Immunology Module 2

The three cytokines listed below are involved in a specific role in the immune system:

• interleukin 4
• interleukin 5
• interleukin 13

Which one of the following best describes this role?

The following are known causes of elevated IgE except?

Which of the following pathogen associated molecular patterns (PAMPs) is expressed by gram negative bacteria?

Which of the following cells of the immune system is the first to deal with a pathogen that have crossed the epithelial barrier?

Which of the following interactions will lead to septic shock in gram negative sepsis?

Which one of the following cell surface molecules, if subject to genetically determined variation, is capable of conferring the greatest resistance to Human Immunodeficiency Virus (HIV) infection?

Which one of the following cells of the immune system is most reliant on its release of mediators into the extracellular fluid surrounding the organism in order to carry out its role in eradication of foreign organisms?

A six-year-old boy is referred with a history of atopic eczema, chronic sinusitis, recurrent otitis media and two past admissions for bacterial pneumonia. He has had nine courses of antibiotics prescribed in the past year.

On examination he is on the third percentile for weight and height.

He has no significant lymphadenopathy, normal tonsillar tissue and his spleen tip is palpable. There is moderate flexural eczema.

Laboratory tests include:

• Haemoglobin (Hb) 152 g/L [115 – 150 g/L]
• Platelets 130 x 109/L [150 – 450 x 109/L]
• White Cell Count (WCC) 9.1 x 109/L [1.2 – 8.0 x 109/L]
• Neutrophils 4.3 x 109/L [0.5 – 7.0 x 109/L]
• Lymphocytes 1.9 x 109/L [2.7 – 12.0 x 109/L]
  Eosinophils 2.0 x 109/L [0.0 – 1.0 x 109/L]
• IgG 3.4 g/L [7.7 – 11.2 g/L]
• IgA 0.5 [1 -35 g/L]
• IgM 0.1 g/L [0.5 – 1.5 g/L]
• IgE 450 KU/L [0 – 250 KU/L]

The most likely diagnosis is:

Which of the following immunodeficiency disorder is associated with a near absence of CD19+ B cells?

Which of the following disorder is primarily a T-cell immunodeficiency?

Which of the following is the main molecular defect in X-linked severe combined immunodeficiency (SCID)?

Recurrent infections with which of the following organisms is most characteristic of a disorder of neutrophil phagocytic function (such as chronic granulomatous disease)?

A 13-month-old boy presented with a three-week history of daily fevers and persistent mouth ulcers, and two days of vomiting and diarrhoea. On examination he was miserable, febrile to 38.9C and drooling. The gingiva were red and friable with multiple shallow grey-coloured ulcers which did not involve the lips, palate or pharynx. He had multiple small cervical lymph nodes.

Initial investigations revealed:

• haemoglobin 89 g/L [95-140]
• white cell count 11.3 x 109/L [5.0-17.0]
• neutrophils 0.2 x 109/L [1.0-8.0]
• lymphocytes 9 x 109/L [2-13]
• platelet count 614 x 109/L [150-500]
• ESR 7 mm/hr [2-20]
• urine culture negative
• blood culture negative

The ulcers were swabbed for viral culture, but no virus was isolated.

The fever, vomiting and diarrhoea settled within three days, the mouth ulcers had healed after six days and the neutrophil count returned to normal after 10 days.

A diagnosis of probable herpes simplex virus infection associated with viral-induced neutropenia was made.

He re-presents two weeks later with a fever and erythema and swelling of the right eye, secondary to preseptal cellulitis.

Serum immunoglobulin levels are as follow:

• IgG: Low (significantly below the normal range for age)
• IgA: Undetectable
• IgM: Elevated (above the normal range for age)

Antibodies to tetanus, diphtheria and Haemophilus influenzae type B are not detected despite his immunisations being up-to-date. T and B cell numbers are normal and T cell proliferation in response to concanavalin A is normal. Flow cytometry demonstrates the absence of CD40 ligand on activated T cells.

This pattern of immunodeficiency fits best with:

Interleukin-1 (IL-1) is produced by which of the following cell types?

Which of the following cytokine is responsible for hyperalgesia (increased sensitivity to pain)?

Which of the following member in the NOD-like receptor group is responsible for the acute inflammation seen in gout?

The large granular lymphocytes observed in the early cellular response to virus infected cells are most likely to be:

Failure of signalling through the interleukin 7 receptor (IL-7 R), due to inherited deficiency of either the common interleukin receptor γ chain (γc) or Janus kinase 3 (JAK3 protein kinase), produces a severe combined immune deficiency (SCID) state, the features of which are best explained by the loss of expansion of which one of the following cell types?

Which one of the following cell surface molecules is not as important in the regulation of natural killer (NK) cell function?

Which of the following processes occurs only during the antigen-dependent phase of B cell development?

In the development of B cells, which of the following event correlates best with the Pro B cell stage of development?

A schematic diagram of the immunoglobulin G (IgG) molecule is shown above. The circled area best represents the:

Which of the following antibody is the first to be released upon exposure to a pathogen?

Which of the following component of bacterial antigen is NOT a T cell independent antigen?

Which of the following Cluster of Differentiation is a marker of mature B-cell?

Which of the following immunoglobulins binds with low affinity and high avidity when exposed to antigen?

A 20 year old man is found to have low levels of mannose binding lectin (MBL).

Which of the following will be the most likely complication?

Dendritic cells are superb at carrying out which type of immune function?

Which one of the following effects of the complement system is least important in the control of infection with gram-positive pyogenic bacteria?