Immunotherapeutics
Textbook Exam Questions
Course Introduction
Immunotherapeutics is a course designed to explore the principles and applications of therapies that modulate the immune system to prevent, manage, or treat diseases. Students will gain a comprehensive understanding of immune system mechanisms, including cellular and molecular foundations, and how these can be harnessed using monoclonal antibodies, vaccines, cell-based therapies, and checkpoint inhibitors. The course also covers the latest advancements and challenges in immunotherapy for cancer, infectious diseases, autoimmune disorders, and emerging therapeutic interventions, emphasizing preclinical development, clinical use, and potential side effects. Ethical and regulatory considerations in developing and administering immunotherapeutic agents will also be discussed.
Recommended Textbook
Immunology for Pharmacy 1st Edition by Dennis Flaherty PhD
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26 Chapters
300 Verified Questions
300 Flashcards
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Page 2
Chapter 1: Cells and Organs of the Immune System
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Sample Questions
Q1) What role does the T helper 1 (Th1) subset play in the immune response?
A) Inhibits viral replication
B) Causes target cell death of infected cells
C) Assists B cells in the production of antibody
D) Generates inflammatory responses to pathogens
Answer: D
Q2) Immature thymocytes begin their initial cycle of proliferation in:
A) The thymic cortex
B) Hassall's corpuscles
C) The germinal center
D) The lymph node medulla
Answer: A
Q3) The __________________ serves as a filter to trap infections in the tissues.
A) Spleen
B) Thymus
C) Bone marrow
D) Lymph system
Answer: D
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3
Chapter 2: Innate Immunity
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Q1) Which are the molecules that are common to many pathogens and are recognized by phagocytes and other innate immune cells?
A) PAMPs
B) Complement
C) Toll-like receptors
D) Mannose-binding lectin
Answer: A
Q2) Which of the following are innate immune components that create a hostile environment for bacteria on the skin?
A) Mucus and cilia
B) Bile salts and pH
C) Sweat and sebum
D) Normal flora and pH
Answer: C
Q3) Where are antimicrobial cryptocidins produced?
A) Skin
B) Liver
C) GI tract
D) Neutrophils
Answer: C
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Chapter 3: Immunogenicity and Antigenicity
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Q1) 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
Q2) How would you treat a mother with type A Rh-negative blood who is pregnant with a type O Rh-positive baby?
A) A dose of RhoGAM at 28 weeks and following delivery
B) A high dose of RhoGAM and then a low dose of RhoGAM
C) A dose of RhoGAM only if there is a trauma or premature termination of pregnancy
D) RhoGAM is not necessary in this situation because there is no compatibility issue
Answer: A
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Chapter 4: Antigen Presenting Molecules
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Q1) Human leukocyte antigen (HLA) class I molecules bind antigens:
A) At the ends and the antigens are larger than HLA class II antigens
B) At the ends and the antigens are smaller than HLA class II antigens
C) In the middle and the antigens are larger than HLA class II antigens
D) In the middle and the antigens are smaller than HLA class II antigens
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) CD1 molecules are similar in structure to:
I- HLA class I molecules
III- HLA class II molecules
III- HLA class III molecules
A) I only
B) III only
C) I and II
D) II and III
E) I, II, and III
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Page 6
Chapter 5: Antigen Presenting Cells
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Q1) After a Langerhans cell captures antigen, it travels to the:
A) Spleen
B) Lymph node
C) Bone marrow
D) Surface of the skin
Q2) Which type of dendritic cell activates both NK cells and CD8 T cells (CTLs) in response to a viral infection?
A) Follicular dendritic cells
B) Interstitial dendritic cells
C) Plasmacytoid dendritic cells
D) Interdigitating dendritic cells
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) Which of the complementarity-determining regions (CDRs) on the a/b TCR only have contact with the MHC class II molecule and do not have contact with the antigen?
A) CDR1s
B) CDR2s
C) CDR3s
D) CDR4s
Q2) When individuals have a congenital defect in which they lack the CD40 ligand (CD40L) on activated T cells, the outcome of that defect is:
A) They are not able to make mature T or B cells
B) They are only able to make CD8 cells and no other types of T cells
C) They are only able to make IgM antibody and no other type of antibody
D) They are not able to any antibodies at all even though B and T cells are present
Q3) 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
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Page 8
Chapter 7: Intracellular Signaling and T Cell Activation
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Q1) Which of the following is/are part of the high affinity IL-2 receptor?
I. a-Chains
II. b-Chains
III. g-Chains
A) I only
B) III only
C) I and II
D) II and III
E) I, II, and III
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
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Chapter 8: B Cell Activation and Signaling
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Sample Questions
Q1) Belimumab is a monoclonal antibody directed against:
A) BLyS
B) CD22
C) Bruton's kinase
D) BLyS and APRIL
Q2) X-linked agammaglobulinemia results from a defect in:
A) IL-7 gene
B) BTK gene
C) BLyS gene
D) CD22 gene
Q3) 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
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Chapter 9: Antibodies
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Q1) During the anamnestic response, IgM-producing plasma cells switch to producing which type of antibody?
A) IgA
B) IgD
C) IgE
D) IgG
Q2) An IgG2 subclass response is important for proper immunization with the meningococcal vaccine because:
A) IgG2 responds better to protein antigens
B) IgG2 responds better to carbohydrate antigens
C) Other IgG subclasses do not activate complement as efficiently
D) Other IgG subclasses are not always induced following vaccination
Q3) Antibodies with high affinity will be able to:
A) Tightly bind lower concentrations of antigen and quickly eliminate infection
B) Tightly bind higher concentrations of antigen and quickly eliminate infection
C) Loosely bind to lower concentrations of antigen and slowly eliminate infection
D) Loosely bind to higher concentrations of antigen and slowly eliminate infection
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11
Chapter 10: Antibody Diversity
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Sample Questions
Q1) What is the purpose of the recognition signal sequences (RSSs) in rearrangement of genes?
A) The RSSs are the coding regions of the DNA.
B) The RSSs are the enzymes that facilitate recombination.
C) The RSSs are spacers that align genes on the same side of DNA.
D) The RSSs are the areas that determine the antigen-binding pocket.
Q2) The hypervariable complementarity-determining regions (CDRs) are primarily coded for by which gene region or regions?
I- Joining (J)
II- Variable (V)
III- Diversity (D)
A) I only
B) III only
C) I and II
D) II and III
E) I, II, and III
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Chapter 11: Complement
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Q1) Patients with paroxysmal nocturnal hemoglobinuria lack which complement regulatory components on the host cell surfaces?
A) Factor H and Factor I
B) Decay accelerating factor (DAF) and CD59
C) Membrane cofactor protein (MCP) and C1INH
D) Homologous restriction factor (HRF) and properdin
Q2) Which of the following complement components acts as a chemoattractant?
A) C2a
B) C3a
C) C4b
D) C5b
Q3) Which of the complement pathways requires antibodies for activation?
I. Lectin pathway
II. Alternative pathway
III. Classical pathway
A) I only
B) III only
C) I and II
D) II and III
E) I, II, and III
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Chapter 12: Phagocytosis and Intracellular Killing
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Sample Questions
Q1) Some bacteria can avoid oxygen-dependent phagocytic killing by producing:
A) Catalase
B) Defensins
C) Singlet oxygen
D) Superoxide dismutase
Q2) Which is a key component in oxygen-independent phagocytic killing?
A) Lysozyme
B) Myeloperoxidase
C) Hypochlorous acid
D) Superoxide dismutase
Q3) Why is enzyme replacement therapy with imiglucerase an effective treatment for some forms of Gaucher's disease?
A) Imiglucerase breaks down glucocerebroside.
B) Imiglucerase regenerates deficient myeloperoxidase.
C) Imiglucerase facilitates the production of active cytochromes.
D) Imiglucerase breaks down fungi when the body is not able to.
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14
Chapter 13: Antibodies and in Vivo Therapy
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Sample Questions
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) 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)
Q3) Low platelet count and antibodies to platelets are signs of:
A) Serum sickness
B) Kawasaki disease
C) Erythroblastosis fetalis
D) Idiopathic thrombocytopenic purpura (ITP)
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Chapter 14: Antibodies and in Vitro Research and Diagnostic Assays
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Q1) When treating leukemias and lymphomas, flow cytometry can aid the physician in diagnosis and treatment by:
A) Identifying increases in cell growth rates
B) Identifying changes in signaling pathways
C) Identifying if a drug has entered a cancer cell
D) Identifying surface markers on cancerous cells
Q2) In flow cytometry, side scatter is a measure of:
A) Cell size
B) Protein content
C) Granularity of a cell
D) Expression of CD markers
Q3) In flow cytometry, the side scatter and forward scatter are displayed on a graph with the purpose of:
A) Identifying specific surface markers
B) Separating populations of peripheral blood cells
C) Determining if a specific protein is present inside a cell
D) Determining if a specific signaling pathway has been activated
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Page 16
Chapter 15: Immediate Allergic Reactions
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Q1) What role does histamine play in allergic reactions?
A) Increases vascular permeability
B) Stimulates eosinophil production
C) Stimulates granule release from mast cells
D) Prevents activation of the coagulation cascade
Q2) The radioallergosorbent (RAST) assay is used to test which individuals for allergies?
A) All individuals get a RAST test
B) Individuals younger than the age of 12
C) Individuals who are at risk for anaphylaxis during other types of testing
D) Individuals who have had no response to previous allergy testing but still appear to have allergies
Q3) During an allergic reaction, IgE binds to Fc receptors on what cell types?
A) Mast cells and basophils
B) Monocytes and macrophages
C) Macrophages and neutrophils
D) Cytotoxic T lymphocytes (CTLs) and natural killer (NK) cells
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Chapter 16: Autoimmunity
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Sample Questions
Q1) Epstein-Barr virus is associated with the etiology of which of the following autoimmune diseases?
I. Type 1 diabetes
II. Rheumatoid arthritis
III. Ankylosing spondylitis
A) I only
B) III only
C) I and II
D) II and III
E) I, II, and III
Q2) Most patients with Hashimoto's thyroiditis have antibodies to:
A) T and T
B) Thyroglobulin
C) TSH receptors
D) TRH receptors
Q3) The goiter associated with Graves' disease is caused by:
A) Inhibition of TSH receptors
B) Inhibition of TRH receptors
C) Constant stimulation of TSH receptors
D) Constant stimulation of TRH receptors
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Chapter 17: Transplantation
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Q1) A patient may have pre-existing antibodies to a major or minor HLA antigen caused by:
I- Medication
II- Pregnancy
III- Previous transplant
A) I only
B) III only
C) I and II
D) II and III
E) I, II, and III
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
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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) As antigen is processed prior to loading onto MHC class I molecules, the antigens are degraded into smaller fragments by the:
A) Proteasome
B) Golgi apparatus
C) Phagolysosome
D) Endoplasmic reticulum (ER)
Q3) MHC class I molecules present antigen to:
A) NK cells
B) CD8 T cells
C) CD4 Th1 cells
D) CD4 Th2 cells
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Page 20
Chapter 19: Delayed Type Hypersensitivity Reactions
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Sample Questions
Q1) In which stage of TB infection does lung necrosis caused by macrophage-derived reactive oxygen species (ROS) begin?
A) The first phase
B) The second phase
C) The third phase
D) The final phase
Q2) What is the difference between a reaction to poison ivy and other delayed-type hypersensitivity reactions?
A) The poison ivy reaction is solely a CD8 response.
B) The poison ivy reaction is solely mediated by IgG.
C) The poison ivy reaction is solely an NK cell response.
D) The poison ivy reaction is solely a macrophage response.
Q3) Which of the following is a virulence factor and drug target for Mycobacterium tuberculosis?
A) Capsule
B) NRAMP1
C) Ergosterol
D) Mycolic acid
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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 cells may contain perforin and granzymes?
I. Tumor cells
II. CD4 T cells
III. CD8 T cells
A) I only
B) III only
C) I and II
D) II and III
E) I, II, and III
Q3) 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
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Chapter 21: Natural Killer Cells
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Q1) Which cell type can kill target cells using the perforin and granzymes method?
A) NKT type I cells
B) NKT type II cells
C) NK CD56dim cells
D) NK CD56bright cells
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) How do CD8 regulatory T cells identify CD4 cells that should be killed?
A) FasL is cleaved from CD4 T cell.
B) Qa-1 is present on CD4 T cell surface.
C) The high affinity IL-2 receptor is stimulated.
D) Antigen expression is required on MHC class II molecules.
Q2) 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)
Q3) 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
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Chapter 23: Cytokines and Biological Modifiers
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Q1) What is one role that type I interferons play in the eradication of viral infections?
A) Inhibit viral uncoating
B) Inhibit viral protein synthesis
C) Block viral entry into host cells
D) Block release of viral progeny from host cells
Q2) Oprelvekin increases levels of:
A) Platelets
B) Neutrophils
C) Macrophages
D) Red blood cells
Q3) 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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25
Chapter 24: Vaccines in Theory and Practice
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Q1) Which of the following is an example of a virulence factor?
A) Host cell cilia
B) Viral subunits
C) Bacterial DNA
D) Polysaccharide capsule
Q2) Which of the following is a conjugate vaccine?
A) Sabin polio
B) Hepatitis A
C) Rotavirus vaccine
D) Pneumococcal vaccine
Q3) 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)
Q4) Lipopolysaccharide (LPS) is an example of a(n):
A) Toxoid
B) Exotoxin
C) Endotoxin
D) Enterotoxin
Page 26
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Chapter 25: Vaccine-Preventable Diseases
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Q1) Why will the Zostavax vaccine be phased out over time?
A) Because the virus can mutate and the vaccine will no longer be effective
B) Because with prolonged use of the vaccine, patients will no longer mount a proper immune response to the virus
C) Because older patients are less likely to be able to afford the vaccine, so it is more cost effective to vaccinate children
D) Because all children will have been vaccinated against Varicella zoster so they will not get shingles when they are older
Q2) Which of the following viruses may be retained for years in the nervous system and reactivated later with different disease symptoms?
A) Rubella
B) Varicella
C) Hepatitis A
D) Measles (rubeola)
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Chapter 26: Acquired Immune Deficiency Syndrome
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Q1) The most important enzyme involved in transcription of HIV RNA into DNA is:
A) Integrase
B) RNA polymerase
C) Late phase protease
D) Reverse transcriptase
Q2) During the initial infection with HIV, the virus is concentrated in the:
A) Thymus
B) Bone marrow
C) Lymph nodes
D) Site of exposure
Q3) Proteins from _______________ genes combine with RNase to form the viral reverse transcriptase complex?
A) Tat and rev
B) Pol and vpr
C) Vpu and nef
D) Gag and env
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