Micro- Chapter 14

(Clinicals) Mark is a 9-year-old Hispanic boy who has come into your emergency room complaining of "chest tightness" and "difficulty breathing." You notice that he is frequently coughing, and his lungs sound very wheezy. His chest X ray shows lungs that are over expanded. His mom said that he has had multiple episodes like this one over the past few years, but none this bad. Recently, he's had 5 episodes over the previous month, each lasting about a day.

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(Clinical) Jonathan is a 46-year-old Caucasian male, whose liver was destroyed from years of alcohol abuse. After he was clean for several years, however, he went into liver failure and needed a transplant. He finally received one 2 days ago from an unrelated donor, and you are his nurse on the transplant unit. His course has been uncomplicated thus far.

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(Clinical) Marian is a 28-year-old woman who is 30 weeks pregnant with her second child. Her first pregnancy and delivery was uncomplicated, and she now has a healthy 2-year-old girl. However, it is known that she is Rh-, and this child could be at risk for hemolytic disease of the newborn. She did receive RhoGAM with her first pregnancy. She presents to your maternal-fetal medicine clinic for a checkup, as she is a medium-risk pregnant mom.

...

A secondary acquired immunodeficiency is A. AIDS. B. adenosine deaminase (ADA) deficiency. C. DiGeorge syndrome. D. agammaglobulinemia. E. SCID.

A. AIDS.

What is the most likely development and progression of Mark's asthma? A. IgE mediated response with lung tissue that is hypersensitive to products of mast cell degranulation B. IgE response that causes the body to not recognize it's own lung tissue, and fights against it by constricting bronchioles C. IgG mediated response with lung tissue that is hypersensitive to products of mast cell degranulation D. IgG response that causes the body to not recognize its own lung tissue, and fights against it by constricting bronchioles

A. IgE mediated response with lung tissue that is hypersensitive to products of mast cell degranulation

Human blood types involve all the following except A. MHC genes. B. ABO antigen markers. C. inheritance of two of three possible alleles. D. genetically determined glycoprotein markers. E. genes that code for an enzyme that adds a terminal carbohydrate to RBC receptors.

A. MHC genes.

Once a mother has been sensitized to the Rh factor A. all other Rh+ fetuses are at risk. B. she can be given RhoGAM in future pregnancies to prevent hemolytic disease of the newborn. C. she can never again have a low risk pregnancy. D. only future Rh- fetuses are at risk. E. None of the choices is correct.

A. all other Rh+ fetuses are at risk.

What is the most likely diagnosis for Mark? A. asthma B. hay fever C. seasonal allergy D. drug allergy

A. asthma

What classification of reaction is Mark currently experiencing? A. atopy B. systemic anaphylaxis C. acute allergic D. cutaneous anaphylaxis

A. atopy

Which event is the process of releasing chemical mediators? A. degranulation B. bonding of allergen to adjacent IgE binding sites on mast cells and basophils C. binding of IgE by the Fc region to mast cells and basophils D. histamine acts on smooth muscle E. prostaglandins cause vasodilation and increased vascular permeability

A. degranulation

Allergic patients receiving small, controlled injections of specific allergens are undergoing A. desensitization. B. sensitization. C. tissue matching. D. degranulation. E. None of the choices are correct.

A. desensitization.

Histamine causes all of the following except A. increased sensitivity to pain. B. constriction of smooth muscle of bronchi and the intestine. C. relaxes vascular smooth muscle. D. wheal and flare reaction in skin. E. pruritis and headache

A. increased sensitivity to pain.

Corticosteroids will A. inhibit the activity of lymphocytes. B. bind to histamine receptors on target organs. C. block synthesis of leukotrienes. D. relieve inflammatory symptoms. E. reverse spasms of respiratory smooth muscles.

A. inhibit the activity of lymphocytes.

In multiple sclerosis, autoantibodies attack A. myelin sheath cells of the nervous system. B. acetylcholine receptors on smooth muscle. C. acetylcholine receptors on skeletal muscle. D. sodium pump proteins in the cell membrane. E. cells in thyroid follicles.

A. myelin sheath cells of the nervous system.

The initial encounter with an allergen is called the A. sensitizing dose. B. provocative dose. C. allergic dose. D. hypersensitivity dose. E. desensitizing dose.

A. sensitizing dose.

Atopy and anaphylaxis are hypersensitivities in the category A. type I only. B. type I and type IV. C. type IV only. D. type I, type II, and type III. E. type I, type II, type III, and type IV.

A. type I only.

In the theory for allergic desensitization, which immunoglobulin blocks the allergen from binding with IgE? A. IgE B. IgG C. IgA D. IgD E. IgM

B. IgG

Tissue transplanted from one body site on a patient to a different body site on that patient is called a/an A. isograft. B. autograft. C. allograft. D. xenograft. E. hypograft.

B. autograft.

An antihistamine will A. inhibit the activity of lymphocytes. B. bind to histamine receptors on target organs. C. block synthesis of leukotrienes. D. relieve inflammatory symptoms. E. reverse spasms of respiratory smooth muscles.

B. bind to histamine receptors on target organs.

What will be the immediate action of an allergen when it enters that body for a second time? A. degranulation B. bonding of allergen to adjacent IgE binding sites on mast cells and basophils C. binding of IgE by the Fc region to mast cells and basophils D. histamine acts on smooth muscle E. prostaglandins cause vasodilation and increased vascular permeability

B. bonding of allergen to adjacent IgE binding sites on mast cells and basophils

Which factor would increase the risk of the unborn child being Rh+? A. previous child being Rh- B. father being Rh+ C. history of preexisting type I hypersensitivity D. both maternal grandparents being Rh-

B. father being Rh+

The potential for hemolytic disease of the newborn occurs when A. maternal Rh+ cells enter an Rh- fetus. B. fetal Rh+ cells enter an Rh- mother. C. maternal Rh- cells enter an Rh+ fetus. D. fetal Rh- cells enter an Rh+ mother. E. fetal Rh+ cells enter an Rh+ mother.

B. fetal Rh+ cells enter an Rh- mother.

What steps should you advocate to be taken by the doctor during this visit? A. nothing can be done about the Rh factor B. first dose of RhoGAM should be administered C. nothing, since it is not known if the first child was Rh+ yet D. plan for first dose of RhoGAM immediately after birth

B. first dose of RhoGAM should be administered

What could result when grafted tissue such as bone marrow contains passenger lymphocytes? A. host rejection of graft B. graft versus host disease C. formation of autoantibodies D. hypogammaglobulinemia E. None of the choices is correct.

B. graft versus host disease

Fungal spores and animal dander are considered to be which type of allergen? A. ingestant B. inhalant C. injectant D. contactant E. None of the choices is correct.

B. inhalant

Which of the following is not true of type III hypersensitivity? A. antigen-antibody complexes are deposited in the basement membrane of epithelial tissues B. involves production of IgG and IgE antibodies C. involves an immune complex reaction D. the Arthus reaction is a local response E. serum sickness is a systemic response

B. involves production of IgG and IgE antibodies

A second encounter with an allergen that causes a response is called the A. sensitizing dose. B. provocative dose. C. allergic dose. D. hypersensitivity dose. E. desensitizing dose.

B. provocative dose.

Epinephrine A. is an antihistamine. B. reverses constriction of airways. C. causes desensitization. D. inhibits the activity of lymphocytes. E. All of the choices are correct.

B. reverses constriction of airways.

What type of hypersensitivity reaction will Marian's babies be at risk for upon delivery? A. type I B. type II C. type III D. type IV

B. type II

After further investigation, it is learned that the father is Rh+, and so was the first child. However, Marian declines the RhoGAM injection because "there were no complications with my first pregnancy and delivery, how can you be sure there will be with this one?" Plus, she also explains how unpleasant the RhoGAM injection was with her first pregnancy, and she would like to avoid it, if at all possible. What is an appropriate response? A. "I didn't realize you received RhoGAM with your first pregnancy. There's a good chance you don't need it this time after all." B. "It is important you receive your RhoGAM injection, because this child will probably develop hemolytic disease of the newborn if you don't." C. "It is important that we keep you from being sensitized to Rh factor, otherwise future pregnancies will be at risk for developing hemolytic disease of the newborn." D. "You were probably sensitized to Rh factor with your first pregnancy, so the chances are decreased that this child will develop hemolytic disease of the newborn. I'll ask the doctor if we can forego the injection."

C. "It is important that we keep you from being sensitized to Rh factor, otherwise future pregnancies will be at risk for developing hemolytic disease of the newborn."

Jonathan is talking to you about his antirejection medications, and wants to know how they work. What is the best explanation? A. "They work on your liver to make it less hostile to its new environment, increasing the chances of organ acceptance." B. "They work by changing the MHC markers on your new liver to be more like your own." C. "They work by suppressing the body's immune response against a foreign organ." D. "They work by tricking your body into thinking its MHC markers are similar to your new liver's."

C. "They work by suppressing the body's immune response against a foreign organ."

71. Marian asks you to explain to her what an Rh reaction involves with her baby. What is the best explanation? A. "Your baby's Rh+ antibodies cross into your system, attacking your red blood cells, and making you unable to deliver a healthy baby." B. "Your baby has a type II hypersensitivity that will render its liver unable to clear bilirubin released from lysed cells." C. "Your Rh antibodies will cross into your baby's fetal circulation, attacking and lysing his red blood cells." D. "As soon as your baby is born, if he doesn't receive RhoGAM, his body will reject not having Rh antibody anymore."

C. "Your Rh antibodies will cross into your baby's fetal circulation, attacking and lysing his red blood cells."

All of the following are involved in type 2 hypersensitivity except A. IgM. B. IgG. C. IgE. D. complement. E. foreign cells.

C. IgE.

If Jonathan experiences graft rejection, what type of cells will most likely be primarily responsible? A. T memory cells B. natural killer cells C. T cytotoxic cells D. T helper cells

C. T cytotoxic cells

Myasthenia gravis disease arises from the production of autoantibodies against A. myelin sheath cells of the nervous system. B. acetylcholine receptors on smooth muscle. C. acetylcholine receptors on skeletal muscle. D. sodium pump proteins in the cell membrane. E. cells in thyroid follicles.

C. acetylcholine receptors on skeletal muscle.

A seasonal reaction to inhaled allergens is A. atopic dermatitis. B. eczema. C. allergic rhinitis. D. asthma. E. anaphylaxis.

C. allergic rhinitis.

What type of transplant did Jonathan receive? A. isograft B. autograft C. allograft D. xenograft

C. allograft

A chronic, local allergy such as hay fever is considered A. delayed. B. T-cell-mediated. C. atopic. D. antibody-mediated. E. systemic anaphylactic.

C. atopic.

Autoimmunity is typically due to A. transfusion reaction. B. IgE and mast cells. C. autoantibodies and T cells. D. graft rejection. E. a deficiency in T-cell development

C. autoantibodies and T cells.

Which event occurs with the sensitizing dose of allergen? A. degranulation B. bonding of allergen to adjacent IgE binding sites on mast cells and basophils C. binding of IgE by the Fc region to mast cells and basophils D. histamine acts on smooth muscle E. prostaglandins cause vasodilation and increased vascular permeability

C. binding of IgE by the Fc region to mast cells and basophils

Which of the following is not a major organ that can be a target of immune complex deposition? A. blood vessels and skin B. heart and lungs C. brain D. joints E. kidneys

C. brain

The DiGeorge syndrome is the result of A. autoantibodies. B. delayed hypersensitivity. C. congenital absence or immaturity of the thymus gland. D. failure of B cell development and maturity. E. a genetic defect in the development of both T cells and B cells

C. congenital absence or immaturity of the thymus gland.

Which of the following conditions would you expect Mark to have in his personal medical history? A. hay fever B. premature birth C. eczema D. blood transfusion reaction

C. eczema

Any heightened or inappropriate immune response resulting in tissue damage is called a/an A. autoimmune disease. B. immunodeficiency. C. hypersensitivity. D. transfusion reaction. E. desensitization.

C. hypersensitivity.

Bee sting venom is considered to be which type of allergen? A. ingestant B. inhalant C. injectant D. contactant E. None of the choices is correct.

C. injectant

A female who is Rh- A. inherited two dominant genes. B. is in the majority of the population with regard to Rh status. C. is at risk for a pregnancy resulting in hemolytic disease of the newborn. D. can never have an Rh+ baby. E. All of the choices are correct.

C. is at risk for a pregnancy resulting in hemolytic disease of the newborn.

The chemical mediator that causes prolonged bronchospasm, vascular permeability, and mucus secretion of asthmatic patients is A. prostaglandin. B. histamine. C. leukotriene. D. serotonin. E. platelet-activating factor.

C. leukotriene.

Degranulation of mast cells leads to A. airway obstruction. B. headache. C. dilated blood vessels. D. All of the choices are correct.

D. All of the choices are correct.

Which of the following allergic mediators are being currently activated in Mark's system? A. mast cells B. leukotrienes C. serotonin D. All of the choices are correct.

D. All of the choices are correct.

What involves determination of donor HLA antigens compared to those of the recipient's tissue? A. skin graft B. blood transfusion C. organ transplantation D. both skin graft and organ transplantation E. All of the choices are correct.

D. both skin graft and organ transplantation

What can be a consequence of a genetic deficiency in B cell survival and maturity? A. host rejection of graft B. graft versus host disease C. formation of autoantibodies D. hypogammaglobulinemia E. None of the choices is correct.

D. hypogammaglobulinemia

Allergic reactions to penicillins are considered a/an _____ hypersensitivity. A. T-cell-mediated B. antibody-mediated C. immune complex-mediated D. immediate E. both T-cell-mediated and antibody-mediated

D. immediate

The study of diseases associated with excesses and deficiencies of the immune system is A. humoralpathology. B. hemopathology. C. epidemiology. D. immunopathology. E. histopathology.

D. immunopathology.

Each of the following is an autoimmune disease except A. systemic lupus erythematosus. B. Graves' disease. C. type I diabetes. D. metastatic cancer. E. rheumatic fever.

D. metastatic cancer.

Allergies run in families because A. immunoglobulins pass from mother to fetus. B. immunoglobulins pass through breast milk. C. the variable region of antibodies is genetically determined. D. relative production of IgE is inherited. E. All of the choices are correct.

D. relative production of IgE is inherited.

Autoantibodies cause tissue injury in all of the following diseases except A. rheumatoid arthritis. B. myasthenia gravis. C. Graves' disease. D. tuberculin reaction. E. multiple sclerosis.

D. tuberculin reaction.

The major categories of hypersensitivities that typically involve a B-cell immunoglobulin response is/are A. type I only. B. type I and type IV. C. type IV only. D. type I, type II, and type III. E. type I, type II, type III, and type IV.

D. type I, type II, and type III.

What type of hypersensitivity reaction is Jonathan at risk for? A. type I B. type II C. type III D. type IV

D. type IV

Contact dermatitis involves A. a sensitizing and provocative dose. B. an allergen entering the skin. C. T lymphocytes secreting inflammatory cytokines. D. itchy papules and blisters. E. All of the choices are correct.

E. All of the choices are correct.

Large quantities of antibodies that react to the second entry of antigen and lead to formation of antigen-antibody complexes occurs in A. serum sickness. B. delayed hypersensitivity. C. anaphylaxis. D. hemolytic disease of the newborn. E. All of the choices are correct.

E. All of the choices are correct.

Transfusion of the wrong blood type can cause A. recipient antibody activating the complement cascade to attack the RBCs. B. fever and anemia. C. systemic shock and kidney failure. D. massive hemolysis of the donor RBCs. E. All of the choices are correct.

E. All of the choices are correct.

Which of the following is not a theory to explain the origin of autoimmune diseases? A. sequestered antigen theory B. clonal selection theory C. theory of immune deficiency D. viral infection theory E. All of the choices are possible theories.

E. All of the choices are possible theories.

Severe combined immunodeficiencies (SCIDs) are due to A. autoantibodies. B. delayed hypersensitivity. C. congenital absence or immaturity of the thymus gland. D. failure of B cell development and maturity. E. a genetic defect in the development of both T cells and B cells.

E. a genetic defect in the development of both T cells and B cells.

Which type/s of hypersensitivities is IgG involved with? A. anaphylaxis B. antibody-mediated C. immune complex-mediated D. both anaphylaxis and antibody-mediated E. both antibody-mediated and immune complex-mediated

E. both antibody-mediated and immune complex-mediated

Which of the following is not a possible symptom of type I hypersensitivity? A. rhinitis B. rashes C. sneezing D. diarrhea E. contact dermatitis

E. contact dermatitis

Which is mismatched? A. food allergy - type I hypersensitivity B. poison ivy dermatitis - type IV hypersensitivity C. serum sickness - type III hypersensitivity D. transfusion reaction - type II hypersensitivity E. hay fever - type IV hypersensitivity

E. hay fever - type IV hypersensitivity

A systemic, sometimes fatal reaction with airway obstruction and circulatory collapse is A. delayed. B. T-cell-mediated. C. atopic. D. antibody-mediated. E. systemic anaphylactic.

E. systemic anaphylactic.

All of the following are associated with IgE and mast cell-mediated allergy except A. drug allergy. B. eczema. C. anaphylaxis. D. allergic asthma. E. systemic lupus erythematosus.

E. systemic lupus erythematosus.

(T/F) A person who is Rh- will have anti-Rh antibodies in their serum from early infancy.

FALSE

(T/F) Allergic rhinitis is also known as asthma

FALSE

(T/F) Eczema is an autoimmune disorder

FALSE

(T/F) The tuberculin reaction develops within 30 minutes of the skin test in people with prior sensitization due to tuberculosis infection.

FALSE

(T/F) A viral infection can cause type I diabetes mellitus.

TRUE

(T/F) A xenograft is graft tissue from a donor of one species transplanted to a recipient of another species.

TRUE

(T/F) AIDS is a secondary immunodeficiency disease that affects several types of immune cells.

TRUE

(T/F) During graft rejection, cytotoxic T cells of the recipient recognize and respond to foreign class I MHC receptors on the grafted cells.

TRUE

(T/F) Food allergies include gastrointestinal symptoms and often hives.

TRUE

(T/F) Systemic anaphylaxis can quickly result in airway blockage, shock, and death.

TRUE