Misc

Question 1

Which one of the following cells of the immune system is most reliant on its release of mediators into the extracellular fluid surrounding the organism in order to carry out its role in eradication of foreign organisms? 
A.	Neutrophils. 
B.	Eosinophils. 
C.	Macrophages. 
D.	Cytotoxic T lymphocytes. 
E.	Natural killer cells.

Answer 1

B

Question 2

Which of the following cytokines when secreted in an acute phase inflammatory response is most responsible for stimulating hepatocytes to synthesise acute phase proteins such as CRP?
A. IL‐6
B. IL‐12
C. IL‐17
D. Interferon gamma
E. Transforming growth factor beta

Answer 2

IL-6

Question 3

Which of the following most accurately reflects the mechanism of complement consumption induced by complement component 3 (C3) nephritic factors?
A. Activation of the classical complement pathway.
B. Stabilisation of the membrane attack complex, C5-9.
C. Amplification of C3 “tickover”.
D. Stabilisation of the C3 convertase, C3bBb.
E. Inhibition of the complement regulator, Factor I.

Answer 3

D. Stabilisation of the C3 convertase, C3bBb.

Question 4

immunodeficiency/Which of the following conditions is most likely to cause recurrent mild meningitis?
A. CD4
B. CD8
C. Neutrophil
D. Total haemolytic complement level (CH50)
E. Immunoglobulins

Answer 4

CH50

Question 5

Recurrent infections with which of the following organisms is most characteristic of a disorder of neutrophil phagocytic function (such as chronic granulomatous disease)?
A. Non-tuberculous mycobacteria
B. Pseudomonas aeruginosa
C. Nocardia species
D. Pneumocystis jiroveci (carinii)
E. Staphylococcus aureus

Answer 5

E

Question 6

A defect in elimination of which of the following is most likely to occur post-splenectomy? 
A. Polysaccharide antigens. 
B. T cell-dependent antigens. 
C. Intracellular microbes. 
D. Protein antigens. 
E. Staphylococcus aureus.

Answer 6

Polysaccharide antigens (make up capsule)

Question 7

Common variable immunodeficiency (CVID) is the most common primary immunodeficiency in adults. What best explains its pathogenesis?
A. Absence of co stimulatory signal between B and T cells (CD40/CD40L)
B. Absent neutrophil respiratory burst
C. Dysfunctional T cell signalling cascade
D. Maturation arrest during B cell development
E. Absent or reduced circulating B cells

Answer 7

Answer: D. Maturation arrest during B cell development

Common variable immunodeficiency (CVID) is a heterogeneous immune disorder characterized by recurrent sinopulmonary infections, autoimmune disorders, granulomatous disease, and an enhanced risk of malignancy. CVID is defined by the following:
• Markedly reduced serum concentrations of IgG, in combination with low levels of IgA and/or IgM
• Poor or absent antibody response to infection or immunization, or both
• An absence of any other defined immunodeficiency state

Question 8

Treatment with IVIg is of most benefit in which of the following conditions?
A. CVID – Common variable immunodeficiency
B. CIDP – Chronic inflammatory demyelination polyneuropathy.
C. Wegener’s granulomatosis
D. pemphigus vulgaris
E. IgG subclass deficiency

Answer 8

CVID

Question 9

Tumours of the immune system developing in patients with immune dysregulation due to immune deficiency (including human immunodeficiency virus (HIV) infection) and autoimmune disease are most likely to arise from which cell lineage?
A. B cell.
B. CD4 positive (CD4+) helper T cell.
C. CD8 positive (CD8+) cytotoxic T cell.
D. Monocyte.
E. Thymocyte.

Answer 9

B cell

Question 10

HAE angioedema

Answer 10

Antihistamines and corticosteroids have no role in the management of HAE related angioedema. The role of adrenaline in the treatment of HAE is not well established. Use C1 inhibitor concentrate. Otherwise FFP

Question 11

Type I HAE

Answer 11

Low C1 esterase, Low C4

Question 12

Type II HAE

Answer 12

Normal C1 esterase, but functional defect. Low C4

Question 13

Type II HAE

Answer 13

Normal C1 esterase, but functional defect. Low C4. Usually present <40

Question 14

Autoimmune or inherited defect of C4

Answer 14

Low C4, Normal C1NH and normal function

Question 15

Which of the following best describes the toxicological mechanism of recurrent acute angioedema related to the use of angiotensin converting enzyme (ACE) inhibitors?
A. IgE (immunoglobulin E) mediated hypersensitivity.
B. Delayed-type hypersensitivity.
C. Enhancement of complement activation.
D. Disruption of endothelial tight junctions.
E. Impairment of bradykinin catabolism.

Answer 15

Impairment of bradykinin catabolism

• ACE inhibitors and ARBs may also unmask deficiencies of C1-INH

Question 16

Desensitisation is most likely to be effective in individuals who have had which of the following reactions to penicillin? 
A. Haemolytic anaemia. 
B. Laryngeal oedema. 
C. Stevens-Johnson Syndrome. 
D. Toxic epidermal necrolysis. 
E. Immune complex reactions.

Answer 16

Laryngeal oedema (only IgE) mediated

Question 17

The cell population most responsible for driving the pathogenesis of sarcoidosis is:
A. macrophage.
B. fibroblast.
C. B lymphocyte.
D. type 1 helper T lymphocyte (Th1 cell).
E. type 2 helper T lymphocyte (Th2 cell).

Answer 17

Th1

Question 18

Which of the following cells is most important in the pathogenesis of vasculitis in temporal arteritis? 
A. Multinucleate giant cell. 
B. Macrophage. 
C. CD8+ T cell. 
D. CD4+ T cell. 
E. Dendritic cell.

Answer 18

CD4+ T cell

Question 19

Sjogrens - In the long-term follow-up, which of the following features is least likely to occur?
A. Glomerulonephritis
B. Raynaud’s phenomenon
C. Arthritis
D. Nephrocalcinosis
E. Lymphoma- lifetime risk of lymphoma in patients with SS is 5%

Answer 19

Glomerulonephritis

Question 20

Bullous pemphigoid

Answer 20

Autoimmune blistering skin condition sparing face and MM. Desquamative gingivitis or mucositis
Classic findings include linear IgG and/ or linear C3 staining along basement membrane zone in bullous pemphigoid.

Management
• Bullous pemphigoid- high potency topical corticosteroids as first line treatment. If topical corticosteroid therapy is not practical or feasible→ systemic glucocorticoid
• Immunosuppressive glucocorticoid-sparing agent is often used (such as mycophenolate, azathioprine or methotrexate)- if treatment needs to continue for many years
• Biological therapy may be useful for the management of patients who fail to respond to topical corticosteroids, systemic glucocorticoids and glucocorticoid-sparing agents (e.g. IVIG or rituximab)

Question 21

Cryoglobulinaemia

Answer 21

Type I - Haematological (normal complement level) e.g. Waldenstroms
Type II - HCV
Type III - autoimmune