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Chapter 15 Flashcards

1
Q

All of the following are characteristics of blood donations and transfusions that enable their extensive use for transplantation purposes except _____.

a. individuals can donate on a regular basis without any deleterious effects
b. erythrocytes do not express MHC class I or class II molecules
c. the blood components only need to function for a few weeks
d. only the ABO antigens need to be compatible between donor and recipient
e. blood transfusion is a straight forward and inexpensive process

A

d. only the ABO antigens need to be compatible between donor and recipient

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2
Q
  1. In routine blood transfusions, which of the following must be matched correctly?

a. A and B antigens and Rhesus D antigen
b. O antigens
c. MHC class I molecules
d. MHC class II molecules
e. None of the above

A

a. A and B antigens and Rhesus D antigen

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3
Q
  1. The underlying molecular basis for distinguishing blood-group antigens A, B and O is _____ at the erythrocyte surface.

a. the presence or absence of fucose in glycolipids
b. differences in the oligosaccharide attached to the lipid ceramide
c. structural polymorphisms in the Rhesus D antigen the levels of MHC class I and class II molecules.
d. differences in the peptide attached to the lipid ceramide

A

b. differences in the oligosaccharide attached to the lipid ceramide

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4
Q
  1. _____ results from alloreactions mediated by donor T cells in the graft subsequent to hematopoietic stem-cell transplantation.

a. Acute rejection
b. Chronic rejection
c. Graft-versus-host disease (GVHD)
d. Serum sickness
e. Hyperacute rejection

A

c. Graft-versus-host disease (GVHD)

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5
Q
  1. Alloantibodies to blood-vessel endothelium on solid organ grafts _____.

a. are specific for HLA class I and class II antigens
b. cause hyperacute rejection
c. cause acute rejection
d. target endothelium for attack by NK cells
e. are IgA and do not fix complement

A

b. cause hyperacute rejection

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6
Q
  1. Which of the following is a permissible match between a blood donor and a recipient (donor: recipient)?

a. O - : AB +
b. O + : AB -
c. AB + : O -
d. A + : A -
e. AB - : O +

A

a. O - : AB +

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7
Q
  1. The direct pathway of allorecognition involves interaction of _____, whereas the indirect pathway of alloreaction involves interaction of _____.

a. donor T cells with allogeneic HLA molecule on recipient dendritic cells; recipient T cells with allogeneic HLA molecules on donor dendritic cells
b. recipient T cells with allogeneic HLA molecules on donor dendritic cells; donor T cells with allogeneic HLA molecule on recipient dendritic cells
c. recipient T cells with allogeneic HLA molecules on donor dendritic cells; recipient T cells with peptides of allogeneic HLA molecules on recipient dendritic cells
d. recipient T cells with peptides of allogeneic HLA molecules on recipient dendritic cells; donor T cells with peptides of allogeneic HLA molecules on donor dendritic cells

A

c. recipient T cells with allogeneic HLA molecules on donor dendritic cells; recipient T cells with peptides of allogeneic HLA molecules on recipient dendritic cells

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8
Q
  1. _____ is a monoclonal antibody administered to transplant patients before and after transplantation in order to induce lymphopenia.

a. Rabbit anti-thymocyte globulin (rATG)
b. Tacrolimus
c. Alemtuzumab
d. Belatacept
e. Basiliximab

A

c. Alemtuzumab

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9
Q
  1. In the context of allogeneic transplantation, identify the mismatched pair.

a. inhibition of inflammation: prednisone
b. inhibition of co-stimulation: daclizumab
c. inhibition of cytokine signaling: basiliximab
d. inhibition of calcineurin: tacrolimus (FK506)
e. inhibition of T-cell proliferation: azathioprine

A

b. inhibition of co-stimulation: daclizumab

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10
Q
  1. Hematopoietic stem cell transplantation is appropriate for all of the following conditions except _____.

a. thalassemia major
b. Wiskott-Aldrich syndrome
c. Falcon anemia
d. cirrhosis of the liver
e. sickle-cell anemia

A

d. cirrhosis of the liver

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11
Q
  1. _____ describes the process by which transplanted pluripotent stem cells find their way to the bone marrow spaces in the bones of the body and begin to produce new blood cells.

a. Myeloablation
b. Engraftment
c. Relapse
d. Graft-vesus-leukemia
e. Chemotherapy

A

b. Engraftment

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12
Q
  1. The risk of _____ is the primary complication in bone marrow transplants.

a. acute host-versus-graft disease
b. hyperacute rejection
c. chronic rejection
d. acute graft-versus-host disease
e. cancer

A

d. acute graft-versus-host disease

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13
Q
  1. _____ from a bone marrow transplant facilitate alloreactive responses, causing the condition defined as acute graft-versus-host disease.

a. Natural killer cells
b. Mature T cells
c. Dendritic cells
thymocytes
Mature B cells

A

b. Mature T cells

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14
Q
  1. Autologous bone marrow transplantation used to treat cancer patients involves reinfusing a(n) _____-depleted stem-cell population into the patient after their cancer treatment has been completed.

a. mature T cell
b. antibody
c. tumor cell
d. dendritic cell
e. NK cell

A

c. tumor cell

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15
Q
  1. Leukapheresis is used in hematopoietic stem-cell transplantation where stem cells from a suitable donor are fractionated on the basis of their expression of _____.

a. CD3
b. the same major histocompatibility antigens as the recipient
c. the same minor histocompatibility antigens as the recipient
d. the same inhibitory KIR receptors as the recipient
e. CD34

A

e. CD34

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16
Q
  1. Males engrafted with HLA-identical bone marrow from their sisters develop graft-versus-host disease because _____.

a. T cells develop in the male thymus that are not tolerant to minor histocompatibility antigens expressed by the sister
b. mature T cells in the graft have specificity for male-specific minor histocompatibility antigens
c. there are differences between the sexes in how self proteins are modified post-translationally
d. NK-cell alloreactions occur
e. residual female hormones in the graft cause upregulation of HLA class I on male dendritic cells presenting minor histocompatibility antigens

A

b. mature T cells in the graft have specificity for male-specific minor histocompatibility antigens

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17
Q
  1. Family members who donate their bone marrow to a transplant patient and who share one out of the two HLA haplotypes are providing a(n) _____ transplant.

a. autologous
b. HLA-matched
c. haploidentical
d. chimeric
e. cross-matched

A

c. haploidentical

18
Q
  1. George Cunningham was diagnosed with Crohn s disease when 23 years old. He was experiencing acute abdominal pain, diarrhea, rectal bleeding, anemia and weight loss. He did not respond to conventional immunosuppressive therapies and was given a course of infliximab, an anti-TNF-alpha monoclonal antibody that suppresses inflammation by blocking TNF-alpha activity. On day 12 after receiving his first infusion, he developed a mild fever, generalized vasculitis, swollen lymph glands, swollen joints and joint pain. Traces of blood and protein were detected in his urine. Which of the following is the most likely cause of these recent symptoms?

a. Type I hypersensitivity involving anaphylaxis.
b. Type II hypersensitivity leading to hemolytic anemia.
c. Type III hypersensitivity caused by immune complex deposition in blood vessels.
d. Type IV hypersensitivity involving CD8 T-cell cytotoxicity.
e. Type II hypersensitivity leading to thrombocytopenia

A

c. Type III hypersensitivity caused by immune complex deposition in blood vessels.

19
Q
  1. The term _____ is used to describe polymorphic antigens that vary between individuals of the same species.

a. xenoantigens
b. immunoantigens
c. alloantigens
d. Histoantigens
e. autoantigens

A

c. alloantigens

20
Q
  1. Graft-versus-host disease (GVHD) is a consequence of _____.
    Selected Answer:

a. mature T lymphocytes from the donor mounting an immune response against tissue of the recipient
b. mature T lymphocytes from the recipient mounting an immune response against tissue of the donor
c. mismatching A, B, and O antigens between donor and recipient
d. mismatching Rhesus antigen between donor and recipient
e. antibodies of the donor stimulating NK cell antibody-dependent cell-mediated cytotoxicity (ADCC) of tissues of the recipient

A

a. mature T lymphocytes from the donor mounting an immune response against tissue of the recipient

21
Q
  1. Which of the following best explains why a bone marrow donor needs to be HLA-matched to the recipient?

a. The bone marrow transplant contains enough mature T cells to reconstitute the recipient and the recipient provides the antigen-presenting cells.
b. The recipient s MHC molecules mediate positive selection of thymocytes in the thymus that interact with donor-derived MHC molecules in the periphery.
c. Reconstituted T cells are restricted by donor, not recipient, HLA allotypes.
d. Without an HLA match, the donor-derived thymocytes undergo negative selection.
e. If the donor is not HLA matched, the reconstituted T cells will be autoreactive.

A

b. The recipient s MHC molecules mediate positive selection of thymocytes in the thymus that interact with donor-derived MHC molecules in the periphery.

22
Q
  1. Richard French, 53 years old, was diagnosed with chronic myelogenous leukemia. His elder brother Don is HLA-haploidentical and will donate bone marrow. The oncologist has recommended him to a medical center that favors using bone marrow depleted of mature T cells prior to infusion. The most likely rationale for employing the practice of T-cell depletion is that _____.

a. T-cell depletion will remove alloreactive T cells from the donor and prevent the potential for graft-versus-host disease (GVHD)
b. mature T-cell chimerism is required to establish long-term tolerance
c. because Don is HLA-haploidentical and male, there is no risk of alloreactivity toward major or minor histocompatibility antigens
d. because of Don s age, the expected bone marrow harvest is already marginal for successful engraftment, and depletion measures would compromise the yield of stem cells
e. the benefit of using a cocktail of immunosuppressive drugs outweighs the risk of contaminating the bone marrow during T-cell depletion

A

a. T-cell depletion will remove alloreactive T cells from the donor and prevent the potential for graft-versus-host disease (GVHD)

23
Q
  1. Forty-four-year old Danielle Bouvier is on the waiting list for a kidney transplant and is receiving weekly dialysis. Her HLA type is: HLA-A: 0101/0301; HLA-B: 0702/0801; HLA-DRB1: 0301/0701. Today, Danielle s physician informed her that several potential kidney donors are available. Which of the following would be the most suitable?

a. A: 0301/0201; B: 4402/0801; DRB1: 0301/0403
b. A: 0301/2902; B: 1801/0801; DRB1: 0301/0701
c. A: 2902/0201; B: 0702/0801; DRB1: 0301/13011
d. A: 0101/0101; B: 5701/0801; DRB1: 0701/0701
e. A: 0101/0301; B: 0702/5701; DRBA: 0403/0301

A

d. A: 0101/0101; B: 5701/0801; DRB1: 0701/0701

24
Q 
149. What type of hypersensitivity reaction would result from a mismatched blood transfusion?
\:	
a. Type I
 b. Type II
c. Type III
d. Type IV
A

b. Type II

25
Q
  1. What is the name of the clinical test used to determine the compatibility between a donor and recipient requiring a blood transfusion?

a. desensitization
b. cross-match test
c. Arthus reaction
d. HLA typing
e. delayed-type hypersensitivity reaction

A

b. cross-match test

26
Q
  1. When an individual receives a kidney transplant, the main concern will be to control the development of _____.

a. graft-versus-host disease
b. transplant rejection
c. xenorecognition
d. allergic reactions
e. lymphoproliferative disorders

A

b. transplant rejection

27
Q
  1. In general, the higher the patient panel reactive antibody (PRA), _____.

a. the higher the number of suitable transplant donors
b. the less likely it is that a hyperacute reaction will occur
c. the higher the risk of developing hemolytic disease of the newborn
d. the more limited the number of suitable transplant donors
e. the higher the risk of developing autoimmunity

A

d. the more limited the number of suitable transplant donors

28
Q
  1. If _____ occurs in an organ to be transplanted, endothelial activation, leukocyte infiltration, inflammatory cytokine production, and complement activation may occur.

a. a mixed lymphocyte reaction
b. the transfusion effect
c. kidney dialysis
d. ischemia
e. myeloablative therapy

A

d. ischemia

29
Q
  1. Acute rejection of a kidney graft involves the activation of recipient T cells by _____ of _____ origin.

a. dendritic cells; recipient
b. B cells; recipient
c. dendritic cells; donor
d. macrophages; recipient
B cells; donor

A

c. dendritic cells; donor

30
Q
  1. Effector mechanisms of _____ rejection resemble those responsible for type IV hypersensitivity reactions.

a. xenogeneic
b. acute
c. chronic
d. hyperacute
e. blood transfusion

A

b. acute

31
Q
  1. When donor MHC:donor self-peptide complexes activate recipient T cells, _____.
    Selected Answer:

a. acute rejection of transplanted organs occurs
b. suppression occurs and transplanted organs are tolerated
c. hyperacute rejection of transplanted organs occurs
d. complement pathways are activated
e. an indirect pathway of allorecognition occurs

A

a. acute rejection of transplanted organs occurs

32
Q
  1. The extent to which an individual T cells respond to allogeneic HLA expressed on irradiated donor cells can be measured in vitro using _____.

a. a cross-match test
b. a superantigen recognition test
c. the mixed lymphocyte reaction
d. the transfusion effect assay
e. the panel reactive antibody test

A

c. the mixed lymphocyte reaction

33
Q
  1. In a mixed lymphocyte reaction the donor cells are irradiated to ensure that they do not _____.

a. stimulate recipient cells
b. become anergic
c. alter their level of expression of HLA molecules
d. proliferate
e. undergo apoptosis

A

d. proliferate

34
Q
  1. In chronic rejection, effector T cells respond to _____ complexes on _____-derived dendritic cells.

a. donor MHC class I:donor self peptide; donor
b. donor MHC class II:donor self-peptide; donor
c. recipient MHC class I:donor MHC peptide; recipient
d. recipient MHC class II:donor MHC peptide; recipient
e. recipient MHC class II:donor MHC peptide; donor

A

d. recipient MHC class II:donor MHC peptide; recipient

35
Q
  1. Alloantibody production after organ transplantation involves _____.
    Selected Answer:

a. a mixed lymphocyte reaction
b. the indirect pathway of allorecognition by CD4 T cells
c. activation of regulatory CD4 T cells
d. the transfusion effect
e. a switch from a chronic to an acute state of organ rejection

A

b. the indirect pathway of allorecognition by CD4 T cells

36
Q
  1. Patients who have previously received a blood transfusion that has HLA-DR allotypes in common with their kidney transplant are _____.

a. less likely to reject the graft owing to the presence of regulatory CD4 T cells
b. more likely to reject the graft owing to the presence of HLA alloantibodies
c. less likely to reject the graft owing to negative selection of alloreactive T-cell clones
d. at risk of developing a hyperacute rejection
e. at risk of developing graft-versus-host disease

A

a. less likely to reject the graft owing to the presence of regulatory CD4 T cells

37
Q
  1. _____ is a nitrogen mustard compound converted to a DNA-alkylating agent in the body that is used to inhibit cell proliferation after transplantation.

a. Methotrexate
b. Rapamycin
c. FK506
d. Cyclophosphamide
e. Mycophenolate mofetil

A

d. Cyclophosphamide

38
Q
  1. Corticosteroids interfere with chemotaxis of leukocytes by _____.

a. decreasing the production of GM-CSF and IL-1
b. inducing apoptosis
c. inhibiting the expression of adhesion molecules on endothelial vessels
d. suppressing the activity of phospholipase A2
e. reducing nitrogen oxide synthase (NOS) activity

A

c. inhibiting the expression of adhesion molecules on endothelial vessels

39
Q
  1. Which of the following are transplanted with a relatively high success rate despite major differences in HLA class I and II between donor and recipient?

a. bone marrow
b. heart
c. cornea and liver
d. kidney
e. lung

A

c. cornea and liver

40
Q
  1. What is the probability that a sibling will be able to provide a HLA-haploidentical kidney for transplantation?

a. 100%
b. 75%
c. 50%
d. 25%
e. 0%

A

c. 50%

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