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

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2. The pathogenesis of contact dermatitis is ________ hypersensitivity
Vasculitis of graft vessels with dense interstitial lymphocytic infiltrate; yes! with immunosuppressants
type four
A j chain
Opsonize bacteria (for enhanced phagocytosis) - neutralize viruses (igG) - activate complement (igM and igG) - sensitize mast cells (igE)

3. What are the four steps in phagocytosis? What are the four disease that correspond to each step?
Opsonization (Brutons agammaglobulinemia) - adhesion (Leukocyte adhesion defect) - phagocytosis (chediak higashi syndrome) - respiratory burst (chronic granulomatous disease)
Induce differentiation of T cells into Th1 helper cells and activates NK cells also; B cells
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
Cell mediated due to T cell cytotoxicity reacting to foreign MHCs; few weeks after

4. What is an autograft? syngeneic graft? allograft? xenograft? What is an ex of an allograft? xenograft?
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
From self; from identical twin or clone; from nonidentical individual of same species; from different species; fetus; pig valve
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
Antihistone

5. are Th cells involved in trapping of antigens of endotoxin/LPS?
No because no peptide fragment!
Activates Th1 helper cells; Macrophages
Fever - urticaria - arthralgias - proteinuria - lymphadenopathy
Cytokine IL 10 secreted by Th2

6. What do mature naive B lymphocytes express?
Lack of response from lymphocytes when activated; because they are self reactive - this is a form of tolerance
Carbohydrate
No because no peptide fragment!
IgM and IgD

7. What are the autoantibodies for autoimmune hepatitis?
Anti smooth muscle
The patient could become cyanotic in the OR!
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)
Immunosuppression after kidney transplantation in combination with cyclosporine and corticosteroids

8. What does granulysin do?
...
Pernicious Anemia and Hashimotos
Antimicrobial also secreted by CD8 and NK cells that induces apoptsosis
Immunosuppression after kidney transplantation

9. Name the three opsonins
Cyclosporine - OKT3
Immunosuppression after kidney transplantation
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
CRP - C3b - IgM

10. What does interferon gamma do? What two type of cells does it attack mostly?
Activate macrophages
Activates Macrophages and Th1 cells; suppresses Th2 cells; antiviral and antitumor
CD21 on B cells (although there is T cell lymphocytosis in EBV)
MHC II - B7

11. What is the toxicity of muromonab?
Fibrosis of blood vessels and graft tissue from ischemia; obliterative vascular fibrosis with intimal thickening
Salmonella - 2 flagellar variants; Borrelia (relapsing fever); and Neisseria gonorrhoaea - pilus protein
Cytokine release syndrome due to initial release from initial binding (fever etc) and hypersensitivity reaction
pentamer

12. What are the symptoms of serum sickness?
Fever - urticaria - arthralgias - proteinuria - lymphadenopathy
Fab portion
Anti mitochondrial
IL 1 and IL 6

13. What are the autoantibodies for primary biliary cirrhosis?
TNF alpha and IL1
Tumor cells and virally infected cells; perforin pore to secrete granzymes through it; apoptosis
Cell mediated due to T cell cytotoxicity reacting to foreign MHCs; few weeks after
Anti mitochondrial

14. What are the T cell functions?
Septicemia with neisseria; because at least you have C3 to act like a neutrophilic chemotactic and an acute phase reactant
Activate B cells - activate Macrophages - kill viruses directly - delayed cell mediated hypersensitivity - acute and chronic rejection
Superior mesenteric
Antidesmoglein

15. What is a type I hypersensitivity reaction? What is atopic?
An anaphylactic immediate reaction; atopy refers to the inherited propensity to develop asthmatic or allergic reactions
Antimicrosomal and antithyroglobulin
IgA
Secretory component

16. other than C3a - what other complement acts as an anaphyloxin?
C5a
Anti topoisomerase
Yes
A B and T cell disorder; defect in DNA repair enzymes; ataxia - telangactasia and IgA def; igA def. and increased AFP

17. What is the mechanism for sirolimus? what else it known as?
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
A j chain
Psoriasis - Ankylosis Spondylitis - IBD - Reiters; all seronegative spondylopathies
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

18. What is recomb beta interferon used for?
T cell activation; no with CD 4 or CD 8
MS
Para aortic
The place of T cell diff and maturation; ant mediastinum above heart; yes; 2

19. What are the labs in brutons agammaglobulinemia?
Cell mediated due to T cell cytotoxicity reacting to foreign MHCs; few weeks after
Lack of response from lymphocytes when activated; because they are self reactive - this is a form of tolerance
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
Normal pro B (CD 19 +) - no mature B cells results in decreased total B cell level - and decreased amount of immunoglobulins in each class

20. What are MHC's necessary for? By themselves?
T cell activation; no with CD 4 or CD 8
C3b; coating of a pathogen with molecules that promotes phagocytosis; IgG and CRP
Hemochromatosis
Histamine; post capillary venules - vasodilation

21. How do we use thymus dependent antigens to prevent infection from organisms that lack a peptide component?
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
Leukocyte adhesion defect; ataxia telangietasia; ataxia telangiectasia; chediak higashi syndrome; IgA def; Digeorge syndrome; Jobs; Chediak Higashi
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
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

22. What is the pathogenesis of chronic granulomatous disease; What is the presentation? What is the labs?
Lack of MHC class I constant region which it binds or a nonspecific activation signal (TLR)
Adenosine deaminase deficiency (AR) - defective IL 2 receptor (X linked) - and failure to synthesize MHC II; both humoral and cell mediated deficiency
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
Lack of NADPH oxidase results in a lack of respiratory burst in neutrophils; susceptibility to catalase positive organisms (S. aureus - E. Coli - Aspergillus)

23. What are the autoantibodies for Celiac disease?
Scratch test - histamine mediated wheal; radioimmunosorbent assay (detects specific IgEs in serum)
Antigliadin - antiendomysial (both are IgAs - anti tissue transgluataminase igA)
pentamer
Kill them because they have CD16 on them that recognize the FcG portion

24. what cytokine does basophils secrete?
By transcytosis
IL 4
Macrophages - Dendritic cells - B cells
Influenza; antigenic shift; antigenic drift

25. What is passive immunity?
IgE
Receiving preformed Antibodies
Type IV
HBV - HBC - Kaposis - leukemias - malignant melanoma - hairy cell leukemia and condyluma accuminata

26. IgE has the ___________ in the serum
lowest concentration
Ig - CD19 - CD20 - CD21 - CD40 - MHC II - B7
If there is class switching and plasma cell production (that is when memory cells are produced)
Anti topoisomerase

27. How do you test for type III hypersensitivity?
Immunoflourescent staining of tissue biopsies
RNA segment reassortment
...
T cell precursor

28. What is the main cytokine that activates eosinophils?
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
Popliteal
IL 5
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 :(

29. What lymph node drains the scrotum?
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
DAF and C1 esterase inhibitor on cells prevent complement activation on their surfaces (microbial surfaces lack this)
Viral neutralization of igM and IgG!
Superficial inguinal

30. which antibody is involved in the primary response or immediate response to an antigen?
Superior mesenteric
IgM
Cross link
pathogenesis

31. can igG cross the placenta?
Kill them because they have CD16 on them that recognize the FcG portion
Tumor cells and virally infected cells; perforin pore to secrete granzymes through it; apoptosis
MHC II - B7 - CD40 and CD14; CD40 and D14 for FcG and C3b resp
Yes

32. What is anergy? why does this occur?
IgM
Cell mediated due to T cell cytotoxicity reacting to foreign MHCs; few weeks after
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

33. What are the autoantibodies for systemic sclerosis?
P - ANCA (antimyeloperoxidase); in neutrophil; p= perinuclear
Proteins; IgG - IgM - endotoxin (microbial surfaces in general - nonspecific ones also) - mannose binding Lectin; classic - alternative - MB pathway (resp)
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
Anti topoisomerase

34. All transplant rejections - _____________ are mediated by Type IV hypersensitivity
except hyperacute
Both decrease cd8 tcell prolif but one through mtor and the other through calcineurin (resp)
IL 3; supports growth and differentiation of bone marrow stem cells
From self; from identical twin or clone; from nonidentical individual of same species; from different species; fetus; pig valve

35. What are the autoantibodies for pemphigus bulgaris?
Antidesmoglein
Recurrent infections to every type of antigen; bone marrow transplant (be weary of GVH disease!)
Superior mesenteric
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

36. What are the autoantibodies for Mixed connective tissue disease?
CD40 (on b cell) CD40 ligand on Th2 cell; and interleukins (4 -5 -6) from Th2 cell; CD40 is actually the second signal
Cyclosporine - OKT3
Anti U1 RNP (ribonucleoprotein)
T cells react to the angtigen and activate leukocyted (macrophage acitivation)

37. what secretes IL 4?
2 heavy chains and two light chains
The place of T cell diff and maturation; ant mediastinum above heart; yes; 2
Basophils! THey want IG E class switch!
Superficial inguinal

38. What are some sinopulmonary infections?
Sinusitis - otitis media - pneumonia
IL 3; supports growth and differentiation of bone marrow stem cells
By transcytosis
neutrophilia!

39. which cytokine inhibits TH2 cells? secreted by who?
...
TNF alpha and IL1
Interferon gamma; Th1
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

40. Which type of selection of thymic development provides central tolerance?
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
Monoclonal Ab to CD3- blocks cellular transduction and signaling of T cells
IL 4 - 5 - 10 - 6
Negative selection

41. What are the sinusoids of the spleen? What is the difference between a spleen and a lymph node?
The igA found in breast milk
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
RNA segment reassortment
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

42. What does IL 10 do? who is secreted by?
Suppresses immune response (also specifically Th1 cells) and activates Th2; regulatory T cells
Anti nuclear Antibodies (ANA); Anti dsDNA - anti Smith
B - T - and NK cells
Negative!

43. which of the IL2 inhibitors produce nephrotoxicity? thrombocytopenia/leukopenia?
Cyclosporine and tacrolimus; sirolimus (as well as hyperlipidemia)
Antiviral for uninfected cells (for future protection) and kills virally infected cells (NK activation)
IL 15; IL 12 - interferon Beta and interferon alpha
Type III hypersensitivity where an internal antigen antibody complexes activate classical complement pathway resulting in C3a neutrophilic chemotaxis and neutrophilic lysosomal death. SLE

44. which antibodies prevent antigens from binding mucosal surfaces?
HBV - HBC - Kaposis - leukemias - malignant melanoma - hairy cell leukemia and condyluma accuminata
...
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
IgA

45. Which disease is associated with B8?
Graves
Basophils! THey want IG E class switch!
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
Legionella - N. gonorrhea - L. monocytogenes - viruses - protozoa (leismaniasis)

46. What is the autoantibody for SLE that is nonspecific? Specific?
Anti nuclear Antibodies (ANA); Anti dsDNA - anti Smith
CRP - C3b - IgM
Its main effect is a defect in Ab opsonization for killing
When you select for which MHC it will have; take out the lymphs that self react

47. What is the main function of TNF alpha? How does it do this?
Mediates septic shock; activates the endothelium for adhesion and dilation and leukocyte recruitment results in vascular leak
Its a serine protease that activates apoptosis; NK and CD8
Activate macrophages
A recomb cytokine of IL 2; RCC and metastatic melanoma

48. What is the pathology of acute transplant rejection? is it reversible?
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
Opsonization (Brutons agammaglobulinemia) - adhesion (Leukocyte adhesion defect) - phagocytosis (chediak higashi syndrome) - respiratory burst (chronic granulomatous disease)
Vasculitis of graft vessels with dense interstitial lymphocytic infiltrate; yes! with immunosuppressants
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

49. What are four results of a splenectomy?
Normal pro B (CD 19 +) - no mature B cells results in decreased total B cell level - and decreased amount of immunoglobulins in each class
CRP - C3b - IgM
Complement activation (active in both)
1) susceptibility to encapsulated organisms 2) Howell Jolly Bodies 3) Target cells 4) Thrombocytosis

50. What is the presentation of Brutons agammaglobulinemia?
Recurrent sinopulmonary bacterial infections after 6 months (d/t mothers igGs transplacental) due to opsonization defect
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
S. aureus - E. Coli - aspergillus
MHC II/CD4 and B7 (on APC) and CD28 (on Th cell); releases cytokines to kill those extracellular buggers!

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USMLE Step 1 Immunology

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