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(Test Bank-Midterm II) Chapter 9: Alterations in Immunity and Inflammation Test with Answers Graded A+
- How is hypersensitivity best defined? a. A disturbance in the immunologic tolerance of self-anti- gens b. An immunologic reaction of one person to the tissue of another person c. An altered immunologic response to an antigen that results in disease d. An undetectable immune response in the presence of antigens
- What is a hypersensitivity reaction that produces an allergic response called? a. Hemolytic shock b. Anaphylaxis c. Necrotizing vasculitis d. Systemic erythematosus
- The common hay fever allergy is expressed through a reaction that is mediated by which class of immunoglob- ulins? a. IgE b. IgG c. IgM d. T cells
ANS: C
Hypersensitivity is an altered immunologic response to an antigen that results in disease or damage to the host. Au- toimmunity is a disturbance in the immunologic tolerance of self-antigens. Alloimmunity is the immunologic reaction of one person to the tissue of another person. An im- mune deficiency of some type would cause undetectable immune response in the presence of antigens. ANS: B Examples of systemic anaphylaxis are allergic reactions to beestings, peanuts, and fish. Hemolytic shock would be a state in which erythrocytes are destroyed by com- plement-mediated lysis to the point of causing a state of shock. Necrotizing vasculitis is inflammation of blood ves- sel walls that limits perfusion. Systemic lupus erythemato- sus (SLE) is a chronic, multisystem, inflammatory disease and is one of the most common, complex, and serious of the autoimmune disorders. ANS: A Type I reactions are mediated by antigen-specific IgE and the products of tissue mast cells. The most common al- lergies (e.g., pollen allergies) are type I reactions. In ad- dition, most type I reactions occur against environmental antigens and are therefore allergic. Hay fever allergy is not mediated by IgG, IgM, or T cells. ANS: B Alloimmunity (also termed isoimmunity) occurs when the immune system of one individual produces an immuno-
(Test Bank-Midterm II) Chapter 9: Alterations in Immunity and Inflammation Test with Answers Graded A+
- What are blood transfusion reactions an example of? a. Autoimmunity b. Alloimmunity c. Homoimmunity d. Hypersensitivity
- During an IgE-mediated hypersensitivity reaction, which leukocyte is activated? a. Neutrophils b. Monocytes c. Eosinophils d. T lymphocytes
- During an IgE-mediated hypersensitivity reaction, what causes bronchospasm? a. Bronchial edema caused by the chemotactic factor of anaphylaxis b. Bronchial edema caused by binding of the cytotropic antibody c. Smooth muscle contraction caused by histamine bound to H1 receptors d. Smooth muscle contraction caused by histamine bound to H2 receptors **not in our edition
- A patient is having an IgE-mediated hypersensitivity reaction. What action by the healthcare professional is best? logic reaction against tissues of another individual. Au- toimmunity is a disturbance in the immunologic tolerance of self-antigens. Homoimmunity refers to the resistance of a lysogenic bacterium that is carrying a phage to an infection by the same type of phage. Hypersensitivity is an altered immunologic response to an antigen that results in disease or damage to the host. ANS: C Of the options provided, only eosinophils are activated during IgE-mediated hypersensitivity reactions. ANS: C During an IgE-mediated hypersensitivity reaction, smooth muscle contraction caused by histamine bound to H receptors results in bronchospasms. The bronchospasm is not caused by edema or by histamine binding to H receptors. ANS: A Histamine is the most potent mediator in an IgE-mediated hypersensitivity reaction (Type 1). Histamine bound to H results in the degranulation of mast cells with the release of histamine. Blocking histamine receptors with antihista-
ANS: C
Antibodies against platelet-specific antigens or against red blood cell antigens of the Rh system coat those cells at low density, resulting in their preferential re- moval by phagocytosis in the spleen, rather than by com- plement-mediated lysis. These blood cells are not de- stroyed by complement-mediated cell lysis, phagocyto- sis by macrophages, neutrophil granules, or toxic oxygen products.
- When soluble antigens from infectious agents enter circulation, what is tissue damage a result of? a. Complement-mediated cell lysis b. Phagocytosis by macrophages c. Phagocytosis in the spleen d. Neutrophil granules and toxic oxygen products
- How are target cells destroyed in a type II hypersen- sitivity reaction? a. Complement-mediated cell lysis b. Phagocytosis by macrophages c. Neutrophil granules and toxic oxygen products d. Natural killer cells
- Graves disease (hyperthyroidism) is an example of which type II hypersensitivity reaction?
ANS: D
Of the options available, only the components of neu- trophil granules as well as the several toxic oxygen prod- ucts produced by these cells, damage the tissue. ANS: D The mechanism that results in a type II hypersensitivity reaction involves a subpopulation of cytotoxic cells that are not antigen specific (natural killer [NK] cells). Antibody on the target cell is recognized by Fc receptors on the NK cells, which releases toxic substances that destroy the target cell. The other options do not cause the destruction of target cells related to a type II hypersensitivity reaction. ANS: A The antibody reacts with the receptors on the target cell surface and modulates the function of the receptor by pre- venting interactions with their normal ligands, replacing the ligand and inappropriately stimulating the receptor or destroying the receptor. For example, in the hyper-
a. Modulation b. Antibody-dependent cell-mediated cytotoxicity c. Neutrophil-mediated damage d. Complement-mediated lysis
- Type III hypersensitivity reactions are a result of which of these? a. Antibodies coating mast cells by binding to receptors that signal its degranulation, followed by the discharge of preformed mediators b. Antibodies binding to soluble antigens that were re- leased into body fluids and the immune complexes being deposited in the tissues c. Tc cells or lymphokine-producing Th1 cells directly at- tacking and destroying cellular targets d. Antibodies binding to the antigen on the cell surface
- A type IV hypersensitivity reaction causes which re- sult? a. Antibodies coating mast cells by binding to receptors that signal its degranulation, followed by the discharge of preformed mediators b. Antibodies binding to soluble antigens that were re- leased into body fluids and the immune complexes being deposited in the tissues c. Lymphokine-producing Th1 cells directly attacking and destroying cellular thyroidism (excessive thyroid activity) of Graves disease, autoantibody binds to and activates receptors for thy- roid-stimulating hormone (TSH) (a pituitary hormone that controls the production of the hormone thyroxine by the thyroid). Graves disease is not a result of cell-mediat- ed cytotoxicity, neutrophil-mediated damage, or comple- ment-mediated lysis. ANS: B Antigen-antibody (immune) complexes that are formed in the circulation and then deposited later in vessel walls or extravascular tissues cause most type III hypersensitivity diseases. Type III hypersensitivity reactions are not the result of antibodies coating mast cells to signal their de- granulation, immune cells directly attacking and destroy- ing targets, or antibodies binding to the antigen on the cell surface. ANS: C Type I, II, and III hypersensitivity reactions are mediated by antibody, type IV reactions are mediated by T lymphocytes and do not involve antibody. Type IV mechanisms occur through either Tc cells or lymphokine-producing Th1 cells. Tc cells directly attack and destroy cellular targets.
not in our edition b. Zinc c. Iodine d. Magnesium
ANS: B
Of the options available, only deficient zinc intake can profoundly depress T- and B-cell function. An Rh-negative woman gave birth to an Rh-positive baby. When discussing Rho[D] immunoglobulin with her, what information should the healthcare professional provide? a. It provides protection against infection from poor im- munity in the baby. b. It prevents alloimmunity and hemolytic anemia of the newborn. c. It provides necessary antibodies in case the mother doesn't breastfeed. d. It causes the intestinal tract of the newborn to produce antibodies.
- Tissue damage caused by the deposition of circulating immune complexes containing an antibody against the host DNA is the cause of which disease? a. Hemolytic anemia b. Pernicious anemia c. Systemic lupus erythematosus d. Myasthenia gravis Why does tissue damage occurs in acute rejection after organ transplantation? a. Th1 cells release cytokines that activate infiltrating macrophages, and cytotoxic T cells directly attack the endothelial cells of the transplant-
ANS: B
Alloimmunity occurs when an individual's immune system reacts against antigens on the tissues of other members of the same species. This can occur when a woman is Rh-negative and gives birth to an Rh-positive baby, lead- ing to hemolytic anemia of the newborn. Rho[D] im- munoglobulin does not provide protection against infec- tion, provide antibodies to a bottle-fed baby, or cause the intestine to produce antibodies. ANS: C The deposition of circulating immune complexes contain- ing an antibody against the host DNA produces tissue damage in individuals with systemic lupus erythematosus (SLE). That is not a process in hemolytic anemia, perni- cious anemia, or myasthenia gravis. ANS: A
ed tissue. b. Circulating immune complexes are deposited in the endothelial cells of transplanted tissue, where the complement cascade lyses tissue. c. Receptors on natural killer cells recognize antigens on the cell surface of transplanted tissue, which releases lysosomal enzymes that destroy tissue. d. Antibodies coat the surface of transplanted tissue to which mast cells bind and liberate preformed chemical mediators that destroy tis- sue.
- Which blood cell carries the carbohydrate antigens for blood type? a. Platelets b. Neutrophils c. Lymphocytes d. Erythrocytes
- A person with type O blood needs a blood transfu- sion. What blood type does the healthcare professional prepare to administer to the patient? a. A b. B c. AB d. O
- Which class of immunoglobulins forms isohemagglu- tinins? The recipient's lymphocytes interacting with the donor's dendritic cells within the transplanted tissue usually initi- ate sensitization, resulting in the induction of recipient Th and Tc cells against the donor's antigens. The Th1 cells release cytokines that activate infiltrating macrophages, and the Tc cells directly attack the endothelial cells in the transplanted tissue. The other options do not accurately describe how acute rejection after organ transplantation results in tissue damage. ANS: D The reaction that causes a blood transfusion recipient's red blood cells to clump together is related to the ABO antigens located on the surface of only erythrocytes. ANS: D Type O individuals have neither A or B antigen but have both anti-A and anti-B antibodies and therefore cannot accept blood from any of the other three types. The health- care professional would prepare to administer a transfu- sion of type O blood. ANS: D
c. 6 to 8 d. 10 to 12
- Considering the ettects of nutritional deficiencies on the immune system, severe deficits in calories and protein lead to deficiencies in the formation of which immune cells? a. B cells b. T cells c. Natural killer cells d. Neutrophils
- Urticaria is a manifestation of a which type of hyper- sensitivity reaction? a. IV b. III c. II d. I
- What is Graves disease a result of? a. Increased levels of circulating immunoglobulins b. The infiltration of the thyroid with T lymphocytes c. Autoantibodies binding to thyroid-stimulating hormone (TSH)-receptor sites d. Exposure to acetylates in substances such as rubber
- Raynaud phenomenon is an example of which type of hypersensitivity? a. IV
ANS: B
Severe deficits in calorie or protein intake lead to defi- ciencies in T-cell function and numbers. B cells, natural killer cells, and neutrophils are not necessarily attected by nutritional deficits. ANS: D Urticaria, or hives, is a dermal (skin) manifestation of only type I allergic reactions. ANS: C In the hyperthyroidism (excessive thyroid activity) of Graves disease, autoantibody binds to and activates re- ceptors for TSH (a pituitary hormone that controls the pro- duction of the hormone thyroxine by the thyroid). Graves disease is not caused by increased levels of circulating immunoglobulins, infiltration of the thyroid by T lympho- cytes, or by exposure to acetylates. ANS: B The characteristics of serum sickness are observed in only
b. III c. II d. I
- Which statement is true concerning an atopic individ- ual? a. They tend to produce less IgE. b. They tend to produce more Fc receptors. c. They tend to attract very few mast cells. d. They tend to produce very high levels of IgM.
- Which statement is true regarding immunodeficien- cy? a. Immunodeficiency is generally not present in other family members. b. Immunodeficiency is never acquired; rather, it is con- genital. c. Immunodeficiency is almost immediately symptomatic. d. Immunodeficiency is a result of a postnatal mutation.
- A person with type O blood is considered to be the universal blood donor because type O blood contains which of these? a. No antigens b. No antibodies c. Both A and B antigens d. Both A and B antibodies
- Immunoglobulin E (IgE) is associated with which type of hypersensitivity reaction? systemic type III autoimmune diseases such as Raynaud phenomenon. ANS: B Atopic individuals tend to produce higher quantities of IgE and have more Fc receptors for IgE on their mast cells. Atopic individuals tend to produce more, not less, IgE. Manifestations these individuals display are influenced greatly by the release of histamine from mast cells, which are found in large numbers in the attected tissue. An IgM response is a mainstay of type II responses. ANS: A Generally, the genetic mutations that cause immunodefi- ciency are sporadic and not inherited; a family history ex- ists in only approximately 25% of individuals. The sporadic mutations occur before birth, but the onset of symptoms may be early or later, depending on the particular syn- drome. The immunodeficiency can be either congenital or acquired. ANS: A Because individuals with type O blood lack both types of antigens, they are considered universal donors, meaning that anyone can accept their red blood cells. Type O indi- viduals, who have neither A or B antigen but have both anti-A and anti-B antibodies, cannot accept blood from any of the other three types. ANS: A Hypersensitivity reactions have been divided into four dis-
d. Nickel e. Detergents
- Which disorders are considered autoimmune? (Select all that apply.) a. Crohn disease b. Addison disease c. Rheumatoid arthritis d. Systemic lupus erythematosus e. Type 2 diabetes
- Which statements best define acute rejection? (Select all that apply.) a. Acute rejection is a cell-mediated immune response. b. Acute rejection is usually a type III rejection. c. Immunosuppressive drugs delay or lessen the intensity of an acute rejection. d. Acute rejection is associated with the body's response to an organ transplant. e. Acute rejection is a response against unmatched human leukocyte antigens (HLAs). not in out edition Which definition is true? a. Allergy means the deleterious ettects of hypersensitivi- ty. b. Immunity means an altered immunologic response. c. Hypersensitivity means the protective response to an antigen. (e.g., neomycin). Food products typically result in type I hypersensitivity reactions. ANS: A, B, C, D Crohn disease, Addison disease, rheumatoid arthritis, and systemic lupus erythematosus are all diseases that result from autoimmune pathologic conditions. Insulin-depen- dent diabetes is also an autoimmune disorder, but type 2 diabetes is not. ANS: A, C, D, E Acute rejection is primarily a cell-mediated immune re- sponse that occurs within days to months after transplan- tation. This type of rejection occurs when the recipient develops an immune response against unmatched HLAs after transplantation. A biopsy of the rejected organ usu- ally shows an infiltration of lymphocytes and macrophages characteristic of a type IV reaction. Immunosuppressive drugs may delay or lessen the intensity of an acute rejec- tion. A Allergy means the deleterious ettects of hypersensitivity to environmental antigens. Immunity is an organism's ability to resist disease. Hypersensitivity is an altered immuno- logic response to an antigen that results in disease or damage to the host. Autoimmunity is a disturbance in the immunologic tolerance of self-antigens.
d. Autoimmunity means the normal response to foreign antigens. not in our edition Which statement is true regarding hypersensitivity reac- tions? a. They require sensitization against a particular antigen. b. They occur after the primary immune response. c. Reactions are always delayed. d. The most delayed reaction is anaphylaxis. not in our edition Which statement best describes a type I reaction? a. Most type I reactions are mediated by IgA. b. Most type I reactions are allergic. c. Most occur against medications. d. Rarely does this type of reaction contribute to autoim- mune diseases. not in our edition What antibody binds to a mast cell? a. Cytotropic b. Allergen c. Antigen d. Fc not in our edition Which statement is true regarding atopic individuals?
A
A hypersensitivity reaction requires sensitivity to an anti- gen and occurs after an adequate secondary immune response. These reactions may then be immediate or de- layed. The most immediate reaction is anaphylaxis. B Most type I reactions are allergic. They are mediated by IgE. Most type I reactions occur against environmental antigens and can contribute to some autoimmune dis- eases. A A cytotropic antibody (also called a reagin) is the antibody that binds to the mast cell. An allergen is an environmen- tal antigen that induces an allergic response. An antigen stimulates the immune response and antibody to bind to the mast cell. The Fc is the portion of the mast cell where IgE binds. C
a. Is immediate in its action b. Is infiltrated with B cells c. Is mediated by antibody production d. Can be transferred by cells not in our edition Which is an example of an alloimmune disease? a. Tuberculin reaction b. Graves disease c. Contact dermatitis d. Penicillin allergy not in our edition Which statement is true regarding unmatched packed red blood cell (RBC) transfusions? a. Only three ditterent RBC antigens have been identified. b. Approximately 80 major carbohydrate antigens exist. c. People with O type blood have neither A or B antigens. d. A person with type A blood contains anti-O antibodies. not in our edition Histamine release leads to which of the following? (Select all that apply.) a. Bronchial smooth muscle contraction b. Bronchoconstriction c. Decreased vascular permeability d. Vasoconstriction e. Edema their onset takes from 24 to 72 hours. The site is infiltrated with T lymphocytes and macrophages. A clear hard center surrounds the erythema (redness). B Graves disease is a classic autoimmune, or alloimmune, disease. Tuberculin reaction is a type IV reaction. Contact dermatitis is a type I reaction. Penicillin is an allergen that induces type I hypersensitivity. C Type O blood does not contain type A or B antigens. However, 80 major ditterent RBC antigens are present. A person with type A blood carries anti-B antibodies and a person with type B blood carries anti-A antibodies. Those with type O blood have anti-A and anti-B antibodies. A,B,E Histamine contracts bronchial smooth muscle, which causes bronchoconstriction. Vascular permeability, ede- ma, and vasodilation also increase.
Which type of antibody is involved in type I hypersensitivity reaction? a. IgA b. IgE c. IgG d. IgM During an IgE-mediated hypersensitivity reaction, the de- granulation of mast cells is a result of which receptor action? a. Histamine bound to H b. Chemotactic factor binding to the receptor c. Epinephrine bound to mast cells d. Acetylcholine bound to mast cells When the maternal immune system becomes sensitized against antigens expressed by the fetus, what reaction occurs? a. T-cell immunity b. Alloimmunity c. Fetal immunity d. Autoimmunity In which primary immune deficiency is there a par- tial-to-complete absence of T-cell immunity? a. Bruton disease b. DiGeorge syndrome c. Reticular dysgenesis d. Adenosine deaminase deficiency Graves disease is an autoimmune disease that results in which maternal antibody?
ANS: B
Type I reactions are only mediated by antigen-specific IgE and the products of tissue mast cells (see Figure 9-1). ANS: A Histamine bound to H2 results in the degranulation of mast cells during an IgE-medicated hypersensitivity reac- tion. The other options do not cause this reaction. ANS: B Alloimmunity occurs when an individual's immune system reacts against antigens on the tissues of other members of the same species. Sensitization against fetal antigens is not the cause of any other available option. ANS: B The principal immunologic defect in DiGeorge syndrome is the partial or complete absence of T-cell immunity. The other options are not the result of either a partial or com- plete absence of T-cell immunity.
