9 

 Extracellular bacteria try to avoid killing by:

 A  Activating neutrophils.

 B  Accelerating complement activation.

 C  Synthesizing capsules.

 D  By deviating complement deposition to the cell membrane.

 E  Limiting variation in their antigens.

10  Toxins are neutralized by:

 A  Complement

 B  Antibody

 C  Toxoids

 D  PGE2

 E  Proteolytic enzymes

11  CR1 complement receptors on phagocytic cells bind:

 A  Factor H

 B  Factor I

 C  C3d

 D  Only inactive C3b (iC3b)

 E  C3b

12  Secretory IgA protects external mucosal surfaces by:

 A  Triggering mast cells.

 B  Recruiting phagocytic cells.

 C  Preventing microbial adherence to the mucosa.

 D  Binding to epithelial cells.

 E  Its secretory piece.

Correct. The IgA blocks adherence of bacteria to the mucosa and also facilitates opsonisation through binding to Fc alpha receptors on phagocytic cells.

17  Viral antigen shift involves:

 A  Single point mutation.

 B  Random point mutations.

 C  Interchange of large segments of the viral genome with other viruses.

 D  Rearrangement of the viral structural architecture.

 E  Regression to an earlier variant.

Correct. The ability to interchange large segments of the genome with a viral reservoir in other animal species is the basis of antigenic shift leading to radical change in
antigen, particularly crucial antigens giving protective immunity such as the viral hemagglutinin.

Next question

19  Interferons:

 A  Opsonize viruses.

 B  Neutralize viruses.
  C  Play a major role in recovery from viral infections.

 D  Prevent viral entry into cells.

 E  Protect against reinfection with virus.

Correct. Interferon inhibits the intracellular replication of viruses.

Next question

20  Cytotoxic T-cells:

 A  Are usually CD4.

 B  Recognize native viral antigen.

 C  Are more readily produced by killed rather than live virus.

 D  Kill viruses directly.

 E  Restrict viral replication.

Correct. The killing early on in the infection of a virally-infected cell prevents the virus from utilizing that cell for replication.

Next question

21  Classical NK cells:

 A  Have rearranged T-cell receptor genes.

 B  Are unaffected by IFN alpha.

 C  Are more active against targets with upregulated MHC class I.

 D  Can kill certain virally-infected cells.

 E  Can kill all virally-infected cells.

Correct. Like cytotoxic T-cells, NK cells can inhibit viral replication by killing the host cell. The difference is that cytotoxic T-cells have a receptor for a specific T-cell
epitope whereas NK cells have a broader specificity.

Next question

28  Extracellular bacteria are killed by:

 A  Secreting exotoxins.

 B  Impeding inflammatory reactions.

 C  Phagocytosis and complement.

 D  Toxin neutralization.

 E  C-reactive protein.

29  The mucosal surfaces of the body are initially protected by free:

 A  IgG.

 B  IgM.

 C  IgE.

 D  Secretory IgA.

 E  IgD.

30  Bacteria growing within macrophages are killed by:

 A  Complement.

 B  Reactive oxygen and nitrogen intermediates.

  C  Antibody.

 D  Cytotoxic T-cells.

 E  Directly by cytokines released from Th1 cells.

31  Some viruses escape the immune system by antigen shift. This involves:

 A  Structural reorganization of existing antigens.

 B  Masking of antigen epitopes.

 C  Point mutations in single genes.

 D  Point mutations in many genes.

E  Interchange of genetic material with other viruses.

32  Protection against worm infestations is particularly associated with an increase in:

 A  IgD.

 B  IgE.

 C  IgG.

 D  IgA.

 E  IgM.
Correct. IgE initiates inflammation which recruits IgG to the site and helps to cause metabolic damage to the worm. Worms are polyclonal stimulators of IgE which will
increase competition for the specific IgE by large amounts of irrelevant molecules.

The membrane attack complex consists of:

 A  OH.

 B  Colicins

 C  C3b3b,Bb

 D  C5b,6,7,8,9

 E  Properdin

C3b:

 A  Is chemotactic.

 B  Is an anaphylatoxin.

 C  Opsonizes bacteria.

 D  Directly injures bacteria.

 E  Is the inactive form of C3.

 A complement component which is strongly chemotactic for neutrophils is:

 A  C9

 B  C5a

 C  C3

 D  C3b

 E  C5b
 The initial complement component that is bound by complement-fixing antibodies is:

 A  C1q

 B  C1s

 C  C3b

 D  C5a

 E  C9

Several of the complement components are:

 A  Glycolipids

 B  Cytokines

 C  Enzymes

 D  Hormones

 E  Antibodies
The classical and alternative pathways meet at complement component:

 A  C4

 B  C4b

 C  Factor D

 D  C5

 E  C3
Correct. Each pathway of complement activation produces a C3 convertase, either C4b2b (classical and lectin pathways) or C3bBb (alternative pathway), which cleaves
C3 into C3a and C3b.

 Clonal selection occurs when antigen is encountered by:

 A  Neutrophils

 B  Mast cells

 C   T-cells

 D  Basophils

 E  Eosinophils

Plasma cells:

 A  Have a thin layer of cytoplasm

 B  Are derived from T-cells

 C  Develop into B-cells

 D  Secrete large amounts of gamma interferon

 E  Have a highly developed rough endoplasmic reticulum

A plasma cell secretes:

 A  Antibody of a single specificity related to that on the surface of the parent B-cell

 B  Antibody of two antigen specificities

  C  The antigen it recognizes

 D  Many different types of antibody

 E  Lysozyme

Adoptive transfer of acquired immune responsiveness involves the transfer of:

 A  Antibody

 B  Complement

 C  Phagocytes

 D  Lymphocytes

 E  Serum

Immunological unresponsiveness to self antigens is called:

 A  Tolerance

 B  Tolerogen

 C  Memory

 D  Acquired immunity

 E  ADCC

Edward Jenner vaccinated against smallpox using:

 A  Killed smallpox virus

 B  A recombinant protein derived from smallpox

 C  An unrelated virus

 D  Toxoid

 E  Cowpox

 Protective antibodies against infectious agents are often:

 A  Autoantibodies

 B  Neutralizing

 C  Toxoids

 D  Natural Killer

 E  Non-specific

Intracellular parasites within macrophages are killed more readily in the presence of:

 A  Antibody

 B  Kinins

 C  Properdin

 D  Gamma-interferon

 E  Anaphylatoxin

 T cell surface receptors for antigen partly recognize:

  A  Cytokines

 B  MHC

 C  ADCC

 D  Antibody

 E  IL-2
Correct. T-cells recognize processed antigen plus the major histocompatibility complex (MHC) molecules which act as a marker to inform the T-cell that it is in contact
with another cell.

 An immune response against grass pollen often involves:

 A  Pathogen-associated molecular patterns

 B  Breakdown of self tolerance

 C  A hypersensitivity reaction

 D  Reaction against MHC

 E  Persistent infection by the pollen

 Secondary antibody responses are better because:

 A  They provide defense against unrelated antigens

 B  The antibody can be made by both T and B cells

 C  Complement-fixing antibodies are made

 D  They do not require T-cell help

 E  They are stronger and faster

Which cell type produces antibodies?:

 A  Macrophages

 B  T-lymphocytes

 C  NK

 D  Plasma cells

 E  Eosinophils

Clonal selection occurs when a B-lymphocyte encounters:

 A  Cytokines

 B  Antigen

 C  T-lymphocytes

 D  Complement

 E  Chemotactic factors

 The secondary, but not the primary, immune response is based on:

 A  Memory

 B  The bonus effect of multivalency

 C  Complement activation
  D  Mast cell degranulation

 E  Clonal selection

 Protection against microorganisms inside cells is provided by:

 A  T-cells

 B  Antibody

 C  C3b

 D  C1q

 E  The membrane attack complex

 A Fab fragment:

 A  Is produced by pepsin treatment.

 B  Is produced by separation of heavy and light chains.

 C  Binds antigen.

 D  Lacks light chains.

 E  Has no interchain disulfide bonds.

 The complementarity determining regions:

 A  Are restricted to light chains.

 B  Are in the constant part of the Ig molecule.

 C  Bind to Fc receptors.

 D  Are concerned in antigen recognition.

 E  Occur at the C-terminal end of the Ig peptide chains.

Ig idiotypes are found:

 A  In the constant region of the heavy chain.

 B  In the constant region of the light chain.

 C  In the hinge region.

 D  In the variable region of both heavy and light chains.

 E  Only in the light chain.

Correct. Idiotypes are the collection of epitopes on the variable region of an immunoglobulin which are recognized by a collection of antibodies directed against them
(the so-called anti-idiotypic serum).

Next question
 Which of the following statements does not apply to IgG?:

 A  Appears early in the primary immune response.

 B  Neutralizes bacterial toxins.

 C  Can fix complement.

 D  Crosses the human placenta.

 E  Opsonizes bacteria.

 IgA in seromucus secretions:

  A  Has no J-chain.

 B  Has no secretory piece.

 C  Is dimeric.

 D  Cannot bind to neutrophils.

 E  Activates the classical complement pathway.

  IgM:

 A  Is usually of high affinity.

 B  Is most commonly tetrameric.

 C  Has the same number of constant domains as IgG.

 D  Is a weak bacterial agglutinator.

 E  Is the main class of the 'natural antibodies'.

Correct. The natural antibodies which include many anti-bacterial antibodies, arise largely without external antigenic stimulation. In the mouse they are made by the
+
CD5  B1 subset.

 IgD:

 A  Is pentameric.

 B  Is resistant to proteolytic degradation.

 C  Is present mainly as a surface receptor on B-cells.

 D  Is present with unusual frequency in myelomas.

 E  Is abundant in milk

IgE:

 A  Is abundant in saliva.

 B  Binds strongly to mast cells.

 C  Cannot bind to macrophages.

 D  Activates the complement cascade.

 E  Has an insignificant role in worm infestations

Cleavage of IgG by papain produces:

 A  Divalent antigen binding fragments.

 B  Isolated light chains.

 C  Isolated heavy chains.

 D  F(ab')2.

 E  Fab.
Correct. Papain splits the hinge sequences above the inter-heavy chain disulfide bond and produces a monovalent antigen binding fragment consisting of light chain and
part of the heavy chain containing the VH and CH1 domains.

Next question

The Fab region of an Ig is responsible for:

 A  C1q fixation.

 B  Binding to antigen.
  C  Binding to Fc receptors.

 D  Binding to macrophages.

 E  The ability of Ig to cross the human placenta.

 The first immunoglobulin heavy chain class to be expressed on the surface of a newly produced B-cell is:

 A  IgA

 B  IgD

 C  IgE

 D  IgG

 E  IgM

 A B-cell is able to make cell-surface and secreted versions of antibody using:

 A  Different gene pools.

 B  Differential splicing.

 C  Different heavy chain class but the same light chain.

 D  Different light chain class but the same heavy chain.

 E  F(ab')2 fragments.
Correct. Differential (alternative) splicing of a primary RNA transcript can produce antibody either with or without exons encoding a hydrophobic transmembrane
sequence which leads to retention of antibody in the cell surface membrane.

Next question

 NK cells lack receptors with:

 A  Specificity for MHC class II molecules.

 B  Specificity for MHC class I molecules.

 C  C-type lectin domains.

 D  Immunoglobulin-like domains.

 E  Specificity for the Fc region of IgG.

The MHC class I heavy chain consists of:

 A  Beta2-microglobulin.

 B  Three Ig-type domains.

 C  A truncated MHC class II heavy chain.

 D  Three globular domains.

 E  Two globular domains.

Correct. They consist of one membrane-proximal immunoglobulin-type domain and two membrane-distal domains which form a grooved structure comprising two
extended alpha-helices lying on top of a beta-pleated sheet floor which can bind peptides generated by cytoplasmic protein processing.

  The molecules mediating signal transduction following antigen binding to cell surface immunoglobulin on a B-cell are called:

 A  Ig Fc

 B  Ig-alpha and Ig-beta

 C  MHC
  D  CD4

 E  CD8
Correct. Ig-alpha and Ig-beta possess C-terminal cytoplasmic regions which become phosphorylated upon cross-linking of membrane immunoglobulin, leading to a rapid
mobilization of intracellular calcium.

Next question

The T-cell receptor for antigen is:

 A  Derived from the immunoglobulin gene pool by alternative splicing.

 B  A tetramer.

 C  A homodimer.

 D  A heterodimer.

 E  A single chain molecule.

Correct. There are two versions of the T-cell receptor, both of which are heterodimers consisting of an alpha chain and a beta chain, or a gamma chain and a delta chain

Next question

Each chain of the T-cell receptor consists of:

 A  An Ig heavy chain.

 B  Two Ig-type domains.

 C  A fibronectin-type domain.

 D  Glycolipid molecules.

 E  Four Ig-type domains.

Correct. Immunoglobulin-type domains are found in a large number of cell surface and soluble molecules, some of which fulfil roles in the immune system (e.g.
immunoglobulins, T-cell receptors, MHC, CD4, CD8) but many of which are found elsewhere such as in the nervous system.

The T-cell receptor antigen recognition signal is transduced by:

 A  The TCR alpha chain.

 B  The TCR beta chain.

 C  CD1.

 D  CD2.

 E  CD3.
Correct. CD3 is a molecule composed of five polypeptide chains (CD3-gamma, -delta, and -epsilon plus zeta-zeta, eta-eta or zeta-eta), which transduces the antigen
recognition signal received by the T-cell receptor heterodimer to the inside of the cell.

Next question

MHC class II molecules are found on:

 A  Virtually all cells in the body.

 B  B cells, dendritic cells and macrophages.

 C  Only gamma-interferon activated cells.

 D  Virtually all nucleated cells in the body.

 E  Only on virally-infected cells.

A hapten is:
  A  An epitope.

 B  A paratope.

 C  A small chemical grouping which reacts with preformed antibodies.

 D  A carrier.

 E  An immunogen.
Correct. The chemical grouping reacts with preformed antibodies including that on the specific B-cell surface but cannot induce an antibody response.

Next question

A discontinuous antigen epitope is:

 A  Presented by MHC molecules.

 B  Usually concave.

 C  Representative of only a minority of B-cell epitopes.

 D  Produced by a continuous linear peptide sequence.

 E  Produced by amino acid residues on non-adjacent polypeptide sequences.

Correct. Residues which may be far apart on the linear sequence of a protein may be brought close together in space by the protein folding. Denaturation of the protein
will tend to result in a loss of binding power for antibody.

Next question

 Binding of antigen to antibody:

 A  Is usually unaffected by molecular rigidity.

 B  Is unaffected by the presence or absence of water molecules.

 C  Involves covalent bonding.

 D  Is optimized by spatial complementarity.

 E  Is usually unaffected by pH.

The intermolecular forces which contribute to the interaction between antibody and antigen:

 A  Are all electrostatic.

 B  Are all van der Waals.

 C  Are all hydrophobic.

 D  Are all hydrogen bonds.

 E  Rely on a combination of the above.

 Which of the following statements is incorrect? Affinity is:

 A  A measure of the strength of the binding of antigen to antibody.

 B  The association constant of the Ag/Ab equilibrium.

 C  Avidity.

 D  Related to the free energy change of the Ag/Ab interaction.

 E  Related to specificity.
Correct. This statement is untrue because avidity refers to the functional 'affinity' of the interaction between a (at least) divalent antibody and a multivalent antigen. In
such cases the avidity is much greater than the intrinsic affinity of the binding of one paratope to one epitope due to the bonus effect of multivalency.

Next question
The antigen moiety on an antigen-presenting cell recognized by the alpha beta T-cell receptor is:

 A  Native protein antigen plus major histocompatibility complex (MHC) molecule.

 B  Processed (peptide) antigen plus MHC.

 C  Processed peptide antigen.

 D  Native antigen.

 E  MHC alone.

The processing of cytosolic protein involves:

 A  Transport into late endosomes.

 B  Proteasome-mediated cleavage.

 C  Displacement of invariant chain.

 D  Displacement of beta2-microglobulin.

 E  Binding to the MHC class II groove.

Correct. The cytosolic proteins are cleaved to small peptides in the proteasome complex before they are transported by the TAP-1/2 molecules into the endoplasmic
reticulum.

Next question

10  The processed peptide binding to the MHC class I groove:

 A  Is usually more than 11 amino acids long.

 B  Hangs over the ends of the groove.

 C  Usually binds to the groove through 2 anchor residues.

 D  Is mainly recognized by the CDR2 of the T-cell receptor chains.

 E  Is derived from exogenous protein taken in by endocytosis.

Correct. Each polymorphic MHC class I molecule usually has two, although sometimes there are three, major pockets associated with the groove which bind strongly to
side chains on the processed peptide.

11  TCR recognition of peptide-MHC class II depends on:

 A  Covalent binding.

 B  Very high affinity interactions.

 C  CDR-mediated binding.

 D  A minimum of 2 peptides occupying the binding groove of each MHC molecule.

 E  The presence of beta2 microglobulin.

Correct. As with antibody molecules, it is the CDRs which are primarily involved in the recognition process.

Next question

12  Cross-presentation of exogenous antigen to   T-cells does not require the involvement of:

 A   Peptide-MHC recognition by the T-cell receptor.

 B  Antigen-processing

 C  MHC class I

 D  MHC class II

 E  An antigen-presenting cell.

Correct. Exogenous antigen is conventionally presented by MHC class II, but if being cross-presented on MHC class I then MHC class II is not required.
 Next question

17  Superantigens:

 A  Do not cause pathology.

 B  Are not mitogenic for T-cells.

 C  Bind to MHC class III.

 D  Bind to all members of a given V beta T-cell receptor family.

 E  Have to be processed before recognition by the T-cell.

Correct. They recognize the common structures in a given V beta T-cell receptor family and bind to all of them, cross-linking the T-cell to the MHC class II on an antigen-
presenting cell. This is a powerful stimulus.

19  An epitope:

 A  Is the area on an antigen which contacts antibody.

 B  Is the area on an antibody which contacts antigen.

 C  Requires both antigen-binding arms of the antibody molecule for its recognition.

 D  Is usually composed of a linear sequence of amino acids.

 E  Is usually associated with a concave region of the antigen.

20  The binding of antigen to antibody:

 A  Is irreversible.

 B  Depends on covalent interactions.

 C  Occurssolely by hydrophobic bonding.

 D  Depends on spatial complementarity.

 E  Is always of high affinity.

21  Alpha beta T-cell receptors recognize:

 A  Native antigen.

 B  Free linear antigenic peptide.

 C  MHC beta2-microglobulin.

 D  Linear antigen peptide in the MHC groove.

 E  Lipid and glycolipid antigens associated with the MHC.

22  Peptides produced by processing of cytosolic proteins largely:

 A  Are generated in late endosomal vacuoles.

 B  Enter the endoplasmic reticulum by diffusion.

 C  Are presented at the cell surface with MHC class II to CD4 T-helpers.

 D  Are presented at the cell surface with MHC class II to CD8 cytotoxic T-cells.

 E  Are presented at the cell surface with MHC class I to CD8 cytotoxic T-cells.

23  Antigenic peptides in the MHC class I groove:

 A  Are usually over 12 residues in length.

 B  Are usually under 12 residues in length.

  C  Extend beyond the groove.

 D  Usually have 3 or more invariant anchor residues.

 E  Do not vary at non-anchor residues.

2  Antibody titer refers to the:

 A  Absolute amount of specific antibody.

 B  Affinity of specific antibody.

 C  Avidity of specific antibody.

 D  Concentration of specific antibody.

 E  Highest dilution of antibody still able to give a positive result in a test system.

5  Latex particles are often used in:

 A  Agglutination tests.

 B  Affinity chromatography.

 C  Affinity measurements.

 D  Adjuvants.

 E  Neutralization assays.

8  Characterization of antigens by electrophoresis and immunofixation relies on the reaction of antigen and antibody in (or on):

 A  Agar.

 B  Streptavidin.

 C  Gold-plated sensor chip.

 D  Latex particles.

 E  Plastic microtiter plates.

9  Western blots are primarily used to detect:

 A  Protein.

 B  Carbohydrate.

 C  Lipid.

 D  RNA.

 E  DNA.

29  In an ELISA you might use an antigen or antibody labeled with:

 A  125I

 B  FITC

 C  Colloidal gold

 D  Europium 3+

 E  Horseradish peroxidase

1  Which one of the following is a primary lymphoid organ:

  A  Lymph nodes

 B  Spleen

 C  Peyer's patch

 D  Tonsil

 E  T hymus

12  Which of the following functions are macrophages unable to carry out:

 A  Pinocytosis.

 B  Phagocytosis.

 C  Antigen processing.

 D  T-cell priming.

 E  Antigen presentation to activated cells.

Correct. Macrophages have an impressive range of functions but appear unable to prime naive lymphocytes. This can be carried out by lymphoid interdigitating dendritic
cells and cultured, but not freshly isolated, Langerhans' cells.

Next question

14  Langerhans' cells are found in:

 A  Lymph

 B  Lymph nodes

 C  Periarteriolar lymphoid sheaths

 D  Skin

 E  Mantle zone

15  Lymphocytes:

 A  Enter the tissues and remain there for the rest of their life.

 B  When mature are only found in secondary lymphoid organs.

 C  Recirculate between blood and lymphoid tissues.

 D  Are only educated in the thymus.

 E  When present in the lymph are called veiled cells.

Correct. Lymphocyte recirculation between the blood and lymphoid tissues is guided by specialized homing receptors on the surface of high walled endothelium of the
postcapillary venules. They then re-enter the bloodstream via the thoracic duct.

17  The spleen is largely involved with the response to antigens which are in the:

 A  Tissues

 B  Blood

 C  Gut

 D  Lungs

 E  Urogenital tract

19  Lymphocytes in the lamina propria secrete large amounts of:

 A  IgD.

 B  IgA.
  C  Gamma delta TCR.

 D  Bence Jones protein.

 E  Isolated secretory component.

Correct. In the gut, antigen enters Peyer's patches across specialized epithelial cells and stimulates antigen-sensitive lymphocytes which after activation drain into the
lymph, then pass via the mesenteric lymph nodes, thoracic duct and bloodstream, to the lamina propria where they become IgA-forming cells.

1  CD8 is a marker of:

 A  B-cells

 B  Helper T-cells

 C  Cytotoxic T-cells

 D  An activated macrophage

 E  A neutrophil precursor

2  CD4:

 A  Is essentially an intracellular glycoprotein.

 B  Is heterodimeric.

 C  Binds processed peptide in its outer groove.

 D  Binds to MHC class II on antigen-presenting cells.

 E  Is highly polymorphic.

3  The following is characteristic of B- but not T-cells:

 A  Class I MHC.

 B  CD3.

 C  Measles virus receptor.

 D  Polyclonal activation by concanavalin A.

 E  Surface immunoglobulin.

14  The carrier T-cell epitope on a thymus-dependent antigen:

 A  Behaves like a hapten.

 B  Needs to be polymeric.

 C  Need not be physically connected to the B-cell epitope.

 D  Is a carbohydrate.

 E  Stimulates help for the B-cell response.

18  B-cells as distinct from T-cells:

 A  Are polyclonally activated by phytohemagglutinin.

 B  Bear surface Ig receptors for antigen.

 C  Bear surface CD3 molecules.

 D  Are lymphocytes.

 E  Can be activated by stimulation through the antigen receptor alone.

19  The T-cell receptor link to MHC/peptide is enhanced by interaction between MHC class II on the antigen-presenting cells with the following molecule on the T-cell:
  A  LFA-1

 B  CD2

 C  CD4

 D  CD8

 E  CD28
Correct. CD4 on helper T

2  Cytokines always act:

 A  By binding to specific receptors.

 B  In an autocrine fashion.

 C  At long range.

 D  Antagonistically with other cytokines.

 E  Synergistically with other cytokines.

6  Which of the following is characteristically produced by the Th2 CD4 cells which provide help for antibody production, but not by Th1 cells?:

 A  IFN-gamma

 B  Lymphotoxin (TNF-beta)

 C  GM-CSF

 D  IL-4

 E  IL-1

10  Prior to class switching, B-cells express:

 A  IgA alone

 B  IgA and IgG

 C  IgM and IgD

 D  IgD alone

 E  No surface Ig
Correct. Differential splicing allows coexpression of IgM and IgD with identical V regions on a single cell. IgD is lost upon antigen stimulation so that memory B-cells lack
this class of immunoglobulin.

11  The cytokine which is most involved in the class switch to IgE production is:

 A  IL-1

 B  IL-2

 C  TGF beta

 D  IL-4

 E  IL-5
Correct. Class switching to IgE can be induced by IL-4 either alone or together with IL-13, whereas IL-4 plus IL-5 tend to support IgM production and IL-4, - 5, - 6, - 13
and IFN-gamma are optimal for IgG production.

17  Th1 cells secrete:

 A  CD4.

 B  IL-4.
  C  IL-5.

 D  IL-6.

 E  Interferon-gamma.
Correct. Th1 cells are concerned with inflammatory processes, macrophage activation and delayed sensitivity. They produce IFN-gamma, IL-2, IL-3, TNF and GM-CSF.

1  A major factor regulating the adaptive immune response is:

 A  The neutrophil.

 B  Complement membrane attack complex.

 C  C-reactive protein.

 D  Antigen concentration.

 E  Haptoglobin.
Correct. Lymphocytes are directly driven by antigen. The concentration of antigen is important because the binding to the surface of responding B-cells is necessary for
continued stimulation. As the antigen concentration falls through catabolism or neutralisation or complex formation with antibody, so the immune response diminishes. In
this way the immune response is not maintained at a high level when the antigen has been eliminated.

6  Suppression of Th2 by Th1 cells may be mediated by:

 A  IL-1.

 B  IL-3.

 C  IL-4.

 D  GM-CSF.

 E  Interferon-gamma.
Correct. Conversely, suppression of Th1 cells by Th2 cells is mediated by IL-4 and, in the mouse, IL-10.

7  Cells bearing MHC class I plus peptide are targets for specific:

 A  B-cells.

 B  Cytotoxic T-cells.

 C  Th1 cells.

 D  Th2 cells.

 E  Interdigitating dendritic cells.

1  The first production of live but non-virulent forms of chicken cholera bacillus was achieved by:

 A  Pasteur.

 B  Salk

 C  Jenner

 D  Montague

 E  Sabin
Correct. A culture of chicken cholera bacillus accidently left on the bench during the warm summer months lost much of its ability to cause disease, but could protect
birds from the effects of fresh virulent bacillus. Pasteur also obtained similar results for anthrax and rabies.

3  The circulation of a two month old breast-fed baby will contain maternal:

 A  IgA

 B  IgD

 C  IgE
  D  IgG

 E  IgM

Correct. Maternal IgG is transferred across the placenta from the mother to the fetus by a mechanism involving the specific Fc gamma receptor FcRn IgG is the only
immunoglobulin class to cross the placenta. Immunoglobulins in the milk (mostly secretory IgA) will provide enteric protection for the baby but are not absorbed. Thus
the maternal immunoglobulin in the circulation of a 2-month-old-baby will mostly be placentally-transferred IgG which will provide 'cover' for the first few months of life.
4  What is the minimum percentage of children which needs to be vaccinated successfully in order to achieve herd immunity to diphtheria;

 A  100%

 B  10%

 C  50%

 D  75%

 E  Herd immunity cannot be achieved against diphtheria

Correct. Herd immunity can only be achieved in those diseases which depend on human transmission, such as diphtheria. Thus, in the case of tetanus, active
immunization is of benefit to the individual, but not to the community, since it will not eliminate the organism which is found in the feces of domestic animals and persists
in soil as highly resistant spores.

5  For vaccination against mycobacterial diseases such as tuberculosis, the most important facet of the immune response to be stimulated is:

 A  A high titer of antibody

 B  Macrophage-activating cell-mediated immunity

 C  Cytotoxic T-cells

 D  Antibody in the gut lumen

 E  Neutrophils
Correct. The objective of vaccination is to provide effective immunity. The particular immune mechanisms which need to be stimulated, and the site of the immune
response evoked by vaccination, will differ for different organisms. Mycobacteria are found as intracellular infections within macrophages and therefore stimulating T-
cells to produce macrophage-activating cytokines such as IFN-gamma is appropriate in this case.

6  Which one of the following diseases has been completely eradicated world-wide?:

 A  Measles

 B  Smallpox

 C  Tuberculosis

 D  Cowpox

 E  Psittacosis
Correct. The eradication of smallpox was due to an enormous World Health Organization (WHO)-sponsored effort combining extensive vaccination and selective
epidemiologic control methods. The WHO also hope to eradicate poliomyelitis in the near future.

Next question

7  BCG is used to protect against:

 A  Tuberculosis

 B  Rabies

 C  Hepatitis B

 D  Influenza

 E  Pertussis
Correct. Bacille Calmette Guérin (BCG) was developed by Calmette and Guérin by chance in 1908 at the Institut Pasteur in Lille. They added bile to the culture medium
in an attempt to achieve dispersed growth of Mycobacterium tuberculosis, but it became attenuated and successfully protected vaccinated children against tuberculosis.
However, although BCG has been in use for 70 years and is reasonably efficacious and safe in healthy non-T-cell deficient subjects, in some parts of the world it elicits
a relatively poor degree of protection against TB and Mycobacterium leprae.

8  A small protein subunit used in a vaccine may fail to stimulate T-cell immunity because of:
  A  Lack of glycosylation

 B  Lack of conformation

 C  Lack of carrier determinants

 D  HLA-related unresponsiveness

 E  Inherently insufficient antigen concentration

Correct. A major concern about subunit vaccines, especially when just short peptides are used, is the variation in ability to associate with the different polymorphic forms
of MHC molecules present in an outbred population.

12  Tetanus toxoid is usually given to humans:

 A  Absorbed to aluminum hydroxide

 B  With complete Freund's adjuvant

 C  Without the addition of any other agent

 D  Together with the toxin

 E  Only as a therapeutic agent, not prophylactically

Correct. Bacterial exotoxins can be detoxified by formaldehyde treatment which does not destroy the major immunogenic determinants. The toxoid is generally given
after adsorption to aluminum hydroxide which acts as an adjuvant and produces higher antibody titers.

13  A potential disadvantage of immunological protection using passive transfer of horse globulins is:

 A  Serum sickness

 B  Irreversible protection

 C  Lack of antibody-mediated immune response

 D  Type IV hypersensitivity reactions

 E  Immunodeficiency
Correct. Horse globulins containing anti-tetanus and anti-diphtheria toxins have been extensively employed prophylactically, but have the drawback that serum sickness
develops in response to foreign proteins, producing vasculitic skin rashes, swollen joints and transient albuminuria due to immune complex-mediated inflammatory
reactions.

Next question

12  Which type of hypersensitivity cannot be transferred with serum antibody?:

 A  Type I.

 B  Type II.

 C  Type III.

 D  Type IV.

 E  Type V.

13  Anaphylaxis can be triggerred by cross-linking of IgE receptors on:

 A  Monocytes.

 B  Mast cells.

 C  B-cells.

 D  Eosinophils.

 E  Neutrophils.
Correct. Cross-linking of IgE antibodies bound to the high affinity IgE receptor (Fc epsilon RI) on mast cells by a bivalent antigen will trigger mediator release; trivalent
antigens are more effective and tetravalent antigens even more so. Degranulation is also induced when the IgE is cross-linked with anti-IgE but univalent (Fab) anti-IgE
is inactive. That the critical event is the cross-linking of the receptors themselves is clearly shown by the ability of antibodies reacting directly with the receptor to trigger
the mast cell.
14  Rhesus hemolytic disease of the newborn involves:

 A  IgE.

 B  Antibody to cell surfaces.

 C  Soluble immune complexes.

 D  Cytokine release from T-cells.

 E  Stimulatory antibodies.
Correct. Rhesus incompatibility between mother and fetus leads to a type II hypersensitivity reaction due to the passage across the placenta of IgG antibodies to the
fetal RhD.

16  Type IV hypersentivity is often referred to as:

 A  Immediate.

 B  Delayed.

 C  Anaphylactic.

 D  Anergic.

 E  Allotypic.
Correct. Type IV hypersensitivity involves T-cell recognition and because of the longer time course of the reaction, this is sometimes referred to as delayed-type
hypersensitivity.

Next question

17  The injection of tuberculin into the skin of a sensitized individual elicits:

 A  Immune complex glomerulonephritis.

 B  Jarisch-Herxheimer reaction.

 C  Isohemagglutinins.

 D  Jones-Mote sensitivity.

 E  Mantoux reaction.
Correct. A type IV delayed-type hypersensitivity characterized by erythema and induration which appears only after several hours and reaches a maximum at 24–48 h,
by which time the predominant cell types are lymphocytes and monocytes/macrophages.

Next question

18  The major effector molecules involved in type IV hypersensitivity reactions are:

 A  Antibodies.

 B  Complement components.

 C  Cytokines.

 D  Prostaglandins.

 E  5-hydroxytryptamine (5-HT).
Correct. Type IV hypersensitivity is based upon the interaction of antigen with primed T-cells which then release cytokines which mediate the events which occur in this
type of hypersensitivity.

19  Septic shock associated with Gram-negative bacteria is primarily due to:

 A  Lipopolysaccharide.

 B  Enterotoxin superantigen.

 C  Platelet aggregation.
  D  Switch off of cytokine release.

 E  Peptidoglycans.
Correct. Septicemia associated with Gram-negative bacteria results primarily from excessive release of tumor necrosis factor (TNF), IL-1 and IL-6, through stimulation of
macrophages and endothelial cells by the lipopolysaccharide (LPS) endotoxin.

Next question