Immunology & Serology

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Immunology & Serology

Immunology & Serology 


Questions and Answers
  • 1. 
    One reason that pathogenic microorganisms have an advantage in the host they infect is because they 
    • A. 

      Have previously been encountered through natural exposure

    • B. 

      Reproduce and evolve more rapidly than the host can eliminate them

    • C. 

      Strengthen the hosts immune response

    • D. 

      Reproduce and evolve more slowly than the host can eliminate them

    • E. 

      Have previously been encountered through vaccination

  • 2. 
    Which of the following is NOT a characteristic of inflammation
    • A. 

      Pain

    • B. 

      Increased vascular permeability and edema

    • C. 

      Inactivation of macrophages

    • D. 

      Influx of leukocytes

    • E. 

      Vasodilation

  • 3. 
    Which of the following is NOT associated with mucosal surfaces
    • A. 

      White pulp

    • B. 

      M cells

    • C. 

      Lysozyme

    • D. 

      Beating cilia

    • E. 

      Mucus=secreting goblet cells

  • 4. 
    Which of the following pairs is mismatched 
    • A. 

      Erythrocyte: oxygen transport

    • B. 

      Natural killer cell: kills virus-infected cells

    • C. 

      Macrophage: phagocytosis and killing of microorganisms

    • D. 

      Eosinophil: defense against parasites

    • E. 

      Lymphocytes: innate immune response

  • 5. 
    Examples of granulocytes include all of the following except 
    • A. 

      Neutrophil

    • B. 

      Monocyte

    • C. 

      Basophil

    • D. 

      Eosinophil

    • E. 

      All of the above are examples of granulocytes

  • 6. 
    The most abundant type of leukocyte in human peripheral blood is 
    • A. 

      Eosinophil

    • B. 

      Basophil

    • C. 

      Monocyte

    • D. 

      Neutrophil

    • E. 

      Lymphocyte

  • 7. 
    Which of the following pairs of association is mismatched 
    • A. 

      Monocyte: macrophages

    • B. 

      B cell: plasma cell

    • C. 

      Myeloid progenitor: neutrophil

    • D. 

      Large granular lymphocyte: T cell

    • E. 

      Megakaryocyte: platelet

  • 8. 
    Which of the following statements is false 
    • A. 

      Megakaryocytes do not circulate and reside only in the bone marrow

    • B. 

      The hematopoietic stem cell gives rise to white blood cells but a different stem cell is the progenitor of red blood cells

    • C. 

      Platelets participate in clotting reactions to prevent blood loss

    • D. 

      During human development, hemotopoiesis takes place a different anatomical locations

    • E. 

      Hematopoeitic stem cells are self-renewing

  • 9. 
    Which of the following describes the flow of lymph through a lymph node draining an infected tissue 
    • A. 

      Artery to lymph node to efferent lymphatic vessel

    • B. 

      Afferent lymphatic vessel to lymph node to efferent lymphatic vessel

    • C. 

      Efferent lymphatic vessel to lymph node to afferent lymphatic vessel

    • D. 

      Venule to lymph node to efferent lymphatic vessel

    • E. 

      Afferent lymphatic vessel to lymph node to artery

  • 10. 
    Which of the following is the predominant route by which pathogens are brought from a site of infection into a lymph node. 
    • A. 

      Efferent lymphatics

    • B. 

      Vein

    • C. 

      Artery

    • D. 

      High endothelial venule

    • E. 

      Afferent lymphatics

  • 11. 
    Which of the following does NOT accuratley describe complement components 
    • A. 

      Soluble proteins

    • B. 

      Made by the spleen

    • C. 

      Located in extracellular spaces

    • D. 

      Some function as proteases once activated

    • E. 

      Activated by a cascade of enzymatic reactions

  • 12. 
    Which of the following is the membrane-bound form of C3 convertase of the alternative pathway of complement activation 
    • A. 

      IC3

    • B. 

      C3a

    • C. 

      C3b

    • D. 

      IC3Bb

    • E. 

      C3bBb

  • 13. 
    The plasma proteins that counteract the activity of factor P by inactivating C3 convertase through the cleavage of C3b are 
    • A. 

      Factor B and factor H

    • B. 

      Factor H and factor I

    • C. 

      Factor B and factor I

    • D. 

      Decay-accelerating factor and factor H

    • E. 

      Decay-accelerating factor and membrane cofactor protein

  • 14. 
    Which of the following polymerizes to form a transmembrane channel that compromises the integrity of cell membranes 
    • A. 

      C5

    • B. 

      C6

    • C. 

      C7

    • D. 

      C8

    • E. 

      C9

  • 15. 
    The ligand for CR3 and CR4 formed by the cleavage of C3b by the combined action of factors H and I is called
    • A. 

      C3bBb

    • B. 

      C3a

    • C. 

      C3b2Bb

    • D. 

      IC3b

    • E. 

      C5b

  • 16. 
    Which of the following does NOT describe the actions of the coagulation system 
    • A. 

      Blood clot formation

    • B. 

      Enhancement of dissemination of microbes into lymphatics and bloodstream

    • C. 

      Decrease in blood loss and fluid into interstitial spaces in tissue

    • D. 

      Release of infammatory mediators by platelets

    • E. 

      Wound healing

  • 17. 
    Which of the following is NOT a characteristic of C-reactive protein 
    • A. 

      Acts as an opsonin by binding to phosphocholine of pathogens

    • B. 

      Synthesized by spleen

    • C. 

      Induced by elevated IL-6

    • D. 

      A member of the pentraxin family

    • E. 

      Triggers the classical pathway of complement activation

  • 18. 
    Which of the following TLR3 and TLR4 adaptor proteins participates in the activation pathway that culminates iin the synthesis of type1 interferons 
    • A. 

      C-reactive protein

    • B. 

      MyD88

    • C. 

      LPS-binding protein

    • D. 

      TRIF and TRAM

    • E. 

      NFKappaB

  • 19. 
    Which of the following is NOT a charactersitc of septic shock
    • A. 

      Organ failure

    • B. 

      High mortality rate

    • C. 

      Compromised blood supply to vital organs

    • D. 

      Blood vessel constriction

    • E. 

      Disseminated intravascular coagulation

  • 20. 
    Which of the following best describes an endogenous pyrogen 
    • A. 

      Cytokines made by pathogens that decrease body temperature

    • B. 

      Pathogen products that decrease body temperature

    • C. 

      Pathogen products that increase body temperature

    • D. 

      Cytokines made by the host that decrease body temperature

    • E. 

      Cytokines made by the host that increase body temperature

  • 21. 
    Which of the following is mismatched 
    • A. 

      Immunoglobin light chain: VJ

    • B. 

      T-cell receptor alpha chain: VJ

    • C. 

      Immunoglobin heavy chain: VJ

    • D. 

      T-cell recepot beta chain:VDJ

    • E. 

      None of the above is mismatched

  • 22. 
    In most cases, adaptive immune responses rely on the initial activation of ________ in secondary lymphoid tissue 
    • A. 

      Macrophages

    • B. 

      T cells

    • C. 

      B cells

    • D. 

      Dendritic cells

    • E. 

      Epithelium

  • 23. 
    Which of the following is NOT a characteristic of native antigen recognized by T cells 
    • A. 

      Peptides ranging between 8 and 25 amino acids in length

    • B. 

      Not requiring degradation for recognition

    • C. 

      Amino acid sequences not found in host proteins

    • D. 

      Primary, and not secondary, structure of protein

    • E. 

      Binding to major histocompatibility complex molecules on the surface of antigen-presenting cells

  • 24. 
    Which of the following statements regarding CD8 T cells is incorrect 
    • A. 

      When activated, CD8 T cells in turn activate B cells

    • B. 

      CD8 is also known as the CD8 T-cell co-receptor

    • C. 

      CD8 binds to MHC molecules at a site distinct from that bound by the T-cell receptor

    • D. 

      CD8 cells kill pathogen-infected cells by inducing apoptosis

    • E. 

      CD8 T cells are MHC class I-restricted

  • 25. 
    Which of the following characteristics permits activated CD8 T cells to destroy any cell type harboring viable and replicating pathogens such as viruses 
    • A. 

      The pathogen is located in extracellular pathogens

    • B. 

      CD8 T cells enable macrophages to kill intracellular pathogens

    • C. 

      Pathogen-derived peptides bind MHC Class I molecules in endocytic vesicles found ubiquitously in most cell types

    • D. 

      MHC class II molecules are expressed ubiquitoously by most nucleated cells

    • E. 

      MHC class I molecules are expressed ubiquitously by most nucleated cells

  • 26. 
    The five isotypes of immunoglobulin differ from each other in there __________.
    • A. 

      Light-chain constant regions

    • B. 

      Heavy-chain constant regions

    • C. 

      Light-chain variable regions

    • D. 

      Heavy-chain variable regions

    • E. 

      Heavy-chain variable and constant regions

  • 27. 
    Circulaating B cell that has never before encountered antigen expresses ____ on the cell surface 
    • A. 

      IgM and IgD

    • B. 

      IgM

    • C. 

      IgD

    • D. 

      IgM and IgG

    • E. 

      IgG

    • F. 

      IgE

  • 28. 
    The antibody transported across mucosal epithelia is ___________. 
    • A. 

      IgA

    • B. 

      IgD

    • C. 

      IgE

    • D. 

      IgG

    • E. 

      IgM

  • 29. 
    The mutational mechanism that results in the production of antibodies that bind antigen with higher affinity is called 
    • A. 

      Somatic recombination

    • B. 

      Isotype switching

    • C. 

      Somatic hypermutation

    • D. 

      Clonal selection

    • E. 

      Antigen processing

  • 30. 
    The process of ______ results in change in the constant region of the heavy-chain of antibodies, causing a change in the effector functino and transport properties of antibodies 
    • A. 

      Complement fixation

    • B. 

      Neutralization

    • C. 

      Isotype switching

    • D. 

      Somatic hypermutation

    • E. 

      Somatic recombination

  • 31. 
    Which of the following does not describe B-cell receptors 
    • A. 

      B cell receptors are membrane bound and secreted

    • B. 

      B cell receptors consist of a variable region and a constant region

    • C. 

      B cell receptors lack specificity and can bind to a number of different antigen

    • D. 

      B cell receptors possess specificity and can therefore bind only to unique epitopes

    • E. 

      B cell receptors undergo affinity maturation as a consequence of somatic hypermutation

  • 32. 
    The antigen-binding site of an immunoglobin is formed from
    • A. 

      The V regions of light chains only

    • B. 

      The V regions of heavy chains only

    • C. 

      Paired V regions of a single heavy chain and a single light chain

    • D. 

      Paired V regions of two light chains

    • E. 

      Paired C regions of two heavy chains

  • 33. 
    The ________ contribute to antigen specificity of immunoglobulins, and ________ make up the conservative flanking regions. 
    • A. 

      Hypervariable loops; framework regions

    • B. 

      Constant domains; variable domains

    • C. 

      Heavy chains; light chains

    • D. 

      Variable gene segments; joining gene segments

    • E. 

      Antigenic determinants; complementarity determing regions

  • 34. 
    The rearrangement of V, D, and J segments to form an immunoglobulin 
    • A. 

      Monoclonal antibody production

    • B. 

      Isotype switching

    • C. 

      Somatic hypermutation

    • D. 

      Opsonization

    • E. 

      Somatic recombination

  • 35. 
    Nucleotide changes in variable regions of immunoglobulin genes affecting affinity for antigen 
    • A. 

      Monoclonal antibody production

    • B. 

      Isotype switching

    • C. 

      Somatic hypermutation

    • D. 

      Opsonization

    • E. 

      Somatic recombination

  • 36. 
    The enzyme responsible for recombining V, D, and J segments during somatic recombination is called 
    • A. 

      V(D)J recombinase

    • B. 

      Terminal deoxynucleotidyl transferase

    • C. 

      Exonuclease

    • D. 

      DNA polymerase

    • E. 

      DNA ligase

  • 37. 
    Which immunoglobulins main function is to mediate sensitization of mast cells 
    • A. 

      IgA

    • B. 

      IgD

    • C. 

      IgE

    • D. 

      IgG

    • E. 

      IgM

  • 38. 
    Which is immunoglobulin is transported efficiently across mucosal epithelium 
    • A. 

      IgA

    • B. 

      IgD

    • C. 

      IgE

    • D. 

      IgG

    • E. 

      IgM

  • 39. 
    Identify which of the following is not associated with acitvation-induced cytidine deaminase (AID) activity 
    • A. 

      Diversification of the V H sub domain but not the V L domain

    • B. 

      Synthesized in proliferating B cells during active immune responses

    • C. 

      Somatic hypermutation

    • D. 

      Isotype switching

    • E. 

      Cytosine conversion to uracil

  • 40. 
    Which of the following does not describe  B cell receptors 
    • A. 

      B cell receptors are membrane bound and secreted

    • B. 

      B cell receptors consist of a variable region and a constant region

    • C. 

      B cell receptors lack specificity and can bind to a number of different antigens

    • D. 

      B cell receptors possess specificity and can therefore bind only to unique epitopes

    • E. 

      B cell receptors undergo affinity maturation as a consequence of somatic hypermutation

  • 41. 
    The antigen binding site of an immunoglobulin is formed from 
    • A. 

      The V regions of light chains only

    • B. 

      The C regions of heavy chains only

    • C. 

      Paired V regions of a single heavy chain and a single light chain

    • D. 

      Paired V regions of two light chains

    • E. 

      Paired C regions of two heavy chains

  • 42. 
    Change of immunoglobulin class but prevention of antigen specificty 
    • A. 

      Monoclonal antibody production

    • B. 

      Isotype switching

    • C. 

      Somatic hypermutation

    • D. 

      Opsonization

    • E. 

      Somatic recombination

  • 43. 
    Which of the following characteristics is common to both T cell receptors and immuniglobulins 
    • A. 

      Somatic recombination of V,D, and J segments is responsible for the diversity of antigen-binding sites

    • B. 

      Somatic hypermutation changes the affinity of antigen-binding sites and contribues to further diversification

    • C. 

      Class switching enables a change in effector function

    • D. 

      The antigen receptor is composed to two identical heavy chains and two identical light chains

    • E. 

      Carbohydrate, lipid and protein antigens are recognized and stimulate a response

  • 44. 
    The antigen recognition site of T cell receptors is formed by the association of which of the following domains 
    • A. 

      V alpha and C alpha

    • B. 

      V alpha and C beta

    • C. 

      C alpha and C beta

    • D. 

      V alpha and C beta

    • E. 

      V alpha and V beta

  • 45. 
    In terms of V, D, and J segment arrangement, the T cell receptor alpha chain locus resembles the immunoglobulin _____ locus while the T cell receptor beta chain locus resembles the immunoglobulin ______ locus. 
    • A. 

      Lambda light chain; kappa light chain

    • B. 

      Heavy chain; lambda light chain

    • C. 

      Kappa light chain; heavy chain

    • D. 

      Lambda light chain; heavy chain

    • E. 

      Kappa light chain; lambda light chain

  • 46. 
    In B cells transport of immunoglobulin to the membrane is dependent on association with two invariant proteins, IG alpha and IG beta. Which of the following invariant proteins provide this function for the T cell receptor in T cells. 
    • A. 

      CD3 gamma

    • B. 

      CD3 delta

    • C. 

      CD3 epsilon

    • D. 

      Zeta

    • E. 

      All of the above

  • 47. 
    MHC Class II molecules are made up of two chains called ________. whose function is to bind peptides and present them to _______ T cells. 
    • A. 

      Alpha and beta; CD4

    • B. 

      Alpha and beta 2-microglobulin; CD4

    • C. 

      Alpha and beta; CD8

    • D. 

      Alpha and beta 2-microglobulin; CD8

    • E. 

      Alpha and beta; gamma delta T cells

  • 48. 
    The peptide binding groove of MHC class I molecules is composed of the following extracellular domains 
    • A. 

      Alpha 1, beta 1

    • B. 

      Beta 1, beta 2

    • C. 

      Alpha 2, beta 2

    • D. 

      Alpha 2, alpha 2

    • E. 

      Alpha 1, alpha 2

  • 49. 
    Which of the following describes the sequence of events involved in processing of peptides that will be presented as antigen with MHC class I. 
    • A. 

      Plasma membrane -- TAP1/2 --- proteasome -- MHC class I -- endoplasmic reticulum

    • B. 

      TAP 1/2 -- proteasome -- MHC class I -- endoplasmic reticulum -- plasma membrane

    • C. 

      Proteasome -- TAP 1/2 -- MHC class I -- endoplasmic reticulum -- plasma membrane

    • D. 

      Proteasome -- TAP 1/2 -- endoplasmic reticulum -- MHC class I -- plasma membrane

    • E. 

      Endoplasmic reticulum -- proteasome -- MHC class I -- TAP 1/2 -- plasma membrane

  • 50. 
    Which of the following describes the sequence of events involved in the processing of peptides that will be presented as antigen with MHC class II. 
    • A. 

      Protease activity, removal of CLIP from MHC class II, binding of peptide to MHC class II, endocytosis, plasma membrane

    • B. 

      Endocytosis, protease activity, removal of CLIP from MHC class II, binding of peptide to MHC class II, plasma membrane

    • C. 

      Removal of CLIP from MHC class II, binding of peptide to MHC class II, protease activity, endocytosis, plasma membrane

    • D. 

      Binding to peptide to MHC class II, endocytosis, removal of CLIP from MHC class II, protease activity, plasma membrane

    • E. 

      Plasma membrane, endocytosis, protease activity, removal of CLIP from MHC class II, binding of peptide to MHC class II.

  • 51. 
    The complemtarity-determining region CDR 1 and CDR2 loops of the T cell receptor contact the ______.
    • A. 

      Side chains of amino acids in the middle of the peptide

    • B. 

      Co-receptors CD4 or CD8

    • C. 

      Membrane-proximal domains of the MHC molecule

    • D. 

      Constant regions of antibody molecules

    • E. 

      Alpha helices of the MHC molecule

  • 52. 
    The high degree of polymorphism in MHC class I molecules that present antigens to CD8 T cells found in _______ becuase ______ is/are monomorphic
    • A. 

      Beta 2 microglobulin; the heavy chain

    • B. 

      Both the alpha and beta chains; none

    • C. 

      HLA-DO beta; HLA-DO alpha

    • D. 

      The heavy chain; beta 2 microglobulin

    • E. 

      HLA-E and HLA-G; HLA-F

  • 53. 
    Which of the following cell surface markers differentiates hematopoietic stem cells from other cell constituents in the bone marrow 
    • A. 

      BAFF receptor

    • B. 

      Pre B cell receptor

    • C. 

      Membrane bound stem cell factor (SCF)

    • D. 

      CD34

    • E. 

      CD4

  • 54. 
    Which of the following is characteristic of large pre B cell 
    • A. 

      V-J is rearranging at the light chain locus

    • B. 

      VDJ is successfully rearranged and mu heavy chain is made

    • C. 

      Mu heavy chain and lambda or kappa light chain is made

    • D. 

      D-J is rearranging at the heavy chain locus

    • E. 

      V is rearranging to DJ at the heavy chain locus

  • 55. 
    Which of the following statements is correct 
    • A. 

      The lambda light chain genes rearrange before the kappa light chain genes

    • B. 

      The lambda light chain genes rearrange before the heavy chain genes

    • C. 

      The kappa light chain genes rearrange before the heavy chain genes

    • D. 

      The kappa light chain genes rearrange before the lambda light chain genes

    • E. 

      The mu heavy chain genes rearrange first and then the lambda light chain genes rearrange

  • 56. 
    Stromal cells produce _________, which is a secreted B cell development growth factor influencing the progression of B cells from the late pro B cell to the pre B cell stage 
    • A. 

      VCAM-1

    • B. 

      VLA-4

    • C. 

      Stem cell factor

    • D. 

      Kit

    • E. 

      IL-7

  • 57. 
    Developing B cells that fail to make productive D to J heavy chain rearrangements on both homologous chromosomes 
    • A. 

      Will rearrange heavy chain loci multiple times until a productive rearrangement is made

    • B. 

      Unpregulate expression of transcription factors E2A and EBF

    • C. 

      Undergo clonal proliferation

    • D. 

      Fail to rearrange V to DJ

    • E. 

      Die to apoptosis in the bone marrow

  • 58. 
    Pro B cells produce a surrogate light chain, which associaes with the mu chain on the cell surface. The surrogate light chain is composed of 
    • A. 

      RAG 1 and RAG 2

    • B. 

      Ig alpha and Ig beta

    • C. 

      E2A and EFB

    • D. 

      VpreB and lambda 5

    • E. 

      Pax5 and CD19

  • 59. 
    An important advantage of having two gene loci kappa and lambda for the light chain is 
    • A. 

      That the likelihood of a successful rearrangement of light chain genes increases

    • B. 

      That immunoglobulins are homogeneous and not heterogeneous in mature B cells

    • C. 

      That different effector functions are conferred by the two different light chain loci

    • D. 

      That surrogate light chain transcription cannot compete with kappa and lambda transcription and enables B cell development

    • E. 

      All of the above

  • 60. 
    A defect in which of the following proteins blocks B cell development at the pre B cell stage, resulting in almost no circulating anitbodies in individuals with this defect
    • A. 

      Brutons tyrosine kinase (Btk)

    • B. 

      CD19

    • C. 

      Terminal deoxynucleotidyltransferase (tDt)

    • D. 

      Pax-5

    • E. 

      IL-7 receptor

  • 61. 
    Which of the following characteristics the B-1 cells that develop prenatally 
    • A. 

      They lack N nucleotides

    • B. 

      They possess polyspecificity for bacterial polysaccharide antigens

    • C. 

      They arise early in embryonic development preceding the development of the majority subset of B cells

    • D. 

      They have little or no IgD on the cell surface

    • E. 

      All of the above

  • 62. 
    _______ involves successive rearrangement at the light-chain loci when reactivity to self antigen occurs during B-cell development 
    • A. 

      Chromosomal translocation

    • B. 

      Receptor editing

    • C. 

      Clonal deletion

    • D. 

      Anergy

    • E. 

      Somatic hhpermutation

  • 63. 
    Which of the following cell surface markers differentiates hematopoietic stem cells from other cells constituents in the bone marrow
    • A. 

      BAFF receptor

    • B. 

      Pre B-cell receptor

    • C. 

      Membrane bound stem cell factor (SCF)

    • D. 

      CD34

    • E. 

      CD4

  • 64. 
    ______ is a T cell specific adhesion molecule expressed before the expression of a functional T cell receptor while the thymocytes are still in their double negative stage of development 
    • A. 

      CD3

    • B. 

      CD25

    • C. 

      CD8

    • D. 

      CD2

    • E. 

      CD4

  • 65. 
    Which of the following cell surface glycoproteins is characteristic of stem cells, but stops being expressed when a cell has committed to the T cell developmental pathway 
    • A. 

      CD25

    • B. 

      CD3

    • C. 

      MHC class II

    • D. 

      CD34

    • E. 

      CD2

  • 66. 
    Which of the following is the first stage of T cell receptor gene rearrangement in alpha beta T cells
    • A. 

      D beta to J beta

    • B. 

      V alpha to D alpha

    • C. 

      V alpha to J alpha

    • D. 

      D alpha to J alpha

    • E. 

      V beta to D beta

  • 67. 
    Which of the following is the first T cell receptor complex containing the beta chain to reach the cell surface during the development of T lymphocytes 
    • A. 

      Beta CD3

    • B. 

      Gamma beta CD3

    • C. 

      PT alpha; beta CD3

    • D. 

      Alpha beta CD3

    • E. 

      Beta CD44

  • 68. 
    The function of negative selection of thymocytes in the thymus is to eliminate 
    • A. 

      Autoreactive thymocytes

    • B. 

      Alloreactive thymocytes

    • C. 

      Double positive thymocytes

    • D. 

      Single positive thymocytes

    • E. 

      Apoptotic thymocytes

  • 69. 
    ________ of thymocytes is necessary to produce a T cell repertoire capable of interacting with self MHC molecules 
    • A. 

      Positive selection

    • B. 

      Apoptosis

    • C. 

      Receptor editing

    • D. 

      Isotype switching

    • E. 

      Negative selection

  • 70. 
    Autoimmune polyendocrinopathycandidiasis-ectodermal dystrophy (APECED) is caused by a defect in 
    • A. 

      The production of regulatory CD4 T cells

    • B. 

      Cathepsin L

    • C. 

      FoxP3

    • D. 

      A transcription factor called AIRE that regulates tissue-specific gene expression in the thymus

    • E. 

      T cell receptor gene receptor

  • 71. 
    A feature of T cell development that may contribute to tumor development is 
    • A. 

      Positive selection

    • B. 

      Expression of two alpha chains by the same T cell

    • C. 

      Apoptosis

    • D. 

      Negative selection

    • E. 

      DNA rearrangement

  • 72. 
    Which of the following is mismatched 
    • A. 

      Double negative CD3- thymocytes: subcapsular zone

    • B. 

      Corticl epithelial cells: subcapsular regions

    • C. 

      Double positive CD3+ thymocytes: cortico-medullary junction

    • D. 

      Dendritic cells: cortico-medullary junction

    • E. 

      Double negative CD3- thymocytes: cortico-medullary junction

  • 73. 
    The human thymus begins to degenerate as early as one year after birth. This process is called ______ and is marked by the accumulation of _____ once occupied by thymocytes 
    • A. 

      Negative selection: gamma delta T cells

    • B. 

      Differentiation gamma delta T cells

    • C. 

      Thymectomy: dendritic cells

    • D. 

      Involution; thymic stroma

    • E. 

      Involution: fat

  • 74. 
    Native lymphocytes homing to lymphoid tissue use ____ to bind to CD34 and GlyCAM-1 on high endothelial venules 
    • A. 

      CCL21

    • B. 

      L-selection

    • C. 

      CD2 (LFA-2)

    • D. 

      CD28

    • E. 

      ICAM-1

  • 75. 
    The co-stimulatory molecule ______ on professional antigen-presenting cells bind ____ on the surface of naive T cells
    • A. 

      MHC class II: CD4

    • B. 

      ICAM-1; LFA-1

    • C. 

      MHC class II: T cell receptor

    • D. 

      B7: CD28

    • E. 

      DC-SIGN: ICAM-3

  • 76. 
    Activated T cells express ________, which binds to B7 with twentyfold higher affinity for B7 than CD28 and results in ______ of T cell activity and proliferation. 
    • A. 

      VLA-4: stimulation

    • B. 

      Fas Ligand: stimulation

    • C. 

      CD40L: suppression

    • D. 

      CTLA4: suppression

    • E. 

      High affinity IL-2 receptor stimulation

  • 77. 
    The area of contact between membranes of T cell and an antigen presenting cell where a clustering of protein protein interactions occur is called a(n)
    • A. 

      Cross-presentation center

    • B. 

      Polarization

    • C. 

      Granuloma

    • D. 

      Immunoreceptor tyrosine-based activation motif (ITAM)

    • E. 

      Immunological synapse

  • 78. 
    ______ is a second messenger in the T cell signaling pathway leading to the activation of NFAT
    • A. 

      Diacylglycerol (DAG)

    • B. 

      Fos

    • C. 

      Inositol triphosphate

    • D. 

      NF (kappa) B

    • E. 

      Ras

  • 79. 
    Which of the following is a protein tyrosine kinase involved in T-cell activation culminating in T-cell proliferation and differentiation
    • A. 

      Lck

    • B. 

      NF Kappa B

    • C. 

      NFAt

    • D. 

      ZAP-70

    • E. 

      AP-1

  • 80. 
    Binding of _______ to ______ induces T-cell proliferation and differentiation of activated T cells 
    • A. 

      LFA-1: ICAM-1

    • B. 

      IL-2: the low affinity IL-2 receptor

    • C. 

      CD28: B7

    • D. 

      CD4: MHC class II

    • E. 

      IL-2: the high-affinity IL-2 receptor

  • 81. 
    Expression of IFN gamma is induced in a CD4 Th1 cell under the direction of the transcription factor ______
    • A. 

      AP-1

    • B. 

      FoxP3

    • C. 

      GATA-3

    • D. 

      T-bet

    • E. 

      NFAT

  • 82. 
    Cytokine receptors are associated with cytoplasmic protein kinases called _____ which become activated when the cytokine receptors bind to their respective cytokines 
    • A. 

      STATs

    • B. 

      JAKs

    • C. 

      LcK

    • D. 

      ZAP-70

    • E. 

      ITAMs

  • 83. 
    Which of the following is not produced by Th2
    • A. 

      TGF beta

    • B. 

      CD40 ligand

    • C. 

      IL-10

    • D. 

      IFN gamma

    • E. 

      IL-4

  • 84. 
    Naive lymphocytes homing to lymphoid tissue use ____ to bind to CD34 and GlyCAM-1 on high endothelial venules 
    • A. 

      CCL21

    • B. 

      L-selection

    • C. 

      CD28

    • D. 

      CD22 (LFA-2)

    • E. 

      ICAM-1

  • 85. 
    The co-stimulatory molecule _____ on professional antigen-presenting cells binds ______ on the surface of naive T cells 
    • A. 

      MHC class II: CD4

    • B. 

      ICAM-1: LFA-1

    • C. 

      MHC class II: T-cell receptor

    • D. 

      B7: CD28

    • E. 

      DC-SIGN: ICAM-3

  • 86. 
    The B-cell co receptor is composed of 
    • A. 

      CD40; MHC class II; CD19

    • B. 

      Ig alpha; Ig beta; Lyn tyrosine kinase

    • C. 

      CR2 (CD21); CD19; CD19

    • D. 

      Ig alpha; Ig beta; CD19

    • E. 

      CD14; CD19; CD18

  • 87. 
    Lipopolysaccharide is an example of a _______ antigen that is recognized by TLR4 when bound to _____.
    • A. 

      Thymus dependent; LPS-binding protein

    • B. 

      Thymus-independent (TI)-2; B cell co receptor

    • C. 

      Immune complex: iccosomes

    • D. 

      Thymus-independent (TI)-1; LPS binding protein

    • E. 

      Thymus-dependent; MHC class II

  • 88. 
    A primary focus forms after a circulating naive B cell forms a conjugate pair with ____ in the ____ of a lymph node
    • A. 

      TH2 cell: T cell zone

    • B. 

      TH1 cell: B cell zone

    • C. 

      Cytotoxic T cell: T cell zone

    • D. 

      CD40 ligand; T cell zone

    • E. 

      Follicular dendritic cell; germinal center

  • 89. 
    Lymphoblasts upregulate a transcription factor called ______ when they terminally differentiate into plasma cells 
    • A. 

      Bcl-xL

    • B. 

      CD40

    • C. 

      B-lymphocyte induced maturation protein 1 (BLIMP-1)

    • D. 

      ICAM-1

    • E. 

      NF Kappa B

  • 90. 
    In the secondary lymphoid tissued, which of the following routes do B cells take during their activation, proliferation and differentiation 
    • A. 

      HEV to B cell zone to T cell zone to medullary cords to light zone of the germinal center

    • B. 

      HEV to T cell zone to dark zone of germinal center to light zone of germinal center to medullary cords

    • C. 

      HEV to T cell zone to medullary cords to dark zone of germinal center to light zone of germinal center

    • D. 

      HEV to medullary cords to T cell zone to dark zone of germinal cneter to light zone of germinal center

    • E. 

      HEV to dark zone of germinal center to light zone of germinal center to T cell zone to medullary cords

  • 91. 
    Denatured toxin molecules called _____ are used to vaccinate individuals to stimulate the production of _____
    • A. 

      Toxoids; passive immunity

    • B. 

      Toxoids; C-reactive protein

    • C. 

      Adhesins; neutralizing antibodies

    • D. 

      Toxoids; neutralizing IgG anitbodies

    • E. 

      Adhesins; complement proteins

  • 92. 
    IgM is particularly efficient at fixing complement because ________.
    • A. 

      It has an extra CH domain

    • B. 

      It is made first in an immune response and therefore has first access to C1q

    • C. 

      It has five binding sites for C1q

    • D. 

      It is a much larger antibody than the other isotypes

    • E. 

      It has easy access to extravascular areas

  • 93. 
    Complexes of IgG bound to soluble multivalent antigens can activate the classical pathway of complement, resulting in the deposition of ______ on the complex, targeting it for endocytic uptake by cells bearing ______. 
    • A. 

      C5-9; CR1 and Fc receptors

    • B. 

      C2a; CR2 and Toll like receptors

    • C. 

      C3b; CR1 and Fc receptors

    • D. 

      C3b: CR2 and Toll like receptors

    • E. 

      C4b; CR2 and Fc receptors

  • 94. 
    Which of the following antibodies exhibits monovalence as a result of the exchange of IgG half molecules (one H plus one L chain) forming bispecific antibody molecules 
    • A. 

      Dimeric IgA

    • B. 

      IgM

    • C. 

      IgG1

    • D. 

      IgE

    • E. 

      IgG4

  • 95. 
    Antibody dependent cell mediated cytotoxicity (ADCC) is carried out by ______ after cross linking of IgG1 or IgG3 antibodies on ____ receptors 
    • A. 

      Macrophages; FC gamma RIIB2

    • B. 

      Neutrophils: Fc gamma RI

    • C. 

      Mast cells; FC epsilon RI

    • D. 

      NK cells; Fc gamma RI

    • E. 

      NK cells; Fc gamma RIII

  • 96. 
    _______ is the vascular addressin found on endothelial cells of intestinal mucosa that binds to integrins of gut-homing effector lymphocytes 
    • A. 

      C-cadherin

    • B. 

      CCr9

    • C. 

      CCL25

    • D. 

      NOD1

    • E. 

      MAdCAM-1

  • 97. 
    Secretory IgA is best described as ________.
    • A. 

      A complement activating immunoglobulin that causes destruction of invasive microflora through the membrane attack complex

    • B. 

      An inflammatory immunoglobulin that stimulates the chemotaxis of neutrophils into mucosal surfaces

    • C. 

      A monomeric IgA that neutralizes antigen effectively at mucosal surfaces

    • D. 

      A non-inflammatory that restricts the passage of antigens across mucosal surfaces

    • E. 

      An opsonizing antibody that facilitates uptake by M cells through Fc receptors

  • 98. 
    Intracytoplasmic bacteria in enterocytes of the gastrointestinal tract are detected by ______. 
    • A. 

      MIC-A and MIC-B

    • B. 

      Poly-Ig Receptor

    • C. 

      Receptors for phosphoantigens

    • D. 

      Major basic protein

    • E. 

      NOD proteins

  • 99. 
    • A. 

      A positive signal leading to somatic hypermutation and production of hight affinity IgM antibodies

    • B. 

      A negative signal leading to apoptosis

    • C. 

      A negative signal leading to inhibition of the production of low affinity IgM antibodies

    • D. 

      A positive signal leading to isotype switching and production of IgG, IgA, or IgE antibodies

    • E. 

      A positive signal leading to the production of low affinity IgM antibodies

  • 100. 
    _____________ is a molecule expressed on NK cells and V gamma: V delta 1 T cells 
    • A. 

      CD3

    • B. 

      NKG2D

    • C. 

      CD94: NKG24

    • D. 

      MIC-A

    • E. 

      Killer cell immunoglobulin like receptor (KIR)

  • 101. 
    Individuals with an immunodeficiency affecting B cell function are more susceptible to infections caused by which of the following pathogens 
    • A. 

      Listeria Monocytogenes

    • B. 

      Toxoplasma gondii

    • C. 

      Haemophilus Influenzae

    • D. 

      Mycobacterium tuberculosis

    • E. 

      Respiratory Synctial virus

  • 102. 
    Women who are heterozygous for a defective Brutons tyrosine kinase (BtK) gene
    • A. 

      Mount normal B cell immune responses despite having lowered levels of serum IgG

    • B. 

      Have non random X inactivation in their B cells

    • C. 

      Exhibit X linked agammaglobulinemia

    • D. 

      Have a 50% chance of having a son with X linked hyper IgM syndrome

    • E. 

      Are more susceptible to infections caused by extracellular pyrogenic bacteria

  • 103. 
    WHich of the following deficiency syndromes affects T cell but not the B cell function
    • A. 

      X linked agammaglobulinemia

    • B. 

      X linked lymphoproliferative syndrome

    • C. 

      X linked SCID

    • D. 

      X linked hyper IgM syndrome

    • E. 

      X linked Wiskott-Aldrich syndrome

  • 104. 
    A genetic defect in ____ results in the accumulation of toxic levels of nucleotide metabolites and loss of T cell function 
    • A. 

      Adenosine deaminase (ADA)

    • B. 

      Myeloperoxidase

    • C. 

      SH2D1A

    • D. 

      NADPH oxidase

    • E. 

      Glucose-6-phosphate dehydrogenase

  • 105. 
    During infection with HIV, a person is said to undergo seroconversion when 
    • A. 

      HIV is transferred from an infected person to an uninfected recipient

    • B. 

      The initial phase of infection is followed by clinical latency

    • C. 

      HIV varients convert from macrophage tropic to lymphocyte tropic late in the infection

    • D. 

      Anti HIV antibodies are detectable in their blood serum

    • E. 

      Cellular transcription favors the production of HIV encoded RNA

  • 106. 
    An example of type III hypersensitivity is _______
    • A. 

      Asthma

    • B. 

      Serum sickness

    • C. 

      Allergic rhinitis

    • D. 

      Tuberculin reaction

    • E. 

      Contact dermatitis

  • 107. 
    An allergic reaction to poison ivy is associated with
    • A. 

      An Arthus reaction

    • B. 

      Eosinophil activation

    • C. 

      Cytotoxic T cell activation

    • D. 

      Mast cell activation

    • E. 

      Complement activation

  • 108. 
    The wheal and flare inflammatory reaction is an example of 
    • A. 

      An immediate type I allergic response

    • B. 

      A late phase type I allergic response

    • C. 

      A late phase type IV allergic response

    • D. 

      An immediate type III allergic response

    • E. 

      A late phase type III allergic response

  • 109. 
    During the course of a successful desensitization process, the patients antibodies will change from an ____ isotype to an _____ isotype 
    • A. 

      IgA: IgM

    • B. 

      IgE: IgM

    • C. 

      IgG1: IgG4

    • D. 

      IgE: IgG4

    • E. 

      IgG4: IgE

  • 110. 
    What type of hypersensitivity reaction would result from a mismatched blood transfusion 
    • A. 

      Type I

    • B. 

      Type II

    • C. 

      Type III

    • D. 

      Type IV

  • 111. 
    Another name for anti immunoglobulin autoantibodies is 
    • A. 

      Rituximab

    • B. 

      C reactive protein

    • C. 

      Infliximab

    • D. 

      Thyroglobulin

    • E. 

      Rheumatoid factor

    • F. 

      Ectopic antibodies

  • 112. 
    • A. 

      Suppressing proliferation of naive self reactive T cells

    • B. 

      Overexpressing CD28 which blocks B7 ligands on antigen presenting cells

    • C. 

      Disrupting T cell zones of secondary lymphoid tissues

    • D. 

      Competing for antigen and proliferating to higher numbers than autoreactive T cells

    • E. 

      Inducing apoptosis of autoreactive T cells

  • 113. 
    ______ is the term used to describe how pathogen antigens resemble host antigens and can sometimes trigger autoimmune disease 
    • A. 

      Linkage equilibrium

    • B. 

      Sympathetic senescence

    • C. 

      Intermolecular epitope spreading

    • D. 

      Intramolecular epitope spreading

    • E. 

      Molecular mimicry

  • 114. 
    The upregulation of ______ by IFN gamma can contribute to anigen specific T cell activation on thyroid epithelium 
    • A. 

      CD4

    • B. 

      HLA class II

    • C. 

      HLA class I

    • D. 

      CD8

    • E. 

      CD28

  • 115. 
    A(n) _____ is an epitope that is typically not accessible to the immune system but is revealed under inflammatory or infectious states 
    • A. 

      Carrier

    • B. 

      Regulatory peptide

    • C. 

      Adjuvant

    • D. 

      Cryptic epitope

    • E. 

      Molecular mimic

  • 116. 
    A conjugate vaccine is one that couples ______ to _____ so as to stimulate T dependent antibody responses 
    • A. 

      Adjuvant, toxoids

    • B. 

      A protein carrier, irradiated DNA

    • C. 

      Protein carrier, toxoids

    • D. 

      Polysaccharide; a protein carrier

    • E. 

      Polysaccharide, filamentous hemagglutinin

  • 117. 
    A major attraction of immune stimulating complexes ISCOMs as an adjucant is that they _______
    • A. 

      Form insoluble particles that resist dispersion and degradation

    • B. 

      Bind to Toll like receptors and initiate a state of inflammation

    • C. 

      Deliver antigen to the cytosol for presenation by MHC class I

    • D. 

      Enhance uptake by macrophages and delivery of antigen to endosomal compartments

    • E. 

      Bind to respiratory epithelium and mimic viral routes of entry

  • 118. 
    The individual protection of unvaccinated individuals as a consequence of sufficient prevalence of vaccination in the population in which they reside is known as 
    • A. 

      Suppressive immunity

    • B. 

      Passive immunity

    • C. 

      Acquired immunity

    • D. 

      Indirect immunity

    • E. 

      Her immunity

  • 119. 
    _____ vaccines are the most effective at evokin memory responses against a virus in an immunized host
    • A. 

      Subunit

    • B. 

      DNA

    • C. 

      Toxoid

    • D. 

      Live attenuated

    • E. 

      Killed

  • 120. 
    Alloantibodies to blood vessel endothelium on solid organ grafts _______
    • A. 

      Cause acute rejection

    • B. 

      Are IgA and do not fix complement

    • C. 

      Target endothelium for attack by NK cells

    • D. 

      Cause hyperacute rejection

    • E. 

      Are specific for HLA class I and class II antigens

  • 121. 
    The extent to which an individuals T cells respond to allogeneic HLA expressed on irradiated donor cells can be measured in vitro using _______
    • A. 

      The transfusion effect assay

    • B. 

      A cross match test

    • C. 

      The mixed lymphocyte reaction

    • D. 

      A superantigen recognition test

    • E. 

      The panel reactive antibody test

  • 122. 
    The risk of _____ is the primary complication in bone marrow transplants 
    • A. 

      Hyperacute rejection

    • B. 

      Chronic rejection

    • C. 

      Acute host-versus graft disease

    • D. 

      Acute graft versus host disease

    • E. 

      Cancer

  • 123. 
    The efficiency of treating bladder cancer is increased by introduing the BCG vaccine. The vaccine component attributing this antitumor effect is _____ which induces a state of chronic inflammation. 
    • A. 

      Peptidoglycan

    • B. 

      Mycolic acid

    • C. 

      Unmethylated Cpg containing DNA

    • D. 

      Teichoic acid

    • E. 

      Lipopolysaccharide

  • 124. 
    Proteins not expressed on normal cells but found on tumor cells are called _______
    • A. 

      Proto oncogene products

    • B. 

      Oncogenic antigens

    • C. 

      Cancer stem cell antigens

    • D. 

      Tumor specific antigens

    • E. 

      Tumor associated antigens

  • 125. 
    A mechanism by which cancer cells an evade an immune response involves an alteration in the amount of MIC on the cell surface by
    • A. 

      Alternative mRNA splicing resulting in a truncated form of MIC that is no longer able to bind to NKG20

    • B. 

      Cytosolic degradation of MIC in proteasomes

    • C. 

      Decreasing the level of MIC transcription

    • D. 

      Switching from a transmembrane form of MIC to a secreted form

    • E. 

      Cleavage of MIC at the cell surface by a protease