Test Bank Ch14 Disorders In Immunity

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

Chapter 14 Disorders in Immunity

1) The major category(ies) of hypersensitivity that typically involve a B-cell immunoglobulin response is (are) ________.

A) type I only

B) type I and type IV

C) type IV only

D) type I, type II, and type III

E) type I, type II, type III, and type IV

2) Which is mismatched?

A) Food allergy - type I hypersensitivity

B) Poison ivy dermatitis - type IV hypersensitivity

C) Serum sickness - type III hypersensitivity

D) Transfusion reaction - type II hypersensitivity

E) Hay fever - type IV hypersensitivity

3) Any heightened or inappropriate immune response resulting in tissue damage is called a(n) ________.

A) autoimmune disease

B) immunodeficiency

C) hypersensitivity

D) transfusion reaction

E) desensitization

4) The study of diseases associated with excesses and deficiencies of the immune system is ________.

A) humoralpathology

B) hemopathology

C) epidemiology

D) immunopathology

E) histopathology

5) Atopy and anaphylaxis are hypersensitivities in the category ________.

A) type I only

B) type I and type IV

C) type IV only

D) type I, type II, and type III

E) type I, type II, type III, and type IV

6) Bee sting venom is considered to be which type of allergen?

A) Ingestant

B) Inhalant

C) Injectant

D) Contactant

E) None of the choices are correct.

7) Fungal spores and animal dander are considered to be which type of allergen?

A) Ingestant

B) Inhalant

C) Injectant

D) Contactant

E) None of the choices are correct.

8) The initial encounter with an allergen is called the ________.

A) sensitizing dose

B) provocative dose

C) allergic dose

D) hypersensitivity dose

E) desensitizing dose

9) A second encounter with an allergen that causes a response is called the ________.

A) sensitizing dose

B) provocative dose

C) allergic dose

D) hypersensitivity dose

E) desensitizing dose

10) What will be the immediate action of an allergen when it enters that body for a second time?

A) Degranulation

B) Bonding of allergen to adjacent IgE binding sites on mast cells and basophils

C) Binding of IgE by the Fc region to mast cells and basophils

D) Histamine acts on smooth muscle

E) Prostaglandins cause vasodilation and increased vascular permeability

11) Which event is the process of releasing chemical mediators?

A) Degranulation

B) Bonding of allergen to adjacent IgE binding sites on mast cells and basophils

C) Binding of IgE by the Fc region to mast cells and basophils

D) Histamine acts on smooth muscle

E) Prostaglandins cause vasodilation and increased vascular permeability

12) Which event occurs with the sensitizing dose of allergen?

A) Degranulation

B) Bonding of allergen to adjacent IgE binding sites on mast cells and basophils

C) Binding of IgE by the Fc region to mast cells and basophils

D) Histamine acts on smooth muscle

E) Prostaglandins cause vasodilation and increased vascular permeability

13) Which of the following is not a possible symptom of type I hypersensitivity?

A) Rhinitis

B) Rashes

C) Sneezing

D) Diarrhea

E) Contact dermatitis

14) Histamine causes all of the following except ________.

A) increased sensitivity to pain

B) constriction of smooth muscle of bronchi and the intestine

C) relaxes vascular smooth muscle

D) wheal and flare reaction in skin

E) pruritus and headache

15) The chemical mediator that causes prolonged bronchospasm, vascular permeability, and mucus secretion of asthmatic patients is ________.

A) prostaglandin

B) histamine

C) leukotriene

D) serotonin

E) platelet-activating factor

16) Which type(s) of hypersensitivity is IgG involved with?

A) Anaphylaxis

B) Antibody mediated

C) Immune complex mediated

D) Both anaphylaxis and antibody mediated

E) Both antibody mediated and immune complex mediated

17) Allergic reactions to penicillins are considered a(n) ________ hypersensitivity.

A) T-cell mediated

B) antibody mediated

C) immune complex mediated

D) immediate

E) both T-cell mediated and antibody mediated

18) Allergies run in families because ________.

A) immunoglobulins pass from mother to fetus

B) immunoglobulins pass through breast milk

C) the variable region of antibodies is genetically determined

D) relative production of IgE is inherited

E) All of the choices are correct.

19) A chronic, local allergy such as hay fever is considered ________.

A) delayed

B) T-cell mediated

C) atopic

D) antibody mediated

E) systemic anaphylactic

20) A systemic, sometimes fatal reaction with airway obstruction and circulatory collapse is ________.

A) delayed

B) T-cell mediated

C) atopic

D) antibody mediated

E) systemic anaphylactic

21) A seasonal reaction to inhaled allergens is ________.

A) atopic dermatitis

B) eczema

C) allergic rhinitis

D) asthma

E) anaphylaxis

22) All of the following are associated with IgE and mast cell-mediated allergy except ________.

A) drug allergy

B) eczema

C) anaphylaxis

D) allergic asthma

E) systemic lupus erythematosus

23) Epinephrine ________.

A) is an antihistamine

B) reverses constriction of airways

C) causes desensitization

D) inhibits the activity of lymphocytes

E) All of the choices are correct.

24) Allergic patients receiving small, controlled injections of specific allergens are undergoing ________.

A) desensitization

B) sensitization

C) tissue matching

D) degranulation

E) None of the choices are correct.

25) An antihistamine will ________.

A) inhibit the activity of lymphocytes

B) bind to histamine receptors on target organs

C) block synthesis of leukotrienes

D) relieve inflammatory symptoms

E) reverse spasms of respiratory smooth muscles

26) Corticosteroids will ________.

A) inhibit the activity of lymphocytes

B) bind to histamine receptors on target organs

C) block synthesis of leukotrienes

D) relieve inflammatory symptoms

E) reverse spasms of respiratory smooth muscles

27) All of the following are involved in type 2 hypersensitivity except ________.

A) IgM

B) IgG

C) IgE

D) complement

E) foreign cells

28) Human blood types involve all the following except ________.

A) MHC genes

B) ABO antigen markers

C) inheritance of two of three possible alleles

D) genetically determined glycoprotein markers

E) genes that code for an enzyme that adds a terminal carbohydrate to RBC receptors

29) Transfusion of the wrong blood type can cause ________.

A) recipient antibody activating the complement cascade to attack the RBCs

B) fever and anemia

C) systemic shock and kidney failure

D) massive hemolysis of the donor RBCs

E) All of the choices are correct.

30) A female who is Rh– ________.

A) inherited two dominant genes

B) is in the majority of the population with regard to Rh status

C) is at risk for a pregnancy resulting in hemolytic disease of the newborn

D) can never have an Rh+ baby

E) All of the choices are correct.

31) The potential for hemolytic disease of the newborn occurs when ________.

A) maternal Rh+ cells enter an Rh- fetus

B) fetal Rh+ cells enter an Rh- mother

C) maternal Rh˗ cells enter an Rh+ fetus

D) fetal Rh˗ cells enter an Rh+ mother

E) fetal Rh+ cells enter an Rh+ mother

32) Once a mother has been sensitized to the Rh factor ________.

A) all other Rh+ fetuses are at risk

B) she can be given RhoGAM in future pregnancies to prevent hemolytic disease of the newborn

C) she can never again have a low risk pregnancy

D) only future Rh˗ fetuses are at risk

E) None of the choices are correct.

33) Which of the following is not true of type III hypersensitivity?

A) Antigen-antibody complexes are deposited in the basement membrane of epithelial tissues

B) Involves production of IgG and IgE antibodies

C) Involves an immune complex reaction

D) The Arthus reaction is a local response

E) Serum sickness is a systemic response

34) Which of the following is not a major organ that can be a target of immune complex deposition?

A) Blood vessels and skin

B) Heart and lungs

C) Brain

D) Joints

E) Kidneys

35) Large quantities of antibodies that react to the second entry of antigen and lead to formation of antigen-antibody complexes occurs in ________.

A) serum sickness

B) delayed hypersensitivity

C) anaphylaxis

D) hemolytic disease of the newborn

E) All of the choices are correct.

36) Contact dermatitis involves ________.

A) a sensitizing and provocative dose

B) an allergen entering the skin

C) T lymphocytes secreting inflammatory cytokines

D) itchy papules and blisters

E) All of the choices are correct.

37) What could result when grafted tissue such as bone marrow contains passenger lymphocytes?

A) Host rejection of graft

B) Graft versus host disease

C) Formation of autoantibodies

D) Hypogammaglobulinemia

E) None of the choices are correct.

38) Tissue transplanted from one body site on a patient to a different body site on that patient is called a(n) ________.

A) isograft

B) autograft

C) allograft

D) xenograft

E) hypograft

39) What involves determination of donor HLA antigens compared to those of the recipient's tissue?

A) Skin graft

B) Blood transfusion

C) Organ transplantation

D) Both skin graft and organ transplantation

E) All of the choices are correct.

40) Autoimmunity is typically due to ________.

A) a transfusion reaction

B) IgE and mast cells

C) autoantibodies and T cells

D) graft rejection

E) a deficiency in T-cell development

41) Autoantibodies cause tissue injury in all of the following diseases except ________.

A) rheumatoid arthritis

B) myasthenia gravis

C) Graves' disease

D) tuberculin reaction

E) multiple sclerosis

42) Each of the following is an autoimmune disease except ________.

A) systemic lupus erythematosus

B) Graves' disease

C) type I diabetes

D) metastatic cancer

E) rheumatic fever

43) Myasthenia gravis disease arises from the production of autoantibodies against ________.

A) myelin sheath cells of the nervous system

B) acetylcholine receptors on smooth muscle

C) acetylcholine receptors on skeletal muscle

D) sodium pump proteins in the cell membrane

E) cells in thyroid follicles

44) In multiple sclerosis, autoantibodies attack ________.

A) myelin sheath cells of the nervous system

B) acetylcholine receptors on smooth muscle

C) acetylcholine receptors on skeletal muscle

D) sodium pump proteins in the cell membrane

E) cells in thyroid follicles

45) Which of the following is not a theory to explain the origin of autoimmune diseases?

A) Sequestered antigen theory

B) Clonal selection theory

C) Theory of immune deficiency

D) Viral infection theory

E) All of the choices are possible theories.

46) What can be a consequence of a genetic deficiency in B-cell survival and maturity?

A) Host rejection of graft

B) Graft versus host disease

C) Formation of autoantibodies

D) Hypogammaglobulinemia

E) None of the choices are correct.

47) The DiGeorge syndrome is the result of ________.

A) autoantibodies

B) delayed hypersensitivity

C) congenital absence or immaturity of the thymus gland

D) failure of B-cell development and maturity

E) a genetic defect in the development of both T cells and B cells

48) Severe combined immunodeficiencies (SCIDs) are due to ________.

A) autoantibodies

B) delayed hypersensitivity

C) congenital absence or immaturity of the thymus gland

D) failure of B-cell development and maturity

E) a genetic defect in the development of both T cells and B cells

49) A secondary acquired immunodeficiency is ________.

A) AIDS

B) adenosine deaminase (ADA) deficiency

C) DiGeorge syndrome

D) agammaglobulinemia

E) SCID

50) In the theory for allergic desensitization, which immunoglobulin blocks the allergen from binding with IgE?

A) IgE

B) IgG

C) IgA

D) IgD

E) IgM

51) Degranulation of mast cells leads to ________.

A) airway obstruction

B) headache

C) dilated blood vessels

D) All of the choices are correct.

52) Systemic anaphylaxis can quickly result in airway blockage, shock, and death.

53) Food allergies include gastrointestinal symptoms and often hives.

54) Allergic rhinitis is also known as asthma.

55) A person who is Rh˗ will have anti-Rh antibodies in their serum from early infancy.

56) The tuberculin reaction develops within 30 minutes of the skin test in people with prior sensitization due to tuberculosis infection.

57) During graft rejection, cytotoxic T cells of the recipient recognize and respond to foreign class I MHC receptors on the grafted cells.

58) A xenograft is graft tissue from a donor of one species transplanted to a recipient of another species.

59) Eczema is an autoimmune disorder.

60) A viral infection can cause type I diabetes mellitus.

61) AIDS is a secondary immunodeficiency disease that affects several types of immune cells.

62) A well-functioning immune system should strike a balance between being over- and underreactive.  An overreactive immune system results in hypersensitivities such as allergy and ________, while an underreactive immune system is due to ________.

A) autoimmunity; immunodeficiency

B) immunodeficiency; anaphylaxis

C) hyposensitivity; atopy

D) inflammation; asthma

E) hyposensitivity; autoimmunity

63) Immunopathology is the disease state associated with the overreactivity or underreactivity of the immune response.

64) A twelve year old girl received a pair of earrings from her friend for her birthday.  The second time she wore them, her earlobes became red, itchy and inflamed, with blisters appearing within 48 hours.  What type of hypersensitivity is causing the discomfort?

A) Type I hypersensitivity

B) Type II hypersensitivity

C) Type III hypersensitivity

D) Type IV hypersensitivity

65) Type II hypersensitivities differ from type III in that ________.

A) type II hypersensitivity involves the activation of complement proteins that attack and lyse cells, whereas type III involves the formation of immune complexes causing chronic inflammation

B) type II hypersensitivity involves the formation of immune complexes causing chronic inflammation, whereas type III involves the activation of complement proteins that attack and lyse cells

C) type II hypersensitivity involves the formation of IgM antibodies that attack tissues, whereas type III involves IgE causing degranulation of mast cells

D) type II hypersensitivity involves B cells whereas type III involves the activation and sensitization of cytotoxic T cells

66) Desensitization of an individual with allergies by injecting small amounts of the allergen under the skin is effective because it ________.

A) induces the formation of IgG antibodies that bind the the allergen before it is able to bind to the IgE associated with mast cells

B) prevents IgE antibodies from being formed, thus eliminating the degranulation of mast cells

C) changes the nature of the allergy from a type I to a type III, which is easier to treat

D) induces the formation of IgA antibodies, which are secreted into the tissues, reducing the amount of degranulation by mast cells in the blood

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 9-year-old male presents to the emergency room complaining of "chest tightness" and difficulty breathing. The RN notes that he is frequently coughing and wheezes are ausculated in all lung fields. His chest x-ray shows a flattened diaphragm and overexpanded lungs. The patient's mother reports that he had five episodes like this one over the past few years, but none this bad. Recently, the patient has had more frequent episodes of difficulty breathing and coughing, each lasting for a few hours. He does not take any medications at home.

67) Based on the patient's symptoms, which of the following is the most likely diagnosis?  

A) Asthma

B) Hay fever

C) Seasonal allergy

D) Eczema

68) Which of the following conditions would be most pertinent for the nurse to ask about while collecting the patient's past medical history?  

A) Hay fever

B) Premature birth

C) Eczema

D) Blood transfusion reaction

69) Following a pulmonology consultation, the patient is diagnosed with asthma. Which of the following allergic mediators is responsible for the patient's reactive airway symptoms?

A) Bradykinin

B) Leukotrienes

C) Serotonin

D) All of the choices are correct.

70) Asthma is classified as what type of reaction?  

A) Atopy

B) Systemic anaphylaxis

C) Acute allergic

D) Cutaneous anaphylaxis

71) The RN most accurately describes the pathophysiology of the patients asthma as an ________.

A) IgE-mediated response with lung tissue that is hypersensitive to products of mast cell degranulation

B) IgE response that causes the body to not recognize its own lung tissue and fight against it by constricting bronchioles

C) IgG-mediated response with lung tissue that is hypersensitive to products of mast cell degranulation

D) IgG response that causes the body to not recognize its own lung tissue and fight against it by constricting bronchioles

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 28-year-old woman is 30 weeks pregnant with her second child and is being seen for a scheduled obstetric visit. Her first pregnancy and delivery was uncomplicated, and she has a healthy 2-year-old girl. It is known that the mother is Rh-, and this child could be at risk for hemolytic disease of the newborn. She received RhoGAM with her first pregnancy.

72) Which factor would increase the risk of the unborn child being Rh+?  

A) Previous child being Rh-

B) Father being Rh+

C) Maternal history of preexisting type I hypersensitivity

D) Both maternal grandparents being Rh+

73) What intervention would the RN expect during this visit?  

A) Fetal blood type testing to determine if RhoGAM is indicated

B) Administration of first dose of RhoGAM

C) Nothing, since it is not known if the fetus is Rh+

D) Plan for first dose of RhoGAM immediately after birth

74) After further investigation, it is learned that the father is Rh+, and so was the first child. The patient declines the RhoGAM injection, stating "there were no complications with my first pregnancy and delivery, how can you be sure there will be with this one?" She explains how unpleasant the RhoGAM injection was with her first pregnancy, and she would like to avoid it, if at all possible. What is the most appropriate response by the nurse?  

A) Because you received RhoGAM with your first pregnancy, it is not necessary during this pregnancy.

B) It is important you receive your RhoGAM injection because this child will probably develop hemolytic disease of the newborn if you do not.

C) It is important that we keep you from being sensitized to Rh factor, otherwise future pregnancies will be at risk for developing hemolytic disease of the newborn.

D) You were probably sensitized to Rh factor with your first pregnancy, so the chances are decreased that this child will develop hemolytic disease of the newborn. I will ask the doctor if we can forego the injection.

75) What type of hypersensitivity reaction is the fetus at risk for upon delivery?  

A) Type I

B) Type II

C) Type III

D) Type IV

76) The patient asks the nurse to explain what an Rh reaction involves with her baby. What is the best explanation? 

A) Your baby's Rh+ antibodies cross into your system, attacking your red blood cells and making you unable to deliver a healthy baby.

B) Your baby has a type II hypersensitivity that will render its liver unable to clear bilirubin released from lysed cells.

C) Your Rh antibodies will cross into your baby's fetal circulation, attacking and lysing his red blood cells.

D) As soon as your baby is born, if you do not receive RhoGAM, the baby's body will reject not having Rh antibody anymore.

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 46-year-old Caucasian male presented to the hospital in fulminant liver failure secondary to prolonged alcohol abuse. He received a liver transplantation two days ago from an unrelated donor. His post-operative course has been uncomplicated thus far.

77) What type of transplant did the patient receive?  

A) Isograft

B) Autograft

C) Allograft

D) Xenograft

78) The patient's clinical status and lab values will be closely monitored for two weeks following his transplant. If he experiences graft rejection, what type of cells will be primarily responsible?  

A) T memory cells

B) Natural killer cells

C) T cytotoxic cells

D) T helper cells

79) What type of hypersensitivity reaction is an organ transplantation patient at risk for?  

A) Type I

B) Type II

C) Type III

D) Type IV

80) The patient discusses his antirejection medication regiment with the nurse. He asks how they work to prevent graft rejection. What is the best explanation by the RN?  

A) Antirejection medications work on your liver to make it less hostile to its new environment, increasing the chances of organ acceptance.

B) Antirejection medications work by changing the MHC markers on your new liver to be more like your own.

C) Antirejection medications work by suppressing the body's immune response against foreign MHC markers.

D) Antirejection medications work by causing your body to think its MHC markers are similar to your new liver's.