Immunology Test (Part 1)

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1) Which complement protein is the product of all 3 activation pathways

A) C20

B) C7

C) C3b

D) C1a

E) C2a

2) Which of the following diseases has a lower incidence/incidence of flare ups in pregnancy?

A) Hyperthyroidism

B) Graves disease

C) Systemic Lupus Erythematous

D) Rheumatoid arthritis

E) Inflammatory bowel disease

3) Which of the following is a tumour marker for trophoblastic disease?

A) HCG

B) MCA

C) CEA

D) AFP

E) Ca 15‐3

4) What is the first immunoglobulin to be synthesised by the neonate?

A) IgA

B) IgG

C) IgM

D) IgD

E) IgE

5) Which immunoglobulin exists as a dimer and is found in secretions such as saliva

A) IgA

B) IgD

C) IgM

D) IgG

E) IgE

6) You are asked to decide on administration of anti‐D immunoglobulin to a 30 year old pregnant patient. A maternal blood test shows the mother to be Rhesus negative with no immune anti‐D. Which of the following situations does not warrant anti‐D immunoglobulin administration?

A) Painless vaginal bleeding at 10 weeks gestation that has resolved after 4 hours

B) Spontaneous complete miscarriage confirmed by scan at 13 weeks gestation

C) Surgically managed ectopic pregnancny at 9 weeks

D) Surgically managed ectopic pregnancny at 14 weeks

E) Molar pregnancy confirmed at 9 weeks

7) Rhesus D immunoglobin treatment utilises what class of antibody?

A) IgA

B) IgG

C) IgM

D) IgD

E) IgE

Anti‐D Ig Key Points from BCSH Guidelines*
 All RhD negative pregnant women who have not been previously sensitised should be
offered routine antenatal prophylaxis with anti‐D Ig (RAADP) either with a single dose
regimen at around 28 weeks, or two‐dose regimen given at 28 and 34 weeks
 Following birth, ABO and Rh D typing should be performed on cord blood and if the
baby is confirmed to be D positive, all D negative, previously non‐sensitised, women
should be offered at least 500 IU of anti‐D Ig within 72h following delivery. Maternal
samples should be tested for FMH and additional dose(s) given as guided by FMH tests
 Following potentially sensitising events, anti‐D Ig should be administered as soon as
possible and always within 72h of the event. If, exceptionally, this deadline has not been
met some protection may be offered if anti‐D Ig is given up to 10 days after the
sensitising event
 In pregnancies <12 weeks gestation, anti‐D Ig prophylaxis is only indicated following
ectopic pregnancy, molar pregnancy, therapeutic termination of pregnancy and in cases
of uterine bleeding where there is repeated, heavy bleeding or associated with
abdominal pain. The minimum dose should be 250 IU. A test for fetomaternal
haemorrhage (FMH) is not required
 For potentially sensitising events between 12 and 20 weeks gestation, a minimum dose
of 250 IU should be administered within 72h of the event. A test for FMH is not required
 For potentially sensitising events after 20 weeks gestation, a minimum anti‐D Ig dose of
500 IU should be administered within 72h of the event. A test for FMH is required
List of Potentially Sensitising Events
 Amniocentesis, chorionic villus biopsy and cordocentesis
 APH and PV bleeding in pregnancy
 External cephalic version
 Abdominal trauma
 Ectopic pregnancy
 Evacuation of molar pregnancy
 Intrauterine death and stillbirth
 In‐utero therapeutic interventions (transfusion, surgery, insertion of shunts, laser)
 Miscarriage, threatened miscarriage
 Therapeutic termination of pregnancy
 Delivery
 Intra‐operative cell salvage

8) At what stage of gestation does fetal immunoglobulin M production begin

A) Week 1

B) Week 6

C) Week 10

D) Week 18

E) Week 32

9) Which of the following best describes the fetus?

A) Autograft

B) Autogenous

C) Autogeneic

D) Allograft

E) Xenograft

10) Which immunoglobulin is the only one capable of crossing the placenta?

A) IgG

B) IgA

C) IgM

D) IgD

E) IgE

11) Which of the following is a tumour marker for ovarian cancer?

A) Ca 15‐3

B) Ca 27‐29

C) CEA

D) Ca 125

E) HCG

12) Which Immunoglobulin (or antibody) is secreted in large amounts in breast milk?

A) IgM

B) IgA

C) IgE

D) IgD

E) IgG

13) With regard to the role of the placenta in preventing immune rejection. Which of the following HLA (Human Leukocyte Antigen) genes are not expressed by cells of the trophoblast?

A) HLA‐A and HLA‐B

B) HLA‐B and HLA‐C

C) HLA‐D and HLA‐E

D) HLA‐B and HLA‐E

E) HLA‐E and HLA G

14) You have just clerked in a patient on the labor ward who has SLE. What type of hypersensitivity reaction is SLE an example of?

A) Type I

B) Type II

C) Type III

D) Type IV

E) Type V

15) At what stage of gestation does maternal immunoglobulin G transfer to the fetus start?

A) From conception

B) 2 weeks

C) 12 weeks

D) 6 weeks

E) 18 weeks

16) Which of the following will require Anti‐D administration post partum?

A) Rhesus negative mother, non‐sensitised, fetal cord blood Rh negative

B) Rhesus negative mother, sensitised, fetal cord blood Rh negative

C) Rhesus negative mother, non‐sensitised, fetal cord blood Rh positive

D) Rhesus positive mother, fetal cord blood Rhesus positive

E) Rhesus positive mother, metal cord blood Rhesus negative

17) With regard to the role of the placenta in preventing immune rejection. Which of the following HLA (Human Leukocyte Antigen) genes is produced at high levels in the maternal interface and is thought to play an important role in suppressing maternal immune function and preventing immune attack against the fetus?

A) HLA‐A

B) HLA‐B

C) HLA‐C

D) HLA‐D

E) HLA‐G

18) Which immunoglobulin is key to passive neonatal immunity?

A) IgD

B) IgE

C) IgM

D) IgA

E) IgG

19) Which of the following increases in pregnancy?

A) Th1

B) Th2

C) TNF‐alpha

D) IFN‐y

E) IL‐2

20) Which of the following cell types act as professional antigen presenter cells (APCs)

A) Neutrophils

B) Interferon

C) Basophils

D) Macrophages

E) Mast cells

21) You are reviewing a patient in the antenatal clinic who has moved to the UK from Bangladesh 1 month ago. She asks about BCG vaccination for her baby. What type of vaccine is the BCG?

A) Attenuated

B) Inactivated

C) Polysaccaride

D) Toxoid

E) Subunit

22) Which of the following plays an important role in the adaptive immune system?

A) Basophils

B) Dendritic cells

C) Macrophages

D) Natural Killer Cells

E) CD4+ T cell

23) You are called back to see a patient 20 minutes after changing her cannula. The patient has come up in hives and asks if you wore latex gloves as she has a latex allergy. What type of hypersensitivity reaction is this?

A) Type I

B) Type II

C) Type III

D) Type IV

E) Type V

24) Haemolytic Disease of the Newborn falls into what type of hypersensitivity reaction?

A) Type I

B) Type II

C) Type III

D) Type IV

E) Type V

25) What is the gold standard test for detection of chlamydia?

A) Microscopy

B) Culture

C) Nucleic Acid Amplification Test

D) Enzyme immunassay

E) POCT

26) Which complement protein recruits other complement proteins to form MAC (membrane attack complex)?

A) C3a

B) C3b

C) C3

D) C5b

E) C1

27) Which of the following cells is considered the basis for the adaptive immune system?

A) Neutrophils

B) Monocytes

C) Lymphocytes

D) Basophils

E) Eosinophils

28) Which of the following is suppressed in pregnancy (the suppression of which is thought to aid immune tolerance of the fetus)?

A) Th1

B) Th2

C) IL‐4

D) IL‐5

E) IL‐10

29) Myasthenia Gravis is an example of what type of hypersensitivity reaction?

A) Type I

B) Type II

C) Type III

D) Type IV

E) Type V

30) What cell type displays the rhesus antigen in Rhesus positive patients?

A) Antigen presenter cell

B) B Lymphocytes

C) T‐helper celss

D) Neutrophils

E) Erythrocytes

31) Macrophages are derived from what type of white blood cell?

A) Natural Killer Cells

B) T‐cells

C) B‐Cells

D) Monocytes

E) Neutrphils

32) Which immunoglobulin (or antibody) has the largest molecular weight and has a pentamer structure?

A) IgA

B) IgE

C) IgG

D) IgM

E) IgD

33) Which of the following cytokines have increased production during pregnancy and are thought to enhance fetal survival?

A) TNF alpha

B) IFN‐y

C) Interleukin 2

D) TNF kappa

E) Interleukin 10

34) The Mantoux test utilises what type of hypersensitvity reaction

A) Type I

B) Type II

C) Type III

D) Type IV

E) Type V

35) You see a patient in antenatal clinic who is concerned that she has never had chicken pox and may catch it during pregnancy. You check her Varicella status and she is non‐immune. She asks you about vaccination. What type of vaccine is the varicella vaccine?

A) Attenuated

B) Inactivated

C) Subunit

D) Polysaccaride

E) Toxoid

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