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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. where do NK cells develop?
CD21 on B cells (although there is T cell lymphocytosis in EBV)
Anti mitochondrial
IgM and IgA
Not thymus - BM

2. What is the main cytokine released by T cells? What does it do
IgG and IgM bind to pathogens activating C1 convertase and leads to C2 and C4 and then C3 convertase activated
Legionella - N. gonorrhea - L. monocytogenes - viruses - protozoa (leismaniasis)
Its involved in inflammation and results in anaphylaxis and neutrophil chemotaxis.
IL 3; supports growth and differentiation of bone marrow stem cells

3. What is the receptor for EBV? On what cells is that located?
Mycobacterium Tuberculosis - Mycobacterium Avium Intracellulare; Toxoplasmosis Gondii
CD21 on B cells (although there is T cell lymphocytosis in EBV)
Monoclonal Ab to CD3- blocks cellular transduction and signaling of T cells
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

4. What are target cells?
Scratch test - histamine mediated wheal; radioimmunosorbent assay (detects specific IgEs in serum)
IgE
Para aortic
Cells that stil have weird parts of their membrane that macrophages usually bite off

5. What is the pathology in hyperacute transplant rejection?
Negative!
Stimulate the liver to release acute phase reactants
Ischemia and necrosis of graft due to occlusion of vessels and fibrinoid necrosis and thrombosis within the vessels
C - ANCA (antiproteinase); in neutrophil; c= cytoplasmic

6. What is MHC II made out of? Where is it found? What does it bind to? What type of antigens does it present?
An alpha and beta chain; only on APCs; TCR and CD4; extracellular (phagocytosed by APCs)
IL 1 and IL 6
pathogenesis
neutrophilia!

7. Which disease is associated with B8?
Graves
Cytokine release syndrome due to initial release from initial binding (fever etc) and hypersensitivity reaction
Legionella - N. gonorrhea - L. monocytogenes - viruses - protozoa (leismaniasis)
Previous transfusion; pregnant woman whose fetus had paternal antigens

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

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9. Which antibodies can be multimeric?
Lymphocytes
IgM and IgA
Lack of response from lymphocytes when activated; because they are self reactive - this is a form of tolerance
Histamine; post capillary venules - vasodilation

10. Which is the main antibody in the delayed or secondary response to an antigen?
Tumor cells and virally infected cells; perforin pore to secrete granzymes through it; apoptosis
IgG
CD56
Anti U1 RNP (ribonucleoprotein)

11. which of the IL2 inhibitors produce nephrotoxicity? thrombocytopenia/leukopenia?
Cyclosporine and tacrolimus; sirolimus (as well as hyperlipidemia)
IgG
except hyperacute
IgM

12. How do you test for chronic granulomatous disease?
Delayed type hypersensitivity
Negative nitroblue tetrazolium reduction test
Wiskott Aldrich syndrome
Antimicrobial also secreted by CD8 and NK cells that induces apoptsosis

13. What is the pathogenesis of a hypersensitivity reaction?
False! B cell class switching requires a second signal
Viral neutralization of igM and IgG!
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
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

14. What is the two fates of the RBCs that go through the spleen? what happens eventually to all of them>
Severe pyogenic infections early in life
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
Cyclosporine - OKT3
Lack of MHC class I constant region which it binds or a nonspecific activation signal (TLR)

15. What kinds of receptors activate innate immunity?
Opsonize bacteria (for enhanced phagocytosis) - neutralize viruses (igG) - activate complement (igM and igG) - sensitize mast cells (igE)
Inferior mesenteric
acute phase reactants
TLR ad nuclear receptors

16. What are the three types of lymphocytes?
Anti nuclear Antibodies (ANA); Anti dsDNA - anti Smith
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
carboxy terminal
B - T - and NK cells

17. In general What are T cells good for?
False! B cell class switching requires a second signal
IL 3; supports growth and differentiation of bone marrow stem cells
An alpha chain and a B2 microglobulin; on all nucleated cells; TCR and CD8; intracellular antigens
Anti viral and anti tumor

18. What cytokines do macrophages release? who else can secrete IL 6? IL 12?
IL 1 - IL 6 - IL 12 - TNF alpha; IL 6- Th2 cells; IL 12- B cells
IL 5
Leukocyte adhesion defect; ataxia telangietasia; ataxia telangiectasia; chediak higashi syndrome; IgA def; Digeorge syndrome; Jobs; Chediak Higashi
Immunosuppression after kidney transplantation in combination with cyclosporine and corticosteroids

19. How does igA cross the epithelium?
Periarteriolar lymphatic sheath in the white pulp that surround that dead end of the capillaries in the red pulp - contain T cells
Previous transfusion; pregnant woman whose fetus had paternal antigens
By transcytosis
CD21 on B cells (although there is T cell lymphocytosis in EBV)

20. Often bacteria are associated with being killed by humoral immunity. Name some bugs that require cell mediated immunity because they evade humoral response
IL 3; supports growth and differentiation of bone marrow stem cells
DM type I and RA
Psoriasis - Ankylosis Spondylitis - IBD - Reiters; all seronegative spondylopathies
Legionella - N. gonorrhea - L. monocytogenes - viruses - protozoa (leismaniasis)

21. Monomer in circulation - ___ when secreted
Defect in CD40L results in inability to class switch; a lot of IgM and no IgG - A - E
dimer
Cyclosporine and tacrolimus; sirolimus (as well as hyperlipidemia)
Receiving preformed Antibodies

22. What are the autoantibodies for scleroderma (CREST)? scleroderma diffuse?
Severe recurrent pyogenic sinus and resp tract And increased susceptibility to type III hypersensitivity like SLE
lowest concentration
IgM
Anticentromere; anti Scl -70 (anti DNA topoisomerase I)

23. What are complements in the complement system? What activates them? there seems to be different ones - What are these pathways called?
Superficial inguinal
Vasculitis of graft vessels with dense interstitial lymphocytic infiltrate; yes! with immunosuppressants
Activates Th1 helper cells; Macrophages
Proteins; IgG - IgM - endotoxin (microbial surfaces in general - nonspecific ones also) - mannose binding Lectin; classic - alternative - MB pathway (resp)

24. What lymph node drains the breast?
Axillary
MHC II - B7
Rheumatic arthritis
Antiviral for uninfected cells (for future protection) and kills virally infected cells (NK activation)

25. What lymph node drains the duodenum - jejunum?
...
Superior mesenteric
AR; defect in MT function results in decreased transport and phagocytosis; recurrent pyogenic infections by staphylococci and streptococci - partial albinism - and peripheral neuropathy
Immunosuppression after kidney transplantation in combination with cyclosporine and corticosteroids

26. What type of fenestrations are found in the red pulp of the spleen?
Anti SS- A (anti RO) and Anti SS- B
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
Brain - eyes - placenta/fetus - testicles; because they can have an antigen in there and not get attacked by immune system because dont have contact with immune system via blood and lymph; if an infection occurs such that trauma results in exposure t
Barrel hoop basement membrane fenestrations

27. What is the mode of inheritance of Chediak Higashi syndrome? What is the disease d/t? What does it result in? What is the presentation?
T
AR; defect in MT function results in decreased transport and phagocytosis; recurrent pyogenic infections by staphylococci and streptococci - partial albinism - and peripheral neuropathy
MHC I; from RER with help of the B2 microglobulin
T cell dysfunction

28. which cells have more complete tolerance - B or T cells?
T
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
Adaptive uses classic pathway to kill; innate uses alternative pathway to kill
Carbohydrate

29. All transplant rejections - _____________ are mediated by Type IV hypersensitivity
2 heavy chains and two light chains
Trypanosomes with programmed rearrangement (results in recurring fever -- sleeping sickness!)
except hyperacute
T cell precursor

30. What is the pathogenesis of acute transplant rejection? When does it occur?
Cell mediated due to T cell cytotoxicity reacting to foreign MHCs; few weeks after
Anticentromere; anti Scl -70 (anti DNA topoisomerase I)
B - T - and NK cells
Daclizumab; prevent ACUTE rejection of renal transplant

31. other than C3a - what other complement acts as an anaphyloxin?
The igA found in breast milk
C5a
Macrophages - Dendritic cells - B cells
Lack of NADPH oxidase results in a lack of respiratory burst in neutrophils; susceptibility to catalase positive organisms (S. aureus - E. Coli - Aspergillus)

32. What is the presentation of common variable immunodef? and What are the labs?
Anti Ach receptor
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
Patient has had previous exposure to blood products which result in presence of preformed anti HLA cytotoxic Abs
Remove encapsulated bacateria

33. What are the autoantibodies for myasthenia gravis?
Axillary
Patient has had previous exposure to blood products which result in presence of preformed anti HLA cytotoxic Abs
Induce differentiation of T cells into Th1 helper cells and activates NK cells also; B cells
Anti Ach receptor

34. What is recomb alpha interferon used for?
HBV - HBC - Kaposis - leukemias - malignant melanoma - hairy cell leukemia and condyluma accuminata
Ig - CD19 - CD20 - CD21 - CD40 - MHC II - B7
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
B - T - and NK cells

35. What amine is the main chemical mediator released by mast cells? Where does it act What does it result in?
Hereditary angioedema; PNH
Cytokine IL 10 secreted by Th2
Histamine; post capillary venules - vasodilation
not Ab mediated

36. IgG...
T cells react to the angtigen and activate leukocyted (macrophage acitivation)
opsonizes
Influenza; antigenic shift; antigenic drift
MS

37. What is the clinical use for sirolimus? what should you combine it with?
Anti IF
Scratch test - histamine mediated wheal; radioimmunosorbent assay (detects specific IgEs in serum)
Immunosuppression after kidney transplantation in combination with cyclosporine and corticosteroids
IL 3; supports growth and differentiation of bone marrow stem cells

38. What is hereditary angioedema? What are the C3 levels?
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
Glycoproteins; HLA
...
TNF alpha and IL1

39. What is the pathogenesis of IgG AIHA ABO hemolytic disease of a newborn? describe what happens.
Kill them because they have CD16 on them that recognize the FcG portion
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
Popliteal
NK cells

40. What are the two signals required for Th1 cells? what happens after then activated?
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
MHC II/CD4 and B7 (on APC) and CD28 (on Th cell); releases cytokines to kill those extracellular buggers!
Daclizumab; prevent ACUTE rejection of renal transplant
A chemotactic factor for neutrophils

41. What is the main function of interferons?
secondary
Anti glutamate carboxylase and anti insulin
Local infection/inflammation; infection of the ln itself; metastasis
Antiviral for uninfected cells (for future protection) and kills virally infected cells (NK activation)

42. What are the autoantibodies for other vasculitides?
Fc
Tumor cells and virally infected cells; perforin pore to secrete granzymes through it; apoptosis
Induce differentiation of T cells into Th1 helper cells and activates NK cells also; B cells
P - ANCA (antimyeloperoxidase); in neutrophil; p= perinuclear

43. What are the autoantibodies for graves?
Anti mitochondrial
Tetanus - Botulinum - HBV - Rabies
Anti TSh receptor
Anti nuclear Antibodies (ANA); Anti dsDNA - anti Smith

44. Which cytokines do Th2 release and For what?
1) susceptibility to encapsulated organisms 2) Howell Jolly Bodies 3) Target cells 4) Thrombocytosis
T cell activation; no with CD 4 or CD 8
IL 4 -5 -6 for B cell class switching - IL 10 to inhibit TH1
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

45. ________ regulate the cell mediated response.
Inferior mesenteric
Legionella - N. gonorrhea - L. monocytogenes - viruses - protozoa (leismaniasis)
Remove encapsulated bacateria
Humoral

46. Give three examples of bacteria that use antigenic variation and how.
mesenchymal
Salmonella - 2 flagellar variants; Borrelia (relapsing fever); and Neisseria gonorrhoaea - pilus protein
Acts as second signal on B cells to induce class switching to IgE and IgG
CRP - C3b - IgM

47. Which diseases are associated with DR5?
Acts as second signal on B cells to induce class switching to IgA; also stimulates eosinophils
MS
DM type I and RA
Pernicious Anemia and Hashimotos

48. What is the most common example of passive immunity?
Th cells fail to produce interferon gamma; a lot of IgE
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
IgAs in mothers breast milk!
T cell activation; no with CD 4 or CD 8

49. what cell surface marker is used for NK cells as it is unique to them?
Popliteal
CD56
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
A j chain

50. Which is the main antibody that provides passive immunity to infants?
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
Tetanus - Botulinum - HBV - Rabies
IgG
TGF beta and IL 10

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USMLE Step 1 Immunology

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