Chapter 18 Immune Disorders
18.1 Multiple Choice Questions
1) Which of the following is NOT considered a hypersensitivity reaction?
A) a rash caused by poison ivy
B) immune system attack on the thyroid gland
C) itchy eyes and a runny nose in a dusty environment
D) dermatitis at the site of a metal watchband
E) breaking into hives after eating strawberries
2) Which of the following immunoglobulins is produced by plasma cells in response to an
allergen?
A) IgA
B) IgD
C) IgE
D) IgG
E) IgM
3) Which of the following reactions is the result of type IV (delayed) hypersensitivity?
A) runny nose triggered by pollen
B) dermatitis in response to latex gloves
C) sensitivity to pet dander
D) skin irritation after wearing wool
E) breathing difficulties after exposure to mold spores
4) The non-leukocyte tissue cells known as ________ produce leukotrienes and prostaglandins
in response to allergen binding.
A) neutrophils
B) basophils
C) monocytes
D) lymphocytes
E) mast cells
5) Which of the following is an example of a type I hypersensitivity reaction?
A) watery eyes after exposure to animals
B) destruction of red blood cells after an incompatible blood transfusion
C) farmer’s lung
D) immune complexes accumulation in the kidneys
E) the tuberculin response
6) When mast cells degranulate and release histamine, which of the following events may
occur?
A) constriction of small blood vessels
B) bronchial spasms
C) increased mucus production
D) both constriction of small blood vessels and bronchial spasms
E) both bronchial spasms and increased mucus production
7) The release of ________ during a type I hypersensitivity reaction contributes to swelling.
A) histamine
B) prostaglandins
C) leukotrienes
D) both histamines and leukotrienes
E) both proteases and prostaglandins
8) Which of the following bind the constant region of IgE?
A) eosinophils
B) mast cells
C) monocytes
D) both mast cells and monocytes
E) both eosinophils and mast cells
9) What is the function of the kinins released when mast cells degranulate?
A) activation of the complement system
B) increased vascular permeability
C) smooth muscle contraction
D) increased production of tears and saliva
E) chemotactic factors
10) Jess has A- blood type, has never received a blood transfusion, and never been pregnant.
Antibodies against what blood antigens could be present in Jess’ blood?
A) O and Rh antigens
B) B antigens
C) A antigens
D) B and Rh antigens
E) O antigens
11) How is hemolytic disease of the newborn prevented?
A) immunizing a woman against Rh factor prior to pregnancy
B) administering anti-IgG antibodies during pregnancy
C) treating with cytokines to prevent B cell activation late in pregnancy
D) administering anti-Rh IgG late in pregnancy and after pregnancy ends
E) treating with glucocorticoids throughout pregnancy
12) Transfusion reactions are the result of antibody reaction to
A) glycolipids and glycoproteins on the surface of red blood cells.
B) MHC molecules on red blood cells.
C) MHC molecules on white blood cells.
D) plasma proteins.
E) foreign antibodies.
13) An accident victim receives a blood transfusion. Shortly thereafter, he begins to have
difficulty breathing, develops a fever, and experiences nausea and vomiting. Which of the
following is the most likely interpretation of these events?
A) The blood transfusion was mismatched.
B) The blood transfusion contained pyrogens.
C) The recipient had previously been exposed to foreign blood group antigens.
D) The blood transfusion was mismatched and contained pyrogens.
E) The blood transfusion was mismatched and the recipient had previously been exposed to the
foreign blood group antigens.
14) Which of the following statements concerning the Rh factor is CORRECT?
A) The Rh antigen is on white blood cells.
B) Eighty-five percent of humans are Rh positive.
C) Preexisting antibodies occur in 85% of the population.
D) Rh antibodies are more abundant than the ABO antibodies.
E) Eighty-five percent of the human population is Rh negative.
15) Which of the following could result in hemolytic disease of the newborn?
A) Rh-negative mother and Rh-negative father
B) Rh-positive mother and Rh-positive father
C) Rh-positive mother and Rh-negative father
D) Rh-negative mother and Rh-positive father
E) either Rh-positive mother and Rh-negative father or Rh-negative mother and Rh-positive
father
16) An agricultural worker experiences difficulty breathing which becomes progressively
worse. Tests show inflammation and damage of the lung tissue, but IgE antibodies and
granulocytes are in the normal ranges. With which disorder of the immune system are these
signs and symptoms consistent?
A) allergic reaction
B) type III (immune complex-mediated) hypersensitivity
C) type IV (delayed) hypersensitivity
D) autoimmunity
E) acquired immunodeficiency
17) If circulating immune complexes are deposited in the glomeruli, the ensuing type III
hypersensitivity reaction can result in
A) allergic contact dermatitis.
B) pneumonitis.
C) kidney damage.
D) multiple sclerosis.
E) rheumatoid arthritis.
18) Which of the following is both a hypersensitivity disorder and an autoimmune disorder?
A) anaphylaxis
B) glomerulonephritis
C) graft rejection
D) hemolytic disease of the newborn
E) rheumatoid arthritis
19) A small amount of antigen is injected under the skin of a patient. After 30 minutes there is
no apparent change at the injection site, but 36 hours later the patient reports that the area is red
and swollen. This type of response is due to
A) type I hypersensitivity.
B) type II hypersensitivity.
C) type III hypersensitivity.
D) type IV hypersensitivity.
E) immunodeficiency.
20) Which of the following blood types can be safely transfused into someone with O blood
type?
A) A
B) B
C) O
D) A and O
E) A, B, and O
21) A young woman comes into the clinic complaining of itchy, red skin and swelling on her
arms and legs. She had not been in any parks or wooded areas recently, but she had been
shopping. A blood sample reveals elevated levels of granulocytes. What treatment is the
physician likely to prescribe at this point?
A) corticosteroids
B) cyclophosphamide
C) interferon
D) methotrexate
E) antihistamines
22) If a T cell is exposed to a “hidden” antigen, what kind of immune reaction will result?
A) an autoimmune disease
B) a delayed hypersensitivity reaction
C) a cytotoxic hypersensitivity reaction
D) allergic contact dermatitis
E) an allergy
23) Which hypersensitivity disorder is the result of cell-mediated response?
A) type I
B) type II
C) type III
D) type IV
E) both type I and II
24) Which of the following statements concerning rheumatoid arthritis (RA) is TRUE?
A) It occurs in humans and animals.
B) The symptoms are due to damage caused by cytotoxic T cells.
C) There is no genetic influence on the likelihood of developing RA.
D) Accumulations of antibody complexes lead to inflammation in and destruction of the joints.
E) The onset of disease is clearly correlated with having been infected with a specific microbe.
25) Primary immunodeficiency diseases
A) develop later in life.
B) are detectable close to birth.
C) may be caused by malnutrition.
D) are never associated with genetic defects.
E) are sometimes caused by severe stress.
26) Which of the following would test positive for the tuberculin response?
A) someone who has previously had tuberculosis
B) someone who has been immunized with the tuberculosis vaccine
C) someone who has previously been injected subcutaneously with tuberculin
D) someone who has been immunized with the tuberculosis vaccine or has previously had
tuberculosis
E) someone who has been immunized with the tuberculosis vaccine or previously been injected
subcutaneously with tuberculin
27) What is the underlying problem in most acquired immunodeficiencies?
A) declining cell-mediated immunity
B) declining humoral immunity
C) production of autoantibodies
D) eosinophilia
E) anemia
28) Which of the following is the mechanism of action of cyclosporine?
A) It blocks the complement cascade.
B) It blocks the activity of activated Th1 T cells.
C) It directly blocks CTL activity.
D) It interferes with activation of Th2 T cells.
E) It is an anti-inflammatory interfering with leukotriene function.
29) A child has a history of recurring serious bacterial infections. A blood sample shows
lymphocyte levels are a little below normal, and no antibodies to the pathogens are detected in
serologic tests. Based on this information, which of the following is the likeliest diagnosis for
this child?
A) Bruton-type agammaglobulinemia
B) Grave’s disease
C) severe combined immune deficiency (SCID)
D) systemic lupus erythematosus (SLE)
E) hemolytic disease of the newborn
30) The condition known as graft-versus-host disease may result after
A) a bone marrow allograft.
B) a mismatched blood transfusion.
C) a bone allograft.
D) a plasmapheresis procedure.
E) any type of allograft procedure.
31) Hypotheses explaining the development of autoimmune disease include
A) molecular mimicry.
B) genetic factors.
C) overuse of vaccines.
D) molecular mimicry and vaccines.
E) molecular mimicry and genetic factors.
32) Multiple sclerosis is
A) a type IV hypersensitivity disease in which cytotoxic T cells attack the myelin sheath of
neurons.
B) a genetic birth defect of the nervous system.
C) a type II hypersensitivity to the myelin of neurons.
D) the formation of antibodies against transplanted tissue.
E) a neurological disease due to the accumulation of immune complexes in nerves.
33) Antibody binding to receptors on the thyroid may result in
A) multiple sclerosis.
B) Graves’ disease.
C) DiGeorge syndrome.
D) type I diabetes.
E) autoimmune hemolytic anemia.
34) The tuberculin response is mediated by
A) memory T cells.
B) mast cells.
C) B lymphocytes.
D) plasma cells.
E) eosinophils.
35) Which of the following statements concerning allografts is TRUE?
A) They are the best type of transplants because they are not associated with rejection.
B) They induce strong type IV hypersensitivity reactions and must be treated with
immunosuppressive drugs.
C) They always require complete destruction of the recipient’s bone marrow cells.
D) They are impossible to perform because the antigens between donor and recipient are so
different.
E) They are the rarest type of transplants.
36) Failure of thymus development may result in
A) type I diabetes.
B) Grave’s disease.
C) Bruton-type agammaglobulinemia.
D) DiGeorge syndrome.
E) chronic granulomatous disease.
37) Type I diabetes is a(n)
A) autoimmune disease.
B) immunodeficiency disease.
C) immune complex-mediated hypersensitivity disorder.
D) delayed hypersensitivity disorder.
E) immediate hypersensitivity disorder.
38) Treatment with glucocorticoids to suppress type IV hypersensitivity may result in
A) acquired immunodeficiency.
B) anaphylaxis.
C) autoimmune disease.
D) DiGeorge syndrome.
E) primary immunodeficiency.
39) Antigen-antibody complexes trapped in tissues and triggering complement activation or
mast cell degranulation are characteristic of
A) type I hypersensitivity.
B) type II hypersensitivity.
C) type III hypersensitivity.
D) autoimmunity.
E) graft rejection.
40) The responses observed in type IV hypersensitivities result from the action of
A) IgE antibodies and mast cells.
B) T cells and phagocytes.
C) IgG and complement.
D) autoantibodies.
E) inflammatory chemicals.
41) Graft rejection can be reduced by
A) preventing B cell activation.
B) antiphagocytic factors.
C) antihistimines.
D) preventing T cell proliferation.
E) epinephrine.
42) Opportunistic infections typical of AIDS but rare otherwise include
A) tuberculosis.
B) Pneumocystis pneumonia.
C) Kaposi’s sarcoma.
D) tuberculosis and shingles.
E) Pneumocystis pneumonia and Kaposi’s sarcoma.
43) The syndrome known as AIDS is characterized
A) by the presence of HIV.
B) as an opportunistic disease resulting from herpesvirus reactivation.
C) by CTL attack on CD4 T cells.
D) by one or more opportunistic diseases and the presence of HIV.
E) by the presence of anti-HIV antibodies.
44) Primary immunodeficiency diseases may be the result of
A) development of food allergies.
B) genetic defects of immune system development.
C) infection with HIV.
D) exposure to environmental toxins.
E) treatment with immunosuppressive drugs.
45) Systemic lupus erythematosus (SLE or lupus) is distinct from other autoimmune disorders
because
A) it is also a hypersensitivity disorder.
B) it involves an antibody response.
C) multiple organs and tissues are affected.
D) it may be triggered by an infection.
E) there is a genetic predisposition.
18.2 True/False Questions
1) Normally, complement-activating immune complexes are eliminated from the body by
phagocytosis.
2) Individuals with AB blood type are called “universal donors” because they do not have
antibodies against blood group antigens.
3) MHC genes are significant genetic factors in predisposition to develop autoimmune disease.
4) The tuberculin response is an example of allergic contact dermatitis.
5) Children with Bruton-type agammaglobulinemia are highly susceptible to recurrent
infections.
6) Systemic lupus erythematosus (SLE) is a disease resulting from accumulation of immune
complexes in various organs and tissues.
7) If an Rh-positive woman marries an Rh-negative man, their children are at risk for hemolytic
disease of the newborn.
8) Infection with certain viruses may lead to the development of type I diabetes.
9) Xenografts are tissue transplants from one individual to another within the same species.
10) All autoimmune diseases have a genetic cause.
1) Contact dermatitis is a type (I/II/III/IV) hypersensitivity disorder.
2) Rheumatoid arthritis is a type (I/II/III/IV) hypersensitivity reaction that results when B cells
produce autoantibodies that damage the joints.
3) Although autoantibodies to nucleic acids are characteristics of (HIV/RA/SLE), many other
autoantibodies are produced.
4) Critically low levels of CD4 lymphocytes are a key diagnostic indicator of (AIDS/MS/SLE).
5) Type I hypersensitivity reactions are also commonly known as
(allergies/autoimmunities/inflammation).
6) Binding of IgE to the surface of sensitized cells leads to (activation/degranulation/lysis) of
the cell, releasing many inflammatory chemicals.
7) Many of the signs and symptoms of inflammation, including redness and itching, are due to
the release of (histamines/leukotrienes/proteases) by degranulation of mast cells.
8) When the release of chemicals in an allergic reaction exceeds the body’s ability to adjust, a
life-threatening condition called (anaphylaxis/autoimmunity/inflammation) may occur.
9) Stress may result in the production of (corticosteroids/leukotrienes/interleukins), which may
lead to acquired immunodeficiency disease.
10) The damage caused by mismatched blood transfusions results from the activation of
(antibody/complement/histamine) proteins.
11) The mechanism of action of RhoGAM is to (activate/neutralize/prevent) an anti-Rh
immune response.
12) The most common type of transplant involves an (allograft/autograft/isograft).
13) Graves’ disease is an autoimmune disease that affects the (lymph/thyroid/adrenal) gland.
14) Immunological attack on the islets of Langerhans resulting in the inability to produce
insulin leads to type (I/II/IV) diabetes Mellitus.
15) Chronic granulomatous disease is a disorder of the (first/second/third) line of immune
defense.
18.4 Essay Questions
1) Compare and contrast type I hypersensitivity with type IV hypersensitivity with respect to
reaction time, mediators, and cells involved.
2) In the wake of the recent Ebola outbreak in West Africa, researchers have observed
infectious Ebola virus is present in the eyes and semen of infected individuals months after
apparent recovery from the acute stage of the disease. Based on information in this chapter,
propose an explanation for this observation.
3) A patient arrives at a hospital suffering from serious difficulty breathing and shortness of
breath. Initial tests indicate none of the standard respiratory infectious agents are present. The
physician suspects an immune disorder. What clinical indicators would distinguish between
asthma, pneumonitis and Pneumocystic pneumonia?
4) One of the important inherited defects in the second line of immune defense is a condition
called chronic granulomatous disease. What is this disease, and how is it caused?
5) Describe the tuberculin response and identify the type of response involved.