Immunity, Hypersensitivity, and Autoimmunity Quiz #2

Chapter 10 – Immunity, Hypersensitivity, and Autoimmunity Q1. The adverse effects that occur during corticosteroid use include all of the following, except; • Answer: Hypertension (not a primary corticosteroid adverse effect). • Book Quotes (Ch. 10, p. 235–236): “Prolonged corticosteroid use is associated with immunosuppression, osteoporosis, glucose intolerance, muscle wasting, and increased risk of infection.” “Adverse effects also include poor wound healing, mood changes, and redistribution of body fat.” Q2. The _________ is a more selective immunosuppressant that reversibly suppresses T helper cells in the G0 or G1 phase of the cell cycle without killing them. • Answer: Cyclosporine • Book Quotes (Ch. 10, p. 236): “Cyclosporine acts as a selective immunosuppressant.” “It inhibits calcineurin and prevents the transcription of IL-2, blocking T-helper cell proliferation.” “Unlike cytotoxic drugs, it does not kill the cells but holds them in the G0 or G1 phase.” Q3. Histamine binds to H1 (histamine 1), H2, H3, and H4 receptors, which are located on many types of cells. Which white blood cell expresses predominantly H2 receptors? • Answer: Neutrophils • Book Quotes (Ch. 10, p. 246): “Histamine exerts its effects through four receptor types: H1, H2, H3, and H4.” “H2 receptors are expressed on neutrophils and lymphocytes where they modulate chemotaxis and suppress lysosomal enzyme release.” Q4. The H3 receptors are located? SELECT ALL THAT APPLY • Answer: Presynaptic neurons in the central nervous system (CNS). • Book Quotes (Ch. 10, p. 246): “H3 receptors are found primarily in presynaptic neurons in the brain.” “They regulate neurotransmitter release and play a role in central nervous system signaling.” Q5. This medication inhibits the synthesis of DNA and is used in multiple autoimmune diseases. Side effects include increased risk of malignancy, bone marrow suppression, nausea, and vomiting. • Answer: Azathioprine • Book Quotes (Ch. 10, p. 236): “Azathioprine is a cytotoxic drug that interferes with DNA synthesis.” “It is used in autoimmune diseases and transplant rejection.” “Toxicities include bone marrow suppression, risk of malignancy, nausea, and vomiting.” Q6. Therapeutic plasmapheresis has been effective in the management of following diseases, EXCEPT; • Answer: Type 1 Diabetes Mellitus • Book Quotes (Ch. 10, p. 237): “Plasmapheresis is used to remove pathogenic autoantibodies.” “It has shown effectiveness in myasthenia gravis, systemic lupus erythematosus, and Goodpasture syndrome.” “It is not effective in type 1 diabetes.” Q7. Intravenous immunoglobulin (IVIg) can also be used for the following disorders, Except; • Answer: Diabetes mellitus • Book Quotes (Ch. 10, p. 237): “Intravenous immunoglobulin (IVIg) is used to provide passive immunity.” “It has therapeutic value in immunodeficiency syndromes, autoimmune diseases, and Kawasaki disease.” “It is not effective in diabetes mellitus.” Q8. This type of hypersensitivity reaction is mediated by the IgG/IgM immune complex, as in immune complex glomerulonephritis and SLE. • Answer: Type III hypersensitivity • Book Quotes (Ch. 10, p. 242): “Type III hypersensitivity is caused by immune complexes of IgG or IgM with antigens.” “These complexes deposit in tissues such as the kidneys, joints, and skin.” “Complement activation and neutrophil recruitment cause tissue injury.” Q9. This type of hypersensitivity reaction is a T cell–mediated and has all of the following categories except; Select all that apply • Answer: Antibody-mediated categories (do not belong). • Book Quotes (Ch. 10, p. 243): “Type IV hypersensitivity is cell-mediated, not antibody-mediated.” “It includes delayed-type hypersensitivity and direct cytotoxic T-cell killing.” “It does not involve IgG or IgM antibodies.” Q10. One of the most important mediators of type I hypersensitivity is ___________. • Answer: Histamine • Book Quotes (Ch. 10, p. 245): “Histamine is the most important mediator of type I hypersensitivity.” “It causes vasodilation, bronchoconstriction, increased vascular permeability, and pruritus.” Q11. The leukotrienes can cause ___________. SELECT ALL THAT APPLY • Answer: Bronchoconstriction, increased vascular permeability, and mucus secretion. • Book Quotes (Ch. 10, p. 245–246): “Leukotrienes are potent mediators of immediate hypersensitivity.” “They cause prolonged bronchoconstriction.” “They increase vascular permeability and promote mucus secretion.” Q12. The following are possible causes of human allergic reactions or anaphylaxis, EXCEPT; • Answer: Bacterial endotoxin (not a typical cause). • Book Quotes (Ch. 10, p. 245): “Type I hypersensitivity may be triggered by pollens, animal dander, foods, insect venoms, or drugs.” “Anaphylaxis is a severe systemic response to allergens such as insect stings, drugs, or foods.” Q13. The removal of this organ reduces serum IgM and the antibody response to encapsulated bacteria. • Answer: The spleen • Book Quotes (Ch. 10, p. 237): “The spleen is a major site of antibody production.” “Splenectomy reduces serum IgM levels and the ability to respond to encapsulated bacteria.” Q14. Some protective, proactive actions taken during pregnancy are thought to decrease the likelihood that type I hypersensitivity will develop in children from families with a history of allergies. These actions include all of the following, except; • Answer: Avoidance of breastfeeding (not protective). • Book Quotes (Ch. 10, p. 246): “Breastfeeding provides IgA and other protective factors that reduce the likelihood of allergic disease.” “Infants at risk benefit from maternal breastfeeding.” Q15. The goal of pharmacologic immunotherapy or desensitization therapy is ______. SELECT ALL THAT APPLY • Answer: To reduce IgE-mediated responses, increase IgG blocking antibodies, and induce tolerance. • Book Quotes (Ch. 10, p. 246–247): “Immunotherapy with repeated exposure to allergens shifts the response from IgE to IgG production.” “IgG antibodies block allergen binding to IgE, reducing hypersensitivity.” “This induces tolerance and reduces symptoms.” Q16. The RhoGAM vaccine is not effective if the mother _______________. • Answer: Is already sensitized (has anti-D antibodies). • Book Quotes (Ch. 10, p. 241): “Administration of RhoGAM prevents sensitization of Rh-negative mothers.” “It is not effective once the mother has formed anti-D antibodies.” Q17. Which is false about Myasthenia gravis? • Answer: False statement: “It is caused by muscle destruction.” True cause: autoantibodies against acetylcholine receptors. • Book Quotes (Ch. 10, p. 240): “Myasthenia gravis is caused by autoantibodies directed against the acetylcholine receptor at the neuromuscular junction.” “This blocks neuromuscular transmission and leads to muscle weakness.” Q18. Which is true about Graves’ Disease? • Answer: Autoantibodies stimulate the TSH receptor, causing hyperthyroidism. • Book Quotes (Ch. 10, p. 240): “In Graves’ disease, autoantibodies bind to the thyroid-stimulating hormone receptor.” “This inappropriate stimulation leads to hyperthyroidism.” Q19. This type of hypersensitivity includes “farmer’s lung” and the interstitial pneumonitis seen in pigeon breeders. • Answer: Type III hypersensitivity (hypersensitivity pneumonitis). • Book Quotes (Ch. 10, p. 243): “Type III hypersensitivity is associated with deposition of immune complexes in the lungs.” “Hypersensitivity pneumonitis, such as farmer’s lung and pigeon breeder’s lung, are examples.” Q20. Which is false about clinical manifestations of Immune Complex Glomerulonephritis? • Answer: False: “It occurs immediately after infection.” True: it develops 10–14 days later. • Book Quotes (Ch. 10, p. 243): “Immune complex glomerulonephritis usually develops 10 to 14 days after streptococcal infection.” “Complexes are deposited in the glomerular basement membrane, leading to inflammation and renal dysfunction.” Chapter 11 – Hematologic Malignancies Q21. The following are some common Manifestations of Hematologic Malignancies, EXCEPT; • Answer: Hypertension (not a manifestation). • Book Quotes (Ch. 11, p. 261–262): “The most common manifestations of hematologic neoplasms are related to bone marrow suppression.” “These include leukopenia, anemia, thrombocytopenia, hepatomegaly, splenomegaly, lymphadenopathy, and bone pain.” “Infections, weight loss, and anorexia are also common.” Q22. Neutropenia is an absolute neutrophil count less than _______________. • Answer: < 500 cells/µL • Book Quotes (Ch. 11, p. 262): “Neutropenia is defined as an absolute neutrophil count less than 500 cells/µL.” “This level places the patient at high risk for severe, life-threatening infections.” Q23. Sternal tenderness is frequently present in chronic myeloid leukemia (CML). • Answer: True – due to marrow expansion. • Book Quotes (Ch. 11, p. 270): “Patients with CML may present with splenomegaly, hepatomegaly, and sternal tenderness.” “Sternal tenderness results from expansion of bone marrow and leukemic cell proliferation.” Q24. A complete remission (CR) is defined as a return to normal hematopoiesis with normal red blood cell, neutrophil, and platelet counts and no detectable neoplastic cells. For leukemia, the bone marrow must have ________________, which are the most immature bone marrow cells, and be maintained for __________________. • Answer: < 5% blasts; maintained for at least 4 weeks. • Book Quotes (Ch. 11, p. 263): “A complete remission is defined as normal hematopoiesis with normal blood counts and no detectable neoplastic cells.” “For acute leukemias, the bone marrow must contain less than 5% blasts.” “This status must be maintained for at least 4 weeks.” Q25. Which one is incorrect about Acute Myeloid Leukemia (AML)? • Answer: AML has good long-term prognosis in adults (? false). • Book Quotes (Ch. 11, p. 268–269): “AML is a malignant disorder associated with transformation of myeloid stem cells.” “Bone marrow aspirate must have greater than 20% blasts for diagnosis.” “Abrupt onset of symptoms such as fatigue, bone pain, and infection.” “Prognosis is worse for AML than ALL: less than 50% of children and 25% of adults survive long term.” Q26. This is the most curable of all AML subtypes, with a 70% to 80% 5-year disease-free survival. • Answer: Acute Promyelocytic Leukemia (APL). • Book Quotes (Ch. 11, p. 269): “Acute promyelocytic leukemia (APL) accounts for 10% to 15% of AML cases.” “It is the most curable of all AML subtypes.” “Five-year disease-free survival ranges from 70% to 80%.” Q27. Which of the following is false about Pathogenesis and Clinical Manifestations of Chronic Lymphoid Leukemia (CLL)? • Answer: CLL primarily affects children (? false). • Book Quotes (Ch. 11, p. 271): “CLL is a disorder of mature B lymphocytes.” “It occurs most often in older adults, with a median age of 65 to 70 years.” “The disease is rare in children.” “Manifestations include lymphadenopathy, splenomegaly, fatigue, and frequent infections.” Q28. Which of the following is false about Pathogenesis and Clinical Manifestations of Hairy Cell Leukemia (HCL)? • Answer: HCL is a T-cell disorder (? false). • Book Quotes (Ch. 11, p. 273): “Hairy cell leukemia is a rare, chronic type of leukemia of B-cell origin.” “It is characterized by hairy-appearing B lymphocytes under the microscope.” “Manifestations include splenomegaly, recurrent infections, anemia, and bleeding tendencies.” Q29. Which of the following is false about Pathogenesis and Clinical Manifestations of Plasma Cell Myeloma (Multiple Myeloma)? (SELECT ALL THAT APPLY) • Answer: Plasma cell myeloma rarely affects bone (? false). Plasma cell myeloma does not cause renal damage (? false). • Book Quotes (Ch. 11, p. 274–276): “Multiple myeloma is a malignant disorder of mature plasma cells.” “It is characterized by abnormal production of monoclonal immunoglobulin (M protein).” “Lytic bone lesions are a hallmark finding.” “Renal dysfunction is common due to light chain protein deposition.” “Manifestations include bone pain, pathologic fractures, recurrent infections, hypercalcemia, and renal insufficiency.” Q30. Which is false about Platelets? • Answer: Platelets are true cells (? false). • Book Quotes (Ch. 11, p. 280): “Platelets are circulating cytoplasmic fragments of megakaryocytes.” “They are not true cells because they lack nuclei.” “They are essential for blood coagulation and control of bleeding.” “Normal platelet count ranges from 150,000 to 400,000/µL of blood.” Chapter 15 – Hemostasis and Coagulation Disorders Q31. The _________ is a divalent cation, is a cofactor for most of the enzyme-activated processes required in blood coagulation. • Answer: Calcium (Ca²?). • Book Quotes (Ch. 15, p. 373): “Calcium is a divalent cation.” “It is required for most of the enzymatic processes in blood coagulation.” “Calcium is necessary for activation of many clotting factors.” Q32. This factor, together with activated factor IX, enzymatically activates factor X. In addition, combines with another protein (von Willebrand factor) to help platelets adhere to capillary walls in areas of tissue injury. • Answer: Factor VIII. • Book Quotes (Ch. 15, p. 373): “Factor VIII functions as a cofactor with factor IXa in the activation of factor X.” “It also circulates bound to von Willebrand factor.” “This complex helps platelets adhere to the vascular wall.” Q33. The following are factors/proteins that are dependent on vitamin K for synthesis and normal activity, EXCEPT; • Answer: Factor VIII (not vitamin K dependent). • Book Quotes (Ch. 15, p. 373): “Vitamin K is required for synthesis of prothrombin and clotting factors VII, IX, and X.” “It is also needed for proteins C and S.” “Factor VIII is not vitamin K dependent.” Q34. The Protein C, a plasma protein, inactivates which factors in the prevention of clot formation? (Select all that apply) • Answer: Factors V and VIII. • Book Quotes (Ch. 15, p. 374): “Protein C is a plasma protein with anticoagulant activity.” “It inactivates factors V and VIII.” “This prevents further clot formation.” Q35. Which of the following is FALSE about the etiology and pathogenesis of Vascular Purpura? • Answer: Platelet count is always decreased (? false). • Book Quotes (Ch. 15, p. 377): “Vascular purpura is due to abnormalities of the vessels or supportive tissues.” “Platelet count and coagulation factors are usually normal.” “It is associated with vascular fragility, senile purpura, or steroid use.” Q36. Which is false about CLINICAL MANIFESTATIONS of Hereditary Hemorrhagic Telangiectasia (HHT)? • Answer: Bleeding is rare (? false). • Book Quotes (Ch. 15, p. 378): “Hereditary hemorrhagic telangiectasia is an autosomal dominant disorder.” “It presents with dilated vessels (telangiectases) on the skin and mucous membranes.” “Recurrent epistaxis is common.” “Bleeding manifestations are frequent and sometimes severe.” Q37. Which is false about the etiology and pathogenesis of thrombocytosis? • Answer: All patients with thrombocytosis have excessive bleeding (? false). • Book Quotes (Ch. 15, p. 379): “Thrombocytosis is an elevated platelet count above 400,000/µL.” “It may be reactive (secondary) or primary (essential thrombocythemia).” “Some patients have risk of thrombosis, others bleeding.” “Not all patients bleed.” Q38. Which is CORRECT about the etiology and pathogenesis of Qualitative Platelet Disorders? • Answer: Platelet count is normal, but function is defective. • Book Quotes (Ch. 15, p. 380): “Qualitative platelet disorders are abnormalities of function rather than number.” “Platelet count is normal, but adhesion, aggregation, or secretion is impaired.” “They may be inherited or acquired.” Q39. Which is false about Hemophilia A? • Answer: It is caused by deficiency of factor IX (? false, that is Hemophilia B). • Book Quotes (Ch. 15, p. 381): “Hemophilia A is an X-linked recessive disorder.” “It is caused by deficiency of factor VIII.” “Hemophilia B is caused by factor IX deficiency.” Q40. Which is false about the etiology of Disseminated Intravascular Coagulation (DIC)? • Answer: DIC is a primary disease (? false). • Book Quotes (Ch. 15, p. 382–383): “DIC is not a primary disease but a secondary complication.” “It results from excessive activation of coagulation.” “Causes include sepsis, trauma, malignancy, and obstetric complications.” “It is characterized by both clotting and bleeding.”