A 4-year-old boy is brought to the physician by his mother for a high fever and lethargy for the past 24 hours. He has also developed skin lesions on his legs during this time.

Which of the following is most likely to be seen in this patient?

A) Deficiency of adenosine deaminase
B) Deficiency of C1q
C) Deficiency of cell-mediated immunity
D) Deficiency of mucosal immunoglobulin
E) Deficiency of total hemolytic complement

A 4-year-old boy is brought to the physician for a follow-up examination. He has a history of bacterial sepsis one year ago and 3 pneumonias since roughly 7 months of age. Which of the following is the most likely cause of the patient’s pathology?

A) Adenosine deaminase deficiency
B) Deficiency of mucosal immunoglobulin
C) Impaired cell-mediated immunity
D) Impaired phagolysosomal fusion
E) Tyrosine kinase deficiency

A 6-year-old boy is brought to physician by his parents for recurrent infections since early infancy. He has had multiple episodes of otitis media and pneumonia requiring antibiotics, and his parents report frequent episodes of diarrhea. Physical examination shows diffuse eczematous rash involving the flexural surfaces and trunk with areas of excoriation. The infant bruises easily, and his parents note frequent nosebleeds and prolonged bleeding after heel sticks. Which of the following is the most likely explanation for this patient’s presentation?

A) Chediak-Higashi syndrome
B) Hyper IgM syndrome
C) IgA deficiency
D) Job syndrome
E) Wiskott-Aldrich syndrome

A 9-year-old girl is brought to the physician by her mother for a 3-day history of small red spots on her shoulders and chest. She has no past medical history apart from a viral infection a couple weeks ago. Hemoglobin is 14 g/dL. Prothrombin time is 12 seconds. Partial thromboplastin time is 34 seconds. Bleeding time is 9 minutes. Leukocytes are 8,000/μL. Glucose is 88 mg/dL fasting. Which of the following is most immunologically similar to this patient’s condition?

A) Arthus reaction
B) Graves disease
C) Malar rash
D) Rhus dermatitis
E) Urticaria

A 22-year-old woman comes to the physician for a 1-day history of swelling of her hands and lips. She has had many such episodes in the past. The swelling is usually non-pitting and non-pruritic. Her right hand is shown.

Which of the following is the most likely explanation for this patient’s findings?

A) Decreased bradykininase activity
B) Increased degranulation
C) Increased high molecular weight kininogen cleavage
D) Increased histamine release
E) Increased recruitment of eosinophils

A researcher is evaluating different vaccines during a study about converting T-independent vaccines into T-dependent ones. Which of the following is the most likely focus of this researcher’s evaluation?

A) Diphtheria
B) Haemophilus influenzae type B
C) Hepatitis B
D) Mumps-Measles-Rubella
E) Rotavirus
F) Tetanus

A 67-year-old woman comes to the physician for a follow-up appointment. She has a 6-month history of mid-upper back pain, as well pain in her right humerus. The results of her serum protein electrophoresis performed last week are shown. “A” reflects a healthy individual; “B” is the patient.

Which of the following is most likely to be seen in this patient?

A) Bone marrow biopsy showing 6% plasma cells
B) Plasmacytoid cells of 12% in bone marrow
C) Raynaud phenomenon
D) Reduced serum parathyroid hormone
E) Systolic dysfunction

An 18-year-old girl comes to the physician for a 3-day history of low-grade fever, dry cough, and mild wheezing. She has been treated for several bacterial pneumonias since childhood and occasional sinusitis. Vitals are: temperature 100 F, RR 16, HR 74, BP 120/80. She has a history of atopic dermatitis. Her older brother has autoimmune gastritis. Which of the following best describes the deficient immunologic species in this patient?

A) Binds complement
B) Component of B cell receptor
C) Highest affinity
D) Highest avidity
E) Secreted as dimer with J-chain via transcytosis

A 39-year-old man comes to the physician for a 2-day history of cola-colored that has been very alarming. There is no associated pain and no recent infections. He also has had a 4-month history of intermittent dry cough that occasionally produces a rust-colored saliva. There is no past medical history. Vitals are normal. A biopsy finding from a similar patient is shown.

Which of the following immunologic processes is most similar to this patient’s pathophysiology?

A) Arthus reaction
B) Bee sting reaction
C) Pernicious anemia
D) Post-streptococcal glomerulonephritis
E) Rhus dermatitis

A 32-year-old woman comes to the physician for a 3-month history of restlessness and feeling periodic “hot flashes,” as though she’s going through menopause. Vitals show a slightly elevated heart rate. Past medical history is unremarkable. She takes no medications. Her brother has SLE.

Which of the following is the most likely explanation for this patient’s findings?

A) Autoantibodies against nuclear Smith antigen
B) Autoantibodies against mitochondrial proteins
C) Autoantibodies against enzyme targeting tyrosine residues
D) Autoantibodies against thyroglobulin
E) Autoantibodies against thyrotropin binding site