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 B C D E Amyloid protein Spirochetes Neoplasms Inhaled dusts 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 B C D Type I hypersensitivity Type II hypersensitivity Type III hypersensitivity 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 B C D E

Anti-receptor antibody Loss of self tolerance Immune complex formation Delayed type hypersensitivity 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 B C D E Serum amyloid-associated protein Lambda immunoglobulin light chains Transthyretin Amyloid precursor protein 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 D) B E) C F) D
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Type I Type II Type III Type IV

(C) CORRECT. The child has a poststreptococcal glomerulonephritis typical of immune complex deposition, a form of type III hypersensitivity

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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 B C D E Interleukin 1 Bradykinin Complement C5a Histamine Thromboxane

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(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 B C Complement C3b and IgG Interleukin-1 and tumor necrosis factor Histamine and serotonin

D E

Prostaglandin and bradykinin 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 B C D E Granulomatous inflammation Acute inflammation Abscess formation Resolution of inflammation 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 B Gangrenous necrosis of the foot Hematoma of the thigh

C D E

Disseminated intravascular coagulation Pulmonary thromboembolism 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 B C D E Macrophage Fibroblast Neutrophil Mast cell 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 (E) B (F) C

Leukotriene B4 Interleukin-1 Prostaglandin

(G) D (H) E -

Bradykinin 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.

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