Immunedermatology MCQs

1
The Epstein-Barr virus utilizes which cell surface receptor to gain access to cells?
1

CR2
2

B7
3

T-cell receptor
4

TLR7
5

MHC II
Q/Q(M)-482724 Report a Problem

The Epstein-Barr virus utilizes which cell surface receptor to gain access to cells?
1

CR2
EBV utilizes the CR2 receptor for cell entry and infection. the CR2 receptor (also known as CD21)
presents antigen to B cells and is a co-receptor for B cell signalling.

The classical complement pathway:
1

Can be activated in the absence of antibody
2

Can be activated by IgG4
3

Can be activated by IgM
4

Includes C3 and factor B
5

Does not cause membrane damage

The classical complement pathway:
3

Can be activated by IgM
The classical complement pathway is activated by antigen-antibody complexes, while the alternate
complement pathway can be activated in the absence of antibody. IgM and IgG are capable of
activating the classical pathway, but IgG4 does not activate complement. The proteins of the
classical pathway are C1, C2, C3, and C4. Factor B, Factor D, properdin, and C3 are proteins in the
alternate pathway. Biologic activities of complement include opsonization, chemotaxis, anaphylaxis,
immune complex solubilization, membrage damage, and B cell activation.

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

IgG
2

IgA
3

IgM
4

IgE
5

IgD
2


Which paraprotein is found most commonly in patients with pyoderma gangrenosum?
2

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

Angiocentric NK/T-cell lymphoma in children may present as:
1

Papular acrodermatitis of childhood
2

Acropustulosis of infancy
3

Childhood dermatomyositis
4

Hydroa vacciniforme
5

En coup de sabre

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

Hydroa vacciniforme
Hydroa vacciniforme a photodermatitis that typically occurs with sun exposure in the spring has
been reported with NK/T cell lymphomas in childhood. for answer

All of the following statements regarding Natural Killer (NK) cells are true EXCEPT:
1

NK cells have properties of innate and acquired immunity
2

NK cells express CD 2 molecules
3

NK cells are large granular lymphocytes
4

NK cells mediate tumor lysis
5

NK cells mediate lysis of viral-infected cells

All of the following statements regarding Natural Killer (NK) cells are true EXCEPT:
2

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

Herpes simplex virus-related erythema multiforme has been associated with an increased frequency
of:
3

1

HLA-B7
2

HLA-B8
3

HLA-B13
4

HLA-B15
5

HLA-B27

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

HLA-B15
Erythema multiforme associated with herpes simplex has been reported to have an increase of HLA-
B15.

Which cytokine is not upregulated in atopic dermatitis patients?
1

IL-13
2

IL-4
3

IL-5
4

IL-10
5

IFN-gamma

Which cytokine is not upregulated in atopic dermatitis patients?
5

IFN-gamma
Interferon gamma is Th1 cytokine which downregulates Th2 responses. The remaining are Th2
cytokines active in atopic dermatitis. IL-4 is a B-cell growth factor and active in signaling isotope
switching from IgM to IgE. IL-5 is an eosinophil growth factor. IL-10 downregulates Th1 immunity
and IL-13 signals isotope switching along with IL-4.

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
4


The most likely target for exfoliative toxin A in bullous impetigo is:
3

Desmoglein 1
Desmoglein 1, the dominant target antigen of the autoantibody involved in pemphigus foliaceus, is
also the target of the exfoliative toxin of group II staphylococcus aureus that is usually responsible
for bullous impetigo.

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

HLA-DRw6
2

HLA-B8
3

HLA-B51
4

All of these answers are correct
5

None of these answers are correct

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

HLA-DRw6
Pemphigus is associated with HLA-DR4 or DRw6.

All of the following statements are true regarding cells of the innate immune system EXCEPT:
1

Neutrophils have receptors for IgG
2

Basophils are a type of granulocyte, as are neutrophils
3

IL-5 downregulates the functions of eosinophils
4

Langerhans cells are poorly phagocytic
5

Langerhans cells express CD1 on their surface

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

IL-5 downregulates the functions of eosinophils
Neutrophils, eosinophils, and basophils are collectively known as granulocytes. Neutrophils have
receptors for IgG and complement. IL-5 enhances all functions of eosinophils. Langerhans cells are
dendritic cells found in high concentration in epithelial surfaces and some areas of lymph nodes and
spleen. They have a high density of class II MHC molecules and express CD1 on their surface. They
are poorly phagocytic.
5

A 27 year old gentleman with a known history of chronic plaque psoriasis complains of pain and
stiffness of his joints, particularly in his hands. Which HLA subtype is associated with psoriatic
arthritis?
1

B27
2

Cw6
3

B17
4

B51
5

B8

A 27 year old gentleman with a known history of chronic plaque psoriasis complains of pain and
stiffness of his joints, particularly in his hands. Which HLA subtype is associated with psoriatic
arthritis?
1

B27
Psoriatic arthritis, as well as generalized psoriasis,is associated with HLA-B27. HLA-Cw6 is
associated with psoriasis, Bw35 with cutaneous lichen planus, B8 with oral lichen planus, and B51
with Behcet's disease.

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

B cells
2

T cells
3

NK cells
4

Mast cells
5

All of the above

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

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

Linear IgA disease is most closely associated with which of the following medications?
1

Erythromycin
2

Vancomycin
6

3

Streptomycin
4

Azithromycin
5

Clarithromycin

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

Vancomycin
Vancomycin is an antibiotic frequently used in subjects allergic to penicillin. It has been reported to
produce subepidermal blistering disease with linear IgA deposits.

Allergic contact dermatitis is caused by T-cell response to topical exposure to compounds that form
complexes with host proteins (haptens). Which cell is responsible for initial sensitization of the T-
cells?
1

Melanocyte
2

Langerhans Cell
3

B-cell
4

Mast Cell
5

Macrophage

Allergic contact dermatitis is caused by T-cell response to topical exposure to compounds that form
complexes with host proteins (haptens). Which cell is responsible for initial sensitization of the T-
cells?
2

Langerhans Cell
The Langerhans cell phagocytizes the haptens in the epidermis or dermis, begins the process of
maturation and migrates to the regional lymph node, where nave T-cells are educated to expand to
a clone of CLA positive memory T-cells. These cells then can expand and extravasate with
subsequent exposure to the same allergen. Melanocytes, B-cells, Mast cells and macrophages are not
involved in the sensitization process of allergic contact dermatitis.

This disease is most associated with:
1

Gamma interferon
2

IL-4
3

IL-5
4

IL-13
7

5


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.

Histamine is a biologic amine produced by which of the following cells?
1

Monocytes
2

Eosinophils
3

Basophils
4

Platelets
5

Basophils and Platelets

Histamine is a biologic amine produced by which of the following cells?
5

Basophils and Platelets
In the skin, histamine is mainly contained within the granules of dermal mast cells. Histamine is
present in mast cells, basophils, and platelets.
8

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

I
2

II
3

III
4

IV
5

VII

Relapsing polychondritis is an autoimmune disease associated with immunity to which type of
collagen?
2

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

A male infant presents with thrombocytopenia, eczema, and recurrent infections. You suspect which
of the following immunodeficiency disorders?
1

Ataxia telangiectasia
2

Di-George anomaly
3

Hyper-IgM syndrome
4

Leiners disease
5

Wiskott-Aldrich syndrome

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

Wiskott-Aldrich syndrome
Wiskott-Aldrich syndrome is an X-linked recessive disorder that presents with thrombocytopenia,
small defective platelets, eczema, autoimmune disease, infections, and lymphoreticular malignancy.

Which cytokine is responsible for activating natural killer cells?
1

Interleukin 4
2

Interleukin 2
9

3

Interferon-alpha
4

Terferon-gamma
5

Tumor necrosis factor-alpha

Which cytokine is responsible for activating natural killer cells?
2

Interleukin 2
Activation of natural killer cells occurs via interleukin 2 (IL-2). IL-2 is a key component of the Th1
(cell-mediated) immunity. It acts to promote growth, proliferation and activation of T cells, B cells
and natural killer cells.

Proteins in the alternate complement pathway include:
1

Factor B
2

properdin
3

C3
4

Factor B and properdin
5

Factor B, properdin and C3

Proteins in the alternate complement pathway include:
5

Factor B, properdin and C3
Proteins in the alternate complement pathway are Factor B, Factor D, properdin, and C3. The
alternate complement pathway is active against pathogenic microorganisms, virus-infected cells, and
neoplastic cells. The proteins of the classical pathway are C1, C2, C3, and C4.

Imiquimod has been used for many dermatologic conditions. It works by binding to toll-like receptor
7. What is the native ligand of TLR-7?
1

Single-stranded RNA
2

TNF-alpha
3

IL-10
4

IL-23
5

Interferon-alph

10

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 receptors involved in innate immunity. They are most
highly expressed on monocytes, dendritic cells, and B cells. Imiquimod works through binding to
toll-like receptor 7. The native ligand for TLR7 is single-stranded RNA.

A very common pentadecacatechol sensitizer is found in all of the following plants/plant
components except:
1

Gingko fruit pulp
2

Poison sumac
3

Mango fruit pulp
4

Cashew oil
5

Indian marking nut oleoresin

A very common pentadecacatechol sensitizer is found in all of the following plants/plant
components except:
3

Mango fruit pulp
The sensitizer in rhus dermatitis is a pentadecacatechol found in the oleoresin of anacardaciae plants,
including poison ivy/oak/sumac, mango rinds (but not pulp), cashew nutshells and oil, Indian
marking nut oleoresin, gingko fruit pulp, and Japanese lacquer tree oleoresin.

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

Papillon-Lefvre syndrome
2

Pachyonychia congenital type II
3

Dyskeratosis congenital
4

Noonans syndrome
5

Incontinentia pigmenti

The gene for NEMO (NF-kappa bets essential modulator) is mutated in:
5

Incontinentia pigmenti
NEMO/IKK gamma is an essential component of the nuclear factor kappa B pathway, which is a
common signaling pathway for many cytokines. Mutation in this pathway have been found to cause
incontinentia pigmenti.
11


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

IL-5
2

TNF-alpha
3

IL-10
4

IL-2
5

Interferon-gamma

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

IL-5
Eosinophils provide many functions of the immune system, including protection against helminths.
They are activated by IL-5.

Which of the following best describes the mechanism of action for infliximab?
1

Inhibition of calcineurin-mediated dephosphorylation of transcription factors
2

Inhibition of retinoic acid 4-hydroxylase activity
3

Inhibition of tumor necrosis factor alpha activity
4

Selective elimination of activated T cells via binding to high affinity IL-2 receptor
5

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

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

Inhibition of tumor necrosis factor alpha activity
Infliximab is a monoclonal antibody given intravenously that binds to membrane-bound and soluble
TNF-alpha.

Efalizumab is an antibody which is directed against LFA1 on the T-cell, blocking this molecule's
interaction with:
1

CD40
2

B7
3

LFA3
12

4

ICAM-1
5

P-selectin

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.

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

A homeless patient presents with a scaling, pustular periorifical eruption around the mouth and
genitalia. What lab abnormality is associated with this condition?
4

Decrease alkaline phosphatase level
In a homeless patient with poor nutrition, acrodermatitis enteropathica due to zinc deficiency can
presents with a scaling eruption of the periorificial regions. In addition to a low zinc level, levels of
alkaline phosphatase, a zinc dependent enzyme, are decreased.

The elicitation of nickel contact dermatitis requires signaling by which of the following?
1

TLR2
2

TLR4
3

LFA-1
4

TNF-alpha
5

IL-4
13

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 non-
conserved histidines 456 and 458 of human TLR4 are required for activation by Ni(2+) but not by
the natural ligand lipopolysaccharide.

What is the mechanism of action of Ipilimumab?
1

BRAF inhibitor
2

anti-CTLA 4 receptor antibody
3

blocks TNF alpha
4

inhibition of hedgehog signaling pathway
5

inhibits IL2

What is the mechanism of action of Ipilimumab?
2

anti-CTLA 4 receptor antibody
Ipilimumab is an anti-CTLA 4 receptor antibody. Side effects include rash and coitis. Vemurafenib
is a BRAF inhibitor specifically for patients with V600E mutation. Vismodegib inhibits the
hedgehog signaling pathway.

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

IgA
2

IgD
3

IgE
4

IgG
5

IgM

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

IgA
A report of 13 patients indicated IgA is most commonly associated with EED.
14


T-cell anergy occurs if:
1

Stimulation by a MHC Class III molecule is involved
2

MHC/TCR engagement occurs without costimulatory molecules
3

FasL is bound on the T-cell
4

MHC Class I or II is bound in the presence of IL-2
5

A HLA-DM facilitator is not involved with the binding

T-cell anergy occurs if:
2

MHC/TCR engagement occurs without costimulatory molecules
MHC/TCR engagement occurs without costimulatory molecules. MHC Class III molecules are not
involved in this process. The MHC III region encodes for soluble proteins of the complement
cascade and the tumor necrosis family. Fas-FasL interactions promote apoptosis on the target cell,
not stimulation. IL-2 is a stimulatory molecule, produced by Th1 T-cells. It does not produce anergy.
HLA-DM facilitates loading of proteins processed by antigen presenting cells into the MHC class II
molecule before being brought to the cell surface.

The pharmacologic activity of tacrolimus includes:
1

Phosphorylation of NFAT (nuclear factor of transcription)
2

Binding and inhibition of NF kappa B
3

Inhibition of interleukin-1 gene transcription
4

Activation of calcineurin
5


The pharmacologic activity of tacrolimus includes:
5

Tacrolimus is a macrolide similar to cyclosporine and pimecrolimus (Elidel). Calcineurin is a
phosphatase that dephosphorylates subunit on NFAT (nuclear factor of activated T cells).

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

Synaptophysin, chromogranin
2

CD34, factor XIIIa
15

3

CD34, CD31
4

CD31, CD3
5

Vimentin, synaptophysin

The most useful pair of immunohistochemical stains to distinguish between Dermatofibroma
protuberans (DFSP) and a fibrous histiocytoma would be:
2

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

Gene rearrangement analysis is usedful for determining:
1

Lymphocyte clonality in mycosis fungoides
2

Lymphocyte activity
3

Gene Function
4

Gene Mutations
5

T cell receptor status

Gene rearrangement analysis is usedful for determining:
1

Lymphocyte clonality in mycosis fungoides
Gene rearrangement studies are useful to detect clonality in antigen specific cell types (B cells, T
cells).

Immunocytomas are:
1

Low grade B-cell lymphomas
2

Aggressive B-cell lymphomas
3

Low grade T-cell lymphomas
4

Aggressive T-cell lymphomas
5

NK cell lymphomas

Immunocytomas are:
1

Low grade B-cell lymphomas
16

These indolent tumors present as solitary or multiple nodules usually on the extremities. The cells
have been reported to have CD-20 (B cell marker) and have been reported to be bcl-2 positive.

Which component of the T cell receptor is associated with superantigen recognition?
1

D-beta
2

J-alpha
3

J-beta
4

V-alpha
5

V-beta

Which component of the T cell receptor is associated with superantigen recognition?
5

V-beta
Superantigens are able to bypass many elements of the normal immune response. They are not
processed by antigen presenting cells. Instead, they bind directly to the MHCII complex and interact
with T cells in a relatively non-specific fashion. Whereas conventional antigens require recognition
in all 5 elements of the T-cell receptor (V-alpha, J-alpha, V-beta, D-beta, J-beta), superantigens are
recognized by V-beta alone.

A 26 year-old man presents with a history of recurrent episodes of targetoid, erythematous,
edematous macules, patches, and plaques on the arms, legs, palms, and soles. The most likely
etiologic agent is:
1

Parvovirus B19
2

Herpes simplex virus
3

Coxsackievirus
4

Cytomegalovirus
5

Human immunodeficiency virus

A 26 year-old man presents with a history of recurrent episodes of targetoid, erythematous,
edematous macules, patches, and plaques on the arms, legs, palms, and soles. The most likely
etiologic agent is:
2

Herpes simplex virus
This description of the skin disorder is compatible with either erythema multiforme or erythema
elevatum diutinum, both of which have been reported in association with HSV.
17

This woman should have a workup for:
1

Lymphoma
2

Nephrolithiasis
3

Pancreatic cancer
4

Hemochromatosis
5

Thalassemia

This woman should have a workup for:
4

Hemochromatosis
Porphyria cutanea tarda has been shown to be associated with hemochromatosis. Patients with
porphyria cutanea tarda have mutations in the HFE gene, and early detection of mutations can
improve life expectancy for these patients.

Dermatitis herpetiformis is associated with which HLA type(s)?
1

HLA-B8
2

HLA-DR3
3

HLA-DQw2
4

All of the above
5

None of the above

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

All of the above
Dermatitis herpetiformis is associated with HLA-B8, -DR3, and -DQw2.

18

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

Gamma interferon
2

Interleukin 2
3

Interleukin 12
4

5


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

The lesion is high immune or tuberculoid leprosy, which is associated with TH1 cytokines including
IFN-gamma, IL2, IL12, IL15, IL18 and IL23.

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

Allergic contact dermatitis
2

Anaphylaxis
3

Latex allergy
4

Transfusion reaction
5

Serum sickness
19

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

There are 4 types of Hypersensitivities: ("ACID") Type I: Anaphylactic and Atopic: Examples -
Urticaria, Asthma, and Allergic Rhinitis Type II: cytotoxic: examples - Transfusion reactions, ABO
incompatibility, Rh disease (erythroblastosis fetalis), Autoimmune reactions, Hemolytic disease of
newborn, Goodpasture's syndrome Type III: Immune complex, Serum sickness, and arthrus
reactions: examples -PAN, glomerulonephritis, SLE, Rheumatoid arthritis, and serum sickness Type
IV: Delayed (cell-mediated)typesL examples -TB skin test, transplant rejection, contact dermatitis,
interactions and skin repsonsiveness to bacteria, fungi, viruses, and protozoa, photo-allergies, insect
bites, etc

Dermatitis Herpetiformis is most commonly associated with which HLA?
1

HLA-DR3
2

HLA-B27
3

HLA-B8
4

HLA-Bw35
5

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

Dermatitis Herpetiformis is most commonly associated with which HLA?
5

HLA-DQ(A1*0501, B1*02)
HLA-DQ (A1*0501, B1*02) genes are present on 90% of all patients with Dermatitis Herpetiformis.
The remainder of patients have the HLA-DQ8 gene. Other associations include: HLA-B8, HLA-
DR3 and DR5/DR7.

Which antibody can bind the FcER1 portion of mast cells, basophils, Langerhans cells, dermal
dendritic cells?
1

IgA
2

IgD
3

IgE
4

IgG
5

IgM

20

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 FcRI IgG is the antibody that can cross the placenta and
the most common antibody found in circulation. IgA is found in mucous membrane secretions and is
able to agglutinate antigens and activate the alternate but not the classic complement pathway. IgD is
not found in circulation other than in hyper-IgD syndrome, an autosomal recessive disorder caused
by mutations in the mevalonate kinase gene. A significant elevation of serum IgD is seen in 95% of
these patients. IgM is the antibody produced in the early stages of antibody responses. It is a
pentamer which can agglutinate antigen and active the classic complement pathway.

Which of the following substances is located in the core of an eosinophil?
1

Eosinophilic cationic protein
2

Eosinophil-derived neurotoxin
3

Eosinophil peroxidase
4

Major basic protein
5

Chymase

Which of the following substances is located in the core of an eosinophil?
4

Major basic protein
Major basic protein is the only protein located in the core of an eosinophil. Eosinophil cationic
protein, eosinophil-derived neurotoxin, and eosinophil peroxidase are all located in the matrix.
Chymase is a mediator stored in granules of a mast cell.

Which of the following immunoglobulin crosses the placenta?
1

IgA
2

IgD
3

IgE
4

IgG
5

IgM

Which of the following immunoglobulin crosses the placenta?
21

4

IgG
IgG is the antibody that can cross the placenta and the most common antibody found in circulation.
IgA is found in mucous membrane secretions and is able to agglutinate antigens and activate the
alternate but not the classic complement pathway. IgD is not found in circulation other than in
hyper-IgD syndrome, an autosomal recessive disorder caused by mutations in the mevalonate kinase
gene. A significant elevation of serum IgD is seen in 95% of these patients. IgE is an anaphylactic
antibody that is involved in nearly all immediate allergic and anaphylactic type reactions. IgM is the
antibody produced in the early stages of antibody responses. It is a pentamer which can agglutinate
antigen and active the classic complement pathway.

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

IgA
2

IgD
3

IgE
4

IgG
5

IgM

Which antibody is most commonly found in circulation of patients with atopic dermatitis?
3

IgE
IgE is an anaphylactic antibody that is involved in nearly all immediate allergic and anaphylactic
type reactions and commonly seen in elevated levels in patients with atopic dermatitis. Mast cells,
basophils, langerhans cells, dermal dendritic cells as well as monocytes from atopic individuals all
express high-affinity FcRI receptor which can bind IgE. More recently, it became clear that can
bind monomeric IgE via the high-affinity FcRI IgG is the antibody that can cross the placenta and
the most common antibody found in circulation. IgA is found in mucous membrane secretions and is
able to agglutinate antigens and activate the alternate but not the classic complement pathway. IgD is
not found in circulation other than in hyper-IgD syndrome, an autosomal recessive disorder caused
by mutations in the mevalonate kinase gene. A significant elevation of serum IgD is seen in 95% of
these patients. IgM is the antibody produced in the early stages of antibody responses. It is a
pentamer which can agglutinate antigen and active the classic complement pathway.

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

TNF-alpha
2

TGF-beta
3

IL-2
4

FGF
5

IL-22
22


Which of the following cytokines has been shown to be critical for epidermal acanthosis in
psoriasis?
5

IL-22
IL-22 has recently been shown to be critical in causing epidermal acanthosis. Interleukin (IL)-23, a
cytokine involved in the development of IL-17-producing T helper cells (Th17 cells), was found to
have a potential function in the pathogenesis of psoriasis. IL-22 is preferentially produced by Th17
cells and mediates the acanthosis induced by IL-23. IL-23 can directly induce the production of IL-
22 in human naive T cells. Furthermore, IL-22 mediates IL-23-induced acanthosis and dermal
inflammation through the activation of Stat3.

Which of the following is a criterion for the diagnosis of Behcet'sdisease?
1

Inflammatory bowel disease
2

Uveitis
3

Conjunctivitis
4

Nasal septal perforation
5

Lobular panniculitis

Which of the following is a criterion for the diagnosis of Behcet'sdisease?
2

Uveitis
Behcet's is a triad that includes oral ulcerations, genital ulcerations and uveitis. Behcet's also
displays arthritis and gastrointestinal disease. Blindness is the most-feared outcome, and relates to
the uveitis.

All of the following statements regarding major histocompatibility complex molecules are true
EXCEPT:
1

MHC class II molecules bind stably to peptides derived from proteins sythesized and
degraded in the cytosol
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.

23

All of the following statements regarding major histocompatibility complex molecules are true
EXCEPT:
1

MHC class II molecules bind stably to peptides derived from proteins sythesized and
degraded in the cytosol
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 derived from proteins degraded in
endocytic vesicles. MHC class I molecules bearing viral peptides are recognized by cytotoxic T-cells
that subsequently kill the infected cell. MHC Class II molecules bearing peptides trigger helper T-
cells and are recognized by TH1 or TH2 cells. Class I molecules such as HLA-A, B, and C, are
present on all nucleated cells, whereas Class II molecules are on B cells, monocytes, dendritic cells,
and are inducible on keratinocytes and endothelial cells. The MHC is located on chromosome 6 in
humans, its polygenic and polymorphic nature contributes to the ability of the immune system to
respond to a multitude of different and rapidly evolving pathogens.

Which cell surface component of T cells is part of the \"signal 2\" which in addition to T cell
receptor binding leads to T cell activation?
1

CD28
2

B7
3

CD80
4

TNF-alpha receptor
5

CD1a

Which cell surface component of T cells is part of the \"signal 2\" which in addition to T cell
receptor binding leads to T cell activation?
1

CD28
Activation of T cells requires two signals. The first is T cell receptor binding to MHC molecule on
the antigen presenting cell. THe second signal involves CD28 on T cell interacting with B7
molecules on the antigen presenting cells. CD80 is expressed on Langerhans cells after activation.
CD1a is a Langerhans cell surface marker.

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
24


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.

All of the following statements regarding Toll receptors are true EXCEPT:
1

Toll receptors are present on macrophages and dendritic cells
2

Toll 2 receptors are typically activated by lipopolysaccharide
3

Toll 4 receptors are typically activated by gram negative bacteria
4

Nuclear factor kappa B (NFKB) is the final common pathway of toll receptors
5

None of the above (all are true)

All of the following statements regarding Toll receptors are true EXCEPT:
2

Toll 2 receptors are typically activated by lipopolysaccharide
Bacteria can induce inflammation through activation of Toll receptors, which are present on a
variety of cutaneous cells including macrophages, dendritic cells, keratinocytes, and mast cells.
Typically, Toll 2 receptors are activated by gram positive bacteria and Toll 4 receptors are activated
by lipopolysaccharide or gram negative bacteria. Nuclear factor kappa B is a final common pathway
of toll receptors and other immune receptors involved in initiating a variety of proinflammatory
cytokines.

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

IgE receptor
2

Tryptase
25

3

Histamine receptor
4

TNF-alpha receptor
5

IL-6 receptor

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

IgE receptor
Many cases of idiopathic urticaria have circulating autoantibodies directed against the chain of high
affinity IgE receptor on the mast cell surface.

Which of the following suture materials induces the least inflammation?
1

Surgical gut
2

Polyglycolic acid (Dexon)
3

Polyglycan 910 (Vicryl)
4

Polypropylene (Prolene)
5

Silk

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

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

Which of the following is the target antigen in pemphigus vulgaris?
1

Desmoglein 3
2

Desmoplakin
3

Cadherin
4

Type XVII collagen
5

Desmoglein 1

Which of the following is the target antigen in pemphigus vulgaris?
1

Desmoglein 3
Desmoglein 3 is the dominant target auto-antigen in pemphigus vulgaris.
26


Which cytokine is upregulated in lesions of tuberculoid leprosy?
1

IL 2
2

IL 4
3

IL 5
4

IL 10
5

None of the answers are correct

Which cytokine is upregulated in lesions of tuberculoid leprosy?
1

IL 2
Tuberculoid leprosy is characterized by a type I immune related response. Tuberculoid leprosy has
increased amounts of TH1 cytokines including IL-2, interferon gamma, and IL-12. These lead to a t-
cell and macrophage mediated cytotoxic response. IL-4, IL-5, and Il-10 are typically downregulated
in tuberculoid leprosy.

Which T-cell subset is commonly found in Szary syndrome?
1

CD4+/CD7+
2

CD8+/CD7-
3

CD4-/CD7+
4

CD4+/CD7-
5

CD8+/CD7+

Which T-cell subset is commonly found in Szary syndrome?
4

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

Which of the following is the most abundant leukocyte?
1

Neutrophil
2

Eosinophil
3

Mast cell
4

Lymphocyte
27

5

Monocyte

Which of the following is the most abundant leukocyte?
1

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

Which immunoglobulin is most efficient at fixing complement?
1

IgM
2

IgE
3

IgD
4

IgA
5

IgG

Which immunoglobulin is most efficient at fixing complement?
1

IgM
IgM is the first antibody produced by B cells. It is secreted by plasma cells as a pentamer. Due to its
size, IgM doesn\'t enter tissue well. It is the most efficient immunoglobin at fixing complement.

An elderly gentleman with metastatic colon cancer is prescribed erlotinib, an epidermal growth
factor receptor monoclonal antibody. What is the most common cutaneous finding seen as a result of
this class of medication?
1

Acneiform eruption
2

Acral erythema
3

Morbilliform eruption
4

Hypotrichosis
5

Urticaria

An elderly gentleman with metastatic colon cancer is prescribed erlotinib, an epidermal growth
factor receptor monoclonal antibody. What is the most common cutaneous finding seen as a result of
this class of medication?
1

Acneiform eruption
Erlotinib, along with cetuximab and gefitinib, are epidermal growth factor receptor inhibitors that
are used for the treatment of multiple visceral malignancies, including metastatic colon cancer. They
28

have all been associated with an acneiform eruption.

Which is not a feature of mast cells?
1

Expresses c-kit
2

Responds to RANTES
3

Produces IL-8
4

Produces prostaglandin D2
5

Stains with napththol chloro-acetate esterase

Which is not a feature of mast cells?
2

Responds to RANTES
Mast cells are an integral portion of immediate type hypersensitivity. RANTES is a chemoattractant
for eosinphils, not mast cells.

Which Th2 cytokine is involved in the proliferation and differentiation of B cells?
1

IL-4
2

IL-5
3

IL-6
4

IL-10
5

IL-13

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

IL-6
The Th2 response is important in promoting humoral immunity. IL-4 promoted Th2 differentiation,
isotype switching and inhibition of macrophages. IL-5 activates eosinophils. IL-6 assists in the
proliferation and differentiation of B cells. IL-10 decreases expression of MHC II. IL-13 is related to
IL-4, and is implicated in allergic inflammation.

What cytokine is most critical for the development and maturation of eosinophils.
1

Interleukin-2
2

Interleukin-4
29

3

Interleukin-5
4

Interferon-alpha
5

Interferon-gamma

What cytokine is most critical for the development and maturation of eosinophils.
3

Interleukin-5
IL-5 is critical in the development and maturation of eosinophils. IL-2 is an autocrine factor for
activated T cells. IL-4 is involved in B-cell class switching and Th2 differentiation. IFN-alpha is a
major part of the antiviral response. IFN-gamma is involved in macrophage activation and specific
isotype switching.

A 44 year old female complains of intra-oral burning lesions. Examination reveals erythematous
plaques with white striae on the buccal mucosa consistent with oral lichen planus. No cutaneous
lesions are seen. Which of the following HLA types is associated with oral lichen planus?
1

B8
2

Cw6
3

Bw35
4

B27
5

B51

A 44 year old female complains of intra-oral burning lesions. Examination reveals erythematous
plaques with white striae on the buccal mucosa consistent with oral lichen planus. No cutaneous
lesions are seen. Which of the following HLA types is associated with oral lichen planus?
1

B8
Oral lichen planus is a relatively common condition that can cause significant morbidity. Oral lichen
planus is associated with HLA-B8. HLA-Cw6 is associated with psoriasis, Bw35 with cutaneous
lichen planus, B27 with psoriatic arthritis, and B51 with Behcet\'s disease.

What is the best screening test for hereditary angioedema?
1

C1 esterase
2

C4
3

CH50
4

C2
5

C3
30


What is the best screening test for hereditary angioedema?
2

C4
C4 is the best screening test for hereditary angioedema (Quinke's edema). There are two types of
hereditary angioedema. In type I, there are low antigenic and functional levels of a NORMAL 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.

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

2
2

6
3

9
4

11
5

17

The human major histocompatibility complex (MHC) is located on chromosome:
2

6
The MHC is highly polygenic and polymorphic, and this contributes to the ability of of the immune
system to respond to a multitude of different and rapidly evolving pathogens. The MHC is located
on chromosome 6 in humans.

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

IgA
2

IgD
3

IgE
4

IgG
5

IgM

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

IgM
IgM is the antibody produced in the early stages of antibody responses. It is a pentamer which can
31

agglutinate antigen and active the classic complement pathway. IgG is the antibody that can cross
the placenta and the most common antibody found in circulation. IgA is found in mucous membrane
secretions and is able to agglutinate antigens and activate the alternate but not the classic
complement pathway. IgD is not found in circulation other than in hyper-IgD syndrome, an
autosomal recessive disorder caused by mutations in the mevalonate kinase gene. A significant
elevation of serum IgD is seen in 95% of these patients. IgE is an anaphylactic antibody that is
involved in nearly all immediate allergic and anaphylactic type reactions.

Anti-Ro (SS-A) antibodies are most commonly found in:
1

Mixed connective tissue disease
2

Eosinophilic fasciitis
3

Drug-induced systemic lupus erythematosus
4

Homozygous C2 deficiency
5

Neonatal lupus erythematosus

Anti-Ro (SS-A) antibodies are most commonly found in:
5

Neonatal lupus erythematosus
Ro 60 kDa autoantigen is a major target for patients with SLE and Sjgrens syndrome. 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 heart block.

The major histocompatibility complex (MHC)consists of a linked set of genes encoding for MHC
Class I, Class II, Class III, and Class IB. Which of the following is/are true:
1

Class II molecules are present on all nucleated cells
2

Class I molecules are present on erythrocytes
3

Class I molecules are expressed on B8 cells, monocytes and dendritic cells
4

The level of Class I and II expression can be modulated by cytokines
5

The MHC region is located on chromosome 17 in humans

The major histocompatibility complex (MHC)consists of a linked set of genes encoding for MHC
Class I, Class II, Class III, and Class IB. Which of the following is/are true:
4

The level of Class I and II expression can be modulated by cytokines
The major hisotcompatibility complex (MHC) consists of a linked set of genes encoding for MHC
Class I, Class II, Class III, and Class IB. The level of Class I and II expression can be modulated by
cytokines.
32


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

3

IL-17A
IL-23 and Th17 cells producing IL-17A and IL-22 are found in excess in skin affected by psoriasis.
IL-6, IL-22, and IL-17A have all been shown to be critical in mediating epidermal hyperplasia in
psoriasis in response to IL-23.

Which systemic anti-inflammatory agent specifically blocks the ability of T cells to leave the
vasculature and enter the skin?
1

Etanercept
2

Infliximab
3

Efalizumab
4

Alefacept
5

None of the above

Which systemic anti-inflammatory agent specifically blocks the ability of T cells to leave the
vasculature and enter the skin?
3

Efalizumab
Efalizumab is a humanized monoclonal antibody to CD11a that blocks the immunologic synapse
between LFA-1 on the T-cell and ICAM-1 on the antigen presenting cell. By targeting LFA-1
efalizumab specifically blocks the ability of T cells to leave the vasculature and enter the skin.

All of the following statements regarding neutrophils are true EXCEPT:
33

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


All of the following statements regarding neutrophils are true EXCEPT:
1

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

Eosinophils are typically seen in the cutaneous infiltrate of:
1

Krabbes disease
2

Kaposiform hemangioendothelioma
3

Kawasakis disease
4

Kimuras disease
5

Ki-1 lymphoma

Eosinophils are typically seen in the cutaneous infiltrate of:
4

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

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

IL-4
2

IL-5
3

IL-10
4

IL-13
5

IFN-gamma

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

IL-4
34

IL-4 is a B cell growth factor. IL-5 is an eosinophil growth factor. IL-10 is a general down-regulator
of TH1 immunity. IL-13 (along with IL-4) promotes an isotype switch from IgM to IgE. IFN-gamma
is not a TH2 cytokine. It is secreted by TH1 cells, and is the main macrophage-activating cytokine.

Psoriatic arthritis is most commonly associated with which HLA?
1

HLA-B27
2

HLA-Cw6
3

HLA-Aw19
4

HLA-Bw35
5

None of these options are correct

Psoriatic arthritis is most commonly associated with which HLA?
1

HLA-B27
HLA-B27 is associated with an increase in psoriatic arthritis as well as pustular psoriasis and
acrodermatitis continua of Hallopeau.

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

CDXIIIa
2

CD31
3

CD34
4

Ulex europaeus
5

Factor VIII-related antigen

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

CDXIIIa
The picture shows Kaposi's scarcoma(KS). It is controversial whether KS represents neoplasia or
hyperplasia; all clinical variants are viewed as a virally induced disease - human herpesvirus 8
35

(HHV-8) is the suspected agent. Cutaneous lesions present as variably distributed pink patches, blue-
violet to black nodules or plaques, and polyps, depending on clinical variant and stage. Variable
staining can occur with CD31, CD34, Ulex europaeus and factor VIII-related antigen. CD XIIIa is
positive in dermatofibroma.

Which of the following diseases occur with an increased frequency in persons deficient in C2?
1

Psoriasis
2

Dermatitis Herpetiformis
3

Androgenetic Alopecia
4

DLE
5

Leiner's disease

Which of the following diseases occur with an increased frequency in persons deficient in C2?
4

DLE
Among the complement deficiencies, C2 defienciency is most frequently seen. Most of these
patients are healthy. Diseases that occur with increased frequency in patients with C2 deficiency are
SLE, SLE-like syndrome, frequent infections, anaphylactoid purpura, lethal dermatomyositis,
vasculitis, disseminated cutaneous lupus erythematosus, and cold urticaria.

Which of the following dietary supplements may inhibit platelet function?
1

Vitamin A
2

Vitamin C
3

Vitamin D
4

Vitamin E
5

Vitamin K

Which of the following dietary supplements may inhibit platelet function?
4

Vitamin E
Supplemental vitamin E can inhibit platelet function and predispose to hemorrhagic stroke. It can be
particularly hazardous in patients with beta-thalassaemia mutations.

Which cytokine is up-regulated in this geometric, eczematous dermatitis?
36

1

IL-2
2

IL-4
3

IL-5
4

IL-7
5

IL-10

Which cytokine is up-regulated in this geometric, eczematous dermatitis?
1

IL-2
The geometric pattern of ertyhema suggests "outside job". Allergic contact dermatitis is a cell-
mediated and Th1 reaction. The cytokines up-regulated in this process are IL-1, IL-2, IL-12,
interferons-alpha and gamma.

The T cell surface receptor CD2 binds to what partner on endothelial cells to assist with adhesion?
1

LFA-3
2

B7
3

E-cadherin
4

CD40
5

ICAM-1

The T cell surface receptor CD2 binds to what partner on endothelial cells to assist with adhesion?
1

LFA-3
CD2 molecules are T cell surface receptors that bind to LFA-3 on endothelial cells and antigen
presenting cells to participate in adhesion and activation.

All of the following statements regarding mast cells are true EXCEPT:
37

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


All of the following statements regarding mast cells are true EXCEPT:
5

Mast cells are the central cell in immediate-type hypersenstivity, and are very important in cutaneous
inflammation. They reside near small blood vessles, and when activated release substances that
affect vascular permeability. They orchestrate allergic responses and protect mucosal surfaces
against pathogens. They have receptors for IgE and certain fragments of complement on their cell
surface.

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

IL-4
2

IL-5
3

IL-10
4

TNF
5

IFN-gamma

Which of the following cytokines is a general down-regulator of TH1 immunity?
3

IL-10
IL-4 is a B cell growth factor. IL-5 is an eosinophil growth factor. IL-10 is a general down-regulator
of TH1 immunity. TNF and IFN-gamma are TH1 cytokines, not TH2 cytokines. IFN-gamma is
secreted by TH1 cells, and is the main macrophage-activating cytokine.

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
38


Which of the following is true of Langerhan cells?
1

They are the primary antigen presenting cell in the epidermis
Langerhans' cell function primarily in the afferent limb of the immune response by providing for the
recognition, uptake, processing, and presentation of antigens to sensitized T lymphocytes. They 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.

Which cytokine is most important in recruiting neutrophils?
1

Interleukin-1
2

Interleukin-2
3

Interleukin-4
4

Interleukin-8
5

Interleukin-10

Which cytokine is most important in recruiting neutrophils?
4

Interleukin-8
Chemotaxis is the process of cells moving through a gradient of towards increasingly higher
concentrations. IL-8 has activating and chemoattractant properties on neutrophils.

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

Avocado
2

Horseradish
3

Cashews
4

Parsnips
5

Garlic

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

Avocado
Latex allergy is a TH2 form of contact sensitivity that is IGE mediated. Using the old Gel and
Coombs classification, it was classified as type I hypersensitivity.
39

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

Major histocompatibility complex (MHC) Class I molecules:
2

Complexed with antigen trigger cytotoxic T cells
MHC Class I molecules are present on all nucleated cells. They are recognized by receptors on
surfaces of CD8+ T cells, and, when complexed with antigen, trigger cytotoxic T cells. The other
statements apply to MHC Class II molecules.

Natural killer (NK) cells eliminate infected cells in all of the following ways except:
1

NK cells adhere to and kill target cells coated with IgG
2

NK cells secrete perforins
3

NK cells secrete granzyme
4

NK cells secrete myeloperoxidase
5

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

Natural killer (NK) cells eliminate infected cells in all of the following ways except:
4

NK cells secrete myeloperoxidase
NK cells focus on the destruction of infected or malignant cells. They achieve this via recognition 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 which granzyme is injected.
Granzyme induces apoptosis by activating the caspase cascade. In addition, NK cells do not target
cells expressing MHC class I molecules on their surface; some virus downregulate MHC class I
molecules to evade recognition by cytotoxic T cells, which may make them susceptible to NK cell
attack. Neutrophils kill ingested organims using myeloperoxidase.

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

IgM
40

2

IgG1
3

IgG2
4

IgG3
5

IgG4

Which of the following immunoglobulins cannot activate the complement pathway?
5

IgG4
Immunoglobulins (Ig) differ in their ability to activate complement. IgM is the largest Ig, is the
major Ig in the primary immune response, and consists of a pentamer that activates the classic
complement pathway. IgG is the most abundant Ig and the major Ig in the secondary immune
response. Four subclasses of IgG exist based on the amino acid residue sequences of their constant
region, IgG1 through IgG4. IgG1 and IgG3 are potent activators of the classic complement pathway,
IgG2 is less effective and IgG4 is unable to do so.

This patient recently developed this rash. You decide to patch test her, but in the meanwhile you tell
her to avoid:
1

Chamomile
2

Primin
3

Abietic acid
4

Benzocaine
5

Cinnamon

This patient recently developed this rash. You decide to patch test her, but in the meanwhile you tell
her to avoid:
5

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

41

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

Benzocaine
2

Chromates
3

Formaldehyde
4

Nickel
5

Rhus

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

Nickel
Nickel is found in virtually all metals of common use. It is the most common sensitizer in women,
and is detected by the dimethylglyoxime test.

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

Psoriasis
2

Systemic lupus erythematosus
3

Granulomatous leprosy
4

Rheumatoid arthritis
5

Multiple sclerosis

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

Systemic lupus erythematous is associated with a Th2 cytokine profile, whereas the other conditions
are associated with a Th1 cytokine profile. Th2 cells are typified by secretion of IL-4, IL-5, IL-6, IL-
9, IL-10 and IL-13, whereas Th1 cells are typified by secretion of IFN-gamma, TNF-beta, and IL-2.

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

CD1
2

CD4
3

CD7
4

CD8
5

CD20
42

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

CD1
CD1 is a surface antigen specific for epidermal Langerhans cells. It is not expressed in other
epidermal structures. The other characteristic ultrastructural feature of Langerhans cells is the
Birbeck granule. CD4 is found on T-helper cells and occasionally on Langerhans cells. CD7 is a T-
cell marker that is often lost in cutaneous T-cell lymphoma. CD8 is found on cytotoxic T-cells.
CD20 is a B-cell marker.

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

Autoimmune thyroiditis
2

Idiopathic thrombocytopenic purpura
3

4

Sjgrens syndrome
5


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.

A previously healthy child presents with palpable purpura, arthritis, and vomiting. You suspect a
hypersensitivity vasculitis characterized by:
1

Perivascular IgA
2

P-ANCA autoantibodies
3

Granulomas and eosinophilia
4

Infiltration of destruction of vessels by atypical lymphocytoid and plasmacytoid cells
5

Nectrotizing granulomatous vasculitis

A previously healthy child presents with palpable purpura, arthritis, and vomiting. You suspect a
hypersensitivity vasculitis characterized by:
1

Perivascular IgA
The child has findings of Henoch-Schonlein purpura, a hypersensitivity vasculitits that presents
clinically with a triad of purpura, joint pain, and GI complaints. Histologically it is characterized by
perivascular deposition of IgA.
43


Tacrolimus is a non-steroidal anti-inflammatory medication that works by inhibiting calcineurin
activity through complexing with what binding protein?
1

FK506
2

TGF-beta
3

NF-kappa-B
4

SRE
5

IL-23

Tacrolimus is a non-steroidal anti-inflammatory medication that works by inhibiting calcineurin
activity through complexing with what binding protein?
1

FK506
Tacrolimus and pimecrolimus are non-steroidal calcineurin inhibitors that act as anti-inflammatory
medications. In dermatology, they are most commonly used in topical preparations. These
medications form complexes with FK506 binding protein, which inhibits calcineurin activity. A key
regulatory step in the activation of T cells is the activation of calcineurin via calmodulin.

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

C3a
2

C3b
3

C5a
4

C5b
5

C1 INH

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

C3a
The classical pathway of complement is activated by antigen-antibody complexes. C3a is a
neutrophil chemoattractant. C3b is an opsonin. C5a is an anaphylatoxin. C5b forms a part of the
membrane attack complex.

Naive T cells express which of the following surface molecules:
1

CD19
2

CD20
44

3

CD79
4

CD45RO
5

CD45RA

Naive T cells express which of the following surface molecules:
5

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

Which virus is most closely associated with Kaposis sarcoma in HIV-infected patients?
1

Human herpes virus 2
2

Cytomegalovirus
3

4

5

Epstein-Barr virus

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

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

Herpes gestationis is most commonly associated with which HLA?
1

HLA-DR3
2

HLA-B27
3

HLA-B51
4

HLA-DR9
5

HLA-DQ8

Herpes gestationis is most commonly associated with which HLA?
1

HLA-DR3
HLA-DR3 is the most commonly found HLA association in herpes gestationis. HLA-DR4 is also
found in addition to HLA-DR3 in about 50% of patients. There is nearly 100% incidence of anti-
45

HLA antibodies patients affected by herpes gestationis.

Which of the following is not true about the effects of ultraviolet radiation on the immune system?
1

UV radiation causes an increase in number of Langerhans cells in the epidermis
2

UV radiation causes nuclear DNA damage
3

Effects can be demonstrated by the example of reactivation of latent herpes simplex infection
after sun exposure
4

UV radiation acts to suppress the immune system both locally and systematically
5

Effects can be demonstrated by the ability of an antigen to induce an allergic hypersensitivity
reaction when applied to skin which has been exposed to low doses of UV radiation

Which of the following is not true about the effects of ultraviolet radiation on the immune system?
1

UV radiation causes an increase in number of Langerhans cells in the epidermis
Effects of UV radiation on the immune system: UV radiation inhibits function of Langerhans cells
(A-False). It causes DNA damage, can reactivate HSV, suppresses immune system, and can induce
allergic hypersensitivity reaction

In adult patients with Henoch-Schnlein purpura with IgA vasculitis, which of the following
complications is most likely to occur?
1

Pulmonary hemorrhage
2

Hemorrhagic cystitis
3

Peripheral neuropathy
4

Mesangial nephropathy
5

Facial edema

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

Which cytokine is the main macrophage-activating cytokine?
1

TNF
46

2

IFN-gamma
3

IL-4
4

IL-10
5

lymphotoxin

Which cytokine is the main macrophage-activating cytokine?
2

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

Major histocompatibility complex class I molecules bind to:
1

Peptides derived from proteins synthesized and degraded in the cytosol
2

Peptides derived from proteins degraded in endocytic vesicles
3

Peptides external to the cell membrane
4

Immunoglobulin E
5


Major histocompatibility complex class I molecules bind to:
1

Peptides derived from proteins synthesized and degraded in the cytosol
Major histocompatibility complex (MHC) class I molecules bind to peptides derived from proteins
synthesized and degraded in the cytosol. They present these processed peptides to CD8+ T-cells.
MHC class II molecules bind stably to peptides derived from proteins degraded in endocytic
vesicles. CD4+ T-cells recognize the MHC class II molecules. Immune activation against the foreign
antigens or pathogens taken up by the cell is the result of these interactions. Peptides external to the
cell are not recognized by MHC molecules. IgE does have a receptor on the cell surface, especially
basophils and mast cells, but is not recognized by the MHC complex.

Which systemic anti-inflammatory agent targets CD2+ activated T cells for apoptosis?
1

Etanercept
2

Infliximab
3

Efalizumab
4

Alefacept
5

None of the above
47

Which systemic anti-inflammatory agent targets CD2+ activated T cells for apoptosis?
4

Alefacept
Alefacept is a soluble form of LFA-3 that blocks the immunologic synapse between CD2 on the T
cell and LFA-3 on the antigen presenting cell. Furthermore, alefacept targets CD2+ activated T cells
for apoptosis.

The immunoglobulin most commonly found in mucous secretions is:
1

IgA
2

IgD
3

IgE
4

IgG
5

IgM

The immunoglobulin most commonly found in mucous secretions is:
1

IgA
IgA is found in mucous membrane secretions and is able to agglutinate antigens and activate the
alternate but not the classic complement pathway. IgG is the antibody that can cross the placenta and
the most common antibody found in circulation. IgD is not found in circulation other than in hyper-
IgD syndrome, an autosomal recessive disorder caused by mutations in the mevalonate kinase gene.
A significant elevation of serum IgD is seen in 95% of these patients. IgE is an anaphylactic
antibody that is involved in nearly all immediate allergic and anaphylactic type reactions. IgM is the
antibody produced in the early stages of antibody responses. It is a pentamer which can agglutinate
antigen and active the classic complement pathway.

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

IL-2
2

MHC II
3

CD20
4

TNF-alpha
5

CD19

A patient with Stage 3 mycosis fungoides is referred to a tertiary referral center for further
48

management. Denileukin diftitox is offered as a potential therapy. This medication binds to what
receptor on the T cell?
1

IL-2
Denileukin diftitox is a fusion of a fragment of diphtheria toxin and IL-2. It binds to high affinity IL-
2 (CD25) receptors on T cells. As the medication is internalized, the toxin leads to cell death. This
medication has been approved for cutaneous T cell lymphoma.

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

Mononuclear phagocytes residing in tissues:
5

All of the above
Mononuclear phagocytes are components of the innate immune system. Once in tissues they are
called macrophages. All of the above are correct.

The human leukocyte antigen that has the closet association with psoriasis is:
1

HLA-B51
2

HLA-DQ3
3

HLA-B27
4

HLA-Cw6
5

HLA-DR1

The human leukocyte antigen that has the closet association with psoriasis is:
4

HLA-Cw6
Human leukocyte antigens (HLA class I molecules) are designated A, B, and C and are present on
all nucleated cells. Class I molecules present antigens including autoantigens to cytotoxic T cells.

49

Of the following complement components, the most powerful neutrophil chemoattractant is:
1

C3
2

C5a
3

C3a
4

C5b, C6, C7, C8, C9
5

C4a

Of the following complement components, the most powerful neutrophil chemoattractant is:
2

C5a
The complement system plays an important role in innate immunity. Of this group, C5a is the most
powerful neutrophil chemoattractant. C3 represents the endpoint for the classic, alternative and lectin
pathways, and results in the generation of immunologically active substances. C3a and C4a cause
mast cell degranulation. Assembly of C5b, C6, C7, C8, C9 components results in the membrane
attack complex (MAC), which perforates cell membranes causing death by osmotic lysis.

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

C1 Esterase Inhibitor
2

C3
3

C4
4

C50
5

Properidin

A deficiency of this complement component may result clinically in susceptibility to pyogenic
infections, glomerulonephritis, and partial lipodystrophy:
2

C3
C3 is the central component of the complement cascade. It plays a key role in the opsonization of
bacteria. An autosomal recessive deficiency of C3 may result in susceptibility to pyogenic
infections, glomerulonephritis, and partial lipodystrophy.

Calcipotriene-induced improvement in psoriasis is associated with increased lesional levels of which
cytokine?
1

Interleukin-2
2

Interleukin-8
3

Tumor necrosis factor
50

4

Interleukin-10
5

Interluekin-12

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.

A 5 year old patient is seen at a tertiary referral center for evaluation of a complex syndrome.
Ultimately, he is diagnosed with IPEX syndrome (immune dysregulation, polyendocrinopathy,
enteropathy, X-linked syndrome.) What gene is mutated in IPEX syndrome?
1

FOXP3
2

LFA-3
3

TGF-beta
4

B7
5

Mac-1

A 5 year old patient is seen at a tertiary referral center for evaluation of a complex syndrome.
Ultimately, he is diagnosed with IPEX syndrome (immune dysregulation, polyendocrinopathy,
enteropathy, X-linked syndrome.) What gene is mutated in IPEX syndrome?
1

FOXP3
IPEX syndrome is a rare x-linked disorder. Mutation of FOXP3 results in absence of regulatory T
cells and is the cause of this syndrome, which includes immune dysregulation, polyendocrinopathy,
and enteropathy.

This patient developed an acute vesicular rash after eating a mango. She has returned for a routine
follow-up. She needs to be careful of exposure to:
1

Ginkgo fruit
2

Croton
3

Ragweed
4

Tea tree oil
5

51

This patient developed an acute vesicular rash after eating a mango. She has returned for a routine
follow-up. She needs to be careful of exposure to:
1

Ginkgo fruit
Patients allergic to the peel of a mango can also be allergic to other plants/products of the
Anacardiaceae family. Cross-reactions can occur with exposure to any plants of the genus
Toxicodendron, to the oil from the cashew nut shell, to the Brazilian pepper tree, to lacquer from the
Japanese lacquer tree, to ink from the Indian marking nut, and to the fruit pulp of the ginkgo tree,
and others.

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

E-cadherin
2

N-cadherin
3

Desmoglein 3
4

P-cadherin
5

B7

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

E-cadherin
Langerhans cells are found in the epidermis and on mucosal surfaces. After antigen exposure 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-cadherin.

The best screen for classical pathway complement deficiency or dysfunction is:
1

CD4/CD8 ratio
2

CH50
3

C2 esterase levels
4

Total C4 levels
52

5

Serum electophoresis

The best screen for classical pathway complement deficiency or dysfunction is:
2

CH50
The appropriate screening test for a complement deficiency is the CH50. The CH50 will detect
deficiencies in the classical pathway and membrane attack pathways.

The endothelial ligand for cutaneous lymphocyte antigen (CLA) is:
1

Intercellular adhesion molecule 1 (ICAM-1)
2

L-selectin
3

E-selectin
4

Vascular cell adhesion molecule (VCAM-1)
5

Leukocyte functional antigen (LFA 3)

The endothelial ligand for cutaneous lymphocyte antigen (CLA) is:
3

E-selectin
Cutaneous lymphocyte antigen (CLA) allow memory T cells to home to the skin, where it binds to
its ligant E-selectin on cutaneous microvessels. Transmigration of memory T cells into the dermis,
however, further requires interaction between leukocyte functional antigen 1 (LFA-1) and ICAM-1,
and B-integrin very late antigen 4 (VLA-4) and VCAM-1. L-selectin is expressed on post-capillary
venules in the lymph nodes and serves as the attachment points for naive T cells.

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

Essential mixed cryoglobulinemia
2

3

Relapsing polychondritis
4

Wegeners granulomatosis
5

Dermatomyositis

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

Essential mixed cryoglobulinemia
Hepatitis C infections can present as urticaria or papable purpura and cryoglobulinemia.
53


With which HLA type is psoriasis most definitively linked?
1

HLA-B51
2

HLA-B8
3

HLA-DR4
4

HLA-DR3
5

HLA-Cw6

With which HLA type is psoriasis most definitively linked?
5

HLA-Cw6
Psoriasis is linked with HLA-Cw6. Patients with this HLA type have a relative risk of having
psoriasis that is 9-15 times normal.

Elaboration of which of the following cytokines is characteristic of TH2 response?
1

Interferon-8 (gamma)
2

Interleukin-1
3

Interleukin-2
4

Interleukin-4
5

Interleukin-12

Elaboration of which of the following cytokines is characteristic of TH2 response?
4

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

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
54

5

Decreased production of interferon-gamma

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.

Which of the following HLA alleles is most strongly associated with Behcets disease?
1

HLA-B27
2

HLA-B51
3

HLA-DQw2
4

HLA-DR1
5

HLA-DR4

Which of the following HLA alleles is most strongly associated with Behcets disease?
2

HLA-B51
HLA-B51 has been reported with increased relative risks in European, Asian and Middle Eastern
populations.

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
55

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 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.

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

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
be at least 3 weeks long, as if the duration is shorter, patients may develop a rapid rebound.

56

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

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.
Toll-like receptors (TLRs) have been found to play an important role in innate immunity. This has
been utilized in the development of medications 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

Toll-like receptors (TLRs) have been found to play an important role in innate immunity. This has
been utilized in the development of medications 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.

Which cytokine is predominantly responsible for the Jarish-Herxheimer reaction?
57

1

TNF-alpha
2

IL-2
3

IL-5
4

IL-6
5

IL-12

Which cytokine is predominantly responsible for the Jarish-Herxheimer reaction?
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. Clinical 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.

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

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.

Imiquimod induces which of the following cytokines?
1

Interleukin-10
2

Interferon-alpha
58

3

Interleukin-2
4

Interleukin-4
5

Interleukin-5

Imiquimod induces which of the following cytokines?
2

Interferon-alpha
Imiquimod is a topical immunomodulator that increases a variety of cytokines including interferon-
alpha.

Keratinocytes express what class of major 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

Keratinocytes express what class of major 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 under
normal conditions, they can be induced to do so in the setting of inflammatory conditions.

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

A patient with chronic atopic dermatitis is found to have elevated IgE levels. Which cytokine
promotes isotype switching to IgE?
59

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 IFN-
gamma. IgA is promoted by IL-5 and TGF-beta. IgE is promoted by IL-4.

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

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.

1

IL-2
2

IL-6
3

IL-12
4

TNF-alpha
5

IFN-gamma

2

IL-6
IL-23 facilitates the differentiation 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.
60

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

5


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

The lesion is low immune or lepromatous leprosy, which is associated with TH2 cytokines including
IL-4, IL-5, IL-10, and IL-13.

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

Nickel
2

Formaldehyde
3

P-phenylenediamine
4

Propylene glycol
61

5

Sorbic acid

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

Formaldehyde
Textile dermatitis has been reported to be associated with purpuric contact dermatitis.

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

C3b
2

C3a
3

C5a
4

C5b
5

C1 INH

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.

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

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
62

clearance of immune complexes, phagocytosis, and immune adherence of antibody-coated bacteria
to erythrocytes.

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

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

all of the above
Chronic idiopathic urticaria is associated with HLA -DR4, -DRB4 53, and -DQ8.

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

CD40
2

CD19
3

CD20
4

CD154
5

CD22

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.

Rituximab works by targeting the CD20 antigen which is predominantly expressed on which of the
following cells?
1

Plasma cells
2

B cells
63

3

B cells and plasma cells
4

T cells
5

Dendritic cells

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 long duration of time as the drug
targets B cells which must then differentiate into plasma cells that ultimately produce the pathogenic
antibodies in their secreted form.

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

Serum IgA antibodies to tissue transglutaminase occur in:
5

Autoantibodies to tissue transglutaminase are an area of active investigation in both celiac disease
and dermatitis herpetiformis.

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

64

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.

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

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.

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

65

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 acts 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.

Psoriasis affects over 2% of the worlds 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

Psoriasis affects over 2% of the worlds 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 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 Reiters disease, with increase
relative risks of 100x, 10-20x, and 35x respectively.

Anti-epiligrin (laminin 5) antibodies may be seen in:
1

Pemphigoid gestationis
2

Pemphigus vegetans
3

Fogo selvagem
4

Cicatricial pemphigoid
5

Paraneoplastic pemphigus

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

Cicatricial pemphigoid
66

Patients with cicatricial pemphigoid have been reported to have anti-epiligrin antibodies.

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

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.

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

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.

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
67

4

5

Erythema multiforme

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.

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 is impaired?
1

CD4 + T cells
2

Natural killer cell activation
3

CD8 + T cells
4

Complement activation
5

Antibody production

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 is impaired?
4

Complement activation
Predisposition to sporadic and occasionally recurrent meningococcal disease occurs in patients with
congenital or acquired complement deficiencies, particularly late acting components C5-9

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

5

Psoriasis

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

Lepromatous Leprosy
68

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.
Langerhans cells are characterized by 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

Langerhans cells are characterized by 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.

All of the following statements regarding Langerhans cells are true 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


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

They are highly phagocytic
Langerhans cells are dendritic cells found 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.

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

Ascorbic acid
69

2

Titanium dioxide
3

Oxybenzone
4

Zinc oxide
5

Dihydroxyacetone

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.

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

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.

Which of the follwing is a chemotactic factor for eosinophils?
1

TNF
2

IL2
3

C5a
4

Plasminogen activator
5

IL8

Which of the follwing is a chemotactic factor for eosinophils?
70

3

C5a
Eosinophil chemotactic factors include all of the following: Histamine, soluble immune complexes,
C5a, and HETE

Which cytokine is primarily responsible for stimulation of neutrophils?
1

IL-1
2

IL-4
3

IL-5
4

IL-6
5

IL-8

Which cytokine is primarily responsible for stimulation of neutrophils?
5

IL-8
IL-8 is primarily responsible for the stimulation of neutrophils. IL-5 stimulates eosinophils. IL-4
stimulates mast cells and IgE isotype switching.

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

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 subepidermal blistering disease with a
homogeneous IgA deposits at the epidermal basement membrane. This occurs in children usually
less than 5 years of age.

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

IL-5
2

IL-10
71

3

IL-13
4

TNF
5

IFN-gamma

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 macrophage-
activating cytokine.

Which cytokine is chemotactic for neutrophils?
1

IL-2
2

IL-3
3

IL-5
4

IL-6
5

IL-8

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 (T-
ells), IL-3 (mast cells), IL-5 (eosinophils), IL-6 (plasma cells).

The most definitive HLA association with psoriasis is:
1

HLA-Cw6
2

HLA-B27
3

HLA-B13
4

HLA-B17
5

HLA-B37

The most definitive HLA association with psoriasis is:
72

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.

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

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

CREST
Anti-centromeric antibodies are associated with CREST 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.

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

73

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.

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