The upcoming exam is based on Dr.

Lopezs virology lectures and lecture 5 and lecture 6 of the

preceding immunology. There will be 17 immunology questions on exam 4 and I am providing
you with 20 practice questions. Your goal should be to understand, and if necessary research,
why you are checking off an answer as correct and why the other answers offered are not. To
encourage you to go through this process first, I will release the answers to the practice
questions tonight at 9 PM.
Regarding the question, Do I need to know x-y-z for the exam? my answer will be YES as
you already know. Also, learning means trying to gain understanding first on your own. Did
you look through the lecture slides and your notes? Thereafter, please discuss with your study
group. If you still dont understand, find the PowerPoint slide from the lecture slides that
comes the closest to your question. Type your concise question into the annotation panel of
this PowerPoint slide. The deadline for the submission of questions is Wednesday at 6 PM
(Email subject line: MIC 301/303/320 exam question slide; Email address:
mlichten@med.miami.edu). Please follow these instructions so that I can combine all questions
and answers into a single PowerPoint for all students.
As before, some of the formats of the practice questions are different from the format of the
exam question that only ask you to identify the one best answer among four options. Please
also note that the lecture material comprises more testable material than the questions below.
Finally, note that I hold a copyright on my questions. Therefore, you are agreeing not to
distribute, publish, copy, broadcast, rewrite or redistribute in part or whole any of the
questions with individuals other than those enrolled in the 2016 MIC301/303/320 class. Thank
you for your attention to all of the above matters and productive studying!

1. Regarding MHC molecules, all of the statements below are correct, EXCEPT THREE:
a. They are encoded by polymorphic genes.
b. Their identities are determined by the parental alleles of a person.
c. They are encoded by two major classes of genes in humans.
d. Each of the two classes of genes consists of subfamilies with many individual
members.
e. Expressed class I genes are different in each cell of our body.
f. With the exception of identical twins, the MIC301/303/320 students are likely to
express different combinations of their HLA gene loci.
g. MHC loci are randomly rearranged during the development of antigen presenting
cells to accommodate diverse pathogens.
h. They are only expressed by antigen-presenting cells.
i. The biological design and function of MHC molecules accommodates peptides
from an unlimited number of pathogens.
2. Autoreactive T-cells are constantly produced in the thymus, including, for example, CD8
T-cells that can recognize insulin-producing cells in the pancreas. Nevertheless, most of
us do not suffer from type I diabetes, a condition in which such T-cells can attack and
destroy cells producing insulin. What are the three main reasons that most of us do not
develop type I diabetes?
Deletion of self-reactive T-cells during their development (negative selection)

Negative control of self-reactive T-cells by regulatory T-cells

Need for "danger" signals to activate costimulatory molecules on DC to initiate an
immune response. Cells other than professional antigen presenting cells cannot
express costimulatory molecules and thus will anergize T-cells rather than
activate T-cells.

3. Immunologically, the most important reason for the expression of HLA class I molecules
by all nucleated cells in our body is that __________.
a. they are required for the generation of antibodies
b. they enable the immune system to see hidden intracellular pathogens from the
outside of cells
c. they enable T-cells to recognize cells presenting extracellular antigens
d. they are needed to perform the matching of organ transplants
e. they cause protection of our cells by type I IFN production
4. The immunological purpose of active vaccinations is to __________.
a. generate antigen-specific memory cells resulting in long or even life-long
immunity
b. use the cheapest means of immunological protection
c. avoid the use adjuvants
d. provide immediate protection of immune-compromised individuals
e. render haptens immunogenic
5. Describe the order of events that protect our body from succumbing to viral infections.
Differentiate two groups for the events, one for the innate immune response and the other
for the adaptive immune response.
Innate: Infected cells themselves produce type I IFNs (alpha and beta) which
promote antiviral activity for themselves and their uninfected neighbors. Type I
IFN also strongly upregulates killing by NK cells. NK cells will kill virally
infected cells after detecting that they are sick. This is not antigen-specific!
They also produce IFN gamma to turn on macrophages to remove the dying
corpses. IFNa alpha strongly activates dendritic cells (DC) that are the bridge
to the adaptive immune system). DC will take up remnants of the dead cells
(including their viral proteins) and process these antigens and deliver them to the
draining lymph node.
Adaptive: Antigen-specific nave CD8 T-cells will be activated by dendritic cells
and this process will be facilitated by the activation of CD4 T-helper cells and
their secretion of cytokine onto the CD8 T-cells. These cells begin to replicate,
acquire cytotoxic activity, will exit the lymph node and reach the infected tissue
via the lymphatics followed by their circulation into the blood from where they
reach the infected tissue and kill the virally infected cells.


6. MHC class II molecules __________.
a. interact with CD8 molecules
b. accommodate only one unique peptide in their peptide binding groove
c. are the receptor for the human immunodeficiency virus
d. can interact with superantigens
e. or more concisely their absence, activates NK cells
f. are two-times larger than MHC class I molecules.
7. CD4+ T-cells ________ (two answers are correct).
a. produce antibodies.
b. develop in the bone marrow.
c. express MHC class I molecules, just like any other nucleated cell.
d. recognize peptides presented in the context of MHC class I.
e. recognize peptides presented in the context of MHC class II
8. Antigen recognition by T-cells (but not B-cells) involves all EXCEPT __________.
a. one or more peptides derived from the antigen
b. the MHC of the individual
c. the blood group of the individual
d. the function of the proteasome for antigen recognition by CD8 T-cells
e. the function of the endosome/lysosome for antigen recognition by CD4 T-cells
9.

NK cells _________ (two answers are correct).

a. are activated by dendritic cells in the draining lymphnode
b. kill through production of superoxide radicals
c. become strongly inhibited in killing target cells as the targets express more MHC
class I molecules
d. kill virally infected cells or tumor cells upon recognizing a little bit of viral
protein or oncogene in the context of MHC class I
e. use pore formation as a conduit for the delivery of apoptosis activating molecules

10. Important principals of passive vaccination include that _________.

a. it can be most readily used to support a humeral defense
b. it can be highly effective in the prevention of infectious disease as well as its
treatment
c. it is effective immediately
d. All answers are correct.
11. Which pair associates a disease with its appropriate treatment?
a. allergy / hyperimmunoglobulin injections
b. autoimmunity / anti-CTLA-4 treatment
c. autoimmunity / active vaccination with the autoantigen
d. allergy / pharmacological blockade of histamine actions

12. Which statement regarding tumor and tumor therapies is FALSE?

a. Emerging tumors can be controlled by NK cells.
b. Large and quickly growing tumors often have evaded the immune system.
c. The CTLA-4 antibody used in melanoma therapy activates regulatory T-cells.
d. Not infrequently, a tumor response to anti-CTLA-4 treatment is accompanied by
initiation of an autoimmune disease.
e. Unlike previous chemotherapy treatments, anti-CTLA-4 treatment, or the use of
similar so-called checkpoint inhibitors, has increased the 5-year survival of
patients with certain previously uncurable metastatic cancers.
13. Which of the following cells or molecules relate THE LEAST to the defense of large
extracellular parasites?
a. B-cells
b. Mast cells
c. CD8 T-cells
d. Eosinophils
e. Basophils
14. Which of the following statements about CD8 T-cells is FALSE?
a. Nave CD8 T-cells cannot kill.
b. CD8 T-cells are activated by antigens in solution (floating antigens).
c. An activated CD8 T-cell can kill several infected cells, one by one, as long as
they are infected by the same intracellular pathogen.
d. Cytotoxic T-cell responses usually require activation of antigen-presenting
dendritic cells and activation of CD4 T-cells.
e. After their activation, cytotoxic T-cells use similar means to kill their target cells
as NK cells (perforin + granzymes).
15. Exposure and infections with certain pathogens appear to prevent a certain type of
immune disease. What are the pathogen and the disease and how are they linked in
simplistic terms?
Pathogen: Large extracellular parasites
Disease: Allergies
Explanation: Antibodies of the IgE isotype are used by mast cells, eosinophils and
basophils as surrogate receptors to direct their activity and release of toxic
materials onto parasites recognized. The parasite is recognized by the antigen
binding site of the antibody while the mast cells, eosinophils and basophils bind
IgE due to its unique Fc portion.
If IgE responses are not used against pathogens the immune system will invent
a reason to exercise this armory by reacting against harmless substances. This
concept is also reflected in the hygiene hypothesis.

16. Upon infection of an epithelial cell of your bronchus with a newly evolved flu strain,
_______________ .
a. viral proteins will be immediately recognized by effector cells that express on
their surface CD4
b. neighboring cells will quickly become more resistant to viral infection even if this
is your first infection with this viral strain
c. neighboring cells will quickly become more resistant to viral infection only if you
have been infected once before with the same virus
d. usually NK cells fail to kill virally infected cells
e. histamine release by mastcells is triggered
17. Your friend has been stung by a bee for the third time in a month and complains about
difficulty breathing and a sudden onset of dizziness. Why is this a serious event that
should remind you of your MIC301/303/320 class?
The history (bee sting) and the symptoms (difficulty breathing and dizziness) are
classic for the beginning of an anaphylactic shock.
Rather than only activating the release of histamine by mast cells in the vicinity of
the bee sting, some of the venom (the usual allergen of bees) got into the blood
and circulation where it now systemically activates mast cells throughout the
body.
The systemic release of histamine causes bronchospasm (difficulty breathing) and
the opening of capillaries throughout the body (reduced blood pressure and
ultimately shock).
18. Explain why superantigens a) activate CD4 T-cells and b) why this activation is not
antigen-specific.
They bind to CD4 and MHC class II molecules on professional antigen presenting
cells.
Unlike antigen peptides they do not bind to a groove in the MHC class II
molecule but instead to a side portion that is well conserved throughout all MHC
class II genes. This mimics a triggering of a signal activating the CD4 T-cells.
19. Explain why a single MHC molecule can present a large number of different peptides
from different antigens.
The rules for a peptide to fit into the groove of an MHC molecule are determined
by the length of the groove. Millions of peptides with identical length (but with
different composition of their amino acids) are produced during antigen
processing.
The number of peptides that can be accommodated is slightly reduced, however,
by the need for two (or three) specific amino acid in two (or three) positions of a
peptide. These amino acids anchor the peptide within the groove of MHC


molecules and, hence, they are referred to as the anchor residues. Each MHC
molecule has its own specific anchor residues.
20. Allergy and autoimmunity __________.
a. are interchangeably used to describe one identical type of immune response
b. involve the production of antibodies belonging to the IgE isotype
c. are caused by cytotoxic T-cells
d. are curable by the injection of CTLA-4 antibodies
e. are treated by bone marrow transplantation
f. are caused by harmless innocuous foreign substances in the case of allergies, and
by self antigens in the case of autoimmunity