Immunology questions Flashcards
The immune system is commonly divided into “innate” versus “adaptive” immunity. Which ONE of the following statements correctly describes aspects of this category?
A) CD4+ helper T-cells are the central hub of innate immunity.
B) Macrophages cannot attack microbes without first undergoing clonal expansion of the ‘right’ clone fitting a specific microbe.
C) Deficiency in innate immunity wouldn’t be expected to cause clinical problems as long as adaptive immunity remains intact.
D) NK cells represent a part of innate immunity because they don’t require prior learning to know which cells to kill.
E) Innate immunity is the key feature required for vaccination.
D) NK cells represent a part of innate immunity because they don’t require prior learning to know which cells to kill.
Which of one the following statements correctly describes aspects of vaccination?
A) The schedule of the so-called “6-in-1” DPT/Polio/Hib/HepB vaccine (given at 2 months, 3 months, 4 months) is done because it contains several different antigens.
B) If you’ve had the MMR vaccination within the last four weeks, you should stay away from pregnant women or babies.
C) A 20 year-old male student is in doubt whether he had all the required MMR vaccinations. Finding his immunization record is critical because an extra MMR injection (if he had been vaccinated) would be risky.
D) The effect of vaccines such as COVID19 in patients with HIV is independent of how many T-cells they have.
E) The formation of memory B cells accounts for the rapid production of IgG at re-exposure to a microbe after vaccination.
E) The formation of memory B cells accounts for the rapid production of IgG at re-exposure to a microbe after vaccination.
Drugs can modulate the immune system therapeutically. Which ONE of the following statements correctly describes aspects of that?
A) Biological drugs (most often monoclonal antibodies) are metabolized by the liver.
B) Targeted biological drugs such as anti-TNF antibodies (e.g. adalimumab) are functionally equivalent to passive immunization using antibodies against a microbe.
C) Common drugs used to suppress autoimmune conditions, e.g. methotrexate, ciclosporine and systemic steroids, all have a similar side effect profile.
D) Biologic drugs targeting a specific cytokine are commonly more immunosuppressive than glucocorticoids.
E) Immunoglobulins can be administered in immunodeficiency, such as CVID or leukemia, but not in autoimmune conditions such as pemphigus, dermatomyositis or Myasthenia Gravis.
B) Targeted biological drugs such as anti-TNF antibodies (e.g. adalimumab) are functionally equivalent to passive immunization using antibodies against a microbe.
Q4. A granuloma is a common reaction pattern seen in many conditions. Which of the following statements is true concerning granulomatous infections?
A) Demonstration of granuloma by biopsy is proof of an infectious disease.
B) Granulomas can be formed as a protective encasement by the interplay of T-lymphocytes and macrophages around bacteria that can’t be eliminated. Once formed, a granuloma is irreversible.
C) All biologic drugs pose a risk for TB by inhibiting granuloma formation regardless of the molecule which they target.
D) If a middle-aged person is found to have granulomas in the lung, they very likely have recently acquired a fresh TB infection.
E) Granuloma found in lung biopsy pose a wide differential including bacterial infection, neoplasm, hyperimmunity, and TB.
E) Granuloma found in lung biopsy pose a wide differential including bacterial infection, neoplasm, hyperimmunity, and TB.
A 22- year old woman is referred to the rheumatology clinic because her fingers change colour in the cold. This has been re-occurring in the year. Her past medical history includes recurrent mouth ulcers and pain in the small joints of her hands.
Measurement of which antibody is most likely to aid diagnosis?
A. Tissue transglutaminase IgA antibody
B. Anti-cyclic citrullinated protein
C. Immunoglobulins
D. Anti-acetylcholine receptor antibody
E. This condition relies on a clinical diagnosis but a Connective Tissue Screen (CTD) could be ordered.
E. This condition relies on a clinical diagnosis but a Connective Tissue Screen (CTD) could be ordered.
A 50-year-old woman has 10 years of dry eyes and a dry mouth. She has a past medical history of vitiligo. She is otherwise well and has no other medical history.
Which autoantibody is most likely to be diagnostic?
A. Parietal cell antibody
B. Anti-cyclic citrullinated peptide
C. Anti-Jo-1
D. Anti-Ro
E. Anti-Scl-70
D. Anti-Ro
Q3. A 60-year old diabetic patient with treatment resistant psoriasis needs to achieve clinical remission of his skin before knee replacement surgery can be carried out. PMH includes alcohol-related cirrhosis, TB, and prostate cancer.
Which of the following consideration would be sensible?
A. Any type of immunosuppression is contraindicated because of the neoplasm in his history.
B. Methotrexate should be considered as first choice.
C. Cyclosporin would be first choice, since it is not very immunosuppressive
D. Although normally not first choice, anti-IL17 biologics could be chosen in this case as they are not hepatotoxic, act swiftly, and pose no TB risk.
D. Although normally not first choice, anti-IL17 biologics could be chosen in this case as they are not hepatotoxic, act swiftly, and pose no TB risk.
A 62-year old man attends the GP with visual blurring; some difficulties swallowing and weakness in his upper limb. He has a family history of ischemic heart disease and is an ex-smoker. Clinical examination elicits bilateral power loss in the upper limbs, ptosis and a mild facial palsy. Referral to the stroke clinic elicits a normal CT head scan.
Measurement of which antibody is most likely to aid the diagnosis?
A. Parietal cell antibody
B. Anti-cyclic citrullinated protein
C. Anti-double stranded DNA
D. Anti-acetylcholine receptor antibody
E. Tissue transglutaminase IgA antibody
D. Anti-acetylcholine receptor antibody
A 32-year old woman presents with a history of recurrent upper respiratory infections requiring at least twice yearly oral antibiotics and intermittent diarrhea over the last 5 years. She is otherwise healthy and on no regular medication. She did have frequent common colds as child but no serious diseases or infections.
Which of the following statements is not true?
A. Primary immunodeficiency is possible in this scenario despite negative FH.
B. Although selective IgA deficiency is most commonly clinically silent, it could underlie both respiratory and gastrointestinal infections.
C. Immunoglobulin levels and FBC could be ordered to rule out Common Variable Immunodeficiency.
D. It could be useful to specifically ask about any autoimmune signs/ symptoms.
E. A primary immunodeficiency is unlikely as symptoms are adult onset and there are no opportunistic infections in PMH.
E. A primary immunodeficiency is unlikely as symptoms are adult onset and there are no opportunistic infections in PMH.
Management of rheumatoid arthritis in a 53 y/o lady, BMI 34, is considered. She has had stable disease with sulfasalazine and non-steroidal anti-inflammatory drugs for the past ten years. Lately, she has marked progression of her RA, requiring further intervention. PMH includes: smoker, penicillin-allergy, hay-fever, non-alcoholic steatohepatitis, allergy to hydroxychloroquine. Possible options would include the following except:
A. Pulsed- steroid treatment
B. Rituximab (anti-CD20: an antibody eliminating B-cells)
C. anti-TNF (e.g. adalimumab or infliximab)
D. DMARDs targeting specific cytokines (e.g. baricitinib)
E. Methotrexate
E. Methotrexate
Management of rheumatoid arthritis in a 53 y/o lady, BMI 34, is considered. She has had stable disease with sulfasalazine and non-steroidal anti-inflammatory drugs for the past ten years. Lately, she has marked progression of her RA, requiring further intervention. PMH includes: smoker, penicillin-allergy, hay-fever, non-alcoholic steatohepatitis, allergy to hydroxychloroquine. After a failed attempt to contain disease progression by steroids, the lady is screened and found negative for TB and then started on Adalimumab. Which of the following considerations is false?
- The lady is receiving a form of passive immunization targeted against Tumour-necrosis factor.
- This treatment could stop being effective if she develops antibodies against the drug.
- Due to the mechanism of drug elimination of Adalimumab, further deterioration of LFT would require withholding the treatment.
- The drug is a powerful anti-inflammatory because it blocks the central pro-inflammatory signalling pathway (NFkappaB activation).
- Due to the mechanism of drug elimination of Adalimumab, further deterioration of LFT would require withholding the treatment.
Management of rheumatoid arthritis in a 53 y/o lady, BMI 34, is considered. She has had stable disease with sulfasalazine and non-steroidal anti-inflammatory drugs for the past ten years. Lately, she has marked progression of her RA, requiring further intervention. PMH includes: smoker, penicillin-allergy, hay-fever, non-alcoholic steatohepatitis, allergy to hydroxychloroquine. After a failed attempt to contain disease progression by steroids, the lady is screened and found negative for TB and then started on Adalimumab. The patient is doing well, no longer requiring strong analgesics to contain her disease. However, six months into treatment she develops weight loss, general malaise, and a persistent dry cough. CXR is unremarkable, CRP normal. Your primary differential includes: (1) cancer (2) TB, (3) bacterial pneumonia
A: 1 or 3
B: 1 or 2
C: 2 or 3
D: 1 or 3
E: all
B: 1 or 2
