46.

A 14-year-old boy develops a pruritic vesicular rash on his face and hands 3
days after hiking in the woods. Which of the following are most likely to be involved
in his illness?

A) Antibody, complement C5-9

B) Circulating immune complexes; complement C5a, neutrophils

C) Cytotoxic T lymphocytes

D) IgE, mast cells, histamine, cytokines

E) Lymphocytes, cytokines, macrophages

48. After activation, neutrophils demonstrate an increased tendency to migrate

out of blood vessels and into the extravascular compartment. Which of the
following is the most likely cause?

A) Altered expression of adhesion molecules

B) Heightened phagocytic ability

C) Increased synthesis of lysosomal enzymes

D) Release of interleukin-1 (IL-1)

E) Upregulated synthesis of Fc receptors

49. Endothelial cells of the postcapillary venules increase expression of

intercellular adhesion molecule-1 (ICAM-1) in response to cytokines. The increased
expression of ICAM-1 results directly in which of the following neutrophil functions?

A) Activation
B) Adherence
C) Chemotaxis
D) Demargination
E) Transmigration
14. Which group of regulators involving inflammatory or immediate (type I)
hypersensitivity reactions is capable of causing increased vascular permeability and
attraction of leukocytes?

A) Essential fatty acids

B) Leukotrienes

C) Prostaglandins

D) Thromboxanes

20. A previously asymptomatic 42-year-old man who has been seropositive for HIV
for 4 years comes to the physician because of the recent onset of fever, cough, and
weight loss. An x-ray film of the chest shows bilateral pulmonary infiltrates. A
methenamine silver-stained preparation of bronchoalveolar lavage fluid is shown.
Which of the following immunologic abnormalities most likely led to the
development of this pulmonary process?

A) Circulating immune complex-induced injury

B) Decrease in the number of CD4+ T lymphocytes

C) Inactivation of pulmonary macrophages

D) Increase in selective cytotoxic CD8+ T-lymphocyte activity

E) Loss of natural killer cell function

22. Which of the following features of the inactivated poliovirus vaccine best
explains why it prevents paralytic polio but does not prevent replication of the
virulent poliovirus in the enteric tract?

A) It does not elicit cell-mediated immunity to viral capsid proteins

B) It does not elicit neutralizing antibody to virulent poliovirus

C) It elicits IgG but not secretory IgA

D) It only protects against one serotype of virulent poliovirus

23. Which of the following immunosuppressive agents acts in the lymphocyte by

complexing to and inactivating the lymphocyte-specific phosphatase calcineurin?

A) Antilymphocyte globulin

B) Azathioprine

C) Corticosteroids

D) Cyclosporine

E) OKT3 monoclonal antibody

2. Tolerance of B lymphocytes to self-antigens develops in which compartment?

A) Bone marrow

B) Lymph nodes

C) Peyer's patches

D) Spleen

E) Thymus

13. The recombinant vaccine used to immunize against hepatitis B infections

elicits antibodies against which of the following viral proteins?

A) HBcAg
B) HBeAg
C) HBsAg
D) Polymerase
16. A 73-year-old woman has bronchopneumonia. Numerous neutrophils,
attracted in part by 5-hydroperoxyeicosatetraenoic acid (5-HPETE) and leukotrienes,
are present in the affected bronchioles and alveoli. Which of the following enzymes
is most directly involved in the production of these molecules?

A) C3 convertase

B) Cyclooxygenase

C) 5-Lipoxygenase

D) Phosphatase

E) Superoxide dismutase

36. The initial vaccines against Haemophilus influenzae type B prepared with
capsular polysaccharides were not very effective in children less than 2 years old.
Subsequent vaccines have been greatly improved by the conjugation of the capsular
polysaccharides to one of several proteins. Why does this conjugation improve
immunogenicity?

A) CD4+ T lymphocytes are activated

B) Cytotoxic T lymphocyte responses are increased

C) Direct activation of B lymphocytes by the vaccine is increased

D) Nonimmune clearance of the vaccine is decreased

E) Phagocytosis of the vaccine is increased

46. Tumor necrosis factor is the primary mediator of host responses initiated by
lipopolysaccharide (LPS) and leading to septic shock. LPS-mediated activation of
transcription most likely depends on which of the following transcription factors?

A) c-ras

B) Nuclear factor-kappa B

C) p53

D) Rb protein

E) VP-16 (etoposide)
19. Activation of T lymphocytes is initiated when processed antigen binds to the T
lymphocyte receptor on the cell membrane, and phospholipase C is activated. This
results in production of which of the following components of signal transduction?
A) Cyclic AMP

B) Cyclic GMP

C) Diacylglycerol

D) Interleukin-2 (IL-2)

24. Which of the following procedures improves the immunogenicity of vaccines

that use capsular polysaccharides as antigens?

A) Heat denaturation

B) Liposome incorporation

C) Oligosaccharide reduction

D) Protein conjugation

49. Neutrophils produce reactive oxygen compounds following the phagocytosis of

bacteria. Which of the following enzymes protects body tissues against these highly
reactive oxygen compounds?

A) Cyclooxygenase

B) Lipoxygenase

C) Myeloperoxidase

D) Superoxide dismutase

E) Xanthine oxidase

17. Poliovirus can be grown in cultured monkey kidney cells through repeated
passages, resulting in virus that is no longer neurovirulent. This virus can be used
as a vaccine because it has become

A) attenuated
B) defective

C) inactivated

D) latent

E) recombinant

26. A 22-year-old woman comes to the emergency department because she has
had fever, dysuria, and flank pain for the past 2 days. Vital signs are:
Rectal temperature 39.4 C (103 F)
Pulse 130/min
Respirations 25/min
Blood pressure 90/55 mm Hg
She has anuria. Blood cultures grow Escherichia coli. Intravenous broad-spectrum
antibiotic therapy is started. Which of the following cytokines contribute to her
current illness?

A) Interleukin-2 (IL-2) and interferon-γ

B) IL-3 and IL-7

C) IL-4 and IL-5

D) IL-10 and IL-12

E) Tumor necrosis factor-α and IL-1

6. Normal healthy children are able to mount diverse antibody responses to

several thousands of different antigens. This process is based primarily on which of
the following DNA mechanisms?

A) Amplification
B) Conformation
C) Recombination
D) Repair
E) Replication

18. Which of the following is the most likely consequence of impaired synthesis of
interleukin-1 (IL-1)?

A) Enhanced phagocytic activity of circulating macrophages

B) Enhanced production of antibody by B lymphocytes
C) Impaired antigen processing by circulating macrophages
D) Impaired function of T lymphocytes
E) Impaired production of leukotrienes by neutrophils

20. Antibodies that can pass from the mother to the fetus through the placenta
are of which class?
A) IgA
B) IgD
C) IgE
D) IgG
E) IgM

29. After a full course of immunization with a new vaccine consisting of a

recombinant polypeptide, 10% of adults fail to make antibody to the polypeptide.
The nonresponders have an increased frequency of one HLA type. What is the most
likely explanation for the failure of this group to respond to immunization?

A) Failure of B lymphocytes to recognize the polypeptide

B) Failure of T lymphocytes to recognize the polypeptide
C) Lack of class I MHC presentation of the polypeptide
D) Lack of class II MHC presentation of the polypeptide

44. The ability of endothelial cells to inhibit platelet aggregation is mediated in

part by the metabolism of cell membrane-derived arachidonic acid by which of the
following?

A) Anaerobic glycolysis

B) Cyclooxygenase pathway

C) Glutathione reductase pathway

D) Lysosomal enzymes pathway

E) Mixed function oxidase pathway

F) Tricarboxylic acid pathway

4. A 10-year-old girl has acute facial swelling and difficulty breathing. An

acquired deficiency of C1 esterase inhibitor is suspected. Which of the following
findings in serum will best support this diagnosis?
A) Decreased concentration of C4

B) Increased concentration of properdin

C) Normal concentration of C1q

D) Normal concentration of C1s

E) Normal concentration of C2

23. Which of the following is the unique function of the central aggregate of
particles (marked by X) in the freeze-fracture image?
A) Adhesion

B) Communication

C) Motility

D) Permeability

E) Secretion

41. A 5-year-old boy with a history of recurrent ear infections receives his
preschool booster immunization against diphtheria-tetanus-pertussis. He is
participating in a community-sponsored study to determine the humoral immune
response to tetanus toxoid (tt). His response is well below normal for age- and sex-
matched children. Peripheral B lymphocyte count and T lymphocyte count and
function are within the reference range. The antibody he makes is positive in both
the passive hemagglutination and complement-mediated lysis of tt-coated
erythrocytes. His antibodies do not opsonize tt-coated latex particles for
phagocytosis and do not directly precipitate tt efficiently. This child most likely has a
defect in which of the following processes?
A) Affinity maturation of immunoglobulins

B) Immunoglobulin isotype switching

C) Recombination of heavy chain variable region genes

D) Recombination of light chain variable region genes

E) Somatic mutation of immunoglobulin genes