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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 passive immunity?
Local infection/inflammation; infection of the ln itself; metastasis
The igA found in breast milk
Receiving preformed Antibodies
Recurrent sinopulmonary bacterial infections after 6 months (d/t mothers igGs transplacental) due to opsonization defect

2. Which MHC presents intracellular peptides? how so?
Viral neutralization of igM and IgG!
MHC I; from RER with help of the B2 microglobulin
Anti Jo -1
Para aortic

3. What is the defect in Brutons agammaglobulinemia? What is its effect on B cells? What is its inheritance pattern?
Superficial inguinal
Defect in BTK a tyrosine kinase gene; failed maturation of B cells; X linked recessive
Antimicrobial also secreted by CD8 and NK cells that induces apoptsosis
Proteins; IgG - IgM - endotoxin (microbial surfaces in general - nonspecific ones also) - mannose binding Lectin; classic - alternative - MB pathway (resp)

4. What are the main Cell surface proteins on T cells?
NK cells
Sinusitis - otitis media - pneumonia
Anti topoisomerase
TCR - CD4/8 - CD28 (binds B7) - CD3 (for intracellular transduction) - CD40L

5. What is the main function of IL 8?
IL 4 -5 -6 for B cell class switching - IL 10 to inhibit TH1
Anti IF
Antigliadin - antiendomysial (both are IgAs - anti tissue transgluataminase igA)
A chemotactic factor for neutrophils

6. What is the general structure of an Ab?
Anti SS- A (anti RO) and Anti SS- B
2 heavy chains and two light chains
Tumor cells and virally infected cells; perforin pore to secrete granzymes through it; apoptosis
This means that MHC can not recognize it and thus will not be phagocytosed. The humoral response rescues - IgM is the primary response attack. Since there is no class switching (without MHC activation no CD40 L and interleukins to activate!) then the

7. 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)?
Th cells fail to produce interferon gamma; a lot of IgE
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
SP infections
Anti mitochondrial

8. What is the presentation of hyperIgM syndrome?
Induce differentiation of T cells into Th1 helper cells and activates NK cells also; B cells
Activates Th1 helper cells; Macrophages
By transcytosis
Severe pyogenic infections early in life

9. Which disease is associated with B8?
Humoral
Graves
Opsonize bacteria (for enhanced phagocytosis) - neutralize viruses (igG) - activate complement (igM and igG) - sensitize mast cells (igE)
T cell and antibody mediated vascular damage due to MHC non self being recognized as self by self lymphocytes and resulting in attack of the foreign antigens it presents (all of them); months to years after; no :(

10. Leukocyte adhesion defect presents with...
neutrophilia!
Fibrosis of blood vessels and graft tissue from ischemia; obliterative vascular fibrosis with intimal thickening
...
Salmonella - 2 flagellar variants; Borrelia (relapsing fever); and Neisseria gonorrhoaea - pilus protein

11. What is the arthus reaction? What is the difference between arthus and serum sickness? give an example. How do you test for it?
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
CD56
pentamer
Decreased Th1 response; disseminated mycobacterial infections; decreased interferon gamma

12. Which disease is associated withB B27?
Its involved in inflammation and results in anaphylaxis and neutrophil chemotaxis.
Psoriasis - Ankylosis Spondylitis - IBD - Reiters; all seronegative spondylopathies
Anti smooth muscle
Its main effect is a defect in Ab opsonization for killing

13. Which HLA's are included in MHC I? MHC II?

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14. explain the process from beginning (ie phagocytosis of the peptide) to end of how Abs are formed in Goodpasteurs.
IL 1 and IL 6
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
DAF and C1 esterase inhibitor on cells prevent complement activation on their surfaces (microbial surfaces lack this)
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

15. What lymph node drains the stomach?
Paracortex; viral infection
Lack of MHC class I constant region which it binds or a nonspecific activation signal (TLR)
The igA found in breast milk
Celiac

16. What are four results of a splenectomy?
Coarse Faces - cold (noninflamed d/t inability to attract neutrophils) staph abscesses - retained primary teeth - high igE - dermatologic problems (eczema)
Negative!
Cross link
1) susceptibility to encapsulated organisms 2) Howell Jolly Bodies 3) Target cells 4) Thrombocytosis

17. Which diseases are associated with DR2?
MS - hay fever - SLE - goodpastures
Axillary
By transcytosis
Activates cytotoxic CD 8 T cells as second signal

18. What are the PALS?
Hereditary angioedema; PNH
Graves
Periarteriolar lymphatic sheath in the white pulp that surround that dead end of the capillaries in the red pulp - contain T cells
IgA; sinus and lung infections from lack of secretory defense - milk allergies and diarrhea from giardiasis; Anaphylasix on exposure to blood products with igA

19. What links the adaptive and innate immunity?
Scratch test - histamine mediated wheal; radioimmunosorbent assay (detects specific IgEs in serum)
Nuclear remnants that are usually taken out of RBC before complete maturation by Macrophages
Complement activation (active in both)
Histamine (causes vasodilation) - leukotrienes (causes bronchoconstriction) - chemotaxins for eos - and heparin (increased blood flow needs to be anticoagulated!)

20. What lymph node drains the testes?
Activates cytotoxic CD 8 T cells as second signal
Recurrent sinopulmonary bacterial infections after 6 months (d/t mothers igGs transplacental) due to opsonization defect
IgM and IgD
Para aortic

21. What is the receptor for EBV? On what cells is that located?
CD21 on B cells (although there is T cell lymphocytosis in EBV)
DAF and C1 esterase inhibitor on cells prevent complement activation on their surfaces (microbial surfaces lack this)
except hyperacute
IgM and IgG

22. The idiotype; the Fc portion determines the...
Patient has had previous exposure to blood products which result in presence of preformed anti HLA cytotoxic Abs
MS - hay fever - SLE - goodpastures
Steroid responsive nephrotic syndrome
isotype

23. Give three examples of bacteria that use antigenic variation and how.
Salmonella - 2 flagellar variants; Borrelia (relapsing fever); and Neisseria gonorrhoaea - pilus protein
Daclizumab; prevent ACUTE rejection of renal transplant
T cell precursor
This means that MHC can not recognize it and thus will not be phagocytosed. The humoral response rescues - IgM is the primary response attack. Since there is no class switching (without MHC activation no CD40 L and interleukins to activate!) then the

24. What is wiskott aldrich syndrome? What is its mode of inheritance? What is the pathogenesis of disease? What is its triad of presentation? what labs does it present with?
...
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
Legionella - N. gonorrhea - L. monocytogenes - viruses - protozoa (leismaniasis)
Hereditary angioedema; PNH

25. What do mature naive B lymphocytes express?
All MHC 1/CD8
lowest concentration
Steroid responsive nephrotic syndrome
IgM and IgD

26. What is the antimetabolite precursor of 6 mercaptopurine? What is the result?
Leukocyte adhesion defect; ataxia telangietasia; ataxia telangiectasia; chediak higashi syndrome; IgA def; Digeorge syndrome; Jobs; Chediak Higashi
Proteins; IgG - IgM - endotoxin (microbial surfaces in general - nonspecific ones also) - mannose binding Lectin; classic - alternative - MB pathway (resp)
...
Fab portion

27. Give an example of someone who could get hyperacute transplant rejection.
Previous transfusion; pregnant woman whose fetus had paternal antigens
IgG
Para aortic
Bind FcG for antibody dependent cellular cytotoxicity

28. What is the monoclonal antibody to IL2 on activated T cells? What is it used for?
Increases expression of MHC I and MHC II and also activates NK cells
Delayed type hypersensitivity
Daclizumab; prevent ACUTE rejection of renal transplant
No! That is why they are different from T cells - they can recognize antigens in free solution; if a bug has a peptide fragment that a mature naive B cell recognizes it will bind to it and cause activation - it then gets activated into a plasma cell!

29. give an example of how influenza does a major antigenic shift.
Normal pro B (CD 19 +) - no mature B cells results in decreased total B cell level - and decreased amount of immunoglobulins in each class
RNA segment reassortment
Wiskott Aldrich syndrome
Bind FcG for antibody dependent cellular cytotoxicity

30. Which is the most abundant antibody in blood?
TCR - CD4/8 - CD28 (binds B7) - CD3 (for intracellular transduction) - CD40L
IgM and IgA
RNA segment reassortment
IgG

31. What are the T cell functions?
Activate B cells - activate Macrophages - kill viruses directly - delayed cell mediated hypersensitivity - acute and chronic rejection
CRP - C3b - IgM
Severe recurrent pyogenic sinus and resp tract And increased susceptibility to type III hypersensitivity like SLE
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

32. What type of cells do NK cells attack? with What tools? by necrosis or apoptosis?
Tumor cells and virally infected cells; perforin pore to secrete granzymes through it; apoptosis
Mycobacterium Tuberculosis - Mycobacterium Avium Intracellulare; Toxoplasmosis Gondii
The patient could become cyanotic in the OR!
neutrophilia!

33. What is recomb beta interferon used for?
MS
Interferon gamma and IL 2
T cell dysfunction
Fc

34. What amine is the main chemical mediator released by mast cells? Where does it act What does it result in?
Recom IL 11; thrombocytopenia
Since it is a comp dependent type II hypersensitivity reaction; C3a brings anaphylotoxins that bring in mediators of shock
Active; passive - fast but short half life (3 weeks!)
Histamine; post capillary venules - vasodilation

35. Other than stimulating fever - what else does IL 6 do?
Stimulate the liver to release acute phase reactants
Not thymus - BM
CD21 on B cells (although there is T cell lymphocytosis in EBV)
secondary

36. What does granulysin do?
An alpha and beta chain; only on APCs; TCR and CD4; extracellular (phagocytosed by APCs)
Antimicrobial also secreted by CD8 and NK cells that induces apoptsosis
IgG
C - ANCA (antiproteinase); in neutrophil; c= cytoplasmic

37. So antibodies are the effectors for the humoral response. List some of their functions.
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
Paracortex
Cross link antigens which increases their phagocytability; activate complement for MAC attack; opsonization; neutralization
Cyclosporine and tacrolimus; sirolimus (as well as hyperlipidemia)

38. Which are the only two antiinflammatory cytokines?
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
IgE; by activating eosinophils
TGF beta and IL 10
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

39. other than eat and bite RBCs what else do Macrophages of spleen do>
The igA found in breast milk
CD40 (on b cell) CD40 ligand on Th2 cell; and interleukins (4 -5 -6) from Th2 cell; CD40 is actually the second signal
Remove encapsulated bacateria
TGF beta and IL 10

40. which interleukin receptor is required for NK development? activation?
IL 15; IL 12 - interferon Beta and interferon alpha
IgE
MHC II/CD4 and B7 (on APC) and CD28 (on Th cell); releases cytokines to kill those extracellular buggers!
Th2; Th1

41. __________ are a part of the innate system.
Para aortic
Antiviral by inducing ribonuclease which degrades only viral mRNA (prevents protein synthesis) and activates NK cells to kill virus infected cells
Antidesmoglein
NK cells

42. What is hereditary angioedema? What are the C3 levels?
Liver! (they are proteins circulating in the blood)
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
Ig - CD19 - CD20 - CD21 - CD40 - MHC II - B7
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

43. what results in symptoms of shock in an acute hemolytic transfusion reaction?
Negative nitroblue tetrazolium reduction test
Since it is a comp dependent type II hypersensitivity reaction; C3a brings anaphylotoxins that bring in mediators of shock
TGF beta and IL 10
isotype

44. give an example of a virus that uses antigenic variation. What does a major variation result in? minor?
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
Viral neutralization of igM and IgG!
pentamer
Influenza; antigenic shift; antigenic drift

45. What is muromonab - CD3 (OKT3)
Influenza; antigenic shift; antigenic drift
Monoclonal Ab to CD3- blocks cellular transduction and signaling of T cells
DM type I
CD40 (on b cell) CD40 ligand on Th2 cell; and interleukins (4 -5 -6) from Th2 cell; CD40 is actually the second signal

46. which of the transplant rejections is antibody mediated? why does it occur?
Hyperacute; presence of preformed antibodies in the recipient ( to blood groups or HLA )
Steroid responsive nephrotic syndrome
Induces fever - chemokine secretion to recruit - activates adhesion molecules; macrophages
Carbohydrate

47. What are C1 - C2 - C3 - C4 important for?
Paracortex
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
Mycobacterium Tuberculosis - Mycobacterium Avium Intracellulare; Toxoplasmosis Gondii
Viral neutralization of igM and IgG!

48. hat is the presentation of Jobs syndrome or Hyper IgE?
pale central germinal centers
Intracellular pathogens (acute and chronic viruses and virally induced cancers)
Coarse Faces - cold (noninflamed d/t inability to attract neutrophils) staph abscesses - retained primary teeth - high igE - dermatologic problems (eczema)
Sinusitis - otitis media - pneumonia

49. What is MHC I made out of? Where is it found? What does it bind to? What type of antigens does it present?
An alpha chain and a B2 microglobulin; on all nucleated cells; TCR and CD8; intracellular antigens
IL 4 - 5 - 10 - 6
MHC II - B7
Vasculitis of graft vessels with dense interstitial lymphocytic infiltrate; yes! with immunosuppressants

50. What is the clinical use for azathioprine?
...
Cells that stil have weird parts of their membrane that macrophages usually bite off
Influenza; antigenic shift; antigenic drift
Antibody mediated cytotoxicity; either complement dependent or complement independent

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USMLE Step 1 Immunology

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