Immunology & Serology Part 2 0 of 2 points

Father of Immunology:*
Most efficient antigen-presenting cell (APC):*
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Edward Jenner
B cell

Louis Pasteur
T cell
Gerald Edelman
Dendritic cell
Paul Ehrlich
Macrophage
Correct answer
Correct answer
Louis Pasteur
Dendritic cell
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STEVENS, TURGEON
Dendritic cells, however, are considered the
Louis Pasteur is generally considered to be the
most effective APC in the body, as well as the
Father of Immunology.
most potent phagocytic cell.
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Most potent phagocytic cell:*

Which of the following is characteristic of B
2/2 cells?*

Dendritic cell 0/2

Phagocytic

Eosinophil

Macrophage Participate in antibody-dependent cellular

cytotoxicity (ADCC) reactions
Neutrophil
Contain surface immunoglobulins
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Secrete the C5 component of complement
Dendritic cells, however, are considered the
most effective APC in the body, as well as the Correct answer
most potent phagocytic cell.
Contain surface immunoglobulins
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B cells carry surface immunoglobulins that react IgA
to a specific antigen. The antigen can then be
IgE
internalized processed and presented to an
appropriate T helper cell. B cells are not IgG
phagocytic, nor do they participate in antibody-
dependent cellular cytotoxicity (ADCC)
reactions. Complement proteins are secreted by IgM
hepatocytes.
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Immunoglobulin G is Ihe predominant class of
0 of 2 points immunoglobulin found in serum. It accounts for
approximately 80% of the total serum
immunoglobulin. The normal range is 800-1600
What is the predominant type of antibody mg/dL.
found in the serum of neonates born after full-
term gestation?* Untitled Section

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Infant IgA

Infant IgG Which class of immunoglobulin possesses 10

antigenic binding sites?*

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Infant IgM
IgA
Maternal IgG
IgD
Correct answer

Maternal IgG
IgG
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IgM
Antibody production is immunogen induced.
Because the fetus develops in a sequestered Correct answer
site, it makes very little immunoglobulin. IgM
Maternal IgG crosses the placenta and is the
primary antibody found in infant's circulation. Feedback

Untitled Section The IgM molecule is a pentamer that contains

10 binding sites. However, the actual valence
2 of 2 points falls to 5 with larger antigen molecules,
probably because of steric restrictions. IgA, IgG,
IgD, and IgE monomers each have two antigenic
The major class of immunoglobulin found in binding sites.
adult human serum is:*
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Measurement of serum levels of which of the

following immunoglobulins could serve as a
Which of the following immunoglobulins is
screening test for multiple allergies?
the most efficient at agglutination?
*
*
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IgA
IgG
IgE

IgA
IgG
IgM
IgM
IgE
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Correct answer
Biological functions of immunoglobulins: lgE is
IgM
the antibody involved in multiple allergies.
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The first isotype of immunoglobulin

lgM antibodies are frequently hemolytic
made by the fetus that may be elevated in cases
because of:
of in-utero infection is:
*
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IgA
Their dimeric structure
IgG
The molecule's 5 antigen-binding sites

Their sedimentation coefficient of 7-15 S

IgM
Their efficient ability to fix complement
IgD

Correct answer
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IgM
Biological functions of immunoglobulins: lgM
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binds complement well and is hemolytic.
Neonate lgG comes from the mother, but if An immediate allergic reaction
there is elevated lgM (the first immunoglobulin
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made by the fetus), an in utero or neonatal
infection is indicated. Type I hypersensitivity reactions occur
immediately after second exposure to an
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allergen. On the first, or primary, exposure, IgE
2 of 2 points specific to the allergen is produced. The IgE
binds to Fc receptors on the surface of basophils
and mast cells. Immune complexes and
The ratio of kappa to lambda light chain- complement are not involved in the response.
producing cells in normal individuals is:
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*
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1:1
Severe combined immunodeficiency(SCID) is
2:1 an:*

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3:1 Immunodeficiency with decreased B cells and

neutrophils
4:1
Immunodeficiency with lymphocytopenia and
Feedback eosinophilia
About 65% of the human immunoglobulin Immunodeficiency with decreased or
molecules have kappa chains and 35% have dysfunctional T and B cells
lambda chains.
Immunodeficiency with decreased lymphocytes
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Correct answer
Type I hypersensitivity is:* Immunodeficiency with decreased or
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Associated with complement-mediated cell lysis Feedback

SCID is defined as a condition in which adaptive

immune responses (i.e., cell-mediated and
Due to immune complex deposition humoral-mediated immune responses) do not
Mediated by activated macrophages occur because of a lack of T and B cell activity. A
number of genetic defects can lead to this
An immediate allergic reaction condition. Children born with SCID need to live
Correct answer
in a sterile environment, and they have a short Xenograft
life expectancy.
Correct answer
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Isograft
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Identical twins have the same genetic makeup.

After exposure to antigen, the first antibodies Grafts between them would be isografts or
that can be detected belong to the class:* syngeneic grafts.

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IgA 0 of 2 points

IgE

IgG In Bruton disease, measurement of serum

immunoglobulins would show:*
IgM
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Elevated levels of IgE

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Elevated levels of IgG
The first B cells to respond to antigen
differentiate into plasma cells that produce IgM
antibody. Later in the immune response,
Normal levels of IgG and IgM but reduced levels
stimulated B cells undergo a phenomenon called
of IgA
"class switching" and begin to produce
antibodies of the IgG, IgA, and IgE classes. High The absence of all immunoglobulins
concentration of IgM in patient serum is
indicative of a recent infection. Correct answer

Untitled Section The absence of all immunoglobulins

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Bruton disease is a congenital form of

agammaglobulinemia. It is a sex-linked
A kidney transplant from one identical twin to phenomenon that affects males. Because B cells
another is an example of a(n):* are not produced, affected males have levels of
IgA, IgD, IgE, and IgM undetectable by routine
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assays. IgG may be absent or present at very
Allograft low levels.

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Autograft 0 of 2 points

Isograft
The type of immunity that follows the injection Artificial passive immunity results following the
of an immunogen is termed:* injection of antibody synthesized by another
individual or animal. This type of immunity is
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only temporary but may be very important in
Artificial active providing "instant" protection from an
infectious agent before the recipient would have
Natural active time to actively synthesize antibody.
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Innate 0 of 2 points

Correct answer Innate immunity includes:*

Artificial active 0/2
Feedback Anamnestic response
Active immunity follows exposure to an antigen Antibody production
that stimulates the recipient to develop his or
her own immune response. Vaccines are an
example of artificial immunity in that the animal
Cytotoxic T cell activity
was exposed to the immunogen by the actions
of a healthcare provider (unnatural). Phagocytosis by polymorphonuclear cells

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0 of 2 points Phagocytosis by polymorphonuclear cells

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The type of immunity that follows the injection Innate, or nonspecific, immunity refers to host
of antibodies synthesized by another individual defenses that are in general present at birth and
or animal is termed:* do not require immunogen stimulation.
Phagocytosis of bacteria by polymorphonuclear
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cells is an example.
Artificial active
Cytotoxic T cell activity is part of the adaptive
Natural adaptive cell-mediated immune response, and antibody
production is the mechanism of protection in
the adaptive humoral-mediated immune
Artificial passive response.
Natural passive Untitled Section
Correct answer 2 of 2 points
Artificial passive

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The antibody most frequently present in Untitled Section
systemic lupus erythematosus is directed
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against:*

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Loss of self-tolerance results in:*
Surface antigens of bone marrow stem cells
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Surface antigens of renal cells
Autoimmune disease
Nuclear antigen
Graft-versus-host disease

Immunodeficiency
Myelin

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Tumors
Antinuclear antibody (ANA) is the most
consistent feature of systemic lupus Correct answer
erythematosus (SLE).
Autoimmune disease
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The immune system recognizes host cells as self
and is tolerant to antigens on those cells. The
loss of tolerance will result in an autoimmune
Elevated IgE levels are typically found in:*
disease in which the immune system mounts an
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Type I hypersensitivity reactions

Graft-versus-host disease occurs when a bone
Type II hypersensitivity reactions marrow graft is incompatible with the host
tissue and attacks the host.

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Type III hypersensitivity reactions
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Type IV hypersensitivity reactions

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The activity of natural killer (NK) cells:*
Type I hypersensitivity reactions
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Does not require previous exposure to an
Elevated IgE levels are found in type I antigen
hypersensitivity reactions. The antibody binds
via the Fc portion of the molecule to Fc Involves phagocytosis and killing of bacteria
receptors on mast cells and basophils. When the
attached antibody binds its specific allergen, the
cell degranulates. Requires interaction with cytotoxic T cells
Requires interaction with B cells 0/2

Correct answer Cl

Does not require previous exposure to an C3

antigen

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C4
The natural killer (NK) cells destroy target cells
C5
through an extracellular nonphagocytic
mechanism. NK cells are part of the host's Correct answer
innate resistance and, therefore, do not need
previous exposure to an antigen to be active. C5

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0 of 2 points The membrane attack complex forms following

the binding of C5 to a biologic membrane. The
complex is formed by the sequential addition of
C6, C7, C8, and C9. When C5-C8 complex with
An autoimmune disease causing destruction of
C9, a tubule is formed that bridges the cell
pancreatic cells can result in:*
membrane.
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Hashimoto disease
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Multiple sclerosis
A cut on a person's finger becomes
Myasthenia gravis contaminated with the bacterium
Staphylococcus aureus. The first response by
Type 1 diabetes
the immune system consists of activity of:*
Correct answer
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Type 1 diabetes
B cells
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Monocytes
Destruction of the beta cells in the pancreas
results in type 1 diabetes. An autoimmune
response destroys the insulin-producing cells. Neutrophils

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Neutrophils

Which of the following complement proteins is Feedback

part of the membrane attack complex (MAC)?*
The first response by the innate immune system Kidneys
consists of an influx of neutrophils into the
Liver
tissue invaded by bacteria. Monocytes and
macrophages, although they are phagocytic Lungs
cells and part of the innate immune system,
play only a minor role in the initial response to Thyroid gland
bacterial invasion.

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0 of 2 points Hashimoto disease is a type of thyroiditis due to
an autoimmune disease. Patients produce
autoantibodies and T cells that respond to
Incompatible blood transfusions are examples thyroid antigens. This results in inflammation
of:* and swelling of the thyroid gland (goiter). The
autoantibody blocks the uptake of iodine, which
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results in a decrease in the production of thyroid
Type I hypersensitivity reactions hormones (hypothyroidism).

Type II hypersensitivity reactions Untitled Section

Type III hypersensitivity reactions 2 of 2 points

Type IV hypersensitivity reactions

Which test is used

to evaluate the cellular immune system in a
Correct answer
patient?
Type II hypersensitivity reactions
*
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Incompatible blood transfusions are examples
Skin test for commonly encountered antigens
of a type II hypersensitivity reaction. These
reactions are characterized as the antigen being
a part of a cell. Antibody binds to the antigen,
Determination of isohemagglutinin titer
complement is activated, and the red blood cells
are lysed. Immunoelectrophoresis of serum
Untitled Section Lymphocyte proliferation to mitogen/antigen
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Skin tests are used to determine whether the

delayed-type hypersensitivity response
Hashimoto disease is an autoimmune disease
mediated by T cells is functioning properly. All
primarily involving the:*
other tests listed evaluate humoral antibody
2/2 responses.
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2 of 2 points Which of the following frequently functions as

an antigen-presenting cell?*

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Contact dermatitis is mediated by:*
Dendritic cell
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Cytotoxic T lymphocyte
B lymphocytes
Natural killer cell
T lymphocytes
T helper cell

Macrophages
Correct answer
Polymorphonuclear cells
Dendritic cell
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Contact dermatitis is a delayed-type
hypersensitivity reaction mediated by T cells. Dendritic cells are considered the most effective
APC in the body, as well as the most potent
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phagocytic cell.
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Which of the following is characteristic of
DiGeorge syndrome?*
A patient with joint swelling and pain tested
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negative for serum RF by both latex
Defective T lymphocyte production agglutination and ELISA methods. What other
test would help establish a diagnosis of RA in
this patient?*
Depressed B cell development 0/2
Suppressed intracellular killing by Anti-CCP
polymorphonuclear cells
ANA testing
Suppressed complement levels

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Flow cytometry
Congenital thymic hypoplasia (DiGeorge
syndrome) Complement levels

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0 of 2 points Anti-CCP
Feedback Nuclear matrix proteins (NMPs) are RNA-protein
complexes. NMP-22 is shed into the urine in
Antibodies to cyclic citrullinated peptide are
persons with bladder carcinoma and is about
often found in RF-negative patients with
25-fold higher than normal in this condition.
rheumatoid arthritis.
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Which of the following tumor markers is used to

Which of the following is the best analyte to
monitor persons with breast cancer for
monitor for recurrence of ovarian cancer?*
RECURRENCE of disease?*
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CA 15-3
Cathepsin-D
CA 19-9
CA 15-3
CA 125

Retinoblastoma gene
CEA
Estrogen receptor (ER)
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CA 15-3 shares the same antigenic determinant
as CA 27.29. The markers are used to monitor
treatment and recurrence of breast cancer.
Which tumor marker is associated with cancer
of the urinary bladder?* Untitled Section

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CA 19-9
Which tumor marker is used to determine the
usefulness of trastuzumab (Herceptin) therapy
CA 72-4 for breast cancer?*
Nuclear matrix protein 2/2
Cathepsin-D PR
Correct answer CEA
Nuclear matrix protein HER-2/neu
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Myc
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Trastuzumab is an antibody to the HER-2/neu CH1 and CH2

gene product, a tyrosine kinase receptor
protein. HER- 2/neu is an oncogene that is
overexpressed in some breast cancers. VH and VL
Overexpression is associated with a more
aggressive clinical course but responds to VH and CL
treatment with trastuzumab, which blocks the CH1, CH2 and CH3
attachment of growth factor to the receptor.
Correct answer
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VH and VL
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Variations in the variable regions of the heavy

Which type of cancer is associated with the and light chains of an immunoglobulin molecule
highest level of AFP?* define the idiotype.
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Hepatoma 0 of 2 points
Ovarian cancer

Mannose-binding lectin is similar to which

Testicular cancer component of the classical pathway?*

Breast cancer 0/2

Correct answer C3

Hepatoma C2

Feedback C1q

AFP is increased in all persons with yolk sac C5a

tumors and over 80% of those with hepatoma.
Levels above 1000 ng/mL are diagnostic of
hepatoma. Correct answer

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Mannose-binding lectin (MBL) of the lectin

pathway of complement activation is found in
Immunoglobulin IDIOTYPES are antibodies with circulation complexed with proteinases. It is
variations in the domains of which of the considered to be similar in structure to C1q of
following?* the classical pathway. The MBL-proteinase
complex does not require antibody for Type IV
complement activation.
Correct answer
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Type IV
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Type IV hypersensitivity is the delayed-type

In Grave’s disease, one of the main hypersensitivity. Skin testing for tuberculosis
autoantibodies is:* causes a delayed-type hypersensitivity to
intradermally injected antigens in individuals
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previously exposed to the organism.
Anti-CCP
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Antibody to islet cells of pancreas
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Antibody to thyroid-stimulating hormone
receptor
A 1-year-old boy is seen for having many
Anti-dsDNA
recurrent infections with Streptococcus
pneumoniae. Laboratory tests revealed a
normal quantity of T cells, but no B cells and no
Correct answer immunoglobulins were seen on electrophoresis.
Antibody to thyroid-stimulating hormone Which of the following would most likely be the
receptor cause?*

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Autoantibody to the thyroid-stimulating Chronic granulotomatous disease

hormone receptor ultimately causes release of Bruton’s agammaglobulinemia
thyroid hormones and a hyperthyroid condition.
DiGeorge’s syndrome
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Wiskott-Aldrich syndrome

Correct answer
Skin testing for exposure to tuberculosis is an
example of which type of hypersensitivity?* Bruton’s agammaglobulinemia

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Type I Bruton’s agammaglobulinemia is typically seen

in infancy. These patients present with frequent
Type II recurring infections, especially after protective
Type III maternal antibody is gone and normal levels of
circulating T cells. The syndrome is a genetic B
cell enzyme deficiency in which the B cells fail to
differentiate and mature to antibody-producing Correct answer
plasma cells.
DiGeorge’s syndrome
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DiGeorge syndrome is the most likely cause. In
this syndrome the thymus fails to develop
before birth. These patients also show a marked
A patient with hereditary angiodema has which
decrease in T cells.
of the following deficiencies?*
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C5-9

Phagocytic cell function

A 3-year-old boy is seen by his physician
Mature B cells
because of many recent bacterial infections.
C1 Inhibitor Flow cytometery indicates normal levels of T
and B cells. The nitroblue tetrazolium test for
oxidative reduction is negative. The most likely
Feedback cause is:*

Hereditary angioedema is characterized by 0/2

recurrent swelling. The condition is genetic or Wegener’s syndrome
can be acquired and is the result of a deficiency
of the complement protein C1 Inhibitor. Chronic granulomatous disease

Untitled Section Bruton’s agammaglobulinemia

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Diabetes mellitus

A radiograph of a 1-year-old boy indicates the Correct answer

lack of a thymus. Complete blood count and
Chronic granulomatous disease
flow cytometry confirm a below-normal
lymphocyte count and a lack of T cells. Which of Feedback
the following would most likely be the cause?*
Chronic granulomatous disease is an inherited
0/2 disease that impairs the neutrophil’s ability to
kill certain bacteria. The neutrophils lack the
DiGeorge’s syndrome
enzyme nicotinamide adenine dinucleotide
Wiskott-Aldrich syndrome phosphate oxidase, easily demonstrated by the
failure to reduce nitroblue tetrazolium or
produce a blue end result. These patients have
Bare lymphocyte syndrome normal levels of lymphocytes.

Bruton’s agammaglobulinemia Untitled Section

2 of 2 points Procalcitonin (PCT) is a biomarker that exhibits
greater specificity than other proinflammatory
markers (e.g., cytokines) in identifying patients
The type of graft rejection that occurs within with sepsis and can be used in the diagnosis of
minutes of a tissue transplant is bacterial infections.
____________.*
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Acute

Chronic
Macrophages have specific names according to
Hyperacute their tissue location. Macrophages in the liver
are:*

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Accelerated
Alveolar macrophages
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Microglial cells
The hyperacute tissue graft reject occurs within
minutes to hours of a transplant and is typically Kupffer cells
associated with transplantation across ABO
blood groups and anti-ABO antibodies.
Histiocytes
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MACROPHAGES NOMENCLATURE IN
DIFFERENTTISSUES
A biomarker that exhibits greater specificity CNS - Microglial cells
than other proinflammatory markers in Kidney - Mesangial cells
identifying patients with sepsis and can be used Liver - Kupffer cells
in the DIAGNOSIS OF BACTERIAL INFECTIONS:* Lung - Alveolar macrophage
Lymph node - Lymph node macrophage
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Ceruloplasmin Untitled Section

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Cytokines

CEA Skin pH keeps most microorganisms from

Procalcitonin growing:*

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Procalcitonin pH 5.6

Feedback pH 6.5
pH 7.2 High titers of antimicrosomal antibodies are
most often found in:*

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pH 8.0
RA
Correct answer
SLE
pH 5.6
Chronic active hepatitis
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Lactic acid in sweat, for instance, and fatty acids

from sebaceous glands maintain the skin at a Hashimoto's thyroiditis
pH of approximately 5.6. This acidic pH keeps
Correct answer
most microorganisms from growing.
Hashimoto's thyroiditis
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Hashimoto’s thyroiditis is an autoimmune
disorder that results in hypothyroidism. More
C1 consists of three subunits: C1q, C1r and C1s, than 80% of the patients with the disease have
which are bound together by:* serum anti-thyroglobulin and anti-microsomal
antibodies.
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Magnesium
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Calcium
Which autoantibodies are strongly associated
Iron
with granulomatosis with polyangiitis
Chloride (Wegener’s granulomatosis)?*

Correct answer 2/2

Calcium ANA

Feedback ANCA

C1 forms the recognition unit of the

complement pathway. It consists of three
AMA
subunits stabilized by calcium.
ASMA
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ANCA: ANTINEUTROPHILIC CYTOPLASMIC
ANTIBODY

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Wiskott Aldrich syndrome is an X-linked

recessive defect that exhibits immunodeficiency,
The immunoglobulin classes most commonly
eczema and thrombocytopenia.
found on the surface of circulating B
lymphocytes in the peripheral blood of normal
persons are:*

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IgM, IgA

IgM, IgG

IgM, IgD

IgM, IgE

Correct answer

IgM, IgD

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IgM and IgD are the classes of immunoglobulin

that are found on most circulating B cells. They
are in effect the B cell receptor.

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Immunodeficiency with thrombocytopenia and

eczema is often referred to as:*

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DiGeorge syndrome

Bruton agammaglobulinemia

Ataxia telangiectasia

Wiskott-Aldrich syndrome

Correct answer

Wiskott-Aldrich syndrome