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IMMUNOLOGY FINAL EXAM
MULTIPLE CHOICE: CHOOSE THE BEST ANSWER
1. A lymphoma that produces terminal transferase (TdT) is MOST LIKELY derived from:
A. A macrophage
B. a mature B cell.
C. An IgG producing plasma cell.
D. An immature B cell
2. Lymphatic vessels (lymphatics) have all of the following functions EXCEPT:
A. Reduction in inflammatory exudate.
B. Circulation of helper and cytotoxic T lymphocytes.
C. drainage of antigens into lymph nodes.
D. Delivery of mature lymphocytes to secondary lymphoid tissue.
E. Processing of antigens for presentation to lymphocytes.
3. Which of the following is the fundamental function of antibody-dependent cell-mediated
cytotoxicity (ADCC)?
A. The Fc portion of antibody attaches to the natural killer cell or phagocytic cell
surface, and the variable portion provides specificity to cell-mediated killing.
B. Antibody directly kills host lymphocytes.
C. Antibody directly kills foreign microbes.
D. Antibody attaches to the B cell surface, causing the B cell to undergo apoptosis.
E. The Fc portion of antibody attaches to the T cell surface, allowing T cell receptor
mediated killing.
4. The first vaccine commonly given to infants in the U.S. is:
A. Pertussis
B. Polio
C. Hemophilus influenzae B
D. Hepatitis B
E. Diphtheria
5. The earliest response to the first exposure to a virus is:
A. Release of perforins by CD8+ T cells
B. Production of IFN-alpha and IFN-beta
C. Secretion of IL-2 and IFN-gamma
D. T cell-mediated killing of infected cells
E. NK cell mediated killing of infected cells
6. Complement factor C5a has all of the following activities EXCEPT:
A. direct lysis of target cells via MAC formation.
B. chemoattractant for eosinophils.
C. chemoattractant for neutrophils.
D. increase in vascular permeability.
E. contraction of smooth muscle.
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7. Antigen-antibody complexes comprised of which of the following immunoglobulins act
as the MOST potent activators of the classical pathway of complement?
A. IgE
B. IgD
C. IgG3
D. IgA
E. IgM
8. All of the following complement proteins and cells participate in the clearance of
immune complexes EXCEPT:
A. C3b
B. Red blood cells
C. Liver macrophages (Kupffer cells)
D. CR2 (CD 21)
E. CR1 (CD 35)
Match the examples given to the most appropriate description.
9. A child has no reaction to poison ivy
upon the first exposure, but has a
severe reaction the second time.
10. A patient undergoing chemotherapy
is given neutrophils from a donor to
compensate for neutropenia (low
neutrophil counts).
11. An Rh+ infant is born with hemolytic
disease of the newborn
A. Passive, innate immunity
B. Passive, adaptive immunity
C. Active, innate immunity
D. Active, adaptive immunity
E. None of the above
Match each autoimmune syndrome with its MOST appropriate statement:
12. Systemic lupus erythematosus (SLE)
13. Myasthenia gravis
14. Graves Disease
A. Autoantibodies directed at
acetylcholine receptors
B. Autoantibodies directed at
double-stranded DNA or nuclear
antigens
C. Autoantibodies directed at pancreatic
islet of Langerhans cells
D. Autoantibodies directed at thyroid
stimulating hormone receptor
E. Autoantibodies directed at basement
membrane structures in kidney
15. In transplantation, a recipient antibody cross-match is performed to avoid:
A. viral infection
B. chronic rejection
C. hyperacute rejection
D. acute rejection
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16. An infant boy was brought to the doctor because of an infected area over the knuckles
on his right hand. An x-ray of the hand showed infection in the underlying bone, as
well. Staphylococcus aureus was cultured from the skin and the bone. The child's
serum immunoglobulin levels were normal, but his total white blood cell count was
35,000 cells/µL (normal less than 10,000). The leukocyte adherence markers
CD1 8/CD1 1a, b, c were present at normal levels. The child's mother demonstrated that
only 50% of her neutrophils reduced nitroblue tretrazolium dye. What is this child's
diagnosis?
A. Hyper IgM syndrome
B. Chronic granulomatous disease
C. X-linked severe combined immunodeficiency
D. Leukocyte adhesion deficiency
E. X-linked agammaglobulinemia
17. All of the following are typical of granulomatous reaction EXCEPT:
A. Multinucleate giant cells.
B. Epitheloid cells.
C. reaction to persistent antigens.
D. Large numbers of plasma cells.
E. Presence of CD4+ T lymphocytes.
Match the following transplantation rejection immune responses to the MOST appropriate
description:
18. Hyperacute rejection
19. Acute rejection
20. Chronic rejection
21. Graft-vs.-host disease
A. Mediated by preformed antibodies to
ABO antigens or MHC antigens
B. Arises when donor T lymphocytes
attack self tissue
C. Arises when host T lymphocytes
attach foreign tissue
D. Mediated by host's antibody and
cellular response against minor
histocompatibility antigens on
transplant tissue
E. Occures by T lymphocyte activation
to donor MHC or tissue antigens
between 10 and 30 days post
transplantation
MATCHING: Match the class of infection with the major immune defense mechanisms
22. Mycobacterial
23. Protozoal
24. Helminth
25. Viral
A. Antibody (Immune complex and
cytotoxicity)
B. DTH and granulomatous reactions
C. Antibody, cytotoxic T lymphocytes
and DTH
D. ADCC and granulomatous reactions
E. DTH and antibody
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26. Identify the correct statement regarding Beta 2 microglobulin molecules:
A. They are associated with HLA-DP and HLA-B.
B. They are associated with CD1 and HLA-DR
C. They are associated with HLA-C only.
D. They are associated with HLA-DR and HLA-DQ.
E. They are associated with HLA-A and CD1.
27. A 30 year old woman notes that she is becoming very "nervous" and "shaky". She has
lost 10 lbs but her appetite has increased. Her heart feels like it is "racing". When she
consults her physician, he notes that her thyroid gland is enlarged. Serum T4 level also
is high. Which one of the following autoantibodies is causing this patients disease?
A. Anti-islet cell antibodies
B. Anti-nuclear antibodies
C. Anti-adrenal antibodies
D. Anti-acetylcholine receptor antibodies
E. Anti-thyroid stimulating hormone receptor antibodies
28. A 16 year old boy develops frequent urination, thirst and hunger. When seen by his
physician he if found to have a high blood sugar and glucose in the urine. Which one of
the following genetic factors is MOST LIKELY to be found?
A. HLA-B27
B. HLA-B51
C. HLA-DR3/DQ6
D. HLA-DR2/DQ6
E. HLA-DR5/DQ7
29. A 20 year old woman becomes increasing hyperactive, loses weight despite an
increased appetite and her friends tell her that her eyes are becoming more prominent.
Her physician diagnoses Graves disease. Which one of the following autoantibodies is
the cause of her disease?
A. Anti-thyroid stimulating hormone receptor
B. Anti-acetylcholine receptor
C. Anti-thyroglobulin
D. Anti-nuclear
E. None of the above
30. A child with congenital asplenia (a genetic defect where the individual has no spleen)
would develop the best IgG antibody response using which route of immunization:
A. Subcutaneous
B. Intravenous
C. Intraperitoneal
D. Oral
E. Equal responses to all the above
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Match the HIV infection manifestations with the MOST appropriate disease stage.
Assume that the patient is not receiving anti-retroviral therapy.
31. High numbers of virions (-109) are
produced per day, but the viral load is
relatively low (<105 HIV virions per ml
of blood).
32. An HIV+ 9-month old infant develops
Pneumocystis carinii pneumonia that
recurs after therapy.
33. Patient has low-grade fever,
lymphadenopathy, and a rash. HIV
antibody tests are nonreactive, CD4+
T cell levels are intermediate (800 per
microliter of blood), and HIV viral load
is high (5x106 /ml blood).
A. Primary infection
B. Asymptomatic infection
C. Early symptomatic infection
D. Late symptomatic infection
34. The switch mechanism for changing IgM to other immunoglobulin classes involves all of
the following EXCEPT:
A. Loss of DNA from the chromosome
B. DNA recombination in the B cell.
C. switch regions adjacent to constant region genes.
D. recombination to form a new light chain gene
35. The immune response during lepromatous leprosy is skewed toward the production of
which cytokines:
A. II-6 and IL-12
B. IL-2 and IFN-gamma
C. IL-2 and TNF-alpha
D. IFN-gamma and TNF-alpha
E. IL-4 and IL-10
36. All of the following contribute to generation of human immunoglobulin diversity
EXCEPT:
A. Gene conversion
B. V-J joining of light chains
C. Somatic mutation
D. N region addition
37. A defect in the VDJ recombinase system would lead to:
A. No detectable immune dysfunction.
B. Defective antibody production with normal T cell activity.
C. Severe combined immunodeficiency (defective T and B cells)
D. Defective T cell activity and normal B cell activity.
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38. A 20 year old woman develops a red rash over her nose and cheeks after brief sun
exposure. A screening test indicates that she has an autoimmune disease. Which of
the following autoantibodies is MOST LIKELY to be present?
A. Anti-IgG
B. Anti-HLA DR4
C. Anti-DNA
D. Anti-thyroglobulin
E. Anti-desmoglein III
39. A MAJOR difference between using animal-derived antiserum vs. human-derived
hyperimmune globulin for passive immunization is:
A. The antigen-specific Ig from hyperimmune globulin achieves a higher initial
serum level.
B. The second administration of antiserum is likely to have adverse reactions than
the first.
C. Hyperimmune globulin has higher risk for serum sickness.
D. Antiserum has a longer half-life in plasma
E. All of the above are correct.
40. Affinity maturation and class switching occur in which microanatomical site?
A. Parafollicular areas of lymph nodes.
B. Vascular compartment
C. Germinal centers in lymph node follicles
D. Bone marrow
E. Mucosa
41. Which of the following correctly describes the Thl/Th2 paradigm?
A. Thl cells secrete IL-4 and protect against parasites, where as Th2 cells secrete
INF-gamma and protect against intracellular infections.
B. Th1 cells secrete IFN-gamma and protect against intracellular infections, where
as Th2 cells secrete IL-4 and protect against parasites.
C. Thl cells secrete IFN-gamma and protect against parasites, where as Th2 cells
secrete IL-4 and protect against intracellular infections.
D. Thl cells secrete IL-4 and protect against intracellular infections, where as Th2
cells secrete INF-gamma and protect against parasites.
42. Immune mechanisms against the helminth Ascaris lumbricoides are MOST associated
with:
A. IgM and complement C5a
B. IgE and antibody-dependent cellular cytotoxicity (ADCC)
C. Macrophages and cytophilic antibodies
D. Cytotoxic T cells
E. NK activity and IgA
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43. Which of the following cell types DO NOT constitutively express Class II MHC
molecules?
A. B lymphocytes
B. Macrophages
C. T lymphocytes
D. Dendritic cells
E. All of the above cells constitutively express Class II MHC molecules.
44. On the first day of the clinical rotation in pediatrics, a third-year medical student is
called STAT to the crib of a newborn infant girl who is having convulsions. The nurse
tells the medical student that a blood calcium level was too low. The child's face
appears to be unusual, in that the ears are low-set on the head, and there is a deep
indentation of the bridge of the nose. What test would MOST rapidly confirm a severe
T-cell immunodeficiency?
A. Delayed hypersensitivity skin test to antigen
B. Antibody response to T-cell dependent antigen
C. Lymphocyte proliferation to antigen
D. DNA test
E. Chest x-ray
45. Suppressor T cells:
A. are only CD4+
B. upregulate MHC expression on target tissues
C. are induced by IL-2 and TNF alpha
D. downregulate responses only to self antigens
E. may secrete TGF beta and IL-10
46. Interaction of which pairs of molecules favors development to TH1 responses?
A. CD40 and Class II MHC
B. CD28 and CTLA4
C. CD28 and B7.1
D. CD154 and CD40
E. CD2 and LFA1
Match the description to the MOST appropriate cytokine.
47. Inhibits development of Th2 cells
48. Promotes TH1 cell development
49. Promotes IgE synthesis
A. IL-4
B. MIP-1 alpha
C. Interferon-gamma
D. IL-2
E. IL-12
50. The specificity of antibody is determined by:
A. The flexibility of the hinge region
B. The variable region of the light chain.
C. The variable regions of the heavy and the light chain.
D. The Fc domain
E. The variable region of the heavy chain
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51. Concerning antigen and tolerance induction:
A. Mid dose antigen is not tolerigenic
B. Specific antibody production stimulates further antibody production against the
same epitopes.
C. High dose antigen tolerizes T cells only
D. Low dose antigen tolerizes both T and B cells
E. B cell tolerance is longer lasting than T cell tolerance.
52. Which complement protein is the MOST abundant in serum (1.0 to 1.5 mg/ml)?
A. C4
B. C5
C. C1
D. C2
E. C3
53. The CD8 protein is expressed on:
A. helper T cells, and binds to Class I MHC molecules.
B. cytotoxic T cells, and binds to Class II MHC molecules.
C. cytotoxic T cells, and binds to Class I MHC molecules.
D. helper T cells, and binds to Class II MHC molecules.
54. A 22 year old woman is diagnosed with systemic lupus erythematosus. She is found to
have significant renal involvement (glomerulonephritis). Which autoantibody is MOST
LIKELY to be found in her blood and kidneys?
A. Anti-Ro/SSA antibodies
B. Anti-red blood cell antibodies
C. Anti-igG antibodies
D. Anti-glomerular basement membrane antibodies
E. Anti-DNA antibodies
55. A 10 year old boy develops polyuria (excessive quantities of urine) and weight loss. His
blood sugar is found to be very high. Which one of the following autoimmune
mechanisms is MOST LIKELY to be present?
A. Autoantibodies to circulating insulin
B. Cell mediated destruction of thyroid
C. Autoantibodies to liver glycogen
D. Cell-mediated destruction of pancreatic islet cells in the pancreas
E. None of the above
56. Which of the following characteristics contribute to immunogenicity of a substance?
A. Chemical complexity
B. Foreignness
C. Degradability
D. High molecular weight
E. All of the above
-8-
Match the process to its effect. Choose the BEST ANSWER.
57. Allelic exclusion
A. Changing secreted antibody to
58. V(D)J recombination
surface bound antibody
59. Class switching
B. Increasing antibody binding
60. Affinity maturation
specificity during B cell proliferation
C. Each B cell expresses antibody of
one specificity
D. The generation of antibody specificity
E. Changing from IgM to IgG expression
MATCHING: For each numbered item, (Column 1), choose the most appropriate answer
(Column 2). FOR ALL MATCHNG QUESTIONS each answer may be used once, more than
once or not at all.
61. Ig that can be either bivalent or
tetravalent, may or may not posses a
J chain peptide covalently bound to it
62. In a normal patient, this Ig is found on
the surface of some subsets of B
cells also bearing IgM.
63. The Ig class with the greatest
molecular mass
64. The Ig class responsible for most
allergies
A. IgG
B. IgA
C. IgM
D. IgE
E. IgD
65. A substance capable of eliciting antibody production and reacting specifically with the
resulting antibodies is BEST described as a(n):
A. immunogen
B. paratope
C. antigen
D. idiotope
E. adjuvant
66. Regarding Natural Killer cells, which of the following is FALSE:
A. They kill by mechanisms similar to those of cytotoxic T lymphocytes.
B. They produce perforins.
C. They can kill via antibody-dependent cellular cytotoxicity (ADCC) mechanisms.
D. They have some surface markers in common with T cells
E. They express CD3 and TCR.
67. A patient is admitted to your clinic with an autoimmune disease and is missing the
second complement component (C2). Which of the following would NOT be affected
by this defect?
A. Classical pathway
B. Alternative pathway
C. Lectin pathway
D. Neither B or C would be affected
E. All complement pathways would be affected.
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68. Delayed type hypersensitivity (DTH) is regulated by the following cell type:
A. CD8 T cells
B. Macrophages
C. Th1 cells (CD4+)
D. Epithelial cells
E. Th3 cells (CD4+)
69. B cells recognize antigens by all interactions EXCEPT:
A. hydrogen bonding
B. Van der Waal's forces
C. electrostatic interaction
D. covalent bonding
E. reversible interaction
70. The halflife of maternal IgG in a newborn is typically:
A. two to three weeks
B. one to two weeks
C. 1 year
D. less than 1 week
E. 2 to 6 months
71. A batter for the Astros gets accidentally beaned by the pitcher and suffers left eye
damage. Two weeks later, the right eye also becomes red and sore and vision is
impaired. Which one of the following causes of autoimmunity is MOST LIKELY?
A. Increased expression of MHC class II molecules in the uninjured eye.
B. Failure of apoptosis to clear autoreactive T cells from the injured eye.
C. Antigens released from the injured eye not before encountered by the immune
system are now being targeted in the uninjured eye.
D. Molecular mimicry between the baseball and the eye
E. None of the Above.
72. Organ transplantation performed between two twin brothers is called:
A. xenograft
B. autograft
C. immunograft
D. isograft
E. None of the above
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73. A healthy 15-year old girl suddenly became ill with a fever, general muschle aches, and
dizziness. When her temperature reached 39.8(C, she was taken to the emergency
room. En route, she quickly developed a rash over her arms which spread to most of
her body. Upon arrival to the ER, her heart rate and respiration were markedly
elevated. Blood, CSF and urine cultures were negative. Vaginal culture revealed
abundant Staphlococcus aureus (Toxic Shock Syndrome). Which statement is FALSE
regarding the antigen TSST-1 ?
A. The antigen interacts with a limited group of T cells with common receptor region
(commonly Vbeta gene segments).
B. The antigen crosslinks the MHC I and the T cell receptor.
C. Response to the antigen will not lead to adaptive immunity against S. aureus.
D. Response to the antigen will result in proliferation of naive T cells.
E. The antigen bind outside of the MHC peptide groove.
74. Hashimoto's thyroiditis has a genetic association with the HLA allele DRS. To which
major histocompatibility class does this allele belong?
A. Class IV
B. Class Ill
C. Class II
D. Class I
75. A C7 complement deficiency would be suspected in which of the following clinical
presentations?
A. Multiple staphylococcal abcesses
B. Aspergillus fumigatus fungemia
C. Pneumocytis carinii pneumonia
D. Miliary (disseminated) tuberculosis
E. Repeated meningococcal meningitis
76. The MOST common diagnostic assay for presence of maternal anti-Rh antibodies is:
A. Radioactive immunoassay
B. Immunofluorescence
C. Ouchterlony double diffusion
D. Direct Coombs' test
E. Radial immunodiffusion
77. The MAJOR reason that it has been difficult to develop a successful vaccine against
HIV is:
A. Gp120 does not elicit a good antibody response.
B. All cells infected with HIV are actively producing HIV virions.
C. CD4+ T cell function declines before an anti-HIV response can be elicited.
D. The human immune response is incapable of inactivating HIV or killing
HIV-infected cells.
E. Each patient may have several different HIV genotypes.
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78. Which of the following cell types DO NOT constitutively express Class I MHC
molecules?
A. B lymphocytes
B. Dendritic cells
C. T lymphocytes
D. Macrophages
E. All of the above cells constitutively express Class I MHC molecules.
79. The procedure where proteins are separated by electrophoresis, transferred to a solid
matrix, and probed using enzymes covalently attached to antibodies is called:
A. Immunoelectrophoresis
B. Nephelometry
C. Southern Blot
D. Northern Blot
E. Western Blot
80. Which of the following statements is FALSE regarding Human Immunodeficiency Virus
(HIV) infection?
A. In latently infected cells, the viral genome persists for months to years as a
double stranded, circular RNA molecule in the host cell nucleus.
B. The virus produces its own reverse transcriptase, which has served as a target
for anti-HIV drugs.
C. The chemokine receptors CCR5 and CXCR4 enhance the binding and
internalization of HIV by host cells.
D. Gp120 is the principal viral receptor involved in the binding of HIV to host cells.
E. Gp41 is involved in the internalization of HIV
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IMMUNOLOGY 2003
FINAL
1
2
3
4
5
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8
9
10
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14
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D
E
A
D
B
A
E
D
D
A
B
B
A
D
C
B
D
A
E
D
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
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40
B
B
E
D
C
E
E
C
A
A
B
D
A
D
E
A
C
C
B
C
41
42
43
44
45
46
47
48
49
50
51
52
53
54
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60
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B
B
C
E
E
C
C
E
A
C
A
E
C
E
D
E
C
D
E
B
61
62
63
64
65
66
67
68
69
70
71
72
73
74
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76
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80
B
E
C
D
A
E
B
C
D
E
C
D
B
C
E
D
E
E
E
A