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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. Which helper T cells' development is induced by IL 4? IL 12?
Superficial inguinal
Th2; Th1
No because no peptide fragment!
Fever - urticaria - arthralgias - proteinuria - lymphadenopathy

2. What lymph node drains the scrotum?
Monoclonal Ab to CD3- blocks cellular transduction and signaling of T cells
Superficial inguinal
Opsonization (Brutons agammaglobulinemia) - adhesion (Leukocyte adhesion defect) - phagocytosis (chediak higashi syndrome) - respiratory burst (chronic granulomatous disease)
CGD; Jobs syndrome (defect in Neutrophil chemotactic response)

3. Which diseases are associated with DR4?
Kill them because they have CD16 on them that recognize the FcG portion
MS
Trypanosomes with programmed rearrangement (results in recurring fever -- sleeping sickness!)
DM type I and RA

4. 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)?
MHC I; from RER with help of the B2 microglobulin
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
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
Paracortex

5. What is oprelevkin? and What is it used for?
The igA found in breast milk
Recom IL 11; thrombocytopenia
Thrombocytopenia
TGF beta and IL 10

6. What is the monoclonal antibody to IL2 on activated T cells? What is it used for?
Activate macrophages
Daclizumab; prevent ACUTE rejection of renal transplant
IL 4 - 5 - 10 - 6
MHC II/CD4 and B7 (on APC) and CD28 (on Th cell); releases cytokines to kill those extracellular buggers!

7. What is the clinical use of Muromonab?
Immunosuppression after kidney transplantation
B - T - and NK cells
MHC class molecules bind to KIRS or CD94 to prevent killing
Mediates septic shock; activates the endothelium for adhesion and dilation and leukocyte recruitment results in vascular leak

8. describe the pathogenesis of delayed type IV hypersensitivity
Periarteriolar lymphatic sheath in the white pulp that surround that dead end of the capillaries in the red pulp - contain T cells
Both decrease cd8 tcell prolif but one through mtor and the other through calcineurin (resp)
T cells react to the angtigen and activate leukocyted (macrophage acitivation)
encapsulated

9. What are the two signals required for B cell class switching? Which is the second signal?
except hyperacute
Yes
HBV - HBC - Kaposis - leukemias - malignant melanoma - hairy cell leukemia and condyluma accuminata
CD40 (on b cell) CD40 ligand on Th2 cell; and interleukins (4 -5 -6) from Th2 cell; CD40 is actually the second signal

10. What are the three types of APCs?
Macrophages - Dendritic cells - B cells
Its involved in inflammation and results in anaphylaxis and neutrophil chemotaxis.
IgG and IgM bind to pathogens activating C1 convertase and leads to C2 and C4 and then C3 convertase activated
dimer

11. Describe the complement independent Type II hypersenstivity reaction. Give an example.
Hereditary angioedema; PNH
The antibodies (igM or IgG) either neutralize the target directly (cytoxic!) or recruit leukocytes (Neutrophils and Macrophages!) to incite tissue damage
NK cells
Celiac

12. What does IgE do on the surface of the mast cell to induce inflammatory mediator release?
Superficial inguinal
Cross link
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
A chemotactic factor for neutrophils

13. What is the white pulp of the spleen?
Celiac
Surrounds the red pulp and begins with PALS and then turns into follicles with B cells/follicles
TNF alpha and IL1
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

14. What are the two signals required for T cells? what happens after?
MHC I/CD8 and IL2/IL 2 Receptor (IL 2 is from Th1!); cytoxicity!
An alpha chain and a B2 microglobulin; on all nucleated cells; TCR and CD8; intracellular antigens
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
Influenza; antigenic shift; antigenic drift

15. what characterizes an arthus reaction?
Edema and necrosis in that region
...
Type IV
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

16. What lymph node drains the lateral side of the dorsum of the foot?
Popliteal
The igA found in breast milk
Since it is a comp dependent type II hypersensitivity reaction; C3a brings anaphylotoxins that bring in mediators of shock
SP infections

17. What is the result of an IL 12 deficiency? What is the presentation? What are the labs?
Cytokine release syndrome due to initial release from initial binding (fever etc) and hypersensitivity reaction
Decreased Th1 response; disseminated mycobacterial infections; decreased interferon gamma
C5a
Anti mitochondrial

18. Describe the capsular structure of a lymph node; What are the functions of the LN?
...
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
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
Its a serine protease that activates apoptosis; NK and CD8

19. What is the main function of TNF alpha? How does it do this?
If there is class switching and plasma cell production (that is when memory cells are produced)
CRP - C3b - IgM
Mediates septic shock; activates the endothelium for adhesion and dilation and leukocyte recruitment results in vascular leak
Opsonization (Brutons agammaglobulinemia) - adhesion (Leukocyte adhesion defect) - phagocytosis (chediak higashi syndrome) - respiratory burst (chronic granulomatous disease)

20. If an antigen lacks a peptide component How does the adaptive immunity attack it? What type of response is this called. give an example of bugs that do this. what implications does this have on splenectomy?
Paracortex; viral infection
IL 1 and IL 6
MHC II - B7 - CD40 and CD14; CD40 and D14 for FcG and C3b resp
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

21. What are some catalase positive organisms?
Cells that stil have weird parts of their membrane that macrophages usually bite off
S. aureus - E. Coli - aspergillus
IL 4
encapsulated

22. What is the receptor for EBV? On what cells is that located?
A recomb cytokine of IL 2; RCC and metastatic melanoma
CD21 on B cells (although there is T cell lymphocytosis in EBV)
Cyclosporine - OKT3
Rheumatic arthritis

23. If the alternative pathway is constitively active - how come normal cells don't get attacked with MAC?
...
Celiac
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
DAF and C1 esterase inhibitor on cells prevent complement activation on their surfaces (microbial surfaces lack this)

24. which cells have more complete tolerance - B or T cells?
Antimicrosomal and antithyroglobulin
CD21 on B cells (although there is T cell lymphocytosis in EBV)
IL 4
T

25. What are the two signals required for Th1 cells? what happens after then activated?
MHC II/CD4 and B7 (on APC) and CD28 (on Th cell); releases cytokines to kill those extracellular buggers!
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
Tetanus - Botulinum - HBV - Rabies
Psoriasis - Ankylosis Spondylitis - IBD - Reiters; all seronegative spondylopathies

26. which B and T cell disorder presents with specifically low IgM?
CGD; Jobs syndrome (defect in Neutrophil chemotactic response)
All MHC 1/CD8
Celiac
Wiskott Aldrich syndrome

27. What is recomb alpha interferon used for?
IgG and IgM bind to pathogens activating C1 convertase and leads to C2 and C4 and then C3 convertase activated
HBV - HBC - Kaposis - leukemias - malignant melanoma - hairy cell leukemia and condyluma accuminata
The igA found in breast milk
Patient has had previous exposure to blood products which result in presence of preformed anti HLA cytotoxic Abs

28. DTH (delayed type hypersensitivity) is the ________ of a PPD reaction
Antigliadin - antiendomysial (both are IgAs - anti tissue transgluataminase igA)
pathogenesis
Lymphocytes
Decreased Th1 response; disseminated mycobacterial infections; decreased interferon gamma

29. What is the antimetabolite precursor of 6 mercaptopurine? What is the result?
T cell activation; no with CD 4 or CD 8
No because no peptide fragment!
mesenchymal
...

30. What cytokines are released by Th1 cells?
Viral neutralization of igM and IgG!
Interferon gamma and IL 2
MHC I - CD16 - CD56
MHC II - B7

31. What lymph node drains the breast?
Axillary
An anaphylactic immediate reaction; atopy refers to the inherited propensity to develop asthmatic or allergic reactions
Lack of MHC class I constant region which it binds or a nonspecific activation signal (TLR)
Activate macrophages

32. Which is the main antibody in the delayed or secondary response to an antigen?
Paracortex
Scratch test - histamine mediated wheal; radioimmunosorbent assay (detects specific IgEs in serum)
IgG
A - B - C; all the D's

33. What is the pathogenesis of HyperIgE syndrome? What are the labs?
Para aortic
Tetanus - Botulinum - HBV - Rabies
MHC II - B7 - CD40 and CD14; CD40 and D14 for FcG and C3b resp
Th cells fail to produce interferon gamma; a lot of IgE

34. How fast does it occur?
Hemochromatosis
Antiviral by inducing ribonuclease which degrades only viral mRNA (prevents protein synthesis) and activates NK cells to kill virus infected cells
Its involved in inflammation and results in anaphylaxis and neutrophil chemotaxis.
The patient could become cyanotic in the OR!

35. What can cause a lymph node enlargement?
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
Adenosine deaminase deficiency (AR) - defective IL 2 receptor (X linked) - and failure to synthesize MHC II; both humoral and cell mediated deficiency
DAF and C1 esterase inhibitor on cells prevent complement activation on their surfaces (microbial surfaces lack this)
Local infection/inflammation; infection of the ln itself; metastasis

36. which cytokine inhibits TH2 cells? secreted by who?
Wiskott Aldrich syndrome
Interferon gamma; Th1
opsonizes
carboxy terminal

37. What are the autoantibodies for pernicious anemia?
Cyclosporine - OKT3
Anti Jo -1
Anti IF
TLR ad nuclear receptors

38. What is the pathology seen in chronic transplant rejection?
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
Severe pyogenic infections early in life
Fibrosis of blood vessels and graft tissue from ischemia; obliterative vascular fibrosis with intimal thickening
carboxy terminal

39. The secondary follicles have __________; primary follicles are dense
B - T - and NK cells
Lack of MHC class I constant region which it binds or a nonspecific activation signal (TLR)
...
pale central germinal centers

40. What are the three types of lymphocytes?
Celiac
Fab portion
Leukocyte adhesion defect; ataxia telangietasia; ataxia telangiectasia; chediak higashi syndrome; IgA def; Digeorge syndrome; Jobs; Chediak Higashi
B - T - and NK cells

41. The two heavy chains of an antibody contribute to the...
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
C - ANCA (antiproteinase); in neutrophil; c= cytoplasmic
...
Fab portion

42. are Th cells involved in trapping of antigens of endotoxin/LPS?
An anaphylactic immediate reaction; atopy refers to the inherited propensity to develop asthmatic or allergic reactions
except hyperacute
IL 1 - IL 6 - IL 12 - TNF alpha; IL 6- Th2 cells; IL 12- B cells
No because no peptide fragment!

43. ________ regulate the cell mediated response.
Humoral
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
Chronic granulomatous disease
Cross link

44. What is the pathogenesis of a candida skin test?
An alpha chain and a B2 microglobulin; on all nucleated cells; TCR and CD8; intracellular antigens
Septicemia with neisseria; because at least you have C3 to act like a neutrophilic chemotactic and an acute phase reactant
Delayed type hypersensitivity
Local infection/inflammation; infection of the ln itself; metastasis

45. what mediates the type II hypersensitivity? What are the two different methods?
Edema and necrosis in that region
Inferior mesenteric
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
Antibody mediated cytotoxicity; either complement dependent or complement independent

46. Which cytokines do Th2 release and For what?
IL 4 -5 -6 for B cell class switching - IL 10 to inhibit TH1
type four
Ischemia and necrosis of graft due to occlusion of vessels and fibrinoid necrosis and thrombosis within the vessels
MHC II - B7

47. What are the autoantibodies for wegeners granulomatosis?
Anti smooth muscle
Salmonella - 2 flagellar variants; Borrelia (relapsing fever); and Neisseria gonorrhoaea - pilus protein
C - ANCA (antiproteinase); in neutrophil; c= cytoplasmic
Viral neutralization of igM and IgG!

48. What are the main symptoms of B cell immunodeficiencies?
IL 1 and IL 6
SP infections
B - T - and NK cells
Cytokine release syndrome due to initial release from initial binding (fever etc) and hypersensitivity reaction

49. What lymph node drains the thigh?
Superficial inguinal
Edema and necrosis in that region
Mycobacterium Tuberculosis - Mycobacterium Avium Intracellulare; Toxoplasmosis Gondii
Lack of response from lymphocytes when activated; because they are self reactive - this is a form of tolerance

50. is IgM an opsonizer?
Steroid responsive nephrotic syndrome
Negative!
MHC II/CD4 and B7 (on APC) and CD28 (on Th cell); releases cytokines to kill those extracellular buggers!
MHC II - B7

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USMLE Step 1 Immunology

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