John is having a very bad week and was just diagnosed with COVID-19. He just found out that viruses like COVID enter into the cells of the body, but often are not the actual reason for cell death– one of our own immune cells is. Which is not true about this type of innate immune cell?

Elevation of which type of cell is most distinctly characteristic of acute inflammation?

Leah is reviewing immuno for Step 1 and has realized that she forgot all about complement… oops! She’s confused how Factor H stops the normally-constitutive alternative pathway from killing everything. What should you tell her? Choose all that apply.

What complement component is considered essential for allowing B cells to be more easily activated?

A 36 y/o female patient presents with the primary complaints of joint pain and blood in the urine. You notice a rash spanning over the patient’s cheeks and nose and she asserts that this is common for her within the past few years, especially after being in the sun. What lab finding would be least consistent with her most likely diagnosis?

A 17 y/o patient presents with the primary concern of frequent random swelling, especially of the face, that usually subsides after a day or two. It is discovered that she has a disease of the complement system. What is the correct pairing of the gene and molecule likely responsible for these symptoms?

Which cytokine listed below does not use the common gamma chain often credited for SCID diagnoses?

Which of the following cytokines is most frequently targeted in inflammatory diseases such as Rheumatoid Arthritis or IBD?

A patient with an autoimmune disorder comes in for an ANA antibody titer, hoping for good news. 6 months ago, her titer was 1:160. What would be the best possible result to suggest improvement of her disease?

Which of the following vaccines is safest to administer to an immunocompromised patient?

A 5 year-old patient presents to the ED with pneumonia. He has a history of recurrent bronchitis, thrush, diarrhea, and ear infections. Family history is pertinent for a maternal uncle dying at a young age from a severe infection. On physical exam, the patient is febrile, short of breath, and has a productive cough. A mutation in what gene is responsible for this patient’s condition?

A 7-year old patient presents with recurrent respiratory infections, chronic bronchitis, and pulmonary fibrosis. A genetic test is run and the patient is found to have a mutation in the TAP gene. Which of the following cells is deficient in this patient?

A 5-month-old girl presents with a 2-week scalp rash, fever, diarrhea and decreased feeding. She has a history of 2 hospitalizations for omphalitis. Laboratory studies show a leukocyte count of 40,000. There is severely decreased or absent expression of which of the following?

Where in the body does negative selection of T-cells occur?

A 32-year-old man sustains a penetrating injury to his left eye while working with metal tools. Several weeks later, he develops blurred vision, photophobia, and pain in both eyes. Examination reveals bilateral granulomatous uveitis. Which of the following best explains the pathogenesis of his ocular findings?

A 58-year-old woman presents with progressive fatigue, paresthesias in her lower extremities, and a smooth, red tongue. Laboratory studies reveal a hemoglobin of 9.2 g/dL, mean corpuscular volume (MCV) of 112 fL, and undetectable serum vitamin B12. Her family history is notable for autoimmune thyroid disease in her mother. Which of the following best describes the pathogenesis of her condition?

Which of the following autoantibodies is most specific for the diagnosis of rheumatoid arthritis?

Which of the following autoantibodies is the most sensitive serologic marker for the diagnosis of systemic lupus erythematosus (SLE)?

A 45-year-old woman presents with progressive proximal muscle weakness and a violaceous, scaly rash over the dorsal aspects of her metacarpophalangeal and interphalangeal joints. She also has a violaceous discoloration with periorbital edema. Laboratory studies reveal elevated creatine kinase and aldolase. Which of the following findings is most specific for her diagnosis?

A 45-year-old woman presents with progressive skin thickening involving her trunk, upper arms, and thighs over the past 6 months. She reports Raynaud phenomenon, dysphagia, and new onset dyspnea on exertion. Physical examination reveals sclerodactyly, digital pitting scars, and diffuse induration of the skin above the elbows and knees. Pulmonary function testing demonstrates a restrictive pattern, and high-resolution CT of the chest shows interstitial lung disease. Laboratory studies reveal a positive antinuclear antibody (ANA) with a speckled pattern. Which autoantibody is most likely to be elevated in this patient?

A 5-year-old boy is brought to the clinic by his father because of coughing and difficulty breathing that began after playing in a field of newly cut hay. He has no history of major medical illness. He is afebrile, and his respirations are 30/min. His physical examination shows labored respirations, intercostal muscle retractions, a prolonged expiratory phase, and diffuse wheezes. Which of the following conditions has a mechanism most similar to the one most likely responsible for this patient’s findings?

A 56-year-old woman develops fever and decreased urine output 1 hour after receiving an unrelated-donor kidney transplant. Her blood type is B, Rh-positive. Records were reviewed and the donor was seen to have blood type A, Rh-negative. Which of the following best describes the mechanism of transplant rejection that is occurring in this patient?

A 48-year-old man with a transplanted kidney comes to the hospital because of body aches, low-grade fever, and reduced urine volume for the past 4 days. He underwent uncomplicated cadaveric kidney transplant 3 weeks ago. Urinalysis shows no bacteria or crystals. His serum creatinine is 2.8 mg/dL, increased from 1.7 mg/dL in the immediate postoperative period. A biopsy of the transplanted kidney is shown. Which of the following markers is most likely to be found on the surface of the cells that are causing the depicted damage to tubular cells?

A 68-year-old woman comes to the physician for a follow-up examination. Three months ago, she underwent heart transplantation for restrictive cardiomyopathy and was started on transplant rejection prophylaxis. Her pulse is 76/min and blood pressure is 148/82 mm Hg. Physical examination shows enlargement of the gum tissue. There is a well-healed scar on her chest. Serum studies show hyperlipidemia. The physician recommends removing a drug that decreases T cell activation by inhibiting the transcription of interleukin-2 from the patient's treatment regimen and replacing it with a different medication. What is the medication that you are wanting to replace?

Which child would be the best donor for the father? for the mother?

A 22-year-old man comes to the office with a rash, itchiness over his palms and soles, and diarrhea for 3 weeks. He recently received an allogeneic donor bone marrow transplant for treatment of his leukemia. On physical examination, a maculopapular rash is noted over his neck, shoulders, abdomen, palms, and soles (as shown in the photograph). Laboratory studies show aspartate aminotransferase of 432 U/L, alanine aminotransferase of 356 U/L, alkaline phosphatase of 400 U/L, and bilirubin of 3 mg/dL. Which of the following events likely led to the patient’s condition?

In preparation for a blood transfusion, ABO testing on whole blood from an uncharacterized donor and recipient is performed. In the five trials, the antibodies (anti-A, anti-B, anti-D) or RBCs (A or B type) are added separately to whole blood samples from a control B-positive subject (B+), the donor, and the recipient. Each whole blood sample is then observed for the presence of agglutination after addition of the antibodies. The results are shown in the chart. Which of the following pairs best represents the blood types for donor and recipient?

Which of the following transfusion reactions is NOT typically associated with fever?

Which types of cancer can be prevented with a vaccination? 

A 2-week-old male presents with recurrent fungal and viral infections. Physical exam reveals a small mandible, low-set ears, and congenital heart defects. Laboratory studies show profoundly decreased circulating T lymphocytes but normal B and NK cell numbers.

Which of the following best explains this immunodeficiency?

A 10-year-old boy presents with recurrent bacterial and viral infections. Genetic testing shows a mutation in the WAS gene, which encodes the actin cytoskeleton regulator. Which immunologic process is most directly impaired?

A patient develops chronic graft-versus-host disease after bone marrow transplantation. Flow cytometry reveals reduced CD4+CD25+FoxP3+ cells. Which mechanism best describes the normal function of these missing cells?

A 35-year-old man undergoes kidney transplantation. He is prescribed sirolimus to prevent rejection. Which step in T cell activation is most directly inhibited by this drug?

A 6-year-old boy has recurrent bacterial sinus and ear infections. Flow cytometry shows normal counts of T and B cells, but sequencing of his immunoglobulin genes reveals markedly reduced receptor diversity. Which enzyme defect best explains this finding?

A 12-year-old girl presents with recurrent sinopulmonary infections. Labs show elevated IgM but markedly reduced IgG, IgA, and IgE. Flow cytometry reveals normal B and T cell counts. Genetic testing shows a mutation in activation-induced cytidine deaminase (AID).

Which process is defective in this patient?

An investigator who is studying a particular primary immunodeficiency disorder performs lymph node biopsies on patients with this disorder and compares the findings with those of healthy subjects. A photomicrograph of the cross-section of the lymph node obtained from a healthy volunteer is shown. The investigator notes that the region indicated by the arrow is absent in patients affected by the immunodeficiency disorder. Which of the following processes most likely occurs in this region? ​

Stromal cells are important for the development of B-cells due to their secretion of __? treatment

Which of the following is true about large pre-B cells? ​

An activated B cell located in the spleen binds an antigen and is activated via cytokines from a nearby T cell. An enzyme is then expressed in the B cell, which causes random nucleotides to be changed in the B cell receptor variable region. Subsequent generations of daughter cells of this B cell develop progressively stronger binding to this antigen. Which of the following correctly describes this process?

A 30-year-old woman gives birth to a newborn with jaundice and anemia. The mother had one previous pregnancy, which resulted in no abnormalities. ​

Which of the following is the most likely cause of the newborn's condition?​

Which of the following is not a contraindication for breastfeeding?​