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22 BMD 430 lecture 22

front 1 1. A “variant” of a pathogen is defined as: A. A completely new species B. A pathogen with genetic differences but still the same species C. A pathogen defined solely by antigenic differences detected by antibodies D. A new strain formed by recombination	back 1 B. A pathogen with genetic differences but still the same species
front 2 2. A serotype is classified based on: A. Genetic sequence only B. Unique clinical symptoms C. Antigenic differences recognized by antibodies D. Host range	back 2 C. Antigenic differences recognized by antibodies
front 3 3. Original antigenic sin refers to: A. A pathogen’s first infection being the most severe B. The immune system using memory responses to the first encountered version of a pathogen C. Immune evasion through gene conversion D. T-cell exhaustion	back 3 B. The immune system using memory responses to the first encountered version of a pathogen
front 4 4. Antigenic drift in influenza involves: A. Gene reassortment B. Large genetic shifts C. Point mutations in HA and NA D. Mutations only in the M2 protein	back 4 C. Point mutations in HA and NA

front 5 5. Antigenic shift leads to: A. Seasonal influenza B. Yearly vaccine updates C. Formation of completely new influenza subtypes D. Mild respiratory infections only	back 5 C. Formation of completely new influenza subtypes
front 6 6. Trypanosomes evade immunity through: A. Antigenic shift B. Cytokine storms C. Gene conversion of VSG genes D. Destruction of CD4 cells	back 6 C. Gene conversion of VSG genes
front 7 7. Superantigens cause immune evasion by: A. Blocking TCR signaling B. Destroying B cells C. Non-specific activation of large numbers of T cells D. Hiding inside macrophages	back 7 C. Non-specific activation of large numbers of T cells
front 8 8. Which primary immunodeficiency is caused by a BTK mutation? A. SCID B. Hyper IgM syndrome C. X-linked agammaglobulinemia D. CVID	back 8 C. X-linked agammaglobulinemia

front 9 9. Leukocyte Adhesion Deficiency (LAD) is caused by: A. ADA deficiency B. CD18 deficiency C. TAP mutation D. FOXP3 mutation	back 9 B. CD18 deficiency
front 10 10. Which deficiency predisposes to recurrent Neisseria infections? A. C1 deficiency B. C3 deficiency C. C5–C9 deficiency D. DAF deficiency	back 10 C. C5–C9 deficiency
front 11 11. HIV gp120 binds to _____ following CD4 attachment: A. CXCL10 B. IFN-γ C. CCR5 or CXCR4 D. MHC I	back 11 C. CCR5 or CXCR4
front 12 12. Which HIV gene encodes reverse transcriptase, integrase, and protease? A. gag B. env C. pol D. nef	back 12 C. pol

front 13 Variant	back 13 Organism with genetic differences from original.
front 14 Strain	back 14 Genetically distinct isolate with unique biological properties.
front 15 Serotype	back 15 Variant distinguished by antigenic differences detected by antibodies
front 16 Describe original antigenic sin	back 16 The immune system preferentially uses memory responses from its first exposure to a pathogen even if a new variant is different, leading to suboptimal immunity.

front 17 antigenic drift	back 17 Small point mutations → seasonal flu.
front 18 antigenic shift.	back 18 Major reassortment events → new subtypes → pandemics.
front 19 What is gene conversion and why is it important for immunity?	back 19 Switching expressed gene with a silent copy to change surface antigens → immune evasion (e.g., Trypanosome VSG switching).
front 20 what are warning signs of primary immunodeficiency?	back 20 Recurrent infections, failure to thrive, chronic diarrhea, needing prolonged antibiotics, opportunistic infections, family history

front 21 Name structural components of HIV involved in host cell entry.	back 21 gp120: binds CD4 + CCR5/CXCR4 gp41: mediates membrane fusion
front 22 Describe the phases of HIV infection.	back 22 Acute: High viral load, flu-like Latency: Gradual CD4 decline AIDS: CD4 < 200 or AIDS-defining illness
front 23 1. A 2-month-old presents with chronic diarrhea, failure to thrive, and recurrent viral and fungal infections. Labs show profound T- and B-cell deficiency. What is the most likely diagnosis?	back 23 SCID
front 24 2. A child has delayed umbilical cord separation and recurrent skin infections with no pus formation. Neutrophil counts are high in blood but absent at infection sites. What defect is most likely?	back 24 CD18 deficiency → Leukocyte Adhesion Deficiency

front 25 *3. A patient gets recurrent Staphylococcus aureus* and Aspergillus infections. Neutrophils fail the NBT test. Diagnosis?**	back 25 Chronic Granulomatous Disease (NADPH oxidase defect)
front 26 4. A young boy has extremely low IgG, IgA, and IgE but very high IgM. What immunodeficiency is suspected?	back 26 Hyper IgM Syndrome (CD40L deficiency)
front 27 5. A teenager presents with recurrent respiratory infections, low IgG and low IgA/IgM. Diagnosis?	back 27 CVID
front 28 6. A patient develops Kaposi sarcoma, oral thrush, and Pneumocystis pneumonia. CD4 count is 150. What stage of HIV infection is this?	back 28 AIDS

front 29 7. An HIV patient begins ART with a drug that prevents viral genome insertion into host DNA. Which drug class is this?	back 29 Integrase inhibitors
front 30 8. A farmer bitten by a tsetse fly develops waves of fever every few weeks. Parasite shows different surface proteins at each visit. What mechanism allows this?	back 30 Gene conversion of VSGs (Trypanosomes)
front 31 1. Which BEST describes antigenic shift in influenza? A. Gradual accumulation of point mutations B. Reassortment of segmented viral genomes C. Switching of silent gene copies D. Mutation caused by selective antibody pressure	back 31 B. Reassortment of segmented viral genomes
front 32 2. A patient infected with influenza A produces a poor response to a newly circulating variant because their immune system relies on memory B cells from their childhood infection. This is an example of: A. Antigenic drift B. Antigenic interference C. Original antigenic sin D. Immune tolerance	back 32 C. Original antigenic sin

front 33 3. Trypanosome antigenic variation occurs through: A. Antigenic drift in the VSG gene B. Antigenic shift between co-infecting parasites C. Gene conversion events from a library of silent VSG genes D. Mutations induced by host enzymes	back 33 C. Gene conversion events from a library of silent VSG genes
front 34 Which statement about superantigens is TRUE? A. They bind the peptide-binding groove of MHC II B. They bind outside the antigen-binding site and activate many T cells C. They induce class switching in B cells D. They promote tolerance by inhibiting cytokines	back 34 B. They bind outside the antigen-binding site and activate many T cells
front 35 5. A pathogen that establishes lifelong latency and reactivates under stress is most likely a: A. Retrovirus B. Coronavirus C. Herpesvirus D. Picornavirus	back 35 C. Herpesvirus
front 36 6. A deficiency in the IL-2Rγ chain most strongly affects: A. Neutrophil migration B. B-cell maturation C. T and NK cell development D. Complement activation	back 36 C. T and NK cell development

front 37 7. A newborn with SCID is found to have normal B cell numbers but no functional T cells. Which cause is most likely? A. ADA deficiency B. CD40L mutation C. IL-2Rγ chain deficiency D. BTK mutation	back 37 C. IL-2Rγ chain deficiency
front 38 8. TAP mutations lead to: A. Loss of CD4 T cells B. Loss of CD8 T cells due to poor MHC I presentation C. Hyper IgM phenotype D. High IgE and cold abscesses	back 38 B. Loss of CD8 T cells due to poor MHC I presentation
front 39 9. Which immunodeficiency presents with recurrent catalase-positive infections and granuloma formation? A. CVID B. Chronic Granulomatous Disease C. Hyper IgE Syndrome D. Leukocyte Adhesion Deficiency	back 39 B. Chronic Granulomatous Disease C. Hyper IgE Syndrome
front 40 10. Hyper IgE syndrome (STAT3 mutation) is characterized by all of the following EXCEPT: A. High IgE B. Cold abscesses C. Eczema D. Absent B cells	back 40 D. Absent B cells

front 41 *11. Which disease is characterized by low IgG and low IgA/IgM* with recurrent respiratory infections?** A. SCID B. XLA C. CVID D. Hyper IgM	back 41 C. CVID
front 42 12. In HIV infection, gp41 specifically functions to: A. Bind CCR5/CXCR4 B. Bind CD4 C. Mediate fusion of the viral envelope with the host membrane D. Integrate viral DNA	back 42 C. Mediate fusion of the viral envelope with the host membrane
front 43 13. The HIV structural protein p24 is part of the: A. Envelope B. RNA genome C. Capsid D. Polymerase complex	back 43 C. Capsid
front 44 14. Which gene encodes HIV’s major structural proteins like p24? A. pol B. env C. gag D. nef	back 44 C. gag

front 45 15. A patient with HIV has a CD4 count of 180 and develops Pneumocystis pneumonia. This indicates: A. Acute HIV B. Clinical latency C. AIDS D. Seroconversion	back 45 C. AIDS
front 46 16. What is the MOST common reason HIV vaccine development is difficult? A. HIV is a DNA virus B. HIV has very stable epitopes C. HIV mutates rapidly and targets immune cells D. HIV is non-enveloped	back 46 C. HIV mutates rapidly and targets immune cells
front 47 17. Which ART class prevents cleavage of viral polyproteins into functional enzymes? A. Protease inhibitors B. Integrase inhibitors C. Fusion inhibitors D. CCR5 antagonists	back 47 A. Protease inhibitors
front 48 18. A mutation in FOXP3 results in: A. Hyper IgM syndrome B. APECED C. IPEX D. LAD	back 48 C. IPEX

front 49 *19. Which immunodeficiency results in no B cells* and therefore no immunoglobulin production?** A. XLA B. Hyper IgE Syndrome C. CVID D. Complement C5–C9 deficiency	back 49 A. XLA
front 50 20. Which immunodeficiency is most strongly associated with recurrent Neisseria infections? A. C1 deficiency B. C3 deficiency C. C5–C9 deficiency D. Properdin deficiency	back 50 C. C5–C9 deficiency