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Immunology

Antigen-antibody reaction ................................................................................................................................................2


Innate & adaptive immunity ............................................................................................................................................3
Cytokines ...............................................................................................................................................................................6
Transplantation ...................................................................................................................................................................6
Hypersensitivity ...................................................................................................................................................................7
Immunoglobulins ................................................................................................................................................................7
Immunodeficiency ..............................................................................................................................................................9
Autoimmune diseases ......................................................................................................................................................10
Immuno-assay ....................................................................................................................................................................11
Antigen-antibody reaction

b. Immunodiffusion is the process of diffusion in


Antigen & antibody reaction is?
semisolid media to detect amount of antibody to
a. Agglutination
1 neutralize antigen. Agglutination necessitates an
b. precipitation
indicator system e.g. RBCs or latex particles.
c. Immunodiffusion
WRONG. All of them are Ag-Ab reactions

b. WRONG
Antigen & antibody complex are? a. is the correct answer
a. Weakly bound Antigens are bound to antibodies through weak and
2 b. strongly bound noncovalent bonds such as electrostatic interactions,
c. no bound at all. hydrogen bonds, Van der Waals forces, and
d. none of the above hydrophobic interactions.
http://www.ncbi.nlm.nih.gov/books/NBK27160/

b. The hook effect is the result of very high antigen


levels giving lower than expected result in a double
antibody sandwich assay.
Hook effect in immune assay occurs a. It occurs when extremely high concentrations of an
because the concentration of antibodies in analyte, such as prolactin, occupy all the sites on both
the well is? the capture and detection antibodies, and thus
3
a. Too low prevent the formation of a sandwich immunoassay.
b. Too high The end result is that few or no tracer antibody.
c. Optimum b.
Hook effect (prozone phenomenon) is due to high
concentration of the analyte leading to false negative
result. In this case, antibodies are the analyte.

Prozone phenomenon:
4 a. Excess Ag b.
b. Excess Ab

Lysis in complement fixation test means


b.
the test is?
In CFT, absence of hemolysis indicates that
5 a. Positive
complement was fixed in antigen antibody reaction so
b. negative
specific antibody was present.
c. invalid.

6 Diffusion in semi solid is used to: Detection amount of Ab to neutralize Ag

Adding Ag to Ab until neutralization is


7 Titration
called:
b. WRONG
a.
CRP is tested because it is increased in?
CRP is an acute phase protein, sensitive non specific
a. Bacterial infection
8 indicator of acute injury, bacterial infection,
b. viral infection
inflammatory bowel disease, arthritis, malignancy
c. other infection.
(e.g. lymphoma) or some autoimmune diseases (e.g.
SLE, vasculitis).

All tube for serial dilution for CRP test


contain 0.5ml of saline & 0.5ml of serum is
added to Tube 1 & 0.5ml is transferred None (something missed in the question).
through the row of tubes & agglutination The titer in the 7th tube = 27 = 128
is demonstrate in tube 7, If sensitivity of So, the concentration of CRP= 128x6= 768mg.
the test is 6 mg/L the concentration of CRP
9
in serum is? Usually in tube method, the last tube is kept without
a. 36 mg serum for negative control, but it is not mentioned in
b. 42 mg that question. If so, then the serum was added only to
c. 6 mg the first 6 tubes, and thus e. is the correct answer.
d. 48 mg
e. 384 mg

Innate & adaptive immunity

the leukocyte that involve in adaptive and


acquired (!!!! innate) immunity
a. lymphocyte
a.
10 b. monocyte
neutrophil: most abundant in WBCs
c. neutrophil
d. basophil
e. eosinophil

leukocyte responsible for cellular (!!! cell


mediated) immunity:
a. T lymphocyte
11 b. B lymphocyte a.
c. monocyte
d. basophile
e. eosinophil

leukocyte responsible for parasitic


infection and allergic reaction:
a. lymphocyte
12 b. monocyte e.
c. neutrophil
d. basophil
e. eosinophil
The following cell is related to antibody
production:
13 a. T cell c.
b. B cell
c. Plasma cell

Unidirectional movement of WBCs directly


to its target:
a. sliding
14 c.
b. phagocytes
c. chemotaxis
d. None of the above

15 First line of body defense against strept is Phagocytosis

16 Cell mediated immunity = Candida. Defective CMI candidiasis.

B cells (x)
Impaired cellular immunity mycobacteria,
nocardia, fungi (e.g. pneumocystis carinii & candida),
viruses, parasites. The majority of conditions
predisposing to Pneumocystis pneumonia are
Responsible for immunity for
17 associated with profound defects in cellular
pneumocystis carinii:
immunity. Also, risk of P. carinii infection increases
when CD4+ T lymphocytes levels are < 200 cells/L
Impaired granulocytes staph. abscesses.
Impaired antibody formation pneumonia by
pyogenic organisms.

e.

T lymphocytes found in?


a. Cortical area of LN
b. Germinal center
18
c. spleen
d. LN sinusoid
e. Paracortical area of LN

http://www.dartmouth.edu/~nlevy/pln3.html
All are false except:
c.
a. T cells are predominantly located at
White pulp contains lymphoid aggregations, mostly
the medullery area of LN
lymphocytes, and macrophages which are arranged
b. T cells are predominantly located at
around the arteries. T lymphocytes (mainly T-helper)
the germinal centre of LN
19 are present in Periarteriolar lymphoid sheaths (PALS),
c. T cells are predominantly located in
while B-cells are present in the follicles.
the periarteriolar region of the white
Red pulp is vascular, and has parencyhma and lots of
pulp of spleen
vascular sinuses. These are sinuosoids - a specialised
d. T cells are predominantly located in
type of capillary, which is very leaky
the red pulp of spleen

Regarding the function of T cells, which is


20 regulates immunoglobulins production by B cells
correct?

B-lymphocyte after attacking foreign


21 Plasma cell
bodies is called:

* Granulocyte production is increased by:


22 GM-CSF or G-CSF (stimulate GM-CFU or G-CFU)
* Neutrophils are produced by:

23 Neutrophil: firstly increased in bacterial infections

c.
Perforin is a cytolytic protein found in the granules
of Cytotoxic T lymphocytes (CTLs) and NK cells.

Content of neutrophil granules except:


a. Casepsin G
24 b. Lactoferin
c. Perforins.
d. Myeloperoxidase.

25 Monocyte = macrophage in tissues


Monocyte .... all except
a. secrete IL1 d.
26 b. secrete growth factors Monocytes, as well as tissue macrophages, secrete IL-
c. MHC II 1, present Ag, secret growth factor and have MHC-ll.
d. not present Ag

Cytokines

27 Activated T-cells secrete: Lymphokines

Lymphocytosis promoting factor and histamine


28 Lymphokines & T-cell activation:
sensitizing factor.

b.
Which is wrong: IL-1 is a pro-inflammatory cytokine released from
a. IL-1 is produced early in immune macrophages & dendritic cells to enhance the
29 response inflammatory process.
b. T cells do not respond to IL2 early in IL-2 promotes the differentiation of effector T cells
immune response and memory T cells when the initial T cells is
stimulated by an antigen.

Transplantation

Graft rejection main mechanism is:


30 a. action of APC of donor b.
b. action of APC of recipient

HLA typing for a patient needs graft. d.


Matching show 2-2-2, which means: In renal transplantation, only HLA-A, B & DR are
a. HLA A negative considered (with DR mismatches more significant
31
b. HLA B negative than A & B). As each HLA gene has 2 copies, then the
c. HLA DR negative maximum number of mismatches is 6.
d. HLA A, HLA B, HLA DR negative "2-2-2" = 6 mismatches, while "0-0-0" = 0 mismatches.

a.
Presence of C4d in graft tissue capillaries
C4d is an inactive split product of C4 cleavage that
a. C4d is stable from classic pathway
occurs in classic or lectin pathways (not alternative). It
b. C4d is unstable from alternative
has no biological function, but it binds to endothelial
32 pathway
cells firmly, with long half life, so it is considered the
c. C4d is unstable from classic pathway
'footprint' of antibody-mediated tissue injury that
d. C4d is of little value as it remain bound
occurs in acute graft rejection.
to endothelium for more than a month.
http://www.medscape.com/viewarticle/761036
Hypersensitivity

Immune response to infection cause all


except: d.?
a. rheumatic fever b.
33
b. TSS (toxic shock syndrome) TSS is caused by a bacterial (staphylococcal)
c. Glomerulonephritis enterotoxin, not an immune response.
d.

* Inflammation of a tissue with more


34 eosinophil and mast cells: Type I hypersensitivity reaction
* Biopsy found eosinophil & mast cell:

35 Immune complex deposits. Type III hypersensitivity

b.
It is a local type III hypersensitivity reaction, in the
Arthus phenomenon results from: form of dermal inflammatory reaction produced
a. Antigen excess. under conditions of antibody excess, when a second
36 b. Antibody excess. injection of antigen produces intravascular antigen-
c. Antigen and antibody in equal antibody complexes which bind complement, causing
proportions. cell clumping, endothelial damage & vascular necrosis.
http://www.ncbi.nlm.nih.gov/
mesh?term=Arthus%20reaction

Tuberculin test. It is an extract of Mycobacterium TB,


Which of the following detects type IV cell
37 M. bovis, or M. avium that is used in skin testing in
mediated immunity?
animals and humans to identify TB infection.

38 Mantoux test is a method for: Tuberculin (= PPD test): Type IV hypersensitivity

39 Tuberculine test is type: IV hypersensitivity

Immunoglobulins

Immunoglobulin is:
a. Synthesized in liver.
40 b. beta globulin d.
c. alfa globulin
d. gamma globulin

Which of white blood cell give


immunoglobulin:
a. lymphocyte
a.
41 b. neutrophil
Plasma cells that are of B-lymphocytes lineage
c. monocyte
d. basophile
e. eosinophil
* Reaginic antibody is:
* Or, Ig elevated in parasitic infection and
d.
allergy:
Reagenic or anaphylactic mechanism refers to events
42 a. IgG
following combination of antigen with IgE molecule
b. IgM
specific for it upon the surface of mast cells.
c. IgD
d. IgE

Ig not part of acquired immunity:


a. IgG
43 b. IgM c.
c. IgA
d. IgE

Ig can cause HDN :-


a. IgG
44 b. IgM a.
c. IgA
d. IgE

the smallest molecular weight ig is: a.


a. IgG IgG = 150 kD
b. IgM IgD = 180 kD
45
c. IgA IgE = 200 kD
d. IgE IgA = 320 kD
a. IgD IgM = 900 kD

Heaviest Ig:
a. IgG
b. IgM
46 b.
c. IgA
d. IgE
a. IgD

one of the immunoglobulin present in


d.
trace amount in serum :
IgG 75%
a. IgG
IgA 15%
47 b. IgM
IgM 10%
c. IgA
IgD 0.2%
d. IgE
IgE 0.002%
e. IgD

IgM is:
a. Acute immunoglobulin
48 b. Immunoglobulin in allergic condition a.
c. Chronic immunoglobulin
d. -globulin
Immunodeficiency

e. CD40/CD40L
Normally, binding between CD40 on B cells & CD40L
(CD158) on T cells is necessary for B cells to switch
from IgM synthesis to IgG, IgA or IgE.
In hyper IgM syndrome, the switching process is
Hereditary IgM increase is due to disease
blocked, leading to normal or high levels of IgM, with
with marker:
low IgA & IgG levels. The patient is susceptible to
a. CD 1a
bacterial infections (also viral, fungl & parasitic). This
49 b. CD 10
is due to:
c. CD 20
X-linked recessive gene mutation of T cells' CD40L:
d. CD 30
the most common.
e. CD 40
Autosomal recessive gene mutation of B cells'
CD40.
Mutations of genes involved in the CD40 signaling
pathway: either autosomal recessive (AID & UNG
genes) or X-linked recessive (NEMO gene).

Hereditary granulomatous disease of childhood.


50 Neutrophil deficiency = !!!!
Neutrophil deficiency = neutropenia

Chronic granulomatous disease is due to b.


immunodeficiency of which of the Chronic granulomatous disease is an X-linked
following? phagocytic disfunction that manifests in the second
a. T-cell member year of life with suscepUbility to organisms of low
51
b. Defective neutrophil function. virulence e.g. staph. epidermidis, serratia, aspergillus.
c. Hypocomplementemia. Complement may be elevated and neutrophils are
d. Defeceient immunoglobulins. usually elevated even without infection. There is
e. neutrophils hypergammaglobulinemia. T-cell function is normal.

b.
* Decrease oxidative burst:
Chronic granulomatous disease (chronic
* Child with long history of repeated
granulomatosis) is a diverse group of hereditary
infection. Investigations show decrease
diseases in which certain cells of the immune system
52 superoxide activity:
have difficulty forming the reactive oxygen
a. Defective phagocytosis
compounds (most importantly, superoxide) used to
b. Granulomatous disease
kill certain ingested pathogens. This leads to
c. Chediak Higashi syndrome
formation of granulomas in many organs.

Complement deficiency:
53 a. Chronic granulomatosis Neither a. nor b.
b. HIV
b.
C1 esterase inhibitor deficiency:
C1 esterase inhibitor is an acute phase reactant that
54 a. Digeorge syndrome
inhibits the complement classical pathway by binding
b. Hereditary Angioedema
to C1r & C1s proteases.

Autoimmune diseases

Autoimmune disease contain all except?


d.
a. Lesion in B/M
In AIDs there is autoanUbodies immune complex
55 b. low complement level in serum
formation complement xaUon complement.
c. immune complex in serum
Also there is cell death or altered function.
d. low Ig in serum.

Oligoclonal band in CSF protein electrophoresis (on


56 Multiple sclerosis diagnosed by:
agarose gel)

40 yrs old male with pain in the knee b. case of rheumatoid arthritis
increase with rest, decrease with walk: c. for ankylosing spondylitis. It is a seronegative (RF -
**Patient with pain increase by rest ve) spondyloarthropathy causing kyphosis, loss of
decrease with exercise. X ray show lesion spinal mobility, arthritis, systemic manifestations (e.g.
57
in pelvic joints. Recommended test is: uveitis, lung fibrosis, aortitis) & Pain.
a. ANA Pain is the initial symptom. It is characteristically
b. RF chronic, dull, insidious onset, low back & gluteal pain.
c. HLA-B27 It is severe at rest, but improves with physical activity.

Case of female with autoimmune disease


& muscle weakness which antibody is
positive:
a. ANA c.
58
b. anti-histone Case of polymyositis for diagnosis anti-jo
c. anti-jo
d. Antimicrosomal
e. ANCA

a.
ANCA is not specific, associated with several AIDs such
Case. patient is P-ANCA +ve
as ulcerative colitis (97% of cases, mostly with ASCA),
59 a. Ulcerative colitis
Crohn's disease (30%), Churg-Strauss syndrome (50%),
b. Chron's disease
PAN, rheumatoid arthritis, glomerulonephritis, AIH
type 1, primary sclerosing cholangitis (PSC).

60 Common cause of renal failure: SLE


Until recently, the most common cause of death in
people with lupus was renal failure. Now, with better
therapies, access to dialysis, and the possibility of
kidney transplantation, the frequency of death from
61 Main cause of death in SLE: kidney disease has decreased sharply. However,
kidney failure is still fatal in some people with lupus.
As death from kidney disease has declined, heart
attacks and related CVS diseases have emerged as
leading causes of early mortality in people with lupus.

Immuno-assay

A standard micro plates in ELISA test has? c.


96 wells are present in the microplate (8 rows x 12
a. 98 wells
62 columns). Of these, 1 is used for the blank, 2 for the ve
b. 94 wells
controls, 2 for the +ve controls and 4 for the cutoff control
c. 96 wells (COC). The remaining 85 for tests.

The label in ELISA tests is?


a. enzyme
63 b. radioactive substance a.
c. antibody
d. antigen

The enzyme in ELISA testing is present in


the?
c.
a. buffer
64 The conjugate is the second antibody conjugated with
b. micro plate
the enzyme.
c. conjugate
d. None of the above

Difference between ELISA & RIA:


a.
a. ELISA technique uses an enzyme.
65 ELISA: the label is an enzyme.
b. ELISA is used by bacteriologists while
RIA: the label is a radio-active substance.
RIA by virologists

b.
In ELISA, the first washing is used to remove the
Washing must be done in all unbound (free) sample antigen. The second washing
heterogeneous ELISA technique because? removes unreacted free label (not excess binding in
a. increase the specificity either of the 2 washings)
66
b. increase the sensitivity If washing is not complete, this will false high
c. it removes the excess binding specificity.
d. none of the above If the question comes as It avoids excess binding,
then this will be the choice.
c.
co efficient ELISA we use :
a. one negative and 3 positive control
67 a.
b. 3 negative and one positive control
c. 3 negative and 3 positive control

Enzyme used to un-union DNA helix in PCR


a. Helicase
68 b. Transcriptase ?a.
c. ..
d. .

Finger printing requires:


a. Polymerase a.
69 b. Restriction endonuclease Polymerase chain reaction (PCR) is used for paternity
c. Transcriptase fingerprinting
d. Ligase

PURINE IS ASSOCIATED WITH: d.


a. Adenine All are correct
70 b. Guanine Adenine & guanine are the purine bases present in
c. Uric acid RNA & DNA. Uric acid is the end product of purine
d. RNA metabolism.

Pyrimidine base:
a. Adenine
b. Guanine c.
71
c. Thymine Pyrimidines = cytosine & thymine
d. Uric acid
e. Urea