Immunology Practice Exam

SELECT THE BEST ANSWER.

1. A young boy has had repeated infections with Staphylococcus aureus. His laboratory data
reveals that he has normal numbers of white blood cells with a normal distribution by
differential counting. His immunoglobulin levels are normal and he responds to candida skin
test antigen with a positive DTH reaction. Which of the following types of immune deficiency
do you suspect?
A. B cell deficiency
B. Granulocyte disorder
C. Combined immunodeficiency
D. T cell deficiency

2. A 27-year-old housewife presents to her family physician with a 3 month history of fatigue,
and a facial rash which is aggravated by sun exposure. Laboratory tests reveal anemia of 10-
gm/dl (normal is 12-14) and immune testing reveals auto-antibodies against DNA. What is the
most likely diagnosis?
A. Rheumatoid Arthritis
B. Goodpasture's Syndrome
C. Systemic Lupus Erythematous
D. Graves Disease
E. Myasthenia Gravis

3. A mother is Rh-. Her first baby is Rh+. During the delivery, some of the fetal blood enters
the mother's blood stream. She develops a strong response which includes isotype switching to
IgG. These antibodies recognize the Rh molecules that were present on the baby's red blood
cells. This is unfortunate for the second fetus because IgG antibodies can cross the placenta.
Consequently, the IgG can harm the second fetus if it is also Rh+. The newborn second child is
suspected of having "hemolytic disease of the newborn". A Coombs test is performed to
determine if the cause of the anemia is the presence of the mother's antibodies to the Rh+
molecule on the RBC of this second child. A Coombs test would require:
A. a serum sample containing the mother's antibodies.
B. a blood sample containing the baby's red blood cells.
C. a labeled animal antibody that recognizes the Fc region of IgG.
D. a + b
E. b + c
4. A 24-year-old medical student is having some difficulty in understanding the role that
antibodies play in the destruction of cells due to complement lysis. The professor decides that
"seeing is believing" and so sends the student to the laboratory. The student is given two
flasks. One flask contains antibodies isolated from an individual whose ABO phenotype is A. In
the other flask there are red blood cells from an individual whose phenotype is unknown. The
student is directed to put the red blood cells into the dish containing agar, and to add the
isolated antibodies. In the second step, the student is directed to add all the complement
proteins, required for cell lysis, to the agar dish. Following incubation of 37oC, the red blood
cells are lysed. The phenotype of the individual from whom the red blood cells were isolated
could have been:
A. only AB
B. only B
C. only A
D. either AB, B or A
E. either AB or B

5. A 17-year-old boy suffered an injury to his left eye when, during a car crash, a sharp silver of
glass penetrated his eye, damaging his lens and uveal tract. The glass was removed and the
injury repaired with complete recovery. However, 3 weeks later he noticed some redness in the
left eye and photophobia, followed by pain and severe visual impairment. The left eye was
removed and histologic examination showed an extensively infiltrated uveal tract with abundant
lymphocutes and mononuclear cells. Two weeks later the other eye began to show the same
symptoms. Since the lens was damaged the most likely scenario is that:
A. this is an example of immediate hypersensitivity.
B. sequestered antigen was released and initiated an immune response.
C. some of the glass must have penetrated the right eye as well.
D. the bacteria entered the damaged eye and is causing an infection in both eyes.

6. You are running a tissue typing laboratory and are faced with matching a potential kidney
transplant recipient with one of several unrelated donors. Serology indicates 5/6 MHC
matches. Which of the following would be the MOST judicious course of action?
A. Proceed with transplantation, with no immunosuppression.
B. Proceed with transplantation, using cyclosporin and prednisone.
C. Wait until you get 6/6 MHC matches.
D. Wait further matching data from MLR (72 hrs).

7. Which one of the following substances works to directly reverse bronchoconstriction and
hence is the treatment of choice in severe allergic respiratory distress? (NOTE: ONLY FOUR
CHOICES)
A. Cromolyn sodium
B. Antihistamines
C. Epinephrine
D. Blocking antibody
8. A new employee in the SPCA was bitten by a rabid dog. The worker was brought to the
Emergency Department even though he had been inoculated for tetanus, only three days before
he was bitten. The attending physician ordered treatment with anti-rabies immune human
globulin. Which one of the following describes the type of immunization the patient received in
the emergency unit?
A. Active natural immunity.
B. Active artificial immunity.
C. Passive natural immunity.
D. Passive artifical immunity.
E. None of the above.

9. You see a young man in the later stages of HIV infection with a markedly decreased CD4+
T-cell count, diarrhea and weight loss, fever and oral candidiasis. Which one of the following is
NOT necessarily an anticipated infection in this man?
A. Intestinal and pulmonary cytomegalovirus infection.
B. Systemic herpes virus infection.
C. Pneumococcal pneumonia.
D. Fungal infection

10. A 3-year-old boy has a history of repeated pyogenic (pus-forming) infections. He had
normal antibody responses following childhood immunizations and normal recovery from
chickenpox and measles. Decreased numbers or functional defects in which of the following
cells best explains the cause of his infections?
A. Eosinophils
B. Neutrophils
C. T lymphocytes
D. B lymphocytes

11. A positive DTH skin reaction involves the interaction of:

A. antigen, complement, and lymphokines.
B. antigen-antibody complexes, complement and neutrophils.
C. Memory T cells, cytokines and macrophages.
D. IgE antibody, antigen, and mast cells
E. Antigen, macrophages and complement.
12. A 24-year-old known atopic patient presented to the out patient medical clinic on a quiet
spring afternoon with history of dry cough, wheeze and breathlessness. Upon examination, the
patient was found to be under to moderate respiratory distress with bilateral lung wheezes. The
patient's previous health records revealed that he was treated several times for acute allergic
bronchial asthma. All of the following are correct concerning the immunological disorder
presented in the above patient EXCEPT:
A. it is immunological E (IgE) mediated reaction.
B. the IgE antibodies that had developed during the initial exposures are bound to the mast cells
and basophils.
C. The present clinical symptoms are due to the release of vasoactive amines from the mast
cells and basophils.
D. The complement factors 'B' and 'D' have an active role in the release of various
immunological mediators of the Type I hypersensitivity.
E. Antihistamines, Epinephrine and Corticosteroids are life saving drugs that are commonly
used for above immunological disorder.

13. A patient who is allergic to ragweed developed IgE myeloma (plasma cell that secretes
IgE). The myeloma IgE does not react with the ragweed pollen. What would be the effect of his
myeloma on the severity of his allergic symptoms during hayfever season?
A. Increased due to his having more IgE.
B. No change
C. Decrease due to the displacement of IgE anti-ragweed on mast cell by myeloma IgE.
D. Increase due to the blocking effect of the myeloma.

14. An Rh-negative mother had an anti-Rh response following the birth of her Rh-positive child.
The second fetus was also Rh+ so the maternal anti-Rh antibodies coated the fetus's
erythrocytes with antibody. The isotype of these antibodies is

A. IgA
B. IgD
C. IgG
D. IgE
E. IgM

15. With reference to the clonal selection theory, the following are true EXCEPT:
A. B and T lymphocytes of all antigenic specificities exist prior to contact with antigen.
B. each lymphocyte carries an antigen receptor on its surface of only a single specificity.
C. lymphocytes can be stimulated by antigen under appropriate conditions to give rise to
progeny with identical antigenic specificity.
D. lymphocytes bear multipotential receptors which become specific after contact with antigen.
16. You are called to assess a patient in the midst of a rapid blood transfusion for an acute
blood loss. She has spiked a fever and feels terribly unwell. You stop the transfusion, infuse
saline, and draw blood for typing. This patient is O positive. The most likely cause of the
reaction is:
A. anti-A reactivity in the recipient.
B. anti-B reactivity in the recipient.
C. anti-A and anti-B reactivity in the donor.
D. could be any of the above

17. A precocious kindergarten child, decided to take her three week old baby brother out of the
carriage so that she could play "mother". Unfortunately she tripped, and the baby fell onto an
old tin can which the dog had dragged onto the front lawn. Since the baby received a
laceration, the mother rushed him to the doctor. Which of the following would be the preferred
treatment?
A. A tetanus immune globulin (human) injection this visit, with an injection of tetanus toxoid
several weeks later.
B. A mixture of tetanus toxoid and tetanus immune globulin (human) as one injection.
C. A tetanus immune globulin (human) infection this visit, with an injection of tetanus toxiod the
following week.
D. Separate injections of tetanus toxoid and tetanus immune globulin in different sites on this
one visit.
E. A tetanus toxoid injection this visit, with an injection of tetanus immune globulin (human)
approximately one week later.

18. Three- year-old Johnny gets burned in a home accident and requires extensive skin
grafting. The attending physician believes that Johnny will tolerate the graft with little, (or no)
immunosuppressive drugs since the child has an immunodeficiency disorder. Johnny most
likely has:
A. DiGeorge's Syndrome
B. Chronic Mucocutaneous Candidiasis
C. X-linked Agammaglobulinemia
D. Chediak-Higashi Syndrome
E. Chronic Granulomatous Disease

19. Positive skin tests to Candida albicans or tuberculoprotein have certain aspects in common
with a reaction to poison ivy. These similarities include the following:
A. They both are chemical responses to caustic irritants.
B. They both are due to IgE antibody.
C. They both occur within 1 hour of antigen exposure.
D. They both are T cell-mediated.
20. A 25-year-old man who recently sustained a severe, dirty laceration of his right foot is
brought to you. He has never received any immunizations. At age 7 he had tetanus. He was
treated with penicillin and tetanus immune globulin (human). Fortunately, he recovered. Which
of the following would you do to prevent tetanus now?
A. Immunize with tetanus toxoid, which will stimulate a secondary antibody response.
B. Administer tetanus immune globulin (human) to passively immunize the patient.
C. Administer tetanus immune globulin (human) in addition to tetanus toxoid, because you
cannot depend on a secondary immune response after 18 years.
D. Administer tetanus immune globulin (human) plus tetanus toxoid, because the patient has
absolutely no immunity to tetanus.
E. Give no injection, because the residual immunity from the clinical tetanus will protect the
patient.

21. You prescribe penicillin for your patient. The patient develops a severe allergic reaction
and dies. In this case, the penicillin molecule was probably acting as a (an):
A. adjuvant.
B. hapten.
C. immunologic carrier.
D. immunotoxin

22. Infantile X-linked agammaglobulinemia occurs in male infants, who begin to suffer from
recurrent bacterial infections at about 6-12 months of age. Patients have virtually no B
lymphocytes. Which of the following is TRUE?
A. The B cell response is intact, but the defect is in antigen processing.
B. The defect may be in stem cell differentiation, as indicated by the occurrence of global
immunodeficiency.
C. The disease is most easily diagnosed by measuring CD4+ lymphocytes in the patient's
peripheral blood.
D. The age of onset of infections is due to disappearance of maternal antibody.

23. A 57-year-old female complains of cold intolerance and undue fatigue. Her hemoglobin is
13-gm/dl (normal 12-14). Tests indicate auto-antibodies to thyroglobulin, and to microsomal
antigens from thyroid epithelial cells. This patient most likely has:
A. Rheumatoid Arthritis
B. Goodpasture's Syndrome
C. Hashimoto's Thyroiditis
D. Systemic Lupus Erythematosus
E. Graves' Disease
24. Which of the following best describes the differences between the classic and alternate
complement pathways?
A. The classic pathway results in the lysis of the target cell, which is not the case with the
alternate pathway.
B. The alternate pathway requires antibody for initiation, and the classic pathway is antibody-
independent.
C. The classic pathway is more active than the alternate pathway.
D. The alternate pathway typically requires C3b for activation, while the classical pathway
typically requires antigen-antibody complexes.

25. In the developmental pathway of B lymphocytes, the sequence of events is as follows:

A. Rearrangement of heavy chain, rearrangement of light chain, surface IgM, surface IgD.
B. Rearrangement of light chain, rearrangement of the heavy chain, surface IgM, surface IgD.
C. Rearrangement of light chain, rearrangement of the heavy chain, surface IgD, surface IgM.
D. Rearrangement of heavy chain, surface IgM, rearrangement of the light chain, surface IgD.
E. Rearrangement of heavy chain, rearrangement of the light chain, surface IgD, surface IgM.

26. An antibody directed against the idiotypic determinants of a human IgG antibody would
react with:
A. the Fc part of the IgG.
B. an IgM antibody produced by the same plasma cell that produced the IgG.
C. all human kappa chains
D. all human gamma chains

27. "Isotype switching" of immunoglobulin classes by B cells involves:

A. simultaneous insertion of VH genes adjacent to each CH gene.
B. insertion of a single VH gene adjacent to different CH gene.
C. activation of homologous genes on chromosome 6.
D. switching of light-chain types (kappa and lambda)
28. Multiple myeloma is a disease that affects primarily the elderly. It is characterized by the
proliferation of a single clone of Ig secreting plasma cells. Sam, a retired engineer has been
diagnosed with multiple myeloma in which the plasma cells secrete IgG. In Sam, which of the
following would be competitively inhibited due to the multiple myeloma? (Assume that the
specificity of the IgG is to an antigen to which Sam would never be exposed.)
A. ADCC mediated lysis of target cells (e.g. virally infected cells) by natural killer cells.
B. Opsonization by phagocytes when the opsonin is IgG.
C. Neutralization of both viruses and toxin
D. Only a and b
E. None of the above

29. Immune surveillance should provide the mechanism for the elimination of tumors that
express tumor specific antigens. However, the presence of tumors in patients indicate that
there are factors that enable the tumor to escape the immune system, as listed below. Which
one of the following is INCORRECT?
A. Tumors may be in privileged sites.
B. Tumors may change their surface antigens (antigenic modulation).
C. Tumor antigens may be recognized by T-cells in the absence of MHC.
D. There may be a hole in the T cell repertoire.
E. There may be blocking antibodies present which bind to soluble tumor antigens.

30. You are a cardiologist and are asked to see a 28-year-old female patient in regards to
palpitations and hyperactivity. Her GP tells her she is merely "overanxious", but she is afraid
she is having intermittent symptoms of a heart attack! When you see her you are struck by her
thick neck and marked protuberance of the eyes (exophthalmos). TSH levels are low.
Cariological work-up is normal. Which one of the following tests might you perform to elucidate
the basic mechanism that underlies the patient's symptoms?
A. Biopsy of tissue in the neck.
B. Assay immunoglobulin and/or complement activity.
C. Assay for antibody to TSH-receptor.
D. Assay for anti-thyroxin antibody.

31. A 24-year-old primigravida after an uneventful pregnancy delivered a male baby at term.
Upon neonatal examination, the baby was found to have low set ears, microcephaly (small
head), rock bottom feet, cynosis (bluish discoloration) of the body due to severe congenital
anomaly of the heart. Within 24 hours, the child died of severe hypocalcemic convulsions.
Autopsy findings revealed redimentary thymus, total agenesis of parathyroid glands and severe
ventricular and atrial defects of the heart. Based on the history, what is the most presumptive
diagnosis?
A. Bruton's syndrome
B. X-linked agammaglobulinemia
C. Severe combined immunoglobulin deficiency (SCID)
D. DiGeorge's syndrome
E. Selective variable immunoglobulin deficiency
32. A 52-year-old patient returns for a routine follow-up to an Oncology Clinic six months after
surgical removal of a tumor. Physical examination and functional inquiry were within the normal
limits. However, laboratory results revealed an elevated level of serum carcinoembryonic
antigen (CEA). Which is the LEAST likely diagnosis?
A. Cancer of the colon.
B. Stomach cancer.
C. Breast cancer.
D. Testicular teratocarcinoma.
E. Lung cancer.

33. An intern working on your medical service accidentally pricks himself with a needle used to
draw blood from a patient believed to be Hepatitis B positive. Optimal post exposure treatment
for this person would be:
A. begin vaccination with recombinant Hepatitis B vaccine only.
B. administration of Hepatitis B immune globulin only.
C. administration of Hepatitis B immune globulin and immunization at different sites.
E. none of the above is required if the person is healthy

34. An individual's finger was caught in a car door and as a result sustained significant tissue
damage and internal bleeding without breaking the skin or infecting the wound with foreign
material. Which of the following is the MOST likely explanation for the resulting inflammation?
A. The inflammation must be the result of nonimmunologic mechanisms because there are no
foreign antigens present.
B. The inflammation must be attributable to natural killer (NK) cells because they do not have a
unique antigen receptor.
C. The inflammation is related to an increase in the amount of C4bC2a on the surface of the
damaged tissue.
D. The inflammation is related to an increased constitutive production of C3b by clotting factors.

35. Three weeks after a bone marrow transplant, the patient began to experience diarrhea and
a skin rash on the palms and soles of the feet spreading to the trunk. This is highly suggestive
of graft versus (GVHD) host disease. All the following are correct regarding GVHD EXCEPT:
A. requires immunocompetent donor cells.
B. may result from infusion of blood products that contain viable lymphocytes into an
immunologically incompetent recipient.
C. requires suppressor T-cells.
D. requires MHC differences between donor and recipient.
36. An antigen found in relatively high concentration in the plasma of normal fetuses and a high
proportion of patients testicular cancer is:
A. viral antigen.
B. carcinoembryonic antigen
C. alpha-fetoprotein
D. heterophile antigen

37. A 42-year-old female had a renal transplant. She was treated with cyclosporine and
steroids. However, two weeks post transplantation she presented with deteriorating renal
function. Her dose of immunosuppressive therapy was increased and she responded favorably.
Which of the following syndromes did she have?
A. Hyperacute rejection
B. Chronic rejection
C. Acute rejection
D. All of the above
E. Only b + c

38. By the age of 9-months, Baby M had had several episodes of sinusitis and otitis media.
Recent tests revealed that this child cannot form antibodies to bacterial antigens. Further tests
indicate that the "machinery" for making antibodies is intact, but has not yet matured to yield
expression of antibodies. Hence a replacement therapy with IgG was started. This therapy:
A. will cure infections of Lymphocytic Choriomeningitis Virus.
B. may delay the formation of his/her own antibodies.
C. may form immune complexes that activates B cells.
D. will cure Leishmania infections.

39. A 7-month-old girl has a history of severe recurrent bacterial and fungal infections. Analysis
of serum Igs, B and T cell counts (and function) show no clear abnormality. Which one of
the following should you suspect?
A. multiple myeloma
B. chronic granulomatous disease
C. X-linked agammaglobulinemia
D. selective IgA deficiency
E. severe combined immunodeficiency disease
40. A car accident victim, who is 12-year-old, suffered lacerations when she was thrown clear
of the vehicle. She has just been brought into the hospital. Her parents stated that she has not
had previous immunization against tetanus. To provide protection against the possibility of
tetanus now and in the future, which of the following is the preferred method of treatment?
A. A mixture of tetanus toxoid and tetanus antitoxin as one injection, thereby causing less pain
and producing an adjucant effect.
B. A tetanus antitoxin injection this visit.
C. A tetanus toxoid injection this visit, with an injection of tetanus antitoxin approximately three
weeks later.
D. Separate injections of tetanus toxoid and tetanus antitoxin in different sites on this visit to
ensure active and passive immunization.
E. None of the above.

41. A kidney biopsy specimen taken from a patient with acute glomerulonephritis and stained
with fluorescein-conjugated anti-human IgG antibody would probably show:
A. no fluorescence
B. uniform fluorescence of the glomerular basement membrane.
C. patchy, irregular fluorescence of the glomerular basement membrane.
D. fluorescent B cells.
E. fluorescent macrophages.

42. Gm allotypes in the population refer to allotypic differences in which antibody isotype?
A. IgM and IgD
B. IgA and IgM
C. IgG and IgA
D. IgE and IgM

43. Activation of the complement cascade plays an important role in host defense by all of the
following EXCEPT:
A. working via the classical pathway, together with antibody, to induce bacteriolysis.
B. mediating bacteriolysis directly, via the alternative pathway, in the absence of specific
antibody.
C. facilitating phagocytosis by generating opsonins.
D. attracting phagocytes to the site of an infection by generating chemotaxins.
E. enhancing the generation of reactive oxygen intermediates

44. When immune complexes from the serum are deposited on glomerular basement
membrane. Subsequent damage to the membrane is caused mainly by which one of the
following?
A. natural killer cells
B. major basic protein released by eosinophils
C. cytotoxic T cells
D. enzymes released by polymorphonuclear cells
45. After bone marrow transplant from his HLA matched sister, Jimmy developed a syndrome
characterized by pancytopenia , aplastic anemia, skin rash, diarrhea, jaundice and weight loss.
This condition is called:
A. allograft rejection.
B. graft versus host disease.
C. failure of bone marrow engraftment.
D. a secondary infection.
E. anamnesis.

46. Sam, a ten month old child, has recurrent bacterial infections, but not viral infections. Tests
show few circulating B cells. This is consistent with
A. chronic mucocutaneous candidiasis.
B. C8 deficiency
C. X-linked agammaglobulinemia.
D. severe combined immunodeficiency disease.

47. Tumors may escape immunosurveillance by any of the following EXCEPT:

A. lack of cells recognizing the tumor antigen.
B. inability of patients MHC to present that particular tumor antigen.
C. antigenic modulation or masking.
D. local overexpression of cytokines IL-2 and/or TNF.
E. failure to provide costimulation to develop anti-tumor immunity.

48. The basis for the control which MHC molecules have over the immune response is best
explained by the:
A. ability of MHC-antigen complexes to be released from antigen presenting cells and stimulate
the activation of lymphocytes.
B. expression of MHC gene products on effector T and B lymphocytes
C. existence of genes controlling the immune response in linkage disequilibrium with MHC
genes.
D. need for antigen-derived peptides to bind an MHC class I or class II molecule for proper
presentation to the receptor of a T lymphocyte.
E. special affinity of unprocessed antigens for MHC molecules.

49. If you could analyze, at the molecular level, a plasma cell that is making IgG antibody, you
would find the following:
A. mRNA specific for J chains.
B. DNA sequence for VD and J genes translocated near the kappa-DNA exon.
C. the c-myc gene translocated near the gamma-DNA exon.
D. a DNA sequence for VD and J genes translocated near the gamma-DNA exon.
E. mRNA specific for both the kappa and lambda light chains.
50. A 4-year-old child suffering from repeated pyogenic infections was found to have normal
phagocytic function and cell mediated immune responses. Lymph node biopsy would probably
reveal:
A. depletion of thymus dependent regions.
B. intact germinal centers.
C. absence of dendritic cells.
D. paucity of plasma cells.

51. A child disturbs a wasp nest, is stung repeatedly, and goes into shock within minutes,
manifesting respiratory failure and vascular collapse. This is MOST likely to be due to:
A. systemic anaphylaxis
B. serum sickness
C. an arthus reaction
D. cytotoxic hypersensitivity

52. A 6-year-old male was hospitalized for bacterial meningitis. Cultures of sputum and CSF
yielded many colonies of Haemophilus influenzae . Past history indicated that the patient
had numerous bacterial infections including seven episodes of pneumonia. Physical exam
showed that tonsillar tissue was scanty. A lymph node biopsy revealed that germinal
centers were absent, but that paracortical and medullary areas had normal numbers of
lymphocytes. A mumps skin test was positive. Additional studies on this patient would
probably show:
A. a normal in vitro response to PHA.
B. absence of T-cells.
C. very low (less than 200-mg/dl) serum immunoglobulin levels.
D. a positive NBT test

53. Which statement is UNTRUE?

A. Hyperacute rejection occurs in minutes to hours.
B. Hyperacute rejection is readily treated with immunosuppressive drugs.
C. Hyperacute rejection is associated with early thrombosis and endothelial injury.
D. Hyperacute rejection is caused by preformed antibodies.

54. A two-year-old boy presents with recurrent bacterial infections. On physical examination
the physician notes that the person has no lymph nodes, and no tonsils. The laboratory
tests indicate that there are virtually no circulating B cells. The person's cell mediated
immunity, as tested in vivo by skin reactivity, is normal.
A. Bruton's agammaglobulinemia.
B. Hyper IgM syndrome
C. Selective IgA deficiency.
D. Chronic granulomatous disease
55. A patient with a central nervous system disorder is maintained on the drug methyldopa.
Hemolytic anemia develops, which resolves shortly after the drug is withdrawn. This is MOST
probably an example of:
A. Type I hypesensitivity
B. Type II hypersensitivity
C. Type III hypersensitivity
D. Type IV hypersensitivity

56. You have a patient who makes autoantibodies against his own red blood cells, leading to
hemolysis. Which one of the following mechanisms is MOST likely to explain the hemolysis?
A. Neutrophils release proteases that lyse the red cells.
B. Perforins from cytotoxic T cells lyse the red cells.
C. Complement is activated, and membrane attack complexes lyse the red cells.
D. Interleukin-2 binds to its receptor on the red cells, which results in lysis of the red cells.

57. B-cell lymphomas in mice, when experimentally treated with anti-idiotype sera, show
regression. However, they frequently recur and now show no reactivity with the same anti-
idiotype sera. Likely explanation(s) for this change could be:
A. Production of Ig splitting enzymes by the lymphoma cells.
B. A loss of surface Ig receptor on the B-lymphoma cells.
C. Production of anticomplementary substances by the lymphoma cells.
D. A change in idiotype expressed by CD4+ T cell receptor.

58. A 21-year-old female presents with a three week history of symmetrical swelling of the
small joints of the hands and feet and morning stiffness of one and one-half hour duration. Tests
indicate IgM auto-antibodies that have a specificity for Fc portion of IgG. This patient most likely
has:
A. Rheumatoid Arthritis
B. Goodpasture's Syndrome
C. Type 1 diabetes
D. Graves' Disease
E. Myasthenia Gravis

59. Baby Y was born with high titers of deoxy-ATP anddeoxyadenosine. He has also shown
an increased susceptibility to both intracellular (i.e. viruses) and extracellular (i.e. bacteria)
pathogens. What do you suspect?
A. SCID
B. XLA
C. CGD
D. Chediak higashi syndrome
60. A patient walks into your clinic complaining of a chronic cough and general fatigue. Upon
examination you diagnose him to have small cell lung cancer. Since the patient has a very
aggressive form of cancer, that has been unresponsive to medication or radiation, you decide to
enroll him in a new clinical trial that is using gene therapy to treat lung cancer. The theory
behind the trial is to use gene therapy to express a protein on the cell surface that will stimulate
T-cell proliferation upon immune surveillance of the tumor cells. Which of the following would
be the most effective co-stimulatory protein to be expressed on the tumor cell in this clinical
trial?
A. CD28
B. I-CAM 2
C. LFA-3
D. CD40-L
E. CD80/CD86

61. A woman comes into your office complaining of lesions on her legs. The lesion is a plaque
with irregular raised, indurated brown areas. In all other respects she is asymptomatic. You
decide to run a serological test. The presence of which antigen would you expect to find?
A. 17-1A
B. Galectin 9
C. Mage 1-3
D. mIg

62. Mr. Arnold was mowing in his back yard when a bee stung him. He has a known allergy to
bee venom, having been stung twice before. He immediately went inside and gave himself an
injection with his Epinephrine pen. This saved his life. Which one of the following is true?
A. Antigen exposure induced IgG production such that IgG bound to to FcR on mast cells.
B. Mr. Arnold did not have any pre-existing antibodies to bee venom.
C. Mr. Arnold has previously been sensitized and has IgE antibodies specific for bee venom.
D. Immune complexes formed in excess deposit on capillary walls during the effector phase of
this reaction type.

63. A child has come in to your clinic repeatedly with thrush. You have prescribed anti-fungal
treatment, which is successful only temporarily. His T-cell count appears to be normal and B-
cells appear to be elevated during bacterial and viral infections. He is healthy despite this and
shows no other signs of illness. Being the astute SGU physician that you are, you suspect:
A. DiGeorges Syndrome
B. Selective IgG deficiency
C. Severe combined immune deficiency
D. Chronic mucocutaneous candidiasis
E. Biotin deficiency
64. Systemic Lupus Erythematosus (SLE), is characterized by immune complexes in serum
and the basement membranes of many organs and joints. This involves Polyclonal B-cell
activation resulting in increased production of IgM and IgG, which activate complement. Which
of the following complement proteins functions as a chemotactic attractant for neutrophils, as
well as an anaphylatoxin?
A. C3a
B. C3b
C. C4a
D. C5a
E. C2b

65. A 51-year-old man had a kidney transplant. Following the transplant, he had reduced renal
function, which cytokine would be LEAST likely to play a role in this?
A. IL-2
B. IFN
C. IL-12
D. TNF
E. IL-4

The group of questions below consists of lettered choices followed by several numbered
items. For each numbered item, select the appropriate lettered option with which it is
most closely associated. Each lettered option may be used once, more than once, or not
at all.

For each clinical situation listed below, select the reaction that is MOST likely to be
associated with it.

66. Hemolytic disease of the newborn results when passively transferred antibody from the
mother reacts with the neonate's erythrocytes.

67. In rheumatoid arthritis, rheumatoid factor (antibody to the immunoglobulin molecule) -

antigen complexes deposit in the joints, resulting in an inflammatory reaction.

68. Poststreptococcal glomerulonephritis appears two weeks after a streptococcal infection.

69. Granuloma formation is associated with the immune response to Mycobacterium

tuberculosis.

70. Contact dermatitis is observed in response to nickel-containing jewelry.

A. Type I hypersensitivity reaction

B. Type II hypersensitivity reaction
C. Type III hypersensitivity reaction
D. Type IV hypersensitivity reaction
71. Sam presented at his physician's office with symptoms of acute hepatitis. Since the
prognosis depends on whether the pathogen is hepatitis B, hepatitis D, or both, an ouchterlony
test was performed. Figure (C) was the result observed. What does this indicate?

Ag1 Ag1 Ag1 Ag2 Ag1 Ag2

Ab1 Ab1 Ab1

Ab2

Figure A Figure B Figure C

A. Hepatitis B and D are antigenically unrelated

B. Hepatitis B and D share antigenic determinants
C. Hepatitis B and D are the same antigen
Answers to Immunology Exam

1. B 36. C
2. C 37. C
3. E 38. B
4. E 39. B
5. B 40. D
6. B 41. C
7. C 42. C
8. D 43. E
9. C 44. D
10. B 45. B
11. C 46. C
12. D 47. D
13. C 48. D
14. C 49. D
15. D 50. D
16. D 51. A
17. A 52. C
18. A 53. B
19. D 54. A
20. D 55. B
21. B 56. C
22. D 57. B
23. C 58. A
24. D 59. A
25. A 60. E
26. B 61. C
27. B 62. C
28. E 63. D
29. C 64. D
30. C 65. E
31. D 66. B
32. D 67. C
33. C 68. C
34. A 69. D
35. C 70. D
71. B