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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 are the cell surface proteins on NK cells?
Th1; interferon gamma; IL 2 for cytotoxic T cell activation
Vasculitis of graft vessels with dense interstitial lymphocytic infiltrate; yes! with immunosuppressants
TGF beta and IL 10
MHC I - CD16 - CD56

2. Describe the interstitial tissue of a spleen including the sinuses. What type of cells are found in the four structures (cortex - paracortex - medulla and sinuses)?
Suppresses immune response (also specifically Th1 cells) and activates Th2; regulatory T cells
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
Cross link
Alternative splicing of mRNA

3. What are the function of B cells?
Make antibody - allergy type 1 (igE) - Cytotoxic and immunecomplex hypersensitivity type II and III (igG); hyperacute organ rejection is Ab mediated
IgE
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
The igA found in breast milk

4. where are complements produced?
Liver! (they are proteins circulating in the blood)
Negative selection
Ig - CD19 - CD20 - CD21 - CD40 - MHC II - B7
Graves

5. What are the mediators that mast cells release?
Histamine (causes vasodilation) - leukotrienes (causes bronchoconstriction) - chemotaxins for eos - and heparin (increased blood flow needs to be anticoagulated!)
RNA segment reassortment
Its involved in inflammation and results in anaphylaxis and neutrophil chemotaxis.
Wiskott Aldrich syndrome

6. What are the autoantibodies for polymyositis and dermatomyositis?
Anti nuclear Antibodies (ANA); Anti dsDNA - anti Smith
Not thymus - BM
Anti Jo -1
MHC I; from RER with help of the B2 microglobulin

7. what cell surface marker is used for NK cells as it is unique to them?
IL 1 and IL 6
Graves
pentamer
CD56

8. Describe complement dependent Type II hypersensitivity. Give an example.
Anti mitochondrial
Complement activation (active in both)
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
IgA; sinus and lung infections from lack of secretory defense - milk allergies and diarrhea from giardiasis; Anaphylasix on exposure to blood products with igA

9. explain the process from beginning (ie phagocytosis of the peptide) to end of how Abs are formed in Goodpasteurs.
For some reason a mature naive B lymphocyte got away from tolerance and the result was a production an Ab on its surface with an Fab region that recognized the alpha 3 collagen subunit on the BM as non self. It then gets activated by a Th2 cell (enti
IgG and IgM bind to pathogens activating C1 convertase and leads to C2 and C4 and then C3 convertase activated
Lack of MHC class I constant region which it binds or a nonspecific activation signal (TLR)
T cell dysfunction

10. What type of fenestrations are found in the red pulp of the spleen?
IgG
Cyclosporine - OKT3
Sinusitis - otitis media - pneumonia
Barrel hoop basement membrane fenestrations

11. What is immune complex disease? give an example.
For some reason a mature naive B lymphocyte got away from tolerance and the result was a production an Ab on its surface with an Fab region that recognized the alpha 3 collagen subunit on the BM as non self. It then gets activated by a Th2 cell (enti
Para aortic
lowest concentration
Type III hypersensitivity where an internal antigen antibody complexes activate classical complement pathway resulting in C3a neutrophilic chemotaxis and neutrophilic lysosomal death. SLE

12. What is the pathology of acute transplant rejection? is it reversible?
Vasculitis of graft vessels with dense interstitial lymphocytic infiltrate; yes! with immunosuppressants
Into cortex and medulla; cortex is where immature T lymphocytes enter - at the corticomedullar junction is where positive and negative selection occur; and at the medulla is where the mature T lymphs - reticulin cells and hassalls corpuscles are (dea
Periarteriolar lymphatic sheath in the white pulp that surround that dead end of the capillaries in the red pulp - contain T cells
It is a localized type III hypersensitivity reaction to an external antigen; localized instead of systemic; ?; intradermal injection of the antigen results in antibody production and antigen antibody complexes deposit in the skin

13. What is the defect in hyper IgM syndrome? What are the lab results?
IgE
Defect in CD40L results in inability to class switch; a lot of IgM and no IgG - A - E
HBV - HBC - Kaposis - leukemias - malignant melanoma - hairy cell leukemia and condyluma accuminata
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

14. What is the common variable immunodeficiency ? How is it different from Brutons?
Defect in B cell maturation; idiopathic - presents at older age and normal number of B cells and hyperplastic germinal centers because B cells can be activated but can not produce Abs
MHC II/CD4 and B7 (on APC) and CD28 (on Th cell); releases cytokines to kill those extracellular buggers!
Antihistone
SP infections

15. Describe the capsular structure of a lymph node; What are the functions of the LN?
Carbohydrate
Capsule of lymph node is made up of type III collagen (made by reticulin fibers!) - extension of this collagen extends into the splenic tissue as trabeculae; nonspecific filtration of lymph by Macrophages - Antibody production (via activation) - stor
Recomb cytokine of GCSF (granulocyte macrophage colony stimulating factor; for recovery of bone marrow
Type II hypersensitivity - complement dependent resulting in phagocytosis of RBCs coated with C3b by fixed macrophages in the spleen; Group O mother has anti A - B - IgG Abs that cross placenta and attach to fetal blood group A or B RBCs

16. What are the autoantibodies for pernicious anemia?
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
Anti IF
Anti topoisomerase
IgG

17. Which diseases are associated with DR2?
MS - hay fever - SLE - goodpastures
Nuclear remnants that are usually taken out of RBC before complete maturation by Macrophages
Proteins; IgG - IgM - endotoxin (microbial surfaces in general - nonspecific ones also) - mannose binding Lectin; classic - alternative - MB pathway (resp)
In any situation where immunologically competent cells are transplanted into immunologically crippled recipient; graft rejects all the cells due to foreign proteins resulting in severe organ dysfunction

18. What is the clinical use for sirolimus? what should you combine it with?
Mediates septic shock; activates the endothelium for adhesion and dilation and leukocyte recruitment results in vascular leak
Immunosuppression after kidney transplantation in combination with cyclosporine and corticosteroids
Salmonella - 2 flagellar variants; Borrelia (relapsing fever); and Neisseria gonorrhoaea - pilus protein
MHC class molecules bind to KIRS or CD94 to prevent killing

19. What happens in a deficiency of C3?
False! B cell class switching requires a second signal
Cytokine release syndrome due to initial release from initial binding (fever etc) and hypersensitivity reaction
Severe recurrent pyogenic sinus and resp tract And increased susceptibility to type III hypersensitivity like SLE
S. aureus - E. Coli - aspergillus

20. The lymphocytes are ________ origin
Severe pyogenic infections early in life
Its a serine protease that activates apoptosis; NK and CD8
mesenchymal
C3b; coating of a pathogen with molecules that promotes phagocytosis; IgG and CRP

21. DTH (delayed type hypersensitivity) is the ________ of a PPD reaction
heavy chains
An anaphylactic immediate reaction; atopy refers to the inherited propensity to develop asthmatic or allergic reactions
pathogenesis
Increases expression of MHC I and MHC II and also activates NK cells

22. What is the presentation of hyperIgM syndrome?
Severe pyogenic infections early in life
Antimicrobial also secreted by CD8 and NK cells that induces apoptsosis
opsonizes
mesenchymal

23. What is Aldesleukin? What is it used for
Histamine; post capillary venules - vasodilation
Superficial inguinal
The patient could become cyanotic in the OR!
A recomb cytokine of IL 2; RCC and metastatic melanoma

24. The alternative pathway is the only constutively...
Antimicrobial also secreted by CD8 and NK cells that induces apoptsosis
Th2; Th1
active complement pathway
DM type I

25. Monomer in circulation - ___ when secreted
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
dimer
Cell mediated due to T cell cytotoxicity reacting to foreign MHCs; few weeks after
Its main effect is a defect in Ab opsonization for killing

26. What is the main cytokine released by T cells? What does it do
IL 3; supports growth and differentiation of bone marrow stem cells
MS
...
Alternative splicing of mRNA

27. How do you test for chronic granulomatous disease?
Fibrosis of blood vessels and graft tissue from ischemia; obliterative vascular fibrosis with intimal thickening
Digeorge syndrome - 22q11 deletion resulting in failure to develop 3rd and 4th pharyngeal pouches; cardiac and great vessel congenital defects - tetany from hypocalcemia - recurrent viral/fungal infections from T cell deficiency; hypoPTH - hypoCa - a
The place of T cell diff and maturation; ant mediastinum above heart; yes; 2
Negative nitroblue tetrazolium reduction test

28. What are the autoantibodies for wegeners granulomatosis?
C - ANCA (antiproteinase); in neutrophil; c= cytoplasmic
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
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
Since cant cross placenta most likely means that child was forced early to produce due to an infection (most likely CMV)

29. which cytokine inhibits TH2 cells? secreted by who?
Interferon gamma; Th1
Pernicious Anemia and Hashimotos
Activates Macrophages and Th1 cells; suppresses Th2 cells; antiviral and antitumor
Yes

30. What is chronic mucocutaneous candidiasis d/t?
pathogenesis
Recom IL 11; thrombocytopenia
T cell dysfunction
Immunosuppression after kidney transplantation in combination with cyclosporine and corticosteroids

31. What part of the complement system also acts as an opsonin? What is opsonization? can you Name two other opsonins?
Paracortex; viral infection
Secretory component
C3b; coating of a pathogen with molecules that promotes phagocytosis; IgG and CRP
In the germinal center of secondary follicles (In the paler center)

32. Which is the main antibody in the delayed or secondary response to an antigen?
Anti alpha subunit 3 of collagen on type IV bm
Type III hypersensitivity where an exogenous antigen results in a systemic antigen antibody complex disease (takes around 5 days after exposure for the Abs to develop); immune complexes then fix in tissue and activate complement resulting in tissue d
For some reason a mature naive B lymphocyte got away from tolerance and the result was a production an Ab on its surface with an Fab region that recognized the alpha 3 collagen subunit on the BM as non self. It then gets activated by a Th2 cell (enti
IgG

33. What do mature naive B lymphocytes express?
An alpha chain and a B2 microglobulin; on all nucleated cells; TCR and CD8; intracellular antigens
Active; passive - fast but short half life (3 weeks!)
IgM and IgD
Anticentromere; anti Scl -70 (anti DNA topoisomerase I)

34. What are the two signals required for B cell class switching? Which is the second signal?
Pernicious Anemia and Hashimotos
CD40 (on b cell) CD40 ligand on Th2 cell; and interleukins (4 -5 -6) from Th2 cell; CD40 is actually the second signal
C5a
IgG

35. Which TCR MHC system is important for viral immunity? neoplastic? donor graft cells?
All MHC 1/CD8
In any situation where immunologically competent cells are transplanted into immunologically crippled recipient; graft rejects all the cells due to foreign proteins resulting in severe organ dysfunction
IL 5
Antidote for digoxin intoxication

36. What is a type I hypersensitivity reaction? What is atopic?
Anticentromere; anti Scl -70 (anti DNA topoisomerase I)
An anaphylactic immediate reaction; atopy refers to the inherited propensity to develop asthmatic or allergic reactions
DM type I
...

37. Which antibodies can be multimeric?
Chronic granulomatous disease
...
IgM and IgA
IgG

38. can igG cross the placenta?
Daclizumab; prevent ACUTE rejection of renal transplant
Cell mediated due to T cell cytotoxicity reacting to foreign MHCs; few weeks after
Yes
An alpha chain and a B2 microglobulin; on all nucleated cells; TCR and CD8; intracellular antigens

39. what bacteria are a splenectomy patient most susceptible to? why?
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
Vasculitis of graft vessels with dense interstitial lymphocytic infiltrate; yes! with immunosuppressants
Anti TSh receptor
Activates Th1 helper cells; Macrophages

40. T/F B cells do not require a second signal
IL 15; IL 12 - interferon Beta and interferon alpha
False! B cell class switching requires a second signal
Anti IF
DM type I

41. What are the three types of Type III hypersensitivity ? What is the common mechanism between them?
Activate B cells - activate Macrophages - kill viruses directly - delayed cell mediated hypersensitivity - acute and chronic rejection
Immune complex - Arthus reaction and Serum sickness; they are all a result of antibody- antigen complex deposition resulting in complement activation
S. aureus - E. Coli - aspergillus
Patient has had previous exposure to blood products which result in presence of preformed anti HLA cytotoxic Abs

42. What are the sinusoids of the spleen? What is the difference between a spleen and a lymph node?
Tetanus - Botulinum - HBV - Rabies
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
Aut. Dominant; C1 esterase inhibitor deficiency resulting in continued C1 which results in increased C2 and C4 cleavage products which have anaphyltoxic activity and result in swelling of face and oropharynx
cannot cross placenta

43. What can cause a lymph node enlargement?
Humoral
Local infection/inflammation; infection of the ln itself; metastasis
Recurrent infections to every type of antigen; bone marrow transplant (be weary of GVH disease!)
T cell activation; no with CD 4 or CD 8

44. What are the autoantibodies for primary biliary cirrhosis?
Cyclosporine and tacrolimus; sirolimus (as well as hyperlipidemia)
Carbohydrate
Negative!
Anti mitochondrial

45. Other than stimulating fever - what else does IL 6 do?
Normal pro B (CD 19 +) - no mature B cells results in decreased total B cell level - and decreased amount of immunoglobulins in each class
By transcytosis
Opsonization (Brutons agammaglobulinemia) - adhesion (Leukocyte adhesion defect) - phagocytosis (chediak higashi syndrome) - respiratory burst (chronic granulomatous disease)
Stimulate the liver to release acute phase reactants

46. What links the adaptive and innate immunity?
CD40 (on b cell) CD40 ligand on Th2 cell; and interleukins (4 -5 -6) from Th2 cell; CD40 is actually the second signal
Antimicrobial also secreted by CD8 and NK cells that induces apoptsosis
IgM and IgG
Complement activation (active in both)

47. What is the monoclonal antibody to IL2 on activated T cells? What is it used for?
Daclizumab; prevent ACUTE rejection of renal transplant
Histamine; post capillary venules - vasodilation
TCR - CD4/8 - CD28 (binds B7) - CD3 (for intracellular transduction) - CD40L
Ischemia and necrosis of graft due to occlusion of vessels and fibrinoid necrosis and thrombosis within the vessels

48. How is sirolimus different from tacrolimus?
Immunosuppression after kidney transplantation in combination with cyclosporine and corticosteroids
Sinusitis - otitis media - pneumonia
Antimicrobial also secreted by CD8 and NK cells that induces apoptsosis
Both decrease cd8 tcell prolif but one through mtor and the other through calcineurin (resp)

49. What is the mode of inheritance of Chediak Higashi syndrome? What is the disease d/t? What does it result in? What is the presentation?
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
AR; defect in MT function results in decreased transport and phagocytosis; recurrent pyogenic infections by staphylococci and streptococci - partial albinism - and peripheral neuropathy
acute phase reactants
Give a vaccine with a peptide comp from it that the cell mediated immunity otherwise cant get to! like h.influenzae vaccine. then class switching and memory response can occur

50. Which helper T cells' development is induced by IL 4? IL 12?
Th2; Th1
Paracortex; viral infection
Activates Macrophages and Th1 cells; suppresses Th2 cells; antiviral and antitumor
Daclizumab; prevent ACUTE rejection of renal transplant

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USMLE Step 1 Immunology

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