Past paper corrections Immunology

Question 1

What infection is associated with P1104A variant of the TYK2

name another mutation that causes this infection

Answer 1

Tuberculosis

mutation in IL12

Question 2

What is the most common HLA association for a seronegative spondyloarthropathy? -

Answer 2

HLA B27

Question 3

What autoimmune condition is associated with a mutation on the “shared epiptope” on HLA-DR1 and HLA-DR4!!? -

Answer 3

rhuematoid arthritis

(4 walls in a rheum)

Question 4

HLA DR3 is associated with what conditions?

Answer 4

Grav3s disease, SLE

three letters in SLE

Question 5

HLA DR15 is associated with what condition?

Answer 5

goodpastures syndrome

Question 6

HLA DR3/DR4 is associated with what condition?

Answer 6

Type 1 diabetes

Question 7

HLA DQ2/DQ8 is associated with what condition

Answer 7

coeliac disease -> i 8 2 much

Question 8

what does FAS mutation cause?

Answer 8

Expansion of lymphocytes/ ALPS

Question 9

most likely HLA association coeliac disease?

Answer 9

DQ2!

(More common than DQ8)

Question 10

pathophysiology of Hyper igM syndrome?

Answer 10

mutation in CD40L

Question 11

IpiLimumab is a licensed therapy in the treatment of metastatic melanoma. But which receptor does it bind to

Answer 11

CTLA4

(Nivolumab and pembrolizumab bind PD1 - indicated in metastatic melanoma AND renal cell carcinoma

Question 12

Which MHC is most important when matching donors?

Answer 12

DR (HLA-DR > B > A). D for donor

Question 13

Live attenuated vaccines

Answer 13

MMR-VBOY = MMR, Varicella, BCG, Oral polio (sabin), Oral Typhoig, yellow fever. Not safe in immunocopromised. However MMR save in HIV
;7

Question 14

Which type of transplant rejection can be treated with plasmapheresis?

Answer 14

antibody mediated transplant rejection

Question 15

Conjugate vaccines?

Answer 15

NHS = N meningitidis, H influenzae, Strep peneumonia. Effective against encapsulated bacteria

Question 16

Child with no B cell, no ig, but t cells

Answer 16

x linked agammaglobulinemia

Question 17

describe 2 treatments for malignant melanoma and their mechanisms

Answer 17

PD1\Nivolumab = prevents T cell death
CTLA4 / ipilimumab = allows T cell activation

Question 18

Crohn’s treatment (monoclonal antibody)

Answer 18

Vedolizumab

Question 19

Which of these is a polysaccharide vaccine?

Answer 19

hemophilus influenzae

Question 20

Question about ulcerative colitis and having used aminosalicylates but without any improvement. What is the next choice of drug?

Answer 20

Vedolizumab

Question 21

Which cytokine is key in promoting the development and terminal differentiation of eosinophils?

Answer 21

IL5

Question 22

A 38 year old male develops fluctuating muscle wean and ptosis. His symptoms improve following an injection of tensilon. Which autoantibody plays a role in the pathogenesis of this condition? -

Answer 22

anti-postsynaptic ACH receptor

Question 23

Antibodies bind to which cell type during the effector phase of antibody mediated rejection of solid organ allografts?

Answer 23

natural killer cells

Question 24

familial mediterranean fever treatment?

Answer 24

colchicine

Question 25

45F develops weakness involving proximal muscles of arms and legs. Blood test results for FBC, renal function and LFT are all normal. Futher ix below. Dx?
IX
ESR – 25 (<20)
CRP – 4 (<5)
Creatine kinase – 3540 (25-175)
ENA (extractable nuclear antigen) screen – positive

Answer 25

Poylmyositis!!!

“inflammation of muscles” = raised CK

also ENA is positive!!

Question 26

Which biologic disease modifying anti- rheumatic drug (DMARD) targeting a specific cytokine pathway would be expected to show efficacy in RA but not psoriatic arthritis?

Answer 26

Tocilizumahb (anti-interleukin 6 receptor antibody) - and sarilumab another IL6

Question 27

n a disease such a phenylketonuria, which term describes the number of true negatives divided by the total number of people that do not have the disease?

Answer 27

specificity

Question 28

Which condition is caused by reactivation of human polyoma virus 2 (John Cunningham (JC) virus) in immunosuppressed people? -

Answer 28

progressive multifocal leukoencephalopathy

Question 29

Doctors should measure the level/activity of which enzyme before prescribing azathioprine?

Answer 29

TMPT = thiopurine methyltransferase

Question 30

Which one of the following agents is effective as a biological disease modifying anti-rheumatic drug (b-DMARD) as part of rheumatoid arthritis management?A

Answer 30

Adalimumab (anti-TNFalpha)

Question 31

Nivolumab is a PD1 inhibitor, what cells does it target?

Answer 31

t regulatory cell

Question 32

What is the effect of the gene mutation in familial mediterranean fever?

Answer 32

increased IL-1 production

Question 33

Mother is a donor for kidney to a child, what is the max number of mismatches possible with HLA class I? -

Answer 33

3/6

Question 34

In a histology slide showing antibody mediated rejection of a renal allograft, where is the inflammatory infiltrate seen?

Answer 34

capillaries

Question 35

Renal transplant recipients on long term immunosuppression have an increased risk of which lymphoid cancer?

Answer 35

EBV associated Diffuse large B cell lymphoma (DLBCL)!!

Viral conditions after transplant are most common!!!, so Kaposi sarcoma, EBV!!

Question 36

What does Denosumab target?

Answer 36

Receptor activator of nuclear factor kappa-B Ligand (RANKL – But do not use acronyms!)

Question 37

Which common condition can be treated with drugs that target with TNF, IL-17 and IL-12/23?

Answer 37

psoriasis

Question 38

What is true about skin prick testing:

Answer 38

95% negative predictive values (poor positive predictive value) - immunology q

Question 39

low thiopurine methyltransferase which drug do you not give?

Answer 39

Azathioprine

it is metabolised by TMPT
= toxic buildup

Question 40

Woman who has mouth/lip swelling following a dental procedure, and her mother reports a similar history in the past.

what is the diagnosis?

Answer 40

hereditary angioedema/ C1 inhibitor deficiency

triggers: stress, Minor trauma surgery or dental procedure, Infection, Hormonal influences