1.

The principal function of the immune system is:

A. Defense against cancer

B. Repair of injured tissues
C. Defense against microbial infections
D. Prevention of inflammatory diseases
E. Protection against environmental toxins

2. A previously healthy 8-year-old boy is infected with an upper respiratory tract virus for the first
time. During the first few hours of infection, which one of the following events occurs?

A. The adaptive immune system responds rapidly to the virus and keeps the viral infection
under control.
B. The innate immune system responds rapidly to the viral infection and keeps the viral
infection under control.
C. Passive immunity mediated by maternal antibodies limits the spread of infection.
D. B and T lymphocytes recognize the virus and stimulate the innate immune response.
E. The virus causes malignant transformation of respiratory mucosal epithelial cells, and the
malignant cells are recognized by the adaptive immune system.

3. Which of the following is a unique property of the adaptive immune system?

A. Highly diverse repertoire of specificities for antigens

B. Self-nonself discrimination
C. Recognition of microbial structures by both cell-associated and soluble receptors
D. Protection against viral infections
E. Responses that have the same kinetics and magnitude on repeated exposure to the same
microbe

4. Antibodies and T lymphocytes are the respective mediators of which two types of immunity?

A. Innate and adaptive

B. Passive and active
C. Specific and nonspecific
D. Humoral and cell-mediated
E. Adult and neonatal

5. A standard treatment of animal bite victims, when there is a possibility that the animal was
infected with the rabies virus, is administration of human immunoglobulin preparations
containing anti-rabies virus antibodies. Which type of immunity would be established by this
treatment?
 A. Active humoral immunity
B. Passive humoral immunity
C. Active cell-mediated immunity
D. Passive cell-mediated immunity
E. Innate immunity

6. At 15 months of age, a child received a measles-mumps-rubella vaccine (MMR). At age 22, she is
living with a family in Mexico that has not been vaccinated and she is exposed to measles.
Despite the exposure, she does not become infected. Which of the following properties of the
adaptive immune system is best illustrated by this scenario?

A. Specificity
B. Diversity
C. Specialization
D. Memory
E. Non-reactivity to self

7. A vaccine administered in the autumn of one year may protect against the prevalent strain of
influenza virus that originated in Hong Kong that same year, but it will not protect against
another strain of influenza virus that originated in Russia. This phenomenon illustrates which
property of the adaptive immune system?

A. Specificity
B. Amnesia
C. Specialization
D. Cultural diversity
E. Self-tolerance

8. The two major functional classes of effector T lymphocytes are:

A. Helper T lymphocytes and cytotoxic T lymphocytes
B. Natural killer cells and cytotoxic T lymphocytes
C. Memory T cells and effector T cells
D. Helper cells and antigen-presenting cells
E. Cytotoxic T lymphocytes and target cells

9. Which of the following cell types is required for all humoral immune responses?

A. Natural killer cells

B. Dendritic cells
C. Cytotoxic T lymphocytes
D. B lymphocytes
E. Helper T lymphocytes
10. During a humoral immune response to a newly encountered bacterial infection, B cells are first
stimulated to proliferate and then secrete antibodies specific for the bacterium. The antibodies
may then bind to the bacteria and facilitate ingestion of the microbes by phagocytic cells. In
what phase of the humoral immune response does the binding of secreted antibodies to
bacteria occur?

A. Recognition phase
B. Activation phase
C. Effector phase
D. Homeostatic phase
E. Memory phase

11. Which of the following statements is consistent with the process of clonal selection?

A. The specificity of a lymphocyte antigen receptor changes to accommodate the structure of

an antigen that binds to it.
B. Many different antigen receptors with different specificities are expressed on each
lymphocyte.
C. Lymphocytes do not express antigen receptors on their cell surfaces until after exposure to
antigen.
D. The diversity of the lymphocyte repertoire for antigens is very small before exposure to
antigen but increases significantly after antigen exposure.
E. The diversity of the lymphocyte repertoire for antigens is very large before exposure to
antigen, with millions of different clones of lymphocytes, each having a different specificity.

12. Which of the following best describes clonal expansion in adaptive immune responses?

A. Increased number of different lymphocyte clones, each clone specific for a different antigen
during the course of an infection
B. Increased number of different lymphocyte clones, each clone specific for a different antigen
during development of the immune system, before exposure to antigen
C. Increased number of lymphocytes with identical specificities, all derived from a single
lymphocyte due to nonspecific stimuli from the innate immune system
D. Increased number of lymphocytes with identical specificities, all derived from a single
lymphocyte stimulated by a single antigen
E. Increased size of the lymphocytes of a single clone due to antigen-induced activation of the
cells

13. In addition to T cells, which cell type is required for initiation of all T cell-mediated immune
responses?
 A. Effector cells
B. Memory cells
C. Natural killer cells
D. Antigen-presenting cells
E. B lymphocytes

14. Interleukin (IL)-2 is a cytokine produced by T lymphocytes that acts as a growth factor for T
lymphocytes. A T cell may bind and respond to the same IL-2 molecules it secretes. Which of the
following terms best describes this mode of action of a cytokine?

A. Endocrine
B. Paracrine
C. Autocrine
D. Autoimmune
E. Holocrine

15. Which one of the following pairs of cytokines has the most redundant functions in innate
immune responses?

A. IL-12 and TNF

B. TNF and IL-1
C. IFN-gamma and IL-10
D. IFN-alpha and IFN-gamma
E. IL-1 and IL-4

16. Anti-tumor necrosis factor (TNF) antibodies are now used in the treatment of patients with
rheumatoid arthritis. A complication of this therapy, seen in a subset of patients, is infections
with various microorganisms, including bacteria and fungi. Which of the following is a function
of TNF that is important in the defense against infections and is likely to be impaired in the
setting of TNF blockade?

A. Induction of fever
B. Reduction in cardiac output
C. Enhanced procoagulant activity of endothelial cells
D. Enhanced glucose utilization by muscle cells
E. Induction of E-selectin expression on endothelial cells

17. One of the principal functions of interleukin (IL)-12 is to enhance the production of which of the
following cytokines by natural killer (NK) cells and T lymphocytes?

A. IL-4
B. TNF
 C. IL-10
D. IL-2
E. IFN-gamma

18. A 19-year-old woman sees the physician because of severe systemic Mycobacterium avium-
intracellulare infections. She had a history of three similar mycobacterial infections between the
ages of 4 and 17 years and severe systemic Salmonella type B infections when she was 4, 7, and
14 years of age. No abnormalities in numbers or cell surface markers of T cells, B cells, natural
killer cells, or macrophage cells were detectable. Mononuclear cells from the patient's blood
produced very little IFN-gamma in response to various stimuli when compared with cells from a
healthy donor. The patient responded well to treatment with antibiotic therapy. Which of the
following is the most likely explanation for this patient's medical history?

A. Defect in interleukin (IL)-12 receptor signaling

B. Defect in IL-4 receptor signaling
C. Defect in cytotoxic T lymphocyte function
D. Defect in B cell antibody production
E. Defect in IL-7 receptor expression

19. Which of the following is a mechanism by which the type I interferons IFN-alpha and IFN-beta
function to eradicate viral infections?

A. Enhance class II MHC expression

B. Enhance IFN-y production by macrophages
C. Induce apoptosis of virally infected cells
D. Enhance class I MHC expression
E. Enhance expression of terminal deoxynucleotidyl transferase (TdT)

20. Inflammatory bowel disease (IBD) is characterized by a dysregulated inflammatory response in

the intestinal mucosa, including abnormally high expression of various inflammatory cytokines
by macrophages. Which one of the following cytokines is the most logical choice as a potential
therapeutic agent for IBD?

A. IL-1
B. IL-10
C. IL-12
D. IL-6
E. IL-2

Try but you may not answer question #21

21. Which of the following cytokines is NOT a product of antigen-activated T cells?
 A. IL-2
B. IL-4
C. IL-5
D. IFN-gamma
E. IFN-alpha

Try but you may not answer question #22

22. A 3-month-old boy is taken to the pediatrician because of diarrhea, failure to thrive,
mucocutaneous candidiasis, and respiratory syncytial virus infection. Laboratory analyses
indicate an absence of T cells, normal numbers of B cells, but very low immunoglobulin levels.
This clinical presentation is consistent with a mutation in the gene encoding a signaling chain
shared by which of the following groups of cytokine receptors?

A. IL-2, IL-4, and IL-7

B. Receptors for granulocyte-macrophage colony-stimulating factor (GM-CSF), IL-3, and IL-5
C. Receptors for IL-6 and IL-11
D. Receptors for interferon IFN-gamma and IFN-alpha
E. Receptors for IL-12 and IL-23

23. Which type of white blood cell is most numerous in normal human blood?
A. Basophil
B. Lymphocyte
C. Monocyte
D. Neutrophil
E. Eosinophil

24. Which of the following cell types do NOT have clonally distributed antigen receptors?

A. Natural killer cells

B. Cytotoxic T lymphocytes
C. Naive B cells
D. Helper T lymphocytes
E. Memory B cells

25. In the blood of a healthy individual, the most abundant type of lymphocyte is the:

A. CD4+T cell
B. CD8+T cell
C. B cell
D. Natural killer cell
E. Plasma cell
Remember you are always asked to find the BEST answer, not just an answer!

26. A 52-year-old man who receives radiation therapy and cytotoxic drugs for treatment of cancer
sustains significant damage to his bone marrow. Which of the following changes will most likely
occur?
A. Decreased production of B lymphocytes but not T lymphocytes
B. Decreased production of T lymphocyte but not B lymphocytes
C. Decreased production of neutrophils and monocytes but not B or T lymphocytes
D. Decreased production of B lymphocytes and T lymphocytes
E. Normal production of all blood cells due to compensatory hematopoiesis

27. In DiGeorge syndrome, the thymus fails to develop. Which of the following characterizes the
immuno-deficiency state in this syndrome?
A. Deficiency in monocytes and tissue macrophages
B. Defect in naive B cell activation and antibody production in response to bacterial
polysaccharides
C. Deficiency in T lymphocytes and associated defects in cell-mediated immunity
D. Normal numbers of naive T cells that cannot be activated by antigen
E. Deficiency in B cell maturation

28. Which of the following statements about memory cells is NOT true?

A. Memory cells can survive for several years.

B. Memory cells are responsible for the more rapid and enhanced responses to antigen upon
secondary exposure, as compared with primary responses.
C. Memory cells can be distinguished from naive cells by the expression of certain cell surface
molecules.
D. Memory cells continuously produce effector cytokines.
E. Many memory cells express adhesion molecules that favor their migration to peripheral sites
of infection.

29. Mononuclear phagocytes participate in adaptive immune responses in each of the following
ways EXCEPT:

A. Antigen presentation to T lymphocytes

B. Activation by helper T cells to kill ingested microbes
C. Production of proinflammatory cytokines
D. Ingestion of microbes opsonized by antibodies
E. Antigen-specific killing of virus-infected cells

30. Tissue macrophages are derived from which type of circulating blood cell?
 A. Polymorphonuclear leukocyte
B. Small lymphocyte
C. Monocyte
D. Basophil
E. Lymphoblast

31. Which of the following is the generative lymphoid organ for T lymphocytes?

A. Bone marrow
B. Spleen
C. Lymph node
D. Thymus
E. Tonsil

No questions #32, 33, and 34

32.

33.

34.

35. Which one of the following descriptions of class I MHC molecules is NOT true?

A. The principal function of class I MHC molecules is to display peptides derived from cytosolic
proteins on the cell surface.
B. Class I MHC molecules bind to CD8 molecules on T cells.
C. Human class I MHC molecules include HLA-A, HLA-B, and HLA-C.
D. Class I MHC molecules are normally expressed only on dendritic cells and other professional
APCs.
E. A cell expresses class I MHC molecules encoded by genes inherited from both parents.

36. Which of the following statements about class II MHC molecules is NOT true?

A. Class II MHC molecules bind peptides derived from extracellular proteins.

B. Class II MHC molecules bind to CD4 molecules on T cells.
C. Class II MHC molecules are expressed on a limited number of cell types, including dendritic
cells.
D. HLA-DR and HLA-DQ are human class II MHC molecules.
E. Class II MHC molecules are not expressed on cells that express class I MHC molecules.
37. The three major families of antigen-binding molecules in the adaptive immune system are:

A. Toll-like receptors, MHC molecules, and antibodies

B. MHC molecules, integrins, and antibodies
C. Antibodies, T cell receptors, and selectins
D. Antibodies, T cell receptors, and MHC molecules
E. MHC molecules, antibodies, and Fc receptors

38. Which of the following statements about antibodies is NOT true?

A. They serve as membrane-bound antigen receptors on the surface of B cells.
B. In secreted form, they serve as effector molecules that facilitate the elimination of microbes
or toxins.
C. They are specific for proteins and polysaccharides exclusively.
D. They bind antigen with average higher affinity than do T cell receptors.
E. They are present in most biologic fluids in the body.

39. Detection of antibodies specific for a particular microbe is commonly used as evidence of prior
infection by that microbe. To obtain these antibodies, blood is collected into tubes and allowed
to clot. Antibodies are found in the fraction of the blood that remains fluid after clotting. What
is this fluid fraction called?

A. Plasma
B. Serum
C. Lymph
D. Water
E. Urine

40. All of the following accurately describe the basic symmetric core structure of an antibody
molecule EXCEPT:

A. Two heavy chains and two light chains

B. Covalent bonds between heavy chains
C. Spatial separation of variable regions from constant regions
D. Covalent bonds between light chains
E. Ag-binding domains in both heavy and light chains

41. The structure of which portion of an antibody defines its isotype?

A. The variable regions of the light chains

B. The variable regions of the heavy chains
C. The constant regions of the heavy chains
D. The J chain
 E. The complementarity-determining regions

42. Which of the following is the major significance of isotypic differences between antibodies?

A. Some isotypes are more likely to be auto-reactive than others.

B. Isotypes reflect allelic variants of heavy chain genes, and each individual in a population will
express only a subset of isotypes.
C. Only certain isotypes of antibodies are radioactive.
D. Function and bodily distribution of antibodies are determined by isotype.
E. The antigen specificity of antibodies is deter-mined by the isotype.

43. Which of the following statements about the innate immune system is NOT true?

A. Innate immunity is present in all multicellular organisms, including plants and insects.
B. Deficiencies in innate immunity markedly increase host susceptibility to infection, even in the
setting of an intact adaptive immune response.
C. Innate immunity is better suited for eliminating virulent, resistant microbes than is adaptive
immunity.
D. The innate immune response can be divided into recognition, activation, and effector phases.
E. The innate immune response against microbes influences the type of adaptive immune
response that develops.

44. A 4-year-old girl stepped on a rusty nail in her backyard. Two days later, she is taken to the
pediatrician because her heel is painful, red, and swollen and is warm to the touch. All of the
following are mechanisms of innate immunity that may be protecting the patient against
pathogenic microbes in the heel wound EXCEPT:

A. Epithelial barrier function of the skin of her foot

B. Intraepithelial lymphocytes present in the skin
C. Circulating neutrophils migrating to the site of the wound
D. Soluble cytokines that induce a local inflammatory response
E. Circulating anti-tetanus toxin antibodies

45. Toll-like receptors (TLRs) are a family of homologous receptors expressed on many cell types
and are involved in innate immune responses. Ten different mammalian TLRs have been
identified, and several ligands for many of these receptors are known. Which of the following is
a TLR ligand?

A. Single-stranded RNA
B. Transfer RNA
C. Double-stranded DNA
D. Unmethylated CpG DNA
 E. Heterochrornatin

46. A 67-year-old homeless man is brought to the emergency department after being found behind
a neighborhood bar in freezing weather. On arrival, he has a shaking chill, fever, and cough
productive of blood-tinged sputum. A chest radiograph shows lobar consolidations consistent
with bacterial pneumonia. Blood cultures are positive for Streptococcus pneumonia. Which of
the following molecular patterns recognized by Toll-like receptors expressed on the surface of
this patient's phagocytes is important for activating his innate immune system against this gram-
positive bacterial infection?

A. Peptidoglycan
B. Double-stranded RNA
C. Lipopolysaccharide (LPS)
D. Lipoarabinomannan
E. Phosphatidylinositol dimannoside

47. Toll-like receptors and other receptors are potent activators of various components of the
innate immune system. All of the following proteins are expressed in response to signaling by
these receptors EXCEPT:

A. Interleukin-12
B. E-selectin
C. Tumor necrosis factor
D. Inducible nitric oxide synthase (iNOS)
E. CD28

48. A 43-year-old man with a history of kidney transplantation is on immunosuppressive drugs. He

presents to the emergency department 84 days after transplantation with a slight fever,
accompanied by violent shaking chills, rapid heart rate, and dangerously low blood pressure.
Blood cultures are positive for gram-negative bacteria, including Klebsiella and Pseudomonas.
Although the patient was initially alert and responsive to fluids and antibiotic therapy, his
condition rapidly deteriorates into septic shock with disseminated intravascular coagulation
(DIG), hypoglycemia, and cardiovascular failure. Which of the following is an essential mediator
of this patient's condition?

A. Transforming growth factor-beta

B. TNF
C. IL-2
D. IL-10
E. IL-3
49. Complement activation in the innate immune system can be initiated in the absence of
antibody. Which of the following molecular components of the complement system is involved
in initiation of antibody-independent complement activation?

A. C1
B. C9
C. Mannose binding lectin
D. CR2
E. Mannose receptor

50. Macrophages and neutrophils express several enzymes that are involved in biochemical
mechanisms that kill ingested microbes. Which of the following is NOT an enzyme expressed by
these cells?

A. Inducible nitric oxide synthase (iNOS)

B. Granzyme B
C. Phagocyte oxidase
D. Myeloperoxidase
E. Lysozyme