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 10gm/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+ Tcell 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.
B.
C.
D.
E.

IgA
IgD
IgG
IgE
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.