MSB 103, DSB 103

MOI UNIVERSITY

SCHOOL OF MEDICINE
END OF TERM III EXAMINATION (ETE III) 2009/2010
COURSE: MSB 103 : BLOOD & IMMUNE MECHANISM
PROGRAMME: M.B.Ch.B, DSB 103 YEAR OF STUDY: 1(ONE)
DATE: 27TH SEPTEMBER, 2010 TIME: 9.00 A.M. - 12.00 NOON

GENERAL INSTRUCTIONS:-

(i) Write your University Registration Number on every piece of paper you use.

(ii) Do not write your names on any piece of paper you use.

(iii) This paper consists of four (4) sections, headed: Section A - Human
Anatomy, Section B - Medical Biochemistry, Section C - Medical Physiology,
Section D - Immunology. All to be answered in a total time of three (3)
hours.

(iv) Each section constitutes a CAT relating to the discipline named.

(v) Answer all the questions in all the four (4) sections.

(vi) Questions in each section must be answered in separate answer booklets or

answer sheets so that they can be handed in separately at the end of the
examination.

(iv) Read carefully the additional instructions preceeding each section.

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SECTION A: HUMAN ANATOMY (60 minutes)

SUBSECTION A I : MULTIPLE CHOICE QUESTIONS (MCQs) (20 minutes)
TYPE 3

INSTRUCTIONS:

I) CHOOSE THE WRONG STATEMENT IN EACH QUESTION (1 – 10) AND

PRINT IT “X” IN THE ANSWER SHEET PROVIDED.

1. Concerning embryonic hemopoiesis

(a) The first blood cells appear within the liver

(b) Extravascular hemopoiesis takes place within the spleen
(c) Megaloblasts have less hemoglobin than the normoblasts
(d) Bone marrow becomes main hemopoietic organ during fetal period
(e) Stem cells originate from the mesenchymal cells

2. Regarding adult hemopoiesis

(a) Hemopoietins stimulate proliferation of precursor cells

(b) Polychromatophilic erythroblasts contain hemoglobin
(c) In granulopoiesis, specific granules appear at the stage of the promyelocyte
(d) All lymphocyte progenitor cells originate in the bone marrow
(e) Azurophilic granules are lysosomes

3. In relation to bone marrow

(a) Bone marrow produces all types of blood cells

(b) Stroma of the bone marrow consists of the reticular tissue, collagen fibers
and sinusoid capillaries
(c) Yellow bone marrow cannot be replaced by the red bone marrow
(d) Megakaryocytes send their pseudopodia through the fenestrae of the sinusoid
capillaries
(e) Bone marrow can be a source of stem cells for other tissues, not just blood
bells

4. About plasma of blood

(a) Plasma constitutes 55 percent of blood

(b) Defibrinated plasma doesn’t contain proteins
(c) Gamma globulins of plasma are antibodies
(d) Prothrombin and fibrinogen participate in blood coagulation
(e) 90 – 93 per cent of plasma constitutes water

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5. Concerning erythrocytes

(a) Normocytes are 7, 2 – 7,9 micrometers in diameter

(b) Protein spectrinis responsible for the shape of cells
(c) Most of hemoglobin granules are located at the centre of erythrocyte
(d) Lifespan of an erythrocyte is about 120 days
(e) Carbooxyhemoglobin reduces capacity of erythrocytes to transport O2

6. Regarding leucocytes

(a) In normal adults, there are about 6000 – 10000 leucocytes per microliter of
blood
(b) Neutrophils constitute 30 – 40 per cent of leucocytes
(c) Specific granules of an eosinophil contain crystalline core
(d) Basophilic specific granules contain heparin and histamine
(e) T lymphocytes originate in the bone marrow and migrate to the thymus

7. Related to thymus

(a) Accidental involution of thymus is irreversible

(b) Epithelial reticular cells are stromal components of the thymus
(c) Thymus capillaries have no fenestrae
(d) Hassallcorpuscles consist of degenerated epithelial reticular cells
(e) Cortex is richer in small lymphocytes than the medulla

8. About spleen

(a) Red pulp is composed of Billroth’s cords and blood vessels

(b) T lymphocytes form PALS around central arteries
(c) Aging erythrocytes cannot pass through the wall of splenic sinusoids
(d) Central artery subdivided to form penicillar arterioles
(e) Splenic cords consist mainly of lymphocytes and monocytes

9. Concerning lymph nodes

(a) Inner cortex contains lymphoid nodules

(b) Germinal centers are composed of macrophages, activated B lymphocytes
and lymphoblasts
(c) Lymphocytes recirculate squizing among high endothelial cells of venules
(d) Medullary cords contain plenty of plasma cells
(e) Subcapsular sinus consists of reticular cells, reticular fibers, and
macrophages

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10. Regarding mucosa associated lymphoid tissue (MALT)

(a) Lymphoid tissue of tonsils is completely encapsulated

(b) Lamina propria of large intestine contains lymphoid follicles
(c) Peyer’s patches of ileum are covered with M cells
(d) Lymphoid nodules and diffuse lymphoid tissue form continuous ring around
crypts of appendix
(e) Lamina propria of bronchi may contain lymphoid nodules

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SUBSECTION A II: SHORT ANSWER QUESTIONS (SAQs) (15 minutes)

INSTRUCTIONS:

I) TEHRE ARE THREE (3) SAQs IN THIS PART

II) ANSWER ALL THE THREE (3) QUESTIONS IN THE BOOKLET
PROVIDED.

SAQ 1. Describe development of an erythrocyte.

(5 minutes)

SAQ 2. Give morphofunctional characteristics of the neutrophil.

(5 minutes)

SAQ 3. Describe blood supply of the spleen.

(5 minutes)

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SUBSECTION AIII: DESCRIPTION OF DIAGRAMS (25 minutes)

INSTRUCTIONS:

I) THERE ARE FIVE (5) DIAGRAMS IN THIS PART.

II) NAME THE DIAGRAMS (1-5) AND WRITE THEIR HISTOLOGICAL

COMPONENTS (A-D) IN THE SHEET WITH DIAGRAM PROVIDED.

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SECTION B: MEDICAL BIOCHEMISTRY (30minutes)

SUB-SECTION BI: MULTIPLE CHOICE QUESTIONS (MCQs) (30 minutes)
TYPE III

INSTRUCTIONS:-

(I) EACH OF THE QUESTIONS IN THIS SUBSECTION CONSISTS OF A

STATEMENT/QUESTION WHOSE MOST APPROPRIATE
COMPLETION/ANSWER IS PROVIDED AMONG THE FIVE OPTIONS
NUMBERED (a) - (e).

(II) FOR EACH QUESTION SELECT THE MOST APPROPRIATE OPTION

AND INDICATE BY PRINTING AN X IN THE APPROPRIATE BOX IN
THE ANSWER SHEETS PROVIDED. IF YOU DO NOT KNOW THE
ANSWER, PRINT X IN THE BOX IN THE `DK' COLUMN

(III) A CORRECT RESPONSE EARNS YOU ONE MARK.

1. One of the following prosthetic group is found in myoglobin and hemoglobin:

(a) Coenzyme A
(b) 2,3-Diphosphoglycerate
(c) Heme
(d) NAD+
(e) Coenzyme Q

2. In O-glycosylation of glycoproteins the sugars are attached to the OH group of:

(a) Asparagine
(b) Histidine
(c) Threonine
(d) Aspartate
(e) Glutamine

3. Tropocollagen consists of how many polypeptides?

(a) One
(b) Two
(c) Three
(d) Four
(e) Five

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4. Which vitamin is required during the formation of collagen?

(a) Vitamin A
(b) Vitamin B1
(c) Vitamin B6
(d) Vitamin D
(e) Vitamin C

5. Heme is synthesized from

(a) Succinyl CoA and lysine

(b) Succinyl CoA and cysteine
(c) Succinate and glycine
(d) Succinyl CoA and glycine
(e) S-aminolevulinate

6. The proteoglycans are different from other glycoproteins because the disaccharide
unit contains:

(a) Two amino sugars

(b) One amino sugar
(c) The two sugars are not amino sugars
(d) The sugars are sulphonated
(e) The sugars are always in -glycosidic bonding

7. Hyaluronate is a chief component of all of the following except

(a) Intracellular matrix

(b) Skin
(c) Synovial fluid
(d) Cartilage
(e) Hair

8. Which of the following amino acids is not commonly found in collagen?

(a) Glycine
(b) Proline
(c) Tryptophan
(d) Hydroxyproline
(e) Hydroxylysine

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9. How many porphobilinogen molecules are required for the formation of heme?

(a) Two
(b) Three
(c) Four
(d) Five
(e) Six

10. One of the following is not associated with hemoglobin

(a) It may bind 2, 3 diphosphoglycerate

(b) It is tertiary protein
(c) It has four iron cations
(d) It has four polypeptides
(e) It is a globular protein

11. Heparin is normally stored in granules of

(a) Platelets
(b) B-lymphocytes
(c) Mast cells
(d) T-lymphocytes
(e) RBC

12. Keratin is absent in one of the following:

(a) Hair
(b) Teeth
(c) Wool
(d) Nails
(e) Hoofs

13. Heme is catabolized to biliverdin in the presence of:

(a) FE3+
(b) NADP+
(c) NADPH
(d) CO
(e) NADH

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14. The enzyme involved in regulatory step of heme synthesis is:

(a) ALA dehydratase

(b) Ferrochelatase
(c) Heme oxygenase
(d) ALA synthase
(e) Uroporphyrinogen I synthase

15. Hemoglobin can bind all of the following except:

(a) O2
(b) 2, 3-diphosphoglucerate
(c) CO2
(d) H+
(e) H2O

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SECTION C: MEDICAL PHYSIOLOGY(60 Minutes)

SUBSECTION C(i) : MULTIPLE CHOICE QUESTIONS (MCQ) (30 minutes)
TYPE 3

INSTRUCTIONS

(I) EACH OF THE QUESTIONS IN THIS SUBSECTION CONSISTS OF A

STATEMENT/QUESTION WHOSE MOST APPROPRIATE
COMPLETION/ANSWER IS PROVIDED AMONG THE FIVE OPTIONS
NUMBERED (a) - (d).

(II) FOR EACH QUESTION SELECT THE MOST APPROPRIATE OPTION

AND INDICATE BY PRINTING AN X IN THE APPROPRIATE BOX IN
THE ANSWER SHEETS PROVIDED.

(III) A CORRECT RESPONSE EARNS YOU PLUS ONE MARK.

1. The inflammatory response includes all of the following except

(a) Vessel constriction

(b) Temperature increase
(c) Increased blood flow
(d) Phagocyte attack

2. Which statement regarding blood cells is correct:

(a) All blood cells originate in red bone marrow

(b) Red bone marrow is the primary source of all blood cells and macrophages
(c) Most types of leukocytes appear in equal amounts in blood
(d) Erythrocytes are produced in red marrow while leukocytes are produced
primarily in lymph nodes

3. Which of the following are organs where activation of T and B cells usually
occurs

(a) Bone marrow

(b) Lymph nodes
(c) Thymus
(d) All of the above

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4. What is the role of complement in the body’s defense:

(a) It interferes with viral replication

(b) It is involved in antibody production
(c) It aids in antigen presentation
(d) It causes cell lysis

5. Which of the following cell types can be infected by HIV

(a) B-cells
(b) T-helper cells
(c) Vaginal epithelial cells
(d) All of the above

6. Which of the following statements is false. ‘For almost every foreign antigen you
may encounter……….’

(a) ………..a subset of B-cells already exists in your body specific to it

(b) ………. a subset of T-helper cells already exists in your body that
expresses a T-cell receptor specific to it
(c) ……… a subset of phagocytes already exists in your body that
phagocytizes only that antigen
(d) ………a subset of antigen-specific memory cells can be produced poin
exposure to that antigen

7. A transfusion of type O blood given to a person who has type A blood would
result in:

(a) The recipient’s O antigen reacting with the donated anti-O antibodies
(b) The recipient’s anti-A antibodies clumping the donated red blood cells
(c) The recipient’s anti-B and anti-O antibodies reacting with the donated red
blood cells if the donor was a heterozygote (OB) for blood type
(d) No reaction because type O is a universal donor

8. A patient with B-blood has ____________ antigen on the surface of red blood
cells:

(a) B and Rh
(b) A and Rh
(c) B and O
(d) B

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9. Majority of clotting factors are produced by:

(a) The liver

(b) Platelets
(c) Monocytes
(d) Endothelial cells

10. The action of plasmin is

(a) Eliminate Ca2+

(b) Antagonise the action of thrombin
(c) To stimulate heparin
(d) Degrade fibrin

11. The osmotic pressure of plasma is maintained by

(a) Albumin
(b) Phaglobulin
(c) Formed elements in blood
(d) Beta globulins

12. Hematocrit of 45% means that in the sample of blood analysed:

(a) 45% Hb is in the RBC

(b) 45% of total blood volume is made up of plasma
(c) 45% of total blood volume is made up of RBC’s and WBC’s
(d) 45% of the blood is made up of proteins

13. Natural killer cells:

(a) Exhibit no memory respone

(b) Recognise cells infected by a specific virus
(c) Are produced in the thymus
(d) All the above

14. The most important phagocytes are:

(a) Lymphocuytes and bacophils

(b) Basophils and mast cells
(c) Neutrophils and macrophages
(d) Macrophages and lymphocytes

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15. The plasma of a normal adult:

(a) Is about 60% water

(b) Accounts for 10% body weight
(c) Contains about 8mmoles/L of potassium (K+)
(d) Contains about 140 mmoles/L of sodium (Na+)

16. For a normal healthy adult of 65kg body weight:

(a) The blood pH is about 7

(b) There are about 4.5 x 1012 red blood cells per liter
(c) The blood volume would be about 4L
(d) There are about 1 x 109 leukocytes per liter

17. Normal human red cells:

(a) Are released into the circulation as immature cells called reiculocytes
(b) Have a multi-lobed nucleus
(c) Increase in numbers on exposure to estrogens
(d) Secrete colony stimulating factors

18. The following statement is true about gas carriage by the blood:

(a) After leaving the lungs, each liter of blood contains 20ml of oxygen
(b) Hemoglobin is half saturated with oxygen when then PO2 is about
25mmHg
(c) As the PCO2 rises the affinity of hemoglobin for oxygen is increased
(d) Fetal hemoglobin has higher oxygen saturation compared to maternal
hemoglobin

19. Regarding the platelets:

(a) Are present in greater number than red blood cells

(b) Secrete the main clotting factors
(c) Aggregate in the presence of prostacyclin
(d) Will adhere to walls of damaged endothelium

20. Which of the following is NOT a product of oxygen dependent pathway:

(a) Superoxide radicals

(b) Hypochlorous acid
(c) Lysozymes
(d) Hydrogen peroxide

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21. In comparison to macrophages, neutrophils:

(a) Are longer lived

(b) Can control intracellular parasites
(c) Can present exogenous antigens
(d) Move and phagocytose more quickly

22. Regarding the ABO antigen system:

(a) People who are blood group O must have 2 parents who are both blood
group O
(b) People who are blood group A will produce anti-A anibody
(c) In group O the H antigen is left unchanged
(d) Anti-A and Anti-B antibodies are usually IgG

23. Which of the following generally does NOT apply to bone marrow

(a) Cellualr proliferation

(b) Differentiation of lymphocytes
(c) Cellular interaction
(d) Antigen-dependent response

24. Effector functions of Immunoglobulins are:

(a) Involved in complement fixation by IgM and IgG

(b) The property of constant region domains of the heavy chains
(c) Illustrated by placental transfer of IgG to the fetus
(d) Not the property of constant region domains of the light chains

25. The breakdown of erythrocytes in the body yields

(a) Iron, most of which is excreted in urine

(b) The pigment bilirubin which is water soluble
(c) The pigment bilirubin which is conjugated in the liver
(d) Bile salts such as sodium tauro-cholate

26. Erythrocyte:

(a) Are responsible for the major part of blood viscocity

(b) Increase their volume in hypertonic saline
(c) Do not require energy for metabolic activities
(d) Hemolyse in a 5% glucose solution

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27. Bleedign from a small cut in the skin:

(a) Is normally diminished by local vascular spasm

(b) Ceases within about 15 minutes in normal people
(c) Will be prolonged if there is severe deficiency of factor VIII
(d) Is greater from cold skin than from warm skin

28. Blood platelets:

(a) Decrase in number after haemorrhage

(b) Have a small single lobed nucleus
(c) Alter shape when in contact with collagen
(d) Are formed in the bone marrow

29. The rate of red cell formation is increased:

(a) By vitamin B12 injections to healthy people on a normal diet

(b) Immediately after a blood donation
(c) At sea level
(d) When the blood reticulocyte count is decreased

30. Total body water:

(a) Forms a smaller percentage of body weight in thin persons than in fat ones
(b) Can be measured by an indicator dilution technique using Evans T-blue te
indicator
(c) Comprises half to two thirds of body weight in young adults
(d) Is a smaller proportion of body weight in men than in women

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SUBSECTION C II – SHORT ANSWER QUESTIONS (SAQs) (30 minutes)

INSTRUCTION:

I) THERE ARE THREE (3) QUESTIONS IN THIS SECTION

II) ANSWER ALL THE THREE (3) QUESTIONS
III) START EACH QUESTION ON A FRESH PAGE OF THE BOOKLET.

SAQ 1. Write an essay on haematopoiesis?

(10 minutes)

SAQ 2. Write short notes haemostasis?

(10 minutes)

SAQ 3. Explain the functions of plasma proteins.

(10 minutes)

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SECTION D: IMMUNOLOGY
(60 Minutes)
INSTRUCTIONS:-

(i) THIS PAPER IS MADE UP OF TWO (2) SUBSECTIONS: I AND II.

SUBSECTION I CONSISTS OF TWENTY (20) MULTIPLE CHOICE
QUESTIONS (MCQs) TO BE ANSWERED IN TWENTY (20) MINUTES.
SUBSECTION II CONSISTS OF ONE (1) SHORT ANSWER QUESTION
(SAQs) TO BE ANSWERED IN TWENTY TEN (10) MINUTES.

(ii) FOR THE MCQs, EACH QUESTION CONSISTS OF A

STATEMENT/STEM WHOSE MOST CORRECT RESPONSE IS
PROVIDED AMONG THE FIVE OPTIONS NUMBERED A TO E.

(iii) FOR EACH MCQ, SELECT ONLY ONE APPROPRIATE OPTION AND
INDICATE BY CIRCLING IT.

EXAMPLE:

Major features of innate immunity include

(a) recognition
(b) specificity
(c) memory
d first line of defense
(e) adaptability
The most appropriate response is d

(iv) ATTEMPT ALL QUESTIONS IN THE TWO SUBSECTIONS.

SUBSECTION DI: MULTIPLE CHOICE QUESTIONS (MCQs) (20 minutes)

1. The effector functions of antibody is determined by:

(a) Hypervariable region

(b) Variable region
(c) Constant region
(d) Complementary-determining region
(e) Hinge region

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2. The basic structure of an antibody consists of

(a) 2H and 2L chains

(b) 1H and 3L chains
(c) 4H and 4L chains
(d) 2H and 1L chains
(e) 3H and 1L chains

3. In comparison with primary humoral immune responses, secondary humoral

immune responses are characterized by:

(a) A faster decline in antibody concentration after the steady state has been
reached
(b) Increased probability of detecting cross-reactive antibodies
(c) Longer Iag phases
(d) Longer persistence of antigen in circulation
(e) The need for greater doses of stimulating antigen

4. Which one of the following is the most likely consequences of injecting human
albumin intravenously into a previously immunized rabbit with anti-human
albumin antibodies in circulation

(a) A new burst of IgM antibody synthesis

(b) Formation of circulating immune complexes
(c) Massive activation of Th2 cells
(d) Immediate increase in the levels of circulating antialbumin antibody
(e) Immediate release of histamine from circulating neutrophils

5. VDJ recombination take place in:

(a) Spleen
(b) Liver
(c) Lymph nodes
(d) Tonsil
(e) Bone marrow

6. Components of alternative complement pathway include:

(a) C1, C4 and C2

(b) Factor D, B and properdin
(c) C3, C4 and C5
(d) CIq, C3b, C4b
(e) Properdin, C1q and factor (Bf)

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7. Regulators of complement system are as follows EXCEPT

(a) Properdin stabilizes C3b, BbP

(b) Factor 1 dissociation atternative C3 convertase
(c) CI-esterase inhibitor (CIINA) dissociates active Cir and CIs active enzyme
site
(d) Decay accelerating factor (DAF) dissociates C3 and C5 convertase
(e) S-protein inhibit C5, C6, C7, C8 polymerization to C5b-9

8. Which of the following is a complement lytic factor?

(a) C4b2b
(b) C3bBb
(c) C4b2b3b
(d) C5b-9
(e) Factor 4

9. Which one of the following is the most potent classical complement pathway
activator

(a) IgG
(b) IgA
(c) IgE
(d) IgD
(e) IgM

10. Major biological function of complement system associated with adaptive

immunity is

(a) Neutralization of microbes

(b) MAC mediated lysis of gram negative bacteria
(c) Immune adherence and phagocytosis of pathogens
(d) Increased B cell priming and memory
(e) Reduced T cell priming and memory

11. Immature double negative thymocytes express the following cell markers

(a) TCR, CD3+, and CD4+

(b) TCR, CD3+ AND CD3+
(c) CD2, CD7+ and CD3+
(d) CD4, CD8- and CD3+
(e) CD4- CD8+ and CD3+

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12. The following is true of mature T lymphocytes

(a) Majority express  TCR

(b) Are not educated to distinguish self and non self
(c) Seed into primary lymphoid organs
(d) Majority express B TCR
(e) Do not acquire TCR

13. Which of the following ligand-receptor interactions plays a major role in the
effector stage of CD8-mediated cytotoxicity

(a) CD2; CD58(LFA-3)

(b) CD8: MHC1
(c) CD95: Fasligand
(d) IL-2 : IL-2R
(e) IFN- : IFN--R

14. In the activation of T cells, antigen signal is delivered through:

(a) HLA-DP-TCR peptide complex

(b) CD28-80/86-peptide complex
(c) HLA-DP-DR and DQ Molecules
(d) CD3CD4/CD8 – TCR-MHC peptide complex
(e) CD3-TCR – CD28 – peptide complex

15. Biochemical events in T cell activation is NOT associated with:

(a) Generation of phosphatidyl inositol triphosphate

(b) In activation of phospholipase C
(c) Increase of intracellular Ca++ and activation of phosphatase
(d) IL-2 receptor synthesis and IL-2 secretion
(e) T cell proliferation and differentiation

16. The following are adhesion molecules in T cell activation EXCEPT:

(a) CD2 (LFA-2) with LFA-3

(b) CD45R with CD22
(c) LFA-1 and ICAM-1
(d) CD28 with 86
(e) ICAM-1(CD54) with CD2

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17. Endogenous antigen presentation requires delivery of antigen peptides to the

endoplasmic recticulum by:

(a) Class I MHC and invariant chain

(b) Calnexin and tapasin
(c) HLA –DM
(d) Leader sequence
(e) TAP-1 and TAP-2

18. Activated T reg can regulate immune responses by signaling activated

lymphocytes to undergo

(a) Apoptosis
(b) Clonal deletion
(c) Clonal proliferation
(d) Cytotoxicity
(e) Somatic hypermutation

19. Antibody exerts feedback control on immune response in the following ways
EXCEPT:

(a) IgG suppress specific IgG synthesis by antibody blocking and recept cross-
linking
(b) Passively administered IgM together with an antigen enhances the immune
respose
(c) Immune complexes may enhance or suppress immune responses using Fc
dependent mechanisms
(d) Anti-idiotypic antibodies cannot down regulate the immune responses
(e) None of the above

20. Low doses of antigen may induce

(a) A secondary response

(b) Hypersensitivity
(c) Low zone tolerance
(d) Low zone tolerance
(e) Low zone immunity

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SUB-SECTION DII - SHORT ANSWER QUESTIONS (SAQs) (29 minutes)

INSTRUCTIONS:

I) THERE IS ONE (1) QUESTION IN THIS SECTION

II) ANSWER THE QUESTION

SAQ 1. (a) Explain effector mechanisms in NK cell mediated cytotoxicity.

(5 minutes)

(b) Explain the mechanism of immune regulation by Treg cells.

(5 minutes)

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