Immunology, Serology and Blood Banking

Question 1

antibody heterogeneity: variations between light and heavy chains; constant regions of all antibodies and kappa and lambda light chains

Answer 1

isotypes

Question 2

antibody heterogeneity: species-specific variations in the constant domains of heavy or light chains; different alleles of heavy chains

Answer 2

allotypes

Question 3

antibody heterogeneity: variation in the variable region; produced by a single clone of cells

Answer 3

idiotypes

Question 4

links multiple monomers of IgM and IgA

Answer 4

joining (J) chain

Question 5

predominant serum antibody, approximately 75% of immunoglobulins in the blood
only Ig that crosses placenta
produced in secondary (anamnestic) antibody response

Answer 5

IgG

Question 6

IgG subclasses

Answer 6

IgG1, IgG2, IgG3, IgG4

Question 7

IgG subclasses that activate the classical complement pathway

Answer 7

IgG1, IgG2, IgG3

Question 8

five monomers linked together by a J chain and interchain disulfide bonds
10% of total serum Ig
first antibody produced against an immunogen
produced in high levels in the primary response
best activator of the classical pathway of complement only one molecule is required

Answer 8

IgM

Question 9

2 forms of IgA

Answer 9

serum IgA
secretory IgA

Question 10

IgA: single Ig molecule; antigen clearance and immune regulation

Answer 10

serum IgA

Question 11

IgA: dimer held together by a J-chain; block attachment of viruses, bacteria and toxins to host cells

Answer 11

secretory IgA

Question 12

2 subclasses of IgA

Answer 12

IgA1 and IgA2

Question 13

accounts for 15-20% of total serum antibody

Answer 13

IgA

Question 14

primarily a cell membrane surface component of beta-lymphocytes
short half-life (2-3 days)

Answer 14

IgD

Question 15

responsible for allergic (type 1 hypersensitivity) reactions
Fc portion binds to receptors on mast cells and basophils
once attached to mast cells, binding to an allergen triggers degranulation of the cell and release of allergic mediators, such as histamine and leukotrienes
elevated concentrations are often found during parasitic infections

Answer 15

IgE

Question 16

identical antibodies that are produced from a single clone of plasma cells
found in individuals with multiple myeloma
produced in industry by fusing an antigen-sensitized, splenic beta-lymphocyte with non secreting myeloma cell thus creating an immortal cell line that secretes an antibody of a single idiotype

Answer 16

monoclonal antibodies

Question 17

quantitation on antibodies

Answer 17

radial immunodiffusion
nephelometry
turbidimetry

Question 18

immune system: responsible for non specific response
phagocytosis of invaders
present immunogens to T helper cells, the first step in an immune response
release cytokines that affect other cells’ activities

Answer 18

myeloid cells

Question 19

myeloid cells in the peripheral blood

Answer 19

monocytes

Question 20

myeloid cells in the tissue

Answer 20

macrophage

Question 21

macrophages have these on their surface

Answer 21

major histocompatibility complex class II
complement receptors
antibody Fc receptors

Question 22

granulocytes: 60-70% of WBCs in circulation; phagocytosis and contributes to inflammatory response

Answer 22

neutrophils

Question 23

granulocytes: 1-3% of circulating wbcs; mediate IgE allergic response

Answer 23

eosinophils

Question 24

granulocytes: 0-1% of circulating wbcs, has receptors for IgE and granules responsible for allergic reactions

Answer 24

basophils

Question 25

20-40% of circulating wbcs

Answer 25

lymphocytes

Question 26

20% of circulating lymphocytes
express surface molecules such as CD19 and CD20
mature in the bone marrow

Answer 26

b cells

Question 27

b cells differentiate into:

Answer 27

plasma cells
memory b cells

Question 28

produce antibody

Answer 28

plasma cells

Question 29

80% of circulating lymphocytes
express surface molecules such as cd2 and cd3
lyse host cells infected with viruses and tumor cells and also produce lymphokines

Answer 29

t cells

Question 30

slightly larger than t or b cells and have cytoplasmic granules

Answer 30

nk cells

Question 31

present antigens to T cells

Answer 31

dendritic cells

Question 32

dendritic cells in the dermis and squamous epithelia

Answer 32

langerhans cells

Question 33

granulocyte resembling basophil that contains many chemicals that affect the immune response

Answer 33

mast cells

Question 34

soluble protein molecules secreted by one cell type that affect other cells turn on genes in target cells

Answer 34

cytokines

Question 35

antiviral proteins that inhibit viral replication and activate NK cells
produced by virally-infected cells

Answer 35

interferon-alpha and -beta

Question 36

antiviral effects, activate macrophages and NK cells, stimulates b cells to produce antibodies
produced by TH1 cells

Answer 36

interferon-gamma

Question 37

produced by macrophages, lymphocytes, and NK cells when encountering bacteria, viruses, tumor cells, toxins, and complement protein C5a

Answer 37

tissue necrosis factor-alpha

Question 38

produced by cd4 and cd8 positive cells after exposure to a specific antigen

Answer 38

tnf-beta

Question 39

cytokine
cellular source: macrophages, b cells, fibroblasts
primary targets: t cells, b cells, macrophages, endothelium

Answer 39

IL-1

Question 40

cytokine
cellular source: t cells
primary targets: t cells

Answer 40

IL-2

Question 41

cytokine
cellular source: t cells
primary targets: stem cells

Answer 41

IL-3

Question 42

cytokine
cellular source: t cells
primary targets: b cells, t cells

Answer 42

IL-4

Question 43

cytokine
cellular source: t cells
primary targets: b cells

Answer 43

IL-5

Question 44

cytokine
cellular source: t cells, b cells, fibroblasts, macrophages
primary targets: b cells, hepatocytes

Answer 44

IL-6

Question 45

cytokine
cellular source: bone marrow, stromal cells
primary targets: pre-b cells, t cells

Answer 45

IL-7

Question 46

cytokine
cellular source: monocytes
primary targets: fibroblasts

Answer 46

IL-8

Question 47

cytokine
cellular source: t cells
primary targets: t cells, mast cells

Answer 47

IL-9

Question 48

cytokine
cellular source: t cells
primary targets: TH1 cells

Answer 48

IL-10

Question 49

cytokine
cellular source: macrophages, mast cells, lymphocytes
primary targets: macrophages, granulocytes, tissue cells

Answer 49

TNF

Question 50

cytokine
cellular source: leukocytes, epithelia, fibroblasts
primary targets: tissue cells

Answer 50

INF-alpha

Question 51

cytokine
cellular source: fibroblasts, epithelia
primary targets: tissue cells, leukocytes

Answer 51

INF-beta

Question 52

cytokine
cellular source: T cells, NK cells, epithelia, fibroblasts
primary targets: leukocytes, tissue cells, TH2 cells

Answer 52

INF-gamma

Question 53

produced by macrophages, B cells, and other cell types
activates T helper cells, increase number of B cells, activates vascular endothelium, causes fever and acute phase protein synthesis and induces T cells to produce lymphokines

Answer 53

IL-1

Question 54

produced by T helper cells
causes proliferation of activated t and b cells

Answer 54

IL-2

Question 55

produced by activated T cells
causes increases in the number of mast cells in skin, spleen and liver

Answer 55

IL-3

Question 56

produced by activated T cells
induces proliferation of T cells and class switching from IgM to IgG1 and IgE

Answer 56

IL-4

Question 57

primary lymph tissues of adults

Answer 57

bone marrow and thymus

Question 58

secondary lymphoid organs: in the lymph nodes, ___ migrate to the cortex and ___ to the paracortex

Answer 58

b cells
t cells

Question 59

secondary lymphoid organs: in the lymph nodes: ____ there are many small b cells, and after stimulations becomes ____

Answer 59

primary follicle
secondary follicle

Question 60

secondary lymphoid organs: has small and large lymphocytes, blast cells, macrophages and dendritic cells

Answer 60

germinal center

Question 61

secondary lymphoid organs: contains plasma cells and large lymphocytes

Answer 61

medulla

Question 62

secondary lymphoid organs: filters blood, contains both t and b cells

Answer 62

spleen

Question 63

secondary lymphoid organs: found in submucosa in gastrointestinal tract and urogenital tract, these surfaces interact with the environment and can begin the immune response early

Answer 63

mucosal associated lymphoid tissue

Question 64

specialized MALT found in the lower ileum

Answer 64

Peyer’s patch

Question 65

cell surface markers that allow immune cells to distinguish self from nonself
first described on white blood cells and are coded for by genes in the MHC located on the chromosome six

Answer 65

human leukocyte antigens

Question 66

MHC found on nearly every nucleated cell surface
antigen presenting cells with MHC I molecules present antigens to CTLs

Answer 66

class I loci

Question 67

class I loci

Answer 67

HLA-A
HLA-B
HLA-C
HLA-E
HLA-F
HLA-G
HLA-I

Question 68

molecules located on the surface of monocytes, macrophages, b cells, activated t cells, dendritic cells, langerhans cells and some epithelial cells
antigen presenting cells with MHC II molecules present antigen to T helper cells
HLA-DM, HLA-DO, HLA-DP, HLA-DQ, HLA-DR

Answer 68

class II

Question 69

complement proteins, TNF-alpha and beta, and other proteins not associated with cell membrane surfaces

Answer 69

class III

Question 70

combination of inherited HLA alleles

Answer 70

combination of inherited HLA alleles

Question 71

true or false: transplants last longer if the HLA antigens from the recipient and the donor are closely matched

Answer 71

true

Question 72

true or false: although poor response to platelet transfusion is multifactorial, antibodies to class I HLA antigens are the primary cause of immune-mediated platelet transfusion refractoriness

Answer 72

true

Question 73

true or false: 46 haplotypes are a genotype

Answer 73

false, only 2 (one from each parent)

Question 74

true or false: HLA loci are polymorphic and recombination is rare. HLA inheritance patterns can exclude fathers with approximately 99%

Answer 74

true

Question 75

HLA antigen associated with ankylosing spondylitis

Answer 75

HLA B-27

Question 76

involved in nonspecific response by attachment to damaged epithelium, migration into tissue chemotaxis, phagocytosis, and digestion of target cells, increased metabolism, and degranulation

Answer 76

PMNs

Question 77

defect in oxidative pathway (respiratory pathway) that phagocytes use to create hydrogen peroxide, which is used to kill bacteria

Answer 77

chronic granulomatous disease

Question 78

granules contain acid phosphatase, peroxidase, histamine and several other types of molecules
clearing immune complexes, limiting inflammatory reactions, protein in granules toxic to parasites

Answer 78

eosinophils

Question 79

release substances that mediate immune reaction
causing increased vascular permeability, smooth muscle contraction, chemotaxins for phagocytes, increased inflammatory response

Answer 79

mediator cells

Question 80

mediator cells

Answer 80

mast cells
basophils
platelets

Question 81

degranulate when membrane-bound IgE binds an allergen or by non immunologic mechanisms such as surgical incisions, heat and skin or mucous membrane infection

Answer 81

mast cells

Question 82

amplify the reactions that start with the mast cells at the site of entry of the antigen
play a role in anaphylactic reactions

Answer 82

basophil

Question 83

mononuclear phagocyte system

Answer 83

alveolar macrophages
splenic macrophages
Kuppfer cells

Question 84

sequenced evens following tissue damage that protect the host from foreign invaders and attempt to minimize tissue damage
increased vascular permeability which then causes fluid to move from the circulation to the space around the injury site

Answer 84

inflammation

Question 85

PMNs move between the endothelial cells to the site of tissue damage

Answer 85

diapedesis

Question 86

components on of the complement system are synthesized by the liver, except ___, which is synthesized in the epithelial cells of the intestines

Answer 86

C1

Question 87

complement system: five proteins unique to the classical pathway

Answer 87

C1q
C1r
C1s
C4
C2

Question 88

complement system: three proteins unique to the alternative pathway

Answer 88

factor B
factor D
properdin

Question 89

complement system: six proteins common to both pathways

Answer 89

C3
C5
C6
C7
C8
C9

Question 90

activation of the complement: classical pathway

Answer 90

immune complexes, require one IgM or two IgG molecules

Question 91

activation of the complement: alternative pathway

Answer 91

antibody-independent, microbial components such as lipopolysaccharide, polysaccharide, teichoic acid, and peptidoglycan

Question 92

activation of the complement: lectin pathway

Answer 92

binding of mannose-binding lectin to mannose residues on glycoproteins or carbohydrates on the surface of microorganisms

Question 93

true or false: C4a, C5a, C6a causes basophils and mast cells to release histamine and also cause smooth muscle contraction and increased vascular permeability

Answer 93

false, C3a, C4a, C5a

Question 94

true or false: C3a adheres to immune complexes and surfaces of substances to facilitate clearing of these molecules

Answer 94

false, C3b

Question 95

true or false: if C3b is attached to a cell, phagocytosis is enhanced

Answer 95

true

Question 96

true or false: C5b is an anaphylatoxin and induces the migration of neutrophils and monocytes to the site

Answer 96

false, C5a

Question 97

true or false: cell lysis through the formation of the membrane attack complex

Answer 97

true

Question 98

components of the membrane attack complex (MAC)

Answer 98

C5 through C9

Question 99

C1 inhibitor combines with C1r and C1s to block ___

Answer 99

C1 activities

Question 100

deficiency in C1INH
autosomal dominant disease
unregulated classical pathway activation resulting in vascular permeability, and swollen mucous membranes in airways which can become blocked

Answer 100

hereditary angioehema

Question 101

removes a single amino acid from C4a, C3a and C5a, rendering them useless as anaphylatoxin

Answer 101

anaphylatoxin inactivator

Question 102

MAC inhibitors

Answer 102

S protein binds to C5b-C7 complex

Question 103

CRI binds C3b and C4b and inhibits the amplification loop

Answer 103

complement receptor type I

Question 104

acute-phase reactants: activate the classical pathway of complement and can also bind to NK cells and monocytes, stimulating them to target tumor cells
may also be increased during acute coronary heart diseases

Answer 104

c-reactive proteins (crp)

Question 105

acute-phase reactants: removes free hemoglobin from circulation

Answer 105

haptoglobin

Question 106

acute-phase reactants: converted to fibrin to heal the injury

Answer 106

fibrinogen

Question 107

acute-phase reactants: family of serine protease inhibitors synthesized in the liver, deficiency causes premature loss of elasticity in the lung and liver damage

Answer 107

alpha-1 antitrypsin

Question 108

acute-phase reactants: principal copper-transport protein, vital in aerobic energy production, collagen formation, and protection against superoxide ions

Answer 108

ceruloplasmin

Question 109

deficiency of ceruloplasmin

Answer 109

wilson disease

Question 110

acute-phase reactants: protease inhibitor, complexes are phagocytized by macrophages and fibroblasts

Answer 110

alpha-2 macroglobulin

Question 111

phagocytic cells that process antigen and express it on the cell surface associated with MHC class I and II molecules

Answer 111

monocyte/macrophages
dendritic cells

Question 112

nonphagocytic cells that attach to antigens in their native form, process antigens and express them on their surface associated with MHC II molecules

Answer 112

b cells

Question 113

true or false: b cell antigen receptor is monomeric IgM and IgG

Answer 113

false, IgM or IgD

Question 114

b cell surface receptors have two identical antigen-binding pockets

Answer 114

Fab portion

Question 115

t cell receptor consists of two non identical _____

Answer 115

peptides
cd3

Question 116

t helper cells have ____ on their surface that interacts with MHCII on the antigen presenting cell

Answer 116

cd4

Question 117

ctls have ___ on their surface that interacts with ___ on the antigen presenting cell

Answer 117

cd8
mhcI

Question 118

mediated by TH1 cells
monocytes and macrophages are stimulated by cytokines from TH1 cells
ctls are activated by cytokines from TH1 cells and then destroy targets by cell-to-cell contact, main function is to destroy infected cells
nk cells kill target cells without being previously sensitized

Answer 118

cell-mediated immunity

Question 119

subset of T helper cells that secrete cytokines that activate other cells involved in the response

Answer 119

TH1 cells

Question 120

b cell activation begins when antigen binds to antibody on B cell surface and the antigen is internalized and linked to an MHC II molecule on the cell’s surface

Answer 120

humoral mediated immunity

Question 121

antibodies can be produced that recognize an unlimited number of antigens but there are a limited number of B cells
due to recombination events that occur during b cell maturation

Answer 121

antibody diveristy

Question 122

produce antibodies with the same specificity of antibodies that were on the surface of the b cell

Answer 122

plasma cells

Question 123

produced when host first encounters antigen
no antibody is produced for about 5-7 days
during this time, the host is producing plasma cells that will secrete antibodies
antibody production starts, slowly peaks, levels off then declines

Answer 123

primary antibody response

Question 124

first antibody produced during the primary antibody response

Answer 124

IgM

Question 125

produced after the host has previously been exposed to an antigen
short lag phase (3-5 days)
higher antibody concentration
IgG produced due to class switching, and persists longer in circulation than IgM

Answer 125

secondary antibody response

Question 126

cytolytic effector cells can lyse antibody coated target cells if there is direct contact

Answer 126

antibody-dependent cell-mediated cytotoxicity

Question 127

occurs when an an individual produces antibodies or a t cell response to his/her own antigens
there is a loss of self-tolerance
antibody-cell surface component interaction > formation of autoantigen-autoantibody complexes > sensitization of t cells

Answer 127

autoimmune disease

Question 128

diseases and conditions associated with hla types: HLA-B8

Answer 128

graves disease
type I disease

Question 129

diseases and conditions associated with hla types: HLA-DR2

Answer 129

SLE
multiple sclerosis
hashimoto disease
myasthenia gravis

Question 130

diseases and conditions associated with hla types: HLA-DR3

Answer 130

sjogren syndrome
myasthenia gravis
SLE
graves disease
type I disease

Question 131

diseases and conditions associated with hla types: HLA-DR4

Answer 131

rheumatoid arthritis
type I diabetes
pemphigus vulgaris

Question 132

autoimmune theories: burnet postulated that when an error in self-recognition occurs during the fetal life and lymphocytes against an autoantigen are not destroyed, then autoantibodies are produced

Answer 132

forbidden-clone theory

Question 133

autoimmune theories: clones developed during fetal life are not stimulated by low doses of antigens. the ability to produce antibodies against higher doses of antigens is still preset

Answer 133

clonal energy

Question 134

autoimmune theories: some antigens are hidden from the immune system during fetal development. when the tissue is damaged, the “hidden cells” are exposed to the immune system and antibodies are produced against these cells

Answer 134

sequestered-antigen theory

Question 135

autoimmune theories: suppressor t cells control antibody production by b cells. if suppressor t cell exhibit decreased activity, then antibodies against autoantigens are produced

Answer 135

immunologic deficiency theory

Question 136

autoimmune theories: an individual can make antibodies or reactive t cells to an infectious agent that cross react with self-antigens

Answer 136

molecular mimicry

Question 137

autoimmune theories: a number of bacteria and viruses are known to non specifically stimulate b cells. if these b cells have activity against self antigens, an autoimmune disease

Answer 137

polyclonal b cell activation

Question 138

diagnostic tests for non-organ specific autoimmune diseases: associated with SLE, mixed connective tissue disease and rheumatoid arthritis

Answer 138

anti-nuclear antibodies (ANA)

Question 139

techniques used to detect ANA

Answer 139

agglutination
indirect immunofluorescence
enzyme immunoassay

Question 140

interpretation of indirect immunofluorescence results: evenly stains the nuclei and is associated with anti-dna antibodies and histones

Answer 140

diffuse or homogenous

Question 141

interpretation of indirect immunofluorescence results: stains the edge of the nuclei and is associated with anti-dna antibody and antibi-lamins (proteins found in the nuclear membrane) antibody

Answer 141

peripheral

Question 142

interpretation of indirect immunofluorescence results: numerous evenly distributed stained speckles within the nuclei associated with antibodies to extractable nuclear antigen-nucleanribonucleoprotein (anti-RNP) and anti-smith

Answer 142

speckled

Question 143

interpretation of indirect immunofluorescence results: stains two or three large areas within the nucleus and is associated with anti-RNP antibody

Answer 143

nucleolar

Question 144

interpretation of indirect immunofluorescence results: stains as a discrete speckled pattern due to anti-centromere antibody

Answer 144

centromere

Question 145

autoantibodies and associated disorders: centromere

Answer 145

CREST (calcinosis cutis, raynaud syndrome, esophageal hypomotility, sclerodactyly and telangiectasia) syndrome

Question 146

autoantibodies and associated disorders: dsDNA

Answer 146

found in SLE and low titers found in rheumatoid arthritis and sjogren syndrome

Question 147

autoantibodies and associated disorders: histone

Answer 147

drug-induced SLE

Question 148

autoantibodies and associated disorders: nuclear RNP

Answer 148

SLE and mixed connective tissue disease

Question 149

autoantibodies and associated disorders: Scl-70

Answer 149

scleroderma (systemic sclerosis)

Question 150

autoantibodies and associated disorders: Sjogren syndrome A (SSA [Ro])

Answer 150

sjogren syndrome and SLE

Question 151

autoantibodies and associated disorders: Sjogren syndrome B (SSA [LA])

Answer 151

sjogren syndrome and SLE

Question 152

autoantibodies and associated disorders: Sm

Answer 152

diagnostic for SLE (high specificity) if present but low sensitivity

Question 153

diagnostic tests for non-organ specific autoimmune diseases: anti-antibody, typically IgM, that binds the Fc portion of IgG; usually detected by latex agglutination, positive for 75% of patients with rheumatoid arthritis and also noted in chronic hepatitis, SLE and syphilis

Answer 153

rheumatoid factor (RF)

Question 154

diagnostic tests for non-organ specific autoimmune diseases: proteins that reversibly precipitates at 4degC, and associated with autoimmune diseases such as vasculitis, glomerulonephritis, SLE, RA and sjogren syndrome

Answer 154

cryoglobulins

Question 155

chronic, non infectious inflammatory disease involving many organs
more likely to occur in women than men and in black than whites
tissue injury is caused by autoantibodies and immune complexes deposited in the tissues
depressed suppressor T cell function allows production of antibodies against self
symptoms include fever, weight loss, malaise, weakness, arthritis, skin lesions, photosensitivity, butterfly rash, renal disease, pericarditis, seizures, ocular changes, pancreatitis, and small-vessel vasculitis

Answer 155

SLE

Question 156

chronic, non infectious, systemic inflammatory disease that primarily affects the joints
women are affected 2-3 times more often than men
due to production of IgM antibodies against IgG in the synovium > immune complexes form > activates complement > inflammatory response proceeds and damages the synovium > attract neutrophil and macrophages to the joint that degranulate and contribute to tissue destruction
symptoms: fatigue, weight loss, weakness, mild fever, anorexia, morning stiffness, joint pain, vasculitis, rheumatoid nodules
lab: elevated ESR, elevated CRP, positive RF, cryoglobulins and sometimes ANAs, synovial fluid is cloudy with a WBC count between 5000-20,000/microliters, elevated protein, poor mucin clot development, decreased complement and positive RF

Answer 156

rheumatoid arthritis

Question 157

an inflammation of the salivary and lacrimal glands causing dryness of the mouth and eyes
lab: polyclonal hypergammaglobulinemia, autoantibodies against the salivary glands and positive RF, ANA (speckled or diffuse pattern), anti-SSA and anti-SSB

Answer 157

sjogren syndrome

Question 158

increased rate of RBC destruction
results in a normocytic, normochromic anemia
autoantibody is directed against RBC antigens
lab: positive direct antiglobulin test and sometimes cold agglutinins

Answer 158

autoimmune hemolytic anemia

Question 159

humoral and cellular immunity are activated and destruction of normal thyroid tissue leads to hypothyroidism, loss of thyroid function and low levels of thyroid hormone in the blood
antithyroid antibodies detected include antithyroglobulin, antithyroid peroxidase (microsomal antigen), and second colloid antigen (CA-2)

Answer 159

hashimoto disease

Question 160

hyperplasia and diffuse goiter caused by autoantibody reacting with thyroid receptor on cells that overstimulates the thyroid gland
autoantibody mimics the activity of thyroid stimulating hormone
thyrotoxicosis results from overstimulation; both free and total T3 and T4 are elevated and TSH is decreased
symptoms: exophthalmos and infiltrative dermopathy

Answer 160

graves disease

Question 161

neuromuscular disease in which the nerve muscle do not function normally
most patients exhibit antibodies to acetylcholine receptors
autoantibodies block nerve impulses and can initiate damage to neurons

Answer 161

myasthenia gravis

Question 162

considered a chronic progressive inflammatory disease with demyelinization of the nerves
active lesion contains CTLs, helper T cells and macrophages
most patients have increased IgG concentrations in the cerebrospinal fluid
oligoclonal bands in CSF on high resolution electrophoresis are also indicative

Answer 162

multiple sclerosis

Question 163

islet cell destruction in the pancreas results in insulin-dependent
autoantibodies and CTLs reactive against pancreatic beta cells produce marked atrophy and fibrosis of the islet cells > insulin deficiency
viruses can trigger autoantibody production by molecular mimicry

Answer 163

type I diabetes

Question 164

overreactive immune responses to innocuous substances on re-exposure that can result in tissue damage
involve humoral (types I-III) and cell-mediated (IV) responses

Answer 164

hypersensitivity

Question 165

classified as an immediate hypersensitivity reaction because it occurs within minutes after re-exposure to an allergen
after the first exposure, basophils and mast cells are sensitized with IgE, upon second exposure, IgE binds to a specific allergen and chemical mediators are released from those cells (degranulation), which causes allergic symptoms

Answer 165

type I hypersensitivity reaction

Question 166

systemic form of the type I hypersensitivity
shock or edema of the upper respiratory tract

Answer 166

anaphylaxis

Question 167

type I hypersensitivity mediators: causes contraction of bronchioles and smooth muscle of blood vessels, increases capillary permeability, increases mucus secretion int he airway

Answer 167

histamine

Question 168

type I hypersensitivity mediators: cause vasodilation and increased vascular permeability

Answer 168

prostaglandins

Question 169

type I hypersensitivity mediators: erythema and wheal formation, 30-1000 times the ability of histamine to cause bronchospasm and also stimulate mucus secretion in the airways

Answer 169

leukotrienes

Question 170

methods used to measure total serum IgE levels

Answer 170

competitive radioimmunosorbent test (RIST)
non competitive RIST
double-antibody radioimmunoassay (RIA)
sandwich enzyme-linked immunosorbent assay (ELISA)

Question 171

due to IgG or IgM antibodies directed against cell surface antigens
immediate hypersensitivity reaction
antibody-mediated tissue damage: PMNs bind to antibody-sensitized cells and destroy the cells by phagocytosis or antibody-dependent cellular cytotoxicity reaction
complement-mediated cell lysis: antibody-antigen complex on cell surface activates the complement pathway to cause lysis
incompatible blood transfusion
damage to sensitize tissue cells causes inflammation which, in turn causes damage to normal tissue cells

Answer 171

type II hypersensitivity

Question 172

immune complex reactions, immune complexes are deposited on tissue causing inflammation
immediate hypersensitivity reaction
circulating immune complexes
SLE, RA, serum sickness, arthus reaction

Answer 172

type III hypersensitivity

Question 173

two sites where immune complexes are often deposited in type III hypersensitivity

Answer 173

heart valves
renal glomerulus

Question 174

type III hypersensitivity: an allergen injected intradermally

Answer 174

arthus reaction

Question 175

type III hypersensitivity: patients develop antibodies against heterologous serum proteins

Answer 175

immune complex disorders

Question 176

type III hypersensitivity: immune complexes are deposited on renal glomeruli, causing inflammation of the kidney and possibly renal failure

Answer 176

glomerulonephritis

Question 177

type III hypersensitivity: inflammation of the blood vessel wall

Answer 177

vasculitis

Question 178

caused by soluble factors or lymphokines released by T cells > antibody and complement are not involved in this reaction
lymphokines are produced by T cells
these chemicals attract macrophages that become activated, causing them to degranulate
as more macrophages arrive at the site, ulceration and necrosis occur

Answer 178

type IV hypersensitivity

Question 179

subcutaneous injection of tuberculosis antigen is sued as a diagnostic skin test
swelling occurring at the site within 24-72 hours indicates previous infection

Answer 179

tuberculin-type hypersensitivty

Question 180

allergens from poison ivy and poison oak cause sensitization resulting in edema in the skin with the formation of microvesicles and itching on subsequent exposure

Answer 180

contact sensitivity (dermatitis)

Question 181

marked deficiency of all classes of Ig is detected after about 6 months of age
recurrent, life-threatening infections occur with encapsulated influenzae, manifested as pneumonia, sinusitis, bronchitis, otitis, furunculosis, meningitis, and septicemia
b cells are markedly decreased or absent

Answer 181

bruton x-linked agammaglobulinemia

Question 182

x-linked genetic disease
serum IgM is increased; IgG and IgA are markedly decreased or absent
defect in CD40 ligand on T helper cells prevents class switching from IgM to IgG, IgA or IgE
affected individuals are prone to respiratory tract infections, often have autoantibodies to platelets, red blood cells and neutrophils

Answer 182

hyper IgM syndrome

Question 183

patients present with small amounts or absence of serum and secretory IgA
usually caused by a genetic defect or by drugs (phenytoin and penicillin)
anaphylaxis may result if IgA is administered to someone with this deficiency

Answer 183

selective IgA deficiency

Question 184

autosomal recessive disorder that presents with ataxia, telangiectasia, recurrent sinopulmonary infections, a high incidence of malignancy, and variable immune defects
typically present with an IgA and sometimes IgE deficiency
defect in a kinase gene that regulates the cell cycle
b and t helper cells are affected

Answer 184

ataxia-telangiectasia

Question 185

because T cells are involved in both humoral and cell mediated responses, individuals with ____ can have a severe combined immunodeficiency

Answer 185

T helper deficiencies

Question 186

hypocalcemic tetany, due to underdevelopment of the thymus and heart disease
immune defect is variable, from slight decrease in T cells to no T cells in the bloodstream
very susceptible to opportunities infections and have a poor prognosis

Answer 186

congenital thymic hypoplasia
digeorge syndrome

Question 187

group of diseases with different causes, that affect T and B cell function, resulting in a suppression of humoral and cell mediated immune responses

Answer 187

severe combined immune deficiency

Question 188

absence of these enzymes causes an accumulation of nucleotide metabolites in all cells which is particularly toxic to T and B cells
very low number of T cells is present, and children often have an underdeveloped thymus-lack of tonsil or lymph nodes, hypogammaglobulinemia, and lymphopenia

Answer 188

adenosine deaminase or purine nucleotide phosphorylase

Question 189

with an mhc class II deficiency, t helper cells fail to develop
patients present with hypogammaglobulinemia and no cell-mediated immune response
mhc class I deficiency is less severe
loss of ctls and response to intracellular pathogens

Answer 189

bare lymphocyte syndrome

Question 190

defect prevents t helper cells from delivering lymphokines to b cells, macrophages and other target cells
patients demonstrate eczema, thrombocytopnenic purpura, and increased risk of infection
platelets are small and defective

Answer 190

wiskott-aldrich syndrome

Question 191

protein involved with cytoskeletal reorganization necessary for delivering cytokines

Answer 191

wiskott aldrich syndrome protein

Question 192

complement deficiencies: patients with defects in early ______ such as factor D and properdin, are susceptible to infections by Neisseria meningitidis

Answer 192

alternative complement proteins

Question 193

complement deficiencies: patients with a ______ have the most severe clinical manifestations

Answer 193

c3 defects

Question 194

decline in serum immunoglobulins during the first few months of life
individuals eventually produce normal amounts of immunoglobulins

Answer 194

transient hypogammaglobulinemia

Question 195

certain viruses impair the function of the immune systems

Answer 195

human immunodeficiency virus
epstein barr virus
cytomegalovirus

Question 196

tremendous amounts of several classes of immunoglobulins to several specific antigens are produced, resulting in a broad spike in the gamma region on serum protein electrophoresis

Answer 196

polyclonal hypergammaglobulinemia

Question 197

causes of polyclonal hypergammaglobulinemia

Answer 197

infectious diseases
inflammatory responses
liver disease

Question 198

malignant transformation of a clone of b cells that produce identical antibodies
narrow peak on serum protein electrophoresis

Answer 198

monoclonal hypergammaglobulinemia

Question 199

lymphoproliferative disease in which plasma cells produce a high concentration of immunoglobulin
approximately 50% of patients have Bence Jones proteins
weakness, anorexia, weight loss, skeletal destruction, plasma cell infiltrate in bone marrow

Answer 199

multiple myeloma

Question 200

light chain fragments

Answer 200

bence jones proteins

Question 201

diagnostic of multiple myeloma, waldenstrom macroglobulinemia, chronic lymphocytic leukemia or lymphoma
immunoglobulin type determination is necessary for diagnosis and prognosis

Answer 201

monoclonal immunoglobulins (m protein)

Question 202

uncontrolled proliferation of a clone of b cells that synthesize a homogenous IgM
cause unknown
hyperviscosity of plasma causes heart failure, headache dizziness, partial or total loss of vision, bleeding and anemia
weakness, fatigue, headache and weight loss
lab: a spike in the beta or gamma region on serum protein electrophoresis, increased plasma viscosity, and abnormal accumulation of lymphoid cells in the bone marrow and tissues

Answer 202

waldenstrom macroglobulinemia

Question 203

non structural protein that becomes insoluble after an alteration in its secondary structure

Answer 203

amyloid protein

Question 204

monoclonal plasma cell disorder in which abnormal immunoglobulin or bence jones protein or less commonly heavy chain fragment is produced
insoluble proteins are deposited in some of the tissues: skin, liver, nerves, heart, kidney
results in progressive loss of organ function
lab: frequent abnormalities of serum Ig and presence of bence jones proteins

Answer 204

primary amyloidosis

Question 205

transfer of tissue from one site to another within an individual

Answer 205

autograft

Question 206

transfer of tissue between genetically identical individuals

Answer 206

isograft (syngraft)

Question 207

transfer of tissue between two genetically non identical individuals of the same species

Answer 207

allograft

Question 208

transfer of tissue between two individuals of different species

Answer 208

xenograft

Question 209

revascularization and healing lead to a repaired site in about 2 weeks

Answer 209

graft acceptance

Question 210

first time a graft is encountered, the immune system attacks and ultimately destroys (rejects) the nonself tissue
occurs 10-14 days after transplantation

Answer 210

first set rejection

Question 211

the second time non self tissue with the same or similar antigens is encountered
rejected within 6 days

Answer 211

second set rejection

Question 212

clinical indications of graft rejection: occurs within 24 hours of transplantation
rejection is caused by a pre-existing antibody to antigens on the grafted tissue
tissue never becomes vascularized
caused by ABO blood group antibodies and MHC class I antibodies

Answer 212

hyperacute rejection

Question 213

clinical indications of graft rejection: occurs within weeks of transplantation
due to cell-mediated response
histopathology reveals massive infiltration of lymphocytes and macrophages

Answer 213

acute rejection

Question 214

clinical indications of graft rejection: occurs months to years after transplantation
mechanisms of rejection include both humoral-mediated and cell-mediated immunity

Answer 214

chronic rejection

Question 215

abnormal mass of tissue that results from the uncontrolled growth of normal cells even after the growth stimulus is removed

Answer 215

neoplasm

Question 216

typically a mild and non progressive tumor that pushes aside normal tissue, but does not invade it, as the tumor expands

Answer 216

benign tumor

Question 217

generally consisting of poorly differentiated cells that grow rapidly and invade surrounding tissue, robbing the normal tissue of nutrients

Answer 217

malignant tumor

Question 218

secondary tumor derived from a malignant primary tumor

Answer 218

metastatic tumor

Question 219

intracellular proteins expressed on the surface of a tumor due to interaction with MHC class I and II moleculues

Answer 219

tumor-specific peptides

Question 220

occurs when macrophages come in close contact with tumor cells

Answer 220

macrophage-mediated cytotoxicity

Question 221

kills those cells with mutations leading to decreased MHC class I products expressed on their surfaces

Answer 221

NK cells

Question 222

antibodies can be produced to antigens found on the surface of tumor cells, which then can be lysed by complement activation or antibody dependent cellular cytotoxicity reactions involving NK cells, PMNs and macrophages

Answer 222

humoral-mediated immunity

Question 223

activates t cells, b cells and nk cells and induces a fever

Answer 223

IL-1

Question 224

destroys tumor cells

Answer 224

TNF alpha

Question 225

produced by activated t cells and nk cells

Answer 225

INF-gamma

Question 226

glycoproteins found in small amounts in normal serum but elevated in certain types of cancers
used to screen for cancer but more commonly are used to monitored therapeutic response or to determine tumor burden

Answer 226

tumor markers

Question 227

used in management of gastrointestinal tumors (colon cancers) and adenocarcinomas of the colon, pancreas, liver and lungs
can also be found in inflammatory bowel disease, ulcerative colitis, crohn disease, polyps tumors of the GI tract, and cigarette smokers

Answer 227

carcinoembryonic antigen (CEA)

Question 228

produced during embryonic and fetal development
high in patients with hepatocellular carcinoma, hepatoblastoma, testicular and ovarian cancer
can also be elevated in viral hepatitis, cirrhosis and ulcerative chelitis
temporary marker for monitoring cancer therapy

Answer 228

alpha fetoprotein (AFP)

Question 229

composed of two subunits: alpha and beta
found in serum and urine during pregnancy
may be produced by neoplastic cells of testicular cancer and various other tumors
levels are useful in evaluating patients with gestational trophoblastic disease, testicular tumors and ovarian germ cell tumors

Answer 229

human chorionic gonadotropin (hCG)

Question 230

glycoprotein that dissolves seminal gel formed after ejaculation
normal prostate tissue contains this but it is present in extremely low amounts in blood
increased in prostrate cancer, benign prostatic hypertrophy, and acute or chronic prostatitis
levels correlate with prostrate size, stage of prostate cancer and response to treatment
used to screen for prostate cancer in conjunction with a digital rectal examination

Answer 230

prostate specific antigen (PSA)

Question 231

antigen-antibody interactions: positively charged portions of one molecule are attracted to negatively charged portions of another molecule
affected by the pH and ionic strength of the environment
increases as the two molecules get closer together

Answer 231

electrostatic force or ionic bonding

Question 232

antigen-antibody interactions: binds to an electronegative atom such as oxygen or nitrogen
weak bond, but it contributes greatly to the antigen-antibody interaction
maximum binding strength occurs below 37degC

Answer 232

hydrogen bonding

Question 233

antigen-antibody interactions: attraction between non polar groups
non polar groups tend to aggregate to reduce surface area, and this increased the strength of the bond

Answer 233

hydrophobic bonding

Question 234

antigen-antibody interactions: a weak, attractive force between an electron orbital of one atom and the nucleus of another atom

Answer 234

van der waals force

Question 235

antigen-antibody interactions: strength of interaction between an antibody binding site and a single epitope

Answer 235

affinity

Question 236

antigen-antibody interactions: describes whether the antigen-antibody complex is highly complementary, and therefore would not bind readily

Answer 236

affinity constant

Question 237

antigen-antibody interactions: affinity for multivalent antigens and multiple antibodies to combine; the extent of bindings capacity
greater than the cumulative affinity constants for all antigen-antibody pairs

Answer 237

avidity

Question 238

antigen-antibody interactions: antibody’s greatest affinity for a particular antigen

Answer 238

specificity

Question 239

antigen-antibody interactions: occurs when the antibody combines with an antigen that is structurally similar to the immunogen that stimulated the antibody production or the antigen that the antibody has the greatest affinity

Answer 239

cross reactivity

Question 240

assays involving antibody-antigen reactions

Answer 240

immunoassays

Question 241

soluble antigen and soluble antibody reacts to form an insoluble product, such as gel diffusion, radial immunodiffusion, immunoelectrophoresis, immunofixation, nephelometry and turbidity

Answer 241

precipitation reaction

Question 242

soluble antibody reacts with insoluble antigen or soluble antigen reacts with insoluble antibody; reactants are made insoluble by combining with latex particles, rbcs, dyes, liposomes

Answer 242

agglutination

Question 243

antigen-antibody interactions: a label producing a measurable end product is attached to an antibody or antigen; labels include fluorochromes, enzymes, chemiluminescent molecules, and radionuclides

Answer 243

labeled reaction

Question 244

precipitation reactions: maximum precipitation occurs when the concentration of the antigen and antibody are about equal

Answer 244

zone of equivalence

Question 245

precipitation reactions: occurs when excess amount of antibody is present, and the antigen and antibody do not combine to form precipitates - the complexes remain soluble; results in a false negative result

Answer 245

prozone

Question 246

precipitation reactions: occurs when excess amount of antigen is present, and the antigen and antibody do not combine to form precipitates - the complexes remain soluble; results in a false negative result

Answer 246

postzone

Question 247

types of precipitation reactions: passive diffusion of soluble antigen and antibody

Answer 247

fluid-phase precipitation

Question 248

measurement of light transmitted through a suspension of particles; formation of immune complexes decreases the amount of light passing through a suspension
the more immune complexes are formed, and the larger they are, the greater the decrease in light able to pass through

Answer 248

turbidimetry

Question 249

direct measure of light scattered by particles suspended in solution
scattering of light is proportional to the size and the amount of immune complexes formed

Answer 249

nephelometry

Question 250

types of precipitation reactions: antigen and antibody diffuse through the agar gel and precipitate when they reach the zone of equivalence; molecular size determines the speed of travel through the gel

Answer 250

precipitation reactions in agar gel

Question 251

types of precipitation reactions: antigen and antibody are placed in wells in the gel and diffuse towards each other, when optimum concentrations are met, a precipitate line forms
can be used to determine if a specific antibody is present in serum

Answer 251

double immunodiffusion (oachterlon) technique

Question 252

types of precipitation reactions: on an agar gel plate or slide, antigen is added to one well, and antibody is added to another well
an electric current accelerates the movement of the antigen and antibody toward each other, resulting in precipitation sooner than if an electric current is not applied
can be used to detect antibody to infectious agents and microbrial antigens

Answer 252

contercurrent immunoelectrophoresis

Question 253

serum urine, or CSF, is electrophoresed
antisera contained in a cellulose acetate strip are then placed on top of the electrophoresis gel
the antibodies diffuse into the electrophoresis
detects the presence of an immunoglobulin in serum or urine

Answer 253

immunofixation electrophoresis

Question 254

used to quantify antigens
antigens are electrophoresed in agar-containing antibody
a pH is selected so that the antibodies are immobile
antibody and antigen combine to form precipitates in the shape of a rocket
height is proportional to the concentration of antigen in the specimen

Answer 254

rocket immunoelectrophoresis

Question 255

occurs when particles in suspension clump together due to antibody-antigen interaction
uses an antigen or antibody attached to a particle (insoluble)

Answer 255

agglutination

Question 256

antibodies that participate in agglutination reaction

Answer 256

IgM
IgG

Question 257

this method uses antigens naturally occurring on a particle to demonstrate agglutination

Answer 257

direct agglutination

Question 258

naturally occurring process in which in virus will agglutinate RBCs by binding to surface receptors

Answer 258

viral agglutination

Question 259

technique in which soluble antigen is attached to a particle, producing agglutination with specific soluble antibody

Answer 259

passive agglutination

Question 260

a technique in which an antibody is attached to a particle, producing agglutination with a specific soluble (antigen)

Answer 260

reverse passive agglutination

Question 261

sometimes used to detect antibody in patient sera
serum is mixed with a specific known antigen
if antibody to the antigen is present, immune complexes forms
complement is added, and if an immune complex is present, it will bind the complement

Answer 261

complement fixation