ACAAI Review for the Allergy &
Immunology Boards UPDATED Exam
Questions and CORRECT Answers
Small-molecule antigen requires covalent linkage to a larger carrier to stimulate adaptive
immune response. The process is achieved in collaboration between hapten-specific B cells
and carrier-specific T cells. This is the basis of developing conjugated vaccines. - CORRECT
ANSWER- ✔✔What is the hapten-carrier effect?
SEB and SEC from Staphylococcus aureus cause food poisoning. TSST from Staphylococcus
aureus and SPE-C from Streptococus pyogenes cause toxic shock syndrome. - CORRECT
ANSWER- ✔✔What are the common superantigens and related diseases?
Natural killer T (NKT) cells recognize lipid antigens, and the CD1 molecule is involved. -
CORRECT ANSWER- ✔✔Which type of T cell recognizes lipid antigens and what molecule
is involved?
Protein antigens are T-cell dependent. Polysaccharide, nucleic acid, and lipids are T-cell
independent. - CORRECT ANSWER- ✔✔Which antigens are T-cell dependent and which
are T-cell independent?
On the MHC class I molecule, α3 is the binding site for CD8. On the MHC class II molecule,
β2 is the binding site for CD4 - CORRECT ANSWER- ✔✔What is the binding site for CD4
on the MHC class I molecule? What is the binding site for CD8 on the MHC class II
molecule?
On the MHC Class I molecule, α1 and α2 make up the peptide binding cleft. On the MHC
class II molecule, α1 and β1 make up the peptide binding cleft. - CORRECT ANSWER-
✔✔Which chain makes up the peptide binding cleft in MHC class I molecules? Which chain
makes up the peptide binding cleft in MHC class II molecules?
An MHC class I molecule presents both intracellular antigens (e.g., viral antigen in
cytoplasm) and extracellular antigens (via cross-presentation). The loading site is
endoplasmic reticulum (ER). - CORRECT ANSWER- ✔✔MHC class I molecule presents
which type of antigens and where does the antigen-MHC class I loading happen?
,The MHC class II locus. They are involved in peptide processing for MHC class I however. -
CORRECT ANSWER- ✔✔In which chromosomal region are the TAP proteins located?
The MHC class II molecule presents extracellular antigens (e.g., antigens from phagocytosed
bacteria). The loading site is phagolysosome. - CORRECT ANSWER- ✔✔MHC class II
molecule presents which type of antigen? Where does the antigen-MHC class II loading
happen?
IL-10 and TGFβ - CORRECT ANSWER- ✔✔Which cytokines are important for Tregs?
TCR, MHC molecules, CD4, CD8, CD19, B7-1, B7-2, Fc receptors, KIR, and VCAM-1 -
CORRECT ANSWER- ✔✔What molecules belong to the Ig superfamily?
Junctional diversity; TdT enzyme is important in this process. - CORRECT ANSWER-
✔✔Which somatic recombination process introduces the greatest diversity in immune
receptors and which enzyme is important in this process?
The FcRn receptor binds to IgG and allows it to be endocytosed. It protects it from the
lysosome and instead recycles it to the cell surface. This accounts for the long half-life of IgG
in humans. This is also the mechanism by which IgG is transported across the placenta and
fetal intestine. IgG3 has the shortest half-life because it poorly binds to FcRn. - CORRECT
ANSWER- ✔✔What is the role of the FcRn receptor?
X-linked lymphoproliferative syndrome (XLP) - CORRECT ANSWER- ✔✔Mutation in SAP
causes which disease?
Cyclosporine binds to cyclophilin, which are proteins also called immunophilins. The drug-
protein complex inhibits calcineurin and therefore NFAT translocation to the nucleus. -
CORRECT ANSWER- ✔✔Immunosuppressant cyclosporine binds to which molecule in T-
cell signaling pathway?
CD21, CD19, and CD81 - CORRECT ANSWER- ✔✔What CD molecules are in the BCR
coreceptor?
,CXCR4 - CORRECT ANSWER- ✔✔Which chemokine receptor is associated with WHIM
(warts, hypogammaglobulinemia, infections, amd myelokathexis) syndrome?
α4β7 - CORRECT ANSWER- ✔✔Which integrin molecule is important for gut homing by
binding to MAdCAM?
4-10 days - CORRECT ANSWER- ✔✔Upon first exposure to a medication, when might a
patient develop symptoms of serum sickness?
IL-4 Rα, which is targeted by dupilumab - CORRECT ANSWER- ✔✔Which component is
shared by IL-4 and IL-13 receptors?
IFNγ receptor deficiency results in susceptibility to Mycobacterium tuberculosis and other
intracellular bacteria. - CORRECT ANSWER- ✔✔What is the result of IFNγ receptor
deficiency?
IL-1β - CORRECT ANSWER- ✔✔What interleukin is excessively produced in
cryopyrinopathies?
Lipopolysaccharide responsive beige-like anchor protein (LRBA) deficiency - CORRECT
ANSWER- ✔✔What disease presents with early onset hypogammaglobulinemia with
autoimmunity and immune dysregulation?
It maintains intracellular stores of CTLA4, which can stop T-cell activation. - CORRECT
ANSWER- ✔✔What is the function of LRBA?
Properidin - CORRECT ANSWER- ✔✔Which complement deficiency is inherited as X-
linked?
CD 59 and S protein - CORRECT ANSWER- ✔✔What two molecules inhibit MAC
formation?
CD 55 and CD 59 - CORRECT ANSWER- ✔✔Which complement receptor is implicated in
PNH (paroxysmal nocturnal hemoglobinuria)?
, Adipose tissue - CORRECT ANSWER- ✔✔What is the main source of Factor D?
HUVS (hypocomplementemic urticarial vasculitis) - CORRECT ANSWER- ✔✔Anti-C1q
antibody is found in which disease process?
Factor XII - CORRECT ANSWER- ✔✔Contact activation pathway is initiated by which
factor?
B-2 receptor - CORRECT ANSWER- ✔✔Bradykinin acts on what receptor on endothelial
cells?
IgG and IgM - CORRECT ANSWER- ✔✔What are the primary immunoglobulins involved
with type II hypersensitivity?
Classical pathway - CORRECT ANSWER- ✔✔IgG and IgM activate which complement
pathway?
Both are type III hypersensitivity reactions; however, serum sickness is systemic and arthus
reaction is local - CORRECT ANSWER- ✔✔How are serum sickness and arthus reaction
similar and different?
Innate immunity and adaptive immunity - CORRECT ANSWER- ✔✔Complement activation
is involved with what types of immunity?
PAMPS - CORRECT ANSWER- ✔✔How do receptors of the innate immune system
recognize microorganisms?
NODs - CORRECT ANSWER- ✔✔What receptor is involved with the inflammasome?
TLR 3 - CORRECT ANSWER- ✔✔Which TLR does not signal through MyD88?
Immunology Boards UPDATED Exam
Questions and CORRECT Answers
Small-molecule antigen requires covalent linkage to a larger carrier to stimulate adaptive
immune response. The process is achieved in collaboration between hapten-specific B cells
and carrier-specific T cells. This is the basis of developing conjugated vaccines. - CORRECT
ANSWER- ✔✔What is the hapten-carrier effect?
SEB and SEC from Staphylococcus aureus cause food poisoning. TSST from Staphylococcus
aureus and SPE-C from Streptococus pyogenes cause toxic shock syndrome. - CORRECT
ANSWER- ✔✔What are the common superantigens and related diseases?
Natural killer T (NKT) cells recognize lipid antigens, and the CD1 molecule is involved. -
CORRECT ANSWER- ✔✔Which type of T cell recognizes lipid antigens and what molecule
is involved?
Protein antigens are T-cell dependent. Polysaccharide, nucleic acid, and lipids are T-cell
independent. - CORRECT ANSWER- ✔✔Which antigens are T-cell dependent and which
are T-cell independent?
On the MHC class I molecule, α3 is the binding site for CD8. On the MHC class II molecule,
β2 is the binding site for CD4 - CORRECT ANSWER- ✔✔What is the binding site for CD4
on the MHC class I molecule? What is the binding site for CD8 on the MHC class II
molecule?
On the MHC Class I molecule, α1 and α2 make up the peptide binding cleft. On the MHC
class II molecule, α1 and β1 make up the peptide binding cleft. - CORRECT ANSWER-
✔✔Which chain makes up the peptide binding cleft in MHC class I molecules? Which chain
makes up the peptide binding cleft in MHC class II molecules?
An MHC class I molecule presents both intracellular antigens (e.g., viral antigen in
cytoplasm) and extracellular antigens (via cross-presentation). The loading site is
endoplasmic reticulum (ER). - CORRECT ANSWER- ✔✔MHC class I molecule presents
which type of antigens and where does the antigen-MHC class I loading happen?
,The MHC class II locus. They are involved in peptide processing for MHC class I however. -
CORRECT ANSWER- ✔✔In which chromosomal region are the TAP proteins located?
The MHC class II molecule presents extracellular antigens (e.g., antigens from phagocytosed
bacteria). The loading site is phagolysosome. - CORRECT ANSWER- ✔✔MHC class II
molecule presents which type of antigen? Where does the antigen-MHC class II loading
happen?
IL-10 and TGFβ - CORRECT ANSWER- ✔✔Which cytokines are important for Tregs?
TCR, MHC molecules, CD4, CD8, CD19, B7-1, B7-2, Fc receptors, KIR, and VCAM-1 -
CORRECT ANSWER- ✔✔What molecules belong to the Ig superfamily?
Junctional diversity; TdT enzyme is important in this process. - CORRECT ANSWER-
✔✔Which somatic recombination process introduces the greatest diversity in immune
receptors and which enzyme is important in this process?
The FcRn receptor binds to IgG and allows it to be endocytosed. It protects it from the
lysosome and instead recycles it to the cell surface. This accounts for the long half-life of IgG
in humans. This is also the mechanism by which IgG is transported across the placenta and
fetal intestine. IgG3 has the shortest half-life because it poorly binds to FcRn. - CORRECT
ANSWER- ✔✔What is the role of the FcRn receptor?
X-linked lymphoproliferative syndrome (XLP) - CORRECT ANSWER- ✔✔Mutation in SAP
causes which disease?
Cyclosporine binds to cyclophilin, which are proteins also called immunophilins. The drug-
protein complex inhibits calcineurin and therefore NFAT translocation to the nucleus. -
CORRECT ANSWER- ✔✔Immunosuppressant cyclosporine binds to which molecule in T-
cell signaling pathway?
CD21, CD19, and CD81 - CORRECT ANSWER- ✔✔What CD molecules are in the BCR
coreceptor?
,CXCR4 - CORRECT ANSWER- ✔✔Which chemokine receptor is associated with WHIM
(warts, hypogammaglobulinemia, infections, amd myelokathexis) syndrome?
α4β7 - CORRECT ANSWER- ✔✔Which integrin molecule is important for gut homing by
binding to MAdCAM?
4-10 days - CORRECT ANSWER- ✔✔Upon first exposure to a medication, when might a
patient develop symptoms of serum sickness?
IL-4 Rα, which is targeted by dupilumab - CORRECT ANSWER- ✔✔Which component is
shared by IL-4 and IL-13 receptors?
IFNγ receptor deficiency results in susceptibility to Mycobacterium tuberculosis and other
intracellular bacteria. - CORRECT ANSWER- ✔✔What is the result of IFNγ receptor
deficiency?
IL-1β - CORRECT ANSWER- ✔✔What interleukin is excessively produced in
cryopyrinopathies?
Lipopolysaccharide responsive beige-like anchor protein (LRBA) deficiency - CORRECT
ANSWER- ✔✔What disease presents with early onset hypogammaglobulinemia with
autoimmunity and immune dysregulation?
It maintains intracellular stores of CTLA4, which can stop T-cell activation. - CORRECT
ANSWER- ✔✔What is the function of LRBA?
Properidin - CORRECT ANSWER- ✔✔Which complement deficiency is inherited as X-
linked?
CD 59 and S protein - CORRECT ANSWER- ✔✔What two molecules inhibit MAC
formation?
CD 55 and CD 59 - CORRECT ANSWER- ✔✔Which complement receptor is implicated in
PNH (paroxysmal nocturnal hemoglobinuria)?
, Adipose tissue - CORRECT ANSWER- ✔✔What is the main source of Factor D?
HUVS (hypocomplementemic urticarial vasculitis) - CORRECT ANSWER- ✔✔Anti-C1q
antibody is found in which disease process?
Factor XII - CORRECT ANSWER- ✔✔Contact activation pathway is initiated by which
factor?
B-2 receptor - CORRECT ANSWER- ✔✔Bradykinin acts on what receptor on endothelial
cells?
IgG and IgM - CORRECT ANSWER- ✔✔What are the primary immunoglobulins involved
with type II hypersensitivity?
Classical pathway - CORRECT ANSWER- ✔✔IgG and IgM activate which complement
pathway?
Both are type III hypersensitivity reactions; however, serum sickness is systemic and arthus
reaction is local - CORRECT ANSWER- ✔✔How are serum sickness and arthus reaction
similar and different?
Innate immunity and adaptive immunity - CORRECT ANSWER- ✔✔Complement activation
is involved with what types of immunity?
PAMPS - CORRECT ANSWER- ✔✔How do receptors of the innate immune system
recognize microorganisms?
NODs - CORRECT ANSWER- ✔✔What receptor is involved with the inflammasome?
TLR 3 - CORRECT ANSWER- ✔✔Which TLR does not signal through MyD88?
