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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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Match each statement with the correct term.
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This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. what happens in a deficiency of C5- C8? why dont you get recurrent pyogenic infections like in C3 def?
Antimicrosomal and antithyroglobulin
MHC I; from RER with help of the B2 microglobulin
Septicemia with neisseria; because at least you have C3 to act like a neutrophilic chemotactic and an acute phase reactant
Adenosine deaminase deficiency (AR) - defective IL 2 receptor (X linked) - and failure to synthesize MHC II; both humoral and cell mediated deficiency

2. What is an example of a parasite showing antigenic variation?
Trypanosomes with programmed rearrangement (results in recurring fever -- sleeping sickness!)
Histamine; post capillary venules - vasodilation
Nuclear remnants that are usually taken out of RBC before complete maturation by Macrophages
Its involved in inflammation and results in anaphylaxis and neutrophil chemotaxis.

3. What are HEV? Where are they found? Where does the vasculature of the lymph node travel to?
Leukocyte adhesion defect; ataxia telangietasia; ataxia telangiectasia; chediak higashi syndrome; IgA def; Digeorge syndrome; Jobs; Chediak Higashi
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
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
Celiac

4. What are the autoantibodies for wegeners granulomatosis?
By transcytosis
C - ANCA (antiproteinase); in neutrophil; c= cytoplasmic
not Ab mediated
encapsulated

5. Give an example of someone who could get hyperacute transplant rejection.
Activate macrophages
Hemochromatosis
Ig - CD19 - CD20 - CD21 - CD40 - MHC II - B7
Previous transfusion; pregnant woman whose fetus had paternal antigens

6. IgM can fix complement but...
IgM and IgA
Anti IF
DM type I
cannot cross placenta

7. __________ are a part of the innate system.
Basophils! THey want IG E class switch!
NK cells
Antimicrosomal and antithyroglobulin
T

8. what prevents NK cells from killing normal cells if their default is to kill?
Both decrease cd8 tcell prolif but one through mtor and the other through calcineurin (resp)
DM type I and RA
Since it is a comp dependent type II hypersensitivity reaction; C3a brings anaphylotoxins that bring in mediators of shock
MHC class molecules bind to KIRS or CD94 to prevent killing

9. What are the function of B cells?
Make antibody - allergy type 1 (igE) - Cytotoxic and immunecomplex hypersensitivity type II and III (igG); hyperacute organ rejection is Ab mediated
IL 1 and IL 6
The igA found in breast milk
1) VJ light chain random creation 2) VDJ (heavy chain) random creation 3) random combination of light with heavy 4) somatic hypermutation (high frequency mutating that occurs on activation) 5) terminal deoxynucleotidyl transferase (TDT) random additi

10. What lymph node drains the lateral side of the dorsum of the foot?
Kill them because they have CD16 on them that recognize the FcG portion
Anti smooth muscle
encapsulated
Popliteal

11. How fast does it occur?
The patient could become cyanotic in the OR!
IL 3; supports growth and differentiation of bone marrow stem cells
T cells react to the angtigen and activate leukocyted (macrophage acitivation)
pale central germinal centers

12. Which diseases are associated with DR5?
lowest concentration
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
Pernicious Anemia and Hashimotos
Activates cytotoxic CD 8 T cells as second signal

13. Only the _______ contribute to the Fc region
A chemotactic factor for neutrophils
Activates Macrophages and Th1 cells; suppresses Th2 cells; antiviral and antitumor
heavy chains
CGD; Jobs syndrome (defect in Neutrophil chemotactic response)

14. What is recomb alpha interferon used for?
HBV - HBC - Kaposis - leukemias - malignant melanoma - hairy cell leukemia and condyluma accuminata
opsonizes
RNA segment reassortment
If there is class switching and plasma cell production (that is when memory cells are produced)

15. What is the presentation of hyperIgM syndrome?
Humoral
Viral neutralization of igM and IgG!
Severe pyogenic infections early in life
Celiac

16. How does igA cross the epithelium?
IL 4
By transcytosis
T
Immunosuppression after kidney transplantation in combination with cyclosporine and corticosteroids

17. What is the general structure of an Ab?
2 heavy chains and two light chains
Anti smooth muscle
Superficial inguinal
type four

18. What kinds of receptors activate innate immunity?
TLR ad nuclear receptors
Negative!
opsonizes
Basophils! THey want IG E class switch!

19. which interleukin receptor is required for NK development? activation?
IL 15; IL 12 - interferon Beta and interferon alpha
Histamine; post capillary venules - vasodilation
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
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

20. What cytokines to Th2 secrete?
Nuclear remnants that are usually taken out of RBC before complete maturation by Macrophages
IL 3; supports growth and differentiation of bone marrow stem cells
Severe pyogenic infections early in life
IL 4 - 5 - 10 - 6

21. What part of the complement system also acts as an opsonin? What is opsonization? can you Name two other opsonins?
...
IgM and IgD
C3b; coating of a pathogen with molecules that promotes phagocytosis; IgG and CRP
Superficial inguinal

22. Which disease is associated with DR3?
Defect in BTK a tyrosine kinase gene; failed maturation of B cells; X linked recessive
type four
DM type I
Inferior mesenteric

23. which of the IL2 inhibitors produce nephrotoxicity? thrombocytopenia/leukopenia?
MHC II/CD4 and B7 (on APC) and CD28 (on Th cell); releases cytokines to kill those extracellular buggers!
Stimulate the liver to release acute phase reactants
Cyclosporine and tacrolimus; sirolimus (as well as hyperlipidemia)
IL 4

24. The two heavy chains of an antibody contribute to the...
Basophils! THey want IG E class switch!
Receiving preformed Antibodies
Antihistone
Fab portion

25. explain the process from beginning (ie phagocytosis of the peptide) to end of how Abs are formed in Goodpasteurs.
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
Severe recurrent pyogenic sinus and resp tract And increased susceptibility to type III hypersensitivity like SLE
IgG and IgM bind to pathogens activating C1 convertase and leads to C2 and C4 and then C3 convertase activated
For some reason a mature naive B lymphocyte got away from tolerance and the result was a production an Ab on its surface with an Fab region that recognized the alpha 3 collagen subunit on the BM as non self. It then gets activated by a Th2 cell (enti

26. What are four results of a splenectomy?
Rheumatic arthritis
1) susceptibility to encapsulated organisms 2) Howell Jolly Bodies 3) Target cells 4) Thrombocytosis
S. aureus - E. Coli - aspergillus
Activates cytotoxic CD 8 T cells as second signal

27. What is the main function of TNF alpha? How does it do this?
T cells react to the angtigen and activate leukocyted (macrophage acitivation)
Coarse Faces - cold (noninflamed d/t inability to attract neutrophils) staph abscesses - retained primary teeth - high igE - dermatologic problems (eczema)
Mediates septic shock; activates the endothelium for adhesion and dilation and leukocyte recruitment results in vascular leak
NK cells

28. What lymph node drains the stomach?
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
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)
False! B cell class switching requires a second signal
Celiac

29. If the alternative pathway is constitively active - how come normal cells don't get attacked with MAC?
Immunosuppression after kidney transplantation
DAF and C1 esterase inhibitor on cells prevent complement activation on their surfaces (microbial surfaces lack this)
Induce differentiation of T cells into Th1 helper cells and activates NK cells also; B cells
Internal iliac

30. How does the alternative pathway lead to MAC activation?
CGD; Jobs syndrome (defect in Neutrophil chemotactic response)
Scratch test - histamine mediated wheal; radioimmunosorbent assay (detects specific IgEs in serum)
Fab portion
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

31. What lymph node drains the duodenum - jejunum?
Superior mesenteric
Alternative splicing of mRNA
Antimicrobial also secreted by CD8 and NK cells that induces apoptsosis
For some reason a mature naive B lymphocyte got away from tolerance and the result was a production an Ab on its surface with an Fab region that recognized the alpha 3 collagen subunit on the BM as non self. It then gets activated by a Th2 cell (enti

32. What are the autoantibodies for type I diabetes mellitus?
Anti glutamate carboxylase and anti insulin
CD21 on B cells (although there is T cell lymphocytosis in EBV)
B - T - and NK cells
pentamer

33. In thymic development - What is the positive selection? negative selections?
RNA segment reassortment
Paracortex; viral infection
Antidote for digoxin intoxication
When you select for which MHC it will have; take out the lymphs that self react

34. What lymph node drains the anal canal (below the pectinate line)?
Severe recurrent pyogenic sinus and resp tract And increased susceptibility to type III hypersensitivity like SLE
Humoral
Chronic granulomatous disease
Superficial inguinal

35. What lymph node drains the testes?
Antibody mediated cytotoxicity; either complement dependent or complement independent
Yes
Para aortic
Lack of MHC class I constant region which it binds or a nonspecific activation signal (TLR)

36. What are the autoantibodies for Mixed connective tissue disease?
...
IgG
Anti U1 RNP (ribonucleoprotein)
A j chain

37. What is the autoantibody for SLE that is nonspecific? Specific?
AR; defect in MT function results in decreased transport and phagocytosis; recurrent pyogenic infections by staphylococci and streptococci - partial albinism - and peripheral neuropathy
Proteins; IgG - IgM - endotoxin (microbial surfaces in general - nonspecific ones also) - mannose binding Lectin; classic - alternative - MB pathway (resp)
C - ANCA (antiproteinase); in neutrophil; c= cytoplasmic
Anti nuclear Antibodies (ANA); Anti dsDNA - anti Smith

38. What happens in a secondary follicle?
dimer
Lack of NADPH oxidase results in a lack of respiratory burst in neutrophils; susceptibility to catalase positive organisms (S. aureus - E. Coli - Aspergillus)
Isotype switching (activated by Th2 cell signals and cytokines) - somatic hypermutation
A j chain

39. A lymph node is a ________ lymphoid organ.
Coarse Faces - cold (noninflamed d/t inability to attract neutrophils) staph abscesses - retained primary teeth - high igE - dermatologic problems (eczema)
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 :(
secondary
Acts as second signal on B cells to induce class switching to IgE and IgG

40. What does IL 5 do?
Acts as second signal on B cells to induce class switching to IgA; also stimulates eosinophils
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
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
Daclizumab; prevent ACUTE rejection of renal transplant

41. The MALT/GALT are not...
CGD; Jobs syndrome (defect in Neutrophil chemotactic response)
encapsulated
IL 1 and IL 6
IL 3; supports growth and differentiation of bone marrow stem cells

42. Which cytokines do Th2 release and For what?
pale central germinal centers
IL 4 -5 -6 for B cell class switching - IL 10 to inhibit TH1
IgM and IgA
TNF alpha and IL1

43. How is the thymus organized? what happens in each section?
Lack of NADPH oxidase results in a lack of respiratory burst in neutrophils; susceptibility to catalase positive organisms (S. aureus - E. Coli - Aspergillus)
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
Antiviral by inducing ribonuclease which degrades only viral mRNA (prevents protein synthesis) and activates NK cells to kill virus infected cells
IgE; by activating eosinophils

44. What is an autograft? syngeneic graft? allograft? xenograft? What is an ex of an allograft? xenograft?
From self; from identical twin or clone; from nonidentical individual of same species; from different species; fetus; pig valve
Mycobacterium Tuberculosis - Mycobacterium Avium Intracellulare; Toxoplasmosis Gondii
Monoclonal Ab to CD3- blocks cellular transduction and signaling of T cells
Anti glutamate carboxylase and anti insulin

45. What are the autoantibodies for systemic sclerosis?
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
Anti topoisomerase
Immunosuppression after kidney transplantation
IgA; sinus and lung infections from lack of secretory defense - milk allergies and diarrhea from giardiasis; Anaphylasix on exposure to blood products with igA

46. Name two endogenous pyrogens
Edema and necrosis in that region
IL 1 and IL 6
Coarse Faces - cold (noninflamed d/t inability to attract neutrophils) staph abscesses - retained primary teeth - high igE - dermatologic problems (eczema)
Previous transfusion; pregnant woman whose fetus had paternal antigens

47. What is the pathogenesis of HyperIgE syndrome? What are the labs?
Anti Ach receptor
Suppresses immune response (also specifically Th1 cells) and activates Th2; regulatory T cells
IL 1 - IL 6 - IL 12 - TNF alpha; IL 6- Th2 cells; IL 12- B cells
Th cells fail to produce interferon gamma; a lot of IgE

48. What is the marginal zone of the spleen? what happens there?
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
No because no peptide fragment!
Th cells fail to produce interferon gamma; a lot of IgE
Hyperacute; presence of preformed antibodies in the recipient ( to blood groups or HLA )

49. Which Thelper cell activated Macrophages? by secreting what? what else does Th1 secrete? For what?
Daclizumab; prevent ACUTE rejection of renal transplant
CD40 (on b cell) CD40 ligand on Th2 cell; and interleukins (4 -5 -6) from Th2 cell; CD40 is actually the second signal
Anti nuclear Antibodies (ANA); Anti dsDNA - anti Smith
Th1; interferon gamma; IL 2 for cytotoxic T cell activation

50. Which disease is associated with B8?
Graves
except hyperacute
Anti TSh receptor
...

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USMLE Step 1 Immunology

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