Final Exam Review Questions

Question 1

A seventeen-year-old patient presents with acute cutaneous lupus erythematosus (SCLE) diagnosed at the age of 15 years old. Prior laboratory measurements showed no detectable C4 proteins, serum C3 levels were lower (77 mg/dL) and C1q inhibitor levels were normal. Which complement activities would be inhibited in this patients?
A. Completion of the classic pathway to the splitting of C3
B. Formation of C3b for opsonization
C. Formation of C5 convertase via the alternative pathway
D. Formation of C5a for chemotactic attractant for neutrophils
E. Formation of the membrane attack complex

Answer 1

A. Completion of the classic pathway to the splitting of C3

Question 2

A patient admitted in hospital who has a severe bacterial infections. He is found to be deficient in C3 component of complement. Which of the complement associated event would still be present in this patient?

a. Hemolysis
b. Chemotaxis
c. Opsonization
d. Hereditary angioneurotic edema
e. Bacteriolysis

Answer 2

d. Hereditary angioneurotic edema

Question 3

A 77-year-old woman with dysuria for 1 week now has a fever. On examination, she has a temperature of 37.9°C, pulse of 103/min, and blood pressure of 80/40 mm Hg. There is right flank pain. A urinalysis shows numerous white blood cells. Her plasma lactate is increased. Urine culture and blood culture grow Escherichia coli. Which of the following is most likely mediating her cardiovascular collapse through attachment to Toll-like cell receptors?
A. Complement C3b
B. Lipopolysaccharide
C. Nitric oxide
D. Platelet-activating factor
E. Toxic shock syndrome toxin-1 
F. Tumor necrosis factor

Answer 3

B. Lipopolysaccharide

Question 4

Cytokine storms are associated with a wide variety of infectious and noninfectious diseases. Which of the following immunosuppressive drugs functions by transcriptional inhibition of pro-inflammatory genes?
A. Cyclosporine A
B. Corticosteroids
C. Tacrolimus
D. Anti-CD3 (OKT3) antibodies 
E. Anti-CD25 antibodies

Answer 4

B. Corticosteroids

Question 5

A 55-year-old man with multiple primary liver abscesses caused by Escherichia coli and anaerobic bacteria has fever and shaking chills. Which of the following is the most likely cause of these symptoms?
A. Associated abscess in the hypothalamus
B. Hypothalamic response to leukocytosis
C. Leukocyte inflammation of the hypothalamus
D. Release of fragments of damaged hepatocytes into the circulation
E. Release of leukocyte cytokines into the circulation

Answer 5

E. Release of leukocyte cytokines into the circulation

Question 6

A 77-year-old man is admitted to the intensive care unit (ICU) of a university hospital from the operating room. Earlier the same day, he had presented to the emergency department with abdominal pain. In the emergency department, he was drowsy and confused when roused and was peripherally cold with cyanosis. The systemic arterial blood pressure was 75/50 mm Hg, and the heart rate was 125 beats per minute. Which of the following is thought to be a major contributor to the septic shock?
A. Clathrin
B. Histamine
C. Interferon
D. Interleukin 2
E. Tumor necrosis factor

Answer 6

E. Tumor necrosis factor

Question 7

A 24-year-old Caucasian male is admitted to the hospital with a one-week history of fever, cough, and chest pain. Lung auscultation reveals crackles over the right lower lung lobe. When placed in an upright glass tube, his anticoagulated red blood cells sedimented at an increased rate of 35 mm per hour. This finding is most likely related to the action of which of the following substances?
A. Bradykinin
B. Leukotriene B4
C. Erythropoietin
D. IL-6
E. Platelet activating factor 
F. Thromboxane A2

Answer 7

D. IL-6

Question 8

A 68 year old female with no history of perianal abscess was examined in the Emergency Department of the hospital verbalizing complaints of swelling and tenderness in the left inguinal area. Physical examination revealed abscess of the left labial area. The patient was admitted to the hospital and surgical incision and drainage was performed by the physician. Which one of the listed cytokines is most important in formation of an abscess?
A. TNF 
B. IL-1 
C. IL-6 
D. IL-8 
E. IL-12

Answer 8

D. IL-8

Question 9

A polypeptide fragment of a large viral antigen is isolated in the laboratory and injected into health volunteers. Researchers find that individuals with particular HLA haplotype do not mount an Ab response to the antigen. Which of the following processes is most likely failing to occur in these subjects?
A. Antigen recognition by T lymphocytes
B. Antigen recognition by B lymphocytes
C. Antigen presentation by macrophages
D. Antigen independent B lymphocyte proliferation
E. Negative selection of T lymphocytes.

Answer 9

A. Antigen recognition by T lymphocytes

Question 10

Class diversity of immunoglobulin molecules is determined by:
A. V,J rearrangements of the DNA coding for variable N terminus of light chain
B. V,D,J rearrangements of the DNA coding for variable N
terminus of heavy chain
C. Alternate splicing of segment of RNA coding for the carboxyl terminus of the heavy chain
D. N-nucleotide addition
E. A,B,C,D

Answer 10

C. Alternate splicing of segment of RNA coding for the carboxyl terminus of the heavy chain

Question 11

A healthy one year old is given an antigen. The immune response shows increasing IgM and no rise in IgG during the next 2 months. Which of the following types of antigens was mostly likely given?

a. bacterial polysaccharide
b. live attenuated measles
c. polio
d. tetanus toxoid
e. unconjugated hapten

Answer 11

a. bacterial polysaccharide

Question 12

You are asked to see a 4-year-old boy who has extremely elevated white blood cell counts, with a profound lymphocytosis. Biopsy of his cervical LN reveals extreme hypocellularity in both cortical and paracortical areas. Absence of which of the following leukocyte surface molecules could result in this clinical picture?
A. Immunoglobulin family cell adhesion molecules
B. Integrins
C. L-selectins
D. Chemokines
E. Addressins

Answer 12

C. L-selectins

Question 13

A 34-year-old female is in need of a blood transfusion because of blood loss due to a road accident. Her blood group is B. Which of the following is a permissible match for the patient?
A. A or B 
B. B or AB 
C. AB or A 
D. A or O 
E. B or O

Answer 13

E. B or O

Question 14

A 42 YO man needs a kidney allograft. His lymphocytes are examined by the mixed lymphocyte reaction with killed stimulator cells from himself & from each of 5 prospective donors. A donor with which of the following thymidine incorporation (cpm) will be most compatible? (the patient has a thymidine value of 425/cpm)

a. 312
b. 1542
c. 2505
d. 15,389
e. 27,482

Answer 14

a. 312

Question 15

A 40-year-old man with chronic myelogenous leukemia undergoes high- dose chemotherapy and bone marrow transplantation from an unrelated donor. Six weeks after the transplant he has good recovery of hematopoiesis but develops diarrhea, a generalized cutaneous rash, and jaundice. Which of the following cell types most likely underlies these signs?
A. B lymphocytes 
B. Eosinophils
C. Mast cells
D. Neutrophils
E. T lymphocytes

Answer 15

E. T lymphocytes

Question 16

A 14-year-old boy develops a pruritic vesicular rash on his face and hands 3 days after hiking in the woods. Which of the following are most likely to be involved in his illness?
A) Antibody, complement C5-9
B) Circulating immune complexes; complement C5a, neutrophils
C) Cytotoxic T lymphocytes
D) IgE, mast cells, histamine, cytokines
E) Lymphocytes, cytokines, macrophages

Answer 16

E) Lymphocytes, cytokines, macrophages

Question 17

A lymph node biopsy from a young boy with X-linked agammaglobulinemia is expected to show which of the following histologic features?
A. Marked perivascular lymphocytic infiltrate
B. Abundant polymorphonuclear inflammation
C. Reduced follicles and germinal centers
D. Nearly absent parafollicular cortical regions
E. Enlarged follicles

Answer 17

C. Reduced follicles and germinal centers

Question 18

Which of the following statements about immune complex-mediated diseases is NOT true?
A. Immune complexes may contain antibodies bound to either self or foreign antigens.
B. Immune complex–mediated diseases generally show systemic manifestations.
C. Pathologic features of immune complex diseases are determined by the cellular source of the antigen.
D. Small complexes are deposited in vessels more than large complexes, which are usually efficiently phagocytized.
E. Complexes containing cationic antigens are more likely to produce severe, long-lasting injury by depositing in blood vessels and renal glomeruli.

Answer 18

C. Pathologic features of immune complex diseases are determined by the cellular source of the antigen.

Question 19

A 5-year-old girl is taken to the emergency department with lethargy, confusion, vomiting, abdominal pain, and flushed skin that is warm to the touch. Respirations are fast and shallow (Kussmaul) and emanate a strong, fruity odor. The mother notes that the child has been excessively thirsty over the past week and that she began wetting her bed during naps. Urine dipstick testing reveals markedly elevated levels of glucose and ketones which led to the diagnosis insulin-dependent diabetes mellitus (type 1). Which hypersensitivity type best matches the associated immunologic disease?
A. Type I hypersensitivity
B. Type II hypersensitivity
C. Type III hypersensitivity
D. Type IV hypersensitivity

Answer 19

D. Type IV hypersensitivity

Question 20

All of the following are key mediators of immediate hypersensitivity reactions EXCEPT:
A. Mast cells
B. Basophils
C. IgE
D. Macrophages
E. TH2 cells

Answer 20

D. Macrophages

Question 21

Immediate hypersensitivity differs from delayed-type hypersensitivity in which one of the following ways?
A. Immediate hypersensitivity is a CD4+ T cell–mediated disease.
B. Immediate hypersensitivity does not require previous exposure to an antigen.
C. Immediate hypersensitivity does not involve inflammation.
D. Immediate hypersensitivity is driven by cytokines such as interleukin (IL)-4, IL-5, and IL-13.
E. Immediate hypersensitivity typically leads to granuloma formation.

Answer 21

D. Immediate hypersensitivity is driven by cytokines such as interleukin (IL)-4, IL-5, and IL-13.

Question 22

In which of the following conditions would you be LEAST likely to see a robust delayed-type hypersensitivity (DTH) response to a Candida antigen skin challenge?
A. X-linked agammaglobulinemia
B. DiGeorge syndrome
C. Selective IgA deficiency
D. Common variable immunodeficiency
E. Chronic granulomatous disease

Answer 22

B. DiGeorge syndrome

Question 23

A 6 year old girl has lymph node biopsy that shows markedly decreased numbers of lymphocytes in the paracortical areas. Analysis of her peripheral blood leukocytes will likely show normal to elevated numbers of cells expressing surface:

A. CD8
B. CD2
C. CD19
D. CD3
E. CD4

Answer 23

C. CD19