Chapter 3 Disorders of the Immune System

Oh No! Not Another Learning Experience

Learning Objective 1
Exercise 3-1
1. Physical barriers
2. membranes
3. Chemical barriers
4. acidic
5. lysozyme
Exercise 3-2
1. Self
2. Nonself
3. Immunity
Learning Objective 2
Exercise 3-3
1. primary lymphoid organs
2. bone marrow
3. thymus
4. tonsils
5. spleen
6. lymph nodes
7. MALT/ Mucosal associated lymphoid tissue
8. lymphatic system
Exercise 3-4
1. True
2. False
3. True

Learning Objective 3
Exercise 3-5
1. nonself
2. Innate immunity
3. nonspecific
4. adaptive immunity
5. programmable
6. specific
7. antibodies
Exercise 3-6
1. Fast
2. Specific
3. Yes
4. No
Exercise 3-7
1. Antigen
2. Hapten
3. Primary immune response
4. Secondary immune response
Learning Objective 4
Exercise 3-8
1. monocytes
2. antigens
3. Dendritic cells
4. skin
5. antigen presenting cells
6. effector cells
7. T lymphocytes
8. cellular
9. B lymphocytes

10. humoral
11. plasma cells
12. innate
Exercise 3-9
1. False. Cluster differentiation (CD) proteins
Learning Objective 5
Exercise 3-10
1. antibodies
2. humoral immunity
3. active immunity
4. passive immunity
5. IgG
6. IgA
7. IgM
8. IgD
9. IgE
Exercise 3-11
1. MALT Tissue
2. temporary
3. B cells
4. mast cells
5. Allergic reactions
6. Smallest
7. Permanent
8. Largest
9. subsides
Exercise 3-12
1. Clonal expansion
2. Memory B cells
3. Immune complex

Learning Objective 6
Exercise 3-13
1. red blood cells
2. glycoproteins
3. antigens
4. aberrant
5. antigen presenting cells
6. attacks
7. reads
8. human leukocyte antigens
Exercise 3-14
1. True
2. True
3. False, B&T cells
4. True
5. False, rapid
Learning Objective 7
Exercise 3-15
1. type IV
2. Immediate hypersensitivity
3. preformed antibodies
4. mast cells
5. histamine
6. Cytotoxic hypersensitivity
7. surface membrane of cells
8. NK cells
9. hapten
10. Immune complex hypersensitivity
11. B cells
12. systemic

13. Delayed hypersensitivity

14. cytotoxic T cells
Exercise 3-16
1. subsequent exposure
2. Anaphylaxis
3. cytolysis
4. Myasthenia Gravis
5. deposits
6. TB test
Exercise 3-17
1.Immediate hypersensitivity
2.Cytotoxic hypersensitivity
3.Immune complex hypersensitivity
4.Delayed hypersensitivity
Learning Objective 8
Exercise 3-18
1. eosinophils
2. Histamine
3. smooth
4. anaphylaxis
Exercise 3-19
1. Allergen
2. Atopy
3. Allergic rhinitis
4. Food Allergy
Learning Objective 9
Exercise 3-20
1. synovium
2. rheumatoid factor

3. Sjgren syndrome
4. salivary
5. lip
6. Scleroderma
7. fibrosis
8. Raynaud phenomenon
9. inflammatory myopathies
10. lymphocytic
11. immune complex
12. malar
13. antinuclear antibodies
14. uveitis
Exercise 3-21
1. True
2. False. Chronic discoid lupus erythematosus also has a butterfly rash, though its the only
characteristic
3. False. It is a mix of SLE, RA, and inflammatory myopathy alone.
Learning Objective 10
Exercise 3-22
1. Amyloidosis
2. hereditary Mediterranean fever
3. Alzheimer
4. light chain deposition
5. proteinuria
6. congestive heart failure
Exercise 3-23
See Exercise 3-22 for key terms covered in this section.
Exercise 3-24
1. rejection
2. Hyperacute

3. preformed
4. Acute
5. B and T cells
6. Chronic
7. Graft versus host disease
8. major blood group antigens
9. Rh blood group
10. minor transfusion reaction
11. major transfusion reactions
Exercise 3-25
1. Minutes to hours
2. graft vasculature
3. Weeks
4. Months to years
Exercise 3-26
1. Autograft
2. Homograft / Allograft
3. Xenograft
4. Hemolytic disease of the newborn/ Erythroblastosis fetalis
5. Blood typing
6. Major crossmatch
7. Minor crossmatch
Learning Objective 12
Exercise 3-27
1. Agammaglobulinemia
2. gastrointestinal
3. DiGeorge syndrome
Exercise 3-28
1. Decreased IgA (from plasma cells)
2. Autosomal recessive

3. Deficiency of T lymphocytes
4.Various genetic causes, severe immunodeficiency
5. Recurrent infections
Exercise 3-29
See Exercise 3-28 for key terms covered in this section.
Learning Objective 13
Exercise 3-30
1. acute viral syndrome
2. chronic (latent) infection
3. progression to clinical AIDS
4. increase
5. Pneumocystis
Exercise 3-31
1. Definitive without labs
2. Definitive with labs
3. Presumptive with labs
Exercise 3-32
1. AIDS
2. HAART (highly active antiretroviral therapy).
Test Yourself
Multiple Choice
1. The answer is B. IgM provides initial protection against a microorganism, and is the first
antibody to appear in the blood.
2. The answer is A. A xenograft is an animal graft. An autograft/homograft is one that
comes from the patient him/herself. Finally, an allograft is from another human.
3. The answer is D. A positive PPD is an example of a delayed type hypersensitivity (Type
IV).
4. The answer is C. T cells learn in the thymus, and B cells in the bone marrow, the
difference between self and nonself. Imperfect fetal B and T cell programming results in a

few nontolerant T and B cell survival. Inaccessible self-antigens prevent antigen exposure
to the B and T cells for them to become tolerant (recognize them as self). Infection and
inflammation may alter self-antigens in a way that makes them appear as nonself. Finally,
molecular mimicry can result in the attack of self-antigens that bear similarity to an
infectious agent or foreign protein.
5. The answer is D. DiGeorge is a disease caused by thymic hypoplasia. Patients with the
disease lack T cell function, but B cell immunity is unaffected. They are therefore prone to
viral, fungal, and protozoal infectious. Because development of the fetal thymus is closely
linked with nearby anatomical structures, DiGeorge patients may lack parathyroid glands
and suffer from hypoparathyroidism, anomalies of the neck, face, ears, heart, and aorta.
6. The answer is B. Acute rejection can occur within a few weeks, owing to an immune
vasculitis, or later if immunosuppressive therapy fails, and involves both B and T cells.
Hyperacute rejection occurs when preformed antibodies in the recipients blood react
immediately with graft vasculature. Finally, chronic rejection is a result of prolonged T cell
assault on donor cells, causing a chronic vasculitis, which deprives the organ of blood flow.
Latent rejection is not a form of rejection.
7. The answer is B. Patients with systemic lupus erythematosus may have lupus
anticoagulant, an antibody that causes a hypercoagulable state, but causes test results that
appear to be the opposite.
8. The answer is D. All of the above are nonimmune defense mechanisms.
9. The answer is A. Systemic sclerosis is a disease of young women, and features sclerosis of
the GI tract (including the esophagus, which can cause dysphagia), lungs (resulting in
pulmonary fibrosis and shortness of breath), kidney, heart, skeletal muscle, and small
blood vessels (which can cause Raynauds phenomenonthe blanching, numbness, and
pain of her fingers and toes).
10. The answer is C. Reactive systemic amyloidosis occurs in conjunction with chronic
inflammatory disease, such as rheumatoid arthritis. The amyloid protein is not an
immunoglobulin but appears to be related to proteins produced during the inflammatory
response.
11. The answer is A. Anaphylaxis is an example of immediate hypersensitivity.

12. The answer is D. Bruton disease is an X-linked immunodeficiency characterized by an

inability to produce normal immunoglobulin. Patients usually present with recurrent
bacterial (staph, strep, and Haemophilus), viral, and parasitic infections after six months
(once he loses the benefit of passive maternal antibodies).
13. The answer is C. B cell immunity is adversely affected because normal B cell function
requires helper T cell support and helper T cells are the prime target of HIV. B cells are also
stimulated by the antigens of HIV, CMV, EBV, and other infections, resulting in the
production or large amounts of ineffective antibody.
14. The answer is A. Patients with Sjgren syndrome suffer from keratoconjunctivitis sicca
(dry eyes) and xerostomia (dry mouth). Diagnosis requires lip biopsy to document
inflammation of small accessory salivary glands.
15. The answer is D. Cytotoxic T cells, in addition serving as the effector cells of cellular
adaptive immunity, they also act to suppress unnecessary antibody production to prevent
runaway reactions and autoimmune disease. Regulatory T cells also modulate the immune
response to prevent development of autoimmune disease.
True or False
16. False. Kidney and bone marrow transplants require close matching of MHC/HLA types,
but heart and liver transplants are less strict.
17. True
18. False, tonsils and lymph nodes are secondary lymphoid organs, while bone marrow and
the thymus are the primary lymphoid organs.
19. True
20. True
21. False. The spleen, bone marrow, and lymph nodes all capture and destroy nonself
material.
22. True
23. False. Class I MHCs are present on the surface of every body cell except red blood cells.
Class II MHCs occur only on macrophages and dendritic cells, and do display external
nonself antigens.
24. True

Matching
25.

A.

<viii> Plasma cells are antibody secreting cells.

B.

<i, ii, iii, iv> Macrophages, Microglia, Kupffer cells, and Dendritic cells ingest
and destroy microbes and other nonself antigens.

C.

<i, iv> Macrophages and dendritic cells capture antigens for presentation to T
lymphocytes.

D.

<i, vi> NK cells and cytotoxic T cells attack and kill virus infected cells and

tumor cells.
E.

<vii> Memory B cells are preprogrammed cells that quickly multiply and
release a flood of antibodies the next time the antigen appears.

26.

A. <iii>
B <iv>
C <ii>
D <iv>
E <iii>
F <iii>

Short Answer
27. Histamine released from IgE-sensitized mast cells causes rhinorrhea, sneezing,
congestion, wheezing, shortness of breath, and itchy watery eyes. Avoiding the allergen or
removing it from the environment is the treatment of choice. But oral antihistamine or
steroids may also be of use. Desensitization, or graduated injections to build up tolerance,
is another possible option.
28. As patients with group AB have no anti-A or anti-B in their plasma, they can receive
blood of any of the four types: AB, A, B, or O. Additionally, Rh+ patients can receive Rh+ or
Rh- blood. Group AB+ is, therefore, the universal recipient.
29. AIDS is a clinical diagnosis, proved by the presence of certain AIDS-related diseases
with or without supporting lab data (HIV antigens or antibodies in blood, CD4+ lymphocyte
< 200 cells/ul). This falls into three categories:

Definitive, without confirming laboratory data: lymphoma or Kaposi sarcoma in a

patient <60 yrs old, Cryptococcosis (other than lung), Mycobacterium avium (other
than lung, skin, or LN), progressive multifocal leukoencephalopathy.

Definitive, with confirming laboratory data: Kaposi or lymphoma at any age,

pulmonary TB, disseminated coccidioidomycosis

Presumptive, with confirming laboratory data: retinal CMV, recurrent pneumonia,

brain toxoplasmosis