6/9/2017 Immunology FRCEM Success
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You have scored 32%
You answered 30 correct out of 94 questions.
Your answers are shown below:
Regarding immunoglobulin, which of the following statements is CORRECT:
a) Within an immunoglobulin molecule, there will be one kappa light chain and one delta light chain.
b) Immunoglobulin expressed by different cells are all identical.
c) The class of immunoglobulin is determined by the heavy chain.
d) Only IgM can cross the placenta.
e) IgG is the main immunoglobulin in the primary immune response.
Something wrong?
Immunoglobulin molecules are composed of two identical heavy and two identical light chains, linked by disulphide
bridges. The heavy and light chains each have a highly variable region which give the immunoglobulin speci city. The
light chains consist of one variable amino terminal domain and one constant domain at the carboxy terminal. The
constant region can be kappa or gamma but both light chains within an Ig molecule will be the same; 60 % of human
light chains are kappa. The heavy chain contains one variable and several constant domains.
There are ve classes of immunoglobulin in humans, IgG, IgA, IgM, IgE and IgD which are determined by the heavy
chain which is gamma, alpha, mu, epsilon or delta respectively. IgG is the most abundant in plasma (comprising 80 % of
normal serum immunoglobulin) and the main circulatory Ig for the secondary immune response, it is the only Ig that
can cross the placenta. IgM is the main Ig in the primary immune response and the most pro cient at complement
xation. IgA is the major Ig in secretions particularly from the gastrointestinal tract (but also in saliva, tears, sweat and
breast milk). IgE is important for mast cell degranulation in allergic and antiparasitic response. IgD is expressed on
naive B-cells and its function is not known.
The following are all examples of type II hypersensitivity except for:
http://frcemsuccess.com/rev/sc41/ 1/60
,6/9/2017 Immunology FRCEM Success
a) Haemolytic disease of the newborn
b) Graves disease
c) Rheumatic heart disease
d) Goodpasture’s syndrome
e) Post streptococcal glomerulonephritis
Something wrong?
Type II hypersensitivity (antibody-mediated hypersensitivity) occurs when antibody (normally IgG) speci c for cell
surface antigens (either antibody to foreign cells or autoantibody) is produced. Cell destruction then occur via
complement xation, antibody-dependent cell-mediated cytotoxicity, and phagocytosis. Onset is normally rapid.
Examples of type II reactions include:
incompatible blood transfusions
haemolytic disease of the newborn
autoimmune haemolytic anaemias
Goodpasture’s syndrome
rheumatic heart disease
Several diseases are caused by antibody directed against cell surface receptors which can either stimulate or block the
receptor e.g. Graves disease or myasthenia gravis.
Post streptococcal glomerulonephritis is a type III hypersensitivity reaction.
Which of the following is NOT a mechanism of NK cell killing:
a) Antibody-dependent cell-mediated cytotoxicity
b) Ligation of FAS receptors on the target cell
c) Ligation of TNF receptors on the target cell
d) Degranulation and release of perforins and granzymes
e) Phagocytosis of foreign or damaged cells
Something wrong?
Natural killer (NK) cells are derived from the lymphoid progenitor cell but are neither T nor B cells, and have a role in
the innate immune system through cell-mediated cytotoxicity. They are large granular lymphocytes, which are non-
speci c and have no memory cells. NK cells do not require T-cell help to kill pathogens, although they are more
effective when T helper cells secrete IFN-gamma. NK cells kill target cells by ligation of FAS and TNF receptors and
secretion of their granular contents (including perforins and granzymes), ultimately inducing target cell apoptosis.
NK cells are designed to kill target cells that have a low level of expression of MHC class I molecules such as a viral
http://frcemsuccess.com/rev/sc41/ 2/60
,6/9/2017 Immunology FRCEM Success
NK cells are designed to kill target cells that have a low level of expression of MHC class I molecules such as a viral
infected cell or a malignant cell. They do this by displaying a number of receptors for MHC molecules on their surface.
When MHC is expressed on a target cell these deliver an inhibitory signal into the NK cell, when it is absent this
inhibitory signal is loss and the NK cell can kill its target. NK cells also display antibody-dependent cell-mediated
cytotoxicity, where killing is initiated by cross-linking of receptors for the Fc portion of IgG, regardless of the presence
of MHC molecules.
Regarding leucocytes, which of the following statement is CORRECT:
a) The earliest recognisable granulocyte precursors are myelocytes.
b) There are three main types of leucocytes in peripheral blood.
c) Neutrophils, eosinophils and monocytes are all granulocytes.
d) IL-5 is particularly important for eosinophil activation.
e) TNF-alpha inhibits granulopoiesis.
Something wrong?
There are ve main types of leucocytes in peripheral blood;
neutrophils
eosinophils
basophils
monocytes
lymphocytes
Neutrophils, eosinophils and basophils contain granules and are termed granulocytes, and all differentiate from the
same precursor. The earliest recognisable granulocyte precursors are myeloblasts, which then undergo a nal division
followed by further maturation into promyelocytes, myelocytes, metamyelocytes and nally, mature granulocytes.
Granulopoiesis is stimulated by many growth factors including interleukin-1 (IL-1), IL-3, IL-5 (for eosinophils), IL-11 and
granulocyte colony stimulating factor (G-CSF).
Monocytes divide and differentiate from the granulocyte macrophage progenitor into monoblasts, promonocytes,
monocytes and tissue macrophages (in increasing order of maturity).
Lymphocytes are derived from the lymphoid progenitor. The primary function of white cells is to protect the body
against infection. Increased granulocyte and monocyte production in response to infection is induced by increased
production of growth factors from stromal cells and T-cells, stimulated by endotoxin and cytokines such as IL-1 and
tumour necrosis factor (TNF).
Which of the following does NOT typically cause a neutrophilic leucocytosis:
a) Myocardial infarction
b) Corticosteroid therapy
c) Myeloproliferative disorders
http://frcemsuccess.com/rev/sc41/ 3/60
, 6/9/2017 Immunology FRCEM Success
c) Myeloproliferative disorders
d) Glandular fever
e) Appendicitis
Something wrong?
Neutrophil leucocytosis is de ned as a neutrophil count greater than 7.5 x 109/L. Neutrophil leucocytosis is sometimes
accompanied by fever as a result of the release of leucocyte pyrogens. Other characteristic features include:
a ‘shift to the left’ (an increase in the number of immature neutrophils)
the presence of cytoplasmic toxic granulation and Dohle bodies
Causes include:
bacterial infection
in ammation and tissue necrosis (e.g. cardiac infarct, trauma, vasculitis)
metabolic disorders (e.g. uraemia, acidosis)
pregnancy
acute haemorrhage or haemolysis
neoplasms of all types
drugs (e.g. corticosteroid therapy, lithium, tetracycline)
asplenia
myeloproliferative disorders (e.g. CML, essential thrombocythaemia, polycythaemia vera, myelo brosis)
rare inherited disorders
Glandular fever causes a lymphocytosis.
Regarding T cytotoxic cells, which of the following statements is CORRECT:
a) They are CD4 receptor positive.
b) They only recognise antigen in associated with MHC class II molecules.
c) They form the majority of the circulating T-cell population.
d) They secrete cytokines which are required for activation of other immune cells.
e) They kill target cells by inducing apoptosis.
Something wrong?
T-cell differentiation begins in the bone marrow, and following migration of early precursor cells (immature
thymocytes), continues in the thymus. During this process, self-reactive T-cells are deleted (negative selection)
whereas T-cells with some speci city for self-MHC molecules are selected (positive selection). T-cells have T-cell
receptors which recognise peptide fragments of an antigen only in association with MHC molecules.
T-cells may be CD8 or CD4 receptor positive. Those that are CD8 receptor positive interact with antigen only in
http://frcemsuccess.com/rev/sc41/ 4/60
Dashboard Subscription expires in: 1 Days Extend
You have scored 32%
You answered 30 correct out of 94 questions.
Your answers are shown below:
Regarding immunoglobulin, which of the following statements is CORRECT:
a) Within an immunoglobulin molecule, there will be one kappa light chain and one delta light chain.
b) Immunoglobulin expressed by different cells are all identical.
c) The class of immunoglobulin is determined by the heavy chain.
d) Only IgM can cross the placenta.
e) IgG is the main immunoglobulin in the primary immune response.
Something wrong?
Immunoglobulin molecules are composed of two identical heavy and two identical light chains, linked by disulphide
bridges. The heavy and light chains each have a highly variable region which give the immunoglobulin speci city. The
light chains consist of one variable amino terminal domain and one constant domain at the carboxy terminal. The
constant region can be kappa or gamma but both light chains within an Ig molecule will be the same; 60 % of human
light chains are kappa. The heavy chain contains one variable and several constant domains.
There are ve classes of immunoglobulin in humans, IgG, IgA, IgM, IgE and IgD which are determined by the heavy
chain which is gamma, alpha, mu, epsilon or delta respectively. IgG is the most abundant in plasma (comprising 80 % of
normal serum immunoglobulin) and the main circulatory Ig for the secondary immune response, it is the only Ig that
can cross the placenta. IgM is the main Ig in the primary immune response and the most pro cient at complement
xation. IgA is the major Ig in secretions particularly from the gastrointestinal tract (but also in saliva, tears, sweat and
breast milk). IgE is important for mast cell degranulation in allergic and antiparasitic response. IgD is expressed on
naive B-cells and its function is not known.
The following are all examples of type II hypersensitivity except for:
http://frcemsuccess.com/rev/sc41/ 1/60
,6/9/2017 Immunology FRCEM Success
a) Haemolytic disease of the newborn
b) Graves disease
c) Rheumatic heart disease
d) Goodpasture’s syndrome
e) Post streptococcal glomerulonephritis
Something wrong?
Type II hypersensitivity (antibody-mediated hypersensitivity) occurs when antibody (normally IgG) speci c for cell
surface antigens (either antibody to foreign cells or autoantibody) is produced. Cell destruction then occur via
complement xation, antibody-dependent cell-mediated cytotoxicity, and phagocytosis. Onset is normally rapid.
Examples of type II reactions include:
incompatible blood transfusions
haemolytic disease of the newborn
autoimmune haemolytic anaemias
Goodpasture’s syndrome
rheumatic heart disease
Several diseases are caused by antibody directed against cell surface receptors which can either stimulate or block the
receptor e.g. Graves disease or myasthenia gravis.
Post streptococcal glomerulonephritis is a type III hypersensitivity reaction.
Which of the following is NOT a mechanism of NK cell killing:
a) Antibody-dependent cell-mediated cytotoxicity
b) Ligation of FAS receptors on the target cell
c) Ligation of TNF receptors on the target cell
d) Degranulation and release of perforins and granzymes
e) Phagocytosis of foreign or damaged cells
Something wrong?
Natural killer (NK) cells are derived from the lymphoid progenitor cell but are neither T nor B cells, and have a role in
the innate immune system through cell-mediated cytotoxicity. They are large granular lymphocytes, which are non-
speci c and have no memory cells. NK cells do not require T-cell help to kill pathogens, although they are more
effective when T helper cells secrete IFN-gamma. NK cells kill target cells by ligation of FAS and TNF receptors and
secretion of their granular contents (including perforins and granzymes), ultimately inducing target cell apoptosis.
NK cells are designed to kill target cells that have a low level of expression of MHC class I molecules such as a viral
http://frcemsuccess.com/rev/sc41/ 2/60
,6/9/2017 Immunology FRCEM Success
NK cells are designed to kill target cells that have a low level of expression of MHC class I molecules such as a viral
infected cell or a malignant cell. They do this by displaying a number of receptors for MHC molecules on their surface.
When MHC is expressed on a target cell these deliver an inhibitory signal into the NK cell, when it is absent this
inhibitory signal is loss and the NK cell can kill its target. NK cells also display antibody-dependent cell-mediated
cytotoxicity, where killing is initiated by cross-linking of receptors for the Fc portion of IgG, regardless of the presence
of MHC molecules.
Regarding leucocytes, which of the following statement is CORRECT:
a) The earliest recognisable granulocyte precursors are myelocytes.
b) There are three main types of leucocytes in peripheral blood.
c) Neutrophils, eosinophils and monocytes are all granulocytes.
d) IL-5 is particularly important for eosinophil activation.
e) TNF-alpha inhibits granulopoiesis.
Something wrong?
There are ve main types of leucocytes in peripheral blood;
neutrophils
eosinophils
basophils
monocytes
lymphocytes
Neutrophils, eosinophils and basophils contain granules and are termed granulocytes, and all differentiate from the
same precursor. The earliest recognisable granulocyte precursors are myeloblasts, which then undergo a nal division
followed by further maturation into promyelocytes, myelocytes, metamyelocytes and nally, mature granulocytes.
Granulopoiesis is stimulated by many growth factors including interleukin-1 (IL-1), IL-3, IL-5 (for eosinophils), IL-11 and
granulocyte colony stimulating factor (G-CSF).
Monocytes divide and differentiate from the granulocyte macrophage progenitor into monoblasts, promonocytes,
monocytes and tissue macrophages (in increasing order of maturity).
Lymphocytes are derived from the lymphoid progenitor. The primary function of white cells is to protect the body
against infection. Increased granulocyte and monocyte production in response to infection is induced by increased
production of growth factors from stromal cells and T-cells, stimulated by endotoxin and cytokines such as IL-1 and
tumour necrosis factor (TNF).
Which of the following does NOT typically cause a neutrophilic leucocytosis:
a) Myocardial infarction
b) Corticosteroid therapy
c) Myeloproliferative disorders
http://frcemsuccess.com/rev/sc41/ 3/60
, 6/9/2017 Immunology FRCEM Success
c) Myeloproliferative disorders
d) Glandular fever
e) Appendicitis
Something wrong?
Neutrophil leucocytosis is de ned as a neutrophil count greater than 7.5 x 109/L. Neutrophil leucocytosis is sometimes
accompanied by fever as a result of the release of leucocyte pyrogens. Other characteristic features include:
a ‘shift to the left’ (an increase in the number of immature neutrophils)
the presence of cytoplasmic toxic granulation and Dohle bodies
Causes include:
bacterial infection
in ammation and tissue necrosis (e.g. cardiac infarct, trauma, vasculitis)
metabolic disorders (e.g. uraemia, acidosis)
pregnancy
acute haemorrhage or haemolysis
neoplasms of all types
drugs (e.g. corticosteroid therapy, lithium, tetracycline)
asplenia
myeloproliferative disorders (e.g. CML, essential thrombocythaemia, polycythaemia vera, myelo brosis)
rare inherited disorders
Glandular fever causes a lymphocytosis.
Regarding T cytotoxic cells, which of the following statements is CORRECT:
a) They are CD4 receptor positive.
b) They only recognise antigen in associated with MHC class II molecules.
c) They form the majority of the circulating T-cell population.
d) They secrete cytokines which are required for activation of other immune cells.
e) They kill target cells by inducing apoptosis.
Something wrong?
T-cell differentiation begins in the bone marrow, and following migration of early precursor cells (immature
thymocytes), continues in the thymus. During this process, self-reactive T-cells are deleted (negative selection)
whereas T-cells with some speci city for self-MHC molecules are selected (positive selection). T-cells have T-cell
receptors which recognise peptide fragments of an antigen only in association with MHC molecules.
T-cells may be CD8 or CD4 receptor positive. Those that are CD8 receptor positive interact with antigen only in
http://frcemsuccess.com/rev/sc41/ 4/60
