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PART 1: QUESTIONS 1-40

Total questions: 100

Worksheet time: 50mins

Name
Class
Date
1.

The process where cells decrease in size due to reduced workload is called:

a)

Hypertrophy

b)

Hyperplasia

c)

Atrophy

d)

Dysplasia

e)

Metaplasia

2.

The first immune cell to arrive at a site of acute inflammation is:

a)

Neutrophils

b)

Macrophages

c)

Eosinophils

d)

Basophils

e)

NK cells

3.

Which of the following are considered first-line defenses of innate immunity?

a)

Intact skin

b)

Mucous membranes

c)

Stomach acid

d)

Cytotoxic T-lymphocytes

e)

Cough reflex

4.

Liquefactive necrosis is most often seen in the brain following ischemia.

a)

True

b)

False

5.

Which antibody is secreted in breast milk to protect infants’ mucosal surfaces?

a)

IgG

b)

IgM

c)

IgA

d)

IgE

e)

IgD

6.

The cardinal signs of acute inflammation include all EXCEPT:

a)

Heat

b)

Redness

c)

Pain

d)

Loss of function

e)

Necrosis

7.

The mediator that is primarily responsible for pain in acute inflammation is:

a)

Histamine

b)

Bradykinin

c)

Complement C3b

d)

Leukotriene C4

e)

CRP

8.

Which chemical mediator causes sustained vascular permeability and bronchoconstriction longer than histamine?

a)

Leukotrienes

b)

PAF

c)

Prostaglandins

d)

Bradykinin

e)

C5a

9.

What is the functional purpose of mucus production during inflammation?

a)

Blocks lymph drainage

b)

Traps pathogens & debris

c)

Dilates vessels

d)

Stimulates fibroblasts

e)

Produces antibodies

10.

The end-product of the clotting cascade that forms the insoluble mesh of a clot is:

a)

Fibrinogen

b)

Fibrin

c)

Thrombin

d)

Collagen

e)

Factor X

11.

Systemic manifestations of significant acute inflammation may include:

a)

Fever

b)

Leukocytosis

c)

Malaise / fatigue

d)

↑ plasma CRP

e)

Decreased vascular permeability locally

12.

The WBC type elevated in parasitic infections is:

a)

Neutrophils

b)

Macrophages

c)

Eosinophils

d)

Basophils

e)

Cytotoxic T-cells

13.

Which antibody class is first produced in a primary immune response and is most efficient at agglutination?

a)

IgA

b)

IgE

c)

IgG

d)

IgM

e)

IgD

14.

Which cells act as professional antigen-presenting cells (APCs) for helper T-cells?

a)

B-lymphocytes

b)

Macrophages

c)

Dendritic cells

d)

All of the above

e)

Neutrophils

15.

The Fab region of an antibody is the part that:

a)

Binds to mast-cell Fc-receptors

b)

Binds to the antigen’s epitope

c)

Anchors antibody to B-cell membrane

d)

Determines antibody class

e)

Activates complement directly

16.

Helper T-cells (CD4+) activate both humoral and cell-mediated immunity by releasing cytokines.

a)

True

b)

False

17.

Which cell type directly kills virus-infected host cells by releasing perforin?

a)

Cytotoxic T-cells (CD8+)

b)

Helper T-cells (CD4+)

c)

B-lymphocytes

d)

Plasma cells

e)

Eosinophils

18.

Which mediator released by mast cells activates platelets during the inflammatory response?

a)

Histamine

b)

PAF (Platelet-Activating Factor)

c)

Prostaglandins

d)

Leukotrienes

e)

TNF-α

19.

Which type of necrosis is typically seen in solid-organ infarcts such as heart & kidney?

a)

Coagulative

b)

Liquefactive

c)

Caseous

d)

Fat

e)

Fibrinoid

20.

Which type of necrosis is typically seen in the brain after ischemia?

a)

Coagulative

b)

Liquefactive

c)

Caseous

d)

Fat

e)

Wet gangrene

21.

Which type of necrosis shows a “cheese-like” appearance in TB granulomas?

a)

Coagulative

b)

Liquefactive

22.

Which cell type predominates in the proliferative phase of wound healing and lays down collagen?

a)

Neutrophils

b)

Macrophages

c)

Fibroblasts

d)

Endothelial cells

e)

Basophils

23.

Factors that can impair wound-healing include:

a)

Diabetes mellitus

b)

Vitamin C deficiency

c)

Corticosteroid therapy

d)

Ischemia / poor perfusion

e)

Adequate oxygen supply

24.

Granulation tissue contains proliferating capillaries, fibroblasts, and macrophages.

a)

True

b)

False

25.

Which vitamin is essential for collagen synthesis during wound-healing?

a)

Vitamin A

b)

Vitamin B12

c)

Vitamin C

d)

Vitamin D

e)

Vitamin K

26.

Dry gangrene is characterized by which pattern of necrosis and what major cause?

a)

Liquefactive – infection by bacteria

b)

Coagulative – chronic arterial occlusion

c)

Caseous – tuberculosis

27.

Which mediator is most associated with swelling/edema due to ↑ vascular permeability?

a)

Histamine

b)

Leukotrienes

c)

Bradykinin

d)

Complement C5a

e)

Thrombin

28.

Wet gangrene differs from dry gangrene by the presence of:

a)

A. A line of demarcation & mummified tissue

b)

B. Anaerobic bacterial infection, foul smell, oozing fluid

c)

C. Ischemic coagulative necrosis without infection

d)

D. Calcification of vessels

e)

E. Granulomatous caseous necrosis

29.

Keloid formation after wound-healing is due to:

a)

Vitamin C deficiency

b)

Excess collagen deposition in scar tissue

c)

Loss of granulation tissue

d)

Low fibroblast activity

e)

Insufficient angiogenesis

30.

The ABO blood-group antigens are carried on:

a)

RBC plasma membrane carbohydrates

b)

WBC MHC-II molecules

c)

Platelet glycoproteins

d)

Serum antibodies

e)

T-cell receptors

31.

Which antibody crosses the placenta to protect the fetus?

a)

IgA

b)

IgE

c)

IgG

32.

Which antibody mediates Type I immediate allergic reactions by binding to mast-cell Fc-receptors?

a)

IgA

b)

IgE

c)

IgG

d)

IgM

e)

IgD

33.

MHC-I molecules present antigens from inside the cell (e.g., viral peptides) on all nucleated cells.

a)

True

b)

False

34.

Helper T-cells (CD4+) are critical in adaptive immunity because they:

a)

Directly lyse virus-infected cells

b)

Produce antibodies themselves

c)

Activate B-cells, cytotoxic T-cells & macrophages via cytokines

d)

Are part of innate immunity only

e)

Activate complement without antigen

35.

Which class of antibody is mainly a B-cell receptor and not secreted in large amounts?

a)

IgA

b)

IgE

c)

IgG

d)

IgM

e)

IgD

36.

Which immune cells suppress B- and T-cell proliferation to help prevent hypersensitivity reactions?

a)

Helper T-cells

b)

Regulatory T-cells

c)

Cytotoxic T-cells

37.

The complement component most important for opsonization of bacteria is:

a)

C1q

b)

C3b

c)

C5a

d)

C9

e)

C-reactive protein

38.

Which cell type predominates later in chronic inflammation, surviving longer than neutrophils and cleaning up debris?

a)

Macrophages

b)

Fibroblasts

c)

Basophils

d)

NK-cells

e)

Mast-cells

39.

The immune-cell target that is progressively lost in HIV infection is:

a)

CD8+ cytotoxic T-cells

b)

CD4+ helper T-cells

c)

B-lymphocytes

d)

Neutrophils

e)

NK-cells

40.

AIDS-defining opportunistic infections often appear when CD4+ T-cell count drops below approximately:

a)

500 cells/μL

b)

350 cells/μL

c)

200 cells/μL

d)

100 cells/μL

e)

50 cells/μL

41.

Which complement component forms the Membrane Attack Complex (MAC) that lyses bacteria?

a)

C1q

b)

C3b

c)

C5b-C9 complex

d)

Factor B

e)

Properdin

42.

The mediator primarily responsible for fever in systemic inflammation is:

a)

IL-1 / TNF-α acting on hypothalamus

b)

Histamine

c)

Bradykinin

d)

Prostaglandin D2

e)

PAF

43.

The mediator that causes vasodilation, increases vascular permeability and attracts neutrophils & eosinophils is:

a)

C3b

b)

Leukotrienes

c)

Histamine

d)

C5a

e)

Thrombin

44.

The mediator primarily responsible for chemotaxis of neutrophils is:

a)

C5a

b)

Histamine

c)

CRP

d)

Bradykinin

e)

IgG

45.

Which WBC type is typically elevated in allergic reactions such as hay fever and asthma?

a)

Neutrophils

b)

Basophils

c)

Eosinophils

46.

Granulomas are collections of activated macrophages (epithelioid cells) often surrounded by lymphocytes.

a)

True

b)

False

47.

Which disease is characterized by granulomatous inflammation with caseous necrosis?

a)

Rheumatoid arthritis

b)

Asthma

c)

Tuberculosis

d)

Lupus nephritis

e)

Gout

48.

The typical histological appearance of caseous necrosis is:

a)

Clear fluid-filled cyst

b)

Cheese-like soft granular center

c)

Calcified scar

d)

Fatty chalky deposits

e)

Gel-like transparent matrix

49.

Which cell type contracts the wound edges during healing?

a)

Myofibroblasts

b)

Macrophages

c)

Fibroblasts

d)

Smooth-muscle cells

e)

Endothelial cells

50.

The difference between regeneration and repair is that:

a)

Regeneration replaces tissue with scar tissue

b)

Repair restores tissue with identical original cells

c)

Regeneration restores original architecture & function; repair uses collagen scar

d)

Both involve fibroblast collagen only

e)

Repair never involves fibroblasts

51.

Local factors that can impair wound-healing include:

a)

Infection at wound site

b)

Poor local blood supply

c)

Excessive movement of wound edges

d)

Foreign bodies in wound

e)

Adequate oxygenation

52.

Dehiscence refers to:

a)

Abnormal narrowing of scar

b)

Separation of wound edges after they were closed

c)

Excessive collagen formation in scar

d)

Formation of purulent cavity

e)

Overgrowth of granulation tissue

53.

Hyperacute transplant rejection occurs because of:

a)

Pre-formed anti-donor antibodies causing complement-mediated lysis

b)

Gradual T-cell infiltration over weeks to months

c)

Graft-versus-host donor T-cells attack recipient

d)

Bacterial infection of graft

e)

Lack of vascular anastomosis

54.

Graft-versus-host disease after bone-marrow transplant is caused by:

a)

Recipient cytotoxic T-cells attacking donor graft

b)

Donor cytotoxic T-cells attacking recipient tissues

c)

IgE-mediated mast-cell degranulation

d)

Immune-complex deposition in joints

e)

Neutrophil enzymes destroying vessels

55.

The pathophysiological mechanism of rheumatic fever-induced carditis following strep throat is:

a)

Immune-complex deposition in myocardium

b)

Cross-reactive IgG antibodies bind to heart valves & activate complement

c)

T-cell-mediated delayed response

d)

Direct bacterial invasion of myocardium

e)

IgE-mediated mast-cell histamine release

56.

Type II hypersensitivity is mediated by IgG or IgM antibodies directed against antigens on cells or tissues.

a)

True

b)

False

57.

An example of a Type II cytotoxic hypersensitivity reaction is:

a)

Serum sickness

b)

Hay-fever allergic rhinitis

c)

Hemolytic transfusion reaction

d)

Contact dermatitis from nickel

e)

Arthus reaction

58.

An example of a Type III immune-complex hypersensitivity is:

a)

Post-streptococcal glomerulonephritis

b)

Graft-versus-host disease

c)

Hemolytic anemia

d)

Asthma attack

e)

TB skin test

59.

An example of a Type IV delayed hypersensitivity reaction is:

a)

Penicillin-induced hemolytic anemia

b)

Serum sickness

c)

Contact dermatitis from poison ivy

d)

Anaphylaxis to peanuts

e)

Pernicious anemia

60.

The difference between acute and delayed hypersensitivity is primarily:

a)

The organ affected

b)

The time after exposure & immune mechanism involved

c)

The dose of antigen

d)

Whether complement participates

e)

Whether fever occurs

61.

The first-line epithelial defense of the respiratory tract is:

a)

Acidic gastric juice

b)

Mucociliary escalator

c)

Salivary amylase

d)

Lysozyme in tears

e)

Normal skin flora

62.

Chemotaxis is important in inflammation because it:

a)

Stimulates fibroblasts to secrete collagen

b)

Guides WBCs to migrate toward higher concentration of chemical attractants

c)

Produces vasodilation to increase blood flow

d)

Causes smooth-muscle contraction in vessels

e)

Activates complement

63.

Liquefactive necrosis commonly leads to abscess formation in bacterial infections.

a)

True

b)

False

64.

Fat necrosis in acute pancreatitis is caused by:

a)

Lipase-mediated digestion of fat and calcium saponification

b)

Caseous degeneration of adipose cells

c)

Coagulative ischemic death of fat lobules

d)

Liquefactive conversion by neutrophils

e)

Immune-complex deposition in adipose

65.

Bilirubin accumulation in tissues most commonly leads to:

a)

Cyanosis

b)

Icterus / jaundice

c)

Hyperpigmented brown skin

d)

Pitting edema

e)

Petechiae

66.

Physiologic situations where apoptosis is normally required include:

a)

A. Embryonic digit separation (fingers & toes)

b)

B. Menstrual cycle endometrial shedding

67.

Necrosis is often accompanied by malaise, fever, leukocytosis and tachycardia, but apoptosis generally is not.

a)

True

b)

False

68.

Hypertrophy of the left ventricle due to chronic hypertension is best described as:

a)

Pathologic increase in cell number

b)

Physiologic enlargement of cell size due to pressure overload

c)

Metaplasia from one cell type to another

d)

Dysplasia from chronic irritation

e)

Hyperplasia due to hormonal stimulus

69.

Metaplasia in the bronchi of a chronic smoker typically involves:

a)

Squamous epithelium → columnar epithelium

b)

Columnar epithelium → stratified squamous epithelium

c)

Fibroblast → adipocyte transformation

d)

Cuboidal → columnar change

e)

Epithelial → mesenchymal conversion

70.

The key difference between dysplasia and metaplasia is that dysplasia:

a)

Is an orderly, reversible change in cell type

b)

Is always physiologic

c)

Shows disordered cell growth with increased nuclear atypia, pre-cancerous

d)

Occurs only in connective tissue

e)

Involves necrosis

71.

The latent period before measurable antibodies appear in a primary immune response is about:

a)

1-2 days

b)

3-5 days

c)

7-10 days

72.

In a secondary immune response after re-exposure, antibodies rise:

a)

Slower and lower than primary response

b)

Faster and to much higher levels than primary

c)

Same as primary response

d)

Only IgE is produced

e)

Requires APCs each time

73.

Most plasma cells survive after activation for about:

a)

2-3 days

b)

4-5 days

c)

2 weeks

d)

1 month

e)

Years

74.

The region of an antibody that binds to Fc-receptors on immune cells and complement proteins is the:

a)

Fab region

b)

Variable light-chain tip

c)

Heavy-chain hinge

d)

Fc region

e)

Idiotype

75.

The first complement component to bind to an antibody-antigen complex and start the classical pathway is:

a)

C1q

b)

C2

c)

C3

d)

C4

e)

C5

76.

Regulatory T-cells help suppress the immune response and prevent autoimmune disease.

a)

True

b)

False

77.

NK-cells kill antibody-coated cells by:

a)

Engulfing them by phagocytosis

b)

Binding to Fc portion of antibody and releasing perforins & granzymes

c)

Activating complement directly

d)

Presenting antigen to CD4 cells

e)

Switching IgM to IgG

78.

The ABO blood-group incompatibility reaction at transfusion is an example of:

a)

Type I hypersensitivity

b)

Type II cytotoxic antibody-mediated hypersensitivity

c)

Type III immune-complex hypersensitivity

d)

Type IV delayed T-cell-mediated hypersensitivity

e)

Innate NK-cell attack

79.

The Arthus reaction and serum-sickness are examples of:

a)

Type I hypersensitivity

b)

Type II hypersensitivity

c)

Type III immune-complex hypersensitivity

d)

Type IV delayed hypersensitivity

e)

Auto-inflammatory fever syndromes

80.

The five cardinal signs of local acute inflammation include:

a)

Redness

b)

Heat

c)

Swelling

d)

Pain

e)

Loss of function

81.

Opsonization refers to:

a)

Coating microbes with antibodies or complement to enhance phagocytosis

b)

Direct lysis of bacteria by complement MAC

c)

Fever induction via IL-1

d)

Histamine-induced vasodilation

e)

Killing by NK-cells without antibodies

82.

The WBC that predominates in chronic inflammation and orchestrates tissue cleanup and repair is:

a)

Neutrophils

b)

Macrophages

c)

Basophils

d)

Eosinophils

e)

NK-cells

83.

Serous exudate is best described as:

a)

Thick, pus-filled creamy fluid

b)

Watery fluid with few cells (like blister fluid)

c)

Thick fibrin-rich sticky mesh

d)

Blood-tinged fluid from vessel rupture

e)

Necrotic tissue debris

84.

Fibrinous exudate is typical of:

a)

Urticaria

b)

Fibrin-rich sticky exudate seen on pericardial or pleural surfaces

c)

Watery blister fluid

d)

Caseous granuloma discharge

e)

Fat necrosis

85.

Purulent (suppurative) exudate is characterized by a high content of:

a)

RBCs

b)

Pus with neutrophils, bacteria & necrotic debris

c)

Watery serum with few cells

d)

Fibrin mesh and plasma proteins

e)

Lymphocytes only

86.

Hemorrhagic exudate contains mainly:

a)

Lymphocytes

b)

RBCs from damaged blood vessels

c)

Dead neutrophils

d)

Fibrin mesh

e)

Eosinophils

87.

Edema refers to excess fluid in interstitial tissue or body cavities.

a)

True

b)

False

88.

Pus-filled cavity within a tissue is called:

a)

Cyst

b)

Granuloma

c)

Abscess

d)

Vesicle

e)

Keloid

89.

Granulomas help contain:

a)

Persistent foreign bodies or pathogens that resist usual acute inflammation

b)

RBC breakdown products like bilirubin

c)

Histamine granules

d)

Acute viral infections that resolve quickly

e)

Edema due to allergy

90.

C-reactive protein (CRP) is an acute-phase reactant whose level rises in:

a)

Chronic stable disease only

b)

Acute inflammation & tissue injury

c)

Viral latency with no inflammation

91.

Rouleaux formation of RBCs in lab tests occurs due to:

a)

Increased plasma fibrinogen and globulins making RBCs stack together

b)

Dehydration shrinking RBCs

c)

Immune-complex coating of RBCs

d)

Overproduction of hemoglobin

e)

Clotting cascade activation

92.

Systemic fever during inflammation decreases serum iron & zinc because:

a)

The liver & spleen sequester them to limit microbial growth

b)

Kidneys excrete them to reduce BP

c)

Hypothalamus destroys them with heat

d)

CRP binds them directly

e)

Complement consumes them

93.

Muscle catabolism during prolonged systemic inflammation occurs because:

a)

Cytokines mobilize amino acids for liver acute-phase protein synthesis

b)

Fever melts down muscle enzymes

c)

Complement degrades myosin

d)

Macrophages phagocytose myocytes

e)

Neutrophils release collagenase

94.

Chronic wounds often have impaired healing because:

a)

Excess oxygen supply damages fibroblasts

b)

Persistent infection, poor perfusion & prolonged inflammation prevent proliferation phase

c)

Lack of platelets to form clot

d)

Absence of macrophages in wound

e)

Excess vitamin C

95.

Vitamin C deficiency affects wound-healing because:

a)

It inhibits complement activation

b)

It is required for hydroxylation of collagen for tensile strength

c)

It stimulates excess fibroblast proliferation

96.

Systemic factors that can impair wound-healing include:

a)

Malnutrition

b)

Diabetes mellitus

c)

Advanced age

d)

Corticosteroid therapy

e)

Peripheral vascular disease

97.

First-intention healing best describes:

a)

Clean surgical incision with minimal tissue loss and closely apposed edges

b)

Large infected wound left open to heal by granulation

c)

Bone fracture callus formation

d)

Scar hypertrophy after trauma

e)

Keloid removal scar

98.

Second-intention healing best describes:

a)

Minimal granulation tissue

b)

Wound edges widely separated, requiring more granulation tissue & contraction

c)

Rapid epithelial regeneration with little scar

d)

Healing under sterile bandage without inflammation

e)

Absence of collagen formation

99.

The main function of clotting cascade in wound-healing is to:

a)

Produce fever for better immunity

b)

Recruit neutrophils by chemotaxis

c)

Form fibrin mesh to stop bleeding & scaffold repair

d)

Break down fibrin to remodel clot

e)

Release histamine to increase permeability

100.

Angiogenesis refers to growth of new capillaries into granulation tissue during repair.

a)

True

b)

False

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