IMMUNOLOGY FINAL EXAM
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1 Name: IMMUNOLOGY FINAL EXAM November 15, :30-11:30 AM 84 questions, 272 total Points 16 pages INSTRUCTIONS 1. Use only a No. 2 pencil. 2. Write your name legibly at the top of the FIRST PAGE of the exam. 3. Write and code entire student ID number on the Scantron form. 4. Write in NAME, FINAL, November 15, and your row and seat number on the front of the form. 5. Fill answer boxes on the Scantron completely; printed numeral should not be visible. Do not make extraneous marks on the form. 6. Mark box A through E, one only. Use A for TRUE and B for FALSE. Each question is intended to have a single best answer. 7. Erase carefully and completely; if in doubt, get a new Scantron. 8. Check your Scantron form before handing it in to see that all questions have been answered. 9. When you are done turn in your exam together with your Scantron.
2 QUESTIONS 1-5: [4 POINTS] MULTIPLE CHOICE Choose the single best answer 1. A mother is blood type A, Rh+, her newborn child is B, Rh. The newborn s blood is likely to contain substantial levels of antibodies to: a) anti-a b) anti-a and anti-rh c) anti-b d) anti-b and anti-rh e) none of the above 2. A congenital T cell deficiency will result in markedly increased susceptibility to infection by: a) extracellular bacteria b) both extracellular and intracellular bacteria c) extracellular bacteria and fungi d) intracellular bacteria and fungi e) extracellular bacteria and viruses 3. The process of somatic hypermutation increases the diversity of antigen-combining sites in: a) IgG b) TcR c) both d) neither 4. CD4 is expressed on: a) TH cells b) macrophages c) NK cells d) both (a) and (b) e) all of the above 5. Which of the following represents part of the process of lymphocyte "recirculation"? a) exit of pre-t-cell from bone marrow into blood b) exit of a naïve B-cell from lymph node into blood c) entry of an effector TH1 cell into a site of inflammation d) both (a) and (b) e) all of the above 2
3 QUESTIONS 6-10: [2 POINTS] MULTIPLE CHOICE. Choose from the following; each choice may be used once, more than once or not at all a) IgA b) IgD c) IgE d) IgG e) IgM 6. Most efficient at complement fixation 7. Predominates in nu/nu ( nude ) mouse serum 8. Exists predominantly as membrane bound form 9. Predominates in secondary responses 10. Binds to macrophage Fc receptors QUESTIONS 11-21: [4 POINTS] MULTIPLE CHOICE Choose the single best answer 11. Barak Obama has been tissue-typed as HLA- A(26);B(17,21), his wife Michelle as A(11,28);B(21,35), and their daughter Sasha as A(11);B(21). Which of the following is the least likely phenotype for Sasha s sister Malia? a) A(11);B(21) b) A(28);B(21,35) c) A(11,26);B(17,21) d) A(11,26);B(17,35) e) A(26,28);B(17,35) 12. (See question #11) If you wanted to use a FACS (fluorescence-activated cell sorter) to recover fetal cells from Michelle s blood during a subsequent pregnancy in order to do prenatal genetic testing on the fetus, your best choice of fluorescent-labeled antibodies would be: a) anti-a11 and B21 b) anti A26 alone c) anti-a11 and A28 d) anti-b17 and B21 e) anti-b21 alone 3
4 13. Disease symptoms are most directly the result of the presence of M-protein in: a) MGUS b) B cell lymphoma c) Multiple myeloma d) Waldenström s macroglobulinemia 14. A virus may greatly reduce T-cell mediated killing of infected cells by causing downregulation of the expression of: a) HLA-A b) HLA-C c) either (a) or (b) d) none of the above 15. A major advantage of a live viral vaccine over a killed one is that the live vaccine will provide more effective: a) isotype switching b) immune complex clearance c) Class I presentation d) Class II presentation e) Treg response 16. During the generation of a humoral response following immunization with a hapten/carrier, T-cells will be presented with carrier peptides associated with which of the following? a) MHC Class I b) MHC Class II c) both d) neither 17. The Coomb s reagent used to develop agglutination reactions is an antibody directed against: a) A and B blood group antigens b) Rh antigen c) C3b d) FcR e) IgG 4
5 18. Development of a GvH reaction would be most likely if whole blood from a donor whose genotype is HLA (B18/18) were transfused into a recipient who is HLA: a) B18/18 b) B27/27 c) B14/18 d) B27/ All of the following are true regarding the original descriptions of acquired immune deficiency syndrome EXCEPT: a) An increase in Kaposi's sarcoma among previously healthy homosexual men in San Francisco. b) An increase in Pneumocystis carinii pneumonia among previously health homosexual men in San Francisco. c) An inversion in the CD4 to CD8 ratio in previously healthy homosexual men in San Francisco due to an increase in the total number of CD8 positive lymphocytes in the blood. d) An increase in Kaposi's sarcoma among previously healthy intravenous drug users in New York City. e) An increase in Pneumocystis carinii pneumonia among previously healthy intravenous drug users in New York City. 20. The newest autoantibody described in Rheumatoid arthritis is anti-cyclic citrullinated peptide (anti CCP). Which of the following statements is FALSE? a) Presence of anti-ccp is associated with severe Rheumatoid arthritis b) Citrullinated peptides are recognized by the T cell in conjunction with MHC II c) Presence of anti-ccp is the result of polyclonal B cell stimulation d) Arginine is replaced with citrulline 21. The symptoms of One-Shot Serum Sickness typically last no longer than a week or two because: a) antibodies have a relatively short half-life b) complement is consumed c) antigen is removed d) all of the above 5
6 QUESTIONS 22-25: [2 POINTS] MULTIPLE CHOICE Choose the single best answer DNA from various sources was digested with the restriction enzyme EcoRI, separated by electrophoresis and hybridized with a radioactive probe specific for human Cκ, resulting in the Southern blot shown on the right. The germ-line band at 2.5kb is indicated. Which of the four lanes in the blot represents the pattern you would most likely see using DNA from each of the following cell sources? 22. T-cell leukemia a b c d 23. Normal lymph node 2.5kb 24. Waldenström s Macroglobulinema 25. Fetal thymus QUESTIONS 26-50: [4 POINTS] MULTIPLE CHOICE Choose the single best answer 26. The idiotypic epitope expressed on the membrane of an Ig-bearing B-cell lymphoma is best described as: a) a virally encoded antigen b) a tumor-associated antigen (TAA) c) a tumor specific antigen (TSA) d) an oncofetal antigen 27. Based on the principles of MHC-restricted recognition, Marge Simpson s cytotoxic T-cells specific for measles virus will be able to kill virus-infected cells derived from: a) her mother Jacqueline b) her father Clancy c) her daughter Maggie d) both (a) and (b) e) all of the above 6
7 28. During the production of a hybridoma line, if the cell mixture following fusion is placed in culture with the drug aminopterin but with no hypoxanthine or thymidine, the result would be: a) proliferation only of unfused plasmacytoma cells b) proliferation only of unfused B cells c) proliferation of both fused cells and unfused plasmacytoma cells. d) proliferation of all cells in the mix e) no cells in the mix would proliferate 29. You have affinity-purified the isohemagglutinin antibodies from a type A donor, and have a dialyzable form of the B blood group antigen. If you analyze this antibody by Equilibrium Dialysis which of the following patterns would you expect to see? r_ c r_ c r_ c a r b r c 5 10 r r_ c r_ c d 5 10 r e 2 4 r 30. During the cell interactions involved in generating a cytotoxic T-cell response, the TC cell receives the necessary Signal 1 through which of the following interactions? a) B7 with CD28 b) IL-2 with IL-2R c) TCR with MHC Class I d) TCR with MHC Class II e) IgD with antigen 31. Peripheral neuropathy is most frequently associated with? a) Multiple myeloma b) IgA MGUS c) IgG MGUS d) IgM MGUS 7
8 32. Histological examination of a patient s lymph node showed an absence of germinal centers but with intact primary follicles, and reduced cellularity of the parafollicular cortex. This pattern is most consistent with: a) Chronic Granulomatous Disease b) Di George Syndrome c) Bruton s Agammaglobulinemia d) Severe Combined Immunodeficiency e) iatrogenic immunodeficiency 33. Which of the following is FALSE regarding opportunistic infections in adult patients with AIDS? a) Marked increase of infections with obligate intracellular bacteria (such as Mycobacterium avium intracellulare). b) Marked increase of fungal infections with yeasts such as Pneumocystis carinii (pneumonia). c) Marked increase of infections with common extracellular bacteria, such as Streptococcus pneumoniae. d) Reactivation of DNA viruses such as Varicella zoster (shingles). e) All the above statements are correct. 34. Opsonization may be mediated by the presence on phagocytic cells of: a) Fc receptors b) complement receptors c) either (a) or (b) d) none of the above 35. Antigen combining sites whose affinity has been improved by the process of somatic hypermutation may be present in: a) IgG b) IgM c) T cell receptors d) both (a) and (b) e) all of the above 8
9 36. As part of the team working on the world-wide eradication of polio, you re carrying out Complement Fixation assays to determine the titers of anti-viral antibody in the serum of subjects following vaccination. The assay is a conventional one in which you add a standard amount of viral antigen and complement to serial dilutions of the subjects sera, then add indicator cells. Your results for one subject are shown below: Lysis with Lysis with Test added no added Sample Dilution antigen antigen #1 1: : : : Based on these results, you conclude that this sample has an antibody titer of: a) 1:10 b) 1:20 c) less than 1:20 d) less than 1:40 e) you can draw no valid conclusion regarding the antibody titer 37. The greatest risk of developing Rheumatoid arthritis is seen in association with: a) β2-microglobulin b) HLA-B27 c) HLA-DRB1 shared epitope d) TRAF locus 38. The mitogen lipopolysaccharide (LPS) can stimulate an effective antibody response in nude (nu/nu) mice. This is because LPS is: a) efficiently presented by the B-cell s MHC Class II b) actively phagocytosed by dendritic cells c) a TD antigen d) able to stimulating Toll-Like Receptors (TLR) on B-cells 39. It is critically important to avoid administering any live vaccine to a patient who might have: a) Bruton s agammaglobulinemia b) DiGeorge syndrome c) both d) neither 9
10 40. Yvonne was given penicillin for a urinary tract infection, and ten days later she returned to the clinic complaining of a headache, itchy lumps on her skin and aching and swollen joints in her hands and feet. The immune reaction which cause her symptoms is most likely: a) an innate immune response b) complement-mediated hemolysis c) complement-mediated tissue damage d) cell-mediated immunity e) an IgE-mediated allergic response 41. The likelihood of a kidney transplant between two HLA haplo-identical siblings being accepted with no rejection reaction is close to: a) 0% b) 25% c) 50% d) 75% e) 100% 42. The swelling at the site of an allergy skin test 15 minutes after introduction of antigen is caused by the infiltration of large numbers of: a) eosinophils b) polymorphonuclear neutrophils c) mast cells d) mononuclear cells e) none of the above 43. The mechanism of receptor blockade will contribute most importantly to maintaining self-tolerance to a) HLA-DQ b) IgD heavy chains c) albumin d) CD4 e) complement receptors 44. A negative result with the Nitro Blue Tetrazolium (NBT) test indicates that there is a defect in: a) complement fixation b) opsonization c) NK cell activity d) intracellular killing of bacteria e) T cell differentiation 10
11 45. Hypocalcemic tetany which develops immediately after birth is associated with which immunodeficiency state? a) Bruton s agammaglobulinemia b) SCID c) DiGeorge Syndrome d) Complement deficiency e) Chronic Granulomatous Disease 46. You ve immunized a rabbit with a human λigd myeloma protein and collected its serum. If you want to prepare an absorbed antiserum that is class-specific, you would begin by passing it over column bearing: a) κigd b) λiga1 c) κige d) λigd e) κigg4 47. A dendritic cell may become activated by receiving a signal from: a) a TH cell b) B7/CD28 recognition c) cross-linking of antigen-specific membrane Ig d) microbe-derived products e) CD4/Class II interaction 48. The MLR (Mixed Lymphocyte Reaction) is used to help determine donor/recipient compatibility for : a) HLA-A b) HLA-B c) HLA-D d) (a) and (b) e) all of the above 49. The maximum number of different HLA Class I molecules that may be expressed by a single memory B cell is close to: a) 1 b) 2 c) 4 d) 6 e) 16 11
12 50. An Rh-negative woman is tested by Indirect Coombs at twenty eight weeks of pregnancy with positive results. This indicates that: a) the father is Rh-positive b) her erythrocytes are coated with antibody c) the fetus is Rh negative d) both (a) and (b) e) all of the above QUESTIONS 51-54: [2 POINTS] MULTIPLE CHOICE Choose the single best answer. Each choice may be used once, more than once or not at all. The results of FACS analysis of a mixed cell population are shown below. For each of the following choose the quadrant (a, b, c or d) in which the cells in question would appear A B 51. B cells 52. pre-t cells 53. predominant thymic lymphocytes 54. Treg cells CD C D CD8 QUESTIONS [2 POINTS] Choose from the following Gell & Coombs categories; each choice may be used once, more than once or not at all a) Type I b) Type II c) Type III d) Type IV 55. Poison oak rash 56. Allergy skin test 57. One-Shot Serum Sickness 58. Smooth distribution of IgG in glomeruli 59. Grave s Disease 12
13 QUESTIONS 60-70: [4 POINTS] ANSWER USING THE FOLLOWING KEY: a) If 1, 2 and 3 are correct b) If 1 and 3 are correct c) If 2 and 4 are correct d) If only 4 is correct e) If all are correct 60. Which of the following antigen preparations would be suitable for use in an agglutination test? 1. leukocytes 2. HSA-coated latex particles 3. erythrocytes 4. DNP-HSA 61. Which of the following antibodies could be used for paternity testing? 1. anti-km 2. anti-g1 3. anti-g3m 4. anti-lambda 62. Which of the following cells might eventually differentiate into an immunoglobulinbearing memory cell? 1. memory B-cell 2. hematopoietic stem cell 3. naïve B-cell 4. naïve T-cell 63. Development of a GvH reaction is a significant risk following transplantation of which of the following organs into an immunosuppressed recipient? 1. bone marrow 2. liver 3. lung 4. heart 13
14 KEY: A. 1, 2 and 3; B. 1 and 3; C. 2 and 4; D. 4 only; E. all 64. In a patient suffering from selective IgA deficiency, there is likely to be greatly reduced levels of expression in his serum of: 1. lambda 2. Km 3. G3m 4. A2m 65. Cell surface markers shared by B-cells and activated dendritic cells include: 1. HLA-DR 2. HLA-A 3. B7 4. IgM 66. Which of the following represents tertiary lymphoid tissue? 1. germinal centers in thymus 2. dendritic cells in skin 3. lymphoid follicles in synovium 4. plasma cells in bone marrow 67. Leukocytes that enter lymph nodes through high endothelial venules (HEVs) include: 1. TC cells 2. B-cells 3. TH cells 4. PMNs 68. Which of the following antigens could be used in an Ouchterlony assay 1. C5a 2. DNP 3. IgG 4. Sheep red blood cells 14
15 KEY: A. 1, 2 and 3; B. 1 and 3; C. 2 and 4; D. 4 only; E. all 69. The amount of DNA in a cell will decrease during which of the following differentiation steps? 1. naïve B-cell to memory B-cell 2. stem cell to naïve B-cell 3. IgG3 B-memory cell to IgG2 B-memory cell 4. naïve B-cell to IgM-secreting plasma cell 70. Antigen dependent differentiation includes the differentiation of: 1. stem cell to TH-cell 2. virgin T cell to memory cell 3. Common Lymphocyte Precursor to TC cell 4. B-cell to plasma cell 15
16 QUESTIONS TRUE/FALSE [2 points] A = TRUE, B = FALSE 71. Genes within the human HLA complex encode Class I and Class II molecules and β2-microglobulin. 72. In the peripheral blood, high affinity Fc receptors for IgE may be found on basophils. 73. Cytotoxic T-cells kill their targets by complement-mediated lysis. 74. The IgE bound to a particular mast cell in the skin is likely to be monospecific, but not monoclonal. 75. Following activation, a dendritic cell may leave the skin and enter the circulation where it will interact with an antigen-specific T-cell. 76. A deficiency in complement component C4 will affect both the classical and MBL pathways for complement fixation. 77. Complement receptors on human erythrocytes selectively bind the membrane attack complex (MAC). 78. Non-identical human twins frequently share a common placental circulation 79. Immunodeficiency which results from cancer chemotherapy is iatrogenic. 80. Enhancing antibodies contribute to more rapid graft rejection. 81. Germinal centers are sites in which B-cells undergo both clonal proliferation and isotype switching. 82. Receptor blockade represents one mechanism of peripheral tolerance 83. Clonal deletion represents one mechanism of central tolerance. 84. In the Mishell & Dutton hot thymidine experiments, antigen-specific B-cells are killed before they begin proliferating. 16
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