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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. Name three things that IL 1 does as a cytokine. other than the liver - who secretes IL 1
IgG
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
Induces fever - chemokine secretion to recruit - activates adhesion molecules; 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

2. What is the defect in Brutons agammaglobulinemia? What is its effect on B cells? What is its inheritance pattern?
IL 4 -5 -6 for B cell class switching - IL 10 to inhibit TH1
Intracellular pathogens (acute and chronic viruses and virally induced cancers)
Glycoproteins; HLA
Defect in BTK a tyrosine kinase gene; failed maturation of B cells; X linked recessive

3. What is epo used for?
Fab portion
T cell precursor
An anaphylactic immediate reaction; atopy refers to the inherited propensity to develop asthmatic or allergic reactions
Anemias (esp due to renal failure)

4. What lymph node drains the rectum (above the pectinate line)?
Internal iliac
Hemochromatosis
MS
carboxy terminal

5. Give three examples of bacteria that use antigenic variation and how.
Inferior mesenteric
Activates Th1 helper cells; Macrophages
Activate macrophages
Salmonella - 2 flagellar variants; Borrelia (relapsing fever); and Neisseria gonorrhoaea - pilus protein

6. What are the autoantibodies for pernicious anemia?
Vasculitis of graft vessels with dense interstitial lymphocytic infiltrate; yes! with immunosuppressants
Anti IF
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
Cytokine IL 10 secreted by Th2

7. What is the pathogenesis of IgG AIHA ABO hemolytic disease of a newborn? describe what happens.
Interferon gamma; Th1
Anti IF
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 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

8. Which helper T cells' development is induced by IL 4? IL 12?
T cell precursor
Severe recurrent pyogenic sinus and resp tract And increased susceptibility to type III hypersensitivity like SLE
Type III hypersensitivity where an internal antigen antibody complexes activate classical complement pathway resulting in C3a neutrophilic chemotaxis and neutrophilic lysosomal death. SLE
Th2; Th1

9. Which cytokines do Th2 release and For what?
Secretory component
IgG
Decreased Th1 response; disseminated mycobacterial infections; decreased interferon gamma
IL 4 -5 -6 for B cell class switching - IL 10 to inhibit TH1

10. What are some catalase positive organisms?
A B and T cell disorder; defect in DNA repair enzymes; ataxia - telangactasia and IgA def; igA def. and increased AFP
Cross link antigens which increases their phagocytability; activate complement for MAC attack; opsonization; neutralization
Hemochromatosis
S. aureus - E. Coli - aspergillus

11. Name the three opsonins
CRP - C3b - IgM
Active; passive - fast but short half life (3 weeks!)
1) susceptibility to encapsulated organisms 2) Howell Jolly Bodies 3) Target cells 4) Thrombocytosis
Make antibody - allergy type 1 (igE) - Cytotoxic and immunecomplex hypersensitivity type II and III (igG); hyperacute organ rejection is Ab mediated

12. The pathogenesis of contact dermatitis is ________ hypersensitivity
type four
DAF and C1 esterase inhibitor on cells prevent complement activation on their surfaces (microbial surfaces lack this)
Th1; interferon gamma; IL 2 for cytotoxic T cell activation
Anti Ach receptor

13. where do somatic hypermutation and class switching occur?
In the germinal center of secondary follicles (In the paler center)
All MHC 1/CD8
...
TLR ad nuclear receptors

14. IgG...
Recom IL 11; thrombocytopenia
opsonizes
pale central germinal centers
Adaptive uses classic pathway to kill; innate uses alternative pathway to kill

15. which interleukin receptor is required for NK development? activation?
IL 15; IL 12 - interferon Beta and interferon alpha
Septicemia with neisseria; because at least you have C3 to act like a neutrophilic chemotactic and an acute phase reactant
2 heavy chains and two light chains
The antibodies (igM or IgG) either neutralize the target directly (cytoxic!) or recruit leukocytes (Neutrophils and Macrophages!) to incite tissue damage

16. What is the difference of IgE AIHA and IgG AIHA if they are both complement dependent type II hypersensitivities?
Cyclosporine and tacrolimus; sirolimus (as well as hyperlipidemia)
Thrombocytopenia
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
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

17. What is the marginal zone of the spleen? what happens there?
Suppresses immune response (also specifically Th1 cells) and activates Th2; regulatory T cells
Adenosine deaminase deficiency (AR) - defective IL 2 receptor (X linked) - and failure to synthesize MHC II; both humoral and cell mediated deficiency
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
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

18. Which disease is associated with B8?
Graves
Negative nitroblue tetrazolium reduction test
MHC II - B7
Superficial inguinal

19. with failed maturation of B cells in Brutons agammaglobulinemia - What is its effect on immune pathways and why?
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
Steroid responsive nephrotic syndrome
Its main effect is a defect in Ab opsonization for killing
IgG

20. IgM can fix complement but...
Axillary
NK cells
Anti Ach receptor
cannot cross placenta

21. If an antigen lacks a peptide component How does the adaptive immunity attack it? What type of response is this called. give an example of bugs that do this. what implications does this have on splenectomy?
Internal iliac
DM type I
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
Daclizumab; prevent ACUTE rejection of renal transplant

22. Type Iv hypersensitivity is...
delayed!
MHC II/CD4 and B7 (on APC) and CD28 (on Th cell); releases cytokines to kill those extracellular buggers!
CGD; Jobs syndrome (defect in Neutrophil chemotactic response)
Tetanus - Botulinum - HBV - Rabies

23. What is the general structure of an Ab?
2 heavy chains and two light chains
Trypanosomes with programmed rearrangement (results in recurring fever -- sleeping sickness!)
False! B cell class switching requires a second signal
Scratch test - histamine mediated wheal; radioimmunosorbent assay (detects specific IgEs in serum)

24. How is i Th1 helper cell inhibited?
Para aortic
IL 1 and IL 6
Cytokine IL 10 secreted by Th2
Anti nuclear Antibodies (ANA); Anti dsDNA - anti Smith

25. What is thrombopoietin used for?
Thrombocytopenia
T cells react to the angtigen and activate leukocyted (macrophage acitivation)
IgG
Intracellular pathogens (acute and chronic viruses and virally induced cancers)

26. 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!)
Anti SS- A (anti RO) and Anti SS- B
Anti U1 RNP (ribonucleoprotein)
Severe pyogenic infections early in life

27. What is anergy? why does this occur?
MAC (membrane attack complex) Which is activated by C5b - C9 and results in lysis and cytoxicity by creating pores in the target membrane; encapsulated organisms (S. pnuemonia - H.influenzae - B perfussis for example) and other organisms with non pep
Scratch test - histamine mediated wheal; radioimmunosorbent assay (detects specific IgEs in serum)
Lack of response from lymphocytes when activated; because they are self reactive - this is a form of tolerance
IgM and IgG

28. what secretes IL 4?
Surrounds the red pulp and begins with PALS and then turns into follicles with B cells/follicles
IgAs in mothers breast milk!
Cyclosporine and tacrolimus; sirolimus (as well as hyperlipidemia)
Basophils! THey want IG E class switch!

29. other than C3a - what other complement acts as an anaphyloxin?
C5a
Lack of response from lymphocytes when activated; because they are self reactive - this is a form of tolerance
Opsonization (Brutons agammaglobulinemia) - adhesion (Leukocyte adhesion defect) - phagocytosis (chediak higashi syndrome) - respiratory burst (chronic granulomatous disease)
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. after C3 spontaneously hydrolyzes to C3b and C3a - what happens to C3a?
Legionella - N. gonorrhea - L. monocytogenes - viruses - protozoa (leismaniasis)
Its involved in inflammation and results in anaphylaxis and neutrophil chemotaxis.
Alternative splicing of mRNA
type four

31. What are the two signals required for B cell class switching? Which is the second signal?
The antibodies (igM or IgG) either neutralize the target directly (cytoxic!) or recruit leukocytes (Neutrophils and Macrophages!) to incite tissue damage
CD40 (on b cell) CD40 ligand on Th2 cell; and interleukins (4 -5 -6) from Th2 cell; CD40 is actually the second signal
Recom IL 11; thrombocytopenia
Complement activation (active in both)

32. How does the alternative pathway lead to MAC activation?
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
IgAs in mothers breast milk!
Anti Ach receptor
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

33. What are the main cell surface proteins on B cells?
Opsonization (Brutons agammaglobulinemia) - adhesion (Leukocyte adhesion defect) - phagocytosis (chediak higashi syndrome) - respiratory burst (chronic granulomatous disease)
Defect in BTK a tyrosine kinase gene; failed maturation of B cells; X linked recessive
Ischemia and necrosis of graft due to occlusion of vessels and fibrinoid necrosis and thrombosis within the vessels
Ig - CD19 - CD20 - CD21 - CD40 - MHC II - B7

34. How fast does it occur?
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
The patient could become cyanotic in the OR!
A j chain
Defect in LFA 1 integrin (CD 18) protein on phagocytes (neutrophils!); recurrent bacterial infections - severe gingivitis - poor wound healing - absent pus formation - and delayed separation of the umbilicus; neutrophilia

35. 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
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
Anti SS- A (anti RO) and Anti SS- B
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

36. what happens in order for class switching to occur (after being activated by IL and cd40 L)?
pale central germinal centers
Alternative splicing of mRNA
Lack of response from lymphocytes when activated; because they are self reactive - this is a form of tolerance
Its involved in inflammation and results in anaphylaxis and neutrophil chemotaxis.

37. Which MHC presents intracellular peptides? how so?
CD40 (on b cell) CD40 ligand on Th2 cell; and interleukins (4 -5 -6) from Th2 cell; CD40 is actually the second signal
MHC I; from RER with help of the B2 microglobulin
Leukocyte adhesion defect; ataxia telangietasia; ataxia telangiectasia; chediak higashi syndrome; IgA def; Digeorge syndrome; Jobs; Chediak Higashi
Lack of response from lymphocytes when activated; because they are self reactive - this is a form of tolerance

38. What is the toxicity of muromonab?
Cytokine release syndrome due to initial release from initial binding (fever etc) and hypersensitivity reaction
Interferon gamma; Th1
CD21 on B cells (although there is T cell lymphocytosis in EBV)
pentamer

39. which of the IL2 inhibitors produce nephrotoxicity? thrombocytopenia/leukopenia?
CD56
Adaptive uses classic pathway to kill; innate uses alternative pathway to kill
Cyclosporine and tacrolimus; sirolimus (as well as hyperlipidemia)
Anti Jo -1

40. What type of fenestrations are found in the red pulp of the spleen?
A chemotactic factor for neutrophils
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
Barrel hoop basement membrane fenestrations
AR; defect in MT function results in decreased transport and phagocytosis; recurrent pyogenic infections by staphylococci and streptococci - partial albinism - and peripheral neuropathy

41. What do multimeric antibodies require for assembly?
A j chain
Surrounds the red pulp and begins with PALS and then turns into follicles with B cells/follicles
Graves
...

42. what results in symptoms of shock in an acute hemolytic transfusion reaction?
Cell mediated due to T cell cytotoxicity reacting to foreign MHCs; few weeks after
Basophils! THey want IG E class switch!
C - ANCA (antiproteinase); in neutrophil; c= cytoplasmic
Since it is a comp dependent type II hypersensitivity reaction; C3a brings anaphylotoxins that bring in mediators of shock

43. Leukocyte adhesion defect presents with...
IL 1 and IL 6
neutrophilia!
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
AR; defect in MT function results in decreased transport and phagocytosis; recurrent pyogenic infections by staphylococci and streptococci - partial albinism - and peripheral neuropathy

44. What is recomb alpha interferon used for?
Isotype switching (activated by Th2 cell signals and cytokines) - somatic hypermutation
A chemotactic factor for neutrophils
HBV - HBC - Kaposis - leukemias - malignant melanoma - hairy cell leukemia and condyluma accuminata
Its main effect is a defect in Ab opsonization for killing

45. The ______ in the BM are DN - the DP are in the cortex of thymus
Anti mitochondrial
T cell precursor
Defect in BTK a tyrosine kinase gene; failed maturation of B cells; X linked recessive
IL 4 - 5 - 10 - 6

46. Which disease is associated with DR7?
Steroid responsive nephrotic syndrome
An anaphylactic immediate reaction; atopy refers to the inherited propensity to develop asthmatic or allergic reactions
IgM and IgA
dimer

47. Which disease is associated withB B27?
Psoriasis - Ankylosis Spondylitis - IBD - Reiters; all seronegative spondylopathies
Nuclear remnants that are usually taken out of RBC before complete maturation by Macrophages
Tumor cells and virally infected cells; perforin pore to secrete granzymes through it; apoptosis
CD40 (on b cell) CD40 ligand on Th2 cell; and interleukins (4 -5 -6) from Th2 cell; CD40 is actually the second signal

48. What lymph node drains the anal canal (below the pectinate line)?
Remove encapsulated bacateria
Superficial inguinal
Graves
DM type I

49. What links the adaptive and innate immunity?
Complement activation (active in both)
Pernicious Anemia and Hashimotos
Leukocyte adhesion defect; ataxia telangietasia; ataxia telangiectasia; chediak higashi syndrome; IgA def; Digeorge syndrome; Jobs; Chediak Higashi
C3b; coating of a pathogen with molecules that promotes phagocytosis; IgG and CRP

50. which antibodies prevent antigens from binding mucosal surfaces?
Defect in LFA 1 integrin (CD 18) protein on phagocytes (neutrophils!); recurrent bacterial infections - severe gingivitis - poor wound healing - absent pus formation - and delayed separation of the umbilicus; neutrophilia
Antigliadin - antiendomysial (both are IgAs - anti tissue transgluataminase igA)
IgA
Antimicrobial also secreted by CD8 and NK cells that induces apoptsosis

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USMLE Step 1 Immunology

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