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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. can igG cross the placenta?
Severe recurrent pyogenic sinus and resp tract And increased susceptibility to type III hypersensitivity like SLE
Yes
Recurrent sinopulmonary bacterial infections after 6 months (d/t mothers igGs transplacental) due to opsonization defect
CD21 on B cells (although there is T cell lymphocytosis in EBV)

2. The alternative pathway is the only constutively...
active complement pathway
Hereditary angioedema; PNH
IgA; sinus and lung infections from lack of secretory defense - milk allergies and diarrhea from giardiasis; Anaphylasix on exposure to blood products with igA
Steroid responsive nephrotic syndrome

3. What is the main function of TNF alpha? How does it do this?
Para aortic
Mediates septic shock; activates the endothelium for adhesion and dilation and leukocyte recruitment results in vascular leak
IgG
MHC II/CD4 and B7 (on APC) and CD28 (on Th cell); releases cytokines to kill those extracellular buggers!

4. How does the alternative pathway lead to MAC activation?
MHC I - CD16 - CD56
Cytokine release syndrome due to initial release from initial binding (fever etc) and hypersensitivity reaction
B - T - and NK cells
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

5. What is epo used for?
TGF beta and IL 10
Intracellular pathogens (acute and chronic viruses and virally induced cancers)
Hereditary angioedema; PNH
Anemias (esp due to renal failure)

6. What is chronic mucocutaneous candidiasis d/t?
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
1) susceptibility to encapsulated organisms 2) Howell Jolly Bodies 3) Target cells 4) Thrombocytosis
T cell dysfunction
RNA segment reassortment

7. What are the labs in brutons agammaglobulinemia?
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
T cell dysfunction
Normal pro B (CD 19 +) - no mature B cells results in decreased total B cell level - and decreased amount of immunoglobulins in each class

8. Which TCR MHC system is important for viral immunity? neoplastic? donor graft cells?
Antiviral by inducing ribonuclease which degrades only viral mRNA (prevents protein synthesis) and activates NK cells to kill virus infected cells
All MHC 1/CD8
Negative nitroblue tetrazolium reduction test
opsonizes

9. How is the antigen loaded onto a MHC II?
IgAs in mothers breast milk!
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
Anticentromere; anti Scl -70 (anti DNA topoisomerase I)
Fever - urticaria - arthralgias - proteinuria - lymphadenopathy

10. What cytokines to Th2 secrete?
1) susceptibility to encapsulated organisms 2) Howell Jolly Bodies 3) Target cells 4) Thrombocytosis
IL 4 - 5 - 10 - 6
Negative nitroblue tetrazolium reduction test
Glycoproteins; HLA

11. How is sirolimus different from tacrolimus?
Both decrease cd8 tcell prolif but one through mtor and the other through calcineurin (resp)
Legionella - N. gonorrhea - L. monocytogenes - viruses - protozoa (leismaniasis)
The antibodies (igM or IgG) either neutralize the target directly (cytoxic!) or recruit leukocytes (Neutrophils and Macrophages!) to incite tissue damage
Acts as second signal on B cells to induce class switching to IgA; also stimulates eosinophils

12. Often bacteria are associated with being killed by humoral immunity. Name some bugs that require cell mediated immunity because they evade humoral response
Adenosine deaminase deficiency (AR) - defective IL 2 receptor (X linked) - and failure to synthesize MHC II; both humoral and cell mediated deficiency
Legionella - N. gonorrhea - L. monocytogenes - viruses - protozoa (leismaniasis)
mesenchymal
Cross link antigens which increases their phagocytability; activate complement for MAC attack; opsonization; neutralization

13. What is the clinical use for sirolimus? what should you combine it with?
Edema and necrosis in that region
Immunosuppression after kidney transplantation in combination with cyclosporine and corticosteroids
opsonizes
2 heavy chains and two light chains

14. The pathogenesis of contact dermatitis is ________ hypersensitivity
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
Antidesmoglein
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
type four

15. IgE has the ___________ in the serum
Celiac
Remove encapsulated bacateria
Activate B cells - activate Macrophages - kill viruses directly - delayed cell mediated hypersensitivity - acute and chronic rejection
lowest concentration

16. What are howell jolly bodies?
Cells that stil have weird parts of their membrane that macrophages usually bite off
Nuclear remnants that are usually taken out of RBC before complete maturation by Macrophages
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
Immune complex - Arthus reaction and Serum sickness; they are all a result of antibody- antigen complex deposition resulting in complement activation

17. which cytokine inhibits TH2 cells? secreted by who?
encapsulated
Interferon gamma and IL 2
Anemias (esp due to renal failure)
Interferon gamma; Th1

18. What are the symptoms of serum sickness?
Celiac
Suppresses immune response (also specifically Th1 cells) and activates Th2; regulatory T cells
Opsonization (Brutons agammaglobulinemia) - adhesion (Leukocyte adhesion defect) - phagocytosis (chediak higashi syndrome) - respiratory burst (chronic granulomatous disease)
Fever - urticaria - arthralgias - proteinuria - lymphadenopathy

19. Leukocyte adhesion defect presents with...
Glycoproteins; HLA
pathogenesis
neutrophilia!
dimer

20. How is i Th1 helper cell inhibited?
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 :(
Leukocyte adhesion defect; ataxia telangietasia; ataxia telangiectasia; chediak higashi syndrome; IgA def; Digeorge syndrome; Jobs; Chediak Higashi
Mediates septic shock; activates the endothelium for adhesion and dilation and leukocyte recruitment results in vascular leak
Cytokine IL 10 secreted by Th2

21. What is recomb gamma interferon used for?
Chronic granulomatous disease
Cells that stil have weird parts of their membrane that macrophages usually bite off
Defect in BTK a tyrosine kinase gene; failed maturation of B cells; X linked recessive
type four

22. __________ are a part of the innate system.
Activates Th1 helper cells; Macrophages
NK cells
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)
Recurrent infections to every type of antigen; bone marrow transplant (be weary of GVH disease!)

23. What is the late phase reaction of anaphylaxis allergy? what mediates it?
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)
MHC II - B7
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
Anti topoisomerase

24. 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
Cell mediated due to T cell cytotoxicity reacting to foreign MHCs; few weeks after
not Ab mediated
Make antibody - allergy type 1 (igE) - Cytotoxic and immunecomplex hypersensitivity type II and III (igG); hyperacute organ rejection is Ab mediated

25. What do multimeric antibodies require for assembly?
A j chain
Viral neutralization of igM and IgG!
IgG
Cross link

26. What are the autoantibodies for goodpastures syndrome?
DAF and C1 esterase inhibitor on cells prevent complement activation on their surfaces (microbial surfaces lack this)
Anti alpha subunit 3 of collagen on type IV bm
Celiac
delayed!

27. What are HEV? Where are they found? Where does the vasculature of the lymph node travel to?
IgA; sinus and lung infections from lack of secretory defense - milk allergies and diarrhea from giardiasis; Anaphylasix on exposure to blood products with igA
Superior mesenteric
1) susceptibility to encapsulated organisms 2) Howell Jolly Bodies 3) Target cells 4) Thrombocytosis
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

28. What is the pathology in hyperacute transplant rejection?
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
Anticentromere; anti Scl -70 (anti DNA topoisomerase I)
Ischemia and necrosis of graft due to occlusion of vessels and fibrinoid necrosis and thrombosis within the vessels
Intracellular pathogens (acute and chronic viruses and virally induced cancers)

29. which of the IL2 inhibitors produce nephrotoxicity? thrombocytopenia/leukopenia?
Cyclosporine and tacrolimus; sirolimus (as well as hyperlipidemia)
Increases expression of MHC I and MHC II and also activates NK cells
acute phase reactants
IgE; by activating eosinophils

30. What are the autoantibodies for Mixed connective tissue disease?
Anti U1 RNP (ribonucleoprotein)
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
Fc
Remove encapsulated bacateria

31. What bugs can actually infect the lymph node itself?
Mycobacterium Tuberculosis - Mycobacterium Avium Intracellulare; Toxoplasmosis Gondii
Cell mediated due to T cell cytotoxicity reacting to foreign MHCs; few weeks after
DM type I
IgM and IgD

32. What does IgA pick up from epithelial cells before being secreted?
Trypanosomes with programmed rearrangement (results in recurring fever -- sleeping sickness!)
P - ANCA (antimyeloperoxidase); in neutrophil; p= perinuclear
Secretory component
Carbohydrate

33. other than mediating shock - what else does TNF alpha do? who releases it mainly?
Activates Th1 helper cells; Macrophages
MHC II - B7
opsonizes
2 heavy chains and two light chains

34. What is the main cytokine that activates eosinophils?
IL 5
Immunosuppression after kidney transplantation in combination with cyclosporine and corticosteroids
Opsonization (Brutons agammaglobulinemia) - adhesion (Leukocyte adhesion defect) - phagocytosis (chediak higashi syndrome) - respiratory burst (chronic granulomatous disease)
T cell precursor

35. when can graft versus host disease? What is the result?
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
Its main effect is a defect in Ab opsonization for killing
Anti viral and anti tumor

36. What is the most common selective Ig deficiency? What is the presentation?
Negative selection
Monoclonal Ab to CD3- blocks cellular transduction and signaling of T cells
Activates Th1 helper cells; Macrophages
IgA; sinus and lung infections from lack of secretory defense - milk allergies and diarrhea from giardiasis; Anaphylasix on exposure to blood products with igA

37. what characterizes an arthus reaction?
IgG
MHC I/CD8 and IL2/IL 2 Receptor (IL 2 is from Th1!); cytoxicity!
Receiving preformed Antibodies
Edema and necrosis in that region

38. What are the three types of Type III hypersensitivity ? What is the common mechanism between them?
Immune complex - Arthus reaction and Serum sickness; they are all a result of antibody- antigen complex deposition resulting in complement activation
Increases expression of MHC I and MHC II and also activates NK cells
A chemotactic factor for neutrophils
Antimicrosomal and antithyroglobulin

39. How is the thymus organized? what happens in each section?
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
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
Daclizumab; prevent ACUTE rejection of renal transplant
Anti topoisomerase

40. What are the autoantibodies for myasthenia gravis?
HBV - HBC - Kaposis - leukemias - malignant melanoma - hairy cell leukemia and condyluma accuminata
Anti Jo -1
Anti Ach receptor
By transcytosis

41. What is an autograft? syngeneic graft? allograft? xenograft? What is an ex of an allograft? xenograft?
Barrel hoop basement membrane fenestrations
From self; from identical twin or clone; from nonidentical individual of same species; from different species; fetus; pig valve
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
A recomb cytokine of IL 2; RCC and metastatic melanoma

42. What is the autoantibody for SLE that is nonspecific? Specific?
An alpha chain and a B2 microglobulin; on all nucleated cells; TCR and CD8; intracellular antigens
Histamine; post capillary venules - vasodilation
Anti nuclear Antibodies (ANA); Anti dsDNA - anti Smith
Anti TSh receptor

43. Which diseases are associated with DR5?
Immunosuppression after kidney transplantation
Th2; Th1
Pernicious Anemia and Hashimotos
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

44. What does CD16 on NK cells do?
Tetanus - Botulinum - HBV - Rabies
Lack of response from lymphocytes when activated; because they are self reactive - this is a form of tolerance
Bind FcG for antibody dependent cellular cytotoxicity
MHC I; from RER with help of the B2 microglobulin

45. How do we use thymus dependent antigens to prevent infection from organisms that lack a peptide component?
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
Coarse Faces - cold (noninflamed d/t inability to attract neutrophils) staph abscesses - retained primary teeth - high igE - dermatologic problems (eczema)
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
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

46. The idiotype; the Fc portion determines the...
A chemotactic factor for neutrophils
IgM and IgA
isotype
Cross link antigens which increases their phagocytability; activate complement for MAC attack; opsonization; neutralization

47. What is a factor that is a predictor for a bad transplantation?
Pernicious Anemia and Hashimotos
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)
Periarteriolar lymphatic sheath in the white pulp that surround that dead end of the capillaries in the red pulp - contain T cells
Patient has had previous exposure to blood products which result in presence of preformed anti HLA cytotoxic Abs

48. What lymph node drains the stomach?
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
Anti SS- A (anti RO) and Anti SS- B
Celiac
Acts as second signal on B cells to induce class switching to IgE and IgG

49. Describe the capsular structure of a lymph node; What are the functions of the LN?
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
Antidote for digoxin intoxication
Interferon gamma and IL 2
Bind FcG for antibody dependent cellular cytotoxicity

50. What kinds of receptors activate innate immunity?
TLR ad nuclear receptors
Mediates septic shock; activates the endothelium for adhesion and dilation and leukocyte recruitment results in vascular leak
Complement activation (active in both)
Decreased Th1 response; disseminated mycobacterial infections; decreased interferon gamma

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USMLE Step 1 Immunology

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