以下是学长姐的资料 至於详解我也不知道对不对 提供给大家看看 PS.这学期怎麽颇有上学期期末考的FU？ 　 书都快念不完了啦= = 念完又忘了 囧 ========================正题开始============================= 1. A 35-year-old man has an enlarged mass in his right neck. Biopsy of the mass shows granulomatous inflammation in soft tissue. Which of the following cells most likely mediates the histological changes？ (A)IgE secreting B lymphocytes (B) IgA secreting B lymphocytes (C)Natural killer cells (D)CD4+ T lymphocyte (E)CD8+ T lymphocyte Ans. (D)【见陈志荣Immune Disease (1)共笔P.13】。 肉牙肿发炎属於第四型过敏反应中的迟发型过敏，以CD4+ T细胞为主，CD4+ T细胞可以活 化macrophage而形成类上皮细胞和giant cell；或分泌许多cytokine造成发炎和乾酪性坏 死。 2. Which of the following cells is most likely involved in a patient with skin rash and itching after having shrimps in his dinner？(A)Mast cells (B)Natural killer cells (C)Macrophages (D)Langerhans cell (E)Follicular dendritic cells Ans. (A)【见陈志荣Immune Disease (1)共笔P.8】。 患者在吃完虾子就产生过敏症状，这是第一型过敏反应（Immediate Type）。和第一型过 敏反应相关的细胞是肥大细胞；此外basophil和eosinophil和B cell也可参与其晚期反应 。 3. A 30-year-old woman has had fever and arthralgia for 2 weeks. On physical examination, she has an erythematosus skin rash on her face. Laboratory tests are positive for ANA at 1:1600 and anti-double-stranded DNA autoantibodies at 1:3200. Pancytopenia is also present. Which hypersensitivity mechanism(s) is (are) mediated for her pancytopenia? (A) Type I hypersensitivity (B) Type II hypersensitivity (C) Type III hypersensitivity (D) Type IV hypersensitivity (E) Types II and III hypersensitivity Ans. (B)（抱歉BC不太确定，查网路应该是B）【见陈志荣Immune Disease (2)共笔P.7】 。 （1） 首先由1.关节痛（arthralgia） 2.脸部红斑（erythematosus skin rash on face ） 3.抗核抗体（ANA）4.免疫失常，出现anti-double-stranded DNA 5.有血液疾病泛血 球减少（pancytopenia） 可诊断为SLE。 （2） SLE的病发机转包括两种： 1. Type III hypersensitivity：免疫复合体 (DNA跟抗核抗体的结合体)所引发的发炎反 应 (或称)是导致多数脏器，尤其是肾脏，受损的主要原因。虽不清楚抗核抗体是不是会 进入细胞，但如果细胞核暴露在外时（如细胞死亡），抗核抗体就会与之结合，并影响染 色质的功能。 2. Type II hypersensitivity：此外，也有些针对红血球、白血球及血小板的自体抗体 会导致这些细胞的折损而引起发炎反应。 4. A 42-year-old man develops difficulty breathing after a sting by虎头蜂. Marked urticaria and edema of the hand that was stung are found. Which of the followings is most likely mediates the reaction? (A) IgA (B) IgD (C) IgE (D) IgG (E) IgM Ans. (C)【见陈志荣Immune Disease (1)共笔P.8】。 蚊虫叮咬属於第一型过敏反应的过敏原，跟它相关的抗体是IgE，常见叮咬包括下列两大 类： 1.蜜蜂、黄蜂、虎头蜂、火蚁会螫人引起全身性血管过敏性休克。2.蚊子、鹿蝇、蝨等会 咬人，但大多为局部性血管反应。另外如果是蛇（非虫）咬到而神经麻痹掉，应该就不算 是过敏了.. 5. A 35-year-old man with chronic renal failure received a renal transplant five years ago. For last few years, he had only minor episodes of rejection that were controlled with immunosuppressive therapy. In the past 6 months, he has had increased serum creatinine and urea nitrogen levels. No proteinuria or leukocyte is noted in his urine. CT scan shows that the allograft is reduced in size. Which of the following immunologic processes most likely accounts for these findings? (A) Granulomatous vasculitis (B) Complement-mediated cell lysis (C) Antibody-mediated vasculitis (D) CD8+ lymphocyte-mediated cell necrosis (E) Vascular intimal fibrosis Ans. (E)（抱歉不是很确定..）【见陈志荣Immune Disease (1)共笔P.16】。 （E）根据患者在移植数年後才有上述反应，可判断是慢性排斥chronic rejection，此排 斥的特徵有：（网路某篇论文）namely glomerular basement membrane duplication (chronic transplant glomerulopathy) and/or arterial intimal fibrosis（和E选项 相同，所以就选了） with intimal mononuclear cell infiltration, showed PTC C4d staining. 造成慢性排斥的机转尚未明了..可能是老师说的Indirect T cell-mediated， 或是赵俊*说的与抗体有关.. （A）很多病如Wegener's granulomatosis (granulomatous vasculitis)，主要是T cells are present.. （B）补体反应主要见於Type II和 III hypersensitivity。和慢性过敏比较无关.. （C）虽说赵俊*说chronic rejection与抗体有关，不过Antibody-mediated vasculitis 通常是指急性过敏（相关资料不是很明确..） ※综合讲义网路和赵俊*：与B cell有关的排斥（参考一下罗 ^^） （1）超急性 数分钟~数小时 体内已有抗体 （2）急性 5天~数月 由Th2、B引起的Antibody-mediated vasculitis（所以不能选C选项 ）。另外也可参考老师的讲义P5也有写acute humoral rejection ※通常急性排斥的主角是细胞型免疫喔.. （3）慢性 数年~数十年 机转未明，可能与T4（CD4+ T细胞）或B细胞有关，特徵如E选项 ，有intimal fibrosis （D）又Indirect T cell-mediated的免疫反应通常是CD4+ T细胞参与，所以(D)错.. 6. A 25-year-old male received peripheral stem cell transplantation for acute leukemia two months ago has developed an extensive scaling rash since last week. A skin biopsy specimen shows upper dermal lymphocytic infiltrates and keratinocyte apoptosis. He also has jaundice. Which of the following cells is most involved in his present disease? (A) CD4+ T lymphocyte (B) CD8+ T lymphocyte (C) IgE-secreting B lymphocyte (D) Macrophage (E) Langerhans cell Ans. (A)（抱歉不是很确定）【2/26陈志荣讲义P.6中Late problems】 老师只有说关於PBSC (peripheral blood stem cell) 移植早期（weeks之内），有皮肤 淋巴腺浸润，就是immunocomptent T cell，网路查有一篇Peripheral blood stem cell allograft rejection mediated by CD4+ T lymphocytes recognizing a single mismatch at HLA-DP1*0901，另外也有一篇写Total T cell, CD4+T cells and CD56+NK cell reconstitution were improved in alloBCT group vs alloBMT group. CD4+/CD8+ ratio evolution were improved in alloBCT group vs alloBMT and autoBCT groups. These results confirm that rapid immune recovery is associated with allogeneic blood stem cell transplantation.所以应该选A吧，不过 其实CD4或CD8好像都有关系。另外如果是後期（3~18个月），老师就有写影响主要是 helper T cell = CD4+ T lymphocyte。 7. After one hour of a mismatched blood transfusion, a 54-year-old male patient becomes tachycardic and hypotensive and passes pink-colored urine. Which of the followings is the most possible mediated mechanism? (A) Complement-mediated lysis of RBCs (B) Mast cell degranulation (C) Immune complex deposition in glomeruli (D) Release of leukotrienes into circulation (E) Activation of macrophages Ans. (A) 输血错误会产生超急性的排斥，造成RBC被抗体-补体路径溶解，故尿液呈粉红 8. A 40-year-old man has been infected with HIV for the last 10 years. In recent one year, he has had several episodes of oral candidiasis and body weight loss in past 6 months. He also has skin lesions that were been diagnosed as Kaposi sarcoma. Which of the following types of cell is most depleted in his lymph nodes? (A) Neutrophil (B) Follicular dendritic cell (C) Macrophage (D) CD8+ lymphocyte (E) CD4+ lymphocyte Ans. (E) 见【讲义2/26陈志荣特别演讲讲义P.10 AIDS部份第六点】 HIV主要使CD4+ T lymphocyte减少 9. Which is the characteristic histological change of type III hypersensitivity? (A) Marked eosinophilic infiltration (B) Lymphocytic infiltration (C) Acute necrotizing vasculitis (D) Granuloma formation (E) Thrombus formation Ans. (C) 2/26陈志荣特别演讲讲义P.4第六行，微观病变可见IC沉积引起急性坏死性血管 炎 10. A 2-year-old boy had continuous infections since he was 6 months old. These infections have included otitis media, pneumonia, and skin infections and were mainly caused by different bacteria. He had an older brother with a similar condition died because of severe infections. The boy's sister and both parents are normal. Which of the following laboratory findings would most likely be seen in this boy? (A) Lower level of IgA (B) Decreased complement C3 (C) Positive ANA test result (D) Markedly decreased immunoglobulin (E) Elevated IgM level Ans. (D)（抱歉不是很确定） 【见陈志荣讲义P.9下SCID部分】 由题干叙述可知此病盛行於男童，推知是遗传X显或隐性的疾病，且影响免疫系统甚钜， 故不断受到感染，再加上6月大发病、死亡率高，推论符合的疾病主要可能有两种： 1.X-linked agammaglobulinemia（体液免疫不全，3月後发病） 2.SCID（有细胞免疫和体液免疫不全的情形，主要3~6月大时发病）。 而这两种病在D选项都成立。 选项BCE老师讲义好像都没讲到。 不选A是因为应该单一缺IgA的话，死亡率和症状都比较不严重，且皮肤比较没病变。 -- 仓木麻衣新作品情报 2009 / 06 / 10 第32张单曲「Beautiful」 发售 CM：化妆品广告印象曲 　　　　　　　　CD + DVD 2009 / 07 / 01 第二张精选辑「Mai Kuraki BEST "MERRY MUSIC!"」 发售 2CD --

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