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USMLE Step 1 Immunology

Subjects : health-sciences, usmle-step-1

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Answer 50 questions in 15 minutes.
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1. What is muromonab - CD3 (OKT3)
opsonizes
Stimulate the liver to release acute phase reactants
Monoclonal Ab to CD3- blocks cellular transduction and signaling of T cells
RNA segment reassortment

2. What is the marginal zone of the spleen? what happens there?
The place of T cell diff and maturation; ant mediastinum above heart; yes; 2
Found in the red pulp; contains the cords of billroth or the splenic parenchyma that have APCs/Macrophages that closely interact with the basement membrane of the vasculature and where RBCs squeeze through into the parenchyma and interact with Macrop
MHC II - B7 - CD40 and CD14; CD40 and D14 for FcG and C3b resp
Defect in LFA 1 integrin (CD 18) protein on phagocytes (neutrophils!); recurrent bacterial infections - severe gingivitis - poor wound healing - absent pus formation - and delayed separation of the umbilicus; neutrophilia

3. Only the _______ contribute to the Fc region
1) susceptibility to encapsulated organisms 2) Howell Jolly Bodies 3) Target cells 4) Thrombocytosis
heavy chains
Severe recurrent pyogenic sinus and resp tract And increased susceptibility to type III hypersensitivity like SLE
IgE

4. Which is the main antibody that provides passive immunity to infants?
Antidesmoglein
If there is class switching and plasma cell production (that is when memory cells are produced)
Delayed type hypersensitivity
IgG

5. What are the autoantibodies for Mixed connective tissue disease?
Thrombocytopenia
Anti U1 RNP (ribonucleoprotein)
The red pulp of the spleen its where the vasculature channels go through and interact with the parenchyma of the spleen (has macrophages) which empty in the sinuses; they are both encapsulated (with trabeculae) secondary lymphoid organs that trap ant
Binds to Mtor which (like tacrolimus and cyclosporine just in a different pathway) inhibits IL 2 production and thus t cell proliferation in response to IL 2 producton

6. ________ regulate the cell mediated response.
RNA segment reassortment
IgM and IgG
Recomb cytokine of GCSF (granulocyte macrophage colony stimulating factor; for recovery of bone marrow
Humoral

7. What is the pathogenesis of acute transplant rejection? When does it occur?
Cell mediated due to T cell cytotoxicity reacting to foreign MHCs; few weeks after
encapsulated
Psoriasis - Ankylosis Spondylitis - IBD - Reiters; all seronegative spondylopathies
Recomb cytokine of GCSF (granulocyte macrophage colony stimulating factor; for recovery of bone marrow

8. What is the difference of IgE AIHA and IgG AIHA if they are both complement dependent type II hypersensitivities?
Trypanosomes with programmed rearrangement (results in recurring fever -- sleeping sickness!)
T cells react to the angtigen and activate leukocyted (macrophage acitivation)
NK cells
In IgE AIHA- it results in MAC attack (remember IgE is not an opsonin!) - in IgG AIHA C3b (and IgG) opsonization results in phagocytosis by fixed macrophages in the spleen

9. How do you test for type III hypersensitivity?
Th cells fail to produce interferon gamma; a lot of IgE
Immunoflourescent staining of tissue biopsies
Graves
Superficial inguinal

10. which antibodies can bind complement?
MS
IL 3; supports growth and differentiation of bone marrow stem cells
IgM and IgG
Anti smooth muscle

11. What is chronic mucocutaneous candidiasis d/t?
Ig - CD19 - CD20 - CD21 - CD40 - MHC II - B7
T cell dysfunction
NK cells
Sinusitis - otitis media - pneumonia

12. What are the cell surface proteins on NK cells?
MHC I - CD16 - CD56
Antigliadin - antiendomysial (both are IgAs - anti tissue transgluataminase igA)
1) VJ light chain random creation 2) VDJ (heavy chain) random creation 3) random combination of light with heavy 4) somatic hypermutation (high frequency mutating that occurs on activation) 5) terminal deoxynucleotidyl transferase (TDT) random additi
Defect in LFA 1 integrin (CD 18) protein on phagocytes (neutrophils!); recurrent bacterial infections - severe gingivitis - poor wound healing - absent pus formation - and delayed separation of the umbilicus; neutrophilia

13. What are the autoantibodies for systemic sclerosis?
Anti topoisomerase
IgM and IgD
Antiviral for uninfected cells (for future protection) and kills virally infected cells (NK activation)
Tumor cells and virally infected cells; perforin pore to secrete granzymes through it; apoptosis

14. What lymph node drains the anal canal (below the pectinate line)?
Superficial inguinal
Recurrent infections to every type of antigen; bone marrow transplant (be weary of GVH disease!)
Intracellular pathogens (acute and chronic viruses and virally induced cancers)
Negative!

15. can igG cross the placenta?
Can be acquired in 20s -30s; increased risk of autoimmune disease - lymphoma - Sp infections; normal number of B cells and no plasma cells and immunoglobulin
IgM and IgD
Yes
Internal iliac

16. What does interferon gamma do? What two type of cells does it attack mostly?
Pernicious Anemia and Hashimotos
Graves
Antibody mediated cytotoxicity; either complement dependent or complement independent
Activates Macrophages and Th1 cells; suppresses Th2 cells; antiviral and antitumor

17. What is recomb gamma interferon used for?
Since it is a comp dependent type II hypersensitivity reaction; C3a brings anaphylotoxins that bring in mediators of shock
Cells that stil have weird parts of their membrane that macrophages usually bite off
SP infections
Chronic granulomatous disease

18. All transplant rejections - _____________ are mediated by Type IV hypersensitivity
All MHC 1/CD8
Type IV
except hyperacute
Vasculitis of graft vessels with dense interstitial lymphocytic infiltrate; yes! with immunosuppressants

19. What does granulysin do?
Antimicrosomal and antithyroglobulin
IgM and IgG
Antimicrobial also secreted by CD8 and NK cells that induces apoptsosis
An acidified endosome with the antigen fuses with the MHC which causes the release of the invariant chain Which is sitting in spot of antigen and stabilizing the MHC II

20. What is the end result of complement activation? what bugs are this important for? through what pathway and why?
T cell precursor
When you select for which MHC it will have; take out the lymphs that self react
MAC (membrane attack complex) Which is activated by C5b - C9 and results in lysis and cytoxicity by creating pores in the target membrane; encapsulated organisms (S. pnuemonia - H.influenzae - B perfussis for example) and other organisms with non pep
Carbohydrate

21. what else does interferon gamma do other than inducing ribonuclease production - activating NK cells - inducing increased MHC expression?
Activate macrophages
active complement pathway
Acts as second signal on B cells to induce class switching to IgE and IgG
MS - hay fever - SLE - goodpastures

22. What is the main function of TNF alpha? How does it do this?
C5a
Mediates septic shock; activates the endothelium for adhesion and dilation and leukocyte recruitment results in vascular leak
The place of T cell diff and maturation; ant mediastinum above heart; yes; 2
Severe recurrent pyogenic sinus and resp tract And increased susceptibility to type III hypersensitivity like SLE

23. where do NK cells develop?
...
Not thymus - BM
C - ANCA (antiproteinase); in neutrophil; c= cytoplasmic
Inferior mesenteric

24. What type of side chains are found on Fc region of an antibody?
Psoriasis - Ankylosis Spondylitis - IBD - Reiters; all seronegative spondylopathies
IgA; sinus and lung infections from lack of secretory defense - milk allergies and diarrhea from giardiasis; Anaphylasix on exposure to blood products with igA
Fab portion
Carbohydrate

25. What happens in a deficiency of C3?
Thrombocytopenia
Severe recurrent pyogenic sinus and resp tract And increased susceptibility to type III hypersensitivity like SLE
An acidified endosome with the antigen fuses with the MHC which causes the release of the invariant chain Which is sitting in spot of antigen and stabilizing the MHC II
IgG

26. which interleukin receptor is required for NK development? activation?
Adaptive uses classic pathway to kill; innate uses alternative pathway to kill
Mediates septic shock; activates the endothelium for adhesion and dilation and leukocyte recruitment results in vascular leak
Activates cytotoxic CD 8 T cells as second signal
IL 15; IL 12 - interferon Beta and interferon alpha

27. Other than stimulating fever - what else does IL 6 do?
IgM or IgG antibodies coat the antigen and result in activation of MAC complex via the classical pathway OR fixed macrophages in the spleen phagoctyose the opsonized (C3b or igG) antigens - ex penicillin reaction; IgM AIHA - anti B IgMs in a group A
Salmonella - 2 flagellar variants; Borrelia (relapsing fever); and Neisseria gonorrhoaea - pilus protein
Stimulate the liver to release acute phase reactants
Remove encapsulated bacateria

28. What links the adaptive and innate immunity?
Anemias (esp due to renal failure)
Its a serine protease that activates apoptosis; NK and CD8
active complement pathway
Complement activation (active in both)

29. which of the IL2 inhibitors produce nephrotoxicity? thrombocytopenia/leukopenia?
MHC class molecules bind to KIRS or CD94 to prevent killing
Cyclosporine and tacrolimus; sirolimus (as well as hyperlipidemia)
A recomb cytokine of IL 2; RCC and metastatic melanoma
Anti viral and anti tumor

30. is IgM an opsonizer?
IL 4 -5 -6 for B cell class switching - IL 10 to inhibit TH1
Opsonization (Brutons agammaglobulinemia) - adhesion (Leukocyte adhesion defect) - phagocytosis (chediak higashi syndrome) - respiratory burst (chronic granulomatous disease)
Fab portion
Negative!

31. What are target cells?
Antihistone
MHC class molecules bind to KIRS or CD94 to prevent killing
Cells that stil have weird parts of their membrane that macrophages usually bite off
Ischemia and necrosis of graft due to occlusion of vessels and fibrinoid necrosis and thrombosis within the vessels

32. What is the toxicity of azathioprine?
Severe pyogenic infections early in life
...
Fc
Para aortic

33. What does interferon gamma do to be antiviral?
Activate B cells - activate Macrophages - kill viruses directly - delayed cell mediated hypersensitivity - acute and chronic rejection
A B and T cell disorder; X linked recessive; progressive deletion of B and T cells; thrombocytopenic purpura - infections - eczema; high IgE and IgA but low IgM
Increases expression of MHC I and MHC II and also activates NK cells
isotype

34. What do macrophages secrete that activate Th1 cells to secrete interferon gamma?
1) susceptibility to encapsulated organisms 2) Howell Jolly Bodies 3) Target cells 4) Thrombocytosis
TNF alpha and IL1
Th1; interferon gamma; IL 2 for cytotoxic T cell activation
Vasculitis of graft vessels with dense interstitial lymphocytic infiltrate; yes! with immunosuppressants

35. What is oprelevkin? and What is it used for?
Recom IL 11; thrombocytopenia
Brain - eyes - placenta/fetus - testicles; because they can have an antigen in there and not get attacked by immune system because dont have contact with immune system via blood and lymph; if an infection occurs such that trauma results in exposure t
Sinusitis - otitis media - pneumonia
Increases expression of MHC I and MHC II and also activates NK cells

36. What does CD16 on NK cells do?
N. meningitidis - H. influenzae - S. pneumonia - Salmonella d/t lack of C3b opsonization for MAC d/t lack of complement activation d/t lack of IgM; MAC is needed by encapsulated avoid by humoral and cell mediated through their capsule
Bind FcG for antibody dependent cellular cytotoxicity
CD40 (on b cell) CD40 ligand on Th2 cell; and interleukins (4 -5 -6) from Th2 cell; CD40 is actually the second signal
The interstitial tissue of a lymph node is structured into the cortex on the outside Which is densely cellular which transitions into the paracortex Which is less dense and then the medulla Which is least dense. The cells that inhabit these tissues a

37. which cells have more complete tolerance - B or T cells?
Basophils! THey want IG E class switch!
T
Fibrosis of blood vessels and graft tissue from ischemia; obliterative vascular fibrosis with intimal thickening
TLR ad nuclear receptors

38. What does granzyme do? who secretes it?
Induce differentiation of T cells into Th1 helper cells and activates NK cells also; B cells
Recomb cytokine of GCSF (granulocyte macrophage colony stimulating factor; for recovery of bone marrow
type four
Its a serine protease that activates apoptosis; NK and CD8

39. Describe complement dependent Type II hypersensitivity. Give an example.
Stimulate the liver to release acute phase reactants
IgM or IgG antibodies coat the antigen and result in activation of MAC complex via the classical pathway OR fixed macrophages in the spleen phagoctyose the opsonized (C3b or igG) antigens - ex penicillin reaction; IgM AIHA - anti B IgMs in a group A
A j chain
If there is class switching and plasma cell production (that is when memory cells are produced)

40. Which type of selection of thymic development provides central tolerance?
Antigliadin - antiendomysial (both are IgAs - anti tissue transgluataminase igA)
Para aortic
Negative selection
Monoclonal Ab to CD3- blocks cellular transduction and signaling of T cells

41. describe the classic complement pathway.
The interstitial tissue of a lymph node is structured into the cortex on the outside Which is densely cellular which transitions into the paracortex Which is less dense and then the medulla Which is least dense. The cells that inhabit these tissues a
Tumor cells and virally infected cells; perforin pore to secrete granzymes through it; apoptosis
C5a
IgG and IgM bind to pathogens activating C1 convertase and leads to C2 and C4 and then C3 convertase activated

42. What is the clinical use for azathioprine?
Hours later (instead of minutes); instead of release of preformed mediators - mast cells synthesize PGs and LTs that mediate the late phase reaction (edema - inflammation - decreased airflow)
When you select for which MHC it will have; take out the lymphs that self react
...
Thrombocytopenia

43. What are the autoantibodies for sjorgens syndrome?
Adenosine deaminase deficiency (AR) - defective IL 2 receptor (X linked) - and failure to synthesize MHC II; both humoral and cell mediated deficiency
IgG and IgM bind to pathogens activating C1 convertase and leads to C2 and C4 and then C3 convertase activated
Anti SS- A (anti RO) and Anti SS- B
T cell dysfunction

44. What are complements in the complement system? What activates them? there seems to be different ones - What are these pathways called?
Proteins; IgG - IgM - endotoxin (microbial surfaces in general - nonspecific ones also) - mannose binding Lectin; classic - alternative - MB pathway (resp)
CROSS LINK Beta region on TCR of CD4 cells to the MHC class II on APCs this results in uncoordinated release of Interferon gamma from CD4 Th1 cells and subsequent release of IL1 - IL6 and TNF alpha from Macrophages --> toxic shock syndrome; s. pyogen
Septicemia with neisseria; because at least you have C3 to act like a neutrophilic chemotactic and an acute phase reactant
Antihistone

45. Which are the only two antiinflammatory cytokines?
TGF beta and IL 10
Fc
dimer
Trypanosomes with programmed rearrangement (results in recurring fever -- sleeping sickness!)

46. How do endotoxin/LPS of gram negative bacteria stimulate the immune system if they do not have a peptide fragment?
Popliteal
delayed!
MHC II - B7 - CD40 and CD14; CD40 and D14 for FcG and C3b resp
They directly stimulate Macrophages by binding CD14; also the alternative complement pathway binds to these host surfaces and induces MAC complex; also TLRs exist for endotoxins; also IgM though not an opsonin can act as a pentamer and trap the antig

47. Name two endogenous pyrogens
IL 1 and IL 6
IL 4
A chemotactic factor for neutrophils
Macrophages - Dendritic cells - B cells

48. What are the T cell functions?
Activate B cells - activate Macrophages - kill viruses directly - delayed cell mediated hypersensitivity - acute and chronic rejection
Secretory component
When you select for which MHC it will have; take out the lymphs that self react
Kill them because they have CD16 on them that recognize the FcG portion

49. The Fc region is found on the...
Suppresses immune response (also specifically Th1 cells) and activates Th2; regulatory T cells
Nuclear remnants that are usually taken out of RBC before complete maturation by Macrophages
carboxy terminal
Cyclosporine - OKT3

50. what happens in a deficiency of C1 esterase inhibitor? DAF?
The antibodies (igM or IgG) either neutralize the target directly (cytoxic!) or recruit leukocytes (Neutrophils and Macrophages!) to incite tissue damage
active complement pathway
Defect in CD40L results in inability to class switch; a lot of IgM and no IgG - A - E
Hereditary angioedema; PNH

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USMLE Step 1 Immunology

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