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ETAS_MCQ_02 immunodermatology

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  • 1. Immunodermatology1)Which of the following statements regarding TH1 and TH2 immune responses is true?A. TH2 cells secrete TNF and lymphotoxinB. TH1 cells secrete IL-10, which is the main macrophage-activating cytokineC. TH2 cytokines include IL-5, which activates B cellsCorrect ChoiceD. TH1 and TH2 cytokines both activate macrophagesE. Key TH2 ctyokines include IFN-gamma and IL-4TH1 and TH2 cells release different, but overlapping sets of cytokines. TH2 cells secrete IL-4 andIL-5, which activate B cells, and IL-10, which inhibits macrophage activation. TH1 cells secrete IFN-gamma, which is the main macrophage-activating cytokine, TNF, and lymphotoxin.2) Linear IgA disease is most closely associated with which of the following medications?A. ClarithromycinB. Vancomycin Correct ChoiceC. AzithromycinD. StreptomycinE. ErythromycinVancomycin is an antibiotic frequently used in subjects allergic to penicillin. It has been reported toproduce subepidermal blistering disease with linear IgA deposits.3)Which monoclonal gammopathy is most commonly associated with erythema elevatum diutinum?A. IgMB. IgDC. IgED. IgA Correct ChoiceE. IgGA report of 13 patients indicated IgA is most commonly associated with EED (Yiannias, et al, 1992).4) Gene rearrangement analysis is usedful for determining all of the following except:A. Lymphocyte clonality in mycosis fungoidesB. T cell clonalityC. B cell clonalityD. LymphocyteE. Natural killer cell clonalityCorrect ChoiceGene rearrangement studies cannot by used to detect clonality in natural killer cells. Natural killercells are not antigen-specific, and therefore, do not undergo gene rearrangement.5) Which systemic anti-inflammatory agent specifically blocks the ability of T cells to leave thevasculature and enter the skin?
  • 2. A. etanerceptB. efalizumabCorrect ChoiceC. infliximabD. alefaceptE. none of the aboveEfalizumab is a humanized monoclonal antibody to CD11a that blocks the immunologic synapsebetween LFA-1 on the T-cell and ICAM-1 on the antigen presenting cell. By targeting LFA-1efalizumab specifically blocks the ability of T cells to leave the vasculature and enter the skin.6) Dermatitis herpetiformis is associated with which HLA type(s)?A. HLA-DQw2B. HLA-B8C. HLA-DR3D. none of the aboveE. all of the aboveCorrect ChoiceDermatitis herpetiformis is associated with HLA-B8, -DR3, and -DQw2.7) The antibody produced in the early stages of antibody responses is:A. IgAB. IgEC. IgDD. IgMCorrect ChoiceE. IgGIgM is the antibody produced in the early stages of antibody responses. It is a pentamer which canagglutinate antigen and active the classic complement pathway. IgG is the antibody that can crossthe placenta and the most common antibody found in circulation. IgA is found in mucous membranesecretions and is able to agglutinate antigens and activate the alternate but not the classiccomplement pathway. IgD is not found in circulation other than in hyper-IgD syndrome, anautosomal recessive disorder caused by mutations in the mevalonate kinase gene. A significantelevation of serum IgD is seen in 95% of these patients. IgE is an anaphylactic antibody that isinvolved in nearly all immediate allergic and anaphylactic type reactions.8) Dermatitis Herpetiformis is most commonly associated with which HLA?A. HLA-DQ(A1*0501, B1*02) Correct ChoiceB. HLA-B8C. HLA-DR3D. HLA-B27E. HLA-Bw35HLA-DQ (A1*0501, B1*02) genes are present on 90% of all patients with Dermatitis Herpetiformis.The remainder of patients have the HLA-DQ8 gene. Other associations include: HLA-B8, HLA-DR3and DR5/DR7.
  • 3. 9) Which of the following dietary supplements may inhibit platelet function?A. Vitamin KB. Vitamin CC. Vitamin E Correct ChoiceD. Vitamin AE. Vitamin DSupplemental vitamin E can inhibit platelet function and predispose to hemorrhagic stroke. It can beparticularly hazardous in patients with beta-thalassaemia mutations (Unchern, et al, 2003; Liu, etal, 2003).10) All of the following statements regarding major histocompatibility complex molecules are trueEXCEPT:A. MHC class I molecules bearing viral peptides are recognized by cytotoxic T-cells that subsequentlykill the infected cellB. The MHC is located on chromosome 6 in humansC. MHC Class II molecules bearing peptides are recognized by TH1 or TH2 cells.D. Class I molecules such as HLA-A, B, and C, are present on all nucleated cellsE. MHC class II molecules bind stably to peptides derived from proteins sythesized and degraded inthe cytosolCorrect ChoiceMHC class I molecules bind stably to peptides derived from proteins sythesized and degraded in thecytosol, while MHC class II molecules bind stably to peptides derived from proteins degraded inendocytic vesicles. MHC class I molecules bearing viral peptides are recognized by cytotoxic T-cellsthat subsequently kill the infected cell. MHC Class II molecules bearing peptides trigger helper T-cells and are recognized by TH1 or TH2 cells. Class I molecules such as HLA-A, B, and C, arepresent on all nucleated cells, whereas Class II molecules are on B cells, monocytes, dendritic cells,and are inducible on keratinocytes and endothelial cells. The MHC is located on chromosome 6 inhumans, its polygenic and polymorphic nature contributes to the ability of the immune system torespond to a multitude of different and rapidly evolving pathogens.11) Which cytokine is upregulated in lesions of tuberculoid leprosy?A. None of the answers are correctB. IL 2Correct ChoiceC. IL 10D. IL 5E. IL 4Tuberculoid leprosy is characterized by a type I immune related response. Tuberculoid leprosy hasincreased amounts of TH1 cytokines including IL-2, interferon gamma, and IL-12. These lead to a t-cell and macrophage mediated cytotoxic response. IL-4, IL-5, and Il-10 are typically downregulatedin tuberculoid leprosy.12) Patients with a type I reaction to latex may have cross-reactions with which of the followingfoods?A. ParsnipsB. Cashews
  • 4. C. Avocado Correct ChoiceD. HorseradishE. GarlicLatex allergy is a TH2 form of contact sensitivity that is IGE mediated. Using the old Gel andCoombs classification, it was classified as type I hypersensitivity (Ranta, et al, 2004; Ebo, et al,2003).13) Natural killer (NK) cells eliminate infected cells in all of the following ways except:A. NK cells secrete myeloperoxidaseCorrect ChoiceB. NK cells secrete perforinsC. NK cells adhere to and kill target cells coated with IgGD. NK cells do not target cells expressing major histocompatibility (MHC) class I moleculesE. NK cells secrete granzymeNK cells focus on the destruction of infected or malignant cells. They achieve this via recognition ofIgG on target cells, the so-called antibody-dependent cellular toxicity. NK cells also eliminate cellsby secreting perforin, which makes holes in the cell membrane, through which granzyme is injected.Granzyme induces apoptosis by activating the caspase cascade. In addition, NK cells do not targetcells expressing MHC class I molecules on their surface; some virus downregulate MHC class Imolecules to evade recognition by cytotoxic T cells, which may make them susceptible to NK cellattack. Neutrophils kill ingested organims using myeloperoxidase.14) Pemphigus is associated with which HLA type(s)?A. HLA-B51B. HLA-B8C. HLA-DRw6Correct ChoiceD. None of these answers are correct.E. All of these answers are correct.Pemphigus is associated with HLA-DR4 or DRw6.15) Allergic contact dermatitis is caused by T-cell response to topical exposure to compounds thatform complexes with host proteins (haptens). Which cell is responsible for initial sensitization of theT-cells?A. MacrophageB. Langerhans CellCorrect ChoiceC. Mast CellD. B-cellE. MelanocyteThe Langerhans cell phagocytizes the haptens in the epidermis or dermis, begins the process ofmaturation and migrates to the regional lymph node, where naïve T-cells are educated to expand toa clone of CLA positive memory T-cells. These cells then can expand and extravasate withsubsequent exposure to the same allergen. Melanocytes, B-cells, Mast cells and macrophages arenot involved in the sensitization process of allergic contact dermatitis.16) Which of the following is associated with hepatitis C infection?
  • 5. A. Relapsing polychondritisB. Essential mixed cryoglobulinemia Correct ChoiceC. Rheumatoid arthritisD. Wegener’s granulomatosisE. DermatomyositisHepatitis C infections can present as urticaria or papable purpura and cryoglobulinemia (Lamprecht,et al, 2003).17) All of the following statements regarding Langerhans cells are true EXCEPT:A. They are found in some areas of lymph nodes and spleenB. None of these answers are correct.C. They express CD1 on their surfaceD. They have a high density of Class II molecules on their surfaceE. They are highly phagocyticCorrect ChoiceLangerhans cells are dendritic cells found in high concentrations in epithelial surfaces and someareas of lymph nodes and spleen. They express CD1 on their surface and have a high density ofClass II MHC molecules. They are poorly phagocytic.18) MHC Class II molecules are present on which of the following cell types:A. NK cellsB. B cellsCorrect ChoiceC. T cellsD. mast cellsE. All of the aboveMHC Class II molecules are on B cells, monocytes, dendritic cells, and are inducible on keratinocytesand endothelial cells.19) Anti Jo-1 antibodies are directed against which of the following?A. Histidyl transfer RNA synthetase Correct ChoiceB. Lysyl oxidaseC. GyraseD. TopoisomeraseE. TelomeraseAnti Jo-1 antibody is typical of autoimmune diseases that involve muscle, including dermatomyositis(Walker, et al, 1987; Dang, et al, 1986).20) Which cytokine is not upregulated in atopic dermatitis patients?A. IL-10B. IFN-gamma Correct ChoiceC. IL-5
  • 6. D. IL-4E. IL-13Interferon gamma is Th1 cytokine which downregulates Th2 responses. The remaining are Th2cytokines active in atopic dermatitis. IL-4 is a B-cell growth factor and active in signaling isotopeswitching from IgM to IgE. IL-5 is an eosinophil growth factor. IL-10 downregulates Th1 immunityand IL-13 signals isotope switching along with IL-4.21) Subacute cutaneous lupus erythematosus has been associated with the ingestion of which of thefollowing drugs?A. Trimethoprim/sulfamethoxazoleB. PhenytoinC. AllopurinolD. AuranofinE. Terbinafine Correct ChoiceSCLE has been reported to be associated with terbinafine. This condition is often associated withanti-Ro (SS-A) and anti-La (SS-B) antibodies.22) An 8 month-old baby with diffuse purpura is admitted to the hospital for her third episode ofbacterial meningitis. Which component of her immune system is impaired?A. Complement activationCorrect ChoiceB. Natural killer cell activationC. CD4 + T cellsD. Antibody productionE. CD8 + T cellsPredisposition to sporadic and occasionally recurrent meningococcal disease occurs in patients withcongenital or acquired complement deficiencies, particularly late acting components C5-923) This lesion is hypoesthetic and is associated with which of the following:A. None of these answers are correctB. Interleukin 12C. All of these answers are correctCorrect ChoiceD. gamma interferonE. Interleukin 2The lesion is high immune or tuberculoid leprosy, which is associated with TH1 cytokines includingIFN-gamma, IL2, IL12, IL15, IL18 and IL23.24) The most common autoimmune disorder in patients with chronic hepatitis C infection isA. autoimmune thyroiditis Correct ChoiceB. Systemic lupus erythematosusC. idiopathic thrombocytopenic purpuraD. rheumatoid arthritisE. Sjögren’s syndrome
  • 7. Autoimmune thrombocytopenia has been reported with hepatitis C infection but not as commonly asautoimmune thyroiditis.25) All of the following statements regarding Natural Killer (NK) cells are true EXCEPT:A. NK cells express CD 2 moleculesCorrect ChoiceB. NK cells mediate lysis of viral-infected cellsC. NK cells have properties of innate and acquired immunityD. NK cells mediate tumor lysisE. NK cells are large granular lymphocytesNK cells do not express CD 2 molecules. The other statements are true.26) This disease is most associated with:A. IL-5B. gamma interferon Correct ChoiceC. IL-4D. None of these answers are correctE. IL-13The answer is gamma interferon, which is the TH1 cytokine associated with a hyperproliferativeepidermis and with micaceous scale as seen in psoriasis.27) Which component of the T cell receptor is associated with superantigen recognition?A. D-betaB. J-betaC. V-alphaD. V-betaCorrect ChoiceE. J-alphaSuperantigens are able to bypass many elements of the normal immune response. They are notprocessed by antigen presenting cells. Instead, they bind directly to the MHCII complex and interactwith T cells in a relatively non-specific fashion. Whereas conventional antigens require recognition inall 5 elements of the T-cell receptor (Vá, Já, Vâ, Dâ, Jâ), superantigens are recognized by Vâ alone.28) Elaboration of which of the following cytokines is characteristic of TH2 response?A. Interleukin-4 Correct ChoiceB. Interleukin-2C. Interleukin-1D. Interferon-8 (gamma)E. Interleukin-12Interleukin-4 (IL-4) is a cytokine involved in B-cell proliferation. Along with IL-5 and IL-13, IL-4 isclassified as a TH2 cytokine (Janeway, et al, 2001).29) Immunocytomas are
  • 8. A. aggressive B-cell lymphomasB. aggressive T-cell lymphomasC. low grade T-cell lymphomasD. low grade B-cell lymphomas Correct ChoiceE. NK cell lymphomasThese indolent tumors present as solitary or multiple nodules usually on the extremities. The cellshave been reported to have CD-20 (B cell marker) and have been reported to be bcl-2 positive.30) Naive T cells express which of the following surface molecules:A. CD19B. CD45RACorrect ChoiceC. CD79D. CD45ROE. CD20Naive T cells express CD45RA whereas memory T cells express CD45RO. CD19, 20, and 79 are Bcell surface markers.31) Eosinophils are typically seen in the cutaneous infiltrate ofA. Ki-1 lymphomaB. Kaposiform hemangioendotheliomaC. Kawasaki’s diseaseD. Krabbe’s diseaseE. Kimura’s disease Correct ChoiceEotaxin, which attracts eosinophils, is produced by T cells in Kimura’s disease (Kimura, et al, 2002).32) Which of the following diseases does not respond with a Th1-type responses?A. Leishmaniasis which self-resolvesB. Lepromatous LeprosyCorrect ChoiceC. Allergic contact dermatitisD. PsoriasisE. Tuberculoid LeprosyLepromatous leprosy is Th2 biased. The remaining conditions are Th1 predominant responses.Leishmaniasis which show strong cell-mediated immunity to the parasite and with self-resolvinglesions are Th1 responses. In indolent/progressive leishmaniasis, a Th2 pattern is predominant.33) Anti-epiligrin (laminin 5) antibodies may be seen inA. pemphigus vegetansB. fogo selvagemC. pemphigoid gestationisD. cicatricial pemphigoid Correct Choice
  • 9. E. paraneoplastic pemphigusPatients with cicatricial pemphigoid have been reported to have anti-epiligrin antibodies (Yancey, etal, 1995; Hsu, et al, 2000).34) Which of the following cytokines, together with IL-4, promotes isotype switching from IgM toIgE?A. IL-10B. IFN-gammaC. IL-13Correct ChoiceD. TNFE. IL-5IL-5 is an eosinophil growth factor. IL-10 is a general down-regulator of TH1 immunity. IL-13 (alongwith IL-4) promotes an isotype switch from IgM to IgE. TNF and IFN-gamma are TH1 cytokines, TH2cytokines. IFN-gamma is secreted by TH1 cells, and is the main macrophage-activating cytokine.35) Which of the following is a criterion for the diagnosis of Behçet’s disease?A. ConjunctivitisB. Lobular panniculitisC. Inflammatory bowel diseaseD. Uveitis Correct ChoiceE. Nasal septal perforationBehçet’s is a triad that includes oral ulcerations, genital ulcerations and uveitis. Behçet’s alsodisplays arthritis and gastrointestinal disease. Blindness is the most-feared outcome, and relates tothe uveitis.36) A disorder of melanosome transfer isA. Piebaldism.B. rufous albinism.C. Hermansky-Pudlak syndrome.D. Chédiak-Higashi syndrome. Correct ChoiceE. Waardenburg’s syndrome type 1.Also called lethal albinism, Chédiak-Higashi syndrome is a primary immunodeficiency disorder thatlinks melanin and leukocyte granule formation. See also Hermansky-Pudlak.37) With which HLA type is psoriasis most definitively linked?A. HLA-Cw6Correct ChoiceB. HLA-B8C. HLA-DR4D. HLA-DR3E. HLA-B51Psoriasis is linked with HLA-Cw6. Patients with this HLA type have a relative risk of having psoriasisthat is 9-15 times normal.
  • 10. 38) Which of the following immunoglobulins cannot activate the complement pathway?A. IgG2B. IgG1C. IgMD. IgG4Correct ChoiceE. IgG3Immunoglobulins (Ig) differ in their ability to activate complement. IgM is the largest Ig, is themajor Ig in the primary immune response, and consists of a pentamer that activates the classiccomplement pathway. IgG is the most abundant Ig and the major Ig in the secondary immuneresponse. Four subclasses of IgG exist based on the amino acid residue sequences of their constantregion, IgG1 through IgG4. IgG1 and IgG3 are potent activators of the classic complementpathway, IgG2 is less effective and IgG4 is unable to do so.39) A patient had antibodies to desmoglein 3, but no antibodies to desmoglein 1 or desmplakin. Thelikely diagnosis is:A. erythema multiformeB. bullous pemphigoidC. pemphigus vulgaris Correct ChoiceD. pemphigus foliaceousE. dermatitis herpetiformisThe answer is pemphigus vulgaris, which typically has autoantibodies to desmoglein 3. While mixedforms of pemphigus can occur, the histology in this case confirmed pemphigus vulgaris.40) Which of the following TH2 cytokines is a B cell growth factor?A. IL-4Correct ChoiceB. IFN-gammaC. IL-5D. IL-10E. IL-13IL-4 is a B cell growth factor. IL-5 is an eosinophil growth factor. IL-10 is a general down-regulatorof TH1 immunity. IL-13 (along with IL-4) promotes an isotype switch from IgM to IgE. IFN-gammais not a TH2 cytokine. It is secreted by TH1 cells, and is the main macrophage-activating cytokine.41) The human major histocompatibility complex (MHC) is located on chromosome:A. 9B. 11C. 2D. 17E. 6Correct ChoiceThe MHC is highly polygenic and polymorphic, and this contributes to the ability of of the immunesystem to respond to a multitude of different and rapidly evolving pathogens. The MHC is located onchromosome 6 in humans.
  • 11. 42) Which of the following is the target antigen in pemphigus vulgaris?A. DesmoplakinB. CadherinC. Desmoglein 1D. Type XVII collagenE. Desmoglein 3 Correct ChoiceDesmoglein 3 is the dominant target auto-antigen in pemphigus vulgaris (Hacker-Foegen, et al,2003).43) The pharmacologic activity of tacrolimus includesA. inhibition of interleukin-2 gene transcription Correct ChoiceB. activation of calcineurinC. binding and inhibition of NF kappa BD. inhibition of interleukin-1 gene transcriptionE. phosphorylation of NFAT (nuclear factor of transcription)Tacrolimus is a macrolide similar to cyclosporine and pimecrolimus (Elidel). Calcineurin is aphosphatase that dephosphorylates subunit on NFAT (nuclear factor of activated T cells).44) The endothelial ligand for cutaneous lymphocyte antigen (CLA) is:A. vascular cell adhesion molecule (VCAM-1)B. Leukocyte functional antigen (LFA 3)C. L-selectinD. E-selectinCorrect ChoiceE. intercellular adhesion molecule 1 (ICAM-1)Cutaneous lymphocyte antigen (CLA) allow memory T cells to home to the skin, where it binds to itsligant E-selectin on cutaneous microvessels. Transmigration of memory T cells into the dermis,however, further requires interaction between leukocyte functional antigen 1 (LFA-1) and ICAM-1,and B-integrin very late antigen 4 (VLA-4) and VCAM-1. L-selectin is expressed on post-capillaryvenules in the lymph nodes and serves as the attachment points for naive T cells.45) The gene for NEMO (NF-kappa bets essential modulator) is mutated inA. Papillon-Lefévre syndromeB. incontinentia pigmenti Correct ChoiceC. dyskeratosis congenitalD. pachyonychia congenital type IIE. Noonan’s syndromeNEMO/IKK gamma is an essential component of the nuclear factor kappa B pathway, which is acommon signaling pathway for many cytokines. Mutation in this pathway have been found to causeincontinentia pigmenti.46) Which virus is most closely associated with Kaposi’s sarcoma in HIV-infected patients?
  • 12. A. Epstein-Barr virusB. Human herpes virus 2C. CytomegalovirusD. Human herpes virus 6E. Human herpes virus 8 Correct ChoiceHSV-8 has been repeatedly associated with all forms of Kaposi’s sarcoma.47) All the following conditions exhibit a T-helper cell 1 (Th1) cytokine secretion profile except:A. rheumatoid arthritisB. multiple sclerosisC. systemic lupus erythematosusCorrect ChoiceD. granulomatous leprosyE. psoriasisSystemic lupus erythematous is associated with a Th2 cytokine profile, whereas the other conditionsare associated with a Th1 cytokine profile. Th2 cells are typified by secretion of IL-4, IL-5, IL-6,IL-9, IL-10 and IL-13, whereas Th1 cells are typified by secretion of IFN-gamma, TNF-beta, andIL-2.48) T-cell anergy occurs if:A. MHC Class I or II is bound in the presence of IL-2B. Stimulation by a MHC Class III molecule is involvedC. MHC/TCR engagement occurs without costimulatory moleculesCorrect ChoiceD. FasL is bound on the T-cellE. A HLA-DM facilitator is not involved with the bindingMHC/TCR engagement occurs without costimulatory molecules. MHC Class III molecules are notinvolved in this process. The MHC III region encodes for soluble proteins of the complement cascadeand the tumor necrosis family. Fas-FasL interactions promote apoptosis on the target cell, notstimulation. IL-2 is a stimulatory molecule, produced by Th1 T-cells. It does not produce anergy.HLA-DM facilitates loading of proteins processed by antigen presenting cells into the MHC class IImolecule before being brought to the cell surface.49) Which cytokine is responsible for fever in patients with sunburn?A. IL-1Correct ChoiceB. IL-5C. IL-10D. TNF-betaE. IL-11IL-1 is a pyrogenic cytokine responsible for the fever in sunburn. It also is causes B cell maturationand proliferation and NK cell activation.50) Sensation is intact in this lesion, but a Fite stain is positive. This lesions is associated with whichof the following:
  • 13. A. IL-5B. IL-4C. None of these answers are correctD. IL-10E. All of these answers are correctCorrect ChoiceThe lesion is low immune or lepromatous leprosy, which is associated with TH2 cytokines includingIL-4, IL-5, IL-10, and IL-13.51) Which of the following suture materials induces the least inflammation?A. Polyglycolic acid (Dexon)B. SilkC. Polyglycan 910 (Vicryl)D. Polypropylene (Prolene) Correct ChoiceE. Surgical gutProlene is a nonabsorbable suture material that evokes only minimal inflammation.52) Which of the following B cell receptors is involved in immunoglobulin isotype switching?A. CD20B. CD19C. CD154D. CD40Correct ChoiceE. CD22CD40 activation on B cells by CD40-ligand (CD154) on T cells induces isotype switching from an IgMto IgG response. Defects in the expression of CD40-ligand result in an immunodeficiency state(hyper-IgM syndrome) characterized by low levels of IgG, IgA and IgE, but elevated IgM. CD19,CD20, CD22 are pan-B cell markers.53) All of the following statements regarding neutrophils are true EXCEPT:A. None of these answers are correct.B. Neutrophils are granulocytesC. Neutrophils have receptors for IgG and complementD. Neutrophils are the most abundant leukocytesE. Neutrophils major function is antigen presentationCorrect ChoiceNeutrophils major function is phagocytosis. The other statements are correct.54)Calcipotriene-induced improvement in psoriasis is associated with increased lesional levels ofwhich cytokine?A. Interleukin-8B. Interleukin-10 Correct ChoiceC. Interluekin-12
  • 14. D. Interleukin-2E. Tumor necrosis factorPsoriasis is generally described as a TH1 autoimmune disease where IL-12/IFN-gamma pathway isdominant. IL-10 is the prototype of TH2 and calcipotriene application results in increased levels ofIL-10, thus decreasing TH1 disease.55) Purpuric contact dermatitis is most likely to be associated withA. nickelB. p-phenylenediamineC. sorbic acidD. formaldehyde Correct ChoiceE. propylene glycolTextile dermatitis has been reported to be associated with purpuric contact dermatitis (Romaguera,et al, 1981; Garcia Bracamonte, et al, 1995).56) The immunoglobulin most commonly found in mucous secretions is:A. IgDB. IgACorrect ChoiceC. IgMD. IgEE. IgGIgA is found in mucous membrane secretions and is able to agglutinate antigens and activate thealternate but not the classic complement pathway. IgG is the antibody that can cross the placentaand the most common antibody found in circulation. IgD is not found in circulation other than inhyper-IgD syndrome, an autosomal recessive disorder caused by mutations in the mevalonatekinase gene. A significant elevation of serum IgD is seen in 95% of these patients. IgE is ananaphylactic antibody that is involved in nearly all immediate allergic and anaphylactic typereactions. IgM is the antibody produced in the early stages of antibody responses. It is a pentamerwhich can agglutinate antigen and active the classic complement pathway.57) Which systemic anti-inflammatory agent targets CD2+ activated T cells for apoptosis?A. infliximabB. none of the aboveC. alefaceptCorrect ChoiceD. efalizumabE. etanerceptAlefacept is a soluble form of LFA-3 that blocks the immunologic synapse between CD2 on the T celland LFA-3 on the antigen presenting cell. Furthermore, alefacept targets CD2+ activated T cells forapoptosis.58) Which of the following causes a photoallergic contact dermatitis that is exacerbated by UVAradiation?A. Titanium dioxideB. Dihydroxyacetone
  • 15. C. Oxybenzone Correct ChoiceD. Zinc oxideE. Ascorbic acidOxybenzone is the most common sunscreen agent causing photoallergic contact dermatitis. Patientssensitive should be instructed to avoid sunscreens containing oxybenzone.59) Psoriasis affects over 2% of the world’s population and has a strong association with which HLAclass I haplotype?A. HLA-DR4B. HLA-CW6Correct ChoiceC. HLA-B27D. HLA-DQ6E. HLA-DR1HLA-CW6 has been seen in up to 90% of patients with early onset psoriasis, 50% with late onsetpsoriasis and only 7.4% of the general population. HLA-DR1 and DR4 are both related toRheumatoid Arthritis and have a 7x increased relative risk (RR) for developing disease. HLA-B27 islinked to ankylosing spondylitis, postinfection arthridites and Reiter’s disease, with increase relativerisks of 100x, 10-20x, and 35x respectively.60) The putative mechanism of action of topical macrolide immunomodulators is inhibition ofA. prostaglandin secretionB. lymphocyte migrationC. lymphokine production Correct ChoiceD. antigen presentationE. neutrophil migrationTacrolimus and pimecrolimus are topical macrolide immunomodulators that inhibit lymphokine orcytokine production via binding to macrophilin. This complex inhibits calcineurin, a phosphataseinvolved in the activation of NF-AT. This suppresses the production of IL-2 and IFN-gamma (TH1cytokines) as well as IL-4, 5 and 13 (TH2 cytokines). In addition, they decrease the expression ofIgE receptors on Langerhans cells and reduce mast cell degranulation.61) This patient had antibodies to 180 kd antigen. The likely diagnosis is:A. bullous lichen planusB. pemphigus foliaceousC. erythema multiformeD. bullous pemphigoid Correct ChoiceE. pemphigus vulgarisThe answer is bullous pemphigoid, which shows a characteristic antibasement membrane antibodyto Bp180.62) Chronic idiopathic urticaria is associated with which HLA type(s)?A. HLA-DR4B. none of the above
  • 16. C. HLA-DQ8D. all of the aboveCorrect ChoiceE. HLA-DRB4 53Chronic idiopathic urticaria is associated with HLA -DR4, -DRB4 53, and -DQ8.63) Anti-Ro (SS-A) antibodies are most commonly found inA. drug-induced systemic lupus erythematosusB. eosinophilic fasciitisC. homozygous C2 deficiencyD. mixed connective tissue diseaseE. neonatal lupus erythematosus Correct ChoiceRo 60 kDa autoantigen is a major target for patients with SLE and Sjögren’s syndrome. Neonatallupus occurs in newborns of mothers with anti-Ro antibodies and leads to children withphotosensitive skin lesions and a cardiac conduction defect, a third degree heart block (Chen, et al,2004; Costedoat-64) The main cytokine secreted by Th1 CD8+ effector T-cells is:A. IFN-gammaCorrect ChoiceB. IL-2C. IL-4D. IL-1E. IL-5Interferon-gamma is the main cytokine secreted by Th1 CD8+ effector T-cells and is active inblocking viral replication. IL-2 is also released in Th1 reactions and causes T cell proliferation anddifferentiation, macrophage, NK, & Tc cell activation. It also acts as a Th1 autocrine growth factor.IL-1 is a pro-inflammatory cytokine and a pyrogen. IL-4 is a B-cell growth factor and active insignaling isotope switching from IgM to IgE. IL-5 is an eosinophil growth factor. Both IL-4 and -5are secreted by Th2 T-cells.65) Which is not a feature of mast cells?A. stains with napththol chloro-acetate esteraseB. expresses c-kitC. produces IL-8D. responds to RANTESCorrect ChoiceE. produces prostaglandin D2Mast cells are an integral portion of immediate type hypersensitivity. RANTES is a chemoattractantfor eosinphils, not mast cells.66) A 26-year-old man presents with a history of recurrent episodes of targetoid, erythematous,edematous macules, patches, and plaques on the arms, legs, palms, and soles. The most likelyetiologic agent isA. coxsackievirusB. herpes simplex virus Correct Choice
  • 17. C. cytomegalovirusD. parvovirus B19E. human immunodeficiency virusThis description of the skin disorder is compatible with either erythema multiforme or erythemaelevatum diutinum, both of which have been reported in association with HSV (Ng, et al, 2003;Burnett, et al, 2003)67) This patient from New York gave a history of frequent outdoor activity. The likely diagnosis is:A. BabesiosisB. H. simplex erythema multiformeC. AnthraxD. ehrlichiosisE. lyme disease Correct ChoiceThe answer is lyme disease with the typical erythema migrans appearance.68) Oral lichen planus is most commonly associated with which HLA?A. All of these options are correctCorrect ChoiceB. DR9C. B51D. Bw57E. HLA-B27All of these HLA associations have been suggested in the literature. No specific HLA allele has beenestablished due to patient selection and geographic heterogeneity.69) The human leukocyte antigen that has the closet association with psoriasis isA. HLA-B51B. HLA-B27C. HLA-DQ3D. HLA-DR1E. HLA-Cw6 Correct ChoiceHuman leukocyte antigens (HLA class I molecules) are designated A, B, and C and are present onall nucleated cells. Class I molecules present antigens including autoantigens to cytotoxic T cells.70) Imiquimod induces which of the following cytokines?A. Interleukin-5B. Interferon-alpha Correct ChoiceC. Interleukin-2D. Interleukin-4E. Interleukin-10Imiquimod is an exciting new topical immunomodulator that increases a variety of cytokinesincluding interferon-alpha (Wagner et al, 1999).
  • 18. 71) Which of the following best describes the mechanism of action for infliximab?A. Inhibition of tumor necrosis factor alpha activity Correct ChoiceB. Inhibition of retinoic acid 4-hydroxylase activityC. Selective elimination of activated T cells via binding to high affinity IL-2 receptorD. Inhibition of calcineurin-mediated dephosphorylation of transcription factorsE. Selective T-cell up-regulation of IL-4 and IL-5 productionInfliximab is a monoclonal antibody given intravenously that binds to membrane-bound and solubleTNF-alpha.72) Of the following complement components, the most powerful neutrophil chemoattractant is:A. C3aB. C3C. C5aCorrect ChoiceD. C5b, C6, C7, C8, C9E. C4aThe complement system plays an important role in innate immunity. Of this group, C5a is the mostpowerful neutrophil chemoattractant. C3 represents the endpoint for the classic, alternative andlectin pathways, and results in the generation of immunologically active substances. C3a and C4acause mast cell degranulation. Assembly of C5b, C6, C7, C8, C9 components results in themembrane attack complex (MAC), which perforates cell membranes causing death by osmotic lysis.73) The most useful pair of immunohistochemical stains to distinguish betweendermatofibrosarcoma protuberans (DFSP) and a fibrous histiocytoma would beA. synaptophysin, chromograninB. CD31, CD3C. CD34, CD31D. CD34, factor XIIIa Correct ChoiceE. vimentin, synaptophysinDermatofibrosarcoma, the more common benign histiocytoma, is usually CD34 negative and factorXIIIa positive. DFSP is usually CD34 positive and factor XIIIa negative.74) This skin disease has been shown to be associated with reduced Beta 2 defensin. The diagnosisis:A. psoriasisB. subacute cutaneous lupus erythematosusC. lepromatous leprosyD. atopic dermatitis Correct ChoiceE. tuberculoid leprosyThe answer is atopic dermatitis. Cathelicidin 37 (LL-37) and Human Beta 2 Defensins (HBD-2) havebeen reported reduced in atopic dermatitis and normal or elevated in psoriasis. This could be onefactor that predisposes atopics, but not psoriatics to bacterial and viral infections.
  • 19. 75) The most definitive HLA association with psoriasis is:A. HLA-B17B. HLA-B27C. HLA-Cw6Correct ChoiceD. HLA-B37E. HLA-B13HLA-Cw6 is associated with a 9-15x greater risk for developing psoriasis. All of the other HLAantigens listed are associated with various types of psoriasis, but at with lesser strength ofassociation.76) Which cytokine is the main macrophage-activating cytokine?A. lymphotoxinB. IFN-gammaCorrect ChoiceC. IL-4D. TNFE. IL-10IFN-gamma is the main macrophage-activating cytokine, and is secreted by TH1 cells.77) The most likely target for exfoliative toxin A in bullous impetigo isA. desmoglein 1 Correct ChoiceB. collagen VIIC. desmoglein 3D. laminin 5E. desmocollinDesmoglein 1, the dominant target antigen of the autoantibody involved in pemphigus foliaceus, isalso the target of the exfoliative toxin of group II staphylococcus aureus that is usually responsiblefor bullous impetigo.78) What is the best screening test for hereditary angioedema?A. C3B. C4Correct ChoiceC. C2D. CH50E. C1 esteraseC4 is the best screening test for hereditary angioedema (Quinkes edema). There are two types ofhereditary angioedema. In type I, there are low antigenic and functional levels of a NORMAL C1esterase inhibitor protein. In type II, there is a normal or elevated level of a DYSFUNCTIONAL C1esterase inhibitor. The low C4 level is a result of continuous activation and consumption ofcomplement components.79) Histamine is a biologic amine produced by which of the following cells?
  • 20. A. EosinophilsB. MonocytesC. PlateletsD. BasophilsE. Basophils and PlateletsCorrect ChoiceIn the skin, histamine is mainly contained within the granules of dermal mast cells. Histamine ispresent in mast cells, basophils, and platelets80) Which of the following immune-mediated events has been demonstrated in psoriasis vulgaris?A. clonal expansion of CD8+ T cellsCorrect ChoiceB. decreased production of interferon-gammaC. decrease dermal Langerhans cellsD. increase Th2 CD4+ T cellsE. downregulation of keratin 16The involvement of T cells in the pathophysiology of psoriasis vulgaris is well-recognized. Availabilityof monoclonal antibodies has allowed for extensive characterization of T cell subsets and othermediators increased in psoriasis lesions. CD8+ T cells are highly concentrated in psoriatic epidermisand studies have demonstrated increased IL-2R and HLA-DR surface molecules indicative ofpersistent activation. Clonal expansion of CD8+ T cells has been observed suggesting that thissubset is the major antigen-reactive population.(Krueger J. J Am Acad Dermatol 2002;46:1-23.81) Which cytokine is predominantly responsible for the Jarish-Herxheimer reaction?A. TNF-alphaCorrect ChoiceB. IL-5C. IL-12D. IL-2E. IL-6The Jarish-Herxheimer reaction may occur after the initiation of treatment of many systemicinfections including syphillis. It is an indirect drug induced effect caused by bacterial endotoxins ormicrobial antigens liberated by the destruction of micro-organisms. Clinical manifestations mayinclude fever, lymphadenopathy, arthralgias, and exacerbation of pre-existing cutaneous lesions.Tumor necrosis factor-alpha is the primary cytokine that mediates this reaction.82) Relapsing polychondritis is an autoimmune disease associated with immunity to which type ofcollagen?A. VIIB. IC. IIID. II Correct ChoiceE. IVRelapsing polychondritis has been reported to have autoantibodies to type II collage (Asadi, 2003).
  • 21. 83) Major histocompatibility complex class I molecules bind to:A. Peptides derived from proteins synthesized and degraded in the cytosol Correct ChoiceB. Immunoglobulin EC. Peptides external to the cell membraneD. Peptides derived from proteins degraded in endocytic vesiclesE. None of these answers are correctMajor histocompatibility complex (MHC) class I molecules bind to peptides derived from proteinssynthesized and degraded in the cytosol. They present these processed peptides to CD8+ T-cells.MHC class II molecules bind stably to peptides derived from proteins degraded in endocytic vesicles.CD4+ T-cells recognize the MHC class II molecules. Immune activation against the foreign antigensor pathogens taken up by the cell is the result of these interactions. Peptides external to the cell arenot recognized by MHC molecules. IgE does have a receptor on the cell surface, especially basophilsand mast cells, but is not recognized by the MHC complex84) Angiocentric NK/T-cell lymphoma in children may present asA. en coup de sabreB. acropustulosis of infancyC. childhood dermatomyositisD. hydroa vacciniforme Correct ChoiceE. papular acrodermatitis of childhoodHydroa vacciniforme a photodermatitis that typically occurs with sun exposure in the spring hasbeen reported with NK/T cell lymphomas in childhood. for answer85) Mononuclear phagocytes residing in tissues:A. Produce cytokines, which recruit other inflammatory cellsB. All of the aboveCorrect ChoiceC. Phagocytose foreign antigens and degrade them into peptidesD. Present antigen to T-cellsE. Are called macrophagesMononuclear phagocytes are components of the innate immune system. Once in tissues they arecalled macrophages. All of the above are correct.86) Efalizumab is an antibody which is directed against LFA1 on the T-cell, blocking this moleculesinteraction with:A. B7B. P-selectinC. CD40D. LFA3E. ICAM-1Correct ChoiceICAM-1 on the antigen presenting cell interacts with LFA1 on the T-cell. By interrupting thisinteraction, T-cell activation is blocked by preventing the pairing of LFA1 with ICAM-1. This preventscostimulatory signals from being given to the T-cell. T-cell ability to traffic into the skin is alsoinhibited in the arrest stage of trafficking.
  • 22. 87) Topical tacrolimus and pimecrolimus are used to treat atopic dermatitis and other inflammatoryskin conditions. On which of the following ions is the inflammatory pathway blocked by thesemedications dependent?A. SeleniumB. PotassiumC. CalciumCorrect ChoiceD. SodiumE. ZincCalcium. Both pimecrolimus and tacrolimus penetrate cutaneous T-cells, forming a complex withcalcineurin, which blocks the activation of NF-AT, thus blocking the transcription of a variety ofgenes with a resultant decrease in T-cell mediated inflammation. This pathway is calciumdependent. The other ions are not involved in this process.88) Herpes gestationis is most commonly associated with which HLA?A. HLA-DR3Correct ChoiceB. HLA-B51C. HLA-B27D. HLA-DQ8E. HLA-DR9HLA-DR3 is the most commonly found HLA association in herpes gestationis. HLA-DR4 is also foundin addition to HLA-DR3 in about 50% of patients. There is nearly 100% incidence of anti-HLAantibodies patients affected by herpes gestationis89) When attempting to identify Langerhans cells in a specimen, which marker is most helpful?A. CD4B. CD1 Correct ChoiceC. CD7D. CD8E. CD20CD1 is a surface antigen specific for epidermal Langerhans cells. It is not expressed in otherepidermal structures. The other characteristic ultrastructural feature of Langerhans cells is theBirbeck granule. CD4 is found on T-helper cells and occasionally on Langerhans cells. CD7 is a T-cellmarker that is often lost in cutaneous T-cell lymphoma. CD8 is found on cytotoxic T-cells. CD20 is aB-cell marker.90) Which of the following HLA alleles is most strongly associated with Behcet’s disease?A. HLA-DQw2B. HLA-DR4C. HLA-B51 Correct ChoiceD. HLA-B27E. HLA-DR1
  • 23. HLA-B51 has been reported with increased relative risks in European, Asian and Middle Easternpopulations (Mizuki et al 2002).91) Which cytokine is up-regulated in this geometric, eczematous dermatitis?A. IL-7B. IL-5C. IL-4D. IL-2Correct ChoiceE. IL-10The geometric pattern of ertyhema suggests "outside job". Allergic contact dermatitis is a cell-mediated and Th1 reaction. The cytokines up-regulated in this process are IL-1, IL-2, IL-12,interferons-alpha and gamma.92) Psoriatic arthritis is most commonly associated with which HLA?A. HLA-Aw19B. HLA-B27Correct ChoiceC. None of these options are correctD. HLA-Cw6E. HLA-Bw35HLA-B27 is associated with an increase in psoriatic arthritis as well as pustular psoriasis andacrodermatitis continua of Hallopeau.93) A putative mechanism of action of dapsone in the treatment of inflammatory conditions relatestoA. suppression of T-cell activationB. suppression of the halide-myeloperoxidase systemC. inhibition of neutrophil migration Correct ChoiceD. enhancement of Th1 to Th2 shiftE. augmentation of interferon-alfaDapsone is especially effective in dermatitis herpetiformis where migration of neutrophils is seen inthe dermal papillae (Zhu, et al, 2001).94) All of the following statements are true regarding cells of the innate immune system EXCEPT:A. IL-5 downregulates the functions of eosinophilsCorrect ChoiceB. Langerhans cells are poorly phagocyticC. Basophils are a type of granulocyte, as a neutrophilsD. Langerhans cells express CD1 on their surfaceE. Neutrophils have receptors for IgGNeutrophils, eosinophils, and basophils are collectively known as granulocytes. Neutrophils havereceptors for IgG and complement. IL-5 enhances all functions of eosinophils. Langerhans cells aredendritic cells found in high concentration in epithelial surfaces and some areas of lymph nodes andspleen. They have a high density of class II MHC molecules and express CD1 on their surface. Theyare poorly phagocytic.
  • 24. 95) All of the following statements regarding mast cells are true EXCEPT:A. Mast cells release substances that affect vascular permeabilityB. Mast cells reside near small blood vesselsC. Mast cells protect mucosal surfaces against pathogensD. Mast cells have receptors for certain fragments of complement on their surfaceE. None of the above (all are true)Correct ChoiceMast cells are the central cell in immediate-type hypersenstivity, and are very important incutaneous inflammation. They reside near small blood vessles, and when activated releasesubstances that affect vascular permeability. They orchestrate allergic responses and protectmucosal surfaces against pathogens. They have receptors for IgE and certain fragments ofcomplement on their cell surface.96) In adult patients with Henoch-Schönlein purpura with IgA vasculitis, which of the followingcomplications is most likely to occur?A. Pulmonary hemorrhageB. Facial edemaC. Mesangial nephropathy Correct ChoiceD. Peripheral neuropathyE. Hemorrhagic cystitisA urinalysis should be ordered in patients with palpable purpura. Red blood cells and proteinuria areoften seen in Henoch-Schönlein syndrome (Tarshish, et al, 2004).97) Which cytokine is most important in recruiting neutrophils?A. Interleukin-2B. Interleukin-10C. Interleukin-8 Correct ChoiceD. Interleukin-1E. Interleukin-4Chemotaxis is the process of cells moving through a gradient of towards increasingly higherconcentrations. IL-8 has activating and chemoattractant properties on neutrophils.98) Which cytokine is present in Woronoff rings?A. IL-10B. Prostaglandin E2Correct ChoiceC. IL-4D. IL-5E. TNF-BetaWornoff ring is the white halo seen surrounding some psoriatic plaques. Prostaglandin E2 is thecytokine responsible for this phenomenon.99) The target antigen of chronic bullous disease of childhood is
  • 25. A. 97 kd LAD-1 (a component of BPAG2) Correct ChoiceB. alpha 6 beta 4 integrinC. plectinD. BPAG 1 9230 kd BPAG)E. collagen type VIIThis rare chronic bullous disease of childhood is a subepidermal blistering disease with ahomogeneous IgA deposits at the epidermal basement membrane. This occurs in children usuallyless than 5 years of age.100) Which antibody is most commonly found in circulation of patients with atopic dermatitis?A. IgDB. IgAC. IgMD. IgECorrect ChoiceE. IgGIgE is an anaphylactic antibody that is involved in nearly all immediate allergic and anaphylactictype reactions and commonly seen in elevated levels in patients with atopic dermatitis. Mast cells,basophils, langerhans cells, dermal dendritic cells as well as monocytes from atopic individuals allexpress high-affinity FcåRI receptor which can bind IgE. More recently, it became clear that canbind monomeric IgE via the high-affinity FcåRIIgG is the antibody that can cross the placenta and the most common antibody found in circulation.IgA is found in mucous membrane secretions and is able to agglutinate antigens and activate thealternate but not the classic complement pathway. IgD is not found in circulation other than inhyper-IgD syndrome, an autosomal recessive disorder caused by mutations in the mevalonatekinase gene. A significant elevation of serum IgD is seen in 95% of these patients. IgM is theantibody produced in the early stages of antibody responses. It is a pentamer which can agglutinateantigen and active the classic complement pathway.101) Which paraprotein is found most commonly in patients with pyoderma gangrenosum?A. IgMB. IgGC. IgED. IgA Correct ChoiceE. IgDIgA paraproteinemia has been reported in over 10-18% of pyoderma gangrenosum.102) Which cytokine is responsible for activating natural killer cells?A. Terferon-gammaB. Interleukin 2Correct ChoiceC. Interferon-alphaD. Interleukin 4E. Tumor necrosis factor-alpha
  • 26. Activation of natural killer cells occurs via interleukin 2 (IL-2). IL-2 is a key component of the Th1(cell-mediated) immunity. It acts to promote growth, proliferation and activation of T cells, B cellsand natural killer cells.103) Which cytokine is primarily responsible for stimulation of neutrophils?A. IL-1B. IL-6C. IL-8Correct ChoiceD. IL-5E. IL-4IL-8 is primarily responsible for the stimulation of neutrophils. IL-5 stimulates eosinophils. IL-4stimulates mast cells and IgE isotype switching104) Herpes simplex virus-related erythema multiforme has been associated with an increasedfrequency ofA. HLA-B8B. HLA-B13C. HLA-B15 Correct ChoiceD. HLA-B27E. HLA-B7Erythema multiforme associated with herpes simplex has been reported to have an increase of HLA-B15.105) The classical complement pathway:A. Includes C3 and factor B.B. Can be activated by IgG4C. Does not cause membrane damageD. Can be activated by IgMCorrect ChoiceE. Can be activated in the absence of antibodyThe classical complement pathway is activated by antigen-antibody complexes, while the alternatecomplement pathway can be activated in the absence of antibody. IgM and IgG are capable ofactivating the classical pathway, but IgG4 does not activate complement. The proteins of theclassical pathway are C1, C2, C3, and C4. Factor B, Factor D, properdin, and C3 are proteins in thealternate pathway. Biologic activities of complement include opsonization, chemotaxis, anaphylaxis,immune complex solubilization, membrage damage, and B cell activation.106) Which of the following immunoglobulin crosses the placenta?A. IgMB. IgAC. IgDD. IgGCorrect ChoiceE. IgE
  • 27. IgG is the antibody that can cross the placenta and the most common antibody found in circulation.IgA is found in mucous membrane secretions and is able to agglutinate antigens and activate thealternate but not the classic complement pathway. IgD is not found in circulation other than inhyper-IgD syndrome, an autosomal recessive disorder caused by mutations in the mevalonatekinase gene. A significant elevation of serum IgD is seen in 95% of these patients. IgE is ananaphylactic antibody that is involved in nearly all immediate allergic and anaphylactic typereactions. IgM is the antibody produced in the early stages of antibody responses. It is a pentamerwhich can agglutinate antigen and active the classic complement pathway.107) Serum IgA antibodies to tissue transglutaminase occur inA. pemphigus foliaceusB. linear IgA diseaseC. bullous lupus erythematosusD. dermatitis herpetiformis Correct ChoiceE. bullous pemphigoidAutoantibodies to tissue transglutaminase are an area of active investigation in both celiac diseaseand dermatitis herpetiformis (Reif, et al, 2004108) All of the following statements regarding Toll receptors are true EXCEPT:A. Nuclear factor kappa B (NFKB) is the final common pathway of toll receptorsB. Toll 4 receptors are typically activated by gram negative bacteriaC. None of the above (all are true)D. Toll 2 receptors are typically activated by lipopolysaccharideCorrect ChoiceE. Toll receptors are present on macrophages and dendritic cellsBacteria can induce inflammation through activation of Toll receptors, which are present on avariety of cutaneous cells including macrophages, dendritic cells, keratinocytes, and mast cells.Typically, Toll 2 receptors are activated by gram positive bacteria and Toll 4 receptors are activatedby lipopolysaccharide or gram negative bacteria. Nuclear factor kappa B is a final common pathwayof toll receptors and other immune receptors involved in initiating a variety of proinflammatorycytokines.109) Which T-cell subset is commonly found in Sézary syndrome?A. CD4+/CD7+B. CD4-/CD7+C. CD8+/CD7-D. CD8+/CD7+E. CD4+/CD7- Correct ChoiceSézary syndrome is the leukemia phase of mycosis fungoides (cutaneous T-cell lymphoma) and isusually a TH2-biased CD4+ leukemia.110) Which of the following cytokines is a general down-regulator of TH1 immunity?A. IL-5B. IFN-gammaC. TNF
  • 28. D. IL-10Correct ChoiceE. IL-4IL-4 is a B cell growth factor. IL-5 is an eosinophil growth factor. IL-10 is a general down-regulatorof TH1 immunity. TNF and IFN-gamma are TH1 cytokines, not TH2 cytokines. IFN-gamma issecreted by TH1 cells, and is the main macrophage-activating cytokine.111) A deficiency of this complement component may result clinically in susceptibility to pyogenicinfections, glomerulonephritis, and partial lipodystrophy.A. C3Correct ChoiceB. ProperidinC. C4D. C50E. C1 Esterase InhibitorC3 is the central component of the complement cascade. It plays a key role in the opsonization ofbacteria. An autosomal recessive deficiency of C3 may result in susceptibility to pyogenic infections,glomerulonephritis, and partial lipodystrophy.112) Proteins in the alternate complement pathway include:A. properdinB. Factor BC. C3D. Factor B and properdinE. Factor B, properdin and C3 Correct ChoiceProteins in the alternate complement pathway are Factor B, Factor D, properdin, and C3. Thealternate complement pathway is active against pathogenic microorganisms, virus-infected cells,and neoplastic cells. The proteins of the classical pathway are C1, C2, C3, and C4.113) Which cytokine is chemotactic for neutrophils?A. IL-2B. IL-8Correct ChoiceC. IL-3D. IL-5E. IL-6IL-8 is chemotactic for neutrophils. The other cytokines elicit other types of immune cells, IL-2 (T-ells), IL-3 (mast cells), IL-5 (eosinophils), IL-6 (plasma cells).114) Major histocompatibility complex (MHC) Class I molecules:A. Are inducible on keratinocytesB. All of the aboveC. Are recognized by receptors on CD4+ T cellsD. Complexed with antigen trigger cytotoxic T cellsCorrect ChoiceE. Bear peptides derived from pathogens taken up into vesicles
  • 29. MHC Class I molecules are present on all nucleated cells. They are recognized by receptors onsurfaces of CD8+ T cells, and, when complexed with antigen, trigger cytotoxic T cells. The otherstatements apply to MHC Class II molecules.115) Which antibody can bind the FcER1 portion of mast cells, basophils, Langerhans cells, dermaldendritic cells?A. IgDB. IgAC. IgGD. IgME. IgECorrect ChoiceIgE is an anaphylactic antibody that is involved in nearly all immediate allergic and anaphylactictype reactions and commonly seen in elevated levels in patients with atopic dermatitis. Mast cells,basophils, Langerhans cells, dermal dendritic cells as well as monocytes from atopic individuals allexpress high-affinity FcERI receptor which can bind IgE. More recently, it became clear that canbind monomeric IgE via the high-affinity FcåRIIgG is the antibody that can cross the placenta and the most common antibody found in circulation.IgA is found in mucous membrane secretions and is able to agglutinate antigens and activate thealternate but not the classic complement pathway. IgD is not found in circulation other than inhyper-IgD syndrome, an autosomal recessive disorder caused by mutations in the mevalonatekinase gene. A significant elevation of serum IgD is seen in 95% of these patients. IgM is theantibody produced in the early stages of antibody responses. It is a pentamer which can agglutinateantigen and active the classic complement pathway.116) Langerhans cells exhibit which of the following antigenic moieties?A. CD45B. LangerinC. all of the options are correctCorrect ChoiceD. vimentinE. MHC class II antigensIn addition to CD1a and S-100, Langerhans constantly express the leukocyte common antigenCD45, MHC class II antigens, vimentin and the Birbeck granule-associated molecule, Langerin.