End of Chapter Questions for Exam 2
The immune mechanism involved in contact dermatitis is which of the following? Presence of circulating IgE Deposition of immune complexes Activation of complement Sensitization of cytotoxic T cells
Sensitization of cytotoxic T cells
Which of the following occurs in hemolytic disease of the newborn? Buildup of IgE on Mom's cells Rh- Mom's exposure to Rh+ baby cells Rh+ Mom's exposure to Rh- baby cells Baby must be Rh-
Rh- Mom's exposure to Rh+ baby cells
An autoimmune disease characterized by pain and progressive destruction of the joints, weight loss, morning stiffness, and presence of an antibody directed against IgG best describes: Rheumatoid arthritis Lupus Hemolytic disease of the newborn Hemolytic anemia
Rheumatoid arthritis
An example of a type III hypersensitivity reaction is: Myasthenia gravis Allergic rhinitis Contact sensitivity Rheumatoid arthritis
Rheumatoid arthritis
Complement is responsible for tissue damage in which types of hypersensitivity reactions?
Type II and III
A hypersensitivity reaction characterized by presence of IgG that reacts with soluble antigen best describes which type of reaction?
Type III
Immune injury resulting from the localization of immune complexes in blood vessels and tissues describes which hypersensitivity reaction?
Type III
A 55-year old male presents with symptoms that include weakness, loss of appetite and anemia. Immunofixation electrophoresis reveals a heavy IgM band. Which of the following is the most likely diagnosis? SCID Multiple myeloma Waldenstrom's macroglobulinemia DiGeorge syndrome
Waldenstrom's macroglobulinemia
Which disease may be expected to show an IgM spike on an electrophoretic pattern? Hypogammaglobulinemia Multicystic kidney disease Waldenstrom's macroglobulinemia Wiskott-Aldrich syndrome
Waldenstrom's macroglobulinemia
Which of the following is associated with an increase in IgE production? a. Transfusion reaction b. Activation of Th1 cells c. Reaction to poison ivy d. HDN
b. Activation of Th1 cells
T cell dependent hypersensitivity occurs: 24-72 hours after exposure to the antigen Immediately after exposure to the antigen 5-7 days after contact with the antigen 1-4 hours after contact with the antigen
24-72 hours after exposure to the antigen
The PPD reaction to determine exposure to tuberculosis is based on which of the following? Formation of antigen-antibody complexes An immediate hypersensitivity reaction A sensitized T-cell response A type II hypersensitivity reaction
A sensitized T-cell response
Digeorge anomaly may be characterized by all of the following except: A. Autosomal recessive inheritance B. Cardiac abnormalities C. Parathyroid hypoplasia D. Decreased number of mature T cells
A. Autosomal recessive inheritance
All of the following may contribute to autoimmunity EXCEPT? A. Clonal deletion of self reactive T cells B. Molecular mimicry C. New expression of class 2 MHC antigens D. Polyclonal activation of T cells
A. Clonal deletion of self reactive T cells
In general, a myeloma secreting which type of M protein is most likely to cause renal failure? A. IgM B. IgG C. K light chains D. u heavy chains
A. IgM
Destruction of the myelin sheath of axons caused by the presence of antibody is characteristic of which disease? A. MS B. MG C. Graves' disease D. Goodpasture's syndrome
A. MS
A 3-year old boy is hospitalized because of recurrent bouts of pneumonia. Lab tests are run, and the following findings are noted: Prolonged bleeding time, decreased platelet count, increased level of serum alpha-fetoprotein, and a deficiency of naturally occurring isohemagglutinins. Based on these results, which is the most likely diagnosis? A. PNP deficiency B. Selective IgA deficiency C. SCID D. WAS
A. PNP deficiency
Hodgkin's lymphoma is characterized by: A. The presence of Reed-Sternberg cells in lymph nodes. B. Proliferation of T cells C. An incurable, rapidly progressive course D. Excess immunoglobulin production
A. The presence of Reed-Sternberg cells in lymph nodes.
Which of the following statement applies to Bruton's X-linked agammaglobulinemia? A. Typically appears in females B. There is a lack of circulating CD19 positive B cells C. T cells are abnormal D. There is a lack of pre-B cells in the bone marrow
A. Typically appears in females
Chronic leukemias are characterizes as: A. Usually being of B-cell origin B. Being curable with chemotherapy C. Usually occurring in children D. Following a rapidly progressive course
A. Usually being of B-cell origin
Which best describes the difference between chronic and acute lymphocytic leukemia? Chronic lymphocytic leukemias are exclusive of T cell origin Acute lymphocytic leukemias have a high response rate to chemotherapy Chronic lymphocytic leukemias have a shorter survival time Acute lymphocytic leukemias progress more slowly
Acute lymphocytic leukemias have a high response rate to chemotherapy
The disease SCID is characterized by which of the following? Diagnosed in infancy Short life span No antibody production All of the above
All of the above
Waldenstrom's macroglobulinemia is associated with which of the following? Cryoglobulins Cold agglutinins IgM monoclonal gammopathy All of the above
All of the above
Which is true of immediate hypersensitivity reactions? Histamine is released from mast cells Antigen must bind to two IgE molecules Eosinophil chemotactic factor is released All of the above
All of the above
All of the following hypersensitivity reactions involve complement except: Allergic reactions Hemolytic disease of the newborn Autoimmune hemolytic anemia Serum sickness
Allergic reactions
All of the hypersensitivity responses have which of the following in common? Involvement of antibody Asymptomatic sensitization phase Release of histamine Activation of macrophage
Asymptomatic sensitization phase
A positive DAT might indicate which of the following? Autoimmune hemolytic anemia Allergic reaction Mismatch of a transplant Rheumatoid arthritis
Autoimmune hemolytic anemia
Which of the following would be considered a significant finding in Graves' disease? A. Increased TSH levels B. Antibody to TSHR C. Decreased T3 and T4 D. Antithyroglobulin antibody
B. Antibody to TSHR
Immunologic findings in type I diabetes mellitus include all of the following except: A. Presence of CD8 T cells in the islets of langerhans B. Antibody to colloid C. Antibody to insulin D. Antibody to GAD
B. Antibody to colloid
Hashimoto's thyroiditis can best be differentiated from Graves' disease on the basis of which of the following? A. Decrease in thyroid hormone levels B. Decrease in thyroid hormone levels C. Enlargement of the thyroid D. Presence of lymphocytes in the thyroid
B. Decrease in thyroid hormone levels
Defects in which arm of the immune system are most commonly associated with severe illness after administration of live virus vaccines? A. cell mediated immunity B. Humoral immunity C. Complement D. Phagocytic cells
B. Humoral immunity
Which of the following would be the best indicator of a malignant clone? A. overall increase in antibody production B. Increase in antibody directed against a specific epitope C. decrease in overall antibody production D. Increase in IgG and IgM
B. Increase in antibody directed against a specific epitope
Flow cytometry results on a patient reveal a lack of cells with CD2 and CD3. What does thsi indicate? A. Lack of B cells B. Lack of T cells C. Lack of monocytes D. Lack of natural killer cells
B. Lack of T cells
SLE can be distinguished from RA on the basis of which of the following? A. Joint pain B. Presence of anti-ds DNA antibodies C. Immune complex formation with activation of complement D. Presence of antinuclear antibodies
B. Presence of anti-ds DNA antibodies
A 6-month old baby has suffered from recurrent bacterial infections. Flow cytometry results indicate a lack of B cells but presence of normally functioning T cells. What is the most likely diagnosis? SCID Common variable hypogammaglobulinemia DiGeorge syndrome Bruton's agammaglobulinemia
Bruton's agammaglobulinemia
Which of the following would be considered an organ specific autoimmune disease? A. SLE B. RA C. Hashimoto's thyroiditis D. Goodpasture's syndrome
C. Hashimoto's thyroiditis
Which of the following best describes the slide agglutination test for RF? A. It is specific for RA B. A negative test rules out the possibility of RA C. It is a sensitive screening tool D. It detects IgG made against IgG
C. It is a sensitive screening tool
Which best describes acute leukemias? A. Usually being of B-cell origin B. Poor response to chemo C. Usually occurring in children D. Cells are well differentiated
C. Usually occurring in children
List three things we can do to determine if a non-Hodgkin's lymphoma is of B or T cell origin.
CD markers (CD19 and CD20 for B cells, CD2, CD3, CD4 and CD8 for T cells), rearrangement of Ig genes, presence of surface Ig
Why are T cell non-Hodgkin's lymphomas more difficult to identify than B cell non-Hodgkin's lymphomas?
Cannot determine Ig products, may not express cell surface markers
Anaphylaxis is characterized by all of the following except: IgE-coated mast cells Massive release of histamine Bronchoconstriction Circulating immune complexes
Circulating immune complexes
Which of the following is characteristic of RA? a.Association with certain HLA-DR genes b.Joint involvement that is symmetric c. Presence of antibody against IgG D. All of the above
D. All of the above
All of the following are features of malignancy except A. Rapid proliferation B. Clonal proliferation C. Chromosomal mutations. D. Excess apoptosis
D. Excess apoptosis
All of the following features are commonly used to classify lymphoid neoplasms except A. Cell of orgin B. Presence of gene translocations C. Morphology/cytology of the malignant cells D. exposure to carcinogens
D. exposure to carcinogens
Reasons for autoimmunity include all of the following except: Antibody that cross-reacts with self-antigens Inheritance of certain MHC antigens Molecular mimicry Deletion of self-reactive lymphocytes during maturation
Deletion of self-reactive lymphocytes during maturation
Lupus can be distinguished from RA on the basis of which of the following: Joint pain Presence of inflammation Deposition of immune complexes in the kidney Antibody to ACh receptors
Deposition of immune complexes in the kidney
A 7-month old boy is seen by a specialist because of hypocalcemia, viral pneumonia, a history significant for recurrent diarrhea, and oral candidiasis. An x-ray reveals the lack of a thymic shadow. This boy most likely has: DiGeorge syndrome Wiskott-Aldrich syndrome Ataxia telangiectasia Bare lymphocyte syndrome
DiGeorge syndrome
A male baby who has suffered from persistent Candida fungal infections and several bouts of pneumonia all before the age of 6 months is found to have some developmental problems as well as low-set ears. Lab testing reveals an absence of T cells. What is the most likely diagnosis? Selective IgA deficiency Common variable immunodeficiency Waldenstrom's macroglobulinemia DiGeorge syndrome
DiGeorge syndrome
True/False: CLL is not compatible with a long survival.
False
True/False: Hodgkin's lymphomas are a grab bag of B and T cell neoplasms.
False
Which of the following disease results in an acquired or secondary immunodeficiency? HIV infection Bruton's agammaglobulinemia Leukocyte adhesion deficiency Wiskott-Aldrich syndrome
HIV infection
A 40-year-old female patient has increased TSH and decreased rT3 and T4 levels with a normal T3 level. Antithyroglobulin is measured as 1:1280, and the antimicrosomal level is reportedly 1:6400. This patient most likely has: Type I diabetes Graves' disease Hashimoto's thyroiditis Systemic lupus erythematosus
Hashimoto's thyroiditis
Preformed mediators that are released during the activation phase of a type I hypersensitivity include which molecules?
Histamine, heparin, neutrophil and eosinophil chemotactic factors
Which lymphoma typically presents with Reed-Sternberg cells in the peripheral lymphoid tissues?
Hodgkin's lymphoma
Type II hypersensitivity could involve all of the following except: IgE cross-linking on the mast cell or basophil Phagocytic cell degranulation and proteolytic enzyme activity A kidney membrane antigen and specific antibody Natural killer cell activation and killing
IgE cross-linking on the mast cell or basophil
ALL has B-cells that haven't gotten past which stage of development?
Immature B
All of the following findings would be useful in the diagnosis of Graves' disease except: Presence of antibodies to TSH receptors Hyperthyroidism Symptoms of nervousness and weight loss Increase in allergic IgE
Increase in allergic IgE
What is the main difference between the leukemias and the lymphomas? In leukemias, malignant cells are mainly located in the tissues Lymphomas are present mainly in peripheral blood Lymphomas arise due to a lack of response to stimulating antigens Lymphomas arise mainly in lymph nodes, the spleen or other lymphoid tissue
Lymphomas arise mainly in lymph nodes, the spleen or other lymphoid tissue
The cells in CLL are arrested in which stage of development?
Mature B
Which of the following statements about SCID are true? Most severe form of immunodeficiency Is accompanied by hypergammaglobulinemia Patients can be vaccinated with live virus Occurs only in males
Most severe form of immunodeficiency
Which immunoproliferative disorder is a cancer of the plasma cells and results in secretion of light chains into the urine? Multiple myeloma Waldenstrom's macroglobulinemia Alpha heavy chain disease DiGeorge syndrome
Multiple myeloma
In which one of the following autoimmune diseases are antibodies to ACh receptors produced, thereby blocking the signal to muscles? Systemic lupus Goodpasture's syndrome Auutoimmune hemolytic anemia Myasthenia gravis
Myasthenia gravis
Which of the following diseases is an example of a type II hypersensitivity? Anaphylaxis Myasthenia gravis Post-streptococcal glomerulonephritis Bruton's agammaglobulinemia
Myasthenia gravis
A child suspected of having an inherited humoral immunodeficiency disease is given diphtheria/tetanus vaccine. Two weeks after the immunization, his level of antibody to the specific antigens is measured. Which result is expected for this patient if he does have this deficiency? Increased levels of specific antibody No change in the level of specific antibody An increase in IgG-specific antibody but not IgM-specific antibody Increased levels of nonspecific antibody
No change in the level of specific antibody
Reasons for autoimmunity may include all of the following except: Inheritance of certain HLA antigens Molecular mimicry Polyclonal B cell activation Normal antibody production
Normal antibody production
Which is true of selective IgA deficiency? It is invariably fatal It is very rare It mainly occurs in older adults Patients may develop an anti-IgA antibody
Patients may develop an anti-IgA antibody
SLE can be characterized by all of the following except: Butterfly rash Joint pain Presence of circulating immune complexes Presence of reagin antibody
Presence of reagin antibody
Which of the following is a test for antibody to a specific allergen? RAST RPR RIST RID
RAST
Which of the following is associated with DiGeorge syndrome? Small or missing thymus Missing B-cell precursors Inherited as X-linked recessive M spike in the gamma region
Small or missing thymus
All of the following are characteristic of cold autoimmune hemolytic anemia except: The antibody responsible is IgG It is usually in older patients The antibody reacts as an anti-I The reaction is only seen at cold temperatures
The antibody responsible is IgG
Explain the clonal hypothesis of malignancy.
Theory that states that all malignant cells arise from one mutated, abnormal parent cell
A 9-month old infant is seen by a physician due to a persistent skin infection. His WBC and RBC counts are normal. Immunofixation electrophoresis indicates a low level of IgG. When the infant return to the physician for a follow-up visit in a month, his IgG level has increased. What condition do these results indicate?
Transient hypogammaglobulinemia
True/False: Hodgkin's lymphoma is highly treatable and often curable found in young adults and in the elderly.
True
The principle difference between type II and type III hypersensitivity reactions is the: Isotype of antibody involved Complement-mediated lysis of host cells Whether the antigen is cellular or soluble Involvement of helper T cells and macrophages
Whether the antigen is cellular or soluble
A 9-month old boy was suspected of having an immune deficiency because he had many recurrent infections with S. pneumonia. Laboratory tests revealed a normal percentage of T cells and T cell subsets but a lack of mature B cells and immunoglobulins. This boy most likely has: Wiskott-Aldrich syndrome DiGeorge syndrome X-linked agammaglobulinemia (Bruton's) Chronic granulomatous disease
X-linked agammaglobulinemia (Bruton's)
3. A 54-year old woman is at the optometrist for difficulty focusing on objects and progressively decreasing vision. She tells her optometrist that her eyelids feel like they're drooping more. He recommends glasses and that she see a rheumatologist (you!). What autoantibody(ies) would you recommend she be checked for? a. Antibody to acetylcholine receptor b. Antibody to myelin basic protein c. Antibody to IgG d. Antibody to thyroid hormone receptor
a. Antibody to acetylcholine receptor
Which of the following is associated with anaphylaxis? a. Buildup of IgE on mast cells b. Activation of complement c. Increase in cytotoxic T cells d. Large amount of circulating IgG
a. Buildup of IgE on mast cells
4. Preformed mediators that are released during the activation phase of a type I hypersensitivity response include which of the following? a. Histamine b. Leukotrienes c. Prostaglandins d. PAF
a. Histamine
4. Which laboratory finding is associated with multiple sclerosis? a. Several bands on electrophoresis of cerebrospinal fluid b. Antibody to thryroglobulin c. Presence of antinuclear antibodies d. Interference in serological testing from rheumatoid factor
a. Several bands on electrophoresis of cerebrospinal fluid
Which of the following explains the difference between type II and type III hypersensitivity reactions? a. Type II involves cellular antigens. b. Type III involves IgE. c. IgG is involved only in type III reactions. d. Type II reactions involve no antibody.
a. Type II involves cellular antigens.
Contact dermatitis can be characterized by all of the following except a. formation of antigen-antibody complexes. b. generation of sensitized T cells. c. Langerhans cells acting as antigen-presenting cells. d. complexing of a hapten to self-antigen.
a. formation of antigen-antibody complexes.
5. Which of the following would lead you to a diagnosis of Hashimoto's thyroiditis rather than Graves' disease? a. Presence of thyroperoxidase antibodies b. Decrease in thyroid hormone levels c. Enlargement of the thyroid d. Oligoclonal banding
b. Decrease in thyroid hormone levels
6. Which of the following occurs in hemolytic disease of the newborn? a. IgE builds up on the mother's cells, causing degranulation b. The Rh- mother is exposed to Rh+ cells, sensitizing her immune system and resulting in the formation of anti-Rh c. The Rh- baby is exposed to Rh+ cells, sensitizing the baby's immune system and resulting in the formation of anti-Rh d. IgE from the mother crosses the placenta and attacks the baby's red blood cells
b. The Rh- mother is exposed to Rh+ cells, sensitizing her immune system and resulting in the formation of anti-Rh
5. A hypersensitivity reaction characterized by the presence of IgG that reacts with soluble antigen best describes: a. Type II hypersensitivity b. Type III hypersensitivity c. Contact dermatitis d. Asthma
b. Type III hypersensitivity
All of the following are associated with type I hypersensitivity except a. release of preformed mediators from mast cells. b. activation of complement. c. cell-bound antibody bridged by antigen. d. an inherited tendency to respond to allergens.
b. activation of complement.
7. Which immune mechanism is involved in autoimmune diseases such as rheumatoid arthritis? a. Presence of circulating cell-bound IgE b. Binding of antibody to cell-bound antigen and subsequent activation of the complement cascade c. Deposition of immune complexes in the tissues and subsequent activation of the complement cascade d. Release of cytokines by sensitized T cells
c. Deposition of immune complexes in the tissues and subsequent activation of the complement cascade
Which of the following is a general characteristic of hypersensitivity reactions? a. Immune responsiveness is depressed. b. Antibody is involved in all reactions. c. Either self-antigen or heterologous antigen may be involved. d. The antigen triggering the reaction is a harmful one.
c. Either self-antigen or heterologous antigen may be involved.
Hyposensitization therapy is thought to work through the administration of: a. Anti-IgE monoclonal antibody, which binds to circulating IgE in the bloodstream b. Anti-IgE monoclonal antibody to prevent further synthesis of IgE by the patient c. Gradually increasing doses of the allergen over time to induce production of blocking IgG antibodies d. Gradually increasing doses of the allergen over time to shift the immune response towards allergen-specific IgM antibodies
c. Gradually increasing doses of the allergen over time to induce production of blocking IgG antibodies
2. A 20-year old clinical laboratory science student has complaints of being tired but being unable to sleep at night. Her hair has been breaking off and she has lost 20 pounds over the past 2 months with no change to diet or exercise. Her pulse and blood pressure are elevated, and exopthalamus is present. Her thyroid stimulating hormone (TSH) is decreased but T4 levels are increased. This student most likely has: a. Systemic lupus erythematosus (SLE) b. Hashimoto's thyroiditis c. Graves' disease d. Myasthenia gravis
c. Graves' disease
6. Antibodies directed against thyroglobulin represent a significant finding in which of the following autoimmune disease states? a. Myasthenia gravis b. Multiple sclerosis c. Hashimoto's thyroiditis d. Goodpasture's syndrome
c. Hashimoto's thyroiditis
2. Immune injury resulting from the localization of immune complexes in blood vessels and tissues describes which type of hypersensitivity reaction? a. I b. II c. III d. IV
c. III
10. Contact dermatitis can be characterized by: a. Formation of antigen-antibody complexes b. Immediate sensitization of Th2 cells c. Inappropriate recruitment of CD8 cells d. Shortness of breath, flushing and a rash
c. Inappropriate recruitment of CD8 cells
8. Which of the following BEST describes the role(s) of eosinophils in a type I hypersensitivity reaction? a. Release of histaminase b. Degradation of histamine c. Down-regulation of immune response d. All of the above
d. All of the above
Which of the following would cause a positive DAT test? a. Presence of IgG on red cells b. Presence of C3b or C3d on red cells c. A transfusion reaction due to preformed antibody d. Any of the above
d. Any of the above
Which newly synthesized mediator has a mode of action similar to that of histamine? a. LTB4 b. Heparin c. ECF-A d. PGD2
d. PGD2
Which condition would result in HDN? a. Buildup of IgE on mother's cells b. Sensitization of cytotoxic T cells c. Exposure to antigen found on both mother and baby red cells d. Prior exposure to foreign red cell antigen
d. Prior exposure to foreign red cell antigen
9. Which newly synthesized mediator has a mode of action similar to that of histamine? a. Leukotrienes b. Heparin c. Eosinophilic chemotactic factor of anaphylaxis (ECF-A) d. Prostaglandin D2
d. Prostaglandin D2
1. A 56-year old woman presents to her physician with complaints of weight gain and joint problems. She is having difficulty walking up stairs and using her fingers for fine motor movements. Fingers in both hands as well as knees on both legs are painful and stiff. Her symptoms have gotten increasingly worse for the past 6 months. Laboratory studies show that rheumatoid factor is elevated and antinuclear antibodies are not detected on ANA. Complement levels are decreased. The most likely diagnosis is: a. Systemic lupus erythematosus (SLE) b. Hashimoto's thyroiditis c. Myasthenia gravis d. Rheumatoid arthritis (RA)
d. Rheumatoid arthritis (RA)
3. Hypersensitivities to poison ivy and nickel are: a. Mediated by IgG and IgM antibodies b. Immunodeficiency diseases c. IgE responses to a hapten d. T cell responses to a hapten
d. T cell responses to a hapten
What is the immune mechanism involved in type III hypersensitivity reactions? a. Cellular antigens are involved. b. Deposition of immune complexes occurs in antibody excess. c. Only heterologous antigens are involved. d. Tissue damage results from exocytosis.
d. Tissue damage results from exocytosis.
