Host Defenses I Overview And – Complete Test Bank – Ch.12

Microbiology Fundamentals: A Clinical Approach, 3e (Cowan)

Chapter 12 Host Defenses I: Overview and Nonspecific Defenses

1) Components of the first line of defense include all the following except ________.

A) the tough cell sheet of the upper epidermis of the skin

B) nasal hairs

C) flushing action of tears and blinking

D) flushing action of urine

E) phagocytic white blood cells

2) Nonspecific chemical defenses include ________.

A) lysozyme

B) lactic acid and electrolytes of sweat

C) skin's acidic pH and fatty acids

D) stomach hydrochloric acid

E) All of the choices are correct.

3) The chemical found in tears and saliva that hydrolyzes the peptidoglycan in certain bacterial cell walls is ________.

A) lactic acid

B) hydrochloric acid

C) lysozyme

D) histamine

E) bile

4) The body region where a ciliary escalator helps to sweep microbes trapped in mucus away from that body site is the ________.

A) skin

B) respiratory tract

C) digestive tract

D) urinary tract

E) eyes

5) This body region is protected by fatty acids, acidic pH, lactic acid, and a tough cell barrier with its own normal biota.

A) Skin

B) Respiratory tract

C) Digestive tract

D) Urinary tract

E) Eyes

6) Keratin is an important aspect of nonspecific defense because it ________.

A) is toxic to pathogens

B) creates a physical barrier against pathogens

C) destroys pathogens

D) physically restricts pathogens to a specific region

E) None of the choices are correct.

7) Each of the following are physical barriers to pathogens except ________.

A) unbroken skin

B) mucus

C) hairs

D) tears

E) T cells

8) Lysozyme is found in ________.

A) mucous membranes of the respiratory tract

B) mucous membranes of the gastrointestinal tract

C) salivary secretions

D) sweat from sweat glands

E) All of the choices are correct.

9) A properly functioning immune system is responsible for ________.

A) surveillance of the body

B) recognition of foreign material

C) destruction of foreign material

D) All of the choices are correct.

E) Only recognition of foreign material and destruction of foreign material are correct.

10) Immune system cells differentiate between self and foreign cells by their ________.

A) cell walls

B) biota

C) markers

D) skin

E) cell processes

11) The term ________ is given to any foreign substance that stimulates a specific immune system response.

A) antibody

B) allergen

C) antigen

D) foreign body

E) None of the choices are correct.

12) Which of the following fluid compartments is not a partner in immune function?

A) Bloodstream

B) Extracellular fluid

C) Lymphatic system

D) Intracellular fluid

13) Plasma ________.

A) is the liquid portion of blood in which blood cells are suspended

B) is mostly water

C) contains albumin and globulins

D) contains fibrinogen

E) All of the choices are correct.

14) Which of the following is incorrect about circulating blood cells?

A) After birth, produced in red bone marrow sites

B) Develop from undifferentiated stem cells

C) Include Kupffer cells

D) Include leukocytes that are either granulocytes or agranulocytes

E) Include erythrocytes that, when mature, lose their nuclei

15) The blood cells that function in allergic reactions and inflammation, contain peroxidase and lysozyme, and particularly target parasitic worms and fungi are ________.

A) basophils

B) eosinophils

C) neutrophils

D) monocytes

E) lymphocytes

16) The least numerous of all white blood cells that release histamine during inflammation and allergic reactions are ________.

A) basophils

B) eosinophils

C) neutrophils

D) monocytes

E) lymphocytes

17) Which white blood cells comprise 20% to 30% of the circulating WBCs and are the cells that function in the body's third line of defense?

A) Basophils

B) Eosinophils

C) Neutrophils

D) Monocytes

E) Lymphocytes

18) The most numerous WBCs that have multilobed nuclei and are very phagocytic are ________.

A) basophils

B) eosinophils

C) neutrophils

D) monocytes

E) lymphocytes

19) Which white blood cells comprise 3% to 7% of circulating WBCs, are phagocytic, and can migrate out into body tissues to differentiate into macrophages?

A) Basophils

B) Eosinophils

C) Neutrophils

D) Monocytes

E) Lymphocytes

20) All of the following pertain to platelets except they ________.

A) contain hemoglobin to transport oxygen and carbon dioxide

B) function primarily in hemostasis

C) originate from giant multinucleate cells called megakaryocytes

D) function in blood clotting and inflammation

E) are not whole cells but are pieces of cells

21) Hematopoiesis is the ________.

A) loss of blood due to hemorrhaging

B) production of only red blood cells

C) production of white blood cells, red blood cells, and platelets

D) plugging of broken vessels to stop bleeding

E) migration of white blood cells from the blood out to the tissues

22) Plasma cells ________.

A) function in cell-mediated immunity

B) are derived from T lymphocytes

C) function in blood clotting

D) produce and secrete antibodies

E) All of the choices are correct.

23) Which type of white blood cells are particularly attracted to sites of parasitic worm infections?

A) Monocytes

B) Eosinophils

C) Basophils

D) Neutrophils

E) Lymphocytes

24) Each of the following are granulocytes except ________.

A) neutrophils

B) eosinophils

C) lymphocytes

D) basophils

E) All of the choices are granulocytes.

25) The granules of basophils contain ________.

A) antibodies

B) antigens

C) digestive enzymes

D) histamine

E) lysozyme

26) Which of the following is in the correct order from greatest to least phagocytic activity?

A) Neutrophils, eosinophils, macrophages

B) Neutrophils, macrophages, eosinophils

C) Eosinophils, macrophages, neutrophils

D) Macrophages, neutrophils, eosinophils

E) Macrophages, eosinophils, neutrophils

27) Neutrophils, eosinophils, and basophils are called ________ because they have prominent cytoplasmic inclusions that, in a stained blood smear, appear with identifying, characteristic colors.

A) leukocytes

B) granulocytes

C) agranulocytes

D) monocytes

E) None of the choices are correct.

28) ________ function in humoral immunity, while ________ function in cell-mediated immunity.

A) B cells; T cells

B) T cells; B cells

C) monocytes; basophils

D) basophils; T cells

E) B cells; neutrophils

29) When monocytes migrate from the blood out to the tissues they are transformed by inflammatory mediators to develop into ________.

A) primary phagocytes

B) neutrophils

C) killer T cells

D) cytotoxic T cells

E) macrophages

30) Leukocytes that are derived from monocytes and have long, thin processes to trap pathogens are ________.

A) dendritic cells

B) eosinophils

C) macrophages

D) platelets

E) mast cells

31) Which of the following lymphoid organs or tissues has the immunological function of filtering pathogens from the blood?

A) Lymph nodes

B) Thymus

C) Spleen

D) GALT

E) Tonsils

32) What structures are found along lymphatic vessels and are heavily clustered in the armpit, groin, and neck?

A) Lymph nodes

B) Thymus

C) Spleen

D) GALT

E) Tonsils

33) Which gland shrinks in size during adulthood and has hormones that function in maturation of T lymphocytes?

A) Lymph nodes

B) Thymus

C) Spleen

D) GALT

E) Tonsils

34) The lymphoid tissues of the intestinal tract are collectively referred to as ________.

A) lymph nodes

B) thymus

C) spleen

D) GALT

E) tonsils

35) Diapedesis is the ________.

A) loss of blood due to hemorrhaging

B) production of only red blood cells

C) production of white blood cells, red blood cells, and platelets

D) plugging of broken vessels to stop bleeding

E) migration of white blood cells from the blood out to the tissues

36) The four classic signs and symptoms of inflammation include all the following except ________.

A) redness

B) warmth

C) swelling

D) pain

E) chills

37) All the following are events of early inflammation except ________.

A) macrophages appear first and begin phagocytosis

B) chemical mediators and cytokines are released

C) brief vasoconstriction is followed by vasodilation

D) exudate and pus can accumulate

E) capillaries become more permeable resulting in edema

38) Which of the following is incorrect about inflammation?

A) It can last hours to years.

B) Pyrogens cause vasodilation and increased capillary permeability.

C) Serotonin causes smooth muscle contraction.

D) Fever could be beneficial to inhibiting the pathogen.

E) Basophils and mast cells release histamine.

39) Which of the following is mismatched?

A) Interferon alpha and beta—inhibits viral replication

B) Interleukin-2—stimulates T-cell mitosis and B-cell antibody production

C) Serotonin—causes smooth muscle contraction

D) Prostaglandins—activate eosinophils and B cells

E) Tumor necrosis factor—increases chemotaxis and phagocytosis

40) Histamine, serotonin, and bradykinin are all ________.

A) vasoactive mediators

B) mediators of B-cell activity

C) mediators of T-cell activity

D) mediators that increase chemotaxis

E) fever inducers

41) Each of the following is involved in the migration of white blood cells except ________.

A) chemotaxis

B) diapedesis

C) motility

D) vasodilation

E) phagocytosis

42) The leakage of excess fluid into tissues is called ________.

A) chemotaxis

B) edema

C) diapedesis

D) vasoactivity

E) pus

43) Which of the following is mismatched dealing with inflammation?

A) Rubor—redness

B) Calor—warmth

C) Tumor—cancer

D) Dolar—pain

E) None of these are mismatched.

44) Which of the following is not a chief function of inflammation?

A) Start tissue repair

B) Destroy microbes

C) Mobilize and attract immune components to injury site

D) Block further invasion

E) Cause a fever

45) The circulating substances that affect the hypothalamus and initiate fever are ________.

A) complement

B) interferons

C) leukotrines

D) pyrogens

E) lysozymes

46) A person will typically experience the sensation of ________ when fever is starting to occur in the body.

A) heat

B) pain

C) chills

D) sweat

E) All of the choices are correct.

47) Each of the following are benefits of fever except it ________.

A) reduces the ability of temperature-sensitive organisms to multiply

B) increases the availability of iron

C) increases phagocytosis

D) increases metabolism

E) stimulates hematopoiesis

48) Which of the following is not a type of phagocyte?

A) Neutrophil

B) Macrophage

C) Kupffer cell

D) Monocyte

E) Lymphocyte

49) Which of the following is not an event of phagocytosis?

A) Diapedesis

B) Chemotaxis

C) Phagolysosome formation

D) Destruction

E) Ingestion

50) What type of molecules act to draw phagocytes to foreign substances?

A) MALTs

B) RES

C) PAMPs

D) BALTs

E) Lysosomes

51) Which of the following is a chemical used by phagocytes to destroy ingested foreign substances?

A) Hydrogen peroxide

B) Nitric oxide

C) Lactic acid

D) Superoxide anion

E) All of these are used.

52) All of the following pertain to interferon except it ________.

A) is a protein

B) is produced by certain white blood cells and tissue cells

C) includes alpha, beta, and gamma types

D) inhibits viruses, tumors, and cancer gene expression

E) increases capillary permeability and vasodilation

53) Which of the following is incorrect about complement?

A) Is composed of at least 20 blood proteins

B) Only appears in the blood during a response to a pathogen

C) Acts in a cascade reaction

D) Involves a classical pathway

E) Involves an alternate pathway

54) The membrane attack stage of the complement cascade involves ________.

A) initiation of the cascade

B) production of inflammatory cytokines

C) a ring-shaped protein that digests holes in bacterial cell membranes and virus envelopes

D) cleaving of C3 to yield C3a and C3b

E) C1q binding to surface receptors on a membrane

55) The ________ system of blood proteins acts to lyse foreign cells and viruses.

A) humoral immunity

B) cell-mediated

C) complement

D) lymphoid

E) None of the choices are correct.

56) What is the first step in the major events of the inflammation process?

A) Formation of pus and edema

B) Scar formation and/or resolution

C) Vascular reactions

D) Injury and mast cells releasing chemical mediators

E) Activation of the complement system

57) During what process are hypochlorite and hydrogen peroxide produced to destroy bacteria and inhibit viral replication?

A) Inflammation

B) Phagocytosis

C) Interferon production

D) Complement production

E) Bradykinin

58) Which protein can be produced by a virus-infected cell, in order to communicate with other cells the need to produce antiviral proteins?

A) Complement

B) Albumin

C) Interferon

D) Histamine

59) Plasma is also called lymph.

60) B lymphocytes and T lymphocytes mature in the thymus gland.

61) Monocytes and lymphocytes are agranular leukocytes.

62) During inflammation, a high neutrophil count is a common sign of bacterial infection.

63) Inflammatory responses are orchestrated by the immune system and are part of the body's third line of defense.

64) Endotoxin is an exogenous pyrogen.

65) A low to moderate fever in an otherwise healthy person should be treated immediately with antipyretic drugs.

66) During phagocytosis, intracellular digestion begins as soon as the phagosome is formed.

67) The production of interferon will protect the host cell from a viral infection.

68) Complement proteins are produced by the spleen.

69) Certain complement components stimulate inflammation and phagocytosis.

70) Cytokines are chemicals and proteins that are critical components of the immune system.  Which of the following statements is incorrect regarding the function of cytokines?

A) All cytokines are synthesized to stimulate the inflammatory response; their purpose is to mediate vascular reactions and diapedesis.

B) Cytokines are secreted by a wide variety of cell types, including immune cells, epithelial and endothelial cells.

C) Cytokines play a role in both inflammatory stimulation, as well as being anti-inflammatory mediators.

D) Cytokines mediate communication between cells; they are crucial for stimulation, suppression and control of all aspects of the immune response.

71) Cytokines mediate a variety of processes in the immune system, for example, ________ encourages inflammatory responses and ________ suppresses the actions of immune cells.

A) TNF-β; IL-10

B) IL-10; TNF-β

C) erythropoietin; TNF-β

D) seratonin; histamine

E) IL-10; IL-7

72) The human microbiome is considered an important component of the first line of defense.  Which statement adequately reflects its role as a defensive barrier?

A) The human microbiota competes with pathogens for space and nutrients limiting their ability to cause infection, and trains the immune system to recognize antigens.

B) The organisms that comprise the microbiota are able to phagocytose potential pathogens, thereby eliminating them from the human host.

C) The human microbiome has evolved with the species so it is able to actively destroy pathogens by raising the body temperature when an infection by a pathogen occurs.

D) Cells in the human microbiome secrete cytokines that play a role in stimulating the immune response when a pathogen has entered the system.

73) Which of the following is not a mechanism employed by the human microbiota to contribute to the first line of defense?

A) It can phagocytose pathogens

B) It can lower the pH making the environment too acidic for pathogens to survive

C) It can out-compete pathogens for limited nutrients

D) It can train the immune cells to recognize antigenic markers

E) It can block potential binding sites on epithelial cells restricting adhesion, which is a necessary step for infection

74) Overuse of disinfectants and antiseptics, as well as antibiotics, can result in inflammatory diseases stemming from an inadequate microbiome.

75) Which of the following is not a component of the second line of defense?

A) Keratin

B) Complement

C) Inflammation

D) Phagocytosis

E) Fever

76) Inflammation, fever, phagocytosis, and antimicrobial molecules are considered innate because ________.

A) they are not antigen-specific; they contribute to host defenses regardless of the source of activation

B) they are activated only if the system has encountered the antigen previously

C) they are physical barriers that block the binding of pathogens to host tissues

D) they operate independently of the first line of defense and the B and T lymphocytes in the third line of defense

77) The second line of defense is a series of systems that involves both cells and chemicals working together.

78) Which statement below characterizes the complement system?

A) Complement comprises a team of blood proteins that are activated in a cascade, ultimately leading to pathogen cytolysis, inflammation and enhanced phagocytosis.

B) Complement pyrogens stimulate the hypothalamus to raise the body temperature, increasing metabolism and preventing the growth of temperature-sensitive pathogens.

C) Complement proteins bind to cell surfaces and induce changes in genetic expression, eliminating not only pathogens, but cancer cells also.

D) Complement proteins, produced by a host cell in response to viral attack, are secreted and enter neighboring cells, stimulating the production of antiviral proteins in anticipation of an invasion.

79) Which statement below characterizes the action of interferon?

A) Interferon, produced by a host cell in response to viral attack, is secreted and enters neighboring cells, stimulating the production of antiviral proteins in anticipation of an invasion.

B) Interferon stimulates the hypothalamus to raise the body temperature, increasing metabolism and preventing the growth of temperature-sensitive pathogens.

C) Interferon comprises a team of blood proteins that are activated in a cascade, ultimately leading to pathogen cytolysis, inflammation and enhanced phagocytosis.

D) Interferon binds to cell surfaces and induces changes in genetic expression, eliminating not only pathogens, but cancer cells also.

NCLEX Prep - Test Bank Question:  Please read the clinical scenario, and then answer the questions that follow to become familiar with the traditional NCLEX question format.

 A 16-year-old male with cystic fibrosis is admitted to the inpatient pulmonary unit. He has been hospitalized several times in the past year with respiratory infections, including Pseudomonas and H. influenza. Because of his thick mucous, airway inflammation, and immobile mucosal cilia, microorganisms are unable to be effectively cleared from his lungs. He is supposed to perform vigorous airway mucous clearance measures at home with a vibrating vest and IPV (intrapulmonary percussive ventilation) device. However, the patient states that his treatment takes hours and he does not always feel sick. He estimates his compliance with home airway clearance regimen to be less than 50%.

80) If the patient's cilia are unable to clear his lungs of mucus, which line of host defense is breached?

A) First line of defense

B) Second line of defense

C) Third line of defense

D) First and second lines of defense

81) The patient asks the nurse to explain to him why he keeps getting sick from the same bacteria. Which of the following statements is the most appropriate response? 

A) Your lungs produce these organisms because your cilia are permanently damaged.

B) Your mucus traps and harbors the microorganisms and when they can't be cleared, they begin to breach your second and third lines of defense.

C) Your disease stunts your immunity, so you are unable to fight those bacteria.

D) You don't have second and third line defenses because of your cystic fibrosis.

82) The patient asks the nurse to explain what cilia are. All of the following statements are correct except ________.

A) cilia form a microscopic brush-like lining

B) cilia help move and expel foreign invaders

C) cilia compose a sort of microscopic "escalator" to expel invading organisms

D) cilia are chemical-excreting natural killer cells

83) Following teaching by the medical team, the patient asks "can I just do my airway clearance exercises when I am not feeling well and on the weekends, even though the doctor tells me I have to do them every day?" What is a correct response by the nurse?

A) It is okay to skip your airway clearance if you are not feeling sick as long as you are compliant on the weekends.

B) Your body does not have the ability to protect itself because of its damaged immunity so you must do airway clearance regularly.

C) As long as you perform airway clearance twice as often when you start to feel sick, you will make up the difference.

D) Your airway clearance activities can be performed at your convenience.

NCLEX Prep - Test Bank Question:  Please read the clinical scenario, and then answer the questions that follow to become familiar with the traditional NCLEX question format.

A 35-year-old male presents to the ER with a laceration on his left hand. The patient reports an hour ago he was working on renovations in his 1945 home, when an old board fell and injured his hand. The laceration is approximately 3 inches long and moderately deep. It appears that the cut was bleeding heavily, but he has stopped the bleeding by holding pressure on the site with an old t-shirt.

84) At this phase of injury, how would the nurse expect the area surrounding the laceration to present?  

A) Cool and blue

B) Pink, warm, and dry

C) Red and hot

D) Dusky, gray, and clammy

85) The patient asks why the laceration is puffy, and has become itchy. Which of the following statements by the nurse is the most appropriate response?  

A) This is a normal response to injury. Blood has rushed to the area, fluid is leaking from the damaged vessels, and chemical mediators called cytokines are causing you to itch.

B) This is a normal response to injury. Your body is building up pressure around the wound to stop the bleeding, and the wood likely left internal splinters that are causing you to itch.

C) This is a concerning sign. I will call the doctor now to lance the swollen area, and in the meantime, I will apply hydrogen peroxide to the wound.

D) This is a concerning sign. Edema and pruritus are early signs of gangrene. To help the swelling, hold your hand above your heart to decrease blood flow to the area.

86) The patient states, "There has to be a way for me to reduce this swelling. There is no way this can be good for me because it is so uncomfortable." Which of the following statements by the nurse is not an appropriate response?

A) Swelling helps trap foreign microbes to prevent them from getting into your main circulation.

B) Inflammation is a sign that your immune system is fighting the effects of your skin barrier being broken.

C) The influx of fluid into the area is helping to dilute toxins.

D) Swelling is a result of your bones responding to the influx of calcium-fighting toxins.

87) What is the natural progression of healing for this wound?  

A) Injury, vascular reactions, secondary injury, scar formation

B) Injury, edema/pus formation, vascular reactions, scar formation

C) Injury, edema/pus formation, scar formation, exudative leaking

D) Injury, vascular reactions, edema/pus formation, scar formation

88) Which line(s) of defense has been breached for this injury? 

A) First line of defense

B) Second line of defense

C) First and second lines of defense

D) First, second and third lines of defense

NCLEX Prep - Test Bank Question:  Please read the clinical scenario, and then answer the questions that follow to become familiar with the traditional NCLEX question format.

The mother of a 6-year-old child brings her daughter to the pediatrician's office because she has had a sore throat, cough, and fever for several days. She reports a fever up to 104°F that worsens at night, but seems to respond to treatment with acetaminophen. The child has not been eating or drinking well because she says, "it hurts to swallow." She is ill appearing, and does not seem interested in playing with the toys that are in the examination room. The physician notes a thick, white exudate on both of the patient's tonsils, which also seem enlarged. A throat culture and complete blood count with differential is ordered.

89) The nurse examines the child and finds that the lymph nodes along of her neck are warm, tender, and slightly enlarged. Her other lymph nodes are nonpalpable or small, nontender, rubbery, and less than 2 mm in size. What is the most accurate interpretation of this finding?  

A) This is a normal examination of the posterior cervical chain lymph nodes.

B) This examination is consistent with a systemic infection.

C) This examination is consistent with a localized infection.

D) This examination is definitive for an oncologic diagnosis.

90) The patient's mother expresses concern about her daughter's fevers. She states that the fevers are a sign that her child is unable to fight this infection. What is a proper response to these concerns?  

A) It is impossible to determine exactly why she is having these fevers. Doctors call this a fever of unknown origin.

B) Fevers are a natural response by the body to help fight infection.

C) These fevers are very dangerous, and you have strong reason for concern.

D) High fever could be a sign of a tumor of the hypothalamus.

91) The nurse examines the child's tonsils while preparing to swab them with the culture swab. A white pustule coating is noted to be covering the tonsils. What is this pus composed of? 

A) Waste from red blood cells

B) Live bacteria

C) Fibrin threads

D) White blood cells and debris from phagocytosis

92) The lab performs a complete blood count with cell differential while the patient is still in the office. The results show an elevated white blood cell count, as well as a high neutrophil count. What does this indicate?  

A) Bacterial infection

B) Viral infection

C) Protozoan infection

D) Helminth infection

93) What is the most likely cause of the patient's swollen tonsils? 

A) Her intense cough caused rupture of the tonsils, and swelling is part of the normal wound-healing process.

B) Tonsils consist of lymphatic tissue, and became swollen by filtering out microbes and their toxic products.

C) She is dehydrated from poor fluid intake, so the tonsils are retaining fluid.

D) Tonsils are sensitive to stimulation, so they became swollen from her constant coughing.