Human Anatomy & Physiology, 10e, (Marieb)
Chapter 21 The Immune System: Innate and Adaptive Body Defenses
21.1 Matching Questions
Figure 21.1
Using Figure 21.1, match the following:
A) B
B) D
C) A
D) E
E) C
1) Heavy chain.
Section: 21.5
Learning Outcome: 21.10a
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
2) Light chain.
Section: 21.5
Learning Outcome: 21.10a
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
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3) Variable region.
Section: 21.5
Learning Outcome: 21.10a
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
4) Constant region.
Section: 21.5
Learning Outcome: 21.10a
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
5) Antigen-binding site.
Section: 21.5
Learning Outcome: 21.10a
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
Answers: 1) A 2) B 3) E 4) D 5) C
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Figure 21.2
Using Figure 21.2, match the following:
A) D
B) C
C) B
D) E
6) Area where B cells become immunocompetent.
Section: 21.3
Learning Outcome: 21.7
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
7) Area where T cells become immunocompetent.
Section: 21.3
Learning Outcome: 21.7
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
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8) Area where activated immunocompetent B and T cells recirculate.
Section: 21.3
Learning Outcome: 21.7
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
9) Area seeded by immunocompetent B and T cells.
Section: 21.3
Learning Outcome: 21.7
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
10) Area where antigen challenge and clonal selection are most likely to occur.
Section: 21.4
Learning Outcome: 21.7
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
Answers: 6) B 7) C 8) D 9) A 10) A
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Match the following:
A) Intact skin and mucous membranes
B) Inflammatory response and skin and mucous membranes
C) Inflammatory response
D) Immune response
11) First line of defense.
Section: 21.1
Learning Outcome: 21.1
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
12) Second line of defense.
Section: 21.1
Learning Outcome: 21.1
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
13) Third line of defense.
Section: 21.1
Learning Outcome: 21.1
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
14) Innate defense system.
Section: 21.1
Learning Outcome: 21.1
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
15) Adaptive defense system.
Section: 21.1
Learning Outcome: 21.1
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
Answers: 11) A 12) C 13) D 14) B 15) D
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Match the following:
A) Regulatory T cell
B) Memory cell
C) Helper T cell
D) B cell
E) Cytotoxic T cell
16) Enables quick and efficient response to secondary exposure to antigen.
Section: 21.3
Learning Outcome: 21.10a, 21.15
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
17) Absence results in no immune response.
Section: 21.3
Learning Outcome: 21.10a, 21.15
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
18) Forms antibody producing cells.
Section: 21.3
Learning Outcome: 21.10a, 21.15
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
19) Kills cancer cells and virus infected body cells.
Section: 21.3
Learning Outcome: 21.10a, 21.15
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
20) Slows or stops the immune response.
Section: 21.3
Learning Outcome: 21.10a, 21.15
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
Answers: 16) B 17) C 18) D 19) E 20) A
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Match the following:
A) IgG
B) IgD
C) IgM
D) IgA
E) IgE
21) Main antibody of both primary and secondary immune response.
Section: 21.5
Learning Outcome: 21.13
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
22) Protects mucosal barriers.
Section: 21.5
Learning Outcome: 21.13
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
23) Involved in allergies.
Section: 21.5
Learning Outcome: 21.13
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
24) Along with IgM, this is a B cell receptor.
Section: 21.5
Learning Outcome: 21.13
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
25) First to peak during a primary immune response.
Section: 21.5
Learning Outcome: 21.13
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
Answers: 21) A 22) D 23) E 24) B 25) C
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21.2 True/False Questions
1) Virus infected cells secrete interferons to "warn" other cells of the presence of virus and deny
entry to them.
Answer: FALSE
Section: 21.2
Learning Outcome: 21.4
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
2) Cytotoxic T cells and NK cells kill by secretion of proteins. The first called perforin which
forms complexes that penetrate the cell membrane and allows the passage of the apoptosis
inducing protein granzyme to enter the targeted cell.
Answer: TRUE
Section: 21.5
Learning Outcome: 21.15
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
3) Dendritic cells and macrophages kill by ingestion and destruction of particulate matter in a
process called phagocytosis.
Answer: TRUE
Section: 21.2
Learning Outcome: 21.2
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
4) The respiratory burst produced by activated macrophages releases free radicals which are
effective at killing pathogens.
Answer: TRUE
Section: 21.2
Learning Outcome: 21.2
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
5) The directional movement of cells in response to chemicals is called chemotaxis.
Answer: TRUE
Section: 21.2
Learning Outcome: 21.3
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
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6) Soluble proteins secreted by plasma cells are called antibodies.
Answer: TRUE
Section: 21.2
Learning Outcome: 21.2
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
7) Viral infection will provoke cell mediated immunity but will not activate a humoral response.
Answer: FALSE
Section: 21.5, 21.6
Learning Outcome: 21.11, 21.15
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
8) Fever is often a beneficial immune response because it can speed the activities of leucocytes.
Answer: TRUE
Section: 21.2
Learning Outcome: 21.3
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
9) Monoclonal antibodies are used in clinical laboratory diagnosis because they bind to many
antigenic determinates.
Answer: FALSE
Section: 21.5
Learning Outcome: 21.13
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
10) B cells must accomplish double recognition: They must simultaneously recognize self and
nonself to be activated.
Answer: FALSE
Section: 21.6
Learning Outcome: 21.12, 21.14
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
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11) Some immunocompetent cells will never encounter an antigen to which they can bind and
therefore will never be called to service in our lifetime.
Answer: TRUE
Section: 21.3
Learning Outcome: 21.5
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
12) Anaphylactic shock is a rare but severe allergic response that may occur if the allergen enters
the blood stream.
Answer: TRUE
Section: 21.7
Learning Outcome: 21.17
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
13) In a case of immediate hypersensitivity the immune system responds with an allergic
response on the first exposure to the allergen.
Answer: FALSE
Section: 21.7
Learning Outcome: 21.17
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
14) Subacute hypersensitivities are categorically less harmful than acute (immediate)
hypersensitivities.
Answer: FALSE
Section: 21.7
Learning Outcome: 21.17
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
15) The nucleotide sequence within the genes that produce B cell receptor and antibodies are
reshuffled by a process called somatic recombination. This produces the huge variability in
antibody types.
Answer: TRUE
Section: 21.4
Learning Outcome: 21.11
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 3 Application
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16) Antibodies typically act extracellularly in body fluids and are therefore considered part of the
humoral branch of adaptive immunity.
Answer: TRUE
Section: 21.5
Learning Outcome: 21.10a
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
1.3 Multiple Choice Questions
1) An advantage to adaptive immunity is ________.
A) the use of antibodies that cause cell lysis and kill invading cells
B) the ability of its individual cells to respond to many different pathogens
C) its memory cells that provide quicker, larger and more efficient immune response upon
second exposure to an antigen
D) its need for several cells to be activated over several days on first exposure
Answer: C
Section: 21.3-21.6
Learning Outcome: 21.5-21.16
Global LO: G2, G7
HAPS LO: HAPS1, HAPS4
Bloom's Level: 3 Application
2) An advantage of innate immunity is ________.
A) its barriers that prevent pathogens from entering into the body
B) the use of antibodies to cause cell lysis and kill invading cells
C) the numerous steps in the activation of its cells that can prevent autoimmune disease
D) the specificity of its individual cells which specialize in the removal on one type of antigen
Answer: A
Section: 21.1, 21.2
Learning Outcome: 21.1-21.4
Global LO: G2, G7
HAPS LO: HAPS1, HAPS4
Bloom's Level: 3 Application
3) B-lymphocytes are categorized as part of the adaptive branch of the immune system for all of
the following reason but one. Which of the following is not one of the reasons B-lymphocytes
are considered part of the adaptive immunity?
A) Their receptors will bind to only one antigen.
B) They are a first line of defense that can begin killing pathogens immediately.
C) They require costimulation from an activated T-helper cell.
D) They produce memory cells when activated.
Answer: B
Section: 21.3-21.6
Learning Outcome: 21.12
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Global LO: G2, G7
HAPS LO: HAPS1, HAPS4
Bloom's Level: 3 Application
4) Overlap in the innate and adaptive immune system is seen in all of the following examples but
one. Which of the following examples does not illustrate the overlap of innate and adaptive
immune responses?
A) Dendritic cells presenting antigens on their MHC II proteins to T-helper cells.
B) Plasma cells that produce large amounts of IgE that will ultimately allow mast cells to release
histamine.
C) NK cells causing apoptosis of an abnormal host cell, lacking MHC proteins.
D) Macrophages becoming activated macrophages in response to cytokines released by T-helper
cells.
Answer: C
Section: 21.6
Learning Outcome: 21.15
Global LO: G2, G7
HAPS LO: HAPS1, HAPS4
Bloom's Level: 3 Application
5) Which of the following examples below describes an autoimmune disease?
A) Release of bacterial endotoxins that block acetylcholine release result in muscle paralysis.
B) Antibody binding to acetylcholine receptors of the motor end plate resulting in muscle
weakness.
C) Infection and death of T-helper cells by a virus, resulting in a loss of adaptive immunity.
D) Uncontrolled cell division resulting in cell surface abnormalities recognized by NK cells.
Answer: B
Section: 21.7
Learning Outcome: 21.18
Global LO: G2, G7
HAPS LO: HAPS1, HAPS4
Bloom's Level: 3 Application
6) Which of the following does not describe actions of interferon (IFN)?
A) IFN binds to normal, uninfected cells stimulating the activation of genes that produce
anti-viral proteins.
B) IFN can penetrate the viral capsid and destroy the virus.
C) Virally infected cells can release interferon which attracts NK cells to attack and kill the IFN
secreting cell.
D) IFN will attract macrophages to the secreting cell to be removed by phagocytosis.
Answer: B
Section: 21.2
Learning Outcome: 21.4
Global LO: G2, G7
HAPS LO: HAPS1, HAPS4
Bloom's Level: 3 Application
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7) A vaccine is effective because ________.
A) B-lymphocytes are unable to mount an immune response the first time they are exposed to a
new pathogen
B) the secondary response of the adaptive immunity is faster and more efficient the primary
response
C) the vaccine contains the lymphocytes necessary to fight infection
D) the vaccine contains the antibodies necessary to fight infection
Answer: B
Section: 21.5
Learning Outcome: 21.10a
Global LO: G2, G7
HAPS LO: HAPS1, HAPS4
Bloom's Level: 3 Application
8) A flu vaccine is needed seasonally to be effective but a polio vaccine is only needed once. The
best explanation of this is ________.
A) the flu vaccine is substantially weaker than the polio vaccine
B) exposure to flu vaccine produces no memory cells from proliferating B-lymphocytes
C) the polio virus is substantially weaker than the flu virus
D) the flu has several strains that change seasonally
Answer: D
Section: 21.5
Learning Outcome: 21.10a
Global LO: G2, G7
HAPS LO: HAPS1, HAPS4
Bloom's Level: 3 Application
9) All of the following are true of the classical pathway of complement activation except one.
Select the one answer that does not describe the classical pathway of complement activation.
A) It is an example of overlap between innate and adaptive immune function.
B) Classical activation will result in enhanced inflammation, opsonization as well as formation
of MAC proteins.
C) It requires that circulating antibodies are bound to antigens.
D) It activates T-helper cells by presenting antigen to them.
Answer: D
Section: 21.2
Learning Outcome: 21.4
Global LO: G2, G7
HAPS LO: HAPS1, HAPS4
Bloom's Level: 3 Application
10) Vaccines work by ________.
A) boosting innate immunity with cytokines
B) providing the necessary antibodies to fight infections
C) suppressing inflation to help speed healing
D) priming the adaptive immunity with a relatively harmless primary exposure
Answer: D
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Section: 21.5
Learning Outcome: 21.10a
Global LO: G2, G7
HAPS LO: HAPS1, HAPS4
Bloom's Level: 3 Application
11) Inflammation ________.
A) is caused by bacterial activity to enhance the spread of disease
B) brings more leukocytes to the sight of infection
C) is caused by viral activity to enhance the spread of the disease
D) slows the healing process with swelling that can impair bodily function
Answer: B
Section: 21.2
Learning Outcome: 21.3
Global LO: G2, G7
HAPS LO: HAPS1, HAPS4
Bloom's Level: 3 Application
12) Membrane attack complex (MAC) kills by ________.
A) providing a passage for antibodies to enter into the bacterial cytosol
B) disrupting the selectively permeability of a bacteria's plasma membrane
C) penetrating the capsule of the bacteria giving antibiotic drugs access to bacterial cells
D) allowing the organelles to spill free from the bacteria
Answer: B
Section: 21.2
Learning Outcome: 21.4
Global LO: G2, G7
HAPS LO: HAPS1, HAPS4
Bloom's Level: 3 Application
13) All but one of the following occur during the inflammatory response. Select the example
below that does not describe the process of inflammation.
A) Vasoconstriction will prevent excessive blood loss due to injury.
B) Chemotaxis draws leucocytes to the site of injury.
C) Increases capillary permeability.
D) Release of prostaglandins resulting in pain.
Answer: A
Section: 21.2
Learning Outcome: 21.3
Global LO: G2, G7
HAPS LO: HAPS1, HAPS4
Bloom's Level: 3 Application
14) During inflammation fluids will passively diffuse out of blood vessels into the nearby,
infected tissues. This implies all of the following except ________.
A) B-lymphocytes will differentiate to become plasma cells
B) the surrounding tissue will swell with excessive fluids
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C) the osmolarity of the fluids surrounding infected tissue is higher than the plasma
D) nearby capillaries have become more permeable
Answer: A
Section: 21.2
Learning Outcome: 21.3
Global LO: G2, G7
HAPS LO: HAPS1, HAPS4
Bloom's Level: 3 Application
15) Choose the best description of an antigen.
A) part or a piece of a disease or pathogen
B) a particle that triggers the adaptive immunity
C) a particle (typically a foreign protein) that triggers inflammation
D) a chemical that enhances or modifies immune response
Answer: B
Section: 21.3
Learning Outcome: 21.5
Global LO: G2, G7
HAPS LO: HAPS1, HAPS4
Bloom's Level: 3 Application
16) Which of the following best describes the qualities of most antigens?
A) macromolecules that are produced by the host organism
B) atomic elements that are not normally present in the human body
C) macromolecules that are foreign to the host
D) atomic elements that are harmful or toxic
Answer: C
Section: 21.3
Learning Outcome: 21.5
Global LO: G2, G7
HAPS LO: HAPS1, HAPS4
Bloom's Level: 3 Application
17) Allergens differ from antigens because ________.
A) allergens are primarily plant derived while antigens are bacterial or viral in nature
B) allergens are only active seasonally and are generally harmless to the body
C) allergens do not involve the leucocytes, they simply stimulate the inflammatory response
D) allergens produce an abnormally large immune response to what is an otherwise harmless
particle
Answer: D
Section: 21.7
Learning Outcome: 21.17
Global LO: G2, G7
HAPS LO: HAPS1, HAPS4
Bloom's Level: 3 Application
18) Without the positive selection process in lymphocyte maturation ________.
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A) NK cells would be non-functional
B) monocytes would not be able to migrate into infected tissue and differentiate into
macrophages
C) T-cells would not be able to properly bind to APC's and therefore not be activated by them
D) autoimmune diseases would be likely to result
Answer: C
Section: 21.4
Learning Outcome: 21.7
Global LO: G2, G7
HAPS LO: HAPS1, HAPS4
Bloom's Level: 3 Application
19) Select the best description of the negative selection process of lymphocyte maturation.
A) removal of lymphocytes that fail to recognize "self" cells
B) teaching a lymphocyte to recognize "self" from foreign antigens
C) removal of lymphocytes that react with "self" cells
D) allowing the survival of lymphocytes that cannot bind to MHC proteins
Answer: C
Section: 21.4
Learning Outcome: 21.7
Global LO: G2, G7
HAPS LO: HAPS1, HAPS4
Bloom's Level: 3 Application
20) Plasma cells ________.
A) have a great deal of rough endoplasmic reticulum reflecting the fact that they secrete a
tremendous amount of protein (antibody)
B) are small so that they slip between endothelial cells of capillaries to fight infection in the
surrounding tissues
C) have a great deal of rough endoplasmic reticulum to dispose of ingested pathogens
D) are large so that they can envelope their prey by phagocytosis
Answer: A
Section: 21.5
Learning Outcome: 21.11
Global LO: G2, G7
HAPS LO: HAPS1, HAPS4
Bloom's Level: 3 Application
21) Which of the following is associated with passive immunity?
A) booster shot of vaccine
B) exposure to an antigen
C) infusion of weakened viruses
D) passage of IgG antibodies from a pregnant mother to her fetus
Answer: D
Section: 21.5
Learning Outcome: 21.12
Global LO: G7
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HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
22) Which of the following is not a type of T cell?
A) helper
B) antigenic
C) cytotoxic
D) regulatory
Answer: B
Section: 21.6
Learning Outcome: 21.15
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
23) B lymphocytes develop immunocompetence in the ________.
A) bone marrow
B) lymph nodes
C) thymus
D) spleen
Answer: A
Section: 21.4
Learning Outcome: 21.7
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
24) Which of the following is not a function of the inflammatory response?
A) prevents the spread of the injurious agent to nearby tissue
B) disposes of cellular debris and pathogens
C) replaces injured tissues with connective tissue
D) sets the stage for repair processes
Answer: C
Section: 21.2
Learning Outcome: 21.3
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 3 Application
25) The redness and heat of an inflamed area are due to a local hyperemia caused by ________.
A) phagocyte mobilization
B) complement production
C) vasoconstriction
D) vasodilation
Answer: D
Section: 21.2
Learning Outcome: 21.3
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Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 2 Comprehension
26) In clonal selection of B cells, which substance is responsible for determining which cells will
eventually become cloned?
A) antigen
B) interferon
C) complement
D) antibody
Answer: A
Section: 21.5
Learning Outcome: 21.11
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 3 Application
27) Which of the following statements regarding NK cells is a false or incorrect statement?
A) NK cells attack cells that display abnormal or lack MHC antigens.
B) NK cells are a type of neutrophil.
C) NK cells attack cancer cells and virus-infected body cells.
D) NK cells are present in the blood, spleen, lymph nodes, and red bone marrow.
Answer: B
Section: 21.6
Learning Outcome: 21.14
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
28) Which of the following is not a role of activated complement?
A) insertion of MAC and cell lysis
B) prevention of immediate hypersensitivity reactions
C) enhancement of inflammation
D) opsonization
Answer: B
Section: 21.2
Learning Outcome: 21.3
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
29) Interferons ________.
A) are routinely used in nasal sprays for the common cold
B) are virus-specific, so that an interferon produced against one virus could not protect cells
against another virus
C) act by increasing the rate of cell division
D) interfere with viral replication within cells
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Answer: D
Section: 21.2
Learning Outcome: 21.4
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
30) Regulatory T cells ________.
A) aid B cells in antibody production
B) may function in preventing autoimmune reactions
C) decrease their activity as antigenic stimulus decreases
D) release cytokines that increase the activity of cytotoxic T cells and activated B cells
Answer: B
Section: 21.6
Learning Outcome: 21.15
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
31) Which of the statements below does not describe antigens?
A) Antigens only come from microbes.
B) The parts of antigen molecules that initiate immune responses are called epitopes or antigenic
determinants.
C) Antigens can include proteins, nucleic acids, lipoproteins, glycoproteins, and certain large
polysaccharides.
D) Antigens exhibit immunogenicity and reactivity.
Answer: A
Section: 21.3
Learning Outcome: 21.5
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
32) Activated T cells and macrophages release ________ to mobilize immune cells and attract
other leukocytes into the area.
A) cytokines
B) interleukin 2 proteins
C) perforins
D) interleukin 1 proteins
Answer: A
Section: 21.2
Learning Outcome: 21.3
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
33) Which of the following is characteristic of complete antigens?
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A) inhibit production of antibodies
B) contain many repeating chemical units
C) small molecules
D) reactivity with an antibody
Answer: D
Section: 21.3
Learning Outcome: 21.5
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 2 Comprehension
34) T-cell activation requires ________.
A) antigen binding and antibody production
B) antigen binding and co-stimulation
C) antigen binding, antibody production, and co-stimulation
D) antibody production and co-stimulation
Answer: B
Section: 21.6
Learning Outcome: 21.14
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 2 Comprehension
35) Cancer cells and virus-infected body cells can be killed before activation of adaptive
immunity by ________.
A) B lymphocytes
B) T lymphocytes
C) pinocytosis
D) natural killer cells
Answer: D
Section: 21.2
Learning Outcome: 21.2
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 2 Comprehension
36) Complement proteins and antibodies coat a microorganism and provide binding sites,
enabling macrophages and neutrophils to phagocytize the organism. This phenomenon is termed
________.
A) opsonization
B) agglutination
C) diapedesis
D) chemotaxis
Answer: A
Section: 21.2
Learning Outcome: 21.2
Global LO: G7
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HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
37) Monoclonal antibodies are used for the diagnosis of all of the following except ________.
A) pregnancy
B) elevated blood glucose
C) hepatitis
D) rabies
Answer: B
Section: 21.5
Learning Outcome: 21.13
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
38) Innate immune system defenses include ________.
A) T cells
B) B cells
C) plasma cells
D) phagocytosis
Answer: D
Section: 21.2
Learning Outcome: 21.2
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
39) Which of the following statements is incorrect or false?
A) Class I MHC molecules are built into the plasma membranes of all body cells.
B) 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.
C) Haptens lack immunogenicity unless attached to protein carriers.
D) MHC proteins are the cell's identity markers.
Answer: B
Section: 21.6
Learning Outcome: 21.14
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
40) Phagocyte mobilization involves ________.
A) monocytes as the most active phagocyte
B) diapedesis, during which cells line up against the capillary wall
C) mainly neutrophil and macrophage migration into inflamed areas
D) margination, which is the process of white cell movement through the walls of capillaries into
injured tissues
Answer: C
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Section: 21.2
Learning Outcome: 21.2
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
41) Fever ________.
A) production is regulated by chemicals that reset the body's thermostat to a higher setting
B) decreases the metabolic rate of the body to conserve energy
C) is a higher-than-normal body temperature that is always dangerous
D) causes the liver to release large amounts of iron, which seems to inhibit bacterial replication
Answer: A
Section: 21.2
Learning Outcome: 21.3
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
42) Immunocompetence ________.
A) prevents intercellular communication so that only specific cell types respond to the invader
B) occurs in one specific organ of the adaptive immune system
C) is the ability of individual cells to recognize a specific antigen by binding to it
D) requires exposure to an antigen
Answer: C
Section: 21.6
Learning Outcome: 21.14
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
43) Select the correct statement about active and passive immunity.
A) Active and passive humoral immunity are both mechanisms of adaptive immunity that use
antibodies.
B) Immunological memory is established by passive immunization.
C) The antibodies utilized in active immunity are acquired from another organism.
D) A vaccination is an example of the introduction of passive immunity into the body.
Answer: A
Section: 21.5
Learning Outcome: 21.12
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
44) Cytotoxic T cells ________.
A) require the double recognition signal of class I MHC plus class II MHC on the target cell in
order to function
B) self-destruct once the antigen has been neutralized
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C) function mainly to stimulate the proliferation of other T cell populations
D) can directly attack and kill other cells of the body
Answer: D
Section: 21.6
Learning Outcome: 21.15
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
45) Helper T cells ________.
A) function in the adaptive immune system activation
B) often function to decrease the immune response
C) bind tightly to target cells and release a lymphotoxin called perforin
D) release B7 proteins
Answer: A
Section: 21.6
Learning Outcome: 21.15
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
46) Select the correct statement about immunodeficiency.
A) Severe combined immunodeficiency (SCID) disease is an acquired condition.
B) Hodgkin's disease is a hereditary immunodeficiency found in children.
C) The most common form of immunodeficiency is graft-versus-host (GVH) disease.
D) The causative agent in acquired immune deficiency syndrome (AIDS) is a virus that
recognizes CD4 proteins.
Answer: D
Section: 21.7
Learning Outcome: 21.17
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
47) Natural killer (NK) cells ________.
A) can kill cancer cells before the immune system is activated
B) are also called cytotoxic T cells
C) are cells of the adaptive immune system
D) are a type of phagocyte
Answer: A
Section: 21.2
Learning Outcome: 21.2
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
48) Select the correct statement about antigens.
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A) "Self-antigens" is another name for incomplete antigens.
B) The largest type of antigen is called a hapten.
C) One antigen may have many different antigenic determinants and may therefore cause the
formation of more than one antibody.
D) Only small antigens exhibit reactivity.
Answer: C
Section: 21.3
Learning Outcome: 21.5
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
49) Clonal selection of B cells ________.
A) occurs during fetal development
B) cannot occur in the presence of antigens
C) results in the formation of plasma cells
D) only occurs in the secondary immune response
Answer: C
Section: 21.5
Learning Outcome: 21.11
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
50) The primary immune response ________.
A) has a lag period while B cells proliferate and differentiate into plasma cells
B) is another name for immunological memory
C) occurs more rapidly and is stronger than the secondary response
D) occurs when memory cells are stimulated
Answer: A
Section: 21.5
Learning Outcome: 21.11
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
51) Which of the following cells has the largest role and most widespread effect on immunity?
A) cytotoxic T cell
B) B cell
C) helper T cell
D) APC
Answer: C
Section: 21.6
Learning Outcome: 21.15
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
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52) Which of the following is not a mechanism for the development of autoimmune disorders?
A) cross-reaction of antibodies formed against foreign antigens (haptens) bound with
self-antigens
B) mutation followed by the appearance of membrane proteins not previously present
C) exposure of previously "hidden" self-antigens to the adaptive immune system during trauma
D) a second exposure to an allergen
Answer: D
Section: 21.7
Learning Outcome: 21.18
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 3 Application
53) Which of the following is not a complement activation pathway?
A) lectin pathway
B) alternative pathway
C) lactate pathway
D) classical pathway
Answer: C
Section: 21.2
Learning Outcome: 21.4
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
54) Antibody functions include all of the following except ________.
A) targeting foreign cells so that complement proteins can cause cellular lysis
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) binding and inactivating chemical toxins released by bacteria or other microorganisms
Answer: B
Section: 21.5
Learning Outcome: 21.10a
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
55) Which statement is true about T cells?
A) They will develop into cytotoxic T cells if antigen is complexed with class II MHC proteins.
B) Once activated, they cannot secrete cytokines.
C) Their proliferation is enhanced by interleukins 1 and 2.
D) They usually directly recognize antigens, which then activates a subpopulation of killer cells.
Answer: C
Section: 21.6
Learning Outcome: 21.15
Global LO: G7
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HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
56) What is the role of interferon in defense against disease?
A) protects cells that have not yet been infected by viruses
B) activates the inflammatory process
C) activates the complement mechanism
D) protects cells that have not yet been infected by bacteria
Answer: A
Section: 21.2
Learning Outcome: 21.4
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
57) 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) After becoming immunocompetent, the naive T cells and B cells are exported to the bone
marrow where the encounters with antigens occur.
C) It is our genes, not antigens, that determine what specific foreign substances our immune
system will be able to recognize and resist.
D) T cells and B cells become activated when they bind with recognized antigens.
Answer: B
Section: 21.4
Learning Outcome: 21.7
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
58) Which immunoglobulin class is attached to the external surface of B cells and acts as an
antigen receptor of the B cell?
A) IgE
B) IgD
C) IgG
D) IgM
E) IgA
Answer: B
Section: 21.5
Learning Outcome: 21.13
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
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1.4 Short Answer Questions
1) Suppressor factors are ________ that suppress the immune system.
Answer: cytokines
Section: 21.2
Learning Outcome: 21.3
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
2) Pure antibody preparations specific for a single antigenic determinant are called ________
antibodies.
Answer: monoclonal
Section: 21.5
Learning Outcome: 21.13
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
3) The most common type of immediate hypersensitivity is ________.
Answer: allergy
Section: 21.7
Learning Outcome: 21.17
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
4) Natural killer cells can lyse and kill cancer cells and virus-infected body cells ________ the
immune system is activated.
Answer: before
Section: 21.2
Learning Outcome: 21.2
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
5) Septic shock is a dangerous condition where the ________ are released unchecked, making
the capillaries very leaky and thus depleting blood fluids.
Answer: cytokines
Section: At the Clinic
Learning Outcome: 21.3
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
6) Harmful or disease-causing microorganisms are called ________.
Answer: pathogens
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Section: 21.1
Learning Outcome: 21.1
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
7) 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 are referred to as ________.
Answer: complement
Section: 21.2
Learning Outcome: 21.2
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
8) The antibody that becomes bound to mast cells and basophils and causes the cells to release
histamine and other chemicals is ________.
Answer: IgE
Section: 21.5
Learning Outcome: 21.12
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
9) Failure of developing T cells to recognize self MHC during positive selection results in
________.
Answer: apoptosis
Section: 21.4
Learning Outcome: 21.7
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
10) An autoimmune disease that severely impairs renal function is ________.
Answer: glomerulonephritis
Section: 21.7
Learning Outcome: 21.18
Global LO: G7
HAPS LO: HAPS1
Bloom's Level: 1 Knowledge
11) 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
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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.
Section: 21.5
Learning Outcome: 21.13
Global LO: G2, G7
HAPS LO: HAPS1
Bloom's Level: 3 Application
12) 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.
Section: 21.6
Learning Outcome: 21.15
Global LO: G2, G7
HAPS LO: HAPS1
Bloom's Level: 3 Application
13) 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.
Section: 21.7
Learning Outcome: 21.17
Global LO: G2, G7
HAPS LO: HAPS1
Bloom's Level: 3 Application
14) 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.
Section: 21.2
Learning Outcome: 21.3
Global LO: G2, G7
HAPS LO: HAPS1
Bloom's Level: 3 Application
15) Name four autoimmune diseases.
Answer: Multiple sclerosis, myasthenia gravis, Graves' disease, juvenile (type I) diabetes,
systemic lupus erythematosus, glomerulonephritis, rheumatoid arthritis.
Section: 21.7
Learning Outcome: 21.17
Global LO: G2, G7
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HAPS LO: HAPS1
Bloom's Level: 3 Application
16) 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.
Section: 21.7
Learning Outcome: 21.18
Global LO: G2, G7
HAPS LO: HAPS1
Bloom's Level: 3 Application
17) 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.
Section: 21.5
Learning Outcome: 21.10a
Global LO: G2, G7
HAPS LO: HAPS1
Bloom's Level: 3 Application
18) 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.
Section: 21.2
Learning Outcome: 21.3
Global LO: G2, G7
HAPS LO: HAPS1
Bloom's Level: 3 Application
19) 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.
Section: 21.2
Learning Outcome: 21.2
Global LO: G2, G7
HAPS LO: HAPS1
Bloom's Level: 3 Application
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1.5 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.
Section: 21.7
Learning Outcome: 21.17
Global LO: G2, G7
HAPS LO: HAPS1
Bloom's Level: 3 Application
2) A woman comes into the hospital emergency room complaining that she is having problems
swallowing and her neck is swelling. She has a history of radiation treatment to her neck as a
child for acne. What could be the problem?
Answer: The woman is suffering from Hashimoto's thyroiditis. The radiation injured the thyroid
gland and released thyroidglobulin into the bloodstream. The immune system has recently
become sensitized and mounted an attack on the thyroid gland.
Section: 21.7
Learning Outcome: 21.18
Global LO: G2, G7
HAPS LO: HAPS1
Bloom's Level: 3 Application
3) 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.
Section: 21.5
Learning Outcome: 21.12
Global LO: G2, G7
HAPS LO: HAPS1
Bloom's Level: 3 Application
4) 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
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infection and unusual cancers. Thus the lower the count, the more protective precautions need to
be taken.
Section: 21.7
Learning Outcome: 21.17
Global LO: G2, G7
HAPS LO: HAPS1
Bloom's Level: 3 Application
5) 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. An agent to counteract
the extreme vasodilation, such as epinephrine, is often the key to survival.
Section: 21.7
Learning Outcome: 21.17
Global LO: G2, G7
HAPS LO: HAPS1
Bloom's Level: 3 Application
6) 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.
Section: 21.2
Learning Outcome: 21.3
Global LO: G2, G7
HAPS LO: HAPS1
Bloom's Level: 3 Application
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