Pharmaceutical Immunology
Mock Exam
Course Introduction
Pharmaceutical Immunology explores the principles of the immune system as they relate to pharmacological agents and therapeutics. The course covers fundamental immunological concepts, including the structure and function of immune cells and organs, antigen-antibody interactions, and immune response mechanisms. Emphasis is placed on the role of immunological processes in the development of drugs and vaccines, mechanisms of immunomodulation, and immunopharmacology. Students will examine disorders of the immune system, immunotherapy strategies, and the assessment of drug-induced immune reactions, preparing them to understand and apply immunological knowledge in pharmaceutical research and clinical practice.
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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Chapter 1: Cells and Organs of the Immune System
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Sample Questions
Q1) Which of the following cells is important for killing virus-infected cells?
A) NK cells
B) Basophils
C) Monocytes
D) Plasma cells
Answer: A
Q2) Phagocytosis is the main function of which of the following cell types?
A) NK cells
B) Basophils
C) Eosinophils
D) Macrophages
Answer: D
Q3) 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
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3
Chapter 2: Innate Immunity
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Sample Questions
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) Binding of a pathogen to Toll-like receptors (TLRs) on phagocytes causes the release of cytokines that activate which type of adaptive immune cell?
A) Mast cell
B) Neutrophil
C) Macrophage
D) Cytotoxic T cell
Answer: D
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4
Chapter 3: Immunogenicity and Antigenicity
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Sample Questions
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) Which of the following drugs can react with red blood cells (RBCs) to cause hemolysis?
A) Penicillin
B) Tetracycline
C) Tolbutamide
D) Procainamide
Answer: D
Q3) Which of the following would be considered the best immunogen?
A) Mannose
B) Viral DNA
C) Surface protein on a parasite
D) Lipid components of fungal membrane
Answer: C
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Chapter 4: Antigen Presenting Molecules
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Q1) A set of HLA antigens on the same chromosome is called a:
A) Gene
B) Hapten
C) Haplotype
D) Single nucleotide polymorphism (SNP)
Q2) 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
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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Sample Questions
Q1) The purpose of the invariant chain is to:
A) Aid in receptor-mediated endocytosis in B cells
B) Guide MHC class II molecules to the endosome
C) Release antigen to stimulate memory cell formation
D) Aid in movement of the early endosome to a late endosome
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) According to the clonal selection theory, the activated T cell clone produces:
A) Only memory cells
B) Daughter cells that all have the same TCR
C) Daughter cells with different TCRs on the same cell
D) Multiple types of clones that each have different TCRs
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8
Chapter 7: Intracellular Signaling and T Cell Activation
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Q1) 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
Q2) 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
Q3) The Rac/JNK pathway activates which signaling component?
A) Fos
B) Jun
C) AP-1
D) NF-kB
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Page 9
Chapter 8: B Cell Activation and Signaling
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Sample Questions
Q1) The phosphorylated immuno-receptor tyrosine-based activation motifs (ITAMs) of the BCR serve as a docking site for what adaptor protein?
A) Syk
B) NFAT
C) ZAP-70
D) Src kinase
Q2) What is the function of the BCR co-receptor complex?
A) Stimulate isotype switching
B) Binding to antigen presenting cells (APCs)
C) Crosslinking of BCRs for signal amplification
D) Recruitment of adaptor proteins to carry signal to nucleus
Q3) Which of the following is an example of a type I thymus-independent antigen?
A) Bacterial enzyme
B) Viral protein coat
C) Lipopolysaccharide (LPS)
D) Pneumococcal capsular polysaccharide
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Chapter 9: Antibodies
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Sample Questions
Q1) The monomeric form of this antibody inserted into the B cell membrane serves as the B cell receptor (BCR):
A) IgA
B) IgE
C) IgG
D) IgM
Q2) Fab fragments can be used clinically to treat:
A) Job syndrome
B) Digoxin overdose
C) Multiple myeloma
D) Common variable immunodeficiency (CVID)
Q3) A patient has bone pain, high calcium levels, high immunoglobulin levels, and Bence Jones proteins in their urine. The most likely diagnosis for this patient is:
A) Job syndrome
B) Multiple myeloma
C) Waldenstrom's macroglobulinemia
D) Common variable immunodeficiency (CVID)
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11
Chapter 10: Antibody Diversity
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Q1) 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
Q2) 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
Q3) The addition of N-nucleotides has which effect on antibody structure?
A) Determines if the light chain is a l-chain or k-chain
B) Allows for removal of amino acids in the open hairpins
C) Adds the C4 region to the heavy chain of some antibodies
D) Changes the amino acid sequence in the hypervariable CDR3
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Chapter 11: Complement
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Q1) The role that C3d plays in the immune response to pathogens is:
A) Activation of B cells
B) Activation of CD4 and CD8 T cells
C) Activation of the alternative pathway
D) Activation of inhibitory factors of the complement pathways
Q2) The role that C3bBb3b plays in the complement pathway is to:
A) Cleave C2 to C2a and C2b
B) Cleave C3 to C3a and C3b
C) Cleave C4 to C4a and C4b
D) Cleave C5 to C5a and 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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Page 13
Chapter 12: Phagocytosis and Intracellular Killing
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Sample Questions
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) Some bacteria can avoid oxygen-dependent phagocytic killing by producing:
A) Catalase
B) Defensins
C) Singlet oxygen
D) Superoxide dismutase
Q3) 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
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14
Chapter 13: Antibodies and in Vivo Therapy
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Sample Questions
Q1) Hybridomas are fusion cells composed of:
A) B cells and T cells
B) Two different myeloma cells
C) Splenic B cells and myeloma cells
D) Lymph node B cells and splenic B cells
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) Bispecific antibodies can react with:
A) Two different antigens
B) Two of the same antigen
C) Antigen and T cell or NK cell
D) Four different antigens on the same cell
Q4) 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) 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
Q2) Which test is used to confirm a diagnosis of HIV-positive after initial testing?
A) Flow cytometry
B) Western blotting
C) Immunochromatographic assay
D) Enzyme-linked immunosorbent assay
Q3) 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
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Page 16
Chapter 15: Immediate Allergic Reactions
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Sample Questions
Q1) The late phase of asthma mainly involves:
A) Vasodilation
B) Inflammation
C) Anticoagulation
D) Bronchoconstriction
Q2) 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
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
Q4) Hyposensitization therapy results in the production of:
A) IgA
B) IgE
C) IgG
D) IgM
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Chapter 16: Autoimmunity
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Sample Questions
Q1) 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
Q2) Reactive arthritis is triggered by:
A) Food
B) Medications
C) Infectious disease
D) Rheumatoid factor
Q3) Type 1 diabetes involves destruction of pancreatic:
I- b Cells
II- d Cells
III- a Cells
A) I only
B) III only
C) I and II
D) II and III
E) I, II, and III
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Page 18
Chapter 17: Transplantation
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Sample Questions
Q1) 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
Q2) 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
Q3) The main immune response in a case of acute rejection of a transplanted organ is:
A) B cell activation
B) Both B and T cell activation
C) Allospecific T cell activation
D) Attack of organ by pre-existing antibodies
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Chapter 18: Antigen Presentation for Cell-Mediated Response
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Q1) What is the purpose of b -microglobulin associated with MHC class I molecules?
A) Stabilization
B) Interacts with T cell
C) Anchors to membrane
D) Scaffolding molecule between TAP and MHC class I molecule
Q2) 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
Q3) 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
Page 20
D) Group A Streptococcus infection (Strep throat)
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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) What role does lipoarabinomannan play in the immune response triggered by tuberculosis (TB) infection?
A) Stimulates production of IL-10
B) Stimulates production of TNF-a
C) Stimulates production of interferon-g
D) Stimulates production of reactive oxygen species (ROS)
Q3) 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
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Chapter 20: Cytotoxic T Cells
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Q1) 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)
Q2) Which molecules are required to stabilize the interaction between CD8 T cells and antigen presenting cells (APCs) that leads to activation of the CTLs?
A) Fas and FasL
B) CD28 and B7-1
C) TNF and TNF receptor 1 (TNFRI)
D) CD2 and lymphocyte function-associated antigen-1 (LFA-1)
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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Sample Questions
Q1) NK cells produce which cytokine that activates macrophages?
A) IL-1
B) IL-13
C) TNF-a
D) Interferon-g
Q2) A host cell that has been infected with the influenza virus and has subsequently downregulated MHC class I molecules is most likely to be recognized by which cell type?
A) T cell
B) B cell
C) NK cell
D) Neutrophil
Q3) Individuals with Chediak-Higashi syndrome have a genetic defect that causes:
A) The increased production of IL-13
B) Increased numbers of NKT type I cells
C) The inability to kill through the perforin and granzymes pathway
D) The inability to produce activating and inhibiting receptors in the NK cell surface
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Chapter 22: Factors That Influence the Immune Response
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Q1) What is the difference between an idiotype and an idiotope?
A) Idiotopes are on the antibody and idiotypes are on the antigen.
B) Idiotopes can only react with T cells and idiotypes can only react with B cells.
C) Idiotopes are an amino acid sequence, and idiotypes are groups of idiotopes.
D) Idiotopes and idiotypes have the same sequence but in different locations on the antibody.
Q2) Immune responses to idiotypes located outside the complementarity-determining regions (CDRs) result in:
A) Increases in autoantibody production
B) Downregulation of autoreactive B cells
C) Increases in activated regulatory T cells
D) Downregulation of MHC class II molecules on APCs
Q3) What is the outcome of matrilysin cleaving FasL from an activated T cell?
A) Soluble FasL is degraded and the activated T cell survives.
B) Soluble FasL binds to Fas and triggers the death of the activated T cell.
C) Soluble FasL binds to Fas and triggers the death of the regulatory T cell.
D) Soluble FasL is disseminated and causes widespread cell death in both immune cells and infected host cells.
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24
Chapter 23: Cytokines and Biological Modifiers
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Q1) 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
Q2) Recombinant IL-2 administration is appropriate for the treatment of:
A) HIV
B) Cancer
C) Arthritis
D) Transplant patients
Q3) Which is one disadvantage to cell-based anticancer vaccines?
A) Vaccines often must be patient-specific.
B) Vaccines may react with other host cells.
C) Vaccines with live cells do not have long-lasting effects.
D) Vaccines are less effective because they use allogeneic cells.
Q4) Which of the following is a marker for melanoma?
A) AFP
B) CEA
C) MART-1
D) Sialyl Tn antigen
25
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Chapter 24: Vaccines in Theory and Practice
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Q1) Which of the following is a conjugate vaccine?
A) Sabin polio
B) Hepatitis A
C) Rotavirus vaccine
D) Pneumococcal vaccine
Q2) Which of the following is an example of a virulence factor?
A) Host cell cilia
B) Viral subunits
C) Bacterial DNA
D) Polysaccharide capsule
Q3) Why are toxoid vaccines an effective means for reducing bacterial illness?
A) The toxin causes the damage, not the bacteria.
B) Bacteria have to die before the toxins can cause damage.
C) The toxins stimulate the immune system better than bacteria.
D) Bacteria have the toxins on their surface, so an immune response to the toxins will neutralize both.
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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) Corynebacterium diphtheriae colonizes:
A) Heart and liver
B) Muscle and liver
C) Tonsils and pharynx
D) Kidneys and adrenal glands
Q3) What is the main symptom of rotavirus infection?
A) Cough
B) Diarrhea
C) Cold sore
D) Swollen salivary glands
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Chapter 26: Acquired Immune Deficiency Syndrome
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Q1) What protein protects viral RNA from degradation by host cell cytoplasmic enzymes?
A) gp120
B) RNase
C) Vif protein
D) Rev protein
Q2) What is the mechanism of HIV-induced death of follicular dendritic cells (FDCs)?
A) TNF released by CD8 cells
B) Lysis following virus production
C) Fas expression upregulated on FDCs
D) Perforin/granzyme-induced apoptosis
Q3) 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
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