Immunology Mcqs-4: Instructions

IMMUNOLOGY MCQs-4
Instructions:
1. Answer ALL questions.
2. Each question has only one answer, select the BEST RESPONSE for each question.
3. Time allowed: 1 hour 45 minutes.
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?
1 A. (NZB × W)F1:
B. MRL-lpr/lpr.
C. Experimental autoallergic encephalomyelitis.
Immunology | USMLE Step-1 Prep

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 randomization 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.
2 E. Produced by CD5+ B-cells.

11. Which one of the following statements about autoimmune diseases is true?
A. Affect about 1 person in every 1000.

B. Are more common in women.
C. Tend to begin in early childhood.
D. Are an inevitable consequence of autoimmune responses.
E. B and D only.
12. Which one of the following statements is true?
A. The thymus controls peripheral tolerance of T cells.

B. Self-reactive T cells are not found in healthy normal subjects.
C. Naive T cells need more than one signal in order to become activated.
D. B cell tolerance is more important than T-cell tolerance in the prevention of autoimmunity.
E. None of the above choices.
13. Which one of the following statements is FALSE? Tolerance can break down:
A. Following administration of an immunological adjuvant.

B. Following administration of IL-2 treatment.
C. By a process of molecular mimicry.
D. After surgical removal of the thymus in the first year of life in humans.
14. Which one of the following statements about autoimmune diseases is FALSE?
A. Can cluster within families.

B. Are often associated with particular HLA alleles.
C. Are usually mediated by type I hypersensitivity.
D. May occur in humans or animals with inherited defects in apoptosis.
15. Which one of these conditions is NOT associated with autoimmune diseases?
A. FAS deficiency.
B. APECED (Autoimmune Polyendocrinopathy Candidiasis Ectodermal Dysplasia Disease.
C. IPEX, (Immune dysregulation, Polyendocrinopathy, Enteropathy, X-linked).
D. C6 deficiency.
E. A and D only.
16. Which one of the following is not a well-defined autoantigen?
3 A. Mitochondrial pyruvate dehydrogenase.

B. TSH receptor.
C. Acetylcholine receptor.

D. Creatine kinase.
17. Which one of the following statements about B cell tolerance is true?
A. B-cell tolerance is more complete than T-cell tolerance.

B. Somatic hypermutation of immunoglobulin genes does not occur in mature B cells.
C. New B cells are only produced from bone marrow precursors in infancy.
D. B cells are able to undergo receptor editing in the bone marrow.
E. A, B and C only.
18. Siblings of patients with an autoimmune disease are more likely to be affected as well.
Which of the increases below reflects the true relative risk (RR) in this group of polygenic
conditions?
A. Systemic lupus erythematosus RR is x100.

B. Insulin-dependent diabetes mellitus RR is x 100.
C. Multiple sclerosis RR is x20.
D. Rheumatoid arthritis RR is x100.
E. C and D only.
19. Which one of the following autoimmune diseases involves only Type II hypersensitivity?
A. Rheumatoid arthritis.
B. Myasthenia gravis.
C. Contact dermatitis.
D. Mixed cryoglobulinaemia.
20. Which one of the following autoimmune diseases involves predominantly Type III
hypersensitivity?
A. Hashimoto' thyroiditis.
B. Idiopathic thrombocytopenic purpura.
C. Multiple sclerosis.
D. Systemic lupus erythematosus.
E. Rheumatoid arthritis.
21. An example of a known oncogenic virus is:
A. Herpes zoster.
B. HIV-2.
4 C. Epstein-Barr virus.
D. Vesicular stomatitis virus.
E. Proteus mirabilis.

22. Boon and colleagues showed that syngeneic transplantable tumors which mutate such that
they express strong transplantation antigens are rejected. They called these variants:
A. tum –
B. Xenogeneic.
C. tum +
D. MCA.
E. Non-immunogenic.
23. In pancreatic carcinoma,the ras gene:
A. Is absent.
B. Is normal but is overexpressed.
C. Has a large deletion.
D. Contains a single point mutation, always at the same position.
E. Contains a single point mutation, but not always at the same position.
24. Wheat germ agglutinin binds strongly to:
A. Surface lipoproteins on resting T-cells.

B. Surface glycoproteins on resting T-cells.
C. Surface glycoproteins on resting B-cells.
D. Surface glycoproteins on activated T- and B-cells.
E. Surface lipoproteins on activated T- and B-cells
25. Strongly immunogenic tumors appear:
A. In virtually all cancers.

B. Only in lymphoma and leukemia.
C. In immunosuppressed patients.
D. Only in experimental animals.
E. Only in elderly patients.
26. A mouse strain deficient in NK cells is the:
A. SJL.
B. Beige.
C. Nude.
D. MRL-lpr/lpr.
E. Moth-eaten viable.
27. Which of the following is most commonly seen in African children with Burkitt's lymphoma?
5
A. Absence of EBV.
B. T-cell neoplasia.
C. Deletion of the c-myc gene.

D. Chromosome 8q24 to Chromosome 14q32 translocation.
E. Chromosome 8q24 to Chromosome 2p12 translocation.
28. Pre-B acute lymphoblastic leukemia (Pre-B ALL) cells lack:
A. Expression of TdT.
B. HLA-DR.
C. Cytoplasmic µ heavy chain.
D. CD5.
E. CD10.
29. Chronic lymphocytic leukemia:
A. Usually has a very poor prognosis.

B. Has a good prognosis only in those patients with circulating monoclonal immunoglobulin.
C. Is mostly a disease of childhood.
D. Is usually found in people over 50 years of age.
E. Is a leukemia where both kappa and lambda light chains are found on the surface of the
malignant cell.
30. Non-Hodgkin lymphomas:
A. Will be positive when stained with antibodies to cytokeratin.

B. Are usually of T-cell origin but sometimes of B-cell origin.
C. Can be differentiated from carcinoma using antibodies to CD45 (leukocyte common
antigen).
D. Are reactive B-cell hyperplasias.
E. Have a good prognosis.
31. Some tumor cells characteristically re-express antigens found only early in normal
development of that cell type. One example of this is which of the following protein/tumor
pairs?
A. CD20 and B cell neoplasm.

B. Prostate-specific antigen (PSA) and prostatic adenocarcinoma.
C. E6/E7 and cervical carcinoma.
D. Alpha-fetoprotein (AFP) and hepatocellular carcinoma.
E. Human epidermal growth factor receptor (HER) and breast carcinoma.
32. Immunosuppressed patients are uniquely more susceptible to the development of tumors
caused by which of the following?
6 A. Familial genetic mutations.

B. Proto-oncogene mutation.
C. Oncogenic virus.

D. Chemical carcinogens.
E. UV radiation.
33. Patients with advanced stage chronic lymphocytic leukemia, a B-cell neoplasm, were
treated with anti-CD20 Fab fragment bound to a radioactive molecule for directed killing.
Surprisingly, use of an intact anti-CD20 molecule without attached toxin or radioactive
molecule was found to be as effective as the radioactive preparation with less toxicity on
normal cells (radioactivity killed surrounding normal hematopoietic cells in the bone marrow).
The intact immunoglobulin was needed to do which of the following?
A. Bind more effectively to the tumor cells.

B. Provide Fc biological properties (complement binding; opsonization).
C. Allow targeting by CTLs.
D. Block CTLA4 on T cells.
34. Currently, the only successful preventive antitumor vaccine is directed at which of the
following?
A. Preventing the establishment of a viral infection.

B. Increasing the antigenicity of tumor cells.
C. Blocking T cell suppression.
D. Augmenting ADCC.
E. All of the above choices.
35. An 8-year-old girl is suffering from hyper-IgM syndrome due to a mutation in AID. In
contrast to male patients with X-linked hyper-IgM syndrome, this girl is expected to have
which of the following?
A. Normal immunoglobulin responses to viral vaccines.

B. Normal numbers of IgA+ plasma cells in mucosal-associated lymphoid tissue (MALT).
C. Normal T cell proliferative responses to mitogens.
D. Normal DTH responses to commonly encountered fungal antigens such as Candida.
E. A and C only.
36. A patient with severe symptoms from rheumatoid arthritis is treated with anti-TNFα
immunotherapy. This iatrogenically imposed immunodeficiency state may lead to which of the
following?
A. Reactivation of latent tuberculosis (TB).

B. Reactivation of hepatitis C.
7 C. Reactivation of herpes zoster (shingles).
D. Reactivation of influenza.

37. In contrast to congenital immunodeficiencies based on mutations in signaling molecules,
those based on most single cytokine deficiencies are extremely rare or have never been
documented. This lack of clinical phenotype is due to which of the following?
A. Embryonic lethality.
B. Redundancy of action among most cytokines.
C. The presence of intact cytokine receptors.
D. The independence of immune responses on cytokines.
38. Boys with X-linked agammaglobulinemia have a congenital loss-of-function mutation in

Btk. An acquired gain-of-function mutation in this molecule may contribute to
A. B-cell lymphoma development.

B. T-cell immunodeficiency.
C. Tolerance to transplanted organs.
D. Hyper-IgM syndrome.
E. B and C only
39. To prevent infection following a laboratory accident of a needle prick with HIV-positive
blood, the exposed individual is immediately given three antiretroviral agents for several
weeks. This procedure has significantly reduced, but not eliminated, the rate of infection. A
clinical study is proposed to add another agent to the treatment. Which of the listed agents
might possibly work, yet have the fewest side effects?
A. Anti-CD4 antibody.
B. CCR5 antagonist.
C. Anti-IL2R antibody.
D. Anti-CD3 antibody.
E. A and D only.
40. A pharmaceutical company approaches you for advice. They have developed a new drug
that decreases bcl-2 protein synthesis and that, in combination with standard chemotherapy,
shows promising results in follicular lymphoma. They would like to use it in other
malignancies. Based on the mechanism of action of the drug and the molecular basis and
pathophysiology of the diseases, which of the following would be the next best candidate
malignancy to test to drug on?
A. Adult T-cell leukemia/lymphoma.

B. CLL/small lymphocytic lymphoma (SLL), del 13q12 subset.
C. Mantle cell lymphoma.
8 D. Pre-B acute lymphocytic leukemia (ALL).
E. Pre-T ALL.

41. A graft between members of the same species is termed an:
A. Autograft.
B. Isograft.
C. Xenograft.
D. Allograft.
42. Which one of the following statements is false? Rejection of a second (set) skin graft from
the same allogeneic donor:
A. Can be blocked by azathioprine (an antimitotic agent).

B. Proceeds at the same speed as the first graft rejection.
C. Shows specificity for the graft donor.
D. Can be transferred to a naive recipient with lymphocytes.
E. Involves recognition of MHC differences.
43. The human major histocompatibility complex:
A. Provokes the most intense allograft reactions.

B. Is termed H-2.
C. Contains only class I and class II genes.
D. Is not expressed as codominant antigens on the cell surface.
E. Encodes the human leukocyte antigens (HLA) expressed only on leukocytes.
44. Mitosis occurs when mixing lymphocytes of two individuals:
A. In presence of mitomycin C.
B. In presence of anti-CD4.
C. Who are identical twins.
D. Of differing MHC class II haplotype.
E. Of differing MHC class I, but identical MHC class II, haplotype.
45. Graft vs host disease occurs on injecting adult T-cells of strain A into:
A. F1(A × B) animals.
B. Unirradiated strain B.
C. Irradiated strain A.
D. Strain A fetuses.
E. Cultures of lymphocytes from strain B.
46. The mixed lymphocyte reaction (MLR) using homozygous stimulating cells can be used to
9 tissue type for antigens encoded by:
A. HLA-A.
B. HLA-B.

C. HLA-C.
D. HLA-D.
E. HLA-E.
47. Non-specific suppression of graft rejection can be achieved with:
A. Ricin A chain.
B. Anti-IL-5.
C. Anti-NF kappa B
D. Anti-CD34.
E. Anti-CD3.
48. The immunosuppressive drug which probably attacks DNA by alkylation and cross-linking
is:
A. Azathioprine.
B. Cyclophosphamide.
C. Cyclosporine.
D. Rapamycin.
E. Prednisone.
49. The target of the monoclonal antibody Daclizumab used to help suppress allograft rejection
is:
A. CD3.
B. CD40L.
C. LFA-1.
D. ICAM-1.
E. CD25.
50. Pigs have been proposed as a source of organs for xenotransplantation to humans
because:
A. They do not pose a risk of zoonoses.

B. Their cell surface glycoproteins bear galactose a-1,3-galactose structures.
C. They lack endogenous virus sequences.
D. Their hearts are an appropriate size and the pigs can be genetically modified to limit the
possibility of hyperacute rejection.
E. Their organs are not susceptible to hyperacute rejection because they become coated with
the natural antibodies normally present in humans.
51. In Burkitt's lymphoma, a vaccine against which of the following might prove useful:
10
A. Epstein-Barr virus.
B. Marek's disease virus.
C. Human papilloma virus.

D. HTLV-1.
E. MMTV.
52. A B-cell lymphoma will express a unique tumor antigen called:
A. p53.
B. Endosialin.
C. SM-3.
D. Idiotype.
E. Lewis Lea.
53. Bone marrow purging in myeloid leukemias can be successfully carried out using
antibodies to:
A. CD3.
B. CD33.
C. CD5.
D. CD45.
E. CD1.
54. A diagnostic marker for tumors of the colon is:
A. Alpha-fetoprotein.
B. Carcinoembryonic antigen (CEA).
C. The presence of Reed-Sternberg cells. :
D. EBV-related antigens.
E. Common acute lymphoblastic leukemia antigen (CALLA).
55. Antigens normally expressed only on embryonic cells but also sometimes found on tumors
are known as:
A. Oncofetal antigens.
B. HTLV-1.
C. Maternal.
D. Neonatal.
E. Cryptic.
56. CD44 is a molecule which may be involved in:
A. Neoplastic transformation.
B. Metastatic spread.
C. Tumor surveillance.
11 D. Antigen recognition.
E. Secretion of tumor necrosis factor.

57. The normal immunological control of tumors is referred to as:
A. Immunological tolerance.
B. Immune surveillance.
C. Type III hypersensitivity.
D. Immunological silence.
E. Superantigen recognition.
58. Malignant lymphoid cells:
A. Show maturation arrest at characteristic stages in differentiation.

B. Form a polyclonal population of cells.
C. Are non-dividing.
D. Express several different tumor-specific antigens.
E. Are always derived from various stages of the normal B-cell differentiation pathway.
59. The amyloid deposits found in 10–20% of patients with myeloma contain:
A. Immunoglobulin light chains.

B. Immunoglobulin heavy chains.
C. Amyloid A (AA) protein.
D. Isolated single molecules.
E. Congo red.
60. In Waldenström's macroglobulinemia there is secretion of:
A. Polyclonal IgG.
B. Monoclonal IgG.
C. Polyclonal IgM.
D. Monoclonal IgM.
E. Monoclonal antibody of mixed class.
61. 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.
62. Which of the following is incorrect? T-helpers can be bypassed by:
12 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.
63. 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.
64. The antiphospholipid syndrome is associated with:
A. Infertility.
B. Severe anemia.
C. Wegener's granulomatosis.
D. Raised platelet levels.
E. Recurrent fetal loss.
65. Exophthalmos is often associated with:
A. Hashimoto's disease.
B. Primary myxedema.
C. Graves' disease.
D. Idiopathic thrombocytopenic purpura.
E. Autoimmune hemolytic anemia.
66. 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.
67. In celiac disease there is T-cell sensitivity to:
A. Vitamin B12.
B. Gluten.
C. b-adrenergic receptors.
D. Gastric H+-K+ dependent ATPase.
E. Myelin basic protein.
13

68. 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.
69. 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.
70. 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
71. Which one of these statements about genetics in human disease is true?
A. If a disease has an HLA association; it must be inherited in an autosomal recessive [AR]

fashion.
B. If a disease has an HLA association, there are no other genes involved.
C. Single gene diseases in man always have a survival advantage to withstand evolutionary
pressures.
D. Single gene diseases in man must have reproductive potential to have persisted in
evolution.
E. Sickle cell disease is an example of a ‘persistent’ single gene disease, due to a survival
advantage.
72. The most frequently diagnosed form of specific primary immunodeficiency is:
A. Severe combined immunodeficiency.

B. X-linked agammaglobulinaemia.
C. Chronic granulomatous disease.
D. Selective IgA deficiency.
14
E. Di George anomaly.

73. Which one is the commonest form of Severe Combined Immune Deficiencies [SCIDs]?
A. Interleukin receptor common gamma chain deficiency.

B. IgA deficiency.
C. IRAK-4 deficiency.
D. RAG1/RAG2 deficiency.
E. Di George syndrome.
74. Given these results from a 4 year-old child, which one PID is most likely? [Normal range
for age is in brackets]
CD3 T cells 2.6 × 109/1 [1.0‐7.2 × 109/1]
CD4 T cells 1.8 × 109/1 [0.5‐5.2 × 109/1]
CD8 T cells 0.7 × 109/1 [0.4‐2.8 × 109/1]
NK cells 0.4 × 109/1 [0.13‐0.8 × 109/1]
B cells 0 × 109/1 [0.2‐2.7 × 109/1]
Total lymphocytes 3.3 × 109/1 [1.1‐5.2 × 109/1]
A. CD40 ligand deficiency.

B. Severe combined immune deficiencies.
C. Chronic granulomatous disease (CGD).
D. X-linked agammaglobulinaemia (XLA or Btk deficiency).
E. HIV.
75. Given these results from a 2-month-old infant, which PID is most likely? [Normal range for
age is in brackets]
CD3 T cells 1.4 × 109/1 22% [2.9‐9.1 × 109/1]
CD4 T cells 0.3 × 109/1 11% [1.4‐6.7 × 109/1]
CD8 T cells 0.3 × 109/1 11% [0.6‐3.3 × 109/1]
NK cells 1.2 × 109/1 44% [0.1‐1.5 × 109/1]
B cells 0.9 × 109/1 30% [0.7‐3.8 × 109/1]
Total lymphocytes 2.7 × 109/1 [4.3‐13.1 × 109/1]
15 A. Severe combined immune deficiency due to JAK3 deficiency.

B. XLA.
C. Severe combined immune deficiency due to IL-7R deficiency.

D. Severe combined immune deficiency due to ADA deficiency.
76. Which one of the following is most pertinent to healthy individuals with selective IgA
deficiency?
A. All individuals can be considered to be normal without risk of infections.

B. They are more likely to develop heart disease than those with normal IgA levels.
C. Will always have a high risk of HIV infection.
D. They have a high risk of a recurrent serious bacterial infection.
E. They have a higher risk of developing an organ specific autoimmune disease than the
general population.
77. Which of the following statements about IgA deficiency is FALSE?
A. IgA deficiency is defined as a blood level <0.07 g/l.

B. IgA deficiency is the most common of the primary immune deficiencies.
C. Most patients with IgA deficiency are healthy throughout their lives.
D. Patients with IgA deficiency may suffer from an increased prevalence of allergies.
E. There is a defined problem with the class switch mechanisms for IgG in such patients.
78. Which one of the following is most pertinent to common variable immune deficiency
disorders?
A. Patients always present before the age of 10 years.

B. Is due to a single gene defect on the X chromosome.
C. Affects 1 in 500 of the population.
D. Patients are treated by replacement immunoglobulin, intravenously or subcutaneously.
E. Most patients die from complications of malignancy.
79. Which one of the following is most pertinent to transient hypogammaglobulinaemia of

infancy:
A. Occurs at 3 months of age.

B. Is more pronounced in premature babies.
C. Is due to placental absorption of IgG.
D. Is linked with autoimmune disease in later life.
E. Involves only the IgA immunoglobulin class.
80. Which one of the following is most pertinent to replacement therapy for
hypogammaglobulinaemia:
16 A. Consists mainly of IgG.

B. Consists mainly of IgA.
C. Consists mainly of IgM.
D. IgD.

E. Ig product should be checked regularly for blood-borne viruses possibly transmitted by
immunoglobulin therapy.
81. A patient with longstanding Sjogren's syndrome calls for an appointment in addition to her
normal checkups. She complains of increased swelling on one side in spite of feeling relatively
well on her mild immunosuppressive therapy. The doctor sends her for a biopsy (small
sample) of the parotid gland, which is where the swelling is. The pathology report indicates
that it is a lymphoma. What type of lymphoma is most likely to occur in this patient?
A. Burkitt's lymphoma.
B. Diffuse large B cell lymphoma.
C. MALT lymphoma.
D. Mantle cell lymphoma.
E. All of the above choices.
82. Although mantle cell lymphoma, CLL/SLL follicular lymphoma, and marginal zone
lymphoma may all be comprised of small B cells, mantle cell lymphoma has a more
aggressive course. This clinical behavior is thought to be due to which of the following?
A. Association with chronic antigenic stimulation, which cannot be eliminated.

B. Decreased expression of CD20.
C. Lack of hypermutation in their immunoglobulin genes.
D. Overexpression of cyclin D1.
E. Translocation of c-MYC.
83. An HIV+ patient with poor compliance to medication develops a diffuse large B cell
lymphoma. Which of the following is the mechanism believed to underlie the development of
this malignancy?
A. B-cell infection by the abundant HIV now present.

B. B-cell stimulation by concurrent fungal and bacterial infections.
C. Uncontrolled expansion and transformation of Epstein–Barr virus (EBV)-infected B cells.
D. Lack of homeostatic control of B-cell numbers by T cells.
E. B and C only.
84 .The most frequent translocation partner seen in lymphoid malignancies involves which of
the following genes?
A. BCR.
B. BCL-2.
C. CCND1 (for cyclin d1).
17 D. CD19.
E. c-MYC.

85. A patient with a long history of gastric complaints and noncompliance with antibiotics for
Helicobacter presents with increased symptoms. A stomach biopsy reveals predominantly
small lymphocytes infiltrating the glandular structures. These cells are likely to do which of
the following?
A. Express BCR.
B. Express CD5.
C. Express IL-2Rα.
D. Produce IL-6.
E. Produce myelin basic protein.
86. A patient with leukocyte adhesion deficiency (LAD) type I and an abscess (infection) of the
skin would be expected to have which of the following?
A. Neutropenia.
B. A hypocellular marrow.
C. Few neutrophils in the abscess.
D. Giant granules in the neutrophils.
E. A mutation in a gene for nicotinamide adenine dinucleotide phosphate (NADPH).
87. Which one of the following is the primary defect in chronic granulomatous disease [CGD]?
A. Neutrophil production in the bone marrow.

B. Neutrophil chemotaxis.
C. Neutrophil intracellular killing of organisms.
D. Opsonization
E. Cytotoxic T-cell activity.
88. Which one of the following is commonly associated with marked secondary antibody
deficiency?
A. Mild protein-energy malnutrition.

B. Multiple myeloma.
C. Non-Hodgkin's lymphoma [NHL].
D. HIV infection.
E. Hodgkin's disease.
89. Which one of the following statements concerning XLA is CORRECT?
A. XLA presents immediately after birth.

B. It is a disease found in equal numbers of boys and girls.
C. Patients with XLA present with recurrent severe bacterial and fungal infections.
18
D. Patients usually have pan-hypogammaglobulinaemia i.e. very low serum levels of IgG, IgA
and IgM, all of which are <10% of normal for age.
E. Patients have normal numbers of plasma cells in the gut.

90. CD40 ligand deficiency is now defined as a combined T & B cell deficiency. Which of the
following statements is FALSE?
A. Boys with this condition often present with Pneumocystitis pneumonia.

B. Cryptosporidial infection is a common cause of death at any age.
C. The number of circulating T cells is reduced.
D. Serum IgM levels may be normal at presentation.
E. Human stem cell transplantation is the method of choice for therapy in a child.
91. The 1-year survival rate for cadaver kidneys grafted into individuals pretreated with blood
transfusion and with no DR mismatches is approximately:
A. > 95%.
B. 80–90%.
C. 55–65%.
D. 40–50%.
E. < 40%.
92. Graft vs host disease often accompanies transplantation of:
A. Cartilage.
B. Kidney.
C. Bone marrow.
D. Heart.
E. Pancreas.
93. HLA-G:
A. Is an MHC class II molecule.

B. Is present on extravillous cytotrophoblast.
C. Stimulates NK cell-mediated lysis.
D. Activates DAF.
E. Stimulates IL-10 synthesis.
94. The very rapid response to a second allogeneic graft is:
A. Specific for antigens of the major histocompatibility complex (MHC).

B. Dependent on minor histocompatibility antigens.
C. Transferred by macrophages to a naive recipient.
D. Transferred by platelets.
E. Transferred by IgA.
19

95. Concerning MHC class II antigen differences between 2 individuals, which of the following
is untrue:
A. They produce mixed lymphocyte reactions.

B. They stimulate formation of helpers to generate cytotoxic T-cells.
C. They cause graft vs host disease.
D. For sibling pairs, they will only exist on average in 1:4 cases.
96. Hyperacute graft rejection is caused by:
A. Preformed antibody.
B. CD4 lymphocytes.
C. CD8 lymphocytes.
D. Platelets.
E. Circulating immune complexes.
97. Which of the following does not minimize allogeneic graft rejection?
A. Cyclosporine.
B. Disodium cromoglycate.
C. Azathioprine.
D. Cross-matching for ABO and MHC.
E. Anti-CD4.
98. Which of the following allogeneic grafts does not require immunosuppression?
A. Kidney.
B. Heart.
C. Liver.
D. Bone marrow.
E. Cartilage.
99. The fetus may be protected from maternal transplantation attack by:
A. Luteinizing hormone.
B. Presence of HLA class I on the fetus:
C. HLA-G on the extravillous cytotrophoblast.
D. C3 convertase on the syncitiotrophoblast.
E. Local production of IL-2.
100. Which one of the following statements about Wiskott-Aldrich syndrome is TRUE?
20
A. Platelet size is large.
B. It is a combined primary immune deficiency due to abnormal cell motility.
C. It is always a severe disease.

D. It is common in girls.
E. It is due to a mutation in the WASP gene on chromosome 6.
*****END*****
21

ANSWERS:
1. B 26. B 51. A 76. E

2. A 27. D 52. D 77. E
3. C 28. D 53. B 78. D
4. E 29. D 54. B 79. B
5. E 30. C 55. A 80. A
6. B 31. D 56. B 81. C
7. D 32. C 57. B 82. D
8. A 33. B 58. A 83. C
9. D 34. A 59. A 84. A
10. D 35. D 60. D 85. A
11. B 36. A 61. B 86. C
12. C 37. B 62. A 87. C
13. D 38. A 63. C 88. B
14. C 39. B 64. E 89. D
15. D 40. B 65. C 90. C
16. D 41. D 66. D 91. B
17. D 42. B 67. B 92. C
18. C 43. A 68. B 93. B
19. B 44. D 69. B 94. A
20. D 45. A 70. D 95. S
21. C 46. D 71. E 96. A
22. A 47. E 72. D 97. B
23. E 48. B 73. A 98. E
24. D 49. E 74. D 99. C
25. C 50. D 75. C 100. B
22

Immunology Mcqs-4: Instructions

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IMMUNOLOGY MCQs-4

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

A. Addison's disease of the adrenal.

5. Which of the following models is an example of a spontaneous organ-specific autoimmune

Immunology | USMLE Step-1 Prep

A. A strong environmental element.

8. HLA-DR2 is a risk factor for:

9. Cryptic T-cell epitopes capable of triggering autoimmune disease:

A. Dominate the normal immune response.

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

Immunology | USMLE Step-1 Prep

A. Affect about 1 person in every 1000.

12. Which one of the following statements is true?

A. The thymus controls peripheral tolerance of T cells.

A. Following administration of an immunological adjuvant.

A. Can cluster within families.

16. Which one of the following is not a well-defined autoantigen?

3 A. Mitochondrial pyruvate dehydrogenase.

Immunology | USMLE Step-1 Prep

A. B-cell tolerance is more complete than T-cell tolerance.

A. Systemic lupus erythematosus RR is x100.

21. An example of a known oncogenic virus is:

Immunology | USMLE Step-1 Prep

23. In pancreatic carcinoma,the ras gene:

24. Wheat germ agglutinin binds strongly to:

A. Surface lipoproteins on resting T-cells.

25. Strongly immunogenic tumors appear:

A. In virtually all cancers.

26. A mouse strain deficient in NK cells is the:

Immunology | USMLE Step-1 Prep

28. Pre-B acute lymphoblastic leukemia (Pre-B ALL) cells lack:

29. Chronic lymphocytic leukemia:

A. Usually has a very poor prognosis.

30. Non-Hodgkin lymphomas:

A. Will be positive when stained with antibodies to cytokeratin.

A. CD20 and B cell neoplasm.

6 A. Familial genetic mutations.

Immunology | USMLE Step-1 Prep

A. Bind more effectively to the tumor cells.

A. Preventing the establishment of a viral infection.

A. Normal immunoglobulin responses to viral vaccines.

A. Reactivation of latent tuberculosis (TB).

Immunology | USMLE Step-1 Prep

38. Boys with X-linked agammaglobulinemia have a congenital loss-of-function mutation in

A. B-cell lymphoma development.

A. Adult T-cell leukemia/lymphoma.

Immunology | USMLE Step-1 Prep

A. Can be blocked by azathioprine (an antimitotic agent).

43. The human major histocompatibility complex:

A. Provokes the most intense allograft reactions.

44. Mitosis occurs when mixing lymphocytes of two individuals:

Immunology | USMLE Step-1 Prep

47. Non-specific suppression of graft rejection can be achieved with:

A. They do not pose a risk of zoonoses.

Immunology | USMLE Step-1 Prep

52. A B-cell lymphoma will express a unique tumor antigen called:

54. A diagnostic marker for tumors of the colon is:

56. CD44 is a molecule which may be involved in:

Immunology | USMLE Step-1 Prep

58. Malignant lymphoid cells:

A. Show maturation arrest at characteristic stages in differentiation.

A. Immunoglobulin light chains.

60. In Waldenström's macroglobulinemia there is secretion of: