Immunology Past Paper Questions

EMQs – 2019

Antibodies:

1. Autoimmune hypothyroidism (Hashimoto’s) –

2. Dry eyes etc. Sjögren’s –
3. Droopy eyelid and movements are easily fatigable –
4. CREST syndrome –
5. Swollen joints of the hand, x-ray shows erosive joint changes –

Immunology:

A. Interferon gamma
B. Interferon alpha
C. TNFalpha
D. Etanercept
E. Basiliximab
F. Tocilizumab
G. Natalizumab
H. Denosumab
1. Ankylosing spondylitis –
2. Resistant Psoriasis –
3. Chronic granulomatous disease treatment – Osteoporosis –
4. Hyper IgM syndrome

Types of immune cells (similar to 2016; 2017, 2018 repeat):

A. Which immune cell is produced in the bone marrow then migrates to site of injury, has
oxidative and non-oxidative killing methods and dies once job is done –
B. Foxp3+ cells, they mature in the thymus –
C. What immune cells detects antigen in the periphery and moves to lymph nodes – What
immune cell detects MHC1 and kills virus infected/cancer cells. Is inhibited by MHC I –
D. What immune cells is targeted by HIV –

EMQs – 2018

Antibodies:

A. Anti-ENA
B. Anti-centromere
C. Anti-cardiolipin
D. ESR
E. Anti-Jo1
 F. Bisphosphonates
G. Serum immunoglobulins and electrophoresis

1. Patient with Sjogren’s (dry mucous membranes) –

2. SLE with recurrent clotting –
3. 72 yr lady with stiff limb girdles (Polymyositis) –
4. CREST syndrome –

EMQs – 2017

Allergy:

Cold Urticaria
Oral allergy syndrome
Lactose intolerance
Drug reaction
Penicillin allergy
Type 1 hypersensitivity latex allergy
Type 3 hypersensitivity latex allergy
Allergic reaction
1. A teenage girl who when she goes cross country running gets an erythematous rash on her
legs. It is well controlled by antihistamines –
2. Man can eat apple pie. But if he eats fresh apples and pears, he gets inflamed lips – Man has
an allergic reaction during surgery and who’s lips becomes swollen/oedematous when
blowing up balloons as his daughter’s birthday party – Bloated after drinking milk but not IgE
mediated –
3. A girl with a sore throat is given penicillin and develops a rash. She is found to have EBV –

Antibodies:

1. Woman presents with aches all over and joint stiffness? –

2. Woman with dry eyes and parotid swelling? –
3. Man with weakness in the gym and ptosis –
4. A patient with well controlled HIV, who is currently on HAART. What would you measure???
5. A women with known SLE presents with an exacerbation of her SLE/worsening symptoms,
what would you measure? –

Primary Immune Deficiency:

1. A 60 year old lady with recurrent chest infections now has reduced total serum protein and
has autoimmune thrombocytopenia –
2. A 12 year old boy has recurrent chest infections and has an ear infection. He doesn’t have
any B Cells –
3. Boy with recurrent abscesses has a negative NBT test –
A Girl is found to have no CD4 cells, but CD8 cells and B cells are present – A boy’s father has TB. The
same boy develops a mycobacterium infection, following their BCG –

EMQs – 2016

Primary Immune Deficiencies

1. Young girl with normal B cells, normal CD8+ but absence of CD4+ -
2. Young boy with normal B cell numbers and absence of CD8+ and CD4+ -
3. Normal B and T cells, high IgM but absence of IgA, IgE and IgG –
4. Lady with spinal fracture due to severe TB –

Patient with recurrent pneumococcal infections and meningitis – Immune therapies

1. Used to treat osteoporosis when the patient cannot tolerate bisphosphonates –

2. Used to treat malignant melanoma, involved in T cell checkpoints – Used to treat Lymphoma
and Rheumatoid arthritis –
3. Used to prevent transplant rejection, by blocking T cell activation and – Used to treat severe
ankylosing spondylitis not controlled by NSAIDs –

Cells of the immune system

1. In its immature form it is specialised to phagocytose pathogens, and in its mature form it is
specialised to present to other cells –
2. Derived from monocytes and resident in peripheral tissues –
3. Cells that express Foxp3 and CD25 –
4. Differentiated B cells that produce immunoglobulins –
5. Responsible for the killing of cancerous cells and are inhibited by MHC-I –

Autoimmune and autoinflammatory diseases

1. Mentioned FAS pathway –

2. Mentioned MEFV gene, periodic abdominal pain and ascites –
3. Nod2/CARD15 –
4. DR4 and CCP –
5. HLA-B27 associated with sacroiliitis –

Allergy

1. When they eat cherries, apples, pears and hazelnuts, they get itchy mouths –
2. Hypertensive and diabetic, with angioedema –
3. Kid with rash on extensor surfaces, IgE mediated –
4. Woman with flushed face, problems breathing that has happened multiple times with
enlarged liver –
5. Patient wondering why they get allergic symptoms every summer, clear discharge from the
nose –
Autoimmune disease markers

1. Anti-centromere and Raynaud’s phenomenon –

2. Patient with dry eyes and anti Ro –
3. Anti dsDNA –

Anti CCP – Anti-endomysial –

Transplant complications

1. Can lead to development of post transplantation lymphoproliferative disease –

2. Causes progressive multifocal leukoencephalopathy –
3. Mechanism behind GVHD –
4. Mechanism behind antibody mediated rejection –
5. Mechanism behind cellular rejection –

VSAs – 2019

1. Receptor mutation/ cytokine that can be protective in HIV?

2. What type of hypersensitivity (Gel and Coombs classification) is myasthenia gravis and what
cell?
3. IPEX affects what type of immune cell?
4. 16 year old girl has pleuritic chest pain, joint pain, positive ANA and Anti-Sm, no liver enzyme
derangement, raised ESR
5. Chimeric antigen receptor T-cell therapy against CD19: what type of haematological
malignancy does it target?
6. Kid has low calcium, cleft palate, low T cells?
7. Ankylosing spondylitis – they’ve tried NSAID and TNF inhibitor, what else can you target?
8. Diffuse continuous inflammation rectum to caecum, with no granulomas
9. 45yo woman with autoimmune diseases, low IgM, IgA and IgE; full blood count is normal?
10. Patient with GI conditions, lack of which substance leads to B12 being malabsorbed?
11. Patient with microcytic anaemia abdominal symptoms. Duodenal biopsy showed crypt
hyperplasia and non-caseating granulomas, lymphocytes
12. Which immunoglobulin is found in mucosa?
13. Patient with subtotal villous atrophy, tall crypts

VSAs – 2018

1. MEFV Mutation, what is it?

2. NOD2/CARD15, what is it found in?
3. Immunodeficiency with common gamma chain problem?
4. A woman is a donor for kidney to a child, what is the max number of HLA mismatches
possible?
5. Sacroiliitis, HLA B27 positive
6. Someone with aphthous ulcers, conjunctivitis, diarrhoea & abdo pain
7. What disease is indicated by the presence of Anti-dsDNA antibodies?
8. Which type of cell does Rituximab target?
 9. cANCA positive man with glomerulonephritis and lung changes, what does he have?

SBAs – 2019

1. Antibody for Graves

2. Nivolumab is a PD1 inhibitor, what cells does it target?
3. Woman with periorbital purple rash (heliotrope) and rash on knees, which enzyme is
elevated?
4. What Type Hypersensitivity causes serum sickness?
5. What is the effect of the gene mutation in familial Mediterranean fever?

Mechanism of hyperacute allograft rejection – antibodies against EBV, antibodies against glomerular
basement membrane,

SBAs – 2018

1. Which of the following are most often used for prophylaxis against allograft rejection?
a. Mycophenolate mofetil, prednisolone, tacrolimus
b. Mycophenolate mofetil, prednisolone, azathioprine
c. Cyclosporin, tacrolimus and rafamycin
2. Which allergy is more likely to present in child than adult?
a. Oral allergy syndrome
b. Egg?
c. Bee
d. Pollen
3. Which of the following can be used to treat rheumatoid arthritis?
a. Adalimumab: TNFalpha
b. Basiliximab: Anti CD25
c. Denosumab: Anti-RANKL
d. Secukinumab: Anti-IL17
4. HIV - what natural antibody against, which confers protective immunity against HIV? Or
something similar
a. HIV – GAG
b. HIV – gp120
c. CXCR4
d. Protease
e. Reverse transcriptase
5. Patient with coeliac. What would you see on biopsy?
a. Intraepithelial leukocytes
b. Intraepithelial eosinophils
c. Intraepithelial macrophages
d. Intraepithelial neutrophils
e. Intraepithelial lymphocytes
6. Child born with abnormal facies and congenital cardiac abnormalities also has normal B cells
but abnormal T cells, what genetic mutation do they have?
22q11.2 deletion syndrome/ DiGeorge syndrome

SBAs – 2017
1. Which of these vaccines must not be given to a pregnant woman?
a. MMR
b. Hep B
c. DTP
2. What cell in the body binds to MHC1?
a. Natural killer cells or CD8+ cells
3. A Girl develops a throat infection. She is given amoxicillin, and a rash develops. It is later
found out that she has infectious mononucleosis, and her symptoms persist:
a. Drug reaction
b. Penicillin allergy
c. Mastocytosis
4. Woman who has mouth/lip swelling following a dental procedure, and her mother reports a
similar history in the past
a. Serum like reaction
b. C1 inhibitor deficiency
5. Man has intermittent mouth & tongue swelling for the past 2 years, which is unresponsive to
over-the-counter anti-histamines, is on aspirin and ACE inhibitor. What is the likely cause?
a. Irritant dermatitis
b. Drug induced reaction
c. Serum like reaction
d. C1 inhibitor deficiency
e. Carcinoid Tumour
6. What is the most specific marker for Rheumatoid arthritis:
a. Anti-nuclear antibodies
b. Anti-cyclic citrullinated protein
c. Rheumatoid factor
d. Tissue-transglutaminase antibody
7. Which type of cell is matured in the Thymus?