BECOM 1 Exam 4 – 2019

Included Content

  • Amino Acid Metabolism
  • RBC Dynamics
  • Synthesis & Catabolism of Porphyrins
  • Iron Metabolism
  • General Blood Histology & Hematopoiesis 
  • Anatomy of the Immune System
  • Cells of the Immune System
  • Antigen Recognition
  • Antigen Presentation
  • Inflammation 

1. Which of the following explains why ammonia must be carried to the liver by a carrier protein for the urea cycle?

  1. It is too large of a molecule to cross without a carrier

  2. It does not have chemotaxis ability to find the liver without a carrier

  3. It is so small that if it were released into the bloodstream it would cross the blood brain barrier

  4. It would bind to the blood cells causing them to be unable to bind oxygen

  5. It would go straight to the kidneys without first being processed


2. Which of the following macromolecules cannot be stored when taken in excessively?

  1. Carbohydrates

  2. Lipids

  3. Proteins

  4. Knowledge

  5. Bar Trivia

3. Which of the following amino acid cannot be synthesized by the human body?

  1. Alanine

  2. Tryptophan

  3. Tyrosine

  4. Glutamine

  5. Glutamate

4. Which of the following amino acids can be both ketogenic and glucogenic?

  1. Threonine

  2. Asparagine

  3. Glycine

  4. Leucine 

  5. Isoleucine

5. Which of the following coenzymes is necessary to transform alpha ketoglutarate and ammonia into glutamate using glutamate dehydrogenase (GDH)?

  1. NADH

  2. NADPH

  3. FADH2

  4. ATP

  5. GTP

6. Which of the following amino acids undergoes non-oxidative deamination that is carried out by a dehydratase?

  1. Glutamate

  2. Cystine

  3. Threonine 

  4. Asparagine 

  5. Phenylalanine

7. Which of the following amino acids is primarily responsible for shuttling ammonia from the brain to the kidney/liver?

  1. Glutamate

  2. Glutamine

  3. Alanine

  4. Aspartate

  5. Asparagine

8. Which of the following is combined with ammonia to produce carbamoyl phosphate in the mitochondria for the urea cycle?

  1. Glutamate

  2. N-acetylglutamate (NAG)

  3. Urea

  4. Bicarbonate

  5. Aspartate

9. After discovering that a patient has cirrhosis you test for hyperammonemia. If they test positive which medication would you give them to help increase excretion of the excess ammonia?

  1. Phenylbutyrate

  2. N-acetylcysteine 

  3. N-acetylglutamate

  4. Methotrexate

  5. Acetylsalicylic Acid

10. Which of the following amino acids should you restrict from someone with maple syrup urine disease?

  1. Lysine 

  2. Alanine 

  3. Isoleucine 

  4. Phenylalanine 

  5. Tyrosine

11. What would you expect a patient to have who has elevated levels of phenylalanine and decreased levels of tyrosine?

  1. Phenylketonuria 

  2. Alkaptonuria 

  3. Tyrosinemia 2

  4. Tyrosinemia 1

  5. Oculocutaneous albinism

12. Most doctors recommend that patients begin to take prenatals that include folate in the form of DHF when they begin to think about becoming pregnant, why is this?

  1. Lack of folate in the first trimester can cause autism

  2. Lack of folate in the first trimester can cause anencephaly

  3. Folate helps to increase your FSH to help you get pregnant

  4. Folate helps to form neurotransmitters

  5. Folate is needed for the synthesis of vitamin B12

13. A patient comes in who has been having excessive thirst and urination and what appears to be a mass on their cornea that has been causing a blind spot to occur. A UA showed elevated levels of cysteine in their urine. Based on their symptoms, which of the following disorders do you believe they have?

  1. Cystinosis

  2. Cystinuria

  3. Homocystinuria

  4. Marfan syndrome

  5. Maple Syrup Urine Disorder


14. Which vitamin is essential to neural tube development?

  1. Thiamin 

  2. Pyridoxal Phosphate

  3. Biotin

  4. Folate

  5. Cobalamin

15. When does the neural tube form and then close after conception?

  1. Before the first week

  2. Between the first and second

  3. Between the third and fourth

  4. Between the fourth and sixth

  5. In the second trimester

16. The combination of tetrahydrofolate (THF) and which amino acid yields a double bound between the carbon of the methyl group and then N10 of THF?

  1. Tryptophan

  2. Histidine

  3. Serine

  4. GLycine

  5. Adenine

17. Using serine hydroxymenthyl transferase (SHMT) with serine and tetrahydrofolate (THF) produces which of following compounds?

  1. Tetrahydrofolate 

  2. N10-Formyl-THF

  3. N5,N10-Methenyl-THF

  4. N5,N10-Mehtylene-THF

  5. N5-Methyl-THF

18. High dietary folate can often mask severe B12 deficiency. Which of the following blood cells will you notice marked visual changes in even before CNS effects/deficits?

  1. Neutrophils

  2. Eosinophils 

  3. Basophils

  4. Macrophages

  5. NK Cells

19. Which of the following enzymes are necessary to maintain cobalamin’s reduced state?

  1. Methionine synthase

  2. Methionine synthase reductase

  3. Methionine synthase oxidase

  4. Methyl malonyl CoA mutase

  5. Succinyl CoA mutase

20. Which of the following procedures/conditions would reduce cobalamin (B12) absorption?

  1. Cirrhosis 

  2. Bone marrow irradiation 

  3. Leukemia 

  4. Liver transplant 

  5. Gastric bypass surgery

21. Which vitamin is necessary for the generation of cysteine from methionine?

  1. Thiamin

  2. Niacin 

  3. Pyridoxal Phosphate

  4. Folate

  5. Cobalamin

22. An attending is quizzing you on various conditions of the patients on the floor. He somehow seems to hate and respect you because you were trained just oh so well at ARCOM. He laughs and says “this should be an easy one”, they’re never easy though. He asks, “which symptoms would you expect to see in our patient with cystinuria?”

  1. Lysosomal accumulation of cystine and often development of Fanconi syndrome (whatever the hell that is)

  2. Lens placement down and out, long limbs, cognitive defects, and increased thrombosis

  3. Fatigue, macrocytic erythrocytes, hyper poly segmented neutrophils

  4. Poor resorption of acidic amino acids, frequent kidney stones, and elevated cystine in the urine

  5. “Mousy” smell, hypopigmentation, developmental delays, and seizures

23. A new patient presents to your clinic after moving to your area. You look at their chart and notice a history of multiple DVTs and as you walk into the room you notice that they have long limbs and the lenses in both of their eyes are inferior and medially positioned. You immediately begin to suspect that they have what condition?

  1. Cystinuria

  2. Homocystinuria 

  3. Cystinosis 

  4. Alkaptonuria 

  5. Marfan’s Syndrome

24. Which form of hemoglobin would you be able to use to prove that Brian has been drinking too many sugary fruity drinks when he goes out?

  1. HbA

  2. HbA2

  3. HbF

  4. HbS

  5. HbA1C

25. In an extreme starvation states (I’m talking Chris Hemsworth in Heart of the Sea kinda thing) what will the erythrocytes begin to use for fuel?

  1. Glucose

  2. Fatty acids

  3. Amino acids

  4. Ketone bodies

  5. Autophagy

26. Red blood cells often produce less ATP per glucose in glycolysis as compared to other cells. What might this be?

  1. Without a nucleus the red blood cells are “dumber” and don’t know how to properly break down a glucose

  2. Red blood cells actually use fructose more often then glucose as a fuel source which leads to less ATP production

  3. Red blood cells will often shunt glycolytic intermediates to make 2,3-BPG

  4. Red blood cells will often shunt glycolytic intermediates to the pentose phosphate pathway to make NADPH 

  5. Red blood cells must use fermentation/lactic acid formation to regenerate NAD+ thus making glycolysis less efficient

27. Which organ is responsible for producing the hormone that causes the generation of new erythrocytes?

  1. Bone Marrow

  2. Hypothalamus

  3. Pituitary gland

  4. Kidneys 

  5. Heart

28. Erythropoietin (EPO) activates which of the following types of receptors?

  1. Tyrosine Kinase

  2. GPCR


  4. Nuclear hormone receptor

  5. Cytosolic hormone receptor

29. Which of the following combinations most accurately describes RBC morphology for patients with sickle cell anemia?

  1. Microcytic, hypochromic 

  2. Microcytic, normochromic 

  3. Normocytic, hypochromic 

  4. Normocytic, normochromic

  5. Macrocytic, normochromic

30. Which of the following combinations most accurately describes RBC morphology of pernicious anemia?

  1. Microcytic, hypochromic 

  2. Microcytic, normochromic 

  3. Normocytic, hypochromic 

  4. Normocytic, normochromic

  5. Macrocytic, normochromic

31. The elimination of dicholor-diphenyl-trichloroethane (DDT) potentially caused the deaths of 50 million people due to increased mosquito populations. Which type of people did this change most likely NOT effect?

  1. Individuals with pernicious anemia 

  2. Individuals with sickle cell anemia

  3. Individuals with iron deficiency 

  4. Individuals with erythroleukemia 

  5. Individuals with lead poisoning

32. While working in the ER, a patient comes in who has been violently throwing up and experiencing seizures. A UA confirms an increase in heme intermediates and you diagnose the patient with acute intermediate porphyria. Which of the following steps of the heme synthesis pathway is this disease concerned with?

  1. Formation of amino levulinic acid

  2. Condensation of four porphobilinogen to one uroporphyrin

  3.  Addition of Fe to the heme molecule

  4. Transfer of porphyrin precursor from the mitochondria to the cytosol

  5. Transfer of the porphyrin precursor from the cytosol to the mitochondria

Answer B.


33. Which of the following TCA cycle intermediates can be used to generate heme/porphyrin?

  1. Oxaloacetate 

  2. Citrulline 

  3. Fumarate

  4. Succinyl-CoA

  5. Malate

34. A patient with hyperammonemia  is prescribed Ammunol and subsequently develops anemia. Why would this happen?

  1. Additional succinyl CoA is excreted which is necessary for heme synthesis

  2. Additional glutamine is excreted which is necessary for heme synthesis

  3. Additional glycine is excreted which is necessary for heme synthesis 

  4. Ammunol has been shown to increased hematuria (blood in the urine) causing increased blood loss 

  5. Ammunol has side effects that can cause decreased erythrocyte production due to sequestering EPO

35. Overproduction of heme can be a dangerous so it has a negative feedback mechanism where it acts as an allosteric inhibitor to which enzyme?

  1. ALA synthase

  2. ALA dehydratase

  3. Porphobilinogen deaminase

  4. Uroporphyrinogen decarboxylase

  5. Ferrochelatase

36. Lead poisoning can lead to microcytic anemia by inhibiting which of the following enzymes?

  1. ALA synthase

  2. ALA dehydratase

  3. Porphobilinogen deaminase

  4. Uroporphyrinogen decarboxylase

  5. Ferrochelatase

37. Your friend Shawn has very sensitive skin to the sun to where he constantly has to wear sunscreen and wear long sleeved clothes or he gets very painful sunburns and blistering. Some have even started to call him a vampire (how mean and slightly funny). Which of the following conditions is it most likely that Shawn has?

  1. Iron deficiency anemia

  2. Acute intermittent porphyria (AIP)

  3. Porphyria cutanea tarda (PCT)

  4. Pernicious anemia

  5. Beta Thalassemia

38. When using heme oxygenase for the degradation of heme, which by product is given off as the ring is cleaved?

  1. O2

  2. CO

  3. CO2

  4. NH3

  5. CH3

39. Bilirubin by itself is not water soluble so it must be transported by albumin to liver where which compound can be added to it to increase its water solubility?

  1. Glutamic acid

  2. Glycine 

  3. Glutamine

  4. Glucose

  5. Glucuronic acid

40. After adding only a diazonium salt to a blood sample, what are you able to measure?

  1. Direct bilirubin

  2. Indirect bilirubin

  3. Bilirubin that is bound to albumin 

  4. Bilirubin prior to conjugation 

  5. Total Bilirubin

41. Which type of jaundice is associated with hemolytic anemias or internal hemorrhages?

  1. Kernicterus 

  2. Prehepatic

  3. Hepatic

  4. Posthepatic 

  5. These diseases can cause a variety of jaundice forms

42. After finding out that a patient is jaundice you run a total and direct bilirubin. You find that both values are elevated beyond their reference ranges. What is a possible cause of the elevations?

  1. Hemolysis

  2. Viral hepatitis 

  3. Cirrhosis

  4. Hemorrhage 

  5. Bile duct obstruction

43. In the spirit of Christmas, which wavelength of light would best be used to treat a jaundiced eight pound six ounce newborn baby jesus who don’t even know a word yet, just a little infant, so cuddly, but so omnipotent?

  1. 380 nm

  2. 480 nm 

  3. 580 nm

  4. 680 nm

  5. Why you praying to baby jesus? He was a grown man with a beard!

44. Chronic iron anemia disease is a normochromic, normocytic anemia that shows characteristically elevated ferritin stores but lower total body iron. Which of the following is a potential reasoning behind these findings?

  1. Increased IL6 and decreased hepcidin

  2. Increased IL6 and increased hepcidin

  3. Decreased IL6 and decreased hepcidin

  4. Decreased IL6 and increased hepcidin

  5. These two are not related

45. Janice is an 85 year old patient who has been admitted to the hospital. She is beginning to show signs of icterus. She has a history of melanoma that was removed when she was 67 with no complications, gallstones last month, kidney stones every couple of months for the last year, and a hysterectomy at the age of 55. Which of the following is the probable cause of her icterus?

  1. Old age

  2. Gallstones

  3. Kidney stones

  4. Hysterectomy

  5. Blue light from her cellphone


46. Which of the following minerals are organic?

  1. Iron

  2. Calcium

  3. Potassium

  4. Magnesium

  5. Minerals are inorganic dumb dumb

47. When iron is not bound to heme it often sequestered into clusters with which amino acid?

  1. Aspartic Acid

  2. Lysine

  3. Cystine

  4. Proline

  5. Methionine

48. Which of the following conditions/situations would cause low iron absorption?

  1. Silly vegans with their iron supplements 

  2. People who eat antacid tablets like cady

  3. Orange juice/Sunny D drinkers

  4. Diets high in red meat

  5. Becoming Ironman

49. Which of the following is responsible for moving the iron from the gut mucosa cell into circulation?

  1. DMT-1

  2. Ferritin

  3. Ferroportin

  4. Transferrin

  5. Hepcidin

50. Most of the iron in the adult body is found where?

  1. In red blood cells in hemoglobin

  2. In muscles as myoglobin

  3. Stored in ferritin in bone marrow for erythropoiesis 

  4. In the liver as a part of cytochrome p450

  5. Bound to albumin in the plasma

51. Which of the following individuals has a higher than normal iron requirement?

  1. Individuals with various thalassemias 

  2. A woman in the first trimester of her pregnancy

  3. Individuals with sickle cell trait

  4. Males who develope the man flu

  5. A woman who is in the third trimester of her pregnancy

52. Which of the following disorders has a decreased mean corpuscular volume (MCV), normal red cell distribution width (RDW), normal RBC amount, normal serum iron studies, no improvement with iron supplementation, and increased hemoglobin A2 on electrophoresis?

  1. Iron deficiency anemia

  2. Antibody mediated RBC destruction

  3. Alpha thalassemia minor

  4. Beta thalassemia minor

  5. Chronic blood loss

53. Which of the following disorders would present with an increased mean corpuscular volume (MCV) aka macrocytic anemia?

  1. Iron deficiency

  2. Thalassemias

  3. Chronic diseases

  4. Alcohol induced cirrhosis 

  5. Combined deficiencies

54. Which of the following is NOT a cause of microcytic anemias?

  1. Sideroblastic anemia

  2. Chronic disease

  3. B12 deficiency

  4. Iron deficiency

  5. Thalassemias

55. Your friend Amal is weird in a lot of ways. Shes always tired and napping, shes constantly chewing on ice (she prefers sonic ice, I mean who doesn’t?), and she doesn’t eat bacon (like forreal). To be fair she also has which form of anemia?

  1. Beta thalassemia

  2. Iron deficiency

  3. Chronic disease

  4. Megaloblastic 

  5. She gets stabbed a lot aka acute blood loss

56. After running a few tests on a patient in which you suspect anemia to better determine the type, you find that they have elevated iron, transferrin saturation, and ferritin levels. Also, when stained with prussian blue some cells have a beautiful blue ring around them. Which form on anemia do they have?

  1. Iron deficiency 

  2. Chronic disease 

  3. Megaloblastic 

  4. Sideroblastic 

  5. Alpha thalassemias

57. A mother frantically races her toddler to the ER after finding they had gone through her medicine cabinet and obviously had been eating some of her medications. She is unsure exactly what was swallowed or how much, if any. She lives about an hour away from the hospital and is unsure of when he may have taken the medications. After getting some lab results back you find that the total iron binding capacity is 100 (ref 240-450) and transferrin saturation is 5% (ref 15-50). What medication did the toddler swallow?

  1. Tylenol

  2. Antacids

  3. Prenatal vitamins

  4. Zyrtec

  5. Benadryl

58. Which medication or treatment would you give to the toddler mentioned in the questions above?

  1. Hemosiderin

  2. Prenatal vitamins

  3. Activated charcoal 

  4. Desferrioxamine

  5. Vitamin B12

59. A gun-shot wound patient comes to the ED with a Hgb:5.5.  They desperately need to be transfused with blood. There is no time for a proper blood type test so you order stat units of “universal donor blood”.  Which blood type, disregarding antibodies, is acceptable for any anyone to receive?


A. A Positive

B. B Positive

C. O Negative

D. AB Negative

E. A Negative



60. A 49 year old male reports to the clinic with lethargy and low oxygen saturation.  You have labs drawn and notice the patient has a noticeably low b12. You believe they have macrocytic anemia from the b12 deficiency but need the MCV value to properly diagnose them.  The cbc results are slow to result but they do have these values…


Hgb: 6

Hct: 25

What is the correct MCV?

A. 85

B. 95

C. 105

D. 125

E. 140



61. A 20 YO athlete reports to you as a sports medicine doc after spending the summer in Colorado preparing for the winter Olympics.  He believes that spending time in hypoxic conditions trained his body to naturally elevate erythropoietin levels. This reminds you of the EPO regulation pathway.  Which of the molecules is stimulated to transcribed EPO during hypoxic conditions?



B. HIF-1alpha



E. Caspase 3



62. Which of the following scenarios would have the highest risk of the fetus developing erythroblastosis fetalis?

  1. A mother with O+  blood and a fetus with A- blood

  2. A mother with A+  blood and a fetus with A-  blood

  3. A mother with A- blood and a fetus with A+ blood

  4. A mother with A+ blood and a fetus with O+ blood

  5. A mother with A- blood and a fetus with O- blood

63. Hereditary spherocytosis is a condition that affects red blood cells. People with this condition typically experience anemia, jaundice, and splenomegaly. This condition can be caused by a mutation in the gene that codes for Spectrin. If this was the case, which of the following explains the spherification and lysis of the RBCs?

  1. Spectrin serves as an anchor on the membrane and without it, RBCs lose their ability to carry proteins and nutrients

  2. Spectrin serves as a liaison between integrin proteins and cytoskeleton components and without this bond, the membrane is not connected to the underlying cytoskeleton so it blebs and forms spheres

  3. Spectrin is a part of the cytoskeleton and without this, it does not form the biconcave shape so it becomes more spherical. 

  4. Spectrin binds the integrin proteins to the cytoskeleton and without it the cytoskeleton binds a different protein that makes it more rigid and more likely to lyse under the stress of the movement through blood vessels. 

  5. Spectrin is a part of the cytoskeleton and without this, the integrins bind to other components making it more rigid and more likely to lyse under the stress of the movement through blood vessels. 


64. After centrifuging a blood sample, in which section would you find platelets?

  1. In the plasma

  2. In the buffy coat

  3. With the erythrocytes

  4. Spread throughout the buffy coat and plasma

  5. Evenly spread throughout all three sections

65. Which of the following are derived from a lymphoid progenitor stell cell?

  1. Erythrocyte 

  2. Thrombocyte

  3. Monocyte

  4. Natural Killer Cell

  5. Eosinophils

66. Which of the following is the most numerous leukocyte?

  1. Neutrophil

  2. Eosinophil

  3. Basophil

  4. Monocyte

  5. Lymphocyte

68. Which of the following leukocytes is primarily responsible for responding to parasitic infections?

  1. Neutrophil

  2. Eosinophil

  3. Basophil

  4. Monocyte

  5. Lymphocyte

69. Which cytoskeletal element is responsible for pinching the nucleus out of the cell in formation of the reticulocyte?

  1. Microfilaments 

  2. Erythrokeratin

  3. Keratin 

  4. Titin

  5. Microtubules

70. If you have blood type A+, which antigens do your blood cells express?

  1. A only

  2. B only

  3. A and Rh

  4. B and Rh

  5. A, B and Rh

71. If you have blood type A+, which antigens will your body produce antibodies against?

  1. A only

  2. B only

  3. A and Rh

  4. B and Rh

  5. A, B, and Rh

72. If a mother has a negative blood type, in which of her pregnancies should you be concerned about hemolytic disease of a newborn (erythroblastosis fetalis)?

  1. Every positive blood type child she has

  2. Every negative blood type child she has

  3. Every positive blood type child she has after the first one

  4. Every negative blood type child she has after the first one

  5. None of them as long as she sings “Jesus take the wheel” by Carrie Underwood

73. What is your mean corpuscular hemoglobin concentration (MCHC) if your mean corpuscular volume (MCV) is 100 fL (10^-15 L) and your mean corpuscular hemoglobin (MCH) is 30 pg(10^-15 Kg)/cell?

  1. 0.3 g/dL

  2. 3 g/dL

  3. 30 g/dL

  4. 300 g/dL

  5. 3000 g/dL

74. Which of the following is correct in regard to how HIF-1a operates in regards to erythropoietin production?

  1. In periods of hypoxia, HIF-1a exits the kidneys and upon entering the blood it becomes erythropoietin 

  2. Oxygen binds to HIF-1A becoming hydroxyl groups which allows it to combine with VHL and then translocate to the nucleus 

  3. With oxygen present, HIF-1a combines with ARNT which leads to ubiquitin proteasome degradation

  4. With oxygen present, HIF-1a is sequestered into lysosomes and degraded by cathepsin proteins 

  5. In periods of hypoxia, HIF-1a translocates to the nucleus and binds to DNA at HRE

75. In acute promyelocytic leukemia (APL), which is a form of AML, a DNA translocation causes fusion of PML and RARA to decrease transcription and thus decrease differentiation. Which of the following best describes how the medication Decitabine is used to treat APL?

  1. Decitabine is lipid soluble and is able to penetrate the mitochondria and release pro apoptotic caspases 

  2. Phosphorylated decitabine replaces cytosine and inhibits methylation triggering differentiation and apoptosis 

  3. Decitabine binds to TNF-alpha receptors and initiates apoptotic pathways through a G protein coupled receptor

  4. Decitabine acts as a competitive inhibitor to thymidylate synthase to inhibit DNA nucleotide synthesis and stop cell division

  5. Decitabine is endocytoses and complexes with p53 to bind to specific DNA sequences and inhibit cell proliferation

76. While being treated for Acute lymphoblastic leukemia, Sarah developed a fever and chills. An hour later she had collapsed and was tachycardic and hypertensive. In the ER she was diagnosed as having septic shock. Which of the following conditions caused by her chemo treatments caused her to deteriorate so rapidly?

  1. Neutropenia

  2. Neutrophillia

  3. Eosinopenia

  4. Eosinopillia

  5. Monocytenia 


77. In which of the following phases is the immune system responsible for surveying and distinguishing antigens as potential threats?

  1. Cognitive

  2. Activator

  3. Effector

  4. Contraction

  5. Memory

78. In which of the following phases is the immune system responsible for regulation and prevention of immune-mediated damage to the body?

  1. Cognitive

  2. Activator 

  3. Effector

  4. Contraction

  5. Memory

79. Which of the following is a characteristic of the innate arm of the immune system?

  1. Responds in about 7-10 after infection

  2. Improves in magnitude/effectiveness throughout duration 

  3. Receptors are germline encoded 

  4. Repeat exposures are treated with stronger responses

  5. Memory capability

80. Which of the following is considered an antigen presenting cell?

  1. Neutrophil

  2. Eosinophil

  3. Natural Killer Cell

  4. Macrophage

  5. T cell

81. Which cluster of differentiation (CD) would you expect to find on a natural killer (NK) cell?

  1. CD 3

  2. CD 8

  3. CD 19

  4. CD 28

  5. CD 56

82. Which of the following is the first site of hematopoiesis for a human?

  1. Axial Skeleton

  2. Long bones

  3. Liver and Spleen

  4. Yolk Sac

  5. Placenta

83. Which of the following is a primary lymphoid organ?

  1. Lymph nodes

  2. Thyroid

  3. Spleen

  4. Peyer’s Patches

  5. Thymus

84. Lymph from distal lymph nodes enter more proximal lymph nodes through which of the following?

  1. Afferent lymph vessels

  2. Efferent lymph vessels

  3. High endothelial venules (HEVs)

  4. Diffusion from capillaries 

  5. Direct arterial supply

85. In which section of a lymph node would expect to find a large number of macrophages?

  1. Cortex

  2. Secondary follicles

  3. Paracortex 

  4. Subcapsular sinus

  5. High endothelial venules (HEVs)

86. In which area of the spleen would you expect to find T cells?

  1. Red pulp

  2. Periarterial lymphoid sheath (PALS)

  3. Marginal zone

  4. Paracortex

  5. Subcapsular sinus

87. After a monocyte has invaded a tissue and been exposed to GM-CSF which of the following will it develop into?

  1. Eosinophil

  2. Macrophage

  3. Natural Killer Cell

  4. Dendritic Cell

  5. Monocytes do not respond to GM-CSF

88. Which of the following is a way in which macrophages are different than neutrophils?

  1. They are myeloid derived cells

  2. They are antigen presenting cells

  3. They are phagocytes

  4. They are circulating cells

  5. They release granules full of cytokines when activated

89. A fellow student is fed up with the lack of study spaces at ARCOM and decides to break into the new building when all the TBL rooms are full in the current building. After stepping on a rust nail, which leukocyte will be the first to respond against the clostridium tetani bacteria now inside of them?

  1. Neutrophils

  2. Eosinophils

  3. Basophils

  4. Macrophages

  5. Dendritic Cells

90. Deficiencies in which of the following will lead to chronic granulomatous disease (CGD)?

  1. NADH Oxidase deficiencies

  2. NOX2 deficiencies 

  3. G6PD Deficiencies 

  4. Superoxide dismutase deficiencies 

  5. Glutathione reductase deficiencies

91. An infection with which of the following would you expect in a patient with eosinophilia?

  1. Bacteria

  2. Fungi

  3. RNA virus

  4. DNA virus

  5. Helminths

92. Which of the following cells are most likely responsible for anaphylactic allergic responses when your peanut allergic friend eats a Reese’s peanut butter cup?

  1. Monocyte

  2. Neutrophil

  3. Eosinophil

  4. Basophil

  5. Plasma cells

93. Dendritic cells become activated when which of the following occurs?

  1. They migrate to the lymph nodes

  2. They receive costimulatory molecules from T cells

  3. PRRs recognize PAMPs and DAMPs

  4. They are fully activated upon release from the bone marrow

  5. Interaction with B cell produced antibodies

94. B cells differ from T cells in which of the following ways ?

  1. B cell receptors undergo DNA rearrangement/combinatorial diversity

  2. B cells are found in the lymph nodes

  3. B cells mature in the thymus

  4. B cells are capable of recognizing only linear polypeptides

  5. B cells express CD 19 and CD 20

95. Which of the following is true in regards to CD8+ cytotoxic T cells?

  1. They are responsible for activating B cells

  2. They express CD3

  3. The are capable of recognizing discontinuous epitopes

  4. Their receptors are germline encoded

  5. Upon activation they begin to secrete soluble TCRs

96. Activated NK cells are responsible for increased immune responses due to the secretion of which of the following?

  1. IL-7

  2. INF-γ

  3. TNF-α

  4. IL-15

  5. CD56

97. A patient with severe recurrent infections is believed to have severe combined immunodeficiency (SCID). How would you determine if they were deficient in adenosine deaminase (ADA) or the common γ chain?

  1. The presence of T cells

  2. The functionality of their B cells

  3. The presence of B cells

  4. The response to virus infected cells

  5. The presence of NK cells

98. Which of the following tools would you utilize to determine an individual’s blood type?

  1. Nephelometry

  2. ELISA

  3. Immunofluorescence 

  4. Flow Cytometry

  5. PCR

99. A 35 YO patient in the ICU has turned septic.  The patient has as overwhelming bacterial infection.  To better fight this bacterial load, APCs with MHC-1 molecules have resorted to cross presentation to better spread the signal of infection.  Which protein complex is responsible for cross presentation in MHC1 presenting cells?

A.      TAP

B.      CLIP

C.      CD4

D.     IFN-α

E.      NADPH oxidase



100. You follow an immunologist for an elective rotation on vaccine production.  The immunologist wants to test your understanding of cell receptors. They ask you, “the MHC1 receptor is a heterodimer composed of HLA-A,B, C, and what 4th component?”

A.      a chain

B.      b chain

C.      b2 microglobulin

D.     γ chain

E.      JAK



101. A researcher was testing with an experimental IFN-γ. It was exceptional at performing all the tasks of normal IFN-γ, such as upregulating MHC1 presentation. It performed this task too well.  As a result, cells began to spontaneously generate MHC1 receptors despite not normally containing them. Which cells do not have MHC1 receptors?

A.      T Cells

B.      B Cells

C.      Macrophages

D.     RBCs

E.      Platelets



102. An 8 YO patient comes to the clinic with recurrent bacterial infections.  You conduct imaging and notice damage to the thymus. You order labs and notice a lack of cells with the CD8 receptor.  Which of these cells is the thymus failing to create?

A.      Basophils

B.      NK Cells

C.      Th Cells

D.     Macrophages

E.      Cytotoxic T Cells



103. A microdeletion in chromosome 6 in which the alleles for HLA-A, B, and C would hinder the activation of cells expressing which of the following cluster of differentiation (CD)?

  1. CD4

  2. CD8

  3. CD19

  4. CD33

  5. CD56

104. Which of the following expression relationships are shown between HLA-DQ and HLA-DR?

  1. Classical dominant

  2. Codominant

  3. Incomplete dominance

  4. X-linked

  5. Autosomal

105. Which of the following explain the difficulty of finding a transplant match for an individual?

  1. MHC expression changes with environmental exposure

  2. An individual must have had the exact same vaccination record as their donor

  3. Since HLA are codominant, even a monozygotic twin can express different combinations

  4. Due to DNA recombination of BCRs and TCRs, they donor and recipient must have near identical recombination patterns

  5. MHC alleles are inherited as haplotypes  so even siblings can have different combinations

106. Mutations in β2 microglobulin would result in disfunction of which of the following?

  1. MHC Class 1

  2. MHC Class 2

  3. BCRs

  4. TCRs

  5. None of the above

107. Which of the following would be most likely to be presented in an MHC class 1 molecule?

  1. Viral processed peptide

  2. Bacterial unprocessed peptide

  3. Fungi processed peptide

  4. Self unprocessed peptide

  5. Fully alive helminth

108. For what purpose would self antigens present in an MHC class 2?

  1. To initiate a response to a viral infection

  2. To initiate a cytotoxic cell response to endogenous infection

  3. To establish T cell tolerance during development in the thymus

  4. To cause contraction after an effective immune response

  5. To initiate a response to a bacterial infection

109. Which of the following is the strongest activator of T cells?

  1. B cells

  2. Macrophages

  3. Dendritic Cells

  4. Neutrophils

  5. Self-activating

110. You walk to the beach following a stressful week of exams.  The stress and extra sun exposure lead to plenty of cell damage. As a result, your cells need to send signal to indicating their damage.  Which of these is a damage associated molecular pattern (DAMP)?

A. Peptidoglycan


C. Lipopolysaccharide

D. dsRNA

E. Flagellin



111. You are conducting research with an immunologist to better understand antigen recognition in human leukocytes.  The researcher was able to successfully knockout the CD80 receptor. You then re-expose the CD80 knockout cells to foreign antigen proteins.  What do you expect to happen?

A. Cell proliferation

B. T-helper cells will bind to the B cell

C. Cross presentation of the antigen

D. Apoptosis due to a lack of costimulation signaling with Th cells

E. Nothing happens due to a lack of costimulation



112. You are working in a pediatric clinic and need to give an 11 year old the meningococcal vaccine.  The mom is worried that you are purposefully infecting the child with bacteria thus causing them harm. You reassure the concerned parent because the vaccine contains only…

A. Toxoid protein only

B. Protein and toxins

C. Hapten polysaccharide and toxoid 

D. Live bacteria

E. Attenuated bacteria only


113. Which of the following most accurately describes what are often added to a vaccination to increase the effectiveness?

  1. Antigens

  2. Epitopes

  3. Immunogens

  4. Adjuvants 

  5. Haptens

114. Which of the following can be recognized by a TCR?

  1. A full viral peptide after cell lysis

  2. A processed peptide presented in an MCH

  3. A processed linear carbohydrate

  4. A full circular DNA bacterial chromosome

  5. A bacterial wall peptide attached to the bacteria

115. Which of the following is a unique quality of superantigens such as S aureus Toxic Shock Syndrome toxin-1 (TSST-1) or S pyogenes exotoxin A (SpeA)?

  1. Can an elicit an immune response

  2. Bind to TCRs and MHCs in the conventional binding site

  3. Activation of both T and B cells

  4. Stimulate large numbers of lymphocytes 

  5. Can cause fevers

116. Which of the following is an essential component of the BCR complex?

  1. CD19

  2. CD20

  3. CD21

  4. CD40L

  5. CD79a

117. Which of the following is a characteristic of toll like receptor (TLR) 4?

  1. Variable

  2. Created by DNA recombination 

  3. Able to be upregulated 

  4. Recognizes general structures/broad patterns 

  5. Cost 25 cents or a riddle to activate

118. The presence of only which of the following would result in sterile inflammation/healing?

  1. Flagellin

  2. Peptidoglycan 

  3. HMGB1

  4. Lipopolysaccharide (LPS)

  5. dsRNA

119. After an APC has been activated by PAMPs/DAMPs which of the following will be increased/upregulated?

  1. TLR 4

  2. CD28

  3. CD40

  4. CD40L

  5. CD80

120. Which of the following when activated will produce germinal center formation in lymph node follicles?

  1. TLR 4

  2. CD28

  3. CD40

  4. CD40L

  5. CD80

121. Which of the following will occur when a T cell is presented with CD80/CD86 but not a corresponding MHC and antigen?

  1. The T cell will begin to undergo clonal proliferation in preparation for the arrival of the corresponding MHC and antigen

  2. The T cell will begin to express CD40L and migrate to the follicles to activate B cells

  3. The T cell will undergo inactivation (anergy) or deletion

  4. The T cell will remain locked in the lymph node until it becomes activated

  5. Absolutely fucking nothing

122. Which of the following is a characteristic of a hapten?

  1. Immunogenic

  2. Able to induce humoral immune responses 

  3. Contain 2 or more epitopes 

  4. Able to be recognized by BCRs

  5. Able to be recognized by TCRs

123. Which of the following is important to remember when giving booster shots for conjugate vaccines?

  1. Booster shots are mainly ineffective in all forms, so there’s no point

  2. The booster should contain the same carrier protein as the original vaccine

  3. The purpose of booster shots are to engage the innate arm of the immune system

  4. The booster should contain a different carrier protein to increase the variety of the immune response

  5.  Individuals with weakened immune systems need fewer or less booster than those with healthy/normal immune systems

124. After eating sushi in the wonderful landlocked state of Arkansas, you acquire an intestinal parasite. Which of the following inflammatory responses is likely to develope?

  1. Th1

  2. Th2

  3. Th17

  4. None of the above

  5. Doesn’t matter, sushi is worth the risk

125. Which of the following inflammatory responses is likely to dominate/be most prevalent in chronic inflammation?

  1. Th1

  2. Th2

  3. Th8

  4. Th17

  5. None of the above

126. Which cardinal sign of inflammation is caused by cytokines found primarily in a Th17 response?

  1. Tumor

  2. Rubor

  3. Dolor

  4. Calor

  5. Loss of function

127. Which of following is capable of inducing both vasodilation and vasopermeability?

  1. Prostaglandins 

  2. Nitric oxide 

  3. Leukotrienes 

  4. Bradykinin 

  5. Acetylsalicylic acid

128. Which interleukin is responsible for endothelial cell activation ?

  1. IL-1

  2. IL-6

  3. IL-5

  4. IL-8

  5. IL-12

129. Which acute phase reactant is used as an opsonin and a nonspecific marker of inflammation?

  1. Ferritin

  2. Fibrinogen

  3. Serum amyloid A

  4. Hepcidin

  5. C-reactive Protein (CRP)

130. A patient on your internal medicine rotation has had chronic inflammation due to rheumatoid arthritis has begun to develope anemia. Which acute phase reactant is responsible for this?

  1. Ferritin

  2. Fibrinogen 

  3. Serum amyloid A

  4. Hepcidin

  5. C-reactive Protein (CRP)

131. A left shift or bandemia is present in which inflammatory response due to increase in which of the following?

  1. Th1, IL-12

  2. Th1, IFN-γ

  3. Th2, IL-5

  4. Th17, G-CSF

  5. Th17, IL-8

132. Which of the following aspects of endothelial cell activation by TNF-α and IL-1 is least important in facilitating diapedesis ?

  1. Increased vasodilation

  2. Endothelial cell contraction

  3. Increased expression of adhesion molecules

  4. Prothrombotic state

  5. Cytokine production

133. Which of the following is the correct pairing between the endothelium and leukocytes that causes extravasation/marginalization?

  1. Selectin – ICAM-1

  2. Selectin – LFA-1

  3. ICAM-1 – Sialyl-Lewis

  4. ICAM-1 – LFA-1

  5. LFA-1 – Sialyl-Lewis

134. Tumors often secrete immunosuppressors in order to better protect themselves from discovery and destruction. Which of the following may a tumor secrete in order to avoid detection?

  1. TNF-α

  2. VEGF

  3. IL-12

  4. IFN-γ

  5. Shelterin

135. A young patient is brought to the clinic after yet another skin infection. Upon taking the history you learn that the patient had delayed umbilical cord detachment, multiple bacterial and fungal infection, and an absence of pus in those infections. Defects in the production of which of the following is most likely the cause of this patients condition?

  1. NADPH oxidase

  2. G-CSF

  3. IL-5

  4. CD18

  5. G6PD

136. Which of the following conditions would you expect to see in an individual with G6PD deficiency that you wouldn’t normally see in an individual with chronic granulomatous disease (CGD)?

  1. Neutrophilia 

  2. Recurrent bacterial/fungal infections

  3. Anemia

  4. Inability to clear Aspergillus or Staphylococcus