Lymphatic and Immunology

1. Functions of the lymphatic system include

a) Fluid recovery
b) Filtration
c) Absorption of fats
d) All
e) None

2. Lymphatic vessels originate from

a) Arteries b) Veins c) Nerves d) None

3. Lymphatic vessels empty into

a) Subclavian veins b) Jugular veins c) IVC d) SVC

4. The Right upper quarter of the body is drained by the ________ Lymphatic duct

5.Lymph is propelled by all of the following except

a) Contractile force of the heart
b) Arterial pulsation
c) Venous contractions
d) Skeletal muscular motions

6.Specialized cells found in lymphatic tissue include

a) Macrophages derived from monocytes
b) Lymphocytes
c) Antigen presenting (Dendritic ) cells
d) Reticular cells
e) All

7.Lymphatic organs include

a)
b)
c)
d)
e)

8. Lymph nodes are evaluated according to:

a) Size b) Consistency c) Mobility d) All of the above d) None

9) Functions of Lymph nodes include

a) Filter lymph
b) Activate immune system
c) Both
d) Neither

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10 Lymph nodes consists of
a) Capsule
b) Hilum
c) Cortex
d) Medulla
e) All

11. Define the term lymphadenopathy:

12: Discuss lymphadenitis

13. Tonsillectomy refers to removal of the _________ tonsils

14. The pharyngeal tonsil is commonly referred to as the ____________

15. Functions of the thymus include

a) Lymphatic activity
b) Endocrine activity
c) Both
d) Neither

16. The thymus is smallest in

a) fetus
b) New born
c) Small child
d) Teenager
e) Adult

17. The thymus secretes

a) Thymosins
b) Thymulin
c) Thymopoietin
d) All
e) None

18. The largest lymphatic organ in the body is the

a) Spleen
b) Liver
c) Kidney
d) Skin

19. The Thoracic Duct drains lymph into the:

a) Left Sumclavian vein b) Right Subclavian vein c) SVC d) IVC

20. The spleen of a child with Sickle Cell anemia is:

a) Enlarged b) Normal c) Shrunken d) Missing

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21. On Monday morning, a patient presented to the "E.R" at York General
complaining of groin pain. On physical examination you notice enlarged inguinal
nodes which were rock hard and nonmotile. This patient should be evaluated for
______________________

22. A person has a "strep throat", which lymph nodes would probably be swollen
and tender?
a) Anteroir auricular b) Axillary c) Pelvic d) None of the above

23. Red pulp of the spleen contain:

a) RBCs b) Lymphocytes c) Macrophages d) All of the
above

24. Which of the following anatomic changes in the spleen are consistent with
Sickle Cell Anemia?
a) Small spleen in children with hypertrophy of the spleen in adults
b) Hypertrophy of the spleen in childhood with splenic atrophy in adults
c) Small spleen in both children and adults
d) Splenic hypertrophy in both children and adults

Immunology

25 Nonspecific immunity include:

A) species resistance B) Mechanical barriers
C) Enzymes D) Inteferon E) All of the above

26. Which of the following contribute to non-specific resistance:

a) Flow of urine b) Ciliary escalator c) Both d)
Neither

27. Mechanical barriers to infection include:

a) Skin b) Mucous membranes c) Both d) Neither

29. Organisms which can penetrate mucous membranes or thrive in mucous

include:
a) Treponema pallidum b) Mycobacterium tuberculosis c)both d)
neither

30. Signs of inflammation include:

A) Heat b) Redness c) Pain d) Swelling e)All

32. Opsonization, Inflammation and cytolosis occur due to activation of:

A) C3 b) C5 c) C7 d) C9

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33. Collagen Vascular diseases occur due to a deficiency of:
A) C1 b) C2 c) C4 d) All e) None

34. Deficiency of C5-C9 is associated with:

A) Anaphalaxis and other hypersensitivity syndromes
B) Increased susceptability to Neisserial infections
C) Both
D) Neither

Directions (applicable questions)

A B C D E
1,2,3 1,3 2,4 4 only All
correct

35. Disorders of immunity include:

1. Hypersensitivity 2. Autoimmunity
3. Immundeficiency 4. Spontaneous mutation

36. In the Alternate pathway C3 may be activated by:

1. Properdin 2. Factor B
3. Factor D 4. Antibody complex

37. Important T-independent antigens include

1. M-Protein 2. Bacterial Flagella
3. Streptolysin O 4. Lipopolysaccharide

38. Regarding inteferons:

1. Inteferes with viral replication 2. Involved in antibody
production
3. Uninfected cells produce anti-viral substance 4. Does not protect infected
cells

39. Which of the following immunologic mechanisms of tissue injury is cell

mediated:
a) Type 1 b) Type 11 c) Type 111 d) Type 1V e) None of the above

40. The transfer of antibodies via breast milk is an example of:

a) Naturally acquired passive immunity b) Artificially acquired passive
immunity
c) Naturally acquired active immunity d) Artificially acquired active
immunity

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41. T- independent antigens stimulate B cells to produce:
a) IgA b) IgD c) IgE d) IgG e) IgM

42. The term "best lymphocyte" applies to:

a) Helper T cells b) Suppressor T cells c) B memory cells d) T memory
cells

43. Indications of anaphalaxis include:

1) Itching and erythema 2) Throat swelling
3) Chest constriction 4) Rash

44. Which of the following cross the placenta

A) IgA b) IgD c) IgE d) IgG e) IgM

44 The portion of an antibody which reacts with an antigen is called the :

a) constant region B) variable region
c) Hinge region D) Fc portion

45. Which of the following is responsible for identification of cells as either

self or non self:
A) Membrane attack complex b) Major histocompatability complex
C) Both D) Neither

46. Factors which contribute to Nonspecific resistance include:

A) Flow of urine B) secretion of tears and perspiration
C) Ciliary escalator d) All of the above

47. Organisms or toxins which may survive gastric juice include:

A) Staph aureus
B) Clostridium botulinum
C) Helicobacter pylori
d) All
E) None of the above

48. Which of the following can survive phagocytosis:

A) HIV B) Mycobacterium tuberculosis
C) Both D) Neither

49. A persons resistance to disease may be influenced by his/her:

A) Genetic factors b) General health c) Age d) Nutritional status E)
all

50. Naturally acquired active immunity:

A) occurs following exposure to antigen B) May be lifelong
C) May be temporary D) All

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51. Naturally acquired active immunity may result from subclinical infections
with:
A) Mumps b) Hepatitis c) Polio d) All e) None of the above

52. Examples of naturally acquired passive immunity include.

A) Transfer of antibodies from mother to fetus across the placenta.
B) Transfer of maternal antibodies to the infant by breast feeding
C) Both
D) Neither

53. Vaccines represent:

A) Naturally acquired active immunty B) Artificially acquired active
immunity
C) Naturally acquired passive immunity D) Artificially acquired passive
immunity

Matching
Note these questions are for your informationonly. They are not on the exam
because of frequent changes in protocol.

Match each of the following vaccines with the most appropriate age at which
it should be administered. Use each choice once only. Please review current
schedule on CDC website. www.cdc.gov

54. DPT a) The elderly

55. Measels b) At or after 15 months
56 Mumps c) Prior to the 4th birthday
57. Pneumovax d) 1 year

Match each of the following vaccines with the most usual form of administration.
Each choice may be once, more than once or not at all.

58. Mumps a) Killed virus

59. Tetanus b) Human immune globulin
60 Rubella c) Toxoid
61.Polio d) Live attenuated virus
e) None of the above

62. Bence-Jones protein is an abnormal gammaglobulin produced in several

immunological disorders such as:
a) Multiple myeloma b) Macroglobulinemia of
Waldenstrom
c) Both d) Neither

63. Antibody mediated (humoral) is directed mainly against:

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A) Bacteria and their toxins B) Viruses
C) Both D) Neither

64.Complement is activated by
a) B cells b) T cells c) Both d) Neither

65. T- independent antigens stimulate B cells to produce

a) IgM b) IgG c) IgD d) IgE e) IgA

66. T-effector cells include:

a) Helper cells b) Suppressor cells c) Both d) Neither

67. Target cells destroyed on contact by Cytotoxic T cells include:

a) Cancer cells
b) phagocytes with intracellular bacteria and viruses
c) Parasites
d) Cells from transplanted tissue
e) All
68. Regulatory T cells include: ________________ and _________________

69. The most abundant immunoglobulin is ___________________________

70. The term “blocking antibody” refers to _________________________

71. Which of the following is found in exocrine secretions:

A) IgG b) IgM c) Both d) Neither

72. Which of the following is called “responsible antibody”:

a) IgA b) IgD c) IgE d)IgG e) IgM

73. The antibody which is usually associated with allergy is _________________

74. Naturally acquired immunity may be life long following exposure to all of the
following except:
a) Common cold b) Measels c) Yellow fever d) Chicken pox

75. Vaccines consist of:

1) Toxoids 2) Killed organisms
3) Live attenuated organisms 4) Nucleic acid extract

76. Naturally acquired passive immunity is effective against:

1) Diptheria 2) Measels
3) Rubella 4) Mumps

77.Which of the following vaccines consists of Human Immune Globulin:

1) DPT 2) Polio

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3) Rubella 4) Rabies

78. Type 11 immediate hypersensitivity may occur following infection with:

1) Viruses 2) Treponema 3) Mycoplasma 4)Streptococcus

79. Type 111 reactions require:

1) Antibody 2) Antigen 3) Complement 4) Basement membrane

80. Which of the following HLA antigens is associated with Salmonella arthritis:
a) A2 B) B27 c) Cw6 d) Dw12 e) None of the above

81. Anti-Smith antibody is commonly found in:

a) Sarcoidosis b) Lupus c) Graves disease d) ITP

82. Which immunologic mechanism of tissue injury relates to anaphalaxis?

a) Type 1 b) Type 11 c) Type 111 d) Type 1V

83. Cytotoxic reactions may occur following infections with:

a) Viruses b) Mycoplasma c) Syphilis d) All of the above

84. The two leading cause of infectious related Type 11 immunologic disorder are:
A) Rubella and Gram - sepsis B) Malaria and
Meningiococcus
C) Both D) Neither

85. Glomerulonephritis may be precipitated by localization of immune complex

In the kidney following infections with:
A) Streptococcus B) Malaria c) Helminths d) Hepatitis virus

86. A rheumatoid arthritis like syndrome can result from deposition of certain
immune
Complexes in the bones. Immunoglobulins implicated in this situation include:
A) IgA and IgE B) IgG and IgM c) Both d) Neither

87. The “TB” skin test ( Mantoux test) is a classical example of which type of
reaction:
a) Anaphalactic
b) Cytotoxic
c) Immune complex
d) Delayed hypersensitivity

88. In rheumatic fever there is cross reaction between __________________ and

antistreptococcal antibody.

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89. Persons with x-linked agammaglobulinemia are strongly predisposed to
infections with:
1. Hemophilus influenzae 2. Streptococcus
pyogenes
3. Staphylococcus aureus 4. Streptococcus
pneumoniae

90. Persons with Bruton’s disease are likely to suffer from:

1. Bronchitis and pneumonia 2. Chronic pharyngitis
3. Otitis media 4. Sinusitis

91. Treatment of choice for Di Deorge’s syndrome is:

a) Faith healing b) Herbal teas c) Antibiotics c)
Surgery

92. Immunologically privilaged tissues include:

a) Cornea b) Brain c) Both d) Neither

Matching

93 . Goodpasture;s syndrome A) Anaphalaxis

94. Idiopathic thrombocytopenia purpura B) Cytotoxic
95. Transplant rejection C) Immune complex
96. Asthma D) Delayed
hypersensitivity
97. Contact dermatitis E) None of the above

98..Which of the following parameters observed on the immune competence

profile of
an AIDS patient would suggest a poor prognosis:
1. Low CD2 2. Low CD4
2. Inverted CD4/CD8 ratio 3. Low CD8

100. The most common serious complication of AIDS

is______________________

101. Which of the following HLA antigens associated with HIV infection may
predispose an AIDS patient to fast progression of the disease.
a) DQB1*0601 b) DQB1*0605 c) Both d) Neither

Answer Key:
Lymphatic
1d 2b 3a 4 right 5a 6e 7 lymph nodes, tonsils,
thymus, spleen, Peyer’s patches, appendix 8d 9c. Please know the locations
of lymph nodes such as cervical,axillary, inguinal, pelvic cavity, abdominal cavity

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and thoracic cavity! 10e 11 Lymphadenopathy refers to nonspecific lymph
node disease
12. Lymphadenitis refers to swollen, painful lymph nodes 13 Palatine tonsils
(note these are paired)14 Adenoids (note this is unpaired even though the word is
commonly used in the plural form) 15c 16e 17d 18a 19a 20a
21 hard nonmotile lymph nodes are often the first indication of CANCER
22a 23d 24b

Immunology: Please note that sometimes it is best to draw from different

disciplines to get the “big picture” having said that we will incorporate a bit of
microbiology into our discussions since a significant portion of our immunity is
directed vs microorganisms in the first place!

25e 26c 27c 29c 30d 32a 33d 34b 35a (meaning choices
123 as per the instructions. This is a commonly used format on professional
exams) 36a 37c
(choices 2 and 4 only) 38e (all ) 39 d (choic 4 only) 40a 41e 42d
(this cell acts like “ a one man gang” 43e 44d 45b 46d 47d 48c
( Note many microbes are destroyed by phagocytosis, however certain organisms
actually use this as w way to get into a cell and cause trouble!) 49e 50d
51d (subclinical infection occurs when you catch something but have
enough resistance to overcome it without even knowing that it was ever there in
the first place. Ie: you were never symptomatic)
Special note: 52-60 will not be on exam because both formulation of vaccines
and protocols for administration vary!52c 53b 54c.55b 56d 57a
58d
59c 60d 61d 62c 63c 64a 65e (same as 41) 66c 67e
68 Helper (T4) and Supressor (T8) cells 69 IgG 70 IgG
71d (note answer is IgA and IgE. ) 72 c (IgE is called “responsible
antibody” because it plays a major role in mediating the allergic response to
various antigens, meanwhile IgG is called “blocking antibody” because it tends to
block, prevent or reduce the nasty effects of IgE). 73 at this point the answer is
obviously IgE 74a (you onlu get chicken pox once but you can catch the
cold every year!) 75 Remember these? Answer is A (1,2,3) 76b
(1and 3 only) 77d (4 only) 78a (note Type 2 reactions are cytotoxic, type 1 is
anaphylactic , type 3 is immune complex and type 4 is delayed hypersensitivity)
79a 80b (Note there are many HLA antigens, many of which are
associated with particular diseases) 81b 82d 83d 84a 85E all Please
note correction. Choice A is a very common cause but the others occur.
86b
87d 88 heart muscle (Now, that’s bad news!) 89e (Note this is an inherited
immune deficiency as opposed to AIDS which is acquired 90 e (This is another
inherited immune deficiency) 91c (another inherited immune deficiency)
92c
(Special note: This is a red hot topic! An immunologically privileged tissue is
one which is protected from tissue destruction by the immune system. For

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example, the cornea can be transplanted from any person to any other person
without having to take the usual complexities into consideration! Sorry folks so far
we are still unable to tranplant a brain otherwise I would have been be the first one
at Einstein’s grave site!)
93c 94b 95d 96a 97d 98a 100 Pneumocystis carinii pneumonia
(PCP, this is probably the most common cause of death of patients with HIV ,
some additional microbiology the organism has been renamed P. jiroverci) 101a
( appreciate the role of genetics! Possession of the DQB*0605 antigen is
associated with a fast progression of the disease)

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