The Salk (IPV) polio virus vaccine is an example of:

c.  An inactivated virus vaccine.

Techniques used in developing all the attenuated virus vaccines currently in use (e.g., measles virus vaccine, mumps virus vaccine, rubella virus vaccine) involved increasing the mutation rate by:

a.  growing the virus in culture at a non-preferred temperature.

b.  growing the virus in culture containing less than optimal amounts of crucial medium components.

c.  growing the virus in culture on cells from a different animal species than the virus normally infects.

d.  All the above (i.e., A, B, and C are all true).

d.  All the above (i.e., A, B, and C are all true).

Adjuvants are useful for making vacines generate a better immune response because they create a state of inflammation at the injection site and:

a.  Activate macrophages.

b.  Decrease processing of antigen by dendritic cells.

c.  Inhibit T-cell interaction with B cells.

d.  Prevent neutrophils from entering the injection site.

a.  Activate macrophages.

Examples of vaccines that contain bacterial polysaccharides include:

a.  Haemophilus influenzae type b and Streptococcus pneumoniae vaccines.

b.  Inactivated poliovirus vaccine (IPV) and the oral poliovirus vaccine (OPV).

c.  Tetanus toxin and diptheria toxin vaccines.

d.  The hepatitis B vaccine and influenza virus vaccines.

a.  Haemophilus influenzae type b and Streptococcus pneumoniae vaccines.

"Back mutation to virulence" is a phenomenon that can occur with

a.  Attenuated virus vaccines.

b.  Genetically engineered virus component vaccines such as the currently used hepatitis B vaccine.

c.  Inactivated whole-virus vaccines.

d.  Virus component vaccines such as the currently used influenza virus vaccines.

a.  Attenuated virus vaccines.

"Rational vaccine design" is hampered by the fact that, in general:

a.  There are no techniques for removing a specific viral gene without inactivating the virus.

b.  Viruses that have had the virulence gene removed no longer evokea protective immune response.

c.  Which viral gene is the "virulence gene" is not known. 

d.  None of the above answers are true (neither A nor B nor C is true).

c.  Which viral gene is the "virulence gene" is not known.

An autograph (autologous graft) is a graft:

a.  From a genetically identical individual.

b.  From an individual of another species.

c.  From another, non-genetically identical, member of the same species.

d.  From one site to another of the same individual.

d.  From one site to another of the same individual.

Aside from the ABO blood group antigens, the major barriers to allograft transplantation are:

a.  Differences in gene products coded for by the X and Y chromosomes.

b.  Differences in MHC (HLA) antigens.

c.  Interspecies differences.

d.  All the above (A, B, and C are all true).

b.  Differences in MHC (HLA) antigens.

Hyperacute rejection of a transplanted organ is due to:

a.  Activated macrophages.

b.  CD8 T cells.

c.  Pre-existing antibodies.

d.  TH1 CD4 T cells.

c.  Pre-existing antibodies.

Acute rejection of a transplanted organ is due to:

a.  Activated macrophages.

b.  CD8 T cells.

c.  Pre-existing antibodies.

d.  TH 1 CD4 T cells.

b.  CD8 T cells.

The immunosuppressive drugs that have had the most impact on successful organ transplantation are:

a.  Anti-T-cell antibodies.

b.  Corticosteroids.

c.  Cytotoxic drugs.

d.  Selective inhibitors of T-cell activation.

d.  Selective inhibitors of T-cell activation.

Examples of selective inhibitors of T-cell activation are:

a.  Azathioprine and cyclophosphamide.

b.  Cyclosporine A and tacrolimus.

c.  Goat anti-T-cell antibody and sheep anti-T-cell antibody.

d.  Methotrexate and prednisone.

b.  Cyclosporine A and tacrolimus.

Most cellular mutations are inconsequential but some cause proliferation without invasion or metastasis and still others cause proliferation, invasion, and metastasis.

a.  True.

b.  False.

a.  True.

Most often, a single mutation in a cell is sufficient to cause that cell to become cancerous.

a.  True.

b.  False.

b.  False.

A major problem in the early detection of cancer is that current detection methods cannot detect cancers where the number of cells involved is less than 10⁶ (1,000,000) cells.

a.  True.

b.  False.

a.  True.

Viruses associated with various kinds of cancer include:

a.  Epstein-Barr virus.

b.  Hepatitis B virus.

c.  Papillomaviruses.

d.  All the above (A, B, and C are all true).

d.  All the above (A, B, and C are all true).

The accompanying illustration makes the point that tumor cells from a mouse that is either MHC-identical or MHC-non-identical will be rejected when transplanted into a recipient mouse.

[image]

a.  True.

b.  False.

b.  False.

The accompanying illustration shows the mechanism by which:

[image]

a. ABO blood group antigen differences arise.

b. Autologous stem cell donations avoid generating antigen differences.

c. Major histocompatibility antigen differences arise.

d. Minor histocompatibility antigen differences arise.

d. Minor histocompatibility antigen differences arise.

Experimental work has shown that it is possible to process antigens from a patient's own cancer to enhance the ability of the patients immune system to recognize cancern cells and destroy them.

a.  True.

b.  False.

a.  True.

There are no vaccines in commercial use that protect individuals against oncogenic viruses.

a.  True.

b.  False.

b.  False.

In autoimmune hemolytic anemia, red cells are cleared from the circulation because they have acquired IgG antibodies on their surface. Autoimmune hemolytic anemia thus resembles a:

A.Type I hypersensitivity reaction.

B.Type II hypersensitivity reaction.

C.Type III hypersensitivity reaction.

D.Type IV hypersensitivity reaction.

B.Type II hypersensitivity reaction.

In Graves’ disease, an autoantibody is developed that reacts with the TSH receptor. The effect of the autoantibody binding to the TSH receptor is to:

A.cause a CD8 T-cell mediated attack on the thyroid, decreasing production of the thyroid hormones T3 and T4.

B.cause increased production of the thyroid hormones T3 and T4.

C.cause the thyroid to involute (become smaller) as the result of complement-mediated cell lysis attributable to the autoantibody bound to thyroid cells.

D.increase the risk of the patient developing thyroid cancer because of autoantibody masking important self antigens on the thyroid.

B.cause increased production of the thyroid hormones T3 and T4.

In Hashimoto’s disease, an autoantibody causes the thyroid to enlarge because:

A.a lack of thyroid hormone production stimulates an increase in thyroid size in a compensatory fashion.

B.the autoantibody stimulates increased production of thyroid epithelial cells.

C.the production of the thyroid hormones T3 and T4 increases. 

D.inflammation occurs and thyroid tissue is replaced with nests of lymphoid tissue.

D.inflammation occurs and thyroid tissue is replaced with nests of lymphoid tissue.

In IDDM, an autoimmune reaction leads to the destruction of:

A.glycogen reserves in muscle.

B.insulin-producing islet cells in the pancreas.

C.the glycogen storage mechanism in the liver.

D.the insulin receptor on adipocytes.

B.insulin-producing islet cells in the pancreas.

In the accompanying illustration, the distinctive rash that lies over both cheeks and the bridge of the nose is caused by:

[image]

A.a delayed type (Type IV) reaction caused by sensitized T cells.

B.antigen-antibody complexes deposited in the skin.

C.CD8 T-cell mediated attack on skin cells.

D.IgE-mediated release of histamine and other effector molecules from tissue mast cells.

B.antigen-antibody complexes deposited in the skin.

In systemic lupus erythematosus (SLE), autoantibodies are formed that may react with:

A.antigens present in nearly every cell of the body.

B.antigens present in the myelin sheath of neurons.

C.antigens present on the surface of red blood cells (RBCs).

D.antigens present only within the medulla of the thymus.

The autoantibody involved in causing myasthenia gravis is directed against:

A.an antigen on the surface of muscle cells.

B.the acetylcholine receptor.

C.the Ca+ transporter protein of muscle cells.

D.the myelin sheath of nerves.

The damage to the hands shown here, the hands of a person with the disease rheumatoid arthritis, is caused by:

[image]

A.  an immune attack on components of the joint.

B.  an untreated bacterial infection of the finger joints.

C.  normal wear and tear on the hand joints as a person ages.

D.  trauma suffered many years previously in an industrial accident involving a piece of

D. manufacturing machinery.

A.  an immune attack on components of the joint.

In multiple sclerosis, nerve damage is caused by a combination of antibodies to myelin and:

A.activated macrophages.

B.CD8 T cells detecting a non-self antigen on neurons.

C.NK cells, reacting to altered self antigens on neurons.

D.TH1 CD4 cells secreting IFN-γ.

D.TH1 CD4 cells secreting IFN-γ.

The fact that T cells participate in autoimmune disease even when the autoimmune disease is caused by antibodies is shown by the fact that:

A.Self-reactive B cells cannot produced disease without T-cell help.

B.T-cell help is needed for isotype switching.

C.T-cell help is needed for somatic hypermutation (affinity maturation).

D.All the above (A, B, and C are each correct).

D.All the above (A, B, and C are each correct).

Regulatory CD4 T cells:

A.express CD25 in addition to CD4

B.express CTLA-4 instead of CD28

C.suppress the autoreactivity of CD4 cells reacting to antigen presented by the same APC.

D.All the above (A, B, and C are each correct).

D.All the above (A, B, and C are each correct).

12.An HLA allotype that greatly increases a person’s risk for acquiring ankylosing spondylitis is:

A.HLA-B27.

B.HLA-B35.

C.HLA-DQ6.

D.HLA-DR3.

A.HLA-B27.

Although celiac disease is associated with the HLA allotype HLA-DQ2, there must be other factors necessary to produce celiac disease because:

A.about 30% of non-Asians have HLA-DQ2 but only 0.5 to 1.0% of those with the allotype have celiac disease, even though almost all non-Asians consume gluten.

B.Asians never get celiac disease even though almost all Asians express HLA-DQ2.

C.avoiding gluten in the diet prevents celiac disease even among individuals who express HLA-DQ2.

D.even individuals who lack HLA-DQ2 have celiac disease at the same rate as individuals who have HLA-DQ2.

A.about 30% of non-Asians have HLA-DQ2 but only 0.5 to 1.0% of those with the allotype have celiac disease, even though almost all non-Asians consume gluten.

The pathology (tissue damage) that occurs in systemic lupus erythematosus (SLE) is caused by:

A.deposition of immune complexes in various organs.

B.release of granules from mast cells.

C.selective deletion of CD4+ T cells

D.All the above (A, B, and C are each true).

A.deposition of immune complexes in various organs.

“Molecular mimicry” has been invoked to explain the autoimmune response that occurs in:

A.Hashimoto’s disease.

B.hemolytic anemia.

C.rheumatic heart disease.

D.systemic lupus erythematosus (SLE).

C.rheumatic heart disease.

Autoimmune diseases occur because:

A.a person does not produce the C3 component of complement.

B.a person produces excessive amounts of IgE

C.a person’s self-tolerance is broken.

D.None of the above (neither A, nor B, nor C is true).

C.a person’s self-tolerance is broken.

T-cell mediated autoimmune diseases include:

A.allergies to peanuts.

B.multiple sclerosis.

C.rash following contact with poison ivy.

D.All the above (A and B and C are each true).

B.multiple sclerosis.

The genes that correlate best with observed susceptibility or resistance to autoimmune diseases are:

A.the genes coding for the various HLA allotypes.

B.the genes coding for the α- and β-chains of the T-cell receptor since all autoimmunity is basically T-cell mediated.

C.the X chromosome, since women have two X-chromosomes and are more susceptible to such autoimmune diseases as SLE and multiple sclerosis.

D.None of the above (neither A nor B nor C is true).

A.the genes coding for the various HLA allotypes.

There are no autoimmune diseases with a mechanism comparable to the mechanism involved in Type I hypersensitivity reactions.

A.True.

B.False.

A.True.

An important feature of mucosal cells in terms of the immune system is that they manage communication between the inside of the body and the outside environment.

A. True

B. False

A. True

Tonsils and adenoids form a ring of lymphoid tissue around the lower end of the gastrointestinal tract, the anus.

A.  True

B.  False

B.  False

M cells are able to take up intact microorganisms and particulate antigens from the lumen

 of the gut and transfer them to immune cells in the Peyer’s patch to initiate an adaptive immune response.

A.True.

B.False

A.True.

The associated illustration shows a dendritic cell sampling the contents of the intestinal lumen.

[image]

A.True.

B.False

A.True.

Effector lymphocytes activated in any one mucosal tissue remain there permanently and do no recirculate to populate other mucosal tissues.

A.True

B.False

B.False

Secretory IgA is capable of:

A.bind and neutralize antigens internalized in endosomes.

B.bind and neutralize toxins and pathogens on the gut surface.

C.exporting toxins and pathogens from the lamina propria.

D.All the statements above are true.

In dealing with intestinal parasites, a TH2 responses are protective against the infection while a TH1 response causes additional tissue damage.

A. True

B. False

In a secondary immune response, highly specific antibody produced by memory cells that differentiate into plasma cells is produced alongside less specific antibody produced by naïve B cells seeing antigen for the first time.

A.True

B.False

Memory T cells can arise only from activated naïve T cells.

A.True

B.False

Both effector B and T cells and memory B and T cells are produced during a primary immune response.

A.  True

B.  False

A.  True

Antigenic drift is a mechanism used by influenza A viruses to exchange gene segments among various strains of the virus.

A.  True.

B.  False.

B.  False.

Antigenic shift is a term that describes mutations that gradually change the antigenic determinants of influenza A virus.

A.True.

B.False.

B.False.

A mechanism used by herpes simplex virus to evade the immune response is:

A.antigenic drift.

B.latency.

C.possession of multiple surface antigens.

D.None of the above (neither A nor B nor C is correct).

B.latency.

An example of a mechanism used by viruses to subvert the immune response is:

A.a virally-encoded Fc receptor.

B.inhibition of peptide transport by TAP.

C.viral inhibition of MHC class I molecule expression.

D.All the above are correct (A and B and C are all correct).

D.All the above are correct (A and B and C are all correct).

Inherited immune deficiency diseases are generally caused by recessive genes.

A.True.

B.False.

A.True.

X-linked agammaglobulinemia:

A.failure of the affected individual to develop functional B cells or to produce antibody.

B.is also called Bruton’s agammaglobulinemia.

C.is caused by a defect in Btk (a specifc tyrosine kinase located on the X chromosome).

D.All the above are correct (A, B, and C are all correct).

D.All the above are correct (A, B, and C are all correct).

Individuals who have an inherited defect affecting the C1 or C2 or C4 components of complement have difficulty clearing immune complexes.

A. True 

B. False

A. True 

Individuals with an inherited defect in the C3 component of complement have difficulty managing viral infections.

Defects in the complement components C5 through C9 make an individual more susceptible to infections with the bacterium Streptococcus pneumoniae.

A.True.

B.False.

An individual whose leukocytes lack CD18:

A.exhibits defective migration of leukocytes from the circulation into infected tissues.

B.exhibits failure of phagosome-lysosome fusion.

C.has leukocytes that lack the ability to generate reactive oxygen metabolites.

D.is more susceptible to influenza virus infection.

A.exhibits defective migration of leukocytes from the circulation into infected tissues.

The fact that human immunodeficiency virus (HIV) is a retrovirus means that it has the capability to make complementary DNA (cDNA) copies of its RNA genome that it can then insert into the chromosome of an infected cell.

A.True.

B.False

A.True.

Targets for attachment of HIV to cells that the virus can infect include:

A.CCR5.

B.CD4.

C.CXCR4.

D.All the above are correct (A, B, and C are all correc).

D.All the above are correct (A, B, and C are all correc).

When an HIV-infected individual’s CD4 T-cell count falls below about 200 CD4 cells per microliter, the person begins to experience opportunistic infections and has entered the “AIDS” portion of the HIV infection cycle.

A.True.

B.False.

A.True.

Highly-Active Anti-Retroviral Therapy (HAART) can prolong survival in individuals infected with HIV but does not increase the number of circulating CD4 T cells.

A.True.

B.False.

B.False.

A way of correcting gene defects in the immune response is:

A.a bone marrow transplant.

B.administration of donor antibodies.

C.continuous administration of antibiotics.

D.transfusion of NK cells.

A.a bone marrow transplant.

A genetic deficiency that confers partial protection against HIV infection is:

A.CCR5

B.CCR5-Δ32.

C.CD4

D.CXCR4

CD4+ T-cell loss during the course of HIV infection occurs because:

A.infected T cells express viral peptides and become targets for CD8+ T-cell killing.

B.infected T cells undergo apoptosis at an increased rate.

C.the HIV virus replication kills the T cells.

D.All the above: A, B, and C above are all correct.

D.All the above: A, B, and C above are all correct.

Malignancies associated with the late stages of AIDS include:

A.Kaposi’s sarcoma (associated with human herpesvirus virus 8).

B.Non-Hodgkin lymphoma, including Burkitt’s lymphoma (associated with Epstein-Barr virus).

C.Primary lymphoma of the brain.

D.All the above: A, B, and C are all correct.

D.All the above: A, B, and C are all correct.

The viral recombination depicted represents the mechanism by which changes in influenza viruses occur by means of:

[image]

A.antigenic drift.

B.antigenic shift.

C.frame shift mutation.

D.point mutation.

B.antigenic shift.

[image]

A.persistence of Epstein-Barr virus in permanently infected B cells.

B.persistence of herpes simplex virus (infection, latency, reactivation).

C.persistence of HIV infection (long-standing viral replication from provirus integrated into host chromosomes)

D.persistence of varicella zoster (chicken pox) virus (infection, latency, reactivation as shingles).

B.persistence of herpes simplex virus (infection, latency, reactivation).

Hypersensitivity reactions that are associated with antibodies include:

A.type I only.

B.types I, II, and III.

C.types I, III, and IV.

D.types II, III, and IV.

B.types I, II, and III.

Examples of common allergens that associated with type I reactions include:

A.dust mite feces.

B.mold spores.

C.plant pollens.

D.All the above (A, B, and C are all true).

D.All the above (A, B, and C are all true).

FcεRI is a receptor involved in:

A.Type I hypersensitivity reactions.

B.Type II hypersensitivity reactions.

C.Type III hypersensitivity reactions.

D.Type IV hypersensitivity reactions.

A.Type I hypersensitivity reactions.

Histamine is a major effector molecule (toxic mediator) in involved in:

A.Type I hypersensitivity reactions.

B.Type II hypersensitivity reactions.

C.Type III hypersensitivity reactions.

D.Type IV hypersensitivity reactions.

A.Type I hypersensitivity reactions.

Cross-linking of IgE bound to mast cell receptors, through IL-4 production, stimulates isotype switching that amplifies production of IgE.

A.True.

B.False.

In the accompanying illustration, the wheal and flare reaction shown is the result of:

[image]

A.activation of specific T cells.

B.degranulation of tissue mast cells.

C.IgG production by B cells in the lymph node adjacent to this reaction.

D.macrophage accumulation at the injection site.

B.degranulation of tissue mast cells.

The effect of mast-cell activation and granule release on airways is:

A.coughing.

B.decreased diameter.

C.increased mucus secretion.

D.All the above (A, B, and C are all true).

D.All the above (A, B, and C are all true).

In systemic anaphylaxis, antigen in the bloodstream activates tissue macrophages throughout the body producing:

A.contraction of smooth muscle cells and constriction of the throat and airways.

B.increased capillary permeability and entry of fluid into tissues.

C.loss of blood pressure because of loss of circulatory volume.

D.All the above (A, B, and C are all true).

D.All the above (A, B, and C are all true).

Desensitization (decreasing a person’s susceptibility to a specific Type I hypersensitivity reaction by injecting repeated small doses of the specific antigen that causes the reaction) is thought to decrease susceptibility by:

A.causing isotype switching for that specific antigen from IgE to IgG4.

B.causing the person’s plasma cells to become anergic to that specific antigen.

C.depleting the supply of CD4 T-helper cells necessary to sustain IgE production.

D.promoting apoptosis of the specific plasma cells producing IgE antibody to that specific antigen.

Pharmacologic measures that can modify the response to Type I hypersensitivity reactions include:

A.antihistamines.

B.corticosteroids (inhaled or systemic).

C.epinephrine.

D.All the above (A, B, and C are all true).

D.All the above (A, B, and C are all true).

Type II hypersensitivity reactions are caused by:

A.IgE antibody bound to receptors on mast cells and basophils.

B.IgG antibody bound to the modified surface antigens of cells.

C.IgM antibody bound to immune complexes.

D.None of the above are true (neither A nor B nor C is true).

B.IgG antibody bound to the modified surface antigens of cells.

Antibody bound to modified proteins on the surface of red blood cells (RBCs) leads to:

A.activation of complement and complement-mediated lysis of the RBC.

B.phagocytosis fo the RBC through phagocyte C3b receptors.

C.phagocytosis of the RBC through phagocyte Fc receptors.

D.All the above (A, B, and C are all true).

D.All the above (A, B, and C are all true).

Manifestations of Type III hypersensitivity typically occur:

A.7-10 days after exposure to the antigen.

B.either within minutes of exposure to the antigen or within 2 to 3 days of exposure to the antigen, depending upon how much antigen the person was exposed to.

C.only after 2 to 3 days following exposure to the antigen. D.within a few minutes after exposure to the antigen.

A.7-10 days after exposure to the antigen.

Type III hypersensitivity reactions are caused by:

A.immune complexes of any size, no matter whether they fix complement efficiently or not.

B.immune complexes of intermediate size that, nonetheless, do fix complement efficiently.

C.large immune complexes that fix complement efficiently.

D.small immune complexes that do not fix complement efficiently.

D.small immune complexes that do not fix complement efficiently.

Type III hypersensitivity reactions are associated with immune complexes that accumulate in:

A.small airways of the respiratory tract.

B.the germinal centers of lymph nodes.

C.the lumen of the gastrointestinal tract.

D.the walls of blood vessels.

D.the walls of blood vessels.

In chronic infection with the hepatitis B virus, some individuals experience damage to their livers (cirrhosis) in which liver tissue is destroyed and replaced by scar tissue. The damage is caused by an inflammatory response brought on by antigen (hepatitis B virus)-antibody (antibody to hepatitis B virus) complexes deposited in the liver. This liver damage is an example of a:

A.Type I hypersensitivity reaction.

B.Type II hypersensitivity reaction.

C.Type III hypersensitivity reaction.

D.Type IV hypersensitivity reaction.

C.Type III hypersensitivity reaction.

In the accompany illustration, in the panel on the left, an antigen associated with the bacterium Mycobacterium tuberculosis is being injected intradermally into an individual. The panel on the right illustrates the result seen two days later – an indurated (hardened) area under the skin. This reaction is an example of a:

[image]

A.Type I hypersensitivity reaction.

B.Type II hypersensitivity reaction.

C.Type III hypersensitivity reaction.

D.Type IV hypersensitivity reaction.

D.Type IV hypersensitivity reaction.

In the accompanying illustration (the same illustration shown with Question 17), the induration (hardened area under the skin) seen in the right panel is caused by:

A.antigen-antibody complexes accumulating at the injection site. B.complement-mediated phagocytosis of tissue cells with modified surface antigens.

C.recruitment of T cells and phagocytes (macrophages) to the injection site.

D.None of the above is correct (neither A nor B nor C is true).

C.recruitment of T cells and phagocytes (macrophages) to the injection site.

Poison ivy sensitivity is an example of a:

A.Type I hypersensitivity reaction.

B.Type II hypersensitivity reaction.

C.Type III hypersensitivity reaction.

D.Type IV hypersensitivity reaction.

D.Type IV hypersensitivity reaction.

Reaction to nickel in jewelry is an example of a:

A.Type I hypersensitivity reaction.

B.Type II hypersensitivity reaction.

C.Type III hypersensitivity reaction.

D.Type IV hypersensitivity reaction.

D.Type IV hypersensitivity reaction.