Which of these describe Innate Immunity?  Select all that apply

A. present at birth

B. primary role is second-line defense

C. not antigen specific

D. responds to invading micro-organism in 6-8 hrs without prior exposure

A, C

-primary role is first-line defense

-is nonspecific so innate immunity can respond to an invading micro-organism within minutes without prior exposure

Acquired immunity is the development of immunity and can be either:  Select 2

A. active

B. cell-mediated

C. humoral

D. passive

Active aquired immunity is a result of what?

A. genetically inherited

B. acquired by development of thymus

C. acquired by invasion of foreign substances

D. results from OTC and prescribed meds

C. aquired by invasion of foreign substances

-examples are diseases or immunizations

-because antibodies are synthesized, immunity takes time to develop but is long lasting

Passive aquired immunity is obtained by?

A. immunizations

B. exposure to disease

C. acquired from an outside source

D. maturation of long bone, bone marrow

C. acquired from an outside source

-aquired from immunoglobulins crossing the placenta or gamma globulin injection

-this immunity has an immediate affect but is short lived because the body is not producing the antibodies

An antigen is a substance that _______ an immune response.  Most antigens are composed of _______.

A. suppresses, proteins

B. mediates, polysaccharides

C. elicits, proteins

D. suppresses, nucleic acids

C. elicits, proteins

-ALL of the bodies cells have antigens on their surface that are unique to that person and enable the body to recognize "self"

The lymphoid system is composed of central (primary) and peripheral lymphoid organs.  Select all of the central organs.

A. tonsils

B. bronchial-associated lymphoid tissue

C. bone marrow

D. lymph nodes

E. spleen

F. thymus gland

C, F

-bone marrow and the thymus are the central lymphoid organs

-peripheral lymphoid organs consist of: the tonsils, gut-, genital-, bronchial-, and skin-associated lymphoid tissue, lymph nodes, and the spleen

Lymphocytes are produced where?

A. bone marrow

B. thymus

C. lymph nodes

D. spleen

A. bone marrow

-lymphocytes eventually migrate to peripheral organs

-the thymus is important in the differentiation and maturation of T lymphocytes and is therefore essential for a cell-mediated immune response

The skin associated lymph tissue primarily consists of lymphocytes and what?

A. epidermis

B. Langerhans' cells

C. IgG immunoglobulins

D. IgA immunoglobulins

B. Langerhans' cells

-these are a type of dendritic cell

-when Langerhans' cells are depleted the skin can neither initiate an immune response nor support a skin-localized delayed hypersensitivity response

After antigens are transported to a lymph node they interact with all of the following except?

A. B lymphocytes

B. T lymphocytes

C. macrophages

D. natural killer cells

What are the 2 important functions of lymph nodes?

A. production of antibodies

B. mediation of cytokines

C. filter foreign material

D. circulation of lymphocytes

What is the primary site of filtration of foreign antigens from the blood?

A. liver

B. lymph nodes

C. kidneys

D. spleen

The spleen consists of what 2 kinds of tissue?

A. white

B. red

C. yellow

D. gray

White pulp in the spleen contains what?

A. natural killer cells

B. erthrocytes

C. IgG and IgM

D. B & T lymphocytes

Red pulp in the spleen contains what?

A. RBCs

B. plasma

C. antibodies

D. Langerhans' cells

The mononuclear phagocyte system consists of moncytes in the blood and marophages throughout the body.  They are responsible for what?

A. production of antibodies

B. transportation of cytokines

C. capture of antigens

D. destruction of antigens

C. capture of antigens

-they are responsible for capturing, processing, and presenting the antigen to lymphocytes.  Thus stimulating either a humoral or cell-mediated immune response.

-capturing is accomplished through phagocytosis

-the macrophage bound antigen is presented to circulating T or B lymphocytes and thus triggers an immune response

B cells (lymphocytes) differentiate into _______ when activated.  

A. macrophages

B. plasma cells

C. antibodies

D. natural killer cells

B. plasma cells

-plasma cells then in turn produce antibodies (immunoglobulins)

Cells that migrate from the bone marrow to the ______ differentiate into T cells (lymphocytes).

A. spleen

B. liver

C. lymph nodes

D. thymus

D. thymus

-T cells compose 70-80% of the circulating lymphocytes and are primarily responsible for immunity to intracellular viruses, tumor cells, and fungi

-T cells live from a few months to the life span of an individual and account for long-term immunity

All mature T cells have the _______ antigen.

A. IL-4

B. CD3

C. CD8

D. G-CSF

T cytotoxic cells carry what antigen?

A. CD4

B. CD8

C. TC3

D. TC8

T cytotoxic cells attack antigens on the cell membrane of foreign pathogens and destroy the pathogen by?

A. phagocytosis

B. reverse transcription

C. interruption of protein synthesis

D. release of cytolytic substances

D. release of cytolytic substances

-T cytotoxic cells have antigen specificity and are sensitized by exposure to the antigen

-similar to B cells some sensitized T cells do not attack the antigen but remain as memory T cells

This immunoglobulin is 76% of the serum concentration, it is located in the plasma, it is the only one that crosses the placenta and is responsible for secondary immune response.

A. IgD

B. IgA

C. IgE

D. IgG

This immunoglobulin is found in tears, saliva, breast milk; it lines the mucous membranes and protects body surfaces.

A. IgG

B. IgA

C. IgE

D. IgM

This immunoglobulin is in plasma; is responsible for primary immune response; forms antibodies to ABO blood antigens.

A. IgM

B. IgG

C. IgE

D. IgD

This immunoglobulin is located in plasma; is present on lymphocyte surface; assists in the differentiation of B lymphocytes.

A. IgA

B. IgE

C. IgD

D. IgG

This immunoglobulin is in plasma; causes symptoms of allergic reactions; fixes to mast cells and basophils; assists in defense against parasitic infections

A. IgE

B. IgD

C. IgM

D. IgA

T helper cells differentiate into 2 subsets.  T_H1 and T_H2.

True or False?

T_H1 cells stimulate what immune response?

A. phagocyte-mediated ingestion and killing of microbes

B. histamine migration and initiation of inflammation

C. CD8 cell migration and lyse of antigen

D. production of IgG in secondary immune response

A. phagocyte-mediated ingestion and killing of microbes

-this is the key component of cell-mediated immunity

T_H2 cells stimulate what immune response?

A. phagocyte- mediated ingestion and killing of microbes

B. eosinophil-mediated immunity

C. migration of natural killer cells

D. production of cytokines

B. eosinophil-mediated immunity

-which is effective against parasites and is involved in allergic responses

True

-these are not T or B cells

-they are large lymphocytes with numerous granules in the cytoplasm

Natural killer cells are antigen specific and require previous exposure to attack an antigen.  

True or False?

False

-NK cells do not require prior sensitization for their generation

-NK cells are involved in recognition and killing of virus infected cells, tumor cells, and transplanted grafts

-NK cells have a significant role in immune surveillance for malignant cell changes

Dendritic cells in the skin are called?

A. Langerhans' cells

B. natural killer cells

C. cytokines

D. Interleukins

A. Langerhans' cells

-these have an atypical shape with extensive dendritic processes that form and retract

The primary function of the dendritic cells are to capture antigens where?

A. lymph channels

B. nerve endings around the spine

C. skin, mucous membranes

D. intestinal tract

C. skin, mucous membranes

-dendritic cells capture antigens at sites of contact with the external environment and transport them until they encounter a T cell with a specificity for that antigen

These are soluble factors secreted by WBCs and a variety of other cells in the body that act as messangers between the cell types instucting them to alter their proliferation, differentiation, secretion, or activity.

A. cytokines

B. immunoglobulins

C. antibodies

D. plasma cells

A. cytokines

-interleukins act as immunomodulatory factors

-colony-stimulating factors act as growth-regulating factors for hematopoietic cells

-interferons are antiviral and immunomodulatory

With of the following is NOT a detrimental effect of cytokines?

A. sepsis

B. tumor formation

C. chronic inflammation

D. autoimmune disease

The cytokine, Interferon, is used clinically to?

A. stimulate hematopoesis

B. attack tumors and viruses

C. stimulate bone marrow to make WBCs

D. stimulate protein synthesis

B. attack tumors and viruses

-Interferon inhibits viral replication, activates NK cells and macrophages, and has antiproliferative effects on tumor cells

Which group of cytokines main action is stimulating proliferation and differentiation?

A. Interleukins

B. Interferons

C. Tumor Necrosis Factor

D. Colony-Stimulating Factors

The cytokine, Tumor Necrosis Factor, is responsible for which side effect of cancer?

A. hair loss

B. weight loss

C. nausea, vomitting

D. joint pain

B. weight loss

-TNF activates macrophages and granulocytes, promotes immune and inflammatory responses, kills tumor cells, is responsible for weight loss associated with chronic inflammation and cancer

The cytokines, Interluekins, work to inhibit the actions of the immune response. 

True or False

False

-there are several subtypes of Interluekins but they seem to mostly promote growth of B and T cells, enhance activity of these and NK cells and macrophages

Say whether each is an example of 1) natural active immunity, 2) artificial active immunity, 3) natural passive immunity, or 4) artificial passive immunity.

A. recovery from chickpox exposure

B. immunoglobulins in colostrum

C. injection of human gamma globulin

D. MMR immunization

E. transplacental immunoglobulins

F. injection of serum from immune human

A. natural active immunity

B. natural passive immunity

C. artificial passive immunity

D. artificial active immunity

E. natural passive immunity

F. artificial passive immunity

Which type of immunity consists of anitbody mediated immunity?

A. humoral

B. cell-mediated

A. humoral

-the major attribute of humoral immunity is the involvement of anitbodies (IgA, IgG, IgM, IgD, IgE)

Which type of cell initiates a humoral immunity response?

A. T helper cells

B. T cytotoxic cells

C. B cells

D. IgG anitbodies

C. B cells

-B cells specific to the antigen come into contact with the antigen either by direct contact or a monocyte or macrophage presents the antigen to the B cell

When a B cell comes into contact with the antigen it is specific too it becomes activated and most will differentiate into what?

A. plasma cells

B. IgG

C. immunoglobulins

D. macrophages

A. plasma cells

-then the mature plasma cells secrete immunoglobulins

-some will remain as memory B cells

Which immunoglobulin is primarily involved in a primary immune response?

A. IgD

B. IgM

C. IgG

D. IgA

B. IgM

-the primary immune response becomes evident 4-8 days after initial exposure.

-IgM is the first type of anitbody formed

-IgM is large and confined to the intravascular space

-As the immune response progresses IgG is formed and can move from intravascular to extravascular space

What is the primary antibody formed in a secondary immune response?

A. IgD

B. IgM

C. IgA

D. IgG

D. IgG

-the response occurs within 1-3 days, is stronger, and lasts longer

-memory cells account for the more rapid response

Which of these is NOT a function of the spleen?

A. red pulp destroys old RBCs

B. stores platelets

C. prevents sepsis in children

D. maturation of T cells

Both B and T cells are produced in bone marrow.

True or False

True

-B cells mature in the bone marrow

-T cells are produced in bone marrow then move to the thymus where they mature

Innate immunity is _______, and immediate response occurs within _____, delayed response occurs within_______.

A. nonspecific, 12 hrs, 36 hrs

B. specific, 4 hrs, 96 hrs

C. specific, 12 hrs, 36 hrs

D. nonspecific, 4 hrs, 96 hrs

D. nonspecific, 4 hrs, 96 hrs

-innate immunity is acquired from the mother, it is nonspecific and broad spectrum against infection

-releases histamine that engulfs foreign bodies

-activated to respond to tissue damage

-helps form scar tissue/repair tissue

On antibodies what serves as binding sites for specific antigens?

A. proteins

B. polysaccarides

C. peptide chains

D. surface markers

Elevation of which antibody indicates an allergic reaction?

A. IgE

B. IgG

C. IgM

D. IgA

Cell-Mediated Immunity involves ______ carrying antigens to lymph nodes for destruction.

A. NK cells

B. B cells

C. macrophages

D. T cells

D. T cells

-helper T cells activate other cells to get busy destroying the antigen

Cell-Mediated Immunity is of primary importance in all of the following except?

A. immunity against pathogens that survive inside cells

B. fungal infections

C. rejection of transplanted tissues

D. anaphylactic responses

E. contact hypersensitivity

F. tumor immunity

D. anaphylactic responses

-these are a result of humoral immunity

Which of these is NOT a cause for immunodeficiency in older adults?

A. levels of immunoglobulins decrease

B. thymic involution

C. T and B cell deficiencies

D. T cell differentiation increases

E. bone marrow suppression

E. bone marrow suppression

-bone marrow is remains relatively unaffected with age

-T and B cells are deficient in activation, transit time through the cell cycle, and subsequent differentiation

-As the thymus shrinks T cell differentiation increases leading to an accumulation of memory cells instead of precursor cells

(this seems to contradict itself to me; its under gerontologic considerations p 217 Med Surg book)

Which immunodeficiency disorder is caused by improperly developed or absent immune cells?

A. primary

B. secondary

A. primary

-these are present at birth; are rare and often serious

-commonly a B cell deficiency

-the basic categories of primary immunodeficiency disorders are 1) phagocytic defects 2) B cell disorders

3) T cell disorders 4) combined B and T cell disorders

What is the most common cause of secondary immunodeficiency disorders?

A. stress

B. age

C. drugs

D. disease

C. drugs

-immunosuppressive therapy is prescribed for patients to treat autoimmune disorders and prevent transplant rejection

-immunosuppression is a serious side effect of drugs used to in chemotherapy

Generalized leukopenia, often a result of chemotherapy, leads to a decreased response of which immunity?

A. humoral

B. cell-mediated

C. both

D. neither

C. both

-because of this secondary infections are common among patients on chemotherapy

Deficiency of what leads to atrophy of the thymus gland and decreased lymphoid tissue?

A. T cells

B. iron

C. protein

D. immunoglobulins

C. protein

-an increased susceptibility to infection also exists

Which virus is especially cytotoxic to lymphoid cells and can lead to immunodeficiency?

A. influenze

B. rubella

C. measles

D. herpes zoster

B. rubella

-Hodgkin's lymphoma greatly impairs cell-mediated immunity and can lead to severe viral or fungal infections

-radiation destroys lymphocytes directly and depletes stem cells

What surgical procedure in children puts them at risk for septicemia?

A. T & A

B. appendectomy

C. tube placement

D. splenectomy

D. splenectomy

-the spleen is the primary site of filtering foreign antigens from the blood; impairment or loss of this in a child can lead to septicemia from a simple respiratory infection

-****watch for signs and symptoms of sepsis in a child s/p splenectomy****

-monitor subtle changes in VS, LOC

-culture wounds

-strict handwashing and aseptic technique

-use moisturizers to maintain skin integrity

-bathe daily

-avoid sick people

-avoid persons who received a LIVE virus vaccine (up to 6 wks)

-balance exercise and adequate rest

A procedure used to to separate components of blood followed by the removal of one or more of the components is called?

A. transfusion

B. dialysis

C. apheresis

D. blood donation

C. apheresis

-ex: platetletpheresis-the removal of platelets (usually for collection from normal individuals to be given to those with low platelet count)

-leukocytapheresis-removal of WBCs

-lymphocytapheresis-removal of lymphocytes

Type 1 hypersensitivity reactions involve which antibody?

A. IgA

B. IgG

C. IgM

D. IgE

D. IgE

-these reactions range from atopic dermatitis and urticaria (hives), to angioedema and anaphylaxis

Asthma is what type of hypersensitivity response?

A. type 1

B. type 2

C. type 3

D. type 4

Types 1, 2, and 3 hypersensitivity reactions are immediate and examples of __________.  Type 4 is delayed and is related to __________.

A. cell-mediated immunity, cell-mediated immunity

B. humoral immunity, humoral immunity

C. cell-mediated immunity, humoral immunity

D. humoral immunity, cell-mediated immunity

D. humoral immunity, cell-mediated immunity

-IgE is involved in Type 1

-IgG and IgM are involved in Type 2 and 3

-no antibodies are involved in Type 4

Which of the following is NOT a cardiovascular symptom of anaphylaxis?

A. hypertension

B. dysrhythmia

C. tachycardia

D. cardiac arrest

A. hypertension

-hypotension is a symptom of anaphylaxis

Allergic rhinitis is the most common Type 2 hypersensitivity reaction.

True or False

False

-allergic rhinitis, hay fever, is the most common Type 1 hypersensitivity reaction

-can be year round or seasonal

-brought on by pollen, dust, mold, animal dander

-affects conjuctiva of the eyes and mucosa of the upper respiratory tract

-S&S: nasal drainage, sneezing, mucosal swelling and airway obstruction

Wheal and flare reactions are the dominant trait associated with atopic dermatitis.

True or False

False

-atopic dermatitis is chronic and inherited and has periods of remission and exacerbation

-IgE is elevated

-there is no wheal and flare, skin lesions are generalized and involve vasodilation of blood vessels, resulting in interstitial edema

Angioedema is similar to uticaria but involves deeper layers of the skin and submucosa.

True or False

True

-areas involved are eyelids, lips, tongue, larynx, hands, feet, GI tract, and genitalia

-swelling begins in the face then progresses to the airways and other parts of the body

-dilation and engorgement of the capillaries secondary to the release of histamine cause the diffuse swelling

-outer skin appears normal or has a reddish hue

-lesions may burn, sting, or itch and can cause acute abd pain

-is not life threatening

Atopic dermatitis can be treated with moisturizers but bad cases may require?

A. benadryl

B. topical steroids

C. penicillin

D. antibiotic creams

The wheal and flare (ex. mosquito bite) is an example of?

A. systemic anaphylaxis

B. local anaphylaxis

C. type 2 hypersensitivity reaction

D. immune-complex reaction

Clinical symptoms of allergic reaction to food include:

Select all that apply

A. wheezing

B. rash

C. swollen face

D. swollen lips/tongue

ALL

-treat with benadryl

An allergic reaction will show an increase in ________ and ____________.

A. IgM, basophils

B. IgG, macrophages

C. IgA, platelets

D. IgE, eosinophils

The purpose of an allergy shot is to increase _______ in an effort to decrease IgE.

A. RBCs

B. sodium concentration

C. IgG

D. basophils

Your pt has just been given penicilin for the first time.  Within minutes he has a drastic drop in BP, becomes tachycardic, you auscltate stridor, and he is having difficulty breathing.  You recognize this is a systemic anaphylactic reaction, what drugs do anticipate administering?  Select all that apply

A. epinephrine

B. benadryl IV

C. IV fluids

D. vasodialators

A,B,C

-vasopressors would be needed to raise the BP

-intubation is also possible

Put the four stages of immune response in order:

-response

-effector

-proliferation

-recognition

1) recognition

2) proliferation

3) response

4) effector

ABO blood incompatibility are examples of which type of hypersensitivity reaction?

A. type 1

B. type 2

C. type 3

D. type 4

B. type 2

-body mistakes normal tissue as foreign

Poison oak and TB are examples of which hypersensitivity reaction?

A. type 1

B. type 2

C. type 3

D. type 4

D. type 4

-these occur within 24-72 hours after exposure and are caused by synthesized T cells

Which of the following is NOT true of systemic lupus erythematosus?

A. an autoimmune disease

B. women 10 times more at risk than men

C. staph infection is a predisposing factor

D. UV exposure triggers exacerbation

E. autoantibodies attack DNA

C. staph infection is a predisposing factor

-strep may be a predisposing factor

With kidney damage you would expect serum creatinine levels to be?

A. 0.5

B. 0.9

C. 1.2

D. 1.7

D. 1.7

-elevated creatinine indicates kidney damage

Patients with systemic lupus erythematosus are at risk for CVA.

True or False

True

-due to artherosclorosis

-kidney failure is the leading cause of death

Blood work on the patient with systemic lupus erythematosus may show ____ WBC, _____ platelets, ______ sed rate.

A. decreased, increased, increased

B. increased, increased, increased

C. decreased, decreased, increased

D. decreased, decreased, decreased

Which of these is NOT a S&S of SLE?

A. fever

B. weakness

C. fatigue

D. weight loss

E. elevated WBC

E. elevated WBC

-also the classic "butterfly rash"

FOUR OF THESE MUST BE PRESENT TO DIAGNOSE WITH SLE

-number 10: anti-DNA and anti-Sm are the definitive tests for SLE

NSAIDs and antimalarial agents (Plaquenil) are used to treat SLE.  Plaquenil treats fatigue and moderate skin and joint problems.  A response to Plaquenil may not be noticed for months.  What can potentially occur with prolonged high dose use of Plaquenil?

A. retinopathy

B. sterility

C. LOC changes

D. seizures

A. retinopathy

-this tends to go away when the drug is discontinued

Blood clots can be a life-threatening side effect of SLE and Coumadin or heparin may be prescribed.

True or False

Why is it important for the pt with SLE to consult her doctor before becoming pregnant?

A. she will require fertility drugs

B. increased risk for stillbirth/abortion

C. the disease will be passed to the infant

D. she wil require a cesarean birth

Which of the following is true of Herpes Zoster?

Select all that apply

A. bacterial infection

B. usually bilateral

C. duration usually 2-3 days

D. contact precautions

E. 1 nucleic acid

D,E

-is a viral infection, not bacterial

-usually unilateral not bacterial

-duration usually 2-3 weeks not 2-3 days

-exam lesions, give antivirals, encourage handwashing, pain control

Treatment of herpes is?

A. penicillin

B. aspirin

C. acylovir

D. prednisone

C. acylovir; topical or PO

-herpes is exacerbated by sunlight, stress, and immunocompromised

-reduce stimuli

-raise HOB

-NO PILLOW

-tylenol with codeine for HA

Viral meningitis is diagnosed by S&S (HA, fever, light sensitive, stiff neck) and spinal tap.  What will the spinal tap show?  Select all that apply

A. increased lymphocytes

B. decreased lymphocytes

C. increased WBCs

D. decreased WBCs

Treatment of choice for encephalitis?

A. acyclovir

B. penicillin

C. azithromycin

D. amoxicillin

A. acyclovir

-S&S: malaise, HA, flu-like, tremors, speech difficulty, increased ICP

-diagnosed by LP

-results from childhood illnesses, also West Nile (mosquito bites)

Rhabdovirus (rabies) is an RNA virus that can progress to what?

A. Hepatitis B

B. meningitis

C. encephalitis

D. scarlet fever

C. encephalitis

-pharyngeal spasms at the sight, sound, taste of water

-clean bite mark and treat with rabies vaccine within 48 hours and follow vaccine regimen

Treat scarlet fever with?

A. tetracycline

B. erthromycin

C. doxicycline

D. prednisone

B. erthromycin

-or penicillin

-child may return to school after 24 hours from antibiotic administration

-caused by strep bacteria

Treat cat scratch fever with?

A. penicillan

B. doxicycline

C. tetracycline

D. prednisone

C. tetracycline

-caused by strep bacteria

Classic signs of diptheria are?

Pick 2

A. nasal manifestations

B. hypotermia

C. stridor

D. odorous nasal discharge

A,D

-treat with diptheria vaccine and antibiotics

Lyme disease is spread by tick bites.  Which of the following is NOT a stage of Lyme disease?

A. early localized

B. late localized

C. early dissemination

D. late dissemination

B. late localized

-early localized is the appearence of the "bulls eye rash" and flu like symptoms

-early dissemination occurs 1-4 months after the bite and is characterized by chronic HA, NV, possible Bell's Palsy and joint inflammation

-late dissemination is months to years after the bite and is characterized by chronic arthritis and neurological problems

Treat Rocky Mountain Spotted Fever with what?

A. doxycycline

B. penicillan
C. tetracycline

D. prednisone

A. doxycycline

-within 5 days of tick bite

-S&S flu like, rash begins on palms and soles of feet and spreads

Thrush is an example of a?

A. bacterial infection

B. fungal infection

C. viral infection

D. autoimmune disease

Protozoans are contracted by visiting foreign countries and drinking the water.

True or False?

At what T cell (CD₄) level does HIV become a diagnosis of AIDS?
A. <200

B. <500

C. <750

D. <1000

A. <200

-<500 begins to show immune suppression

-<200 begin to develop oppurtunistic viruses

-healthy T cells live for about 100 days; infected T cells live 2 days

What is given as a prophylaxis for pneumonia in HIV patients?

A. bactrim

B. penicillan

C. tetracycline

D. doxycycline

Stage A of HIV infection is the period from initial exposure (fever, skin rash) may last ________ before immunocompromised.

A. 2-4 years

B. 8-10 years

C. 12-15 years

D. 15-20 years