WS SbebeeeuuNaaveeesercnar ‘A tycar.ldpalesookang boy protons wth high grado fvor and acchymesi, which ho as been experiencing forthe past 2 weoks, The boy has atioved all ‘evelopmenta milerones one andhas no story ot mecca nse inthe past ab investigations reves! flowin: Hemoglobin 55 gid wac 12000! Pateets —15000!rm" ex ‘orethow ‘ho boys teterod wo ahematlogs, wn suspects athe maybe suing rom the neoplase poferatin of mature 8 cells. The physkan decides todo flow ‘jtomety sna steeon of ahich othe flleying markers wold he conten ‘mo suspecea dhagnests? > AMC! > 8.c03,TcR © CoN terminal deosynucteotay! anserase (a) ECDI.MHCHWS SbebeeeuuNaaveeesercnar ‘A tycarl, pale tookag boy presents wth high grado fever and ecchymesis, hich he as boon experiencing forthe past 2 wooks, The boy hs achieved all ‘evelopmeta milertenes on time anes no history of medical ines nthe past ab investigations reves! flowin: Hemoglobin 55 gf wac’ 1220000? Pintelets —15000imm et tosrethow ‘ho boys teterod wo ahematlogs, wn suspects athe maybe sung rom the neoplase poferatin of mature 8 cells. The physkan decides todo flow ‘jtomety sna steeon of ahich othe flleying markers wold he conten ‘mo suspecea dhagnests? Awnci aco. Ter 4 €.cot terminal deoeyouteotay wansterase (et) Salas ECDI.MHCH IExplanation: ‘Comet answer C: This psn surterng tom acute phobias oukomia oused by immature pre-B cells CD'8s the marker for 8 hmohoctes. The brerence of lt mcests tat the cl are immature imphocyts. ok ean ‘rzyme ht pays an paint oe in tho fematlon of ansgon cry ot lmmunoglobuns and Tellrocoptersby randomly orig VD. and J agmantsofDRA en onintne eure otlymphosne developmen tosontin ho mature phocytes, om pro and cots. ‘Option A: CD19 and MHC I ae present in al 8 cls, fom inmate to mate “Throor, he presence of CD er MHC Mould cate thal te col bang tothe B col fay, but wuld not ndcate whether the cls are mature oF rare pre ces, ‘Option B:CD3 and TCR ae present on cas. CO3 functions inthe signal ‘vansducton comply of T call TERIE aT ellocoptr. ‘Option D:c036's present on natal ler col. ‘Option E: COIs and MHC Hae poser inal cas, rom mature 19 mate “Threor, the presence of CD er MHC would cat thal he col bang tothe 8 colar, bt woud not reat whether the col are mate ot rmaure pre ces, WS See BeeeUuNaaveseserssarecarevsaasus| Related Videos: © lato eee ot cat Psy Leer ews ipa Letoma A) — We Boca Cot © fevccr First Aid References: Fst Ad forthe USMLE Step 1 2019, 29th e424 Fst Ad forthe USMLE Sep 12018, 28: 420 Fst Ad forthe USMLE Step 1 201727 4 410WS See BeeeUuNaaveseserssarecarevsaasus| Explanation: ‘Comect answer C: Tis patent sure tom acute phobias leukemia ‘caused by immature pro. calle CDI9.= th marker for Bhmphocyce. The resence of et nceatos that he cls are mmatineIymphocts. Tat ian ‘rzyme thet plays an impart ole inthe fematon of antigenic cvs of rmunestobuis and Teallrocoptars by randomly arin VD, ana J segments of DNA ey on inthe course of hmmphoce development ts resent nthe immature phocytes both pre Band-T eas. ‘Option A: CDI and MHC I are presentin ll cele, fom inmatue to mature. “Teroor, he presnce of CDS or MHC Mould cat ha fo col bang tothe B col fal, but would not ndcate whether th ols are mature or Immature pre coe, ‘Option B:CD3 ax TCR ae precant cn cals. CDRs ithe sg ‘onsducton complex of T call TERIsa Teall eceptt Option D: C056 present on natura ler cells ‘Option: CD19 and MHC ar present inal cals, fom inmate to mate, “Theroor, the presence of CO er MHC woul cat that fe col bang tothe B calf, but would not reat whether the cel are mats ot Immature pres coe, ‘Leaming objective: Tet presotin immature phocytes (pre and Tea), ung ter development. Related Videos: © Leukemia: cute Levi - White Sod Cel Patclogy Loum cut Lymphocyte Loukomia ALL — Yo loca Cat © Pear First Aid References: Fst Ad forthe USMLE Step 1 2019, 20h: 424 Fst Afr the USMLE Step 1 2018, 2th: 420 Feat Ad forthe UEMLE Sep 2047 27 0WS SbebeeeuuNaaveeesercnar Fuotesain an artical dak range colored organic molecu usa in tho {agnosis of cores! ulcrs aed herpetic coma infections tk ebserved ata ‘epsrmenta animal, the horecen binds fo receptors oncom cl, butt does not sunutate thom to produce MurescinSpoaeantbodos unless fst attoched to a ager molecule such as albumin, Which ofthe folowing tems beet ‘eecribes torercon?WS SbebeeeuuNaaveeesercnar © A canier Hopton Tolerogen D.Aajvent immungen ces and herpetic comeal fects, Mis observed hath rm, the horessen binds Yo receptors on cash cle, butt does not sunutate thom to produce MurescinSpoaeantbodos unless fst attoched to a ager molecule such as albumin, Which ofthe folowing tems beet ‘eecribes torercon? Result: Explanation: First Aid References: sto ttsGrecgcvsayrgcacwessacacasessoe afl Result: © tnconect Explanation: Const anawer & Fuorescanis shale acai meets Wo re {ios et eh an ene reper el 2 When coupled oan tmunogent ee an mune espa s bapa rsa wen fron bods) ac can indo mune cepa, tna er cone pre sr tere rsponen by trots re ‘otlnmurogenic However where hapten chia bound oon trogen (uo cated carer an une rspenee Ea be roeed {Sxinltn haptrserie conoetn ene belo First Aid References: Frat Ad forthe USMLE Stp 1 (2019, 20h od 12,19 Fst Ad forthe USMLE Stop 12018, 280 315, Fst Ad forthe USMLE Stop 12017, 270 309=o 3 2 £ Complete antigen (Option A: cane melee ao an immune. Option: A tolrogen sa substance that produces immunoogie trance (12, our immune stom doos not mount a response ints prseace) #@8 Bees UREA EN ee eegsarecasenveeeu= = a Compete antigen ‘Option A camer melee 0 an meg. #@8 Bees UREA EN ee eegsarecasenveeeu Option: A tokrogen ira estas that produces immunaogitlrancs| (Ge, our immune system doesnot mount response nts presence) ‘Option D: An ackvort sa substance that teases the bodys ne ‘Option E: An munagon 2 substance tat produces n mune respon ‘an nhumocl anor alumedite mune response Looming objective: A hapten sa non immunogen molec that can bin to Immune cos cts However when combsned wih cari becomes rmunogenc. and antbodies ae produced apansti‘8 Zyearold Boy presents wth multiple shin ebscessos caused by Staphylococcus ures, Post meal istry lnficant for recut infections bythe sme frganiem The nobles ergo NET test ements nity tl rmerobes. Which oho folowing detects mest hat response fo the tangs a this patent? #@e Bees BREEN esenssaracacenwoes 1 Dairy of CDAOL. on acne als Tyrosine kinase deictncy Hocking B cellmatuation nati ta genorte to mires opie ust Inti to ize ysosomes wh phagosomes MME coe tonysO ree gcuusuyrgcacwessacacasessou Bh. ‘8 Zyearold Boy presents wth multiple shin ebscessos caused by Staphylococcus ures, Post meal istry lnficant for recut infections bythe sme frganiem The nobles ergo NET test ements nity tl rmerobes. Which oho folowing detects mest hat response fo the tangs a this patent? A Defcon of CD40 on acted Teale 2. Tsne nae detcecy ecg cl mstuson % tiny genre th lock espa bust os © Init oe heowanes wih shagoones MHC ces eeny ox L =| Result Explanation: comet newer C1 Related Videos:sO ree gcuusuyrgcacwessacacasessou Bh. Explanation: Ccomact newer : Tho pitontmest ely hs cone granulomatous dase (CGO) ke aninenodeticioney cierer mune ty the deeancyf the NADPH ondaso enzyme compl which nowmaly produces ecto Teall Type. mediates by ge antboaes Type, modated by bG ambos Type V, mete by 9G and gM anodessOrecgcusayrgcacwessacecas Bh oese.- ‘A 3 yoa-ld woman prsonts oho primary cate provider oases ho ost froma previous urine anata Sho hs no ew compli nc foes wel Past adie hit ignineat or eyeem pus erythematorie. She wns agnore 'yoass ag an takosnyaroxyeovoqune every ay and peansone when her ‘ond res, Her previous urine anoles shows oleate potin evel (4) and biood (The une sediment contained ed bood clef RECsMgh poe el), ‘he weatng physian would the operon areal biopsy ore out pS nophite. Wht typeof hypetconctivtyi sugoeative of aps nels? © A Type Mediated by CD4* T cts 8.Typel, mediated by CO4> Teall Type. mediates by ge antboaes 1. Type, odie byl antbodios ge aa8 Type lV, mete by 9G and gh antoodies Result: © trcoect a#@¥ Bees Be eRe rev esenssarecas . Incomect Explanation: ‘Comect answer D: This patient wih aknown sty of systemilupus ccytiemoais (SLE = ely alfering rom ips nephi Immne ‘omplows form inthe blood and depost nthe glomensor bacement ‘membrane, smelting an immune fesponse. Ths smost consent wah a ‘ype Wt yparsenstvy reaction, ‘pe rypersonstvty eactons occur whon antbetos tnd anigens an ‘oemsalibe antger-anibody compeves preci ot ofthe ood and ae ‘8S mon. presets wa ocuring hin intoctons. ast mecca istry i sloniicant fr 3 eplsodce of cite ots medi since bith Tho patent vs born at 30 weeks wa an uncomplested,sporancous raneeqial deWery, bt here was ‘layed umbilal ord separation she has met all developmental mostones. On Byscl examination he skin around her mouth iamed adred Which of he folowing mont kel respon or hs clas cna presentation? [A Defectintyosine kinase * 8. A meroutudo astuncion ™ CLA receptor etieney x 0. Absence of CIB molecule onthe srtace of ekoeytse sox E Doticioncy mNADPH axtaso es Explanation: Related Videos:sGreegevsayrgcuswessBcacaseseesee> O concer Explanation: Related Videos: ‘cco conn cated ico eosin axceny, tthconmonty om sone a present ninfoncy wih reat skink¥ecter dis o Stpyococcs Pp ‘ror gram-aegnve bate an fing One othe haar fs ‘eae Inarmeton athlogy is delayed umbica cota separation end absence of pus tation ° tbe to alock of CDI on leukocytes CIE, ao known as ntogrn bet? ora factatesinegin-necsted cel adhesion OUR. Heres no ‘acres dependent migration cut ofthe vasculature and othe ste of aye dross Ps canton to ue How omc to delet We presen ‘or ebsence of he Cus marker onthe euoeytes Pallets ae usualy First Aid References: ‘emtonsit wostes wih arate andre cig ra Nematopoate tom Fst Ad forthe USMLE Stop 12019, 29h of 213 cel orton witha hgh success ate, Those wi a sever presenta ° complete ack of CO) ate mere kay to succumb te Medhvestening Infocons.Toso wih mir conos Holy to rocove and gon to Fut id for the UBLE Step 1207 270 ei: 207 cuthoos with proper teatert. Fst Afr the USMLE Stop 1 (2018, 28 od 212 ‘The soquonta stops of neuropil recrutmentin the acute flammatory responte ae leed mt tle Plow5 a ‘Stage Beton Important Meco Margination Vesa! dation around the aoa ot NO argon infirm ide) subetancos eting ——_LNawtoprsooseyatach to thevessat Pana E was telecine erdthnl els in are of damage ‘Adnesion Tight atachment ofnoutephistotho | LFAImogins sndthoiom | can (com ‘Exwavasation 1 Dipedsis of neuvophis acossine —_itegnns see Pseudopoaia ‘mote noubopis to miata tothe sites of sGreegevsayrgcuswessBcacaseseesee>‘ChomotansExravascl chemical aractantscnizo 8 more neuropis to migrseto the ster of og, highest pation concentation ee — mation pepses ‘Optom A: Tyrosine kinase cefets an Kink rcossve svar seen ‘primoty male chen Ths condon cauics defective matration of {ols and decreseedprositon nal eres of mmunoglbulns presente #@e Beas eweRd EL eseess| ‘Option B: Microxtaseaystunction presets in patents wth Chedak igasht ‘of phagcysosomes. The patents present wth recent pyogent: fection, atl ris, pancytopenia, and oer neurologic symptoms. The patient in ‘Option C:1L-72 promotes cellmectatd nme, aes matraton of eas Into the Th subtype, stmulstes macrophages to secrete IFN ane actvtee [NK cls Absence of L12 leds to dssominatod efectos, parca neo-T3 ‘mycobectera, Samone, and cantons to sop. Tho pation aueston hasnt had any syst nections ‘Opton EA decency NADPH oxide anXnked recess condonomen 10 < 1. = a ‘Option B: Mirobuedystunction resets in patons with Chediak Higashi ‘synrome, sung in prblans win phagocytst: duo totale of frmation ‘of phagcysesomes. The patents present wth recent pyogent: fection, etal aris panctopria and oer neurologic symptoms. The pallet in ‘ueation lacks any pad does na exon otor symptoms of Chadak- High ‘Option C12 promotes cllmekatd Inman, cause maturation of Tas Into he Tn subtype, etmulstesmarophages fo secrete IFN, ana nese [NK cls Absence of L12 lads to dssominatd efectos, parla non-T ‘mycobectera, Salmone, and cantons to sepsis. The pation in aueston ‘oerthad any yom infections. ‘Option EA dafclency I NADPH one anXnked recessive conton that mace cormon nals. Pants wth this condton aren ele to combat inectensduoto ctalaso-posne bacteraSuch a8 Saurus, ca ‘sper, and Cando, cna he neurons ick the byt under ‘the exdatve burs which normaly resutsin api lease of reactive oxygen spodes hat ats nase ypes ot bate, #@e Beas eweRd EL eseess| Leeming objective: The scien esponse tthe tat stp of he Immune response ag ctrl focton Nowtophis ao th st cals fo Sve ing CO's kngan ae ntagn Beta2, che an achenon ‘molecule ital toe abit of nop o axvavasato rom to vasclatee nd enter the ote of fection Pats ith an absence orkid neon of {CDIB have leukocyte adasion defen, a conden characterized by recuring bacteria tector,‘A sclntst'ssutying the dovlopment of CD81 cls nis oxpovnans, he wos 2 radioactive de te mark population of cals. Ones ete nto the hes these ‘nis nd tot t9 MHC stramignn comple Latrin tne experiment the Scent cant any marke cts ithe perpheral bleed Which of he fatlowing Processes respons forthe lors of CDS" cals? | Poste selecton 8 Negative selection 1. APC antgon presentation ScueeeuuNaaruvesens © 2 seutnton|sGrecgcuvsayrgcucweaHlacecasesseesee- ‘A sclrtst's studying the development of CD81 cls nis oxpevinans, he wes ‘radoactive dye tomatk population of cols, Once ected to the hyn, ‘there cals bind gy o AMC | setanigan coments Latarin the experiment he Scent cant ny marked cls inthe pert blcoa Wii oho folowing processes responsible fr tho loss of COS" cls? | Poste selecton 18 1B. Negatve selection 8 © D.APC antigen presentation Ey © 2 seutnton * Result: Explanation: Comat newer Bs Homatopoiti tr call onsite inthe bone mio She Related Videos:Explanation: and scroring. be" recent selection (22 moge blow, a ™y @-«-6€ sGrecgcuvsayrgcucweaHlacecasesseesee- CCorec newer: Hematopoiti stm calls oie inthe bone moron and gre tothe thy are hey ansege Teal rector TCR matraon os wih uncon TCR nay express both CDA" and 1 this or ale "dobe posts Tells. These call are then expored toa wile varity of eaF angen nt tym and undergo Related Videos: otic Cat Macrophages and mae First Aid References: Fst Afr the USMLE Step 12018, 29th 101,102 Fst Ad forthe USMLE Step 12018, 20 e101 Fst Afr the USMLE Step 1 201727 od: 97~ @-. First Aid References: ened i Fre A forthe USMLE Sep 2019, 298 0.102 ‘ a Fret Ato USL Sop 1208, 2 11 ™ : = ‘First Aid for the USMLE Step 1 (2017, 27th ed) 97 ' =y @®-«-6€ ——/ e y= ‘The rt sep Flecon& postive selection, whch dove postive T cole ‘bind foreign asgens inte presence of se MHC. Here hey derentoe sGrecgcuvsayrgcucweaHlacecasesseesee-‘bind foreign arsigens nthe presonce of of MC Here they diferente Into ether CD4” or CD8'T ete depending onthe MHC aeeaited wth n= ‘antigen MHC Her COB” and MHC ter CDA’ Fo aero cat fom, ho ‘olv doute postive col mast be exposed othe MHC Lantgen compen Te stcend stp ia noglivesleton, in wtich T cats erdenge apopesa thoy bind too tty MHC presented self-amiges. hs step missed, autoimmune disease may develop. Hence, cry T cell that bina weak to MC settamigon complos Survive. Tho fomainng COB T eats wil ature and be released it he organism ‘Option: A nucleated cells inthe body contain MHC | on tel surace When ‘tase call become inecieg wit an vacluar pathogen the cll degrades ‘ho fool proton Te antigens then presored on be MH cass 10 he {608+ col nd a second igo! C028" ane B7 interact) s needed to complete the actin proces. Activation snetinveved in CDS ScueeeuuNaaruvesers (Option 0: APCs are nvoledin the peocess faction decerbed aove Option: Aer cctoxic cel acted can undetg9 clonal expansion Ma tintin of 2. which ats aga grow factr for T el Ts process Incoss05 the numberof ols a aspect aragan rvacng he macro conan, Learing objective: The development footie Tells boginsin the marion, Umsre nematpoiet cells crignate, Prom nec, thoy migrate to he tym,smtsreen dames ry ern Hayy Fei al nd ey MAC se-anigen complevos rave Theremaineg COB" T cats wl tire and be released it the organi. ‘Option: At nucleated calls inthe body contain MHC on thei surface When tase coll bocoma inoced wit an traces patwogon the cll degrades the foreign prot. The antigen sthenpresered one MHC cass tothe {CD8+ call and a second signal C028" and 87 irteracen)s needed to complete ho actvatin process. Activations nt involved in CDS development. Option: APCS are involedin the proces of activation desrbod above. They ar esponste for presenting the degraded inaceligar antigen othe T ScueeeuuNaaruvesers Options: Aer a cyctxc cli cated can undergo clonal expansion va stimuton of 2, wh act 8a grow air fo cal. Ts process Increases the number of cl for aspect antigen vag the macro corgeiem, Leaming objective: The development ejotoe Teall beginsin the mao, ‘ere each ell has both CDS" and COA receptors on ts soca the ‘thymus, these unaerated calle underge postive elocton, wre they ‘indo olga argon fnta oF exvecollen and afrentat rx ator {cD8" or 4 respectively. The not stp is eld negate selection which ‘olethat bind st-amigen too Shy underge apoposieprir to bang ‘release the gan, to prevent autereacvyarr a ‘8 853yoa-od malo wah a istry of COPD presents tthe emergancy doparment vith dyepnon, productive cough, nt fever of $00% (108 forthe past 2 de. ‘On physical examinaton ris espiatoryrtee20/in bod pressure 2585 mm He, aranoar at 95m, A chost ay tained ana stows aight ower obo infra. Sputan stares ate ponding and ho ttc avo, The paint hae not ecaved any vaccratons mth ast 20 years The phyican decrees wth him he mperance of geting a vaccine that cn produce mnunty a wien ofthe 1 TeatindependentB cet response 8 Tlkdependont 8 cal esponse ScueeeuuNaaruyes ee Natural lr cet ospengo Mest oll egtenulaton response No need to vache, ag the pabent has asa hac a preumonia‘8 853yoa-od malo wah a istry of COPD presents tthe emergancy doparment vith dyepnon, productive cough, nt fever of $00% (108 forthe past 2 de. ‘On physical examinaton ris espiatoryrtee20/in bod pressure 2585 mm He, aranoar at 95m, A chost ay tained ana stows aight ower obo infra. Sputan stares ate ponding and ho ttc avo, The paint hae not ecaved any vaccratons mth ast 20 years The phyican decrees wth him he mperance of geting a vaccine that cn produce mnunty a wien ofthe 1 TeatindependentB cet response 2% 1. Teal dependent cal response ex ScueeeuuNaaruyes ee Natural lr cet ospenso * Mest oll egtenulaton response Ey © ENoneedto vacate, a the patent has arady hada preumonia 2%Result: = Explanation: ‘Comect answer B: To ferent preumona vaccines protect against various stains of Svoptococcus proumenae:Prowar 1,3 alent eorugate ‘ocone, and Pneumowsx23[PPSV23} a unconiugaed pobalet ‘neunococcl vaccine, Both vaccine ee recommended for patents 6 yeas ‘of age old: Nowe fo smear who nas not ad ther vacin, fs recommended that Prev 1 be given frst. followed by asngle dose of PSV23 yea ltr ‘Thus fort acne patient, the pylon willy recommend the Promar 13 conugstod vaccine, hie eet aT cotldepenont 8 call respon, sted of PPSV22, wich a non-convanted apse ‘The abe below compares the 2 afeentnerne mechaniens Trymuedepencent Trymesencepencent Function Peptide detection Detection of nen peptide Interacts wth Teo ear 2895 panegons lar patnogers a are sGreegcuisayrgcaceslsacacasecseesees Related Videos: © Beste phere Aen ‘Meyaton and Mauraton ef crigtaung Dende Ces an Cal Dierontaten - Lymphocyte Actuation First Aid References: Frat Ad forthe USMLE Stop 12018, 2h od 10,105 601 Fst A forthe USMLE Step 12018, 28h ed 100,398, Fst Ad forthe USMLE Step 12017 27th dh 97.388.sGreegcuisayrgcaceslsacacasecseesees ‘The abl etow compares the 2 eran ere mechoniens stops ection ‘Trymus dopencont ‘Tymusincependeet Poptie detection Detection of nonpaptide antigens Intact wth Tcl to lar pathogens (ler patnogens tat ore missed by Teas ‘.prtoin antgons re 1. Beallraceptrs rostnk by ‘endocytosed onddetected__pymeri antigens ctl by Bcallecestr cotwal or 175, 2.Endosomsl processing ot 2 Mogens promote actunton ‘zigensandpresentaton of Beals voNHCI {esigen compen by ‘atte Ty cals ‘teraction of CD40 on B ‘cole wth CD40 ligand 5. Cytokine stmaatod “ferentiation Fst Ad forthe USMLE Step 1 (2019, 29h of: 10,105, 01 Fst Ad forthe USMLE Step 12018, 28 100,398 Fst Ad forthe USMLE Stop 1 (2017, 270 dh 97,388, a5. Cytokine stmuatod Imporard! Musthave pepieartigen No ass sitching or afingy Musthave factional hafper martin Teste Ne immuncogic mamony roqutesrevaccnaton 8 tympnocyts awa by he yrs dopondont patrway ae yay releocedin2 waves: primary wove, which manly aMsecroing plasma ‘cal and 2 secondary wave whichis aetvate Blymphocyes that underg> ‘onal expansion nthe geminal centers of hha tse ing which the Clones undengo afta mation eed ache aching Le pede thet tasss of ernunoglbuls. Te tyes dependent pathway i beter at producing iastnginmunty agans patnogens because of aay maturation ScueeeuuNaaruyes ee ‘Option A: AT clLndependent cet tesponce ota by nan poptigo| antigens sch as batt celal components. The PPSVZ3 vctne made {p of bactorial coll wall components Tis vaccine is lento people ver te ge of ory ar Promar 1 gvon end does no produce anit ‘motiraton or lon fr class sutehng pon: Natural io oe ae nat mune stom cel vaved in ‘eating vrata call ‘Option D: Mast els mediate he allergic respons but not the humeral ‘Option E: Preumenis vaccines have been shownto be effective in preventingSern a 1. = a ‘3h the production of mmunologe memery ‘Option A: &Teltindependent cel responce kite by non peptide antigens such as batt ellwall components. The PPSV23 vaccine S made {por bacon col wall conpanorts. THs vaccin siento people oe ne 08 0 5 cry ater Prev 1 glen an! does no oroduce any ‘maturation orl fr class etching, ‘Option C: Nature ale ae nate immune system cel nveved in cloaing weaLetectoa cas ‘Option D: Mast cots modato he aller response bu net the humeral (OpionE:Precmnia vecines have bee shown tbe fictive in proving ‘lseaee porully people whe sor om pumonary condone sues ae coo ScueeeuuNaaruyes ee Leaming objective: Humotlimmunty canbe actated by wo dasces of antigens: thymus independent antigens suchas paysacchasdes, ta do ot ‘ecu cel imelvement and thymus dependet antigens, such peptides ‘hat requie allel. nthe thymus dependent pathway. the andgen must then recognized by acted helper T cel and subsequent nrc | {CDsDen Beats wen the CDAD gana. Th hymue-ncepancer pathy ‘actuated by to wossnking of col recep by patymaricaigens such as polaecharide bacterial cll wall cmponets, which hen promotes B al ‘ety However, the pataay dae not ona to es ntehing ot any ‘maturation or produce mmunclogeal mena expense‘st. year-ld era 5 para prosonsto the pysician fx pratt cate at 32 \wooks of reananey. She comes froma na region af thopia and dot have Sppropnte prenatal are cg prev pregnancies She has complains of Seling,convactons, oss fo bleed om the vagina Dung he csrent prograncy. she hs received proper care ac has completed the requie Inboratory and isomerate, wtih id no show any pathology He blood pressures 130/70 mm Hg, hearate is 77min fespistery ates Tsim, and temperatures 36.6 (STS). Hor examinations consistent wth orn! 32 \weoks’ gestation. The patent tthe physician ha shes gong to delves her Chaat home, wanout ary medal a The psn nailes about her tetanus ‘ecenaton snus The pation epee hat she had tetanus year fer he fet ‘every at the 390 of 16, and wos managed appropiate She Nano tetas ‘accinatns sine then Which athe lowing statements sue? ‘A Thopatent doesnot need vacation Because she has ‘developed nar rmunty aginst etn and wl ons tt het aor ‘actor 20 ony tho cheat sk of deveoping etn ar an ou ‘thor! delve The patent should recelve atleast 2 doses of tars tx ‘itn the 4weckinterval to ensure thal she end er baby wl oth The enubeces om tetanus inmune lobulnvacia igen toa logramt woman, would et e055 he pacertal ara.arr a 1. = a reser 512070 mm Hg, heros 77m resprtory att Sm, and tomperature 35.6 (9787, Her examination is consstrt wth anormal 32- ‘wool gestation. Tho patont te he pyscan hat sos gong te dalver Nor ‘tad at home, whout ary mecca The Dacian nies abowt he tetas ‘accinaton status. The patent reports hat she had tetanus year after he fst ‘atvory atthe age of 16, and = was managed appropiatly She Ne no tetanus ‘acinations since then Which ofthe lowing sterner sts? A The patent dose not ned vacation becsiee she hae veloped natal munity agaist anus and wl 23s R16 hor baby. 8. The patents protected against tetanus de o her past metal soy, 50 ony the has at sk of deveioping tars ater an cu re ee The patent should cave atleast 2 doses of eta tow itn the 4eck interval 1 ensure that she and her baby wil both ‘vo mmunty agaist tars 1. The anthodtes fom tetanus mune globin vaccine, ahve 9 pregnant woman, would et cross he placenta bare. Evento patent recoWes appropiatottanus vacation, wl De necesary 6 administer twat the nebo,arr a 1. = a reser 512070 mm Hg, heros 77m resprtory att Sm, and tomperature 35.6 (9787, Her examination is consstrt wth anormal 32- ‘wool gestation. Tho patont te he pyscan hat sos gong te dalver Nor ‘tad at home, whout ary mecca The Dacian nies abowt he tetas ‘accinaton status. The patent reports hat she had tetanus year after he fst ‘atvory atthe age of 16, and = was managed appropiatly She Ne no tetanus ‘acinations since then Which ofthe lowing sterner sts? A The patent dose not ned vacation becsiee she hae veloped natal munity agaist anus and wl 23s R16 hor baby. 8. Thepatentis protected aganettotas eo heepastmeckcal 9 soy, 50 ony the has at sk of deveioping tars ater an cu #Oe Bees eeere res ee g| Thepatert should recatve atleast 2.osesof tetanus owrld SO ‘tin the week interval to ensure that she ond her baby wil bath avo mmunty agaist tears. 1. The anthodtes fom tetanis immune gobuln vaccine, fahenton 8% pregnant woman, would et cross he placenta bare. Even ifn patent recoWes appropiat ttanus vaccination, wil TH De necesary 6 administer twat the nebo,#Oebeeseugabynye Result: = Explanation: CCoact answer C: ts oconmondd tha al prognat women bo mmunizad, {© prevent mote and neonatal etn Fong administration of to ‘acon ane sete mmimy develops Dang te a tmestroF rognancy, to ransplacontl crossing of ne arias tom moter toc ‘eau, 20. woman who i propery vaccinated can provide protection het ‘aby The cis wl aque a natal parse rainy that lat ong peu to plete them ut! test sehecued Tp admnistation at 2 ‘mone of ge Te carent Word Healt Organization (WHO) guile gest tht two doses of feta orld oF ap shoul be given one month ‘part bere deveryto women witout aistoy of vaccination against the has ot been vaccination nthe past 8 years, she shoud be Wetec Luwoccinated ae bermanaged a5 noted above. ‘Option A: People who recover rom etanus do net acquit Iteong immunity ‘Option B: Bott mother and her baby ate aris of equing tetanuesnce ing tetanu ony proves shorerm humoral many, Bocause has ‘eer 18 yeas since the patient sured frm tetanus, here no cance thet ho all har aniboces to the deste, and therefore wl be urate to past Related Videos: First Aid References: Frat Ad forth USMLE Stop 12018, 28h 01,138 Frat Ad forth USMLE Stop 12018, 28H oa Fst A forthe USMLE Sep 1 (2017, 27h ed 107#Oe Bees eeere res ee g| ‘spat bore delvery to women witout ahstory of vaccination againet the ‘seese Tetanus dos not nduceMeYong snnunty, and becouse is patent \anacenated and bemanaged 2¢ noted above, ‘Option A: People who recover rom tans do ot acute Melong munity ‘Option B: Bathe mother and her bby ate ats of ccna tetaru snce having tetanue ony provides hort erm humeral mma Geeauee thee ean i yoas since tho patent sured am tans, her Sno chance hat sho stil hos anibodes to the dsoase, and therefore wl be una to pass ‘hore atnoree ont heres ‘Option The tetas immune globin contains IgG cass antbodies, wach Option: There axe no such ecommendations for newborn tars prevention. The baby wl ne ogo tho est Taapadmanstaion et? ‘montis of age Lsoming objective: Despite advances fn fhting maternal and neonatal tetas. this lease contnus tebe prler in ome afas fhe wold Poverty pcr iypone enn accens to hel arcs merese he fk ‘fraternal ne neon ats, Vaccnaten the best way to prevent ‘eanemiazon A popedyInmunized metas can pars atone hee ee {and powder ci wth nara passive munity So that both ae protected {tthe tine of every. WHO recommends that a pregnant woman wthout pit nmin etry sould css two dee of ttn esa or Tp ‘month apa before delven. Fst A forthe USMLE Step 12019, 2h od 198. Frat Aid forthe USMLE Step 12018, 20H of Fst Afr the USMLE Stop 12017, 27 ed 07‘A boy bom vainly nthe 36 Weck gestation oa W.yea cts woman (aude 2 paras szcesod one 2nd dy off, Hs vl ude blood presa '85/40 mm Hg, dees 1m, allay temperatures 366°C (98.07), and respratay rat amin. Ho appears tobe lethargic: Ns skins jaunced an sont acrocanoss wits several petctine i note. Phys examination revels nystagmus mute’ heart sound wih 3 conto mm, an hepatasplenomegal, The boy's bith weight 193 4g (425 B) and Apgar sctes at tho tet and Sth minutes were 5 and expechvely Hs mother unseat of het Inrmanaon eat ane id no receive ary areata cre She Series ay sty ofinfecton medication use or kool ri subsonce se dre pregnay. Serology for aapectedcongerstal TORCH inflection stow the flown rut: ‘Anxopasina gondt gM Nogatve ‘Ancxoplasm gor lg6. Pesitve #6¥ Bees Beuaarey as ‘nt. cN igh Negatve MCN GG Pestve a ‘an Rubel iM Pesitve : ‘at. 29 Ig Pose ans ig Negative \Which cara abnormaty wou be expected inthis infant on echoardography? | Pulmonary valve stenosis 8 Pwentctue oneroese— =z 2 > is aa Sem] ementn a an ote my er Se Goes ohn Tl) cnacon meses eno santo tenance erg peminey fim) Sec raopan cota Yor ence sre ow ss a sence on Neve ; femora int ge Poste 4 fcc weave : teenie mane 2 ‘emsanunt Poe : fcaioige Posh : fc ves ° maevige vos =e \Which cara abnomty woud be expected in this infant on echocarosraphy? #6¥ Bees Beuaarey as 8 Patents otros enti spt defect © Ata sopea ater Atlleation ofthe ight ventePerens a 1. = oa = Tho Stand sth innutes wots 5 and respectively Hs other Bunewate oer . Ivmuntzaon sats and dll not receive any amr care She deries any isto © tinfecion medlenion ues or ial ii substance se ig pregnanny 7 Serciogy or suspected congenital TORCH inlocton stows he flowy fut: is Antiexopasina gona gM Negatve i ‘anuexopasma gona igs Pose © ‘nt. igh Negoive ® An IgG Pestive ™ ‘aimbot Mt ostve . ‘rw-p 9 Pestve * ‘a5 itt Negatve ° ‘ants 196 Nogatve = \Which cara abnomty woud be expected in this infant on echocarosraphy? #Ov Bees Beuaarey as 8. Pert acts oreo enti spt defect © Ata sopea ater Atlleation ofthe ight ventesGreegcuvsayrecucPlsasacacaseeseesees Explanation: Unt Sates, remains endemic in many countries, Conger rubella si sects more 700.000 nants annual rund the won ean be ene ‘made it necessary obo aware ofthe sgn, symotoms, and dagnostc features ‘of eongental rea emdrome (RS, though congenital Yectons maybe associated with 9 varity of arse anomalies, patnt ductus ateosus PDA} sthe mast common ne found in patonts wi congonta rat, whieh hs patients sigs fcongontal heart ‘sease and hepatosplenomegalysonpes Is 0 cone by serologic findings postive antiabalaigM dg ere Indcatve forgoing bel Infection, whch was ansmited om the boy's mother whe mest aly had an ‘symptom ifecbon ring her pregnancy) ‘ria features such as pall, azoeyanosstachypnes tachycard clvated pute reeeure naa mrmuhesrd ding syetse nd etl me saggeete ‘th bod out rom te act tothe pulmonary ate wich can lead ‘pulmonary hypertension over ne and congestive heat aire eh Related Videos: © mines © Iiisssetcara Me First Aid References: Fst A forthe USMLE Step 12019, 28h ea 298, 169, Fst A forthe USMLE Step 12018, 28h od 296,169, Frat Aid forthe USMLE Stop 1 (2017, 270 ed 165,178, 269,290#Ov Bees Beuaarey as ‘Option A: Pumenay valve steno estes ood ow tthe pulmonary Spparent te pian or may remain amma fo long te, The ‘usautatr fading inthis patent aso do ot support this lagnets (creszondeaecroscando ection murmur can be nerd nadia hve severe pmonsry stanoss) Punonary artery steno anaher| congenital heart anomaly x patente wih congenital bela and hae a sr emedynanieofoct 5 POA ‘Option c: Vertu opal toc (¥SD}s common in chiston wth torent ‘congenial fectons aswel arin cildrn wth gonee esas and ft Seoholynsrome. The patent clini ndings nd metry donot spot ths ‘agnosis howover Lord shunt n VSD cen cause cial ngs sia tothose found in PDA but are usualy assisted witha pansytle mum As Ul, VSD not oon epatacinehcran th eangenta ale ‘Option D: Atria sept defect sao associated wh lett stant and can be preset nits wth congentalnecuons, buts neteported te be auscutatoy pewre ‘Option: Atoation of he nt vee also known as Este anor the dsplacomentoficuspid valve leafs toward te apox ofthe heat. is ‘often seen infants of mothers who have tkon sum cng to at temester of pregnancy arf not aaseciated wit congenital ba, ‘Learing objective: Congenital ube syndrome is energing as serious and prowetabe cnn of bon piteloges inant inthe Une Str. ‘Matemalvacinaon agaist ubeta can prevent congental ube syne‘congerial ee ano npetrds wh congo be ade inde bemodmanic ort 9 POR ‘Option: Venta septal detect (VSD common i chien wth ferent ‘congenital ifecione ac wel ein cidren nih geneUc cease and etal ‘cohol syncrome, This palonts clinica dings and nstry doe supper hs ‘agnosis owever. Left shunt n VSD can cause cine ngs var tethoce fund n PDA but are usualy assoiated witha panoyeolc murmut. As Wo, VSDIs not on ported i chuctan wi cangetal uot ‘option D: Ata septa dofet is alo aesoclated wih lett stant and can ‘be preset nts with congentalinfectons, bts net reported tebe specticaly associated wih congentalrubelipreducesacterent uscuatory pice ‘Option: Aazation ofthe ish vetlel known as Esten anomaly is ‘me dsplacoment of weuspid valve lait toward te apex of he Neat i ‘olen seen in infos of mothers who have akan its crn the fst ‘umester of pregnancy ands not aseeciated with congenital bol, #Ov Bees Beuaarey as ‘Leaming objective: Congenital rubs syndrome Is emerging serous and ‘Motors vacinson against abel can proven congental cia syndrome Inthe nenbom The diagnose of cengental basin aneubom can Be confemad by soo sts. Sian ool ot gM an gG are suggest ‘of mate rratrine vansmisson The fetes of congentl bola {yndroms ince eariae orm, of win pen dit teroeue and pulmonary ane stenosis are the most common.Seren a 1. = a ‘82-year-old man prosents to ho emergency deparent wth sovaresubsornal oot est which iste os loam ant He epots tht he hae hadi butmidr pam several mes nthe pet ng srs srl He naa hea tansplaaion duet latery casomyopaty 5 yous ago wan an acu rejection reaction that wos sucesthly Heated wth ericeterois He had been aking mo tacrolimus twice acy for 35 yeas bit than ecominied Rand hana regula foto ps. The man does nat hae e family history of premature cernary atety 22/me. ae temperature 373° (981) On physical examinstion the pavent = Bert response, and aptated, Cardiac ausculaten reves a Youth heat sound (58) and an rogultyfregiar hon yim Hs ECG show: ST clevation nade 1. V5, and V8, ad ST depression nla Hand AVE He compet blood cea and lpdogiam ae wehin normal ks. The pants carla uoponi | ad Tlevls ae ‘lovato. A coronary angogram eves aure concen nartoning of al brancnes of hele coronary artery, Whats the most kel causative mechani of ths patents cordacechemia? ‘A Vasospas of ctl coronary anes branches 8. Lot vortriclr hyperrophy Oatteratve atopy roe increased oxygen demand duet tatyeala Granulomatous vac of corona entiSeren a 1. = a ‘82-year-old man prosents to ho emergency deparent wth sovaresubsornal oot est which iste os loam ant He epots tht he hae hadi butmidr pam several mes nthe pet ng srs srl He naa hea tansplaaion duet latery casomyopaty 5 yous ago wan an acu rejection reaction that wos sucesthly Heated wth ericeterois He had been aking mo tacrolimus twice acy for 35 yeas bit than ecominied Rand hana regula foto ps. The man does nat hae e family history of premature cernary atety 22/me. ae temperature 373° (981) On physical examinstion the pavent = Bert response, and aptated, Cardiac ausculaten reves a Youth heat sound (58) and an rogultyfregiar hon yim Hs ECG show: ST clevation nade 1. V5, and V8, ad ST depression nla Hand AVE He compet blood cea and lpdogiam ae wehin normal ks. The pants carla uoponi | ad Tlevls ae ‘lovato. A coronary angogram eves aure concen nartoning of al brancnes of hele coronary artery, Whats the most kel causative mechani of ths patents cordacechemia? © A. Vasospasm of ctl coronary artes branches os 8. Lot verti hyperrophy cy Obtteatve atopy oe roe increased oxygen demand duet tachycardia * Granulomatous vac of corona enti aesSreegcuusayrgcallecgsacacasecseesee- Explanation: Ccorect answer C:Obiteatweatropaty, or gratvasculrsese, 5 progressive atoning ofthe ttt muscular ates, which's te main fate ‘ot etronc gat tection. Morphology this narrowing resus rom ‘trom hypertasa and brat remodeling of he rte wall Coronary streroeleoo, ncn can be waned inthe hea afoot. cn 3 contd to Schama evatvrnnt Chronic ga jection develops gradualy fd monet yore ater transplantation, usuoyinsieiy ‘rmunoroppressas patnt. The cine synptome rec rom conc tech the tanepantd gan chs ra ejection the most key cause of hs paint symp mmunosuppessionno fay hsteryof premature cardiac seas, ae 2 ‘eam pd rote tis pallent, oie gra ejection resued i arac ‘Schema with tosjmptoms of angina allowed by acit coronaysycme ‘rh characte ECG features and levaton of ara openine ‘Option A: Vosospasm of coronary ares she cause of variant angina. Mis charactenzedby chostpain ecuring curing rect at ight. Variant angina i {etkoly to bo he cause of ths patent's chest pai option’ Auch voila hypertopy can caus schomla and oven toad Related Videos: © Hosen Facter onsen Teton © Leanna ote ezamon First Aid References: Fst Afr the USMLE Step 12019, 29h ed 19,01 Fst Ad forthe USMLE Step 12018, 28h 101,10 Fst A forthe USMLE Step 12017, 27h 15‘normal pt prot, tis pan, conc ga rejecon reed earac ecihdltocae GUE bis oREIon con: ‘Seema wit te symptoms of angina flowed by acute coronay syne ‘wih charectssc ECG fosknes and lov of coc openina Frat Ad forthe USMLE Stop 1 (207 27th 13 ‘Option A: Vasaspasm of cotnary ators ho eause ef vara angin. Mis choratenzedby chest pan ecuring during ester at ight. Variant angina ts Lrthaly io be the cause ofthis patents chest pain ‘Option B: Aknough veil hypertephy ean caus echena an even eas tecute coronary syncronoin errome cas, uk obo tho caso ot ‘hs patents mpm, ‘Option: Athugh increased onygon demand due to tachycardia can cause ‘ether, his patents ml tcycardi whichis no key tobe the ease cotischema, especialy cosideing his age and ansence of comorbid. ‘Option: The patents angiographic amination snot suggestive of ‘fosdemstous tasmaton, Te iammatn eo ota fost of chore tafe, wchsthe most ly reason for this patients smote Leeming objective: Chron oof rejection develops morths to yes afer ‘vasplartaton. ek octorsnctude ator of acute rejection: adequate ‘such 9 dabots, hyperemia and hypertension: repersion ky othe ‘Srgpn lense enema te nd portaneparintction. Chron raf ‘ojectonis bom co nd antibody. mediated, The man morplogica featue ‘ofthis candon is rant! Myporpine and roc romodelng of he Sete heh reste ma raring oho ameres ana gr eam (Chronic rjacion occurs n 25-60% of al cardac alga ecient, roeSerer ry ' yea boy has undergone kanoy vansplanaton dye to stage V chen echey seace A presransplntaton sooo aszesrent showed that hos negate forpost or present HN fac, vil hepa, EV, ne CMY ection He has a known atergy for macrolides. The patnthas no conplats1cay tr transplantation Hi also inca: blood presi 12070 min Hg heat ato 89m espa ste Win, an temperate 320 (8.6 On py ‘eration the patent appease be pale, is lungs ate dea on austen, heart curds ate normal and hi abdomen non tondr on palpation Hi coatine iz (068 mga. (575 pmol), GER ie 713 mLImiNt 73m, ar inne cut 09 MLK ‘Which othe foloning chugs sould be used inthe Inmunceuperesiveraginen 1 Solis —— 8 Basibamat SceeeeuuNaary 2. Baatcopt E Omatmunad' yea boy has undergone kanoy vansplanaton dye to stage V chen echey seace A presransplntaton sooo aszesrent showed that hos negate forpost or present HV infection, vl hepa, Ean CMY facto, Helse known allergy fr macrolides. The patot has ne compas day ate troneptntton His al sg inci: blood presixe 12070 min Hs heat at 89¢me, respon ate Min, and temperate 370 (88.6), On physica feranation the patent appea'so be pale, lungs ate dear on austen, ‘resin 50.85 mgt. (575 oll), GFR ie 713 mL. 73 ma nec Is 09mUAgM. Which of he following rugs Spat be used nthe 1 Stolmis om tite 2% 2. Baatcopt ~ E Omatmunad 8 SceeeeuuNaarysGrecgcuvsayrecPlseegsacacaseeaeusee > Explanation: CComect newer: Basinoman i a monoclonal ankibody tat acts against (CD25, on alpha choi of 2 and hts been approved by the FDA forthe prevention and westment of eno tanepin election acs by compete ‘ining oto 12 receptor or ympocyes, preversng that epeatlon ana ‘a 9 conmequonce, the aetvton and ferentiation of @ hmphocytes wich Sreresponsbe forthe progicton ot abodes that insta a ole sna ramet th damage. The only conrandteatin fr bastbamab uses a ‘known lor tothe mecicaton o nyo ts components. is wed in ombration eth corcosterids and cyclosporine ‘Option A: Stim is a TOR nor that is aperoved for ust patente wh a anspiated Kidney fr menunecuppresinNowever Conindeated n palo wana known sary to maces ‘Option C:Dactaumad ea manaconal antibody ht. he asisima, ate agnist C025 Is used or keey rans elcton ropes, However, ‘eusein vansplantaton was continued, and is now usd th caton ve over tac) as a dsoase modtyeg agent patos wih male ders, Option D: Beatacopt susan poten composed of human iF agmonts tinued the extacelinr domain onan CTLA-A inhi Tall acaton Related Videos: © Ret econ nc anson © Tae tra nmonneresne Ong anscono First Aid References: Fst A forthe USMLE Step 12019, 2h 19,101 Fst Ad forthe USMLE Sep 12018, 2h e101 19 Fst Ad forth USMLE Sop 1 2017, 27h od 15sGrecgcuvsayrecPlseegsacacaseeaeusee > (Ooon A Sn STC th eed oii as ‘rth a eaneplanted hey fr merenoesrgresson Nowe conaindcatedn patents wih a known aery to maces. ‘Option ¢:Dactzumab isa manaconal antibody tht. he beta, acts ‘against CO2S, Ris wad or kaey ranplant jc prop. Howe, {suse in ansplantaton was daconined, and Ris now used th eats ue to ver tc) asa dcease modtyng agent patios wih mutts ‘Option D: Betxacopt is tusion protein composed of human i Fe Heamonts Srko tthe extacaluiordomain of human CTLA-A, Rint T call ation and is ncated for trap eecon ropa howover, omindcatedn patents wan negate of unknown EBY serostatus because ofthe ak of post Ransplant hphoprtteratve doer ‘Opton: Omatzunab a manccona srody that acs agaist gE ands ‘oct Wea alr conetons, Xi ot neat ere i rapt, Leoming objective: Posttranspiantition gra recon prota th mmunesuppressans can escntal par of managing patents undargehng ‘Yorpletaton In idneyresplniatn, on inmunoauppreasivereginen ‘sua ncdos 9 cortosterld and cyclosporine or arora he ‘opten oan aston hes ig Several ages of cg ey serv ath ‘acartonl tc agent ncludingantwotteratve augs (3, mycophonose ac {szathioprne nTOR inhibitors, slim, everolmus and monoconal Srtvodes eg, basa rhsxmno nity, ane snap hon inners). 1. = G First Aid References: Fst Ad forthe USMLE Stop 12019, 29h of 19,01 Fst A forthe USMLE Step 12018, 26101, 19 Fst Ad forthe USMLE Stop 12017270 1S‘A ayearold boy is brewgtt tomo emergency dopant by is paronts. Hes lethrge and conkired nd has 9 severe Headache, voring, and hh tee ‘oversee eae tht day He mther eps tht he ehke wre cng we 2 «ays 290 whan he dovelopod a over and cen nasa cschargo. The patenthas history of neonatal sepsis meningococcaminat 8 months of go. and Feumocorcal preumoni 2a 3 yeas of ag8 Hi sched acca a2 Up date Hs blood pressure TO/S0 mn Hg eat aes 120m, espHatxy fate is 22hme, andtemperature x38. (02.7, On examination the hide lethage ad his skin's pale. wth Soverl petechive over his buttocks. There 3 Purlen nasal dcharge fom beh ost Te ng are cleat ausctation ‘ctrl esr sounds ore norma, Ther is maton neck Sy Crebrapinal fad nates snows te following ret pening esse 100 mm HO Appearance lousy Prewin Soompat (Sot) White Blood cot 2500iu.pemerphonucler predominance) Pra ‘50mg (4594) Gucose Stma/tL 17 ae Catire Pottve for meno SceeeeuuNaay a [Which fhe fling immunological processes mos key tobe pated nth {A roducton of L-2by Tm cats 8 Acwaton of TR by MHCA Formation of 5.9 comple