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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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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. is IgM an opsonizer?
Opsonize bacteria (for enhanced phagocytosis) - neutralize viruses (igG) - activate complement (igM and igG) - sensitize mast cells (igE)
Negative!
Antidote for digoxin intoxication
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

2. What is the clinical use of Muromonab?
Carbohydrate
IgA; sinus and lung infections from lack of secretory defense - milk allergies and diarrhea from giardiasis; Anaphylasix on exposure to blood products with igA
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
Immunosuppression after kidney transplantation

3. which of the IL2 inhibitors produce nephrotoxicity? thrombocytopenia/leukopenia?
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
Cyclosporine and tacrolimus; sirolimus (as well as hyperlipidemia)
IgM
Remove encapsulated bacateria

4. What type of fenestrations are found in the red pulp of the spleen?
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
Opsonize bacteria (for enhanced phagocytosis) - neutralize viruses (igG) - activate complement (igM and igG) - sensitize mast cells (igE)
Barrel hoop basement membrane fenestrations
Th2; Th1

5. describe the pathogenesis of delayed type IV hypersensitivity
Defect in CD40L results in inability to class switch; a lot of IgM and no IgG - A - E
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
T cells react to the angtigen and activate leukocyted (macrophage acitivation)
Superficial inguinal

6. Which antibody mediates immunity to worms? how?
SP infections
C - ANCA (antiproteinase); in neutrophil; c= cytoplasmic
Inferior mesenteric
IgE; by activating eosinophils

7. How is sirolimus different from tacrolimus?
isotype
IL 15; IL 12 - interferon Beta and interferon alpha
Both decrease cd8 tcell prolif but one through mtor and the other through calcineurin (resp)
MHC II/CD4 and B7 (on APC) and CD28 (on Th cell); releases cytokines to kill those extracellular buggers!

8. DTH (delayed type hypersensitivity) is the ________ of a PPD reaction
Negative nitroblue tetrazolium reduction test
pathogenesis
IL 3; supports growth and differentiation of bone marrow stem cells
The patient could become cyanotic in the OR!

9. Which Thelper cell activated Macrophages? by secreting what? what else does Th1 secrete? For what?
Lack of MHC class I constant region which it binds or a nonspecific activation signal (TLR)
Superior mesenteric
Th1; interferon gamma; IL 2 for cytotoxic T cell activation
MHC I - CD16 - CD56

10. What is a factor that is a predictor for a bad transplantation?
acute phase reactants
not Ab mediated
Patient has had previous exposure to blood products which result in presence of preformed anti HLA cytotoxic Abs
Superficial inguinal

11. IgG...
Hemochromatosis
MHC I/CD8 and IL2/IL 2 Receptor (IL 2 is from Th1!); cytoxicity!
Immune complex - Arthus reaction and Serum sickness; they are all a result of antibody- antigen complex deposition resulting in complement activation
opsonizes

12. What is ataxia telangectasia? What is it caused by? What is the triad of presentation? and its labs?
Cyclosporine and tacrolimus; sirolimus (as well as hyperlipidemia)
Yes
TCR - CD4/8 - CD28 (binds B7) - CD3 (for intracellular transduction) - CD40L
A B and T cell disorder; defect in DNA repair enzymes; ataxia - telangactasia and IgA def; igA def. and increased AFP

13. What are the autoantibodies for wegeners granulomatosis?
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
C - ANCA (antiproteinase); in neutrophil; c= cytoplasmic
Monoclonal Ab to CD3- blocks cellular transduction and signaling of T cells
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

14. What is chronic mucocutaneous candidiasis d/t?
P - ANCA (antimyeloperoxidase); in neutrophil; p= perinuclear
Wiskott Aldrich syndrome
T cell dysfunction
Opsonize bacteria (for enhanced phagocytosis) - neutralize viruses (igG) - activate complement (igM and igG) - sensitize mast cells (igE)

15. Which disease is associated with DR3?
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
Receiving preformed Antibodies
IgM and IgD
DM type I

16. IgE has the ___________ in the serum
DAF and C1 esterase inhibitor on cells prevent complement activation on their surfaces (microbial surfaces lack this)
Cytokine IL 10 secreted by Th2
lowest concentration
Bind FcG for antibody dependent cellular cytotoxicity

17. What are the three immune privileged sites? why are they called that? what happens after infection in these areas?
Pernicious Anemia and Hashimotos
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
An anaphylactic immediate reaction; atopy refers to the inherited propensity to develop asthmatic or allergic reactions
dimer

18. What is digoxin immune Fab used for?
Antidote for digoxin intoxication
Celiac
Tetanus - Botulinum - HBV - Rabies
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

19. What type of side chains are found on Fc region of an antibody?
Carbohydrate
Cell mediated due to T cell cytotoxicity reacting to foreign MHCs; few weeks after
Periarteriolar lymphatic sheath in the white pulp that surround that dead end of the capillaries in the red pulp - contain T cells
Severe recurrent pyogenic sinus and resp tract And increased susceptibility to type III hypersensitivity like SLE

20. describe the classic complement pathway.
Not thymus - BM
A B and T cell disorder; defect in DNA repair enzymes; ataxia - telangactasia and IgA def; igA def. and increased AFP
Antihistone
IgG and IgM bind to pathogens activating C1 convertase and leads to C2 and C4 and then C3 convertase activated

21. What is colostrum?
IL 4 -5 -6 for B cell class switching - IL 10 to inhibit TH1
The patient could become cyanotic in the OR!
Induce differentiation of T cells into Th1 helper cells and activates NK cells also; B cells
The igA found in breast milk

22. What are the autoantibodies for goodpastures syndrome?
MS
Anti alpha subunit 3 of collagen on type IV bm
RNA segment reassortment
opsonizes

23. What is thrombopoietin used for?
cannot cross placenta
Thrombocytopenia
carboxy terminal
neutrophilia!

24. What do macrophages secrete that activate Th1 cells to secrete interferon gamma?
TNF alpha and IL1
Defect in BTK a tyrosine kinase gene; failed maturation of B cells; X linked recessive
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
Superficial inguinal

25. What is filgrastim and sargramostim? and What is it used for?
Recomb cytokine of GCSF (granulocyte macrophage colony stimulating factor; for recovery of bone marrow
Activates Macrophages and Th1 cells; suppresses Th2 cells; antiviral and antitumor
IL 5
Basophils! THey want IG E class switch!

26. What does IL 10 do? who is secreted by?
Th2; Th1
IgG
Opsonize bacteria (for enhanced phagocytosis) - neutralize viruses (igG) - activate complement (igM and igG) - sensitize mast cells (igE)
Suppresses immune response (also specifically Th1 cells) and activates Th2; regulatory T cells

27. What do multimeric antibodies require for assembly?
TGF beta and IL 10
P - ANCA (antimyeloperoxidase); in neutrophil; p= perinuclear
RNA segment reassortment
A j chain

28. What does it mean if there are igM in the serum at birth?
CD56
Since cant cross placenta most likely means that child was forced early to produce due to an infection (most likely CMV)
Its involved in inflammation and results in anaphylaxis and neutrophil chemotaxis.
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

29. with failed maturation of B cells in Brutons agammaglobulinemia - What is its effect on immune pathways and why?
Scratch test - histamine mediated wheal; radioimmunosorbent assay (detects specific IgEs in serum)
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
Its main effect is a defect in Ab opsonization for killing
Carbohydrate

30. What is oprelevkin? and What is it used for?
Internal iliac
Anti U1 RNP (ribonucleoprotein)
Recom IL 11; thrombocytopenia
Superficial inguinal

31. What is the thymus ? Where is it located? is it encapsulated? How many lobes does it have?
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
IgG
The place of T cell diff and maturation; ant mediastinum above heart; yes; 2
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

32. Which cytokines do Th2 release and For what?
IL 4 -5 -6 for B cell class switching - IL 10 to inhibit TH1
Recurrent infections to every type of antigen; bone marrow transplant (be weary of GVH disease!)
Scratch test - histamine mediated wheal; radioimmunosorbent assay (detects specific IgEs in serum)
Anti Jo -1

33. What are C1 - C2 - C3 - C4 important for?
T
C5a
Viral neutralization of igM and IgG!
Superficial inguinal

34. What is the antimetabolite precursor of 6 mercaptopurine? What is the result?
MHC class molecules bind to KIRS or CD94 to prevent killing
...
A - B - C; all the D's
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!

35. what cell surface proteins are on all APCs?
Induce differentiation of T cells into Th1 helper cells and activates NK cells also; B cells
AR; defect in MT function results in decreased transport and phagocytosis; recurrent pyogenic infections by staphylococci and streptococci - partial albinism - and peripheral neuropathy
The antibodies (igM or IgG) either neutralize the target directly (cytoxic!) or recruit leukocytes (Neutrophils and Macrophages!) to incite tissue damage
MHC II - B7

36. How do you test for chronic granulomatous disease?
Cytokine release syndrome due to initial release from initial binding (fever etc) and hypersensitivity reaction
Negative nitroblue tetrazolium reduction test
By transcytosis
Inferior mesenteric

37. What is the clinical use for azathioprine?
dimer
Antihistone
IgG
...

38. What are the autoantibodies for Celiac disease?
dimer
Antigliadin - antiendomysial (both are IgAs - anti tissue transgluataminase igA)
Recurrent sinopulmonary bacterial infections after 6 months (d/t mothers igGs transplacental) due to opsonization defect
Th cells fail to produce interferon gamma; a lot of IgE

39. What happens in a secondary follicle?
neutrophilia!
Influenza; antigenic shift; antigenic drift
SP infections
Isotype switching (activated by Th2 cell signals and cytokines) - somatic hypermutation

40. what results in symptoms of shock in an acute hemolytic transfusion reaction?
Anticentromere; anti Scl -70 (anti DNA topoisomerase I)
Since it is a comp dependent type II hypersensitivity reaction; C3a brings anaphylotoxins that bring in mediators of shock
SP infections
Superior mesenteric

41. What is the white pulp of the spleen?
Surrounds the red pulp and begins with PALS and then turns into follicles with B cells/follicles
Paracortex
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
Wiskott Aldrich syndrome

42. What are the two signals required for Th1 cells? what happens after then activated?
Defect in CD40L results in inability to class switch; a lot of IgM and no IgG - A - E
Cytokine release syndrome due to initial release from initial binding (fever etc) and hypersensitivity reaction
MHC II/CD4 and B7 (on APC) and CD28 (on Th cell); releases cytokines to kill those extracellular buggers!
Immunosuppression after kidney transplantation in combination with cyclosporine and corticosteroids

43. which antibody activate mast cells - basophils - and eosinophils?
encapsulated
IgE
Isotype switching (activated by Th2 cell signals and cytokines) - somatic hypermutation
not Ab mediated

44. What is the presentation of Brutons agammaglobulinemia?
Anti mitochondrial
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
Fever - urticaria - arthralgias - proteinuria - lymphadenopathy
Recurrent sinopulmonary bacterial infections after 6 months (d/t mothers igGs transplacental) due to opsonization defect

45. Which disease is associated with DR7?
Steroid responsive nephrotic syndrome
mesenchymal
Mycobacterium Tuberculosis - Mycobacterium Avium Intracellulare; Toxoplasmosis Gondii
Recomb cytokine of GCSF (granulocyte macrophage colony stimulating factor; for recovery of bone marrow

46. The Fc region is found on the...
Induces fever - chemokine secretion to recruit - activates adhesion molecules; macrophages
Severe pyogenic infections early in life
TLR ad nuclear receptors
carboxy terminal

47. What is the result of an IL 12 deficiency? What is the presentation? What are the labs?
Lack of response from lymphocytes when activated; because they are self reactive - this is a form of tolerance
Mediates septic shock; activates the endothelium for adhesion and dilation and leukocyte recruitment results in vascular leak
Decreased Th1 response; disseminated mycobacterial infections; decreased interferon gamma
By transcytosis

48. What is the pathogenesis of chronic granulomatous disease; What is the presentation? What is the labs?
Lack of NADPH oxidase results in a lack of respiratory burst in neutrophils; susceptibility to catalase positive organisms (S. aureus - E. Coli - Aspergillus)
T cell activation; no with CD 4 or CD 8
IgM and IgA
Ig - CD19 - CD20 - CD21 - CD40 - MHC II - B7

49. Type IV hypersensitivity is i...
Type IV
Wiskott Aldrich syndrome
encapsulated
not Ab mediated

50. Which TCR MHC system is important for viral immunity? neoplastic? donor graft cells?
All MHC 1/CD8
Cytokine IL 10 secreted by Th2
T cell dysfunction
Macrophages - Dendritic cells - B cells

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USMLE Step 1 Immunology

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