USMLE Immunology - Part 2

15 Questions | By Chachelly | Last updated: Feb 21, 2013

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USMLE Immunology - Part 2

Questions and Answers

1.

Patients sharing similar clinical symptoms and disease pathology may nevertheless present differently based upon age at disease onset. Adultonset rheumatoid arthritis (RA) and juvenile rheumatoid arthritis (JRA) are both the result of infl ammatory processes. How does the presentation of JRA differ from the presentation of adult-onset RA?

Discuss
- A.
  
  JRA is simply the presence of RA that begins before the age of 21 years
- B.
  
  Patients with JRA are less likely to have systemic symptoms, but the likelihood of high levels of serum rheumatoid factor is the same
- C.
  
  Patients with JRA are more likely to have large joint involvement, but the likelihood of concurrent systemic symptoms is the same
- D.
  
  Patients with JRA are more likely to have systemic symptoms and high levels of serum rheumatoid factor
- E.
  
  Patients with JRA are more likely to have systemic symptoms and large joint involvement
2.

A 37-year-old man comes to the physician with recurrent viral infections. Blood studies show normal levels of circulating lymphocytes and neutrophils. A defi ciency in which of the following cytokines would most likely lead to this man’s condition?

Discuss
- A.
  
  Interleukin-2
- B.
  
  Interleukin-3
- C.
  
  Interleukin-4
- D.
  
  Interleukin-5
- E.
  
  Interleukin-8
3.

Cluster of differentiation (CD) antigens are glycoproteins present on the cell surface of many cell types involved in the immune system. They are recognized by monoclonal antibodies and aid in the identifi cation of various cell types. Which of the following glycoproteins is present on the cell surface of all thymocytes: helper T-cells, cytotoxic T-cells, and natural killer cells?

Discuss
- A.
  
  B7
- B.
  
  CD2
- C.
  
  CD3
- D.
  
  CD4
- E.
  
  CD19
- F.
  
  T-cell receptor
4.

A 2-year-old girl with a lifelong history of malabsorptive and foul-smelling diarrhea, weakness, and general failure to thrive has just undergone a small intestine biopsy (see image). Her parents believe her problems began at 6 months of age, when she started eating solid foods, but have signifi cantly worsened over the past few months. The only recent change in her diet is that she eats a bowl of cereal every morning with her parents before they go to work. She tried a dairy-free diet a month ago, but it did not improve her symptoms. Which of the following is the most likely diagnosis?

Discuss
- A.
  
  Abetalipoproteinemia
- B.
  
  Celiac sprue
- C.
  
  Lactase defi ciency
- D.
  
  Viral enteritis
- E.
  
  Whipple’s disease
5.

A pediatrician becomes concerned after learning the family and medical history of an infant who is currently suffering from pneumonia, with a presumed diagnosis of Streptococcus pneumoniae infection. Over the past year, the patient has suffered from erysipelas as well as a previous bout of pneumococcal pneumonia; both were treated successfully with antibiotics. The patient’s mother says that her son’s maternal uncle also suffered from repeated bacterial infections and was successfully treated with antibiotics. On physical examination, it appears that the patient does not have tonsils. His mother denies a previous tonsillectomy. Analysis of the boy’s serum would most likely yield which of the following results?

Discuss
- A.
  
  Absence of T lymphocytes
- B.
- C.
  
  IgA, IgG, and IgM levels normal
- D.
  
  IgG and IgM levels markedly decreased, no IgA
- E.
  
  IgG and IgM levels normal, IgA markedly decreased
6.

A 25-year-old man presents to his doctor with a 2-day history of blood in his urine. A kidney biopsy is obtained. When the tissue is stained with fl uorescent anti-IgG antibodies, the staining reveals a linear pattern. Which of the following is the most likely diagnosis?

Discuss
- A.
  
  Acute poststreptococcal glomerulonephritis
- B.
  
  Alport’s syndrome
- C.
  
  Goodpasture’s syndrome
- D.
  
  IgA nephropathy
- E.
  
  Membranous glomerulonephritis
7.

A clinician is concerned that an Rh-negative mother may be pregnant with an Rh-positive fetus. The potential pathology that the clinician is concerned about is classifi ed as which of the following immune reactions?

Discuss
- A.
  
  Graft-versus-host disease
- B.
  
  Type I hypersensitivity
- C.
  
  Type II hypersensitivity
- D.
  
  Type III hypersensitivity
- E.
  
  Type IV hypersensitivity
8.

A 14-year-old boy presents to the physician with recurrent pyogenic infections. Physical examination shows that the boy has pruritic papulovesicular dermatitis. Blood is drawn and sent for laboratory evaluation of platelets and immunoglobulin levels. The results show a markedly low platelet count, a low serum IgM level, and an elevated IgA level. This patient most likely has which of the following conditions?

Discuss
- A.
  
  Bruton’s agammaglobulinemia
- B.
  
  Chédiak-Higashi disease
- C.
  
  Job’s syndrome
- D.
  
  Thymic aplasia
- E.
  
  Wiskott-Aldrich syndrome
9.

A 32-year-old woman comes to the emergency department complaining of sudden blindness. On obtaining a thorough history, it is learned that the patient’s right leg has “given out” from time to time, causing the patient to have episodes of weakness and falling. Periventricular white matter plaques are found on MRI. Which of the following cells are primarily damaged in this disease?

Discuss
- A.
  
  Astrocytes
- B.
  
  Ependymal cells
- C.
  
  Oligodendrocytes
- D.
  
  Schwann cells
- E.
  
  T cells
10.

Women have about a 2.7 times greater lifetime risk of developing at least one autoimmune disease than men. Which of the following statements, if true, would support the higher rate of systemic lupus erythematosus in women than in men?

Discuss
- A.
  
  Androgens such as testosterone have an inhibitory role in the process of clearing immune complexes
- B.
  
  Both estrogens and androgens have the same potency in inhibiting the clearing of immune complexes
- C.
  
  Estrogen has an inhibitory role in the process of antibody production of B cells
- D.
  
  Estrogen has an inhibitory role in the process of clearing immune complexes
- E.
  
  Estrogen has a stimulatory role in the process of clearing immune complexes
11.

A 2-year-old boy is brought to the physician by his parents because of recurrent sinus infections. The parents also state that the boy has had multiple lung infections. Which of the following results would most likely be found on further testing?

Discuss
- A.
  
  A defi cit in IgA level
- B.
  
  A low IgM level, with increased IgA
- C.
  
  A negative nitroblue tetrazolium dye test
- D.
  
  An increase in IgE level
- E.
  
  A normal Ig level for all isotypes
12.

A 50-year-old man presents to his clinician because of bilateral itching, burning, and redness of the lower extremities. He states that he wore shorts while gardening outside his house recently and could have come in contact with poison ivy. Which of the following statements regarding this patient’s immune response is most correct?

Discuss
- A.
  
  Goodpasture’s syndrome is a disease with a similar reaction pathogenesis
- B.
  
  Histamine is the primary mediator leading to this type of reaction
- C.
  
  The pathogenesis implicates previously sensitized B lymphocytes
- D.
  
  The patient has never been exposed to poison ivy
- E.
  
  The patient is suffering from a type I hypersensitivity reaction
- F.
  
  The patient must have been exposed to a poison ivy plant prior to this instance
13.

Antibodies are one of the major players in the adaptive immune response. All antibody molecules consist of two heavy chains and two light chains, and the specifi c type of heavy and light chain will determine the antigen binding site. In all antibodies, the two heavy chains and the two light chains are identical. Like most proteins, much of their functional capabilities and antigen binding characteristics stem from their three-dimensional structure. Which of the following holds the heavy and light chains together to make the three-dimensional structure of the antibody?

Discuss
- A.
  
  Disulfide bonds
- B.
  
  Hydrogen bonds
- C.
  
  Ionic bonds
- D.
  
  Triple covalent bonds
- E.
  
  Van der Waals forces
14.

A 23-year-old woman comes to the physician for a routine checkup. She has generally been well over the past year, although she notes that she has “had a few falls lately.” On physical examination, the lesion shown in the image is found on her skin. Blood is drawn for laboratory evaluation. The results show that the woman has very low levels of IgA. Based on her presentation, this patient will most likely also present with which of the following symptoms?

Discuss
- A.
  
  Cerebellar problems
- B.
  
  Granulomas
- C.
  
  Low levels of all other immunoglobulin isotypes
- D.
  
  Tetany
- E.
  
  Visual hallucinations
15.

A 50-year-old man comes to the physician with hemoptysis and diffuse joint pain. He states that both his father and cousin had similar symptoms and were diagnosed with microscopic polyangiitis, a disease affecting mediumto small-sized arteries that is believed to have an autoimmune component to its pathogenesis. Which of the following autoantibodies might be present in this patient?

Discuss
- A.
  
  Anticentromere antibodies
- B.
  
  Antineutrophil cytoplasmic autoantibodies
- C.
  
  Anti-Smith antibodies
- D.
  
  Anti-SS-A (Ro) antibody
- E.
  
  Anti-SS-B (La) antibody

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