immunedermatology mcqs

8/11/2019 Immunedermatology MCQs

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The Epstein-Barr virus utilizes which cell surface receptor to gain access to cells?

1 CR2

2 B7

3 T-cell receptor

4 TLR7

5 MHC II

Q/Q(M)-482724 Report a Problem

The Epstein-Barr virus utilizes which cell surface receptor to gain access to cells?

1 CR2

EBV utilizes the CR2 receptor for cell entry and infection. the CR2 receptor (also known as CD21)

presents antigen to B cells and is a co-receptor for B cell signalling.


The classical complement pathway:

1 Can be activated in the absence of antibody

2 Can be activated by IgG4

3 Can be activated by IgM

4 Includes C3 and factor B

5 Does not cause membrane damage


The classical complement pathway:

3 Can be activated by IgM

The classical complement pathway is activated by antigen-antibody complexes, while the alternate

complement pathway can be activated in the absence of antibody. IgM and IgG are capable of

activating the classical pathway, but IgG4 does not activate complement. The proteins of the

classical pathway are C1, C2, C3, and C4. Factor B, Factor D, properdin, and C3 are proteins in the

alternate pathway. Biologic activities of complement include opsonization, chemotaxis, anaphylaxis,immune complex solubilization, membrage damage, and B cell activation.


Which paraprotein is found most commonly in patients with pyoderma gangrenosum?

1 IgG

2 IgA

3 IgM

4 IgE

5 IgD


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Which paraprotein is found most commonly in patients with pyoderma gangrenosum?

2 IgA

IgA paraproteinemia has been reported in over 10-18% of pyoderma gangrenosum.


Angiocentric NK/T-cell lymphoma in children may present as:

1 Papular acrodermatitis of childhood

2 Acropustulosis of infancy

3 Childhood dermatomyositis

4 Hydroa vacciniforme

5 En coup de sabre


Angiocentric NK/T-cell lymphoma in children may present as:

4 Hydroa vacciniforme

Hydroa vacciniforme a photodermatitis that typically occurs with sun exposure in the spring has

been reported with NK/T cell lymphomas in childhood. for answer


All of the following statements regarding Natural Killer (NK) cells are true EXCEPT:

1 NK cells have properties of innate and acquired immunity

2 NK cells express CD 2 molecules

3 NK cells are large granular lymphocytes

4 NK cells mediate tumor lysis

5 NK cells mediate lysis of viral-infected cells


All of the following statements regarding Natural Killer (NK) cells are true EXCEPT:

2 NK cells express CD 2 molecules

NK cells do not express CD 2 molecules. The other statements are true.


Herpes simplex virus-related erythema multiforme has been associated with an increased frequency

of:


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1 HLA-B7

2 HLA-B8

3 HLA-B13

4 HLA-B15

5 HLA-B27Q/Q(M)-474205 Report a Problem

Herpes simplex virus-related erythema multiforme has been associated with an increased frequency

of:

4 HLA-B15

Erythema multiforme associated with herpes simplex has been reported to have an increase of HLA-

B15.


Which cytokine is not upregulated in atopic dermatitis patients?

1 IL-13

2 IL-4

3 IL-5

4 IL-10

5 IFN-gamma


Which cytokine is not upregulated in atopic dermatitis patients?

5 IFN-gamma

Interferon gamma is Th1 cytokine which downregulates Th2 responses. The remaining are Th2

cytokines active in atopic dermatitis. IL-4 is a B-cell growth factor and active in signaling isotope

switching from IgM to IgE. IL-5 is an eosinophil growth factor. IL-10 downregulates Th1 immunity

and IL-13 signals isotope switching along with IL-4.Q/Q(M)-477687 Report a Problem

The most likely target for exfoliative toxin A in bullous impetigo is:

1 Desmoglein 3

2 Laminin 5

3 Desmoglein 1

4 Collagen VII

5 Cesmocollin


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The most likely target for exfoliative toxin A in bullous impetigo is:

3 Desmoglein 1

Desmoglein 1, the dominant target antigen of the autoantibody involved in pemphigus foliaceus, is

also the target of the exfoliative toxin of group II staphylococcus aureus that is usually responsiblefor bullous impetigo.


Pemphigus is associated with which HLA type(s)?

1 HLA-DRw6

2 HLA-B8

3 HLA-B51

4 All of these answers are correct

5 None of these answers are correct


Pemphigus is associated with which HLA type(s)?

1 HLA-DRw6

Pemphigus is associated with HLA-DR4 or DRw6.


All of the following statements are true regarding cells of the innate immune system EXCEPT:

1 Neutrophils have receptors for IgG

2 Basophils are a type of granulocyte, as are neutrophils

3 IL-5 downregulates the functions of eosinophils

4 Langerhans cells are poorly phagocytic

5 Langerhans cells express CD1 on their surfaceQ/Q(M)-476126 Report a Problem

All of the following statements are true regarding cells of the innate immune system EXCEPT:

3 IL-5 downregulates the functions of eosinophils

Neutrophils, eosinophils, and basophils are collectively known as granulocytes. Neutrophils have

receptors for IgG and complement. IL-5 enhances all functions of eosinophils. Langerhans cells are

dendritic cells found in high concentration in epithelial surfaces and some areas of lymph nodes and

spleen. They have a high density of class II MHC molecules and express CD1 on their surface. They

are poorly phagocytic.



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A 27 year old gentleman with a known history of chronic plaque psoriasis complains of pain and

stiffness of his joints, particularly in his hands. Which HLA subtype is associated with psoriatic

arthritis?

1 B27

2 Cw6

3 B17

4 B51

5 B8


A 27 year old gentleman with a known history of chronic plaque psoriasis complains of pain and

stiffness of his joints, particularly in his hands. Which HLA subtype is associated with psoriatic

arthritis?

1 B27

Psoriatic arthritis, as well as generalized psoriasis,is associated with HLA-B27. HLA-Cw6 is

associated with psoriasis, Bw35 with cutaneous lichen planus, B8 with oral lichen planus, and B51

with Behcet's disease.


MHC Class II molecules are present on which of the following cell types:

1 B cells

2 T cells

3 NK cells

4 Mast cells

5 All of the above


MHC Class II molecules are present on which of the following cell types:

1 B cells

MHC Class II molecules are on B cells, monocytes, dendritic cells, and are inducible on

keratinocytes and endothelial cells.


Linear IgA disease is most closely associated with which of the following medications?

1 Erythromycin

2 Vancomycin


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3 Streptomycin

4 Azithromycin

5 Clarithromycin


Linear IgA disease is most closely associated with which of the following medications?

2 Vancomycin

Vancomycin is an antibiotic frequently used in subjects allergic to penicillin. It has been reported to

produce subepidermal blistering disease with linear IgA deposits.


Allergic contact dermatitis is caused by T-cell response to topical exposure to compounds that form

complexes with host proteins (haptens). Which cell is responsible for initial sensitization of the T-

cells?

1 Melanocyte

2 Langerhans Cell

3 B-cell

4 Mast Cell

5 Macrophage


Allergic contact dermatitis is caused by T-cell response to topical exposure to compounds that form

complexes with host proteins (haptens). Which cell is responsible for initial sensitization of the T-

cells?

2 Langerhans Cell

The Langerhans cell phagocytizes the haptens in the epidermis or dermis, begins the process of

maturation and migrates to the regional lymph node, where nave T-cells are educated to expand toa clone of CLA positive memory T-cells. These cells then can expand and extravasate with

subsequent exposure to the same allergen. Melanocytes, B-cells, Mast cells and macrophages are not

involved in the sensitization process of allergic contact dermatitis.Q/Q(M)-477686 Report a Problem

This disease is most associated with:

1 Gamma interferon

2 IL-4

3 IL-5

4 IL-13


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This disease is most associated with:

1 Gamma interferon

The answer is gamma interferon, which is the TH1 cytokine associated with a hyperproliferative

epidermis and with micaceous scale as seen in psoriasis.Q/Q(M)-474881 Report a Problem

Histamine is a biologic amine produced by which of the following cells?

1 Monocytes

2 Eosinophils

3 Basophils

4 Platelets

5 Basophils and Platelets


Histamine is a biologic amine produced by which of the following cells?

5 Basophils and Platelets

In the skin, histamine is mainly contained within the granules of dermal mast cells. Histamine is

present in mast cells, basophils, and platelets.



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Relapsing polychondritis is an autoimmune disease associated with immunity to which type of

collagen?

1 I

2 II

3 III

4 IV

5 VII


Relapsing polychondritis is an autoimmune disease associated with immunity to which type of

collagen?

2 II

Relapsing polychondritis has been reported to have autoantibodies to type II collage.


A male infant presents with thrombocytopenia, eczema, and recurrent infections. You suspect which

of the following immunodeficiency disorders?

1 Ataxia telangiectasia

2 Di-George anomaly

3 Hyper-IgM syndrome

4 Leiners disease

5 Wiskott-Aldrich syndrome


A male infant presents with thrombocytopenia, eczema, and recurrent infections. You suspect whichof the following immunodeficiency disorders?

5 Wiskott-Aldrich syndrome

Wiskott-Aldrich syndrome is an X-linked recessive disorder that presents with thrombocytopenia,

small defective platelets, eczema, autoimmune disease, infections, and lymphoreticular malignancy.


Which cytokine is responsible for activating natural killer cells?

1 Interleukin 4

2 Interleukin 2


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3 Interferon-alpha

4 Terferon-gamma

5 Tumor necrosis factor-alpha


Which cytokine is responsible for activating natural killer cells?

2 Interleukin 2

Activation of natural killer cells occurs via interleukin 2 (IL-2). IL-2 is a key component of the Th1

(cell-mediated) immunity. It acts to promote growth, proliferation and activation of T cells, B cells

and natural killer cells.


Proteins in the alternate complement pathway include:

1 Factor B

2 properdin

3 C3

4 Factor B and properdin

5 Factor B, properdin and C3


Proteins in the alternate complement pathway include:

5 Factor B, properdin and C3

Proteins in the alternate complement pathway are Factor B, Factor D, properdin, and C3. The

alternate complement pathway is active against pathogenic microorganisms, virus-infected cells, and

neoplastic cells. The proteins of the classical pathway are C1, C2, C3, and C4.


Imiquimod has been used for many dermatologic conditions. It works by binding to toll-like receptor

7. What is the native ligand of TLR-7?

1 Single-stranded RNA

2 TNF-alpha

3 IL-10

4 IL-23

5 Interferon-alph



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Imiquimod has been used for many dermatologic conditions. It works by binding to toll-like receptor7. What is the native ligand of TLR-7?

1 Single-stranded RNA

Toll-like receptors are pattern recognition receptors involved in innate immunity. They are most

highly expressed on monocytes, dendritic cells, and B cells. Imiquimod works through binding to

toll-like receptor 7. The native ligand for TLR7 is single-stranded RNA.


A very common pentadecacatechol sensitizer is found in all of the following plants/plant

components except:

1 Gingko fruit pulp

2 Poison sumac

3 Mango fruit pulp

4 Cashew oil

5 Indian marking nut oleoresin


A very common pentadecacatechol sensitizer is found in all of the following plants/plant

components except:

3 Mango fruit pulp

The sensitizer in rhus dermatitis is a pentadecacatechol found in the oleoresin of anacardaciae plants,

including poison ivy/oak/sumac, mango rinds (but not pulp), cashew nutshells and oil, Indianmarking nut oleoresin, gingko fruit pulp, and Japanese lacquer tree oleoresin.


The gene for NEMO (NF-kappa bets essential modulator) is mutated in:

1 Papillon-Lefvre syndrome

2 Pachyonychia congenital type II

3 Dyskeratosis congenital

4 Noonans syndrome

5 Incontinentia pigmenti


The gene for NEMO (NF-kappa bets essential modulator) is mutated in:

5 Incontinentia pigmenti

NEMO/IKK gamma is an essential component of the nuclear factor kappa B pathway, which is a

common signaling pathway for many cytokines. Mutation in this pathway have been found to causeincontinentia pigmenti.


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Which of the following cytokines is primarily involved in activating eosinophils?

1 IL-5

2 TNF-alpha

3 IL-10

4 IL-2

5 Interferon-gamma


Which of the following cytokines is primarily involved in activating eosinophils?

1 IL-5

Eosinophils provide many functions of the immune system, including protection against helminths.

They are activated by IL-5.


Which of the following best describes the mechanism of action for infliximab?

1 Inhibition of calcineurin-mediated dephosphorylation of transcription factors

2 Inhibition of retinoic acid 4-hydroxylase activity

3 Inhibition of tumor necrosis factor alpha activity

4 Selective elimination of activated T cells via binding to high affinity IL-2 receptor

5 Selective T-cell up-regulation of IL-4 and IL-5 production


Which of the following best describes the mechanism of action for infliximab?

3 Inhibition of tumor necrosis factor alpha activityInfliximab is a monoclonal antibody given intravenously that binds to membrane-bound and soluble

TNF-alpha.


Efalizumab is an antibody which is directed against LFA1 on the T-cell, blocking this molecule's

interaction with:

1 CD40

2 B7

3 LFA3


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4 ICAM-1

5 P-selectin


Efalizumab is an antibody which is directed against LFA1 on the T-cell, blocking this molecule'sinteraction with:

4 ICAM-1

ICAM-1 on the antigen presenting cell interacts with LFA1 on the T-cell. By interrupting this

interaction, T-cell activation is blocked by preventing the pairing of LFA1 with ICAM-1. This

prevents costimulatory signals from being given to the T-cell. T-cell ability to traffic into the skin is

also inhibited in the arrest stage of trafficking.


A homeless patient presents with a scaling, pustular periorifical eruption around the mouth andgenitalia. What lab abnormality is associated with this condition?

1 Increased zinc level

2 Increased copper level

3 Decreased copper level

4 Decrease alkaline phosphatase level

5 Increased alkaline phosphatase level


A homeless patient presents with a scaling, pustular periorifical eruption around the mouth and

genitalia. What lab abnormality is associated with this condition?

4 Decrease alkaline phosphatase level

In a homeless patient with poor nutrition, acrodermatitis enteropathica due to zinc deficiency can

presents with a scaling eruption of the periorificial regions. In addition to a low zinc level, levels of

alkaline phosphatase, a zinc dependent enzyme, are decreased.


The elicitation of nickel contact dermatitis requires signaling by which of the following?

1 TLR2

2 TLR4

3 LFA-1

4 TNF-alpha

5 IL-4



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The elicitation of nickel contact dermatitis requires signaling by which of the following?

2 TLR4

Allergies to nickel (Ni(2+)) are the most frequent cause of contact hypersensitivity (CHS) in

industrialized countries. The efficient development of CHS requires both a T lymphocyte-specific

signal and a proinflammatory signal. Ni(2+) triggers an inflammatory response by directly activatinghuman Toll-like receptor 4 (TLR4). Studies with mutant TLR4 proteins revealed that the non-

conserved histidines 456 and 458 of human TLR4 are required for activation by Ni(2+) but not by

the natural ligand lipopolysaccharide.


What is the mechanism of action of Ipilimumab?

1 BRAF inhibitor

2 anti-CTLA 4 receptor antibody

3 blocks TNF alpha

4 inhibition of hedgehog signaling pathway

5 inhibits IL2


What is the mechanism of action of Ipilimumab?

2 anti-CTLA 4 receptor antibody

Ipilimumab is an anti-CTLA 4 receptor antibody. Side effects include rash and coitis. Vemurafenib

is a BRAF inhibitor specifically for patients with V600E mutation. Vismodegib inhibits the

hedgehog signaling pathway.


Which monoclonal gammopathy is most commonly associated with erythema elevatum diutinum?

1 IgA

2 IgD

3 IgE

4 IgG

5 IgM


Which monoclonal gammopathy is most commonly associated with erythema elevatum diutinum?

1 IgAA report of 13 patients indicated IgA is most commonly associated with EED.


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T-cell anergy occurs if:

1 Stimulation by a MHC Class III molecule is involved

2 MHC/TCR engagement occurs without costimulatory molecules

3 FasL is bound on the T-cell

4 MHC Class I or II is bound in the presence of IL-2

5 A HLA-DM facilitator is not involved with the binding


T-cell anergy occurs if:

2 MHC/TCR engagement occurs without costimulatory molecules

MHC/TCR engagement occurs without costimulatory molecules. MHC Class III molecules are not

involved in this process. The MHC III region encodes for soluble proteins of the complement

cascade and the tumor necrosis family. Fas-FasL interactions promote apoptosis on the target cell,

not stimulation. IL-2 is a stimulatory molecule, produced by Th1 T-cells. It does not produce anergy.

HLA-DM facilitates loading of proteins processed by antigen presenting cells into the MHC class II

molecule before being brought to the cell surface.


The pharmacologic activity of tacrolimus includes:

1 Phosphorylation of NFAT (nuclear factor of transcription)

2 Binding and inhibition of NF kappa B

3 Inhibition of interleukin-1 gene transcription

4 Activation of calcineurin



The pharmacologic activity of tacrolimus includes:


Tacrolimus is a macrolide similar to cyclosporine and pimecrolimus (Elidel). Calcineurin is a

phosphatase that dephosphorylates subunit on NFAT (nuclear factor of activated T cells).


The most useful pair of immunohistochemical stains to distinguish between Dermatofibroma

protuberans (DFSP) and a fibrous histiocytoma would be:

1 Synaptophysin, chromogranin

2 CD34, factor XIIIa


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3 CD34, CD31

4 CD31, CD3

5 Vimentin, synaptophysin


The most useful pair of immunohistochemical stains to distinguish between Dermatofibroma

protuberans (DFSP) and a fibrous histiocytoma would be:

2 CD34, factor XIIIa

Dermatofibroma, the more common benign histiocytoma, is usually CD34 negative and factor XIIIa

positive. DFSP is usually CD34 positive and factor XIIIa negative.


Gene rearrangement analysis is usedful for determining:

1 Lymphocyte clonality in mycosis fungoides

2 Lymphocyte activity

3 Gene Function

4 Gene Mutations

5 T cell receptor status


Gene rearrangement analysis is usedful for determining:

1 Lymphocyte clonality in mycosis fungoides

Gene rearrangement studies are useful to detect clonality in antigen specific cell types (B cells, T

cells).


Immunocytomas are:

1 Low grade B-cell lymphomas

2 Aggressive B-cell lymphomas

3 Low grade T-cell lymphomas

4 Aggressive T-cell lymphomas

5 NK cell lymphomas


Immunocytomas are:

1 Low grade B-cell lymphomas


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These indolent tumors present as solitary or multiple nodules usually on the extremities. The cells

have been reported to have CD-20 (B cell marker) and have been reported to be bcl-2 positive.


Which component of the T cell receptor is associated with superantigen recognition?

1 D-beta

2 J-alpha

3 J-beta

4 V-alpha

5 V-beta


Which component of the T cell receptor is associated with superantigen recognition?

5 V-beta

Superantigens are able to bypass many elements of the normal immune response. They are not

processed by antigen presenting cells. Instead, they bind directly to the MHCII complex and interact

with T cells in a relatively non-specific fashion. Whereas conventional antigens require recognition

in all 5 elements of the T-cell receptor (V-alpha, J-alpha, V-beta, D-beta, J-beta), superantigens are

recognized by V-beta alone.


A 26 year-old man presents with a history of recurrent episodes of targetoid, erythematous,

edematous macules, patches, and plaques on the arms, legs, palms, and soles. The most likely

etiologic agent is:

1 Parvovirus B19

2 Herpes simplex virus

3 Coxsackievirus

4 Cytomegalovirus

5 Human immunodeficiency virus


A 26 year-old man presents with a history of recurrent episodes of targetoid, erythematous,

edematous macules, patches, and plaques on the arms, legs, palms, and soles. The most likely

etiologic agent is:

2 Herpes simplex virus

This description of the skin disorder is compatible with either erythema multiforme or erythema

elevatum diutinum, both of which have been reported in association with HSV.Q/Q(M)-474217 Report a Problem


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This woman should have a workup for:

1 Lymphoma

2 Nephrolithiasis

3 Pancreatic cancer4 Hemochromatosis

5 Thalassemia


This woman should have a workup for:

4 Hemochromatosis

Porphyria cutanea tarda has been shown to be associated with hemochromatosis. Patients with

porphyria cutanea tarda have mutations in the HFE gene, and early detection of mutations can

improve life expectancy for these patients.Q/Q(M)-475819 Report a Problem

Dermatitis herpetiformis is associated with which HLA type(s)?

1 HLA-B8

2 HLA-DR3

3 HLA-DQw2

4 All of the above

5 None of the above


Dermatitis herpetiformis is associated with which HLA type(s)?

4 All of the above

Dermatitis herpetiformis is associated with HLA-B8, -DR3, and -DQw2.



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This lesion is hypoesthetic and is associated with which of the following:

1 Gamma interferon

2 Interleukin 2

3 Interleukin 12




This lesion is hypoesthetic and is associated with which of the following:


The lesion is high immune or tuberculoid leprosy, which is associated with TH1 cytokines including

IFN-gamma, IL2, IL12, IL15, IL18 and IL23.


Which of the following is an example of a delayed hypersensitivity reaction?

1 Allergic contact dermatitis

2 Anaphylaxis

3 Latex allergy

4 Transfusion reaction

5 Serum sickness



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Which of the following is an example of a delayed hypersensitivity reaction?

1 Allergic contact dermatitis

There are 4 types of Hypersensitivities: ("ACID") Type I: Anaphylactic and Atopic: Examples -

Urticaria, Asthma, and Allergic Rhinitis Type II: cytotoxic: examples - Transfusion reactions, ABOincompatibility, Rh disease (erythroblastosis fetalis), Autoimmune reactions, Hemolytic disease of

newborn, Goodpasture's syndrome Type III: Immune complex, Serum sickness, and arthrus

reactions: examples -PAN, glomerulonephritis, SLE, Rheumatoid arthritis, and serum sickness Type

IV: Delayed (cell-mediated)typesL examples -TB skin test, transplant rejection, contact dermatitis,

interactions and skin repsonsiveness to bacteria, fungi, viruses, and protozoa, photo-allergies, insect

bites, etc


Dermatitis Herpetiformis is most commonly associated with which HLA?1 HLA-DR3

2 HLA-B27

3 HLA-B8

4 HLA-Bw35

5 HLA-DQ(A1*0501, B1*02)


Dermatitis Herpetiformis is most commonly associated with which HLA?

5 HLA-DQ(A1*0501, B1*02)

HLA-DQ (A1*0501, B1*02) genes are present on 90% of all patients with Dermatitis Herpetiformis.

The remainder of patients have the HLA-DQ8 gene. Other associations include: HLA-B8, HLA-

DR3 and DR5/DR7.


Which antibody can bind the FcER1 portion of mast cells, basophils, Langerhans cells, dermal

dendritic cells?

1 IgA

2 IgD

3 IgE

4 IgG

5 IgM



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Which antibody can bind the FcER1 portion of mast cells, basophils, Langerhans cells, dermaldendritic cells?

3 IgE

IgE is an anaphylactic antibody that is involved in nearly all immediate allergic and anaphylactic

type reactions and commonly seen in elevated levels in patients with atopic dermatitis. Mast cells,

basophils, Langerhans cells, dermal dendritic cells as well as monocytes from atopic individuals all

express high-affinity FcERI receptor which can bind IgE. More recently, it became clear that canbind monomeric IgE via the high-affinity FcRI IgG is the antibody that can cross the placenta andthe most common antibody found in circulation. IgA is found in mucous membrane secretions and is

able to agglutinate antigens and activate the alternate but not the classic complement pathway. IgD is

not found in circulation other than in hyper-IgD syndrome, an autosomal recessive disorder caused

by mutations in the mevalonate kinase gene. A significant elevation of serum IgD is seen in 95% of

these patients. IgM is the antibody produced in the early stages of antibody responses. It is a

pentamer which can agglutinate antigen and active the classic complement pathway.


Which of the following substances is located in the core of an eosinophil?

1 Eosinophilic cationic protein

2 Eosinophil-derived neurotoxin

3 Eosinophil peroxidase

4 Major basic protein

5 Chymase


Which of the following substances is located in the core of an eosinophil?

4 Major basic protein

Major basic protein is the only protein located in the core of an eosinophil. Eosinophil cationic

protein, eosinophil-derived neurotoxin, and eosinophil peroxidase are all located in the matrix.

Chymase is a mediator stored in granules of a mast cell.


Which of the following immunoglobulin crosses the placenta?

1 IgA

2 IgD

3 IgE

4 IgG

5 IgM


Which of the following immunoglobulin crosses the placenta?


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4 IgG

IgG is the antibody that can cross the placenta and the most common antibody found in circulation.

IgA is found in mucous membrane secretions and is able to agglutinate antigens and activate the

alternate but not the classic complement pathway. IgD is not found in circulation other than in

hyper-IgD syndrome, an autosomal recessive disorder caused by mutations in the mevalonate kinase

gene. A significant elevation of serum IgD is seen in 95% of these patients. IgE is an anaphylactic

antibody that is involved in nearly all immediate allergic and anaphylactic type reactions. IgM is theantibody produced in the early stages of antibody responses. It is a pentamer which can agglutinate

antigen and active the classic complement pathway.


Which antibody is most commonly found in circulation of patients with atopic dermatitis?

1 IgA

2 IgD

3 IgE

4 IgG

5 IgM


Which antibody is most commonly found in circulation of patients with atopic dermatitis?

3 IgE

IgE is an anaphylactic antibody that is involved in nearly all immediate allergic and anaphylactic

type reactions and commonly seen in elevated levels in patients with atopic dermatitis. Mast cells,

basophils, langerhans cells, dermal dendritic cells as well as monocytes from atopic individuals all

express high-affinity FcRI receptor which can bind IgE. More recently, it became clear that canbind monomeric IgE via the high-affinity FcRI IgG is the antibody that can cross the placenta andthe most common antibody found in circulation. IgA is found in mucous membrane secretions and is

able to agglutinate antigens and activate the alternate but not the classic complement pathway. IgD is

not found in circulation other than in hyper-IgD syndrome, an autosomal recessive disorder caused

by mutations in the mevalonate kinase gene. A significant elevation of serum IgD is seen in 95% of

these patients. IgM is the antibody produced in the early stages of antibody responses. It is a

pentamer which can agglutinate antigen and active the classic complement pathway.


Which of the following cytokines has been shown to be critical for epidermal acanthosis in

psoriasis?

1 TNF-alpha

2 TGF-beta

3 IL-2

4 FGF

5 IL-22


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Which of the following cytokines has been shown to be critical for epidermal acanthosis in

psoriasis?

5 IL-22

IL-22 has recently been shown to be critical in causing epidermal acanthosis. Interleukin (IL)-23, a

cytokine involved in the development of IL-17-producing T helper cells (Th17 cells), was found to

have a potential function in the pathogenesis of psoriasis. IL-22 is preferentially produced by Th17

cells and mediates the acanthosis induced by IL-23. IL-23 can directly induce the production of IL-

22 in human naive T cells. Furthermore, IL-22 mediates IL-23-induced acanthosis and dermal

inflammation through the activation of Stat3.


Which of the following is a criterion for the diagnosis of Behcet'sdisease?

1 Inflammatory bowel disease

2 Uveitis

3 Conjunctivitis

4 Nasal septal perforation

5 Lobular panniculitis


Which of the following is a criterion for the diagnosis of Behcet'sdisease?

2 Uveitis

Behcet's is a triad that includes oral ulcerations, genital ulcerations and uveitis. Behcet's also

displays arthritis and gastrointestinal disease. Blindness is the most-feared outcome, and relates to

the uveitis.


All of the following statements regarding major histocompatibility complex molecules are true

EXCEPT:1

MHC class II molecules bind stably to peptides derived from proteins sythesized and

degraded in the cytosol

2MHC class I molecules bearing viral peptides are recognized by cytotoxic T-cells that

subsequently kill the infected cell

3 Class I molecules such as HLA-A, B, and C, are present on all nucleated cells

4 The MHC is located on chromosome 6 in humans

5 MHC Class II molecules bearing peptides are recognized by TH1 or TH2 cells.



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All of the following statements regarding major histocompatibility complex molecules are true

EXCEPT:

1MHC class II molecules bind stably to peptides derived from proteins sythesized and

degraded in the cytosol

MHC class I molecules bind stably to peptides derived from proteins sythesized and degraded in thecytosol, while MHC class II molecules bind stably to peptides derived from proteins degraded in

endocytic vesicles. MHC class I molecules bearing viral peptides are recognized by cytotoxic T-cells

that subsequently kill the infected cell. MHC Class II molecules bearing peptides trigger helper T-

cells and are recognized by TH1 or TH2 cells. Class I molecules such as HLA-A, B, and C, are

present on all nucleated cells, whereas Class II molecules are on B cells, monocytes, dendritic cells,

and are inducible on keratinocytes and endothelial cells. The MHC is located on chromosome 6 in

humans, its polygenic and polymorphic nature contributes to the ability of the immune system to

respond to a multitude of different and rapidly evolving pathogens.


Which cell surface component of T cells is part of the \"signal 2\" which in addition to T cell

receptor binding leads to T cell activation?

1 CD28

2 B7

3 CD80

4 TNF-alpha receptor

5 CD1a


Which cell surface component of T cells is part of the \"signal 2\" which in addition to T cell

receptor binding leads to T cell activation?

1 CD28

Activation of T cells requires two signals. The first is T cell receptor binding to MHC molecule on

the antigen presenting cell. THe second signal involves CD28 on T cell interacting with B7

molecules on the antigen presenting cells. CD80 is expressed on Langerhans cells after activation.

CD1a is a Langerhans cell surface marker.Q/Q(M)-482715 Report a Problem

This patient has a lichenified plaque in the lower mid abdomen as well as these two exczematous

plaques. This patient needs:

1 Patch testing

2 A steroid

3 An antiviral

4 A KOH scraping

5 An antifungal


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This patient has a lichenified plaque in the lower mid abdomen as well as these two exczematous

plaques. This patient needs:

1 Patch testing

This patient is likely allergic to the nickel in her belt buckle and possibly to metals that she places in

her pocket. She needs patch testing. While a topical steroid might help resolve pruritus, the patient

ultimately needs to be diagnosed with her allergy and avoid nickel. Dimethylglyoxime can be usedas an indicator to detect nickel in metals.


All of the following statements regarding Toll receptors are true EXCEPT:

1 Toll receptors are present on macrophages and dendritic cells

2 Toll 2 receptors are typically activated by lipopolysaccharide

3 Toll 4 receptors are typically activated by gram negative bacteria

4 Nuclear factor kappa B (NFKB) is the final common pathway of toll receptors

5 None of the above (all are true)


All of the following statements regarding Toll receptors are true EXCEPT:

2 Toll 2 receptors are typically activated by lipopolysaccharide

Bacteria can induce inflammation through activation of Toll receptors, which are present on a

variety of cutaneous cells including macrophages, dendritic cells, keratinocytes, and mast cells.

Typically, Toll 2 receptors are activated by gram positive bacteria and Toll 4 receptors are activatedby lipopolysaccharide or gram negative bacteria. Nuclear factor kappa B is a final common pathway

of toll receptors and other immune receptors involved in initiating a variety of proinflammatory

cytokines.


A 24 year old female patient is referred for management of chronic idiopathic urticaria. Many cases

of this disease are associated with autoantibodies against what?

1 IgE receptor

2 Tryptase


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3 Histamine receptor

4 TNF-alpha receptor

5 IL-6 receptor


A 24 year old female patient is referred for management of chronic idiopathic urticaria. Many cases

of this disease are associated with autoantibodies against what?

1 IgE receptor

Many cases of idiopathic urticaria have circulating autoantibodies directed against the chain of high

affinity IgE receptor on the mast cell surface.


Which of the following suture materials induces the least inflammation?

1 Surgical gut

2 Polyglycolic acid (Dexon)

3 Polyglycan 910 (Vicryl)

4 Polypropylene (Prolene)

5 Silk


Which of the following suture materials induces the least inflammation?

4 Polypropylene (Prolene)

Prolene is a nonabsorbable suture material that evokes only minimal inflammation.


Which of the following is the target antigen in pemphigus vulgaris?

1 Desmoglein 3

2 Desmoplakin

3 Cadherin

4 Type XVII collagen

5 Desmoglein 1


Which of the following is the target antigen in pemphigus vulgaris?

1 Desmoglein 3

Desmoglein 3 is the dominant target auto-antigen in pemphigus vulgaris.


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Which cytokine is upregulated in lesions of tuberculoid leprosy?

1 IL 2

2 IL 4

3 IL 5

4 IL 10

5 None of the answers are correct


Which cytokine is upregulated in lesions of tuberculoid leprosy?

1 IL 2

Tuberculoid leprosy is characterized by a type I immune related response. Tuberculoid leprosy has

increased amounts of TH1 cytokines including IL-2, interferon gamma, and IL-12. These lead to a t-

cell and macrophage mediated cytotoxic response. IL-4, IL-5, and Il-10 are typically downregulated

in tuberculoid leprosy.


Which T-cell subset is commonly found in Szary syndrome?

1 CD4+/CD7+

2 CD8+/CD7-

3 CD4-/CD7+

4 CD4+/CD7-

5 CD8+/CD7+


Which T-cell subset is commonly found in Szary syndrome?

4 CD4+/CD7-Szary syndrome is the leukemia phase of mycosis fungoides (cutaneous T-cell lymphoma) and isusually a TH2-biased CD4+ leukemia.


Which of the following is the most abundant leukocyte?

1 Neutrophil

2 Eosinophil

3 Mast cell

4 Lymphocyte


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5 Monocyte


Which of the following is the most abundant leukocyte?

1 Neutrophil

Neutrophils are the most abundant leukocyte. The major function of neutrophils is phagocytosis.


Which immunoglobulin is most efficient at fixing complement?

1 IgM

2 IgE

3 IgD

4 IgA

5 IgG


Which immunoglobulin is most efficient at fixing complement?

1 IgM

IgM is the first antibody produced by B cells. It is secreted by plasma cells as a pentamer. Due to its

size, IgM doesn\'t enter tissue well. It is the most efficient immunoglobin at fixing complement.


An elderly gentleman with metastatic colon cancer is prescribed erlotinib, an epidermal growth

factor receptor monoclonal antibody. What is the most common cutaneous finding seen as a result of

this class of medication?

1 Acneiform eruption

2 Acral erythema

3 Morbilliform eruption

4 Hypotrichosis

5 Urticaria


An elderly gentleman with metastatic colon cancer is prescribed erlotinib, an epidermal growth

factor receptor monoclonal antibody. What is the most common cutaneous finding seen as a result of

this class of medication?

1 Acneiform eruption

Erlotinib, along with cetuximab and gefitinib, are epidermal growth factor receptor inhibitors that

are used for the treatment of multiple visceral malignancies, including metastatic colon cancer. They


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have all been associated with an acneiform eruption.


Which is not a feature of mast cells?

1 Expresses c-kit

2 Responds to RANTES

3 Produces IL-8

4 Produces prostaglandin D2

5 Stains with napththol chloro-acetate esterase


Which is not a feature of mast cells?

2 Responds to RANTES

Mast cells are an integral portion of immediate type hypersensitivity. RANTES is a chemoattractant

for eosinphils, not mast cells.


Which Th2 cytokine is involved in the proliferation and differentiation of B cells?

1 IL-4

2 IL-5

3 IL-6

4 IL-10

5 IL-13


Which Th2 cytokine is involved in the proliferation and differentiation of B cells?

3 IL-6The Th2 response is important in promoting humoral immunity. IL-4 promoted Th2 differentiation,

isotype switching and inhibition of macrophages. IL-5 activates eosinophils. IL-6 assists in the

proliferation and differentiation of B cells. IL-10 decreases expression of MHC II. IL-13 is related to

IL-4, and is implicated in allergic inflammation.


What cytokine is most critical for the development and maturation of eosinophils.

1 Interleukin-2

2 Interleukin-4


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3 Interleukin-5

4 Interferon-alpha

5 Interferon-gamma


What cytokine is most critical for the development and maturation of eosinophils.

3 Interleukin-5

IL-5 is critical in the development and maturation of eosinophils. IL-2 is an autocrine factor for

activated T cells. IL-4 is involved in B-cell class switching and Th2 differentiation. IFN-alpha is a

major part of the antiviral response. IFN-gamma is involved in macrophage activation and specific

isotype switching.


A 44 year old female complains of intra-oral burning lesions. Examination reveals erythematous

plaques with white striae on the buccal mucosa consistent with oral lichen planus. No cutaneous

lesions are seen. Which of the following HLA types is associated with oral lichen planus?

1 B8

2 Cw6

3 Bw35

4 B27

5 B51


A 44 year old female complains of intra-oral burning lesions. Examination reveals erythematous

plaques with white striae on the buccal mucosa consistent with oral lichen planus. No cutaneous

lesions are seen. Which of the following HLA types is associated with oral lichen planus?

1 B8

Oral lichen planus is a relatively common condition that can cause significant morbidity. Oral lichen

planus is associated with HLA-B8. HLA-Cw6 is associated with psoriasis, Bw35 with cutaneouslichen planus, B27 with psoriatic arthritis, and B51 with Behcet\'s disease.


What is the best screening test for hereditary angioedema?

1 C1 esterase

2 C4

3 CH50

4 C2

5 C3


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What is the best screening test for hereditary angioedema?

2 C4

C4 is the best screening test for hereditary angioedema (Quinke's edema). There are two types of

hereditary angioedema. In type I, there are low antigenic and functional levels of a NORMAL C1esterase inhibitor protein. In type II, there is a normal or elevated level of a DYSFUNCTIONAL C1

esterase inhibitor. The low C4 level is a result of continuous activation and consumption of

complement components.


The human major histocompatibility complex (MHC) is located on chromosome:

1 2

2 63 9

4 11

5 17


The human major histocompatibility complex (MHC) is located on chromosome:

2 6

The MHC is highly polygenic and polymorphic, and this contributes to the ability of of the immune

system to respond to a multitude of different and rapidly evolving pathogens. The MHC is located

on chromosome 6 in humans.


The antibody produced in the early stages of antibody responses is:

1 IgA

2 IgD

3 IgE

4 IgG

5 IgM


The antibody produced in the early stages of antibody responses is:

5 IgMIgM is the antibody produced in the early stages of antibody responses. It is a pentamer which can


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agglutinate antigen and active the classic complement pathway. IgG is the antibody that can cross

the placenta and the most common antibody found in circulation. IgA is found in mucous membrane

secretions and is able to agglutinate antigens and activate the alternate but not the classic

complement pathway. IgD is not found in circulation other than in hyper-IgD syndrome, an

autosomal recessive disorder caused by mutations in the mevalonate kinase gene. A significant

elevation of serum IgD is seen in 95% of these patients. IgE is an anaphylactic antibody that is

involved in nearly all immediate allergic and anaphylactic type reactions.


Anti-Ro (SS-A) antibodies are most commonly found in:

1 Mixed connective tissue disease

2 Eosinophilic fasciitis

3 Drug-induced systemic lupus erythematosus

4 Homozygous C2 deficiency

5 Neonatal lupus erythematosus


Anti-Ro (SS-A) antibodies are most commonly found in:

5 Neonatal lupus erythematosus

Ro 60 kDa autoantigen is a major target for patients with SLE and Sjgrens syndrome. Neonatallupus occurs in newborns of mothers with anti-Ro antibodies and leads to children with

photosensitive skin lesions and a cardiac conduction defect, a third degree heart block.Q/Q(M)-474231 Report a Problem

The major histocompatibility complex (MHC)consists of a linked set of genes encoding for MHC

Class I, Class II, Class III, and Class IB. Which of the following is/are true:

1 Class II molecules are present on all nucleated cells

2 Class I molecules are present on erythrocytes

3 Class I molecules are expressed on B8 cells, monocytes and dendritic cells

4 The level of Class I and II expression can be modulated by cytokines

5 The MHC region is located on chromosome 17 in humans


The major histocompatibility complex (MHC)consists of a linked set of genes encoding for MHC

Class I, Class II, Class III, and Class IB. Which of the following is/are true:

4 The level of Class I and II expression can be modulated by cytokines

The major hisotcompatibility complex (MHC) consists of a linked set of genes encoding for MHC

Class I, Class II, Class III, and Class IB. The level of Class I and II expression can be modulated by

cytokines.


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IL-23 plays a critical role in the pathogenesis of psoriasis. Which of the following cytokines is

critical for IL-23-mediated epidermal hyperplasia in psoriasis?

1 IL-2

2 IL-12

3 IL-17A

4 TNF-alpha

5 IFN-gamma


IL-23 plays a critical role in the pathogenesis of psoriasis. Which of the following cytokines is

critical for IL-23-mediated epidermal hyperplasia in psoriasis?3 IL-17A

IL-23 and Th17 cells producing IL-17A and IL-22 are found in excess in skin affected by psoriasis.

IL-6, IL-22, and IL-17A have all been shown to be critical in mediating epidermal hyperplasia in

psoriasis in response to IL-23.


Which systemic anti-inflammatory agent specifically blocks the ability of T cells to leave the

vasculature and enter the skin?

1 Etanercept

2 Infliximab

3 Efalizumab

4 Alefacept

5 None of the above


Which systemic anti-inflammatory agent specifically blocks the ability of T cells to leave the

vasculature and enter the skin?

3 Efalizumab

Efalizumab is a humanized monoclonal antibody to CD11a that blocks the immunologic synapse

between LFA-1 on the T-cell and ICAM-1 on the antigen presenting cell. By targeting LFA-1

efalizumab specifically blocks the ability of T cells to leave the vasculature and enter the skin.


All of the following statements regarding neutrophils are true EXCEPT:


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1 Neutrophils' major function is antigen presentation

2 Neutrophils have receptors for IgG and complement

3 Neutrophils are granulocytes

4 Neutrophils are the most abundant leukocytes

5 None of these answers are correctQ/Q(M)-476613 Report a Problem

All of the following statements regarding neutrophils are true EXCEPT:

1 Neutrophils' major function is antigen presentation

Neutrophils' major function is phagocytosis. The other statements are correct.


Eosinophils are typically seen in the cutaneous infiltrate of:

1 Krabbes disease

2 Kaposiform hemangioendothelioma

3 Kawasakis disease

4 Kimuras disease

5 Ki-1 lymphoma


Eosinophils are typically seen in the cutaneous infiltrate of:

4 Kimuras disease

Eotaxin, which attracts eosinophils, is produced by T cells in Kimuras disease.


Which of the following TH2 cytokines is a B cell growth factor?

1 IL-4

2 IL-5

3 IL-10

4 IL-13

5 IFN-gamma


Which of the following TH2 cytokines is a B cell growth factor?

1 IL-4


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IL-4 is a B cell growth factor. IL-5 is an eosinophil growth factor. IL-10 is a general down-regulator

of TH1 immunity. IL-13 (along with IL-4) promotes an isotype switch from IgM to IgE. IFN-gamma

is not a TH2 cytokine. It is secreted by TH1 cells, and is the main macrophage-activating cytokine.


Psoriatic arthritis is most commonly associated with which HLA?1 HLA-B27

2 HLA-Cw6

3 HLA-Aw19

4 HLA-Bw35

5 None of these options are correct


Psoriatic arthritis is most commonly associated with which HLA?

1 HLA-B27

HLA-B27 is associated with an increase in psoriatic arthritis as well as pustular psoriasis and

acrodermatitis continua of Hallopeau.


All of the following stains can be reactive in this condition except

1 CDXIIIa2 CD31

3 CD34

4 Ulex europaeus

5 Factor VIII-related antigen


All of the following stains can be reactive in this condition except

1 CDXIIIa

The picture shows Kaposi's scarcoma(KS). It is controversial whether KS represents neoplasia or

hyperplasia; all clinical variants are viewed as a virally induced disease - human herpesvirus 8


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(HHV-8) is the suspected agent. Cutaneous lesions present as variably distributed pink patches, blue-

violet to black nodules or plaques, and polyps, depending on clinical variant and stage. Variable

staining can occur with CD31, CD34, Ulex europaeus and factor VIII-related antigen. CD XIIIa is

positive in dermatofibroma.


Which of the following diseases occur with an increased frequency in persons deficient in C2?

1 Psoriasis

2 Dermatitis Herpetiformis

3 Androgenetic Alopecia

4 DLE

5 Leiner's disease


Which of the following diseases occur with an increased frequency in persons deficient in C2?

4 DLE

Among the complement deficiencies, C2 defienciency is most frequently seen. Most of these

patients are healthy. Diseases that occur with increased frequency in patients with C2 deficiency are

SLE, SLE-like syndrome, frequent infections, anaphylactoid purpura, lethal dermatomyositis,

vasculitis, disseminated cutaneous lupus erythematosus, and cold urticaria.


Which of the following dietary supplements may inhibit platelet function?

1 Vitamin A

2 Vitamin C

3 Vitamin D

4 Vitamin E

5 Vitamin K


Which of the following dietary supplements may inhibit platelet function?

4 Vitamin E

Supplemental vitamin E can inhibit platelet function and predispose to hemorrhagic stroke. It can be

particularly hazardous in patients with beta-thalassaemia mutations.


Which cytokine is up-regulated in this geometric, eczematous dermatitis?


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1 IL-2

2 IL-4

3 IL-5

4 IL-7

5 IL-10Q/Q(M)-476802 Report a Problem

Which cytokine is up-regulated in this geometric, eczematous dermatitis?

1 IL-2

The geometric pattern of ertyhema suggests "outside job". Allergic contact dermatitis is a cell-

mediated and Th1 reaction. The cytokines up-regulated in this process are IL-1, IL-2, IL-12,

interferons-alpha and gamma.


The T cell surface receptor CD2 binds to what partner on endothelial cells to assist with adhesion?

1 LFA-3

2 B7

3 E-cadherin

4 CD40

5 ICAM-1Q/Q(M)-482717 Report a Problem

The T cell surface receptor CD2 binds to what partner on endothelial cells to assist with adhesion?

1 LFA-3

CD2 molecules are T cell surface receptors that bind to LFA-3 on endothelial cells and antigen

presenting cells to participate in adhesion and activation.


All of the following statements regarding mast cells are true EXCEPT:


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1 Mast cells reside near small blood vessels

2 Mast cells protect mucosal surfaces against pathogens

3 Mast cells release substances that affect vascular permeability

4 Mast cells have receptors for certain fragments of complement on their surface

5 None of the above (all are true)Q/Q(M)-476614 Report a Problem

All of the following statements regarding mast cells are true EXCEPT:

5 None of the above (all are true)

Mast cells are the central cell in immediate-type hypersenstivity, and are very important in cutaneous

inflammation. They reside near small blood vessles, and when activated release substances that

affect vascular permeability. They orchestrate allergic responses and protect mucosal surfaces

against pathogens. They have receptors for IgE and certain fragments of complement on their cell

surface.


Which of the following cytokines is a general down-regulator of TH1 immunity?

1 IL-4

2 IL-5

3 IL-10

4 TNF5 IFN-gamma


Which of the following cytokines is a general down-regulator of TH1 immunity?

3 IL-10

IL-4 is a B cell growth factor. IL-5 is an eosinophil growth factor. IL-10 is a general down-regulator

of TH1 immunity. TNF and IFN-gamma are TH1 cytokines, not TH2 cytokines. IFN-gamma is

secreted by TH1 cells, and is the main macrophage-activating cytokine.Q/Q(M)-476660 Report a Problem

Which of the following is true of Langerhan cells?

1 They are the primary antigen presenting cell in the epidermis

2 They are primarily involved in the innate immune response

3 They do not express the CD1a marker

4 They contain intranuclear birbeck granules

5 They are increased on the palms, soles, genitalia, and buccal mucosa


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Which of the following is true of Langerhan cells?

1 They are the primary antigen presenting cell in the epidermis

Langerhans' cell function primarily in the afferent limb of the immune response by providing for the

recognition, uptake, processing, and presentation of antigens to sensitized T lymphocytes. They arenormally found scattered among keratinocytes of the stratum spinosum, or prickle cell layer. of the

epidermis. They can be stained with CD1a or S-100. They originate in the bone marrow. They

contain intracytoplasmic Birbeck granules.


Which cytokine is most important in recruiting neutrophils?

1 Interleukin-1

2 Interleukin-23 Interleukin-4

4 Interleukin-8

5 Interleukin-10


Which cytokine is most important in recruiting neutrophils?

4 Interleukin-8

Chemotaxis is the process of cells moving through a gradient of towards increasingly higher

concentrations. IL-8 has activating and chemoattractant properties on neutrophils.


Patients with a type I reaction to latex may have cross-reactions with which of the following foods?

1 Avocado

2 Horseradish

3 Cashews4 Parsnips

5 Garlic


Patients with a type I reaction to latex may have cross-reactions with which of the following foods?

1 Avocado

Latex allergy is a TH2 form of contact sensitivity that is IGE mediated. Using the old Gel and

Coombs classification, it was classified as type I hypersensitivity.



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Major histocompatibility complex (MHC) Class I molecules:

1 Are inducible on keratinocytes

2 Complexed with antigen trigger cytotoxic T cells

3 Are recognized by receptors on CD4+ T cells4 Bear peptides derived from pathogens taken up into vesicles

5 All of the above


Major histocompatibility complex (MHC) Class I molecules:

2 Complexed with antigen trigger cytotoxic T cells

MHC Class I molecules are present on all nucleated cells. They are recognized by receptors on

surfaces of CD8+ T cells, and, when complexed with antigen, trigger cytotoxic T cells. The otherstatements apply to MHC Class II molecules.


Natural killer (NK) cells eliminate infected cells in all of the following ways except:

1 NK cells adhere to and kill target cells coated with IgG

2 NK cells secrete perforins

3 NK cells secrete granzyme

4 NK cells secrete myeloperoxidase

5 NK cells do not target cells expressing major histocompatibility (MHC) class I molecules


Natural killer (NK) cells eliminate infected cells in all of the following ways except:

4 NK cells secrete myeloperoxidase

NK cells focus on the destruction of infected or malignant cells. They achieve this via recognition ofIgG on target cells, the so-called 'antibody-dependent cellular toxicity.' NK cells also eliminate cells

by secreting perforin, which makes holes in the cell membrane, through which granzyme is injected.

Granzyme induces apoptosis by activating the caspase cascade. In addition, NK cells do not target

cells expressing MHC class I molecules on their surface; some virus downregulate MHC class I

molecules to evade recognition by cytotoxic T cells, which may make them susceptible to NK cell

attack. Neutrophils kill ingested organims using myeloperoxidase.


Which of the following immunoglobulins cannot activate the complement pathway?

1 IgM


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2 IgG1

3 IgG2

4 IgG3

5 IgG4


Which of the following immunoglobulins cannot activate the complement pathway?

5 IgG4

Immunoglobulins (Ig) differ in their ability to activate complement. IgM is the largest Ig, is the

major Ig in the primary immune response, and consists of a pentamer that activates the classic

complement pathway. IgG is the most abundant Ig and the major Ig in the secondary immune

response. Four subclasses of IgG exist based on the amino acid residue sequences of their constant

region, IgG1 through IgG4. IgG1 and IgG3 are potent activators of the classic complement pathway,

IgG2 is less effective and IgG4 is unable to do so.Q/Q(M)-478141 Report a Problem

This patient recently developed this rash. You decide to patch test her, but in the meanwhile you tell

her to avoid:

1 Chamomile

2 Primin

3 Abietic acid

4 Benzocaine

5 Cinnamon


This patient recently developed this rash. You decide to patch test her, but in the meanwhile you tell

her to avoid:

5 Cinnamon

This patient likely has a fragrance allergy. Patients allergic to fragrances also need to avoid certain

spices like cinnamon.



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Which common contact allergen is detected via the dimethylglyoxime test?

1 Benzocaine

2 Chromates

3 Formaldehyde

4 Nickel

5 Rhus


Which common contact allergen is detected via the dimethylglyoxime test?

4 Nickel

Nickel is found in virtually all metals of common use. It is the most common sensitizer in women,

and is detected by the dimethylglyoxime test.


All the following conditions exhibit a T-helper cell 1 (Th1) cytokine secretion profile except:

1 Psoriasis

2 Systemic lupus erythematosus

3 Granulomatous leprosy

4 Rheumatoid arthritis

5 Multiple sclerosis


All the following conditions exhibit a T-helper cell 1 (Th1) cytokine secretion profile except:


Systemic lupus erythematous is associated with a Th2 cytokine profile, whereas the other conditions

are associated with a Th1 cytokine profile. Th2 cells are typified by secretion of IL-4, IL-5, IL-6, IL-

9, IL-10 and IL-13, whereas Th1 cells are typified by secretion of IFN-gamma, TNF-beta, and IL-2.


When attempting to identify Langerhans cells in a specimen, which marker is most helpful?

1 CD1

2 CD4

3 CD7

4 CD8

5 CD20



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When attempting to identify Langerhans cells in a specimen, which marker is most helpful?

1 CD1

CD1 is a surface antigen specific for epidermal Langerhans cells. It is not expressed in other

epidermal structures. The other characteristic ultrastructural feature of Langerhans cells is the

Birbeck granule. CD4 is found on T-helper cells and occasionally on Langerhans cells. CD7 is a T-cell marker that is often lost in cutaneous T-cell lymphoma. CD8 is found on cytotoxic T-cells.

CD20 is a B-cell marker.


The most common autoimmune disorder in patients with chronic hepatitis C infection is:

1 Autoimmune thyroiditis

2 Idiopathic thrombocytopenic purpura


4 Sjgrens syndrome



The most common autoimmune disorder in patients with chronic hepatitis C infection is:

1 Autoimmune thyroiditis

Autoimmune thrombocytopenia has been reported with hepatitis C infection but not as commonly asautoimmune thyroiditis.


A previously healthy child presents with palpable purpura, arthritis, and vomiting. You suspect a

hypersensitivity vasculitis characterized by:

1 Perivascular IgA

2 P-ANCA autoantibodies

3 Granulomas and eosinophilia

4 Infiltration of destruction of vessels by atypical lymphocytoid and plasmacytoid cells

5 Nectrotizing granulomatous vasculitis


A previously healthy child presents with palpable purpura, arthritis, and vomiting. You suspect a

hypersensitivity vasculitis characterized by:

1 Perivascular IgA

The child has findings of Henoch-Schonlein purpura, a hypersensitivity vasculitits that presentsclinically with a triad of purpura, joint pain, and GI complaints. Histologically it is characterized by

perivascular deposition of IgA.


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Tacrolimus is a non-steroidal anti-inflammatory medication that works by inhibiting calcineurin

activity through complexing with what binding protein?

1 FK506

2 TGF-beta

3 NF-kappa-B

4 SRE

5 IL-23


Tacrolimus is a non-steroidal anti-inflammatory medication that works by inhibiting calcineurin

activity through complexing with what binding protein?1 FK506

Tacrolimus and pimecrolimus are non-steroidal calcineurin inhibitors that act as anti-inflammatory

medications. In dermatology, they are most commonly used in topical preparations. These

medications form complexes with FK506 binding protein, which inhibits calcineurin activity. A key

regulatory step in the activation of T cells is the activation of calcineurin via calmodulin.


Which component of the classical pathway of complement acts as a neutrophil chemoattractant?

1 C3a

2 C3b

3 C5a

4 C5b

5 C1 INH


Which component of the classical pathway of complement acts as a neutrophil chemoattractant?

1 C3a

The classical pathway of complement is activated by antigen-antibody complexes. C3a is a

neutrophil chemoattractant. C3b is an opsonin. C5a is an anaphylatoxin. C5b forms a part of the

membrane attack complex.


Naive T cells express which of the following surface molecules:

1 CD19

2 CD20


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3 CD79

4 CD45RO

5 CD45RA


Naive T cells express which of the following surface molecules:

5 CD45RA

Naive T cells express CD45RA whereas memory T cells express CD45RO. CD19, 20, and 79 are B

cell surface markers.


Which virus is most closely associated with Kaposis sarcoma in HIV-infected patients?

1 Human herpes virus 2

2 Cytomegalovirus



5 Epstein-Barr virus


Which virus is most closely associated with Kaposis sarcoma in HIV-infected patients?4 Human herpes virus 8

HHV-8 has been repeatedly associated with all forms of Kaposis sarcoma.


Herpes gestationis is most commonly associated with which HLA?

1 HLA-DR3

2 HLA-B27

3 HLA-B51

4 HLA-DR9

5 HLA-DQ8


Herpes gestationis is most commonly associated with which HLA?

1 HLA-DR3

HLA-DR3 is the most commonly found HLA association in herpes gestationis. HLA-DR4 is also

found in addition to HLA-DR3 in about 50% of patients. There is nearly 100% incidence of anti-


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HLA antibodies patients affected by herpes gestationis.


Which of the following is not true about the effects of ultraviolet radiation on the immune system?

1 UV radiation causes an increase in number of Langerhans cells in the epidermis

2 UV radiation causes nuclear DNA damage

3Effects can be demonstrated by the example of reactivation of latent herpes simplex infection

after sun exposure

4 UV radiation acts to suppress the immune system both locally and systematically

5Effects can be demonstrated by the ability of an antigen to induce an allergic hypersensitivity

reaction when applied to skin which has been exposed to low doses of UV radiation


Which of the following is not true about the effects of ultraviolet radiation on the immune system?

1 UV radiation causes an increase in number of Langerhans cells in the epidermis

Effects of UV radiation on the immune system: UV radiation inhibits function of Langerhans cells

(A-False). It causes DNA damage, can reactivate HSV, suppresses immune system, and can induce

allergic hypersensitivity reaction


In adult patients with Henoch-Schnlein purpura with IgA vasculitis, which of the following

complications is most likely to occur?1 Pulmonary hemorrhage

2 Hemorrhagic cystitis

3 Peripheral neuropathy

4 Mesangial nephropathy

5 Facial edema


In adult patients with Henoch-Schnlein purpura with IgA vasculitis, which of the followingcomplications is most likely to occur?

4 Mesangial nephropathy

A urinalysis should be ordered in patients with palpable purpura. Red blood cells and proteinuria are

often seen in Henoch-Schnlein syndrome.


Which cytokine is the main macrophage-activating cytokine?

1 TNF


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2 IFN-gamma

3 IL-4

4 IL-10

5 lymphotoxin


Which cytokine is the main macrophage-activating cytokine?

2 IFN-gamma

IFN-gamma is the main macrophage-activating cytokine, and is secreted by TH1 cells.


Major histocompatibility complex class I molecules bind to:

1 Peptides derived from proteins synthesized and degraded in the cytosol

2 Peptides derived from proteins degraded in endocytic vesicles

3 Peptides external to the cell membrane

4 Immunoglobulin E



Major histocompatibility complex class I molecules bind to:

1 Peptides derived from proteins synthesized and degraded in the cytosol

Major histocompatibility complex (MHC) class I molecules bind to peptides derived from proteins

synthesized and degraded in the cytosol. They present these processed peptides to CD8+ T-cells.

MHC class II molecules bind stably to peptides derived from proteins degraded in endocytic

vesicles. CD4+ T-cells recognize the MHC class II molecules. Immune activation against the foreign

antigens or pathogens taken up by the cell is the result of these interactions. Peptides external to the

cell are not recognized by MHC molecules. IgE does have a receptor on the cell surface, especially

basophils and mast cells, but is not recognized by the MHC complex.


Which systemic anti-inflammatory agent targets CD2+ activated T cells for apoptosis?

1 Etanercept

2 Infliximab

3 Efalizumab

4 Alefacept

5 None of the above



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Which systemic anti-inflammatory agent targets CD2+ activated T cells for apoptosis?

4 Alefacept

Alefacept is a soluble form of LFA-3 that blocks the immunologic synapse between CD2 on the T

cell and LFA-3 on the antigen presenting cell. Furthermore, alefacept targets CD2+ activated T cells

for apoptosis.Q/Q(M)-476725 Report a Problem

The immunoglobulin most commonly found in mucous secretions is:

1 IgA

2 IgD

3 IgE

4 IgG

5 IgM


The immunoglobulin most commonly found in mucous secretions is:

1 IgA

IgA is found in mucous membrane secretions and is able to agglutinate antigens and activate the

alternate but not the classic complement pathway. IgG is the antibody that can cross the placenta and

the most common antibody found in circulation. IgD is not found in circulation other than in hyper-

IgD syndrome, an autosomal recessive disorder caused by mutations in the mevalonate kinase gene.

A significant elevation of serum IgD is seen in 95% of these patients. IgE is an anaphylactic

antibody that is involved in nearly all immediate allergic and anaphylactic type reactions. IgM is the

antibody produced in the early stages of antibody responses. It is a pentamer which can agglutinate

antigen and active the classic complement pathway.


A patient with Stage 3 mycosis fungoides is referred to a tertiary referral center for further

management. Denileukin diftitox is offered as a potential therapy. This medication binds to what

receptor on the T cell?

1 IL-2

2 MHC II

3 CD20

4 TNF-alpha

5 CD19


A patient with Stage 3 mycosis fungoides is referred to a tertiary referral center for further


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management. Denileukin diftitox is offered as a potential therapy. This medication binds to what

receptor on the T cell?

1 IL-2

Denileukin diftitox is a fusion of a fragment of diphtheria toxin and IL-2. It binds to high affinity IL-

2 (CD25) receptors on T cells. As the medication is internalized, the toxin leads to cell death. This

medication has been approved for cutaneous T cell lymphoma.Q/Q(M)-482731 Report a Problem

Mononuclear phagocytes residing in tissues:

1 Are called macrophages

2 Phagocytose foreign antigens and degrade them into peptides

3 Present antigen to T-cells

4 Produce cytokines, which recruit other inflammatory cells5 All of the above


Mononuclear phagocytes residing in tissues:

5 All of the above

Mononuclear phagocytes are components of the innate immune system. Once in tissues they are

called macrophages. All of the above are correct.


The human leukocyte antigen that has the closet association with psoriasis is:

1 HLA-B51

2 HLA-DQ3

3 HLA-B27

4 HLA-Cw6

5 HLA-DR1Q/Q(M)-474199 Report a Problem

The human leukocyte antigen that has the closet association with psoriasis is:

4 HLA-Cw6

Human leukocyte antigens (HLA class I molecules) are designated A, B, and C and are present on

all nucleated cells. Class I molecules present antigens including autoantigens to cytotoxic T cells.



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Of the following complement components, the most powerful neutrophil chemoattractant is:

1 C3

2 C5a

3 C3a

4 C5b, C6, C7, C8, C9

5 C4a


Of the following complement components, the most powerful neutrophil chemoattractant is:

2 C5a

The complement system plays an important role in innate immunity. Of this group, C5a is the most

powerful neutrophil chemoattractant. C3 represents the endpoint for the classic, alternative and lectin

pathways, and results in the generation of immunologically active substances. C3a and C4a cause

mast cell degranulation. Assembly of C5b, C6, C7, C8, C9 components results in the membraneattack complex (MAC), which perforates cell membranes causing death by osmotic lysis.


A deficiency of this complement component may result clinically in susceptibility to pyogenic

infections, glomerulonephritis, and partial lipodystrophy:

1 C1 Esterase Inhibitor

2 C3

3 C4

4 C50

5 Properidin


A deficiency of this complement component may result clinically in susceptibility to pyogenic

infections, glomerulonephritis, and partial lipodystrophy:

2 C3

C3 is the central component of the complement cascade. It plays a key role in the opsonization of

bacteria. An autosomal recessive deficiency of C3 may result in susceptibility to pyogenic

infections, glomerulonephritis, and partial lipodystrophy.


Calcipotriene-induced improvement in psoriasis is associated with increased lesional levels of which

cytokine?

1 Interleukin-2

2 Interleukin-8

3 Tumor necrosis factor


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4 Interleukin-10

5 Interluekin-12


Calcipotriene-induced improvement in psoriasis is associated with increased lesional levels of whichcytokine?

4 Interleukin-10

Psoriasis is generally described as a TH1 autoimmune disease where IL-12/IFN-gamma pathway is

dominant. IL-10 is the prototype of TH2 and calcipotriene application results in increased levels of

IL-10, thus decreasing TH1 disease.


A 5 year old patient is seen at a tertiary referral center for evaluation of a complex syndrome.

Ultimately, he is diagnosed with IPEX syndrome (immune dysregulation, polyendocrinopathy,enteropathy, X-linked syndrome.) What gene is mutated in IPEX syndrome?

1 FOXP3

2 LFA-3

3 TGF-beta

4 B7

5 Mac-1


A 5 year old patient is seen at a tertiary referral center for evaluation of a complex syndrome.Ultimately, he is diagnosed with IPEX syndrome (immune dysregulation, polyendocrinopathy,

enteropathy, X-linked syndrome.) What gene is mutated in IPEX syndrome?

1 FOXP3

IPEX syndrome is a rare x-linked disorder. Mutation of FOXP3 results in absence of regulatory T

cells and is the cause of this syndrome, which includes immune dysregulation, polyendocrinopathy,

and enteropathy.


This patient developed an acute vesicular rash after eating a mango. She has returned for a routine

follow-up. She needs to be careful of exposure to:

1 Ginkgo fruit

2 Croton

3 Ragweed

4 Tea tree oil




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This patient developed an acute vesicular rash after eating a mango. She has returned for a routine

follow-up. She needs to be careful of exposure to:

1 Ginkgo fruit

Patients allergic to the peel of a mango can also be allergic to other plants/products of the

Anacardiaceae family. Cross-reactions can occur with exposure to any plants of the genus

Toxicodendron, to the oil from the cashew nut shell, to the Brazilian pepper tree, to lacquer from theJapanese lacquer tree, to ink from the Indian marking nut, and to the fruit pulp of the ginkgo tree,

and others.


Langerhans cell adhesion to keratinocytes is mediated by what adhesion molecule?

1 E-cadherin

2 N-cadherin

3 Desmoglein 34 P-cadherin

5 B7


Langerhans cell adhesion to keratinocytes is mediated by what adhesion molecule?

1 E-cadherin

Langerhans cells are found in the epidermis and on mucosal surfaces. After antigen exposure andactivation, they migrate to regional lymph nodes where they mature into antigen presenting cells.

Adhesion to keratinocytes in the epidermis is mediated by e-cadherin.


The best screen for classical pathway complement deficiency or dysfunction is:

1 CD4/CD8 ratio

2 CH50

3 C2 esterase levels

4 Total C4 levels


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5 Serum electophoresis


The best screen for classical pathway complement deficiency or dysfunction is:

2 CH50

The appropriate screening test for a complement deficiency is the CH50. The CH50 will detect

deficiencies in the classical pathway and membrane attack pathways.


The endothelial ligand for cutaneous lymphocyte antigen (CLA) is:

1 Intercellular adhesion molecule 1 (ICAM-1)

2 L-selectin

3 E-selectin

4 Vascular cell adhesion molecule (VCAM-1)

5 Leukocyte functional antigen (LFA 3)


The endothelial ligand for cutaneous lymphocyte antigen (CLA) is:

3 E-selectin

Cutaneous lymphocyte antigen (CLA) allow memory T cells to home to the skin, where it binds to

its ligant E-selectin on cutaneous microvessels. Transmigration of memory T cells into the dermis,

however, further requires interaction between leukocyte functional antigen 1 (LFA-1) and ICAM-1,

and B-integrin very late antigen 4 (VLA-4) and VCAM-1. L-selectin is expressed on post-capillary

venules in the lymph nodes and serves as the attachment points for naive T cells.


Which of the following is associated with hepatitis C infection?

1 Essential mixed cryoglobulinemia


3 Relapsing polychondritis

4 Wegeners granulomatosis

5 Dermatomyositis


Which of the following is associated with hepatitis C infection?

1 Essential mixed cryoglobulinemia

Hepatitis C infections can present as urticaria or papable purpura and cryoglobulinemia.


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With which HLA type is psoriasis most definitively linked?

1 HLA-B51

2 HLA-B8

3 HLA-DR4

4 HLA-DR3

5 HLA-Cw6


With which HLA type is psoriasis most definitively linked?

5 HLA-Cw6

Psoriasis is linked with HLA-Cw6. Patients with this HLA type have a relative risk of having

psoriasis that is 9-15 times normal.


Elaboration of which of the following cytokines is characteristic of TH2 response?

1 Interferon-8 (gamma)

2 Interleukin-1

3 Interleukin-2

4 Interleukin-4

5 Interleukin-12


Elaboration of which of the following cytokines is characteristic of TH2 response?

4 Interleukin-4

Interleukin-4 (IL-4) is a cytokine involved in B-cell proliferation. Along with IL-5 and IL-13, IL-4 isclassified as a TH2 cytokine.


Which of the following immune-mediated events has been demonstrated in psoriasis vulgaris?

immunedermatology mcqs

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