Question Text Question Type Points

A 32-year-old male with a known severe peanut

allergy is inadvertently exposed to peanuts by
eating a homemade cookie. Within minutes of exposure
he develops a widespread rash and difficulty
breathing, which resolve with a self-administered
epinephrine injection. Which of the following
statements
is most characteristic regarding this type of
allergic reaction?

Multiple Choice
A 42-year-old woman presents to her primary
care physician complaining of itching and watery
eyes, runny nose, and frequent sneezing. She denies
fever or cough. She experiences similar symptoms
every year in the spring. Which of the following is
responsible for her symptoms? Multiple Choice

blood type O+ infant is delivered to a multiparous

blood type O- mother without prenatal care.
The infant is born with severe anemia, jaundice, and
severe edema. What is the underlying mechanism of
this disease? Multiple Choice
A 23-year-old male is hit by a bullet during a
drive-by shooting at a local store. He is rushed to the
emergency room and is determined to have a
hemothorax.
A chest tube is placed and intravenous fluids and
blood are given. Immediately after the transfusion, he
develops a temperature of 100.3°F and chills. Shortly
thereafter, he develops a blood pressure of 80/50 mm
Hg. Of the following, which is most likely occurring? Multiple Choice
An 8-year-old boy presents with periorbital edema and
throbbing headaches. His parents report that the boy
had a
“strep throat” 2 weeks ago. Urinalysis shows 3+
hematuria.
A renal biopsy shows hypercellular glomeruli, and
electron
microscopic examination of glomeruli discloses
subepithelial
“humps.” Which of the following best explains the
pathogenesis
of glomerulonephritis in this patient? Multiple Choice
A 50-year-old man complains of fever, weight loss,
abdominal
pain, and bloody urine. Physical examination reveals
red-purple discoloration of the skin. Serologic fi ndings
are
inconclusive, but a positive P-ANCA test suggests an
autoimmune
disease. Biopsy of lesional skin discloses fi brinoid
necrosis
of a small muscular artery. Which of
the following immune responses best explains the
pathogenesis
of infl ammation and necrotizing vasculitis in this
patient? Multiple Choice
A 34-year-old inmate presented to the prison clinic
with fever, cough, and night sweats. Tuberculosis was
suspected and PPD (purifi ed protein derivative) was
injected intradermally. A skin reaction characterized
by erythema and induration developed at the injection
site within 2 days. Which cell type is primarily
responsible for reacting to the PPD and releasing
mediators that resulted in the skin manifestation? Multiple Choice
 On the first day of medical school, a sample of purified Multiple Choice
protein derivative from Mycobacterium tuberculosis
was injected into the student's skin. If the student had
been previously exposed to tuberculosis, which of the
following responses would be observed at the injection
site?
Question Explanation Answer 1 Answer 2
Correct: This type of allergic
reaction is
caused by excessive TH2 response
(C)
This patient is experiencing an
anaphylactic reaction,
a classic type I (immediate)
hypersensitivity reaction.
Type I hypersensitivity reactions are
triggered
by crosslinking of membrane-bound
IgE on mast
cells (A, B). Previous antigen
exposure is required
for the production of this antigen-
specific IgE (E).
This previous exposure results in
TH2 cells secreting
IL-4 and IL-5, which promotes B-cell
class switching
to produce the IgE (C). These
reactions follow a
characteristic pattern of initial
reaction (caused by
mast cell activation and release of
mediators, including
prostaglandins) followed 2 to 24
hours later by
a late-phase reaction mostly due to
activation of
eosinophils (D).

The immediate reaction is The immediate allergic

triggered by IgM reaction is triggered by
bound to antigen. activation of eosinophils
Correct: Binding of antigen to IgE on
mast cell
surfaces.
This woman is presenting with
classical symptoms
of seasonal allergies, a type 1
hypersensitivity reaction
caused by crosslinking of IgE on
previously
sensitized mast cells (A).
Recognition of antigen presented
on MHC1 activates CD8+ T-cells,
which plays
an important role in defense against
viruses and
intracellular pathogens but no role
in seasonal allergies
(B). Recognition of microbial
polysaccharides
by lectin receptors activates
leukocytes in response
to extracellular pathogens (C). (D, E)
describe the
mechanism of Type 2 and Type 3
hypersensitivity
reactions respectively.

[Y]Binding of antigen to IgE on Recognition of antigen

mast cell surfaces associated with MHC-1

Correct: IgG binding to cell

surfaces .
Autoimmune hemolytic disease of
the newborn is a
type 2 hypersensitivity reaction. In
this condition a
previously sensitized woman
develops IgG antibodies
against Rh+ antigens on fetal red
cells. These antibodies
cross the placenta and lead to lysis
of fetal red
cells (B). Crosslinking of IgE on mast cell
surfaces [Y]IgG binding to cell surfaces
A type II hypersensitivity reaction
(B)
Given that the patient just received
blood and
immediately afterward developed
fever and chills,
an immediate transfusion reaction,
caused by IgM
reacting against AB blood antigens,
is the most likely
cause. This is a type II
hypersensitivity reaction (B).
The IgM antibodies against the A or
B antigen are
naturally occurring and do not
require previous sensitization
to the antigen. Intravascular
hemolysis will
occur, causing free hemoglobin to
be identified in the
blood. This type of transfusion
reaction can be fatal.
A type I hypersensitivity [Y]A type II hypersensitivity
reaction reaction
The answer is : Deposition of
circulating immune complexes.
Type III hypersensitivity reactions
are characterized by immune
complex deposition, complement fi
xation, and localized
infl ammation. Antibody directed
against either a circulating
antigen or an antigen that is
deposited in a tissue can give rise
to a type III response. Diseases that
seem to be most clearly
attributable to the deposition of
immune complexes are systemic
lupus erythematosus, rheumatoid
arthritis, and varieties
of glomerulonephritis.
Streptoccocal infection in this case
led to the deposition of antigens
and antibodies in glomerular
basement membranes, resulting in
clinical features of nephritic
syndrome (e.g., hematuria, oliguria,
and hypertension).
Poststreptococcal
illnesses do not include any of the
other choices.
Diagnosis: Postinfectious
glomerulonephritis Antineutrophil cytoplasmic [Y]Deposition of circulating
autoantibodies immune complexes
The answer is : Immune complex
disease. Immune complex
(type III) hypersensitivity reactions
cause vasculitis. Antigenantibody
complexes are either formed in the
circulation and
deposited in the tissues or formed
in situ. Immune complexes
induce a localized infl ammatory
response by fi xing complement,
which leads to the recruitment of
neutrophils and monocytes.
The vasculitis in patients with
polyarteritis nodosa involves small
to medium-sized muscular arteries.
The diagnosis is usually
made by biopsy of the skin, muscle,
peripheral nerves, or the
most affected internal organ (the
kidney in this case). The most
prominent morphologic feature of
the affected artery is an area
of fi brinoid necrosis (see
photomicrograph). Other examples
of
type III hypersensitivity reactions
include Henoch-Schönlein
purpura (vascular IgA deposits) and
vasculitis associated
with hepatitis C infection. The other
choices are uncommon
mediators of vasculitis in patients
with polyarteritis nodosa.
Diagnosis: Polyarteritis nodosa Antibody-dependent cellular
cytotoxicity Cytopathic autoantibodies
The answer is : Th1 cells. The
reaction to PPD in a
tuberculosis patient is the result of
Mycobacterium
tuberculosis-specifi c memory T
helper 1 (Th1 cells that
encounter the antigen presented by
skin dendritic cells
(Langerhans cells). Following
antigen interaction, the
Clinical Immunology 165
Th1 cell releases cytokines and
chemokines, which
recruit and activate mononuclear
cells from the blood.
The infl ammatory response that
develops, with its
vasodilation and cellular infi ltrate,
accounts for the erythema
and induration seen at the site of
antigen injection.
If any of the other cells were
primarily involved
in this reaction, even uninfected
individuals would
respond by mounting an infl
ammatory response following
antigen injection. The skin test is
used to detect
memory cells elicited following
primary exposure to
M. tuberculosis.
Endothelial cells Keratinocytes
The answer is -indurated swelling & Immediate (less than 2 Deposition of immune
erythema developing over the next minutes) erythema & complexes & the fixation of
24-48 hours, resulting primarily edematous swelling lasting complement over the next 24-
from the accumulation of 24-48 hours. 48 hours
monocytes & lymphocytes-. This is
the classic definition of a DTH
reaction. The antigen is
administrated in the skin, & only the
local reaction is evaluated. The
indurated nature of the reaction
indicates that lymphocytes &
monocytes were drawn to the site
of antigen application. If neutrophils
were brought to the area, that
would produce a more edematous
reaction & implicate antigen-
antibody complexes.
F.
Answer 3 Answer 4 Answer 5
Prostaglandins do not play a Previous exposure to the
role in this type of antigen is not required
reaction. for this type of reaction.

[Y]This type of allergic

reaction is caused by
excessive a TH2 response.
 Inflammation due to
deposition of antigenantibody
complex

Binding of polysaccharide to
membrane-bound Destruction of cells coated
lectin receptors with IgM

Deposition of antigen
antibody complexes in the Antibody mediated activation
fetal tissue T-cell mediated cytotoxicity of apoptosis
A type IIIa hypersensitivity A type IIIb hypersensitivity A type IV hypersensitivity
reaction reaction reaction
 IgE-mediated mast cell T cell–mediated delayed
degranulation hypersensitivity reaction

Directly cytotoxic IgG and IgM

antibodies
 Immediate hypersensitivity [Y]Immune complex disease

Delayed-type hypersensitivity
 [Y]Th1 cells

Langerhans cells Mast cells

Indurated swelling & [Y]indurated swelling & Activation & accumulation of
erythema developing over the erythema developing over the CD8 cytotoxic T lymphocytes
next 24-48 hours, resulting next 24-48 hours, resulting at the injection site over the
primarily from the primarily from the next 24-48 hours.
accumulation of neutrophils accumulation of monocytes &
lymphocytes.
Answer 6 Answer 7 Answer 8
Answer 9 Answer 10
Question Types
Multiple Choice
Multiple Answers
True/False
Sequence
Set Correct Answer
In order to set the correct answer insert these symbols before the answer text: [Y]