Gen Path Chapter 1: Combined

1-69. The antigen binding end of an antibody molecule is the A. Fc fragment B. C-terminal C. anergy terminus D. FAB fragment E. Fc receptor

D. FAB fragment

1-72.Immunoglobulins have a _____________region that recognizes and binds to antigens. A. Fc fragment B. C-terminal C. anergy terminus D. FAB fragment E. Fc receptor

D. FAB fragment

1-61. The CD4 lymphocyte then differentiates into a TH 1 clone influenced by: A. immunoglobulin M B. complement proteins C. IL 4 D. IL 12, interferon gamma E. IL 1

D. IL 12, interferon gamma

1-41. Following histamine, which serum enzyme is activated in order to activate other proteins that perpetuate vasodilation? A. Serotonin B. Hageman factor C. Glucoronidase D. Kallikrein E. Lipase

D. Kallikrein

1-66. A hapten is a chemical that, A. is not by itself antigenic B. is foreign, yet represents a small molecule C. a chemical that binds a host protein to become antigenic D. all of the above

D. all of the above

1-67. When B lymphocytes synthesize immunoglobulins that react with a noninfectious, otherwise harmless antigen the process is known as: A. cell mediated immunity B. autoimmunity C. anergy D. allergy

D. allergy

1-65. A/an ________ is any protein or glycoprotien recognized by the host as foreign. A. immunoglobulin B. complement protein C. hapten D. antigen E. proteosome

D. antigen

1-46. In normal fluid exchange which pressures move water and electrolytes out of the vascular compartment on the arterial side of the capillary bed? A. tissue hydrostatic, blood osmotic B. tissue osmotic, tissue hydrostatic C. blood osmotic, tissue osmotic D. blood hydrostatic, tissue osmotic

D. blood hydrostatic, tissue osmotic

1-83. The membrane attack complex mediated by C 8,9 results in A. phagocytosis B. opsonization C. vasodilation D. cell lysis E. C3 activation

D. cell lysis FINAL REACTIONS: If virus is the antigen ==> C4 combines with C1 ⇒ Viral Inactivation occurs If antigen > Virus (Ex: Bacteria, fungi, human cellular antigens) o Complexing of C5,6,7 involves fractions of C8 + C9 • C8,9 ⇒ aggregate on cell surface and forms a MEMBRANE ATTACK COMPLEX ⇒ bursts a hole in the cytoplasm END RESULT of C1-9 = CYTOLYSIS = CELL DEATH

An acute diffuse inflammation of soft tissues which is not circumscribed and not confined to an area is known as A. abscess B. osteitis C. phlebitis D. cellulites E. osteomyelitis

D. cellulites

Which of the following is the best description of the characteristic lesion of chronic granulomatous inflammation? A. localized collection of liquefied cellular debris and dead or dying neutrophils B. diffuse collection of liquefied cellular debris and dead or dying neutrophils C. localized area of inflamed connective tissue exposed to the environment as a result of denuding the overlying epithelium D. circumscribed collection of lymphocytes, macrophages and epithelioid cells with a background of fibroblasts, capillaries and delicate collagen fibers

D. circumscribed collection of lymphocytes, macrophages and epithelioid cells with a background of fibroblasts, capillaries and delicate collagen fibers

1-20.Migration of blood cells through vessels during inflammation is termed A. emigration B. matriculation C. inflammation D. diapedesis

D. diapedesis

1-57. Antigens are engulfed into the cytoplasm of APCs by the process of: A. exocytosis B. cell lysis C. self antigen recognition D. endocytosis E. diapedesis

D. endocytosis

1-64. ________ mediated immunity is mediated by plasma cells generated by a TH2 profile while _____ mediated immunity invokes a TH1 pathway mediated by cytotoxic T cells. A. innate,B cell B. antibody,innate C. cell, antibody D. immunoglobulin, cell E. all of the above

D. immunoglobulin, cell

1-49. Edema can result from all of the following except A. lymphatic blockage B. heart failure C. deficient protein intake D. increased carbohydrate intake E. glomerular damage

D. increased carbohydrate intake We encounter edema in a variety of pathologic states other than inflammation: HEART FAILURE = result in fluid retention in the interstitial compartment ⇒ stasis/congestion of blood within the vessels increases hydrostatic pressure forcing fluids out RENAL FAILURE = allows for loss of protein form the vascular compartment ⇒ increases TISSUE OSMOTIC PRESSURE LYMPHATIC BLOCKAGE = prevents fluids from being circulated back into the lymph nodes and vasculature • Ex: When tumor cells fill the lymph node or parasitic worms clog up the lymphatics in the node DEFICIENT DIETARY PROTEIN INTAKE = leads to low plasma protein levels with ↓BOP (proteins in blood) + fluid loss • Leads to ASCITIS = edema in the abdominal cavity

1-19 The leukocytes may then, under the influence of chemokines, enter the tissues as a/an A. integrin B. pathogen C. immigrater D. inflammatory cell E. immunogen

D. inflammatory cell

1-73. The two types of light chains, each with a distinct constant region are: A. MHC I, MHC II B. α and β C. Fab, Fc D. lambda and kappa E. light and heavy

D. lambda and kappa 5 Classes of Immunoglobulins: o IgG = Prototype of all immunoglobulins o Each immunoglobulin has: 1. VARIABLE REGION = different for each molecule • located in the Fab terminal ⇒ governs which specific antigen binds • 10 million possible variations in a.a. sequence 2. CONSTANT REGION = encompasses the same a.a. sequences for a given class of Ig • THUS ⇒ Classes of Ig are categorized by: o 1. Identical constant region make-up o 2. Identical configuration of prototype o All immunoglobulins have 2 species of LIGHT CHAINS ⇒ each has a common constant region • A given antibody has either: • 2 Kappa or 2 Lambda light chains o Never one of each

1-52. Innate immunity is immediate and relies on the indiscriminate recognition of foreign agents by A. T and B lymphocytes B. macrophages and T lymphocytes C. natural killer cells and T lymphocytes D. macrophages and natural killer cells

D. macrophages and natural killer cells

1-17. Following adhesion and rolling, leukocytes coat the inner surface of the endothelium in a process termed A. margination B. chemotaxis C. emigration D. pavementing

D. pavementing

1-34. A chronically inflamed mass of granulation tissue at the tooth apex is a: A. periapical abscess B. specific granulomatous reaction C. cellulites D. periapical granuloma E. periapical scar

D. periapical granuloma

1-98. Patients with lymphocyte malignancies are immunodeficient because: A. their antibodies are defective B. they lack complement C. their immunoglobulins are far too elevated D. their lymphoid cells no longer function normally

D. their lymphoid cells no longer function normally

1-39.The earliest vascular change in response to injury, mediated by a neural reflex arc is A. vasodilation B. vascular permeability C. leukocyte margination D. vasoconstriction E. emigration

D. vasoconstriction

1-28. An infiltrate represented by neutrophils is A. chronic B. granulomatous C. subacute D. allergic E. acute

E. acute

1-97. Which of the following immunodeficiencies are defects in cell mediated immunity? 1. ataxia telangiectasia 2. DeGeorge syndrome 3. HIV 4. Swiss type thymic alymphoplasia A. 1,2 B. 1,2,3 C. 1,3 D. 2,3 E. all are correct

E. all are correct

1-60. Clonal expansion explains lymphadenopathy and occurs as a result of A. MHC II stimulation of macrophages to undergo mitosis B. IL 12, an interleukin that upregulates IL 1 C. the T cell receptor binding to IL 1 D. interaction between IL 1 and IL 12 to generate an immune response by CD4 lymphocytes E. binding of MHC II/Ag to CD4 cells triggering the macrophage secretion of IL-1, subsequently causing CD4 cells to divide

E. binding of MHC II/Ag to CD4 cells triggering the macrophage secretion of IL-1, subsequently causing CD4 cells to divide

1-85. PMNs can directly react with immunoglobulins and complement because they express cell surface: A. complement receptors B. Fc fragment receptors C. herpesvirus receptors D. both B and C are correct E. both A & B are correct

E. both A & B are correct

Multinucleated giant cells of the foreign body type originate from A. nuclear division of granulocytes B. atypical regeneration of epithelium C. bone marrow with migration into the area D. multiplication of nuclei in surrounding fibrocytes E. fusion or nuclear division of mononuclear cells.

E. fusion or nuclear division of mononuclear cells.

1-25. Plasma cells synthesize A. cell mediated immune factors B. histamine C. lysosomal enzymes D. perforins E. immunoglobulins/antibodies

E. immunoglobulins/antibodies

Which of the following cell types is associated with antibody formation? A. basophil B. monocyte C. eosinophil D. neutrophil E. plasma cell

E. plasma cell

1-43. The effects of bradykinin include all of the following except A. pain B. chemotaxis C. stagnation of blood flow D. fascilitation of emigration E. vasoconstriction

E. vasoconstriction SUMMARY: MAST CELL → releases HISTAMINE → VASODILATION → secretes HAGEMAN FACTOR → activates KALLIKREIN → cleaves High MW Kinogen → DECAPEPTIDE → hydrolyzed to BRADYKININ → causes vascular permeability, arteriolar dilation, extravascular smooth muscle contraction, + pain

1-93. The mantle zone is home for ____________cells whereas the germinal center is the location of __________ cells. A. Langerhans, T B. T, B C. B, T D. T, Langerhans

B. T, B

1-51. Which receptors bind a variety or microbial antigens and are a component of innate immunity? A. IgM B-cell receptors B. Toll like receptors C. T cell receptors D. MHC II receptors

B. Toll like receptors

1-54. Acquired immunity involves specific recognition of antigen via the ________ limb of the immune response. A. innate B. afferent C. humoral D. cell mediated E. efferrent

B. afferent AFFERENT PATHWAY OF IMMUNITY = Host recognizes microbes as foreign because of the proteins and glycoproteins on their cell membranes → ultimately activates B + T lymphocytes 1. Recognition involves uptake of ANTIGENS (Ag) (infectious proteins) by ANTIGEN PRESENTING CELLS (macrophages) 2. APCs then migrate through tissues ⇒ into LYMPHATIC VESSELS, where they are transported to REGIONAL LYMPHNODES 3. In the node ⇒ macrophages interact with B-LYMPHOCYTES + T-LYMPHOCYTES EFFERENT PATHWAY = the actions of B + T lymphocytes to eliminate infectious agents

1-77. IgM antibodies are synthesized: A. during a secondary challenge by antigen B. at the beginning stages of the primary response C.. by CD45RA positive lymphocytes D. after IgG antibodies

B. at the beginning stages of the primary response

1-55. A host recognizes infectious agents by virtue of their A. lipid cell membrane molecules B. foreign protein and glycoprotein antigens C. self antigens D. IgA dimmers E. metallic trace elements

B. foreign protein and glycoprotein antigens

1-22.Basophils, in tissue termed MAST cells, secrete the anticoagulant and the vasoactive substances: A. leukotriene, epinephrine and cortisol B. heparin, histamine and leukotrienes C. Immunoglobulin, complement and plasminogen D. prothrombine, fibrinogen and thrombin

B. heparin, histamine and leukotrienes

The principal chemical mediator located in the granules of mast cells is A. plasmin B. histamine C. complement D. bradykinin E. norepinephrine

B. histamine

Suppuration is mainly the result of the combined action of four factors. Which of the following is not one of these factors? A. necrosis of tissue B. presence of lymphocytes C. collection of neutrophils D. accumulation of tissue fluid E. autolysis by proteolytic enzymes

B. presence of lymphocytes

1-47.On the venous end, a rise in ______ ___________ pressure and an increase in _____ _______ pressure will pull fluids back into the vessel. A. tissue osmotic, blood osmotic B. tissue hydrostatic, blood osmotic C. blood osmotic, tissue osmotic D. blood hydrostatic, tissue osmotic

B. tissue hydrostatic, blood osmotic

1-38. Circular inflammatory red edematous lesions of skin are known as A. pimples B. urticaria C/ plaques D. macules E/ papules

B. urticaria = Hives

1-91. Cytotoxic CD8 cells use their T cell receptors to recognize antigen displayed on A. Fc receptors B. immunoglobulins C MHC I molecules D. viral receptors

C) MHC I molecules MHC Class 1 • Expressed on all nucleated cells • Interact with CD8+ T cells (Cytotoxic T Cells) ⇒ causes lysis and apoptosis of infected cells MHC Class 2 • Expressed constitutively only on APCs (antigen presenting cells) • Interact with CD4+ T cells (T Helper Cells)

1-58. MHC II proteins are 1. expressed on the surface of APCs 2. carriers of antigenic peptides 3. found on the surface T lymphocytes 4. molecules with a binding cleft where antigens are held 5. a component of the proteosome A. 1,2 only B. 2,3,5 only C. 1,2,4 only D. all of the above

C. 1,2,4 only MHC Class 1 • Expressed on all nucleated cells • Interact with CD8+ T cells (Cytotoxic T Cells) ⇒ causes lysis and apoptosis of infected cells MHC Class 2 • Expressed constitutively only on APCs (antigen presenting cells) • Interact with CD4+ T cells (T Helper Cells)

Granulation tissue typically contains 1.fibroblasts 2.nerve fibers 3.endothelial cells 4.epithelioid cells 5.giant cells B. 1,2 C. 1,3 D. 2,4 E. 3,4 F. 3,5

C. 1,3

1-79. Which complement fractions participate to activate C 3? A. C7 B. C 5,6,7 C. C1,4,2 D. C1,5,6

C. C1,4,2 Complement is composed of 9 specific factors 1. The initial event of complement fixation involves complement fraction C1q, which binds to the Fc fragment. 2. C1q ⇒ activates C1s →becomes C1 esterase. 3. This enzyme ⇒ acts upon C4 ⇒ forms C4a and C4b. 4. C4b enzyme ⇒ cleaves C2 ⇒ into C2a and C2b ⇒ an event that activates C3. 5. The C4-2-3 complex activates the combination of factors, 5, 6, and 7 to split off C5a and remaining C5-6-7 is a leukoattractant. FINAL REACTIONS: If virus is the antigen ==> C4 combines with C1 ⇒ Viral Inactivation occurs If antigen > Virus (Ex: Bacteria, fungi, human cellular antigens) o Complexing of C5,6,7 involves fractions of C8 + C9 • C8,9 ⇒ aggregate on cell surface and forms a MEMBRANE ATTACK COMPLEX ⇒ bursts a hole in the cytoplasm END RESULT of C1-9 = CYTOLYSIS = CELL DEATH

1-50. Transmembrane receptor molecules recognize foreign molecules by virture of A. intracellular variable amino acid sequences that bind to antigens B. T lymphocyte immunoglobulins that bind to T lymphocytes C. Extracellular domains that bind specific microbial proteins D. Complement fixing IgD antibodies

C. Extracellular domains that bind specific microbial proteins

1-53. Which receptors can engage microbes indiscriminately and result in their elimination? A. immunoglobulins B. T cell receptors C. Toll like receptors D. B cell receptors

C. Toll like receptors

1-76. CD45RA negative lymphocytes are: A. naïve, being inactive against antigens B. active only during a secondary repsonse C. activated immune cells that become effector lymphocytes D. never transformed into memory cells

C. activated immune cells that become effector lymphocytes NAÏVE CELLS = RESTING IMMUNE CELLS that have not faced specific challenges • CD45RA = surface protein on naïve cells ACTIVATED IMMUNE CELLS = T cells + B cells after interaction with APC in lymphnode • Becomes CD45RA NEGATIVE • Activated cells either: • 1. Become effector cells • 2. Assist with elimination of antigen by synthesizing ab • 3. Remain in lymph node as MEMORY CELLS

1-96. All immunoglobulins are absent in _______________________ whereas only one class of antibodies are defective or absent in _________________________. A. DiGeorge syndrome, ataxia telangiectasia B. HIV, DiGeorge syndrome C. agammaglobulinemia, dysgammaglobulinemia D. dysgammaglobulinemia, hypogammaglobulinemia

C. agammaglobulinemia, dysgammaglobulinemia

1-74. Whereas light chains are either lambda or kappa, immunoglobulin molecules are classified according to the constant regions of their heavy chains including A. alpha, gamma, delta, mu, epsilon B. IgA, IgG, IgD, IgM, IgE C. all of the above D. non of the above

C. all of the above

1-84. Antibody dependent cellular cytotoxicity involves A. T-lymphocytes directly destroying cells B. Direct cell lysis due to antibody binding to B-lymphocytes C. antibody binding to cell surface antigens with PMNs or macrophages binding of Fc receptor to the Fc fragment of the antibody D. Fc receptor reacting with antibody on the surface of B lymphocytes that then act to release more antibodies

C. antibody binding to cell surface antigens with PMNs or macrophages binding of Fc receptor to the Fc fragment of the antibody

1-21. Eosinophils A. secrete heparin and function as mast cells B. migrate out of vessels during allergy by release of histamine C. are associated with allergies and parasite infections and release antihistamines.

C. are associated with allergies and parasite infections and release antihistamines.

1-75. Immune tolerance occurs when: A. all antigens are no longer recognized as foreign B. B lymphocytes kill T cells C. autoreactive immune cells undergo apoptosis D. Pathogens are no longer recognized as foreign E. Self antigens become immunogenic

C. autoreactive immune cells undergo apoptosis SELF-RECOGNITION = occurs in the thymus gland + bone marrow + peripheral lymph nodes • IN THYMUS = AUTOREACTIVE T-cells that react to self-proteins ⇒ undergo APOPTOSIS o IMMUNE TOLERANCE = process of eliminated self-reactive B cell and T cell clones

1-35. A diffuse suppurative reaction is known as A. periapical abscess B. specific granulomatous reaction C. cellulites D. periapical granuloma E. periapical scar

C. cellulites

1-56. The cells that process foreign proteins include A. lymphocytes B. Polymorphonuclear leukocytes C. dendritic cells, macrophages, Langerhans cells D. eosinophils and basophils.

C. dendritic cells, macrophages, Langerhans cells

1-27. From a cellular viewpoint, subacute inflammation is characterized by infiltration of: A. neutrophils B. basophils C. granulocytes and mononuclear cells D. eosinophiis E. lymphocytes and plasma cells

C. granulocytes and mononuclear cells

1-71. What are antibodies referred to that form an immune lattice with red blood cells? A. precipitins B. agglutinins C. hemagglutinins D. opsonins

C. hemagglutinins

Certain enzymes are responsible for suppuration. These enzymes derive from A. serum B. tissue C. neutrophils D. lymphocytes E. plasma cells

C. neutrophils

1-95. Both immunoglobulin and T-cell mediated defense mechanisms are defective in AIDS leading to A. pathogen elimination B. hypergammaglobulinemia C. opportunistic infections D. suppurative inflammation

C. opportunistic infections

1-23. Macrophages or histiocytes are mononuclear phagocytes that engulf microorganisms and foreign particles by A. incorporation of them into opsonins B. transforming them into lysosomal enzymes C. packaging them into phagosomes that contain lysosomal enzymes D. activation of PMNs.

C. packaging them into phagosomes that contain lysosomal enzymes

1-26. Which of the following is true concerning lymphocytes? A. B lymphocytes function in cell mediated immunity B. T lymphocytes transform into plasma cells C. plasma cells are derived from B lymphocytes and produce antibodies. D. they are laden with lysosomes

C. plasma cells are derived from B lymphocytes and produce antibodies.

1-48. During inflammation, edema develops due to: A. rise in blood osmotic pressure, drop in tissue hydrostatic pressure B. drop in tissue osmotic pressure, drop in blood hydrostatic pressure C. rise in tissue osmotic pressure, rise in blood hydrostatic pressure D. rise in blood hydrostatic pressure, drop in tissue osmotic pressure

C. rise in tissue osmotic pressure, rise in blood hydrostatic pressure

1-31. Granulation tissue in which multinucleated giant cells are found is termed A. abscess B. granuloma C. specific granulomatous inflammation D. neoplasm

C. specific granulomatous inflammation

1-45. Which of the following pressures in a normal state osmotically draws water from the intravascular compartment? A. blood hydrostatic pressure B. blood osmotic pressure C. tissue osmotic pressure D. tissue hydrostatic pressure

C. tissue osmotic pressure

1-4. Inflammation that persists for many weeks, months or years is: a. Subacute b. Chronic c. Acute d. Abscess

Chronic

1-40.Which of the following contribute to vasodilation and increased capillary permeability during inflammation? 1. serotonin 2. leukotriens 3. norepinephrin 4. prostaglandins 5. histamine A. 1,2,3 only B. 2,4,5 only C. 2,3,4,5 only D. 1,2,4,5 only E. all of the above

D. 1,2,4,5 only 1. serotonin 2. leukotriens 4. prostaglandins 5. histamine

Which of the following are components of an acute inflammatory exudate? 1. plasma cells 2. plasma fluids 3. plasma proteins 4. white blood cells A. 1,2,3 B. 1,2,4 C. 1,3,4 D. 2,3,4 E. 1,2,3,4

D. 2,3,4

1-88. In a cell mediated immune reaction, T cells cause swelling with induration in A. 2 hours B. 7 days C. 24 hours D. 48 hours

D. 48 hours

1-70. The constant region of immunoglobulin harbors the A. Fc fragment B. N-terminal C. anergy terminus D. FAB fragment E. Fc receptor

A. Fc fragment

1-78. which immunoglobulins bind complement proteins? A. IgM, IgG B. IgD only C. IgE, IgA D. IgG, IgM, IgA

A. IgM, IgG

1-92. Which antigen presenting cells reside within the epithelium of the skin and mucous membranes? A. Langerhans cells B. follicular dendritic cells C. tissue macrophages D. blood monocytes

A. Langerhans cells

1-30. A granuloma is characterized by A. a localized inflammatory response showing granulation tissue which is infiltrated with mononuclear inflammatory cells B. a diffuse infiltration by PMNs C. a walled off area of granulation tissue infiltrated by PMNs D. none of the above

A. a localized inflammatory response showing granulation tissue which is infiltrated with mononuclear inflammatory cells

1-36. The terms suppurative exudate, purulent and pus refer to A. acute reactions with PMNs and fluid B. subacute inflammation with PMNs and mononuclear cells 81 C. chronic responses with granulation tissue and mononuclear leukocytes. D.a mixture of both acute and chronic forms of inflammation

A. acute reactions with PMNs and fluid

1-29. A localized zone of acute inflammation with sheets of PMNs and necrotic (dead cell) debris is called A. an abscess B. a granuloma C. chronic inflammation D. subacute

A. an abscess

1-18. Another group of cell adhesion molecules(CAMs) including ICAM1 and VCAM on the vessel lining A. bind to LFA 1 a leukocyte ligand subsequently allowing for emigration B. facilitate pavementing by mast cells C. which prevents emigration.

A. bind to LFA 1 a leukocyte ligand subsequently allowing for emigration

1-86. The type of immunity that utilizes T lymphocytes to mediate a reaction is termed: A. cell mediated immunity B. complement mediated immunity C. antibody dependent cellular cytotoxicity D.antigen agglutination

A. cell mediated immunity

1-94. Lymphocytes are able to home into certain tissues and locations in lymph nodes by virtue of A. chemokines and integrins B. follicular dendritic cells C. immunoglobulin receptors D. proinflammatory prostaglandins

A. chemokines and integrins

1-82. C 5,6,7 act together to trigger: A. chemotaxis of leukocytes B. opsonization of bacteria C. phagocytosis D. vasodilation

A. chemotaxis of leukocytes 1. ANAPHYLATOXINS (C3A, C5a) = induce mast cells to release HISTAMINE ⇒ vasodilation, vascular permeability • C5a = INCREAES LEUKOCYTE ADHESION to endothelial cells ⇒ potent chemotactic agent for PMNs and macrophages 2. OPOSONINS (C3b, C3bi) = coat antigens with serum proteins to enhance phagocytosis 3. LEUKOATTRACTANT (C5, 6, 7) = causes chemotaxis of phagocytes

1-87. T cell mediated immunity includes all of the following reactions except: A. immunoblobulin binding to antigens B. contact hyperrsensitivity C. delayed hypersensitivity D. cell mediated immunity E. T lymphocyte mediated immunity

A. immunoblobulin binding to antigens

1-44. Starling's principle involves movement of water and molecules through the following compartments A. intravascular, interstitial, intracellular B. interstitial, neural, cellular C. intracellular, extravascular, lymphatic D. intravascular, extraskeletal, interneural

A. intravascular, interstitial, intracellular

1-42.Kallikrein enzymes act on _________ to release __________, a potent vasodilator and mediator of capillary permeability. A. kininogen, bradykinin B. Hageman factor, bradykinin C. leukotriene, histamine D. bradykinin, prostaglandins

A. kininogen, bradykinin

1-24.Molecules that allow microorganisms to stick to the macrophage membrane are known as: A. opsonins B. leukotrienes C. coagulants D. adhesions E. agglutinins

A. opsonins

1-90. A primary cytolytic enzyme in CD8 mediated effects is A. perforin B. lysozyme C. myeloperoxidase D. lipase E. complement fraction C3b

A. perforin CD8 = Cytotxic T Cell

1-33. A focal acute infection at the apex of an infected tooth is a A. periapical abscess B. specific granulomatous reaction C. cellulites D. periapical granuloma E. periapical scar

A. periapical abscess

1-59. CD4 lymphocytes are MHC II restricted because they A. possess cell surface proteins that react with Ag nested within MHC II clefts B. use the CD3 receptor to lyse MHC II molecules C. use MHC II molecules to adhere to lymphatic vessels D. use MHC II molecules to wander through lymph node

A. possess cell surface proteins that react with Ag nested within MHC II clefts

1-32. Specific granulomatous inflammation occurs when A. there is a specific microorganism such as TB bacillus B. a noninfectious foreign body is present in the tissues C. A and B are correct D. neither A nor B are correct

A. there is a specific microorganism such as TB bacillus B. a noninfectious foreign body is present in the tissues C. A and B are correct

1-68. An immunoglobulin molecule is comprised of A. two heavy chains, two light chains B. one alpha and one beta chain C. one heavy and two light chains D. a single long peptide E. two MHN class I molecule

A. two heavy chains, two light chains

1-37.Redness (rubor) and swelling of inflammation are due to: A. vascular permeability, vasodilation and edema B. vasoconstriction C. leukocyte infiltration and decreased vascular permeability D. increased osmotic pressure in venules

A. vascular permeability, vasodilation and edema

Which of the following elements are usual constituents of an inflammatory infiltrate? 1. fluids 2. emboli 3. neutrophils 4. macrophages 5. multinuclear giant cells A. 1,3 B. 1,3,4 C. 1,3,5 D. 2,4,5 E. 2,5 F. all of the above

B. 1,3,4

Significant function of polymorphonuclear leukocytes in inflammation are 1. replication of new cells 2. phagocytosis of bacteria 3. elaboration of proteolytic enzymes 4. elaboration of antibodies A. 1,2 B. 1,3 B. 2,3 C. 2,4 D. 3,4

B. 2,3

1-63. TH 2 cells secrete IL ___, a mitogen for B lymphocytes bearing the immunoglobulin receptor. A. 1 B. 4 C. 2 D. 12

B. 4 1. T HELPER 1 (TH1) CELLS → CELL MEDIATED IMMUNITY • Secrete IL-2 + IFN-γ o IL-2 = mitogenic for CYTOTOXIC T CELLS (CD-8) → Activates it o IFN-γ = production is increased by IFN-12 from APC • IL-2 + IFN-γ ⇒ bind to + activate CYTOTOXIC T CELLS (CD8) • 2. T HELPER 2 (TH2) CELLS → Ab MEDIATED IMMUNITY • Secrete IL-4, IL-5, IL-10 o IL-4 = mitogenic for B CELLS • IL-4, IL-5, and IL-10 ⇒ bind to and activate B CELLS

1-80. Which fractions of complement, known as anaphylatoxins cause vasodilation and increased capillary permeability? A. C3b B. C3a, C5a C. C567 D. C1 esterase

B. C3a, C5a 1. ANAPHYLATOXINS (C3A, C5a) = induce mast cells to release HISTAMINE ⇒ vasodilation, vascular permeability • C5a = INCREAES LEUKOCYTE ADHESION to endothelial cells ⇒ potent chemotactic agent for PMNs and macrophages 2. OPOSONINS (C3b, C3bi) = coat antigens with serum proteins to enhance phagocytosis 3. LEUKOATTRACTANT (C5, 6, 7) = causes chemotaxis of phagocytes

In either an allergic reaction or a parasitic infection, which of the following cells increase in number in the blood stream? A. Basophils B. Eosinophils C. Plasma cells D. lymphocytes E. Nucleated erythrocytes

B. Eosinophils

1-62. A TH 1 pathway is dependent on A. IL 5 and immunoglobulin B. IL 2 and IFN-γ to activate CD8 lymphocytes C. IL 4, 5 and 10 to activate B lymphocytes D. interaction between B lymphocytes and CD8 T lymphocytes

B. IL 2 and IFN-γ to activate CD8 lymphocytes

1-81. Which complement proteins act as opsonins, factors that facilitate binding of leukocytes to pathogenic microbes? A. C3a B. C2,4 C. C567 D. C3b, C5 cleavage peptide

D. C3b, C5 cleavage peptide 1. ANAPHYLATOXINS (C3A, C5a) = induce mast cells to release HISTAMINE ⇒ vasodilation, vascular permeability • C5a = INCREAES LEUKOCYTE ADHESION to endothelial cells ⇒ potent chemotactic agent for PMNs and macrophages 2. OPOSONINS (C3b, C3bi) = coat antigens with serum proteins to enhance phagocytosis 3. LEUKOATTRACTANT (C5, 6, 7) = causes chemotaxis of phagocytes

1-89. The effector cell that mediates cytotoxic immune reactions is a: A. neutrophil B. erythrocyte C. B-lymphocyte D. CD8-lymphocyte E. eosinophil

D. CD8-lymphocyte CD8 Cell = Cytotoxic T Cell

Which of the following are phagocytes? 1. histiocytes 2. plasma cells 3. T-lymphocytes 4. polymorphonuclear leukocytes 5. Kupffer cells of the liver sinusoids E. 1,2,5 F. 1,3,4 G. 1,3,5 H. 1,4,5

H. 1,4,5

1-1.The response of the body to injury or assault is termed a. Organization b. Canalization c. Inflammation d. Hydration e. Margination

Inflammation

1-3.The cells, which migrate from vessels into the zone of assault are: a. Megakaryocytes b. Leukocytes c. Chondrocytes d. Microcytes e. Erythrocytes

Leukocytes

1-2. The cardinal clinical signs of this response include all except: a. Rubor b. Tumor c. Rigor d. Dolor e. Calor

Rigor

1-11. The ___ receptor on PMN's helps bind microbes to the phagocyte via antibody molecules. a. Fc b. HSV c. C3 d. FAB e. EGF

a. Fc

1-15. During inflammation what is the first event that leukocytes undergo? a. Margination b. Secretion of E selectin c. Rolling d. Expression of P selectin

a. Margination 1. MARGINATION = local blood flow slows down → PMNs move to the outer limits of the vascular wall, towards the margin of the vessel 2. ROLLING = PMNs stick to ADHESINS expressed on vascular endothelium + slowly roll over inner surface of vessel • Injury/infection induces release of various CHEMICAL MEDIATORS + CYTOKINES ⇒ induces genetic up-regulation of P-SELECTIN + E-SELECTIN on PMNs + the complementary SIALYL LIGANDS on endothelial plasma membranes (including LEUKOCYTE (L) SELECTIN) P-selectin (sialyl-Lewis protein) Rolling E-selectin (sialyl-Lewis protein) Rolling, adhesion GlyCam-1 or CD34 (L-selectin) Rolling 3. PAVEMENTING = PMNs coat the inner vessel lining • Mediated by expression of VASCULAR CELL ADHESION MOLECULE (VCAM1) + INTERCELLUALR ADHESION MOLECULE (ICAM-1) on the vessel lining + binding of LEUKOCYE INTEGRINS (VLA4) + LEUKOCYTE FACTOR of ACTIVATION (LFA-1) respectively ICAM-1 (CD11/CD18 integrins) Adhesion, arrest, transmigration VCAM-1 (VLS04 integrin) 4. EMIGRATION - PMNs migrate across the vessel wall through both the endothelium and basement membrane • Occurs at the sites of intercellular junctions of the endothelial cells, which are loosened in the inflammatory process • NOTE: Physiologically, vessels do not allow efflux of leukocytes. • The events that regulate emigration are related to chemical mediators released when tissues are injured physically or by infectious agents. • Thus only during injurious processes are white cells able to traverse the endothelial barrier and enter the connective tissues as an inflammatory cell infiltrate. • NOTE: Emigration occurs not only with PMNs but also with eosinophils, basophils and monocytes. • The movement through the vascular wall is ameboid. • Erythrocytes may passively follow the white cell migration. • DIAPEDESIS = movement through vessels by blood cells o 5. Once cells emigrate, they are attracted to sites of infection or injury by chemokines and other related chemotactic molecules. • SUMMARY: o SELECTINS = proteins on pletelets, endothelium, and leukocytes ⇒ mediates the ROLLING ACTION of leukocytes o INTEGRINS = proteins on surface of leukocytes ⇒ help leukocytes ADHERE to endothelium

1-7. The basophil, has a tissue counterpart, the a. Mast cell b. Neutrophil c. Dendritic cell d. Histiocyte e. Fibroblast

a. Mast cell

1-6. The blood leukocytes with mononuclear (non-segmented) nuclei are: a. Neutrophils, macrophages, mast cells b. Lymphocytes and monocytes c. Basophils, neutrophils, histiocytes d. Neutrophils, eosinophils, basophils

b. Lymphocytes and monocytes

Margination of leukocytes refers to a. crowding of the cells into an axial stream b. lining up of the cells along the wall of a dilated artery c. an increase in the number of cells at the margin of a wound d. abnormal motility of the cells

b. lining up of the cells along the wall of a dilated artery

1-12.In addition to lysosomal enzymes, PMNs elaborate other antimicrobial molecules including the dimeric protein: a. IgG b. IgA c. Calprotectin d. Myeloperoxidase e. Complement fraction C3 and C5

c. Calprotectin

1-13. PMNs secrete free radicals that are toxic to microorganisms and include: a. Superoxides b. Calprotectin c. Hypochlorous acid d. A and C are correct e. B and C are correct

d. A and C are correct

1-9. Monocyte derived cells in tissue include: a. Plasma cells and lymhocytes b. Dendritic cells and neutrophils c. Lymphocytes and eosinophils d. Histiocytes or macrophages

d. Histiocytes or macrophages

1-8. The mononuclear cells in blood include: a. Eosinophils/basophils b. Erythrocytes/plasma cells c. Monocytes/plasma cells d. Lymphocytes/monocytes

d. Lymphocytes/monocytes

1-14. PMNs secrete which enzyme to produce hypochlorous acid? a. Lipase b. Phosphorylase c. Glycoisidase d. Myeloperoxidase

d. Myeloperoxidase

1-5. The leukocytes with segmented nuclei include: a. Neutrophils, macrophages, mast cells b. Plasma cells, lymphocytes and eosinophils c. Basophils, neutrophils, histiocytes d. Neutrophils, eosinophils, basophils

d. Neutrophils, eosinophils, basophils

1-16. Rolling occurs subsequent to the expression of which adhesion molecules? a. Myeloperoxidase b. S selectin on leukocytes c. L selectin on endothelial cells d. P and E selectin on endothelium, sialyl ligands on leukocytes e. Binding of E selectin to the P selectin on lymphocytes

d. P and E selectin on endothelium, sialyl ligands on leukocytes

1-10. The PMMs have which of the following functions in inflammation? a. Phagocytosis b. Release of lysosomal enzymes c. Movement in response to chemokines d. Hydrolysis of organic compounds e. All of the above

e. All of the above