Cumulative Questions Flashcards
(317 cards)
1
Q
Which of the following generally does not apply to bone marrow (a primary lymphoid organ)
but does apply to secondary lymphoid organs?
A
Antigen-dependent response
2
Q
Which of the following is involved in recognition of intracellular pathogens in innate immune
cells?
A
NOD-like receptors (NLRs)
3
Q
Which of the following is a correct statement about NK cells?
A
They kill target cells in an extracellular fashion
4
Q
Mature dendritic cells are capable of which of the following?
A
Activating naïve antigen-specific T cells
5
Q
Killer-cell inhibitory receptors (KIRs) expressed by NK cells bind to which of the following to
prevent killing of normal cells:
A
MHC class I
6
Q
Which of the following applies uniquely with respect to B cells found in secondary lymphoid
organs?
A
Terminally differentiate into plasma cells
7
Q
The germinal centers found in the cortical region of lymph nodes and the peripheral region of
splenic peri- arteriolar lymphatic tissue
A
Provide an infrastructure that on antigenic stimulation contains large populations of B
lymphocytes and plasma cells
8
Q
Which of the following sequence correctly describes lymphocyte migration from lymph nodes to
blood?
A
Postcapillary venules, efferent lymphatic vessels, thoracic duct, vena cava, heart
9
Q
Clonal expansion of which of the following cells occurs following their direct interaction with the
antigen for which they are specific?
A
B cells
10
Q
A large glycoprotein has been enzymatically digested in the laboratory to yield a mixture of
glycopeptides ranging in size from 4 to 6 amino acids in length. Which of the following would
be expected if the peptide mixture were administered to an experimental animal together with
an adjuvant such as complete Freund’s adjuvant?
A
There would be neither a humoral nor cell-mediated immune response to the peptides in
the mixture
11
Q
The protection against smallpox virus infection afforded by prior infection with cowpox virus
represents
A
Antigenic cross-reactivity
12
Q
Converting a toxin to a toxoid
A
Reduces the pharmacological activity of the toxin
13
Q
Haptens
A
A) require carrier molecules to be immunogenic, B) react with specific
antibodies when homologous carriers are not employed C) interact with specific
antibody even if the hapten is monovalent D) cannot stimulate secondary
antibody responses without carriers
14
Q
An adjuvant is a substance that
A
Enhances the immune response to the immunogen
15
Q
A polyclonal antibody made against a large protein antigen reacts with it even when it is
denatured by disrupting all disulfide bonds. Another monoclonal antibody against the antigen
fails to react when it is similarly denatured. The most likely explanation can be stated as follows:
A
The polyclonal antibody contains antibodies specific for several non-conformational
epitopes expressed by the antigen
16
Q
Functional properties of immunoglobulins such as binding to Fc receptors are associated with
A
Heavy chains
17
Q
The idiotype of an antibody molecule is determined by the amino acid sequence of the
A
Variable regions of the heavy and light chains
18
Q
Which of the following would generate a polyclonal rabbit antiserum specific for human γ
heavy-chain, κ chain, λ chain, and Fc regions of Ig:
A
Pooled IgG
19
Q
A polyclonal antiserum raised against pooled human IgA will react with
A
A) human IgM, B) κ light chains, C) human IgG, D) J chain
20
Q
An individual was found to be heterozygous for IgG1 allotypes 3 and 12. The different possible
IgG1 antibodies produced by this individual will never have
A
Two heavy chains, one of allotype 3 and one of allotype 12
21
Q
Papain digestion of an IgG preparation of antibody specific for the antigen hen egg albumin
(HEA) will
A
Produce two Fab molecules and one Fc fragment
22
Q
If an individual who is highly allergic to cat dander is exposed to a pet cat in a friend’s house,
which class of immunoglobulin would most likely be found to be elevated soon after this
exposure?
A
IgE
23
Q
Which of the following immunoglobulins can activate complement as a single molecule when
bound to an antigen?
A
IgM
24
Q
The relative level of pathogen-specific IgM antibodies can be of diagnostic significance because
A
Relatively high levels of IgM often correlate with a first and recent exposure to the
inducing agent
25
Primary and secondary antibody responses differ in
A) the predominant isotype generated, B) the number of lymphocytes
responding to antigen, C) the time it takes for measurable amounts of
antibodies to appear in the serum, D) the biologic functions manifested by the
Ig isotypes produced
26
In an individual predisposed to allergic responses, which of the following statement best
describes the outcome of his/her exposure to an allergen:
Clinical reactions such as wheezing and sneezing may soon manifest soon after exposure
due to the presence of allergen-specific IgE that is retained by cells such as mast cells that
express Fcε receptors
27
Which of the following is required to ensure the integrity and stability of immunoglobulin
molecules but is not associated with interactions between antigens and antibodies?
Covalent bonds
28
If an IgG antibody preparation specific for hen egg lysosome (HEL) is treated with papain to
generate Fab fragments, which of the following statements concerning the avidity of such
fragments is true?
They will have a lower avidity for HEL as compared with the intact IgG
29
Western blot assays used to test serum samples for the presence of antibodies to infectious
agents, such as HIV, are particularly useful as diagnostic assays because
Antibodies specific for multiple antigenic epitopes can be detected
30
The major difference between transgenic mice and knockout mice is that
Transgenic mice have a functional foreign gene added to their genome
31
SCID mice have a genetic defect that prevents development of functional
B cells and T cells
32
Which of the following statements regarding B cell hybridomas is true?
They are derived by fusing B Cells with malignant plasma cells that are unable to secrete
immunoglobulin
33
An ELISA designed to test for the presence of serum antibody for a new strain of pathogenic
bacteria is under development. Initially, a monoclonal antibody specific for a single epitope of
the organism was used both to sensitize the wells of the ELISA plate and as the enzyme- labeled
detecting antibody in a conventional sandwich ELISA. The ELISA failed to detect the antigen
despite the use of a wide range of antibody concentrations. What is the most probable cause of
this problem?
The monoclonal antibody used to sensitize the wells is blocking access of the epitope;
thus, when the same antibody is enzyme-labeled, it cannot bind to the antigen
34
The DNA for an H chain in a B-cell making IgG2 anti- body for diphtheria toxoid has the
following structure: 5′-V17D5J2 Cγ2–Cγ4–Cε–Cα2–3′. How many individual rearrangements
were required to go from the embryonic DNA to this B-cell DNA?
3
35
If you had 40V, 25D, and 6J regions able to code for an H chain and 40V and 5J-region genes
able to code for an L chain, you could have a maximum repertoire of:
More than 1,200,000 specificities
36
The antigen specificity of a particular B cell:
Is determined by H+L-chain variable-region sequences
37
If you could analyze at the molecular level a plasma cell making IgA antibody, you would find all
of the following except:
mRNA specific for μ chains
38
The ability of a single B cell to express both IgM and IgD molecules on its surface at the same
time is made possible by:
Alternative RNA splicing
39
Which of the following statements concerning the organization of Ig genes is correct?
The VDJ segments coding for an Ig VH region may associate with different H-chain
constant-region genes
40
Which of the following does not contribute to the antigen-binding site diversity of B-cell antigen
receptors?
Inheritance of multiple C-region genes
41
Which of the following statements regarding a B cell expressing both IgM and IgD on its
membrane is incorrect?
The IgM and IgD have different antigenic specificities
42
Which of the following plays a role in changing the antigen binding site of a B cell after
antigenic stimulation?
Somatic hypermutation
43
The earliest stages of B-cell differentiation:
Involve rearrangement of heavy-chain gene segments
44
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
45
Which of the following statements is incorrect?
Synthesis of antibody in a primary response to a thymus-dependent antigen occurs
predominantly in the blood
46
Immature B lymphocytes:
Are at a stage of development where contact with antigen may lead to receptor editing
and deletion
47
Antigen binding to the B-cell receptor:
Transduces a signal through the Igα and Igβ molecules
48
Which of the following would not be found on a memory B cell?
Surrogate light chains
49
Germinal centers found in lymph nodes and spleen:
Are sites where antigen-activated mature B cells proliferate and differentiate
50
All the following are characteristics of both MHC class I and II molecules except:
They are expressed constitutively on all nucleated cells
51
MHC class I molecules are important for which of the following?
Binding to CD8 molecules on T cells
52
Which of the following is incorrect concerning MHC class II molecules?
MHC class II molecules are associated with β2-microglobulin on the cell surface.
53
The peptide transporter TAP
Transports peptides into the endoplasmic reticulum for binding to MHC class I
54
Which of the following statements about HLA genes is incorrect?
They code for both chains of every HLA class I molecule expressed.
55
Which of the following is found on the surface of every B cell, T cell, and pancreatic cell?
MHC class I molecules
56
After a virus infects a boy’s liver cells, which of the following about the processing and
presentation of virus- derived proteins is correct?
Some virus-derived peptides are presented to CD8+ T cells.
57
Which of the following statements concerning T-cell development is correct?
Interaction with thymic nonlymphoid cells is critical.
58
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?
negative selection
59
Which of the following statements is correct?
CD4+ CD8+ T cells form the majority of T cells in the thymus.
60
Which of the following is incorrect regarding mature T cells that use αβ as their antigen-specific
receptor?
They can further rearrange their TCR genes to express γδ as their receptor.
61
Which of the following statements is incorrect concerning TCR and Ig genes?
Both Ig and TCR are able to switch C-region usage.
62
Which of the following statements is incorrect concerning antigen-specific receptors on both B
and T cells?
They have extensive cytoplasmic domains that interact with intracellular molecules
63
Which of the following is correct concerning the characteristics of T cells that exit the thymus?
They express either CD4 or CD8 with a TCR that has low to moderate affinity for MHC
plus self-antigen.
64
The role of the APC in the immune response is all of the following except:
To present nonself-peptides associated with MHC class I molecules to CD4+ T cells
65
Which of the following statements about IL-2 is incorrect?
It is produced primarily by activated macrophages.
66
Which of the following pairs of cell surface proteins do NOT interact with each other?
Membrane Ig on the B cell and CD4 on the T cell
67
Which of the following statements about the activation of CD4+ T cells is incorrect?
```
The interaction between peptide–MHC class II on an APC and the TCR of an appropriate
CD4+ T cell is necessary and sufficient for full T-cell activation.
```
68
Which of the following statements about cytokines and subsets of CD4+ T cells is incorrect?
Cytokines synthesized by TH1 and TH2 cells inhibit the action of Treg cells.
69
Which of the following statements about CD8+ CTL is incorrect?
They cannot kill CD4+ T cells.
70
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?
Vaccinia-infected cells expressing the same MHC class I molecules as the individual
71
Polarization of naïve CD4+ T-cell differentiation toward the TH2 lineage is associated with which
of the following cytokines?
IL-4
72
A patient with active rheumatoid arthritis feels systemically ill with low-grade fever, malaise,
morning stiffness, and fatigue. The protein(s) or cytokine(s) most likely to be responsible for
these symptoms are:
TNF and IL-1
73
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?
Nothing happens
74
IL-1, IL-6, and TNF-α are proinflammatory 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 acutephase
responses, D) have endogenous pyrogen properties
75
Which of the following cytokines plays a role in terminating inflammatory responses?
TGF-β
76
Assuming there were no other compensatory mechanisms to replace IL-8 function, which of the
following would be preserved as a functional activity in an IL-8 knockout mouse strain?
Reduction of cytokine production by TH1 cells
77
Superantigens cause a burst of cytokine production by T cells due to their ability to
Cross-link the Vβ segments of T-cell receptors with class II MHC molecules on APCs
78
An individual normally does not make an immune response to a self-protein because:
Lymphocytes that express a receptor reactive to a self-protein are inactivated by
deletion, anergy, or receptor editing.
79
Which of the following autoimmune diseases has been proven to be due to a single gene
defect?
Autoimmune lymphoproliferative syndrome (ALPS)
80
Rheumatoid factor, found in synovial fluid of patients with rheumatoid arthritis, is most
frequently found to be:
IgM reacting with H-chain determinants of IgG
81
In which of the following diseases do TH1 CD4+ cells, cytotoxic CD8+ T cells, and autoantibody
all contribute to the pathology?
type I diabetes mellitus
82
A 22-year-old woman has an erythematous rash on the malar eminences of her face that gets
worse when she goes out in the sun. She has lost about 10 pounds, com- plains of generalized
joint pain, and feels tired much of the time. Physical examination is normal except for the rash.
Laboratory tests reveal a WBC count of 5500 (normal). Urinalysis shows elevated levels of
protein in
high levels of antibodies to double-stranded DNA
83
Blocking any of the following processes can result in peripheral tolerance in mature T cells
except:
negative selection of thymocytes
84
Which of the following is least likely to lead to autoimmunity?
increased clearance of immune complexes
85
A 30-year-old woman with a previous history of rheumatic fever has recently developed a heart
murmur. The most likely cause is:
molecular mimicry of a streptococcal antigen and cardiac myosin
86
Curtis Jones, a retired sanitation worker, developed double vision. Upon neurologic
examination he was observed to have weakness of his facial muscles and his tongue and
abnormality in ocular movements. Several months later he developed difficulty in chewing,
swallowing food, and breathing. Serologic tests revealed the presence of autoantibodies
directed to receptors at the neuromuscular junction. The most likely diagnosis is:
myasthenia gravis
87
A patient is admitted with multiple bacterial infections and is found to have a complete absence
of C3. Which complement-mediated function would remain intact in such a patient?
None of the above
88
Complement is required for:
Antibody-mediated lysis of bacteria
89
Which of the following is associated with the development of SLE-like symptoms?
Deficiencies in C1, C4, or C2
90
Activated fragments of C5 can lead to all of the following except:
Attachment of lymphocytes to macrophages
91
The alternative pathway of complement activation is characterized by all of the following
except:
Activation of C4
92
DAF regulates the complement system to prevent complement-mediated lysis of cells. This
involves:
Dissociation of the C3 convertase complex
93
The following activate(s) the alternative pathway of complement:
lipopolysaccharides, B) some viruses and virus-infected cells, C) fungal and
yeast cell walls, D) many strains of Gram-positive bacteria
94
A 22-year-old male, with significant cat allergies, visits a home with multiple cats. Two hours
later, he arrives at an urgent care center with a severe exacerbation of asthma. He is treated
with a short-acting bronchodilator and epinephrine. Initially, his symptoms resolved after
treatment; however, 8 hours later he is forced to go the emergency room with another
exacerbation. What is the most likely cause of his symptoms?
Eosinophil and basophil infiltration leading to the release of proinflammatory mediators
95
A 21-year old male who is allergic to cat dander is exposed to a friend’s cat while wearing a
facial mask to reduce his contact with the allergen. Nevertheless, several hours later, he is
wheezing and coughing. Which of the following best explains this individual’s allergic reaction?
Mast cells in his lung degranulated following the cross-linking of allergen-specific IgE on
their surface.
96
The usual sequence of events in an allergic reaction is as follows:
The allergen binds to IgE fixed to mast cells.
97
Epinephrine
causes bronchodilation, B) is effective even after anaphylactic symptoms
commence, C) relaxes smooth muscle, D) decreases vascular permeability
98
A human volunteer agrees to be passively sensitized with IgE specific for a ragweed antigen
(allergen). When challenged with the allergen intradermally, he displays 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?
No reaction would occur because the Fc fragments would interact with FcεR receptors
on mast cells.
99
The following mechanism(s) may be involved in the clinical efficacy of desensitization therapy to
treat patients with allergies to known allergens:
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
100
Antihistamines
Block H1 receptors and inhibit smooth muscle contraction, dilatation of small blood
vessels, and mucus production
101
Which of the following remains the gold standard for asthma management?
Corticosteroids
102
Anaphylactic reactions
evolve in minutes and abate within 30 minutes, B) may be followed by
inflammatory reactions hours later, C) are the consequences of released
pharmacologic agents, D) may involve components of mast-cell granule matrix
103
Graves’ disease is an example of type II hypersensitivity whose pathophysiology is best
explained by:
Disease-causing agonistic autoantibodies to cell surface receptors
104
Which of the following is most likely to involve a reaction to a hapten as its etiologic cause?
Hemolytic anemia following treatment with penicillin
105
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:
The Fc region of the IgA antibody does not bind receptors for Fc receptors on
phagocytic cells
106
The glomerular lesions in immune complex disease can be visualized microscopically with a
fluorescent anti- body against:
A) IgG heavy chains, B) κ light chains, C) C1, D) C3
107
Immune complexes are involved in the pathogenesis of which of the following rheumatic feverassociated
diseases:
Poststreptococcal glomerulonephritis
108
The final damage to vessels in immune complex-mediated arthritis is due to
Lysosomal enzymes of polymorphonuclear leukocytes
109
Serum sickness is characterized by
Deposition 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
110
Type II hypersensitivity
Involves antibody-mediated destruction of cells
111
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
The symptoms of farmer’s lung are complicated by an IgE-mediated reactivity to the
same antigen
112
Which of the following does not involve cell-mediated immunity?
Serum sickness
113
A positive delayed-type hypersensitivity skin reaction involves the interaction of
Antigen, antigen-sensitive T cells, and macrophages
114
Delayed skin reactions to an intradermal injection of antigen may be markedly decreased by
Exposure to a high dose of X-irradiation
115
Which of the following statements is characteristic of contact sensitivity?
Some chemicals acting as haptens induce sensitivity by covalently binding to host
proteins acting as carriers
116
Positive skin tests for delayed-type hypersensitivity to intradermally injected antigens indicate
that
A cell-mediated immune response has occurred
117
T-cell–mediated immune responses can result in
A) formation of granulomas, B) induration at the reaction site, C) rejection of a
heart transplant, D) eczema of the skin in the area of prolonged contact with a
rubberized undergarment
118
Which one of the following statements about the PPD skin test is true?
B, C and D are all true
119
An 8-month-old baby has a history of repeated Gram- positive bacterial infections. The most
probable cause for this condition is:
None of the above
120
A 50-year-old worker at an atomic plant who previously had a sample of his own bone marrow
cryopreserved was accidentally exposed to a minimal lethal dose of radiation. He was
subsequently transplanted with his own bone marrow. This individual can expect to:
None of the above
121
Which of the following immune deficiency disorders is associated exclusively with an
abnormality of the humoral immune response?
X-linked agammaglobulinemia (Bruton’s agammaglobulinemia)
122
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:
Plasma cell myeloma
123
Patients with DiGeorge syndrome may fail to produce IgG in response to immunization with Tdependent
antigens because:
They have a decreased number of T helper cells
124
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?
B-cell deficiency
125
A healthy woman gave birth to a baby. The newborn infant was found to be HIV-seropositive.
This finding is most likely the result of:
Maternal HIV-specific IgG being transferred across the placenta to the baby
126
Immunodeficiency disease can result from a:
A) developmental defect of T lymphocytes, B) developmental defect of bone
marrow stem cells, C) defect in phagocyte function, D) defect in complement
function
127
A 9-month-old baby was vaccinated against smallpox with attenuated smallpox virus. He
developed a progressive necrotic lesion of the skin, muscles, and sub- cutaneous tissue at the
site of inoculation. The vaccination reaction probably resulted from:
T-cell deficiency
128
The most common clinical consequence(s) of C3 deficiency is (are):
Increased susceptibility to bacterial infections
129
In clinical transplantation, preformed cytotoxic antibodies reactive against MHC antigens
expressed on the grafted tissue cause:
Hyperacute rejection
130
Following transplantation of a solid organ, skewing an immune response in a direction that
promotes activation of TH1 and TH17 T cells would be expected to:
Promote allograft rejection
131
Which of the following is a pathophysiologic mechanism for activation of donor APCs in
individuals who have received organ transplants?
Their exposure to damaged cells in the recipient
132
Transplant rejection may involve
cell-mediated immunity, B) activation of TH17 cells, C) complementdependent
cytotoxicity, D) the release of IFN-γ by alloreactive TH1 cells
133
Molecular HLA genotyping of peripheral blood lymphocytes from an individual in need of a
kidney trans- plant donor confirms the expression of the following alleles: HLA-A1, -A3; HLA-B7,
-B8; HLA-DR3 -DR4. What would be the most likely outcome of a renal trans- plant performed
in this individual using a donor with the following HLA genotype: HLA-A1, A1; HLA-B8, -B22;
HLA-DR3, -DR4?
The graft would be accepted if maintenance immunosuppressive therapy were used.
134
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
The binding of anti-CD28 to T cells, which interferes with signal transduction needed for
T-cell activation
135
Impairments in which of the following immune mechanisms is associated with the
appearance of many primary lymphoreticular tumors in humans?
Cell-mediated immunity
136
Tumor antigens have been shown to cross-react immunologically in cases of
Tumors induced by RNA viruses
137
Which of the following is not considered a mechanism by which cytokines mediate antitumor
effects?
They induce complement-mediated cytolysis.
138
Rejection of a tumor may involve which of the following?
T-cell–mediated cytotoxicity, B) ADCC, C) complement-dependent
cytotoxicity, D) destruction of tumor cells by phagocytic cells
139
Which of the following best defines immunotoxins?
Toxins coupled to antigen-specific immunoglobulins
140
It has been shown that a B-cell lymphoma could be eliminated with anti-idiotypic antibodies.
The use of this approach to treat a plasma cell tumor would not be warranted because
The plasma cells do not have surface Ig
141
Monoclonal antibodies used in hematologic malignancies such as chronic lymphocytic leukemia
act, in part, because of their ability to
Induce apoptosis after binding B-cell tumors
142
The usual sequence of events in the development of an effective immune response to a viral
infection is
Interferon secretion, cellular immune response, antibody synthesis, NK cell ADC
143
Differences between Gram-positive and Gram-negative bacteria include
staining with crystal violet, B) ability of complement to lyse cells, C)
thickness of the peptidoglycan layer, D) endotoxin in the cell walls of Gramnegative
bacteria
144
Antigenic variation is a mechanism of immune evasion that results in
Alterations in important surface antigens so that escape variants arise as a result of
immune selection
145
The best way to provide immunologic protection against tetanus neonatorum (of the newborn)
is to
immunize the mother with tetanus toxoid before or early in pregnancy
146
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
Antibody in the serum protects against the viremia that leads to disease
147
The administration of vaccines is not without hazard. Of the following, which is least likely to
adversely affect an immunocompromised host?
Pneumococcal vaccine
148
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 which?
Onset in 24–48 hours
149
The pneumococcal polysaccharide vaccine should be administered to all except which group?
Children (<2 years of age)
150
The following statements about human immune serum globulin are true except which one?
The ethanol precipitation does not render preparation of globulin free of hepatitis virus.
151
A common feature of helminth infections is that the host response immune mechanisms
involved are dominated by:
TH2 responses
152
Which cell types are characteristically involved in the innate immune response?
Which cell types are characteristically involved in the innate immune response?
153
Which of the following is NOT a characteristic of the adaptive immune response?
Natural barriers
154
Which phrase best defines the concept of adoptive immunization?
The transfer of immunity by the transfer of immune cells
155
Structures in secondary lymphoid organs that are sites of B cell somatic hypermutation and class switching, as well as the development of memory and plasma cells, are called…
Germinal centers
156
Which cell type is a polymorphonuclear leukocyte?
Neutrophil
157
Which class of pattern-recognition receptor is used to recognize intracellular pathogen-associated molecular patterns?
NOD-like receptors
158
Which part of an immunoglobulin binds antigen specifically?
The CDR
159
Which of the following substances is mostly likely to be highly immunogenic in humans?
Denatured whale myoglobin derived from whale muscle tissue
160
Which type of antibody heavy chain polypeptide is first expressed on the surface of developing B cells?
μ chains
161
The elimination or deletion of self-reactive immature B cells during their development occurs in the…
Bone marrow
162
Which isotypes are expressed by memory B cells?
IgA or IgE or IgG
163
Which of the following can activate the classical pathway of complement?
Soluble antigen-antibody complexes
164
Which complement pathway uses MASP?
Lectin
165
Which complement protein would best help in the removal of immune complexes from the circulation?
C3b
166
Which of the following is NOT a characteristic of hereditary angioedema?
Abnormally high serum levels of free C2 and free C4
167
Polyclonal antibodies were raised to the first antigen shown in the figure; the antigen (denoted Ag “A”) has three different epitopes. (All epitopes in this question are designated by geometric shapes; different shapes indicate different epitopes.) The polyclonal antibodies to Ag “A” were then tested against the next three antigens, which likewise contain three epitopes. Which of the following best predicts the cross-reactivity of the polyclonal antibodies with these new antigens (see figure below)?
Both Ag “C” and “D” will show cross reactivity with Ag “A”
168
Which of the following statements regarding MHC is correct?
Each human expresses two HLA haplotypes that are expressed co-dominantly.
169
Which of the following is a correct feature of peptide-MHC binding:
The peptide-MHC complex is a stable interaction with a long half-life.
170
The class II pathway of antigen processing includes all of the following except:
Peptide loading onto MHC by TAP and tapasin within the endoplasmic reticulum
171
Positive Selection:
Promotes survival of self-restricted MHC molecules.
172
Which of the following statements regarding the T cell receptor is incorrect?
The TCR is expressed on the T cell precursor exiting the bone marrow.
173
During T cell maturation:
The mature single-positive T cell expresses the TCR complex with CD4 or CD8 and has a low avidity for self-MHC
174
Hyperacute rejection:
All of the above
175
From the list below, please select the molecule that binds B7 protein on the surface of the dendritic cell resulting in a signal that inhibits T cell activity (see figure below).
CTLA-4
176
Please select the statement that best describes Th-1 cells:
Activation of Th-1 cells is restricted by MHC II proteins – that signal extracellular pathogen.
177
Infection with a polio virus results in the priming of virus-specific CD8 + T cells. If these polio virus specific CD8 + T cells are subsequently removed from the individual, which of the following cells will they kill in vitro?
Polio-infected cells expressing the same MHC class I molecules as the individual.
178
Thymus dependent B cell activation includes all the events described below EXCEPT:
Crosslinking of B cell receptors on the surface of the B cell provides signal one.
179
From the statements below, please select the one that best describes thymus independent route of B-cell activation.
Anatomically restricted to splenic marginal zone.
180
Please select the statement below that best describes the secondary humoral immune response:
For secondary response to occur, same peptide antigen epitopes must be presented to B and T cell.
181
The basic Ig unit is composed of:
2 identical heavy and 2 identical light chains.
182
Which of the following binds to various cellular receptors and to complement?
Fc region
183
Which of the following mediates antigen recognition?
Fab region
184
Recombination of V, D and J Ig gene segments:
Is carried out by enzymes called recombinases
185
A female patient was given penicillin for an infection. Ten days later she returned to the clinic complaining of a headache, itchy lumps on her skin and aching and swollen joints in her hands and feet. The immune reaction responsible for her symptoms is most likely:
An IgE-mediated allergic response
186
A B-cell is able to make cell-surface and secreted versions of antibody using:
Alternative mRNA splicing.
187
From the list below, please select the statement that best describes the property of pleiotropy
IL-2 produced by a Th cell will result in proliferation of lymphocytes and other cells like mast cells
188
IL-2 receptor is composed of 3 subunits, a, b, and y. From the list below, please select the INCORRECT statement that describes the properties of this cytokine receptor
configuration of subunits can result in high affinity IL-2Ra, intermediate affinity IL-2Rab, and low affinity IL-2aby receptor
189
which cytokine from the list below is the principal mediator of the early innate immune response and at the same time the key inducer of the adaptive immune response?
IL-12
190
Please select the statement that INCORRECTLY describes the inhibitory role of TGF-b
it inhibits cellular immunity in favor of humoral responses
191
Self-tolerance is achieved by all of the following EXCEPT
positive selection of immature T cells in the bone marrow
192
Please choose the INCORRECT description of regulatory T cell mediated suppression mechanism in periphery
undergo activation-induced cell death upon binding to antigen
193
Autoimmune disease is a consequence of multiple genetic abnormalities and environmental factors. However, a single gene defect in all the genes listed below will result in an autoimmune disease, EXCEPT
NFAT gene defect
194
Anti-CD19 monoclonal and polyclonal antibodies have been developed. Regarding on-target binding, which of the following statements is most common?
mutation of one of two amino acids in CD19 can be sufficient to prevent recognition by an anti-CD-19 monoclonal antibody
195
in a cytotoxic T-cell, binding of the specific antigen by the T-cell receptor sets off a signal transduction cascade, which is modulated by immune checkpoint pathways. consider the list of immune checkpoint molecules and downstream effects, and select the most correct pairing
PD-1/PD-L1, decreased survival and proliferation
196
in CAR-T therapy, the chimeric antigen receptor is designed to ___, and ___.
interact with tumor-specific antigen; transmit an activation signal to the T cell after antigen binding
197
one mechanism by which tumor cells can avoid being destroyed by the immune system is expression of
inhibitory immune checkpoint molecules
198
HIV attacks a human's immune system by
binding onto and replicating within CD4+T cells, which the lyses the CD4+T cell
199
What is/are (a) risk factor(s) for JM to have acquired HIV?
Unprotected sexual intercourse
200
After meeting with the provider, JM meets with the clinical pharmacist on site that day, and asks the pharmacist to explain what will happen if he does no start HIV treatment like the provider recommends. How would the pharmacist respond appropriately to HIV's course if JM remains untreated? The pharmacist begins by telling JM that HIV will attack the body's immune system by
replicating and causing the amount of virus to increase while attacking and killing CD4+ T cells which can decrease his body's ability to fight off infections
201
which of the following is false regarding Type I hypersensitivity?
initial exposure to allergen in an atopic individual results in allergic symptoms such as wheezing
202
all of the following are thought to favor Th2 differentiation and/or IgE production except
> 3 older siblings or < 6 mo. at daycare
203
in comparing the 4 types of hypersensitivity, which of the following statements is true
in type II, the antibody reacts with the antigen on the cell whereas in type III, the antibody reacts with the antigen and then deposits in tissue
204
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 fo IgG, which binds allergen before it reaches mast cells B) skewing of T-cell responses from Th2 to Th1 C) decreased production of IgE antibody
205
which of the statements is/are criteria for the diagnosis of anaphylaxis due to exposure to a likely antigen
A) sudden skin or mucosal signs and symptoms B) sudden respiratory signs and symptoms C) sudden reduction in blood pressure D) sudden GI symptoms
206
which of the following is true regarding the management of anaphylaxis
refractory cases of anaphylaxis may require the use of dobutamine
207
which of the following is true regarding patients suffering from a drug-induced allergy consisting of an urticarial reaction?
can be given an H1 blocker and H2 blocker
208
which of the following interventions and/or monitoring would not be appropriate for the management of a severe rituximab infusion reaction resulting in SOB and hypotension?
hold the infusion, then restart at a slower rate when symptoms resolve
209
which of the follwoing would be the most appropriate monitoring parameters/labratory tests for someone receiving pembrolizumab therapy?
skin rash, thyroid function, diarrhea
210
which of the following is true regarding tocilizumab therapy
it is an IL-6 receptor antagonist used for the treatment of cytokine release syndrome from CAR-T therapy
211
which of the following is not one of the three primary functions of the innate immune system?
memory of previous pathogen encounters
212
activation of the NK-kb pathway leads to transcription of cytokines, whereas induction of the inflammasome leads to
maturation and secretion of IL-1
213
polysaccharide capsules of bacteria are an effective means of evading the immune system by which primary mechanism?
masking deposited opsonins on bacterial surfaces
214
LD is a 56-year-old male who just had his spleen removed after a car accident. The physician taking
care of LD in the hospital calls you with some questions about vaccination. What is the most
appropriate recommendation for LD?
LD should receive the 13-valent pneumococcal conjugate vaccine today followed by the 23-valent
pneumococcal polysaccharide vaccine 8 weeks later
215
Which of the following is most correct?
The live, attenuated influenza vaccine is no longer recommended by ACIP due to decreased
efficacy compared to the inactivated vaccine
216
Which of the following is an important factor determining the immunogenicity of immunization?
The conjugation of bacterial soluble capsular material with a carrier protein
217
Which of the following statements best describes the efficacy of vaccinations?
In adults <65 years old, the inactivated flu vaccine is approximately 60% effective at preventing
influenza when the efficacy of the A and B strains is taken together
218
Which of the following drug classes binds to muscarinic receptors on the surface of the lungs and
leads to the dilation of bronchoconstrictor muscles?
Anticholinergics
219
The following effects are directly or indirectly caused by corticosteroids, EXCEPT:
Increase in prostaglandin production
220
AJ asks you for a treatment recommendation for his symptoms. Based on the patient’s clinical
presentation, which of the following FDA approved products would be a preferred initial
recommendation for AJ based on efficacy and side effect profile?
Loratadine
221
Two weeks later, AJ returns to your pharmacy. He states that the product you recommended has
relieved his original symptoms, but he has now noticed that his nose is congested since the flowers
in his garden started blooming. He is looking for a product recommendation for this additional
symptom that he can use for the next month or two. Which one of the following products would you
recommend to AJ?
Fluticasone nasal spray
222
To reduce the concentration of allergens that AJ is exposed to, he should do all of the following,
EXCEPT:
Raise indoor humidity to > 50%
223
Which of medications can cause or worsen asthma?
Ibuprofen
224
This patient should be made aware that some of her other health conditions can worsen asthma.
Which problem is NOT known to worsen asthma?
Hyperlipidemia
225
Which of the following could indicate this patient is at increased risk of an asthma exacerbation?
Her last prednisone burst was three months ago
226
You’ve been asked to develop an asthma action plan for a patient with persistent asthma on
beclomethasone (Qvar®) and albuterol (Ventolin®) PRN. The patient does not monitor peak
expiratory flow (PEF) measurements at home. Which of the following is an appropriate
recommendation to include in the asthma action plan?
Increase albuterol use if shortness of breath is worsening
227
A patient with asthma recently lost his insurance and cannot afford his inhalers. His physician
provided him with samples of olodaterol (Striverdi® Respimat). What is the most appropriate
counseling to provide to the patient and physician?
This medication may increase the risk of asthma-related death if used alone
228
What is the most appropriate initial medication to recommend in addition to as needed albuterol?
Low-dose budesonide/formoterol (Symbicort®)
229
What would be the most appropriate initial medication recommendation if the same patient
presented with daily asthma symptoms?
Medium-dose fluticasone/salmeterol (Advair®) + oral prednisolone burst
230
Patient is a 45-year-old with COPD and is smoking cigarettes 1 pack per day. She smokes nonmenthol
cigarettes and starts smoking within 30 minutes of waking. She has hypertension and
seizures. Her renal function is normal and she denies problems with her mood. Which regimen
on her insurance plan is recommended to treat tobacco dependence?
Varenicline starter pack 0.5 mg daily titrated up to 1 mg twice daily
231
COPD must be diagnosed by:
Spirometry
232
A 65-year-old patient with COPD is currently taking albuterol as needed for shortness of breath.
She has a FEV1/FVC that is 51% of the predicted value and a FEV1 that is 70% of the predicted
value. She has a COPD-related hospitalization in the past year and a score of 18 on the COPD
assessment test. What COPD regimen is recommended for this patient?
Umeclidinium/Vilanterol
233
Which of the following medications is the best alternative to glycopyrrolate if this
medication is not covered on the patient’s insurance?
Aclidinium
234
For COPD, which intervention has been shown to slow the long-term decline in lung function?
Smoking cessation
235
Which of the following is recommended to treat a COPD exacerbation?
Add prednisone 40 mg daily for 5 days
236
Which of the following statements is TRUE about the Respimat Inhaler?
The cartridge needs to be inserted into the base prior to initial use
237
What effect on the immunosuppressant activity would be observed in Cyclosporin A (CyA) if MeLeu6
was replaced with MeAla6.
The immunosuppressant activity of MeAla6 CyA is several orders of magnitude lower due to lack of
affinity for calcineurin
238
```
Mycophenolate mofetil is a prodrug. The active metabolite, mycophenolic acid, inhibits which of the
following pathway(s)? (Circle the correct answer)
```
De Novo synthesis pathway of purine biosynthesis
239
Which of the following statements is TRUE regarding Sirolimus (Rapamycin)?
Sirolimus binds to the same cytoplasmic receptor as tacrolimus - FKBP 12 and this complex inhibits
mTOR
240
NJ is an obese 49 yo AAF with history of ESRD due to DM/HTN on dialysis x 7 years who is getting a
deceased donor renal transplant tonight. Her height is 5’11’’ and her weight is 110kg. For
induction, she will receive methylprednisolone 500 mg IVPB one time in OR and thymoglobulin 1.5
mg/kg IVPB daily for 5 days. Please calculate her thymoglobulin dose.
Administer thymoglobulin 100 mg IVPB in OR, then daily x 4 doses
241
Choose the CORRECT statement(s) regarding the CNIs:
TAC therapy is associated with higher incidence of neurologic adverse reactions and new onset
diabetes after transplant (NODAT) than CSA therapy
242
Tacrolimus+Mycophenolate+Prednisone is the most commonly used immunosuppression regimen
after kidney transplant. CNI associated nephrotoxicity is the Achilles heel of the modern
maintenance IMS regimens. Please identify the BEST renal sparing strategy from the list below.
Switch from TAC to belatacept
243
Which of the following statement(s) regarding steroid avoidance and maintenance is/are CORRECT:
I. Steroid avoidance benefits include reduction in NODAT and less weight gain posttransplant
II. Early steroid withdrawal results in higher acute rejection rates but with little impact on
graft function; patients experience significant reduction in cardiovascular risk factors
III. Late steroid withdrawal is not beneficial because it leads to increased incidence of
chronic rejection in patients that are already manifesting side effects associated with
long-term steroid use
IV. Steroids should be maintained post-transplant in patients that were on steroids pretransplant
for management of autoimmune disease
244
The AUC curve below displays MPA AUC in the presence of cyclosporine. This statement is:
FALSE
245
If a patient comes in for antibody mediated rejection treatment, what is the initial treatment of
choice?
Plasmapheresis and IVIG 10 gm IVPB daily or every other day for 5 treatments
246
Acute tubular necrosis is usually caused by decreased oxygen delivery to the kidney tissue
(ischemia). However, use of depleting agents may result in decreased inflammatory response and
improved outcomes. Please select the only lymphocyte depleting agent from the list below:
Alemtuzumab
247
Osalazine (above) is used to treat IBD. It is a prodrug, which is converted to the active principle. Which of
the following is true?
Osalazine is converted to the active principle (ASA) by bacteria present in the lower intestine
248
Which of the following statement is true regarding methylprednisolone?
The alpha methyl group at position 6 decreases salt retention
249
A 45-year-old woman was recently diagnosed with mild Crohn’s disease. The colonoscopy revealed
inflammation in jejunum. Which one of the following is the best option for maintenance treatment?
Mesalamine (Apriso®) 1.5 g orally daily
250
What is the most important counseling point to educate patients on when starting sulfasalazine?
Sulfasalazine may turn your urine orange.
251
A 37-year-old woman has newly diagnosed mild-moderate ulcerative colitis. She presents with
intermittent diarrhea and rectal pain. Colonoscopy reveals diffuse superficial inflammation of her colon.
Which one of the following is best to recommend for this patient?
Mesalamine (Pentasa®) 1000 mg orally four times daily
252
The provider is concerned that the patient may develop antibodies. Which one of the following is the best
recommendation to prevent antibody formation?
Add methotrexate 25 mg subcutaneously every week plus folic acid 1 mg daily.
253
Which one of the following diagnostic tests would best be evaluated before he starts azathioprine
therapy?
Thiopurine methyltransferase (TPMT)
254
Two months later, he returns to the clinic reporting a flare of her symptoms. Thiopurine metabolites are
checked; 6-thioguanine nucleotide (6-TGN) concentration is 130 pmol/8 108 RBCs (Reference range:
230-450 pmol/8 108 RBCs), and 6-methylmercaptopurine concentration is 12,800 pmol/8 108 RBCs
(Reference range: <5700 pmol/8 108 RBCs). Which one of the following is most likely the cause of his
thiopurine therapy failure?
Excessive TPMT expression
255
MJ is a 35-year-old female diagnosed with relapsing-remitting multiple sclerosis about 5 years ago. She is
in clinic today for a change in her DMT (disease modifying therapy). She has heard about the drug,
teriflunomide (Aubagio) and is asking if that is an appropriate option for her. Which of the following is
correct about teriflunomide?
TB test is required prior to initiation of the drug
256
After reviewing the DMT options, a decision is made to initiate fingolimod (Gilenya). Which of the following
is correct about fingolimod?
Fingolimod is contraindicated in patients taking class III antiarrhythmic drugs
257
Her husband accompanying MJ is asking if natalizumab (Tysabri) is an option for her. Which of the
following is correct regarding natalizumab?
Natalizumab has higher efficacy compared to fingolimod in reducing annualized relapse rate
258
MJ is started on fingolimod (Gilenya) and returns to clinic 4 months later for a follow up. She states that
she ran out of medication 3 weeks ago and has not been taking it but has been feeling well and asks for
refills. Which of the following is correct?
Do not provide her with any refills and advise her that the initial monitoring procedures should be
repeated
259
Six months later, MJ is brought to emergency room with complaints of gradually worsening vision over the
past few days. She also has complaints about her mood. She is feeling very depressed. What is your
assessment of her current symptoms?
She is experiencing a relapse and should receive methylprednisolone 1000mg x 3 days
260
While in the hospital bloodwork is done and shows an elevated ALT and AST. A decision is made to
switch her therapy to a different DMT. Based on the characteristics of each DMT and the patient’s current
symptoms and results, which of the following DMTs is the most appropriate option for her?
Ocrelizumab (Ocrevus)
261
Which of the following is least likely to be a property of a new drug for MS?
Ligand at the S1P receptor type-3 (S1P3 receptor).
262
Which of the following statements about multiple sclerosis (MS) drugs is untrue?
A proven mechanism of action is required for FDA approval.
263
Which of the following drugs is considered the ‘cornerstone’ of combinatorial DMARD therapies to treat
rheumatoid diseases?
Methotrexate
264
The general strategy of all DMARD AND biologic drugs used to treat rheumatoid arthritis is to:
Block autoimmune activities by disrupting the propagation of signaling pathways and immune cell
activation that lead to inflammation.
265
The half-life of methotrexate is short in the body until:
folylpolyglutamate synthase (FPGS) generates polyglutamated MTX.
266
Which answer lists ALL the laboratory monitoring requirements for adalimumab?
CBC, LFTs, TB, Hep B
267
Which of the following statements is FALSE?
It is safe to administer live vaccines to patients while on biologics if their disease is controlled and
their CBC is within normal limits
268
When monitoring for efficacy, an increase in __________ is a sign that she is improving.
C3/C4
269
Which of the following statements is TRUE?
To minimize the possibility of infusion reactions, patients are often pre-medicated with
diphenhydramine, methylprednisolone (Solumedrol), and acetaminophen
270
What is the best treatment option for 32-month-old patient with mild plaque psoriasis on his arm?
Hydrocortisone ointment 1%
271
```
Which of the following medications used for the treatment of psoriasis requires monitoring of renal
function labs every 2 weeks for the first 12 weeks?
```
Cyclosporine
272
In adaptive immunity, what do we mean by the term humoral immunity?
Immune responses that involve antibody
273
Which term refers to generation of pus at the sites of response to bacteria with large capsules?
Pyogenic
274
Which immune system cell type is a short-lived (< 1 day) phagocyte, characterized by a
segmented lobular nucleus and cytoplasmic granules filled with degradative enzymes?
Neutrophil
275
Which is an immune system cell type that is derived from myeloid progenitor cells?
Monocyte
276
What is the role of NOD-like receptors in inducing immune responses?
To recognize cytoplasmic pathogen-associated molecular patterns and/or endogenous danger
signals
277
Which of the following is NOT a basic component of innate immunity?
B cells and T cells
278
Which cell type responds first in the acute phase of inflammation?
PMN leukocytes
279
What would be the characteristic clinical effect of a deficiency in C1-INH?
Angioedema
280
Which complement factor(s) act as a C3 convertase inhibitor?
Factor H
281
What would be the effect on complement system functioning if there was a complete lack of
CD59?
MAC would damage host cells
282
Which of the following statements regarding MHC is correct?
Each human expresses 2 HLA haplotypes that are expressed co-dominantly.
283
Which of the following is a correct feature of peptide-MHC binding:
The peptide-MHC complex is a stable interaction with a long half-life.
284
The class II pathway of antigen processing includes all of the following except:
Peptide loading onto MHC by TAP and tapasin within the endoplasmic reticulum
285
Finish the sentence correctly: Positive selection . . .
Promotes survival of self-restricted MHC molecules
286
Which of the following statements regarding the T cell receptor is incorrect?
The TCR is expressed on the T cell precursor exiting the bone marrow
287
Finish the sentence correctly: During T cell maturation, . . .
The mature single-positive T cell expresses the TCR complex with CD4 or CD8 and has a
low avidity for self-MHC
288
Which of the following is the most antigenic?
Proteins
289
Small chemical groups on antigen molecules that can interact with antibodies are called:
Epitopes
290
Which of the following statements regarding opsonization of a pathogenic bacterium by an
antibody is TRUE?
The opsonizing antibody helps to target the bacterium for phagocytosis
291
Which Ig is most abundant in serum
IgG
292
Recombination of V, D, and J segments of immunoglobulin gene segments:
Precedes class switch recombination
293
A B cell is able to make IgD and IgM using:
Alternative mRNA splicing
294
Somatic hypermutation of V genes
Can both decrease or increase antibody affinity
295
Which of the following is NOT true of antibody structure?
The light chain alone determines antigen recognition
296
Which of the following is NOT a feature of a secondary immune response to an antigen,
when compared to the first response to the same antigen?
The antibody produced will be monoclonal
297
A naive B cell has encountered a “self” antigen and will then most likely undergo which of
the following?
Apoptosis
298
Which of the following best applies to a monoclonal antibody?
Recognition of a single epitope
299
A patient was infected with a pathogen as a child, and is exposed to the same pathogen as an
adult. Which of the following cell types is most important in the adult's immune response to the
pathogen?
Memory B cell
300
Which of the following does NOT describe the relationship between a therapeutic antibody
and its biosimilar?
The approval process is identical for both antibodies
301
From the list below, select the statement that incorrectly describes CD8+ T cell activity.
CD8+ T cells recognize a combination of (Ag + MHC II) molecular complex rather than Ag
alone
302
Select the statement that best describes Th-2 cells’ activation:
Activation of Th-2 cells is restricted to MHC II proteins – that signal the presence of an
extracellular pathogen
303
Negative regulation of the T cell response occurs once:
The B7 protein on the surface of an APC binds CTLA4 on the surface of a T cell
304
Thymus-dependent B cell activation is restricted to which anatomical area?
Mucosa-associated lymphoid tissue
305
From the statements below, select the one that best describes B cell activation by a mitogen.
Second signal is provided via Toll-like receptors that induce antibody production
306
Select the correct statement associated with CD40/CD40L co-stimulation:
This promotes Th cells to secrete cytokines IL4 and IL5 that will increase B cell proliferation
and antibody production
307
You were recently hired at a pharmaceutical company and charged with developing a novel vaccine for a
newly discovered bacteria called S. flowermyces which has been demonstrated to cause pneumonia.
Which of the following includes the most optimal vaccine characteristics to provide the best
immunogenicity and allow the vaccine to be administered to the broadest patient population?
Inactivated, conjugated, includes aluminum hydroxide adjuvant, made recombinantly,
administered intramuscularly These are the optimal vaccine characteristics for bacterial
pathogens
308
Which of the following is NOT correct about the influenza vaccine?
The safest formulations of the inactivated vaccine for patients with a severe egg allergy are those
made through cell-culture based techniques This is not true as cell-culture based
formulations still contain egg protein. Recombinant vaccines made through revers
genetics in insect cell lines are the safest.
309
Which of the following is NOT an important factor determining the immunogenicity of immunization?
The number of vaccines administered simultaneously to a child Number of vaccines does not
affect immunity. Estimates say up to 10,000 vaccines could be administered at once and
have equal immune response.
310
Which of the following statements best describes the efficacy of vaccinations?
The 2018-2019 influenza vaccine is predicted to be more effective this year due to changes in the
A(H3N2)-like and B strain A strain changed from A/Hong Kong/4801/2014 to
A/Singapore/INFIMH-16-0019/2016 and B changed from B/Brisbane/60/2008 to
B/Phuket/3073/2013
311
What effect on the immunosupressant activity would be observed for tacrolimus if the 15 O-Methyl is removed?
The immunosuppressant activity of 15-O-desmethyl derivative is several orders of magnitude
lower due to lack of affinity for calcineurin
312
Azathioprine is a prodrug. The active metabolite, 6-Mercaptopurine, inhibits which pathway?
De Novo synthesis pathway of purine biosynthesis
313
Which of the following statements is TRUE regarding Everolimus?
Everolimus binds to the same cytoplasmic receptor as tacrolimus - FKBP 12 and this complex
inhibits mTOR
314
Patient is being switched from tacrolimus to cyclosporine. Which of the following effects will be seen in the
area under the curve (AUC) of mycophenolic acid?
AUC will decrease by 30-40%
315
In phase 3 trials for belatacept, patients were observed to have an increased risk of post-transplant
lymphoproliferative disorder (PTLD), predominantly involving the central nervous system. Which of the
following must be present for the patient to receive belatacept?
Epstein–Barr virus (EBV) seropositive
316
Which of the following statement(s) is correct regarding calcineurin inhibitors?
Both agents are associated with neurotoxicity and hypertension
317
Mycophenolic acid and azathioprine both inhibit the _________ but azathioprine also inhibits the _______ making
mycophenolic acid more specific than azathioprine in its mechanism of action.
De novo pathway of nucleotide synthesis; salvage pathway of nucleotide synthesis
