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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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1. What are the cell surface proteins for Macrophages? which two are for opsonins?
Immune complex - Arthus reaction and Serum sickness; they are all a result of antibody- antigen complex deposition resulting in complement activation
MHC II - B7 - CD40 and CD14; CD40 and D14 for FcG and C3b resp
Influenza; antigenic shift; antigenic drift
Interferon gamma and IL 2

2. DTH (delayed type hypersensitivity) is the ________ of a PPD reaction
pathogenesis
IgM and IgD
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
Intracellular pathogens (acute and chronic viruses and virally induced cancers)

3. What lymph node drains the rectum (above the pectinate line)?
Graves
Lack of response from lymphocytes when activated; because they are self reactive - this is a form of tolerance
Internal iliac
Tetanus - Botulinum - HBV - Rabies

4. what cytokine does basophils secrete?
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
Immunosuppression after kidney transplantation
IL 4
A j chain

5. Which Thelper cell activated Macrophages? by secreting what? what else does Th1 secrete? For what?
Th1; interferon gamma; IL 2 for cytotoxic T cell activation
MHC II - B7 - CD40 and CD14; CD40 and D14 for FcG and C3b resp
Previous transfusion; pregnant woman whose fetus had paternal antigens
Wiskott Aldrich syndrome

6. What are the four steps in phagocytosis? What are the four disease that correspond to each step?
C5a
Opsonization (Brutons agammaglobulinemia) - adhesion (Leukocyte adhesion defect) - phagocytosis (chediak higashi syndrome) - respiratory burst (chronic granulomatous disease)
Cross link antigens which increases their phagocytability; activate complement for MAC attack; opsonization; neutralization
T cells react to the angtigen and activate leukocyted (macrophage acitivation)

7. describe the pathogenesis of delayed type IV hypersensitivity
T cells react to the angtigen and activate leukocyted (macrophage acitivation)
IL 4 -5 -6 for B cell class switching - IL 10 to inhibit TH1
Ischemia and necrosis of graft due to occlusion of vessels and fibrinoid necrosis and thrombosis within the vessels
Fever - urticaria - arthralgias - proteinuria - lymphadenopathy

8. What are the autoantibodies for myasthenia gravis?
Anti Ach receptor
Edema and necrosis in that region
Histamine (causes vasodilation) - leukotrienes (causes bronchoconstriction) - chemotaxins for eos - and heparin (increased blood flow needs to be anticoagulated!)
Anticentromere; anti Scl -70 (anti DNA topoisomerase I)

9. What is the pathogenesis of IgG AIHA ABO hemolytic disease of a newborn? describe what happens.
T
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
Active; passive - fast but short half life (3 weeks!)
Complement activation (active in both)

10. What are howell jolly bodies?
Severe pyogenic infections early in life
Nuclear remnants that are usually taken out of RBC before complete maturation by Macrophages
Immunosuppression after kidney transplantation in combination with cyclosporine and corticosteroids
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

11. What are the autoantibodies for sjorgens syndrome?
Anti SS- A (anti RO) and Anti SS- B
...
Its a serine protease that activates apoptosis; NK and CD8
Hemochromatosis

12. Which diseases are associated with DR4?
DM type I and RA
Antimicrobial also secreted by CD8 and NK cells that induces apoptsosis
MHC I/CD8 and IL2/IL 2 Receptor (IL 2 is from Th1!); cytoxicity!
Thrombocytopenia

13. What lymph node drains the thigh?
T cells react to the angtigen and activate leukocyted (macrophage acitivation)
Superficial inguinal
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
A B and T cell disorder; defect in DNA repair enzymes; ataxia - telangactasia and IgA def; igA def. and increased AFP

14. other than C3a - what other complement acts as an anaphyloxin?
T cells react to the angtigen and activate leukocyted (macrophage acitivation)
Adaptive uses classic pathway to kill; innate uses alternative pathway to kill
C5a
IL 4

15. What are the autoantibodies for type I diabetes mellitus?
Fc
Macrophages - Dendritic cells - B cells
Receiving preformed Antibodies
Anti glutamate carboxylase and anti insulin

16. Describe the complement independent Type II hypersenstivity reaction. Give an example.
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
...
Negative nitroblue tetrazolium reduction test
The antibodies (igM or IgG) either neutralize the target directly (cytoxic!) or recruit leukocytes (Neutrophils and Macrophages!) to incite tissue damage

17. How is the thymus organized? what happens in each section?
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
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
lowest concentration
IgM and IgA

18. Often bacteria are associated with being killed by humoral immunity. Name some bugs that require cell mediated immunity because they evade humoral response
mesenchymal
A recomb cytokine of IL 2; RCC and metastatic melanoma
Pernicious Anemia and Hashimotos
Legionella - N. gonorrhea - L. monocytogenes - viruses - protozoa (leismaniasis)

19. What type of fenestrations are found in the red pulp of the spleen?
The patient could become cyanotic in the OR!
Scratch test - histamine mediated wheal; radioimmunosorbent assay (detects specific IgEs in serum)
Barrel hoop basement membrane fenestrations
Remove encapsulated bacateria

20. What is the result of an IL 12 deficiency? What is the presentation? What are the labs?
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
Lack of response from lymphocytes when activated; because they are self reactive - this is a form of tolerance
Decreased Th1 response; disseminated mycobacterial infections; decreased interferon gamma
...

21. What does IL 4 do?
Acts as second signal on B cells to induce class switching to IgE and IgG
Carbohydrate
Normal pro B (CD 19 +) - no mature B cells results in decreased total B cell level - and decreased amount of immunoglobulins in each class
Influenza; antigenic shift; antigenic drift

22. Which disease is associated with B8?
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
Th1; interferon gamma; IL 2 for cytotoxic T cell activation
Graves
Cyclosporine and tacrolimus; sirolimus (as well as hyperlipidemia)

23. Which disease is associated withB B27?
Legionella - N. gonorrhea - L. monocytogenes - viruses - protozoa (leismaniasis)
Psoriasis - Ankylosis Spondylitis - IBD - Reiters; all seronegative spondylopathies
carboxy terminal
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

24. What lymph node drains the anal canal (below the pectinate line)?
IgM and IgD
Superficial inguinal
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
Periarteriolar lymphatic sheath in the white pulp that surround that dead end of the capillaries in the red pulp - contain T cells

25. What do macrophages secrete that activate Th1 cells to secrete interferon gamma?
TNF alpha and IL1
secondary
CGD; Jobs syndrome (defect in Neutrophil chemotactic response)
IgG

26. What is immune complex disease? give an example.
Induce differentiation of T cells into Th1 helper cells and activates NK cells also; B cells
An anaphylactic immediate reaction; atopy refers to the inherited propensity to develop asthmatic or allergic reactions
Type III hypersensitivity where an internal antigen antibody complexes activate classical complement pathway resulting in C3a neutrophilic chemotaxis and neutrophilic lysosomal death. SLE
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

27. What is an example of a parasite showing antigenic variation?
Trypanosomes with programmed rearrangement (results in recurring fever -- sleeping sickness!)
Antimicrosomal and antithyroglobulin
Coarse Faces - cold (noninflamed d/t inability to attract neutrophils) staph abscesses - retained primary teeth - high igE - dermatologic problems (eczema)
TGF beta and IL 10

28. what happens in a deficiency of C5- C8? why dont you get recurrent pyogenic infections like in C3 def?
Septicemia with neisseria; because at least you have C3 to act like a neutrophilic chemotactic and an acute phase reactant
Stimulate the liver to release acute phase reactants
encapsulated
Basophils! THey want IG E class switch!

29. which of the transplant rejections is antibody mediated? why does it occur?
IL 3; supports growth and differentiation of bone marrow stem cells
A j chain
cannot cross placenta
Hyperacute; presence of preformed antibodies in the recipient ( to blood groups or HLA )

30. Which diseases are associated with DR2?
Anti SS- A (anti RO) and Anti SS- B
MS - hay fever - SLE - goodpastures
Cells that stil have weird parts of their membrane that macrophages usually bite off
Th1; interferon gamma; IL 2 for cytotoxic T cell activation

31. What are the major functions of Antibodies?
Histamine; post capillary venules - vasodilation
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 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
Opsonize bacteria (for enhanced phagocytosis) - neutralize viruses (igG) - activate complement (igM and igG) - sensitize mast cells (igE)

32. What is recomb gamma interferon used for?
Immunosuppression after kidney transplantation
Recomb cytokine of GCSF (granulocyte macrophage colony stimulating factor; for recovery of bone marrow
Chronic granulomatous disease
Some microbial surfaces (only) have mannan binding lectin which activates a protease that cleaves C2 and C4 which combine to make C3. the rest follows the alternative pathway

33. What is the most common example of passive immunity?
IL 3; supports growth and differentiation of bone marrow stem cells
IgAs in mothers breast milk!
IL 4 -5 -6 for B cell class switching - IL 10 to inhibit TH1
Sinusitis - otitis media - pneumonia

34. What are the symptoms of serum sickness?
Fever - urticaria - arthralgias - proteinuria - lymphadenopathy
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
Hyperacute; presence of preformed antibodies in the recipient ( to blood groups or HLA )
No because no peptide fragment!

35. The alternative pathway is the only constutively...
Adenosine deaminase deficiency (AR) - defective IL 2 receptor (X linked) - and failure to synthesize MHC II; both humoral and cell mediated deficiency
Edema and necrosis in that region
active complement pathway
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

36. What are some sinopulmonary infections?
...
Sinusitis - otitis media - pneumonia
Activate B cells - activate Macrophages - kill viruses directly - delayed cell mediated hypersensitivity - acute and chronic rejection
not Ab mediated

37. What are the function of B cells?
C3b; coating of a pathogen with molecules that promotes phagocytosis; IgG and CRP
Antimicrobial also secreted by CD8 and NK cells that induces apoptsosis
Edema and necrosis in that region
Make antibody - allergy type 1 (igE) - Cytotoxic and immunecomplex hypersensitivity type II and III (igG); hyperacute organ rejection is Ab mediated

38. What are the two signals required for Th1 cells? what happens after then activated?
Anti topoisomerase
IL 4
MHC II/CD4 and B7 (on APC) and CD28 (on Th cell); releases cytokines to kill those extracellular buggers!
Induces fever - chemokine secretion to recruit - activates adhesion molecules; macrophages

39. what cell surface marker is used for NK cells as it is unique to them?
CD56
Pernicious Anemia and Hashimotos
Superior mesenteric
Para aortic

40. which of the hypersensitivity reactions is not Ab mediated?
Type IV
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
1) susceptibility to encapsulated organisms 2) Howell Jolly Bodies 3) Target cells 4) Thrombocytosis
The igA found in breast milk

41. what happens in a deficiency of C1 esterase inhibitor? DAF?
Rheumatic arthritis
T cell dysfunction
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
Hereditary angioedema; PNH

42. with failed maturation of B cells in Brutons agammaglobulinemia - What is its effect on immune pathways and why?
IL 3; supports growth and differentiation of bone marrow stem cells
Its main effect is a defect in Ab opsonization for killing
Complement activation (active in both)
neutrophilia!

43. What is thrombopoietin used for?
Thrombocytopenia
IL 1 - IL 6 - IL 12 - TNF alpha; IL 6- Th2 cells; IL 12- B cells
Suppresses immune response (also specifically Th1 cells) and activates Th2; regulatory T cells
When you select for which MHC it will have; take out the lymphs that self react

44. What are the autoantibodies for polymyositis and dermatomyositis?
Anti Jo -1
Interferon gamma and IL 2
Cross link antigens which increases their phagocytability; activate complement for MAC attack; opsonization; neutralization
IgAs in mothers breast milk!

45. What is the monoclonal antibody to IL2 on activated T cells? What is it used for?
Daclizumab; prevent ACUTE rejection of renal transplant
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
isotype
IgE; by activating eosinophils

46. What is the common variable immunodeficiency ? How is it different from Brutons?
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
Adenosine deaminase deficiency (AR) - defective IL 2 receptor (X linked) - and failure to synthesize MHC II; both humoral and cell mediated deficiency
Activates Macrophages and Th1 cells; suppresses Th2 cells; antiviral and antitumor
DM type I and RA

47. What is the toxicity of muromonab?
Cytokine release syndrome due to initial release from initial binding (fever etc) and hypersensitivity reaction
The igA found in breast milk
Barrel hoop basement membrane fenestrations
Th1; interferon gamma; IL 2 for cytotoxic T cell activation

48. What is the presentation of hyperIgM syndrome?
IL 1 - IL 6 - IL 12 - TNF alpha; IL 6- Th2 cells; IL 12- B cells
Severe pyogenic infections early in life
Anticentromere; anti Scl -70 (anti DNA topoisomerase I)
Nuclear remnants that are usually taken out of RBC before complete maturation by Macrophages

49. In thymic development - What is the positive selection? negative selections?
MHC II - B7
When you select for which MHC it will have; take out the lymphs that self react
MHC II - B7 - CD40 and CD14; CD40 and D14 for FcG and C3b resp
Normal pro B (CD 19 +) - no mature B cells results in decreased total B cell level - and decreased amount of immunoglobulins in each class

50. Complements are...
Surrounds the red pulp and begins with PALS and then turns into follicles with B cells/follicles
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
Nuclear remnants that are usually taken out of RBC before complete maturation by Macrophages
acute phase reactants

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USMLE Step 1 Immunology

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