RACP- Immunology

Question 1

A 27-year-old woman presents requesting the seasonal influenza vaccine. She recalls developing an urticarial reaction after scrambled eggs as a child. She has since avoided raw or undercooked eggs. She has had no reaction to cakes or bakes goods containing egg. What is the most appropriate advice regarding the seasonal influenza vaccine?
a) She can be given the influenza vaccine
b) She should undergo desensitisation to egg protein
c) Skin prick testing to egg white should be performed
d) She should have a trial of the influenza vaccine at 1/10th the dose
e) The influenza vaccine should be avoided for life

Answer 1

a) She can be given the influenza vaccine

Question 2

Which of the following is the most common clinical presentation of AA Amyloidosis?

a) Gastroparesis
b) Macroglossia
c) Peripheral Neuropathy
d) Restrictive Cardiomyopathy
e) Nephrotic Syndrome

Answer 2

e) Nephrotic Syndrome

Question 3

Defects in apoptosis resulting in delayed elimination of self-proteins is thought to be involved in the pathogenesis of which of the following diseases?

A. Immune thrombocytopenia purpura
B. Multiple Sclerosis
C. SLE
D. Type 1 diabetes mellitus
E. Ulcerative Colitis

Answer 3

C- SLE

Question 4

A 55 year old lady, non smoker, long history of atopy, presents with productive cough, sometimes clear, other times green. CT scan showed bilateral bronchiectasis and congestion in maxillary sinus. Eosinophil count 2.5, IgE 1500. (reference ranges were given). What’s the most likely diagnosis:

A. ABPA
B. PAN
C. Wegeners
D. Churg strauss

Answer 4

A- ABPA

Question 5

Question 54

A 60 year male is found to weakness biceps femoris, anterior tibilalis and flexor carpus radialis. This is most consistent with?

A) Inclusion body myositis
B) Statin myopathy
C) Polymyositis
D) Dermatomyositis
E) Necrotising autoimmune myositis

Answer 5

A- Inclusion body myositis

Question 6

An 18 year old girl presents with Neisseria meningitidis bacteraemia. On further investigation, she has had recurrent similar episodes of meningitis for 10 years.

Which is the most important diagnosis to exclude?

A. Chronic granulomatous disease
B. Common variable immunodeficiency
C. Hyper IgE
D. IgA deficiency
E. Membrane attack complex deficiency

Answer 6

E. Membrane attack complex deficiency

Question 7

If MHC class 1 expression is downregulated by a virus, which of the following cells will be unable to act?

A. CD19 lymphocytes
B. CD4+ T cells
C. CD8+ T cells
D. Dendritic cells
E. NK cells

Answer 7

C. CD8+ T cells

Question 8

Which of the following antibodies is related with ILD and scleroderma

A. Anti smith
B. Anti-topoisomerase I
C. Anti RNA polymerase III
D. Anti centromere
E. Ds-DNA

Answer 8

B. Anti-topoisomerase I

A. Anti-Smith: Specific for systemic lupus erythematosus (SLE), not scleroderma or ILD.
C. Anti-RNA polymerase III: Associated with diffuse cutaneous systemic sclerosis, especially with renal crisis, but less linked to ILD.
D. Anti-centromere: Associated with limited cutaneous systemic sclerosis (CREST syndrome), often without significant ILD.
E. Ds-DNA: Specific for SLE, not scleroderma or ILD.

Question 9

Which cell is most involved in acute sarcoidosis?

A. Lymphocytes
B. Macrophages
C. Neutrophils
D. Eosinophils

Answer 9

A. Lymphocytes

Question 10

What is the marker for peripheral blood stem cells?
A. CD 19
B. CD 20
C. CD 34
D. CD 38

Answer 10

C. CD 34

note CD38 on lymphocytes

Question 11

Question 64
Patients with delayed hypersensitivity reaction to mammalian meat and IgE to galactose-alpha-1,3-galactose (alpha-gal) are most likely to have sensitivity to:

A. Inhaled cat epithelium
B. Uncooked mammalian meat
C. Tick bite
D. Working on a dairy farm

Answer 11

C. Tick bite

Patients with delayed hypersensitivity reactions to mammalian meat and IgE to galactose-alpha-1,3-galactose (alpha-gal) are most likely to have sensitivity due to tick bites, specifically from the lone star tick (Amblyomma americanum). This condition is known as alpha-gal syndrome.

Question 12

A patient has the following hepatitis B serology: HBsAg negative, HBsAb positive, HBcAb positive (i.e. past infection). Which medication is has the highest risk of reactivation?

A. Rituximab
B. Tocilizumab
C. Prednisolone
D. Infliximab

Answer 12

A. Rituximab

Question 13

What is the mechanism of action of ocrelizumab in the treatment of multiple sclerosis?

A. Alpha4beta1 integrin antagonist
B. Inhibits CD20
C. Sphigosine-1-phosphate receptor modulator
D. Lysing CD52 monoclonal antibody

Answer 13

B. Inhibits CD20

Question 14

72. Beta 2 microglobulin is a key compoment of which immunological cell?
    A) B cell
    B) T cell
    C) MHC I
    D) MHC II

Answer 14

C) MHC I

Question 15

79. Problem with V(D)J cause deficiency in which lymphocyte?
    A) B cell
    B) B cell, T cell
    C) B cell, NK, T cell
    D) T Cell

Answer 15

B) B cell, T cell

V(D)J recombination (variable–diversity–joining rearrangement) is the mechanism of somatic recombination that occurs only in developing lymphocytes during the early stages of T and B cell maturation.
This can cause SCID

Question 16

81. Type B nerve fibres are small and myelinated. What are they responsible for?

A) Pain and Temperature afferent
B) Position and vibration afferent
C) Infrafusal muscle afferent
D) Autonomic afferent

Answer 16

D) Autonomic afferent

Question 17

There are 11 hallmarks of cancer as described by Hanahan and Weinberg in 2000. What feature do checkpoint inhibitors target?

Answer 17

A) Avoidance of immune destruction

Question 18

What are the types of amyloidosis

Answer 18

AL amyloidosis: deposition of protein derived from immunoglobulin light chain fragments. Potential complication of plasma cell dyscrasia that produces monoclonal immunoglobulin
- Renal involvement

Transthyretin amyloidosis (ATTR): due to either heritable mutations such as familial amyloid polyneuropathy (FAP), and/or familial amyloid cardiomyopathy, or non-familial form
- Rarely affects the kidneys

AA amyloidosis: commonly in chronic diseases such as RA, spondylarthritis or IBD. Doesn’t affect the heart

Question 19

12. What form of cardiac amyloid has the worst prognosis if left untreated
    A) AL amyloid
    B) Transthyretin
    C) AA amyloid

Answer 19

A) AL amyloid

Question 20

14. What is the vaccination regime for pneumococcus in a patient with a splenectomy?
    A) Conjugate vaccine and repeat conjugate vaccine in 8 weeks
    B) Conjugate vaccine first and polysaccharide vaccine in 8 weeks
    C) Polysaccharide vaccine and repeat polysaccharide vaccine in 8 weeks
    D) Polysaccharide vaccine first and conjugate vaccine 8 weeks after

Answer 20

B) Conjugate vaccine first and polysaccharide vaccine in 8 weeks

Conjugate vaccine (PCV13) first, then Polysaccharide vaccine (PPSV23) is given later (8 weeks after the conjugate vaccine)

Question 21

23. Recurrent pancreatitis. Enlarged lacrimal glands. Retroperitoneal lymph node enlargement with dilated bile ducts on imaging. A biopsy of lacrimal glands that shows storiform fibrosis.
    A) Sarcoidosis
    B) IgG4 disease
    C) Lymphoma
    D) Sjogren’s Syndrome

Answer 21

B) IgG4 disease

Question 22

Patient with chronic bony pain. Splenomegaly on examination. Knee x-ray showing an Erlenmeyer flask deformity (radiological finding given in stem). Marrow aspirate slide shown with an arrow labelling the “Abnormal cell”

A) Fabry’s Disease
B) Glycogen Storage Disorder
C) Gaucher’s Disease
D) Haemophagocytic lymphohistiocytosis

Answer 22

C) Gaucher’s Disease

Question 23

30. What cytokine is most implicated in the pathogenesis of auto-inflammatory conditions such as familial mediterranean fever?
    A) IL-1
    B) TNF-a
    C) IL-7
    D) IFN-Gamma

Answer 23

A) IL-1
remember, affects thermostat

Question 24

42. Of the proportion of of HLA B-27 positive people in the general population, what percentage have ankylosing spondylitis?
    A) 5%
    B) 25%
    C) 50%
    D) 90%

Answer 24

A) 5%

Question 25

2021

Q8. Chimeric antigen receptor engineered cells are useful in treating some patients with haematological
malignancies. Which of the following is the main effector cell in this therapy?

A. B cells
B. Dendritic cells
C. NK cells
D. T cells

Answer 25

D. T cells

Question 26

2021

Q15. A 34 year old man is newly diagnosed with HIV. His CD4 count is 726 and his viral load is >80000. He is HBV
and HCV negative, and asymptomatic and otherwise well. When is the most appropriate time to start treatment?
A. Now
B. CD4 <200
C. CD4 <500
D. CD4 <500 and viral load >100,000

Answer 26

A. Now

Question 27

2021

Q20. A 45-year-old female who previously developed a rash after taking amoxicillin at the age of 5 years now has
streptococcal pneumonia. She has tolerated cephalosporins and roxithromycin previously without any reaction.
There is no family history of penicillin allergy.
Which of the following is the best indication to de-label her as having true penicillin allergy?
A. Age at which the reaction occurred
B. Tolerance to cephalosporins
C. Tolerance to roxithromycin
D. No family history of penicillin allergy

Answer 27

Double check!

B. Tolerance to cephalosporins

if true allergy then AMX and AMP share same/similar R1 side chain as cephalexin and cefaclor (this is the reason for cross-reactivity with cephalosporins)

Question 28

Q97/Q98 EMQ – Match the following side effects to immunosuppressive medications from the list of options:
A. Anti-thymocyte globulin
B. Tacrolimus
C. Cyclosporin
D. Sirolimus
E. Mycophenolate mofetil
F. Basiliximab
G. (Rhubarb)
H. (Rhubarb)
Q97. Which of the listed immunosuppressive medications cause chronic diarrhoea?

Answer 28

q97. D. Sirolimus

The manufacturer reports that 25% to 42% of people taking sirolimus experience diarrhea. The likelihood of diarrhea increases with higher doses

Question 29

Q8. Chimeric antigen receptor engineered cells are useful in treating some patients with haematological
malignancies. Which of the following is the main effector cell in this therapy?
A. B cells
B. Dendritic cells
C. NK cells
D. T cells

Answer 29

D. T cells