Question 1

A 15-year-old girl says that she breaks out with hives every time she eats seafood. This is an example of:

A Type I hypersensitivity

B Cell-mediated hypersensitivity

C Release of complement C3b

D Hyperglobulinemia

E Localized immune complexes

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Question 2

A renal biopsy in a 55 year old male who has developed progressive renal failure shows extensive
glomerular and vascular deposition of pink amorphous material on H&E staining. This material
demonstrates apple-green birefringence under polarized light after Congo red staining. Which of the
following findings is most likely in this man:

A Rheumatoid arthritis

B Tuberculosis

C Systemic lupus erythematosus

D Multiple myeloma

E Alzheimer's disease

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Question 3

A 22-year-old female has myalgias, pleural effusions, pericarditis, and arthralgias without joint deformity.
A good screening test to begin the workup for her condition would be a( an):

A CD4 lymphocyte count

B Blood culture

C Antinuclear antibody test

D Sedimentation rate

E Creatine phosphokinase

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Question 4

A six-month-old male infant has been getting one bacterial pneumonia after another with both H.
influenzae and S. pneumoniae cultured from sputum. You should most strongly suspect that he has:

A DiGeorge's syndrome

B IgA deficiency

C Epstein-Barr virus (EBV) infection

D Acute leukemia

E X-linked agammaglobulinemia

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Question 5

The matching of renal allografts by HLA tissue typing for DR (Class II) antigens best helps to prevent:

A Amyloidosis

B Cell lysis by CD8 lymphocytes

C Graft versus host disease

D CD4 lymphocyte activation

E Serum sickness

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Question 6

A 25-year-old female has been feeling tired for weeks. She says she "aches all over". Physical
examination reveals only a malar rash. Laboratory findings include a serum creatinine of 3.8 mg/dl and a
positive antinuclear antibody (ANA) test with titer of 1:512. Which additional test would be most useful:

A Blood culture

B Skin biopsy

C CD4 lymphocyte count

D Sedimentation rate

E Anti-double stranded DNA

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Question 7

A muscle biopsy from a 20-year-old female with symmetrical, proximal muscle weakness shows acute
inflammation of the muscle fibers. What additional finding would be most likely in this situation:

A Heart failure

B Malabsorption

C Peripheral neuropathy

D Skin rash

E Renal failure
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Question 8

An appropriate, useful type I hypersensitivity response of the immune system, accompanied by

eosinophilia, would be directed against:
A Amyloid protein

B Spirochetes

C Neoplasms

D Inhaled dusts

E Liver flukes

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Question 9

The antinuclear antibody test is positive with a titer of 1:256 and a nucleolar pattern in a 54-year-old
female with Raynaud's phenomenon and malignant hypertension. These findings most strongly suggest
that she has:

A Discoid lupus erythematosus (DLE)

B Progressive systemic sclerosis (PSS)

C Polymyositis-dermatomyositis

D Sjogren's syndrome (SS)

E Rheumatoid arthritis (RA)

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Question 10

Several hours after going on a hike through dense foliage, a 40-year-old male notices a slightly raised and
tender irregular reddish rash on one forearm. This rash gradually increases in intensity for a couple of
days and then fades after two weeks. The rash is most indicative of:

A Type I hypersensitivity

B Type II hypersensitivity
C Type III hypersensitivity

D Type IV hypersensitivity

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Question 11

The renal biopsy from a 30-year-old female with renal failure and pleural effusions shows a granular
pattern of immunofluorescence staining with C1q. This pattern is most typically produced as a
consequence of:

A IgE coating mast cells

B Antiglomerular basement membrane antibody

C Antigen-antibody complexes

D Macrophage release of lymphokines

E Release of prostaglandins

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Question 12

Which of the following findings would be most likely to accompany a type II hypersensitivity reaction:

A Hemolysis

B Laryngeal edema

C Neutrophilic vasculitis

D Granuloma formation

E Nasal polyps
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Question 13

The best example of the mechanism for autoimmunity based upon bypass of low-zone tolerance through
cross-reactivity with an infectious agent is:
A Acute rheumatic fever

B Systemic lupus erythematosus

C Rheumatoid arthritis

D Dermatomyositis

E Diabetes mellitus

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Question 14

A 60-year-old female has anemia, vertebral bone pain, and sudden onset of renal failure. A renal biopsy
shows pink, amorphous, irregular glomerular deposits which, by immunohistochemical staining, contain
only lambda light chains. The most likely diagnosis is:

A Multiple myeloma

B Systemic lupus erythematosus

C Metastatic breast carcinoma

D Diabetes mellitus

E Chronic lymphocytic leukemia

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Question 15

A male in his mid-30's presents with malar skin rash, polyarthritis, pale conjunctivae, and sensitization to
cold. The best laboratory test to help determine his underlying disease process is:

A Skin biopsy

B Anti-double stranded DNA

C Rheumatoid factor

D Serum C1q complement level

E Renal biopsy

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Question 16

A 48 year old male has a chronic cough with fever, the chest radiograph reveals a diffuse reticulonodular
pattern, and microscopically on transbronchial biopsy there are granulomas. This is most typical for
which of the following immunologic responses:

A Type I hypersensitivity

B Type II hypersensitivity

C Graft versus host disease

D Polyclonal B-cell activation

E Type IV hypersensitivity

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Question 17

Several weeks following a streptococcal throat infection, a child is noted to have hematuria on urinalysis.
An immunofluoresence staining pattern in a renal biopsy shows granular deposition of IgG and
complement. Which of the following immune hypersensitivity mechanisms is most likely responsible for
this pattern:

A Type I

B Type II

C Type III
D Type IV

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Question 18
A 40-year-old female with sclerodactyly and difficulty swallowing has a skin biopsy that shows extensive
dermal fibrosis but no inflammatory cell infiltrates. This is most typical for:

A Mixed connective tissue disease

B Discoid lupus erythematosus

C CREST syndrome

D Dermatomyositis

E Amyloidosis

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Question 19

A 27 year old female is given intravenous penicillin to treat infective endocarditis. Within minutes of
starting this therapy, she begins to have difficulty breathing. Her symptoms are most likely to be
mediated by:

A Interleukin 1

B Bradykinin

C Complement C5a

D Histamine

E Thromboxane

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Question 20

Complement factor C3b plays a significant role in all of the following pathologic processes EXCEPT:

A Glomerulonephritis in systemic lupus erythematosus

B Autoimmune hemolytic anemia

C Phagocytosis of bacteria by neutrophils

D Anaphylaxis from penicillin allergy

E Alternate pathway of complement activation

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Question 21

A 31-year-old female with pleural and pericardial serous effusions has an anti-double stranded DNA titer
of 1:512. If she develops renal disease, it will probably be the result of:

A Atherosclerosis

B Glomerular immune deposits

C Amyloid deposition

D Vascular chronic inflammation

E Anti-glomerular basement membrane antibody

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Question 22

The appearance of a fine, scaling skin rash in a patient several weeks following allogeneic bone marrow
transplantation is most consistent with which of the following:

A Thrombocytopenia

B Apoptosis of epidermal keratinocytes

C Dry gangrene

D Contact dermatitis
E Abrasions from a fight in the ICU

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Question 23

A 22-year-old female has a prominent malar rash, but no other findings on physical examination. If her
antinuclear antibody (ANA) test is <1:20, then the most likely diagnosis is:

A Discoid lupus erythematosus

B Progressive systemic sclerosis

C Contact dermatitis

D Systemic lupus erythematosus

E Dermatomyositis

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Question 24

A granular pattern of immunofluorescence in the region of capillary loops in the glomerulus, with
antibody directed against the C1q component of complement, in a patient with acute renal failure is
most typical for:

A Goodpasture's syndrome

B Streptococcal septicemia

C Nodular glomerulosclerosis

D Amyloidosis

E Lupus nephritis

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Question 25

An 18-month-old male has had upper and lower respiratory tract infections as well as otitis media almost
continuously for 9 months. Both Hemophilus influenzae and Staphylococcus aureus have been cultured.
The most probable condition to account for these findings is:
A X-linked agammaglobulinemia

B Common variable immunodeficiency

C Severe combined immunodeficiency

D DiGeorge's syndrome

E C2 deficiency

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Question 26

The symptoms associated with hay fever in the spring with allergies to plant pollens are primarily
mediated by:

A Prostaglandin

B Histamine

C Leukotriene

D Complement C3b

E Interferon gamma

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Question 27

A 28-year-old female has an extrinsic allergic alveolitis (a type of localized immune complex disease) with
respiratory difficulty, but her symptoms improve when she is on vacation. Which of the following
histories is most likely to explain these findings:

A She raises parrots in the basement of her house.

B She is a heavy cigarette smoker.

C Her house is downwind from a lead smelter.

D She abuses crack cocaine.

E She has systemic lupus erythematosus.

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Question 28

CD4 lymphocytes are LEAST likely to play a role in:

A Delayed hypersensitivity reactions with granuloma formation

B Recognition of HLA-DR antigens in renal allograft rejection

C Initial infection by human immunodeficiency virus

D Cytotoxicity directed against cells infected with Epstein-Barr virus

E Release of interleukin to promote proliferation of more CD4 cells

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Question 29

A 62-year-old female complains of dry eyes and dry mouth for a number of years. She has
autoantibodies to the nuclear antigen SS-A. The most serious long term complication of her disease is:

A Pneumocystis carinii pneumonia

B Monoclonal B-lymphocyte proliferation

C Malabsorbtion with diarrhea

D Diffuse pulmonary interstitial fibrosis

E Glomerulonephritis
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Questions 30 and 31: Click on the checkbox first, then the lettered item:

(30) A 3-year-old boy has had numerous bacterial infections, and his serum IgG is very low.
(31) A neonate that had hypocalcemia is found to have a susceptibility to infections with fungal and viral
agents.

A Atopy, asthma, and chronic diarrhea

B Thymic hypoplasia

C Congenital HIV infection

D Chronic granulomatous disease

E Absence of plasma cells in lymph nodes

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Questions 32 and 33: Click on the checkbox first, then the lettered item:

(32) A bee sting is suffered by a 28 year old male, and his wife searches frantically for the medical kit
with the injectible epinephrine.

(33) Myasthenia gravis has been diagnosed because of progressive, increasing muscular weakness in a
45-year-old female.

A Local immune complexes

B Interleukin release from macrophages

C Type II hypersensitivity

D Systemic anaphylaxis

E Complement activation
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Questions 34 and 35: Click on the checkbox first, then the lettered item:

(34) A 25-year-old male wants a laboratory test that will help to determine his risk for ankylosing
spondylitis.
(35) A 45-year-old male has the most common primary immunodeficiency disease, but he is bothered
only by chronic diarrhea.

A HLA B27 present

B ANA positive at 1:256

C Serum IgA nearly absent

D Markedly decreased serum complement

E HLA DR3 present

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Question 36

A 45 year old male has been plagued by mild chronic diarrhea for most of his life. Following a motor
vehicle accident with multiple lacerations to the lower leg, he has a significant blood loss requiring
transfusion of blood products. During the transfusion, he is noted to have an anaphylactic transfusion
reaction. The best explanation for these findings is:

A Selective IgA deficiency

B Amyloidosis

C Systemic lupus erythematosus

D Niemann-Pick disease

E Graft versus host disease

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Question 37

A 55 year old woman has difficulty swallowing. Her blood pressure is also markedly elevated. Laboratory
testing reveals a positive ANA with a nucleolar pattern. Serum complement levels are normal. Which of
the following lesions is most likely to be seen in the kidney with renal biopsy:
A Renal cell carcinoma

B Nodular glomerulosclerosis

C Acute glomerulonephritis

D Hyperplastic arteriolosclerosis

E Polycystic change

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Question 38

A positive tuberculin skin test, which appeared 60 hours following injection of the PPD, mainly takes
place as a consequence of:

A Type I hypersensitivity

B Type II hypersensitivity

C Type III hypersensitivity

D Type IV hypersensitivity

E Complement activation

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Question 39

The immunofluorescence pattern in the skin, with antibody to IgG, which shows a band of
immunofluorescence at the dermal-epidermal junction, is most often based upon which of the following
pathologic mechanisms:

A Increased numbers of CD4 lymphocytes infiltrating the dermis

B Degranulation of mast cells

C Trapping of antigen-antibody complexes

D Macrophages are releasing cytokines

E Neutrophils are emigrating from capillaries

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Question 40

A 15 year old male underwent bone marrow transplantation, with marrow donated from a sibling, with a
5 out of 6 antigen match. He later developed a fine, scaling skin rash as well as diarrhea. The laboratory
finding most likely to accompany this microscopic appearance is:

A Hyperamylasemia

B Hyperbilirubinemia

C Hypocomplementemia

D Neutrophilia

E Elevated creatine kinase

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