Immune System Mechanisms, Exams of Nursing

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Clinical Immunology and Serology

A Laboratory Perspective - Stevens

and Miller: Review Questions and

detailed answers

c. First attenuated vaccines

1. Which of the following can be attributed to Pasteur? a. Discovery of opsonins b. Observation of phagocytosis c. First attenuated vaccines d. Theory of humoral immunity d. Monocyte
2. Which WBC is capable of further differentiation in tissues? a. Neutrophil b. Eosinophil c. Basophil d. Monocyte a. Innate immunity
3. The cells that Metchnikoff first observed are associated with which phenomenon? a. Innate immunity b. Adaptive immunity c. Humoral immunity d. Specific immunity

a. Bone marrow

4. Where are all undifferentiated lymphocytes made? a. Bone marrow b. Spleen c. Thymus d. Lymph nodes d. They kill target cells without prior exposure to them.
5. Which of the following statements is true of NK cells? a. They rely upon memory for antigen recognition. b. They have the same CD groups as B cells. c. They are found mainly in lymph nodes. d. They kill target cells without prior exposure to them. b. Dendritic cell
6. Which cell is the most potent phagocytic cell in the tissue? a. Neutrophil b. Dendritic cell c. Eosinophil d. Basophil a. innate immunity
7. The ability of an individual to resist infection by means of normally present body functions is called a. innate immunity b. humoral immunity c. adaptive immunity d. cross-immunity d. neutrophil
8. A cell characterized by a nucleus with two to five lobes, a diameter of 10 to 15 μm, and a large number of neutral staining granules is identified as a(n) a. eosinophil b. monocyte

c. basophil d. neutrophil c. Thymus

9. Which of the following is a primary lymphoid organ? a. Lymph node b. Spleen c. Thymus d. MALT a. Unstimulated B cells
10. What type of cells would be found in a primary follicle? a. Unstimulated B cells b. Germinal centers c. Plasma cells d. Memory cells b. Presence of surface antibody
11. Which of the following is a distinguishing feature of B cells? a. Act as helper cells b. Presence of surface antibody c. Able to kill target cells without prior exposure d. Active in phagocytosis a. Secondary lymphoid organs
12. Where do lymphocytes mainly come in contact with antigens? a. Secondary lymphoid organs b. Bloodstream c. Bone marrow d. Thymus b. CD
13. Which of the following is found on the T cell subset known as helpers? a. CD b. CD

c. CD d. CD c. Specificity for each individual pathogen

14. Which of the following statements best characterizes adaptive immunity? a. Relies on normally present body functions b. Response is similar for each exposure c. Specificity for each individual pathogen d. Involves only cellular immunity a. produce cytokines that regulate both innate and adaptive immunity.
15. The main function of T cells in the immune response is to a. produce cytokines that regulate both innate and adaptive immunity. b. produce antibodies. c. participate actively in phagocytosis. d. respond to target cells without prior exposure. b. Neutralization of toxins by serum
16. Which of the following is a part of humoral immunity? a. Cells involved in phagocytosis b. Neutralization of toxins by serum c. Macrophages and mast cells in the tissue d. T and B cells in lymph nodes c. the condition of being resistant to disease.
17. Immunity can be defined as a. the study of medicines used to treat diseases. b. a specific population at risk for a disease. c. the condition of being resistant to disease. d. the study of the noncellular portion of the blood. d. eosinophils
18. A blood cell that has reddish staining granules and is able to kill large parasites describes

a. basophils b. monocytes c. neutrophils d. eosinophils c. It collects fluid from the tissues.

19. Which of the following statements best describes a lymph node? a. It is considered a primary lymphoid organ. b. It removes old RBCs. c. It collects fluid from the tissues. d. It is where B cells mature. b. clusters of differentiation (CD)
20. Antigenic groups identified by different sets of antibodies reacting in a similar manner to certain standard cell lines best describes a. cytokines b. clusters of differentiation (CD) c. neutrophilic granules d. opsonins d. found on host cells. All of the following are characteristics of an effective immunogen except: a. internal complexity. b. large molecular weight. c. the presence of numerous epitopes. d. found on host cells. b. Antigenic only when coupled to a carrier Which of the following best describes a hapten? a. Cannot react with antibody b. Antigenic only when coupled to a carrier c. Has multiple determinant sites d. A large chemically complex molecule a. Protein with a molecular weight of 200,

Which would be the most effective immunogen? a. Protein with a molecular weight of 200, b. Nylon polymer with a molecular weight of 250, c. Polysaccharide with a molecular weight of 220, d. Protein with a molecular weight of 175, c. A weightlifter who is 35 years old Which of the following individuals would likely respond most strongly to a bacterial infection? a. An adult who is 75 years of age b. A malnourished 40-year-old c. A weightlifter who is 35 years old d. A newborn baby d. A key portion of the immunogen Which best describes an epitope? a. A peptide that must be at least 10,000 MW b. An area of an immunogen recognized only by T cells c. A segment of sequential amino acids only d. A key portion of the immunogen a. Protects antigen from being degraded Adjuvants act by which of the following methods? a. Protects antigen from being degraded b. Facilitates rapid escape from the tissues c. Limits the area of the immune response d. Decreases number of APCs b. exists in unrelated plants or animals. A heterophile antigen is one that a. is a self-antigen. b. exists in unrelated plants or animals. c. has been used previously to stimulate antibody response. d. is from the same species but is different from the host.

a. They are found on B cells and macrophages. Which of the following is true of class II MHC (HLA) antigens? a. They are found on B cells and macrophages. b. They are found on all nucleated cells. c. They all originate at one locus. d. They are coded for on chromosome 9. a. CD4+ T cells Class II MHC molecules are recognized by which of the following? a. CD4+ T cells b. CD8+ T cells c. Natural killer cells d. Neutrophils c. They transport peptides into the lumen of the endoplasmic reticulum. Which of the following best describes the role of TAP? a. They bind to class II molecules to help block the antigen-binding site. b. They bind to class I proteins in proteasomes. c. They transport peptides into the lumen of the endoplasmic reticulum. d. They help cleave peptides for transport to endosomes. b. Blocks binding of endogenous peptides What is the purpose of the invariant chain in antigen processing associated with class II MHC molecules? a. Helps transport peptides to the binding site b. Blocks binding of endogenous peptides c. Binds to CD8+ T cells d. Cleaves peptides into the proper size for binding c. Class II molecules have presented bacterial antigen to CD4+ T cells. An individual is recovering from a bacterial infection and tests positive for antibodies to a protein normally found in the cytoplasm

of this bacterium. Which of the following statements is true of this situation? a. Class I molecules have presented bacterial antigen to CD8+ T cells. b. Class I molecules have presented bacterial antigen to CD4+ T cells. c. Class II molecules have presented bacterial antigen to CD4+ T cells. d. B cells have recognized bacterial antigen without help from T cells. a. Transplantation of a kidney from one individual to another In relation to a human, alloantigens would need to be considered in which of the following events? a. Transplantation of a kidney from one individual to another b. Vaccination with the polysaccharide coat of a bacterial cell c. Oral administration of a live but heat-killed virus particle d. Grafting skin from one area of the body to another b. Binds peptides made within the cell Which is characteristic of class I MHC molecules? a. Consists of one α and one β chain b. Binds peptides made within the cell c. Able to bind whole proteins d. Coded for by DR, DP, and DQ genes d. Protect fetal tissue from destruction by NK cells Class I MHC antigens E and G serve which function? a. Enhance the response by macrophages b. Transport antigen for recognition by CD4+ T cells c. Bind to A, B, and C antigens to protect the binding site d. Protect fetal tissue from destruction by NK cells c. Only immunogens can trigger an immune response. Which best explains the difference between immunogens and antigens? a. Only antigens are large enough to be recognized

by T cells. b. Only immunogens can react with antibody. c. Only immunogens can trigger an immune response. d. Only antigens are recognized as foreign. b. haplotype. When a child inherits one set of six HLA genes together from one parent, this is called a(n) a. genotype. b. haplotype. c. phenotype. d. allotype. a. Class I HLA molecules A, B, and C belong to which MHC class? a. Class I b. Class II c. Class III d. Class IV a. opsonization. The term for enhancement of phagocytosis by coating of foreign particles with serum proteins is a. opsonization. b. agglutination. c. solubilization. d. chemotaxis. c. Lysozyme Which of the following plays an important role as an external defense mechanism? a. Phagocytosis b. C-reactive protein c. Lysozyme d. Complement c. decreased capillary permeability.

The process of inflammation is characterized by all of the following except a. increased blood supply to the area. b. migration of WBCs. c. decreased capillary permeability. d. appearance of acute-phase reactants. a. Innate Skin, lactic acid secretions, stomach acidity, and the motion of cilia represent which type of immunity? a. Innate b. Cross c. Adaptive d. Auto d. phagolysosome The structure formed by the fusion of engulfed material and enzymatic granules within the phagocytic cell is called a a. phagosome. b. lysosome. c. vacuole. d. phagolysosome b. Competing with potential pathogens The presence of human microbiota (normal flora) acts as a defense mechanism by which of the following methods? a. Maintaining an acid environment b. Competing with potential pathogens c. Keeping phagocytes in the area d. Coating mucosal surfaces c. diagnosis of a specific bacterial infection. Measurement of CRP levels can be used for all of the following except a. monitoring drug therapy with anti-inflammatory agents. b. tracking the progress of an organ transplant.

c. diagnosis of a specific bacterial infection. d. determining active phases of rheumatoid arthritis. b. recognizing molecules that are unique to pathogens. Pathogen recognition receptors act by a. recognizing molecules common to both host cells and pathogens. b. recognizing molecules that are unique to pathogens. c. helping to spread infection because they are found on pathogens. d. all recognizing the same pathogens. d. All of the above Which of the following are characteristics of acute-phase reactants? a. Rapid increase following infection b. Enhancement of phagocytosis c. Nonspecific indicators of inflammation d. All of the above c. Hypochlorite ions Which is the most significant agent formed in the phagolysosome for the elimination of microorganisms? a. Proteolytic enzymes b. Hydrogen ions c. Hypochlorite ions d. Superoxides a. Haptoglobin Which acute-phase reactant helps to prevent formation of peroxides and free radicals that may damage tissues? a. Haptoglobin b. Fibrinogen c. Ceruloplasmin d. Serum amyloid A d. They enhance phagocytosis. Which statement best describes Toll-like receptors (TLRs)? a. They protect adult flies from infection. b. They are found on all host cells.

c. They only play a role in adaptive immunity. d. They enhance phagocytosis. a. CRP acts before the antibody appears. The action of CRP can be distinguished from that of an antibody because a. CRP acts before the antibody appears. b. only the antibody triggers the complement cascade. c. binding of the antibody is calcium-dependent. d. only CRP acts as an opsonin. b. Innate immunity depends upon normally present body functions. How does innate immunity differ from adaptive immunity? a. Innate immunity requires prior exposure to a pathogen. b. Innate immunity depends upon normally present body functions. c. Innate immunity develops later than adaptive immunity. d. Innate immunity is more specific than adaptive immunity. b. Alpha1-antitrypsin A 40-year-old male who is a smoker develops symptoms of premature emphysema. The symptoms may be caused by a deficiency of which of the following acute-phase reactants? a. Haptoglobin b. Alpha1-antitrypsin c. Fibrinogen d. Ceruloplasmin d. They are able to kill target cells without previous exposure to them. Which statement best describes NK cells? a. Their response against pathogens is very specific. b. They only react when an abundance of MHC antigens is present. c. They react when both an inhibitory and activating signal is triggered. d. They are able to kill target cells without previous exposure to them.

b. Class II Which MHC molecule is necessary for antigen recog-nition by CD4+ T cells? a. Class I b. Class II c. Class III d. No MHC molecule is necessary. d. It consists of a limited number of repeating determinants. Which would be characteristic of a T-independent antigen? a. The IgG antibody is produced exclusively. b. A large number of memory cells are produced. c. Antigens bind only one receptor on B cells. d. It consists of a limited number of repeating determinants. a. Production of antibody by plasma cells Humoral immunity refers to which of the following? a. Production of antibody by plasma cells b. Production of cytokines by T cells c. Elimination of virally infected cells by cytotoxic cells d. Downregulation of the immune response a. Bone marrow Where does antigen-independent maturation of B lymphocytes take place? a. Bone marrow b. Thymus c. Spleen d. Lymph nodes c. MHC antigens In the thymus, positive selection of immature T cells is based upon recognition of which of the following? a. Self-antigens b. Stress proteins

c. MHC antigens d. μ chains b. IgM and IgD Which of these are found on a mature B cell? a. IgG and IgD b. IgM and IgD c. Alpha and beta chains d. CD d. They produce granzymes that stimulate apoptosis. How do cytotoxic T cells kill target cells? a. They produce antibodies that bind to the cell. b. They engulf the cell by phagocytosis. c. They stop protein synthesis in the target cell. d. They produce granzymes that stimulate apoptosis. c. Cytokines Which of the following can be attributed to antigen-stimulated T cells? a. Humoral response b. Plasma cells c. Cytokines d. Antibody a. μ chains in the cytoplasm Which is a distinguishing feature of a pre-B cell? a. μ chains in the cytoplasm b. Complete IgM on the surface c. Presence of CD21 antigen d. Presence of CD25 antigen b. As the cell becomes an immature B cell When does genetic rearrangement for coding of antibody light chains take place during B-cell development? a. Before the pre-B cell stage b. As the cell becomes an immature B cell

c. Not until the cell becomes a mature B cell d. When the B cell becomes a plasma cell b. CD Which of the following antigens are found on the T-cell subset known as helper/inducers? a. CD b. CD c. CD d. CD d. Lymph nodes Where does the major portion of antibody production occur? a. Peripheral blood b. Bone marrow c. Thymus d. Lymph nodes c. CD2+CD3+CD4-CD8- Which of the following would represent a double-negative thymocyte? a. CD2-CD3+CD4-CD8+ b. CD2-CD3-CD4+CD8- c. CD2+CD3+CD4-CD8- d. CD2-CD3-CD4+CD8- d. Alpha and beta chains are unique for each antigen. Which of the following best describes the T-cell receptor for antigen? a. It consists of IgM and IgD molecules. b. It is the same for all T cells. c. It is present in the double-negative stage. d. Alpha and beta chains are unique for each antigen. c. Elimination of virally infected cells A cell flow cytometry pattern belonging to a 3-year-old patient showed the following: normal CD4+ T-cell count, normal CD19+ B- cell count, low CD8+ T-cell count. Which type of immunity would be

affected? a. Production of antibody b. Formation of plasma cells c. Elimination of virally infected cells d. Down regulation of the immune response b. Ability to remember a prior exposure to a pathogen Which of the following is a unique characteristic of adaptive immunity? a. Ability to fight infection b. Ability to remember a prior exposure to a pathogen c. A similar response to all pathogens encountered d. Process of phagocytosis to destroy a pathogen a. Elimination of autoimmune responses Clonal deletion of T cells as they mature is important in which of the following processes? a. Elimination of autoimmune responses b. Positive selection of CD3/TCR receptors c. Allelic exclusion of chromosomes d. Elimination of cells unable to bind to MHC antigens d. In lymph nodes Where do germinal centers occur? a. In the thymus b. In the bone marrow c. In peripheral blood d. In lymph nodes a. They occur on both the H and L chains. Which of the following is characteristic of variable domains of immunoglobulins? a. They occur on both the H and L chains. b. They represent the complement-binding site. c. They are at the carboxy-terminal ends of the molecules. d. They are found only on H chains.

a. can cross the placenta. All of the following are true of IgM except that it a. can cross the placenta. b. fixes complement. c. has a J chain. d. is a primary response antibody. b. IgE has one more constant region than IgG. How does the structure of IgE differ from that of IgG? a. IgG has a secretory component and IgE does not. b. IgE has one more constant region than IgG. c. IgG has more antigen-binding sites than IgE. d. IgG has more light chains than IgE. d. 10 How many antigen-binding sites does a typical IgM molecule have? a. 2 b. 4 c. 6 d. 10 b. L chains Bence Jones proteins are identical to which of the following? a. H chains b. L chains c. IgM molecules d. IgG molecules c. one L chain and one-half of an H chain. A Fab fragment consists of a. two H chains. b. two L chains. c. one L chain and one-half of an H chain. d. one L chain and an entire H chain. a. IgA

Which antibody best protects mucosal surfaces? a. IgA b. IgG c. IgD d. IgM d. IgG1m3 and IgG1m Which of the following pairs represents two different immunoglobulin allotypes? a. IgM and IgG b. IgM1 and IgM c. Anti-human IgM and anti-human IgG d. IgG1m3 and IgG1m a. 2L and 2H chains The structure of a typical immunoglobulin consists of which of the following? a. 2L and 2H chains b. 4L and 2H chains c. 4L and 4H chains d. 2L and 4 H chains a. Kappa Which of the following are L chains of antibody molecules? a. Kappa b. Gamma c. Mu d. Alpha c. Immunodeficiency disorder If the results of serum protein electrophoresis show a significant decrease in the gamma band, which of the following is a likely possibility? a. Normal response to active infection b. Multiple myeloma c. Immunodeficiency disorder d. Monoclonal gammopathy

b. the arrangement of disulfide bonds. The subclasses of IgG differ mainly in a. the type of L chain. b. the arrangement of disulfide bonds. c. the ability to act as opsonins. d. molecular weight. a. A transport mechanism across endothelial cells Which best describes the role of the secretory component of IgA? a. A transport mechanism across endothelial cells b. A means of joining two IgA monomers together c. An aid to trapping antigen d. Enhancement of complement fixation by the classical pathway c. Enhancing proliferation of B cells Which represents the main function of IgD? a. Protection of the mucous membranes b. Removal of antigens by complement fixation c. Enhancing proliferation of B cells d. Destruction of parasitic worms d. IgM Which antibody is best at agglutination and complement fixation? a. IgA b. IgG c. IgD d. IgM b. B cells are preprogrammed for specific antibody synthesis. Which of the following can be attributed to the clonal selection hypothesis of antibody formation? a. Plasma cells make generalized antibody. b. B cells are preprogrammed for specific antibody synthesis. c. Proteins can alter their shape to conform to antigen. d. Cell receptors break off and become circulating antibody. b. is heat stable.

All of the following are true of IgE except that it a. fails to fix complement. b. is heat stable. c. attaches to tissue mast cells. d. is found in the serum of allergic persons. c. Four different regions are involved in coding of H chains. Which best describes coding for immunoglobulin molecules? a. All genes are located on the same chromosome. b. L chain rearrangement occurs before H chain rearrangement. c. Four different regions are involved in coding of H chains. d. Lambda rearrangement occurs before kappa rearrangement. b. Restricting the growth of myeloma cells What is the purpose of HAT medium in the preparation of monoclonal antibody? a. Fusion of the two cell types b. Restricting the growth of myeloma cells c. Restricting the growth of spleen cells d. Restricting antibody production to the IgM class d. 2 Fab and 1 Fc fragment Papain digestion of an IgG molecule results in which of the following? a. 2 Fab' and 1 Fc' fragment b. F(ab')2 and 1 Fc' fragment c. 2 Fab and 2 Fc fragments d. 2 Fab and 1 Fc fragment a. IgG Which antibody provides protection to the growing fetus because it is able to cross the placenta? a. IgG b. IgA c. IgM d. IgD

c. There is a large increase in IgG but not IgM. Which best characterizes the secondary response? a. Equal amounts of IgM and IgG are produced. b. There is an increase in IgM only. c. There is a large increase in IgG but not IgM. d. The lag phase is the same as in the primary response. b. pleiotropy. The ability of a single cytokine to alter the expression of several genes is called a. redundancy. b. pleiotropy. c. autocrine stimulation. d. endocrine effect. a. Mediation of the innate immune response Which of the following effects can be attributed to IL-1? a. Mediation of the innate immune response b. Differentiation of stem cells c. Halted growth of virally infected cells d. Stimulation of mast cells d. All of the above Which of the following precursors are target cells for IL-3? a. Myeloid precursors b. Lymphoid precursors c. Erythroid precursors d. All of the above d. Decreased eosinophil count A lack of IL-4 may result in which of the following effects? a. Inability to fight off viral infections b. Increased risk of tumors c. Lack of IgM d. Decreased eosinophil count c. IL- 2

Which of the following cytokines is also known as the T-cell growth factor? a. IFN-γ b. IL- 12 c. IL- 2 d. IL- 10 a. Increased IL-2 receptor expression by the Th cell producing it Which of the following represents an autocrine effect of IL-2? a. Increased IL-2 receptor expression by the Th cell producing it b. Macrophages signaled to the area of antigen stimulation c. Proliferation of antigen-stimulated B cells d. Increased synthesis of acute-phase proteins throughout the body d. IFN-α and IFN-β inhibit cell proliferation, whereas IFN- gamma stimulates antigen presentation by class II MHC molecules. IFN-α and IFN-β differ in which way from IFN-gamma? a. IFN-α and IFN-β are called immune interferons, and IFN-gamma is not. b. IFN-α and IFN-β primarily activate macrophages, whereas IFN- gamma halts viral activity. c. IFN-α and IFN-β are made primarily by activated T cells, whereas IFN-gamma is made by fibroblasts. d. IFN-α and IFN-β inhibit cell proliferation, whereas IFN-gamma stimulates antigen presentation by class II MHC molecules. b. TNF A patient in septic shock caused by a gram-negative bacterial infection exhibits the following symptoms: high fever, very low blood pressure, and disseminated intravascular coagulation. Which cytokine is the most likely contributor to these symptoms? a. IL- 2 b. TNF c. IL- 12 d. IL- 7 c. IFN-gamma

IL-10 acts as an antagonist to what cytokine? a. IL- 4 b. TNF-α c. IFN-gamma d. TGF-β d. ELISA testing Which would be the best assay to measure a specific cytokine? a. Blast formation b. T-cell proliferation c. Measurement of leukocyte chemotaxis d. ELISA testing b. Decrease in IL- 2 Selective destruction of Th cells by the human immunodeficiency virus contributes to immune suppression by which means? a. Decrease in IL- 1 b. Decrease in IL- 2 c. Decrease in IL- 8 d. Decrease in IL- 10 b. Increase production of certain types of leukocytes Why might a colony stimulating factor be given to a cancer patient? a. Stimulate activity of NK cells b. Increase production of certain types of leukocytes c. Decrease the production of TNF d. Increase production of mast cells a. Decreased ability to fight gram-negative bacterial infections Which of the following would result from a lack of TNF? a. Decreased ability to fight gram-negative bacterial infections b. Increased expression of class II MHC molecules c. Decreased survival of cancer cells d. Increased risk of septic shock c. IL- 12

Which cytokine acts to promote differentiation of T cells to the Th1 subclass? a. IL- 4 b. IFN-α c. IL- 12 d. IL- 10 b. Suppression of the immune response by inducing IL- 10 What is the major function of T regulatory cells? a. Suppression of the immune response by producing TNF b. Suppression of the immune response by inducing IL- 10 c. Proliferation of the immune response by producing IL- 2 d. Proliferation of the immune response by inducing IL- 4 d. TNF-α and IL- 6 Th17 cells affect the innate immune response by inducing production of which cytokines? a. IFN-γ and IL- 2 b. IL-4 and IL- 10 c. IL-2 and IL- 4 d. TNF-α and IL- 6 b. antigen-antibody complexes. The classical complement pathway is activated by a. most viruses. b. antigen-antibody complexes. c. fungal cell walls. d. mannose in bacterial cell walls. a. Normally present in serum Which of the following is characteristic of complement components? a. Normally present in serum b. Mainly synthesized by B cells c. Present as active enzymes d. Heat stable d. C1q becomes an active esterase.

All of the following are true of the recognition unit except a. it consists of C1q, C1r, and C1s. b. the subunits require calcium for binding together. c. binding occurs at the FC region of antibody molecules. d. C1q becomes an active esterase. c. C3bBb Which of the following is referred to as C3 convertase? a. C1qrs b. C3bD c. C3bBb d. C4b5a c. C1q Mannose-binding protein in the lectin pathway is most similar to which classical pathway component? a. C3 b. C1rs c. C1q d. C4 a. Stabilization of C3/C5 convertase Which of the following describes the role of properdin in the alternative pathway? a. Stabilization of C3/C5 convertase b. Conversion of B to Bb c. Inhibition of C3 convertase formation d. Binding and cleavage of Factor B d. C9 polymerizes to form the transmembrane channel. Which best characterizes the membrane attack complex (MAC)? a. Each pathway uses different factors to form it. b. C5 through C9 are not added in any particular order. c. One MAC unit is sufficient to lyse any type of cell. d. C9 polymerizes to form the transmembrane channel. a. decreased clearance of antigen-antibody complexes.