Immunology (Lippincott Illustrated Reviews Series) 2nd Edition

Review Questions

1.   A 10-year-old male patient is diagnosed with an acute bacterial infection. His blood leukocyte count was 38,000 cells per μL (reference range: 4,500 to 12,500 per μL). The predominant cell type found in increased numbers in this patient’s blood is

A. eosinophils.

B. neutrophils.

C. monocytes.

D. B cells.

E. dendritic cells.

Correct answer B. See Chapter 4page 38.

2.   Cytotoxic T cells are isolated from a sample of peripheral blood from a healthy 25-year-old female medical student participating in a research study. Which of the following molecules will these cells express on their cell surfaces in addition to CD8?


B. CD1d

C. CD3

D. CD4

E. CD19

Correct answer C. See Chapter 7pages 8081.

3.   A previously healthy 17-year-old male patient presents for evaluation of recent onset severe pain in his knees and elbows. He is febrile and examination reveals a rash on his trunk, arms, and legs. His past medical history is unremarkable, and he is up-to-date on all immunizations. Further questioning reveals that he had a sore throat about 3 weeks ago that resolved without treatment. The signs and symptoms experienced now by this patient are most likely the result of a/an

A. allergic reaction.

B. cell-mediated hypersensitivity.

C. cytotoxic reaction.

D. contact dermatitis.

E. immune complex disease.

Correct answer E. See Chapter 14pages 207210.

4.   Antibodies directed against which of the following proteins are useful in identifying T helper cells in samples of peripheral blood?

A. CCL21

B. CD4

C. CD56


E. LFA-1

Correct answer B. See Chapter 6page 72.

5.   A 4-year-old boy has a history of recurrent bacterial infections, including several episodes of pneumococcal sepsis. He has an undetectable level of serum immunoglobulins and is diagnosed with an X-linked disorder. The disorder most likely to be responsible for the findings in this patient is

A. Bruton agammaglobulinemia.

B. Chediak–Higashi syndrome.

C. common variable immunodeficiency.

D. DiGeorge syndrome.

E. hereditary angioedema.

Correct answer A. See Chapter 15pages 227 and 229.

6.   A 27-year-old female presents for evaluation of fatigue, loss of appetite, and muscle aches of several months duration. She also reports increased sensitivity to sunlight. Testing reveals the presence of antinuclear antibodies. The HLA gene most likely associated with her condition is

A. B8.

B. B27.

C. Cw6.

D. DR3.

E. DR4.

Correct answer D. See Chapter 16pages 254255.

7.   A 17-year-old female patient has mounted a considerable adaptive immune response. Which of the following most likely served as the trigger of this response?

A. Albumin (a protein) from her own blood plasma

B. Botulinum toxin from Clostridium botulinum C. Ethinyl estradiol (an estrogenic steroid hormone) from her oral contraceptives

D. Fructose from high-fructose corn syrup

E. Glycine (an amino acid) from a mouse protein

Correct answer B. See Chapter 2pages 1415.

8.   A healthy 27-year-old male participates in a research study. Cells isolated from his peripheral blood express MHC Class II molecules. Which of the following types of cell have been isolated?

A. B cells

B. Eosinophils

C. Erythrocytes

D. Granulocytes

E. Natural killer cells

Correct answer A. See Chapter 6page 67.

9.   A certain population of lymphocytes inhibits activity of autoreactive lymphocytes. Such inhibitory cells express both

A. CD4 and CD25.

B. CD19 and CD45.

C. CD28 and CD80.

D. IgA and IgD.

E. IgG and IgM.

Correct answer A. See Chapter 12page 161.

10.   A previously healthy 9-year-old girl becomes infected with a strain of Streptococcus pyogenes that she has not encountered in the past. She does not want to miss a birthday party, does not complain of a sore throat, and does not receive medical treatment. Two weeks later, her symptoms have resolved and microbial numbers have decreased rapidly. The isotype of antibody responsible for eventual clearing of this infection is

A. IgA.

B. IgD.

C. IgE.

D. IgG.

E. IgM.

Correct answer D. See Chapter 16page 246.

11.   A large amount of a certain immunoglobulin isotype is found associated with the mucosal surface of the gastrointestinal tract. This immunoglobulin isotype is most likely

A. IgA.

B. IgD.

C. IgE.

D. IgG.

E. IgM.

Correct answer A. See Chapter 13page 187.

12.   A naive B cell is migrating from the blood into a lymph node and first rolls along high endothelial venules of the lymph node. Which of the following is expressed by the B cell to facilitate the rolling process?

A. C3a

B. CD4


D. IgM

E. L-selectin

Correct answer E. See Chapter 6page 71.

13.   A healthy 18-month old female child, who has received all immunizations required to attend a licensed child care facility near her home, relocates with her family to an area where an additional vaccine, to protect against invasive pneumococcal disease, has been required for several years. She is allowed to attend a child care facility after receiving the first of her catch-up vaccines. However, four doses are recommended to provide long-lasting immunity. Which of the following best explain why she does not develop invasive pneumococcal disease prior to achieving full immunity?

A. Anergy

B. Genetic drift

C. Herd immunity

D. Immune evasion

E. Tolerance

Correct answer C. See Chapter 13page 192.

14.   A 4-year-old male patient presents with signs and symptoms of febrile respiratory disease caused by adenovirus. Natural killer (NK) cells of this patient’s immune system detect this patient’s virally infected cells by

A. decreased expression of MHC I molecules on virally infected cells.

B. decreased expression of pathogen-associated molecular patterns on infected cells.

C. increased expression of pattern recognition receptors on virally infected cells.

D. increased expression of somatically generated receptors on NK cells.

E. secretion of virus-specific antibodies by NK cells.

Correct answer A. See Chapter 1page 6.

15.   A 23-year-old female patient developed vaginal candidiasis (a fungal infection) after recovering from a urinary bladder infection caused by Escherichia coli. The most likely explanation for development of this fungal infection is

A. movement of fungi from her urinary bladder to her vagina.

B. antibiotic-induced reduction in vaginal commensal bacteria.

C. decreased vaginal pH resulting from the recent infection.

D. increased vaginal mucus secretion following antibiotic therapy.

E. overgrowth of Lactobaccilli in her cervical os.

Correct answer B. See Chapter 3page 31.

16.   A previously healthy although unvaccinated 3-year-old boy is diagnosed with epiglottitis (infection of the upper airway) as a result of infection with Haemophilus influenzae B. The capsular polysaccharide of this infectious agent is classified as a TI-2 antigen. In stimulating an immune response it will

A. activate mature B cells.

B. bind pMHC I.

C. increase CD28 expression.

D. induce B cell IL4R.

E. require CD4+ cells.

Correct answer A. See Chapter 10pages 134135.

17.   Vaccination for varicella (chicken pox) is reported to be 95% effective in preventing serious disease. Some studies indicate that immunity lasts at least 20 years after vaccination. Based on these findings, the type of vaccine used for varicella is most likely

A. attenuated.


C. extract.

D. killed.

E. recombinant.

Correct answer A. See Chapter 13page 193.

18.   Immunoglobulin DJ gene joining and cytoplasmic expression of surrogate light chain is occurring within a developing B cell. Which of the following stages of development has this cell achieved?

A. Pre-pro-B cell

B. Pro-B cell

C. Early pre-B cell

D. Later pre-B cell

E. Immature B cell

Correct answer B. See Chapter 9page 119.

19.   A 16-year-old female patient is evaluated for a history of frequent, severe abdominal pain. Imag ing studies do not reveal a cause of her pain. Further questioning reveals a history of swelling of the face and hands and an episode that involved difficulty swallowing and swelling of her throat that was assumed to be allergic in nature. The disorder most likely to be responsible for the findings in this patient is

A. Chediak–Higashi syndrome.

B. chronic granulomatous disease.

C. hereditary angioedema.

D. leukocyte adhesion deficiency.

E. Wiskott–Aldrich syndrome.

Correct answer C. See Chapter 15page 234.

20.   In the course of an immune response against Mycobacterium tuberculosis, nonspecific damage is done to previously healthy axons and myelin sheaths. The response involved was most likely

A. cell-mediated lysis.

B. delayed-type hypersensitivity.

C. humoral in nature.

D. mediated by IgE.

E. programmed cell death.

Correct answer B. See Chapter 11page 149.

21.   A strain of Escherichia coli, to which he was never previously exposed, enters the bloodstream of a 4-year-old boy. B cells with immunoglobulins specific for epitopes unique to this strain of E. coli are already present. This finding is best explained by

A. affinity maturation of immunoglobins to recognize these new epitopes.

B. antigen-independent rearrangements of immunoglobulin genes.

C. existence of maternally derived immunoglobulins to this strain of E. coli.

D. memory B cells recognizing directed against epitopes on intestinal E. coli.

E. somatic hypermutation of existing immunoglobulins with similar specificity.

Correct answer B. See Chapter 8page 99.

22.   B-1 B cells

A. are widely distributed throughout the body.

B. arise in the postnatal period of development.

C. have a broad antigen recognition repertoire.

D. monitor potential portals of microbial entry.

E. show extensive immunologic memory.

Correct answer D. See Chapter 9page 120.

23.   A 37-year-old male patient presents for evaluation of recurrent sinus infections requiring antibiotic treatment. He has a history of bacterial pneumonia and of chronic diarrhea. Testing reveals significantly decreased levels of serum IgG and mildly decreased levels of IgA. The disorder most likely to be responsible for the findings in this patient is

A. Bruton agammaglobulinemia.

B. common variable immunodeficiency.


D. multiple myeloma.

E. Waldenström macroglobulinemia.

Correct answer B. See Chapter 15, pages 228–229.

24.   A previously healthy 58-year-old female presents for a routine health examination. Findings are significant for slight exophthalmos (protrusion of the eyeball) and atrial fibrillation (abnormal heart rhythm). Laboratory studies indicate abnormal thyroid function. The autoimmune disease most likely to be responsible for the findings in this patient is

A. Crohn disease.

B. Goodpasture syndrome.

C. Graves disease.

D. myasthenia gravis.

E. scleroderma.

Correct answer C. See Chapter 16pages 252 and 255.

25.   During the course of specialized diagnostic tests on a 49-year-old male patient, granular leukocytes are isolated for further examination. Which of the following cell types may be involved in this study?

A. B cells

B. Monocytes

C. Dendritic cells

D. Natural killer cells

E. Basophils

Correct answer E. See Chapter 4page 38.

26.   A 23-year-old male patient presents for evaluation of pain in the sacrum that occasionally radiates down his legs. He reports that his back seems stiff in the morning. Mild loss of lateral flexion of the lumbar spine is noted upon examination. Tests results are significant for an increased erythrocyte sedimentation rate, and he is positive for HLA-B27. Initial therapy for this patient’s condition will most likely include

A. corticosteroids.

B. cyclosporine.

C. IFN-β-1a.


E. retinoids.

Correct answer D. See Chapter 18page 287.

27.   A 71-year-old female patient develops fever and inflammation of her left knee 3 days after discharge from the hospital following knee replacement surgery. Staphylococcus epidermidis organisms causing her infection are initially not targets of the patient’s phagocytic cells. However, after IgG1 antibodies bind to their capsules, many S. epidermidis cells are readily destroyed via phagocytosis. This process of antibody-enhanced phagocytosis is known as

A. affinity maturation.

B. agglutination.

C. neutralization.

D. opsonization.

E. precipitation.

Correct answer D. See Chapter 11pages 143144.

28.   After surgery following diagnosis of breast cancer, a 46-year-old female patient is given several drug therapies, including Trastuzumab (Herceptin). This drug is used to arrest cell division of her tumor cells that express


B. HER-2.

C. MART-1.

D. p53.


Correct answer B. See Chapter 19pages 301302.

29.   A 31-year-old woman developed nausea and urticaria (hives) after eating oysters at a party. No other partygoers who ate the oysters became ill. A month later, she again consumed oysters and developed abdominal pain, vomiting, and angioedema (swelling of lips and tongue) in addition to her previous symptoms. In this patient, oysters functioned as a(n)

A. adjuvant.

B. hapten.

C. immunogen.

D. pathogen-associated molecular pattern.

E. tolerogen.

Correct answer C. See Chapter 2page 13.

30.   A 34-year-old female patient with diabetes develops a Staphylococcus aureus infection. Which of the following structures expressed by cells of her innate immune system enable them to recognize the bacteria?

A. MHC I molecules

B. MHC II molecules

C. Pathogen-associated molecular patterns

D. Pattern recognition receptors

E. Somatically generated receptors

Correct answer D. See Chapter 1page 7.

31.   Cells are obtained from a primary immune organ of a mouse as part of a research project. From which of the following organs were these cells isolated?

A. Adrenals

B. Lymph node

C. Spleen

D. Peyer’s patch

E. Thymus

Correct answer E. See Chapter 7page 84.

32.   A neonatal female child is evaluated for malformation of the face and jaw. Additional testing reveals a small deletion in chromosome 22 as well as abnormalities of the aorta and parathyroid gland. The most likely consequences of her condition will be an impairment of

A. B-cell receptor expression.

B. cell-mediated immunity.

C. membrane attack complex formation.

D. phagocytosis of microbes.

E. scavenger receptor binding.

Correct answer B. See Chapter 15pages 225226.

33.   A cell within the thymus undergoes positive selection. Successful completion of this process results in which of the following by that cell?

A. Activation of the classical complement pathway

B. An ability to bind both MHC class I and II molecules

C. Loss of either the CD4 or CD8 protein

D. Programmed cell death

E. Secretion of antigen-specific IgM

Correct answer C. See Chapter 9pages 115116.

34.   A viral protein in the cytosol of a host cell is targeted for destruction by covalent binding of ubiquitin. Destruction of this viral protein will occur via

A. action of lysosomal acid hydrolases.

B. clathrin-mediated phagocytosis.

C. creation of a membrane attack complex.

D. proteosome-mediated proteolysis.

E. the mannan-binding lectin pathway.

Correct answer D. See Chapter 10pages 125 and 127.

35.   Following IL-2 binding to its receptor on a T cell, JAK 1 and JAK 3 are activated. Which of the following will be phosphorylated and then induced to dimerize and migrate to the nucleus as a subsequent step in this signaling process?

A. CD8

B. LFA-1


D. Ras


Correct answer E. See Chapter 6page 72.

36.   An NKT cell can be distinguished from an NK cell by the NKT cell’s ability to

A. assist plasma cells in their secretion of immunoglobulin.

B. bind to KAR and KIR proteins on surfaces of target cells.

C. express BCRs of limited repertoire on their surfaces.

D. recognize lipids presented by nonclassical Class I molecules.

E. respond to various epitopes presented by MHC Class II molecules.

Correct answer D. See Chapter 7page 83.

37.   A plasma cell has developed from a B cell. Compared to the cell from which it was derived, the plasma cell

A. displays more pMHC Class II.

B. is a more efficient antigen-presenting cell.

C. recognizes different epitopes.

D. releases soluble immunoglobulins.

E. undergoes more efficient isotype switching.

Correct answer D. See Chapter 10page 137.

38.   A CD4+ T cell is exposed to IL-12 produced by antigen-presenting cells in response to microbederived lipopolysaccharide. This CD4+ T cell will

A. facilitate cell-mediated responses.

B. produce B-cell mitogens.

C. release granzymes.

D. respond to extracellular pathogens.

E. secrete IL-4.

Correct answer A. See Chapter 10page 130.

39.   A 38-year-old previously healthy man developed a Staphylococcus aureus infection after sustaining multiple abrasions in a bicycle accident. IgG antibodies bind to epitopes on the S. aureus cells, facilitating binding of C1q. The result or outcome of the pathway that is stimulated will be

A. an isotype switch of antibodies to S. aureus from IgG to IgM.

B. destruction of S. aureus by the membrane attack complex.

C. downregulation of Class II molecules on infected cells.

D. secretion of chemokines to attract more cells to the site of infection.

E. release of histamine from mast cells.

Correct answer B. See Chapter 6page 65.

40.   A 36-year-old previously healthy female patient is diagnosed with septicemia. The causative pathogenic agent is identified as Klebsiella pneumoniae. This patient’s initial immune response to these gram-negative bacteria will involve

A. binding by somatically generated receptors to K. pneumoniae.

B. release of K. pneumoniae-specific cytokines.

C. recognition of LPS by toll-like receptors.

D. secretion of K. pneumoniae-specific immunoglobulins.

E. stimulation of the classical complement pathway.

Correct answer C. See Chapter 5page 43.

41.   A 9-year-old girl is stung on her arm by a bee. The first time she was stung was 2 years ago, the sting site was painful and became swollen but resolved uneventfully. This time however, widespread urticaria (hives) develops soon after the sting. She also develops facial edema (swelling) and reports difficulty breathing. This patient has most likely experienced

A. anaphylaxis.

B. antibody-mediated toxicity.

C. contact sensitivity.

D. serum sickness.

E. type II hypersensitivity.

Correct answer A. See Chapter 14pages 204205.

42.   An 8-month-old female patient is evaluated for recurrent bacterial infections. Examination reveals albinism of the eyes and skin. Testing reveals decreased NK and T-cell functions and further evaluation reveals impaired fusion of lysosomes with phagosomes. The disorder most likely to be responsible for the findings in this patient is

A. adenosine deaminase deficiency.

B. Bruton agammaglobulinemia.

C. Chediak–Higashi syndrome.

D. severe combined immune deficiency.

E. Waldenström macroglobulinemia.

Correct answer C. See Chapter 15pages 229231.

43.   As part of a research project, plasma cells are to be isolated from mice immunized against a specific antigen. Which of the following will help to identify the cells of interest?

A. Decreased volume compared to other lymphocytes

B. Membrane complexes of heavy and light chains

C. Immunoreceptor tyrosine-based activation motifs

D. Surface-bound B-cell receptors

E. Nuclei with stellate patterns

Correct answer E. See Chapter 7pages 8283.

44.   A 23-year-old female who has never been vaccinated against seasonal influenza is exposed to an influenza virus. Which of the following structures allow cells of her innate immune system to attempt to prevent infection and illness?

A. Complement receptor C3

B. Membrane attack complexes

C. Pattern recognition receptors

D. Surface-bound IgM molecules

E. T-cell antigen receptors

Correct answer C. See Chapter 5page 44.

45.   Upon encountering an appropriate pMHC I on a virally infected host cell,

A. B cells rearrange cell-surface receptors.

B. CD8+ T cells undergo apoptosis.

C. cytotoxic T cells release granzymes.

D. Th1 cells express IL-2 receptors.

E. Th0 cells differentiate into Th2 cells.

Correct answer C. See Chapter 11page 151.

46.   An 11-year-old with acute lymphoblastic leukemia receives a bone marrow transplant from his older sister that contains stem cells and mature T cells. Development of which of the following will be of primary concern in this patient?

A. Acute hemolytic reaction

B. Graft-versus-host disease

C. Hyperacute rejection

D. Tolerance

E. Type IV hypersensitivity

Correct answer B. See Chapter 17page 276.

47.   A 28-year-old female presented with an acute urinary tract infection and is given amoxicillin. Her symptoms resolved, and she completed the course of antibiotic therapy. Two weeks later, she presented with fatigue, dyspnea (difficulty in breathing), and tachycardia (rapid heart rate). Autoimmune hemolytic anemia is diagnosed based on decreased hemoglobin and a positive direct Coombs test (presence of antibodies on erythrocyte surfaces). These findings suggest which type of hypersensitivity?

A. Type I, mediated by CD4+ T cells

B. Type II, mediated by IgG antibodies

C. Type III, mediated by IgM antibodies

D. Type IV, mediated by CD4+ T cells

E. Type IV, mediated by IgE antibodies

Correct answer B. See Chapter 14, pages 204–206.

48.   Following his lunch of a peanut butter sandwich, two cookies and a glass of 2% milk on a cloudy, 75°F June day, a 4-year-old boy consumes several fist-sized portions of a freshly prepared “mud pie” created by his 2-year-old sister from garden soil, grass, and water. Despite the presence of several species of bacteria within the mud pie, this boy’s intestines were not colonized by the ingested bacteria. The most likely explanation for this lack of colonization is

A. acid in his stomach kills the bacteria before they enter the intestines.

B. lactose (a sugar) in the milk he drank kills the bacteria in his gut.

C. IgE produced in response to peanut ingestion inhibits growth of the bacteria.

D. unfavorable environmental conditions kill the bacteria before he eats them.

E. soil bacteria are digested and quickly eliminated along with food from his lunch.

Correct answer A. See Chapter 3page 28.

49.   A thymocyte that has survived positive selection arrives at the corticomedullary junction and efficiently binds to pMHC II on a dendritic cell. This thymocyte will

A. cease expression of CD4.

B. enter the circulation.

C. rearrange its V, D, and J genes.

D. upregulate IL-7 receptors.

E. undergo apoptosis.

Correct answer E. See Chapter 9page 116.

50.   A soluble, free epitope is recognized by the B-cell receptor on a circulating B cell. No additional stimulation is provided by a CD4+ T cell. Such a B cell

A. activates CD8+ suppressor T cells.

B. becomes nonresponsive.

C. secretes epitope-specific IgG.

D. upregulates cell-surface IgM.

E. will be engulfed by a macrophage.

Correct answer B. See Chapter 12page 244.