Chapter 11 quiz (13,16,17)

Question 1

_____ results when a gene affecting the immune system mutates, thereby compromising the immune defense against infection.

a. gene conversion
b. epidemics
c. primary immunodeficiency disease
d. secondary immunodeficiency disease
e. seroconversion

Answer 1

c. primary immunodeficiency disease

Question 2

A primary immune response against influenza virus produces antibodies that bind to _____.

a. hemagglutinin and neuraminidase
b. variable surface glycoproteins
c. EBNA-1
d. protein toxins
e. gp41 and gp120

Answer 2

a. hemagglutinin and neuraminidase

Question 3

The serotypes of Streptococcus pneumoniae differ in their _____.

a. superantigen products
b. ability to fix complement
c. rates of gene conversion
d. capsular polysaccharides
e. variable surface glycoproteins

Answer 3

d. capsular polysaccharides

Question 4

All of the following are associated with the ability of influenza virus to escape from immunity except _____.

a. age
b. error-prone replication of its DNA genome
c. co-infection with avian and human influenza viruses
d. recombinant strains
e. the phenomenon of Ôoriginal antigenic sinÕ

Answer 4

b. error-prone replication of its DNA genome

Question 5

All of the following use gene conversion to avoid immune detection except _____.

a. Salmonella typhimurium
b. Trypanosoma brucei
c. Treponema pallidum
d. Neisseria gonorrhoeae
e. None of the above

Answer 5

c. Treponema pallidum

Question 6

Genes encoding _____ rearrange in trypanosomes permitting replication and survival of the pathogen until the host produces an antibody response against the altered gene product.

a. pilin
b. flagellin
c. variable surface glycoproteins (VSGs)
d. hemagglutinin
e. neuraminidase

Answer 6

c. variable surface glycoproteins (VSGs)

Question 7

_____ is a strategy used by herpesviruses where replication and the generation of virus-derived peptides are avoided in order to hide from the immune response.

a. latency
b. antigenic shift
c. antigenic drift
d. seroconversion
e. gene conversion

Answer 7

a. latency

Question 8

Which of the following statements regarding herpes simplex virus is false?

a. Because sensory neurons express low levels of MHC class I molecules, they provide appropriate sites for viral dormancy.
b. Reactivation of herpesviruses follows stressful incidents.
c. Cold sores develop as a consequence of CD8 T-cell killing.
d. In oneÕs lifetime, periodic episodes of reactivation are common.
e. Herpes simplex virus infects B lymphocytes.

Answer 8

e. Herpes simplex virus infects B lymphocytes.

Question 9

Which of the following is not associated with the reactivation of herpesviruses?

a. hormonal fluctuations
b. antibody deficiency
c. bacterial infection
d. immunosuppression
e. ultraviolet radiation

Answer 9

b. antibody deficiency

Question 10

Herpesviruses include all of the following except _____.

a. varicella-zoster
b. Epstein-Barr virus
c. herpes simplex virus
d. cytomegalovirus
e. All of the above are herpesviruses.

Answer 10

e. All of the above are herpesviruses.

Question 11

Shingles is associated with infection by _____.

a. Epstein-Barr virus
b. Staphylococcus aureus
c. herpes zoster
d. Candida albicans
e. Listeria monocytogenes

Answer 11

c. herpes zoster

Question 12

Superantigens bind to all of the following molecules except _____.

a. CD4
b. MHC class II alpha chain
c. CD28
d. T-cell receptor Vbeta chain
e. B-cell receptor

Answer 12

d. T-cell receptor Vbeta chain

Question 13

All of the following are associated with superantigens except _____.

a. effective at minuscule concentrations
b. nonspecific activation of 2-20% of CD8 T cells
c. processing to peptides is not required for T-cell activation
d. massive production of IL-2, IFN-gamma, and TNF-alpha
e. activate alpha:beta T cells

Answer 13

b. nonspecific activation of 2-20% of CD8 T cells

Question 14

Staphylococcal superantigen-like protein 7 (SSLP7) produced by Staphylococcus aureus, binds to _____ and thereby prevents the killing of the bacterium by the host immune system during infection.

a. NK-cell activating receptors
b. C5 complement protein and Fc region of IgA
c. B-cell receptor
d. CD8 co-receptor
e. T-cell receptor Vbeta chain

Answer 14

b. C5 complement protein and Fc region of IgA

Question 15

Which of the following is not associated with bacterial infection due to a genetic defect in or pathogen-induced subversion of normal phagocytic processes?

a. leukocyte adhesion deficiency
b. chronic granulomatous disease
c. hereditary angioedema
d. Chediak-Higashi syndrome
e. Listeria monocytogenes

Answer 15

c. hereditary angioedema

Question 16

Which of these characteristics is not true of IFN-gamma?

a. When it acts on target cells, it enhances the engulfment and killing of bacteria.
b. It is the major activating cytokine of macrophages.
c. It activates the JAK-STAT signal transduction pathway after binding to its cognate receptor.
d. It is secreted by CD8 cytotoxic T cells, CD4 Th1 cells, and NK cells.
e. It is secreted and functions as a monomer but facilitates the dimerization of its receptor.

Answer 16

e. It is secreted and functions as a monomer but facilitates the dimerization of its receptor.

Question 17

Dominant mutant forms of IFNgammaR1 exhibit all of the following in heterozygotes except _____.

a. they are recycled by endocytosis more quickly than the normal receptor
b. the cytoplasmic tail is truncated
c. they are able to form stable dimers with the normal form
d. they cause less severe immunodeficiency than do the homozygous recessive forms
e. they are unable to transduce signals when bound to the normal form

Answer 17

a. they are recycled by endocytosis more quickly than the normal receptor

Question 18

Individuals with an antibody deficiency are more susceptible to infections by all of the following except _____.

a. Streptococcus pneumoniae
b. Haemophilus influenzae
c. Streptococcus pyogenes
d. Mycobacterium tuberculosis
e. Staphylococcus aureus

Answer 18

d. Mycobacterium tuberculosis

Question 19

All of the following are X-linked immunodeficiencies except _____.

a. WiskottÐAldrich syndrome caused by deficiency of WASP
b. hyper IgM syndrome caused by deficiency of CD40 ligand
c. lymphoproliferative syndrome caused by deficiency of SH2D1A
d. Chediak-Higashi syndrome caused by deficiency of CHS1
e. agammaglobulinemia caused by deficiency of Bruton tyrosine kinase

Answer 19

d. Chediak-Higashi syndrome caused by deficiency of CHS1

Question 20

Paroxysmal nocturnal hemoglobinuria is caused by _____.

a. a profound deficiency of neutrophils
b. leukocytosis
c. immune-complex deposition in tissues
d. defects in recruitment of phagocytes to infected tissues
e. complement-mediated lysis of erythrocytes

Answer 20

e. complement-mediated lysis of erythrocytes

Question 21

All of the following are associated with hereditary angioedema except _____.

a. possible death by suffocation
b. overproduction of vasoactive C2a fragment and peptide bradykinin
c. hyporesponsiveness of classical complement pathway
d. subepithelial edema
e. C1 inhibitor deficiency

Answer 21

c. hyporesponsiveness of classical complement pathway

Question 22

Severe combined immune deficiency (SCID) describes a condition in which neither _____ nor _____ are functional.

a. classical; alternative pathways of complement
b. T-cell-dependent antibody responses; cell-mediated immune responses
c. innate; acquired immune responses
d. MHC class I; MHC class II molecules

Answer 22

b. T-cell-dependent antibody responses; cell-mediated immune responses

Question 23

Mutations affecting all of the following except _____ interfere directly with the rearrangement of immunoglobulin and T-cell receptor genes.

a. Artemis
b. purine nucleoside phosphorylase (PNP)
c. DNA-dependent protein kinase (DNA-PK)
d. RAG-1
e. RAG-2

Answer 23

b. purine nucleoside phosphorylase (PNP)

Question 24

A deficiency in _____ causes a condition that closely resembles X-linked severe combined immunodeficiency and is characterized by inefficient cytokine signalling.

a. adenosine deaminase (ADA)
b. class II transactivator (CIITA)
c. TAP1 or TAP2
d. RAG1 or RAG2
e. Janus 3 kinase (Jak3)

Answer 24

e. Janus 3 kinase (Jak3)

Question 25

Patients who lack _____ are very susceptible to infections with intracellular bacteria, including the ubiquitous nontuberculous strains of mycobacteria.

a. CD40 ligand
b. IL-12 and IFN-gamma receptors
c. properdin (factor P)
d. CD18
e. IL-1 receptor

Answer 25

b. IL-12 and IFN-gamma receptors

Question 26

Which of the following explains why Streptococcus pneumoniae can infect an individual recurrently?

a. Previous infection with S. pneumoniae wears down the immune system over time.
b. S.Êpneumoniae is never completely eradicated during an infection and can reactivate if the host is immunocompromised.
c. Immune responses against S. pneumoniae are serotype-specific and protect only against strains that possess the same capsular polysaccharide antigens.
d. Anti-capsular antibodies are cleared from the host quickly after an active infection.
e. The capsular polysaccharide antigens of S. pneumoniae do not induce immunological memory.

Answer 26

c. Immune responses against S. pneumoniae are serotype-specific and protect only against strains that possess the same capsular polysaccharide antigens.

Question 27

Protective antibodies generated in response to influenza virus bind to _____ of the viral envelope.

a. hemagglutinin and neuraminidase
b. polysaccharides
c. variable surface glycoproteins
d. superantigens
e. gp41 and gp120

Answer 27

a. hemagglutinin and neuraminidase

Question 28

All of the following contribute to new epidemics and the long-term survival of the influenza virus in the human population, except:

a. New viral strains possess epitopes not recognized by antibodies made in the previous epidemic.
b. The first influenza strain provoking a primary immune response constrains the types of antibodies made during a subsequent encounter with a different strain.
c. The virus loses the capacity to express hemagglutinin, thereby rendering neutralizing antibodies useless.
d. The RNA genome of the influenza virus is subject to point mutations during viral replication.
e. None of the above.

Answer 28

c. The virus loses the capacity to express hemagglutinin, thereby rendering neutralizing antibodies useless.

Question 29

An epidemic affects _____, whereas a pandemic affects _____.

a. susceptible individuals; immune individuals
b. immune individuals; susceptible individuals
c. global populations; local populations
d. local populations; global populations

Answer 29

d. local populations; global populations

Question 30

_____ cause(s) mild and limited disease, whereas _____ cause(s) more severe disease and higher mortality.

a. Antigenic drift; antigenic shift
b. Antigenic shift; antigenic drift
c. Epidemics; pandemics
d. Pandemics; epidemics

Answer 30

a. Antigenic drift; antigenic shift

Question 31

Which of the following is not a virus that can cause a persistent infection in the host by establishing latency?

a. influenza virus
b. herpes simplex virus
c. varicella-zoster
d. Epstein-Barr virus
e. human immunodeficiency virus

Answer 31

a. influenza virus

Question 32

Trypanosomes escape from adaptive immunity by altering the type of _____ expressed on the parasite surface.

a. neuraminidase
b. hemagglutinin
c. variable surface glycoprotein (VSG)
d. superantigen
e. capsular polysaccharide

Answer 32

c. variable surface glycoprotein (VSG)

Question 33

EpsteinÐBarr virus infects and establishes latency in _____, gaining entry by binding to _____.

a. B cells; CR2
b. T cells; CD4
c. T cells; CD8
d. neurons; MHC class I
e. B cells; EBNA-1

Answer 33

a. B cells; CR2

Question 34

Which of the following is not used by the herpes simplex virus to subvert host immune responses?

a. a virus-encoded Fc receptor
b. a virus-encoded complement receptor
c. inhibition of MHC class I expression
d. inhibition of peptide transport by transporter associated with antigen processing (TAP)
e. inhibition of ICAM-1 expression

Answer 34

e. inhibition of ICAM-1 expression

Question 35

Listeria monocytogenes replicates in _____ of macrophages after _____.

a. the phagosome; inhibition of fusion of the phagosome with the lysosome
b. the cytosol; escaping from the phagosome
c. a specialized membrane-bound vesicle; infection of the cell
d. extracellular spaces; coating itself with human proteins
e. nucleus; fusion with the nuclear membrane

Answer 35

b. the cytosol; escaping from the phagosome

Question 36

Which of the following is not a characteristic of staphylococcal enterotoxins?

a. They bind to MHC class I molecules and T-cell receptors.
b. They cause T cells to divide and differentiate into effector T cells.
c. They stimulate between 2% and 20% of the total T-cell population.
d. They cause excessive synthesis and release of cytokines.
e. They induce suppression of the immune response by causing T cells to undergo apoptosis.

Answer 36

a. They bind to MHC class I molecules and T-cell receptors.

Question 37

Which of the following statements regarding inherited immunodeficiency diseases is correct?

a. Affected individuals are less susceptible to infection.
b. Mortality rates are reduced by the administration of antibiotics to affected individuals.
c. Most deficiency syndromes are caused by dominant gene defects.
d. Women are more likely than men to inherit X-linked immunodeficiencies.
e. Extracellular bacterial infections are common in deficiency syndromes with T-cell defects.

Answer 37

b. Mortality rates are reduced by the administration of antibiotics to affected individuals.

Question 38

Individuals with an immunodeficiency affecting B-cell function are more susceptible to infections caused by which of the following pathogens?

a. Toxoplasma gondii
b. respiratory syncytial virus
c. Haemophilus influenzae
d. Listeria monocytogenes
e. Mycobacterium tuberculosis

Answer 38

c. Haemophilus influenzae

Question 39

Which of the following deficiency syndromes affects T-cell but not B-cell function?

a. X-linked agammaglobulinemia
b. X-linked hyper IgM syndrome
c. X-linked lymphoproliferative syndrome
d. X-linked SCID
e. X-linked Wiskott-Aldrich syndrome

Answer 39

e. X-linked Wiskott-Aldrich syndrome

Question 40

Chronic granulomatous disease (CGD), a condition resulting in chronic bacterial and fungal infections, is caused by one or more defects in _____, compromising the ability of macrophages to _____.

a. CD18; produce cell adhesion molecules
b. NADPH oxidase; produce superoxide radical
c. CD40 ligand; produce GM-CSF
d. C5-C9; defend against Neisseria
e. C3; opsonize capsulated bacteria

Answer 40

b. NADPH oxidase; produce superoxide radical

Question 41

A genetic defect in _____ results in the accumulation of toxic levels of nucleotide metabolites and loss of T-cell function.

a. NADPH oxidase
b. glucose-6-phosphate dehydrogenase
c. myeloperoxidase
d. SH2D1A
e. adenosine deaminase (ADA)

Answer 41

e. adenosine deaminase (ADA)

Question 42

Herpes simplex virus favours neurons for latency because of the low level of _____, which reduces the likelihood of killing by CD8 T cells.

a. LFA-3
b. Toll-like receptors (TLRs)
c. transporter associated with antigen processing (TAP)
d. MHC class I
e. MHC class II

Answer 42

d. MHC class I

Question 43

Which statement regarding retrovirus proviruses is false?

a. Proviruses form immediately after the RNA genome assembles with viral proteins and infectious virions are produced.
b. Proviruses consist of double-stranded DNA.
c. Proviruses are flanked by repetitive sequences called long terminal repeats (LTRs).
d. The host cell must provide the transcriptional and translational machinery in order for RNA and protein products to be made from proviruses.
e. A cDNA intermediate is required in order to produce a provirus.

Answer 43

a. Proviruses form immediately after the RNA genome assembles with viral proteins and infectious virions are produced.

Question 44

The pol gene of HIV produces all of the following except _____.

a. Integrase
b. protease
c. matrix protein
d. reverse transcriptase

Answer 44

c. matrix protein

Question 45

For infectious HIV virions to be made, the infected cell must _____.

a. be CD4-positive and express functional NFkB
b. express low levels of CCR5
c. be latent
d. be polyreactive
e. be CD8-positive

Answer 45

a. be CD4-positive and express functional NFkB

Question 46

Which of the following is required for fusion of the human immunodeficiency viral envelope with the host cell membrane and subsequent internalization?

a. reverse transcriptase
b. gp120
c. gp41
d. integrase
e. protease

Answer 46

c. gp41

Question 47

During infection with HIV, a person is said to undergo seroconversion when _____.

a. HIV variants convert from macrophage-tropic to lymphocyte-tropic late in infection
b. anti-HIV antibodies are detectable in their blood serum
c. cellular transcription favors the production of HIV-encoded RNA
d. HIV is transferred from an infected person to an uninfected recipient
e. the initial phase of infection is followed by clinical latency

Answer 47

e. the initial phase of infection is followed by clinical latency

Question 48

A patient is diagnosed with AIDS when CD4 T-cell counts _____.

a. rise markedly after T-cell activation
b. fall below the CD8 T-cell count
c. fall below 1000 cells/ul
d. fall below 500 cells/ul
e. fall below 200 cells/ul

Answer 48

e. fall below 200 cells/ul

Question 49

Reverse transcriptase is a _____ encoded by _____.

a. DNA-dependent DNA polymerase; HIV
b. DNA-dependent DNA polymerase; influenza virus
c. RNA-dependent DNA polymerase; HIV
d. RNA-dependent DNA polymerase; influenza virus
e. RNA-dependent RNA polymerase; HIV

Answer 49

c. RNA-dependent DNA polymerase; HIV

Question 50

Preferred viral targets for HIV therapy include:

a. reverse transcriptase and protease
b. matrix protein
c. gp120
d. CD4
e. polymerase

Answer 50

a. reverse transcriptase and protease

Question 51

Autoimmune diseases, which are classified on the basis of the effector mechanism that causes the symptoms, include all of the following types of hypersensitivity reaction except _____.

a. type I
b. type II
c. type III
d. type IV

Answer 51

a. type I

Question 52

Which type of autoimmune disease is correctly matched with its cause?

a. type I: IgE-mediated
b. type II: effector T cells
c. type III: immune complex deposition in tissues
d. type IV: extracellular matrix-associated autoantigens
e. type V: cell-surface components

Answer 52

c. type III: immune complex deposition in tissues

Question 53

Which of the following is an example of a type II autoimmune response?

a. subacute bacterial endocarditis
b. GoodpastureÕs syndrome
c. multiple sclerosis
d. systemic lupus erythematosus
e. mixed essential cryoglobulinemia

Answer 53

b. GoodpastureÕs syndrome

Question 54

Which of the following is an example of a type III autoimmune response?

a. subacute bacterial endocarditis
b. acute thrombocytopenia purpura
c. systemic lupus erythematosus
d. rheumatoid arthritis
e. insulin-resistant diabetes

Answer 54

c. systemic lupus erythematosus

Question 55

Which of the following is an example of a type IV autoimmune response?

a. pemphigus vulgaris
b. autoimmune thrombocytopenia purpura
c. subacute bacterial endocarditis
d. type 1 diabetes
e. systemic lupus erythematosus

Answer 55

d. type 1 diabetes

Question 56

All of the following are associated with GoodpastureÕs syndrome except _____.

a. alpha chain of type IV collagen
b. inflammation
c. extracellular matrix antigen
d. neutropenia and type III hypersensitivity reaction
e. renal tubules and glomeruli

Answer 56

d. neutropenia and type III hypersensitivity reaction

Question 57

_____ is a highly variable type III autoimmune disease in which immune complexes form and may cause glomerulonephritis of the kidney, arthritis of the joints, and vasculitis of the face.

a. pemphigus vulgaris
b. systemic lupus erythematosus
c. rheumatoid arthritis
d. multiple sclerosis
e. GoodpastureÕs syndrome

Answer 57

b. systemic lupus erythematosus

Question 58

Individuals who have two defective alleles of the AIRE gene _____.

a. exhibit symptoms of autoimmunity at a young age
b. are unable to activate regulatory T cells
c. exhibit decreased predisposition to autoimmune disease
d. are very effective at inducing anergy of circulating autoreactive B and T cells
e. are more likely to be women of African or Asian origin

Answer 58

a. exhibit symptoms of autoimmunity at a young age

Question 59

All of the following autoimmune diseases are correctly matched with their HLA disease associations except _____.

a. HLA-B27: ankylosing spondylitis
b. HLA-DQ2: type 1 diabetes in Africans and Asians
c. HLA-B35: birdshot retinopathy
d. HLA-DR4: rheumatoid arthritis
e. HLA-DQ6: narcolepsy

Answer 59

c. HLA-B35: birdshot retinopathy

Question 60

The haplotype A1-B8-DR3-DQ2 is associated with several common autoimmune diseases including all of the following except _____.

a. ankylosing spondylitis
b. systemic lupus erythematosus
c. autoimmune hepatitis
d. myasthenia gravis
e. type 1 diabetes

Answer 60

a. ankylosing spondylitis

Question 61

With the exception of ______, these autoimmune diseases are more prevalent in women than in men.

a. rheumatoid arthritis
b. multiple sclerosis
c. ankylosing spondylitis
d. Sj grenÕs syndrome
e. GravesÕ disease

Answer 61

c. ankylosing spondylitis

Question 62

Which of the following is not a characteristic of GravesÕ disease?

a. weight loss
b. enlarged thyroid gland
c. elevated thyroid-stimulating hormone
d. heat intolerance
e. overproduction of T3 and T4

Answer 62

c. elevated thyroid-stimulating hormone

Question 63

All of the following are true regarding thyroglobulin except _____.

a. its tyrosine residues are iodinated and cross-linked
b. it is broken down to produce thyroid hormones
c. it is stored in follicles of the thyroid
d. it signals the pituitary gland to stop releasing thyroid-stimulating hormone
e. it is synthesized initially as a glycoprotein by thyroid epithelial cells

Answer 63

d. it signals the pituitary gland to stop releasing thyroid-stimulating hormone

Question 64

Which of the following describes myasthenia gravis?

a. Ectopic lymphoid tissue forms and impairs endocrine function.
b. Disruption of adhesion molecules of cellular junctions.
c. Autoimmune response to proteins of anterior chamber of the eye.
d. Chronic inflammation of the gut mucosa.
e. The neuromuscular junction is compromised.

Answer 64

e. The neuromuscular junction is compromised.

Question 65

The reason why babies born to mothers with GravesÕ disease suffer passively from the disease for only a short while after birth is that _____.

a. very little IgM is transported across the placenta
b. only antibodies, and not the B cells making the autoantibodies, cross the placenta
c. the newbornÕs regulatory T cells suppress autoantibody production
d. the newbornÕs thyroid gland develops resistance to the effects of maternal autoantibodies
e. thyroglobulin synthesis does not commence until months after birth

Answer 65

b. only antibodies, and not the B cells making the autoantibodies, cross the placenta

Question 66

The formation of ectopic lymphoid tissues occurs in all of the following conditions except _____.

a. pemphigus foliaceus
b. chronic hepatitis C infection
c. HashimotoÕs disease
d. rheumatoid arthritis
e. multiple sclerosis

Answer 66

a. pemphigus foliaceus

Question 67

A(n) _____ binds to the antigen-binding site of another antibody.

a. cryptic epitope
b. anti-idiotypic antibody
c. molecular mimic
d. receptor antagonist
e. autoantibody

Answer 67

b. anti-idiotypic antibody

Question 68

All of the following are linked to the development of rheumatoid arthritis or are associated with its treatment except _____.

a. anti-immunoglobulin autoantibodies
b. Adalumumab
c. leukocyte infiltration in synovial tissue
d. joint inflammation
e. pulmonary hemorrhage and rheumatic fever

Answer 68

e. pulmonary hemorrhage and rheumatic fever

Question 69

It is believed that the allotype DRB1*_____ may confer protection against rheumatoid arthritis because it contains _____ amino acid residues at positions 70 and 71 that bind to different subsets of peptides compared with the allotypes that confer susceptibility to this disease.

a. 04:01; acidic
b. 04:02; acidic
c. 04:04; basic
d. 04:05; basic
e. 04:08; acidic

Answer 69

b. 04:02; acidic

Question 70

Celiac disease exhibits all of the following symptoms except _____.

a. villous atrophy
b. anemia
c. diarrhea
d. tissue ulceration
e. malabsorption

Answer 70

d. tissue ulceration

Question 71

All of the following are characteristics of tissue transglutaminase except ____.

a. generation of negatively charged peptides that bind well to the positively charged pockets of the DQ2 and DQ8 allotypes
b. conversion of glutamine to glutamate by deamination
c. upregulation during tissue inflammation
d. stimulation of IgG or IgA autoantibodies in celiac disease
e. predisposition to celiac disease if individual possesses particular polymorphic variants

Answer 71

e. predisposition to celiac disease if individual possesses particular polymorphic variants

Question 72

A recent therapy developed for the treatment of rheumatoid arthritis includes the use of _____ monoclonal antibodies that suppress the autoimmune response.

a. anti-TNF-alpha and anti-CD20
b. anti-C-reactive protein
c. anti-CD14
d. anti-rheumatoid factor
e. anti-CD3

Answer 72

a. anti-TNF-alpha and anti-CD20

Question 73

Chronic diseases in which the immune response is targeted toward autologous entities of oneÕs body are known as _____.

a. hypersensitivity reactions
b. innate immune reactions
c. allergic reactions
d. autoimmune diseases
e. anergic reactions

Answer 73

d. autoimmune diseases

Question 74

Which of the following would be consistent with a diagnosis of GoodpastureÕs syndrome?

a. pulmonary hemorrhage and glomerulonephritis
b. joint inflammation
c. hyperglycemia
d. anti-collagen IgG deposition in renal glomeruli
e. None of the above

Answer 74

a. pulmonary hemorrhage and glomerulonephritis

Question 75

Thyroid-stimulating hormone is made in the _____ and induces the release of thyroid hormones after proteolytic processing of _____.

a. pituitary gland; thyroglobulin
b. hypothalamus; thyroxine
c. pancreas; thyroglobulin
d. pituitary gland; thyroid-stimulating hormone receptor
e. thyroid gland; thyroid peroxidase

Answer 75

a. pituitary gland; thyroglobulin

Question 76

GravesÕ disease causes _____, whereas HashimotoÕs disease causes _____.

a. hypothyroidism; hyperthyroidism
b. hyperthyroidism; hypothyroidism
c. hypoglycemia; hyperglycemia
d. hyperglycemia; hypoglycemia
e. glomerulonephtitis; systemic vasculitis

Answer 76

b. hyperthyroidism; hypothyroidism

Question 77

Which of the following are correctly matched?

a. exocrine tissue: islets of Langerhans
b. type 2 diabetes: insulin-dependent diabetes mellitus
c. beta cells of pancreas: insulin production incorrect
d. alpha cells of pancreas: insulin production

Answer 77

c. beta cells of pancreas: insulin production incorrect

Question 78

Another name for anti-immunoglobulin autoantibodies is _____.

a. C-reactive protein
b. rheumatoid factor
c. Rituximab
d. thyroglobulin
e. ectopic antibodies

Answer 78

b. rheumatoid factor

Question 79

Rituximab, used in the treatment of rheumatoid arthritis, depletes _____ through a process involving the cross-linking of _____ on the surface of NK cells and the induction of antibody-dependent cell-mediated cytotoxicity.

a. NK cells; NKG2D
b. T cells: NKG2D
c. inflammatory cytokines; TNF-alpha
d. C-reactive protein; FcgammaRIII
e. B cells; FcgammaRIII

Answer 79

e. B cells; FcgammaRIII

Question 80

_____ autoantibodies enhance receptor function.

a. Neutralizing
b. Opsonizing
c. Agonist
d. Complement-fixing
e. Antagonist

Answer 80

c. Agonist

Question 81

Ankylosing spondylitis has a strong association with polymorphisms found in _____.

a. HLA-B27
b. AIRE
c. CTLA-4
d. HLA-DQ6
e. HLA-Cw6

Answer 81

a. HLA-B27

Question 82

Autoantibody specificities are affected by HLA class II polymorphisms. In the case of systemic lupus erythematosus, indicate which of the following associations between HLA-class II and autoantigens have been observed in these patients.

a. HLA-DR3; nuclear ribonucleoprotein complex
b. HLA-DR5; small cytoplasmic ribonucleoprotein complex
c. HLA-DR2; double-stranded DNA
d. HLA-DR4; single-stranded RNA
e. HLA-DQ8; double-stranded RNA

Answer 82

c. HLA-DR2; double-stranded DNA

Question 83

_____ is the term used to describe how pathogen antigens resemble host antigens and can sometimes trigger autoimmune disease.

a. intramolecular epitope spreading
b. molecular mimicry
c. intermolecular epitope spreading
d. sympathetic senescence
e. linkage equilibrium

Answer 83

b. molecular mimicry

Question 84

The upregulation of _____ by IFN-gamma can contribute to antigen-specific T-cell activation on thyroid epithelium.

a. CD4
b. CD8
c. HLA class I
d. HLA class II
e. CD28

Answer 84

d. HLA class II

Question 85

A(n) _____ is an epitope that is typically not accessible to the immune system but is revealed under inflammatory or infectious states.

a. cryptic epitope
b. molecular mimic
c. regulatory peptide
d. carrier
e. adjuvant

Answer 85

a. cryptic epitope

Question 86

The process by which the human thymus gradually decays is known as _____.

a. Apoptosis
b. Senescence
c. involution
d. the hygiene hypothesis
e. self-tolerance

Answer 86

c. involution

Question 87

Amanda Chenoweth, 21 years old, returned from a summer job as a pianist on a cruise ship where she was exposed daily to excessive sun; she developed a rash on her cheeks. She complained that her finger joints were stiff and painful, which made it difficult to play the piano, and that her hips became painful after sitting at the piano for long periods. Her blood sample tested positive for anti-nuclear antibodies and had decreased serum C3 levels. A urine albumin test showed elevated protein levels. A course of prednisone (an anti-inflammatory steroid) in combination with naprosyn (a nonsteroidal anti-inflammatory agent) was begun and her condition improved rapidly. What is the most likely cause and clinical name of her condition?

a. deterioration of the central nervous system; multiple sclerosis
b. cartilage destruction by bone-cell enzymes; rheumatoid arthritis
c. immune complexes fixing complement in kidney, joints, and blood vessels; systemic lupus erythematosus
d. autoantibodies against acetylcholine receptor at the neuromuscular junction; myasthenia gravis
e. consumption of seafood to which she was allergic; acute systemic anaphylaxis

Answer 87

c. immune complexes fixing complement in kidney, joints, and blood vessels; systemic lupus erythematosus

Question 88

At 42 years of age, Stephanie Goldstein developed occasional blurred and double vision, numbness and Ôpins and needlesÕ in her arms and legs (paresthesia), and bladder incontinence. After a month of these symptoms she went to her doctor, who sent her to the neurology specialist. An MRI scan revealed areas of demyelination in the central nervous system (CNS), and Stephanie was diagnosed with the autoimmune disease multiple sclerosis (MS). Which of the following best explains why some people are susceptible to the development of MS?

a. Negative selection of autoreactive T cells occurs during T-cell development.
b. Apoptosis of autoreactive B cells occurs in the bone marrow during B-cell development.
c. An inability to produce immunological tolerance toward CNS-derived constituents results in the generation of self-reactive lymphocytes.
d. An immunodeficiency inhibiting somatic recombination of immunoglobulins and T-cell receptors results in impaired lymphocyte development.
e. Regulatory T cells fail to activate autoreactive T cells in secondary lymphoid organs.

Answer 88

c. An inability to produce immunological tolerance toward CNS-derived constituents results in the generation of self-reactive lymphocytes.

Question 89

Anders Anderson, was seen by his pediatrician at 24 months of age after a recent bout of diarrhea and vomiting. He had lost his appetite and complained that his stomach hurt. Anders was in 5th percentile for weight, had slender limbs, wasted buttocks, and a protuberant abdomen. Jejunal biopsy revealed abnormal surface epithelium, and villous atrophy with hyperplasia of the crypts. Which of the following would be a likely clinical finding in this patient?

a. Glomerulonephritis
b. urticarial rash
c. anti-gliadin IgA antibodies
d. chronic wheezing
e. low blood pressure

Answer 89

c. anti-gliadin IgA antibodies

Question 90

Seventeen-year-old Lisa Montague practiced piano for 3Ð4 hours each day while preparing for music college auditions. Some of her pieces required sustained arm-muscle activity and she began to find them hard to play, even though she had previously played them easily. When she also started to have difficulty swallowing and chewing, she told her mother, who took her to the emergency room, where the physician noticed drooping eyelids and limitation of ocular motility. An electromyogram detected impaired nerve-to-muscle transmission. Administration of pyridostigmine rapidly improved LisaÕs symptoms. Which of the following blood-test results would be most consistent with her condition?

a. elevated rheumatoid factor
b. elevated anti-myelin basic protein antibodies
c. elevated anti-acetylcholine receptor antibodies
d. elevated anti-nuclear antibodies
e. elevated anti-Rh antibodies

Answer 90

c. elevated anti-acetylcholine receptor antibodies

Question 91

Which of the following is mismatched?

a. oncology: diagnosis and treatment of tumors
b. carcinoma: characteristic cell types found in benign tumors
c. mutation: changes in DNA involving substitutions, deletions, insertions, recombinations, and translocations
d. leukemia: cancer of the immune system affecting circulating cells
e. malignant transformation: gain of ability to form a cancer

Answer 91

b. carcinoma: characteristic cell types found in benign tumors

Question 92

Which of the following is mismatched?

a. tumor suppressor genes: mutated in over 50% of human cancer cases
b. HTLV-1: an RNA retrovirus associated with adult T-cell leukemia
c. Helicobacter pylori: bacterial infection associated with colon cancer
d. Sipuleucel-T cell vaccine: treatment for late-stage metastatic prostate cancer
e. cancer immunosurveillance: recognition and elimination of cancer cells by defense mechanisms

Answer 92

c. Helicobacter pylori: bacterial infection associated with colon cancer

Question 93

Mutagens that increase one s predisposition to developing cancer are called _____.

a. carcinogens
b. tumor antigens
c. neoplastic mutagens
d. oncogenes
e. proto-oncogenes

Answer 93

a. carcinogens

Question 94

Human papillomaviruses express proteins that bind to _____ and block its function.

a. MIC glycoproteins
b. p53 and Rb
c. CT antigens
d. TLR4
e. TLR2

Answer 94

b. p53 and Rb

Question 95

In domestic dogs and Tasmanian devils, successful passage and growth of tumors through copulation and biting, respectively, are attributed to _____.

a. absence of quiescent cancer stem cells in the tumor
b. limited MHC diversity between animals
c. repression of tumor-specific antigen expression
d. repression of tumor-associated antigen expression
e. lack of regulatory T cells

Answer 95

b. limited MHC diversity between animals

Question 96

_____ is/are commonly associated with the fusion between the BCR gene and the ABL proto-oncogene.

a. Non-small cell lung carcinoma
b. Bladder tumors
c. Melanoma
d. Head and neck squamous cell carcinoma
e. Chronic myelogenous leukemia

Answer 96

e. Chronic myelogenous leukemia

Question 97

Which of the following cell types in a tumor biopsy would not be associated with a promising prognosis?

a. B cells
b. memory T cells
c. TFH cells
d. regulatory T cells
e. cytotoxic T cells

Answer 97

d. regulatory T cells

Question 98

Adoptive transfer of Sipuleucel-T-primed dendritic cells is a form of immunotherapy currently used for the treatment of _____.

a. late-stage metastatic prostate cancer
b. multiple myeloma
c. chronic myelogenous leukemia
d. melanoma
e. cervical cancer

Answer 98

a. late-stage metastatic prostate cancer

Question 99

When the immune system is involved in _____, an appraisal for cancer cells is occurring.

a. malignant transformation
b. apoptosis
c. antineoplasia
d. immunosurveillance
e. immunosuppression

Answer 99

d. immunosurveillance

Question 100

A benign tumor of glandular tissue is known as a(n) _____.

a. sarcoma
b. myeloma
c. adenoma
d. adenocarcinoma
e. lymphoma

Answer 100

c. adenoma

Question 101

A malignant tumor is characterized by which of the following features?

a. encapsulation
b. localized
c. restricted in size
d. metastasizes to distant sites
e. results from single mutation affecting cell division or survival

Answer 101

d. metastasizes to distant sites

Question 102

_____ describes the condition in which a cell becomes able to cause cancer.

a. Malignant mutation
b. alignant recombination
c. Malignant neoplasm
d. Malignant transformation
e. Malignant suppression

Answer 102

d. Malignant transformation

Question 103

A protein expressed in response to damage to DNA that results in death to the cell is _____.

a. Ras
b. p53
c. Rb
d. Abl
e. MAGEA1

Answer 103

b. p53

Question 104

Human herpesvirus 8 (HHV8) is associated with the development of _____ in immunocompromised patients.

a. Burkitt lymphoma
b. chronic myeloid leukemia
c. melanoma
d. myeloma
e. Kaposi sarcoma

Answer 104

e. Kaposi sarcoma

Question 105

Li-Fraumeni syndrome is linked to a greater risk of cancer as a result of the inheritance of a germline mutation in one copy of _____.

a. TLR-9
b. p53
c. CTLA4
d. heat-shock protein
e. Rb

Answer 105

b. p53

Question 106

Chemical and physical agents that increase mutation rates by damaging DNA and increase the likelihood of developing cancer are known as _____.

a. oncogenes
b. malignant transformers
c. antitumor suppressor agents
d. carcinogens
e. tumor-associated agents

Answer 106

d. carcinogens

Question 107

_____ agents usually cause single nucleotide substitutions in DNA, whereas _____ agents produce more significant damage to DNA.

a. mutagenic; carcinogenic
b. chemical; physical
c. benign; malignant
d. tumor-associated; tumor-specific
e. benign; oncogenic

Answer 107

b. chemical; physical

Question 108

BurkittÕs lymphoma is a tumor associated with _____ infection, which causes _____ to divide uncontrollably.

a. Epstein-Barr virus; B cells
b. hepatitis B virus; epithelial human T-cell
c. leukemia; hepatocytes
d. human herpesvirus; T cells
e. papillomavirus; uterine cells

Answer 108

a. Epstein-Barr virus; B cells

Question 109

Cancers develop their own blood supply and become vascularized through _____.

a. apoptosis
b. neoplasia
c. angiogenesis
d. metastasis
e. malignant transformation

Answer 109

c. angiogenesis

Question 110

Systemic distribution of cancer cells to other sites of the body through the bloodstream or lymph is a process known as _____.

a. apoptosis
b. neoplasia
c. angiogenesis
d. metastasis
e. malignant transformation

Answer 110

d. metastasis

Question 111

The efficacy of treating bladder cancer is increased by introducing the BCG vaccine. The vaccine component attributing this antitumor effect is _____, which induces a state of chronic inflammation.

a. mycolic acid
b. unmethylated CpG-containing DNA
c. lipopolysaccharide
d. teichoic acid
e. peptidoglycan

Answer 111

b. unmethylated CpG-containing DNA

Question 112

Proteins not expressed on normal cells but found on tumor cells are called _____.

a. cancer stem cell antigens
b. oncogenic antigens
c. tumor-associated antigens
d. tumor-specific antigens
e. proto-oncogene products

Answer 112

d. tumor-specific antigens

Question 113

A tumor-associated antigen normally expressed only in the testis is called a _____ antigen.

a. MIC
b. CT
c. male-specific
d. sex chromosome-encoded privileged

Answer 113

b. CT

Question 114

A mechanism by which cancer cells can evade an immune response involves an alteration in the amount of MIC on the cell surface by _____________.

a. decreasing the level of MIC transcription
b. cleavage of MIC at the cell surface by a protease
c. switching from a transmembrane form of MIC to a secreted form
d. cytosolic degradation of MIC in proteasomes
e. alternative mRNA splicing resulting in a truncated form of MIC that is no longer able to bind to NKG2D

Answer 114

b. cleavage of MIC at the cell surface by a protease

Question 115

One of the side effects of treating tumor patients with anti-CTLA4 monoclonal antibodies is _____.

a. the development of autoimmune disease
b. lymphoproliferative disorder
c. increased levels of mutation in tumor cells
d. upregulation of CT antigens
e. reactivation of embryonic genes

Answer 115

a. the development of autoimmune disease