Charlene Cook, a 38-year-old primigravida, is 35 weeks pregnant. Until recently she has
had an uneventful pregnancy. Two weeks ago, her obstetrician noted lower-extremity
edema, trace protein in her urine (10-20mg/dl), and normal blood pressure (120/80mmHg).
At today’s appointment her blood pressure is elevated at 160/100mmHg, she has marked
proteinuria (3+; 300mg/dl), worsening of ankle swelling, facial and hand swelling, and she
mentions sudden onset of headache and visual disturbance. Charlene is admitted
immediately to hospital and is diagnosed with pre-eclampsia. Within hours she is induced
and gives birth to a healthy baby girl. In the context of uterine NK-cell function, which of
the following is inconsistent with the cause of Charlene’s pre-eclampsia?
a.There is inadequate extravillous trophoblast invasion of the spiral arteries or the uterus.
b.She has maternal homozygosity for the KIR A haplotype.
c.Uterine NK cells fail to secrete adequate amount of cytokines and growth factors needed
to promote angiogenesis and remodeling of the maternal arteries.
d.The baby’s father and mother are homozygous for the C1 epitope.
e.Insufficient activating signals were delivered to uterine NK cells.
Patients who lack _____ are very susceptible to infections with intracellular bacteria,
including the ubiquitous nontuberculous strains of mycobacteria. (Select all that apply.)
a.CD40 ligand
b.the IL-12 receptor
c.the receptor
d.properdin (factor P)
e.CD18.
The autoreactive CD4 T cells of elderly people with rheumatoid arthritis _____. (Select all
that apply.)
a.express high levels of CD28
b.are predominantly anergic
c.express KIR2DS2
d.are highly susceptible to apoptosis in inflamed joints
e.produce IFN- .
A genetic defect in the 5 gene would cause which of the following consequences? (Select
all that apply.)
a.inability to produce functional chains
b.inability to produce a pre-B-cell receptor
c.inability to produce functional or chains
d.production of different light chains owing to defects in allelic exclusion
e.B-cell immunodeficiency
f.chronic bacterial infections
g.requirement for prophylactic injections of antibodies from healthy donors.
Explain specifically how interferon- produced during an infection enhances (A) antigen
processing in the MHC class I pathway, and (B) antigen presentation in the MHC class II
pathway.
Place the following phases of a B cell’s life history in the correct chronological order.
a.negative selection
b.attacking infection
c.finding infection
d.searching for infection
e.repertoire assembly
f.positive selection.
Which of the following is characteristic of a large pre-B cell?
a.VDJ is successfully rearranged and heavy chain is made.
b.V-J is rearranging at the light-chain locus.
c. heavy chain and or light chain is made.
d.V is rearranging to DJ at the heavy-chain locus.
e.D-J is rearranging at the heavy-chain locus.
When a naive B cell binds to an IgG:antigen complex on its cell surface using Fc³RIIB1,
while simultaneously binding to the same antigen using membrane-bound IgM, _____.
a.the IgG:antigen complex is endocytosed
b.the B cell becomes anergic
c.the B cell will switch isotype to IgG
d.the B cell undergoes affinity maturation
e.the B cell secretes large amounts of IgM before becoming a memory B cell.
Some types of B-cell tumor have been treated with rituximab, an anti-CD20 monoclonal
antibody, which exerts its effect through a mechanism known as ______ involving the
participation of NK cells.
a.degranulation
b.neutralization
c.opsonization
d.antibody-dependent cell-mediated cytoxicity
e.receptor-mediated endocytosis.
All of the following are characteristics of blood donations and transfusions that enable
their extensive use for transplantation purposes except _____.
a.individuals can donate on a regular basis without any deleterious effects
b.erythrocytes do not express MHC class I or class II molecules
c.the blood components only need to function for a few weeks
d.only the ABO antigens need to be compatible between donor and recipient
e.blood transfusion is a straight forward and inexpensive process.
A.Explain how mouse monoclonal antibodies (MoAbs) can be used to suppress acute graft
rejection.
B.What feature of these mouse antibodies compromises their effectiveness in vivo and
limits their use?
Which of the following is mismatched?
a.100-110-amino-acid motif: immunoglobulin domain
b.discontinuous epitope: amino acids that are separated in the protein chain but come
together in the folded protein
c.heavy-chain classes: IgG, IgA, IgM, IgE, IgD
d.multivalent antigen: antigen that carries several epitopes of the same or different
specificity
e.four C domains: IgM and IgD.
Identify four different ways in which an individual may come into contact with an allergen
and provide two examples of allergens for each type of contact.
A-(i) Describe the structure of an MHC class I molecule, identifying the different
polypeptide chains and domains. (ii) What are the names of the MHC class I molecules
produced by humans? Which part of the molecule is encoded within the MHC region of
the genome? (iii) Which domains or parts of domains participate in the following: antigen
binding; binding the T-cell receptor; and binding the T-cell co-receptor? (iv) Which
domains are the most polymorphic?
B-Repeat this for an MHC class II molecule.
The surrogate light chain operating during pre-B-cell development is made up of VpreB: .
Its expression with on the pre-B-cell surface is an important checkpoint in B-cell
maturation. Name the T-cell analog of VpreB: 5 and discuss how it is functionally similar.
A-Identify which features of the RAG genes have similarity to the transposase gene of
transposons.
B-Explain how the mechanisms for immunoglobulin and T-cell receptor rearrangement
may have evolved in humans.
Match the physical effects of IgE-mediated mast-cell degranulation in column A with the
tissue exposed to the allergen in column B.
The third hypervariable region (CDR3) is the most variable site in an immunoglobulin V
region. It differs in its composition between the light-chain and heavy-chain V regions.
Explain what this difference is and how the diversity in CDR3 is generated.