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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 autoantibodies for systemic sclerosis?
Anti topoisomerase
Soluble C3 spontaneously hydrolyzes spontaneously to C3b and opsonizes microbial and host cell surfaces and accumulates on surfaces; C3b activates C5 convertase which leads to MAC activation
Negative!
acute phase reactants

2. What is the thymus ? Where is it located? is it encapsulated? How many lobes does it have?
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
Type III hypersensitivity where an internal antigen antibody complexes activate classical complement pathway resulting in C3a neutrophilic chemotaxis and neutrophilic lysosomal death. SLE
The place of T cell diff and maturation; ant mediastinum above heart; yes; 2
Since it is a comp dependent type II hypersensitivity reaction; C3a brings anaphylotoxins that bring in mediators of shock

3. What is the pathology seen in chronic transplant rejection?
IL 3; supports growth and differentiation of bone marrow stem cells
Antihistone
Fibrosis of blood vessels and graft tissue from ischemia; obliterative vascular fibrosis with intimal thickening
Lack of MHC class I constant region which it binds or a nonspecific activation signal (TLR)

4. What are the T cell functions?
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
Activate B cells - activate Macrophages - kill viruses directly - delayed cell mediated hypersensitivity - acute and chronic rejection
2 heavy chains and two light chains
neutrophilia!

5. What are four results of a splenectomy?
isotype
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
Induces fever - chemokine secretion to recruit - activates adhesion molecules; macrophages
1) susceptibility to encapsulated organisms 2) Howell Jolly Bodies 3) Target cells 4) Thrombocytosis

6. What type of side chains are found on Fc region of an antibody?
Carbohydrate
Lack of MHC class I constant region which it binds or a nonspecific activation signal (TLR)
Immunosuppression after kidney transplantation in combination with cyclosporine and corticosteroids
Anti Ach receptor

7. What is ataxia telangectasia? What is it caused by? What is the triad of presentation? and its labs?
MHC II - B7 - CD40 and CD14; CD40 and D14 for FcG and C3b resp
Recom IL 11; thrombocytopenia
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
A B and T cell disorder; defect in DNA repair enzymes; ataxia - telangactasia and IgA def; igA def. and increased AFP

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

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9. What type of cells do NK cells attack? with What tools? by necrosis or apoptosis?
MHC II - B7
Tumor cells and virally infected cells; perforin pore to secrete granzymes through it; apoptosis
encapsulated
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

10. Complements are...
IgE
acute phase reactants
IL 4
Viral neutralization of igM and IgG!

11. Which antibodies can be multimeric?
CD21 on B cells (although there is T cell lymphocytosis in EBV)
isotype
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
IgM and IgA

12. What is the main cytokine released by T cells? What does it do
In the germinal center of secondary follicles (In the paler center)
IL 3; supports growth and differentiation of bone marrow stem cells
Daclizumab; prevent ACUTE rejection of renal transplant
IgG and IgM bind to pathogens activating C1 convertase and leads to C2 and C4 and then C3 convertase activated

13. other than eat and bite RBCs what else do Macrophages of spleen do>
Histamine; post capillary venules - vasodilation
Both decrease cd8 tcell prolif but one through mtor and the other through calcineurin (resp)
Remove encapsulated bacateria
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

14. What is the pathogenesis of a hypersensitivity reaction?
2 heavy chains and two light chains
Anti U1 RNP (ribonucleoprotein)
First a B cell gets sensitized to an allergen - after sensitization - it gets induce by Th2 secreting IL4 to class switch from IgM to IgE - next time blood stream is exposed to allergen these antigens cross like IgEs on mast cells and result in chemi
Recurrent infections to every type of antigen; bone marrow transplant (be weary of GVH disease!)

15. Which is the most abundant antibody in blood?
...
IgG
Its involved in inflammation and results in anaphylaxis and neutrophil chemotaxis.
Antiviral by inducing ribonuclease which degrades only viral mRNA (prevents protein synthesis) and activates NK cells to kill virus infected cells

16. T/F B cells do not require a second signal
Basophils! THey want IG E class switch!
From self; from identical twin or clone; from nonidentical individual of same species; from different species; fetus; pig valve
False! B cell class switching requires a second signal
IgA

17. How does complement link innate and adaptive?
Anti U1 RNP (ribonucleoprotein)
Adaptive uses classic pathway to kill; innate uses alternative pathway to kill
By transcytosis
Edema and necrosis in that region

18. What is the monoclonal antibody to IL2 on activated T cells? What is it used for?
Daclizumab; prevent ACUTE rejection of renal transplant
Cross link
P - ANCA (antimyeloperoxidase); in neutrophil; p= perinuclear
Edema and necrosis in that region

19. Which diseases are associated with DR5?
except hyperacute
MHC II/CD4 and B7 (on APC) and CD28 (on Th cell); releases cytokines to kill those extracellular buggers!
Pernicious Anemia and Hashimotos
IL 4 -5 -6 for B cell class switching - IL 10 to inhibit TH1

20. Only the _______ contribute to the Fc region
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
heavy chains
IgG
IgM and IgA

21. What cytokines to Th2 secrete?
An antigen encounter (presented by APC for Th2) with Th2 will result in it to go to the cortical section and help with B cell activation; Cytotoxic T cell will enter vasculature/efferent lymph to go kill; B cell will wait for Th2 for activation and t
Defect in CD40L results in inability to class switch; a lot of IgM and no IgG - A - E
IL 4
IL 4 - 5 - 10 - 6

22. describe the pathogenesis of delayed type IV hypersensitivity
Pernicious Anemia and Hashimotos
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
T cells react to the angtigen and activate leukocyted (macrophage acitivation)
Adaptive uses classic pathway to kill; innate uses alternative pathway to kill

23. What type of fenestrations are found in the red pulp of the spleen?
Cytokine IL 10 secreted by Th2
Barrel hoop basement membrane fenestrations
Defect in CD40L results in inability to class switch; a lot of IgM and no IgG - A - E
First a B cell gets sensitized to an allergen - after sensitization - it gets induce by Th2 secreting IL4 to class switch from IgM to IgE - next time blood stream is exposed to allergen these antigens cross like IgEs on mast cells and result in chemi

24. What lymph node drains the rectum (above the pectinate line)?
acute phase reactants
Internal iliac
Para aortic
Cross link antigens which increases their phagocytability; activate complement for MAC attack; opsonization; neutralization

25. What is the clinical use of Muromonab?
neutrophilia!
Immunosuppression after kidney transplantation
Para aortic
lowest concentration

26. What are the three types of Type III hypersensitivity ? What is the common mechanism between them?
No because no peptide fragment!
Immune complex - Arthus reaction and Serum sickness; they are all a result of antibody- antigen complex deposition resulting in complement activation
The place of T cell diff and maturation; ant mediastinum above heart; yes; 2
P - ANCA (antimyeloperoxidase); in neutrophil; p= perinuclear

27. All transplant rejections - _____________ are mediated by Type IV hypersensitivity
except hyperacute
not Ab mediated
Activates cytotoxic CD 8 T cells as second signal
Superficial inguinal

28. What is the late phase reaction of anaphylaxis allergy? what mediates it?
Th cells fail to produce interferon gamma; a lot of IgE
AR; defect in MT function results in decreased transport and phagocytosis; recurrent pyogenic infections by staphylococci and streptococci - partial albinism - and peripheral neuropathy
active complement pathway
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)

29. What is the symptoms involved in graft versus host disease? it What transplant cases does it usually occur? give an example
SP infections
Celiac
Maculopapular rash (palm - soles - back - neck) - jaundice with bile duct necrosis - hepatosplenomegaly - diarrhea; bone marrow and liver transplants (rich with lymphocytes); SCID patient receiving whole blood transfusion
Liver! (they are proteins circulating in the blood)

30. Name three things that IL 1 does as a cytokine. other than the liver - who secretes IL 1
MHC I/CD8 and IL2/IL 2 Receptor (IL 2 is from Th1!); cytoxicity!
Opsonization (Brutons agammaglobulinemia) - adhesion (Leukocyte adhesion defect) - phagocytosis (chediak higashi syndrome) - respiratory burst (chronic granulomatous disease)
Induces fever - chemokine secretion to recruit - activates adhesion molecules; macrophages
IgM

31. what characterizes an arthus reaction?
By transcytosis
Edema and necrosis in that region
MS
MS - hay fever - SLE - goodpastures

32. What is the defect in Brutons agammaglobulinemia? What is its effect on B cells? What is its inheritance pattern?
TLR ad nuclear receptors
Anti mitochondrial
except hyperacute
Defect in BTK a tyrosine kinase gene; failed maturation of B cells; X linked recessive

33. 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)?
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
Psoriasis - Ankylosis Spondylitis - IBD - Reiters; all seronegative spondylopathies
Viral neutralization of igM and IgG!
Activates Macrophages and Th1 cells; suppresses Th2 cells; antiviral and antitumor

34. What are the main Cell surface proteins on T cells?
TCR - CD4/8 - CD28 (binds B7) - CD3 (for intracellular transduction) - CD40L
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
Daclizumab; prevent ACUTE rejection of renal transplant
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

35. The Fc region is found on the...
carboxy terminal
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
Decreased Th1 response; disseminated mycobacterial infections; decreased interferon gamma
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

36. 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)
IgM
Its involved in inflammation and results in anaphylaxis and neutrophil chemotaxis.
DM type I and RA

37. What are superantigens? give two examples.
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
opsonizes
S. aureus - E. Coli - aspergillus
IgG

38. What does IgA pick up from epithelial cells before being secreted?
T
A j chain
MHC I; from RER with help of the B2 microglobulin
Secretory component

39. What is the pathogenesis of chronic transplant rejection? When does it occur? is it reversible?
Periarteriolar lymphatic sheath in the white pulp that surround that dead end of the capillaries in the red pulp - contain T cells
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 :(
carboxy terminal
Superficial inguinal

40. What is the main function of IL 12? other than macrophages who else can release IL 12?
Induce differentiation of T cells into Th1 helper cells and activates NK cells also; B cells
When you select for which MHC it will have; take out the lymphs that self react
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
Both decrease cd8 tcell prolif but one through mtor and the other through calcineurin (resp)

41. which interleukin receptor is required for NK development? activation?
Hemochromatosis
opsonizes
IL 15; IL 12 - interferon Beta and interferon alpha
Antidote for digoxin intoxication

42. where are complements produced?
Liver! (they are proteins circulating in the blood)
Superficial inguinal
Cyclosporine and tacrolimus; sirolimus (as well as hyperlipidemia)
IgA

43. What is the toxicity of azathioprine?
All MHC 1/CD8
Scratch test - histamine mediated wheal; radioimmunosorbent assay (detects specific IgEs in serum)
S. aureus - E. Coli - aspergillus
...

44. How is sirolimus different from tacrolimus?
Activate macrophages
Both decrease cd8 tcell prolif but one through mtor and the other through calcineurin (resp)
C - ANCA (antiproteinase); in neutrophil; c= cytoplasmic
Some microbial surfaces (only) have mannan binding lectin which activates a protease that cleaves C2 and C4 which combine to make C3. the rest follows the alternative pathway

45. Which disease is associated with DR7?
Steroid responsive nephrotic syndrome
pentamer
Immune complex - Arthus reaction and Serum sickness; they are all a result of antibody- antigen complex deposition resulting in complement activation
Tetanus - Botulinum - HBV - Rabies

46. which cells have more complete tolerance - B or T cells?
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
Barrel hoop basement membrane fenestrations
T
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

47. For which toxins are preformed antibodies (passive) given?
Its a serine protease that activates apoptosis; NK and CD8
Monoclonal Ab to CD3- blocks cellular transduction and signaling of T cells
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
Tetanus - Botulinum - HBV - Rabies

48. What are the cell surface proteins for Macrophages? which two are for opsonins?
Fibrosis of blood vessels and graft tissue from ischemia; obliterative vascular fibrosis with intimal thickening
Periarteriolar lymphatic sheath in the white pulp that surround that dead end of the capillaries in the red pulp - contain T cells
MHC II - B7 - CD40 and CD14; CD40 and D14 for FcG and C3b resp
Superficial inguinal

49. where do NK cells develop?
Activates Macrophages and Th1 cells; suppresses Th2 cells; antiviral and antitumor
TLR ad nuclear receptors
Its a serine protease that activates apoptosis; NK and CD8
Not thymus - BM

50. What is the white pulp of the spleen?
IgG
Surrounds the red pulp and begins with PALS and then turns into follicles with B cells/follicles
Recurrent infections to every type of antigen; bone marrow transplant (be weary of GVH disease!)
Cytokine IL 10 secreted by Th2

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USMLE Step 1 Immunology

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