Type I hypersensitivity responses of the immune system are accompanied by

eosinophilia. An appropriate, useful type I response would most likely be directed

against which of the following?

A Amyloid protein

B Spirochetes

C Neoplasms

D Inhaled dusts

E Liver flukes

E) CORRECT. Parasitic infestations can be accompanied by a type I hypersensitivity reaction

- Twelve hours after going on a hike through dense foliage, a 40-year-old man notices a
slightly raised and tender irregular reddish rash on one forearm that was not covered by
clothing. This rash gradually increases in intensity for 2 days and then fades away after
two weeks. Which of the following forms of immunologic hypersensitivity is most likely
demonstrated in this patient?

A Type I hypersensitivity

B Type II hypersensitivity

C Type III hypersensitivity

D Type IV hypersensitivity

This is a contact dermatitis, typical of exposure to a plant such as poison ivy.

The second pregnancy for a 23-year-old woman appears uncomplicated until ultrasound
performed at 19 weeks shows hydrops fetalis. The fetal organ development is
consistent for 19 weeks, and no congenital anomalies are noted. Her first pregnancy
was uncomplicated and resulted in the birth of a normal girl at term. The current
pregnancy ends with birth of a baby boy at 32 weeks gestation. On examination the
baby has marked icterus. Laboratory studies show a hemoglobin of 7.5 g/dL, and
neonatal exchange transfusion is performed. Which of the following immunologic
mechanisms best explains this infant's findings?
A Anti-receptor antibody

B Loss of self tolerance

C Immune complex formation

D Delayed type hypersensitivity

E Complement mediated cell destruction

(E) CORRECT. This is immune hydrops, probably from Rh incompatibility, resulting in maternal antibody
crossing the placenta and destroying baby's RBCs through complement mediated lysis, a form of type II
hypersensitivity reaction.

-A 60-year-old woman has developed crippling arthritis over the past 20 years. On
physical examination the arthritis primarily involves her hands and feet, with marked
joint deformities characterized by ulnar deviation and swan-neck deformities of her
fingers. She has an irregular heart rate. Laboratory studies show that her rheumatoid
factor titer is markedly elevated, but her antinuclear antibody test is negative. A rectal
biopsy shows submucosal deposition of pink amorphous material that stains positively
with Congo red. Which of the following precursor proteins most likely gave rise to these
deposits?

A Serum amyloid-associated protein

B Lambda immunoglobulin light chains

C Transthyretin

D Amyloid precursor protein

E Beta-2-microglobulin

A) CORRECT. She has rheumatoid arthritis, which is a chronic inflammatory condition that can be
complicated by amyloidosis of the reactive systemic variety with SAA protein contributing to
amyloid deposition in a variety of organs.

B) A 9-year-old boy has a sore throat. A throat culture grows group A hemolytic
streptococcus. He receives antibiotic therapy. However, 17 days later he
develops dark-coloured urine. Laboratory studies show 3+ blood on urinalysis. A
renal biopsy is performed. On immunofluorescence staining the biopsy shows
granular deposition of IgG and complement around glomerular capillary loops.
 Which of the following immune hypersensitivity mechanisms is most likely
responsible for this pattern of findings?
C) A Type I
D) B Type II
E) C Type III
F) D Type IV
- (C) CORRECT. The child has a poststreptococcal glomerulonephritis typical of immune complex
deposition, a form of type III hypersensitivity

- A 27-year-old woman is given intravenous penicillin to treat infective

endocarditis. Within minutes of starting this therapy, she begins to have severe
difficulty breathing with respiratory stridor and tachypnea. She suddenly develops
an erythematous skin rash over most of her body. Her symptoms are most likely
to be produced by release of which of the following chemical mediators?
- A Interleukin 1
- B Bradykinin
- C Complement C5a
- D Histamine
- E Thromboxane
- (D) CORRECT. She is having a type 1 hypersensitivity reaction with systemic anaphylaxis, in part
mediated by histamine released from mast cells, which causes vascular permeability. About 20%
of all persons will have some reaction to penicillin or similar drugs, and a few of these will be sev

Questions in inflammation

Question 1

A 22-year-old man develops marked right lower quadrant abdominal pain over the past
day. On physical examination there is rebound tenderness on palpation over the right
lower quadrant. Laparoscopic surgery is performed, and the appendix is swollen,
erythematous, and partly covered by a yellowish exudate. It is removed, and a
microscopic section shows infiltration with numerous neutrophils. The pain experienced
by this patient is predominantly the result of the formation of which of the following two
chemical mediators?

A Complement C3b and IgG

B Interleukin-1 and tumor necrosis factor

C Histamine and serotonin

D Prostaglandin and bradykinin

E Leukotriene and HPETE

(D) CORRECT. The findings are those of acute appendicitis. The acute inflammation is marked
by neutrophil exudation. Release of a variety of chemical mediators results in the findings
associated with inflammation: calor (warmth), rubur (erythema), tumor (swelling), dolor (pain).
Aspirin, by inhibiting the cyclooxygenase pathway, can decrease prostaglandin synthesis.

- Question 5

A clinical study is performed of patients with pharyngeal infections. The most typical
clinical course averages 3 days from the time of onset until the patient sees the
physician. Most of these patients experience fever and chills. On physical examination,
the most common findings include swelling, erythema, and pharyngeal purulent
exudate. Which of the following types of inflammation did these patients most likely
have?

A Granulomatous inflammation

B Acute inflammation

C Abscess formation

D Resolution of inflammation

E Chronic inflammation

(B) CORRECT. The short course of days and the purulent exudate are typical features of acute
inflammation with a neutrophilic response

Question 8

After two weeks in the hospital following a fall in which she incurred a fracture of her left
femoral trochanter, a 76-year-old woman now has a left leg that is swollen, particularly
her lower leg below the knee. She experiences pain on movement of this leg, and there
is tenderness to palpation. Which of the following complications is most likely to occur
next after these events?

A Gangrenous necrosis of the foot

B Hematoma of the thigh

C Disseminated intravascular coagulation

D Pulmonary thromboembolism

E Soft tissue sarcoma

(D) CORRECT. She has deep and superficial venous thrombosis as a consequence of venous
stasis from immobilization following the accident. The large deep venous thrombi can embolize to
the lungs and lead to death.

Question 9

A 40-year-old woman has had a chronic cough with fever and weight loss for the past
month. A chest radiograph reveals multiple nodules from 1 to 4 cm in size, some of
which demonstrate cavitation in the upper lobes. A sputum sample reveals the presence
of acid fast bacilli. Which of the following cells is the most important in the development
her lung lesions?

A Macrophage

B Fibroblast

C Neutrophil

D Mast cell

E Platelet

(A) CORRECT. Epithelioid cells and giant cells are derived from activated macrophages. Tissue
macrophages are derived from blood monocytes. These cells are important in the
development of granulomatous inflammation.

(B) Question 13
(C) A 35-year-old woman has been taking acetylsalicylic acid (aspirin) for arthritis
for the past 4 years. Her joint pain is temporarily reduced via this therapy.
However, radiographs of her knees reveals continuing joint destruction with
loss of articular cartilage and joint space narrowing. This pain reduction is
most likely to be the result of diminishing which of the following chemical
mediators?
(D) A Leukotriene B4
(E) B Interleukin-1
(F) C Prostaglandin
 (G) D Bradykinin
(H) E Hageman factor
- (C) CORRECT. Prostaglandins are produced via the cyclooxygenase pathway of arachidonic acid
metabolism. Aspirin and non-steroidal anti-inflammatory drugs block the synthesis of
prostaglandins, which can produce pain. Acetaminophen, which does not have the effect upon
platelets that aspirin does, would be a better choice for the arthritis pain.