Copyright © 2019, Elsevier Inc. All Rights Reserved. 1Chapter 09: Alterations in Immunity and InflammationMcCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th EditionMULTIPLE CHOICE 1. How is hypersensitivity best defined?a. A disturbance in the immunologic tolerance of self-antigensb. An immunologic reaction of one person to the tissue of another personc. An altered immunologic response to an antigen that results in diseased. An undetectable immune response in the presence of antigensANS: CHypersensitivity is an altered immunologic response to an antigen that results in disease or damage to the host. Autoimmunity is a disturbance in the immunologic tolerance of self-antigens. Alloimmunity is the immunologic reaction of one person to the tissue of another person. An immune deficiency of some type would cause undetectable immune response in the presence of antigens.PTS: 1 DIF: Cognitive Level: Remembering 2. What is a hypersensitivity reaction that produces an allergic response called?a. Hemolytic shockb. Anaphylaxisc. Necrotizing vasculitisd. Systemic erythematosusANS: BExamples of systemic anaphylaxis are allergic reactions to beestings, peanuts, and fish. Hemolytic shock would be a state in which erythrocytes are destroyed by complement-mediated lysis to the point of causing a state of shock. Necrotizing vasculitis is inflammation of blood vessel walls that limits perfusion. Systemic lupus erythematosus (SLE) is a chronic, multisystem, inflammatory disease and is one of the most common, complex, and serious of the autoimmune disorders.PTS: 1 DIF: Cognitive Level: Remembering 3. The common hay fever allergy is expressed through a reaction that is mediated by which class of immunoglobulins?a. IgEb. IgGc. IgMd. T cellsANS: AType I reactions are mediated by antigen-specific IgE and the products of tissue mast cells. The most common allergies (e.g., pollen allergies) are type I reactions. In addition, most type I reactions occur against environmental antigens and are therefore allergic. Hay fever allergy is not mediated by IgG, IgM, or T cells.PTS: 1 DIF: Cognitive Level: Remembering 4. What are blood transfusion reactions an example of?a. Autoimmunityb. Alloimmunityc. Homoimmunityd. HypersensitivityANS: BAlloimmunity (also termed isoimmunity) occurs when the immune system of one individual produces an immunologic reaction against tissues of another individual. Autoimmunity is a disturbance in the immunologic tolerance of self-antigens. Homoimmunity refers to the resistance of a lysogenic bacterium that is carrying a phage to an infection by the same type of phage. Hypersensitivity is an altered immunologic response to an antigen that results in disease or damage to the host.PTS: 1 DIF: Cognitive Level: Remembering 5. During an IgE-mediated hypersensitivity reaction, which leukocyte is activated?a. Neutrophilsb. Monocytesc. Eosinophilsd. T lymphocytesANS: COf the options provided, only eosinophils are activated during IgE-mediated hypersensitivity reactions.PTS: 1 DIF: Cognitive Level: Remembering 6. During an IgE-mediated hypersensitivity reaction, what causes bronchospasm?a. Bronchial edema caused by the chemotactic factor of anaphylaxisb. Bronchial edema caused by binding of the cytotropic antibodyc. Smooth muscle contraction caused by histamine bound to H1 receptorsd. Smooth muscle contraction caused by histamine bound to H2 receptorsANS: CDuring an IgE-mediated hypersensitivity reaction, smooth muscle contraction caused by histamine bound to H1 receptors results in bronchospasms. The bronchospasm is not caused by edema or by histamine binding to H2 receptors.PTS: 1 DIF: Cognitive Level: RememberingCopyright © 2019, Elsevier Inc. All Rights Reserved. 2 7. A patient is having an IgE-mediated hypersensitivity reaction. What action by the healthcare professional is best?a. Give the patient an antihistamine.b. Prepare to give the patient a blood transfusion.c. Ask the patient is he/she is having pain at the site.d. Apply warm, moist heat to the affected area.ANS: AHistamine is the most potent mediator in an IgE-mediated hypersensitivity reaction (Type 1). Histamine bound to H2 results in the degranulation of mast cells with the release of histamine. Blocking histamine receptors with antihistamines can control some type I responses. The healthcare professional would not need to give the patient blood; warm; moist heat; or ask about pain.PTS: 1 DIF: Cognitive Level: Applying 8. What characteristic do atopic individuals have that make them genetically predisposed to develop allergies?a. Greater quantities of histamineb. More histamine receptorsc. Greater quantities of IgEd. A deficiency in epinephrineANS: CAtopic individuals tend to produce higher quantities of IgE and to have more crystalline fragment (Fc) receptors for IgE on their mast cells. Greater quantities of histamine, more histamine receptors, and a deficiency in epinephrine do not lead to a genetic predisposition to allergies.PTS: 1 DIF: Cognitive Level: Remembering 9. A student asks about the mechanism that results in type II hypersensitivity reactions. What description by the professor is best?a. Antibodies coat mast cells by binding to receptors that signal its degranulation, followed by a discharge of preformed mediators.b. Antibodies bind to soluble antigens that were released into body fluids, and the immune complexes are then deposited in the tissues.c. Cytotoxic T lymphocytes or lymphokine-producing helper T 1 cells directly attack and destroy cellular targets.d. Antibodies bind to the antigens on the cell surface.ANS: DThe mechanism that results in a type II hypersensitivity reaction begins with antibody binding to tissue-specific antigens or antigens that have attached to particular tissues. The cell can be destroyed by antibody IgG or IgM and activation of the complement cascade through the classical pathway.PTS: 1 DIF: Cognitive Level: Understanding 10. When mismatched blood is administered causing an ABO incompatibility, how are the erythrocytes destroyed?a. Complement-mediated cell lysisb. Phagocytosis by macrophagesc. Phagocytosis in the spleend. Natural killer cellsANS: AErythrocytes are destroyed by complement-mediated lysis in individuals with autoimmune hemolytic anemia or as a result of an alloimmune reaction to ABO-mismatched transfused blood cells. Erythrocytes are not destroyed by phagocytosis or natural killer cells.PTS: 1 DIF:
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