Chapter 17 - Immunologic Disorders
True/False: A lack of T cells makes one more vulnerable to intracellular parasites.
True
True/False: Autoimmunity occurs when a person's immune system fails to differentiate between "self" and "non-self" antigens.
True
True/False: Secondary or acquired immunodeficiencies can be caused by infections, cancer, immunosuppressive agents, or pregnancy.
True
Please rank the following statements about glomerulonephritis in the order they occur. 1. IgG is produced in response to an antigen. 2. Complement is activated. 3. Neutrophils release tissue-damaging enzymes. 4. Neutrophils are recruited to the site. 5. Immune complexes form. 6. Immune complexes lodge in kidneys.
1, 5, 2, 6, 4, 3
Please match the correct type of hypersensitivity reaction to the statement that best describes it to test your understanding of hypersensitivities. 1. Includes anaphylaxis—a systemic fatal reaction with airway obstruction and respiratory collapse 2. Involves complement-assisted lysis of cells coated with antibodies as seen in transfusion reactions 3. Immune complexes form and become lodged in blood vessel walls 4. T cell-mediated delayed hypersensitivity reactions including contact dermatitis and graft rejection reactions
1. Type I 2. Type II 3. Type III 4. Type IV
Please place the following events in the correct order to test your understanding of the mechanism of action of desensitization or "allergy shots." 1. Degranulation of mast cells is prevented. 2. Allergen-specific IgG antibodies are produced by B cells. 3. IgG binds to allergen before it can bind IgE. 4. Diluted but gradually increasing concentrations of pure allergen are injected.
4, 2, 3, 1
Please place the following statements in the correct order to reflect the sequence of events that occur upon secondary exposure to allergens in type I hypersensitivities. 1. Degranulation and release of chemical mediators from mast cell. 2. Allergen attaches to IgE on mast cells. 3. Systemic distribution of mediators via bloodstream. 4. Symptoms appear in various organs. 5. Allergen is encountered after previous sensitization event.
5, 2, 1, 3, 4
Defects in bone marrow stem cells result in a condition known as A. SCID B. AIDS C. Di George's syndrome D. Chediak-Higashi disease E. Chronic granulomatous disease
A. SCID
A secondary immunodeficiency disease is not the result of A. genetic defects B. malignancies C. advanced age D. malnutrition E. certain virus infections
A. genetic defects
Antibodies that have arisen in the blood plasma without any obvious or deliberate stimulus are called A. natural B. acquired C. injurious D. active E. inactive
A. natural
Which of the following is/are NOT immune complex-mediated disorders? (NOTE: Please change all question marks to checkmarks for correct answers or empty boxes for incorrect answers.) A. Glomerulonephritis B. Hay fever and asthma C. Contact dermatitis D. Tissue transplant rejection E. Systemic lupus erythematosus F. Hemolytic disease of the newborn
B, C, D, F
Please select all statements that apply to hemolytic disease of the newborn to test your understanding of this disorder. (NOTE: Please change all question marks to checkmarks for correct answers or empty boxes for incorrect answers.) A. Occurs due to Rh incompatibility between an Rh+ mom and Rh- baby. B. Fetal RBC leakage sensitizes the mother to make anti-Rh antibodies. C. Anti-Rh antibodies that are IgG can cross the placenta and induce complement-mediated lysis of fetal RBCs. D. After sensitization with Rh+ fetal RBCs, all subsequent pregnancies (Rh+ and Rh- fetuses) are at risk for hemolytic disease. E. Hemolytic disease is a type II hypersensitivity reaction.
B, C, E
What type of hypersensitivity reaction causes rejection of transplanted organs? A. Immediate IgE-mediated B. Cytotoxic C. Immune-complex mediated D. Delayed-type cell-mediated E. Cytotoxic OR delayed-type cell-mediated
D. Delayed-type cell-mediated
Which of the following about immune complexes is FALSE? A. They consist of antigen-antibody bound together. B. They are usually cleared rapidly from the body. C. They bind to Fc receptors on cells. D. They are involved in type II hypersensitivity reactions. E. They are involved in type III hypersensitivity reactions
D. They are involved in type II hypersensitivity reactions.
In the figure below, which shows the last step of a type III hypersensitivity, what type of cell is indicated by A? A. Dendritic cells B. Phagocyte C. Basophil D. B cell E. Neutrophil
E. Neutrophil
True/False: A hapten is an antigen that is capable of causing antibody production on its own.
False
True/False: In people with HIV, cell-mediated immunity is affected but humoral immunity is not.
False
True/False: Anti-A and anti-B antibodies are natural antibodies and are present at birth. Group starts
False
Activated complement plays a role in which hypersensitivities? A. Type I only B. Type IV only C. Type III only D. Types I and III E. Type II only F. Types I and II G. Types II and III H. Types II and IV
G. Types II and III
True/False: Anaphylaxis is the name given to allergic reactions caused by IgE-mediated release of mast cell granules.
True
People with deficiencies in late complement system components are at risk of recurrent Neisseria infections because A. these components play a role in clearing immune complexes. B. these components play a role in membrane attack complex formation, and Neisseria is a Gram-positive organism. C. these components play a role in initiating interferon synthesis and antiviral protein formation. D. these components play a role in membrane attack complex formation, and Neisseria is a Gram-negative organism. E. these components help to activate B cells that destroy bacteria.
D. these components play a role in membrane attack complex formation, and Neisseria is a Gram-negative organism.
Categorize the following disorders as either primary or secondary deficiencies. Not all of the given disorders fall into these categories. 1. AIDS 2. Selective IgA deficiency 3. Hemolytic disease of the newborn 4. Chronic granulomatous disease 5. Severe combined immunodeficiency 6. Monoclonal gammopathy 7. Anaphylactic shock 8. Rheumatoid arthritis 9. DiGeorge syndrome
1. Secondary 2. Primary 3. *not used* 4. Primary 5. Primary 6. Secondary 7. *not used* 8. *not used* 9. Primary
Place each of the following types of transplants in order based on their likelihood of inducing rejection reactions (least likely to most likely). 1. Isografts (from an identical sibling) 2. Autografts (from a different area on the patient's own body) 3. Xenografts (from another species) 4. Allografts (from a different individual of the same species)
2, 1, 4, 3
The redness and induration found after a tuberculin skin test involve the action of A. sensitized T cells B. IgE C. complement proteins D. basophil cells E. activated dendritic cells
A. sensitized T cells
The immunoglobulin associated with Type I hypersensitivity is A. IgG B. IgE C. IgA D. IgM E. IgD
B. IgE
IgE molecules involved in hypersensitivity reactions have become attached to A. neutrophils B. mast cells C. B cells D. macrophages E. mast cells AND B cells
B. mast cells
Delayed-type cell-mediated hypersensitivity primarily involves A. erythrocytes B. B cells C. T cells D. mast cells E. T cells and platelets
C. T cells
Transplant rejection is largely mediated by A. the natural antibodies that bind to blood group antigens on donor red blood cells B. cell-mediated immunity, centered around the actions of effector helper T cells C. cell-mediated immunity, centered around the actions of effector cytotoxic T cells and natural killer (NK) cells D. humoral immunity, centered around the production of donor cell-specific antibodies E. activation of macrophages that seek and destroy the donor tissue cells
C. cell-mediated immunity, centered around the actions of effector cytotoxic T cells and natural killer (NK) cells
Hemolytic disease of the newborn (erythroblastosis fetalis) is rare in the United States today because A. there are very few Rh-positive individuals in the population B. treatment with RhoGAM medication prevents Rh-negative blood cells from stimulating a primary immune response in Rh-negative women C. treatment with RhoGAM medication prevents Rh-positive blood cells from stimulating a primary immune response in Rh-negative women D. there are very few Rh-negative individuals in the population E. in utero blood transfusions for the fetus with Rh-negative blood are cheap, easy, and effective
C. treatment with RhoGAM medication prevents Rh-positive blood cells from stimulating a primary immune response in Rh-negative women
Arthus reactions and serum sickness are examples of ______ hypersensitivity. A. type I B. type II C. type III D. type IV E. type V
C. type III
Most cases of generalized anaphylaxis are a result of A. fire ant stings and bites B. aspirin and heparin C. bananas and strawberries D. peanuts, bee stings, or penicillin injections E. All of these
D. peanuts, bee stings, or penicillin injections
True/False: Generalized anaphylaxis may be quickly controlled with the use of antihistamines.
False
True/False: Most intermediate size immune complexes (more antigen than antibody) are removed by phagocytosis.
False
True/False: After complement activation, basophils may degranulate, releasing mediators that cause vasodilation.
True
Please select all of the correct statements concerning systemic lupus erythematosus (SLE) to test your understanding of the pathogenesis of autoimmune diseases. (NOTE: Please change all question marks to checkmarks for correct answers or empty boxes for incorrect answers.) A. Auto-antibodies bind self antigens forming immune complexes that accumulate in basement membranes of various organs. B. SLE represents a type III hypersensitivity reaction. C. Auto-antibodies made against DNA and other nuclear components in a variety of cells. D. Results in an autoimmune disease that targets the thyroid. E. Results in muscle weakness as its principle symptom.
A, B, C
Myasthenia gravis is an example of an autoimmune disease that involves A. sensitized T cells B. cytotoxic T cells C. antibodies D. IgD E. muscle genes
C. antibodies
Which autoimmune disease is CORRECTLY described? A. Systemic lupus erythematosus—antibodies bind to acetylcholine receptors at the neuromuscular junction, thereby blocking nerve impulses that normally cause muscle contraction. B. Diabetes mellitus—characterized by a variety of autoantibodies and immune complexes that lodge in tissues around the body, causing damage. C. Grave's disease—antibodies bind to the THS receptor of the thyroid and activate it inappropriately, leading to increased thyroid hormone production and enlargement of the gland. D. Myesthenia gravis—infiltration of connective tissues, most often within joints, by T cells that release cytokines and cause inflammation. E. Rheumatoid arthritis—formation of immune complexes in small blood vessels caused by autoantibodies to DNA and other nuclear components.
C. Grave's disease—antibodies bind to the THS receptor of the thyroid and activate it inappropriately, leading to increased thyroid hormone production and enlargement of the gland.
In which of the following types of hypersensitivity are B cells involved? A. Types II, III, and IV but not type I hypersensitivity B. Type I but not types II, III, or IV hypersensitivity C. Type IV but not types I, II, or III hypersensitivity D. B cells are never involved in hypersensitivity E. B cells are involved in all hypersensitivity F. Types I, II, and III but not type IV hypersensitivity
F. Types I, II, and III but not type IV hypersensitivity
Drag the statements to the type of reaction they best describe to evaluate examples of type II and type III hypersensitivities. 1. A reaction that involves IgG and IgM and the activation of complement against cell-surface bound antigens 2. A reaction that involves IgG and IgM-mediated reactions to soluble antigens 3. Arthus reaction involving localized dermal injury at antigen injection site 4. Type O, or universal donor, blood is given to a Type AB patient 5. Anti-A antibodies in donated Type B blood now circulate in a patient with Type A blood after a transfusion 6. Immune complexes are trapped in vessel walls leading to neutrophil-mediated destruction of tissue 7. An Rh-mother, making anti-Rh antibodies, is carrying her second Rh+ fetus 8. Serum sickness Involving systemic injury due to circulating antigen-antibody complexes 9. Type AB, or universal recipient, blood is given to a type O patient 10. An Rh+ mother is carrying her first Rh+ fetus
1. Type II 2. Type III 3. Type III 4. No hypersensitivity reaction occurs 5. Type II 6. Type III 7. Type II 8. Type III 9. Type II 10. No hypersensitivity reaction occurs
Complete each sentence about type IV hypersensitivities and then arrange the sentences in a logical sequence. Not all words are used. 1. ____________ , or tissue used from one's own body, offer the lowest risk of graft rejection; these are followed by isografts (identical twin donor); ____________ , which are the most common source of grafts today; and ____________ , which are experimental as genetic engineering works to reduce their antigenicity in humans. 2. Compared to type III hypersensitivities, ____________ reactions primarily involve ____________ cell activity. 3. The most common delayed allergic reaction, however, is ____________ , which occurs after exposure to antigens in plant resins, drugs or personal articles, and involves the production of inflammatory cytokines that cause blistering. 4. Type IV dysfunction is known as ____________ hypersensitivity because symptoms arise one to several days following secondary antigen exposure. 5. One example occurs during the ____________ skin test in people sensitized by tuberculosis infection. 6. Host rejection of grafted tissue is due to ____________ -mediated reactions, while ____________ occurs when cells in the grafted tissue attack host cells.
2. Type IV; T 4. delayed 5. tuberculin 3. contact dermatitis 6. MHC I; GVHD 1. Autografts; allografts; xenografts
Please place the following statements in the correct order to test your understanding of the pathogenesis of delayed type hypersensitivity contact dermatitis reactions. 1. Tc cells and macrophages release mediators inducing inflammation and skin damage. 2. Epithelial dendritic cells process and present hapten-peptide complex. 3. Activated sensitized TH cells secrete cytokines. 4. Allergens release small chemicals (haptens) that combine with skin proteins. 5. Sensitized TH cells recognize presented hapten-peptide complex.
4, 2, 5, 3, 1
Please select all statements that apply to type III hypersensitivity reactions to test your understanding of these reactions. (NOTE: Please change all question marks to checkmarks for correct answers or empty boxes for incorrect answers.) A. Involve IgG, IgM, and IgA B. Antibody binds soluble antigen C. Antibody binds to cell surface antigen D. Damage is due to complement-mediated lysis E. Damage is due to inflammation caused by neutrophil granule release
A, B, E
While it is unknown what the exact causes of autoimmunity are, several possible causes could be to blame. Which of the following are considered to be possible causes of autoimmunity? Check all that apply. (NOTE: Please change all question marks to checkmarks for correct answers or empty boxes for incorrect answers.) A. A deficiency in the action or control of regulatory T cells that normally inhibit responses to "self." B. A genetic component, perhaps related to specific major histocompatibility molecules, as a predisposing factor. C. Multiple (three or more) pregnancies D. Common childhood diseases (such as chickenpox). E. Infections where a pathogen mimics a self molecule to evade detection and elimination by the immune system. F. Injuries that release self-antigens to the immune system when they were previously sequested (sheltered) in privileged (isolated) areas of the body.
A, B, E, F
Select the statements about self-tolerance that are TRUE. (NOTE: Please change all question marks to checkmarks for correct answers or empty boxes for incorrect answers.) A. Self-tolerance occurs because lymphocytes that recognize autoantigens undergo apoptosis in the thymus (negative selection). B. Lymphocytes that recognize autoantigens are destroyed by activated macrophages in the thymus. C. Lymphocytes that recognize autoantigens do not receive confirmation signals and become unresponsive. D. Lymphocytes that recognize autoantigens are filtered out by the spleen.
A, C
Which of the following does NOT describe an anaphylactic response? A. Allergen route of entry is always due to inhalation. B. All statements describe the anaphylactic response. C. Associated with high concentration of chemical mediators. D. Allergens do not act directly on the target organ. E. Sudden respiratory and circulatory disruption that can be rapidly fatal.
A. Allergen route of entry is always due to inhalation.
Which type of antibodies are present in the blood of a person with type O, Rh- blood? A. Anti-A and anti-B antibodies B. Anti-A and anti-Rh antibodies C. Anti-O and anti-Rh antibodies. D. Anti-B and anti-Rh antibodies E. Anti-A, anti-B and anti-Rh antibodies
A. Anti-A and anti-B antibodies
Which of the following are mechanisms triggered during a transfusion reaction that lead to destruction of the donor red blood cells? Check all that apply. (NOTE: Please change all question marks to checkmarks for correct answers or empty boxes for incorrect answers.) A. Binding of natural antibodies to the donor red blood cells, triggering the complement system and formation of the membrane attack complex (MAC). B. Stimulation of the cell-mediated adaptive immune response, triggering cytotoxic T lymphocytes that will seek and destroy the donor red blood cells. C. Stimulation of the humoral adaptive immune response, generating new highly specific IgG antibodies to antigens on the donor red blood cells. D. Activation of NK cells by coating of the donor red blood cells by antibodies, followed by binding of NK cells to the Fc portions of the antibodies. E. Activation of basophils by cross-linking of IgE antibodies with allergen, followed by release of granzymes by these cells.
C, D, E
What is NOT a reason that the kidneys are particularly prone to damage caused by immune complexes? A. Kidney blood vessel wall cells have receptors for antibodies on them, which makes them take up antibodies or immune complexes from the bloodstream. This blocks the kidneys up and causes them to malfunction and become damaged. B. Blood is pushed through the kidneys at a very high pressure. Any blockage of the vessels, such as what might be caused by immune complex deposits, can lead to ruptures/inflammation and damage of these organs. C. While blood vessel walls do NOT have receptors for antibodies, large immune complexes forced through small diameter vessels can become embedded within them. This can trigger complement system inflammation and cell destruction. D. Trapped immune complexes that initiate inflammation can attract neutrophils. The neutrophils degranulate in the area of the immune complexes, leading to cell/tissue destruction. E. These are all reasons that the kidneys are very susceptible to damage caused by immune complexes.
A. Kidney blood vessel wall cells have receptors for antibodies on them, which makes them take up antibodies or immune complexes from the bloodstream. This blocks the kidneys up and causes them to malfunction and become damaged.
Select the statement that best explains how RhoGAM works. A. RhoGAM contains anti-Rh antibodies; these bind to any Rh+ erythrocytes that may have entered the mother's circulation from an Rh+ baby, preventing these RBCs from stimulating a primary immune response in the mother. B. RhoGAM contains anti-Rh antibodies; these bind to any Rh- erythrocytes that may have entered the mother's circulation from an Rh- baby, preventing these RBCs from stimulating a primary immune response in the mother. C. RhoGAM contains anti-Rh antibodies; these bind to any Rh+ leukocytes that may have entered the mother's circulation from an Rh+ baby, preventing these WBCs from stimulating a primary immune response in the mother. D. RhoGAM contains anti-Rh antibodies; these bind to any Rh+ erythrocytes that may have entered the mother's circulation from an Rh+ baby, preventing these RBCs from stimulating a secondary immune response in the mother. E. RhoGAM contains anti-ABO antibodies; these bind to any ABO+ erythrocytes that may have entered the mother's circulation from a ABO+ baby, preventing these RBCs from stimulating a primary immune response in the mother.
A. RhoGAM contains anti-Rh antibodies; these bind to any Rh+ erythrocytes that may have entered the mother's circulation from an Rh+ baby, preventing these RBCs from stimulating a primary immune response in the mother.
Why do Rh-negative but not Rh-positive mothers sometimes have babies with hemolytic disease of the newborn? A. This disease results when an Rh-negative mother's immune system is primed to produce anti-Rh IgG antibodies that can cross the placenta. If the mother is Rh-positive, she won't produce any anti-Rh antibodies at all. B. Rh-positive mothers produce IgM antibody, not IgG. Even although they make anti-Rh antibody, IgM antibody can't cross the placenta, so it can't cause hemolytic disease of the newborn. C. Rh-positive mothers will receive a preventative shot from their physician prior to conception. This will provide the protection the fetus needs AFTER conception to avoid the disease. D. Rh-negativity is also associated with hyperproduction of antibodies. As such, Rh-negative mothers are more likely than Rh-positive mothers to produce the antibodies needed to produce this disease. E. This disease results when an Rh-positive mother's immune system is primed to produce anti-Rh IgG antibodies that can cross the placenta. If the mother is Rh-negative, she won't produce any anti-Rh antibodies at all.
A. This disease results when an Rh-negative mother's immune system is primed to produce anti-Rh IgG antibodies that can cross the placenta. If the mother is Rh-positive, she won't produce any anti-Rh antibodies at all.
Please select all the TRUE statements about primary immunodeficiencies. (NOTE: Please change all question marks to checkmarks for correct answers or empty boxes for incorrect answers.) A. These disorders are acquired later in life, through a variety of factors B. These disorders result from a genetic defect C. These disorders are easily treated with medications D. These disorders are relatively common E. These disorders are rare and may be life-threatening F. Examples of these disorders are SCID and CGD G. Examples of these disorders are AIDS and monoclonal gammopathy H. These disorders are seldom life-threatening and do not require treatment
B, E, F
Immunosuppressive medications such as cyclosporin A and tacrolimus suppress cellular-signaling mechanisms in A. macrophages and neutrophils, preventing phagocytosis. B. T lymphocytes, suppressing T cell proliferation and responses. C. B lymphocytes, preventing antibody production. D. mast cells and basophils, preventing degranulation. E. all white blood cells.
B. T lymphocytes, suppressing T cell proliferation and responses.
If the immune system responds inadequately to antigenic stimulation, this is termed A. hypersensitivity B. immunodeficiency C. autoimmunity D. cell-mediated immunity E. allergy
B. immunodeficiency
The fetus is not rejected because A. it is too small B. it is in an immunologically privileged site C. the father is immunosuppressed D. it has no antigens E. it has no normal microbiota
B. it is in an immunologically privileged site
Consider the figure of a step in the sequence of type I hypersensitivity reactions. If the allergen shown were to attach at position A, A. the mast cell would degranulate, releasing its mediators. B. the mast cell would not degranulate, because no IgE cross-linking would occur. C. the person would develop a delayed-type hypersensitivity. D. the mast cell would be stimulated to produce anti-allergen antibodies. E. the mast cell would differentiate to become a basophil.
B. the mast cell would not degranulate, because no IgE cross-linking would occur.
The type of hypersensitivity expressed with the lysing of red blood cells is A. type I B. type II C. type III D. type IV E. type V
B. type II
Please select the TRUE statements about lymphocyte disorders. (NOTE: Please change all question marks to checkmarks for correct answers or empty boxes for incorrect answers.) A. Children born with severe combined deficiency disorder (SCID) can be kept healthy using antibiotics. B. Children born with severe combined deficiency disorder (SCID) are at risk for bacterial but not viral infections. C. People with defects in their late complement system components are at risk for repeated Gram-negative bacterial infections. D. People who have defects in their phagocytes are at increased risk for viral infections. E. People with selective IgA deficiency are at risk for repeated infections of the respiratory tract. F. Children with DiGeorge syndrome are at risk for virus and obligate intracellular bacterial infections.
C, E, F
Please select the TRUE statement about people with selective IgA deficiency. A. People with this disorder do not produce IgA or IgD, but they do produce IgG, IgM, and IgE. B. People with this disorder develop it as a result of some kind of virus infection. C. People with this disorder have a lower risk of the autoimmune disorder type I diabetes mellitus. D. People with this disorder are at risk of repeated respiratory, gastrointestinal, and genitourinary infections. E. People with this disorder do not produce any differentiated B cells or T cells.
D. People with this disorder are at risk of repeated respiratory, gastrointestinal, and genitourinary infections.
Omalizumab is a recombinant humanized monoclonal antibody that can be administered by IV injection. This IgG antibody works by A. binding to allergen molecules, preventing them from binding to IgE that is coating the outside of basophils and mast cells B. binding to the Fab portion of IgE antibodies coating the outside of basophils and mast cells C. binding to allergen molecules, preventing them from binding to IgE that is coating the outside of neutrophils D. binding to the Fc portion of IgE antibodies, preventing them from binding to mast cells and basophils E. binding to basophils and mast cells in place of IgE.
D. binding to the Fc portion of IgE antibodies, preventing them from binding to mast cells and basophils
Molecular mimicry likely plays a role in autoimmunity because A. the pathogen is unable to make its own antibodies B. the mimicry causes autoantigens to be released systemically in the host C. the mimicry causes immune cells to recognize all MHC molecules on self cells D. the host develops an immune response to autoantigens that the pathogen has used to avoid the immune system E. the host coats self cells in the same molecules as those on the pathogen surface
D. the host develops an immune response to autoantigens that the pathogen has used to avoid the immune system
In which of the following do cytotoxic T cells play a role in sign and symptom development? A. Tuberculin skin test B. Graves' disease C. Myesthenia gravis D. Monoclonal gammopathy E. Type 1 diabetes mellitus F. Serum sickness G. Anaphylactic shock H. Rheumatoid arthritis
E. Type 1 diabetes mellitus
If the thymus fails to develop, A. functional T cells are absent B. functional B cells are absent C. Di George's syndrome exists D. complement deficiencies exist E. functional T cells are absent AND Di George's syndrome exists
E. functional T cells are absent AND Di George's syndrome exists
Gene therapy technology A. may be used to generate cells for transplantation B. may overcome graft rejection C. may treat cancer D. may down-regulate the immune response E. may overcome graft rejections AND may treat cancer
E. may overcome graft rejections AND may treat cancer
