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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. What are the autoantibodies for pemphigus bulgaris?
Anti mitochondrial
Antidesmoglein
Defect in CD40L results in inability to class switch; a lot of IgM and no IgG - A - E
Yes

2. what will NK cells do to cells covered in IgG Ab? why?
Septicemia with neisseria; because at least you have C3 to act like a neutrophilic chemotactic and an acute phase reactant
Severe pyogenic infections early in life
Scratch test - histamine mediated wheal; radioimmunosorbent assay (detects specific IgEs in serum)
Kill them because they have CD16 on them that recognize the FcG portion

3. What are the autoantibodies for pernicious anemia?
Anti IF
Recurrent infections to every type of antigen; bone marrow transplant (be weary of GVH disease!)
Make antibody - allergy type 1 (igE) - Cytotoxic and immunecomplex hypersensitivity type II and III (igG); hyperacute organ rejection is Ab mediated
Carbohydrate

4. What is chronic mucocutaneous candidiasis d/t?
IgAs in mothers breast milk!
Nuclear remnants that are usually taken out of RBC before complete maturation by Macrophages
T cell dysfunction
Th2; Th1

5. What is the arthus reaction? What is the difference between arthus and serum sickness? give an example. How do you test for it?
When you select for which MHC it will have; take out the lymphs that self react
Histamine (causes vasodilation) - leukotrienes (causes bronchoconstriction) - chemotaxins for eos - and heparin (increased blood flow needs to be anticoagulated!)
Legionella - N. gonorrhea - L. monocytogenes - viruses - protozoa (leismaniasis)
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

6. What lymph node drains the lateral side of the dorsum of the foot?
A recomb cytokine of IL 2; RCC and metastatic melanoma
Popliteal
Fever - urticaria - arthralgias - proteinuria - lymphadenopathy
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 :(

7. What is epo used for?
Cell mediated due to T cell cytotoxicity reacting to foreign MHCs; few weeks after
Anemias (esp due to renal failure)
Interferon gamma; Th1
Antibody mediated cytotoxicity; either complement dependent or complement independent

8. What are the main symptoms of T cell immunodeficiencies?
CRP - C3b - IgM
Anti smooth muscle
Intracellular pathogens (acute and chronic viruses and virally induced cancers)
Cells that stil have weird parts of their membrane that macrophages usually bite off

9. What are C1 - C2 - C3 - C4 important for?
Graves
Viral neutralization of igM and IgG!
T cell activation; no with CD 4 or CD 8
MHC I; from RER with help of the B2 microglobulin

10. explain the process from beginning (ie phagocytosis of the peptide) to end of how Abs are formed in Goodpasteurs.
AR; defect in MT function results in decreased transport and phagocytosis; recurrent pyogenic infections by staphylococci and streptococci - partial albinism - and peripheral neuropathy
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
Superior mesenteric
Anti mitochondrial

11. what prevents NK cells from killing normal cells if their default is to kill?
DM type I
MHC class molecules bind to KIRS or CD94 to prevent killing
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
Daclizumab; prevent ACUTE rejection of renal transplant

12. give an example of how influenza does a major antigenic shift.
RNA segment reassortment
Suppresses immune response (also specifically Th1 cells) and activates Th2; regulatory T cells
...
Carbohydrate

13. 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 )
Vasculitis of graft vessels with dense interstitial lymphocytic infiltrate; yes! with immunosuppressants
Both decrease cd8 tcell prolif but one through mtor and the other through calcineurin (resp)
Recomb cytokine of GCSF (granulocyte macrophage colony stimulating factor; for recovery of bone marrow

14. which antibody activate mast cells - basophils - and eosinophils?
HBV - HBC - Kaposis - leukemias - malignant melanoma - hairy cell leukemia and condyluma accuminata
The place of T cell diff and maturation; ant mediastinum above heart; yes; 2
IgE
A chemotactic factor for neutrophils

15. what cell surface marker is used for NK cells as it is unique to them?
CD56
CGD; Jobs syndrome (defect in Neutrophil chemotactic response)
Anti Ach receptor
Acts as second signal on B cells to induce class switching to IgA; also stimulates eosinophils

16. What are the symptoms of serum sickness?
Fever - urticaria - arthralgias - proteinuria - lymphadenopathy
Ig - CD19 - CD20 - CD21 - CD40 - MHC II - B7
type four
Cyclosporine and tacrolimus; sirolimus (as well as hyperlipidemia)

17. Type IV hypersensitivity is i...
opsonizes
not Ab mediated
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

18. after C3 spontaneously hydrolyzes to C3b and C3a - what happens to C3a?
Its involved in inflammation and results in anaphylaxis and neutrophil chemotaxis.
Anti alpha subunit 3 of collagen on type IV bm
Activates Th1 helper cells; Macrophages
An alpha and beta chain; only on APCs; TCR and CD4; extracellular (phagocytosed by APCs)

19. What are the autoantibodies for wegeners granulomatosis?
Kill them because they have CD16 on them that recognize the FcG portion
C - ANCA (antiproteinase); in neutrophil; c= cytoplasmic
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.

20. Which diseases are associated with DR2?
Anti nuclear Antibodies (ANA); Anti dsDNA - anti Smith
Lack of MHC class I constant region which it binds or a nonspecific activation signal (TLR)
MS - hay fever - SLE - goodpastures
Influenza; antigenic shift; antigenic drift

21. What part of the lymph node specifically expands during a cellular immune response? when would this occur?
Scratch test - histamine mediated wheal; radioimmunosorbent assay (detects specific IgEs in serum)
Paracortex; viral infection
Anti TSh receptor
Severe pyogenic infections early in life

22. What bugs can actually infect the lymph node itself?
T cell dysfunction
Active; passive - fast but short half life (3 weeks!)
Mycobacterium Tuberculosis - Mycobacterium Avium Intracellulare; Toxoplasmosis Gondii
Graves

23. What is thrombopoietin used for?
Thrombocytopenia
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
IL 1 - IL 6 - IL 12 - TNF alpha; IL 6- Th2 cells; IL 12- B cells
Axillary

24. What is Aldesleukin? What is it used for
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
Surrounds the red pulp and begins with PALS and then turns into follicles with B cells/follicles
A recomb cytokine of IL 2; RCC and metastatic melanoma
Negative!

25. The alternative pathway is the only constutively...
Cyclosporine - OKT3
active complement pathway
Activates Macrophages and Th1 cells; suppresses Th2 cells; antiviral and antitumor
Receiving preformed Antibodies

26. Which helper T cells' development is induced by IL 4? IL 12?
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
Antidesmoglein
Th2; Th1
MHC I; from RER with help of the B2 microglobulin

27. What are the autoantibodies for Celiac disease?
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
type four
Anticentromere; anti Scl -70 (anti DNA topoisomerase I)
Antigliadin - antiendomysial (both are IgAs - anti tissue transgluataminase igA)

28. ________ regulate the cell mediated response.
carboxy terminal
Humoral
Th2; Th1
Superficial inguinal

29. What does IgA pick up from epithelial cells before being secreted?
Cross link antigens which increases their phagocytability; activate complement for MAC attack; opsonization; neutralization
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
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
Secretory component

30. Which type of selection of thymic development provides central tolerance?
1) susceptibility to encapsulated organisms 2) Howell Jolly Bodies 3) Target cells 4) Thrombocytosis
Basophils! THey want IG E class switch!
Antibody mediated cytotoxicity; either complement dependent or complement independent
Negative selection

31. How does complement link innate and adaptive?
RNA segment reassortment
Adaptive uses classic pathway to kill; innate uses alternative pathway to kill
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
DM type I and RA

32. How do endotoxin/LPS of gram negative bacteria stimulate the immune system if they do not have a peptide fragment?
Increases expression of MHC I and MHC II and also activates NK cells
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
DAF and C1 esterase inhibitor on cells prevent complement activation on their surfaces (microbial surfaces lack this)
Immunosuppression after kidney transplantation in combination with cyclosporine and corticosteroids

33. What is the toxicity of muromonab?
Septicemia with neisseria; because at least you have C3 to act like a neutrophilic chemotactic and an acute phase reactant
Recurrent sinopulmonary bacterial infections after 6 months (d/t mothers igGs transplacental) due to opsonization defect
Chronic granulomatous disease
Cytokine release syndrome due to initial release from initial binding (fever etc) and hypersensitivity reaction

34. describe the classic complement pathway.
Fab portion
IgG and IgM bind to pathogens activating C1 convertase and leads to C2 and C4 and then C3 convertase activated
Cyclosporine and tacrolimus; sirolimus (as well as hyperlipidemia)
MHC class molecules bind to KIRS or CD94 to prevent killing

35. IgM can exist as a _______ also
pentamer
Anti Ach receptor
Normal pro B (CD 19 +) - no mature B cells results in decreased total B cell level - and decreased amount of immunoglobulins in each class
Anti nuclear Antibodies (ANA); Anti dsDNA - anti Smith

36. What is the clinical use for sirolimus? what should you combine it with?
Alternative splicing of mRNA
Immunosuppression after kidney transplantation in combination with cyclosporine and corticosteroids
Severe recurrent pyogenic sinus and resp tract And increased susceptibility to type III hypersensitivity like SLE
Remove encapsulated bacateria

37. which cytokine inhibits TH2 cells? secreted by who?
Antimicrobial also secreted by CD8 and NK cells that induces apoptsosis
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
Septicemia with neisseria; because at least you have C3 to act like a neutrophilic chemotactic and an acute phase reactant
Interferon gamma; Th1

38. What is the receptor for EBV? On what cells is that located?
T cell activation; no with CD 4 or CD 8
T
CD21 on B cells (although there is T cell lymphocytosis in EBV)
IgM and IgG

39. What are the T cell functions?
Negative!
Secretory component
Activate B cells - activate Macrophages - kill viruses directly - delayed cell mediated hypersensitivity - acute and chronic rejection
Activates Macrophages and Th1 cells; suppresses Th2 cells; antiviral and antitumor

40. T/F B cells do not require a second signal
False! B cell class switching requires a second signal
IgG
Induces fever - chemokine secretion to recruit - activates adhesion molecules; macrophages
Cell mediated due to T cell cytotoxicity reacting to foreign MHCs; few weeks after

41. 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
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
Recom IL 11; thrombocytopenia
Popliteal

42. What is the most common selective Ig deficiency? What is the presentation?
Its main effect is a defect in Ab opsonization for killing
IgA; sinus and lung infections from lack of secretory defense - milk allergies and diarrhea from giardiasis; Anaphylasix on exposure to blood products with igA
Delayed type hypersensitivity
Opsonization (Brutons agammaglobulinemia) - adhesion (Leukocyte adhesion defect) - phagocytosis (chediak higashi syndrome) - respiratory burst (chronic granulomatous disease)

43. What are the main Cell surface proteins on T cells?
TCR - CD4/8 - CD28 (binds B7) - CD3 (for intracellular transduction) - CD40L
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
T cells react to the angtigen and activate leukocyted (macrophage acitivation)
Recom IL 11; thrombocytopenia

44. How fast does it occur?
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
The patient could become cyanotic in the OR!
mesenchymal
Tumor cells and virally infected cells; perforin pore to secrete granzymes through it; apoptosis

45. Complements are...
Th1; interferon gamma; IL 2 for cytotoxic T cell activation
acute phase reactants
Induces fever - chemokine secretion to recruit - activates adhesion molecules; macrophages
The patient could become cyanotic in the OR!

46. What does interferon gamma do? What two type of cells does it attack mostly?
Negative selection
Activates Macrophages and Th1 cells; suppresses Th2 cells; antiviral and antitumor
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
The patient could become cyanotic in the OR!

47. What are some sinopulmonary infections?
Sinusitis - otitis media - pneumonia
Defect in CD40L results in inability to class switch; a lot of IgM and no IgG - A - E
T
cannot cross placenta

48. What are MHC's necessary for? By themselves?
T cell activation; no with CD 4 or CD 8
Severe pyogenic infections early in life
Antigliadin - antiendomysial (both are IgAs - anti tissue transgluataminase igA)
Antibody mediated cytotoxicity; either complement dependent or complement independent

49. What is the presentation of hyperIgM syndrome?
Cells that stil have weird parts of their membrane that macrophages usually bite off
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
IgM and IgD
Severe pyogenic infections early in life

50. What do macrophages secrete that activate Th1 cells to secrete interferon gamma?
IgM
Surrounds the red pulp and begins with PALS and then turns into follicles with B cells/follicles
TNF alpha and IL1
CD40 (on b cell) CD40 ligand on Th2 cell; and interleukins (4 -5 -6) from Th2 cell; CD40 is actually the second signal

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USMLE Step 1 Immunology

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