- 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
1. Which of the following explains why ammonia must be carried to the liver by a carrier protein for the urea cycle?
It is too large of a molecule to cross without a carrier
It does not have chemotaxis ability to find the liver without a carrier
It is so small that if it were released into the bloodstream it would cross the blood brain barrier
It would bind to the blood cells causing them to be unable to bind oxygen
It would go straight to the kidneys without first being processed
2. Which of the following macromolecules cannot be stored when taken in excessively?
Bar TriviaAnswer C and D.
3. Which of the following amino acid cannot be synthesized by the human body?
4. Which of the following amino acids can be both ketogenic and glucogenic?
5. Which of the following coenzymes is necessary to transform alpha ketoglutarate and ammonia into glutamate using glutamate dehydrogenase (GDH)?
6. Which of the following amino acids undergoes non-oxidative deamination that is carried out by a dehydratase?
7. Which of the following amino acids is primarily responsible for shuttling ammonia from the brain to the kidney/liver?
8. Which of the following is combined with ammonia to produce carbamoyl phosphate in the mitochondria for the urea cycle?
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?
Acetylsalicylic AcidAnswer A.
10. Which of the following amino acids should you restrict from someone with maple syrup urine disease?
11. What would you expect a patient to have who has elevated levels of phenylalanine and decreased levels of tyrosine?
Oculocutaneous albinismAnswer A.
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?
Lack of folate in the first trimester can cause autism
Lack of folate in the first trimester can cause anencephaly
Folate helps to increase your FSH to help you get pregnant
Folate helps to form neurotransmitters
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?
Maple Syrup Urine Disorder
14. Which vitamin is essential to neural tube development?
15. When does the neural tube form and then close after conception?
Before the first week
Between the first and second
Between the third and fourth
Between the fourth and sixth
In the second trimesterAnswer C.
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?
17. Using serine hydroxymenthyl transferase (SHMT) with serine and tetrahydrofolate (THF) produces which of following compounds?
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?
NK CellsAnswer A.
19. Which of the following enzymes are necessary to maintain cobalamin’s reduced state?
Methionine synthase reductase
Methionine synthase oxidase
Methyl malonyl CoA mutase
Succinyl CoA mutaseAnswer B.
20. Which of the following procedures/conditions would reduce cobalamin (B12) absorption?
Bone marrow irradiation
Gastric bypass surgeryAnswer E.
21. Which vitamin is necessary for the generation of cysteine from methionine?
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?”
Lysosomal accumulation of cystine and often development of Fanconi syndrome (whatever the hell that is)
Lens placement down and out, long limbs, cognitive defects, and increased thrombosis
Fatigue, macrocytic erythrocytes, hyper poly segmented neutrophils
Poor resorption of acidic amino acids, frequent kidney stones, and elevated cystine in the urine
“Mousy” smell, hypopigmentation, developmental delays, and seizuresAnswer D.
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?
Marfan’s SyndromeAnswer B.
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?
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?
26. Red blood cells often produce less ATP per glucose in glycolysis as compared to other cells. What might this be?
Without a nucleus the red blood cells are “dumber” and don’t know how to properly break down a glucose
Red blood cells actually use fructose more often then glucose as a fuel source which leads to less ATP production
Red blood cells will often shunt glycolytic intermediates to make 2,3-BPG
Red blood cells will often shunt glycolytic intermediates to the pentose phosphate pathway to make NADPH
Red blood cells must use fermentation/lactic acid formation to regenerate NAD+ thus making glycolysis less efficientAnswer C.
27. Which organ is responsible for producing the hormone that causes the generation of new erythrocytes?
28. Erythropoietin (EPO) activates which of the following types of receptors?
Nuclear hormone receptor
Cytosolic hormone receptorAnswer C.
29. Which of the following combinations most accurately describes RBC morphology for patients with sickle cell anemia?
Macrocytic, normochromicAnswer D.
30. Which of the following combinations most accurately describes RBC morphology of pernicious anemia?
Macrocytic, normochromicAnswer E.
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?
Individuals with pernicious anemia
Individuals with sickle cell anemia
Individuals with iron deficiency
Individuals with erythroleukemia
Individuals with lead poisoningAnswer B. [/showhide
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?
Formation of amino levulinic acid
Condensation of four porphobilinogen to one uroporphyrin
Addition of Fe to the heme molecule
Transfer of porphyrin precursor from the mitochondria to the cytosol
Transfer of the porphyrin precursor from the cytosol to the mitochondria
33. Which of the following TCA cycle intermediates can be used to generate heme/porphyrin?
34. A patient with hyperammonemia is prescribed Ammunol and subsequently develops anemia. Why would this happen?
Additional succinyl CoA is excreted which is necessary for heme synthesis
Additional glutamine is excreted which is necessary for heme synthesis
Additional glycine is excreted which is necessary for heme synthesis
Ammunol has been shown to increased hematuria (blood in the urine) causing increased blood loss
Ammunol has side effects that can cause decreased erythrocyte production due to sequestering EPOAnswer C.
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?
36. Lead poisoning can lead to microcytic anemia by inhibiting which of the following enzymes?
FerrochelataseAnswer A and E.
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?
Iron deficiency anemia
Acute intermittent porphyria (AIP)
Porphyria cutanea tarda (PCT)
Beta ThalassemiaAnswer C.
38. When using heme oxygenase for the degradation of heme, which by product is given off as the ring is cleaved?
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?
Glucuronic acidAnswer E.
40. After adding only a diazonium salt to a blood sample, what are you able to measure?
Bilirubin that is bound to albumin
Bilirubin prior to conjugation
Total BilirubinAnswer A.
41. Which type of jaundice is associated with hemolytic anemias or internal hemorrhages?
These diseases can cause a variety of jaundice formsAnswer B.
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?
Bile duct obstructionAnswer E.
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?
Why you praying to baby jesus? He was a grown man with a beard!Answer B.
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?
Answer B. IL6 is produced to regulate inflammation and immune response. It induces hepcidin synthesis during inflammation to regulate iron transport out of the cell. This thus decreases the amount of circulating Fe3+ giving the typical symptoms of anemia and the lower total body iron count, but it does not affect the amount of iron being absorbed so the iron that is circulating gives its normal color and normal RBC shape.
Increased IL6 and decreased hepcidin
Increased IL6 and increased hepcidin
Decreased IL6 and decreased hepcidin
Decreased IL6 and increased hepcidin
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?
Blue light from her cellphone
46. Which of the following minerals are organic?
Minerals are inorganic dumb dumbAnswer E.
47. When iron is not bound to heme it often sequestered into clusters with which amino acid?
48. Which of the following conditions/situations would cause low iron absorption?
Silly vegans with their iron supplements
People who eat antacid tablets like cady
Orange juice/Sunny D drinkers
Diets high in red meat
Becoming IronmanAnswer B.
49. Which of the following is responsible for moving the iron from the gut mucosa cell into circulation?
50. Most of the iron in the adult body is found where?
In red blood cells in hemoglobin
In muscles as myoglobin
Stored in ferritin in bone marrow for erythropoiesis
In the liver as a part of cytochrome p450
Bound to albumin in the plasmaAnswer A.
51. Which of the following individuals has a higher than normal iron requirement?
Individuals with various thalassemias
A woman in the first trimester of her pregnancy
Individuals with sickle cell trait
Males who develope the man flu
A woman who is in the third trimester of her pregnancyAnswer E.
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?
Iron deficiency anemia
Antibody mediated RBC destruction
Alpha thalassemia minor
Beta thalassemia minor
Chronic blood lossAnswer D.
53. Which of the following disorders would present with an increased mean corpuscular volume (MCV) aka macrocytic anemia?
Alcohol induced cirrhosis
Combined deficienciesAnswer D.
54. Which of the following is NOT a cause of microcytic anemias?
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?
She gets stabbed a lot aka acute blood lossAnswer B.
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?
Alpha thalassemiasAnswer D.
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?
58. Which medication or treatment would you give to the toddler mentioned in the questions above?
Vitamin B12Answer D.
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 NegativeAnswer C.
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…
What is the correct MCV?
E. 140Answer D.
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?
E. Caspase 3Answer B.
62. Which of the following scenarios would have the highest risk of the fetus developing erythroblastosis fetalis?
A mother with O+ blood and a fetus with A- blood
A mother with A+ blood and a fetus with A- blood
A mother with A- blood and a fetus with A+ blood
A mother with A+ blood and a fetus with O+ blood
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?
Spectrin serves as an anchor on the membrane and without it, RBCs lose their ability to carry proteins and nutrients
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
Spectrin is a part of the cytoskeleton and without this, it does not form the biconcave shape so it becomes more spherical.
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.
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?
In the plasma
In the buffy coat
With the erythrocytes
Spread throughout the buffy coat and plasma
Evenly spread throughout all three sectionsAnswer B.
65. Which of the following are derived from a lymphoid progenitor stell cell?
Natural Killer Cell
66. Which of the following is the most numerous leukocyte?
68. Which of the following leukocytes is primarily responsible for responding to parasitic infections?
69. Which cytoskeletal element is responsible for pinching the nucleus out of the cell in formation of the reticulocyte?
70. If you have blood type A+, which antigens do your blood cells express?
A and Rh
B and Rh
A, B and RhAnswer C.
71. If you have blood type A+, which antigens will your body produce antibodies against?
A and Rh
B and Rh
A, B, and RhAnswer B.
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)?
Every positive blood type child she has
Every negative blood type child she has
Every positive blood type child she has after the first one
Every negative blood type child she has after the first one
None of them as long as she sings “Jesus take the wheel” by Carrie UnderwoodAnswer C.
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?
3000 g/dLAnswer C.
74. Which of the following is correct in regard to how HIF-1a operates in regards to erythropoietin production?
In periods of hypoxia, HIF-1a exits the kidneys and upon entering the blood it becomes erythropoietin
Oxygen binds to HIF-1A becoming hydroxyl groups which allows it to combine with VHL and then translocate to the nucleus
With oxygen present, HIF-1a combines with ARNT which leads to ubiquitin proteasome degradation
With oxygen present, HIF-1a is sequestered into lysosomes and degraded by cathepsin proteins
In periods of hypoxia, HIF-1a translocates to the nucleus and binds to DNA at HREAnswer E.
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?
Decitabine is lipid soluble and is able to penetrate the mitochondria and release pro apoptotic caspases
Phosphorylated decitabine replaces cytosine and inhibits methylation triggering differentiation and apoptosis
Decitabine binds to TNF-alpha receptors and initiates apoptotic pathways through a G protein coupled receptor
Decitabine acts as a competitive inhibitor to thymidylate synthase to inhibit DNA nucleotide synthesis and stop cell division
Decitabine is endocytoses and complexes with p53 to bind to specific DNA sequences and inhibit cell proliferationAnswer B.
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?
Answer A. Neutrophiles would be the first to attack the virus, but because of the chemo, neutrophil levels are decreased (neutropenia) so the body does not have a fast response so the infections can get wildly out of hand in a short time span.
77. In which of the following phases is the immune system responsible for surveying and distinguishing antigens as potential threats?
78. In which of the following phases is the immune system responsible for regulation and prevention of immune-mediated damage to the body?
79. Which of the following is a characteristic of the innate arm of the immune system?
Responds in about 7-10 after infection
Improves in magnitude/effectiveness throughout duration
Receptors are germline encoded
Repeat exposures are treated with stronger responses
Memory capabilityAnswer C.
80. Which of the following is considered an antigen presenting cell?
Natural Killer Cell
T cellAnswer D.
81. Which cluster of differentiation (CD) would you expect to find on a natural killer (NK) cell?
CD 56Answer E.
82. Which of the following is the first site of hematopoiesis for a human?
Liver and Spleen
83. Which of the following is a primary lymphoid organ?
84. Lymph from distal lymph nodes enter more proximal lymph nodes through which of the following?
Afferent lymph vessels
Efferent lymph vessels
High endothelial venules (HEVs)
Diffusion from capillaries
Direct arterial supplyAnswer A.
85. In which section of a lymph node would expect to find a large number of macrophages?
High endothelial venules (HEVs)Answer D.
86. In which area of the spleen would you expect to find T cells?
Periarterial lymphoid sheath (PALS)
Subcapsular sinusAnswer B.
87. After a monocyte has invaded a tissue and been exposed to GM-CSF which of the following will it develop into?
Natural Killer Cell
Monocytes do not respond to GM-CSFAnswer D.
88. Which of the following is a way in which macrophages are different than neutrophils?
They are myeloid derived cells
They are antigen presenting cells
They are phagocytes
They are circulating cells
They release granules full of cytokines when activatedAnswer B.
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?
Dendritic CellsAnswer A.
90. Deficiencies in which of the following will lead to chronic granulomatous disease (CGD)?
NADH Oxidase deficiencies
Superoxide dismutase deficiencies
Glutathione reductase deficienciesAnswer B.
91. An infection with which of the following would you expect in a patient with eosinophilia?
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?
Plasma cellsAnswer D.
93. Dendritic cells become activated when which of the following occurs?
They migrate to the lymph nodes
They receive costimulatory molecules from T cells
PRRs recognize PAMPs and DAMPs
They are fully activated upon release from the bone marrow
Interaction with B cell produced antibodiesAnswer C.
94. B cells differ from T cells in which of the following ways ?
B cell receptors undergo DNA rearrangement/combinatorial diversity
B cells are found in the lymph nodes
B cells mature in the thymus
B cells are capable of recognizing only linear polypeptides
B cells express CD 19 and CD 20Answer E.
95. Which of the following is true in regards to CD8+ cytotoxic T cells?
They are responsible for activating B cells
They express CD3
The are capable of recognizing discontinuous epitopes
Their receptors are germline encoded
Upon activation they begin to secrete soluble TCRsAnswer B.
96. Activated NK cells are responsible for increased immune responses due to the secretion of which of the following?
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?
The presence of T cells
The functionality of their B cells
The presence of B cells
The response to virus infected cells
The presence of NK cellsAnswer C.
98. Which of the following tools would you utilize to determine an individual’s blood type?
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?
E. NADPH oxidaseAnswer A.
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. JAKAnswer C.
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
E. PlateletsAnswer D.
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?
B. NK Cells
C. Th Cells
E. Cytotoxic T CellsAnswer E.
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)?
104. Which of the following expression relationships are shown between HLA-DQ and HLA-DR?
105. Which of the following explain the difficulty of finding a transplant match for an individual?
MHC expression changes with environmental exposure
An individual must have had the exact same vaccination record as their donor
Since HLA are codominant, even a monozygotic twin can express different combinations
Due to DNA recombination of BCRs and TCRs, they donor and recipient must have near identical recombination patterns
MHC alleles are inherited as haplotypes so even siblings can have different combinationsAnswer E.
106. Mutations in β2 microglobulin would result in disfunction of which of the following?
MHC Class 1
MHC Class 2
None of the aboveAnswer A.
107. Which of the following would be most likely to be presented in an MHC class 1 molecule?
Viral processed peptide
Bacterial unprocessed peptide
Fungi processed peptide
Self unprocessed peptide
Fully alive helminthAnswer A.
108. For what purpose would self antigens present in an MHC class 2?
To initiate a response to a viral infection
To initiate a cytotoxic cell response to endogenous infection
To establish T cell tolerance during development in the thymus
To cause contraction after an effective immune response
To initiate a response to a bacterial infectionAnswer C.
109. Which of the following is the strongest activator of T cells?
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)?
E. FlagellinAnswer B.
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 costimulationAnswer D.
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 onlyAnswer C.
113. Which of the following most accurately describes what are often added to a vaccination to increase the effectiveness?
114. Which of the following can be recognized by a TCR?
A full viral peptide after cell lysis
A processed peptide presented in an MCH
A processed linear carbohydrate
A full circular DNA bacterial chromosome
A bacterial wall peptide attached to the bacteriaAnswer B.
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)?
Can an elicit an immune response
Bind to TCRs and MHCs in the conventional binding site
Activation of both T and B cells
Stimulate large numbers of lymphocytes
Can cause feversAnswer D.
116. Which of the following is an essential component of the BCR complex?
117. Which of the following is a characteristic of toll like receptor (TLR) 4?
Created by DNA recombination
Able to be upregulated
Recognizes general structures/broad patterns
Cost 25 cents or a riddle to activateAnswer D.
118. The presence of only which of the following would result in sterile inflammation/healing?
119. After an APC has been activated by PAMPs/DAMPs which of the following will be increased/upregulated?
120. Which of the following when activated will produce germinal center formation in lymph node follicles?
121. Which of the following will occur when a T cell is presented with CD80/CD86 but not a corresponding MHC and antigen?
The T cell will begin to undergo clonal proliferation in preparation for the arrival of the corresponding MHC and antigen
The T cell will begin to express CD40L and migrate to the follicles to activate B cells
The T cell will undergo inactivation (anergy) or deletion
The T cell will remain locked in the lymph node until it becomes activated
Absolutely fucking nothingAnswer E.
122. Which of the following is a characteristic of a hapten?
Able to induce humoral immune responses
Contain 2 or more epitopes
Able to be recognized by BCRs
Able to be recognized by TCRsAnswer D.
123. Which of the following is important to remember when giving booster shots for conjugate vaccines?
Booster shots are mainly ineffective in all forms, so there’s no point
The booster should contain the same carrier protein as the original vaccine
The purpose of booster shots are to engage the innate arm of the immune system
The booster should contain a different carrier protein to increase the variety of the immune response
Individuals with weakened immune systems need fewer or less booster than those with healthy/normal immune systemsAnswer B.
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?
None of the above
Doesn’t matter, sushi is worth the riskAnswer B.
125. Which of the following inflammatory responses is likely to dominate/be most prevalent in chronic inflammation?
None of the aboveAnswer A.
126. Which cardinal sign of inflammation is caused by cytokines found primarily in a Th17 response?
Loss of functionAnswer D.
127. Which of following is capable of inducing both vasodilation and vasopermeability?
Acetylsalicylic acidAnswer D.
128. Which interleukin is responsible for endothelial cell activation ?
129. Which acute phase reactant is used as an opsonin and a nonspecific marker of inflammation?
Serum amyloid A
C-reactive Protein (CRP)Answer E.
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?
Serum amyloid A
C-reactive Protein (CRP)Answer D.
131. A left shift or bandemia is present in which inflammatory response due to increase in which of the following?
Th17, IL-8Answer D.
132. Which of the following aspects of endothelial cell activation by TNF-α and IL-1 is least important in facilitating diapedesis ?
Endothelial cell contraction
Increased expression of adhesion molecules
Cytokine productionAnswer D.
133. Which of the following is the correct pairing between the endothelium and leukocytes that causes extravasation/marginalization?
Selectin – ICAM-1
Selectin – LFA-1
ICAM-1 – Sialyl-Lewis
ICAM-1 – LFA-1
LFA-1 – Sialyl-LewisAnswer D.
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?
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?
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)?
Recurrent bacterial/fungal infections
Inability to clear Aspergillus or Staphylococcus