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Immunology
Questions LYMPHOID STRUCTURES
1. Which lymph node area contains cords of closely packed lymphocytes, plasma cells, and sinuses? (p. 200) ________________________________________________________________________ Which lymph node structures communicates with efferent lymphatics and contains reticular cells and macrophages? (p. 200) ________________________________________________________ Which lymph node area contains endothelial venules through which T and B cells enter the nodes from the blood? (p. 200) ___________________________________________________________ Which part of the lymph node contains B cells? (p. 200) __________________________________ In which part of the lymph node are follicles located? (p. 200) _____________________________ Which lymph node area becomes greatly enlarged during an extreme cellular immune response? (p. 200) ________________________________________________________________________ Match the area of the body with its primary lymph node drainage site. (Numbers may be used more than once). (p. 200) _____ A. _____ B. _____ C. _____ D. _____ E. _____ F. _____ G. _____ H. _____ I. _____ J. _____ K. _____ L. _____ M. 8. Anal canal (below pectinate line) Duodenum Jejenum Lateral breast Lateral side of dorsum of foot Rectum (above pectinate line) Scrotum Sigmoid colon Stomach Superficial thigh Testes Thigh (superficial) Upper limbs 1. 2. 3. 4. 5. 6. 7. 8. Axillary Celiac Colic to inferior mesenteric Internal iliac Popliteal Superficial and deep plexuses to para-aortic Superficial inguinal Superficial mesenteric

2.

3.

4. 5. 6.

7.

What three findings are typically seen on peripheral blood smears of postsplenectomy patients? (p. 201) __________________________________________________________________________ Postsplenectomy patients are most susceptible to which four pathogens? (p. 201) ____________ ______________________________________________________________________________

9.

10.

B cells mature in the _______________ (bone marrow/thymus), while T cells mature in the _______________ (bone marrow/thymus). (p. 201)

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LYMPHOCYTES
11. In the chart below, checkmark which components are part of the adaptive vs. the innate immune system. (p. 202) Component Antibody B cells Complement Dendritic cells Macrophages Natural killer cells Neutrophils T cells 12. 13. 14. What are the three MHC class I genetic loci? (p. 202) ____________________________________ What are the three MHC class II genetic loci? (p. 202) ___________________________________ Match the HLA subtype with its associated disease. (Numbers may be used more than once.) (p. 202) _____ A. _____ B. _____ C. _____ D. _____ E. _____ F. _____ G. _____ H. _____ I. _____ J. _____ K. _____ L. _____ M. _____ N. _____ O. 15. Ankylosing spondylitis 1. Diabetes mellitus type 1 2. Goodpastures syndrome 3. Graves disease 4. Hay fever 5. Hashimotos thyroiditis 6. Hemochromatosis 7. Inflammatory bowel disease 8. Multiple sclerosis Pernicious anemia Psoriasis Reiters syndrome Rheumatoid arthritis Steroid-responsive nephrotic syndrome Systemic lupus erythematosus A3 B8 B27 DR2 DR3 DR4 DR5 DR7 Adaptive Immune System Innate Immune System

_______________ (B cells/T cells) are involved in hyperacute organ rejection, while _______________ (B cells/T cells) are involved in chronic organ rejection. (p. 203) _______________ (Th1/Th2) cells are involved in the cell-mediated immune response, while _______________ (Th1/Th2) cells are involved in the humoral response. (p. 203).

16.

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17.

In the chart below, checkmark whether the functions below are mediated by Th1 cells or Th2 cells. (p. 204) Function Antibody production (via B cells) CD8 T-cell activation Interferon- secretion IL-2 secretion IL-4 secretion IL-5 secretion IL-10 secretion Macrophage activation Th1 Cells Th2 Cells

18.

By which four mechanisms is antibody diversity generated? (p. 205) ________________________ ______________________________________________________________________________

19.

Match each immunoglobulin isotype with its characteristic. (Numbers may be used more than once.) (p. 206) _____ A. _____ B. _____ C. _____ D. _____ E. _____ F. _____ G. _____ H. _____ I. _____ J. _____ K. _____ L. Activates eosinophils 1. IgA Antigen receptor on B cell surface 2. IgD Binds mast cells and basophils 3. IgG Fixes complement and crosses the placenta 4. IgE Fixes complement but does not cross the placenta 5. IgM Function is unclear Main antibody in primary immune response Main antibody in secondary immune response Mediates type I hypersensitivity Neutralizes bacterial toxins and viruses Opsonizes bacteria Prevents attachment of bacteria and viruses to mucous membranes

IMMUNE RESPONSES
20. In the chart below, identify the component(s) of the complement system associated with each action. (p. 207) Function Anaphylaxis Cytolysis by MAC Opsonization Neutrophil chemotaxis Viral neutralization Primary opsonins in bacterial defense Complement

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21.

What activates the alternative, lectin, and classic pathways? (p. 207) ________________________ ______________________________________________________________________________

22. 23. 24.

Which cytokines are secreted by macrophages? (p. 208) _________________________________ Which cytokines are secreted by T cells? (p. 208) _______________________________________ Match the cytokine with its action(s). (p. 208) _____ A. _____ B. _____ C. _____ D. _____ E. _____ F. _____ G. _____ H. _____ I. _____ J. _____ K. Activates macrophages and Th1 cells, suppresses Th2 cells Causes fever and acute inflammation, induces chemokine secretion Causes fever and stimulates production of acute-phase proteins Induces differentiation of T cells to Th1 cells, activates NK cells Induces differentiation of T cells to Th2 cells, enhances class switching to IgE and IgG Major chemotactic factor for neutrophils Modulates inflammatory response, inhibits Th1 cells Mediates septic shock, recruits leukocytes Promotes B cell differentiation, enhances class switching to IgA Stimulates growth of Th and Tc cells Supports growth and differentiation of bone marrow stem cells 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. IL-1 IL-2 IL-3 IL-4 IL-5 IL-6 IL-8 IL-10 IL-12 INF- TNF-

25.

In the chart below, checkmark which cell-surface proteins and receptors are expressed by which type of cell. (p. 209) Protein/Receptor B7 C3b receptor CD3 CD4 CD8 CD14 CD16 receptor CD19 CD20 CD21 CD28 CD40 CD40L CD56 receptor Fc receptor IgG MHC I receptor MHC II TCR Copyright 2011 by MedIQ Learning, LLC All rights reserved B cells T cells Macrophages NK cells

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26. 27. 28. 29. 30.

Which type of hypersensitivity reaction is mediated by T cells? (p. 210) ______________________ Which type of hypersensitivity reaction is mediated by antibody? (p. 210) ____________________ Which type of hypersensitivity reaction is mediated by an immune complex? (p. 210) ___________ Which type of hypersensitivity reaction occurs rapidly due to preformed antibody? (p. 210) _______ Match the type of hypersensitivity reaction with the conditions it mediates. (Numbers can be used more than once.) (p. 211) _____ A. _____ B. _____ C. _____ D. _____ E. _____ F. _____ G. _____ H. _____ I. _____ J. _____ K. _____ L. _____ M. _____ N. _____ O. _____ P. _____ Q. _____ R. _____ S. _____ T. _____ U. _____ V. _____ W. Allergic rhinitis Anaphylaxis Anemia (pernicious, hemolytic) Arthus reaction Asthma Bullous phemphigoid Contact dermatitis Diabetes mellitus type 1 Erythroblastosis fetalis Hashimotos thyroiditis Hypersensitivity pneumonitis Goodpastures syndrome Graft-vs-host disease Graves disease Gullain-Barr syndrome Multiple sclerosis Myasthenia gravis Polyarteritis nodosum Poststreptococcal glomerulonephritis Rheumatic fever Rheumatoid arthritis Serum sickness Systemic lupus erythematosus 1. 2. 3. 4. Type I Type II Type III Type IV

31 .

Match the autoantibody with its associated disorder. (p. 212) _____ A. _____ B. _____ C. _____ D. _____ E. _____ F. _____ G. _____ H. _____ I. _____ J. _____ K. _____ L. _____ M. _____ N. _____ O. _____ P. _____ Q. _____ R. Autoimmune hepatitis Celiac disease Dermatomyositis, polymyositis Diabetes mellitus type 1 Drug-induced lupus Goodpastures syndrome Hashimotos thyroiditis Mixed connective tissue disease Vasculitides (other than Wegeners) Pemphigus vulgaris Primary biliary cirrhosis Rheumatoid arthritis Scleroderma (CREST) Scleroderma (diffuse) Sjgrens syndrome SLE SLE, nonspecific Wegeners granulomatosis 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. Antibasement membrane Anticentromere Anti-desmoglein Anti-dsDNA, anti-Smith Antigliadin, antiendomyosial Antiglutamate decarboxylase Antihistone Anti-IgG Anti-Jo-1 Anti-microsomal, antithyroglobulin Antimitochondrial Antinuclear antibodies Anti-Scl-70 Antismooth muscle Anti-SS-A, anti-SS-B Anti-U1 RNP c-ANCA p-ANCA

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32.

What immune deficiency is most closely associated with each clinical scenario? (pp.213-214) A. A 9-year-old boy presents with recurrent sinusitis, otitis media, and erythematous skin infections. _________________________________________________________________ An infant is brought to his pediatrician for the sixth time in several months. Upper respiratory infection had been diagnosed previously, and he underwent incision and drainage of several buttock abscesses. Today he is fussy and febrile, and has rhinorrhea and demarcated erythema in the skin folds._____________________________________________________ An infant arrives for her 2-month well-child visit. Her abdomen is soft and nontender, but her umbilical remnant is still present. A red, firm area is present on the back of her thigh, with no evidence of fluctuance. _______________________________________________________ A 5-year-old presents because of recurrent skin infections. In the past, she has been treated for an E. coli urinary tract infection as well as numerous skin infections. Results of todays nitroblue tetrazolium test are negative. ___________________________________________ A 9-year-old boy presents with coarse facies and a rash. Physical examination reveals he has two sets of teeth where his adult dentitia have erupted. ___________________________

B.

C.

D.

E.

33.

Which autosomal-recessive immune deficiency presents with recurrent pyogenic staphylococcal and streptococcal infections, partial albinism, and peripheral neuropathy? (pp. 213-214) ________ ______________________________________________________________________________

34.

Which immune deficiency presents with a triad of symptoms that include recurrent pyogenic infections, thrombocytopenic purpura, and eczema? (pp. 213-214) _________________________ Name three possible causes of severe combined immunodeficiency. (pp 213-214) ____________ ______________________________________________________________________________

35.

36.

What are the four signs and symptoms of graft-vs-host disease? (p. 215) ____________________ ______________________________________________________________________________

IMMUNOSUPPRESSANTS
37. 38. What is the mechanism of action of cyclosporine? (p. 215) ________________________________ What is the mechanism of action of sirolimus, and what effect does this have on immunity? (p. 216) ______________________________________________________________________________ 39. Which two antibodies are used to treat Crohns disease, rheumatoid arthritis, and psoriatic arthritis? 217) __________________________________________________________________________

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Answers LYMPHOID STRUCTURES

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Medulla. Medullary sinuses. Paracortex. Follicles. Outer cortex. Paracortex. A-7, B-8, C-8, D-1, E-5, F-4, G-7, H-3, I-2, J-7, K-6, L-7, M-1. Howell-Jolly bodies, target cells, and thrombocytosis. Salmonella, S. pneumonia, H. influenza, and N. meningitides. Bone marrow; thymus.

LYMPHOCYTES
11. Component Antibody B cells Complement Dendritic cells Macrophages Natural killer cells Neutrophils T cells 12. 13. 14. 15. HLA-A, HLA-B, HLA-C. HLA-DR, HLA-DP, HLA-DQ. A-3, B-5, C-4, D-2, E-4, F-7, G-1, H-3, I-4, J-7, K-3, L-3, M-6, N-8, O-4. B cells; T cells. Adaptive Immune System Innate Immune System

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16. 17.

Th1; Th2.

Function Antibody production (via B cells) CD8 T-cell activation Interferon- secretion IL-2 secretion IL-4 secretion IL-5 secretion IL-10 secretion Macrophage activation 18.

Th1 Cells

Th2 Cells

Random recombination of VJ or VDJ genes; random combination of heavy and light chains; somatic hypermutation; and addition of nucleotides to DNA during genetic recombination by terminal deoxynucleotidyl transferase A-4, B-5, C-4, D-3, E-5, F-2, G-5, H-3, I-4, J-3, K-3, L-1.

19.

IMMUNE RESPONSES
20. Function Anaphylaxis Cytolysis by MAC Opsonization Neutrophil chemotaxis Viral neutralization Primary opsonins in bacterial defense 21. Complement C3a, C5a C5b-9 C3b C5a C1, C2, C3, C4 IgG and C3b

The alternative and lectin pathways are activated by substances (e.g., endotoxin) on microbial surfaces, and the classic pathway is activated by antigen-antibody complexes. IL-1, IL-6, IL-8, IL-12, and TNF- IL-3, IL-2, interferon-, IL-4, IL-5, and IL-10. A-10, B-1, C-6, D-9, E-4, F-7, G-8, H-11, I-5, J-2, K-3.

22. 23. 24.

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25. Protein/Receptor B7 C3b receptor CD3 CD4 CD8 CD14 CD16 receptor CD19 CD20 CD21 CD28 CD40 CD40L CD56 receptor Fc receptor IgG MHC I receptor MHC II TCR 26. 27. 28. 29. 30. Type IV. Type II. Type I. Type III. A-1, B-1, C-2, D-3, E-1, F-2, G-4, H-4, I-2, J-4, K-3, L-2, M-4, N-2, O-4, P-4, Q-2, R-3, S-3, T-2, U3, V-3, W-3. A-14, B-5, C-9, D-6, E-7, F-1, G-10, H-16, I-18, J-3, K-11, L-8, M-2, N-13, O-15, P-4, Q-12, R-17. A = Brutons agammaglobulinemia; B = severe combined immunodeficiency; C = leukocyte adhesion deficiency; D = chronic granulomatous disease; E = Jobs syndrome. Chdiak-Higashi syndrome. Wiskott-Aldrich syndrome. Defective IL-2 receptor, adenosine deaminase deficiency, and failure to synthesize MHC II. Maculopapular rash, jaundice, hepatosplenomegaly, and diarrhea. B cells T cells Macrophages NK cells

31. 32.

33. 34. 35. 36.

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IMMUNOSUPPRESSANTS
37. 38. 39. Inhibits calcineurin and prevents production of IL-2 and the IL-2 receptor. Binds mammalian target of rapamycin (mTOR) and inhibits T-cell proliferation in response to IL-2. Inhibits de novo synthesis of guanine and blocks lymphocyte production.

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