Practice examMicro 3200 Immunology: disease scenario questions: Correct answers in bold1. A 25-year old African-American woman with a 13-year-history of systemic lupus erythematosus is referred to nephrologist for evaluation of her kidney function. Results of the blood and urine tests are consistent with glomerulonephritis. Which of the following is the most likely immunologic mechanism involved?1. Immune complex reaction 2. Immediate hypersensitivity reaction3. Antibody-mediated cytotoxicity 4. Cell-mediated hypersensitivity2. A 23-year old medical student received an intradermal PPD (purified protein derivative or tuberculin) injection as a part of the IPC (Introduction to Patient Care) requirements. Forty eight hours later, she developed an area of induration that measured 25 mm in diameter. The response was most likely mediated by which of the following? 1. B cells2. Plasma cells3. T cells4. Eosinophils5. Mast cells3. A 10-year old girl presents with cough, difficulty breathing and wheezing. Her history is remarkable for frequent episodes of bronchitis and recurrent episodes ofwheezing, mostly in the spring and winter, that required multiple emergency visits. She cannot participate in physical education class because of dyspnea. Pulmonary function tests are suggestive of an obstructive airway disease, which improved following administration of albuterol (reduces smooth muscle constriction of airways). What is the most likely cause?1. Antibody and complement mediated destruction of the bronchial epithelium2. Immune complex deposition with subsequent activation of complement system 3. Antigen-crosslinked IgE/FcRI causing mast cell activation and degranulation4. Interaction between antigen, antigen-presenting cells and T cells causing airway inflammation 4. A 20-year old woman presented with scaly, erythematous and itchy rash around her eyes. The lesions appeared several days after she reapplied a lightening hair dye to maintain her new hair color. The dermatologist diagnosed her with allergiccontact dermatitis and prescribed a topical corticosteroid (triamcinolone). Which of the following hypersensitivities was most likely involved?1. Type I2. Type II 3. Type III4. Type IV5. Type V5. A 24-hour old newborn was transferred to the neonatal intensive care unit becauseof jaundice. The baby’s mother was a 19-year old unwed woman with a history ofabortion at age 16. She had had no prenatal care and her HIV and hepatitis B status were unknown. Physical exam revealed a term infant with marked jaundice and enlarged liver. The baby’s and mother’s blood types were ORh+ andARh- respectively. What is the most likely diagnosis?1. AIDS2. Hepatitis B3. ABO incompatibility4. Hemolytic disease of the newborn5. Physiologic jaundice6. A 3-week old infant was admitted to hospital with congenital heart disease and hypocalcemia (low serum Ca). Physical exam revealed a dysmorphic child with short neck, low-set small ears, blunted nose with a broad bridge, “fish” mouth andunderdeveloped mandible. Immunological studies showed decreased lymphoproliferative response to phytohemagglutinin (a non-specific mitogen). Serum IgA, IgE and IgG levels were within normal range. There were no T cells present in the blood. What is the most likely diagnosis?1. Bruton’s agammaglobulinemia2. DiGeorge syndrome3. Combines severe immunodeficiency syndrome4. Acquired immunodeficiency syndrome5. Hyper-IgM syndrome 7. A 9-month old boy with a history of frequent bacterial and fungal infections is found to have a significant decrease in absolute lymphocyte count, complete absence of B cells and very low levels of IgG. His maternal uncle had similar problems in his early childhood and has been treated with gamma-globulin (antibody-containing blood product). What is the most likely diagnosis? 1. X-linked agammaglobulinemia2. X-linked sever combined immunodeficiency3. DiGeorge syndrome4. Hyper IgM syndrome5. Chronic granulomatous disease8. During a campus-wide blood drive, all members of a fraternity house pledge to donate blood the Red Cross. One of the fraternity brothers has an AB blood type. Which of the following statements regarding his blood type is correct?1. He is a universal donor2. He may receive blood type AB, A and B, but not O type 3. He has anti-A and anti-B isohemagglutinin antibodies4. He has A and B antigens5. He may donate blood to persons with blood type O9. A 13-year old girl is evaluated for swelling and pain in her knees, wrists and hands and myalgias of 3-day duration. On examination, she is found to have a “butterfly rash” on her face. Lab findings are remarkable for pancytopenia (decrease counts of all blood cell types), high levels of antinuclear antibodies and erythrocyte sedimentation rate (ESR) of 50 mm/hr (indicative of inflammation). What is the most likely diagnosis?1. Rheumatoid arthritis2. Systemic lupus erythematosus3. Acute rheumatic fever4. Polyarteritis nodosa5. Chronic granulomatous disease10. A 23-year old man presents with sneezing, nasal congestion and itching and rhinorrhea. Allergic rhinitis is suspected, which is most likely related to1. IgG-mediated activation of the classical complement pathway2. IgA-mediated bronchial inflammatory response IgM-mediated direct cytotoxicity3. Immune complex and complement-mediated damage to respiratory mucosa4. IgE-mediated release of vasoactive compounds11. A 60-year old man who was on quinidine for his arrhythmia has developed widespread petechiae (pin-point rash) and ecchymoses (bruising), accompanied by gingival bleeding. Immune thrombocytopenic purpura is suspected. Which of the following is/are most directly involved in destruction of thrombocytes?1. membrane attack complex2. anti-platelet antibodies3. quinidine4. malaria parasites5. viral infection12. A 25-year old woman presented with a 2-week history of numbness and weaknessin her extremities, double vision, difficulty maintaining coordination while walking and bladder control problems. Two days ago, she began experiencing dizziness and her speech became slurred. An MRI (Magnetic Resonance Imaging) showed areas of demyelination in the brain suggestive of multiple sclerosis. What is the most likely pathomechanism involved?1. Destruction of myelin sheaths by cytotoxic T cells2. Immune complex deposition 3. Lysis of peripheral neurons mediated by membrane attack complex4. Granulomatous inflammation5. Viral encephalitis13. Diphtheria toxin