IMMUNOLOGY FINAL EXAM
Tufts University School of Medicine
– 40 questionsA child with a mutation of the TAP-1 protein is likely to show:
A) Inability to make immunoglobulin
B) Abnormal expression of the CD4 molecule
C) Defective cytotoxicity by CD8+ cells
D) Defective IL-1 and TNF production
E) Defective production of the T-cell alpha-beta receptor
2. Superantigens:
A) Bind to the groove of MHC Class I molecules
B) Bind to the variable portion of the T-cell receptor
C) Bind to the outside of the B-cell receptor
D) Bind to the CD8 molecule on T-cells
E) Bind to CD3 on the surface of T-cells
3. Which statement concerning dendritic cells is incorrect:
A) They express receptors for IFN-gamma
B) They express both Class I and Class II MHC molecules on their surface
C) They produce IL-1 when activated
D) They express B7 (CD80) molecules on their surface
E) They produce IL-2 when activated
4. A mouse is injected with a polysaccharide from an E. coli organism. This is a thymus-independent antigen. After 6 weeks the blood of the animal will show:
A) IgG and IgM antibodies specific for the antigen
B) IgA antibodies specific for the antigen
C) Almost exclusively IgM antibodies specific for the antigen
D) No antibodies specific for that antigen
E) IgE antibodies specific for the antigen
5. A 1-year old male child is being evaluated for recurrent skin infection. His past medical history is also significant for delayed separation of the umbilical cord that occurred 16 weeks after birth. Which one of the following is most likely under-expressed or defective in this patient:
A) A late complement component
B) A gamma-globulin
C) Superoxide anion
D) A leukocyte adhesion molecule
E) An opsonin
CHOOSE THE ONE BEST ANSWER (Continued)
6. A medical student from Texas is stung by a fire ant and within 10 minutes develops difficulty in breathing and a drop in blood pressure (shock). He is treated with epinephrine and recovers. Subsequently hyposensitization therapy is initiated in an attempt to:
A) Increase IgE levels
B) Activate TH1 cells
C) Increase IL-4 levels
D) Decrease IgG levels
E) Activate TH2 cells
7. A 25-year-old woman develops vaginal candidiasis following a course of antibiotics for acne. A small dose of candida extract is injected into the skin of her arm and a red, raised wheal develops at the site in 48 hours. Which one of the following statements is correct:
A) B cell immunodeficiency should be excluded
B) This reaction indicates that the patient has normal cell-mediated immunity
C) IgE antibodies to candida are likely to be increased
D) The patient should have a chest x-ray to exclude tuberculosis
E) Biopsy of this lesion is likely to show immune complexes and complement deposition
8. A speleologist (person who explores caves) is attacked and bitten by a bat. Fearing that the animal may be rabid his physician injects him with a dose of horse anti-rabies serum. Within 10 minutes he complains of generalized itching, and urticarial wheals (hives) appear on his skin. The most likely cause of this is:
A) Circulating immune complex deposition
B) IgE-mediated allergic reaction
C) Direct effect of bat saliva on mast cells
D) A type II cytotoxic reaction
E) An Arthus reaction
9. A 52-year-old woman develops a dry scaly, itchy scalp which is thought to be due to a reaction against p-phenyl diamine found in the material she uses to color her hair. To make a definitive diagnosis we could:
A) Place a patch containing the chemical onto her skin
B) Inject a small quantity of the chemical intradermally and look for a wheal in 5 minutes
C) Send blood for specific IgE measurement
D) Do a tuberculin test by injecting PPD into the skin
E) Count the number of CD4+ cells in her blood
CHOOSE THE ONE BEST ANSWER (Continued)
10. A 20-year-old immigrant gives birth to a healthy child at home without medical help. The infant’s father cuts the umbilical cord with a kitchen knife. One week later the child develops symptoms of tetanus presumably as a result of using the contaminated knife. The child’s condition could most likely have been prevented by which of the following:
A) Infant vaccinated at the time of birth
B) Maternal vaccination during pregnancy
C) Antibiotics to the mother at the time of delivery
D) Breast feeding the infant
E) Paternal vaccination during the mother’s pregnancy
11. Which one of the following is found both on the surface of cells and free in the serum:
A) The alpha-beta T-cell receptor
B) C1-Inhibitor (C1 -INH)
C) Immunoglobulin
D) C3
E) CD3
12. A young girl consumes some undercooked meat, which is contaminated with an unusual strain of Salmonella. The bacterium expresses mannose on its surface and it is rapidly destroyed by factors in the patient’s serum. Which one of the following plays no role in this process:
A) MASP-1
B) Factor B
C) C3b
D) Mannan-binding ligand
E) C1q
13. This child has never previously been exposed to Salmonella but she does have Salmonella-specific B cells. Which one of the following immunoglobulin isotypes is or are expressed on the surface of these specific B cells?
A) IgA
B) IgG
C) IgE
D) IgM and IgD
E) None of the above
CHOOSE THE ONE BEST ANSWER (Continued)
14. Which one of the following is the correct statement concerning the T cell receptor (TCR) and the B cell receptor (BCR):
A) Both are associated with CD3
B) Both are MHC restricted
C) Both exhibit diversity generated by somatic hypermutation
D) Both exhibit diversity generated by imprecise joining of gene segments
E) Both have one antigen binding site
15. A patient who breeds canaries and parakeets complains of breathlessness and a diagnosis of bird-fancier’s disease is made. Which one of the following statements is incorrect:
A) This is an example of an Arthus reaction
B) The blood may contain T-cells which are specifically sensitized to avian antigens
C) The blood may contain IgG antibodies to avian antigens
D) Biopsy of the area will show the presence of degranulated mast cells with IgE antibodies on their surface
E) The area will be infiltrated by T-cells, macrophages and neutrophils
16. Which one of the following is not considered part of the innate immune system:
A) Pattern recognition receptors
B) Alternative complement pathway
C) NK cells
D) Interferon-?
E) The alpha-beta T-cell receptor
17. Which one of the following statements concerning cytokines is incorrect:
A) IL-6 inhibits dendritic cell activity
B) IL-12 activates TH1 cells
C) IFN-gamma activates macrophages
D) IL-1 activates liver cells to release acute phase proteins
E) TNF increases adhesion molecules on endothelial cells
CHOOSE THE ONE BEST ANSWER (Continued)
18. Normally immune responses to antigens diminish over time. Which one of the following statements dealing with this decline in response is incorrect:
A) IL-10 produced by macrophages is immunosuppressive
B) Activated T-cells produce Fas ligand ultimately resulting in apoptosis of the same and other T-cells
C) TGF-beta produced by many cells inhibit lymphocyte function
D) Activation of CTLA-4 by B7 delivers an inhibitory signal to T cells
E) IL-1 inhibits T-cell responses late in an immune response
19. Which statement concerning immunological tolerance is correct?
A) Positive selection in the thymus results in the development of tolerance to self-antigens
B) Preventing the interaction of B7 with CD28 may result in tolerance
C) The maintenance of tolerance depends on the elimination of the antigen
D) Defective production of IL-2 may result in immunological tolerance
E) Tolerance to one initial antigen may result in tolerance to a variety of antigens
20. A medical student is treated with antibiotics for a prostate infection. A week later he complains of joint pain and a skin rash and a biopsy of the skin shows vasculitis and neutrophil infiltrates in the small arterioles. Which one of the following findings is most likely to accompany this patient’s condition:
A) Raised serum IgE
B) Decreased C3 level in the blood
C) Low serum IgA level
D) A negative skin test to Candida and other antigens
E) Absent C1-inhibitor
21. Which one of the following does not directly involve the Fc portion of an IgG antibody?
A) Opsonization
B) Virus neutralization
C) Complement activation
D) Crossing the placental barrier
E) ADCC (antibody dependent cellular cytotoxicity)
CHOOSE THE ONE BEST ANSWER (Continued)
22. Complement activity is finely controlled by various proteins. Which one of the following is not an inhibitor of complement activity:
A) Factor I
B) C1-INH
C) Factor H
D) CR1 (C3b receptor)
E) C1q
23. An animal that has the gene for CTLA-4 “knocked out” is likely to develop:
A) Severe combined immunodeficiency (SCID)
B) An increased number of T-regulatory (Treg) cells
C) Type I hypersensitivity
D) Tolerance to a skin graft
E) Autoimmune disease
24. Patients with Di George syndrome will have:
A) Decreased numbers of surface IgM and IgD positive B-cells
B) Normal serum IgE levels
C) Normal serum IgG levels after immunization with a foreign antigen
D) Normal ability to produce acute phase proteins such as CRP
E) Normal IL-2 production
25. Which one of the following statements concerning Goodpasture’s disease is correct?
A) It is due to specific IgE antibodies
B) It is due to circulating immune complexes
C) It is due to T-cells attacking glomerular basement membranes
D) It is due to antibodies binding to basement membranes in the lung and kidney
E) A kidney biopsy will show immune complexes deposited in the vessel walls
26. Which one of the following is not found on the surface of an activated T-cell:
A) CD40
B) CD3
C) IL2 receptor
D) Class I MHC molecules
E) CTLA-4
CHOOSE THE ONE BEST ANSWER (Continued)
27. The germinal center of a lymph node is most likely to contain cells undergoing which one of the following processes:
A) VDJ recombination
B) VJ recombination
C) Isotype switching
D) Negative selection of immature T-cells
E) Development of central tolerance
28. Which one of the following is a feature of both class I and class II MHC molecules?
A) They are both involved in the presentation of peptide fragments to T cells
B) They both may be made of either alpha beta or gamma delta chains
C) They are both found on the surface of normal glomerular basement membranes
D) When synthesized they both associate with CD74 inside the endoplasmic reticulum
E) They both present peptides that have been degraded by proteasomes
29. Flow cytometry of a fetal thymus shows a population of cells that are positive for both CD4 and CD8 – i.e., they are CD4+CD8+. These cells are best characterized as which of the following:
A) Immature cortical T-lymphocytes
B) Mature cytotoxic T-lymphocytes
C) Mature helper T-lymphocytes
D) Natural killer cells
E) Thymic epithelial cells
30. During the process of T-lymphocyte maturation in fetal life, T-cell receptors of many developing lymphocytes demonstrate a very high affinity interaction with MHC molecules expressed on thymic stromal cells. These lymphocytes are most likely to undergo: BAD QUESTION. STUDENTS GAVE BOTH B and D
A) Isotype switching
B) Positive selection
C) T-cell receptor DNA rearrangement
D) Negative selection
E) Affinity maturation
CHOOSE THE ONE BEST ANSWER (Continued)
31. Gram negative bacteria isolated from the blood of a young woman, produce a protease that splits the IgA molecule at the hinge region. Which one of the following is the most likely biological consequence of the action of this enzyme:
A) Impaired opsonization and phagocytosis
B) Enhanced survival of intracellular organisms
C) Impaired complement mediated lysis
D) Enhanced mucosal penetration of organisms
E) Impaired secondary immune response generation
32. A 34-year-old man experiences low-grade fever and decreased urine output 8 days after kidney transplantation. Graft biopsy shows dense infiltration by lymphoid cells and monocytes. Which one of the following is the most likely cause of this patient’s current condition:
A) Preformed antibodies against graft MHC proteins
B) Host B-cells sensitized against graft MHC proteins
C) Host T-cells sensitized against graft MHC proteins
D) Graft B-cells sensitized against host MHC proteins
E) Graft T-cells sensitized against host MHC proteins
33. A 9-month-old boy has fungal sinusitis. He has had 3 previous episodes of bacterial pneumonia and blood tests show a very low serum immunoglobulin level and no CD3+ cells. Which one of the following is the most likely diagnosis: BAD QUESTION MOST STUDENTS GAVE A. A FEW GAVE THE CORRECT ANSWER B
A) Di George syndrome
B) Mutation of the IL-2 receptor
C) X-linked agammaglobulinemia
D) Common variable immunodeficiency
E) Wiskott-Aldridge syndrome
34. A medical student is exposed to a patient with active tuberculosis. 2-years later the student has no symptoms but on a routine chest X-ray a small calcified old tuberculosis lesion is seen in his lung. Which one of the following contributed most to the containment of the infection: BAD QUESTION. MOST STUDENTS GAVE A NOT B
A) CD8+ T-lymphocytes and NK cells
B) CD4+ T-lymphocytes and macrophages
C) B-cells and macrophages
D) CD4+ T-lymphocytes and polymorphonuclear leukocytes
E) CD8+ T-lymphocytes and B-lymphocytes
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