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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 happens in a secondary follicle?
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
Adaptive uses classic pathway to kill; innate uses alternative pathway to kill
IgM and IgG
Isotype switching (activated by Th2 cell signals and cytokines) - somatic hypermutation

2. What are the autoantibodies for primary biliary cirrhosis?
Acts as second signal on B cells to induce class switching to IgE and IgG
Superficial inguinal
Patient has had previous exposure to blood products which result in presence of preformed anti HLA cytotoxic Abs
Anti mitochondrial

3. where are complements produced?
Popliteal
Liver! (they are proteins circulating in the blood)
pale central germinal centers
...

4. In thymic development - What is the positive selection? negative selections?
T cell dysfunction
Paracortex; viral infection
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
When you select for which MHC it will have; take out the lymphs that self react

5. What is recomb alpha interferon used for?
HBV - HBC - Kaposis - leukemias - malignant melanoma - hairy cell leukemia and condyluma accuminata
Its involved in inflammation and results in anaphylaxis and neutrophil chemotaxis.
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
From self; from identical twin or clone; from nonidentical individual of same species; from different species; fetus; pig valve

6. To what portion of the Antibody do the complements bind?
Fc
Anti IF
When you select for which MHC it will have; take out the lymphs that self react
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

7. what secretes IL 4?
Basophils! THey want IG E class switch!
Popliteal
MHC II - B7 - CD40 and CD14; CD40 and D14 for FcG and C3b resp
False! B cell class switching requires a second signal

8. What is hereditary angioedema? What are the C3 levels?
IgM
Hyperacute; presence of preformed antibodies in the recipient ( to blood groups or HLA )
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
Salmonella - 2 flagellar variants; Borrelia (relapsing fever); and Neisseria gonorrhoaea - pilus protein

9. How do you test for chronic granulomatous disease?
Anemias (esp due to renal failure)
Negative nitroblue tetrazolium reduction test
IgA
isotype

10. what happens in order for class switching to occur (after being activated by IL and cd40 L)?
Anemias (esp due to renal failure)
Antihistone
pentamer
Alternative splicing of mRNA

11. What part of the lymph node specifically expands during a cellular immune response? when would this occur?
neutrophilia!
Paracortex; viral infection
IgG and IgM bind to pathogens activating C1 convertase and leads to C2 and C4 and then C3 convertase activated
Complement activation (active in both)

12. What does IgA pick up from epithelial cells before being secreted?
Carbohydrate
Defect in CD40L results in inability to class switch; a lot of IgM and no IgG - A - E
Secretory component
The antibodies (igM or IgG) either neutralize the target directly (cytoxic!) or recruit leukocytes (Neutrophils and Macrophages!) to incite tissue damage

13. which antibody is involved in the primary response or immediate response to an antigen?
IL 4
IgM
Active; passive - fast but short half life (3 weeks!)
Cyclosporine and tacrolimus; sirolimus (as well as hyperlipidemia)

14. What is recomb beta interferon used for?
T cell activation; no with CD 4 or CD 8
IL 4
MS
Anti nuclear Antibodies (ANA); Anti dsDNA - anti Smith

15. What is the main function of interferons?
Cross link
Antiviral for uninfected cells (for future protection) and kills virally infected cells (NK activation)
Internal iliac
Th1; interferon gamma; IL 2 for cytotoxic T cell activation

16. All transplant rejections - _____________ are mediated by Type IV hypersensitivity
except hyperacute
HBV - HBC - Kaposis - leukemias - malignant melanoma - hairy cell leukemia and condyluma accuminata
Fab portion
Glycoproteins; HLA

17. What are the autoantibodies for polymyositis and dermatomyositis?
Anti Jo -1
Induce differentiation of T cells into Th1 helper cells and activates NK cells also; B cells
Paracortex
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

18. How fast does it occur?
Normal pro B (CD 19 +) - no mature B cells results in decreased total B cell level - and decreased amount of immunoglobulins in each class
Antiviral by inducing ribonuclease which degrades only viral mRNA (prevents protein synthesis) and activates NK cells to kill virus infected cells
The patient could become cyanotic in the OR!
Septicemia with neisseria; because at least you have C3 to act like a neutrophilic chemotactic and an acute phase reactant

19. What does CD16 on NK cells do?
Bind FcG for antibody dependent cellular cytotoxicity
In the germinal center of secondary follicles (In the paler center)
Activates Th1 helper cells; Macrophages
Ischemia and necrosis of graft due to occlusion of vessels and fibrinoid necrosis and thrombosis within the vessels

20. What kinds of receptors activate innate immunity?
IgE
Interferon gamma; Th1
type four
TLR ad nuclear receptors

21. What is the arthus reaction? What is the difference between arthus and serum sickness? give an example. How do you test for it?
Negative!
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
MHC II - B7
Scratch test - histamine mediated wheal; radioimmunosorbent assay (detects specific IgEs in serum)

22. What is Aldesleukin? What is it used for
Activate B cells - activate Macrophages - kill viruses directly - delayed cell mediated hypersensitivity - acute and chronic rejection
High endothelial venules are post capillary cuboidal endothelial cells that contain specific adhesion molecules for lymphocytes with specific binders that allows for lymphocytes to drain out of the vasculature into the lymph node structure (this is h
Not thymus - BM
A recomb cytokine of IL 2; RCC and metastatic melanoma

23. The pathogenesis of contact dermatitis is ________ hypersensitivity
Lack of NADPH oxidase results in a lack of respiratory burst in neutrophils; susceptibility to catalase positive organisms (S. aureus - E. Coli - Aspergillus)
Leukocyte adhesion defect; ataxia telangietasia; ataxia telangiectasia; chediak higashi syndrome; IgA def; Digeorge syndrome; Jobs; Chediak Higashi
type four
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

24. IgG...
opsonizes
From self; from identical twin or clone; from nonidentical individual of same species; from different species; fetus; pig valve
Defect in BTK a tyrosine kinase gene; failed maturation of B cells; X linked recessive
Activate macrophages

25. What is chronic mucocutaneous candidiasis d/t?
T cell dysfunction
cannot cross placenta
No because no peptide fragment!
Axillary

26. IgM can fix complement but...
Fab portion
Axillary
Influenza; antigenic shift; antigenic drift
cannot cross placenta

27. What are target cells?
secondary
Anticentromere; anti Scl -70 (anti DNA topoisomerase I)
Cells that stil have weird parts of their membrane that macrophages usually bite off
IL 1 and IL 6

28. can igG cross the placenta?
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
Lack of NADPH oxidase results in a lack of respiratory burst in neutrophils; susceptibility to catalase positive organisms (S. aureus - E. Coli - Aspergillus)
Recomb cytokine of GCSF (granulocyte macrophage colony stimulating factor; for recovery of bone marrow
Yes

29. The lymphocytes are ________ origin
Wiskott Aldrich syndrome
Paracortex; viral infection
mesenchymal
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

30. 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?
Recom IL 11; thrombocytopenia
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
Immunosuppression after kidney transplantation in combination with cyclosporine and corticosteroids
Macrophages - Dendritic cells - B cells

31. What is the pathology in hyperacute transplant rejection?
Recurrent infections to every type of antigen; bone marrow transplant (be weary of GVH disease!)
Ischemia and necrosis of graft due to occlusion of vessels and fibrinoid necrosis and thrombosis within the vessels
neutrophilia!
A - B - C; all the D's

32. What are the sinusoids of the spleen? What is the difference between a spleen and a lymph node?
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 patient could become cyanotic in the OR!
Barrel hoop basement membrane fenestrations
Hereditary angioedema; PNH

33. Which antibody mediates immunity to worms? how?
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
C3b; coating of a pathogen with molecules that promotes phagocytosis; IgG and CRP
IgE; by activating eosinophils
Anti glutamate carboxylase and anti insulin

34. What portion of the lymph node is not well developed in DiGeorge Syndrome?
Paracortex
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)
Scratch test - histamine mediated wheal; radioimmunosorbent assay (detects specific IgEs in serum)
Anti IF

35. What lymph node drains the thigh?
Superficial inguinal
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!)
Legionella - N. gonorrhea - L. monocytogenes - viruses - protozoa (leismaniasis)

36. What is the toxicity of muromonab?
AR; defect in MT function results in decreased transport and phagocytosis; recurrent pyogenic infections by staphylococci and streptococci - partial albinism - and peripheral neuropathy
Basophils! THey want IG E class switch!
CRP - C3b - IgM
Cytokine release syndrome due to initial release from initial binding (fever etc) and hypersensitivity reaction

37. Name the three opsonins
CRP - C3b - IgM
Antiviral by inducing ribonuclease which degrades only viral mRNA (prevents protein synthesis) and activates NK cells to kill virus infected cells
Its main effect is a defect in Ab opsonization for killing
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

38. In general What are T cells good for?
Anti viral and anti tumor
Recurrent sinopulmonary bacterial infections after 6 months (d/t mothers igGs transplacental) due to opsonization defect
High endothelial venules are post capillary cuboidal endothelial cells that contain specific adhesion molecules for lymphocytes with specific binders that allows for lymphocytes to drain out of the vasculature into the lymph node structure (this is h
T cells react to the angtigen and activate leukocyted (macrophage acitivation)

39. what cell surface proteins are on all APCs?
MHC II - B7
If there is class switching and plasma cell production (that is when memory cells are produced)
Fibrosis of blood vessels and graft tissue from ischemia; obliterative vascular fibrosis with intimal thickening
NK cells

40. What is an example of a parasite showing antigenic variation?
Trypanosomes with programmed rearrangement (results in recurring fever -- sleeping sickness!)
CD56
All MHC 1/CD8
Recomb cytokine of GCSF (granulocyte macrophage colony stimulating factor; for recovery of bone marrow

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

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42. Which are the only two antiinflammatory cytokines?
TGF beta and IL 10
Induces fever - chemokine secretion to recruit - activates adhesion molecules; macrophages
Paracortex; viral infection
Inferior mesenteric

43. what else does interferon gamma do other than inducing ribonuclease production - activating NK cells - inducing increased MHC expression?
Paracortex
Activate macrophages
1) susceptibility to encapsulated organisms 2) Howell Jolly Bodies 3) Target cells 4) Thrombocytosis
dimer

44. What is a factor that is a predictor for a bad transplantation?
Opsonize bacteria (for enhanced phagocytosis) - neutralize viruses (igG) - activate complement (igM and igG) - sensitize mast cells (igE)
Patient has had previous exposure to blood products which result in presence of preformed anti HLA cytotoxic Abs
Induces fever - chemokine secretion to recruit - activates adhesion molecules; macrophages
B - T - and NK cells

45. What does it mean if there are igM in the serum at birth?
Active; passive - fast but short half life (3 weeks!)
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
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
Since cant cross placenta most likely means that child was forced early to produce due to an infection (most likely CMV)

46. The Fc region is found on the...
Anti IF
carboxy terminal
Fc
Surrounds the red pulp and begins with PALS and then turns into follicles with B cells/follicles

47. 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)?
Closed circuit where go directly to veins and open where squeeze out of capillary sinusoids and interact with either PALS or with macrophages in the cords of Billroth (for antigen immune function or for blood cleaning or for both) and squeeze back in
Internal iliac
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

48. Complements are...
acute phase reactants
Tetanus - Botulinum - HBV - Rabies
Antibody mediated cytotoxicity; either complement dependent or complement independent
IgE; by activating eosinophils

49. What is the defect in hyper IgM syndrome? What are the lab results?
Defect in CD40L results in inability to class switch; a lot of IgM and no IgG - A - E
IgE
SP infections
Superior mesenteric

50. What are howell jolly bodies?
Nuclear remnants that are usually taken out of RBC before complete maturation by Macrophages
Celiac
Carbohydrate
An alpha chain and a B2 microglobulin; on all nucleated cells; TCR and CD8; intracellular antigens

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USMLE Step 1 Immunology

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