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CHAPTER 13
Disruption of Healthy Tissue by the Immune Response
Questions
13–1
Chronic diseases in which the immune response is targeted toward autologous entities of one’s
body are known as _____.
a. hypersensitivity reactions
b. innate immune reactions
c. allergic reactions
d. autoimmune diseases
e. anergic reactions.
13–2
Discuss why splenectomy is a viable treatment for chronic autoimmune diseases targeted at
circulating neutrophils.
13–3
Indicate whether each of the following statements is true (T) or false (F).
___ a. Autoimmune diseases are rarely resolved.
___ b. Autoimmune responses are the result of innate immune responses directed toward self
antigens.
___ c. Some forms of autoimmune disease involve IgE autoantibodies.
___ d. During pregnancy the fetus is exposed to maternal leukocytes.
___ e. Ectopic lymphoid tissue resembling secondary lymphoid tissue may develop under the
influence of lymphotoxin (LT).
13–4
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.
13–5
Which of the following is an example of a type II autoimmune response? (Select all that apply.)
a. subacute bacterial endocarditis
b. Goodpasture’s syndrome
c. multiple sclerosis
d. systemic lupus erythematosus
e. myasthenia gravis.
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13–6
Which of the following is an example of a type III autoimmune response? (Select all that apply.)
a. mixed essential cryoglobulinemia
b. acute thrombocytopenia purpura
c. systemic lupus erythematosus
d. rheumatoid arthritis
e. insulin-resistant diabetes.
13–7
Which of the following is an example of a type IV autoimmune response? (Select all that apply.)
a. pemphigus vulgaris
b. autoimmune thrombocytopenia purpura
c. subacute bacterial endocarditis
d. type 1 diabetes
e. multiple sclerosis.
13–8
Match the autoimmune disease in column I with the consequence in column II.
Column I
Column II
___ a. type 2 diabetes
1. skin blistering
___ b. rheumatoid arthritis
2. joint deterioration
___ c. mixed essential cryoglobulinemia
3. keotacidosis
___ d. acute rheumatic fever
4. heart valve scarring
___ e. pemphigus vulgaris
5. systemic vasculitis
13–9
Match the autoimmune disease in column I with the autoantigen in column II.
Column I
Column II
___ a. mixed essential cryoglobulinemia
1. thyroid-stimulating hormone receptor
___ b. myasthenia gravis
2. cell wall components of Streptococcus
___ c. Graves’ disease
3. myelin basic protein
___ d. acute rheumatic fever
4. acetylcholine receptor
___ e. multiple sclerosis
5. rheumatoid factor IgG
13–10
If autoantibodies of the IgG or IgM isotype were produced with specificity for components found
on the surface of erythrocytes, which of the following would occur? (Select all that apply.)
a. formation of membrane-attack complex
b. immune-complex deposition in renal glomeruli
c. anemia
d. hypothyroidism
e. receptor-mediated endocytosis via Fc receptors on phagocytes.
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13–11
Which of the following would be consistent with a diagnosis of Goodpasture’s syndrome?
(Select all that apply.)
a. pulmonary hemorrhage
b. joint inflammation
c. glomerulonephritis
d. anti-collagen IgG deposition in renal glomeruli
e. hyperglycemia.
13–12
Thyroid-stimulating hormone is made in the _____ and induces the release of thyroid hormones
after proteolytic processing of _____.
a. pituitary gland; thyroglobulin
b. hypothalamus; thyroxine
c. pancreas; thyroglobulin
d. pituitary gland; thyroid-stimulating hormone receptor
e. thyroid gland; thyroid peroxidase.
13–13
Graves’ disease causes _____, whereas Hashimoto’s disease causes _____.
a. hypothyroidism; hyperthyroidism
b. hyperthyroidism; hypothyroidism
c. hypoglycemia; hyperglycemia
d. hyperglycemia; hypoglycemia
e. glomerulonephtitis; systemic vasculitis.
13–14
(A) What is ectopic lymphoid tissue? (B) Give four examples where this type of tissue forms in
autoimmune disease.
13–15
How do the treatments for Hashimoto’s and Graves’ diseases differ, and why?
13–16
Which of the following are correctly matched? (Select all that apply.)
a. exocrine tissue: islets of Langerhans
b. type II diabetes: insulin-dependent diabetes mellitus
c. cells of pancreas: insulin production
d. cells of pancreas: somatostatin production
e. insulitis: lymphocyte infiltration in islets of Langerhans.
13–17
Examples of rheumatic diseases caused by autoimmune responses include _____. (Select all that
apply.)
a. rheumatoid arthritis
b. acute rheumatic fever
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c. multiple sclerosis
d. autoimmune hemolytic anemia
e. Sjögren’s syndrome
f. systemic lupus erythematosus.
13–18
Another name for anti-immunoglobulin autoantibodies is _____.
a. C-reactive protein
b. rheumatoid factor
c. rituximab
d. thyroglobulin
e. ectopic antibodies
f. infliximab.
13–19
Rituximab, used in the treatment of rheumatoid arthritis, depletes _____ through a process
involving the cross-linking of _____ on the surface of NK cells and the induction of antibody-
dependent cell-mediated cytotoxicity.
a. NK cells; NKG2D
b. T cells: NKG2D
c. inflammatory cytokines; TNF-
d. C-reactive protein; FcRIII
e. B cells; FcRIII.
13–20
Which of the following autoimmune diseases affect the nervous system? (Select all that apply.)
a. myasthenia gravis
b. mixed essential cryoglobulinemia
c. Graves’ disease
d. pemphigus vulgaris
e. multiple sclerosis.
13–21
_____ autoantibodies enhance receptor function.
a. Neutralizing
b. Opsonizing
c. Agonist
d. Complement-fixing
e. Antagonist.
13–22
Antagonistic autoantibodies made against insulin cause _____. (Select all that apply.)
a. type 1 diabetes
b. hypoglycemia
c. hyperglycemia
d. insulin-resistant diabetes
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e. light-headedness.
13–23
The primary function of the transcription factor AIRE is to _____.
a. facilitate apoptosis of self-reactive B lymphocytes in the bone marrow
b. activate the expression of tissue-specific proteins in the thymus
c. activate regulatory T cells
d. induce a state of nonresponsiveness in self-reactive T lymphocytes
e. participate in gene expression events required for positive selection of the developing T-
cell repertoire.
13–24
Deficiency in the production of AIRE results in _____. (Select all that apply.)
a. normal expression of tissue-specific proteins in the bone marrow and thymus
b. incomplete negative selection of developing T cells
c. the development of autoimmune B-cell and T-cell responses against endocrine glands and
other tissues
d. death in infancy
e. the development of autoimmune polyendocrinopathy–candidiasis–ectodermal dystrophy
(APECED).
13–25
Regulatory T cells function by _____.
a. competing for antigen and proliferating to higher numbers than autoreactive T cells
b. inducing apoptosis of autoreactive T cells
c. suppressing proliferation of naive self-reactive T cells
d. disrupting T-cell zones of secondary lymphoid tissue
e. overexpressing CD28, which blocks B7 ligands on antigen-presenting cells.
13–26
Describe two different ways in which infection with bacteria or viruses compromises T-cell
tolerance, leading to the production of effector T cells specific for self antigens.
13–27
Regulatory T cells can be distinguished from naive T cells by the expression of _____. (Select all
that apply.)
a. CD25
b. AIRE
c. FoxP3
d. CTLA-4
e. CD8.
13–28
Ankylosing spondylitis has a strong association with polymorphisms found in _____.
a. HLA-B27
b. AIRE
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c. CTLA-4
d. HLA-DQ6
e. HLA-Cw6
f. FoxP3
g. TNF-.
13–29
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.
13–30
Explain the mechanism that gives rise to a broadening B-cell response during the course of
systemic lupus erythematosus.
13–31
_____ is an example in which physical trauma provides access of lymphocytes to an otherwise
immunologically privileged site. (Select all that apply.)
a. rheumatoid arthritis
b. multiple sclerosis
c. type 1 diabetes
d. myasthenia gravis
e. sympathetic ophthalmia.
13–32
Bacterial infections are associated with which of the following autoimmune diseases? (Select all
that apply.)
a. Reiter’s syndrome
b. pemphigus vulgaris
c. reactive arthritis
d. rheumatic fever
e. myasthenia gravis.
13–33
_____ is the term used to describe how pathogen antigens resemble host antigens and can
sometimes trigger autoimmune disease.
a. intramolecular epitope spreading
b. molecular mimicry
c. intermolecular epitope spreading
d. sympathetic senescence
e. linkage equilibrium.
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13–34
(A) What is meant by the term ‘epitope spreading’? (B) Name one autoimmune disease affecting
the skin in which epitope spreading is involved, and explain how.
13–35
The upregulation of _____ by IFN- can contribute to antigen-specific T-cell activation on
thyroid epithelium.
a. CD4
b. CD8
c. HLA class I
d. HLA class II
e. CD28.
13–36
An activated autoimmune T cell can become functional upon interaction with an antigen-
presenting cell expressing _____. (Select all that apply.)
a. MHC class II and also CD4
b. MHC class I and also CTLA-4
c. MHC class I and also CD28
d. MHC class II and also B7
e. MHC class II, but not B7.
13–37
A(n) _____ is an epitope that is typically not accessible to the immune system but is revealed
under inflammatory or infectious states.
a. cryptic epitope
b. molecular mimic
c. regulatory peptide
d. carrier
e. adjuvant.
13–38
The process by which the human thymus gradually decays is known as _____.
a. apoptosis
b. senescence
c. involution
d. the hygiene hypothesis
e. self-tolerance.
13–39
The autoreactive CD4 T cells of elderly people with rheumatoid arthritis _____. (Select all that
apply.)
a. express high levels of CD28
b. are predominantly anergic
c. express KIR2DS2
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d. are highly susceptible to apoptosis in inflamed joints
e. produce IFN-.
13–40
Explain the hygiene hypothesis and its relationship to predisposition to autoimmune disease.
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Answers