Microbiology: An Introduction, 13e (Tortora et al.)
Chapter 19 Disorders Associated with the Immune System
19.1 Multiple-Choice Questions
1) All of the following are true of hypersensitivity EXCEPT
A) it occurs in the presence of an antigen.
B) it is synonymous with “allergy.”
C) it occurs when an individual is exposed to an allergen for the first time.
D) it is due to an altered immune response.
E) it requires previous exposure to an antigen.
2) The chemical mediators of anaphylaxis are
A) found in basophils and mast cells.
B) antibodies.
C) antigens.
D) antigen-antibody complexes.
E) the proteins of the complement system.
3) Which of the following may result from systemic anaphylaxis?
A) hay fever
B) asthma
C) shock
D) hives
E) immunodeficiency
4) Which antibodies will be in the serum of a person with blood type B, Rh+?
A) anti-A, anti-B, anti-Rh
B) anti-A, anti-Rh
C) anti-A
D) anti-B, anti-Rh
E) anti-B
5) Which of the following types of transplant is least compatible?
A) autograft
B) allograft
C) isograft
D) xenotransplant
E) All of these types of transplant are equally compatible.
6) When testing donated blood for compatibility you would find a person with O type blood
A) has O type antigens on their red blood cells.
B) will lack plasma antibodies to A and B type antigens.
C) will lack A and B red blood cell antigens.
D) lacks HLA and MHC antigens.
E) will have anti-O antibodies in their plasma.
7) Graft-versus-host disease will most likely be a complication of a(n)
A) skin graft.
B) bone marrow transplant.
C) blood transfusion.
D) Rh incompatibility between mother and fetus.
E) corneal transplant.
8) A positive tuberculin skin test is an example of
A) delayed cell-mediated immunity.
B) autoimmunity.
C) acute contact dermatitis.
D) psoriasis.
E) innate immunity.
9) A healthy immune system destroys cancer cells with
A) tumor-specific antigens.
B) CTLs.
C) CTLs and activated macrophages.
D) activated macrophages.
E) CD+ T cells.
10) The symptoms of an immune complex reaction are due to
A) destruction of the antigen.
B) complement activation.
C) phagocytosis.
D) antibodies against self.
E) cytokines.
11) Rheumatoid arthritis is due to deposition of
A) IgG and IgA complexes in joints.
B) IgA antibodies in joints.
C) IgD and IgE complexes in joints.
D) complement in joints.
E) complexes of IgM and IgG and also complement in joints.
12) Allergic contact dermatitis is due to
A) sensitized T cells.
B) IgG antibodies.
C) IgE antibodies.
D) IgM antibodies.
E) activated macrophages.
13) Attachment of HIV to the target cell depends on
A) gp120 combining with the CD4+ receptor.
B) gp120 combining with the chemokine receptor CCR5.
C) gp41 binding to the CD4+ receptor.
D) gp120 binding to the CD4+ plasma membrane.
E) CXCR4 binding to the CD4+ receptor.
14) Which of the terms regarding treatments after transplantation of an organ is mismatched?
A) cyclosporine-suppression of B cells.
B) cyclosporine- kidney toxicity.
C) sirolimus-inhibit cell mediated and humoral immunity.
D) basiliximab-chimeric monoclonal.
E) tacrolimus-suppression of IL-2 secretion.
15) The process of desensitization to prevent allergies involves the injection of increasing
amounts of
A) IgE.
B) IgG.
C) antihistamine.
D) antigen.
E) RhoGAM.
16) Which of the following statements about type I reactions is FALSE?
A) They involve helper T cells.
B) They involve IgE antibodies.
C) The symptoms are due to histamine.
D) Antibodies bind to mast cells and basophils.
E) The symptoms occur soon after exposure to an antigen.
17) Which of the following statements about type IV reactions is FALSE?
A) Reactions are primarily due to T cell proliferation.
B) Reactions are not apparent for a day or more.
C) Cytokines initiate tissue damage.
D) Allergic contact dermatitis is an example.
E) Hemolytic disease of the newborn is an example.
18) Table 19.1
Donor Recipient
1. AB, Rh– AB, Rh+
2. A, Rh+ A, Rh–
3. A, Rh+ O, Rh+
4. B, Rh– B, Rh+
5. B, Rh+ A, Rh+
Which blood transfusions in Table 19.1 are incompatible?
A) 2 and 5
B) 1, 2, and 3
C) 2, 3, and 5
D) 3 and 4
E) 1 and 2
19) Hemolytic disease of the newborn can result from an
A) Rh+ mother with an Rh– fetus.
B) Rh– mother with an Rh+ fetus.
C) AB mother with a B fetus.
D) AB mother with an O fetus.
E) Rh– mother and an A fetus.
20) Which is true regarding Herceptin therapy?
A) It neutralizes the growth factor EGF.
B) It acts as an immunotoxin to target and kill cancer cells.
C) It is used to treat some breast cancer patients.
D) It is a vaccine to prevent the development of cancer.
E) It is an endotoxin that stimulates TNF by macrophages.
21) Which of the following utilizes a combination of monoclonal antitumor antibody and
immunotoxin?
A) immunologic enhancement
B) immunologic surveillance
C) immunotherapy
D) immunosuppression
E) immune complex
22) All of the following are reasons why an HIV vaccine has not been developed EXCEPT
A) there is no known animal model of natural immunity for HIV infection.
B) use of a weakened virus would potentially transmit the infection.
C) small, inexpensive animals which could be used for HIV vaccine research are not available.
D) vaccines are not effective against viral infections.
E) HIV has a high mutation rate so one vaccination would not be effective to treat the world-
wide pandemic.
23) Treatment with certain drugs to reduce transplant rejection can cause
A) immunologic enhancement.
B) immunologic surveillance.
C) immunotherapy.
D) immunosuppression.
E) autoimmunity.
24) The reasons for investigating stem cells to replace damaged organs and tissues in a patient
include all of the following EXCEPT
A) the patient will not reject tissues produced with their stem cells.
B) adult stem cells can be successfully induced to develop into some specifically needed cell
types.
C) embryonic stem cells can be coaxed into developing into any cell type in the body.
D) umbilical cord blood cells are less likely to cause GVHD than adult stem cell grafts.
E) pluripotent stem cells naturally occur even late in life in mammals.
Figure 19.1
25) In immune complex reaction shown in Figure 19.1, what is the small, circular/spherical
structure labeled “a”?
A) antibody
B) antigen
C) complement
D) neutrophil
E) mast cell
26) In immune complex reaction shown in Figure 19.1, what is the end result of the reaction?
A) IgG is directed against cell membrane antigens.
B) Complement is activated.
C) Neutrophils are attracted and release enzymes.
D) Endothelial cells are damaged.
E) Antibodies destroy neutrophils.
27) Worldwide, the primary method of transmission of HIV is
A) heterosexual intercourse.
B) homosexual intercourse.
C) intravenous drug use.
D) blood transfusions.
E) nosocomial.
28) HIV spikes attach to CD4+ receptors found on
A) T helper cells.
B) macrophages.
C) dendritic cells.
D) T helper cells and macrophages.
E) T helper cells, macrophages, and dendritic cells.
29) Which of the following is the least likely vaccine against HIV?
A) attenuated virus
B) glycoprotein
C) protein core
D) subunit
E) All of these vaccines are equally likely.
30) Which of the following is a possible outcome of an HIV infection?
A) Virions may remain latent.
B) There may be persistent yeast infections.
C) Infection may initially be asymptomatic.
D) The disease does not progress to AIDS.
E) All of the answers are correct.
31) Which of the following regions has the greatest distribution of HIV infection and AIDS in
the world?
A) North America
B) Eastern Europe and Central Asia
C) South and Southeast Asia
D) sub-Saharan Africa
E) Latin America
32) Chemotherapy to inhibit the progression of HIV infection utilizes all of the following
mechanisms EXCEPT
A) termination of viral DNA.
B) inhibition of viral proteases.
C) blockage of viral attachment.
D) prohibition of viral integration into host cell DNA.
E) destruction of viral ribosomes.
33) Detecting HIV antibodies during HIV infection
A) is not possible due to immunosuppression during infection.
B) is used to diagnose infection.
C) is possible after a few weeks after infection.
D) is possible after a few weeks and is used to diagnose infection.
E) can occur during phase 2 and 3 of infection.
34) Anaphylaxis is the term for reactions caused when certain antigens combine with
A) IgE antibodies.
B) macrophages.
C) IgG antibodies.
D) complement.
E) histamine.
35) All of the following regarding “immune privileged sites” are true EXCEPT
A) they include corneal and brain tissue.
B) they do not have lymphatic vessels.
C) they are rarely rejected.
D) they include any tissue transplanted from a pig.
E) they explain how animals tolerate pregnancies without rejecting the fetus.
36) All of the following are considered examples of type I hypersensitivity EXCEPT
A) asthma.
B) dust allergies.
C) severe reactions to insect venom.
D) pollen allergies.
E) transplant rejections.
37) All of the following lead to drug-induced thrombocytopenic purpura. Which occurs first?
A) Antibodies and complement react with platelets.
B) Antibodies against haptens are formed.
C) Drug binds to platelets.
D) Platelets are destroyed.
E) Purpura occurs on the skin.
38) Immunodeficiencies are a result of all of the following EXCEPT
A) HIV infection.
B) cyclosporine.
C) DiGeorge syndrome.
D) Hodgkin’s disease.
E) corneal transplantation.
39) Which of the following describes a cytotoxic autoimmune reaction?
A) Antibodies react to cell-surface antigens.
B) Antibodies are not made.
C) Cells are killed.
D) Immune complexes form.
E) Mediated by T cells.
40) Symptoms of delayed cell-mediated reactions are due to
A) IgE antibodies.
B) neutrophils.
C) cytokines.
D) IgG antibodies.
E) antigens.
41) Desensitization involves injection of
A) antigens.
B) IgG antibodies.
C) IgE antibodies.
D) antihistamine.
E) histamine.
42) In the serological method for tissue typing, if human cells expressing HLA-I are mixed with
anti-HLA-I, complement, and trypan blue, what would indicate the cells are HLA-I?
A) Enzyme is released from neutrophils.
B) Cells are damaged by complement.
C) Trypan blue enters the cells.
D) Anti-HLA antibodies bind to HLAs on lymphocytes.
E) None of the answers are correct; the T cells are missing.
43) In rheumatoid arthritis, IgM, IgG, and complement deposit in joints. This is an example of
A) cytotoxic autoimmunity.
B) immune complex autoimmunity.
C) cell-mediated autoimmunity.
D) immunosuppression.
E) acquired immunodeficiency.
44) The number of T cells drops to below 200 cells/microliter in which phase of HIV infection?
A) phase 1
B) phase 2
C) phase 3
D) initial phase
E) asymptomatic phase
45) HIV can evade host antibodies by
A) remaining an inactive provirus.
B) causing cell-to-cell fusion.
C) remaining an inactive provirus, causing cell to cell fusion, and virions remaining latent in
vacuoles.
D) lowering the CD4+ cell count.
E) virions remaining latent in vacuoles.
46) Increases in the numbers of Kaposi’s sarcoma and Pneumocystis pneumonia cases seen in the
1980s
A) are examples of newly discovered diseases.
B) were due to increased numbers organ transplantations.
C) were examples of emerging diseases correlating with an increased population experiencing
loss of normal immune function.
D) were unusual phenomena due to climate change.
E) were typical and expected.
47) Which of the following statements is true of phase 3 HIV infection?
A) HIV in blood stabilizes at 1000-10,000 per ml of blood.
B) CD4+ cell population drops to less than 200 cells per μl of blood.
C) HIV peaks to 10 million per ml of blood.
D) asymptomatic infection.
E) Seroconversion occurs.
48) An inherited immunodeficiency is termed ________ and a secondary immunodeficiency is
also known as ________.
A) congenital; acquired
B) birth defect; inherited
C) dysgenesis; congenital
D) aplasia; SCID
E) immune syndrome; lymphoma
49) Which autoimmune diseases and terms are mismatched?
A) Multiple sclerosis – myelin sheath destruction
B) Grave’s disease – prevention of thyroid hormone production
C) Myasthenia gravis – blocked acetocholine receptors
D) Systemic lupus erythematosus – immune complex reactions
E) Rheumatoid arthritis – IgM binds Fc of IgG
50) Support for the concept that cancer arises due to a failure of the immune response is found in
all of the following statements EXCEPT
A) cancers arise more frequently in the elderly.
B) cancers occur more often in immunosuppressed individuals.
C) cancers arise in the very young more frequently than in adolescents.
D) tumor cells acquire tumor-associated antigens that stimulate cell-mediated responses.
E) development of hyperacute rejection reactions.
19.2 True/False Questions
1) Individuals who do not express CCR5 are highly resistant to infection by HIV.
2) Vaccines against HIV have proven to be very effective in halting the spread of disease.
3) All hypersensitivities involve antibody-antigen reactions.
4) Skin tests are reliable indicators for the diagnosis of food-related allergies.
5) HIV attack of CD4+ T cells causes suppression of both cell-mediated and humoral immune
responses.
6) Autoimmune diseases occur when the immune system is unable to discriminate “self” from
“nonself.”
7) Xenotransplantation is an effective alternative to using isografts.
8) All stem cells are derived from embryonic stem cells.
9) Cancer is similar to an infectious disease in that it is due to a failure of the body’s defenses.
10) HIV is believed to have arisen by mutation of a virus endemic to wild animals in Africa.
11) A hypersensitivity reaction refers to immune responses to antigens beyond what would be
normal.
19.3 Essay Questions
1) Differentiate type II from type III hypersensitivity reactions.
2) Even though AIDS is an infectious disease caused by a virus, why is it also considered an
immunodeficiency disease?
3) What is desensitization? Explain how this treatment can induce systemic anaphylaxis. How is
systemic anaphylaxis treated?
4) A health care worker had a needlestick injury while drawing blood from an AIDS patient. Lab
tests on the worker’s serum were negative. Explain why the worker can still be infected even
though her lab tests were negative. How should her health care be monitored?
5) Explain why a transplant tissue would be rejected if that tissue had different HLAs compared
to the HLAs of the recipient. How can this rejection be decreased?
6) Explain the relationship between thymic selection of maturing T cells and self-tolerance.