Wattle Pharmacy Prep

Immunology
Practice questions with explanations

Immunology belongs to Biomedical sciences, which makes up about 20% of the Overseas Pharmacist Readiness Assessment (OPRA®). Answer each question yourself before opening the explanation.

1. Which principle applies to the timing of vaccination relative to immunoglobulin administration?

  1. Live vaccines may be inhibited by passive antibody, so an interval is observed between immunoglobulin and live vaccination
  2. No interval is needed
  3. Immunoglobulin enhances live vaccine responses
  4. Inactivated vaccines are affected most
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A. Live vaccines may be inhibited by passive antibody, so an interval is observed between immunoglobulin and live vaccination

Passive antibody neutralises the live vaccine virus before it can replicate and induce immunity, and the required interval depends on the immunoglobulin dose, ranging from weeks to many months. Inactivated vaccines are unaffected. This matters after blood products, immunoglobulin therapy and post-exposure prophylaxis.

2. Which type of hypersensitivity reaction is anaphylaxis?

  1. Type I, IgE-mediated mast cell degranulation
  2. Type IV, delayed T cell-mediated
  3. Type III, immune complex deposition
  4. Type II, antibody-mediated cytotoxicity
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A. Type I, IgE-mediated mast cell degranulation

In type I reactions, allergen cross-links IgE bound to mast cells and basophils, releasing histamine, tryptase and leukotrienes within minutes, causing vasodilation, capillary leak and bronchoconstriction. Type II includes haemolytic transfusion reactions, type III includes serum sickness, and type IV includes contact dermatitis and the delayed drug rashes that appear days into a course.

3. Why is a second dose of adrenaline sometimes needed in anaphylaxis?

  1. The first dose is always given at too low a dose deliberately
  2. It is inactivated by antihistamines
  3. Its effect lasts only minutes and a biphasic reaction can occur hours after apparent recovery
  4. Repeat dosing is never required
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C. Its effect lasts only minutes and a biphasic reaction can occur hours after apparent recovery

Adrenaline is rapidly metabolised, so a further intramuscular dose is given after about five minutes if there is no improvement. Biphasic reactions, recurring hours later without further exposure, are the reason for a period of observation and for supplying two autoinjectors with an action plan. Patients are taught to lie flat, not to stand up, since standing can precipitate cardiac arrest.

These are 3 of the 40 questions on immunology in the app.

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