Chapter 6: The Complement System, Part 1 Chapter 6: The Complement System, Part 2 Allergy and Immunology Review Corner: Chapter 5 of Middleton’s Allergy Principles and Practice, 7th Edition, edited by N. Franklin Adkinson, et al Chapter 5: Immunoglobulin Structure and Function Prepared by Jeremy Katcher, MD, LeBonheur Children’s Hospital, and Jennifer W. Mbuthia, MD, Walter Reed Army Medical Center 1. Ig-alpha and Ig-beta of the B cell receptor: A. Are structurally similar to CD4 B. Have a conserved ITAM (immunoreceptor tyrosine-based activation motif) sequence C. Don’t recognize all immunoglobulin isotypes D. Are redundant signaling proteins 2. During which stage of B cell development do you see the presence of mu heavy chain with surrogate light chain transiently expressed on the cell surface? A. Stem cell B. Pro-B cell C. Pre-B cell D. Immature B cell 3. Which of the following has the correct sequence of receptor-ligand interactions required for class switching? A. T cell receptor/MHC II processed antigen from B cell interaction, CD40 ligand/CD40 interaction, CD80(86)/CD28 interaction B. CD80(86)/CD28 interaction, T cell receptor/MHC II processed antigen from B cell interaction, CD40 ligand/CD40 interaction C. T cell receptor/MHC II processed antigen from B cell interaction, CD80(86)/CD28 interaction, CD40 ligand/CD40 interaction D. CD80(86)/CD28 interaction, CD40 ligand/CD40 interaction, T cell receptor/MHC II processed antigen from B cell interaction 4. The unique protein sequence of an immunoglobulin that is on the antigen-binding fragment (Fab) is called the: A. Isotype B. Idiotype C. Haplotype D. Allotype 5. Which is the only immunoglobulin isotype that can cross the placenta? A. IgA B. IgE C. IgG D. IgM 6. Which of the IgG subtypes cannot fix complement and generally is associated with Th2-type responses? A. IgG1 B. IgG2 C. IgG3 D. IgG4 7. Which immunoglobulin has the shortest half-life? A. IgG4 B. IgM C. IgA D. IgE 8. Humans produce more ______ than any other immunoglobulin class. A. IgA B. IgE C. IgG D. IgM 9. What process unique to B cells allows them to enhance the specificity and affinity of their antigen receptors after they have encountered antigen? A. Allelic exclusion B. Class switching C. Somatic hypermutation D. Receptor editing 10. A monoclonal antibody that is humanized will have a generic name ending with which of the following: A. –ximab B. –zumab C. –omab D. –umab Answers: 1. B, page 74 2. C, page 74 3. C, page 76 4. B, page 86 The isotype is on the Fc portion of the immunoglobulin. 5. C, page 80 6. D, page 80 7. D, page 80, Table 5.2 8. A, page 81 IgG is the major immunoglobulin in serum (85 percent of total serum IgG), but IgA is produced in larger amounts than any other immunoglobulin class. 9. C, page 84 Class switch also occurs after antigen exposure, but does not involve enhancing specificity for the antigen. 10. B, page 86 Chimeric is –ximab, mouse antibody is –omab, and human is –umab. Allergy and Immunology Review Corner: Chapter 6, Part 1 of Middleton’s Allergy Principles and Practice, 7th Edition, edited by N. Franklin Adkinson, et al. Chapter 6: The Complement System, Part 1 (Pages 89-96) Prepared by Nathanael Brady, DO, University Hospitals, Cleveland, and Christopher R. Martin, MD, Walter Reed Army Medical Center 1. Which of the following disease states can compromise the production of complement components? A. Advanced liver disease B. Severe cardiac disease C. Extensive inflammatory bowel disease D. End stage neurodegenerative disease 2. Which is the correct order of antibody efficiency in activating complement? A. IgG3 > IgM > IgA B. IgM > IgG3 > IgG1 C. IgG1 > IgG3 > IgM D. IgA > IgM > IgG 3. What classical pathway complex is referred to as the C3 convertase? A. C4b B. C2bC2a C. C4bC2a D. C4bB 4. What alternative pathway complex is also known as C3b(2)Bb? A. Factor B B. Factor D C. C5 convertase D. C3 convertase 5. Susceptibility to infection with what bacteria is a consequence of a terminal complement deficiency? A. Neisseria B. Staphylococcus C. Steptococcus D. E. coli 6. Adipsin which is made by adipocytes is better known as what? A. Factor B B. C1q C. Properdin D. Factor D E. C7 7. Bloodstream S. pneumonia can be specifically recognized by __________ on marginal zone macrophages, delivery to marginal zone B-cells, and T-independent antibody production. A. CD11b/CD18 B. ICAM-1 C. SIGN-R1 D. CRIg E. IL-8 8. This is the primary receptor mediating clearance of complement-tagged blood-borne pathogens, with primarily Kupffer cells having a dominant role in the process. A. CR3 B. CRIg C. C1qRp D. CR1 E. C3aR 9. The most important role of CD35 is? A. Enhancing phagocytosis B. Clearance of immune complexes C. Maintaining C4b in a soluble state D. Inactivation of C3 and the destabilization of C3 and C5 convertase complexes 10. The primary function of MASP-2 and MASP-1 in the lectin activation pathway is? A. Cleaves C4, Cleaves C2 B. Cleaves C3, stabilizes C4bC2a C. Cleaves C4, Cleaves C3 D. Stabilizes C4bC2a, Cleaves C4 Answers 1. A, page 90 2. B, page 91 3. C, page 91 Of note, due to changes, this is now called C4bC2b. 4. C, page 93 5. A, page 94 6. D, page 89 B, C, and E are primarily made by Myeloid Cells and A is made by hepatocytes. 7. C, page 96 8. B, page 96 9. B, page 95 In a normal individual, immune complexes are maintained in a soluble state by complement through the binding of C3b, and it is this C3b that is recognized by CR1 (CD35), which allows the complexes to be cleared. (Note: there is an error in Table 6.1 – CD21 and CD35 are switched in the first 2 lines.) 10. C, page 93 Allergy and Immunology Review Corner: Chapter 6, Part 2 of Middleton’s Allergy Principles and Practice, 7th Edition, edited by N. Franklin Adkinson, et al. Chapter 6: The Complement System, Part 2 (Pages 96-110) Prepared by Christopher R. Martin, MD, Walter Reed Army Medical Center 1. End-Stage Renal Disease can be successfully cured with renal transplant in which of the following deficiencies? A. Factor H B. Factor I C. MCP D. MBL 2. The major contributor to elevated absolute neutrophil count in LAD is? A. Impaired diapedesis B. Disruption of the IL-17/IL-23 pathway C. Up-regulated Factor H & I binding D. Hemo-concentration 3. Which cascade component deficiency does not result in a CH50 of zero or near zero? A. C3 B. C4 C. C8 D. C9 4. Recognition of C3b by ________ allows the immune complexes to travel to the Kupffer cells of the liver, where they are taken up and degraded. A. CD35 B. CR2 C. CR3 D. CD21 5. These IgG antibodies, when found in the serum of patients with SLE, are strong predictors of renal disease? A. Anti-C2 B. Anti-C4 C. Anti-C1q D. Anti-C5 6. What would be expected in Factor I factor deficiency? A. CH50 Low, AH50 Normal B. CH50 Zero, AH50 Zero C. CH50 Normal, AH50 Zero D. CH50 Low, AH50 Low 7. SLE is associated with which of the following inherited complement deficiencies? A. Factor D B. Vitronectin C. MBL D. MCP E. C7 8. A fluid-phase inhibitor of the membrane attack complex is? A. DAF B. S-protein C. Protein S D. CD59 9. The only X-linked complement deficiency? A. MASP2 B. Factor B C. MBL D. Properdin 10. This dissociates both C3 and C5 convertases. A. Factor I B. C1 inhibitor C. Membrane cofactor protein D. DAF E. CD59 Answers 1. C, page 107 Since MCP is a membrane protein and intrinsic to the kidney, renal failure can be corrected by successful renal transplantation. 2. B, page 108 Though impaired diapedesis may play a small role, disruption of the interleukin 17 & 23 pathway is the major contributor. 3. D, page 110 4. A, page 99 C3b is recognized by CR1 (CD35). 5. C, page 100 6. D, page 106 In the first phenotype of Factor I deficiency, CH50 and AH50 are depressed but not absent. 7. C, page 101 SLE is associated with inherited deficiencies in C1q, C1r/s, C4, C2, and MBL. 8. B, page 100 S-protein is the only known fluid phase inhibitor of the MAC and is thought to be a “back-up” plan for other membrane-bound regulators of terminal complement (such as CD59). 9. D, page 103 10. D, page 97 DAF (also known as CD55) deficiency is also known as the Inab blood group phenotype. |
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