1. B lymphocytes maturationa. bone marrowb. lymphnodesc. liend. thymuse. MALTs 2. APC introduce microbes to lymphocytes for the 1st time:a. bone marrowb. follicle of secondary lymphoid organc. medulla of lymph nodesd. NK celle. cortex of lymph nodes 3. Cell that play major role in adaptive immunitya. macrophageb. neutrophilc. lymphocyted. natural killer celle. complement 4. Mononuclear phagocyte in the blood circulationa. macrophageb. monocytec. kuffler celld. microgliae. alveolar macrophage 5.phagocyte microbe destroyed by?a. NO and ROSb.c.d.e. 6.component of innate immunity?a. complementb. lymphocytec. B lymphocyted.e. 7. Complement activationa. alternative, classicalb. alternative, classical, lectinc. alternative, lectind. classical, lectine. classical, lectin, sirculatory 8. Cytokine released by NK cellsa. IFN alphab. TNF alphac. IFN betad. TNF beta

e. IFN gamma 9.MHC class I is expressed onA.every nucleated cellB.T cellC.macrophageD.NK cellE.B cell 10.CD4 T cell is recognised as antigen that form a complex withA.MHC IB.MHC IIC.APCD.CD8 T cellE.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 cellb.basophilc.eusophild.neutrophile.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 isa.Th1bTh2c.Th17d.Nk cellE.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 AB.Ig D

C.Ig ED.Ig GE.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 AB.Ig DC.Ig ED.Ig GE.Ig Mhttp://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. IgAb. IgDc. IgEd. IgGe. 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 IgGB. Affinity of the antibody produced relatively lowC. Immune response occur at day 1-3 after infection/immunizationD. Memory B cell has a major role on the initiation of the immune responseE. 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 toxoidb. BCGc. bordetella pertussis vaccined. inactivated polioe. tetaus toxoidhttp://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 anaphylaxisc. The Arthus reaction is mediated by IgMd.The characteristic Arthus lesion develops slowlye. 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 tesB. Floculation testC. Lateral flowD. Complement Fixation TestE. Microscopic Agglutination tes (MAT) 24. The serological test for typhoid fever to detect immunoglobulin:A. IgAB. IgGC. IgDD. IgME. 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. IgAB. IgGC. IgDD. IgME. IgE 26. Cytokine related gene that involve in B cell maturation to produce the immunoglobulin as humoral immunity response to microbial infection:A. Interleukin 6B. Interleukin 10C. 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 BetaB. Transduction signalling of TLR-4 by LPS of L.icterohaemorrhagicaC. Depresion of proliferation CD 8 by SOCS-3D. Increasing chitotriosodase activities in serumE. Depresion of CD 8 memory cells by SOCS-1 28. Initial process in phagocytosis of bacterial cells:A. EngulfmentB. FusionC. ChemotaxisD. DigestionE. Formasi fagosom 29. Cytokine as antiviral functions:A. Interleuikin-10B. IL-1C. Interferon alphaD. TNF alphaE. TGF beta

 30. Which of the following Immunoglobulin classes not involves in active complement:A. IgAB. IgG-1C.IgG-2D. IgME. IgEhttp://www.newworldencyclopedia.org/entry/Antibody 31. Here are some conditions dealing with ideal vaccine:A. Activate T cell onlyB. Give antigen response temporaryC. Activate B cell onlyD. not activate interleukin releaseE. activate APC 32. Which one is correct about adjuvantA. SpecificB. HarmfulC. Not influence the host immunityD. Decrease the host immune responseE. can activate APChttp://www.invivogen.com/review-vaccine-adjuvants 33. Which one of not relevant to succes of immunizationa. host immune statusb. vaccine costc. vaccin qualityd. genetic factor of hoste. vaccine quantity 34. Vasculitis disease that is called pulseless diseasea. HS purpurab. Takayasu diseasec. Kawasaki diseased. Wegener granulomatosise. PAN 35. Vasculitis disease that occur at large blood vesselsa. HS purpurab. Takayasu diseasec. kawasaki diseased. Wegener granulomatouse. PAN 36. Vasculitis that affect the respiratory tracta. HS purpurab. Takayasu diseasec. kawasaki diseased. Wegener granulomatouse. PAN 37. Migration of effector T cell to the side of infection is guided by :a. T-cell receptor

b. Antigen specificity infect cellc. infected celld. adhesion moleculee. antigen presenting cell 38. Antibody dependant T cell :a. For lipopolysaccharide antigenb. produced by marginal B cellc. no isotype switchingd. no affinity maturation processe. produced by plasma cell 39. Activated macrophages able to produce the following microbial:I - Carbon dioxideII - Reactive OxygenIII - Carbon MonoxideIV - Nitric OxideAns: C 40. CD8+ CTLs effector T lymphocyte mediated viral eradication by:1.spraying infected cell by porifirin2. produce caspase3. spraying infected by granule enzyme4. induce effector cells apoptosisans: B 41. Virulent Strain of Cryptococcus Neoformans may survive in human body byi - inhibit production of TNF by macrophageii - inhibit produciton of IL-12 by neutrophilsiii - Stimulate production IL -10iv - INhibit caspace activationAns : e 42. Host tissue injury is caused byi - long activation of macrophageii - high production of NO and ROSiii - Granolomatous inflammationiv - TGF - b productionAns : A 43. chronic helminth infection is marked by1. Th-2 immuneresponse2. Prod. of IL-43. Prod of IgE4. Prod. of IL-5Answer : E (slide dr sri wahyuni-Immunity to parasite &fungi) 44. Low allergy prevalance in endemic area of helminth infection is caused by1. low allergen exposure2. rice as a main course3. low prod. of IgE4. prod. of regulatory T-cell 45. Mechanism of immunoevasion by parasite including :

1. Antigenic variation2. Acquired resistance to complement,CTLs3. Inhibition of host immune responses4. Antigen shedding 46. In indirect detection,method of immunohistochemistry, the labelling could be tagged in :A. Secondary antibodyB. Bridging antibodyC. Primary antibodyD. Tertiary complex antibodyE. 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. IgAB. IgMC. IgGD. IgDE. 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-BB.her blood group-O,husband-AC.her blood group-AB.husband-AD.her blood group-O,husband-ABE.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.tyrosineB.ArginineC.GlutamineD.LeucineE.Histidine 51.To increase function in this patient, he needs the following amino acids which can produce NO, a potent bactericidal and vasodilator.A. TyrosineB. GlutamineC. ArginineD. LeucineE. Histidine 52. Which of the malnutrition characteristic in this patient that is associated with increased morbidity, mortality, and prolonged hospital stay.A. OedemaB. AnemiaC. Hypoalbuminemia

D. WastingE. 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 allergyB. Food allergy in this patient tends to be outgrownC. The best management of food allergy is medicineD. Food substitution with other kind of egg is neededE. Avoidance of egg is not important  55. The characteristics of an acute transplant rejectioni- Occurster within days or monts after transplantii- Mediated by both humoral (antibody mediated) and cellulariii- Vasculittis is prominent feature which mediated b anti-donor antibody that attcak the vascular walliv- There are also parenchyma and cell injuries which indicated by prominent interstitial accumulation of lymphocytes 56- Nutrient with anti-inflammatory effectA-GlutamineB-Thiaminec-AlbuminD- N-3 PufaE- N-6 Pufa 59: The mechanism of clonal anergy to develop aotoimmunity:a)molecular mimicryb)polyclonal activationc)exposure to hidden self antigend)fail of receptor editinge)apoptosis of clonal anergised cells 60)which immune-competent cells act against tumor cella)nk cellb)cytotoxic (cd8) T-lymphocytesc)macrophaged)B-lymphocyte (antibody to tumor cell) 61. to do a sensitivity test should be aA. screening testB. follow up therapyC. confirmation testD. follow up complicationE. patch test 62. Western blot function to detect :A. DNAB. ProteinC. RNAD. Polysaccharide 

63. Complex fixation isA. haemolysis of erythrocytes without complementB. Binding of antigen-antibody induce the complement activationC. Complement is activated if there is high amount of antigenD. Complement fixed in membrane react with antigenE. Complement dont needed in antigen-antibody reaction 64. Interpretation of immunochromatography of dengue testA. Invalid ; no test lineB. Secondary infection ; C, M, G line appearsC. Invalid ; No M lineD. Negative; No C lineE. All above not true 65. A doctor prescribe CTM for treatment of allergic dermatitis. what is the class of this medicine?A. Autonomic oralB. Corticosteroid oralC. Anti-Histamine 1D.E. Anti-Histamine 2 66. 15 y.o boy, has allergic rhinitis. he is an active boy. best medicine to treat rhinorheaA. Loratidine oralB. Prednisone Oral 67. Budesonide is a corticosteroid used as inhalant. Mechanism of its action :A. Bind to histamine-1 receptorB. Bind to histamine-2 receptorC. Stimulate adrenergic beta-1 receptorD. Inhibit adrenergic beta-1 receptorE. Keep intact of mast cells 68. The uses of corticosteroid for a long term can cause :A. Decrease in body weightB. Decrease in blood pressureC. Decrease of fat in handD. Decline immunity against virusE. Decrease of fat in leg 69. Man 40years old suffered can't move his leg. The diseaseA.Grave diseaseB.Mysthenia gravisC.Swiss typhe agammaglobulinemiaD.De George syndromeE. Bruton disease 70.mysthenia graviss patient. he has receptor toA.TSH receptorB. Mast cell receptorC. CD4 receptorD. Basophylic receptorE. Aceythlcholine receptor 71. This condition is categorized as:A. Hipersensitivity Type 1

B. Hipersensitivity Type 3C. Hipersensitivity Type 2D. Hipersensitivity Type 4E. Arthus ReactionAns : C 72. the reaction below as an IgE immediated inflammation except:a. allergic rhinitisb.urtikariac.skin prick test rxnd.food cyclic antigen rxne.asthma bronchiole  73. in vivo examination to support diagnosis of type 4 hypersensitivity is: A. prick testB. patch testC. ELISA D. RASTE. COOMBS test 74. A mediator that cause mast cell degranulation without cross lingking Fc?RI:1.TNF beta2.C3a3.IL-24.C5aAns:C 75. The cells is instrumental in transmitting HIV to CD4+ T lymphocytesA. CD8+ cellsB. NeutrophilsC. NK cellsD. Plasma cellsE. Dendritic cells 76. according to WHO staging system, the patient with unexplained chronic diarrhea more than one month in stage:A. stage IB. stage IIC. stage IIID stage IVE. stage IVsource : 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. 100B. 200C. 300D. 400E. 500 78.HIV is less likely to be transmitted through....A.blood transfusionB.breastfeedingC sweat.D.sharing needleEsexual intercourse

 79. HIV group subvirus belongs to retrovirus known as......which means "slow" virusans: lentivirus 80. Antiretroviral than works by inhibit replication process inside the cell i- NNRTIii- NRTIiii- protease inhibitoriv- fusion inhibitorslide 63 AIDS 81. co-receptor for HIV virusi- cxcr5ii- ccr4iii- b7iv- cxcr4ans: 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 cellB. HIV change its surface epitopeC. Activated-induced apoptosisD. HIV destroy CCR5 receptorE. HIV change DNA genome into RNA 83. Innate immunity to intracellular matrix activated byA. NK cellsB. IL-12C. CD 4D. B cellsE. CD 8 84. Below are autoantibody against sperm excepta. produced by mother against her husband's spermb. negatively against the sperm motalityc. may be due to the genital tract infection or trauma on testisd. may be found after vesectomye. may cause infertility 85.Treatment of immune induced infertilityi.condom therapy ii.intrauterine iii.corticosteroid therapy iv.in vitro fertilizationAnswer: E 86) There are true about conginetal Phagocytic dysfunction except:a) conginetal immunodeficiency of innate immunityb) leukocyte is unable to stop in blood circulationc) macrophage and neutrophil are unable to kill phagocytosed bacteriad) etiology mutation(X linked or autosomal recessive)e) result in chronic granulomatous disease

 87.genetical etiology of SCID are1)ADA deficiency2)PNP deficiency 3)RAG deficiency4)Y-chain deficiencyanswer : E.all correct 88) XLA (Bruton Disease)i. defect maturation of B lymphocyte from pre B to immature Bii. No gammaglobulin in serumiii. Etiology is mutation or deletion of gene on chromosome on chromosom xq22iv. 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 differentiationiv-enlarge lymph gland.........ans: A (i,ii,iii) 90)DiGeorge syndrome:i)defect in cellular mediated immunity duee to T-cell deficiencyii)defect in the development of thymus and parathyroidiii)defect in chromosome 22q11.2iv)the symptom is tetanyans:E all correct 91) defect in T cell activation1.defect in expression of molecule for T cell activation2.defective class2 MHC expression3.defective class 1 MHC expression4.defect T cell receptor expressionANS:A 92. Etiology of acquired immunodeficiencies:1. Malnutrition2. Neoplasm3. Infection4. Drugsans : E 93. HIV virus:i. Attack CD4ii. Attack CD8iii.Attack macrophageiv.Attack NK cellsans : B 94.HIV virus1)enter the cell via gp1202)provirus integrated into genome of infected cell3)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 lysisanswer : 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 urticariaB. ADC. drug eruptionD. food allegyE. 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 testB.Patch testC.Prick testD.KOH testE.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 corticosteroidb. Emollient + topical antifungalc. Emollient + topical antibioticsd. Topical antibiotics + topical corticosteroide. 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-13b.IFN-gamma,IL-12,Il-3c.TNF-alpha,IFN-gamma,IL-3d.IL-4,IL-5,IL-12e.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 dermatitisb. furunculosisc. sellulitisd erysipelaye. 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 celli. clonal deletionii. receptor editingiii. clonal anergyiv. T cell regulator A factor that may not contribute to the development of autoimmunity

a. Activation of clonal anergyb. Exposure to "hidden" self antigenc. Apoptosis of clonal anergized celld. ...e. molecular mimicry (according to scenario ) what type of hypersensitivity is this?A. 1B. 2C. 3D. 4E. 5