Immunology for Pharmacy
Chapter Exam Questions
Course Introduction
This course introduces pharmacy students to the fundamental concepts of immunology, emphasizing the structure and function of the immune system and its relevance to human health and disease. Key topics include innate and adaptive immunity, the molecular and cellular components of immune responses, immunological mechanisms underlying hypersensitivity, autoimmunity, transplantation, and immunodeficiency. The course also explores the pharmacological manipulation of the immune system, including the mechanism of action, therapeutic applications, and side effects of immunomodulatory drugs and vaccines. Special attention is given to the role of immunology in the development of targeted therapies and in the management of infectious diseases, cancers, and allergic disorders, preparing students for informed decision-making in clinical pharmacy practice.
Recommended Textbook
Immunology for Pharmacy 1st Edition by Dennis Flaherty PhD
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26 Chapters
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Page 2
Chapter 1: Cells and Organs of the Immune System
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Q1) Development of which cell type is impaired in DiGeorge syndrome?
I- T cells
II- B cells
III- NK cells
A) I only
B) III only
C) I and II
D) II and III
E) I, II, and III
Answer: A
Q2) The main function of _______________ is to ingest and destroy bacteria.
A) B cells
B) Eosinophils
C) Natural killer (NK) cells
D) Polymorphonuclear leukocytes (PMNs)
Answer: D
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Chapter 2: Innate Immunity
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Q1) Cathelicidins perform which of the following functions?
I. Chemotaxis
II. Neutralization of endotoxins
III. Broad spectrum antimicrobial activity
A) I only
B) III only
C) I and II
D) II and III
E) I, II, and III
Answer: E
Q2) Where are antimicrobial cryptocidins produced?
A) Skin
B) Liver
C) GI tract
D) Neutrophils
Answer: C
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Page 4
Chapter 3: Immunogenicity and Antigenicity
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Q1) When a low molecular weight (<3000 Da) pharmaceutical agent binds to albumin, the pharmaceutical agent is acting as a/an:
A) Hapten
B) Allergen
C) Immunogen
D) Carrier protein
Answer: A
Q2) Isoantigens found on red blood cells (RBCs) may lead to a hemolytic transfusion reaction because:
A) CD4<sup>+</sup> T cells and macrophages mediate an inflammatory response
B) Individuals have antibodies to the ABO antigens they do not express
C) CD8<sup>+</sup> T cells recognize the isoantigens as foreign and destroy the RBC
D) The isoantigens are metabolized to reactive metabolites that cause an allergic reaction
Answer: B
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Chapter 4: Antigen Presenting Molecules
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Q1) Why are HLA heterozygotes more resistant to disease than homozygotes?
A) They have more single nucleotide polymorphisms.
B) They have a more diverse range of minor HLA loci.
C) They have more diversity in the antibodies they produce.
D) They have a more varied repertoire of antigen-presenting HLA molecules.
Q2) HLA class III genes produce:
A) Stress molecules
B) Complement components
C) Antigen presenting molecules
D) Receptors that activate natural killer (NK) cells
Q3) In bare lymphocyte syndrome, individuals lack which surface molecules on their lymphocytes?
A) CD4
B) CD8
C) HLA class I molecules
D) HLA class II molecules
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Chapter 5: Antigen Presenting Cells
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Q1) The _________________ is the vacuole in a B cell where an endocytosed antigen is located.
A) Iccosome
B) Endosome
C) Phagosome
D) Phagolysosome
Q2) Primed dendritic cells are a potential treatment for:
I- HIV
II- Psoriasis
III- Cancer
A) I only
B) III only
C) I and II
D) II and III
E) I, II, and III
Q3) The largest reservoir of interstitial dendritic cells is located in the:
A) Eye
B) Skin
C) Brain
D) Tonsils
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Chapter 6: Surface Interactions Between T Cells and Antigen-Presenting
Cells
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Q1) In the function of the TCR, the purpose of the CD3 complex is to:
A) Bind antigen
B) Transduce signals
C) Anchor the TCR in the membrane
D) Stabilize the interaction between the TCR and the APC
Q2) The interaction between CTLA-4 and B7 leads to:
A) Downregulation of T cell signaling
B) Stabilization of the TCR/APC interaction
C) B cell activation and generation of memory cells
D) Production of proteins that regulate the cellular response to interleukin-2 (IL-2)
Q3) T cells with the g/d TCR are primarily located in the:
A) Bone marrow
B) Lymph nodes
C) Mucosal tissue
D) Peripheral blood
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8
Chapter 7: Intracellular Signaling and T Cell Activation
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Q1) Which of the following is an example of autocrine signaling?
A) An NK cell responding to IL-12 produced by a macrophage.
B) A macrophage responding to TNF made by the same macrophage.
C) A T helper cell responding to IL-2 produced by a neighboring T cell.
D) A neutrophil responding to IL-1 produced by vascular endothelial cell.
Q2) What is the purpose of adaptor proteins in signal transduction?
A) Activate transcription
B) Facilitate dimerization of receptors
C) Anchor the receptor to the membrane
D) Carry the signal from the membrane into the cytoplasm
Q3) The major defect in X-linked severe combined immunodeficiency (SCID) is:
A) Inability to produce IL-2
B) Lack of ZAP-70 protein kinase
C) Inability to produce B or T cells
D) Lack of g-chain in interleukin receptors
Q4) The activation of inositol-1,4,5-triphosphate (IP ) signaling results in:
A) Activation of NF-kB signaling
B) Release of intracellular calcium
C) Phosphorylation of downstream targets
D) Formation of the immunological synapse
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Chapter 8: B Cell Activation and Signaling
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Q1) Most long-lived plasma cells reside in the:
A) Spleen
B) Thymus
C) Lymph node
D) Bone marrow
Q2) Long-lived plasma cells are most likely to be produced in response to:
A) Thymic-dependent antigens
B) Type I thymic-independent antigens
C) Type II thymic-independent antigens
D) Both thymic-dependent and thymic-independent antigens result in production of long-lived plasma cells
Q3) Which two cytokines are the main stimuli for B cell differentiation into plasma cells?
A) TNF and IL-1
B) TACI and BLyS
C) BLyS and APRIL
D) TLR-4 and Lipid A
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Chapter 9: Antibodies
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Q1) Which region of the antibody is important for physical flexibility of the antigen binding region?
A) J chain
B) Hinge region
C) Secretory piece
D) Variable regions
Q2) Which of the following antibody regions is involved in antigen binding?
I. Light chain variable region
II. Heavy chain variable region
III. Heavy chain constant region
A) I only
B) III only
C) I and II
D) II and III
E) I, II, and III
Q3) Fab fragments can be used clinically to treat:
A) Job syndrome
B) Digoxin overdose
C) Multiple myeloma
D) Common variable immunodeficiency (CVID)
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Chapter 10: Antibody Diversity
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Q1) Small nuclear RNA and small nuclear riboprotein are involved in which process?
A) Opening of hairpins
B) Ligation of V and J genes
C) Addition of P- and N-nucleotides
D) Attachment of C genes to V and J genes
Q2) Choose the correct order of the steps of light chain gene recombination.
A) Gene segments loop close together, signal joint removed, hairpins formed and opened, gene segments ligated together
B) Hairpins formed and opened, gene segments loop close together, signal joint removed, gene segments ligated together
C) Signal joint removed, hairpins formed and opened, gene segments loop close together, gene segments ligated together
D) Gene segments loop close together, gene segments ligated together, hairpins formed and opened, signal joint removed
Q3) Somatic mutation theory of antibody diversity states that:
A) A limited number of genes undergo mutations
B) Separate genes exist for each antibody molecule
C) A limited number of genes undergo genetic rearrangements
D) The many genes inherited from both parents undergo a few mutations
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Page 12
Chapter 11: Complement
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Q1) In the alternative pathway, C3b can bind to which of the following?
I. To C3bBb
II. To factor B
III. The microbe cell surface
A) I only
B) III only
C) I and II
D) II and III
E) I, II, and III
Q2) What is the role of C9 in the complement pathways?
A) Creates pore
B) C3 convertase
C) C5 convertase
D) Binds to antibodies on microbe surface
Q3) Which of the following complement components acts as a chemoattractant?
A) C2a
B) C3a
C) C4b
D) C5b
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Page 13
Chapter 12: Phagocytosis and Intracellular Killing
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Q1) Following phagocytic ingestion of a pathogen, which of the following occurs?
A) Pinocytosis
B) Phagosome fusion with granules
C) Binding to antibody by Fc receptor on phagocyte
D) Binding to complement fragments by complement receptors
Q2) Patients with this disease are at greater risk for fungal infections than patients with other phagocytosis-related deficiencies:
A) Gaucher's disease
B) Myeloperoxidase deficiency
C) Chronic granulomatous disease
D) Complement receptor deficiency
Q3) Some bacteria can avoid oxygen-dependent phagocytic killing by producing:
A) Catalase
B) Defensins
C) Singlet oxygen
D) Superoxide dismutase
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14
Chapter 13: Antibodies and in Vivo Therapy
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Q1) A monoclonal antibody used as a drug has a name that ends in what suffix?
A) U
B) Ab
C) Mab
D) Imm
Q2) Chimeric antibodies are a combination of:
A) Murine and yeast genes
B) Human and yeast genes
C) Human and murine genes
D) Murine genes from two different sources
Q3) Radiolabeled antibodies to CD20, including tositumomab labeled with iodine-131, are frequently used to treat which disorder?
A) Multiple myeloma
B) Rheumatoid arthritis
C) Non-Hodgkin's lymphoma
D) Human immunodeficiency virus (HIV)
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Chapter 14: Antibodies and in Vitro Research and Diagnostic Assays
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Q1) A patient with acquired immunodeficiency syndrome (AIDS) is having lab work, and the doctor orders flow cytometry. What is flow cytometry used to detect most often in AIDS patients?
A) B cell levels
B) NK cell levels
C) CD4 T cell levels
D) CD8 T cell levels
Q2) In a direct immunochromatographic assay, in order for the test to be positive, a color change reaction must be evident at:
I- Test zone
II- Control zone
III- Reaction zone
A) I only
B) III only
C) I and II
D) II and III
E) I, II, and III
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Page 16
Chapter 15: Immediate Allergic Reactions
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Q1) The late phase of asthma mainly involves:
A) Vasodilation
B) Inflammation
C) Anticoagulation
D) Bronchoconstriction
Q2) What is the difference between anaphylactic and anaphylactoid reactions?
A) Anaphylaxis causes more serious symptoms.
B) Anaphylactoid reactions do not involve mast cells or basophils.
C) Anaphylactoid reactions cannot be prevented and anaphylactic reactions are preventable.
D) Anaphylaxis is caused by IgE and anaphylactoid reactions are caused by complement.
Q3) Oral allergy syndrome is caused by:
A) Food allergies
B) Overproduction of eosinophils
C) Bacterial infection that stimulates IgE production
D) Cross reaction between shared antigens on food and pollen
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Chapter 16: Autoimmunity
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Q1) The symptoms of myasthenia gravis are caused by:
A) Destruction of type IV collagen
B) Decreased levels of thyroid hormones
C) Destruction of acetylcholine receptors
D) Deposition of immune complexes in tissue
Q2) Which of the following autoimmune disorders involves a complement defect?
A) Rheumatic fever
B) Goodpasture syndrome
C) Autoimmune hemolytic anemia
D) Systemic lupus erythematosus (SLE)
Q3) Which is one way that a microbial infection may act as a trigger for an autoimmune disease?
A) Microbial antigens may closely resemble self-antigens.
B) Microbes may colonize the lymph nodes and overstimulate T and B cells.
C) Microbes may secrete chemicals that resemble cytokines and inappropriately activate an immune response to self-antigens.
D) Microbial antigens may be distributed out into tissues and remain for long periods of time, triggering an extended immune response that also targets the host.
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18
Chapter 17: Transplantation
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Q1) Direct antigen presentation occurring during allogeneic graft rejection occurs when:
A) Donor APCs present antigen to the donor T cells
B) A recipient's T cells recognize donor cells as foreign
C) Donor antibodies bind to recipient cell surface molecules
D) A recipient's T cells recognize foreign antigen processed on the recipient's APCs
Q2) Without genetic modification, what is the main cause of rejection in xenotransplants?
A) Transfer of infection
B) Organs are the wrong size
C) The minor HLA antigens do not match
D) Pre-existing antibodies to alpha-galactosyl
Q3) One of the steps taken to avoid graft-versus-host disease (GVHD) is:
A) Immunostimulation
B) Matching minor histocompatibility
C) Removing all T cells from the graft
D) Removing all B cells from the graft
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Chapter 18: Antigen Presentation for Cell-Mediated Response
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Q1) Which of the following is most likely to generate a CD8 T cell response?
A) Tapeworm infection
B) Influenza virus infection
C) Fungal infection causing athlete's foot
D) Group A Streptococcus infection (Strep throat)
Q2) MHC class I molecules present antigen to:
A) NK cells
B) CD8 T cells
C) CD4 Th1 cells
D) CD4 Th2 cells
Q3) Which of the following is an example of an immune response following cross-priming?
I. An NK cell killing a tumor cell.
II. A CD8 cell killing a tumor cell.
III. A macrophage ingesting a tumor cell.
A) I only
B) III only
C) I and II
D) II and III
E) I, II, and III
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Chapter 19: Delayed Type Hypersensitivity Reactions
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Q1) Why is a positive PPD skin test not sufficient to determine if a patient has active TB?
A) The skin test does not test for all strains.
B) There are many false positive test results.
C) Only the latent form gives a positive skin test.
D) The positive skin test only indicates previous exposure.
Q2) Defects in NRAMPs cause:
A) Phagosome dysfunction
B) Disruption of protein synthesis
C) Inability to package and release antibodies
D) Defective interactions between CD4 T cells and antigen-presenting cells (APCs)
Q3) Patients with celiac sprue need to avoid what agent?
A) Latex
B) Nickel
C) Gluten
D) Sumac
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Chapter 20: Cytotoxic T Cells
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Q1) Which of the following is a method that tumors use to evade the immune response?
A) Producing IL-2 analogs
B) Reducing TAP function
C) Upregulating MHC class I molecules
D) Engaging Fas receptors on T cells to cause T cell death
Q2) Which of the following is a method that viruses use to evade the immune system?
A) Mutation of hemagglutinin
B) Upregulation of TAP molecules
C) Prevention of MHC class II expression
D) Increased production of transforming growth factor-b (TGF-b)
Q3) What role does perforin perform in the death of target cells?
A) Perforin activates caspases.
B) Perforin creates a pore in the host cell.
C) Perforin disrupts mitochondrial function.
D) Perforin cleaves and activates granzymes.
Q4) Patients have a high risk of losing all of their teeth due which disease?
A) Melanoma
B) Papillion-Lefèvre syndrome
C) Autoimmune lymphoproliferative syndrome type 2
D) Familial erythrophagocytic lymphohistiocytosis type 2
Page 22
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Chapter 21: Natural Killer Cells
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Q1) NK cells have cell surface receptors that contain immunoreceptor tyrosine-based inhibitory motifs (ITIMs), which bind ligand and recruit which type of molecule to transmit the inhibitory signal?
A) cAMP
B) Kinase
C) ATPase
D) Phosphatase
Q2) If a host cell expresses both MHC class I molecules and ligands that bind activating receptors on NK cells, what is the outcome for the host cell?
A) The host cell will not be killed because the NK cell needs two different activating signals to kill a host cell.
B) The host cell will not be killed because the MHC class I molecules cause inhibition that overrides the activating signals.
C) The host cell will be killed because the NK cell does not bind MHC class I molecules and the activating signal causes cell death.
D) The host cell will be killed because the activating signal overrides the inhibitory signal caused by the MHC class I molecule binding.
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Chapter 22: Factors That Influence the Immune Response
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Q1) What is the immune response to high doses of antigen?
A) T cells are inactivated.
B) B cells are inactivated.
C) NK cells are inactivated.
D) Macrophages are inactivated.
Q2) Which methods of antigen administration elicit a vigorous immune response?
I. Intravenous
II. Intramuscular
III. Subcutaneous
A) I only
B) III only
C) I and II
D) II and III
E) I, II, and III
Q3) Defects in Fas:FasL engagement and signaling may contribute to which disease?
A) Graves' disease
B) Rheumatoid arthritis
C) Type II diabetes mellitus
D) Systemic lupus erythematosus (SLE)
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Page 24
Chapter 23: Cytokines and Biological Modifiers
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Q1) What is the mechanism of action of the sipuleucel-T prostate cancer vaccine?
A) Dendritic cells are incubated with a fusion protein containing prostate specific antigen (PSA) and GM-CSF.
B) A plasmid that codes for an antibody that expresses prostate specific antigen (PSA), and dendritic cells present PSA to T cells.
C) A single B cell clone that is tumor specific is grown in the lab and infused into the patient to produce large amounts of tumor specific antibody.
D) Patient tumor cells are exposed to a viral vector containing a gene for prostate specific antigen (PSA), and then the tumor cells are infused into the patient to stimulate an immune response.
Q2) A defect in production of cryopyrin leads to:
A) Increased synthesis of IL-2
B) Increased synthesis of TNF
C) Increased synthesis of IL-1b
D) Increased synthesis of IL-1a
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Chapter 24: Vaccines in Theory and Practice
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Q1) Which type of vaccine may revert to a virulent form of the organism?
A) Cholera vaccine
B) Pertussis vaccine
C) Salk polio vaccine
D) Influenza vaccine (subcutaneous version)
Q2) Which of the following is an advantage of live, attenuated vaccination over other types of vaccination?
A) Inexpensive to make
B) One dose produces immunity
C) Always stimulate mucosal and systemic immunity
D) Pose no health risks to immunosuppressed individuals
Q3) What is the purpose of adding an adjuvant to a vaccine?
A) To reduce side effects
B) To enhance the immune response
C) To lower risk of allergic reactions
D) To prevent microbial contamination
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Chapter 25: Vaccine-Preventable Diseases
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Q1) In a vaccine such as Menactra, what is the main purpose of linking the capsular polysaccharides of Neisseria meningitis to the diphtheria toxin?
A) To stimulate a T cell-dependent immune response
B) To eliminate infections that commonly occur together
C) To add another vaccine to reduce the number of injections a patient receives
D) To prevent destruction of the polysaccharide antigens before an immune response can be mounted
Q2) Why was the first rotavirus vaccine in the United States removed from the market?
A) It caused jaundice.
B) It caused allergic reactions.
C) It caused bowel obstructions.
D) It caused cardiac arrhythmias.
Q3) Which of the following are live, attenuated vaccines?
A) Rubella and hepatitis B
B) Rotavirus and papilloma virus
C) Mumps and measles (rubeola)
D) Influenza (intramuscular [IM] form) and hepatitis A
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Chapter 26: Acquired Immune Deficiency Syndrome
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Q1) After the human immunodeficiency virus (HIV) binds to CD4 on a T cell, what other molecule does it need to bind for entry into the host cell?
A) H-1
B) H-2
C) CCR5
D) CXCR4
Q2) Which of the following agents is/are entry/fusion inhibitor(s) administered to treat HIV infection?
I. Maraviroc
II. Enfuvirtide
III. Zidovudine
A) I only
B) III only
C) I and II
D) II and III
E) I, II, and III
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