46. A 14-year 14-year-old -old boy deve develops lops a prurit pruritic ic vesicul vesicular ar rash on his face face and hands hands 3 days after hiking in the woods. Which of the following are most likely to be involved in his illness A!
Antibody" complement #$-%
&!
#irculating immune comple'es( complement #$a" neutrophils
#!
#ytoto'ic #ytoto'ic ) lymphocytes
*!
+g," mast cells" histamine" cytokines
,!
ymphocytes" ymphocyte s" cytokines" cytokines " macrophages macrophag es
4. After After activatio activation" n" neutrophil neutrophils s demonstrate demonstrate an increa increased sed tendency tendency to migrate migrate out out of bloo blood d vess vessel els s and into the e'tra 'trava vasc scul ular ar comp compar artm tmen ent. t. Whic Which h of the the following is the most likely cause A!
Altered Altered e'pression e'pression of adhesion molecules
&!
/eightened phagocytic ability
#!
+ncreased synthesis of lysosomal en0ymes
*!
elease elease of interleukin-1 2+-1!
,!
pregulated synthesis of c receptors receptors
4%. ,ndo 4%. ,ndoth thel elia iall cell cells s of the the post postca capi pill llar ary y venu venule les s incr increa ease se e'pr 'pressi ession on of intercellular adhesion molecule-1 2+#A5-1! in response to cytokines. )he increased e'pression e'pression of +#A5-1 results directly in which of the following neutrophil functions A! &! #! *! ,!
Activation Adherence #hemota'is *emargination )ransmigration
14. Which group of regulators involving inammatory or immediate 2type +! hypersensitivity reactions is capable of causing increased vascular permeability and attraction of leukocytes A!
,ssential fatty acids
&!
eukotrienes
#!
7rostaglandins
*!
)hrombo'anes
89. A previously asymptomatic 48-year-old man who has been seropositive for /+: for 4 years comes to the physician because of the recent onset of fever" cough" and weight loss. An '-ray ;lm of the chest shows bilateral pulmonary in;ltrates. A methenamine silver-stained preparation of bronchoalveolar lavage uid is shown. Which of the following immunologic abnormalities most likely led to the development of this pulmonary process
A!
#irculating immune comple'-induced in
&!
*ecrease in the number of #*4= ) lymphocytes
#!
+nactivation of pulmonary macrophages
*!
+ncrease in selective cytoto'ic #*= )-lymphocyte activity
,!
oss of natural killer cell function
88. Which of the following features of the inactivated poliovirus vaccine best e'plains why it prevents paralytic polio but does not prevent replication of the virulent poliovirus in the enteric tract A!
+t does not elicit cell-mediated immunity to viral capsid proteins
&!
+t does not elicit neutrali0ing antibody to virulent poliovirus
#!
+t elicits +g> but not secretory +gA
*!
+t only protects against one serotype of virulent poliovirus
83. Which of the following immunosuppressive agents acts in the lymphocyte by comple'ing to and inactivating the lymphocyte-speci;c phosphatase calcineurin A!
Antilymphocyte globulin
&!
A0athioprine
#!
#orticosteroids
*!
#yclosporine
,!
?@)3 monoclonal antibody
8.
)olerance of & lymphocytes to self-antigens develops in which compartment
A!
&one marrow
&!
ymph nodes
#!
7eyers patches
*!
Bpleen
,!
)hymus
13. )he recombinant vaccine used to immuni0e against hepatitis & infections elicits antibodies against which of the following viral proteins A! /&cAg &! /&eAg #! /&sAg *! 7olymerase 16. A C3-year-old woman has bronchopneumonia. Dumerous neutrophils" attracted in part by $-hydropero'yeicosatetraenoic acid 2$-/7,),! and leukotrienes"
are present in the aEected bronchioles and alveoli. Which of the following en0ymes is most directly involved in the production of these molecules A!
#3 convertase
&!
#ycloo'ygenase
#!
$-ipo'ygenase
*!
7hosphatase
,!
Bupero'ide dismutase
36. )he initial vaccines against /aemophilus inuen0ae type & prepared with capsular polysaccharides were not very eEective in children less than 8 years old. BubseFuent vaccines have been greatly improved by the con
#*4= ) lymphocytes are activated
&!
#ytoto'ic ) lymphocyte responses are increased
#!
*irect activation of & lymphocytes by the vaccine is increased
*!
Donimmune clearance of the vaccine is decreased
,!
7hagocytosis of the vaccine is increased
46. )umor necrosis factor is the primary mediator of host responses initiated by lipopolysaccharide 27B! and leading to septic shock. 7B-mediated activation of transcription most likely depends on which of the following transcription factors A!
c-ras
&!
Duclear factor-kappa &
#!
p$3
*!
b protein
,! :7-16 2etoposide! 1%. Activation of ) lymphocytes is initiated when processed antigen binds to the ) lymphocyte receptor on the cell membrane" and phospholipase # is activated. )his results in production of which of the following components of signal transduction
A!
#yclic A57
&!
#yclic >57
#!
*iacylglycerol
*!
+nterleukin-8 2+-8!
84. Which of the following procedures improves the immunogenicity of vaccines that use capsular polysaccharides as antigens A!
/eat denaturation
&!
iposome incorporation
#!
?ligosaccharide reduction
*!
7rotein con
4%. Deutrophils produce reactive o'ygen compounds following the phagocytosis of bacteria. Which of the following en0ymes protects body tissues against these highly reactive o'ygen compounds A!
#ycloo'ygenase
&!
ipo'ygenase
#!
5yelopero'idase
*!
Bupero'ide dismutase
,!
Ganthine o'idase
1C. 7oliovirus can be grown in cultured monkey kidney cells through repeated passages" resulting in virus that is no longer neurovirulent. )his virus can be used as a vaccine because it has become A!
attenuated
&!
defective
#!
inactivated
*!
latent
,!
recombinant
86. A 88-year-old woman comes to the emergency department because she has had fever" dysuria" and ank pain for the past 8 days. :ital signs areH ectal temperature 3%.4 # 2193 ! 7ulse 139Imin espirations 8$Imin &lood pressure %9I$$ mm /g Bhe has anuria. &lood cultures grow ,scherichia coli. +ntravenous broad-spectrum antibiotic therapy is started. Which of the following cytokines contribute to her current illness A!
+nterleukin-8 2+-8! and interferon-J
&!
+-3 and +-C
#!
+-4 and +-$
*!
+-19 and +-18
,!
)umor necrosis factor-K and +-1
6. Dormal healthy children are able to mount diverse antibody responses to several thousands of diEerent antigens. )his process is based primarily on which of the following *DA mechanisms A! &! #! *! ,!
Ampli;cation #onformation ecombination epair eplication
1. Which of the following is the most likely conseFuence of impaired synthesis of interleukin-1 2+-1! A! &! #! *!
,nhanced phagocytic activity of circulating macrophages ,nhanced production of antibody by & lymphocytes +mpaired antigen processing by circulating macrophages +mpaired function of ) lymphocytes
,!
+mpaired production of leukotrienes by neutrophils
89. Antibodies that can pass from the mother to the fetus through the placenta are of which class A! +gA &! +g* #! +g, *! +g> ,! +g5
8%. After a full course of immuni0ation with a new vaccine consisting of a recombinant polypeptide" 19L of adults fail to make antibody to the polypeptide. )he nonresponders have an increased freFuency of one /A type. What is the most likely e'planation for the failure of this group to respond to immuni0ation A! &! #! *!
ailure of & lymphocytes to recogni0e the polypeptide ailure of ) lymphocytes to recogni0e the polypeptide ack of class + 5/# presentation of the polypeptide ack of class ++ 5/# presentation of the polypeptide
44. )he ability of endothelial cells to inhibit platelet aggregation is mediated in part by the metabolism of cell membrane-derived arachidonic acid by which of the following A!
Anaerobic glycolysis
&!
#ycloo'ygenase pathway
#!
>lutathione reductase pathway
*!
ysosomal en0ymes pathway
,!
5i'ed function o'idase pathway
!
)ricarbo'ylic acid pathway
4. A 19-year-old girl has acute facial swelling and diMculty breathing. An acFuired de;ciency of #1 esterase inhibitor is suspected. Which of the following ;ndings in serum will best support this diagnosis A!
*ecreased concentration of #4
&!
+ncreased concentration of properdin
#!
Dormal concentration of #1F
*!
Dormal concentration of #1s
,!
Dormal concentration of #8
83. Which of the following is the uniFue function of the central aggregate of particles 2marked by G! in the free0e-fracture image A! Adhesion &!
#ommunication
#!
5otility
*!
7ermeability
,!
Becretion
41. A $-year-old boy with a history of recurrent ear infections receives his preschool booster immuni0ation against diphtheria-tetanus-pertussis. /e is participating in a community-sponsored study to determine the humoral immune response to tetanus to'oid 2tt!. /is response is well below normal for age- and se'matched children. 7eripheral & lymphocyte count and ) lymphocyte count and function are within the reference range. )he antibody he makes is positive in both the passive hemagglutination and complement-mediated lysis of tt-coated erythrocytes. /is antibodies do not opsoni0e tt-coated late' particles for phagocytosis and do not directly precipitate tt eMciently. )his child most likely has a defect in which of the following processes A! AMnity maturation of immunoglobulins &!
+mmunoglobulin isotype switching
#!
ecombination of heavy chain variable region genes
*!
ecombination of light chain variable region genes
,!
Bomatic mutation of immunoglobulin genes
