Immunology: MCQs on Immune Tolerance & Autoimmunity

                  Multiple Choice Questions on  Immune Tolerance & Autoimmunity

1) Which of the following options is the mechanism for induction of immune tolerance?
a) Central Anergy
b) Peripheral Anergy
c) Clonal Anergy
d) All of the above

2) The central tolerance occurs in the thymus and bone marrow. 
Which of the following statements is true regarding central tolerance?
a) The positive selection occurs in the cortex before maturing and entering the circulation.
b) The negative selection occurs in the medulla.
c) The negative selection removes cells that have high affinities for self-antigen
d) All of the above

3) After exiting the thymus, mature T cells are subjected to the secondary selection where most self-reactive T cells are deleted or rendered anergic.
The process is known as............................................?
a) Central Anergy
b) Peripheral Anergy
c) Clonal Anergy
d) All of the above 

4) Certain autoimmune disorders are monogenic-caused by a mutation in a single gene.
The following are the monogenic autoimmune diseases, Except?
a) Autoimmune lymphoproliferative syndrome
b) Autoimmune polyadenopathy
c) Immunodysregulation polyendocrinopathy (X-linked)
d) Systemic Lupus Erythematosus

5) The autoimmune thyroid disorder with the presence of anti-TSH receptor antibodies is suggestive of:
a) Hashimoto thyroiditis
b) Grave's disease
c) Goodpasture syndrome
d) None of the above

6) Which of the following is the multifactorial autoimmune disorder?
a) Multiple Sclerosis
b) Rheumatic fever
c) Autoimmune hepatitis
d) Lymphoproliferative syndrome

7) The antibody generated against the intrinsic factor in the gastric tissue leads to which of the following conditions?
a) Goodpasture syndrome
b) Pernicious anemia
c) Celiac disease
d) None of the above

8) The autoimmune disorder with an elevated anti-thyroglobulin antibody is known as....................................?
a) Hashimoto thyroiditis
b) Grave's disease
c) Goodpasture syndrome
d) None of the above

9) The presence of anti-glutamic acid decarboxylase antibodies increased the susceptibility to which of the following disorders?
a) Type 1 Diabetes mellitus
b) Celiac disease
c) Grave's disease
d) Pernicious anemia 

10) The following antibodies are not associated with Systemic Lupus Erythematosus, EXCEPT?
a) Anti-ANA antibody
b) Anti-cardiolipin antibody
c) Anti-dsDNA
d) None of the above

11) In 'Rheumatic fever ', the cross-reactivity between the bacterial M protein and human lysoganglioside leads to the development of cardiac T cells. 
M protein is a cell wall component of........................................?
a) Staphylococcus aureus
b) Streptococcus pyogenes
c) Hemophilus influenza
d) Neisseria gonorrhea 

12) The generation of reactive cells against HHV-6 encoded U24 cross-reactive with myelin basic protein resulting in autoimmune disease
a) Myasthenia gravis
b) Multiple sclerosis
c) Grave's disease
d) Systemic Lupus Erythematosus

13) 'Myasthenia Gravis' is caused by the production of autoantibodies against the..................................?
a) Myelin basic proteins
b) TSH receptor
c) Acetylcholine receptor
d) None of the above

14) Which of the following MHC allelic forms is protective against ulcerative colitis?
a) HLA class II DR2
b) HLA class II DR4
c) HLA class II DR15
d) HLA class II DR9

15) The B27 HLA allele is associated with which of the following conditions?
a) Ankylosing spondylitis
b) Psoriasis
c) Inflammatory bowel disease
d) All of the above

Multiple Choice Answers with Explanation:
1-d) All of the above
Central Tolerance occurs during T cell development in the thymus, where self-reactive T cells are eliminated to prevent autoimmunity.
Peripheral Tolerance: Tolerance mechanisms that operate outside the thymus, including anergy (inactivation of self-reactive T cells), suppression by regulatory T cells (Tregs), and deletion of self-reactive B cells.
Clonal anergy" refers to a state in which a lymphocyte (such as a T cell or B cell) becomes functionally unresponsive or inactive when exposed to its specific antigen. This state of unresponsiveness occurs when the lymphocyte encounters its antigen without the appropriate co-stimulatory signals, typically required for full activation

2-d) All of the above
Positive selection occurs in the cortex of the thymus. During positive selection, immature T cells are screened for their ability to recognize self-major histocompatibility complex (MHC) molecules. T cells that can weakly bind to self-MHC molecules receive a survival signal and move on to mature and enter the circulation.
Negative selection occurs in the medulla of the thymus. In the medulla, self-reactive T cells are tested for their ability to bind strongly to self-antigens presented by thymic epithelial cells. T cells that react too strongly with self-antigens are eliminated through negative selection to prevent autoimmunity.
Negative selection removes T cells that have high affinities for self-antigens. This process helps ensure that only T cells with a moderate affinity for self-antigens, which are less likely to cause autoimmune reactions, are allowed to mature and circulate in the body.

3-b) Peripheral Anergy
Peripheral Tolerance: Tolerance mechanisms that operate outside the thymus, including anergy (inactivation of self-reactive T cells), suppression by regulatory T cells (Tregs), and deletion of self-reactive B cells.

4-d) Systemic Lupus Erythematosus
Systemic Lupus Erythematosus (SLE), often referred to as lupus, is a complex autoimmune disease with a strong genetic component. While the exact cause of SLE is not fully understood, there are various genetic factors that play a role in its development and susceptibility.

5-b) Grave's disease
An autoimmune thyroid disorder characterized by the presence of anti-thyroid-stimulating hormone (TSH) receptor antibodies is typically referred to as Graves' disease. Graves' disease is the most common cause of hyperthyroidism and is characterized by the overproduction of thyroid hormones (thyroxine or T4 and triiodothyronine or T3) due to the activation of TSH receptors by these autoantibodies.

6-d) Lymphoproliferative syndrome
Lymphoproliferative syndrome (LPS) is a group of rare and diverse disorders characterized by an abnormal proliferation of lymphocytes, a type of white blood cell. This uncontrolled growth of lymphocytes can lead to various clinical manifestations and complications. There are several different forms of lymphoproliferative syndrome, each with its distinct genetic, clinical, and immunological features.

7-b) Pernicious anemia
Antibodies generated against intrinsic factor in gastric tissue can lead to a condition known as pernicious anemia. Intrinsic factor is a protein produced in the stomach that is essential for the absorption of vitamin B12 (cobalamin) in the small intestine. When antibodies target and interfere with intrinsic factor, it can result in pernicious anemia, which is characterized by a deficiency of vitamin B12.

8-a) Hashimoto thyroiditis
Anti-thyroglobulin antibodies are one of the hallmark autoantibodies found in Hashimoto's thyroiditis. Thyroglobulin is a protein produced by the thyroid gland, and these antibodies target it. The presence of anti-thyroglobulin antibodies is a key diagnostic feature of Hashimoto's thyroiditis.

9-a) Type 1 Diabetes mellitus

10-d) None of the above
In Systemic Lupus Erythematosus (SLE), a complex autoimmune disease, various antibodies are associated with the condition. Some of the key antibodies and autoantibodies commonly found in SLE include: Antinuclear Antibodies (ANAs), Anti-double-stranded DNA (anti-dsDNA) Antibodiesnti-Smith (anti-Sm) Antibodies, Anti-Phospholipid Antibodies, Anti-Ro (SSA) and Anti-La (SSB) Antibodies, Antibodies to Ribosomal P Proteins, Complement-Fixing Antibodies

11-b) Streptococcus pyogenes

12-b) Multiple sclerosis
The immune system generates T cells or antibodies against HHV-6-encoded U24 that cross-react with MBP, it can result in an autoimmune attack on the myelin sheath in the nervous system. MBP is a major component of the myelin sheath, which insulates nerve fibers. Autoimmune attacks against myelin can lead to demyelination and are associated with diseases like multiple sclerosis (MS).

13-c) Acetylcholine receptor
Myasthenia Gravis (MG) is an autoimmune disorder primarily caused by the production of autoantibodies against a specific target in the body, which is the acetylcholine receptor (AChR) located on the surface of muscle cells.

14-b) HLA class II DR4

15-d) All of the above


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