1  Which of the following is a non-organ-specific (systemic) autoimmune disease:

 A  Myasthenia gravis. 
 B  Systemic lupus erythematosus (SLE). 
 C  Hashimoto's thyroiditis. 
 D  Pernicious anemia. 
 E  Insulin-dependent diabetes mellitus.

2  Which of the following antibodies are of most use for the diagnosis of pernicious anemia:
 A  Anti-parietal cell. 
 B  Anti-thyroid peroxidase. 
 C  Anti-nuclear. 
 D  Anti-IgG Fc 
 E  Anti-TSH receptor.

3  Which of the following antibodies are useful for the diagnosis of Sjögren's syndrome:
 A  Anti-cardiolipin. 
 B  Anti-neutrophil cytoplasm (ANCA). 
 C  Anti-SS-A(Ro), anti-SS-B(La). 
 D  Anti-21-hydroxylase. 
 E  Anti-glomerular basement membrane.

4  The disease most frequently seen in association with pernicious anemia is:
 A  Addison's disease of the adrenal. 
 B  Multiple sclerosis. 
 C  Autoimmune hemolytic anemia. 
 D  Rheumatoid arthritis. 
 E  Graves' disease.
5  Which of the following models is an example of a spontaneous organ-specific autoimmune
disease:
 A  (NZB × W)F1: 
 B  MRL-lpr/lpr. 
 C  Experimental autoallergic encephalomyelitis. 
 D  Thyroiditis induced by early thymectomy and irradiation. 
 E  Non-obese diabetic (NOD) mouse.

6  The high concordance rate for monozygotic vs dizygotic twins in type 1 diabetes indicates:
 A  A strong environmental element. 
 B  A strong genetic element. 
 C  A major influence of sex. 
 D  The influence of HLA. 
 E  That microbial infection cannot be involved

7  The undue tendency for closely linked genes on a chromosome to remain associated rather than
undergo genetic randomisation, is termed:
 A  Tandem duplication. 
 B  Meiotic crossover. 
 C  Relative risk. 
 D  Linkage disequilibrium. 
 E  Gene conversion.

8  HLA-DR2 is a risk factor for:

 A  Multiple sclerosis. 
 B  Insulin-dependent (type I) diabetes. 
 C  Ankylosing spondylitis. 
 D  Rheumatoid arthritis. 
 E  Myasthenia gravis.
9  Cryptic T-cell epitopes capable of triggering autoimmune disease:
 A  Dominate the normal immune response. 
 B  Negatively select T-cells. 
 C  Are unable to bind in the MHC groove. 
 D  Can be derived by antigen processing. 
 E  Are presented by MHC class I but not MHC class II molecules.

10  Which of the following is incorrect 'Natural antibodies' are often:

 A  Autoreactive. 
 B  Polyspecific. 
 C  Reactive with bacterial carbohydrates. 
 D  High affinity IgG. 
 E  Produced by CD5+ B-cells.

11  Autoantigen selection of responding B-cells is indicated by:

 A  Germ line configuration of the antibody. 
 B  High affinity antibody. 
 C  Expression of a public idiotype. 
 D  A monoclonal antibody response. 
 E  A response to many different autoantigens

12  Which of the following is incorrect: T-helpers can be bypassed by:

 A  Failure of regulatory T-cells. 
 B  Polyclonal activation of B-cells. 
 C  Idiotypic mechanisms. 
 D  Antigenic cross-reaction. 
 E  T-cell recognition of carrier complexed to autoantigen.

13  In the NZB model of autoimmune hemolytic anemia:

 A  There are no T-cell regulatory abnormalities. 
 B  Disease is unaffected by neonatal thymectomy. 
 C  The red cell autoantibodies cause disease. 
 D  CD5+ B-cells are not involved in pathogenesis. 
 E  Thyroid autoantibodies are prevalent.
14  The antiphospholipid syndrome is associated with:
 A  Infertility. 
 B  Severe anemia. 
 C  Wegener's granulomatosis. 
 D  Raised platelet levels. 
 E  Recurrent fetal loss.

15  Exophthalmos is often associated with:

 A  Hashimoto's disease. 
 B  Primary myxedema. 
 C  Graves' disease. 
 D  Idiopathic thrombocytopenic purpura. 
 E  Autoimmune hemolytic anemia.

16  Neonatal myasthenia gravis is thought to be caused by:

 A  An inherited genetic defect. 
 B  Transplacental transfer of maternal IgG against the TSH receptor. 
 C  Anti-idiotype to maternal IgG. 
 D  Transplacental transfer of maternal IgG against the acetylcholine receptor. 
 E  Maternal T-cells transferred across the placenta.

17  In celiac disease there is T-cell sensitivity to:

 A  Vitamin B12. 
 B  Gluten. 
 C  -adrenergic receptors. 
 D  Gastric H+-K+ dependent ATPase. 
 E  Myelin basic protein.

18  Glomerulonephritis associated with pulmonary hemorrhage is referred to as:

 A  Pemphigus vulgaris. 
 B  Goodpasture's syndrome. 
 C  Systemic lupus erythematosus. 
  D  Lambert–Eaton syndrome. 
 E  Wegener's granulomatosis.
19  A spontaneous model of systemic lupus erythematosus is the:
 A  Balb/c mouse. 
 B  MRL-lpr/lpr mouse. 
 C  SJL mouse. 
 D  Obese strain chicken. 
 E  SCID mouse

20  In rheumatoid arthritis the non-lymphoid synovial tissue shows aberrant expression of:
 A  Immunoglobulin genes. 
 B  T-cell receptor genes. 
 C  MHC class I. 
 D  MHC class II. 
 E  MHC class III.

21  IgG in patients with rheumatoid arthritis has abnormal:

 A  Glycosylation. 
 B  Disufide bonds. 
 C  Light chain sequence. 
 D  Hinge regions. 
 E  Valency.

22  Rheumatoid arthritis can be induced in rats by injection of:

 A  Pooled normal rat IgG. 
 B  Freund's incomplete adjuvant. 
 C  Freund's complete adjuvant. 
 D  A T-cell clone specific for thyroglobulin. 
 E   2-macroglobulin.

23  The inflammatory infiltrate in autoimmune thyroiditis comprises mostly:

 A  Phagocytic cells. 
 B  Polymorphonuclear leukocytes. 
 C  Lymphocytes. 
  D  Mast cells. 
 E  Eosinophils.

24  In type 1 diabetes (insulin-dependent diabetes mellitus), the target of the autoimmune attack is:
 A  All of the cells in the islets of Langerhans. 
 B  The -cells in the islets of Langerhans. 
 C  The somatostatin-producing cells in the islets of Langerhans. 
 D  The glucagon-producing cells in the islets of Langerhans. 
 E  Cells throughout the body which have an insulin receptor

25  An animal model for multiple sclerosis is:

 A  EAT. 
 B  EAE. 
 C  NOD mouse. 
 D  Nude mouse. 
 E  MRL-lpr/lpr mouse. 

26  Pernicious anemia can be treated with:

 A  Thyroxine. 
 B  Insulin. 
 C  Vitamin B12. 
 D  Thymectomy. 
 E  Acetylcholine esterase inhibitors

27  A therapeutic approach in rheumatoid arthritis is to:

 A  Stimulate TNF (TNF) production. 
 B  Inhibit TNF (TNF) activity. 
 C  Reduce TGF secretion. 
 D  Administer silver salts. 
 E  Use prostaglandin

28  Animals have been protected against experimental autoimmune encephalomyelitis (EAE) by

immunization with:
 A  T-cell receptor V peptide. 
 B  Pooled normal immunoglobulin. 
  C  Myelin basic protein in complete Freund's adjuvant. 
 D  T-cell receptor V peptide. 
 E  An antibody to myelin basic protein.
29  Immune defenses in the gut have evolved mechanisms which restrict the activation of:
 A  Th1 cells. 
 B  Th2 cells. 
 C  B-cells. 
 D  Cytotoxic T-lymphocytes. 
 E  Mast cells.

30  The NZBxW F1 hybrid provides an example of autoimmune disease which is:

 A  Experimentally induced systemic. 
 B  Spontaneous systemic. 
 C  Experimentally induced organ-specific. 
 D  Spontaneous organ-specific. 
 E  None of the above.

31  Which of the following factors has not been associated with the development of autoimmune
disease:
 A  Sex. 
 B  HLA. 
 C  Genetic factors other than HLA. 
 D  Infection. 
 E  SCID.

32  'Natural antibodies' in the mouse are produced by:

 A  Pre-B-cells. 
 B  B-1 cells. 
 C  CD4 cells. 
 D  CD8 cells. 
 E  NK cells.

33  Which of the following responses is incorrect. Autoimmunity can arise when:

 A  Exogenous antigens cross-react with self-antigen. 
 B  Exogenous antigens cross-react with self-idiotypes. 
  C  B-cells are stimulated with polyclonal activators. 
 D  Regulatory T-cells are stimulated. 
 E  Cytokine imbalance occurs.

34  A difference between organ-specific and nonorgan-specific autoimmune disorders is that:

 A  Only in organ-specific autoimmune disorders is there a greater incidence in women. 
 B  Associations with HLA are only seen in nonorgan-specific autoimmunity. 
 C  Circulating autoantibodies react with normal body components only in organ-specific
autoimmune disorders. 
 D  It is only in organ-specific autoimmune disorders that autoantibody tests are of diagnostic
value. 
 E  Only in nonorgan-specific autoimmune diseases are anti-nuclear antibodies a frequent
feature

35  Ankylosing spondylitis is strongly associated with HLA-:

 A  B8. 
 B  DR3. 
 C  DR4. 
 D  B27. 
 E  DR2. 

36  In rheumatoid arthritis, the outgrowth of synovial lining cells which produces erosions in the
underlying cartilage and bone is called:
 A  Opsonin. 
 B  Proteoglycan. 
 C  Pannus. 
 D  The Arthus reaction. 
 E  Frustrated phagocytosis.

37  Rheumatoid factors are:

 A  DNA:anti-DNA immune complexes. 
 B  Autoantibodies to IgM. 
 C  Autoantibodies to complement components. 
 D  Autoantibodies to IgG. 
 E  Any factor predisposing to rheumatoid arthritis
38  Thyrocytes (thyroid epithelial cells) expressing MHC class II in autoimmune thyroid disease are
direct targets for locally activated Th1 cells specific for:
 A  PMN proteinase III. 
 B  Acetylcholine receptor. 
 C  Cardiolipin/ 2-glycoprotein 1 complex. 
 D  A peroxidase enzyme. 
 E  Pre-synaptic calcium channels.

39  An animal model of type 1 diabetes (insulin-dependent diabetes mellitus) is the:

 A  Obese strain chicken. 
 B  (NZB × NZW) F1 mouse. 
 C  BXSB mouse. 
 D  Brown Norway rat. 
 E  NOD mouse.