1. What date is it today?

May 9, 2005
May 1, 2005
May 3, 2005
May 15, 2005
May 31, 2005

2. Bruton's hypogammaglobulinemia is indicative of a deficiency of what cell type?

B cell
macrophage
T cell
monocyte
neutrophil

3. A 3-year-old boy has a history of repeated sinopulmonary infections. He has also had
several episodes of diarrheal disease. Phagocytic functions and T cell numbers are normal.
Also, complement levels as well as IgG and IgM levels are normal. There is a selective IgA
deficiency and some T cell functional deficits detected by laboratory analysis. Which is the
most likely diagnosis?
acquired immune deficiency syndrome (AIDS)
common variable hypogammaglobulinemia
C3 deficiency

ataxia-telangiectasia
Bruton's hypogammaglobulinemia
4. Chronic granulomatous disease (CGD) is a result of which one of the following
immunodeficiency conditions?
hypocomplementemia
defect in T cell number
defect in B cell number
defect in B cell function
defect in neutrophil function

5. Job's syndrome is thought to result from

a B cell deficit
suppressed IgE production
defect in macrophage killing
defect in neutrophil chemotaxis
suppressed IgA production

6. The rapid rise, elevated level, and prolonged production of antibody that follows a second
exposure to antigen known as the

delayed hypersensitivity reaction

autoimmune response
anamnestic response
conditioned response
thymus-independent response

7. The mammalian counterpart of the avian bursa of Fabricius is the

spleen
gut-associated lymphoid tissue (GALT)
thymus
bone marrow
liver

8. One of the characteristics of the secondary immune response is that it

is mainly IgM antibody
requires only a low dose of immunogen for induction
has low-affinity antibodies
has a short duration of antibody synthesis
has a slow rate of antibody synthesis

9. Which of the following is a serious complication associated with the use of

immunosuppressive agents?
increased incidence of autoimmune diseases
increased susceptibility to opportunistic infections
loss of tuberculin sensitivity in patients with tuberculosis
hair loss
decreased complement levels

10. Which of the following areas is most likely to be affected by the chronic inflammation
that is characteristic of Sjoegren's syndrome?
thyroid glands
isles of Langerhans
prostate gland
nasal passages
skin

11. Renal failure is a common cause of death in patients with

Sjoegren's syndrome
rheumatoid arthritis
rheumatic fever
pemphigus vulgaris

systemic lupus erythematosus

12. Which of the following statements is true about autoimmune diseases in general?
they have a tendency to occur more frequently in men
hypogammaglobulinemia is common
no hereditary pattern has been noted
autoantibodies are usually found in the serum
elevated serum complement levels are common

13. Autoimmune diseases may be organ-specific or they may have multiple target tissues.
The latter are sometimes called collagen-vascular diseases or connective tissue diseases.
Which of the following autoimmune diseases is systemic?
thyroiditis
SLE
pernicious anemia
multiple sclerosis
myasthenia gravis

14. Some cells that function in innate resistance contain granules, which play a major role in
cytotoxicity and ability of the cell to destroy tumors. Examples of such cells include which of
the following?

basophils
NK cells
eosinophils
mucosal epithelial cells
plasma cells

15. Inflammation is one of the major responses of the body to injury. Which of the following
is a derivative of arachidonic acid that is involved in the increased diapedesis of neutrophils
from the blood into acute inflammatory lesions?
IgG1
fibronectin
C3a
lysozyme
leukotriene B4

16. Several types of immunologic rejection reactions can occur after organ transplantation.
The rejection reaction that is caused by the presence of preformed antibodies in the
recipient is referred to as
acute
hyperacute
chronic
immediate

accelerated

17. Chronic graft rejection may be caused by

T cells
antibodies
T cells and antibodies
T cells and macrophages
natural killer cells

18. An immune response to foreign tissue is suppressed in which of the following

phenomena?
immune tolerance
immune enhancement
immune surveillance
immune deviation
immune complex reactions

19. Which of the following transplants involves a transfer of skin from the thigh to the face?
allogeneic
autologous

heterogenic
idiotypic
syngeneic

20. Which of the following anti-tumor compounds is produced primarily by macrophages?

IFN-
perforin
nucleases
nitric oxide
proteases

21. Which of the following cells is the most susceptible to tolerance induction?
T helper cell
B cell
macrophage
cytotoxic T cell
plasma cell

22. A child stung by a bee experiences respiratory distress within minutes and lapses into
unconsciousness. This reaction is probably mediated by

IgE antibody
IgG antibody
sensitized T cells
complement
IgM antibody

23. Bacille Calmette-Guerin (BCG) is sometimes used for

nonspecific suppression of immune response
passive immunization for tuberculosis
potentiation of the cell mediated immunities
active immunization for tuberculosis in the US
potentiation of the humoral immune response

24. A 9-year-old boy's mother received a frantic call from the teacher who was hosting a
picnic as part of the class trip to the zoo. The boy's tongue, lips, and cheek were grossly
swollen. He was having difficulty breathing. This boy is experiencing a severe
anaphylactic reaction
cardiovascular collapse
panic attack
bronchospasm brought on by exertion

delirium episode

25. A 9-year-old boy's mother received a frantic call from the teacher who was hosting a
picnic as part of the class visit to the zoo. The boy's tongue, lips, and cheek were grossly
swollen. He was having difficulty breathing. The therapy for this boy should include
epinephrine
antihistamine
phosphodiesterase
histamine
cromolyn sodium

26. Which of the following interleukins down regulates T H 1 cells and thus inhibits cytokine
synthesis?
IL-6
IL-10
IL-4
IL-8
IL-9

27. An important characteristic of inflammatory responses is the influx of phagocytic cells

into the area of damage. Which of the following interleukins is a chemotaxin?

IL-1
IL-8
IL-12
IL-4
IL-9

28. Asthma is a serious allergy which kills approximately 5,000 people (usually children) in
the US each year. IgE is the antibody that is primarily involved in this sensitivity. Which of
the following promotes IgE production?
IL-8
IL-4
IL-1
IL-2
IL-12

29. The patient has a rash on his wrist immediately beneath his watch, the back of which is
made of nickel. The most likely cause of this dermatitis is
Arthus reaction
immune complex disease
contact dermatitis
atopic dermatitis

cytotoxic antibody-mediated disease

30. Which of the antigens listed below has the highest correlation of occurrence in patients
with multiple myeloma?
common acute lymphoblastic leukemia antigen (CALLA)
Bence Jones protein
carcinoembryonic antigen (CEA)
prostate specific antigen (PSA)
alpha-fetoprotein (AFP)

31. While eating at a seafood restaurant, a 47-year-old man develops urticaria, nausea,
abdominal pain, chest tightness, and dyspnea. His blood pressure is 88/60 mmHg. Which of
the following is the mechanism most likely to be involved in this illness?
Activation of the alternative complement pathway by proteins contained in the ingested
seafood
IgA-mediated activation of an intestinal inflammatory response
IgE-mediated release of histamine from mast cells
IgM-mediated activation of the classic complement pathway
IgG-mediated activation of the classic complement pathway

32. A 49-year-old man who had the "flu" last month is currently experiencing tingling in his
fingers and toes and has marked muscular weakness in his extremities. Deep tendon

reflexes are absent. A diagnosis of peripheral neuritis is made. Which of the following
disorders most likely affects this man?
amyotrophic lateral sclerosis
SLE
Guillain-Barre syndrome
Sjoegren's syndrome
Goodpasture syndrome

33. Which of the following disorders is characterized by overproduction of monoclonal IgG?

Waldenstroem's macroglobulinemia
multiple myeloma
asthma
hypersensitivity pneumonitis
serum sickness

34. Most antibodies are synthesized within which of the following structures?
Golgi apparatus
central lymphoid organs
thymus
peripheral lymphoid organs

macrophages

35. Which of the following is a component of acquired immunity?

complement
lysozyme
T lymphocytes
turbulence in the upper airways
NK lymphocytes

36. A kidney transplant from a cadaver donor is most likely a(n)

autograft
allograft
isograft
lifesaving event in a patient with systemic lupus erythematosus
xenograft

37. A substance that can evoke either a humoral or a cell-mediated immune response is
termed a(n)
hapten
antigen

epitope
adjuvant
immunogen

38. During a normal immune response, an individual makes IgM antibodies first followed by
IgG or another class of antibody. Which of the following interleukins plays an important role
in the class switching?
IL-10
IL-1
IL-4
IL-2
IL-3

39. Features of major histocompatibility complex (MHC) control of the immune response
include which of the following?
thymus independence
regulation through the action of B cells
class III molecule participation
B7-CD28 interactions in B cell activation
CD molecule recognition

40. Which of the following substances works to directly reverse bronchoconstriction and,
therefore, is the treatment of choice in severe allergic respiratory distress?
cromolyn sodium
methylxanthine drugs
epinephrine
blocking antibody
antihistamine

41. The anamnestic response is defined as

the lag in antibody production after initial antigen exposure
a gradual rise in antibody titres
true immunological paralysis
prompt production of antibodies after a second exposure to antigen
species-specific antibodies

42. A patient has been on dialysis for 3 years waiting for an organ match. One is found and
the surgery is performed. Which of the following drugs could be used to inhibit the
transcription of the interleukin-2 gene?
azathioprine
corticosteroid
antilymphocyte globulin

cyclosporine
cyclophosphamide

43. Transplantation of the thymus gland from an aborted fetus to an immunodeficient

neonate has been beneficial in which of the following immunodeficiency disorders?
Chediak-Higashi syndrome
DiGeorge syndrome
Bruton's disease
hereditary angioedema
Wiskott-Aldrich syndrome

44. Which of the following substances is a cytokine that enhances proliferation of B cells?
IL-1
lipopolysaccharide
IFN-
IL-4
IL-2

45. Lysis of foreign cells is an important aspect of immunity. Which of the following
describes a group of serum proteins that can lyse gram-negative bacteria that have antibody
on their surface?

complement
lactoferrin
lysozyme
lactoperoxidase
IFN-

46. A 4-year-old patient has a history of repeated infections. History reveals congenital
absence of the parathyroid glands, accompanied by rudimentary development of the
thymus. Which of the following is the most appropriate treatment for this patient?
transfusion of neutrophils
bone marrow transplant
fetal thymus transplant
infusion of adenosine desaminase
thymectomy

47. If the emergence of forbidden clones is not continuously suppressed throughout life, a
person may develop
autoimmune disease
serum sickness
allergic conditions
hypergammaglobulinemia

autotolerance

48. The most likely combination for producing erythroblastosis fetalis (hemolytic disease of
the newborn) is:
Rh+ mother, Rh- father, Rh- child
Rh- mother, Rh+ father, Rh+ child
Rh- mother, Rh+ father, Rh- child
Rh+ mother, Rh+ father, Rh+ child
Rh+ mother, Rh+ father, Rh- child

49. Immunosuppressive measures are most effective when administered

immediately before antigen exposure
1 week before antigen exposure
1 week after antigen exposure
1 month before antigen exposure
1 month after antigen exposure

50. Which one of the following is true about the T cell receptor (TCR)?
it has a hinge region that gives it flexibility
it is bivalent

it is associated with the CD3 protein complex in the membrane

it is present in low numbers on T helper lymphocytes
it is readily secreted from the cell

51. In radioimmunoassay (RIA), it is essential that the substance to be detected have which
one of the following characteristics? It
can be labeled with fluorescein isothiocyanate
does not contain titrated thymidine
can induce specific antibodies
is an allergen
is protein in nature