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BY

Assistant Professor
Meroj A. Jasem
Department of Biology-College of Sciences
Al-Mustansiriyah University

2015

ϭ

 Preface
7KURXJK P\FDUHHU LQWKH ILHOG RIHGXFDWLRQ , IRXQGWKDW³WHVWLQJ before
OHDUQLQJ´LVRQHWKHPRVWHIILFLHQWPRGHs of education just like in real life
where we experience problems and then learn from them.

Based on this principle, I put in your hands this humble work which is a
book containing 1500 multiple choice questions in general and clinical
immunology, most of them were collected from different references
(printed and online) and some of them of my own.

Hoping this book will give some help to graduated and postgraduate
students of colleges of Medicine, Veterinary medicine, Pharmacy,
Science and education.

Finally I would like to acknowledge my family for their continued

support especially my husband for his love and care.

Meroj

Ϯ

 Dedication
To
Nebras
,W VEHHQDORQJWLPH«

ϯ

 Contents


Chapter 2QH«««««« Innate and adaptive immunity MCQ 5
Innate and adaptive immunity Answers 22
&KDSWHU7ZR«««««« Immunogen, antigen and antibody MCQ 23
Immunogen, antigen and antibody Answers 41
&KDSWHU7KUHH«««««« Complement system MCQ 42
Complement system Answers 59
&KDSWHU)RXU«««««« Cytokines MCQ 60
Cytokines Answers 77
&KDSWHU)LYH«««««« Hypersensitivity MCQ 78
Hypersensitivity Answers 96
&KDSWHU6L[««««««« Serology and vaccination MCQ 97
Serology and vaccination Answers 115
Chapter Seven ««««« Major Histocompatibility MCQ 116
Major Histocompatibility Answers 134
&KDSWHU(LJKW«««««« Practical Immunology MCQ 135
Practical Immunology Answers 155
&KDSWHU1LQH«««««« T & B cells development and activation MCQ 156
T & B cells development and activation 178
Answers
&KDSWHU7HQ«««««« TCR and BCR MCQ 179
TCR and BCR Answers 198
Chapter Eleven ««««« Immunity to infectious agents MCQ 199
Immunity to infectious agents Answers 218
Chapter Twelve ««««« Autoimmunity and Tolerance MCQ 219
Autoimmunity and Tolerance Answers 237
Chapter Thirteen «««« Transplantation MCQ 238
Transplantation Answers 261
&KDSWHU)RXUWHHQ«««« Tumor Immunology MCQ 262
Tumor Immunology Answers 281
Chapter Fifteen ««««« Primary and secondary immunodeficiency 282
MCQ
Primary and secondary immunodeficiency 302
Answers
References 303






ϰ

 &KDSWHU2QH
,QQDWHDQGDGDSWLYHLPPXQLW\
0&4
1. Functional specific immunity is divided into
a. T cells and macrophages
b. Antibodies and complement proteins
c. Innate and adaptive immune mechanisms
d. Cellular and humoral immune responses
2. Antibodies and immunoglobulins which of the following does not
protect body surfaces:
a. Skin.
b. Mucus.
c. Gastric acid.
d. Salivary amylase
e. Gut microflora.
3. Natural killer (NK) cells:
a. Express CD3+ TCR+ cell markers
b. Are non-phagocytic and non-adherent cells
c. Do not express CD16 and CD56 differentiation antigens
d. Eliminate target tumor cells under MHC-restriction
e. Do not regulate CD8 cytotoxic T cells
4. Pattern recognition receptors (PRR) include:
a. LPS.
b. Pamps.
c. Lipoteichoic acid.
d. Lectin-like molecules.
e. Unmethylated cpg sequences.
5. The mononuclear phagocyte system does not include:
a. Monocytes.
b. Kupffer cells.
c. Kidney mesangial cells.
d. Lymph node medullary macrophages.
e. Endothelial cells.
6. A polymorphonuclear neutrophil (PMN):
a. Is a bone marrow stem cell.
b. Is closely similar to a mast cell.
c. Contains microbicidal cytoplasmic granules.
d. Is not a professional phagocytic cell.
e. Has granules which stain with eosin.

ϱ

 7. Which of the following is not produced following activation of the
NADPH oxidase microbicidal pathway
a. O2 ±
b. O2
c. H2O2
d. NO
e. OH
8. Neutrophil defensins are:
a. Anti-toxins.
b. Oxygen-dependent.
c. Enzymes.
d. Glycolipids.
e. Peptide antibiotics.
9. The TLR9 pattern recognition receptor recognizes:
a. Cpg motifs.
b. Gram +ve peptidoglycan.
c. Mycobacterial lipoarabinomannan.
d. Gram ±ve LPS.
e. Dsrna.
10.Complement component C3 is cleaved by:
a. C3b
b. C3bbb
c. Factor B
d. Factor D
e. Factor H
11.The membrane attack complex consists of:
a. OH.
b. Colicins
c. C3b3b,Bb
d. C5b,6,7,8,9
e. Properdin
12.Acute inflammation characteristically involves:
a. Constriction of arterioles.
b. Capillary endothelial cell enlargement.
c. Influx of macrophages.
d. Influx of mast cells.
e. Influx of neutrophils
13.Lysozyme:
a. Is a cytoplasmic organelle.
b. Activates complement.
c. Is a proteolytic enzyme.
d. Splits peptidoglycan.
e. Is released by mast cells.

ϲ

 14.Which of the following is NOT an acute phase protein:
a. Serum amyloid P component.
b. Chondroitin sulfate.
c. C-reactive protein.
d. Mannose binding lectin.
e. Fibrinogen.
15.Interferons:
a. Are found only in mammalian species.
b. Are divided into 5 main families.
c. Induce enzyme synthesis in the target cell.
d. Only affect infected cells.
e. Are specific for individual viruses.
16.Natural killer (NK) cells do not:
a. Respond to interferon.
b. Contain perforin.
c. Contain tumor necrosis factor (TNF).
d. Kill only by damaging the target cell outer membrane.
e. Contain serine proteases.
17.Eosinophils do not:
a. Stain with basic dyes.
b. Contain a major basic protein.
c. Contain peroxidase.
d. Give a respiratory burst on activation.
e. Have C3b receptors.
18.Polymorphonuclear neutrophils attack bacteria:
a. Exclusively by oxygen-dependent mechanisms.
b. Exclusively by oxygen-independent mechanisms.
c. By phagocytosis.
d. By secreting complement.
e. By secreting interferon
19.Acute inflammation can be initiated by:
a. Mast cell activation.
b. Influx of neutrophils.
c. An increase in vascular permeability.
d. C3.
e. Lysozyme.
20.Clonal selection occurs when antigen is encountered by:
a. Neutrophils
b. Mast cells
c. T-cells
d. Basophils
e. Eosinophils
21.Plasma cells:

ϳ

 a. Have a thin layer of cytoplasm
b. Are derived from T-cells
c. Develop into B-cells
d. Secrete large amounts of gamma interferon
e. Have a highly developed rough endoplasmic reticulum
22.Specific antibodies are readily detectable in serum following primary
contact with antigen after:
a. 10 min
b. 1 h
c. 5±7 days
d. 3±5 weeks
e. Only following a second contact with antigen
23.A plasma cell secretes:
a. Antibody of a single specificity related to that on the surface
of the parent B-cell
b. Antibody of two antigen specificities
c. The antigen it recognizes
d. Many different types of antibody
e. Lysozyme
24.Adoptive transfer of acquired immune responsiveness involves the
transfer of:
a. Antibody
b. Complement
c. Phagocytes
d. Lymphocytes
e. Serum
25.The main reason an experimental animal treated with X-rays can act
as a living test tube for lymphocyte transfer experiments is because:
a. It is microbiologically sterile
b. Complement components will be inactivated
c. The host lymphocytes are destroyed or unable to divide
d. Only non-dividing cells are affected
e. The requirement for T-cell help is overcome
26.Protective antibodies against infectious agents are often:
a. Autoantibodies
b. Neutralizing
c. Toxoids
d. Natural Killer
e. Non-specific
27.Intracellular parasites within macrophages are killed more readily in
the presence of:
a. Antibody
b. Kinins

ϴ

 c. Properdin
d. Gamma-interferon
e. Anaphylatoxin
28.T cell surface receptors for antigen partly recognize:
a. Cytokines
b. MHC
c. ADCC
d. Antibody
e. IL-2
29.Secondary antibody responses are better because:
a. They provide defense against unrelated antigens
b. The antibody can be made by both T and B cells
c. Complement-fixing antibodies are made
d. They do not require T-cell help
e. They are stronger and faster
30.Clonal selection occurs when a B-lymphocyte encounters:
a. Cytokines
b. Antigen
c. T-lymphocytes
d. Complement
e. Chemotactic factors
31.The secondary, but not the primary, immune response is based on:
a. Memory
b. The bonus effect of multivalency
c. Complement activation
d. Mast cell degranulation
e. Clonal selection
32.Which type of cells is known to be involved in the initial
presentation of antigen to T lymphocytes?
a. Dendritic cells
b. Plasma cells
c. Neutrophil polymorphonuclear leucocytes
d. Erythrocytes
e. Platelets
33.Which of the following cells are thought NOT to be of monocyte-
macrophage lineage?
a. Neutrophils
b. Follicular dendritic cells of lymph nodes
c. Kupffer cells in liver
d. Histiocytes in tissues
e. Monocytes in blood
34.Which of the following types of cell produce IgE?
a. Mast cells

ϵ

 b. Eosinophils
c. Basophils
d. T lymphocytes
e. Plasma cells
35.Helper CD4+ T lymphocytes recognize which one of the following
types of molecules on dendritic cells?
a. HLA class I antigen
b. HLA class III antigen
c. Processed peptides from antigen
d. CD8 antigen
e. Surface immunoglobulin
36.Regarding acute inflammation
a. Initial vasoconstriction is the result of histamine and nitric
oxide
b. Stasis occurs due to vasodilatation and the larger caliber of
vessels
c. Increased permeability leads to protein depleted plasma
leaking into the tissue
d. Initial formation of endothelial gaps lasts for only 15-30
minutes
e. Cytokines (IL-1 and TNF) are responsible for the early
permeability
37.Chronic inflammation is characterized by all of the below EXCEPT
a. Tissue destruction
b. Angiogenesis
c. Infiltration with neutrophils
d. Fibrosis
e. Increased tissue concentration of lymphocytes
38.Which of the following are two hallmarks of the adaptive immune
system?
a. Immediate and broad
b. Specificity and memory
c. Innate and short
d. Non-specific and fast
e. Immediate and passive
39.All of the following are important functions of the innate immune
system EXCEPT that it
a. Promotes early defense against infectious agents
b. Has immunoregulatory functions
c. Recognize microbes through receptors for "molecular
patterns"
d. Recognize microbes through receptors for antigens
e. Has nonclonal distribution of receptors

ϭϬ

 40.All of the following can be part of innate immune responses
EXCEPT
a. Alternative pathway of complement activation
b. Natural killer cells
c. B -cells
d. MAC
e. Macrophage
41.Receptors associated with innate immunity recognize microbes by
detecting
a. Insulin
b. Pathogen associated molecular patterns (pamps
c. )F¶V
d. Complement
e. None of the above.
42.Adoptive-acquired immunity may be the result of
a. Transfer of bone marrow from one individual to another
b. Immunization with a vaccine
c. Exposure to an individual who has an infectious disease
d. A physician administering a gamma globulin shot to
someone who has had a needle stick (immunoglobulins)
e. a and d.
43.The antigen presenting cell
a. May be a dendritic cell in the skin
b. May be a T cell
c. Does not produce cytokines which influence the adaptive
response
d. Matures upon antigenic stimulation and becomes a plasma
cell
e. All of the above
44.Mucosal immunity provides most of its protection by blocking
a. Microbial receptors specific for colonization
b. The complement cascade
c. Blocking penetration of undigested food products into the
mucosal tissues
d. a and c
e. None of the above
45.Tissue macrophage are mature
a. B cells
b. T cells
c. NK cells
d. Monocytes
e. None of the above.

ϭϭ

 46.Hormone-like host peptides used for communications in innate and
adaptive immunity are known as
a. Pamps
b. Cell adhesion molecules
c. Elisas
d. Cytokines
e. None of the above.
47.Innate host defense mechanisms are critical to the protection of the
body because
a. They utilize pre-committed antigen presenting cells that have
already been induced by other immune responses
b. The antibodies derived from the innate response are critical
to neutralize bacterial toxins
c. They are highly specific for the invading pathogens that
avoid PAMP receptor recognition
d. They provide immediate, continuous protection in the
absence of a specific immune response
e. b and d
48.An essential part of the innate immune system is phagocytosis
followed by destruction of the phagocytosed particle/microbe
followed by antigen- presentation What cells are considered
professional phagocytes"
a. Granulocytes, monocytes, macrophages, dendritic cells
b. Granulocytes, monocytes, macrophages, dendritic cells, B
cells
c. Granulocytes, monocytes, macrophages, B cells
d. Antigen presenting cells
e. All innate immune cells
49.Cells of the innate immune system are specialized. Although several
of them can ingest microbes, one cell type is found both
undifferentiated in the blood and resident in tissues. What cell type
best fit this description"
a. Macrophages
b. Neutrophils
c. Natural Killer Cells
d. Dendritic Cells
e. Granulocytes
50.Regarding acquired immunity which of the following statements is
CORRECT
a. Class I MHC expressed by all nucleated cells are important
in viral infection
b. Class II MHC will activate cytotoxic T cells through CD8+
interaction

ϭϮ

 c. T cells mature into plasma cells which secrete large
quantities of immunoglobulins
d. B memory cells activate T cells for a greater immune
response
51.Which of the following is not part of the acquired immune system
a. T cells
b. Natural Killer cells
c. B cells
d. Immunoglobulins
52.Phagocytosis must be preceded by
a. Antigen binding to the phagocyte.
b. Chemotaxis.
c. Extravasation.
d. Integrin binding to Ig superfamily cams.
e. Oxidative burst
53.Selectins
a. Are present on both leukocytes and vascular endothelial
cells.
b. Bind Ig-like vascular addressins.
c. Include ICAM, VCAM, and madcam.
d. Select antigen-specific lymphocytes to extravasate into the
infection site.
e. Select antigen-specific macrophages to extravasate into the
infection site
54.Phagocytes kill bacteria using all of the following EXCEPT
a. H2O2.
b. Hydrolytic enzymes.
c. Low pH
d. Lysozyme.
e. Strong reducing agents
55.Macrophages are attracted to the site of infection by all of the
following EXCEPT
a. Bacterial peptides.
b. Chemokines.
c. C5a.
d. IL-8.
e. Madcam
56.Inflammatory cytokines produced by macrophages activate all of the
following EXCEPT
a. B cells to secrete acute phase proteins.
b. Integrin on leukocytes to bind more strongly to vascular
cams.
c. Neutrophils to be more cytotoxic.

ϭϯ

 d. NK cells to kill virus-infected cells.
e. Vascular endothelium to increase expression of cams.
57.The ____ immune system uses ____ as well as molecules (e.g.
Complement components). The ____ immune system uses ____ as
well as antigen recognition molecules.
a. Adaptive; Phagocytes; Innate; Lymphocytes
b. Adaptive; Lymphocytes; Innate; Phagocytes
c. Innate; Phagocytes; Adaptive; Lymphocytes
d. Innate; Lymphocytes; Adaptive; Phagocytes
58.Phagocytic white cells (leukocytes, e.g. Macrophages) congregate
within ____ when foreign organisms get through a cut in the skin.
a. Microseconds
b. Seconds
c. Minutes
d. Hours
e. Days
59.Which of the following mediates an early response to viral infections
by the innate immune system?
a. Complement components
b. Vaccines
c. T and B lymphocytes
d. Cytokines
e. Interferons
60.Which of the following is a messenger that mediates the connection
between the innate and adaptive immune systems?
a. Complement components
b. Vaccines
c. T and B lymphocytes
d. Cytokines
e. Interferons
61.Which of the following immune system components would NOT
recognize a macromolecule epitope (binding site)?
a. Phagocyte
b. T lymphocyte
c. B lymphocyte
d. Antibody
62.Which of the following is a large genomic region or gene family
found in most vertebrates, playing an important role in immunity?
a. Antigen-recognition molecules
b. Major histocompatibility complexes (MHCs)
c. Human leukocyte antigens (HLAs)
d. Immunoglobulin
e. Epitopes

ϭϰ

 63.How are B-cell and T-cell antigen receptors distributed?
a. By size (steric hindrance)
b. By molecular weight
c. By activation (clonal)
d. By location in the body
e. Equally (same number of each receptor
64.Adaptive immune system response typically takes how long:
a. Microseconds
b. Seconds
c. Minutes
d. Hours
e. Days
65.Which of the following is NOT true when comparing innate to
adaptive immunity?
a. Innate responds quickly and adaptive responds slowly
b. Innate has few pathogen (non-self) recognition mechanisms
and adaptive has many
c. Innate has immunologic memory and adaptive does not
d. Innate does not show response improvements over time and
adaptive does
e. Innate response is non-specific and adaptive is very specific
66.Which of the following components of the innate immune system
involves recognition molecules such as mannan-binding lectin
(MBL) for bacteria with mannose on the surface?
a. Natural killer (NK) cells
b. Complement system
c. Oxygen dependent and independent killing
d. Interferons
e. Acute phase proteins
67.Which of the following components of the innate immune system
involves cytokines produced by macrophages, which are produced
during infection?
a. Natural killer (NK) cells
b. Complement system
c. Oxygen dependent and independent killing
d. Interferons
e. Acute phase proteins
68.Which of the following components of the innate immune system
involves the release of histamine?
a. Neutrophil
b. Eosinophil
c. Macrophage
d. Tissue mast cell

ϭϱ

 e. Natural killer cell
69.Which of the following components of the adaptive immune system
secretes immunoglobulin (Ig)?
a. Activated B cell (plasma cell)
b. CD4+ activated T cell
c. CD8+ cytotoxic T cell (CTL)
d. Resting lymphocytes (B cell, CD4+ T cell, CD8+ T cell)
e. B and C
70.Which of the following components of the adaptive immune system
causes lysis of virally infected cells and the release of cytokines?
a. Activated B cell (plasma cell)
b. CD4+ activated T cell
c. CD8+ cytotoxic T cell (CTL)
d. Resting lymphocytes (B cell, CD4+ T cell, CD8+ T cell)
e. B and C
71.Antigen presenting cells (APCs) include macrophages and dendritic
cells, which are found in lymphoid tissues and the ____. These are
critical in the uptake and presentation of antigen to T cells.
a. Liver
b. Kidney
c. Skin
d. Brain
e. Gallbladder
72.Humoral immunity is mediated by antibodies from ____ and is
involved in the elimination of ____ pathogens. Cell mediated
immunity is mediated by ____ and is involved in the elimination of
____ pathogens.
a. B lymphocytes; Intracellular; T lymphocytes; Extracellular
b. B lymphocytes; Extracellular; T lymphocytes; Intracellular
c. T lymphocytes; Intracellular; B lymphocytes; Extracellular
d. T lymphocytes; Extracellular; B lymphocytes; Intracellular
73.Which of the following types of antigen presenting cells (APCs) is
specialized for degradation and presentation of particulate antigens
to T cells?
a. Macrophage
b. Dendritic cell
c. B cell
d. All of them
74.Natural killer cells are thought to fill the gap between initial innate
response and adaptive immune response. They evolved to detect low
levels of MHC caused by the diseases of ____ and ____.
a. Staph bacteria; Strep bacteria
b. Catalase positive bacteria; Helminths (worms)

ϭϲ

 c. Herpes virus; Tumor cells
d. Influenza virus; Rabies virus
e. Leprosy; Gonorrhea bacteria
75.The primary purpose of the adaptive immune system is to
a. Block all pathogens from entering the body.
b. Cure allergic reactions.
c. Kill tumor cells
d. Protect from disease upon re-infection with a specific
pathogen.
76.The antigen specificity of an adaptive immune response is due to
a. Activation of antigen-specific lymphocytes
b. Folding of antibody to fit the pathogen.
c. Lysis of only certain pathogens by neutrophils.
d. Phagocytosis of only certain pathogens by macrophages.
77.Humoral immunity can be acquired passively by
a. Catching a virus from a friend by shaking hands.
b. Receiving a vaccine of influenza virus grown in eggs
c. Receiving serum from someone who has recovered from an
infection
d. Receiving leukocytes from an immune family member
78.Which cells and which signaling molecules are responsible for
initiating an inflammatory response?
a. Phagocytes: lysozymes
b. Phagocytes: chemokines
c. Dendritic cells: interferons
d. Mast cells: histamines
e. Lymphocytes: interferons
79.Inflammatory responses may include which of the following?
a. Clotting proteins migrating away from the site of infection
b. Increased activity of phagocytes in an inflamed area
c. Reduced permeability of blood vessels to conserve plasma
d. Release of substances to decrease the blood supply to an
inflamed area
e. Inhibiting the release of white blood cells from bone marrow
80.These cells are involved in innate immunity, and a person lacking
these cells may have a higher than normal chance of developing
malignant tumors:
a. Cytotoxic T cells
b. Natural killer cells
c. Helper T cells
d. Macrophages
e. B cells

ϭϳ

 81.Which of the following is the last line of defense against an
extracellular pathogen?
a. Lysozyme production
b. Phagocytosis by neutrophils
c. Antibody production by plasma cells
d. Histamine release by basophils
e. Lysis by natural killer cells
82.The following events occur when a mammalian immune system first
encounters a pathogen. Which shows the correct sequence in which
they occur?
I. Pathogen is destroyed.
II. Lymphocytes secrete antibodies.
III. Antigenic determinants from pathogen bind to
antigen receptors on lymphocytes.
IV. Lymphocytes specific to antigenic determinants
from pathogen become numerous.
V. Only memory cells remain.
a. ,ĺ,,,ĺ,,ĺ,9ĺ9
b. ,,,ĺ,,ĺ,ĺ9ĺ,9
c. ,,ĺ,ĺ,9ĺ,,,ĺ9
d. ,9ĺ,,ĺ,,,ĺ,ĺ9
e. ,,,ĺ,9ĺ,,ĺ,ĺ9
83.Which cell type interacts with both the humoral and cell-mediated
immune pathways?
a. Plasma cells
b. Cytotoxic T cells
c. Natural killer cells
d. CD8 cells
e. Helper T cells
84.Both lysozyme and cytotoxic T cells:
a. Kill cells through chemical interactions.
b. Kill cells by inducing apoptosis.
c. Kill cells by generating a membrane attack complex.
d. Are part of innate immunity.
e. Are involved in cell-mediated immune responses.
85.Naturally acquired passive immunity would involve the:
a. Injection of vaccine.
b. Ingestion of interferon.
c. Placental transfer of antibodies.
d. Absorption of pathogens through mucous membranes.
e. Injection of antibodies.
86.Which of the following is true of active but not passive immunity?
a. Acquisition and activation of antibodies.

ϭϴ

 b. Proliferation of lymphocytes in bone marrow.
c. Transfers antibodies from the mother across the placenta.
d. Requires direct exposure to a living or simulated pathogen.
e. Requires secretion of interleukins from macrophages.
87.Which of the following is a characteristic of the early stages of local
inflammation?
a. Anaphylactic shock
b. Fever
c. Attack by cytotoxic T cells
d. Release of histamine
e. Antibody- and complement-mediated lysis of microbes

88.Th2 response is associated with the following cytokines:

a. IL ± 4, IL ± 5, IL ± 10 and IL ± 13
b. IL ± 8, IL ± 10 and IL ± 13
c. ? - IFN and TNF - ?
d. IL ± 4, IL ± 5, IL ± 10 and IL ± 12
e. ? - IFN and IL ± 13
89.Investigation of T cell function involves
a. Enumeration of smlg+ lymphocytes
b. Detection of CD3 T cells only
c. Detection and measurement of cytokine inhibition
d. Phenotype characterization of CD4 and CD8 T cells
e. Antigen-specific B cell proliferative response
90.Cell-mediated immunity:
a. Can be transferred passively using sera
b. Is mediated by B and T cells
c. Is mediated by T cells, macrophages and interleukins
d. Forms the major part of innate immunity
e. Is mediated by antibodies and interleukins
91.What substances are in the innate immune system that binds iron and
thereby limits bacterial growth"
a. lactoferrin and transferrin
b. lactoferrin and proferrin
c. transferrin and preferrin
d. b and c
92.Precursor (undifferentiated form) of a Macrophage:
a. T-lymphocyte
b. Monocyte
c. Neutrophil
d. Mast cell
93.Cell type which belongs to both the adaptive and innate immune
system, main function is as an antigen presenting cell.

ϭϵ

 a. T-lymphocyte
b. Plasma cell
c. Dendritic cell
d. Natural Killer cell
94.Innate immunity:
a. Is activated immediately upon infection.
b. Depends on a newly infected animal's previous exposure to
the same pathogen.
c. Is based on recognition of antigens that are specific to
different pathogens.
d. Is found only in vertebrate animals. E) utilizes highly
specific antigen receptors on b cells
95.This type of immunity is present only when a newborn infant is
being fed by actively nursing on its mother and ends when nursing
ends.
a. Innate immunity
b. Active immunity
c. Passive immunity
d. Cell-mediated immunity
e. Adaptive immunity
96.In active immunity, but not passive immunity, there is:
a. Acquisition and activation of antibodies.
b. Proliferation of lymphocytes in bone marrow.
c. The transfer of antibodies from the mother across the
placenta.
d. The requirement for direct exposure to a living or simulated
pathogen.
e. The requirement of secretion of interleukins from
macrophages
97.Which one of the following phrases describes an example of a
mechanism of innate immunity?
a. Antibody opsonization of bacteria
b. Inhibition of bacterial colonization activities of the ciliated
mucous of the bronchial tree
c. T lymphocyte response to a vaccine
d. Elimination of antigen by the formation of an antigen-
antibody complex
e. Killing of a target cell by an activated T lymphocyte
98.Which one of the following statements correctly describes
differences between the primary and secondary immune response?
a. A secondary immune response is observed only in humoral
(antibody) immunity

ϮϬ

 b. The primary immune response is higher in magnitude but
takes longer to develop than the secondary response
c. The primary immune response is lower in magnitude and
takes longer to develop than the secondary immune response
d. The secondary immune response is lower in magnitude and
takes longer to develop than the primary immune response
99.A patient suffered a total blockage in a major artery of the heart. As
a result, a section of the heart died and became necrotic from the
lack of oxygen. Because no foreign organisms were introduced,
which one of the following statements best describes immune
response to this sterile, necrotic tissue?
a. There will be no inflammatory response
b. Because the tissue is sterile, only the B cell component of
the immune system will be able to respond
c. Because the tissue is sterile, only the T cell component of the
immune system will be able to respond
d. Although there are inflammatory responses, they are
nonspecific and do not involve cells of the immune system
e. Components of the immune system detect dead and damaged
autologous tissues and initiate inflammatory responses
similar to inflammation caused by foreign antigens
100. Lymphocytes and phagocytes must interact and function to
produce the most effective response to a foreign agent. Which one of
the following functions is uniquely associated with the lymphocytes?
a. Distinguishing between self and foreign materials
b. Killing infecting organisms
c. Presenting antigens to the immune system
d. Synthesizing factors to repair damaged tissues
e. Synthesizing factors to coordinate inflammatory activities


Ϯϭ

 &KDSWHU2QH
,QQDWHDQGDGDSWLYHLPPXQLW\
 $QVZHUV
1. d 26.b 51.b 76.a
2. d 27.d 52.b 77.c
3. b 28.b 53.d 78.d
4. d 29.e 54.c 79.b
5. e 30.b 55.e 80.b
6. c 31.a 56.a 81.c
7. d 32.a 57.c 82.e
8. e 33.a 58.c 83.e
9. a 34.e 59.e 84.a
10.b 35.c 60.d 85.c
11.d 36.d 61.a 86.d
12.e 37.c 62.b 87.d
13.d 38.b 63.b 88.a
14.b 39.d 64.e 89.d
15.c 40.c 65.c 90.c
16.d 41.b 66.b 91.a
17.a 42.a 67.e 92.d
18.c 43.a 68.b 93.c
19.a 44.d 69.a 94.a
20.c 45.d 70.e 95.c
21.e 46.d 71.d 96.d
22.c 47.d 72.b 97.b
23.a 48.a 73.b 98.c
24.d 49.a 74.c 99.e
25.c 50.a 75.d 100. d

ϮϮ

 &KDSWHU7ZR
,PPXQRJHQDQWLJHQDQGDQWLERG\
0&4
1. What are antigens"
a. Proteins found in the blood that cause foreign blood cells to
clump
b. Proteins embedded in B cell membranes
c. Proteins that consist of two light and two heavy polypeptide
chains
d. Foreign molecules that trigger the generation of antibodies
e. Proteins released during an inflammatory response
2. An immunoglobulin (Ig) molecule, of whatever class, has regions
symbolized as C or V, H or L. A light chain has which of these
regions"
a. One C and one V region
b. Three C and one V region
c. One H and one L region
d. Three H and one L region
e. Two C and two V regions
3. How do antibodies of the different classes IgM, IgG, IgA, IgD, and
IgE differ from each other?
a. In the way they are produced
b. In their heavy chain structure
c. In the type of cell that produces them
d. By the antigenic determinants that they recognize
e. By the number of carbohydrate subunits they have
4. An epitope associates with which part of an antibody?
a. The antibody-binding site
b. The heavy-chain constant regions only
c. Variable regions of a heavy chain and light chain combined
d. The light-chain constant regions only
e. The antibody tail
5. Antibodies to polysaccharides in humans are MOST likely to be of
which one of the following isotypes"
a. IgG1
b. IgG2
c. IgG3
d. IgG4
e. IgG2

Ϯϯ

 6. Which of the following differentiates an antigen from an
immunogen"
a. An antigen is a foreign molecule
b. An antigen can cause the production of antibodies
c. An antigen does not always elicit an immune response
d. Antigens are usually proteins or polysaccharides
e. Antigens are capable of being bound by immunologic
receptors
7. Which of the following is NOT true regarding effective
immunogens"
a. Foreign to the host
b. Fairly large (molecular weight > 6000
c. Chemically complex (e.g. Proteins made of many nucleotide
bases)
d. Requires a carrier-conjugate to cause the generation of
antibodies
8. Which of the following best describes penicillin, a hapten"
a. Large in size and can induce an immune response alone
b. Large in size and needs to be coupled to induce an immune
response
c. Small in size and can induce an immune response alone
d. Small in size and needs to be coupled to induce an immune
response
9. Which of the following is NOT true?
a. The term epitope is not synonymous with antigen
b. A viral protein may contain a large number of epitopes that
are capable of interacting with many different specific
antibodies
c. Immunologic receptors on T cells recognize continuous
(linear) epitopes
d. Immunologic receptors on T cells recognize discontinuous
(conformational)epitopes
e. Antibodies can recognize both continuous and discontinuous
epitopes
10.Which of the following is an agent (e.g. Aluminum salts, oil-
based, virosomes) often used to modify or augment the effects of a
vaccine by stimulating the immune system torespond to the vaccine
more vigorously, and thus providing increased immunity to a
particular disease?
a. Antigen
b. Epitope
c. Immunogen
d. Stimulant

Ϯϰ

 e. Adjuvant
11.What fraction of serum are the antibodies (immunoglobulins)
initially found when using lytical techniques (e.g. Electrophoresis"

a. Albumin
b. *DPPD Ȗ JOREXOLQ
c. %HWD ȕ JOREXOLQ
d. $OSKD Į JOREXOLQ
12.In the electrophoresis of human serum, which of the following is
the mostelectronegative and thus migrates farthest toward the
positive electrode?
a. Albumin
b. *DPPD Ȗ JOREXOLQ
c. %HWD ȕ JOREXOLQ
d. $OSKD Į JOREXOLQ
13.The aim of monoclonal antibody production is to produce cells that
only secrete immunoglobulin directed against the antigen used in
immunization. Which of the following hybridoma production steps
is NOT correct?
a. Immunize a mouse with antigen of choice then remove the
spleen when them on use is making an antibody response
b. Fuse the immune spleen cells with a myeloma tumor cell
c. The cells are cultured in a selective medium allowing fused
and non-fused cells to survive
d. Cells are grown in individual culture plate wells, and culture
supernatants from wells contains growing hybrid cells are
screened for presence of desired antibody by an enzyme-
linked immunosorbent assay (ELISA)
e. This clone (hybridoma) is an immortal producer of the
desired monoclonal antibody
14.Each polypeptide chain (heavy and light) on immunoglobulin has a
variable (V) and constant (C) region. Immunoglobulin chains are
encoded by _____ that is/are rearranged during ____ development
to assemble a functional gene encoding either a heavy or a light
chain.
a. A single continuous DNA sequence; B cell
b. A single continuous DNA sequence; T cell
c. Sets of gene segments; B cell
d. Sets of gene segments; T cell1
15.Which of the following is only contained in heavy chains and not
in light chains?
a. Leader (L)
b. Joining (J)

Ϯϱ

 c. Diversity (D)
d. Variable (V)
e. Constant (C)
16.During the development of B cells, the Ig gene segments are
rearranged and brought next to each other to form a contiguous
functional gene (somatic recombination). The complex of enzymes
involved in somatic recombination in lymphocytes is called:
a. RAG-1 (Recombination-Activating Gene)
b. RAG-2 (Recombination-Activating Gene)
c. V(D)J-recombinase
d. V(D)J-lyase
e. A & B
17.In somatic recombination, the ____ rearranges first. The ____
region of the antibody molecule is generated via somatic
recombination as it binds to the antigen and contains both a
constant region and a variable region.
a. Heavy chain; Fab
b. Light chain; Fab
c. Heavy chain; Fc
d. Light chain; Fc
18.The two types of light chains are:
a. $OSKD Į DQGEHWD ȕ
b. 6LJPD ı DQGJDPPD Ȗ
c. (SVLORQ İ DQGGHOWD į
d. 2PHJD Ȧ DQG]HWD ȗ
e. /DPEGD Ȝ DQGNDSSD ț
19.During the final step of synthesis for heavy and light
immunoglobulin chains, which of the following peptides is
cleaved?
a. Leader (L)
b. Joining (J)
c. Diversity (D)
d. Variable (V)
e. Constant (C)
20.Which of the following is NOT true regarding the mechanisms of
generating antibody diversity?
a. V, D, and J gene segments are present in multiple copies
(germline diversity)
b. VJ and VDJ gene segments can recombine in multiple
combinations(combinatorial diversity)
c. Different sequences at the joint lead to greater antibody
diversity (junctional diversity)
d. A single combination of light and heavy chains

Ϯϲ

 e. Somatic hypermutation after antigenic stimulation
21.Class switching (isotype switching) involves rearrangement of the
V(H) exon to associate with a different C(H) exon at different
times in the course of an immune response. The ____ region of the
antibody molecule is affected (changed) via class switching and,
unlike somatic recombination, this process is antigen ____.
a. Fab; Dependent
b. Fab; Independent
c. Fc; Dependent
d. Fc; Independent
22.  BBBBis frequently found on the surface of B cells co-expressed
with ____. These two classes are co-expressed not by class
switching but by alternative processing of a primary RNA
transcript. Both molecules expressed on the single mature B cell
have the same binding specificity for antigen.
a. IgA & IgG
b. IgD & IgM
c. IgE & IgA
d. IgG & IgM
e. IgM & IgE
23.If alternative processing uses the first polyadenylation site, then
what type of heavy chain mRNA is derived?
a. Į DOSKD
b. Ȗ JDPPD
c. į GHOWD
d. İ HSVLORQ
e. µ(mu)
24.If alternative processing uses the second polyadenylation site, then
what type of heavy chain mRNA is derived?
a. Į DOSKD
b. Ȗ JDPPD
c. į GHOWD
d. İ HSVLORQ
e. µ(mu
25.Production of secreted antibodies (pas site) involves a ____ chain
of amino acids with a stretch of charged (versus non-charged)
amino acids at the ____ terminus, in comparison to membrane
bound antibody production (pam site).
a. Shorter; NH2
b. Shorter; COOH
c. Longer; NH2
d. Longer; COOH

Ϯϳ

 26.In heterozygous individuals who have, for example, inherited two
alternative forms of the constant region gene for IgG1(i.e.,
IgG1m(1) and IgG1m(2)), which of the following is true regarding
the Ig expression by a particular B cell, according to allelic
exclusion?
a. It will be of the IgG1m(1) type
b. It will be of the IgG1m(2) type
c. It will contain both types
d. It will contain neither type
e. It will contain only one of the types
27.All of the following are true of antigen EXCEPT which one of the
following?
a. They contain epitopes
b. They will react with antibodies
c. They contain antigenic determinants
d. They can elicit an immune response
e. They contain paratopes
28.All of the following are true with respect to IgE molecules,
EXCEPT which one"
a. They are the principal immunoglobulin class involved in
allergic reactions
b. They are involved in mediating anti-parasitic immune
responses
c. They will cross the placenta and fix complement
d. They can affect the release of histamine and other chemical
mediators
e. They are the least abundant immunoglobulin in the serum
29.All of the following are true about antibodies, EXCEPT which
one"
a. They fix complement
b. They occur on the surface of B-lymphocyte
c. They predominate the primary immune response to antigen
d. They are glycoproteins
e. They are molecule with a single, defined amino acid
sequence
30.The major immunoglobulin family to which a particular
immunoglobulin belongs can be determined by sequential analysis
of the 110 amino acids beginning from the
a. Amino terminus of the light chain
b. Carboxy terminus of the light chain
c. Amino terminus of the heavy chain
d. Carboxy terminus of the heavy chain
e. None of the above

Ϯϴ

 31.The immunoglobulin Joining chain (J-chain) is
a. Only produced by T-Cells
b. Only produced by neutrophils
c. Associated with only multimeric forms of IgM and IgA.
d. Associated with IgE for histamine release
e. Only produced by mast cells
32.All of the following are true EXCEPT
a. An epitope is a small portion of a macromolecule
b. The variable region domains contain the antigen recognition
site
c. An antigenic determinant is a paratope
d. The class of an immunoglobulin is determined by its heavy
chain
e. An IgG antibody is bivalent
33.Which immunoglobulin is the principal one found in secretions
such as milk"
a. IgG
b. IgM
c. IgA
d. IgD
e. IgE
34.Individuals unable to make the J protein found in certain
immunoglobulins would be expected to have frequent infections of
the:
a. Brain
b. Blood
c. Liver
d. Pancreas
e. Intestinal tract
35.Which of the following statements best characterizes an antibody"
a. An antibody contains high molecular weight RNA as its
basic structure
b. An antibody is composed of protein and cannot be
distinguished from the albumin fraction of the serum
proteins
c. An antibody is composed of four identical protein subunits
which may be caused to dissociate by treatment with urea
d. An antibody contains protein as its major chemical
component and its synthesis may be elicited by the
administration of a foreign protein or polysaccharide
e. An antibody contains muco-polysaccharides as its major
chemical component and the synthesis of these may be

Ϯϵ

 elicited by the administration of a foreign protein or
polysaccharide
36.Class switching of immunoglobulins occurs:
a. Usually with booster immunizations, going from IgM to
IgG.
b. Binds complement
c. Causes the histamine release
d. Mediates immunoglobulin class switching
e. Results in the glycosylation of immunoglobulins
37.When a B-cell undergoes immunoglobulin class switching
a. The variable region of the light chain changes, but its
constant region remains the same.
b. The variable region of the light chain remains the same, but
its constant region changes
c. The variable region of the heavy chain remains the same but
its constant region changes
d. The variable region of the heavy chain changes but its
constant region remains the same
e. Both the variable and constant regions change
38.The class of an immunoglobulin:
a. Is determined by Class I and Class II major
histocompatibility complex proteins
b. Is determined by the carbohydrate attached to the light chain
is
c. Determined by the antigen
d. Is determined by the heavy chain type
e. Is determined by the J-chain
39.Light chains are:
a. Specific for each class of antibody
b. Not specific for each class of antibody
c. Reactive with antigen
d. Have only a constant region
e. Are composed only of carbohydrate
40.Each of the following is a characteristic of antibodies, EXCEPT
which one"
a. They are proteins with variable and constant regions
b. They contain carbohydrates
c. They are only secreted by T-cells
d. They can combine very specifically with antigen
e. They are structurally organized in globular domains
41.The variable regions in the light chains participate in
a. Fc receptor binding
b. Epitope binding

ϯϬ

 c. Affinity of the complement receptors
d. Interaction of the Fab with cytokines
e. None of the above
42.Plutonian immunoglobulin molecules follow the same rules of
proportions that are found in human immunoglobulins. If you were
told that Plutonian light chains had a molecular weight of 4 kda
(each), what would you expect the molecular weight of their IgG
molecules to be"
a. 150,000 kda
b. 900,000 kda
c. 12 kda
d. 8 kda
e. None of the above
43.J-chains are associated with
a. IgG
b. 3RO\PHULFLPPXQRJOREXOLQV PRUHWKDQWZR)DE¶V 
c. Serum IgA
d. IgE
e. None of the above.
44.IgG binding to neutrophils cells is mediated by
a. Fc-dependent cellular homing mechanisms
b. Sensitization of Mast cells and basophils
c. Fc receptors specific for IgG
d. ,&$0¶V
e. None of the above
45.IgD participates in antigen recognition by
a. Immature T cells
b. NK cells
c. Macrophages
d. B cells
e. None of the above
46.Antibody affinity is not determined by the amino acid sequence in
a. The constant regions of the immunoglobulin molecule
b. The variable regions of the immunoglobulin molecule
c. The Fc of the immunoglobulin molecule
d. The J-chain
e. a, c and d
47.Avidity is important because
a. It amplifies the binding strengtKRIORZDIILQLW\)DE¶V
b. Fc receptor binding depends on it
c. G-protein-mediated signal transduction will not occur
without it

ϯϭ

 d. It results in the activation of high affinity antibody-
producing clones
e. None of the above.
48.All the following are functions of IgG EXCEPT:
a. Opsonize bacteria
b. Activate complement
c. Cross the placenta
d. Be secreted into mucus
e. Facilitate ADCC.
49.Which statement regarding antibodies is incorrect"
a. They serve as the specific receptors on B cells
b. They are composed of two heavy (H) chains and two light
(L) chains
c. Antigen binding sites are composed of constant (C) regions
within one H and one L chain
d. Antibodies exist in a Y-shaped arrangement
e. The amino acid sequence within the variable (V) regions
varies widely from one clone of lymphocytes to another
50.Immunoglobulin heavy (H) chains genes are composed of genes
from what segments of the genome"
a. V and D
b. C and J
c. V, D, and J
d. V, J, and C
e. V, D, J, and C
51.A lymphocyte recognizes and responds to what component of an
antigen"
a. Hapten
b. Antigenic determinant
c. Constant region
d. Variable region
e. Joining chain
52.What is an example of a poor immunogen"
a. Glycoproteins
b. Whole fungal cells
c. Antibodies
d. Glycogen
e. Enzymes
53.What antibody is a significant component of the mucous and
serous secretions of the salivary glands, intestine, nasal membrane,
breast, lung, and genitourinary tract"
a. Monomeric IgA
b. Dimeric IgA

ϯϮ

 c. IgM
d. IgE
e. IgG
54.What is the component found in the human body which can serve
as a carrier molecule when bound by haptens"
a. Red blood cells
b. Macrophages
c. Plasma
d. White blood cells
e. Serum proteins
55.Which of the following immunoglobulin regions/domains
determine the affinity, specificity and idiotype of the molecule"
a. The light chain hypervariable and constant domains
b. The light and heavy chain hypervariable and constant
domains
c. The light and heavy chain hypervariable domains
d. The light chain hypervariable domains
e. The light and heavy chain framework domains
56.A single patient that produces IgG1 to differing epitopes will have
which of the following"
a. Same isotype, same allotype, same idiotype
b. Same isotype, different allotype and different idiotype
c. Same isotype, different allotype, same idiotype
d. Different isotype, different allotype, different idiotype
e. Same isotype, same allotype, different idiotype
57.In 1972 Rodney Porter won the Nobel Prize for demonstrating the
structure of antibodies, He digested IgG using papain to produce
what"
a. One F(abi)2 plus some small fragments
b. 2Fab plus one Fc
c. 2Fc plus one Fab
d. One F(ab')2 plus one Fc
58.Antibodies of different classes, including IgM, IgG, IgA, and IgE,
arise after varying kinds of antigenic stimulation. In which of the
following situations would particular antibody responses be
expected"
a. Antigens such as polysaccharides give rise to T cell-
dependent responses resuting in mostly IgG
b. Antigens such as proteins give rise to T dell-independent
responses resulting in mostly IgM
c. IgM produced after exposure to a carbohydrate antigen will
have relatively low affinity for its antigen

ϯϯ

 d. When antigen is presented at MUCOS3i surfaces, IgE is
likely to be the main antibody secreted at the surface
59.IgM differs from IgG in a number of ways, but which of the
following differences between IgG and IgM would you agree with?

a. IgM is almost always low affinity for antigen, while IgG is
usually high affinity for antigen
b. IgM, but not IgG can bind to soluble antigens
c. Certain subtypes of IgG, can activate complement, but IgM
can almost never activate complement by the classical
pathway
d. Both ign1 and IgG are produced subsequent to somatic
hypermutabon of SCR genes. Innate defenses, Cdrnplernent,
Antigen and antibody structure and function
60.$KXPDQP\HORPDSURWHLQ ,J0  ț LVXVHGWRLPPXQL]HDUDEELW
The resulting antiserum is then absorbed with a large pool of IgM
purified from normal human serum. Following this absorption, the
antiserum is found to react only with the particular IgM myeloma
protein used for immunization; it is now defined as an anti-
idiotypic antiserum. With what specific portion(s) of the IgM
myeloma protein would the antiserum react?
a. &RQVWDQWUHJLRQRIWKHțFKDLQ
b. 9DULDEOHUHJLRQVRIWKH—DQGțFKDLQV
c. Constant region of the µchain
d. J chain
e. None of these.
61.The fusion of what cells leads to a hybridoma cell line that secrets
monoclonal antibodies?
a. Plasma cells and myeloma cells
b. Monocytes and lymphocytes
c. Lymphocytes and lymphoma cells
d. Plasma cells and activated T cells
e. None of these.
62.Transfectomas are
a. Antibodies infected by viruses
b. Hybridomas resulting from fusion induced by viruses
c. Mono-clonal antibodies that stop bacterial transfection
d. Cells that produce hybrid antibodies resulting from
transfection of bacteria with antibody genes
e. None of these.
63.The ability to produce billions of different antibodies in humans
results from:

ϯϰ

 a. The presence of billions of complete antibody genes in B
cells
b. The fact that both T cells and B cells contain antibody genes
c. The production of variable regions of light and heavy
antibody genes by DNA rearrangement The combination of
gene fragments prior to binding antigen produces the
variable coding sequence for the antibody gene.
d. The fact that a single antibody gene produces an antibody
capable of billions of different three-dimensional structures
and the ability to combine with any antigen
64.If a B cell clone began to produce antibody with altered binding
strength and specificity for antigen, you would expect the mutation
of the antibody gene to involve:
a. The variable region of the heavy chain or the constant region
of the light chain
b. The variable region of the light chain or the constant region
of the heavy chain
c. The variable regions of the light or heavy chains.
d. The constant regions of the light or heavy chains.
65.Stainless- steal pins and plastic prostheses being used in surgery do
not act as antigen because:
a. Their structure is relatively simple.
b. The molecular weight is less than 750 daltons
c. They are biochemically inert.
d. All of the above.
66.Which of the following the most powerful antigen?
a. Serum albumin
b. Haemocyanin
c. Angiotensin
d. P-azobenzene ± arsonate- trityrosine.
67.For having a good antigenicity, the size of the foreign molecule
VKRXOGEHEHWZHHQ«««««'DOWRQV
a. 50,000 and 500
b. 50,000 and 2500
c. 70,000 and 650
d. 60,000 and 750
68.Antigenic property of foreign proteins can be increased by:
a. Deleting tyrosine and trypophan from them.
b. Incorporating tyrosine or tryptophan into them.
c. Adding co-enzyme to them.
d. Incorporating cysteine into the proteins.

ϯϱ

 69.Nucleic acids, when injected into the blood stream, do not
stimulate the host`s immune system. The possible reason for this is
that:
a. Nucleic acids are very large molecules.
b. Nucleic acids are structurally unstable.
c. The host cannot recognize them as foreign nucleic acids,
since their general structure is the same.
d. Nucleic acids are composed of four types of simple
nucleotides.
70.For acting as good antigen, the foreign substance should be :
a. Large and stable
b. Structurally complex.
c. Reactive.
d. All the above.
71.Polymers of D- amino acids, which are usually poor in antigenic
properities, can be made into antigen by:
a. Incorporating tyrosine.
b. Incorporating tryptophan.
c. Incorporating some L- form of amino acids.
d. Adding haptanes.
72.Polymers of D- amino acids are poorly antigenic , because :
a. They are flexible molecules.
b. They are highly soluble
c. They are structurally no so simple.
d. They are metabolically inert in mammals.
73.In hapten mediated immune reactions, the carrier:
a. Increases the antigenic strength of the hapten.
b. Neither reduce or increase the antigenic power of the hapten.
c. Reduce the antigenic power of the hapten.
d. A+ boosts up the immune system to show a good antigen
response.
74.All are haptens EXCEPT :
a. Lysozyme
b. Urushiol
c. Dinitrophenol
d. Ferrous oxide
75.Which one one of the cell components is the most powerful
antigens?
a. Polysaccharides
b. Nucleic acids
c. Structural proteins
d. Lipids.

ϯϲ

 76.A- antigen in human blood is cross-reactive with antibody
generated against:
a. Capsular polysaccharide of Pneumococcus.
b. Capsular polysaccharide of Proteus vulgaris.
c. Capsular polysaccharide of Rickettsia typhi
d. Capsular polysaccharide of E. Coli.
77.B- antigen in human blood is cross-reactive with antibody
generated against:
a. Capsular polysaccharide of some strains of E. Coli.
b. Egg albumin of hen.
c. Egg albumin of duck
d. Antigen on the surface of RBC of dog.
78.What is the chemical nature of forssman antigen?
a. Protein
b. Flagellar protein
c. Capsular polysaccharide
d. Glycolipid
79.What is the chemical nature of O- antigens:
a. Disaccharide
b. Trisaccharide
c. Trisaccharide with immunodominant molecule at one end.
d. Pentose sugar.
80.K- antigen is found in which of the following structure?
a. Pili
b. Flagella
c. Capsule
d. Cell wall.
81.Polysaccharides in bacterial capsule are good antigens since they
contain:
a. Side chains
b. Hexose amines
c. Reactive group
d. Lipid units
82.The concentration of IgG antibodies in the human blood is:
a. 800-1600 mg/100 ml
b. 150-400 mg/100 ml
c. 1.5-40 mg/100ml
d. 50-220 mg/100ml.
83.When IgG is digested by 2- mercaptoethanol, how many
polypeptides we could obtain?
a. Four identical polypeptide chains.
b. Two identical long chains and two identical short chains.
c. Four non- identical poly[eptide chains.

ϯϳ

 d. Three polypeptide chains.
84.Papain split IgG into:
a. Four polypeptide chains.
b. Two identical long chains and two identical short chain.
c. Many irregular fragments.
d. Three fragments
85.True about immunoglobulin IgG is:
a. Y- shaped molecule
b. One antigen binding site is present in each arm of the Y
c. Two heavy chains and two light chains in the molecule.
d. All the above.
86.The antigen binding sequence of IgG is located :
a. At the C- terminal end of the molecule.
b. At the n- terminal end of the molecule.
c. At the C- terminal end located in the arm of the molecule.
d. At the tail of the Y- shaped molecule.
87.The part of immunoglobulin with molecular weight is about 50,000
daltons is:
a. H- chain.
b. J- chain.
c. L- chain.
d. Variable sequence.
88..DSSD ț DQGODPEGD Ȝ VXE-types of sequences are found in :
a. Light chain of IgG.
b. Light chain of IgM.
c. J- chain of IgA.
d. Light chain of all types of immunoglobulins.
89.The incorrect statement about Fab segment of immunoglobulin is
that:
a. Fab determines the biological properties of immunoglobulin.
b. It is an insoluble fragment.
c. Two chains of fab are held together by disulfide linkage.
d. Two Fab in antibody.
90.The subclasses of IgG are determined by determinant sequences in
:
a. Light chain.
b. Heavy chain.
c. J- chains
d. Fab fragments.
91.7KH VXEW\SH ,J* KDV ««««« LQWHU KHDY\ FKDLQ GLVXOILGH
linkages.
a. 2
b. 4

ϯϴ

 c. 13
d. 3
92.The subtype of IgG present in largest amount in blood is :
a. IgG1
b. IgG2
c. IgG3
d. IgG4
93.The maximum life time of IgG immunoglobulins in the blood is :
a. 23 days.
b. 16 days.
c. 43 days.
d. 46 days.
94.The subclass of IgG that cannot pass through human placenta is:
a. IgG1
b. IgG2
c. IgG3
d. IgG4
95.Which type of IgG does not bind with Fc receptor of macrophages
and K- cells?
a. IgG1 and IgG2.
b. IgG2 and IgG4.
c. IgG1 and IgG3
d. IgG1 and IgG4
96.Which is not true about heavy chain of IgG immunoglobulin?
a. The heavy chain is made up of 445 amino acids.
b. A sequence of 115 amino acids in N- terminal is the variable
region.
c. The constant region lies in the C- terminal part.
d. The variable region lies in the C- terminal part consisting of
330 amino acids.
97.Secretary IgA molecules are produced in :
a. Epithelial cells.
b. Liver cells.
c. Connective tissue.
d. None of the above.
98.Disulfide bonds between the heavy and light chains are absent in
which of the following?
a. IgG3
b. IgM
c. IgA1
d. IgA2
99.Isotype is:

ϯϵ

 a. Antigenic determinants found in immunoglobulins of some
animals of a species.
b. Antigenic determinants found in immunoglobulins of all
animals of a species.
c. Antigenic determinants found in immunoglobulins made by
changes in hyper variable regions.
d. None of the above.
100. Allotypes are antigenic deteminants found in the
immunoglobulines of :
a. All members of a species.
b. Some animals of a species.
c. Animals into which a foreign antibody is injected .
d. All of the above.

ϰϬ

 &KDSWHU7ZR
,PPXQRJHQDQWLJHQDQGDQWLERG\
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1. d 26.b 51.b 76.a
2. a 27.e 52.d 77.a
3. b 28.c 53.b 78.d
4. c 29.e 54.e 79.c
5. b 30.d 55.c 80.c
6. c 31.c 56.e 81.b
7. c 32.c 57.b 82.a
8. d 33.c 58.c 83.b
9. d 34.e 59.a 84.d
10.e 35.d 60.c 85.d
11.b 36.a 61.a 86.b
12.a 37.c 62.d 87.a
13.c 38.d 63.c 88.d
14.d 39.b 64.c 89.a
15.c 40.c 65.d 90.b
16.c 41.b 66.b 91.c
17.a 42.e 67.c 92.a
18.e 43.b 68.b 93.d
19.a 44.c 69.c 94.b
20.d 45.d 70.d 95.b
21.c 46.e 71.c 96.d
22.b 47.a 72.d 97.a
23.e 48.d 73.d 98.d
24.c 49.c 74.d 99.b
25.c 50.e 75.c 100. b

ϰϭ

 &KDSWHU7KUHH
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0&4
1. Which of the following is a function of the complement system?
a. Agglutination of incompatible red cells.
b. Antibody-dependent cell mediated cytotoxicity (ADCC)
c. Attraction of lymphocytes to inflammation sites
d. Cross-linking polysaccharide antigens
e. Enhanced phagocytosis of infectious agents
2. Which of the following is observed ONLY when complement is
activated by the classical complement pathway?
a. Activation of C1s
b. Activation of C2
c. Activation of the membrane attack complex
d. Breakdown of C3 into C3a and C3b
e. Generation of anaphylatoxins
3. The mechanism leading to red cells lysis in severe cases of
paroxysmal nocturnal hemoglobinuria involves:
a. Complement activation induced by anti ±red cell antibodies
b. Deficiency of Factor I, limiting the ability to inactivate C3b
bound to erythrocyte CR1 receptor
c. Opsonization and phagocytosis of red cells
d. Shedding of DAF into the circulation
e. Unchecked deposition of C3b on the red cell followed by
activation of C5 to C9
4. The location of complement activation is determined by:
a. The location of Fc receptors.
b. The location of dendritic cells.
c. The location of specific antibody/antigen complexes.
d. b and c.
e. None of the above.
5. Complement damage is generally limited to the immediate area in
which complement is activated because of the:
a. Short half-lives of the activated complement components
and their rapid inactivation.
b. Very low concentrations of the inactivated complement
components in serum.
c. The inability to activate the system in the presence of IgG
antibodies.

ϰϮ

 d. Once activated, the destructive activities of complement are
non-specific.
e. None of the above.
6. All of the following processes are considered functions of the
complement system EXCEPT:
a. Inflammation
b. Antibody production
c. Cytolysis
d. Opsonization
e. Clearance of immune complexes.
7. After activation of C3 of the complement system, which of these is
a role of its component part, C3b?
a. It acts as an enzyme to convert nitric oxide into hydrogen
peroxide.
b. It causes vasodilation of local blood vessels.
c. It acts a chemoattractant for macrophages.
d. It stimulates the conversion of monocytes to neutrophils.
e. It acts as an opsonin that is recognized by phagocytes
targeting the microbe for destruction.
8. Histamine is released from mast cells stimulated by:
a. C1q
b. C2a
c. C4b
d. C5a
e. C3b
9. In the classical pathway of complement activation:
a. Complement is activated within liver cells and released into
the blood.
b. Complement binds to an antibody that is bound to a foreign
substance.
c. Complement binds with polysaccharides on a microbial cell
wall.
d. Complement inhibits inflammation and binds to opsonins.
e. All of the above are true.
10.The amplification loop can be efficiently activated by:
a. Antigen-antibody complexes
b. C5-9
c. Chemically cross-linked Fc fragments of IgG
d. Ca2+
e. Properdin
11.Which statement about the complement system is TRUE?
a. These proteins are involved in innate immunity and not
acquired immunity.

ϰϯ

 b. These proteins are secreted by cytotoxic T cells and other
CD8 cells.
c. This group of proteins includes interferons and interleukins.
d. These proteins are one group of antimicrobial proteins acting
together in cascade fashion.
e. These proteins act individually to attack and lyse microbes.
12.Which of the following is NOT observed when complement is
activated by the alternative pathway?
a. Breakdown of C3 into C3a and c3b
b. Breakdown of C4 into C4a and c4b
c. Breakdown of C5 into C5a and c5b
d. Activation of the membrane attack complex
e. Activation of C1 complex
13. The lectin pathway leads to activation of the classical complement
pathway through:
a. Antibody binding.
b. Production of C1 complex.
c. Mannose-binding lectin (MBL) and activation of MBL
associated serum proteases (MASP).
d. C5 convertase.
e. Decay-accelerating factor (DAF).
14. Which is NOT a pathway to activate the complement cascade?
a. Lectin binding to microbe
b. Interferon binding to host
c. C3 binding directly to the microbial surface
d. Antibody binding to antigen
15.Which of the following is the correct complement cascade
sequence?
a. C1-C2-C4-C3-C5-C6-C7-C8-c9n
b. C1-C4-C2-C3-C5-C6-C7-C8-c9n
c. C9n-C8-C7-C6-C5-C4-C3-C2-C1
d. C2-C3-C4-C1-C5-C8-C6-C7-c9n.
e. None of the above.
16.Complement fixation refers to:
a. The ingestion of c3b-coated bacteria by macrophages.
b. The destruction of complement in serum by heating at 56°C
for 30 minutes.
c. The binding of complement components by antigen-
antibody complexes.
d. The interaction of C3b with mast cells.
17.The classic complement pathway is initiated by interaction of C1
with:
a. Antigen.

ϰϰ

 b. Factor B.
c. Antigen-IgG complexes.
d. Bacterial lipopolysaccharides
18. Patients with severely reduced C3 levels tend to have:
a. Increased numbers of severe viral infections.
b. Increased numbers of severe bacterial infections.
c. Low gamma globulin levels.
d. Frequent episodes of hemolytic anemia.
19.Individuals with a genetic deficiency of C6 have:
a. Decreased resistance to viral infections.
b. Increased hypersensitivity reactions.
c. Increased frequency of cancer.
d. Decreased resistance to Neisseria bacteremia.
20.Which one of the following is NOT true regarding the alternative
complement pathway?
a. It can be triggered by infectious agents in absence of
antibody.
b. It does not require C1, C2, or C4.
c. It cannot be initiated unless C3b fragments are already
present.
d. It has the same terminal sequence of events as the classic
pathway.
21. In setting up a complement fixation test for antibody, the reactants
should be added in what sequence? (Ag = antigen; Ab = antibody;
C = complement; EA = antibody-coated indicator erythrocytes.)
a. Ag + EA + C/wait/ + patient's serum
b. C + patient's serum + EA/wait/ + Ag
c. Ag + patient's serum + EA/wait/ + C
d. Ag + patient's serum + C/wait/ + EA
22.Complement lyses cells by:
a. Enzymatic digestion of the cell membrane.
b. Activation of adenylate cyclase.
c. Insertion of complement proteins into the cell membrane.
d. Inhibition of elongation factor 2.
23.Complement can enhance phagocytosis because of the presence on
macrophages and neutrophils of receptors for:
a. Factor D.
b. C3b.
c. C6.
d. Properdin.
24. Congenital absence of the late complement component
(c5,C6,C7,C8) is most often:
a. Viral Infection.

ϰϱ

 b. Recurrent Neisserial Infection
c. Candidiasis
d. Delayed separation of umbilical cord
25. Congenital complement deficiencies are best screened by which of
the following laboratory:
a. Quantitative Immunogloubulins
b. NBT
c. Total CH50
d. C3,C4 and properdin
e. Flow Cytometry
26.One principal function of complement is to:
a. Inactivate perforins
b. Mediate the release of histamine
c. Bind antibodies attached to cell surfaces and to lyse these
cells
d. Phagocytize antigens
e. Cross link allergens
27.The major role of the complement system is to work in conjunction
with :
a. Antibodies to lyse cells via the C8 and C9 components.
b. The major histocompatibility complex for cell recognition.
c. Antibodies to opsonize cellsd.
d. The T-cell receptor for production of lymphokinese.
e. Antibodies to lyse cells via the perforin molecules
28.Complement components with important opsonizing activity
include:
a. C1qrs
b. C3b
c. C5a
d. Both b and c
e. All of the above
29.Deficiency of complement component C6 will affect the:
a. Classical pathway
b. Alternate pathway
c. MBL pathway
d. A and b only
e. All of the above
30.Complement receptors on human erythrocytes are important for:
a. Complement fixation
b. Innate immunity
c. Clearance of immune complexes
d. Opsonization
e. Isotype switching

ϰϲ

 31. Complement system :
a. Consists of 20 serum proteins.
b. Serum proteins act as biological cascade
c. Both a and b
d. Are set of antibodies
32. Complement system is involved in :
a. Specific defence
b. Non-specific defence
c. Both a and b
d. None of these
33. Which of the following statements are true regarding complement
activation:
a. Lysis of pathogen, tumor cells and allograft.
b. Production of mediators that attracts neutrophils to the site
of inflammation.
c. Opsonization
d. All of these
34.Classical pathways of complement system is activated by:
a. Antibody ± antigen complexes
b. Antigen
c. Antigenic peptide
d. Antigens bound to MHC
35.Alternative pathways of complement system is activated by:
a. Antibody ± antigen complexes
b. Antigen
c. Microorganisms or its toxins
d. Antigens bound to MHC
36. Classical pathway of complement is involved by:
a. Specific defence
b. Adaptive immunity
c. Both a and b
d. Non- specific defence.
37. Alternative pathway of complement is involved by:
a. Non- specific defence
b. Innate immunity
c. Both a and b
d. Adaptive immunity
38. Which of the following is the central molecule in complement
pathway:
a. C1
b. C2
c. C3b
d. C5

ϰϳ

 39. Cell lysis in complement pathway is initiated by:
a. Membrane destruction complex.
b. Membrane degradation complex
c. Membrane attacking complex
d. Membrane lysis complex
40. MAC is:
a. C5b6789 complex
b. C5b5678 complex
c. C5b5789 complex
d. Protein polysaccharide complex
41. Which of the following is required for C1 activation:
a. Ca
b. Mg
c. Mn
d. Zn
42.Which of the following is the most potent anaphylatoxin:
a. C3a
b. C4a
c. C5a
d. C1
43. In alternative pathway :
a. Factor b is involved
b. Factor d is involved
c. Only factor f is involved
d. Both a and b
44. Biological role of complement system include:
a. Cytolysis and chemotaxis
b. Opsonization
c. Anaphylotoxin and enhanced antibody production
d. All of these
45. Body`s own cells are protected from membrane attack complex by
a surface glycoprotein called:
a. MHC
b. DAF
c. TCR
d. BCR
46.Several of the complement components are:
a. Antibodies
b. Cytokines
c. Enzymes
d. Glycolipids
e. Hormones

ϰϴ

 47. The classical and alternative pathways meet at complement
component:
a. C3
b. C4
c. C4b
d. C5
e. Factor D
48.Complement is:
a. Activated by binding to specific complement receptors.
b. Antigen-specific.
c. A potent promoter of virus entry into host cells.
d. A series of intracellular proteins which work with antibody
to eliminate endogenous antigen.
e. Present in the circulation in an inactive form.
49.The alternative pathway of complement activation:
a. Causes tissue damage in the absence of C1INH.
b. Occurs after the classic pathway is activated.
c. Occurs only if the classical pathway is ineffective in
pathogen clearance.
d. Requires C3.
e. Requires C4.
50.If a person is born without C2 and C4,
a. C5 can still be cleaved by the classical pathway.
b. C3b will not be able to bind to bacteria.
c. C9 will polymerize inappropriately and lyse host cells.
d. The classical pathway will be changed into the alternative
pathway.
e. The amount of C3b produced during bacterial infections will
be reduced.
51.In the membrane attack phase of the classical complement
pathway, the role of C5b is:
a. Activate the C5 convertase activity.
b. Attract neutrophils to lyse the pathogen.
c. Initiate formation of the MAC.
d. Polymerize into a membrane-spanning channel.
e. All of these are activities of c5b.
52.Complement receptors (CR):
a. Activate complement on the surface of pathogens.
b. Bind only activated complement proteins.
c. Inhibit complement activation on the surface of host cells.
d. On erythrocytes remove immune complexes from the
circulation.
e. On macrophages signal host cells to make opsonins.

ϰϵ

 53. A deficiency in complement proteins or in their regulators can
result in:
a. Blood in the urine from erythrocyte lysis.
b. Decreased levels of certain complement proteins in the
circulation.
c. Immune complex disease.
d. Increased numbers of infections.
e. All of the above can result from complement deficiencies.
54.The finding of a positive result with the serum control in a
complement fixation test is MOST likely explained by the presence
of:
a. Anti-Forssman antibodies.
b. Anti-human red blood cell antibodies.
c. Free antigen in circulation.
d. High levels of heat-labile ige.
e. Soluble immune complexes.
55.Which of the following is NOT true regarding the complement
system?
a. They are serum proteins that form protein cascades, each
activated component activating the next to generate a
physiologic response
b. They can bind to bacteria, making holes in their membrane
c. They attract phagocytes to both foreign material and self-
cells
d. Binding of MBLs to a bacterial capsule triggers the
complement cascade
e. They help to eliminate immune complexes (antibody-
antigen) and prevent them from damaging the body
56.Which of the following key components of the complement
pathway can be activated by the lectin, classical, and alternative
pathways?
a. C1
b. C3
c. C5
d. C7
e. C9
57. The classical pathway of complement begins with:
a. Activation of C1
b. Cleavage and activation of C4,C2,and C3
c. IgA binding to specific epitope.
d. Initiation of membrane attack complex formation
e. Production of C3 convertase

ϱϬ

 58. Which of the following antibody isotypes facilitate the sequential
binding of the C1, C4, C2,and C3 components of the complement
system?
a. IgA and IgD
b. IgA and IgE
c. IgA and IgM
d. IgE and IgG
e. IgG and IgM
59. The initial complement component that is bound by complement-
fixing antibodies is:
a. C1q
b. C1s
c. C3b
d. C5a
e. C9
60.What causes the formation of of the C3 convertase enzyme?
a. C3bbb
b. C4b2a
c. C3ac3b
d. A and b
e. A and c
61.C5 convertase cleaves C5 into C5a and C5b in all pathways which
initiates:
a. Opsonisation and phagocytosis
b. Formation of MAC and lysis of the cell
c. Formation of C5 convertase
d. Formation of C3 convertase
62.The Lectin Pathway is initiated when the immune system
recognizes:
a. Lectin on microbes
b. Mannose on microbes
c. An antibody
d. MASP1 and 2 on microbes
63.Which complement initiates pore formation in the membrane?
a. C5
b. C6
c. C7
d. C8
e. C9
64.Which gives the correct order of the complement activation
pathway functions?

ϱϭ

 a. Initiation, Inflammation via c3b, Opsonisation and
Phagocytosis via c3a, Inflammation via c3a, Lysis of
microbe via MAC
b. Initiation, Opsonisation and Phagocytosis via c3a,
Inflammation via c3a, Lysis of microbe via MAC
c. Initiation, Inflammation via c3a, Inflammation via c3b,
Opsonisation and Phagocytosis via c3a, Lysis of microbe via
MAC
d. Initiation, Inflammation via c3a, Opsonisation and
Phagocytosis via c3b, Inflammation via c5a, Lysis of
microbe via MAC.
65.Molecules that target a microbe for phagocytosis are called
a. MbLs
b. Properdins
c. Opsonins
d. MACs
66.Chemoattraction occurs with neutrophils via complement
components:
a. C3a, C4a and c5a
b. C3b, C4b and c5b
c. C3a and c3b
d. C4a and c5a
67.The capillaries of endothelial cells expand so that fluids and
proteins leak out from blood and tissue causing inflammation. This
is caused by:
a. MAC formation
b. The release of histamine
c. Cell lysis
d. Phagocytosis
68.What would inhibit C9 binding which would prevent the action of
MAC"
a. C1 INH (serpin)
b. DAF
c. CD59
d. None of the above
69.What would inhibit C3 convertase formation"
a. C1 INH (serpin)
b. DAF
c. CD59
d. None of the above
70.7KH PDMRU ³DQDSK\ORWR[LF´ FRPSRQHQW V  RI FRPSOHPHQW ZKLFK
increase(s) capillary permeability and contribute to the heat,
redness and swelling associated with inflammation, are:

ϱϮ

 a. C1q,r,s
b. C3b
c. C4b
d. C3a, C5a
e. C5b6789
71.In the lectin complement pathway, mannan-binding lecting (MBL)
indirectlyactivated which of the following components?
a. C1
b. C2
c. C3
d. C4
e. C2 & C4
72.In the classical complement pathway, which of the following
components is the initiating protein(s)?
a. C1
b. C2
c. C3
d. C4
e. C2 & C4
73.Which of the following component molecules is activated in the
classical pathway after binding to an Fc ±
a. C1
b. C2
c. C3
d. C4
e. C2 & C4
74.In the alternative complement pathway, this component molecule
undergoes spontaneous activation, which creates a challenge for
organ xenotransplantation:
a. C1
b. C2
c. C3
d. C4
e. C2 & C4
75.Which complement pathway is activated by (and requires)
antibodies, with IgM being particularly good at C1 binding?
a. Lectin
b. Classical
c. Alternative
d. All of the three pathways
76.Anaphylatoxins are chemotaxins that stimulate phagocytosis and
degranulation. Which complement components is/are mainly
involved?

ϱϯ

 a. C2 & C4
b. C3
c. C5
d. C3 & C5
e. C5-C9
77.Opsonization is the process by which bacteria and other cells are
made available for phagocytosis and involves opsonin or IgG.
Which complement components is/are mainly involved?
a. C2 & C4
b. C3
c. C5
d. C3 & C5
e. C5-C9
78.The membrane attack complex (MAC) uses C3 to activate the final
part of the complement pathway. It is important in defense against
Neisseria. Which of the following components is/are inserted into
the plasma membrane of the target cell, allowing for free passage
of water/solute and thus killing the cell?
a. C5 & C6
b. C7
c. C8
d. C9
e. C7-C9
79.Which of the following is NOT a major function of complement
activation?
a. Opsonization
b. B-cell stimulation
c. T-cell stimulation
d. Immune complex clearance
80.To prevent inadvertent complement activation, eight inhibitors
exist. Which of the following is an inhibitor preventing activation
of C2 and C4, and prevents C3 activation by the alternative
pathway?
a. C1 inhibitor
b. C2 inhibitor
c. C3 inhibitor
d. C4 inhibitor
e. C2 & C4 inhibitor
81.A deficiency in complement inhibitors could lead to which of the
following?
a. Meningitis
b. Leprosy
c. X-linked hyper-IgM syndrome

ϱϰ

 d. Hereditary angiodema
e. X-linked agammaglobulinemia
84. A patient is admitted with multiple bacterial infections and is
found to have a complete absence of complement. Which
complement-mediated function would remain intact in such a
patient"
a. Lysis of bacteria
b. Opsonization of bacteria
c. Generation of anaphylatoxins
d. Generation of neutrophil chemotactic factors
e. None of the above
85.Which of the following screening tests would be most useful for
confirming a presumptive diagnosis of a congenital absence of a
complement component"
a. Quantitation of serum opsonic activity
b. Quantitation of serum hemolytic activity
c. Quantitation of C3 content of serum
d. Quantitation of C1 content of serum
e. Electrophoretic analysis of patient's serum
86.Complement is required for
a. Lysis of erythrocytes by lecithinase
b. NK-mediated lysis of tumor cells
c. Phagocytosis
d. Bacteriolysis by specific antibodies
e. All of the above
87.Which of the following is associated with the development of
systemic lupus erythematosus (SLE) ?
a. Deficiencies in C1, C4, or C2
b. Deficiencies in C5, C6, or C7
c. Deficiencies in the late components of complement
d. Increases in the serum C3 level
e. Increases in the levels of C1, C4, or C2
88.Active fragments of C5 can lead to the following, EXCEPT
a. Contraction of smooth muscle
b. Vasodilation
c. Attraction of leukocytes
d. Attachment of lymphocytes to macrophages
e. All of the above
89.The alternative pathway of complement activation is characterized
by the functions listed below, EXCEPT
a. Activation of complement components beyond C3 in the
cascade
b. Participation of properdin

ϱϱ

 c. Generation of anaphylatoxin
d. Use of C
90.Decay-accelerating factor (DAF) regulates the complement system
to prevent complement-mediated lysis of cells. This involves
a. Dissociation of C4b2a or the c3bbb enzyme complex
b. Blocking the binding of C3 convertase to the surface of
bacterial cells
c. Inhibiting the membrane attack complex from binding to
bacterial membranes
d. Acting as a cofactor for the cleavage of c3b
e. Causing dissociation of C5 convertase
91.The following activate(s) the alternative pathway of complement
a. Lipopolysaccharides
b. Some viruses and virus-infected cells
c. Fungal and yeast cell walls (zymosin)
d. Many strains of gram-positive bacteria
e. All of the above
92.Which component(s) of complement could be missing and still
leave the remainder of the complement system capable of
activation by the alternative pathway"
a. C1, C2, and C3
b. C3 only
c. C2, C3, and C4
d. C1, C2, and C4
e. C1, C3, and C4
93. An antigen-antibody immune complex in a C3-deficient individual
will still result in:
a. Anaphylatoxin production
b. Depression of factor B
c. Production of chemotactic factors
d. Activation of C
e. Activation of C5.
94.CR1 receptors on phagocytic cells have the greatest affinity for:
a. C3a
b. C3b
c. C3d
d. C3dg
e. iC3b
95.Which of the following is a major characteristic of hereditary
angioneurotic edema?
a. A quantitative or functional deficiency of C1-INH
b. Induction by inhalation of complement- activating
compounds

ϱϲ

 c. Normal levels of C2 and C4
d. Spontaneous breakdown of C3 and C5
e. Very high levels of IgE
96.Neutrophil aggregation as a consequences of hemodialysis is
believed to result from:
a. Direct activation of the alternative pathway by trace levels of
heparin
b. Excessive amounts of calcium
c. Generation of C5a
d. Production of C3b
e. Retention of antigen-antibody complexes in the dialysis
membrane and activation of the classical pathway
97.A deficiency of erythrocyte CR1 receptors is associated with:
a. Accumulation of C3dg and C3d in circulation
b. Increased deposition of antigen-antibody complexes in
tissues
c. Increased incidence of angioneurotic edema
d. Paroxysmal nocturnal hemoglobinuria
e. Release of massive amount of histamine
98.Which of the immunoglobulin activates the complement system?
a. IgG
b. IgE
c. IgM
d. IgG & IgM
e. IgG & IgA
99.To prevent inadvertent complement activation, eight inhibitors
exist. Which of the following is an inhibitor preventing activation
of C2 and C4, and preventsC3 activation by the alternative
pathway?
a. C1 inhibitor
b. C2 inhibitor
c. C3 inhibitor
d. C4 inhibitor
e. C2 & C4 inhibitor
100. A patient presents in the winter months with swollen lips.
The patient saysthey forgot their lip balm. Uncontrolled activation
of the classical complement pathway is responsible for the
swelling. Records show the patient has a C1inhdeficiency. Which
of the following does this patient have?
a. C5-C9 deficiency
b. Glucose-6-phosphate dehydrogenase deficiency
c. Hereditary angioedema
d. Severe combined immunodeficiency disease (SCID)

ϱϳ

 e. C3 deficiency
101. 58-year-old white man presents with weight loss, night
sweats, anddyspnea. On examination, the patient appears
chronically ill and is pale. Laboratory testing reveals leukocytosis,
anemia, and throm-bocytopenia. A bonemarrow biopsy with
aspirate is performed, and a diagnosis of acute
myelogenousleukemia is confirmed. In counseling the patient
about chemotherapy, you informhim that he is going to be at
increased risk for infections and that a major source of infection
will be his own gastrointestinal tract. Which of the following
statementsregarding the innate immune system and the epithelial
barrier in the GI tract isfalse?
a. Lectins found in secretions bind sugars on pathogens and
activate the lectin pathway of complement activation
b. Granulocytes marginate in small blood vessels throughout
much of the barrier tissues and are available for rapid
recruitment to a possible site of infection
c. Mucus itself is a protective barrier that traps organisms and
debris
d. Secretions on the epithelial barrier concentrate complement
in such a way that the concentration of complement in
secretions is higher than theconcentration in plasma
e. Monocytes are present in secretions and in most tissues,
where they phagocytose unwanted microbes

ϱϴ

 &KDSWHU7KUHH
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$QVZHUV

1. e 26.c 51.c 76.d
2. a 27.a 52.d 77.b
3. e 28.b 53.e 78.e
4. c 29.e 54.e 79.c
5. a 30.a 55.c 80.a
6. b 31.c 56.b 81.d
7. e 32.c 57.a 82.e
8. d 33.d 58.e 83.b
9. b 34.a 59.a 84.d
10.a 35.c 60.d 85.a
11.d 36.c 61.b 86.d
12.b 37.c 62.b 87.a
13.c 38.c 63.e 88.d
14.b 39.c 64.d 89.d
15.a 40.a 65.c 90.a
16.c 41.a 66.a 91.e
17.c 42.c 67.b 92.d
18.b 43.d 68.c 93.d
19.d 44.d 69.b 94.b
20.c 45.b 70.d 95.a
21.d 46.c 71.e 96.c
22.c 47.a 72.a 97.b
23.b 48.e 73.c 98.d
24.b 49.b 74.c 99.a
25.c 50.e 75.b 100. c

ϱϵ

 &KDSWHU)RXU
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0&4
1. Cytokines:
a. Are usually around 150±200 kda.
b. Have glycosyl phosphatidylinositol (GPI) anchors.
c. Can be pleiotropic.
d. Generally act at long range.
e. Produce very stable long-lived messenger RNA.
2. The major purpose of lymphokines is to:
a. Bind to class I major histocompatibility molecules for
cytotoxic function
b. Specifically recognize antigens or their fragments
c. Stimulate the production of complement
d. Help control and regulate the cells of the Immune system
3. Cytokines are NOT:
a. Able to induce increased blood vessel permeability.
b. Antigen-specific.
c. Made in response to bacterial antigens.
d. Signals from one cell that affects the behavior of another
cell.
e. Secreted by macrophages.
4. Cytokines always act:
a. By binding to specific receptors.
b. In an autocrine fashion.
c. At long range.
d. Antagonistically with other cytokines.
e. Synergistically with other cytokines.
5. A Cytokine receptor which is a member of the hematopoietin
receptor family is:
a. IL-8 receptor.
b. ,)1ȖUHFHSWRU
c. TNF (TNF-Į UHFHSWRU
d. IL-1 receptor.
e. IL-2 receptor
6. The alpha beta heterodimeric form of the IL-2 receptor:
a. Is downregulated on activated cells.
b. Binds IL-2 with high affinity.
c. Is found only on T-cells.
d. Uses CD45 as an alpha chain.

ϲϬ

 e. Allows rapid dissociation of bound IL-2.
7. IFN-gamma and TNF (TNF alpha) can act synergistically
a. To downregulate expression of MHC class I
b. Because IFN-gamma downregulates expression of TNF
receptors
c. To upregulate expression of MHC class II
d. Because they both bind to the same receptor
e. Because they cross-link IFN-gamma and TNF beta
receptors
8. Which of the following is characteristically produced by the Th2
CD4 cells which provide help for antibody production, but not by
Th1 cells?
a. IFN-gamma
b. Lymphotoxin (TNF-ȕ 
c. GM-CSF
d. IL-4
e. IL-1
9. Dendritic cells can be driven from a resting state to an activated
state by the T-cell surface molecule:
a. TCR
b. CD40L
c. CD28
d. B7
e. CD40
10.In the germinal center, B-cells become memory cells under the
influence of:
a. CD40
b. CD23
c. IL-1 alpha
d. IL-4
e. TGF beta
11.The cytokine which is most involved in the class switch to IgE
production is:
a. IL-1
b. IL-2
c. GF beta
d. IL-4
e. IL-5
12.Antigens and lymphoid cells are delivered to the secondary
lymphoid tissues (spleen, lymph nodes) VIA:
a. ǹȕ7-cell
b. īį7-cell
c. B- cell

ϲϭ

 d. Macrophage
e. Dendritic cells
13.Cytokines produced by TH1 are ____ (microbial infection
response) and cytokines produced by TH2 are ____ (parasitic
infection response and allergy response).
a. IFN-ȖDQGWXPRUQHFURVLVIDFWRUȕ,/-4 and IL-5
b. IL-4 and IL-5; IFN-ȖDQGWXPRUQHFURVLVIDFWRU ȕ
c. IFN-ȖDQG,/-4; Tumor necrosis factor ȕDQG,/-5
d. 7XPRUQHFURVLVIDFWRUȕDQG,/-5; IFN-ȖDQG,/-4
e. IFN-ȖDQG,/-7XPRUQHFURVLVIDFWRUȕDQG,/-42.2) IFN-Ȗ
14.Cellular interactions between B and T cells involve costimulatory
activation. There is a physical interaction between ____ on the B
cell and ____ on the T cell. This leads to a B cell producing high
affinity antibody.
a. CD154; CD40
b. CD28; CD4
c. CD40; CD154
d. CD28; CD3
e. CD3; CD80
15.Activation of the gene for IL-2, and eventually TH proliferation, is
causes by a critical signal (along with TCR signal transduction)
from ____ on the B cell and ____ on the T cell.
a. CD154; CD40
b. CD28; CD80
c. CD40; CD154
d. CD80; CD28
e. CD3; CD4
16.What is the immunologic consequence of mutation in CD40L
(CD154)?
a. Leprosy and immunity to protozoal infections
b. Acquired immune deficiency syndrome (AIDS)
c. X-linked hyper-IgM syndrome
d. Systemic inflammatory response syndrome (SIRS, sepsis)
e. X-linked agammaglobulinemia
17.Which of the following is required for a CD8+ cell to differentiate
into an effector cytotoxic T cell (CTL)? Is this a physical
interaction?
a. Recognition of antigen; No
b. Costimulatory signals from CD4+ TH cells; No
c. Recognition of antigen; Yes
d. Costimulatory signals from CD4+ TH cells; Yes
e. A and B

ϲϮ

 18. Extracellular pathogen response involves ____ T cells and MHC
____ molecules. Intracellular pathogen response involves ____ T
cells and MHC ____ molecules.
a. CD4+; Class I; CD8+; Class II
b. CD4+; Class II; CD4+; Class I
c. CD8+; Class I; CD4+; Class II
d. CD8+; Class II; CD4+; Class
19.____ T cell activation of TH1 leads to ____ antibody production
and opsonization (or macrophage activation). Activation of TH2
leads to ____ antibody production and activation of mast cells and
eosinophil.
a. CD4+; IgE; IgG
b. CD4+; IgG; IgE
c. CD8+; IgE; IgG
d. CD8+; IgG; IgE
20.Which of the following is a chemoattractant that attracts neutrophils to the site
of infection?
a. IL-1
b. IL-6
c. IL-7
d. IL-12
e. TNF
21.Which of the following alerts the adaptive immune system to the presence
of infection?
a. IL-1
b. IL-6
c. IL-8
d. IL-12
e. TNF
22.Which of the following are secreted by macrophages after they have
recognized pathogens using pattern recognition molecules (induction phase)?
a. IL-1
b. IL-6
c. IL-7
d. IL-12
e. A,B,and E
23.Which of the following statements regarding the functional
properties of cytokines is false?
a. They typically have pleiotropic properties.
b. They often exhibit functional redundancy.
c. They often display antigen specificity.
d. They exhibit synergistic or antagonistic properties.

ϲϯ

 e. They assist in the regulation and development of immune
effector cells.
24.When IL-2 is secreted by antigen-specific T cells activated due to
presentation of antigen by APCs, what happens to naive antigen-
nonspecific T cells in the vicinity?
a. They proliferate due to their exposure to IL-
b. They often undergo apoptosis.
c. They begin to express IL-2 receptors.
d. They secrete cytokines associated with their T H phenotype.
e. Nothing happens.
25.Which of the following cytokines have receptors that exhibit
structural similarity that helps to account for their functional
redundancy?
a. IL-3, IL-15, and GM²CSF
b. IL-1, IL-2, and M²CSF
c. IL-2, IL-3, and IL-8
d. IL-3, TNF-ȕDQG5$17(6
e. IL-3, IL-4, and IFN-Ȗ
26.What type of immune response is not mediated by the TH subset?
a. Responses to viral infections
b. Delayed-type hypersensitivity
c. Activation of cytotoxic T cells
d. Activation of IgE synthesis
e. Responses to intracellular pathogens
27.IL-1, IL-6, and TNF-Į DUH pro-inflammatory cytokines that are
known to:
a. Cause increased vascular permeability.
b. Act in concert with chemokines to promote migration of
inflammatory cells to sites of infection.
c. Initiate acute-phase responses.
d. Have endogenous pyrogen properties.
e. All of the above.
28.Which of the following cytokines plays a role in terminating
inflammatory responses?
a. IL-2
b. IL-4
c. TGF-b
d. IFN-a
e. IL-3
29.All of the following are induced by the chemokine IL-8 EXCEPT
a. Activation of neutrophils.
b. Attraction of neutrophils to sites of tissue damage.
c. Wound healing.

ϲϰ

 d. Extravasation of neutrophils.
e. Reduction of cytokine production by T H cells.
30.Superantigens cause a burst of cytokine production by T cells due
to their ability to:
a. &URVVOLQN WKH 9ȕ VHJPHQWV RI 7 FHOO UHFHSWRUV ZLWK FODVV ,,
MHC molecules on APCs.
b. &URVVOLQN WKH 9Į VHJPHQWV RI 7 FHOO UHFHSWRUV ZLWK FODVV ,,
MHC molecules on APCs.
c. Crosslink T cell receptors and CD
d. Crosslink multiple cytokine receptors on a large population
of T cells.
e. Crosslink CD
31. High affinity B-cell clones in mammals are usually generated by:
a. Somatic hypermutation.
b. Expression of high affinity precursors in the virgin (naive)
B-cell population.
c. Class switching.
d. Apoptosis.
e. Gene conversion
32.Effector memory T-cells can be distinguished from the central
memory T-cells from which they arise by:
a. Their life-span.
b. CD45RA.
c. CCR7.
d. CD3.
e. IL-4 secretion.
33.Th1 cells secrete:
a. CD4.
b. IL-4.
c. IL-5.
d. IL-6.
e. Interferon-gamma.
34.Which one of the following cytokines can mediate release of acute
phase proteins from the liver?
a. IL-10.
b. 7*)ȕ
c. IL-6.
d. IL-12.
e. IL-8.
35.Memory T-cells:
a. Are continuously produced directly from naive progenitors
without the need for antigenic stimulation.
b. Express high levels of CD44.

ϲϱ

 c. Are only present in primary immune responses.
d. Switch from an alpha beta to a gamma delta T-cell receptor.
e. Express germ line Ig V genes.
36.Activated memory T-cells can be distinguished from naive T-cells
on the basis of expression of:
a. T-cell receptor.
b. Immunoglobulin.
c. MHC class II molecules.
d. CD45RO.
e. IL-1.
37. Cytokines may exhibit __________ action, signaling the cells that
produce them:
a. Antagonistic
b. Autocrine
c. Endocrine
d. Paracrine.
e. Synergistic
38. Several cytokines may have the same effect on the cells they bind.
This is an example of:
a. A cascade.
b. Antagonism.
c. Pleiotropism.
d. Redundancy.
e. Synergy.
39. Characterization of cytokine activities is NOT made more difficult
by their:
a. Gene structure.
b. Pleiotropism.
c. Redundancy.
d. Secretion close to target cell membranes.
e. Short half-lives
40. Interferons:
a. Activate B cells to make virus-specific antibodies.
b. Are Th2 cytokines.
c. Are virus proteins that interfere with activation of cytotoxic
T cells.
d. Block virus infection of host cells.
e. Inhibit virus replication in infected cells.
41. Members of a cytokine receptor family:
a. All bind the same cytokines.
b. Are grouped together because they share antigen specificity
c. Are often found on the same cells

ϲϲ

 d. Are similar in protein structure and sometimes in regions of
amino acid sequence.
e. Are specific for cytokines produced by a single cell type
42. A knock-out mouse for a particular cytokine allows
immunologists to characterize cytokine function:
a. By doing a dose-response study with competing cytokines.
b. In the absence of all other cytokines.
c. On all cell types simultaneously.
d. Under controlled conditions of local cytokine concentrations.
e. With defined cell populations.
43. Activated T-cells can regulate immune responses by signaling
activated lymphocytes to undergo:
a. Apoptosis.
b. Clonal deletion.
c. Clonal proliferation.
d. Cytotoxicity.
e. Somatic hypermutation.
44.Inflammatory cytokines produced by macrophages activate all of
the following EXCEPT:
a. B cells to secrete acute phase proteins.
b. Integrin on leukocytes to bind more strongly to vascular
cams.
c. Neutrophils to be more cytotoxic.
d. NK cells to kill virus-infected cells.
e. Vascular endothelium to increase expression of cams.
45. Interleukin-7 (IL-7) is a hematopoietic growth factor secreted by
the stromal cells (macrophages and adipocytes) of the red marrow
and thymus capable of stimulating the proliferation of lymphoid
____. It ____ affected by X-linked SCID.
a. Hematopoietic stem cells (HSCs); Is
b. Progenitor (precursor) cells; Is
c. Mature cells; Is
d. Hematopoietic stem cells (HSCs); Is not
e. Progenitor (precursor) cells; Is not f) Mature cells; Is not
46.IFN-ȖVWLPXODWHVBBBBLPPXQLW\E\HQKDQFLQJBBBB7FHOOVDVZHOO
as activating macrophages and natural killer cells. IL-4/IL-5
stimulates ____ immunity (antibodies) by activating B cells and
eosinophils and induce ____-type responses.
a. Cell-mediated; CD8+; Humoral; IgE
b. Cell-mediated; CD4+; Humoral; IgE
c. Cell-mediated; CD8+; Humoral; IgM
d. Cell-mediated; CD4+; Humoral; IgM
e. Humoral; CD8+; Cell-mediated; IgE

ϲϳ

 47.Which of the following is NOT true of interleukins"
a. They are cytokines which can be produced by various cells
of the immune system
b. They are hormones which allow one cell to communicate
with another cell
c. They are in need of receptors on the target cell in order to
mediate their effects
d. They are able bind antigen with a high level of specificity
e. They are able to modulate various aspects of the B-cell arm
of immune system.
48.Which two proinflammatory cytokines are rapidly elevated during
early phases of bacterial septic shock?
a. TNF-ĮDQG,/-ȕ
b. IL-2 and TNF-ȕ
c. IL-4 and IL-5
d. TNF-ȕ7*)-ȕ
49.Which cytokines are typically secreted by the TH2 subset?
a. IFN-Ȗ71)-ȕ,/-2
b. IL-4, IL-5, IL-10
c. IL-12, IL-6, IL-1
d. IL-8, RANTES, MIP-Į
50.Microorganisms associated with periodontal disease, such as
Porphyromonas gingivalis, are thought to control the cytokine
expression and affect TH1 and TH2 pathways by :
a. Suppressing Mast cell activity.
b. Stimulating PAMP receptors of innate immunity to express
cytokines that result in adaptive response that is not
protective
c. Avoiding PAMP receptors and, thereby, avoiding innate
immunity.
d. Stimulating adrenergic receptors.
e. None of the above
51. All of the following are important functions of type 1 IFN
EXCEPT that they:
a. Induce resistance to viral infection
b. Promote MHC class I expression
c. Activate NK cell cytotoxicity
d. Are important growth and proliferation factors for B cells
e. Are part of innate defense mechanisms
52. IL-12 is important for which of the following?
a. CD8 expression
b. TNF production
c. IFN-ȖSURGXFWLRQ

ϲϴ

 d. Eosinophil differentiation
e. CD28 expression
53.A normal 12 year old is found to be infected with helminth
parasites. He is doing well because of an endogenous Th2 type
cytokine response. Which of the following would you expect to
see?
a. IgA
b. CD4 T cell IFN-ȖSURGXFWLRQ
c. IL-5
d. IL-12
e. CTL
54. An individual is genetically deficient for the IFN- Ȗ UHFHSWRU
Which of the following would you expect to be blocked?
a. NK cell development
b. Cell surface expression of functional T cell receptor for
antigen on mature T cells .
c. Antimicrobial defense
d. Immunoglobulin gene rearrangement.
55. Chemokines are:
a. Low molecular weight cytokines important in inflammation
b. Cytokines important in proliferation
c. Activators of complement
d. Factors promoting chaos
e. Differentiation cytokines
56. All of the following are cytokines of the innate immune system
EXCEPT:
a. TNF
b. IL-12
c. NK cell produce IFN-Ȗ
d. Type 1 IFN
e. IL-2
57. The Th2 subset of CD4 + T helper cells is best characterized by the
release of which cytokine (s)?
a. IFN-Ȗ71)-ȕ
b. IL-12
c. IL-2
d. IL-7
e. IL-4, IL-5
58. Which one of the following is NOT released by activated helper T
cells?
a. Gamma interferon
b. IL-4
c. IL-2

ϲϵ

 d. Alpha interferon
59.Cytokines involved in acquired immunity :
a. IL-1, IL-6, IL-18, IFN-Į,)1-ȕDQG71)-Į
b. IL-2, IL-4, IL-5, IL-13, IFN-Ȗ71)-ȕDQG7*)-ȕ
c. Only IL-1, IL-6, IL-12, and TNF-Į
d. Only IFN-ȖDQG,/-10
60.Which of the following is true regarding the number of subfamilies
of chemokines:
a. 2
b. 4
c. 3
d. 0 subfamilies
61.The innate immunity cytokines are
a. IL-1, IL-6, IL-12 and TNF-ĮRQO\
b. IL-2, IL-4, IL-5, IL-13, IFN-Ȗ71)-ȕDQG7*)-ȕ
c. Only IFN-Ȗand IL-2
d. IL-1, IL-6, IL-12, IL-18, IFN-Į,)1-ȕDQG71)-Į
62.IL-8 is which type of chemokine:
a. CC-CC
b. CXC
c. CXCX
d. CXXC
63.Chemokines are produced mostly by which molecules:
a. NK cells
b. Macrophages
c. Endothelial cells, epithelial cells, and fibroblasts
d. Th1 and th2 cells
64.Interferon synthesis:
a. Protects the synthesizing cell from viral attack
b. Signals cells nearby to synthesize antiviral proteins
c. Blocks viral attachment to nearby cells
d. Degrades viral nucleic acids.

65.Ctokines may exhibit ------------------action, signaling-----------------

---.
a. Antagonistic, other cytokines.
b. Autocrine, different target cells to produce different effects.
c. Endocrine, receptors on the
d. Synergistic
66. Cytokines are not:
a. Antigen specific
b. Capable of activating more than one cell type

ϳϬ

 c. Made by lymphocytes
d. Small protein molecules
e. Synthesized de novo in response to antigen or other
cytokines
67. Characterization of cytokine activities is not made difficult by
their :
a. Gene structure
b. Pleiotropism
c. Redundancy
d. Secretion
e. Short half ±lives
68.TH 1 cells secrete cytokines that:
a. Activate cytotoxic T cells.
b. Increase susceptibility to allergic action.
c. Inhibit macrophage secretion of inflammatory cytokines
d. Stimulate b cells to secrete igg
e. Stimulate proliferation of T H2 cells
69. The ability of cytokine to change gene expression in the target cell
is influenced by all of the following EXCEPT:
a. Presence of high ±affinity receptors on the target cell.
b. Presence of soluble cytokine receptors.
c. Proximity of the producing and target cells.
d. Rate of transport of cytokine-receptor complexes into the
cytoplasm.
e. Simultaneous production of another cytokine whose receptor
uses the same signal transduction subunit.
70.Cytokines are NOT:
a. Able to inhibit the function of other cytokines.
b. Able to stimulate the synthesis of other cytokines
c. Produced by more than one cell type.
d. Small protein molecules
e. Stored in the cell for quick release.
71.The IL-2 R contains receptors for IL-2, IL-4,IL-7,IL-9,and IL-5.
This group of cytokine receptors:
a. Bind all five cytokines to promote synergistic action on
target cells.
b. Binds cytokines that are produced by the same cell.
c. Each has a unique high affinity cytokine- specific alpha
chain.
d. Shits the immune response towards cellular immunity.
e. Shares a signal- transducing gamma chain.
72. An antagonist for cytokine X may NOT BE:
a. Cytokine A, comparing for a shared receptor subunit.

ϳϭ

 b. Cytokine B, which act synergistically with Cytokine X.
c. Cytokine C, which inhibits the activation of the cell that
produces cytokine X.
d. Made by microorganisms.
e. Soluble cytotoxine X receptors.
73. A knock out mouse for a particular cytokine allows immunologist
to characterize cytokine function:
a. By doing a dose- response study with comparing cytokines.
b. In the absence of all other cytokines.
c. On all cell types simultaneously.
d. Under controlled conditions of local cytokine concentrations.
74.Regarding mediators of inflammation
a. TNF is a chemokine with chemoattractant properties
b. TNF contributes to cachexia of disease
c. TNF and IL-1 are produced mainly by activated leukocytes
d. The systemic acute phase response is induced by MIP-1 and
RANTES chemokines
e. PAF causes vasodilation when expressed at high levels
75. The TH cells influence cells produced?
a. Autocrine cytokines
b. Paracrine cytokines
c. Endocrine cytokines
d. Synergic cytokines
e. Antagonistic cytokines
76. If two or more cytokines have similar action the property is said to
be:
a. Pleiotropic
b. Additive
c. Synergistic
d. Antagonistic
e. Redundancy
77. Cytokines act as:
a. Immunomodulating agents
b. Immunosuppressing agents
c. Growth factors
d. Factors affecting differentiation of cells
e. All the above
78. Choose the common phenomenon that occurs in cytokine
production:
a. Stimulation by antigen binding
b. Cascade mechanism
c. Activation on binding with receptors
d. Signaling through calcium ions

ϳϮ

 e. Signaling through neuroendocrine process.
79. Which of the following is false with cytokines?
a. The soluble receptors protect cytokines from degradation
b. The specificity of cytokines is maintained by careful
regulation of expression of receptors.
c. Cytokines induce short ± lived gene transcription and short-
lived mrna.
d. The production of cytokines is influenced by individual
signals received but also by the balance of signals received
through one or more receptors.
e. The local concentration of cytokine affects the distant target
cell to react
80. Match and choose:
i. T helper 1 cells A.TNF
ii. T helper 2 cells B. INF
iii. Viral infection C.IL-2
iv. Macrophage D. IL-4
a. (i) D,(ii) C, (iii) B, (iv) A
b. (i) C, (ii) D, (iii) A, (iv) B
c. (i) B, (ii) D, (iii) A, (iv) B
d. (i) D, (II) A, (III) D, (iv) A
81. Three major cytokines secreted by macrophage are:
a. IL-1,IL-2, and IL-3
b. IL-1,IL-12 and TNF-Į
c. IL-2,IL-12 and TNF-Į
d. IL-1, TNF-ĮDQG,1)-Ȗ
82.All of the following are lymphokines EXCEPT:
a. Interferon
b. Histamine
c. Tumor necrosis factor
d. Transforming growth factor
83. The key cytokines produced by Th2 cells are:
a. IL-4 ,IL-DQG7*)ȕ
b. IL-12 and INF-Ȗ
c. IL-1 and TNF-Į
d. IL-10 and TNF-Į
84. Polarization of naïve CD4 + T- cell differentiation toward the T H2
lineage is associated with which of the following cytokines?
a. IL-1
b. IL-4
c. IL-6
d. IL-23
e. IL-25

ϳϯ

 85. A patient with active rheumatoid arthritis feels systemically IL-l
with low- grade fever, malaise, morning stiffness, and fatigue. The
protein(s) or cytokine(s) most likely to be responsible for these
symptoms are:
a. Rheumatoid factor
b. TNF and IL-1
c. IL-4 and IL-10
d. Complement component 1-9
e. Gamma globulin
86.When IL-2 is secreted by antigen- specific T cells activated due to
presentation of antigen by APCs, what happens to naïve antigen-
nonspecific T cells in the vicinity?
a. They proliferate due to their exposure to IL-2
b. They often undergo apoptosis
c. They secret cytokines associated with their Th phenotype
d. They begin to express IL-2 receptors.
e. Nothing happens
87.IL-1, IL-6 and TNF-Į  DUH SUR inflammatory cytokines that are
known to:
a. Cause increase vascular permeability
b. Act in concert with chemokines to promote migration of
inflammatory cells to sites of infection
c. Initiate acute phase responses.
d. Have endogenous pyrogen properties
e. All of the above
88.Which of the following cytokines plays a role in terminating
inflammatory response?
a. IL-2
b. IL-4
c. TGF-ȕ
d. IFN-Į
e. IL-3
89.Assuming there were no other compensatory mechanism to replace
IL-8 function, which of the following would be preserved as a
functional activity in an IL-8 Knockout mouse strain?
a. Activation of neutrophil
b. Attraction of neutrophils to sites of tissue damage
c. Wound healing
d. Extravasation of neutrophils
e. Reduction of cytokine production by Th1 cells
90. Which of the following DOES NOT describe cytokines?
a. They are produced by antigen ± stimulated T cells
b. They are only produced by antigen ± stimulated B cells

ϳϰ

 c. They are pleiotropic
d. They are glucoproteins of low molecular weight
e. They interact with specific receptors on surface of target
cells
91.Gamma ±interferon Ȗ-IFN)
a. Enhances MHC II expression on accessory cells
b. Enhances MHC I expression on macrophages
c. Is a colony stimulatory factor
d. Is a Th2 cytokine
e. Promotes differentiation of eosinophils
92.Which of the following statements concerning interferon -ȖLVWUXH"
a. It is produced by T memory cells.
b. It is produced by T suppressor cells.
c. It activates macrophages.
d. It inhibits macrophages.
e. It induces viral proliferation.
93.Which of the following statements regarding cytokines is
INCORRECT?
a. Cytokines act directly on target cells and may potentiate the
actions of one another.
b. Interleukin 1 (IL-1) is a major pro-inflammatory mediator
with multiple effects, including regulation of skeletal muscle
proteolysis in patients with sepsis or significant injury.
c. Platelet-activating factor (PAF) is a major cytokine that
results in platelet aggregation, bronchoconstriction, and
increased vascular permeability.
d. Tumor necrosis factor alpha (TNF-a), despite its short
plasma half-life, appears to be a principal mediator in the
evolution of sepsis and the multiple organ dysfunction
syndrome because of its multiple actions and the secondary
cascades that it stimulates.
94.Cytokines with clearly defined actions in acute inflammation and
early tissue injury include all of the following EXCEPT:
a. Interleukin -10 (IL-10)
b. Tumor Necrosis Factor (TNF-Į
c. Transforming Growth Factor-b (TGF-b)
d. Interleukin-6 (IL-6)
e. Platelet Derived Growth Factor (PDGF)
95.All the following statements regarding transforming growth factor
ȕ 7*)-ȕ DUHWUXH(;&(37
a. TGF-b expression is autoregulated
b. TGF-b enhances collagen synthesis
c. TGF-b inhibits extracellular matrix production

ϳϱ

 d. TGF-b may inhibit or promote cellular proliferation
96.Which of the following belong to the family of CXC chemokines?
a. IL-4
b. IL-10
c. Growth Related Oncogene-Į
d. Leukotreine B4
97.Cytokines are low-molecular-weight polypeptides exerting a wide
variety of biologic effects at both local and systemic levels. Which
of the following statement(s) is/are true concerning the production
and actions of cytokines?
a. Cytokines are produced solely by macrophages
b. Cytokines act only on other cells within the same local
environment
c. Cytokines may have both protective and deleterious effects
on the host
d. Each specific cytokine is produced by a single cell type
98.The hematopoietic cytokine, erythropoietin is produced by ______.
a. liver.
b. kidney.
c. pancreas
d. spleen.
99.Which of the following components of the innate immune system
involves cytokines produced by macrophages, which are produced
during infection?
a. Natural killer (NK) cells
b. Complement system
c. Oxygen dependent and independent killing
d. Interferons
e. Acute phase proteins
100. Enhance diapedesis and stimulate TH2 responses:
a. Trypase & Chemotrypsin
b. Histamine
c. Cytokines/IL-4
d. Cytokines/TNF
e. MMP-1

ϳϲ

 &KDSWHU)RXU
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1. c 26.d 51.d 76.e
2. d 27.e 52.c 77.e
3. b 28.c 53.c 78.b
4. a 29.e 54.b 79.e
5. e 30.a 55.a 80.a
6. b 31.a 56.e 81.b
7. c 32.c 57.e 82.b
8. d 33.e 58.d 83.a
9. b 34.c 59.b 84.b
10.a 35.b 60.b 85.b
11.d 36.d 61.b 86.e
12.e 37.b 62.b 87.e
13.a 38.d 63.b 88.c
14.c 39.d 64.b 89.e
15.d 40.e 65.c 90.b
16.c 41.e 66.a 91.a
17.e 42.b 67.a 92.c
18.c 43.a 68.a 93.c
19.b 44.c 69.d 94.a
20.b 45.b 70.e 95.c
21.d 46.b 71.e 96.c
22.e 47.d 72.b 97.c
23.c 48.a 73.c 98.b
24.e 49.b 74.b 99.e
25.a 50.b 75.b 100. d

ϳϳ

 &KDSWHU)LYH
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0&4
1. The skin biopsy of a patient having a delayed hypersensitivity
reaction is characterized by:
a. The deposition of Ig and complement in the arterial wall.
b. Neutrophil infiltrates around arteries.
c. Necrosis of the epidermis.
d. Mononuclear cell infiltrates surrounding small vessels.
e. Edema.
2. Which Hypersensitivity type may involve complement activation,
pore formation, and destruction of cells?
a. Type I
b. Type II
c. Type III
d. Type IV
e. Type II and III
3. Which antibody type is involved in type II hypersensitivity?
a. IgE
b. IgG
c. IgM
d. B and C
e. A and C
4. Which types of hypersensitivity reaction do not involve cells and
antibodies?
a. Type I & II
b. Type II & III
c. Type III & IV
d. None of the above
e. All of the above
5. Which of the following is a characteristic of type II
hypersensitivity reaction?
a. Complement activation
b. Cell lysis
c. Allergen on a cell or matrix
d. All of these.
e. None of these.
6. Which type of hypersensitivity reaction mismatched?
a. Type I ± Anaphylactic
b. Type II ± Cytotoxic

ϳϴ

 c. Type III - Immune Complex
d. Type IV - Delayed Hypersensitivity
e. All are correct.
7. Jane just joined the soccer team, but recently started having hay
fever and rashes after every practice. She thinks she might be
having an allergic reaction to the grass. What type of
hypersensitivity reaction is she having?
a. Anaphylactic
b. Cytotoxic
c. Immune complex
d. Delayed hypersensitivity
e. None of these.
8. A patient comes in with a rash on both arms that began earlier
today. Until yesterday, he says, he had been on vacation. He was
hiking in the woods days ago, and prior to that he had visited his
grandmother and her 12 cats. The rash is most likely due to which
kind of hypersensitivity reaction?
a. Type I
b. Type II
c. Type III
d. Type IV
9. What is an example for a systemic effect of a Type I
hypersensitivity?
a. Increased vasopermeability
b. Constriction of airways
c. Hay fever
d. Shock
10.What is an example for a type III hypersensitivity reaction?
a. Reaction to insect venom
b. Tuberculin test
c. Transfusion reaction
d. Serum sickness
e. All of these.
11.What type of hypersensitivity reaction is the fastest?
a. Type IV
b. Type III
c. Type II
d. Type I
e. All have the same response time.
12.Which of the following does not result from release of histamine
containing granules?
a. Increased vasopermeability
b. Increased mucus production

ϳϵ

 c. Joint pain and swelling
d. Constriction of airways
e. All of these are correct.
13.Examples of immediate hypersensitivity are
a. Conjunctivitus
b. Allergic rhinitis
c. Allergic asthma
d. Atopic dermatitis
e. All of the preceding
14.Which one of the following mast cell products is not preformed
and therefore has to be newly synthesized?
a. Histamine.
b. Prostaglandin D2.
c. Heparin.
d. Neutral protease.
e. Eosinophil chemotactic factor (ECF).
15.Lol p1-11V are allergens cloned from:
a. Rye grass pollen.
b. House dust mite.
c. House dust mite feces.
d. Animal danders.
e. Dermatophagoides pteryonyssinus
16.Type I hypersensitivity can be blocked using:
a. Histamine.
b. An iga myeloma.
c. A myeloma protein of mixed antibody class.
d. Sodium cromoglycate.
e. Interleukin-5.
17.Maple bark stripper's disease is a hypersensitivity largely affecting
the:
a. Skin.
b. Kidneys.
c. Nervous system.
d. Lung.
e. Platelets.
18.Which type of hypersensitivity cannot be transferred with serum
antibody?
a. Type I.
b. Type II.
c. Type III.
d. Type IV.
e. Type V.
19.Anaphylaxis can be triggered by cross-linking of IgE receptors on:

ϴϬ

 a. Monocytes.
b. Mast cells.
c. B-cells.
d. Eosinophils.
e. Neutrophils.
20.Rhesus hemolytic disease of the newborn involves:
a. IgE.
b. Antibody to cell surfaces.
c. Soluble immune complexes.
d. Cytokine release from T-cells.
e. Stimulatory antibodies.
21.Type IV hypersentivity is often referred to as:
a. Immediate.
b. Delayed.
c. Anaphylactic.
d. Anergic.
e. Allotypic.
22.The injection of tuberculin into the skin of a sensitized individual
elicits:
a. Immune complex glomerulonephritis.
b. Jarisch-Herxheimer reaction.
c. Isohemagglutinins.
d. Jones-Mote sensitivity.
e. Mantoux reaction.
23.The major effector molecules involved in type IV hypersensitivity
reactions are:
a. Antibodies.
b. Complement components.
c. Cytokines.
d. Prostaglandins.
e. 5-hydroxytryptamine (5-HT).
24.Septic shock associated with Gram-negative bacteria is primarily
DUE TO:
a. Lipopolysaccharide.
b. Enterotoxin superantigen.
c. Platelet aggregation.
d. Switch off of cytokine release.
e. Peptidoglycans.
25.Which one of the following statements is NOT true for peanut
allergy?
a. Peanut allergy is an example of immediate hypersensitivity
b. Atopy is a risk factor in peanut allergy
c. Anaphylaxis can occur on first exposure

ϴϭ

 d. Igg is believed to be centrally involved in anaphylaxis to
peanut antigens
e. Self-administered adrenaline can be life saving
26.Which one of the following statements about wasp venom
desensitization is true?
a. Wasp venom desensitization is only indicated if there is a
history of two or more severe reactions to wasp stings
b. Wasp venom desensitization is associated with adverse
reactions in less than 30% of treated patients
c. Is effective after a 5-week course of injections
d. Is only successful in those in whom total serum ige levels
are reduced
e. Is probably effective by increasing levels of antigen specific
Tregs
27.Systemic anaphylaxis is NOT caused by which one of the
following:
a. Wasp venom
b. ACE inhibitors
c. Penicillin
d. Nut ingestion
e. Latex
28.Which one of the following statements about food allergy is true?
a. In children, it is often due to cow's milk
b. Food allergy can be diagnosed confidently by skin-prick
testing
c. Migraine is a common presenting feature
d. Food allergy is a common cause of irritable bowel
syndrome
e. 0RVWFKLOGUHQZLOOµJURZRXW¶RIQXWDOOHUJ\E\WKHDJHRI
years
29.Which one of the following is a FALSE statement about atopic
eczema?
a. It commonly begins in infancy
b. Super-added herpes simplex infection is a serious
complication
c. The serum ige level is normally raised
d. The skin lesions are typically itchy
e. Treatment with systemic steroids is often necessary
30.Which ONE of the following statements about penicillin allergy is
true"
a. Anaphylaxis to penicillin occurs in 1-2% of those taking the
drug

ϴϮ

 b. Reactions occur only in those with a previous history of
penicillin allergy
c. A milder reaction is more likely with parental penicillin than
with oral penicillin
d. A negative skin-prick test indicates a low risk of a reaction.
31.Which one of the following is a true statement about chronic
urticaria"
a. By definition, it must be present for at least 3 weeks
b. It is commonly due to urticarial vasculitis
c. It can be triggered by ige antibodies to aspirin
d. ,WFDQEHDVVRFLDWHGZLWKDXWRDQWLERGLHVWR)FȖ5,
e. Systemic steroids are usually required to suppress attacks
32.Hyposensitization (specific allergen immunotherapy) is of proven
benefit in which one of the following conditions
a. Peanut allergy
b. House dust mite allergy
c. Wasp venom hypersensitivity
d. Coeliac disease
e. Latex anaphylaxis
33.Which one of the following statements is FALSE ? Allergic asthma
is characterized by
a. Response to ciclosporin therapy in severe disease
b. Is characterized by reversible airways obstruction
c. Th2 cells are found in bronchoalveolar lavage fluid
d. Affects around 10% of the population
e. The relevant allergen provoking allergic asthma in a given
patient is diagnosed routinely by use of RAST.
34.Which of the following is/are initiated by the interaction of host
cell membraneswith IgM and IgG antibody but never IgE
antibody?
a. Arthus reaction
b. Serum sickness
c. Type I hypersensitivity reaction
d. Type II hypersensitivity reaction
e. Type IV hypersensitivity reaction
35.Which category of hypersensitivity BEST describes hemolytic
disease of the newborn caused by Rh incompatibility"
a. Atopic or anaphylactic
b. Cytotoxic
c. Immune complex
d. Delayed
36.The principal difference between cytotoxic (type II) and immune
complex (type III) hypersensitivity is:

ϴϯ

 a. The class (isotype) of antibody
b. The site where antigen-antibody complexes are formed
c. The participation of complement
d. The participation of T cells
37.A child stung by a bee experiences respiratory distress within
minutes and lapses into unconsciousness. This reaction is probably
mediated by:
a. IgE antibody
b. IgG antibody
c. Sensitized T cells
d. Complement
e. IgM antibody
38.A patient with rheumatic fever develops a sore throat from which
beta-hemolytic streptococci are cultured. The patient is started on
treatment with penicillin, and the sore throat resolves within
several days. However, 7 days after initiation of penicillin therapy
the patient develops a fever of 103°F, a generalized rash, and
proteinuria. This MOST probably resulted from:
a. Recurrence of the rheumatic fever
b. A different infectious disease
c. An ige response to penicillin
d. An IgG-IgM response to penicillin
e. A delayed hypersensitivity reaction to penicillin.
39.Hypersensitivity to penicillin and hypersensitivity to poison oak
are both:
a. Mediated by IgE antibody
b. Mediated by IgG and igm antibody
c. Initiated by haptens
d. Initiated by Th-2 cells.
40.A positive tuberculin skin test (a delayed hypersensitivity reaction)
indicates that:
a. A humoral immune response has occurred
b. A cell-mediated immune response has occurred
c. Both the T and B cell systems are functional
d. Only the B cell system is functional
41.Reaction to poison ivy or poison oak is
a. An IgG-mediated response
b. An IgE-mediated response
c. A cell-mediated response
d. An Arthus reaction
42.A child disturbs a wasp nest, is stung repeatedly, and goes into
shock within minutes, manifesting respiratory failure and vascular
collapse. This is MOST likely to be due to

ϴϰ

 a. Systemic anaphylaxis
b. Serum sickness
c. An Arthus reaction
d. Cytotoxic hypersensitivity
43.A patient with a central nervous system disorder is maintained on
the drug methyldopa. Hemolytic anemia develops, which resolves
shortly after the drug is withdrawn. This is MOST probably an
example of:
a. Atopic hypersensitivity
b. Cytotoxic hypersensitivity
c. Immune-complex hypersensitivity
d. Cell-mediated hypersensitivity.
44.A delayed hypersensitivity reaction is characterized by:
a. Edema without a cellular infiltrate
b. An infiltrate composed of neutrophils
c. An infiltrate composed of helper T cells and macrophages
d. An infiltrate composed of eosinophils.
45.Which of the following is the most effective treatment for nasal
allergy:
a. Over-the-counter antihistamines
b. Prescription antihistamines
c. Antihistamine decongestant combination pills
d. Nasal corticosteroids sprays
e. Oral leukotriene receptor antagonists
46.Which of the following is least likely to trigger asthma?
a. Strenuous exercise
b. A common cold
c. Reading the newspaper
d. Cat dander
e. Tobacco smoke
47.Which of the following factors can pre-dispose you to having
allergies?
a. A family history of allergies
b. Environmental condition
c. Number and type of exposure
d. Emotional factors
e. All the above
48.Which of the following is the most commonly prescribed treatment
for hives?
a. Oral antihistamines
b. Oral corticosteroids like prednisone
c. Epinephrine (adrenaline)
d. Aspirin

ϴϱ

 e. Immunotherapy
49.The major advantage of second generation antihistamines is:
a. They do cross the blood brain barrier and help patients to
relax
b. They are very long acting
c. They cause decongestion as well as decreasing rhinorrhea
d. They minimally cross the blood brain barrier and have a
decreased sedation effect
e. They decrease appetite.
50.What type of allergens are the most allergenic"
a. Carbohydrates
b. Proteins
c. Nucleic acids
d. Fats
e. Haptens
51.What sets the stage for the reactions that occur upon repeated
exposure to the same allergen in a type I hypersensitivity reaction"
a. The release of the allergenic particles into the tissue fluids
and lymphatics
b. Recognition of the allergen by B and T cells
c. Proliferation and differentiation of B cells into plasma cells
d. Secretion of IgE by plasma cells
e. Binding of IgE to mast cells and basophils
52.Mast cells have important roles in the development of allergies.
This is due to all but which of the following reasons:
a. Their tendency to degranulate
b. Their cytoplasmic granules that contain physiologically
active chemicals
c. Their ubiquitous location in tissues
d. Their ability to produce IgE
e. Their capacity to bind ige during sensitization
53.What is the most abundant and fastest acting cytokine released by
mast cells"
a. Serotonin
b. Histamine
c. Bradykinin
d. Leukotriene
e. Platelet-activating factor
54.What differs between atopy and anaphylaxis"
a. The allergen that triggers the response
b. The site of the reaction
c. The concentrations of the chemical mediators released
d. The organ systems targeted by the chemical mediators

ϴϲ

 e. The types of chemical mediators released
55.What is injected into patients undergoing allergic desensitization?
a. IgG antibodies
b. IgEe antibodies
c. Monoclonal antibodies against IgE
d. Corticosteroids
e. Pure allergen to which the patient is allergic
56.In what manner does a type III hypersensitivity reaction differ from
a type II hypersensitivity reaction"
a. The antigens involved in a type III reaction are not bound to
a cell's surface, while those involved in a type II reaction are
bound to the surface
b. Type III is an immediate hypersensitivity, while type II is a
delayed hypersensitivity reaction
c. Type III hypersensitivities involve IgE, while type II
hypersensitivities involve IgG and IgM
d. Type III hypersensitivities are T-cell mediated, while type II
hypersensitivities are B-cell mediated
e. Type III hypersensitivities involve complement, while type
II hypersensitivities do not
57.All but which of the following statements characterizes an Arthus
reaction"
a. It is a systemic reaction
b. It depends on the formation of IgG, IgM, or IgA antibodies
c. The onset of symptoms is delayed
d. Large doses of antigen are required for its initiation
e. It is a localized reaction
58.A positive tuberculin skin test is an example of what type of
hypersensitivity reaction"
a. Type I
b. Type II
c. Type III
d. Type IV
e. Types II and III
59.Which of these reactions is NOT a Type 1 hypersensitivity?
a. Anaphylaxis
b. Asthma
c. Contact dermatitis
d. Atopy
60.Which of these reactions involves cell-mediated hypersensitivity?
a. Arthus reaction
b. Mantoux test
c. Good pastures syndrome

ϴϳ

 d. Asthma
61.Which of these is NOT a type of antibody-dependent
hypersensitivity?
a. Goodpastures syndrome
b. *UDYHV¶GLVHDVH
c. +DVKLPRWR¶VWK\URLGLWLV
d. Erythroblastosis fetalis
62.Which of these is NOT a mechanism of Type II hypersensitivity?
a. Oponisation-Phagocytosis
b. Antibody mediated receptor blockade
c. Complement mediated inflammation
d. Mast cell degranulation
63.Myasthenia gravis is what type of hypersensitivity?
a. Type 1
b. Type II
c. Type III
d. Type IV
64.Which of the following does not involve cell-mediated immunity?
a. Contact sensitivity to lipstick
b. Rejection of a liver graft
c. Serum sickness
d. Tuberculin reaction
e. Immunity to chicken pox
65.A positive delayed-type hypersensitivity skin reaction involves the
interaction of
a. Antigen, complement, and cytokines.
b. Antigen, antigen-sensitive lymphocytes, and macrophages.
c. Antigen ²antibody complexes, complement, and
neutrophils.
d. IgE antibody, antigen, and mast cells.
e. Antigen, macrophages, and complement.
66.Delayed skin reactions to an intradermal injection of antigen may
be markedly decreased by
a. Exposure to a high dose of X-irradiation.
b. Treatment with antihistamines.
c. Treatment with an antineutrophil serum.
d. Removal of the spleen.
e. Decreasing levels of complement.
67.Which of the following statements is characteristic of contact
sensitivity?
a. The best therapy is oral administration of the antigen.
b. Patch testing with the allergen is useless for diagnosis.

ϴϴ

 c. Sensitization can be passively transferred with serum from
an allergic individual.
d. Some chemicals acting as haptens induce sensitivity by
covalently binding to host proteins acting as carriers.
e. Antihistamines constitute the treatment of choice.
68.Positive skin tests for delayed-type hypersensitivity to intra-
dermally injected antigens indicate that:
a. A humoral immune response has occurred.
b. A cell-mediated immune response has occurred.
c. Both T cell and B cell systems are functional.
d. The individual has previously made IgE responses to the
antigen.
e. Immune complexes have been formed at the injection site.
69.An IgA antibody to a red blood cell antigen is unlikely to cause
autoimmune hemolytic anemia because
a. It would be made only in the gastrointestinal tract.
b. Its Fc region would not bind receptors for Fc on phagocytic
cells.
c. It can fix complement only as far as C1, C4, C
d. It has a too-low affinity.
e. It requires secretory component to work.
70.The glomerular lesions in immune complex disease can be
visualized microscopically with a fluorescent antibody against
a. IgG heavy chains.
b. ȀOLJKWFKDLQV
c. C1
d. C3
e. All of the above.
71.The lesions in immune complex-induced glomerulonephritis
a. Are dependent on erythrocytes and complement.
b. Result in increased production of urine.
c. Require both complement and neutrophils.
d. Are dependent on the presence of macrophages.
e. Require all nine components of complement.
72.Serum sickness occurs only
a. When anti-basement membrane antibodies are present.
b. In cases of extreme excess of antibody.
c. When ige antibody is produced.
d. When soluble immune complexes are formed.
e. In the absence of neutrophils.
73.Immune complexes are involved in the pathogenesis of
a. Poststreptococcal glomerulonephritis.
b. Pigeon breeder's disease.

ϴϵ

 c. Serum sickness.
d. An edematous hemorrhagic reaction in the skin of a
beekeeper, 2 hours after he was stung for the 20 th time.
e. All of the above.
74.The Arthus reaction and farmer's lung differ because
a. Only the former is due to antigen ²antibody complexes.
b. The mode of contact with the antigen is different.
c. Only the former requires complement.
d. Only the latter can occur in farmers.
e. The reactions in farmer's lung are much more rapid.
75.The final damage to vessels in immune complex-mediated arthritis
is due to
a. Cytokines produced by T cells.
b. Histamine and SRS-A.
c. The C5, C6, C7, C8, C9 membrane attack complex.
d. Lysosomal enzymes of polymorphonuclear leukocytes.
e. Cytotoxic T cells.
76.Serum sickness is characterized by
a. Eposition of immune complexes in blood vessel walls when
there is a moderate excess of antigen.
b. Phagocytosis of complexes by granulocytes.
c. Consumption of complement.
d. Appearance of symptoms before free antibody can be
detected in the circulation.
e. All of the above.
77.A patient is suspected of having farmer's lung. A provocation test
involving the inhalation of an extract of moldy hay is performed. A
sharp drop in respiratory function is noted within 10 minutes and
returns to normal in 2 hours, only to fall again in another 2 hours.
The most likely explanation is that:
a. The patient has existing T cell-mediated hypersensitivity.
b. This is a normal pattern for farmer's lung.
c. The patient developed a secondary response after the
inhalation of antigen.
d. The symptoms of farmer's lung are complicated by an IgE-
mediated reactivity to the same antigen.
e. All of the above.
78.The usual sequence of events in an allergic reaction is as follows:
a. The allergen combines with circulating IgE, and then the
IgE-allergen complex binds to mast cells.
b. The allergen binds to IgE fixed to mast cells.
c. The allergen is processed by antigen-presenting cells and
then binds to histamine receptors.

ϵϬ

 d. The allergen is processed by antigen-presenting cells and
then binds to mast cells.
e. The allergen combines with IgG.
79.Epinephrine :
a. Causes bronchodilation.
b. Is effective even after anaphylactic symptoms commence.
c. Relaxes smooth muscle.
d. Decreases vascular permeability.
e. All of the above.
80.A human volunteer agrees to be passively sensitized with IgE
specific for a ragweed antigen (allergen). When challenged with
the allergen intradermally, he displayed a typical skin reaction due
to an immediate hypersensitivity reaction. If the injection with
sensitizing IgE was preceded by an injection (at the same site) of
Fc fragments of human IgE followed by intradermal injection with
allergen, which of the following outcomes would you predict?
a. No reaction would occur because the Fc fragments would
interact with the allergen and prevent it from gaining access
to the sensitized mast cells.
b. No reaction would occur because the Fc fragments would
interact with the IgE antibodies making their antigen-binding
sites unavailable for binding to antigen.
c. No reaction would occur because the Fc fragments would
interact with Fc receptors on mast cells.
d. The reaction would be exacerbated due to the increased
local concentration of IgE Fc fragments.
e. The reaction would be exacerbated due to the activation of
complement.
81.The following mechanism(s) may be involved in the clinical
efficacy of desensitization therapy to treat patients with allergies to
known allergens:
a. Enhanced production of IgG, which binds allergen before it
reaches mast cells
b. Skewing of T cell responses from TH2 to TH1
c. Decreased sensitivity of mast cells and basophils to
degranulation by allergen
d. Decreased production of IgE antibody
e. All of the above.
82.Immediate hypersensitivity skin reactions
a. Usually occur within 24 hours.
b. Exhibit a raised wheal due to infiltration by mononuclear
cells.
c. Exhibit a red flare due to vasodilation.

ϵϭ

 d. Cannot be elicited by monovalent haptens.
e. All are correct.
83.Mast cells:
a. Are found circulating in the blood.
b. Release their granules following lysis.
c. Are basophilic after complete degranulation.
d. Are very similar to basophils.
e. All are correct.
84.Antihistamines:
a. Bind to receptors for histamine, thereby preventing the
histamine from exerting a pharmacologic effect.
b. Are more effective given before, rather than after, the onset
of allergic symptoms.
c. Do not influence the activity of leukotrienes.
d. Do not affect binding of IgE to mast cells.
e. All are correct.
85.In the RAST assay for ragweed pollen
a. The patient's serum is first mixed with a radiolabeled anti-
IgE.
b. Only IgE anti-ragweed antibodies are detected.
c. The patient's serum competitively inhibits binding of the
anti-IgE.
d. Monovalent IgE is used.
e. Complement is utilized.
86.Which of the following statements is FALSE?
a. IL-4 and IL-13 produced by T cf15hcf12 cells play a key
role in regulating IgE responses.
b. Interferon-g produced by T cf15h cf11 cells can
downregulate IgE responses.
c. In normal individuals, a balance between Tcf15Hcf11-
derived and T cf15hcf12-derived cytokines helps to maintain
normal levels of IgE.
d. IL-4 levels are higher in atopic patients.
e. In IL-4 knockout mice, ige production is normal following
their exposure to parasites due to the regulatory activity of
IL-1
87.Anaphylactic reactions:
a. Evolve in minutes and abate within 30 minutes.
b. May be followed by inflammatory sequelae hours later.
c. Are the consequences of released pharmacologic agents.
d. May involve components of mast-cell granule matrix.
e. All of the above.

ϵϮ

 88.Michelle is allergic to ragweed pollen. To reduce her allergic
response, she has been treated with minute concentrations of
ragweed pollen allergen followed by repeated and gradually
increasing doses (desensitization or hyposensitization therapy). If
this treatment is successful, which of the following is most likely to
have occurred?
a. Clearance of antigen-specific IgE immune complexes
b. Greater production of circulating high affinity igg antibody
c. Depletion of the mast cell pool by repeated degranulation
d. Specific tolerance induction
89.Peanut allergy is due to:
a. IgG mediated reaction
b. IgM mediated reaction
c. IgD mediated reaction
d. IgE mediated reaction
e. IgA mediated reaction
90.A person suffering from fever went to physician and administered
with a dose of pencillin. After a week he developed , skin reashes
with mild fever and blood test report shows increased and
production of acute phase protein. It is due to:
a. Recurrence of the infection
b. New infection
c. Late phase allergic response
d. Antibody mediated response
e. Delayed hypersensitivity reactions.
91.The type IV hypersensitivity reactions differ from other types of
hypersensitive reactions because it is:
a. IgE mediated
b. IgG mediated
c. Cell mediated
d. Immune complex mediated
e. Complement mediated
92.Match the type of hypersensitive reactions with their example
i. Type I hypersensitive reaction A. Farmer`s lung
ii. Type II hypersensitive reaction B. granulomatous
disease
iii. Type III hypersensitive reaction C. Allergic asthma
iv. Type IV hypersensitive reaction D. Drug induced
haemolytic anemia
a. (i) B, (ii) C, (iii) D, (iv) A
b. (i) D, (ii) C, (iii) B, (iv) A
c. (i) C, (ii) A, (iii) D, (iv) B
d. (i) C, (ii) D, (iii) A, (iv) B

ϵϯ

 93.Match the allergen with the organ it affects
i. Poison ivy A. Systemic effect
ii. Pollen B. Intestine
iii. Peanut C. Skin
iv. Penicillin D. Respiratory system
a. (i) B, (ii) C, (iii) D, (iv) A
b. (i) C, (ii) D, (iii) B, (iv) A
c. (i) C, (ii) A, (iii) D, (iv) B
d. (i) C, (ii) D, (iii) A, (iv) B
94.Match the type of hypersensitive reactions with their causative
agents
i. Type I hypersensitive reaction A. Blood
transfusion
ii. Type II hypersensitive reaction B. Nickle
jewellery
iii. Type III hypersensitive reaction C. Sea food
iv. Type IV hypersensitive reaction D. dried pigeon
faeces
a. (i) B, (ii) C, (iii) D, (iv) A
b. (i) D, (ii) C, (iii) B, (iv) A
c. (i) C, (ii) A, (iii) D, (iv) B
d. (i) C, (ii) D, (iii) A, (iv) B
95.Graves` disease is an example of type II hypersensitivity whose
pathophysiology is best explained by :
a. Disease- causing antagonistic autoantibodies to cell surface
receptors.
b. Disease- causing agonistic autoantibodies to cell surface
receptors.
c. Disease- causing autoantibodies to nuclear antigens.
d. Disease- causing autoantibodies to acetylcholine receptors.
96.Which of the following is most likely to involve a reaction to a
hapten as its etiologic cause?
a. Goodpasteur`s syndrome following a viral respiratory
infection.
b. Hemolytic anemia following treatment with penicillin.
c. Rheumatoid arithritis following a parasitic infection.
d. Farmer`s lung following exposure to moldy hay.
97.In an experimental mouse model for the study of autoimmune
hemolytic anemia, intravenous administration of a monoclonal IgA
antibody specific for a red blood cell antigen did not cause anemia
to occur. The best explanation for this observation is that:
a. The IgA would localized in the gastrointestinal tract.

ϵϰ

 b. The Fc region of the IgA antibody does not bind receptors
for Fc receptors on phagocytic cells.
c. The IgA cannot activate complement beyond the splitting of
C2
d. The IgA used has a low affinity for the red blood cell
antigen.
e. The IgA used requires secretory component to work.
98.The final damage to vessels in immune complex- mediated
arithritis is due to :
a. Cytokines produced by T cells
b. Histamine and SRS-A
c. The C5,C6,C7,C8,C9 membrane attack complex
d. Lysosomal enzyme of polymorphonuclear leukocytes.
e. Cytotoxic T cells.
99.Type II hypersensitivity:
a. Is antibody- independent.
b. Is complement ± independent.
c. Is mediated by CD+T cells.
d. Requires immune complex formation.
e. Involves antibody-mediated destruction of cells.
100. A patient is suspected of having farmer`s lung. A
provocation test involving the inhalation of an extract of moldy hay
is performed. A sharp drop in respiratory function is noted within
10 minutes and returns to normal in 2 hours, only to fall again in
another 2 hours. The likely explanation is that:
a. The patient has exisiting T cell ± mediated hypersensitivity
b. This is a normal pattern for farmer`s.
c. The patient developed a secondary response after inhalation
of antigen.
d. The symptoms of farmer`s lung are complicated by an IgE-
mediated reactivity to the same antigen.
e. All of the above.

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1. Which of the following vaccines uses attenuated viruses"
a. Tetanus vaccine
b. MMR vaccine
c. Influenza vaccine
d. Diphtheria vaccine
e. Hepatitis B vaccine
2. All of the following are true of toxoid vaccines EXCEPT
a. They may cause infection
b. Require booster shots for maximum efficacy
c. Are derived from toxins
d. Are used, for example, to prevent diphtheria
e. Are used, for example, to prevent symptoms of tetanus
3. Subunit vaccines tend to be safer than whole cell vaccines because
a. They produce a stronger immune response
b. They are antigenic
c. They cannot reproduce in the host
d. They contain intact but dead microbes
4. Which of the following is true about conjugated vaccines
a. They are useful because young children respond poorly to
polysaccharides
b. They contain only protein subunits
c. The antigens are made using recombinant DNA technology
d. They contain only T-dependent antigens
5. DNA vaccines
a. Are important in triggering cellular rather than humoral-
immunity
b. Would result in pathogen nucleic acid, but not protein,
production in the host
c. Take advantage of host cell class II MHC molecules
d. Are important because of their ability to cause a B cell
response
6. Viral vaccines have been produced using viruses grown by all of
the following methods EXCEPT
a. Isolated directly from humans
b. Grown in bird embryos
c. Grown in animal cell culture
d. Grown on agar plates
7. Which of the following is one cardinal rule for a workable vaccine"

ϵϳ

 a. It must last a lifetime
b. It must contain an antigen that will provide protection but
not cause the disease
c. It must induce only the humoral immune response to be
considered effective
d. It must be administered intramuscularly to increase its
effectiveness
e. It must use live organisms in order to induce protective
immunity
8. How long does the protection provided by immune serum globulin
(ISG) last"
a. minutes
b. hours
c. weeks
d. months
e. year
9. What is the current form of treatment for a patient who has been
bitten by a coral snake"
a. Immune serum globulin
b. Specific immune globulin
c. Antisera/antitoxin of horse origin
d. Immunization
e. Supportive care
10.Which of the following is not a quality of an effective vaccine"
a. It should require periodic boosters to maintain its
effectiveness
b. It should stimulate the production of memory cells
c. It should stimulate both a humoral and cell-mediated
immune response
d. It should protect against the natural form of the pathogen
e. It should be easy to administer
11.The majority of licensed vaccines today consist of all but which of
the following antigenic preparations"
a. Killed, whole bacteria or viruses
b. Live, attenuated bacteria or viruses
c. Acellular antigens derived from bacteria or viruses
d. Active toxins derived from bacteria
e. Recombinant bacteria, viruses, or antigens
12.What is not a method of attenuation"
a. Long-term cultivation of the microbe
b. Treatment of the microbial culture with heat, radiation, or
formalin
c. Selection of mutant strains of the microbe

ϵϴ

 d. Removal of critical microbial virulence factors
e. Passage of the microbe through unnatural hosts or tissues
13.What is one disadvantage of using attenuated vaccines"
a. They require fewer doses and boosters than other types of
vaccines
b. They provide long-lasting protection
c. They produce an infection following vaccination
d. The organisms multiply following vaccination
e. The organisms can mutate back to a virulent form following
vaccination
14.Under what conditions is an cellular or subunit vaccine produced"
a. When the causative agent of infection is known
b. When the exact composition of the antigenic determinant is
known
c. When the exact antigenic determinants that stimulate
immunity are known
d. When the organism produces a weakly antigenic toxin
e. When the DNA sequence of the microbe is known
15.If an anti-idiotype vaccine was utilized, a patient would be injected
with what component"
a. Purified microbial antigen
b. Heat-killed whole microbial cells
c. Purified antibodies against the microbial antigen
d. Anti-idiotypic antibodies
e. DNA corresponding to the microbial antigen
16.Why is using an adjuvant in a vaccine preparation advantageous"
a. It prevents pain during the injection
b. It alleviates the necessity of booster doses of the vaccine
c. It enhances the immunogenicity of the antigen
d. It helps prevent back-mutations of attenuated microbes
e. It prevents local reactions at the injection site
17.Why are non-immunized school age children often protected from
vaccine-preventable diseases such as diphtheria, measles, and
polio"
a. Because they are still protected by maternal antibodies
b. Because the majority of children are immunized against
these diseases (herd immunity).
c. Because these diseases have been eradicated
d. Because such diseases exist only in underdeveloped
countries
e. Because they are not part of the group targeted by these
infectious microbes
18.The term variolation refers to:

ϵϵ

 a. The generation of antibody variable regions.
b. The attenuation of virulent organisms
c. Inoculation of scab material into small skin wounds
d. The removal of scab material from an individual with
smallpox
e. A type of gene therapy
19.For vaccination against mycobacterial diseases such as
tuberculosis, the most important facet of the immune response to
be stimulated is:
a. A high titer of antibody
b. Macrophage-activating cell-mediated immunity
c. Cytotoxic T-cells
d. Antibody in the gut lumen
e. Neutrophils
20.Which one of the following diseases has been completely
eradicated world-wide?
a. Measles
b. Smallpox
c. Tuberculosis
d. Cowpox
e. Psittacosis
21.A small protein subunit used in a vaccine may fail to stimulate T-
cell immunity because of:
a. Lack of glycosylation
b. Lack of conformation
c. Lack of carrier determinants
d. HLA-related unresponsiveness
e. Inherently insufficient antigen concentration
22.DNA vaccines
a. Are relatively poor at stimulating cytotoxic T lymphocyte
responses in mice
b. Must be administered on gold particles if they are to be
effective
c. Are only effective if followed by a protein boost
d. May have distinct advantages when preparing subunit
vaccines against viruses which frequently alter their antigens
e. Require cold storage in tropical countries
23.A peptide immunogen
a. Adopts a single rigid structure in solution
b. Can mimic a part of a discontinuous epitope
c. Can elicit potent antibody responses in the absence of T-cell
help
d. Can be used to stimulate B-cell but not T-cell responses

ϭϬϬ

 e. Lack contact residues capable of interacting with the antigen
receptor on the relevant lymphocytes.
24.Tetanus toxoid is usually given to humans
a. Absorbed to aluminum hydroxide
b. With complete Freund's adjuvant
c. Without the addition of any other agent
d. Together with the toxin
e. Only as a therapeutic agent, not prophylactically
25.A potential disadvantage of immunological protection using
passive transfer of horse globulins is
a. Serum sickness
b. Irreversible protection
c. Lack of antibody-mediated immune response
d. Type IV hypersensitivity reactions
e. Immunodeficiency
26.A feature of a Salmonella-based vaccine expressing antigens from
other infectious agents is that
a. Immunity is limited to the gut
b. Only secretory IgA is elicited
c. It does not invade the mucosal lining of the gut
d. It provokes both oral and systemic immunity
e. The organism does not need to be attenuated
27.To which one of the following groups would it be acceptable to
give a live attenuated viral vaccine
a. Children under 8 years of age
b. Patients treated with steroids
c. Pregnant mothers
d. Patients with leukemia
e. Patients treated with radiotherapy
28. Idiotypes can be exploited as epitope-specific vaccines if they are
a. IgG but not IgM
b. At least bivalent
c. First deglycosylated
d. Only if they are anti-idiotypes
e. Internal image
29.An antibody response to a protein vaccine can only be obtained
a. If the molecule is first linked to a carrier
b. If the molecule maintains discontinuous epitopes
c. If the molecule is glycosylated
d. If disulfide bonds are maintained
e. If the peptide bonds are maintained
30.Naturally acquired passive immunity would involve the:
a. Injection of vaccine.

ϭϬϭ

 b. Ingestion of interferon.
c. Placental transfer of antibodies.
d. Absorption of pathogens through mucous membranes.
e. Injection of antibodies
31.Which of the following is true of the successful development of a
vaccine to be used against a pathogen"
a. It is dependent on the surface antigens of the pathogen not
changing
b. It requires a rearrangement of the B cell receptor antibodies
c. It is not possible without knowing the structure of the
surface antigens on the pathogen
d. It is dependent on the pathogen having only one epitope
e. It is dependent on MHC molecules being heterozygous.
32.Jenner successfully used cowpox virus as a vaccine against the
virus that causes smallpox. Why was he successful even though he
used viruses of different kinds?
a. The immune system responds nonspecifically to antigens.
b. The cowpox virus made antibodies in response to the
presence of smallpox.
c. Cowpox and smallpox are antibodies with similar
immunizing properties.
d. There are some antigenic determinants common to both pox
viruses.
33.Which of the following vaccines would be contraindicated in a 4
year old boy receiving immunosuppressive therapy for
autoimmune hepatitis"
a. Hepatitis A vaccine
b. Hepatitis B vaccine
c. Acellular pertussis vaccine
d. Inactivated polio vaccine
e. Varicella vaccine
34.Which vaccine should not be given to an 8 year old girl who has
not been immunized previously"
a. Hepatitis B vaccine
b. Tetanus vaccine
c. Acellular pertussis vaccine
d. Inactivated polio vaccine
e. Measles vaccine
35. Which parenteral vaccine should not be characterized as an
attenuated live virus vaccine"
a. Influenza vaccine
b. Measles vaccine
c. Mumps vaccine

ϭϬϮ

 d. Rubella vaccine
e. Varicella vaccine
36.Which passive or active immunization is specifically recommended
for women in the second or third trimester of pregnancy"
a. Respiratory syncytial virus immune globulin
b. Cytomegalovirus immune globulin
c. Rubella vaccine
d. Influenza vaccine
e. Varicella vaccine
37. Increased risk for intussusception was observed as a rare
complication following immunization with which vaccine"
a. Inactivated polio vaccine
b. Oral polio vaccine
c. Rotavirus vaccine
d. Hepatitis A vaccine
e. Hepatitis B vaccine
38.A 3.5 year old child has not received primary immunization.
Which of the following is the best vaccination advice to such a
child"
a. BCG, DPT1 and OPV1. DPT2 and OPV2 after 4 weeks
b. BCG, DT1, OPV1, measles, vitamin A
c. BCG, DPT1, OPV1, measles, vitamin A
d. DT1, DT2 and booster after 1 year
39.Which one of the following vaccination is absolutely
contraindicated in pregnancy
a. Hepatitis B
b. Cholera
c. Rabies
d. Yellow fever
40.A pregnant woman passes antibodies to her unborn baby through
the placenta to protect against certain diseases. About how long
does this natural immunity last after birth"
a. 1 month
b. 2 months
c. 6 weeks
d. 3 months
41.Which vaccine is given soon after birth?
a. Polio
b. Hepatitis B
c. Measles, mumps, and rubella (MMR)
d. Varicella
42. Bacterial meningitis strikes infants more often than any other age
group. Which vaccine will help prevent one previously common

ϭϬϯ

 type of meningitis?
a. Tetanus
b. Hib
c. HIV
d. Varicella

43.What type of reaction commonly occurs after the diphtheria,

tetanus, and cellular pertussis (DTaP) vaccine"
a. Swelling and tenderness at the injection site
b. Fever up to 103 degrees
c. Continual crying
d. Limp, listless behavior
44.When should an infant not be given a DTaP vaccine"
a. The child has a moderate or serious illness with or without
fever
b. The child had a previous anaphylactic reaction (serious
allergic reaction) to DTaP vaccine
c. The child had encephalopathy after a vaccination when no
other cause was apparent
d. All of the above
45.In the combined DTP immunization used in the past, which of the
three vaccine components reportedly caused severe reactions"
a. Diphtheria
b. Pertussis
c. Tetanus
d. All three when given together
46.Which of the following results in long-term immunity?
a. The passage of maternal antibodies to a developing fetus
b. The inflammatory response to a splinter
c. The administration of serum obtained from people immune
to rabies
d. The administration of the chicken pox vaccine
e. The passage of maternal antibodies to a nursing infant.
47.Jenner successfully used cowpox virus as a vaccine against the
virus that causes smallpox. Why was he successful even though
he used viruses of different kinds?
a. The immune system responds nonspecifically to antigens.
b. The cowpox virus made antibodies in response to the
presence of smallpox.
c. Cowpox and smallpox are antibodies with similar
immunizing properties.
d. There are some antigenic determinants common to both pox
viruses.

ϭϬϰ

 48.The immune response to a booster vaccine is called a(n):
a. Cellular response.
b. Humoral response.
c. Innate response.
d. Primary response.
e. Secondary response.
49.A virus vaccine that can activate cytotoxic T cells MUST contain
a. A high dose of virus particles.
b. An adjuvant to stimulate T cell division.
c. Foreign MHC.
d. Live virus.
e. Virus peptides.
50.Which of the following is an agent (e.g. Aluminum salts, oil-based,
virosomes) often used to modify or augment the effects of a
vaccine by stimulating the immune system to respond to the
vaccine more vigorously, and thus providing increased immunity to
a particular disease"
a. Antigen
b. Epitope
c. Immunogen
d. Stimulant
e. Adjuvant
51.Which of the following is NOT true about live vaccines"
a. They were the first vaccines to be discovered
b. They are currently the least effective vaccines
c. They replicate and thus deliver sustained doses of antigen
d. They deliver antigenic peptides to MHC class I
e. They replicate at the infection site, focusing immune
response.
52.Which of the following live vaccines is recommended for children
but not adults"
a. Poliovirus
b. Measles, mumps, rubella (MMR)
c. Varicella
d. Meningococcal
e. Influenza
53.Which of the following live vaccines is recommended for adults
but not children"
a. Poliovirus
b. Measles, mumps, rubella (MMR)
c. Varicella
d. Meningococcal
e. Influenza

ϭϬϱ

 54.Which of the following killed vaccines is recommended for
children but not adults"
a. Hepatitis A
b. Influenza
c. Inactivated poliovirus
d. None of the above
55.Subunit vaccines contain components from pathogens, which are
inactivated and referred to as ____. These vaccines are generally of
low immunogenicity and may need____ to work effectively
a. Cytokines; IgE
b. LPS; Live vaccination
c. Capsules; Homeostasis
d. Toxoids; Adjuvants
e. Antigens; B & T cells
56.Which of the following subunit vaccines is recommended for
children but not adults"
a. Pneumonococcal (PCV)
b. Haemophilus influenzae type B
c. Hepatitis B
d. Diphtheria, tetanus, pertussis
57.DNA vaccines (tested in mice) use the gene for the immunogenic
protein and coat it with what element, which is injected into cells
and results in antibody production"
a. Tin
b. Zinc
c. Copper
d. Gold
e. Silver
58.Immunostimulatory complexes (ISCOMS) can be used for mucosal
vaccines and induce widespread mucosal immunity in the gut and
respiratory tract. They are the one way that ____ response can be
promoted
a. B cell
b. Helper T cell
c. Cytotoxic T cell
d. Eosinophil
e. Macrophage
59.Which of the following is NOT true regarding live viral vectored
vaccines"
a. They require strong adjuvants
b. They are economical to produce
c. They can be delivered through needle-free methods
d. They induce a broad and long-lasting immune response

ϭϬϲ

 e. They induce both cellular and humoral immunity
60.Alum is an effective adjuvant because it
a. Disaggregates the antigen.
b. Is immunogenic for stem cells
c. Slows the release of antigen
d. Transports antigen into the cytoplasm of antigen-presenting
cells.
61.Which of the following is not related with Adjuvants?
a. Antigens persistence is prolonged
b. Costimulatory signals are enhanced.
c. Local inflammation is increased
d. Specific proliferation of lymphocytes is stimulated.
62.Pediatricians who treat children with egg allergies are cautious
about using certain vaccines because they may be grown in an egg
medium. Which of these vaccines warrant caution?
a. MMR
b. Flu
c. Polio
d. A and B
e. B and C
63. Previous clinical studies with cancer vaccines have:
a. Clearly demonstrated induction of tumor-specific immune
response.
b. Repeatedly demonstrated clinical response to large tumor
burden.
c. Not clearly demonstrated induction of tumor-specific
immune response.
d. Not been performed to date.
64.The best way to provide immunologic protection against tetanus
neonatorum (of the newborn) is to
a. Inject the infant with human tetanus antitoxin
b. Inject the newborn with tetanus toxoid
c. Inject the mother with toxoid within 72 hours of the birth of
her child
d. Immunize the mother with tetanus toxoid before or early in
pregnancy
e. Give the child antitoxin and toxoid for both passive and
active immunization
65.Active, durable immunization against poliomyelitis can be
accomplished by oral administration of attenuated vaccine (Sabin)
or by parenteral injection of inactivated (Salk) vaccine. These
vaccines are equally effective in preventing disease because

ϭϬϳ

 a. Both induce adequate IgA at the intestinal mucosa, the site
of entry of the virus
b. Antibody in the serum protects against the viremia that leads
to disease
c. Viral antigen attaches to the anterior horn cells in the spinal
cord, preventing attachment of virulent virus
d. Both vaccines induce formation of interferon
e. Both vaccines establish a mild infection that can lead to
formation of antibody
66.The administration of vaccines is not without hazard. Of the
following, which is least likely to affect adversely an
immunocompromised host"
a. Measles vaccine
b. Pneumococcal vaccine
c. Bacille Calmette-Guaerin
d. Mumps vaccine
e. Sabin poliomyelitis vaccine
67.The administration of foreign (e.g., equine) antitoxin for passive
protection in humans can lead to serum sickness, which is
characterized by all of the following EXCEPT
a. Production by host of antibody to foreign antibody
b. Onset in 24²48 hours
c. Use of homologous antitoxin
d. Deposition of antigen²antibody complexes at various sites
in the host
e. Although delayed, the reaction is not a cell-mediated,
delayed, type IV immune response
68.The pneumococcal polysaccharide vaccine should be administered
to all EXCEPT
a. Individuals with chronic cardiorespiratory disease
b. Elderly (over 60 years of age) persons
c. Children (under 2 years of age)
d. Persons with chronic renal failure
e. Individuals with sickle-cell disease
69.The following statements about human immune serum globulin
(ISG) are true EXCEPT
a. The source is human placenta
b. The globulins are obtained by precipitation with cold
ethanol
c. The concentration of IgG is more than 10-fold greater than
in plasma
d. IgA and IgM are present in concentrations slightly lower
than in plasma

ϭϬϴ

 e. The ethanol precipitation does not render preparation of
globulin free of hepatitis virus
70.In order to prevent Rhesus hemolytic disease of the newborn
developing in babies that are at risk because of the parents' blood
group types, to whom and at what time should Rhogam (anti-
Rhesus) be administered"
a. The baby should be transfused once with Rhogam in utero as
soon as the procedure is feasible
b. The mother should receive it within 3 days of birth
c. The mother should receive it before pregnancy and again as
soon as she knows she is pregnant
d. The mother should receive it immediately after the baby is
born and then again within about 2-3 weeks
e. The newborn baby should receive it within 24 hours of
delivery
71.Which of the following is not a disadvantage of passive
immunization?
a. The antibodies confer long-term immunity only.
b. The antibodies are expensive to produce.
c. The antibodies confer short-term immunity only.
d. Passive immunization can lead to serious allergic reaction.
72.Even unvaccinated child can be protected against some of
vaccination preventable diseases because of
a. Herd immunity
b. Genetical predisposition
c. Antigenic shift
d. Imunity escape
e. Tolerance
73.Herd effect is not possible
a. If more than 85 % are vaccinated
b. For tetanus and rabies
c. Diphtheria, pertussis, haemophilus meningitis
d. Measles, rubella, mumps
e. Poliomyelitis, variola ± small pox
74.The successful protection of humans against smallpox infection by
vaccination with cowpox marked the foundation of Immunology as
described by
a. Emil von Behring
b. Elie Metchnikoff
c. Peter Medawar
d. Edward Jenner
e. Rolf Zinkernagal

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 75.Administration of the DPT vaccine would stimulate which type of
immunity?
a. Adaptive
b. Artificial passive
c. Artificial active
d. Natural active
76.It is difficult to develop a universal flu vaccine that would not need
to be re-administered every year because of:
a. Ease of transmission through water or food
b. Changes in the antigens of the influenza virus
c. Difficulty of producing non-infectious flu viruses to provide
the antigen
d. Lack of proteins in the viral capsid
e. Excessive inflammatory response
77.Which of the following is true about the development of a vaccine
for smallpox?
a. After the variolation procedure, an individual was protected
against smallpox
b. The smallpox vaccination is 100% effective.
c. The survival rate after variolation was higher than the
survival rate after vaccination.
d. The smallpox vaccine contains live smallpox virus.
78.A vaccination works because it
a. Triggers an innate immune system response that has innate
memory
b. Contains antibodies that will circulate in the body
c. Triggers a full immune response to the antigens present
d. Produces specific memory b and t cells to those particular
antigens
e. Triggers generalized memory B and T cells that can respond
to antigens similar to the ones in the vaccine
79.When SARS was spreading through China, one technique used to
stop the spread was the isolation of antibodies from individuals
who were sick with SARS but having a robust immune response.
These antibodies were then given directly to others in an attempt to
prevent SARS. Which one of the following describes the type of
immunization the patient received?
a. Active natural immunity.
b. Active artificial immunity.
c. Passive natural immunity.
d. Passive artificial immunity.
80.Currently, the only successful preventive antitumor vaccine is
directed at which of the following?

ϭϭϬ

 a. Preventing the establishment of a viral infection.
b. Increasing the antigenicity of tumor cells.
c. Blocking T cell suppression.
d. Augmenting ADCC.
81.If you are vaccinated for the flue this year, how come you can get
the flu next year?
a. The flu shot is an example of passive immunity and the
antibodies wear out after a year
b. The flu shot was defective
c. Your body only remembers pathogens for about a year, then
you can get the flu again
d. The virus that causes the flu changes frequently and the flu
that comes around next year is a different strain of flue that
the immune system has not seen before
e. You will only have a mild case of the flu
82.Which is considered the "gold standard" of existing vaccines?
a. Purified proteins
b. Whole-organism
c. DNA-based
d. Inactivated exotoxins
e. Capsular polysaccharides
83.Which macromolecule is currently NOT being used as a vaccine in
humans?
a. Capsular polysaccharides
b. Recombinant surface antigens
c. Inactivated exotoxins
d. DNA-based
e. All of the above
84.Plasmids encoding antigenic protein from a pathogen that is
directly injected into the cells it express consititute
a. Protein vaccines
b. Nucleotide vaccines
c. DNA vaccines
d. Recombinant vaccines
85.What is the difference between active immunity and passive
immunity?
a. Both are short lived, but active immunity helps protects right
away.
b. Passive immunity results when a person is given someone
HOVH¶V DQWLERGLHV ZKHUHDV DFWLYH LPPXQLW\ UHVXOWV Zhen a
SHUVRQ¶V LPPXQH V\VWHP ZRUNV WR SURGXFH DQWLERGLHV DQG
activate other immune cells to certain pathogens.

ϭϭϭ

 c. Active immunity results when a person is given someone
HOVH¶V DQWLERGLHV ZKHUHDV SDVVLYH LPPXQLW\ UHVXOWV ZKHQ D
SHUVRQ¶V LPPXQH V\VWHP ZRUNV Wo produce antibodies and
activate other immune cells to certain pathogens.
d. None of the above
86.An obstetrician sees a pregnant patient who was exposed to rubella
virus in the eighteenth week of pregnancy. She does not remember
getting a rubella vaccination. The best immediate course of action
is to
a. Terminate the pregnancy
b. Order a rubella antibody titer to determine immune status
c. Reassure the patient because rubella is not a problem until
after the thirtieth
d. week
e. Administer rubella immune globulin
f. Administer rubella vaccine
87.A 70-year-old nursing home patient refused the influenza vaccine
and subsequently developed influenza. She died of acute
SQHXPRQLD  ZHHN DIWHU FRQWUDFWLQJ WKH ³IOX´ 7KH PRVW FRPPRQ
cause of acute postinfluenzal pneumonia is
a. Legionella
b. Listeria
c. Staphylococcus aureus
d. Klebsiella
e. Escherichia coli
88.Which of the following causes a fatal encephalitis for which a
vaccine is available?
a. Rabies
b. Rhinovirus
c. Cytomegalovirus
d. Respiratory syncytial virus
e. Mumps
89.Which of the following is available and effective for hepatitis A?
a. Acyclovir
b. Killed virus vaccine
c. Inactivated virus vaccine
d. Live virus vaccine
e. Recombinant viral vaccine
90.Patients should be vaccinated annually for influenza with which of
the following vaccines?
a. Immune serum globulin
b. Killed virus vaccine
c. Inactivated virus vaccine

ϭϭϮ

 d. Live virus vaccine
e. Recombinant viral vaccine
91.A vaccine is available for one of the most common causes of
infantile gastroenteritis. However, it has recently been recalled.
The virus is
a. Cytomegalovirus
b. Rotavirus
c. Varicella-zoster virus
d. Adenovirus
e. Papillomavirus
92.A true statement concerning vaccines include:
a. Inactivated vaccines are hazardous to the mother
b. Cases of congenital rubella syndrome have been reported in
fetuses born to mothers who were immunized early in
pregnancy
c. Inactivated vaccines are hazardous to the fetus
d. The polio virus has the ability to spread from the vaccine to
susceptible persons in the immediate environment
e. Non-immune pregnant women who are exposed to children
who recently received the measles-mumps-rubella (MMR)
vaccine are at high risk of delivery of an infected fetus
93. All the given vaccines are attenuated or inactivated whole
pathogen EXCEPT:
a. Salk
b. Sabin
c. Hepatitis A
d. Tetanus
94. Which of the following statements are true regarding polio
vaccines:
a. Salk and Sabin are polio vaccines
b. Sabin is live attenuated polio vaccine
c. Salk is an inactivated polio vaccine
d. All of these
95. Which of the following is a polysaccharide vaccine
a. Anthrax vaccine
b. Rabies vaccine
c. Hepatitis A
d. Hib vaccine
96. Tetanus toxoid is given to children in four doses-why?
a. In order to make the immune system to have anamnestic
response
b. The toxoid has short antigenic lifetime

ϭϭϯ

 c. Administering all the toxoid in a single dose may cause
tetanus in children
d. In order to make the children to tolerate the toxoid
97.Anamnestic response is:
a. The memory of the immune system to produce the same
antibodies in large proportions after the second vaccination.
b. Rapid destruction of antibodies produced in the first
vaccination after injecting the vaccine for the second time
c. Production of autacoids in the blood
d. Anemia produced after vaccination
98.Which of the following is the correct reason for higher production
of antibodies after second vaccination?
a. Antibody producing system has the memory of previous
vaccination
b. Antibody produced after the first vaccination is also added to
the antibodies produced after second vaccination
c. Antibodies produced in the first vaccination triggers the
immune system to produce more antibodies after the second
vaccination
d. All of the above
99.Which of the IROORZLQJLVWKH)UHXG¶VFRPSOHWHDGMXYDQW )&$ "
a. Bordetella pertussis and oil-in- water emulsion
b. Killed Mycobacterium tuberculosis and oil-in-water
emulsion
c. Killed Mycobacterium tuberculosis and aluminum phosphate
d. Killed Corynebacterium parvum and saponin
100. Silica and kaolin are mixed with killed microbial culture
before they are used for vaccination, because:
a. They help to provide prolonged immunity
b. They are necessary to stimulate immunity
c. The stimulate B cells to provoke the immune response
d. They provide additional antigenic determinant sites

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1. MHC class II molecules are found on:
a. Virtually all cells in the body
b. B cells, Dendritic cells and macrophages
c. Only gamma-interferon activated cells
d. Virtually all nucleated cells in the body
e. Only on virally-infected cells
2. Each of the following statements concerning class II MHC proteins
is correct EXCEPT:
a. They are found on the surface of both B and T cells
b. They have a high degree of polymorphism
c. They are involved in the presentation of antigens by
macrophages
d. They have a binding site for Cd4 proteins
3. What is the role of class II MHC proteins on donor cells in the
process of graft rejection?
a. They are recognized by helper T cells, which then activate
cytotoxic T cells to kill the donor cells
b. They are the receptors for IL-2, which produced by
macrophages when they attack the donor cells
c. They cause the release of perforins to lyse the cells
d. They induce IgE, which mediated graft rejection
4. What is the function of major histocompatibility complex (MHC)
molecules?
a. Present sugars to T cells
b. Present peptides to T cells 
c. Create holes in the membranes of bacteria
d. Lyse foreign antigens
e. Phagocytize foreign antigens
5. Class III MHC genes encode for which of the following
a. CD4+ T cells
b. CD8+ T cells
c. Compliment molecules
d. Cytokine molecules
e. c & d
6. MHC class I has three genes (HLA-A, HLA-B, & HLA-C). Which
of the following is the correct order from most alleles (most
polymorphic) to least alleles"

ϭϭϲ

 a. A > B > C
b. A > C > B
c. B > A > C
d. B > C > A
e. C > A > B
f. C > B > A
7. How many genes does MHC class II have"
a. 2HLA-DP alpha/beta
b. 2HLA-DQ alpha/beta
c. 4HLA-DP alpha/beta, HLA-DQ alpha/beta
d. 4HLA-DQ alpha/beta, HLA-DR alpha/beta
e. 6HLA-DP alpha/beta, HLA-DQ alpha/beta, HLA-DR
alpha/beta
8. Which of the following MHC class II genes has the most alleles
(most polymorphic)?
a. DQ beta
b. DR alpha
c. DP alpha
d. DP beta
e. DQ alpha
9. Which of the following MHC class II genes has the lease alleles"
a. DP alpha
b. DP beta
c. DQ alpha
d. DQ beta
e. DR alpha
f. DR beta
10.MHC molecules exhibit____ and immunoglobulin/TCR molecules
exhibitBBBB.
a. Allelic exclusion; Allelic exclusion
b. Allelic exclusion; Co-dominant expression
c. Co-dominant expression; Co-dominant expression
d. Co-dominant expression; Allelic exclusion
11.Because of a lack of genetic recombination in the MHC, blocks of
alleles (haplotypes) are inherited together, and they are identical in
families. Which of the following is the likely result of this"
a. Family members have identical combinations of HLA
alleles, thus tissue transplantation is simple
b. Family members have identical combinations of HLA
alleles, thus tissue transplantation is difficult
c. No family members have identical combinations of HLA
alleles, thus tissue transplantation is simple

ϭϭϳ

 d. No family members have identical combinations of HLA
alleles, thus tissue transplantation is difficult
12.Class II MHC molecules accommodate____ peptides and thus____
EH UHIHUUHG WR DQDORJRXVO\ DV D ³KRWGRJ LQ D EXQ´, in contrast to
class I MHC molecules
a. Smaller; Would
b. Smaller; Would not
c. Larger; Would
d. Larger; Would not
13.Which of the following is NOT a structural chain in class I MHC"
a. ȕ
b. Į
c. Į
d. Į
e. ȕ-microglobulin
14.Which of the following is NOT a structural chain in class II MHC?
a. Į
b. Į
c. Į
d. ȕ
e. ȕ
15.Evidence is accumulating showing that polymorphism in the MHC
may be advantageous. Homozygosity at HLA class I has been
shown to be a(n)____ with respect to HIV/AIDS. Similarly, there
is evidence that homozygosity at HLA class II____ the risk of
hepatitis B virus infection persisting
a. Advantage; Decreases
b. Advantage; Increases
c. Disadvantage; Decrease
d. Disadvantage; Increase
16.Human Class I MHC a chain molecules are:
a. ȕ-microglobulin.
b. H-2 D, K, and L.
c. H-2 IA and IE
d. HLA-A. -B, and -C.
e. HLA-DR, -DP, and -DQ.
17.Cells which have MHC Class II are _________________, which
present _____________ antigen to Th cells.
a. Antigen presenting cells, endogenous
b. Antigen presenting cells, exogenous
c. Infected cells, inflammatory
d. Target cells, endogenous
e. Target cells, exogenous

ϭϭϴ

 18.Endogenous antigen presentation requires delivery of antigen
peptides to the endoplasmic reticulum by
a. Class I MHC and invariant chain.
b. Calnexin and tapasin.
c. HLA-DM.
d. Leader sequence.
e. TAP-1 and TAP-2.
19.Exogenous antigen is processed
a. After presentation by antigen presenting cells.
b. By nearly every nucleated cell.
c. By the cytosolic processing pathway.
d. ,QWKHSUHVHQFHRIȕ-microglobulin.
e. In acidified endosomes.
20.Class II MHC does not efficiently present endogenous antigen
because
a. Antigen synthesized inside the cell never makes it to the
endosomal compartment.
b. Endogenous antigen cannot be processed into peptides small
enough.
c. HLA DM transports Class II to the surface before it can bind
endogenous peptide.
d. Invariant chain blocks binding of endogenous peptide in the
ER.
e. Phagocytosed antigen binds Class II as rapidly as Class II is
synthesized.
21. In order to have pathogen peptide plus Class II MHC
molecules expressed on the membrane of host cells, all of the
following are required EXCEPT
a. ȕ-microglobulin.
b. CLIP.
c. HLA-DM.
d. HLA-DR, -DP, and -DQ alpha chains.
e. Ii .
22.Invariant chain (Ii)
a. Inhibits binding of endogenous peptide to Class I MHC.
b. Is degraded in the MIIC compartment to CLIP.
c. Is released from Class II upon binding of b2-microglobulin.
d. Is the constant region of Class I peptide binding site.
e. Prevents exogenous peptide binding to Class II MHC in the
ER.
23.Antigen binding by Class I MHC molecules
a. Accommodates many different peptides.

ϭϭϵ

 b. Preferentially occurs for peptides 13-18 amino acids in
length.
c. Occurs at a site on Class I MHC formed by folding of a1 and
ȕ-microglobulin domains.
d. Occurs only on antigen presenting cells.
e. Takes place at the plasma membrane of the infected cell.
24.Both Class I and Class II MHC molecules are
a. Composed of a and b chains with variable and constant
regions.
b. Expressed constitutively on all nucleated cells.
c. Expressed on the B cell membrane.
d. Part of the T cell receptor for antigen.
e. Synthesized in response to antigen processing.
25.The major histocompatibility complex has
a. Dozens of loci for Class I and Class II proteins.
b. Genes that encode proteins associated with antigen
processing.
c. Only genes encoding Class I and Class II molecules.
d. Single loci for Class I and Class II proteins.
e. Three regions encoding Class I, Class II, and Class III
receptors.
26.MHC polymorphism
a. Is generated by recombination of HLA A, B, and C gene
segments.
b. Is present primarily in the peptide-binding regions of MHC
proteins.
c. Is the result of random association of many alpha and beta
genes.
d. Restricts the ability of B cells to bind antigen.
e. Results in expression of dozens of MHC alleles on each
APC.
27.T cells are MHC-restricted in their ability to respond to antigen
because
a. All antigens must be processed and presented to activate
lymphocytes.
b. During an infection, all cells in the body present antigen on
MHC Class I.
c. MHC binds antigen more specifically than TCR does.
d. TCR must recognize both antigen and MHC molecules.
e. The T cells should not respond to antigen on allogeneic
cells.
28.All of the following are associated with the expression of Class I
MHC molecules EXCEPT

ϭϮϬ

 a. Antigen peptide presentation on membrane Class I MHC to
Tc.
b. Graft rejection.
c. Increased risk of certain autoimmune diseases.
d. Lysis of virus-infected cells.
e. Stimulation of antibody production.
29.Human Class II MHC molecules
a. Are encoded by the genes HLA-A, B, and C.
b. Are found on all nucleated cells.
c. Have an antigen binding site formed from regions of two
polypeptide chains.
d. Must be associated ZLWKȕ-microglobulin molecules to bind
peptide.
e. Present antigen to CD8 cytotoxic T cells.
30.Which of the following statements is TRUE?
a. Each individual expresses all the diversity of MHC protein
structure.
b. If a family has four children, no two of them will have the
same MHC genotype.
c. Someone with bare lymphocyte syndrome who expressed no
MHC proteins would die in infancy.
d. TCR on Tc cells binds a1 and b2 domains of Class I MHC
protein.
e. The chances of finding a tissue match are much higher
between children and their parents than between siblings.
31.The region of a Class I or II MHC molecule that is responsible for
binding processed antigen peptides for presentation:
a. Peptide-binding groove
b. Peptide-bonding antigen
c. Peptide-binding hinge
d. Antigen bending peptide
32.Class --------- antigen are restricted to cells involved in immune
response. Class------ antigens are expressed on all nucleated cells:
a. 2,3
b. 2,1
c. 1,2
d. A,DR
e. A,B
33.MHC class ------- proteins present peptides to cytotoxic T cell
a. III
b. II
c. IV
d. V

ϭϮϭ

 e. I
34.Which of the following has a protein chain which goes through cell
membrane associated with small protein called beta
macroglobulin?
a. HLA-DR
b. HLA-DQ
c. HLA-DP
d. HLA-B
35.A large cluster of genes on human chromosome 6 that control
many activities of immune cells, including the transplantation
rejection process and the killing of virus-infected cells by specific
killer T lymphocytes:
a. LHA
b. HLA
c. HA
d. HAL
e. MHC
36.You are 90 times as likely to get the rheumatic disease Ankylosing
spondylitis if you are:
a. HLA A3
b. HLA A1
c. HLA B27
d. HLA DR3
e. HLA B8
37.Has alleles at the DP, DQ, Dr loci which consist of a larger alpha
chain and small beta chain (beta chain macroglobulin ± the gene
for this chain lies on chromosome 15 and shows no variability). Is
expressed on cells with which T cells with which T cells are
required to interact with-antigen presenting cells, B cells and
activated T cells:
a. MHC III
b. MHC I
c. MHC IV
d. MHC V
e. MHC II
38.Which of the following has 2 protein chains which go through cell
membrane?
a. HLA-A
b. HLA-DR
c. HLA-B
d. HLA-C
39.Glycoproteins found on the surface of mammalian cells which
make each of us unique.First found on white cells. Six families of

ϭϮϮ

 proteins all coded for by genes. Two classes- Class 1: A,B & Class
2: DP,Dq,DR
a. HLA
b. MHC
c. MLA
d. HLC
e. MHC
40.The number of MHC protein combinations possible in a given
population is enormous. However, an individual in that population
has only a couple of MHC possibilities. Why?
a. The MHC proteins are made from several different gene
regions that are capable of
b. Rearranging in a number of ways.
c. MHC proteins from one individual can only be of class I or
class II.
d. Each of the MHC genes has a large number of alleles, but
each individual only inherits 2 for each gene.
e. Once a B cell has matured in the bone marrow, it is limited
to two MHC response categories.
41.The major histocompatibility complex proteins function to
a. Degrade T4 and T8 polypeptides
b. Bind antibody for lymphokine production
c. Bind complement for cell lysis
d. Bind antigen fragments for presentation to T-cells
42. MHC genes in mouse is located in
a. Chromosome 1
b. Chromosome 2
c. Chromosome 4
d. Chromosome 6
43. Which of the following cells recognize peptides in association
with Class I MHC molecules?
a. B lymphocytes.
b. T lymphocytes expressing only CD4 on their surface.
c. T lymphocytes expressing only CD8 on their surface.
d. Developing thymocytes, expressing both CD4 and CD8 on
the same cell.
e. Developing thymocytes that express neither CD4 nor CD8
on their surface.
44.The process that begins when a helper T-cell binds to an MHC
class II protein on a displaying cell is known as
a. Costimulation
b. Antigen proliferation
c. T-cell proliferation

ϭϮϯ

 d. Self antigen recognition
45.Which cells phagocytize antigen-bearing cells and bind them to
their MHCs"
a. Antigen presenting cells
b. Plasma cells
c. NK cells
d. Helper T-cells
e. All immune cells
46. The necessity of expressing most antigens in the context of MHC
to initiate specific immune responses is termed:
a. Immune surveillance
b. Clonal selection
c. MHC-restriction
d. MHC-presentation
e. Tissue typing
47. An endocardial cell from the mitral valve of the heart would be
expected to exhibit
a. Class I MHC proteins
b. Class II MHC proteins
c. Class III MHC proteins
d. None of the above
48._______ are activated by antigen fragments complexed with MHC
I proteins
a. CD8 T cells
b. CD4 T cells
c. CD8 B cells
d. CD4 B cells
49. The human major histocompatibility complex
a. Provokes the most intense allograft reactions
b. Is termed H-2
c. Contains only class I and class II genes
d. Is not expressed as co-dominant antigens on the cell surface
e. Encodes the human leukocyte antigens (HLA) expressed
only on leukocytes.
50. Concerning MHC class II antigen differences between 2
individuals, which of the following is untrue
a. They produce mixed lymphocyte reactions
b. They stimulate formation of helpers to generate cytotoxic T-
cells
c. They cause graft vs host disease
d. For sibling pairs, they will only exist on average in 1:4
cases
e. None of the above.

ϭϮϰ

 51.Which of the following is true concerning the MHC in mammals?
a. In the mouse it is located on chromosome 18.
b. Transplant rejection is determined by major
histocompatibility antigens.
c. Its primary function is the rejection of foreign transplants.
d. None of these.
52.On the HLA complex, the D/Dr region
a. Codes for cytokines
b. Codes for class I antigen
c. Codes for class III antigen
d. Codes for molecules found mainly on antigen ±presenting
cells
e. None of these
53.Molecules encoded by the K and D regions are characterized by
a. Expression on immune cells only
b. A requirement for interaction between T and B cells
c. Their effect on Tc lymphocytes
d. 7KHSUHVHQFHRIDQĮDQGĮȖFKDLQ
e. None of these
54.The H-2 complex
a. Is located on chromosome 6
b. Regulates T- independent antigen immune response
c. Was discovered by Dausset
d. Codes for transplantation antigens
e. A and d are correct
55.MHC molecules are highly polymorphic because
a. It helps the exchange of tissue or organs among the various
vertebrate species
b. It decreases the possible interactions among the cells of the
immune system
c. It helps the spleen to perform a variety of regulatory
functions
d. It ensures that all members of a species are not equally
susceptible to a pathogen
e. None of these
56. Class I molecule of H-2 complex
a. Are encoded by the I region
b. Are found mainly on lymphocytes
c. Are found in the same region that codes for complement
components
d. Are highly polymorphic and unique for each strain
e. None of these

ϭϮϱ

 57.Concerning the structure of HLA-encoded class I MHC molecules,
which of the following is true:
a. They comprise three polypeptides
b. 7KH\FRQWDLQDȕ- macroglobulin
c. They contain a heavy chain that traverses the lipid cellular
bilayer
d. a,b and c are correct
e. b and c are correct
58.MHC Class I molecules are found on the following cells
a. T cells
b. Kidney cells
c. Gametes
d. All of the above
e. None of these
59.MHC Class II molecules:
a. Allow interaction between dendritic cells and T cells
b. Require interaction between T and B cells
c. Are located on immune cells
d. All of the above
e. None of these
60.Class III molecules are concerned with which of the following :
a. C4,C2, and factor B
b. Transplant rejection
c. B cell idiotypes
d. T cells
e. None of these
61. Which of the following naïve cells load peptide fragments into
MHC class II molecules?
a. CD4+ T cells
b. CD8+ T cells
c. Dendritic cells
d. īį7FHOOV
e. Neutrophils
62.Upon encounting an appropriate pMHC on an infected cells
a. B- cells receptors become cross- linked and signaling ensues
b. CD4+ cells release IL-4
c. CD8+ cytotoxic T cell destroy the infected cells
d. Naïve Th1 cells secrets cytokines
e. Th0 cells differentiate into Th2 cells
63. One principal function of the Class I and Class II major
histocompatibility complex S proteins is to :
a. Transduce the signal to the T-cell interior following antigen
binding

ϭϮϲ

 b. Mediate immunoglobulin class switching
c. Present antigen for recognition by the T-cell antigen receptor
d. Stimulate production of interleukins
e. Bind complement
64. The single best unique description of the interaction of the alpha-
beta T-cell receptor with peptide-MHC is that it
a. Involves non-covalent forces
b. Results in T-cell activation
c. Requires the peptide to be presented by MHC class I
d. Involves CDR (complementarity-determining region)
binding to both peptide and MHC
e. Is of relatively low affinity compared with antibody binding
to native antigen
65.MHC polymorphism is a product of:
a. Allelic inheritance
b. Recombination
c. Lemarckian evolution
d. Antigen receptors
66. All the following are characteristics of both MHC class I and
class II molecules EXCEPT:
a. They are expressed co-dominantly.
b. They are expressed constitutively on all nucleated cells.
c. They are glycosylated polypeptides with domain structure.
d. They are involved in presentation of antigen fragments to T
cells.
e. They are expressed on the surface membrane of B cells.
67.MHC class I molecules are important for which of the following?
a. Binding to CD8 molecules on T cells
b. Presenting exogenous antigen (e.g., bacterial protein) to B
cells
c. Presenting viral protein to antigen-presenting cells such as
macrophages
d. Binding to CD4 molecules on T cells
e. Binding to Ig on B cells
68.Which of the following is INCORRECT concerning MHC class II
molecules?
a. B cells may express different MHC class II molecules on
their surface.
b. MHC class II molecules are synthesized in the endoplasmic
reticulum of many cell types.
c. Genetically different individuals express different MHC
class II alleles.

ϭϮϳ

 d. MHC class II molecules are associated with b2-
microglobulin on the cell surface.
e. A peptide that does not bind to an MHC class II molecule
will not trigger a CD4+ T cell response.
69.Products of TAP-1 and -2 genes :
a. Bind b2-microglobulin.
b. Prevent peptide binding to MHC molecules.
c. Are part of the proteasome.
d. Transport peptides into the endoplasmic reticulum for
binding to MHC class I.
e. Transport peptides into the endoplasmic reticulum for
binding to MHC class II.
70.Which of the following is incorrect concerning the processing of
an antigen, such as a bacterial protein, in the acid compartments of
the cell?
a. It results in production of potentially immunogenic peptides
that associate with MHC class II molecules.
b. Predominantly exogenous antigens are processed by this
pathway.
c. It may lead to activation of CD4+ T cells.
d. It may lead to the activation of CD8 + T cells.
e. Bacterially derived peptides displace a fragment of the
invariant chain from the MHC class II binding groove.
71.Which of the following statements about the MHC is
INCORRECT?
a. It codes for complement components.
b. It codes for both chains of the MHC class I molecule.
c. It codes for both chains of the MHC class II molecule.
d. It is associated with susceptibility and resistance to different
diseases.
e. The total set of MHC alleles on the chromosome is known
as the MHC haplotype.
72.When the sequences of different MHC class I molecules are
compared; the variation between molecules is concentrated within
which of the following?
a. Areas of the molecule that bind CD4
b. Areas of the molecule that bind to the T cell receptor and to
the antigenic peptide
c. B-2 microglobulin
d. The transmembrane domain of the a chain
e. The b1 domain (the N terminal domain of the b chain)

ϭϮϴ

 73.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
74.Class II MHC molecules include
a. Gene products of HLA-D, HLA-DP and HLA-B
b. Gene products of HLA-A, B and C
c. Gene products of HLA ± DP, DQ and DR
d. Complement components C2, Factor B, C4b and c4a
e. Gene products of HLA-B, C and DP
75.Certain MHC haplotypes are associated with autoimmune disease.
Match the disease with the HLA type: Ankylosing spondylitis
a. B27
b. DR2
c. DR3
d. DR4
e. DQ2
76.Formation of pMHC I on infected cell
a. Results in BCRs cross binding and signalisation to the
nucleus
b. CD4+ T cell secretion of IL-4
c. CD8+ T cell killing of infected cell
d. Naive Th1 cell secretion of cytokines
e. Th0 cells differentiate to Th2 cell
77.Which of mentioned cells need cooperation of pMHC with
costimulatory 2nd signals from APC to be activated?
a. Anergised T cells
b. B cells
c. Mastocytes
d. Naïve T cells
e. Natural killers
78.Which of the following is NOT true about MHC molecules but true
about B and T cells?
a. The genes that encode molecules are the most variable genes
we know of in the human genome (polygenic)
b. They are extensively polymorphic (existence of multiple
alleles or forms of the same gene)
c. Every cell in each individual expresses the same set of
molecules

ϭϮϵ

 d. Every cell expresses a different molecule created from
multiple gene segments that undergo somatic rearrangement
e. Their diversity exists in the population as a whole, not in the
individual
79.*LYHQ WKDWDQ LQGLYLGXDO¶VSDUHQWVKDYHFRPSOHWHO\GLIIHUHQW +/$
genes, that individual will have about ____ different class I and II
MHC molecules on the surface of certain of their lymphoid cells.
a. 3
b. 6
c. 9
d. 12
e. 15
80.Which histocompatibility antigen is not involved in either
transplantation acceptance or rejection?
a. Minor histocompatibility antigen
b. Class I MHC
c. Class II MHC
d. Class III MHC
81.Which one of the following domains is structurally homologous to
the constant domain of immunoglobulins?
a. ȕPDQGĮ
b. ĮDQGĮ
c. ĮDQGȕP
d. ĮDQGĮ
82.CD8 molecules present on T cytotoxic cells confer MHC
specificity by interacting with the _______ domain of class I MHC.
a. ȕP
b. Į
c. Į
d. Į
83.The peptide-binding domain involved in the interaction with TCR
in both class I MHC and class II MHC is:
a. Į
b. ȕ
c. ȕ
d. Į
84.Which of the following is not true for class II MHC?
a. Binds antigenic peptide of about 13-18 amino acid residues
b. PeptidHELQGLQJVLWHIRUPHGE\ĮDQGȕFKDLQV
c. Presents antigenic peptide to CD4+ T-cells
d. :LOO QRWEHGLVSOD\HGRQFHOOVXUIDFH LI ȕ PLFURJOREXOLQ LV
not synthesized
85.Which of the following is a component of class III MHC?

ϭϯϬ

 a. HLA-DM
b. Transporter associated with antigenic peptide
c. Steroid hydroxylase
d. ȕ- microglobulin
86.Which of the following murine MHC loci are linked?
a. Class I MHC, class III MHC
b. Class II MHC, class III MHC
c. Class I MHC, class II MHC, class III MHC
d. Class I MHC, class II MHC
87.Which of the following is an example of murine non-classical
class-I MHC molecule?
a. H2-D
b. H2-Oa
c. H2-Q
d. H2-IA
88.Which of the following is NOT a classical class II MHC molecule?
a. HLA-DP
b. HLA-DR
c. HLA-DM
d. HLA-DQ
89.Which of the following cells will not express class II MHC
PROHFXOHHYHQZKHQH[SRVHGWRȖ-interferon?
a. Macrophage
b. Endothelial cells
c. Neurons
d. Hepatocyte
90.Which one of the following Antigen-presenting molecules is not a
histocompatibility antigen?
a. HLA-B
b. H2-Qa
c. CD1
d. HLA-A
91.An antigen, during its processing and presentation, may never
encounter which of the following molecules in its lifetime?
a. CD1 molecule
b. Class II MHC
c. Class III MHC
d. Class I MHC
92.Each of the following statements is correct for HLA-B, EXCEPT:
a. Plays a major role in atopic dermatitis
b. Present on all nucleated cells
c. Present peptide to Tcyt,/sub> cell
d. ȕ-microglobulin polypeptide present

ϭϯϭ

 93.Which one of the following histocompatibility molecules has
enzymatic activity is associated with it?
a. CD1 molecule
b. Class III MHC molecule
c. Class I MHC molecule
d. Class II MHC molecule
94.Which of the following is not a cell surface molecule ±
a. Class III MHC
b. Class II MHC
c. ȕ-microglobulin
d. CD1
95.Which of the following cells express the highest number of class I
MHC molecules?
a. Macrophages
b. Platelets
c. Lymphocytes
d. Dendritic cells
96.Which of the following domains of MHC does not possess the
structural characteristics of the immunoglobulin constant domain?
a. None of the above
b. ȕ-microglobulin
c. Į-domain
d. Į-domain
97.Which of the following is not coded by class III MHC loci?
a. Tumor necrosis factor
b. Heat shock protein
c. Steroid hydroxylase
d. LMP
98.The CD4 molecule binds to this domain of class II MHC molecule:
a. ȕ
b. ȕ
c. Į
d. Į¤
99.Class II MHC present/display:
a. Pyrophosphate-containing antigen
b. Protein derived from virus-infected host cell
c. Lipid antigen
d. Exogenous antigen
100. The major histocompatibility complex (MHC) is a set of cell
surface molecules encoded by a large gene family that controls a
major part of the immune system in vertebrates. Which of the
following is NOT true about MHC?
a. It is composed of glycoproteins on the plasma membrane

ϭϯϮ

 b. It allows immune system to differentiate self and non-self
cells
c. The donor for organ transport will be affected by
autoimmune disease due to incompatible MHC
d. All of the above is true

ϭϯϯ

 &KDSWHU6HYHQ
0DMRU+LVWRFRPSDWLELOLW\
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1. b 26.b 51.b 76.c
2. a 27.d 52.d 77.d
3. a 28.d 53.c 78.d
4. b 29.c 54.d 79.d
5. e 30.c 55.e 80.d
6. c 31.a 56.d 81.c
7. e 32.b 57.a 82.c
8. e 33.e 58.d 83.d
9. e 34.d 59.a 84.d
10.d 35.e 60.a 85.c
11.d 36.c 61.c 86.c
12.c 37.e 62.c 87.c
13.a 38.b 63.c 88.c
14.c 39.a 64.d 89.c
15.d 40.d 65.a 90.c
16.d 41.d 66.b 91.c
17.b 42.d 67.a 92.a
18.e 43.c 68.d 93.b
19.e 44.a 69.d 94.a
20.d 45.a 70.d 95.c
21.a 46.c 71.b 96.c
22.b 47.a 72.b 97.d
23.a 48.a 73.a 98.a
24.c 49.a 74.c 99.d
25.b 50.d 75.a 100. c

ϭϯϰ

  &KDSWHU(LJKW
 3UDFWLFDO,PPXQRORJ\
 0&4
1. All of the following forces are involved in antigen antibody
reaction EXCEPT:
a. Vander Waal`s forces
b. Electrostatic bond
c. Hydrogen bond
d. Covalent bond
2. All true about precipitation reaction EXCEPT:
a. Reaction of soluble antigen with antibody
b. Very sensitive for detection of antigens
c. Kahn test is an example
d. Eleks test is an example
e. All are true
3. All of the following are agglutination tests EXCEPT:
a. Widal
b. Paul Bunnel
c. Wasserman reaction
d. Coomb`s
4. The following precipitation curve is prepared by adding variable
amount of tetanus toxoid to a series of tubes containing 0.7 mg of

antibody each:

Precipitation observed in supernatant Supernatant from tube #

after addition of
1 2 3 4 5 6 7 8 9

ϭϯϱ

 Antibody -- -- -- -- + + + + +
Antigen + + ± -- -- -- -- -- --
+ means visible precipitation; -- means no visible precipitation

Which tube(s) correspond to the antigen excess zone?

a. 1 to 3
b. 1 to 4
c. 4
d. 4 to 9
e. 5 to 9
5. Using the data in question before, what was the concentration of
antigen added to the tube corresponding to the equivalence point?
a. 0.005 mg
b. 0.01 mg
c. 0.05 mg
d. 0.1 mg
e. 0.5 mg
6. The affinity of an antigen ± antibody reactions depends primarily
on the :
a. Activation of the complement system
b. Antibody isotype
c. Closeness of fit between antibody ± binding site and antigen
epitope
d. Nature of the antigen
e. Valency of the antibody
7. If you immunized a rabbit with sheep red cells and managed to
separate anti-sheep red cells antibodies of several different
isotypes. Then you proceeded to mix I ml of saline containing
5X109 red cells and guinea pig complement with equimolecular
concentrations of antibodies to sheep red cells of each different
isotype. After incubating the mixture of red cells and anti-red cells
for 5 minutes, you measured the amount of free hemoglobin in
each tube. Which antibody were you likely to have added to the
tube in which the concentration of free hemoglobin was highest?
a. IgA
b. IgD
c. IgG1
d. IgG4

ϭϯϲ

 e. IgM
8. If you proceed to perform another experiment in which you
incubated 1 ml of saline containing 5X109 red cells with
equimolecular concentration of antibodies to sheep red cells of
each different isotypes in the complete absence of complement.
After incubating the mixture of red cells and anti- red cells
antibodies for one hour, you washed the red cells, added them to
human monocytes microscopically to determine whether they had
ingested the sheep red cells. Which antibody was most likely to
have been added to the red cells that were more efficiently
ingested?
a. IgA
b. IgD
c. IgE
d. IgG1
e. IgM
9. The protective effect of performed antiviral antibodies is related
to their ability to:
a. Agglutinate circulating viral particles
b. From a soluble immune complexes with viral antigens
c. Induce phagocytosis of the virus
d. Lyse the virus
e. Prevent the virus from infecting its target cell(s)
10.Which of the following hypotheses would sufficiently explain the
non-precipitation of an antigen ± antibody system?
a. The antigen has only two determinants
b. The antigen has multiple, closely repeated determinants
c. The antibody has been cleaved with papain
d. The antibody has been cleaved with pepsin
e. Both C and D are correct
11.Agarose gel electrophoresis and pulsed field gel electrophoresis
may be used to resolve respectively:
a. 2000 kb and 20kb DNA
b. 1000 kb and l0kb DNA
c. 20 kb and 2000 kb DNA
d. 10 kb and 1000 kb DNA

ϭϯϳ

 12.7KH,37*LVDJUDWXLWRXVLQGXFHUVRI ȕ-galactosidase, and x-gal is
DFKURPRJHQLFVXEVWUDWH:KHQ Į-complementation occurs which
colour is produced?
a. Blue
b. White
c. Brown
d. No colour is produced
13.The competitive immunoassay can be used
a. To detect very small amounts of antigen
b. To detect antibody associated with allergies (IgE)
c. Both (a) and (b)
d. Commonly to detect trace amounts of drugs.
14.Which of the following is an immunodiffusion test?
a. Double-diffusion
b. Gel diffusion
c. Ouchterloney technique
d. All of these
15.In Counter immunoelectrophoresis
a. Electrophoresis will drive the antibody and antigen parallel
to each other
b. Electrophoresis will drive the antibody and antigen toward
each other
c. The antibody will migrate towards anode
d. The antibody will migrate towards cathode
16.What is the ELISA test intended to measure?
a. Antibody to HIV only
b. Antigen to HIV only
c. Presence of free, circulating virus in the patient
d. Antibodies directed against HLA molecules
17.Immunoaffinity chromatography can be used in biochemical
applications to
a. Break down antibody structure
b. Purify protein antigen
c. Break down antigen and analyze quantitatively
d. None of the above

ϭϯϴ

 18.Different form of a plasmid, on an agarose gel, after
electrophoresis may be in which of the following sequence in
decreasing molecular weight?
a. Open circular, super coiled, linear plasmid DNA
b. Linear plasmid, open circular, super coiled plasmid
c. Open circular, super coiled, linear plasmid DNA
d. Open circular, linear plasmid, super coiled plasmid
19.In Rocket Immunodiffusion the length of the rocket is
a. Proportional to the amount of antibody placed in each well
b. Inversely proportional to the amount of antibody placed in
each well
c. Inversely proportional to the amount of antigen placed in
each well
d. Proportional to the amount of antigen placed in each well
20.Radial Immunodiffusion is similar to
a. Double-diffusion
b. Gel diffusion
c. Ouchterloney technique
d. All of these
21.Agarose a porous matrix used in various molecular biology
technique is made by repetitive units of
a. Maltose
b. Agarobiose
c. Agar
d. None of these
22.What radioactive molecule is used to end-label an
oligonucleotide?
a. (alpha)-32P-ATP
b. (alpha)-32P-dutp
c. (gamma)-32P-ATP
d. Any of these
23.Which of the following radioactive element is generally involved
in RIA?
a. Tritium
b. Carbon-14
c. Iodine-125
d. All of these

ϭϯϵ

 24.What is approximately the half-life of 32-Phosphorus?
a. 14 days
b. 28 days
c. 42 days
d. 30 days
25.Rocket Immunodiffusion is also known as
a. Gel diffusion
b. Electroimmunodiffusion
c. Double-diffusion
d. None of these
26.DNA- footprinting is a suitable technique for identifying which of
the following?
a. Particular mrna in mixture
b. Particular t-RNA in mixture
c. Introns within DNA
d. Protein binding site within DNA
27.What would happen if serum is omitted from the ELISA, but all
other steps remain same?
a. Anti-human Ig-conjugate would not bind and be washed
away
b. The OD values would be nearly the same as the assay
control
c. Both (a) and (b)
d. Anti-human Ig-conjugate would bind non-specifically to the
ELISA plate
28.RAST test (radio allergosorbent test) is often used to detect
a. Antibodies associated with allergies (IgE)
b. Antigen associated with allergies (IgE)
c. Bacteriophages
d. None of the above
29.What would happen if the anti-human Ig-conjugate is not washed
free of the well before the substrate is added?
a. The ELISA would not develop when the substrate was added
b. The ELISA would develop normally
c. All wells would show uniform over-development due to
unbound and excess anti-human Ig enzyme conjugate
d. None of the above

ϭϰϬ

 30.An antigen preparation and an antibody preparation are tested by
immunodiffusion. Three bands are found, indicating that
a. There was more than one antigen
b. The antibody was impure
c. The temperature was too high
d. There was one antibody and one antigen
31.Immunoelectrophoresis techniques are designed to separate the
mixture components from each other by using electrophoresis
a. Prior to reaction with antibody
b. Prior to reaction with antigen
c. After reaction with antibody
d. After reaction with antigen
32.Which of the following is a positively charged matrix for ion
exchange chromatography?
a. CM cellulose
b. DEAE cellulose
c. Phosphocellulose
d. None of these
33.Which of the following is an immunoelectrophoresis technique?
a. Two-dimensional immunoelectrophoresis
b. Counterimmunoelectrophoresis
c. Coimmunoelectrophoresis
d. Both (a) and (b)
34.In extreme antigen excess, immune complexes between IgG and a
tetravalent antigen have the composition:
a. Ag1Ab4
b. Ag4Ab3
c. Ag2Ab1
d. Ag3Ab2
e. Ag2Ab7
35.Antibody titer refers to the:
a. Absolute amount of specific antibody.
b. Affinity of specific antibody.
c. Avidity of specific antibody.
d. Concentration of specific antibody.
e. Highest dilution of antibody still able to give a positive
result in a test system

ϭϰϭ

 36.The association constant (Ka) at equilibrium is represented by:
a. [agab complex]
b. [free Ag][free Ab]
c. [free Ag][free Ab]/[agab complex]
d. [agab complex]/[free Ag][free Ab]
e. [free Ag]/[free Ab]
37.The affinity of an antibody can be determined by measuring:
a. Its concentration.
b. The valency of antigen binding.
c. The amount of antibody bound at various antigen
concentrations.
d. Its ability to neutralize bacterial toxins.
e. The sedimentation coefficient of the antibody.
38.Latex particles are often used in:
a. Agglutination tests.
b. Affinity chromatography.
c. Affinity measurements.
d. Adjuvants.
e. Neutralization assays.
39.Surface plasmon resonance is a system based on:
a. Fluorescence.
b. Radioactivity.
c. Reflected light.
d. Molecular resonance.
e. Magnetic fields.
40.Characterization of antigens by electrophoresis and
immunofixation relies on the reaction of antigen and antibody in
(or on):
a. Agar.
b. Streptavidin.
c. Gold-plated sensor chip.
d. Latex particles.
e. Plastic microtiter plates.
41.Western blots are primarily used to detect:
a. Protein.
b. Carbohydrate.
c. Lipid.

ϭϰϮ

 d. RNA.
e. DNA.
42.SDS-PAGE separates proteins on the basis of:
a. Isoelectric point.
b. Sedimentation coefficient.
c. Amino acid sequence.
d. Degree of glycosylation.
e. Size.
43.The pepscan technique is most useful for determining:
a. Antibody structure.
b. Discontinuous epitopes recognized by antibodies.
c. Epitopes recognized by T-cells.
d. MHC haplotypes.
e. TCR V beta usage.
44.HAT medium is used to:
a. Immortalize B-lymphocytes.
b. Culture B-lymphocytes.
c. Select for hybrids in the hybridoma technique.
d. Kill B-cell hybridomas.
e. Fuse B-lymphocytes to myeloma cells.
45.A HAMA response cannot be reduced or eliminated using:
a. ADEPT.
b. Chimeric antibodies.
c. Humanized antibodies.
d. Grafted CDRs.
e. Human antibodies.
46.Human monoclonal antibodies can be obtained:
a. Using Epstein-Barr virus immortalization of T-cells.
b. Easily from human hybridomas selected with HT medium.
c. Using transgenic xenomouse strains.
d. By a single point mutation of a mouse monoclonal antibody.
e. Only by fusing human B-cells with mouse myeloma cells.
47.In affinity chromatography the required ligand is often released
by:
a. Changing the ph
b. Vigorous shaking
c. Changing the temperature from 37° to 4°.

ϭϰϯ

 d. Boiling.
e. Adding a small amount of detergent (e.g. 0.025% Tween
20).
48.Coating a cell with specific antibody facilitates its selection by:
a. Sedimentation rate.
b. Buoyant density.
c. Adherence to plastic surfaces.
d. Magnetic beads coated with anti-Ig.
e. Light scatter in the fluorescence activated cell sorter
(FACS).
49.A T-cell hybridoma
a. Is obtained by continuous culture of T-cells with antigen.
b. Is obtained by cloning antigen-specific splenic T-cells.
c. Is obtained by fusing T-cells with a T-cell tumor cell line
and cloning.
d. Expresses a multiplicity of T-cell receptor specificities.
e. Results from producing a mouse which is transgenic for the
rearranged alpha- and beta-receptor from a T-cell clone
50.Which of the following is not used as a direct conjugate to the
antibody for visualizing tissue antigens:
a. Fluorescein.
b. Anti-immunoglobulin.
c. Alkaline phosphatase.
d. Peroxidase.
e. Gold particles.
51.A confocal microscope at high magnification does not:
a. Bring all focal planes of an image into focus simultaneously.
b. Permit construction of a 3-dimensional image.
c. Improve the quality of image definition in a single plane.
d. Provide quantitative data.
e. Function with fluorescent conjugates.
52.The use of green fluorescent protein in flow cytofluorimetry
permits measurement of:
a. Cell size.
b. Cell granularity.
c. Antibody secretion.
d. DNA content.

ϭϰϰ

 e. Intracellular gene expression.
53.The functional activity of neutrophils can be assessed by:
a. The nitroblue tetrazolium test.
b. Proliferation.
c. Limiting dilution analysis.
d. A plaque test for antibody.
e. A fluorescent antibody test for myeloperoxidase.
54.The activation of lymphocytes cannot be assessed by:
a. Mitosis.
b. Cytokine release.
c. Phagocytosis.
d. Cytotoxicity.
e. Limiting dilution analysis.
55.The TUNEL technique can be employed to measure:
a. Precursor frequency.
b. Apoptosis.
c. Directional migration of neutrophils.
d. Phagocytosis.
e. Surface exposed phosphatidylserine.
56.Antibody-secreting cells can be enumerated by:
a. Mitosis.
b. Cytokine release.
c. Total antibody content.
d. Cell surface immunoglobulin.
e. ELISPOT.
57.Introduction of a gene into a cell using calcium phosphate
precipitate is termed:
a. Electroporation.
b. Homologous recombination.
c. Biolistics.
d. Transfection.
e. Mutation.
58.A catalytic antibody is:
a. An enzyme used to digest antibody.
b. An immunoabsorbent.
c. Found in the vacuoles of phagocytic cells.
d. An antibody that is capable of acting as an enzyme.

ϭϰϱ

 e. An antibody to zymosan.
59.In an ELISA you might use an antigen or antibody labeled with:
a. 125I
b. FITC
c. Colloidal gold
d. Europium 3+
e. Horseradish peroxidase
60.Which of the following is not used for the precipitation of immune
complexes?
a. Nephelometry.
b. Polyethylene glycol.
c. Ammonium sulfate.
d. Antibody to immunoglobulin.
e. Staphylococci.
61.Antigen-specific B-cells can be purified by:
a. Sedimentation rate.
b. Panning on anti-Ig plates.
c. Phagocytosis.
d. Forward light scatter in the fluorescence activated cell sorter
(FACS).
e. Binding of fluorescent antigen and separation in the FACS.
62.Antigens in tissues can be localized with fluorescent antibodies
using:
a. Flow cytofluorimetry.
b. A confocal fluorescence microscope.
c. Autoradiography.
d. An enzyme substrate.
e. The electron microscope.
63.A gene can be selectively disrupted by:
a. Electroporation with the normal gene.
b. Homologous recombination.
c. Liposome transfection with the normal gene.
d. Antisense RNA.
e. X-Irradiation.
64.Both agglutination and precipitation tests:
a. Result in antibody cross-linking antigen.
b. Cannot detect antibody.

ϭϰϲ

 c. Result in changes that require microscopy to detect.
d. Involve IgG but not IgM.
e. Involve soluble antigen.
65.Hemagglutination in an immunoassay:
a. Must indicate the presence of antibody.
b. Is not truly agglutination.
c. Requires complement to be fixed.
d. Involves antibodies cross-linking erythrocytes
66.The viral hemagglutination inhibition test:
a. Involves antibodies against erythrocytes blocking viral
binding sites.
b. Involves antiviral antibodies enhancing binding of viral
particles to erythrocytes.
c. Can be used to detect the presence of antibody to the measles
virus in patient serum.
d. Is used to determine blood type.
e. Can be used to detect the presence of the measles virus in
patient serum.
67.Which of the following detects antigen or antibody by a color
change reaction?
a. Agglutination test
b. Toxin neutralization test
c. Precipitation test
d. Complement fixation test
e. ELISA
68.The toxin neutralization assay:
a. Can detect the presence of antitoxin.
b. Is designed to neutralize toxins by cross-linking the antibody
molecules directed against them.
c. Requires antibody molecules to be labeled with a fluorescent
dye.
d. Is designed so that, in the presence of toxin and
corresponding antibodies, toxin molecules bind to target
cells then to antibodies directed against that toxin.
e. Is designed to show the presence of a particular toxin when
the cells used in the assay are damaged by toxin.

ϭϰϳ

 69.In an agglutination assay where serum is diluted by half in each
successive well (1:2; 1:4; 1:8; 1:16, etc.), if the 1:64 well is the
last well to show agglutination, the titer is:
a. 64
b. 1:64
c. 32
d. 128
e. 1:32
70.In a complement fixation test, for a serum sample containing
antibody against the target antigen:
a. Complement will not be fixed and sheep red blood cells will
lyse.
b. Complement will be fixed and sheep red blood cells will not
lyse.
c. Complement will be fixed and sheep red blood cells will
lyse.
d. Complement will be fixed and the sheep red blood cells will
agglutinate.
e. Complement will not be fixed and sheep red blood cells will
not agglutinate
71.A patient's serum is tested using the complement fixation test. If
hemolysis occurs:
a. The patient suffers from a disease in which complement is
lacking or in low concentration.
b. It can be concluded that the patient had antibody to sheep red
blood cells.
c. Complement was not fixed by antibodies in the patient's
serum, thus was available to the antibodies inducing lysis of
sheep red blood cells.
d. It can be concluded that the patient had antibody to the test
antigen.
e. Complement bound to neither the antibody directed against
the target antigen nor the antibody directed against sheep red
blood cells.
72.To detect the presence of antibody to a pathogen in a person
through use of the indirect fluorescent-antibody technique:

ϭϰϴ

 a. A slide is coated with patient serum and labeled antibodies
against human antibodies are added.
b. A slide is coated with patient serum and microbes dyed with
a fluorescent stain are added.
c. A known antigen is fixed to a slide, patient serum is added,
and labeled anti-mouse immune serum globulin is added.
d. A known antigen is fixed to a slide, patient serum is added,
and labeled antibodies that are directed against human
antibodies are added.
e. A known antigen is fixed to a slide and patient serum labeled
with a fluorescent tag is added.

73.For both the direct and the indirect ELISA:

a. Substrate is added as a final step.
b. Agglutination of antigen is observed.
c. Fluorescence of the antigen is observed.
d. The purpose is to detect antigen.
e. The purpose is to detect antibody.
74.Monoclonal antibodies have all of the following properties
EXCEPT:
a. They can be combined with toxins and used therapeutically
to destroy cancer cells.
b. They can be produced in large quantities.
c. They consist of antibodies that react with many different
antigens.
d. They are produced by a hybrid cell formed by combining a
myeloma cell with a normal B-cell.
e. They can be used to suppress T cell activity and prevent
transplant rejection.
75.Which of the following is not a property of the fluorescence-
activated cell sorter (FACS)?
a. It can detect serum antibody levels.
b. It can detect fluorescence.
c. It uses a laser beam.
d. It can separate cells based on charge.
e. It can modify cell charge.

ϭϰϵ

 76.Which is not true for the indirect ELISA?
a. It can detect antibody in patient serum.
b. Microtiter plate wells are first coated with antigen.
c. An antibody sandwich is created.
d. If testing human serum, labeled antiglobulins directed
against human antibodies should be used.
e. It is important to wash off unbound molecules between
steps.
77.Which one of the following specimens for immunological
investigation of a possible myeloma is NOT appropriate?
a. Heparinized blood
b. Clotted blood
c. Sputum
d. Early morning sample of urine
78.Which one of the following is the quickest method for measuring
serum immunoglobulin levels accurately?
a. Immunoelectrophoresis
b. Nephelometry
c. Radioimmunoassay
d. Serum protein electrophoresis
e. Radial immunodiffusion
79. The method of choice for measuring antigen-specific IgE in the
serum is:
a. Radial immunodiffusion
b. Serum protein electrophoresis
c. Indirect immunofluorescence
d. Countercurrent electrophoresis
e. Enzyme-linked immunosorbent assay
80.Which one of the following is NOT a functional test of
neutrophils?
a. The NBT test
b. Cell transformation
c. Bacterial killing
d. Chemotaxis
e. Dihydrorhodamine reduction assay

ϭϱϬ

 81. Which one of the following statements about the tissues to be
used to detect antinuclear antibodies (ANA) is the most
appropriate?
a. Intestine only
b. Kidney only
c. Liver only
d. Any human cell line
e. All of the above
82. Which one of the following autoantibodies is the most
significant in active SLE?
a. Rheumatoid factor
b. IgM antinuclear antibodies
c. Antibodies to dsDNA
d. Antibodies to histones
83.Which one of the following samples can be sent to the laboratory
for reliable routine quantitation of lymphocyte subpopulations.
a. Clotted blood
b. Cerebrospinal fluid
c. Heparinized blood
d. EDTA blood sample
84. Which one of the following diseases does not involve the routine
investigation of different types of circulating cells by flow
cytometry?
a. Severe combined immunodeficiency [SCID]
b. X-linked agammaglobulinaemia [XLA]
c. Acute leukaemias
d. Acquired immune deficiency syndrome (HIV)
e. Rheumatoid arthritis [RA]
85. Which one of the following statements about the types of
monoclonal M bands found by electrophoresis of serum indicates
multiple myeloma?
a. An M band that moves in the beta position on protein
electrophoresis
b. M band found in alpha position
c. Heavy deposit at the original suggesting large load of
monoclonal protein
d. All of the above

ϭϱϭ

 e. None of the above
86.A chromogen may be used in which of the following assays?
a. Direct immuonsorbent assay
b. Indirect immunosorbent assay
c. Western blotting
d. All of the above
e. None of the above
87.The single radial diffusion assay (Mancini technique) quantifies
a. Antibodies.
b. Antigen.
c. Immune complexes.
d. Cytokines.
e. All of the above.
88.Which of the following involves separation of antigens by size on
a gel, followed by diffusion and precipitation?
a. Flow cytometry
b. Double diffusion immunoassay
c. Dmmunoelectrophoresis
d. Direct immunosorbent assay
e. Indirect immunosorbent assay
89.In the direct antiglobulin test _____.
a. Antibody serves as the index molecule.
b. 5%&¶VVHUYHDVWKHLQGLFDWRU
c. Rh factor serves as the indicator.
d. Fluorescence antibody serves as the agent detected.
e. Enzyme-linked antibody serves as the agent detected.
90. Which of the following procedures or tests allows the
identification and collecting of a particular type of cell that has
been recognized by labeled antibody?
a. Western blot
b. Electrophoresis
c. Fluorescence-activated cell sorting
d. Immunofluorescence
e. Immunofixation test
91.What term is defined as the ability of a test to detect small
concentrations of an antigen or antibody?
a. Serology

ϭϱϮ

 b. Agglutination
c. Specificity
d. Titer
e. Sensitivity
92.What type of immunologic reaction occurs when specific
antibodies are mixed with whole cell antigens?
a. Agglutination
b. Precipitation
c. Immunodiffusion
d. Complement fixation
e. Immunoassay
93.Complement fixation testing requires all but which of the
following components?
a. Antibody
b. Antigen
c. Complement
d. Sensitized sheep red blood cells
e. Streptolysin toxin
94.What indicates a positive reaction in the complement fixation test?
a. Antigen-antibody precipitation
b. Solubilization of sheep red blood cells
c. No hemolysis of sheep red blood cells
d. Hemolysis of sheep red blood cells
e. Agglutination of sheep red blood cells
95.Why is serotyping used?
a. To identify, classify, and subgroup certain bacteria into
categories
b. To determine the susceptibility of sheep red blood cells to
complement
c. To identify and diagnose a disease
d. To verify the presence of specific antibodies that react with
specific antigens
e. To identify persons of the same blood type
96.What is the fundamental tool in immunofluorescence testing?
a. Specific antigen
b. Red blood cells
c. Complement

ϭϱϯ

 d. Fluorescent monoclonal antibody
e. Fluorescent polyclonal antibody
97.What reagent is quantified when performing an indirect ELISA?
a. Antigen
b. Antibodies in patient's serum
c. Fluorescent antibody
d. Chromagen
e. Complement
98.When performing a capture ELISA, what must be different about
the antibodies used?
a. The antigen each antibody recognizes
b. The class of antibody each antibody belongs to
c. The antigenic determinant each antibody recognizes
d. The avidity to which each antibody binds to the antigen
e. The concentration of each antibody
99.What is injected into a patient when the tuberculin skin test is
performed?
a. Complement
b. Monoclonal antibodies
c. Sheep red blood cells
d. Polyclonal antibodies
e. Antigen
100. Which one of the following sequences is appropriate for
testing a patient for antibody against the AIDS virus with the
ELISA procedure?
a. Patient`s serum/enzyme substrate/HIV antigen/enzyme
labeled antibody against HIV.
b. HIV antigen/patient`s serum/enzyme- labeled antibody
against human gamma globulin/enzyme substrate.
c. Enzyme-labeled antibody against human gamma
globulin/patient`s serum/HIV antigen/enzyme substrate
d. Enzyme-labeled antibody against HIV/HIV
antigen/patient`s serum/enzyme substrate

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  &KDSWHU1LQH
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0&4
1. The role of the antigen-presenting cell in the immune response is
all of the following EXCEPT:
a. The limited catabolism of polypeptide antigens.
b. To allow selective association of MHC gene products and
peptides.
c. To supply second signals required to fully activate T cells.
d. To present non-self peptides associated with MHC class II
molecules to B cells.
e. To present peptide-MHC complexes to T cells with the
appropriate receptor.
2. Which of the following statements about interleukin 2 (IL-2) is
incorrect?
a. It is produced primarily by activated macrophages.
b. It is produced by CD4+ T cells.
c. It can induce the proliferation of CD4+ T cells.
d. It binds to a specific receptor on CD4+ T cells.
e. It can activate CD8+ T cells in the presence of antigen.
3. CD40 Ligand (CD154) is expressed by which of the following?
a. B cells
b. Dendritic cells
c. Resting T cells
d. Activated T cells
e. All leukocytes
4. Which of the following statements about the activation of CD4 +
cells is incorrect?
a. Binding of peptide + MHC to the TCR results in rapid
phosphorylation of tyrosine residues in proteins associated
with the TCR.
b. Intracellular calcium levels rise rapidly following activation.
c. Only peptide bound in the groove of MHC class II activates
the CD4 + T cells.
d. Interaction of B7 and CD28 stabilizes IL-2 mRNA so
effective IL-2 translation occurs.

ϭϱϲ

 e. The activated cell synthesizes IL-2 and a receptor for IL-
5. Which of the following statements about CD8 + CTL is incorrect?
a. They lyse targets by synthesizing perforin and granzymes.
b. They cause target cell apoptosis.
c. They cannot kill CD4+ T cells.
d. They interact with their target through paired cell surface
molecules.
e. They must be activated before exerting their cytotoxic
function.
6. Infection with vaccinia virus results in the priming of virus-specific
CD8+ T cells. If these vaccinia virus-specific CD8+T cells are
subsequently removed from the individual, which of the following
cells will they kill in vitro?
a. Vaccinia-infected cells expressing MHC class II molecules
from any individual
b. Influenza-infected cells expressing the same MHC class I
molecules as the individual
c. Uninfected cells expressing the same MHC class I molecules
as the individual
d. Vaccinia-infected cells expressing the same MHC class I
molecules as the individual
e. Vaccinia-infected cells expressing the same MHC class II
molecules as the individual
7. Bacterial lipopolysaccharide (LPS), a T-independent antigen,
stimulates antibody production in mice. Which of the following is
incorrect?
a. The antibody produced will be predominantly IgM.
b. Memory B cells will not be induced.
c. IL-4 and IL-5 are required for the production of antibody
during the response.
d. The polymeric nature of the antigen crosslinks B-cell surface
receptors.
e. B cell activation involves phosphorylation of intracellular
molecules.
8. When antigen binds to the T cell receptor, which of the following
is involved in signal transduction?
a. CD3

ϭϱϳ

 b. CD21
c. LFA-1 (CD11a/CD18)
d. ,JĮ,Jȕ &'Įȕ
9. SGR (e.g. BCR resp TCR) on B and T lymphocytes are
a. Bound only to MHC I molecules
b. Encoded to recognize PAMP
c. First to be produced after exposition to foreign molecule
d. Of the same specificity in everybody
e. Randomly generated during intrauterine development
10.T cell development in the thymus includes the following processes:
a. T cell receptor rearrangement
b. Negative selection
c. Positive selection
d. All of the above
e. Only B and C
11.Which of the following describe the role of CD28 in T cell
activation?
a. CD28 on thet cell binds tocd40l on the antigen presenting
cell.
b. Activation of CD28 promotes cell death
c. Preferential engagement CTLA-4 versus CD28 may lead to
cell proliferation
d. A,B C are correct
e. None of the above
12.Which of the following statements is TRUE regarding naïve T-
cells?
a. Naïve T cells circulate throughout the entire body, including
the spleen and readily leave their intravascular space.
b. Naive T cells produce large amounts of effector cytokines
such as IFN-ȖDQG,/-1 12
c. Naïve T cells express T cell receptor but have not been
exposed on antigen.
d. Naïve T cells are extremely short lived, within average
survival time of 8-12 hours.
e. Naïve T cells require little co-stimulation or activation.
13.The structure of the B-cell receptor contains the invariant proteins
,JĮDQG,JȕZKLFKDUHOLQNHGYLDBBBBDQGDUHHVVHQWLDOIRUVLJQDO

ϭϱϴ

 generation across the B-cell surface membrane and for surface
expression of immunoglobulin receptors (mIgs).
a. Covalent bonding
b. Hydrophobic interactions
c. Sulfide bonding
d. Hydrogen bonding
e. Peptide bonding
14.Immunoreceptor tyrosine-based activation motifs (ITAMs) are
essential for signal transduction in ____ cells.
a. B cells
b. T cells
c. B cells or T cells
d. B cells and T cells
e. Neither B or T cells
15.Regarding the structure of the T-cell receptor, which of the
following is NOT an invariant CD3 protein chain?
a. =HWD ȗ FKDLQ
b. (SVLORQ İ FKDLQ
c. *DPPD Ȗ FKDLQ
d. 'HOWD į FKDLQ
16.Which of the following is the correct order for a lymphocyte to be
activated?
a. Recognition of antigen, activation of tyrosine kinases,
clustering of receptors phosphorylation
b. Recognition of antigen, clustering of receptors, activation of
tyrosine kinases, phosphorylation
c. Recognition of antigen, activation of tyrosine kinases,
phosphorylation, clustering of receptors
d. Recognition of antigen, activation of tyrosine kinases,
clustering of receptors,
e. Phosphorylation
f. Recognition of antigen, clustering of receptors,
phosphorylation, activation of tyrosine kinases
17.Protein antigens bound to complement component C3d can bind
simultaneously to both ____ and the BCR. This enables the co-
receptor complex to cluster and crosslink with the BCR, inducing
phosphorylation.

ϭϱϵ

 a. CD19
b. CD20
c. CD21
d. CD81
18.B cell co-UHFHSWRU SKRVSKRU\ODWLRQ VLWHV LQFOXGH ,J Į  ,JȕDQG
which of the following?
a. CD19
b. CD20
c. CD21
d. CD81
19.Presence of the TCR co-receptor molecules (CD4 or CD8) has
been estimated to reduce the number of MHC-peptide complexes
required to trigger a T-cell response by about:
a. 5-fold
b. 10-fold
c. 50-fold
d. 100-fold
e. 1000-fold
20.Leukocyte-specific protein tyrosine kinase (Lck) is integral in the
signaling cascade in ____ cells. Zeta-chain-associated protein
kinase 70 (ZAP-70), which binds CD3-zeta,is ____ cell specific.
Spleen tyrosine kinase (Syk), a signal transmitter, is found
predominantly in ____ cells.
a. B; B; B
b. T; T; T
c. B; B; T
d. T; T; B
e. B; T; T
f. T; B; B
21.Protein tyrosine kinases (PTKs) play an important role in
lymphocyte function and activation. A mutation in the genes
encoding the enzyme ZAP-70 would lead to which of the
following?
a. Human immunodeficiency virus (HIV) infection
b. Acquired immune deficiency syndrome (AIDS)
c. Severe combined immunodeficiency (SCID) syndrome
d. Systemic inflammatory response syndrome (SIRS, sepsis)

ϭϲϬ

 e. X-linked agammaglobulinemia
22.A mutation in the genes encoding the enzyme Bruton's tyrosine
kinase (Btk) would lead to which of the following?
a. Human immunodeficiency virus (HIV) infection
b. Acquired immune deficiency syndrome (AIDS)
c. Severe combined immunodeficiency (SCID) syndrome
d. Systemic inflammatory response syndrome (SIRS, sepsis)
e. X-linked agammaglobulinemia
23.During B cell development, negative selection occurs in an attempt
to ensure the antigen receptor:
a. Can bind with a specific antigen
b. Cannot bind with certain foreign antigens
c. Can bind to self-antigens
d. Cannot bind to self-antigens
24.During B cell development, precursor cells are found in the ____
and immature cells are found in the ____.
a. Bone marrow; Bone marrow
b. Bone marrow; Periphery
c. Periphery; Periphery
d. Periphery; Bone marrow
e. Spleen; Bone marrow
25.Which of the following has the surface marker CD34 instead of the
surface marker CD19, during B cell development?
a. Stem cell
b. Pro-B cell
c. Early pre-B cell
d. Late pre-B cell
e. Immature cell
26.During B cell development, when is there rearrangement in the
heavy (H) chain of the immunoblobulin gene started?
a. Pro-B cell stage
b. Early pre-B cell stage
c. Late pre-B cell stage
d. Immature cell stage
e. Stem cell
27.During B cell development, at what stage can cytoplasmic µ chains
being to be found?

ϭϲϭ

 a. Pro-B cell stage
b. Early pre-B cell stage
c. Late pre-B cell stage
d. Immature cell stage
e. Stem cell
28.During B cell development, at what stage is membrane bound IgM
found?
a. Pro-B cell stage
b. Early pre-B cell stage
c. Late pre-B cell stage
d. Immature cell stage
e. Stem cell
29.Which of the following best describes the role of the pre-B cell
receptor (pre BCR)?
a. Signal transduction leading to cell proliferation
b. Signal transduction leading to cell apoptosis
c. Prevention of self-recognition and thus cell proliferation
d. Acquisition of self-recognition and thus cell apoptosis
e. Binding with cell adhesion molecules (cams)
30.At what stage of B cell development are auto-reactive cells
removed?
a. Stem cell
b. Pro-B cell stage
c. Early pre-B cell stage
d. Late pre-B cell stage
e. Immature cell stage
31.Allelic exclusion creates mono-specific B-cell receptors (BCRs).
The result is these cells each secrete:
a. Different antibodies with distinct antigenic specificities
b. Similar antibodies with distinct antigenic specificities
c. Different antibodies with the same antigenic specificity
d. Similar antibodies with the same antigenic specificity
32.What surface immunoglobulins are present once an immature B
cell becomes amateur (peripheral) B cell?
a. IgD
b. IgM
c. IgA

ϭϲϮ

 d. IgA & IgM
e. IgM & IgD
33.What are peripheral cells called if they have never come in contact
with antigen?
a. Mature cell
b. Immature cell
c. Naïve cell
d. Plasma cell
e. Stem cell
34.Tolerance refers to the ability of B cells to:
a. Tolerate T cells
b. Tolerate other B cells
c. Tolerate self antigens
d. Tolerate foreign antigens
e. Tolerate changes in pH, body temperature, and other
homeostatic changes
35.The activation of a naïve B cell, which generally requires a second
accessory signal, occurs when the B cell exits the bloodstream and
into a ____ lymphoid organ, meets antigen, internalizes the BCR-
antigen complex, and eventually becomes ____ cells.
a. Primary; Plasma
b. Primary; Memory
c. Primary; Plasma & memory
d. Secondary; Memory
e. Secondary; Plasma & memory
36.A young child undergoes implantation of a cardiac pacemaker.
During surgery, the physician must remove the thymus. If this
child encounters an antigen requiring B-cell-T-cell collaboration,
they will ____ to mount an immune response. These antigens are
thus called ____.
a. Still be able; Thymus dependent (TD)
b. Still be able; Thymus independent (TI)
c. Not be able; Thymus dependent (TD)
d. Not be able; Thymus independent (TI)
37.B cells whose BCRs bind antigen with high-affinity receives
survival signals (called____ selection) from follicular dendritic

ϭϲϯ

 cells (FDCs) and germinal center T cells, whereas those that fail to
bind antigen ____.
a. Positive; Proliferate
b. Positive; Die (apoptosis)
c. Negative; Proliferate
d. Negative; Die (apoptosis)
e. Negative; Re-enter circulation
38.Where does affinity maturation occur?
a. Para-cortex of lymphoid tissue
b. Cortex of lymphoid tissue
c. Germinal center of lymphoid tissue
d. Follicular dendritic cells
e. Plasma cells
39.Most peripheral B cells belong to a pool of long lived follicular B
lymphocytes called____ cells. The majority of B cells found in the
fetus and neonate are ____ cells, which express the surface marker
CD5. ____ cells are the most likely to be involved in
autoimmunity.
a. B-1; B-1; B-1
b. B-2; B-1; B-1
c. B-1; B-1; B-2
d. B-2; B-1; B-2
e. B-1; B-2; B-1
40.Which of the following is the correct order of developmental stages
for T cells?
a. Double-positive (DP) then double-negative (DN) then
single-positive (SP)
b. Double-positive (DP) then single-positive (SP) then double-
negative (DN)
c. Double-negative (DN) then double-positive (DP) then
single-positive (SP)
d. Double-negative (DN) then single-positive (SP) then double-
positive (DP)
41.In which of the following developmental stages of T cells are
surface molecules CD4and CD8 NOT expressed?
a. DN cell
b. DP cell

ϭϲϰ

 c. SP cell
d. Mature T cell
42.Where are single-positive (SP) cells found?
a. Bone marrow
b. Thymus subcapsular zone
c. Thymus cortex
d. Thymus medulla
e. Periphery
43.Where are double-negative (DN) cells found?
a. Bone marrow
b. Thymus subcapsular zone
c. Thymus cortex
d. Thymus medulla
e. Periphery
44.Where are double-positive (DP) cells found?
a. Bone marrow
b. Thymus subcapsular zone
c. Thymus cortex
d. Thymus medulla
e. Periphery
45.At what stage does selection occur and where in the thymus does it
occur?
a. DN; Cortex
b. DP; Cortex
c. SP; Cortex
d. DN; Subcapsular zone
e. DP; Subcapsular zone
f. SP; Subcapsular zone
46.Approximately how many cells survive the selection process?
a. 95%
b. 75%
c. 50%
d. 25%
e. 5%
47.Which of the following begins at the DP stage and not the DN
stage?
a. ǹFKDLQUHDUUDQJHPHQW

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 b. ǺFKDLQUHDUUDQJHPHQW
c. īFKDLQUHDUUDQJHPHQW
d. ǻFKDLQUHDUUDQJHPHQW
48.At what stage are rearranged TCRs expressed on the cell surface?
a. DN
b. DP
c. SP
d. Mature naïve T cell
49.Establishment of self-restriction occurs in the thymus ____ and is
called ____selection. Establishment of central self-tolerance occurs
in the thymus ____ and is called____ selection.
a. Cortex; Positive; Medulla; Negative
b. Cortex; Negative; Medulla; Positive
c. Medulla; Positive; Cortex; Negative
d. Medulla; Negative; Cortex; Positive
50.Where does a mature T cell encounter antigen for the first time?
a. Freely in the blood stream
b. Freely in a primary lymphoid organ
c. Freely in a secondary lymphoid organ
d. On an antigen presenting cell (APC) in a primary lymphoid
organ
e. On an antigen presenting cell (APC) in a secondary
lymphoid organ
51.Activation of a T cell requires ____. Following activation, the T
cell proliferates and differentiates into ____, then moves into
peripheral tissues and other organs.
a. A costimulatory signal; Naïve cells
b. Recognition of antigen displayed on MHC molecules and a
costimulatorysignal; Naïve cells
c. Recognition of antigen displayed on MHC molecules;
Effector cells
d. A costimulatory signal; Effector cells
e. Recognition of antigen displayed on MHC molecules and a
costimulatory signal; Effector cells
52.CD4+ cells recognize antigen displayed on MHC ____ molecules
and CD8+ cells recognize antigen displayed on MHC ____
molecules. ____ has TH1 and TH2 cell populations.

ϭϲϲ

 a. Class I; Class II; CD4+
b. Class I; Class II; CD8+
c. Class II; Class I; CD4+
d. Class II; Class I; CD8
53.Which of the following enhances IgE antibody response and mast
cell and eosinophil function?
a. TH1 cell population
b. TH2 cell population
c. Which of the following enhances inflammatory responses
(e.g. Activate macrophages to kill intracellular bacteria) and
stimulates IgG production?
d. TH2 cell population
54.Patients with MHC class II (or class I) antigen deficiency would
exhibit which of the following?
a. Human immunodeficiency virus (HIV) infection
b. Acquired immune deficiency syndrome (AIDS)
c. Persistent bacterial and viral infections
d. Coagulation disorders (hemophilia)
e. Systemic inflammatory response syndrome (SIRS, sepsis)
55.7KHȖįWFHOODFWVDVDSDUWRIWKH ILUVW OLQH RIGHIHQVHUHFRJQL]LQJ
microbial invaders. They appear to recognize commonly occurring
PLFURELDOSDWKRJHQV:KHUHFDQȖįWFHOOVEHIRXQG"
a. Liver and kidney
b. Bone marrow and spleen
c. Skin and gut mucosa
d. Respiratory tract and bone marrow
e. Brain and spinal cord
56.,Q FRQWUDVW WR Įȕ 7 FHOOV ȖįW FHOOV UHFRJQL]H FHUWDLQ SHSWLGH DQG
non-peptide antigens ____ processing and in the ____ of MHC
class I and/or II molecules.
a. Only with; Absence
b. Only with; Presence
c. Without; Absence
d. Without; Presence
57.T-cell CD40L provides a costimulatory signal to B-cells by
ligating:
a. Surface Ig

ϭϲϳ

 b. MHC class II
c. CD28
d. CD19
e. CD40
58.On injection into mice, bovine serum albumin conjugated with
dinitrophenol (DNP) behaves as a:
a. Type 1 thymus-independent antigen.
b. Type 2 thymus-independent antigen.
c. Thymus-dependent antigen.
d. A polyclonal T-cell activator.
e. Hapten.
59.Which one of the following events occurs earliest in T-cell
signaling:
a. Activation of phospholipase C.
b. Activation of protein kinase C.
c. Production of inositol triphosphate.
d. Activation of protein tyrosine kinase.
e. Mobilization of intracellular calcium
60.The main costimulatory signal for activation of resting T-cells is
provided by ligation of:
a. CD28
b. Surface Ig
c. LFA-1
d. VLA-4
e. IL-2
61.The T-cell receptor link to MHC/peptide is enhanced by interaction
between MHC class II on the antigen-presenting cells with the
following molecule on the T-cell:
a. LFA-1
b. CD2
c. CD4
d. CD8
e. CD28
62.B-cells as distinct from T-cells:
a. Are polyclonally activated by phytohemagglutinin.
b. Bear surface Ig receptors for antigen.
c. Bear surface CD3 molecules.

ϭϲϴ

 d. Are lymphocytes.
e. Can be activated by stimulation through the antigen receptor
alone
63.Activation of resting B-cells by T-helpers depends directly upon
costimulatory interaction between:
a. CD40 and CD40L.
b. B7 and CD28.
c. B7 and CTLA-4.
d. CD4 and MHC class II.
e. ICAM-1 and LFA-1
64.Cross-linking of B-cell surface receptors:
a. Is a characteristic feature of thymus-dependent antigens.
b. Lowers the intracellular Ca++ concentration.
c. Rapidly phosphorylates the Ig-alpha and Ig-beta chains of
the surface Ig receptor.
d. Requires contiguity of 2 B-cell epitopes of different
specificity on the same antigen molecule.
e. Cannot be achieved by anti-idiotypic antibodies
65.T-cell help for antibody production:
a. Depends on T-cell recognition of native antigen bound to B-
cell surface Ig.
b. Depends on T-cell recognition of antigen processed by the
B-cell.
c. Involves class I MHC on the B-cell.
d. Can occur in X-irradiated mice.
e. Is a feature of the antibody response to pneumococcal
polysaccharide SIII.
66.The carrier T-cell epitope on a thymus-dependent antigen:
a. Behaves like a hapten.
b. Needs to be polymeric.
c. Need not be physically connected to the B-cell epitope.
d. Is a carbohydrate.
e. Stimulates help for the B-cell response
67.Lipopolysaccharide (LPS) from Gram-negative bacteria is:
a. A thymus-dependent antigen.
b. A type 2 thymus-independent antigen.
c. A polyclonal activator of murine B-cells.

ϭϲϵ

 d. Cross-links Ig receptors on B-cells.
e. Produces high affinity IgG memory responses
68.T-cell mutants lacking CD45 cannot transduce signals received
through the specific T-cell receptor because CD45:
a. Has protein tyrosine kinase activity.
b. Directly phosphorylates CD4.
c. Is a calcium ion channel.
d. Removes a phosphate group from a negative regulatory site
on the Lck kinase.
e. Acts as a nuclear transcription factor.
69.In the immunological synapse:
a. The acetylcholine receptor in expressed on the T-cell.
b. Production of substance P by the antigen-presenting cell is a
key event.
c. The initial interaction between TCR and MHC is unstable.
d. Adhesion molecule pairs eventually move to the center of
the synapse.
e. The B7±CD28 interaction is redundant.
70.The nuclear AP-1 site responsible for 90% of IL-2 enhancer
activity binds:
a. The Oct ± 1 transcriptional factor.
b. The Fos/Jun transcription factors.
c. The nuclear factor of activated T-cells (NFAT).
d. The NF-kappa B transcriptional factor.
e. Polyclonal mitogenic agents such as concanavalin A.
71.The early increase in phospholipase C gamma 1 activity following
T-cell stimulation:
a. Represents a sensitive regulatory negative feedback control
mechanism.
b. Dephosphorylates protein tyrosine kinase inhibitors.
c. Accelerates hydrolysis of diacylglycerol.
d. Accelerates hydrolysis of phosphatidylinositol diphosphate.
e. Accelerates hydrolysis of inositol triphosphate.
72.Protein tyrosine kinase activity following T-cell stimulation:
a. Phosphorylates and thereby activates phospholipase C
gamma 1.

ϭϳϬ

 b. Is an inherent property of the T-cell receptor alpha and beta
chains.
c. Is an inherent property of CD3.
d. Is unaffected by herbimycin A.
e. Is unrelated to phosphorylation of the CD3-associated zeta
chains.
73.Proliferation of activated T-cells:
a. Is stimulated by a single signal induced by engagement of
the T-cell receptor.
b. Requires both the signal described in A plus costimulation
from B7.
c. Requires both the 2 signals described in B plus interaction
between LFA-1 and ICAM-1.
d. Requires only mutual binding of LFA-3 and CD2 on the
antigen-presenting cell and T-cell respectively.
e. Is unaffected by anergy
74.The T-cell ligand binding B7 on a professional antigen-presenting
cell is:
a. CD28
b. CD2
c. LFA-1
d. ICAM-1
e. VCAM-1
75.When a resting naive T-cell engages its specific MHC/peptide
complex displayed on the surface of a fibroblast it:
a. Undergoes blast cell formation.
b. Produces IL-2.
c. Moves from Go to G1 of the cell cycle.
d. Becomes anergic.
e. Secretes IL-1.
76.Positive and negative selection processes in the thymus generate a
T cell repertoire that is both self-tolerant and self-restricted. This
means that the mature T cells that develop have a repertoire of
receptors that are specific for:
a. Non-self antigenic peptides bound to non-self MHC
molecules
b. Self antigenic peptides bound to self MHC molecules

ϭϳϭ

 c. Self antigenic peptides bound to non-self MHC molecules
d. Non-self antigenic peptides bound to self-MHC molecules
e. Any peptide antigen bound to any MHC molecule.
77.A mature naïve helper T cell would express which combination of
WKHVXUIDFHPROHFXOHVGHVLJQDWHG7&5 Įȕ &'DQG&"
a. TCR- CD4- CD8-
b. TCR+ CD4+ CD8+
c. TCR= CD4- CD8-
d. TCR- CD4+ CD8-
e. TCR+ CD4+ CD8-
78.Cytotoxic T cells (CTL) isolated from an individual infected with
Virus A will kill virally infected cells in an in vitro assay. What
viral antigen /MHC molecules combination do these CTL
recognize?
a. Infected with virus A and expressing the identical MHC
class I molecule as the CTL
b. Infected with Virus B and expressing the identical MHC
class I molecules as the CTL
c. Infected with Virus A and expressing the different MHC
class I molecules as the CTL
d. Infected with Virus B and expressing the different MHC
class I molecules as the CTL
79.Which "receptor/ligand" pair supplies the crucial second signal for
activation of B lymphocytes by T helper cells?
a. CD4/MHC II
b. LFA-1/ICAM-1
c. CD28/CD80 (B7)
d. Antigen/immunoglobulin
e. CD2/CD58
80.During the maturation of a B lymphocyte, the first immunoglobulin
heavy chain synthesized is the:
a. Gamma chain
b. Mu chain
c. Epsilon chain
d. Alpha chain
81.Antigen- presenting cells that activate cytotic T cells must express
which one of the following on their surface?

ϭϳϮ

 a. IgG
b. Gamma interferon
c. Class II MHC antigens
d. Class I antigens
82.Which of the following is a pathway that would lead to the
activation of cytotoxic T cells?
a. %FHOOFRQWDFWDQWLJHQĺKHOSHU7FHOOLVDFWLYDWHGĺFORQDO
selection occurs
b. %RG\ FHOO EHFRPHV LQIHFWHG ZLWK D YLUXV ĺ QHZ YLUDO
proteins aSSHDU ĺ FODVV , 0+& PROHFXOH-antigen complex
displayed on cell surface
c. Self-WROHUDQFHRILPPXQHFHOOVĺ%FHOOVFRQWDFWDQWLJHQĺ
cytokines released
d. &RPSOHPHQWLVVHFUHWHGĺ%FHOOFRQWDFWVDQWLJHQĺKHOSHU
7FHOODFWLYDWHGĺF\WRNLQHVUHOHDVHG
e. Cytotoxic T FHOOV ĺ FODVV ,, 0+& PROHFXOH-antigen
FRPSOH[GLVSOD\HGĺF\WRNLQHVUHOHDVHGĺFHOOO\VLV
83.Which of the following are characteristics of the DN3 phase or
region 3 of T cell development?
a. Cells commit to T cell lineage
b. TCR B-chain rearrangement occurs
c. T cell lineages Alpha /Beta or Gamma/Delta diverge
d. CD44-CD25+CD4-CD8-
e. All of the above
84.Which of the following correspond to the DN1 phase of T cell
development?
a. Uncommitted progenitors; CD44+CD25-CD4-CD8
b. Clonal expansion
c. Lose potential to become B cells or NK cells
d. Cells commit to T cell lineage and TCR B-chain
rearrangement occurs
85.Double positive CD44-CD25-CD4+CD8+ cells are found:
a. In region 1 of the thymus
b. In region 2 of the thymus
c. In region 3 of the thymus
d. In region 4 of the thymus
86.Positive selection involves which interactions between which cells:

ϭϳϯ

 a. CD3+TCR+ T cells and cortical TECs
b. CD3+TCR+ T cells and IL-7
c. CD3+TCR+ T cells and CD40l
d. CD3+TCR+ Tcells and CD4LOWCD8+ T cells
87.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
88.A defect in which of the following proteins blocks B cell
development at the pre B cell stage, resulting in almost no
circulating antibodies in individuals with this defect:
a. Brutons tyrosine kinase (Btk)
b. CD19
c. Terminal deoxynucleotidyltransferase (tdt)
d. Pax-5
e. IL-7 receptor
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.B cells predominantly express the following cell markers:
a. CD19 and CD20
b. CD16 and CD56
c. CD18 and CD35
d. CD46 and CD55
e. CD28 and CD23
91.Most of the intrathymic death of potential T cell subsets is due to:
a. Apoptosis
b. Necrosis
c. Phagocytosis

ϭϳϰ

 d. Pinocytosis
e. MHC-restriction
92.Thymus is roughly divided into:
a. REGIONS
b. REGIONS
c. REGIONS
d. 5 REGIONS
93.The earliest stages of B-cell differentiation:
a. Occur in the embryonic thymus .
b. Require the presence of antigen .
c. ,QYROYHUHDUUDQJHPHQWRIț-chain gene segments .
d. Involve rearrangement of surrogate light-chain gene
segments .
e. Involve rearrangement of heavy-chain gene segments
94.T cells mature in the thymus. Their maturation is driven by the
______ protein that is expressed by stromal cells in the thymus
a. zeta protein of CD3
b. CD44
c. IL-2
d. Notch
e. NF-κB
95.Ig-α/Ig-β signaling in B cells is similar to CD3 signaling in T
cells. Their signaling involves activation of _____ on their
cytoplasmic tail:
a. NFκB
b. ITAM
c. Rho
d. Phospholipase C
e. B7
96.The clonal selection theory states that
a. All B cells are exact clones of each other.
b. All T cells are exact clones of each other.
c. When a B or T cell is stimulated by encountering the correct
antigen, it divides to form a clone of cells that will respond
to the same antigen.

ϭϳϱ

 d. When a B or T cell is stimulated by encountering the correct
antibody, it divides to form a clone of cells that will respond
to the same antibody.
e. None of these is a correct statement.
97.Although DC generally are strong activators of T lymphocytes by
way of their natural capacity to express co-stimulatory molecules,
there are instances requiring CD4+ T lymphocyte help in order to
achieve complete CD8+ T lymphocyte activation during some viral
infections. What is the nature of CD4+ T lymphocyte help?
a. 1L-4 stimulation of CD8+ T lymphocytes
b. 1L-3 stimulation of CD8+ T lymphocytes
c. IL-1 stimulation of CD8+ T lymphocytes
d. 1L-2 stimulation of CD8+ T lymphocytes
e. IL-6 stimulation of CD8+ T lymphocytes
98.For naive CD4+ T lymphocytes to commit to a TH1 response, they
require several signals. What are they?
a. MHC class I antigen presentation, CD80/CD86 co-
stimulation and 1L-12
b. MHC class I antigen presentation, CD80/CD66 co-
stimulation and 1L-4
c. MHC class II antigen presentation, CD80/CD86 co-
stimulation and 1L-4
d. MHC class II antigen presentation, CD40 co-stimulation and
1L-4
e. MHC class II antigen presentation, CD80/CD86 co-
stimulation and 1L-12
99.T lymphocytes are subdivided into CD4+ T cells and CD8+ T
cells. CD4+ T cells, or, helper T cells, are further subdivided into
Th1 and Th2 cells by which manner?
a. Th2 cells develop under the influence of IL-12 to secrete IL-
2 and interferon-y
b. Th2 cells develop under the influence of IL-2 to effect
allergic reactions
c. Th1 cells develop under the influence of IL-4 to effect
antibody formation
d. Th1 cells develop under the influence of IL-12 to drive cell-
mediated immune responses

ϭϳϲ

 100. Some mice have been developed that cannot produce the
molecule B2 microglobulin. What will happen to the T cells of
these mice as they undergo selection in the thymus?
a. They will fail to develop any T cells
b. As they still can produce T cells thymic selection will be
unaffected
c. They cannot produce CD4+ T cells
d. They cannot produce CD8+ T cells

ϭϳϳ

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15.a 40.c 65.b 90.a
16.b 41.a 66.e 91.a
17.b 42.d 67.c 92.b
18.c 43.b 68.d 93.e
19.a 44.c 69.c 94.d
20.d 45.b 70.b 95.b
21.c 46.e 71.d 96.c
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  &KDSWHU7HQ
 7&5DQG%&5
0&4
1. The T-cell receptor:
a. Is composed of four polypeptide chains
b. Is secreted into the plasma by the T-cell
c. Is the recognition element of the humoral arm of the immune
system
d. Recognizes antigen fragments via the alpha and beta chains
2. Fundamental difference between the antigen receptors on B cells
(BCR) and on T cells(TCR) is their
a. Different requirements for antigen presentation.
b. Function following antigen binding.
c. Heterogeneity from one lymphocyte to the next.
d. Heterogeneity on each lymphocyte.
e. Membrane location.
3. Protein and nucleic acid sequence data have been obtained for many
TCs with different specificities. Analyses of these sequences
suggest the existence of how many hypervariable (HV) regions
within the variable region?
a. 1
b. 2
c. 3
d. 4
e. 5
4. The biochemical structure of the T-cell receptor (TCR) of the
ĮȕW\SH  RI KXPDQ 7&5V  LV FRPSDUDEOH WR D BBBB
immunoglobulin ____ fragment, having very short cytoplasmic tails
a. Secreted; Fab
b. Secreted; Fc
c. Membrane-bound; Fab
d. Membrane-bound; Fc
5. Where are įȖW FHOOV JHQHUDOO\ IRXQG LQ WKH ERG\ ORFDWLRQ RI 7&5
rearrangement)?
a. Spleen
b. Bone marrow

ϭϳϵ

 c. Thyroid
d. Thymus
e. Thalamus
6. ,QFRPSDULVRQWRĮȕWFHOOVįȖ7FHOOVBBBBDQGDUHK\SRWKHVL]HGWR
be a ____ line of immune defense.
a. Recognize peptide antigens by MHC; Primary
b. Do not recognize peptide antigens by MHC; Primary
c. Recognize peptide antigens by MHC; Secondary
d. Do not recognize peptide antigens by MHC; Secondary
7. :KLFKRIWKHIROORZLQJEHVWGHVFULEHVWKHORFDWLRQRIWKHGHOWD į -
chain locus inhuman T-cell receptors?
a. Chromosome 7
b. &KURPRVRPHZLWKLQWKHDOSKD Į -locus
c. Chromosome 14
d. &KURPRVRPHZLWKLQWKHEHWD ȕ -locus
e. &KURPRVRPHZLWKLQWKHDOSKD Į -locus
8. Which of the following are located in chromosome 7 within human
T-cell receptors?
a. $OSKD Į -locus
b. Beta ȕ -locus
c. *DPPD Ȗ -locus
d. A & B
e. B & C
9. Comparing the arrangement of TCR genes and BCR genes, the
____ chain is analogous to the heavy (H) chain and the ____ chain
is analogous to the light (L) chain.
a. $OSKD Į %HWD ȕ
b. %HWD ȕ $OSKD Į
c. 'HOWD į *DPPD Ȗ
d. *DPPD Ȗ 'HOWD į
10.Which of the following TCR genetic chains contain D-segments,
similar to immunoglobulin heavy chains?
a. $OSKD Į %HWD ȕ
b. 'HOWD į *DPPD Ȗ
c. %HWD ȕ 'HOWD į
d. *DPPD Ȗ $OSKD Į
e. $OSKD Į 'HOWD į

ϭϴϬ

 11.Which of the following TCR genetic chains contains V and J
segments, similar to genes for immunoglobulin kappa and lambda
light chains?
a. $OSKD Į %HWD ȕ
b. 'HOWD į *DPPD Ȗ
c. %HWD ȕ 'HOWD į
d. *DPPD Ȗ $OSKD Į
e. $OSKD Į 'HOWD į
12.The process used to increase antigen binding affinity is called
somatic ____ and occursin ____ cells but not ____ cells.
a. Cell hybridization; B; T
b. Cell hybridization; T; B
c. Hypermutation; B; T
d. Hypermutation; T; B
13.Deficiencies in ____ lead to autosomal-recessive severe combined
immunodeficiency disease (SCID).
a. RAG-1
b. RAG-2
c. RAG-1 or RAG-2
d. Both RAG-1 and RAG-2
14.If both RAG-1 and RAG-2 mutations occur, which of the following
is TRUE?
a. T cells will be absent but B and NK cells will be present
b. T and B cells will be absent but NK cells will be present
c. B cells will be absent but T and NK cells will be present
d. B and NK cells will be present but T cells will be absent) B,
T, and NK cells will be absent
15.If a B cell successfully rearranges the first heavy chain locus, it
inhibits the rearrangement of the other heavy chain on the other
chromosome. What is this called?
a. Affinity maturation
b. Allelic exclusion
c. Class switching
d. Somatic cell hybridization
e. Somatic hypermutation

ϭϴϭ

 16.Allelic exclusion is a process by which the protein from only one
allele is expressed while other allele(s) are silenced. Allelic
exclusion occurs (generally) in which of the following?
a. B cells and TCR beta chains, but not in alpha chains
b. B cells and TCR alpha chains, but not in beta chains
c. TCR beta chains, but not in alpha chains or B cells
d. TCR alpha chains, but not in beta chains or B cells
e. B cells, TCR beta chains, and TCR alpha chains
17.Super antigens such as staphylococcal enterotoxins bind to certain
TCR ____ chains and to MHC class II molecules. MHC binding
does not involve the peptide groove. Tcells can then release
extremely high levels of cytokines, which lead to toxic shock
syndrome (TSS) when they appear in the blood.
a. $OSKD Į
b. Beta ȕ
c. 'HOWD į
d. *DPPD Ȗ
18.The TCR binds with ____, and the relatively ____ surface of the
TCR interacts with its ligand.
a. MHC only; Flat
b. MHC only; Curved
c. Peptide antigen only; Flat
d. Peptide antigen only; curved
e. Both MHC and peptide antigen; Flat
19.T cells ____ the potential to express an alternative secreted form
like the B-cellantigen receptor. Super antigens can activate T cells
____ antigen processing andpresentation.
a. Have; Only with
b. Have; Independent of
c. Do not have; Only with
d. Do not have; Independent of
20.A TCR complex is comprised of the TCR, CD3 molecules, and
which of the following CD3 chains?
a. 'HOWD į FKDLQ
b. Gamma Ȗ FKDLQ
c. (SVLORQ İ FKDLQV WZRFKDLQV
d. =HWD ȗ FKDLQV WZRFKDLQV

ϭϴϮ

 21.Which of the following molecules is necessary (not accessory) for
antigen recognition and T cell activation?
a. CD2
b. CD3
c. CD4
d. CD8
e. CD28
22.CD4 molecules bind with ____ MHC molecules and are found on
(expressed by) ____ cells. CD8 molecules bind with ____ MHC
molecules and are found on (expressed by) ____ cells.
a. Class I; Helper T; Class II; Cytotoxic T
b. Class I; Cytotoxic T; Class II; Helper T
c. Class II; Helper T; Class I; Cytotoxic T
d. Class II; Cytotoxic T; Class I; Helper T
23.Which of the following is the cellular receptor for HIV attachments
to T cells?
a. CD2
b. CD3
c. CD4
d. CD8
e. LFA-1
24.CD4 and CD8 enhance the response of specific T cells, both by
stabilizing the TCR-peptide-MHC complex and by bringing what
type of protein kinase into the proximity of the cytoplasmic tails,
thereby facilitating signal transduction and cell activation?
a. Serine
b. Threonine
c. Aspartic acid
d. Histidine
e. Tyrosine
25.Activation of the gene for IL-2, and eventually TH proliferation, is
causes by a critical signal (along with TCR signal transduction)
from ____ on the B cell and ____ on the T cell.
a. CD154; CD40
b. CD28; CD80
c. CD40; CD154
d. CD80; CD28

ϭϴϯ

 e. CD3; CD4
26.Which of the following is TRUE regarding immunoglobulin and T-
cell receptor (TCR) proteins and gene segments?
a. +HDY\ FKDLQ DQDORJRXV WR ȕį 7&5 FKDLQ XVLQJ 9'- JHQH
VHJPHQW /LJKW FKDLQ DQDORJRXV WR ĮȖ 7&5 FKDLQ XVLQJ 9-
gene segment
b. /LJKW FKDLQ DQDORJRXV WR ȕį 7&5 FKDLQ XVLQJ 9'- JHQH
VHJPHQW+HDY\FKDLQDQDORJRXVWR ĮȖ7&5FKDLQXVLQJ9-
gene segment
c. +HDY\ FKDLQ DQDORJRXV WR ȕį 7&5 FKDLQ XVLQJ 9- JHQH
VHJPHQW/LJKWFKDLQDQDORJRXVWRĮȖ7&5FKDLQXVLQJ9'-
gene segment
d. /LJKW FKDLQ DQDORJRXV WR ȕį 7&5 FKDLQ XVLQJ 9- JHQH
VHJPHQW +HDY\ FKDLQ DQDORJRXV WR ĮȖ 7&5 FKDLQ XVLQJ
VDJ gene segment
e. Heavy chain DQDORJRXV WR ĮȖ 7&5 FKDLQ XVLQJ 9'- JHQH
VHJPHQW /LJKW FKDLQ DQDORJRXV WRȕį 7&5 FKDLQ XVLQJ 9-
gene segment
27.Which of the following has an immunoglobulin fold?
a. BCRs
b. TCRs
c. MHCs
d. BCRs & TCRs
e. BCRs, TCRs, & MHCs
28.The genes encoding which of the following can undergo
hypermutation to create receptors that are an even better fit for
foreign antigens?
a. BCRs
b. TCRs
c. MHCs
d. BCRs & TCRs
e. BCRs, TCRs, & MHCs
29.The genes encoding which of the following are extensively
polymorphic (have multiple alleles or forms of the same gene)?
a. BCRs
b. TCRs
c. MHCs

ϭϴϰ

 d. BCRs & TCRs
e. BCRs, TCRs, & MHCs
30.Which of the following is a transmembrane glycoprotein that serves
as a co-receptor for the T cell receptor (TCR), and is also known as
a cytotoxic T cell (CTL)?
a. Cluster of differentiation 4 (CD4+)
b. Cluster of differentiation 8 (CD8+)
c. Plasma cells (activated B cells)
d. None of the above
31.Positive selection involves which interactions between which cells:

a. CD3+TCR+ T CELLS AND CORTICAL TECs
b. CD3+TCR+ T CELLS AND IL-7
c. CD3+TCR+ T CELLS AND CD40L
d. CD3+TCR+ T CELLS AND CD4LOWCD8+ T CELLS
32.The TCR B locus contains V-D-J segments like the IGH locus and
the TCR alpha locus contains:
a. D segments
b. V-J segments like Ig light chain loci
c. Somatic mutation
d. Diversity segments
33.Coligation of TCR with MHC/peptide CTLA-4 with B7 leads to
a. Arrest of cell-cycle and termination of t-cell activation
b. Enables t cell to be recognized by both cell-CLL contact and
cytokines
c. Promotes b-cell proliferation and differentiation, prevents
apoptosis of germinal center b cells and promotes antibody
class switching
d. None of the above
34. A/B TCRs have a total diversity of
a. ~ 10^18
b. ~ 10^13
c. ~ 10^14
d. ~ 10^15
35. Which of the following is NOT True about TCR?
a. All TCRs on a particular T cell have identical idiotypes.
b. CDR3 of TCR has the most sequence variability from
molecule to molecule.
c. TCR has binding sites for both antigen and self MHC.
d. TCR is a disulfide-bonded heterodimer.
e. 7KH Įȕ RU Ȗį LVRW\SH RI 7&5 GHWHUPLQHV WKH ELRORJLFDO
function of its secreted form.
ϭϴϱ

 36.The antigen-binding region of TCR is formed by the folding of
a. 9ĮDQG9ȕFKDLQV
b. 9Į9ȕDQG&'FKDLQV
c. 9ĮDQG9ȕ-microglobulin chains.
d. 9ȖDQG9ĮFKDLQV
e. VL and VH chains.
37.Which of the following properties are NOT shared by TCR and
BCR?
a. Antigen-binding avidity is increased by the presence of two
antigen binding regions on each receptor.
b. Antigen-binding diversity is generated through gene
rearrangement.
c. Folding of protein domains is maintained by intrachain
disulfide bonds.
d. Membrane expression and lymphocyte activation by antigen
require receptors to be associated with signal transduction
molecules.
e. Receptor antigen-binding sites are formed from two
polypeptide chains.
38.TCR most closely resembles
a. Class I MHC.
b. Class II MHC.
c. Fab region of immunoglobulin.
d. Fc region of immunoglobulin.
e. Light chain of immunoglobulin.
39. Rearrangement of both TCR and BCR gene segments does NOT
a. Generate diversity of antigen binding by recombination of a
large pool of germ-line V, D, and J segments.
b. Lead to CDR3 being the most hypervariable region in the
receptor chains.
c. Require RAG-1, RAG-2, and TdT expression.
d. Result in allelic exclusion of membrane receptors.
e. Result in isotype switching after antigen stimulation of the
mature lymphocytes.
40.The amount of diversity in TCR generated within one individual by
somatic recombination
a. Is higher than BCR diversity.
b. Is about the same as for BCR diversity.
c. Is lower than BCR diversity.
d. Is lower than Class I MHC diversity.
e. Is lower than Class II MHC diversity.
41.T cells use all of the following for generating antigen-recognition
diversity on the TCR, EXCEPT

ϭϴϲ

 a. Combinatorial association of chains.
b. Combinatorial association of segments.
c. Large germline pool of gene sequences.
d. N region addition of nucleotides.
e. Somatic hypermutation.
42.CD8 is a co-receptor on T cells that binds:
a. CD3.
b. Endogenous antigen peptide.
c. The constant region of Class I MHC.
d. The constant region of TCR.
e. The variable region of Class I MHC.
43. All of the following are true for antigen receptors on both B cells
and T cells EXCEPT
a. Associated with signal transduction molecules in the
membrane.
b. Generated by somatic recombination during lymphocyte
development.
c. Members of the Ig gene superfamily.
d. MHC-restricted in their ability to bind antigen.
e. Specific for a single antigen epitope.
44.Which of the following statements is FALSE?
a. TCR is allelically excluded on individual T cells.
b. CD4 and CD8 co-receptors are also signal transducing
molecules for T cell activation.
c. The arrangement of a chain gene segments most closely
resembles that of k chain.
d. The gene segments for the d chain are interspersed with
those for the g chain.
e. The T cells that are most likely to react against allogeneic
kidney cells are CD8+ cytotoxic T cells.
45.Which of the following statements is incorrect concerning TCR and
Ig genes?
a. In both B- and T-cell precursors, multiple V-, D-, J-, and C-
region genes exist in an un rearranged configuration.
b. Rearrangement of both TCR and Ig genes involves specific
recombinase enzymes that bind to specific regions of the
genome.
c. Both Ig and TCR are able to switch C-region usage.
d. Both Ig and TCR exhibit allelic exclusion.
e. Both Ig and the TCR use combinatorial association of V, D,
and J genes and junctional imprecision to generate diversity.
46.The earliest stages of B-cell differentiation
a. Occur in the embryonic thymus

ϭϴϳ

 b. Require the presence of antigen
c. Involve rearrangement of k-chain gene segments
d. Involve rearrangement of surrogate light-chain gene
segments
e. Involve rearrangement of heavy-chain gene segments
47.Which of the following is expressed on the surface of the mature B
lymphocyte"
a. CD40
b. MHC class II molecules
c. CD32
d. IgM and IgD
e. All of the above
48.Which of the following statements is incorrect"
a. Antibodies in a secondary immune response generally have a
higher affinity for antigen than antibodies formed in a
primary response
b. Somatic hypermutation of V region genes may contribute to
changes in antibody affinity observed during secondary
responses
c. Synthesis of antibody in a secondary response occurs
predominantly in the blood
d. Isotype switching occurs in the presence of antigen
e. Predominantly IgM antibody is produced in the primary
response
49.Immature B lymphocytes
a. Produce only m chains
b. Are progenitors of T as well as B lymphocytes
c. Express both IgM and IgD on their surface
d. Are at a stage of development where contact with antigen
may lead to unresponsiveness
e. Must go through the thymus to mature
50.Antigen binding to the B-cell receptor
a. Transduces a signal through the antigen-binding chains
b. Invariably leads to B-cell activation
c. 7UDQVGXFHVDVLJQDOWKURXJKWKH,JĮDQG,JȕPROHFXOHV
d. Results in macrophage activation
e. Leads to cytokine synthesis, which activates T cells
51.Which of the following would not be found on a memory B cell
a. ,JĮDQG,Jȕ
b. īKHDY\FKDLQV
c. ‫ڙ‬KHDY\FKDLQV
d. Surrogate light chains
e. ȀOLJKWFKDLQV

ϭϴϴ

 52.A 19-year-old African-American presents to her primary care
physician with an extranodal mass involving the mandible. Biopsy
revealed lymphoma cells with the following characteristics: germ
line TCR genes, surface IgM+, surface IgD+, CD19+. What normal
cell component markers are most similar to those expressed by the
lymphoma cell?
a. Pre-B cell
b. Immature B cell
c. Mature B cell
d. Immature T cell
e. Mature T cell
53.In B cell development when the heavy chain first rearranges it may
be expressed on the cell surface prior to light chain rearrangement.
If this occurs, the heavy chain is associated with which of the
following on the surface of the cell"
a. Invariant chain
b. Surrogate light chains
c. CLIP
d. B-2 microglobulin
e. It is expressed by itself
54.Which of the following statements concerning T-cell development
is correct"
a. Progenitor T cells that enter the thymus from the bone
marrow have already rearranged their T cell receptor genes
b. Interaction with thymic non-lymphoid cells is critical
c. Maturation in the thymus requires the presence of foreign
antigen
d. MHC class II molecules are not involved in positive
selection
e. Mature, fully differentiated T cells are found in the cortex of
the thymus
55.The development of self-tolerance in the T-cell compartment is
important for the prevention of autoimmunity. Which of the
following results in T-cell self-tolerance"
a. Allelic exclusion
b. Somatic hypermutation
c. Thymocyte proliferation
d. Positive selection
e. Negative selection
56.Which of the following statements is correct"
a. The TCR ab chains transduce a signal into a T cell
b. A cell depleted of its CD4 molecule would be unable to
recognize antigen

ϭϴϵ

 c. T cells with fully rearranged ab chains are not found in the
thymus
d. T cells expressing the gd receptor are found only in the
thymus
e. Immature CD4+ CD8+ T cells form the majority of T cells
in the thymus
57.Which of the following is incorrect regarding mature T cells that
use AB as their antigen-specific receptor"
a. They coexpress CD3 on the cell surface
b. They may be either CD4 + or CD8
c. They interact with peptides derived from nonself antigens
d. They can further rearrange their TCR genes to express gd as
their receptor
e. They circulate through blood and lymph and migrate to
secondary lymphoid organs
58.CD4 :
a. Binds directly to peptide antigen
b. Binds to an invariant portion of MHC class I molecules
c. Binds to an invariant portion of MHC class II molecules
d. Binds to CD8 on the T cell surface
e. Binds to the peptide-binding site of MHC class II
59.Which of the following statements is incorrect concerning antigen-
specific receptors on both B and T cells"
a. They are clonally distributed transmembrane molecules
b. They have extensive cytoplasmic domains that interact with
intracellular molecules
c. They consist of polypeptides with variable and constant
regions
d. They are associated with signal transduction molecules at the
cell surface
e. They can interact with peptides derived from non-self
antigens.
60.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

ϭϵϬ

 61.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
62.In terms of V, D, and J segment arrangement, the TCR 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
63.Which of the following characteristics is common to both T cell
receptors and immunoglobulins
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
64.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
65.Which of the following is the first stage of T-cell receptor gene
UHDUUDQJHPHQWLQĮȕ7FHOOV"
a. 9Įĺ'Į
b. 'Įĺ-Į
c. 9ȕĺ'ȕ
d. 'ȕĺ-ȕ

ϭϵϭ

 e. 9Įĺ-Į
66.Which of the following characteristics is common to both T-cell
receptors and immunoglobulins?
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 contributes to further diversification.
c. Class switching enables a change in effector function.
d. The antigen receptor is composed of two identical heavy
chains and two identical light chains.
e. Carbohydrate, lipid and protein antigens are recognized and
stimulate a response.
67.The function of the T-cell receptor (TCR) is to:
a. Recognize foreign antigens in the blood
b. Bind to the CD8 co-receptor
c. Kill infected host cells
d. Bind growth factors (cytokines)
e. Recognize antigenic peptides associated with MHC on the
surface of antigen-presenting cells
68.What is true about B cell receptors ?
a. They are found on cell membrane
b. The bring the antigen to bind with B lymphocytes
c. They stimulate the B cells to produce antibodies in response
to the antigen
d. Both a & b
69.The antigen receptor present both in B cells and T cells is :
a. Insulin receptors
b. CR1 receptor
c. Fc receptor
d. All of the above
70.The complement receptor absent in T cells is:
a. CR1
b. CR2
c. CR3
d. CR4
71.Receptors absent in B cells are:
a. Erythrocyte receptors
b. Histamine receptors H-1 and H-2
c. ǹ-fetoprotein receptor
d. All of the above
72.Rosette formation is induced by:
a. E receptor on T cells
b. E receptor on B cells

ϭϵϮ

 c. Histamine receptors
d. Complement receptors
73.The human T cells having Fcµ receptors function as:
a. Complement system
b. Helper cells
c. Histamine receptors
d. Complement receptors
74.The histamine receptor H1 on T cells:
a. Induces the T cell`s function
b. Suppresses the T cell`s function
c. Neither induces or suppresses the functioning of T cells
d. A & b
75.The histamine receptor H2 on T cells:
a. Induces the T cell`s function
b. Suppresses the T cell`s function
c. Neither induces or suppresses the functioning of T cells
d. A & b
76.Diversity of T cell receptors is increased by _____.
a. Binding to different MHC receptors.
b. Somatic cell mutations after T cell activation.
c. Addition of N nucleotides at recombination junction sites.
d. Rearranging both beta chains of the T cell receptor at the
same time.
e. Combination of the beta chains of the T cell receptor with
different forms of the CD3 complex.
77.Which of the following is NOT true of the ability of the T-cell
receptor (TCR) to specifically recognize antigen?
a. The antigen must be "processed" first by an accessory cell of
immune system in order for it to bind to the TCR.
b. The recognition of the antigen by the TCR can mediate
helper, suppressor or cytotoxic function.
c. The recognition of antigen by the TCR can result in cytokine
secretion and/or an increase in cell proliferation within the
immune system.
d. The antigen is recognized by the T3-TCR complex only
when it is associated with a protein of the major
histocompatibility complex
e. Only the alpha chain of the TCR is necessary for antigen
78.The T3 or CD3 component of the T-cell receptor:
a. Is composed of two polypeptide chains
b. Specifically recognizes antigen bound to class 1 and class ii
MHO proteins

ϭϵϯ

 c. Participates in transducing the antigen recognition signal to
the T-cells interior
d. Occurs only on accessory cells such as macrophages
79.The percentage of human peripheral blood T-cells bearing a gamma
delta T-cell receptor is:
a. 30±80%.
b. 1-5%.
c. 100%.
d. 0%.
e. Only present during mycobacterial infections.
80.The T-cell receptor genes were originally identified using:
a. A monoclonal anti-idiotype.
b. The polymerase chain reaction.
c. A liver DNA gene library.
d. In situ hybridization.
e. Subtractive hybridization.
81.A chromosome on which T-cell receptor alpha chain gene
rearrangement has occurred lacks which of the following gene
segments:
a. Joining (J).
b. Diversity (D).
c. Variable (V).
d. Constant (C).
e. TCR beta chain.
82.The T-cell receptor for antigen is:
a. Derived from the immunoglobulin gene pool by alternative
splicing.
b. A tetramer.
c. A homodimer.
d. A heterodimer.
e. A single chain molecule.
83.Each chain of the T-cell receptor consists of:
a. An Ig heavy chain.
b. Two Ig-type domains.
c. A fibronectin-type domain.
d. Glycolipid molecules.
e. Four Ig-type domains
84.The T-cell receptor antigen recognition signal is transduced by:
a. The TCR alpha chain.
b. The TCR beta chain.
c. CD1.
d. CD2.
e. CD3.

ϭϵϰ

 85.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
86. 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
87. Which of the following is mismatched
a. T-cell recepot beta chain:VDJ
b. T-cell receptor alpha chain: VJ
c. Immunoglobin heavy chain: VJ
d. None of the above is mismatched
e. Immunoglobin light chain: VJ
88.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. Heavy chain; lambda light chain
b. Kappa light chain; lambda light chain
c. Lambda light chain; heavy chain
d. Lambda light chain; kappa light chain
e. Kappa light chain; heavy chain
89.The antigen recognition site of T cell receptors is formed by the
association of which of the following domains
a. V alpha and C beta
b. V alpha and V beta
c. C alpha and C beta
d. V alpha and C beta
e. V alpha and C alpha
90.The B-cell co receptor is composed of
a. CD40; MHC class II; CD19
b. Ig alpha; Ig beta; CD19
c. CR2 (CD21); CD19; CD19
d. CD14; CD19; CD18
e. ,JĮ,Jȕ/\QW\URVLQHkinase

ϭϵϱ

 91.Which of the following is characteristic of large pre B cell
a. V-J is rearranging at the light chain locus
b. Mu heavy chain and lambda or kappa light chain is made
c. V is rearranging to DJ at the heavy chain locus
d. VDJ is successfully rearranged and mu heavy chain is made
e. D-J is rearranging at the heavy chain locus
92.______ 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. CD25
b. CD3
c. CD2
d. CD4
e. CD8
93.CD40 ligand (CD 154) is expressed by the following cells
a. B cells
b. Dendritic cells
c. Resting T cells
d. Activated T cells
e. All leukocytes
94.Which one of following statements best describes the differences
between antigen receptors on B and T cells?
a. The specificity of the B-cell antigen receptor is randomly
generated, while antigen helps instruct the T cell on the
construction of the TCR.
b. There are no differences in the nature of the antigen that
binds to either the B- cell receptor or the TCR because both
receptors bind to native, intact antigen.
c. The B-cell antigen receptor is capable of directly binding
native, unprocessed antigen, whereas the TCR requires that
the antigen be fragmented and displayed on cell-surface
MHC molecules.
d. The TCR is capable of directly binding native, unprocessed
antigen, whereas the B-cell antigen receptor requires that the
antigen be fragmented and displayed on cell-surface MHC
molecules.
95.A fundamental difference between the antigen receptors on B cells
(BCR) and receptors on T cells (TCR) is that
a. BCRs belong to the immunoglobulin superfamily while
TCRs do not
b. TCRs are MHC restricted while BCRs are not
c. TCRs have the same specificity on all T cells while B cells
have BCRs of only one specificity

ϭϵϲ

 d. BCRs bind to carbohydrates while TCRs bind to peptides.
96.B and T cell receptors generate diversity in roughly similar ways.
Which of the following is not common to both B and T cell
receptors"
a. The use of V region genes
b. Somatic hypermutation
c. The use of terminal deoxynucleotidyl transferease
d. The expression of recombination activation genes
97.Identify the TRUE statement about T cell receptors on αβ T cells
a. The T cell receptor is composed of a common α subunit
and a unique β subunit
b. The β subunit of T cell receptor is the product of rearranged
V, D, and J segments that are combined with a constant
region
c. The T cell receptor has a signal transduction region on its
cytoplasmic side
d. The T cell receptor on a given T cell will recognize all MHC
molecules
e. On average, a T cell receptor binds to its cognate antigen
peptide more firmly than an antibody binds to its cognate
antigen peptide.
98.SGR (e.g. BCR resp TCR) on B and T lymphocytes are
a. Bound only to MHC I molecules
b. Encoded to recognize PAMP
c. First to be produced after exposition to foreign molecule
d. Of the same specificity in everybody
e. Randomly generated during intrauterine development
99.Epitope-specific receptors on T lymphocytes (TCR) are present
a. In cytoplasm and/or on membrane bound proteins
b. In plasma, lympha other body fluids
c. On surface of plasmatic cells
d. As transmembrane polypeptides
e. In lipid bilayer of nucleus
100. Existence of BCR and TCR specific only for one antigen is
enabled by:
a. Rearrangement of genes for variable part of immunoglobulin
molecule
b. Maturation of immunity
c. Exclusion of allels
d. Isotype switch
e. Junction diversity


ϭϵϳ

  &KDSWHU7HQ
 7&5DQG%&5
$QVZHUV

1. d 26.a 51.d 76.c

2. a 27.d 52.c 77.e
3. c 28.a 53.c 78.c
4. c 29.c 54.b 79.b
5. d 30.b 55.e 80.e
6. b 31.a 56.e 81.b
7. e 32.b 57.d 82.d
8. e 33.a 58.c 83.b
9. b 34.d 59.b 84.e
10.c 35.e 60.c 85.a
11.d 36.a 61.a 86.c
12.c 37.a 62.c 87.c
13.c 38.c 63.a 88.e
14.b 39.e 64.c 89.b
15.b 40.a 65.d 90.c
16.a 41.e 66.a 91.d
17.b 42.c 67.e 92.c
18.e 43.d 68.d 93.d
19.d 44.d 69.d 94.c
20.d 45.c 70.b 95.b
21.b 46.e 71.d 96.b
22.c 47.e 72.a 97.b
23.c 48.c 73.b 98.e
24.e 49.d 74.a 99.d
25.d 50.c 75.b 100. a

ϭϵϴ

 &KDSWHU(OHYHQ
,PPXQLW\WRLQIHFWLRXVDJHQWV
0&4
1. The largest number of deaths from infectious diseases are caused
by:
a. AIDS.
b. Acute respiratory infections.
c. Diarrheal diseases.
d. Tuberculosis.
e. Measles.
2. The usual sequence of events in the development of an effective
immune response to a viral infection is:
a. Interferon secretion, antibody synthesis, cellular immune
response, NK cell ADCC.
b. Antibody synthesis, interferon secretion, NK cell ADCC,
cellular immune response.
c. NK cell ADCC, interferon secretion, antibody synthesis,
cellular immune response
d. Interferon secretion, cellular immune response, antibody
synthesis, NK cell ADCC.
e. Cellular immune response, interferon secretion, antibody
synthesis, NK cell ADCC.
3. Differences between gram-positive and gram-negative bacteria
include :
a. Staining with crystal violet.
b. Ability of complement to lyse cells.
c. Thickness of the peptidoglycan layer.
d. Endotoxin in the cell walls of gram-negative bacteria.
e. All of the above.
4. Antigenic variation is a mechanism of immune evasion that results
in :
a. Interference with attachment to host receptors.
b. Induction of immune suppression.
c. Alterations in important surface antigens such that escape
variants arise as a result of immune selection.
d. Mutations in surface antigens.
e. Destruction of antigens by proteolytic enzymes
5. The following statements about human immune serum globulin
(ISG) are true EXCEPT:
a. The source is human placenta.

ϭϵϵ

 b. The globulins are obtained by precipitation with cold ethanol.
c. The concentration of IgG is more than 10-fold greater than in
plasma.
d. IgA and IgM are present in concentrations slightly lower than
in plasma.
e. The ethanol precipitation does not render preparation of
globulin free of hepatitis virus.
6. In order to prevent Rhesus hemolytic disease of the newborn
developing in babies that are at risk because of the parents' blood
group types, to whom and at what time should RhoGAM (anti-
Rhesus) be administered?
a. The baby should be transfused once with RhoGAM in utero as
soon as the procedure is feasible
b. The mother should receive it within 3 days of birth
c. The mother should receive it before pregnancy and again as
soon as she knows she is pregnant
d. The mother should receive it immediately after the baby is
born and then again within about 2-3 weeks
e. The newborn baby should receive it within 24 hours of
delivery
7. In which one of the following types of glomerulonephritis is the
serum C3 level characteristically normal?
a. Early acute post-streptococcal nephritis.
b. Active systemic lupus erythematosus nephritis.
c. Minimal-change nephropathy.
d. Membrane-proliferative glomerulonephritis type II.
8. In acute post-streptococcal glomerulonephritis, which one of the
following statements is true?
a. It only occurs following upper respiratory tract infection.
b. It typically follows within 5 days of streptococcal infection.
c. The anti-DNase B titre is a better indicator of streptococcal
skin sepsis than the ASO titre.
d. It is consistently associated with a normal C3 level in the early
phase.
e. The clinical course is usually one of complete recovery in only
10% of children.
9. A previously healthy 8-month-old girl with fever and wheezing is
diagnosed with respiratory syncytical virus (RSV) infection.
Assuming that this is the child`s first exposure to RSV, which of
the following mechanisms will almost likely operate to clear the
infection?
a. CD4+ T cell-mediated necrosis of infected cells
b. Complement-mediated lysis of infected cells

ϮϬϬ

 c. Cytotoxic T cell-induced apoptosis of infected cells
d. MHC I presentation of viral peptide on CD8+ T cell
e. Virus-specific antibodies that neutralize free virus
10.In a patient with salmonella infection, which of the following
mechanisms will most likely be the earliest adaptive response for
clearing the infection while bacteria are present within intracellular
endosomes?
a. Antibody-mediated neutralization of free bacteria
b. Complement-mediated lysis of infected cells
c. CTL recognition of bacterial peptides presented by MHC II
d. DTH responses generated by CD4+ T cells
e. Type I hypersensitivity mediated by ige antibodies
11.A 25 year-old man is exposed to the roundworm Ascaris but does
not develop clinical signs of infection. Which of the following
mechanisms is likely to be responsible for the resistance of the
infection?
a. Antibody-mediated destruction of worm-infected host cells
b. CTL-induced apoptosis of worm-infected host cells
c. Complement-mediated lysis of worm attached to host tissues
d. IgE-mediated type I hypersensitivity disrupting worm
attachment
e. Phagocytosis of worms followed by necrosis of phagocytes
12.Despite having recovered fully from influenza the previous winter,
a 56-year-old man becomes ill after being exposed to a colleague
with influenza virus. Which of the following mechanisms permits
his reinfection despite previous exposure to influenza virus?
a. Neutralizing antibodies against influenza disappear rapidly
b. Insufficient time has passed for CD4+ T cells to develop
memory
c. Intracellular viral particles immune surveillance
d. Type I hypersensitivity response occur on second exposure to
influenza
e. Viral variants evade the immune response against the original
virus.
13.A 35-year-old woman left her country for the first time and
traveled to Brazil, where she contracted malaria. Which of the
following describes the state of immunity resulting from this
infection?
a. Antibody-mediated neutralization clears the infection
b. CTL-induced apoptosis of infected erythrocytes clears the
infection
c. Complement-mediated lysis of infected erythrocytes clears the
infection

ϮϬϭ

 d. DTH responses generated by CD4+ T cells clears the infection
e. Most immunity is evaded by protozoa reproducing within
erythrocytes
14.In response to lipopolysaccharide from a gram negative bacterial
infection, local host phagocytes release proinflammatory cytokines
, including IL-6, which then stimulate hepatic synthesis and release
of:
a. C-reactive protein
b. Chemokines
c. Complement
d. Immunoglobulins
e. Interleukins
15.Which of the following is the predominant immunoglobulin
isotype secreted in the human MALT (mucosa associated lymphoid
tissues)?
a. IgA
b. IgD
c. IgE
d. IgG
e. IgM
16.Which of the following is characteristic of the mucosal immune
system?
a. A vigorous response is made to all non-self antigens
encountered
b. Chronic inflammation makes an inhospitable environment for
microbes
c. IL-2 and INF-ȖFRQWULEXWHWRD7h-1 like environment
d. Secretion of igg predominates over secretion of IgA.
e. Tolerance to foreign antigen is the norm rather than the
exception
17.The major structural protein (core) of the HIV-1 virus is:
a. Gp41
b. P24
c. Gp34
d. Gp140
18.HIV can infect all of the following cells EXCEPT:
a. CD4+ subset of lymphocytes
b. Macrophages
c. Monocytes
d. Polymorphonuclear leukocytes
19.The most rapidly growing segment of the HIV-infected
population is:
a. Homosexual males

ϮϬϮ

 b. Lesbians
c. Health care workers
d. IV drug users and their sexual partners
20.In HIV infections, a window period of seronegativity extends from
the time of initial infection up to:
a. 2 weeks
b. 2 to 6 weeks or longer
c. 6 to 12 weeks or longer
d. 4 to 8 months or longer
21.The criteria for HIV infection for persons 13 years of age
or older include:
a. Repeatedly reactive screening test for HIV antibody
b. Specific HIV antibody identified by use of supplemental tests
c. Direct identification of the virus
d. All of the above
22.After the early period of primary HIV infection, the patient enters a
period of clinical latency that lasts a median of _______ years.
A. 5
b. 10
c. 15
d. 20
23.As AIDS progresses, the quantity of _______ diminishes and the
risk of opportunistic infection increases.
A. HIV antigen
b. HIV antibody
c. CD4+ T lymphocytes
d. CD8+ T lymphocytes
24.The clinical symptoms of the later phase of AIDS are:
a. Weight loss and decreased polymorphonuclear leukocyte (PMN)
cells
b. Extreme weight loss and fever
c. Multiple secondary (opportunistic) infections
d. Both b and c
25.The most frequent malignancy observed in AIDS patients is:
a. Pneumocystis jiroveci (P. Carinii)
b. Kaposi's sarcoma
c. Toxoplasmosis
d. Non-Hodgkin's lymphoma
26.Sources of error in the Western blot test include:
a. Concentration of HIV antigen
b. Presence of other infectious agents
c. Technical skill and experience of the technologist performing the

ϮϬϯ

 test
d. Age of the blood specimen
27.All the following methods have been developed to detect HIV-1
antigen EXCEPT:
a. Transcriptase method
b. Synthetic peptide approach
c. Immunofluorescence assay
d. Immunohistochemical staining
28.All the following methods have been developed to detect the
presence of HIV-1 viral gene EXCEPT:
a. Radioimmunoassay
b. In situ hybridization
c. Southern blot analysis
d. DNA amplification
29.Which one of the following sequences is appropriate for testing a
patient for antibody against the AIDS virus with the ELISA
procedure? (The assay is carried out in a plastic plate with
incubation and a wash step after each addition EXCEPT the final
one.
a. Patient's serum/enzyme substrate/HIV antigen/enzyme-labeled
antibody against HIV
b. HIV antigen/patient's serum/enzyme-labeled antibody against
human gamma globulin/enzyme substrate
c. Enzyme-labeled antibody against human gamma
globulin/patient's serum/HIV antigen/enzyme substrate
d. Enzyme-labeled antibody against HIV/HIV antigen/patient's
serum/enzyme substrate.
30.A co-receptor for HIV is
a. RANTES
b. CD8
c. CD54
d. CR5
e. CXCR4
31.Epstein-Barr virus is NOT implicated in which one of the
following conditions:
a. Infectious mononucleosis.
b. Nasopharyngeal carcinoma.
c. Chronic lymphatic leukaemia.
d. Burkitt's lymphoma.
e. Post-transplantation lymphoproliferative syndrome
32.Which one of the following does NOT predispose to superficial
Candida albicans infection?
a. Pregnancy

ϮϬϰ

 b. Lymphoma
c. Diabetes mellitus
d. Vegetarian diet
e. Broad-spectrum antibiotics
33.Which one of the following micro-organisms does not use
antigenic variation as a major means of evading host defenses?
a. Streptococcus pneumoniae.
b. Influenza A virus.
c. Borrelia recurrentis
d. HIV
e. Trypanosomes
34.Which one of the following statements regarding super-antigens is
FALSE?
a. Staphylococcal toxic shock syndrome is an example of super-
antigen associated disease.
b. Super-antigen associated diseases are characterized by
markedly elevated circulating levels of pro-inflammatory
cytokines.
c. In humans, a super-antigen reacts with approximately 1 in 50 T
cells.
d. Superantigens activate large numbers of B cells
35.The cytokine profile of a helper T cell (Th1 or Th2) is an important
determinant of host immunity. Which ONE of the following
statements regarding the cytokine profile of various diseases is
true?
a. Cutaneous leishmaniasis is associated with a predominant Th2
profile.
b. Visceral leishmaniasis is associated with a good Th1 response.
c. Tuberculoid leprosy is associated with a predominant Th2
profile.
d. Lepromatous leprosy is associated with a predominant Th1
profile.
e. Widespread disease in patients with Mycobacteria tuberculosis
infection (military tuberculosis) is associated with a Th2
response.
36.Which one of the following statements about CMV is FALSE?
a. Cytomegalovirus is a member of the retroviral group of viruses
b. Herpes viruses are DNA viruses
c. CMV can down regulate the host response
d. CMV is named for the large inclusion bodies in the nucleus of
the infected cell
e. Primary CMV infection can be mild and similar to glandular
fever (infectious mononucleosis)

ϮϬϱ

 37.Which one of these statements about malaria is FALSE:
a. Malaria is caused by one of several types of Plasmodium
b. Plasmodium is a protozoan parasite
c. Less than 2 million people are infected in the world
d. The vector is a mosquito, which inoculates the sporozoite into
the blood of the host
e. Sporozoites are taken up into the liver parenchymal cells
38.Which ONE of these statements about immune responses to
Plasmodium is TRUE?
a. The immune response to Plasmodium is not stage specific
b. Protection against sporozoites is mediated by antibodies to
prevent invasion into erythrocytes
c. Antisporozoite antibodies react with the binding sites of the
parasite known as MSP1, MSP2 and MSP3 and are T cell
dependent IgG antibodies
d. Antibodies produced in an infection are fully effective for
protection.
39.Which one of the following mechanisms does NOT help to clear
Aspergillus spores from the bronchial tree?
a. Bronchial cilia
b. Alveolar macrophages
c. Engulfment by neutrophils
d. Pulmonary dendritic cells taking up spores by coiling
phagocytosis
e. Stimulation of Th2 cells resulting in lytic antibody production
40.Granuloma formation in mycobacterial infection does NOT include
which one of the following processes?
a. Engulfment of the mycobacteria by macrophages.
b. Replication of the mycobacteria within the phagosomes.
c. Production of IL-12 to drive Th1 differentiation of immature
CD4 cells.
d. TNF-ĮSURGXFWLRQ IRUDFWLYDWLRQRI PDFURSKDJHVWRHSLWKHORLG
forms.
e. Production of IL-4
41.A 19-year-old college student presents with a high fever, neck
stiffness and purple spots that do not fade on pressure. These have
all arisen in the last 24 hours. Her temperature is 40.1°C and she
appears to be very sick though not shocked, but you are concerned
about meningitis. Blood cultures eventually grow Neisseria
meningitides type B. Which one of the following tests does NOT
provide evidence of meningitis?
a. White blood cell count and differential
b. C reactive protein (acute phase protein)

ϮϬϲ

 c. Eosinophil
d. Bacteria gram stain on the cerebrospinal fluid
e. Cell count on the cerebrospinal fluid
42.Which one group of the following types of patients is at particular
risk of Neisseria infection?
a. Those with defective classical complement pathway
components
b. Those who have had their spleens removed
c. Students in crowded dormitories
d. Military personnel in barracks
e. Those with final lytic pathway defects of complement
43.The incidence of Neisseria meningitis has been shown to be
reduced by immunization. Which strain of Neisseria meningitides
is not routinely available as a vaccine yet?
a. Group A
b. Group B
c. Group C
d. Group Y
e. Group W-135
44.What one precaution should be taken to prevent infection for
college room-mates of this patient?
a. Penicillin or similar antibiotic to eliminate nasal carriage.
b. Immunization with Meningococcal C conjugate vaccine to
offer some cross-reactive protection.
c. Both of the above.
d. Neither of the above.
e. Isolation of all contacts for 4 weeks.
45.Which one of the following statements relating to vaccines is
TRUE?
a. Pneumovax is a conjugate vaccine
b. Prevenar is a live attenuated vaccine
c. Influenza A+B vaccine is a live attenuated vaccine
d. Hepatitis B is a pure polysaccharide vaccine
e. None of them
46.Which one of the following statements about the use of pure
carbohydrate vaccines in humans is FALSE?
a. They are useful in children under 2 years of age
b. They consist of cell wall extracts of encapsulated bacteria?
c. Their efficacy is increased if conjugated to a protein, to provide
DµFRQMXJDWH¶YDFFLQH
d. They provoke short term responses, without inducing memory
B cells
e. They are mainly T cell-independent

ϮϬϳ

 47.An evaluation of efficacy of a new vaccine against M. Tuberculosis
is best done using which one of the following markers?
a. Clinical evaluation of infection incidence in the field post-
completion of an immunization program of susceptible
individuals
b. In vivo IgM antibody responses
c. In vivo IgG responses
d. Quantification of Ag-specific T cells by ELISPOT
e. Quantification of Ag-specific T cells by flow cytometric-based
intracellular cytokine staining assay
48.Which one statement in relation to fungal infections is FALSE?
a. Fungal infections are often symptomatic
b. Are always characterized by a rise in neutrophils in the blood
c. Common in HIV patients, in whom they account for a
significant mortality
49.Which one statement about viruses is TRUE?
a. Herpes simplex virus (HSV) is an example of a virus that
undergoes antigenic variation
b. Epstein-Barr Virus (EBV) is an example of a virus that can
inhibit antigen processing
c. HHV 8 is an example of a virus that can infect lymphocytes
d. VZV is an example of a virus that can become latent
e. Rotavirus commonly infects epithelia to cause warts
50.Which statement relating to the risk of Aspergillus infections in
patients is the best answer?
a. Those on high doses of corticosteroids for rejection are at high
risk of Aspergillosis
b. Those with neutropenia following chemotherapy are at high
risk of Aspergillosis
c. Those with congenital neutropenia are at high risk of
Aspergillosis
d. Those with severe asthma are at high risk of Aspergillosis due
to bronchoconstriction and high doses of corticosteroids
e. All of the above
51.Protection against worm infestations is particularly associated with
an increase in:
a. IgD.
b. IgE.
c. IgG.
d. IgA.
e. IgM.
52.Some viruses escape the immune system by antigen shift. This
involves:

ϮϬϴ

 a. Structural reorganization of existing antigens.
b. Masking of antigen epitopes.
c. Point mutations in single genes.
d. Point mutations in many genes.
e. Interchange of genetic material with other viruses
53.Bacteria growing within macrophages are killed by:
a. Complement.
b. Reactive oxygen and nitrogen intermediates.
c. Antibody.
d. Cytotoxic T-cells.
e. Directly by cytokines released from Th1 cells
54.Extracellular bacteria are killed by:
a. Secreting exotoxins.
b. Impeding inflammatory reactions.
c. Phagocytosis and complement.
d. Toxin neutralization.
e. C-reactive protein.
55.Inflammation is a defensive reaction initiated by infection or tissue
injury which first causes:
a. Upregulation of adhesion molecules on endothelial cells and
leukocytes.
b. Chemotaxis.
c. IL-8 release.
d. Phagocytosis.
e. Bacterial killings.
56.Immune complex±induced nephrotic syndrome is a feature of:
a. Trypanosomiasis.
b. Quartan malaria.
c. Schistosomiasis.
d. Leishmaniasis.
e. Chagas' disease.
57.Abnormally folded prion proteins are:
a. Relatively sensitive to protease digestion.
b. Associated with CGD.
c. Present in follicular dendritic cells in individuals with
transmissible spongiform encephalopathies.
d. Normally eliminated by B-cells.
e. Destroyed by macrophages
58.Trypanosomes do not evade the host immune response by:
a. Pre-empting complement defenses.
b. Releasing decoy proteins.
c. Varying their surface antigens.
d. Escaping from the phagosome.

ϮϬϵ

 e. Completely resisting phagocytosis.
59.Th1 cells are of major importance in defense against:
a. Trypanosoma brucei.
b. Leishmania donovani.
c. Malarial merozoites.
d. Malarial sporozoites.
e. Trichinella spiralis.
60.IgE levels are high in infections with:
a. Trichinella spiralis.
b. Trypanosoma cruzi.
c. Trypanosoma rhodesiense.
d. Plasmodium falciparum.
e. Leishmania tropica.
61.The HIV Nef protein affects antigen presentation by:
a. Causing MHC class I endocytosis.
b. Containing glycine-alanine repeats which inhibit proteasome-
mediated processing of the virus.
c. Preventing peptide binding to TAP.
d. Preventing peptide transport through the TAP pore.
e. Competing for peptide binding to the MHC class I heavy chain
62.Viral antigen shift involves:
a. Single point mutation.
b. Random point mutations.
c. Interchange of large segments of the viral genome with other
viruses.
d. Rearrangement of the viral structural architecture.
e. Regression to an earlier variant.
63.Lepromatous leprosy is characterized by:
a. Poor T-cell responses.
b. Good cell-mediated immunity.
c. Good lepromin dermal response.
d. Poor B-cell responses.
e. Poor phagocytic ability
64.Specific immunity to M. Tuberculosis in mice can be transferred to
naive histocompatible recipients by:
a. B-cells.
b. T-cells.
c. Macrophages.
d. Neutrophils.
e. Igg.
65.Individuals lacking C8 or C9 are more prone to infection with the
following type of bacteria:
a. Haemophilus influenzae.

ϮϭϬ

 b. Bacillus anthrax.
c. Vibrio cholerae.
d. Neisseria.
e. Listeria monocytogenes.
66.The pyrogenic streptococcal exotoxins SPE, A, B, and C:
a. Are M proteins.
b. Cause post-streptococcal autoimmune disease.
c. Produce high titers of anti-streptolysin O.
d. Have hyaluronidase activity.
e. Are superantigens.
67.Extracellular bacteria try to avoid killing by:
a. Activating neutrophils.
b. Accelerating complement activation.
c. Synthesizing capsules.
d. By deviating complement deposition to the cell membrane.
e. Limiting variation in their antigens
68.Extracellular bacteria are optimally killed by:
a. Macrophages.
b. Complement.
c. Antibody.
d. Macrophages plus complement.
e. Macrophages plus antibody plus complement
69.Vaginal candidiasis (infection produced by funguses ±microbes)
after ATB therapy is caused by:
a. The amount of secreted lysozyme in vagina
b. The amount of secreted mucus in vagina
c. Changes in physiological flora
d. pH in vagina
e. Changes of function of epitelial cells
70.Repeated pneumoniae ± infectious inflammation of lung-caused by
opportunistic pathogens in patient with impaired ciliated
epithelium of bronchusis is conditioned by:
a. Decreased IgA antibodies production
b. Changes in total antibodies production
c. Decrease of pH
d. Decrease of nonspecific immune reactions
e. Impairment of specific immune mechanism
71.Permanent ureteral catheter as one of the cause of cystitis
(inflamation of urine bladder) results in:
a. Production of conditions favorable for changes of molecules
betweenepitelium and environment
b. Introduction of microorganisms in urethra
c. Secretion of mucus from epithelial cells

Ϯϭϭ

 d. Changes of pH of urine
e. All possibilities are correct
72.Which of mentioned possibilities is the example of physiological
barrier inhibiting colonization by microorganisms
a. Respiratory tract with pH - 9,0 ± 11,0
b. Skin - pH around 8,0
c. Stomac - pH 1,0 ± 3,0
d. Upper part of GIT pH - 6,5 ± 7,5
e. Vagina pH around 7,0
73.Which of the mentionned possibilities is the cause of microbicidal
activity in respiratory tract:
a. Lysosyme that degrades 1,4 glycosidical binding of bacteria
b. Saliva that break IgA molecules in mucous membrane
c. Fatty acids of commensal bacteria degrading the peptidoglycan
of pathogens
d. Tears enabling ingestion of microbes by phagocytes
e. Lysozyme degrading DNA and RNA produced by pathogenic
microbes
74.In microscopic smear of the pus from bacterial infection site there
will be mostly present
a. Basophils
b. Eosinophil
c. Lymphocytes
d. Monocytes
e. Neutrophils
75.PAMP ± pathogen-associated molecular patterns
a. Enable lymphocytes to recognize microbes and disrupt them
b. Are cysteine-rich peptides of leucocytes
c. Are recognized by PRR ± receptors of innate immunity
d. Are proteins on the surface of infected cell
e. Induce secretion of interferon
76.Primary immunity to Gram ± negative bacterium involves
a. Nonspecific stimulation of complement
b. Production of specific somatically generated receptors
c. Production and secretion of specific antibodies
d. Production of specific cytokines by lymphocytes
e. Stimulation of KIR on NK cells
77.Which of below mentioned molecules are expressed on the
surfaces of human infected cells or abnormal cells and are
recognized as stress molecules by NK cells
a. Alfa or beta defensines
b. C3 convertase and properdine
c. Cytokines and chemokines

ϮϭϮ

 d. Interferon and/or interferon beta
e. MICA and MICB
78.Antigen antibody binding that will result in incapability of microbe
to bind on target cells is:
a. Agglutination
b. Complement activation
c. Neutralization
d. Opsonization
e. Precipitation
79.Which of mechanisms are/is responsible for repeated infection with
influenza virus
a. Neutralization antibodies are short living
b. Low stimulation of CD4+ T cells to produce memory cells
c. Intracellular localization disable stimulation of immune system
d. Hypersensitivity type 1 is present only in second exposition
e. Variability of viral antigens
80.Molecule of acute phase of infection synthesized in liver during
bacterial and viral infection is
a. CRP
b. Chemokine
c. Complement
d. Immunoglobulin
e. Interleukin
81.A 30-year-old female developed vaginal candidiasis (a fungal
infection) after receiving antibiotic therapy for a sinus infection.
One possible explanation for the fungal infection is antibiotic-
reduction in vaginal
a. Lysozyme secretion
b. Mucous secretion
c. Normal commensal bacteria
d. pH
e. RNase and DNase
82.People with cystic fibrosis have recurrent infections with bacteria
such as Pseudomonas aerugenosa because of respiratory tract
changes that include a/an
a. Decrease in lysozyme secretion
b. Decrease in mucous secretion
c. Decrease in ph
d. Increase in viscosity of secretions
e. Increase in watery secretions
83.During a hospital stay, a catheter was placed into the urethra of a
70-year-old male who subsequently developed cystitis (urinary

Ϯϭϯ

 bladder infection). One of the factors that most likely contributed
to the establishment of the infection was:
a. Epithelial cell facilitation of molecule exchange with the
environment
b. Introduction of microbes into the urethra during the placement
of the urethra
c. Mucous secretion from the epithelial cells lining the urinary
truck
d. pH level in the sterile urine of the catheterized patient
e. Sebaceous and sudoriferous gland of sebum and sweat
84.Which of the following is an example of a normal pH barrier to
microbial colonization?
a. Respiratory tract pH between 9.0 and 11.0
b. Skin pH approximately 8.0
c. Stomach pH between 1.0 and 3.0
d. Upper gastrointestinal tract pH between 6.5 and 7.5
e. Vaginal pH of approximately 7.0
85.Which of the following is a correct pairing of a soluble molecule
with its microbial action in the respiratory tract?
a. Ǻ-defensins increase microbial susceptibility to phagocytosis
b. DNase enzymatically damages microbial membrane
c. Fatty acids of commensal microbes degrade microbial
peptidoglycan
d. Lacrimal secretions facilitate ingestion of microbes by
phagocytosis
e. Lysozyme degrades DNA and RNA produced by pathogenic
microbes
86.Your patient tests positive for the tuberculin antigen. You send him
for a chest x-ray because:
a. The tuberculin test is only presumptive, indicating that he has
been exposed to a tuberculosis antigen.
b. He may have other lung infections.
c. You are looking for fluid in his lungs due to inflammation
caused by the bacillus
d. A and b.
e. None of the above
87.Microorganisms associated with periodontal disease, such as
Porphyromonas gingivalis, are thought to control the cytokine
expression and affect TH1 and TH2 pathways by :
a. Suppressing Mast cell activity.
b. Stimulating PAMP receptors of innate immunity to express
cytokines that result in an adaptive response that is not
protective

Ϯϭϰ

 c. Avoiding PAMP receptors and, thereby, avoiding innate
immunity.
d. Stimulating adrenergic receptors.
e. None of the above
88.Mechanisms whereby intracellular microbes resist cell-mediated
immune responses
a. Enzymes that cleave and activate enzymes called caspases,
which induce apoptosis
b. Secrete cytokines TNF, IL-1 and chemokines, and platelet-
derived growth factor which stimulates growth of and activities
of fibroblasts, which helps to repair tissue when the infection is
gone -leads to increased expression of class II MHC molecules
and co-stimulators, thereby enhancing APC fxn, which
promtoes T cell activation
c. Inhibiting phagolysosome fusion -escaping from the vesicles of
phagocytes -inhibiting the assembly of class I MHC-peptide
complexes -producing inhibitory cytokines or decoy cytokine
receptors
d. Recognize the antigens of microbes that have been ingested by
macrophages -expresses CD40 ligand and secrete IFN-gamma,
which fxn cooperatively to activate macrophages -stimulates
defense against intracellular microbes
89.One reason that pathogenic microorganisms have an advantage in
the host they infect is because they
a. Have previously been encountered through vaccination
b. Strengthen the hosts immune response
c. Reproduce and evolve more rapidly than the host can eliminate
them
d. Have previously been encountered through natural exposure
e. Reproduce and evolve more slowly than the host can eliminate
them
90.Which of the following is the predominant route by which
pathogens are brought from a site of infection into a lymph node?
a. High endothelial venule
b. Artery
c. Afferent lymphatics
d. Vein
e. Efferent lymphatics
91.In tuberculin test
a. Positivity indicates past CD8 T cell exposure to gram-negative
bacteria
b. False positive reaction may occur due to immunodeficiency
c. Screening for anergy is ineffective

Ϯϭϱ

 d. Positivity indicates past CD4 T cell exposure to mycobacterial
infection
e. Contact sensitivity is always negative
92.Which of the following convey the longest lasting immunity to an
infectious agent?
a. Naturally acquired passive immunity
b. Artificially acquired passive immunity
c. Naturally acquired active immunity
d. All of these
e. None of these
93.Which of the following immune cells/molecules are most effective
at destroying intracellular pathogens?
a. T helper cells
b. B cells
c. Antibodies
d. Complement
e. T cytolytic cells
94.Receptors associated with innate immunity recognize microbes by
detecting:
a. insulin.
b. pathogen associated molecular patterns (PAMPs).
c. )F¶V
d. complement.
e. none of the above
95.DNA virus(one of the largest viruses), enters throat/respiratory via
inhalation, invades phagocytes (macrocytes) , travels to blood cells
and skin cells, death 10-16 days (RENAL(kidneys) failure,
bacteremia)
a. Smallpox- Poxviridae Orthopox
b. Varsilis Virus
c. Variola Virus
d. Smallpox- Vedirmae Orthopox
e. A and C
96.Variolation is inoculation as a method of purposefully infecting
aperson with smallpox (Variola virus) in a controlled manner so as
tominimize the severity of the infection and also to induce
immunityagainst further infection. Whats incorrect
a. Was used in 8th century China
b. Was used in 8th century India
c. Was the live virus from open lesions of infected person, high
morbidity, even mortality
d. Discovered later the scabs of mildly infected person improved
safety of intentional inoculation

Ϯϭϲ

 e. Was in China in 10th century
97.Your patient, a 7 monthǦold boy, is suffering from repeated ear
infections. In the lab, you determine that he has a defect in B cell
function. What is the most likely defect?
a. Inability to synthesize toxic nitric oxides
b. Failure to produce complement components
c. Failure to express tollǦlike receptors
d. Failure to express MHC class I molecules
e. Failure to express surfaceǦbound antibody molecules
98.Immunodeficienies can be caused by defects in expression of many
different molecules that contribute to both adaptive and innate
immune responses. Failure to express which molecule would have
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extracellular bacterium?
a. MHC class I
b. MHC class II
c. SurfaceǦbound antibody molecules
d. TollǦlike receptors
e. Complement components
99.What type of pathogen would be processed and loaded into MHC
class II molecules?
a. Antigens from a parasite that infects endothelial cells
b. Antigens from a virus infecting endothelial cells
c. Antigens from a bacterium infecting endothelial cells
d. Antigens from extracellular bacteria
e. Antigens from bacteria that infects endothelial cells
100. Which one of the following statements best describes
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mode of action in producing resistance to viral infection?
a. It stimulates a cell-mediated immunity
b. It stimulates humoral immunity
c. Its direct antiviral action is related to the suppression of
messenger RNA formation
d. Its action is related to the synthesis of a protein that inhibits
translation or transcription
e. It alters the permeability of the cell membrane so that viruses
cannot enter the
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2. d 27.b 52.e 77.e
3. e 28.a 53.b 78.c
4. c 29.b 54.c 79.e
5. e 30.e 55.a 80.a
6. b 31.c 56.b 81.c
7. c 32.d 57.c 82.d
8. c 33.a 58.e 83.b
9. c 34.d 59.b 84.c
10.d 35.e 60.a 85.a
11.d 36.a 61.a 86.a
12.e 37.c 62.c 87.b
13.e 38.c 63.a 88.c
14.a 39.e 64.b 89.c
15.a 40.e 65.d 90.c
16.e 41.c 66.e 91.d
17.b 42.e 67.c 92.c
18.d 43.b 68.e 93.e
19.d 44.a 69.c 94.b
20.c 45.e 70.d 95.e
21.d 46.a 71.b 96.a
22.b 47.a 72.c 97.e
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0&4
1. Autoimmune disease is :
a. Caused by certain body cells of the patients themselves.
b. Caused by phagocytosis of cells.
c. Caused by the destructive action of antibodies and
lymphocytes produced in the individual against certain
antigens.
d. None of the above.
2. Self ±tolerance people can tolerate:
a. Graft rejection.
b. Autoimmune disease.
c. Blood agglutination
d. Infectious diseases
3. The "immunotolerance" of a pregnant woman toward her unborn
child is the result of:
a. The tenacity with which the unborn child's immune system
counteracts the woman's immune system.
b. The relative quiescence of a pregnant woman's immune
system compared to when she was not pregnant.
c. The complete physical separation from her cells and those of
the unborn child.
d. The unborn child having enough of the woman's identity so
as to escape detection as foreign.
e. Modern medical intervention during every pregnancy.
4. *UDYHV¶ DXWRLPPXQH WK\URLGLWLV is associated with all of the
following immunologic observations EXCEPT:
a. An antibody directed against the thyroid-stimulating
hormone (TSH) receptor.
b. An antibody directed against the thyroid cell receptor.
c. Infiltration of macrophages into the thyroid.
d. Activation of HLA-DR antigens on thyroid epithelial cells.
e. A frequent association with HLA-DR3 expression.
5. Which of the following is a non-organ-specific (systemic)
autoimmune disease:
a. Myasthenia gravis.
b. Systemic lupus erythematosus (SLE).
c. Hashimoto's thyroiditis.
d. Pernicious anemia.

Ϯϭϵ

 e. Insulin-dependent diabetes mellitus.
6. Which of the following antibodies are of most use for the diagnosis
of pernicious anemia:
a. Anti-parietal cell.
b. Anti-thyroid peroxidase.
c. Anti-nuclear.
d. Anti-IgG Fc
e. Anti-TSH receptor.
7. Which of the following antibodies are useful for the diagnosis of
Sjögren's syndrome:
a. Anti-cardiolipin.
b. Anti-neutrophil cytoplasm (ANCA).
c. Anti-SS-A(Ro), anti-SS-B(La).
d. Anti-21-hydroxylase.
e. Anti-glomerular basement membrane.
8. Which of the following models is an example of a spontaneous
organ-specific autoimmune disease:
a. (NZB × W)F1:
b. MRL-lpr/lpr.
c. Experimental autoallergic encephalomyelitis.
d. Thyroiditis induced by early thymectomy and irradiation.
e. Non-obese diabetic (NOD) mouse.
9. The high concordance rate for monozygotic vs. dizygotic twins in
type 1 diabetes indicates:
a. A strong environmental element.
b. A strong genetic element.
c. A major influence of sex.
d. The influence of HLA.
e. That microbial infection cannot be involved.
10. The undue tendency for closely linked genes on a chromosome to
remain associated rather than undergo genetic randomisation, is
termed:
a. Tandem duplication.
b. Meiotic crossover.
c. Relative risk.
d. Linkage disequilibrium.
e. Gene conversion.
11.HLA-DR2 is a risk factor for:
a. Multiple sclerosis.
b. Insulin-dependent (type I) diabetes.
c. Ankylosing spondylitis.
d. Rheumatoid arthritis.
e. Myasthenia gravis.

ϮϮϬ

 12.Cryptic T-cell epitopes capable of triggering autoimmune disease:
a. Dominate the normal immune response.
b. Negatively select T-cells.
c. Are unable to bind in the MHC groove.
d. Can be derived by antigen processing.
e. Are presented by MHC class I but not MHC class II
molecules.
13. Which of the following is incorrect 'Natural antibodies' are often:
a. Autoreactive.
b. Polyspecific.
c. Reactive with bacterial carbohydrates.
d. High affinity IgG.
e. Produced by CD5+ B-cells.
14. Autoantigen selection of responding B-cells is indicated by:
a. Germ line configuration of the antibody.
b. High affinity antibody.
c. Expression of a public idiotype.
d. A monoclonal antibody response.
e. A response to many different autoantigens.
15. Which of the following is incorrect: T-helpers can be bypassed by:
a. Failure of regulatory T-cells.
b. Polyclonal activation of B-cells.
c. Idiotypic mechanisms.
d. Antigenic cross-reaction.
e. T-cell recognition of carrier complexed to autoantigen.
16. In the NZB model of autoimmune hemolytic anemia:
a. There are no T-cell regulatory abnormalities.
b. Disease is unaffected by neonatal thymectomy.
c. The red cell autoantibodies cause disease.
d. CD5+ B-cells are not involved in pathogenesis.
e. Thyroid autoantibodies are prevalent.
17. The antiphospholipid syndrome is associated with:
a. Infertility.
b. Severe anemia.
c. Wegener's granulomatosis.
d. Raised platelet levels.
e. Recurrent fetal loss.
18. Exophthalmos is often associated with:
a. Hashimoto's disease.
b. Primary myxedema.
c. Graves' disease.
d. Idiopathic thrombocytopenic purpura.
e. Autoimmune hemolytic anemia.

ϮϮϭ

 19. Neonatal myasthenia gravis is thought to be caused by:
a. An inherited genetic defect.
b. Transplacental transfer of maternal IgG against the TSH
receptor.
c. Anti-idiotype to maternal IgG.
d. Transplacental transfer of maternal IgG against the
acetylcholine receptor.
e. Maternal T-cells transferred across the placenta.
20. In celiac disease there is T-cell sensitivity to:
a. Vitamin B12.
b. Gluten.
c. B-adrenergic receptors.
d. Gastric H+-K+ dependent ATPase.
e. Myelin basic protein.
21. Glomerulonephritis associated with pulmonary hemorrhage is
referred to as:
a. Pemphigus vulgaris.
b. Goodpasture's syndrome.
c. Systemic lupus erythematosus.
d. Lambert±Eaton syndrome.
e. Wegener's granulomatosis.
22. A spontaneous model of systemic lupus erythematosus is the:
a. Balb/c mouse.
b. MRL-lpr/lpr mouse.
c. SJL mouse.
d. Obese strain chicken.
e. SCID mouse.
23. In rheumatoid arthritis the non-lymphoid synovial tissue shows
aberrant expression of:
a. Immunoglobulin genes.
b. T-cell receptor genes.
c. MHC class I.
d. MHC class II.
e. MHC class III.
24.IgG in patients with rheumatoid arthritis has abnormal:
a. Glycosylation.
b. Disufide bonds.
c. Light chain sequence.
d. Hinge regions.
e. Valency.
25.Rheumatoid arthritis can be induced in rats by injection of:
a. Pooled normal rat IgG.
b. Freund's incomplete adjuvant.

ϮϮϮ

 c. Freund's complete adjuvant.
d. A T-cell clone specific for thyroglobulin.
e. Į-macroglobulin.
26. The inflammatory infiltrate in autoimmune thyroiditis comprises
mostly:
a. Phagocytic cells.
b. Polymorphonuclear leukocytes.
c. Lymphocytes.
d. Mast cells.
e. Eosinophils.
27. In type 1 diabetes (insulin-dependent diabetes mellitus), the target
of the autoimmune attack is:
a. All of the cells in the islets of Langerhans.
b. 7KHȕ-cells in the islets of Langerhans.
c. The somatostatin-producing cells in the islets of Langerhans.
d. The glucagon-producing cells in the islets of Langerhans.
e. Cells throughout the body which have an insulin receptor.
28. An animal model for multiple sclerosis is:
a. Experimental autoimmune thyroiditis (EAT)
b. Experimental autoimmune encephalomyelitis (EAE)
c. NOD mouse.
d. Nude mouse.
e. MRL-lpr/lpr mouse.
29. Pernicious anemia can be treated with:
a. Thyroxine.
b. Insulin.
c. Vitamin B12.
d. Thymectomy.
e. Acetylcholine esterase inhibitors.
30. A therapeutic approach in rheumatoid arthritis is to:
a. 6WLPXODWH71) 71)Į SURGXFWLRQ
b. ,QKLELW71) 71)Į DFWLYLW\
c. 5HGXFH7*)ȕVHFUHWLRQ
d. Administer silver salts.
e. Use prostaglandin.
31. Animals have been protected against experimental autoimmune
encephalomyelitis (EAE) by immunization with:
a. T-FHOOUHFHSWRU9ĮSHSWLGH
b. Pooled normal immunoglobulin.
c. Myelin basic protein in complete Freund's adjuvant.
d. T-FHOOUHFHSWRU9ȕSHSWLGH
e. An antibody to myelin basic protein.

ϮϮϯ

 32. Immune defenses in the gut have evolved mechanisms which
restrict the activation of:
a. Th1 cells.
b. Th2 cells.
c. B-cells.
d. Cytotoxic T-lymphocytes.
e. Mast cells.
33. Which of the following factors has not been associated with the
development of autoimmune disease:
a. Sex.
b. HLA.
c. Genetic factors other than HLA.
d. Infection.
e. Severe combined immunodeficiency (SCID).
34. 'Natural antibodies' in the mouse are produced by:
a. Pre-B-cells.
b. B-1 cells.
c. CD4 cells.
d. CD8 cells.
e. NK cells.
35. Which of the following responses is incorrect? Autoimmunity can
arise when:
a. Exogenous antigens cross-react with self-antigen.
b. Exogenous antigens cross-react with self-idiotypes.
c. B-cells are stimulated with polyclonal activators.
d. Regulatory T-cells are stimulated.
e. Cytokine imbalance occurs.
36. Difference between organ-specific and non-organ-specific
autoimmune disorders is that:
a. Only in organ-specific autoimmune disorders is there a
greater incidence in women.
b. Associations with HLA are only seen in non-organ-specific
autoimmunity.
c. Circulating autoantibodies react with normal body
components only in organ-specific autoimmune disorders.
d. It is only in organ-specific autoimmune disorders that
autoantibody tests are of diagnostic value.
e. Only in non-organ-specific autoimmune diseases are anti-
nuclear antibodies a frequent feature.
37.Ankylosing spondylitis is strongly associated with HLA-:
a. B8.
b. DR3.
c. DR4.

ϮϮϰ

 d. B27.
e. DR2.
38. In rheumatoid arthritis, the outgrowth of synovial lining cells
which produces erosions in the underlying cartilage and bone is
called:
a. Opsonin.
b. Proteoglycan.
c. Pannus.
d. The Arthus reaction.
e. Frustrated phagocytosis.
39. Rheumatoid factors are:
a. DNA:anti-DNA immune complexes.
b. Autoantibodies to IgM.
c. Autoantibodies to complement components.
d. Autoantibodies to IgG.
e. Any factor predisposing to rheumatoid arthritis.
40. Thyrocytes (thyroid epithelial cells) expressing MHC class II in
autoimmune thyroid disease are direct targets for locally activated
Th1 cells specific for:
a. PMN proteinase III.
b. Acetylcholine receptor.
c. &DUGLROLSLQȕ-glycoprotein 1 complex.
d. A peroxidase enzyme.
e. Pre-synaptic calcium channels.
41.An animal model of type 1 diabetes (insulin-dependent diabetes
mellitus) is the:
a. Obese strain chicken.
b. (NZB × NZW) F1 mouse.
c. BXSB mouse.
d. Brown Norway rat.
e. NOD mouse.
42. Which one of the following statements about autoimmune diseases
is TRUE?
a. Affect about 1 person in every 1000.
b. Are more common in women.
c. Tend to begin in early childhood.
d. Are an inevitable consequence of autoimmune responses
43. Which one of the following statements is TRUE?
a. The thymus controls peripheral tolerance of T cells.
b. Self-reactive T cells are not found in healthy normal
subjects.
c. Naive T cells need more than one signal in order to become
activated.

ϮϮϱ

 d. B cell tolerance is more important than T-cell tolerance in
the prevention of autoimmunity.
44. Which one of the following statements is FALSE? Tolerance can
break down:
a. Following administration of an immunological adjuvant.
b. Following administration of IL-2 treatment.
c. By a process of molecular mimicry.
d. After surgical removal of the thymus in the first year of life
in humans.
45. Which one of the following statements about autoimmune diseases
is FALSE?
a. Can cluster within families.
b. Are often associated with particular HLA alleles.
c. Are usually mediated by type I hypersensitivity.
d. May occur in humans or animals with inherited defects in
apoptosis.
46. Which one of these conditions is NOT associated with
autoimmune diseases?
a. FAS deficiency
b. APECED (Autoimmune Polyendocrinopathy Candidiasis
Ectodermal Dysplasia Disease
c. IPEX, (Immune dysregulation, Polyendocrinopathy,
Enteropathy, X-linked)
d. C6 deficiency
47. Which one of the following is NOT a well-defined autoantigen?
a. Mitochondrial pyruvate dehydrogenase
b. TSH receptor
c. Acetylcholine receptor
d. Creatine kinase
48. Which one of the following statements about B cell tolerance is
TRUE?
a. B-cell tolerance is more complete than T-cell tolerance
b. Somatic hypermutation of immunoglobulin genes does not
occur in mature B cells
c. New B cells are only produced from bone marrow precursors
in infancy
d. B cells are able to undergo receptor editing in the bone
marrow
49. Siblings of patients with an autoimmune disease are more likely to
be affected as well. Which of the increases below reflects the true
relative risk (RR) in this group of polygenic conditions"
a. Systemic lupus erythematosus RR is x100
b. Insulin-dependent diabetes mellitus RR is x 100

ϮϮϲ

 c. Multiple sclerosis RR is x20
d. Rheumatoid arthritis RR is x100.
50. Which one of the following autoimmune diseases involves only
Type II hypersensitivity"
a. Rheumatoid arthritis
b. Myasthenia gravis
c. Contact dermatitis
d. Mixed cryoglobulinaemia
51. Which one of the following autoimmune diseases involves
predominantly Type III hypersensitivity"
a. Hashimoto' thyroiditis
b. Idiopathic thrombocytopenic purpura
c. Multiple sclerosis
d. Systemic lupus erythematosus
52. Which one of these statements about genetics in human disease is
TRUE"
a. If a disease has an HLA association, it must be inherited in
an autosomal recessive [AR] fashion
b. If a disease has an HLA association, there are no other genes
involved
c. Single gene diseases in man always have a survival
advantage to withstand evolutionary pressures
d. Single gene diseases in man must have reproductive
potential to have persisted in evolution
e. 6LFNOHFHOOGLVHDVHLVDQH[DPSOHRIDµSHUVLVWHQW¶VLQJOHJHQH
disease, due to a survival advantage.
53. Most autoimmune diseases are caused by a:
a. Single genetic defect.
b. Known infectious organism.
c. Constellation of genetic and environmental events.
d. Hormonal dysregulation.
e. B-cell defect.
54.Identifying an autoimmune disease in humans is often
accomplished by:
a. Finding an antibody against self-components.
b. Passively transferring specific T cells from a patient to a
healthy individual.
c. Showing that T cells or antibodies are the cause of the tissue
damage.
d. Circumstantial evidence, such as MHC association and
clinical improvement, with immunosuppressive drugs.
e. Finding the definitive agent or agents responsible for the
disease.

ϮϮϳ

 55.The following is/are possible mechanism(s) for the recognition of
self-components by the immune system in autoimmune diseases:
a. Alteration of a self-antigen so it is recognized as foreign
b. Leakage of sequestered self-antigen
c. Loss of suppressor cells
d. Infection with a microorganism that carries a cross-reactive
antigen
e. Any of the above.
56.Rheumatoid factor, found in synovial fluid of patients with
rheumatoid arthritis, is most frequently found to be:
a. IgM reacting with L chains of IgG.
b. IgM reacting with H-chain determinants of IgG.
c. IgE reacting with bacterial antigens.
d. Antibody to collagen.
e. Antibody to DNA.
57.The pathology in autoimmune diseases due to antibody may be a
result of:
a. The formation of antigen ²antibody complexes.
b. Antibody blocking a cell receptor.
c. Antibody-induced phagocytosis.
d. Antibody-induced complement mediated lysis.
e. Any of the above.
58.Autoimmune hemolytic anemia:
a. Is usually due to warm agglutinins belonging to the IgM
class directed against Rh antigens on red blood cells
b. May be due to the production of either cold agglutinins after
viral infection or autoantibodies following drug treatment.
c. Is the result of cytotoxic T cells lysing red blood cells
d. Does not generally involve complement components in red
blood cell lysis
e. Can be characterized by a negative Coombs test
59.Systemic lupus erythematosus :
a. Is due to a mutation in double-stranded DNA.
b. Is a classic example of a T-cell-mediated autoimmune
disease.
c. Has multiple symptoms and affects many organs.
d. Results from antibodies specific to thyroid.
e. Affects only skin epithelial cells.
60.Diseases in which TH cells and cytotoxic CD8+ T cells probably
play major roles in their pathology include all of the following
EXCEPT:
a. Myasthenia gravis.
b. Hashimoto's thyroiditis.

ϮϮϴ

 c. Rheumatoid arthritis.
d. Multiple sclerosis.
e. Insulin-dependent diabetes mellitus.
61. A patient is found to have a form of diabetes in which his immune
system is destroying his pancreatic islet cells. Which is the most
likely explanation for this disease state?
a. The patient has an acquired immunodeficiency syndrome.
b. Immune complex formation and complement are the main
contributors to insulitis.
c. In the islets of the pancreas, b cells have upregulated MHC
class II and Fas molecules, making them susceptible to cell
death by immune cells.
d. There is an increase in suppressor cells.
e. CD4+ T cells are being destroyed by pancreatic enzymes.
62..Hashimoto's thyroiditis :
a. Is due primarily to antibodies formed to thyroid-stimulating
hormone receptors.
b. Mimics an animal model in which the disease is induced by
immunization with thyroglobulin.
c. Can be transplacentally transmitted causing a neonatal form
of the disease.
d. Is an autoimmune disease which affects males and females
equally.
e. Is characterized by immune complex deposition in the
thyroid.
63. What cell types can be made tolerant?
a. T-cell alone
b. B- cell alone
c. T- and B- cells
d. Macrophages
64. The major step in inducing T-cell tolerance occurs in:
a. Thymus
b. Bone marrow
c. Spleen
d. Lymph nodes
65. When a T- cell is made tolerant by receiving inappropriate co-
stimulation, it is called:
a. Negative selection
b. Clonal selection
c. Immune paralysis
d. Positive selection
66. In the T cells the interaction that triggers death signal and
apoptosis is:

ϮϮϵ

 a. B7 & CD28
b. MHC class I and TCR
c. MHC class II and TCR
d. Fas and FasL
e. IL-10 and its receptor.
67.Each of the following statements concerning immunologic
tolerance is correct EXCEPT:
a. Tolerance is not antigen-specific; i.e., paralysis of the
immune cells results in a failure to produce a response
against many antigens.
b. Tolerance is more easily induced in T cells than in B cells.
c. Tolerance is more easily induced in neonates than in adults.
d. Tolerance is more easily induced by simple molecules than
by complex ones.
68. You have a patient who makes autoantibodies against his own red
blood cells, leading to hemolysis. Which one of the following
mechanisms is MOST likely to explain the hemolysis?
a. Perforins from cytotoxic T cells lyse the red cells.
b. Neutrophils release proteases that lyse the red cells.
c. Interleukin-2 binds to its receptor on the red cells, which
results in lysis of the red cells.
d. Complement is activated, and membrane attack complexes
lyse the red cells.
69. Acute Rheumatic fever is an example of which of the following:
a. An autoimmune disease.
b. Molecular mimcry with induction of the disease dependent
upon an immune response to streptococcus cell wall antigen
cross ±reacting with a myocartial antigen.
c. Breaking of tolerance to self
d. A disease dependent upon antibody
e. All of the above.
70. Mechanisms of inducing tolerance to self include which of the
following?
a. Central tolerance resulting from deletion of self-reactive
cells in the thymus
b. Peripheral tolerance resulting from deletion of self-reactive
cells
c. Peripheral tolerance resulting from anergy
d. A and B
e. A, B, and C
71. Which of the following is not an autoimmune disease?
a. Multiple sclerosis
b. Type II diabetes

ϮϯϬ

 c. Systemic lupus erythematosus
d. Glomerulonephritis
72.Which of the following is not a mechanism for the development of
autoimmune disorders?
a. Exposure of previously "hidden" self-antigens to the
adaptive immune system
b. A second exposure to an allergen
c. Mutation followed by the appearance of membrane proteins
not previously present
d. Cross-reaction of antibodies formed against foreign antigens
with self-antigens.
73. The failure to inactivate or eliminate self-reactive cells results in :
a. Autoimmunity
b. Positive selection
c. Negative selection
d. Suppression
e. Tolerance
74.Failure of the immune system to respond against an epitope in an
aggressive way is termed:
a. Autoimmunity
b. Positive selection
c. Negative selection
d. Suppression
e. Tolerance
75.Deliberate inactivation or destruction of lymphocytes bearing bcrs
or tcrs capable of recognizing and binding specific self-epitopes
results in:
a. Hypersensitivity
b. Autoimmunity
c. Molecular mimicry
d. Positive selection
e. Self-tolerance
76. Lymphocytes expressing both the CD4 and CD25 markers on their
surfaces function as:
a. Antigen-presenting cells
b. Autoantibody-secreting B-cells
c. Cytotoxic T cell
d. Natural killer-like T cells
e. T- regulatory cells
77.During an infection with Streptococcus pyogenes , an individual
generated sufficiently high levels of IgM and IgG antibodies
against S. Pyogenes antigen with structural similarity with
molecules on the heart that cardiac damage was caused. In this

Ϯϯϭ

 example, the microbe contributed to autoimmunity via process
known as:
a. Anergy
b. Molecular mimicry
c. Central tolerance
d. Epitope spreading
e. Loss of suppression
78.Graves disease is an example of which of the following
immunological processes?
a. Autoimmune disease associated with HLA gene B27.
b. Autoimmune disease associated with HLA gene DR3
c. Immune deficiency associated with HLA gene DR2
d. Immune deficiency associated with HLA gene DR4
e. Type III hypersensitivity associated with HLA gene Cw6
79.Which of the following is the underlying immunological process in
ankylosing spondylitis?
a. Autoimmune disease associated with HLA gene B27
b. Development of autoantibodies against nucleic acids
c. Immune-mediated destruction of neurons
d. Immune deficiency associated with HLA gene DR4
e. Molecular mimicry of the acetylcholine receptor
80. A chronic inflammatory disease of connective tissue, affecting the
skin and various internal organs. Typically, there is a red scaly rash
on the face, over cheek and nose bridge and arthritis:
a. Rheumatoid arthritis
b. Systemic lupus erythematosus
c. Polymyositis
d. Sjorgren disease syndrome
e. Scleroderma
81. A generalized disease of the muscles that may be acute or chronic.
Microscopic examination of the affected muscles shows diffuse
inflammatory changes:
a. Osteoarithritis
b. Polymyositis
c. Myasthenia gravis
d. Sjorgren syndrome
82. In myasthenia gravis autoantibodies are directed against the --------
-----receptors in the motor end plate that stimulate muscular
contraction:
a. Acetylcholine
b. Dopamine
c. Epinephrine
d. Melatonin

ϮϯϮ

 e. Serotonin
83.Correlated with the genesis of rheumatoid arithritis, type 1 diabetes
mellitus, and pemphigus vulgaris:
a. HLA DR2
b. HLA DR3
c. HLA DR1
d. HLA DR5
e. HLA DR4
84.Strongly positively correlated with systemic lupus erythematosus
and multiple sclerosis, and negatively correlated with DM type 1:
a. HLA DR4
b. HLA DR2
c. HLA DR3
d. HLA DR5
e. HLA DR1
85.An autoimmune disease produced when the patient`s immune
system attacks cells presenting an specific antigen ( a type II
hypersensitivity reaction), which are found in the kidney and lung
causing damage to these organs:
a. Systemic lupus erythematosus
b. Myasthenia gravis
c. Primary myxedema
d. Addison`s disease
e. Goodpasteure`s syndrome
86. The chinning of the skin, either localized or generalized, resulting
in waxy ivory-colored areas. Treatment is unsatisfactory, but
spontaneous resolution may occur:
a. Scleroderma
b. Myasthenia gravis
c. Primary myxedema
d. Addison`s disease
e. Goodpasteure`s syndrome
87.A patchy inflammation of the walls of small blood vessels.
Rheumatoid factor may play a role:
a. Capilitis
b. Vasculitis
c. Phlebitis
d. Nephritis
e. Arteritis
88.Abnormal dryness of the eyes, mouth and vagina.The dryness
results from the reduced secretion of various kinds of glands
following invation and damage by lymphocytes:
a. Systemic lupus erythematosus

Ϯϯϯ

 b. Sjorgrens syndrome
c. Primary myxedema
d. Addison`s disease
e. Goodpasteure`s syndrome
89. Correlated strongly with Sjogren`s syndrome, myasthenia
gravis,and DM type 1:
a. HLA DR1
b. HLA DR3
c. HLA DR2
d. HLA DR5
e. HLA DR4
90.Perinicious anemia occurs when the immune system makes
antibodies against ---------- or against the stomach cells that make
it:
a. Innate factor
b. Exogenous factor
c. Intrinsic factor
d. Endogenous factor
e. Extrinsic factor
91. A theory that postulates that if immunologically compotent cells
capable of anti-self reaction arise they are soon eliminated:
a. Forbidden Clone
b. Adjuvant effect
c. Molecular mimicry
d. Sequestered antigen
e. Antigenic drift
92.Glomerulonephritis seen in systemic lupus erythematosus is the
result of:
a. Anti-glomerular basement membrane antibody deposits
b. Anti-glomerular basement membrane antibody deposits and
complement destruction
c. Cell-mediated immune response to a glomerular basement
membrane antigen
d. Glomerular basement membrane deposits of immune
complexes
93. Peripheral tolerance is produced:
a. In primary lymphoid organs in utero
b. In primary lymphoid organs after birth
c. By regulatory inhibition of autoreactive cells
d. Not existence of the 2nd signal to activate T lymphocytes
after formationof immunological synapsis
e. C and D is correct
94.Central tolerance is produced:

Ϯϯϰ

 a. In primary lymphoid organs in utero
b. In secondary lymphoid organs in utero
c. In primary lymphoid organs after birth
d. In secondary lymphoid organs after birth
e. By not existence of the 2nd signal to activate T lymphocytes
after immunological synapsis is produced
95.Molecular mimicry is resulting from reaction against self structures
produced by:
a. Cross reacting antibodies
b. Loss of toleranie
c. Loss of negative selection
d. Loss of anergy of immunological privileged organs
e. Loss of central tolerance
96.Inactivation and destruction of lymphocytes bearing the BCR or
TCR recognising self molecules results in:
a. Autoimmunity
b. Positive selection
c. Negative selection
d. Tolerance
e. Suppression
97.Deficiency of immune system to recognize epitope and eliminate it
is
a. Autoimmunity
b. Positive selection
c. Negative selection
d. Tolerance
e. Suppression
98.Rheumatoid factor is
a. IgM antibody bound on Fc fragment IgG
b. Diagnostical for reumatic fever
c. Both a and b are correct
99.Immunological tolerance is defined as what?
a. Accelerated response to an antigen that is induced by a
previous exposure to the antigen
b. Unresponsiveness to an antigen that is induced by a previous
exposure to an unrelated antigen
c. Unresponsiveness to an antigen that is induced by a previous
exposure to the same antigen
d. Spontaneous unresponsiveness to an antigen
100. Match the T cell tolerance mechanism with the cause
(i) T cell ignorance A. Excessive
cytokine secretion

Ϯϯϱ

 (ii) T cell anergy B. Expression of
FasL
(iii) Phenotypig skewing C. Expression of
CTLA4/PD1
(iv) T cell apoptosis D. Low affinity for
self-antigen
a. (i)D, (ii) C, (iii) A, (iv) B
b. (i)C, (ii) D, (iii) A, (iv) B
c. (i)B, (ii) C, (iii) D, (iv) A
d. (i)B, (ii) A, (iii) D, (iv) C

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6. a 31.d 56.b 81.b
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8. e 33.e 58.b 83.e
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  &KDSWHU7KLUWHHQ
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0&4
1. A graft between members of the same species is termed an:
a. Autograft.
b. Isograft.
c. Xenograft.
d. Allograft.
e. None of the above.
2. Which one of the following statements is false. Rejection of a
second (set) skin graft from the same allogeneic donor:
a. Can be blocked by azathioprine (an antimitotic agent).
b. Proceeds at the same speed as the first graft rejection.
c. Shows specificity for the graft donor.
d. Can be transferred to a naive recipient with lymphocytes.
e. Involves recognition of MHC differences.
3. The human major histocompatibility complex:
a. Provokes the most intense allograft reactions.
b. Is termed H-2.
c. Contains only class I and class II genes.
d. Is not expressed as codominant antigens on the cell surface.
e. Encodes the human leukocyte antigens (HLA) expressed
only on leukocytes.
4. Mitosis occurs when mixing lymphocytes of two individuals:
a. In presence of mitomycin C.
b. In presence of anti-CD4.
c. Who are identical twins.
d. Of differing MHC class II haplotype.
e. Of differing MHC class I, but identical MHC class II,
haplotype.
5. Transplantation success depend on:
a. Family relationship
b. Genetical match
c. Imunosupresive therapy
d. A,B, and C is correct
e. B&C is correct

Ϯϯϴ

 6. Transplantat from the genetically identical twin is:
a. Autotransplantat
b. Isotransplantat
c. Allotransplantat
d. Heterotransplantat
e. Idiotransplantat
7. Transplantat from parents is:
a. Autotransplantat
b. Isotranspl antat
c. Allotransplantat
d. Heterotransplantat
e. Idiotransplantat
8. Transplantat of skin from of animal given to man is:
a. Autotransplantat
b. Isotransplantat
c. Allotransplantat
d. Heterotransplantat
e. Idiotransplantat
9. Acute reaction to graft is characterized by rejection within
minutes
a. Resulting from activity of existing sensibilised T cells
b. Resulting from production of new reaction to non-self
antigens in graft
c. Resulting from preexisting antibodies
d. Resulting from the loss of tolerance
10.Chronical reaction to graft is characterised by rejection within
minutes
a. Resulting from activity of existing sensibilised T cells
b. Resulting from production of new reaction to non-self
antigens in graft
c. Resulting from preexisting antibodies
d. Resulting from the loss of tolerance
11.Accelerated reaction to graft is characterized by rejection within
minutes
a. Resulting from activity of existing sensibilised T cells
b. Resulting from production of new reaction to non-self
antigens in graft

Ϯϯϵ

 c. Resulting from preexisting antibodies
d. Resulting from the loss of tolerance
12.Hyperaccute reaction to graft is characterised by within minutes
a. Resulting from activity of existing sensibilised T cells
b. Resulting from production of new reaction to nonself
antigens in graft
c. Resulting from preexisting antibodies
d. Resulting from the loss of tolerance
13.Host versus graft reaction is:
a. Typical for reaction after transplantation of bone marrow
b. Typical for reaction in second transplantation
c. Characterised by rising success in direction auto, iso, allo,
xeno
d. Characterised by existence of memory cells
e. All answers are correct
14.Graft versus host reaction is:
a. Typical for reaction after transplantation of bone marrow
b. Typical for reaction in second transplantation
c. Characterised by rising success in direction auto, Iso, Allo,
Xeno
d. Characterised by existence of preformed antibodies
e. All answers are correct
15. You would want the cells from a potential transplantation donor to
have or do all of the following EXCEPT:
a. A match for class II MHC
b. A match for class I MHC
c. Stimulate proliferation of your peripheral white blood cells.
d. Be free of HIV
e. Be matched for blood group antigens
16. Mechanisms with the potential to contribute to allogeneic graft
rejection include all of the following EXCEPT
a. Antibody-mediated hyperacute rejection
b. CTL- mediated cell destruction
c. T cell- enhancedacute rejection
d. Chronic rejection with vessel occlusion
e. Passenger lymphocytes

ϮϰϬ

 17.The mixed lymphocyte reaction (MLR) using homozygous
stimulating cells can be used to tissue type for antigens encoded
by:
a. HLA-A
b. HLA-B
c. HLA-C
d. HLA-D
e. HLA-E
18. Non-specific suppression of graft rejection can be achieved with:
a. Ricin A chain.
b. Anti-IL-5.
c. Anti-NF kappa B
d. Anti-CD34.
e. Anti-CD3.
19. The immunosuppressive drug which probably attacks DNA by
alkylation and cross-linking is:
a. Azathioprine.
b. Cyclophosphamide.
c. Cyclosporine.
d. Rapamycin.
e. Prednison
20. The target of the monoclonal antibody Daclizumab used to help
suppress allograft rejection is:
a. CD3.
b. CD40L.
c. LFA-1.
d. ICAM-1.
e. CD25.
21.Pigs have been proposed as a source of organs for
xenotransplantation to humans because:
a. They do not pose a risk of zoonoses.
b. Their cell surface glycoproteins bear galactose a-1,3-
galactose structures.
c. They lack endogenous virus sequences.
d. Their hearts are an appropriate size and the pigs can be
genetically modified to limit the possibility of hyperacute
rejection.

Ϯϰϭ

 e. Their organs are not susceptible to hyperacute rejection
because they become coated with the natural antibodies
normally present in humans.
22. The 1-year survival rate for cadaver kidneys grafted into
individuals pretreated with blood transfusion and with no DR
mismatches is approximately:
a. > 95%.
b. 80±90%.
c. 55±65%.
d. 40±50%.
e. < 40%.
23.Graft vs. host disease often accompanies transplantation of:
a. Cartilage.
b. Kidney.
c. Bone marrow.
d. Heart.
e. Pancreas.
24.The very rapid response to a second allogeneic graft is:
a. Specific for antigens of the major histocompatibility
complex (MHC).
b. Dependent on minor histocompatibility antigens.
c. Transferred by macrophages to a naive recipient.
d. Transferred by platelets.
e. Transferred by IgA.
25.Concerning MHC class II antigen differences between 2
individuals, which of the following is untrue:
a. They produce mixed lymphocyte reactions.
b. They stimulate formation of helpers to generate cytotoxic T-
cells.
c. They cause graft vs host disease.
d. For sibling pairs, they will only exist on average in 1:4
cases.
e. None of the above.
26.Hyperacute graft rejection is caused by:
a. Preformed antibody.
b. CD4 lymphocytes.
c. CD8 lymphocytes.

ϮϰϮ

 d. Platelets.
e. Circulating immune complexes.
27.Which of the following does not minimize allogeneic graft
rejection:
a. Cyclosporine.
b. Disodium cromoglycate.
c. Azathioprine.
d. Cross-matching for ABO and MHC.
e. Anti-CD4.
28.Which of the following allogeneic grafts does not require
immunosuppression:
a. Kidney.
b. Heart.
c. Liver.
d. Bone marrow.
e. Cartilage.
29.The fetus may be protected from maternal transplantation attack
by:
a. Luteinizing hormone.
b. Presence of HLA class I on the fetus:
c. HLA-G on the extravillous cytotrophoblast.
d. C3 convertase on the syncitiotrophoblast.
e. Local production of IL-2.
30.Which one of the following sets of antigens is NOT important in
relation to successful renal grafting?
a. MHC class II antigens
b. Lewis red cell antigens
c. Sex antigens (products of X and Y chromosomes)
d. ABO red cell antigens
31.Which one of the following factors is NOT indicative of renal graft
rejection?
a. Fever
b. Increase in serum IgG level
c. Tenderness of the graft
d. Drop in urine volume
e. Rise in creatinine

Ϯϰϯ

 32.Which one of the following conditions is NOT an accepted
indication for bone marrow transplantation (BMTx) or Human
Stem Cell Transplantation [HSCT]?
a. Acute myeloid leukaemia in remission
b. Chronic lymphocytic leukaemia
c. Severe combined immunodeficiency
d. Drug-induced aplastic anaemia
e. Osteopetrosis
33.Which one of the following is NOT a risk associated with the use
of lymphocyte depletion with CAMPATH-1H as an induction
therapy for renal transplantation, in comparison with OKT3
prophylaxis?
a. Viral infection/viral reactivation
b. First dose cytokine release syndrome
c. EBV Lymphoproliferative disease
d. Vasculopathy/atherosclerosis
e. Chronic rejection
34.How long does it take for the first haematopoetic cells to
regenerate following human stem cell transplantation from a well-
matched donor?
a. 1 week
b. 10 days
c. 1 month
d. 2 months
e. 1 year
35.Which one of the following drugs specifically inhibits calcineurin?
a. Azathioprine
b. Ciclosporin
c. Cyclophosphamide
d. Methotrexate
e. Mycophenolate
36.Which one of the following statements regarding graft-versus-host
disease (GVHD) is FALSE"
a. Occurs in only a few patients receiving allogeneic bone
marrow transplants
b. May occur mildly following bone marrow transplantation
between HLA-identical siblings

Ϯϰϰ

 c. May occur following unirradiated blood transfusion in
babies with severe combined immune deficiency
d. Is preventable by depleting T cells from donor bone marrow
e. Clinically involves the skin, liver and intestine
37.Which one of the following statements regarding immunological
and haematological reconstitution following bone marrow
transplantation is FALSE"
a. The rate of granulocyte recovery is faster than that of
lymphocytes
b. T-cell function returns to normal 6-8 weeks following
transplantation
c. Recovery of B-cell function may be protracted
d. The overall pace of immunological recovery is slower in
recipients of HLA-incompatible bone marrow
e. Immune reconstitution is delayed in recipients who develop
severe graft-versus-host disease.
38.Which one of the following statements about heart transplantation
is true?
a. Azathioprine is the most useful immunosuppressive agent
b. ABO matching has no role in heart transplantation
c. HLA matching is essential
d. Monitoring depends on ECG changes
39.Which ONE of these approaches would be most suitable for
mobilization of stem cells into the peripheral blood of an individual
who is donating peripheral blood stem cells for allogeneic stem cell
transplantation?
a. Administration of subcutaneous granulocyte colonyǦ
stimulating factor (GǦCSF)
b. Administration of intravenous cyclophosphamide at a dose
of 1.5 g
c. Erythropoietin infections given twice weekly for 2 weeks
d. Administration of granulocyte-macrophage colonyǦ
stimulating factor (GMǦCSF)
40.What are the potential advantages of considering allogeneic stem
cell transplantation compared with autologous transplantation for a
young patient with multiple myeloma?

Ϯϰϱ

 a. It is more convenient to obtain stem cells from a healthy
donor as it is generally not possible to obtain adequate stem
cells from a patient with myeloma
b. Stem cells taken from the patient are inferior at
reconstituting an adequate immune system and therefore
infectious complications are more common after autologous
transplantation
c. The graftǦversusǦleukaemia effect of allogeneic stem
transplantation means that there is a possibility of curing the
multiple myeloma
d. It is associated with a lower transplantǦrelated mortality
41.Which of these individuals might be considered as the optimal
stem cell donor for an adult patient with acute myeloid leukaemia
in first remission?
a. An identical twin
b. An HLAǦmatched unrelated donor
c. An HLAǦmatched sibling donor
d. A cord blood stem cell donation
42.Which viral infection is most likely to be responsible for a clinical
picture of fever and pulmonary infiltration 6 weeks after an
allogeneic stem cell transplant?
a. Cytomegalovirus
b. Varicella zoster virus
c. Herpes simplex virus
d. Parvovirus
43.Which of these is NOT suitable for donation of stem cells for
allogeneic stem cell transplantation?
a. A sibling of the same blood group without further genetic
testing
b. An unrelated donor who is matched for HLA alleles
c. A syngeneic donor (identical twin)
d. Cord blood cells from donor with 5/6 match at major HLA
alleles
44.Which of these patients might be considered most suitable for
autologous stem cell transplantation?
a. A child with an inherited immunodeficiency
b. A 40ǦyearǦold with relapsed acute myeloid leukaemia

Ϯϰϲ

 c. A 6ǦyearǦold child with thalassaemia
d. A 57ǦyearǦold woman with myeloma
45.Which of these is most useful in evaluating that a stem cell
donation has an adequate number of stem cells prior to
transplantation?
a. The relative depletion of T cells
b. The number of CD34+ cells in the graft
c. The number of CD33 myeloid cells in the graft
d. The total nucleated cell count
46.Which of these is a clinical advantage of autologous stem cell
transplantation relative to allogeneic transplantation?
a. The stem cells are collected after chemotherapy and so there
is less contamination by tumour cells
b. There is less opportunity for graftǦversusǦhost disease
c. There is more chance of achieving a curative outcome
d. Ciclosporin can be reduced more quickly after autologous
transplants
47.Which of these is the most typical clinical picture of acute graft-
versus-host disease?
a. Erythematous skin rash and raised bilirubin level
b. Constipation and urticaria
c. Mouth ulcers and joint contractures
d. Immune deficiency and lung fibrosis
48.Which of these is NOT TRUE regarding donor leucocyte infusions
(DLI)?
a. The dose that is given is calculated by the number of T cells
in the infusion
b. This treatment can cure leukaemia without the need for
chemotherapy
c. DLI is given as an intravenous infusion, rather like a blood
transfusion
d. DLI given soon after the transplant has a reduced risk of
causing graftǦversusǦhost disease
49.Kidney transplantation was performed using a kidney from a donor
who was matched to the recipient by serologic tissue typing.
However, within a few months the kidney was rejected. Assuming

Ϯϰϳ

 no technical problems with the surgical procedure, one reason for
the rejection may be that
a. There was insufficient blood supply to the graft.
b. There could have been a mismatch, which would have been
detected by a mixed lymphocyte reaction.
c. The recipient developed blocking antibodies.
d. The recipient also suffered from Wiskott ²Aldrich
syndrome.
e. The donor was agammaglobulinemic.
50.Currently, the best indicator for predicting compatibility for
transplantation of tissue from donor A to recipient B is obtained by
a. One-way mixed leukocyte reaction between B cells and
mitomycin C-treated A cells.
b. One-way mixed leukocyte reaction between A cells and
mitomycin C-treated B cells.
c. Serologic typing and cross-matching of A and B cells.
d. Two-way mixed leukocyte reaction between A and B cells.
e. Matching for blood group antigens.
51.The MHC contains all of the following EXCEPT
a. Genes that encode transplantation antigens.
b. Genes that encode immunoglobulins.
c. Genes that regulate immune responsiveness.
d. Genes that encode some components of complement.
e. Genes that encode class I and class II antigens.
52.The most common serologic test used for the detection of HLA
antigens on lymphocytes is
a. The complement fixation test.
b. Double gel diffusion.
c. Complement-dependent cytotoxicity test.
d. Mixed lymphocyte reaction.
e. Radioimmunoassay.
53.Which of the following statements regarding GVH disease is
incorrect?
a. GVH can result from MHC differences between donor and
recipient.
b. GVH requires immunocompetent donor cells.

Ϯϰϴ

 c. GVH may result from infusion of blood products that
contain viable lymphocytes into an immunologically
incompetent recipient.
d. GVH requires natural killer cells.
e. GVH may occur in an immunosuppressed individual.
54.Transplant rejection may involve
a. Cell-mediated immunity.
b. Type III (immune complex) hypersensitivity.
c. Complement-dependent cytotoxicity.
d. The release of IFN-g.
e. All of the statements are correct.
55.Which of the following statements concerning the mixed leukocyte
reaction (MLR) is correct?
a. Specific responding cells are B lymphocytes.
b. MLR results in clonal expansion of specific, alloantigen-
reactive cells.
c. MLR between unrelated individuals who differ according to
HLA serology is usually negative.
d. Stimulation of proliferation is controlled primarily by the
HLA-A region alleles.
e. All of the statements are correct.
56.In clinical transplantation, cytotoxic antibodies reactive against
antigens expressed on the grafted tissue:
a. Cause delayed rejection of the transplant.
b. Are responsible for hyperacute rejection.
c. Cause rejection when present in the donor.
d. Are not usually directed against HLA antigens.
e. Activate cytotoxic T cells, which then cause hyperacute
rejection.
57.Serologic testing before kidney transplantation reveals that the
leukocytes of a prospective recipient are killed by the following
anti-HLA antibodies in the presence of complement: anti-B27,
anti-A1, and anti-A You can conclude that
a. The prospective recipient expresses the B27, A1, and A3
HLA specificities.
b. The prospective recipient does not express the B27, A1, and
A3 HLA specificities.

Ϯϰϵ

 c. The potential donor and the prospective recipient are not
siblings.
d. The potential donor and the prospective recipient are not
identical twins.
e. The prospective recipient should not receive a kidney graft
that expresses these HLA specificities.
58.A clinical trial investigating the efficacy of a humanized anti-CD28
monoclonal antibody in prolonging kidney allograft survival shows
that patients treated with this biologic reagent have significantly
fewer episodes of chronic rejection. The probable mechanism
responsible for this effect is best explained by:
a. The binding of anti-CD28 to B cells, which blocks their
interaction with B7.1 and B7.2 expressed on T cells.
b. The formation of circulating CD28-anti-CD28 immune
complexes.
c. The binding of anti-CD28 to T cells, which interferes with
signal transduction needed for T-cell activation.
d. The binding of anti-CD28 to suppressor T cells, which then
become activated.
e. The binding of anti-CD28 to B and T cells which interferes
with signal transduction and activation of both populations.
59.Bone marrow transplantation in immunocompromised patients
presents which major problem?
a. Potentially lethal graft-versus-host disease
b. High risk of T cell leukemia
c. Inability to use a live donor
d. Delayed hypersensitivity
60.Which of the choices shown below correctly completes the
following statement? The frequency of T cells in a normal
individual capable of directly recognizing allogeneic MHC
molecules is:
a. Almost undetectable before transplantation
b. About the same as that of T cells directed to a given nominal
antigen (e.g., measles virus)
c. Many times higher than that of T cells directed to a given
nominal antigen

ϮϱϬ

 d. Zero because T cells recognize antigen only in association
with self-MHC molecules
e. Unrelated to acute rejection of organ allografts
61.Which of the choices shown below correctly completes the
following statement? Minor histocompatibility antigens are:
a. The major rejection problem in MHC-mismatched renal
transplantation
b. Of no consequence in allograft rejection
c. Critical targets during hyperacute rejection of organ
allografts
d. Recognized as polymorphic donor peptides associated with
self-MHC antigens
e. Encoded by genes located within the MHC
62.Which of the choices shown below correctly completes the
following statement? Allografts are grafts transplanted:
a. Between genetically different individuals of the same species
b. Between genetically identical individuals of the same species
c. In the same individual, i.e., the donor is the recipient
d. Between individuals of different species
63.Which is of the following statement is NOT correct?
a. Second set rejection of allografts exhibits memory and
specificity
b. Allograft rejection can be mediated by lymphocytes
c. Second set rejection of allografts occurs in recipients who
receive a second transplant from the same donor
d. Allograft rejection does not occur if donor and recipient are
matched for MHC alleles
64.Antibodies of which of the following specificities can trigger
antibody-mediated rejection?
a. Antibodies to HLA antigens
b. Antibodies to non-MHC molecules
c. Antibodies to ABO blood group antibodies
d. All of the above
65.Which of the following statement about antibody-mediated
rejection is NOT correct?
a. Antibody-mediated acute rejection occurs only at early time
points after organ transplantation

Ϯϱϭ

 b. Risk factors for antibody-mediated rejection include multiple
transplantation, previous pregnancies, and a history of blood
transfusions
c. Hyperacute rejection is mediated by high levels of pre-
existing anti-donor antibodies
d. The cross-match assay is performed to prevent hyperacute
rejection
66.Which of the following statements regarding C4d deposition is
NOT correct?
a. C4d is a fragment of C4 produced during the classic
complement activation pathway
b. C4d deposition is known to cause severe graft injury in renal
transplantation
c. C4d deposition in the peritubular capillaries correlates with
the presence of circulating anti-donor antibodies
d. C4d is highly stable and persists at the cell surface for a long
time periods
67.The direct allogeneic antigen presentation involves the recognition
of peptides through intact MHC molecules displayed on ______
APCs while indirect allogeneic antigen presentation involves the
recognition of ______ through self-MHC displayed on ______
APCs.
a. Donor; host MHC; host
b. Host; host MHC; donor
c. Donor; donor MHC; host
d. Host; donor MHC; donor
68.Immunosuppressive drugs that inhibit T cell responses to
transplanted organs utilize various mechanisms. These may include
which of the following?
a. Inhibiting cytokine production
b. Inhibiting cellular division
c. Inducing cellular death
d. Blocking cellular processes
e. All of the above
69.Which of the following statements about xenotransplantation is
NOT true?

ϮϱϮ

 a. Xenotransplantation is a potential solution to the current
shortage of donor organs for clinical transplantation
b. Antibodies to the a-Gal carbohydrate moiety dominate the
humoral response to xenografts
c. Innate immune responses may contribute to immune
destruction of xenografts
d. Anti-a-Gal antibody is the only kind of antibody that can
trigger humoral rejection after xenotransplantation
70.Which of the following infections is LEAST likely in the first 4
weeks after an otherwise successful liver transplantation?
a. Pulmonary aspergillosis
b. E. Coli urinary tract infection
c. Staphylococcal bacteremia
d. West Nile virus meningitis
71.Which of the following antimicrobial agents is most likely to
increase calcineurin inhibitor blood levels?
a. Azithromycin
b. Cefazolin
c. Rifampin
d. Clarithromycin
72.In the early period after solid organ transplantation, pneumonia is
most often:
a. Community acquired
b. Nosocomial
c. Opportunistic
d. None of these
73.Nocardiosis is most common in patients transplanted with which of
the following organs?
a. Kidney
b. Pancreas
c. Lung
d. Liver
74.Of the following, which is the most common disorder leading to
liver transplantation in children?
a. Wilson's disease
b. Alcoholic cirrhosis
c. Biliary atresia

Ϯϱϯ

 d. Autoimmune hepatitis
75.7KH ³IDWKHU RI H[SHULPHQWDO VXUJHU\´ ZKR SHUIRUPHd pioneering
research, including several transplantation procedures, was:
a. Homer, the Greek who described the Chimaera in his Iliad.
b. Gasparo Tagliacozzi, the Italian who described a method of
reconstructing the nose.
c. John Hunter, the Scot who performed autografts and
xenografts.
d. Emrick Ullmann, the Austrian who performed the first
successful renal allograft.
e. Alexis Carrel, the Franco-American who described a
successful technique for vascular anastomosis.
76.The modern era of clinical organ transplantation began with the
advent of chemical immunosuppression. The important drug
discovery that produced the initial success of cadaveric
transplantation was:
a. Cyclophosphamide.
b. Azathioprine.
c. Cyclosporine.
d. Antilymphocyte serum.
e. Monoclonal antibody OKT3.
77.All the following statements correctly characterize the genetic
basis of histocompatibility EXCEPT
a. Histocompatibility is determined by a series of genes
inherited as a complex and subject to the mendelian rules
that characterize recessive traits.
b. Histocompatibility depends in part on the inheritance of
histocompatibility genes and in part on the inheritance of T-
cell receptor genes.
c. Major histocompatibility genes are not polymorphic.
d. Histocompatibility genes are independently segregating and
co-dominant.
78.Which of the following distinguish MHC class I from MHC class
II antigens?
a. MHC class I and class II antigens are encoded in different
regions of the MHC complex.

Ϯϱϰ

 b. MHC class I antigens are expressed on specialized antigen-
presenting cells, whereas MHC class II antigens are
expressed on all cells.
c. MHC class I and class II are members of different supergene
families.
d. MHC class I are considered to be the major
histocompatibility antigens and MHC class II the minor
histocompatibility antigens.
79.The unusual intensity of alloimmune responses reflects which of
the following characteristics EXCEPT?
a. The presence of a peptide-binding groove in the MHC
molecule.
b. Recognition of the native structure of allogeneic MHC
molecules.
c. The high frequency of T cells able to recognize directly
allogeneic MHC antigens.
d. Stimulation of many T-cell receptors during the interaction
of a T cell with an antigen-presenting cell.
e. The high frequency of antigen-presenting cells able to be
recognized by T cells.
80.Which of the following statements correctly characterize the role of
histocompatibility typing in transplantation?
a. Histocompatibility typing must be carried out before
transplantation can safely be undertaken.
b. 7KH ³UXOHV´ RI KLVWRFRPSDWLELOLW\ ZHUH HVWDEOLVKHG VKRUWO\
after the advent of immunosuppressive therapy made
transplantation feasible.
c. Histocompatibility typing does not involve serologic,
cellular, and molecular procedures for typing.
d. The role of histocompatibility matching in transplantation is
controversial.
81.The following statements characterize the biology of
allotransplantation EXCEPT?
a. The rejection response is systemic.
b. The rejection response is learned.
c. The rejection response involves a constellation of
immunologic and environmental factors.

Ϯϱϱ

 d. Allotransplantation evokes a cellular immune response.
e. Allotransplantation evokes a humoral immune response.
82.Allograft rejection may involve all of the following EXCEPT :
a. Helper T cells.
b. Veto cells.
c. Cytotoxicity.
d. Cytokines.
83.Which of the following statements about allograft rejection are
true?
a. In the absence of immunosuppression, the time and intensity
of rejection of transplants between unrelated donors and
recipients is highly variable.
b. Allograft rejection may be mediated by antibodies or by
cells.
c. Allograft rejection is thought to be caused by Th2 cells.
d. Acute cellular rejection is the major cause for loss of clinical
organ transplants.
e. $Q LQGLYLGXDO ZLWK ³WROHUDQFH´ LV XQDEOH WR UHMHFW DQ
allograft.
84.The presence of donor-reactive lymphocytotoxic antibodies in the
serum of a potential kidney transplant recipient:
a. Can be detected by in vitro testing with recipient leukocytes
and donor serum.
b. Is a contraindication to kidney transplantation.
c. Can be found in all male patients older than 20 years.
d. None of the above
85.Utilization of a living related donor instead of a cadaver donor is
no longer an advantage in renal transplantation because:
a. Public recognition of transplantation as a successful therapy
has facilitated obtaining family permission for recovery of
transplantable organs. Thus, because sufficient kidneys are
DYDLODEOH IURP ³EUDLQ-GHDG´ DFFLGHQW YLFWLPV WKHUH LV QR
need to use related donors.
b. Cyclosporine therapy after cadaveric renal transplants has
improved their outcome, which is now comparable to
related-donor transplants.

Ϯϱϲ

 c. Modern preservation techniques can maintain viability of
kidneys from cadaver donors for many hours, consistently
allowing their early function to be as good as that of kidneys
from living donors.
d. None of the above.
86.Large volumes of urine in the early postoperative course of renal
transplant patients:
a. Result from osmotic stimuli to diuresis.
b. May signify reversible polyuric acute tubular necrosis.
c. Should be replaced by administration of equal volumes of
crystalloid.
d. Facilitate the diagnosis of rejection and obstruction of the
renal artery and/or collecting system.
e. All of the above
87.As compared with the early immunosuppressive drugs
(azathioprine, steroids, antilymphocyte serum) some newer agents
have the following specific advantages:
a. Cyclosporine, which interferes with lymphokine production,
exhibits neither bone marrow nor renal toxicity.
b. Monoclonal antibody (OKT3) is more available and has
greater specificity and fewer side effects than anti-
lymphocyte serum.
c. Tacrolimus (FK506) has properties similar to those of
cyclosporine but is especially valuable for rescue of grafts
that are failing on cyclosporine therapy.
d. None of the above.
88.Survival rates for patients on dialysis are better than those for
patients receiving renal allografts in the following circumstances:
a. A living related donor is available.
b. A cadaver donor must be used.
c. The recipient's renal failure is secondary to diabetes.
d. None of the above.
89.Post-transplantation hypertension can be caused by:
a. Rejection.
b. Cyclosporine nephrotoxicity.
c. Renal transplant artery stenosis (RTAS).
d. Recurrent disease in the allograft.

Ϯϱϳ

 e. All of the above
90.Which of the following statements about post-transplantation
malignancy is correct?
a. Certain immunosuppressive agents increase the incidence of
malignancy in transplant recipients, whereas others do not.
b. Those malignancies most commonly seen in the general
population (breast, colon) are substantially more common in
transplant recipients.
c. Lymphoproliferative states and B-cell lymphomas are
associated with Epstein-Barr virus.
d. None of the above.
91.One week after receiving a cadaver renal allograft, the recipient
remains oliguric and dialysis dependent. Ultrasonography reveals a
larger perigraft fluid collection. Your next step in management
includes:
a. No further investigations (since perigraft collections are
fairly common after renal transplantation).
b. Aspiration of the perigraft fluid collection and instillation of
a fibrosis-inducing agent to obliterate the dead space.
c. Angiography for localization of a bleeding site in the renal
allograft.
d. Aspiration of the perigraft fluid collection for chemical
analysis.
92.Regarding access for hemodialysis, which of the following
statements is/are incorrect?
a. Some patients are not candidates for hemodialysis.
b. Some complications can lead to exsanguination.
c. The best access to place for a patient beginning dialysis is a
leg polytetrafluoroethylene (PTFE) graft from the femoral
artery to the saphenous vein.
d. First of all one should attempt to create a Brescia-Cimino
fistula.
e. The leading complication of PTFE grafts is infection.
93.Access to the peritoneal cavity for peritoneal dialysis can be gained
all of the following EXCEPT:
a. Percutaneously.
b. Surgically.

Ϯϱϴ

 c. Using laparoscopy.
d. Only using general anesthesia.
94.The following are true concerning immunosuppression EXCEPT?
a. Current immunosuppressive agents function in a nonspecific
manner to suppress rejection.
b. The use of immunosuppressive agents is associated with an
increased rate of opportunistic infections.
c. An increased rate of malignancy is not associated with the
use of immunosuppressive agents.
d. In almost all cases, the graft is rejected if
immunosuppression is discontinued.
95.The most common types of immunosuppressive agents used
clinically include which of the following?
a. Antimetabolites.
b. Alkylating agents.
c. Inhibitors of helper T-cell activation.
d. Irradiation.
e. All of the above.
96.Which of the following are true of cyclosporine?
a. It was the first immunosuppressive agent to be used
clinically.
b. It acts selectively on T cells to suppress rejection.
c. Toxic effects include hirsutism, hypertension,
nephrotoxicity, and increased risk of opportunistic
infections.
d. B & C true
97.Hypothermia (0˭ to 4˭ C) is a critical component of successful
organ cold storage because:
a. Oxygen is more soluble in cold solutions and provides a
continual supply for energy metabolism.
b. There is no way to suppress microbial growth EXCEPT by
cooling and slowing the growth rate.
c. Hypothermia diminishes energy requirements and allows the
limited energy reserve to keep the organ alive.
d. It slows metabolism and the enzymatic processes that would
destroy the cell.

Ϯϱϵ

 98.Which of the following statements about hepatic artery thrombosis
following liver transplantation is/are correct?
a. Thrombosis of the hepatic artery following liver
transplantation is more common in children than in adult
patients.
b. Thrombosis of the hepatic artery usually occurs several
weeks after transplant as a result of arteriosclerosis.
c. Thrombosis of the hepatic artery in the early days following
transplantation is a serious complication leading to death
unless retransplantation can be performed within 36 to 72
hours.
d. A,C and E correct
e. Thrombosis of the portal vein is more frequent than hepatic
artery thrombosis following liver transplantation.
99.The following statements about immunology in liver
transplantation are correct EXCEPT?
a. Good human leukocyte antigen (HLA) matching between
recipient and donor is mandatory for a good outcome for
liver transplantation.
b. Hyperacute rejection is almost nonexistent following liver
transplantation.
c. Acute rejection occurs in more than 50% of patients and is
reversible in most patients with large doses of steroids.
d. Acute rejection is very rare later than 2 months after liver
transplantation unless the patient is inadequately
immunosuppressed.
e. Chronic rejection is different from acute rejection, is usually
irreversible, and often requires re-transplantation.
100.An elevated serum amylase level following pancreas-kidney
transplantation may be due to all of the following EXCEPT:
a. Preservation/procurement injury.
b. Rejection.
c. Reflux pancreatitis.
d. Duodenal segment leak or bladder leak.
e. Native pancreatitis.

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1. An example of a known oncogenic virus is:
a. Herpes zoster.
b. HIV-2.
c. Epstein-Barr virus.
d. Vesicular stomatitis virus.
e. Proteus mirabilis.
2. Boon and colleagues showed that syngeneic transplantable tumors
which mutate such that they express strong transplantation antigens
are rejected. They called these variants:
a. Tum ± .
b. Xenogeneic.
c. Tum + .
d. MCA.
e. Non-immunogenic
3. In pancreatic carcinoma the ras gene:
a. Is absent.
b. Is normal but is overexpressed.
c. Has a large deletion.
d. Contains a single point mutation, always at the same
position.
e. Contains a single point mutation, but not always at the same
position.
4. Wheat germ agglutinin binds strongly to:
a. Surface lipoproteins on resting T-cells.
b. Surface glycoproteins on resting T-cells.
c. Surface glycoproteins on resting B-cells.
d. Surface glycoproteins on activated T- and B-cells.
e. Surface lipoproteins on activated T- and B-cells.
5. Strongly immunogenic tumors appear:
a. In virtually all cancers.
b. Only in lymphoma and leukemia.
c. In immunosuppressed patients.
d. Only in experimental animals.

ϮϲϮ

 e. Only in elderly patients.
6. A mouse strain deficient in NK cells is the:
a. SJL.
b. Beige.
c. Nude.
d. MRL-lpr/lpr.
e. Moth-eaten viable.
7. Which of the following is most commonly seen in African children
with Burkitt's lymphoma:
a. Absence of EBV.
b. T-cell neoplasia.
c. Deletion of the c-myc gene.
d. Chromosome 8q24 to Chromosome 14q32 translocation.
e. Chromosome 8q24 to Chromosome 2p12 translocation.
8. Pre-B acute lymphoblastic leukemia (Pre-B ALL) cells lack:
a. Expression of terminal deoxynucleotidyl transferase
b. HLA-DR.
c. Cytoplasmic µ heavy chain.
d. CD5.
e. CD10.
9. Chronic lymphocytic leukemia:
a. Usually has a very poor prognosis.
b. Has a good prognosis only in those patients with circulating
monoclonal immunoglobulin.
c. Is mostly a disease of childhood.
d. Is usually found in people over 50 years of age.
e. Is a leukemia where both kappa and lambda light chains are
found on the surface of the malignant cell.
10.Non-Hodgkin lymphomas:
a. Will be positive when stained with antibodies to cytokeratin.
b. Are usually of T-cell origin but sometimes of B-cell origin.
c. Can be differentiated from carcinoma using antibodies to
CD45 (leukocyte common antigen).
d. Are reactive B-cell hyperplasias.
e. Have a good prognosis.
11.In Burkitt's lymphoma, a vaccine against which of the following
might prove useful:

Ϯϲϯ

 a. Epstein-Barr virus.
b. Marek's disease virus.
c. Human papilloma virus.
d. HTLV-1.
e. MMTV.
12.A B-cell lymphoma will express a unique tumor antigen called:
a. P53.
b. Endosialin.
c. SM-3.
d. Idiotype.
e. Lewis Lea.
13.Bone marrow purging in myeloid leukemias can be successfully
carried out using antibodies to:
a. CD3.
b. CD33.
c. CD5.
d. CD45.
e. CD1.
14.A diagnostic marker for tumors of the colon is:
a. Alpha-fetoprotein.
b. Carcinoembryonic antigen (CEA).
c. The presence of Reed-Sternberg cells. :
d. EBV-related antigens.
e. Common acute lymphoblastic leukemia antigen (CALLA).
15.Antigens normally expressed only on embryonic cells but also
sometimes found on tumors are known as:
a. Oncofetal antigens.
b. HTLV-1.
c. Maternal.
d. Neonatal.
e. Cryptic.
16.CD44 is a molecule which may be involved in:
a. Neoplastic transformation.
b. Metastatic spread.
c. Tumor surveillance.
d. Antigen recognition.
e. Secretion of tumor necrosis factor

Ϯϲϰ

 17.The normal immunological control of tumors is referred to as:
a. Immunological tolerance.
b. Immune surveillance.
c. Type III hypersensitivity.
d. Immunological silence.
e. Superantigen recognition.
18.Malignant lymphoid cells:
a. Show maturation arrest at characteristic stages in
differentiation.
b. Form a polyclonal population of cells.
c. Are non-dividing.
d. Express several different tumor-specific antigens.
e. Are always derived from various stages of the normal B-cell
differentiation pathway.
19.The amyloid deposits found in 10±20% of patients with myeloma
contain:
a. Immunoglobulin light chains.
b. Immunoglobulin heavy chains.
c. Amyloid A (AA) protein.
d. Isolated single molecules.
e. Congo red.
20.In Waldenström's macroglobulinemia there is secretion of:
a. Polyclonal IgG.
b. Monoclonal IgG.
c. Polyclonal IgM.
d. Monoclonal IgM.
e. Monoclonal antibody of mixed class
21.The appearance of many primary lymphoreticular tumors in
humans has been correlated with
a. Hypergammaglobulinemia.
b. Acquired hemolytic anemia.
c. BCG treatment.
d. Resistance to antibiotics.
e. Impairment of cell-mediated immunity.
22.Tumor antigens have been shown to cross-react immunologically
in cases of
a. Tumors induced by chemical carcinogens.

Ϯϲϱ

 b. Tumors induced by RNA viruses.
c. All tumors.
d. Tumors induced by irradiation with ultraviolet light.
e. Tumors induced by the same chemical carcinogen on two
separate sites on the same individual.
23.Which of the following is not considered a mechanism by which
cytokines mediate antitumor effects?
a. They enhance the expression of MHC class I molecules.
b. They activate LAK and TIL cells.
c. They have direct antitumor activity.
d. They induce complement-mediated cytolysis.
e. They increase activity of cytotoxic T cells, macrophages,
and NK cells.
24.Rejection of a tumor may involve which of the following?
a. T-cell-mediated cytotoxicity
b. ADCC
c. Complement-dependent cytotoxicity
d. Destruction of tumor cells by phagocytic cells
e. All are correct.
25.Immunotoxins are
a. Toxic substances released by macrophages.
b. Cytokines.
c. Toxins completed with the corresponding antitoxins.
d. Toxins coupled to antigen-specific immunoglobulins.
e. Toxins released by cytotoxic T cells.
26.It has been shown that a B-cell lymphoma could be eliminated with
anti-idiotypic serum. The use of this approach to treat a plasma cell
tumor would not be warranted because
a. Plasma cell tumors have no tumor-specific antigens.
b. Plasma cell tumors are not expected to be susceptible to
ADCC.
c. Plasma cell tumors can be killed in vivo only by cytotoxic T
lymphocytes that bear the same A, B, and C transplantation
antigens.
d. The plasma cells do not have surface Ig.
e. The idiotype on the plasma-cell surface is different from that
on the B-cell surface.

Ϯϲϲ

 27.A line of tumor cells prepared from one mouse is injected into an
MHC-matched recipient. The tumor was destroyed within 5 days.
When tissues from the recipient were analyzed, the animal had a
negligible cytotoxic T lymphocyte (CTL) response against the
tumor. Flow cytometry revealed that the tumor cells expressed very
low levels of MHC class I molecules. The BEST explanation for
the destruction of the tumor cells in the recipient is that:
a. CTL had an MHC-induced alloreaction against the tumor
cells
b. CTL specific for the tumor antigens killed the tumor cells
c. Mast cells released histamine and other inflammatory
mediators that clear the tumor
d. Natural killer cells bound anti-tumor antibodies and killed
the tumor cells
e. Natural killer cells recognized the absence of MHC class I
molecules and killed the tumor cells
28.Which of the following is not a Tumor Specific Antigen?
a. EBV
b. HPV
c. HER2
d. HTLV
29.Which of the following is the most effective response to a tumor?
a. Antibodies
b. CTLs
c. Macrophages
d. NK cells
30.Which of the following is not a tumor evasion strategy?
a. Sequestration
b. Tumors lose their expression of antigens that elicit responses
c. Producing anit-tumor antibodies
d. None of the above
31.Which of the following causes an increase in class I MHC?
a. IFN
b. TGF-alpha
c. IL-2
d. TNF

Ϯϲϳ

 32.Which of the following are derived from peripheral blood of a
patient and cultured with recombinant IL-2?
a. TILs
b. JAKs
c. LAKs
d. BCG
33.Which of the following is used as a treatment for TB?
a. BCG
b. Whole cell tumor vaccines
c. Gene modified tumor vaccines
d. MAGE
34.The term cancer means
a. Cell division.
b. Out of control.
c. Crab.
d. Lobster.
35. Cancer is often the result of activation of ____ to ____ and the
inactivation of ____ genes.
a. Oncogenes, tumor-suppressor genes, proto-oncogenes
b. Proto-oncogenes, oncogenes, tumor-suppressor genes
c. Oncogenes, proto-oncogenes, tumor-suppressor genes
d. Proto-suppressor genes, suppressors, oncogenes
36. About 50% of all human cancers may involve an abnormal or
missing
a. Oncogene.
b. Proto-oncogene.
c. P53 gene.
d. BRCA-1 gene.
37. Inherited retinoblastoma requires ____ mutation(s) or deletion(s).
a. One
b. Two
c. Three
d. Four
38. In which of the human cells listed below is telomerase active?
a. Blood
b. Bone
c. Muscle

Ϯϲϴ

 d. Sperm
39.Which of the following is not a characteristic of cancer cells?
a. Loss of cell cycle control
b. Transplantability
c. Loss of contact inhibition
d. All are characteristic
40. The Philadelphia chromosome is associated with which type of
cancer?
a. Breast
b. Thyroid
c. Nerve
d. Leukemia
41. BRCA-1 is associated with which cancer?
a. Breast
b. Thyroid
c. Nerve
d. Leukemia
42. An increasing number of women in the rural south die from ____
cancer.
a. Breast
b. Colon
c. Lung
d. Mouth
43. Which of the following statements about telomerase is incorrect?
a. It is an enzyme that adds DNA to telomeres.
b. It serves as the template for telomeres lengthening.
c. It is not activated in cancer cells.
d. Its activity continually resets the cellular clock.
44. Familial cancer is caused by
a. A mutation in somatic cells only.
b. A mutation in germline cells only.
c. A germline mutation plus a somatic mutation in affected
tissue.
d. Two germline mutations.
45. Which type of cancer in humans is directly caused by a viral
infection?
a. Acute T cell leukemia

Ϯϲϵ

 b. Wilms' tumor
c. Burkitt's lymphoma
d. Rous sarcoma
46. An oncogene transcribed and translated with another gene
produces a:
a. Transcribed protein.
b. Fusion protein.
c. Fusion cell.
d. Cancer protein.
47. The P53 protein normally promotes:
a. DNA repair.
b. Tumor formation.
c. Cell division.
d. Apoptosis.
48. The P53 gene is especially prone to:
a. Point mutation.
b. Chromosomal rearrangement.
c. Loss.
d. None of the above.
49. FAP colon cancer results from ____ mutation(s).
a. One
b. Two
c. Three
d. Four or more
50. Which type of study compares the incidence of a type of cancer
among very different groups of people?
a. Population
b. Case-control
c. Prospective
d. Empiric
51. Which type of study would compare cancer rates seen in a group
of individuals who take herbal supplements versus those in a
control group who do not use the supplement?
a. Population
b. Case-control
c. Prospective
d. Empiric

ϮϳϬ

 52. Which of the following cancers develops from loss of tumor
suppression?
a. Cute T cell leukemia
b. Wilms' tumor
c. Burkitt's lymphoma
d. Rous sarcoma
53. Why is genetic counseling for familial breast cancer difficult?
a. BRCA1 and BRCA2 are incompletely penetrant.
b. Breast cancer can occur in other ways.
c. Not all mutations are associated with disease.
d. All of the above
54. Which of the following is not a traditional cancer treatment?
a. Blocking telomerase
b. Inhibiting angiogenesis
c. Stimulating specialization
d. None of the above
55. A mutation in which gene makes nearby DNA more susceptible to
replication errors?
a. APC
b. BRCA1
c. P53
d. RB
56. Which of the following may contribute to causing cancer?
a. A mutation in a gene that slows the cell cycle
b. Faulty DNA repair
c. Loss of control over telomere length
d. All of the above
57.Which of the following tumor markers is/are associated with
pancreatic cancers?
a. CEA and CA-19-9
b. CA-19-9 and CA-125
c. CEA
d. Calcitonin
e. CA - 125
58.:KLFKRIWKHIROORZLQJFDQFHUVLV127DVVRFLDWHGZLWKȕ-HCG?
a. Choriocarcinoma
b. Prostate carcinoma

Ϯϳϭ

 c. Gestational trophoblastic tumors
d. Hydatidiform mole
59.What tumor marker is extremely elevated in a patient with a
hydatidiform mole?
a. Ǻ-HCG
b. CA-125
c. PSA
d. ǹ-fetoprotein
60.What tumor marker is associated with melanoma?
a. TRAP
b. S-100
c. Bombesin
d. Alkaline phospatase
61.Which childhood cancer has bombesin as a tumor marker?
a. Acute lymphoblastic leukemia
b. Neuroblastoma
c. Lung cancer
d. Gastric cancer
62.Obstructive biliary disease and Paget's disease of the bone have
which of the following tumor markers in common?
a. Tartrate-resistant acid phosphatase (TRAP)
b. S-100
c. Alkaline phosphatase
d. Calcitonin
63.What cancer marker is a associated with CA-125
a. Hepatocellular carcinomas
b. Pancreatic cancers
c. Melanoma
d. Surface epithelial tumors of the ovaries
64.An example of a cancer-specific marker, CEA, or
carcinoembryonic antigen, is a blood-borne protein, first noted to
be produced by tumors of the ________.
a. Peritonitis
b. Human gastrointestinal tract
c. Ascending cholangitis
d. Colorectal cancer

ϮϳϮ

 65. Example: elevated AFP in a child previously treated for ________
suggests relapse with endodermal sinus tumor.
a. Germ cell tumor
b. Teratoma
c. ICD-10 Chapter II: Neoplasms
d. Choriocarcinoma
66.PSA (________) is produced by the normal prostate.
a. Factor X
b. Prostate-specific antigen
c. Reelin
d. Plasmin
67.Surgical intervention or ________), and a recurrence can often be
detected by the finding of rising levels.
a. Cancer immunotherapy
b. Antineoplastic
c. Chemotherapy
d. ATC code L
68.Elevated CA15-3, in conjunction with ________, was shown to
increase chances of early recurrence in breast cancer.
a. Phospholipase A2
b. Alkaline phosphatase
c. Aspartate transaminase
d. Reference ranges for blood tests
69.A tumor marker is a substance found in the ________, urine, or
body tissues that can be elevated in cancer, among other tissue
types.
a. Blood plasma
b. Platelet
c. Red blood cell
d. Blood
70.Which of the following may be expected in cells over expressing
Src?
a. Enhanced rate of apoptosis
b. Death by necrosis
c. Increased expression of MHC I molecules
d. Unregulated cell division

Ϯϳϯ

 71. A bone marrow biopsy from a patient with acute lymphocytic
leukemia reveals the presence of mutated form of p53 within
leukemic cells. This mutation is likely responsible for which of the
following:
a. An increase in the Bax-to Bcl-2 ratio
b. Decrease activity of NK cell KIR function
c. Excess activity of a GTP- binding protein
d. Growth of malignant cells as a solid tumor
e. Loss of suppression of cell growth
72.Which of the following is correct regarding tumor- specific
transplantation antigens (TSTAs)?
a. Also present in high concentration on normal somatic cells
b. Often found on normal fetal cells as well as on tumor cells
c. Readily identified on most naturally occurring tumors
d. Result from mutant proteins expressed
e. Stimulate apoptosis on cells that express them
73.According to immune surveillance theory,
a. Antibodies arise during fetal development that can destroy
tumors
b. Cancer cells rarely arise within a normal individual
c. Innate immune responses eliminate specific tumor cell
antigens
d. Tumor arise only if malignant cells escape immune detection
e. Tumor-infiltrating lymphocytes prevent malignant
transformations
74.Which of the following is a cytokine known to have antitumor
activity?
a. Epidermal growth factor
b. Interferon-Ȗ
c. Interleukin-2
d. Interleukin-12
e. Platelets derived growth factor
75.Lymphokine-activated killer (LAK) cells are indistinguishable
from
a. B lymphocytes
b. Macrophage
c. Malignant somatic cells

Ϯϳϰ

 d. NK cells
e. T lymphocytes
76.Which of the following provides evidence of immune evasion by
tumor cells?
a. Down-regulation of MHC I molecules by tumor cells
b. Enhanced production of tumor necrosis factor by
macrophages
c. INF- Ȗ- mediated inhibition of tumor cell proliferation
d. Generation of antibodies against tumor-specific antigens
e. Stimulation of tumor cells apoptosis by increased Bax
expression
77.A new method to reduce the incidence of cervical cancer involves
a. Administration of tumor necrosis factor to the cervix
b. Injection of antibodies against other patients` cervical tumors
c. Stimulation of antibody-mediated cell lysis of cervical tumor
cells
d. Use of patient`s tumor cells to develop an individualized
vaccine
e. Vaccination against human papillomavirus
78.If you have a tumor but did not know which of its proteins might
be an antigen, what might be the best procedure to attempt to
induce an immune response against it?
a. Vaccinate with dendritic cells genetically modified to
express tumor antigens
b. Vaccinate with dendritic cells pulsed with tumor antigens
c. Vaccinate with tumor cells genetically modified to
expression costimulatory molecules
d. Treat with IL-13
e. Deplete endogenous T cells
79. Most cases of acute leukaemia in children are of which type:
a. T-cell ALL
b. Mature B-cell ALL
c. Hairy cell leukaemia
d. Pre-B-cell ALL
e. Histiocytic leukaemia
80.Acute leukaemias are often associated with which of the
following?

Ϯϳϱ

 a. Bleeding
b. Bruising
c. Tiredness
d. Infection
e. All of the above
81.The following surface marker results were obtained with
lymphocytes from a 21-year-old-man with a lymphocytosis of 16 ×
109/L. Percentage of peripheral lymphocytes reactive with antisera
to: Kappa = 6%; Lambda = 4%; CD19 = 10%; CD11c = 0%; T
cells = 81%; CD56 (NK cells) = 6%. Which ONE is the most likely
diagnosis?
a. Early chronic lymphocytic leukaemia
b. Sézary syndrome
c. Infectious mononucleosis
d. Non-Hodgkin's lymphoma
82.Chronic lymphocytic leukaemia is commonly associated with
which one feature of those listed below?
a. Invariably a rapidly demise
b. A slow but progressive course
c. Overwhelming bleeding
d. Hepatitis
e. Thymoma
83.The type of leukaemia most likely to have skin involvement is:
a. Acute leukaemia
b. Hairy cell leukaemia
c. Plasma cell leukaemia
d. Chronic lymphocytic leukaemia (common type)
e. Sézary syndrome
84.Low serum levels of all major immunoglobulin classes are often a
feature of which one of these lymphoid diseases?
a. Chronic lymphocytic leukaemia
b. Benign paraproteinaemia
c. Waldenström's macroglobulinaemia
d. Infectious mononucleosis
85.Bence Jones proteins are:
a. Fragments of transferrin
b. Polyclonal free light chains

Ϯϳϲ

 c. Monoclonal free light chains
d. Beta 2-microglobulin
e. Prostaglandins
86.Waldenström's macroglobulinaemia patients often subsequently
develop which one of the following?
a. Meningitis
b. Duodenal ulcer
c. Hyperviscosity syndrome
d. Non-Hodgkin's lymphoma
e. Multiple myeloma
87.Which one of the following investigations is essential for the
diagnosis of all solid B-cell tumours?
a. Gene rearrangement studies
b. Detection of a thymoma
c. Bone marrow/lymph node examination
d. Analysis of urine for protein
e. X-ray of the skull
88.Which one of the following statements about patients with
monoclonal serum bands is true?
a. All will develop a lymphoid malignancy within 3 years
b. All should be followed up once a year, with quantitation of
the band and examination of the urine
c. All should have a skull X-ray
d. Over 90% will have frank myeloma
e. Only those with renal failure need urine examination for
monoclonal free light chains
89.Sézary syndrome patients often subsequently develop which one of
the following?
a. Meningitis
b. Duodenal ulcer
c. Gangrene of the toes
d. Non-Hodgkin's lymphoma
e. Multiple myeloma
90.Some tumor cells characteristically re-express antigens found only
early in normal development of that cell type. One example of this
is which of the following protein/tumor pairs"
a. CD20 and B cell neoplasm

Ϯϳϳ

 b. Prostate-specific antigen (PSA) and prostatic
adenocarcinoma
c. E6/E7 and cervical carcinoma
d. Alpha-fetoprotein (AFP) and hepatocellular carcinoma
e. Human epidermal growth factor receptor (HER) and breast
carcinoma.
91.Immunosuppressed patients are uniquely more susceptible to the
development of tumors caused by which of the following"
a. Familial genetic mutations
b. Proto-oncogene mutation
c. Oncogenic virus
d. Chemical carcinogens
e. UV radiation.
92.Patients with advanced stage chronic lymphocytic leukemia, a B-
cell neoplasm, were treated with anti-CD20 Fab fragment bound to
a radioactive molecule for directed killing. Surprisingly, use of an
intact anti-CD20 molecule without attached toxin or radioactive
molecule was found to be as effective as the radioactive
preparation with less toxicity on normal cells (radioactivity killed
surrounding normal hematopoietic cells in the bone marrow). The
intact immunoglobulin was needed to do which of the following?
a. Bind more effectively to the tumor cells.
b. Provide Fc biological properties (complement binding;
opsonization).
c. Allow targeting by CTLs.
d. Block CTLA4 on T cells.
93.Graft and tumor rejection are mediated primarily by
a. Non-complement-fixing antibodies
b. Phagocytic cells
c. Helper t cells
d. Cytotoxic T cells.
94.Chemically-induced tumors have tumor-associated transplantation
antigens that
a. Are always the same for a given carcinogen
b. Are different for two tumors of different histologic type even
if induced by the same carcinogen
c. Are very strong antigens

Ϯϳϴ

 d. Do not induce an immune response
95.Polyomavirus (a DNA virus) causes tumors in "nude mice" (nude
mice do not have a thymus, because of a genetic defect) but not in
normal mice. the BEST interpretation is that
a. Macrophages are required to reject polyomavirus-induced
tumors
b. Natural killer cells can reject polyomavirus-induced tumors
without help from t lymphocytes
c. Lymphocytes play an important role in the rejection of
polyomavirus-induced tumors
d. B lymphocytes play no role in rejection of polyomavirus-
induced tumors.
96.The increased incidence of cancer in the elderly reflects the fact
that
a. Immune surveillance increases
b. Tumor cells are eliminated effectively
c. Their diets do not meet nutritional standards
d. Everyone is prone to disease
e. Immune surveillance declines with age.
97.The chemical mediators responsible for killing tumor cells,
stimulating T cell activity, and inhibiting parasites and viruses are
termed
a. Interleukins
b. Interferons
c. Tumor necrosis factors
d. Phagocytic regulators
e. Colony-stimulating factors.
98.Which of the following is not a likely reason that a tumor might
display antigens that could be recognized as foreign?
a. The tumor cells are infected by a virus, and viral antigens are
displayed on MHC I.
b. The cancer cells produce large amounts of proteins that are
normally made only in very small quantities.
c. Apoptosis of the cancer cells exposes molecules not
normally seen by the immune system, giving an
autoimmune-like response.

Ϯϳϵ

 d. Mutated versions of normal self proteins are displayed on
MHC I.
99.Which of the following is not a line of evidence suggesting that
immune surveillance can help control tumors?
a. Transfer of lymphocytes from an animal with a tumor can
PDNH D VHFRQG DQLPDO ³LPPXQH´ WR FDQFHU LQGXFHG E\
injection of cells from the tumor.
b. Tumor cells may stop producing MHC class I molecules.
c. Large numbers of lymphocytes can sometimes be observed
around cancerous tissue.
d. Individuals with immunodeficiencies (such as AIDS) show
increased susceptibility to certain kinds of cancer.
100. Which of the following is not a possible form of
immunotherapy for cancer?
a. Monoclonal antibodies that bind and block complement-
inactivating proteins on the cell surface.
b. Monoclonal antibodies specific for tumor antigens linked to
a radioactive molecule or a toxin.
c. A DNA vaccine with a gene encoding a tumor antigen.
d. Injection of tumor cells that have been transfected with the
B7 gene.

ϮϴϬ

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 0&4

1. Which of the following diseases occurs with the absence of a
thymus?
a. 'LJHRUJH¶VV\QGURPH
b. Severe combined immunodeficiency disease (SCID)
c. Chronic granulomatous disease (CGD)
d. Bare lymphocyte syndrome (BLS)
e. Wiskott Aldrich syndrome (WAS)
2. Which of the following diseases affect neutrophils?
a. 'LJHRUJH¶VV\QGURPH
b. Severe combined immunodeficiency disease (SCID)
c. Chronic granulomatous disease (CGD)
d. Bare lymphocyte syndrome (BLS)
e. Wiskott Aldrich syndrome (WAS)
3. Which of the following diseases affects mature T cells?
a. 'LJHRUJH¶VV\Qdrome
b. Severe combined immunodeficiency disease (SCID)
c. Chronic granulomatous disease (CGD)
d. Bare lymphocyte syndrome (BLS)
e. Wiskott-Aldrich syndrome (WAS)
4. A child presents with a maculopapular rash on the extremities and
trunk. Petechiae is found on the trunk and mucous membranes. Lab
tests show a Neisseria infection and the physician is concerned
about meningococcemia. Which of the following is the most
likely?
a. C3 deficiency
b. C5-C9 deficiency
c. Leukocyte adhesion deficiency (LAD)
d. Hyper IgM syndrome (HIM)
e. Selective IgA deficiency
5. A patient in his early 20s presents with recurrent bacterial
infections. Lab work shows B cells in the periphery as well as low
immunoglobulin levels. History shows immunoglobulin levels
have decreased with age. Which of the following is the most
likely?
a. Myeloperoxidase deficiency
b. 'LJHRUJH¶VV\QGURPH
c. X-linked agammaglobulinemia
ϮϴϮ

 d. Wiskott-Aldrich syndrome (WAS)
e. Common variable immunodeficiency
6. A child presents with recurrent infections with bacteria, fungi, and
viruses. The resident asks the attending physician about IL-2R $
chain mutations, as the patient is a male. The attending physician
makes a diagnosis and begins writing orders for bone marrow
transplantation and possible gene therapy. Which of the following
does the patient have?
a. Ataxia telangiectasia
b. Wiscott-Aldrich syndrome (WAS)
c. Hereditary angioedema
d. Severe combined immunodeficiency disease (SCID)
e. C3 deficiency
7. A patient presents in the winter months with swollen lips. The
patient says they forgot their lip balm. Uncontrolled activation of
the classical complement pathway is responsible for the swelling.
Records show the patient has a c1inh deficiency. Which of the
following does this patient have?
a. C5-C9 deficiency
b. Glucose-6-phosphate dehydrogenase deficiency
c. Hereditary angioedema
d. Severe combined immunodeficiency disease (SCID)
e. C3 deficiency
8. An infant presents with recurrent bacterial infections and partial
albinism. Lab work reveals giant granules and neutropenia. Which
of the following is the most likely?
a. 'LJHRUJH¶VV\QGURPH
b. Chediak-Higashi disorder
c. Chronic granulomatous disease (CGD)
d. Bare lymphocyte syndrome (BLS)
e. Myeloperoxidase deficiency
9. A male patient presents with severe and recurrent bacterial
infections. Lab work confirms the patient is only infected with
certain bacteria due to a mutation in a gene for NADPH oxidase.
Which of the following is the most likely?
a. 'LJHRUJH¶VV\QGURPH
b. Chediak-Higashi disorder
c. Bare lymphocyte syndrome (BLS)
d. Wiskott-Aldrich syndrome (WAS)
e. Chronic granulomatous disease (CGD)
10.A 6-year-old presents with the appearance of being intoxicated
while walking. Opthlamoscopic findings reveal broken capillaries

Ϯϴϯ

 in the sclera of the eye. Lab work reveals IgA deficiency. Which of
the following is the most likely?
a. Ataxia telangiectasia
b. Wiscott-Aldrich syndrome (WAS)
c. Hereditary angioedema
d. Myeloperoxidase deficiency
e. C3 deficiency
11. A male infant presents with a triad of symptoms including
thrombocytopenia, eczema, and immunodeficiency. Which of the
following is the most likely?
a. Transient hypogammaglobulinemia of infancy
b. Wiscott-Aldrich syndrome (WAS)
c. Hereditary angioedema
d. Selective IgA deficiency
e. Hyper IgM deficiency
12. A young patient presents with severe infections from encapsulated
bacteria and collagen vascular disease. Lab work confirms a
diagnosis via CH50 and AP50. Which of the following is the most
likely?
a. Transient hypogammaglobulinemia of infancy
b. Wiscott-Aldrich syndrome (WAS)
c. Paroxysmal nocturnal hemoglobinuria (PNH)
d. Selective IgA deficiency
e. C3 deficiency
13.An infant presents with recurrent infections with Candida and
viruses. Cardiac abnormalities result in the patient requiring heart
surgery. During surgery, no thymus is found. Which of the
following is the most likely?
a. 'LJHRUJH¶VV\QGURPH
b. Chediak-Higashi disorder
c. Bare lymphocyte syndrome (BLS)
d. Wiskott-Aldrich syndrome (WAS)
e. Chronic granulomatous disease (CGD)
14. A patient presents for a follow-up visit after a diagnosis of
systemic lupus erythematosus (SLE). The physician suspects a
misdiagnosis after finding immune complexes accumulated in the
blood, lymph, and tissues. Which of the following is the most
likely?
a. C3 deficiency
b. C5-C9 deficiency
c. Early complement deficiency
d. Hyper IgM syndrome (HIM)
e. Selective IgA deficiency

Ϯϴϰ

 15.A patient presents with complaints of dark urine in the morning
that clears up partially during the day. Lab work reveals hemolytic
anemia, thrombosis in large vessels, and a deficiency in
Hematopoiesis. Which of the following is the most likely?
a. Transient hypogammaglobulinemia of infancy
b. Wiscott-Aldrich syndrome (WAS)
c. Selective IgA deficiency
d. Paroxysmal nocturnal hemoglobinuria (PNH)
e. Chediak-Higashi disorder
16.A patient presents with symptoms similar to chronic
granulomatous disease (CGD).It is found that there is a problem
with generation of NADPH. Which of the following is the most
likely?
a. C5-C9 deficiency
b. Glucose-6-phosphate dehydrogenase deficiency
c. Myeloperoxidase deficiency
d. Severe combined immunodeficiency disease (SCID)
e. C3 deficiency
17. A patient is being seen for recurrent infections. However, the
patient does not seem to think anything special of these infections
and there has been no previous diagnosis other than the infections.
Lab work reveals abnormalities with hypochlorous acid andh2o2
conversion. Which of the following is the most likely?
a. Ataxia telangiectasia
b. Wiscott-Aldrich syndrome (WAS)
c. Hereditary angioedema
d. Myeloperoxidase deficiency
e. C3 deficiency
18. A patient presents at age 6-months with pneumonia and difficulty
fighting off infections of encapsulated bacteria and enteroviruses.
$PXWDWLRQLQ%UXWRQ¶VW\URVLQHNLQDVH EWN LVVXVSHFWHG:KLFKRI
the following is the most likely?
a. Myeloperoxidase deficiency
b. 'LJHRUJH¶VV\QGURPH
c. X-linked agammaglobulinemia
d. Wiskott-Aldrich syndrome (WAS)
e. Common variable immunodeficiency
19.A male infant presents with decreased levels of IgA, IgG, and IgE.
History reveals recurrent bacterial infections and severe diarrhea. A
mutation on CD40L (CD154) on T-cells is suspected. Which of the
following is the most likely?
a. Bare lymphocyte syndrome (BLS)
b. C5-C9 deficiency

Ϯϴϱ

 c. Early complement deficiency
d. Hyper IgM syndrome (HIM)
e. Selective IgA deficiency
20. A patient presents at 3-years-old for a follow-up visit. At age 6-
months, the patient had a delayed onset of synthesis of an
immunoglobulin. At this visit, the mother reports that the recurrent
respiratory infections have stopped due to antibiotics and globulin
replacement. Which of the following was the most likely for this
patient?
a. Transient hypogammaglobulinemia of infancy
b. Wiscott-Aldrich syndrome (WAS)
c. Paroxysmal nocturnal hemoglobinuria (PNH)
d. Selective IgA deficiency
e. C3 deficiency
21. Which of the following is often asymptomatic to presenting with
an increased incidence of respiratory tract infections and is the
most common immunodeficiency disease?
a. C3 deficiency
b. C5-C9 deficiency
c. Early complement deficiency
d. Hyper IgM syndrome (HIM)
e. Selective IgA deficiency
22.$SDWLHQWSUHVHQWVZLWKV\PSWRPVVLPLODUWR'LJHRUJH¶VV\QGURPH
,W LV GHWHUPLQHG WKDW WKH SDWLHQW¶V 7+ FHOOV DUH XQDEOH WR GHYHORS
Which of the following is the most likely?
a. Leukocyte adhesion deficiency (LAD)
b. Chediak-Higashi disorder
c. Bare lymphocyte syndrome (BLS)
d. Wiskott-Aldrich syndrome (WAS)
e. Chronic granulomatous disease (CGD)
23.An 8-month-old baby has a history of repeated gram-positive
bacterial infections. The most probable cause for this condition is
that
a. The mother did not confer sufficient immunity on the baby
in utero.
b. The baby suffers from erythroblastosis fetalis (hemolytic
disease of the newborn).
c. The baby has a defect in the alternative complement
pathway.
d. The baby is allergic to the mother's milk.
e. None of the above.
24.A 50-year-old worker at an atomic plant who previously had a
sample of his own bone marrow cryopreserved was accidentally

Ϯϴϲ

 exposed to a minimal lethal dose of radiation. He was subsequently
transplanted with his own bone marrow. This individual can
EXCEPT
a. To have recurrent bacterial infections.
b. To have serious fungal infections due to deficiency in cell-
mediated immunity.
c. To make antibody responses to thymus-independent antigens
only.
d. All of the above.
e. None of the above.
25.Which of the following immune deficiency disorders is associated
exclusively with an abnormality of the humoral immune response?
a. X-linked agammaglobulinemia (Bruton's
agammaglobulinemia)
b. Digeorge syndrome
c. Wiskott-Aldrich syndrome
d. Chronic mucocutaneous candidiasis
e. Ataxia telangiectasia
26.A sharp increase in levels of IgG, with a spike in the IgG region
seen in the electrophoretic pattern of serum proteins is an
indication of
a. IgA or IgM deficiency.
b. Multiple myeloma.
c. Macroglobulinemia.
d. Hypogammaglobulinemia.
e. Severe fungal infections.
27.Patients with Digeorge syndrome may fail to produce IgG in
response to immunization with T-dependent antigens because
a. They have a decreased number of B cells that produce IgG.
b. They have increased numbers of suppressor T cells.
c. They have a decreased number of helper T cells.
d. They have abnormal antigen-presenting cells.
e. They cannot produce IgM during primary responses.
28.A 2-year-old child has had three episodes of pneumonia and two
episodes of otitis media. All the infections were demonstrated to be
pneumococcal. Which of the following disorders is most likely to
be the cause?
a. An isolated transient T-cell deficiency
b. A combined T- and B-cell deficiency
c. A B-cell deficiency
d. Transient anemia
e. The child has AIDS.
29.Immunodeficiency disease can result from

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 a. A developmental defect of T lymphocytes.
b. A developmental defect of bone marrow stem cells.
c. A defect in phagocyte function.
d. A defect in complement function.
e. All of the above.
30.A 9-month-old baby was vaccinated against smallpox with
attenuated smallpox virus. He developed a progressive necrotic
lesion of the skin, muscles, and subcutaneous tissue at the site of
inoculation. The vaccination reaction probably resulted from
a. B-lymphocyte deficiency.
b. Reaction to the adjuvant.
c. Complement deficiency.
d. T-cell deficiency.
e. B- and T-lymphocyte deficiency.
31.Defects in neutrophil NADPH oxidase system produce:
a. Chronic granulomatous disease.
b. Chediak-Higashi disease.
c. Leukocyte adhesion deficiency.
d. Hashimoto's disease.
e. Streptococcal infection.
32.Mendelian susceptibility to mycobacterial infection does not
involve the gene for:
a. ,)1Ȗ5
b. IL-12 p40.
c. ,)1Ȗ5
d. MEFV.
e. IL-12rbi.
33.Paroxysmal nocturnal hemoglobulinuria results from deficiency in:
a. Myeloperoxidase.
b. Decay accelerating factor. (DAF).
c. Classical pathway C components.
d. C1 inhibitor.
e. C8.
34.X-linked agammaglobulinemia results from a mutation in:
a. ,)1Ȗ5UHFHSWRU
b. The CIITA promoter protein.
c. An HLA gene.
d. CD40L (CD154).
e. A tyrosine kinase gene
35.Di George syndrome results from a defect in:
a. Purine nucleoside phosphorylase.
b. WASP.
c. Thymic development.

Ϯϴϴ

 d. DNA repair.
e. CD3.
36.Mutations in the gamma chain of the receptors for IL-2, 4, 7, 9 and
15 lead to:
a. Reticular dysgenesis.
b. Bare lymphocyte syndrome.
c. Hyper±IgM syndrome.
d. Severe combined immunodeficiency (SCID).
e. Build-up of toxic nucleotide metabolites.
37.The approximate percentage of cases of severe combined
immunodeficiency (SCID) due to defects in the Armetis gene is:
a. 5%.
b. 10%.
c. 15%.
d. 40%.
e. 60%.
38.Poor skin tests to a range of microbial antigens such as tuberculin
and mumps indicate a deficiency of:
a. NK cells.
b. T-cells.
c. B-cells.
d. Phagocytosis.
e. Opsonization.
39.Which of the following HIV antigens provides a potential target for
neutralizing antibody:
a. U3
b. Gp120
c. Reverse transcriptase
d. Protease
e. Tat
40.Primary immunodeficiency producing susceptibility to infection by
viruses and molds is due to:
a. B-cell deficiency.
b. T-cell deficiency.
c. Phagocyte deficiency.
d. Complement deficiency.
e. Eosinophil deficiency
41.Deletions in the T-cell CD154 (CD40L) gene produce:
a. The hyper±IgM syndrome.
b. Congenital X-linked agammaglobulinemia.
c. IgA deficiency.
d. Wiskott±Aldrich Syndrome.
e. Deficiency in cytotoxic T-cell activity

Ϯϴϵ

 42.Which of the following have not provided examples of secondary
immunodeficiency:
a. Viral infection.
b. Lymphoproliferative disorders.
c. Cytotoxic drugs.
d. High fat diet.
e. Low iron diet.
43.Which of the following conditions results in Eczema,
Thrombocytopenia and immunodeficiency combined?
a. XL
b. CVID
c. X-linked Hyper IgM
d. Wiskott-Aldrich Syndrome
e. 2PHQQ¶V
44.In complement deficiencies (pick the most TRUE):
a. Infection is an early component
b. Infection and Systemic Lupus Erythromatosus-like
syndrome are early components
c. Meningitis and Infection and Systemic Lupus
Erythromatosus-like syndrome are early components
d. Infection and Meningitis are early components
e. Meningitis is an early component
45.Which of the following is not a T and B cell linked
immunodeficiency?
a. SCID subtypes
b. X-linked Hyper IgM
c. XL
d. 2PHQQ¶V
e. Wiskott-Aldrich
46.Human RAG-1 Deficiency is caused by an autosomal recessive
mutation which destroys the recombinase Activating Genes. This
results in a lack of ability to produce:
a. Immunoglobulin
b. T-cell receptor (TCR)
c. Both
d. Neither
47.A rare X-linked recessive disease characterized by bruising,
eczema, thrombocytopenia, immune deficiency, bloody diarrhea,
and a propensity for autoimmune disorders and malignancies.
Generally becomes symptomatic in children. The overwhelming
majority are male.
a. MHC Class II deficiency
b. Wiskott- aldrich syndrome

ϮϵϬ

 c. Adenosine Deaminase deficiency
d. Purine Bucleoside Phosphorylase Deficiency
48.A genetic disorder in which both B and T cells are crippled, due to
a defect in one of several possible genes.Chronic diarrhea, ear
infections, recurrent Pneumocystis jirovecii pneumonia, and
profuse oral candidiasis commonly occurs. These babies, if
untreated, usually die within 1 year due to severe, recurrent
infections.
a. IgG subclass deficiency
b. X- linked agammaglobulimaemia
c. Transient Hypogammaglobulimaemia of infancy
d. Severe combined immunodeficiency (SCID)
49. A condition in which the immune system matures more slowly
than usual, but eventually functions entirely normally.
a. Autosomal recessive Hyper IgM syndrome
b. IgG subclass Deficiency
c. X- linked agammaglobulimaemia
d. Transient Hypogammaglobulimaemia of infancy
e. IgA deficiency
50. The inability in humans to synthesize certain immunoglobulins. It
was the first hereditary immune disease to be reported. This disease
is now known to be caused by mutation in a gene at Xq21.3-q22.
The gene is 36,740 bp long, and it encodes a protein containing
659 amino acids.
a. X- linked agammaglobulimaemia
b. Autosomal recessive Hyper igm syndrome
c. IgA deficiency
d. Transient Hypogammaglobulimaemia of infancy
e. IgG subclass Deficiency
51. A rare primary immunodeficiency. Characterized by marked
leukocytosis and localized bacterial infection that are difficult to
detect until they have progressed to an extensive level secondary to
lack of leukocyte recruitment. Caused by an absence of adhesion
molecules which allow migration of neutrophils.
a. LAD
b. CGD
c. GCD
d. DGC
e. DAL
52.People with this condition have two copies of an abnormal gene,
one inherited from each parent. Children usually become ill
between the ages of six months and two years, once the antibodies
they received from their mother during pregnancy have

Ϯϵϭ

 disappeared. Common problems include recurrent infections which
may be severe and/or very frequent .If this immunodeficiency is
not spotted and treated , there is a risk of permanent damage of
lung or ears.
a. X- linked agammaglobulimaemia
b. IgG subclass Deficiency
c. Autosomal recessive Hyper igm syndrome
d. Transient Hypogammaglobulimaemia of infancy
e. IgA deficiency
53.A diverse group of hereditary diseases in which certain cells of the
immune system have difficulty forming the reactive oxygen
compounds (most importantly, the superoxide radical) used to kill
certain ingested pathogens. This leads to the formation of
granulomata in many organs
a. LAD
b. CGD
c. DAL
d. DGC
e. GCD
54.SCID can occur due to the absence of an enzyme
a. Adenosine deaminase
b. Guanosine deaminase
c. Phosphorylase
d. Thymidine deaminase
55. Within few weeks of initial HIV infection peripheral blood shows
an increase number of
a. CD8+ T cells
b. Cd9+ T-cells
c. CD10+ T-cells
d. CD11+ T-cells
e. CD12+ T-cells
56. A group of disorders resulting from a failure to produce
bactericidal oxygen radicals during the "respiratory burst" which
accompanies activation of phagocytes. The classic type is inherited
as an X-linked recessive disorder, and typically presents in the first
3 months of life as severe skin sepsis. Complications include
regional lymphoadenopathy, hepatospleenomegaly, hepatic
abscesses and osteomyelitis.
a. Di George syndrome
b. Chronic granulomatous disease (CGD)
c. Common variable immunodeficiency (CVID)
d. X-linked agammaglobulinaemia (XLA)-Bruton`s disease
e. Selective IgA deficiency

ϮϵϮ

 57. 3DWLHQWV ZLWK ««« GHILFLHQF\ RFFXOWLQJ DV D SULPDU\ RU
secondary defect (due to deficiencies of factor H or factor I) have
increases susceptibility to recurrent bacterial infection.
a. C1
b. C2
c. C3
d. C4
e. C5
58. In congenital forms of antibody deficiency, recurrent infectious
XVXDOO\ EHJLQ EHWZHHQ «««« RI DJH EHFDXVH PDWHUQDOO\
transferred IgG affords passive protection
a. 8 months and 4 years
b. 2 months and 1 year
c. 4 months and 2 years
d. 1 and 6 months
e. 4 months and 6 years
59.+HUHGLWDU\DQJLRHGHPDLVFDXVHGE\GHILFLHQF\RI«««SDWLHQWV
experience recurrent attacks of cutaneous, intestinal or laryngeal
oedema which can be fatal if the airway is occluded.
a. C1 inhibitor
b. C2 inhibitor
c. C3 inhibitor
d. C4 inhibitor
e. C5 inhibitor
60. This X-linked disease is now known to be due to a failure of CD40
ligand expression on CD 4+ T-lymphocytes. As a result, T-cells
fail to trigger the switch from IgM to IgG or IgA production in
antigen-stimulated B-cells.
a. X-linked agammaglobulinaemia (XLA)-Bruton`s disease
b. Hyper IgM syndrome
c. Selective IgA deficiehncy
d. Common variable immunodeficiency (CVID)
e. Di George syndrome
61. Imunodeficiency caused by genetic or innate impairment is
a. Primary
b. Secondary
c. Always lethal
d. Not detectable
e. All answers are correct
62. Secondary immunodeficiency is not consistent with
a. Di Geoerge syndrome
b. Malnutrition
c. HIV infection

Ϯϵϯ

 d. Immunosupresive therapy
e. All answers are correct
63. Deficiency in lymphoid line is presented by
a. Impairment in specific humoral immunity
b. Impairment in non-specific cellular immunity
c. Impairment in ADCC
d. Impairment in DTH
e. All answers are correct
64. Deficiency in T cell immunity is presented by
a. Mild specific humoral immunity impairment
b. Non-specific cellular immunity impairment
c. Impairement in ADCC
d. DTH impairement
e. All answers are correct
65.Deficiency in complement system will be presented by important
impairment of:
a. Opsonization
b. Bacterial lysis
c. Inflammation generation
d. Non-specific immunity
e. All answers are correct
66. Deficiency to inactivate and eliminate of autoreactive cells is the
result of :
a. Autoimmunity
b. Positive selection
c. Negative selection
d. Tolerance
e. Suppression
67. Deficiency of immune system to recognize epitope and eliminate
it is:
a. Autoimmunity
b. Positive selection
c. Negative selection
d. Tolerance
e. Suppression
68.Select the INCORRECT statement about HIV cytopathic effects:
a. Gp120 binding to CD4 inside the cell blocks CD4
expression at the cell surface.
b. Vpu and nef gene products upregulate CD4 and MHC class I
c. Syncytia formation kills both infected and uninfected cells
d. Increase in plasma membrane permeability results in the
uptake of lethal amounts of calcium (osmotic lysis)
69.Which one of these conditions is not directly associated with HIV?

Ϯϵϰ

 a. Profound immunosuppression
b. Opportunistic infection and CNS degeneration
c. Multiple sclerosis
d. Malignancies and wasting
70.Which statement is INCORRECT about CCR5?
a. Is expressed on dendritic cells, macrophage, CD4+ cells
b. Appears late in disease and is the only co-receptor for HIV
c. Is the receptor used by the most frequent transmitted virus
(mucosal route)
d. Serves as coreceptors for macrophage- tropic HIV strains
71.A 2 month-old male infant presents with persistent diarrhea, signs
and symptoms of Pneumocytosis carinii pneumonia and an oral
fungal infection with Candida albicans. Test results for HIV was
negative by PCR the most likely cause of these findings is:
a. Grossly reduced levels of B cells
b. An X-linked inheritance of HLA genes
c. Defective isotype swithching
d. Defective T- cell function
e. Selective IgA deficiency
72.A 5-years-old girl has a small deletion in chromosome 22.She has
impired thymus development with a significant deficiency in the
number of functional T cells. The most likely etiology for these
findings is:
a. Adenosine deaminase (ADA) deficiency
b. Chediak-Higashi syndrome
c. Di George syndrome
d. Hereditary angiodema
e. Severe combined immunodeficiency (SCID)
73.A 3-years-old boy with X-linked defect in the Bruton tyrosine
kinase (BTK) gene is impaired in which of the following
mechanisms?
a. Antibody mediated bacterial clearance.
b. Formation of the membrane attack complex
c. Delayed (-type) hypersensitivity (DTH) response
d. IFN-ȖVHFUHWLRQE\&'7FHOOV
e. T-cell precursor migration to the thymus
74. A 6-months-old male infant has diarrhea, extensive fungal
infections, and skin rashes and has failed to gain weight. He is
deficient in both T- and B- cells function. The thymus is of normal
size. The most likely prospect for permanent restoration of normal
immunity for this patient would be:
a. An antibiotic (cocktail) given as regular intervals.
b. Bone marrow transplantation

Ϯϵϱ

 c. Exogenous immunoglobulins administrated periodically.
d. Isolation to an antiseptic environment.
e. Thymic hormones given throughout his life.
75.A female neonate has a malformed jaw, cardiac abnormalities, and
hypocalcemia, in addition to diminish cell-mediated and B-cell
responses. Which of the following immune deficiencies should be
included in the differential diagnosis of this patient?
a. Adenosine deamylase (ADA) deficiency
b. Digeorge syndrome
c. Hereditary angioedema
d. Severe combined immunodeficiency (SCID)
e. Wiskott-Aldrich syndrome
76.A 21-years-old woman has a history since childhood of recurrent
episodes of swelling of the sub-mucosal and sub-cutaneous tissue
of the gastrointestinal and respiratory tracts. Her C1 inhibitor level
is less than 5% of the reference value. These findings support a
diagnosis of :
a. Digeorge syndrome
b. Hereditary angioedema
c. Nutrition based immunodeficiency
d. Paroxysmal nocturnal haemoglobinuria
e. Wiskott-Aldrich syndrome
77.A 3-month-old male infant has recurrent infections and is found to
have un impaired ability to kill microbes by the nitroblue
tetrazolium test (which evaluates effectiveness of degradative
enszymes). Which of the following conditions is most likely
responsible for the findings in this patient:
a. Chidiak-Higashi syndrome
b. Chronic granulomatous disease
c. Hereditary angioderma HIV/AIDS
d. Waldenstrom macroglobulinemia
78.A 24-year-old male presents with fever, cough, and night sweats.
Examination reveals an elevated temperature, increased respiratory
rate, oral thrush (fungal infection), and decreased breath sounds in
right midlung field. Laboratory testing reveals a CD4 count of
60/ml (reference range: 400/ml). On the basis of these findings, the
most likely underlying process is:
a. Autoimmune disease with pneumonia
b. Bacterial pneumonia
c. HIV/AIDS with possible mycobacterium tuberculosis
d. Hypersensitivity pneumonitis
e. Mycobacterium tuberculosis infection only

Ϯϵϲ

 79.Which one of the following answers is TRUE for this statement:
Symptomatic primary immunodeficiencies (PIDs) are commoner
than secondary causes of immunodeficiency?
a. This statement is only true for adults.
b. This statement is true at all ages.
c. This statement is untrue for all ages.
d. None of the above
80.The most frequently diagnosed form of specific primary
immunodeficiency is:
a. Severe combined immunodeficiency
b. X-linked agammaglobulinaemia
c. Chronic granulomatous disease
d. Selective IgA deficiency
e. Digeorge anomaly
81.Which one of the following is the commonest form of Severe
Combined Immune Deficiencies (SCIDs)?
a. Interleukin receptor common gamma chain deficiency
b. IgA deficiency
c. IRAK-4 deficiency
d. RAG1/RAG2 deficiency
e. DiGeorge syndrome
82.Data handling for a diagnosis: Given these results from a 4-year-
old child, which one PID is most likely? (Normal range for age is
in brackets)
i. CD3 T cells 2.8 × 109/l (1.0?7.2
× 109/l)
ii. CD4 T cells 1.8 × 109/l (0.5?5.2
× 109/l)
iii. CD8 T cells 0.9 × 109/l (0.4?2.8
× 109/l)
iv. NK cells 0.4 × 109/l (0.13?0.8 ×
109/l)
v. B.cells 0 × 109/l (0.2?2.7 ×
109/l)
vi. Total lymphocytes = 3.3 × 109/l (1.1?5.2 ×
109/l)
a. CD40 ligand deficiency
b. Severe combined immune deficiencies
c. Chronic granulomatous disease
d. X-linked agammaglobulinaemia (Btk deficiency)
e. HIV

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 83.Data handling for a diagnosis: Given these results from a 2-month-
old infant, which PID is most likely? (Normal range for age given
in brackets)
i. CD3 T cells 0.6× 109/l (2.9?9.1 ×
109/l)
ii. CD4 T cells 0.3 × 109/l (1.4?6.7 ×
109/l)
iii. CD8 T cells 0.3 × 109/l (0.6?3.3 ×
109/l)
iv. NK cells 1.2 × 109/l (0.1?1.5 ×
109/l)
v. B.cells 0.9 × 109/l (0.7?3.8 ×
109/l)
vi. Total lymphocytes 2.7 × 109/l
(4.3?13.1 × 109/l)
a. Severe combined immune deficiency due to JAK3
deficiency
b. XLA
c. Severe combined immune deficiency due to IL-7R
deficiency
d. Severe combined immune deficiency due to ADA deficiency
84.Which one of the following is most pertinent to healthy individuals
with selective IgA deficiency?
a. All individuals can be considered to be normal without risk
of infections.
b. They are more likely to develop heart disease than those
with normal IgA levels.
c. Will always have a high risk of HIV infection
d. They have a high risk of a recurrent serious bacterial
infection.
e. They have a higher risk of developing an organ specific
autoimmune disease or allergies than the general population.
85.Which one of the following statements about IgA deficiency is
FALSE?
a. IgA deficiency is defined as a blood level <0.07 g/l.
b. IgA deficiency is the most common of the primary immune
deficiencies.
c. Many patients with IgA deficiency are healthy throughout
their lives.
d. Patients with IgA deficiency may suffer from an increased
prevalence of allergies.
e. There is a defined problem with the class switch mechanisms
for IgG in such patients.

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 86.Which one of the following is most pertinent to common variable
immune deficiency disorders?
a. Always presents before the age of 10 years.
b. Is due to a single gene defect on the X chromosome.
c. Affects 1 in 500 of the population.
d. Patients are treated by replacement immunoglobulin,
intravenously or subcutaneously.
e. Most patients die from complications of malignancy.
87.Which one of the following is most pertinent to transient
hypogammaglobulinaemia of infancy:
a. Occurs at 3 months of age.
b. Is more pronounced in premature babies.
c. Is due to placental absorption of IgG.
d. Is linked with autoimmune disease in later life.
e. Involves only the IgA immunoglobulin class.
88.Which one of the following is most pertinent to replacement
therapy for hypogammaglobulinaemia:
a. Consists mainly of IgG
b. Consists mainly of IgA
c. Consists mainly of IgM
d. IgD
e. Ig product should be checked regularly for blood-borne
viruses possibly transmitted by immunoglobulin therapy.
89.Which one of the following is the primary defect in chronic
granulomatous disease [CGD]?
a. Neutrophil production in the bone marrow.
b. Neutrophil chemotaxis.
c. Neutrophil intracellular killing of organisms.
d. Opsonization
e. Cytotoxic T-cell activity.
90.Which one of the following is commonly associated with marked
secondary antibody deficiency?
a. Mild protein-energy malnutrition.
b. Multiple myeloma.
c. Non-Hodgkin's lymphoma [NHL].
d. HIV infection.
e. Hodgkin's disease.
91.Which one of the following statements concerning XLA is TRUE?
a. XLA presents immediately after birth.
b. It is a disease found in equal numbers of boys and girls
c. Patients with XLA present with recurrent severe bacterial
and fungal infections

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 d. Patients usually have pan-hypogammaglobulinaemia i.e.
Very low serum levels of IgG, IgA and IgM, all of which are
<10% of normal for age.
e. Patients have normal numbers of plasma cells in the gut
92.CD40 ligand deficiency is now defined as a combined T & B cell
deficiency. Which one of the following statements is FALSE?
a. Boys with this condition often present with Pneumocystitis
pneumonia
b. Cryptosporidial infection is a common cause of death at any
age
c. The number of circulating T cells is reduced
d. Serum igm levels may be normal at presentation
e. Human stem cell transplantation is the method of choice for
therapy in a child
93.Which one of the following is a cellular co-receptor for HIV:
a. CD8 antigen
b. CD21 antigen
c. CD 69 antigen
d. CXCR 4 antigen
e. FAS ligand
94.Which one of the following clinical features is NOT usually
associated with HIV infection?
a. A glandular fever-like illness.
b. Persistent generalized lymphadenopathy.
c. Gonococcal septicaemia.
d. µ6OLPGLVHDVH¶
e. Presenile dementia.
95.Which one of the following is a proven route of transmission of
HIV?
a. Swimming pools
b. Mosquitoes
c. Shared bathroom facilities
d. Semen
e. Bed bugs
96.Which one of the following findings is the most common indicator
in an infant with Severe Combined Immune Deficiency?
a. Lymphopenia
b. Severe asthma
c. Dry skin
d. Pneumonia
e. Staphylococcal abscesses
97.Which one of the following statements about Wiskott Aldrich
syndrome is TRUE?

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 a. Platelet size is large
b. It is a combined primary immune deficiency due to abnormal
cell motility
c. All individuals who carry the mutated gene are severely
affected.
d. It is common in girls
e. Thrombocytopenia is due to failure of bone marrow
megakaryocytosis
98.Which one of the following statements about Adenosine
Deaminase deficiency [ADA] is TRUE?
a. ADA deficiency results from a developmental defect
confined to the bone marrow.
b. ADA deficiency accounts for 50% of all present cases of
SCID
c. Affected infants have subtle (and often late presenting)
neurological problems
d. Common presentation is with smelly urine
e. B cells are unaffected
99.Which one of the following is true in severe congenital neutropenia
(SCN)?
a. The mode of inheritance can be autosomal recessive
b. Mutations in the G-CSF receptor are found in most cases
c. Patients rarely respond to G-CSF
d. Mutations in ELA-2 are found in <10% of cases
e. The mode of inheritance is usually X-linked
100. Which one of the following is true in children with Cyclic
Neutropenia?
a. There is generally no family history
b. There is a 28-day cycling of the neutrophil count
c. Patients are treated with high doses of G-CSF
d. The major cause of the oscillations is an increased rate of
apoptosis of neutrophil precursors

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1. a 26.b 51.a 76.b
2. c 27.c 52.c 77.b
3. d 28.c 53.b 78.c
4. b 29.e 54.a 79.c
5. e 30.d 55.a 80.d
6. d 31.a 56.b 81.a
7. c 32.d 57.c 82.c
8. b 33.b 58.c 83.c
9. e 34.e 59.a 84.e
10.a 35.c 60.b 85.e
11.b 36.d 61.a 86.d
12.e 37.c 62.a 87.b
13.a 38.b 63.e 88.a
14.c 39.b 64.e 89.c
15.d 40.b 65.e 90.b
16.b 41.a 66.a 91.d
17.d 42.d 67.d 92.c
18.c 43.d 68.b 93.d
19.d 44.b 69.c 94.c
20.a 45.c 70.b 95.d
21.e 46.c 71.d 96.a
22.c 47.b 72.c 97.b
23.e 48.d 73.a 98.c
24.e 49.d 74.b 99.a
25.a 50.a 75.b 100. d

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 Some References and For Further Readings
1. Eli Benjamini, Richard Coico, and Geoffrey Sunshine (2000)
Immunology: A Short Course, 4th Edition ,Weily Interscience
2. Gabriel Virella . (2005) Medical Immunology. 5th Edition. Marcel
Dekker, INC.
3. Goldsby, R. ,et al.,(2000) Kuby Immunology, 4th Edition. W.H.
Freeman
4. Helen Chapel, Mansel Haeney, Siraj Misbah, Neil Snowden .
(2014) Essentials of Clinical Immunology, 6th Edition. Wiley-
Blackwell
5. Kumaresan Veliah. (2005). Medical Microbiology. 2nd Edition.
Lulu
6. Peter J. Delves, Seamus J. Martin, Dennis R. Burton, Ivan M. Roitt
(2011) Roitt's Essential Immunology, 12th Edition, Wiley-
Blackwell
7. Richard Coico and Geoffrey Sunshine. (2015). Immunology: A
Short Course, 7th Edition ,Wiley-Blackwell.
8. Seemi Farahat Basir (2012) Text Book of Immunology . 2nd
Edition. PHI Learning Private Ltd.
9. Soumen Bhattacharya and Jayanta Sinha (2006). A textbook of
immunology, 1st Edition. Academic Publishers.
10.Thao Doan , et al. (2013) Immunology. 2nd Edition. Lippincott
Williams & Wilkins.
11.Tripathi G. (2010) Cellular and Biochemical Science, 1st Edition I.
K. International Pvt. Ltd.

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Website References
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http://www. usmleforum.com/archives/2006/1/107768-1.php
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https://www.quizlet.com/20373654/exam-2-immunology-flash-cards/

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