Practice Test. Test 5

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1 Practice Test Test 5 1) A plasma cell can directly differentiate from: a. An activated B cell. b. Isotype switched, somatically hypermutated centrocyte c. Memory B cell. d. A & B e. All of the above. 2) Which of the following statement/statement s about DiGeorges syndrome is false? a. B cells will not be able to undergo isotype switching. b. A patient with DiGeorges syndrome will have low count (close to none) of B cells c. A patient with DiGeorges syndrome will have a low count (close to none) of T cells. d. B & C 3) When a B cell recognizes a TI antigen: a. There needs to be receptor clustering for the B cell to successfully activate. b. The tyrosine Syk will bind to the Igß transmembrane chain and start the signaling cascade that will lead to gene expression of the B cell. c. Will bind its CR2 to C3d on the surface of the pathogen, and will also need CD81 and CD19 as co-receptors that will assist the signaling cascade. d. The phosphorylated cytoplasmic tail of CD19 will synergize the B cell s signals by 10,000 fold. 4) Follicular dendritic cells are phagocytic cells that hold antigens for a long period of time. 5) To enter the Secondary Lymphoid Tissue, the B cell: a. Will follow a gradient of CCL-19 and CCL-21 that will guide the B cell in the follicle. b. Will follow a gradient of CCL-19 and CCL-21 that will guide the B cell to cross the HEV and enter the Secondary Lymphoid tissue. c. Will follow a gradient of CXCL-13 to enter the follicle after passing through the HEV. e. B & C 6) A B cell will recognize a TD antibody in a secondary lymphoid tissue, will internalize it, process it, and express it in an MHC I molecule which will be presented to a T FH. 7) When an activated naïve B cell starts interacting with a T FH Cell: a. The T cell will release IL-5 and IL-6 in the medullary cord b. IgM is the most abundant antibody that is being secreted by the B lymphoblast. c. B cells that formed a conjugate pair with a T FH, induced the expression of CD40 ligand, that activated transcription factor NF K B in the B cell.

2 d. B lymphoblast will express ICAM-1 on their surface, which will interact with LFA-1 on the T-cell to create a strong binding; thanks to these adhesion molecules, B and T cells can interact for several days. 8) Which of the following statement/statements regarding germinal centers is/are NOT true? a. A centrocyte is found in the dark zone, does not have any BCR s on its surface, and has a high level of AID activity that mediates somatic hypermutation and isotype switching. b. FDC s will secrete several cytokines including IL-6, IL-15, 8D6 and BAFF which will signal the B cells to proliferate. c. In the light zone, B cells will have BCR s on the surface, and will compete with other somatically hypermutated B cells to test their new BCR s. Failure to successfully bind the BCR to an antigen in the FDC will result in apoptosis. d. A & B. 9) Which of the following statement/statements regarding a recently somatically hypermutated and isotype switched B cell is/are true? a. Will have to compete to interact with a T FH cell. b. Will die by apoptosis if the B cell is induced to produce the Bcl-xL signal c. Can turn into a plasma cell or a memory cell without signals from the T FH cell. 10) If a centrocyte develops a self-reactive Ig: a. A CD8 Cytotoxic T cell will signal the B cell to die by apoptosis b. A CD4 T FH T cell will signal the cell to become anergic. c. A CD8 T FH T cell will signal the cell to die by apoptosis d. It will be impossible for the immune system to stop it at this point, and will most likely cause an autoimmune disease 11) Tangible bodies macrophages are: a. Macrophages that can be found in any tissue in our body b. Macrophages that are found in the germinal center and engulf recently apoptotic centrocytes. c. They are the same as Subcapsular Sinus Macrophages 12) Which of the following do not happen as a result of hyper IgM syndrome? a. Lack of CD40 ligand on the T cell. b. Immunodeficiency due to a lack of B cell activation. c. Abnormally high amounts of IgA and IgG in the blood due to increased somatic hypermutation and isotype switching, d. Cannot respond to TD antigens. 13) At the beginning of an infection, T FH are expected to secrete more to induce B cells to differentiate into. a. IL-10, memory cells.

3 b. IL-4, memory cells. c. IL-10, plasma cells. d. IL-4 plasma cells. 14) C3bBb can cleave which of the following a. C3 b. Factor H c. C5 e. None of the above 15) Which of the following regulatory proteins are used to slowdown the activation of complement? a. Factor P b. DAF c. MCP d. B & C e. None of the above 16) C1q can bind to a. One IgM b. Two IgG c. One CRP d. All of the above 17) The protein that initiates the cascade in the classical pathway is: a. C1q b. C3b c. C1s e. None of the above 18) Which of the following statement/statements regarding IgM is/are not true? a. Is the first Ig secreted. b. Is very useful when activating complement through the classical pathway. c. IgM s dimeric nature reduces the capability of entering an infected tissue. d. A & B e. A & C. 19) Which of the following scenarios can be considered as a form of passive immunization? a. IgA crossing the placenta to enter the fetuses blood stream. b. Somatically hypermutated and isotype switched IgG that are being released by a plasma cell in a secondary lymphoid tissue during an infection. c. Steve Irwin (R.I.P.) getting antivenom after being bit by a black cobra because he felt like petting the thing. 20) Which of the following molecules is responsible to transport IgG from the blood to endothelial spaces?

4 a. Brambell receptor b. FcRB c. FcRn d. All the above. 21) A mast cell that has been sensitized to allergens will have several IgE on its surface, which will all have the same binding to the same specific antigen... 22) Dimeric IgA is transported to the luminal side of the lactiferous sinus of a lactating mother by FcRB. 23) Which of the following statement/statements is/are true about IgE? a. IgE provides protection against parasitic worm infections b. IgE is involved in allergic reactions in the developed countries c. IgE is bound to the surface of a mast cell through a FcεRI receptor. d. A & B 24) Little Tim has just been infected by S. pyogenes, but it s the same strand that infected him last year. Which antibody present in his pharynx will most likely be the one that will opsonize the pathogen? a. IgG b. IgA c. IgM d. IgE e. IgD 25) The only function of an erythrocyte is to transport oxygen and carbon dioxide from and to tissues. 26) Which of the following statement/statements regarding mucins is/are not true? a. Mucin is secreted by goblet cells in the intestinal tract. b. They contain sialic acid that facilitates the transport of antimicrobials, defensins and IgA. c. The reduced viscosity impedes the movement of microorganisms to the surface of epithelial cells. d. None of the above 27) Which of the following are part of the GALT? a. Mesenteric lymph nodes b. Palatine, adenoid, and lingual tonsils. c. Peyer s patches.

5 28) Microbes of the gut are kept in check thanks to several factors, one of those being our immune system working constantly to avoid any microorganism to cross the epithelial barrier and cause an infection. Which of the following strategies is used by out immune system to keep our intestinal microbiota in check? a. Continuous release of inflammatory cytokines in order to flush out microorganisms. b. Proactive immune responses against microbes in the gut that make it to the lumen of the gut. c. Release of defensins and antimicrobial enzymes along with mucin. d. B & C 29) Which of the following is true regarding Crohn s disease? a. Patients with this condition will have abnormally high levels of IL-10 from T reg cells, which cause the inflammatory response. b. Inflammation is down-regulated by T H1 and T H17 cells. c. Patients with this condition will lack IL-10 receptor, which will turn off inflammatory response. 30) In tissues associated with the GALT, epithelial cells have the ability of producing inflammatory cytokines, while macrophages cannot express inflammatory cytokines. 31) An individual with celiac disease has oral tolerance for wheat gluten.. 32) Naïve lymphocytes can circulate through MALT, lymphnodes, spleen, or any secondary lymphoid tissue because they follow a and gradient, but once a lymphocyte has been activated it will follow a gradient, and will express the adhesion molecule. a. α 1 :ß 7 ; CCL 25; CCL 19; CCL 21 b. CCL 19; CCL 21; α 1 :ß 7 ; CCL 25 c. CCL 19; CCL 21; CCL 25; α 1 :ß 7 33) A somatically hypermutated plasma cell will secrete in the GALT will secrete: a. IgA b. Pentameric IgA c. Dimeric IgA d. Dimeric IgM e. Pentameric IgM. 34) When an individual has a helminth infection, which type of response is more effective? a. Th1 response secreting INF-γ b. Th2 response secreting IL-3 and IL-9. c. Both responses have the same effectiveness in clearing the helminth infection.

6 Challenge Question: 1) Anthony was well until 6 months of age, when he was hospitalized for pneumonia. In the following years he was hospitalized five more times for additional episodes of pneumonia, septic arthritis, and febrile convulsion. Yesterday Anthony was diagnosed with pneumonia caused by Pneumocystis jirovecii, and consultation with an immunologist was requested. Anthony's tests revealed neutropenia, normal numbers of B cells and T cells, slightly elevated IgM, but a marked decrease in IgG and IgA compared with normal. Autoantibodies against neutrophils were not detected. Liver function tests were normal. Bone marrow aspiration indicated severe maturational arrest of the myeloid lineage at the promyelocyte-myelocyte stage. A diagnosis of X-linked hyper-igm syndrome (XHIGM) was made. Anthony's parents were informed that their son would require long-term treatment with intravenous immunoglobulin (IVIG), prophylactic antibiotics, and periodic injection of granulocyte colony-stimulating factor (G-CSF) for episodes of neutropenia. Genetic analysis of the gene encoding revealed a frameshift and stop codon mutation causing aberrant transcription of this gene. a. CD40 ligand b. CD3 c. CD19 d. RAG1 e. CD81 2) Richard Brennan began penicillamine therapy after he was diagnosed with Wilson s disease (manifested by copper accumulation in the tissues) at age 10 years. Ten months after beginning this treatment he began to experience multiple sinus infections, and one episode of pneumonia. Recently he came to the emergency room with acute diarrhea, vomiting, fever, and foul-smelling intestinal gas. Stool samples revealed the presence of trophozoites of Giardia. Blood tests showed normal levels of B and T cells and normal IgM and IgG concentrations, but markedly decreased IgA at 6 mg/dl (normal range mg/dl). Richard was treated for his giardiasis with metronidazole. His selective IgA deficiency was associated with penicillamine, shown previously to be a complication in some patients with Wilson s disease. His IgA levels returned to normal when penicillamine was discontinued. This is an example of a drug-induced transient form of IgA deficiency. Which of the following antibodies that uses the same transport receptor as dimeric IgA would have been present in the lumen of the gastrointestinal tract and mucosal secretions of Richard while he was taking penicillamine? a. IgD b. IgM c. IgG d. IgE

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