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Step 1 Express 2019-Immunology
Step 1 Express 2019-Immunology
Immunology
Questions
LYMPHOID STRUCTURES
1. Which lymph node structures communicate with efferent lymphatics and contain reticular cells and
macrophages? (p 96) _____________________________________________________________
2. Which lymph node area contains endothelial venules through which T and B cells enter the nodes
from the blood? (p 96) ____________________________________________________________
4. In which part of the lymph node are follicles located? (p 96) _______________________________
5. Which lymph node area enlarges during an extreme cellular immune response? (p 96)
______________________________________________________________________________
6. Match the area of the body with its primary lymph node drainage site. (Numbers may be used more
than once). (p 97)
7. Which side of the upper body does the thoracic duct drain? (p 97) _________________________
8. What are the distinct blood findings seen on peripheral blood smears of postsplenectomy patients?
(p 98) _________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
10. B cells mature in the _______________ (bone marrow/thymus), whereas T cells mature in the
_______________ (bone marrow/thymus). (p 98)
CELLULAR COMPONENTS
11. In the following chart, check which components are part of the adaptive versus the innate immune
system. (p 99)
Antibody
B cells
Complement
Dendritic cells
Macrophages
Monocytes
Neutrophils
Secreted enzymes
T cells
12. What are the three MHC class I genetic loci? (p 100) ____________________________________
13. What are the three MHC class II genetic loci? (p 100) ____________________________________
14. What cell surface marker is specific to natural killer cells? (p 101, 110) ______________________
15. Which cytokine is secreted by Th1 cells, enhancing the ability of monocytes and macrophages to kill
microbes they ingest? (p 102) _______________________________________________________
16. Name the enzymes used by CD8 + T cells to kill virus-infected, neoplastic, and donor graft cells. (p
102) __________________________________________________________________________
17. What two major anti-inflammatory cytokines are produced by regulatory T cells? (p 102)
______________________________________________________________________________
IMMUNE RESPONSES
18. By which three mechanisms is antibody diversity generated? (p 104) ________________________
______________________________________________________________________________
19. Match each immunoglobulin isotype with its characteristic. (Numbers may be used more than once.)
(p 105)
20. What activates the alternative, lectin, and classic pathways? (p 106) _______________________
______________________________________________________________________________
24. In the chart below, check which cell surface proteins and receptors are expressed by which type of
cell. (p 110)
25. Which type of vaccination induces strong, often life-long immunity? (p 111) __________________
28. Which type of hypersensitivity reaction occurs rapidly due to preformed antibody? (p 112) _______
29. Which type of hypersensitivity reaction is mediated by accumulation of immune complexes? (p 113)
______________________________________________________________________________
31. What immunodeficiency is most closely associated with each clinical scenario? (pp 116-117)
A. A 7-month-old boy presents with recurrent sinusitis, otitis media, and erythematous skin
infections. _________________________________________________________________
B. An infant is brought to his pediatrician for the sixth time in several months. Oral thrush and
Upper respiratory infection have been diagnosed previously, and he underwent incision and
drainage of several buttock abscesses. Chest X-ray demonstrates an absence of thymic
shadow. ___________________________________________________________________
C. An infant arrives for her 2-month well-child visit. Her abdomen is soft and nontender, but her
umbilical remnant is still present. A red, firm area is present on the back of her thigh, with no
evidence of fluctuance. _______________________________________________________
D. A 5-year-old presents because of recurrent skin infections. In the past, she has been treated
for an E coli urinary tract infection as well as numerous Candida infections. Results of today’s
nitroblue tetrazolium test are negative. ___________________________________________
E. A 9-year-old boy presents with coarse facies and a rash. Physical examination reveals he has
two sets of teeth where his adult dentitia have erupted. ______________________________
32. Which autosomal-recessive immune deficiency presents with recurrent pyogenic infections, partial
albinism, and peripheral neuropathy? (p 117) __________________________________________
33. Which immunodeficiency presents with a triad of symptoms that include recurrent pyogenic
infections, thrombocytopenia, and eczema? (p 117) _____________________________________
34. Name two possible causes of severe combined immunodeficiency. (p 117) __________________
______________________________________________________________________________
35. What are the signs and symptoms of graft-versus-host disease? (p 119) _____________________
______________________________________________________________________________
IMMUNOSUPPRESSANTS
36. What is the mechanism of action of cyclosporine, and to which organ is it most toxic? (p 120) ____
______________________________________________________________________________
37. What is the mechanism of action of sirolimus, and what effect does this have on immunity? (p 120)
______________________________________________________________________________
______________________________________________________________________________
38. Name the agents that can stimulate the production of RBCs, WBCs, and platelets respectively.
(p 121) ________________________________________________________________________
39. Which antibodies are used to treat the following diseases? (p 122)
b) Osteoporosis__________________________________________________________________
Answers
LYMPHOID STRUCTURES
1. Medullary sinuses.
2. Paracortex.
3. Follicles.
4. Outer cortex.
5. Paracortex.
6. A-10, B-5, C-9, D-3, E-2, F-11, G-6, H-4, I-8, J-7, K-1.
7. Left.
CELLULAR COMPONENTS
11.
Component Adaptive Immune System Innate Immune System
Antibody √
B cells √
Complement √
Dendritic cells √
Macrophages √
Monocytes √
Natural killer cells √
Neutrophils √
Physical epithelial barriers √
Secreted enzymes √
T cells √
IMMUNE RESPONSES
18. Random recombination of VJ (light-chain) or V(D)J (heavy-chain) genes, random combination of
heavy and light chains, and random addition of nucleotides to DNA during genetic recombination by
terminal deoxynucleotidyl transferase (TdT).
19. A-4, B-5, C-4, D-3, E-5, F-2, G-5, H-3, I-4, J-3, K-3, L-1.
20. The alternative pathway is activated by microbe surface molecules. The Lectin pathway is activated
by mannose or other sugars on microbial surfaces, and the classic pathway is activated by antigen-
antibody complexes (IgG and IgM).
23. A-11, B-8, C-1, D-6, E-9, F-4, G-10, H-7, I-5, J-2, K-3.
24.
Protein/Receptor B cells T cells Macrophages NK cells
B7 √ √
C3b receptor √
CD3 √
CD4 √
CD8 √
CD14 √
CD19 √
CD20 √
CD21 √
CD28 √
CD40 √ √
CD40L √
CD56 √
Fc receptor √
IgG √
All nucleated cells All nucleated cells All nucleated cells All nucleated cells
MHC I except RBCs except RBCs except RBCs except RBCs
MHC II √ √
TCR √
28. Type I.
30. A-15, B-1, C-25, D-5, E-16, F-24, G-8, H-6, I-3, J-7, K-11, L-18, M-17, N-19, O-12, P-22, Q-2, R-23,
S-20, T-9, U-14, V-4, W-13, X-10, Y-21.
IMMUNOSUPPRESSANTS
36. Inhibits calcineurin and blocks T-cell activation by preventing IL-2 transcription. It is most toxic to the
kidney.
37. Inhibits mammalian target of rapamycin (mTOR), binds FKBP, and blocks T-cell activation and B-cell
differentiation by preventing response to IL-2.
b) Denosumab.
c) Omalizumab