Immunology Review Corner

Immunology Review Corner: Chapter 58 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al.

Prepared by Dr. Thao N. Tran, Puget Sound Allergy, Asthma and Immunology, and Dr. Karla L. Davis, Walter Reed Medical Center.

Chapter 58:  Immune Complexes and Allergic Diseases

1. Which of the following skin eruptions is the most common in patients with serum sickness?
a. Angioedema
b. Exfoliative rash
c. Vesiculo-bullous lesions
d. Urticaria

2. Immune complexes tend to be large at:
a. Equivalence (number of available antigenic sites is equal to the number of available antibody-combining sites)
b. Antibody excess
c. Antigen excess
d. Only when monovalent antigens are present

3. Which of the following antibody isotypes activates complement by the alternative pathway?
a. IgG1
b. IgG2
c. IgM
d. IgA

4. Which of the following receptors has a high affinity for IgG and can bind monomeric IgG?
a. Fc gamma receptor I
b. Fc gamma receptor II
c. Fc gamma receptor III
d. Fc epsilon receptor I

5. Binding of the C3 degradation fragment (C3d) to which of the following complement receptors promotes B cell activation and proliferation?
a. CR1
b. CR2
c. CR3
d. CR4

6. Which of the following cell adhesion molecules is up-regulated by histamine?
a. P-selectin (GMP-140)
b. E-selectin (ELAM-1)
c. Intracellular adhesion molecule-1 (ICAM-1)
d. Vascular cell adhesion molecule-1 (VCAM-1)

7. Presence of which of the following substances can lead to a false-positive result in the 125I-C1q binding assay used in the detection of circulating immune complex?
a. Bacterial endotoxin
b. Bacterial DNA
c. Heparin
d. Ethylenediaminetetraacetic acid (EDTA)

8. Serum sickness occurs how many days after starting the culprit drug in a patient not previously sensitized?
a. 1-2 days
b. 7-21 days
c. 30-60 days
d. 90-180 days

9. Which of the following lab findings is observed in a patient with serum sickness.
a. Low levels of IgG and IgM
b. Low titers of immune complex
c. Low levels of serum C3 and C4
d. Significantly elevated CH50

10. Patients with systemic lupus erythematosus have decreased numbers of which of the following receptors on their erythrocytes?
a. Complement receptor 1
b. Fc gamma receptor 1
c. P-selectin
d. Neoantigen receptors

11. Which of the following laboratory findings is suggestive of membranoproliferative glomerulonephritis?
a. Decreased C4 and C3
b. Decreased C3, decreased factor B, or decreased properdin
c. Increased levels of decay-accelerating factor (DAF)
d. C1q inhibitor deficiency

Answers:
1. d, page 997
2. a, page 998
3. d, page 998
4. a, page 999
5. b, page 1000
6. a, page 1001
7. c, page 1005
8. b, page 1006
9. c, page 1007
10. a, page 1008
11. b, page 1010