear in the serum of persons with rheumatoid arthritis until
late in the course of the illness
118. The diagnosis of many rheumatic diseases, including rheumatoid arthritis, is based
entirely on clinical grounds. Clinical characteristics associated with rheumatoid arthritis include
A. *prolonged morning stiffness
B. migratory polyarthritis
C. arthritis involving the distal interphalangeal joints
D. headache
E. palpatations
119. A patient with rheumatic fever develops a sore throat from which beta-hemolytic
streptococci are cultured. The patient is started on treatment with penicillin, and the sore throat
resolves within several days. However, 7 days after initiation of penicillin therapy the patient
develops a fever of 103 °F, a generalized rash, and proteinuria. This MOST probably resulted from
A. recurrence of the rheumatic fever
B. a different infectious disease
C. an IgE response to penicillin
D. *an IgG-IgM response to penicillin
E. a delayed hypersensitivity reaction to penicillin
120. Which one of the following statements BEST explains the relationship between
inflammation of the heart (carditis) and infection with group A beta-hemolytic streptococci?
A. *Streptococcal antigens induce antibodies cross-reactive with heart tissue
B. Streptococci are polyclonal activators of B cells
C. Streptococcal antigens bind to IgE on the surface of heart tissue and histamine is released
D. Streptococci are ingested by neutrophils that release proteases that damage heart
tissue
E. None of above
121. You have a patient who makes autoantibodies against his own red blood cells, leading
to hemolysis. Which one of the following mechanisms is MOST likely to explain the hemolysis?
A. Perforins from cytotoxic T cells lyse the red cells
B. Neutrophils release proteases that lyse the red cells
C. Interleukin-2 binds to its receptor on the red cells, which results in lysis of the red cells
D. *Complement is activated, and membrane attack complexes lyse the red cells
E. None of above
122. All the diseases are systemic autoimmune ones except:
A. systemic lupus erythematosus
B. rheumatoic arthritis
C. systemic diffuse sclerosis
D. *subacute thyroiditis
E. dermatopolsmyositis
123. All the criteria are diagnostic for systemic lupus erythematosus except:
A.
serositis
B.
arthritis
C.
leucopenia
D.
renal failure
E.
*pancreatitis
124. All the mechanisms could be triggers of autoimmunity except:
A.
*ligand-receptor interaction
B.
antigen mimicry
C.
releasing of seqestered antigenes
D.
loss of suppressor cell function
E.
None of above
125. What is the target in Goodpasture's syndrome?
A.
glomerular basement membrane
B.
membrane of pulmonary capillares
C.
*glomerular basement membrane and membrane of pulmonary capillares
D.
glomerular basement membrane and cartilages synovial membrane
E.
membrane of pulmonary capillares and cartilages synovial membrane
126. All the medicines could be useful in case of SLE except:
A.
prednisone
B.
betametasone
C.
indometacin
D.
heparin
E.
*epinephrine
127. Reumatoid factor can be found in all the cases except:
A.
*Syphilis
B.
reumatoid artritis
C.
malaria
D.
sarcoidosis
E.
infectious endocarditis
128. All the types of autoantibodies are common for SLE except:
A.
antinuclear
B.
anti-DNA
C.
antimiocardial
D.
antiphospholipid
E.
*anti-DNP
129. A 40-year-old woman has a history of chronic inflammation of the small joints of
the hands bilaterally. You suspect rheumatoid arthritis. Which one of the following is the MOST
accurate regarding the pathogenesis of this disease?
A. It is caused by sensitized CD4-positive T lymphocyte and macrophages invading the
joints
B. *It is caused by antibody against human IgG-forming immune complexes within the
joints
C. It is caused by the release of mediators from mast cells when environmental
agents cross-link adjacent IgEs within the joints
D. It is caused by superantigens inducing the release of large amounts of lymphokines
from helper T cells within the joints
E. None of above
130. A 30-year-old woman with a previous history of rheumatic fever now has a fever
for the past 2 weeks. Physical examination reveals a new heart murmur. You suspect endocarditis
and do a blood culture, which grows a viridans group streptococcus later identified as
Streptococcus sanguis. Of the following body sites, which one is the MOST likely source of this
organism?
A. Colon
B. *Mouth
C. Skin
D. Stomach
E. Vagina
131. Which clinical feature is commonly found in patients with SLE?
A.
*Vasculitis is the basic lesion
B.
A linear deposition of immunoglobulin in their glomerular basement membrane
occurs with nephritis
C.
Thyroid receptor antibody is present
D.
Rheumatoid factor is rarely present
E.
None of above
132. Which one of the following statement best describes the rheumatoid factor?
F.
It is the antigen initiating the rheumatoid inflammatory process
G.
It is an antibody against cellular DNA
H.
It consists primarily of DNA
I.
*It is an antibody against immunoglobuline
J.
It is a protein
133. Match the following condition (autoimmune hemolytic anemia) with the type of
hypersensitivity reaction most closely related to it?
A. Type I (anaphylactic) hypersensitivity reaction
B. *Type II (cytotoxic) hypersensitivity reaction
C. Type III (immune complex) hypersensitivity reaction
D. Type IV (delayed) hypersensitivity reaction
E. None of above
134. Which one of the following statements best describes the rheumatoid factor?
A.
It is the antigen initiating the rheumatoid inflammatory process
B.
It is an antibody against cellular DNA
C.
It consists primarily of DNA
D.
*It is an antibody against immunoglobulin
E.
It is a protein
135. A 41-year-old woman complains of weakness, fatigue, fever up to 38°C, rash on the
face skin, pain in the wrists and the elbows. On physical exam,erythematous rash on the cheeks
with “butterfly” appearance, the wrists and elbow joints are involved symmetrically, swollen,
tender on motions, friction rub over the lungs, the heart sounds are weak, regular, HR of 88/
minute, BP of 160/95 mm Hg. GBC shows anemia, leucopenia, lymphopenia; on urinalysis:
proteinuria, leukocyturia, casts. What is the main mechanism of disease development?
A. *Production of antibodies to double-stranded DNA
B. Production of antibodies to myocytes.
C. Production of antibodies to endothelial cells
D. Production of antibodies to myosin.
E. Production of antimitochondrial antibodies.
136. A 14 year old patient. He complains of chest pain, temperature 38,5, breathlessness.
He had acute tonsillitis2 weeks ago. He is in a bad state. The skin is pale. Heart borders are
widened, the tones are weakened. Above all heart area you can hear pericardium friction sound.
Electrocardiogramm: the descent of voltage QRS, the inversion T. The liver is 3 sm enlarged.
ESR – 4mm/h, ASL – 0 – 1260, C-reaction protein +++. Your diagnosis:
A. *Rheumatic pancarditis
B. Rheumatic pericarditis
C. Rheumatic myocarditis
D. Rheumatic endocarditis
E. Septic endocarditis
137. A 34-year-old woman fell ill 3 months ago after cold exposure. She complained of
pain in the hand and knee joints, morning stiffness, and fever up to 38°C. Interphalangeal,
metacarpophalangeal and knee joints are swollen, hot, with decreased ranges of motions; ESR of
45 mm/hr, CRP (+++), Vaaler-Rouse test of 1:128. What group of medicines would you
recommend to the patient?
A.* Nonsteroidal anti-inflammatory drugs
B. Cephalosporines
C. Tetracyclines
D. Sulfonamides
E. Fluorchinolones
138. A 45-year-old woman with systemic lupus erythematosus who has been receiving
long-term corticosteroid therapy is evaluated in a routine office follow-up visit. She smokes a
pack of cigarettes daily. Her blood pressure is 140/90 mm Hg. There are no abnormalities on
cardiac or pulmonary auscultation, no carotid bruits or friction rubs, and no chest wall
tenderness. Previous laboratory tests have not shown antiphospholipid antibodies. Her total
serum cholesterol concentration is 250 mg/dL (hypercholesterolemia). Which of the following is
the best next step in the management of this patient?
A. Measurement of serum thyroid-stimulating hormone
B. Measurement of serum creatinine
C.* Measurement of fasting plasma glucose and serum lipids
D. Esophageal manometry
E. High-resolution CT scan of the chest
139. A 46-year-old woman with rheumatoid arthritis is evaluated because the
subcutaneous nodules that were present on her elbows have increased in size, and she has
developed some nodules on the Achilles tendons bilaterally. She has been treated for 8 months
with methotrexate in an ascending dose schedule. She is currently taking 17.5 mg/week, along
with enteric-coated aspirin, 3 g/d. This regimen has alleviated her joint pain; her morning
stiffness is limited to 35 minutes, as opposed to the previous duration of 2 hours. On examination
the nodules are not warm, and her joints appear much improved. No other physical abnormalities
are found. Which of the following is the most appropriate next step in this patient’s
management?
A. Biopsy a newly developed nodule.
B. *Reassure the patient that these nodules occur occasionally with methotrexate therapy.
C. Initiate antituberculosis therapy.
D. Measure fasting serum lipids, including triglycerides.
E. Measure serum uric acid.
140. A 27-year-old woman is evaluated because she had a spontaneous abortion 6 weeks
after becoming pregnant for the first time. Laboratory studies reveal the presence of
anticardiolipin antibodies. Levels of IgG and IgA are normal. The IgM level is low-positive.
Sensitive partial thromboplastin time and modified Russell viper venom time are normal. Which
of the following would be appropriate management during this patient’s next pregnancy?
A. Warfarin
B. Heparin, prophylactic dose
C. Heparin, therapeutic dose
D. Aspirin, 80 mg/d
E. *No treatment
141. A 32-year-old woman is evaluated because of a 5-year history of Raynauds
phenomenon and thickened skin over the fingers. Two years ago, she developed small patches (1
to 2 mm in diameter) of calcinosis on the distal fingers and dorsum of one hand, which have
persisted. She reports mild dyspnea when she climbs stairs. She takes a proton pump inhibitor for
reflux esophagitis. Physical examination reveals sclerodactyly, with one digital tip ulcer,
minimal calcinosis, and two telangiectasias on her face, without limitation of oral opening. Lung
and heart examination are normal. Chest radiograph reveals no infiltrates or interstitial fibrosis in
the lungs and a normal heart size. Results of routine laboratory tests are normal, including renal
function. Echocardiogram suggests mild right ventricular diastolic dysfunction. The diffusing
capacity for carbon monoxide (DLCO) is 44% of normal. Within the next 5 years, she is at high
risk for developing which of the following?
A. Fine, dry crackles indicative of pulmonary fibrosis
B. Renovascular hypertension with hyperreninemia
C. Sclerodermatous changes on the forearms and face
D. *Pulmonary hypertension
E. Esophageal varices
142. A 55-year-old woman who has had rheumatoid arthritis for 10 years is evaluated
because of severe pain in the left shoulder that developed over the course of the previous day. In
recent months, her disease has been poorly controlled on a regimen of methotrexate,
hydroxychloroquine, and low-dose prednisone. She has approximately 90 minutes of morning
stiffness. On physical examination, her temperature is 36.8 °C (98.2 °F), her pulse rate is
82/min, and her blood pressure is 110/70 mm Hg. She has moderate tenderness of the small
joints of her hands and of both wrists. Her left shoulder is warm and very tender; she can move it
only slightly before being limited by pain. What is the best next step in this patient’s
management?
A. Orthopedic consultation for possible shoulder arthroplasty
B. *Aspiration of the shoulder to exclude septic arthritis
C. Radiography of the shoulder
D. MRI contrast arthrography of the shoulder
E. Physical therapy for the shoulder
143. A 50-year-old woman is evaluated because of a 5-year history of diffuse skin
lesions, joint pain, and back pain. Her rash was initially diagnosed as psoriasis. She has tried
only topical therapies, which were modestly helpful. One year ago, she developed redness, pain,
and swelling in several fingers, her right knee, and left ankle. The symptoms, which have
continued, are worse in the morning and have been progressive, leading to functional difficulty.
She has also recently had severe right-sided lower back pain, especially on arising, which
improves as the day goes on. Physical examination reveals a typical papulosquamous eruption
involving the extensor surfaces of the elbows and knees and more than 50% of the back and
chest. Most of her nails are pitted. Joint examination shows erythema and swelling of the right
first and third distal interphalangeal (DIP) joints, the right second proximal interphalangeal (PIP)
joint, and the left second DIP and fourth PIP joints. There is a large, warm right knee effusion
with a 20-degree flexion deformity. Warmth, swelling, and pain on motion are present in the left
medial malleolus. What is the most appropriate treatment for this patient?
A. A nonsteroidal anti-inflammatory drug
B. Intensive topical corticosteroids for the psoriatic skin lesions
C. A nonsteroidal anti-inflammatory drug followed by hydroxychloroquine
D. *A nonsteroidal anti-inflammatory drug followed by escalating doses of methotrexate
E. A nonsteroidal anti-inflammatory drug followed by etanercept
144. A 28-year-old pregnant woman, who previously had a single early first-trimester
pregnancy loss, is evaluated in a routine office visit. An anticardiolipin antibody assay done after
she suffered her first pregnancy loss was moderately positive, and there was no lupus
anticoagulant. Her obstetrician suspects a hypercoagulable state and has started her on
subcutaneous unfractionated heparin (twice daily) during her current pregnancy. An
anticardiolipin assay and lupus anticoagulant testing are ordered and yield the following results.
Laboratory studies: Anticardiolipin IgG
Low-positive range .Anticardiolipin lgM Normal
.Anticardiolipin IgA Normal .Sensitive partial thromboplastin time
45 sec (slightly
prolonged) .Which one of the following is the correct interpretation of these laboratory tests?
A. Because only one of the two clotting times is abnormal, there is no lupus
anticoagulant.
B. The patient has neither a lupus anticoagulant nor antiphospholipid antibody syndrome.
C. The patient has both a lupus anticoagulant and antiphospholipid antibody syndrome.
D. *The lupus anticoagulant tests cannot be interpreted because of unfractionated heparin
use
E. The partial thromboplastin time proves the presence of a lupus anticoagulant.
145. A 39-year-old woman with systemic lupus erythematosus who has been receiving
long-term corticosteroid therapy is evaluated in the emergency department because of substernal
chest pain of several hours duration. The pain is not positional or pleuritic. On physical
examination, there is no chest wall tenderness, and lung fields are clear to auscultation. On
cardiac examination, there is tachycardia. Previous laboratory tests have not shown the presence
of antiphospholipid antibodies. Electrocardiogram shows anterolateral T-wave changes. Arterial
blood gases are normal. What is the best initial diagnostic test?
A. *Measurement of serum troponin or serum creatine kinase MB
B. Ventilation-perfusion scan
C. Echocardiography
D. Pulmonary function tests
E. High-resolution chest CT
146. A 35-year-old man with hemiplegia is referred by the emergency department. He
has antiphospholipid antibody syndrome, which was diagnosed after recurrent episodes of deep
venous thrombosis, and he takes warfarin. Skin examination shows livedo reticularis. He has a
mitral regurgitation murmur. On physical examination, his leg is normal, without a Homans sign.
A CT scan done in the emergency department shows an infarct in the middle cerebral artery
distribution, with no hemorrhage. Laboratory studies: Hematocrit
45% .Leukocyte count
7800/μL .Platelet count
110,000/μL .INR
2.1 .Results of a peripheral blood
smear are pending. . What is the most likely cause of his stroke?
A. Systemic lupus erythematosus with central nervous system vasculitis
B. Thrombotic thrombocytopenic purpura
C. *Cerebral embolus
D. Cerebral hemorrhage
E. Patent foramen ovale with paradoxical embolus
147. A 23-year-old woman with systemic lupus erythematosus presents with swelling of
the left leg. Her disease was previously manifested by episodes of acute confusion, nephritis,
rash, and mild arthritis; she had a pulmonary thromboembolism 3 years ago. At that time, she
tested highly positive for lupus anticoagulant, and she was treated with heparin and then
warfarin, which she has continued to take. Her examination is normal apart from the mild leg
swelling with some calf tenderness. Peripheral venous Doppler examinations show evidence of
deep femoral venous obstruction by clot. Laboratory studies: Hematocrit
42%
.Leukocyte count
5200/μL .Platelet count
120,000/μL .INR
1.9 .An MRI is normal,
and the measure of IgG anticardiolipin moderately positive. She asks whether she should stop the
anticoagulant therapy. Which of the following is the next best step in this patient’s management?
A. Substitute aspirin, 80 mg/d, for warfarin.
B. Maintain the present warfarin dosage.
C. Increase the warfarin therapy to achieve an INR of 3.5 for 3 months, then stop the
anticoagulation therapy.
D. *Increase the warfarin therapy to achieve an INR 3.5, and maintain it for the long
term.
E. None of above
148. A 27-year-old woman is evaluated because she has dusky erythema over her palms
and around her eyes. She has also reports difficulty getting up from a reclining position. On
physical examination, she has an erythematous rash over her face, neck, and anterior chest that
blanches with pressure and clear evidence of proximal muscle weakness. Laboratory tests show
an erythrocyte sedimentation rate of 45 mm/h, serum creatine kinase of 450 U/L, and an
antinuclear antibody titer of 1:160. Which of the following antibodies would indicate an
increased risk of interstitial lung disease in this patient?
A. Anti-ribonucleoprotein
B. *Anti-histidyl-tRNA synthetase
C. Anti-signal recognition peptide
D. Anticollagen
E. Anti-PM-Sd
149. Which one of the following factors is predictive of an unfavorable outcome in adults
with polymyositis or dermatomyositis?
A. Presence of a rash
B. The amount of increase in the serum creatine kinase level
C. *Presence of dysphagia
D. Age at onset
E. Absence of myositis-specific antibodies
150. A 39-year-old woman with a 3-year history of rheumatoid arthritis is evaluated
because of slight shortness of breath of new onset when she climbs the stairs in her home. She
also has a dry hacking cough of 3 weeks duration. She has been active, working part-time as a
secretary as well as caring for two young children at home. She has been taking methotrexate, 20
mg by mouth each week, and folic acid, 1 mg/d, for 1 year, and she says her joints “have been
great.” On physical examination, her temperature is 37.7 °C (99.8 °F). Fine crackles are audible
at the bases of both lungs on deep inspiration. There is some tenderness with full palmar flexion
and dorsiflexion of the right wrist; the rest of the joints are brought through full range of painless
motion, and there is no other evidence of active synovitis. Serum alanine aminotransferase level
is 44 U/L and serum aspartate aminotransferase level is 50 U/L. Complete blood count and
serum albumin levels are normal. Chest radiograph is normal. Which of the following is the best
next step in this patients management?
A. Order liver biopsy.
B. Obtain radiographs of wrists.
C. *Stop the methotrexate.
D. Initiate prednisone therapy.
E. None of above
151. What is the most important reason that autoimmune diseases are a complex genetic
trait?
A. Disease can be inherited in eighther a resseive or a dominant manner
B. Disease is dependent on genes that interact with each other (referred to as epistasis)
C. Genetic heterogeneity
D. *Disease is dependent on multiple genetic contribution, each with low penetrance
E. There has been no selection against the disease-assosiated alleles, which does occur in
many single gene disorders
152. High titer of rheumatoid factor are found in what percentage of patients with RA?
A. 20 %
B. 50 %
C.* 70 %
D. >90 %
E. 100 %
153. Which of the following statements about the immunoglobulin genes that encode
rheumatoid factor is true?
A. *They are present in normal people
B. They are present only in patient with RA
C. They are found in normal people and in patients with RA but are somatically mutated
in patients with arthritis
D. They are never found in the germline
E. None of above
154. Which of the following is the most common site immune complex deposition?
A. Both ureters
B. Cardiac septum
C.* Capillaries in the kidney
D. Posterior lobe of the pituitary gland
E. None of above
155. Which of the following is a possible diagnostic feature identified in the RA
synovium?
A. Increased neutrophil infiltration
B. Hyperplasia of the intimal lining layer and infiltration of the mononuclear cells in the
synovial sublining
C. Increased vascularity and cellularity of the synovial sublining
D. *Massive infiltration by plasma cells and macrophages in the synovial sublining
E. A, B
156. Women who develop RA are
A. Less likely to be marryed
B. Less likely to have children after marrying
C. Less likely to be divorced
D. More likely to be divorced
E.* Less likely to remarry after devorce
157. Sulfasalazine may be least effective in which of the following conditions?
A. Inflammatory bowel disease
B. RA
C. Psoriatic arthritis
D. Systemic onset of juvenile RA*
E. A, B
158. With regard to methotrexate, the DMARD most commonly used to treat RA, which
of the following statements is true?
A. Methotrexate absorption after oral administration is approximately 90 % and is
similar from one patients to the next
B. *Data suggest that folic acid given in a dose up to 3 mg per day does not interfere
with a therapeutic effect of methotrexate
C. When giving methotrexate parenterally, intramuscular administration is preferred
over subcutaneous because of grater bioavailability
D. Methotrexate has been shown to be effective steroid-sparing in the treatment of
polymyalgia rheumatica
E. A, C
159. Which of the following is/are recommended before initiating anti-TNF-α treatment?
A. PPD skin test
B. Pregnancy test
C. Evaluation of signs of infection
D. Evaluation for history of canser
E. *All of above
160. The genetics of RA shows which of the following?
A. *HLA-DR is the most important genetic influence on susceptibility to RA
B. Concordance of RA between identical twins is more then 75 %
C. Environmental influences play a minimal role in the RA susceptibility
D. RA is caused by interaction between HLA-DR and Klebsiella pneumoniae
E. RA is caused by interaction between HLA-DR and Streptococcus
161. Which of the following statements about treatment of RA is true?
A. Primary therapy with NSAIDs without the use of a DMARD is reasonable approach to
RA
B. Biologocal response modifiers are the best approach for all patients
C.* Initiation and escalation of DMARDs until the disease is controlled is paramount to
the treatment of this disease
D. Combination therapies significantly increase the risk of side effects
E. None of above
162. A 28-year-old woman is hospitalized with a history of weight loss, polyuria,
palpitations, and diaphoresis. She is experiencing heat intolerance and fatigue.
On physical examination, the patient is 173 cm (68 in) tall and weighs 52 kg (115 Ib); her pulse
rate is 120/min. A diffusely enlarged 75-g goiter is present, over which a bruit is auscultated. The
palms are flushed and there is a tremor of the outstretched hands. Laboratory studies reveal a
plasma glucose level of 350 mg/dL, positive serum ketones, strongly positive antibodies to
glutamic acid decarboxylase-65, and a serum thyroid-stimulating hormone level less than 0.001
μU/mL.
What is the most likely diagnosis?
A. Type 2 diabetes mellitus
B. Hashimotos thyroiditis
C.* Autoimmune polyglandular syndrome type II
D. Multiple endocrine neoplasia type 1
E. Multiple endocrine neoplasia type 2
163. A 27-year-old male athlete is referred for evaluation of abnormal thyroid function
test results during evaluation of an asymptomatic goiter. He has occasional headaches and loss of
libido. Medical and family history are unremarkable. Physical examination reveals a pulse rate of
88/min, a diffusely enlarged 30-g thyroid gland without nodules, and slightly brisk deep tendon
reflexes. Laboratory testing reveals a serum free thryoxine level of 2.4 ng/dL, a serum thyroidstimulating hormone level of 4.3 μU/mL, and a decreased serum free testosterone level. Tests for
antithyroid peroxidase and antithyroglobulin antibodies are negative. What is the most
appropriate next step in the evaluation of this patient?
A. Point mutation analysis of the thyroid-stimulating hormone receptor
B. Thyroid function testing of all first-degree relatives
C. Measurement of thyroid-stimulating and thyroid-blocking antibodies
D. *Gadolinium-enhanced MRI of the sella turcica
E. Measurement of antithyroxine autoantibodies
164. A 45-year-old man presents with fatigue, constipation, and a 2-kg (5-Ib) weight
gain. The patient has Hashimotos thyroiditis and is compliant with taking levothyroxine, 0.25
mg/d. Six months ago, the serum thyroid-stimulating hormone (TSH) level was 1 .9 μU/mL and
the serum free thyroxine level was 1.3 ng/dL. The serum TSH is now 12.0 μU/mL, and the
serum free thyroxine level is 0.8 ng/dL. What is the most likely explanation for the change in
thyroid hormone levels?
A. *He has been taking sertraline for depression starting 3 months ago.
B. He has begun taking an over-the-counter vitamin B complex supplement and highdose vitamin C tablets.
C. The pharmacy inadvertently dispensed 0.025-mg tablets to him 3 months earlier.
D. His weight gain has led to a decreased volume of distribution.
E. He has developed adrenal insufficiency.
165. A 28-year-old man has a 2-week history of watery stools and a 2.2-kg (5.0-Ib)
weight loss. He has not traveled recently or taken antibiotics. The patients father has a history of
‘inflammatory bowel disease.” Physical examination reveals hyperactive bowel sounds and
diffuse, mild abdominal tenderness without guarding. Stool cultures show no growth. Which of
the following would most strongly support the diagnosis of Crohns disease rather than ulcerative
colitis in this patient?
A. *Positive assay for antisaccharomyces cerevisiae antibody (ASCA); negative assay for
perinuclear antineutrophil cytoplasmic antibody (p-ANCA)
B. Barium enema examination showing inflammation of the most distal 4 cm of ileum
C. Small bowel radiograph series showing inflammation of the most distal 4 cm of ileum
D. Colonic biopsy specimens showing mucosal and submucosal inflammation and crypt
abscesses
E. The patients reporting that he stopped smoking 3 or 4 weeks ago
166. An 18-year-old man is evaluated because of severe diarrhea and cramping
abdominal pain of 3 months’ duration. Colonoscopy shows ulcerative colitis with moderate
inflammatory changes from the rectum to the mid-transverse colon. Biopsy specimens show
moderate chronic inflammation. Which of the following will provide the optimal therapeutic
regimen for this patient?
A. *Oral prednisone followed by maintenance with oral sulfasalazine
B. Oral prednisone followed by maintenance with oral low-dose prednisone every other
day
C. Oral prednisone followed by maintenance with oral budesonide
D. Intravenous cyclosporine followed by maintenance with oral 6-mercaptopurine
E. Intravenous cyclosporine followed by maintenance with oral sulfasalazine
167. Manifestations of hypothyroidism include
A. diminished QRS voltage on ECG
B. depressed serum cholesterol
C. microcytic anemia
D.* increased serum creatine phosphokinase, increased serum lactic dehydrogenase
E. none of above
168. A 19-year-old female exchange student from London has had bouts of jaundice,
fever, malaise, arthralgias, and marked elevation of hepatic transaminases
over the last 6 months. The patient was not exposed to hepatotoxic drugs.
Hypergammaglobulinemia has been noted. Serologic evaluation for infection with hepatitis A, B,
and C has been negative, as have tests for systemic lupus. Liver biopsy now reveals bridging
necrosis. Which of the following tests will be most helpful in confirming the diagnosis?
A. Rheumatoid factor
B. Hemoglobin electrophoresis
C.* Antibodies to liver and kidney microsomal antigens
D. Antibodies to hepatitis D virus
E. Antibodies to hepatitis E virus
169. The medical therapy for Crohn's disease can be described by all the following
statements EXCEPT
A. Metronidazole is useful if the perineal area is involved
B. Azathioprine may reduce steroid requirements
C. The frequency of recurrence is not altered by prophylactic therapy with steroids
D. The frequency of recurrence is not altered by prophylactic therapy with sulfasalazine
E.* Sulfasalazine is contraindicated in the treatment of pregnant women who have
Crohn's disease
170. If an individual was genetically unable to make J chains, which immunoglobulin(s)
would be affected?
A. IgG
B. IgM
C. IgA
D. IgG and IgM
E.
*IgM and IgA
171. The class of immunoglobulin present in highest concentration in the blood of a human
newborn is
A. *IgG
B. IgM
C. IgA
D. IgD
E.
IgE
172. Which of the following antibody classes is the first to be produced in an immune
response to a given antigen?
A.
IgA
B.
IgG
C.
*IgM
D.
IgD
E.
IgE
173. In most normal persons, what percentage of the total serum immunoglobulins is
IgG?
A.
10 %
B.
25 %
C.
50 %
D.
60 %
E.
*Over 70 %
174. Which one of the following immunoglobulins is the principal immunoglobulin in
exocrine secretion?
A.
*IgA
B.
IgG
C.
IgM
D.
IgD
E.
IgE
175. Which of the following statements about IgM is true?
A.
It is a reagenic antibody
B.
*It is important in the first few days of the primary immune response
C.
It increases in serum concentration after IgG has reached its peak serum
concentration
D.
It is the smallest of the immunoglobulin molecules
E.
It is involved in the allergic reaction
176. Produced by B-cells in response to antigen
A. IgA
B. IgG
C. *IgM
D. IgD
E. IgE
177. Longest half-life
A. IgA
B. *IgG
C. IgM
D. IgD
E. IgE
178. Which of the following conditions is LEAST likely to occur in late extraarticular
seropositive rheumatoid arthritis?
A. Neutropenia
B. Dry eyes
C. Leg ulcers
D. Sensorimotor polyneuropathy
E. *Hepatitis
179. Each of the following statements concerning the variable regions of heavy chains
and the variable regions of light chains in a given antibody molecule is correct EXCEPT:
A.
*They have the same amino acid sequence
B.
They define the specificity for antigen
C.
They are encoded on different chromosomes
D.
They contain the hypervariable regions
E.
They bind with epitop
180. Your patient became ill 10 days ago with a viral disease. Laboratory examination
reveals that the patient's antibodies against this virus have a high ratio of IgM to IgG. What is
your conclusion?
A.
*It is unlikely that the patient has encountered this organism previously
B.
The patient is predisposed to IgE-mediated hypersensitivity reactions
C.
The patient has encountered this organism previosly
D.
It is likely that the patient has an autoimmune disease
E.
The patient has chronic viral disease
181. A child stung by a bee experiences respiratory distress within minutes and lapses
into unconsciousness. This reaction is probably mediated by
A.
*IgE antibody
B.
IgG .antibody
C.
sensitized T cell
D.
complement
E.
IgM antibody
182. A patient with rheumatic fever develops a sore throat from which.beta-hemolytic
streptococci are. cultured. The patient is started on treatment wilh penicillin, and the sore throat
resolves within several days. However, 7 days after initiation of penicillin therapy the patient
develops a fever of 103 F, a generalized rash, and proteinuria. This MOST probably resulted
from
A. recurrence of the rheumatic fever
B. a different infectious disease
C. an IgE response to penicillin
D. *an IgG-M response to penicillin
E. a delay hypersensitivity reaction to penicillin
183. A patient with severe asthma gets no relief from antihistamines. The symptoms are
MOST likely to be caused by
A.
interleukin-2
B.
*slow-reacting substance A (leukotrienes)
C.
serotonin
D.
bradykinin
E.
α-interferon
184. Hypersensitivity to penicillin and bypersensitivity to poison oak are both
A.
mediated by IgE antibody
B.
mediated by IgG and IgM antibody
C.
*initiated by haptens
D.
initiated by Th-2 cells
E.
i
185. What is the role of class II MHC proteins on donor cells in graft rejection?
A.
They are the receptors for interleukin-2, which is produced by macrophages when
they attack the donor cells
B.
*They are recognized by helper T cells, which then activate cytotoxic T cells to
kill the donor cells
C.
They induce the production of blocking antibodies that protect the graft
D.
They induce IgE which mediates graft rejection
E.
They induce complement depended cytolysis of the graft
186. A positive tuberculin skin test (a delayed hyper-sensitivity reaction) indicates that
A.
a humoral immune response has occurred
B.
*a cell-mediated immune response has occurred
C.
both the T and B cell systems are functional
D.
only the B cell system is functional
E.
a humoral immune response has decreased
187. A child disturbs a wasp nest, is stung repeatedly, and goes into shock within
minutes, manifesting respiratory failure and vascular collapse. This is MOST likely to be due to
A.
*systemic anaphylaxis
B.
serum sickness
C.
an Arthus reaction
D.
cytotoxic hypersensitivity
E.
endotoxic shock
188. A delayed hypersensitivity reaction is characterized by
A.
edema without a cellular infiltrate
B.
an infiltrate composed of neutrophils
C.
*an infiltrate composed of helper T cells and macrophagcs
D.
an infiltrate composed of eosinophils
E.
an infiltrate composed of natural killers
189. When immune complexes from the serum are deposited on glomerular basement
membrane, damage to the membrane is caused mainly by
A.
gamma interferon
B.
phagocytosis
C.
cytotoxic T cells
D.
*enzymes released by polymorphonuclear cells
E.
natural killers
190. Hemolytic disease of the newborn caused by Rh blood group incompatibility
requires
maternal antibody to enter the fetal bloodstream. Therefore, the mediator of this disease
is
A.
IgE antibody
B.
*IgG antibody
C.
IgM antibody
D.
IgA antibody
E.
IgD antibody
191. You have a patient who makes autoantibodies against his own red blood cells,
leading to hemolysis. Which one of the following mechanisms is MOST likely to explain the
hemolysis?
A.
Performs from cytotoxic T cells lyse the red cells
B.
Neutrophils release proteases that lyse the red cells
C.
lnterieukin-2 binds to its receptor on the red cells, which results in lysis of the red
cells
D.
*Complement is activated, and membrane attack complexes lyse the red cells
E.
Autoantibodies direct lyse the red cells
192. The main advantage of passive immunization over active immunization is that
A.
it can be administered orally
B.
*it provides antibody more rapidly
C.
antibody persists for a longer period
D.
it contains primarily IgM
E.
it contains only antibacterial antibodies
193. A patient with severe asthma gets no relief from antihistamines. The symptoms are
MOST likely to be caused by
A.
interleukin-2
B.
*slow-reacting substance A (leukotrienes)
C.
serotonin
D.
bradykinin
E.
none of above
194. A patient with rheumatic fever develops a sore throat from which beta-hemolytic
streptococci are cultured. The patient is started on treatment wilh penicillin, and the sore throat
resolves within several days. However, 7 days after initiation of penicillin therapy the patient
develops a fever of 103 F, a generalized rash, and proteinuria. This MOST probably resulted
from
A.
recurrence of the rheumatic fever
B.
*a different infectious disease
C.
an IgE response to penicillin
D.
an IgG-M response to penicillin
E.
a delay hypersensitivity reaction to penicillin
Module 1
Bases of Clinical immunology and allergology
Picture tests
1. Which cell is marked number on the picture Рис.Fig.1?
A. *T-helper-1
B. Tissue Basophil
C. T-suppressor
D. T-helper-2
E. T-cytotoxic
2. Which cell is marked number 2 on the picture Рис.Fig.1?
A. *T-helper-2
B. Tissue Basophil
C. T-suppressor
D. T-helper-1
E. T-cytotoxic
3. Which cell is marked number 3 on the picture Рис.Fig.1?
A. *T-helper-2
B. Tissue Basophil
C. T-suppressor
D. T-helper-1
E. T-cytotoxic
4. What is the mechanism of immune cell starts at number 1 on the picture Рис.Fig.1?
A. *Cell
B. Humoral
C. Phagocytosis
D. Nonspecific
E. All of above
5. What is the mechanism of immunity runs under the cell number 2 on the picture
Рис.Fig.1?
A. *Humoral
B. Cell
C. Phagocytosis
D. Nonspecific
E. All of above
6. Which does cell 1 do on the picture Рис.Fig.1?
A. *Activation of cellular immunity
B. Activation of humoral immunity
C. Activation of phagocytosis
D. Activation of nonspecific immunity
E. None of the above
7. Which does cell 2 do on the picture Рис.Fig.1?
A. *Activation of humoral immunity
B. Activation of cellular immunity
C. Activation of phagocytosis
D. Activation of nonspecific immunity
E. None of the above
8. Which does cell 3 do on the picture Рис.Fig.1?
A. *Presentation of antigen
B. Activation of humoral immunity
C. Activation of cellular immunity
D. Activation of phagocytosis
E. Activation of nonspecific immunity
9. What are cytokines number 4 on the picture Рис.Fig.1?
A. *IL-2, gamma-ISP
B. Beta-ISP, IL-1
C. IL-4, IL-5
D. All listed
E. None of the above
10. What are the cytokines number 5 on the picture Рис.Fig.1?
A. *IL-4, IL-5
B. IL-2, gamma-ISP
C. Beta-ISP, IL-1
D. All listed
E. None of the above
11. What is the function of cytokines, marked number 5 on the picture Рис.Fig.1?
A. *Activation of humoral immunity
B. Activation of cellular immunity
C. Activation of phagocytosis
D. Activation of nonspecific immunity
E. None of above
12. What is the function of cytokines, marked number 4 on the picture Рис.Fig.1?
A. *Activation of cellular immunity
B. Activation of humoral immunity
C. Activation of phagocytosis
D. Activation of nonspecific immunity
E. None of above
13. What is the process of interaction between CD4-lymphocytes and cells number 3 on the
picture Рис.Fig.1?
A. *Presentation of antigen
B. Immunotentiation
C. Toleryzatsiya
D. Immunosuppression
E. Imunoproliferatsiya
14. What does cell 3 do on the picture Рис.Fig.1?
A. *All numbered
B. None of above
C. Presentation of antigen
D. Phagocytosis
E. Production of cytokines
15. What protection does t cell number 1 perform on the picture Рис.Fig.1?
A. *All numbered
B. None of the above
C. Antiviral
D. Against intracellular bacteria
E. Antifungal
16. What protection does t cell number 2 perform on the picture Рис.Fig.1?
A. *Against extracellular bacteria
B. All numbered
C. Antiviral
D. Against intracellular bacteria
E. Antifungal
17. What protection does cytokines number 4 perform on the picture Рис.Fig.1?
A. *All numbered
B. None of the above
C. Antiviral
D. Against intracellular bacteria
E. Antifungal
18. What protection does cytokines number 5 perform on the picture Рис.Fig.1?
A. *Against extracellular bacteria
B. All numbered
C. Antiviral
D. Against intracellular bacteria
E. Antifungal
19. What is name of cytokines, prodused by cell 3 on the picture Рис.Fig.1?
A. *Monokin
B. Limfokin
C. Interferon
D. Tumoronekrotyci factor
E. Growth factor
20. What is name of cytokines, prodused by cell CD4 on the picture Рис.Fig.1?
A. *Limfokin
B. Monokin
C. Interferon
D. Tumoronekrotyc factor
E. Growth factor
21. What is the function of Th3 cells represented on the picture on the picture Рис.Fig.1?
A. *Imunoregulation
B. Immunostimulation
C. Antibactirial
D. Antiparasitic
E. Antitumor
22. What Immunoglobulin could be prodused by B-lymphocytes in the case activation of cell
2 on the picture Рис.Fig.1?
A. *M
B. G
C. A
D. All of them
E. None of above
23. What Immunoglobulin could be prodused by B-lymphocytes in the case activation of cell
1 on the picture Рис.Fig.1?
A. *None of above
B. G
C. M
D. A
E. All of them
24. What cell can have the function similar to cell 3 on the picture Рис.Fig.1?
A. *All of them
B. Monocytes
C. Microglia cells
D. Pulmonary macrophages
E. Kupffer cells
25. What cell can have the function similar to cell 3 on the picture Рис.Fig.1?
A. *None of above
B. T-lymphocyte
C. B-lymphocyte
D. T-helper-1
E. T-helper-2
26. A fragment of wich chromosome is depicted on the picture Рис.Fig.2?
A. 1
B. *6
C. 12
D. 5
E. 10
27. What science studies the structure shown on the picture Рис.Fig.2?
A. *Imunohenesis
B. Immunology
C. Genetics
D. Pharmacology
E. Biochemistry
28. What number is marked structure that encodes the HLA class 1 on the picture Рис.Fig.2?
A. *3
B. 1
C. 2
D. None of above
E. All of them
29. What number is marked structure that encodes the HLA 2-class on the picture Рис.Fig.2?
A. *1
B. 3
C. 2
D. None of above
E. All of them
30. What number is marked structure that encodes the HLA Class 3 on the picture Рис.Fig.2?
A. *2
B. 1
C. 3
D. None of above
E. All of them
31. In which locus coding genes control immune response on the picture Рис.Fig.2?
A. *1
B. 3
C. 2
D. None of above
E. All of them
32. Which figure shown locus perform coding genes control of immune response on the
picture Рис.Fig.2?
A. *DR
B. DP
C. DQ
D. DS
E. DT
33. What is the immunological function of molecules encoded by locus 3 on the picture
Рис.Fig.2?
A. *Immunological "passport" cells
B. Control interaction between imunotsytamy
C. Production of cytokines
D. Control of immunoglobulin
E. All numbered
34. What is the immunological function of molecules encoded by locus 1 on the picture
Рис.Fig.2?
A. *Control interaction between imunotsytamy
B. Immunological "passport" cells
C. Production of cytokines
D. Control of immunoglobulin
E. All numbered
35. Match of which locusss is successful for allotransplantatation of parenchymatosus organs
on the picture Рис.Fig.2?
A. *1
B. 2
C. 3
D. All numbered
E. None of above
36. Which lymphocytes interact with structures that are encoded locus 3 on the picture
Рис.Fig.2?
A. *T- cytotoxic
B. T-helper
C. B-lymphocyt
D. Macrophag
E. Neutrophil
37. Which lymphocytes interact with structures that are encoded locus 1 on the picture
Рис.Fig.2?
A. *T-helper
B. T- cytotoxic
C. B-lymphocyt
D. Macrophag
E. Neutrophil
38. What lymphocyte receptors interact with structures that are encoded locus 3 on the
picture Рис.Fig.2?
A. *CD8
B. CD3
C. CD4
D. CD16
E. CD21
39. What lymphocyte receptors interact with structures that are encoded locus 1 on the
picture Рис.Fig.2?
A. *CD4
B. CD8
C. CD3
D. CD16
E. CD21
40. What antigens presented on a diagram belon to the main transplantation antigens on the
picture Рис.Fig.2?
A. *All numbered
B. HLA-DR
C. HLA-A
D. HLA-In
E. None of above
41. What organ transplantation needs of the coinsidence of the antigens that are encoded by
genes, indicating the number 1 on the picture Рис.Fig.2?
A. *Bone marrow
B. Heart
C. Liver
D. Kidneys
E. Lung
42. What organ transplantation needs of the coinsidence of the antigens that are encoded by
genes, indicating the number 1 on the picture Рис.Fig.2?
A. *All numbered
B. Heart
C. Liver
D. Kidneys
E. Lung
43. What organ transplantation needs of the coinsidence of the antigens that are encoded by
genes, indicating the number 3 on the picture Рис.Fig.2?
A. *None of above
B. Heart
C. Liver
D. Kidneys
E. Lung
44. What structure incompatibility can lead to superacute graft rejection on the picture
Рис.Fig.2?
A. *None of above
B. 1
C. 2
D. 3
E. All numbered
45. What structure incompatibility can lead to acute graft rejection on the picture Рис.Fig.2?
A. *3
B. None of above
C. 1
D. 2
E. All numbered
46. On the picture Рис.Fig.3– native heart valve in case of Libman-Sacks endocarditis. What
autoimmune disease can cause valve damage of this type?
A. *SLE
B. Systemic sclerosis
C. Rheumatoid arthritis
D. Аnkilosing spondylitis
E. Dermatopolymyositis
47. What diseases can cause Libman-Sacks endocarditis, which is presented on the picture
Рис.Fig.3?
A. Dressler‫יִ‬s syndrome
B. *SLE
C. Primery infective endocarditis
D. Secondary infective endocarditis
E. Rheumatic heart disease
48. On the picture Рис.Fig.5– molecule of the СRP. Increased concentration of it means:
A. *The patient has inflammatory syndrome
B. The patient has an immunodeficiensy
C. Normal data
D. The inflammatory syndrome is absent
E. None of above
49. For what purpose to use estimation of concentration of CRP in patient with autoimmune
diseases on the picture Рис.Fig.5?
A. *To estimate the stage of activity and to correct the treatment
B. For the prognosis
C. To find out concomitant disease
D. As a reason to stop usage of all medicine
E. None of above
50. On the picture Рис.Fig.6– sclerodactylia. Wht disease can you suspect in patient?
A. Rheumatoid arthritis
B. *Systemic sclerosis
C. SLE
D. Reactive arthritis
E. Goat
51. Sclerodactylia, which is presented on the picture Рис.Fig.6 is the component of the next
syndrome:
A. *CREST-синром
B. Dressler‫יִ‬s syndrome
C. Syndrome of the systemic inflammatory response
D. Raynaud‫יִ‬s syndrome
E. None of above
52. Sclerodactylia, which is presented on the picture Рис.Fig.6 is the component CRESTsyndrome in case of systemic sclerosis. What are the components of the CREST-syndrome?
A. *Calcification of the soft tissues, Raynaud‫יִ‬s syndrome, еsophagitis, sclerodactylia,
tеlеаngiectasia
B. Calcification of the soft tissues, Raynaud‫יִ‬s syndrome, erythema facial, sclerodactylia,
tеlеаngiectasia
C. Calcification of the soft tissues, Raynaud‫יִ‬s syndrome, erythema of the trunk,
sclerodactylia, tеlеаngiectasia
D. Calcification of the soft tissues, Raynaud‫יִ‬s syndrome, erythema nodosum, sclerodactylia,
tеlеаngiectasia
E. None of above
53. On the picture Рис.Fig.6 – wrists of the patient L. 37 years old, female. Her diagnosis is
systemic scleroderma.What medicines are DMARD for this disease?
A. *Аntifibrotic medicine
B. Immunostimulators
C. Intravenous immunoglobuline
D. NSAID
E. None of above
54. On the picture Рис.Fig.8– patient L., 45 years old. She is ill for the 10 years. This face is
typical for:
A. Dermatopolymyositis
B. Rheumatoid arthritis
C. Psoriatic arthritis
D. SLE
E. *Systemic sclerosis
55. On the picture Рис.Fig.8– patient L., 45 years old? With systemic scleroderma?
A. Аnti-Native-DNA
B. Anti-Sm
C. Аnti-SS-A
D. Аnti-SS-B
E. *Аnti-Scl-70
56. On the picture Рис.Fig.8– patient L., 45 years old. She is ill for the 10 years. Her
diagnosis is systemic scleroderma. She can not use D-penicilamine because of allergy. What
are the other medicine which can be used as DMARD in case of systemic sclerosis?
A. *NSAID
B. Prednisone
C. Vascular medicine
D. Cytostatics
E. None of above
57. On the picture Рис.Fig.9 presented rash of the female of 16 years old with the diagnosis:
Henoch-Schonlein purpura. What is the pathogenesis of this disease?
A. *Leucocytoclastic vasculitis with IgA deposition
B. Immunocomplex type of the vasculitis
C. Cryoglobuline deposition
D. Vasculopathy, which is caused by viruses
E. Vasculopathy, which is caused by bacteria
58. What syndromes can be found in patient, who is presented on the picture Рис.Fig.9, with
Henoch-Schonlein purpura?
A. *Skin syndrome, joint syndrome, syndrome of kidney involvement and аbdominal
syndrome
B. Hepatonephric syndrome
C. Heart failure syndrome and skin syndrome
D. Malabsorption syndrome
E. Syndrom of dysplasia of connective tissue
59. What symptome is presented on the picture Рис.Fig.10?
A. *Livedo reticularis
B. Non-identify rash
C. Psoriatic rash
D. Skin syndrome at cryoglobuline vasculitis
E. Аllergic rash
60. What disease can have a patient with such a manifestation on the picture Рис.Fig.10?
A. *Аutoimmune thyroiditis
B. Multiple sclerosis
C. Polyarteritis nodosa
D. SLE
E. Henoch-Schonlein purpura
61. On the picture Рис.Fig.10 - Livedo reticularis. Patient is female, 35 years old, with SLE
and antiphospholipid syndrome. What medicine are the basic in treatment of this disease?
A. *Immunosuppresive medicine
B. Іmmunostimulators
C. Іmmunoglobulines
D. NSAID
E. None of above.
62. On the picture Рис.Fig.10- Livedo reticularis. Patient is female, 35 years old, with SLE
and antiphospholipid syndrome. What group of medicine are DMARDs for this disease?
A. Prednisone
B. *Cytostatics
C. NSAID
D. Vascular medicine
E. None of above.
63. On the picture Рис.Fig.11 – X-ray of the female, 25 years old with rheumatoid arthritis.
What medicine is the standart in treatment of this disease?
A. D-penicilamine
B. *Меthotrexate
C. Aspirin
D. Sulindac
E. Prednisone
64. On the picture Рис.Fig.11 – X-ray of the female, 25 years old with rheumatoid arthritis.
For the long period of time (1year 7 months) uses mеthotrexate, but did not get clear effect of
it. What medicine the doctor should recommend the patient?
A. Immunostimulators
B. Іmmunoglobulines
С. *Моnoclonal аntibodies
D. Vascular medicine
E. Add more pain-killers
65. On the picture Рис.Fig.12– wrist of the patient G., 40 років. Shi is ill for the last 10
years. The patient uses mеthotrexate 15 mg once a week? How to reduce side effects of
methotrexate?
A. To prescribe NSAID
B. To prescribe prednisone
С. To prescribe polyvitamins
D. *To prescribe folate
E. None of above.
66. On the picture Рис.Fig.13 – patient В., 42 years old, with idiopathic
dermatopolymyositis. What medicines have to be prescribed?
A. Аntibiotic
B. Skin cream
C. *Cytostatic+glucocorticosteroid
D. NSAID+pain-killers
E. Sulfonamides
67. On the picture Рис.Fig.13 – patient В., 42 years old, with idiopathic
dermatopolymyositis. What indications for the prescription of intravenous immunoglobuline
in such a patient?
A. *Juvenile DM, resistant DM to cytostatic and glucocorticosteroid
B. Severe joint syndrome
C. Severe weakness in muscles
D. Combination of skin syndrome and severe weakness in muscles
E. High activity of the inflammation
68. What is the influence of this medicine on the picture Рис.Fig.15?
A. *Suppression of IL-1β, TNF-α, IL-6
B. Stimulation of endogenic interferon
C. Immunostimulator with prevalence influence on cell chain of immunity
D. Elimination of immune complexes
E. None of above.
69. What group of medicine Zinaxin belongs to on the picture Рис.Fig.15?
A. Medicine for the treatment of the lung inflammatory diseases
B. Immunostimulators
C. Antiallergic medicines
D. *Medicine for the treatment of musculoskeletal disorders
E. None of above.
70. On the picture Рис.Fig.7 – rash of the patient with psoriatic arthritis. Prescribe the
treatment:
A. *Cytostatic + NSAID + skin cream
B. Immunostimulator with prevalence influence on cell chain of immunity
C. Stimulators of endogenic interferon + NSAID
D. Stimulators of endogenic interferon + glucocorticosteroid
E. Stimulators of endogenic interferon + NSAID + skin cream
71. Male, 34 years old, сomplains on the pain in the joints, difficulties of movements. Also
has a pain in spinal column. During the examination it was found the rash, which is presented
in the photo on the picture Рис.Fig.7. What is your diagnosis.
A. *Psoriatic arthritis
B. Rheumatoid arthritis
C. Reactive arthritis
D. SLE
E. SSD
72. What medicini is DMARD for the disease, which is presented on X-ray on the picture
Рис.Fig.17?
A. *Sulfasalazin
B. Diklofenak
C. Diclofenac-Natrium
D. Prednisone
E. Мydocalm
73. X-ray of the patient with ankylosing spondylitis is presented on the picture Рис.Fig.17.
Patient uses sulfasalazin for the long period of time What side effect can happen to the
patient?
A. *Еxanthema, itching
B. Areas of skin necrosis
C. Secondary vasculitis
D. Hyperpigmentation
E. Hypopigmentation
74. What biological medicine is recommended for the patient with ankylosing spondylitis,
whose X-ray is presented on the picture Рис.Fig.18?
A. Immunoglobulinum anticytomegalovirusum humanum
B. Bioven mono
C. *Tumor necrosis factor inhibitor
D. Immunoglobulinum humanum antichlamidicum
E. Mycoplasma-imun
75. Patient L. on the picture Рис.Fig.19, 35 years old, with ankylosing spondylitis uses
sulfasalazin, but the doctor noticed progretion of the disease. What another DMARD can be
recomended?
A. Prednisone
B. Меdrol
C. *Меthotrexate
D. Diklofenak
E. None of above
76. What molecule is presented on the picture Рис.Fig.39?
A. *Immune globulin
B. MHC I molecule
C. MHC II molecule
D. Interferon
E. TNF molecule
77. What the main function of immune molecule that is presented on the picture Рис.Fig.39?
A. *Antigen binding
B. Binding with immune cells
C. Binding with immune molecules
D. Binding with macrophages
E. Nothing above
78. What is the function of immunoglobulin part that pointed by red color on the picture
Рис.Fig.39?
A. *Antigen binding
B. Binding with immune cells
C. Binding with immune molecules
D. Binding with macrophages
E. Nothing above
79. What the main function of immune molecule that is presented on the picture Рис.Fig.39?
A. *Antigen binding
B. Stimulation of immune system
C. Inhibition of immune system
D. Interaction of immune cells
E. Nothing above
80. What cell on the picture is pointed by 1 on the picture Рис.Fig.40?
A. *Т-helper
B. Tissue basophile
C. Т-suppressors
D. В-lymphocyteТ-cytotoxic
81. What is pointed on the picture by x on the picture Рис.Fig.40?
A. *Antigen
B. Virus
C. Bacteria
D. Interleukin
E. Immunoglobulin
82. What is pointed on the picture Рис.Fig.40 by 2?
A. *Macrophage
B. Tissue basophile
C. Т-suppressors
D. В-lymphocyte
E. Т-cytotoxic
83. What is pointed on the picture Рис.Fig.40 by 3?
A. *The main hystocompatibility complex molecule-2
B. The main hystocompatibility complex molecule-1
C. T-helper recognizing receptor
D. B-cell recognizing receptor
E. T- cytotoxic cell recognizing receptor
84. What is pointed on the picture Рис.Fig.40 by 3?
A. *T-helper recognizing receptor
B. The main hystocompatibility complex molecule-2
C. The main hystocompatibility complex molecule-1
D. B-cell recognizing receptor
E. T- cytotoxic cell recognizing receptor
85. What is the name of process on the picture Рис.Fig.40?
A. *Antigen presentation
B. Allergic reaction
C. Immunostimulation
D. Immunosuppression
E. Formation of immune memory
86. What is the result of process on the picture Рис.Fig.40?
A. *Transduction of antigen information
B. Immunostimulation
C. Immunosuppression
D. Formation of immune memory
E. Immunoregulation
87. What cell will be the cell No1 after influence of IL12 on the picture Рис.Fig.40?
A. *Т-helper 1
B. Т- helper 2
C. Т-suppressor
D. В-lymphocyte
E. Т-cytotoxic
88. What cell will be the cell No1 after influence of IL4 on the picture Рис.Fig.40?
A. *Т-helper 2
B. Т- helper 1
C. Т-suppressor
D. В-lymphocyte
E. Т-cytotoxic
89. The clinical picture of what disease is represented on the picture Рис.Fig.28?
A. kheylitis
B. Kheylozis
C. *Edema Quinke
D. stomatitis
E. Anasarca
90. What antigen stimuli are the triggers of the process on the picture Рис.Fig.28?
A. None of above
B. All the above
C. *Allergen
D. Prisons
E. Extracellular bacteria
91. What antigen stimuli are the triggers of the process on the picture Рис.Fig.28?
A. All the above
B. Viruses
C. Oncoantigenes
D. Intracellular bacteria
E. *Allergen
92. For what diseases are these syndromes specific on the picture Рис.Fig.30?
A. *Allergical
B. Pseudoallergical
C. Paraalergical
D. Allergical and pseudoallergical
E. Allergical and Paraalergical
93. What antigen stimuli are the triggers of the process on the picture Рис.Fig.30?
A. All the above
B. Viruses
C. Oncoantigenes
D. Intracellular bacteria
E. *Allergen
94. What is represented on a photo on the picture Рис.Fig.33?
A. Results of patch -test
B. *Results of prik-test
C. Results of specific desensibilisation
D. Results of nonspecific desensibilisation
E. Results of inrtadermal skin test
95. The stages of what process are represented on the picture Рис.Fig.34?
A. *the allergy
B. the pseudoallergy
C. the Paraalergy
D. the allergy and pseudoallergy
E. the allergy and paraalergy
96. What antigen stimuli are the triggers of the process on the picture Рис.Fig.34?
A. All the above
B. Viruses
C. Oncoantigenes
D. Intracellular bacteria
E. *Allergen
97. What is represented on a photo on the picture Рис.Fig.35?
A. patch -test
B. *prick-test
C. specific desensibiliisation
D. nonspecific desensibilisation
E. intradermal test
98. What cell is represented on the picture Рис.Fig.29?
A. Limfocit
B. Makrophag
C. Microphage
D. *Mastocit
E. Plazmocit
99. What cell is presented on the picture Рис.Fig.29?
A. Т-helper-1
B. *Mastocit
C. Т-helper-2
D. Т-suppressor
E. Т-contrsuppressor
100. What mechanism of immune response initiates the cell on the picture Рис.Fig.29?
A. Cell
B. *Humoral
C. Phagocyte
D. Non-specific
E. All the above
101. What is named the cell to the membranes of which Ig E is fixed (represented on a
picture on the picture Рис.Fig.29?
A. Limfocit
B. Makrophag
C. Microphag
D. *Mastocit
E. Plazmocit
102. The method of what allergical intervention is represented on the picture Рис.Fig.36?
A. *patch-test
B. prick-test
C. specific desensibilisation
D. Nonspecific desensibilisation
E. Intradermal test
103. What the method of immunodiagnostics is presented on the photo on the picture
Рис.Fig.41?
A. *Immune agglutination
B. Immune fluorescence
C. Amplification
D. Polymerase chain reaction
E. Lygase chain reaction
104. What are the principles of the reaction on the photo on the picture Рис.Fig.41?
A. *Antigen-antibody
B. Antibody- antibody
C. Immunoglobulin-enzyme
D. Substrate-enzyme
E. Cell-complement
105. In what cell the agglutination has performed on the picture Рис.Fig.41?
A. *А1
B. В1
C. С1
D. D1
E. None of above
106. In what cell the agglutination has NOT performed on the picture Рис.Fig.41?
A. *В1
B. А1
C. А2
D. D1
E. None of above
107. What is the clinical applying of the method of immune diagnostics on the picture
Рис.Fig.41?
A. *Diagnostics of infectious diseases
B. Immune state assessment
C. Oncoimmunology
D. All the above
E. None of above
108. What class of immunoglobulin molecule is presented on the picture Рис.Fig.42 by 1?
A. *G
B. A
C. M
D. None of above
E. All the above
109. What kind of immunoglobulin is presented on the picture Рис.Fig.42 by 1?
A. *Е
B. A
C. M
D. None of above
E. All the above
110. What immune molecule is presented on the picture Рис.Fig.42 by 1?
A. *Immunoglobulin
B. MHC-1
C. MHC-2
D. Interferon
E. TNF
111. What is presented on the picture Рис.Fig.42 by 2?
A. *Fixed receptor
B. Soluble receptor
C. Bacteria
D. Onco-cell
E. Virus
112. What is the next stage after interaction of 1 and 3 on the picture Рис.Fig.42?
A. *Complement activation
B. Antibody production
C. Immunostimulation
D. Immunosuppression
E. NK activation
113. What is the result of 1 and 3 interactions on the picture Рис.Fig.42?
A. *Antibody-dependant cytolyses
B. Antibody-non-dependant cytolyses
C. Apoptosis
D. Mitosis
E. Non of above
114. Immune role of molecule that is presented on the picture Рис.Fig.42 by 1:
A. *All the above
B. None of above
C. Opsonisation of phagocytosis
D. Virus neutralization
E. Complement activation