That's it. Im finally done with Immunology. It's unbelievable to find out that there are so many things which we are expected to know but sadly I havent heard mentioned in class. Time to be more proactive Julian! Anyway, here are some sample test questions from the end of the Immunology chapter. If you can get any of them right, good job!:) I also include the answer explanation after the question and bear with me because I will be explaining in my own words (actually just for me to revise:P)
1. Haemophilus Influenza and Neisseria meningitidis both possess a polysaccharide outer capsule. Effective vaccination against these species results in the generation of antibodies that recognize the polysaccharide capsule. Which of the following explains best why the childhood vaccines for H. Influenza type B and N. meningitidis serogroup C are composed of a polysaccharide coat conjugated to a protein carrier.
(a) The protein carrier increases the half life of vaccine (b) The protein carrier increases the production of IgE immunoglobulins which confer protection (c) The protein carrier makes the vaccine less virulent and thus decreases the risk of a child developing disease form the immunization (d) The protein carrier is added to recruit T lymphocyte help and increase antibody production.
Ans: D Exp: Polysaccharides like many other bacterial antigens are thymus-independent antigens. This means they can cross link the IgM receptors present on the B cell stimulating them to produce IgM without the need for a T lymphocyte to act it. The protein carrier however allows the B cell to present the antigen as recognizable for the T cell thus eliciting a T lymphocyte response as well.
2. Women have about a 2.7 times greater lifetime risk of developing at least one autoimmune disease than men. Which of the following statements, if true, would support the higher rate of systemic lupus erythematosus in women than in men?
(a) Androgens such as testosterone have an inhibitory role in the process of clearing immune complexes. (b) Both estrogen and androgens have the same potency in inhibiting the clearing of immune complexes. (c) Estrogen has an inhibitory role in the process of antibody production of B cells (d) Estrogen has an inhibitory role in the process of clearing immune complexes (e) Estrogen has a stimulatory role in the process of clearing immune complexes.
Ans: D Exp: Actually this question is rather straightforward and can be solved just by simple reasoning. Answers A-D all point to the opposite outcome. SLE is a type III hypersensitivity disease. Autoantibodies bind to self antigens and form immune complexes that activate complement, which we all know is a potent activator of neutrophils. Estrogen inhibits the clearing of these complexes hence the greater risk of developing autoimmune diseases.
3. A 23 year old woman comes to the physician for a routine checkup. She has generally been well over the past year although she notes that she has had a few falls recently. On physical examination, a spider angioma is found on her skin. Blood is drawn for laboratory evaluation. The results show that the woman has very low levels of IgA. Based on her presentation, this patient will most likely also present with which of the following symptoms?
(a) Cerebellar problems (b) Granulomas (c) Low levels of all other immunoglobulin isotypes (d) Tetany
Ans: A Exp: The lady suffers from a disease that is known as Ataxia-telangiectasia. It is due to a defect in DNA repair enzymes. Spider angiomas and ataxia are hallmarks for this disease. Thrombocytopenia can also be observed.
The answer cannot be B because granulomas are seen in another disease known as Chronic Granulomatous Disease. This disease is due to the defiency of NADPH oxidase which results in failure to produce oxygen radicals which we all know is crucial in myeloperoxidase-dependent intracellular killing
The answer also cannot be C because that refers to Bruton's aggamaglobulinemia. It is a X-linked disease and therefore only presents in males. Patient is a 23 year old woman;)
The answer cannot be D because tetany is one of the clinical manifestations of DiGeorge's syndrome. We should know that DiGeorge syndrome is due to the failure of the third and fourth pharyngeal pouches to develop which lead to the absence of the thymus and parathyroid glands. Hypocalcemia is a result and can present with tetany.
Kaplan is simply amazing. For those of you that dont know, they are a company that has prep courses for US board exams.
I managed to download both the video lectures as well as the lecture notes. I even went a step further and purchased some books from Amazon. Among them is Medessentials by Kaplan. Its basically a review of all the basic sciences and system by system review. It includes anatomy, embryology(something I realised I know jack about) , physiology, pathology, pharmacology, biochemistry and pretty much every subject we've learnt so far. I really recommend this book to anyone who wants to brush up their basic sciences during this long winter break.
So far I've managed to cover embryology on a few subjects, a smattering of physio and yeah Immunology. A subject I pretty much know nothing about due to my first sem teacher being Yuri-_- The lady lecturer goes through all the major mechanisms in detail. I was pleasantly surprised to see that all the diagrams used in the lecture and tables could all be found in my Kaplan book. Now thats a good $44 well spent.
If anyone wants any of the lectures or lecture notes, just come along to my room with an empty hard drive. Anything to help my fellow comrades, I'm more than willing:)
Now back to the Immunology lectures at 530am. God they are addictive:) Best feeling is when you find you can act solve the USMLE practice questions at the end of the lecture thanks to the material delivered.
Lets all study damn hard to shake the impression that all russian grads are flops and do well together!
It's been a long time since I've had time for myself. Somehow or rather, I feel writing in the wee hours of the morning therapeutic. In the last semester, I honestly can say my learning curve has taken a huge jump exponentially. It's amazing to be on the path of my destiny!
Worries of the future ahead still plague me from time to time. All I can do now, is study hard and study smart. Pray for the best because i truly believe that my future holds great things in store for me.
For I know the plans I have for you," declares the LORD, "plans to prosper you and not to harm you, plans to give you hope and a future.
Amen, I hold true to your promise God. In the mean time, I'm gonna study my brains out!:)
Finally the long awaited winter break has dawned upon us. It feels strange to sit at my table with a loss for what to do. Luckily in a few days, I'm out of this place. Just yesterday, we sat for one of the most overrated finals in this program. Anatomy. The amount of preparation put into the test was both mentally and physically taxing. Mcq was just well mcq *winks. But the oral exam is where you earn your worth.
Upon entering the exam hall, you could literally cut the tension in the air in half with a sharp knife. Left and right, worried faces littered my view. Underneath a nonchalant exterior, my articulatio genus were almost threatening to give way. In the center of the hall lay two bodies, two mangled bodies (I must add) and arranged in a semicircle were the so called preparat or internal organs. I took my questions from the students on duty and without sneaking a peek at them yet, made my way to a seat and prepared for the worse.
Looking to right, I was greeted by the wide but forced smile of one of my hostel roommates. Deep creases had formed on his forehead and I swore a whole battalion of soldiers could find refuge from enemy shelling within those trenches. Opening my question paper, I was greeted by the first question.
"Explain the relationship between the Duodenum and the Peritoneum."
I fought back a smile as a story of forbidden love formed in my head. I could almost picture the plot. A secret love story between a boy named D and a beautiful girl named P. How they were separated by some tragic event but eventually meet just to find themselves engaged to other people. Then they both murder their fiancées but their diabolical doings get discovered by the authorities. Running hand in hand through a hail of bullets, they attempt to dodge their pursuers and just as they were about to make it, D is shot in the back and falls to the ground. P turns behind and screams "Nooo..." and is shot repeatedly too. She falls in slow motion on top of him. "Aha!..retroperitoneal". I scribbled the answer as fast as I can and stifled a laugh.
Next question. "What organs adjoin superior part of the duodenum from above and behind"
This was a rather easy question and wasting no time, I answered it and took a look at the theoretical questions.
"Describe the digestive cavity, sinuses, grooves, flexures, major anatomical formations"
The smile induced by the previous question died off like a green plant in the hot furnace of the Sahara desert. For a moment my mind was blank as I attempted to understand the question. Then it hit me and I began to answer the question hoping the little fragments of memories would not leave me.
I heaved a great sigh of relief. I had almost left this part out from studying and at that moment I was so glad I had not. I quickly listed down the membranous parts and the bony parts of the ear even though they were part of the internal ear but heck, I wanted my answer sheet to look full. I also wrote down the walls of the tympanic cavity and the components of the auditory ossicles. Blood supply and innervation? I was stumped for a moment and then it all came back to me and I wrote down the answer. "Alright God, I've done my part. Now give me the easiest teacher and I promise not to do drugs for the rest of my life."
"Dzhulliiaan Thon Vei Eee" I heard my name being called out by one of the easier teachers of the department. I gave an imaginary high five to the Big loving Man upstairs and made my way down to the stage.
" Where your glurves and peek one payper" I hastily put on my gloves, took out my forceps and proceeded to select a list for my pointing examination. I mustered what I felt was the most charming smile I could effect under the circumstances and nodded my head. "I'm ready" We then headed to the centre of the hall where the preparat lay.
"Furst, lateral condyle of femur"
Heh..Jesus loves me this I know. I pointed it out immediately and smiled. Confidence was at an all time high.
"Show mi plis Right Colic Flexure"
Is that the best you've got? I walked over to a body with the abdominal cavity exposed and yanked out the large intestine and pointed it out. Anat finals is awesome!
Whoops, my mind went blank. Where the hell is that? I hesitated and pointed to the chest region. Bad move, a look of disapproval descended as rapidly as a flock of angry bees upon my examiners face. "Oi oi..musculus zygomaticus" Recovering from my stupid mistake, I chuckled and pointed out the muscle on the face. Alright God I get it, if I play the fool, You're gonna leave me alone.
Last pointing. "Ulnar veins"
I picked up the cadavers arm and started probing around in the ulnar region. The texture was just weird and it kinda reminded me of the type of dish your mom would prepare once in a while and that you would refuse to eat but eventually hold your breath and swallow because it's "expensive and good for your body!". After proceeding to mangle the hand of the cadaver, I pulled out two vein looking objects and gestured to the teacher. She nodded and it was finally time for oral answers.
Sitting down at the table, I was prepared to unleash a torrent of crap upon her unsuspecting words. All I needed was the bark of the starting gun.
"Answer please the first question"
Kicking my creative juices into high gear, I repeated what I had written on the paper and spiced it up with random information that came into my head as torrents of nonsense poured from my lips. I stopped to catch a breath. "Kontinew!" that was her swift reply. For a moment D's eyes popped into my mind, his life slowly slipping away from those orbs. Pinching myself, I proceeded to answer in this fashion for the remaining 4 questions.
By the point I reached the 3rd question, I gradually had the feeling that nobody was listening to me at all. She jsut sat there with her gaze to the floor and I was pretty convinced she was buying it all. I therefore decided to briefly rush through the third question. Bad move. "Vait, tell mi about the greter omentoom" The previous night's revision was fresh upon me on that particular topic and I then explained that anatomical structure briefly. As soon as that was done, I knew I kinda had managed to pull this off.
"That's all. Please wait outside the hall for your credit book" The most beautiful string of unaccented english words left her oral cavity and caused my auditory ossicles to vibrate in perfect and magnificient unison. "Alright thanks" I then smiled and walked outside the lecture hall not before smirking at the rest of the students waiting for their turn. That was the end of anatomy finals for me but not the end of my worries just yet. A countless number of prayers were made later and more deals were struck with the Man upstairs for a reason that does not even involve my ownself. And sure enough He delivered again. Heh. All in all, good! Bye bye nelly! I wish you well in the torture of other students:)