1.

B lymphocytes maturation
a. bone marrow
b. lymphnodes
c. lien
d. thymus
e. MALTs

2. APC introduce microbes to lymphocytes for the 1st time:

a. bone marrow
b. follicle of secondary lymphoid organ
c. medulla of lymph nodes
d. NK cell
e. cortex of lymph nodes

3. Cell that play major role in adaptive immunity

a. macrophage
b. neutrophil
c. lymphocyte
d. natural killer cell
e. complement

4. Mononuclear phagocyte in the blood circulation

a. macrophage
b. monocyte

c. kuffler cell
d. microglia
e. alveolar macrophage

5.phagocyte microbe destroyed by?

a. NO and ROS
b.
c.
d.
e.

6.component of innate immunity?

a. complement
b. lymphocyte
c. B lymphocyte
d.
e.

7. Complement activation
a. alternative, classical
b. alternative, classical, lectin
c. alternative, lectin
d. classical, lectin
e. classical, lectin, sirculatory

8. Cytokine released by NK cells

a. IFN alpha
b. TNF alpha
c. IFN beta
d. TNF beta
e. IFN gamma

9.MHC class I is expressed on

A.every nucleated cell
B.T cell
C.macrophage
D.NK cell
E.B cell

10.CD4 T cell is recognised as antigen that form a complex with

A.MHC I
B.MHC II
C.APC
D.CD8 T cell
E.B cell

11.-a patient (tak igt lelaki ke perempuan) visit puskesmas for the 2nd time
-sputum taken for lab examination
-3 weeks persistent cough with some whitish-yellow
-fever, night sweats, general lethargy, lost weight

-doctor suspected mycobacteria infection

mycobacteria is a type of intracellular bacteria that can survive within phagocyte in the alveolus.the most
likely cell is:
a.NK cell
b.basophil
c.eusophil
d.neutrophil
e.macrophage

12.why CD4 can bind at T cell?

b.TCR complex

13) Part of APC that act as costimulator for 2nd activation of cd4 t cell ?
B7

14)cytokine produce cd4 t-cell to enchange virus related to this case ?

15)Subtype of cd4+ and T cell that play major role in this case is
a.Th1
bTh2
c.Th17
d.Nk cell
E.cytotoxic cell

16)Isotype that act as receptor on membrane bound of naive B cell are?

-IgD and IgM-

slide 7 antigen recognition in adaptive immune system-dr syamsu

17)On the phases of humoral immune response, if there is no participation of Th cells, naive B cells typically
will be activated, proliferate, & differentiate into plasma cell and may produce:
A.Ig A
B.Ig D
C.Ig E
D.Ig G
E.Ig M
(slide Humoral response no. 8)
Kalau xde Th, Naive B cell --> IgM,
Dgn bantuan Th, Naive B cell --> IgG, IgA, IgE

18) The immunoglobilin isotype that has a major role in mucosal immune system is?
A.Ig A
B.Ig D
C.Ig E
D.Ig G
E.Ig M
http://www.nature.com/mi/journal/v1/n1/full/mi20076a.html

19. which of the following immunoglobin has ability to cross the placental barrier so that it can provide a
major line of defense for the 1st week of a baby's life?
a. IgA

b. IgD
c. IgE
d. IgG
e. IgM
(slide Humoral response no. 26: IgG subclasses, IgG1 & IgG3 -placental transfer, FcR dependent phagocyte
response & complement activation))

20. Which one of the following is correct concerning the primary humoral immune response?
A. Antibody isotype produced especially IgG
B. Affinity of the antibody produced relatively low
C. Immune response occur at day 1-3 after infection/immunization
D. Memory B cell has a major role on the initiation of the immune response
E. The quantity of immunoglobulin produced is relatively high compared to the secondary response.
slide 10 humoral immune response..

21)A young girl has had repeated infection with candida albicans and respiatory viruses since the time she
was 3 month old. As part of the clinical evaluation of her immune status, her responses to routine
immunization procedure should be tested. In this evaluation, the use of which of the following vaccines is
contraindicated?(ADIL)
a. dipththeria toxoid
b. BCG
c. bordetella pertussis vaccine
d. inactivated polio
e. tetaus toxoid
http://reference.medscape.com/drug/tice-bcg-vaccine-tice-strain-343147#5

22)the arthus reaction is a classic inflammation inflammatory response that is best described by which of the
following statements?(ADIL)

a. The Arthus reaction requires a low concentration of antigen and antibody.

b. The Arthus reaction appears later after injection than does passive cutaneous anaphylaxis
c. The Arthus reaction is mediated by IgM
d.The characteristic Arthus lesion develops slowly
e. the extent of the Arthus lesion is independent of the quantity of reacting Antigen and Antibody.
http://medical-dictionary.thefreedictionary.com/Arthus+reaction

23. Man, age 26y.o with suspect typhoid fever and melena at 7 days ago. Physcal examinataion:fever 38.2
degree celcius, coated tongue and subcomatous. Serological test to confirm the diagnosis as typhoid fever:
A. Haemagglutination tes
B. Floculation test
C. Lateral flow
D. Complement Fixation Test
E. Microscopic Agglutination tes (MAT)

24. The serological test for typhoid fever to detect immunoglobulin:

A. IgA
B. IgG
C. IgD
D. IgM
E. IgE

25. Woman, age 45y.o with Mycobacterium leprae (M.leprae) infection at one year ago. Acid Fast Bacilli (AFB)
was found in right earlobe. Humoral immunity responses in this patient will be increase through the titer of
immunoglobulin againt Phenolic Glycolipid-I (PGL-1). M.leprae specific antigen:
A. IgA
B. IgG

C. IgD
D. IgM
E. IgE

26. Cytokine related gene that involve in B cell maturation to produce the immunoglobulin as humoral
immunity response to microbial infection:
A. Interleukin 6
B. Interleukin 10
C. Supressor of cytokine signaling-1 (SOCS-1)
D. Supressor of cytokine signaling-3 (SOCS-3)
E. Toll Like Receptor-4 (TLR-4)

27. Man, age 17y.o with digestive tract infection at 8 days ago. Physical examination: fever, icterus, muscle
pain and laboratory test with increasing of IgM titer against Leptospira Icterohaemorrhagica specific antigen.
Effector mechanisms of humoral immunity response through pathway:
A. Proliferation of B cell memory by TGF Beta
B. Transduction signalling of TLR-4 by LPS of L.icterohaemorrhagica
C. Depresion of proliferation CD 8 by SOCS-3
D. Increasing chitotriosodase activities in serum
E. Depresion of CD 8 memory cells by SOCS-1

28. Initial process in phagocytosis of bacterial cells:

A. Engulfment
B. Fusion
C. Chemotaxis
D. Digestion
E. Formasi fagosom

29. Cytokine as antiviral functions:

A. Interleuikin-10
B. IL-1
C. Interferon alpha
D. TNF alpha
E. TGF beta

30. Which of the following Immunoglobulin classes not involves in active complement:
A. IgA
B. IgG-1
C.IgG-2
D. IgM
E. IgE
http://www.newworldencyclopedia.org/entry/Antibody

31. Here are some conditions dealing with ideal vaccine:

A. Activate T cell only
B. Give antigen response temporary
C. Activate B cell only
D. not activate interleukin release
E. activate APC

32. Which one is correct about adjuvant

A. Specific

B. Harmful
C. Not influence the host immunity
D. Decrease the host immune response
E. can activate APC
http://www.invivogen.com/review-vaccine-adjuvants

33. Which one of not relevant to succes of immunization

a. host immune status
b. vaccine cost
c. vaccin quality
d. genetic factor of host
e. vaccine quantity

34. Vasculitis disease that is called pulseless disease

a. HS purpura
b. Takayasu disease
c. Kawasaki disease
d. Wegener granulomatosis
e. PAN

35. Vasculitis disease that occur at large blood vessels

a. HS purpura
b. Takayasu disease
c. kawasaki disease
d. Wegener granulomatous

e. PAN

36. Vasculitis that affect the respiratory tract

a. HS purpura
b. Takayasu disease
c. kawasaki disease
d. Wegener granulomatous
e. PAN

37. Migration of effector T cell to the side of infection is guided by :

a. T-cell receptor
b. Antigen specificity infect cell
c. infected cell
d. adhesion molecule
e. antigen presenting cell

38. Antibody dependant T cell :

a. For lipopolysaccharide antigen
b. produced by marginal B cell
c. no isotype switching
d. no affinity maturation process
e. produced by plasma cell

39. Activated macrophages able to produce the following microbial:

I - Carbon dioxide

II - Reactive Oxygen
III - Carbon Monoxide
IV - Nitric Oxide
Ans: C

40. CD8+ CTLs effector T lymphocyte mediated viral eradication by:

1.spraying infected cell by porifirin
2. produce caspase
3. spraying infected by granule enzyme
4. induce effector cells apoptosis
ans: B

41. Virulent Strain of Cryptococcus Neoformans may survive in human body by

i - inhibit production of TNF by macrophage
ii - inhibit produciton of IL-12 by neutrophils
iii - Stimulate production IL -10
iv - INhibit caspace activation
Ans : e

42. Host tissue injury is caused by

i - long activation of macrophage
ii - high production of NO and ROS
iii - Granolomatous inflammation
iv - TGF - b production
Ans : A

43. chronic helminth infection is marked by

1. Th-2 immuneresponse
2. Prod. of IL-4
3. Prod of IgE
4. Prod. of IL-5
Answer : E (slide dr sri wahyuni-Immunity to parasite &fungi)

44. Low allergy prevalance in endemic area of helminth infection is caused by

1. low allergen exposure
2. rice as a main course
3. low prod. of IgE
4. prod. of regulatory T-cell

45. Mechanism of immunoevasion by parasite including :

1. Antigenic variation
2. Acquired resistance to complement,CTLs
3. Inhibition of host immune responses
4. Antigen shedding

46. In indirect detection,method of immunohistochemistry, the labelling could be tagged in :

A. Secondary antibody
B. Bridging antibody
C. Primary antibody
D. Tertiary complex antibody

E. Avidin biotin complex

47. In substrate for peroxidase of immunohistochemistry that produce brown colour is?
C. diaminobenzadine

48. In the process of hyposensitization the formation of "blocking antibody" is belong to?
A. IgA
B. IgM
C. IgG
D. IgD
E. IgE

49.Mother that always has stillborn babies after her first baby is possible to have this condition:
A.her blood group-A,her husband-B
B.her blood group-O,husband-A
C.her blood group-AB.husband-A
D.her blood group-O,husband-AB
E.she is rhesus(-),husband-rhesus(+)

A man 54 years old has been admitted to the intensive care unit for a critical ill.On physical examination he
has edema on his lower legs and hands.Laboratory work reveals hypoalbuminemia (2.2 G.dl) and anemia(Hb
9.4g/dl) among other abnormal biochemical results.He also has fever (38.4 C) which is intractable to
antipyretic drugs.He has been on total parenteral nutritions (intravenous/nofood/nodrinks per oral)
50.Amino acis that maybe lacking in this patient and can cause GI tract mucosal atrophy and bacteria
translocation across the gap epithelium is:
A.tyrosine
B.Arginine

C.Glutamine
D.Leucine
E.Histidine

51.To increase function in this patient, he needs the following amino acids which can produce NO, a potent
bactericidal and vasodilator.
A. Tyrosine
B. Glutamine
C. Arginine
D. Leucine
E. Histidine

52. Which of the malnutrition characteristic in this patient that is associated with increased morbidity,
mortality, and prolonged hospital stay.
A. Oedema
B. Anemia
C. Hypoalbuminemia
D. Wasting
E. Low body weight

53. Mineral that especially crucial for integrity of linings of the GI and pulmonary tract.
A. Cu B. Se C. Zn D. Mg E. Fe

54. A girl 5 y.o has been taken to the emergency unit for itchy, skin rashes over her body after eating egg.
She has suffered this condition since she was 1 y.o. Which of the following statements about the case above
are true?
A. The diagnosis of this patient is likely food allergy

B. Food allergy in this patient tends to be outgrown

C. The best management of food allergy is medicine
D. Food substitution with other kind of egg is neededE. Avoidance of egg is not important

55. The characteristics of an acute transplant rejection

i- Occurster within days or monts after transplant
ii- Mediated by both humoral (antibody mediated) and cellular
iii- Vasculittis is prominent feature which mediated b anti-donor antibody that attcak the
vascular wall
iv- There are also parenchyma and cell injuries which indicated by prominent interstitial
accumulation of lymphocytes

56- Nutrient with anti-inflammatory effect

A-Glutamine
B-Thiamine
c-Albumin
D- N-3 Pufa
E- N-6 Pufa

59: The mechanism of clonal anergy to develop aotoimmunity:

a)molecular mimicry
b)polyclonal activation
c)exposure to hidden self antigen
d)fail of receptor editing
e)apoptosis of clonal anergised cells

60)which immune-competent cells act against tumor cell

a)nk cell
b)cytotoxic (cd8) T-lymphocytes
c)macrophage
d)B-lymphocyte (antibody to tumor cell)

61. to do a sensitivity test should be a

A. screening test
B. follow up therapy
C. confirmation test
D. follow up complication
E. patch test

62. Western blot function to detect :A. DNA

B. Protein
C. RNA
D. Polysaccharide

63. Complex fixation is

A. haemolysis of erythrocytes without complement
B. Binding of antigen-antibody induce the complement activation
C. Complement is activated if there is high amount of antigen
D. Complement fixed in membrane react with antigen
E. Complement dont needed in antigen-antibody reaction

64. Interpretation of immunochromatography of dengue test

A. Invalid ; no test line
B. Secondary infection ; C, M, G line appears
C. Invalid ; No M line
D. Negative; No C line
E. All above not true

65. A doctor prescribe CTM for treatment of allergic dermatitis. what is the class of this medicine?
A. Autonomic oral
B. Corticosteroid oral
C. Anti-Histamine 1
D.
E. Anti-Histamine 2

66. 15 y.o boy, has allergic rhinitis. he is an active boy. best medicine to treat rhinorhea
A. Loratidine oral
B. Prednisone Oral

67. Budesonide is a corticosteroid used as inhalant. Mechanism of its action :

A. Bind to histamine-1 receptor
B. Bind to histamine-2 receptor
C. Stimulate adrenergic beta-1 receptor
D. Inhibit adrenergic beta-1 receptor
E. Keep intact of mast cells

68. The uses of corticosteroid for a long term can cause :

A. Decrease in body weight
B. Decrease in blood pressure
C. Decrease of fat in hand
D. Decline immunity against virus
E. Decrease of fat in leg

69. Man 40years old suffered can't move his leg. The disease
A.Grave disease
B.Mysthenia gravis
C.Swiss typhe agammaglobulinemia
D.De George syndrome
E. Bruton disease

70.mysthenia graviss patient. he has receptor to

A.TSH receptor
B. Mast cell receptorC. CD4 receptor
D. Basophylic receptor
E. Aceythlcholine receptor

71. This condition is categorized as:

A. Hipersensitivity Type 1
B. Hipersensitivity Type 3
C. Hipersensitivity Type 2
D. Hipersensitivity Type 4

E. Arthus Reaction
Ans : C

72. the reaction below as an IgE immediated inflammation except:a. allergic rhinitis
b.urtikaria
c.skin prick test rxn
d.food cyclic antigen rxn
e.asthma bronchiole

73. in vivo examination to support diagnosis of type 4 hypersensitivity is: A. prick test
B. patch test
C. ELISA
D. RAST
E. COOMBS test

74. A mediator that cause mast cell degranulation without cross lingking Fc?RI:
1.TNF beta
2.C3a
3.IL-2
4.C5a
Ans:C

75. The cells is instrumental in transmitting HIV to CD4+ T lymphocytes

A. CD8+ cells
B. Neutrophils

C. NK cells
D. Plasma cells
E. Dendritic cells

76. according to WHO staging system, the patient with unexplained chronic diarrhea more than one month in
stage:
A. stage I
B. stage II
C. stage III
D stage IV
E. stage IV
source : http://hab.hrsa.gov/deliverhivaidscare/clinicalguide11/cg-205_hiv_classification.html

77. CDC defines AIDs to include all HIV+ people with CD4+ T cell count below.... per uL :
A. 100
B. 200
C. 300
D. 400
E. 500

78.HIV is less likely to be transmitted through....

A.blood transfusion
B.breastfeeding
C sweat.
D.sharing needle
Esexual intercourse

79. HIV group subvirus belongs to retrovirus known as......which means "slow" virus
ans: lentivirus

80. Antiretroviral than works by inhibit replication process inside the cell
i- NNRTI
ii- NRTI
iii- protease inhibitor
iv- fusion inhibitor
slide 63 AIDS

81. co-receptor for HIV virus

i- cxcr5
ii- ccr4
iii- b7
iv- cxcr4
ans: D (iv only)
http://www.stanford.edu/group/virus/1999/kasson/CoreceptorFrame.html

82. There are at least 3 mechanisms through which CD+ t count is decrease by HIV infection. The virus kills
the infected cell when HIV multiplies, CTL directly kills the cell and :
A. HIV activates NK cell
B. HIV change its surface epitope
C. Activated-induced apoptosis
D. HIV destroy CCR5 receptor
E. HIV change DNA genome into RNA

83. Innate immunity to intracellular matrix activated by

A. NK cells
B. IL-12
C. CD 4
D. B cells
E. CD 8

84. Below are autoantibody against sperm except

a. produced by mother against her husband's sperm
b. negatively against the sperm motality
c. may be due to the genital tract infection or trauma on testis
d. may be found after vesectomy
e. may cause infertility

85.Treatment of immune induced infertility

i.condom therapy
ii.intrauterine
iii.corticosteroid therapy
iv.in vitro fertilization
Answer: E

86) There are true about conginetal Phagocytic dysfunction except:

a) conginetal immunodeficiency of innate immunity
b) leukocyte is unable to stop in blood circulation

c) macrophage and neutrophil are unable to kill phagocytosed bacteria

d) etiology mutation(X linked or autosomal recessive)
e) result in chronic granulomatous disease

87.genetical etiology of SCID are

1)ADA deficiency
2)PNP deficiency
3)RAG deficiency
4)Y-chain deficiency
answer : E.all correct

88) XLA (Bruton Disease)

i. defect maturation of B lymphocyte from pre B to immature B
ii. No gammaglobulin in serum
iii. Etiology is mutation or deletion of gene on chromosome on chromosom xq22
iv. Kelenjar limpanya membesar

89) which is the defect of B cell activation?

i- Selective immunoglobulin isotypes deficiency (IgA, IgG Subclass).
ii- Defect in T cell dependent B cell activation (The X-linked Hyper-IgM Syndrome)
iii- defect in B cell differentiation
iv-enlarge lymph gland.........
ans: A (i,ii,iii)

90)DiGeorge syndrome:

i)defect in cellular mediated immunity duee to T-cell deficiency

ii)defect in the development of thymus and parathyroid
iii)defect in chromosome 22q11.2
iv)the symptom is tetany
ans:E all correct

91) defect in T cell activation

1.defect in expression of molecule for T cell activation
2.defective class2 MHC expression
3.defective class 1 MHC expression
4.defect T cell receptor expression
ANS:A

92. Etiology of acquired immunodeficiencies:

1. Malnutrition
2. Neoplasm
3. Infection
4. Drugs
ans : E

93. HIV virus:

i. Attack CD4
ii. Attack CD8
iii.Attack macrophage
iv.Attack NK cells

ans : B

94.HIV virus
1)enter the cell via gp120
2)provirus integrated into genome of infected cell
3)cytokine integrate the provirus to synthesis protein into cytosolic of the infected cell for
production of new viral protein
4)the virus leaves the infected cell by breaking out the cell membrane which result in cell lysis
answer : E.all correct

95. 10 years old boy came to clinic with macula erythematosus, itchy, touch warm on his arm fold since 2
weeks ago. Associated with food, disease worst if he take egg. What is the diagnose.
A. acute urticaria
B. AD
C. drug eruption
D. food allegy
E. atopic dermatitis/allergy contact dermatitis

96.5 y/o boy was diagnosed to have atopic dermatitis.It is associated with IgE dependent/hypersensitivity
type 1.What test that could be carried out to support your diagnosis?
A.Intradermal test
B.Patch test
C.Prick test
D.KOH test
E.MED test

97. A 9 y.o. girl comes to clinic with xerosis skin, itch and erythematous macule almost whole of the
body (suitable with major criteria of Haniffin & Rajka). The important points to treat the patients are:
a. Emollient + topical corticosteroid
b. Emollient + topical antifungal
c. Emollient + topical antibiotics
d. Topical antibiotics + topical corticosteroid
e. Topical antifungal +topical antibiotics

98.A 7 y.o girl come to clinic with itch and erythematous macule in are fold. Lab results increase IgE specific i
acute phase of disease cytokine involved are:
a.IL-4,IL-5,IL-13
b.IFN-gamma,IL-12,Il-3
c.TNF-alpha,IFN-gamma,IL-3
d.IL-4,IL-5,IL-12
e.IL-4,IL-5,Il-3

99. 5 months baby come to clinic with itchy and erythematous on both chicks (CHEEKS) since last 2 weeks.
the lab test shows increase level of IgG. thus, what is the differential diagnosis 4 dis case?
a. seborrhoic dermatitis
b. furunculosis
c. sellulitis
d erysipelay
e. impetigo krustosa

100. a man 25 y.o. had red eyes, erythematous, had scale and pain on his lips and mouth. these symptoms
started after he took some medicine 3 years ago. his diagnosis is (paz year)
SSJ

The mechanism of both tolerance t cell and B cell

i. clonal deletion
ii. receptor editing
iii. clonal anergy
iv. T cell regulator

A factor that may not contribute to the development of autoimmunity

a. Activation of clonal anergy
b. Exposure to "hidden" self antigen
c. Apoptosis of clonal anergized cell
d. ...
e. molecular mimicry

(according to scenario ) what type of hypersensitivity is this?

A. 1
B. 2
C. 3
D. 4
E. 5