Immunology Quiz 1 Basic Concepts and Components of the Immune System 1.

.1) The ____ immune system uses ____ as well as molecules (e.g. complement components). The ____ immune sy stem uses ____ as well as antigen recognition molecules. a) Adaptive; Phagocytes ; Innate; Lymphocytes b) Adaptive; Lymphocytes; Innate; Phagocytes c) Innate; Ph agocytes; Adaptive; Lymphocytes d) Innate; Lymphocytes; Adaptive; Phagocytes 1.2 ) Phagocytic white cells (leukocytes, e.g. macrophages) congregate within ____ w hen foreign organisms get through a cut in the skin. a) Microseconds b) Seconds c) Minutes d) Hours e) Days 1.3) Which of the following mediates an early respon se to viral infections by the innate immune system? a) Complement components b) Vaccines c) T and B lymphocytes d) Cytokines e) Interferons 1.4) Which of the fo llowing is a messenger that mediates the connection between the innate and adapt ive immune systems? a) Complement components b) Vaccines c) T and B lymphocytes d) Cytokines e) Interferons 1.5) Which of the following immune system components would NOT recognize a macromolecule epitope (binding site)? a) Phagocyte b) T l ymphocyte c) B lymphocyte d) Antibody 1.6) Which of the following is a large gen omic region or gene family found in most vertebrates, playing an important role in immunity? a) Antigen-recognition molecules b) Major histocompatibility comple xes (MHCs) c) Human leukocyte antigens (HLAs) d) Immunoglobulin e) Epitopes 1.7) B-cell antigen receptors can interact directly with antigen, whereas T-cell ant igen receptors only recognize antigen when it is presented to them on the surfac e of another cell. a) True Version: 16Oct2008 Page 1 of 50

Immunology Quiz b) False 1.8) How are B-cell and T-cell antigen receptors distributed? a) By siz e (steric hindrance) b) By molecular weight c) By activation (clonal) d) By loca tion in the body e) Equally (same number of each receptor) 1.9) A medical studen t acquired hepatitis B through a needle-stick injury. The student had not receiv ed their vaccinations for this virus and eventually experienced liver problems. One of the clinical signs of this disease is jaundice, which turns the skin and sclera what color? a) Black b) Red c) White d) Yellow e) Blue 1.10) Monoclonal a ntibodies (mAb) are antibodies with a wide range of clinically important applica tions, such as pregnancy tests, cancer diagnosis, and cancer treatment. These an tibodies are ____ and come from ____ parent cell(s). a) Dissimilar; Multiple b) Dissimilar; A single c) Identical; Multiple d) Identical; A single 1.11) Adaptiv e immune system response typically takes how long/ a) Microseconds b) Seconds c) Minutes d) Hours e) Days 2 Basic Concepts 1) Which of the following is NOT true when comparing innate to adaptive immunity? a) Innate responds quickly and adap tive responds slowly b) Innate has few pathogen (non-self) recognition mechanism s and adaptive has many c) Innate has immunologic memory and adaptive does not d ) Innate does not show response improvements over time and adaptive does e) Inna te response is non-specific and adaptive is very specific 2) Phagocytes ingest p articular matter into cells for degradation. Which of the following is NOT consi dered a phagocyte? a) Macrophage b) Neutrophil c) Eosinophil d) Basophil e) Lymp hocyte Version: 16Oct2008 Page 2 of 50

Immunology Quiz 3.1) Which of the following components of the innate immune system involves reco gnition molecules such as mannan-binding lectin (MBL) for bacteria with mannose on the surface? a) Natural killer (NK) cells b) Complement system c) Oxygen depe ndent and independent killing d) Interferons e) Acute phase proteins 3.2) Which of the following components of the innate immune system involves cytokines produ ced by macrophages, which are produced during infection? a) Natural killer (NK) cells b) Complement system c) Oxygen dependent and independent killing d) Interf erons e) Acute phase proteins 3.3) Which of the following components of the inna te immune system involves the release of histamine? a) Neutrophil b) Eosinophil c) Macrophage d) Tissue mast cell e) Natural killer cell 4.1) Which of the follo wing components of the adaptive immune system secretes immunoglobulin (Ig)? a) A ctivated B cell (plasma cell) b) CD4+ activated T cell c) CD8+ cytotoxic T cell (CTL) d) Resting lymphocytes (B cell, CD4+ T cell, CD8+ T cell) e) B and C 4.2) Which of the following components of the adaptive immune system causes lysis of virally infected cells and the release of cytokines? a) Activated B cell (plasma cell) b) CD4+ activated T cell c) CD8+ cytotoxic T cell (CTL) d) Resting lympho cytes (B cell, CD4+ T cell, CD8+ T cell) e) B and C 4.3) Antigen presenting cell s (APCs) include macrophages and dendritic cells, which are found in lymphoid ti ssues and the ____. These are critical in the uptake and presentation of antigen to T cells. a) Liver b) Kidney c) Skin d) Brain e) Gallbladder 4.4) Which of th e following is NOT a major feature (characteristic) of the adaptive immune syste m? Version: 16Oct2008 Page 3 of 50

Immunology Quiz a) Specificity b) Diversity c) Memory d) Improvement e) Speed 5) Humoral immunit y is mediated by antibodies from ____ and is involved in the elimination of ____ pathogens. Cell mediated immunity is mediated by ____ and is involved in the el imination of ____ pathogens. a) B lymphocytes; Intracellular; T lymphocytes; Ext racellular b) B lymphocytes; Extracellular; T lymphocytes; Intracellular c) T ly mphocytes; Intracellular; B lymphocytes; Extracellular d) T lymphocytes; Extrace llular; B lymphocytes; Intracellular 6) How many doses of the Hepatitis B vaccin e (5 g HBsAg in 0.5mL intramuscular) are required to reach a protective level of a ntibody? a) One b) Two c) Three d) Four e) Five Match the following innate immun e system cell types with their function: 7.1) Eosinophils a) Phagocytosis and ba cteriocidal mechanisms, antigen presentation 7.2) Macrophages b) Lysis of some v irally infected cells 7.3) Tissue mast cells c) Killing parasites 7.4) Natural k iller cells d) Release of histamine and other mediators 7.5) Neutrophils e) Phag ocytosis and bacteriocidal mechanisms 7.6) In a resting lymphocyte, B cells and T cells can be distinguished from each other via a simple blood smear. a) True b ) False 7.7) T cells are made in the ____ and complete their differentiation in the ____. a) Spleen; Thyroid b) Spleen; Thymus c) Bone marrow; Thyroid d) Bone m arrow; Thymus e) Bone marrow; Thalamus 7.8) Which of the following is a transmem brane glycoprotein that serves as a co-receptor for the T cell receptor (TCR), a nd is also known as a cytotoxic T cell (CTL)? a) Cluster of differentiation 4 (C D4+) b) Cluster of differentiation 8 (CD8+) c) Plasma cells (activated B cells) 7.9) Which of the following produce large amounts of antibodies (Igs) and differ entiate upon stimulation from CD4+ cells? a) Cluster of differentiation 4 (CD4+) b) Cluster of differentiation 8 (CD8+) c) Plasma cells (activated B cells) Version: 16Oct2008 Page 4 of 50

Immunology Quiz 7.10) Which of the following is a glycoprotein expressed on the surface of T hel per cells, regulatory T cells, monocytes, macrophages, and dendritic cells? a) C luster of differentiation 4 (CD4+) b) Cluster of differentiation 8 (CD8+) c) Pla sma cells (activated B cells) 8) An individual is bitten by a dog with rabies an d begins to develop antibodies against the rabies. These antibodies are harveste d and transferred to unimmunized individuals to confer protection more rapidly f or these individuals. This is an example of: a) Active immunity b) Passive immun ity Match the stage of an adaptive (acquired) immune response with the descripti on: 9.1) Proliferation of cells with matching receptors a) Cognitive phase 9.2) Eventual elimination of antigen b) Activation phase 9.3) Recognition of antigen c) Effector phase 9.4) What stage of an adaptive immune response involves secret ion of antibody from a large plasma cell with extensive endoplasmic reticulum? a ) Cognitive phase b) Activation phase c) Effector phase 10.1) Which of the follo wing types of antigen presenting cells (APCs) is critical in uptake and presenta tion of antigen to T cells? a) Macrophage b) Dendritic cell c) B cell 10.2) Whic h of the following types of antigen presenting cells (APCs) has immunoglobulin t hat functions as a receptor, then the antigen is internalized, degraded, and pre sented to T cells? a) Macrophage b) Dendritic cell c) B cell 10.3) Which of the following types of antigen presenting cells (APCs) is specialized for degradatio n and presentation of particulate antigens to T cells? a) Macrophage b) Dendriti c cell c) B cell 3 Introduction to Antigen Recognition 1.1) Which of the followi ng is NOT true regarding the complement system? a) They are serum proteins that form protein cascades, each activated component activating the next to generate a physiologic response b) They can bind to bacteria, making holes in their membr ane c) They attract phagocytes to both foreign material and self cells d) Bindin g of MBLs to a bacterial capsule triggers the complement cascade e) They help to eliminate immune complexes (antibody-antigen) and prevent them from damaging th e body Version: 16Oct2008 Page 5 of 50

Immunology Quiz 1.2) Which of the following key components of the complement pathway can be acti vated by the lectin, classical, and alternative pathways? a) C1 b) C3 c) C5 d) C 7 e) C9 Match the three types of molecules that recognize antigen with their des cription: 2.1) Recognize antigens bound to MHC a) B cell receptor (BCR) 2.2) Can create a soluble antigen receptor (antibody) b) T cell receptor (TCR) 2.3) A cl uster of genes that encode proteins c) Major histocompatibility complex (MHC) 2. 4) Which of the following has an immunoglobulin fold? a) BCRs b) TCRs c) MHCs d) BCRs & TCRs e) BCRs, TCRs, & MHCs 2.5) The genes encoding which of the followin g can undergo hypermutation to create receptors that are an even better fit for foreign antigens? a) BCRs b) TCRs c) MHCs d) BCRs & TCRs e) BCRs, TCRs, & MHCs 2 .6) The genes encoding which of the following are extensively polymorphic (have multiple alleles or forms of the same gene)? a) BCRs b) TCRs c) MHCs d) BCRs & T CRs e) BCRs, TCRs, & MHCs 3.1) What types of cell is class I MHC found on? a) B cells b) Macrophages c) Dendritic cells d) Essentially all cells e) Mainly on A, B, & C 3.2) What types of cell is class II MHC found on? a) B cells b) Macropha ges c) Dendritic cells d) Essentially all cells e) Mainly on A, B, & C 3.3) What is the function of major histocompatibility complex (MHC) molecules? a) Present sugars to T cells b) Present peptides to T cells Version: 16Oct2008 Page 6 of 50

Immunology Quiz c) Create holes in the membranes of bacteria d) Lyse foreign antigens e) Phagocy tize foreign antigens 4.1) Unlike B cell receptors (BCRs), T cell receptors (TCR s) can only recognize foreign antigen if it is presented as a complex with a MHC molecule. a) True b) False 4.2) If the structure of an individuals MHC molecule s makes it impossible for them to recognize and bind any peptide antigen from a given virus, that individual will still be able to activate a T cell response to cells infected with that virus. a) True b) False 5.1) Which of the following is NOT true about MHC molecules but true about B and T cells? a) The genes that en code molecules are the most variable genes we know of in the human genome (polyg enic) b) They are extensively polymorphic (existence of multiple alleles or form s of the same gene) c) Every cell in each individual expresses the same set of m olecules d) Every cell expresses a different molecule created from multiple gene segments that undergo somatic rearrangement e) Their diversity exists in the po pulation as a whole, not in the individual 5.2) Given that an individuals parents have completely different HLA genes, that individual will have about ____ diffe rent class I and II MHC molecules on the surface of certain of their lymphoid ce lls. a) 3 b) 6 c) 9 d) 12 e) 15 4 Antigen and Antibody Structure 1) Which of the following differentiates an antigen from an immunogen? a) An antigen is a forei gn molecule b) An antigen can cause the production of antibodies c) An antigen d oes not always elicit an immune response d) Antigens are usually proteins or pol ysaccharides e) Antigens are capable of being bound by immunologic receptors 2) Which of the following is NOT true regarding effective immunogens? a) Foreign to the host b) Fairly large (molecular weight > 6000) c) Chemically complex (e.g. proteins made of many nucleotide bases) d) Requires a carrier-conjugate to cause the generation of antibodies 3) Which of the following best describes penicilli n, a hapten? a) Large in size and can induce an immune response alone b) Large i n size and needs to be coupled to induce an immune response Version: 16Oct2008 Page 7 of 50

Immunology Quiz c) Small in size and can induce an immune response alone d) Small in size and ne eds to be coupled to induce an immune response 4) An epitope is generally used t o refer to an area on a much larger molecule (e.g., a viral protein) with which an antibody can react. a) True b) False 5) Which of the following is NOT true? a ) The term epitope is not synonymous with antigen b) A viral protein may contain a large number of epitopes that are capable of interacting with many different specific antibodies c) Immunologic receptors on T cells recognize continuous (li near) epitopes d) Immunologic receptors on T cells recognize discontinuous (conf ormational) epitopes e) Antibodies can recognize both continuous and discontinuo us epitopes 6) Which of the following is an agent (e.g. aluminum salts, oil-base d, virosomes) often used to modify or augment the effects of a vaccine by stimul ating the immune system to respond to the vaccine more vigorously, and thus prov iding increased immunity to a particular disease? a) Antigen b) Epitope c) Immun ogen d) Stimulant e) Adjuvant 7.1) What fraction of serum are the antibodies (im munoglobulins) initially found when using lytical techniques (e.g. electrophores is)? a) Albumin b) Gamma () globulin c) Beta () globulin d) Alpha () globulin 7.2) In the electrophoresis of human serum, which of the following is the most electr onegative and thus migrates farthest toward the positive electrode? a) Albumin b ) Gamma () globulin c) Beta () globulin d) Alpha () globulin 7.3) Gamma () globulin serum fraction contains predominantly which immunoglobulin? a) IgA b) IgD c) IgE d) IgG e) IgM 8) On an early morning run near his home, a runner startled a gro up of dogs being exercised and was bitten on the leg. The runner was later unabl e to locate the dog and its owner to verify that the dog had an up-to-date rabie s vaccination. Given that rabies is always fatal, and despite the very low incid ence in domesticated dogs, prudence dictated undergoing treatment. The runner wa s given human immunoglobulin G-containing Version: 16Oct2008 Page 8 of 50

Immunology Quiz antibodies to rabies virus (anti-rabies immunoglobulin) injected around the site of the wound and at several other intramuscular sites. This antibody preparatio n confers instant protection from the virus without requiring the body to develo p a response. This is an example of: a) Active immunity b) Passive immunity 9) T he aim of monoclonal antibody production is to produce cells that only secrete i mmunoglobulin directed against the antigen used in immunization. Which of the fo llowing hybridoma production steps is NOT correct? a) Immunize a mouse with anti gen of choice then remove the spleen when the mouse is making an antibody respon se b) Fuse the immune spleen cells with a myeloma tumor cell c) The cells are cu ltured in a selective medium allowing fused and non-fused cells to survive d) Ce lls are grown in individual culture plate wells, and culture supernatants from w ells contains growing hybrid cells are screened for presence of desired antibody by an enzyme-linked immunosorbent assay (ELISA) e) This clone (hybridoma) is an immortal producer of the desired monoclonal antibody Match the following descri ptions with their term: 10.1) Allows for flexibility a) Light chain 10.2) Binds antigen b) Heavy chain 10.3) Binds to various cellular receptors and to compleme nt c) Fab region 10.4) Only has fragment antigen-binding (Fab) region d) Fc regi on 10.5) Has an fragment crystallizable (Fc) and Fab region e) Hinge region 10.6 ) Each antibody molecule contains ____ heavy chains and ____ light chains. a) 1; 1 b) 1; 2 c) 2; 1 d) 2; 2 e) 2; 3 Match the immunoglobulin(s) with the function al description: 11.1) Activates the complement system a) IgG 11.2) Involved in a llergic responses b) IgE 11.3) Predominant in the primary (early) immune respons e c) IgM 11.4) Has different subtypes d) IgG & IgM 11.5) Can transfer across the placental (maternal protection) e) IgG & IgA 11.6) Pepsin cleaves what region o f immunoglobulin? a) Heavy chain b) Light chain c) Hinge region 11.7) Papain cle aves what region of immunoglobulin? a) Heavy chain b) Light chain c) Hinge regio n 11.8) IgM is structurally characterized as: Version: 16Oct2008 Page 9 of 50

Immunology a) Monometric b) Bimetric c) Trimetric d) Tetrametric e) Pentametric 11.9) Which of the following is the main immunoglobulin in the gut and secretion s (saliva, milk, tears) and is important in mucosal immunity? a) IgA b) IgD c) I gE d) IgG e) IgM 11.10) Which of the following binds to an Fc receptor on mast c ells and basophils? a) IgA b) IgD c) IgE d) IgG e) IgM 11.11) Which of the follo wing is chiefly found on the surface of B cells as a receptor molecule and is in volved in cell activation? a) IgA b) IgD c) IgE d) IgG e) IgM Quiz 5 Antibody-Antigen Interactions 1) Which of the following is NOT involved in the antigen-antibody interaction? a) Electrostatic interactions between charged sid e-chains b) Hydrophobic interactions c) Van der Waals forces d) Hydrogen bonds e ) Peptide bonds 2.1) Which of the following best describes cross-reactivity? a) When one antibody can bind with one antigen b) When one antibody can bind with m ultiple antigens c) When multiple antibodies can bind with one antigen d) When m ultiple antibodies can bind with multiple antigens 2.2) Penicillin can form a ha pten-carrier conjugate with a self-protein that can then act as an immunogen and generate an immunoglobulin ____ antibody, and can cross-react with a number of other antibiotics. This can complicate the treatment of bacterial infections in these patients because they are unable to take the antibiotics necessary to comb at the infection. a) IgA b) IgD c) IgE Version: 16Oct2008 Page 10 of 50

Immunology Quiz d) IgG e) IgM 3.1) Which of the following is used to enumerate and/or separate l ive cells that express an antigen , sorted by applying an electric charge to the stained cells? a) ELISA (Enzyme-linked immunosorbent assay) b) Fluorescent anti body (fluorochromes) c) FACS (fluorescence-activated cell sorting) d) Western bl otting (immunoblotting) 3.2) Which of the following is a very sensitive and simp le test for antigens, which uses a covalent complex of enzyme linked to antibody , to detect antigen directly or to bind antibody-antigen complex? a) ELISA (Enzy me-linked immunosorbent assay) b) Fluorescent antibody (fluorochromes) c) FACS ( fluorescence-activated cell sorting) d) Western blotting (immunoblotting) 3.3) W hich of the following is used to characterize antigens in complex mixtures bioch emically? a) ELISA (Enzyme-linked immunosorbent assay) b) Fluorescent antibody ( fluorochromes) c) FACS (fluorescence-activated cell sorting) d) Western blotting (immunoblotting) 3.4) Which of the following uses ultraviolet (UV) light for ex amining specimens? a) ELISA (Enzyme-linked immunosorbent assay) b) Fluorescent a ntibody (fluorochromes) c) FACS (fluorescence-activated cell sorting) d) Western blotting (immunoblotting) 3.5) Which of the following would be used as prelimin ary screening for the presence of antibodies to HIV proteins in a patient s bloo d sample? a) ELISA (Enzyme-linked immunosorbent assay) b) Fluorescent antibody ( fluorochromes) c) FACS (fluorescence-activated cell sorting) d) Western blotting (immunoblotting) 3.6) What color light is emitted when antigens are exposed to UV light after being treated with fluorescein isothiocyte (FITC), such as in the test for Treponema pallidum (syphilis) or to dye the Chicago river for a partic ular holiday (fluorescein)? a) Blue b) Purple c) Red d) Orange e) Green 3.7) Whi ch of the following uses the enzyme horseradish peroxidase (HRP)? a) ELISA (Enzy me-linked immunosorbent assay) b) Fluorescent antibody (fluorochromes) c) FACS ( fluorescence-activated cell sorting) d) Western blotting (immunoblotting) e) ELI SA & Western blotting Version: 16Oct2008 Page 11 of 50

Immunology Quiz 3.8) Which of the following is used extensively to detect antigens in cells or t issue sections, as well as to screen for auto-antibodies to cell or tissue antig ens? a) ELISA (Enzyme-linked immunosorbent assay) b) Fluorescent antibody (fluor ochromes) c) FACS (fluorescence-activated cell sorting) d) Western blotting (imm unoblotting) 3.9) Which of the following uses protein antigens separated by mole cular weight using sodium dodecyl sulfate polyacrylamide gel electrophoresis (SD S-PAGE)? a) ELISA (Enzyme-linked immunosorbent assay) b) Fluorescent antibody (f luorochromes) c) FACS (fluorescence-activated cell sorting) d) Western blotting (immunoblotting) 6 Antibody Diversity 1.1) Each polypeptide chain (heavy and lig ht) on immunoglobulin has a variable (V) and constant (C) region. Immunoglobulin chains are encoded by _____ that is/are rearranged during ____ development to a ssemble a functional gene encoding either a heavy or a light chain. a) A single continuous DNA sequence; B cell b) A single continuous DNA sequence; T cell c) S ets of gene segments; B cell d) Sets of gene segments; T cell 1.2) Which of the following is only contained in heavy chains and not in light chains? a) Leader ( L) b) Joining (J) c) Diversity (D) d) Variable (V) e) Constant (C) 2.1) During t he development of B cells, the Ig gene segments are rearranged and brought next to each other to form a contiguous functional gene (somatic recombination). The complex of enzymes involved in somatic recombination in lymphocytes is called: a ) RAG-1 (Recombination-Activating Gene) b) RAG-2 (Recombination-Activating Gene) c) V(D)J-recombinase d) V(D)J-lyase e) A & B 2.2) In somatic recombination, the ____ rearranges first. The ____ region of the antibody molecule is generated vi a somatic recombination as it binds to the antigen and contains both a constant region and a variable region. a) Heavy chain; Fab b) Light chain; Fab c) Heavy c hain; Fc d) Light chain; Fc 2.3) The two types of light chains are: a) Alpha (a) and beta (b) b) Sigma (s) and gamma (g) Version: 16Oct2008 Page 12 of 50

Immunology Quiz c) Epsilon (e) and delta (d) d) Omega (o) and zeta (z) e) Lambda (l) and kappa ( k) 2.4) During the final step of synthesis for heavy and light immunoglobulin ch ains, which of the following peptides is cleaved? a) Leader (L) b) Joining (J) c ) Diversity (D) d) Variable (V) e) Constant (C) 3) Which of the following is NOT true regarding the mechanisms of generating antibody diversity? a) V, D, and J gene segments are present in multiple copies (germline diversity) b) VJ and VDJ gene segments can recombine in multiple combinations (combinatorial diversity) c ) Different sequences at the joint lead to greater antibody diversity (junctiona l diversity) d) A single combination of light and heavy chains e) Somatic hyperm utation after antigenic stimulation 4) Class switching (isotype switching) invol ves rearrangement of the V(H) exon to associate with a different C(H) exon at di fferent times in the course of an immune response. The ____ region of the antibo dy molecule is affected (changed) via class switching and, unlike somatic recomb ination, this process is antigen ____. a) Fab; Dependent b) Fab; Independent c) Fc; Dependent d) Fc; Independent 5.1) ____ is frequently found on the surface of B cells co-expressed with ____. These two classes are co-expressed not by class switching but by alternative processing of a primary RNA transcript. Both molec ules expressed on the single mature B cell have the same binding specificity for antigen. a) IgA & IgG b) IgD & IgM c) IgE & IgA d) IgG & IgM e) IgM & IgE 5.2) If alternative processing uses the first polyadenylation site, then what type of heavy chain mRNA is derived? a) (alpha) b) (gamma) c) (delta) d) (epsilon) e) mu) 5.3) If alternative processing uses the second polyadenylation site, then wh at type of heavy chain mRNA is derived? a) (alpha) Version: 16Oct2008 Page 13 of 50

Immunology Quiz b) (gamma) c) (delta) d) (epsilon) e) (mu) 6) Production of secreted antibodies (pAs site) involves a ____ chain of amino acids with a stretch of charged (versu s non charged) amino acids at the ____ terminus, in comparison to membrane bound antibody production (pAm site). a) Shorter; NH2 b) Shorter; COOH c) Longer; NH2 d) Longer; COOH 7) In heterozygous individuals who have, for example, inherited two alternative forms of the constant region gene for IgG1 (i.e., IgG1m(1) and IgG1m(2)), which of the following is true regarding the Ig expression by a parti cular B cell, according to allelic exclusion? a) It will be of the IgG1m(1) type b) It will be of the IgG1m(2) type c) It will contain both types d) It will con tain neither type e) It will contain only one of the types 7 The T Cell Receptor (TCR) 1.1) Protein and nucleic acid sequence data have been obtained for many T CRs with different specificities. Analyses of these sequences suggest the existe nce of how many hypervariable (hv) regions within the variable region? a) 1 b) 2 c) 3 d) 4 e) 5 1.2) The biochemical structure of the T-cell receptor (TCR) of t he type (95% of human TCRs) is comparable to a ____ immunoglobulin ____ fragment, having very short cytoplasmic tails. a) Secreted; Fab b) Secreted; Fc c) Membra ne-bound; Fab d) Membrane-bound; Fc 2.1) Where are T cells generally found in the body (location of TCR rearrangement)? a) Spleen b) Bone marrow c) Thyroid d) Th ymus e) Thalamus 2.2) In comparison to T cells, T cells ____ and are hypothesized to be a ____ line of immune defense. a) Recognize peptide antigens by MHC; Prima ry b) Do not recognize peptide antigens by MHC; Primary Version: 16Oct2008 Page 14 of 50

Immunology Quiz

c) Recognize peptide antigens by MHC; Secondary d) Do not recognize peptide anti gens by MHC; Secondary 3.1) Which of the following best describes the location o f the delta ()-ch in locus in human T-cell receptors? a) Chromosome 7 b) Chromoso me 7 within the alpha ()-locus c) Chromosome 14 d) Chromosome 14 within the beta ()-locus e) Chromosome 14 within the alpha ()-locus 3.2) Which of the following ar e located in chromosome 7 within human T-cell receptors? a) Alpha ()-locus b) Bet a ()-locus c) Gamma ()-locus d) A & B e) B & C 3.3) Comparing the arrangement of T CR genes and BCR genes, the ____ chain is analogous to the heavy (H) chain and t he ____ chain is analogous to the light (L) chain. a) Alpha (); Beta () b) Beta (); Alpha () c) Delta (); Gamma () d) Gamma (); Delta () 3.4) Which of the following TCR genetic chains contain D-segments, similar to immunoglobulin heavy chains? a) A lpha (); Beta () b) Delta (); Gamma () c) Beta (); Delta () d) Gamma (); Alpha () e) ha (); Delta () 3.5) Which of the following TCR genetic chains contains V and J se gments, similar to genes for immunoglobulin kappa and lambda light chains? a) Al pha (); Beta () b) Delta (); Gamma () c) Beta (); Delta () d) Gamma (); Alpha () e) A a (); Delta () 4) The process used to increase antigen binding affinity is called somatic ____ and occurs in ____ cells but not ____ cells. a) Cell hybridization; B; T b) Cell hybridization; T; B c) Hypermutation; B; T d) Hypermutation; T; B 5.1) Deficiencies in ____ lead to autosomal-recessive severe combined immunodefi ciency disease (SCID). a) RAG-1 b) RAG-2 Version: 16Oct2008 Page 15 of 50

Immunology Quiz c) RAG-1 or RAG-2 d) Both RAG-1 and RAG-2 5.2) If both RAG-1 and RAG-2 mutations occur, which of the following is true? a) T cells will be absent but B and NK c ells will be present b) T and B cells will be absent but NK cells will be presen t c) B cells will be absent but T and NK cells will be present d) B and NK cells will be present but T cells will be absent e) B, T, and NK cells will be absent 6.1) If a B cell successfully rearranges the first heavy chain locus, it inhibi ts the rearrangement of the other heavy chain on the other chromosome. What is t his called? a) Affinity maturation b) Allelic exclusion c) Class switching d) So matic cell hybridization e) Somatic hypermutation f) V(D)J gene rearrangement 6. 2) Allelic exclusion is a process by which the protein from only one allele is e xpressed while other allele(s) are silenced. Allelic exclusion occurs (generally ) in which of the following? a) B cells and TCR beta chains, but not in alpha ch ains b) B cells and TCR alpha chains, but not in beta chains c) TCR beta chains, but not in alpha chains or B cells d) TCR alpha chains, but not in beta chains or B cells e) B cells, TCR beta chains, and TCR alpha chains 7.1) Superantigens such as staphylococcal enterotoxins bind to certain TCR ____ chains and to MHC c lass II molecules. MHC binding does not involve the peptide groove. T cells can then release extremely high levels of cytokines, which lead to toxic shock syndr ome (TSS) when they appear in the blood. a) Alpha () b) Beta () c) Delta () d) Gamm a () 7.2) The TCR binds with ____, and the relatively ____ surface of the TCR int eracts with its ligand. a) MHC only; Flat b) MHC only; Curved c) Peptide antigen only; Flat d) Peptide antigen only; curved e) Both MHC and peptide antigen; Fla t f) Both MHC and peptide antigen; Curved 7.3) T cells ____ the potential to exp ress an alternative secreted form like the B-cell antigen receptor. Superantigen s can activate T cells ____ antigen processing and presentation. a) Have; Only w ith b) Have; Independent of c) Do not have; Only with Version: 16Oct2008 Page 16 of 50

Immunology Quiz d) Do not have; Independent of 8.1) A TCR complex is comprised of the TCR, CD3 m olecules, and which of the following CD3 chains? a) Delta () chain b) Gamma () cha in c) Epsilon () chains (two chains) d) Zeta () chains (two chains) 8.2) Which of the following molecules is necessary (not accessory) for antigen recognition and T cell activation? a) CD2 b) CD3 c) CD4 d) CD8 e) CD28 f) CD45R g) LFA-1 Match the description with the molecules: 9.1) Co-receptor molecule involved in signal transduction a) TCR 9.2) Adhesion molecule b) CD3 9.3) Antigen recognition mole cule c) CD4 & CD8 9.4) Involved in signal transduction on different T cells d) C D11a (LFA-1) 9.5) Genes involved in antigen processing e) LMP/TAP 9.6) CD4 molec ules bind with ____ MHC molecules and are found on (expressed by) ____ cells. CD 8 molecules bind with ____ MHC molecules and are found on (expressed by) ____ ce lls. a) Class I; Helper T; Class II; Cytotoxic T b) Class I; Cytotoxic T; Class II; Helper T c) Class II; Helper T; Class I; Cytotoxic T d) Class II; Cytotoxic T; Class I; Helper T 9.7) Which of the following is the cellular receptor for HI V attachments to T cells? a) CD2 b) CD3 c) CD4 d) CD8 e) LFA-1 9.8) CD4 and CD8 enhance the response of specific T cells, both by stabilizing the TCRpeptide-MHC complex and by bringing what type of protein kinase into the proximity of the c ytoplasmic tails, thereby facilitating signal transduction and cell activation? a) Serine b) Threonine c) Aspartic acid d) Histidine e) Tyrosine 8 Major Histoco mpatibility Complex (MHC) 1.1) Class III MHC genes encode for which of the follo wing? Version: 16Oct2008 Page 17 of 50

Immunology Quiz a) CD4+ T cells b) CD8+ T cells c) Compliment molecules d) Cytokine molecules e) C & D 1.2) MHC class I has three genes (HLA-A, HLA-B, & HLA-C). Which of the fo llowing is the correct order from most alleles (most polymorphic) to least allel es? a) A > B > C b) A > C > B c) B > A > C d) B > C > A e) C > A > B f) C > B > A 1.3) How many genes does MHC class II have? a) 2 (HLA-DP alpha/beta) b) 2 (HLA -DQ alpha/beta) c) 4 (HLA-DP alpha/beta, HLA-DQ alpha/beta) d) 4 (HLA-DQ alpha/b eta, HLA-DR alpha/beta) e) 6 (HLA-DP alpha/beta, HLA-DQ alpha/beta, HLA-DR alpha /beta) 1.4) Which of the following MHC class II genes has the most alleles (most polymorphic)? a) DP b) DP c) DQ d) DQ e) DR f) DR 1.5) Which of the following MHC cla ss II genes has the lease alleles? a) DP b) DP c) DQ d) DQ e) DR f) DR 2.1) MHC molecu les exhibit ____ and immunoglobulin/TCR molecules exhibit ____. a) Allelic exclu sion; Allelic exclusion b) Allelic exclusion; Co-dominant expression c) Co-domin ant expression; Co-dominant expression d) Co-dominant expression; Allelic exclus ion 2.2) Because of a lack of genetic recombination in the MHC, blocks of allele s (haplotypes) are inherited together, and they are identical in families. Which of the following is the likely result of this? a) Family members have identical combinations of HLA alleles, thus tissue transplantation is simple b) Family me mbers have identical combinations of HLA alleles, thus tissue transplantation is difficult Version: 16Oct2008 Page 18 of 50

Immunology Quiz c) No family members have identical combinations of HLA alleles, thus tissue tra nsplantation is simple d) No family members have identical combinations of HLA a lleles, thus tissue transplantation is difficult 3.1) Class II MHC molecules acc ommodate ____ peptides and thus ____ be referred to analogously as a hotdog in a bun, in contrast to class I MHC molecules. a) Smaller; Would b) Smaller; Would no t c) Larger; Would d) Larger; Would not 3.2) Which of the following is NOT a str uctural chain in class I MHC? a) 1 b) 1 c) 2 d) 3 e) -micro lo in 3.3) Which of the f ollowing is NOT a structural chain in class II MHC? a) 1 b) 2 c) 3 d) 1 e) 2 4) Evide nce is accumulating showing that polymorphism in the MHC may be advantageous. Ho mozygosity at HLA class I has been shown to be a(n) ____ with respect to HIV/AID S. Similarly, there is evidence that homozygosity at HLA class II ____ the risk of hepatitis B virus infection persisting. a) Advantage; Decreases b) Advantage; Increases c) Disadvantage; Decrease d) Disadvantage; Increase Certain MHC haplo types are associated with autoimmune disease. Match the disease with the HLA typ e: 5.1) Ankylosing spondylitis a) B27 5.2) Insulin-dependent diabetes mellitus b ) DR2 5.3) Pemphigus vulgaris c) DR3 5.4) Systemic lupus erythematosus d) DR4 5. 5) Good pastures syndrome e) DQ2 5.6) Multiple sclerosis 5.7) Rhematoid arthritis 9 Review of Antigen Recognition 1.1) Which of the following is true regarding i mmunoglobulin and T-cell receptor (TCR) proteins and gene segments? a) Heavy cha in analogous to TCR chain using VDJ gene segment; Light chain analogous to TCR cha in using VJ gene segment Version: 16Oct2008 Page 19 of 50

Immunology Quiz b) Light chain analogous to TCR chain using VDJ gene segment; Heavy chain analogo us to TCR chain using VJ gene segment c) Heavy chain analogous to TCR chain using VJ gene segment; Light chain analogous to TCR chain using VDJ gene segment d) Lig ht chain analogous to TCR chain using VJ gene segment; Heavy chain analogous to TC R chain using VDJ gene segment e) Heavy chain analogous to TCR chain using VDJ ge ne segment; Light chain analogous to TCR chain using VJ gene segment f) Light cha in analogous to TCR chain using VDJ gene segment; Heavy chain analogous to TCR cha in using VJ gene segment Match the following structure with its function (recogn ition of antigen): a) Immunoglobulin b) TCR c) TCR 1.2) Dual recognition: self MHC + peptide antigen 1.3) Directly: some recognize nonpeptide phosphorylated lipid s and carbohydrates; other recognize antigen that have not been processed 1.4) D irectly: carbohydrate, protein, lipid, nucleic acid epitopes 1.5) MHC class I ha s peptides of ____ amino acid residues and is an ____ antigen. MHC class II has peptides of ____ amino acid residues and is an ____ antigen. a) 8-11; Endogenous ; 9-30; Exogenous b) 9-30; Endogenous; 8-11; Exogenous c) 8-11; Exogenous; 9-30; Endogenous d) 9-30; Exogenous; 8-11; Endogenous 1.6) Which of the following is NOT true of T-cell receptors, when compared to immunoglobulin? a) Prior to expos ure to antigen, there are multiple V region gene segments b) Prior to exposure t o antigen, somatic recombination of gene segments occurs c) Prior to exposure to antigen, there is junctional variability d) Prior to exposure to antigen, there are multiple combination of chains e) After exposure to antigen, there is somat ic hypermutation and class switching 10 Antigen Processing and Presentation 1) T he ____ T cell-APC interaction is MHC ____-restricted, and the ____ T cell-targe t cell interaction is MHC ____-restricted. a) CD4+; Class I; CD8+; Class II b) C D4+; Class II; CD8+; Class I c) CD8+; Class I; CD4+; Class II d) CD8+; Class II; CD4+; Class I 2.1) Which of the following describes where class I MHC is found and not where class II MHC is found? a) B cells b) Dendritic cells c) Macrophage s d) Antigen presenting cells (A, B, & C) e) All nucleated cells 2.2) Peptides a ntigens generated in the cytosolic compartment (intracellular infection, e.g. vi rus) bind to ____ MHC molecules for presentation to ____ T cells. Peptide antige ns Version: 16Oct2008 Page 20 of 50

Immunology Quiz generated in vesicles (extracellular infection, e.g. bacteria) bind to ____ MHC molecules for presentation to ____ T cells. a) Class I; CD4+; Class II; CD8+ b) Class II; CD4+; Class I; CD8+ c) Class I; CD8+; Class II; CD4+ d) Class II; CD8+ ; Class I; CD4+ 3.1) In the processing pathway for extracellular antigens, synth esis of MHC class II and invariant chain (li) occurs in the ____. a) Cytosol b) Golgi apparatus c) Endoplasmic reticulum d) Ribosomes e) Lysosomes 3.2) The inva riant chain ____ the empty peptide-binding groove. After vesicle fusion, the inv ariant chain is ____ and peptides can enter the MHC class II grove. a) Activates ; Added b) Activates; Degraded c) Blocks; Added d) Blocks; Degraded 4.1) In the processing pathway for intracellular antigens, the proteasome will ____ viral pr otein molecules until peptides of ____ residues are formed; these can bind to cl ass I MHC molecules. a) Build; 8-11 b) Build; 9-30 c) Break down; 8-11 d) Break down; 9-30 4.2) The transporter associated with antigen presentation (TAP) ____ the peptides to traverse the membrane bilayer of the endoplasmic reticulum and b ind in the empty peptide-binding groove of nascent MHC ____ molecules being synt hesized in the endoplasmic reticulum. a) Permits; Class I b) Permits; Class II c ) Does not allow; Class I d) Does not allow; Class II 5) Mutations in TAP-1 or T AP-2 may alter the function of the heterodimer TAP. Which of the following is co mmon for patients with TAP mutations? a) Human immuno-deficiency virus (HIV) inf ection b) Acquired immune deficiency syndrome (AIDS) c) Upper respiratory tract infections d) Coagulation disorders (hemophilia) e) Systemic inflammatory respon se syndrome (SIRS, sepsis) 6.1) Certain strains of adenovirus express a protein that inhibits the transcription of class I MHC molecules. What is a consequence of this? a) Reduced likelihood that peptides will be expressed at the cell surfa ce b) Fewer peptides are available to bind to class I MHC Version: 16Oct2008 Page 21 of 50

Immunology Quiz c) Reduced number of class I MHC molecules available to display peptides to CD8+ lymphocytes 6.2) A protein of herpes simplex virus (HSV) binds to TAP and inhib its peptide transport into the endoplasmic reticulum. What is a consequence of t his? a) Reduced likelihood that peptides will be expressed at the cell surface b ) Fewer peptides are available to bind to class I MHC c) Reduced number of class I MHC molecules available to display peptides to CD8+ lymphocytes 6.3) Bacteria such as Mycobacterium tuberculosis have acquired the capacity to inhibit phagos ome-lysosome fusion. What is a consequence of this? a) Reduced likelihood that p eptides will be expressed at the cell surface b) Fewer peptides are available to bind to class I MHC c) Reduced number of class I MHC molecules available to dis play peptides to CD8+ lymphocytes 11 Lymphocyte Activation 1.1) The structure of the B-cell receptor contains the invariant proteins Ig and Ig, which are linked v ia ____ and are essential for signal generation across the B-cell surface membra ne and for surface expression of immunoglobulin receptors (mIgs). a) Covalent bo nding b) Hydrophobic interactions c) Sulfide bonding d) Hydrogen bonding e) Pept ide bonding 1.2) Immunoreceptor tyrosine-based activation motifs (ITAMs) are ess ential for signal transduction in ____ cells. a) B cells b) T cells c) B cells o r T cells d) B cells and T cells e) Neither B or T cells 1.3) Regarding the stru cture of the T-cell receptor, which of the following is NOT an invariant CD3 pro tein chain? a) Zeta () chain b) Epsilon () chain c) Gamma () chain d) Delta () chain 2) Which of the following is the correct order for a lymphocyte to be activated ? a) Recognition of antigen, activation of tyrosine kinases, clustering of recep tors, phosphorylation b) Recognition of antigen, clustering of receptors, activa tion of tyrosine kinases, phosphorylation c) Recognition of antigen, activation of tyrosine kinases, phosphorylation, clustering of receptors d) Recognition of antigen, activation of tyrosine kinases, clustering of receptors, phosphorylatio n Version: 16Oct2008 Page 22 of 50

Immunology Quiz e) Recognition of antigen, clustering of receptors, phosphorylation, activation of tyrosine kinases 3.1) The B cell co-receptor can co-cluster with the BCR and increase the efficiency of signaling. Which of the following proteins does NOT m ake up the co-receptor? a) CD19 b) CD20 c) CD21 d) CD81 3.2) Protein antigens bo und to complement component C3d can bind simultaneously to both ____ and the BCR . This enables the co-receptor complex to cluster and crosslink with the BCR, in ducing phosphorylation. a) CD19 b) CD20 c) CD21 d) CD81 3.3) B cell co-receptor phosphorylation sites include Ig/I and which of the following? a) CD19 b) CD20 c) CD21 d) CD81 4.1) Presence of the TCR co-receptor molecules (CD4 or CD8) has be en estimated to reduce the number of MHC-peptide complexes required to trigger a T-cell response by about: a) 5-fold b) 10-fold c) 50-fold d) 100-fold e) 1000-f old 4.2) Leukocyte-specific protein tyrosine kinase (Lck) is integral in the sig naling cascade in ____ cells. Zeta-chain-associated protein kinase 70 (ZAP-70), which binds CD3-zeta, is ____ cell specific. Spleen tyrosine kinase (Syk), a sig nal transmitter, is found predominantly in ____ cells. a) B; B; B b) T; T; T c) B; B; T d) T; T; B e) B; T; T f) T; B; B 5.1) Protein tyrosine kinases (PTKs) pl ay an important role in lymphocyte function and activation. A mutation in the ge nes encoding the enzyme ZAP-70 would lead to which of the following? a) Human im muno-deficiency virus (HIV) infection b) Acquired immune deficiency syndrome (AI DS) c) Severe combined immunodeficiency (SCID) syndrome d) Systemic inflammatory response syndrome (SIRS, sepsis) e) X-linked agammaglobulinemia Version: 16Oct2008 Page 23 of 50

Immunology Quiz 5.2) A mutation in the genes encoding the enzyme Bruton s tyrosine kinase (Btk) would lead to which of the following? a) Human immuno-deficiency virus (HIV) inf ection b) Acquired immune deficiency syndrome (AIDS) c) Severe combined immunode ficiency (SCID) syndrome d) Systemic inflammatory response syndrome (SIRS, sepsi s) e) X-linked agammaglobulinemia 12 Hematopoiesis 1.1) What is the major site f or hematopoiesis, where all blood cells are formed? a) Spleen b) Bone marrow c) Liver d) Thymus e) Kidneys 1.2) Which of the following are cells with some linea ge commitment and little or no selfrenewal capacity? a) Hematopoietic stem cells (HSCs) b) Progenitor (precursor) cells c) Mature cells 1.3) Which of the follow ing are lineage restricted, morphologically identifiable, and express differenti ation markers? a) Hematopoietic stem cells (HSCs) b) Progenitor (precursor) cell s c) Mature cells 1.4) Which of the following are pluripotential, self-renewing CD34+ cells? a) Hematopoietic stem cells (HSCs) b) Progenitor (precursor) cells c) Mature cells 2) Which of the following is NOT a cell that progenitors ultimat ely differentiation into? a) B cells b) T cells c) Erythrocytes d) Platelets e) Granulocytes f) NK cells g) Macrophages (monocytes) h) HSCs 3) Cytokine interleu kin-7 (IL-7) is a hematopoietic growth factor secreted by the stromal cells (mac rophages and adipocytes) of the red marrow and thymus capable of stimulating the proliferation of lymphoid ____. It ____ affected by X-linked SCID. a) Hematopoi etic stem cells (HSCs); Is b) Progenitor (precursor) cells; Is c) Mature cells; Is d) Hematopoietic stem cells (HSCs); Is not e) Progenitor (precursor) cells; I s not Version: 16Oct2008 Page 24 of 50

Immunology Quiz f) Mature cells; Is not Match the lymphoid or myeloid cell type with its role: A DCC = antibody-dependent cell-mediated cytotoxicity 4.1) Lyse certain virally in fected cells and some tumor cells a) B cells 4.2) Phagocytose, bacteriocidal act ivity, ADCC b) T cells 4.3) Important role in allergic response; heparin & hista mine c) NK cells 4.4) Major source of antigen-specific protection against viral infection d) Neutrophils 4.5) Combat certain parasitic infections (e.g. worms); hydrolytic enzymes e) Mast cells 4.6) Critical in antigen-capture and uptake in peripheral tissues f) Eosinophils 4.7) Produce antibody and express immunoglobul in g) Monocytes/Macrophages 4.8) Phagocytic and cytotoxic activities; chemotacti c factors h) Dendritic cells 5) The mutation on the X chromosome responsible for X-SCID is in the gene for a subunit of several cytokine receptors. Which of the following is true for boys affected with X-SCID at birth? a) Non-functional B c ells, T cells, & NK cells b) Non-functional B cells & T cells, and no NK cells c ) Non-functional B cells, and no T cells or NK cells d) Non-functional T cells & NK cells, and no B cells e) No B cells, T cells, or NK cells 6.1) Granulocyte c olony-stimulating factor (G-CSF) causes an increase in the production of which o f the following in the bone marrow? a) Neutrophils b) Mast cells c) Eosinophils d) Monocytes/Macrophages e) Dendritic cells 6.2) Macrophage colony-stimulating f actor (M-CSF) causes an increase in the production of which of the following? a) Neutrophils b) Mast cells c) Eosinophils d) Monocytes/Macrophages e) Dendritic cells 6.3) Granulocyte-macrophage colony-stimulating factor (GM-CSF) causes an i ncrease in the production of which of the following? a) Neutrophils b) Mast cell s c) Eosinophils d) Monocytes/Macrophages e) Dendritic cells 13 The Organs and T issues of the Immune System 1.1) In the embryonic human, the primary lymphoid or gans are initially in the yolk sac, then in the fetal ____, and finally in the _ ___. a) Spleen and kidneys; Bone marrow and thymus b) Spleen and thymus; Bone ma rrow and kidneys Version: 16Oct2008 Page 25 of 50

Immunology Quiz c) Kidneys and thymus; Bone marrow and spleen d) Kidneys and bone marrow; Spleen and thymus e) Spleen and liver; Bone marrow and thymus 1.2) In the adult, the p rimary lymphoid organs, whose cells expand clonally, are the ____ and secondary lymphoid organs, which create effector cells, are the ____, as well as mucosa as sociated lymphoid tissue (MALT) lining the respiratory, GI, and reproductive tra cts. a) Spleen and lymph nodes; Bone marrow and thymus b) Bone marrow and thymus ; Spleen and lymph nodes c) Spleen and bone marrow; Lymph nodes and thymus d) Bo ne marrow and lymph nodes; Thymus and spleen 2) The thymus is the primary site o f T-cell development. Which of the following is the correct order arranged from the area with the earliest progenitor cells to the area with the most mature T l ymphocytes? a) Medulla then cortex then subcapsular zone b) Medulla then subcaps ular zone then cortex c) Subcapsular zone then medulla then cortex d) Subcapsula r zone then cortex then medulla e) Cortex then medulla then subcapsular zone f) Cortex then subcapsular zone then cortex 3.1) The spleen, the major filter for b lood, is about the size of a clenched fist and is found on the ____ side associa ted posteriorly with ribs ____. a) Left; 7-9 b) Left; 9-11 c) Right; 5-7 d) Righ t; 7-9 e) Right; 9-11 3.2) The spleen has a red pulp (macrophages and red blood cells) and a white pulp (dense lymphoid tissue). T cells are found chiefly in th e ____ and B cells are found in the ____, both within the ____ pulp. a) Periarte riolar lymphoid sheaths (PALS); Follicles; White b) Periarteriolar lymphoid shea ths (PALS); Follicles; Red c) Follicles; Periarteriolar lymphoid sheaths (PALS); White d) Follicles; Periarteriolar lymphoid sheaths (PALS); Red 3.3) The spleen responds to ____ antigens and the lymph nodes respond to ____ antigens for pres entation to ____. a) Lymph-borne; Blood-borne; B cells b) Lymph-borne; Blood-bor ne; T cells c) Blood-borne; Lymph-borne; B cells d) Blood- borne; Lymph-borne; T cells 4.1) Which of the following is NOT a major area where lymph nodes can be found? a) Cervical b) Axillary c) Mesenteric d) Inguinal e) Cardiac Version: 16Oct2008 Page 26 of 50

Immunology Quiz Match the lymph node location with the cells it contains: 4.2) Medulla a) B cell s 4.3) Paracortex b) CD4+ T cells 4.4) Cortex c) B cells, T cells, macrophages 5 .1) Epithelial ____ cells take up antigens that are inhaled or ingested, through the process of ____. a) M; Phagocytosis b) N; Phagocytosis c) G; Phagocytosis d ) M; Pinocytosis e) N; Pinocytosis 5.2) Which of the following locations has cel l that transport the antigens by transcytosis into sub-epithelial tissues (e.g. lamina propria) where they encounter lymphocytes? a) Tonsils (nasopharyngeal-ass ociated lymphoid tissue, NALT) b) Adenoids (nasopharyngeal-associated lymphoid t issue, NALT) c) Peyers patches (gut-associated lymphoid tissue, GALT) d) Axilla ( lymph node center) e) Thymus (T cell development) 5.3) Regarding mucosa-associat ed lymphoid tissue (MALT), which of the following is secreted by B cells across the epithelium? a) IgA b) IgD c) IgE d) IgG e) IgM 6) Intraepithelial lymphocyte s (IEL) act to protect the host against viral and bacterial pathogens encountere d in the gut and secrete cytokines. Their predominant phenotype is: a) T cells b) T cells c) B cells d) Macrophages e) Dendritic cells 7) Regarding the cutaneous immune system (skin), T lymphocytes and Langerhans cells (chiefly ____) are foun d in the ____ and macrophages and T cells are found in the ____. a) CD4+; Dermis ; Epidermis b) CD8+; Dermis; Epidermis c) CD4+; Epidermis; Dermis d) CD8+; Epide rmis; Dermis 8.1) ____ lymphocytes migrate to and lodge in selected tissue sites (lymphocyte homing). ____ constantly circulate among the ____ lymphoid organs u ntil they encounter antigen or die. a) Effector (memory) T lymphocytes; Nave T ly mphocytes; Primary b) Effector (memory) T lymphocytes; Nave T lymphocytes; Second ary c) Nave T lymphocytes; Effector (memory) T lymphocytes; Primary d) Nave T lymp hocytes; Effector (memory) T lymphocytes; Secondary Version: 16Oct2008 Page 27 of 50

Immunology Quiz 8.2) ____ are trafficked via cell adhesion molecules (CAMs), which are a part of the immunoglobulin superfamily. a) Nave T lymphocytes b) Effector (memory) T lym phocytes c) Both nave T lymphocytes and effector (memory) T lymphocytes d) Either nave T lymphocytes or effector (memory) T lymphocytes e) Neither nave T lymphocyt es nor effector (memory) T lymphocytes 9.1) Which of the following is the correc t order of lymphocyte extravasation? a) Lymphocyte activation then adhesion to e ndothelium then arrested adhesion then transmigration/chemostaxis b) Arrested ad hesion then lymphocyte activation then adhesion to endothelium then transmigrati on/chemostaxis c) Arrested adhesion then adhesion to endothelium then lymphocyte activation then arrested adhesion then transmigration/chemostaxis d) Adhesion t o endothelium then arrested adhesion then lymphocyte activation then transmigrat ion/chemostaxis e) Adhesion to endothelium then lymphocyte activation then arres ted adhesion then transmigration/chemostaxis 9.2) Lymphocyte passage (diapedesis or transmigration) occurs at the ____ between adjacent endothelial cells then i nto the tissues. a) Gap junction b) Tight junction (zonula occludens) c) Adheren s junction (zonula adherens) d) Desmosome (macular adherens) 14 B Cell Developme nt 1.1) During B cell development, negative selection occurs in an attempt to en sure the antigen receptor: a) Can bind with a specific antigen b) Cannot bind wi th certain foreign antigens c) Can bind to self-antigens d) Cannot bind to selfantigens 1.2) During B cell development, precursor cells are found in the ____ a nd immature cells are found in the ____. a) Bone marrow; Bone marrow b) Bone mar row; Periphery c) Periphery; Periphery d) Periphery; Bone marrow e) Spleen; Bone marrow 2) Which of the following has the surface marker CD34 instead of the sur face marker CD19, during B cell development? a) Stem cell b) Pro-B cell c) Early pre-B cell d) Late pre-B cell e) Immature cell Version: 16Oct2008 Page 28 of 50

Immunology Quiz 3.1) During B cell development, when is there rearrangement in the heavy (H) cha in of the immunoblobulin gene started? a) Pro-B cell stage b) Early pre-B cell s tage c) Late pre-B cell stage d) Immature cell stage e) Stem cell 3.2) During B cell development, when is there rearrangement in the light (L) chain of the immu noblobulin gene started? a) Pro-B cell stage b) Early pre-B cell stage c) Late p re-B cell stage d) Immature cell stage e) Stem cell 3.3) During B cell developme nt, at what stage can cytoplasmic chains being to be found? a) Pro-B cell stage b) Early pre-B cell stage c) Late pre-B cell stage d) Immature cell stage e) Ste m cell 3.4) During B cell development, at what stage is membrane bound IgM found ? a) Pro-B cell stage b) Early pre-B cell stage c) Late pre-B cell stage d) Imma ture cell stage e) Stem cell 4) Which of the following best describes the role o f the pre-B cell receptor (pre BCR)? a) Signal transduction leading to cell prol iferation b) Signal transduction leading to cell apoptosis c) Prevention of self -recognition and thus cell proliferation d) Acquisition of self-recognition and thus cell apoptosis e) Binding with cell adhesion molecules (CAMs) 5) At what st age of B cell development are auto-reactive cells removed? a) Stem cell b) Pro-B cell stage c) Early pre-B cell stage d) Late pre-B cell stage e) Immature cell stage 6) Allelic exclusion creates monospecific B-cell receptors (BCRs). The res ult is these cells each secrete: a) Different antibodies with distinct antigenic specificities b) Similar antibodies with distinct antigenic specificities c) Di fferent antibodies with the same antigenic specificity d) Similar antibodies wit h the same antigenic specificity Version: 16Oct2008 Page 29 of 50

Immunology Quiz 7.1) What surface immunoglobulins are present once an immature B cell becomes a mature (peripheral) B cell? a) IgD b) IgM c) IgA d) IgA & IgM e) IgM & IgD 7.2) What are peripheral cells called if they have never come in contact with antigen ? a) Mature cell b) Immature cell c) Nave cell d) Plasma cell e) Stem cell 8) Tol erance refers to the ability of B cells to: a) Tolerate T cells b) Tolerate othe r B cells c) Tolerate self antigens d) Tolerate foreign antigens e) Tolerate cha nges in pH, body temperature, and other homeostatic changes 9) The activation of a nave B cell, which generally requires a second accessory signal, occurs when t he B cell exits the bloodstream and into a ____ lymphoid organ, meets antigen, i nternalizes the BCR-antigen complex, and eventually becomes ____ cells. a) Prima ry; Plasma b) Primary; Memory c) Primary; Plasma & memory d) Secondary; Plasma e ) Secondary; Memory f) Secondary; Plasma & memory 10) A young child undergoes im plantation of a cardiac pacemaker. During surgery, the physician must remove the thymus. If this child encounters an antigen requiring B-cell-Tcell collaboratio n, they will ____ to mount an immune response. These antigens are thus called __ __. a) Still be able; Thymus dependent (TD) b) Still be able; Thymus independent (TI) c) Not be able; Thymus dependent (TD) d) Not be able; Thymus independent ( TI) 11.1) B cells whose BCRs bind antigen with high-affinity receive survival si gnals (called ____ selection) from follicular dendritic cells (FDCs) and germina l center T cells, whereas those that fail to bind antigen ____. a) Positive; Pro liferate b) Positive; Die (apoptosis) c) Negative; Proliferate d) Negative; Die (apoptosis) e) Negative; Re-enter circulation 11.2) Where does affinity maturati on occur? a) Paracortex of lymphoid tissue Version: 16Oct2008 Page 30 of 50

Immunology Quiz b) Cortex of lymphoid tissue c) Germinal center of lymphoid tissue d) Follicular dendritic cells e) Plasma cells 12) Most peripheral B cells belong to a pool of long lived follicular B lymphocytes called ____ cells. The majority of B cells found in the fetus and neonate are ____ cells, which express the surface marker CD5. ____ cells are the most likely to be involved in autoimmunity. a) B-1; B-1; B-1 b) B-2; B-1; B-1 c) B-1; B-1; B-2 d) B-2; B-1; B-2 e) B-1; B-2; B-1 f) B-2; B-2; B-1 g) B-1; B-2; B-2 h) B-2; B-2; B-2 15 T Cell Development 1.1) Which of the following is the correct order of developmental stages for T cells? a) Doubl e-positive (DP) then double-negative (DN) then single-positive (SP) b) Double-po sitive (DP) then single-positive (SP) then double-negative (DN) c) Double-negati ve (DN) then double-positive (DP) then single-positive (SP) d) Double-negative ( DN) then single-positive (SP) then double-positive (DP) 1.2) In which of the fol lowing developmental stages of T cells are surface molecules CD4 and CD8 NOT exp ressed? a) DN cell b) DP cell c) SP cell d) Mature T cell 2.1) Where are singlepositive (SP) cells found? a) Bone marrow b) Thymus subcapsular zone c) Thymus c ortex d) Thymus medulla e) Periphery 2.2) Where are double-negative (DN) cells f ound? a) Bone marrow b) Thymus subcapsular zone c) Thymus cortex d) Thymus medul la e) Periphery 2.3) Where are double-positive (DP) cells found? a) Bone marrow b) Thymus subcapsular zone c) Thymus cortex d) Thymus medulla Version: 16Oct2008 Page 31 of 50

Immunology Quiz e) Periphery 3.1) At what stage does selection occur and where in the thymus doe s it occur? a) DN; Cortex b) DP; Cortex c) SP; Cortex d) DN; Subcapsular zone e) DP; Subcapsular zone f) SP; Subcapsular zone 3.2) Approximately how many cells survive the selection process? a) 95% b) 75% c) 50% d) 25% e) 5% 4.1) Which of t he following begins at the DP stage and not the DN stage? a) chain rearrangement b) chain rearrangement c) chain rearrangement d) chain rearrangement 4.2) At wh at stage are rearranged TCRs expressed on the cell surface? a) DN b) DP c) SP d) Mature nave T cell 5) Establishment of self-restriction occurs in the thymus ___ _ and is called ____ selection. Establishment of central self-tolerance occurs i n the thymus ____ and is called ____ selection. a) Cortex; Positive; Medulla; Ne gative b) Cortex; Negative; Medulla; Positive c) Medulla; Positive; Cortex; Nega tive d) Medulla; Negative; Cortex; Positive 6) Where does a mature T cell encoun ter antigen for the first time? a) Freely in the blood stream b) Freely in a pri mary lymphoid organ c) Freely in a secondary lymphoid organ d) On an antigen pre senting cell (APC) in a primary lymphoid organ e) On an antigen presenting cell (APC) in a secondary lymphoid organ 7) Activation of a T cell requires ____. Fol lowing activation, the T cell proliferates and differentiates into ____, then mo ves into peripheral tissues and other organs. a) Recognition of antigen displaye d on MHC molecules; Nave cells b) A costimulatory signal; Nave cells c) Recognitio n of antigen displayed on MHC molecules and a costimulatory signal; Nave cells d) Recognition of antigen displayed on MHC molecules; Effector cells e) A costimul atory signal; Effector cells Version: 16Oct2008 Page 32 of 50

Immunology Quiz f) Recognition of antigen displayed on MHC molecules and a costimulatory signal; Effector cells 8.1) CD4+ cells recognize antigen displayed on MHC ____ molecule s and CD8+ cells recognize antigen displayed on MHC ____ molecules. ____ has TH1 and TH2 cell populations. a) Class I; Class II; CD4+ b) Class I; Class II; CD8+ c) Class II; Class I; CD4+ d) Class II; Class I; CD8+ 8.2) Which of the followi ng enhances IgE antibody response and mast cell and eosinophil function? a) TH1 cell population b) TH2 cell population 8.3) Which of the following enhances infl ammatory responses (e.g. activate macrophages to kill intracellular bacteria) an d stimulates IgG production? a) TH1 cell population b) TH2 cell population 9) Pa tients with MHC class II (or class I) antigen deficiency would exhibit which of the following? a) Human immuno-deficiency virus (HIV) infection b) Acquired immu ne deficiency syndrome (AIDS) c) Persistent bacterial and viral infections d) Co agulation disorders (hemophilia) e) Systemic inflammatory response syndrome (SIR S, sepsis) 10.1) The T cell acts as a part of the first line of defense, recogniz ing microbial invaders. They appear to recognize commonly occurring microbial pa thogens. Where can T cells be found? a) Liver and kidney b) Bone marrow and splee n c) Skin and gut mucosa d) Respiratory tract and bone marrow e) Brain and spina l cord 10.2) In contrast to T cells, T cells recognize certain peptide and nonpept ide antigens ____ processing and in the ____ of MHC class I and/or II molecules. a) Only with; Absence b) Only with; Presence c) Without; Absence d) Without; Pr esence 16 Cell-Cell Interaction in Generating Effector Lymphocytes 1) Antigens a nd lymphoid cells are delivered to the secondary lymphoid tissues (spleen, lymph nodes) via: a) T cells b) T cells c) B cells d) Macrophages Version: 16Oct2008 Page 33 of 50

Immunology Quiz e) Dendritic cells 2.1) Cytokines produced by TH1 are ____ (microbial infection response) and cytokines produced by TH2 are ____ (parasitic infection response a nd allergy response). a) IFN- and tumor necrosis factor ; IL-4 and IL-5 b) IL-4 an d IL-5; IFN- and tumor necrosis factor c) IFN- and IL-4; Tumor necrosis factor and IL-5 d) Tumor necrosis factor and IL-5; IFN- and IL-4 e) IFN- and IL-5; Tumor nec rosis factor and IL-4 2.2) IFN- stimulates ____ immunity by enhancing ____ T cell s as well as activating macrophages and natural killer cells. IL-4/IL-5 stimulat e ____ immunity (antibodies) by activating B cells and eosinophils and induce __ __-type responses. a) Cell-mediated; CD8+; Humoral; IgE b) Cell-mediated; CD4+; Humoral; IgE c) Cell-mediated; CD8+; Humoral; IgM d) Cell-mediated; CD4+; Humora l; IgM e) Humoral; CD8+; Cell-mediated; IgE f) Humoral; CD4+; Cell-mediated; IgE g) Humoral; CD8+; Cell-mediated; IgM h) Humoral; CD8+; Cell-mediated; IgM 3.1) Cellular interactions between B and T cells involve costimulatory activation. Th ere is a physical interaction between ____ on the B cell and ____ on the T cell. This leads to a B cell producing high affinity antibody. a) CD154; CD40 b) CD28 ; CD4 c) CD40; CD154 d) CD28; CD3 e) CD3; CD80 f) CD80; CD3 3.2) Activation of t he gene for IL-2, and eventually TH proliferation, is causes by a critical signa l (along with TCR signal transduction) from ____ on the B cell and ____ on the T cell. a) CD154; CD40 b) CD28; CD80 c) CD40; CD154 d) CD80; CD28 e) CD3; CD4 f) CD4; CD3 4) What is the immunologic consequence of mutation in CD40L (CD154)? a) Leprosy and immunity to protozoal infections b) Acquired immune deficiency synd rome (AIDS) c) X-linked hyper-IgM syndrome d) Systemic inflammatory response syn drome (SIRS, sepsis) e) X-linked agammaglobulinemia 5) Which of the following is required for a CD8+ cell to differentiate into an effector cytotoxic T cell (CT L)? Is this a physical interaction? a) Recognition of antigen; No Version: 16Oct2008 Page 34 of 50

Immunology Quiz b) Costimulatory signals from CD4+ TH cells; No c) Recognition of antigen; Yes d ) Costimulatory signals from CD4+ TH cells; Yes e) A and B f) C and D 6.1) Extra cellular pathogen response involves ____ T cells and MHC ____ molecules. Intrace llular pathogen response involves ____ T cells and MHC ____ molecules. a) CD4+; Class I; CD8+; Class II b) CD4+; Class II; CD4+; Class I c) CD8+; Class I; CD4+; Class II d) CD8+; Class II; CD4+; Class I 6.2) ____ T cell activation of TH1 le ads to ____ antibody production and opsonization (or macrophage activation). Act ivation of TH2 leads to ____ antibody production and activation of mast cells an d eosinophils. a) CD4+; IgE; IgG b) CD4+; IgG; IgE c) CD8+; IgE; IgG d) CD8+; Ig G; IgE 17 Immunologic Memory 1) Which of the following is NOT true when comparin g primary immune response to subsequent (secondary) immune response? a) Primary response takes 5-10 days b) Secondary response takes 1-3 days c) Primary respons e has IgM as the major antibody class d) Secondary response has IgH (IgA or IgE) as the major antibody class e) Primary response has a high affinity for antigen 2.1) Which of the following is a low affinity antibody? a) IgA b) IgE c) IgH d) IgM 2.2) Which of the following best describes the affinity of antibody secrete d for effector B cells? a) High b) Low c) Increases during response d) Decreases during response 2.3) The response time to antigenic stimulation for memory B an d T cells is described as ____, for nave B and T cells is described as ____, and for effector B and T cells is described as ____. a) Slow; Fast; Responding b) Fa st; Slow; Responding c) Responding; Slow Fast d) Responding; Fast; Slow e) Slow; Slow; Slow Version: 16Oct2008 Page 35 of 50

Immunology Quiz f) Fast; Fast; Fast 2.4) Expression of L-selectin (CD62L), the receptor that fac ilitates homing of peripheral lymph nodes, is ____ for memory T cells, ____ for nave T cells, and ____ for effector T cells. a) High; Low; Variable b) Low; High; Variable c) Variable; High; Low d) Variable; Low; High e) High; Variable; Low f ) Low; Variable; High 3) Which of the following is NOT true regarding apoptosis of target cells? a) Apoptosis is triggered by Fas-Fas interactions and the activ ation of Caspase b) The critical cascade step is the activation of Caspase-activ atable DNase (CAD) c) bcl genes are apoptotic genes meant to shorten memory cell survival d) Apoptosis of memory cells would lead to decreased secondary respons e e) Lack of apoptosis would lead to long term survival of memory cells 18 Revie w of Immune Physiology 1.1) The route of antigen processing (cytosolic versus ve sicle bound) determines whether an antigen is presented by MHC class II molecule s to a TCR on a CD4+ helper (TH) cell, or by major histocompatibility complex (M HC) class I molecules to a TCR on a CD8+ cytotoxic T cell. a) True b) False 1.2) The processes of affinity maturation and class switching are used to generate a lower-affinity, less effective antibody molecule during the immune response. a) True b) False 1.3) Cell adhesion molecules (CAMs) are important in the traffick ing of lymphocytes. a) True b) False 1.4) Antiapoptotic molecules are encoded by the death-inhibiting family of bcl genes. a) True b) False 19 Constitutive Defe nses Including Complement 1.1) Which of the following is a function of the adapt ive immune system and NOT the innate immune system? a) Distinguishes self from n on-self b) Has preformed or rapidly formed components c) Responds within minutes to infection d) Has no specificity and responds to a range of pathogens e) Uses pattern-recognition molecules 1.2) Which of the following is a function of the innate immune system and NOT the adaptive immune system? a) Has possibility of u p to 10^18 different receptors Version: 16Oct2008 Page 36 of 50

Immunology Quiz b) Recognizes conformational structures or short peptides bound to MHC c) Has im munological memory d) Frequently malfunctions and may cause autoimmunity e) Uses germline genes to produce collectins Match the innate immune component with the name and location: 2.1) Low pH a) Langerhans cells in skin 2.2) Surfactants, pa thogen binding collectins b) Upper respiratory tract 2.3) Initially prevent orga nism penetration c) GI tract 2.4) Mucociliary escalator d) Dead skin keratinocyt es 2.5) Migrate and present antigen to T cells e) Living skin keratinocytes 2.6) Secrete cytokines if damaged f) Lower respiratory tract 3.1) What type of cells produce type I interferons (IFN- and IFN-)? a) Monocytes b) Myeloid dendritic cel ls (mDC) c) Plasmacytoid dendritic cells (pDC) d) Plasma cells e) Goblet cells 3 .2) Type I interferon is released in response to ____, which is recognized using a pattern-recognition molecule called Toll-like receptor 3. a) Single-stranded DNA b) Double-stranded DNA c) Single-stranded RNA d) Double-stranded RNA 3.3) Wh ich of the following is NOT true regarding interferon? a) Interferon prevents in fection spreading from cell to cell b) NK cells are activated by interferon and lyse infected cells c) Antigen-presenting cells are inactivated d) Interferon is viral specific, attacking viral protens e) Stimulation of activity of TAP (tran sporter-associated with antigen presentation) occurs 4.1) In the lectin compleme nt pathway, mannan-binding lecting (MBL) indirectly activated which of the follo wing components? a) C1 b) C2 c) C3 d) C4 e) C2 & C4 4.2) In the classical comple ment pathway, which of the following components is the initiating protein(s)? a) C1 b) C2 c) C3 d) C4 e) C2 & C4 4.3) Which of the following component molecules is activated in the classical pathway after binding to an Fc? Version: 16Oct2008 Page 37 of 50

Immunology Quiz a) C1 b) C2 c) C3 d) C4 e) C2 & C4 4.4) In the alternative complement pathway, t his component molecule undergoes spontaneous activation, which creates a challen ge for organ xenotransplantation. a) C1 b) C2 c) C3 d) C4 e) C2 & C4 4.5) Which complement pathway is activated by (and requires) antibodies, with IgM being par ticularly good at C1 binding? a) Lectin b) Classical c) Alternative 5.1) Anaphyl atoxins are chemotaxins that stimulate phagocytosis and degranulation. Which com plement components is/are mainly involved? a) C2 & C4 b) C3 c) C5 d) C3 & C5 e) C5-C9 5.2) Opsonization is the process by which bacteria and other cells are mad e available for phagocytosis and involves opsonin or IgG. Which complement compo nents is/are mainly involved? a) C2 & C4 b) C3 c) C5 d) C3 & C5 e) C5-C9 5.3) Th e membrane attack complex (MAC) uses C3 to activate the final part of the comple ment pathway. It is important in defense against Neisseria. Which of the followi ng components is/are inserted into the plasma membrane of the target cell, allow ing for free passage of water/solute and thus killing the cell? a) C5 & C6 b) C7 c) C8 d) C9 e) C7-C9 6) Which of the following is NOT a major function of compl ement activation? a) Opsonization b) B-cell stimulation c) T-cell stimulation d) Immune complex clearance Version: 16Oct2008 Page 38 of 50

Immunology Quiz 7.1) To prevent inadvertent complement activation, eight inhibitors exist. Which of the following is an inhibitor preventing activation of C2 and C4, and preven ts C3 activation by the alternative pathway? a) C1 inhibitor b) C2 inhibitor c) C3 inhibitor d) C4 inhibitor e) C2 & C4 inhibitor 7.2) A deficiency in complemen t inhibitors could lead to which of the following? a) Meningitis b) Leprosy c) X -linked hyper-IgM syndrome d) Hereditary angiodema e) X-linked agammaglobulinemi a 20 Phagocytes 1.1) Pus formed at the site of infection is largely composed of dead: a) Macrophages b) Neutrophils c) Eosinophils d) Basophils e) Lymphocytes 1 .2) Which of the following describes this image? a) Macrophage b) Neutrophil c) Eosinophil d) Basophil e) Lymphocyte 1.3) Which of the following describes this image? a) Macrophage b) Neutrophil c) Eosinophil d) Basophil e) Lymphocyte 1.4) Which of the following is NOT true of neutrophils compared with macrophages? a) Rapid increase in production during acute response b) Is short-lived (dies after phagocytosis) c) Has a single mature form d) Found in healthy tissues e) Rapidl y forms pus Match the description with the term involved in recruitment of phago cytes: 2.1) Follows concentration gradient of chemokines to the site of infectio n a) Diapedesis 2.2) Uses integrin molecules to squeeze between endothelial cell s b) Chemotaxis 2.3) Makes integrins more sticky c) G-CSF 2.4) Increases marrow pr oduction of neutrophils d) Chemokines Match the description with the receptor in volved in recruitment of phagocytes: Version: 16Oct2008 Page 39 of 50

Immunology Quiz 2.5) Binds sugars on bacteria a) Fc 2.6) Mediate adherence and prime for phagocy tosis b) CD14 & toll-like 2.7) Bind lipopolysaccharide on pathogens and dying ce lls c) Complement 2.8) Bind opsonized pathogens on immune complexes d) Chemokine & cytokine 2.9) Bind Ig-coated pathogens e) C-lectin Match the respiratory burs t enzyme with the resulting molecule: 3.1) NADPH oxidase a) HOCl 3.2) Myeloperox idase b) Nitric oxide 3.3) Nitric oxide synthetase c) H2O2 3.4) A 4-year-old boy presents with chronic granulomatous disease (CGD), confirmed with a nitro blue tetrazolium (NBT) test. Which of the following pathogens could this child still mount a defense against? a) Staphylococcus b) Enterobacteria c) Aspergillus d) S treptococcus e) Pseudomonas 4.1) What is the primary response seen in acute-phas e responses to infection? a) Decreased blood pH b) Decreased metabolic pH c) Inc reased body temperature d) Increased heart rate e) Decreased blood pressure 4.2) Which of the following is a chemoattractant that attracts neutrophils to the si te of infection? a) IL-1 b) IL-6 c) IL-7 d) IL-12 e) TNF f) A, B, & C 4.3) Which of the following alerts the adaptive immune system to the presence of infection ? a) IL-1 b) IL-6 c) IL-8 d) IL-12 e) TNF f) A, B, & E 4.4) Which of the followi ng are secreted by macrophages after they have recognized pathogens using patter n recognition molecules (induction phase)? a) IL-1 b) IL-6 c) IL-7 d) IL-12 e) T NF Version: 16Oct2008 Page 40 of 50

Immunology Quiz f) A, B, & E 5.1) Which of the following are early clinical signs of (septic) sh ock? a) Hypertension and bradycardia b) Hypotension and bradycardia c) Hypertens ion and tachycardia d) Hypotension and tachycardia 5.2) Most cases of septic sho ck are caused by gram ____ organisms with the ____ acting as the endotoxin in th e disease. a) Positive; Lipopolysaccharide (LPS) b) Negative; Lipopolysaccharide (LPS) c) Positive; Capsule d) Negative; Capsule 5.3) ____ shock syndrome is med iated by cytokines secreted from ____ cells. a) Septic; B b) Septic; T c) Toxic; B d) Toxic; T 21 Killing in the Immune System 1) Parasitic worm eggs are resist ant to low pH and proteolytic digestion in the stomach. Adult worms living insid e the lower gut are protected from many of the components of the immune response . Mast cells respond to worms. What immunoglobulin activates these mast cells, l eading to degranulation? a) IgA b) IgD c) IgE d) IgG e) IgM Match the descriptio n with the pre-stored granular chemical mediator: 2.1) Increases vascular permea bility a) Trypase & Chemotrypsin 2.2) Increase mucus secretion and smooth muscle contraction b) Histamine 2.3) Enhance diapedesis and stimulate TH2 responses c) Cytokines/IL-4 2.4) Activates TH2 and stimulates eosinophil production d) Cytok ines/TNF 2.5) Mast cell arachidonic acid metabolites include cyclo-oxygenase, wh ich produces prostaglandins that stimulate ____ and increase ____ of smooth musc le in the gut and bronchi. Metabolites also include leukotrienes, which have a _ ___ effect than prostaglandins. a) Vasoconstriction; Constriction; Slower b) Vas oconstriction; Constriction; Faster c) Vasodilation; Dilation; Slower d) Vasodil ation; Dilation; Faster e) Vasodilation; Constriction; Slower f) Vasodilation; C onstriction; Faster 2.6) Which of the following would NOT act initially during m ast cell (or basophil) activation? a) Trypase Version: 16Oct2008 Page 41 of 50

Immunology Quiz b) Chemotrypsin c) Histamine d) Prostaglandins e) Leukotrienes 3) Which of the f ollowing is NOT true regarding eosinophils? a) They are specifically recruited t o tissues during some types of inflammation b) Their granules contain particular ly toxic substances c) Their production is stimulated by IL-3 and IL-5 d) They a re recruited to parasite infected sites by chemokine eotaxin e) They are a major acidic and anionic protein 4.1) Natural killer (NK) cells are excellent killers of cells infected by some ____. They also have an additional role of stimulatin g the ____ immune response. a) Bacteria; Adaptive b) Viruses; Adaptive c) Bacter ia; Innate d) Viruses; Innate 4.2) Antibody-dependent cellular cytotoxicity (ADC C) is the process by which natural killer cells destroy infected cells, identifi ed by what immunoglobulin on the surface? a) IgA b) IgD c) IgE d) IgG e) IgM 4.3 ) Natural killer cells are thought to fill the gap between initial innate respon se and adaptive immune response. They evolved to detect low levels of MHC caused by the diseases of ____ and ____. a) Staph bacteria; Strep bacteria b) Catalase positive bacteria; Helminths (worms) c) Herpes virus; Tumor cells d) Influenza virus; Rabies virus e) Leprosy; Gonorrhea bacteria 4.4) Natural killer cell rece ptors NKG2/CD94 and killer inhibitory receptors allow for the killing of antibod ies in the presence of: a) MHC class I b) MHC class II c) Both MHC class I and I I d) Either MHC class I or II e) Neither MHC class I nor II Match the descriptio n with the cytotoxic T cell (CTL) killing mechanism: 5.1) Potent inducer of apop tosis a) Perforin 5.2) Degrade host cell proteins, activate caspase enzyme syste m b) Granzyme 5.3) Forms a pore in the target cell membrane (like MAC) c) Fas li gand 24 Infections and Vaccines 1) Vaccines (natural exposure) is considered act ive immunotherapy and leads to the development of immunologic memory. Version: 16Oct2008 Page 42 of 50

Immunology Quiz a) True b) False 2.1) Which of the following is NOT true about live vaccines? a) They were the first vaccines to be discovered b) They are currently the least e ffective vaccines c) They replicate and thus deliver sustained doses of antigen d) They deliver antigenic peptides to MHC class I e) They replicate at the infec tion site, focusing immune response 2.2) Which of the following live vaccines is recommended for children but not adults? a) Poliovirus b) Measles, mumps, rubel la (MMR) c) Varicella d) Meningococcal e) Influenza 2.3) Which of the following live vaccines is recommended for adults but not children? a) Poliovirus b) Measl es, mumps, rubella (MMR) c) Varicella d) Meningococcal e) Influenza 3) Killed va ccines are theoretically much safer than live vaccines, but cannot replicate in hosts and cannot enter intracellular antigen presenting pathways. Which of the f ollowing killed vaccines is recommended for children but not adults? a) Hepatiti s A b) Influenza c) Inactivated poliovirus 4.1) Subunit vaccines contains compon ents from pathogens, which are inactivated and referred to as ____. These vaccin es are generally of low immunogenicity and may need ____ to work effectively. a) Cytokines; IgE b) LPS; Live vaccination c) Capsules; Homeostasis d) Toxoids; Ad juvants e) Antigens; B & T cells 4.2) Which of the following subunit vaccines is recommended for children but not adults? a) Pneumonococcal (PCV) b) Haemophilus influenzae type B c) Hepatitis B d) Diptheria, tetanus, pertussis 5.1) DNA vacc ines (tested in mice) use the gene for the immunogenic protein and coat it with what element, which is injected into cells and results in antibody production? a ) Tin b) Zinc c) Copper d) Gold e) Silver Version: 16Oct2008 Page 43 of 50

Immunology Quiz f) Lead 5.2) Immunostimulatory complexes (ISCOMS) can be used for mucosal vaccin es and induce widespread mucosal immunity in the gut and respiratory tract. They are the one way that ____ response can be promoted. a) B cell b) Helper T cell c) Cytotoxic T cell d) Eosinophil e) Macrophate 5.3) Which of the following is N OT true regarding live viral vectored vaccines? a) They require strong adjuvants b) They are economical to produce c) They can be delivered through needle-free methods d) They induce a broad and long-lasting immune response e) They induce b oth cellular and humoral immunity f) Adenovirus vectors are a good choice to use for vaccines 6) Pathogens can evade the immune system through antigenic drift, which is a ____ mutation that leaves existing antibodies ____, and antigenic shi ft, which is a ____ mutation that leaves existing antibodies ____. a) Minor; Par tially effective; Major; Ineffective b) Minor; Ineffective; Major; Partially eff ective c) Major; Partially effective; Minor; Ineffective d) Major; Ineffective; Minor; Partially effective 31 Primary Immunodeficiency Diseases 1.1) Which of th e following diseases occurs with the absence of a thymus? a) DiGeorges syndrome b ) Severe combined immunodeficiency disease (SCID) c) Chronic granulomatous disea se (CGD) d) Bare lymphocyte syndrome (BLS) e) Wiskott Aldrich syndrome (WAS) 1.2 ) Which of the following diseases affect neutrophils? a) DiGeorges syndrome b) Se vere combined immunodeficiency disease (SCID) c) Chronic granulomatous disease ( CGD) d) Bare lymphocyte syndrome (BLS) e) Wiskott Aldrich syndrome (WAS) 1.3) Wh ich of the following diseases affects mature T cells? a) DiGeorges syndrome b) Se vere combined immunodeficiency disease (SCID) c) Chronic granulomatous disease ( CGD) d) Bare lymphocyte syndrome (BLS) e) Wiskott-Aldrich syndrome (WAS) 1.4) A child presents with a maculopapular rash on the extremities and trunk. Petechiae is found on the trunk and mucous membranes. Lab tests show a Neisseria infectio n and the Version: 16Oct2008 Page 44 of 50

Immunology Quiz physician is concerned about meningococcemia. Which of the following is the most likely? a) C3 deficiency b) C5-C9 deficiency c) Leukocyte adhesion deficiency ( LAD) d) Hyper IgM syndrome (HIM) e) Selective IgA deficiency 1.5) A patient in t heir early 20s presents with recurrent bacterial infections. Lab work shows B ce lls in the periphery as well as low immunoglobulin levels. History shows immunog lobulin levels have decreased with age. Which of the following is the most likel y? a) Myeloperoxidase deficiency b) DiGeorges syndrome c) X-linked agammaglobulin emia d) Wiskott-Aldrich syndrome (WAS) e) Common variable immunodeficiency 1.6) A child presents with recurrent infections with bacteria, fungi, and viruses. Th e resident asks the attending physician about IL-2R chain mutations, as the pati ent is a male. The attending physician makes a diagnosis and begins writing orde rs for bone marrow transplantation and possible gene therapy. Which of the follo wing does the patient have? a) Ataxia telangiectasia b) Wiscott-Aldrich syndrome (WAS) c) Hereditary angioedema d) Severe combined immunodeficiency disease (SCI D) e) C3 deficiency 1.7) A young child presents with cervical adenitis and gingi vostomatitis. History reveals recurrent pyogenic infections. Tests are done to d etermine leukocytosis and the presence of cell adhesion molecules. Which of the following is the most likely? a) C3 deficiency b) Wiscott-Aldrich syndrome (WAS) c) Leukocyte adhesion deficiency (LAD) d) Hyper IgM syndrome (HIM) e) Selective IgA deficiency 1.8) A patient presents in the winter months with swollen lips. The patient says they forgot their lip balm. Uncontrolled activation of the clas sical complement pathway is responsible for the swelling. Records show the patie nt has a C1inh deficiency. Which of the following does this patient have? a) C5C9 deficiency b) Glucose-6-phosphate dehydrogenase deficiency c) Hereditary angi oedema d) Severe combined immunodeficiency disease (SCID) e) C3 deficiency 1.9) An infant presents with recurrent bacterial infections and partial albinism. Lab work reveals giant granules and neutropenia. Which of the following is the most likely? a) DiGeorges syndrome Version: 16Oct2008 Page 45 of 50

Immunology Quiz b) Chediak-Higashi disorder c) Chronic granulomatous disease (CGD) d) Bare lymph ocyte syndrome (BLS) e) Myeloperoxidase deficiency 1.10) A male patient presents with severe and recurrent bacterial infections. Lab work confirms the patient i s only infected with certain bacteria due to a mutation in a gene for NADPH oxid ase. Which of the following is the most likely? a) DiGeorges syndrome b) ChediakHigashi disorder c) Bare lymphocyte syndrome (BLS) d) Wiskott-Aldrich syndrome ( WAS) e) Chronic granulomatous disease (CGD) 1.11) A 6-year-old presents with the appearance of being intoxicated while walking. Opthlamoscopic findings reveal b roken capillaries in the sclera of the eye. Lab work reveals IgA deficiency. Whi ch of the following is the most likely? a) Ataxia telangiectasia b) Wiscott-Aldr ich syndrome (WAS) c) Hereditary angioedema d) Myeloperoxidase deficiency e) C3 deficiency 1.12) A male infant presents with a triad of symptoms including throm bocytopenia, eczema, and immunodeficiency. Which of the following is the most li kely? a) Transient hypogammaglobulinemia of infancy b) Wiscott-Aldrich syndrome (WAS) c) Hereditary angioedema d) Selective IgA deficiency e) Hyper IgM deficien cy 1.13) A young patient presents with severe infections from encapsulated bacte ria and collagen vascular disease. Lab work confirms a diagnosis via CH50 and AP 50. Which of the following is the most likely? a) Transient hypogammaglobulinemi a of infancy b) Wiscott-Aldrich syndrome (WAS) c) Paroxysmal nocturnal hemoglobi nuria (PNH) d) Selective IgA deficiency e) C3 deficiency 1.14) An infant present s with recurrent infections with Candida and viruses. Cardiac abnormalities resu lt in the patient requiring heart surgery. During surgery, no thymus is found. W hich of the following is the most likely? a) DiGeorges syndrome b) Chediak-Higash i disorder c) Bare lymphocyte syndrome (BLS) d) Wiskott-Aldrich syndrome (WAS) e ) Chronic granulomatous disease (CGD) 1.15) A patient presents for a follow-up v isit after a diagnosis of systemic lupus erythematosus (SLE). The physician susp ects a misdiagnosis after finding immune Version: 16Oct2008 Page 46 of 50

Immunology Quiz complexes accumulated in the blood, lymph, and tissues. Which of the following i s the most likely? a) C3 deficiency b) C5-C9 deficiency c) Early complement defi ciency d) Hyper IgM syndrome (HIM) e) Selective IgA deficiency 1.16) A patient p resents with complaints of dark urine in the morning that clears up partially du ring the day. Lab work reveals hemolytic anemia, thrombosis in large vessels, an d a deficiency in Hematopoiesis. Which of the following is the most likely? a) T ransient hypogammaglobulinemia of infancy b) Wiscott-Aldrich syndrome (WAS) c) S elective IgA deficiency d) Paroxysmal nocturnal hemoglobinuria (PNH) e) ChediakHigashi disorder 1.17) A patient presents with symptoms similar to chronic granu lomatous disease (CGD). It is found that there is a problem with generation of N ADPH. Which of the following is the most likely? a) C5-C9 deficiency b) Glucose6-phosphate dehydrogenase deficiency c) Myeloperoxidase deficiency d) Severe com bined immunodeficiency disease (SCID) e) C3 deficiency 1.18) A patient is being seen for recurrent infections. However, the patient does not seem to think anyth ing special of these infections and there has been no previous diagnosis other t han the infections. Lab work reveals abnormalities with hypochlorous acid and H2 O2 conversion. Which of the following is the most likely? a) Ataxia telangiectas ia b) Wiscott-Aldrich syndrome (WAS) c) Hereditary angioedema d) Myeloperoxidase deficiency e) C3 deficiency 1.19) A patient presents at age 6-months with pneum onia and difficulty fighting off infections of encapsulated bacteria and enterov iruses. A mutation in Brutons tyrosine kinase (btk) is suspected. Which of the fo llowing is the most likely? a) Myeloperoxidase deficiency b) DiGeorges syndrome c ) X-linked agammaglobulinemia d) Wiskott-Aldrich syndrome (WAS) e) Common variab le immunodeficiency 1.20) A male infant presents with decreased levels of IgA, I gG, and IgE. History reveals recurrent bacterial infections and severe diarrhea. A mutation on CD40L (CD154) on T cells is suspected. Which of the following is the most likely? a) Bare lymphocyte syndrome (BLS) b) C5-C9 deficiency c) Early complement deficiency Version: 16Oct2008 Page 47 of 50

Immunology Quiz d) Hyper IgM syndrome (HIM) e) Selective IgA deficiency 1.21) A patient presents at 3-years-old for a follow-up visit. At age 6-months, the patient had a delaye d onset of synthesis of an immunoglobulin. At this visit, the mother reports tha t the recurrent respiratory infections have stopped due to antibiotics and globu lin replacement. Which of the following was the most likely for this patient? a) Transient hypogammaglobulinemia of infancy b) Wiscott-Aldrich syndrome (WAS) c) Paroxysmal nocturnal hemoglobinuria (PNH) d) Selective IgA deficiency e) C3 def iciency 1.22) Which of the following is often asymptomatic to presenting with an increased incidence of respiratory tract infections and is the most common immu nodeficiency disease? a) C3 deficiency b) C5-C9 deficiency c) Early complement d eficiency d) Hyper IgM syndrome (HIM) e) Selective IgA deficiency 1.23) A patien t presents with symptoms similar to DiGeorges syndrome. It is determined that the patients TH cells are unable to develop. Which of the following is the most like y? a) Leukocyte adhesion deficiency (LAD) b) Chediak-Higashi disorder c) Bare ly mphocyte syndrome (BLS) d) Wiskott-Aldrich syndrome (WAS) e) Chronic granulomato us disease (CGD) Version: 16Oct2008 Page 48 of 50

Immunology AnswerKey Imm #1 1.1) C 1.2) C 1.3) E 1.4) D 1.5) A 1.6) B 1.7) A 1.8 ) C 1.9) D 1.10) D 1.11) E Imm #2 1) C 2) E 3.1) B 3.2) E 3.3) D 4.1) A 4.2) E 4 .3) C 4.4) E 5) B 6) C 7.1) C 7.2) A 7.3) D 7.4) B 7.5) E 7.6) B 7.7) D 7.8) B 7 .9) C 7.10) A 8) B 9.1) B 9.2) C 9.3) A 9.4) C 10.1) B 10.2) C 10.3) A Imm #3 1. 1) C 1.2) B 2.1) B 2.2) A 2.3) C 2.4) D 2.5) A 2.6) C 3.1) D 3.2) E 3.3) B 4.1) A 4.2) B 5.1) D 5.2) D Imm #4 1) C 2) D 3) D 4) A 5) D 6) E 7.1) B 7.2) A 7.3) D 8) B 9) C 10.1) E 10.2) C 10.3) D 10.4) A 10.5) B 10.6) D 11.1) D 11.2) B 11.3) C 11.4) E 11.5) A 11.6) A 11.7) C 11.8) E 11.9) A 11.10) C 11.11) B Imm #5 1) E 2.1) B 2.2) C 3.1) C 3.2) A 3.3) D 3.4) B 3.5) A 3.6) E 3.7) E 3.8) B 3.9) D Im m #6 1.1) D 1.2) C 2.1) C 2.2) A 2.3) E 2.4) A 3) D 4) C 5.1) B 5.2) E 5.3) C 6) B 7) E Imm #7 1.1) C 1.2) C 2.1) D 2.2) B 3.1) E 3.2) E 3.3) B 3.4) C 3.5) D 4) C 5.1) C 5.2) B 6.1) B 6.2) A 7.1) B 7.2) E 7.3) D 8.1) D 8.2) B 9.1) B 9.2) D 9.3) A 9.4) C 9.5) E 9.6) C 9.7) C 9.8) E Imm #8 1.1) E 1.2) C 1.3) E 1.4) F 1.5 ) E 2.1) D 2.2) D 3.1) C 3.2) A 3.3) C 4) D 5.1) A 5.2) E 5.3) D 5.4) C 5.5) B 5 .6) B 5.7) D Imm #9 1.1) A 1.2) B 1.3) C 1.4) A 1.5) A 1.6) E Imm #10 1) B 2.1) E 2.2) C 3.1) C 3.2) D 4.1) C 4.2) A 5) C 6.1) C 6.2) B 6.3) A Quiz Imm #11 1.1) C 1.2) D 1.3) A 2) B 3.1) B 3.2) C 3.3) A 4.1) D 4.2) D 5.1) C 5.2) E Imm #12 1.1) B 1.2) B 1.3) C 1.4) A 2) H 3) B 4.1) C 4.2) G 4.3) E 4.4) B 4.5 ) F 4.6) H 4.7) A 4.8) D 5) C 6.1) A 6.2) D 6.3) E Imm #13 1.1) E 1.2) B 2) D 3. 1) B 3.2) A Version: 16Oct2008 Page 49 of 50

Immunology 3.3) D 4.1) E 4.2) C 4.3) B 4.4) A 5.1) D 5.2) C 5.3) A 6) B 7) D 8.1 ) B 8.2) C 9.1) E 9.2) B Imm #14 1.1) D 1.2) B 2) A 3.1) A 3.2) C 3.3) B 3.4) D 4) A 5) E 6) D 7.1) E 7.2) C 8) C 9) F 10) C 11.1) B 11.2) C 12) B Imm #15 1.1) C 1.2) A 2.1) D 2.2) B 2.3) C 3.1) B 3.2) E 4.1) A 4.2) B 5) A 6) E 7) F 8.1) C 8.2) B 8.3) A 9) C 10.1) C 10.2) C Imm #16 1) E 2.1) A 2.2) B 3.1) C 3.2) D 4) C 5) E 6.1) C 6.2) B Imm #17 1) E 2.1) D 2.2) C 2.3) B 2.4) C 3) C Imm #18 1.1) A 1.2) B 1.3) A 1.4) A Imm #19 1.1) A 1.2) E 2.1) C 2.2) F 2.3) D 2.4) B 2.4) A 2 .6) E 3.1) C 3.2) D 3.3) C 4.1) E 4.2) A 4.3) C 4.4) C 4.5) B 5.1) D 5.2) B 5.3) E 6) C 7.1) A 7.2) D Imm #20 1.1) B 1.2) B 1.3) A 1.4) D 2.1) B 2.2) A 2.3) D 2 .4) C 2.5) E 2.6) D 2.7) B 2.8) C 2.9) A 3.1) C 3.2) A 3.3) B 3.4) D 4.1) C 4.2) B 4.3) D 4.4) F 5.1) D 5.2) B 5.3) D Imm #21 1) C 2.1) B 2.2) A 2.3) D 2.4) C 2 .5) E 2.6) E 3) E 4.1) B 4.2) D 4.3) C 4.4) D 5.1) C 5.2) B 5.3) A Imm #24 1) A 2.1) B 2.2) A 2.3) D 3) C 4.1) D 4.2) B 5.1) D 5.2) C 5.3) A 6) A Imm #31 1.1) A 1.2) C 1.3) D 1.4) B 1.5) E 1.6) D 1.7) C 1.8) C 1.9) B 1.10) E 1.11) A 1.12) B 1.13) E 1.14) A 1.15) C 1.16) D 1.17) B 1.18) D 1.19) C 1.20) D 1.21) A 1.22) E 1.23) C Quiz Quiz by: James Lamberg Version: 16Oct2008 Page 50 of 50