Chapter 21 The Immune System: Innate and Adaptive Body Defenses

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Using Figure 21.1, match the following:
1) Heavy chain.
Answer: B

2) Light chain.
Answer: D

3) Variable region.
Answer: C

4) Constant region.
Answer: E

5) Antigen-binding site.
Answer: A

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Using Figure 21.2, match the following:
6) Area where B cells become immunocompetent.
Answer: C

7) Area where T cells become immunocompetent.
Answer: B

8) Area where activated immunocompetent B and T cells recirculate.
Answer: E

9) Area seeded by immunocompetent B and T cells.
Answer: D

10) Area where antigen challenge and clonal selection are most likely to occur.
Answer: D


Match the following:

A) Inflammatory response and skin and mucous membranes
B) Immune response
C) Inflammatory response
D) Intact skin and mucous membranes

11) First line of defense. D

12) Second line of defense. C

13) Third line of defense. B

14) Innate defense system. A

15) Adaptive defense system. B


Match the following:
A) Interferon
B) Regulatory T cells
C) Complement
D) Helper T cells

16) Small proteins secreted by virus-containing cells.
Answer: A

17) Major innate mechanism that mediates destruction of foreign substances in the body.

18) Stimulate the proliferation of other lymphocytes.
Answer: D

19) Dampen the activity of both T cells and B cells.

20) Present the double activation signal to T cell
Answer: E


Match the following:

A) IgG
B) IgD
C) IgE
D) IgA
E) IgM

21) Main antibody of both primary and secondary immune response.
Answer: A

22) Protects mucosal barriers.
Answer: D

23) Involved in allergies.
Answer: C

24) Along with IgM, this is a B cell receptor.
Answer: B

25) Activates complement.
Answer: E


Multiple-Choice Questions

1) Which of the following is characteristic of antibodies?
A) carbohydrate structure
B) composed of heavy and light polypeptide chains
C) three binding sites per antibody monomer
D) incapable of being transferred from one person to another

Answer: B


2) Which of the following is associated with passive immunity?
A) exposure to an antigen
B) infusion of weakened viruses
C) passage of IgG antibodies from a pregnant mother to her fetus
D) booster shot of vaccine

Answer: C


3) Which of the following is not a type of T cell?
A) cytotoxic
B) antigenic
C) helper
D) regulatory

Answer: B


4) B lymphocytes develop immunocompetence in the ________.
A) thymus
B) spleen
C) bone marrow
D) lymph nodes

Answer: C


5) Which of the following is not a function of the inflammatory response?
A) prevents the spread of the injurious agent to nearby tissue
B) replaces injured tissues with connective tissue
C) disposes of cellular debris and pathogens
D) sets the stage for repair processes

Answer: B


6) The redness and heat of an inflamed area are due to a local hyperemia caused by ________.
A) vasodilation
B) vasoconstriction
C) phagocyte mobilization
D) production of complement and interferon

Answer: A


7) The antibody molecule is held together by ________ bonds.
A) disulfide
B) hydrogen
C) amino acid
D) sodium

Answer: A


8) In clonal selection of B cells, which substance is responsible for determining which cells will eventually become cloned?
A) antigen
B) interferon
C) antibody
D) complement

Answer: A


9) Which of the following statements regarding NK cells is a false or incorrect statement?
A) NK cells are a type of neutrophil.
B) NK cells are present in the blood, spleen, lymph nodes, and red bone marrow.
C) NK cells attack cells that display abnormal MHC antigens.
D) NK cells attack cancer cells and virus-infected body cells.

Answer: A


10) The process whereby neutrophils and other white blood cells are attracted to an inflammatory site is called ________.
A) diapedesis
B) chemotaxis
C) margination
D) phagocytosis

Answer: B


11) Small molecules that bind with self-proteins to produce antigenic substances are called ________.
A) haptens
B) antibodies
C) ions
D) reagins

Answer: A


12) Which of the following is the correct sequence of events in phagocytosis?
A) adherence, digestion, killing, ingestion, chemotaxis
B) chemotaxis, ingestion, digestion, adherence, killing
C) chemotaxis, adherence, ingestion, digestion, killing
D) ingestion, adherence, chemotaxis, digestion, killing

Answer: C


13) The only T cells that can directly attack and kill other cells are the ________.
A) regulatory cells
B) helper cells
C) cytotoxic cells
D) plasma cells

Answer: C


14) Which of the following does not respond to cell-mediated immunity?
A) intracellular pathogens that reside within host cells
B) some cancer cells
C) foreign tissue transplants
D) pathogens in the CNS

Answer: D


15) ________ predominate at the sites of chronic infections.
A) Basophils
B) Eosinophils
C) Macrophages
D) B cells

Answer: C


16) Interferons ________.
A) are virus-specific, so that an interferon produced against one virus could not protect cells against another virus
B) act by increasing the rate of cell division
C) interfere with viral replication within cells
D) are routinely used in nasal sprays for the common cold

Answer: C


17) ________ determine(s) what specific foreign substances our adaptive immune system will be able to recognize and resist.
A) The type of antigen
B) Memory cell production
C) Enzymes present at the time of the invasion
D) Our genes

Answer: D


18) Regulatory T cells ________.
A) release cytokines that increase the activity of cytotoxic T cells and activated B cells
B) decrease their activity as antigenic stimulus decreases
C) may function in preventing autoimmune reactions
D) are the most thoroughly understood T cells

Answer: C


19) Select the correct definition about tissue grafts.
A) Isografts are between identical twins.
B) Allografts are between different species.
C) Xenografts are between individuals of the same species.
D) Autografts are between two genetically identical individuals.

Answer: A


20) Which of the statements below does not describe antigens?
A) Antigens exhibit immunogenicity and reactivity.
B) Antigens only come from microbes.
C) The parts of antigen molecules that initiate immune responses are called epitopes or antigenic determinants.
D) Antigens can include proteins, nucleic acids, lipoproteins, glycoproteins, and certain large polysaccharides.

Answer: B


21) ________ are released by activated T cells and macrophages to mobilize immune cells and attract other leukocytes into the area.
A) Cytokines
B) Perforins
C) Interleukin 1 proteins
D) Interleukin 2 proteins

Answer: A


22) Which of the following is a part of the second line of defense against microorganisms?
A) keratin
B) cilia
C) gastric juice
D) phagocytes

Answer: D


23) Which of the following is characteristic of complete antigens?
A) small molecules
B) reactivity with an antibody
C) contain many repeating chemical units
D) inhibit production of antibodies

Answer: B


24) B cells respond to the initial antigen challenge by ________.
A) reducing its size
B) immediately producing antigen-specific antibodies
C) forming of a large number of cells that are unlike the original B cell
D) producing progeny cells that include plasma cells and memory cells

Answer: D


25) Graft rejection may be caused by ________.
A) using a xenograft
B) use of immunosuppressive drugs
C) treatment with antilymphocyte serum
D) total body irradiation

Answer: A


26) Cancer cells and virus-infected body cells can be killed before activation of adaptive immunity by ________.
A) natural killer cells
B) T lymphocytes
C) B lymphocytes
D) pinocytosis

Answer: A


27) Complement proteins and antibodies coat a microorganism and provide binding sites, enabling macrophages and neutrophils to phagocytize the organism. This phenomenon is termed ________.
A) diapedesis
B) agglutination
C) opsonization
D) chemotaxis

Answer: C


28) Which of the following is not characteristic of the adaptive immune system?
A) It is antigen-specific.
B) It is systemic.
C) It has memory.
D) It is specific for a given organ.

Answer: D


29) Monoclonal antibodies are used for the diagnosis of all of the following except ________.
A) juvenile diabetes
B) hepatitis
C) rabies
D) pregnancy

Answer: A


30) Which of the following would be classified as a delayed hypersensitivity reaction?
A) immune complex hypersensitivity
B) anaphylaxis
C) cytotoxic hypersensitivity
D) allergic contact dermatitis

Answer: D


31) Innate immune system defenses include ________.
A) B cells
B) T cells
C) plasma cells
D) phagocytosis

Answer: D


32) Which of the following statements is incorrect or false?
A) Haptens lack immunogenicity unless attached to protein carriers.
B) Class 1 MHC molecules are built into the plasma membranes of all body cells.
C) Class II MHC molecules appear only on the surface of antigen-presenting cells, thymic cells, and T cells that have been activated by exposure to antigens.
D) MHC proteins are the cell’s identity markers.

Answer: C


33) Phagocyte mobilization involves ________.
A) diapedesis, during which cells line up against the capillary wall
B) margination, which is the process of white cell movement through the walls of capillaries into injured tissues
C) mainly neutrophil and macrophage migration into inflamed areas
D) monocytes as the most active phagocyte

Answer: C


34) Fever ________.
A) is a higher-than-normal body temperature that is always dangerous
B) decreases the metabolic rate of the body to conserve energy
C) production is regulated by chemicals that reset the body's thermostat to a higher setting
D) causes the liver to release large amounts of iron, which seems to inhibit bacterial replication

Answer: C


35) Immunocompetence ________.
A) occurs in one specific organ of the adaptive immune system
B) is the ability of individual cells to recognize a specific antigen by binding to it
C) prevents intercellular communication so that only specific cell types respond to the invader
D) requires exposure to an antigen

Answer: B


36) Select the correct statement about the prevention of immune attack on "self."
A) The development of tolerance is specific to B cells only.
B) Neutrophils capable of binding to self-antigens are chemically inactivated.
C) Tolerance to self is due to the action of foreign antigens that inactivate the immune response to one's own tissues.
D) Tolerance is developed during fetal life.

Answer: D


37) Select the correct statement about active and passive immunity.
A) Immunological memory is established by passive immunization.
B) A vaccination is an example of the introduction of passive immunity into the body.
C) The antibodies utilized in active immunity are acquired from another organism.
D) Active and passive humoral immunity are both mechanisms of adaptive immunity that use antibodies.

Answer: D


38) Cytotoxic T cells ________.
A) are the only T cells that can directly attack and kill other cells
B) require the double recognition signal of I MHC plus II MHC on the target cell in order to function
C) function mainly to stimulate the proliferation of other T cell populations
D) self-destruct once the antigen has been neutralized

Answer: A


39) Helper T cells ________.
A) bind tightly to target cells and release a lymphotoxin called perforin
B) often function to decrease the immune response
C) release B7 proteins
D) function in the adaptive immune system activation

Answer: D


40) Select the correct statement about immunodeficiency.
A) Severe combined immunodeficiency (SCID) disease is an acquired condition.
B) The causative agent in acquired immune deficiency syndrome (AIDS) is a virus that recognizes CD4 proteins.
C) Hodgkin's disease is a hereditary immunodeficiency found in children.
D) The most common form of immunodeficiency is graft-versus-host (GVH) disease.

Answer: B


41) Which of the following is true of immediate hypersensitivities?
A) They are also called type IV hypersensitivities.
B) They are are adaptive immune responses to disease organisms.
C) They include allergic contact dermatitis.
D) They involve IgE antibodies and the release of histamine from mast cells and basophils.

Answer: D


42) Delayed hypersensitivities ________.
A) are mediated by B cells
B) include allergic contact dermatitis
C) include anaphylactic shock, a systemic vasodilation that results in inadequate blood delivery to all tissues
D) do not involve T cells

Answer: B


43) Natural killer (NK) cells ________.
A) are also called cytotoxic T cells
B) are a type of phagocyte
C) are cells of the adaptive immune system
D) can kill cancer cells before the immune system is activated

Answer: D


44) Select the correct statement about antigens.
A) "Self-antigens" is another name for incomplete antigens.
B) The largest type of antigen is called a hapten.
C) Only small antigens exhibit reactivity.
D) One antigen may have many different antigenic determinants and may therefore cause the formation of more than one antibody.

Answer: D


45) Clonal selection of B cells ________.
A) occurs during fetal development
B) results in the formation of plasma cells
C) cannot occur in the presence of antigens
D) only occurs in the secondary immune response

Answer: B


46) The primary immune response ________.
A) occurs more rapidly and is stronger than the secondary response
B) occurs when memory cells are stimulated
C) is another name for immunological memory
D) has a lag period while B cells proliferate and differentiate into plasma cells

Answer: D


47) Select the correct statement about the function of antibodies.
A) Antibodies may directly destroy "invaders."
B) Neutralization is the process by which antibodies cause invading cells to clump together.
C) Complement fixation is the main mechanism by which antibodies provide protection.
D) The most potent agglutinating agent is IgG.

Answer: C


48) Which of the following cells is the most critical cell in immunity?
A) B cell
B) helper T cell
C) cytotoxic T cell

Answer: B


49) Which of the following is not an autoimmune disease?
A) multiple sclerosis
B) type II diabetes
C) systemic lupus erythematosus
D) glomerulonephritis

Answer: B


50) Which of the following is not a mechanism for the development of autoimmune disorders?
A) exposure of previously "hidden" self-antigens to the adaptive immune system
B) a second exposure to an allergen
C) mutation followed by the appearance of membrane proteins not previously present
D) cross-reaction of antibodies formed against foreign antigens with self-antigens

Answer: B


51) Select the correct statement about complement.
A) An adaptive immune mechanism is often involved in directing complement to its target.
B) Complement can be activated through three pathways: classical, secondary, and alternate.
C) The membrane attack complex consists of complement proteins C3a through C5.
D) Complement proteins C1 through C9 act exclusively in the classical pathway.

Answer: A


52) Which of the following is true about the number of binding sites per functional antibody unit?
A) IgD contains 4 binding sites.
B) IgA contains 6 binding sites.
C) IgG contains 6 binding sites.
D) IgM contains 10 binding sites.

Answer: D


53) Antibody functions include all of the following except ________.
A) binding and inactivating chemical toxins released by bacteria or other microorganisms
B) cross-linking cell-bound antigens on red blood cells when blood types are properly matched
C) linking soluble antigens together so that they fall out of solution
D) targeting foreign cells so that complement proteins can cause cellular lysis

Answer: B


54) Which statement is true about T cells?
A) They usually directly recognize antigens, which then activates a subpopulation of killer cells.
B) Their proliferation is enhanced by interleukins 1 and 2.
C) Once activated, they cannot secrete cytokines.
D) They will develop into cytotoxic T cells if antigen is complexed with class II MHC proteins.

Answer: B


55) Toll-like receptors (TLRs) trigger the release of ________ to attract white blood cells to the scene.
A) cytokines
B) histamine
C) prostaglandins
D) complement

Answer: A


56) Which of the following is not a method by which antibodies work?
A) neutralizing antigen
B) activating cytokines
C) enhancing phagocytosis
D) agglutinating and precipitating antigen

Answer: B


57) What is the role of interferon in defense against disease?
A) protects cells that have not yet been infected by viruses
B) protects cells that have not yet been infected by bacteria
C) activates the complement mechanism
D) activates the inflammatory process

Answer: A


58) Which of the following statements is a false or incorrect statement?
A) The lymphoid organs where lymphocytes become immunocompetent are called primary lymph organs. All other lymphoid organs are referred to as secondary lymphoid organs.
B) It is our genes, not antigens, that determine what specific foreign substances our immune system will be able to recognize and resist.
C) After becoming immunocompetent, the naive T cells and B cells are exported to the bone marrow where the encounters with antigens occur.
D) T cells and B cells become fully immunocompetent when they bind with recognized antigens.

Answer: C


Fill-in-the-Blank/Short Answer Questions

1) ________ are grafts taken from another animal species.

Answer: Xenografts


2) Pure antibody preparations specific for a single antigenic determinant are called ________ antibodies.

Answer: monoclonal


3) ________ is the most common type of immediate hypersensitivity.

Answer: Allergy


4) ________ cells can lyse and kill cancer cells and virus-infected body cells before the immune system is activated.

Answer: Natural killer


5) ________ is a dangerous condition where the cytokines are released unchecked, making the capillaries very leaky and thus depleting blood fluids.

Answer: Septic shock or Sepsis


6) Harmful or disease-causing microorganisms are called ________.

Answer: pathogens


7) ________ refers to a group of at least 20 plasma proteins that normally circulate in an inactive state and are a major mechanism for destroying foreign substances in the body.

Answer: Complement


8) The antibody that becomes bound to mast cells and basophils and causes the cells to release histamine and other chemicals is ________.

Answer: IgE


9) A(n) ________ is a cell hybrid formed from the fusion of tumor cells and B lymphocytes.

Answer: hybridoma


10) ________ cells are the only T lymphocytes that can directly attack and kill other cells.

Answer: Cytotoxic T


11) ________ is an autoimmune disease that severely impairs renal function.

Answer: Glomerulonephritis


12) List and briefly discuss innate body defenses to disease.

Answer: Innate body defenses to disease include surface membrane barriers, such as the skin and mucous membranes, as the first line of defense. Not only do the skin and mucous membranes act as a physical barrier to microorganisms, but they also secrete chemicals such as saliva, sebum, mucus, and HCl that kill microorganisms. Innate cellular defenses include the use of phagocytes and natural killer cells. Inflammation occurs in response to injury. The inflammation response includes vasodilation, increased vascular permeability, and phagocyte mobilization. Antimicrobial substances such as interferon and complement are also produced as innate defenses by the body.


13) What are monoclonal antibodies? How are they produced, and what are some of their clinical uses?

Answer: Monoclonal antibodies are pure antibody preparations that exhibit specificity for a single antigenic determinant. They are produced from the progeny of a single B cell hybridoma "clone," prepared by injecting a specific antigen into a lab animal and then harvesting sensitized B cells from its spleen. The cells are mixed with myeloma cells and incubated, and the resulting hybridoma cells (B cells fused with myeloma cells) produce the monoclonal antibody. They are used for the diagnosis of pregnancy, certain sexually transmitted diseases, hepatitis, rabies, and for other purposes.


14) What is the antigen challenge, and where does it usually take place?

Answer: The antigen challenge is the first encounter between an immunocompetent lymphocyte and an invading antigen. It usually takes place in the spleen or a lymph node, but may happen in any lymphoid tissue.


15) Why are regulatory T cells important to the immune process?

Answer: They are vital in the final stopping of an immune response after the antigen is inactivated. They may also help prevent autoimmune reactions.


16) What is the most likely type of hypersensitivity associated with an agonizingly itchy case of poison ivy, appearance of hives after eating shellfish, or a positive TB test?

Answer: The hypersensitivity associated with poison ivy is delayed hypersensitivity allergic contact dermatitis. The hypersensitivity associated with hives is a local anaphylactic reaction. The hypersensitivity associated with a positive TB test is delayed hypersensitivity.


17) Children born without a thymus must be kept in a germ-free environment if they are to survive. Explain why this is necessary.

Answer: If the thymus fails to develop, the T cells will not mature and become immunocompetent. If T cell function is disrupted, there is no resistance to disease.


18) What are the signs of inflammation, and how does inflammation serve as a protective function?

Answer: The four signs of inflammation are swelling, redness, heat, and pain. The signs are caused by local vasodilation and increased capillary permeability. This is of benefit because the process helps to dilute harmful substances that may be present; brings in large quantities of oxygen, nutrients, and cells necessary for the repair process; and allows the entry of clotting proteins. Pain helps immobilize the injury.


19) Name four autoimmune diseases.

Answer: Multiple sclerosis, myasthenia gravis, Graves' disease, juvenile (type I) diabetes, systemic lupus erythematosus, glomerulonephritis, rheumatoid arthritis.


20) What are two general mechanisms by which autoimmune diseases could arise?

Answer: 1) Appearance of new self-proteins in the circulation that have not previously been exposed to the immune system. 2) An immune response to foreign antigens resembling self-antigens.


21) Elderly people tend to develop cancer more frequently than younger people. Give an explanation for this observation that relates to immune function.

Answer: As one ages, the efficiency of the immune system begins to decline. This may allow cancer to become established more easily.


22) Why do schools require inoculations for childhood diseases such as mumps, measles, and whooping cough? Why are the inoculations of value?

Answer: The inoculations are required to try to prevent epidemics of these microbiological infections. The inoculations are of great benefit in preventing the diseases because the vaccines cause immunity to the pathogens by stimulating both the formation of protective antibodies and the establishment of immunological memory against future infection


23) Tom gets a cut on his hand. After several days he notes swelling, pain, heat, and redness. Upon opening the wound to relieve the pressure, the presence of pus is noted. What has happened to the wound?

Answer: The wound has become infected, probably with bacteria. The initial symptoms indicate acute inflammation. Pus indicates the presence of dead or dying neutrophils, broken-down tissue cells, and living and dead pathogens.


24) What are some of the drawbacks of passive humoral immunity?

Answer: The effects are short lived; it does not trigger memory cell production; and your body degrades the antibodies.


Clinical Questions

1) A 36-year-old man enters the hospital in an extremely debilitated condition. He has purple-brown skin lesions (a symptom of Kaposi's sarcoma) and a persistent cough. A physical examination reveals swollen lymph nodes, and laboratory tests find a very low lymphocyte count. Information taken during the personal history reveals that he has multiple sex partners with whom he frequently engages in unprotected sex. What is likely to be the man's problem and what is his outlook?

Answer: He is probably suffering from AIDS. His outlook is poor once the disease has progressed to this advanced stage. There is no cure and drug therapy has had limited short-term success.


2) A young girl requires a liver transplant due to failure of her liver to function. What is required for her to have a good prognosis and why?

Answer: The ABO and other blood group antigens of the donor and recipient must be determined. Next, donor and recipient tissues are matched as closely as possible. Following surgery she must receive immunosuppressive therapy to keep her body from rejecting the new liver as foreign tissue.


3) A woman comes into the hospital emergency room complaining that she is having problems swallowing and her neck is swelling. She was involved in an automobile accident a couple days ago but only bruised her neck. What could be the problem?

Answer: The woman is suffering from Hashimoto's thyroiditis. The automobile accident injured the thyroid gland and released thyroidglobulin into the bloodstream. The immune system has mounted an attack on the thyroid gland.


4) Max is bitten by a rattlesnake while on a camping trip. His friends immediately apply ice packs to the bitten area to slow the spread of the protein-based toxin; they then rush him to an emergency facility. What treatment would be given and why?

Answer: Max could be given an immune serum to the rattlesnake venom, thereby conferring passive immunity. The reason for passive immunization is that the venom could kill the person before active immunity could be established. The passive immunity would last until the "borrowed" antibodies naturally degraded in the body. No immunological memory would be established because B cells are not activated.


5) A physician orders Tylenol for a temperature greater than 101 degrees F. The patient's temperature is 100.4 F. Explain the rationale for not medicating a fever of 100.4 F.

Answer: A mild or moderate fever is an adaptive response that seems to benefit the body. Bacteria need large amounts of zinc and iron to multiply. During fever, the liver and spleen sequester these nutrients, making them less available, which helps to reduce the bacterial population.


6) Nursing care of a patient with acquired immune deficiency syndrome (AIDS) includes monitoring of T lymphocyte counts. Explain why.

Answer: The primary defect in patients with AIDS is depletion of helper T cells, and therefore the cell-mediated response. This immunodeficiency makes the patient more susceptible to infection and unusual cancers.


7) After receiving penicillin intravenously, a 32-year-old male patient has an anaphylactic reaction. The nurse understands that therapeutic management includes what critical items?

Answer: Therapeutic management includes speed in recognition of signs and symptoms of an anaphylactic reaction because death can occur within minutes. Maintaining an open airway is critical, because the bronchioles constrict, making it difficult to breathe.


8) When the white blood cell count is depressed, the classic signs of infection such as redness, heat, and swelling are not manifested. In this case, the nurse should avoid administering aspirin. Explain why.

Answer: Aspirin would disguise a fever that would indicate infection.


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