📑 Past Papers — 2019 & 2020
Final Examination Paper · Medical Immunology for International Students · both papers in full, with worked answers
⭐ These are very nearly the same exam
Comparing the two papers section by section gives a result unlike anything else in this semester. The MCQ section, the true/false section and the brief-answer section repeat word for word. Only the definitions rotate, and even then within pairs.
20/20
MCQ identical
12/12
True/False identical
5/5
Brief answers identical
3/6
Definitions shared
62%
of marks repeated
Use this, but do not lean on it blindly. Exactly one true/false statement changes between the years — question 3 swaps Th1 for Th2, and the correct answer flips from False to True. Anyone who memorised the 2019 key without understanding the cytokine profiles scores 11 out of 12. It is highlighted in gold below.
⚠️ A THIRD format exists — do not assume the paper will match these two
Slide 3 of the Immunoassay lecture (Yu Chunyan, who also teaches Type II hypersensitivity and Immunotherapy) states an exam structure that matches neither 2019 nor 2020:
| Section | Lecturer's slide | 2019 & 2020 papers |
|---|---|---|
| I. Definitions | 6 × 3 = 18 | 6 × 3 = 18 ✓ same |
| II. Blanks | 56 blanks × 0.5 = 28 | 20 blanks × 1 = 20 |
| III. Single-choice MCQ | 20 × 1 = 20 | 20 × 1 = 20 ✓ same |
| IV. | 10 MULTIPLE choices = 10 | 12 True/False = 12 |
| V. Brief answers | 4 × 6 = 24 | 5 × 6 = 30 |
Three things could
change: the blanks may be half-mark and far more numerous; a
multiple-ANSWER section may appear, which is scored quite differently from
single-best-answer; and true/false may be gone.
Prepare the content, not the format. Everything on this site is organised by
what the questions test, not only by the shape they took in 2019 and 2020 — which
is why the trainers cover definitions, blanks, true/false and comparison tables separately.
The same slide adds a warning worth obeying: “Any careless and illegible answers will get deduction of the points. If your handwriting is too difficult to make out, the answer will be directly regarded as ZERO.”
The shape of the 2019 and 2020 papers
| Section | Marks | Format |
|---|---|---|
| I. Definitions | 18 | 6 terms × 3 marks |
| II. Fill in the blanks | 20 | 1 mark per blank, 7 numbered items |
| III. Best-response MCQ | 20 | 20 questions × 1 mark, four options (A–D) |
| IV. True / False | 12 | 12 statements × 1 mark |
| V. Brief answers | 30 | 5 questions × 6 marks — all five are comparison tables |
The written paper is 70% of the course mark; the experiments carry the other 30%. (TMU Lecture 1, slide 2.)
Section I — Definitions (9 terms seen across the two papers)
| Term | Set in | Covered by |
|---|---|---|
| Antigen | 2019 | Unit 2 |
| Epitope | 2020 | Unit 2 |
| Immunoglobulin | 2019 | Unit 3 |
| Antibody | 2020 | Unit 3 |
| Cytokine (CK) | both years | Unit 5 |
| APCs | 2019 | Unit 11 |
| MHC | 2020 | Unit 10 |
| Hypersensitivity | both years | Unit 13 |
| Immunotherapy | both years | Unit 17 |
The examiner appears to rotate within pairs — Antigen↔Epitope, Immunoglobulin↔Antibody, APCs↔MHC — so all nine terms are live. Three have already been set twice.
Section II — Fill in the blanks (9 items)
1Cellular immunity is mediated by ___ cell. Humoral immunity is mediated by ___ cell.
T · B both years Unit 1
2The functions of immune systems include ___, ___ and ___.
immune defence · immune homeostasis · immune surveillance (2019 supplied “immune defence”) both years Unit 1
3Peripheral immune organs include ___, ___ and ___.
lymph nodes · spleen · MALT (2020 supplied “spleen”) both years Unit 1
4In the classical pathway, C3 convertase is ___; C5 convertase is ___; MAC is ___.
C4b2a · C4b2a3b · C5b–9 2019 Unit 4
5In the alternative pathway, C3 convertase is ___; C5 convertase is ___; MAC is ___.
C3bBb · C3bBb3b · C5b–9 2020 Unit 4
6Ig with the largest molecular weight ___ (2019) / mediating mucosal immunity ___ (2020); dimer ___; mediates type I ___; appears early in infection ___.
IgM / SIgA · SIgA · IgE · IgM both years Unit 3
7Complement C1 is a large protein complex composed of ___, ___ and ___.
C1q · C1r · C1s 2019 Unit 4
8Professional APCs include ___, ___ and ___.
macrophage · dendritic cell · B cell both years Unit 11
9Cytokines secreted by Th1 cells include ___, ___ and ___.
IFN-γ · IL-2 · TNF-β 2020 Unit 5
Section III — MCQ (20 questions, identical both years)
Try each before revealing. Answers are verified against the TMU lecture decks and Janeway's 10e.
1Which of the followings is the organ that T cells and B cells originate?
Answer: B
Both lineages arise from haematopoietic stem cells in bone marrow. T cells then leave to mature in the thymus — so read the verb.Set identically in 2019 and 2020 · Unit 1
2Haptens have
Answer: B
A hapten is bindable but cannot induce a response until coupled to a carrier. The four options are simply the four combinations of two yes/no properties.Set identically in 2019 and 2020 · Unit 2
3Which Ig has the highest concentration in the serum?
Answer: B
IgG is about 75–80% of serum immunoglobulin. IgE is the rarest by far.Set identically in 2019 and 2020 · Unit 3
4Which Ig can cross the placenta?
Answer: B
IgG alone crosses, via FcRn. This is the basis of natural passive immunity in the newborn — and of haemolytic disease of the newborn.Set identically in 2019 and 2020 · Unit 3
5Which component can be shared by the three pathways of complement activation?
Answer: C
All three pathways converge on cleaving C3. C1, C2 and C4 belong to the classical (and lectin) pathway only.Set identically in 2019 and 2020 · Unit 4
6The antigen-binding cleft of MHC class II molecules locates between:
⚠️ Greek letters were lost in text extraction and reconstructed from context — verify against the paper image.
Answer: A
Class II is a two-chain molecule and its groove is formed by α1 and β1. Class I forms its groove from α1 and α2, with β2-microglobulin as a non-polymorphic support.Set identically in 2019 and 2020 · Unit 10
7All the following cells express HLA class I molecules except:
Answer: D
Class I is on all nucleated cells. Mature red cells have no nucleus — and that is precisely why transfusion compatibility runs on ABO/Rh rather than HLA.Set identically in 2019 and 2020 · Unit 10
8Which cell is the most powerful APC and can elicit primary immune response?
Answer: B
The dendritic cell is the only APC that can activate a naïve T cell, so it alone initiates the primary response. Neutrophils are not APCs at all.Set identically in 2019 and 2020 · Unit 11
9Which of the following is not the heavy chain of immunoglobulin?
⚠️ Option B was blank in the extracted text and is reconstructed as α — verify against the paper image.
Answer: D
The five heavy chains are γ, α, μ, ε, δ — defining IgG, IgA, IgM, IgE, IgD. κ is a light chain, the other being λ.Set identically in 2019 and 2020 · Unit 3
10Which molecule on B cells delivers the most important second signal of B cell activation?
Answer: B
CD40 sits on the B cell and receives CD40L from the activated Th cell. CD40L is the T-cell side of the same pair; CD28 is the T cell's own second-signal receptor; BCR delivers signal one.Set identically in 2019 and 2020 · Unit 8
11Which of the following cells participates in adaptive immunity?
Answer: B
αβ T cells carry a rearranged, highly diverse TCR and are the classical adaptive T cell. γδ T cells, B1 cells and NKT cells all have limited repertoires and behave as innate-like lymphocytes.Set identically in 2019 and 2020 · Unit 7
12Which of the following molecules is expressed on B cells?
Answer: C
CD20 is the classic pan-B marker — and the target of rituximab. CD2 and CD3 are T-cell molecules; PD-1 is an inhibitory receptor mainly on activated T cells.Set identically in 2019 and 2020 · Unit 8
13Which of the following molecules is expressed on T cells?
Answer: C
CD40L (CD154) is on the activated helper T cell. CD19, CD21 and CD81 together form the B-cell co-receptor complex.Set identically in 2019 and 2020 · Unit 7
14Which one is the characteristic of mature DCs?
Answer: C
Maturation is a trade: the DC gives up antigen capture and gains presentation. Immature DCs do the opposite — they sit in peripheral tissue taking up antigen with low MHC II and B7.Set identically in 2019 and 2020 · Unit 11
15Which of the followings does not belong to the properties of cytokines?
Answer: B
Cytokines are pleiotropic and redundant — several different cytokines produce the same effect, and one cytokine acts on many cell types. Specificity is exactly what they lack; it belongs to antigen receptors.Set identically in 2019 and 2020 · Unit 5
16Among the following molecules, which one can down-regulate T cell activation?
Answer: A
CTLA-4 (CD152) binds the same B7 ligands as CD28 but with higher affinity and delivers an inhibitory signal. CD28 is the stimulatory twin. Blocking CTLA-4 is how ipilimumab works.Set identically in 2019 and 2020 · Unit 7
17Which of the following cells is not involved in type I hypersensitivity?
Answer: D
Type I runs on IgE-armed mast cells and basophils, with eosinophils recruited in the late phase. NK cells belong to type II, where they mediate ADCC.Set identically in 2019 and 2020 · Unit 13
18In the following diseases, which one is caused by type III hypersensitivity?
Answer: A
SLE is the archetypal immune-complex disease. Asthma is type I; tuberculin reactions and contact dermatitis are type IV.Set identically in 2019 and 2020 · Unit 15
19In the following diseases, which one has target cell damage?
⚠️ The original paper misprints this question: two options are both labelled “B”. Reproduced here with corrected lettering.
Answer: C
Type II hypersensitivity is defined by antibody binding a specific target cell and destroying it — here the fetal red cell.Set identically in 2019 and 2020 · Unit 14
20In the following diseases, which one is caused by type I hypersensitivity?
Answer: D
Allergic rhinitis is IgE-mediated type I. Serum sickness is type III, haemolytic anaemia type II, rheumatoid arthritis largely type III. (“animia” is the paper's own typo.)Set identically in 2019 and 2020 · Unit 13
Section IV — True / False (12 statements)
The gold-bordered row is the one that changes between the two years.
1Mitogens can specifically activate T cells or B cells.
2019 FALSE 2020 FALSE
Mitogens act non-specifically and polyclonally. The trap is the adverb.Unit 2
2The co-receptor of B cell includes CD19/ CD20 /CD81.
2019 FALSE 2020 FALSE
The B-cell co-receptor is CD19 / CD21 / CD81. CD21 — the complement receptor CR2, and the Epstein–Barr virus receptor — not CD20.Unit 8
3Cytokines secreted by Th1 (2019) / Th2 (2020) cells include IL-4, IL-5, IL-10.
2019 FALSE 2020 TRUE
⭐ The one item that changes between the two years. IL-4, IL-5 and IL-10 are the Th2 profile, so the 2019 version (Th1) is FALSE and the 2020 version (Th2) is TRUE. Th1 makes IFN-γ, IL-2 and TNF-β. Memorise last year's key and you get this wrong.Unit 5
4Immune response includes innate and adaptive immune response.
2019 TRUE 2020 TRUE
Stated directly in Lecture 1.Unit 1
5Effector CTLs specifically kill target cell by releasing perforin, granzyme and expressing FasL.
2019 TRUE 2020 TRUE
Both killing routes: the perforin/granzyme granule pathway and the Fas–FasL death-receptor pathway.Unit 7
6Co-expression of both mIgM and mIgD on the cell surface are the markers for B cell maturation.
2019 TRUE 2020 TRUE
A mature naïve B cell leaving the marrow carries both mIgM and mIgD. Immature B cells have mIgM only.Unit 8
7Hemolytic disease of newborn caused by Rh antigen incompatibility can be prevented by administrating Anti-Rh antibody (Rhogam) in mother within 72 hours after the first delivery.
2019 TRUE 2020 TRUE
Anti-D clears fetal Rh⁺ cells from the mother's circulation before she can be sensitised, so no memory forms and the next pregnancy is protected.Unit 14
8Toxoid is a bacterial exotoxin which has been treated usually with formaldehyde so that it has lost its toxic properties but retains its ability to stimulate an immune response against the toxin.
2019 TRUE 2020 TRUE
The definition of a toxoid, and the basis of the tetanus and diphtheria vaccines.Unit 17
9Features of effective vaccines include safe, protective, sustained protection and practical considerations.
2019 TRUE 2020 TRUE
The standard four criteria.Unit 17
10NK cells, macrophages and complements are involved in type II hypersensitivity.
2019 TRUE 2020 TRUE
All three effector routes of type II: ADCC by NK cells, opsonised phagocytosis by macrophages, and complement-mediated lysis.Unit 14
11Th1 cells are involved in Type IV hypersensitivity and Th2 cells are involved in Type I hypersensitivity.
2019 TRUE 2020 TRUE
Th1 drives delayed-type hypersensitivity; Th2 drives IgE class switching and so type I.Unit 15
12HLA class II molecules can be expressed on the surface of all nucleated cells.
2019 FALSE 2020 FALSE
That describes class I. Class II is restricted to professional APCs — dendritic cells, macrophages and B cells — plus thymic epithelium.Unit 10
Section V — Brief answers (5 questions, identical both years)
Every one is a table. Answer in table form — several rows ask for a single word, and prose earns no extra credit.
1Fill in the table to compare the characteristics of innate immunity and adaptive immunity (“Yes”/“no” & “quick”/“slow”): if need antigen · response · specific · immune memory.
Innate — no · quick · no · no.
Adaptive — yes · slow · yes · yes.
Adaptive — yes · slow · yes · yes.
2Fill in the table to compare the differences between papain and pepsin cleaving IgG: cleaving position · fragments formed · functions.
Papain cuts above the hinge disulfides → 2 Fab + 1 Fc; each Fab binds antigen monovalently, Fc mediates effector function.
Pepsin cuts below the hinge → 1 F(ab′)₂ + Fc fragments; F(ab′)₂ binds antigen bivalently and can cross-link, but has no effector function.
Pepsin cuts below the hinge → 1 F(ab′)₂ + Fc fragments; F(ab′)₂ binds antigen bivalently and can cross-link, but has no effector function.
3Fill the table to compare cellular and humoral immune response.
Cellular — T lymphocytes; effector T cells; intracellular microbes; kills infected cells; transferred by cells.
Humoral — B lymphocytes; antibody; extracellular microbes and toxins; neutralises and targets for elimination; transferred by serum.
Humoral — B lymphocytes; antibody; extracellular microbes and toxins; neutralises and targets for elimination; transferred by serum.
4Fill in the table to compare primary and secondary humoral immune response: immunogen threshold · lag phase · antibody level · IgM · IgG · affinity and avidity.
Primary — high threshold; long lag (5–10 d); low peak; IgM predominates; little IgG; low affinity.
Secondary — low threshold; short lag (1–3 d); high peak; little IgM; IgG predominates; high affinity.
Secondary — low threshold; short lag (1–3 d); high peak; little IgM; IgG predominates; high affinity.
5Please list the functions of B cells — across cellular immune response, humoral immune response, infection defence, hypersensitivity mediation, anti-tumour effect and allograft rejection.
B cells produce antibody (humoral immunity), act as professional APCs to CD4⁺ T cells (contributing to the cellular response), secrete cytokines, defend against extracellular infection by neutralisation and opsonisation, mediate types I–III hypersensitivity through antibody, contribute anti-tumour antibody and ADCC, and participate in allograft rejection via alloantibody.
⚠️ Sourcing and honesty
The questions above are reproduced from
the genuine papers in the course materials. The answers are not from an official
marking scheme — TMU's 2019 marking scheme exists in the notes but is an image-only
scan that has not yet been read. Every answer here was worked out from the TMU lecture decks
and checked against Janeway's Immunobiology 10e.
Where the students' circulated review sheets disagree with the lectures, the lectures
win. One such disagreement is already known: the review sheets give the classical-pathway
C3 convertase as C4b2b, but TMU's own Lecture 4 deck writes C4b2a
seventeen times and C4b2b never. The value above is C4b2a.
Two MCQs lost their Greek letters in text extraction and are reconstructed from context; they
are flagged individually and should be checked against the paper image before being treated as
certain.