Open Book Exam / Basic Immunology/ Forth Year/ Dr.

Batool Ali Ahmed

Q I: Choose the most suitable correct answer with explanation
1. A 12-year-old boy presented with a 1-week history of pain in the left loin. This was diagnosed as a
urinary tract infection and treated with amoxicillin. One week later, he developed a purpuric rash around
the ankles, accompanied by some blistering and superficial necrosis. Shortly afterwards, he developed
pain in the left elbow joint. On admission to hospital, he was noted to have and a blood pressure of
130/90. Over the next month, he suffered further episodes of abdominal colic and purpura. His
haemoglobin was 95 g/l with a normal white cell count. Total haemolytic complement, C4 and C3 levels
were normal. Although his blood urea was normal, his creatinine clearance was low at 31 ml/min per m2
with proteinuria of 4.5 g/day.
Diagnosis involved detection of the followings EXCEPT:
A. Haematuria and proteinuria
B. Antinuclear antibodies
C. Biopsy for skin lesion
D. Anti-CCP
2. A 9-year-old boy was admitted as an emergency with puffiness of the face, eyes and
trunk. A week previously he had complained of a sore throat. His urine showed
proteinuria, haematuria and red cell casts. Antibodies to streptococcal antigens were
present in high titre: antistreptolysin O titer 1600 IU/ml (normal <300 IU/ml). Your
Suggestion is:
A. A case of Henoch–Schönlein nephritis.
B. Post-streptococcal glomerulonephritis.
C. Membranoproliferative glomerulonephritis – type II
D. Anti-glomerular basement membrane glomerulonephritis
3. A 48-year-old man presented with a 3-month history of intermittent swelling of his ankles and puffiness of
his face. There were no urinary symptoms and no family history of renal disease. He was taking no
medication. On examination, he was pale and thin with ankle oedema and a blood pressure of 130/80.
Investigations showed a normal hemoglobin and white cell count and an ESR of 32 mm/h.
I. What is the proposed case if the results of investigations are the followings:
A. His blood urea was 9.1 mmol/l (NR 2.5–7.5),
B. Serum albumin 26 g/l with a urinary protein loss of 7.8 g/day and a creatinine clearance of
106 ml/min.
C. His serum IgG was low at 5.1 g/l (NR 7.2–19.0).
D. His serum immunoglobulin IgM and IgA, C3 and C4 levels were normal,
E. Antinuclear antibodies, hepatitis B surface antigen and antibody, and hepatitis C antibody
were not detected.
II. What are the complementary tests for confirming your diagnosis???
4. All the following are the characteristics of Wegener’s’ Granulomatosis EXCEPT:
A. Abnormal chest X-ray.
B. Strawberry gingivitis.
C. Soluble immune complexes are responsible for disease development
D. Vasculitis of medium size.
E. C-ANCA antibodies are associated with the disease.

10. All the followings are histological types of glomerulonephritis Except:

A. Minimal change nephropathy

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 Open Book Exam / Basic Immunology/ Forth Year/ Dr. Batool Ali Ahmed
B. Primary focal segmental glomerulosclerosis (FSGS)
C. Lupus Nephritis
D. Membranous nephropathy
E. Membranoproliferative glomerulonephritis (also called mesangiocapillary)
11. The most diagnostic Ab in Wegener’s granulomatosis is:
A. P-ANCA.
B. C-ANCA.
C. Anti-smooth muscle.
D. Anti-mitochondrial.

12. All the following are the characteristics of Wegener’s’ Granulomatosis EXCEPT:
A. Abnormal chest X-ray.
B. Strawberry gingivitis.
C. Soluble immune complexes are responsible for disease development
D. Vasculitis of medium size.
E. C-ANCA antibodies are associated with the disease.
Q2. A. Answer with TRUE or FALSE on the followings [10 M]:
№ Question Answer

1 Membranous glomerulonephritis is one of the in situ immune complex renal diseases.

2 Membranoproliferative glomerulonephritis is one of the circulating immune complex

diseases.
3 IgA nephropathy is always associated with skin purpura.
4 Henoch-Schonlein nephritis mostly occur after respiratory tract infection or sever
exercise.
5 Anti-dsDNA positive is the main serological feature of lupus nephritis.
6 The presence of C3NeF antibodies is a diagnostic feature of Membranoproliferative
glomerulonephritis type I.
7 Persistent Ags as viral infection, tumor or autoimmune disease is the main cause of
acute immune complex glomerulonephritis.
8 Staphylococcus aureus is the main cause of post-infection glomerulonephritis in
children
9 Immune system may mediated lung injury due to drug administration which act as an
immunogen when adheres to lung tissue.