IMMU 7630 Practice Final Test 2010
1. A 2-year old boy has had numerous bacterial infections this year. His serum is sent for electrophoresis. Given only this history, you think the gamma globulin peak will be:
A. Elevated.
B. Decreased.
C. Either elevated or decreased.
2. A patient has developed serum sickness after treatment with horse antibody to botulinum toxin. You ask the lab to measure total serum hemolytic complement, expecting it to be:
A. Elevated.
B. Decreased.
C. Either elevated or decreased.
3. A patient with lung cancer is treated with OncoZap, a monoclonal antibody to a lung tumor TAA (tumor-associated antigen) to which radioactive 90yttrium is coupled. The tumor regresses by 75% but gradually regrows, so you give him a second injection of OncoZap 5 months after the first. This time there is no tumor regression. Which of the following is the LEAST likely possible explanation for this therapeutic failure?
A. The patient made antibodies against OncoZap.B. The tumor has downregulated the synthesis of the TAA.
C. The TAA is no longer expressed on the cell surface.
D. The tumor is suppressing the patient’s immune system.
E. The tumor is growing slower and thus is more radioresistant.
4. A 12-year old patient is skin tested with mumps antigen, and has a positive result at 48 hours. He was immunized with mumps at 1 and 5 years of age. From this result, which of the following would NOT be a fair conclusion for you to make?
A. His antigen-presenting cells process antigen normally.B. His macrophages respond chemotactically to interferon gamma.
C. He has more Th1 against mumps than does a nonimmune subject.
D. His Th1 can make interferon gamma.
E. He will have elevated IgM anti-mumps in his serum.
Questions 5-9: Choose the letter of the immunological mechanism most likely to be involved in the clinical situation.
A. Type I (IgE mediated)B. Type II (specific antibody)
C. Type III (immune complexes)
D. Type IV (T cell mediated)
E. None of these mechanisms
5. A traveler has a sore arm some time after a booster injection of yellow fever vaccine. A biopsy shows a heavy infiltrate of polymorphonuclear neutrophils, and complement deposited in capillary basement membranes.
6. A rabbit, being immunized against horse actin, wheezes, collapses and dies after the second injection.
7. The more eye shadow a young girl puts on to hide it, the worse the red rash around her eyes becomes.
8. An asthmatic skier from Florida is fine until she begins her first winter run down a Colorado mountain, when she starts to wheeze. She goes to the lodge and immediately feels better.
9. A baby is born weak and floppy. Its mother, it turns out, has myasthenia gravis.
Questions 10-13: Chose the diagnosis that is best supported by the available lab data.
A. Farmer’s lung
B. Systemic lupus erythematosus
C. Goodpasture’s syndrome
D. Poststreptococcal glomerulonephritis
E. Bruton’s X-linked agammaglobulinemia
10. A patient has protein in his urine. Complement C3 in plasma is decreased; serum IgG is normal; patient’s serum stains the nuclei of normal (permeabilized) cells; patient’s serum does not stain the basement membranes of normal kidney; patient’s own kidney shows deposits of IgG (pattern not mentioned).
11. A patient has respiratory distress. Complement C3 in plasma is normal; serum IgG is normal; patient’s serum does not stain the nuclei of normal (permeabilized) cells; patient’s serum stains the basement membranes of normal kidney in a linear pattern; patient’s own kidney shows deposits of IgG (pattern not mentioned).
12. Another patient has respiratory distress. Complement C3 in plasma is decreased; serum IgG is normal; patient’s serum does not stain the nuclei of normal (permeabilized) cells; patient’s serum does not stain the basement membranes of normal lung; patient’s own lung shows IgG in the basement membrane in a lumpy-bumpy pattern.
13. A third patient has respiratory distress. Complement C3 in plasma is normal; serum IgG is decreased; patient’s serum does not stain the nuclei of normal (permeabilized) cells; patient’s serum does not stain the basement membranes of normal lung; patient’s own lung shows no IgG deposits.
Questions 14-21: Choose the best answer.
14. I mix extensively washed leukocytes from a tumor patient’s blood with the patient’s tumor cells grown in tissue culture. The tumor cells are killed. The mechanism could be:
A. Killer T cells (CTL)B. ADCC
C. Either
D. Neither
15. I mix extensively washed leukocytes from a tumor patient’s blood, the patient’s serum, and the patient’s tumor cells grown in tissue culture. The tumor cells are killed. The mechanism could be:
A. ADCCB. NK cells
C. Either
D. Neither
16. I plan to create a genetic “knock-in/knock-out” mouse, by inactivating the genes for MHC Class I in a fertilized ovum and then adding back MHC class I genes only on thymic stromal cell-specific promoters. This mouse will express no Class I except on its thymic stromal cells. About this mouse:
A. He will be agammaglobulinemic.B. He will be an excellent mouse model for AIDS.
C. He will have normal numbers of CD8 cells but they will not protect him.
D. He will have normal numbers of CD4 cells but they will not protect him.
E. He will be unable to reject unrelated skin grafts.
17. Transfer of antibodies in milk is an example of which kind of immunity?
A. Natural, active
B. Natural, passive
C. Artificial, active
D. Artificial, passive
18. Which of these statements about antigen presentation is true?
A. Dendritic cells pick up antigen in the periphery and carry it to the thymus.
B. Dendritic cells are phagocytes as well as antigen-presenting cells.
C. In an infection, neutrophils pick up antigen and carry it to the draining lymph node.
D. Dendritic cells constantly bring brain antigens to the draining lymph nodes, but there are no T cells which can recognize them.
E. Because of the blood-brain barrier, lymphocytes never enter the brain.
19. Your neighbor has had a baby and asks what the general scheme of immunizations will be. You say:
A. If you breast-feed it, we don’t recommend immunization until preschool because the infant will have your antibodies.
B. Get all immunizations done early; don’t wait beyond 6 months for any of them.
C. Protein and killed vaccines are given early; live virus vaccines after a year.
D. Get the immunizations your caregiver recommends, and be sure to add smallpox and anthrax before starting preschool.
E. Be cautious, since early exposure to antigens increases the risk of asthma.
20. Mrs. Jones, two months pregnant, contracts German measles (rubella). You are concerned that it may have been passed to her fetus. At birth, the lab takes umbilical cord blood and finds that there is antibody in it to rubella virus. You think:
A. That doesn’t help, as the cord blood is mother’s.
B. It is good news if the antibodies are IgG and not IgM.
C. It is good news if the antibodies are IgM and not IgG.
D. If the antibodies are IgG there must be some mistake.
E. The antibodies cannot be IgM, as it does not pass the placenta.
21. While spending a year doing research and clinical work in the high Andes in Peru, you find that all the women of a small, very isolated village actually make IgG anti-A and anti-B. They are an exception to the rule that anti-A and –B isohemagglutinins are IgM. Otherwise, the people seem healthy and happy, and the population is growing. You form a hypothesis:
A. Everybody in the village is type O.
B. Everybody in the village is extremely anemic.
C. Every woman must have been treated with RhoGAM during every pregnancy.
D. Everybody in the village is genetically AO or BO.
E. All women in the village must also be Rh(D) negative.