Immunology

Question 1

19 year old male presents to A&E with severe respiratory difficulty, light-headedness and a red itchy rash. On examination he has laryngeal oedema, bilateral wheezing across the lung fields and is hypotensive. He has recently been taking antibiotics for a chest infection.

Answer 1

Anaphylaxis

Question 2

A 3 year old girl is brought into A&E by her parents. She has had vomiting and diarrhoea since early yesterday evening when she was at a birthday party. On examination she has urticaria.

Answer 2

Food allergy

Question 3

A 40 year old man presents to his GP complaining of loss smell and nasal itching and discharge. On examination his nasal mucosa are swollen and have a bluish tinge. His symptoms improve with a corticosteroid spray

Answer 3

Allergic rhinitis

Question 4

A 25 year old woman presents to her GP complaining of itchy, red wheals on her torso which have been present for 7 weeks. She can not remember how they started but has noticed they are worse in the heat and when she exercises.

Answer 4

Chronic urticaria

Question 5

A 30 year old women presents to her GP with a red, itchy, oozing rash around her neck and fingers

Answer 5

Contact dermatitis

Question 6

A 55 year old man with history of angina was advised to take a tablet before a long flight. After taking the pill, he suddenly finds that he has difficulty breathing, feels nauseous and is itching.

Answer 6

Mast cell degranulation

Question 7

A 24 year old medical student develops worsening swelling of the hands and feet and abdominal pain before her final year medical exams. She says that similar milder episodes have occurred preciously.

Answer 7

C1 inhibitor deficiency

Question 8

A 50 year old Irish woman presents to her GP with episodes of diarrhoea, which is difficult to flush, abdominal pain, weight loss and fatigue. She also describes a blistering itchy rash on her knees.

Answer 8

Coeliac disease

Question 9

A 26 year old male who has been suffering from ‘flu-like’ symptoms with fever presents to the GP after developing skin rash in the last few days.

Answer 9

Acute urticaria

Question 10

A 35 year old woman presents with persistent itchy wheels for the last 2 months. She noticed that when this is at its worst, she also has a fever and feels generally unwell. After an acute attack, she has bruising and post-inflammatory residual pigmentation at the site of the itching.

Answer 10

Urticarial vasculitis

Question 11

A 19 year old male presents to A&E with increasing breathlessness. On examination his blood pressure is 90/55 mmHg and his respiratory rate is 28/min. He shows you a generalised red itchy skin rash, and examination of his chest reveals bilateral inspiratory and expiratory wheezes throughout.
Diagnosis and management?

Answer 11

Anaphylaxis

IM adrenaline 1mL of 1:1000

Question 12

A 35 year old woman presents with a two day history of a red itchy skin rash which started soon after her first scuba-diving lesson. She is otherwise well.
Dx and mgmt?

Answer 12

Acute urticaria

PO antihistamines

Question 13

A 22 year old woman presents with an intermittently itchy and desquamating skin rash on her abdomen which is unresponsive to antihistamines

Answer 13

Contact hypersensitivity

Question 14

A 40 year old man complains of loss of smell with nasal itching and discharge over 4 weeks. He also describes morning sneezing. He is otherwise in good health. On examination his nasal mucosa are swollen and hyperaemic.
Dx and mgmt?

Answer 14

Allergic rhinitis

PO antihistamines

Question 15

This 45 year old woman presents to A&E with tongue swelling and acute respiratory tract obstruction. She has longstanding hypertension and received a renal transplant two years previously. She has no history of allergic disease. On examination her blood pressure is stable, and examination of her lung fields reveal normal breath sounds. Her current medication includes cyclosporine, azathioprine, captopril and nifedipine.
Dx and mgmt?

Answer 15

Acute angioedema

IM adrenaline 0.5 mL of 1:1000

Question 16

Cytokines exerting an anti-viral effect

Answer 16

Interferons

Question 17

Immunoglobulin dimer

Answer 17

IgA

Question 18

MHC associated with Th1 cells

Answer 18

MHC II

Question 19

Acts on hepatocytes to induce synthesis of acute phase proteins in response to bacterial infection

Answer 19

IL-6

Question 20

Arise in the first few days after infection and are important in defence against viruses and tumors

Answer 20

NKCs

Question 21

MHC associated with Th2 cells

Answer 21

MHC II

Question 22

MHC associated with cytotoxic T cells

Answer 22

MHC I

Question 23

Along with IgD, is one of the first immunoglobulins expressed on B cells before they undergo antibody class switching

Answer 23

IgM

Question 24

The most abundant (in terms of g/L) immunoglobulin in normal plasma

Answer 24

IgG

Question 25

Deficiencies in this predispose to SLE

Answer 25

Classical complement pathway

Question 26

Kostmanns syndrome is a congenital deficiency of which component of the immune system?

Answer 26

Neutrophils

Question 27

Which component of the innate immune system is usually one of the first to respond to infection through a cut?

Answer 27

Neutrophils

Question 28

Which infection is most common as a consequence of B cell deficiency?

Answer 28

Bacterial

Question 29

Meningococcal infections are quite common as a result of which deficiency of the component of the immune system?

Answer 29

Complement

Question 30

Produced by the liver, when triggered, enzymatically activate other proteins in a biological cascade and are important in innate and antibody mediated immune response?

Answer 30

Complement

Question 31

A complete deficiency in this molecule is associated with recurrent respiratory and gastrointestinal infections.

Answer 31

IgA

Question 32

Leukocyte Adhesion Deficiency is characterised by a very high count in what cell?

Answer 32

Neutrophils

Question 33

Which crucial enzyme is vital for the oxidative killing of intracellular micro-organisms?

Answer 33

NADPH oxidase

Question 34

Which complement factor is an important chemotaxic agent?

Answer 34

C3a

Question 35

What is the functional complement test used to investigate the classical pathway?

Answer 35

CH50

Question 36

``` A. Type IV – Complement mediated B. Type III – Immune complex mediated C. Type III – T-cell mediated D. Not an autoimmune disease E. Type IV – T-cell mediated F. Type II – Antigen mediated G. Type II – Antibody mediated H. Type III – complement mediated ``` Graves Disease

Answer 36

Type II – Antibody mediated

Question 37

``` A. Type IV – Complement mediated B. Type III – Immune complex mediated C. Type III – T-cell mediated D. Not an autoimmune disease E. Type IV – T-cell mediated F. Type II – Antigen mediated G. Type II – Antibody mediated H. Type III – complement mediated ``` SLE

Answer 37

. Type III – Immune complex mediated

Question 38

``` A. Type IV – Complement mediated B. Type III – Immune complex mediated C. Type III – T-cell mediated D. Not an autoimmune disease E. Type IV – T-cell mediated F. Type II – Antigen mediated G. Type II – Antibody mediated H. Type III – complement mediated ``` Rheumatoid arthritis

Answer 38

E. Type IV – T-cell mediated

Question 39

``` A. Type IV – Complement mediated B. Type III – Immune complex mediated C. Type III – T-cell mediated D. Not an autoimmune disease E. Type IV – T-cell mediated F. Type II – Antigen mediated G. Type II – Antibody mediated H. Type III – complement mediated ``` Asthma

Answer 39

D. Not an autoimmune disease

Question 40

``` A. Type IV – Complement mediated B. Type III – Immune complex mediated C. Type III – T-cell mediated D. Not an autoimmune disease E. Type IV – T-cell mediated F. Type II – Antigen mediated G. Type II – Antibody mediated H. Type III – complement mediated ``` Type 1 diabetes

Answer 40

E. Type IV – T-cell mediated

Question 41

``` A. Type IV – Complement mediated B. Type III – Immune complex mediated C. Type III – T-cell mediated D. Not an autoimmune disease E. Type IV – T-cell mediated F. Type II – Antigen mediated G. Type II – Antibody mediated H. Type III – complement mediated ``` Immune thrombocytopaenic purpura

Answer 41

G. Type II – Antibody mediated

Question 42

``` A. Type IV – Complement mediated B. Type III – Immune complex mediated C. Type III – T-cell mediated D. Not an autoimmune disease E. Type IV – T-cell mediated F. Type II – Antigen mediated G. Type II – Antibody mediated H. Type III – complement mediated ``` ABO hemolytic transfusion reaction

Answer 42

G. Type II – Antibody mediated

Question 43

``` A. Type IV – Complement mediated B. Type III – Immune complex mediated C. Type III – T-cell mediated D. Not an autoimmune disease E. Type IV – T-cell mediated F. Type II – Antigen mediated G. Type II – Antibody mediated H. Type III – complement mediated ``` Hepatitis C associated membranoproliferative glomerulonephritis type I

Answer 43

B. Type III – Immune complex mediated

Question 44

``` A. Type IV – Complement mediated B. Type III – Immune complex mediated C. Type III – T-cell mediated D. Not an autoimmune disease E. Type IV – T-cell mediated F. Type II – Antigen mediated G. Type II – Antibody mediated H. Type III – complement mediated ``` Goodpastures syndrome

Answer 44

G. Type II – Antibody mediated

Question 45

``` A. Type IV – Complement mediated B. Type III – Immune complex mediated C. Type III – T-cell mediated D. Not an autoimmune disease E. Type IV – T-cell mediated F. Type II – Antigen mediated G. Type II – Antibody mediated H. Type III – complement mediated ``` Myasthenia gravis

Answer 45

G. Type II – Antibody mediated

Question 46

Most useful diagnostic antibody - SLE

Answer 46

Anti-DNA antibody

Question 47

Most useful diagnostic antibody - Wegener's granulomatosis

Answer 47

c-ANCA

Question 48

Most useful diagnostic antibody - Rheumatoid arthritis

Answer 48

Anti-CCP

Question 49

Most useful diagnostic antibody - Auto-immune haemolytic anaemia

Answer 49

Coombs test

Question 50

Most useful diagnostic antibody - primary biliary cirrhosis

Answer 50

Anti-mitochondrial antibody

Question 51

Goodpastures syndrome - What is the specific auto-antigen that is the target of the immune system?

Answer 51

Type IV collagen

Question 52

Goodpastures syndrome - The pattern of the antibody deposition in the glomerular basement membrane is typically described as what?

Answer 52

Smooth linear

Question 53

Goodpastures syndrome - Name the drug most likely to be used in the treatment of this disease.

Answer 53

Prednisolone

Question 54

Goodpastures syndrome - Immune damage may be associated with the kidney and commonly which other tissue?

Answer 54

Lung