Question 1 of 5

Which of the following is correct regarding immunoglobulin (IgG)?

A Cannot cross the placenta to the fetus

B Comprises one antigen‐binding site and a site for the binding of complement
C Constitutes approximately 25% of all immunoglobulins in a healthy individual
D Has a Y‐shaped molecular structure This is the correct answer
E Is secreted from T‐lymphocytes

Immunoglobulins (antibodies) are secreted from activated B‐lymphocytes (plasma cells) in

response to a specific antigen. B cells do not produce antibodies until activated.

IgGs have a Y‐shaped molecular structure. They are composed of two antigen‐binding sites and
a site for the binding of complement. Both antigen‐binding sites are identical and consist of a
long and heavy chain.

IgGs constitute approximately 75% of all immunoglobulins in a healthy individual.

Only IgGs can cross the placenta. This is important as they provide immune protection for the
newborn in the first few months of life.

The terminology for blood cells can be confusing as different names are given to the same cell.

Question 2 of 5

HIV positive patients may receive which of the following vaccines?

A BCG
B Measles vaccine This is the correct answerthe only live attenuated that can be given
C Oral polio vaccine
D TY21a (oral typhoid vaccine)
E Yellow fever vaccine

Most live virus vaccines are contraindicated in patients who are HIV infected.

The following vaccines should not be given:

  BCG
 Cholera (CVD103‐HgR)
 TY21a
 Oral poliomyelitis
 Influenza (intranasal), and
 Smallpox (Vaccinia).

However, guidelines recommend that patients are given the measles vaccine despite it being a
live vaccine, particularly if the CD4 cell count is high.

Reference:

British HIV Association (BHIVA). Immunization of HIV‐infected adults (2008).

Question 3 of 5

Which of the following statements regarding anaphylaxis is incorrect?

A Causes degranulation of basophils and mast cells

B Causes eosinophilia
C Causes urticaria
D Is produced by Ig E antibody
E Occurs 24 hours after the initial stimulus This is the correct answer

Anaphylaxis is a type 1 hypersensitivity reaction and occurs within minutes or hours.

Anaphylaxis may be associated with urticaria and pruritus as well as:

 Bronchoconstriction
 Vasodilatation, and
 Circulatory collapse with pharyngeal swelling and possible airway obstruction.

Further Reading:

Patient.co.uk. Anaphylaxis and its Treatment.

Question 4 of 5

Which of the following is a contraindication to MMR vaccination?

 A A history of convulsions
B An anaphylactic reaction to previous dose This is the correct answer
C Congenital heart disease
D Cystic fibrosis
E Down's syndrome

There are very few absolute contraindications to MMR vaccinations.

Contraindications include:

 Children with allergies to neomycin or kanamycin (very rare)

 A confirmed anaphylactic reaction to previous MMR
 Untreated cancer or diseases of the immune system, and
 Children receiving immunosuppressive therapy or high dose steroids.

Reasons to postpone vaccination include:

 An acute febrile illness

 Administration of another live vaccine within three weeks of proposed MMR
vaccination, or
 The administration of immunoglobulins within three months of the proposed MMR
vaccine.

Question 5 of 5

Which of the following is correct in the T cell response to antigen?

A A process of affinity maturation of the T cell receptor occurs

Co‐operation with other cell types is required for T cell recognition of antigen
B This is the correct answer
C Gamma/delta + T cells respond to antigen presented in association with MHC class II molecules
D Intact antigen is presented in association with self MHC molecules
E Interactions of the TcR with an appropriate Ag/MHC complex activates a resting T cell

Affinity maturation in an ongoing immune response that is a feature of the antibody response.
There is no evidence that a similar process occurs in the T cell response.
T cells recognise antigen only when presented by (self) MHC molecules on an antigen
presenting cell.

MHC molecules present short antigen‐derived peptides, not the intact antigen.

MHC class II molecules present antigen to CD4+, alpha/beta+ T cells. It is still not clear how
gamma/delta+ T cells recognise antigen, however most gamma/delta+ T cells do not appear to
be restricted by (self) MHC molecules.

Additional 'costimulatory' signals are required to activate a resting T cell. Interaction of the TcR
of a resting T cell with an appropriate Ag/MHC complex in the absence of costimulatory signals
may lead to the induction of anergy.