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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 are the autoantibodies for polymyositis and dermatomyositis?
Anti IF
Adaptive uses classic pathway to kill; innate uses alternative pathway to kill
Paracortex; viral infection
Anti Jo -1

2. Type IV hypersensitivity is i...
Superior mesenteric
MHC I/CD8 and IL2/IL 2 Receptor (IL 2 is from Th1!); cytoxicity!
Rheumatic arthritis
not Ab mediated

3. What does granzyme do? who secretes it?
Anti nuclear Antibodies (ANA); Anti dsDNA - anti Smith
not Ab mediated
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
Its a serine protease that activates apoptosis; NK and CD8

4. Which disease is associated with HLA A3?
Hemochromatosis
C - ANCA (antiproteinase); in neutrophil; c= cytoplasmic
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
IgG and IgM bind to pathogens activating C1 convertase and leads to C2 and C4 and then C3 convertase activated

5. What is chronic mucocutaneous candidiasis d/t?
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
T cell dysfunction
Nuclear remnants that are usually taken out of RBC before complete maturation by Macrophages
Negative!

6. How do you test for type III hypersensitivity?
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
Immunoflourescent staining of tissue biopsies
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
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

7. which of the IL2 inhibitors produce nephrotoxicity? thrombocytopenia/leukopenia?
Tumor cells and virally infected cells; perforin pore to secrete granzymes through it; apoptosis
Cyclosporine and tacrolimus; sirolimus (as well as hyperlipidemia)
Nuclear remnants that are usually taken out of RBC before complete maturation by Macrophages
Anti IF

8. What lymph node drains the breast?
Cytokine IL 10 secreted by Th2
Axillary
Type IV
MHC class molecules bind to KIRS or CD94 to prevent killing

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

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10. what cell surface proteins are on all APCs?
IgG
Graves
MHC II - B7
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

11. What is anergy? why does this occur?
Acts as second signal on B cells to induce class switching to IgE and IgG
Lack of response from lymphocytes when activated; because they are self reactive - this is a form of tolerance
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

12. Often bacteria are associated with being killed by humoral immunity. Name some bugs that require cell mediated immunity because they evade humoral response
Its a serine protease that activates apoptosis; NK and CD8
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
Legionella - N. gonorrhea - L. monocytogenes - viruses - protozoa (leismaniasis)
Negative!

13. Which diseases are associated with DR2?
Anti Jo -1
DAF and C1 esterase inhibitor on cells prevent complement activation on their surfaces (microbial surfaces lack this)
IL 1 - IL 6 - IL 12 - TNF alpha; IL 6- Th2 cells; IL 12- B cells
MS - hay fever - SLE - goodpastures

14. other than eat and bite RBCs what else do Macrophages of spleen do>
A recomb cytokine of IL 2; RCC and metastatic melanoma
Rheumatic arthritis
Steroid responsive nephrotic syndrome
Remove encapsulated bacateria

15. The idiotype; the Fc portion determines the...
Negative selection
2 heavy chains and two light chains
isotype
Hyperacute; presence of preformed antibodies in the recipient ( to blood groups or HLA )

16. What are the autoantibodies for drug induced lupus?
CD56
Antihistone
IL 4 - 5 - 10 - 6
carboxy terminal

17. What is the defect in hyper IgM syndrome? What are the lab results?
opsonizes
Defect in CD40L results in inability to class switch; a lot of IgM and no IgG - A - E
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
Graves

18. What happens in a secondary follicle?
Isotype switching (activated by Th2 cell signals and cytokines) - somatic hypermutation
Edema and necrosis in that region
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
Increases expression of MHC I and MHC II and also activates NK cells

19. If the alternative pathway is constitively active - how come normal cells don't get attacked with MAC?
DAF and C1 esterase inhibitor on cells prevent complement activation on their surfaces (microbial surfaces lack this)
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
MHC I/CD8 and IL2/IL 2 Receptor (IL 2 is from Th1!); cytoxicity!

20. How does complement link innate and adaptive?
pathogenesis
Cells that stil have weird parts of their membrane that macrophages usually bite off
Normal pro B (CD 19 +) - no mature B cells results in decreased total B cell level - and decreased amount of immunoglobulins in each class
Adaptive uses classic pathway to kill; innate uses alternative pathway to kill

21. What are the autoantibodies for graves?
IL 3; supports growth and differentiation of bone marrow stem cells
2 heavy chains and two light chains
Anti TSh receptor
Antidote for digoxin intoxication

22. How is the antigen loaded onto a MHC II?
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
Interferon gamma; Th1
Negative nitroblue tetrazolium reduction test
Yes

23. IgM can exist as a _______ also
Its a serine protease that activates apoptosis; NK and CD8
dimer
Digeorge syndrome - 22q11 deletion resulting in failure to develop 3rd and 4th pharyngeal pouches; cardiac and great vessel congenital defects - tetany from hypocalcemia - recurrent viral/fungal infections from T cell deficiency; hypoPTH - hypoCa - a
pentamer

24. What happens in a deficiency of C3?
Periarteriolar lymphatic sheath in the white pulp that surround that dead end of the capillaries in the red pulp - contain T cells
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
Severe recurrent pyogenic sinus and resp tract And increased susceptibility to type III hypersensitivity like SLE
Legionella - N. gonorrhea - L. monocytogenes - viruses - protozoa (leismaniasis)

25. What are the T cell functions?
MHC I; from RER with help of the B2 microglobulin
Antidote for digoxin intoxication
Activate B cells - activate Macrophages - kill viruses directly - delayed cell mediated hypersensitivity - acute and chronic rejection
Activates Th1 helper cells; Macrophages

26. What is the most common selective Ig deficiency? What is the presentation?
A chemotactic factor for neutrophils
IgA; sinus and lung infections from lack of secretory defense - milk allergies and diarrhea from giardiasis; Anaphylasix on exposure to blood products with igA
No! That is why they are different from T cells - they can recognize antigens in free solution; if a bug has a peptide fragment that a mature naive B cell recognizes it will bind to it and cause activation - it then gets activated into a plasma cell!
MHC class molecules bind to KIRS or CD94 to prevent killing

27. What are the autoantibodies for pernicious anemia?
2 heavy chains and two light chains
type four
Defect in BTK a tyrosine kinase gene; failed maturation of B cells; X linked recessive
Anti IF

28. which of the transplant rejections is antibody mediated? why does it occur?
Hyperacute; presence of preformed antibodies in the recipient ( to blood groups or HLA )
MS
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
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

29. What lymph node drains the stomach?
The igA found in breast milk
Celiac
TLR ad nuclear receptors
not Ab mediated

30. what cytokine does basophils secrete?
Tetanus - Botulinum - HBV - Rabies
IL 4
Lack of response from lymphocytes when activated; because they are self reactive - this is a form of tolerance
Nuclear remnants that are usually taken out of RBC before complete maturation by Macrophages

31. what happens in order for class switching to occur (after being activated by IL and cd40 L)?
Immune complex - Arthus reaction and Serum sickness; they are all a result of antibody- antigen complex deposition resulting in complement activation
Chronic granulomatous disease
Alternative splicing of mRNA
Th1; interferon gamma; IL 2 for cytotoxic T cell activation

32. What is thrombopoietin used for?
isotype
Thrombocytopenia
IgM and IgD
Fab portion

33. Name the three opsonins
By transcytosis
CRP - C3b - IgM
...
IgM and IgA

34. What does IL 4 do?
Activate macrophages
Acts as second signal on B cells to induce class switching to IgE and IgG
Anti viral and anti tumor
Ischemia and necrosis of graft due to occlusion of vessels and fibrinoid necrosis and thrombosis within the vessels

35. Which type of selection of thymic development provides central tolerance?
An alpha chain and a B2 microglobulin; on all nucleated cells; TCR and CD8; intracellular antigens
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
Negative selection
C - ANCA (antiproteinase); in neutrophil; c= cytoplasmic

36. What can cause a lymph node enlargement?
pale central germinal centers
S. aureus - E. Coli - aspergillus
Local infection/inflammation; infection of the ln itself; metastasis
Carbohydrate

37. The Fc region is found on the...
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
Severe recurrent pyogenic sinus and resp tract And increased susceptibility to type III hypersensitivity like SLE
Cross link
carboxy terminal

38. 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
Proteins; IgG - IgM - endotoxin (microbial surfaces in general - nonspecific ones also) - mannose binding Lectin; classic - alternative - MB pathway (resp)
Periarteriolar lymphatic sheath in the white pulp that surround that dead end of the capillaries in the red pulp - contain T cells
IgM and IgG

39. What type of side chains are found on Fc region of an antibody?
Histamine (causes vasodilation) - leukotrienes (causes bronchoconstriction) - chemotaxins for eos - and heparin (increased blood flow needs to be anticoagulated!)
Lack of MHC class I constant region which it binds or a nonspecific activation signal (TLR)
Carbohydrate
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

40. All transplant rejections - _____________ are mediated by Type IV hypersensitivity
Recurrent sinopulmonary bacterial infections after 6 months (d/t mothers igGs transplacental) due to opsonization defect
A recomb cytokine of IL 2; RCC and metastatic melanoma
except hyperacute
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

41. What is the two fates of the RBCs that go through the spleen? what happens eventually to all of them>
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
Paracortex; viral infection
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
Rheumatic arthritis

42. What is the main function of interferons?
IL 3; supports growth and differentiation of bone marrow stem cells
Antiviral for uninfected cells (for future protection) and kills virally infected cells (NK activation)
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
Fibrosis of blood vessels and graft tissue from ischemia; obliterative vascular fibrosis with intimal thickening

43. Which diseases are associated with DR5?
IgG
Mycobacterium Tuberculosis - Mycobacterium Avium Intracellulare; Toxoplasmosis Gondii
opsonizes
Pernicious Anemia and Hashimotos

44. Which TCR MHC system is important for viral immunity? neoplastic? donor graft cells?
Trypanosomes with programmed rearrangement (results in recurring fever -- sleeping sickness!)
Periarteriolar lymphatic sheath in the white pulp that surround that dead end of the capillaries in the red pulp - contain T cells
Immunosuppression after kidney transplantation
All MHC 1/CD8

45. What is the clinical use for azathioprine?
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
...
MHC I; from RER with help of the B2 microglobulin

46. What is the presentation of common variable immunodef? and What are the labs?
CD40 (on b cell) CD40 ligand on Th2 cell; and interleukins (4 -5 -6) from Th2 cell; CD40 is actually the second signal
Periarteriolar lymphatic sheath in the white pulp that surround that dead end of the capillaries in the red pulp - contain T cells
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
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

47. Describe the interstitial tissue of a spleen including the sinuses. What type of cells are found in the four structures (cortex - paracortex - medulla and sinuses)?
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
Macrophages - Dendritic cells - B cells
Stimulate the liver to release acute phase reactants
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

48. which interleukin receptor is required for NK development? activation?
IL 15; IL 12 - interferon Beta and interferon alpha
SP infections
C5a
Induces fever - chemokine secretion to recruit - activates adhesion molecules; macrophages

49. What lymph node drains the lateral side of the dorsum of the foot?
HBV - HBC - Kaposis - leukemias - malignant melanoma - hairy cell leukemia and condyluma accuminata
MHC II - B7
carboxy terminal
Popliteal

50. in which immunodef order do you see a lot of pus? no pus?
Glycoproteins; HLA
CGD; Jobs syndrome (defect in Neutrophil chemotactic response)
pale central germinal centers
C - ANCA (antiproteinase); in neutrophil; c= cytoplasmic

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USMLE Step 1 Immunology

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