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Immunology > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

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

A

Primary Immunodeficiencies

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2
Q

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

A

hemagglutinin and neuraminidase

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3
Q

The serotypes of Streptococcus pneumoniae differ in their _____.

A

capsular polysaccharides

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4
Q

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 ‘original antigenic sin’

A

b. error-prone replication of its DNA genome (RNA Virus)

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5
Q

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

A

c. Treponema pallidum

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6
Q

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

variable surface glycoproteins (VSGs)

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7
Q

_____ 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

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8
Q

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 one’s lifetime, periodic episodes of reactivation are common.
e. Herpes simplex virus infects B lymphocytes.

A

e. Herpes simplex virus infects B lymphocytes. (EBV-infects B-cells)

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9
Q

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.

A

b. antibody deficiency

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10
Q

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.

A

All of the above are herpes viruses

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11
Q

Shingles is associated with infection by _____.

A

herpes zoster

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12
Q

All of the following are associated with superantigens except _____.

a. effective at minuscule concentrations
b. nonspecific activation of 2–20% of body’s CD8 T cells
c. processing to peptides is not required for T-cell activation
d. massive production of IL-2, IFN-γ, and TNF-α
e. activate α:β T cells

A

b. nonspecific activation of 2–20% of body’s CD8 T cells

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13
Q

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

A

C5 complement protein and Fc region of IgA

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14
Q

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. Chédiak–Higashi syndrome
e. Listeria monocytogenes
f. Mycobacterium tuberculosis.

A

c. hereditary angioedema

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15
Q

Which of these characteristics is not true of IFN-γ?
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.
f. It is able to render target cells responsive even if they express only one functional allele of
IFNγR1.

A

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

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16
Q
  1. Dominant mutant forms of IFNγR1 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.
A

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

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17
Q

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.

A

d. Mycobacterium tuberculosis

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18
Q

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

a. Wiskott–Aldrich 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. Chédiak–Higashi syndrome caused by deficiency of CHS1
e. agammaglobulinemia caused by deficiency of Bruton’s tyrosine kinase

A

Chédiak–Higashi syndrome caused by deficiency of CHS1

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19
Q

Paroxysmal nocturnal hemoglobinuria is caused by _____.
a. a profound deficiency of neutrophils
b. leukocytosis
3
c. immune-complex deposition in tissues
d. defects in recruitment of phagocytes to infected tissues
e. complement-mediated lysis of erythrocytes

A

e. complement-mediated lysis of erythrocytes

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20
Q
  1. 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.
A

c. hyporesponsiveness of classical complement pathway

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21
Q

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

A

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

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22
Q

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

A

purine nucleoside phosphorylase (PNP)

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23
Q

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

A

Janus 3 kinase (Jak3)

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24
Q

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

A

IL-12 and IFN-γ receptors

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25
Q

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. pneumoniae 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.

A

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

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26
Q

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

A

hemagglutinin and neuraminidase

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27
Q

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.

A

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

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28
Q

An epidemic affects _____, whereas a pandemic affects _____.

A

local populations; global populations.

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29
Q

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

A

Antigenic drift; antigenic shift

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30
Q

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.

A

a. influenza virus

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31
Q

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

A

variable surface glycoprotein (VSG)

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32
Q

Epstein–Barr virus infects and establishes latency in _____, gaining entry by binding to _____.

A

B cells; CR2

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33
Q

. 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.

A

inhibition of ICAM-1 expression.

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34
Q

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.

A

the cytosol; escaping from the phagosome

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35
Q

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.

A

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

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36
Q

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

A

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

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37
Q

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.

A

X-linked Wiskott–Aldrich syndrome.

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38
Q

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

NADPH oxidase; produce superoxide radical (O2-)

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39
Q

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

A

adenosine deaminase (ADA).

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40
Q

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

A

MHC class I

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41
Q

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.

A

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

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42
Q

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

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

A

matrix protein

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43
Q

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

A

be CD4-positive and express functional NFκB

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44
Q

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

A

gp41

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45
Q

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

A

fall below 200 cells/ul

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46
Q

Reverse transcriptase is a _____ encoded by _____.

A

RNA-dependent DNA polymerase; HIV

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47
Q

Preferred viral targets for HIV therapy include:

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

A

a. reverse transcriptase and protease

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48
Q

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

A

Haemophilus influenzae

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49
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

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

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50
Q

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 and B antigens and Rhesus D antigen

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51
Q

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

A

differences in the oligosaccharide attached to the lipid ceramide

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52
Q

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

A

Graft-versus-host disease (GVHD)

53
Q

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

A

cause hyperacute rejection

54
Q

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

A

O –: AB +

55
Q

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

A

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

56
Q

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

A

Alemtuzumab

57
Q

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

inhibition of co-stimulation: daclizumab

58
Q 
Hematopoietic stem cell transplantation is appropriate for all of the following conditions
except \_\_\_\_\_.
a. thalassemia major
b. Wiskott–Aldrich syndrome
c. Fanconi’s anemia
d.cirrhosis of the liver
e. sickle-cell anemia
A

cirrhosis of the liver

59
Q

_____ 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

Engraftment

60
Q

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

A

acute graft-versus-host disease

61
Q

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

A

Mature T cells

62
Q

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

tumor cell

63
Q

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

CD34

64
Q

Males engrafted with HLA-identical bone marrow from their sisters develop graft-versushost
disease because _____.

A

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

65
Q

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

haploidentical

66
Q

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-α monoclonal antibody that suppresses inflammation by blocking
TNF-α 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

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

67
Q

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

A

alloantigens

68
Q

Graft-versus-host disease (GVHD) is a consequence of _____.

A

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

69
Q

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

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

70
Q

Richard French, 53 years old, was diagnosed with chronic myelogenous leukemia. His elder
brother Don is HLA-haploidentical and will donate bone marrow. Richard’s 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)

71
Q

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; HLADRB1:
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

0101/0101; B: 5701/0801; DRB1: 0701/0701

72
Q

What type of hypersensitivity reaction would result from a mismatched blood transfusion?

A

Type II

73
Q

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

A

cross-match test

74
Q

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

A

transplant rejection

75
Q

In general the higher the patient’s panel reactive antibody (PRA), _____.

A

the more limited the number of suitable transplant donors

76
Q

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

A

ischemia

77
Q

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

A

Dendritic cells : donor

78
Q

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

A

acute

79
Q

When donor MHC:donor self-peptide complexes activate recipient T cells, _____.

A

acute rejection of transplanted organs occurs

80
Q

The extent to which an individual’s T cells respond to allogeneic HLA expressed on
irradiated donor cells can be measured in vitro using _____.

A

the mixed lymphocyte reaction

81
Q

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

A

proliferate

82
Q

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

A

recipient MHC class II:donor MHC peptide; recipient

83
Q

Alloantibody production after organ transplantation involves _____.

A

the indirect pathway of allorecognition by CD4 T cells

84
Q

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

85
Q

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

A

Cyclophosphamide

86
Q

Corticosteroids interfere with chemotaxis of leukocytes by _____.

A

inhibiting the expression of adhesion molecules on endothelial vessels

87
Q

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

cornea and liver

88
Q
  1. What is the probability that a sibling will be able to provide a HLA-haploidentical kidney for
    transplantation?
A

50%

89
Q

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

A

type I

90
Q

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

A

type III: immune complex deposition in tissues

91
Q

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

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

A

Goodpasture’s syndrome

92
Q

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

A

systemic lupus erythematosus

93
Q

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

A

type 1 diabetes

94
Q

All of the following are associated with Goodpasture’s syndrome except _____.

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

A

neutropenia and type III hypersensitivity reaction

95
Q

_____ 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

systemic lupus erythematosus

96
Q

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

A

exhibit symptoms of autoimmunity at a young age

97
Q

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

A

HLA-B35: birdshot retinopathy

98
Q

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

A

ankylosing spondylitis

99
Q 
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. Sjögren’s syndrome
e. Graves’ disease
A

ankylosing spondylitis

100
Q

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

A

elevated thyroid-stimulating hormone

101
Q

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

A

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

102
Q

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.

A

The neuromuscular junction is compromised.

103
Q

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

A

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

104
Q

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

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

A

pemphigus foliaceus

105
Q

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

A

anti-idiotypic antibody

106
Q

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

A

pulmonary hemorrhage and rheumatic fever

107
Q

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

04:02; acidic

108
Q

Celiac disease exhibits all of the following symptoms except _____.

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

A

tissue ulceration

109
Q

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

A

predisposition to celiac disease if individual possesses particular polymorphic variants

110
Q

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

111
Q

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

A

autoimmune diseases

112
Q

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

A

pulmonary hemorrhage and glomerulonephritis

113
Q

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

A

pituitary gland; thyroglobulin

114
Q

Graves’ disease causes _____, whereas Hashimoto’s disease causes _____.

A

hyperthyroidism; hypothyroidism

115
Q

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
d. alpha cells of pancreas: somatostatin production
e. alpha cells of pancreas: insulin production

A

beta cells of pancreas: insulin production

116
Q

Another name for anti-immunoglobulin autoantibodies is _____.

A

rheumatoid factor

117
Q

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 antibodydependent
cell-mediated cytotoxicity.

A

B cells; FcgammaRIII

118
Q

_____ autoantibodies enhance receptor function.

A

Agonist

119
Q

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

A

HLA-B27

120
Q

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

A

. HLA-DR2; double-stranded DNA

121
Q

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

A

molecular mimicry

122
Q

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

A

HLA class II

123
Q

. 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

124
Q

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

A

involution

125
Q

Amanda Chenoweth, 21 years of age, 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

A

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

126
Q

At 42 years old, Stephanie Goldstein developed occasional blurred and double vision, numbness
and ‘pins and needles’ 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.

A

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

127
Q

Anders Anderson, was seen by his pediatrician at 24 months old after a recent bout of diarrhea
and vomiting. He had lost his appetite and complained that his stomach hurt. Anders was in the
5% centile 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.

A

anti-gliadin IgA antibodies

128
Q

Seventeen-year-old Lisa Montague practiced piano for 3–4 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’s 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.

A

elevated anti-acetylcholine receptor antibodies

Immunology (3 decks)

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