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WorksheetsExam 3 Crashcourse
Total questions: 126
Worksheet time: 11hrs 30mins
During a secondary immune response, high-affinity IgG antibodies are produced. Which of the following best explains why low-affinity IgM antibodies are not made?
Naive pathogen-specific B cells isotype switch and hypermutate much more quickly during secondary immune responses.
Memory B cells outnumber naive B cells.
Naive pathogen-specific B cells are suppressed by negative signaling through FcγRIIB1.
Low-affinity IgM antibodies are made only when antigen concentration is exceedingly high.
The CD45RA isoform is associated with stronger signals in response to antigen.
True
False
The efficiency and specificity of adaptive immune defenses and immunological memory improve each time a particular pathogen is encountered because _____.
of protective immunity
effector memory T cells outnumber central memory T cells
the half-life of antibodies made in secondary and tertiary immune responses exceeds that of antibodies made in primary immune responses.
of affinity maturation.
The production of CD45RO results from the removal of _____ during _____ processing.
domain A; post-translational
domain A; post-transcriptional
exons A, B, and C; post-translational
exons A, B, and C; post-transcriptional
exon A; post-transcriptional
What would be the outcome if a naive B cell were to bind to pathogen coated with specific antibody made by an effector B cell in a primary immune response using FcγRIIB1, and simultaneously bind to the same pathogen using its B-cell receptor?
a positive signal leading to the production of low-affinity IgM antibodies
a positive signal leading to isotype switching and the production of IgG, IgA, or IgE antibodies
a positive signal leading to somatic hypermutation and the production of high-affinity IgM antibodies
a negative signal leading to inhibition of the production of low-affinity IgM antibodies
a negative signal leading to apoptosis.
When a naive B cell binds to an IgG:antigen complex on its cell surface using FcγRIIB1, while simultaneously binding to the same antigen using membrane-bound IgM, _____.
the IgG:antigen complex is endocytosed
the B cell becomes anergic
the B cell will switch isotype to IgG
the B cell undergoes affinity maturation
the B cell secretes large amounts of IgM before becoming a memory B cell
Which of the following characterizes immunological memory? (Select all that apply.)
The host retains the capacity to mount a secondary immune response.
The host retains the ability to respond to pathogen many years after primary exposure.
Naive T cells are activated more quickly when exposed to pathogen.
Memory B cells produce higher-affinity antibody than naive B cells.
Memory T cells undergo somatic hypermutation.
Which of the following statements is incorrect regarding memory B cells?
Memory B cells are maintained for life.
In secondary responses, the number of pathogen-specific B cells is about 10–100-fold that seen in primary responses.
The sensitivity of memory B cells is improved compared with naive B bells because affinity maturation has occurred.
Memory B cells express lower levels of MHC class II and B7 than do naive B cells.
Memory B cells differentiate into plasma cells more rapidly than do naive B cells.
_____ accounts for the production of different isoforms of the CD45 protein observed in naive, effector, and memory T cells.
Isotype switching
Affinity maturation
Alternative splicing
Somatic hypermutation
Recirculation to peripheral tissues
“Original antigenic sin” is best described as a phenomenon in which _____.
a highly mutable virus gradually escapes from immunological memory and interferes with compensatory immune responses.
latent viruses periodically activate effector T cells specific for the original antigen recognized in the primary immune response.
the persistence of antigen is necessary to sustain maintenance of immunological memory.
memory T cells no longer express the same profile of adhesion molecules and cytokine receptors compared with the original profile of the naive precursor T cell.
By which process are fetal erythrocytes destroyed in hemolytic anemia of the newborn?
lysis of erythrocytes by cytotoxic T cells
lysis of erythrocytes by complement activation
clearance of antibody-coated erythrocytes by macrophages in the fetal spleen
lysis of erythrocytes by NK cells via antibody-dependent cell-mediated cytotoxicity
cytotoxicity caused by major basic protein released from eosinophils.
In which ways do memory B cells active in a secondary immune response differ from the naive B-cell population activated in a primary immune response? (Select all that apply.)
The antibody produced is of higher affinity in a secondary immune response.
The frequency of antigen-specific B cells is lower in a secondary immune response.
The level of somatic hypermutation is higher in a secondary immune response.
Memory B cells express higher levels of MHC class II molecules.
Higher levels of IgM are produced in secondary immune responses.
Memory B cells differ from memory T cells in the following ways. (Select all that apply.)
They suppress naive antigen-specific lymphocytes during secondary immune responses.
They recirculate only through secondary lymphoid organs.
They secrete their antigen receptors throughout their life-span.
They generate long-lived clones of memory cells during the primary immune response.
RhoGAM is administered to pregnant RhD– women so as to _____. (Select all that apply.)
stimulate only anti-RhD IgM antibody
cause selective removal of anti-RhD memory B cells from the maternal circulation
inhibit a primary immune response to RhD antigen
block transcytosis of IgG to fetal circulation by interfering with FcRn function
prevent hemolytic anemia of the newborn
For a viral subunit vaccine to be effective, _____. (Select FOUR that apply.)
B cells must be activated
cytotoxic T cells must be activated
neutralizing antibodies must be induced
CD4 TFH cells must be activated
it must be derived from viral surface components.
Inactivation of viruses for vaccine use can be achieved by _____.
irradiation
heat treatment
mutation
formalin treatment
Indicate which of the following statements is TRUE.
The Bacille Calmette–Guérin (BCG) vaccine is commonly used in the United States to provide protection against tuberculosis.
BCG is a heat-killed strain of bovine Mycobacterium tuberculosis.
Lipopolysaccharide-deficient Salmonella typhi is used to vaccinate against typhoid fever.
Live attenuated bacterial vaccines are more common than live attenuated viral vaccines.
Which of the following is FALSE regarding an inactivated or killed virus vaccine?
It elicits a strong B cell response
It elicits a strong T cell response
Usually is injected intramuscularly
Usually elicits a humoral response
Which of the following is FALSE regarding the history of vaccination?
Edward Jenner is credited with the development of the technique called vaccination
Fluid from a cowpox blister can be used to protect against smallpox
An ancient chinese practice used dried smallpox pustules and introduced material from the pustule into healthy individuals to protect against smallpox
The cowpox virus cannot infect humans
Which of the following is NOT an inactivated virus vaccine?
Flumist
Salk Polio vaccine
Hepatitis A
Influenza
With reference to the RotaTaq vaccine, identify the FALSE statement. (Select TWO that apply.)
It is an attenuated vaccine derived from a human rotavirus.
It has been genetically engineered to express a variety of human VP4 and VP7 glycoproteins.
It is a mixture of five bovine rotaviruses.
It is pathogenic if a genetic reversion occurs.
Standard tissue culture methods are used for its production.
conjugate vaccine is one that couples _____ to _____ so as to stimulate T-dependent antibody responses.
polysaccharide; a protein carrier
a protein carrier; irradiated DNA
protein carrier; toxoids
adjuvant; toxoids
polysaccharide; filamentous hemagglutinin
An adjuvant enhances the effectiveness of vaccines by inducing the expression of _____ on ________.
co-stimulatory molecules; macrophages and dendritic cells
CD28; macrophages
MHC class II molecules; T cells
T-cell receptor; T cells
immunoreceptor tyrosine-based activation motifs; dendritic cells
Approximately one-quarter of individuals infected with hepatitis C _____.
develop a chronic infection of hepatocytes
are at risk of developing liver cancer
experience episodes of liver destruction and regeneration
require a liver transplant
mount an effective immune response and eradicate the virus
Reasons complicating the development of vaccines to combat chronic diseases include _____. (Select all that apply.)
evasion of the host's immune system by the pathogen
the polymorphic diversity of MHC class I and class II molecules
the generation of inappropriate immune responses that do not eradicate the pathogen
high mutation rates in the pathogen
survival of the infectious agent for long periods inside the host
The Human Papilloma Virus (HPV) vaccine is controversial because of which association?
the implicit association with adolescent sexual activity
association with higher rates of cervical cancer
low levels of efficacy in eliminating HPV
high rates of side effects
Which of the following explain why the safety standards for vaccines are set higher than those for drugs? (Select all that apply.)Some vaccines can induce a disease state.
Some vaccines can induce a disease state.
Vaccines provoke side-effects in otherwise healthy children.
Vaccines are much more costly to develop and test than most drugs.
Vaccination programs are targeted at large populations.
Subunit vaccines can potentially integrate into the host genome and activate host oncogenes, leading to the development of cancer.
A stressed cell will express....
NKG2D
HLA-E
MIC glycoproteins
Cytotoxins
Identify which of the following is not a characteristic of CD94:NKG2A.
prevents killing of self cells
is an inhibitory NK-cell receptor
binds to carbohydrate ligands
is a disulfide-linked heterodimer
contains an immunoreceptor tyrosine-based inhibitory motif (ITIM)
The only single receptor that can activate NK cells without the need for a second activating receptor is _____.
NKG2D
CD56
2B4
CD94:NKG2A
CD16
Which of the following is TRUE regarding the evolution of the immune system?
Innate immune system developed after the appearance of the adaptive immune system
The innate immune system is found only in invertebrates
The adaptive immune system is absent in sharks
The appearance of the RAG genes is associated with the appearance of the adaptive immune system
Which of the following statements regarding NK cells is false?
They express either inhibitory receptors or activating receptors, but not both.
Their inhibitory receptors are necessary to prevent killing of healthy cells.
They all express CD56.
Because NK cells express diverse combinations of receptors, no single NK cell expresses them all.
Some of their activating and inhibitory receptors use MHC class I ligands.
All NK cells express _____.
MIC
CD3
NKG2D
KIR2DL1
All of the following are characteristic of NK cells except _____.
they express Toll-like receptors
they are tolerant of healthy cells
they circulate in a partly activated state
they all express the same selection of activating and inhibitory NK-cell receptors
they can be activated by FcγRIIIA (CD16a).
All of the following are correct regarding MAIT cells except _____. (Select all that apply.)
CD8+
respond to viral infection
respond to antigen presented by BTN3A
positively selected by thymic epithelium expressing high levels of MR1.
activated by microbiota that make riboflavin
Identify which of the following is not a characteristic of γ:δ T cells. (Select all that apply.)
They are subject to MHC restriction.
They make up the minority of resident T cells in tissues.
Their response is solely dependent on the T-cell receptor.
Most do not express either CD4 or CD8.
They undergo gene rearrangement.
If, during development, none of the KIRs expressed by a NK cell are able to interact with self-MHC class I molecules, then the NK cell is likely to be
Activated
autoreactive
inhibitory
NKT cell
Anergic
In regard to killer-cell immunoglobulin-like receptors (KIRs) indicate which of the following statements is TRUE?
KIRs have a broader range of specificity for HLA class I compared with CD94:NKG2A
KIRs are activating receptors of NK cells and stimulate the release of perforin and granzyme
MIC-A and MIC-B are suitable ligands for KIRs.
KIRs bind to specific allotypes of HLA-A, -B, and -C molecules.
T cells are positively selected to recognize "self" while NK cells are often described as recognizing "missing self." Which process is NOT involved in how NK cells avoid killing other cells in the body?
Some NK cells express CD94:NKG2A, which binds HLA-E presenting peptides from the leader sequences of HLA-A, HLA-B and HLA-C
During development, NK cells lacking inhibitory receptors that recognize HLA class I molecules become anergic
During development, NK cells lacking inhibitory receptors that recognize HLA class I molecules become anergic
During development, NK cells expressing activating receptors that recognize self HLA class I molecules become anergic
During development, NK cells capable of recognizing HLA class I molecules presenting self-peptides undergo apoptosis and are eliminated
Vγ9:Vδ2 T cells differ from α:β T cells in that they _____. (Select all that apply.)
respond to phosphorylated metabolic intermediates (phosphoantigens) of isoprenoid biosynthesis pathways
do not carry out gene rearrangement
bind to lipid antigens presented by CD1
are not subject to positive and negative selection in the thymus
have limited diversity of V gene rearrangement.
Which of the following is not a ligand for α:β T cells?
peptide antigens
lipid antigen
sulfatides
heterocyclic organic molecules.
_____ is a molecule expressed on NK cells and Vγ:Vδ1 T cells.
CD3v
MIC-A
NKG2D
CD94:NKG2A
killer-cell immunoglobulin-like receptor (KIR).
A primary immune response against influenza virus produces antibodies that bind to _____.
hemagglutinin and neuraminidase
variable surface glycoproteins
EBNA-1
protein toxins
gp41 and gp120
All of the following are associated with the ability of influenza virus to escape from immunity except _____.
age
co-infection with avian and human influenza viruses
error-prone replication of its DNA genome
recombinant strains
the phenomenon of 'original antigenic sin.'
Epstein–Barr virus infects and establishes latency in _____, gaining entry by binding to _____.
B cells; CR2
T cells; CD4
T cells; CD8
neurons; MHC class I
B cells; EBNA-1
Genes encoding _____ rearrange in trypanosomes permitting replication and survival of the pathogen until the host produces an antibody response against the altered gene product.
pilin
flagellin
variable surface glycoproteins (VSGs)
hemagglutinin
Herpes simplex virus favors neurons for latency because of the low level of _____, which reduces the likelihood of killing by CD8 T cells.
LFA-3
Toll-like receptors (TLRs)
transporter associated with antigen processing (TAP)
MHC class I
MHC class II
Herpesviruses include all of the following except _____.
varicella-zoster
Epstein–Barr virus
herpes simplex virus
cytomegalovirus
All of the above are herpesviruses.
Individuals with an antibody deficiency are more susceptible to infections by all of the following except _____.
Streptococcus pneumoniae
Haemophilus influenzae
Streptococcus pyogenes
Mycobacterium tuberculosis
Staphylococcus aureus
Shingles is associated with infection by _____.
Epstein–Barr virus
Staphylococcus aureus
herpes zoster
Candida albicans
Listeria monocytogenes
The mode of evolution responsible for the production of recombinant influenza viruses composed of a genome derived from two different influenza variants is called _____.
gene conversion
antigenic shift
latency
immune evasion
antigenic drift
What medical condition does a Staphylococci infection result in?
Toxic shock syndrome from the action of superantigens
Dysentry from the action of superantigens
Toxic shock syndrome from disabling of macrophages
Cold sores from the infection of the trigeminal neurons
Which of the following contribute to new epidemics and the long-term survival of the influenza virus in the human population? (Select all that apply)
New viral strains possess epitopes not recognized by antibodies made in the previous epidemic.
The first influenza strain provoking a primary immune response constrains the types of antibodies made during a subsequent encounter with a different strain.
The virus loses the capacity to express hemagglutinin, thereby rendering neutralizing antibodies useless.
The virus uses gene rearrangement to achieve antigenic variation, which creates new epitopes.
The RNA genome of the influenza virus is subject to point mutations during viral replication.
Which of the following is incorrectly matched?
Neisseria gonorrhoeae: sexually transmitted disease
Neisseria gonorrhoeae: Variant pilin protein expression
Salmonella typhimurium: food poisoning
Salmonella typhimurium: Coating its surface with human proteins
_____ cause(s) mild and limited disease, whereas _____ cause(s) more severe disease and higher mortality.
Antigenic drift; antigenic shift
Antigenic shift; antigenic drift
Epidemics; pandemics
Pandemics; epidemics
Dominant mutant forms of IFNγR1 exhibit all of the following in heterozygotes except _____.
they are hyperactive receptors resulting in increased signaling
the cytoplasmic tail is truncated
they are able to form stable dimers with the normal form
they cause less severe immunodeficiency than do the homozygous recessive forms
they are unable to transduce signals when bound to the normal form
Which of the following statements regarding inherited immunodeficiency diseases is correct?
Affected individuals are less susceptible to infection.
Mortality rates are reduced by the administration of antibiotics to affected individuals.
Most deficiency syndromes are caused by dominant gene defects.
Women are more likely than men to inherit X-linked immunodeficiencies.
Extracellular bacterial infections are common in deficiency syndromes with T-cell defects.
Which of these characteristics is FALSE regarding IFN-γ?
When it acts on target cells, it enhances the engulfment and killing of bacteria.
It is the major activating cytokine of macrophages.
It activates the JAK–STAT signal transduction pathway after binding to its cognate receptor.
It is secreted by CD8 cytotoxic T cells, CD4 TH1 cells, and NK cells.
It is secreted and functions as a monomer but facilitates the dimerization of its receptor.
A deficiency in _____ would cause a condition that closely resembles X-linked severe combined immunodeficiency and is characterized by inefficient cytokine signaling.
adenosine deaminase (ADA)
TAP1 or TAP2
class II transactivator (CIITA)
RAG1 or RAG2
Janus 3 kinase (Jak3)
A genetic defect in _____ results in the accumulation of toxic levels of nucleotide metabolites and loss of T-cell function.
NADPH oxidase
glucose-6-phosphate dehydrogenase
myeloperoxidase
SH2D1A
adenosine deaminase (ADA)
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 _____.
CD18; produce cell adhesion molecules
NADPH oxidase; produce superoxide radical (O2–)
CD40 ligand; produce GM-CSF
C5–C9; defend against Neisseria
C3; opsonize capsulated bacteria
Individuals with an antibody deficiency are more susceptible to infections by all of the following except _____.
Streptococcus pneumoniae
Haemophilus influenzae
Streptococcus pyogenes
Mycobacterium tuberculosis
Staphylococcus aureus
Individuals with an immunodeficiency affecting B-cell function are more susceptible to infections caused by which of the following pathogens?
Toxoplasma gondii
respiratory syncytial virus
Haemophilus influenzae
Listeria monocytogenes
Mycobacterium tuberculosis
Severe combined immune deficiency (SCID) describes a condition in which neither _____ nor _____ are functional.
classical; alternative pathways of complement
T-cell-dependent antibody responses; cell-mediated immune responses
innate; acquired immune responses
MHC class I; MHC class II molecules
When deficient, which of the following proteins does not render the individual more susceptible to encapsulated bacteria?
C1INH
C3
Bruton's tyrosine kinase
factor D
factor I
Women who are heterozygous for a defective Bruton's tyrosine kinase (Btk) gene _____.
are more susceptible to infections caused by extracellular pyogenic bacteria
have a 50% chance of having a son with X-linked hyper IgM syndrome
mount normal B-cell immune responses despite having lowered levels of serum IgG
exhibit X-linked agammaglobulinemia
are healthy and all their B cells have functional Btk
During infection with HIV, a person is said to undergo seroconversion when _____.
HIV variants convert from macrophage-tropic to lymphocyte-tropic late in infection
anti-HIV antibodies are detectable in their blood serum
cellular transcription favors the production of HIV-encoded RNA
HIV is transferred from an infected person to an uninfected recipient
the initial phase of infection is followed by clinical latency
For infectious HIV virions to be made, the infected cell must _____. (Select all that apply)
be CD4-positive
express low levels of CCR5
express functional NFκB
be latent
be polyreactive
Reverse transcriptase is a _____ encoded by _____.
DNA-dependent DNA polymerase; HIV
DNA-dependent DNA polymerase; influenza virus
RNA-dependent DNA polymerase; HIV
RNA-dependent DNA polymerase; influenza virus
RNA-dependent RNA polymerase; HIV
Some people are resistant to HIV infection because a primary infection cannot be established in macrophages or memory T cells. What is the likely reason for this?
They have a specific type of HLA polymorphism
They are homozygous for a mutant form of CCR5 that cannot be used by HIV as a co-receptor
They generate antibodies against the GP41 protein
They have previously been infected with simian immunodeficiency virus
The pol gene of HIV produces all of the following except _____.
integrase
protease
matrix protein
reverse transcriptase
Which genetic event can convert a HIV macrophage tropic virus to a lymphocyte tropic virus?
The recombination of different HIV strains
A gene conversion in the proviral DNA
A point mutation in the gp120 protein
The process of virus latency
Which of the following is an Elite neutralizer of HIV?
An individual who loses expression of the CCR5 co-receptor when they are exposed to HIV
An individual who has cardiovascular disease and is hence in chronic inflammatory state that helps to defend against HIV
An individual who suppresses their infection so effectively that HIV RNA is not detectable and the individual has a certain HLA-B genotypes
An individual making broadly neutralizing antibodies after exposure to several HIV strains
Which of the following statements about human immunodeficiency virus (HIV) are correct? (Select all that apply)
HIV has a DNA genome.
HIV must synthesize reverse transcriptase immediately after infecting a cell.
HIV infects cells expressing CD4.
HIV requires the CXCR4 co-receptor for internalization by T cells.
NFkB is a transcription factor that facilitates the transcription of proviral RNA.
Which property of HIV renders the virus difficult to eradicate by the body's immune defenses and also limits the efficacy of drug therapies?
The NFkB transcription factor initiates transcription of mRNA molecules with high rate of mutations
Activation-induced deaminase introduces point mutations with the proviral DNA
The HIV reverse transcriptase is an error-prone DNA polymerase resulting in increased protein mutations.
The HIV reverse transcriptase will splice RNA into random combinations resulting in surface glycoproteins with varied epitopes
Which viral targets for HIV therapy is involved in processing of long viral polypeptides into shorter peptides?
reverse transcriptase
matrix protein
gp120
CD4
protease
Adaptive immune responses targeted at infections by helminth worms and other parasitic multicellular animals employ all of the following except _____. (Select all that apply)
basophils
eosinophils
IgE
mast cells
CD4 TH2 cells
IL-4
neutrophils
CD8 T cells
All of the following are biological effects mediated by the products of mast cells except _____.
chemotaxis of neutrophils, eosinophils, and effector T cells
growth factor secretion
smooth muscle contraction
connective tissue remodeling
Anita Garcia, 17 years old, and her roommate Rosa Rosario were celebrating a friend's birthday at a dessert buffet at a local restaurant when Anita developed acute dyspnea, and angioedema. She complained of an itchy rash, and then had difficulty swallowing. Rosa drove Anita to the emergency room two blocks away rather than wait for an ambulance. As they approached the hospital, Anita lost consciousness.
Anita was suffering from _______ likely caused by _____ present in the cake.
Food poisoning; bacterial toxins
Contact dermatitis: plant oils
Anaphylaxis; nuts
Type III hypersensitivity; preservative compounds
Aspirin (acetyl salicylate) inhibits prostaglandin synthesis by binding irreversibly to prostaglandin synthase, the first enzyme in the _____ pathway.
cyclooxygenase
carboxypeptidase
metalloprotease
lipooxygenase
peroxidase
During a primary immune response IgM sometimes switches to IgE. Which of the following best describes the consequence of this early switch?
The B cell would switch again to IgG3.
The B cell would remain in the germinal center but would not differentiate into a plasma cell.
The B cell would die by apoptosis.
The IgE produced would have low affinity for antigen.
During the course of a successful desensitization process, the patient's antibodies will change from an _____isotype to an _____ isotype.
IgG4:IgE
IgG4:IgE
IgA:IgM
IgG1:IgG4
IgE:IgG4
The antigens that provoke hypersensitivity reactions are referred to as
T-independent antigens
superantigens
subunit vaccines
attenuated vaccines
allergens
The wheal-and-flare inflammatory reaction is an example of
an immediate type I allergic response
a late-phase type I allergic response
a late-phase type IV allergic response
an immediate type III allergic response
a late-phase type III allergic response
Which of the following are associated with soluble antigen? (Select all that apply)
type I hypersensitivity
type II hypersensitivity
type III hypersensitivity
type IV hypersensitivity
mast-cell activation
Which of the following are consequences of anaphylactic shock? (Select all that apply)
smooth muscle contraction
immune complex deposition on blood vessels
loss of blood pressure
constriction of airways
complement activation
Which of the following are matched correctly? (Select all that apply)
type I hypersensitivity: IgE
type II hypersensitivity: IgG
type III hypersensitivity: immune complexes
type IV hypersensitivity: delayed-type hypersensitivity
type IV hypersensitivity: IgG
Which of the following are potential means by which type I allergic reactions can be managed or treated? (Select all that apply)
Use antihistamines to block histamine binding to H1 histamine receptors.
Use corticosteroids to suppress inflammation.
Desensitize the patient by feeding them allergen and skewing the immune response from an IgE to an IgA response.
Anergize allergen-specific T cells through vaccination with allergen-derived peptides.
Block high-affinity IgE receptors to prevent mast-cell degranulation.
Which of the following genetic polymorphisms is associated with a predisposition to asthma? (Select all that apply)
promoter variants of IL-5
structural variant of IgG receptor
HLA class II allotypes
β2-adrenergic receptor variant
ACOX5 (5-lipoxygenase)
Which of the following is associated with type III hypersensitivity?
nickel
recombinant human insulin
plant oil
mouse-derived monoclonal antibody
helminth infection
Which of the following is not mediated by antibodies?
type I hypersensitivity
type II hypersensitivity
type III hypersensitivity
type IV hypersensitivity
_____ express FcεRI and contain granules containing inflammatory mediators. (Select all that apply)
macrophages
activated eosinophils
mast cells
natural killer cells
basophils
Indicate whether the following statement is true:
ABO or Rhesus antigen mismatches stimulate cytotoxic T-cell responses.
True
False
Indicate whether the following statement is true:
There are polymorphic antigens other than ABO and Rhesus antigens that can cause type II hypersensitivity reactions
True
False
Acute rejection of a kidney graft involves the activation of recipient T cells by _____ of _____ origin.
dendritic cells; recipient
B cells; recipient
dendritic cells; donor
macrophages; recipient
B cells; donor
All of the following are characteristics of blood donations and transfusions that enable their extensive use for transplantation purposes except _____.
individuals can donate on a regular basis without any deleterious effects
erythrocytes do not express MHC class I or class II molecules
the blood components only need to function for a few weeks
only the ABO antigens need to be compatible between donor and recipient
blood transfusion is a straight forward and inexpensive process.
Alloantibodies to blood-vessel endothelium on solid organ grafts _____.
are specific for HLA class I and class II antigens
cause hyperacute rejection
cause acute rejection
target endothelium for attack by NK cells
are IgA and do not fix complement
Alloantibody production after organ transplantation involves _____.
a mixed lymphocyte reaction
the indirect pathway of allorecognition by CD4 T cells
activation of regulatory CD4 T cells
the transfusion effect
a switch from a chronic to an acute state of organ rejection
As time progresses following an organ transplant, the alloreactive T-cell response shifts from a(n) _____ pathway to a(n) _____ pathway of allorecognition.
exogenous; endogenous
inflammatory; cytotoxic
hyperacute; suppressive
autologous; heterologous
direct; indirect
Blood transfusions mismatched for ABO and/or rhesus antigens are associated with _____. (Select all that apply)
type III hypersensitivity reactions
alloreactive immune responses
lysis of recipient red blood cells
laboratory errors in the cross-matching procedure
activation of host complement and destruction of donor cells
Following a hematopoietic stem cell transplant, T-cell responses will be activated by dendritic cells of _____ origin.
donor
recipient
both donor and recipients
Graft-versus-host disease (GVHD) is a consequence of _____.
mature T lymphocytes from the donor mounting an immune response against tissue of the recipient
mature T lymphocytes from the recipient mounting an immune response against tissue of the donor
mismatching A, B, and O antigens between donor and recipient
mismatching Rhesus antigen between donor and recipient
antibodies of the donor stimulating NK cell antibody-dependent cell-mediated cytotoxicity (ADCC) of tissues of the recipient
In a mixed lymphocyte reaction the donor cells are irradiated to ensure that they do not _____.
stimulate recipient cells
become anergic
alter their level of expression of HLA molecule
proliferate
undergo apoptosis
What type of hypersensitivity reaction would result from a mismatched blood transfusion?
Type I
Type II
Type III
Type IV
A characteristic of the human eye that enables the cornea to be transplanted with a 90% success rate is that _____. (Select all that apply)
antigen-presenting cells in the eye do not express the co-stimulatory molecule B7
the cornea is not vascularized
anterior-chamber-associated immune deviation (ACAID) establishes a state of tolerance in the eye
only regulatory T cells express the adhesion molecules necessary to enter the cornea
the aqueous humor of the anterior chamber contains TGF-b, which downregulates CD40 and inhibits IL-12 secretion
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.
autologous
HLA-matched
haploidentical
chimeric
cross-matched
Following a hematopoietic stem cell transplant, T-cell responses will be activated by dendritic cells of _____ origin.
donor
recipient
both donor and recipient
For the patient's new immune system to function effectively in bone marrow recipients, some HLA allotypes must be shared because _____. (Select all that apply)
professional antigen-presenting cells are host-derived
professional antigen-presenting cells are donor-derived
otherwise an autoimmune disease would develop
newly generated T cells are positively selected on the recipient's thymic epithelium
if all HLA molecules were mismatched, acute rejection of the grafted cells would occur
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; HLA-DRB1: 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: 0301/0201; B: 4402/0801; DRB1: 0301/0403
A: 0301/2902; B: 1801/0801; DRB1: 0301/0701
A: 2902/0201; B: 0702/0801; DRB1: 0301/13011
A: 0101/0101; B: 5701/0801; DRB1: 0701/0701
A: 0101/0301; B: 0702/5701; DRBA: 0403/0301
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?
Type I hypersensitivity involving anaphylaxis.
Type II hypersensitivity leading to hemolytic anemia.
Type III hypersensitivity caused by immune complex deposition in blood vessels.
Type IV hypersensitivity involving CD8 T-cell cytotoxicity.
Type II hypersensitivity leading to thrombocytopenia.
Hematopoietic stem cell transplantation is appropriate for all of the following conditions except _____.
thalassemia major
Wiskott–Aldrich syndrome
cirrhosis of the liver
Fanconi's anemia
non-Hodgkin's lymphoma
In routine blood transfusions, which of the following must be matched correctly? (Select all that apply)
A and B antigens
O antigens
Rhesus D antigen
MHC class I molecules
MHC class II molecules
Indicate whether the following statement is true:
Lymphocytes and erythrocytes express HLA class I and II molecules.
True
False
Indicate whether the following statement is true (T) or false (F):
Antithymocyte globulin (ATG) is a monoclonal antibody specific for T-cell surface antigens.
True
False
Indicate whether the following statement is true (T) or false (F):
Immunosuppressive xenogeneic antibodies can be used repeatedly for multiple episodes of transplant rejection without complication.
True
False
Indicate whether the following statement is true (T) or false (F):
A possible side-effect of using antilymphocyte globulin (ALG) is serum sickness.
True
False
Males engrafted with HLA-identical bone marrow from their sisters develop graft-versus-host disease because _____.
T cells develop in the male thymus that are not tolerant to minor histocompatibility antigens expressed by the sister
mature T cells in the graft have specificity for male-specific minor histocompatibility antigens
there are differences between the sexes in how self proteins are modified post-translationally
NK-cell alloreactions occur
residual female hormones in the graft cause upregulation of HLA class I on male dendritic cells presenting minor histocompatibility antigens
Myeloablative therapy is carried out in bone marrow transplantation in order to _____. (Select all that apply)
prevent graft-versus-host disease
prevent host-versus-graft disease
suppress autoreactive T cells in the graft
provide space for colonization of transplanted stem cells in bone marrow stroma
destroy tumors of immune-system cells
Prednisone is a steroid used in transplantation that _____. (Select all that apply)
is combined with cytotoxic drugs to improve its efficacy
causes a decrease in production of inflammatory cytokines
can lead to bone demineralization as an unwanted side-effect
decreases the synthesis of IkBa
binds to a cell-surface receptor and inhibits the function of NFkB
Residual leukemia cells persisting in a patient after they have received chemotherapy, irradiation, and a bone-marrow transplant are sometimes eliminated by a _____ effect which involves the action of _____. (Select all that apply)
graft-versus-leukemia; alloreactive T cells
haploidentical; regulatory T cells
acute minor histocompatibility; recipient NK cells
myeloablation; mature T cells
graft-versus-leukemia; alloreactive NK cells
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 _____.
T-cell depletion will remove alloreactive T cells from the donor and prevent the potential for graft-versus-host disease (GVHD)
mature T-cell chimerism is required to establish long-term tolerance
because Don is HLA-haploidentical and male, there is no risk of alloreactivity toward major or minor histocompatibility antigens
because of Don's age, the expected bone marrow harvest is already marginal for successful engraftment, and depletion measures would compromise the yield of stem cells
the benefit of using a cocktail of immunosuppressive drugs outweighs the risk of contaminating the bone marrow during T-cell depletion
Tacrolimus causes which of the following effects? (Select all that apply)
reduced T-cell proliferation
decreased production of nitric oxide
decreased production of IL-3, IL-4, GM-CSF, and TNF-a
decreased activity of cyclo-oxygenase type 2
serum sickness
What is the probability that a sibling will be able to provide a HLA-haploidentical kidney for transplantation?
100%
75%
50%
25%
0%
Which of the following immunosuppressive drugs functions by inhibiting DNA synthesis? (Select all that apply)
cyclophosphamide
prednisone
azathioprine
methotrexate
mycophenolate mofetil
_____ is a monoclonal antibody administered to transplant patients before and after transplantation in order to induce lymphopenia.
Tacrolimus
Alemtuzumab
Belatacept
Basiliximab
Rabbit antithymocyte globulin (rATG)
_____ results from alloreactions mediated by donor T cells in the graft subsequent to hematopoietic stem-cell transplantation.
Acute rejection
Chronic rejection
Graft-versus-host disease (GVHD)
Serum sickness
Hyperacute rejection
