Patho

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1. T Nonpathogenic bacteria in the gastrointestinal tract 15. A Which antimicrobial peptide is activated by tumor
produce chemicals that inhibit colonization of pathogenic necrosis factor alpha and is found in alveolar
microorganisms macrophages and T-lymphocytes?
A. -Defensins
2. T Many of the normal bacterial flora in the intestines
B. -Defensins
produce vitamin K and assist with the absorption of
C. Cathelicidin
calcium, iron and magnesium.
D. Interleukin 1
3. T Opsonization is a process that renders bacteria more
16. B What process causes edema that occurs during the
susceptible to phagocytosis.
inflammatory process?
4. F The main function of natural killers cells is recognition and A. Vasodilation
elimination of bacteria B. Increased capillary permeability
5. F The inflammatory response is the body's first line of C. Endothelial cell contraction
defense. D. Emigration of neutrophils

6. F Activated T and B lymphocytes provide innate immunity. 17. A What process causes heat and redness that occur during
the inflammatory process?
7. F Neutrophils are involved in activation of the adaptive
A. Vasodilation
immune system.
B. Platelet aggregation
8. T Several bacteria, such as Mycobacterium tuberculosis, are C. Increased capillary permeability
resistant to killing by granulocytes and can survive inside D. Endothelial cell contraction
macrophages.
18. A Which component of the plasma protein system tags
9. T Eosinophils phagocytose parasites pathogenic microorganisms for destruction by neutrophils
10. T Resolution is best defined as the restoration of original and macrophages?
structure and physiologic function. A. Complement cascade
B. Clotting system
11. C What is a purpose of the inflammatory process? C. Kinin system
A. To provide specific responses toward antigens D. Immune system
B. To lyse cell membranes of microorganisms
C. To prevent infection of the injured tissue 19. C What is a vascular effect of histamine released from mast
D. To create immunity against subsequent tissue injury cells?
A. Platelet adhesion
12. B How do surfactant proteins A & D provide innate B. Initiation of the clotting cascade
resistance? C. Vasodilation
A. They initiate the complement cascade. D. Increased endothelial adhesiveness
B. They promote phagocytosis
C. They secrete mucus. 20. D What is an outcome of the complement cascade?
D. They synthesize lysosomes. A. Activates the clotting cascade
B. Prevents the spread of infection to adjacent tissues
13. D Which secretion provides antibacterial and antifungal fatty C. Inactivates chemical mediators such as histamine
acids and lactic acid to provide a first line of defense? D. Attacks bacterial cell membranes
A. Tears
B. Saliva 21. A What is function of the complement cascade called
C. Perspiration opsonization?
D. Sebaceous glands A. It is the tagging of pathogenic microorganisms for
destruction by neutrophils and macrophages.
14. C Which bacterium grows in the intestines after prolonged B. It is the processing of pathogenic microorganisms so
antibiotic therapy? that activated lymphocytes can be created for acquired
A. Lactobacillus immunity.
B. Candida albicans C. It is the destruction of glycoprotein cell membranes of
C. Clostridium difficile pathogenic microorganisms.
D. Helicobacter pylori D. It is the anaphylatoxic activity resulting in mast cell
degranulation.
22. D Which chemical interacts among all plasma protein 29. B What is the role of eosinophils in regulating vascular
systems by degrading blood clots, activating mediators released from mast cells?
complement and activating the Hageman factor? A. Eosinophils release arylsulfatase B, which stimulates
A. Kallikrein the formation of B lymphocytes.
B. Histamine B. Eosinophils release histaminase, which limits the effects
C. Bradykinin of histamine during acute inflammation.
D. Plasmin C. Eosinophils release lysosomal enzymes, which activate
mast cell degranulation during acute inflammation.
23. A Which chemical mediators induce pain during an
D. Eosinophils release immunoglobulin E, which defends
inflammatory response?
the body against parasites.
A. Prostaglandins and bradykinin
B. Leukotrienes and serotonin 30. D Which cytokines are produced and released from virally
C. Tryptase and histamine infected host cells?
D. Phospholipase and prostacyclin A. Interleukin 1 (Il-1)
B. Interleukin 10 (Il-10)
24. C What effect does chemotactic factor have on the
C. Tumor necrosis factor alpha (TNF
inflammatory process?
D. Interferons alpha and beta (IFN and IFN )
A. It causes vasodilation around the inflamed area.
B. It stimulates smooth muscle contraction in the inflamed 31. C Where is tumor necrosis factor alpha (TNF ) secreted?
area. A. From virally infected cells
C. It directs leukocytes to the inflamed area. B. From bacterial infected cells
D. It produces edema around the inflamed area. C. From macrophages
D. From mast cells
25. C Which chemical mediator derived from mast cells retracts
endothelial cells to increase vascular permeability and 32. B Which manifestation of inflammation is systemic?
causes leukocyte adhesion to endothelial cells? A. Formation of exudates
A. Leukotrienes B. Fever and leukocytosis
B. Prostaglandin E C. Redness and heat
C. Platelet-activating factor D. Pain and edema
D. Bradykinin
33. A One systemic manifestation of the acute inflammatory
26. D What are the inflammatory effects of nitric oxide (NO)? response is fever that is produced by:
A. It increases capillary permeability and causes pain. A. endogenous pyrogens acting on the hypothalamus.
B. It increases neutrophil chemotaxis and platelet B. bacterial endotoxin acting on the hypothalamus.
aggregation. C. antigen-antibody complexes acting on the
C. It causes smooth muscle contraction and fever. hypothalamus.
D. It decreases mast cell function and decreases platelet D. exogenous pyrogens acting directly on the
aggregation. hypothalamus.
27. C When looking at white blood cell differentials, nurses 34. A What occurs during the process of repair after tissue
know that patients have early, acute inflammatory damage?
reactions when they notice elevations of which leukocyte? A. Destroyed tissue is replaced by non-functioning scar
A. Monocytes tissue.
B. Eosinophils B. Regeneration occurs in which original tissue is
C. Neutrophils replaced.
D. Basophils C. Resolution occurs when tissue is regenerated.
D. Destroyed tissue is replaced by epithelialization.
28. B The predominant phagocytic cells in the later stages of
an inflammatory response are: 35. C What is the role of fibroblasts during the reconstructive
A. neutrophils. phase of wound healing?
B. monocytes. A. To generate new capillaries from vascular endothelial
C. macrophages. cells around the wound
D. eosinophils. B. To establish connections between neighboring cells
and contract their fibers
C. To synthesize and secrete collagen and the connective
tissue proteins
D. To provide enzymes that debride the wound bed of
dead cells
36. B _____ may activate the complement system. 44. B Many neonates have a transient depressed inflammatory
A. Viruses response because:
B. Antigen-antibody complexes A. their circulatory system is too immature to adequately
C. Mast cells perfuse tissues.
D. Macrophages B. they are deficient in complement and chemotaxis.
C. they have an insufficient number of mast cells.
37. B The _____ system is a plasma protein system that forms a
D. their lungs are too immature to deliver oxygen to
fibrinous network at an inflamed site to prevent spread of
tissues.
infection to adjacent tissues and keep microorganisms
and foreign bodies at the site of greatest inflammatory 45. C Why do many older adults have impaired inflammation
activity. and wound healing?
A. complement A. Because their circulatory system cannot adequately
B. coagulation perfuse tissues.
C. kinin B. Because they are deficient in complement and
D. fibrinolysis chemotaxis.
C. Because they have underlying chronic illnesses.
38. C In the clotting cascade, the intrinsic and the extrinsic
D. Because they have an insufficient number of mast cells.
pathways converge at:
A. factor XII. 46. B What is a role of natural killer cells?
B. Hageman factor. A. To initiate the complement cascade
C. factor X. B. To eliminate malignant cells
D. factor V. C. To bind tightly to antigens
D. To proliferate after immunization with antigen
39. A When histamine binds the histamine 2 (H2) receptor,
inflammation is: 47. B Match each step of phagocytosis with its function.
A. inhibited. E A. Opsonization
B. activated. A B. Engulfment
C. accelerated. D C. Phagosome
D. not changed. C D. Fusion
E. Destruction
40. C Frequently histamine 1 (H1) and histamine 2 (H2) receptors
are located on the same cells and act in a/an _____ fashion.
1. Microorganisms are ingested
A. synergistic
B. additive
2. Microorganisms are killed and digested
C. antagonistic
D. agonistic
3. Enhance recognition and adherence of bacteria by
41. C Which of the following indicates a correct sequence in phagocytes
phagocytosis?
A. Engulfment, recognition, fusion, destruction 4. Lysosomal granules enter the phagocyte
B. Fusion, engulfment, recognition, destruction
C. Recognition, engulfment, fusion, destruction 5. Intracellular phagocytic vacuole is formed
D. Engulfment, fusion, recognition, destruction
48. B Match the biochemical barriers with its function. (Terms
42. A Which solution is best to use when cleaning a wound that A can be used more than once.)
is healing by epithelialization? B A. Secrete antibacterial and antifungal fatty acids and
A. Normal saline B lactic acid
B. Povidone-iodine B. Attack cell walls of gram positive bacteria
C. Hydrogen peroxide
D. Dakins solution
43. C A keloid is the result of which dysfunctional wound 6. Tears
healing response?
A. Impaired epithelialization 7. Sebaceous glands
B. Impaired contraction
C. Impaired collagen matrix assembly 8. Perspiration
D. Impaired maturation
9. Saliva
49. T Each individual T and B lymphocyte specifically
recognizes only one particular antigen
50. F Antibodies cannot protect a host against viral infections
51. F Most antigens react directly with cells of the immune
system
52. T Before birth, humans produce a large number of T
lymphocytes (T cells) and B lymphocytes (B cells) that
have the capacity to recognize almost any foreign antigen
found in the environment.
63.
53. T An antigen that is capable of inducing an immune
response is called an immunogen.
54. F T lymphocytes are primarily responsible for protection
against bacteria and a variety of viruses.
55. T Major histocompatibility complex (MHC) molecules are
located on the surface of all body cells except 64.
erythrocytes.
56. F Endogenous protein antigens are presented by Class II
molecules of major histocompatibility complex (MHC).
57. T While macrophages present processed antigens to
memory Th cells, B lymphocytes present antigens to
helper Th cells.
65.
58. T The helper T cell (Th) interacts with immunocompetent B
cells causing the production of a plasma cells.
59. B What are primary characteristics that differentiate the
immune response from other protective mechanisms such
as inflammation?
A. The immune system responds in the same way each 66.
time it is activated.
B. The immune response is specific to the antigen that
initiates it.
C. The immune response is a short-term response to a
specific pathogen.
D. The immune response is an innate response, rather than
acquired.
60. C Where do B lymphocytes mature and undergo changes
that commit them to becoming B cells?
A. In the thymus gland
B. In regional lymph nodes
C. In bone marrow
D. In the spleen
61. A What is the term for the process in which lymphoid stem 67.
cells migrate from the bone marrow to the central
lymphoid organs (the thymus or bone marrow) where they
undergo cellular changes into either immunocompetent T
cells or immunocompetent B cells?
A. Generation of clonal diversity
B. Clonal differentiation
C. Clonal selection
D. Clonal competence 68.
62. B Which type of immunity is produced by an individual after
either natural exposure to the antigen or after
immunization against the antigen?
A. Passive acquired immunity
B. Active acquired immunity
C. Passive innate immunity
D. Active innate immunity
A What type of immunity is produced when an
immunoglobulin crosses the placenta?
A. Passive acquired immunity
B. Active acquired immunity
C. Passive innate immunity
D. Active innate immunity
C The portion of the antigen that is configured for
recognition and binding is called an antigenic determinant
or a(n):
A. immunotope.
B. paratope.
C. epitope.
D. antigenitope.
B What is the most important determinant of
immunogenicity?
A. The antigen's size
B. The antigen's foreignness
C. The antigen's complexity
D. The antigen's quantity
D When antigens are administered to patients to produce
immunity, why are different routes of administration used
(e.g., some are given intravenously, whereas others are
given subcutaneously or nasally)?
A. Different routes allow the speed of onset of the antigen
to be varied, with intravenous route being the fastest.
B. Some individuals appear to be unable to respond to an
antigen by a specific route, thus requiring the availability
of different routes for the same antigen.
C. Antigen-presenting cells are highly specialized and
thus require stimulation by different routes.
D. Each route stimulates a different lymphocyte-
containing tissue resulting in different types of cellular
and humoral immunity.
A How are the functions of major histocompatibility
molecules and CD1 molecules alike?
A. They are both antigen-presenting molecules.
B. They both bind antigens to antibodies.
C. They both secrete interleukins during the immune
process.
D. They are both capable of activating cytotoxic T
lymphocytes.
C Where are antibodies produced?
A. In helper T lymphocytes
B. In the thymus gland
C. In plasma cells
D. In the bone marrow
69. A Which immunoglobulin is present in blood, saliva, breast 76. C Which is an example of an exogenous antigen?
milk, and respiratory secretions? A. Virus
A. Immunoglobulin A (IgA) B. Cancer cells
B. Immunoglobulin E (IgE) C. Bacteria
C. Immunoglobulin G (IgG)
77. B Which cytokine is needed for the maturation of a
D. Immunoglobulin M (IgM)
functional helper T cell?
70. B Which antibody is detected in the circulation to indicate a A. Interleukin-1 (Il-1)
typical primary immune response? B. Interleukin-2 (Il-2)
A. IgG C. Interleukin-4 (Il-4)
B. IgM D. Interleukin-12 (Il-12)
C. IgA
78. C Helper T 2 cells (Th2) produce interleukin 4 (Il-4) that
D. IgE
suppresses which lymphocytes?
71. D How is the function of the B-cell receptor (BCR) complex A. B lymphocytes
different from the function of circulating antibodies? B. Cytotoxic T lymphocytes
A. The B-cell receptor (BCR) complex communicates C. Helper T1 cells (Th1)
information about the antigen to the helper T cell. D. Memory T lymphocytes
B. The B-cell receptor (BCR) complex secretes chemical
79. B What are characteristics of helper T1 cells (Th1)?
signals to communicate between cells.
A. They are induced by antigens derived from allergens.
C. The B-cell receptor (BCR) complex recognizes the
B. They are induced by antigens derived from cancer
antigen on the surface of the B lymphocyte.
cells.
D. The B-cell receptor (BCR) complex communicates
C. They produce interleukins 4, 5, 6, and 13.
information about the antigen to the cell nucleus.
D. They assist in the development of humoral immunity.
72. C If a person had very low levels of Ig__, he or she may be
80. A What are characteristics of helper T2 cells (Th2)?
more susceptible to infections of mucous membranes.
A. They are induced by antigens derived from allergens.
A. G
B. They are induced by antigens derived from cancer
B. M
cells.
C. A
C. They produce interleukin 1 (Il-2) tumor necrosis factor ß
D. E
and interferon
73. A During which phase of life does the generation of clonal D. They assist in the development of cell-mediated
diversity occur? immunity.
A. In the fetus
81. D When a person is exposed to most antigens, how long
B. In the neonate
does it take before an antibody can be detected in the
C. In the infant after first immunizations
circulation?
D. In the first year of life
A. 12 hours
74. C Which are characteristics of the generation of clonal B. 24 hours
diversity? C. 3 days
A. The process involves antigens selecting those D. 6 days
lymphocytes with compatible receptors.
82. B How are vaccinations able to provide protection against
B. The process allows the differentiation of cells into
certain microorganisms?
antibody-secreting plasma cells or mature T cells.
A. Because of the strong response from immunoglobulin
C. The process takes place in the primary (central)
M (IgM)
lymphoid organs (i.e., thymus and bone marrow).
B. Because of the level of protection provided by
D. The process causes antigens to expand and diversify
immunoglobulin G (IgG)
their populations.
C. Because of the memory cells for immunoglobulin E
75. B Which are characteristics of clonal selection? (IgE)
A. The process is driven by hormones and does not D. Because of the rapid response from immunoglobulin A
require foreign antigens. (IgA)
B. The process involves antigens selecting those
lymphocytes with compatible receptors.
C. The process takes place in the primary (central)
lymphoid organs (i.e., thymus and bone marrow).
D. The process generates immature, but
immunocompetent T and B cells with receptors
83. A Why are some viruses, such as measles and herpes, 89. C Match each immunoglobulin with its characteristic or
inaccessible to antibodies after the initial infection? D function. (Immunoglobulins can be used more than once.)
A. These viruses do not circulate in the blood, they are B A. Immunoglobulin A (IgA)
inside of infected cells. D B. Immunoglobulin E (IgE)
B. These viruses do not have antibody receptors on their C C. Immunoglobulin G (IgG)
cell surfaces. D. Immunoglobulin M (IgM)
C. These viruses resist agglutination.
D. These viruses are soluble antigens.
1. Crosses the placenta
84. C Which is an example of a bacterial toxin that has been
inactivated, but still retains its immunogenicity to protect
2. Is the first antibody produced during initial or primary
the person?
response to an antigen
A. Poliomyelitis
B. Measles
3. Mediates many common allergic responses
C. Tetanus
D. Gonorrhea
4. Synthesized early in neonatal life
85. B How do antibodies protect the host from bacterial toxins?
A. By lysing the cell membrane of the toxins 5. Most abundant immunoglobulin and accounts for most
B. By binding to the toxins to neutralize their biologic of the protective activity against infections
effects
90. B Match the CD 4 (cluster of differentiation) cells and CD 8
C. By inhibiting the synthesis of DNA proteins needed for
A cells with their characteristics. (Answers may be used
growth
B more than once.)
D. By interfering with the DNA enzyme needed for
A A. CD 4 cells
replication
B B. CD 8 cells
86. D Which T cell controls or limits the immune response to A
protect the host's own tissues against an autoimmune
response? 6. Recognize antigens presented by endogenous protein
A. Cytotoxic T cells molecules
B. Helper 1 (Th1) cells
C. Helper 2 (Th2) cells 7. Recognize antigens presented by exogenous protein
D. Regulatory T (Treg) cells molecules
87. B At birth, samples of blood from the umbilical cord
indicate which immunoglobulin levels, if any, are near 8. Develop into cytotoxic T cells
adult levels?
A. None of the immunoglobulins are near adult level. 9. Develop into helper T cells
B. Immunoglobulin G (IgG)
C. Immunoglobulin M (IgM) 10. Recognize antigens presented by MHC I molecules
D. Immunoglobulin E (IgE)
11. Recognize antigens presented by MHC II molecules
88. A Increased age may cause which of these changes in
lymphocyte function?
A. Increased production of antibodies against self-
antigens
B. Decreased number of circulating T cells
C. Decreased production of autoantibodies
D. Increased production of helper T cells.
91. B Match each the helper T cell subset (Th1 or Th2) with its 102. A Once they have penetrated the first line of defense, which
A characteristics. (Th1 and Th2 can be used more than microorganisms do neutrophils actively attack, engulf
A once.) and destroy by phagocytosis?
B A. Helper T1 lymphocytes (Th1) A. Bacteria
A B. Helper T2 lymphocytes (Th2) B. Fungi
B C. Viruses
A D. Mycoplasma
12. Provide help in developing humoral immunity
103. C Once they have penetrated the first line of defense, which
microorganisms do natural killer cells actively attack?
13. Provide help in developing cell-mediated immunity
A. Bacteria
B. Fungi
14. Produce interleukin 2 (Il-2), tumor necrosis factor ß
C. Viruses
(TNF ß), interferon (IFN ) and interleukin 12 (Il-12)
D. Mycoplasma

15. Produce interleukins 4, 5, 6, and 13 104. A In a bacterial infection, what activates helper T cells?
A. Macrophage display of antigens
16. Are induced by antigens derived from viral or B. Phagocytosis by neutrophils
bacterial pathogens C. Activation of the complement cascade
D. Cytokines engulf bacteria
17. Are induced by antigens derived from allergens 105. B How do pathogens use antigenic shifts to escape
recognition by host defenses?
18. Are induced by antigens derived from cancer cells A. By creating mutations allowing for the emergence of
92. T Colonization is the first stage of infection. new strains of pathogens
B. By a recombination of genes from different pathogens
93. F Macrophages bind to the surface of bacteria, act as
C. By pathogens switching genes off and on to avoid
opsonins and activate complement
host's immune response
94. T Endotoxins from gram negative bacteria can activate the D. By changing the appearance of surface antigens to
coagulation cascade avoid detection
95. T Viruses have no metabolism and are incapable of 106. A Which element is necessary for bacteria to multiply?
independent reproduction A. Iron
B. Zinc
96. T Diseases caused by fungi are called mycoses.
C. Iodine
97. F Immunoglobulins are important in controlling fungi. D. Copper
98. T All viruses have a protein receptor binding site on their 107. B Which mechanism is used by bacteria such as
surface that adheres to specific binding site on the host Staphylococcus, Streptococcus and Mycobacterium
cell. tuberculosis to fight off or alter the human inflammatory
99. F Endotoxins are contained in the cell wall of gram- response or resist immune defenses?
positive bacteria. A. They coat the surfaces to inhibit phagocytosis.
B. They produce toxins that damage cells and alter
100. B What is colonization?
function.
A. The ability of a pathogen to invade and multiply in the
C. They create surface receptors that bind to host cells.
host
D. They produce proteases to digest immunoglobulins.
B. The presence of pathogens on or in the body without
tissue invasion 108. D Which are characteristics of exotoxins?
C. An important factor in determining a pathogen's A. They are contained in cell walls of gram-negative
degree of virulence bacteria.
D. Direct damage to cells rendering them dysfunctional B. They are released during the lysis of bacteria.
C. They can initiate the complement and coagulation
101. B For which microorganisms is the skin the site of
cascades.
reproduction?
D. They are released during bacterial growth.
A. Viruses
B. Bacteria and fungi
C. Protozoa and rickettsiae
D. Mycoplasma
109. B How are vaccines against viruses made? 115. B Match term with its definition.
A. Vaccines are made from killed organisms or extracts of E A. Toxigenicity
antigens. A B. Infectivity
B. Vaccines are made from live organisms weakened so D C. Colonization
that antigens, which limits controllable infection. D. Pathogenicity
C. Vaccines are made from purified toxins that have been E. Virulence
chemically detoxified without loss of immunogenicity.
D. Vaccines are made from recombinant pathogenic
protein. 1. Ability of the pathogen to invade and multiply in the
host
110. C Cytokines are thought to raise the thermoregulatory set
point to cause fever by stimulating the synthesis of which
2. Potency of a pathogen measured in terms of the
chemical mediator?
number of microorganisms or micrograms of toxin
A. Leukotriene
required to kill the host
B. Histamine
C. Prostaglandin
3. An important factor in determining a pathogen's ability
D. Bradykinin
to produce disease by production of a soluble toxin
111. A One systemic manifestation of an acute inflammatory
response is fever that is produced by: 4. The ability of an agent to produce disease
A. endogenous pyrogens acting directly on the
116. C Match the microorganism with its characteristics.
hypothalamus.
D (Answers may be used more than once.)
B. exogenous pyrogens acting directly on the
B A. Bacteria
hypothalamus.
A B. Viruses
C. immune complexes acting indirectly on the
C. Mycoses
hypothalamus.
D. Dermatophytes
D. cytokines acting indirectly on the hypothalamus.
112. D What is the major cause of death worldwide?
A. Starvation 5. Grow as parasites on or near skin and mucous
B. Traumatic injury membranes
C. Cardiovascular disease
D. Infectious disease 6. Invade skin, hair and nails
113. C Which statement about vaccines is true?
A. Most bacterial vaccines contain attenuated organisms. 7. Use metabolism of hosts cells to proliferate
B. Most viral vaccines are made by using dead
organisms. 8. Injure cells by producing exotoxins and endotoxins
C. Vaccines with booster injections induce primary and 117. T Some forms of severe combined immune deficiency can
secondary immune responses. be caused by a single gene defect.
D. Vaccines provide effective protection for all people
118. T Immune deficiencies can either be congenital or
against viruses, bacteria and fungal infections.
acquired.
114. B Which statement is true about fungal infections?
119. F Persons with blood type O are considered universal
A. They occur only on skin, hair, and nails.
recipients
B. They are controlled by phagocytes and T
lymphocytes. 120. F Atopic individuals tend to produce higher levels of IgM.
C. They result in release of endotoxins.
121. F One person with HIV cannot transmit the virus to others
D. They are be prevented by vaccines.
until HIV antibodies are detected.
122. T Antibodies to HIV appear within weeks of transmission
through blood products, but within months after sexual
transmission.
123. F The patient with HIV infection is asymptomatic during the
latency because the HIV virus lies dormant in lymph
nodes
124. B What is the name of the hypersensitivity reaction that 131. C What is a characteristic of atopic individuals who are
occurs after a person who is allergic to bee stings is genetically predisposed to develop allergies?
stung by a bee? A. They produce greater quantities of histamine than
A. Hemolytic shock other individuals.
B. Anaphylaxis B. They have more histamine receptors than other
C. Necrotizing vasculitis individuals.
D. Systemic erythematosus C. They produce greater quantities of immunoglobulin E
(IgE) than other individuals.
125. C Hypersensitivity is best defined as a(n):
D. They have a deficiency in epinephrine compared with
A. disturbance in the immunologic tolerance of self-
other individuals.
antigens.
B. immunologic reaction of one person to the tissue of 132. B What is the mechanism in type I hypersensitivity
another person. reactions?
C. altered immunologic response to an antigen that A. Antibodies bind to the antigen on the cell surface and
results in disease. cause lysis.
D. undetectable immune response in the presence of B. Antibodies coat mast cells by binding to receptors
antigens. that signal its degranulation followed by discharge of
preformed mediators.
126. A Through which lymphocyte is the common allergy hay
C. Antibodies bind to soluble antigens that were released
fever expressed?
into body fluids and the immune complexes are
A. IgE-mediated reactions
deposited in the tissues.
B. IgG-mediated reactions
D. Cytotoxic T lymphocytes or lymphokines-producing
C. IgM-mediated reactions
Th1 cells attack and destroy cellular targets directly.
D. T cell-mediated reactions
133. D What is the mechanism in type II hypersensitivity
127. C During an immunoglobulin E-mediated (IgE)
reactions?
hypersensitivity reaction, which leukocyte is activated?
A. Antibodies coat mast cells by binding to receptors
A. Neutrophils
that signal its degranulation followed by discharge of
B. Monocytes
preformed mediators.
C. Eosinophils
B. Antibodies bind to soluble antigens that were released
D. T lymphocytes
into body fluids and the immune complexes are
128. C During an immunoglobulin E-mediated (IgE) deposited in the tissues.
hypersensitivity reaction, what causes bronchospasm? C. Cytotoxic T lymphocytes or lymphokines-producing
A. Bronchial edema caused by chemotactic factor of Th1 cells attack and destroy cellular targets directly.
anaphylaxis D. Antibodies bind to the antigens on the cell surface.
B. Bronchial edema caused by binding of the cytotropic
134. A In a Type II hypersensitivity reaction, when mismatched
antibody
blood is administered causing an ABO incompatibility,
C. Smooth muscle contraction caused by histamine
what destroys the erythrocytes?
bound to H1 receptors
A. Complement-mediated cell lysis
D. Smooth muscle contraction caused by histamine
B. Phagocytosis by macrophages
bound to H2 receptors
C. Phagocytosis in the spleen
129. A During an immunoglobulin E-mediated (IgE) D. Natural killer cells
hypersensitivity reaction, what stops the degranulation of
135. C In a Type II hypersensitivity reaction, when antibodies are
mast cells?
formed against red blood cell antigens of the Rh system,
A. The action of histamine bound to H2 receptors
how are the blood vessels destroyed?
B. The action of chemotactic factor of anaphylaxis bound
A. By complement-mediated cell lysis
to receptors
B. By phagocytosis by macrophages
C. The action of epinephrine bound to mast cell
C. By phagocytosis in the spleen
receptors
D. By neutrophil granules and toxic oxygen products
D. The action of acetylcholine bound to mast cell
receptors 136. D In a Type II hypersensitivity reaction, when soluble
antigens from infectious agents enter circulation, what
130. C During an anaphylactic reaction, what reverses the
causes tissue damage?
effects of histamine?
A. Complement-mediated cell lysis
A. Acetylcholine
B. Phagocytosis by macrophages
B. Antihistamine
C. Phagocytosis in the spleen
C. Epinephrine
D. Neutrophil granules and toxic oxygen products
D. Corticosteroid
137. D In a Type II hypersensitivity reaction, that is an antibody-
dependent cell-mediated cytotoxicity (ADCC), what
destroys the target cells?
A. Complement-mediated cell lysis
B. Phagocytosis by macrophages
C. Neutrophil granules and toxic oxygen products
D. Natural killer cells
138. A In Graves' disease (hyperthyroidism), autoantibodies bind
to and activate receptors for thyroid stimulating hormone
(TSH) so that excessive T4 (thyroxine) is secreted, causing
clinical manifestations of an increased metabolism. This
mechanism is an example of which Type II
hypersensitivity reaction?
A. Modulation
B. Antibody-dependent cell-mediated (ADCC)
C. Neutrophil-mediated damage
D. Complement-mediated lysis
139. A In myasthenia gravis, the acetylcholine receptor
antibodies block acetylcholine from attaching to their
receptors impairing the neuromuscular transmission and
causing muscle weakness. This mechanism is an example
of which Type II hypersensitivity reaction?
A. Modulation
B. Antibody-dependent cell-mediated (ADCC)
C. Neutrophil-mediated damage
D. Complement-mediated lysis
140. B What is the mechanism in type III hypersensitivity
reactions?
A. Antibodies coat mast cells by binding to receptors
that signal its degranulation followed by discharge of
preformed mediators.
B. Antibodies bind to soluble antigens that were released
into body fluids and the immune complexes are
deposited in the tissues.
C. Cytotoxic T lymphocytes or lymphokines-producing
Th1 cells attack and destroy cellular targets directly.
D. Antibodies bind to the antigen on the cell surface.
141. C In a type III hypersensitivity reaction, what causes the
harmful effects after the immune complexes are
deposited in tissues?
A. Cytotoxic T cells
B. Natural killer cells
C. Complement activation
D. Degranulation of mast cells
142. A What mechanism occurs in Raynaud phenomenon that
classify it as a type III hypersensitivity reaction?
A. Immune complexes are deposited in capillary beds
blocking circulation.
B. Mast cells bind to specific endothelial receptors that
cause them to degranulate creating a localized
inflammatory reaction that occludes capillary circulation.
C. Cytotoxic T lymphocytes attack and destroy the
capillaries so that they are unable to perfuse local
tissues.
D. Antibodies detect the capillaries as foreign protein and
destroy them using lysosomal enzymes and toxic oxygen
species.
143. C What is the mechanism in type IV hypersensitivity
reactions?
A. Antibodies coat mast cells by binding to receptors
that signal its degranulation followed by discharge of
preformed mediators.
B. Antibodies bind to soluble antigens that were released
into body fluids and the immune complexes are
deposited in the tissues.
C. Cytotoxic T lymphocytes or lymphokines-producing
Th1 cells attack and destroy cellular targets directly.
D. Antibodies bind to the antigen on the cell surface.
144. B When a tuberculin skin test is positive, what forms the
hard center and erythema surrounding the induration?
A. Histamine
B. T lymphocytes and macrophages
C. Immune complexes
D. Products of complement
145. C What disease involves the deposition of circulating
immune complexes containing an antibody against host
DNA, resulting in tissue damage?
A. Hemolytic anemia
B. Pernicious
C. Systemic lupus erythematosus
D. Myasthenia gravis
146. B The class of antibody involved in type I hypersensitivity
reactions is:
A. IgA.
B. IgE.
C. IgG.
D. IgM.
147. A How does tissue damage occur in acute rejection after 154. B Considering the effects of nutritional deficiencies on the
an organ transplant? immune system, severe deficits in calories and protein
A. Helper T cells (Th1) release cytokines that activate lead to deficiencies in the formation of which immune
infiltrating macrophages and cytotoxic T cells directly cells?
attack the endothelial cells of the transplanted tissue. A. B cells
B. Circulating immune complexes are deposited in the B. T cells
endothelial cells of transplanted tissue where the C. Natural killer cells
complement cascade lyses tissue. D. Neutrophils
C. Antigens on the cell surface of transplanted tissue are
155. B When the maternal immune system becomes sensitized
recognized by receptors on natural killer (NK) cells,
against antigens expressed by the fetus, _____ disease is a
which release lysosomal enzymes that destroy tissue.
result.
D. Antibodies coat the surface of transplanted tissue to
A. allergic
which mast cells bind and liberate preformed chemical
B. alloimmune
mediators that destroy tissue.
C. fetalimmune
148. D Which blood cell carries the carbohydrate antigens for D. autoimmune
blood type?
156. B Blood transfusion reactions are an example of:
A. Platelets
A. autoimmunity.
B. Neutrophils
B. alloimmunity.
C. Lymphocytes
C. homoimmunity.
D. Erythrocytes
157. B In which primary immune deficiency is there a partial to
149. C A person with type O blood is likely to have high titers
complete absence of T-cell immunity?
of anti-___ antibodies.
A. Bruton disease
A. A
B. DiGeorge syndrome
B. B
C. Reticular dysgenesis
C. A and B
D. Adenosine deaminase (ADA) deficiency
D. O
158. B Which of the following is a characteristic of the human
150. D Which class of immunoglobulins forms
immunodeficiency virus (HIV)?
isohemagglutinins?
A. It only infects T helper cells.
A. Immunoglobulin A (IgA)
B. The virus is retrovirus.
B. Immunoglobulin E (IgE)
C. It carries genetic information in DNA.
C. Immunoglobulin G (IgG)
D. Five strains have been identified.
D. Immunoglobulin M (IgM)
159. D What is the role of reverse transcriptase in HIV infection?
151. B Deficiencies in which element can produce depression of
A. It converts single DNA into double-stranded DNA.
both B- and T-cell function?
B. It is needed to produce integrase.
A. Iron
C. It transports the RNA into the cell nucleus.
B. Zinc
D. It converts RNA into double-stranded DNA.
C. Iodine
D. Magnesium 160. B Which cells are primary targets for HIV?
A. CD4-positive Th cells only
152. D Which component of the immune system is deficient in
B. CD4-positive Th cells, macrophages, and natural killer
people with infections caused by viruses, fungi, or yeast?
cells
A. Natural killer cells
C. CD8-positive Tc cells and plasma cells
B. Macrophages
D. CD8-positive Tc cells only
C. B cells
D. T cells 161. D Which secretion transmits human immunodeficiency
syndrome?
153. C By _____ months, the newborn is sufficiently protected by
A. Sweat
antibodies produced by its own B cells.
B. Urine
A. 1 to 2
C. Saliva
B. 4 to 5
D. Breast milk
C. 6 to 8
D. 10 to 12
162. A Cells in _____ may act as a reservoir in which HIV can be 172. T Most cancers must acquire mutation in six distinct areas:
relatively protected from antiviral drugs. growth signals, antigrowth signals, evading apoptosis,
A. the central nervous system replicating ability, angiogenesis, and invasion and
B. bone marrow metastasis.
C. the thymus gland
173. F There is no current evidence that associates obesity with
D. the lungs
cancer formation.
163. C A major immunologic finding in AIDS is the striking
174. T An increased number of sexual partners has been shown
decrease in the number of which cells?
to be related to the incidence of cervical cancer.
A. Macrophages
B. CD8+ T cells 175. F There appears to be no relation between the incidence of
C. CD4+ Th cells melanoma and age at the time of exposure to excessive
D. Memory T cells UV radiation.

164. B HIV antibodies appear within ______ weeks after infection 176. T The term "neoplasm" can refer to a benign tumor.
through blood products. 177. A Which are cancers arising from connective tissue tissues?
A. 1 to 2 A. Osteogenic sarcoma
B. 4 to 7 B. Basal cell carcinoma
C. 10 to 12 C. Multiple myeloma
D. 20 to 24 D. Adenocarcinoma
165. B After sexual transmission of HIV, a person can be 178. B Carcinoma refers to abnormal cell proliferation
infected yet seronegative for _____ months. originating from which tissue origin?
A. 1 to 2 A. Blood vessels
B. 6 to 14 B. Epithelium cells
C. 18 to 20 C. Connective tissue
D. 24 to 36 D. Glandular tissue
166. A Match the phrases with the corresponding descriptions. 179. C What are characteristics of cancer in situ?
C A. Agammaglobulinemia A. Cells have broken through the local basement
B B. Raynaud phenomenon membrane.
E C. Poison ivy B. Cells have invaded immediate surrounding tissue.
D D. Urticaria C. Cells remain localized in the glandular or squamous
E. Graves' disease cells.
D. Cellular and tissues changes indicate dysplasia.
180. D Cells from a muscle tumor show a reduced ability to
1. Congenital immune deficiency
form new muscle and appear highly disorganized. This is
an example of:
2. Type IV hypersensitivity
A. dysplasia.
B. hyperplasia.
3. Type III hypersensitivity
C. myoplasia.
D. anaplasia.
4. Type II hypersensitivity
181. A What are tumor cell markers?
5. Type I hypersensitivity A. Hormones, enzymes, antigens, and antibodies
produced by cancer cells
167. T Anaplasia is recognized by loss or organization and a
B. Receptor sites on tumor cells that can be identified
marked increase in nuclear size.
and marked
168. T Some tumors initially described as benign can progress C. Cytokines produced against cancer cells
to malignant tumors. D. Identification marks used in administering radiation
169. T Cancer is predominantly a disease of aging. therapy

170. T A hallmark of cancer cells is their immortality. 182. D How are tumor cell markers used?
A. To provide a definitive diagnosis of cancer
171. F For the function of tumor suppressor genes to be lost,
B. To treat certain types of cancer
only one chromosome (allele) of the gene must be
C. To predict where cancers will develop
inactivated
D. To screen individuals at high risk for cancer
183. B Intestinal polyps are benign neoplasms and the first
stage in development of colon cancer. These findings
support the notion that:
A. cancers of the colon are more easily diagnosed in the
benign form because they can be visualized during
colonoscopy.
B. an accumulation of mutations in specific genes is
required for the development of cancer.
C. tumor invasion and metastasis progress more slowly
189.
in the gastrointestinal tract.
D. apoptosis is triggered by diverse stimuli including
excessive growth.
184. C What is autocrine stimulation?
A. The ability of cancer cells to stimulate angiogenesis to
create their own blood supply
B. The ability of cancer cells to stimulate secretions that
turn off normal growth inhibitors
190.
C. The ability of cancer cells to secrete growth factors
that stimulate their own growth
D. The ability of cancer cells to divert nutrients away
from normal tissue for their own use
185. A What is apoptosis?
A. A normal mechanism for cells to self-destruct when
191.
growth is excessive
B. An antigrowth signal activated by tumor suppressor
Rb
C. A mutation of cell growth stimulated by the p53 gene
D. The transformation of cells from dysplasia to
anaplasia
186. C Many cancers create a mutation of ras. What is ras?
A. A tumor suppressor gene
B. A growth promoting gene
C. An intracellular signaling protein that regulates cell
growth
192.
D. A cell surface receptor that allows signaling to the
nucleus about cell growth
187. A What are oncogenes?
A. Genes that have undergone mutation that direct the
synthesis of protein to accelerate the rate of tissue
proliferation
B. Genes that direct synthesis of proteins to regulate
growth and provide necessary replacement of tissue
C. Genes that encode proteins that negatively regulate
193.
the synthesis of proteins to show or halt replacement of
tissue
D. Genes that have undergone mutation to direct
malignant tissue toward blood vessels and lymph nodes
for metastasis
188. B Burkitt lymphomas designate a chromosome that has a
piece of chromosome 8 fused to a piece of chromosome
14. This is an example of which mutation of normal genes
to oncogenes?
A. Point mutation
B. Chromosome translocation
C. Gene amplification
D. Chromosome fusion
D In chronic myeloid leukemia (CML) a piece of
chromosome 9 fuses to a piece of chromosome 22. This
is an example of which mutation of normal genes to
oncogenes?
A. Point mutation
B. Chromosome fusion
C. Gene amplification
D. Chromosome translocation
B What aberrant change causes the abnormal growth in
retinoblastoma?
A. Proto-oncogenes are changed to oncogenes.
B. The tumor suppressor gene is turned off.
C. Genetic amplification causes the growth.
D. Chromosomes 9 and 21 are fused.
A Why are two "hits" required to inactivate tumor
suppressor genes?
A. Because each allele must be altered and each person
has two copies, or alleles, of each gene, one from each
parent
B. Because the first "hit" stops tissue growth and the
second "hit" is needed to cause abnormal tissue growth
C. Because they are larger than proto-oncogenes
requiring two "hits" to effect carcinogenesis
D. Because the first "hit" is insufficient to cause sufficient
damage to cause a mutation
C By what process does the ras gene convert from a proto-
oncogene to an oncogene?
A. By designating a chromosome that has a piece of one
chromosome fused to a piece of another chromosome
B. By duplicating a small piece of a chromosome
repeatedly making numerous copies
C. By alternating one or more nucleotide base pairs
D. By promoting proliferation of growth signals by
impairing tumor suppressor genes
B Normally, which cells, if any, are "immortal" (never die)?
A. None, all cells eventually die
B. Stems cells and germ cells
C. Blood cells
D. Epithelial cells
194. C How do cancer cells use the enzyme telomerase? 202. A Which of the viruses below are oncogenic DNA viruses?
A. They use it to repair the telomeres at the end of A. Papovaviruses, adenoviruses, and herpesviruses
chromosome to restore somatic cell growth. B. Retroviruses, papovaviruses, and adenoviruses
B. They use it as an intracellular signaling chemical to C. Adenoviruses, herpesviruses, and retroviruses
stimulate cell division. D. Herpesviruses, retroviruses, and papovaviruses
C. They switch off the telomerase so that cells can divide
203. C Which characteristic among women correlates with a
indefinitely.
high morbidity of cancer of the colon, liver, gallbladder,
D. They switch on the telomerase so that cells can divide
pancreas, breast, uterus, and kidney?
indefinitely.
A. Women over 45 years
195. D What are characteristics of benign tumors? B. Women who never had children
A. They invade local tissues. C. Women who had a high body mass index
B. They spread through lymph. D. Woman who smoked for more than 10 years
C. They cause systemic symptoms.
204. B Which cancers are associated with chronic inflammation?
D. They have a low mitotic index.
A. Skin, lung, and pancreatic
196. B Which of the following represents the correct B. Colon, liver, and lung
nomenclature for benign and malignant tumors of C. Bone, blood cells, and pancreatic
adipose tissue, respectively? D. Bladder, skin, and kidney
A. Liposarcoma, lipoma
205. C How does chronic inflammation cause cancer?
B. Lipoma, liposarcoma
A. By vasodilation and increased permeability that alter
C. Adisarcoma, adipoma
cellular response to DNA damage
D. Adipoma, adisarcoma
B. By liberating lysosomal enzymes when cells are
197. B Most human cancers appear to arise via: damaged, which initiates mutations
A. autosomal recessive gene inheritance. C. By releasing compounds such as reactive oxygen
B. spontaneous gene mutations. species that promote mutations
C. X-linked recessive gene inheritance. D. By increasing the abundance of leukotrienes that are
D. autosomal dominant gene inheritance. associated with some cancers
198. B Smoking is associated with cancers of all of the 206. C Inherited mutations that predispose to cancer are almost
following except: invariably what kind of gene?
A. lung. A. Proto-oncogenes
B. skin. B. Oncogenes
C. bladder. C. Tumor suppressor genes
D. kidney. D. Growth promoting genes
E. pancreas.
207. D Match the description with its corresponding term.
199. A Which of the following has been shown to increase the C A. Loss of differentiation
risk of cancer when used in combination with smoking? A B. Cancer cells secrete growth factor for their own
A. Alcohol E growth
B. Steroids B C. Cells that vary in size and shape
C. Antihistamines D. Unaltered normal allele
D. Antidepressants E. Responsible for maintenance of genomic integrity
200. C The major virus involved in cervical cancer is:
A. herpes simplex virus type 6.
1. Proto-oncogene
B. herpes simplex virus type 2.
C. human papillomavirus.
2. Pleomorphic
D. human immunodeficiency virus.
201. C The Papanicolaou (Pap) test is used to screen for which 3. Anaplasia
cancer?
A. Ovarian 4. Caretaker gene
B. Uterine
C. Cervical 5. Autocrine stimulation
D. Vaginal
208. T Most childhood cancers originate from the mesodermal
germ layer that gives rise to connective tissue, bone,
blood, blood vessels, kidney, and lymph.
209. F Cancers in children are slow growing and usually have 224. B An example of an embryonic tumor is:
not metastasized at time of diagnosis. A. osteosarcoma.
B. neuroblastoma.
210. T Leukemia is the most common malignancy in children.
C. leukemia.
211. F Embryonic tumors are usually diagnosed after 5 years of D. adenocarcinoma.
age.
225. A Chronic myelogenous leukemia, retinoblastoma and
212. T Secondary cancers are a late effect faced by children osteosarcoma are associated with which genetic factors
cured of cancer. in childhood cancers?
213. T Mutation of proto-oncogenes into oncogenes stimulates A. Chromosome aberrations or single gene defects
uncontrolled cell growth B. Mutation of proto-oncogenes to oncogenes
C. Tumor suppressor genes that have lost their
214. F Cancer is the leading cause of death in children
suppressor function
215. F Childhood cancer has a longer latency period than D. Congenital malformations
cancer in adults.
226. C Childhood exposure to all of the following risk factors
216. T Mutations of proto-oncogenes into oncogenes have increase susceptibility to cancer except:
been identified with pediatric lymphoma and leukemia. A. drugs.
217. T Children with acquired immunodeficiency syndrome B. ionizing radiation.
(AIDS) have an increased risk of developing certain C. cigarette smoke
cancers such as Kaposi sarcoma. D. viruses.

218. A What congenital malformation is commonly linked to 227. D There is a carcinogenic relationship between Hodgkin
acute leukemia in children? disease and the:
A. Down syndrome A. herpes simplex virus.
B. Wilms tumor B. human immunodeficiency virus.
C. Retinoblastoma C. varicella virus.
D. Neuroblastoma D. Epstein-Barr virus.

219. B When are childhood cancers are most often diagnosed?

A. During infancy
B. At peak times of physical growth
C. After early warning signs
D. After an acute illness
220. C Prenatal exposure to diethylstilbestrol can result in:
A. breast cancer.
B. leukemia.
C. vaginal cancer.
D. lymphoma.
221. D What percentage of children with cancer can be cured?
A. 48%
B. 58%
C. 68%
D. 78%
222. B Most childhood cancers arise from the:
A. epithelium.
B. mesodermal germ layer.
C. embryologic ectodermal layer.
D. viscera.
223. D Which cancers are more common in black children?
A. Leukemia
B. Retinoblastoma
C. Lymphoma
D. Osteosarcoma