Pharmacy Therapeutics
Midterm Exam
Course Introduction
Pharmacy Therapeutics is an essential course that focuses on the principles and application of pharmacological treatments for various diseases and health conditions. Students learn to evaluate drug therapies, understand mechanisms of action, side effects, drug interactions, and clinical guidelines for the effective management of patient health. The course emphasizes evidence-based decision-making, patient-centered care, and the ethical responsibilities of pharmacists in optimizing therapeutic outcomes and ensuring safe medication practices across diverse populations.
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) The __________________ serves as a filter to trap infections in the tissues.
A) Spleen
B) Thymus
C) Bone marrow
D) Lymph system
Answer: D
Q2) All T cells express which of the following CD markers?
A) CD3
B) CD4
C) CD8
D) CD16
Answer: A
Q3) Which cell type contains granules that are specific for killing parasites?
A) PMNs
B) Eosinophils
C) Macrophages
D) Large granular lymphocytes
Answer: B
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Chapter 2: Innate Immunity
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Sample Questions
Q1) Where are antimicrobial cryptocidins produced?
A) Skin
B) Liver
C) GI tract
D) Neutrophils
Answer: C
Q2) Activation of a phagocyte by Toll-like receptors (TLRs) bound to a pathogen triggers what innate immune response?
A) Phagocytosis
B) Complement activation
C) Cathelicidin production
D) Decrease in body temperature
Answer: A
Q3) 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
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Chapter 3: Immunogenicity and Antigenicity
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Sample Questions
Q1) Genetic factors that influence immunogenicity include:
I- Decreased functional capacity of the immune system over time
II- Lack of a T cell clone with a TCR that reacts to the antigen
III- Defect in antigen processing and antigen presentation
A) I only
B) III only
C) I and II
D) II and III
E) I, II, and III
Answer: D
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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Sample Questions
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) Which of the following molecules are capable of presenting antigen?
I. CD1 molecules
II. HLA class I molecules
III. HLA class II molecules
A) I only
B) III only
C) I and II
D) II and III
E) I, II, and III
Q3) Allelic polymorphism assures that some members of a species will survive a microbial infection because the different alleles:
A) Better distinguish between foreign and self
B) Provide receptors with greater affinity for antigen
C) Allow the immune system to respond to a wide range of antigens
D) Produce a greater variety of cytokines to assist in the immune response
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Chapter 5: Antigen Presenting Cells
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Q1) Which type of dendritic cell does not present antigen, but instead aids B cell maturation into plasma cells?
A) Langerhans cells
B) Follicular dendritic cells
C) Interstitial dendritic cells
D) Plasmacytoid dendritic cells
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) Dendritic cells are important parts of the immune response because they are:
A) Able to produce antibody
B) Circulating in the blood waiting for antigen
C) Able to kill tumor cells and virally-infected cells
D) Located in areas that are likely sites of pathogen entry
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Chapter 6: Surface Interactions Between T Cells and
Antigen-Presenting Cells
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Sample Questions
Q1) How are superantigens able to uniquely activate large amounts of T cells?
A) Superantigens secrete many toxins that are able to activate many different T cells.
B) Superantigens are able to travel to the lymph node to interact directly with more T cells.
C) Superantigens bind to the TCR and MHC class II molecule outside the binding groove.
D) Superantigens bind to the TCR in the binding groove like other antigens but they have more epitopes than other antigens.
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
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Chapter 7: Intracellular Signaling and T Cell Activation
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Q1) The Rac/JNK pathway activates which signaling component?
A) Fos
B) Jun
C) AP-1
D) NF-kB
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) Cyclosporine A binding to cyclophilin blocks T cell activation by:
A) Inhibiting calcineurin and NFAT
B) Inhibiting RAP by binding to FKBP-12
C) Inhibiting IL-2 binding to the IL-2 receptor
D) Inhibiting calcineurin and protein kinase C (PKC)
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Page 9
Chapter 8: B Cell Activation and Signaling
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Sample Questions
Q1) 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
Q2) 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
Q3) Most long-lived plasma cells reside in the:
A) Spleen
B) Thymus
C) Lymph node
D) Bone marrow
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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) 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 numerous skin lesions, including boils and abscesses, and has Staphylococcus aureus-induced lung disease. The patient also has coarse facial features and skeletal abnormalities. The patient exhibits high levels of IgE in the serum. The patient is most likely suffering from:
A) Job syndrome
B) Multiple myeloma
C) Waldenstrom's macroglobulinemia
D) Common variable immunodeficiency (CVID)
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Page 11
Chapter 10: Antibody Diversity
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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) Which of the following represents possible antibody conformations?
I. One l light chain, one k light chain, two g heavy chains
II. Two l light chains, one g heavy chain, one m heavy chain
III. Two k light chains, two m heavy chains
A) I only
B) III only
C) I and II
D) II and III
E) I, II, and III
Q3) 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
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Chapter 11: Complement
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Q1) 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
Q2) Which of the following complement components acts as a chemoattractant?
A) C2a
B) C3a
C) C4b
D) C5b
Q3) 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
Q4) Which of the following components can act as an opsonin?
A) C1q
B) C3b
C) C4a
D) C5b
Page 13
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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) 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
Q3) What is the purpose of complement receptor binding to complement fragments during phagocytosis?
A) Reduces production of ATP
B) Causes production of catalase
C) Triggers production of superoxide
D) Facilitates internalization of pathogen
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Chapter 13: Antibodies and in Vivo Therapy
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Sample Questions
Q1) 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
Q2) A monoclonal antibody used as a drug has a name that ends in what suffix?
A) U
B) Ab
C) Mab
D) Imm
Q3) A serious potential side effect of using antiserum therapy is the development of immune complexes that can lead to serious damage in the:
A) Brain
B) Lungs
C) Muscles
D) Kidneys
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15
Chapter 14: Antibodies and in Vitro Research and Diagnostic Assays
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Sample Questions
Q1) 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
Q2) In an ELISA, the intensity of the color is directly proportional to:
A) The antigen concentration
B) The degree of drug response
C) The amount of antibody added
D) Nothing; the assay is not quantitative
Q3) Western blots are used to identify:
A) Different cell populations
B) Proteins in a complex mixture
C) Pregnancy hormone found in urine
D) Granularity and size of a population of cells
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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) Hyposensitization therapy results in the production of:
A) IgA
B) IgE
C) IgG
D) IgM
Q3) Which of the following is/are responsible for class switching to IgE production in allergic reactions?
I. IL-5
II. IL-4
III. IL-13
A) I only
B) III only
C) I and II
D) II and III
E) I, II, and III
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Chapter 16: Autoimmunity
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Sample Questions
Q1) Which of the following is a symptom of Graves' disease?
A) Bulging eyes
B) Double vision
C) Blurred vision
D) Drooping eyelids
Q2) Most patients with Hashimoto's thyroiditis have antibodies to:
A) T and T
B) Thyroglobulin
C) TSH receptors
D) TRH receptors
Q3) Cytomegalovirus (CMV), as well as other infections, may contribute to the development of which autoimmune disorder?
A) Diabetes
B) Myasthenia gravis
C) Pernicious anemia
D) Systemic lupus erythematosus (SLE)
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Chapter 17: Transplantation
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Sample Questions
Q1) How is the T cell response during transplant rejection different from the response during an infection?
A) Few T cells are responding during rejection
B) No T cells respond during rejection, only B cells
C) The number of T cells responding is much higher during rejection
D) The same amount of cells respond, but the response is stronger during rejection
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) Which immunosuppressive agent causes redistribution of CD4 T cells from the peripheral blood to the spleen and bone marrow?
A) Corticosteroids
B) Monomurab-CD3
C) Calcineurin inhibitors
D) Antiproliferative agents
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Chapter 18: Antigen Presentation for Cell-Mediated Response
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Q1) MHC class I molecules present antigen to:
A) NK cells
B) CD8 T cells
C) CD4 Th1 cells
D) CD4 Th2 cells
Q2) 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
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) 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)
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) What is the difference between granulomas found in coccidioidomycosis and TB?
A) There are no T cells present in coccidioidomycosis granulomas.
B) There are B cells present only in coccidioidomycosis granulomas.
C) There are no fibroblasts present in coccidioidomycosis granulomas.
D) There are lymphocytes present only in coccidioidomycosis granulomas.
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Chapter 20: Cytotoxic T Cells
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Q1) 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.
Q2) The main immunological defect in familial erythrophagocytic lymphohistiocytosis type 2 is:
A) Inability to synthesize perforin
B) Production of nonfunctional granzymes
C) Inability to secrete perforin and granzymes
D) Production of reduced amounts of cathepsin C
Q3) 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
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Chapter 21: Natural Killer Cells
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Q1) 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
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) NK cells produce which cytokine that activates macrophages?
A) IL-1
B) IL-13
C) TNF-a
D) Interferon-g
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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) 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.
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) Which of the following is an outcome of IL-1 release from activated immune cells?
A) Cleavage of viral RNA
B) Prevention of microbial growth
C) Increased production of antibodies
D) Downregulation of adhesion molecules
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
Q3) Recombinant IL-2 administration is appropriate for the treatment of:
A) HIV
B) Cancer
C) Arthritis
D) Transplant patients
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25
Chapter 24: Vaccines in Theory and Practice
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Q1) 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
Q2) 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.
Q3) Which of the following is a conjugate vaccine?
A) Sabin polio
B) Hepatitis A
C) Rotavirus vaccine
D) Pneumococcal vaccine
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Chapter 25: Vaccine-Preventable Diseases
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Q1) Immunization against ____________ is protective against otitis media.
A) Pertussis
B) Neisseria spp.
C) Pneumococcus
D) Haemophilus influenza type b
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) Measles and German measles are clinically similar because:
A) Both cause arthritis.
B) The spots of the rash are similar in size.
C) They are caused by different strains of the virus.
D) The rashes start at the head and neck and spread down the body.
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Chapter 26: Acquired Immune Deficiency Syndrome
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Q1) 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
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) 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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