"Best Of Five Questions For MRCP UK And Ireland Examinations"

Dr. Osama Amin MBChB, MRCPUK part I,MRCPI part I ,MRCPI part II written
Senior House Officer and 4th year student of the…..Board of Neurology.
....... Teaching Hospital /Department of Neurology

Dedication to The Republic Of Iraq and Iraqi Doctors all over the world.

Q1
In Immunoglobulins …….all are true except:
1-IgA is mainly found in body fluids
2-IgM is a high molecular weight immunoglobulin that is the largest of all immunoglobulins
3-IgG is the only one that passes the placental barrier
4-IgE is involved in Type IV hypersensitivity reactions
5-IgD is found on the surface of B cells and may be involved in the maturation of them

Answer 4
1-true……hence IgA deficiency may cause chronic or repeated sinu-plumonary and GIT infections
2-agglutinating one
3-hence the passive neonatal immunity and false positive neonatal screening for many infections (actually from the mother!!)
4-type I ……….a famous thing
5-yes….actually its function is still not that 100% …..Has a very low serum level.

Q2
Immunoglobulins, all are true except:
1-IgA may cause hyperviscosity in multiple myeloma
2-IgE is very high in allergic bronchopulmonary asplergillosis
3-IgG is the usual immunoglobulin detected as a rheumatoid factor by the slide agglutination test
4-selective IgA deficiency prevalence is 1/700 of the populations in general
5-anti-nuclear factor is usually an IgG

Answer 3
1-also certain IgG subclasses in MM……………in Waldenstrom's it is the IgM
2-true………very higher than asthma .useful clue when suspecting ABPA complicating asthma
3-IgM not IgG
4-true.it is not that rare …..
5-true...Many don’t know that

Q3
The complement system, all are true except:
1-the classical pathway can be activated by IgG immune complexes
2-properdin deficiency is usually X linked
3-deficiency of late complements components is associated with disseminated Niesseria infection
4-SLE may be induced by congenital deficiency of the early complements components
5-C1 esteresa inhibitor deficiency is autosomal dominant and the defect is qualitative in 90% of cases

Answer 5
1-or IgM. IgA activates the alternative pathway
2-and hence family tree is important in the male relatives
3-true……..including recurrent meningitis
4-true….? may be due to inability to remove immune complexes
5-fasle 10% only is of qualitative defect. The majorities are of a quantitative defect

Q4
Hypogammaglubuinemia is associated with all of the followings except:
1-thymoma
2-phenytoin treatment
3-myotonia dytrophica
4-protein losing enteropathy
5-chronic active hepatitis

Answer: 5
1-considered to be a primary not a secondary phenomenon
2-also, gold and penicillamine
3-and nephritic syndrome
4-also CLL and MM
5-false …associated with hypergammmaglobulinemia mainly of IgG type

Q5
In common variable immune deficiency (CVID), all are true except:
1- 30% have an associated lymphopenia and lymphadenopathy
2- IgA is virtually absent ,but IgG is usually severely decreased but still detectable
3- Although defective cell mediated immunity is documented but opportunistic infections due to this defect is rare in clinical practice
4- In theory the presentation may be at any age ,but usually in the 3rd decade
5- First degree relatives are at increased risk of IgG subclass deficiency

Answer: 5
1-true…..and the spleen also may be enlarged in 30% of cases
2-and IgM may be normal or low or even raised
3-true …..The T cells are usually functionally immature
4-and there is no specific HLA association
5-fasle …increased risk of selective IgA deficiency

Q6
Long term complication of hypogammaglobulinemia , all are true except :
1-induction of varieties of autoimmune diseases
2-high risk of lymphoreticular malignancies
3-bronchiectasis
4-malabsorption
5-chronic active hepatitis
Answer 5
Chronic active hepatitis is associated with hypergammaglobinemia is not a complication of HYPOgammaglobinemia

Q7
X linked Agammaglobinemia , all are true except ;
1-T cell number and function and normal
2-there are no mature B cells in the peripheral blood
3-IgG is usually still detectable but extremely low
4-the presentation is usually after 3-6 months after birth
5-it is a very common disease

Answer: 5
1-hence no defective cell medicated immunity
2-true …..due to defective maturation in the bone marrow
3-true, usually below 50 mg / dl
4-usually with repeated chest infection
5-fasle…fortunately rare

Q8
Selective IgA deficiency. all are true except :
1-its incidence is 1/700 of the general population and usually sporadic
2-in theory, checking serum IgA level should be done in all patients prior to truncal vagotomy
3-all suspected patients should be tested for IgA auto-antibodies
4-it is seen in 50 % of celiac disease patients
5-can be found in patients with rheumatoid arthritis.

Answer: 4
1-true……check their relatives for CVID!!
2-because of the resulting gut hypomotility may be an additional risk factor for bacterial overgrowth.
3-true……as blood or blood product transfusion may cause severe anaphylactic reactions
4-fasle….around 3-4% …..And may cause false negative IgA anti-endomycium antibodies testing …….hence we check both IgA and IgG there to overcome this problem.
5-true….due to the disease per se or its treatment with gold and penicillamine

Q9
In HIV infection, all are true except:
1-there are M-tropic and T tropic strains
2-there is polyclonal B cell activation
3-NK cell no. and function are usually impaired
4-there is no single mechanism to explain the progressive CD4 positive cells attrition over time
5-the macrophages are CD4 negative cells and hence protected from infection

Answer: 5
1-Depending on certain chemokine receptors and associated ligands
2-hence the hypergammaglobinemia
3-true…usually under estimated
4-true……..many complicated mechanisms
5-false ……….it is CD4 positive and infected early in the course …..Hence the name M (macrophage) strains of the virus

Q10
The major histocompatibility complex (MHC) and human leukocyte antigen (HLA) ….. All are true except:
1-MHC calls II antigen is restricted in distribution to certain cell types
2-the inheritance is autosomal co-dominant
3-the loci encoding the complement components are located near by at chromosome 6
4-certain HLA haplotypes are associated with varieties of autoimmune diseases
5-HLA DR2 confers a high risk of developing type I diabetes mellitus

Answer 5
1-unlike the widely distributed class I
2-true…like the blood ABO antigen
3-true…short arm
4-if you don’t know this ….this is a disaster!!!
5-fasle…..supposed to be protective against type I diabetes, unlike HLA DR3/4