Chapter 16

Question 1

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 1

a. type I

Question 2

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 2

c. type III: immune complex deposition in tissues

Question 3

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

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

Answer 3

b. Goodpasture syndrome

Question 4

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 4

c. systemic lupus erythematosus

Question 5

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 5

d. type 1 diabetes

Question 6

All of the following are associated with Goodpasture s 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 6

d. neutropenia and type III hypersensitivity reaction

Question 7

_____ 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. Goodpasture s syndrome

Answer 7

b. systemic lupus erythematosus

Question 8

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 8

a. exhibit symptoms of autoimmunity at a young age

Question 9

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 9

c. HLA-B35: birdshot retinopathy

Question 10

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 10

a. ankylosing spondylitis

Question 11

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 gren syndrome
e. Graves disease

Answer 11

c. ankylosing spondylitis

Question 12

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

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

Answer 12

c. elevated thyroid-stimulating hormone

Question 13

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 13

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

Question 14

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 14

e. The neuromuscular junction is compromised.

Question 15

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 newborn regulatory T cells suppress autoantibody production
d. the newborn thyroid gland develops resistance to the effects of maternal autoantibodies
e. thyroglobulin synthesis does not commence until months after birth

Answer 15

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

Question 16

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

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

Answer 16

a. pemphigus foliaceus

Question 17

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 17

b. anti-idiotypic antibody

Question 18

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 18

e. pulmonary hemorrhage and rheumatic fever

Question 19

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 19

b. 04:02; acidic

Question 20

Celiac disease exhibits all of the following symptoms except _____.

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

Answer 20

d. tissue ulceration

Question 21

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 21

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

Question 22

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 22

a. anti-TNF-alpha and anti-CD20

Question 23

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

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

Answer 23

d. autoimmune diseases

Question 24

Which of the following would be consistent with a diagnosis of Goodpasture s 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 24

a. pulmonary hemorrhage and glomerulonephritis

Question 25

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 25

a. pituitary gland; thyroglobulin

Question 26

Graves disease causes _____, whereas Hashimoto disease causes _____.

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

Answer 26

b. hyperthyroidism; hypothyroidism

Question 27

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

e. alpha cells of pancreas: insulin production

Answer 27

c. beta cells of pancreas: insulin production

Question 28

Another name for anti-immunoglobulin autoantibodies is _____.

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

Answer 28

b. rheumatoid factor

Question 29

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 29

e. B cells; FcgammaRIII

Question 30

_____ autoantibodies enhance receptor function.

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

Answer 30

c. Agonist

Question 31

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 31

a. HLA-B27

Question 32

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 32

c. HLA-DR2; double-stranded DNA

Question 33

_____ 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 33

b. molecular mimicry

Question 34

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 34

d. HLA class II

Question 35

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 35

a. cryptic epitope

Question 36

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 36

c. involution

Question 37

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 37

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

Question 38

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 38

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

Question 39

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 39

c. anti-gliadin IgA antibodies

Question 40

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 Lisa 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 40

c. elevated anti-acetylcholine receptor antibodies