Immunedermatology MCQs

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. Q/Q(M)-482724 Report a Problem 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 Q/Q(M)-476134 Report a Problem

The classical complement pathway: 3

Can be activated by IgM

The classical complement pathway is activated by b y 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. Q/Q(M)-476134 Report a Problem

Which paraprotein is found most commonly in patients with pyoderma gangrenosum? 1

IgG

2

IgA

3

IgM

4

IgE

5

IgD 1

Q/Q(M)-474203 Report a Problem 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. Q/Q(M)-474203 Report a Problem

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 Q/Q(M)-474204 Report a Problem

Angiocentric NK/T-cell lymphoma in children may present as: 4

Hydroa vacciniforme

Hydroa vacciniforme a photodermatitis that typically occurs with s un exposure in the spring has  been reported with NK/T cell lymphomas lymphomas in childhood. for answer Q/Q(M)-474204 Report a Problem

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 Q/Q(M)-476612 Report a Problem

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 The other statements are true. Q/Q(M)-476612 Report a Problem Herpes simplex virus-related erythema multiforme has been associated with an increased frequency frequenc y of:

2

1

HLA-B7

2

HLA-B8

3

HLA-B13

4

HLA-B15

5

HLA-B27 Q/Q(M)-474205 Report a Problem

Herpes simplex virus-related erythema multiforme has been associated with an increased frequency frequenc y of: 4

HLA-B15

Erythema multiforme associated with herpes simplex has been reported to have an increase of HLAB15. Q/Q(M)-474205 Report a Problem

Which cytokine is not upregulated in atopic dermatitis patients? 1

IL-13

2

IL-4

3

IL-5

4

IL-10

5

IFN-gamma Q/Q(M)-477687 Report a Problem

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 i n 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 3

Q/Q(M)-474208 Report a Problem

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 exfoliati ve toxin of group II staphylococcus aureus that is usually responsible for bullous impetigo. Q/Q(M)-474208 Report a Problem

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 Q/Q(M)-476657 Report a Problem

Pemphigus is associated with which HLA type(s)? 1

HLA-DRw6

Pemphigus is associated with HLA-DR4 or DRw6. Q/Q(M)-476657 Report a Problem

All of the following statements are true regarding r egarding 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 surface Q/Q(M)-476126 Report a Problem

All of the following statements are true regarding r egarding cells of the innate immune system EXCEPT: 3

IL-5 downregulates the functions of eosinophils

 Neutrophils, eosinophils, and basophils 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. Q/Q(M)-476126 Report a Problem 4

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 Q/Q(M)-482728 Report a Problem

A 27 year old gentleman with a known history of chronic plaque psoriasis complains of pain and stiffness of his joints, particularly particularl y 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 li chen planus, and B51 with Behcet's disease. Q/Q(M)-482728 Report a Problem

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 Q/Q(M)-476619 Report a Problem

MHC Class II molecules are present on which of the following cell types: 1

B cells

MHC Class II molecules are on B cells, cel ls, monocytes, dendritic cells, and are inducible on keratinocytes and endothelial cells. Q/Q(M)-476619 Report a Problem Linear IgA disease is most closel y associated with which of the following medications? 1

Erythromycin

2

Vancomycin 5

3

Streptomycin

4

Azithromycin

5

Clarithromycin Q/Q(M)-474195 Report a Problem

Linear IgA disease is most closel y associated with which of the following medications? 2

Vancomycin

Vancomycin is an antibiotic frequently used in subjects all ergic to penicillin. It has been reported to  produce subepidermal blistering disease with linear IgA deposits. Q/Q(M)-474195 Report a Problem 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 Tcells? 1

Melanocyte

2

Langerhans Cell

3

B-cell

4

Mast Cell

5

Macrophage Q/Q(M)-477686 Report a Problem

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 Tcells? 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 na �ve T-cells are educated to expand to a clone of CLA positive memory T-cells. These cell s 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 6

5

None of these answers are correct Q/Q(M)-474881 Report a Problem

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 Q/Q(M)-478585 Report a Problem

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. Q/Q(M)-478585 Report a Problem 7

Relapsing polychondritis is an autoimmune disease associated with immunity to which type of collagen? 1

I

2

II

3

III

4

IV

5

VII Q/Q(M)-474230 Report a Problem

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. Q/Q(M)-474230 Report a Problem A male infant presents with thrombocytopenia, eczema, and recurrent infec tions. You suspect which of the following immunodeficiency disorders? 1

Ataxia telangiectasia

2

Di-George anomaly

3

Hyper-IgM syndrome

4

Leinerâ™s

5

Wiskott-Aldrich syndrome

disease

Q/Q(M)-482142 Report a Problem

A male infant presents with thrombocytopenia, eczema, and recurrent infec tions. You suspect which of the following immunodeficiency disorders? 5

Wiskott-Aldrich syndrome

Wiskott-Aldrich syndrome is an X-linked recessive disorder that pr esents with thrombocytopenia, small defective platelets, eczema, autoimmune disease, infections, and lymphoreticular malignancy. Q/Q(M)-482142 Report a Problem Which cytokine is responsible for activating natural killer cells? 1

Interleukin 4

2

Interleukin 2 8

3

Interferon-alpha

4

Terferon-gamma

5

Tumor necrosis factor-alpha Q/Q(M)-477170 Report a Problem

Which cytokine is responsible for activating natural killer cells? 2

Interleukin 2

Activation of natural killer cells occurs via interleukin i nterleukin 2 (IL-2). IL-2 is a key ke y component of the Th1 (cell-mediated) immunity. It acts to promote growth, proliferation and act ivation of T cells, B cells and natural killer cells. Q/Q(M)-477170 Report a Problem

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 Q/Q(M)-476135 Report a Problem

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. Q/Q(M)-476135 Report a Problem 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 Q/Q(M)-482709 Report a Problem

9

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

Toll-like receptors are pattern recognition r ecognition receptors involved in innate immunity. They are most highly expressed on monocytes, dendritic cells, cells , and B cells. Imiquimod works through binding to toll-like receptor 7. The native ligand for TLR7 is single-st randed RNA. Q/Q(M)-482709 Report a Problem

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 Q/Q(M)-482140 Report a Problem

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 nutshel ls and oil, Indian marking nut oleoresin, gingko fruit pulp, and Japanese lacquer tree oleoresin. Q/Q(M)-482140 Report a Problem

The gene for NEMO (NF-kappa bets essential modulator) is mutated in: 1

Papillon-Lef �vre syndrome

2

Pachyonychia congenital type II

3

Dyskeratosis congenital

4

 Noonan�s syndrome

5

Incontinentia pigmenti Q/Q(M)-474183 Report a Problem

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 nuclear factor kappa B pathway, which is a common signaling pathway for many cytokines. Mutation in this pathway have been found to cause c ause incontinentia pigmenti. 10

Q/Q(M)-474183 Report a Problem 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 Q/Q(M)-482711 Report a Problem

Which of the following cytokines is primarily involved in activating eosinophils? 1

IL-5

Eosinophils provide many functions of the immune s ystem, including protection against helminths. They are activated by IL-5. Q/Q(M)-482711 Report a Problem 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 Q/Q(M)-474192 Report a Problem

Which of the following best describes the mechanism of action for infliximab? 3

Inhibition of tumor necrosis factor alpha activity

Infliximab is a monoclonal antibody given intravenously that binds to membrane-bound and soluble TNF-alpha. Q/Q(M)-474192 Report a Problem

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 11

4

ICAM-1

5

P-selectin Q/Q(M)-477688 Report a Problem

Efalizumab is an antibody which is directed against LFA1 on the T-cell, blocking this molecule's interaction 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. Q/Q(M)-477688 Report a Problem

A homeless patient presents with a scaling, pustular periorifical eruption around the mouth and genitalia. 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 Q/Q(M)-482856 Report a Problem

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, acrodermatiti s 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. Q/Q(M)-482856 Report a Problem

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 Q/Q(M)-482540 Report a Problem 12

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 activating human Toll-like receptor 4 (TLR4). Studies with mutant TLR4 proteins revealed that the nonconserved histidines 456 and 458 of human TLR4 are required for activation by Ni(2+) but not by the natural ligand lipopolysaccharide. Q/Q(M)-482540 Report a Problem 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 Q/Q(M)-482913 Report a Problem

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. Q/Q(M)-482913 Report a Problem Which monoclonal gammopathy is most commonly associated with erythema elevatum diutinum? 1

IgA

2

IgD

3

IgE

4

IgG

5

IgM Q/Q(M)-474218 Report a Problem

Which monoclonal gammopathy is most commonly associated with erythema elevatum diutinum? 1

IgA

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

Q/Q(M)-474218 Report a Problem

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 Q/Q(M)-477694 Report a Problem

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. famil y. 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. Q/Q(M)-477694 Report a Problem

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

5

Inhibition of interleukin-2 gene transcription Q/Q(M)-474214 Report a Problem

The pharmacologic activity of tacrolimus includes: 5

Inhibition of interleukin-2 gene transcription

Tacrolimus is a macrolide similar to cyclosporine and pimecrolimus (Elidel). Calcineurin is a  phosphatase that dephosphorylates dephosphorylates subunit on NFAT (nuclear factor of activated T cells). Q/Q(M)-474214 Report a Problem

The most useful pair of immunohistochemical stains to distinguish between Dermatofibroma  protuberans (DFSP) and a fibrous fibrous histiocytoma would be: 1

Synaptophysin, chromogranin

2

CD34, factor XIIIa 14

3

CD34, CD31

4

CD31, CD3

5

Vimentin, synaptophysin Q/Q(M)-474213 Report a Problem

The most useful pair of immunohistochemical stains to distinguish between Dermatofibroma  protuberans (DFSP) and a fibrous 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. Q/Q(M)-474213 Report a Problem

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 Q/Q(M)-477161 Report a Problem

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 t ypes (B cells, T cells). Q/Q(M)-477161 Report a Problem

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 Q/Q(M)-474206 Report a Problem

Immunocytomas are: 1

Low grade B-cell lymphomas 15

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. Q/Q(M)-474206 Report a Problem

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 Q/Q(M)-477227 Report a Problem

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 res ponse. They are not  processed by antigen presenting cells. Instead, they bind bind directly to the MHCII complex and interact with T cells in a relatively relativel y 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. Q/Q(M)-477227 Report a Problem

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 Q/Q(M)-474217 Report a Problem

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 16

This woman should have a workup for: 1

Lymphoma

2

Nephrolithiasis

3

Pancreatic cancer

4

Hemochromatosis

5

Thalassemia Q/Q(M)-475819 Report a Problem

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 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 Q/Q(M)-476511 Report a Problem

Dermatitis herpetiformis is associated with which HLA type(s)? 4

All of the above

Dermatitis herpetiformis is associated ass ociated with HLA-B8, -DR3, and -DQw2. Q/Q(M)-476511 Report a Problem

17

This lesion is hypoesthetic and is associated with which of the following: 1

Gamma interferon

2

Interleukin 2

3

Interleukin 12

4

All of these answers are correct

5

None of these answers are correct Q/Q(M)-474883 Report a Problem

This lesion is hypoesthetic and is associated with which of the following: 4

All of these answers are correct

The lesion is high immune or tuberculoid leprosy, which is associated with TH1 cytokines including IFN-gamma, IL2, IL12, IL15, IL18 and IL23. Q/Q(M)-474883 Report a Problem

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 Q/Q(M)-478663 Report a Problem

18

Which of the following is an example of a delayed hypersensitivity reaction? 1

Allergic contact dermatitis

There are 4 types of Hypersensitivities: ("ACID") T ype I: Anaphylactic and Atopic: Examples Urticaria, Asthma, and Allergic Rhinitis Type II: c ytotoxic: examples - Transfusion reactions, ABO incompatibility, Rh disease (erythroblastosis fetalis), Autoimmune reactions, Hemolytic disease of newborn, Goodpasture's syndrome Type III: Immune complex, Serum si ckness, 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-aller gies, insect  bites, etc Q/Q(M)-478663 Report a Problem

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, HLA-DQ(A1*0501, B1*02) Q/Q(M)-477696 Report a Problem

Dermatitis Herpetiformis is most commonly associated with which HLA? 5

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

HLA-DQ (A1*0501, B1*02) B1*02) genes are present on 90% of all patients with Dermatitis Herpetiformis. The remainder of patients have the HLA-DQ8 gene. Other associations i nclude: HLA-B8, HLADR3 and DR5/DR7. Q/Q(M)-477696 Report a Problem

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 Q/Q(M)-477705 Report a Problem

19

Which antibody can bind the FcER1 portion of mast cells, basophils, Langerhans cells, dermal dendritic 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 can  bind monomeric IgE via the high-affinity high-affinity Fc �RI IgG is the antibody that can cross the placenta pla centa and the most common antibody found in circulation. IgA is found in mucous membrane secretions and is able to agglutinate antigens and activate the alt ernate 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 earl y stages of antibody responses. It is a  pentamer which can agglutinate antigen and active the classic complement pathway. pathway. Q/Q(M)-477705 Report a Problem

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 Q/Q(M)-482386 Report a Problem

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 and eosinophil peroxidase are all located in the matrix. Chymase is a mediator stored in granules of a mast cell. Q/Q(M)-482386 Report a Problem Which of the following immunoglobulin crosses the placenta? 1

IgA

2

IgD

3

IgE

4

IgG

5

IgM Q/Q(M)-477701 Report a Problem

Which of the following immunoglobulin crosses the placenta? 20

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 f ound 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 alle rgic 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. Q/Q(M)-477701 Report a Problem

Which antibody is most commonly found in circulation of patients with atopic dermatitis? 1

IgA

2

IgD

3

IgE

4

IgG

5

IgM Q/Q(M)-477704 Report a Problem

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 Fc�RI receptor which can bind IgE. More recently, it became cle ar that can  bind monomeric IgE via the high-affinity high-affinity Fc �RI IgG is the antibody that can cross the placenta pla centa and the most common antibody found in circulation. IgA is found in mucous membrane secretions and is able to agglutinate antigens and activate the alt ernate 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 earl y stages of antibody responses. It is a  pentamer which can agglutinate antigen and active the classic complement pathway. pathway. Q/Q(M)-477704 Report a Problem

Which of the following cytokines has been shown to be critical for epidermal a canthosis in  psoriasis? 1

TNF-alpha

2

TGF-beta

3

IL-2

4

FGF

5

IL-22 21

Q/Q(M)-482543 Report a Problem Which of the following cytokines has been shown to be critical for epidermal a canthosis in  psoriasis? 5

IL-22

IL-22 has recently been shown to be critical in c ausing 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 IL22 in human naive T cells. Furthermore, IL-22 mediates IL-23-induced acanthosis and dermal inflammation through the activation of Stat3. Q/Q(M)-482543 Report a Problem

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 Q/Q(M)-474227 Report a Problem

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. Q/Q(M)-474227 Report a Problem

All of the following statements regarding major histocompatibility complex molecules are true EXCEPT: MHC class II molecules bind stably stabl y to peptides derived from proteins sythesized and 1 degraded in the cytosol 2

MHC 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. Q/Q(M)-476132 Report a Problem

22

All of the following statements regarding major histocompatibility complex molecules are true EXCEPT: MHC class II molecules bind stably stabl y to peptides derived from proteins sythesized and 1 degraded in the cytosol MHC class I molecules bind stably to peptides derived from proteins sythesized and degraded in the cytosol, while MHC class II molecules bind stably to peptides der ived 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 Tcells 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. Q/Q(M)-476132 Report a Problem 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 Q/Q(M)-482715 Report a Problem

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 23

Q/Q(M)-475824 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

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 used as an indicator to detect nickel in metals. Q/Q(M)-475824 Report a Problem

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) Q/Q(M)-476724 Report a Problem

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 bacteri a and Toll 4 receptors are activated  by lipopolysaccharide or gram negative bacteria. Nuclear factor kappa B is a final common pathway pathway of toll receptors and other immune receptors involved in initiati ng a variety of proinflammatory cytokines. Q/Q(M)-476724 Report a Problem

A 24 year old female patient is referred refe rred for management of chronic idiopathic urticaria. Many cases of this disease are associated with autoantibodies against what? 1

IgE receptor

2

Tryptase 24

3

Histamine receptor

4

TNF-alpha receptor

5

IL-6 receptor Q/Q(M)-482712 Report a Problem

A 24 year old female patient is referred refe rred 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 cir culating autoantibodies directed against the chain of high affinity IgE receptor on the mast cell surface. Q/Q(M)-482712 Report a Problem

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 Q/Q(M)-474196 Report a Problem

Which of the following suture materials induces the least inflammation? 4

Polypropylene (Prolene)

Prolene is a nonabsorbable suture material that evokes only minimal inflammation. Q/Q(M)-474196 Report a Problem

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 Q/Q(M)-474220 Report a Problem

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. 25

Q/Q(M)-474220 Report a Problem 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 Q/Q(M)-476627 Report a Problem

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 tcell and macrophage mediated cytotoxic response. IL-4, IL-5, and Il-10 are t ypically downregulated in tuberculoid leprosy. Q/Q(M)-476627 Report a Problem

Which T-cell subset is commonly found in S �zary syndrome? 1

CD4+/CD7+

2

CD8+/CD7-

3

CD4-/CD7+

4

CD4+/CD7-

5

CD8+/CD7+ Q/Q(M)-474207 Report a Problem

Which T-cell subset is commonly found in S �zary syndrome? 4

CD4+/CD7-

S�zary syndrome is the leukemia phase of mycosis fungoides (cutaneous T-cell lymphoma) and is usually a TH2-biased CD4+ leukemia. Q/Q(M)-474207 Report a Problem Which of the following is the most abundant leukocyte? 1

Neutrophil

2

Eosinophil

3

Mast cell

4

Lymphocyte 26

5

Monocyte Q/Q(M)-482710 Report a Problem

Which of the following is the most abundant leukocyte? 1

Neutrophil

 Neutrophils are the most abundant leukocyte. leukocyte. The major function of neutrophils is phagocytosis. phagocytosis. Q/Q(M)-482710 Report a Problem

Which immunoglobulin is most efficient at fixing complement? 1

IgM

2

IgE

3

IgD

4

IgA

5

IgG Q/Q(M)-482720 Report a Problem

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. Q/Q(M)-482720 Report a Problem

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 Q/Q(M)-482732 Report a Problem

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 27

have all been associated with an acneiform eruption. Q/Q(M)-482732 Report a Problem 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 Q/Q(M)-476757 Report a Problem

Which is not a feature of mast cells? 2

Responds to RANTES

Mast cells are an integral inte gral portion of immediate type hypersensitivity. RANTES is a chemoattractant for eosinphils, not mast cells. Q/Q(M)-476757 Report a Problem

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 Q/Q(M)-482718 Report a Problem

Which Th2 cytokine is involved in the proliferation and differentiation of B cells? 3

IL-6

The Th2 response is important in promoting humoral immunity. IL-4 promoted Th2 differentiati on, 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. Q/Q(M)-482718 Report a Problem What cytokine is most critical for the development and maturation of eosinophils. 1

Interleukin-2

2

Interleukin-4 28

3

Interleukin-5

4

Interferon-alpha

5

Interferon-gamma Q/Q(M)-482409 Report a Problem

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. Q/Q(M)-482409 Report a Problem

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 Q/Q(M)-482727 Report a Problem

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 as sociated 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 cutaneous lichen planus, B27 with psoriatic arthritis, and B51 with Behcet\'s disease. Q/Q(M)-482727 Report a Problem

What is the best screening test for hereditary angioedema? 1

C1 esterase

2

C4

3

CH50

4

C2

5

C3 29

Q/Q(M)-476516 Report a Problem

What is the best screening test for hereditary angioedema? 2

C4

C4 is the best screening test for f or hereditary angioedema (Quinke's edema). There are two types of hereditary angioedema. In type I, there are low ant igenic and functional levels of a NORMAL C1 esterase 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. Q/Q(M)-476516 Report a Problem

The human major histocompatibility complex (MHC) is located on chromosome: 1

2

2

6

3

9

4

11

5

17 Q/Q(M)-476615 Report a Problem

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 abilit y 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. Q/Q(M)-476615 Report a Problem

The antibody produced in the early stages of antibody responses is: 1

IgA

2

IgD

3

IgE

4

IgG

5

IgM Q/Q(M)-477703 Report a Problem

The antibody produced in the early stages of antibody responses is: 5

IgM

IgM is the antibody produced in the early stages of antibody responses. It is a pentamer which can 30

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 act ivate the alternate but not the classic cla ssic 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 pat ients. IgE is an anaphylactic antibody that is involved in nearly all immediate allergic and anaphylactic type reactions. Q/Q(M)-477703 Report a Problem

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 Q/Q(M)-474231 Report a Problem

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 Sj �gren�s syndrome. Neonatal lupus 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 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 t rue: 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 Q/Q(M)-478657 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: 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 e ncoding for MHC Class I, Class II, Class III, and Class IB. The level of Class I and II expression can be modulated by cytokines. 31

Q/Q(M)-478657 Report a Problem 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 Q/Q(M)-482545 Report a Problem

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 h yperplasia in  psoriasis in response to IL-23. Q/Q(M)-482545 Report a Problem

Which systemic anti-inflammatory agent specificall y 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 Q/Q(M)-476726 Report a Problem

Which systemic anti-inflammatory agent specificall y 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 ICAM-1 on the antigen presenting cell. By targeting LFA-1 LFA-1 efalizumab specifically blocks the ability of T cells to leave the vasculature and enter the skin. Q/Q(M)-476726 Report a Problem All of the following statements regarding neutrophils are true EXCEPT:

32

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 correct Q/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. phagocytosis. The other statements are correct. Q/Q(M)-476613 Report a Problem Eosinophils are typically seen in the cutaneous infiltrate of: 1

Krabbe�s disease

2

Kaposiform hemangioendothelioma

3

Kawasaki�s disease

4

Kimura�s disease

5

Ki-1 lymphoma Q/Q(M)-474216 Report a Problem

Eosinophils are typically seen in the cutaneous infiltrate of: Kimura�s disease

4

Eotaxin, which attracts eosinophils, is produced by T cells in Kimura �s disease. Q/Q(M)-474216 Report a Problem 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 Q/Q(M)-476659 Report a Problem

Which of the following TH2 cytokines is a B cell growth factor? 1

IL-4 33

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 b y TH1 cells, and is the main macrophage-activating c ytokine. Q/Q(M)-476659 Report a Problem

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 Q/Q(M)-477699 Report a Problem

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. Q/Q(M)-477699 Report a Problem

All of the following stains can be reactive in this condition except 1

CDXIIIa

2

CD31

3

CD34

4

Ulex europaeus

5

Factor VIII-related antigen Q/Q(M)-482128 Report a Problem

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 ar e viewed as a virally induced disease - human herpesvirus 8 34

(HHV-8) is the suspected agent. Cutaneous lesions present as variably distributed pink patches, blueviolet 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 i s  positive in dermatofibroma. Q/Q(M)-482128 Report a Problem

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 Q/Q(M)-478660 Report a Problem

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. Q/Q(M)-478660 Report a Problem

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 Q/Q(M)-474228 Report a Problem

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. Q/Q(M)-474228 Report a Problem

Which cytokine is up-regulated in this geometric, eczematous dermatitis? 35

1

IL-2

2

IL-4

3

IL-5

4

IL-7

5

IL-10 Q/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 cellmediated and Th1 reaction. The cytokines up-regulated in this process are IL-1, IL-2, IL-12, interferons-alpha and gamma. Q/Q(M)-476802 Report a Problem

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-1 Q/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 anti gen  presenting cells to participate in adhesion and activation. Q/Q(M)-482717 Report a Problem All of the following statements regarding mast cells are true EXCEPT: 36

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 r elease 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. Q/Q(M)-476614 Report a Problem

Which of the following cytokines is a general down-regulator of TH1 immunity? 1

IL-4

2

IL-5

3

IL-10

4

TNF

5

IFN-gamma Q/Q(M)-476660 Report a Problem

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 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 37

Q/Q(M)-478681 Report a Problem

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 li mb of the immune response by providing for the recognition, uptake, processing, and presentation of antigens to sensitized T lymphocytes. They are normally 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. Q/Q(M)-478681 Report a Problem

Which cytokine is most important in recruiting neutrophils? 1

Interleukin-1

2

Interleukin-2

3

Interleukin-4

4

Interleukin-8

5

Interleukin-10 Q/Q(M)-477348 Report a Problem

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. Q/Q(M)-477348 Report a Problem Patients with a type I reaction to latex lat ex may have cross-reactions with which of the following foods? 1

Avocado

2

Horseradish

3

Cashews

4

Parsnips

5

Garlic Q/Q(M)-474224 Report a Problem

Patients with a type I reaction to latex lat ex may have cross-reactions with which of the following foods? 1

Avocado

Latex allergy is a TH2 form of contact sensitivity sensiti vity that is IGE mediated. Using the old Gel and Coombs classification, it was classified as type I hypersensitivity. Q/Q(M)-474224 Report a Problem 38

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 cells

4

Bear peptides derived from pathogens taken up into vesicles

5

All of the above Q/Q(M)-476618 Report a Problem

Major histocompatibility complex (MHC) Class I molecules: 2

Complexed with antigen trigger cytotoxic T cells

MHC Class I molecules are present on all al l nucleated cells. They are recognized by receptors on surfaces of CD8+ T cells, and, when complexed with antigen, trigger cytotoxic T cells. The other statements apply to MHC Class II molecules. Q/Q(M)-476618 Report a Problem

 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 Q/Q(M)-478138 Report a Problem

 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 malignant cells. They achieve this via recognition of IgG 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 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. Q/Q(M)-478138 Report a Problem

Which of the following immunoglobulins cannot activate the complement pathway? 1

IgM 39

2

IgG1

3

IgG2

4

IgG3

5

IgG4 Q/Q(M)-478141 Report a Problem

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 cl assic 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 r esidue sequences of their constant region, IgG1 through IgG4. IgG1 and and IgG3 are potent activators of the classic cl assic 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 Q/Q(M)-475823 Report a Problem

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. Q/Q(M)-475823 Report a Problem

40

Which common contact allergen is detected via the dimethylglyoxime test? 1

Benzocaine

2

Chromates

3

Formaldehyde

4

Nickel

5

Rhus Q/Q(M)-482139 Report a Problem

Which common contact allergen is detected via the dimethylglyoxime test? 4

Nickel

 Nickel is found in virtually all metals of common use. It It is the most common sensitizer in women, and is detected by the dimethylglyoxime test. Q/Q(M)-482139 Report a Problem

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 Q/Q(M)-478140 Report a Problem

All the following conditions exhibit a T-helper cell 1 (Th1) cytokine secretion profile except: 2

Systemic lupus erythematosus

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, IL9, IL-10 and IL-13, whereas Th1 cells are typified by secretion of IFN-gamma, TNF-beta, and IL-2. Q/Q(M)-478140 Report a Problem

When attempting to identify Langerhans cells in a specimen, which marker is most helpful? 1

CD1

2

CD4

3

CD7

4

CD8

5

CD20 Q/Q(M)-477689 Report a Problem

41

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 Tcell marker that is often lost in cutaneous T-cell lymphoma. CD8 is found on cytotoxic T-cells. CD20 is a B-cell marker. Q/Q(M)-477689 Report a Problem

The most common autoimmune disorder in patients with chronic hepatitis C infection is: 1

Autoimmune thyroiditis

2

Idiopathic thrombocytopenic purpura

3

Rheumatoid arthritis

4

Sj�gren�s syndrome

5

Systemic lupus erythematosus Q/Q(M)-474200 Report a Problem

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 as autoimmune thyroiditis. Q/Q(M)-474200 Report a Problem

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 Q/Q(M)-482138 Report a Problem

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 presents clinically with a triad of purpura, joint pain, and GI complaints. Histologicall y it is characterized by  perivascular deposition of IgA. 42

Q/Q(M)-482138 Report a Problem

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 Q/Q(M)-482729 Report a Problem

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. Q/Q(M)-482729 Report a Problem

Which component of the classical pathway of complement acts as a neutrophil chemoattractant? 1

C3a

2

C3b

3

C5a

4

C5b

5

C1 INH Q/Q(M)-482721 Report a Problem

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. Q/Q(M)-482721 Report a Problem  Naive T cells express which of the following surface molecules: 1

CD19

2

CD20 43

3

CD79

4

CD45RO

5

CD45RA Q/Q(M)-477818 Report a Problem

 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 79 are B cell surface markers. Q/Q(M)-477818 Report a Problem

Which virus is most closely associated with Kaposi�s sarcoma in HIV-infected patients? 1

Human herpes virus 2

2

Cytomegalovirus

3

Human herpes virus 6

4

Human herpes virus 8

5

Epstein-Barr virus Q/Q(M)-474209 Report a Problem

Which virus is most closely associated with Kaposi�s sarcoma in HIV-infected patients? 4

Human herpes virus 8

HHV-8 has been repeatedly associated with all forms of Kaposi�s sarcoma. Q/Q(M)-474209 Report a Problem

Herpes gestationis is most commonly associated with which HLA? 1

HLA-DR3

2

HLA-B27

3

HLA-B51

4

HLA-DR9

5

HLA-DQ8 Q/Q(M)-477698 Report a Problem

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 anti44

HLA antibodies patients affected by herpes gestationis. Q/Q(M)-477698 Report a Problem

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

3

Effects can be demonstrated by the example of re activation of latent herpes simplex infection after sun exposure

4

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

5

Effects can be demonstrated by the ability abilit y of an antigen to induce an allergic hypersensitivity reaction when applied to skin which has been exposed to low doses of UV radiation Q/Q(M)-478682 Report a Problem

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 f unction of Langerhans cells (A-False). It causes DNA damage, can reactivate reacti vate HSV, suppresses immune system, and can induce allergic hypersensitivity reaction Q/Q(M)-478682 Report a Problem

In adult patients with Henoch-Sch �nlein 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 Q/Q(M)-474232 Report a Problem

In adult patients with Henoch-Sch �nlein purpura with IgA vasculitis, which of the following complications 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-Sch�nlein syndrome. Q/Q(M)-474232 Report a Problem Which cytokine is the main macrophage-activating cytokine? 1

TNF 45

2

IFN-gamma

3

IL-4

4

IL-10

5

lymphotoxin Q/Q(M)-476131 Report a Problem

Which cytokine is the main macrophage-activating cytokine? 2

IFN-gamma

IFN-gamma is the main macrophage-activating cytokine, and is secr eted by TH1 cells. Q/Q(M)-476131 Report a Problem

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

5

None of these answers are correct Q/Q(M)-477692 Report a Problem

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 f rom 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 de graded 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 re ceptor on the cell surface, especially especi ally  basophils and mast cells, but is not recognized by the MHC complex. Q/Q(M)-477692 Report a Problem

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 Q/Q(M)-476725 Report a Problem 46

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 t argets 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 Q/Q(M)-477702 Report a Problem

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 t he antibody that can cross the placenta and the most common antibody found in circulation. IgD is not found in circulation other than in hyperIgD 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 alle rgic 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. Q/Q(M)-477702 Report a Problem

A patient with Stage 3 mycosis fungoides is referred to a tertiary referral center for further management. Denileukin diftitox is offered as a potential therap y. This medication binds to what receptor on the T cell? 1

IL-2

2

MHC II

3

CD20

4

TNF-alpha

5

CD19 Q/Q(M)-482731 Report a Problem

A patient with Stage 3 mycosis fungoides is referred to a tertiary referral center for further 47

management. Denileukin diftitox is offered as a potential therap y. 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. I t binds to high affinity IL2 (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 cells

5

All of the above Q/Q(M)-476616 Report a Problem

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. Q/Q(M)-476616 Report a Problem

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-DR1 Q/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 des ignated A, B, and C and are present on all nucleated cells. Class I molecules present antigens including autoantigens to cytotoxic T cells. Q/Q(M)-474199 Report a Problem

48

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 Q/Q(M)-478137 Report a Problem

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 immunologically active substances. C3a and C4a cause mast cell degranulation. Assembly of C5b, C6, C7, C8, C9 components results in the membrane attack complex (MAC), which perforates cell membranes me mbranes causing death by osmotic lysis. Q/Q(M)-478137 Report a Problem

A deficiency of this complement component may result clinicall y in susceptibility to pyogenic infections, glomerulonephritis, and partial lipodystrophy: 1

C1 Esterase Inhibitor

2

C3

3

C4

4

C50

5

Properidin Q/Q(M)-476517 Report a Problem

A deficiency of this complement component may result clinicall y in susceptibility to pyogenic infections, glomerulonephritis, and partial lipodystrophy: l ipodystrophy: 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. l ipodystrophy. Q/Q(M)-476517 Report a Problem Calcipotriene-induced improvement in psoriasis is associated with increased lesional levels of which cytokine? 1

Interleukin-2

2

Interleukin-8

3

Tumor necrosis factor 49

4

Interleukin-10

5

Interluekin-12 Q/Q(M)-474202 Report a Problem

Calcipotriene-induced improvement in psoriasis is associated with increased lesional levels of which cytokine? 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. Q/Q(M)-474202 Report a Problem

A 5 year old patient is seen at a tertiary referral center c enter for evaluation of a complex syndrome. s yndrome. Ultimately, he is diagnosed dia gnosed 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 Q/Q(M)-482716 Report a Problem

A 5 year old patient is seen at a tertiary referral center c enter for evaluation of a complex syndrome. s yndrome. Ultimately, he is diagnosed dia gnosed 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 t his syndrome, which includes immune dysregulation, polyendocrinopathy, and enteropathy. Q/Q(M)-482716 Report a Problem

This patient developed an acute vesicular rash aft er 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

5

All of these answers are correct Q/Q(M)-475817 Report a Problem 50

This patient developed an acute vesicular rash aft er 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 the Japanese lacquer tree, to ink from the Indian marking nut, and to the fruit pulp of the ginkgo tree, and others. Q/Q(M)-475817 Report a Problem

Langerhans cell adhesion to keratinocytes is mediated by what adhesion molecule? 1

E-cadherin

2

N-cadherin

3

Desmoglein 3

4

P-cadherin

5

B7 Q/Q(M)-482714 Report a Problem

Langerhans cell adhesion to keratinocytes is mediated by what adhesion molecule? 1

E-cadherin

Langerhans cells are found in the epidermis and on mucosal surfa ces. After antigen exposure and activation, they migrate to regional lymph nodes where they mature into antigen presenting cells. Adhesion to keratinocytes in the epidermis is mediated by e-c adherin. Q/Q(M)-482714 Report a Problem

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 51

5

Serum electophoresis Q/Q(M)-478676 Report a Problem

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. Q/Q(M)-478676 Report a Problem

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) Q/Q(M)-478143 Report a Problem

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 expresse d on post-capillary venules in the lymph nodes and serves as the attachment points for naive T cells. Q/Q(M)-478143 Report a Problem

Which of the following is associated with hepatitis C infection? 1

Essential mixed cryoglobulinemia

2

Rheumatoid arthritis

3

Relapsing polychondritis

4

Wegener �s granulomatosis

5

Dermatomyositis Q/Q(M)-474226 Report a Problem

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. 52

Q/Q(M)-474226 Report a Problem

With which HLA type is psoriasis most definitively linked? 1

HLA-B51

2

HLA-B8

3

HLA-DR4

4

HLA-DR3

5

HLA-Cw6 Q/Q(M)-476658 Report a Problem

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. Q/Q(M)-476658 Report a Problem

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 Q/Q(M)-474219 Report a Problem

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 is classified as a TH2 cytokine. Q/Q(M)-474219 Report a Problem Which of the following immune-mediated events has been demonstrated in psoriasis vulgaris? 1

Clonal expansion of CD8+ T cells

2

Decrease dermal Langerhans cells

3

Downregulation of keratin 16

4

Increase Th2 CD4+ T cells 53

5

Decreased production of interferon-gamma Q/Q(M)-475857 Report a Problem

Which of the following immune-mediated events has been demonstrated in psoriasis vulgaris? 1

Clonal expansion of CD8+ T cells

The involvement of T cells in the pathophysiology of psoriasis vulgaris is well-recognized. Availability of monoclonal antibodies has allowed for extensive characterization of T cell subsets and other mediators increased in psoriasis lesions. CD8+ T cells are highly concentrated in psoriatic epidermis and studies have demonstrated increased IL-2R and HLA-DR surface molecules indicative of persistent activation. Clonal expansion of CD8+ T cells has been observed suggesting that this subset is the major antigen-reactive population. Q/Q(M)-475857 Report a Problem Which of the following HLA alleles is most strongly str ongly associated with Behcet�s disease? 1

HLA-B27

2

HLA-B51

3

HLA-DQw2

4

HLA-DR1

5

HLA-DR4 Q/Q(M)-474193 Report a Problem

Which of the following HLA alleles is most strongly associ ated with Behcet�s disease? 2

HLA-B51

HLA-B51 has been reported with increased relative risks in European, Asian and Middle Eastern  populations. Q/Q(M)-474193 Report a Problem

This skin disease has been shown to be associated with reduced Beta 2 defensin. The diagnosis is: 1

Atopic dermatitis

2

Psoriasis

3

Lepromatous leprosy

4

Tuberculoid leprosy

5

Subacute cutaneous lupus erythematosus Q/Q(M)-474882 Report a Problem

54

This skin disease has been shown to be associated with reduced Beta 2 defensin. The diagnosis is: 1

Atopic dermatitis

The answer is atopic dermatitis. Cathelicidin Catheli cidin 37 (LL-37) and Human Beta 2 Defensins (HBD-2) have been reported reduced in atopic dermatitis and normal or elevated in psoriasis. This could be one factor that predisposes atopics, but not psoriatics to bacterial and viral infections. Q/Q(M)-474882 Report a Problem

This patient says the rash is spreading and not controlled with topical therapy. You give him a course of oral treatment that lasts: 1

1 week

2

2 weeks

3

3 weeks

4

4 weeks

5

5 weeks Q/Q(M)-475827 Report a Problem

This patient says the rash is spreading and not controlled with topical therapy. You give him a course of oral treatment that lasts: 3

3 weeks

Generally, for poison ivy dermatitis, if patients are given a course of oral steroids, the course should s hould  be at least 3 weeks long, as if the duration is shorter, patients may develop a rapid rebound. rebound. Q/Q(M)-475827 Report a Problem

55

A patient with severe chronic psoriasis has failed multiple systemic therapies. Alefacept is initiated for a three month trial. This medication induces apoptosis of T cells by binding to what T cell receptor molecule? 1

CD2

2

CD45RO

3

LFA-3

4

CTLA-4

5

p40 Q/Q(M)-482730 Report a Problem

A patient with severe chronic psoriasis has failed multiple systemic therapies. Alefacept is initiated for a three month trial. This medication induces apoptosis of T cells by binding to what T cell receptor molecule? 1

CD2

Alefacept is a human fusion protein of LFA-3 with Fc protion of IgG1. It binds CD2 on CD45RO memory effector T cells, thus blocking the 2nd signal of T cell activation and leading to apoptosis. A  provider must monitor the CD4 T cell count while a patient is on this medication. Q/Q(M)-482730 Report a Problem Toll-like receptors (TLRs) have been found to play an important role in innate immunit y. This has  been utilized in the development of medications frequently frequently used in dermatology. The mechanism of what medication involves activation of TLR7. 1

Clobetasol

2

Tacrolimus

3

Cyclosporine

4

5-Fluorouracil (5-FU)

5

Imiquimod Q/Q(M)-482408 Report a Problem

Toll-like receptors (TLRs) have been found to play an important role in innate immunit y. This has  been utilized in the development of medications frequently frequently used in dermatology. The mechanism of what medication involves activation of TLR7. 5

Imiquimod

TLRs recognize pathogen-associated molecular patterns (PAMPs) present in a variety of pathogens and activate signaling pathways involved in innate immunity, as well as augmenting adaptive immunity. The mechanism of action of imiquimod involves activation of these pathways via TLR7.  None of the other medications listed above involve TLRs as their main mechanism of action. Q/Q(M)-482408 Report a Problem

Which cytokine is predominantly responsible for the Jarish-Herxheimer reacti on? 56

1

TNF-alpha

2

IL-2

3

IL-5

4

IL-6

5

IL-12 Q/Q(M)-476523 Report a Problem

Which cytokine is predominantly responsible for the Jarish-Herxheimer reacti on? 1

TNF-alpha

The Jarish-Herxheimer reaction may occur after the initiation of treatment of many systemic infections including syphillis. It is an indirect drug induced effect caused by bacterial endotoxins or microbial antigens liberated by the destruction of micro-organisms. Clinica l manifestations may include fever, lymphadenopathy, arthralgias, and exacerbation of pre-existing cutaneous lesions. Tumor necrosis factor-alpha is the primary cytokine that mediates this reaction. Q/Q(M)-476523 Report a Problem Topical tacrolimus and pimecrolimus are used to treat atopic dermatitis and other inflammatory skin conditions. On which of the following ions is the inflammatory pathway blocked by these medications dependent? 1

Sodium

2

Potassium

3

Calcium

4

Selenium

5

Zinc Q/Q(M)-477693 Report a Problem

Topical tacrolimus and pimecrolimus are used to treat atopic dermatitis and other inflammatory skin conditions. On which of the following ions is the inflammatory pathway blocked by these medications dependent? 3

Calcium

Calcium. Both pimecrolimus and tacrolimus penetrate cutaneous T-cells, forming a complex with calcineurin, which blocks the activation of NF-AT, thus blocking the transcription of a variety of genes with a resultant decrease in T-cell mediated inflammation. This pathway is calcium dependent. The other ions are not involved in this process. Q/Q(M)-477693 Report a Problem

Imiquimod induces which of the following cytokines? c ytokines? 1

Interleukin-10

2

Interferon-alpha 57

3

Interleukin-2

4

Interleukin-4

5

Interleukin-5 Q/Q(M)-474229 Report a Problem

Imiquimod induces which of the following cytokines? c ytokines? 2

Interferon-alpha

Imiquimod is a topical immunomodulator that increases a variety of cytokines including interferonalpha. Q/Q(M)-474229 Report a Problem

Keratinocytes express what class of major maj or histocompatibility complex under normal conditions? 1

MHC Class I

2

MHC Class II

3

MHC Class III

4

MHC Class IV

5

MHC Class V Q/Q(M)-478683 Report a Problem

Keratinocytes express what class of major maj or histocompatibility complex under normal conditions? 1

MHC Class I

Keratinocytes express MHC Class I molecules and therefore can be attacked by CD8+ Tc cells, in  particular after viral infection. Although keratinocytes do not express MHC Class II molecules molecules under normal conditions, they can be induced to do so in the setting of inflammatory conditions. Q/Q(M)-478683 Report a Problem

A patient with chronic atopic dermatitis is found to have elevated IgE levels. Which cytokine  promotes isotype switching to IgE? 1

IL-4

2

IL-6

3

IL-5

4

Interferon-gamma

5

IL-23 Q/Q(M)-482719 Report a Problem

A patient with chronic atopic dermatitis is found to have elevated IgE levels. Which cytokine  promotes isotype switching to IgE? 58

1

IL-4

In a typical humoral response, isotype switching occurs subsequent to exposure to antigen. Switching is regulated by T cell derived cytokines. IgG is promoted by IL-4, IL-6, IL-2 and IFNgamma. IgA is promoted by IL-5 and TGF-beta. IgE is promoted by IL-4. Q/Q(M)-482719 Report a Problem

Subacute cutaneous lupus erythematosus has been associated with the ingestion of which of the following drugs? 1

Phenytoin

2

Allopurinol

3

Terbinafine

4

Trimethoprim/sulfamethoxazole

5

Auranofin Q/Q(M)-474198 Report a Problem

Subacute cutaneous lupus erythematosus has been associated with the ingestion of which of the following drugs? 3

Terbinafine

SCLE has been reported to be associated with terbinafine. This condition is often associated with anti-Ro (SS-A) and anti-La (SS-B) antibodies. Q/Q(M)-474198 Report a Problem 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-6

3

IL-12

4

TNF-alpha

5

IFN-gamma Q/Q(M)-482544 Report a Problem

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? 2

IL-6

IL-23 facilitates the differentiation differentiati on and induces complete maturation of Th17 cells. Lesional  psoriatic skin has increased levels of IL-23. IL-6 is essential for development of the IL-23-elicited responses and is required for the development of epidermlal hyerplasia. Q/Q(M)-482544 Report a Problem

59

Sensation is intact in this lesion, but a Fite stain is positive. This lesions is associated with which of the following: 1

IL-4

2

IL-5

3

IL-10

4

All of these answers are correct

5

None of these answers are correct Q/Q(M)-474884 Report a Problem

Sensation is intact in this lesion, but a Fite stain is positive. This lesions is associated with which of the following: 4

All of these answers are correct

The lesion is low immune or lepromatous leprosy, which is associated with TH2 cytokines including IL-4, IL-5, IL-10, and IL-13. Q/Q(M)-474884 Report a Problem

Purpuric contact dermatitis is most likely to be associated with: 1

Nickel

2

Formaldehyde

3

P-phenylenediamine

4

Propylene glycol

60

5

Sorbic acid Q/Q(M)-474225 Report a Problem

Purpuric contact dermatitis is most likely to be associated with: 2

Formaldehyde

Textile dermatitis has been reported to be associated with purpuric contact dermatitis. Q/Q(M)-474225 Report a Problem Which component of the classical pathway of complement acts as an opsonin? 1

C3b

2

C3a

3

C5a

4

C5b

5

C1 INH Q/Q(M)-482722 Report a Problem

Which component of the classical pathway of complement acts as an opsonin? 1

C3b

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. Q/Q(M)-482722 Report a Problem Eight complement receptors have been described. CR1 is the main receptor for which component of complement? 1

C3b

2

Factor B

3

Properdin

4

C1

5

C5b Q/Q(M)-482723 Report a Problem

Eight complement receptors have been described. CR1 is the main receptor for which component of complement? 1

C3b

CR1 (also known as CD35) is the main receptor for C3b. It plays an important role in mediating 61

clearance of immune complexes, phagocytosis, and immune adherence of antibody-coated bacteria to erythrocytes. Q/Q(M)-482723 Report a Problem

Chronic idiopathic urticaria is associated with which HLA type(s)? 1

HLA-DR4

2

HLA-DRB4 53

3

HLA-DQ8

4

all of the above

5

none of the above Q/Q(M)-476524 Report a Problem

Chronic idiopathic urticaria is associated with which HLA type(s)? 4

all of the above

Chronic idiopathic urticaria is associated with H LA -DR4, -DRB4 53, and -DQ8. Q/Q(M)-476524 Report a Problem

Which of the following B cell receptors is involved in immunoglobulin isotype switching? 1

CD40

2

CD19

3

CD20

4

CD154

5

CD22 Q/Q(M)-478142 Report a Problem

Which of the following B cell receptors is involved in immunoglobulin isotype switching? 1

CD40

CD40 activation on B cells by CD40-ligand (CD154) on T cells induces isotype switching from an IgM to IgG response. Defects in the expression of CD40-ligand result in an immunodeficiency state (hyper-IgM syndrome) characterized by low levels of IgG, IgA and IgE, but elevated IgM. CD19, CD20, CD22 are pan-B cell markers. Q/Q(M)-478142 Report a Problem Rituximab works by targeting the CD20 antigen which is predominantly expressed on which of the following cells? 1

Plasma cells

2

B cells 62

3

B cells and plasma cells

4

T cells

5

Dendritic cells Q/Q(M)-482539 Report a Problem

Rituximab works by targeting the CD20 antigen which is predominantly expressed on which of the following cells? 2

B cells

Rituximab targets the CD20 antigen which is predominantly expressed on mature B cells but not  plasma cells, T cells, or dendritic cells. Therefore, even when used in antibody-mediated diseases (such as pemphigus vulgaris), the response to therapy requires a l ong duration of time as the drug targets B cells which must then differentiate dif ferentiate into plasma cells that t hat ultimately produce the pathogenic antibodies in their secreted form. Q/Q(M)-482539 Report a Problem Serum IgA antibodies to tissue transglutaminase occur in: 1

Bullous pemphigoid

2

Linear IgA disease

3

Pemphigus foliaceus

4

Bullous lupus erythematosus

5

Dermatitis herpetiformis Q/Q(M)-474222 Report a Problem

Serum IgA antibodies to tissue transglutaminase occur in: 5

Dermatitis herpetiformis

Autoantibodies to tissue transglutaminase are an area of active investigation in both celiac disease and dermatitis herpetiformis. Q/Q(M)-474222 Report a Problem The putative mechanism of action of topical macrolide immunomodulators is inhibition of: 1

Lymphokine production

2

Prostaglandin secretion

3

Antigen presentation

4

Neutrophil migration

5

Lymphocyte migration Q/Q(M)-474197 Report a Problem

63

The putative mechanism of action of topical macrolide immunomodulators is inhibition of: 1

Lymphokine production

Tacrolimus and pimecrolimus are topical macrolide immunomodulators that inhibit lymphokine or cytokine production via binding to macrophilin. This complex inhibits calcineurin, a phosphatase involved in the activation of NF-AT. This suppresses the production of IL-2 and IFN-gamma (TH1 cytokines) as well as IL-4, 5 and 13 (TH2 cytokines). In addition, they decrease the expression of IgE receptors on Langerhans cells and reduce mast cell degranulation. Q/Q(M)-474197 Report a Problem

For this patient, you request that the lab perform indirect immunofluorescence using what substrate ? 1

Monkey esophagus

2

Rat bladder

3

Guinea pig esophagus

4

Mouse epithelium

5

Hep-2 cells Q/Q(M)-475826 Report a Problem

For this patient, you request that the lab perform indirect immunofluorescence using what substrate ? 3

Guinea pig esophagus

This patient has pemphigus folicaceus, and indirect immunofluorescence works best on guinea pig esophagus. Q/Q(M)-475826 Report a Problem

The main cytokine secreted by Th1 CD8+ effector T-cells is: 1

IL-1

2

IL-2

3

IFN-gamma

4

IL-4

5

IL-5 Q/Q(M)-477691 Report a Problem

64

The main cytokine secreted by Th1 CD8+ effector T-cells is: 3

IFN-gamma

Interferon-gamma is the main cytokine secreted by Th1 CD8+ effector T -cells and is active in  blocking viral replication. IL-2 is also released in Th1 reactions and causes T cell proliferation and differentiation, macrophage, NK, & Tc cell activation. It also a cts as a Th1 autocrine growth factor. IL-1 is a pro-inflammatory cytokine and a pyrogen. 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. Both IL-4 and -5 are secreted by Th2 T-cells. Q/Q(M)-477691 Report a Problem

Psoriasis affects over 2% of the world �s population and has a strong association with which HLA class I haplotype? 1

HLA-DR4

2

HLA-DR1

3

HLA-CW6

4

HLA-B27

5

HLA-DQ6 Q/Q(M)-477647 Report a Problem

Psoriasis affects over 2% of the world �s population and has a strong association with which HLA class I haplotype? 3

HLA-CW6

HLA-CW6 has been seen in up to 90% of patients with early onset psoriasis, 50% with late onset  psoriasis and only 7.4% of the general general population. HLA-DR1 and DR4 are both related to Rheumatoid Arthritis and have a 7x increased relative risk (RR) for developing disease. HLA-B27 is linked to ankylosing spondylitis, postinfection arthridites and Reiter �s disease, with increase relative risks of 100x, 10-20x, and 35x respectively. Q/Q(M)-477647 Report a Problem Anti-epiligrin (laminin 5) antibodies may be seen in: 1

Pemphigoid gestationis

2

Pemphigus vegetans

3

Fogo selvagem

4

Cicatricial pemphigoid

5

Paraneoplastic pemphigus Q/Q(M)-474215 Report a Problem

Anti-epiligrin (laminin 5) antibodies may be seen in: 4

Cicatricial pemphigoid 65

Patients with cicatricial pemphigoid have been reported to have anti -epiligrin antibodies. Q/Q(M)-474215 Report a Problem

Which of the following features of IgG is true? 1

IgG is not an opsonizing antibody

2

IgG is the only class of immunoglobulin that can pass through the placenta

3

IgG cannot activate the complement cascade

4

IgG represents 15% of the total protein in serum

5

IgG is the second immunoglobulin synthesized by the fetus Q/Q(M)-478669 Report a Problem

Which of the following features of IgG is true? 2

IgG is the only class of immunoglobulin that can pass through the placenta

IgG opsonizes bacteria, fixes complement, neutralizes bacterial toxins and viruses, crosses the  placenta. It has the highest serum concentration of all immunoglobulins. Q/Q(M)-478669 Report a Problem

Which cytokine is responsible for fever in patients with sunburn? 1

IL-1

2

IL-5

3

IL-10

4

IL-11

5

TNF-beta Q/Q(M)-476527 Report a Problem

Which cytokine is responsible for fever in patients with sunburn? 1

IL-1

IL-1 is a pyrogenic cytokine responsible for the fever in sunburn. It also is causes B cell maturation and proliferation and NK cell activation. Q/Q(M)-476527 Report a Problem

A patient had antibodies to desmoglein 3, but no antibodies to desmoglein 1 or desmplakin. The likely diagnosis is: 1

Pemphigus vulgaris

2

Pemphigus foliaceous

3

Bullous pemphigoid 66

4

Dermatitis herpetiformis

5

Erythema multiforme Q/Q(M)-474877 Report a Problem

A patient had antibodies to desmoglein 3, but no antibodies to desmoglein 1 or desmplakin. The likely diagnosis is: 1

Pemphigus vulgaris

The answer is pemphigus vulgaris, which typically has autoantibodies to desmoglein 3. While mixed forms of pemphigus can occur, the histology in this case confirmed pemphigus vulgaris. Q/Q(M)-474877 Report a Problem An 8 month-old baby with diffuse purpura is admitted to the hospital for her third episode of  bacterial meningitis. Which component of her immune system system is impaired? 1

CD4 + T cells

2

Natural killer cell activation

3

CD8 + T cells

4

Complement activation

5

Antibody production Q/Q(M)-477377 Report a Problem

An 8 month-old baby with diffuse purpura is admitted to the hospital for her third episode of  bacterial meningitis. Which component of her immune system system is impaired? 4

Complement activation

Predisposition to sporadic and occasionally recurrent meningococcal disease occurs in patients with congenital or acquired complement deficiencies, particularl y late acting components C5-9 Q/Q(M)-477377 Report a Problem

Which of the following diseases does NOT respond with a Th1-type responses? 1

Leishmaniasis which self-resolves

2

Lepromatous Leprosy

3

Tuberculoid Leprosy

4

Allergic contact dermatitis

5

Psoriasis Q/Q(M)-477695 Report a Problem

Which of the following diseases does NOT respond with a Th1-type responses? 2

Lepromatous Leprosy 67

Lepromatous leprosy is Th2 biased. The remaining conditions are Th1 predominant responses. Leishmaniasis which show strong cell-mediated immunity to the parasite and with self-resolving lesions are Th1 responses. In indolent/progressive leishmaniasis, a Th2 pattern is predominant. Q/Q(M)-477695 Report a Problem Langerhans cells are characterized b y the racket-shaped Birbeck granules seen on electron microscopy. What role do Birbeck granules perform in cells? 1

Endosomal recycling

2

Peptide packaging

3

Cellular trafficking

4

Initiation of apoptosis

5

Scaffolding for RNA synthesis Q/Q(M)-482713 Report a Problem

Langerhans cells are characterized b y the racket-shaped Birbeck granules seen on electron microscopy. What role do Birbeck granules perform in cells? 1

Endosomal recycling

Langerhans cells are important dendritic antigen-presenting cells in the epidermis and mucosa. The characteristic Birbeck granules are part of the endosomal recycling compartment. Q/Q(M)-482713 Report a Problem

All of the following statements regarding Langerhans cells are t rue EXCEPT: 1

They are highly phagocytic

2

They express CD1 on their surface

3

They are found in some areas of lymph nodes and spleen

4

They have a high density of Class II molecules on their surface

5

None of these answers are correct Q/Q(M)-476617 Report a Problem

All of the following statements regarding Langerhans cells are t rue EXCEPT: 1

They are highly phagocytic

Langerhans cells are dendritic cells found f ound in high concentrations in epithelial surfaces and some areas of lymph nodes and spleen. They express CD1 on their surface and have a high density of Class II MHC molecules. They are poorly phagocytic. Q/Q(M)-476617 Report a Problem

Which of the following causes a photoallergic contact dermatitis that is exacerbated by UVA radiation? 1

Ascorbic acid 68

2

Titanium dioxide

3

Oxybenzone

4

Zinc oxide

5

Dihydroxyacetone Q/Q(M)-474212 Report a Problem

Which of the following causes a photoallergic contact dermatitis that is exacerbated by UVA radiation? 3

Oxybenzone

Oxybenzone is the most common sunscreen agent causing photoallergic contact dermatitis. Patients sensitive should be instructed to avoid sunscreens containing oxybenzone. Q/Q(M)-474212 Report a Problem

Anti Jo-1 antibodies are directed against which of the following? 1

Topoisomerase

2

Lysyl oxidase

3

Gyrase

4

Histidyl transfer RNA synthetase

5

Telomerase Q/Q(M)-474221 Report a Problem

Anti Jo-1 antibodies are directed against which of the following? 4

Histidyl transfer RNA synthetase

Anti Jo-1 antibody is typical of autoimmune diseases that involve muscle, including dermatomyositis. Q/Q(M)-474221 Report a Problem Which of the follwing is a chemotactic factor fact or for eosinophils? 1

TNF

2

IL2

3

C5a

4

Plasminogen activator

5

IL8 Q/Q(M)-478656 Report a Problem

Which of the follwing is a chemotactic factor fact or for eosinophils? 69

3

C5a

Eosinophil chemotactic factors include all of the foll owing: Histamine, soluble immune complexes, C5a, and HETE Q/Q(M)-478656 Report a Problem

Which cytokine is primarily responsible for stimulation of neutrophils? 1

IL-1

2

IL-4

3

IL-5

4

IL-6

5

IL-8 Q/Q(M)-477483 Report a Problem

Which cytokine is primarily responsible for stimulation of neutrophils? 5

IL-8

IL-8 is primarily responsible for the stimulation stimulati on of neutrophils. IL-5 stimulates eosinophils. IL-4 stimulates mast cells and IgE isotype switching. Q/Q(M)-477483 Report a Problem The target antigen of chronic bullous disease of childhood is: 1

BPAG 1 9230 kd BPAG)

2

97 kd LAD-1 (a component of BPAG2)

3

Collagen type VII

4

Alpha 6 beta 4 integrin

5

Plectin Q/Q(M)-474194 Report a Problem

The target antigen of chronic bullous disease of childhood is: 2

97 kd LAD-1 (a component of BPAG2)

This rare chronic bullous disease of childhood is a s ubepidermal blistering disease with a homogeneous IgA deposits at the epidermal basement membrane. This occurs in children usually less than 5 years of age. Q/Q(M)-474194 Report a Problem

Which of the following cytokines, together with IL-4, promotes isotype switching from IgM to IgE? 1

IL-5

2

IL-10 70

3

IL-13

4

TNF

5

IFN-gamma Q/Q(M)-476663 Report a Problem

Which of the following cytokines, together with IL-4, promotes isotype switching from IgM to IgE? 3

IL-13

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. TNF and IFN-gamma are TH1 cytokines, TH2 cytokines. IFN-gamma is secreted by TH1 cells, and is the main macrophageactivating cytokine. Q/Q(M)-476663 Report a Problem

Which cytokine is chemotactic for neutrophils? 1

IL-2

2

IL-3

3

IL-5

4

IL-6

5

IL-8 Q/Q(M)-476554 Report a Problem

Which cytokine is chemotactic for neutrophils? 5

IL-8

IL-8 is chemotactic for neutrophils. The other cytokines elicit other types of immune cells, IL-2 (Tells), IL-3 (mast cells), IL-5 (eosinophils), IL-6 (plasma cells). Q/Q(M)-476554 Report a Problem

The most definitive HLA association with psoriasis is: 1

HLA-Cw6

2

HLA-B27

3

HLA-B13

4

HLA-B17

5

HLA-B37 Q/Q(M)-477700 Report a Problem

The most definitive HLA association with psoriasis is: 71

1

HLA-Cw6

HLA-Cw6 is associated with a 9-15x greater risk for developing psoriasis. All of the other HLA antigens listed are associated with various types of psoriasis, but at with lesser strength of association. Q/Q(M)-477700 Report a Problem

Anti-centromeric antibodies are associated with which rheumatologic disease? 1

CREST

2

Mixed connective tissue disease

3

SLE

4

Dermatomyositis/polymyositis

5

Progressive systemic sclerosis Q/Q(M)-482141 Report a Problem

Anti-centromeric antibodies are associated with which rheumatologic disease? 1

CREST

Anti-centromeric antibodies are associated with CREST C REST syndrome. Anti-RNP antibodies are associated with MCTD, anti-dsDNA, ssDNA, and Sm associated with SLE, anti-Jo-1 associated with  polymositis, and anti-Scl 70 associated with PSS. Q/Q(M)-482141 Report a Problem

This patient had antibodies to 180 kd antigen. The likely diagnosis is: 1

Bullous pemphigoid

2

Pemphigus vulgaris

3

Pemphigus foliaceous

4

Erythema multiforme

5

Bullous lichen planus Q/Q(M)-474878 Report a Problem

72

This patient had antibodies to 180 kd antigen. The likely diagnosis is: 1

Bullous pemphigoid

The answer is bullous pemphigoid, which shows a characteristic antibasement membrane antibody to Bp180. Q/Q(M)-474878 Report a Problem

73