IMMUNOLOGY FINAL EXAM
1. A Major difference between using anumal-derived antiserum vs. human-derived hyperimmune
globulin for passive immunization is:
A. Antiserum has a longer half-life plasma.
B. The antigen-specific Ig from hyperimmune globulin achieves a higher initial serum
level.
C. The second administration of antiserum is likely to have adverse reactions that the
first.
D. Hyperimmune globulin has a higher risk for serum sickness.
E. All of the above are correct.
2. Tight regulation of the immune system occurs via multiple mechanisms. Which is NOT one of
these mechanisms?
A. Permanent inactivation of self-reactive cells via clonal anergy.
B. Suppression of self-reactive cells by T-cells
C. Production of anti-idiotypic antibodies
D. Release of inhibitory cytokines by lymphocites
3. Which of the following is a primary lymphoid organ?
A. Spleen
B. Bone Marrow
C. Lymph Node
D. Lung
E. Gall Bladder
4. 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. Failure of apoptosis to clear autoreactive T cells from the injured eye
B. Increased expression of MHC class II molecules in the uninjured ere
C. Molecular mimicry between the baseball and the eye
D. Antigens released from the injured eye not before encountered by the immune
system are now being targeted in the uninjured eye
E. None of the above
5. The half-life of maternal IgG in a newborn is typically:
A.
B.
C.
D.
E.
Less than a week
One to two weeks
1 month
2 to 6 months
1 year
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6. Which of the following statements is TRUE:
A. MHC Class II present endogenous Ag epitopes to CD8 T cells
B. MHC Class I present exogenous Ag epitopes to CD8 T cells
C. MHC Class II present exogenous Ag epitopes to CD8 T cells
D. MHC Class I present endogenous Ag epitopes to CD8 T cells
E. MHC Class II present endogenous Ag epitopes to CD4 T cells
7. Immune mechanisms against Ascaris lumbricodes are MOST associated with:
A.
B.
C.
D.
E.
Macrophages and cytophilic antibodies
IgE and antibody-dependent cellular cytotoxicity (ADCC)
NK activity and IgA
IgM and complement C5a
Cytotoxic T cells
8. The earliest response to the first exposure to a virus is
A.
B.
C.
D.
E.
T cell mediated killing of infected cells
NK cell mediated killing of infected cells
Release of perforins by CD8+ T cells
Production of IFN-alpha and IFN-beta
Secretion of IL-2 and IFN-gamma
9. Which property is FALSE regarding NK cells:
A.
B.
C.
D.
E.
They can kill by ADCC-mediated mechanisms
They express antigen-specific receptors
They are large granular lymphocytes
They can kill tumor cells
They can kill virus-infected targets
10. Each of the following represent pairs of molecules (one from the antigen presenting cell and
one from the CD6 + T cell) that interact during antigen presentation EXCEPT:
A.
B.
C.
D.
LFA-3 and LFA-1
CD28 and B7
ICAM-1 and LFA-1
CD4 and Class II MHC
2
11. Organisms avoid host immune responses through which of the following mechanisms
A.
B.
C.
D.
E.
Antigenic modulation
Immune deviation
Immunesuppression
Masking
All of the above
12. A 20 year old woman develops a red rash over her nose and cheeks after brief sum exposure.
A screening test indicates that she has an autoimmune disease. Which of the following antibodies
is MOST LIKELY to be present?
A.
B.
C.
D.
Anti-centromere
Anti-desmoglein III
Anti- IgG
Anti-HLA DR4
13. The first vaccine commonly given to infants in the U.S. is
A.
B.
C.
D.
E.
Hemophilus influenzae B
Diphtheria
Hepatitis b
Pertussis
Polio
14. In patients with thrombotic thrombocytopenic purpura cytotoxic antibodies immediate
hemolytic anemia. This is an example of which type of hypersensitivity reaction?
A.
B.
C.
D.
Type I
Type II
Type III
Type IV
15. To determine the HLA haplotypes of the donor and recipient in preparation for a familial
kidney transplant you need to examine:
A. HLA of donor only
B. HLA of recipient only
C. HLA of donor and recipient
D. HLA of multiple family members
3
16. Regarding Natural Killer Cells, which of the following is FALSE:
A.
B.
C.
D.
E.
They have some surface markers in common with T cells.
They kill by mechanism similar to those of cytotoxic T lymphocytes
They express CD3 and TCR
They produce perforins
They can kill via antibody-dependent cellular cytotoxicity (ADCC) mechanisms.
17. Lymphatic vessels (lymphatics) have all of the following functions EXCEPT:
A.
B.
C.
D.
E.
Drainage of antigens into lymph nodes
Processing of antigens for presentation to lymphocytes
Delivery of mature lymphocytes to secondary lymphoid tissue
Reduction in inflammatory exudates
Circulation of helper and cytotoxic T lymphocytes
18. Complement factor C5a has all of the following activities EXCEPT:
A. Vasolidation
B. Contraction of smooth muscle
C. Direct lysis of target cells via MAC formation
D. Chemoattractant for eosinphils
E. Chemoattractant for neutrophils
19. The immune response to lepromatous leprosy is skewed toward the production of which
cytokines:
A. IL-2 and TNF-alpha
B. IL-4 and IL-10
C. IL-6 and IL-12
D. IL-2 and IFN-gamma
20. Hashimoto’s thyroiditis has a genetic association with the HLA allele DR5. TO which major
histocompatibility class does this allele belong?
A.
B.
C.
D.
Class I
Class II
Class III
Class IV
4
21. 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.
B.
C.
D.
Intravenouse
Subcutaneous
Oral
Equal response to all the above
22. A 20 year old woman becomes increasing hyperactive, loses weight despite an increase
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.
B.
C.
D.
Anti-nuclear
Anti-thyroid stimulating hormone receptor
Anti-acetylcholin receptor
Anti-thyroglobulin
23. Polymorphisms of which one of the following immune system genes have shown the
strongest genetic associations with autoimmune diseases?
A. Complement C4 alleles
B. T cell receptor beta alleles
C. Immunoglobulin light chain alleles
D. HLA class II alleles
E. None of the above.
24. Deposition of antigen-antibody immune complexes in the glomeruli is most characteristic of
which one of the following autoimmune diseases?
A.
B.
C.
D.
E.
Systemic lupus eythematosus
Myasthenia gravis
Type I diabetes mellitus
Autoimmune hemolytic anemia
None of the above.
25. A 10 year old boy develops polyuria (excessive quantities of urine) and weight loss. His
blood sugar is found to very high. Which one of the following autoimmune mechanisms is likely
to be present?
A.
B.
C.
D.
E.
Cell-mediated destruction of pancreatic islet cells in the pancreas
Autoanitibodies to circulating insulin
Cell mediated destruction of thyroid
Autoantibodies to liver glycogen
None of the above
5
26. Which complement protein is most abundant in serum (1.0 to 1.5 mg/ml)?
A.
B.
C.
D.
E.
C1
C2
C3
C4
C5
27. Antigen-antibody complexes comprised of which of the following immunoglobulins act as
the most potent activators of the classical pathway of complement?
A.
B.
C.
D.
E.
IgA
IgD
IgE
IgM
IgG3
28. 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.
B.
C.
D.
E.
Classical pathway
Alternative pathway
Lectin pathway
Neither B or C would be affected
All complement pathways would be affected.
29. All of the following complement proteins and cells participate in the clearance of immune
complexes EXCEPT:
A.
B.
C.
D.
E.
C3b
CR1 (CD 35)
CR2 ( CD 21)
Red blood cells
Liver macrophages (Kupffer cells)
6
30. Which of the following statements is FALSE regarding Human Immunodeficiency Virus
(HIV) infection?
A. The chemokine receptors CCR5 and CXCR4 enhance the binding and
internalization of HIV by host cells.
B. Gp120 is the principal viral receptor involved in the binding of HIV to host cells.
C. Gp41 is involved in the internalization of HIV
D. In latently infected cells, the viral genome persists for months to years as a double
stranded, circular RNA molecules in the host cell nucleus.
E. The virus produces its own reverse transcriptase, which has served as a target for
anti-HIV drugs.
31. Cytokines
A.
B.
C.
D.
Are large, high molecular weight proteins
Are produced only by lymphocytes and macrophages
Are very stable and have long plasma half lives
Each have distinctive biological activities that do not overlap with those of other
cytokines.
E. Can act in an endocrines, pracrine, or autocrine fashion
32. Which statement sis FALSE:
A. The chief function of the immune system is to distinguish between self and nonself
B. During clonal selection, antigen selectively stimulates cells which express specific
receptors for it to divide and differentiate.
C. Generation of antigen-binding diversity occurs only after antigen exposure
through DNA rearrangement
D. Self reactive B and T cell clones may be eliminated via apoptosis
E. A memory response to an antigen is stronger that a primary response to the same
antigen
33. Which of the following characteristics contribute to the immunogenicity of a substance?
A.
B.
C.
D.
E.
High molecular weight
Chemical complexity
Foreignness
Degradability
All of the above
7
34. The most common diagnostic assay for presence of maternal anti-RH antibodies is:
A. Direct Coomb’s test
B. Ouchterlony double diffusion
C. Radial immunodiffusion
D. Radioactive immunoassay
E. Immunoflurescence
35. B cells recognize antigens by all interaction EXCEPT:
A.
B.
C.
D.
E.
Covalent bonding
Reversible interaction
Hydrogen bonding
Van der Waal’s forces
Electrostatic interaction
36. The procedure where proteins are separated by electrophoresis, transferred to a solid matrix,
and probed using enzymes covalently attached to antibodies is called:
A.
B.
C.
D.
E.
Western Blot
Northern Blot
Southern Blot
Immunoelectrophoresis
Nephelometry
37. A substance capable of eliciting antibody production and reacting specifically with the
resulting antibodies is best described as a (an):
A. Idiotope
B. Adjuvant
C. Paratope
D. Immunogen
E. Antigen
38. The ouchterlony method of immunodiffusion analysis:
A.
B.
C.
D.
E.
Is very expensive to perform
Can directly compare the antigenic relatedness of two antigens
Is a standard quantitative assay
Requires use of radioactive antibodies
Measures only autoantibodies
8
39. Cytotoxic T cells:
A. Bind to target cells via antibody and Fc receptors
B. Recognize antigen bound to class II MHC proteins
C. Recognize endogenously processed and presented antigens
D. Are typically CD4+
E. None of the above
40. The state of unresponsiveness to a particular antigenic epitope while the rest of the response
remains intact is called
A. Immunosuppression
B. Anergy
C. Apoplosis
D. Tolerance
E. Immunomodulation
41. All of the following contribute to generation of human immunoglobulin diversity EXCEPT:
A.
B.
C.
D.
V-J joining of light chains
Gene conversion
N region addition
Somatic mutation
42. Abnormalities associated with phagocytic disorders include:
A. Neutropenia
B. Reduced leukocyte adhesion
C. Reduced chemotaxis
D. Reduce microbicidal activity
E. All of the above
43. X-linked severe combined immunodeficiency (SCID) the MAJOR underlying defect is:
A.
B.
C.
D.
E.
Abnormal or inactive IL-2 secretion
BTK enzyme deficiency
Adenosine deaminase deficiency
Defective γ chain in IL-2 receptor
Absence of mature B cells
44. In transplantation, a recipient antibody cross-match is performed to avoid:
A. Chronic rejection
B. Hyperacute rejection
C. Acute rejection
D. Viral infection
9
45. Organ transplantation performed between two twin brothers is called:
A. Isograft
B. Xenograft
C. Autograft
D. Allograft
E. None of the above
46. The switch mechanism for chaining IgM to other immunoglobulin classes involves all of the
following EXCEPT:
A.
B.
C.
D.
Recombination to form a new light chain gene
Switch regions adjacent to constant region genes
DNA recombination in the B cell
Loss of DNA from the chromosome
47. Hyperacute allograft rejection is mediated by
A.
B.
C.
D.
T cells
Macrophages
NK cells
Antibodies
48. A C7 complement deficiency would be suspected in which of the following clinical
presentations?
A. Pneumocytis carinii pneumonia
B. Miliary (disseminated) tuberculosis
C. Repeated meningococcal meningitis
D. Multiple staphylococcal abscesses
E. Apergillus fumigates fungemia
49. A consistent property of member of the immunoglobulin gene superfamily is
A.
B.
C.
D.
Variable region gene recombination
Lack of interactions among members
Predominantly α helical protein structure
One or more immunoglobulin-like domains
50. One reason that it has been difficult a vaccine against HIV is
A. The human immune responses in incapable of inactivating HIV or killing HIV
infected cells
B. Gp120 does not elicit a good antibody response
C. Each patient may have several different HIV genotypes
D. All cells infected with HIV are actively producing HIV virions
E. CD4+ T cell function declines before an anti-HIV response can be elicited.
10
51. Suppressor T cells:
A.
B.
C.
D.
E.
Are induced by IL-2 and TNFα
Downregulate responses only to self antigens
Are only CD4May secreted TGFβ and IL-10
Upregulate MHC expression on target tissues
52. In delayed type hypersensitivity:
A. Release if interferon0gamma and other factors leads to macrophage activation
B. CD4+ Th2 cells are principal lymphocytes involved
C. The reaction is maximal 2 to 6 hours after antigen exposure
D. DTH lymphocytes directly kill target cells, as demonstrated by the chromium
release essay
E. High reactivity in a mixed leukocyte culture would provide evidence that the
transplant donor and recipient are a good match
53. Concerning antigen and tolerance induction:
A. High dose antigen tolerizes T cells only
B. Low dose antigen tolerizes both T and B cells
C. Mid dose antigen is not tolerigenic
D. B cell tolerance is longer lasting that T cell tolerance
E. Specific antibody production stimulates further antibody production against the
same epitopes
54. Which of the following diseases is complement the LEAST important?
A.
B.
C.
D.
E.
Glomerulonephritis
Staphylococcus aureus infection
Myasthenia gravis
Disseminated infection due to Neisseria gonorrhea
Rheumatic fever
55. A lymphoma that produces terminal transferase (TdT) is most likely derived from:
A. A mature B cell
B. An immature B cell
C. An IgG producing plasma cell
D. A macrophage
11
56. Assessment of isohemagglutinin titer would be a screen for production of which
immunoglobulin isotype?
A. IgG
B. IgA
C. IgM
D. IgD
E. IgE
57. All of the following are typical granulomatous reaction EXCEPT:
A.
B.
C.
D.
E.
Reaction to persistent antigens
Presence of CD4+ T lymphocytes
Multinucleate giant cells
Epitheloid cells
Large numbers of plasma cells
58. A defect in VDJ recombinase system would lead to:
A.
B.
C.
D.
Defective antibody production with normal T cell activity
Severe combined immunodeficiency (defective T and B cells)
Defective T cell activity and normal B cell activity
No detectable immune dysfunction
Matching. For each numbered item, (Column 1), choose the most appropriates answer
(Column2). FOR ALL MATCHING QUESTIONs each answer may be used once, more than
once or not at all.
59. Ig that can be either bivalent or
Tetravalent, may or may not possess a
J chain peptide covalently bound to it
60. In a normal patient this Ig is found on
the surface of some subsets of B
cells also bearing IgM.
61. The Ig class with the greater
Molecular mass
62. The Ig class responsible for most allergies
A. IgG
B. IgA
C. IgM
D. IgE
E. IgD
Match the description to the most appropriate cytokine.
63. Inhibits development of Th2 cells
64. Inhibits Th1 cells
65. Promotes IgE synthesis
66. Global T cell growth factor
A. IL-4
B. IL-10
C. Interferon-gamma
D. IL-2
E. Tumor necrosis factor beta
12
MATCHING. Which of the following immune mechanisms is MOST important in each disease:
67. Graves disease
68. Tuberculosis
69. Immune clearance of Streptococcus
pneumoniae
70. Adverse reaction to repeated
injections of horse immunoglobulins
in large quantities.
A. Delayed type hypersensitivity
B. Immune complex formation
C. Cytotoxic/cytolytic antibody reactions
D. Anaphylactic reactions
E. Inactivation or activation due to
antibody binding
Match the HIV infection manifestations with the most appropriate disease stage. Assume that the
patient is not receiving anti-retroviral therapy.
71. High numbers of virions (-109) are
produced per day, but the viral load is
relatively low (<105 HIV virions per ml
of blood).
72. An HIV+ 9-month old baby infant develops
pneumocystus carinii pneumonia that
recurs after therapy
73. Patient has lower-grade fever,
lymphadenopathy, and a rash.
HIV antibody test 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 infections
D. Late symptomatic infection
MATCHING. Match the class of infection with the major immune defense mechanisms
74. Mycobacterial
75. Fungal
76. Helminth
77. 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
13
Match the examples given to the most appropriated description.
78. A child has no reaction to poison ivy
Upon has the first exposure, but has a
severe reaction the second time.
79. A patient undergoing chemotherapy
is given neutrophis from a donor to
Compensate for neutropenia (low
Neutrophil counts)
80. 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
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C
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B
D
D
D
B
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B
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D
C
B
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C
B
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C
B
B
B
D
A
A
C
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B
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C
C
A
A
A
D
B
C
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D
B
E
D
B
A
A
D
C
D
C
D
A
C
C
B
C
E
B
B
E
C
D
C
B
A
D
E
A
C
B
B
D
A
B
B
D
C
D
A
B
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