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Answers to Questions in the Book, Chapter 4, Altered Immunity
Answers to Exercises in Book: Stop and Consider Questions and Practice Exam Questions
Short Answer (Stop and Consider Questions)
1. When increased lymphocyte production is stimulated, these additional cells travel to
the lymph nodes. How could you determine if this was occurring with a physical
examination? What signs and symptoms might a person have if this occurs?
Answer: Lymph nodes will be enlarged (lymphadenopathy). They can be felt
using palpation. Usually painless, enlarged lymph nodes may be noticed
visually or by touch by the affected person.
2. People can suffer from the same illness, such as a cold, many times. What is a
possible explanation for this?
Answer: The rhinovirus that causes common cold has many variations,
allowing the virus to escape detection by the adaptive immune system. The
antigenic variation prevents immunologic memory. The innate immune
system is activated early and is usually effective at clearing the virus.
3. Some immunodeficiency diseases primarily affect one cell type. What part of the
immune defense would be affected if the number of neutrophils was decreased? What
would occur with a decrease in the number of macrophages? What would occur with a
decrease in the number of plasma cells?
Answer: Deficiency in neutrophil cell number may prevent an adequate
response of the innate immune system and place a person at risk for
bacterial infection. Phagocytosis would be impacted by decreased number of
macrophages, limiting the adaptive immune responses of both cell-mediated
immunity and humoral immunity. Antibody production would be impaired if
there were a decrease in plasma cell number.
4. Why is there less chance of rejection when a transplant occurs between identical twins?
Is the chance of rejection the same if the twins are fraternal (not identical)?
Answer: Identical twins share the same genetic make-up, making it less likely
for the donor tissue to carry foreign antigens that are able to stimulate an
immune response.
Fraternal twins have the genetic similarity of siblings and have more potential
to stimulate transplant rejection.
5. The adrenal gland stops producing cortisol during prednisone treatment. Why
does this happen? What are the special considerations made when prednisone
treatment is no longer needed?
Answer: Negative feedback stimulated by the supraphysiologic cortisol levels
induced by prednisone removes the signal to the adrenal gland to produce
the hormone. In order to restore the signal and allow enough time for
adrenal hormone production, the prednisone dose is slowly reduced to allow
restoration of a positive feedback loop.
6. Many vaccines are available to protect against common diseases and conditions.
What are some reasons why people do not get immunized?
Answer: Barriers for vaccination against infectious disease include (1) the
need for multiple injections for adequate protection in some vaccines, (2)
concern about potential side effects, (3) cost, (4) accessibility, (5) convenience,
(6) belief that risk to get the infectious disease is minimal, and (7) concern
about vaccines requiring injection.
7. Why are patients with immunosuppression at greater risk for cancer?
Answer: Cells that do not normally divide can be recognized by the immune
system and removed. Impaired immune response may not be able to clear
oncogenic cells, promoting the risk of cancer development.
d. T-cell mediated
Answer: a
- The following season, you are concerned about getting the flu again. Which of the
following statements is true?
a. You continue to be at risk because nothing can protect you from
reinfection.
b. Vaccination for prevalent strains of influenza virus can provide
improved protection against the disease.
c. Premedication with immunosuppressants will provide protection against
infection.
d. Because you have had the flu once, you will be protected from getting it
again.
Answer: b
- Immune suppression in AIDS is related to:
a. decreased platelet count.
b. decreased red blood cell count.
c. decreased lymphocyte count.
d. elevated lymphocyte count.
Answer: c
- Which of the following conditions represents pathologic responses caused by
immunologic memory?
a. Common cold
b. Anaphylaxis
c. Shingles
d. Strep throat
Answer: b
- The pathology related to systemic lupus erythematosus is due to:
a. neutrophil activation.
b. delayed immunity.
c. immunosuppression.
d. immune complex deposition.
Answer: d
- Immunodeficiency is the result of:
a. failure of host defense mechanisms.
b. hypersensitive immune responses.
c. inappropriate immune response to self.
d. immune response stimulated by antigens from other individuals.
Answer: a
- A hypersensitivity reaction resulting from a yellow jacket sting is an example of:
a. type I, immediate hypersensitivity reaction.
b. type II, antibody-mediated reaction.
c. type III, immune complex reaction.
d. type IV, cell-mediated reaction.
Answer: a
- A hypersensitivity reaction resulting from complement activation due to insoluble
c. passive immunity.
d. alloimmunity.
Answer: c
- Which of the following is true regarding cytotoxic T lymphocytes?
a. They recognize the MHC class 1–antigen complex.
b. They recognize the MHC class II–antigen complex.
c. They carry the CD4 marker.
d. They present antigen to B lymphocytes for antibody production.
Answer: a
- Which of the following are considered antigen-presenting cells?
a. Dendritic cells
b. Eosinophils
c. B lymphocytes
d. T lymphocytes
Answer: a
- Which of the following markers identifies a nucleated body cell?
a. CD
b. BCR
c. MHC I
d. MHC II
Answer: c
- Which of the following is true regarding pharmacologic treatment for AIDS?
a. Drugs are used to target increased red blood cell number.
b. Drugs are used to target increased white blood cell number.
c. Drugs are used to increase host DNA replication.
d. Drugs are used to inhibit HIV replication.
Answer: d
Additional Exercises for the Instructor’s Resource: Brownstone Test Generator (25-
questions), Additional Case Studies (1-3), Additional Learning Activities (worksheets or other
application exercises)
Multiple Choice
1. Immunology is the study of:
a. structure of the immune system.
b. function of the immune system.
c. phenomena of induced sensitivity and allergy.
d. all of the above.
Answer: d
2. All blood cells are produced from which one of the following precursor cell types?
a. Myeloid progenitor
b. Lymphoid progenitor
c. Pluripotent stem
d. Neutrophil
Answer: c
Answer: b
7. The type of macrophage specific to the liver is:
a. microglia.
b. Kupffer cells.
c. Langerhans cells.
d. histiocytes.
Answer: b
8. One primary cell type involved in adaptive immunity includes:
a. B lymphocyte.
b. neutrophil.
c. macrophage.
d. dendritic cell.
Answer: a
9. Antibodies are secreted from which one of the following cell types?
a. Macrophage
b. Cytotoxic T lymphocyte
c. Helper T lymphocytes
d. Plasma cells
Answer: d
10. One primary cell type involved in cell-mediated immunity includes:
a. B lymphocyte.
b. cytotoxic T lymphocytes.
c. macrophage.
d. dendritic cell.
Answer: b
11. The membrane surface molecule expressed on cytotoxic T lymphocytes is:
a. CD8.
b. CD4.
c. TH1.
d.
T
H
Answer: a
12. The MHC class 1 molecule is recognized by which cell type?
a. CD
b. CD
c.
T
H
d.
T
H
Answer: a
13. Your mother has a clinic appointment for a possible infection and is told that she has
a high neutrophil count. This implies:
a. she has a streptococcal infection.
b. she has an acute infection.
c. she has a chronic infection.
d. she does not have an infection.
a. Immediate hypersensitivity reaction
b. Antibody-mediated reaction
c. Immune complex reaction
d. Autoimmune reaction
Answer: d
18. This type of hypersensitivity reaction involves complement activation
stimulated by deposition of bound antigen to antibody?
a. Immediate hypersensitivity reaction
b. Antibody-mediated reaction
c. Immune complex reaction
d. Autoimmune reaction
Answer: c
19. A graft between unrelated individuals is called:
a. autograft.
b. allograft
c. syngeneic graft.
d. monogenic graft.
Answer: b
20. Treatment to regulate the immune response through interference with DNA
synthesis in dividing cells is achieve through the use of:
a. cytotoxic drugs.
b. anti-inflammatory medications.
c. bacterial derivative drugs.
d. fungal derivative drugs.
Answer: a
21. The loss of cell-mediated and humoral immunity in acquired immunodeficiency
syndrome is due to:
a. CD4 lymphocytes.
b. CD8 lymphocytes.
c. plasma B lymphocytes.
d. memory B lymphocytes.
Answer: a
22. Which of the following serves as the rationale for AIDS treatment with
antiretroviral therapy?
a. Monotherapy with reverse transcriptase inhibitors
b. Monotherapy with protease inhibitors
c. Monotherapy with fusion inhibitors
d. Triple therapy with reverse transcriptase, protease, and fusion inhibitors
Answer: d
23. Systemic lupus erythematosus is an example of which type of hypersensitivity reaction?
a. Type I
b. Type II
c. Type III
d. Type IV
Answer: c
Answer: Clonal selection involves a single, specific receptor on each lymphocyte. When
the receptor binds to its antigen, a signal stimulating repeated rounds of mitosis leads
to clones of the antigen-specific T and B lymphocytes providing the basis of the
immune response.
28. List the clinical manifestations for anaphylaxis.
Answer: Bronchospasm, urticaria, angioedema, hypotension, and edema.
29. Compare and contrast the two response stages involved in immediate
hypersensitivity reactions.
Answer: Stage one manifestations are related to mast cell degranulation and include
vasodilatation and nonvascular smooth muscle contraction. The second stage is
characterized by manifestations similar to those in stage 1, stimulated by lipid
mediators.
30. List ways that pathogens can evade the immune system.
Answer: Host defense failure antigenic variation, viral latency,
immunosuppression, immunodeficiency.
Reference Case Study 3
You are watching a news report about an outbreak of avian influenza or bird flu. The
reporter stated that there is concern about a pandemic. In order to be better prepared,
you decide to find out more about avian influenza.
1. What is the source of the avian influenza virus?
Answer: These influenza viruses occur naturally among birds colonized in their
intestines. Avian influenza is very contagious among birds and can infect many
bird species. The virus is shed in saliva, nasal secretions, and feces.
Domesticated birds may become infected with avian influenza virus through
direct contact with infected waterfowl or other infected poultry, or through
contact with or that have been contaminated with the virus. The highly
pathogenic avian influenza spreads rapidly through flocks of poultry. This form
may cause disease that affects multiple internal organs and has a mortality rate
that can reach 90% to 100% often within 48 hours.
2. How do people contract avian flu?
Answer: The risk from avian influenza is low to most people, though cases of human
infection have been confirmed. Most cases of human infections are due to contact
with infected poultry, rather than contact with infected individuals.
3. What signs and symptoms are likely to present in those infected with avian influenza?
Answer: Symptoms of avian influenza include fever, cough, sore throat, muscle aches,
eye infections, pneumonia, and severe respiratory diseases. Symptoms can vary
depending on the form of avian influenza involved.
4. What is the risk of avian flu transmission between individuals?
Answer: Human-to-human contact due to avian influenza subtype H5N1 is rare and has
not been transmitted beyond one person. Because humans have not previously been
exposed to this virus, there is no immunity in the population. Should human–to-human
transmission develop, there is a significant risk for the development of a pandemic due
to the absence of immune protection in the global population.
5. What prevention strategies need to be employed?
Answer: Vaccine protection is currently unavailable. Vaccine development is limited
by the ability of the virus to mutate. Antigenic variation promotes immune system
evasion.
Reference Case Study 4
4. How is primary immunodeficiency diagnosed?
Answer: History and physical examination is important in establishing a diagnosis.
Laboratory tests include a complete blood count, immunoglobulin types and levels,
antibody responses, complement.
5. What treatment plan is expected as Maria is treated?
Answer: Treatment involves antibiotic therapy and symptomatic care to control
infection. In severe cases, bone marrow transplant may be necessary.
